M EAS12 COUNTY BOROUGH OF EAST HAM. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1936. The Woodgrange Frees, Lfcd.. London, E.7. Ac 44113 e COUNTY BOROUGH OF EAST HAM. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1936. MALCOLM E. BARKER, M.R.C.S. (Eng.), L.R.C.P., D.P.H., (Lond.) 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 11 General Provision of Health Services 20 General & Special Hospitals & Children's Homes 29 Mental Deficiency 37 Welfare of the Blind 41 Invalid Children's Aid Association 43 Infectious Diseases 45 Tuberculosis 62 Maternity and Child Welfare 90 Unemployment and Out-Door Assistance 100 Meteorological Record 102 Sanitary Section and Housing 104 School Medical Service: — Introduction 123 Report 126 Index 171 EAST HAM CORPORATION PUBLIC HEALTH COMMITTEE. Also Committee under Blind Persons Act, 1920, Sec. 2. *The Mayor (Alderman J. J. Pope, J.P.). †*The Deputy-Mayor (Councillor E. B. Hall, J.P.). *°The Deputy-Mayor (Alderman Mrs. A. Taylor). *Alderman E. F. Markey (Chairman, Public Health Committee, Institutions and General Sub-Committee, and Maternity and Child Welfare Sub-Committee). * Councillor S. A. Elson (Vice-Chairman). *Alderman J. W. Barton. Alderman J. Brooks, J.P. *Alderman T. W. Burden, J.P. Councillor W. H. W. Beecham. *Councillor Mrs. E. M. Brace. *CouncilIor C. W. Brading, C.R.P., J.P. Councillor W. T. Bush. *Councillor H. B. Harper, J.P. Councillor W. E. Hurford. Councillor H. Joseph. Councillor G. H. Manser, M.R.S.I., R.P., J.P. *Councillor G. H. Moncar. Councillor H. Restarick. *Councillor Mrs. A. B. Spencer. *Councillor W. Thompson. *Councillor Mrs. B. Wilkens. * Also Member of the Institutions and General Sub-Committee. † Died 15.6.36. °Appointed 28.7.36 MATERNITY AND CHILD WELFARE SUB-COMMITTEE. Maternity and Child Welfare Act, 1918, Sec. 2. Same members as Public Health Committee, with— Mrs. E. M. Fell (co-opted). Mrs. K. Moger (co-opted). 4 COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. Mental Deficiency Act, 1913, Sec. 28. The Mayor (Alderman J. J. Pope, J.P.). *The Deputy-Mayor (Councillor E. B. Hall, J.P.). †The Deputy-Mayor (Alderman Mrs. A. Taylor). Councillor Mrs. B. Wilkens {Chairman). Councillor Mrs. E. M. Brace (Vice-Chairman). Alderman T. I. Lethaby, J.P. Councillor Mrs. A. B. Spencer. Councillor C. W. Dixon. Mrs. C. J. Cross (co-opted). Councillor H. B. Harper, J.P. Mrs. A. M. Gray (co-opted). Councillor Mrs. K. M. Knight. Mrs. L. J. Nichols (co-opted). Councillor R. W. Moger, J.P. * Died 15.6.36. † Appointed 28.7 36 EAST HAM EDUCATION COMMITTEE. The Mayor (Alderman J. J. Pope, J.P.). fThe Deputy-Mayor (Councillor E. B. Hall, J.P.). "The Deputy-Mayor (Alderman Mrs. A. Taylor) Councillor T. I. Lethaby, J.P. (Chairman). Councillor H. E. P. Jackson (Vice-Chairman). Alderman J. W. Barton. Councillor H. B. Harper, J.P. Alderman T. W. Burden, J.P. Councillor E. C. Howlett. Alderman R. J. Fell. Councillor W. E. Hurford. Alderman E. F. Markey. Councillor G. H. Manser, J.P. Alderman W. T. Newling, J.P. Councillor R. W. Moger, J.P. Councillor Mrs. E. M. C. Brace. Councillor H. Restarick. Councillor Mrs. W. M. Knight. Councillor E. R. Thomas. Councillor Mrs. B. Wilkens. Councillor W. Thompson. Councillor R. Bailey. Councillor E. A. Wood. Councillor C. W. Brading, Mrs. E. A. Brown. C.R.P., J.P. Mrs. L. A. Lethaby. Councillor W. T. Bush. Mr. A. E. Francis. Councillor C. W. Dixon. Mr. E. J. Sullivan. Councillor S. A. Elson. 'Alderman J. Brooks, J.P. * Co-opted Member of Libraries Sub-Committee. † Died 15.6.36. ° Appointed 28.7.36 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. 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. J. S. Coleman, M.B., B.S., M.R.C.S., L.R.C.P., Assistant Medical Officer and Medical Officer, Aldersbrook Homes. 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. Savege, M.B., Ch.B., F.R.C.S. ((Edin.), D.L.O, Aural Surgeon. R. V. Brews, L.R.C.P., L.R.C.S., L.M., District Medical Officer; Public Vaccinator. 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:— J. E. Austin, M.S.I.A., A.M.I.P.C., Cert.S.I.J.B, Cert. Meat Ins., Cert. Smoke Ins., Senior Sanitary Inspector; Food and Shops Act Inspector; Inspector Contagious Diseases (Animals) Act. R. A. Baskett, M.S.I.A.; M.J.J. Hillyard, M.S.I.A.; 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., f*D. G. Tonkin, 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: — fL. 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. Worrall, S.R.N, S.C.M, R.S.I. (H.V.'s Cert.). *M. K. Howe, 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. 1M. K. Howe, S.R.N, S.C.M, R.S.I. (H.V.'s Cert.). 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. 2i Thomas, S.R.N, S.C.M, R.S.I. (H.V.'s Cert.). D. Young, S.R.N, S.C.M. Tuberculosis Nurses:— L. E. Mallon, S.R.N. 3M. Lantry, S.R.N, T.A.Cert. F. M. Williams, S.R.N, T.A.Cert. 3aC. A. Sumption-Jones, S.R.N, S.C.M, T.A.Cert. Public Assistance Nurse and Assistant Relieving Officer:— 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:— E. A. Bloomfield. C. L. Durbin, A.C.I.S. G. W. Friend. G. H. Green. R. A. Goff. B. E. R. Hartley, A.C.I.S. C. J. Hayes. Shorthand Typists:— D. Gordon. 5C. Goodman. O. E. Griffin. H. E. Ritterspack. E. M. Walton. Female Clerks— J. M. Flynn.:- A. R. Gaster. 4D. M. Greene. F. E. Hales. W. M. Hales. M. A. McCall. F. C. Wells. †*Commenced 10.8.36 3 Resigned 31.7.36. †Resigned 15.8.36 3a Commenced 1.7.36. * Commenced 4.11.36 4 Resigned 3.3.36 1 Commenced 3.2.36 Terminated 3.11.36 5 Commenced 3.7.36. 2 Commenced 11.1.37 7 Public Health Department, Town Hall. May, 1937. To His Worship the Mayor, Aldermen and Councillors of the County Borough of East Ham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you my Annual Report on the health of the County Borough of East Ham for the year 1936, together with the Annual Report to the Education Authority on the work of the School Medical Service. The year has been one of steady progress in all sections of the Department, which is reflected in the maintenance of a high standard of public health, in the improvement of housing and environmental conditions, and increased facilities at the Council's clinics for investigation, advice and treatment. The development of the services generally and the advantages to be gained thereby in matters of health need to be more widely known and appreciated. It will be seen from a study of the vital statistics that there is little change in the birth rate and death rate. The maternal mortality rate has decreased from 4.9 in 1935 to 2.0 for the past year, which is satisfactory. The infant mortality figure shows a slight increase, which was due to prevailing epidemics. There has been a further diminution in the incidence and severity of notifiable infectious diseases, particularly diphtheria and scarlet fever. The mortality attributed to these illnesses have been considerably lessened and in the case of Scarlet Fever altogether absent, which constitutes a record in the annals of the Borough. 8 The immunisation of children against diphtheria, strongly advocated for some years, has played an important part in the reduction of this illness. It must be realised, however, that in the presence of a virulent type of epidemic the number so protected would not afford sufficient safeguard to the rest of the community: hence the need of securing by simple effective measures greater immunity among the younger population. The epidemic of measles in the early part of the year accounted for several deaths of infants and children. Many cases with severe complications were admitted to the Isolation Hospital for treatment. Complications and sequelae of Measles may be responsible for much illness in later life, and for this reason every effort should be made to combat infection. The use of prepared serum obtained from convalescent cases is not only of value in the treatment of the illness but is found particularly advantageous as a prophylactic where children have been exposed to infection—for instance, where there are several others in a family or a case arises in a hospital ward. During the year a number of children were protected in this way by the use of a small quantity of serum. It should be more generally known that adult and adolescent patients, who have recently suffered from measles, can be the means of affording protection to others. A "measles serum service "may, in the future, play a large part in limiting the extent of this infection. The Tuberculosis and Chest Clinic has been equipped with an X-ray plant of high power, a description of which is given later in the Report. This has provided facilities for the investigation and diagnosis of chest conditions comparable to that of any other centre throughout the country. The installation of X-ray apparatus at Harts has proved invaluable, and has helped to augment co-ordination in the work of the Chest Clinic and Sanatorium and thus ensure treatment based on modern and scientific principles. 9 Plans have been submitted for approval of the Ministry of Health for the new central clinic and public health offices in Barking Road, also for a new pavilion treatment block and recreation Hall with additional accommodation for staff at Harts Sanatorium. The unsatisfactory provision for our clinics, to which reference has so often been made in these reports, will be superseded by modern buildings and equipment; such will greatly enhance the value of the services and permit of greater comfort and expeditious treatment. The replacement of old structures at Harts Sanatorium with the additional facilities mentioned, is the only requirement needed to place this hospital in the forefront of institutions available for this purpose. It is anticipated that building operations will commence at an early date. Consideration was given to the needs of the district from the point of view of maternity and child welfare services, and re-organisation resulted in the closure of the Masterman Road branch clinic and concentration of the work at the High Street centre. The alterations generally have met with success. Arrangements were considered by the Public Health Committee with the object of affording a complete training for nurses, including experience in fevers and tuberculosis. Unfortunately, owing to certain restrictions by outside bodies, it was not possible to proceed with the scheme at the time. The overcrowding survey under the Housing Act, 1935, was expeditiously carried out, and showed overcrowding to the extent of 2.1 per cent, of all houses in the Borough; such a result compares favourably with similar districts throughout the country. As elsewhere, outstanding examples were apparent of insufficient accommodation detrimental to the health of the inhabitants. During the year, clearance orders affecting 48 houses in different areas, including a number of caravans in an 10 encampment, were confirmed by the Minister. Proceedings are continuing in respect of similar structures coming under the heading of caravans. To meet the requirements of these Acts, proposals were under consideration at the end of the year for the building of 74 houses, which scheme may be implemented according to the needs 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 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. 11 Statistical and Social Conditions of the Area Area (in statute acres) land and inland water, 3,324. Population. Census, 1931, ,142,394 (males 68,923, females 73,471). Estimated to middle of 1936, 133,400. Number of inhabited houses (end of 1936) according to rate books (including tenements and shops), approx. 33,050. Rateable value at 31st December, 1936, £757,774. Sum represented by a penny rate for the year 1936/7, £3,030 estimated. 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. Malts. Females. Live Births Legitimate 1,881 967 914 Birth rate per 1,000 of the estimated population 144. (illegitimate 50 27 23 Still Births 64 34 30 Rate per 1,000 total (live and still) births 32.0. Deaths 1,421 712 709 Death rate per 1,000 of the estimated population 10-6. Death from puerperal causes:— Deaths. Rate per 1,000 total live and still) births. Puerperal sepsis 1 0.50 Other puerperal causes 3 1.50 Total 4 2.00 12 Death rate of infants under one year of age:— All infants per 1,000 live births 50 Legitimate infants per 1,000 legitimate live births 51 Illegitimate infants per 1,000 illegitimate live births 20 Deaths from Measles (all ages) 17 Deaths from Whooping Cough (all ages) 10 Deaths from Diarrhoea (under 2 years of age) 19 Particulars of any unusual or Excessive Mortality during the Year which has received or required comment. It will be seen that the deaths from Measles and Whooping Cough exceeded those of recent years owing to the prevalence of these diseases in the Greater London area. Infantile Enteritis was responsible for a larger number of deaths, without any apparent cause. Still-Births. An investigation extending over a period of 13 months, from February, 1935, to March, ,1936, was carried out with the object of ascertaining as far as possible the causes of still births. The total number of still births for the above period was 82, and replies were obtained in 77 instances. Details of the complete investigation arc herewith appended. Upon receipt of a notification of still birth an enquiry form was forwarded to the medical practitioner or midwife in attendance. Owing to the nature of the enquiry and the indeterminate character of the information obtained, it will be appreciated that considerable difficulty was experienced in interpreting the results. I am grateful, however, to the medical practitioners, hospital staffs and midwives for their assistance in kindly furnishing me with available details. It will be understood 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. 13 Although the conclusions to be drawn from the investigation are somewhat indefinite, certain facts emerge which are helpful in the light of present-day obstetric service. Whilst many of the conditions giving rise to still births are inevitable or unavoidable, it is apparent that in certain cases closer ante-natal supervision might have revealed preventable causes and permitted of appropriate treatment before confinement. Malpresentation, disproportion, and history of previous still births come within this category. Malpresentation was responsible for the still births in 26.3 per cent. of cases admitted to hospital; in 21.4 per cent. of the confinements attended by general practitioners, and in 36 per cent, of those conducted by midwives. In four cases the health of the mother was considered to be the predisposing cause of the still birth. The investigation revealed that in certain cases delay in obtaining medical aid may have jeopardised the life of the child. In no instance is there any evidence of a child having been born without a doctor or State Certified Midwife being in attendance or engaged. There is no evidence to substantiate any suggestion that still births were due to attempts to terminate pregnancy by artificial means. Conditions arising before confinement 33 Conditions arising at birth 38 No obvious cause 6 Total 77 Malpresentation 22 Premature 17 History of previous still births 11 Associated with Maternal Deaths 2 Any causes of Sickness or Invalidity which have been specially noteworthy in the Borough during the year; arid any Conditions of Occupation or Environment 14 The still-births registered numbered 64. The rate per 1,000 total (live and still) births was 32.0. For the previous year the rate was 36.3. Deaths. The number of deaths was 1,421 as compared with 1,388 for the year 1935. The death rate was 10.6, or 0.4 greater than that of the previous year. Of the total deaths 765 or 53.8 per cent, died in institutions. The number of residents who died outside the area and whose deaths were assigned to this Borough was 701. Eighty-five deaths of non-residents occurred. 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 11.6 (1935—11.2). This figure is arrived at by multiplying the crude death rate (10.6) by an adjusting factor, that for East Ham being 1.10. The live birth rates in the various Wards were as follows Manor Park Little Ilford Woodgrange ] Plashet 13.4 17.2 12.1 14.3 Kensington Castle Central Wall End Greatfield South 13,3 12.8 8.9 16.3 9.4 15.9 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 sufficient importance upon which to comment in this section. Births. The number of live births registered was 1,931 as compared with 1,960 for the year 1935, equivalent to a birth rate of 14.4 per 1,000 of the population, similar to that of the previous year. 15 The percentage of total deaths in the various age groups was as follows :— Under i Year 1-2 Years 2-5 Years 5-15 Years 15-25 Years 25-35 years 35-45 Years 45-55 Years 55-65 Years 65-75 Years 75 Years and upwards 6.8 1.2 1.5 2.2 3.1 4.5 4.8 9.6 16.6 23.8 25.7 Infantile Mortality. Deaths of infants under one year of age numbered 97—equivalent to an infant mortality rate of 50 per thousand live births— compared with the rate of 43 for the previous year. The rate for England and Wales is 59. One death of an illegitimate child occurred out of a total of 50 illegitimate births, giving a mortality rate of 20 as compared with a figure of 70 per 1,000 for the year 1935. Similarly to last year the death rate of illegitimate infants has again been reduced by half. Neo Natal Mortality. This rate is obtained by estimating the deaths of infants under one month per 1,000 live births. The neo-natal mortality rates for the past five years are as follows:— 1932—29.5, 1933—22.8, 1934—22.5, 1935—23.4, 1936—21.7 This is the lowest rate so far recorded. Maternal Mortality. The number of maternal deaths was 4, the maternal mortality rate for 1936 was therefore 2.00 per 1,000 live births and 2.00 per 1,000 live and still-births. I am pleased to report a reduction in the number of maternal deaths as compared with last year (10). It will be seen that the mortality rate is markedly lower than that for England and Wales as a whole. 16 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. As stressed on numerous occasions, 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 cause of death in one case was puerperal septicaemia. In the other instances conditions associated with pregnancy were responsible for death, and included Pulmonary Embolism, Eclampsia, and operation following Ruptured Ectopic pregnancy. Obstetrical Specialist. The services of a Consultant Obstetrician were requested by General Practitioners on two occasions. Particulars are given below :—- No. Diagnosis. Where treated. Result. 1. Uterine Sepsis Queen Charlotte's Hospital Recovered. 2. Puerperal Fever B.H.Infectious Diseases Hospital „ Population. The Registrar-General's estimate of the population to the middle of 1936, is 133,400, which is a decrease of 2,000 compared with that for the year 1935. 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. TABLE 1. Puerperal Sepsis Other Causes Total England & Wales East Ham England & Wales East Ham England & Wales East Ham Per 1,000 Live Births 1.40 0.51 2.41 1.55 3.81 2.06 „Total Births (Live 8: Still) 1.34 0.50 2.31 1.50 3.65 2.00 TABLE 3. Causes of Death in Age Groups, 1936. Cause of death. All ages. Deaths at different periods of life of residents whether occurring within or without the district. Under 1 year 1-2 years 2-5 years 5-15 years 15-25 years 25-35 years 35-45 yerrs 45-55 years 55-65 years 65-75 years 75 years and upwards. M F M F M F M F M F M F M F M F M F " M F M F M F A —Infectious and Parasitic Diseases 100 69 5 6 9 7 8 8 4 7 8 15 15 12 5 11 6 i 22 4 3 5 1 7 B.—Cancer and Other Tumours 110 93 - - - - - - - - 1 1 1 - 5 9 13 16 i 31 26 39 28 20 13 C.—Rheumatism, Diseases of Nutrition and of Endocrine Glands and other General Diseases 14 25 - - - - 3 2 2 3 - 1 1 3 4 4 1 2 2 9 - 1 D.—Diseases of the Blood and Blood-forming Organs 12 7 - - - - - - - 4 1 - 1 1 1 2 - 3 3 1 - - 1 E.—Diseases of the Nervous System and Sense 42 62 1 - 1 - - - - 3 1 1 3 1 2 1 3 8 9 12 12 20 10 16 F.—Diseases of the Circulatory System 201 258 - 1 - - - - - - 4 - 3 4 5 3 19 15 ; 36 24 67 84 67 127 G.—Diseases of the respiratory System 73 78 15 10 4 1 1 1 - 3 2 1 5 2 - 1 5 4 16 13 9 12 16 30 h.—Diseases of the Digestive System 51 35 11 7 1 — 1 2 1 1 - 1 3 2 2 3 8 — 9 8 11 5 4 6 I.—Non-Venereal Diseases of the Genitourinary System and Annexa 40 19 - - - - 1 - - - 1 - - 1 - 2 4 5 ; 6 2 13 5 15 4 j .—Diseases of Pregnancy, Childbirth and the Puerperal State - 4 - - - - - - - - - - 1 - 2 - - - - - - - - K —Diseases of the Skin and Cellular Tissue 3 1 1 - - - - - - - - - - - - 1 - - - 1 1 - - L.—Diseases of the Joints and other Organs of 1 - 1 - - - - - - - - - - - - - - - - - - - - - M.—Congenital Malformations 6 2 6 - - - - - - 1 - - - - - 1 - - - - - - - - N.—Diseases of Early Infancy 15 15 15 15 - - - - - - - - - - - - - - - - - - -- O.—Old Age 9 18 - - - - - - - - 3 3 6 15 P.—Deaths from Violence 34 23 - 1 1 - - - 5 1 3 2 3 3 7 2 5 3 1 5 4 3 2 2 5 Q.—III Defined Diseases 1 - - - - - - - - - - - - - - - - - - - 1 - - - Totals 712 709 57 40 16 2 10 11 17 15 25 19 33 31 35 33 75 61 138 98 165 174 141 225 A-Innections and parasitic Diseases. 1. Measles 8 9 3 2 1 1 3 5 1 1 - -- - - - - - - - - - -- 2. Scarlet Fever - - - - - - - - - - - - - - - -- - - - - - - - - 3. Whooping Cough 8 2 1 1 5 - 1 1 1 - - - - - - - - - - -- - - - 4 Diphtheria 2 3 - — - — 2 1 - 2 - - - - - - - - - - - - -- 5. Influenza 4 9 - 1 - - - - - - - - - - - - - - 3 1 2 — 6 6. Erysipelas 1 3 - 1 - - - - - - - - - - - 2 - - 1 - - - - - 7. Acute poliomyelitis - 1 - - - - - - - - - 1 - - - - - - - - - - - - 8. Tuberculosis—Respiratory System 62 35 - - 1 - - - 3 - 7 7 14 14 10 2 11 6 i 14 4 2 2 - - 9 „Central Nervous System 5 1 - - - - 1 - 3 - - - 1 - - 1 - - -- - - - - 10 „Intestine and Peritoneum - 1 - - - - -- - - - - - - - -- - - - - -- 1 11 „Vertebral Column - 1 - - - - - - - - - - - 1 - - - - - - - -- - 12. „ of other Bones and Joints - - - - - - - - - - - - - - - - - - - - - - - - 13. „ Disseminated - 2 - - - - - 1 - 1 - - - -- - - - - - - - - - 14. Syphilis 7 - 1 - 1 - - - - - - - - - 1 - - - 4 - - - - - 15. Purulent Infection—Septicaemia 2 1 - 1 - - - - - - - - - - 1 - - - - - - - 1 - 16. Other Infectious Diseases 1 1 - - 1 - - - - - - - - - - - - - - - - 1 - - B.—Cancer and other Tumours 17. Cancer, Malignant Disease Buccal Cavity and Pharynx 6 - - - - - - - - - - - - - - - 1 - 1 - 3 - 1 - 18. „ „ DigestiveOrgans and Peritoneum 66 60 - - - - - - - - - 1 1 - 1 6 9 8 17 17 26 19 12 9 19„ „ „ Respiratory Organs 12 4 - - - - - - - - - - - - 1 1 3 6 - - 1 - - 20. „ „ „ Uterus - 6 - - - - - - - - - - - - - - - - - 1 - 2 - 2 21. „ „ „ Other Female Genital Organs - 3 - - - - - - - - - - - - - - - - - 1 - 1 - - 22 „ Breast - 10 - - - - - - - - - - - - - - - - - 5 - 1 - 1 23 „ „ MaleGenito- Urinary Organs 14 - - - - - - - - - - - - - - - - - 3 - 6 - 4 - 24. „ „ „ Skin 1 1 - - - - - - - - - - - - - - - - - - - 1 1 - 25.„ „ „ Other or Un- specified Organs 10 4 - - - - - - - - 1 - - - 2 - - - 4 1 1 2 2 - 26 Non-Malignant Tumours - 1 - - - - - - - - - - - - - 1 - - - - - - - - 27. Tumours of Undetermined Nature 1 4 - - - - - - - - - - - - - - - 1 - 1 1 1 - 1 C.—Rheumatism, Diseases of Nutrition and of Endocrine Glands, and other General Diseases. - 28. Rheumatic Fever 5 7 - - - - - - 2 2 1 - - - - 2 1 - 1 - - 3 - - 29. Chronic Rheumatism, Osteo-Arthritis 1 4 - - - - - - - - - - - - - - 1 1 - — — 2 - 1 30. Diabetes 2 12 - - - - — - 1 - - 1 - 1 - - - 3 - 2 1 4 - — 31. Diseases of the Thymus 1 - - - - - - - - - -- - - - - - - - - - - - - 32. „ „ Thyroid 2 2 - - - - - - - - - 2 - - - - 1 - - - 1 - - - 33.„ „ Adrenals 1 - - - - - - - - - - - - - 1 - - - - - - - - - 34. Other General Diseases 2 - 1 - - - - - - - 1 - - - - - - - - - - - - - D.—Diseases of the Blood and Blood-forming Organs. 35. Anaemia, Chlorosis 2 3 1 - - - - - - - - - - - -- - - - 2 1 - - 1 36. Leukaemia, Aleukaemia 10 4 - - - - - - - - 4 1 - 1 1 1 2 - 3 1 - - - - E.—Diseases of the Nervous System and Sense Organs. 37. Encephalitis 1 - - - - - - - _ _ - - 1 - - - - - - - - - - - 38. Meningitis 1 - - - — — — — - - 1 - - - - - - - - — - - — — 39. Tabes Dorsalis (Locomotor Ataxy) 1 2 - - - - - - - 1 - - - - - - - 1 1 - - - - - 40. Other Diseases of the Spinal Cord 3 - - - - - - - - - - - - - - - 1 - 1 - 1 - - - 41. Cerebral Haemorrhage, Apoplexy, etc 29 51 - - - - -- - - - - 1 1 1 2 6 7 10 9 18 1 10 15 42. Epilepsy - 4 - - - - - - - 1 - 1 - - - - - - - 1 - 1 - - 43. Other Diseases of the Nervous System 4 3 - - 1 - - - - - - - 1 - 1 - - - - 1 1 1 - 1 44. Diseases of the Ear and Mastoid Sinus 3 2 1 - - - - - - 1 - - 1 - - - - 1 - - 1 - - - F.—Diseases of the Circulatory System. - 45. Pericarditis 1 - - - - - - - - - 1 - - - - - - - - - - - - - 46. Acute Endocarditis 4 1 - - - - - - - - 1 - - - 1 - - 1 2 - - - - - 47. Chronic Endocarditis, Valvular Disease 20 23 - - - - - - - - - - 2 1 4 3 2 - 5 4 4 7 3 8 48. Diseases of the Myocardium 105 180 - 1 — — — - — — - - 1 3 - - 7 IS 13 6 37 56 47 102 49. Diseases of the Coronary Arteries, Angina Pectoris 28 17 - - - - - - - - - 1 - - - - 4 1 7 5 10 6 6 5 50. Other Diseases of the Heart 7 9 - - - - - - - - - - - - - - - - 3 2 2 2 2 5 51. Aneurysm 9 3 - - - - -- - - - - - - - - 4 - 3 2 2 1 - - 52. Arterio-Sclerosis 27 24 - - - - - - - 1 - - - — - 2 - 3 5 12 12 9 7 53. Diseases of the Veins - 1 - - - - - — - - - - - - — — - 1 - - - - - - G.—Diseases of the Respiratory System. - 54. Diseases of the Nose — 1 - - - - - - - 1 - -- - - - - - - - - - - - 55. Diseases of the Larynx - 1 - 1 — — - — — — - - — - — — - - - - — — — - 56. Bronchitis 28 24 2 1 - - - - - - - - - - - - - 1 I 7 3 6 2 12 17 57. Broncho-Pneumonia 29 32 11 6 4 1 1 1 - 2 2 1 1 2 - 1 2 1 . 5 5 1 6 2 6 58. Lobar-Pneumonia 12 14 1 - - - - - - - - - 2 - - - 1 1 4 5 2 3 2 5 59. Pneumonia (not otherwise defined) 2 3 1 2 - - - - - - - - 1 - - - - 1 - - - - - - 60. Congestion and Haemorrhagic-Infarct of Lung, etc. 1 3 - - - - - - - - - - - 1 - - - - - - - 1 - 2 61. Asthmo 1 - - - - - - - - - - - -- - - 1 - — — - - - - H.—Diseases of the Digestive System. - 62. Diseases of the Buccal Cavity, Pharynx, etc. - 2 - - - - - - - 1 - - - - - - - - - -- 1 - - 63. Ulcer of the Stomach or Duodenum 14 4 - - - - - - - - - - 1 - 2 - 6 - 3 - 2 3 - 1 64. Other Diseases of the Stomach 2 2 - - - - - - - - - - - - - 1 - - 1 - - - - 1 65. Diarrhoea and Enteritis (under 2 years) 12 7 11 7 1 - - - - - - - - - - -- - - - - -- - 66. „ „ (over 2 years) 3 3 - - - - - - - - - - 1 - - 2 1 - 1 1 - - - - 67. Appendicitis 5 4 . - - - 1 - 1 - - 1 1 - - - - - 1 2 1 1 - - 68. Hernia, Intestinal Obstruction 3 6 - - - - - 1 - - - - - - - - - 1 2 1 - 1 3 69. Other Diseases of the Intestines - 1 - - - - - - - - - - - 1 - - - - 1 - - - - - 70. Cirrhosis of the Liver 3 1 - - - - - - - - - - - 1 - - - - - - 2 - 1 - 71. Other Diseases of the Liver 1 2 - _ _ _ 1 _ > _ _ _ 1 _ — 1 _ 72. Other Diseases of the Gall Bladder and Ducts 7 3 - - - - - - - - - - - - - - - - 1 2 4 - 2 1 73. Diseases of the Pancreas 1 - - - - - - - - - - - - - - - - - 1 - - - - - I.—Non-Venereal Diseases of the Genitourinary System and Annexa. 74. Acute Nephritis 1 1 - - - - 1 - - - - - - - - - - 1 - - - - - - 75. Chronic Nephritis 17 11 - - - - - - - - 1 - - - - - 4 4 3 1 5 3 4 3 76. Nephritis (not stated to be acute or chronic) 2 2 - - - - - - - - - - - - 1 - - - - 1 - 2 1 1 77. Other Diseases of the Kidney and Annexa - 5 - - - - - - - - - - - 1 - 1 - - - 1 - - - 78. Diseases of the Bladder 4 - - - - - - - - - - - - -_- - -_- - - - - 1 - 3 - 79. Diseases of the Prostate 16 - - - - - - - - - - - - - - - - - 3 - 6 - 7 - J.—Diseases of Pregnancy, Childbirth and the Puerperal State. 80. Ectopic Gestation - 1 - - - - - - - - - - - 1 - - - - - - - - - - 81. Puerperal Sepsis (not returned as postabortion) - 1 - - - - - - - - - - - - - 1 - - - - - - - - 82 Eclampsia - 1 - - - - - - - - _ 83. Puerperal Embolism - 1 - - - - - - - - 1 - - - - - - - - - - - - X.—Diseases of the Skin and Cellular Tissue. 84. Cellulitis, Acute Abscess 3 1 1 - - - - - - - - - - - - - 1 - - - 1 1 - - L.—Diseases of the J oints and other Organs of Locomotion. 85. Diseases of Joints 1 - 1 - - - - - - - - - - - - - - - - - - - - - M.—Congenital Malformations. 86. Congenital Malformations 6 2 6 - - - - - - 1 - - - - - 1 - - - - - - - - N.—Diseases of Early Infancy. 87. Congenital Debility 1 1 1 1 - - - - - - - - - - - - - - - - - - - - 88. Premature Birth 11 6 11 6 - - - - - - - - - - - - - - - - - - - - 89. Injury at Birth 1 1 1 1 - - - - - - - - - - - - - - - - - - - - 90. Other Diseases peculiar to Early Infancy 2 7 2 7 - - - - - - - - - - - - - - - -- - - - - O.—Old age. 91. Old Age 9 18 - - - - - - - - - - - - - - - - -- - 3 3 6 15 P.—Deaths from Violence. 92. Suicide—By Solid or Liquid Poisons or Corrosive Substances 2 2 - - - - - - - - - 1 1 1 - - 1 - - - - - - - 93. „ By Poisonous Gas 4 4 - - - - - - - - - - - 1 1 1 1 - 1 1 - - 1 94. „ By Hanging or Strangulation - 2 - - - - - - - - - - - 1 - - - 1 - - - - - - 95. „ By Cutting or Piercing Instruments 2 1 - - - - - - - - - - - - 1 - - 1 1 - - - - - 96. ,, By Crushing 1 - - - - - - - - - - - - - 1 - - - - - - - - - 97. Homicide—By Other Means - 1 - - - - - - - - - - - - - 1 - - - - - - - - 98. Other Acute Accidental Poisoning (not by Gas) - 1 - - - - - - - - - - - - - - - - - 1 - - - - 99.. Accidental Burns (Conflagration excepted) 1 - - - 1 - - - - - - - - - - - - - - - - - - - 100 „ Drowning 3 - - - - - - 1 - 1 - - - 1 - - - - - - - - - 101. ,, Injury by Fall or Crushing, etc. 19 12 - 1 - - - - 4 1 2 1 - 1 3 - 3 - 3 2 2 2 2 4 102. Lightning 1 - - - - - - - - - - - - - - - - - 1 - - - - - 103. Violent Deaths of Unstated Origin 1 - - - - - - - - - - - 1 - - - - - - - - - - - Q.—Ill-Defined Diseases. - 104. Cause of Death Ill-Defined 1 - - - - - - - - - - - - - - - - - - - 1 - - - 17 TABLE 2.—BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1936. Rate per 1,000 Population. Annual Death Rate per 1,000 Population. Rate per l.OOC 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 14.8 0.61 12.1 0.01 — 0.07 0.01 0.05 0.07 0.14 0.52 5.9 59 122 County Boroughs & Great Towns including London 14.9 0.67 12.3 0.01 — 0.09 0.01 0.06 0.08 0.14 0.45 8.2 63 143 Smaller Towns (estimated resident populations 25,000 -50,000 at census 1931) 15.0 0.64 11.5 0.00 - 0.04 0.01 0.04 0.05 0.15 0.39 3.4 55 London 13.6 0.53 12.5 0.01 — 0.14 0.01 0.06 0.05 0.14 0.52 14.4 66 EAST HAM 14.4 0.47 10.6 — — 0.12 — 0.07 0.03 0.09 0.42 9.8 50 M 03 TABLE 4.—Ward Distribution of Deaths, and Ward Death Rates, 1936. Cause of death. Wards. South. Total. Deaths in Institutions. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle Central. Wall End. Greatfield. 1. Typhoid & Paratyphoid Fevers - — - — - ... - - - - - — 2. Measles 2 3 1 — 1 1 3 6 — — 17 15 3. Scarlet Fever — — — — — — — — — — — — 4. Whooping Cough 3 — 1 1 1 2 — 2 — — 10 9 5. Diphtheria 1 — — 1 — 1 — 1 — 1 5 5 6. Influenza 1 1 3 1 2 1 2 - 1 1 13 1 7. Encephalitis Lethargica — — — — — -— — - — — - — 8. Cerebro-SpinalFever — - — — — - - - - - - — 9. Tuberculosis of Respiratory System 3 9 10 9 7 11 11 19 8 10 97 61 10. Other Tuberculous Diseases 2 — — — 1 1 3 — — 3 10 8 11. Syphilis — — 1 1 — 1 1 1 - 2 7 3 12. General Paralysis of the Insane, Tabes Dorsalis - 2 - - - - - 1 - - 3 3 13. Cancer 25 16 24 15 13 24 19 20 13 28 197 100 14. Diabetes 2 — 3 2 1 2 1 2 - 1 14 9 15. Cerebral Haemorrhage, etc. 4 9 9 10 8 5 4 9 12 10 80 42 16. Heart Disease 33 23 28 59 45 53 39 43 38 34 395 187 17. Aneurysm 1 1 1 1 1 1 2 — 2 2 12 3 18. Other Circulatory Diseases 11 6 5 5 5 5 8 3 2 2 52 12 19. Bronchitis 4 9 5 3 5 7 4 7 4 4 52 19 20. Pneumonia (allforms) 9 10 5 10 7 9 11 10 11 10 92 51 21. Other Respiratory Diseases 1 1 1 1 — — - 1 1 1 7 5 22. Peptic Ulcer 2 2 — 2 2 — 1 5 1 3 18 13 23. Diarrhoea, etc. 3 4 2 1 1 3 1 3 5 2 25 23 24. Appendicitis — 2 — — 2 2 — 2 - 1 9 8 25. Cirrhosis of Liver — — — 2 — — — - 1 1 4 3 26. Other Diseases of Liver, etc. 1 2 — 2 — 1 2 1 3 1 13 7 27. Other Digestive Diseases 4 1 1 1 — 1 4 2 3 17 13 28. Acute and Chronic Nephritis 3 4 2 5 4 2 3 5 4 2 34 21 29. Puerperal Sepsis — — — 1 — — — — 1 1 30. Other Puerperal Causes — — — — — — - 1 1 1 3 3 31. Congenital Debility, Premature Birth, Malformations, etc. 6 3 1 7 3 1 1 10 3 3 38 20 32. Senility 7 3 3 3 2 2 3 - 3 1 27 12 33. Suicide 1 6 1 — — 4 - 3 2 1 18 5 34. Other violence 7 6 3 3 5 2 1 3 1 8 39 29 35. Other defined causes 13 14 11 9 11 10 9 18 7 9 111 74 36. Causes ill-defined or unknown — — — — — — — 1 — — 1 — Totals 149 137 121 155 127 152 133 179 126 142 1,421 765 Rates (Census population for Wards) 10.7 8.4 9.5 11.3 10.8 11.1 9.5 10.4 8.9 9.1 10.6 — 18a TABLE 5. 18a Infant Deaths Under One Year of Age, 1936. CAUSE OF DEATH. Total Ages and Sex Total under 1 year Wards Deaths in Institutions  Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Manor Park Little Ilford Wood- grange Plashet Kensington Castle Central Wall End Great- field South M F M F M F M F M F M F M F M F M F Measles 5 - - - - - - - - - - - - 2 2 1 - 3 2 1 1 1 - - 1 1 - - - 5 Whooping Cough 2 - - - - - - - - - 1 1 - — - - - 1 1 - - - - 1 - - 1 - - 1 Influenza 1 - - - - - - - 1 - - - - - - - - - 1 - - - - 1 - - - - - - syphilis 1 1 - - - - - - - - - - - - - - 1 - - - - 1 - - - - - - — Heart Disease 1 - 1 - - — — - — — - - - - - - - - 1 - 1 - - - - - - - - - Bronchitis 3 — — — — - - - - - - 2 - - - - 1 2 1 - 1 - - - - 1 - - 1 1 Pneumonia 21 - - - - - - 2 - 4 2 4 2 2 2 1 2 13 8 2 2 2 1 - 1 4 3 2 4 10 Diarrhoea, etc. 18 - - - - - 1 2 - 4 2 1 2 3 - 1 2 11 7 2 4 2 1 - 1 - 2 5 1 17 Congenital Debility and Malformations, Premature Births 36 6 10 4 1 7 2 - - 3 - 1 - - 1 - 1 21 15 5 3 1 7 3 1 1 10 3 2 22 Other defined causes 9 1 - 1 - - - 2 - - 9 1 1 - 1 - - 5 4 3 1 - 1 - - - 2 - 2 7 All Causes 97 8 11 5 1 7 3 6 1 11 7 10 5 7 6 3 6 57 40 13 13 6 11 5 4 7 18 10 10 63 Infantile Mortality Rates per 1,000 live births 50 - - - - - - - - - - - - - - - - - 70 46 38 56 32 32 23 23 56 64 75 40 - It will be seen that this table has been extended at the request of the Ministry of Health to show the allocation of infant deaths to wards and ward infantile mortality rates. 19 Special Reports submitted to the Council during the year 1936. Date 1936 Subject January The existing and future use of Harts torium for certain types of tuberculous patients. „ Staffing of Harts Sanatorium. „ Training Scheme for Nurses. February Arrangements for the Treatment of Seamen suffering from Tuberculosis. March Rules and Regulations for the Resident Staff, Harts Sanatorium and Infectious Diseases Hospital. April Supervision of Midwifery Services of the Borough. „ Review of Home Help Scheme and Report upon Schemes for Home Helps in other areas. „ Distribution of work at Infant Welfare ics. „ Investigation into the causes of Still Births (additional report). May Maternity Schemes. June Admission of Maternity Cases to Forest Gate Hospital. „ Duties of District Nurse and Assistant lieving Officer. August Memorandum on the Deaf Blind. September Supervision of children under School Age. „ Maternity and Child Welfare Conference at Liverpool. „ Congress of the Royal Sanitary Institute at Southport. October Summary of provisions, Midwives Act. „ Conference of National Association for the Prevention of Tuberculosis. November Proposed scheme under Midwives Act, 1936. 20 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. 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. The midwives from the Sir Henry Tate Home attend a few mothers in the North Woolwich area. 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 1936, was 56. Of this number 37 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches—3 at Sir Henry Tate Nurses' Home, Silvertown—2 at the Kelvingrove Nursing Home, Windsor Road—and 14 practised independently. Summary of Visits Paid during 1936 by Nurses of Plaistow Maternity Hospital and District Nurses Home. Midwifery 430, Monthly 156, Hospital 329. 21 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 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 ,1936:— Ordinary Police East Ham 1352 491 West Ham 3 3 Ilford — 1 Barking 4 16 East Ham for:— West Ham — 10 Ilford — — Barking 14 16 1373 537 Calls (as above) 1910 Not required on arrival 79 Malicious calls 14 Special service calls 3 Maintenance journeys, etc. 88 Total number of journeys 2094 Total mileage: 16,659. Average mileage per journey: 7.95. Owing to the reciprocal arrangements with adjoining authorities in the event of breakdown or emergency, the two ambulances meet the needs of the Borough. 22 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 1936 are shown below:— Specimen Number Blood for Widal Test 1 Cerebro-spinal Fluid 1 Faeces (for Tuberculosis) 3 Mantoux Skin Test (Tuberculosis) 68 Pleural Effusion 4 Smear (for Gonococci) 1 Sputa (for Tuberculosis) 1087 Sputa (for Tuberculosis-Antiformin method) 24 Swabs (for Tuberculosis) 3 Total 1192 Pathological examinations carried out by Counties P. H. Laboratories during ,1936:— Blood (for Streptococci) 1 Pus (for Streptococci) 4 Swabs (for Streptocci-various) 36 Virulence Test (for Diphtheria) 1 Total 42 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. 3,378 219 3,159 Of the above total 2,485 were examined at the hospital. 23 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 (if 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 Public Baths and houses 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 24 Public Health Acts Amendment Act, 1907, Part VI July 12, 1932 Dec. 19, 1932 Public Health Act, 1925, Part VI Public Health Act, 1925, Part III, Sec. 43 and 44 June 9, 1936 Aug. 1, ,1936 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. 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. Nuisances. Offensive Trades. 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. 25 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, and amendments to the same in later reports. Public Assistance Domiciliary Medical Service. The detailed scheme was set out in my report for 1934. TABLE 6. Public Assistance Domiciliary Medical Service. Statistical Return for the Year Ending 31.12.36. 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. 2,507 4,952 15,435 20.387 1,325 812 Number of cases urgently admitted to hospital 3 Number of applications to Medical Officer of Health for hospital treatment 92 Public Assistance Nurse and Assistant Relieving Officer Number of requisitions received for attendance of nurse 42 Total attendances at homes by nurse 1922 Number of Maternity cases 229 Total visits to such cases 513 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 1936:— Number of individual patients 70 Number of attendances at homes 322 Number of attendances at surgery 329 Total number of attendances 651 26 Number of occasions medicines supplied without seeing patients 25 Number of recommendations for extra nourishment 10 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 20 Soft Chancre 2 Gonorrhoea 97 Not Venereal 125 Total 244 Total attendances of all patients 14,614 Number of in-patient days during 1936 245 There were fewer cases of specific disease in comparison with the previous year, and a larger attendance of non-venereal cases. The total attendances decreased. Pathological Examinations. For or at the Centres— Spirochaetes 28 Gonococci 2648 Wassermann 409 Others 801 Total 3886 27 For Practitioners— Spirochaetes — Gonococci 41 Wassermann 32 Others 35 Total 108 During 1936, one East Ham patient was in residence under the Hostel Scheme for a period of 202 days. 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 sessions at the centres are as follows, viz: — 28 TABLE 7. 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 Tuesdays, 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, 2i p.m.; Thursday, 2 p.m. „ „ Light Clinics Monday, 9 a.m. (Girls); „ 2 p.m. (Babies). Tuesday, 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. (Girls & Babies). 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 Clinic. (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. *From 13.7.36 at High Street Schools. 29 With the exception of the General Clinic, Town Hall, which was temporarily removed to High Street School in July, and some re-organisation of areas and re-allocation of medical services, there were no alterations or additions to the Clinics. The X-ray equipment installed at the Chest Clinic is described under the Tuberculosis section. 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. East Ham and Southend-on-Sea Joint Hospital Board. The following buildings were completed and in use at the end of 1936:— The Administrative Unit, Admission Hospital, Male Convalescent, Male Non-Parole, Women's Convalescent (for Staff), Harper Unit (Sick Hospital). At this period several other buildings were finished but not furnished or occupied—they were in use shortly after the New Year, although it was not possible to effect any strict classification of patients. Cases were first admitted on 21st May, 1936. 30 It is anticipated that the official opening of the Hospital will take place about June 1937. A Psychiatric Clinic in association with Runwell Hospital has been established at the East Ham Memorial Hospital, patients attend on Fridays, 2 p.m. TABLE 8 Disposition of East Ham Mental Patients on 31.12.1936 Institution Male Female Total Brentwood 7 20 27 Canterbury 18 — 18 Cardiff — 18 18 Colchester 8 27 35 Cotford 9 — 9 Gateshead — 11 11 Gloucester 29 20 49 Goodmayes 29 6 35 Oxford — 12 12 Park Prewitt — 20 20 Peckham House 13 26 39 Powick (Worcester) 20 10 30 Runwell 87 32 119 Stone (Dartford) 6 2 8 Three Counties 1 23 24 Wells — 40 40 Miscellaneous Hospitals 9 10 19 Totals 236 277 513 (h) Smallpox. The provisional arrangements made with the London County Council for the reception of cases has continued throughout the year. (i) East Ham Memorial Hospital. The number of beds remains the same, viz., 100. The following tables are abstracted from the hospital report for 1936:— 31 TABLE 9. 1.—In-Patients. Number of Beds and In-Patients. Numbers in 1936 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 1.6 1.2 (iii) Other Causes — — (d) Average Daily Number Open during the year 98.5 98.8 (e) Average Daily Number Occupied during the year 94 2 95,4 2. Number of In-Patients in the Hospital at beginning of year. 96 98 3. Number of In-Patients admitted during year 1,850 1,527 4. Number of In-Patients in the Hospital at the end of the year 91 96 5. Average number of days each Patient was resident (ascertained by dividing the yearly total of daily counts, viz.:— 34 472 by the number of Patients treated to a conclusion, i.e., (2) plus (3) - (4).) 18.58 22.8 6. Number of Patients admitted and discharged during the year who were resident for— (i) only 1 day 94 67 (ii) 2 and 3 days 144 96 2.—Out-Patients. Numbers. Numbers in 1936 Numbers in previous year 1. Total number of new Out-Patients 14,134 12,957 2. Total number of Out-Patient Attendances 80.113 72,407 (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 3,970 3,516 (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 - - 32 (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. 33 TABLE 10. Cases Admitted to West Ham Corporation Public Assistance Institutions from East Ham. Institution. Chargeable on 31.12.35 Admitted during 1936 Born during 1936 Total. Discharged. Died. Transferred to other Instns. Chargeable on 31.12.36 Whipps Cross Hospital 149 1687 — 1836 1197 273 234 132 Central Homes 246 441 - 687 127 173 141 246 Forest Gate Hospital 126 300 209 635 469 7 26 133 Forest House and Cottages 36 23 — 59 — — 19 40 34 (k) Aldersbrook Homes and Scattered Homes. Mr Pitt Steele, Superintendent of the Children's Homes, Aldersbrook, has kindly supplied the following information: TABLE 11. Highest number chargeable during 6 months ending 30-6-36 507 6 months ending 31.12.36 507 Lowest „ „ „ 462 „ „ „ 459 In Receiving Homes on 1st January, 1936 297 1st July, 1936 262 „ Scattered „ „ „ 203 „ „ „ 205 500 467 In Receiving Homes on 1st July, 1936 262 1st January, 1937 270 „ Scattered „ „ „ 205 „ „ „ 189 467 459 On 1st July, 1936, chargeability was apportioned as follows:— To the County Borough of East Ham 75 1st January, 1937 68 „ „ „ „ West Ham 253 „ „ „ 254 „ Essex County Council 139 „ „ „ 137 467 459 Average No. of admissions weekly —6 months ending 30-6-36 10 6 months ending 31.12.36 8 „ „ discharges „ „ 11.2 „ „ „ 81 Greatest No. of admissions on any one day—6 months ending 30-6-36 10 „ „ „ 10 Number of deaths in institutions— 6 months ending 30-6-36 1 „ „ „ Number of children admitted from East Ham—6 months ending 30-6-36 56 „ „ „ 37 Number of children admitted from West Ham—6 months ending 30-6-36 136 „ „ „ 99 Number of children admitted from Essex C.C.—6 months ending 30-6-36 78 „ „ „ 70 Extracts from the six-monthly Reports of the Medical Officer (Dr. J. S. Coleman): September, 1936. HEALTH OF THE CHILDREN. The incidence of serious sickness amongst the children has been small. Apart from minor injuries and ailments which were treated at Aldersbrook, 4 cases of more serious injury, and 3 of severe illness occurred, all of which were removed to Whipps Cross Hospital for Treatment. 35 INFECTIOUS DISEASE. During the period under review there have been successive epidemics of Measles, Whooping Cough and Chicken Pox, confined almost exclusively to the Nursery and smaller children. With each disease the outbreak has coincided with an epidemic wave that has swept the whole country. Every effort was made in consultation with the Medical Officer of Health to keep the numbers down, by the rigid isolation of infected children, contacts and new admissions, and the transference of several cases to Isolation Hospital, when nursing at Aldersbrook was considered inadvisable. An outbreak of Diphtheria on William Morris Lodge was checked by the rapid immunization of all the children and staff with appropriate serum. In addition two members of the nursing staff contracted Scarlet Fever. DEATHS. One death occurred in the Homes—an infant aged 8 months, the cause of death being Meningeal complication of lobar pneumonia. GENERAL NURSING AND DIETS. The care and attention given to the personal hygiene of every chilid by the Matron and her staff is reflected in the bright clean appearance and happy disposition of the children—who were never better cared for, clothed and fed than they are to-day. These welcome factors must ally themselves with the ultimate object of giving these boys and girls a real opportunity to become good and useful citizens. THE NURSERY. The work in this unit continues with the same even tenor and calculated efficiency. It is pleasing to record the happy relationship that exists between the nurses and the infants. In many instances there is a real "Mothering" affection for the babies, which in my opinion is of more value and advantage to the infants than more expert "automatic" nursing. Seven infants were successfully vaccinated with parental consent. 36 ACCOMMODATION. There has been sufficient suitable accommodation for all age groups of children. THE SCATTERED HOMES. The health and well-being of the children in these Homes continues at a high standard. This is in no small measure due to the responsibility accepted by the Foster Mothers, and the ever watchful supervision of the Matron, of every detail of administration of these Scattered Homes. DENTAL SUPERVISION AND TREATMENT. Mr. Rose has made his routine visits of dental inspection at Aldersbrook and the Scattered Homes, in addition to giving his prompt attention to all cases referred to him as emergencies. The teeth of the children under our care are in good order. January, 1937. The health of the children has been very good, and the number of cases of serious illness small. Of infectious diseases, sporadic cases occurred as follows:— Ringworm 2, Measles 2, Whooping Cough 3, Chicken Pox 16, whilst a sharp epidemic of Diphtheria with 8 cases was promptly dealt with as described in my December report. The low figures for infectious diseases are in great measure due to the vigilance of the Staff in recognising early symptoms of the various contagious diseases, so that these cases are brought to my notice at once, and speedily isolated or disposed of to other Institutions for treatment. The care and nursing of the children is maintained at a high standard. The supply of medical and surgical requisites has been adequate in every way. 37 No deaths have occurred, and the small number of serious accidents reported speaks for the high discipline which is everywhere apparent. There has been adequate accommodation for all our needs. This has in some measure been made possible in the various Blocks by the judicious movement of children to the Scattered Homes as and when required by the influx of new cases. As reported elsewhere, I have carried out a systematic routine inspection of all the children. The defects discovered are being remedied as speedily as possible in order of the urgency of individual cases. I have visited the Scattered Homes as and when required, and am pleased to report that the health and wellbeing of the children continues at a high standard. The diet, clothing, and daily routine are considered to be well suited to the requirements of the various groups of children. The dental work has been carried out with promptness and efficiency by Mr. Rose. 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 12. VISITS. No. of reports— register, files, &c. Number of interviews Statutory Supervision Guardianship Institution Training Centre Friendly Care Total 930 165 154 113 116 1,478 820 110 38 TABLE 13. Particulars of Mental Defectives as on 1st January, 1937. (A) "Subject to be dealt with" by the Local Authority. (B) Who may become "subject to be dealt with" by the Local Authority. N.B.—No case is included under more than one heading of A or B. A.—Number of mental defectives ascertained to be "subject to be dealt with ":— 1. Under "Order":— M. F. T. (a) (1) In Institutions (excluding cases on Licence)— Under 16 years of age 14 13 27 Aged 16 years and over 44 33 77 (2) On Licence from Institutions— Under 16 years of age — — — Aged 16 years and over 3 1 4 (b) (1) Under Guardianship (excluding cases on Licence)— Under 16 years of age 2 1 3 Aged 16 years and over 15 8 23 (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:— 76 82 158 Awaiting removal to an Institution 3 1 4 4. Action not yet taken under any one of the above headings:— (a) Notified by Local Education Authorities (Sec. 2 (2) ) 4 2 6 (b) Mental Defectives in receipt of Poor Relief:— (1) Institutional— (a) In Public Assistance Institutions and Municipal General Hospitals not approved under Sec. 37 - - - (6) In Institutions certified under the M.D. Acts (including those approved under Sec. 37):— (1) Cases "placed" under Sec. 3 1 2 3 (2) Other Cases — — — (2) Domiciliary — 7 7 (c) Otherwise "ascertained" — 1 1 B.—Number of mental defectives not at present " subject to be dealt with" but for whom the Local Authority may subsequently become liable:— 39 1. In Institutions or under Guardianship—dealt with tinder Sec. 3:— (a) In regard to whom the Local Authority contributes under its permissive powers 2 - 2 (6) 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 - - - (b) All other cases 27 22 49 Of whom, number, if any, under Voluntary Supervision 27 22 49 Number of above Cases on the Registers of Occupation and Industrial Centres:— Under Statutory Supervision 9 13 22 Under Voluntary Supervision 1 — 1 On Licence from Institutions — — — Under Guardianship 3 5 8 On Licence from Guardianship — — — DURING THE YEAR 1936. 1. (a) Number of instances in which Licence was granted during 1936:— M. F. T. (1) From Institutions 2 1 3 (2) From Guardianship - 1 1 3 Institutional and 4 Guardianship cases were granted 2 weeks holiday at Seaford and Bognor Regis. (6) Number of instances in which cases on Licence have been returned to Institutions or transferred to Guardianship during the year 1936— (1) To Institutions - - - (2) To Guardianship 1 - - * Two were returned but again Licensed. 2. Cases notified by Local Education Authorities (Section 2 (2)) during the year 1936:— Method of disposal— M. F. T. Sent to Institutions (by Order) — — — Placed under Guardianship (by Order) — — — Placed under Statutory Supervision 7 3 10 Placed in "Places of Safety" - - - Died or Removed from Area 2 - 2 Action not yet taken— (a) In receipt of Poor Relief - - - (b) Others 3 2 5 Total 12 5 1 7 40 3. Of the total number of mental defectives known to the Local Authority:— (a) Number who have given birth to children during 1936:— (1) After marriage 1 (2) While unmarried - Males. Females. (b) Number who have married during 1936 — - Defectives under Guardianship. The number of defectives under guardianship orders on 1-1-37, chargeable to the Local Authority:— M. F. T. Residing in the guardianship of a parent 9 5 14 Not residing in the guardianship of a parent 8 4 *12 Total under guardianship 17 9 26 * 3 with relatives. Training and Occupation Centre. The morning' session is devoted to youths and boys, and the afternoon to women, girls, and young children. The work undertaken at the classes has reached a high standard, and the pupils show an intelligent interest both whilst they are at the Centre and after they reach home. They are delighted to exhibit their work to parents and friends. The successful result of their training is apparent from the number of orders received throughout the year. The trainees receive a small percentage of the sale of articles made by them, as some encouragement. Physical drill and musical games are indulged in freely, particularly in the afternoon. There is always a bright and happy atmosphere at the Centre. TABLE 14. Statistics of Training Centre, 1936. Morning Session—Males. Afternoon Session— Girls and Juniors. Grand T otal Attendances No. on Register No. of Sessions heid Total Attendances Average Attendance No. on Register No. of Sessions held Total Attendances Average Attendance 9 215 1,521 7.07 23 215 3,367 15.66 4,888 41 Blind Persons Act, 1920 The East Ham Welfare Association for the Blind has continued its good work throughout the year. The report states that all activities have been well maintained and the objects of the Association satisfactorily sustained. The number of blind persons on the register is 219, being 15 less than the previous year. The Committee record their appreciation of the hearty co-operation of the East Ham Council and the Education Authority in their work, and the grant of one hundred pounds to their funds. The Council's Ophthalmic Specialist examines all new cases and certifies where necessary. Number of cases examined 12 Number of cases certified 12 42 TABLE 15. Work of the Visitor to the Blind. Year. No. of technically Blind Persons on Register. No. of Visits to same. No. of Partially Blind Persons No. of Visits to same Other Visits. Total Visits. No. of Lessons Given Lessons Given in Cane Basket Work. Braille Moon. Knitting. Crochet. Wool Ball Work. Manual. Straw - bag making Daily. Eve'ng. 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 — 1936 224 2,456 41 149 236 5 2,738 487 — 232 147 54 33 — 21 — Note. The decrease in the number of visits is due to the fact that Miss Kingston attended hospital several days per week for the treatment of an injury sustained in the course of her duties. Also that visits formerly made in connection with payments to blind persons have now ceased. TABLE 16. Welfare of the Blind.—Registration. As at 31.3.37. M=Males. In the following tables, the registration of the blind, ages at which blindness occurred, training and employment and occupations, as at 31.3.37, are set out:— F=Female. T = Total. 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 (l) 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 1 4 1 3 4 15 13 28 19 12 31 24 21 45 17 13 30 37 39 76 (i) 116 102 218 (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 5 6 6 5 11 4 6 10 12 7 19 8 8 16 11 12 23 18 12 30 23 23 46 13 13 26 5 3 8 Children of School Age 5-16 Normal Mentally tive Physically tive M F M F M F In Schools for the Blind 1 - - - - 1 Other Schools - - - - - - Not at Schools - — 2 — — — Occupations of Employed Blind Persons. Agents, Collectors, etc. Basket Workers Bedding(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 Dealers, Tea Agents, News. Agents, Shopkeepers. 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 Machinists Upholsterers Within Institutions for the Blind - 2 3 - - - - - - - - - - - - - - - 1 - - - - - 1 - - - - - - 4 - 11 In approved Home Workers Schemes - - - - - 1 - - - - - - - - - - - - 1 - - - - - - - - - - - 3 - - 5 Others (not pastime Workers) 1 1 - - - 2 - - 1 - 2 - 1 - - 3 - - - - 1 - - - - - - - - 2 - - 2 16 Total 1 3 3 - - 3 - - 1 - 2 - 1 - - 3 - - 2 - 1 - - - 1 - - - - 2 3 4 2 32 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. 8 3 11 10 9 19 (i) 8 (i) 8 (i) 16 — — — 1 — 1 — — — — - — 27 20 47 — 1 1 1 2 3 6 6 12 (ii)- (ii) 2* (ii) 2 * Deaf Mutes are also shown in the Deaf column. Training and Employment. Age period 16 and upwards. Employed Undergoing Training Trained but Unemployed (h) No Training but Trainable (i) Unemployable (j) Total (k) By Blind Organisations. All others not included in (a) & (b) (c) Total employed (d) Industrial (e) Secondary (f) Professional or University (g) Workshops Home Workers 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 6 11 4 1 5 12 4 16 21 11 32 3 3 6 1 — 1 — — — 4 — 4 2 1 3 82 87 169 116 103 219 42A 42b TABLE 16.— Continued. Number of persons over 70 years of age M. F. T. 37 39 76 Blind Persons Registered as New Cases (Not Transfers from other Registers) during the year ended 31. 3. 37. Arranged in Age Periods. 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. - - - - - - - - - - - - - 2 2 1 — 1 1 1 2 — 2 2 — 2 2 (i) 2 (i) 7 (i) 9 (ii) - (ii) - (ii) - Blind Persons Registered as New Cases (Not Transfers from other Registers) During the Year ended 31. 3. 37, arranged according to the age 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. - - - - - - - - - - - — — 2 2 - - — 1 - 1 1 — 1 — 4 4 — 1 1 — — - 43 Prevention of Blindness No action has been taken during the year under Section 66 of the Public Health Act, 1925. The Invalid Children's Aid Association. The East Ham Branch of the I.C.A.A. has again rendered invaluable service during the year. Under the auspices of the Association a large number of children have been accommodated at special hospitals, sanatoria and convalescent homes, with considerable benefit to their health. The close co-operation that exists affords a ready means of overcoming difficulties for the immediate treatment of sick and debilitated children, and those suffering from post-operative conditions. The careful supervision of the various Homes is a factor of which the I.C.A.A. is ever mindful, and expressions of gratitude and thanks received from parents contained in the Annual Report shew the extent to which the work of the Association is appreciated. It is a fact worthy of note that during recent years there has been a gradual decrease in the number of seriously crippled children. This is excellent testimony to the effective value of the Association's service. Mrs. A. A. Woodman, S.R.N., Senior Health Visitor, was Chairman of the Branch for the year 1936, an honour merited by her great interest and work on behalf of the Association, extending over many years. I desire to express my thanks to the Committee and Officers for their continued assistance. 44 The following is abstracted from the Annual Report for the year 1936:— Number of cases dealt with 327 New Cases 188 Re-application for assistance 49 Referred for clothing 37 Extensions from 1935 53 327 The 188 new cases were referred by:— Hospitals and Medical Practitioners 82 Medical Officer of Health and Infant Welfare Centre 23 School Medical Officer and Education Committee 43 Public Assistance Committee 2 Tuberculosis and Chest Clinic 30 Parents, etc. 8 188 The types of new cases were as follows:— Tuberculosis 16 Rheumatism, heart and chorea 8 Anaemia and debility 27 Lung Conditions (non-tuberculous) 31 Marasmus and Malnutrition 14 Various 92 188 The 327 cases dealt with during the year have been assisted as follows:— Sent to Sanatoria, Nursing and Convalescent Homes 181 Extensions from 1935 53 Surgical instruments provided 40 Clothing 37 Referred to other Agencies 1 Referred for Visiting and Advice 15 327 45 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 57. The death rate was 0.4 per 1,000 population, as compared with a rate of 0.2 for 1935. This increase may be attributed entirely to the measles epidemic, the prevalence of whooping cough, and infantile enteritis. No cases of smallpox were reported during the year under review. Vaccinations 1936. The following figures shew the vaccinations carried out by the Public Vaccinators from 1/1/36 to 31/12/36:— Dr. O'Moore Dr. Brews Total Number of successful primary vaccinations of children under one year of age 443 31 474 Number of successful primary vaccinations of persons one year and upwards 82 12 94 Total primary vaccinations 525 43 568 Number of successful re-vaccinations 131 26 157 Scarlet Fever. Three hundred and fifty-nine notifications of this disease were received during 1936, as compared with 411 for the previous year. No deaths occurred from this cause, and 323 cases or 90.0 per cent. received hospital treatment as against 83.7 per cent, for the previous year. Diphtheria. Notifications for the year totalled 134, a decrease of 120 cases when compared with 1935. All the cases notified were removed 46 to and treated in hospital, 98.4 per cent. being the percentage removed for the previous year. The number of deaths was 5 or a case mortality of 3.7 per cent. There is no change in the arrangements for the supplying of antitoxin to Medical Practitioners as set out in previous years. Diphtheria Immunization Clinics. During the year 1936 1,078 infants and children have been completely immunised. The total number of inoculations performed has been 3,226, of which 933 were carried out at the Town Hall Clinic, 2,120 at the Maternity and Child Welfare Clinics, 86 at the Infectious Diseases Hospital, and 87 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 933 Number inoculated three times 298 Number inoculated twice 10 Number inoculated once 7 In addition to the above, three children were inoculated four times. Maternity and Child Welfare Clinics. Total number of inoculations 2120 Number inoculated three times 597 Number inoculated twice 34 Number inoculated once 6 In addition one child received six inoculations, five children five, and fifty-six four inoculations. Infectious Diseases Hospital. *Total number of Inoculations 86 (and completely immunised) 47 Private Practitioners. In addition to the above, during the same period 21 children were inoculated three times by private practitioners, one child five times, two children four times, one twice, and one once, and eight* children were completely immunised with one injection. * Inoculated once with A.P.T. Number inoculated in the various age groups:— Ages in years 1 2 3 4 5 6 7 8 9 10 11 12 13 14 and over No. inoculated 128 192 140 130 160 88 62 45 43 44 42 29 21 13 750 282 105 1137 N.B.—In considering the combined totals it will be noticed that G5.9 per cent. of the cases are in the age group 1—5 years, 24.8 per cent. in the age group 6—10 years, and 9.2 per cent. in the group over 10 years. The Schick test for susceptibility to Diphtheria was performed during the year in 1,028 of the completed cases, of which 972 proved negative. In 56 of the cases positive results were obtained and further inoculations were carried out. The total number of children completely immunized from 27/9/29 to 31/12/36 was 4,990, made up as follows:— Town Hall 2706 Maternity and Child Welfare 1716 Hospital 282 General Practitioners 286 Total 4990 Enteric Fever. Two cases notified, both of whom received hospital treatment. There were no deaths. Erysipelas. Fifty-nine notifications received, 22 removed to hospital, and four patients died. 48 Puerperal Fever. Seven cases notified, all received hospital treatment, and one died. Puerperal Pyrexia. Seven notifications received, five were admitted to hospital; no deaths occurred. TABLE 17. Total Cases of Notifiable Diseases, 1913-1936. Disease. 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Smallpox - - - - - 3 1 10 - - - - - - - 17 25 70 51 13 1 1 - - Scarlet Fever 526 667 499 267 341 272 530 718 1,355 502 170 215 221 350 798 832 743 484 245 779 701 979 411 359 Diphtheria 258 319 204 225 279 273 451 426 309 198 160 128 246 337 464 669 578 473 196 157 180 379 254 134 Enteric Fever 19 21 5 7 9 2 15 10 7 4 3 5 9 7 2 7 2 3 8 7 5 - 2 2 Erysipelas 119 130 96 86 66 52 72 72 57 34 32 38 41 41 38 60 49 63 54 55 69 74 55 59 Puerperal Fever 8 4 4 1 2 1 6 6 5 3 5 5 5 5 5 4 8 9 10 4 4 7 12 7 Puerperal Pyrexia Not Notifiable 11 11 12 14 6 23 10 11 14 7 Meningococcal Meningitis 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 6 Ac. Polio Myelitis 8 4 1 10 - - 3 1 - - 3 1 1 - 5 - 2 - 1 7 2 5 13 2 Ac. Polio Encephalitis Not Notifiable - - - - - - - - - - - - - 3 2 1 - - Dysentery Not Notifiable - - 1 - - - - - - - - - - - - 1 - - Malaria Not Notifiable - - 1 - - - - - - - - - - 1 1* - - - Measles Not Notifiable 1,650 1,404 1,538 Not Notifiable German Measles Not Notifiable 123 115 134 Not Notifiable Continued Fever - - - - - - 1 - - - - - - - - - - - - - - - - - Typhus Fever 1 - - - - - - - - - - - - - - - - - - - - - - - Pneumonia Not Notifi able 85 92 54 79 91 70 114 82 102 59 75 77 148 100 88 101 Total 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 1,568 858 677 * Induced in an Institution. 49 50 TABLE 18. Prevalence of and Control over Infectious Disease.—Notified Cases for the 53 Weeks ending 2nd January,, 1937. 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 359 3 83 150 50 34 29 8 2 - 32 59 23 33 38 21 21 45 31 56 323 - Diphtheria 134 1 37 55 20 10 10 1 - - 18 15 6 31 9 11 5 13 6 20 134 5 Erysipelas 59 2 2 1 1 2 7 10 30 4 6 4 3 8 3 6 5 10 5 9 22 4 Puerperal Fever 7 - - - - - 5 2 - - - - 1 - 1 1 - 1 - 3 7 1 Puerperal Pyrexia 7 - - - - - 6 1 - - 2 - - 2 - - 1 - - 2 5 - Pneumonia 101 3 13 12 2 5 15 17 27 7 11 9 6 16 6 12 9 11 4 17 60 92 Ophthalmia Neonatorum 6 6 - - - - - - - - 1 - - 1 - - - - - 4 1 - Enteric Fever 2 - 1 - - - - 1 - - - 1 - - - - 1 - - - 2 - Acute Polio Myelitis 2 - 1 - - 1 - - - - - 1 - - 1 - - - - - 2 1 51 TABLE 19. Ophthalmia Neonatorum. Vision Unimpaired. Vision Impaired. Vision Lost. Still under treatment at end of year. Died. Removed from District. Not Classified. 5 - - 1 - - - Borough Infectious Diseases Hospital Dr. Landon's observations are contained in the following report upon the work of the hospital:- The year 1936 showed a decline in the incidence of infectious disease, although not so pronounced as the previous year. The total number of patients admitted to Hospital was 657, compared with 684 in 1935 and 1,290 in 1934. The death rates for the two most prevalent zymotic diseases were correspondingly low, namely 3.4% in the case of Diphtheria and nil per cent.in the case of Scarlet Fever. This comparative freedom from infectious disease appears to be due to a decrease in the infectivity of the causal organisms, although other factors, such as decreased susceptibility, or increased powers of resistance on the part of the individual, may also play their part. There can be no doubt, furthermore, that the immunisation of children against diphtheria is, in part, responsible for the smaller incidence of that disease resulting, as it does, in a diminution in the number of susceptible persons. Unfortunately, this state of affairs may not last indefinitely; and it is a well known fact that periods of quiescence, such as we are now experiencing, are liable to be followed by an increase both in the incidence and severity of epidemic disease. This view is expressed, in relation to scarlet fever, by a Report (No. 180, 1933) of the Medical Research Council, which suggests that the death rate for scarlet fever may have reached its lowest level and may tend to rise again. A similar immunity cannot, unfortunately, be claimed in the case of measles. Many cases, complicated by pneumonia and 52 enteritis, were admitted in the early part of the year. The provision of an oxygen tent will, it is hoped, do something to alleviate the symptoms in these severe cases, and may even be instrumental, in certain instances, in saving life. Diphtheria. During 1936, 142 patients were admitted compared with 250 during 1935. Of this number 105 were faucial, 30 nasal, 5 laryngeal, and 2 aural. Eleven patients remained under treatment at the end of 1936. As already stated, in most instances the infection was of low virulence, but severe cases occurred. Completed cases totalled 148. The number of deaths of cases treated at this hospital was five, giving a death rate of 3.4% as compared with 4.3% in ,1935. Tracheotomy was performed in two cases. In the first case the patient died as a result of continued obstruction, while in the second case the patient died two days after the operation as a result of heart failure. The remaining three deaths were due to the following conditions:— 1. Cardiac failure complicated by broncho-pneumonia and marasmus. 2. Cardiac failure complicated by broncho-pneumonia and measles. 3. Acute myocarditis following haemorrhagic diphtheria. There were several cases of recovery following severe and prolonged paralysis, notably the case of a boy of six years who developed, in addition, a severe degree of heart block with a pulse rate of 28 per minute. He was transferred to a heart hospital where he remained under treatment for several months. The age incidence of the patients admitted was as follows :— 0—5 5—10 10—15 15+ Total 40 59 21 22 142 Scarlet Fever. During the year, 320 cases were admitted compared with 344 cases during 1935. Fourteen patients remained under treatment 53 at the end of 1936. The type of disease was, on the whole, mild, but a number of severe cases occurred, including a case of haemolytic streptococcal septicaemia in a man of 21 years, resulting in widespread pyaemic abscesses, necessitating numerous incisions and prolonged drainage. He was transferred to the Memorial Hospital for the treatment of residual muscular weakness, etc., after a stay in Hospital of 69 days. The wide use of serum, the Dick test and immunisation against diphtheria were continued as in previous years. Of a series of 272 cases treated in the scarlet fever wards with antiscarlatinal serum:— 84.5% were discharged in four weeks. 5.9% were discharged in five weeks. 9.6% were discharged in from five to nine weeks. Complications for the series totalled 42 cases or 15.5%, this figure including such conditions as septic fingers, blepharitis, and other minor conditions not directly associated with scarlet fever. The main complications were:— Otorrhoea 2.9% Mastoiditis (followed by operation) 0.7% Endocarditis 1.9% Albuminuria 1.5% Rhinorrhoea 0.8% Adenitis 1.5% Other complications 6.2% In one case, where double mastoidectomy was performed, prontosil was used with good effect; the temperature, which had remained high 12 days after the operation, falling to normal in 24 hours. A good deal of research is going on as to the value of prontosil in the treatment of scarlet fever, but no reliable results are yet to hand. Bronchopneumonia. Sixty-six cases were admitted during the year. Of these, 29 followed measles, four following whooping-cough, 19 followed 54 measles and whooping-cough, and 14 were unassociated with either disease. The mortality rate for this series was high, namely 45.5%, and was due to the fact that a large number of these patients were less than a year old and were suffering, in addition, from acute enteritis. A big proportion of these cases came late under treatment, and many arrived at the Hospital in a moribund condition. In two cases death certificates were issued by outside doctors, as the patients died shortly after admission. Measles. Sixty-four cases of uncomplicated measles were treated, recovery taking place in all cases. Whooping Cough. Fifteen cases were admitted, recovery occurring in all cases. Convalescent Measles Serum. Convalescent measles serum was administered to contacts when a case of measles occurred in the scarlet fever wards. No further cases occurred. Erysipelas. Eight cases of varying severity were admitted during the year. Good results were obtained by the use of antiscarlatinal serum which, in three cases, was given intravenously. Puerperal Sepsis One case was admitted. Recovery followed the use of intrauterine glycerine combined with large doses of antiscarlatinal and polyvalent antistreptococcal serum. Bacteriological Examinations. During the year, 2,485 swabs were examined at the Hospital, and of this number 197 were found to be positive. 55 Laboratory Work. Investigations made included:— Blood cultures 1 Culture of pus 4 Virulence test for K.L.B. 1 Sputum for T.B. 1 Examination of C.S.F. 1 Preparation of autogenous antistaphylococcal vaccine 1 Post-Mortem Examination. An examination was performed on a patient who died after having been sent in as an observation case. An advanced general miliary tuberculosis was found to be present. Immunisation. See Diphtheria Immunisation. Operations. The following operations were performed:— Radical Mastoidectomy (including one double case) 2 Myringotomy 1 Lumbar Puncture 1 Mastoid incisions 2 Incision of breast abscess 1 Suture of draining tube to cervix 1 Aspiration of abscesses 4 Incisions of pyaemic abscesses 8 Incisions of glandular abscesses 20 Infection among Staff. The following cases occurred:— Diphtheria 1 Scarlet Fever 3 56 Measles 1 Influenza 5 Tonsillitis 11 Nurses' Training School. The percentage of passes in the Final State Fever examinations was 63.6%. In the Preliminary Nursing examination 87.5% of the candidates were successful. Note. Cases from Aldersbrook and the Scattered Homes admitted to the Isolation Hospital are notified to the Authority in the area in which they occur, hence the difference in the number of admissions to hospital and those registered in East Ham. 57 TABLE 20 Admissions, Discharges, Etc., 1936 —Borough Infectious Diseases Hospital. Disease. Remaining at end of 1935 Admitted during 1936 Died during 1936 Discharged during 1936 Remaining at end of 1936 Diphtheria 17 142 5 143 11 Scarlet Fever 43 320 — 349 14 Scarlet Fever & Measles - 1 — 1 — Scarlet Fever & Whooping Cough - 1 - 1 - Scarlet Fever & Chicken Pox - 1 - - 1 Broncho pneumonia & Measles 9 29 15 23 - Measles 12 64 - 76 - Erysipelas 1 8 — 9 — Broncho-pneumonia, Whooping Cough & Measles 1 4 2 3 - Pertussis 1 15 — 16 — Pneumonia - 14 5 8 1 Whooping Cough & Measles - 4 - 4 - Influenza - 1 - 1 - Tonsillitis - 2 - 2 - Impetigo - 1 - 1 - Whooping Cough & Pneumonia - 19 8 11 - Bronchitis - 1 - 1 - Chicken Pox - 23 - 16 7 Measles & Chicken Pox - 1 - 1 - Puerperal Sepsis - 1 - 1 - Tuberculous Meningitis - 1 1 - - Observation Cases - 4 - 4 - 84 657 36 671 34 58 TABLE 21. Borough Infectious Diseases Hospital Year ended 31st March, 1937. Expenditure Cost per Patient per week £ S. d. Salaries and Wages 5742 44 9 Superannuation 184 1 5 Provisions 2564 20 0 Anti-toxin 360 2 10 Disinfectants, Drugs and Appliances 220 1 9 Coal, Coke and Firewood 778 6 1 Electricity, Gas and Water 1157 9 0 Furniture, Bedding and Linen 189 1 5 Uniforms and Dresses 106 10 Chandlery and Sundries 523 4 1 Crockery and Hardware 32 3 General Repairs 429 3 4 Special Repairs and Alterations 700 5 5 Garden Implements, Seeds, etc. 68 6 Maintenance and Upkeep of Ambulances 623 4 11 Printing, Stationery and Advertisements 85 8 Rent of Telephone 53 5 Rates, Taxes and Insurance 364 2 10 Cinema Apparatus, Films, etc. 15 1 Provision of Greenhouse 200 1 7 £14392 112 2 Cancer. No investigations have been undertaken as set out in Circular 1136 of 31st July, 1930. Lectures are given to women's organisations and other associations on the subject of Cancer. Patients are referred to the general hospitals for investigation and special treatment. 59 Cancer Deaths, 1936: Total deaths 197 Males 109 Females 88 Classification: Cancer (type not stated) 3 Carcinoma 185 Epithelioma 3 Sarcoma 5 Rodent Ulcer 1 Total 197 The number of deaths attributed to cancer in all forms for the year 1936 is approximately the same as for the year 1935, and calls for no special comment. It will be seen, however, when fiveyearly periods are considered, that the rate is slightly above that for England and Wales. (Table 23.) This is more pronounced in the case of males than females. 60 Table 22. Cancer Deaths.—Parts of the Body Affected. Parts of Body Affected. Ages 0-1 1-2 2-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75 and upwards Total Sex M F M F ' M F M F M F M F M F M F M F M F M F M F Buccal Cavity and Pharynx - - - - - - - - - - - - - - 1 - 1 - 3 - 1 - 6 - Digestive Organs & Peritoneum - - - - - - - - - 1 1 - 1 6 9 8 17 17 26 19 12 9 66 60 Respiratory Organs - - - -- - - - - - - - - 1 1 3 2 6 - 2 1 - - 12 4 Uterus - - - - - - - - - - - - - - - 1 - 1 - 2 - 2 - 6 Other Female Genital Organs - - - - - - - - - - - - - - - 1 - 1 - 1 - - - 3 Breast - - - - - - - - - - - - - 1 - 2 - 5 - 1 - 1 - 10 Male Genitourinary Organs - - - - - - - - - - - - 1 - - - 3 - 6 - 4 - 14 - Skin - - - - - - - - - - - - - - - - - - - 1 1 - 1 1 Other or Unspecified Organs - - - - - - - - 1 - - - 2 - - 1 4 1 1 2 2 - 10 4 Totals - - - - - - - - 1 1 1 - 5 8 13 15 31 25 38 27 20 12 109 88 61 The information given in the table below covers a period of the last three quinquennia, 1921-1935, inclusive, and shows the percentage of cancer deaths to total deaths from all causes in each age group and for each sex, and East Ham deaths as compared with those for England and Wales. TABLE 23. Cancer Deaths—1921-1935—Sex and Age Groups. Age Group Males Females 1921—25 1926—30 1931—35 1921—25 1926—30 1931—35 East Ham England and Wales East Ham England and Wales East Ham England and Wales East Ham England and Wales East Ham England and Wales East Ham England and Wales 0—1 - 0.03 - 0.04 0.3 0.06 - 0.04 0.3 0.06 0.5 0.07 1—5 0.4 0.3 - 0.4 0.7 0.6 1.6 0.3 0.5 0.4 - 0.5 5—15 1.5 0.9 - 0.9 2.4 1.2 2.4 0.6 0.6 0.9 0.9 1.0 15—25 0.9 1.5 2.4 1.6 - 1.6 1.7 1.2 - 1.4 1.3 1.5 25—45 5.8 4.9 5.5 5.3 9.5 6.2 11.1 10.4 14.7 11.2 12.4 11.6 45—65 11.1 17.2 18.1 17.2 22.3 17.9 24.9 23.9 28.3 24.1 24.6 25.0 65—75 17.7 25.5 19.5 16.7 20.3 17.8 17.7 16.5 21.3 17.2 16.8 17.5 75 + 10.1 7.9 7.5 8.9 10.3 9.5 8.7 8.1 9.7 9.0 9.8 9.2 Total 11.2 9.3 11.2 10.6 13.7 11.8 12.4 11.6 15.1 12.8 14.2 13.7 62 Tuberculosis. Chest Clinic A description of the new Clinic was given in last year's report. An experience of twelve months in the new building, with its equipment for complete clinical and radiological investigations, with adequate facilities from the nursing and clerical point of view, with provision for handicraft classes, After-Care Committees, etc., indicates the great value, that such an all-inclusive Unit can be to patients and General Practitioners in the Borough. Diagnosis and treatment can now be carried out more quickly and with greater efficiency. The X-Ray apparatus recently installed consists of a fourvalve rectified transformer to operate from 415 volts three phase A.C. supply. Shockproof switch table with "leads" in an armoured flexible cable, dual control giving independent settings of milli amperage and kilo voltage for screening and radiography, with rapid changeover switch, are included in the equipment; also an auto transformer giving graduations of control, filament switch and rheostat, synchronous motor timer permitting of exposures down to l/50th of a second. A three-phase to single phase transformer was also added. The couch and screen stand is capable of long range movement up to 6ft. focal film distance. A LevyWest fluorescent screen and special cassette support and stool for seating patients at the other end of the couch, permits of rapid working and accurate radiography. The Metalix tube is enclosed in shock-proof shield. Notifications: The number of primary notifications during the year 1936 was 257 as compared with 255 for 1935. Of the primary notifications of pulmonary tuberculosis, in 46.8 per cent. tubercle bacilli were found in the sputum. In other words, 46.8 per cent. of cases were definitely infectious, and the smaller this number becomes the better the ultimate outlook for the individual sufferers. 63 Statistical: The total number of notified cases on the register of the Clinic on 31st December, 1936, was 953 (pulmonary and nonpulmonary), or 7.03 per 1,000 estimated population, as opposed to 974 or 7.19 per 1,000 population in the previous year. Of these 336 (or 35.2 per cent.) were definitely infectious, i.e. cases in which tubercle bacilli have been found in the sputum at some period of the illness. Deaths: The number of deaths (1931-1936) from tuberculosis is shown below. Pulmonary Non-Pulmonary Of Cases on the Clinic Register 1931 100 15 74 1932 108 16 91 1933 99 16 75 1934 92 15 80 1935 80 16 76 1936 97 10 77 New Cases: The following are the comparative figures for the years 1932-36:— 1932 1933 1934 1935 1936 New Cases (and Contacts) 511 504 510 548 618 Number proved, after complete investigation, to be tuberculous 32.1% 33.9% 36.4% 35.0% 29.4% 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 referred by local practitioners and hospitals, the increasing use made of such services. (2) The steady average of only about 33% of new patients proving, after close investigation, to be tuberculous. 64 Attendances and Medical Examinations. Total Attendances. Medical Examinations. 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 1936 3,733 3,297 Consultations at Homes of Patients: During the year 96 visits (including 18 personal consultations) to homes of patients who were too ill to attend the Clinic were made. New cases are visited by Dr. Ellman, old cases being visited by Dr. Crawford. Dr. Philip Ellman, Consultant to the Chest Clinic, comments on the work of the Clinic as follows:— 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. Co-ordination of the Work of the Chest Clinic and Sanatorium: Further experience of this close co-ordination, whereby my visits to the Sanatorium enable me to discuss the treatment of all cases with the Medical Superintendent, Dr. Crawford, is proving of inestimable value. We are thus able to assess the prognosis and results of treatment. A study of the patients' reactions to the varied forms of treatment advised—the psychological, social and economic factors—can, therefore, be made, with the result that the follow-up of such cases and the great importance of after-care is greatly enhanced, in value. 66 The present position of the Treatment of Pulmonary Tuberculosis in the light of recent advances. The problem of the treatment of pulmonary tuberculosis remains a twofold one, the disease producing two distinct manifestations:— (1) The general constitutional disturbance, due to absorption of bacterial products into the systemic circulation. (2) The local inflammatory lesion in the lung. Despite all the recent advances, nothing has arisen to replace an old established form of treatment, especially of factor (1), namely, the Sanatorium treatment, where every patient is treated under the best possible conditions with constant medical, nursing and dietetic supervision. The more recent therapeutic measures, valuable as they undoubtedly are, only serve as an adjunct to Sanatorium treatment. Moreover, during the last decade, with the remarkable progress in radiography, the value of certain important features of the Sanatorium regime have been doubly emphasised. Healing by Resolution in the soft exudative (non-fibrotic) type of disease has been clearly indicated by serial radiography. Complete immobilisation of the patient by Absolute Rest—an important aspect of Sanatorium treatment—is one of the very best methods of securing such healing. This result has tended to concentrate our attention, in selected cases, to the great value of Prolonged Rest as an important feature of treatment. Many patients accordingly undergo prolonged immobilisation with considerable benefit. If, however, serial radiographs show no signs of healing, Collapse Therapy is considered where conditions are favourable. Artificial Pneumothorax is undertaken and refills subsequently continued at the Clinic for several years. Unfortunately, the efficacy of this treatment is frequently hampered by (a) Pleural Adhesions preventing satisfactory collapse (often a contra-selective collapse). (b) Pleural Effusions which occur in about 50% of cases. 66 Pleural Adhesions can frequently be dealt with by cutting them, with the aid of a thorascope, with the Electrocautery, and this procedure of thoracoscopy and cauterisation of adhesions— in the hands of an Expert Thoracic Surgeon—may be responsible for a complete lung collapse. Phrenic Evulsion or Crush is another method of attack, which has been described in previous reports. Where artificial pneumothorax, with or without the aid of adhesion cutting is impossible, the more permanent method of surgical collapse of the lung is carefully considered. Here the very closest co-operation between the patient, physician and thoracic surgeon is essential for success. This team work is of the greatest importance. Several of our patients have undergone treatment by Partial or complete Thoracoplasty with strikingly successful results. In some cases the procedure has proved to be a lifesaving device. This recognition of lung immobilisation in the treatment of pulmonary tuberculosis has, of necessity, meant additional medical and nursing work entailed by this modern outlook. Finally the question of Drug Therapy which has played no little part in the more recent advances in treatment. There exists no specific drug treatment for tuberculosis, and in consequence many therapeutic agents have been, and continue to be, recommended for its cure nevertheless, certain drugs have been proved to be of value in clinical practice. All such known drugs are being utilised in the treatment of our patients. Cold Salts in conjunction with collapse therapy, or alone, are being used with an appreciable degree of success. Healing of tuberculous lesions, in selected cases, is not infrequently observed, reduction of the expectoration of sputum is experienced, and infective cases with tubercle bacilli in large numbers sometimes respond to a full course of treatment by becoming non-infective and losing their tubercle bacilli. The indiscriminate use of the drug is, however, fraught with danger, and its indications and contra-indications must be recognised. 67 Calcium Salts are sometimes used in the hope of stimulating calcification of tuberculous lesions. The gluconate intramuscularly and intravenously has been found to be the most reliable preparation. Vitamin Therapy. Cod Liver Oil continues to be of great value, not only because of its value as a food due to its high percentage of unsaturated fatty acids, but also because of its potency in respect of two fat-soluble vitamins, namely, A and D; one serving to increase resistance to infection, and the other promoting the metabolism of Calcium. Vitamin C Therapy: Clinical research has shown that the tuberculous subject makes an increased demand on Vitamin C (ascorbic acid) with the result that its excretion as measured by the urine is considerably lower than that execreted by the normal subject. The more active the disease the lower is the urinary excretion of vitamin C, and this excretion can to some extent assist in assessing a prognosis. In view of this reduced Vitamin C excretion the possibility of using Ascorbic Acid as a therapeutic measure in pulmonary tuberculosis becomes a practical proposition. Insulin continues to be used, where the important nutritional aspect requires attention, with very satisfactory results in selected cases. Details of its use have been outlined in previous reports. Tuberculin is also being used in a few cases where the possibility of stimulating further fibrosis arises. The careful spacing of doses to avoid severe reactions and its use to the limit of tolerance require the closest attention. It will be seen, therefore, that our patients have every opportunity of benefiting to the full—be it by Thoracic Surgical methods which are being increasingly utilised, or by Drug Therapy of various kinds—by advances in treatment. At the same time, the fundamental background of the Sanatorium regime with its opportunities for prolonged rest, and graduated exercise when indicated, is never lost sight of. X-ray Investigations in Diagnosis and Treatment. With the introduction of our new apparatus it is now possible to produce chest radiographs with the best possible 68 nique, and subsequent serial films enabling us to study the progress of the disease can be taken under precisely the same conditions. This enables us to make an exact and reliable comparison of the patients' condition at regular intervals of time. Many films have to be taken in varied planes—anterio-posterior, oblique and lateral, in order to render the greatest diagnostic help. Obviously increasing use is being made of these facilities as the figures go to show. No. of X-ray Examinations at the Chest Clinic. 1931 ,1932 1933 1934 1935 1936 352 454 533 633 762 1322 Whilst the number of these examinations has been doubled within the last two years, it can be stated that no patient is subjected to this examination unless there is a definite indication for it. Observation Cases. A limited number of patients require close observation in an institution by reason of symptoms and signs which closely resemble those of pulmonary tuberculosis. Where this is essential such patients are referred to an observation bed in the Sanatorium. Suspected cases of Cancer of the lung and bronchiectasis are the diseases which chiefly require such observation, and further investigations by - specialised methods can be done in the Sanatorium which clinch the diagnosis in a short period of time. Nursing Staff Duties of the Clinic. With the introduction of three specially trained Sisters, the tuberculosis work in the Borough is under very complete control. The Borough is divided up into three Districts, each under the supervision of a Sister, who is able closelv to follow up all cases. Each Sister is now able to become familiar with the medical, social and economic conditions of all her patients. This results in an increased interest in the work and promotes great efficiency. The quiet unobtrusive work of the Sisters is, with very few exceptions, greatly appreciated by patients and the local medical practitioners alike. Occupational Therapy. See Page 89 TABLE 24. Return showing the work of the Tuberculosis and Chest Clinic, 1936. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 71 56 1 4 5 8 6 6 76 64 7 10 157 (b) Diagnosis not completed — — — — — — — — 3 13 1 1 18 (c) Non-tuberculous - - - - - - - - 69 67 16 13 165 B.—Contacts examined during the year:— (a) Definitely tuberculous 8 11 1 4 — — — 1 8 11 1 5 25 (b) Diagnosis not completed - - - - - - - - 1 2 1 3 7 (c) Non-tuberculous — — — — — — — — 50 85 58 53 246 C.—Cases written off the Clinic Register as— (a) Recovered 1 4 1 2 1 1 2 2 2 5 3 4 14 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Clinic Register as tuberculous) - - - - - - - - 128 165 77 69 439 D.—Number of Cases on Clinic Register on December 31st, 1936:— (a) Definitely tuberculous 361 331 22 6 65 82 55 31 426 413 77 37 953 (b) Diagnosis not completed - - - - - - - - 4 15 2 4 25 69 70 1. Number of cases on Clinic Register on January 1st, 1935 1002 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 41 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 153 4. Cases written off during the year as Dead (all causes) 77 5. Number of attendances at the Clinic (including Contacts) 3733 6. Number of Insured Persons under Domiciliary Treatment on the 31st December, 1936 39 7. Number of consultations with medical practitioners:— (a) Personal 18 (b) Other 367 8. Number of visits by Tuberculosis Officers to Homes ing personal consultations) 96 9. Number of visits by Nurses or Health Visitors to Homes for Clinic purposes 4555 10. Number of (a) Specimens of sputum, &c., examined 882 (b) X-ray examinations made (inclusive of both film and screen examinations)1322 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, 1936 336 Number of Clinics for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 1 70A TABLE 25. 70a Pulmonary Tuberculosis. Supplementary Annual Return showing in summary form (a) the condition at the end of 1936 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 1927 1928 1929 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Tot«l(Class | T.B. Plus) Group 1 Group 2 Group 3 TotaKClass i T.B. Plui) Group 1 Group 2 Group 3 Tot»(ICIass T.B. Plus) Group 1 Group 2 Group 3 Tot»l(Class T.B. Plus) Group 1 Group 2 Group 3 Totalckass T.B. Plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 18 5 6 - 11 1 — 2 - 2 — — — - - 1 — — - - — 1 1 - 2 F. 8 1 2 - 3 1 — 1 - 1 4 - - — — 3 — — - - 2 — — — Children 7 - - - - - - - - - - - - - - - - - - - - - - - - Disease not Arrested Adults M. 11 8 13 — 21 — 2 1 3 2 1 2 - 3 2 4 2 6 5 2 2 — 4 F. 12 5 11 - 16 1 1 3 — 4 2 — 1 1 2 3 4 — — 4 4 4 2 2 8 Children 6 - - - - - - - - - - - - - - 1 - - 1 1 3 - - - — Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st Dec. 62 19 32 - 51 5 1 8 1 10 15 1 3 1 5 14 8 2 1 11 17 7 5 2 14 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 20 2 - — 2 1 1 — - 1 2 — 1 — 1 2 — — - - 2 — - - — F. 17 1 - - - - - - - - - - - - - - - - - - - - - - - Children 23 - - - - - - - - - - - - - - - - - - - - - - - 1 Lost sight of or otherwise removed from Dispensary Register 327 39 56 4 99 61 9 27 — 36 47 13 21 2 36 62 - 23 3 44 47 9 27 - 36 Dead Adults M. 39 8 55 29 92 9 2 24 12 38 5 3 29 11 43 10 2 25 10 37 4 3 25 16 44 F. 26 5 31 23 59 6 6 21 10 37 1 1 17 8 26 3 5 10 10 25 7 2 10 6 18 Children 5 - 1 1 2 1 - — 1 1 4 1 - — 1 1 — 1 — 1 — — — — — Total written off Dispensary Register 457 55 143 57 255 79 18 72 23 113 61 18 68 21 107 81 25 59 23 107 61 15 62 22 99 Grand Totals 519 74 175 57 306 84 19 80 24 123 76 19 71 22 112 95 33 61 24 118 78 22 67 24 112 1930 1931 1932 1933 1934 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 2 1 — 3 2 - - - - - - - - - - - - - - - - - - - F. 1 1 - - - - - - - - - - - - - - - - - - - - - - - Children 1 - - - - - - - - - - - - - - - - - - - - - - - - Disease not Arrested Adults M. 7 4 6 1 11 6 2 8 - 10 8 4 8 - 12 14 3 13 - 16 14 6 16 6 28 F. 6 - 9 1 10 9 4 8 - 12 11 3 6 1 10 21 3 5 1 9 8 3 15 1 19 Children 4 - - - - - - - - - - - - - - - - - - - 9 — 1 1 2 Condition not ascertained during the year - - - - - - - - - -- - - - - - - - - - - - - - - - Total on Dispensary Register at 31st Dec. 21 7 16 2 25 18 6 16 - 22 23 7 14 1 22 45 6 18 1 25 31 9 32 8 49 -(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 26 9 12 4 25 19 9 17 4 30 33 4 22 — 26 19 5 24 3 32 15 6 12 1 19 Dead Adults M. 7 4 16 20 40 4 1 13 6 20 4 2 19 6 27 4 1 16 9 26 4 1 13 13 27 F. 3 4 13 10 27 6 6 16 9 31 5 3 12 8 23 5 — 9 5 14 1 1 5 10 16 Children — - - 2 2 — — — - - 1 - 2 — 2 — — — — — 2 — — — — Total written off Dispensary Register 36 17 41 36 94 29 16 46 19 81 43 9 55 14 78 28 6 49 17 72 22 8 30 24 62 Grand Totals 57 24 57 38 119 47 22 62 19 103 66 16 69 15 100 73 12 67 18 97 53 17 62 32 111 1935 1936 (a) Remaining on Dispensary | Register on 31st December. Disease Arrested Adults M. - - - - - - - - - - F. - - - - - - - - - - Children - - - - - - - - - - Disease not Arrested Adults M. 24 7 16 5 28 37 1 21 7 29 F. 20 3 15 1 19 35 2 15 8 25 Condition not ascertained during Children 9 — — — - 8 1 — — 1 the year - - - - - - - - - - Total on Dispensary Register at 31st Dec. 53 10 31 6 47 80 4 36 15 55 (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 14 2 12 2 16 5 — 10 1 11 Dead Adults M. 3 — 7 15 22 - — 3 5 8 F. 1 1 5 7 13 — - — 1 1 Children - - — 1 1 - - - - — Total written off Dispensary Register 18 3 24 25 52 5 — 13 7 20 GrandTotals 71 13 55 31 99 85 4 49 22 75 70B TABLE 26 Non-pulmonary Tuberculosis. Supplementary Annual Return showing in summary form (a) the co ndition at the end of 1936 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 J oints Abdominal Other Organs Peripheral Glands Total Bones and J oints Abdominal Other Organs Peripheral Glands Total Bones and J oints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensar | Register on 31st December, Disease Arrested Adults M. 3 - 1 — 4 - — - — - - - - 1 1 1 — - - 1 2 — - — 2 F. 3 - - 1 4 - - — — - - - - - - - — — 1 1 - 1 - — 1 Children - 1 1 10 12 1 - - 1 2 2 - 1 2 5 2 — - 2 4 - 2 - 5 7 Disease not Arrested Adults M. .1 - 2 - 3 1 - 2 — 3 - - - - - 1 - 1 - 2 1 1 - - 2 F. 3 - 1 - 4 1 - — - 1 - - - - - - - - 1 1 — - - 2 2 Children 5 - 1 10 16 - 1 — - 1 1 -- - - 1 2 — - 4 6 2 2 - 1 5 Condition not ascertained during the year 1 1 - - 2 - - — 1 1 1 - - - 1 - - - - - - - - - - Total on Dispensary Register at 31st Dec. 16 2 6 21 45 3 i 2 2 8 4 - 1 3 8 6 — 1 8 15 5 6 - 8 19 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 - - - - - - - - - - - - - - - - - - - F. 4 1 1 1 7 — - — 1 1 - - - - - - - - - - - - - - - Children 9 2 2 18 31 — - - 1 1 - 1 - 2 3 — — - - - 1 - - 2 3 Lost sight of, or otherwise removed from Dispensary Register 60 10 19 97 186 11 3 6 16 36 7 1 2 10 20 — 2 5 15 22 8 — 4 20 32 Dead Adults M. 2 - - - -- - - - - - - - - - - - - - - - - - - - - F. 3 - - - - - - - - - - - - - - - - - - - - - - - - Children 4 - - - - - - - - - - - - - - - - - - - - - - 1 1 Total written off Dispensary Register 87 13 25 118 243 13 3 6 18 40 7 3 2 12 24 2 2 5 15 24 9 - 4 23 36 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 103 15 31 139 288 16 4 8 20 48 11 3 3 15 32 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 - - - -- - — — - — — — — — — - - - - - ^ , F. - - - - - - - 1 - 1 1 - - - 1 - - - - - - - - - Children 1 - 1 4 6 1 - - - 1 - - - - - - - - - - - - - - Disease not Arrested Adults M. - - - - - - -- - - - 1 — 1 1 3 1 1 1 1 4 2 1 — — 3 F. 1 1 2 1 5 - 3 2 - 5 2 - 1 1 4 2 - - 1 3 3 - - 2 5 Children 1 - - 3 4 - — - — - 6 4 - 5 15 5 1 - 5 11 2 - 1 8 11 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - 1 1 Total on Dispensary Register at 31st Dec. 3 2 3 9 17 1 3 3 - 7 10 4 2 7 23 8 2 1 7 18 7 1 1 11 20 Transferred to Pulmonary - - - - - - - -- - - - - - - - - - - - - - - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - - - 1 1 - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - -- - - - - - - - - - - - - - Lost sight of, or otherwise removed from the Dispensary Register - 3 3 15 21 7 - 3 12 22 4 2 1 4 11 4 5 3 6 18 3 - 2 4 9 Dead Adults M. 1 - 2 3 - - - - - 2 - - - 2 - - - - - 1 - - - 1 F. - - - - - - - - — 1 - 1 — 2 - - 1 1 2 - - - - - Children - - - 1 1 - - - - - - - - - - - - - - - - - - - - Total written off Dispensary Register 1 3 5 16 25 7 - 3 13 23 7 2 2 4 15 4 5 4 7 20 4 2 4 10 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 4 5 8 25 42 8 3 6 13 .... 30 17 6 4 11 38 12 7 5 14 38 11 1 3 15 30 1935 1936 (a) Remaining on Dispensary Register on 31st December. Adults M. - - - - - - - - - - Disease Arrested F. - - - - - - - - - - Children - - - - - - - - - - Adutls M. 2 — 2 2 6 2 — 2 1 5 Disease not Arrested F. 2 - 2 1 5 3 1 2 3 9 Children 2 2 11 15 1 1 - 10 12 Condition not ascertained during the year - — - 1 1 - - - - — Total on Dispensary Register at 31st Dec. 6 2 4 15 27 6 2 4 14 26 Transferred to Pulmonary - - - -- - - - - - - (6) 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 1 3 - - - - - Dead Adults M. - - - - - - - - - - F. - 1 - - - - - - - - Children - - - - - 1 - - - 1 Total written off Dispensary Register - 1 1 3 1 - - - 1 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 6 3 5 16 30 7 2 4 14 27 71 After History for five years of 263 New Gases of Tuberculosis reported from all sources in 1931. The close follow-up of cases of tuberculosis over a number of years yields information of considerable practical importance. An analysis, closely comparable with the Lancashire County Council Report last year, of the cases to show how they fared during the five years succeeding 1931, that is, to 1936, is here reproduced in the form of a chart. As in Lancashire the observation of each living case has been carried to a period of five years after the date when first reported to us as tuberculous. For instance, a case first coming to our notice in May, 1931, has been followed up (if living and still tuberculous) until May, 1936. The following noteworthy features are presented:— 1. 71.1 percent. of the gross number of new tuberculous cases coming to our knowledge in the County Borough of East Ham during 1931 were dealt with under the tuberculosis scheme. A further 6.0 percent. of the gross number related to cases in which the statutory notification was cancelled, after a period of observation. 2. The reasons why 22.9 percent. of the gross number did not come directly under the Council's scheme were: (a) Cases reported at death only, 5.0 percent. (b) cases in Mental Hospitals, 0.8 percent; (c) cases dying within several weeks (average three weeks) of notification, 9.5 percent.; (d) cases removing from the County Borough area several days after notification, 4.2 percent.; and (e) patients declining to have treatment under the official Council scheme, 3.4 percent. 3. Of the 149 pulmonary cases, 79.8 percent. received one or more periods of sanatorium or hospital treatment; of 38 nonpulmonary cases, about nine-tenths received special treatment at a hospital (e.g. orthopaedic and artificial light). 4. Of the net number (101 of definite pulmonary cases, removals from area, etc., excluded), 61 died from tuberculosis within the five years (34.5 percent. dying in the first year, 3,1.2 percent. in the second year, 14.7 percent. in the third, 13.1 percent. in the fourth, and 6.5 percent. in the fifth). 72 It is estimated that 55 cases of the 263 new cases were cases of adolescent phthisis, i.e. at least one in every 5 occurred between the 15-25 years period. It is a well-known fact that (1) cases occurring at this age of life have a poorer prognosis; (2) many of them occur as a result of contact with other cases of pulmonary tuberculosis in the home. The greatest significance is placed upon the need for the examination of every adolescent person who has been in contact with a case of pulmonary tuberculosis whose sputum is positive. Most unfortunately, whilst child contacts in whom the risk of pulmonary tuberculosis is a small one, and who, like all school children, are under the preventive supervision of the School Medical Service, attend the Clinic for examination in large numbers, great difficulty is often experienced in getting the adolescent contact to attend for a preventive examination. Parents, who themselves are often keen on these adolescents being examined, frequently state that they cannot get them to attend for examination, because they are well and see no reason for such precaution. On many occasions it has been observed subsequently that pulmonary tuberculosis has developed in such adolescents in a very acute form. They have been obliged to attend the Clinic on account of symptoms, and advanced disease has not infrequently been detected. It would have been easier to have seen these people before the onset of disease and to have urged the valuable preventive measures to be adopted. Our Visiting Sisters are aware of this important problem of the development of phthisis in the adolescent contact, and a special drive is made (sometimes at the risk of making themselves a great nuisance to the family) to get these contacts to attend the Clinic. 72A TABLE 27. CHART SHOWING HISTORY FOR FIVE YEARS OF 263 NEW CASES OF TUBERCULOSIS REPORTED FROM ALL SOURCES IN 1931. Total New Cases of Tuberculosis Reported from all Sources during 1931. 263 Cases Reported at Death only Cases found to be Non-T.B. and Notification Cases not dealt with under Tuberculosis Scheme Number of Cases Treated under Tuberculosis Scheme 13 16 47 187 Transferred from other Areas and found to be recovered Died from other than Tuberculosis Cases in Mental Institutions, etc. Patients refusing Treatment Died Several Weeks after Notification Changed Address few days after Notification 0 0 2 9 25 11 Number of Cases Treated under Tuberculosis Scheme 187 1 Pulmonary Tuberculosis 1 Non-Pulmonary Tuberculosis 149 38 Males 72. Age 0-15—5. Males 17. Age 0-15—19. Females 77. A sre 15-45—116. Females 21. Age 15-45—19. Age 45 4—28. Age 45-0. Received Institutional Treatment between 1931 and 1936 Received Home Treatment and Dispensary Supervision only About Nine-Tenths of Special Treatment these Patients received in Hospitals or Dispensary. 119 30 Position at End of 5 years. Position at End of 5 years. Died from other than Tuberculosis Died from Tuberculosis Removals, further Untraced, Refused Treatment Eventually found to be Non-Tuberculous Still under Treatment Died from Tuberculosis Removals, Untraced, Refused further Treatment Eventually found to be Non-Tuberculous Still under Treatment Recovered after 3 years Quiescence 3 61 48 2 35 1 19 0 17 1 Within 12 months 1-2 years 2-3 years 3-4 years 4-5 years 4-5 years 1 21 19 9 8 4 0-3 months 2 3-6 months 7 6-9 months 8 9-12 months 4 73 Dental Treatment of Uninsured Tuberculous Patients. TABLE 28. Case No. Date. Treatment. Cost. £ s. d. 1 3-1-36 Extractions 12 upper and 12 lower with general anaesthetic, complete upper and lower dentures 7 0 0 2 4-1 35 Extractions 12 lower, complete lower denture 2 15 0 3 19-5-36 Extractions 16, complete upper and lower dentures 6 15 0 Total £16 10 0 Harts Sanatorium. STATISTICS. Discharges, including deaths: 148 (90 M., 58 F.). Deaths: 13 (8 M.,5F.). Insured patients: 111 (74 M., 37 F.). Non-insured patients: 37 (16 M., 21 F.). Average duration of treatment: 32 .19 weeks. Number of patient-days: 26,520. Number of beds available at end of year: 80 (78 adult, 2 children). Average number of beds occupied: 72.18 (90.24%). Of the discharges, two men were admitted for observation ; one was discharged Non-tuberculous, the diagnosis being Spontaneous Pneumothorax; the other diagnosis was Doubtful. Immediate Results of Treatment. Discharged Quiescent: 52 (30 M., 22 F.). Discharged Non-quiescent: 78 (47 M., 31 F.). Improved : 63 (41 M., 22 F.). Not Improved: 15 (6 M., 9 F.). One female, Non-pulmonary, Tuberculous Peritonitis, is included in the Improved number. 74 Of the cases discharged or deceased, 14 had already had one course of treatment at the Sanatorium (7 M., 7 F.), and one man had had two courses. Complications. (a) Tuberculous. Bones and joints; Left shoulder joint 1, Right hip joint ,1, Sternum 1; Larynx, 3; Cervical Adenitis, 1; Epididymoorchitis, 2; Retino-choroiditis, right eye, 1. (b) Non-tuberculous. Bronchitis and Emphysema, 3; Diabetes Mellitus, 2; Asbestosis, 1; Rheumatic Carditis, 1; Appendicitis, 1; Bursitis, right elbow, 1; Fibrositis, 1; Cellulitis, right thigh, 1. Admissions by ambulance: 35 (18 M., ,17 F.). From Hospitals: 21 (9 M., 12 F.). From their homes: 14 (9 M., 5 F,), Dr. J. Crawford comments on the work of the Sanatorium as follows:— Artificial Pneumothorax. This treatment continues to be employed in suitable cases. Seventeen inductions were done during the year; three were unsuccessful owing to large pleural adhesions. Refills were given at appropriate intervals, and in all three hundred and fourteen refills were given to twenty-seven cases. Some of these cases were continued from previous years, and some had been commenced elsewhere. The figures do not include refills given after discharge; these are performed at the Chest Clinic. The X-Ray apparatus, which was installed in August, has been of great service in the treatment of these cases ; screening of the chest is done at frequent intervals in order to control the progress of the collapse. Gold Salts. Ten courses of treatment, commenced in 1935, were completed during the year. 75 Sixty-two courses were commenced during 1936, of which 24 were current at the end of the year. Of the 48 courses terminated, 10 were incomplete; one case had severe complications (erythematous rash and buccal ulceration) which eventually cleared up; in two cases the disease ended fatally, the courses of treatment having been stopped some time previously; 7 patients were transferred or took their discharges, 4 showing improvement and 3 none. Of the 38 full courses completed, 1,1 were considered quiescent, 24 much improved, 2 not improved ; one patient died some time after the course ended. Two preparations were used, suspensions of gold salts in oil, injected intra-muscularly. Thirty courses of one preparation were given and 8 of the other. The number of complications in each series was 4. The administration of a preparation of Calcium Gluconate along with the injection of Gold Salts seems to have the effect of preventing the appearance of complications of the treatment or diminishing their severity. There is some evidence that a full course of Gold Salts is often associated with a diminution in the quantity of sputum or a complete cessation of its production with a reduction in the numbers of Tubercle Bacilli in the sputum or their complete disappearance from it; and with a greater or lesser degree of resolution of the lung lesion. Tuberculin In certain selected cases the administration of Tuberculin gives favourable results; nine patients were chosen for a series of injections throughout the year. Insulin Where stimulation of the appetite is required and drug stimulants fail, the use of small doses of Insulin, injected twice daily, and continued over a period of weeks, has been found in some 76 cases to cause an increase in appetite, a consequent gain in weight, and an improvement in general well-being. Rest Although the pulse and temperature are within normal limits, and the patient appears well, active disease may be present, and it is reasonable to suppose that by giving a course of very complete rest, some improvement or healing of a lung lesion will follow. A minimal activity of the body means a minimal activity of the basal functions and a consequent occasion for repair of damaged lung tissue. That this does occur may be shown by serial radiographs taken over a period; progressive healing of lesions and disappearance of cavities can be observed. The patient gains in weight, physical lung signs disappear, and a great improvement in general well-being is noted by the patient. The complete rest is naturally followed by very slow graduated exercise, first in sitting up then in getting up. Such repair seems to happen more easily in localised early exudative lesions, especially in young adults. Indeed, intensive prolonged immobilisation of the body often avoids the necessity of inducing collapse of a lung, itself a method of complete rest, with its risk of failure or complications. When the treatment has been explained to them, the majority of patients are willing to undergo its admitted rigours, in a number of cases with very beneficial results. One method of assessing the type of case likely to respond to this treatment, and its ultimate value, that is the estimation of blood sedimentation rates, is not yet available. The services of a trained laboratory assistant would enable these investigations to be carried out. Bacteriology. Monthly examinations of sputum are made at each clinical examination of the patient, and during the year 689 specimens were examined microscopically, besides examination of pleural fluids. 77 Dental Treatment Numerous patients arrive suffering from much dental caries and consequent inability to masticate properly. Their period of residence would seem a suitable time to undergo dental treatment, provided the physical condition permits. Such treatment should be slowly carried out, two or three extractions at most being done at one time. The provision of a regular dental service would enable such patients to be discharged with thoroughly clean mouths, with undoubted benefit to their genera! health. X-Ray. The radiographer makes a weekly visit to produce films of patients chosen. Since the service commenced, 156 films were taken. The X-Ray plant installed comprised a shockproof "Sunic" super Roentgen Unit with "Versatil" couch, a LevyWest screen suitable for use in all positions, and rapid intensifying screens. The tube is of heavy anode type, with shield, fan, and dynamically balanced motor, thus allowing greater efficiency when working with the tube. A Potter Bucky diaphram permits of more general work. Consultations The visits of the Consultant, Dr. Philip Ellman, at fortnightly intervals throughout the year, when selected patients are seen, and their treatments discussed, have been of great value to the service of the Sanatorium. The visits of the Greatfield Players, the Woodford Amateur Operatic and Dramatic Society, and others are recorded with great appreciation. Their entertainments are thoroughly enjoyed. 78 TABLE 29. HARTS SANATORIUM.—Year ended 31st March, 1937. Expenditure Cost per Patient per week £ s. d. Salaries and Wages 3907 20 7 Superannuation 125 0 8 Provisions 2930 15 5 Disinfectants, Drugs and Appliances 306 1 7 Coal, Coke and Firewood 381 2 0 Electricity, Gas and Water 762 4 0 Furniture, Bedding and Linen 220 1 2 Uniforms and Dresses 50 0 3 Chandlery and Sundries 357 1 11 Crockery and Hardware 60 0 4 General Repairs 286 1 6 Special Repairs and Alterations 300 1 7 Garden Implements, Seeds, etc. 80 0 5 Haulage 20 0 1 Printing, Stationery and Advertisements 137 0 0 Rent of Telephones 35 0 2 Rates, Taxes and Insurance 256 1 4 Motor Car Allowance—Resilient M.O. 59 0 4 X-Ray Examinations 114 0 7 Alteration to X-Ray Room 33 0 2 Mechanical Cultivator 120 0 8 Occupational Therapy 35 0 2 10573 55 8 TABLE 30. Number of Beds available for the Treatment of Tuberculosis on the 31st December 1936 in Institutions belonging to the Council. Name of Institution For Pulmonary Cases For NonPulinonary Cases Total Adults Children under 15 Adults Children under 15 The Harts Sanatorium, Woodford Green, Essex 78 2 — — 80 79 TABLE 31. Return showing the extent of Residential Treatment and Observation during the Year 1936 in Harts Sanatorium. In Institution on J an. 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 cas3s admitted fort observation Adults M. - 2 2 - - F. — — Children ... — — — — — Total — 2 2 — — Numher of pitient s suffering from pulmonary tuberculosis Adults M. 47 82 80 8 41 F. 30 58 52 5 31 Children — — — — — Total ... ... 77 140 132 13 72 Number of patients suffering from nonpulmonary tuberculosis Adults M. - — - - - F. 1 — 1 — - Children ... — — — — — Total ... ... 1 — 1 — — Grand Total ... 78 142 135 13 72 TABLE 32. RETURN SHOWING THE RESULTS OF DOUBTFULLY TUBERCULOUS CASES DISCHARGED DURING THE YEAR 1936 FROM HARTS SANATORIUM. 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 - - - - - - - - - - - - - - - Non-tuberculous - - - 1 - - - - - - - - 1 - - Doubtful *1 — — — — — — — — — — — 1 — — Totals 1 — — 1 — — — — — — — — 2 — — Ch. * Still under observation at Chest Clinic. TABLE 33. Return showing the immediate Results of Treatment of definitely Tuberculous patients discharged during the year 1936 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 - 1 - 13 10 - 1 2 - - - - 14 13 - 27 T.B. Not quiescent — 1 - - 2 - 1 - - - 1 - 1 4 - 5 minus. Died in Institution — — — — — — — — — — — — — — — — Class T.B. Quiescent — — — 1 — - 2 - - - - 1 2 - 3 plus Not quiescent - - - - 2 - 2 1 - - - - 2 3 - 5 Group 1. Died in Institution — 1 — — — — — — — — — — — 1 — 1 Class T.B. Quiescent 1 — — 3 2 — 7 5 — 3 - - 14 7 — 21 plus Not quiescent 7 2 - 8 3 - 7 12 — 5 3 - 27 20 - 47 Group 2. Died in Institution 1 — — 1 1 — 1 1 — 1 — — 4 2 - 6 Class T.B. Quiescent - - - - - - - - - 1 - - 1 - - 1 plus Not quiescent 1 - - 6 3 - 7 - - 3 - - 17 3 - 20 Group 3. Died in Institution... 1 1 — 1 - — 1 1 — - — — 3 2 — 5 i Totals (pulmonary) 11 6 — 33 23 — 27 24 — 13 4 — 84 57 — 141 80 TABIvB 33—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 Instituiton — — — — — — — — — — — — — — — - Abdominal. Quiescent Not quiescent - — — - - - - 1 - - - - - 1 - 1 Died in Institution — — — — — — — — — — — — — — Other Organs. Quiescent - - - - - - - - - - - - - - - - Not quiescent - — — — — — — — — — — — — — — - Died in Institution - — — — — — — — — — — — — — — - Peripheral glands. Quiescent - - - - - - - - - - - - - - - - Not Quiescent - — — — — — — — — — — — — — — - Died in Institution - — — — — — — — — — — — — — — - Totals (non-pulmonary) — — — — — — - 1 — — — — — 1 — 1 81 82 TABLE 34. Return showing the extent of Residential Treatment and Observation during the Year 1936 in Institutions (other than Poor Law Institutions) approved for the Treatment of Tubercu losis (including Harts Sanatorium). 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 doubtfully tuberculous cases admitted for observation adults M. 2 2 - - F. — — — - — Children ... — — — — Total ... ... — 2 2 — — Numberof patients suffering from pulmonary tuberculosis Adults M. 50 90 87 10 43 F. 35 72 57 7 43 Children ... 12 8 11 — 9 Total ... ... 97 170 155 17 95 Number of patients suffering fron nonpulmonary tuberculosis Adults M. 2 8 7 - 3 F. 9 4 8 — 5 Children ... 17 12 15 — 14 Total ... ... 28 24 30 — 22 Grand Total ... ... 125 196 187 17 117 TABLE 35. Return showing the extent of Residential Treatment provided during the year 1936 in poor Law institutions for Persons Chargeable to the Council. In Institutions on J an.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 M. 4 37 13 19 9 F. 2 23 18 5 2 dren ... — — — — — Total ... ... 6 60 31 24 11 Number of patients suffering from nonpulmonary tuberculosis Adults M - - - - - F. — 1 1 — — Chidren ... — — — — — Total ... ... - 1 1 — — Grand Total ... ... 6 61 32 24 11 TABLE 36. Return showing the immediate results of Treatment of definitely tuberculous patients discharged during the year 1936 from institutions approved for the treatment of tuberculosis (including "harts" Sanatorium) Classification on admission to the Institution. Duration of Residential Treatment in the Institution. Condition at time of discharge. 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. Pulmonary Tuberculosis. Class T.B. minus. Quiescent - 1 - 13 10 1 1 2 5 - - 5 14 13 11 38 Not quiescent — 1 — — 2 — 1 — — — 1 - 1 4 — 5 Died in Institution — - — — — — — — — — — — — — — — Class T.B. plus Group 1. Quiescent — — — 2 — — — 3 — — — - 2 3 - 5 Not quiescent — — — 1 2 — 3 1 — — — — 4 3 — 7 Died in Institution — 1 — — — — — — - — — — — 1 — 1 Class T.B. plus Group 2. Quiescent 1 - - 3 2 — 7 5 - 3 1 - 14 8 - 22 Not quiescent 8 2 - 8 4 - 7 13 - 5 3 - ?8 ?,? - 50 Died in Institution 2 - — 1 1 — 2 1 — 1 — 6 2 — 8 Class T.B. plus Group 3. Quiescent - - - - - - - - - 1 - - 1 - - 1 Not quiescent 1 1 - 6 3 — 7 - - 3 - - 17 4 - 21 Died in Institution 1 2 — 1 — — 1 1 — 1 — — 4 3 — 7 Totals (pulmonary) 13 8 — 35 24 1 29 26 5 14 5 5 91 63 11 165 83 TABLE 36—continued. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months, 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 1 - - 1 _ 1 - - - - 3 4 2 3 5 10 Not quiescent - — — — — — — — — 1 — - 1 — — 1 Died in Institution - — — — — — - 1 - - - - - 1 1 Abdominal. Quiescent - - - - - 1 1 - 1 - - 1 1 - 3 4 Not quiescent - — — — - — — 1 — — — - — 1 — 1 Died in Institution - — — — — — — — — — — - — — — — Other Organs. Quiescent - - - - - - - 1 - - - - - 1 - 1 Not quiescent - 1 — 2 - - - - - - - - 2 1 — 3 Died in Institution - — — — — — — — — — — - — — — — Peripheral Slands. Quiescent - - - 1 1 1 - - 1 - 1 4 1 2 6 9 Not quiescent - — — — — — — — — — — - — — — Died in Institution - — — — — — — — — — - - — — — — Totals (non-pulmonary) 1 1 — 4 1 3 1 2 3 1 4 9 7 8 15 30 84 TABLE 37. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications During the period 1.1.36 to 31.12.36. Age periods. Formal Notifications. Number of Primary Notifications of new cases of tuberculosis. Total notifications. 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) Pulmonary Males 1 1 1 1 16 1 18 18 11 14 12 2 94 104 „ Females ... — 2 2 2 12 17 19 12 8 4 — 78 82 Non-pulm. Males — 1 3 3 1 — 2 — — 2 12 12 „ Females ... - 4 2 4 3 2 — 2 1 — 1 19 19 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification:— Age periods. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and over Total cases. Pulmonary Males — — 1 1 2 3 8 2 3 — — 20 ,, Females — — 1 — 1 4 6 2 2 4 2 22 Non-pulmonary Males — 1 1 1 — — 1 — — — 4 „ Females — 1 1 — — — 2 2 1 — 1 8 85 TABLE 37—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 4 2 transferable deaths from Registrar General 1 3 Posthumous notifications 4 4 "Transfers" from other areas (other than transferable deaths) 31 3 Other sources if any (specify) (Merchant Seamen) 2 — Notification Register. Number of cases of Tuberculosis remaining at the 31st December 1936, 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 511 420 931 150 142 292 1,223 Number of cases removed from Registers during the year by reason inter alia of:— 1. Withdrawal of notification — 1 1 — — — 1 2. Recovery from the disease 2 6 8 3 3 6 14 3. Death 64 33 97 6 7 13 110 86 TABLE 38. Notified Cases of Tuberculosis, 1936. 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 and under 2 — 1 1 - - - - - - - - - - - - - - - - - - - 2 2 2-3 — - — - 1 1 - - - - - - - - - - - - - - - - 1 1 3-4 — - — - — - 1 - 1 - - - - 2 2 - - - - - - 1 2 3 4-5 1 1 2 - - - - - - - - - - - - 1 - 2 - - - - - - 5-10 2 3 5 - - - - - 1 - 1 - 1 1 3 2 5 - - - - - - - - - 10-15 2 2 4 - - - 1 - 1 1 1 2 1 2 3 1 1 2 - - - 6 6 12 15-20 18 13 31 - - - - - - - - - 1 9 3 - - 1 - - - 6 6 12 20-25 21 21 42 - 1 1 - - - - 1 1 - - - - - - - - - 19 23 44 25-35 26 25 51 - - - - - - - - 1 - 1 1 3 - 3 - - - 29 27 56 35-45 13 14 27 - 1 1 - - - - - - - - - - 3 3 - - - 13 18 31 45-55 17 10 27 - - - - - - - 2 2 - - - - - - - - - 17 12 29 55-65 12 8 20 - - - - - - - - - - - - - - - - - - 12 8 20 Over 65 2 2 4 1 1 2 - - - - - - - 1 1 1 - 1 — — — 4 4 8 Totals 114 100 214 1 4 5 3 — 3 1 6 7 5 10 15 6 7 13 — — — 130 127 257 87 88 Table 39. Tuberculosis. New Cases and Mortality, 1936. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. M. F. M. F. M. F. M. F. Under 1 year 1 — 5 yrs 1 2 2 5 1 — 1 1 5 — 15 „ 4 5 8 7 3 — 3 1 15—25 „ 39 34 1 5 7 7 — — 25 — 45 „ 39 39 3 6 24 16 1 2 45 — 65 ,, 29 18 — 2 25 10 — — 65 and upward ,, 2 2 2 2 2 2 - 1 Totals 114 100 16 27 62 35 5 5 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths for the year was 1—16. No action has been taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 62, Public Health Act 1925. 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. One hundred and thirty-eight 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. Garments have been supplied to necessitous patients during their stay in the Sanatorium. Other patients have been helped by the provision of surgical appliances, spectacles and repairs to artificial limbs. Part cost of the funeral expenses of a patient who died in an Institution, was borne. At Christmas 40 parcels of groceries were given to the most needy cases. 89 It is perhaps not sufficiently realised that, to some extent, the treatment of the tuberculous subject begins after the patient has left the Sanatorium. If this was adequately appreciated there would be fewer relapses. It might be asked what factors are responsible for these relapses. Experience shows that they are due to insufficient protection resulting from varied causes such as: (1) Return to bad home conditions. (2) Inadequate nutritional supplies to maintain the condition on discharge from the Sanatorium. (3) Inability to compete in the open labour market. The quiescent or arrested tuberculous subject should not have to travel long distances to and from his work in crowded trains or trams, he should work not more than eight hours per day, and should have a complete hour's rest for lunch, and a minimum of nine hours for sleep. The need for rehousing a number of tuberculous patients (as exists in certain other Boroughs in the Country), is of paramount importance in the interests of the public health of the population. It is doubtful whether local authorities sufficiently recognise that expenditure on the immediate institutional treatment of the tuberculous subject is only one aspect of the problem. If the results to be achieved thereby are to be maintained, a far greater financial expenditure is required for the continued care of the tuberculous subject. Occupational Therapy: In October, 1935, 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. 90 Occupational therapy aims at keeping the mental attitude of these patients favourably influenced, and provides a means whereby they may escape from the boredom of inactivity and depression. The average attendance throughout the year was 8. Consequent upon the following report submitted by Dr. Crawford, classes were instituted at Harts Sanatorium in October, 1936. "As a matter of policy, the institution of well-recognised and accepted forms of therapy is advisable in the best interests of the patients and of the sanatorium. Therapeutic work, such as gardening, wood sawing and light domestic work, is employed for those whose physical conditions enable them to benefit from it. For patients unable to perform heavy work, the teaching of the arts of basket and rug-making and other forms of such work enable them not only to direct their minds and energies in useful channels while in the institutions, but in the case of a number of patients permit them to acquire interests which can be maintained in their own homes. It would be unwise to minimise the difficulties which may arise, such as inertia of some patients, and the dislike of some male patients for such forms of work, but in time the scheme should grow to acquire a real significance for good in the work of the sanatorium." It is hoped that the interest of patients in occupational therapy will be maintained upon discharge from the Sanatorium, and that the attendances at the Chest Clinic will be thereby augmented. The handicrafts class at the Clinic is open to inspection any Wednesday afternoon. Interested visitors will be welcomed by Miss Ross-Smith, the Occupational Therapist. A Sale of Work of articles made by patients at the Tuberculosis and Chest Clinic was held in December, 1936, and was eminently successful. 91 Maternity and Child Welfare. Dr. J. MacLaren's observations are contained in the following report:— Infant Welfare Clinics Attendances at Infant Welfare Clinics. Number of general Clinics held during the year 460 Number of individual children who attended the Clinics 3273 Total number of attendances at all Centres 30941 Total number of children who attended the Clinics for the first time during the year:— (a) Children under 1 year 1317 (b) Children between the ages of 1—5 years 380 (excluding examination of toddlers) Number of medical consultations at general Clinics 9306 Number of Medical consultations at special Clinics 1319 The daily average attendances at the Clinics were as follows: Central Clinic, Monday afternoon 69 Church Road, Monday afternoon 84 Plashet Grove, Tuesday morning 63 North Woolwich, Tuesday afternoon 21 Masterman Road, Wednesday afternoon 56 (Central from June, 1936) Church Road, Wednesday afternoon 55 (from June, 1936) Central Clinic, Thursday morning 58 Church Road, Thursday afternoon 77 Plashet Grove, Friday afternoon 91 Central Clinic, Friday afternoon 39 (from June, 1936) Excluding North Woolwich Infant Welfare Centre, which supplies a very small area, the average attendance of children Der session at all centres during the year is 68.4. 92 During 1936, 3,273 children attended the centres. The total attendance of infants from 0—5 was 30,941. 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 mornings, at Church Road Clinic, and on Thursday afternoon at the Central Clinic. During 1936, 911 examinations were made. In cases where defects were found, the patients were transferred to the appropriate Specialist Service, or hospital. A record of the cases examined is transferred to the School Medical Service when the children enter school. Immunisation Clinic See Report, page -16. Tonsils and Adenoids During 1936, 155 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. 93 One hundred and eighteen mothers and 258 infants were referred to the Dental Department during 1936. Ophthalmic Treatment Ophthalmic defects requiring special treatment are seen at the special clinic each week by the School Ophthalmic Surgeon. During 1936, 28 cases were referred to the School Ophthalmic Clinic. Aural Treatment Aural cases requiring special treatment are referred to the School Aural Surgeon. During 1936, 8 patients received treatment at the School Aural Clinic. 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 Visitors from their district visits. The statistics for 1936 are as follows:— Number of medical consultations 1319 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. 94 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 1936 were 18,182. Visits to infants under one year of age 7445 Visits to children over one year of age 9360 Visits to tonsils and adenoid cases 100 Visits to ante-natal cases, first visits 504 Visits to ante-natal cases, revisits 114 Visits to foster mothers 194 Special visits not included in the above group 465 18182 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 Clinics and expectant mothers. 7. Ante-natal Clinics 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) Tonsils and adenoid cases. (e) Pneumonia. (f) Infantile Diarrhoea. (g) Other special visits. Still Births The number of still births registered during the year was 64. The proportion of still births to live births was as 1 to 30. 95 The still birth rate was 32.0 per 1,000 live and still births. On investigation it was found that in 52 cases the months of pregnancy at which the still births took place were as follows:— 7th month 9 8th month 7 9th month 36 An analysis of the causes to which the still births were attributable will be found in the following table :— Malpresentation 11 Prolonged labour 3 Contracted Pelvis 3 Excessive size of Foetus (including post maturity) 1 Congenital Deformity 2 Prolapse of Cord 1 Ante-partum haemorrhage 7 Albuminuria 6 Prematurity 12 Causes unknown 18 Ante-Natal and Post-Natal Work. 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:— Ante-Natal. Number of new cases 462 Total number of cases attended 536 Subsequent attendances 1545 Total number of attendances 2007 Average attendance of expectant mothers per session (excluding North Woolwich) 18.64 Post-Natal. Total number of cases attended 13 Total number of attendances 17 96 The following table gives an analysis of the pre-maternal cases found to be slightly or seriously abnormal:— Contracted pelvis 11 Albuminuria 20 Hyperemesis gravidarum 4 Ante-partum haemorrhage 4 Malpresentation 9 Cervicitis 4 Valvular disease of heart 7 Varicose veins 13 Phlebitis 1 Anæmia 4 Bronchitis 1 Pulmonary tuberculosis 1 It is satisfactory to note that during this year a larger number of cases attending the Ante-natal Clinic were sent by midwives, but I would again urge the necessity of midwives taking more advantage of the Clinic, and bringing their cases for medical examination and advice, for though many midwives carry out ante-natal supervision with care and accuracy, conditions may be present or develop which can only be discovered by medical examination. The detection and treatment of these conditions would minimise many dangers and prevent 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 1936, 618 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 the institutional treatment of complicated midwifery cases, and for women whose homes are unsuitable for their confinements, the East Ham County Borough Council have provisional arrangements for the accommodation of necessitous cases requiring in- 97 patient treatment at Forest Gate Hospital, the Maternity District Nurses' Home, Plaistow, and Queen Mary's Hospital, Stratford. During 1936, 158 cases were admitted to Forest Gate Hospital. i Inspection of Midwives Fifty-six midwives notified the Local Supervising Authority of their intention to practise within the Borough during 1936— 50 were on the register on 31/12/36, including staff at Burges Road. Fifty-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 281 cases as follows:— Mother. Ruptured perineum 91 Prolonged labour 26 Ante-partum haemorrhage 18 Retained placenta 21 Rise of temperature 13 Malpresentations 8 Breech 4 Albuminuria 7 Other causes 58 246 98 Child. Prematurity and dangerous feebleness 6 Unsatisfactory condition of infant 8 Discharging eyes 8 Other causes 13 35 Puerperal Fever and Puerperal Pyrexia. Seven cases of Puerperal Fever and seven cases of Puerperal Pyrexia were notified during the year under the Regulations of 1926 and 1928. Maternal Mortality There were four deaths associated directly with pregnancy. The Maternal mortality rate was, therefore, 2.00 per 1,000 live and still births compared with 4.9 in 1935. Ophthalmia Neonatorum During ,1936, six cases of Ophthalmia Neonatorum were notified. 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 1936 was £1,719. In every case careful investigation of the family circumstances is made to ensure that only necessitous cases shall receive this benefit. Voluntary Associations Appreciation and thanks are again gratefully accorded to the Invalid Children's Aid Association for their co-operation with the 99 Maternity and Child Welfare Department, and help in arranging Convalescent Home Treatment for delicate children. Nineteen 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, 27. (b) Number of children on the Register: (i) at the end of the year, 33. (ii) who died during the year,— (iii) on whom inquests were held during the year,— (c) Number of Infant Protection I isitors 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: (l) under (a) of Section 3 of the Act of 1908 (ii) under (b) of Section 3 of the Act of 1908 (iii) under (c) of Section 3 of the Act of 1908}Nil. (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. Home Helps. During 1936, 22 suitable applicants were registered as Home Helps, and 25 applications were received for the services of Home Helps. 100 Maternity Boxes. Maternity Boxes containing clothing and necessities for newborn babies are available upon application to the Senior Health Visitor. Staff. The staff at present consists of two Assistant Medical Officers, seven Health Visitors, three Clerks, and one S't. John Ambulance Nurse who attends seven Clinics per week. Unemployment and Outdoor Assistance. Extent of Unemployment during 1936. Mr. A. J. Barton, Manager, East Ham Employment Exchange, has kindly supplied the following statistics:— 100a TABLE 40—Number of Persons Registered as Unemployed during 1936 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 2,398 61 515 51 2,201 46 482 33 1,956 32 442 19 1,744 40 427 18 1,578 29 354 11 1,581 27 332 5 (3) Non-Claimants to Benefit (i.e. persons registered for work only) 448 113 95 79 439 43 80 65 465 36 97 31 460 87 109 61 429 42 88 29 412 19 86 19 4) Persons normally in Casual Employment 958 3 40 — 852 2 34 — 818 3 36 — 746 1 29 — 651 — 48 — 658 — 28 — (5) Temporarily stopped 16 1 135 5 8 1 115 10 20 2 52 1 6 — 53 1 6 1 40 — 17 — 52 1 Total—1936 Total—1935 3,820 4,012 178 188 785 692 135 165 3,500 3,940 92 151 711 678 108 120 3,259 3,718 73 90 627 657 51 79 2,956 3,589 128 183 618 677 80 110 2,664 3,188 72 151 530 605 40 34 2,668 3,476 46 71 498 575 25 44 (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 1,504 25 278 6 1,482 42 271 6 1,576 39 253 11 1,681 31 279 10 1,745 22 232 11 1,529 14 224 10 (3) Non-Claimants to Benefit (i.e., persons registered for work only) 409 59 86 35 385 119 76 47 359 94 74 29 376 37 97 10 365 24 84 11 325 21 69 15 (4) Persons normally in Casual Employment 808 — 16 — 701 — 10 — 545 — 5 — 600 — 5 — 745 — 5 — 722 1 7 — (5) Temporarily stopped 11 — 89 — 24 — 57 5 17 — 49 — 14 — 43 2 — 1 91 9 — — 99 16 Total—1936 2,732 84 469 41 2 592 161 414 58 2 497 133 381 40 2 671 68 424 22 2 855 47 412 31 2,576 36 399 41 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 50 101 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 31-12-36:— TABLE 41. 1936 Men Women Children Total 1936 Total 1935 January 1,199 1,703 1,516 4,418 4,597 February 1/218 1,734 1,542 4,494 4,695 March 1,181 1,699 1,454 4,334 4,600 April 1,145 1,693 1,411 4,249 4,439 May 1,094 1,675 1,348 4,117 4,402 Juno 1,074 1,660 1,332 4,066 4,300 July 1,056 1,627 1,265 3,948 4,232 August 1,084 1,642 1,300 4,026 4,263 September 1,070 1,645 1,289 4,004 4,183 October 1,104 1,681 1,346 4,131 4,257 November 1,129 1,728 1,401 4,258 4,307 December 1,118 1,722 1,372 4,212 4,221 Swimming Baths and Pools. The Borough Council own public baths, comprising a large and a minor swimming bath, vapour, and slipper baths. Serving the South of the Borough is an open-air bath situate in the North Woolwich Gardens which is under the control of the London County Council. During the year samples of water from the two swimming baths owned by the Council were submitted for analysis and found very satisfactory. TABLE 42. METEOROLOGICAL RECORD—YEAR 1936. Rain Gauge 5-in. in diameter, placed 1 foot above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Mean Temperature of Air. Rainfall. Highest Maximum. Lowest Minimum. Mean of No of Days on which Rain fell, 0.01 and over Amount collected in inches. Mean rate of fall for Rainy Days. Greatest fall in 24 hours. Date of greatest fall. All Highest. All Lowest. January 57° 25° 45°.7 36°.9 41°.3 20 3.20 0.16 0.50 28th February 55° 21° 42°.7 32°.8 37°.7 12 1.31 0.11 0.37 17th March 64° 30° 52°.1 39°.8 45°. 9 12 1.10 0.09 0.26 31st April 65° 30° 51°.7 38°.9 45°.3 12 1.33 0.11 0.31 20th May 76° 37° 63°.9 46°.1 55°.0 7 0.48 0.07 0.17 22nd June 84° 43° 69°.9 53°.6 61°.7 19 3.08 0.16 0.37 25th July 76° 48° 69°.0 55°9 62°.4 21 2.76 0.13 0.54 14th August 84° 49° 72°.4 55°.5 63°.9 6 0.37 0.06 0.21 10th September 76° 41° 66°.7 53°.9 60°.3 17 2.29 0.14 0.50 20th October 67° 36° 57°.1 44°.0 50°.5 12 1.51 0.13 0.46 31st November 56° 32° 49°.2 38°.8 44°.0 16 2.98 0.18 0.74 11th December 56° 28° 47°.5 37°.3 42°.6 17 1.73 0.10 0.65 14th Means and Totals for the Year 84° 210 57°.3 44°.5 50°.9 171 22.14 0.12 0.74 11th Nov. The Rainfall for the Year was 1 .02 ins. belo-w. and the number of days 011 which rain fell 8 above the year 1935. at East Ham. 102 103 TABLE 43. Inspection of Factories, Workshops and Workplaces, 1936. 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) 123 24 - Workshops (including Workshop Laundries) 80 7 - Workplaces (other than Outworkers' premises) 14 4 - Total 217 35 - Defects Found in Factories, Workshops and Workplaces. Number of defects. Number of offences in respect to which prosecutions were instituted. Particulars. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 34 31 - — Want of ventilation 4 4 - — Overcrowding — — - — Want of drainage of floors — — - — Other nuisances 22 20 - — Sanitary accommodation— Insufficient 5 2 - - Unsuitable or defective 15 12 - — Not separate for sexes 4 2 - — 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 84 71 — - Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 104 Outwork in Unwholesome Premises, Section 108. Notices ProsecuNature of Work Instances Served tions Wearing Apparel—Making, etc. 2 11 Sanitary Section and Housing. Mr. J. E. Austin, Senior Sanitary Inspector, has compiled this section of the Report:— Water Supply. The requirements of the district appear adequately satisfied by the Metropolitan Water Board. Unsatisfactory means of domestic storage continue to reveal themselves in consequence of housing inspections by the Sanitary Inspectors, and in 171 instances a supply tap on the rising main to the storage cistern was provided in response to a requisition served upon the owner. What is believed to be the remaining houses having external water supply in the Borough were dealt with during the year 1936 and, with their demolition under the Housing Acts, all East Ham houses will now possess an internal supply of water. Drainage and Sewerage. Considerable nuisance was occasioned residents of certain streets in the Borough, in particular in the Little Ilford Ward, by flooding from sewers. Schemes to relieve this flooding of certain districts of the Borough are under consideration. The policy of devoting strict attention to drainage where rat infestations are investigated has proved valuable for in 643 cases drainage repairs were carried out at the instance of the department, and in many of these cases complete reconstruction was effected. No extensions of the sewerage or disposal works were carried out. 105 Rivers and Streams. The network of water courses in the Borough continues to be a source of nuisance. In many cases the water stagnates and during the few fine days in the year the courses become serious breeding places for mosquitoes. Spraying with larvicide was carried out by the Authority in order to abate the nuisance. No serious trade pollution of the water courses was observed. Closet Accommodation. The water carriage system prevails throughout the Borough. Public Cleansing. The Borough Engineer reports that arrangements for public cleansing were continued as in previous years. The only development was the use of land in the Little Ilford Ward for the purpose of controlled tipping mainly of refuse from the neighbouring County Borough of West Ham. No complaints were received by this department despite the close proximity of the tip to certain houses. Sanitary Inspection Despite the unprecedented activity of the inspectorate in the matter of the housing overcrowding survey, during the first quarter of the year, the number of inspections and visits only shewed a slight reduction as compared with 1935. Details of these inspections are set out in the following statement:— (a) Inspections. (i) Housing:— House to house 3,928 Under Public Health Act 1,867 Other visits 274 Reinspections 18,559 (ii) Sanitary Circumstances:— Drainage and San. Acc. 559 Factories and Workshops (exc. Bakehouses) 95 106 Workplaces and Outworkers 315 Caravans 474 Re offensive fumes 1,570 Miscellaneous 960 (iii) Food Supply:— Slaughterhouses 1,272 Dairies 218 Food Premises 333 Bakehouses 103 Re sampling 502 (iv) Infectious Disease:— Visits 573 (b) Notices. The number of notices served during the year totalled 4,998, 442 of which were statutory notices. The number of notices complied with numbered 4,042. The ward classification of notices served is as follows:— Manor Park 514 Castle 224 Woodg range 735 Central 222 Little Ilford 965 Wall End 450 Kensington 637 Greatfield 412 Plashet 496 South 343 (c) Improvements. In consequence of the service of the foregoing requisitions the following improvements were effected at the number of houses shewn:— Dampness remedied— Repointing executed 1,004 Roofs repaired 1,102 Rain water gutters repaired 1,169 Ventilation improved— Windows (including cords) repaired 1,065 Water supply improved— Service tap provided on main 171 Sanitary conveniences repaired 1,119 Washing facilities provided or improved (coppers) 251 107 Drainage improved or reconstructed 643 Paving of yards repaired 854 Disrepair remedied— Stoves and firegrates repaired or renewed 810 Plasterwork repaired or renewed 943 Floors repaired or renewed 522 Cleansing executed 2,047 Miscellaneous defects remedied 5,077 (d) Complaints. During the year 1936 complaints totalling 2,099 were received and where justified appropriate action taken. Many of the complainants requested the services of the drain cleaner or rat catcher. (e) Factories and Workshops. Inspections of factories, workshops, and outworkers' premises numbered 513. Eighty-four defects found, necessitated the service of 35 notices, and during the year 71 defects were remedied. Apallingly filthy conditions in food preparing premises which constitute factories arc not infrequently found, but are tragically outside the pale of the Local Authority's jurisdiction. (f) Cinemas. The cinemas, the theatre and public houses subject to licences for music, etc., were inspected during the year and minor improvements effected in the sanitary accommodation. (g) Rat Extermination. The official ratcatcher made 1,944 visits resulting in the destruction of 4,323 rats. Certain Corporation land demanded and received attention. (h) Atmospheric Pollution. This subject again called for considerable expenditure of time, 1,570 visits being made in this connection. The comprehensive investigation into atmospheric conditions in the vicinity of a chemical manufactory carried out in the previous year was supplemented by further observations in the year under review and culminated in legal proceedings. A considerable volume of evidence by official and unofficial witnesses of the serious 108 nuisances arising from the emission of chlorine from a chloral hydrate plant was accumulated. At the hearing before the Stipendiary the defendant firm pleaded guilty and were fined £2, and costs amounting to 75 guineas were allowed the Council. Immediately prior to the hearing the firm installed additional condensing apparatus. A repeated complaint of emissions from a Sulphuric acid plant was referred to H.M. District Inspector under the Alkali, Etc., Works Act. Other action in connection with smoke abatement is described later in this report. (i) Mosquito Control. The mosquito nuisance did not reach so serious proportions as in the previous years, but systematic treatment of infested ditches and water courses was again undertaken with satisfactory results. (j) Special Classes of Premises and Occupations subject to control of the Local Authority. The Council declared further trades to be offensive and adopted certain provisions of the Public Health Acts and made byelaws with a view to more effective control of offensive trades. The application to control fried fish businesses was not successful. It was, nevertheless, gratifying to report that during an investigation of conditions into the conduct of that business in the Borough the appallingly bad conditions referred to in the report for the previous year were with only one exception removed by the installation of new appliances and the traders' response to the department's demand for more cleanly methods. (k) Caravan Encampment. This year witnessed the first act of implementing the policy of the Council in the matter of the caravan colony, a problem of nearly half a century in East Ham. One yard containing 10 vans was declared a clearance area, and the subsequent order was confirmed by the Minister of Health. A further area included five vans and the subsequent clearance area was confirmed. Illicit placing of vans on land in contravention of the bye-laws resulted in immediate proceedings against three 109 piers and subsequent removal of the vans. In consequence of the adoption during the year of powers contained in the Public Health Act, 1925, proceedings were instituted in respect of two yards containing 24 vans with a view to obtaining prohibition orders. Success in this, our first application, was delayed, and fines amounting to £24 were inflicted. However, early in ,1937, orders in respect of vans in one of these yards were made by the Stipendiary and the yard cleared. Delay in the provision of replacement houses in connection with clearance schemes is somewhat delaying further action in connection with the caravans. (l) Rag Flock Acts. Thirteen samples of rag flock were submitted for analysis, and three samples failed to comply with the regulations. In one case of excessive chlorine content (45 parts) the vendor and manufacturer were cautioned. In another case (210 parts) proceedings were instituted direct against the manufacturers vending to the local user, and fines totalling £4 imposed. In another case (240 parts) the local vendor was fined £1 and costs of £1 Is. imposed. (m) Rent Restriction. It is surprising to find the little use made of the Rent Restriction Acts by tenants, for the rapidity with which house repairs are executed by certain delinquent owners, when a certificate of disrepair is threatened, is noteworthy. Only six applications were received for certificates. (n) Prosecutions. The following statement gives a summary of legal proceedings instituted during the year:— Public Health Act—Abatement of Nuisance (S.91) Cases withdrawn (Nuisance abated) 10 Orders made 8 Disobeying orders—penalty inflicted 3 Case withdrawn (Nuisance abated) 2 Public Health Act—Nuisance from effluvia (S.114) Penalty inflicted 1 East Ham Improvement Act—Absence of Water Supply— Case withdrawn (water reinstated) 2 110 Bye-laws respecting Tents, Vans and Sheds— Penalty inflicted 25 Case withdrawn (van removed) 2 Rag Flock Acts— Penalty inflicted 2 Food and Drugs Act— Penalty "inflicted 2 Public Health Act—Power of Entry— Order to admit (Proceedings subsequently instituted for disobeying order, but withdrawn on admission being granted) 1 Shops Act, 1934. The following is an extract from the Annual Report of the Chief Shops Inspector for 1936:— Provisions for Health and Comfort of Persons Employed. Inspections of shops in connection with sanitary conveniences, etc., numbered 1,324, and in 213 instances conditions were found unsatisfactory. Written notices numbered 98, whilst verbal notices were given in respect of the other contraventions when promise of amendment was immediately forthcoming. Reinspections in connection with these contraventions totalled 836. The following improvements were carried out in consequence of action by your Inspectors: (1) Ventilation and Temperature of Shops:— Means of heating provided 10 (2) Sanitary conveniences:— Provided 6 Reconstructed 10 Repaired, etc. 121 (3) Lighting:— Improved 1 (4) Washing Facilities:— Provided 10 Reconstructed 20 Repaired, etc. 12 (5) Facilities for meals:— Provided 5 Repaired, etc. 22 Alternative arrangements 19 111 Smoke Abatement During the year 46 observations of factory chimneys were made; in 5 cases contraventions of the Council's bye-laws limiting black smoke emission to two minutes in half-an-hour were observed and 5 statutory notices were served. Thirteen half-hourly observations were made of railway engines, and in consequence one railway company was communicated with upon the existence of a smoke nuisance. Eradication of Bed Bugs The number of Council houses disinfested during the year by the Borough Engineer's Department for the Housing Manager was 28. In connection with other houses all infestations are not recorded, the incidence varying in localities, but in all instances affected occupiers are advised on measures of disinfestation and of their legal obligations. Where houses become occupied and new tenants complain of infestation, owners are approached by the Department with an estimate of the cost of disinfesting. In 47 cases disinfestation was carried out by the Department, and the method employed generally was fumigation with sulphur dioxide (Concentration of 5% vol.), and supplementary spraying with a contact insecticide. The cost of the work is paid by the house owner, and infrequently by the occupier. The costs recoverable for work during the year amounted to approximately £43. By arrangement with the Housing Manager, inspection of houses and contents of prospective tenants of Council houses is carried out, and where necessary fumigation of household effects with hydrogen cyanide is carried out concurrently with removal. A contractor is employed for cyanide fumigation. Housing (a) Overcrowding. In the matter of housing the year proved one of unprecedented activity. Prolonged consideration of the overcrowding survey delayed its commencement until the end of January. Carried out within a month of commencement the primary survey 112 revealed 812 cases of overcrowding or 2.1 per cent. of all houses in the Borough. The cost of the Survey including subsequent tabulation of results and incidental clerical work amounted to £801. The incidence of overcrowding in the various wards is set out in the following statement:— Ward FAMILIES Overcrowded Likely to become Overcrowded within 2 years Uncrowded Total Percentage Overcrowded Summary. North Section. Manor Park Ward 44 29 3,911 3,984 1.104 Little Ilford Ward 173 47 4,146 4,366 3.962 Woodgrange Ward 32 18 3,667 3,717 0.861 Plashet Ward 60 28 3,633 3,721 1.612 Kensington Ward 29 9 3,135 3,173 0.914 Totals. 338 131 18,492 18,961 1.783 South Section. Castle Ward 93 30 3,396 3,519 2.643 Central Ward 87 22 3,557 3,666 2.373 Wall End Ward 80 26 4,497 4,603 1.738 Greatfield Ward 41 25 3,712 3,778 1.085 South Ward 173 62 3,660 3.895 4.956 Totals. 474 165 18,822 19,461 2.435 NORTH SECTION 338 131 18,492 18,961 1.783 SOUTH SECTION 474 165 18,822 19,461 2.435 Grand Totals. 812 296 37,314 38,422 2.113 The severity of overcrowding in the Borough is shewn in the accompanying table on the page opposite. 112a OVERCROWDING SURVEY.—SUMMARY. * ½ = a dwelling of 1 room between 50 and 70 square feet. NOTE.—The numbers of overcrowded families are shown below the stepped diagonal line. 113 The tendency of recent years in East Ham has been towards multiple tenancy of the six-roomed house prevailing in the Borough, with a consequent loss of large type houses. In determining the rehousing requirements, regard has been had for the effect of a theoretical redistribution of houses and populace, and the resultant calculations reveal a surplus of houses of small accommodation (185 houses capable of accommodation up to 6 persons) and a deficiency of houses of large accommodation. The Council have, therefore, adopted a programme of constructing 85 x 4 bedroomed houses and 47 x 5 bedroomed houses to decrowd the 812 families. At the close of the year tenders were under consideration for 32 houses, or one quarter of the programme for decrowding purposes. The solution of the problem of providing rehousing accommodation of such large dimensions for those of the community who have the largest families and whose means are so limited, is difficult to comprehend in the absence of a sufficient subsidy. On account of the slight extent of slum clearance activity in the Borough and the financial difficulties inherent in the present slum clearance programme, little rent relief, if any, will be available in the case of overcrowded families. The "appointed day" has been determined by the Minister as 1st July, 1937. It was ascertained upon re-survey at the close of 1936 of the 812 cases initially found, 279 houses had become decrowded and 49 had since the initial survey become overcrowded, leaving the net number of overcrowding cases 582 at December, 1936. Of the 57 initial cases of overcrowding in Council houses, 16 had been abated and 5 further houses had become overcrowded by December, 1936. An additional Sanitary Inspector was appointed in July to deal especially with the administration of the overcrowding provisions of the Housing Acts. (b) Slum Clearance. The remaining three families from areas included in the original programme of 1930 were rehoused during the year. A small supplementary programme of demolition of 92 houses was adopted by the Council in April, 1936, and at the close of the year Clearance Orders had been confirmed by the Minister in respect of 48 houses. The majority of the remaining 'houses' to be dealt 114 with comprise 'vans' in the Wall End encampment. Tenders for the construction of 42 replacement houses on the Bonny Downs housing site were being considered at the close of the year. Fourteen caravans were included in the Clearance Areas in respect of which Orders were confirmed. During the year 21 houses were closed or demolished for industrial purposes, and two parts of houses were closed and 10 houses demolished under the Housing Acts. (c) Maintenance of Houses. House-to-house inspection was almost completely suspended during the first quarter of the year, on account of the overcrowding survey, but despite this deferment, 3,928 houses were inspected under the Housing Regulations. Other inspections of houses numbered 2,141, and of the total (6,069), 4,503 were found defective. A total of 3,355 were repaired in accordance with the requisitions of the department, and the improvements effected thereby are set out on Page 106. At the close of the year works were in progress at nearly three-fourths of the remaining houses found defective. The more thorough type of inspection, the systematising of the house-to-house inspections, improved system of keeping statistics, and the adoption of a uniform specification are factors contributing to the general qualitative improvement in housing maintenance in the district. The Housing statistics are included in the following statement:— 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) 6,069 (b) Number of inspections made for the purpose 24,628 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,928 (b) Number of inspections made for the purpose 13,125 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 48 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 4,503 115 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 2,968 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:— (а) By owners 6 (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 442 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners 387 (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) Number of separate tenements or underground rooms in respect of which Closing Orders were determined the tenement or room having been rendered fit - IV.—Housing Act, 1935.—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 582 (ii) Number of families dwelling therein 593 (iii) Number of persons dwelling therein 4,113 (b) Number of new cases of overcrowding reported during the year 49 (c) (i) Number of cases of overcrowding relieved during the year 279 (ii) Number of persons concerned in such cases 1,783 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding — (e) For other comments on overcrowding see report. Number of New Houses Erected During the Year 1936:— By Private Enterprise 77 By the Local Authority 24 116 Inspection and Supervision of Food, (a) Milk Supply. (1) Dairies. The efforts of the previous year to improve the many unsatisfactory dairies were continued during the year under review. Administration of the Milk and Dairies Order, 1926, has resulted in considerable improvement in milk distribution in East Ham. The remaining dairies in appallingly bad condition were reconstructed in 1936. In each of the dairies are appliances for "cleansing and scalding by steam" all vessels and appliances, and in each of our dairies "all practicable precautions for preventing the milk from being contaminated" are required to be taken by the use of mechanical filling appliances for bottles and the mechanical closing of bottles of milk. The hitherto cold wash (only) for the bottle, the filling of bottles with a dipper (and the not infrequent dipping of the hand into the milk), and the closing of bottles by handling of each disc with none too clean hands in the open backyard, are now 'past practice.' The new practice must still be supervised, and there is still room for improvement in some of the older dairy structures. At the instigation of the Department, four dairymen ceased sales of loose milk from counter pans in general shops and commenced the sale of milk in the receptacles in which it is received, i.e. four premises ceased to be dairies. The revision of the registers continues, and will be completed in the ensuing year. During the year under review 20 purveyors were added to the register. Complete reconstruction of the pasteurising plant at the large local establishment resulted in thermostatic control being introduced at the instigation of the Department. Thermographic records were examined systematically and the whole of the plant periodically. During the year the process of stassanisation was introduced at a new dairy, and a plant for the manufacture of waxed cartons and for filling and closing them installed. Nine hundred gallons of milk are being so processed and distributed daily by this dairy. (2) Bacteriological Examination of Milk. Systematic sampling of the milk supply for bacteriological examination was continued, and the results are set out in the following statement:— 117 Bacteriological Examination of Milk Samples. Total Ungraded Sterilised. Pasteurised. Grade A Grade A I.T. Bacteriological SamplesSatisfactory 73 36 2 28 3 4 Unsatisfactory 9 9 — — — — Biological Samples— Satisfactory 47 32 - 13 - 2 Unsatisfactory 1 1 — - - - Appropriate action was taken in respect of all unsatisfactory samples and repeat samples taken in cases where tubercle bacilli were found present in the supply. Two unsatisfactory reports upon microscopical examination of milk were transmitted to the responsible authorities, and this immediate action proved successful in the early detection of diseased cows. (3) Craded Milk. The licences in force on 31st December, 1936, were as follows:— Certified Milk— Dealers' Licences 1 Supplementary Licences 1 Grade A (T.T.)— Bottling Establishment 1 Dealers' Licences 9 Supplementary Licences 2 Grade A— Dealers' Liccnces 4 Supplementary Licences — Grade A Pasteurised— Dealers' Licences 1 Supplementary Licences 1 Pasteurised— Establishment Licences 1 Dealers' Licences 12 Supplementary Licences 3 (b) Meat and Other Foods (1) Meat Inspection. The Sanitary Inspectors made 1,272 visits to the slaughter-houses for the purpose of carrying out post mortem inspection of 27,749 animals, including 2,603 bovines, 118 20,686 pigs, 3,649 sheep, and 811 calves. With the exception of very few lambs, the whole of the animals slaughtered in the Borough were inspected. In consequence of this examination, the following diseased carcases and organs were condemned:— For Tuberculosis— Bovine carcases, 24. Bovine organs, 1,621. Porcine carcases, 8. Porcine organs, 265. Sheep carcases, Nil. Calves carcases, Nil. For Diseases other than Tuberculosis— Bovine carcases, 7. Bovine organs, 743. Porcine carcases, 13. Porcine organs, 1,335. Sheep carcases, 12. Sheep organs, 90. Calves carcases, Nil. Calves organs, 6. The butchers' shops throughout the Borough are periodically visited, those in the busy thoroughfares and markets being supervised weekly. (2) Food Premises. Systematic visitation of bakehouses, markets, fried fish shops and restaurants, and ice cream premises is carried out by the Inspectors. There appears considerable room for improvement in bakehouses, and more attention is being directed with a view to effecting this improvement. The year was a particularly busy one in the matter of improving many food premises. As has been previously mentioned, the appalling conditions prevailing in several fried fish premises have been swept away. The many manufactories for ice cream were surveyed during the year, and here many unsatisfactory premises and insanitary practises revealed. By rigid enforcement of the food laws the premises were either improved, or, as happened in the majority of cases, the small itinerant vendor was persuaded to purchase bulk supplies of the product already prepacked by reputable manufacturers. Four samples of ice cream were submitted for bacteriological examination in order to give support if needs be to our requirements, and it is no small wonder that two were reported upon adversely. Some practices are revolting, and one Inspector actually records that he observed one street vendor of ice cream "polishing" his appliances for making "wafers" with "grit" from the street gutter. 119 (3) Food and Drugs Adulteration. Samples of foodstuffs and drugs, submitted for analysis to the Public Analyst, numbered 498 or 3.7 samples per thousand of population. Of the number, 176 samples were taken formally and 322 informally. Fifteen samples were reported upon adversely, 8 being in respect of milk. In four instances the deficiency of milk fat was observed in an institution belonging to the Council, but subsequent formal samples proved genuine. A sample of bread was found to contain glass but upon investigation no evidence could be obtained as to how such glass had gained entrance to the loaf. Details of the samples taken, and adulterations are included in the following tables :— Number of Samples. Percentage samples adulterated. Examined. Found adulterated or below standard. Bread 1 — — Butter 20 — — Cheese 2 — — Cocoa 6 — — Coffee 3 — — Confectionery 28 — - Jam and Marmalade 16 — - Cream 6 - — Flour 1 — — Lard 4 — — Margarine 4 — — Milk 185 8 4 „ Condensed and Dried 1 — - Sausage 23 1 4 Sugar 3 — - Tea 5 — - Vinegar 10 — - Wines, Spirits 3 — — Drugs 28 — - Other Articles 149 6 4 498 15 3 Details of samples adulterated or below standard are described as follows, together with the resultant action:— 120 The Public Analysts for the Borough are Dr. Bernard Dyer and Partner, London, E.C. DETAILS OF ADULTERATION. No. I. or F. Article. Adulteration or Deficiency. Action Taken. 235 F. Beef Suet 10% water Vendor cautioned. 305 F. „ „ 16 % water „ „ 391 I. Beef Sausage Undeclared preservative. Sulphur dioxide—100 pts. „ „ 514 I. Minced Beef „ „ „ —160 pts. See formal sample 517. 517 F. „ „ ,, „ „ —400 pts. Vendor fined. 415 F. Milk 5% fat deficiency Vendor cautioned. 424 F. „ 7% „ „ „ „ 425 F. „ 11% „ „ „ „ 526 I. „ 8% „ „ Formal samples taken in course of delivery to Institution proved satisfactory. 529 I. „ 8% „ „ 530 I. „ 10% „ „ 531 I. „ 11% „ „ 693 F. „ 1% Added Water Investigation referred to contiguous Authority 641 I. Mustard 5% Wheaten flour No action taken. 658 I. Bread Broken Glass Vendor advised. I. = Informal Sample. F. - Formal Sample. 121 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE School Mimical Service:— INTRODUCTION REPORT For the year 1936. 123 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 ended 31st December, 1936. There were 16,660 children on the School Roll as compared with 17,370 for the year 1935. The number of routine and special cases, of elementary school children, examined, totalled 9,037, showing an increase on the previous year of 123. Of this number 3,664 were re-examined at the time of re-inspection in the schools. The routine medical examination of 1,016 pupils attending the Secondary Schools has also been carried out. An important decision of the Education Committee, to admit children at the age of 4½ years to the Elementary Schools, has met with an appreciable response (951 admissions being recorded during the Autumn Term of 1936). As this facility becomes more widely known there is no doubt that a large number of children under the age of five years will enter school: these will come within the purview of the School Medical Service and to that extent the problem of the pre-school child will be simplified. There has been no outstanding development in the School Medical Department during the year, and consideration of the Administrative Programme of Educational Development (Circular 1,444), issued by the Board of Education, indicates that the Local Education Authority has made adequate provision in regard to most of the services mentioned. Certain deficiencies exist however, and the position was briefly reported to the Education Committee in March 1936:— 124 (a). Dental Treatment. This is incomplete according to the standard suggested by the Board of Education. The percentage of acceptances for treatment although improved recently, is still unsatisfactory. The present staff appears sufficient to cope with the work. (b). Orthopaedic Treatment. There is a complete scheme in operation for hospital treatment, remedial exercises, electrical treatment and massage at Queen Mary's Hospital, Stratford, and the Memorial Hospital, East Ham. (c). Aural Treatment. Full arrangements are established in this respect. The Authority's Aural Surgeon attends at the Central Clinic for two sessions each week. Ionization treatment is carried out in suitable cases and operation for mastoid disease is provided at the Balaam Street Hospital, Plaistow. Arrangements for the operative treatment of tonsils and adenoids have been negotiated with four local hospitals. (d). Open Air Schools. There are no Day Open Air Schools in the Borough and, apart from the lack of suitable sites, it is doubtful whether any advantage would be gained from this form of treatment in East Ham over the system at present adopted for dealing with such cases. The policy of reserving an increasing number of places in Residential Open Air Schools and Schools of Recovery in different parts of the Country, is likely to prove of much greater value in the treatment of delicate and ailing scholars. On the other hand, the provision of a Day School for Physically Defective Children (Cripples and Heart Cases), who do not require a change of air or environment, would be a definite asset both physically and educationally. (e). Treatment of Rheumatism. The institutional treatment of children suffering from Rheumatism is provided at the East Ham Memorial Hospital, at Queen Mary's Hospital, at Victoria Park Hospital and in the Rheumatic Clinic at Great Ormond Street Hospital. 125 These arrangements are on a purely voluntary basis, except in regard to the East Ham Memorial Hospital, and the results have been very satisfactory. The relationship existing between the Hospitals and the School Medical Service is cordial, and co-operation in the interests and well-being of the children is complete. (f). Provision for Sub-Normal Children is fully established and all cases are suitably placed and graded either at the Authority's Day Special School or at Residential Special Schools. (g). Accommodation for Blind and Deaf Children. This is also fully provided at the West Ham Authority's Day Special School or at Residential Special Schools as occasion demands. Additional information will be found under the separate sections of this report and it will be appreciated that the needs of the scholars as regards their health, physical development and fitness are being met in a very complete and efficient manner. I wish to thank Dr. F. E. Bendix for his assistance in the preparation of this Report, and all the members of my staff for their keen interest and loyal co-operation. My thanks are also due to Mr. F. R. Thompson, Secretary to the Education Committee, and the Teachers for their great help and courtesy on innumerable occasions. In conclusion, I respectfully beg to express my indebtedness to the Chairman and Members of the Local Education Committee for the earnest consideration and support 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. 126 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. The sanitary arrangements and hygienic conditions of the Schools are inspected by the Medical Officers and School Nurses at each visit, and matters requiring attention are reported to the Education Department. A comprehensive programme for the improvement or replacement of unsatisfactory and old-fashioned conveniences, lavatories and cloakrooms has been adopted by the Authority. On the whole, the sanitary conditions of the Schools are good. 4. Medical Inspection. The following is a synopsis of School Medical Work for the year 1936, as compared with previous statistics. COMPARATIVE STATEMENT OF WORK. 1932. 1933. 1934. 1935. 1936 Routine & Special Inspection (on School premises):— Secondary 771 812 1,017 1,093 1,016 Elementary 10,458 10,193 9186 8,914 9 037 Re-Inspection 2,700 2,773 3203 3,115 3 664 Consultations at Inspection Clinic 16,122 18,294 17,750 17,612 16,708 Number of Treatments at Clinic 12,819 13,636 13,770 22,073* 27,976* General Cleanliness Visits to Schools 307 341 296 339 281 Nurses' Visits to Homes 3,078 3,124 3,206 3,563 3,558 Children Examined for Cleanliness 50,513 50,064 47,550 45,356 44.145 *Increase due to extension of light treatment. 127 (a) Medical Inspection and Re-inspection. At the commencement of the year arrangements were made for the Medical Inspection of all children admitted to the schools during the year, of all children between 8 and 9 years of age, and of all children between 12 and 13 years of age, together with children over 13 years of age who had not already been examined after reaching the age of 12. Routine Medical Inspection and Re-inspection was completed in all the schools of the Borough. (b) Exceptional Children. Towards the termination of routine medical inspection in each school, teachers are requested to bring before the School Medical Officer any special cases who may require examination, and to include amongst these all cases falling within the category of "exceptional children" (Table III). In this way an annual census of all cripples is rendered possible, whilst particulars may be obtained and advice given as to their progress and treatment. (c) Places of Medical Inspection. 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 1936 was 5,552, or 33 per cent. of the number on school roll. In addition 3,485 children were referred for some special reason by parents, nurses, teachers or attendance officers. The total number of children medically examined was therefore 9,037, or 54 per cent. of those on the school roll. The number of re-inspections carried out was 3,664. 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 1936:— 128 FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. 1931 1932 1933 1934 1935 1936 1931 1932 1933 1934 1935 1936 1931 1932 1933 1934 1935 1936 Entrants 2,047 2,245 2,040 1,747 1,898 1,719 263 255 250 447 299 234 12.8 11.4 11.2 25.5 15.7 13.6 Second Age Group 1,987 2,028 2,006 1,873 1,622 1,786 217 240 230 230 200 189 10.9 11.8 12.4 12.2 12.3 10.5 Third Age Group 1,855 1,985 2,079 1,895 1,713 1,636 181 175 180 193 196 208 9.7 8.8 8.6 10.1 11.4 12.7 Totals 5,889 6,258 6,125 5,515 5,233 5,141 661 670 660 870 695 631 11.2 10.7 10.7 15.7 13.1 12.2 129 The comparatively low percentage of children who were found, at routine medical inspection, to require treatment is some criterion of the popularity and efficiency of the School Clinics and of the vigilance and care exercised by parents, teachers, nurses, and attendance officers. Reference to Table II. will provide additional evidence of this fact, since the routine examination of 5,141 children revealed only 832 defects requiring treatment, whereas there were 3,273 conditions referred for treatment in the case of special examinations carried out at the School Clinics. This position is satisfactory in that the health of the scholars is well maintained. The average school attendance of 88.5% for the year 1936 is further proof of the standard of health of East Ham scholars. There is no doubt that the activity of the School Medical Service has brought about a remarkable change in the general health, physique, vitality and personal hygiene of the scholars : the delicate, dull or malnourished child, so commonly encountered at its inception, has given place to the more robust, alert, clean and athletic type met with in our schools to-day. Similarly one seldom meets with that gross lack of interest or desire to seek treatment for conditions which are perfectly obvious to the parents, and it is gratifying to think that the suffering, and even fatality, consequent upon the neglect of defects, trivial perhaps at first, is now of very rare occurrence. (a) Uncleanliness. The School Nurses have carried out three cleanliness surveys of all children in the elementary schools during the year 1936. During the year the School Nurses made 44,145 examinations, as compared with 45,356 in 1935. Of this number 157 children showed vermin and many nits in the hair (140 in 1935), whilst 1,354 children showed only a few nits (1,854 in 1935). 130 Comparative table:— Year Number Examined Number with Nits Number with Head Vermin No. of Exclusion Certificates 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 1936 44,145 1,354 157 101 It will be noted that the low incidence in the number of children suffering from uncleanliness is maintained, and much credit is due to the School Nurses, whose efforts have contributed to this reduction. Parents are becoming more and more convinced of the importance of personal hygiene in the prevention of minor ailments and ill-health, and it is the general experience that cases of uncleanliness, discovered and reported, are now more speedily remedied; this is reflected in the decrease in the number of exclusion certificates issued. Unfortunately there remains a small minority of habitual offenders who will only respond to definite pressure. The School Nurses may be excused their remarks in regard to such cases! In addition to the routine general cleanliness surveys, some hundreds of children have been examined at the request of the authorities of the Children's Country Holiday Fund and other voluntary organisations. These examinations have been conducted just prior to the departure of the children for summer holiday camps, convalescent homes, etc. 131 TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. Schools. Dept. Number Exam'd Few Nits Many Nits and Vermin Schools. Dept. Number Exam'd Few Nits Many Nits and Vermin Monega S. Boys 692 — — Myope 46 2 - Altmore S. Mixed 875 6 Napier Infants 548 55 1 Avenue Infants 500 9 10 J. Boys 1158 19 2 J. Girls 676 36 16 S. Boys 920 8 - J. Boys 748 11 10 Plashet Infants 525 16 4 Brampton Infants 1171 32 1 J. Boys 830 15 - J. Girls 1330 23 5 S. Boys 753 3 - S. Girls 812 8 2 Salisbury Infants 617 28 4 Castle Street R.C. Mixed 591 14 - J Mixed 1079 29 - Central Park Infants 829 11 1 S. Mixed 706 9 - J. Boys 1258 2 - Sandringham Infants 546 9 5 S. Boys 830 - - J. Mixed 840 10 4 Cornwell Infants 893 100 10 Sandringham Central 400 1 - S. Girls 797 65 6 Shaftesbury Infants 798 20 - S. Boys 774 10 - J. Girls 887 32 - Dersingham Mixed 794 65 11 S. Girls 730 16 - Essex Infants 788 47 7 Shrewsbury Special 163 7 - J. Boys 855 5 2 Storey Street J. Mixed 558 31 - S. Boys 527 7 1 S. Mixed 737 36 3 Hartley Infants 726 18 - Silvertown J. Mixed 257 20 - J. Girls 853 45 - S. Mixed 579 29 2 S. Girls 642 13 - St. Michael's R.C. Mixed 530 31 2 Kensington Infants 572 7 1 St. Winifride's R.C. Mixed 819 25 8 J. Girls 917 30 11 Vicarage Infants 967 66 7 S. Girls 566 6 8 J. Girls 1110 106 — Lathom Infants 928 10 1 S. Girls 753 61 2 J . Girls 879 25 5 Winsor J. Mixed 825 37 2 J. Boys 902 - - S. Mixed 678 18 2 Monega Infants 709 6 1 Wakefield C Girls 200 1 - J. Boys 957 3 - Boys 195 - - Total 44145 1354 157 Per cent. in 1936 3.06 0.3 Per cent. in 1935 4.08 0.3 132 (b) Minor Ailments. Chief Minor Ailments. Discovered at Routine Medical Inspection Discovered by Teachers and Nurses and sent to Clinic 1935 1936 1935 1936 Scabies 1 - 12 15 Impetigo 7 3 236 240 Conjunctivitis 1 — 57 65 Blepharitis 1 4 28 35 Ear Diseases 46 36 204 195 Ringworm (Scalp) — — 3 1 Ringworm (Body) 1 — 33 35 The very low incidence of ringworm is noteworthy, and cases of scabies and blepharitis, the number and severity of which were a source of constant difficulty and anxiety in the past, are remarkably few. This satisfactory state of affairs is due to the decided improvement in personal hygiene. On the other hand, although the occurrence is 50% less than it was ten years ago, impetigo is still a serious foe to be reckoned with so far as school attendance is concerned. The neglect of trivial cuts, abrasions, or scratches, with consequent irritation, is responsible for many of the cases and, although in most instances the condition is much less severe and the period of exclusion from school of short duration, it is evident that this infection of the skin should not occur. Several cases of conjunctivitis appeared to have some relationship to attendance at the swimming baths, clue perhaps to irritation of the eyes of certain children through slight overchlorination of the water. At any rate, advice in regard to the washing of the eyes with fresh water and appropriate treatment after the swimming lesson, has produced satisfactory results. (c) Tonsils and Adenoids. 5.1 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids," either separately or combined, as compared with 4.4 per cent. in the year 1935. Of these, much enlarged tonsils accounted for 1.4 per cent.; definite adenoids were present in 0.1 per cent.; and the combined 133 defect was diagnosed in 3.6 per cent.; the figures for 1935 were 0.9 per cent.; 0.1 per cent.; and 3.4 per cent. respectively. The percentage of children moderately affected and requiring to be kept under observation was 7.7, the corresponding percentage in 1935 being 7.4. In this case 7.4 per cent. had moderately enlarged tonsils, 0.1 per cent. exhibited signs of the presence of adenoids, whilst 0.2 per cent. showed enlarged tonsils and adenoids of moderate degree, as compared with 6.9 per cent.; 0.29 per cent; and 0.3 per cent. respectively in the year 1935. (d) Tuberculosis. The total number of cases of tuberculosis, occurring in children of school age, notified to the Medical Officer of Health during the year, was as follows:— Boys Girls Total Pulmonary Tuberculosis 4 8 12 Other forms of Tuberculosis 5 7 12 9 15 24 (e) Skin Disease and (f) External Eye Disease. At medical inspections during the year, 559 children were found to be suffering from skin affections (as compared with 547 in the year 1935). One hundred and four cases of external eye disease were discovered, as compared with 87 in the year 1935. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 439. In addition, there were 233 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. 0.9 per cent. of the children examined were found to be suffering from otitis media. (1.3 per cent in 1935.) The percentage of deaf children was 0.25, the corresponding number for last year being 0.09. (i) Dental Defects. Medical Inspection has revealed a continued high incidence of dental defects, and the statistics contained in Table V. are far 134 from encouraging. The percentage of children found to be in need of dental treatment is 61.7%, and this matter requires the closest attention if the health of the children is to be maintained at the highest possible level. (j) Crippling Defects. Reference to Table III will furnish information with regard to the occurrence of crippling defects in the area. Forty-six cases were discovered at routine medical inspection during the year. 6. INFECTIOUS DISEASES. There was a marked diminution in the number of cases of Diphtheria. 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 forty-nine swabs were taken for this purpose, all of which proved negative. (b) In suspicious cases seen at the Clinics or Schools, two hundred swabs were taken, and two proved to be positive. (c) In cases where an undetected source of infection appears to be present in a class or school, thirteen swabs were taken and none proved to be positive. The statistics and comments 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. A detailed account of the scheme adopted for the detection and prevention of infectious diseases has been submitted in previous reports, and the accompanying table furnishes statistics in regard to the incidence of the acute infectious diseases during the year 1936. 135 Table of the Chief Infectious Diseases, Showing the Monthly Incidence in Children of School Age Month. Measles Chicken Pox Whooping Cough Mumps Scarlet Fever Diphtheria January 385 21 41 2 12 5 February 61 22 46 6 14 7 March 89 39 26 2 13 9 April 99 33 44 2 20 5 May 19 24 37 — 18 7 June 1 26 18 1 11 4 July 1 16 1 2 14 7 August | 8 6 11 3 28 6 September i October 3 32 2 2 23 4 November 5 111 6 12 17 1 December — 52 2 — 10 1 Totals (464) 671 (119) 382 (77) 234 (737) 32 (187) 180 (148) 56 The totals in brackets are those for the year 1935 and are inserted for comparison. The return of cases of non-notifiable infectious diseases is not sufficiently accurate to indicate the prevalence of these illnesses amongst school children. 136 7. FOLLOWING UP. The School Nurses have paid 3,558 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. Of the 773 children referred for treatment, 520, or 67 per cent., have obtained treatment. The School Nurses have also paid 281 special visits to the Schools, and have undertaken 18 journeys in connection with the admission and discharge of children to Institutions. All children referred for the operative treatment of tonsils and adenoids (464) have been visited prior to and after the operation. The value of "following up" cannot be over-estimated, and is responsible to a large extent for the highly satisfactory results obtained by the School Medical Service. The agreement of parents to treatment advised by the Medical Officers plays an important part in diminishing the incidence of disease amongst the children. 8. MEDICAL TREATMENT. The following Clinics are held weekly for the treatment of defects in school children:— (1) Ceneral Clinic (Minor Ailments and Observation Cases), †(a) Town Hall—Mondays, Wednesdays and Saturdays, 9 a.m. Average attendance, 80. *(b) High Street Schools—as above. (c) Church Road, Manor Park—Tuesdays and Thursdays at 9 a.m. Average attendance, 90. (d) North Woolwich—Mondays and Fridays at 2 p.m. Average attendance, 40. (2) Eye Specialist Clinic. Town Hall—Tuesdays, Thursdays 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. 137 (b) Manor Park- Mondays, 9 a.m., Girls; 2 p.m., Babies. Tuesdays, 2 p.m., Boys. Wednesdays, 9 a.m., Girls; 2 p.m., Babies. Thursdays, 9 a.m., Boys; 2 p.m., Locals. Fridays, 9 a.m., Girls and Babies. 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 1936, 27,976 attendances were made for treatment at the various clinics, and there were 16,708 attendances for consultation with the Medical Officers. † Town Hall General Clinic closed 11/7/36. * High Street Schools General Clinic commenced 13/7/36. As a temporary measure, pending the provision of permanent premises, the Central General Clinic has been transferred to the High Street School. Access and accommodation are more satisfactory, but the position in regard to equipment and suitability tor clinic purposes still leaves much to be desired. (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 424 received operative treatment during the year 1936. (c) Tuberculosis. The arrangements for the treatment of Tuberculosis have been continued on the lines fully set forth in the reports for previous years. 138 (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. (e) External Eye Disease. One hundred and four cases (87 in 1935) of external eye disease were treated at the School Clinics. (f) Vision. During the year 1936, the Ophthalmic Clinic was held on five sessions per fortnight. Five hundred and twenty-five accepted treatment in respect of visual defect during the year 1936 (of these 17 children with markedly defective vision had not been seen by the Ophthalmic Surgeon) and, including 83 cases awaiting treatment at the termination of the year 1935, 591 cases have been treated in the past year. A Sight-saving Class at Monega Road School was opened by the Education Committee in June, 1928, 14 children are in attendance at this class, and they are all kept under observation by the Ophthalmic Surgeon at intervals. Mr. S. C. Reeve-Flaxman, the Ophthalmic Surgeon, reports as follows:— General Clinic. Number of new cases 591 Glasses prescribed 369 Glasses not necessary 224 Glasses obtained 362 Special treatment 77 Re-examinations 2058 Discharged 201 Strabismus operation at Royal Westminster Hospital 2 Eye removed (Glioma) at Royal Westminster Hospital 1 Sent to Swanley (Blepharitis) 1 139 Baby Clinic. Number of new cases 34 Glasses prescribed 16 Glasses obtained 16 Special treatment 5 Re-examinations 78 Discharged 2 Lachrymal obstruction treated at Royal Westminster Hospital 3 Sight-Saving Class. Number of pupils 14 Most of the treatment and operation cases were successfully dealt with. A few chronic lid inflammations are still under treatment. The sight-saving class has done very useful work. The School Medical Service and optical and clerical staff have given extremely kind and efficient help. (g) Ear Disease. During the year ,1936, 84 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 1,686, making an average attendance, at each session, of 20 patients. lonisation treatment was carried out in 14 cases, 56 applications being made. Mr. Ronald Savege, F.R.C.S., the Aural Surgeon, reports as follows:— Eighty-four clinics were held during the year, with a total attendance of 1,686. Fifty-six per cent. of the cases were, after treatment, discharged cured. I operated on 342 East Ham children for septic tonsils and adenoids, and in three cases of chronic mastoid disease. The statistical report is as follows:— Cases of Chronic Otitis Media 143. Discharged 83 Cases of Deafness 17. „ 10 Other Ear Cases 74. „ 55 140 Cases of Chronic Rhinitis 49. „ 28 Other Nose Cases 27. „ 15 Cases of Enlarged Tonsils and Adenoids 305. „ 156 Other Throat Cases 52. „ 29 Mastoid Operations 3. „ 1 I should like to take this opportunity of expressing my thanks to the medical, nursing and clerical staffs for their very efficient help. (h) Dental Defects. The question of dental defect is a problem which is growing in importance year by year. It is very difficult to convince parents of the harmful effect of unhygienic and septic conditions of the mouth upon general health and nutrition, although, apart from interference with digestion resulting from faulty mastication, it is evident that the mouth provides access for infection associated with many serious diseases. It is astonishing that only 44.8% of the children, found to be suffering from dental disease, were presented for treatment at the School Dental Clinics, especially in view of the fact that veryfew parents arrange private dental treatment for their children. Despite the efforts of the School Dental Surgeons and Nurses, in spite of the persistent advice given by the Medical Officers and School Nurses, the position remains unsatisfactory. Much might be done to improve the situation by extending the campaign of propaganda, and in this direction the School Teachers could be of invaluable assistance in supplementing the advice given by the School Medical Service. Mr. C. Stanley Neame, the School Dental Surgeon, reports as follows:— The age-groups inspected were from 5 years to 12 years inclusive. The number inspected was 12,358, and the number referred for treatment was 7,787. The "specials" number 258; these are urgent cases referred by the School Medical Officers and Head Teachers. (See Table V.) 141 Dental inspection is carried out at the schools so that every child in the routine age-groups is inspected once a year. At inspection is the opportunity to talk to the children and get them to realise the importance of dental cleanliness. The treatment is carried out so that pain is almost nonexistent. Injections are given for the extraction of most temporary teeth and some permanent teeth, and gas is administered in the case of septic temporary teeth and the majority of permanent teeth. Gas is also given for all extractions when the patient is very nervous or hyper-sensitive. Injections are also given for sensitive fillings in permanent teeth. Gradually the antipathy of parents to fillings is being overcome, and it is interesting to record that nearly 300 more permanent teeth were filled than in 1535. Regulation of the permanent teeth is carried out by judicious extraction or by the making of regulation plates, and some very striking results have been obtained. This work is very important, as it restores the teeth to their normal function, that is to provide perfect mastication, and definitely improves the appearance of the child, often in a very remarkable manner. The more difficult cases are referred to the London Hospital or to Guy's Hospital. The percentage of children with sound mouths is 38%, which figure compares very favourably with the 22% of the other County Boroughs of England and Wales. The increase (percentage) in the number of children who have no dental defects for the past five years is shown in the following table:— Year Percentage of children with sound mouths (Ages 5—12 years incl.) 1932 29% 1933 31% 1934 32% 1935 34% 1936 38% Maternity and Child Welfare Centres. Details of the dental work in connection with the Maternity and Child Welfare Centres are shewn in the following table:— 142 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 88 358 616 424 93 840 128 Total No. of Extractions Total No. of Fillings No. of Adminis trations of General Anaesthetics No. of other Operations Permanent Teeth Tem- porary Teeth 1264 221 117 141 107 Two sessions per week have been devoted to cases referred by the Medical Officers of the Maternity and Child Welfare Centres, these being children under 5 years of age, pre-natal and nursing mothers. General and local anaesthetics are used for the extraction of both temporary and permanent teeth. Fillings are done when possible, and dentures supplied in a few case (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. Seven out-patients have received treatment during the year. The total out-patient attendances were 128. Payment is made to the Hospital Authorities by a per capita grant contribution in respect of East Ham scholars sent to the Hospital through the School Medical Service. All children referred by the Authority's Medical Officers to the Hospital for treatment are kept under observation at frequent intervals at one or other of the School Clinics, in order that the progress of the cases may be watched and recorded, and to ensure that treatment has not been allowed to lapse. If at any time such 143 a case fails to attend the School Clinic it automatically becomes included in the following up list of one of the School Nurses. The recent extension of facilities for orthopaedic treatment at the East Ham Memorial Hospital has enabled the School Medical Department to refer several cases to this Hospital, under the general terms of agreement between the East Ham Corporation and the Hospital Authorities. (j) The Light Clinic. A further twelve months' experience of actino-therapy does not warrant any change of opinion as to the superior value of this form of treatment, in the type of cases selected, over all other measures which have been given a trial, and I can only confirm my reports of previous years in this respect. 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. Condition Boys Girls Babies Anaemia and Debility 97 111 116 Malnutrition 33 44 3 Cervical Adenitis 14 9 2 Bronchial Catarrh 53 35 16 Rheumatism 6 7 2 Sinus 1 — — Dermatitis — 1 — Rachitis — 1 1 Asthma a 2 — Debility and Rheumatism — 3 — Nervous Debility 7 10 — Debility and Bronchial Catarrh - 1 - Chorea 3 4 1 Alopecia 6 5 — Rickets 4 1 8 Eczema 1 — — Debility and Cervical Adenitis 1 1 - Debility and Eneuresis 1 — — Bronchial Catarrh and Rheumatism 1 - - Bronchial Catarrh and Anaemia 1 - - 144 Bronchial Catarrh and Adenitis 1 - - Rheumatism and Malnutrition - 1 - Bronchitis — 2 — Cough -— 2 — Fibrosis Lung 1 — — Contact T.B -— 1 — Underweight 1 — — Blepharitis 1 — — 234 241 149 Number of Children Treated (General) 598 Number of Children Treated (Local) 26 Number of Attendances (General) 16447 Number of Attendances (Local) 690 Total Number of Attendances (Local and General 17137 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 152 scholars to the Kessingland Holiday Camp during the year 1936, and in addition the following School Journeys were undertaken :— Brampton Senior Girls 50 Central Park Senior Boys 27 Plashet Senior Boys 50 Total 127 (c) Open-Air Classrooms in Public Elementary Schools. There are four open-air classrooms at the Brampton School and one at Castle Street School. 145 (d) Open-Air Day Schools. There are 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. Catherine's School at Ventnor, Suntrap School at Hayling Island, St. Mary's School of Recovery at Dover, and to the Institutions of the Invalid Children's Aid Association. The following statistical table gives particulars of the number of children admitted to these schools during the year 1936:— 146 Particulars of the number of Children who were resident in Schools of Recovery between 1st January and 31st December, 1936, 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 — — — 4 — 1 — 1 1 1 6 1 5 1 2 3 — — 2 3 1 1 2 3 19 19 38 I.C.A.A. (hdqts.) — 3 — 1 2 — 4 2 2 2 1 1 - 1 - - - - - - - - - - 9 10 19 St.Catherines 2 — 2 — 1 — — — 1 1 — 1 1 — — — — — — 1 — — 3 — 10 3 13 St. Dominic's - - 3 - - - 6 - 7 - - - 5 - - - 3 - - - - - 4 - 28 - 28 Suntrap — — — — 3 1 - - - - - - - - - - - - - - - - - - 3 1 4 No. of Weeks RussellCotes 4 12 14 24 26 Total B. G. B. G. B. G. B. G. B. G. B. G. 2 2 20 15 9 5 4 — 1 1 36 23 147 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. SYNOPSIS OF CASES REFERRED TO EAST HAM I.C.A.A. BY SCHOOL MEDICAL SERVICE DURING 1936. Diseases from which children were suffering. Debility following illnesses, accidents and operations 20 Anaemia and debility 12 Diseases of the bones 5 Bronchitis and pneumonia 2 Chorea and nervous debility 2 Glands 1 Sub-normal nutrition 1 48 Action taken. Convalescence 34 Surgical instruments provided 5 Fares to and from Hospital for treatment granted 1 Parents refused treatment offered 3 43 (f) Day Special Schools for Physically Defective Children Arising out of the consideration of Circular 1444, the Education Committee were furnished with particulars of the position in regard to physically defective children who would derive benefit from education in a Day Special School:— No definite policy has been adopted in regard to the provision for the education of physically defective children in East Ham, and the methods of dealing with these children hitherto has left much to be desired. 148 Permanent and prolonged exclusion from school has been recommended in many cases, and the Special Class (at High Street School and subsequently at Lathom Road and Hartley Avenue Schools) was unable to meet the needs of children certified, by reason of physical defect, as being incapable of receiving proper benefit from instruction in an ordinary elementary school. The factors which operated against the efficient conduct of this class are briefly as follows:— (a) No arrangements for conveyance of scholars to and from the Class, which rendered it difficult to suggest to parents that a long and inconvenient journey is more beneficial than attendance at a nearby elementary school. (b) Difficulty in ensuring an adequate standard of education owing to varying ages of children. Many parents were dissatisfied with the educational progress of the scholars in the Special Class. In this connection it will be realised that scholastic attainments are of the utmost importance to children suffering from physical defects. (c) The Teacher in charge of the Special Class had no special experience or qualification for dealing with this type of child. In view of these circumstances many children coming within the category of physically defective have been allowed to attend local ordinary elementary schools, with a recommendation that special precautions should be observed in particular cases, e.g. abstinence from physical exercises, organised games or play; avoidance of stair-climbing; permission to arrive at school late and leave early; half-time attendance at school, etc. It is difficult to ensure that these precautions are enforced, added responsibility is thrown upon the Teaching Staff and, in any case, it is undesirable that physically defective children should be continually reminded of their handicap and disability. The policy of reserving an increasing number of places in Residential Schools of Recovery and Special Schools, in different parts of the country, for the reception of delicate and ailing children and those suffering from active crippling defects, has proved 149 of tremendous value, and is far more beneficial than attendance at local Day Open-Air Schools. On the other hand the necessity for a Day Special School for Physically Defective Children has been emphasized repeatedly in the Annual Reports of the School Medical Officer, and there is no doubt that the provision of a Special School for scholars suffering from crippling defects, but who do not require a change of air or environment, would be a definite asset to the physical and educational welfare of these children. Such a school, efficiently organized along the lines laid down by the Board of Education, with proper facilities for educational classification; provision of meals and arrangements for transport, would enhance the probability of the scholars obtaining suitable remunerative employment despite their physical defects. Statistics in regard to the physically defective children, at present attending ordinary elementary schools, who would benefit by attendance at a Day Special School, are given in the accompanying table. In addition many children, who are considered sufficiently recovered to be discharged from Residential Schools, would derive benefit from a transition period at the Day Special School. It is often found that the health of such children shows a tendency to deteriorate upon resuming normal school life and, not infrequently, a further period in a Residential School becomes necessary. 150 STATISTICS AND CLASSIFICATION OF SCHOLARS WHO WOULD BENEFIT BY ATTENDANCE AT A DAY SPECIAL SCHOOL FOR PHYSICALLY DEFECTIVE CHILDREN. Heart defects due to Rheumatism, Chorea, Scarlet Fever, Diptheria, etc. Rheumatic Cases Congenital Heart Defects Congenital & Infantile Paralysis Tubercular Cases (Quiescent) Joints Glands Abdominal Pulmonary G B G B G B G B G B G B G B G B 21 17 8 4 7 7 6 14 5 3 4 4 1 3 1 2 Asthma Cases Epilepsy Minor Crippling (Deformity) due to Congenital Causes Rickets Accident Disease G B G B G B G B G B G B 6 7 7 3 3 2 4 2 — 2 2 1 Total: Girls 75. Boys 71 = 146. 151 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 168,802 meals were provided for children, as compared with 185,405 in 1935. The Medical Officers and School Nurses visit the various feeding centres periodically. On these occasions the quality of the food and the preparation, distribution and service of the meals have been satisfactory. 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 1936 the number of parents who were present at the routine medical inspections was 4,237 (4,442 in 1935), that is, 76.3 per cent. of the cases examined (77.4 per cent. in 1935). 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 22 were medically examined, reports and advice in each case being sent to the Secretary of the Education Committee. 152 16. CO-OPERATION OF VOLUNTARY BODIES. Reference to Section 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. One hundred and ten 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 1936. The Inspectors have made 601 visits in regard to these cases and the following table indicates the work performed by the Society Condition Number of Cases Treatment Obtained Treatment arranged Cases under Observation Tonsils and Adenoids 8 5 2 1 Defective Vision 14 14 — — Dental Caries 2 2 — — General Neglect 77 71 improved — 6 Ill-Treatment 4 3 improved — 1 Others 5 5 improved — — 110 100 2 8 The fact that Court Proceedings were avoided in every case is deserving of special mention and the Society is to be congratulated upon the excellent results achieved. 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. (See Table III). Nine children are suffering from physical defects which prevents them attending public elementary schools. 153 Two hundred and eleven children considered physically defective and 92 children suffering from glandular and noninfectious pulmonary tuberculosis, are attending ordinary elementary schools. (See Section 9 (e).) Mentally Defective Children. During the year 1936, the number of cases examined for purposes of the Mental Deficiency Acts was 38 (24 in 1935). Of these, ten were classified as mentally deficient and 28 as dull and backward, recommendations being made as shown in the following table:— Number examined 38 Classified as mentally deficient 6 10 Classified as morally deficient — Classified as imbeciles 4 Classified as idiots — Classified as dull and backward 28 Recommended for Special School 6 18. NURSERY SCHOOLS. There are at present no Nursery Schools in East Ham. 19. SECONDARY SCHOOLS. There are two secondary schools in East Ham, and tables relating to the work carried out in connection with these schools are appended. 20. CONTINUATION SCHOOLS. There are at present no Continuation Schools in East Ham. 21. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. All children in their final medical examination prior to leaving school have a note placed on their medical card if there is any 154 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-one boys have been specially examined in accordance with the Bye-laws, and these were found to be fit for employment. In addition, 15 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. No special enquiries were carried out during the year 1936. 23. MISCELLANEOUS. During the year 1936, the following special medical examinations were made in connection with the appointment of staff:— Teachers 26 Assistant Teachers and Student Teachers 23 Caretakers, School Attendants and Cleaners 37 Cook-Attendants and Assistant Cook 1 155 TABLE I. RETURN OF MEDICAL INSPECTIONS. CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups— Entrants 1,719 Second Age Group 1,786 Third Age Group 1,636 Total 5,141 Number of other Routine Inspections 411 Grand Total 5,552 B.—OTHER INSPECTIONS. Nun ber of Special Inspections 3,485 Number of Re-Inspections 3,664 Total 7,149 C.—CHILDREN FOUND TO REQUIRE TREATMENT. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding defects of Nutrition, Uncleanliness and Dental Diseases). Group For defective vision (xcluding squint) For all other conditions recorded in Table IIA Total (l) (2) (3) (4) Entrants - 234 234 Second Age Group 92 138 189 Third Age Group 85 168 208 Total (Prescribed Groups) 177 540 631 Other Routine Inspections 56 46 82 Grand Total 233 586 713 Note:—No individual child is counted more than once in any column of this table. 156 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1936. Routine Inspections. Special Inspections. Defect or Disease 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 (1) Ringworm—Scalp — — 1 — (2) ,, Body — — 35 — (3) Scabies — — 15 — (4) Impetigo 3 6 240 — (5) Other Diseases (NonTuberculous) 15 25 250 — Total (Heads 1 to 5) 18 31 541 — Eye (6) Blepharitis 4 7 35 — (7) Conjunctivitis — 2 65 — (8) Keratitis — — 1 — (9) Corneal Opacities — — — — (10) Other Conditions (excluding Defective Vision and Squint) 4 5 77 1 Total (Heads 6 to 10) 8 14 178 1 (11) Defective Vision (excluding Squint) 233 177 121 13 (12) Squint 16 21 26 — Ear (13) Defective Hearing 7 3 16 1 (14) Otitis Media 11 7 73 — (15) Other Ear Diseases 25 43 12 3 Nose and Throat (16) Chronic Tonsillitis only 76 670 57 3 (17) Adenoids only 6 12 5 1 (18) Chronic Tonsillitis and Adenoids 160 17 160 5 (19) Other Conditions 43 48 116 3 157 TABLE II.—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 Treatment. Requiring Treatment. Requiring to be kept under obser vation, but not requiring Treatment. (1) (2) (3) (4) (5) 20) Enlarged Cervical Glands (NonTuberculous) 12 133 43 - (21) Defective Speech 4 12 10 3 Heart and Circulation Heart Disease : (22) Organic 5 28 9 - (23) Functional 3 30 2 1 (24) Anaemia 18 21 51 - Lungs ((25) Bronchitis 38 126 112 4 (26) Other Non-Tuberculous Diseases 2 13 4 — Tuberulosis Pulmonary :— (27) Definite — — 1 — (28) Suspected 3 1 4 2 Non-Pulmonary :— (29) Glands 1 1 1 — (30) Bones and Joints — — 1 — (31) Skin — - — \ (32) Other Forms — — — — Total (Heads 29 to 32) 1 1 2 — Nervous System (33) Epilepsy 1 1 (34) Chorea 4 2 14 — (35) Other Conditions 1 13 4 2 Deformities (36) Rickets 1 3 - - (37) Spinal Curvature 9 3 - 1 ((38) Other Forms 7 45 20 2 (39) Other Defects and Diseases (excluding defects of Nutrition, Uncleanliness and Dental Diseases... 121 76 1581 94 Total 832 1551 3273 139 158 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 1,719 93 5.4 1,564 90.9 62 3.6 – – Second Agegroup 1,786 140 7.8 1,570 87.9 76 4.2 – – Third Agegroup 1,636 163 10.0 1,433 87.5 40 2.4 Other Routine Inspections 411 35 8.5 366 89.0 10 2 4 — — Total 5,552 431 7.7 4,933 88.8 188 3.4 — — 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 is included in this section. At Certified Schools for the Blind At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 2 — — — 2 Partially Sighted Children. 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, are entered in this Section. 159 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 are not 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. — 12 3 — — 15 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 for partially deaf children. Only the first class is included in this Section. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Res. Day 5 9 — — — 14 Partially Deaf Children. Children who can appropriately be taught only in a school for the partially deaf are entered in this Section. 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. Res. 1 – 1 — — 2 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 160 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 includes 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. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Res Day 5 63 — 6 — 74 Epileptic Children. Children Suffering from Severe Epilepsy. In this part of the Table only those children are 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. 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. Only children diagnosed as tuberculous and requiring treatment for tuberculosis at a sanatorium, a dispensary, or elsewhere are recorded in this category. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) 161 Table III—continued. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 8 30 — I 39 II.—Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in I. above.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 12 62 1 2 77 B. Delicate Children. This Section is 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 At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 64 140 — — 204 C. Crippled Children. This Section is 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 to take part, in any complete sense, in physical exercises or games or such activities of the school curriculum as gardening or forms of handwork usually engaged in by other children, and in whose case the Medical Officer would be prepared to certify under 162 Table III—continued 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. 8 32 4 2 16 D. Children with Heart Disease. This Section is 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. 13 39 1 3 56 Children Suffering from Multiple Defects. Information is given 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. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Blind and M.D. _ 1 1 M.D. and Heart 1 — — — 1 163 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 (ii.) Other – – – Ringworm-Body 33 – 33 Scabies 13 1 14 Impetigo 234 1 235 Other skin disease 202 7 209 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 110 4 114 Minor Ear Defects 170 8 178 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 1754 174 1928 Total 2516 195 2711 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) 528 — 528 Other defect or disease of the eyes (excluding those recorded in Group 1) — — — Total 528 — 528 No. of Children for whom spectacles were (a) Prescribed 330 — 330 (b) Obtained 325 2 327 164 TABLE IV.—continued. GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Defects. Received Operative Treatment. Received other forms of of Treatment. Total number treated Under the Authority's Scheme, iu 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) 35 8 298 49 5 — 7 7 40 8 305 56 45 454 (i) Tonsils only, (ii) Adenoids only defects of the nose and throat. (iii) Tonsils and adenoids. (iv) Other GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS. Under the Authority's Scheme. (1) Otherwise. (2) Total number treated Residential treatment with education. (i) Residentialtreat- ment without education. (ii) Non-residential treatment at an orthopaedic clinic. (iii) Residential treatment with education. (i) Residentialtreat ment without education. (ii) Non-residential treatment at an orthopaedic clinic (iii) Number of children treated — — 8 — — 23 31 165 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 1456 1571 1413 1659 1687 1770 1982 820 – — 12358 (6) Specials 258 (c) Total (Routine and Specials) 12616 (2) Number found to require treatment 7787 (3) Number actually treated 3480 (4) Attendances made by children for treatment 7837 (5) Half-days devoted to :— Inspection 114 Treatment 697 Total 811 (6) Fillings :— Permanent Teeth 1933 Temporary Teeth 495 Total 2428 (7) Extractions :— Permanent Teeth 1109 Temporary Teeth 6801 Total 7910 (8) Administrations of general anaesthetics for extractions 791 (9) Other Operations :— Permanent Teeth 877 Temporary Teeth 332 Total 1209 TABLE VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 3 (ii.) Total number of examinations of children in the Schools by School Nurses 44145 (iii) Number of individual children found unclean 708 (iv.) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 – (v.) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 – (b) Under School Attendance Byelaws – 166 TABLE I. RETURN OF MEDICAL INSPECTIONS CHILDREN ATTENDING SECONDARY SCHOOLS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the Prescribed Groups— Boys. Girls. All ages 213 212 Number of other Routine Inspections 259 332 Total 472 544 B.—OTHER INSPECTIONS. Number of Special Inspections — — Number of Re-Inspections 43 19 Total 43 19 C.—CHILDREN FOUND TO REQUIRE TREATMENT. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding defects of Nutrition, Uncleanliness and Dental Diseases). Group (1) For defective vision (excluding squint; (2) For all other conditions recorded in Table IIA (3) Total (40) B G B G B G All ages 8 G 10 6 18 12 Other Routine Inspections 9 19 2 – 11 19 Total 17 25 12 6 29 31 167 SECONDARY SCHOOLS. TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1936. Defect of Disease. (1) Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. (2) Requiring to be kept under obser vation, but not requiring Treatment. (3) Requiring Treatment. (4) Requiring to be kept under obser vation, but not requiring Treatment. (5) Skin B G B G B G B G (1) Ringworm—Scalp — — — — — — — — (2) „ Body — — — — — — — — (3) Scabies — — — — — — — — (4) Impetigo 1 2 — 1 — — — — (5) Other Diseases (NonTuberculous) — — 1 — — — — — Total (Heads 1 to 5) 1 2 1 1 — — — — Eye (6) Blepharitis — — — — — — — — (7) Conjunctivitis — — — — — — — — (8) Keratitis — — — — — — — — (9) Corneal Opacities — — — — — — — — (10) Other Conditions (ex cluding Defective Vision and Squint) — — — — — — — — Total (Heads 6 to 10) — — — — — — — — (11) Defective Vision(excluding Squint) 17 25 16 6 — — — — (12) Squint 1 — — — — — — — Ear (13) Defective Hearing — — — — — — — — (14) Otitis Media 1 — — — — — — — (15) Other Ear Diseases — — 1 10 — — — — Nose and Throat (16) Chronic Tonsillitis only — — 6 — — — — — (17) Adenoids only — — — — — — — — (18) Chronic Tonsillitis and Adenoids — — — — — — — — (19) Other Conditions — — — — — — — — 168 TABLE IX.—continued. Defect or Disease. (1) Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. (2) Requiring to be kept under obser vation, but not requiring Trea tmnt. (3) Requiring Treatment. (4) Requiring to be kept under obser vation but not requiring Treatment. (5) (20) Enlarged Cervical Glands (NonTuberculous) B G B G B G B G — — 6 — — — — — (21) Defective Speech — — 1 4 — — — — Heart Disease : Heart and Circulation (22) Organic — — — — — — — — — (23) Functional 1 — — 6 — — — — ( (24) Anaemia — — — 1 — — — — Lungs ( (25) Bronchitis — — — — — — — — (26) Other Non-Tuberculous Diseases — — — — — — — — Tuberculosis Pulmonary :— — — — — — — — — (27) Definite — — — — — — — — (28) Suspected — — — — — — — — Non-Pulmonary:— — — — — — — — — (29) Glands — — — — — — — — (30) Bones and Joints — — — — — — — — (31) Skin — — — — — — — — (32) Other Forms — — — — — — — — Total (Heads 29 to 32) — — — — — — — — Nervous System ( (33) Epilepsy — — — — — — — — (34) Chorea 1 — — — — — — — ( (35) Other Conditions — — — 9 — — — — Deformities (36) Rickets — — — — — — — — (37) Spinal Curvature . (38) Other Forms 1 — 4 34 — — — — (39) Other Defects and Diseases (excluding defects of Nutrition, Uncleanliness and Dental Diseases 6 4 1 8 — — — — Total 29 31 36 79 — — — — 169 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. % All Ages 425 42 9.87 369 86.82 14 3.29 — — Other Routine Inspe ctions 591 73 12.35 509 86.12 8 1.35 1 0.17 Total ... 1,016 115 11.32 878 86.41 22 2.16 1 0.09 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 Skin— Ringworm-Scalp— (i). X-Ray Treatment. – – – – – – (ii.) Other – – – – – – Ringworm-Body – – – – – – Scabies – – – – – – Impetigo – – – – – – Other skin disease – – – – – – Minor Eye Defects (External and other, but excluding cases falling in Group II.) – – – – – – Minor Ear Defects – — – — — — Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 3 8 1 1 4 9 Total 3 8 1 1 4 9 170 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. B G B G B G ERRORS OF REFRACTION (including squint). 17 46 – – 17 46 Other defect or disease of the eyes (excluding those recorded in Group I) – – – – – – Total 17 46 — — 17 46 No. of Children for whom spectacles ware (a) Prescribed 10 27 — — 10 27 (b) Obtained 10 25 — 2 10 27 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 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 - - - - - - — 1 2 2 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and adenoids. (iv) Other defects of the nose and throat. INDEX 172 INDEX A. Act—Blind Persons, 1920 41-43 Act—Local Government, 1929 25 Acts—Children, 1908-32 99 Acts—Housing 111-115 Acts—Mental Deficiency 37 Acts—Midvvives, 1902-18 20 Acts—Nursing Homes Registration, 1927 21 Act—Rag Flock 109 Act—Rents Restriction 109 Act—Shops, 1934 110 Adenoids 92, 132, 137 After-Care Committee 88 Aldersbrook Homes 34 Ambulance Facilities 21 Attendance Officers, Cooperation of 151 Ante-Natal Clinic 28,95 Area 11 Artificial Sunlight 23 Atmospheric Pollution 107 Aural Surgeon, report of 139 Aural Treatment 92, 136, 164, 170 B. Bacteriology 22,54 Bacteriological Examinations 55, 116 Baths—School 151 Baths—Swimming 101 Bed Bugs—Eradication of 11l Birth Rate 11,17 Births 11,14, 93 Births, Illegitimate 11 Births, Still 11,12,94 Blind Persons Act, 1920 41-43 Blind Children 152, 158 Blindness—Prevention of 43 Byelaws—Premises and occupations controlled by 108 C. Camps—School 144 Cancer 58 Caravans 108 Centre-Training and Occupation M.D 40 Children's Acts, 1908-32 99 Children's Homes 29,34 Children Invalid Aid Association 43-44, 98,147 Cinemas 107 Classrooms, Open Air 144 Cleansing, Public 105 Clinics, Ante-Natal 28,95 Clinics, Artificial Sunlight 28,136,143 Clinics, Aural 28, 93, 136 Clinics, Dental 28 Clinics, Immunisation 28,46,92,137 Clinics, Infant 28,91 Clinics, Manor Park 28,136 Clinics, Morning 28,93 Clinics, Ophthalmic 28, 93,136 Clinics, School 28,136 Clinics, Toddlers' 28,92 Clinics, Tuberculosis and Chest 28,62-70 Clinics and Treatment Centres 27 Closet Accommodation 105 Committees 3 Complaints 107 Contents—Principal 2 Continuation Schools 153 Co-ordination 126 Cripples 134,142,161 D Dairies 116 Day-Schools, Open Air 144 Deaf Children 152,159 Deaths 11,14,17 Death-rate General 11,14,17 Death-rate. Infantile 12,15,18a Death-rate, Zymotic 45 Deaths, Causes of 17a Deaths, Infants n 12,15,18a Deaths, in Wards and Rates 18 Dental Treatment 92,133,140,165 Dental Treatment—Tuberculous Patients 73 Dental Surgeons, Report of 140 Diarrhoea 12 Diphtheria 45, 46, 52 Drainage and Sewerage 104 Dust Collection 105 E. Ear Diseases 133,139 East Ham Memorial Hospital 30 Education Committee 4 Employment of Children 153 Enteric Fever 47 Epileptic Children 160 Erysipelas 47,54 Eye Diseases of Children 133,138 Exceptional School Children 127 Extracts from Vital Statistics 11 Excessive Mortality, Particulars of 12 F. Factories and Workshops 103,107 Following-up 136 Food and Drugs Adulteration 119 Food Inspection 116-120 Free Supplies of Milk 98 173 INDEX—continued. G. General Provision—Health Services 20-29 General and Special Hospitals and Children's Homes 29-37 H. Harts Sanatorium 73-81 Health Committee 3 Health Services— General Provision of 20-29 Health Visitors 94 Home Helps 99 Home—Nursing in 20 Homes, Aldersbrook and Scattered 29,34 Homes—Nursing 21 Homeless Children 21 Hospitals—General and Special 29-37 Hospital, Infectious Diseases 51-58 Hospital, East Ham Memorial 30 Hospital, Maternity 29,96 Hospital, Mental 29 Hospital, Smallpox 30 Hospital, Whipps Cross 32 Houses—Inhabited 11 Housing Acts 111-115 Housing Statistics 114 I. Illegitimate Births 11 Immunisation Clinics 28,46,92 Increase of Rent (Restriction) Act 109 Infant Deaths 12,18a Infant Welfare Clinics 28,91 Infantile Mortality 12,15, 18a Infectious Diseases Hospital 51-58 Infectious Diseases 54-58,134 Inhabited Houses 11 Inspection of and Supervision of Food 116-120 Inspections 105,114 Inspection of School Children 127 Institutional Provisions for Unmarried Mothers, Illegitimate Infants etc 21 Institutions controlled by West Ham 32,33 Invalid Children's Aid Association 43-44, 98,147 L. Laboratory Facilities 22,55 Legal Proceedings 109 Legislation in Force 23 Light Treatment 28,136,143 Local Government Act, 1929 25 M. Manor Park Clinic 28,136 Maternal Mortality 11,15, 98 Maternity and Child Welfare 90-100 Maternity and Child Welfare Committee 3 Maternity Homes and Hospitals 21,29,96 Meals, Provision of 151 Measles 12, 54 Meat Inspection 117 Medical Examinations, Miscellaneous 154 Medical Inspection and Findings of School Children 126-134 Medical Officer of Health's Report 1-104 Medical Relief, Poor Law 25 Mental Defects, School Children 159 Mental Deficiency 27,37,40 Mental Deficiency Committee 4 Mental Hospital 29 Meteorology 102 Midwives 20,97 Milk—Free Supplies 98 Milk (Special Designation) Orders 117 Milk Supply 116 Minor Ailments 132,137, 163, 169 Mortality, Analysis of 17 Mortality, Excessive—Particulars of 12 Mortality, Infantile 12, 15 Mortality, Maternal 11,15,98 Mortality, Neo-natal 15 Mosquito Control 108 N. Neo-natal Mortality 15 Noteworthy Causes of Sickness or Invalidity 13 Notices served and Complied with 106 Notification of Births 93 Nursing Arrangements 20 Nursing Homes Registration Act. 1927 21 Nurserv Schools 153 O. Obstretrical Specialist 16 Occupations and Premises controlled by Byelaws 108 Occupational Therapy—Tuberculosis 89 Open Air Education 144 Ophthalmia Neonatorum 51,98 Ophthalmic Clinic 28, 93,136 Ophthalmic Surgeon, Report of 138 Ophthalmic Treatment 93 Orthopaedic Treatment 164 Outdoor Assistance 100-101 Overcrowding Survey Ill 174 INDEX—continued. P. Parents, Cooperation of 151 Physical Features of Area 11 Physically Defective Children 147,152,159 Physical Training 151 Plaistow Maternity Hospital and District Nurses Home 20 Playground Classes 144 Pneumonia 53 Pools—Swimming 101 Poor Law Medical Out Relief 25 Population 11,16 Post-Natal Work 95 Premises and Occupations Controlled by Byelaws 108 Prevention of Blindness 43 Principal Contents 2 Prosecutions 109 Provision of Meals 151 Public Assistance Domiciliary Medical Service 25 Public Assistance Institutions 33 Public Cleansing 105 Public Health Committee 3 R. Puerperal Fever and Pyrexia 48,54,98 Rag Flock Act 109 Rat Extermination 107 Rateable Value 11 Refuse Removal and Disposal 105 Rents Restriction Act 109 Reports, Special 19 Residential Schools 145 Ringworm 92 Rivers and Streams 105 Runwell Mental Hospital 29 S. Sanatoria 73-84 Sanitary Circumstances 105 Sanitary Inspection 105,114 Sanitary Section and Housing 104-120 Scarlet Fever 45,52 Scattered Homes 29,34 Schick Immunisation Clinics 28, 46,137 School Attendance Officers- Co-operation of 151 School Baths 151 ,, Blind Children 152 „ Camps 144 ,, Children, Blind, Deaf, Defective and Epileptic 152 ,, Children, Minor Ailments 132 ,, Children, Medical Inspection 126-134 ,, Children, Mentally Defective 153 School Children, Physically Defective 147 ,, Children, Verminous Conditions 131 ,, Continuation 153 Cripples 134,142 ,, Exceptional Children 127 ,, Meals 151 ,, Medical Officer's Report 121-170 ,, Medical Service in Relation to Public Elementary Schools 126 ,, Medical Treatment 136-144 „ Nursery 153 ,, Open Air 144 Schools of Recovery 146 Schools. Secondary 153 Senior Sanitary Inspector, Report of 104-120 Sewerage 104 Shops Act, 1934 110 Sickness or invalidity, any Noteworthy Causes 13 Skin Diseases 133,138 Slaughterhouses 117 Slum Clearance 113 Smallpox 30,45 Smoke Abatement Ill Social Conditions of Area 11 Special Enquiries 154 Special Reports 19 Special Schools—Physically Defective Children 147 Staff 5,126 Statistical and Social Conditions of Area 11-19 Still Births 11,12,94 Streams 105 Swimming Baths and Pools 101 T Table, Birth-rate, etc 17 ,, Blind Persons . 42, 42a, 42b ,, Cancer 60,61 ,, Clinics and Treatment Centres 28 „ Cost at Institutions 58,78 „ Death Rate, etc. 17 „ Deaths, Causes of 17a ,, Deaths, Ward — Rates 18 ,, Dental Treatment 73 ,, East Ham Memorial Hospital 31 ,, Exceptional Children 158 ,, Factories and Workshops Act 103 ,, Food and Drugs Adulteration 120 ,, Housing 114 „ Infant Deaths 18a 175 INDEX—continued. Table, Infectious Diseases, Notifiable 49,50 ,, Infectious Diseases, Removed to Hospital 50, 57 Infectious Diseases in School Children 135 ,, Maternal Mortality 16 ,, Mental Defectives ... 38,40 y Mental Patients—disposition of 30 „ Meteorology 102 „ Ophthalmia Neonatorum 51 ,, Overcrowding Survey 112,112a ,, Out-door Assistance- 101 ,, Public Assistance Domiciliary Medical Service 25 ,, Public Assistance Institutions 33 „ School Children, Defects of 156 ,, School Children Examined 155 „ School Children found to require Treatment 128, 155 ,, School Children—Malnutrition 158,169 „ School Children, Treatment carried out 163,169 „ Schools of Recovery 146 „ Secondary School Examinations 166-170 ,, Special School— Physically Defective Children 150 ,, Sunlight Treatment 143 „ Tuberculosis Deaths 88 „ Tuberculosis and Chest Clinic 69-70b „ Tuberculosis, Five years After-History 72a „ Tuberculosis Notifications 85-87 „ Tuberculosis, Residential Treatment 78-84 ,, Unemployed 100a „ Vaccination 45 ,, Verminous Condition of School Children 131 Teaching Staff, Co-operation of 151 Toddlers 'Clinic 28,92 Tonsils and Adenoids 92,132,137 Training Centre, Mental Defective 40 Treatment Centres 27 Tuberculosis 62-90,133,137,160 Tuberculosis and Chest Clinic 28,62-70 Tuberculosis After Care Committee 88 Tuberculosis, Five years After-History 71 Tuberculosis—Occupational Therapy 89 U. Uncleanliness 129 Unemployment and out-door Assistance 100-101 Unmarried Mothers 21 V. Vaccination 45 Verminous Conditions— School Children 131 Venereal Diseases 26 Vital Statistics, Extracts from 11 Visionm 133, 138, 163, 170 Visits, Health Visitors 94 Visits, School Nurses 136 Voluntary Associations 20, 41, 43, 98,152 W. Wards, Deaths in and Rates 18 Water Supply 104 Whipps Cross Hospital 32 Whooping Cough 12,54 Workshops 103, 107 z. Zymotic Diseases 45