CAC 44113 COUNTY BOROUGH OF EAST HAM. Annual Report of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1934. MALCOLM E. BARKER, M.R.C.S., L.R.C.P.. D.P.H. recorders, ilford. COUNTY BOROUGH OF EAST HAM. Annual Report of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1934. MALCOLM E. BARKER. M.R.C.S., L.R.C.P., D.P.H. recorders, ilford. PRINCIPAL CONTENTS. Sections :— page Constitution of Committees 3 Public Health Staff 5 Introduction 7 Statistical and Social Conditions of the Area 11 General Provision of Health Services 20 General and Special Hospitals and Children's Homes 34 Mental Deficiency 46 Welfare of the Blind 51 Invalid Children's Aid Association 56 Infectious Diseases 57 Tuberculosis 77 Maternity and Child Welfare 107 Unemployment and Out-Door Assistance 126 Meteorological Record 130 Sanitary Section and Housing 132 School Medical Service :— Introduction 153 Report 155 Index 213 3 EAST HAM CORPORATION. PUBLIC HEALTH COMMITTEE. Also Committee under Blind Persons Act, 1920, Sec. 2. *The Mayor (Alderman W. W. Bagot, J.P.). The Deputy-Mayor (Councillor R. J. Fell). *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 C. W. Brading, J.P. *Alderman J. Brooks, J.P. *Alderman T. W. Burden. *Alderman G. H. Manser, J.P. *Alderman Mrs. A. Taylor. *Councillor J. W. Barton. Councillor G. W. Boultwood, J.P. Councillor W. T. Bush. *Councillor H. B. Harper, J.P. Councillor G. H. Moncar. Councillor J.J. Pope. Councillor A. Simons. *Councillor Mrs. B. Wilkens. *Also Member of the Institutions and General Sub-Committee. MATERNITY AND CHILD WELFARE SUBCOMMITTEE. Maternity and Child Welfare Act, 1918, Sec. 2. Same members as Public Health Committee, with— The Mayoress (Mrs. M. W. Bagot) (co-opted). Miss E. R. Davies (co-opted). Mrs. K. Moger (co-opted). 4 COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. Mental Deficiency Act, 1913, Sec. 28. The Mayor (Alderman W. W. Bagot, J.P.). The Deputy-Mayor (Councillor R. J. Fell). Councillor 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 F. Welch. Mrs. C. J. Cross (co-opted). Mrs. A. M. Gray (co-opted). Mrs. L. J. Nichols (co-opted). EAST HAM EDUCATION COMMITTEE. Councillor E. H. Thompson (Chairman). Councillor T. I. Lethaby, J.P. (Vice-Chairman). The Deputy-Mayor (Councillor R. J. Fell). Alderman Mrs. A. Taylor. Councillor Mrs. B. Wilkens. Alderman C. W. Brading, J.P. Alderman T. W. Burden. Alderman g. H. Manser, J.P. Alderman E. F. Markey. Alderman W. T. Newling, J.P. Councillor J. W. Barton. Councillor W. T. Bush. Councillor F. H. Edwards. Councillor S. A. Elson. Councillor E. B. Hall, J.P. Councillor H. B. Harper, J.P. Councillor E. C. Howlett. Councillor H. P. Jackson. Councillor R. W. Moger, J.P. Councillor A. H. W. Owen. Councillor J.J. Pope, J.P. Councillor H. Restarick. Councillor A. Simons. Councillor E. R. Thomas. Councillor W. Thompson. Councillor T. W. Williams. Mrs. W. M. Knight. Mrs. L. A. Lethaby. Mr. A. E. Francis. Mr. E. J. Sullivan. "Alderman J. Brooks, J.P. •Co-opted Member of Libraries Sub-Committee. 5 PUBLIC HEALTH OFFICERS OF THE AUTHORITY. A. Medical—whole-time. Malcolm E. Barker, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health ; General Medical Superintendent; School Medical Officer. F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S., Deputy and Senior Assistant Medical Officer of Health. G. W. Cheater, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H., Tuberculosis Officer and Resident Medical Superintendent, Harts Sanatorium. Mary M. Thomson, L.R.C.P., L.R.C.S., D.P.H., Assistant Medical Officer. Jessie A. MacLaren, M.B., Ch.B., D.P.H., Assistant Medical Officer. J. Crawford, M.B., Ch.B., D.P.H., Assistant Medical Officer. †1 J. Landon, M.R.C.S., L.R.C.P., Assistant Medical Officer ; Resident Medical Superintendent, Borough Infectious Diseases Hospital. Medical—part-time. Philip Ellman, M.R.C.P., M.R.C.S., M.D. (Laus.), Tuberculosis Officer. S. C. Reeve-Flaxman, M.R.C.S., L.R.C.P., Ophthalmic Surgeon. R. Savege, M.B., Ch.B., F.R.C.S. (Edin.), D.L.O., Aural Surgeon. R. V. Brews, L.R.C.P., L.R.C.S., L.M., District Medical Officer. J. S. Greig, M.B., C.M., Medical Officer, Aldersbrook Homes. †2 M. E. O'Moore, M.B., B.Ch., B.A.O., Public Vaccinator. B. Dental Surgeons :— A. E. Hall, L.D.S. (Liverpool). C. S. Neame, L.D.S., R.C.S. C. Sanitary and Food Inspectors :— G. D. Lill, M.S.I.A., Senior Sanitary Inspector ; Food and Shops Act Inspector ; Inspector Contagious Diseases (Animals) Act. R. A. Baskett, M.S.I.A., M. J. J. Hillyard, M.S.I.A., W. H. Thurston, R.P., A.R.S.I., M.S.I.A., W. S. C. Tooby, A.R.S.I., M.S.I.A., W. J. Worley, A.R.S.I., M.S.I.A. Assistant Sanitary Inspector:— H. G. Luckett, A.R.S.I., M.S.I.A. Shops Act Inspector:— C. H. Pursall, A.R.S.I. D. Nursing Staff:— Matron, Borough Infectious Diseases Hospital:— H. M. McLoughlin, S.R.N. Matron, Harts Sanatorium G. E. Sharpe, S.R.N. Senior Health Visitor :— A. A. Woodman, S.R.N., C.M.B., M.R.S.I. (H.V's Cert.). Health Visitors :— L. Barrett, S.R.N., C.M.B. 1 E. Hazelden, S.R.N., C.M.B., R.S.I. (H.V's Cert.). A. E. O'Leary, S.R.N., C.M.B., R.S.I. (H.V's Cert.). M. Preston, S.R.N., C.M.B., R.S.I. (H.V's Cert.). E. E. Roberts, S.R.N., C.M.B. D. E. Skeggs, S.R.N., C.M.B., R.S.I. (H.V's Cert.). 2 C. R. Worrall, S.R.N., C.M.B., R.S.I. (H.V's Cert.). 6 School Nurses C. G. Case, R.F.N., A.R.S.I. A. I. Childs, S.R.N., C.M.B., A.R.S.I. A. R. Kekwick, S.R.N., A.R.S.I. D. M. Maltby, R.R.C. A. Nears, S.R.N. M. H. Nunn, C.M.B. V. Olifent, R.F.N. M. A. Sorrell, S.R.N., A.R.S.I. D. Young, S.R.N., C.M.B. Tuberculosis Nurses :— E. E. Cook, S.R.N., C.M.B. L. E. Mallon, S.R.N. E. Meadhurst (Assistant). Public Assistance Nurse :— E. E. Kelley, S.R.N., C.M.B., Fever Trained. E. Other Staff :— Ascertainment and Supervising Officer, M.D. Acts :— E. L. Hicks. M.D. Training Centre :— A. H. Bleaden, Supervising Officer. M. E. Greenaway, Asst. Supervising Officer. Home Teacher, Blind Persons Act :— L. Kingston. F. Clerical Staff:— Chief Administrative Clerk :— T. B. Clark. Chief Clerk and Vaccination Officer :— F. J. Kendall, A.R.S.I. Male Clerks 3 L. C. Cross. C. L. Durbin, A.C.I.S. G. W. Friend. G. H. Green. B. E. R. Hartley, A.C.I.S. C. J. Hayes. Shorthand Typists :— D. Gordon. O. E. Griffin. H. E. Ritterspack. Female Clerks :— J. M. Flynn. A. R. Gaster. D. M. Greene. F. E. Hales. W. M. Hales. M. A. McCall. F. C. Wells. †1 Temporary—Permanent as from 8.1.35. †£ „ „ „ 1.1.35. 1 Terminated 8.6.34. 2 Commenced 16.7.34. 3 Temporary duty. 7 Public Health Department, Town Hall, May, 1935. To the Mayor, Aldermen and Councillors of the County Borough of East Ham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you herewith my Annual Report relating to the health of the County Borough of East Ham for the year 1934, together with the Annual Report to the Education Authority on the work of the School Medical Service. In accordance with the directions of the Minister of Health, the contents comprise an "Ordinary Report" limited to a record of alterations, improvements and developments which have taken place during the period under consideration. The year has been noteworthy in several respects. Changes in administration of the Public Health Department with the object of ensuring a greater degree of centralisation and thereby closer co-operation of the medical staff in the carrying out of preventative and remedial measures, were initiated at the beginning of the year. The knowledge thus gained of the work of the various Clinics, Centres and Institutions has proved not only helpful in assessing the benefits to the community, but has brought into closer liaison the specialised services maintained by the Authority. Such procedure, more easily adopted in a circumscribed area, tends to a definite and direct association of the individual with the general health work of the Borough. The interest taken by members of the Council in public health matters is evinced by the large number of special reports furnished by me during the year, which has greatly exceeded that of any such previous period. The information elicited has not only proved valuable in surveying the particular work under consideration, but has been of material advantage in arriving at important 8 decisions. Excerpts from these are quoted throughout this Annual Report. The completion of the new Church Road Clinic, Manor Park, at the end of the year has permitted improvement and extension of the Maternity and Child Welfare and School Medical Services in the north area of the Borough. The building provides adequate accommodation and comfort for parents and children, and increased facilities for efficient work by the staff. A description of the Clinic and the arrangements of the sessions are contained in the Report. The Domiciliary Medical Service for persons in receipt of Public Assistance initiated on October 1st, 1933, for a period of one year, has proved an unqualified success and has enabled many patients to continue treatment at the hands of their own doctor, or to exercise "freedom of choice" in regard to their medical attendant. Recent conversations with representatives of the medical practitioners have resulted in a continuance of the scheme on terms satisfactory both to them and the Authority. As in many other areas epidemic illness has been somewhat rife, and the number of cases of notifiable infectious disease has exceeded that of last year. Scarlet Fever has been prevalent although of a mild character, whilst Diphtheria in many instances has shown evidence of the "Gravis" type. In respect to the serious nature of this malady, I am indebted to the Press for kindly inserting in their columns articles written by me, with the object of drawing attention to the urgent necessity of seeking medical advice, the need for early treatment, and the prevention of this insidious disease by efficient immunization. It will afford general satisfaction to know that this publicity has met with a ready response and the number of protected children in the Borough is thereby increased. The extension to the Infectious Diseases Hospital has provided the necessary accommodation for treatment and has fully justified its provision. The plans of the new Tuberculosis and Chest Clinic at Durban House received the sanction of the Minister of Health, and 9 the building is now in course of erection. This branch of preventative and curative work has for many years been carried on in premises of a temporary character, unsuitable and inadequate for the purpose. It is a matter for congratulation that this Clinic will in the near future be housed under conditions which will permit of every facility for highly scientific investigation, and for the care, control and comfort, of the sufferer from tuberculosis. The need for the provision of maternity hospital accommodation within the confines of the Borough has received the careful consideration of the appropriate Committees and various schemes have been explored. The establishment of an obstetric service, in no way associated with former Poor Law conditions is expected as a right by that section of the population whom it will serve, and is long overdue. The present maternity arrangements necessitate travelling some considerable distance, and apart from other disadvantages, do not permit of that complete supervision and close association of ante-natal and natal requirements which have as their object the reduction of maternal mortality and morbidity. I am pleased to report that the Council has agreed to the services of an Obstetrical Specialist being retained for the purpose of consultation with general medical practitioners when required. The formation of a Juvenile Instruction Centre might, I suggest, permit of some voluntary medical inspection of those attending and thus help to bridge the gap between school and adolescence. I record with much regret the resignation, on grounds of illhealth, of Councillor F. H. Edwards, Vice-Chairman of the Public Health Committee. Much additional work has been thrown upon the Department by the increased duties in respect of the several health services, and the adoption of the Domiciliary Medical Service, and I desire to express my thanks to the Chairman and members of the Public Health Committee for their very helpful support and advice in regard to various important matters and also for their consideration in the appointment of the necessary staff. 10 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 continued interest and encouragement. I desire, also, to acknowledge my indebtedness to the Chief Officers of the Council for their kind assistance on many occasions, and to the members of the Public Health staff for the loyalty and devotion to duty which have conduced, so largely, to the efficiency and smooth running of the Department during a year of exceptional activity. I have the honour to be, Your obedient servant, Medical Officer of Health. 11 Statistical 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 1934, 137,050. Number of inhabited houses (end of 1934) according to rate books (including tenements and shops), estimated 33,292. Rateable value at 31st December, 1934, £751,895. Sum represented by a penny rate, 1934, £3,037. Physical Features of the Area. See report for the year 1930. Social Conditions of the Area. See report for the year 1930. General information associated with the physical features and social conditions of the area is more applicable to a five years' survey report, such as will be requested by the Minister of Health for the year 1935. Extracts from Vital Statistics. Total. Males. Females Live Births Legitimate 1,902 986 916 Birth rate per 1,000 of the estimated population 14 2. Illegitimate 51 25 26 Still Births 68 44 24 Rate per 1,000 total (live and still) births 33'6. Deaths 1,566 781 785 Death rate per 1,000 of the estimated population 1T4. Death from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 3 1.50 Other puerperal causes — — Total 3 1.50 12 Death rate of infants under one year of age :— All infants per 1,000 live births 47 Legitimate infants per 1,000 legitimate live births 45 Illegitimate infants per 1,000 illegitimate live births 116 Deaths from Measles (all ages) 14 Deaths from Whooping Cough (all ages) 4 Deaths from Diarrhoea (under 2 years of age) 12 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. The following statistics from the Returns of the Causes of Death for the past three years are given for comparison with the object of elucidating, if possible, any detrimental factors bearing on illness terminating fatally. No record as to the amount of present sickness from any of these conditions is available but taken over a period of years the number of deaths will afford some estimation, by no means precise, of previous invalidity from these causes. (a) Infectious and Parasitic Diseases (b) Cancer Cancer— Digestive Organs (c) Rheumatism (f) Circulatory Acute Heart Conditions (g) Respiratory System Tuberculosis, All Forms 1934 217 209 112 47 460 156 163 110 1933 215 228 123 35 390 134 189 115 1932 202 244 117 30 315 99 191 124 It will be seen that the number of deaths from Cancer has decreased, which may be due to earlier recognition of the disease and more efficient treatment, or to lessening of those retrogressive influences which herald the "pre-cancerous" stage. Cancer of the digestive organs far exceeds affections of other parts of the body and although its origin may be obscure, the many and varied causes of excessive stimulation and chronic irritation bring the etiology of this disease within the preview of all workers engaged in public health. 13 Heart disease and diseases of the circulatory system are still accountable for much serious invalidity and fatal illness. The total number of deaths from these causes include a large number of elderly persons who have exhibited heart disease as a terminal complication; consequently it is necessary to separate the more acute and chronic types occurring in the young and in adult life, as it is these with which we are mostly concerned, especially in their relation to rheumatic affections and infectious diseases such as Scarlet Fever and Diphtheria. Comparison for the three years would appear to show a definite increase in this number, although insufficient to attribute to causes other than those mentioned. On the other hand respiratory affections account for a smaller number of deaths. Probably the absence of severe Influenza and the long spell of dry summer weather in 1934, was a beneficial factor in this respect. Scarlet Fever assumed almost epidemic proportions, whilst many severe cases of Diphtheria were admitted to hospital. The necessity for early diagnosis and prompt treatment is stressed later in the report. Much inconvenience and annoyance during the summer was caused to residents in the South Ward owing to the prevalence of a species of mosquito. Every effort was made to deal with this nuisance but the causes were not confined to the Borough, and the fact that a considerable length of sewer, under the control of another Authority, had been laid off for partial re-construction, etc., permitted hordes of these offenders to disturb the peace and comfort of many people living in close proximity. Births. The number of births registered was 1,953 as compared with 1,922 for the year 1933. The birth rate was therefore 14.2 or 0.5 higher than that of the previous year. Deaths. The number of deaths was 1,566 as compared with 1,503 for the year 1933. The death rate was 11.4, or 0.7 greater than that of the previous year. Of the total deaths 742 or 47.3 per cent. died in institutions. 14 The number of residents who died outside the area and whose deaths were transferred was 696. Seventy-one deaths of nonresidents occurred in the Borough. The standardised death rate, that is the rate adjusted to compare with the crude death rate of the country as a whole, or with the mortality of any local area, was 12.5. This figure is arrived at by multiplying the crude death rate (11.4) by an adjusting factor, that for East Ham being 1.10. It will be seen that there is little variation in the death rate of the Borough as shown over a period of years, and East Ham compares favourably with any area throughout England and Wales. A larger proportion of residents of advanced age with a correspondingly higher number of deaths may contribute to an increased death rate. In the absence of a serious outbreak of epidemic illness or other detrimental factors to health, slight differences in the rate may be attributed to this cause. 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 5.9 1.6 2.3 3.7 3.6 4.4 5.1 9.9 16.0 21-9 25-2 Infantile Mortality. Deaths of infants under one year of age numbered 93— equivalent to an infant mortality rate of 47 per thousand live births—compared with the rate of 45 for the previous year. The rate for England and Wales is 59. The mortality figure is to a great extent an index of the efficiency of the maternity and child welfare work, and I am pleased to state that the considerable reduction effected last year has been practically maintained despite some difficulties. Six deaths of illegitimate children occurred out of a total of 51 births, giving a mortality rate of 116 as compared with a figure of 133 per thousand illegitimate live births for the year 1933. 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 15 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 5 years are as follows :— 1930 25.1 1932 29.5 1931 26.8 1933 22.8 1934 22.5 Maternal Mortality. The maternal mortality rate for 1934 was 1.53 per 1,000 live births and 1.50 per 1,000 live and still births, the lowest rate recorded in this Borough. As stressed on numerous occasions, regular and efficient ante-natal care does much to reduce the risk of complications of child bearing which may lead to fatal consequences. This service is available to all expectant mothers in the district. 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 203 1.53 2.57 — 4.60 1.53 ,, Total Births (Live & Still) 1.95 1.50 2.46 — 4.41 1.50 Population. The Registrar General's estimation of the population to the middle of 1934, is given as 137,050, that is a decrease of 2,450, as compared with that for the year 1933. The rates per thousand of the population mentioned in this report are based on this estimate, with the exception of the ward rates, which are calculated according to Census returns. 16 TABLE 1.—Birth Rate, Death Rate and Analysis of Mortality, 1934. 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 14.8 0.62 11.8 0.00 0.00 0.09 0.02 0.05 0.10 0.14 0.54 5.5 59 90.4 6.5 2.1 1.0 118 County Boroughs & Great Towns including London 14.7 0.66 11.8 0.00 0.00 0.12 0.02 0.06 0.11 0.12 0.47 7.4 63 90.5 6.1 2.9 0.5 132 Smaller Towns (estimated resident populations 25,00050,000 at census 1931) 150 0-67 11-3 0-00 0-07 002 0-04 009 014 0.42 3.6 53 91.2 6.1 1.6 1.1 London 13.2 0.50 11.9 0.00 0-00 0.20 0.02 0.07 0.11 0.12 0.56 12.6 67 87.8 6.8 6.0 0.0 East Ham 14-.2 0.48 11.4 — — 0.10 0.03 0.02 0.32 0.10 0.51 6.0 47 90.3 5.4 4.3 — 17 / >1 a/. /■: i'. Causes of Death jn Age Groups, 1934. Cause of death. All ages. I Deaths at different periods of life of residents whether occurring within or I without the district. Under 1 year 1-2 years 1 2-5 years 5-15 years 116-25 years 25-35 years 135-46 years 45-55 years 55-65 years 65-75 years 1 75 years and upwards A.—Infectious and Parasitic Diseases 217 9 ' 11 28 35 22 29 24 19 24 9 7 B.—Cancer and Other Tumours ... 209 — — — I 1 2 11 35 61 59 39 C.—Rheumatism, Diseases of Nutrition and of 47 — — — 4 5 4 2 5 4 13 10 Endocrine Glands and other General Diseases D.—Diseases of the Blood and Blood-forming 13 2 — 5 4 2 Organs E.—Diseases of the Nervous System and Sense 129 5 — — 7 6 2 4 16 22 39 28 Organs F.—Diseases of the Circulatory System 460 — 1 — 2 8 6 17 45 67 128 186 G.—Diseases of the Respiratory System 163 19 10 6 4 3 12 5 8 22 30 44 H.—Diseases of the Digestive System ... 95 10 3 2 4 2 2 7 7 21 21 1 16 X.—Non-Venereal Diseases of the 56 — — — — 3 2 1 4 12 23 11 urinary System and Annex a 1 J.—Diseases of Pregnancy, Childbirth and the 3 — — — — 3 — — — — — Puerperal State K.—Diseases of the Skin and Cellular Tissue 4 — — — — — — 1 2 1 — — L.—Diseases of the Bones and Organs of 1 — 1 motion M.—Congenital Malformations ... 8 8 N.—Diseases of Early Infancy ... 40 40 O.—Old Age ... 51 — — — .— — — — — 1 9 41 P.—Deaths from Violence 70 2 — — 1 7 8 7 14 11 9 11 Totals ... 1,566 93 25 36 58 57 70 81 155 252 344 395 A.—Infectious and Parasitic Diseases. 1. Measles ... 14 — 9 4 1 2. Scarlet Fever ... 5 — — 2 2 — — — — I — — 3. Whooping Cough 4 3 — 1 4. Diphtheria 45 2 — I 17 26 5. Influenza 15 —■ I — ' — I [ — 1 — 5 5 3 6. Erysipelas 6 — — — ' - 1 — — 1 2 2 7. Acute Poliomyelitis 1 1 - 8. Encephalitis Lethargica 4 — — — 1 1 — 2 ■— — — 9. Cerebro-Spinal Fever ... 5 1 — — 1 1 1 1 — — — 2 — — 10. Tuberculosis—Respiratory System ... 92 — / — / 1 — 17 1 24 22 1 14 12 2 / — 11. ,, Central Nervous System 7 1 2 1 \ 2 1 - — — \ •— — 1 — 12. ,, Intestine and Peritoneum ... 2 — — — ! 1 — — — | 1 — I — 13. ,, Vertebral Column 2 — — — — 1 — 1 — — — 14. ,, Genito-Urinary System 2 — — — — 1 — 1 — — — — 15. ,, Disseminated ... 2 1 — 1 16. Syphilis... 3 1 | 17. Purulent Infection—Septicaemia 6 — — 1 — 1 1 — — 2 — 1 18. Mycoses 1 — — — — — 1 — — — ■ — — 19. Other Infectious or Parasitic Diseases 1 1 B.—Cancer and other Tumours 20. Cancer, Malignant Disease—Buccal Cavity and Pharynx 9 — -— 7 2 21. ,, „ „ Digestive Organs and Peritoneum 112 3 10 31 39 29 22. „ „ „ Respiratory Organs 19 — 1 6 8 3 1 23. ,, ,, ,, Uterus 10 — 1 2 4 3 — 24. ,, ,, ,, Other Female Genital Organs 6 1 3 1 1 25. ,, ,, ,, Breast 17 3 3 7 2 2 26. ,, ,, „ Male Genito- Urinary Organs 9 5 1 3 27. ,, ,, ,, Skin ... 1 — —■ 1 28. ,, „ „ Other or Unspecified Organs 18 — — — 1 1 1 2 5 5 2 1 29. Non-Malignant Tumours 2 — — — — — — — 1 — — 1 30. Tumours of Undetermined Nature ... 6 — — — — — 1 — — 4 — 1 C..—Rheumatism, Diseases of Nutrition and of Endocrine Glands, and other General Diseases. 31. Rheumatic Fever 14 — — — 2 3 4 — 2 — 1 2 32. Chronic Rheumatism, Osteo-Arthritis 12 1 1 4 6 33. Diabetes 20 — — — 1 2 — 2 2 3 8 2 34. Diseases of the Thymus 1 1 D.—Diseases of the Blood and Blood-forming Organs. 35. Haemorrhagic Conditions 1 — — — — — — .— — 1 — — 36. Anaemia, Chlorosis 6 —. — — — — — 1 — 1 3 1 37. Leukaemia, Aleukamia 6 - - ~~ — — - 1 3 1 1 E.—Diseases of the Nervous System and Sense Organs. 38. Encephalitis 1 — — 1 — — — — — — 39. Meningitis 8 1 — — 3 1 1 — — 2 — — 40. Tabes Dorsalis (Locomotor Ataxy) ... 3 — — — — — 1 — 2 — 41. Other Diseases of the Spinal Cord ... 6 — — — 1 — 4 — 1 — 42. Cerebral Haemorrhage, Apoplexy, etc. 83 — — — — 2 7 15 31 28 43. General Paralysis oi tne Insane 3 — — — — 1 .— 1 1 •— — 44. Other Forms of Insanity 7 — — — — 1 3 2 1 — 45. Epilepsy 6 — — — 4 — — 1 1 — 46. Infantile Convulsions (age under 5 years) ... 4 4 47. Other Diseases of the Nervous System 5 1 — 1 3 — 48. Diseases of the Ear and Mastoid Sinus 3 — 1 — — 3 — — — — ■— — F.—Diseases of the Circulatory System. 49 Pericarditis 3 — 1 — — — — 1 — — 1 50. Acute Endocarditis 11 — — — 1 3 2 1 3 1 — — 51. Chronic Endocarditis, Valvular Disease 85 — — — 1 1 4 9 12 10 17 31 52. Diseases of the Myocardium 247 — — — — 2 — 4 16 35 75 115 53. Diseases of the Coronary Arteries, Angina Pectoris 33 1 6 6 11 9 54. Other Diseases of the Heart ... 24 — — — — 2 — 1 2 7 9 3 55. Aneurysm 4 — — — — — — 1 — 2 — 1 56. Arterio-Sclerosis 48 — — — —, — — — 1 6 16 26 57. Gangrene 2 — — — — — — — 1 — — 1 58. Diseases of the Veins ... 1 — — —• — — — — 1 —- — — 59. Abnormalities of Blood Pressure 2 — — — — — — — 2 — — — G.—Diseases of the Respiratory System. 60. Bronchitis 48 2 — 1 - | — 1 1 — 1 8 10 25 61. Broncho-Pneumonia ... 63 14 9 5 1 | 1 3 1 2 4 6 6 12 62. Lobar-Pneumonia 24 2 1 i — 2 6 1 — 5 5 3 63. Pneumonia (not otherwise defined) ... 6 1 i 1 — — — — 2 ■— 2 1 64. Pleurisy... I — | — — — — 1 — — 65. Congestion and Haemorrhagic-Infarct of Lung, etc. 12 — 1 — 1 1 — 1 1 4 3 66. Asthma ... 4 — — — — — — 1 3 — 67. Pulmonary Emphysema 1 — — 1 — — — — — — — 68. Other Diseases of the Respiratory System ... 4 — — 1 1 2 — — — — H.—Diseases of the Digestive System. 69. Diseases of the Buccal Cavity, Pharynx, etc. 6 — 1 1 — 1 — 1 2 — — 70. Ulcer of the Stomach or Duodenum 16 2 1 5 6 2 71. Diarrhoea and Enteritis (under 2 years) 12 9 3 72. ,, (over 2 years) 4 — — 1 1 — — — — — — 2 73. Appendicitis 9 — — — 1 1 1 1 — — 5 — 74. Hernia, Intestinal Obstruction 30 1 — — 1 — 1 3 8 5 11 75. Other Diseases of the Intestines 3 — — — 1 1 1 — 76. Cirrhosis of the Liver 5 — 1 — 2 1 1 77. Other Diseases of the Liver 1 1 — — 78. Other Diseases of the Gall Bladder and Ducts 4 1 1 2 — 79. Peritonitis (without stated cause) 3 — — — 1 — 1 — 1 — -— 80. Diseases of the Pancreas 2 — — — — — — — 1 1 — I.—Non-Venereal Diseases of the GenitoUrinary System and Annexa. 81. Acute Nephritis 2 — — — — 1 — — — 1 — 82. Chronic Nephritis 24 — — — 1 — 1 4 6 9 3 83. Nephritis (not stated to be acute or chronic) 2 1 1 84. Other Diseases of the Kidney and Annexa ... 7 — — — 1 3 3 85. Diseases of the Bladder ... ... ... | 4 1 1 2 86. Diseases of the Urethra, Urinary Abscess, etc. 2 2 — — 87. Diseases of the Prostate 11 - — — — — 2 8 1 88. Diseases of the Male Genital Organs 1 - — — 1 — — — — — 89. Diseases of the Female Genital Organs 3 — — — 2 — — — — — 1 j.—Diseases of Pregnancy, Childbirth and the Puerperal State. 90. Post Abortive Sepsis 1 — 1 — — — 91. Puerperal Sepsis (not returned as postabortion) 2 K.—Diseases of the Skin and Cellular Tissue. 92. Carbuncle, Boil 1 1 — — 93. Cellulitis, Acute Abscess 2 2 — — 94. Other Diseases of the Skin and its Annexa ... 1 — — — — — — — — 1 — — L.—Diseases of the Bones and Organs of Locomotion 95. Diseases of the Joints 1 — — — — — — — 1 — — M.—Congenital Malformations. 96. Congenital Malformations 8 8 — — — — — — — — — — N.—Diseases of Early Infancy. 97. Congenital Debility 6 6 — — — — — — — — — 98. Premature Birth 25 25 . — — .— — — 99. Injury at Birth 2 2 — — — — — — — — 100. Other Diseases peculiar to Early Infancy ... 7 7 O.—Old Age. 101. Old Age 51 — — — — — — — — 1 9 41 P.—Deaths from Violence. 102. Suicide—By Solid or Liquid Poisons or Corrosive Substances 10 3 2 4 1 — — 103. ,, —By Poisonous Gas ... 12 — — 1 1 — 3 4 2 1 104. ,, —By Hanging or Strangulation 1 — — — — — — — — 1 — 105. ,, —By Firearms 1 — — — — — — 1 — — — 106. ,, —By Cutting or Piercing Instruments 3 — — — — 1 — — — 1 1 107. „ —By Crushing 2 — — — — — — 2 — — — 108. Other Acute Accidental Poisoning (not by Gas) 2 — — — 1 — 1 — — 109. Accidental Burns (Conflagration excepted) 2 — — — 1 — 1 — — — — 110. ,, Mechanical Suffocation... 2 1 — — — — 1 — — — 111. „ Injury by Fall or Crushing, etc. 34 — — — 1 4 3 3 3 6 5 9 112. Other and Unstated Forms of Accidental Violence 1 1 19 Cause of death. Manor Park. Little Ilford. Woodgrange. WARDS Greatfield. South. Total. Deaths in Institutions. Plashet. Kensington. Castle. Central. Wall End. 1. Typhoid & Paratyphoid Fevers — — — — — — — — — — — — 2. Measles 1 4 — — — 4 — 2 1 2 14 8 3 Scarlet Fever 1 — 1 — — — — 1 1 1 5 5 4. Whooping Cough — 1 1 — — — — 1 — 1 4 2 5. Diphtheria 3 8 6 3 1 3 3 7 4 7 45 43 6. Influenza 1 — 1 2 1 2 1 4 1 2 15 3 7. Encephalitis Lethargica — 1 — — — 1 — — 2 — 4 ~ 8. Cerebro-Spinal Fever ... — 1 1 1 — — — — — 2 5 4 9. Tuberculosis of Respiratory System 10 6 8 7 5 18 6 12 5 15 92 54 10. Other Tuberculous Diseases ... 4 — — 2 1 3 — — 4 1 15 12 11. Syphilis — — — — — 1 — 1 1 — 3 3 12. General Paralysis of the Insane, Tabes Dorsalis — 1 1 1 1 — 1 1 — — 6 5 13. Cancer 26 23 18 21 19 19 15 22 18 20 201 91 14. Diabetes 1 3 4 3 1 2 1 — 2 3 20 14 15. Cerebral Haemorrhage, etc. 10 4 3 11 10 11 9 5 9 11 83 44 16 Heart Disease 53 45 32 37 42 35 40 48 33 38 403 158 17. Aneurysm 1 — 1 — — — 1 — — 1 4 2 18. Other Circulatory Diseases 7 4 5 9 6 6 4 2 3 7 53 14 19. Bronchitis 2 3 9 6 4 7 6 5 3 3 48 14 20. Pneumonia (all forms) 8 9 6 4 7 14 14 15 7 9 93 34 21. Other Respiratory Diseases 2 4 1 3 2 3 — 4 1 2 22 12 22. Peptic Ulcer 2 4 1 1 2 — 1 2 1 2 16 6 23. Diarrhoea, etc. 1 3 1 3 — 2 1 3 1 1 16 10 24. Appendicitis — 2 1 — 2 — 1 2 1 — 9 7 25. Cirrhosis of Liver 2 — — — 1 — 1 — — 1 6 — 26. Other Diseases of Liver, etc. 1 1 — — — — — 3 — — 5 5 27. Other Digestive Diseases 4 5 6 5 3 6 4 4 3 4 44 23 28 Acute and Chronic Nephritis 4 2 4 2 — 2 4 4 4 2 28 15 29. Puerperal Sepsis — — — — — 1 1 — 1 — 3 3 30. Other Puerperal Causes — — — — — — — — — — — — 31. Congenital Debility, Premature Birth. Malformations, etc. ... 9 6 4 4 3 2 3 5 5 7 48 15 32. Senility ... 9 5 4 a — 7 10 5 3 6 51 31 33. Suicide 1 5 5 3 1 4 1 1 3 5 29 5 34 Other violence 6 5 8 3 1 3 4 6 2 3 41 30 35. Other defined causes ... 17 14 16 9 8 15 15 13 14 15 136 70 36. Causes ill-defined or unknown — — — — — — — — — — — — Totals 186 169 148 145 121 171 147 178 133 168 1,566 742 Rates (Census population for Wards) 13.3 10.4 11.6 10.5 10.3 12.5 10.5 10.3 9.4 10.8 11.4 — 20 TABLE 4. Infant Deaths under One Year of Age, 1934. 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. Diphtheria M — — — — — — — 1 1 F — — — — — — — i i Whooping Cough M — — — — — 1 — — i F — — — — 1 1 — — 2 Syphilis M — — — — — — — — — F — — — — 1 — — — 1 Meningococcal Meningitis M — — — — — — — 1 1 F — — — — — — — — — Tuberculosis (all forms) M — — — — — — 1 — 1 F — — — — — — — 1 1 Bronchitis M — — — — — — — 1 1 F — — — — — 1 — — 1 Pneumonia M — — — 2 2 1 3 — 8 F — 1 1 — 3 — 2 2 9 Diarrhoea, etc. M — — — 1 2 3 2 1 9 F — — — — — — — — — Congenital Debility and Malformations, Premature Births. M 17 1 2 2 5 3 — — 30 F 14 — — — 4 — — — 18 Other defined causes M — 1 — 1 2 1 1 1 7 F — — — 1 — — — — 1 All causes M 17 2 2 6 11 9 7 5 59 F 14 1 1 1 9 2 2 4 34 General Provision of Health Services. Professional Nursing in the Home. (a) General, (b) Infectious Diseases. A. General.—The excellent work performed by the nurses attached to the Branch Home in Katherine Road of the Plaistow District Nurses is of inestimable benefit to residents of the district. The Authority makes a grant in aid of these services. For Public Assistance cases the services of Nurse Kelley are available upon recommendation of the patient's medical attendant. B. Infectious Diseases.—No provision is made for the nursing of cases of infectious disease in the home, but where in non-notifiable illness such as Measles, Whooping Cough, the 21 ditions are wholly inadequate the patient is, if possible, admitted to hospital. In all cases of Diphtheria and Scarlet Fever admission to hospital is advised. C. Midwives.—No midwives are subsidised by the Authority. A considerable amount of midwifery work is undertaken by the nurses of the Plaistow Maternity Hospital attached to the Burges Road Branch Home, and the Branch at Tidal Basin. In addition there are several midwives in private practice. Midwives Acts, 1902 and 1918. The number of midwives on the roll for 1934 was 51. Of this number 38 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches-3 at Sir Henry Tate Nurses' Home, Silvertown-3 at the Kelvingrove Nurses' Home, Windsor Road, and 7 practised independently. Summary of Visits Paid during 1934 by Nurses of Plaistow Maternity Hospital and District Nurses Home. Midwifery 530, Monthly 161, Hospital 354. 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 22 Institutional Provision for Unmarried Mothers and Homeless Children. Already detailed in report for 1930. Ambulance Facilities. General. The two ambulances operating- from the Fire Station carried out the following work during 1934 :— Cases conveyed to and from various hospitals 1,629 Accident cases 489 Illness cases 1,140 Journeys made 1,727 Miles run 16,151 East Ham cases removed by other ambulances :— Barking 41 Ilford 4 West Ham 21 Cases removed for other authorities :— West Ham 10 Barking 18 Infectious Cases. Two ambulances are available for this purpose at the Infectious Diseases Hospital. Laboratory Facilities. As detailed in previous reports, the majority of the specimens are now sent for examination to the East Ham Memorial Hospital. The number and nature of these examinations for 1934 are shown below :— Specimen. Number. Blood Count 1 Blood Sugar Estimation 3 Blood for Widal Test 2 Mantoux Skin Test (Tuberculosis) 49 Swabs (for Tuberculosis) 3 Faeces (for Tuberculosis) 25 Sputa (for Asbestosis) 4 Sputa (for Tuberculosis) 1,155 Sputum (for fungi and other organisms) 1 Total 1,243 23 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. 6,237 433 5,804 Of the above total 4,539 were examined at the hospital, as compared with 1,267 for the year 1933, a much larger number than in former years. Legislation in Force. Legislation in force was printed in the report for 1932. During 1934, the following Bye-laws came into force :— Nuisances by Dogs. Houses-let-in-Lodgings. Employment of Children and Street Trading. 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 1934. Public Assistance Domiciliary Medical Service. Consequent upon the retirement of the 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 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. As a result the Council adopted a system whereby persons in receipt of public assistance would be permitted "open choice" of doctor. 24 A panel of practitioners willing to carry out such duties was established and subsequently 31 out of 45 practitioners accepted service. A patient upon requiring medical treatment would either continue under the care of his own doctor, if accepting service under the Scheme, or be permitted to select the name of a practitioner 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 for an experimental period of one year from October 1st, 1933. At the expiration of this time, it was possible to report on the first year's working of the scheme and a joint meeting of the representatives of the panel practitioners and the Public Assistance Committee was held to discuss matters in detail. It was agreed to continue the Capitation Fee then in operation until the end of the year, in order to permit of full consideration. Subsequently this fee was increased to 16s. per annum payable in four quarterly (Calendar) instalments. As before, the payment in each case covers a period of twelve months' treatment from the first attendance on the patient. The arrangements since their inception have worked exceedingly smoothly and few administrative difficulties have been encountered, although the amount of such work undertaken by the staff is considerable. There have been no complaints from patients. The relationship between the Authority, their Officers and Medical Practitioners has been most cordial. The scheme has been amended in certain particulars, and requirements of the Public Assistance order relating to supervision of mental cases included. 25 REGULATIONS GOVERNING TERMS AND CONDITIONS OF SERVICE. (Revised December, 1934.) 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, who will retain card during treatment. 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 Ophthalmic 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 (6) ), 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) ); 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; and to issue to the patient upon application a certificate as to his fitness to resume work; 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 forwarded to the Public Assistance Officer for transmission 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. Duties under Lunacy Act, 1890. The Medical Practitioner on obtaining knowledge that a poor person on his panel is or is deemed to be of unsound mind, and a proper person to be sent to a Mental Hospital, to give notice in writing within three days to the Relieving Officer.— Sec, 14 (1); 26 to visit once in every quarter any poor person of unsound mind notified to him by the Public Assistance Officer. (The statutory fee of 2s. 6d. will be paid for each visit.—Sec. 202 (1) and (4).); in any case where a poor person of unsound mind had been handed over to the care of a relative or friend with an allowance for maintenance, to furnish to the Mental Hospitals Visiting Committee within three days after each quarterly visit a report stating whether in his opinion the patient is properly taken care of and may properly remain out of a Mental Hospital. (The statutory fee of 2s. 6d. will be paid for the report.—Sec. 202 (3) and (4).); to make a return to the Town Clerk for transmission to the Board of Control within seven days after the end of each quarter of all poor persons of unsound mind visited by him during the preceding quarter, or, if he has no knowledge of any such cases, to make a return to that effect. (The forms on which these returns are to be made will be supplied, but no fee is payable). Change of Medical Attendant. A patient who once chooses his or her medical attendant shall be allowed to change that attendant at the expiration of any calendar quarter, i.e., 31st March, 30th June, 30th September, 31st December. The Medical Practitioner shall be allowed to relinquish a patient at the end of any calendar quarter if some other Medical Practitioner on the panel will accept the case, otherwise the duties set out in this scheme shall in respect of such patient be carried out by the Medical Practitioner initially responsible, for a period of 12 months from the date of issue of the Medical Card. Capitation Fee. A capitation fee of 16s. 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. In any case where a patient changes his Medical Attendant or a Medical Attendant relinquishes the patient, at the end of a calendar quarter, no further instalment of the capitation fee shall be payable to the Medical Attendant from whom the patient has transferred or by whom he is being relinquished. In any case of a change of a Medical Attendant, payment of the annual capitation fee to the new Medical Attendant shall commence as from the quarter during which the patient first receives treatment, subject to the issue of a medical card by the Relieving Officer. 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 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. 28 For the period 1st October, 1933, to 30th September, 1934, 1,954 persons were treated and the cost for medical attention at 10s. per head (payable quarterly at 2s. 6d.) was £735. The number of quarters in respect of which payment was made was 5,866, and of this total there were 2,220 quarters in which no medical treatment was provided. †All drugs supplied ex Chemists as from 1st October, 1933. *Includes administration expenses and cost of pricing prescriptions. TABLE 5. Public Assistance Domiciliary Medical Service. Statistical Return for the Year Ending 31.12.34. 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. 1,719 3,920 10,301 14,221 1,183 441 Number of cases urgently admitted to hospital 17 Number of applications to Medical Officer of Health for hospital treatment 1ll Public Assistance Nurse. Number of requisitions received for attendance of nurse 52 Total attendances at homes by nurse 1,824 The Public Assistance Domiciliary Medical Service is available for the whole of East Ham, except for a small area to the South of King- George V. and Royal Albert Docks. The following is a statement of the drugs supplied for the past 4 years and also the cost of same for the first year of the scheme:— £ s. d. Year ending 31.3.31 331 0 1 Year ending 31.3.32 252 18 11 Year ending 31.3.33 293 19 2 Year ending 31.3.34 507 3 4† 1.10.33 to 30.9.34 715 0 0* 29 Dr. Brews, the District Medical Officer for this area (North Woolwich), dealt with the following cases during 1934 Number of individual patients 40 Number of attendances at homes 406 Number of attendances at surgery 424 Total number of attendances 830 Number of occasions medicines supplied without seeing patients 22 Number of recommendations for extra nourishment 4 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 41 Soft Chancre 1 Gonorrhoea 90 Not Venereal 98 Total 230 Total attendances of all patients 12,674 Number of in-patients during 1934 871 Salvarsan substitutes—doses 822 Pathological Examinations. For or at the Centres— Spirochaetes 4 Gonococci 1,945 Wassermann 410 Others 1,956 Total 4,315 30 For Practitioners— Spirochaetes — Gonococci 31 Wassermann 41 Others 32 Total 104 During 1934, no East Ham patients were in residence under the Hostel Scheme. Mental Deficiency. The Corporation of West Ham admit to their Colony at South Ockenden a number of mental defectives from this area. This arrangement has materially eased the situation as regards the provision of institutional treatment for higher-grade cases. The object of the Colony is to provide adequate training and instruction in suitable occupations, as well as environment conducive to happiness and physical well-being. The institution is ideally situated and fulfils this requirement in every respect. In addition patients of a similar category are admitted to various institutions including Cell Barnes, Herts. Many slight cases are placed with suitable guardians. Low and medium grade defectives are accommodated at Forest Gate Hospital. Clinics and Treatment Centres. These are shewn below and are all provided by the Council. TABLE 6. 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 North Woolwich Clinic, Fernhill St. Infant Welfare ,, ,, Tuesday 9.30 a.m. Friday 2 p.m. Tuesday 2 p.m. Manor Park Clinic. Weighing and Minor Ailments Room Leading to Ante-Natal and Doctor's Consulting Rooms. Light Clinic. 31 TABLE 6. Clinics and Treatment Centres—continued. Situation Purpose used Sessions St. George's Church Hall, Masterman Rd. Infant Welfare 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. 32 (1) School Clinic (minor ailment) or Child Welfare, or Ante-Natal. (2) Light Clinic. (3) Dental Treatment. (1) School Clinic (minor ailment). These have been held on Tuesday and Thursday morning's and the present number of sessions would appear to satisfy the needs of the area. Child Welfare. One Clinic has been held per week on Thursday afternoons at which two Medical Officers have been in attendance. It is proposed to increase this to two sessions on Monday and Thursday with one doctor present, and to institute Toddlers' Clinics on Monday and Friday mornings, part of the latter session being devoted to immunization. Ante-Natal. An ante-natal session is suggested on Wednesday mornings. (2) Light Clinics. These are arranged for girls, boys and babies alternately and will occupy every morning session of the week and three afternoon sessions. This number would appear adequate. (3) Dental Treatment. One dentist will work at the clinic and devote his whole time to the treatment of school children, mothers and infants in the north area of the Borough. On Wednesday mornings whilst the ante-natal clinic is in progress, dental inspections will be arranged at schools. The allocation of premises is as follows:— 33 Suggested Arrangement at New Manor Park Clinic. Day Maternity and Child Welfare and School Clinics. Light Clinics Dental Clinics. Monday a.m. p.m. a.m. p.m. a.m. p.m. Toddlers Child Welfare School (Girls) Babies Clinic (S.M.S.) Clinic or Insp. (S.M.S.) Tuesday School Special M. & C. W. (alternate) School (Boys) — do. Clinic (S.M.S.) Wednesday Ante-natal — School (Girls) Babies Inspection (S.M.S.) Clinic (M.&.C.W.) Thursday School Child Welfare School (Boys) Clinic (S.M.S.) Clinic (S.M.S.) Friday Immunization and Toddlers - Babies School (Girls) do. do. Saturday — — School (Boys) — do. — A carbon-arc lamp and a mercury vapour lamp have been installed in the Light Room at the Manor Park Clinic and it is proposed to carry out light treatment at the sessions indicated in the above table. The increase in the number of Light sessions at Manor Park and eventually at the Town Hal], preclude such duties being wholly allocated to the present nursing staff. For this reason, additional staff will be required to maintain this service efficiently. These requirements cannot be viewed alone : they have a direct association with other work of the Public Health Department and are closely connected with administration of other services likely to eventuate. It is recommended that a Sister, trained in radiography and light treatment, should be appointed to supervise generally, and to undertake personally, to a great extent, the work of the sunlight clinics in the Borough. Coincident with this is the likelihood of the services of a radiographer being required for two half-day X-ray sessions per 34 week in association with the work of the Tuberculosis and Chest Clinic, and also at Harts Sanatorium. It would be unwise to suggest the appointment of a nurse to assist at Light Clinics without taking into consideration the immediate needs of the Council in respect of X-ray services. The suggested allocation in regard to the duties of the Light Clinic Sister is six sessions per week to the School Medical Service and the remaining five sessions to duties associated with the Public Health Department (Maternity and Child Welfare and Tuberculosis.) 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. Particulars relating to the new Clinic are given in the Tuberculosis Section. General and Special Hospitals and Children's Homes. Hospitals— (a) Provided by Local Authority, (b) Maternity, (c) 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 arrangements under the above headings. Particulars have been set out in previous reports. Runwell Mental Hospital. The plans approved by the Joint Visiting Committee of the Corporations of the County Boroughs of East Ham and Southendon-Sea for the new Mental Hospital at Runwell, Essex, were submitted to the Ministry of Health and Board of Control during the early part of the year. After some adjustments, final sanction was obtained and building operations commenced about April, 1934. 35 The Hospital is situated on a site of 500 acres, between Wickford and Rettendon, Essex, and will eventually accommodate 1,085 patients. Administrative and other buildings are beingerected in accordance with the plans of the complete scheme. The whole Hospital will form a fully equipped community of about 1,500 people, and some 40 to 50 buildings will be constructed to complete the project. The buildings will be widely spaced to permit of the maximum amount of sunlight and to avoid that sense of restriction and "institutional feeling" so common in many existing hospitals. They will include the administrative unit with its large recreation hall fitted with a stage and cinema projectors, central kitchens and workshops, etc. There will be a large admission unit for preliminary observation and for uncertified voluntary patients, and this will be fitted with modern forms of mental therapy treatment and serve as an extremely useful research department for the whole hospital. A large hospital unit for patients requiring medical and surgical treatment will be provided with a section for the staff needing similar attention. A separate closed unit for disturbed or restless patients is provided, well to the western side of the site, which will give privacy from the rest of the hospital. In close proximity to the central administration unit will be found the units for quiet cases requiring constant attention, and, on the northern portion of the site, separate units for "parole" patients are provided separating them somewhat from the rest of the hospital. In addition to the actual patients' buildings, provision is made for a nurses' home, separate houses for the medical superintendent, the resident physicians, and cottages for the staff. A modern laundry on somewhat new lines will be provided and there will be recreation grounds and facilities for outdoor exercise. Later there will be suitable farm buildings and vegetable gardens. Negotiations were proceeding with the Chelmsford R.D.C. and the South Essex Water Works Company in regard to the water supply, and with the former Authority in respect of sewage disposal. The Committee invited applications for the appointment of Medical Superintendent of the Hospital, and R. StromOlsen, M.D., B.Ch., D.P.M., Deputy Superintendent at Cardiff City Mental Hospital, was appointed to commence his duties on January 1st, 1935. It is anticipated that the selection 36 of the necessary equipment, furniture, etc., for the Hospital, and the determination and selection of the necessary staff would occupy the Medical Superintendent for a period of not less than twelve months. The Committee also desired to benefit by the experience and advice of the Medical Superintendent during the construction of the Hospital, and to permit him to exercise supervision in regard to the many details involved. The Foundation Stone was laid on June 20th, 1934, by Mr. (now Sir Laurence) L. G. Brock, C.B., Chairman of the Board of Control. The ceremony was attended by the Worshipful the Mayors of East Ham and Southend-on-Sea (Alderman W. W. Bagot, J.P., and Councillor H. E. Frith, J.P.), and by Aldermen and Councillors of both Authorities. The Chairman of the Joint Committee (Councillor H. B. Harper, J.P.) presided at the luncheon which followed the stonelaying and was supported by all the members of the Joint Visiting Committee. Councillor Harper outlined the work of the Committee since its inception, the many difficulties with which they had to contend, and the progress attained. He expressed the thanks of the Committee for the help afforded to them by the Chairman (Sir George Wyatt Trustcott, Bart., J.P.) and Members of the Mental Hospital Committee of the Corporation of London. Councillor Harper stated that from the time they formulated the plans and submitted them to the Board, these were dealt with in a most expeditious manner. The urgent need and acute position, particularly of East Ham, justified that, and they had to thank Mr. Brock for the solution of their difficulties. The Committee were satisfied that in planning the Hospital they would obtain everything that human sympathy and medical skill could devise. The Mental Hospitals of the future were going to be hospitals for the treatment of patients with the object of restoring them to health, and not merely barracks for the housing of these unfortunate people. In reply thereto, Mr. L. G. Brock enunciated at some length modern scientific thought, and the principles underlying care and treatment. He stated that it was a very large, a very vital and important service, that everything in this Hospital had been 37 planned to facilitate active, intensive medical treatment, and to minimise all those distressing sights and sounds which were so painfully familiar to those whose duty it was to visit many other Mental Hospitals. He pointed out that a detached admission unit and treatment centre planned in the light of more recent experience and supplemented by the newest type of convalescent villa would permit early and recoverable cases to pass from the admission stage to the convalescent stage without having to enter the main building. "I believe," stated Mr. Brock, "that when this hospital is completed, it will be a model of its kind in every way. It will be a magnificent machine, the most complete, the most modern in design and, I hope, one of the best equipped machines in the whole country. While, however, I feel justified in calling it a magnificent machine, may I remind you that it is not an automatic machine? Its success will depend-—must depend—on the men and women who work in it; and, above all, its success must depend on your choice of medical superintendent." The Mayor of Southend-on-Sea and the Deputy Mayor of East Ham paid tribute to the work of Councillor Harper and Members of the Joint Visiting Committee. TABLE 7. Disposition of East Ham Mental Patients on 31.12.1934. Male. Female. Total. Brentwood 7 31 38 Colchester 4 31 35 Wells — 39 39 Gateshead 13 61 74 Powick (Worcester) 68 10 78 Canterbury 35 — 35 Cotford 9 — 9 Peckham House 28 34 62 Gloucester 29 10 39 Park Prewitt — 20 20 Various Institutions 12 17 29 Totals 205 253 458 38 (i) Smallpox. The treatment of this disease is carried out, by arrangement, with the London County Council. (j) East Ham Memorial Hospital. The number of beds remains the same, viz., 100. The following tables are abstracted from the hospital report for 1934 :— 1.—In-Patients. A. Number of Beds and In-Patienxs. Numbers in 1934. Numbers in previous year. 1. Beds :— (a) Complement at 31st December 100 100 (6) 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 1.7 1 (iii) Other Causes — — (d) Average Daily Number Open during the year 98.3 99 (e) Average Daily Number Occupied during the year 92.7 92.5 2. Number of In-Patients in the Hospital at beginning of year 95 87 3. Number of In-Patients admitted during year 1,491 1,400 4. Number of In-Patients in the Hospital at the end of the year 98 95 5. Average number of days each Patient was resident (Ascertained by dividing the yearly total of daily counts, viz. 33,849 by the number of Patients treated to a conclusion, i.e., (2)-)-(3) —(4).) 22.7 24.3 6. Number of Patients admitted and discharged during the year who were resident for (i) only 1 day (ii) 2 and 3 days 76 111 98 62 39 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. 1934 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. f. s. d. £ s. d. £ s. d. 1. Provisions (including Board of Officials) 3,091 12 10 2 1 7 13 2 2 5 9 2. Surgery and Dispensary 1,264 5 3 17 0 5 3 18 1 3. Domestic 2,790 11 7 1 17 6 11 7 2 0 0 4. Salaries and Wages (Maintenance) 5,446 1 2 6 3 13 2 I 2 9 3 19 0 5. Miscellaneous 463 1 11 6 3 1 11 6 9 6. Administration 714 2 11 9 7 2 10 9 9 Statistical Cost 13,768 2 17 0 9 5 1 2 17 6 9 19 4 7. Establishment:— Renewals and Repairs 120 6 1 7 9 2 8 8. Finance 990 4 1 13 4 4 2 14 5 Total Cost 14,878 3 1 7 10 0 0 3 2 5 10 16 5 •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) in A above) and dividing by the number of weeks in the year (viz., 52 1/7 or 52 2/7). t 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-f3—4 in A above). 2.—Out-Patients. A. Numbers. Numbers Numbers in in previous 1934. year. 1. Total number of new Out-Patients 10,966 10,006 2. Total number of Out-Patient Attendances 70,880 50,640 (a) Number of Patients on books at the beginning Not Not of the year able able (b) Number of Casualty Patients included in No. 3,357 3,239 1 above (c) Number of Maternity Patients included in — — No. 1 above, attended at home (id) Number of Attendances on Maternity — — Patients included in No. 2 above 40 2.—OUT-PATIENTS—continued. B. Annual Expenditure on Out-Patients and Average Cost of each Out-Patient Attendance and of each Out-Patient. 1934 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. i Pence Pence Pence Pence 1. Provisions (including Board of Officials) 448 1-52 9-81 1-71 8-66 2. Surgery and Dispensary 1,256 4-25 27-49 4-15 20-99 3. Domestic ... 203 •69 4-44 •95 4-82 4. Salaries and Wages (Maintenance) 1,886 6-39 41-28 7-08 35-86 5. Miscellaneous 134 •45 2-93 •58 2-93 6. Administration 177 •60 3-87 •63 3-16 Statistical Cost 4,104 13-90 89-82 15-10 76-42 7. Establishment Renewals and Repairs 21 ■07 •46 •25 1-27 8. Finance 358 1-21 7-83 1-73 8-75 Total Cost 4,483 15-18 9811 17-08 86-44 •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). fAverage 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). (k) Whipps Cross Hospital and Institutions controlled by West Ham. Beds Allocated on User Basis to East Ham. Institution. No. of Type. Beds. Whipps Cross Hospital 155 Medical and Surgical. Central Homes 254 Able-bodied and Sick. Forest Gate Hospital 74 Sick, Maternity and Mental Defectives. forest House and Cottages 26 Chronic cases. Margate Convalescent Home 11 Convalescent children to 16 years. 41 TABLE 8. Cases Admitted to West Ham Corporation Public Assistance Institutions from East Ham. Institution. Chargeable on 31.12.33 Admitted during 1934. Born during 1934. Total. Discharged. Died. Transferred to other Instns. Chargeable on 31.12.34 Whipps Cross Hospital 118 1,617 — 1,735 1,165 246 175 149 Central Homes 250 401 — 651 158 163 90 240 Forest Gate Hospital 131 205 122 458 281 27 24 126 Forest House and Cottages 39 14 — 53 2 — 13 38 Margate Home 2 9 — 11 7 — 3 1 42 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 30-6-34 538 6 months ending31-12-34 546 Lowest „ „ „ 507 „ „ „ 517 In Receiving Homes on 1st January, 1934 303 1st July, 1934 315 ,, Scattered ,, „ „ 220 „ „ 217 523 532 In Receiving Homes on 1st July, 1934 315 1st January, 1935 305 „ Scattered ,, „ „ 217 „ „ 213 532 518 On 1st July, 1934, chargeability was apportioned as follows:— To the County Borough of East Ham 74 1st January, 1935 79 „ ,, West Ham 324 „ „ 305 ,, Essex County Council 134 „ „ 134 532 518 Average No. of admissions weekly—6 months ending 30-6-34 7.7 6 months ending 31-12-34 6.5 „ „ discharges ,, „ 7.4 „ „ „ 7.1 Greatest No. of admissions on any one day—6 months ending 30-6-34 6 „ „ „ 8 Number of deaths in institutions— 6 months ending 30-6-34 3 „ „ „ 0 Number of children admitted from East Ham—6 months ending 30-6-34 23 „ „ „ 38 Number of children admitted from West Ham—6 months ending 30-6-34 ... 125 „ „ „ 94 Number of Children admitted from Essex C.C.—6 months ending 30-6-34 54 „ „ „ 37 Transfers to Institutions (not under the control of the East or West Ham County Boroughs) 6 months ending 30-6-34 12 „ „ „ 16 Total No. of days maintenance—6 months ending 30-6-34 95,069 „ „ „ 97,802 Infants under 3 years on 1st July, 1934 39 On 1st January, 1935 45 Children over 3 and under 5 years on 1st July, 1934 59 „ „ 43 Children over 5 and under 8 years on 1st July, 1934 99 „ „ 86 Boys over 8 and under 14 years on 1st July, 1934 133 „ „ 138 Girls over 8 and under 14 years on 1st July, 1934 130 On 1st January, 1935 130 Boys over 14 and under 16 years on 1st July, 1934 45 „ „ 42 Girls over 14 and under 16 years on 1st July, 1934 27 „ „ „ 34 532 518 Accommodation—Beds Provided Receiving Homes, on 1st July, 1934 371 On 1st January, 1935 371 Scattered Homes ,, ,, „ 232 „ „ 232 603 603 Accommodation (Certified) 555 „ „ 555 43 Aldersbrook Homes and Scattered Homes—continued. No. of boys sent to situations during 6 months ending 30-6-34 23 6 months ending 31-12-34 14 No. of girls sent to situations during 6 months ending 30-6-34 9 „ „ „ 5 No. of boys returned from situations and not yet replaced, 6 months ending 30-6-34 2 „ „ „ and not yet replaced 0 No. of girls returned from situations and not yet replaced, 6 months ending 30-6-34 1 6 months ending 31-12-34 0 No. of boys whose wages were subsidised since the last report (with the sanction of Ministry of Health)—6 months ending 30-6-34 1 „ „ „ 0 Dr. J. Sangster Greig, Medical Officer to the Children's Homes, Aldersbrook, has kindly furnished the following reports:— September, 1934. As required by Articles 170 (13) and 179 (1) of the Public Assistance Order, 1930, I submit my half-yearly report for the half-year ended on the 30th June, 1934. Health of the Children. The general health of the children in the Aldersbrook and Scattered Homes has been very good indeed during the past six months. Very few cases of serious illness having occurred during the period under review. Infectious Diseases. In April, an outbreak of Measles developed in the Nursery at Aldersbrook which affected the Toddlers chiefly. In addition the following sporadic cases of infectious diseases occurred:— Diphtheria 2, Scarlet Fever 6, Whooping Cough 3, German Measles 1. These figures are very gratifying and go to show that the Staff are still exercising every care and precaution in detecting the symptoms of disease at their initiation. This not only minimises the danger of serious outbreaks, but tends to reduce the number of subsequent complications. Nursing. The Matron and her Staff display much energy and ability in the nursing of the infants and sick children, which continues to be of a very high standard. 44 The Nursery. The Nursery, which has been in use for the past twelve months, is still demonstrating its valuable utility. Its first class position and the excellent arrangements of the wards and appurtenances have produced the healthy and happy condition of the children there. Supply of Medical and Surgical Requisites. The supply of medical and surgical requisites is adequate and complete. Deaths. Three deaths have occurred during the period under review. Accommodation. The Elizabeth Fry Lodge has now been occupied and the numbers in excess in the other Lodges have been reduced. Visiting. I and my Assistant made approximately 280 visits to Aldersbrook and 102 to the Scattered Homes. 202 children were thoroughly examined on admission, and 185 on discharge. Minor operations have been performed when the necessity arose, and other treatment given when required. The usual routine inspections have been regularly performed. Vaccination. No children have been vaccinated during the past six months. The Dentist, Mr. Rose, has made the usual visits and inspections at Aldersbrook and the Scattered Homes, 97 children being treated for extractions, fillings and scalings. I desire to record my indebtedness to the Superintendent and Matron for their unfailing help and assistance when visiting the Homes. January, 1935. As required by Articles 170 (13) and 179 (1) of the Public Assistance Order, 1930, I submit my half-yearly report for the half-year ended on the 31st December, 1934. 45 Health of the Children. The health of the children in the Aldersbrook and Scattered Homes has been excellent and the number of cases of serious illness has been very small during the past six months. Infectious Diseases. There has been no epidemic of infectious disease during the period under review. The following sporadic cases have developed during this time Diphtheria 4, Chicken Pox 3, Measles, Whooping Cough, Mumps, and Erysipelas, 1 each. The absence of any epidemic of infectious disease is most probably due to the attention of the Staff, who exercise every care in detecting the initial signs and symptoms of disease. Nursing. The very high standard of nursing is still being maintained, and the Matron and her Staff spare no pains in their endeavour to treat the children in the best and most up to date methods. The Nursery. The Nursery continues to demonstrate its large sphere of usefulness, and the healthy, happy, and contented children pay high tribute to the excellence of its construction and direction. Supply of Medical and Surgical Requisites. There are no defects in the supply of medical and surgical requisites. Deaths. There have been no deaths among the children during the period under review. Accommodation. The Elizabeth Fry Lodge is now in occupation, and the numbers in the other Lodges have not been in excess. Visiting. I and my Assistant made approximately 309 visits to Aldersbrook and 227 to the Scattered Homes. 161 children were thoroughly examined on admission and 190 on discharge. Minor operations were performed when necessary, and other treatment given as and when required. The usual routine inspections have been regularly performed. 46 Vaccination. Nine children were successfully vaccinated, with the consent of their parents, during the past six months. The Dentist. Mr. Rose has made the usual visits and inspections at Aldersbrook and the Scattered Homes. 110 children were treated for extractions, fillings, and scalings during the period under review. I desire to express my indebtedness to the Superintendent and Matron for their unfailing help and courtesy when visiting the Homes. 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. Unfortunately, these have in no sense diminished and a considerable amount of time is devoted to careful and detailed examination and certification. Such procedure, however, cannot be lightly undertaken and is of the utmost importance both to the individual and the relatives. The changing circumstances of many cases and the many relevant factors associated with their daily life whist under guardianship or statutory supervision, require no little consideration. Visits to institutions and guardianship patients have been paid by the Chairman and members of the Committee and the opportunity taken to become conversant with the methods of training and the life of the defectives. Despite the difficulties that occasionally arise owing to the inability to obtain the right kind of guardian or suitable accommodation, the work on behalf of the mentally deficient is adequately encompassed. Miss Hicks, the Ascertainment and Supervising Officer, performed the following duties during the year under review:— 47 TABLE 9. VISITS. No. of reports— register, files, &c. Number of interviews Statutory Supervision Guardianship Institution Training Centre Friendly Care Total 1,118 137 158 * 102 1ll 1,626 987 67 * In addition, two weeks supervision in February. TABLE 10. Particulars of Mental Defectives as on 1st January, 1935. (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 heading of A or B. A.—Number of mental defectives ascertained to be " subject to be dealt with ":— 1. Under " Order ":— M. F. T. (a) (1) In Institutions (excluding cases on Licence)— Under 16 years of age 17 10 27 Aged 16 years and over 42 29 71 (2) On Licence from Institutions— Under 16 years of age 2 — 2 Aged 16 years and over 2 1 3 (b) (1) Under Guardianship (excluding cases on Licence)— Under 16 years of age 1 1 2 Aged 16 years and over 13 5 18 (2) On Licence from Guardianship— Under 16 years of age — — — Aged 16 years and over — — — 2. In "places of safety":— Under 16 years of age 1 2 3 Aged 16 years and over — 1 1 3. Under Statutory Supervision 74 78 152 Of whom:— Awaiting removal to an Institution 4 4 8 4. Action not yet taken under any one of the above headings:— (a) Notified by Local Education Authorities (Sec. 2 (2)) — — — (b) Mental Defectives in receipt of Poor Relief:— (1) Institutional— (a) In Public Assistance Institutions and Municipal General Hospitals not approved under Sec. 37 - - - 48 (b) In Institutions certified under the M.D. Acts (including those approved under Sec. 37):— M. F. T. (1) Cases "placed" under Sec. 3 — — -- (2) Other Cases — — — (2) Domiciliary I 3 4 (c) Otherwise "ascertained" — — — B.—Number of mental defectives not at present "subject to be dealt with" but for whom the Local Authority may subsequently become liable:— 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 (6) Maintained wholly by parents, relatives or others — 1 1 2. Reported to the Local Authority from any reliable source and recognized by them as mentally defective but as to whom no action under the Mental Deficiency Acts has been taken:— (a) Children between the ages of 14 and 16 years — — — Of whom, number, if any, under Voluntary Supervision — — — (6) All other cases 1 — 1 Of whom, number, if any, under Voluntary Supervision — — — Number of above Cases on the Registers of Occupation and Industrial Centres:— Under Statutory Supervision 11 14 25 Under Voluntary Supervision 1 — 1 On Licence from Institutions 1 — 1 Under Guardianship 3 5 8 On Licence from Guardianship — — — DURING THE YEAR 1934. 1. (a) Number of instances in which Licence was granted during 1934:— M. F. T. (1) From Institutions 3 1 4 (2) From Guardianship — — — (6) Number of instances in which cases on Licence have been returned to Institutions or transferred to Guardianship during the year 1934:— (1) To Institutions 1 — 1 (2) To Guardianship 1 — 1 2. Cases notified by Local Education Authorities (Section 2 (2)) duri r. the year 1934 :— Method of disposal. M. F. T. Sent to Institutions (by Order) 1 1 2 Placed under Guardianship (by Order) — — — Placed under Statutory Supervision 5 4 9 Placed in "Places of Safety" — — — Died or Removed from Area — — — 49 Action not yet taken— M. F. T. (a) In receipt of Poor Relief — — — (6) Others — — — Total 6 5 11 3. Of the total number of mental defectives known to the Local Authority:— (а) Number who have given birth to children during 1934:— (1) After marriage 1 (2) While unmarried — Males. Females. (b) Number who have married during 1934 — 1 Training and Occupation Centre. The Occupation Centre continues its good work and affords to both children and adults an opportunity of acquiring some dexterity in handicrafts which, apart from usefulness, results in increased general adaptability. The interest evinced by the older scholars in their work and the comparatively high standard attained in the making of various household requisites and other goods, is a matter of great satisfaction to parents. The number of saleable articles has considerably increased, and in some instances the demand has exceeded the supply. Even in those cases in which there is marked lack of concentration and response to instruction is slow, it is surprising what improvement will result by personal tuition, care and infinite patience. Simple games and drills, the cleaning of teeth and personal hygiene comprise part of the daily routine of the younger children and result in better behaviour, more distinct speech and greater personal control. The morning session is devoted to boys and the afternoon to girls and young children. The average attendance of the former is about 10, whilst that of the girls is usually 20. There has been little illness of an infectious character and the health of those attending the Centre has remained satisfactory, which has resulted in good attendances. The Committee has carefully considered the suggestion of providing a whole-day session for both sexes, but with the present accommodation this is not possible and it is somewhat doubtful if the satisfactory attendances would be maintained. 50 Again, certain of the children are brought to the Centre by guides and parents who kindly assist in this respect, but in many instances the distances are great, and additional journeys would prove inconvenient and necessitate the provision of meals at the Centre, or in close proximity. A small remuneration for completed orders is now offered to those receiving instruction and in consequence there is a greater interest and endeavour to finish the articles in good time. The Exhibition of work and Annual Christmas Party was attended by the Mayor and Mayoress (Alderman T. W. and Mrs. Burden), Mrs. Councillor Wilkens, Chairman of the Committee for the Mentally Defective, and other members of the Council. A great variety of articles consisting of baskets, trays, rugs, mats, bookshelves, knitted goods, etc., made by the scholars was for sale. Much appreciation of the work was expressed by parents and visitors which resulted in numerous repeat orders. Miss Bleadon, the Supervisor, and her helpers are largely responsible for the efficient work of the centre and the increased attendance. TABLE 11. Statistics of Training Centre, 1934. 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 12 210 2,06ft 9.35 24 210 4,249 20.5 6,314 51 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 accommodation for concerts and meetings. The Education Committee is responsible for the cost of the children from five to sixteen years of age, and the Higher Education Committee for the training of persons over 16. During the year five cases were sent to convalescent homes, eleven pairs of special glasses, and three surgical aid appliances were supplied. Many of those with visual defects were sent to hospital for treatment. The Association will not make any grants for glasses until the applicant has been examined by a qualified ophthalmic surgeon. Thirty-six weekly and fifteen monthly Braille and Moon magazines were supplied, whilst the Borough Libraries continue to issue Braille books. Practically all the blind in the Borough have now had free wireless sets provided and installed, and the cost of maintenance where necessary is undertaken. The Ladies Clothing Sub-Committee have again maintained their excellent work with funds raised by them, and the houseto-house collection continues to be successful. The weekly club held at St. Bartholomew's Institute has an average attendance of 90. In addition, eight socials were also held during the winter months in the Minor Hall. The Home Teacher and Visitor to the Blind (Miss Kingston) works in close co-operation with the Association and her sympathetic and skilled activities are greatly valued. The Council's Ophthalmic Specialist examines all new cases and certifies where necessary. Number of cases examined 24 Number of cases certified 21 53 In the following tables, the registration of the blind, ages at which blindness occurred, training and employment and occupations, as at 31.3.35, are set out:— TABLE 12. Welfare of the Blind.—Registration. As at 31/3/35. 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. — — — 3 2 5 1 2 3 8 5 13 9 8 17 16 10 26 17 13 30 32 25 57 36 47 83 122 112 234 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. 18 8 26 1 3 4 6 7 13 4 6 10 12 6 18 10 9 19 11 12 23 18 11 29 23 27 50 15 16 31 11 (a) Training and Employment. Age period 16 and upwards. Employed Undergoing Training Trained but Unemployed (h) No Training but Trainable (i) Unemployable (j) Total (k) By Blind Institutions All others not included in (a) & (b) (c) Total employed (d) Industrial (e) Secondary (f) Professional or University (g) Workshops (a) Home Workers (b) 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. 6 6 12 4 1 5 13 4 17 23 11 34 2 2 4 — - - — — — 6 — 6 4 1 5 84 96 180 119 110 229 (b) Occupations of Employed. Agents, Collectors, etc. Basket Workers Bedding (including Divans and Ottomans) and Upholstering. Boot repairers Brushes Carpenters and Woodworkers Chair Seaters Ministers of Religion Clerks, Typists Telephone Operators Dealers (Tea Agents, Shopkeepers, etc.) Domestic Servants Farmers Hawkers Home Teachers Knitters Labourers Massage Mat Makers Musicians and Music Teachers Netting Makers Newsvendors Porters, Packers and Cleaners Poultry Farmers School Teachers Straw Bagmakers Tuners Weavers Miscellaneous Total Mattress Makers Machinists Upholsterers Pan Wiredrawn Hand Machine Within Institutions for the Blind — 2 3 — — — — — — — — — — — — — — — — 2 — — 1 — — — — — — — — 4 — 12 In approved Home Workers Schemes — — — — — 1 — — — — — — — — — — — — — 1 — — — — — — — — — — 3 — — 5 Others (not pastime Workers) 1 1 — — — 1 — — 1 — — 2 2 1 1 — 4 — — — — 1 — — — — — — — — — — 2 17 Total 1 3 3 — — 2 — — 1 — 2 2 1 1 — 4 — — 3 — 1 1 — — — — — — — 3 4 2 34 Physically and Mentally Defective (All Ages) (a) Mentally Defective. (b) Physically Defective. (c) Deaf. (d) Combination of (a) and (b) (e) Combination of (a) and (c) Total M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 5 2 7 7 7 14 8 8 16 1 0 1 1 0 1 22 17 39 55 TABLE 13. 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 same. Other Visits. Total Visits. No. of Lessons Given. Lessons Given in Cane Basket Work. Braille. Moon. Knitting. Crochet Wool Ball Work. Manual. Straw- bag making. 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 — 1934 235 4,380 37 125 212 4 4,633 488 — 201 123 114 26 — 24 — 56 The Invalid Children's Aid Association. The East Ham Branch of the Association is of inestimable benefit to the invalid and crippled children of the Borough, and the Report for 1934 shows an even greater achievement than that of any previous year. The Public Health Committee and the Education Committee value the close co-operation that exists with the Branch and the opportunity afforded to them of obtaining immediate and suitable treatment or convalescence for the many little sufferers who come under their care. In numerous instances were it not for the expeditious and efficient arrangements made by the Association, considerable difficulty would be experienced in placing children in appropriate institutions, and much hardship would therefore result. The opportunities afforded for furthering the benefit obtained by minor operations and special treatment and of raising the resistance of children after serious illness, is due to the many facilities available and an efficient system which is indispensable alike to the Authority and residents of East Ham. I desire to express my thanks to the Committee and to Miss H. Webber, the Secretary, for their kind assistance during the past year. The following is abstracted from the Annual Report for the year 1934:— Number of cases dealt with 339 New cases 218 Old cases 66 Referred for clothing 28 Referred for visiting, home reports and advice 27 339 The 218 new cases were referred by:— Hospitals and Medical Practitioners 104 Medical Officer of Health 4 School Medical Officer 38 Tuberculosis Officer 37 Infant Welfare Centre 28 Parents, etc. 7 218 57 The types of new cases were as follows:— Tuberculosis 25 Rheumatism, heart and chorea 36 Anaemia and debility 29 Bronchitis and asthma 27 Malnutrition 28 Various 73 218 The 339 cases dealt with during the year have been assisted as follows :— Sent to Sanatoria, Convalescent Homes, etc. 184 Extensions at Homes from previous year 54 Surgical instruments provided 38 Clothing 27 Convalescent Home " Letters" 2 Extra nourishment 1 Referred to other Agencies 6 Referred to for Visiting and Advice 27 339 Infectious Diseases. An increased number of notifications in respect of persons suffering from Scarlet Fever and Diphtheria was received during the year. Many cases of the latter illness were late in coming under treatment, and in some infection appeared extremely virulent and less responsive to curative measures, thus approximating the "Gravis" type. The following article furnished by me appeared in editions of the local press and I am indebted to the Editors of the "Stratford Express," "East Ham Echo "and the "Citizen" for the beneficial results of this publication. Diphtheria. The Importance of Early Diagnosis and Treatment. Diphtheria is a dangerous infectious disease that gives rise to few outward signs at the commencement of the illness, yet it 58 is at this stage that treatment is likely to prove effectual in warding off serious complications or even in saving the life of the sufferer. There is always some reason for a child being "off colour," and when slight sore throat, hoarseness, croupy cough, tenderness of neck glands, lassitude and pallor are present, either singly or together, the possibility of infection by the diphtheria germ must not be overlooked. With such indications parents should obtain medical advice at. once. Patches or a film of greyish deposit subsequently appear on the tonsils or back of the throat and treatment then becomes extremely urgent. Every hour's delay permits a greater quantity of poison to be absorbed into the tissues of the body, and renders the outlook more grave. Of cases treated by means of diphtheria antitoxin (serum) it has been found that on— 1st day of disease—3 deaths occur in every 100 cases. 2nd „ „ „ 12 „ „ „ „ „ „ 3rd „ „ „ 21 „ „ „ „ „ „ 4 th „ „ „ 28 „ „ „ „ „ „ 5th „ „ „ 32 „ „ „ „ „ „ The unnecessary loss of child life consequent upon delay in seeking medical advice and early admission to hospital is a matter of grave concern to members of this Authority and their Medical Officers, and in view of the facilities and accommodation available, should not occur. Efficient and expeditious arrangements for treatment exist and are at the service of all inhabitants of the Borough. Expert advice is available if required. Delay is dangerous, often fatal! Parents! The responsibility in the first instance is yours! Do not class as trivial the danger signals already mentioned! Do not delay in obtaining medical advice! Examination for Diphtheria Germs. The examination of swabs taken from the throat or nose of suspected cases is part of the daily routine of the Public Health Department. A negative result does not necessarily prove the 59 absence of diphtheria and the time required to determine this— approximately 24 hours—may involve disastrous delay in commencing treatment. If there is in the mind of the patient's medical attendant a reasonable suspicion of diphtheria, especially in the case of a young child, the doctor may consider it advisable to commence treatment at once, without waiting for the result of the swab examination, by giving a precautionary dose of antitoxin. This can do no harm, and it may be the means of saving life. It will certainly curtail the period of hospital treatment and tend to avoid serious and distressing complications. THE SAD TOLL OF YOUNG LIVES. During the past five years 1,584 children in East Ham have had diphtheria, and of this number, 121 have died. What a tragedy it is that so many parents have had to mourn for their little ones! What a number of valuable citizens have been lost to the community! THESE CHILDREN NEED NOT HAVE HAD DIPHTHERIA. Since the year 1929 the Council has provided free immunization against diphtheria for all those who desire to avail themselves of the opportunity. This method of preventing diphtheria is founded on a sure scientific basis and the protection afforded by the simple inoculations is effective for several years. The child experiences no pain, little inconvenience, and no after-effects. Surely, three visits to the Immunization Clinic is a very small price to pay for the knowledge that your child will not be confronted with the perils of diphtheria and that you will never have to endure the terror and anxiety experienced by parents whose children have been afflicted with this disease. During the period under review, 2,000 children have attended for immunization. These Children are Protected. Is your child one of the fortunate 2,000 ? Not only are most young children susceptible to diphtheria, but they are more liable than older children to take the disease in 60 a severe form. Most deaths occur under the age of five years. Parents are inclined to wait until their children reach school age, but by doing so they leave the child unprotected during the most critical years of its life. Inoculation should therefore be done at as early an age as possible. Parents! Does not this deserve your careful consideration ? DO NOT WAIT FOR AN EPIDEMIC! It is during an epidemic that parents are most concerned for the safety of their children, but a few months must elapse from the time the child is inoculated until protection is sufficient to resist an attack of Diphtheria. Therefore begin at once, whilst the disease is not prevalent, and there is less risk of infection. NOW IS THE TIME TO PROTECT YOUR CHILD! In most cases your own medical attendant is prepared to carry out the necessary inoculations, or you may attend the School Clinic, Town Hall, East Ham (any Friday at 3 p.m.) or the Maternity and Child Welfare Clinic, High Street School, East Ham (any Friday at 10.30 a.m.), where free treatment is available. The deaths from the seven principal zymotic diseases (Smallpox, Whooping Cough, Measles, Diphtheria, Diarrhoea, Scarlet Fever and Enteric Fever) during the year numbered 84, equivalent to a zymotic death rate of 0.6 per 1,000 population, as compared with a rate of 0.3 for 1933. Only one case of Smallpox was reported, and the following are the particulars:— Initials. Date of Notification. Age. Sex. Probable Source of Infection. No. of contacts traced and kept under observation. State of Vaccination of Patient. H.L. 21.4.34 24 M. Place of Employment 5 Not. 61 VACCINATION, 1934. The Public Vaccinator carried out the following vaccinations during the year:— Number of successful primary vaccinations of children under one year of age 443 Number of successful primary vaccinations of persons one year and upwards 75 Total primary vaccinations 518 Number of successful re-vaccinations 55 Dr. O'Moore acted as Temporary Public Vaccinator throughout the year. Dr. O'Moore and Dr. Brews were permanently appointed as Public Vaccinators as from 1st January, 1935. Scarlet Fever. The number of notifications totalled 979, as against 701 for 1933. There were 5 deaths and 805 cases, or 82.2 per cent. received hospital treatment, compared with 79.3 per cent. for the previous year. Although the type of Scarlet Fever is mild in character and parents are therefore apt to consider the illness less formidable, removal to hospital must still be insisted upon for several reasons. Apart from the likelihood of infection to others in close proximity, the illness thereby getting beyond control, many cases require skilled nursing and close medical supervision. The loss of school attendance in the case of contacts where children are nursed at home is detrimental in every respect. Again the necessity of informing employers with regard to infection in the homes of members of their staff can be avoided by admission of the case to hospital. Diphtheria. The cases notified numbered 379. For 1933, the number was 180. Of the 379 cases, 375 were admitted to and treated in hospital, equivalent to 98.9 per cent., compared with 99.4 per cent. 62 for the preceding year. The number of deaths was 45, equivalent to a case mortality of 11.8 per cent. There is no change in the arrangements for the supplying of antitoxin to Medical Practitioners as outlined in previous reports. Schick Immunization Clinics. During the year 1934, 1,140 infants and children have received three inoculations. The total number of inoculations performed has been 3,822, of which 1,904 were carried out at the Town Hall Clinic, 1,386 at the Maternity and Child Welfare Clinic, 460 at the Infectious Diseases Hospital, and 72 by Private Practitioners. The following figures are intended to indicate the number inoculated and the age groups involved in the cases treated. 1. Town Hall Clinic. Total number of inoculations 1,904 Number inoculated three times 584 Number inoculated twice 18 Number inoculated once 21 In addition to the above, one child was inoculated eleven times, one child ten times, one nine, one seven, three six, four five, and five four times. 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 20 46 45 57 65 66 73 58 56 48 35 30 22 18 233 301 105 639 2. Maternity and Child Welfare Clinic. Total number of inoculations 1,386 Number inoculated three times 386 Number inoculated twice 18 Number inoculated once 16 In addition, one child received seven inoculations, two children six, nine received five injections, and 28 received four injections. 63 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 55 105 78 60 63 20 15 20 10 10 6 10 4 4 361 75 24 400 3. Infectious Diseases Hospital. Total number of inoculations 460 Number inoculated three times 146 Number inoculated twice 8 Number inoculated once 6 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 2 27 20 22 33 17 11 1 2 3 3 2 5 12 104 34 22 100 4. Private Practitioners. In addition to the above2 during the same period, twenty-four children were inoculated three times by Private Medical Practitioners and the ages at which inoculation was performed were as follows:— Ages in years 1 2 3 4 5 6 7 8 9 10 11 12 13 14 and over No. inoculated - — 3 4 1 7 — — 1 - 2 5 1 — 8 8 8 24 N.B.—In considering the combined totals (1-4) it will be noticed that 55 per cent. of the cases are in the age group 1-5 years, 32.5 per cent. in the age group 6-10 years, and 12.3 per cent. in the group over 10 years. The Schick test for susceptibility to Diphtheria was performed during the year in 541 of the completed cases of which 533 proved negative. In eight of the cases positive results were obtained and further inoculations were carried out. 64 Enteric Fever. No cases were notified. Erysipelas. Seventy-four notifications received, 29 received hospital treatment and six patients died. Puerperal Fever. Four cases notified, three received hospital treatment and three died. Puerperal Pyrexia. Eleven notifications received, two were admitted to hospital, no deaths occurred. 65 TABLE 14. 65 Total Cases of Notifiable Diseases, 1911-1934. Disease. 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 Smallpox — — — — — — — 3 1 10 - - - - - - - 17 25 70 51 13 1 1 Scarlet Fever 377 435 526 677 499 267 341 272 530 718 1,355 502 170 215 221 350 798 832 743 484 245 779 701 979 Diphtheria 121 72 258 319 204 225 279 273 451 426 309 198 160 128 246 337 464 669 578 473 196 157 180 379 Enteric Fever 56 13 19 21 5 7 9 2 15 10 7 4 3 5 9 7 2 7 2 3 8 7 5 — Erysipelas 134 152 119 130 96 86 66 52 72 72 57 34 32 38 41 41 38 60 49 63 54 55 69 74 Puerperal Fever 6 8 8 4 4 1 2 1 6 6 5 3 5 5 5 5 4 8 9 10 4 4 7 4 Puerperal Pyrexia Not Notifiable Not Notifiable 11 11 12 14 6 23 10 11 Meningococcal Meningitis 2 6 1 8 6 7 3 3 3 4 — 1 1 1 1 4 1 1 3 8 5 1 3 Encephalitis Lethargica Not Notifiable 4 5 7 — — 9 6 1 2 3 1 — — — 1 1 Ophthalmia Neonatorum — 17 16 16 7 11 13 30 3 11 11 11 6 8 10 12 3 8 6 6 6 9 Ac. Polio Myelitis 2 8 4 1 10 — — 3 1 — — 3 1 1 — 5 — 2 — 1 7 2 5 Ac. Polio Encephalitis Not Notifiable - - - - - - - - - - - - - 3 2 1 Dysentery Not Notifiable - - 1 - - - - - - - - - - - - 1 Malaria Not Notifiable - - 1 - - - - - - - - - - 1 1* — Measles Not Notifiable 1,650 1,404 1,538 Not Notifiable German Measles Not Notifiable 123 115 134 Not Notifiable Continued Fever - - - - - - - - 1 - - - - - - - - - - - - - - - Typhus Fever - - 1 - - - - - - - - - - - - - - - - - - - - - Pneumonia Not Notifiable 85 92 54 79 91 70 114 82 102 59 75 77 148 100 Total 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 1,568 * Induced in an Institution. 66 TABLE 15. Prevalence of and Control over Infectious Disease.—Notified Cases for the 52 Weeks ending 29th December, 1934. 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 979 5 206 393 233 46 68 20 8 — 100 56 54 80 46 143 91 101 170 138 805 5 Diphtheria 379 5 88 156 78 16 28 3 4 1 56 46 21 14 16 35 36 39 40 76 375 45 Erysipelas 74 1 2 1 4 4 8 6 39 9 8 10 7 6 9 5 5 10 7 7 29 6 Puerperal Fever 4 — — — — — 3 1 — — 1 — — — 1 1 — — — 1 3 3 Puerperal Pyrexia 11 — — — — 1 7 3 — — 1 1 — 1 1 1 1 4 1 — 2 — Pneumonia 100 4 12 7 7 8 20 16 16 10 7 14 8 13 2 22 7 13 — 14 52 93 Ophthalmia Neonatorum 9 9 — — — — — — — — 2 — 2 — — — — 2 — 3 5 — Meningococcal Meningitis 3 1 — — — — 1 — 1 — — — 1 1 — — — 1 — — 3 5 Enteric Fever — — — — — — — — — — — — — — — — — — — — — — Acute Polio Encephalitis 1 — — — 1 — — — — — — 1 — — — — — — — — 1 — Acute Polio Myelitis 5 1 — 2 1 1 — — — — — — — 1 1 1 1 — — 1 3 1 Dysentery 1 — 1 — — — — — — — — — — — 1 — — — — — — — Encephalitis Lethargica 1 — — — 1 — — — — — — — — — — 1 — — — — — 4 67 TABLE 16. Disease Cases. Vision Unimpaired Vision Impaired Cases still under treatment at end of year Total blindness Deaths Notified Treated At home Hospital Ophthalmia Neonatorum 9 4 5 5 1 3 — — Report on Work at the Borough Infectious Diseases Hospital for the year 1934. Dr. Landon reports as follows :— During the year 1934, 1,290 patients were admitted to Hospital. This, it is believed, is the largest number admitted in any year and was chiefly due to the incidence of Scarlet Fever which can be said to have reached epidemic proportions. In all, 1,468 patients were treated during the year, 175 patients having remained under treatment at the end of 1933. The number of Scarlet Fever patients admitted was 796, compared with 569 during 1933; the number of Diphtheria admissions was 374, compared with 176 during the preceding year. Table 17 shows the variety of conditions treated during the year and the full use that was made of our cubicle accommodation. The innovation was made during 1934, of giving antiscarlatinal serum to every patient admitted to the general scarlet fever wards. The results appear fully to justify this procedure even in mild cases. Complications are reduced to a minimum and desquamation is slight or even entirely absent. These factors admit of the earlier and safe discharge of patients and the fact that it was possible to discharge 853 cases of scarlet fever during the year while observing, carefully, the recommendations of the Ministry of Health with regard to bed spacing, is an indication of the efficacy of the general serum administration. The cost of serum is, of course, increased but as its use permits, with great regularity, of a shortened stay in hospital, the cost of treatment per patient is, on the whole, diminished. In addition a larger number of patients can be passed through the scarlet fever wards. It will be noticed, under the heading of Scarlet Fever, that, of a series of 500 consecutive cases treated with serum, 87 per cent. 68 were discharged from hospital in four weeks and a further 5.8 per cent. in five weeks. It is interesting to record that practically the whole of the patients admitted to hospital with diphtheria had not been immunised and that in the few cases which had, the attacks were invariably mild. As will be seen below, the hospital helped, during 1934, towards the ideal of a highly immunised community and 460 immunising injections were given. One of the difficulties which the staff had to contend with during the year was the inadequate heating; of D block, the new cubicle block. During the winter months the temperature often fell to 45°F. Special difficulty was met with in the treatment of broncho-pneumonia which requires a temperature of 65° to 70°. However, the question of the heating of D block is under review and it is hoped that, shortly, the present disability will be removed. Reference must also be made to the plague of mosquitoes which infested the hospital from July to October. This caused a great deal of annoyance to patients and staff and few escaped without being bitten to a greater or a lesser extent. Frequently, within 24 hours of admission, patients were so severely bitten on faces and hands as to resemble cases of measles. Sleep was interfered with and even the provision of mosquito-nets proved of little avail. The accommodation at the Hospital, so greatly improved in 1931, is being used to the full to provide nursing facilities as near to the ideal as possible. Diphtheria. During the year, 374 patients were admitted, compared with 176 during the preceding year. Of this number 304 were faucial, 42 nasal, 5 laryngeal, 3 faucial and laryngeal and 20 faucial and nasal. Fifty-two patients remained under treatment at the end of 1933. A severe form of the disease was prevalent and 17 hæmorrhagic cases were admitted. These cases are not hæmorrhagic from the start but become so as a result of prolonged toxaemia in cases of infection with the diphtheria gravis 69 bacillus. The urgency of early diagnosis and treatment is thus apparent. It is not easy, admittedly, to discriminate between the early diphtheritic lesion and the numerous forms of tonsillitis met with in general practice. Nevertheless, it would appear that too much importance is often attached to bacteriological diagnosis in cases where, on clinical grounds alone, a diagnosis of diphtheria would be justified. Of the cases admitted, the number of deaths was 41, givinga total death rate, for completed cases (358), of 11.4 per cent., compared with 10.6 per cent. for 1933. An analysis of the fatal cases is as follows Seventeen cases were hæmorrhagic. In two cases certificates of death were furnished by medical practitioners as the patients died a few hours after admission. In a number of fatal cases, death was determined by some co-existing condition, but the deaths were attributed to diphtheria in accordance with the Registrar-General's Classification of Causes of Death. These cases were as follows:— 1. Nasal diphtheria and broncho-pneumonia. 2. Nasal diphtheria, septicaemia and measles. 3. Diphtheria and retropharyngeal abscess. 4. Nasal diphtheria, broncho-pneumonia and measles. 5. Nasal diphtheria, infective endocarditis and pneumonia. Owing to the severity of many of the cases, large doses of antitoxin were administered, many patients receiving as much as 100,000 units. Intravenous injection was frequently resorted to. Tracheotomy was performed in two cases. In the first case, the laryngeal obstruction was secondary to severe faucial infection. The patient made a good recovery and left the hospital in 58 days. In the second case, tracheotomy relieved the obstruction but the patient died the following day. Post-mortem examination showed the presence of a broncho-pneumonia secondary to a foreign body in the larynx. One unusual case of diphtheria was complicated by an acute nephritis and urgemic convulsions. The patient, however, recovered. 70 The age incidence of the patients admitted was as follows :— Years 0-5 5-10 10-15 15+ Total 93 154 78 49 374 Scarlet Fever. The number of patients admitted was 796, compared with 569 during 1933. 128 patients remained under treatment at the end of 1933. 853 patients were discharged during the year. The following is a summary of the routine treatment. On admission, 10 c.c's. of anti-scarlatinal serum is given in cases of ordinary severity. As soon as the constitutional symptoms begin to subside, the Schick test is performed. Schick-positive patients are subsequently immunised while still in hospital providing the parents are agreeable. It must be mentioned here that the administration of anti-scarlatinal serum definitely affects the Schick test owing to the percentage of anti-diphtheritic serum contained in most specimens of anti-scarlatinal serum supplied. It is, therefore, only the very susceptible patients who give a positive Schick result. On the eighteenth day each patient is Dick-tested. About 95 per cent. are found to be negative. The remaining 5 per cent. are put into cubicles as it is found that they are liable to re-infection if left in the general ward. Patients are generally sent home in four weeks. Thus, of a series of 500 consecutive cases treated as above:— 87 per cent. were discharged in four weeks. 5.8 per cent. were discharged in five weeks. 7.2 per cent. were discharged in from five to eight weeks. Complications for this series totalled 36 cases or 7.2 per cent, which may be analysed as follows:— Otorrhcea, 2.8 per cent. Rhinorrhœa, 2.0 per cent. Endocarditis, 0.8 per cent. Rheumatism, 1.0 per cent. Nephritis, 0.6 per cent. There were five deaths, the mortality rate being 0.58 per cent. as compared with 0.9 per cent. for the previous year. The age incidence was as follows:— Yeats 0-5 5-10 10-15 15+ Total 176 317 182 121 796 7! Broncho- Pneumonia. Thirty-three cases were admitted during the year. Of these, 28 were due to Measles and five to Whooping Cough. Many of the children were gravely ill on admission, malnutrition being an important factor. There were seven deaths, four of the patients dying within 48 hours of admission. There is little doubt that, but for their timely removal to hospital, this number would have been considerably higher, as in nearly all the cases, the home conditions were very bad. In addition, 18 cases of uncomplicated measles were admitted, recovery taking place in all cases. Cerebro-Spinal Fever. One case of considerable severity, in a man of 36 years, was admitted to hospital. Two hundred c.c.'s of anti-meningococcal serum were given, 180 c.c. 's being injected into the spinal theca and 20 c.c.'s intravenously. The patient made a good recovery and left the hospital after 114 days. Bacteriological Examinations. Routine swabbing of every patient, before discharge, was undertaken during the year. In addition, a large number of swabs were received from the Medical Officer of Health, the School Medical Officer and from private medical practitioners. In all, 4,539 swabs were examined. Post-mortem Examinations. Post-mortem examinations were made in five cases where the cause of death was in doubt. The value of this kind of work is illustrated by the case of one child who was admitted as a diphtheria on account of laryngeal obstruction, but was found, post-mortem, to have a piece of rabbit bone in the larynx. Death was due to broncho-pneumonia and heart failure. Laboratory Work. Cerebro-spinal fluid examinations were made in five cases in conjunction with the Memorial Hospital. 72 Operations. One major operation and many minor ones were undertaken during the year. They were as follows:— Radical mastoid operation 1 Mastoid incisions 2 Myringotomy 1 Paracentesis thoracis 2 Tracheotomy 2 Aspiration of abscesses 3 Lumbar punctures 10 Incisions of glandular abscesses 20 Immunisation. Immunisation against diphtheria was advised in the scarlet fever wards in the case of all patients under five years of age, and in all cases which gave a positive Schick test result. 460 immunising doses were given, 160 patients being thus protected. Infection among Staff. The following cases occurred:—Diphtheria 4, Scarlet Fever 2, Erysipelas 1, Tonsillitis 12, Influenza 3. Nurses' Training School. There were 17 entries for the Final State Fevers examination. Eleven candidates were successful, or 64.7 per cent. Of the 10 entrants for the Preliminary Nursing examination, 6 were successful, or 60 per cent. 73 TABLE 17. Admissions, Discharges, Etc., 1934—Borough Infectious Diseases Hospital. Disease. Remaining at end of 1933 Admitted during 1934. Discharged during 1934. Died during 1934. Remaining at end of 1934 Diphtheria 30 354 298 38 48 Diphtheria and Chicken Pox 1 1 2 — — Diphtheria and Impetigo 1 — 1 — — Diphtheria and Measles 1 3 1 2 1 Diphtheria and Pneumonia — 1 — 1 — Diphtheria and Scarlet Fever 3 15 15 — 3 Scarlet Fever 128 796 853 5 66 Scarlet Fever and Chicken Pox — 1 1 — — Scarlet Fever and Measles 2 2 4 — — Anterior Poliomyelitis — 1 1 — — Broncho-Pneumonia and Measles — 28 19 7 2 Broncho-Pneumonia and Whooping Cough — 5 5 — — Catarrhal Gastro-enteritis — 1 1 — — Cerebro Spinal Fever — 1 1 — — Erysipelas 1 2 3 — — Lobar Pneumonia — 1 — 1 — Measles 7 18 25 — — Marasmus and Pemphigus — 1 — 1 — Meningitis and Pneumonia — 1 — 1 — Pyelitis — 1 1 — — Ophthalmia Neonatorum — 1 1 — — Polio Encephalitis — 1 — 1 — Purpura — 1 1 — — Rubella — 13 13 — — Tonsillitis — 26 26 — — Whooping Cough 1 2 3 — — Vincents Angina — 1 — 1 — Streptococcal Meningitis — 1 — 1 — Pneumonia and foreign body in larynx — 1 — 1 — Observation cases — 13 13 — — 175 1,293 1,288 60 120 74 TABLE 18. Borough Infectious Diseases Hospital. Year ended 31st March, 1935. Expenditure Cost per Patient per week £ s. d. Salaries and Wages 6,153 20 5 Superannuation 161 0 6 Provisions 3,380 11 3 Anti-toxin 1,100 3 8 Disinfectants, Drugs and Appliances 379 1 3 Coal, Coke and Firewood 774 2 7 Electricity, Gas and Water 1,148 3 10 Furniture, Bedding and Linen 201 0 8 Uniforms and Dresses 125 0 5 Chandlery and Sundries 560 1 11 Crockery and Hardware 56 0 2 General Repairs 546 1 10 Garden Implements, Seeds, etc. 66 0 2 Maintenance and Upkeep of Ambulances 556 1 10 Printing, Stationery and Advertisements 83 0 3 Rent of Telephones 98 0 4 Rates, Taxes and Insurance 323 1 1 Motor Vehicle Reserve 100 0 4 £15,809 52 6 Cancer. The total deaths from Cancer during 1934 show some decrease over the number for the previous year, viz., 201 against 218, a decrease of 17 deaths. 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. 75 No investigations have been taken as set out in Circular 1136 of 31st July, 1930. Cancer Deaths, 1934. Total deaths 201 Males 96 Females 105 Classification. Cancer (type not stated) 9 Carcinoma 180 Epithelioma 3 Glioma (Malignant) 2 Hypernephroma 3 Rodent Ulcer 1 Sarcoma 3 Total 201 76 TABLE 19. Cancer Deaths.—Parts of Body Affected. Parts of Body Affected. Ages 0-1 1-2 2-5 5-15 15-25 25-35 35-4 5 45-55 55-65 65-75 75 and upwards Total Sex M F M F M F M F M F M F M F M F M f M f M f M f Buccal Cavity and Pharynx — — — — — — — — — — — — — — — — — — 6 1 1 1 7 2 Digestive Organs & Peritoneum — — — — — — — — — — — — 2 1 6 4 18 13 24 15 12 17 62 50 Respiratory Organs — — — — — — — — — — — — 1 — 3 3 6 2 2 1 — 1 12 7 Uterus — — — — — — — — — — — — — 1 — 2 — 4 — 3 — — — 10 Other Female Genital Organs — — — — — — — — — — — — — 1 — 3 — 1 — — — 1 — 6 Breast — — — — — — — — — — — — — 3 — 3 — 7 — 2 — 2 — 17 Male GenitoUrinary Organs — — — — — — — — — — — — — — 5 — 1 — 3 — — — 9 — Skin — — — — — — — — — — — — — — — — — — — — 1 — 1 — Other or Unspecified Organs — — — — — — 1 — — 1 — 1 — 2 — 5 3 2 1 1 — 1 5 13 Totals — — — — — — 1 — — 1 — 1 3 8 14 20 28 29 36 23 14 23 96 105 77 Tuberculosis. Prevention and Control of Tuberculosis. The accommodation provided at Durban House for the Tuberculosis and Chest Clinic has been considered for a long- time unsuitable and unworthy as a centre for the investigation and control of the tuberculosis services of the Borough. Adequate facilities are needed in the campaign against tuberculosis, otherwise the function of the Clinic and the work of the Tuberculosis Officer are necessarily restricted. Much time and thought has been given to the plans of the new Clinic which will be situated on an adjoining site and, in that respect, central for the whole district which it will serve. The outstanding features are lofty and well-ventilated rooms, providing the maximum of light and air and so arranged that patients, whether for consultation, X-ray investigation, artificial pneumothorax or other treatment, will receive attention expeditiously and with due regard to their privacy and comfort. The sequence of the Waiting Room adjoining the Record Office, Nurses and Weighing Rooms, separate Cubicles and Consultation Room, X-ray Room and Operating Room ensures an efficient system in the working of the Clinic. The object is to prevent confusion during a busy session and avoid those long and dreary periods of waiting which affect the regular attendance of patients. On the first floor, rest room accommodation is provided for the medical and nursing staff, and an after-care Committee room, and a small kitchen for the use of the staff. A flat roof over a portion of the building will permit of rest and recreation for patients if required. It is necessary to keep in mind the functions of the Tuberculosis and Chest Clinic, and they may be summarised as follows, viz. :— 1. A Centre for diagnosis. 2. A Centre for observation cases and routine examinations. 3. A Centre for after-care (that is following Sanatorium treatment). 78 4. A Centre for special curative treatment and supervision. 5. A Centre for examination of Contacts. 6. An Information Bureau and Educational Centre. A scheme for the efficient control of all forms of tuberculosis must be comprehensive in character, and the Clinic plays the greater part in this organisation. It will be seen that adequate supervision of the patient and close knowledge of his home circumstances and of the many difficulties with which he has to contend outside, are essentiol to the success of any such social service. So much can be attained by a sympathetic interest in his everyday existence and those difficulties, financial and otherwise, which are encountered by patients suffering from disease of recent origin, or often from chronic and incapacitating illness. The Tuberculosis Officer should be the friend and confidant of his patients, and much stress is laid by most Authorities, including the London County Council, on the necessity for close and personal association with the many factors that arise. The arrangements should be such as will permit the Tuberculosis Officer to visit the homes of his patients, at least once, in order to become familiar with their environmental conditions, and to enable him to augment and supervise the work of the Tuberculosis Visitors. Every facility should exist at the Clinic for diagnosis and scientific investigation and periodical X-ray examinations aire necessary, but this plays only a part in the prevention and control of tuberculosis. It will afford the patient little satisfaction to know that some clinical manifestation of the disease is substantiated, or otherwise by X-rays, or again that some extension is evident in one direction or tendency to heal in another, if he is worried and anxious about his home affairs, his wife and family, his job or his social relationship with his neighbours and colleagues at work. He looks for advice and instruction to the Tuberculosis Officer appointed for the purpose who knows his condition, understands better than anyone else his many difficulties, and whose duty is is to help him get well and prevent other cases of tuberculosis occurring. Where circumstances permit, there should be no break in the continuity of observation by the Tuberculosis Officer, and it is in 79 the interest of the patient that close collaboration should exist between the respective Medical Officers during- his treatment at the sanatorium and when under supervision at the clinic. Housing Accommodation for Tuberculous Patients. The position remains as outlined in the last Annual Report. From enquiries elicited the following- report was submitted in January, 1934, upon infectious cases of pulmonary tuberculosis subject to be dealt with under the Public Health Act, 1925, Section 62. (1) Where it is proved to the satisfaction of a court of summary jurisdiction :— (a) that any person suffering from pulmonary tuberculosis is in an infectious state, and (b) that the lodging or accommodation provided for that person is such that proper precautions to prevent the spread of infection cannot be taken or that such precautions are not being taken and (c) that serious risk of infection is thereby caused to other persons, and (d) that a suitable hospital or institution exists for the reception and accommodation of that person. Proceedings under the Act were taken in the case of a male patient aged 29 years (No. 5). Upon the patient appearing in Court, he agreed to accept treatment at Harts Sanatorium. 80 Report of Infectious Cases of Pulmonary Tuberculosis Previously Notified as having Refused Treatment. Sex and Age. Recommendation. 1.—(M.) 47 yrs. Postpone action under regulations. 2.—(M.) 37 yrs. Has accepted treatment in Harts Sanatorium. 3.—(F.) 42 yrs. Will probably accept treatment when arrangements completed with regard to disposal of family. 4.—(F.) 35 yrs. Has accepted treatment in Harts Sanatorium. 5.—(M.) 29 yrs. For report. "Precautions not being taken." Information refused. 6.—(F.) 59 yrs. Will accept treatment later date. Recommend no action at present. Precautions satisfactory. 7—(F.) 29 yrs. Died December, 1933. 8.—(F.) 55 yrs. Discharged recently from Whipps Cross. Refuses further treatment at present. 9—(F.) 31 yrs. Recommended further treatment. Will accept in March, 1934. 10.—(M.) 50 yrs. Seen with Chairman—patient absolutely refuses on grounds of previous prolonged treatment in Harts. Shelter recommended for a period. 81 East Ham Tuberculosis After-Care Committee. After-Care Committee. The After-Care Committee, under the Chairmanship of Mr. Alderman G. H. Manser, J.P., has continued to do excellent work during the year. Its value in assisting necessitous cases makes the scheme more effective. Fifty-five patients have been provided with clothing and bedding. This 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 £9 14s. 5d., was held in October, and two Dances showed a profit of £4 15s. 2d. A collection on the West Ham Football Ground amounted to £3 4s. 5d. Contribution boxes at the Harts Sanatorium and Tuberculosis and Chest Clinic realised £10 0s. 8d. and 14s. lOd. respectively. As a result of the Musical and Dance Performance given by Wells' pupils on Thursday, 15th November, 1934, a cheque for £13 6s. 9d. was received. Other patients have been helped by the provision of crutches, spectacles, repairs to artificial limbs, and payment of removal expenses. Part cost of funeral expenses was borne in the case of a patient who died at Papworth Hall. Handicraft Class. It is hoped to commence handicraft classes in the new clinic. Several patients are already looking forward to being, at any rate, partially self supporting, and there is little doubt that this factor alone will react favourably on their condition. Dr. Philip Ellman reports as follows on the principal features of the work at the Tuberculosis and Chest Clinic for 1934. Statistical. The number of primary notifications of tuberculosis during the year 1934, was 258 as compared with 249 for 1933. Of these primary notifications in 46.2 per cent. tubercle bacilli were found in the sputum. In other words, 46.2 per cent., 82 of cases were definitely infectious, rand the smaller this number becomes the better the ultimate outlook for the individual sufferers. To wait for a positive sputum before a diagnosis is made is not a thing to be encouraged if our ultimate results are to be as satisfactory as we should like. Notifications. The total number of notified cases on the register of the Clinic on 31st December, 1934, was 959 (pulmonary and non-pulmonary), or 6.99 per 1,000 estimated population, as opposed to 947 or 6.79 per 1,000 population in the previous year. Of these 346 (or 36.1 per cent.) 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 (1925-1934) 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 1934 92 15 80 New Cases. The following are the comparative figures for 1932, 1933 and 1934. 1932. 1933. 1934. New Cases (and contacts) 511 504 510 Number proved, after complete investigation, to be tuberculous 32.1% 33.9% 36.4% 83 In 63.6 per cent. of the new cases (and contacts), following complete investigations, clinical, radiological and bacteriological, no tuberculous disease was found, and they were (1) either free from disease, or (2) suffering from a disease simulating, from the point of view of clinical signs or symptoms, that of tuberculosis, justifying the general practitioner and the Authority's medical officers in making use of the services provided at the Clinic to establish a diagnosis of contacts examined as a routine measure. 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 1934 4,030 3,265 The years 1933 and 1934 show a very appreciable increase in attendances, the bulk of which are for the purposes of examination. This increase is likely to continue further with the advent of the new Clinic, and the better conditions which will prevail. Co-operation of General Practitioners in the Work of the Clinic. During 1934, 58.8 per cent. of new patients were sent with letters from their doctors asking for a consultation. This cooperation of the local practitioners is very much appreciated and encouraged to the full, particularly in view of the ample opportunity the practitioner has in his direct and intimate contact with his patients in assisting us to detect the disease in the early and curable stages. The direct interest exhibited by certain practitioners in the investigations of their patients, by their attendance at the consultation, and their interest in the clinical and X-ray investigations is a noteworthy sign, and their active desire to co-operate in the specialised treatment of their cases by, e.g., insulin, tuberculin, and gold therapy in selected cases, has a very valuable effect on the psychological aspect of the patient. This inevitably reacts more favourably on the patient's physical condition. 84 Consultations at Homes of Patients. During the year 95 visits to patients who were too ill to attend the Clinic have been made to their own homes In 69 of these cases the patient's own doctor was present at the consultation. This again testifies to the interest and co-operation exhibited by many of the local practitioners. Co-operation with Specialised and General Hospitals. There is a continuance of this co-operation, which has been outlined in reports of previous years. The existence of the hospital block at the " Harts Sanatorium " has curtailed considerably the use previously made of the Whipps Cross Hospital. Acknowledgment is made of the help and courtesy received from the Staffs of the various hospitals in the interests of the Council's patients. X-Ray Examinations of the Chest. The number of these examinations has increased by leaps and bounds, year by year, as the following figures show:— 1928 1929 1930 1931 1932 1933 1934 29 97 302 352 4S4 Screen 268 Films 265 533 Screen 264 Films 399 663 (The figures include X-ray examinations by screen and film for the past 5 years.) The steady increase in the use made of this very valuable method of investigation cannot be over-emphasised. The increase, over the already high figure for 1933, of 130 X-ray examinations is noteworthy and inevitable in view of the fund of information which such form of examination reveals for the purposes both of diagnosis and treatment. Whilst these figures show so decided a progressive increase in numbers (which is likely to continue on the upgrade), it must be emphasised that no single method of examination is in itself complete in the diagnosis and treatment of this disease. 85 X-ray examination is recognised as a valuable aid and accessory method, but no clinician of experience in this disease would dream of relying on this method by itself, and it is important that the information afforded by such X-ray examination should not be made the excuse for a faulty clinical examination. It can be stated, however, that viewed in its correct perspective, with an adequate knowledge of the invaluable help it can give with correct interpretation and satisfactory technique, its services are invaluable. In point of fact, no patient has been completely investigated without such radiological examination, no more than he has been completely investigated without a complete clinical examination. The important factors in the diagnosis of pulmonary tuberculosis are:— 1. A full history with particular reference to contact exposure, pleurisy, hæmoptysis, etc. 2. Careful use of the thermometer and pulse record. 3. Careful use of the weighing machine. 4. Repeated examinations of the sputum, collected on special instructions for the purpose of providing a valid specimen. 5. Complete clinical investigation. G. Complete X-ray investigation. It is upon the cumulative results of all these investigations that diagnosis must rest. Whilst great significance is placed upon the value of a good radiological examination it cannot be too strongly emphasised that a poor radiogram is worse than useless and may prove to be a veritable danger from the point of view of interpretation. It is not enough to have an X-ray examination. A radiograph must be technically satisfactory, i.e., it must be taken with the X-ray tube at the correct distance from the patient, the tube being correctly centred and the time exposure sufficiently rapid, i.e., 1/10th second or less. Serious errors of interpretation may arise from failure to observe these elementary rules. The Value of Serial Radiography. Serial radiograms must be taken under exactly the same conditions to be of any real value. 86 It has been found that in order to follow up cases and trace the progress of the patient as a result of treatment, serial photographs at intervals of 3, 6 or 12 months according to the nature of the case, are extraordinarily valuable. The resolution of certain acute types of phthisis following absolute rest, and other forms of therapy in this disease, are sometimes very striking, and serve to give some indication of the real value of serial radiography providing the radiograms are:— (a) technically satisfactory; (b) taken under exactly similar conditions. It is more than likely that in the future serial radiography will help to serve as a valuable guide to prognosis in this disease. The correct interpretation of radiograms. This is indeed a very wide problem It can truly be said that the correct interpretation of shadows, often fleeting, often permanent, requires as much, if not greater, experience than the correct interpretation of the sounds heard via the stethoscope. The interpretation, moreover, must be made with a full knowledge of the history and clinical findings of the patient. Interpretation divorced from these findings is almost worthless and hence the clinician alone is in the most favourable position to interpret and differentiate between the various shadows seen in chest radiograms. Catarrhal Chests. The significance of minor chronic non-tuberculous lung infections is not sufficiently realised. I refer to simple catarrhal lung changes sometimes arising primarily in the lungs, but often due to secondary involvement from catarrhal changes in the upper air passages, with direct secondary involvement of the lower respiratory tract, namely, the lungs. Such "catarrhal chests" form a very large proportion of the new cases and contacts seen at the Clinic during the year. The symptoms of these cases may closely resemble those of pulmonary tuberculosis. Cough; expectoration, not infrequently blood-stained ; loss of weight—often associated with an anxiety state; digestive disturbances and the like may all be present. 87 The greatest care and the most complete investigation, clinical and radiological, as well as a complete bacteriological examination of the sputum, may be necessary to differentiate these cases. In any case such cases are " a soil for a seed " and preventive measures must be adopted to the full. Industrial Lung Diseases. These have been dealt with very fully in connection with pulmonary asbestosis in previous reports. It is astonishing what a large percentage of these cases subsequently, often several years later, develop a superimposed lung tuberculosis, and this indicates the real necessity for keeping such cases under periodic observation. Other dusty trades often produce chest symptoms, and the industrial history is found to be of the greatest significance among workers in such trades. Spontaneous Pneumothorax. The occurrence of a spontaneous collapse of the lungs in apparently healthy persons has been observed among several patients attending the Clinic. Subsequent observation has shown that the air undergoes absorption and the lung re-expands as a general rule, in the course of 6-8 weeks, the patient ultimately recovering, without any further trouble having developed. Whilst the initial symptoms are often alarming the ultimate recovery is often very dramatic. Of course the possibility of a recurrence has never to be forgotten. It is, however, of interest to note that in an appreciable number of these cases tuberculosis is not the cause of the trouble and does not develop subsequently. Such cases, however, require to be kept under periodic observation. Cancer of the Lung. A considerable amount of attention has been directed to the apparently alarming- increase in the incidence of this disease. Any person of the cancerous age (40-60) with chronic chest symptoms, where sputum is persistently negative on examination for tubercle bacilli, and who on examination is found to have 88 some localised chest Infection, must be so suspected until complete investigation has negatived this. Our experience at the Clinic has been no exception to the rule, and several cases have occurred of late where lung tuberculosis had originally been suspected. Numerous theories with regard to the causation of the supposed increase of the incidence of lung cancer have been suggested, but they are all, at the moment, highly problematical. Advances in Thoracic Surgery. Advances in thoracic surgery are proceeding; by leaps and bounds. The approach to the chest by surgery is now made almost as readily as the approach to the abdomen. It must be very strongly emphasised, however, that only the expert Thoracic Surgeon should be relied upon to make such an approach. Cavities in the lung, which are potential dangers to any existing healthy lung, can now be collapsed in a variety of ways. One patient with a cavity in the apex of the lung, about the size of a small apple, has had his cavity successfully collapsed by an open operation, the remaining space between the compressed lung- and the chest wall having been filled in by paraffin wax. This operation of "apicolysis" has been most successful in his case, and he has had no recurrence of previous large haemorrhages. Thoracoplasty of a more localised nature promises great hope for the future welfare of the tuberculous subject, and advances are taking place so rapidly in the realm of thoracic surgery that it is not unlikely that where tuberculous disease is limited to one lobe it may even prove to be possible to remove the offending lobe by " lobectomy " as in the case of bronchiectasis and new growths of the lung. 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. 89 TABLE 20. Return showing the work of the Tuberculosis and Chest Clinic, 1934. 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 69 57 2 4 7 7 9 5 76 64 11 9 160 (b) Diagnosis not completed — — — — — — — — 9 5 1 2 17 (c) Non-tuberculous — — — — — — — — 38 41 10 12 101 B.—Contacts examined during the year:— (a) Definitely tuberculous 10 7 4 3 — 1 1 — 10 8 5 3 26 (b) Diagnosis not completed — — — — — — — — 5 6 4 6 21 (c) Non-tuberculous — — — — — — — — 37 73 40 35 185 C.—Cases written off the Clinic Register (a) Recovered 5 4 4 3 1 2 6 2 6 6 10 5 27 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Clinic Register as tuberculous) — — — — — — — — 84 128 54 55 321 D.—Number of Cases on Clinic Register on December 31st, 1934:— (a) Definitely tuberculous 351 305 34 9 73 80 74 33 424 385 108 42 959 (6) Diagnosis not completed — — — — — — — — 14 11 5 8 38 90 1. Number of cases on Clinic Register on January 1st, 1934 981 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 41 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of" 107 4. Cases written off during the year as Dead (all causes) 80 5. Number of attendances at the Clinic (including Contacts) 4030 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 24 7. Number of consultations with medical practitioners:— (а) Personal 69 (b) Other 231 8. Number of visits by Tuberculosis Officers to Homes (including personal consultations) 95 9. Number of visits by Nurses or Health Visitors to Homes for Clinic purposes 3990 10. Number of (a) Specimens of sputum, &c., examined 1004 (b) X-ray examinations made (inclusive of both film and screen examinations) 663 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 346 Number of Clinics for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 1 91 TABLE 21. 91 PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 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 Group 1 Group 2 Group 3 Total Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus; Group 1 Group 2 Group 3 Total 'Class T.B. Plus) Group 1 Group 2 Group 3 Total (Class T.B. Plus) (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 22 5 6 — 11 1 1 2 — 3 3 1 1 — 2 4 1 — — 1 2 — 1 — 1 F. 7 2 2 4 1 1 — 1 4 — — — 4 — — — — 4 — — — — Children 21 — — — — 1 — — — — 5 — — — — 3 — — — — 4 1 — — 1 Disease not Arrested Adults M. 18 12 13 1 26 2 1 3 1 5 2 2 2 — 4 2 3 2 — 5 8 3 6 — 9 F. 13 8 18 1 27 2 1 3 — 4 2 — 2 — 2 5 4 2 1 7 5 4 4 1 9 Children 9 — — — — 2 — — — — 3 — — — — 1 — — 1 1 5 — — — — Condition not ascertained during the year 2 — 1 — 1 — — — — — 1 — — — — 2 — — — — 2 — — — — Total on Clinic Register at 31st December 92 27 40 2 69 9 3 9 1 13 20 3 5 — 8 21 8 4 2 14 30 8 11 1 20 (6) Not now on Clinic Register and | reasons for removal therefrom. | Discharged as Recovered Adults M. 15 2 — — 2 1 — — — — 1 — — — — — — — — — — — — — — F. 16 1 — — 1 1 — — — — 1 — — — — 1 — — — — — — — — — Children 17 — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of or otherwise removed from Clinic Register 307 34 49 4 87 57 8 26 — 34 44 11 21 2 34 57 18 22 3 43 37 9 23 — 32 Dead Adults M. 37 5 52 28 85 9 2 24 12 38 5 3 27 11 41 10 2 24 10 36 3 3 22 16 41 F. 25 5 27 21 53 6 6 21 10 37 1 1 16 8 25 3 5 10 9 24 7 2 10 6 18 Children 5 — 1 1 2 1 — — 1 1 4 1 — — 1 1 — 1 — 1 — — — — — Total written off Clinic Register 422 47 129 54 230 75 16 71 23 110 56 16 64 21 101 72 25 57 22 104 47 14 55 22 91 Grand Totals 514 74 169 56 299 84 19 80 24 123 76 19 69 21 109 93 33 61 24 118 77 22 66 23 111 1930 1931 1932 1933 1934 (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. — 1 — — 1 2 — — — — 1 — — — — — — — — — — — — — — F. 1 — — — — 1 — — — — — — — — — — — — — — — — — — — Children 1 — 1 — 1 — — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults M. 6 7 7 2 16 5 4 6 — 10 14 5 18 1 24 20 6 22 3 31 20 5 29 15 49 F. 6 1 7 — 8 9 6 7 — 13 15 7 9 — 16 26 4 12 — 16 18 7 22 4 33 Children 4 — — — — 3 — — — — 4 — — — — — — — — — 9 — 1 2 3 Condition not ascertained during the year — — — — — — — — — — 2 — 1 — 1 1 — — — — — — — — — Total on Clinic Register at 31st December 18 9 15 2 26 20 10 13 — 23 36 12 28 1 41 60 10 34 3 47 47 12 52 21 85 (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 23 7 9 3 19 17 7 15 4 36 23 3 15 — 18 4 2 19 3 24 3 1 2 — 3 Dead Adults M. 7 3 13 20 36 4 1 10 6 17 3 1 15 6 22 4 — 8 7 15 1 — 4 4 8 F. 3 4 13 10 27 5 3 15 9 27 3 — 10 8 18 2 — 6 5 11 1 — 2 5 7 Children — — — 2 2 — — — — — 1 — 1 — 1 — — — — — 1 — — — — Total written off Clinic Register 33 14 35 35 84 26 11 40 19 70 30 4 41 14 59 10 2 33 15 £0 6 1 8 9 18 Grand Totals 51 23 50 37 110 46 21 53 19 93 66 16 69 15 100 70 12 67 18 97 53 13 60 30 103 92 TABLE 22. 92 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 193+ 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 Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 4 — 1 – 5 – — — 1 1 — — — 1 1 1 — — — 1 2 — – — 2 F. 5 — — 1 6 — — — — — — — — — — — — — 1 1 — 1 — — 1 Children 2 1 1 19 23 1 — — 1 2 2 1 — 2 5 2 — — 1 3 1 2 — 5 8 Disease not Arrested Adults M. 1 – 2 — 3 1 — 2 — 3 — — — — — 1 — 1 — 2 1 1 1 — 3 F. 6 – 1 – 7 – – – – – – – – – – – – – 2 2 – – – 1 1 Children 4 — 1 13 18 — 1 — — 1 2 — 1 1 4 2 — — 6 8 4 2 — 8 14 Condition not ascertained during the year 1 1 — 2 4 – – – – – – – – – – – – – – – – – – 2 2 Total on Clinic Register at 31st December 23 2 6 35 66 2 1 2 2 7 4 1 1 4 10 6 — 1 10 17 8 6 1 16 31 Transferred to Pulmonary 3 — 1 4 8 – – – – – – – – 1 1 – – – – – – – – – – (b) Not now on Clinic Register and reasons for removal therefrom. Discharged as Recovered Adults M. 5 — 2 2 9 1 – – – 1 – – – – – – – – – – – – – – – F. 3 1 1 1 6 — — — 1 1 – – – – – – – – – – – – – – – Children 8 2 2 14 26 — — 1 1 — — — 1 1 — — — — — 1 — — 1 2 Lost sight of or otherwise removed from Clinic Register 53 10 19 87 169 11 3 6 15 35 6 1 2 10 19 — 2 5 13 20 5 — 3 13 21 Dead Adults M. 2 – 1 – 3 – – – – – – 1 – – 1 1 – – – 1 – – – – – F. 3 – – – 3 1 – – – 1 – – – – – 1 – – – 1 – – – – – Children 4 – – – 4 – – – – – – – – – – – – – – – – – – 1 1 Total written off Clinic Register 78 13 25 104 220 13 3 6 17 39 6 2 2 11 21 2 2 5 13 22 6 — 3 15 24 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary) 101 15 31 139 286 15 4 . 8 19 46 10 3 3 15 31 8 2 6 23 39 14 6 4 31 55 1930 1931 1932 1933 1934 (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. – – – – – – – – 1 1 – – – – – – – – – – – – – – – F. – – – – – – – 1 1 2 – – – – – – – – – – – – – – – Children 1 — 2 6 9 2 — — 2 4 — — — — — 1 — — — 1 — — — — — Disease not Arrested Adults M. 1 1 — 2 4 – – – – – 1 — 1 1 3 2 1 2 1 6 5 — 1 1 7 F. – 2 2 3 7 — 3 1 — 4 4 1 – — 5 2 — 1 — 3 4 — 1 3 8 Children 1 1 — 8 10 1 — 1 2 8 5 1 7 21 4 2 — 10 16 2 1 1 11 15 Condition not ascertained during the year 1 – – – 1 – – – – – – – – – – – – – – – – – – – – Total on Clinic Register at 31st December 4 4 4 19 31 3 3 2 5 13 13 6 2 8 29 9 3 3 11 26 11 1 3 15 30 Transferred to Pulmonary – – – – – – – – – – – – – – – – – – – – – – – – – (6) 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 5 — 3 8 16 2 — 1 2 5 3 4 1 2 10 — — — — — Dead Adults M. — — 2 — 2 — — — — — 2 — — — 2 — — — — — — — — — — F. – – – – – – – – – – – – 1 – 1 – – 1 1 2 – – – – – Children – – – 1 1 – – – – – – – – – – – – – – – – – – – – Total written off Clinic Register — 1 4 6 11 5 — 3 8 16 4 — 2 2 8 3 4 2 3 12 – – – – – Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 4 5 8 25 42 8 3 5 13 29 17 6 4 10 37 12 7 5 14 38 11 1 3 15 30 93 Dental Treatment of Uninsured Tuberculous Patients. 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 arc tuberculous, the approved societies make a contribution towards the cost of dental attention required. 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." The following are the details:— Case No. Date Treatment Cost 1 22/3/34 Seven extractions, complete upper dentures £ s. d. 3 0 0 2 17/4/34 Twenty extractions, complete upper and lower dentures 5 10 0 3 4/5/34 Thirteen extractions, complete upper and lower dentures 5 10 0 4 18/5/34 Complete upper and lower dentures 4 15 0 5 20/7/34 Extraction of all teeth, complete upper and lower dentures (half cost) 3 0 0 G 21/9/34 Three extractions, scaling, fillings and 5 teeth on upper denture 4 16 0 7 22/9/34 One extraction and four fillings 1 12 6 8 15/11/34 Extraction of all teeth and stumps, complete upper and lower dentures 6 6 0 £34 9 6 94 Harts Sanatorium. Dr. J. Crawford reports as follows In 1934 the number of patients discharged was 1 167 (83 males, 75 females, 9 children). Of these, 106 were insured (72 males, 34 females) and 61 non-insured (11 males, 50 females). Deaths 39 (included in the 167 above). Average duration of treatment 19.24 weeks. Number of patient days 27,549. Number of beds available at end of year 80. Average number of beds occupied 75.48 (94.35 per cent.). Out of the 167 cases discharged, two were admitted for observation and discharged non-tuberculous. The immediate results of treatment are as follows:— 41 cases were discharged as " Quiescent " (17 males, 19 females, five children). 82 cases were discharged as " Not Quiescent." Of the latter 64 cases (36 males, 26 females, two children) were "improved" and 18 (seven males, nine females, two children) were "not improved." Three of the 167 cases discharged were Non-Pulmonary. Out of the 167 cases discharged or died, 30 had previously had one course of sanatorium treatment (18 males, 12 females), whilst nine had been in more than once. Seven (five males, two females) twice previously, and two females, four times previously. Fifty-eight patients were admitted by ambulance (22 males, 33 females, three children), 20 from general hospitals and 38 from their homes. Complications. The Complications met with and treated were as follows :— (a) Tuberculous. Laryngitis seven, peritonitis two, bladder and kidney, one, fistula in ano one, glands of neck one, intestines one. 95 (b) Non-tuberculous. Inguinal hernia one, diabetes mellitus, one, anaemia one, arthritis of knee one, chronic nasal catarrh one, bronchitis and emphysema two, bronchitis and asthma one, dental caries six, pyorrhoea four. Artificial Pneumothorax. Collapse of the lung, by introducing air under slight pressure into the pleural space, is a valuable method of giving- complete rest to the organ which is the seat of disease, especially in cases of unilateral lung tuberculosis. This form of treatment, in selected cases, was continued throughout the year, and 152 refills were given. It is very necessary to control this type of therapy by reasonably frequent X-ray examinations, and such patients as were able to make the journey were conveyed by ambulance to Forest Hospital, Buckhurst Hill, for that purpose. Treatment by Gold Salts. This form of treatment used now throughout sanatoria in this country as an adjunct in the treatment of tuberculosis, was instituted in the later months of the year. Watery solutions of gold salts were injected intravenously and salts suspended in oil emulsion were injected intramuscularly, in selected cases. Sufficient time had not yet elapsed at the end of the year to comment on the results ; some of the patients improved during the courses of treatment. Bacteriology. The number of sputa examined in 1034 was 315, as compared with 263 in 1933. Specimens of other body fluids, including pleural effusions, urine, pus, etc., were also examined microscopically. Thanks are expressed to those individuals and members of dramatic societies who have so kindly given of their time and talents to provide entertainment during the winter months. Their performances are very much enjoyed by both patients and staff, 96 TABLE 25. HARTS SANATORIUM.—Year ended 31st March, 1935. Expenditure. Cost per Patient per week. Salaries and Wages £ 3,524 S. 17 d. 9 Superannuation 91 0 6 Provisions 2,353 11 10 Disinfectants, Drugs and Appliances 240 1 3 Coal, Coke and Firewood 354 1 9 Electricity, Gas and Water 732 3 8 Furniture, Bedding and Linen 220 1 1 Uniforms and Dresses 26 0 2 Chandlery and Sundries 320 1 7 Crockery and Hardware 36 0 2 General Repairs 1,255 6 4 Garden Implements, Seeds, etc. 71 0 4 Printing', Stationery and Advertisements 25 0 2 Rent of Telephones 36 0 2 Rates, Taxes and Insurance 353 1 9 X-Ray Examinations 40 0 3 £9,676 48 9 97 TABLE 23. 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 24. Return showing the extent of Residential Treatment and Observation 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 doubtfully tuberculous cases admitted for observation Adults M. 1 1 F 1 1 Children ... — 1 – — 1 Total ... ... — 3 2 — 1 Number of patients suffering from pulmonary tuberculosis Adults m. 43 84 61 20 46 F 30 71 54 19 28 Children ... 1 9 8 – 2 Total ... ... 74 164 123 39 76 N umber of patients suffering from nonpulmonary tuberculosis Adults m. 1 1 F – 1 1 – – Children ... — 1 1 — — Total ... ... — 3 3 — — Grand Total 74 170 128 39 77 98 TABLE 26. Return showing the immediate rksults 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 3 3 1 1 8 2 1 1 1 – – – 5 12 4 21 Not quiescent 2 2 2 1 4 3 7 Died in Institution — — — — — — — 1 – – – – 1 — 1 Class T.B. plus. Group 1 Quiescent 1 – – 2 – – 2 – – – – – 5 – – 5 Not quiescent 2 1 — 1 2 — 1 – – – – – 4 3 7 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus Group 2. Quiescent 2 – – 4 6 – – 1 – 1 – – 7 7 – 14 Not quiescent 6 7 13 7 1 3 4 1 23 18 1 42 Died in Institution — — — 2 1 — 1 2 — 1 2 — 4 5 — 9 Class T.B. plus Group 3. Quiescent – – – – – – – – – – – – – – – – Not quiescent 1 – 8 5 1 2 9 8 17 Died in Institution 2 4 — 6 5 — 3 1 — 1 — — 12 10 — 22 Totals (pulmonary) 18 16 1 39 36 3 12 13 1 4 2 — 73 67 3 146 99 TABLE 26—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 1 – – – – – – – – – – – 1 – – 1 Died in Institution – – – – – – – – – – – – – – – – Peripheral glands. Quiescent – – – – – – – – – – – – – – – – Not Quiescent – – – – – – – – – – – – – – – – Died in Institution – – – – – – – – – – – – – – – – Totals (non-pulmonary) 1 — 1 – – – – – – – – – 1 — 1 2 100 TABLE 27. Return showing the extent of Residential Treatment and Observation 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 doubt- fully tuberculous cases admitted for observation Adults M. 1 1 — F. — 1 1 — — Children ... — 1 — — 1 Total ... ... — 3 2 — 1 Number of patients suffering from pulmonary tuberculosis Adults M. 47 90 66 23 48 F. 31 76 54 19 34 Children 11 19 17 — 13 Total ... ... 89 185 137 42 95 Number of patients suffering from nonpulmonary tuberculosis Adults M. 4 4 5 3 F. 3 8 3 — 8 Children 24 17 22 — 19 Total ... ... 31 29 30 — 30 Grand Total 120 217 169 42 126 101 TABLE 28. Return showing the Results of Observation of Doubtfully Tuberculous Cases Discharged during the Year from Institutions approved for the Treatment of Tuberculosis. Diagnosio on discharge from observation. For Pulmonary Tuberculosis. For Non-Pulmonary Tuberculosis. Totals. Stay under 4 weeks. Stay over 4 weeks. Stay under 4 weeks. Stay over 4 weeks. m. F. Ch. m. F. Ch. m. F. Ch. m. F. Ch. m. F. Ch. Tuberculous – – – – – – – – – – – – – – – Non-tuberculous — — — 1 1 — — — — — — — 1 1 — Doubtful – – – – – – – – – – – – – – – Totals — — — 1 1 — — — — – — — 1 1 — TABLE 29. 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 (1) Admitted during the year. (2) Discharged during the year. (3) Died in the institutions. (4) In Institutions on Dec. 31. (5) Number of patients suffering from pu1monary tuberculosis | Adults M. 2 2 1 3 – F. — 7 3 1 3 Children ... — 2 1 1 — Total ... ... 2 11 5 5 3 Number of patients suffering from nonpulmonary tuberculosis Adults M. — F. 1 2 2 1 — Children — 3 2 — 1 Total ... ... 1 5 4 1 1 Grand Total 3 16 9 6 4 102 TABLE 30 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 3 3 1 1 8 4 1 1 6 – – 2 5 12 13 30 Not quiescent 2 — — 2 2 — — 1 — — — — 4 3 7 Died in Institution — — — — — — — 1 — — — — — 1 — 1 Class T.B. plus. Group 1. Quiescent 1 – – 2 – – 2 – – – – – 5 – – 5 Not quiescent 2 1 1 2 — 1 – – – – – 4 3 — 7 Died in Institution — — — — — — — — — — — — — — – — Class T.B. plus. Group 2. Quiescent 2 4 6 1 1 – 2 – – 9 7 – 16 Not quiescent 7 7 — 14 7 1 3 4 — 1 — — 25 18 1 44 Died in Institution 1 — — 2 1 — 2 2 — 1 2 — 6 5 — 11 Class T.B. plus. Group 3. Quiescent – – – – – – – – – – – – – – – – Not quiescent — 1 — 8 5 — 1 2 — — — — 9 8 — 17 Died in Institution 2 4 — 7 5 — 3 1 — 1 — — 13 10 — 23 Totals (pulmonary) 20 16 1 41 36 5 14 13 6 5 2 2 80 67 14 161 103 TABLE 30.—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 5 2 5 7 Not quiescent – – 1 – – – 1 – – – – 1 1 — 2 3 Died in Institution – – – – – – – – – – – – – – – – Abdominal. Quiescent – – 1 – – – 1 – 2 – – 1 1 – 4 5 Not quiescent – – – – – – – – – – – – – – – – Died in Institution – – – – – – – – – – – – – – – – Other Organs. Quiescent – – – – – – – – – 1 – – 1 – – 1 Not quiescent 2 – – – – – – – – – – – 2 — — 2 Died in Institution — — — — — — — — — — — — — — — — Peripheral Glands. Quiescent – – 1 – – 2 – – 3 – 3 – – 9 9 Not quiescent 2 – – – – – – – – – – – 2 2 Died in Institution — — — — — — — — — — — — — — — — Totals (non-pulmonary) 2 — 5 — 1 2 2 — 5 1 1 10 5 2 22 29 104 TABLE 31. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications. During the Period 1.1.34 to 31.12.34. Age periods. Formal Notifications. Number of Primary Notifications of new cases of tuberculosis. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 & over Total (all ages) Total notifications. Pulmonary Males — 3 3 1 11 11 17 15 18 9 1 89 92 Females — 2 1 3 8 14 28 13 5 4 1 79 82 Non-pulm. Males — 5 3 4 2 — — 1 2 2 — 19 20 ,, Females — 1 3 1 1 1 2 1 2 1 – 13 13 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 — — 1 2 5 4 1 4 1 19 ,, Females — — — — 2 4 10 3 1 2 — 22 Non-pulmonary Males 1 2 1 1 — 1 1 1 — — 8 „ Females 1 1 — 1 — 2 1 1 1 1 — 9 105 TABLE 31—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 2 5 transferable deaths from Registrar General 7 4 Posthumous notifications 3 4 " Transfers " from other areas (other than transferable deaths) 27 4 Other sources if any (specify) (Merchant Seamen) 2 — Notification Register. Number of cases of Tuberculosis remaining at the 31st December, 1934, 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 496 379 875 158 143 301 1,176 Number of cases removed from Registers during the year by reason inter alia of :— 1. Withdrawal of notification — — — — — — — 2. Recovery from the disease 9 7 16 7 4 11 27 3. Death 48 40 88 6 1 7 95 106 TABLE 32. Notified Cases of Tuberculosis, 1934. Ages. Pulmonary. Abdominal. Meninges. Bones and Joints. Glands. Other Organs. Disseminated. All forms. Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Under 1 year – – – – – – 1 – 1 – – – – – – – 1 1 – – – 1 1 2 1 and under 2 3 1 4 – – – 1 — 1 — – — – – — – 1 1 – – – 4 2 6 2-3 1 – 1 – – – I – 1 — – — – 1 1 – – — – – – 2 1 3 3-4 – – – – – – – – – – – – 2 – 2 – – – – – – 2 — 2 4-5 – ] 1 – – – – – – 2 – 2 1 – 1 – – – – – – 3 1 4 5-10 3 1 4 – – – – – – – 1 1 4 2 6 – – – – – – 7 4 11 10-15 1 3 4 1 – 1 1 1 2 — – — 2 1 3 1 – 1 – – – 6 5 11 15-20 12 10 22 – – – — – — 2 – 2 — 1 1 – – — – – – 14 11 26 20-25 13 18 31 – – – — 1 1 1 1 — 1 1 1 – 1 – – – 14 21 35 25-35 22 38 60 – – – — – — 1 – 1 — 1 1 – 1 1 – 1 1 23 41 64 35-45 19 16 35 – – – — – — 1 1 — — — 1 1 2 – – – 20 18 38 45-55 19 6 25 – – – – – – 2 3 5 1 — 1 – – – – – – 22 9 31 55-65 13 6 19 – – – — – — 2 2 4 – – – – – – – – – 15 8 23 Over 65 2 1 3 – – – – – – – – – – – – – – – – – 2 1 3 Totals 108 101 209 1 — 1 4 2 6 9 8 17 10 7 17 3 4 7 – 1 1 135 123 258 107 TABLE 33. Tuberculosis. New Cases and Mortality, 1934. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. M. F. M. F. M. F. M. #] Under 1 vear — — 1 1 — — 1 1 1 — 5 years 4 2 7 2 1 — 2 2 5 — 15 „ 4 4 9 5 — — 1 2 15 — 25 „ 25 28 3 4 5 12 1 1 25 — 45 „ 41 54 2 5 22 24 1 1 45 — 65 „ 32 12 5 5 19 7 1 1 65 and upward „ 2 I — — 1 1 — — Totals 108 101 27 22 48 44 7 8 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths for the year was 1-6. Maternity and Child Welfare. The following Special Report was submitted to the Council in December in accordance with Circular 1433 on Maternal Mortality issued by the Minister of Health. The Minister referred to Circular 1167 of the 11th December, 1930, and the Memorandum accompaying it—156/M.C.W.— dealing with this subject. Circular 1167 draws attention to the fact that the Interim Report of the Departmental Committee on Maternal Mortality and Morbidity stresses two essential measures in securing a reduction in maternal deaths — (1) General and sustained efforts to enlighten the women of the country as to the importance of ante-natal supervision, 108 (2) The improvement and expansion, where necessary, of the maternity services of Local Authorities, which must form an important part of any national scheme. The Minister recognises that in many areas the Local Authorities and Voluntary Associations have already realised the importance of fully exercising' their powers for the care of maternity but there is still much to be done if the preventable maternal deaths are to be prevented. He desires to commend to the earnest attention of all Councils the suggestions contained in Memorandum 156/M.C.W. This Memorandum was considered by the Maternity and Child Welfare Committee in 1931, and the following- recommendations were made:— Report of the Medical Officer of Health. Recommendations or opinion of Sub-Committee. 1. Ante-Natal Clinics. Women mostly attended by midwives of Plaistow Maternity. Charity and Ante-Natal Clinics. Private midwives advised to send cases to Municipal AnteNatal Clinics conducted by Assistant Medical Officers. That this service needs extension and until a complete scheme is built up around the new Maternity Hospital, the appointment of a full-time Assistant Medical Officer will greatly add to the existing efficiency of this service. 2. Supply of Midwives. Suggests municipal midwife service be attached to new Maternity Hospital. Agreed. 3. Consultants in Special Cases. Medical Officer of Health acts as Consultant in cases of Puerperal Fever and cases usually removed to an Institution. Suggest an isolation block for these cases should be provided in new Maternity Hospital and a Specialist appointed. That the Medical Officer of Health be directed to continue to act as Consultant for these cases until Consultant appointed to new Hospital. That Borough Engineer be directed to make provision in plans for new Hospital for an isolation block for cases of puerperal fever. 4. Provision of Ancillaries. (a) Sterilised Maternity Outfits, 109 The issue of these Outfits was discontinued after experiments had proved unsatisfactory. (a) That this question be again considered when the new Maternity Hospital is erected. (b) Home Helps. Does not consider them necessary at present. *(b) That the Medical Officer of Health be directed to submit to a subsequent meeting of the Maternity and Child Welfare Sub-Committee a report on the conditions of service and appointment of Home Helps by neighbouring authorities. (c) Supply of Milk for Mothers. Provision already made with Maternity and Child Welfare Clinics. (d) Laboratory Facilities. Specimens forwarded by Medical men or midwives are sent to London Laboratories for examination. 5. Post Natal Clinics. Agreed. Should be conducted at new Maternity Hospital. 6. Provision for Ophthalmia Neonatorum. Cases are seen by Ophthalmic Surgeon and, if necessary, are admitted to East Ham Memorial Hospital. 7. Provision for Unmarried Mothers. Cases are usually admitted to Forest Gate Sick Home or Salvation Army Hostel. That arrangement be continued, pending erection of new Maternity Hospital. * This Scheme is now in operation. In Circular 1433 the Minister states that he has recently reviewed the action which has been taken throughout the country to give effect to the suggestions in the above Memorandum, and recognises that on the whole there has been a widespread response. 110 He states that a satisfactory feature of this service has been the tendency in some areas to concentrate the maternity work at the institutions transferred to County and County Borough Councils under the Local Government Act, 1929, by modernising the maternity wards and their equipment and by strengthening the medical and nursing staff employed for this work. The report recommends that new maternity accommodation should, where practicable, be associated with general hospitals. This recommendation was made on grounds of efficiency, as well as to facilitate specialist treatment of non-obstetric conditions associated with pregnancy and child-birth, and the Minister is advised that recent experience has shown that it is in general undesirable to provide small maternity homes as separate units. In all areas there is probably need for more intensive efforts to educate women as to the importance of ante-natal supervision and to persuade them to make use of the facilities provided for this purpose. Maternal Mortality Rates. Per 1,000 Live Births. Per 1,000 Total Births. England and Wales. East Ham. England and Wales. East Ham. 1931 4.11 3.90 3.94 3.77 1932 4.21 3.88 4.04 3.60 1933 4.51 3.12 4.32 3.01 Although the reference to a persistent high maternal mortality rate is not applicable to this Borough, the Minister considers it would be desirable to call for a special report in all cases shewing to what extent effect has been given to the suggestions contained in Memo. 156/M.C.W. and the final report of the Departmental Committee on Maternal Mortality, 1930. It will be seen that the Council's findings in 1931 have not yet been fully carried out : further, the recommendations of the final report of 1932 called for information under the following headings:— 1. Improving the Ante-Natal Services. The present arrangements provide for one ante-natal clinic at. the High Street South Centre on Friday morning. The attendances for the years 1931-1933 were as follows:— Ill 1931. 1932. 1933. Number of new cases 192 231 332 Subsequent attendances 369 532 639 Total number of attendances 561 763 971 In addition, the Burges Road Branch of the Plaistow Maternity Hospital provides ante-natal care and the services of midwives for expectant mothers attended in their homes. 1931. 1932. 1933. Number of mothers attended by midwives 554 488 397 A clinic is not available in the North Woolwich area of the Borough. The majority of cases are undertaken by midwives who work in close co-operation with the Ante-Natal Centre of the Plaistow Maternity Hospital at Tidal Basin. It is proposed that a second Ante-Natal Clinic should be held weekly at the new Church Road Centre in the Manor Park area of the Borough, commencing at the beginning of the year. Taken into conjunction with the services of the Voluntary Societies mentioned, the needs of the Borough would appear to be met, although further developments will take place with the completion of the proposed Maternity Hospital. An ante-natal clinic will be attached to this hospital. It will be necessary to consider a clinic for the North Woolwich area when expectant mothers have the opportunity of being admitted to this Maternity Hospital. 2. Provision of Trained Midwives for all Confinements. The number of midwives who notified the Local Supervising Authority of their intention to practise during the year 1933 was 50. Except in 13 cases, all were associated with the voluntary services enumetated above. The number of expectant mothers attended by midwives practising privately was 217 in 1933, and 277 in 1934 (to date). The following statistics relating to notified births are given for comparison:— 1931. 1932. 1933. Midwives' cases 851 796 582 Doctors' cases 1,168 1,352 1,287 112 There is no provision in the County Borough for subsidising midwives. 3. 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 arranges for the accommodation of necessitous cases requiring in-patient treatment, at Queen Mary's Hospital, Stratford, the Maternity Hospital and District Nurses' Home, Plaistow, and the Forest Gate Sick Home. During 1933, three were referred to Queen Mary's Hospital and 77 were admitted to Forest Gate Hospital. The Forest Gate Hospital is administered by the West Ham Public Assistance Committee, who admit cases from East Ham on a user basis. The arrangements are made in accordance with the Public Assistance Regulations. Owing to the fact that an order for admission can only be obtained within a few days of confinement, some hardship and anxiety has been caused to many expectant mothers in the past. The Council have had this matter under consideration, and propose that the special services of a visitor shall be available to ensure supervision and facilitate arrangements for admission to hospital. Abnormal cases coming within the supervision of the Assistant Medical Officer at the Clinic are recommended for admission to Queen Mary's Hospital, Stratford, and to Forest Gate Hospital, for the necessary treatment, at which hospitals specialist service for serious cases is available. In those cases under the care of a general practitioner, the Medical Officer of Health is called in consultation, or arrangements are made for admission direct with one of the London Hospitals —Queen Mary's Hospital or Whipps Cross Hospital. Similarly, the Burges Road Home works in conjunction with the Plaistow Maternity Hospital. 113 The Council of this County Borough is considering the provision of maternity hospital accommodation on the Durban House site which adjoins the East Ham Memorial Hospital. This would provide for the admission of all types of cases and ante-natal cases requiring treatment. The proposed accommodation would be 27 beds with a separate isolation block of two beds, and would permit of extension if required. 4. Isolation and Nursing of Cases of Puerperal Sepsis. These cases are at present admitted to hospitals already mentioned and the proposed maternity hospital would provide such accommodation in the Borough. 5 Service of Consultant for Medical Practitioners. No consultant is available at present apart from the Medical Officer of Health, but the Council would consider the appointment of a consulting Obstetrical Specialist in association with its Maternity Hospital. His services would be available for the general practitioners of the Borough when required. A Maternity Hospital would centralise the maternity work of the district and, in association with voluntary agencies and those of the Council, provide both an effective and comprehensive service within the Borough. It would thus adequately fulfil the recommendations set forth in the various Memoranda of the Minister of Health regarding Maternal Mortality. The above report was considered and deferred for further particulars to be submitted regarding Sterilized Maternity Outfits and the services of an Obstetrical Specialist. These particulars were embodied in a further report to the Council, viz. :—- Sterilized Maternity Outfits. A small quantity of these outfits was ordered about three years ago—very few of which were subsequently issued. 114 In November, 1932, the Ministry of Health intimated that from information supplied to them from other sources certain outfits were not sterile when despatched from the manufacturers. A sample from the Maternity and Child Welfare Department was submitted to bacteriological examination and found unsatisfactory in this respect. In consequence the remaining stock was immediately returned and a fresh batch obtained. One of these outfits was also submitted for investigation and the result showed that all the articles were sterile except the two brown paper sheets contained in the package. This was pointed out to the makers and they replied to the effect that although treated it was impossible to ensure that the paper sheets would not show a growth of bacteria upon examination. I am informed that there is very little demand for the outfits but there are still some in stock for issue either free or at cost price. It is suggested that the brown paper sheets should either be omitted or some material such as mackintosh substituted. Services of Obstetrical Specialists. Arrangements have been made by various Authorities for the services of Obstetrical Specialists in association with Maternity Hospitals or Maternity Departments of General Hospitals and for the purpose of consultations with General Practitioners. Such arrangements as to status, cost and availability have to be sanctioned by the Minister of Health. I find upon enquiry that the usual fees payable are as follows :— £3 3s. for consultations. £2 2s. if minor operations performed. £2 2s. for travelling time according to distance and travelling expenses by car at the rate of 6d. per mile during the day and 1s. per mile at night. In some areas a retaining fee is paid. The demand for such services is apparently infrequent owing to the fact that difficult and complicated cases are usually admitted to a Maternity Hospital or suitable General Hospital within reach, 115 These two reports were considered by the Council and dealt with as follows:— Maternal Mortality. That they have had before them and adopted the reports of the Medical Officer of Health regarding the operation in the Borough of the recommendations contained in the Ministry of Health Circular No. 1167 and Memorandum dated 11th December, 1930, and of the Final Report of the Departmental Committee on Maternal Mortality and Morbidity dated 1932. The reports set out the recommendations or opinions of the Sub-Committee re Maternal Mortality and Morbidity adopted by the Council in March, 1931, and attention is now drawn to developments since that date as follows:— Ante-Natal Clinics.—That in addition to the session on Friday morning at the Central Clinics a session has been arranged for Wednesday morning at the Church Road Clinic. Further, the Burges Road branch of the Plaistow Maternity Hospital provides ante-natal care and a service of midwives to attend expectant mothers in their own homes. As recommended in 1931 an additional full time Assistant Medical Officer has been appointed. Further development of this service will take place upon the completion of the proposed Maternity Hospital to which will be attached an ante-natal clinic. Subsequently, consideration will be needed of the question of providing a clinic in the North Woolwich area. Home Helps.—This service has been inaugurated and at present there are registered the names and addresses of 19 women available as home helps. Maternity Accommodation.—That pending the erection of the Maternity Home, arrangements are under consideration for the admission of maternity cases into Forest Gate Sick Home upon the recommendation of the Medical Officer of Health and for the administration in connection with maternity cases by the Maternity and Child Welfare SubCommittee for and on behalf of the Public Assistance Committee. 116 Abnormal cases coming under the supervision of the Assistant Medical Officers at the Clinics are recommended for admission to Queen Mary's Hospital, Stratford, and to Forest Gate Hospital for treatment, at which hospitals specialist service is available. Cases under the care of general practitioners are admitted after consultation with the Medical Officer of Health to Queen Mary's, Whipps Cross, or the London Maternity Hospitals. Similarly the Burges Road Home works in conjunction with the Plaistow Maternity Hospital. Isolation and Nursing of Serious Puerperal Cases.— These cases are admitted to hospitals, already mentioned. When the Maternity Hospital is erected, provision will be made for an Isolation Ward for treatment of these cases. Proposed Maternity Hospital. That they have considered the joint report of the Borough Engineer and the Medical Officer of Health relative to the proposed Maternity Hospital on the Durban House Site, together with the draft plans prepared by the Borough Engineer, and recommend that the Town Clerk be directed to request the East Ham Memorial Hospital Committee to appoint members to confer with your Sub-Committee at an early date on the whole question of the provision of Maternity Hospital accommodation in East Ham. Birth Control. In a report to the Maternity and Child Welfare Committee dated September, 1934, Circular 1408 of May, 1934, issued by the Minister of Health, subsequent to Memo. 153, March, 1931, was fully dealt with. The Memo, stated that any Departmental sanction which might be necessary to the establishment of such clinics would only be given on the following conditions:— (1) That the clinics will be available only for women who are in need of medical advice and treatment for gynaecological conditions, and (2) that advice on contraceptive methods will be given only to married women who attend the clinics for such medical advice or treatment, and in whose cases pregnancy would be detrimental to health. 117 Circular 1408 referred to clinics already established on these grounds and extended their use to married women suffering from other forms of sickness, physical and mental, such as those mentioned in the Report of the Departmental Committee. The Minister states that what is or is not medically detrimental to health must be decided by the professional judgment of the registered medical practitioner in charge of the clinic. No clinic had previously been formed for the purpose of carrying out suggestions contained in Memo. 153, and consequently the increased scope of the clinic outlined in Circular 1408 was therefore not applicable in this Borough. Those patients, however, for whom such advice appeared necessary had already been recommended to a properly constituted Birth Control Clinic, and the Council recommend this be continued for cases coming within the meaning of both the Circular and Memorandum of the Minister of Health. Dr. J. MacLaren reports as follows on the work of the Maternity and Child Welfare Section for 1934. Staff. The staff at present consists of two Assistant Medical Officers, seven Health Visitors, three Clerks, and one St. John Ambulance Nurse who attends seven Clinics per week. Infant Welfare Clinics. Attendances at Infant Welfare Clinics. Number of general Clinics held during the year 347 Number of individual children who attended the Clinics 3,577 Total number of attendances 33,223 Total number of children who attended the Clinic for the first time during the year :— (1) Children under 1 year 1,351 (2) Children between the ages of 1-5 years 397 Number of medical consultations at general Clinics 13,356 118 Number of medical consultations at special Clinics 1,090 Total number of visits to all Infant Welfare Clinics 34,313 The daily average attendances at the Clinics were as follows:— Central Clinic, Monday afternoon 80 Plashet Grove, Tuesday morning 61 North Woolwich, Tuesday afternoon 23 Masterman Road, Wednesday afternoon 91 Central Clinics, Thursday morning 83 Manor Park, Thursday afternoon 133 Plashet Grove, Friday afternoon 142 Excluding North Woolwich Infant Welfare Centre, which supplies a very small area, the average attendance of children per session at all centres during the year is 98.3, compared with 102.8 in 1933. During 1934, 3,577 children attended the centres. The total attendance of infants from 0-5 increased from 31,483 in 1933 to 33,223, an increase of 1,740. 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 1934, 1,199 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. 119 Immunisation Clinic. The Immunisation Clinic of the Maternity and Child Welfare Service was continued throughout 1934. 43 sessions were held and 1,386 inoculations were made. 460 children were thus afforded protection by this means. The majority of children attending were given three injections of immunising fluid, and 386 cases were thus fully protected. 176 additional attendances were made by 40 cases who showed some reaction to the initial doses, and who consequently received a longer course of smaller injections. In addition, 34 children, whose immunisation was not complete during the year, received 52 injections. 208 Schick tests were performed, and these cases attended once again for reading. Tonsils and Adenoids. During 1934, 149 children received operative treatment, as compared with 171 in 1933. 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. 117 mothers and 316 infants were referred to the dental department during 1934. Ophthalmic Treatment. Ophthalmic defects requiring special treatment are seen at the special clinic each week by the School Ophthalmic Surgeon. During 1934, 43 cases were referred to the School Ophthalmic Clinic. 120 Aural Treatment. Aural cases requiring special treatment are referred to the School Aural Surgeon. During 1934, 18 patients received treatment at the School Aural Clinic. Morning Clinics. Special Clinics are held thrice weekly to deal with cases that cannot be satisfactorily dealt with at the ordinary clinics. Minor ailments requiring observation and treatment are referred to these morning sessions, also defects and cases of difficult feeding, and children who have been referred to the Medical Officer by the Health Visitor from their district visits. The statistics for 1934 are as follows :— Number of medical consultations 1,090 Notification of Births. The Notification of Births Act, 1915, requires that all births be notified to the Medical Officer of Health within 36 hours of their occurrence. All cases notified are visited by the Health Visitor as soon as possible after the doctor or midwife has ceased to attend. Advice is given with regard to the care, management, feeding and clothing of the child, and also the general health and care of the mother. Thereafter, periodic visits are made to the homes of infants during the first two years of life, and, as far as possible, at wider intervals during the next three years, up to the time when the child comes under the observation of the School Medical Service. The visits made by the Health Visitors during 1934 were 20,640. Visits to infants under one year of age 8,046 Visits to children over one year of age 11,591 Visits to tonsils and adenoid cases 118 Visits to ante-natal cases, first visits 71 Visits to ante-natal cases, revisits 247 Visits to foster mothers 225 Special visits not included in the above group 342 121 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. Visiting Home Helps. 6. Home visiting in connection with Ante-natal Clinic and expectant mothers. 7. Ante-natal clinic for expectant mothers. 8. Infant Welfare Clinics for children up to 5 years of age. 9. Special visiting of :— (a) Still Births. (b) Ophthalmia Neonatorum (c) Puerperal Fever and Pyrexia. (d) Visits to tonsils and adenoid cases. (e) Pneumonia. (f) Infantile Diarrhoea. (g) Other special visits. Still Births. The number of still births registered during the year was 68. The proportion of still births to live births was as 1 to 28. The still birth rate was 3.4 per cent. of the registered live births. On investigation into 49 of these still births it was found that the month of pregnancy at which the still births took place were as follows:— 7th month 7 8th month 9 9th month 33 An analysis of the causes to which the still births were attributable will be found in the following table :— Malpresentation 2 Prolonged labour 3 Hydrocephalus 1 Contracted Pelvis 1 Placenta Prævia 1 122 Ante-partum Haemorrhage 2 Albuminuria 5 Breech presentation 8 Valvular Disease of Heart 2 Post-partum Haemorrhage 2 Pelvis Cellulitis 1 Hydramnios 1 Prematurity 17 Causes unknown 22 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 316 Subsequent attendances 588 Total number of attendances 904 Average attendance of expectant mothers per session 17.7 Number of patients referred to Dental Clinic... 40 The following table gives an analysis of the pre-maternal cases found to be slightly or seriously abnormal— Hyperemesis gravidarum 3 Contracted pelvis 12 Albuminuria 32 Ante-partum haemorrhage 5 Malpresentations 7 Cervicitis 6 Valvular disease of the heart 4 Varicose veins 12 Phlebitis 3 Anaemia 5 Bronchitis 6 Expectant mothers are visited by the Health Visitors in their homes and given advice regarding arrangements for confinement and general hygiene. 123 During 1934, 318 visits were paid to expectant mothers. When a Home Help is provided the home is visited on the 4th and 14th day of confinement to ascertain whether the work is satisfactorily undertaken. 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 Hospital. During 1934, 81 cases were admitted to Forest Gate Hospital. Inspection of Midwives. Fifty-one midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1934. Thirty-eight visits of inspection were made by the Inspecting Medical Officer during the year. 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 241 cases as follows :— Mother— Ruptured perineum 72 Prolonged labour 33 Ante-partum haemorrhage 8 Retained placenta 13 Rise of temperature 32 Malpresentations 9 Extended breech 6 Albuminuria 4 Other causes 29 206 124 Child- Prematurity and dangerous feebleness 15 Unsatisfactory condition of infant 4 Discharging eyes 8 Still birth 1 Skin eruptions 2 Other causes 5 35 Puerperal Fever and Puerperal Pyrexia. Four cases of Puerperal Fever and 11 cases of Puerperal Pyrexia were notified during the year under the Regulations of 1926 and 1928. The Puerperal Fever case rate was 1.98 per 1,000 births and the Puerperal Pyrexia case rate was 5.4 per 1,000 births. Maternal Mortality. There were three deaths associated directly with pregnancy. The maternal mortality rate was, therefore, 1.50 per 1,000 live and still births compared with 3.01 in 1933. Ophthalmia Neonatorum. During 1934, nine cases of Ophthalmia Neonatorum were notified. For result of treatment, see table 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 1934 was £2,189. In every case careful investigation of the family circumstances is made to ensure that only necessitous cases shall receive this benefit. 125 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. Twenty-eight cases were referred to the I.C.A.A. and received treatment. 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. (b) Number of children on the Register : (i) at the end of the year, 36. (ii) who died during the year, 1. (iii) on whom inquests were held during the year, — (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) (iii) (c) Nil (g) Number of orders obtained during the year under Section 67 of the Act of 1932: (i) from a court of summary jurisdiction1 (ii) from a single justice Nil 126 Home Helps. During 1934, 12 suitable applicants were registered as Home Helps and 15 applications were received for the services of Home Helps. Maternity Boxes. Maternity Boxes containing clothing and necessities for newborn babies are available upon application to the Senior Health Visitor. These were provided by means of a grant from the Mayor's Fund at the request of Mrs. Alderman Taylor, Vice-Chairman of the Committee. Unemployment and Outdoor Assistance. Extent of Unemployment during 1934. Mr. D. G. Bolton, Manager, East Ham Employment Exchange, has kindly supplied the following statistics :— 127 TABLE 34.—Number of Persons Registered As Unemployed during 1934 at East Ham Employment Exchange. (1) Live Register. January. February. March. April. May. June. Men Boys Wom'n Girls Men. Boys. Wom'n Girls. Men. Boys. Wom'n Girls. Men. Boys. Wom'n Girls. Men. Boys. Wom'n Girls. Men. Boys. Wom'n | Girls. (2) Persons normally in Full Time Employment 3,048 35 483 27 2,909 41 455 34 2,644 33 422 11 2,400 29 408 14 2,229 28 404 19 2,136 12 351 7 (3) Non-Claimants to Benefit (i.e., persons registered for work only) 447 200 106 156 434 152 127 112 446 78 115 62 435 181 96 110 422 129 85 98 446 46 82 42 (4) Persons normally in Casual Employment 1,028 1 3 — 1,001 — — — 951 — — — 781 — 1 — 771 — 3 — 920 — 5 — (5) Temporarily stopped 30 1 112 2 26 — 98 1 30 — 55 — 28 — 56 — 23 — 65 — 37 — 118 1 (6) Total 4,553 237 704 185 4,370 193 680 147 4,071 1ll 592 73 3,644 210 561 124 3,445 157 557 117 3,539 58 556 50 (1) Live Register. July. August. September. October. November. December. Men. Boys. Wom'n Girls. Men. Boys. Wom'n Girls. Men. Boys. Wom'n Girls. Men. Boys. Wom'n Girls. Men. Boys. Wom'n Girls. Men. Boys. Wom'n Girls. (2) Persons normally in Full Time Employment 2,187 14 311 3 2,085 21 321 18 2,171 33 356 11 2,336 43 374 9 2,378 29 343 6 2,538 39 509 23 (3) Non-Claimants to Benefit (i.e., persons registered for work only) 439 69 67 56 428 187 79 122 437 165 129 96 446 85 98 64 453 60 80 31 446 161 73 148 (4) Persons normally in Casual Employment 904 1 1 — 805 — 3 — 804 — 8 — 972 — — — 899 — 6 — 806 — — — (5) Temporarily stopped 34 — 159 3 58 — 123 2 182 — 100 1 60 — 95 13 48 1 130 6 55 — 149 12 (6) Total 3,564 84 538 62 3,376 208 526 142 3,594 198 593 108 3,814 128 567 86 3,778 90 559 43 3,845 200 731 183 129 Outdoor Assistance—Public Assistance Committee. The following statement, kindly provided by Mr. C. M. Ready, the Public Assistance Officer, shows the average number of persons receiving Outdoor Assistance under the Public Assistance Committee during the 12 months ending 31.12.34 :— Men. Women. Children. Total. January 1,164 1,581 1,621 4,366 February 1,182 1,600 1,645 4,427 March 1,163 1,573 1,587 4,323 April 1,152 1,578 1,514 4,244 May 1,107 1,529 1,445 4,081 June 1,118 1,546 1,522 4,186 July 1,133 1,579 1,514 4,226 August 1,112 1,561 11,488 4,161 September 1,126 1,566 1,474 4,166 October 1,158 1,612 1,524 4,294 November 1,177 1,632 1,571 4,380 December 1,217 1,702 1,678 4,597 Crematorium. The City of London Cemetery, situated at Manor Park, contains an, 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. 130 TABLE 35. METEOROLOGICAL RECORD—YEAR 1934. Rain Gauge 5-in. in diameter, placed 1 fool above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Mean Temperature of Air. Rainfall. Highest Maximum. Lowest Minimum. Mean of No. of Days on which Rain fell, 0.01 and over. Amount collected in inches. Mean rate of fall for Rainy Days. Greatest fall in 24 hours. Date of greatest fall. All Highest. All Lowest. January 56° 24° 45°. 0 34°.8 39°.9 15 1.08 0.07 0.26 11th February 54° 24° 45°.0 33°.0 39°.0 6 0.13 0.02 0.04 28th March 58° 30° 49°.5 36°.4 42°.9 17 1.84 0.11 0.25 6th April 76° 30° 56°.3 41°.4 48.°8 14 2.36 0.17 0.53 27th May 79* 40° 64°.6 46°.8 55°.7 6 0.48 0.08 0.16 6th June 86° 46° 71°.3 52°.7 62°.0 9 1.49 0.16 0.46 28th July 85° 67° 76°.7 57°.0 66°.8 6 0.68 0.11 0.34 24th August 80° 44° 71°.6 54°.7 63°.2 11 1.83 0.17 0.52 28th September 82° 44° 71°.4 52°.9 62°.2 7 1.11 0.16 0.60 2nd October 67° 32° 59°.4 48°.3 53°.9 14 1.09 0.08 0.25 2nd November 56° 31° 48°.8 40°.5 44°.6 8 2.03 0.25 0.76 10th December 57° 34° 51°.5 44°.4 48°.0 25 4. 32 0.17 0.49 6th Means and Totals for the Year. 86° 24° 59°.3 45°.2 52°.3 138 18.44 0.13 0.76 10th Nov. The Rainfall for the Year was 1.31 ins. above, and the number of days on which rain fell 4 above the year 1933, at East Ham. 131 TABLE 36. 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) 12 – – Workshops (including Workshop Laundries) 168 3 – Workplaces (other than Outworkers' premises) 6 — — Total 186 3 – 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 2 2 – – Overcrowding — — — – Want of drainage of floors — — — – Other nuisances 2 2 1 – Sanitary accommodation :— Insufficient — — – – Unsuitable or defective 1 1 — – 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 9 9 1 – * Including those specified in sections 2, 3, 7 and 8of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Outwork in Unwholesome Premises, Section 108 Nil. 132 Sanitary Section and Housing. Mr. G. D. Lill, Chief Sanitary Inspector, reports as follows :— 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 no water supply to a house. The owner-occupier was proceeded against under the Public Health Acts with a result as recorded under that heading. 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 133 collected once weekly, all of which is normally burnt in the Destructor. Sanitary Inspection of the Borough. The particulars of these inspections are set out in detail as follows :— TABLE 37. Inspections for the Year. Ordinary House-to-house Total January 628 430 1,058 February 563 452 1,015 March 739 431 1,170 April 644 418 1,062 May 530 637 1,167 June 542 448 990 July 538 265 803 August 568 343 911 September 538 581 1,119 October 688 468 1,156 November 706 362 1,068 December 764 220 984 Total for Year 7,448 5,055 12,503 Small Pox Contacts. In addition to the foregoing inspections, 26 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 f/,055 house-to-house inspections for the year 1934 as compared with 5,528 for the previous year. At 65.76 per cent. of these visits sanitary defects were found. 134 TABLE 38. 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. Ord. H. to H. Ord. H. to H Ord. H. to H. Ord. H. to H. Ordinary House to House January 86 15 68 — 38 — 86 97 62 68 37 65 62 — 77 90 36 — 76 95 628 430 February 88 23 53 35 36 38 54 44 64 95 53 — 48 47 74 113 27 — 66 57 563 452 March 105 26 67 — 79 80 67 — 62 20 57 88 53 30 124 109 54 35 71 43 739 431 April 95 14 67 — 30 — 83 99 56 7 37 80 62 5 73 144 44 32 97 37 644 418 May 101 8 68 — 31 — 49 121 47 135 34 15 31 127 66 113 35 76 68 42 530 637 June 97 23 56 — 40 15 40 100 75 35 36 1 46 60 61 95 31 58 60 61 542 448 July 72 20 51 — 30 — 52 71 58 49 50 20 66 22 60 52 33 — 66 31 538 265 August 110 16 53 — 20 — 40 23 59 1 42 69 61 54 71 81 30 58 82 41 568 343 September 88 56 44 — 35 — 58 89 53 45 41 55 57 122 54 96 36 97 72 21 538 581 October 107 17 68 30 57 — 38 114 69 59 39 43 84 84 85 41 50 80 91 — 688 468 November 92 36 73 — 45 — 81 82 71 — 72 50 53 25 101 68 45 58 73 43 706 362 December 92 — 63 — 60 6 93 53 83 — 79 30 69 — 90 23 43 55 92 53 764 220 1133 254 731 65 501 139 714 893 759 514 577 517 692 576 936 1025 464 549 914 524 7,448 5,055 135 TABLE 39. Complaints Received for 1934. Manor Park Woodgrange Kensington Little Ilford Plashet Castle Central Wall End Greatfield South Total January 12 16 13 16 15 7 12 13 3 16 123 February 8 9 19 14 20 13 8 11 6 10 118 March 8 11 10 15 10 10 12 7 6 12 101 April 17 11 13 17 19 14 19 20 9 15 154 May 9 10 10 15 17 18 21 15 7 16 138 June 9 13 11 20 16 13 19 13 5 16 135 July 26 12 13 23 12 11 25 24 5 19 170 August 20 9 13 22 18 14 24 12 9 14 155 September 8 11 12 29 13 9 28 13 6 15 144 October 23 12 23 20 17 7 16 17 5 13 153 November 18 26 18 27 20 20 16 17 5 20 187 December 17 15 15 31 15 14 20 11 11 15 164 175 155 170 249 192 150 220 173 77 181 1,742 Nuisances. As a result of the inspections shown in the foregoing tables 18,084 nuisances were discovered. A detailed list is given in the inset table, No. 47. To secure abatement the following notices were served :— 1933. 1934. Preliminary 5,155 4,708 Statutory 1,221 937 6,376 5,645 136 Complaints. The following table shows the number of complaints received for the year as compared with the previous year :— TABLE 40. Year Written Oral Total 1933 418 1,282 1,700 1934 507 1,235 1,742 For details see table on previous page. TABLE 41. Notices Complied with during the year ended 31st December, 1934 :— District No. 1 No. 2 No. 3 No. 4 No. 5 Total Complied 519 915 1,037 1,776 1,216 5,463 Notices Outstanding at 31st December, 1934:— TABLE 42. District No. 1 No. 2 No. 3 No. 4 No. 5 Total Informal 89 103 198 296 256 942 Statutory 7 17 22 89 73 208 Rents Restriction (Notice of Increase) Act, 1923. Twenty-seven applications were made by tenants for certificates under this Act. Thirteen were granted. In 11 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 three the necessary work was carried out under the Public Health Acts. 137 TABLE 43. Prosecutions under the Public Health Acts for the Year 1934. Date. Situation of premises. Offence. Result. March Land. — Hampton Road Non-compliance with sanitary notice Work complied. Withdrawn 2s. 6d. costs March Denbigh Road do. Work complied. Withdrawn 2s. 6d. costs April Halley Road do. Work complied. Withdrawn 2s. 6d. costs May Strone Road do. Work complied. Withdrawn 2s. 6d. costs May do. do. Work complied. Withdrawn 2s. 6d. costs May Land. — Greenhill Grove. do. Work complied. Withdrawn 2s. 6d. costs May Vicarage Lane do. Work complied. Withdrawn 2s. 6d. costs May do. do. Work complied. Withdrawn 2s. 6d. costs October Ernald Avenue do. Work complied. Withdrawn 2s. 6d. costs October do. do. Work complied. Withdrawn 2s. 6d. costs October do. do. Work complied. Withdrawn 2s. 6d. costs November Parkhurst Road do. Work complied. Withdrawn 2s. 6d. costs November Browning Road do. Fined £1. December Albert Road do. Work complied. Withdrawn 2s. 6d. costs 138 TABLE 43— continued. Date. Situation of premises. Offence. Result. December Eastbourne Road Non-compliance with sanitary notice Work com plied. With drawn 2s. 6d. costs December do. do. Work com plied. With drawn 2s. 6d. costs December do. ' do. Work complied. Withdrawn 2s. 6d. costs December do. do. Work complied. Withdrawn 2s. 6d. costs December do. do. Work complied. Withdrawn 2s. 6d. costs December do. do. Work complied. Withdrawn 2s. 6d. costs December do. do. Work complied. Withdrawn 2s. 6d. costs December Alexandra Road do. Work complied. Withdrawn 2s. 6d. costs December do. do. Work complied. Withdrawn 2s. 6d. costs 139 TABLE 44. Prosecutions under the Food and Drugs (Adulteration) Act, 1928, for the Year 1934. Date Offence. Result. February Selling milk deprived of 20% of its milk fat Fined £10 February Selling milk deprived of 20% of its milk fat Dismissed See previous case February Selling milk deprived of 20% of its milk fat Dismissed See previous case October Selling minced meat containing sulphur dioxide to the extent of 1500 parts per million Fined £2 Costs 10/6 October Selling milk deprived of at least 20% of its milk fat Fined £2 Costs 10/6 Special fees for analyst £4 14 6 November Delivering to the Central Hall Dining Rooms, E.6, a quantity of suet not of the nature, substance and quality demanded to the prejudice of the purchaser Dismissed Improper service Smoke Abatement. Six occurrences of factory smoke nuisance were observed during the year, two being from the same premises. In each case the manager and stoker were cautioned by the District Inspectors and the nuisances abated. 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. 140 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 214½ Wanstead Flats is an open unfenced space under the control of the City Corporation. The Royal Victoria Gardens is an enclosed park abutting on 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. 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. 141 Rag Flock Act. There are no premises in the Borough in which Rag Flock is manufactured. Of three samples taken from furniture upholsterers, one was satisfactory, the remaining two being taken in connection with a prosecution during the year 1933 and were not analysed. Public Water Closets and Urinals. There are 11 public conveniences in the Borough under the supervision of the Cleansing Superintendent of the Borough Engineer's Department. No complaint has been received during the year and they have been well maintained in a satisfactory condition. There are 34 Public Houses and Beer Houses in the Borough, the majority of which are well equipped with sanitary conveniences and with an occasional exception these are also well maintained. Schools. There are 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 45. Housing Statistics. Number of new houses erected during the year:— (a) Total (including numbers given separately under (b)). (i) By the Local Authority 29 (ii) By other Local Authorities — (iii) By other bodies and persons 180 (b) With State assistance under the Housing Acts: (i) By the Local Authority 29 (a) For the purpose of Part II. of the Act of 1925 — 142 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) 10,478 (b) Number of inspections made for the purpose 32.716 2. (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 – (b) Number of inspections made for the purpose 3. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation – 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 5,529 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 4,528 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 28 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners Nil. (b) By Local Authority in default of owners Nil. B.—Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 4,708 143 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 935 (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 underground rooms in respect of which Closing Orders were made Nil. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. E.—Proceedings under Section 3 of the Housing Act, 1925 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, G, 7, 8, 9 and 10. STOREY STREET: 1, 3, 5, 7, 9, 11, 13, 15, 17, ]9, 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. 144 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. 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, and on February 23rd, 1934, the Orders were confirmed in respect of the Market Street property and of Numbers 1 to 19, Storey Street, the remainder of the dwellings in this latter street being excluded from the provision of the Compulsory Purchase Order. In issuing the Orders, the Ministry suggested that the Council should take action under Section 17 of the Act, and this was accordingly carried out and the houses are in process of being rendered fit for human habitation. Certain of these houses in respect of which notices under Section 17 had been served were the subject of appeal to the County Court, and by agreement such notices were amended. In connection with the re-housing of families from the clearance area, the Council with the approval of the Ministry of Health accepted the estimate of the Borough Engineer for the erection of 17 houses and 12 flats on vacant land at Gooseley Lane. At the close of the year this contract was being carried out. The plans and estimate of the Borough Engineer for the erection of 18 dwellings on the Claremont Street and Francis Street Clearance Area sites are under consideration. (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 145 milk carriers to ensure the milk being delivered as it comes from the cow. An increasing number of consumers is being; supplied with their milk—much of it sterilised or pasteurised—in capsuled bottles, thus avoiding any contamination in transit or in the house. Dairies. There are 130 registered premises for the sale of milk in the Borough. This number includes a few shops other than dairies where milk is sold. These premises have been periodically inspected and are maintained in good condition. Milk (Special Designation) Order, 1923. Dealers' licences (Form B) were granted for the Sale of Milk under this Order. 3 for Grade A. 5 for Grade A (Tuberculin Tested). 13 for Pasteurised. 1 for Certified. 1 for Grade A Pasteurised. One Dealer's licence (Form B) was granted for the bottling of Grade A (Tuberculin Tested) Milk under this Order. One Pasteuriser's licence (Form C) was granted for the pasteurisation of milk under this Order. Supplementary licences (Form D) were granted for the Sale of Milk under this Order. — for Grade A. 1 for Grade A (Tuberculin Tested). 1 for Pasteurised. —for Grade A Pasteurised. — Certified. • Bacteriological Examinations. Sixteen 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, 146 Ten samples of Ice Cream were submitted for bacteriological analysis, five of which were certified as being; of a high standard of purity, and five were satisfactory. Two samples of Cream were also submitted for bacteriological analysis and were found to be of a very high standard. (b) Meat and other Foods. Public Health (Meat) Regulations, 1924. Considerable time has been spent by the Inspectors on this important branch of the work. All owners and occupiers of slaughter-houses are supplied with printed and addressed notification forms. During the year 1,172 notifications of intention to slaughter were received referring to — Cattle 2,127 Sheep 931 Pigs 20,838 Lambs 3,542 Calves 462 27,900 Slaughtering; is carried out at all hours of the day up to late evening and also on Sundays. There is a rota for the District Inspectors to take extra office hours and Sunday duty in turn. The Inspector on duty rings up my house at 10.30 a.m. on Sundays to report and receive any further messages. This arrangement, which has been in operation for some years, has been found to work very satisfactorily. Slaughterhouses. Following is a list of slaughter-houses in the Borough:— Manor Way Farm, New Beckton. 319, Green Street. 167, Plashet Grove. 843, Romford Road (not used during past 4 years). 524, Romford Road. 733, Romford Road. 28, Station Road. Forest View Road. 147 Food Supplies. The food supplies of the Borough are exceedingly good. As 1 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. Four parcels of various goods purchased from retail tradesmen were condemned, and the purchasers reimbursed on my certificate. Three wholesale deliveries were 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 twenty-eight samples were taken under the above Act, of which 126 were Milk. These were all submitted to Dr. Bernard Dyer, the Public Analyst for the Borough. Of this number 37 were taken formally, 32 of which were certified to be genuine. Details of the five non-genuine samples are as follows:— (i) A sample of Milk contained 28 per cent. of added water and was submitted by a resident who suspected that it had been adulterated after delivery. (ii) A sample of Milk showed a deficiency of milk fat to the extent of at least 20 per cent. Summonses were laid with the result that the vendor was fined £10. (iii) A sample of Milk showed a deficiency of milk fat to the extent of 20 per cent., with the result that the vendor was fined £2 together with costs and special fees to a total of £5 5s. (iv) A sample of Minced Meat contained sulphur dioxide to the extent of 1,500 parts per million. A summons was laid, with the result that the vendor was fined £2 and 10s. 6d. costs. 148 (v) A sample of Suet contained moist and mouldy rice flour to the extent of 15.3 per cent. A summons was laid but dismissed owing to improper service. Three hundred and ninety-one informal samples were taken, of which 383 proved to be genuine. Of the non-genuine:— (i) A sample of Milk was deficient in milk fat to the extent of at least 33 per cent. (ii) A sample of Beef Sausages was found to contain sulphur dioxide in the proportion of 450 parts per million. (iii) A sample of Whisky had a strength of 36 degrees under proof. (iv) A sample of Milk was deficient in milk fat to the extent of at least 15 per cent. (v) A sample of Suet contained extraneous moisture to the extent of 4 per cent. (vi) A sample of Milk was deficient in milk fat to the extent of 5 per cent. (vii) A sample of Whisky had a strength of 36 degrees under proof. TABLE 46. The following is a detailed list of the articles sampled:— Almonds, Essence of 1 Cheese 3 Almonds, Ground Children's Cough Linctus 1 Anchovy Paste 1 Aspirin, Quinine and Cinnamon Tablets 1 Chocolate Assortment 1 Chutney Sauce 1 Bakewell Tart 1 Citrate of Magnesia 1 Barley Sugar Sticks 1 Cocoa 6 Beef Cubes 1 Coffee 2 Beef, Minced 4 Coffee and Chicory 1 Beer 1 Cocoanut, Dessicated 2 Blancmange 1 Cream, Fresh 20 Brawn Cream, Tinned 1 Bread 4 Cream of Tartar 1 Brine 1 Cream, Split 1 Bronchial Lozenges 1 Custard Powder 1 Butter 26 Dessert Cake 1 Camphorated Oil 1 Dripping 1 Castor Oil 1 Figs 2 149 TABLE 46—continued. Fish Paste 1 Parrish's Food 1 Fruit Pectin 1 Peaches, Sliced 1 Fruit, Mixed 1 Pears, Dried 1 Gin Peas, Cooked 1 Ginger Bread 1 Peas, Green 1 Ginger Wine Essence 1 Peas, Prepared 1 Glace Cherries 1 Peas, Soaked Glycerine 1 Peas, Tinned 1 Grape Fruit 1 Pectoral Balsam 1 Grape Fruit Powder 1 Pepper 4 Grape Fruit Wine 1 Piccalilli 2 Herbal Cough Candy 2 Pickle, Sweet 2 Herrings in Tomato Sauce 2 Pilchards 1 Pills, Colocynth Compound 1 Ice Cream 2 Influenza Mixture 1 Polish Nuts 1 Jam, Raspberry Jam, Red Plum 2 Pork Pie 1 1 Prunes 1 Jam Roll 1 Puffed Pastry 1 Jellied Eels 1 Rennett, Essence of 1 Jubes, Blood 1 Rice, Ground 2 Lard 8 Rice, Flaked 1 Lemonade Powder 3 Rum 3 Lemon Crystals 1 Salmon 1 Lemon Curd 1 Salmon, Pink 1 Lime Fruit Health Saline 1 Salmon, Red 2 Salmon and Shrimp Paste 1 Lime Water 2 Liquorice Powder 1 Salts, Liver 1 Malted Milk, Horlicks 1 Sauce 1 Margarine 11 Sauce, Yorkshire 1 Marmalade 3 Sausages 1 Marmalade, Orange 1 Sausages, Beef 11 Meat Pie 2 Sausages, Breakfast 3 Milk 126 Sausages, Liver 1 Milk, Evaporated 1 Sausages, Parisian 3 Milk, Condensed 2 Sausages, Pork 9 Milk, Sterilized 2 Sausages, Roll 1 Milk Scone 1 Sausage Meat, Beef 1 Mince Pie 1 Sausage Meat, Pork 1 Mincemeat 1 Scone 1 Minced Meat 7 Sherbert Powder 1 Minced Steak 3 Snuff, Mentholated 1 Mint Sauce 3 Spaghetti, Cooked 1 Mustard 1 Sponge Cake 1 Nutmeg 1 Sponge Fingers 1 Olive Oil 2 Suet 2 Oranges, Mandarin 2 Suet, Chopped 1 Palmalade 1 Sugar, Granulated 1 150 TABLE 46—continued. Sugar, Icing 2 Trifle, Sponge 1 Sulphur Tablets 1 Tripe 1 Tablets, Chlorophyll Compound 1 Turkish Delight 2 Vegetable Laxative 1 Tablets, Digestive 1 Vinegar, Malt 4 Tablets, Phosphorous and Quinine 1 Whisky 8 Christmas Pudding 1 Tablets, Pneu-Pyrin 1 Tea 428 Tomato Sauce 1 Tomato Ketchup 1 ( d) Laboratories. The samples taken under the Food and Drugs Adulteration Act are analysed by Dr. Bernard Dyer, of 17, Great Tower Street, E.C., and bacteriological samples are examined by the Counties Public Health Laboratories, 91, Queen Victoria Street, E.C. TABLE 47. 150a The Following is a Record in Detail of the Inspections made during the Year 1934 :— district No. 1. DISTRICT NO. 2. DISTRICT NO. 3. DISTRICT No. 4. DISTRICT No. 5. Total. Manor Park Ward. Woodgrange Ward. Kensington Ward. Little Ilford Ward. Plashet Ward. Castle Ward. Central Ward. Wall End Ward. Greatfield Ward. South Ward. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H.to H. Ord. H. to H. Ord. H.to H. Ord. H.toH. Ord. H. to H. Ord. H.toH. Premises found in fair condition 577 78 265 15 221 85 284 515 408 160 278 127 292 127 334 336 261 199 307 95 3218 1731 Factory and workshop premises 35 ... 30 ... 1 ... 1 ... 20 ... 18 ... 33 ... 35 ... 3 ... 10 ... 186 ... Outworkers' premises 15 ... 12 ... 33 44 ... 21 ... 27 ... 32 ... 27 ... 36 ... 14 ... 261 ... Bakehouses 39 ... 17 ... 17 7 ... 8 ... 5 ... 9 ... 3 ... 3 ... 11 ... 119 ... Dairies 16 ... 17 ... 12 58 ... 7 ... 16 ... 8 ... 1 ... 7 ... 23 ... 165 ... Slaughter-houses 480 ... 259 ... ... ... ... 299 ... ... ... ... ... ... ... ... ... 183 ... 1221 ... Unsound food 161 ... 185 ... 3 5 ... 99 ... 3 ... 5 ... ... ... ... ... 98 ... 559 ... Urinals inspected 4 ... 3 ... 20 ... 13 ... 1 ... ... ... 14 ... 3 ... ... ... 16 ... 73 ... Walls and ceilings dirty and dilapidated 73 21 96 30 77 29 114 177 94 255 109 285 119 360 94 401 73 236 199 312 1048 2106 Yard paving dilapidated 23 27 13 3 4 1 12 35 6 20 13 53 38 55 31 130 6 70 41 77 187 471 Defective forecourt paving ... 5 6 ... 1 2 2 2 6 22 1 8 6 21 4 56 2 19 4 32 32 167 Defective drains 24 4 13 ... 12 2 19 2 ... 2 8 1 9 12 8 3 2 2 14 1 109 29 Defective w.c. traps 27 19 21 6 19 9 11 48 10 32 11 32 24 49 13 35 9 10 22 23 167 263 Soil pans foul and broken 14 16 8 2 11 3 8 13 9 26 15 25 25 15 8 40 6 7 6 10 110 157 Defective Hushing apparatus 18 12 17 4 9 3 17 26 16 18 12 22 22 73 20 62 6 34 30 30 167 284 Defective vent pipes 5 13 5 2 3 2 4 15 1 8 14 11 17 48 7 35 4 7 10 23 70 164 Rain water pipes and eaves gutters defective 26 29 50 13 28 3 42 87 27 66 31 87 75 125 101 182 28 125 73 168 481 885 Roofs leaky 31 9 40 7 55 9 79 85 29 65 38 102 63 108 117 125 19 74 88 89 559 673 Dampness 41 19 45 8 32 7 111 71 26 106 32 103 48 91 52 62 16 90 95 191 498 748 Defective sink waste pipes 11 10 13 2 10 3 8 15 8 10 6 15 19 44 21 42 5 12 31 43 132 196 Drinking water improperly stored 11 20 14 2 ... ... 1 3 1 ... 1 4 4 6 4 31 1 ... 2 4 39 70 Defective brickwork 12 10 24 7 2 ... 2 15 8 78 12 102 37 81 33 194 11 58 18 87 159 632 Defective cement to yard gully 4 4 6 ... 3 1 5 15 8 22 4 31 28 121 21 122 12 43 16 47 107 406 Defective sashcords and windows 35 10 27 23 38 22 37 122 34 142 39 112 46 143 35 86 19 97 73 138 383 915 Insufficient underfloor ventilation 4 14 5 3 8 7 9 19 14 24 6 17 12 62 10 80 5 14 13 30 86 276 Dilapidated floors 20 11 15 4 13 2 43 24 11 35 18 41 17 41 22 26 6 4 44 65 209 253 Accumulations 31 17 17 2 40 ... 53 5 12 1 17 1 32 ... 22 3 7 1 24 ... 255 30 Overcrowding 1 ... ... ... ... ... 2 ... 1 2 1 6 1 1 2 1 1 ... 5 10 14 20 No dust bins 2 1 1 3 2 2 6 8 1 ... 1 ... 3 6 1 5 5 9 9 9 31 43 Defective stoves 22 ... 25 5 35 2 31 28 35 81 30 110 40 109 35 48 13 25 47 66 313 474 Defective coppers 8 ... 9 3 4 3 10 7 13 43 13 44 11 59 14 33 4 26 27 48 113 266 Animals improperly kept 1 3 1 ... ... ... 4 ... ... ... 1 ... 3 ... 1 ... ... ... ... ... 11 3 Factory smoke nuisance 3 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... 6 ... Breaches of Bve-Laws and Regulations 2 ... 1 ... 2 ... 13 ... 2 ... ... ... 8 ... ... ... ... ... ... ... 28 ... Other nuisances 193 143 151 23 97 10 137 78 132 284 135 328 223 266 322 537 80 244 254 312 1724 2225 Drains tested 40 ... 24 ... 26 ... 49 ... 8 ... 6 ... 10 ... 11 ... 6 ... 7 ... 187 ... Inspections 1133 254 731 65 501 139 741 893 759 514 577 516 692 576 936 1025 464 549 914 524 7448 5055 Total Inspections 1387 796 640 1634 1273 1093 1268 1981 1013 1438 12503 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. School Medical Secvice:- INTRODUCTION REPORT For the year 1934. 153 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, 1934. There were 18,022 children on the School Roll, as compared with 19,719 for the year 1933. The number of routine and special cases, of Elementary School children, examined totalled 9,186; showing a decrease on the previous year, which is largely accounted for by the reduction in the school population. A complete medical inspection of all the scholars attending the Secondary Schools has also been carried out. The School Medical Service, in common with the Maternity and Child Welfare and the Tuberculosis Services, has been handicapped, very considerably, in the endeavour to attract parents to seek advice and treatment, by unsuitable and poorly equipped Clinic premises. The year 1934 has witnessed very appreciable improvements in this respect and it is a matter for congratulation that the combined Centre, for School Medical and Maternity and Child Welfare Clinics, at Manor Park was completed by the end of the year: a full description of this Centre is contained in my Report. The arrangements entered into with the Woolwich Borough Council, by which accommodation is afforded to this Authority for Clinic purposes in the North Woolwich area, have proved extremely satisfactory. The Education Committee have under consideration the accommodation afforded at the Central Clinic, on the second floor of the Town Hall building. As previously pointed out 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 are fully realised. The Clinic is in use during every available session throughout 154 the week, and even under these circumstances does not meet the full demands of the service. Administration is considerably handicapped by inadequate office accommodation. Progress and efficiency in the School Medical Service are dependent upon good working conditions. The investigation into the nutrition of children attending the schools of the Borough elicited no excessive proportion of sufferers in this respect. Malnutrition would not appear to be dependent ??? lack of food alone but to many factors associated with domestic and environmental conditions, and it is in this regard that the public generally should be made aware of detrimental influences affecting the health of the child. Details of this inquiry are submitted later in the Report. (Sec. 22. Special Enquiries.) Much time and patience has been expended by members of the Authority in obtaining detailed information in regard to the quality and quantity of food and methods of preparation and cooking adopted at the Feeding Centres. As a result the alterations affected have been the means of placing the dietary, both from a medical and general aspect upon a definite basis and thus ensure to the children a substantial, appetising and highly nutritious meal. (Sec. 11. Provision of Meals.) 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. 155 1. Staff. A list of the Staff of the School Medical Department will be found at the beginning of this Report. 2. Co-Ordination. Closer co-operation of the various health services of the County Borough has been fully discussed and advocated and the changes introduced during the year 1934 will permit 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 1934, 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 1934. The figures for the years 1930 to 1933 are also given for comparison:— 156 COMPARATIVE STATEMENT OF WORK. 1930. 1931. 1932. 1933. 1934. Routine and Special Inspection (on School Premises) 8,325 10,351 10,458 10,193 9,186 Re-inspection 3,574 2,883 2,700 2,773 3,203 Consultations at Inspection Clinic 14,490 13,241 10,122 18,294 17,750 Number of Treatments at Clinic 16,967 15,180 12,819 13,636 13,770 General Cleanliness Visits to Schools 309 307 307 341 296 Nurses' Visits to Homes 3,479 3,081 3,078 3,124 3,206 Children Examined for Cleanliness 51,607 48,607 50,513 50,004 47,550 (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. 157 5. Findings of Medical Inspections. The number of children included in routine inspection during 1934 was 6,036 or 33.4 per cent of the number on school roll. In addition 3,150 children were referred for some special reason by parents, nurses, teachers or attendance officers. The total number of children medically examined was therefore 9,186 or 50.9 per cent of those on the school roll. The number of re-inspections carried out was 3,203. The incidence of principal defects requiring treatment or needing to be kept under observation is shown in Table II. 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 specified age groups inspected during the year 1934:— 158 FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. 1929 1930 1931 1932 1933 1934 1929 1930 1931 1932 1933 1934 1929 1930 1931 1932 1933 1934 Entrants 2,998 2,314 2,047 2,245 2,040 1,747 411 264 263 255 250 447 13.7 11.4 12.8 11.4 11.2 25.5 Second Age Group 2,208 2,207 1,987 2,028 2,006 1,873 316 237 217 240 230 230 14.3 10.7 10.9 11.8 12.4 12.2 Third Age Group 2,366 1,912 1,855 1,985 2,079 1,895 248 119 181 175 180 193 10.5 6.2 9.7 8.8 8.6 10.1 Totals 7,572 6,433 5,889 6,258 6,125 5,515 975 620 661 670 660 870 12.9 9.6 11.2 10.7 10.7 15.7 159 The increased proportion of defects discovered in the Entrants Group is accounted for by two circumstances. There has been an unusual increase in the incidence of catarrhal infections; particularly nasopharyngeal catarrh, aural defects, bronchial catarrh, conjunctivitis and blepharitis. Again the incidence of malnutrition has been the subject of extremely careful consideration throughout the year, and special surveys and investigations have resulted in the inclusion under this heading of children whose nutrition is only slightly subnormal. Apart from these facts the findings of medical inspection do not call for any special comment. (a) Uncleanliness. The School Nurses have carried out 3 cleanliness surveys of all the children in the elementary schools during the year 1934. During the year the School Nurses made 47,550 examinations, as compared with 50,064 in 1933. Of this number 140 children showed vermin and many nits in the hair (349 in 1933), whilst 776 children showed only a few nits (1,395 in 1933). 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 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 1934 47,550 776 140 151 160 TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. Altmore S. Mixed 1010 9 Napier Infants 731 48 9 Avenue Infants 577 13 7 J. Boys 1091 35 3 j. Girls 727 37 16 S. Boys 1037 6 – J. Boys 665 16 3 Plashet Infants 538 19 4 Brampton Infants 1332 12 3 J. Boys 910 12 5 J. Girls 1274 30 — S. Boys 810 9 – S. Girls 851 14 — Salisbury Infants 619 27 2 Castle Street R.C. Mixed 609 22 — J. Mixed 971 27 2 Central Park Infants 761 15 6 S. Mixed 773 12 3 J. Boys 1129 6 2 Sandringham Infants 715 14 7 S. Boys 881 — — J. Mixed 768 8 2 Cornwell Infants 1153 79 9 Sandringham Central Central 398 – 1 S. Girls 907 31 4 Shaftesbury Infants 988 37 2 S. Boys 963 9 1 J. Girls 971 40 – Dersingham Mixed 921 46 6 S. Girls 860 28 — Essex Infants 801 25 3 Shrewsbury Special 181 6 – J. Boys 777 1 — Storey Street J. Mixed 515 31 3 S. Boys 660 — — S. Mixed 757 28 1 Hartley Infants 627 15 5 Silvertown R.C. J. Mixed 321 23 2 J. Girls 896 73 3 S. Mixed 403 30 14 S. Girls 784 29 1 St. Michael's R.C. Mixed 707 31 – High Street Infants 298 11 2 St. Winefride's R.C. Mixed 768 33 15 Kensington Infants 736 4 3 Vicarage Infants 1178 72 35 J. Girls 961 32 11 J. Girls 1098 72 5 S. Girls 546 2 — S. Girls 1031 47 5 Lathom Infants 844 24 2 Winsor J. Mixed 896 54 3 J. Girls 906 28 1 S. Mixed 852 22 4 J. Boys 888 5 — Wakefield Central Girls 200 2 – Monega Infants 913 16 – Boys 198 – – J. Boys 939 8 — Total 47550 1385 215 S. Boys 848 — — Myope 51 Per cent. in 1934 291 0.43 Per cent. in 1933 2 78 0.7 161 It will be noticed that the low incidence in the number of children suffering from uncleanliness of the hair and scalp is very 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 holiday 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 Teacher* and Nurses and sent to Clinic. 1933 1934 1933 1934 Scabies – 1 17 30 Impetigo 6 8 193 174 Conjunctivitis 5 2 87 79 Blepharitis 2 6 30 49 Ear Disease 60 87 200 223 Ringworm (Scalp) — — — 2 Ringworm (Body) – 1 38 20 (c) Tonsils and Adenoids. 4.3 per cent of the children examined during the year were referred for treatment for "tonsils and adenoids," either separately or combined, as compared with 3.93 per cent in the year 162 1933. Of these, much enlarged tonsils accounted for 1.51 per cent; definite adenoids were present in 0.18 per cent; and the combined defect was diagnosed in 2.61 per cent; the figures for 1933 were 1.08 per cent; 0.12 per cent; and 2.73 per cent; respectively. The percentage of children moderately affected and requiring to be kept under observation was 8.7, the corresponding percentage in 1933 being 10.0. In this case 8.0 per cent had moderately enlarged tonsils, 0.2 per cent exhibited signs of the presence of adenoids, whilst 0.5 per cent showed enlarged tonsils and adenoids of moderate degree, as compared with 9.5 per cent; 0.2 per cent; and 0.3 per cent; respectively in the year 1933. (d) Tuberculosis. The total number of cases of tuberculosis, occurring in children of school age, notified to the Medical Officer of Health during the year, was as follows :— Boys. Girls. Total. Pulmonary Tuberculosis 4 4 8 Other forms of Tuberculosis 9 5 14 13 9 22 (e) Skin Disease and (f) External Eye Disease. The number of these cases still remains high. At medical inspections during the year 480 children were found to be suffering from skin affections (as compared with 481 in the year 1933). Cases of external eye disease also continue to show a high incidence, 136 in the year 1934 and 126 in the year 1933. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 524. In addition, there were 120 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.) 163 (h) Ear Disease and Hearing. 1.6 per cent of the children examined were found to be suffering from otitis media. (0.1 per cent in 1933.) The percentage of deaf children was 0.4, the corresponding number for last year being 0.4. (i) Dental Defects. (See Report of Dental Surgeon.) (j) Crippling Defects. Reference to Table III will furnish information with regard to the occurrenc of crippling defects in the area. 71 cases were discovered at routine medical inspection during the year. 6. Infectious Diseases. The accompanying table gives some indication as to the incidence of the principal notifiable and non-notifiable infectious diseases in children of school age. The statistics in regard to the non-notifiable infectious diseases are compiled from returns submitted by the Head Teachers and Attendance Officers and cannot be regarded as exact. Scarlet Fever, Diphtheria and Measles all show an increased incidence during the year but, whilst Measles threatened to assume epidemic proportions at the commencement of the year, the number of cases of Scarlet Fever and Diphtheria did not give rise to serious anxiety at any period. Unfortunately many of the Diphtheria cases were of the severe type and resulted in a comparatively heavy mortality amongst children of school age. 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. 242 swabs were taken for this purpose, and the fact that one of these proved to be positive shows the importance of this procedure. 164 (b) In suspicious cases seen at the Clinics or Schools. 93 swabs were taken and 10 proved to be positive. (c) In cases where an undetected source of infection appears to be present in a class or school. 101 swabs were taken and three proved to be positive. The statistics relating to protective immunization against Diphtheria are included in my report as Medical Officer of Health. The attendance at the Immunization Clinics is fairly well maintained and there is no doubt that the scheme of propaganda which has been introduced will lead to a marked increase in the number of applicants for this form of treatment. 165 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 236 49 16 — 41 18 February 187 7 13 1 44 5 March 77 13 8 3 50 13 April 37 4 9 1 54 14 May 25 3 8 — 46 14 June 47 30 24 3 48 18 July 6 — 18 — 52 36 August 5 30 4 2 82 41 September October 4 39 9 5 91 23 November 1 13 4 7 55 27 December 4 40 1 1 41 16 Totai.s (302) 629 (256) 228 (243) 114 (69) 23 (450) 604 (109) 225 The totals in brackets are those for the year 193JJ 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. 166 During the year 1934 the Education Committee requested particulars and information in regard to "arrangements for the disinfection of books and apparatus used by scholars who are subsequently excluded from school owing to infectious disease," and it was considered desirable to prepare a report outlining the advantages and disadvantages in regard to the disinfection of school equipment and materials. Disinfection in the Schools after Cases of Acute Infectious Disease. In order to arrive at a definite opinion as to the measures required to prevent the spread of infection in the Schools it is necessary to recall some salient facts in connection with the somewhat controversial question in regard to the value of disinfection in reducing the incidence and dissemination of the acute infectious diseases. There is no doubt that, for the most part, infection occurs by direct contact (i.e., from individual to individual) and that fomites and furniture (except perhaps articles used in connection with personal hygiene, such as handkerchiefs, towels, drinking vessels, tooth brushes, etc., and articles likely to come in contact with the mouth, such as books, pencils or penholders) are seldom, if ever, a source of infection. These facts are significant when considered in association with the average distance to which infection may be propelled during coughing, sneezing or loud speaking ; this distance has been proved by experiment to exceed six feet, and in some illnesses may be greater. The diffusion of acute infectious disease except by personal contact must be very rare, and no case is on record where school material has been demonstrated as the cause of the spread of infection; it is fortunate that such diffusion is rare since normal school organisation and routine make it difficult, if not impossible, to ensure the collection and disinfection or destruction of all the school equipment used by an infected scholar. It is generally recognised that the only sure and satisfactory means of disinfection is by the application of either moist or dry heat and that liquid or fumigant disinfectants are not effective unless used in a concentration which is either dangerous to life 167 or destructive to the articles subjected to their action. Thus it is obvious that the only logical method of disinfecting school materials used by infected scholars, if such disinfection be considered necessary, is by destruction. The value placed upon the use of disinfectants has undergone great modification since the time of Lord Lister; in modern aseptic operative technique both disinfectants and antiseptics are conspicuous by their absence and strict soap-and-water cleanliness is relied upon to prevent the introduction of infection. Some Local Authorities have discontinued the practice of carrying out disinfection of premises and fomites in cases of acute infectious diseases and have produced statistics which demonstrate conclusively that the incidence of such diseases has remained unaffected. Arthur Newsholme in his work on School Hygiene states that " disinfection after cases of acute infectious disease is probably a waste of money when it goes beyond the use of soap and water; apart from its moral sustaining effect, it is probably a waste of time and material. Dr. J. J. Sykes termed school disinfection ' a sanitary rite of considerable moral value.' " There is, however, the other side of the question, and one wonders how often the pretence of disinfection has afforded a false sense of security which eliminates the fulfilment of far more important hygienic measures, such as thorough cleansing with soap and water, frequent intensive ventilation by flushing halls and class-rooms with fresh air and the periodic exposure of school equipment to the action of air and sunlight. The problem which confronts the Medical Staff of the Education Authority is not the danger of infection from school materials but the difficulty experienced in preventing the attendance at school of children who are " carriers " of, or who are suffering from extremely mild attacks of, acute infectious disease. It is by no means uncommon to find, upon bacteriological investigation, that apparently healthy scholars are harbouring diphtheria germs in the nose or throat and, not infrequently, children are discovered in school who exhibit the typical "peeling" of scarlet fever, after a period of absence certified as being due to tonsillitis, food rash, urticaria, German measles, or the like. 168 The following points demand consideration in arriving at a decision as to the policy which should be adopted in regard to the necessity or otherwise for disinfecting or destroying school materials used by infected scholars :— 1. Infection occurs by direct contact. 2. There is no case on record where school materials have been demonstrated as the cause of the spread of infection (Arthur Newsholme). 3. The difficulty of determining what articles of school material have been used by an infected scholar. 4. The only sure means of disinfecting school materials is by destruction, e.g., burning. 5. The value placed upon the use of disinfectants and antiseptics has undergone considerable modification in modern times. 6. The discontinuance of the practice of disinfection does not appear to have affected the incidence of acute infectious disease. 7. The relative importance of the moral sustaining effect of disinfection as compared with the false sense of security produced by possible out-of-date sanitary rites. 8. The necessity for making use of natural hygienic measures for preventing infection—cleanliness, fresh-air and sunlight. The Education Committee subsequently resolved to recommend that the following procedure be adopted in future:— (a) That pens and pencils known to have been used by the notified scholar immediately prior to the commencement of absence from school be destroyed by burning. (b) That books and similar apparatus used by the scholar be disinfected by exposure to the air for a suitable period. (c) That school furniture used by the child, so far as it is possible to definitely locate it, be thoroughly washed with soap and water by the Caretaker of the School. 169 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 3,206 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. Of the 1,140 children referred for treatment, 653 or 57 per cent have obtained treatment. The School Nurses have also paid 183 special visits to the Schools, and 21 visits to the Feeding Centres, and have undertaken 12 journeys in connection with the admission and discharge of children to Institutions. All children referred for the operative treatment of tonsils and adenoids (530) 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), Methodist Church, 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 2 p.m. (6) Light Clinic, Town Hall—Mondays and Wednesdays, at 2 p.m. (7) Immunization Clinic, Town Hall—Fridays at 3 p.m. During the year, 1934, 13,770 attendances were made for treatment at the various clinics, and there were 17,750 attendances for consultation with the Medical Officers. 170 (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. (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 530 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. 171 (e) External Eye Disease. 137 cases (126 in 1933) of external eys disease were treated at the School Clinics. (f) Vision. During the year 1934, the Ophthalmic Clinic was held on five sessions per fortnight. 524 cases were referred for treatment in respect of visual defect during the year 1934 (of these 43 children with markedly defective vision had not been seen by the Ophthalmic Surgeon) and, including 56 cases awaiting treatment at the termination of the year 1933, 537 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 120 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, 16 children are in attendance at this class, and they are all kept under observation by the Ophthalmic Surgeon at certain intervals. (See also Ophthalmic Surgeon's Report.) (g) Ear Disease. During the year 1934, 83 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 1,975, making an average attendance, at each session, of 23 patients. Ionisation treatment was carried out in 19 cases, 73 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., 172 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.) (h) Dental Defects. (See Report of Dental Surgeon.) (i) Crippling Defects. In November, 1929, the Authority entered into an agreement with Queen Mary's Hospital, Stratford, in respect of a complete scheme for the treatment of orthopaedic cases. The treatment at the hospital includes operative, electrical and massage treatment, remedial exercises and the supply of surgical appliances, and is carried out under the direction of an orthopaedic surgeon. Payment is made to the Hospital Authorities on a per capita contribution basis in respect of East Ham scholars sent to the Hospital through the School Medical Service. All children referred by the Authority's Medical Officers to the Hospital for treatment are kept under observation at frequent intervals at one or other of the School Clinics, in order that the progress of the cases may be watched and recorded, and to ensure that treatment has not been allowed to lapse. If at any time such a case fails to attend the School Clinic it automatically becomes included in the following-up list of one of the School Nurses. During the year 1934, 11 out-patients have received treatment, the total out-patient attendances being 158. The highly satisfactory results achieved are due, in no small measure, to the efforts and keen co-operation of the responsible Orthopaedic Surgeon. 173 (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. 174 SUNLIGHT REPORT, 1934. DIAGNOSIS. Boys. Girls. Anaemia 9 11 Debility 73 64 Malnutrition 15 25 Bronchial Catarrh 19 22 Adenitis 17 20 Rheumatism 1 5 Malnutrition and Anæmia 4 1 Malnutrition and Debility 1 3 Debility and Anaemia 2 6 Debility and Catarrh 2 3 Debility and Rheumatism 2 1 Debility and Headaches — 1 Debility and Bronchitis — 1 Bronchial Catarrh and Anaemia 2 5 Bronchial Catarrh and Malnutrition 1 — Bronchial Catarrh and Asthma 1 1 Bronchial Catarrh and Rheumatism 1 — Malnutrition and Adenitis 1 5 Anaemia and Cough 2 1 Debility and Adenitis — 1 Pre T.B — 1 Under weight 3 1 Chorea 3 2 Cough 2 6 Throat — 2 Sinus 1 — Rickets 3 — Bronchitis 3 2 Headaches — 3 Rachitis — 2 Impetigo 1 — Contact T.B. 1 3 Gastro Enteritis 1 1 Pleurisy 1 — Asthma 1 1 Pes Planus — 1 Blinking and Blepharitis 1 — Fibrosis (R. lung) 1 — Mitral Stenosis 1 — Abdominal pain - 1 Total 176 202 Number of children treated (general) 378 Number of children treated (local) 48 175 Number of attendances (general) 4,353 Number of attendances (local) 646 Total number of attendances (local and general) 4,999 The great difficulty has been 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 petweek, 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 1934 show a still greater demand for sunlight therapy. The daily use of the artificial light apparatus will be a great asset in our endeavours towards the prevention of ill-health and disease in early life, and the provision of specific accommodation at Manor Park will make this possible. The much larger waiting room and preparation room will enable the children to have a comfortable period of rest after treatment before they leave the building. 176 9. Open-Air Education. (a) Playground Classes. In a few cases playground classes continue to be held occasionally. (b) School Camps. The Education Committee sent 181 scholars to the East Cowes Holiday Camp during the year 1934, and in addition the following- School Journeys were undertaken :— Brampton Senior Girls 31 Plashet Senior Boys 50 Total 81 (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. Patrick's Open Air School at Hayling, St. Mary's School of Recovery at Dover, and to the Institutions of the Invalid Children's Aid Association. The accompanying table gives particulars in connection with these children. The difficulty of providing satisfactory treatment for delicate, malnourished, debilitated and physically defective children, who in 177 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-one children have been sent to Schools of Recovery, through this Association, by arrangement with the Local Education Authority. In addition, the very courteous co-operation of the Association, with the Authority's Medical Officers, has secured open-air and convalescent treatment for 42 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 1934. Disease. Debility following Diphtheria 11 Debility following Measles 3 Debility following Pneumonia 3 Debility following Chicken Pox 1 Debility following Whooping Cough 1 Debility following Appendicectomy 1 Debility following Tonsillectomy 2 Nervous Debility, Anaemia and Malnutrition 9 Rheumatism 2 Mitral Stenosis 1 Bronchial Catarrh 4 Glands 1 Pre-Tuberculosis 1 Catarrh 2 Flat Feet 1 43 Action taken. Convalescent 42 Surgical Instrument 1 43 178 Particulars of the number of Children who were resident in Schools of Recovery between 1st January and 31st December, 1934, and the periods of their stay between those two dates. School No. of Months Totals 1 2 3 4 5 6 7 8 9 10 11 12 B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G Total Ogilvie — 1 — 2 3 2 2 3 — 1 4 8 1 — — - 4 4 — — — — 6 2 20 23 43 1.C A.A. (hqtrs.) — 1 — 2 2 3 6 4 — 1 2 - - - - - - - - - - - - - 10 11 21 St. Catherine's 3 — — 2 — — 2 — 2 - 1 — 1 2 — 1 - - - - - - - - 9 5 14 St. Dominic's 4 — 1 — 1 — 1 — — — 2 - 4 - 1 — 1 — — — — — 9 — 24 - 24 No. OF Weeks 4 10 12 18 24 26 B. G. Russell-Cotes 1 — — 1 26 21 1 — 3 — 3 1 34 23 57 179 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 203,105 meals were provided for children, as compared with 224,350 in 1933. A great deal of consideration has been given to the preparation and service of school dinners and many important improvements have been recommended by the Children's Care and Welfare Sub-Committee. Perhaps the most important feature in this respect was the decision to amplify the menus in order to ensure greater variety in the meals provided. It was also suggested that official recipes should be issued for the purpose of maintaining a uniform quality of the cooked food at each dining centre, and that the order of the menus should be varied to deal with the cases of children who stay away from the dining room when an unpopular dinner is expected to be served. The following menus and lists of quantities were approved and adopted by the Education Committee, the revised dietary consisting of eleven menus so arranged as to avoid the repetition of a meal on an}' particular day of the week. 180 WINTER MENUS OF MEALS. Menu No. 1st Course. 2nd Course. 1 Roast Beef, Roast or Boiled Potatoes, Cabbage. Stewed Apples (fresh), Custard (made with milk). 2 *Irish Stew, Boiled Celery. Baked Jam Roll. 3 Boiled Salt Beef, Carrots and Dumplings, Boiled Potatoes. *Sago Pudding. 4 *Stewed Minced Steak, Mashed Potatoes (with milk) *Bread and Butter Pudding. 5 Roast Mutton and Gravy, Boiled or Roast Potatoes. Sultana Roll. 6 Boiled Mutton (Leg), Butter Beans and Onions, Boiled Potatoes. Apple (fresh) Pie, Custard (made with milk). 7 *Stewed Steak and Vegetables, Boiled Potatoes. Stewed Figs and Custard (made with milk). 8 Steak and Kidney Pudding or Roll, Brussels Sprouts, Boiled Potatoes. *Rice Pudding. 9 Pea Soup, Dumpling. Baked Treacle Tart. 10 Boiled Rabbit and Pork, Boiled Potatoes, Cabbage. Fresh Apple. 11 (Every Friday) Baked Fish, Baked or Boiled Potatoes. Boiled Raisin Pudding, Custard (made with milk). * This meal to be prepared strictly in accordance with the approved recipes. 181 Quantities of each Ingredient Required for 50 Children. WINTER MENUS. Menu No. 1 2 3 4 5 6 7 8 9 10 11 *Meat (excluding Bone) net. 25% net. net. 25% 25% net. net. Beef Lbs. 12 (Todside) 9 (Stewine) 9 8 — — — Mutton „ — 10 (Neck) 12 12 (Stewing) — — — Salt Beef „ — — 12 (Silverside) (Leg) — — — —• Ham, Bacon or Pork „ — — — — — — — — — 5 — Kidneys „ — — — — — — — 4 — — — Rabbits „ — — — — — — — — — 12 — Suet „ — 2½ 2½ — 2½ — — 2½ 1½ — 2½ Fish „ — — — — — — — — — — 18 Fresh Green Vegetables— Cabbage „ 15 — — — — — — — — 15 — Brussels Sprouts „ — — — — — — — 14 — — — Fresh Vegetables— Carrots „ — — 6 4 — — 5 — 2 4 — Turnips „ —. — — — — — 5 — 2 3 — Onions „ — 5 — 4 — 3 5 — 4 4 — Celery Heads — 8 — — — — — — — — — Dry Vegetables— Butter Beans Lbs. — — — — — 6 3 — — — — Split Peas „ — — — — — — — — 6 — — Potatoes „ 20 22 18 18 20 20 18 18 18 18 20 Bread „ 4 4 4 7 4 4 4 4 4 4 4 Flour „ — 6 6 1 6 34 1 4 10 — 6 Margarine „ — — — 1 1 2 — — 14 — — Sugar „ 2 — 2 1½ 2 2 4 2 4 — 1 Jam „ — 4 — — — — — — — — — Syrup „ — — — — — — — — 4 — — Fresh Fruit— Apples „ 12½ — — — — 12½ — — — 12½ — Dry Fruit— Currants „ — — — 1 — — — — — — — Raisins „ — — — — — — — — — — 2 Sultanas „ — — — — 1½ — — — — — — Figs „ — — — — — — 8 — — — — Sago „ — — 3 — — — — — — — — Rice „ — — — — — — — 2 — — — Eggs Each — — 6 6 — — — — — — — Milk Pints 15 — 20 9 — 15 15 20 6 — 15 Custard Powder Lbs. 1 — — — — 1 1 — — — 1 * Meat.—The average weight of the meat to be delivered will be nett or 25% in excess as shown above. All other food materials required to be requisitioned by Cooks-in-Charge as may be necessary. 182 SUMMER MENUS OF MEALS. Menu No. 1st Course. 2nd Course. 1 Roast Mutton and gravy. Boiled or Roast Potatoes, Cabbage or Green Peas. Fresh Fruit (Orange) Salad. 2 Cold Roast Beef, Mashed Potatoes (with Milk), Lettuce and Tomatoes. Stewed Apples (fresh), Custard (made with Milk). 3 *Meat Roly-poly with Brown Sauce, Boiled Cabbage. Sago Pudding (made with Milk and Eggs). 4 Corned Beef, Salad (Egg, Lettuce, Tomato and Watercress). Rhubarb Tart, Cornflower Sauce (made with Milk). 5 Roast Beef, Roast or Boiled Potatoes, Cabbage. Tapioca Pudding. 6 *Shepherd's Pie, Mashed Turnips. Rice Pudding, Baked Apples. 7 Meat and Potato Pie (with Crust), Fresh Green Peas (in season) or Butter Beans. Fresh Banana Fruit Salad and Custard (made with Milk). 8 Baked Liver and Streaky Bacon, Boiled Potatoes, Cabbage. Baked Jam Roll. 9 *Stewed Steak and Vegetables, Boiled Potatoes. Stewed Figs and Custard (made with Milk). 10 Cold Boiled Silverside (Beef), Salad. (See 4 above). Baked Bread Pudding. 11 (Every Friday) Baked Fish, Boiled or Baked Potatoes. Boiled Sultana Roll, Custard Sauce (made with Milk). * This meal should be prepared strictly in accordance with the approved recipes. 183 Quantities of each Ingredient Required for 50 Children. SUMMER MENUS. Menu No. 1 2 3 4 5 6 7 8 9 10 11 *Meat (excluding Bone) 25% net. net. net. net. 25% net. net. - Beef Lbs. — 9 9 — 12 9 6 — 9 9 — Mutton „ 12 — — — — — —. — (Stewing) - Corned Beef „ — — - 8 — - - - - - - Bacon or Pork „ - - - - - - - 4 - - - Liver „ - - - - - - - 8 - - - Suet „ — — 1½ — — — — 2 — — 2 Fish „ - - - - - - - - - - 18 Fresh Green Vegetables— Cabbage „ 15 — 15 — 15 — - 15 - - — Peas, Beans† „ 8 - - - - - 8 - - - - Fresh Vegetables— Carrots „ — — 6 - - - - - 5 - - Turnips „ — — 6 — — 12 — — 5 - — Onions „ — — — — — 3 3 — 5 - — Tomatoes „ — 6 — 6 - - - - - 6 - Lettuce Each — 15 — 15 — — — — - 15 - Potatoes Lbs. 20 18 — — 20 18 9 20 18 — 20 Dry Vegetables— Butter Beans† „ - - - - - - 6 - 3 - - Bread „ 4 4 4 4 4 4 4 4 4 7 4 Flour „ — — 5 3½ — — 4½ 4 1 — 3½ Margarine „ — — — 1¼ — — 1½ — — — — Sugar „ 2 2 2 2 2 2 1 — 4 2 1 Jam „ - - - - - - - 4 — — — Fresh Fruit— Rhubarb „ — — — 12 - - - - - - — Oranges Each 50 - - - - - - - - - - Apples Lbs. — 12 — — — 12 — — - — - Bananas Each - - - - - - 50 — — — — Dry Fruit— Figs Lbs. - - - - - - - - 8 - - Currants „ - - - - - - - - - 1 - Sultanas „ - - - - - - - - - - 1½ Rice „ - - - - - 2 - - - - - Sago ,, - - 3 - - - - - - - - Tapioca ,, - - - - 2 - - - - - - Eggs Each — — 6 20 - - - - - 20 — Milk Pints — 20 20 15 20 20 15 — 15 3 15 Watercress Lbs. — 4 — — — — — — Custard Powder „ - 1 — — — — 1 — 1 — 1 Cornflour „ - - - 1 - - - - - - - *meat.—The average weight of the meat to be delivered will be net or 25% in excess as shown above. † Fresh green peas when in season, otherwise Cabbage (Menu No. 1) or Butter Beans (Menu No. 7). All other food materials required to be requisitioned by Cooks-in-Charge as may be necessary. 184 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 1934 the number of parents who were present at the routine medical inspections was 4,314 (4,935 in 1933), that is, in 71.5 per cent of the cases examined (64.7 per cent in 1933). The interest which parents take in the work of the School Medical Service demonstrates the value which they place upon this work, and assists greatly in ensuring that our advice and directions are carefully carried out. 14. Co-operation of Teachers. The Teachers render most valuable assistance to the School Medical Service, and the great interest which they exhibit in regard to all matters affecting the physical and mental condition of the scholars is extremely stimulating and encouraging to the School Medical Officers and Nurses. 15. Co-operation of School Attendance Officers. The co-operation of School Attendance Officers and the coordination of the School Medical Service with that of the School Attendance Department has been fully discussed in previous reports. Many cases have been referred for special examination by the Attendance Officers on Form 21, and of these cases 47 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) 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. 185 Ninety-three such cases have been dealt with by the Society's Inspectors as the result of direct reference from the School Medical Service, during the year 1934. The Inspectors have made 333 visits in regard to these cases and the following table indicates the work performed by the Society :— CONDITION. Number of Cases. Treatment Obtained. Treatment Arranged. Cases under Observation. Tonsils and Adenoids 12 11 1 — Defective Vision 13 13 — — Otitis Media 1 1 — — Dental Caries 1 1 - — General Neglect 66 50 Improved - 16 TOTAL 93 76 1 16 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 16 children suffering from physical defects are not receiving education owing to their being totally unfit to attend public elementary schools. In addition it will be seen that 359 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 85 children suffering from glandular and non-infectious pulmonary tuberculosis, who are attending ordinary 186 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 16 children who come within this category, there are 99 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 1934, the number of cases examined for purpores of the Mental Deficiency Acts, was 37 (42 in 1933). Of these 12 were classified as mentally deficient, and 18 as dull and backward, recommendations being made as shown in the following table :— Number examined ... 37 Classified as mentally deficient 12 17 Classified as morally deficient — Classified as imbeciles 3 Classified as idiots 2 Classified as dull and backward ... 18 Recommended for Special School ... 12 Decertified ... 1 Recommended for Residential School for P.D. children ... 1 Reference to Table III will show that the 83 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. 187 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. Nine boys have been specially examined in accordance with the Bye-laws, and these were found to be fit for employment. In addition, eleven 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. An investigation into the incidence and causation of malnutrition in scholars attending the Elementary Schools was carried out early in the year and the following report was submitted to the Education Committee in April, 1934 :— Malnutrition in East Ham School Children. The School Medical Service is so organised that it should be impossible for any case of malnutrition to escape observation. Apart from the annual routine medical examination of children of the ages of five years, eight years and twelve years, the School Medical Clinics show an attendance, for consultation, of 16,000 per annum. School Nurses, School Teachers and School Attendance Officers have been specially requested to be on the look-out for cases of malnutrition and to refer such cases to Routine Medical Inspection or to the School Medical Clinics, whilst parents are 188 encouraged and persuaded to seek the advice of the School Medical Staff upon even the simplest matters in connection with the health of their children. Statistics in regard to the incidence of malnutrition in school children during the past fifteen years are indicated in the following table:— Annual Number of Cases of Malnutrition coming within the Purview of the School Medical Officer during the past 15 Years. Year. * Routine Medical Inspection. †Special Cases. Requiring treatment. Requiring to be under observation. Requiring treatment. Requiring to be under observation. 1919 32 41 2 — 1920 66 3 8 4 1921 76 — 10 1 1922 75 24 10 1 1923 31 17 15 3 1924 19 9 11 2 1925 24 33 8 8 1926 57 18 6 2 1927 30 3 6 1 1928 37 5 22 3 1929 60 36 9 — 1930 28 12 22 1 1931 24 8 12 — 1932 42 4 10 1 1933 41 3 16 — * Routine Medical Inspection, is medical inspection carried out on the lines of the approved Schedule at the time when routine medical inspection is due and made on the school premises or other place sanctioned by the Board of Education under the Code. f "Special Cases " are those children specially referred to the Medical Officer and not due for routine medical inspection under the Code at the time when specially referred. Such children may or may not be of Code-group age and may be referred to the Medical Officer at the School or the Clinic by the Committee, Medical Officer, School Nurses, Teachers, Attendance Officers, Parents or otherwise. In order to appreciate the problem of malnutrition it is necessary to realise that the factors which operate to cause the condition are numerous and the subject is a complex one. It is not enough that the body be supplied with food of any sort; that of itself will not suffice. There must be the proper proportion of nutrients, sufficient protein to meet the demand for nitrogen, sufficient carbohydrate and fat to yield heat and energy. There must be sufficient solids, vitamines, vegetable acids and water, and there must be a sufficiency also in regard to quantity. 189 Over and above this provision there must be healthy activity of those physiological processes which have to do with mastication and preparation, with absorption, assimilation, metabolism and excretion. Healthy and complete nutrition is something more than mere feeding. We must therefore take a wide and comprehensive view of nutrition, which must be estimated not only in terms of bulk and weight, but of the ratio of stature to weight, of the general appearance and "substance" of the body and of its carriage and bearing; of the firmness of the tissues; of the presence of subcutaneous fat; of the condition and process of development of the muscular system; of the condition of the skin and the redness of the mucous membranes; of the nervous and muscular systems as expressed in listlessness, or alertness, apathy or keenness ; of the condition of the various systems of the body ; and of the relative balance and co-ordination of the functions and powers of dig-estion, absorption, assimilation of food, and of the excretion of waste products. In brief, it may be said that malnutrition is usually due to one of four causes :— (a) Physical defect. (b) Debility following- illness. (c) Faulty hygiene and unsuitable food. (d) Shortage of food. "More than one-half of the chronic complaints which embitter the middle and latter part of life," said Sir Henry Thompson, the surgeon, "is due to avoidable errors in diet." One cause of error is lack of knowledge in the choice of good and evil in regard to food—its selection, nutritive value, preparation and consumption. But there are other aspects of the dietetic habit which have a large share in the production of disease: (a) irregularity of meals and the consumption of food or drink between them; (b) the unvaried monotony of the average dietary; (c) the failure to masticate food owing to defective teeth or the habit of bolting food; (d) drinking too much with meals; (e) bad teeth; (f) chronic constipation; and (g) the abuse of tea, spices and alcoholic beverages. These seem to be trivial matters, but it is out of the smaller habits and neglectfulness of men that disease is born. 190 The accompanying table shows the classified causes of malnutrition as it occurs in children at present in attendance at the schools under the Authority, the type of treatment carried out iri connection with these children and the results obtained. It will be seen that there are 169 children who are still under treatment for malnutrition; the average school attendance for the period involved is 18,470; giving a figure for children suffering from malnutrition of 9.1 per thousand, as compared with a figure of 10.7 per thousand for England and Wales. In conclusion I beg to submit that it is doubtful whether "the most susceptible index of malnutrition in a community is concerned with children of school age." In this connection must be considered the several facilities for combating malnutrition in school children and the natural parental affection which often entails serious sacrifice in the interest of the off-spring. This latter factor is by no means uncommon in East Ham and it may well be that the percentage of cases of malnutrition in the adult members of the population is greater than that which exists amongst school children. 191 Table Showing the Causes of Malnutrition, the Treatment adopted and the Results of such Treatment in East Ham School Children found to be Suffering from Subnormal Nutrition. Classified Causes of Malnutrition. Treatment Adopted. Results. Number of Cases. School Clinics. Cod Liver Oil, Parrish's Food or Virol. Light Clinic. Additional Nourishment (Public Assistance). Referred for School Dinners. Admitted to Schools of Recovery. Hospital. Admitted to Sanatorium. Referred to N.S.P.C.C. Under Treatment—No Definite improvement at present. Treatment effective and still in opreation. Regained normal nutrition, treatment discontinued Diagnosis not confirmed, progress satisfactory. Surgical. Medical. Circulatory:— Anaemia 28 28 21 18 4 9 12 — 2 — 2 4 10 13 1 Cardiac disease 15 15 8 7 4 — 6 — 11 — — 2 10 3 — Respiratory:— Bronchitis 26 26 23 15 — — 8 — 4 — — 3 5 18 — Asthma 4 4 3 3 — — 2 — 1 — — 1 2 1 — Pneumonia 6 6 5 4 1 — 1 — — — — 2 — 4 — Empyema 1 1 1 — — — 1 1 — — — — 1 — — Alimentary:— Dental caries and oral sepsis 21 21 7 1 — — 1 — — — 4 2 6 12 1 Gastro-enteritis 8 8 4 3 — — 1 — 5 — — 2 1 5 — Appendicitis 3 3 3 2 — — — 3 — — — 1 — 2 — Constipation 11 11 9 — — 3 — — 2 — — 2 4 5 — Threadworms 18 18 1 1 — 6 — — 6 — 4 2 8 7 1 Chronic Naso-Pharyngeal Infection (Enlarged tonsils, adenoids, etc.) 40 40 30 19 3 8 2 27 — — 7 5 11 23 1 Ear disease (Otitis media, mastoiditis, etc.) 5 5 4 3 — — 1 3 — — — 1 — 4 — Acute Infectious Diseases:— Whooping Cough 16 16 16 8 — — 6 2 1 — — 2 2 12 — Diphtheria 6 6 5 4 — — 2 — — — — — 1 5 — Scarlet Fever 5 5 5 5 1 — — — — — — — 2 3 — Measles 26 26 26 15 3 4 11 3 — — 2 3 6 17 — Small Pox 1 1 1 — — — — — — — — — — 1 — Influenza 16 16 16 12 — 3 3 2 — — — 2 4 10 — T uberculosis 7 7 5 6 — — — — 1 6 — 3 3 1 — Other diseases:— Rickets 13 13 12 11 4 8 4 1 1 — — 1 4 8 — Infantile Paralysis 5 5 5 3 — — 1 2 — — — — 3 2 — Subacute Rheumatism 16 16 14 12 3 2 4 1 1 — — 3 4 9 — Chorea 3 3 3 1 — — 1 — 2 — — — 2 1 — Herpes 1 1 1 — — — — — — — — — — 1 — Pyelitis 1 1 1 — 1 — — — 1 — — — 1 — — Social and Domestic Conditions:— Shortage of food (Necessity) 15 15 13 5 7 12 9 — — — — 4 2 7 2 Errors in dietary, unhygienic mode of life, etc. (Vitamin deficiency) 38 38 19 17 — 11 2 — — — — 6 18 13 1 Indifference and neglect 13 13 13 10 — 9 8 — — — 9 5 3 5 — Totals 368 368 274 185 31 75 86 45 38 6 28 56 113 192 7 193 23. Miscellaneous. During the year 1934 the following special medical examinations were made:— Teachers 12 Assistant Teachers 43 Student Teachers 9 Caretakers 6 Cleaners 23 Cook Attendants 1 194 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 sixth annual report on the work done in the Aural Clinic during 1934. Eighty-three clinics were held during- the year, with a total attendance of 1,975. Sixty-two per cent of the cases were, after treatment, discharged cured. I operated on 286 East Ham children for septic tonsils and adenoids, and in five cases of chronic mastoid disease. The statistical report is as follows :— Cases of Chronic Otitis Media 204 Discharged 138 Cases of Deafness 45 „ 21 Other Ear Cases 76 „ 62 Cases of Chronic Rhinitis 65 „ 39 Other Nose Cases 27 „ 19 Cases of Enlarged Tonsils and Adenoids 204 „ 111 Other Throat Cases 10 ,, 4 Mastoid Operations 5 „ 1 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. 195 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 1934. General Clinic. Number of new cases 605 Glasses prescribed 369 Glasses not necessary 236 Glasses obtained 363 Special treatment 81 Re-examinations 2,730 Discharged 309 Cysts treated at St. Bart's 10 Baby Clinic. Number of new cases 57 Glasses prescribed 22 Glasses obtained 21 Special treatment 15 Re-examinations 196 Discharged 12 Lachrymal obstructions treated at St. Bart's 12 Myope Class. Number of pupils 16 Most of the treatment and operation cases were successfully dealt with, only a few chronic lid inflammations remaining;. The sight-saving' class has done very useful work. The School Medical Service and optical and clerical staff have given very kind and efficient help. I have the honour to be, Sir, Your obedient Servant, S. C. REEVE-FLAXMAN. 196 Report on the Work Done in the School Dental Clinic. To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I have much pleasure in submitting to you my report for the year 1934. The age groups inspected were from 5 years to 11 years inclusive. The number of children inspected was 10,977 and the number referred for treatment was 7,465, to which must be added the Specials, which numbered 278. These are urgent cases of toothache or oral sepsis referred by the School Medical Officers and the Head Teachers. Details will be found in the following statistical table :— TABLE IV. Group V. Dental Defects. Dental inspection of the age groups 5 years to 11 years is carried out at the schools once a year. At these inspections everything is done to gain the confidence of the children and to impart wholesome advice where necessary. The treatment is carried out so that the young patients suffer the very minimum of pain. Injections are given for the extraction of temporary and some permanent teeth. Ethyl-chloride or freezing is used in the case of septic temporary teeth and gas for the majority of permanent teeth, and also for the extraction of temporary teeth in the case of very nervous children. Small cavities are filled in temporary teeth either with amalgam or cement, and all cavities, where possible, are filled in permanent teeth, particular care being taken of the first or 6 year molars. Regulation of the permanent teeth is carried out by judicious extraction where the mouth is overcrowded and by the making of regulation plates. The children quickly get used to wearing these plates, and some very good results have been obtained by 197 this method during the past year. The very difficult or abstruse cases requiring- X-Ray, etc., are referred to Guy's Hospital or the London Hospital. It is interesting to note that the percentage of children with sound mouths has risen from 23 per cent in 1923 to 32 per cent in 1934. This is a very gratifying result and one which shows a steady improvement of the mouths of the children inspected. The parents to-day take much more care and interest in the dental treatment of their children than they did 10 years ago, and there is a great improvement in cleanliness and the oral conditions of the school children. It is very rare to-day to see a really septic mouth, whereas in 1924 it was only too common. During the year 1935, owing to a slight decrease in the school population, the age groups to be inspected will be increased to include the 12 year group, thus bringing the age groups from 5 years to 12 years inclusive. Maternity and Child Welfare Centre. Statistical details of the dental work carried out for the Maternity and Child Welfare Centres are shown in the following table:— No. of Sessions devoted to Treatment. No. of Attendances. No. of Permanent Teeth. No of Temporary Teeth. Total No. of Extractions. Total No. of Fillings No. of Adminis trations of General Anaesthetics. No. of other Operations. Adults Children. Extrac ted. Filled. Extrac ted. Filled. Permanent Teeth. Temporary Teeth. 92 215 616 312 52 945 159 1,257 211 62 119 01 Two sessions per week have been devoted to the cases referred from the Maternity and Child Welfare Centres. These are children under 5 years of age and mothers. In the case of the children the temporary teeth are extracted by local injection or by freezing, and fillings done where necessary and where possible. Mothers obtain complete treatment, extractions are mostly done under gas and sometimes by local injection, and necessary fillings are carried out. Dentures are supplied when necessary. 198 May I thank my colleague, Mr. Hall, and the two Dental Nurses for their help and co-operation during the year, and also the Medical Officers, Nurses, Teachers, and Clerical Staff for their valued assistance. I have the honour to be, Sir, Your obedient Servant, (Signed) C. S. NEAME. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups— Entrants 1,747 Second Age Group 1,873 Third Age Group 1,895 Total 5,515 Number of other Routine Inspections 521 B.—OTHER INSPECTIONS. Number of Special Inspections 3,150 Number of Re-Inspections 3,203 Total 6,353 199 TABLE 11. A.—A Return of Defects found by Med;cal Inspection in the Year ended 31st December, 1934. 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) (8) (4) (5) Malnutrition 58 o 24 3 Skin Ringworm: Scalp — — 2 — Body 1 — 20 — Scabies 1 — 30 — Impetigo 8 3 174 — Other Diseases (Non- Tuberculous) 22 25 222 — Eye Blepharitis 6 11 49 — Conjunctivitis 2 1 79 2 Keratitis — — 1 — Corneal Opacities — — — — Defective vision (exc luding Squint) 240 74 215 29 Squint 24 16 39 1 Other conditions 8 6 82 2 liar Defective Hearing 8 5 35 5 Otitis Media 82 15 118 — Other Ear Diseases 55 66 105 — Nose and Throat Chronic Tonsillitis only 91 737 48 5 Adenoids only 7 26 10 1 Chronic Tonsillitis and Adenoids 146 44 94 2 Other conditions 44 52 90 5 Enlarged Cervical Glands (Non- Tuberculous) 27 396 34 2 Defective Speech — 12 6 2 Heart and Circulation. Heart Disease: Organic 13 42 8 3 Functional 1 55 1 1 .Anaemia 20 28 36 1 200 Table II.—(continued). (1) (2) (3) (4) (5) I.ungs Bronchitis 8 93 8 2 Other Non-Tuberculous Diseases 38 58 65 4 Tuber- culosis Pulmonary: Definite — — — — Suspected 4 — — — Non-Pulmonary: Glands — — — — Bones and Joints — 1 2 — Skin — — — — Other Forms 1 — — — Nervous System Epilepsy — 4 2 — Chorea 3 3 17 1 Other conditions 4 11 4 — Deformities Rickets 3 3 1 — Spinal Curvature 11 2 1 — Other Forms 14 11 12 1 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 128 160 1301 75 Total 1034 1902 2935 147 13.—Number of Individual Children found at Routine Medicai. Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Inspected Found to require Treatment. (1) (2) (3) Prescribed Groups:— Entrants 1747 447 Second Age Group 1873 230 Third Age Group 1895 193 Total (Prescribed Groups) 5515 870 Other Routine Inspections 521 96 Grand Total 6036 960 201 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Children Suffering from Multiple Defects. Information is only required in respect of children suffering from any combination of the following types of defect :— Blindness (Excluding Partially Sighted Children). Deafness (Excluding Partially Deaf Children). 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 ^ any combination of the above defects 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 — — — 3 Partially Sighted 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 sighted. 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 Sighted. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 19 4 1 — 24 202 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 mentallv defective children. The following table should include all such children except those who have been notified to the Local Authority under the Mental Deficiency Act in accordance with Article 3 of the Mental Deficiency (Notification of Children) Regulations, 1928. Particnlars relating to these children should be entered in the return of notified children—Form 307M. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 77 — 6 private schools — 83 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. 203 Table III—continued. For practical purposes the Board are of opinion that children who are 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. 2 — — 2 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, f At other Institutions. At no School or Institution. Total. 9 32 3 44 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, f At other Institutions. At no School or Institution. Total. 15 53 3 7 78 †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. 204 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. 66 175 — — 241 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 in by other children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 17 48 4 2 71 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. 31 51 3 4 89 205 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1934. 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— Ri ng worm-Scalp— (i.) X-Ray Treatment — — — Cii.) Other Treatment 2 — 2 Ringworm-Bodv 25 2 27 Scabies 29 1 30 Impetigo 179 179 Other skin disease 218 5 223 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 167 6 178 Minor Ear Defects 275 12 287 Miscellaneous (e.g., minor injuries, bruises,sores, chilblains, etc.) 1460 113 1573 Total 2355 139 2494 206 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. No. of children for whom spectacles were Under the Authority's Scheme. C Otherwise. Total. Prescribed Obtained (i) (2) (i) (ii) (i) (>') Under the Authority's Scheme. Otherwise Under the Authority's Scheme. Otherwise. (1) (2) (3) (4) Errors of Refraction (including Squint) 524 53 377 369 9 360 9 Other Defect or Disease nf the Eyes (excluding those recorded in Group i.) — — — Total 524 551 577 Group III.—Treatment of Defects ok Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number Treated. Under the Authority's SchemeinClinic 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) 65 409 33 6 270 3 9 1 21 1 42 7 291 4 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids (iv) Other defects of the nose and throat. 207 Table IV.—continued. Group IV.—Orthop.edic and Postural Defects. Under the Authority's Scheme. (1) Otherwise. (2) Total number treated. Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic. (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Nonresident'al treatment at an orthopaedic clinic. (iii) Number 1 of | children 1 treated J — 10 — — 13 23 Group V.-—Dental Defects. 1) Number of Children who were : — (i) Inspected by the Dentist— Age. Routi'ie Age Groups. Specials Grand t otal. 5 6 7 8 9 1 10 11 Total. 1426 1601 1658 1689 1836 1886 881 10977 278 11255 ! (ii) Found to require treatment 7465 (iii) Actually Treated... 2734 (2) Hall-days devoted to:— Inspection 109 ■ Total 795 Treatment 686 (3) Attendances made by children for treatment 6332 (4) Fillings :— Permanent Teeth 1383 Total 1867 Temporary Teeth ... 484 (5) Extractions:— Permanent 1 eeth ... 823 Total 7603 Temporary Teeth 6780 (0) Administrations of general anaesthetics for extractions 544 (7) Other operations :— Permanent Teeth 544 Total 869 Temporary Teeth 325 Group VI.—Uncleanliness and Verminous Conditions. (i.) Average number of visits per school made during the yearby the School Nurses ... 3 (ii.) Total number of examinations of children in the Schools by School Nurses 47,550 (iii.) Number of individual children found unclean 1,038 (iv.) Number of children cleansed under arrangements made by the Local Education Authority Nil. (v.) Number of cases in which legal proceedings were taken :— (o) Under the Education Act, 1921 Nil. (6) Under School Attendance Byelaws Nil, 208 TABLE I. RETURN OF MEDICAL INSPECTIONS. For the Year ended 31st December, 1934. SECONDARY SCHOOL. A.—ROUTINE MEDICAL INSPECTIONS. Number ol: Inspections in the prescribed Groups— Boys. Girls Entrants — — Second Age Group — — Third Age Group 132 190 Total 132 190 Number of other Routine Inspections 303 392 B. —OTHER INSPECTIONS. Number of Special Inspections 10 8 Number of Re-Inspections 36 51 Total 46 59 209 TABLE 11. SECONDARY SCHOOL. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1934. 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. 15. G. B. G. B. G. Malnutrition — 1 — — — — — — Skin Ringworm: Scalp — — — — 1 — — — Body — — — — — — — Scabies — — — — — — — — Impetigo — — — — — — — — Other Diseases non-Tuberculous — 2 2 — 1 — — — Eve Blepharitis — — 1 1 — — — — Conjunctivitis — — — — 1 1 — 1 Keratitis — — — — — — — — Corneal Opacities — — — — — — — — Defective Vision (excluding Squint) 16 31 2 — 1 — — Squint — — — — — — — — Otlier Conditions 1 1 1 3 — — — — Ear Defective Hearing — 1 — — — — — — Otitis Media — 4 — — 2 — — — Other Ear Diseases — 8 2 11 — — — — Nose and Throat Chronic Tonsillitis only 1 2 7 2 — — — — Adenoids only — — 1 — — — — — Chronic Tonsillitis and Adenoids 2 3 1 — — — — — Other Conditions 7 — 3 2 — — — Enlarged Cervical Glands (Non-Tuberculous) — 1 7 3 1 — — — Defective Speech — — 1 — — — — — 210 Table II.—(continued.) (1) (2) (3) (4) (5) Heart and Circulation Heart Disease: B. G. B. G. b. G. B. G. Organic — — 2 — — — _ — Functional — — — 2 — — — — Anaemia — — — 1 — — — — Bronchitis 1 — 4 1 — — — — Lungs Other Non Tuberculous Diseases 1 — 2 — — — — — Tuberculosis Pulmonary: Definite — — — — — — — — Suspected — — — — — — — — Non-Pulmonary: Glands — — — — — — — — Bones and Joints — — — — — — — — Skin — — — — — — — — Other Forms — — — — — — — — Nervous System Epilepsy — — — — — — — — Chorea — — — — — — — 1 Other Conditions — 1 — 3 — — — — Deformities Rickets — — — — — — — — Spinal Curvature 2 5 Other Forms — — — — — — — Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 5 18 3 2t 3 1 — — Total 30 85 3(5 51 11 3 — 2 B.—Number of individual children found at Routine Medicai. Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). . GROUP. Number of Children Inspected Found to require Treatment. (1) (2) (3) B. G. B. G. Prescribed Groups:— Entrants — — — — Second Age Group — — .— — Third Age Group 132 190 10 16 Total (Prescribed Groups) — — — — Other Routine Inspections 303 392 14 60 Grand Total 435 582 24 76 211 TABLE IV. SECONDARY SCHOOL. Return of Defects Treated during the Year ended 31st December, 1934. 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— (i ) X-Rav Treatment — — — — — — (ii.) Other Treatment — — — — — — R in gworm -Body 1 — — — 1 — Scabies — — — — — — Impetigo — — — — — — Other skin diseases — — — — — — Minor Eye Defects (External and other, but excluding cases falling in Group II.) 2 3 — — 2 3 Minor Ear Defects 2 5 — — 2 5 Miscellaneous (e.g..minor injuries, bruises, sores, chilblains, etc.) 8 30 3 2 11 32 Total 13 38 3 2 16 40 212 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. No. of children for whom spectacles were Under the Authority's Scheme. Otherwise. Total. Prescribed (1) Obtained (2) (i) (ii) (i) (ii) Under the Authority's Scheme. Otherwise Under the Authority's Scheme. Otherwise. (1) (2) (3) (4) B. G. B. G. B. G. B. G. B. G. B. G. B. G. Errors of Refraction (including Squint) 8 21 — — 3 21 1 13 — — 1 13 — — Other Defect or Disease of the Eyes (excluding those recorded in Group I.). — — — — — — Total 3 21 — — 3 21 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 1 — 2 — — — — — — — — 1 — — — 1 1 2 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. Received other forms of treatment Roys — Girls 2 Total number treated Boys 2 Girls 3 INDEX. 214 INDEX. A. Abatement of Nuisances 135 Act—Blind Persons, 1920 51-55 Act—Local Government, 1929 23 Acts—Children, 1908-32 125 Act—Housing, 1930 143-144 Acts—Mental Deficiency 46-50 Acts—Midwives, 1902-18 21, 123 Act—Nursing Homes Registration, 1927 21 Act—Rag Flock 141 Act, Rents Restriction 136 Adenoids 119, 161, 170 After-Care Committee 81 Aldersbrook Homes 42-46 Ambulance Facilities 22 Attendance Officers, Cooperation of 184 Ante-Natal Clinic 122 Artificial Sunlight 31 34. 173, 174 Aural Surgeon, report of 194 Aural Treatment 34, 120, 194 B. Bacteriology 22, 71, 145, 150 Bacteriological Examinations 71 Baths-School 184 Birth-rate 13 Births 11, 13, 120 Birth Control 116 Births, Illegitimate 11 Births, Still 11, 121 Blind Persons Act, 1920 51-55 Blind Children 185 Byelaws—Premises and occupations controlled by 139 C. Camps—School 176 Cancer 74-76, 87 Cemeteries 129, 140 Centre-Training and Occupation M.D. 46 Cerebro-Spinal Fever 71 Chief Sanitary Inspector— Report of 132-151 Children Act, 1908-32 125 Children-Invalid Aid Association 56, 125 Classrooms, Open Air 176 Clinic, Ante-natal 122 Clinic, Artificial Sunlight 31-34, 173, 174 Clinic, Aural 194 Clinic, Dental 196 Clinic, Immunisation57-60, 62, 72, 119 Clinic—-Manor Park 31-34 Clinic, Ophthalmic 195 Clinic, School 156 Clinic, Toddlers' 118 Clinic, Tuberculosis and Chest 34, 81-92 Clinics, Infant 117 Clinics, Morning 120 Clinics and Treatment Centres 30 Closet Accommodation 132 Committees 3-4 Complaints of Nuisances 135, 136 Contents—Principal 2 Continuation Schools 187 Co-ordination 155 Crematorium 129 Cripples 163, 172 D. Dairies 145 Day-Schools, Open air 176-178 Deaf Children 185 Deaths 13 Death-rate, General 13 Death-rate, Infantile 11, 14 Deaths, Causes of 17 Deaths, Infants 20 Deaths, in Wards and Rates 19 Dental Treatment 119, 163, 172, 196 Dental Treatment —- Tuberculous Patients 93 Dental Surgeons, Report of 196 Diphtheria 57-60, 61, 68-70 Disinfection in Schools 166-168 District Medical Officer 29 District Nurses Home 21 Drainage and Sewerage 132 Dust Collection 132 E. Ear Diseases 34, 163, 172 East Ham Memorial Hospital 38-40 Education Committee 4 Employment of Children 187 Enteric Fever 64 Epileptic Children 185 Erysipelas 64 Eye Diseases of Children 162, 171 Exceptional School Children 156, 201 Extracts from Vital Statistics 11 F. Factories and Workshops 131 Following-Up 169 Food and Drugs 139, 147-150 Food Inspection 144-150 Free Supplies of Milk 124 C- General Provision—Health Services 20-34 H. Harts Sanatorium 94-100 Health Committee 3 215 INDEX—continued. Health Services— General Provision of 20-34 Health Visitors 121 Home—Nursing in 20 Homes—Nursing 21 Home Helps 126 Homes, Aldersbrook and Scattered 42-46 Homeless Children 22 Hospitals—General and Special 34-46 Hospital, Infectious Diseases 67-74 Hospital, East Ham Memorial 38-40 Hospital, Maternity 21, 34, 116, 123 Hospital, Mental 34-37 Hospital, Smallpox 38 Hospital, Whipps Cross 40, 41 House-to-House Inspection 133 Housing Act, 1930 143-144 Housing Statistics 141-143 I. Illegitimate Births 11 Immunisation Clinic 57-60, 62, 72, 119 Increase of Rent (Restriction) Act 136 Infant Deaths 20 Infant Welfare Clinics 117 Infantile Mortality 14 Infectious Diseases Hospital 67-74 Infectious Diseases 57-74, 163-168 Inspection of and Supervision of Food 144-150 Inspection. House-to-House 133, 134, 151 Inspection of School Children 156, 157, 158 Institutional Provision for Unmarried Mothers, Illegitimate Infants, etc. 22 Institutions Controlled by West Ham 40, 41 Invalid Children's Aid Association 56, 125, 177 L. Laboratory Facilities 22, 71, 145, 150 Legal Proceedings 137-139 Legislation in Force 23 Light Treatment 31-34, 173, 174 Local Government Act, 1929 23 M. Malnutrition—School Children 187-191 Manor Park Clinic 31-34 Maternal Mortality 15, 107-116, 124 Maternity and Child Welfare 107-126 Maternity and Child Welfare Committee 3 Maternity Homes and Hospitals 21, 34, 116, 123 Meals, Provision of 179-183 Meat Regulations 146 Medical Examinations, Miscellaneous 193 Medical Inspection—School Children 156, 157, 158, 198 Medical Officer of Health's Report 1-151 Medical Relief, Poor Law 23-29 Mental Defects, School Children 186 Mental Deficiency 30, 46-50, 186 Mental Deficiency Committee 4 Mental Hospital 34-37 Menus of Meals 180-183 Meteorology 130 Midwives 21, 123 Milk—Free Supplies 124 Milk (Special Designation) Order 145 Milk Supply 144 Minor Ailments 161, 170 Mortality, Analysis of 16 Mortality, Infantile 14 Mortality, Maternal 15, 107 1)6, 124 Mortality, Neo-natal 14 N. Neo-natal Mortality 14 Noteworthy Causes of Sickness or Invalidity 12 Notices Served and Complied with 135, 136 Notification of Births 120 Nuisances Abated 135 Nuisances Discovered 135 Nursing Arrangements 20, 21, 28 Nursing Homes Registration Act, 1927 21 Nursery Schools 186 0. Open-air Education 176-178 Ophthalmia Neonatorum 34, 67, 124 Ophthalmic Clinic 195 Ophthalmic Surgeon, Report of 195 Ophthalmic Treatment 119 Orthopaedic 34, 207 Outdoor Assistance 129 P. Parents, Co-operation of 184 Physical Features of Area 11 Physically Defective Children 185 Physical Training 179 216 INDEX—continued Plaistow Maternity Hospital and District Nurses Home 21 Playground Classes 176 Pneumonia 71 Poor Law Medical Out Relief 23-29 Population 15 Premises and Occupations Controlled by Byelaws 139 Principal Contents 2 Prosecutions, Milk 139 Prosecutions, Public Health Acts 137-138 Prosecutions, Sale of Food and Drugs Acts 139 Provision of Meals 179-183 Public Assistance Domiciliary Medical Service 23-29 Public Assistance Institutions 40, 41 Public Health Committee 3 Puerperal Fever and Pyrexia 34, 64, 124 R. Rag Flock Act 141 Rateable Value 11 Refuse Removal and Disposal 132 Rents Restriction Act 136 Residential Schools 176-178 Ringworm 119 Rivers and Streams 132 Runwell Mental Hospital 34-37 S. Sanatoria 94-103 Sanitary Circumstances of the Borough 132 Sanitary Inspection of Borough 133 Sanitary Section and Housing 132-150a Scarlet Fever til 70 Scattered Homes 42 4<" Scavenging 132 Schick Immunisation Clinic 57,60,62,72 119 School Attendance Officers— Co-operation of 184 School Baths 184 „ Blind Children 185 ,, Camps 176 „ Children, Blind, Deaf, Defective and Epileptic 185 „ Children, Minor Ailments 161, 170 „ Children, Medical Inspection 155-158, 198 ,, Children, Mentally Defective 186 ,, Children, Physically Defective 185 Children, Verminous Conditions 160 School Continuation 187 Cripples 163, 172 ,, Disinfection 166-168 ,, Exceptional Children 156 ,, Hygiene 155 ,, Meals 179-183 ,, Medical Officer's Report 151-212 Medical Service in Relation to Public Elementary Schools 155 ,, Medical Treatment 169 Nursery 186 Open-air 176-178 Schools of Recovery 178 Schools, Secondary 186 Schools, Survey of 141 Sewerage 132 Sickness or Invalidity, any Noteworthy Causes 12 Skin Diseases 162, 170 Slaughterhouses 146 Smallpox 38, 60, 133 Smoke Abatement . 139 Social Conditions of Area 11, 126-129 Special Enquiries 187 Special Schools 178 Staff 5-6, 155 Statistical and Social Conditions of area 11-20 Statistics 11 Still Births 11 Streams 132 T. Table, Birth-rate etc. 16 „ Blind Persons 53-55 „ Cancer 76 „ Complaints Received 135, 136 ,, Cost at Institutions 74, 96 „ Death Rate etc. 16 Deaths, Causes of 17 ,, Deaths, Ward and Rates 19 ,, Defective Vision and Squint 206, 212 ,, Dental Treatment 207 ,, East Ham Memorial Hospital 38-40 „ Exceptional Children 201-204 ,, Factories and Workshops Act 131 „ Food and Drugs Acts 148-150 ,, Harts Sanatorium ... 96-99 „ Housing 141-143 „ Infant Deaths 20 ,, Infectious Diseases, Notifiable 65, 66 „ Infectious Diseases Removed to Hospital 73 „ Infectious Diseases in Schoolchildren 165 217 INDEX continued Table, Inspections for year 133, 150a ,, Inspections in Wards 134 Mental Defectives 47, 49,50 ,, Mental Hospitals 37 ,, Meteorology 130 Minor Ailments 161 ,, Nose and Throat 206, 212 Ophthalmia Neonatorum 67 ,, Orthopaedic Defects 207 ,, Outdoor Assistance 129 Public Assistance Institutions 41 Public Health Acts Prosecutions 137-138 Record of Inspections 151 Sale of Food and Drugs Acts Prosecutions 139 ,, School Children, Defects of ... ... 199, 209 ,, School Children Examined ... ... ... 198, 208 ,, School Children Found to require Treatment 158, 200, 210 ,, School Children—Malnutrition 188, 191 ,, School Children—Provision of Meals 180-183 School Children,—Treatment carried out 205-207, 211 ,, Schools of Recovery 178 ,, Secondary School Examinations 208-212 ,, Sunlight Treatment 174 ,, Throat and Nasal Defects 206-212 „ Tuberculosis Deaths 107 Tuberculosis and Chest Clinic 89-92 ,, Tuberculosis Notifications 104-106 ,, Tuberculosis, Residential Treatment 97-103 ,, Unemployed 127 Table, Vaccination 61 ,, Verminous Condition of Schoolchildren 160 Teaching Staff, Co-operation of 184 Toddlars' Clinic 118 Tonsils and Adenoids 119, 161, 170 Training Centre, Mental Defective 49 Treatment Centres 30 Tuberculosis 77-107, 162, 170 Tuberculosis and Chest Clinic 34,81-92 Tuberculosis after care Committee 81 U. Uncleanliness 159 Unemployment and Outdoor Assistance 126-129 Unmarried Mothers 22 Urinals 141 V. Vaccination 61 Verminous Conditions— School Children 161 Venereal Diseases 29 Vital Statistics, Extracts from 11 Vision 162,171,206,212 Visits, Health Visitors 121 Visits, School Nurses 169 Voluntary Associations 56,125, 177, 184 w. Wards, Deaths in and Rates 19 Water Supply 132 Whipps Cross Hospital 40, 41 Workshops 131 Z Zymotic Diseases 60