Journal Rebind Co. Ltd. Unit 4, Pier Wharf Grays Essex COUNTY BOROUGH OF EAST HAM. Annual Report OF THB Medical Officer of Health AND School Medical Officer FOR THE YEAR 1935. The Woodgrange Press, Ltd., London, E.7. C.i. M Ac 4411. EAS 11 68002 COUNTY BOROUGH OF EAST HAM. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1935. MALCOLM E. BARKER, M.K.C.S., L.H.C.P., D.P.H. The Woodgrange Press, Ltd., London, E.7. PRINCIPAL CONTENTS. Sections:— PAGE. Constitution of Committees 3 Public Health Staff 5 Introduction 7 Statistical and Social Conditions of Area 10 General Provision of Health Services 19 General & Special Hospitals & Children's Homes 30 Mental Deficiency 37 Welfare of the Blind 40 Invalid Children's Aid Association 43 Infectious Diseases 44 Tuberculosis 59 Maternity and Child Welfare 82 Unemployment and Out-Door Assistance 91 Meteorological Record 93 Sanitary Section and Housing 95 School Medical Service:— Introduction 111 Report 113 Index 160 3 EAST HAM CORPORATION PUBLIC HEALTH COMMITTEE. Also Committee under Blind Persons Act, 1920, Sec. 2. *The Mayor (Alderman T. W. Burden, J.P.). *The Deputy-Mayor (Alderman C. W. Brading, J.P.). *Alderman E. F. Markey (Chairman, Public Health Committee, Institutions and General Sub-Committee, and Maternity and Child Welfare Sub-Committee). *Alderman Mrs. A. Taylor (Vice-Chairman). *Alderman W. W. Bacot, J.P. *Alderman G. H. Manser, J.P. *Councillor J. W. Barton. *Councillor G. W. Boultwood, J.P. *Councillor Mrs. E. M. Brace. Councillor W. T. Bush. Councillor S. A. Elson. Councillor R J. Fell. *Councillor H. B. Harper, J.P. Councillor T. I. Lethaby, J.P. *Councillor G. H. Moncar. Councillor J. J. Pope. *Councillor H. Restarick. Councillor W. Thompson. Councillor F. Welch. *Councillor Mrs. B. Wilkens. *Also Member of the Institutions and General Sub-Committee. MATERNITY AND CHILD WELFARE SUB-COMMITTEE. Maternity and Child Welfare Act, 1918, Sec. 2. Same members as Public Health Committee, with— The Mayoress (Mrs. M. W. Bagot) (co-opted). Mrs. E. M. Fell (co-opted). Mrs. K. Moger (co-opted). 4 COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. Menial Deficiency Act, 1913, Sec. 28. The Mayor (Alderman T. W. Burden, J.P.). The Deputy-Mayor (Alderman C. W. Brading, J.P.). Councillor Mrs. B. Wilkens {Chairman). Councillor Mrs. K. M. Knight (Vice-Chairman). Alderman Mrs. A. Taylor. Councillor R. W. Moger, J.P. Councillor G. W. Boultwood, J.P. Councillor A. Rhodes, J.P. Councillor C. W. Dixon. Mrs. C. J. Cross (co-opted). Councillor H. B. Harper, J.P. Airs. A. M. Gray (co-opted). Councillor T. I. Lethaby, J.P. Mrs. L. J. Nichols (co-opted). EAST HAM EDUCATION COMMITTEE. The Mayor (Alderman T. W. Burden, J.P.). The Deputy-Mayor (Alderman C. W. Brading, J.P.). Councillor T. I. Lethaby, J.P. (Chairman). Alderman E. H. Thompson (Vice-Chairman). Alderman Mrs. A. Taylor. Councillor Mrs. E. M. C. Brace. Councillor Mrs. W. M. Knight. Councillor Mrs. B. Wilkens. Councillor J. W. Barton. Alderman G. H. Manser, J.P. Alderman E. F. Markey. Alderman W. T. Newling, J.P. Councillor W. T. Bush. Councillor S. A. Elson. Councillor R. J. Fell. 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 J. J. Pope, J.P. Councillor H. Restarick. Councillor E. R. Thomas. Councillor W. Thompson. Councillor T. W. Williams. Councillor E. A. Wood. Mrs. E. A. Brown. 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 H. 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 and Resident Medical Superintendent, Harts Sanatorium. 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.), Consultant, Tuberculosis and Chest Clinic. S. C. Reeve-Flaxman, M.R.C.S., L.R.C.P., Ophthalmic Surgeon. R. Savf.ce, 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; Public Vaccinator. J. S. Greig, M.B., C.M., Medical Officer, Aldersbrook Homes. 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:— †1G. D. Lill, M.S.I.A., Senior Sanitary Inspector; Food and Shops Act Inspector; Inspector Contagious Diseases (Animals) Act. †2J. E. Austin, M.S.I.A., A.M.I.P.C., Cert.S.I.J.B., Cert. Meat Ins., Cert. Smoke Ins. R. A. Baskett, M.S.I.A.; M.J.J. Hillyard, M.S.I.A.; H. G. Luckett, A.R.S.I., 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. 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., S.C.M., M.R.S.I. (H.V.'s Cert.). Health Visitors:— L. Barrett, S.R.N., S.C.M. A. E. O'Leary, S.R.N., S.C.M., R.S.I. (H.V.'s Cert.). M. Preston, S.R.N., S.C.M., R.S.I. (H.V.'s Cert.). E. E. Roberts, S.R.N., S.C.M. D. E. Skeggs, S.R.N., S.C.M., R.S.I. (H.V.'s Cert.). C. R. Worrali, S.R.N., S.C.M., 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., S.C.M., A.R.S.I. A. R. Kekwick, S.R.N., A.R.S.I. †3D. M. Maltry, R.R.C. A. Nears, S.R.N. M. H. Nunn, S.C.M. V. Olifent, R.F.N. M. A. Sorrell, S.R.N., A.R.S.I. D. Young, S.R.N., S.C.M. Tuberculosis Nurses:— †4E. E. Cook, S.R.N., S.C.M. L. E. Mallon, S.R.N. †5E. Meadhurst (Assistant). †6M. Lantry, S.R.N., T.A.Cert. †7F. M. Williams, S.R.N., T.A.Cert. Public Assistance Nurse:— E. E. Kelley, S.R.N., S.C.M., Fever Trained. E. Other Staff:— Ascertainment and Supervising Officer, M.D. Acts: — E. L. Hicks. M.D. Training Centre:— A. H. Bleadon, 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:— †8E. A. Bloomfield. 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. †9E. M. Walton. Female Clerk:— J. M. Flynn. A. R. Gaster. D. M. Greene. F. E. Hales. W. M. Hales. M. A. McCall. F. C. Wells. †4 Superannuated as from 23.10.35. †5 Superannuated as from 27.6.35. †6 Commenced 19.8.35. †7 Commenced 6.1.36. †8 Commenced 4.11.35. †9 Commenced 24.6.35. †Superannuated as from 1.8.35. *Appointed Resident Medical Superintendent, Harts Sanatorium on 22.10.35. †1 Superannuated as from 3.2.35. †2 Commenced on 25.3.35. †3 Superannuated as from 1.11.35. 7 Public Health Department, Town Hall. May, 1936. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you my Annual Report relating to the health of the County Borough of East Ham for the year 1935, together with the Annual Report to the Education Authority on the School Medical Service. In accordance with the instructions of the Ministry of Health, the contents comprise an "ordinary report" limited to a record of alterations, improvements and developments during the past year. It will be seen that the health of the Borough has been well maintained, and that all statistics relating to public health shew some improvement, except the maternal mortality rate. I regret to report an increase over the exceptionally low figure for 1934. It could hardly be anticipated, however, that this would be continued year by year; the association of general illness with maternity causes considerable variation in the mortality rate. A permanent reduction in maternal deaths is dependent upon many other factors, of which by no means the least important is a well organized and equipped maternity service. It should be stressed that undue anxiety is often caused by frequent reference and publicity of maternal mortality statistics. The incidence of notifiable infectious diseases has shewn marked diminution. There have been fewer cases of diphtheria, and in most instances of a less virulent type. The admission to hospital during the year of severe cases of non-notifiable infectious diseases (measles, whooping cough, etc.) has undoubtedly been the means of saving the lives of many whose home conditions did not permit of adequate nursing and attention. The opening of the new Tuberculosis and Chest Clinic has afforded opportunities for a more complete investigation of 8 cious chest conditions. The correlation now effected between Harts Sanatorium and the Chest Clinic ensures continuity of treatment and supervision, which is so essential to the recovery and future welfare of the patient. Many applications are made to me throughout the year for more suitable and adequate housing accommodation, which difficulty will be solved to some extent by measures directed towards the prevention and abatement of overcrowding. The requirements of sufferers from Tuberculosis call for special attention. It is undesirable to segregate these families in any particular area; arrangements should permit of a satisfactory environment for the patient and protection for other members in contact with him. Financial circumstances should not debar these cases from such opportunities. The Council have had under consideration the provision of additional perma-nent buildings at Harts to take the place of the present unsatisfactory wooden pavilion and shelters which have been in use for many years. It is possible to visualize Harts as a Sanatorium for the treatment of Pulmonary Tuberculosis and allied diseases in which modern methods, surgical and medical, would be available. The suggested alterations to the Administrative Block and Nurses' Home will afford better facilities, and a greater measure of comfort to members of the staff. The rapidly increasing requirements of the Public Health Department and Central Clinic have been mentioned on numerous occasions, and it is gratifying to report that this matter, which is becoming more urgent and insistent, has recently received the close and favourable attention of the Council. A list of reports submitted to the various committees is included. It will be seen that they deal with information on a variety of subjects, and in many instances contain statistics of comparable boroughs relevant to the matters under consideration. It is only in this way that an assessment of the value of the Public Health Services is clearly demonstrated, and the reports indicate the favourable position of East Ham in this respect. I wish to record the valued services rendered by Mr. G. D. Lill, M.S.I.A., Senior Sanitary Inspector, who retired in February 9 last. Mr. Lill was associated with the Public Health Department for approximately 40 years, and his knowledge, ability and courtesy effected considerable improvement, and the maintenance of a high standard, in the sanitary conditions of the Borough. I desire to express my thanks to the Chairman and members of the Public Health Committee, and also to those members of the Authority with whom I am associated on other committees, for their continued support and help. My thanks are due to the Chief Officers of the Council for their assistance on many occasions, and to the members of the Public Health Staff for their efficiency, willingness and loyalty during the past year. I have the honour to be, Your obedient Servant, Medical Officer of Health. 10 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 1935, 135,400. Number of inhabited houses (end of 1935) according to rate books (including tenements and shops), approx. 33,000. Rateable value at 31st December, 1935, £752,544. Sum represented by a penny rate for the year 1935/6, £3,025. Physical Features of the Area. See report for year 1930. Social Conditions of the Area. See report for year 1930. Extracts from Vital Statistics. Total. Males Females. Live Births Legitimate 1,917 986 931 Birth rate per 1,000 of the estimated population 14.4. Illegitimate 43 24 19 Still Births 74 38 36 Rate per 1.000 total (live and still) births 36.3. Deaths 1,388 719 669 Death rate per 1,000 of the estimated population 10.2. Death from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 6 2.95 Other puerperal causes 4 1.95 Total 10 4.9 11 Death rate of infants under one year of age :— All infants per 1,000 live births 43 Legitimate infants per 1,000 legitimate live births 42 Illegitimate infants per 1,000 illegitimate live births 70 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) 4 Deaths from Diarrhoea (under 2 years of age) 7 Particulars of any unusual or Excessive Mortality during the Year which has received or required comment. Still-Births. An investigation extending over a period of ten months was carried out with the object of ascertaining, as far as possible, the causes of still-births. Upon receipt of a notification of a stillbirth, an enquiry form was forwarded to the medical practitioner or midwife in attendance. Information was requested in respect of the following:— 1. History of previous pregnancies. 2. Attendances at ante-natal clinics. 3. Date and time, doctor or midwife called and arrived. Hour of delivery. 4. Description of Labour,—duration,—instrumental? 5. Medical aid required? 6. Details of abnormalities of mother or child. 7. Information as to probable cause of still-birth. Replies were obtained in 65 instances of still birth, and details are submitted as follows:— Ante-natal supervision all cases. Number of still-births which occurred in Maternity Hospital cases 30 Number of still-births which occurred in Medical Practitioners' cases 12 Number of still-births which occurred in Midwives' cases 23 Midwives' cases (Medical Aid summoned) 13 12 Associated with maternal deaths 2 Causes associated with conditions arising before confinement 27 Causes associated with conditions arising at birth .... 31 No obvious cause 7 Malpresentation 18 Premature 14 History of previous still-births (information not given in some reports) 8 It will be appreciated that many of the cases in hospitals have been admitted owing to a history of previous difficult delivery or on account of urgent complications of pregnancy or labour. I am indebted to medical practitioners and midwives for their assistance in the preparation of this report. 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 and any evidence, Statistical or otherwise, that unem ployment has exercised any significant influence on the Health or Physique of children or adults. There are no conditions of occupation or environment of sufficient importance to report. Investigations do not indicate evidence of malnutrition amongst school children. Births. The number of live births registered was 1,960 as compared with 1,953 for the year, 1934, equivalent to a birth rate of 14.4 per 1,000 of the population or 0.2 higher than that of the previous year. The still-births registered numbered 74. The rate per 1,000 total (live and still) births was 36.3. For the previous year the rate was 33.6. Deaths. The number of deaths was 1,388 as compared with 1,566 for the year 1934. The death rate was 10.2, or 1.2 less than that of 13 the previous year. Of the total deaths 682 or 49.1 per cent. died in institutions. The number of residents who died outside the area and whose deaths were transferred was 635. Sixty-eight 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 11.2 (1934—12.5). This figure is arrived at by multiplying the crude death rate (10.2) by an adjusting factor, that for East Ham being 1.10. It will be seen that the Death Rate for the year shews an appreciable diminution. 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 \ ears 35-45 Years 45-55 Years 55-65 Years 65-75 Years 75 Years and upwards 6.1 1.01 1.3 2.2 3.1 4.4 5.6 9.9 17.4 24.5 24.3 Infantile Mortality. Deaths of infants under one year of age numbered 85—equivalent to an infant mortality rate of 43 per thousand live births— compared with the rate of 47 for the previous year. The rate for England and Wales is 57. There is again a marked improvement in the infant mortality rate which may be largely attributed to the greater interest shown by parents in the care and nurture of children and the work of the Infant Welfare Clinics. Three deaths of illegitimate children occured out of a total of 43 illegitimate births, giving a mortality rate of 70 as compared with a figure of 116 per 1,000 for the year 1934—the death rate of illegitimate children is therefore halved. Neo Natal Mortality. This rate is obtained by estimating the deaths of infants under one month per 1,000 live births. 14 The neo-natal mortality rates for the past five years are as follows:— 1931—26.8, 1932—29.5, 1933—22.8, 1934—22.5, 1935—23.4. Maternal Mortality. The maternal mortality rate for 1935 was 5.1 per 1,000 live births and 4.9 per 1,000 live and still-births. The number of maternal deaths was 10. The maternal mortality rate, therefore, is higher than that for the previous year but consideration must be given to the actual causes of death in each case. It should be appreciated that maternal deaths include conditions such as abnormal pregnancy necessitating urgent and serious operation—general illness at the time of the confinement and pneumonia following abortion. Four such cases occurred during the year and are partly accountable for the increase in the mortality rate. As stressed on numerous occasions, a regular and efficient ante-natal care reduces the risk of complications which may lead to fatal consequences. Facilities for ante-natal supervision and advice are available at the special clinics held at the High Street and Manor Park Centres. The maternal mortality rates for East Ham as compared with England and Wales are as follows:- Puerperal Sepsis Other Causes Total England & Wales East Ham England & Wales East Ham England & Wales East Ham Per 1,000 Live Births 1.68 3.06 2.42 2.04 4.10 5.1 „ Total Births (Live ft Still) 1.61 2.95 2.32 1.95 3.93 4.9 Obstetrical Specialist. The services of a Consultant Obstetrician were requested by General Practitioners on two occasions. 15 Particulars are given below:— No. Diagnosis. Where treated. Result. 1. Puerperal Septicaemia. University College Hospital. Recovered 2. „ „ Population. The Registrar-General's estimate of the population to the middle of 1935, is 135,400, which is a decrease of 1,656 compared with that for the year 1934. The rates per thousand of the population mentioned in this report are based on this estimate, except in the case of the Ward rates, which are calculated according to the Census returns, 16 TABLE 1.—BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1935. Rate per 1,000 Population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. 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 Yr. England & Wales 14.7 0.62 11.7 0.00 — 0.03 0.01 0.04 0.08 0.18 0.52 5.7 57 121 County Boroughs & Great Towns including London 14.8 0.68 11.8 0.00 — 0.04 0.01 0.04 0.09 0.16 0.45 7.9 62 140 Smaller Towns (estimated resident populations 25,000 -50,000 at census 1931) 14.8 0.64 11.2 0.00 - 0.03 0.01 0.03 0.07 0.17 0.41 3.8 55 London 13.3 0.52 11.4 0.00 — 0.00 0.01 0.04 0.06 0.11 0.51 11.2 58 EAST HAM 14.4 0.54 10.2 0.00 — — 0.00 0.03 0.11 0.10 0.44 3.5 43 16a TABLE 2. Causes of Death in Age Groups, 1935. Cause of death. All ages. Deaths at different periods of life of residents whether occurring within or without the district. Under 1 year 1-2 years 2-5 years 5-15 year 15-25 years 25-35 years 35-45 years 45-55 years 55-65 years 65-75 years 75 years and upwards. A.—Infectious and Parasitic Diseases 148 6 6 10 18 20 20 23 23 9 9 4 B.—Cancer and Other Tumours 212 - - - 1 - 8 12 32 57 66 36 C.—Rheumatism, Diseases of Nutrition and of Endocrine Glands and other General Diseases 41 1 - - 1 2 5 1 4 9 13 5 D.—Diseases of the Blood and Blood-forming Organs 9 — 1 - 1 — 1 1 2 1 1 1 E.—Diseases of the Nervous System and Sense Organs 106 2 1 — 2 3 3 4 9 20 42 20 F.—Diseases of the Circulatory System 442 - - - - 4 8 1 27 67 136 198 G.—Diseases of the respiratory System 145 16 4 4 - 5 1 13 9 33 32 28 H.—Diseases of the Digestive System 75 9 - 2 1 - 1 4 14 22 17 5 I.—Non-Venereal Diseases of the Genitourinary System and Annexa 66 — — — 2 1 2 8 7 13 16 17 J.—Diseases of Pregnancy, Childbirth and the Puerperal State 10 — — — - 1 4 4 1 - - - K.—Diseases of the Skin and Cellular Tissue 4 1 - - - 1 - - - 2 - - L.—Congenital Malformations 11 10 - - - - 1 - - - - - M.—Diseases of Early Infancy 40 40 - - - - - - - - - - N.—Old Age 19 - - - - - - - - - - 19 O.—Deaths from Violence 60 - 2 2 4 6 7 7 10 8 9 5 Totals 1,388 85 14 18 31 43 61 78 138 241 341 338 A.—Infectious and Parasitic diseases. 1. Typhoid Fever 1 - - - - - 1 - - - - - 2. Scarlet Fever 1 - - - 1 - - - - - - - 3. Whooping Cough 4 2 2 - - - - - - - - - 4. Diphtheria 16 - - 6 10 - - - - - - - 5. Influenza 14 - - 1 - - 1 1 3 2 2 4 6. Erysipelas 2 - - - - - - - 1 - 1 - 7. Acute Poliomyelitis 3 - - 1 2 - - - - - - - 8. Encephalitis Lethargica 2 - - - - - - 1 1 - - - 9. Cerebro-Spinal Fever 1 1 - - - - - - - - - - 10. Tuberculosis—Respiratory System 80 1 1 1 3 19 15 19 11 6 4 - 11. ,, Central Nervous System 8 - 2 1 1 1 1 2 - - - - 12. ,, Intestine and Peritoneum 3 - - - - - - - 1 - 1 - 13. ,, Vertebral Column 2 - - - - - 1 - 1 - - - 14. ,, of other Bones and Joints 2 - - - - - 1 - 1 - - 15. „ Disseminated 1 1 - - - - - - - - - - 16. Syphilis 2 1 - - - - - - 1 - - - 17. Purulent Infection—Septicaemia 6 - — — 1 — — — 3 1 1 — 3.—Cancer and other Tumours 18. Cancer, Malignant Disease Buccal Cavity and Pharynx 6 - - - - - 1 - 1 2 2 Digestive Organs and Peritoneum 119 - - - - - 2 8 16 29 44 20 20. „ „ „ Respiratory Organs 14 - - - - - 1 - 4 3 3 3 21. „ „ „ Uterus 12 - - - - - - 2 2 3 4 1 22. „ „ ,, Other Female Genital Organs 8 - - - - - - 1 4 2 - 1 23. „ „ ,, Breast 19 - - - - - 1 1 4 9 1 3 24. „ „ ,, Male Genitourinary Organs 14 — - - - - 2 - - 3 4 5 25. „ „ ,, Skin 1 - - - - - - - - - - 1 26. „ „ ,, Other or Unspecified Organs 12 — - - 1 - - 2 3 6 - 27. Non-Malignant Tumours 3 - - - - - 1 - - 1 1 - 28. Tumours of Undetermined Nature 4 - - - - - - - - 3 1 — C.—Rheumatism, Diseases of Nutrition and of Endocrine Glands, and other General Diseases. 29. Rheumatic Fever 14 - - - 1 2 4 i 2 2 2 - 30. Chronic Rheumatism, Osteo-Arthritis 10 1 - - - - - - 1 3 2 3 31. Diabetes 14 - - - - - - - - 4 8 2 32. Diseases of the Thymus 1 - - - - - 1 - - - - - 33. ,, „ Thyroid 1 — — — — - - - 1 — 3 - 34. Other General Diseases 1 — - - - - - - - - 1 - D.—Diseases of the Blood and Blood-forming Organs. 35. Haemorrhagic Conditions 3 - - - 1 - - - 1 - - 1 36. Anaemia, Chlorosis 4 - 1 - - - - 1 1 - 1 - 37. Leukaemia, Aleukamia 2 - - — — — 1 - - 1 — - E.—Diseases of the Nervous System and Sense Organs. 38. Encephalitis 1 — - - - - - - - 1 - - 39. Meningitis 7 1 - - 2 1 1 1 - 1 - - 40. Tabes Dorsalis (Locomotor Ataxy) 1 - - - - - - - - - - - 41. Other Diseases of the Spinal Cord 4 - - - - - 1 - 2 1 - - 42. Cerebral Haemorrhage, Apoplexy, etc. 82 - - - - - 1 2 6 15 39 19 43. General Paralysis of the Insane 1 - - - - - - - 1 - - - 44. Other Forms of Insanity 1 - - - - - - - - - - 1 45. Epilepsy 3 - - - - 2 - 1 - - - - 46. Infantile Convulsions (age under 5 years) 1 - - - - - - - - - - - 47. Other Diseases of the Nervous System 4 - - - - - - - - 2 2 - 48. Diseases of the Ear and Mastoid Sinus 1 — 1 - — — — — — - - - F.—Diseases of the Circulatory System. 49. Acute Endocarditis 2 - - - 1 - 1 - - - - - 50. Chronic Endocarditis, Valvular Disease 54 - - - - 2 3 - 6 9 14 20 51. Diseases of the Myocardium 284 - - - - - 2 1 9 36 87 149 52. Diseases of the Coronary Arteries, Angina Pectoris 30 - - - - - 1 — 5 8 11 5 53. Other Diseases of the Heart 21 - - - - 1 1 - 3 3 5 8 54. Aneurysm 12 - - - - 1 - - 1 3 4 55. Arterio-Sclerosis 38 - - - - - - - 2 8 15 13 56. Other Diseases of the Arteries 1 — — — — — — — 1 — — — G.—Diseases of the Respiratory System. 57. Diseases of the Larynx 1 — — - - - - - - 1 - - 58. Bronchitis 39 — — - — - - 3 2 7 9 18 59. Broncho-Pneumonia 58 13 4 4 — 1 — 4 3 11 13 5 60. Lobar-Pneumonia 30 1 - - - 4 — 4 4 6 7 4 61. Pneumonia (not otherwise defined) 3 - - - - - - - - 2 - 1 62. Pleurisy 3 1 - - - - 1 - - 1 - - 63. Congestion and Haemorrhagic-Infarct of Lung, etc. 4 - - - - - - - - 2 2 — 64. Asthma 6 1 - - - - - 1 - 3 I - 65. Other Diseases of the Respiratory System 1 - - - - - - 1 - - - - H.—Diseases of the Digestive System. 66. Diseases of the Buccal Cavity, Pharynx, etc. 2 - - - - - - - - 1 1 - 67. Ulcer of the Stomach or Duodenum 16 - - - - - 1 3 3 5 4 - 68. Other Diseases of the Stomach 2 1 - 1 - - - - - - - - 69. Diarrhoea and Enteritis (under 2 years) 7 7 - - - - - - - - - - 70. ,, ,, (over 2 years) 2 — — 1 - — - - - 1 - - 71. Appendicitis 9 — — - 1 — — - 4 4 - - 72. Hernia, Intestinal Obstruction 18 1 - - - - - 1 3 5 6 2 73. Other Diseases of the Intestines 3 - - - - - - - - 2 - 1 74. Cirrhosis of the Liver 5 - - - - - - - 2 2 1 - 75. Biliary Calculi 4 - - - - - - - - - 3 1 76. Other Diseases of the Gall Bladder and Ducts 6 - - - - - - - 1 2 2 1 77. Diseases of the Pancreas 1 — — — — — - — 1 - - - I-Non-Venereal Diseases of the Genitourinary System and Annexa. 78. Acute Nephritis 3 - - - 2 - - 1 - - - - 79. Chronic Nephritis 29 - - - - 1 1 3 4 9 7 4 80. Nephritis (not stated to be acute or chronic) 5 - - - - - - - - - 3 2 81. Other Diseases of the Kidney and Annexa 9 - - - - - 1 3 1 1 1 2 82. Diseases of the Bladder 3 - - - - - - - - 1 1 1 83. Diseases of the Urethra, Urinary Abscess, etc. 2 - - - - - - - 1 - 1 - 84. Diseases of the Prostate 13 - - - - - - - 1 1 3 8 85. Diseases of the Female Genital Organs 2 — — — — — — 1 — 1 — — J.—Diseases of Pregnancy, Childbirth and the Puerperal State. 86. Ectopic Gestation 1 - - - - - 1 - - - - - 87. Puerperal Sepsis (not returned as postabortion) 6 — — — — 1 3 1 1 - - - 88. Eclampsia 1 - - - - - - 1 - - - - 89. Other accidents of Childbirth 2 — — — — — — 2 — — — — K.—Diseases of the Skin and Cellular Tissue. 90. Carbuncle, Boil 2 - - - - 1 - - - 1 - - 91. Cellulitis, Acute Abscess 2 1 — — — - — — — 1 — — L.—Congenital Malformations. 92. Congenital Malformations 11 10 — — — — 1 - - - - - M.—Diseases of Early Infancy. 93. Congenital Debility 2 2 - - - - - - - - - - 94. Premature Birth 25 25 - - - - - - - - - - 95. Injury at Birth 2 2 - - - - - - - - - - 96. Other Diseases peculiar to Early Infancy 11 11 - - - - - - - - - - N.—Old age. 97. Old Age 19 - - - - - - - - - - 19 O.—Deaths from Violence. 98. Suicide—By Solid or Liquid Poisons or Corrosive Substances 6 - — - - 1 1 1 2 1 - - 99. ,, By Poisonous Gas 9 - - - - 1 1 2 - 3 2 - 100. „ By Hanging or Strangulation 2 - - - - - 1 - - 1 - - 101. ,, By Cutting or Piercing Instruments 4 - - - - - - 1 2 - - 1 102. Homicide—By Cutting or Piercing Instruments 1 - - - - - - 1 - - - - 103. ,, By Other Means 1 - - - - - 1 - - - - - 104. Other Acute Accidental Poisoning (not by Gas) 1 - - - - - - - 1 - - - 105.. Accidental Burns (Conflagration excepted) 3 - 1 - 1 1 - - - - - - 106 ,, Drowning 1 - - - - 1 - - - - - - 107. ,, Injury by Fall or Crushing, etc. 31 - - 2 3 2 3 2 5 3 7 4 108. Attack by Venomous Animals 1 - 1 - - - - - - - - - 17 Table 3.—Ward Distribution of Deaths, and Ward Dhath-Rate. 1935 Cause of death. Wards. Total. Deaths in Institutions. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle Central. Wall End. Greatfield. South. 1. Typhoid & Paratyphoid Fevers - 1 - - - - - - - - 1 1 2. Measles — — - - - - - - - - - - 3. Scarlet Fever — - - - - - 1 - - - 1 1 4. Whooping Cough — — - 1 1 - - 1 - 1 4 - 5. Diphtheria — 3 - 1 1 3 1 1 1 5 16 16 6. Influenza 3 3 1 1 2 1 - 2 1 - 14 2 7. Encephalitis Lethargica — 1 - - - - - 1 - - 2 9 8. Cerebro-Spinal Fever — 1 - - - - - - - - 1 1 9. Tuberculosis of Respiratory System 8 7 - 12 8 10 10 9 7 9 80 48 10. Other Tuberculous Diseases 1 4 1 3 1 2 1 2 - 1 16 15 11. Syphilis — — - - - 1 1 - - - 2 2 12. General Paralysis of the Insane, Tabes Dorsalis - - - - - - - - 1 1 2 1 13. Cancer 19 31 17 23 16 24 24 16 17 18 205 102 14. Diabetes 2 — - 2 1 3 2 3 - 1 14 4 15. Cerebral Haemorrhage, etc. 8 5 5 11 6 12 6 15 9 5 82 50 16. Heart Disease 51 33 46 45 36 31 46 41 30 32 391 156 17. Aneurysm 2 1 — 1 1 4 1 1 1 - 12 2 18. Other Circulatory Diseases 2 5 2 4 3 5 4 5 3 6 39 10 19. Bronchitis 10 2 2 6 3 7 2 4 1 2 39 14 20. Pneumonia (all forms) 8 18 3 8 7 3 9 13 10 12 91 39 21. Other Respiratory Diseases 2 — 1 - 2 2 - 3 3 2 15 - 22. Peptic Ulcer 3 3 2 1 - 3 2 - 1 1 16 10 23. Diarrhoea, etc. 2 2 - - 2 - 1 1 - 1 9 7 24. Appendicitis 2 — 1 - - 1 - 4 1 - 9 9 25. Cirrhosis of Liver — 1 - - 2 - 1 1 - - 5 1 26. Other Diseases of Liver, etc. — - 1 - - 3 5 - 1 - 10 5 27. Other Digestive Diseases 2 3 1 1 4 2 5 4 3 1 26 22 28. Acute and Chronic Nephritis 3 7 4 5 2 2 4 3 4 3 37 21 29. Puerperal Sepsis — — - 1 - 2 - 2 - 1 6 6 30. Other Puerperal Causes 1 - 2 - - - - 1 - - 4 4 31. Congenital Debility, Premature Birth, Malformations, etc. 3 7 1 11 6 3 4 10 - 6 51 25 32. Senility 3 2 3 1 2 2 2 - - 4 19 9 33. Suicide 3 1 2 1 1 1 2 3 1 6 21 8 34 Other violence 5 7 4 1 1 6 3 6 4 2 39 29 35 Other defined causes 12 17 8 13 9 5 15 11 11 8 109 60 36 Causes ill-defined or unknown — — — — - - - - - - - - Totals 155 165 107 153 117 138 152 163 110 128 1,388 682 Rates (Census population for Wards) 11.1 10.1 8.4 11.1 10.0 10.1 10.9 9.5 7.8 8.2 10.2 — 18 TABLE 4. Infant Deaths under One Year of Age, 1935. Cause of Death. Sex Ages. Total under 1 year. Under 1 week 1-2 weeks. 2-3 weeks. 3-4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Whooping Cough M - - - - 1 - 1 - 2 F - - - - - - - - - Syphilis M — — — 1 — — — — 1 F - - - - - - - — - Meningococcal Meningitis M — — — — — 1 — — 1 F - - - - - - - - - Tuberculosis (all forms) M - - - - - - - 1 1 F - - - - - - - 1 1 Pneumonia M — — — — 3 3 5 — 11 F - — — — 1 1 — 1 3 Diarrhoea, etc. M - - - - - 3 2 1 6 F — — — — 1 — — — 1 Congenital Debility and Malformations, Premature Births, M 23 1 — — 2 1 — - 27 F 12 3 3 — 5 - — — 23 Other defined causes M 1 1 — — 3 — — 1 6 F 1 - - - - - - 1 2 All causes M 24 2 - 1 9 8 8 3 55 F 13 3 3 — 7 1 — 3 30 Special Reports submitted to the Council during the year 1935. Jan. 21st Comprehensive Report on Tuberculosis Services. „ „ Report—Sterilized Maternity Outfits. „ „ Report—Services of Obstetric Specialists. „ „ Report on duties of Senior Sanitary Inspector. Jan. 81st Report re formation of Port Welfare Committees for Seamen in London. Mar. 25th Report upon Arrangements for treatment of Tuberculous Seamen. Mar. 11th Report upon adoption of principle of 48 hour week for all Officers and Employees in Hospital and Institutions. 19 Mar. 18th Report—Equipment of new Tuberculosis and Chest Clinic. April 12th Report—Heating and Lighting Attendants, Harts. April 15th Report—Cases of Puerperal Fever. May 13th Report re duties of Engineering Staff and alternative arrangements. „ „ Report on administration and work of Manor Park Clinic. June 24th Report—Tuberculosis Scheme. Arrangement between Authorities. „ „ Report—Staffing, duties and hours of employment, Infectious Diseases Hospital and Harts. Sept. 26th Report—Re-organisation of duties, Chest Clinic. Oct. 7th Report—Investigation into causes of StillBirths. Oct. 4th Report—Conference, National Association for the Prevention of Tuberculosis (Southport). Oct. 7th Report—Staffing. „ 12th Report—Conference, Royal Sanitary Institute. Nov. 15th Report—Arrangements for visiting of patients, Infectious Diseases Hospital and Harts. Nov. 18th Report—Medical supervision, Children's Homes, Aldersbrook. „ „ Report on X-ray equipment. „ „ Report—Dietary Scales. Nov. 13th Report—X-ray apparatus for Tuberculosis and Chest Clinic and Harts. General Provision of Health Services Professional Nursing in the Home. A. GENERAL. The services of the Plaistow District Nurses attached to the Branch Home in Katherine Road are of inestimable benefit to residents of East Ham. The Authority makes a grant in aid of these services. 20 For Public Assistance Cases the services of Nurse Kelley are available upon the recommendation of the patient's medical attendant. B. INFECTIOUS DISEASE Admission to hospital is advised of all cases of diphtheria and scarlet fever and statistics shew a high percentage of acceptances. No provision is made for the nursing of infectious disease in the home but many cases of measles, whooping cough and bronchopneumonia are admitted to hospital where the home conditions are inadequate. The satisfactory results obtained warrant such procedure. C. MIDWIVES. The sister midwives and nurses of the Plaistow Maternity Hospital attached to the Burges Road Home and Branch at Tidal Basin attend mothers in the district. No midwives are subsidized by the Council. MIDWIVES ACTS, 1902 and 1918 The number of midwives who notified their intention to practise in East Ham during, 1935, was 55. Of this number 39 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches—3 at Sir Henry Tate Nurses' Home, Silvertown—1 at the Kelvingrove Nursing Home, Windsor Road,—1 from Oldchurch Hospital, Romford, and 11 practised independently. Summary of Visits Paid during 1935 by Nurses of Plaistow Maternity Hospital and District Nurses Home. Midwifery 402, Monthly 165, Hospital 367. 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 21 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 1935:— Cases conveyed to and from various hospitals 1,664 Private accidents/illnesses 1,207 Street accidents/illnesses 257 Journeys made 1,744 Miles run 13,487 East Ham cases removed by other ambulances:— Barking 26 Ilford 1 West Ham 32 Cases removed for other authorities:— West Ham 13 Barking 11 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 1935 are shown below:— Specimen Number Blood Sugar Estimation 1 Blood for Widal Test 2 Mantoux Skin Test (Tuberculosis) 63 Swabs (for Tuberculosis) 1 Faeces (for Tuberculosis) 15 Pleural Effusion (including 2 inocculations of guinea pigs) 4 Sputa (for Asbestosis) 4 Sputa (for Tuberculosis) 983 Total 1073 22 Pathological examinations carried out by Counties P. H Laboratories during 1935:— Swabs for Haemolytic Streptococci 29 Blood for Streptococcal Infection 3 Pus for Streptococcal Infection 1 Blood for Widal Reaction 1 Faeces for Typhoid and Para-typhoid Bacilli 1 Cerebro Spinal Fluid 4 Total 39 The same arrangements exist for the examination of suspected diphtheria swabs as in previous years. The number examined at the Infectious Diseases Hospital and the Town Hall Laboratory was as follows, viz:— Number. Positive. Negative. 4127 314 3813 Of the above total 2,801 were examined at the hospital. Legislation in Force. Acts of Parliament applied to the Borough by Order:— (a) Ministry of Health— Public Health Acts Amendment Act, 1907, Part 10, Sec. 95 Oct. 16, 1923 (b) Home Office— Public Health Acts Amendment Act, 1907, Part 7, S'ec. 85 Mar. 6, 1929 Acts of Parliament Adopted. Name of Act adopted Date of Adoption Date of Coming into Operation Infectious Diseases (Notification) Act, 1889 Nov. 12, 1889 Jan. 1, 1890 Infectious Diseases (Prevention) Act, 1890 Oct. 14, 1890 Nov. 18, 1890 Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5 Jan. ,13, 1891 Feb. 18, 1891 23 Public Baths and Washhouses Acts Mar. 16, 1897 Mar. 16, 1897 Housing of the Working Classes Act, 1890, Part 3 Feb. 16, 1897 Feb. 16, 1897 Public Libraries Act, 1892 June 18, 1895 Aug. 1, 1895 Infectious Disease (Notification) Act, 1889 (Extension) Education (Provision of Meals) Act, 1906 Nov. 24, 1908 Nov. 24, 1908 Local Government and Other Officers' Superannuation Act, 1922 July 17, 1923 Oct. 1, 1923 Public Health Act, 1925, Part 2, Sec. 25 Apl. 13, 1926 June 1, 1926 Public Health Acts Amendment Act, 1907, Part VI July 12, 1932 Dec. 19, 1932 Public Health Act, 1925, Part VI By-Laws, Regulations, etc. BY-LAWS. The following By-laws, Regulations, etc., are in force in the County Borough of East Ham:— Regulation of Advertisements. New Streets and Buildings and Alteration of Buildings. Employment of Children and Street Trading by persons under the age of 18 years. Provision of Means of Escape from Fire in Factories, etc. Public Pleasure Grounds. Registries for Female Domestic Servants. Removal of House Refuse. Sale of Coal. 24 Slaughterhouses. Tents, Vans, Sheds, etc, used for Human Habitation. Unauthorised Persons on School Premises. Houses intended or used for occupation by the Working Classes and let in lodgings, etc. Smoke Abatement. REGULATIONS. Blind Persons Act, 1920. Administration of Outdoor Assistance. Domiciliary Assistance to Necessitous Blind Persons. Cleansing and Disinfection (Diseases of Animals Acts). Closing Orders for Barbers and Hairdressers, Butchers, Chemists, Grocers, etc. Council Housing Estates. Fire Brigade. Administrative Scheme under Local Government Act, 1929. Public Assistance Domiciliary Medical Service. Allotments. 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. The Council initiated a scheme in October, 1935 enabling expectant mothers to obtain admission to Forest Gate Hospital without the need for personal attendance at Arragon Road Relief Station as heretofore. Although the maternity beds at this Hospital are primarily for Public Assistance cases, many mothers are anxious to avail themselves of the care and nursing facilities provided. The combined appointment of Nurse Kelley as District Nurse and Assistant Relieving Officer has rendered this possible and intending applicants are now visited in their homes where the necessary enquiries are made. Regular supervision during the ante-natal period at one of the Maternity and Child Welfare Clinics is thereby encouraged. A provisional admission card is handed to the expectant mother at her first visit for use in case of emergency and is 25 lowed subsequently by the order of admission which thus complies with the Regulations and reduccs to a minimum the association of maternity accommodation with Public Assistance. Public Assistance Domiciliary Medical Service. The detailed scheme was set out in my report for 1934. The following particulars are of interest:— Quarterly payments to medical practitioners for the 12 months ending 31-12-35 £1568 10 9 Cost of drugs, etc., for 12 months ending 31-12-35 £907 9 1 Cost per total attendance for medical attention only (includes visits to surgeries) 1s. 8d. Cost per total attendance for drugs, etc. only 11d. Cost per total attendance for medical attention and drugs, etc. 2s. 7d. No of individual patients treated:- March Quarter 1771 June Quarter 1884 September Quarter 2062 December Quarter 2118 Administrative charges are not included in any of the foregoing figures. TABLE 5. Public Assistance Domiciliary Medical Service. Statistical Return for the Year Ending 31.12.35. 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. 2,118 4.400 14,410 18,810 1,353 793 Number of cases urgently admitted to hospital 5 Number of applications to Medical Officer of Health for hospital treatment 93 26 Public Assistance Nurse and Assistant Relieving Officer Number of requisitions received for attendance of nurse 52 Total attendances at homes by nurse 1458 Number of Maternity cases 28 Total visits to such cases 78 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. Dr. Brews, the District Medical Officer for this area (North Woolwich), dealt with the following cases during 1935:— Number of individual patients 37 Number of attendances at homes 344 Number of attendances at surgery 357 Total number of attendances 701 Number of occasions medicines supplied without seeing patients 34 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 25 Soft Chancre 2 Gonorrhoea 106 Not Venereal 96 Total 229 Total attendances of all patients 15231 Number of in-patients during 1935 117 A.B.C.—doses 605 27 Pathological Examinations. For or at the Centres— Spirochaetes 21 Gonococci 2654 Wassermann 375 Others 841 Total 3891 For Practitioners— Spirochaetes — Gonococci 4 Wassermann 38 Others 26 Total 68 During 1935, no East Ham patients were in residence under the Hostel Scheme. Mental Deficiency. As stated in previous reports, a number of cases are admitted to the South Ockendon Colony for Mental Defectives—the Cell Barnes Colony, Herts, and similar institutions. Low and medium grade defectives are accommodated at Forest Gate Hospital. Clinics and Treatment Centres. These are all provided by the Council. The revised sessions at the centres are as follows, viz:— 28 TABLE 6. Clinics and Treatment Centres. Situation. Purpose Used. Sessions. *Central Clinic, High Street South Schools Special Clinics Monday & Saturday, 9.30 a.m. *„ „ Toddlers' Clinics Thursday, 2 p.m. *„ „ Infant Welfare Monday, 2 p.m.; Wednesday, 9.30 a.m. and 2 p.m.; Thursday, 9.30 a.m.; Friday, 2 p.m. „ „ Ante-Natal Clinic Friday, 9.30 a.m. *„ „ Immunization Clinic Tuesday, 9.30 a.m. *Church Road, Manor Park Toddlers' Clinics Monday, 9.30 a.m. *„ „ Special Clinics Alternate Tuesday, 2 p.m. „ „ Ante-Natal Clinic Wednesday, 9.30 a.m. *„ „ Immunization Clinic Friday, 9.30 a.m. *„ „ Infant Welfare Monday, 2 p.m.; Wednesday, 2 p.m.; Thursday, 2 p.m. „ „ Light Clinics Monday, 9 a.m. (Girls); ,, 2 p.m. (Babies). Tuesday, 9 a.m. (Locals); ., 2 p.m. (Boys). Wednesday, 9 a.m. (Girls); ,, 2 p.m. (Babies). Thursday, 9 a.m. (Boys); ,, 2 p.m. (Locals). Friday, 9 a.m. ((Babies); „ 2 p.m. (Girls). Saturday, 9 a.m. (Boys). Baptist Church Hall, Plashet Grove Infant Welfare Tuesday, 9.30 a.m.; Friday, 2 p.m. North Woolwich Clinic, Fernhill Street Infant Welfare Tuesday, 2 p.m. Durban House. Katherine Rd. Tuberculosis & Chest Clinic Monday, 2 p.m.; Tuesday, 2 p.m.; Thursday, 6 p.m.; Friday, 2 p.m.; Saturday, (Children only), 9.15 a.m. Town Hall, East Ham General Clinic. (Minor Ailments & Observation Cases.) Monday, Wednesday and Saturday, 9 a.m. Church Road, Manor Park . General Ciinic. (Minor Ailments & Observation Cases.) Tuesday and Thursday, 9 a.m. North Woolwich, Fernhill St. General Clinic Monday; and Friday, 2 p.m. Town Hall, East Ham Immunization Clinic Friday, 3 p.m. „ „ Ear Clinic Thursday and Friday, 2 p.m. „ „ Eye Clinic Tuesday, Thursday and Friday, 9 a.m. „ „ Light Clinic Monday (Boys), 2 p.m.; Wednesday (Girls), 2 p.m. Durban House, Katherine Road and Church Road, Manor Park Dental Clinics By appointment. *Clinics re-organized as from May, 1936. 29 The Tuberculosis and Chest Clinic. I he new Clinic, opened in September, 1935, is situated in the grounds of Durban House, and is constructed to provide up-todate facilities for the diagnosis, care and treatment of sufferers from Tuberculosis, whilst affording opportunities for careful investigation of chcst cases generally and the supervision of contacts. The outstanding features of the Clinic are lofty and wellventilated 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 and 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 busv session and avoid those long and dreary periods of waiting which affect the regular attendance of patients. The Waiting Room affords ample accommodation and can be used alternatively as a Lecture Room or for the purpose of instruction in occupational Therapy. 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. The modern equipment which has been installed will ensure complete scientific investigation in every case, whilst clerical services and the system of record keeping will afford to both medical and nursing staff, complete and ready information. The building was erected by direct labour under the supervision of Mr. A. T. Bridgewater, F.S.I., Borough Engineer and Surveyor. 30 General and Special Hospitals and Children's Homes. Hospitals— (a) Provided by Local Authority, (b) Maternity, (c) Orthopaedic, (d) Ear, Nose, and Throat, (e) Puerperal Fever and Pyrexia, (f) 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. (g) Runwell Mental Hospital. Considerable progress has been made during the year with the construction of the new buildings. It is anticipated that the Admission Unit will be completed and available for uncertified voluntary patients and for the preliminary observation of other cases, about May, 1936. This will lessen the difficulty now experienced in securing suitable accommodation for such patients from this district. TABLE 7 Disposition of East Ham Mental Patients on 31.12.1935 Male. Female. Total Brentwood 7 25 32 Cambridge — 10 10 Canterbury 35 — 35 Cardiff — 20 20 Colchester 6 27 33 Cotford 9 — 9 Gateshead — 24 24 Gloucester 28 20 48 Goodmayes 24 — 24 Oxford — 12 12 Park Prewitt — 20 20 Peckham House 23 30 53 Powick (Worcester) 70 10 80 Stone (Dartford) 5 2 7 Three Counties (Bedfordshire 9 9 Wells — 39 39 Various Institutions 14 15 29 Totals 221 263 484 31 (h) Smallpox. The treatment of this disease is carried out, by arrangement, with the London County Council. (i) East Ham Memorial Hospital. The number of beds remains the same, viz., 100. The following tables are abstracted from the hospital report for 1935:— 1.—In-Patients. Number of Beds and In-Patients. Numbers in 1935. Numbers in previous year. 1. Beds:— (a) Complement at 31st December 100 100 (b) Average Daily Complement during the year 100 100 (c) Average Daily Number Closed during the year, owing to:— (i) Rebuilding or Extension Schemes - - (ii) Repairs, Redecoration, Cleaning or Infection 1.2 1.7 (iii) Other Causes — - (d) Average Daily Number Open during the year 98.8 98.3 (?) Average Daily Number Occupied during the year 95.4 92.7 2. Number of In-Patients in the Hospital at beginning of year. 98 95 3. Number of In-Patients admitted during year 1,527 1,491 4. Number of In-Patients in the Hospital at the end of the year 96 98 5. Average number of days each Patient was resident (ascertained by dividing the yearly total of daily counts, viz.:— 34,809 by the number of Patients treated to a conclusion, i.e., (2) plus (3) - (4).) 22.8 22.7 6. Number of Patients admitted and discharged during the year who were resident for— (i) only 1 day 67 76 (ii) 2 and 3 days 96 111 32 2.—Out-Patients. Numbers. Numbers in 1935. Numbers in previous year. 1. Total number of new Out-Patients 12,957 10,966 2. Total number of Out-Patient Attendances 72,407 70,880 (a) Number of Patients on books at the beginning of the year Not ascertainable Not ascertainable (b) Number of Casualty Patients included in No. 1 above 3,516 3,357 (c) Number of Maternity Patients included in No. 1 above, attended at home — - (d) Number of Attendances on Maternity Patients included in No. 2 above - - (j) Whipps Cross Hospital and Institutions controlled by West Ham. Beds Allocated on User Basis to East Ham. Institution. No. of Beds. Type. Whipps Cross Hospital ... 155 Medical and Surgical. Central Homes 254 Able-bodied and Sick. Forest Gate Hospital 74 Sick, Maternity and Mental Defectives. Forest House and Cottages 26 Chronic cases. Margate Convalescent Home 11 Convalescent children to 16 years 33 TABLE 8. Cases Admitted to West Ham Corporation Public Assistance Instittions from East Ham. Institution. Chargeable on 31.12.34 Admitted during 1935 Born during 1935 Total. Discharged. Died. Transferred to other Instns. Chargeable on 31.12.35. Whipps Cross Hospital 149 1,472 1 1,622 1,074 202 197 149 Central Homes 240 455 - 695 143 184 122 246 Forest Gate Hospital 126 221 161 508 345 19 18 126 Forest House and Cottages 38 12 - 50 3 - 11 36 *Margate Convalescent Home 1 3 - 4 4 - - - *Margate Home was closed on 31.8.35. 34 (k) 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 30-6-35 525 6 months ending 31.12.35 520 Lowest „ „ „ 508 " " " 489 In Receiving Homes on 1st January, 1935 305 1st July, 1935 291 „ Scattered „ „ „ 213 " " 219 — 518 — 510 In Receiving Homes on 1st July, 1935 291 1st January, 1936 297 „ Scattered „ „ „ 219 " " 203 — 510 — 500 On 1st July, 1935, chargeability was apportioned as follows:— To the County Borough of East Ham 79 1st January, 1936 76 West Ham 298 " " 285 „ Essex County Council 133 " " 139 — 510 —500 Average No. of admissions weekly —6 months ending 30-6-35 7 6 months ending 31.12.35 7 „ „ discharges „ „ 7.2 " " " 8 Greatest No. of admissions on any one day—6 months ending 30-6-35 10 " " " 8 Number of deaths in institutions— 6 months ending 30-6-35 — " " " 1 Number of children admitted from East Ham—6 months ending 30-6-35 42 " " " 56 Number of children admitted from West Ham—6 months ending 30-6-35 83 " " " 85 Number of children admitted from Essex C.C.—6 months ending 30-6-35 57 " " " 41 I submit the following extracts from the report of the Medical Officer, September, 1935:— HEALTH OF THE CHILDREN. The incidence of sickness among the children in the Aidersbrook and Scattered Homes has been very small, and the number of cases of serious illness has been almost negligible during the past six months. INFECTIOUS DISEASE. During the period under review there has been no epidemic of infectious disease, a few sporadic cases only having occurred. The cases were assigned to the following areas:— 35 Disease East Ham West Ham Essex Total Whooping Cough 2 2 2 6 Chicken Pox 1 1 — 2 Mumps 3 8 — 11 Erysipelas 1 — — 1 Diphtheria 2 — — 2 No deaths have occurred at the Homes during- the period of this report. THE NURSERY. The high value of the Nursery is daily evidenced. The health and freedom from disease are greatly facilitated by the modernity of the Institution and the excellence of its appurtenances. ACCOMMODATION. There has been sufficient accommodation for all classes of children. VISITING. Approximately 273 visits were made to Aldersbrook and 231 to the Scattered Homes. One hundred and eighty-two children were examined on admission and 190 on discharge. Minor operations have taken place when necessity arose, and treatment for other ailments has been given as and when required. DENTAL SURPERVISION AND TREATMENT. The usual visits and inspections have been made by the Dental Surgeon. One hundred and twelve children have been treated for extractions, fillings and scalings during the period under review. January, 1936. HEALTH OF THE CHILDREN. The incidence of sickness amongst the children has been small. Apart from minor injuries and ailments, three cases of serious illness occurred which, in each case, necessitated removal to hospital. 36 No. of cases. Nature of illness Age Hospital 1 Broncho Pneumonia. 2 years Whipps Cross 1 Rheumatic Fever. 12 years " " 1 T.B. Gland in Neck. 2 years " " INFECTIOUS DISEASE. During the period under review there has been a mild epidemic of Chicken Pox, and to date 21 cases have occurred. There is every indication that this is now drawing to a close. Appended is a tabulated list of all the infectious cases, indicating the nature of each case, and the Borough or County Institution to which the child was sent for treatment:— Disease East Ham West Ham Essex Total Chicken Pox 7 9 5 21 Whooping Cough 3 4 2 9 Scarlet Fever 1 1 5 7 Diphtheria 2 1 - 3 GENERAL NURSING AND DIETS. The care and attention given to the children is abundantly manifest in their bright, clean appearance, contented disposition, and general demeanour. The diets, carefully balanced and prepared, are, in my opinion, excellently varied and completely adequate. THE NURSERY. The work in the Nursery progresses with the same even tenor. The general efficiency of the Department is maintained at a high level, and, as a unit, has proved an undoubted success. DEATHS. One death occurred, which was reported on October 1st, 1935. ACCOMMODATION. There has been sufficient suitable accommodation for all classes of children. 37 VISITING. Visits to Aldersbrook and the Scattered Homes, necessitated at any time by illness, accident or injury to children or staff, have been carried out in addition to the daily routine. One hundred and eighty-six children were examined on admission, and 196 on discharge. DENTAL TREATMENT. I can express myself completely satisfied with the general condition of the children's teeth. Suitable anaesthetics are administered for extractions when required. Mental Deficiency Acts, 1913-27. The ascertainment and supervision of persons coming within the scope of these Acts, and the examination, certification and completion of reports for the Board of Control and other Authorities, have been carried out satisfactorily. The administration of the mentally deficient plays no inconsiderable part in Public Health procedure. TABLE 9. VISITS. No. of reports— register, files, &c. Number of interviews Statutory Supervision Guardianship Institution Training Centre Friendly Care Total 967 154 113 116 104 1,484 1990 110 TABLE 10. Particulars of Mental Defectives as on 1st January, 1936. (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. 38 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 15 13 28 Aged 16 years and over 43 31 74 (2) On Licence from Institutions— Under 16 years of age - - - Aged 16 years and over 3 2 5 (b) (1) Under Guardianship (excluding cases on Licence)— Under 16 years of age 2 1 3 Aged 16 years and over 13 6 19 (2) On Licence from Guardianship— Under 16 years of age - - - Aged 16 years and over - - - 2 In "places of safety":— Under 16 years of age - 1 1 Aged 16 years and over - - - 3. Under Statutory Supervision Of whom:— 74 78 152 Awaiting removal to an Institution 2 2 4 4. Action not yet taken under any one of the above headings:— (a) Notified by Local Education Authorities (Sec. 2 (2)) 12 8 20 (b) Mental Defectives in receipt of Poor Relief:— (1) Institutional— (a) In Public Assistance Institutions and Municipal General Hospitals not approved under Sec. 37 - - - (b) In Institutions certified under the M.D. Acts (including those approved under Sec. 37):- (1) Cases "placed" under Sec. 3 - - - (2) Other Cases - - - (2) Domiciliary - 1 1 (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 2 - 2 (b) Maintained wholly by parents, relatives or others - 1 1 2. Reported to the Local Authority from any reliable source and recognised 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 - - - 39 (b) All other cases 24 27 51 Of whom, number, if any, under Voluntary Supervision 24 27 51 Number of above Cases on the Registers of Occupation and Industrial Centres:— Under Statutory Supervision 10 14 24 Under Voluntary Supervision 1 - 1 On Licence from Institutions - - - Under Guardianship 2 4 6 On Licence from Guardianship - - - DURING THE YEAR 1935. 1. (a) Number of instances in which Licence was granted during 1935:— M. F. T. (1) From Institutions 1 1 2 (2) From Guardianship - - - (b) Number of instances in which cases on Licence have been returned to Institutions or transferred to Guardianship during the year 1935— (1) To Institutions 1 - 1 (2) To Guardianship - - - 2. Cases notified by Local Education Authorities (Section 2 (2)) during the year 1935:— Method of disposal— M. F. T. Sent to Institutions (by Order) 1 1 2 Placed under Guardianship (by Order) - - - Placed under Statutory Supervision 6 4 10 Placed in "Places of Safety" - - - Died or Removed from Area 2 1 3 Action not yet taken— M. F. T. (a) In receipt of Poor Relief - - - (b) Others 3 2 5 Total 12 8 20 3. Of the total number of mental defectives known to the Local Authority:— (a) Number who have given birth to children during 1935:— (1) After marriage - (2) While unmarried 1 Males. Females. (b) Number who have married during 1935 - - Training and Occupation Centre. The morning session is devoted to boys and youths, and the afternoon to girls and women. There has been marked progress and a higher standard reached, in all branches of work. 40 The children have evinced greater interest in games, physical drill and handwork, and have made many saleable articles. The older girls exhibit more intelligent interest, and in many instances take work home with them to Complete. The boys work well with a minimum of supervision, and have been encouraged by the many orders they have received. TABLE 11. Statistics of Training Centre, 1935. Morning Session—Males. Afternoon Session— Girls and Juniors. Grand Total Attendances No. on Register No. of Sessions held Total Attendances Average Attendance No. on Register No. of Sessions held Total Attendances Average Attendance 10 206 1,537 7.4 21 206 3,295 16 4,332 Blind Persons Act, 1920 The work of the East Ham Welfare Association for the Blind has resulted in steady progress. The objects of the Association are as follows:— 1. To compile a register of all blind persons living in the Borough. 2. To organise the work of the Home Teacher (visitor). 3. To co-operate with the Education Committee regarding necessary investigations and arrangements for the education of children and adults. 4. To assist all efforts for the prevention of Blindness. 5. To approach the Borough Council when necessary respecting any cases requiring consideration. 41 6. To obtain Old Age and other pensions as cases become eligible. 7. To assist deserving Blind persons, and to do all such other things as are considered to be for the general welfare of the Blind. 8. To supply materials to those engaged in pastime occupation, and to market the articles they make. 9. To brighten the lives of the Blind by means of entertainments, visiting, etc. All activities on behalf of the Blind have been well maintained, and the Association records the hearty co-operation of the East Ham Council and Education Committee in making an annual grant of £100, and providing accommodation for concerts and meetings. During the year, 24 pairs of special glasses and four surgical aid appliances were supplied. Two cases were sent to Convalescent Homes for the Blind, and those suffering from visual defects were treated in hospitals. All the Blind in the Borough, where required, now have wireless sets provided and installed and the cost of maintenance undertaken. The weekly club at St. Bartholomew's Institute continues with every success, and has an average attendance of 90. The Home Teacher (Miss Kingston) works in close co-operation with the Association. The Council's Ophthalmic Specialist examines all new cases and certifies where necessary. Number of cases examined 11 Number of cases certified 11 42 TABLE 12. Work of the Visitor to the Blind. Year. No. of technically Blind Persons on Register. No. of Visits to same. Daily.Eve'ng. 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 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 - 1935 231 3,987 46 120 199 5 4,237 401 20 159 107 56 32 - 27 - In the following tables, the registration of the blind, ages at which blindness occurred, training and employment and occupations, as at 31.3.36, are set out:— 42a M=Males F=Females. T=Total. TABLE 13. Welfare of the Blind.— Registration. As at 31.3.36. Age Period 0—1 Age Period 1—5 Age Period 5—16 Age Period 16—21 Age Period 21—40 Age Period 40—50 Age Period 50—65 Age Period 65—70 Age Period 70 and over (i) Total of all age groups. (ii) Age 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. - - - - - - 3 2 5 1 3 4 17 11 28 18 10 28 31 24 55 17 14 31 38 44 82 (i) 125 108 233 (ii) — 1 1 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 and over Age Period 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. M. F. T. 15 9 24 1 3 4 6 6 12 4 5 9 13 5 18 10 8 18 13 12 25 18 14 32 25 25 50 14 16 30 6 6 12 Children of .School Age 5-l6 Normal. Mentally Defective Physically Defective Training and Employment. Age period 16 and upwards. Employed Undergoing Training Trained but Unemployed (h) No Training but Trainable (i) Unemployable (j) Total (k) M F M F M F By Blind Institutions. All others not included in (a & (b) (c) Total employed (d) Industrial (e) Secondary (f) Professional or University (g) In Schools for the Blind 1 1 - - - - 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. N. F. T. M. F. T. M. F. T. M. F. T. Other Schools - - - - - 1 5 6 11 4 1 5 13 5 18 22 12 34 3 1 4 1 - 1 - - - 5 - 5 2 2 4 89 92 181 122 107 229 Not at Schools - - 2 - - - Occupations of Employed. Agents, Collectors, etc. Basket Workers Beddmg(including Divans and Ottomans) and Upholstering. | Boot repairers Braille copyists & Proof Readers Brush Makers Carpenters and Woodworkers Chair Seaters Clerks and Typists Coal Bag Makers Tea NewsShop- Firewood Workers Gardeners Hawkers, News vendors etc Home Teachers knitters Labourers Massage Mat Makers Ministers of Religion Musicians and Music Teachers Netting Makers Porters, Packers Cleaners Poultry Farmers School Teachers Ship's Fender (Fendoff)Makers Telephone Operators Tuners Weavers Miscellaneous Total | Hand Machine Mattress Makers Machi- nists Uphol- sterers Dealers, Agents, Agents, keepers Within Institutions for the Blind 1 2 3 - - - - - - - - - - - - - - - 1 - - - - - 1 - - - - - - 4 - 12 In approved Home Workers Schemes - - - - - 1 - - - - - - - - - - - - 1 - - - - - - - - - - - 3 - - 5 Others (not pastime Workers) - 1 - - - 2 - - 1 - 2 - 1 - - 4 - - - - 1 - - - - - - - - 2 - - 3 17- Total 1 3 3 - - 3 - 1 - 2 - 1 - - 4 - - 2 - 1 - - - 1 - - - - 2 3 4 3 34 Unemployable persons resident in Homes Physically and Mentally Defective (including those children 5-16). for the Blind Mental Hospitals or Poor Law Institutions. (a) Mentally Defective (b) Physically Defective (c) (i) Deaf (ii) Deaf-mute Combinations of (a) and (b) Combinations of (a) and (c) Combinations of (b) and (c) Combinations of (a), (b), (c) Total Homes for the Blind Mental Hospitals Poor Law Institutions 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. 5 2 7 8 7 15 (i) 8 (i) 9 (i) 17 - - - 1 - 1 - - - - - - 22 18 40 - 1 1 1 2 3 6 9 15 (ii) - (ii) 2 (ii) 2* *Deaf Mutes are also shown in the Deaf column. 43 The Invalid Children's Aid Association. The Public Health Committee and the Education Committee value the close co-operation that exists with the East Ham Branch of the I.C.A.A. and the opportunity afforded to them of obtaining immediate and suitable treatment or convalescence for the many little sufferers who come under their care. Considerable difficulty would be experienced in placing children in appropriate institutions were it not for the expeditious and efficient arrangements made by the Association. I desire to express my thanks to the Committee and the Officers for their kind assistance during the past year. The following is abstracted from the Annual Report for the year 1935:— Number of cases dealt with 338 New cases 213 Old cases 92 Referred for clothing 33 - 338 The 213 new cases were referred by:— Hospitals and Medical Practitioners 89 Medical Officer of Health and Infant Welfare Centre 35 School Medical Officer and Education Committee 43 Tuberculosis and Chest Clinic 38 Parents, etc 8 - 213 The types of new cases were as follows:— Tuberculosis 21 Rheumatism, heart and chorea 22 Anæmia and debility 34 Lung Conditions (non-tuberculous) 49 Marasmus and Malnutrition 18 Various 69 - 213 44 The 338 cases dealt with during the year have been assisted as follows:— Sent to Sanatoria, Convalescent Homes, etc. 178 Extensions at Homes from previous years 58 Surgical instruments provided 44 Clothing 33 Convalescent Home "Letters" 1 Extra nourishment 5 Massage 1 Referred to other Agencies 4 Referred for Visiting and Advice 14 - 338 Infectious Diseases. Zymotic Death Rate. The deaths from the seven principal zymotic diseases (Smallpox, Whooping Cough, Measles, Diphtheria, Diarrhoea, Scarlet Fever, and Enteric Fever) during the year numbered 31. The death rate was 0.2 per 1,000 population, as compared with a rate of 0.6 for 1934. No cases of small pox were reported during the year under review. Vaccinations 1935. The following figures shew the vaccinations carried out by the Public Vaccinators from 1/1/35 to 31/12/35:— Dr. O'Moore Dr. Brews Total Number of successful primary vaccinations of children under one year of age 441 26 467 Number of successful primary vaccinations of persons one year and upwards 46 5 51 Total primary vaccinations 487 31 518 Number of successful re-vaccinations 68 17 85 45 Scarlet Fever. Four hundred and eleven notifications of this disease were received during 1935, as compared with 979 for the previous year. The number of deaths occurring from this cause was one, and 344 cases or 83.7 per cent. received hospital treatment as against 82.2 per cent. for the previous year. Diphtheria. Notifications for the year totalled 254, a decrease of 125 cases when compared with 1934. Of the total cases notified 250 were removed to and treated in hospital, equivalent to 98.4 per cent., 99.4 per cent. being the comparable percentage for the previous year. The number of deaths was 16 or a case mortality of 0.3 per cent. There is no change in the arrangements for the supplying of antitoxin to Medical Practitioners as set out in previous years. Schick Immunization Clinics. During the year 1935, 1,007 infants and children have been completely immunised. The total number of inoculations performed has been 3,544, of which 1,627 were carried out at the Town Hall Clinic, 1,497 at the Maternity and Child Welfare Clinic, 282 at the Infectious Diseases Hospital, and 138 by Private Practitioners. The following figures are intended to indicate the number inoculated and the age groups involved in the cases treated . Town Hall Clinic. Total number of inoculations 1027 Number inoculated three times 504 Number inoculated twice 15 Number inoculated once 13 In addition to the above, one child was inoculated twelve times, two children nine times, one seven, one six, one five, and six, four inoculations. 46 Maternity and Child Welfare Clinic. Total number of inoculations 1497 Number inoculated three times 343 Number inoculated twice 16 Number inoculated once 29 In addition, four children received six inoculations, nineteen children five times, and seventy-two four times. Infectious Diseases Hospital. Total number of inoculations 282 *Number completely immunised 114 Number inoculated twice 6 Number inoculated once 4 Private Practitioners. In addition to the above, during the same period, forty-six children were inoculated three times by Private Medical Practitioners. Number inoculated in the various age groups:— Ages in years No. inoculated 1 2 3 4 5 6 7 8 9 10 11 12 13 14 and over 94 121 140 119 171 116 82 74 71 64 49 ) 40 37 19 645 407 145 1,197 N.B.—In considering the combined totals it will be noticed that 53.8 per cent. of the cases are in the age group 1-5 years, 34.0 per cent. in the age group 6-10 years, and 12.1 per cent. in the group over 10 years. The Schick test for susceptibility to Diphtheria was performed during the year in 1,216 of the completed cases of which 1,125 proved negative. In 91 of the cases positive results were obtained and further inoculations were carried out. *76 children received three inoculations. 38 ,, inoculated once with A.P.T. (Alum Precipitated Toxoid). 47 Enteric Fever. Two cases notified, both of whom received hospital treatment. There was one death. Erysipelas. Fifty-five notifications received, 22 removed to hospital, and two patients died. Puerperal Fever. Twelve cases notified, 11 received hospital treatment, and six died. Puerperal Pyrexia. Fourteen notifications received, six were admitted to hospital; no deaths occurred. 48 TABLE 14. Total Cases of Notifiable Diseases, 1912-1935. Disease. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Smallpox - - - - - - 3 1 10 - - - - - - - 17 25 70 51 13 1 1 - Scarlet Fever 435 526 667 499 267 341 272 530 718 1,355 502 170 215 221 350 798 832 743 484 245 779 701 979 411 Diphtheria 72 258 319 204 225 279 273 451 426 309 198 160 128 246 337 464 669 578 473 196 157 180 379 254 Enteric Fever 13 19 21 5 7 9 2 15 10 7 4 3 5 9 7 2 7 2 3 8 7 5 - 2 Erysipelas 152 119 130 96 86 66 52 72 72 57 34 32 38 41 41 38 60 49 63 54 55 69 74 55 Puerperal Fever 8 8 4 4 1 2 1 6 6 5 3 5 5 5 5 5 4 8 9 10 4 4 7 12 Puerperal Pyrexia Not Notifiable 11 11 12 14 6 23 10 11 14 Meningococcal Meningitis 2 6 1 8 6 7 3 3 3 4 - 1 1 1 1 4 1 1 3 8 5 1 3 3 Encephalitis Lethargica Not Notifiable 4 5 7 - 9 6 1 2 3 1 - - - 1 1 1 Ophthalmia Neonatorum - - 17 16 16 7 11 13 30 3 11 11 6 8 10 12 3 8 6 6 6 9 5 5 Ac. Polio Myelitis 2 8 4 1 10 - - 3 1 - - 3 1 1 - 5 - 2 - 1 7 2 5 13 Ac. Polio Encephalitis Not Notifiable - - - - - - - - - - - - - 3 2 1 - Dysentery Not Notifiable - - - - - - - - - - - - - - - 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 - - - - - - - - - - - - - - - - - - - - - - - - Typhus Fever - 1 - - - - - - - - - - - - - - - - - - - - - - Pneumonia Not Notifiable 85 92 54 79 91 70 114 82 102 59 75 77 148 100 88 Total 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 1,568 858 * Induced in an Institution. 49 TABLE 15. Prevalence of and Control over Infectious Disease.— Notified Cases for the 52 Weeks ending 28th December, 1935. 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. Scarlet Fever 411 3 108 170 56 28 38 5 3 - 34 41 35 37 30 35 51 37 46 65 344 *1 Diphtheria 254 3 64 107 48 13 15 2 2 - 28 35 9 33 26 22 21 27 16 37 250 16 Erysipelas 55 1 1 2 1 4 5 7 26 8 4 3 4 8 3 3 9 6 4 11 22 2 Puerperal Fever 12 - - - - 1 9 1 1 - - 1 1 2 - 2 2 2 1 1 11 6 Puerperal Pyrexia 14 - - - - - 13 - 1 - - 1 2 1 2 2 2 3 - 1 6 - Pneumonia 88 7 7 9 5 4 15 14 21 6 5 13 12 18 3 9 5 6 6 11 39 91 Ophthalmia Neonatorum 5 5 - - - - - - - - 2 - - - - 1 - - - 2 - - Meningococcal Meningitis 3 1 - - - - 1 - 1 - - 1 - - 1 - - 1 - - 3 1 Enteric Fever 2 - - - - - 1 - 1 - - - - - - - 1 - 1 - 2 1 Acute Polio Myelitis 13 - 5 4 3 1 - - - - 2 1 3 - 1 - 3 - 2 1 13 3 Encephalitis Lethargica 1 - - - - - - - 1 - - - - - - - - 1 - - 1 2 * Inward transferable death. 50 TABLE 16. Ophthalmia Neonatorum. Vision Unimpaired. Vision Impaired. Vision Lost. Still under treatment at end of year. Died. Removed from District. Not Classified. 4 - - - - - *1 * Doctor and trained nurse in attendance on child. Parent did not desire any visits from Health Visitor. Report on Work at the Borough Infectious Diseases Hospital for the year 1935. Dr. Landon reports as follows:— During the year 1935 there was a fall in the incidence of acute infectious disease compared with the preceding year. In all, 684 patients were admitted to Hospital compared with 1,290 during 1934. The virulence of the diphtheria bacillus appeared to have diminished and the mortality rate for this disease fell to 4.3 per cent. Scarlet Fever was less prevalent than usual, the number of patients admitted being 344. The mortality rate at the hospital for this disease was nil. It is interesting to note that apart from one death from tuberculous meningitis, diphtheria was responsible for all the deaths during the year. An important disability from which the Hospital has suffered for some time was removed during 1935. The hot water system on D block has been augmented, and the result now appears to be quite satisfactory. The higher temperatures now obtainable in the cubicles have added greatly to the comfort of the patients and have facilitated treatment, especially in acute pulmonary conditions as, for example, in broncho-pneumonia following measles and whooping-cough. Table 17 shows the wide range of diseases treated at the Hospital. It is learned that in future, cases of acute lobar pneumonia will also be admitted. This is a welcome addition in view of the excellent facilities that obtain for the nursing of this disease. The differentiation, by the use of type-specific antisera, 51 of the various strains of pneumococci require a high degree of laboratory organisation, and these investigations would, if necessary, have to be made in conjunction with a general hospital or public laboratory. Diphtheria. During 1935, 250 patients were admitted compared with 374 during 1934. Of this number 203 were faucial, 37 were nasal, 5 laryngeal, 3 aural, 1 faucial and nasal, and ,1 aural and nasal. Forty-eight patients remained under treatment at the end of 1934. The disease showed a decline both in prevalence and virulence, although many cases of considerable severity occurred. The number of completed cases was 281. The number of deaths was twelve, giving a mortality rate of 4.3 per cent, compared with 11.4 per cent, for 1934. An analysis of the fatal cases is as follows:— Five cases were haemorrhagic. In one case the patient died on admission and the certificate was furnished by the outside medical practitioner. Five cases showed severe infection with the diphtheria gravis bacillus and died within two weeks of admission. The remaining two were cases of cardiac and respiratory paralysis. Eighteen other cases of severe complications occurred, but all ended in recovery. One rather unusual case of faucial diphtheria was complicated on admission, by marked cardiac dilatation, cyanosis, ascitis and general oedema. The patient fortunately responded to treatment and was transferred to a Chest Hospital after 56 days. The age incidence of the patients admitted was as follows:— 0 — 5 5 — 10 10—15 15 + Total 63 109 48 30 250 Scarlet Fever. During 1935, 344 cases were admitted compared with 796 in 1934. Sixty-six patients remained under treatment at the end of 52 1934. In general, the type encountered was mild, although many severe cases occurred. One case of haemolytic streptococcal septicaemia was admitted (vide infra), recovery taking place. Ninety-five per cent, of the above patients were given antiscarlatinal serum which, in the more severe cases, was given intravenously. The wide use of this serum continues to justify itself in the rapid subsidence of acute symptoms, the avoidance of septic complications and the general well-being of the patients. The Schick and Dick tests were applied in all cases, and immunisation offered in the case of all patients under five years of age and in all Schick-positive cases. Of a series of 235 consecutive cases:— 80.9 per cent. were discharged in four weeks. 7.7 per cent. were discharged in five weeks. 11.4 per cent. were discharged in from five to nine weeks. Complications for this series totalled 27 cases or 11.5 per cent., which may be analysed as follows:— Otorrhoea 3.4 per cent. Adenitis 3.5 per cent. Endocarditis 0.8 per cent. Nephritis1.3 per cent. Rhinitis 2.5 per cent. There were no deaths from scarlet fever during 1935, compared with a mortality rate of 0.58 per cent, during 1934. The age incidence of the patients admitted was 0—5 5—0 10—15 15 + Total 94 138 47 65 344 The following is a resume of a severe case of haemolytic streptococcal septicaemia following scarlet fever:— J.W.C. Four years, was admitted on June 6th, 1935, with scarlet fever. A septicaemic condition was present, and blood culture showed a pure growth of haemolvtic streptococci. In all, 200 ccs of antiscarlatinal serum were given, and the patient continued to run a temperature between 100 and 102 for 10 weeks. . During this period 53 the complications which ensude included an osteomyelitis of the neck of the right femur, arthritis of many joints, multiple abscesses, acute bronchitis, ctc. A blood transfusion was given with beneficial results. An X-ray of the right hip joint was taken at the Memorial Hospital. The right knee was incised under general anaesthesia and a large effusion was evacuated. The patient made a good recovery, and was transferred to a general hospital for treatment of a residual arthritis of the right knee 106 days after admission. Bronchopneumonia. Thirteen cases of this disease were treated during the year. Of these, twelve were due to measles and one to whooping-cough and measles. All cases recovered. Measles. Nineteen uncomplicatcd cases were treated during the year. Convalescent Measles Serum. This was used in cases that had been in contact with measles and satisfactory results were obtained. Where the scrum was injected within a week of exposure to infection, protection was afforded in most cases. Later injection resulted in marked attenuation of the disease but not in complete protection. The supply of this serum is unfortunately strictly limited. Acute Anterior Poliomyelitis. Six cases were admitted within a short time of each other. Four of these cases developed marked paralysis. All the patients were transferred to the Memorial Hospital at the end of about three weeks for massage and electrical treatment. Erysipelas. Five cases were admitted. Good results were obtained in four of these by the intravenous injection of anti-scarlatinal serum. 54 Bacteriological Examination. During the year, 2,801 swabs were examined. Of this number, 240 were found to bepositive. Laboratory Work. Investigations made included:— Blood cultures 3 Blood count 1 Virulence test for K.L.B 1 Examinations of cerebrospinal fluid 4 Examination of faeces for typhoid bacilli 1 Culture of synovial fluid 1 Typing of blood group 1 Post-Mortem Examination. A post-mortem examination on a patient who had been admitted with a tentative diagnosis of scarlet fever showed death to have been due to tuberculous meningitis and acute miliary tuberculosis of the lungs. Immunisation. During the year, 278 immunising injections were given, 123 patients being thus protected against diphtheria. Of these, 38 were immunised with alum precipitated diphtheria toxoid (single dose method). While this appears to be suitable in the case of children, its use is contra-indicated in adults because of the severe local and general reactions which ensue. Operations. The following operations were performed:— Radical mastoid operations 2 Mastoid incision 1 Lumbar punctures 7 55 Incision of knee-joint 1 Blood transfusion 1 Removal of finger-nail under general anaesthesia 1 Incisions- for cellulitis of leg 2 Incisions of glandular abscesses 12 Aspiration of joints 3 Infection among Staff. The following cases occurred:— Diphtheria 2 Scarlet Fever 2 Erysipelas 2 Measles 1 Influenza 19 Tonsillitis 8 Nurses' Training School. The percentage of passes in the Final State Fever examination was 65; in the Preliminary Nursing examination 66.5 per cent. of candidates were successful. 56 TABLE 17 Admissions, Discharges, Etc., 1935 Borough Infectious Diseases Hospital. Disease. Remaining at end of 1934 Admitted during 1935 Died during 1935 Discharged during 1935 Remaining at end of 1935 Diphtheria 48 250 13 268 17 Scarlet Fever 66 344 - 367 43 Diphtheria and Measles 1 - - 6 Diphtheria & Scarlet Fever 3 3 - 6 - Scarlet Fever & Chicken Pox — 1 — 1 - Broncho-Pneumonia and Measles 2 11 4 9 Measles — 19 — 7 12 Erysipelas — 5 - 4 1 Broncho-Pneumonia, Whooping Cough and Measles - 1 - - 1 Pertussis — 7 — 6 1 Parotitis — 6 — 6 Pyaemia and Pyelitis — 1 — 1 - Influenza — 1 — 1 — Tonsillitis — 6 - 6 - Typhoid & Para-Typhoid B. — 1 - 1 - Impetigo — 2 - 2 - Acute Anterior Poliomyelitis — 6 — 6 — Marasmus — 1 - l - Broncho-Pneumonia and Rubella — 1 — 1 — Bronchitis and Laryngitis... — 1 - 7 - Chicken Pox — 7 - 1 - Rubella — 1 - 1 - Retro-pharyngeal Abscess Ovarian Cyst — 1 — 1 — Observation Cases 7 1 7 - Tuberculous Meningitis -— 1 120 685 14 707 84 57 TABLE 18. Borough Infectious Diseases Hospital Year ended 31st March, 1936. Expenditure Cost per Patient per week £ s. d. Salaries and Wages 6047 35 5 Superannuation 195 1 2 Provisions 2783 16 3 Anti-toxin 690 4 0 Disinfectants, Drugs and Appliances 217 1 3 Coal, Coke and Firewood 775 4 7 Electricity, Gas and Water .... 1149 6 9 Furniture, Bedding and Linen 190 1 1 Uniforms and Dresses 110 8 Chandlery and Sundries 531 3 1 Crockery and Hardware 84 6 General Repairs ..., 1025 6 0 Garden Implements, Seeds, etc 65 5 Maintenance and Upkeep of Ambulances . 648 3 8 Printing, Stationery and Advertisements . 76 6 Rent of Telephone 55 4 Rates, Taxes and Insurance 361 2 2 Cinema Apparatus, Films, etc. 92 6 £15093 88 4 Cancer. No investigations have been taken as set out in Circular 1136 of 31st July, 1930. Cancer Deaths, 1935: Total deaths 205 Males100 Females 105 Classification: Cancer (type not stated) 14 Carcinoma,184 Epithelioma 1 Sarcoma 6 Total 205 Table 19. Cancer Deaths.—Parts of the Body Affected. Parts of Ages Body 0-1 1-2 2-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75 and upwards Total Affected. 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 - - - - - - - - - - - 1 - - - - 1 - 1 1 2 - 4 2 Digestive Organs & Peritoneum - - - - - - - - - - 1 1 3 5 9 7 16 13 25 19 14 6 68 51 Respiratory Organs — — — — — — — — — — 1 — - - 3 1 2 1 2 1 2 1 10 4 Uterus - - - - - - - - - - - - - 2 — 2 — 3 — 4 - 1 - 12 Other Female Genital Organs - - - - - - - - - - - - - 1 - 4 - 2 - - - 1 - 8 Breast — — — — — — — — — — - 1 — 1 — 4 — 9 — 1 - 3 - 19 Male Genitourinary Organs - - - - - - - - - - 2 - - - - - 3 - 4 - 5 - 14 - Skin — — — — — — — — — — — — — — — — — — - - - 1 - 1 Other or Unspecified Organs - - - - - - - - - - - - - - - 2 2 1 2 4 - - 4 8 Totals — — — — — — — 1 — — 4 3 3 9 12 20 24 29 34 30 23 13 100 105 58 59 Prevention of Blindness. No action has been taken during the year under Section 66 of the Public Health Act, 1925. Tuberculosis. East Ham Tuberculosis After Care Committee. The After-Care Committee, under the Chairmanship of Mr. Councillor 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. Eighty-four patients have been provided with clothing and bedding. The provision of bedding has enabled the patients concerned to sleep alone, thus acting as a preventive measure to the healthy members of the family. Other patients have been helped by the provision of crutches, splints, spectacles, repairs to artificial limbs, and payment of removal expenses. Part cost of dental treatment was borne in one case, and another patient's arrears of National Health Insurance contributions were paid to enable him to keep in benefit. Funds arc urgently needed. Occupational Therapy: In October a handicraft centre was formed at the Chest Clinic for patients suffering from chronic tuberculosis and having no definite form of employment. Each patient does the craft work which he or she thinks would be most useful, and all patients have individual tuition. This includes raffia work, small baskets, table mats, various ways of seating stools with seagrass and rushes, rug-making needle-weaving, weaving, Italian quilting, glove-making, and soft woollie toys. Occupational therapy is keeping the mental attitude of these patients favourably influenced and is providing a means whereby they may escape from the boredom of inactivity and depression. 66 Dr. Philip Ellman reports as follows on the principal features of the work at the Tuberculosis and Chest Clinic for 1935. Statistical: The number of primary notifications during the year 1935 was 255 as compared with 258 for ,1934. Of these primary notifications in 41.7 per cent. tubercle bacilli were found in the sputum. In other words, 41.7 per cent, of cases were definitely infectious, and the smaller this number becomes the better the ultimate outlook for the individual sufferers. It is again emphasised how ill-advised it is to wait for a positive sputum before a diagnosis is made, given that other criteria are present enabling one to establish a positive diagnosis of pulmonary tuberculosis. The results in the negative sputum cases are, as a general rule, infinitely superior in the "noninfectious" cases. The Clinic Sessions: Our entry into the new Clinic took place only in September of this year, but our facilities have since improved beyond measure. Since November there has been a re-arrangement of the Clinic sessions, anil we have now the valuable co-operation of Dr. Crawford, enabling me to apply my attention principally to new cases. Notifications: The total number of notified cases on the register of the Clinic on 31st December, 1935, was 974 (pulmonary and nonpulmonary), or 7.19 per 1,000 estimated population, as opposed to 959 or 6.99 per 1,000 population in the previous year. Of these 364 (or 37.4 per cent.) were definitely infectious, i.e., cases in which tubercle bacilli have been found in the sputum at some period of the illness. 61 Deaths: The number of deaths (1929-1935) from tuberculosis is shown hereunder. Of Cases on the Pulmonary Non-Pulmonary Clinic Register 1931 100 15 74 1932 108 16 91 1933 99 16 75 1934 92 15 80 1935 80 16 76 New Cases: The following are the comparative figures for 1932, 1933, 1934 and 1935: 1932 1933 1934 1935 New Cases (and CONTACTS) 51.1 504 510 548 Number proved, after complete investigation, to be tuberculous 32.1% 33.9% 36.4% 35.0% Two important conclusions can be drawn from the above figures: (1) The steady increase in the number of new cases seeking the facilities of services provided at the Chest Clinic, and, since these new cases are all referred by local practitioners and hospitals, the increasing use made of such services. (2) The steady average of only about 34% of new patients proving, after close investigation, to be tuberculous. 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 1935 3,737 3,006 62 Consultations at Homes of Patients: During the year 148 visits to patients who were too ill to attend the Clinic have been made to their own homes. New cases are visited by Dr. Ellman, old cases being visited by Dr. Crawford. Co-operation with Specialised and General Hospitals: There is a continuance of this co-operation, which has been outlined in reports of previous years. Acknowledgment is made of the help and courtesy received from the Staffs of the various hospitals in the interests of the Council's patients. Close Co-operation of the work of the Sanatorium and Clinic. The co-operation between the work of the Clinic and Sanatorium, recently established by the Medical Officer of Health, is already proving its great value. Its potentialities for good are self-evident. The enormous advantage to be derived in the patient's interests, from a close follow-up of cases originally seen and diagnosed at the Clinic who are subsequently recommended for institutional treatment at the Harts Sanatorium, and who are again followed up, on their discharge at the Clinic, requires no emphasis. The increased application of Thoracic Surgery in Chest Diseases: Previous reports have emphasised the increasing value of thoracic surgery in the treatment of "selected" cases of pulmonary tuberculosis and allied diseases. It is of vital importance that close co-operation should exist between the Chest Physician and Thoracic Surgeon in this valuable form of treatment. 63 An appreciable number of cases are being treated by collapse therapy. The more usual form is by artificial pneumothorax. Little more than 5% of all cases seen here are really suitable for "successful" treatment of this kind. The results in suitable cases are, however, very striking. A number of cases exhibiting thick-walled cavities in the lung, have been referred to hospital for "partial thoracoplasty." These cases have had haemorrhage, abundant sputum with tubercle bacilli in large numbers, and a local thoracoplasty has successfully closed the cavity and rendered the patient free from infected sputum. The integrity of the remaining healthy lung has thereby been maintained. It will therefore be seen that an advanced case of tuberculosis, which in the days before thoracic surgery would have been regarded as beyond help, may make remarkable progress with such treatment. The strict Sanatorium Regime in Treatment: Despite all that has been said concerning active interference in the treatment of this disease, a word of caution is very necessary. It must be remembered that many cases will equally require masterly inactivity in treatment, and active interference in such cases may be fraught with the gravest danger. Hence the value of initial periods of observation, close co-operation between Clinic and Sanatorium staff, X-ray, sputum, temperature and haematological control in these cases. Absolute Rest, the patient having every want attended to and remaining himself completely immobile, will in a certain type of case produce equally remarkable results. Clinical and serial X-ray examination will often show unexpected signs of resolution of the disease. This treatment to be effective necessitates experienced nursing and constant supervision. Graduated Exercise and work therapy also play a very prominent part in helping to raise a patient's resistance. This 64 ment by graduated rest followed by exercise under strict medical supervision may not be a new advance, but the results achieved have in numerous cases produced equally remarkable results. Their value in the majority of cases must in no way be masked by the more dramatic results which are achieved in a comparatively smaller number of selected cases responding to newer methods of treatment. X-Ray Investigations in Diseases of the Chest: The number of these examinations has increased year by year, as the following figures show:— 1931 1932 1933 1934 1935 352 454 Screen 268) Screen 264 Screen 245 Films 265) 533 Films 399 663 Films 517 762 (The figures include X-ray examinations by screen and film for the past six years.) Almost all cases that are filmed are automatically screened as a routine. In some cases, however, i.e., 245 during the year, films were found to be unnecessary, with the result that there has been an appreciable financial saving. Increased appreciation is being recorded concerning this method of examination. Its value for good in diagnosis and assessing the value of treatment is incalculable. The introduction of a first-class X-ray apparatus in the Clinic, enabling us to take X-rays of the chest with perfect technique, will greatly enhance the value of our work. Moreover, increased resort will inevitably be made to this valuable aid in assessing our results of treatment. There are many expert chest physicians who hold the view that apart from the value of an X-ray of the chest in diagnosis, the increased value of serial X-ravs in estimating the results of treatment are incalculable at the Sanatorium. Many institutions, especially first-class sanatoria, have an X-ray record every month to study and assess the progress of each individual patient. In this way knowledge of the disease has 65 advanced to an enormous degree, and forms of treatment such as "absolute rest" have shown signs of healing which it would have been impossible to appreciate in any other way. Chronic Miliary Tuberculosis: Several cases showing the radiological features of a general miliary tuberculosis (which has hitherto been regarded as an acute and rapidly fatal disease), whose course has been a chronic one, have been seen at the Clinic. X-ray examination of the chest has brought the condition to our notice, and the extended chronic course with signs of natural resolution following treatment by prolonged rest has been revealed through repeated radiograms over periodic intervals. Acute adolescent phthisis: Mention has been made in previous reports of the numbers of cases of adolescent phthisis occurring, especially in young girls of the 15—25 age period. Despite the steadily declining death rate in this disease the young" adult death rate is not declining. Again, it is astonishing how silent these cases often are from the point of view of symptoms and signs. This is so misleading that it is often extremely deceptive to both patient and doctor. Many of these cases who attend here show extensive signs of disease on X-ray examination, despite very few symptoms and signs. There would appear to be a phase in these young adolescents when the disease is apparently quite latent. It is more than probable that if we were to X-ray many of these young adolescents, even though they were free from symptoms, radiological evidence of disease would be detected. Treatment at that stage might well prevent onset of active clinical disease, and so assist in the reduction of the high mortality rate of pulmonary tuberculosis at this dangerous age period. The problem is becoming such a social menace at this age period that the matter must be constantly in our minds. 66 Our main work therefore in the field of prevention would appear to be a concentration on young adolescents, and the assistance to be derived by the installation of our new X-ray apparatus might well prove to be of incalculable value in this domain. Blood investigation in Pulmonary Tuberculosis: Hitherto the facilities for this form of investigation have not been available. So much is, however, to be learned concerning the prospects of good recovery or otherwise from such investigations as blood sedimentation rates, that it is hoped in the future that these blood investigations will be available. Nursing Staff at Clinic: With three fully trained Sisters the Nursing aspect of our work is everything that can be desired both at the clinic and on the District, where during the year 3,728 visits to the homes of the patients have been made. I L9 TABLE 20. Return showing the work of the Tuberculosis and Chest Clinic, 1935. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total Adults. Children. Adults. Children. Adults. Children. M. P. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the (a) Definitely tuberculous 71 57 6 3 7 6 9 6 78 63 15 9 165 (b) Diagnosis not completed — — - - - - - 8 5 1 2 16 (c) Non-tuberculous — — — — — — — — 58 36 11 14 119 B.—Contacts examined during the year :— (a) Definitely tuberculous 13 8 2 2 — — 2 — 13 8 4 2 27 (b) Diagnosis not completed - - - - - - - - 1 6 4 1 12 (c) Non-tuberculous — — — — — — — — 51 76 43 39 209 C.-—Cases written off the Clinic Register as — (a) Recovered 11 — 4 1 - - 2 2 11 - 6 3 20 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Clinic Register as tuberculous) - - - - - - - - - - - - - D.—Number of Cases on Clinic Register on December 31st, 1935 :— (a) Definitely tuberculous 369 327 30 10 68 78 63 29 437 405 93 39 974 (b) Diagnosis not completed — — — — — — — — 9 11 5 3 28 68 1. Number of cases on Clinic Register on January 1st, 1935 997 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 44 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of" 122 4. Cases written off during the year as Dead (all causes) 76 5. Number of attendances at the Clinic (including Contacts) 3,737 6. Number of Insured Persons under Domiciliary Treatment on the 31st December, 1935 30 7. Number of consultations with medical practitioners:— (a) Personal 102 (b) Other 304 8. Number of visits by Tuberculosis Officers to Homes ing personal consultations) 148 9. Number of visits by Nurses or Healih Visitors to Homes for Clinic purposes 3,728 10. Number of (a) Specimens of sputum, &c., examined 744 (b) X-ray examinations made (inclusive of both film and screen examinations) 762 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, 1935 364 Number of Clinics for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) :— Provided by the Council 1 TABLE 21. 68a Pulmonary Tuberculosis. Supplementary Annual Return showing in summary form (a) the condition at the end of 1935 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at tha t time. Condition at the time of the last record made during the year to which the return relates Previous to 1926 1926 Class T.B. minus 1927 1928 1929 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group Group 2 Group 3 Total(Class T.B. Plus) Group Group 2 Group 3 TotaI(Class T.B. PIui) Group Group 2 Group 3 Tota(lClass 'T.B. Plus)| Group Group 2 Group 3 Toul(Class T.B. Plus) Group Group 2 Group 3 Total(Class T.B. Plus) (a) Rema-ining on Dispensary Register on 31st December. Disease Arrested Adults M. 19 5 6 — 11 2 1 2 — 3 1 1 — — 1 3 — — — — 1 1 1 — 2 F. 8 1 2 — 3 1 — 1 — 1 4 — — — — 5 — — — — 4 — — — — Children 13 - - - - 3 - - - - - - - - - - - - - - - - - - 1 Disease not Arrested Adults M. 14 11 16 - 27 1 1 2 1 4 2 1 3 — 4 2 4 2 — 6 6 2 4 — 6 F. 15 7 12 1 20 1 1 3 — 4 2 — 1 — 1 4 4 — 2 6 4 4 3 1 8 Children 5 - - - - - - - - - - - - - - - - - - - - - - - - Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - 17 Total on Dispensary Register at 31st Dec. 74 24 36 1 61 8 3 8 1 12 16 2 4 — 6 20 8 2 2 12 23 8 8 1 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 20 2 — — 2 1 — — — — 2 — 1 — 1 2 — — — — 2 — — — — F. 16 1 - - - - - - - - 1 - - - - - - - - - - - - - - Children 21 - - - - - - - - - 1 - - - - - - - - - - - - - - Lost sight of or otherwise removed from Dispensary Register 318 36 51 4 91 58 8 27 — 35 46 12 21 2 35 58 18 23 3 44 42 9 24 — 33 Dead Adults M. 39 6 54 28 88 9 2 24 12 38 5 3 27 11 41 10 2 25 10 37 4 3 24 16 43 F. 25 5 30 22 57 6 6 21 10 37 1 1 17 8 26 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 Dispensary Register 444 50 136 55 241 76 16 72 23 111 60 17 66 21 104 75 25 59 22 106 55 14 58 22 94 Grand Totals 518 74 172 56 302 84 19 80 24 123 76 19 70 21 110 95 33 61 24 118 78 22 66 23 111 1930 1931 1932 1933 1934 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 1 1 2 2 - - - - - - - - - - - - - - - - - - - F. 1 - - - - - - - - - - - - - - - - - - - - - - - - Children 2 - 1 - 1 - - - - - - - - - - - - - - - - - - - - Disease not Arrested Adults M. 5 7 7 1 15 6 3 7 — 10 11 4 14 — 18 19 4 16 — 20 18 6 22 9 37 F. 9 1 8 1 10 10 6 7 — 13 12 4 9 1 14 23 4 9 1 14 15 8 17 1 1 26 Children 4 - - - - 2 - - - - 3 - - - - 12 - - - - 10 — 1 2 Condition not ascertained during 1 he year - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st Dec. 23 9 17 2 28 20 9 14 — 23 28 8 24 1 33 55 8 25 1 34 43 14 40 11 (b) .Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - - - - - - - - - - - - - - - - - - - - — F. - - - - - - - - - - - - - - - - - - - - - - - - — Children - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of or otherwise removed from Dispensary Register 24 7 10 3 20 17 7 15 4 26 29 4 18 — 22 10 4 22 3 29 5 1 8 1 10 16 Dead Adults M. 7 3 15 20 38 4 1 13 6 20 4 2 16 6 24 4 — 13 9 22 2 — 7 9 F. 3 4 13 10 27 6 4 16 9 29 4 2 10 8 20 4 — 7 5 12 1 1 5 10 16 Children — — — 2 2 — — — — — 1 — 1 — 1 — — — — — 2 — — — — Total written off Dispensary Register 34 14 38 35 87 27 12 44 19 75 38 8 45 14 67 18 4 42 17 63 10 2 20 20 42 Grand Totals 57 23 55 37 115 47 21 58 19 98 66 16 69 15 100 73 12 67 18 97 53 16 60 31 107 1935 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. - - - - - F. - - - - - Children - - - - - Disease not Arrested Adults M. 25 6 21 15 42 F. 27 4 21 5 30 Children 10 — — 1 30 Condition not ascertained during the year - - - - 1 Total on Dispensary Register at 31st Dec. 62 10 42 21 73 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - F. - - - - - Children - - - - - Lost sight of, or otherwise removed from Dispensary Register 6 — 3 1 4 Dead Adults M. 2 — 3 6 9 F. 1 — 2 3 5 Children - - - - - Total written off Dispensary Register 9 — 8 10 18 Grand Totals 71 10 50 31 91 \ TABLE 22. 68b Non-pulmonary Tuberculosis. Supplementary Annual Return showing in summary form (a) the condition at the end of 1935 of all patients remaining on the Dispensary 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 Dispensary Register on 31st December, Disease Arrested Adults M. 4 - 1 - 5 - - — - - - - - 1 1 1 — — — 1 2 — - - 2 F. 4 - — 1 5 - - — — - - - - - - — — — 1 1 — 1 - - 1 Children — 1 1 15 17 1 - - 1 2 1 - - 2 3 2 — - 2 4 - 2 - 5 7 Disease not Arrested Adults M. 1 - 2 - 3 1 - 2 — 3 - - — — - 1 — 1 1 3 1 1 - 2 4 F. 3 - 1 1 5 - - - - - - - - - - - - - - - - - - 2 2 Children 5 - 1 12 18 — 1 —- — 1 2 - 1 - 3 2 — - 5 7 4 2 - 1 7 Condition not ascertained during the year 1 1 — - 2 - - - - - 1 - - - 1 - - - - - - - - - - Total on Dispensary Register at 31st Dec. 18 2 6 29 55 2 1 2 1 6 4 - 1 3 8 6 — 1 9 16 7 6 - 10 23 Transferred to Pulmonary 2 - — 4 6 - - — - - — — — 1 1 — — 1 1 — — — - - (b) Not now on Dispensary 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 9 2 2 14 27 - - - 1 1 - 1 — 2 3 — — — — — 1 - - 2 3 Lost sight of, or otherwise removed from Dispensary Register 58 10 19 93 180 11 3 6 16 36 6 1 2 10 19 - 2 5 14 21 6 — 4 18 28 Dead Adults M. 2 - 1 - 3 - - - - - - 1 — — 1 1 — — — 1 - - - - - F. 3 - - - - - - - - 1 - - - - - 1 - - - 1 - - - - - Children 4 - - - 4 - - - - - - - - - - - - - - - - - - 1 1 Total written off Dispensary Register 84 13 25 110 232 13 3 6 18 40 6 3 2 12 23 2 2 5 14 23 7 - 4 21 32 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 102 15 31 139 287 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 Dispensary | Register on 31st December. Disease Arrested Adults M. - 1 — 1 2 — - - 1 1 - - — — - — - - - — 1 - - - 1 F. - - - - - - - 1 1 2 1 - - - 1 - - - - - - - - - - Children 1 - 1 6 8 2 - - - 2 - - - - - - - - - - - - - - - Disease not Arrested Adults M - - - - - - - - - - 1 - 1 1 3 1 1 2 1 5 2 1 - - 3 F. 1 1 2 1 5 - 3 1 - 4 3 — 1 1 5 2 — 1 1 4 4 - — 2 6 Children 1 - - 3 4 1 - - - 1 6 4 — 5 15 5 1 - 9 15 2 - 2 11 15 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st Dec. 3 2 3 11 19 3 3 2 2 10 11 4 2 7 24 8 2 3 11 24 9 1 2 13 25 Transferred to Pulmonary - - - - - - - - - - - - - - - - - - - - - - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from the Dispensary Register — 3 3 13 19 5 — 3 11 19 4 2 1 3 10 4 5 1 2 12 1 — 1 2 4 Dead Adults M. 1 - 2 - 3 - - - - - 2 - - - - - - - - - 1 - - - 1 F. - - - - - - - - - - - - - - - - - 1 1 2 - - - - - Children - - - 1 1 - - - - - - - - - - - - - - - - - - - - Total written off Dispensary Register 1 3 5 14 23 5 - 3 11 19 6 2 2 3 13 4 5 2 3 14 2 — 1 2 5 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 1935 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. - - - - — F. - - - - - Children - - - - - Disease not Arrested Adults M. 2 - 2 2 6 F. 2 1 2 1 6 Children 2 2 - 12 16 Condition not ascertained during the year - - - - - Total on Dispensary Register at 31st Dec. 6 3 4 15 28 Transferred to Pulmonary - - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - F. - - - - - Children - - — - - Lost sight of, or otherwise removed from Dispensary Register — — 1 1 2 Dead 1 Adults M. - - - - - F. - - - - - Children - - — - - Total written off Dispensary Register - - 1 1 2 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 6 3 5 16 30 69 Dental Treatment of Uninsured Tuberculous Patients. Case No. Date. Treatment. Cost. £ s. d. 1 3.1.35 Eight extractions, complete upper and lower dentures 5 5 0 2 21.5.35 Complete upper and lower dentures 4 10 0 3 30.7.35 Complete upper and lower dentures 4 10 0 4 11.9.35 Twenty extractions, complete upper and lower dentures 6 0 0 5 7.11.35 Twelve extractions, complete upper and lower dentures 5 10 0 6 5.12.35 Three extractions, complete upper and lower dentures 4 15 0 7 10.12.35 Complete upper and lower dentures 4 15 0 Total £35 5 0 Harts Sanatorium. Dr. J. Crawford reports as follows:— In 1935 the number of patients discharged (deaths included) was 150 (87 males, 57 females, 6 children). Of these, 107 were insured (78 M., 29 F.) and 43 non-insured, (9 M. 28 F. 6 Ch.). Deaths: 27 (18 M. 8 F. 1 Ch.). Average duration of treatment: 29.725 weeks. No. of patient days: 27,932. No. of beds available at end of year: 80. Average No. of beds occupied: 76.5 (95.62%). Of the ,150 cases discharged, 2 were admitted for observation (1 M. 1 Ch.), one male was discharged non-tuberculous, and the child tuberculous. Immediate Results of Treatment. Discharged "Quiescent": 51 (33 M. 17 F. 1 Ch.). Discharged "Non-quiescent": 70 (35 M. 32 F. 3 Ch.). Of the latter cases there were: "Improved" 57 (28 M. 27 F. 2 Ch.); "Not improved" 13 (7 M. 5 F. 1 Ch.). One non-pulmonary female is included in the "Improved" number. 70 Of the 150 cases discharged or deceased, 24 had already had one course of treatment at the Sanatorium; three had had two courses, and one patient four courses. Thirty-five patients were admitted by ambulance (20 males, 15 females). Of these 15 (8 M. 7 F) were admitted from general hospitals, and 20 (12 M. 8 F.) from their homes. Complications. (a) Tuberculous. Bone, sternum, 2; spine, 1; Larynx, 9; Bowel and peritoneum, 3; Kidney, 1; Epididymo-orchitis, 2; Ischio-rectal abscess with cellulitis of thigh, 1; Fistulain-ano, 1; Eye, retino-choroiditis, 1. (b) Non-tuberculous. Bronchitis and Emphysema, 4; Diabetes mellitus, 3; Asbestosis, 2; Mastoid abscess, 1; Arthritis, knee-joint, 1. Artificial Pneumothorax. The majority of cases admitted have bilateral disease, and are unsuitable for this form of treatment. A few cases may have a gross lesion in one lung and the other lung only slightly involved; in this type a pneumothorax is often helpful. The number of unilateral cases, in which this treatment is most useful, has been small. During the year 24,1 refills were given to 17 patients, some of whom had their treatment commenced elsewhere. Gold Salts. The course of treatment extends over 15 to 20 weeks, weekly injections being given. Twenty-nine patients had courses of treatment, 10 of which were current at the end of the year. Five courses were discontinued owing to complications, which cleared up with treatment. 71 Bacteriology. The course of sanatorium treatment is controlled to some extent by the examination of sputa, which is done at least monthly; in 1935, 808 specimens were examined. (1934, 31,5.) The fortnightly visits of the Consultant during the latter part of the year have been much appreciated. The provision by the Tuberculosis After-care Committee of garments and shoes to necessitous cases has been of material benefit to several patients. Entertainments provided by amateur dramatic societies during the Winter months have been much enjoyed by patients and staff, who have expressed their appreciation of these visits. During the year, visitors have contributed, through the Sanatorium collecting boxes, the sum of £7 8s. 11d. to the funds of the Tuberculosis After-care Committee. TABLE 23. HARTS SANATORIUM.—Year ended 31st March, 1936. Expenditure Cost per Patient per week Salaries and Wages 3774 19 1 Superannuation 122 0 7 Provisions 2674 13 6 Disinfectants, Drugs and Appliances 223 1 2 Coal, Coke and Firewood 372 1 11 Electricity, Gas and Water 725 3 8 Furniture, Bedding and Linen 190 1 0 Uniforms and Dresses 60 0 3 Chandlery and Sundries 373 1 11 Crockery and Hardware 42 0 3 General Repairs 679 3 5 Garden Implements, Seeds, etc. 108 0 7 Printing, Stationery and Advertisements 30 0 2 Rent of Telephones 35 0 2 Rates, Taxes and Insurance 248 1 3 X-Ray Examinations 42 0 3 Motor Car Allowance—Resident M.O. 74 0 4 £9771 49 6 72 TABLE 24. 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 25. Return showing the extent of Residential Treatment and Observation during the Year in Harts Sanatorium. In Institution on Jan. 1 Admitted during the year. Discharged during the year Died in the Institution. In Institution on Dec. 31. (1) (2) (3) (4) (5) Number of doubtfully tuberculous' casus admitted for observation Adults Children M. - 1 1 - - F. - — — — — 1 — 1 — - Total 1 1 2 — - Number of patients suffering from pulmonary tuberculosis Adults Children M. 46 87 68 18 47 F. 28 58 48 8 30 2 3 4 1 — Total 76 148 120 27 77 Number of patients suffering from nonpulmonary tuberculosis Adults Children M. — — — - F. — 2 1 — 1 — - — — — Total — 2 1 — 1 Grand Total 77 151 123 27 78 TABLE 26. Return showing the immediate Results of Treatment of definitely Tuberculous patients discharged during the year from harts sanatorium. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months, but exceeding 28 days. 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 Quiescent 10 7 - 8 4 - 3 - - 1 - - 22 11 - 33 T.B. Not quiescent — 1 — 2 — 1 1 1 1 — 1 1 3 3 3 9 minus. Died in Institution - - - - - - - - - - - - - - - - Class T.B. Quiescent 2 1 - - - - - 1 - - - - 2 2 - 4 plus Not quiescent — — — — 2 — — — — — — — — 2 - 2 Group 1. Died in Institution - - - - - - - - - - - - - - - — Class T.B. Quiescent 1 2 — 4 2 — 3 1 — — — — 8 5 - 13 plus Not quiescent — 6 — 11 7 — 5 4 — 4 2 — 20 19 — 39 Group 2. Died in Institution 2 — — 1 — 1 1 — — 2 — — 6 — 1 7 Class T.B. Quiescent - - - - - - - - - - 1 1 - 1 1 2 plus Not quiescent — 1 — 5 2 — 1 1 — 4 — — 10 4 — 14 Group 3. Died in Institution 5 2 — 3 2 — 2 1 — — 1 — 10 6 — 18 Totals (pulmonary) 20 20 — 34 19 2 16 9 1 11 5 2 81 53 5 139 73 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, but exceeding 28 days. 3-6 months. 6-12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Non-Pulmonary Tuberculosis. Bones and Joints. Quiescent - - - - - - - - - - - - - - - - Not quiescent — - — - - - - - - - - - - - - - Died in Institution — — — — — — — — — — — — — — — — Abdominal. Quiescent Not quiescent — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — — — — Other Organs. Quiescent - - - - - - - - - - - - - - - - Not quiescent — — — — 1 - - - - - - — - 1 - 1 Died in Institution — — — — — — — — — — — — — — — — Peripheral glands. Quiescent - - - - - - - - - - - - - - - - Not quiescent - - - - - - - - - - - - - - - - Died in Institution — — — — - — — — — — — — — — — — Totals (non-pulmonary) - - - - 1 - - - - - - - - 1 — 1 74 75 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 Admitted during the year. Discharged during the year. Died in the Institutions. In Institutions on Dec. 31. (1) (2) (3) (4) (5) Number of doubtfully tuberculous cases admitted for observation Adults Children M - 1 1 - -_ F. — — — — — 1 — 1 — — Total 1 1 2 — — Number of patients suffering from pulmonary tuberculosis Adults Children M. 48 90 69 19 50 F. 34 62 53 8 35 13 14 14 1 12 Total 95 166 136 28 97 Number of patients suffering from nonpulmonary tuberculosis Adults Children M. 3 5 4 2 2 F. 8 9 8 — 9 19 20 22 — 17 Total 30 34 34 2 28 Grand Total 126 201 172 30 125 76 TABLE 28. Return showing the Results of Observation of Doubtfully Tuberculous Cases Discharged during the Year from Institutions approved for the Treatment of Tuberculosis. Diagnosis 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 - - - - - 1 - - - - - - - - 1 Non-tuberculous - - - 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 pulmonary tuberculosis Adults Children M. - 16 5 7 4 F 3 12 9 4 2 ... — — — — — Total ... ... 3 28 14 11 6 Number of patients suffering from nonpulmonary tuberculosis Adults Children M - - - - - F. — 1 1 — — ... 1 — 1 — — Total 1 1 2 — — Grand Total 4 29 16 11 6 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, but exceeding 28 days. 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 10 7 - 8 4 1 3 1 2 1 7 22 12 10 44 Not quiescent — 1 — 2 — 1 1 1 1 — 1 1 3 3 3 9 Died in Institution - - - - - - - - - - - - - - - - Class T.B. plus Group 1. Quiescent 2 1 - - - - - 1 - - - - 2 2 — 4 Not quiescent - - - - 2 - - - - - - - - 2 — 2 Died in Institution - - - - - - - - - - - - - - - - Class T.B. plus Group 2. Quiescent 1 2 - 4 2 - 4 1 - - - - 9 5 - 14 Not quiescent — 6 — 11 10 - 5 4 — 4 2 — 20 22 — 42 Died in Institution 2 - — 1 — 1 1 — — 3 - - 7 — 1 8 Class T.B. plus Group 3. Quiescent - - - - - - - - - - 1 1 - 1 1 2 Not quiescent - 1 - 5 2 - 1 1 - 4 1 - 10 5 — 15 Died in Institution 5 2 — 3 2 - 2 1 — — 1 — 10 6 — 16 Totals (pulmonary) 20 20 — 34 22 3 17 10 3 12 6 9 83 58 15 156 77 TABLE 30—continued. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Under 3 months, but exceeding 28 days. 3-6 months. 6-12 months. More than 12 months. Totals. Grand Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Non-Pulmonary Tuberculosis. | Bones and Joints. Quiescent - - 2 - - - - 1 1 1 3 6 1 4 9 14 Not quiescent - - - - - - - - - - 1 - - 1 — 1 Died in Institution - - - - - - 1 - - 1 - - 2 - - 2 Abdominal. Quiescent - - - - - - - - - - - 1 - - 1 1 Not quiescent - - - - 1 - - - - - - - - 1 — 1 Died in Institution - - - - - - - - - - - - - - - - Other Organs. Quiescent - - - 1 - - 1 - - - - - 2 - - 2 Not quiescent — — — - 1 — 1 — — — — — 1 1 — 2 Died in Institution - - - - - - - - - - - - - - - - Peripheral Glands. Quiescent - - - - - 2 - 1 7 - - 3 - 1 12 13 Not quiescent - - - - - - - - - - - - - - - - Died in Institution - - - - - - - - - - - - - - - - Totals (non-pulmonary) - - 2 1 2 2 3 2 8 2 4 10 6 8 22 36 78 TABLE 31. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications During the period 1.1.35 to 31.12.35. Formal Notifications. Number of Primary Notifications of new cases of tuberculosis. Age periods. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 & over Total (all ages) Total notifications. Pulmonary Males 1 1 3 3 5 21 29 9 13 12 1 98 106 „ Females 1 1 1 2 13 13 24 5 4 5 2 71 78 Non-pulm. Males — 6 1 4 3 1 1 3 1 - - 20 20 „ Females - 4 4 3 - - 3 1 1 1 — 17 17 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 — — — 2 — 5 6 5 1 — — 19 „ Females - 1 1 1 1 2 4 4 1 — — 15 Non-pulmonary Males - 2 2 — — — 1 1 2 — — 8 „ Females 1 1 1 1 — — 1 1 — — 1 7 79 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 transferable deaths from Registrar General 2 2 Posthumous notifications 2 5 "Transfers" from other areas (other than transferable deaths) 27 6 Other sources if any (specify) (Merchant Seamen) 3 — Notification Register. Number of cases of Tuberculosis remaining at the 31st December 1935, 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 493 396 889 154 131 285 1,174 Number of cases removed from Registers during the year by reason inter alia of:— 1. Withdrawal of notification — - — — — — — 2. Recovery from the disease 15 1 16 2 2 4 20 3. Death 51 33 84 9 9 18 102 80 TABLE 32. Notified Cases of Tuberculosis, 1935. 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 2 - - - - - - - - - - - - - 1 1 - - - 1 2 3 1 and under 2 — 1 1 — 1 1 1 - 1 - - - - - - 1 1 2 - - - 2 3 5 2-3 - - - - - - - - - - 1 1 1 - 1 - 1 1 - - - 1 2 3 3-4 1 - 1 - - - - 1 1 1 - 1 2 - 2 - - - - — — 4 1 5 4-5 - 1 1 1 - 1 - - - - - - 1 - - - - - - - - 2 1 3 5-10 3 2 5 - 1 1 1 - 1 - 2 2 2 1 3 - 1 1 - - — 6 7 13 10-15 5 3 8 1 1 2 - - - 1 1 2 2 2 4 - - - - - - 9 7 16 15-20 5 14 19 1 - 1 - - - - - - 1 - 1 1 - 1 - - - 8 14 22 20-25 26 15 41 - - - - - - - - - 1 - 1 - - - - — — 27 15 42 25-35 35 28 63 1 - 1 1 - 1 - - - - - 1 - - - - - - 37 32 69 35-45 14 9 23 - - - 2 1 3 1 1 2 - 2 2 - 2 2 - — — 18 11 29 45-55 14 5 19 1 - 1 - - - 1 1 2 - - - 1 - 1 - — — 17 6 23 55-65 12 5 17 - - - - - - - 1 1 - - - 1 - 1 - — — 12 6 18 Over 65 1 2 3 — 1 1 — — — — - - - - - - - - - - - 1 3 4 Totals 117 86 203 5 4 9 5 2 7 4 7 11 10 5 15 4 6 10 — — 145 110 255 81 82 Table 33. Tuberculosis. New Cases and Mortality, 1935. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. M. F. M. F. M. F. M. F. Under 1 year 1 1 - 1 1 - - 1 1 — 5 yrs 1 2 8 5 — 2 1 3 5 — 15 „ 8 5 7 9 1 2 1 — 15 — 25 „ 31 29 4 — 12 7 1 — 25 — 45 „ 49 37 6 6 17 17 4 1 45 — 65 „ 26 10 3 2 12 5 2 1 65 and upward „ 1 2 - 1 3 1 - 1 Totals 117 86 28 24 46 34 9 7 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths for the year was 1—13. No action has been taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 62, Public Health Act 1925. Maternity and Child Welfare. Dr. J. MacLaren reports as follows on the work of the Maternity and Child Welfare Section, for 1935. 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 395 Number of individual children who attended the Clinics 3542 Total number of attendances 30163 83 Total number of children who attended the Clinic for the first time during the year (a) Children under 1 year 1330 (b) Children between the ages of 1—5 years 369 Number of medical consultations at general Clinics 10777 Number of Medical consultations at special Clinics 1567 Total number of visits to all Infant Welfare Clinics 31730 The daily average attendances at the Clinics were as follows: Central Clinic, Monday afternoon 77 Church Road, Monday afternoon 91 Plashet Grove, Tuesday morning 54 North Woolwich, Tuesday afternoon 21 Masterman Road, Wednesday afternoon 93 Central Clinic, Thursday morning 79 Church Road, Thursday afternoon 91 Plashet Grove, Friday afternoon 103 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 84.0. During 1935, 3,582 children attended the centres. The total attendance of infants from 0—5 was 30,163. 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' Clinics Clinics for the examination of "Toddlers"—children between the ages of two and five years—are held on Monday and Friday mornings, at Church Road Clinic, and on Thursday afternoon at the Central Clinic. During 1935, 1,072 examinations were made. In cases where defects were found, the patients were transferred to the appropriate Specialist Service, or hospital. 84 A record of cases examined is transferred to the School Medical Service when the children enter school. Immunisation Clinic See Report, page 54. Tonsils and Adenoids During 1935, 109 children received operative treatment. 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. Ninety-two mothers and 311 infants were referred to the dental department during 1935. Ophthalmic Treatment Ophthalmic defects requiring special treatment are seen at the special clinic each week by the School Ophthalmic Surgeon. During 1935, 33 cases were referred to the School Ophthalmic Clinic. Aural Treatment Aural cases requiring special treatment are referred to the School Aural Surgeon. During 1935, 21 patients received treatment at the School Aural Clinic. 85 Morning Clinics Special clinics arc 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 1935 are as follows:— Number of medical consultations 1567 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 1935 were 20,298. Visits to infants under one year of age 9149 Visits to children over one year of age 9709 Visits to tonsils and adenoid cases 79 Visits to ante-natal cases, first visits 511 Visits to ante-natal cases, revisits 200 Visits to foster mothers 207 Special visits not included in the above group 443 86 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 five years of age. 3. Home visiting of pre-school children in regard to defect. 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 five 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. The number of still births registered during the year was 74. The proportion of still births to live births was as 1 to 26. The still birth rate was 3.7 per cent. of the registered live births. An analysis of the causes to which the still births were attributable will be found on page 11. An Ante-Natal Clinic is held at:— The Central Clinic, High Street School, on Friday at 10 a.m. Church Road Clinic, Manor Park, on Wednesday at 10 a.m. During the year the following attendances were recorded:— Number of new cases 397 Total number of cases attended 448 Subsequent attendances 1145 Total number of attendances 1542 Still Births Ante-Natal Work 87 Average attendance of expectant mothers per session 15.47 Number of patients referred to Dental Clinic 51 The following table gives an analysis of the pre-maternal cases found to be slightly or seriously abnormal:— Contracted pelvis 5 Albuminuria 14 Hyperemesis gravidarum 4 Ante-partum haemorrhage 3 Malpresentation 8 Cervicitis 3 Valvular disease of heart 3 Varicose veins 13 Phlebitis 1 Anaemia 6 Bronchitis 4 Pulmonary tuberculosis 2 Dyspepsia 11 It is satisfactory to note that during this year a larger number of cases attending the Ante-natal Clinic were sent by midwives, but I would again urge the necessity of midwives taking more advantage of the Clinic, and bringing their cases for medical examination and advice, for though many midwives carry out ante-natal supervision with care and accuracy, conditions may be present or develop which can only be discovered by medical examination. The detection and treatment of these conditions would minimise many dangers and prevent unavoidable difficulties at the confinement, thus safeguarding both mother and child. Expectant mothers are visited by the Health Visitors in their homes and given advice regarding arrangements for confinement and general hygiene of the mother. The following-up of cases also ensures regular attendance at the Clinic. During 1935, 711 visits were paid to expectant mothers. Maternity Accommodation Under the provision of the Maternity and Child Welfare Act 1918, empowering Local Authorities to make arrangements for 88 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 1935, 15,1 cases were admitted to Forest Gate Hospital. Inspection of Midwives Fifty-five midwives notified the Local Supervising Authority of their intention to practise within the Borough during 1935—49 were on the register on 31-12-35, including staff at Burges Road. Forty-two visits of inspection were made by the inspecting Medical Officer during the year. Their work including records was satisfactory. Visits have been paid as required to one registered Nursing Home in the district. Under the rules issued by the Central Midwives' Board, a midwife must notify the Local Supervising Authority within 36 hours if she has summoned medical aid during pregnancy, in a confinement, or within 10 days afterwards. During the year help was obtained in 284 cases as follows:— Mother. Ruptured perineum 91 Prolonged labour 42 Ante-partum haemorrhage 10 Retained placenta 25 Rise of temperature 28 Malpresentations 4 Extended breech 5 Other causes 41 246 89 Child. Prematurity and dangerous feebleness 11 Unsatisfactory condition of infant 9 Discharging eyes 8 Other causes 10 38 Puerperal Fever and Puerperal Pyrexia. Twelve cases of Puerperal Fever and 14 cases of Puerperal Pyrexia were notified during the year under the Regulations of 1926 and 1928. Maternal Mortality There were ten deaths associated directly with pregnancy. The maternal mortality rate was, therefore, 4.9 per 1,000 live and still births compared with 1.50 in 1934. Ophthalmia Neonatorum During, 1935, five cases of Ophthalmia Neonatorum were notified. For results 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 1935 was £2,011. In every case careful investigation of the family circumstances is made to ensure that only necessitous cases shall receive this benefit. 90 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. Thirty-five cases were referred to the I.C.A.A. and received treatment. Children Acts, 1908-1932. 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, 38. (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) under (b) of Section 3 of the Act of 1908 Nil. (iii) under (c) of Section 3 of the Act of 1908 (g) Number of orders obtained during the year under Section 67 of the Act of 1932: (i) from a court of summary jurisdiction (ii) from a single justice Nil 91a 91a TABLE 34—Number of Persons Registered as Unemployed during 1935 at East Ham Employment Exchange. (1) Live Register. January. February. March. April. May. June. Men Boys Wmn. Girls Men Boys Wmn. Girls Men Boys Wmn. Girls Men Boys Wmn. Girls Men Boys Wmn. Girls Men Boys Wmn. Girls (2) Persons normally in Full Time Employment 2,619 40 474 26 2,538 40 492 23 2,258 25 512 21 2,197 18 498 14 2,127 26 453 6 2,126 22 395 11 (3) Non-Claimants to Benefit (i.e. persons registered for work only) 491 148 73 136 530 110 91 94 526 65 58 56 477 165 98 93 465 125 93 28 443 49 95 32 4) Persons normally in Casual Employment 855 - 13 — 829 — 4 — 900 — 4 — 896 — 4 — 570 — 3 — 876 - 3 — (5) Temporarily stopped 47 — 132 3 43 1 91 3 34 - 83 2 19 — 77 3 26 — 56 — 31 — 82 1 Total—1935 4,012 188 692 165 3,940 151 678 120 3,718 90 657 79 3,589 183 677 110 3,188 151 605 34 3,476 71 575 44 Total—1934 4,553 237 704 185 4,370 193 680 147 4,071 111 592 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 Wmn. Girls Men Boys Wmn. Girls Men Boys Wmn. Girls Men Boys Wmn. Girls Men Boys Wmn. Girls Men Boys Wmn. Girls (2) Persons normally in Full Time Employment 2,095 26 325 14 2,036 20 316 17 2,074 33 330 17 2,134 27 298 9 2,113 35 355 20 1,997 32 336 9 (3) Non-Claimants to Benefit (i.e., persons registered for work only) 380 42 79 53 413 101 95 41 412 80 76 68 430 56 99 26 445 19 100 44 430 23 91 33 (4) Persons normally in Casual Employment 744 — 2 — 819 1 23 — 806 2 15 — 719 2 32 — 698 2 43 — 731 1 28 — (5) Temporarily stopped 34 — 76 3 29 2 88 5 85 2 68 — 51 — 58 2 35 1 131 9 41 1 109 8 Total—1935 3,253 68 482 70 3,297 124 522 63 3,377 117 489 85 3,334 85 487 37 3,291 57 629 73 3,199 57 564 50 Total—1934 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 91 Home Helps. During 1935, 11 suitable applicants were registered as Home Helps and 18 applications were received for the services of Home Helps. Maternity Boxes. Maternity Boxes containing clothing and necessities for newborn babies arc available upon application to the Senior Health Visitor. Unemployment and Outdoor Assistance. Extent of Unemployment during 1935. Mr. D. G. Bolton, Manager, East Ham Employment Exchange, has kindly supplied the following statistics:— 92 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 31-12-35:— 1935 Men Women Children Total 1935 Total 1934 January 1,222 1,702 1,673 4,597 4,366 February 1,259 1,717 1,719 4,695 4,427 March 1,231 1,689 1,680 4,600 4,323 April 1,189 1,687 1,563 4,439 4,244 May 1,179 1,685 1,538 4,402 4,081 June 1,151 1,656 1,493 4,300 4,185 July 1,122 1,635 1,475 4,232 4,226 August 1,136 1,639 1,488 4,263 4,161 September 1,132 1,621 1,430 4,183 4,166 October 1,164 1,641 1,452 4,257 4,294 November 1,177 1,665 1,465 4,307 4,380 December 1,151 1,643 1,427 4,221 4,597 Swimming Baths and Pools. Samples of water taken from the Swimming Baths have been analysed for purity and chlorine content. The results of these examinations have shewn the condition of the water to be highly satisfactory for such purposes. TABLE 35. METEOROLOGICAL RECORD—YEAR 1935. Rain Gauge 5-in. in diameter, placed 1 foot above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Mean Temperature of Air. Rainfall. Highest Maximum. Lowest Minimum. Mean of No of Days on which Rain fell, 0.01 and over Amount collected in inches. Mean rate of for Rainy Days. Greatest fall in 24 hours. Date of greatest fall. All Highest. All Lowest. January 54° 26° 45°.1 37°.3 41°.2 13 1.14 0.09 0.28 11th February 58° 28° 48°.7 38°.7 43°.7 15 1.78 0.12 0.32 24th March 66° 35° 51°.7 38°.4 45°.0 4 0.36 0.09 0.11 3rd April 64° 33° 54°.7 42°.0 48°.4 21 2.66 0.13 0.35 7th May 76° 33° 61°.1 43°.9 52°.5 10 1.50 0.15 0.39 20th June 84° 44° 69°.5 53°.9 61°.7 19 2.71 0.14 0.71 9th July 86° 47° 76°.4 57°.2 66°.8 4 0.48 0.12 0.28 1st August 88° 45° 74°.9 55°.8 65°.4 8 1.91 0.24 0.74 20th September 74° 42° 67°.1 52°.5 59°.8 20 2.52 0.13 0.47 29th October 62° 31° 58°.1 45°.7 51°.9 11 2.48 0.23 0.98 3rd November 64° 26° 51°.5 41°.1 46°.3 19 3.43 0.18 0.50 16th December 53° 23° 43°.6 35°.4 39°.5 19 2.19 0.12 0.39 30th Means and Totals for the Year 88° 23° 58°.5 44°.3 51°.9 163 23.16 0.15 0.98 3rd Oct. The Rainfall for the Year was 4.72 ins. above, and the number of days on which rain fell 25 above the year 1934, at East Ham. 93 94 TABLE 36. Inspection of Factories, Workshops and Workplaces, 1935. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written notices. Occupiers prosecuted. (1) (2) (3) (4) Factories (including Factory Laundries) 21 1 - Workshops (including Workshop Laundries) 120 4 - Workplaces (other than Outworkers' premises) 15 — - Total 156 5 — Defects Found in Factories, Workshops and Workplaces. Particulars. Number of defects. Number of offences in respect to which prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 7 5 - - Want of ventilation 4 4 - - Overcrowding — — - - Want of drainage of floors 3 2 - - Other nuisances 14 12 - - Sanitary accommodation— Insufficient 5 4 _ Unsuitable or defective 6 3 - - 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 39 30 - - Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Outwork in Unwholesome Premises, Section 108 Nil. 95 Sanitary Section and Housing. Mr. J. E. Austin, Chief Sanitary Inspector, has compiled the section of the report relating to sanitary circumstances, housing and food inspection. Sanitary Circumstances. Water Supply. During the course of housing inspections 185 instances of improper storage of water were observed and in all cases owners were requested to provide a supply tap to the rising main to the storage cistern. Two houses having an external water supply were provided with an internal supply. There still remains a few houses unprovided with an internal supply. Three prosecutions were instituted during the year for absence of sufficient water supply. Drainage and Sewerage. Instances of flooding from sewers in the Little Ilford Ward occurred during the year. An increasing number of defects in drainage were found during the examination of premises for rats. On investigation it was frequently found necessary to require complete reconstruction of the drainage. In one case the drainage of certain premises, found to be discharging into a surface water sewer, was disconnected and reconnected to the "foul" sewer. Rivers and Streams. Complaints were investigated regarding the state of certain watercourses in the Borough. The watercourses were found in an exceedingly foul state and appropriate action was taken resulting in an improvement. An apparent difficulty of emptying and refilling certain watercourses arises from the fact that the process would entail refilling with a mild sewage, not from East Ham Works. The watercourses which are so numerous in the Borough continued to be a breeding place for mosquitoes and throughout the summer were subject to spraying with larvicide. A complaint 96 regarding badly infested watercourses was transferred to a neighbouring authority. Apparently the measures for mosquito control must continue until some scheme of land drainage in the south of the Borough materialises and results in a reduction of so many open ditches and watercourses. Closet Accommodation. A privy closet was abolished during the year and a water closet substituted therefor at a slaughter house. Public Cleansing. There was no outstanding matter to report on this service, which is carried out under the supervision of the Borough Engineer. House refuse collected weekly and the method of disposal is by controlled tipping and incineration. Salvage of saleable material is ?tised. Modern vehicles are used in the collection of refuse and a dustbin hire service exists. Sanitary Inspection. Details of which are given below, numbered 12,625 during the year 1935, as compared with 12,503 in ,1934. I he system of sanitary inspection was reorganised during the year, inspections of special premises being systematised, and house-to-house inspections "planned." Inspections. House-to-house under Housing Act 4399 Premises under P.H. Act 4436 Slaughter-houses 1234 Dairies 308 Factories, Workshops and Outworkers' Premises 267 Bakehouses 136 Miscellaneous 1845 Reinspections 21595 Total inspections and reinspections 34220 97 Notices. Notices served during the year 1935 numbered 5,366, compared with 5,645 in 1934. Of this number 4,705 were preliminary intimation notices and 661 statutory notices. The number of notices complied with was 5,326. Improvements Improvements effected consequent upon the serving of notices included the following matters:— Cleansing and redecoration of houses 2893 Dampness remedied at houses by repointing 1153 Leaking roofs repaired 1383 Rain water gutters and pipes renewed or repaired 1421 Windows (including sashcords) repaired or renewed 1446 Floors repaired or renewed 437 Stoves and firegrates repaired or renewed 743 Washing coppers repaired or received 295 Defective drainage reconstructed or repaired 570 Defective w.c. pans and traps renewed 818 Defective w.c. flushing apparatus renewed or repaired 431 Defective yard and forecourt paving repaired 968 Other nuisances abated 7907 Complaints Complaints during the year 1935 numbered 2,276, including those relating to choked drainage and rat infestation. In both these latter matters the Corporation maintains a free service of drain clearing and rat repression. Factories and Workshops. One hundred and fifty-six inspections were made of Factories and Workshops and 39 defects were found. Five notices were served and resulted in 30 defects being remedied. In one factory 10 additional water closets were provided to comply with the notice served. The restricted application of the law relating to food premises where such premises are a factory or workshop is a serious impediment to improving conditions in certain cases. Details of the work done in this connection are set forth in table 36. 68 Cinemas, etc. The cinemas and theatres were periodically inspected as to their sanitary condition, and a number of minor defects remedied Rat Extermination. The official rat catcher made 2,089 visits to premises, and was responsible for the extermination of 4,467 rats. During the year rat extermination on certain Corporation lands was carried out by hydrogen cyanide. Defective drainage at a number of houses was revealed and remedied consequent upon investigation of rat infestations. Disinfection and Disinfestation. The disinfector carried out terminal disinfection at 1,003 premises. Steam disinfection of bedding, post infection diseases (except smallpox) is not generally carried out, but in connection with cases of scabies steam disinfection is carried out. Numerous applications for advice on vermin destruction were made during the year, and in 16 cases disinfestation measures were carried out at the cost of the owners of the property. The method comprised fumigation with sulphur dioxide (5—6 lbs. sulphur pur 1,000 c. ft.) and supplementary spraying with contact insecticides. In connection with the slum clearance displacements all household effects were disinfested by hydrogen cyanide, and all bedding steam disinfected. Atmospheric Pollution. Considerable attention was given to this subject during the year. Fifty-six observations of factory chimneys were made and* three notices of offence served. In two cases statutory notices followed but no subsequent offence was committed. Complaints of effluvia from a Chemical manufactory resulted in a comprehensive investigation of the atmospheric condition in the vicinity of the factory concerned. Intensive observations were made over a period of three months, when it was revealed that the nuisance arose primarily from the emission of chlorine from a chloral hydrate plant. At the close of the year legal proceedings were pending in this connection. Complaints of alleged damage to crops on allotments and alleged injury to persons by atmospheric pollution caused by a 99 sulphuric acid plant were investigated and were the subject of a report to the Committee. The matter was referred to the Inspector under the Alkali, etc. Works Act. Mosquito Nuisance. In the early summer complaints were received relative to this nuisance, which had assumed considerable proportions during the previous summer. An examination of the many breeding places was made and revealed serious infestation. Spraying with a suitable larvicide was immediately carried out and systematically repeated throughout the summer with good results. The sealing of certain surface ventilators on the Northern outfall sewer was completed in the early summer. Special Classes of Premises and Occupations subject to Control of the Local Authority. During the year the Authority had under consideration the adoption of Bylaws relating to Nuisances and Offensive Trades. The number of trades existent in the Borough are as follows:— Gut Scraper 1 Bone Boiler and Fat Extractor 1 Rag and/or Bone Dealer 13 The conditions of certain of these premises and of certain of the 49 fried fish shops in the Borough were found appallingly bad, and improvements are being required. Registration of 65 Houses-let-in-lodgings was effected during the year. The Caravan encampment at Wall End was the subject of a number of special reports to the Council, and a policy of treatment has been formulated. A survey in August, 1935, indicated that there were 122 vans and 21 sheds occupied in 32 enclosures. There were 29 unoccupied vans on the site. Of the total 172 vans and sheds, 106 had been on the site for two years or more. The population of the encampment was 492. In consequence of service of notices, 10 caravans removed from land on which they were situate in contravention of the Byelaws. Three occupiers were each fined £2 for contravening the Byelaws. 100 Rag Flock Acts. Seven samples of Rag Flock were submitted for analysis, and in two instances the samples were unsatisfactory, inasmuch as they were found to contain 80 and 215 parts respectively of Chlorine per 100,000 parts of flock. Proceedings were instituted and in one case the two defendants were each fined 10/- and ordered to pay £2 2s. Od. costs. The remaining case was adjourned until 1936, when the vendor was fined £3 and £2 2s. Od. costs. Rent Restrictions. Ten applications were received for certificates as to sanitary conditions of houses under the Rents Restrictions Act. Prosecutions. The following statement gives a summary of the prosecutions instituted during the year 1935: Public Health Act—Abatement of Nuisance. Summonses withdrawn on completion of works and payment of costs:— Cases adjourned from 1934 9 Cases, 1935 16 Order made and Penalty inflicted 7 East Ham Improvement Act—Absence of Water Supply. Summons withdrawn on reinstatement of water and payment of costs 1 Penalty inflicted 1 Defendant remanded for medical examination 1 Bye-laws respecting Tents, Vans and Sheds—Absence of water and refuse receptacle. Penalty inflicted 6 Rag Flock Acts—Unclean flock. Penalty inflicted 1 Adjourned to 1936 1 Food and Drugs Acts. Penalty inflicted 4 The total penalties inflicted and costs ordered amounted to £47 13s. 6d. Shops Act, 1934. The following is an extract from the Annual Report of the Chief Shops Inspector for 1935. 101 Shops Act, 1934. (ii) Arrangements for health and comfort of workers. The sanitary conveniences and facilities for taking meals were examined during the resurvey at 1,387 shops. In 207 cases either sanitary accommodation or meal facilities or both were unsatisfactory, 84 (written preliminary intimation) notices were served under the Act, and in 123 instances a verbal notice was given and the work promised. In 189 out of the 203 cases the requisite work had been carried out. Three hundred and twenty-seven inspections of work in progress have been made. The following improvements have been made as a result of the notices:— (1) Ventilation and Temperature of Shops (Shop reconstructed on account of ill ventilation) 1 (2) Sanitary conveniences:— Provided 10 Reconstructed 9 Repaired, etc. 174 (3) Lighting Nil (4) Washing Facilities:— Provided 5 Reconstructed 4 Repaired 18 (5) Facilities for meals:— Provided 2 Repaired or cleansed 28 Cooking facilities provided or repaired 8 Seventy-three miscellaneous defects or nuisances were remedied in consequence of the visits. It is hoped to devote more attention to the means of heating and ventilation of the shops in the future. Considerable good is arising from this part of the New Act, although the difficulties in its administration are numerous. Housing The main work of the department in the matter of housing in this Borough is the maintenance and repair of houses. The 102 sanitary improvements effected at houses as a result of inspections under the Housing Acts and Public Health Acts are set out in a previous paragraph. The number of dwelling houses inspected and recorded under the Housing Consolidated Regulations was 4,399. At long last the displacement of families from Clearance Areas commenced during the year, and at the close of the year three families out of sixty-five remained. The number of persons actually rehoused was 126. Dwelling houses demolished number 31, whilst 25 were made fit formally and 20 informally. There still remains a number of unfit houses despite the completion of the programme of clearance, and in the forthcoming year it is proposed to deal formally with these. The outstanding problem of housing in East Ham is the caravan cncampment at Wall End, and again during the forthcoming year it is proposed to deal with a number of the enclosures under the new powers contained in the Housing Act, 1935. It is contemplated that more than 100 additional new houses will be required to meet the further displacements. Early in November a report and estimate of cost of the proposed housing overcrowding survey was presented to the Public Health Committee. At the close of the year the report was still under consideration and the survey had not been commenced. Housing Statistics. Housing Statistics. I.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for defects (under Public Health or Housing Acts) 8,835 (6) Number of inspections made for the purpose 30,430 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 4,399 (b) Number of inspections made for the purpose 15151 (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 aqbitation 4,705 103 II —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 4,539 III.—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 — (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 25 (b) By Local Authority in default of owners — (b) Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 661 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 777 (b) By Local Authority in default of owners — (c) Proceedings under section 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which lition Orders were made — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders — (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 2 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined the tenement or room having been rendered fit — (e) Proceedings under section 3 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which notices became operative requiring repairs — (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners (b) By Local Authority in default of owners — (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (/) Proceedings under sections 11, 12 and 15 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which Closing Orders became operative (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit. - (3) Number of dwelling-houses in respect of which lition Orders became operative - (4) Number of dwelling-houses demolished in pursuance of Demolition Orders - Number of New Houses Erected During the Year 1935:— By Private Enterprise 109 By the Local Authority 39 104 Inspection and Supervision of Food. Milk Supply. A survey of the dairies was carried out during 1935, and in consequence several improvements were effected, including:— Suitable means for cleansing and scalding bottles and receptacles—(Sterilising outfits) provided 16 Suitable means of "bottling" milk (mechanical fillers) provided 3 Suitable means of closing milk bottles (mechanical capping machines) provided 5 Dairies reconstructed 9 Four dairymen having most unsatisfactory premises and little or no equipment, ceased business as dairymen but continued as purveyors of bottle milk only. One dairyman who was reinstated in the Spring of 1935 was finally removed from the register "absolutely." Milk (Special Designations) Order. The large pasteurising establishment in the Borough was kept under constant supervision and thermographic records scrutinised. "Check" thermometers have been installed upon request, and means of thermostatically controlling the process is under consideratioh. The licences in force on 31st December, 1935, were as follows:— Certified Milk— Dealers' Licences1 Supplementary Licences 1 Grade A (T.T.) — Bottling Establishment 1 Dealers' Licences 9 Supplementary Licences 2 Grade A— Dealers' Licences 3 Grade A Pasteurised— Dealers' Licences 1 Supplementary Licences 1 10 5 Pasteurised— Establishment Licences 1 Dealers' Licences 14 Supplementary Licences 3 Bacteriological Examination. Systematic sampling of all sources of milk was instituted during the year for the bacteriological and biological examination and proved of considerable value in the effort to improve methods and equipment in the dairies. The results of the samples taken are summarised in the following table :— Bacteriological Examination of Milk Samples. Total Ordinary Sterilised. Pasteurised. Grade "A" Grade "A.T.T." Samples — Satisfactory 48 22 2 17 6 1 Unsatisfactory 4 4 — — — — Biological Samples— Satisfactory 28 12 1 12 3 — Unsatisfactory Nil. — — — — — The bacteriological work is carried out by the' Counties Public Health Laboratories, E.C.4. It was gratifying to find that all milks submitted for biological examination, which is for the detection of tubercle bacilli, were satisfactory. Registration. Steps have been taken to effect the registration of all purveyors of bottled milk, and the registers at the close of the year were undergoing complete revision. Meat Inspection. The number of visits by the Sanitary Inspector to slaughterhouses for the purpose of carrying out post mortem examinations of animals was 1,234. Much of the inspection is carried on in the late evenings and Sundays. The animal carcases examined included 2,189 bovines, 22,483 pigs, 3,066 sheep, and 881 calves, a total of 28,6,19 as compared with 27,900 carcases in 1934. Meat destroyed in consequence of inspection included the carcases of 106 25 bovines, 40 porcines, 13 sheep and 2 calves, and 2,321 parts of carcases and animal organs. Food Premises. Bakehouses, fried fish shops, markets, butchers' shops, and ice-cream manufactories were visited during the year, and the method of inspection systematised. Food and Drugs Adulteration. Samples obtained by the Sanitary Inspectors for analysis numbered 504 or 3.7 samples per thousand of population. This is an increase of 76 samples over the previous year. One hundred and ten samples were taken formally and 394 informally. The number of samples found adulterated or not up to standard was 28 or 5.6 per cent. The following tabular statement gives details of the samples and results of analyses:— Number of Samples. Percentage samples adulterated. Examined. Found adulterated or below standard. Bread 3 — — Butter 30 — — Cheese 1 — — Cocoa 4 — — Coffee 4 — — Confectionery 12 1 7 Jam and Marmalade 15 3 20 Cream 16 — — Flour 3 — — „ Self-raising 2 — — Lard 8 2 25 Margarine 21 — — Milk 142 6 4 „ Condensed and Dried 3 — — Sausage 50 8 16 Sugar 4 2 50 Tea 8 — — Vinegar 7 — — Wines, Spirits 5 — — Drugs 26 — — Other Articles 139 6 4 504 28 5.6 Details of samples adulterated or below standard are described as follows, together with the resultant action :— 107 DETAILS OF ADULTERATION. No. I. or F. Article. Adulteration or Deficiency. Action Taken. 930 I. Milk 2°/o added wate Subsequent formal sample genuine. 541 I. ,, 3% „ ,, ,, ,, ,, 279 F. ,, 3% ,, ,, Vendor cautioned. 426 F. ,, 8% fat deficiency. ,, ,, 21 I. ,, 10% ,, ,, Sample from hospital. 165 F. ,, 2% added water Vendor cautioned. 303 I. Sausages Undeclared preservative. Sulphur dioxide—100 pts. Vendor cautioned. 307 I. ,, ,, ,, ,, —100 ,, ,, ,, 308 I. ,, ,, „ ,, —150 „ ,, ,, 242 I. ,, ,, ,, —380 ,, ,, ,, 237 I. ,, ,, ,,—190 ,, ,, ,, 577 I. ,, ,, ,, ,, ,, — 70 ,, ,, ,, 152 I. ,, ,, ,, ,, ,,—150 ,, ,, ,, 168 I. ,, ,, ,, ,, ,, —120 ,, ,, ,, 354 I. Jam Excess preservative. Sulphur dioxide—120 pts. See Sample No. 6 (F.). 6 F. ,, ,, ,, ,, ,, — 90 ,, Vendor fined. 110 I. ,, Misdescribed as Full Fruit Standard Subsequent formal sample genuine. 14 I. Lard Substitute. In accordance with contract. 204 I. ,, ,, ,, ,, ,, ,, 177 I. Suet Unsound. No action taken. 205 I. ,, 20°/o extraneous water. Vendor cautioned. 195 I. ,, 16% ,, ,, ,, ,, 111 I. Pepper 50% arrowroot. Vendor fined for refusing to sell subsequent formal sample. 207 I. Sugar 1.7% sand. Vendor surrendered stock for destruction. 206 F. ,, 1.5% ,, ,, ,, ,, 10 I. Olive Oil Arachis oil See Sample No. 35 (F.). 35 F. ,, 18% Arachis oil Vendor fined. 68 I. French Cream Sandwich Cream substitute. No action taken. I. = Informal Sample. F. = Formal Sample. The Public Analysts for the Borough are Dr. Bernard Dyer and Partner, London, E.C. 109 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. School Medical Service:— INTRODUCTION REPORT For the year 1935. 111 County Borough of East Ham Education Committee TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I have the honour to present the Annual Report on the School Medical Department of the County Borough of East Ham, for the year ending 31st December, 1935. There were 17,370 children on the School Roll as compared with 18,022 for the year 1934. The numbers of routine and special cases of elementary school children examined totalled 8,914, showing a decrease on the previous year, which is accounted for by a reduction in the school population. A complete medical inspection of all the scholars attending the Secondary Schools has also been carried out. I am pleased to state that the Manor Park Clinic, whilst affording greater scope and hygienic conditions for supervision and treatment at Minor ailment clinics, has also permitted the administration of ultra-violet light to a much larger number of children, with beneficial results. Regular sessions have been instituted for general light baths and for those cases requiring local treatment, by carbon arc and mercury vapour lamp. (See Light Clinics). An inspection was carried out by Dr. Ralph Williams, Medical Inspector to the Board of Education, with the object of ascertaining the degree of malnutrition in scholars attending certain schools in different areas of the Borough. The enquiry elicited few instances of suspected malnutrition, and each case was found to be under careful supervision and treatment. The report is submitted herewith. I wish to express appreciation of the keen interest and loyal co-operation of all the members of my Staff. 112 My sincere thanks are extended to the Teachers for their great help and courtesy and to Mr. Thompson, the Secretary of 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 earnest consideration and assistance 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. 113 1. Staff. A list of the Staff of the School Medical Department will be found at the beginning of this Report. 2. Co- Ordination. The system outlined in my previous reports has continued with beneficial results alike to staff and scholars. 3. The School Medical Service in relation to Public Elementary Schools. A complete survey of the sanitary and hygienic conditions of all the schools has been carried out and reports submitted to the Committee. 4. Medical Inspection. The following is a synopsis of School Medical Work for the year 1935, as compared with previous statistics. COMPARATIVE STATEMENT OF WORK. 1931. 1932. 1933. 1934. 1935. Routine and Special Inspection (on School Premises) 10,351 10,458 10,493 9,186 8,914 He-inspection 2,883 2,700 2,773 3 203 3,115 Consultations at Inspection Clinic 13,241 16,122 18,294 17,750 17,612 Number of Treatments at Clinic 15,180 12,819 13,636 13,770 22,073* General Cleanliness Visits to Schools 307 307 341 296 339 Nurses' Visits to Homes 3,081 3,078 3,124 3,206 3,563 Children Examined for Cleanliness 48607 50,513 50,064 47,550 45,356 *Increase due to extension of light treatment. (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 114 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. There is no change in the arrangements for the medical inspection of scholars, which is undertaken with due consideration for school routine. 5. Findings of Medical Inspections. The number of children included in routine inspection during 1935 was 5,734, or 33 per cent. of the number on school roll. In addition 3,180 children were referred for some special reason by parents, nurses, teachers or attendance officers. The total number of children medically examined was therefore 8,914, or 51.7 per cent. of those on the school roll. The number of re-inspections carried out was 3,115. 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 1935 :— 115 FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. 1930 1931 1932 1933 1934 1935 1930 1931 1932 1933 1934 1935 1930 1931 1932 1933 1934 1935 Entrants 2,314 2,047 2,245 2,040 1,747 1,898 264 263 255 250 447 299 11.4 12.8 11.4 11.2 25.5 15.7 Second Age Group 2,207 1,987 2,028 2,006 1,873 1,622 237 217 240 230 230 200 10.7 10.9 11.8 12.4 12.2 12.3 Third Age Group 1,912 1,855 1,985 2,079 1,895 1,713 119 181 175 180 193 196 6.2 9.7 8.8 8.6 10.1 11.4 Totals 6,433 5,889 6,258 6,125 5,515 5,233 620 661 670 660 870 695 9.6 11.2 10.7 10.7 15.7 13.1 116 It will be seen that the percentage of defects found upon inspection of "entrants" is much less than for the year 1934, although still somewhat in excess of previous years. (a) Uncleanliness. The School Nurses have carried out three cleanliness surveys of all children in the elementary schools during the year 1935. During the year the School Nurses made 45,356 examinations, as compared with 47,550 in 1934. Of this number 140 children showed vermin and many nits in the hair (140 in 1934), whilst 1,854 children showed only a few nits (776 in 1934). 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 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 1935 45,356 1,854 140 174 11 7 TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. Schools. Dept. Number Exam'd Few Nits Many Nits and Vermin Altmore S. Mixed 700 10 - Avenue Infants 567 17 2 J. Girls 700 43 20 J. Boys 745 17 12 Brampton Infants 1145 29 4 J. Girls 1185 33 4 S. Girls 803 5 - Castle Street R.C. Mixed 644 13 - Central Park Infants 771 18 - J. Boys 1102 - - S. Boys 805 - - Cornwell Infants 1150 166 3 S. Girls 812 85 7 S. Boys 842 41 5 Dersingham Mixed 873 238 13 Essex Infants 809 44 - J. Boys 760 12 2 S. Boys 623 5 1 Hartley Infants 723 25 1 J. Girls 871 80 6 S. Girls 785 21 - High Street Infants 198 4 1 Kensington Infants 722 4 1 J. Girls 871 19 10 S. Girls 558 2 1 Lathom Infants 992 14 - J. Girls 882 19 - J. Boys 794 - - Monega Infants 764 9 1 J. Boys 955 6 - TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. Schools. Dept. Number Exam'd Few Nits Many Nits and Vermin Monega S. Boys 859 - - Myope 64 1 - Napier Infants 623 68 2 J. Boys 1109 38 - S. Boys 870 10 - Plashet Infants 560 21 1 J. Boys 880 9 - S. Boys 760 6 - Salisbury Infants 703 16 3 J. Mixed 1064 31 2 S. Mixed 885 10 — Sandringham Infants 631 9 4 J. Mixed 792 14 4 Sandringham Central 420 2 1 Shaftesbury Infants 1034 23 - J. Girls 903 40 - S. Girls 763 23 - Shrewsbury Special 175 7 2 Storey Street J. Mixed 528 54 1 S. Mixed 740 30 3 Silvertown J. Mixed 353 37 2 S. Mixed 617 39 4 St. Michael's R.C. Mixed 138 6 - St. Winifrede's R.C. Mixed 737 104 12 Vicarage Infants 1256 72 1 J. Girls 826 77 - S. Girls 702 51 1 Winsor J. Mixed 930 53 3 S. Mixed 863 23 - Wakefield C. Girls 206 1 - Boys 214 - - Total 45356 1854 140 Per cent. in 1935 4.08 0.3 Per cent. in 1934 2.91 0.43 118 (b) Minor Ailments. Chief Minor Ailments. Discovered at Routine Medical Inspection Discovered by Teachers and Nurses and sent to Clinic 1934 1935 1934 1935 Scabies l 1 30 12 Impetigo 8 7 174 236 Conjunctivitis 2 1 79 57 Blepharitis 6 1 49 28 Ear Disease 87 46 223 204 Ringworm (Scalp) - - 2 3 Ringworm (Body) 1 1 20 33 (c) Tonsils and Adenoids. 4.4 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids," either separately or combined, as compared with 4.3 per cent. in the year 1934. Of these, much enlarged tonsils accounted for 0.9 per cent.; definite adenoids were present in 0.1 per cent.; and the combined defect was diagnosed in 3.4 per cent.; the figures for 1934 were 1.51 per cent.; 0.18 per cent.; and 2.61 per cent.; respectively. The percentage of children moderately affected and requiring to be kept under observation was 7.4, the corresponding percentage in 1934 being 8.7. In this case 6.9 per cent. had moderately enlarged tonsils, 0.29 per cent. exhibited signs of the presence of adenoids, whilst 0.3 per cent. showed enlarged tonsils and adenoids of moderate degree, as compared with 8.0 per cent.; 0.2 per cent.; and 0.5 per cent.; respectively in the year 1934. (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 8 5 13 Other forms of Tuberculosis 7 9 16 15 14 29 119 (e) Skin Disease and (f) External Eye Disease. At medical inspections during the year 547 children were found to be suffering from skin affections (as compared with 480 in the year 1934). Eighty-seven cases of external eye disease were discovered, as compared with 136 in the year 1934. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 406. In addition, there were 217 children in whom there was evidence of a lesser degree of visual defect and these are being kept under observation. (h) Ear Disease and Hearing. 1.3 per cent. of the children examined were found to be suffering from otitis media. (1.6 per cent. in 1934). The percentage of deaf children was 0.09, the corresponding number for last year being 0.4. (i) Dental Defects. (See Report of Dental Surgeon on page 139. (j) Crippling Defects. Reference to Table III will furnish information with regard to the occurrence of crippling defects in the area. Fifty-eight cases were discovered at routine medical inspection during the year. 6. INFECTIOUS DISEASES. There was a marked diminution in the number and severity of cases of Diphtheria and Scarlet Fever. Non-notifiable diseases also showed a decrease except Mumps, which was somewhat prevalent during the period March to June. 12,0 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. Two hundred and seventy-six swabs were taken for this purpose, and the fact that two of these proved to be positive shows the great importance of this procedure. (b) In suspicious cases seen at the Clinics or Schools. Two hundred and twelve swabs were taken and seven proved to be positive. (c) In cases where an undetected source of infection appears to be present in a class or school. Thirty-four swabs were taken and none 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. 121 Table of the Chief Infectious Diseases, Showing the Monthly Incidence in Children of School Age Month. Measles Chicken Pox Whooping Cough Mumps Scarlet Fever Diphtheria January 3 55 1 51 10 15 February - 16 1 91 22 15 March 1 3 - 129 11 13 April - 9 - 119 13 7 May 46 15 3 204 12 15 June 91 9 1 101 17 5 July 2 - 11 15 11 16 August 1 4 17 3 18 22 September October 99 — 5 8 24 19 November 30 3 15 4 18 4 December 191 5 23 12 31 17 Totals (629) 464 (228) 119 (114) 77 (23) 737 (604) 187 (225) 148 The totals in brackets are those for the year 1934 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. 122 7. FOLLOWING UP. The School Nurses have paid 3,274 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. Of the 1,132 children referred for treatment, 593, or 52 per cent., have obtained treatment. The School Nurses have also paid 130 special visits to the Schools, and three visits to the Feeding Centres, and have undertaken 23 journeys in connection with the admission and discharge of children to Institutions. All children referred for the operative treatment of tonsils and adenoids (450) 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), (a) Town Hall—Mondays, Wednesdays and Saturdays, 9 a.m. Average attendance, 90. (b) Church Road, Manor Park—Tuesdays and Thursdays at 9 a.m. Average attendance, 62. (c) North Woolwich—Mondays and Fridays at 2 p.m. Average attendance, 27. (2) Eye Specialist Clinic. Town Hall—Tuesdays at 9 a.m., Thursdays at 9 a.m., and Fridays at 9 a.m. (3) Ear Specialist Clinic. Town Hall—Thursdays and Fridays at 2 p.m. (4) Light Clinics. (a) Town Hall—Mondays (boys) and Wednesdays (girls) at 2 p.m. (b) Manor Park— Monday, 9 a.m., Girls; 2 p.m., Babies. Tuesdays, 9a.m., Locals; 2 p.m., Boys. Wednesdays, 9 a.m., Girls; 2 p.m., Babies. Thursdays, 9 a.m., Boys; 2 p.m., Locals. 123 Fridays, 9 a.m., Babies; 2 p.m., Girls. Saturdays, 9 a.m., Boys. (5) Immunization Clinics. (a) Town Hall—Fridays at 3 p.m. (b) Maternity and Child Welfare (Central Clinic)—Tuesdays at 9 a.m. (c) Manor Park Clinic—Fridays at 9 a.m. During the year 1935, 22,073 attendances were made for treatment at the various clinics, and there were 17,012 attendances for consultation with the Medical Officers. (a) Minor Ailments. An analysis of the chief minor ailments treated at the School Clinics, and otherwise, will be found in Table IV, Group 1. (b) Tonsils, and Adenoids. Of the children referred for treatment 379 received operative treatment during the year 1935. (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 was one case of Ringworm requiring X-ray treatment. (e) External Eye Disease. Eighty-seven cases (136 in 1934) of external eye disease were treated at the School Clinics. 124 (f) Vision. During the year 1935, the Ophthalmic Clinic was held on five sessions per fortnight. Four hundred and six cases were referred for treatment in respect of visual defect during the year 1935 (of these 83 children with markedly defective vision had not been seen by the Ophthalmis Surgeon) and, including 43 cases awaiting treatment at the termination of the year 1934, 366 cases have been treated in the past year. There were 217 cases discovered during the year. A Sight-saving Class at Monega Road School was opened by the Education Committee in June, 1928, 19 children are in attendance at this class, and they are all kept under observation by the Ophthalmic Surgeon at intervals. (See also Ophthalmic Surgeon's Report). (g) Ear Disease. During the year 1935, 83 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 1,788, making an average attendance, at each session, of 22 patients. Ionisation treatment was carried out in 17 cases, 56 applications being made. (See Aural Surgeon's report.) (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. Eleven out-patients have received treatment during the year. The total out-patient attendances were 75. 125 (j) The Light Clinic. As previously mentioned, the opening of the Church Road Clinic has provided for the inclusion of a large number of children hitherto precluded from treatment by ultra-violet rays. Marked benefit continues to be obtained in selected cases. Condition Boys Girls Babies Anaemia and Debility 118 135 41 Malnutrition 30 48 3 Cervical Adenitis 40 23 2 Bronchial Catarrh 35 36 1 Rheumatism 7 12 - Sinus 2 - - Dermatitis 1 - - Rachitis 2 2 5 Asthma 2 2 - Enteritis 1 1 - Blepharitis 1 - - Eneuresis - 1 - Alopecia 6 3 - Infantile Paralysis 1 - - Chorea 1 8 - 247 271 52 Number of Children Treated (General) 570 Number of Children Treated (Local) 319 Number of Attendances (General) 11950 Number of Attendances (Local) 780 Total Number of Attendances (Local and General) 12730 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 146 scholars to the Kessingham Holiday Camp during the year 1935, and in addition the following School Journeys were undertaken 126 Brampton Senior Girls 70 Plashet Senior Boys 45 Essex Senior Boys 46 Total 161 (c) Open- Air Classrooms in Public Elementary Schools. There are four open-air classrooms at the Brampton School and one at Castle Street School. (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 difficulty of providing satisfactory treatment for delicate, malnourished, debilitated and physically defective children, who in many cases require a change of air and the regulation and routine of a healthy life, has been overcome largely as the result of the keen activity of the Local Branch of the Invalid Children's Aid Association. 127 SYNOPSIS OF CASES REFERRED TO EAST HAM I.C.A.A. BY SCHOOL MEDICAL SERVICE DURING 1935. Disease: Debility, anaemia and malnutrition 19 Bronchitis and bronchial catarrh 5 Debility following rheumatic fever and rheumatism 5 Debility following operations and accidents 5 Heart 2 Asthma 2 Infantile Paralysis 2 Debility following diphtheria 1 Pre- tuberculosis 1 Deformed feet 1 43 Action taken: Convalescence 40 Surgical instruments 3 43 123 Particulars of the number of Children who were resident in Schools of Recovery between 1st January and 31st December, 1935, 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. Totals Ogilvie - - 7 4 - 4 4 4 - - - - 2 - 2 - - 2 1 2 - - 8 3 24 19 43 I.C.A.A. (hdqts.) 1 3 2 1 — 3 — 4 — — 2 2 — 2 — — — — — — — — — — 5 16 21 St. Catherines — — — — 1 1 — 1 — 1 3 — — — — — — 1 — — — — — — 4 4 8 St. Dominic's 1 — — — 3 — 4 — 1 — 3 — 3 — 2 — 2 — — — — — 6 — 25 — 25 No. of Weeks 11 12 13 14 24 25 28 Total RussellCotes 1 1 15 7 — 1 14 8 1 1 2 1 2 1 55 129 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 ,185,405 meals were provided for children, as compared with 203,105 in 1934. The re-organization of the Feeding Centres and revised dietary have provided every facility for nutritious and well-cooked meals. 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 1935 the number of parents who were present at the routine medical inspections was 4,442 (4,314 in 1934), that is, 77.4 per cent. of the cases examined (71.5 per cent. in 1934). 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. Many cases have been referred for special examination by the Attendance Officers on Form 21, and of these cases 27 were medically examined, reports and advice in each case being sent to the Secretary of the Education Committee. 130 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. 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 1935. The Inspectors have made 437 visits in regard to these cases and the following table indicates the work performed by the Society Condition Numbet of Cases Treatment Obtained Trtatment arranged Cases under Observation Tonsils and Adenoids 6 1 2 3 Defective Vision 13 13 — — Dental Caries 1 — — 1 General Neglect 64 46 improved — 18 Ill- Treatment 5 5 improved — — Others 4 3 improved — 1 93 68 2 23 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. (See Table III). Fifteen children are suffering from physical defects which prevents them attending public elementary schools. 131 Three hundred and thirty-seven children considered physically defective and 54 children suffering from glandular and noninfectious pulmonary tuberculosis, are attending ordinary elementary schools. Mentally Defective Children. During the year 1935, the number of cases examined for purposes of the Mental Deficiency Acts was 24 (37 in [1934). Of these, six were classified as mentally deficient and 15 as dull and backward, recommendations being made as shown in the following table :— Number examined 24 Classified as mentally deficient 6 7 Classified as morally deficient — Classified as imbeciles 1 Classified as idiots — Classified as dull and backward 15 Recommended for Special School 6 Recommended for Residential School for Physically Defective Children 1 Recommended for Residential Special School 1 18. NURSERY SCHOOLS. There are at present no Nursery Schools in East Ham. 19. SECONDARY SCHOOLS. There are two secondary schools in East Ham, and tables relating to the work carried out in connection with these schools are appended. 20. CONTINUATION SCHOOLS. There are at present no Continuation Schools in East Ham. 132 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. Thirty-seven boys have been specially examined in accordance with the Bye-laws, and these were found to be fit for employment. In addition, 18 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. In accordance with the suggestions of the Board of Education arrangements were made for Dr. Ralph P. Williams to conduct a nutrition survey in two of the Authority's Schools on 17th October, 1935. The selected Schools were Cornwell and Kensington, and the survey was based upon the classification outlined in Administrative Memorandum No. 124, which is as follows :— A — Excellent nutrition. B — Normal nutrition. C — Slightly subnormal nutrition. D — Bad nutrition. The memorandum also suggests that the classification should be made on clinical grounds and not based solely on the height and weight of the child. It is recognised that some variation in the standards adopted by Medical Officers may be unavoidable, but experience appears to show that, generally speaking, a clinical classification is more reliable than one based only upon a heightweight-age ratio. 133 The main issue is to estimate the general well-being of the child. Such general assessment cannot as a rule be based upon any single criterion such as any ratio of age, sex, height and weight, but should also have regard to other data derived from clinical observation; for example, the general appearance, facies, carriage, posture; the condition of the mucous membranes; the tone and functioning of the muscular system; and the amount of subcutaneous fat. An alert cheerful child, with bright eyes and a good colour, may usually be accepted as well-nourished without demur. On the other hand, a child who appears dull, listless and tired, who has a muddy complexion or stands slackly, is at once under suspicion and should be further examined. Too much reliance on a single sign may lead to error. It is the general impression which decides the issue. 13 4 The Results of the Nutrition Survey. School Agegroup Number Examined Not having School Meals or Milk Having School Meals or Milk No. Examined Classification No. Examined Classification A B C D A B C D CORNWELL Infants 5 40 6 0 6 0 0 34 4 28 1 1 6 35 6 2 1 3 0 29 7 20 2 0 7 28 2 1 1 0 0 26 3 23 0 0 Girls 11 36 15 4 11 0 0 21 2 19 0 0 13 29 13 4 7 2 0 16 4 11 1 0 Boys 11 36 19 0 19 0 0 17 0 17 0 0 Totals 204 61 11 45 5 0 143 20 118 4 1 KENSINGTON Infants 5 31 6 3 3 0 0 25 8 17 0 0 6 33 4 0 4 0 0 29 9 18 2 0 7 35 15 5 9 1 0 20 2 14 4 0 J. Girls 10 39 12 7 5 0 0 27 9 17 1 0 S. Girls 28 12 4 8 0 0 16 4 12 0 0 13 33 12 5 7 0 0 21 3 18 0 0 Totals 199 61 24 36 1 0 138 35 96 7 0 135 The following percentage analysis of the totals is shown for the purpose of comparison between the two schools :— CORNWELL KENSINGTON Not having School Meals or Milk Having School Meals or Milk Not having School Meals or Milk Having School Meals or Milk 29.9% 70.1% 30.7% 69.3% A B C D A B C D A B C D A B C D 18.1 % 73.7 % 8.2 % 0 14 % 82.5 % 2.8 % 0.7 % 39.4 % 59 % 1.6 % 0 25 % 70 % 5 % 0 Of the 403 scholars examined, only one child showed a serious degree of malnutrition (0.2 per cent.); she is suffering from rickets and under observation and treatment at the School Clinic. Seventeen children were considered to be slightly subnormal in nutrition (4.2 per cent.); eleven of these children were receiving school meals or milk and four were attending the School Clinic for anaemia, adenitis, bronchial catarrh and rheumatic heart condition respectively. It will be seen by the foregoing figures that the present survey definitely confirms the statistics supplied to the Committee in April, 1934. (See Annual Report, 1934). Periodical surveys might in certain instances result in the earlier recognition of subnormal nutrition; to carry out such surveys, however, twice a year, would necessitate the services of a medical officer for 120 sessions per annum, which I submit is impracticable without additional staff. 136 23. MISCELLANEOUS. During the year 1935, the following special medical examinations were made in connection with the appointment of staff :— Teachers 19 Assistant Teachers and Student Teachers 12 Caretakers, School Attendants and Cleaners 43 Cook-Attendants and Assistant Cook 2 Officers 35 137 Report of the Aural Surgeon. To the School Medical Officer, Education Committee, County Borough of East Ham. Sir, I have the honour to present by seventh annual report on the work done in the Aural Clinic during 1035. Eighty-three clinics were held during the year, with a total attendance of 1,788. Sixty per cent. of the cases were, after treatment, discharged cured. I operated on 283 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 175. Discharged 112 Cases of Deafness 33. ,, 17 Other Ear Cases 71. ,, 68 Cases of Chronic Rhinitis 60. ,, 29 Other Nose Cases 31. ,, 22 Cases of Enlarged Tonsils and Adenoids 274. ,, 152 Other Throat Cases 21. ,, 17 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. 138 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 1935. General Clinic. Number of new cases 592 Glasses prescribed 394 Glasses not necessary 198 Glasses obtained 392 Special treatment 68 Re-examinations 2346 Discharged 126 Cysts treated at Royal Westminster Ophthalmic Hospital 1 Baby Clinic. Number of new cases 48 Glasses prescribed 21 Glasses obtained 21 Special treatment 11 Re-examinations 136 Discharged — Lachrymal obstructions treated at East Ham Memorial Hospital 1 Lachrymal obstructions treated at St. Bart's Hospital 2 Lachrymal obstructions treated at Westminster Ophthalmic Hospital 1 Myope Class. Number of pupils 19 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. 139 Report of Dental Surgeon. Mr. C. S. Neame, L.D.S., reports as follows:— This year another age group has been brought into the routine inspection, making the age groups which were inspected five years to 12 years, inclusive. The total number inspected by myself and my colleague was 12,661, and those who required treatment numbered 8,290. Urgent cases referred by the School Medical Officers and the Head Teachers numbered 197, these referred to as Specials. Details will be found in the following statistical table:— Table IV. Group V. Dental Defects. All the children in the routine age groups are inspected once a year and those requiring treatment are notified to attend the Dental Clinics. Sometimes inspection at the schools is hampered by the outbreak of epidemics such as influenza, etc., then a further visit is made at a later date for the inspection of the absentees. The work at the Clinics is carried out to give the patients the very minimum of pain. Gas is given for the extraction of permanent teeth, with a few exceptions, and also for the extraction of temporary teeth in the case of nervous children, and deepseated sepsis. For the extraction of temporary teeth local injection is used, and ethyl-chloride or freezing in the case of loose or septic teeth. Great importance is attached to the filling of permanent teeth, especially the six year molars, and where the cavity is very sensitive a local injection is used to make it painless. Small cavities are filled in temporary teeth. An increasing amount of regulation work is done by judicious extraction in overcrowded mouths and by' regulation plates. This is very important work, as it puts the mouth into such a condition that all the teeth are able to be used as Nature intended, that is with the maximum efficiency, which means that the health of the child in the future has every chance, and is not handicapped. Abnormal cases are sent to Guy's Hospital or the London Hospital, where they can have necessary X-ray, etc. 140 It is of importance that those children leaving school, viz., the 14 year age group, should have their mouths in sound condition. The School Dental Service is not established to extract as many teeth as possible but to prevent decay and consequent pain: it other words, it is a preventive service. So many parents ignore all notices for their children to attend the Clinics for routine treatment, and these same children come along in turn, often at inconvenient times, to have aching teeth extracted, upsetting the routine work in progress. Maternity and Child Welfare Centres. Statistical details of the dental work done for the Maternity and Child Welfare Centres are shown in the following table :— No. of Sessions devoted to Treatment No. of Attendances No. of Permanent Teeth No. of Temporary Teeth Adults Children Extrac ted Filled Extrac ted Filled 90 278 621 316 66 879 129 Total No. of Extractions Total No. of Fillings No. of Adminis trations of General Anaesthetics No. of other Operations Permanent Teeth Temporary Teeth 1195 195 132 82 89 Two sessions per week have been devoted to the children under five years, and the mothers referred by the Medical Officers of the Maternity and Child Welfare Centres. Extractions have been done either by gas or local injection; and necessary fillings of permanent and temporary teeth. Dentures have been made for mothers in a few cases. 141 TABLE I. RETURN OF MEDICAL INSPECTIONS. CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.— ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups— Entrants 1,898 Second Age Group 1,622 Third Age Group 1,713 Total 5,233 Number of other Routine Inspections 501 Grand Total 5,734 B.— OTHER INSPECTIONS. Number of Special Inspections 3,180 Number of Re-Inspections 3,115 Total 6,295 C.— CHILDREN FOUND TO REQUIRE TREATMENT Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Prescribed Groups— Entrants 299 Second Age Group 200 Third Age Group 196 Total (Prescribed Groups) 695 Other Routine Inspections 72 Grand Total 767 142 MEDICAL INSPECTION RETURNS. TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1935. 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) Skin (1) Ringworm—Scalp - - 3 - (2) ,, Body 1 1 33 - (3) Scabies 1 - 12 1 (4) Impetigo 7 7 236 - (5) Other Diseases (NonTuberculous) 11 29 243 - Total (Heads 1 to 5) 20 37 527 1 Eye (6) Blepharitis 1 2 28 - (7) Conjunctivitis 1 5 57 1 (8) Keratitis - - - - (9) Corneal Opacities 1 1 - - (10) Other Conditions (excluding Defective Vision and Squint) 3 3 73 2 Total (Heads 6 to 10) 6 11 158 3 (11) Defective Vision (excluding Squint) 239 181 135 16 (12) Squint 14 17 18 3 Ear (13) Defective Hearing 2 -_ 6 - (14) Otitis Media 27 3 95 - (15) Other Ear Diseases 19 98 109 - Nose and Throat (16) Chronic Tonsillitis only 62 697 32 - (17) Adenoids only 7 30 11 - (18) Chronic Tonsillitis and Adenoids 194 24 136 3 (19) Other Conditions 34 50 103 5 14 3 TABLE II.— continued. 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) (20) Enlarged Cervical Glands (NonTuberculous) 19 187 39 - (21) Defective Speech 6 16 8 3 Heart and Circulation Heart Disease : (22) Organic 5 27 7 2 (23) Functional 3 56 3 - (24) Anaemia 13 26 61 1 Lungs 25) Bronchitis 25 136 84 3 (26) Other Non-Tuberculous Diseases 7 14 25 - Tuberculosis Pulmonary :— (27) Definite - - - - (28) Suspected 2 1 2 - Non-Pulmonary :— (29) Glands 1 1 1 - (30) Bones and Joints - - - - (31) Skin - - - - (32) Other Forms - - - - Total (Heads 29 to 32) 1 1 1 - Nervous System (33) Epilepsy - 2 4 - (34) Chorea 5 3 25 - (35) Other Conditions 1 30 3 3 Deformities (36) Rickets - 2 1 -_ (37) Spinal Curvature 8 3 2 1 (38) Other Forms 2 53 22 5 (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases 124 158 1350 120 Total 845 1863 2967 169 144 B. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age-groups Number of Children Inspected A (Excellent B (Normal) C (Slightly subnormal) D (Bad) No. % No. '% No. % No. % Entrants 1,898 105 5.53 1,703 89.73 89 4.69 1 .04 Second Agegroup 1,622 87 5.36 1,459 89.95 76 4.68 - - Third Agegroup 1,713 119 6.95 1,528 89.20 66 3.85 - - Other Routine Inspections 501 74 14.77 383 76.44 44 8.78 - - Total 5,734 385 6.71 5,073 88.47 275 4.80 1 0.01 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Blind Children. A blind child is defined by Section 69 of the Education Act, 1921, as one who is "too blind to be able to read the ordinary school books used by children." This definition covers some children who are totally, or almost totally, blind and can only be appropriately taught in a school for blind children, and others who have partial sight and can be appropriately taught in a school for partially sighted children. Only the first class should be included in this section. 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 the partially sighted. 145 Table III—continued. 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 3 1 - 23 Deaf Children. A deaf child is defined by Section 69 of the Education Act, 1921, as one who is "too deaf to be taught in a class of hearing children in an elementary school." This definition covers some children who are totally, or almost totally, deaf and can only be appropriately taught in a school for deaf children, and others who have partial hearing and can be appropriately taught in a school tor partially cleat children. Unly the first class should be included in this section. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 17 — — — 17 Partially Deaf Children. Enter in this Section children who can appropriately be taught only 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 14 6 Table III—continued. defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools but are not incapable by reason of that defect of receiving benefit from instruction in Special Schools for mentally defective children. 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. Particulars 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. 69 — 5 2 76 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. For practical purposes the Board are of opinion that children who ire 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. 1 — — — 1 Physically Defective Children. A. Tuberculous Children. Tuberculous children in areas other than Counties or County Boroughs who have been ascertained by the County Tuberculosis Officer should not appear in the Table for the County but in the Table for the appropriate area. Only children diagnosed as tuberculous and requiring treatment for tuberculosis at a sanatorium, a dispensary, or elsewhere should be recorded 147 Table III—continued. in this category. 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 conforms to the description of a crippled child given at the head of Section C below. All other tuberculous children who are regarded as being no longer in need of treatment should bq recorded as delicate children provided the Medical Officer is prepared to certify under Section 55 of the Education Act, 1921, that they are incapable by reason of physical defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools. 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. 10 28 — 2 40 II.—Children Suffering from Non-Pulmonary Tuberculosis. (This category should include tuberculosis of all sites other than those shown in I. above.) At Certified Special Schools. At Public Elementary Schools.† At other Institutions. At or Institution, no School Total. 7 54 1 5 67 t 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. 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 under Section 55 of the Education Act, 1921, that 148 Table III—continued 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. 61 156 — - 217 C. Crippled Children. This Section should be confined to children (other than those diagonised 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, ta 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, and in whose case the Medical Officer would be nrenared to certifv under Section 55 of the Education Act, 1921, that they are incapable by reason of such 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 Schocfl or Institution. Total. 11 41 4 2 58 D. Children with Heart Disease. This Section should be confined to children in whose case the Medical Officer would be prepared to certify, under Section 55 of the Education Act, 1921, that they are incapable by reason of such 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. 15 58 2 6 81 149 Table III—continued 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 (Feeble-minded). Severe Epilepsy. Active Tuberculosis. Crippling (as defined in Section C above). Heart Disease. The clinical condition causing the defect need not be specified; it will, for example, be sufficient to enter in Column 1, Blind and Feeble-minded. Deaf, Crippled and Heart. Should there be no children suffering from Multiple Defects, please enter "Nil." Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. M.D. and Heart 1 1 M.D. and Par. Blind - - - 1 1 150 MEDICAL INSPECTIONS RETURN. Year ended 31st December, 1935. TABLE IV. TREATMENT TABLES. GROUP I.—MINOR AILMENTS (excluding Uncleanliness, for which see Table VI) Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm-Scalp— (i). X-Ray Treatment. If none, indicate by dash 1 1 (ii.) Other - - - Ringworm-Body 37 - 37 Scabies 11 1 12 Impetigo 206 2 208 Other skin disease 196 3 199 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 132 1 133 Minor Ear Defects 228 8 236 Miscellaneous 1470 173 1643 (e.g., minor injuries, bruises, sores, chilblains, etc.). Total 2281 188 2469 151 Table IV—continued. GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group I.). No. of Defects dealt with. Under the Authority's Scheme Otherwise. Total. Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the School Med ical Officer's Report.) 406 24 430 Other defect or disease of the eyes (excluding those recorded in Group 1) Total — — — 406 24 430 Under the Authority's Scheme Otherwise. Total. No. of Children for whom spectacles were (a) Prescribed 394 1 395 (b) Obtained 392 1 393 (i) Tonsils only, (ii) Adenoids only., (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Defects. Received Operative Treatment. Total number treated Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. Received other forms of of Treatment. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) — 7 447 4 — — 6 1 — 7 453 5 103 568 152 TABLE IV.—continued. GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS. Under the Authority's Scheme. Otherwise. (1) (2) Residential treatment with education. Residentialtreat- ment without education. Non-residential treatment at an orthopaed c clinic. Residential treatment with education. Residentialtreat- ment without education. Non-reeidential (reatment at an orthopaedic clinic Total number treated (i) (ii) (iii) (i) (ii) (iii) Number of children treated — — 11 — — 16 27 TABLE V.—DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist. (a) Routine age-groups. Age 5 6 7 8 9 10 11 12 13 14 Total Number 1553 1576 1589 1703 1656 1854 1778 952 - - 12661 (6) Specials 197 (e) Total (Routine and Specials) 12858 (2) Number found to require treatment 8290 (3) Number actually treated 3497 (4) Attendances made by children for treatment 7812 (5) Half-davs devoted to:— (7) Extractions:— Inspection 116 Permanent Teeth 1172 Treatment 688 Temporary Teeth 7847 Total 804 Total 9019 (8) Administrations of general anaesthetics for extractions 853 (6) Fillings:— (9) Other Operations:— Permanent T eeth. 1698 Permanent Teeth 749 Temporary Teeth 504 T emporary Teeth 330 Total 2202 Total 1079 TABLE VI.—UNCLEANLINESS ANl) VERMINOUS CONDITIONS. (i). Average number of visits per school made during the year by the School Nurses 3 (ii.) Total number of examinations of children in the Schools by School Nurses 45356 (iii) Number of individual children found unclean 925 (iv.) Number of children cleansed under arrangements made by the Local Education Authority — (v.) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 _ (b) Under School Attendance Byelaws — 153 A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the Prescribed Groups— Boys. Girls Entrants - - Second Age Group — — Third Age Group 142 184 Total 142 184 Number of other Routine Inspections 331 436 Grand Total 473 620 C.—CHILDREN FOUND TO REQUIRE TREATMENT. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Prescribed Groups— Boys. Girls. Entrants - - Second Age Group - - Third Age Group 10 14 Total (Prescribed Groups) 10 14 Other Routine Inspections 9 42 Grand Total 19 56 TABLE I. RETURN OE MEDICAL INSPECTIONS CHILDREN ATTENDING SECONDARY SCHOOLS. B.—OTHER INSPECTIONS. Number of Special Inspections 1 Number of Re-Inspections 9 26 Total 10 26 154 SECONDARY SCHOOLS. MEDICAL INSPECTION RETURNS. TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1935. Defect of Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under obser vation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under obser vation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin B G B G B G B G (1) Ringworm—Scalp - - - - - - - - (2) „ Body - — — — — — — - (3) Scabies - - - - - - - - (4) Impetigo — 2 — 1 — — — - (5) Other Diseases (NonTuberculous) - - - - - - - - Total (Heads 1 to 5) — 2 — 1 — — — — Eye - (6) Blepharitis 1 - - - - - - - (7) Conjunctivitis 1 — - - - - - - (8) Keratitis — — — — — — — - (9) Corneal Opacities - - - - - - - (10) Other Conditions (ex eluding Defective sion and Squint) Total (Heads 6 to 10) 1 3 2 2 — 1 1 — — Ear (11) Defective Vision(excluding Squint) 8 23 8 7 - - - - (12) Squint — — — — — — — — (13) Defective Hearing - 3 - - - - - - (14) Otitis Media — 2 - - - - - - (15) Other Ear Diseases - 4 1 7 — — — - Nose and Throat (16) Chronic Tonsillitis only - 3 5 2 - - - - (17) Adenoids only - - - - - - - - (18) Chronic Tonsillitis and Adenoids 1 4 3 1 - - - - (19) Other Conditions ... - 3 1 5 - - - - 155 TABLE IL—continued. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under obser vation, but not requiring Requiring Treatment. Requiring to be kept under obser vation but not requiring (1) (2) (3) (4) (5) B G B G B G B G (20) Enlarged Cervical Glands (NonTuberculous) — — 4 3 — — — — (21) Defective Speech — — 2 — — — — — Heart and Circulation Heart Disease : (22) Organic — — 2 4 — — — — (23) Functional - - - - - - - - (24) Anaemia 1 1 I 2 - - - - Lungs (25) Bronchitis 1 — 3 — — — — — (26) Other Non-Tuberculous Diseases - - - - - - - - Pulmonary:— (27) Definite — — — — - — - — (28) Suspected - - - - - - - - Tuberculosis Non-Pulmonary (29) Glands - - - - - - - - (30) Bones and Joints - - - - - - - - (31) Skin — — — — - — - - (32) Other Forms - - - - - - - - Total (Heads 29 to 32) - - - - - - - - Nervous System (33) Epilepsy - - - - - - - - (34) Chorea - - - - - - - - (35) Other Conditions — 1 — 5 - — - — Defor- mities (36) Rickets - - 2 - - - - - (37) Spinal Curvature - - - - - - - - (38) Other Forms - - - - - - - - (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases 5 10 11 51 - - - - Total 19 56 45 88 1 - - - 156 B. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age-groups. Number of children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants - - - - - - - - - Second Agegroup - - - - - - - - - ThirdAge-group 326 31 9.5 275 84.3 20 6.1 — — Other Routine Inspections 767 98 12.7 641 83.5 28 - - - Total 1,093 129 11.8 916 83.8 48 4.3 — — TABLE IV. TREATMENT TABLES GROUP I.—MINOR AILMENTS (excluding Uncleanliness, for which see Table 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) B G B G B G B G B G B G Skin— Ringworm-Scalp— (i). X-Ray Treatment. If none, indicate by dash - - - - - - (ii.) Other — — — — — — Ringworm-Body — — — — — — Scabies — — — — — — Impetigo — — - - — — Other skin disease — 1 — — — 1 Minor Eye Defects 1 2 - - 1 2 (External and other, but excluding cases falling in Group II.) Minor Ear Defects — 1 — — — 1 Miscellaneous 5 20 - - 5 20 (e.g., minor injuries, bruises, sores, chilblains, etc.) Total 6 24 — — 6 24 157 GROUP IX—DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group I.). No. of Defects dealt with. Under the Authority's Scheme Otherwise. Total. B G B G B G ERRORS OF REFRACTION (including squint) 12 18 - - 12 18 (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) Other defect or disease of the eyes (excluding those recorded in Group I) - - - - - - Total 12 18 - - 12 18 Under the Authority's Scheme. Otherwise Total. No. of Children for whom spectacles were (a) Prescribed 8 13 - - 8 13 (b) Obtained 8 13 - - 8 13 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated Under the Athority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 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 B G - - - - 2 1 - - - - - - - - - - - - - 2 1 - - - - 2 1 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. INDEX 160 INDEX A. Act- Blind Persons, 1920 40-42a Act—Local Government, 1929 24 Acts—Children, 1908-32 93 Acts—Housing 101 Acts—Mental Defiency, 37 Acts—Midwives, 1902-18 20, 88 Acts—Nursing Homes Registration, 1927 20 Act—Rag Flock 100 Act—Rents Restriction 1C0 Act—Shops, 1934 100 Adenoids 84,118,123 After-Care Committee £9 Aldersbrook Homes 30,34 Ambulance Facili:ies 21 Attendance Officers, Cooperation of 129 Ante-Natal Clinic 28,86 Area 10 Ar.ificial Sunlight 28, 125 Atmospheric Pollution 68 Aural Surgeon, report of 137 Au.al Treatment 84 137 B. Bacteriology . 21,54,71,105 Bacteriological Examinations 54 Baths-School 129 Baths—Swimming 92 Birth-rate 10,12,16 Births 10,12,16,85 Births, Illegitimate 10 Births, Still 10,11,86 Blind Persons Act, 1920 40-42a Blind Children 130 Blindness—Prevention of £9 Byelaws—Premises and occupations controlled by 69 C. Camps—School 125 Cancer 57 Caravans ^9 Centre-Training and Occupation M.D. 39 Chief Sanitary Inspector— Report of 95-107 Children Act, 19C8 32 90 Children's Homes 30,34 Children-Invalid Aid Association 43,89,127 Cinemas 98 Classrooms, Open Air 126 Cleansing, Public 96 Clinics, Ante-Natal 28,86 Clinics, Artificial Sunlight 28,125 Clinics, Aural 28,122,137 Clinics, Dental 28,139 Clinics, Immunisation £8,45,54,84,123 Clinics, Infant 28,82 Clinics, Manor Park 28, 122 Clinics, Morning 28,85 Clinics, Ophthalmic 28, 122,138 Clinics, School 28, 122 Clinics, Toddlers' 28,83 Clinics, Tuberculosis and Chest 28,29,60 Clinics and Treatment Centres 27 Closet Accommodation 96 Committees 3 Complaints of Nuisances 97 Contents—Principal 2 Continuation Schools 131 Co-ordination 113 Cripples 119,124 D Dairies 105 Day-Schools, Open Air 126 Deaf Children 130 Deaths 10,12, 16 Death rate, General 10, 12, 16 Death-rate, Infantile 11,13 Death-rate, Zymotic 44 Deaths, Causes of 16a Deaths, Infants 11,18 Deaths, in Wards and Rates 17 Dental Treatment 84,119,124,139 Dental Treatment — Tuberculous Patients 69 Dental Surgeons, Report of 139 Diarrhœa 11 Diphtheria 45, 51 Disinfection in Schools 166-168 Disinfection and Disinfestation 98 Drainage and Sewerage 95 Dust Collection 96 E. Ear Diseases 119,124 East Ham Memorial Hospital 31 Education Committee 4 Employment of Children 132 Enteric Fever 47 Epileptic Children 130 Erysipelas 47,53 Eye Diseases of Children 119,123,138 Exceptional School Children 114 Extracts from Vital Statistics 10 Excessive Mortality, Particulars of 11 F. Factories and Workshops 94,97 Following-Up 122 Food & Drugs Adultuation 106 Food Inspection 104,106 Free Supplies of Milk 89 161 INDEX—continued. M. Malnutrition—School Children 12,132,134 Manor Park Clinic 28,122 Maternal Mortality 10,14, 89 Maternity and Child Welfare 82-91 Maternity and Child Welfare Committee 3 Maternity Homes and Hospitals 30,87 Meals, Provision of 129 Measles 11,53 Meat Inspection 105 Medical Examinations, Miscellaneous 136 Medical Inspection—School Children 113,114 Medical Officer of Health's Report 1-108 Medical Relief, Poor Law 25 Mental Defects, School Children 131 Mental Deficiency 27,37-40 Mental Deficiency Committee 4 Mental Hospital 30 Meteorology 93 Midwives 20,88 Milk—Free Supplies 89 Milk (Special Designation) Orders 104 Milk Supply 104 Minor Ailments 118,123 Mortality, Analysis of 16 Mortality, Excessive—Particulars of 11 Mortality, Infantile 11,13 Mortality, Maternal 10,14 Mortality, Neo-natal 13 Mosquitoes 99 N. Neo-natal Mortality 13 Noteworthy Causes of Sickness or Invalidity 12 Notices severed and Complied with 97 Notification of Births 85 Nursing Arrangements 19 Nursing Homes Registration Act, 1927 20 Nursery Schools 131 O. Obstretrical Specialist 14 Occupational Therapy 59 Open-air Education 125 Opthalmia Neonatorum 50,89 Opthalmic Clinic 28,122,138 Opthalmic Surgeon, Report of 138 Opthalmic Treatment 84,138 Outdoor Assistance 92 G. General Provision—Health Services 19-29 General and Special Hospitals and Children's Homes 30-37 H. Harts Sanatorium 69 Health Committee 3 Health Services— General Provision of 19-29 Health Visitors 86 Home Helps 91 Home—Nursing in 19 Homes, Aldersbrook and Scattered 30,34 Homes—Nursing 20 Homeless Children 21 Hospitals—General and Special 30-37 Hospital, Infectious Diseases 50 Hospital, East Ham Mem'ial 31 Hospital, Maternity 30,87 Hospital, Mental 30 Hospital, Smallpox 31 Hospital, Whipps Cross 32,33 Houses—Inhabited 10 Housing Acts 101 Housing Statistics 102 I. Illegitimate Births 10 Immunisation Clinics 28, 45, 54, 84 Increase of Rent (Restriction) Act 100 Infant Deaths 11,13 Infant Welfare Clinics 28,82 Infantile Mortality 13 Infectious Diseases Hospital 50 Infectious Diseases 44.58,119 Inhabited Houses 10 Inspection of and Supervision of Food 104 Inspections 96 Inspection of School Children 113,114 Institutional Provision for Unmarried Mothers, Illegitimate Infants, etc. 21 Institutions controlled by West Ham 32 Invalid Children's Aid Association 43, 89,127 L. Laboratory Facilities 21,54,71,105 Legal Proceedings 100 Legislation in Force 22 Light Treatment 28,125 Local Government Act, 1929 24 162 INDEX—continued. P. Parents, Co-operation of 129 Physical Features of Area 10 Physically Defective Children 130 Physical Training 129 Plaistow Maternity Hospital and Distiict Nurses Home 20 Playground Classes 125 Pneumonia 53 Poliomyelitis 53 Pools—Swimming 92 Poor Law Medical Out Relief 25 Population 10,15 Premises and Occupations Controlled by Byelaws 99 Prevention of Blindness 59 Principal Contents 2 Prosecutions 100 Provision of Meals 129 Public Assistance Domiciliary Medical Service 25 Public Assistance Institutions 32,33 Public Cleansing 96 Public Health Committee 3 Puerperal Fever and Pyrexia 47,89 R. Rag Flock Act 100 Rats 98 Rateable Value 10 Refuse Removal and Disposal 96 Rents Restriction Act 100 Reports—Special 18 Residential Schools 126,127 Rivers and Streams 95 Runwell Mental Hospital 30 S. Sanatoria 69-78 Sanitary Circumstances 95 Sanitary Inspection 96 Sanitary Section and Housing 95-107 Scarlet Fever 45,51 Scattered Homes 30,34 Schick Immunisation Clinics 28,45, 54, 84 School Attendance Officers— Co-operation of 129 School Baths 129 „ Blind Children 130 ,, Camps 125 „ Children, Blind, Deaf, Defective and Epileptic 130 „ Children, Minor Ailments 118,123 ,, Children, Medical Inspection 113,114 „ Children, Mentally Defective 131 School Children, Physically Defective 130 „ Children, Verminous Conditions 116 „ Continuation 131 „ Cripples 119,124 „ Exceptional Children 114 Meals 129 ,, Medical Officer's Report 109-157 ,, Medical Service in Relation to Public Elementary Schools 113 ,, Medical Treatment 122 „ Nursery 131 „ Open-air 125, 126 Schools of Recovery 126,127 Schools, Secondary 131 Sewerage 95 Shops Act, 1934 100 Sickness or Invalidity, any Noteworthy Causes 12 Skin Diseases 119,123 Slaughterhouses 146 Smallpox 31 Social Conditions of Area 10 Special Enquiries 132 Special Reports 18 Staff 5,113 Statistical and Social Conditions of Area 10-19 Statistics 10 Still Births 10,11,86 Streams 95 Swimming Baths and Pools 92 T Table, Birth-rate etc 16 „ Blind Persons 42,42a „ Cancer 58 „ Clinics and Treatment Centres 28 ,, Cost at Institutions 57,71 ,, Death Rate etc. 16 „ Deaths, Causes of 16a „ Deaths, Ward & Rates 17 „ Dental Treatment 69 ,, East Ham Memorial Hospital 31 „ Exceptional Children 144 „ Factories and Workshops Act 94 ,, Food and Drugs Adulteration 106,107 „ Housing 102 „ Infant Deaths 18 „ Infectious Diseases, Notifiable 48,49 „ Infectious Diseases Removed to Hospital 56 163 INDEX—continued. Table, Infectious Diseases in School Children 121 „ Mental Defectives 37 „ Mental Hospitals 30 „ Meteorology 93 „ Opthalmia Neonatorum 50 „ Out-door Assistance 92 „ Public Assistance Institutions 33 „ School Children, Defects of 142 „ School Children Examined 141 „ School Children Found to require Treatment 115 „ School Children—Malnutrition 134 „ School Children, Treatment carried out 150 „ Schools of Recover 127,128 „ Secondary School Examinations 153.157 „ Sunlight Treatment 125 „ Tuberculosis Deaths 82 „ Tuberculosis and Chest Clinic 67, 68, 68a, 68b „ Tuberculosis Notifications 79.81 „ Tuberculosis, Residential Treatment 72-78 „ Unemployed 91a „ Vaccination 44 „ Verminous Condition of School Children 117 Teaching Staff, Co-operation of 129 Toddlers' Clinic 28,83 Tonsils and Adenoids ... 84,118,123 Training Centre, Mental Defective 39 Treatment Centres 27 Tuberculosis 59-82,118,123 Tuberculosis and Chest Clinic 28, 29, 60 Tuberculosis after care Committee 59 U. Uncleanliness 116 Unemployment and Out-door Assistance 91 92 Unmarried Mothers 21 V. Vaccination 44 Verminous Conditions— School Children 116 Venereal Diseases 26 Vital Statistics, Extracts from 10 Vision 119,123 Visits, Health Visitors 86 Visits, School Nurses 122 Voluntary Associations 43,89,127,130 W. Wards, Deaths in and Rates 17 Water Supply 95 Whipps Cross Hospital 32,33 Whooping Cough 11 Workshops 94,97 Z. Zymotic Diseases 44