AC 44113 M EAS 13 COUNTY BOROUGH OF EAST HAM. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1937. MALCOLM E. BARKER, M.R.C.S. (Eng.), L.R.C.P., D.P.H., (Lond.) The Woodgrange Press, Ltd., London, B.7. COUNTY BOROUGH OF EAST HAM. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1937. MALCOLM E. BARKER, M.R.C.S. (Eng.), L.R.C.P., D.P.H., (Lond.) Medical Officer of Health; School Medical Officer; General Medical Superintendent; Medical Officer to the Maternity and Child Welfare Committee and Statutory Committee for Mental Deficiency; Chief Tuberculosis Officer. The Woodgrange Press, Ltd., London, E.7. PRINCIPAL CONTENTS Sections:— Page Constitution of Committees 3 Public Health Staff 5 Introduction 7 Statistical and Social Conditions of Area 10 General Provision of Health Services 18 General & Special Hospitals & Children's Homes 27 Mental Deficiency 38 Welfare of the Blind 42 Invalid Children's Aid Association 47 Maternity and Child Welfare 49 Infectious Diseases 63 Tuberculosis 80 Sanitary Section and Housing 112 Inspection and Supervision of Food 123 Unemployment and Out-Door Assistance 128 Meteorological Record 130 School Medical Service:— Introduction 135 Report 137 Index 185 3 EAST HAM CORPORATION PUBLIC HEALTH COMMITTEE. Also Committee under Blind Persons Act, 1920, Sec. 2. *The Mayor (Alderman J. W. Barton, J.P.). *The Deputy-Mayor (Alderman J. J. Pope, J.P.). *Alderman Mrs. B. Wilkens (Chairman, Public Health Committee, Institutions and General Sub-Committee, and Maternity and Child Welfare Sub-Committee). *Councillor S. A. Elson (Vice-Chairman). * Alderman E. F. Markey. *Alderman Mrs. A. Taylor. *Alderman F. Welch. Councillor W. H. W. Beecham. *Councillor L. A. V. Bennett. Councillor G. W. Boultwood, J.P. *Councillor Mrs. E. M. C. Brace Councillor W. T. Bush. *Councillor W. J. Davis. *Councillor H. B. Harper, J.P. Councillor H. Joseph. *Councillor Mrs. W. M. Knight. *Councillor G. H. Moncar. *Councillor Mrs. A. B. Spencer. *Councillor W. Thompson. Councillor T. W. Williams. *Also Member of the Institutions and General Sub-Committee. MATERNITY AND CHILD WELFARE SUB-COMMITTEE. Maternity and Child Welfare Act, 1918, Sec. 2. Same members as Public Health Committee, with— Mrs. L. M. Brignell (co-opted). Mrs. E. M. Devenay (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. W. Barton, J.P.). The Deputy-Mayor (Alderman J. J. Pope, J.P.)- Alderman Mrs. A. Taylor (Chairman). Councillor Mrs. A. B. Spencer (Vice-Cliairman). Alderman Mrs. B. Wilkens. Councillor W. J. Davis. Councillor C. W. Dixon. Councillor B. G. Goodenough. Councillor H. B. Harper, J.P. Councillor Mrs. K. M. Knight. Councillor A. Prior. Mrs. C. J. Cross (co-opted). Mrs. A. M. Gray (co-opted). Mrs. L. J. Nichols (co-opted). EAST HAM EDUCATION COMMITTEE. The Mayor (Alderman J. W. Barton, J.P.). The Deputy-Mayor (Alderman J. J. Pope, J.P.). Councillor T. I. Lethaby, J.P. (Chairman). Alderman J. J. Pope, J.P. (Vice-Chairman). Alderman Mrs. A. Taylor. Alderman Mrs. B. Wilkens. Alderman T. W. Burden, J.P. Alderman R. J. Fell. Alderman E. F. Markey. Alderman W. T. Newling, J.P. Alderman F. Welch. Councillor Mrs. E. M. C. Brace. Councillor Mrs. W. M. Knight. Councillor R. Bailey. Councillor C. W. Brading, C.R.P., J.P. Councillor W. T. Bush. Councillor C. W. Dixon. Councillor S. A. Elson. Councillor H. B. Harper, J.P. Councillor J. A. Hart. Councillor E. C. Howlett. Councillor H. P. Jackson. Councillor H. Joseph. *Councillor G. H. Manser, M.R.S.I., R.P., J.P. Councillor R. W. Moger, J.P. Councillor W. Thompson. Councillor E. A. Wood. Mrs. W. E. Hyland. Mrs. L. A. Lethaby. Mr. A. E. Francis. Mr. E. J. Sullivan j- Alderman J. Brooks, J.P. • Died 1.10.37. t Co-opted Member of Libraries Sob-Committee. 5 PUBLIC HEALTH OFFICERS OF THE AUTHORITY. A. Medical—whole-time. Malcolm E. Barker, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health; General Medical Superintendent; School Medical Officer. F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S., Deputy and Senior Assistant Medical Officer of Health. 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., D.P.H., 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., 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:— 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. Skecgs, 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. 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. I. 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. F. M. Williams, S.R.N, T.A.Cert. C. 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. * Municipal Midwives:— M. E. Hackett, S.R.N, S.C.M. M. Law, S.C.M. E. I. Purnell, S.R.N, S.C.M. E. Other Staff:— Ascertainment and Supervising Officer, M.D. Acts:— E. L. Hicks. M.D. Training Centre:— A. H. Bleadon, Supervising Officer. L. B. Cooney, 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, D.P.A. B. E. R. Hartley, A.C.I.S. C. J. Hayes. Shorthand Typists:— D. Gordon. C. Goodman. O. E. Griffin. †E. M. Pritchard. H. E. Ritterspack. E. M. Walton. Female Clerks:— J. M. Flynn. A. R. Gaster. F. E. Hales. W. M. Hales. M. A. McCall. F. C. Wells. * Commenced duty 1.9.37. † Commenced duty 1.3.37. 7 Public Health Department, Town Hall, East Ham. May, 1938. Madam Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report on the health of the County Borough of East Ham for the year 1937, together with the Annual Report to the Education Committee on the work of the School Medical Service. The benefit to the community of the various health services is revealed by a close study of the numerous statistics. It will be seen that the scope of the provisions instituted by the Council for the prevention of disease and maintenance of health is being rapidly widened. The increased facilities at the Clinics for supervision and advice, and other schemes of assistance, have as their object the preservation of health, and are, in addition, of real social service to the Borough. Measures for the improvement of physique and the attainment of physical fitness are now largely the responsibility of the local authority. Although the figures for the previous year were very satisfactory, I am pleased to report a steady improvement in almost all respects. There is a lessened incidence of disease generally, and the low mortality rates—in some infectious diseases completely absent—are a striking feature of the Report. The infant mortality and maternal death rates were still further reduced. Reference to Table 41, page 111a wherein is given for comparison information relative to County Boroughs of similar populations, shows remarkable figures for this Borough. It must be acknowledged that such results can only be achieved by a comprehensive and active health service, and by minute attention to detail in both its administrative and clinical aspects. The year has been eventful in other respects—the appointment of Municipal Midwives under the Midwives' Act, 1936, has 8 enabled the Council to provide directly, midwifery and maternity nursing services in the homes. Particulars regarding this provision are given later in the Report. The arrangement made by the Council with the Committee of the East Ham Memorial Hospital for the provision of maternity accommodation at the Hospital has progressed to the extent that plans were submitted and subsequently approved by the Minister of Health. The extensions at the Hospital also include a new Children's Ward. These additions will prove of material benefit to mothers and children of the district. The erection of the new Public Health Offices and Central Clinic mentioned in previous Reports was commenced in the latter part of the year, and it is anticipated that such will be completed in ,1938. In accordance with the circular issued by the Ministry of Health and Board of Education, initiating the scheme of propaganda outlined by the Central Council for Health Education, the Authority arranged for the general display of posters on health topics, and the distribution of leaflets, etc., at all Schools and Clinics in the Borough; in addition, during the period of the campaign, October, 1937, to February, 1938, numerous lectures were given to various organisations, and every effort was made to stimulate interest in the Council's public health activities. A matter of outstanding interest was the clearance of caravan areas. The necessary investigations involved numerous visits, the collection of a vast amount of data, statutory enquiries by the Ministry of Health, and, in some instances, proceedings in Court, although the latter were obviated as far as possible. Mr. J. E. Austin and the sanitary inspectorate are to be congratulated on the satisfactory solution of a difficult problem. The transfer of patients suffering from mental illness from institutions in various parts of the country to Runwell Hospital was proceeded with in gradual stages as the buildings became available for use. Details concerning the disposition of patients will be found in the appropriate section of the Report. 9 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, and to the members of the Public Health staff for their willing co-operation and efficient service. I have the honour to be, Your obedient Servant, Medical Officer of Health. 10 Statistical and Social Conditions of the Area Area (in statute acres) land and inland water, 3,324. Population. Census, 1931, ,142,394 (males 68,923, females 73,471). Estimated to middle of 1937, 131,100. Number of inhabited houses (end of 1937) according to rate books (including tenements and shops), approx. 30,125. Rateable value at 31st December, 1937, £761,575. Sum represented by a penny rate for the year 1937/8, £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. Males. Females Live Births Legitimate 1,902 969 933 Birth rate per 1,000 of the estimated population 14-8. Illegitimate 50 30 20 Still Births 58 36 22 Rate per 1.000 total (live and still) births 28 8. Deaths 1,422 736 686 Death rate per 1,000 of the estimated population 10.8. Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis – — Other puerperal causes 1 0.49 Total 1 0.49 11 Death rate of infants under one year of age:— All infants per 1,000 live births 48 Legitimate infants per 1,000 legitimate live births 47 Illegitimate infants per 1,000 illegitimate live births 80 Deaths from Cancer (all ages) 219 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) 5 Deaths from Diarrhoea (under 2 years of age) 14 Particulars of any unusual or Excessive Mortality during the Year which has received or required comment. Deaths from cancer (all forms) shew an appreciable increase over the previous year, whilst those attributed to diseases of the circulatory system generally, including heart disease, were decreased. Male deaths from cancer exceed in larger proportion female deaths. Any causes of Sickness or Invalidity which have been specially noteworthy in the Borough during the year; and any Conditions of Occupation or Environment which appear to have had a prejudicial effect on Health and any evidence, Statistical or otherwise, that unemployment has exercised any significant influence on the Health or Physique of children or adults. There is no evidence that unemployment, conditions of occupation, or local environment have had any particular effect on health or physique. Owing, however, to the large increase in populated areas this side of London, travelling facilities during the rush hours are not conducive to a lessening of fatigue or to the general well-being of many residents of the Borough. Still-Births. The number of still-birth registered was 58, compared with 64 for the previous year. The rate per 1,000 total (live and still) births was 28.8, the figure for 1936 being 32.0. 12 Births. The number of live births registered was 1,952 as compared with 1,931 for the year 1936, equivalent to a birth rate of 14.8 per 1,000 of the population—14.4 for the previous year. The live birth rates in the various Wards were as follows Manor Park 13.5 Little Ilford 17.9 Woodgrange 11.7 Plashet 13.0 Kensington 14.8 Castle 12.6 Central 12.2 Wall End 14.4 Greatfield 10.4 South 14.5 Deaths. The number of deaths was 1,422 as compared with 1,42,1 for the year 1936. The death rate was 10.8, or 0.2 greater than that of the previous year. Of the total deaths 723 or 50.8 per cent. died in institutions. The number of residents who died outside the area and whose deaths were assigned to this Borough was 676. Seventy-eight 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 11.8 (1936—11.6). This figure is arrived at by multiplying the crude death rate (10.8) by an adjusting factor, that for East Ham being 1.10. The percentage of total deaths in the various age groups was as follows:— Under 1 Year 1-2 Years 2-5 Years 5-iS Years 15-25 Years 25-35 Years 35-45 Years 45-55 Years 55-65 Years 65-75 Years 75 Years and upwards 6.6 0.5 0.5 1.1 2.7 4.5 5.0 8.8 17.2 25.6 27.3 Infantile Mortality. Deaths of infants under one year of age numbered 95—equivalent to an infant mortality rate of 48 per thousand live births— compared with the rate of 50 for the previous year. The rate for England and Wales is 58. 13 Four deaths of illegitimate children occurred out of a total of 50 illegitimate births, giving a mortality rate of 80 as compared with a figure of 20 per 1,000 live births for the year 1936. 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:— 1933—22.8, 1934—22.5, 1935—23.4, 1936—21.7, 1937—25.6 Maternal Mortality. The number of maternal deaths was 1, the maternal mortality rate for 1937 was therefore 0.51 per 1,000 live births and 0.49 per 1,000 live and still-births. I am pleased to report a further reduction in the number of maternal deaths as compared with last year (4). It will be seen that the mortality rate is markedly lower than that for England and Wales as a whole. TABLE 1. Puerperal Sepsis Other Causes Total England & Wales East Ham England & Wales East Ham England & Wales East Ham Per 1,000 Live Births 0.97 – 2.26 0.51 3.23 0.51 Total Births (Live & Still) 0.94 — 2.17 0.49 3.11 0.49 Regular and efficient ante-natal care lessens the risk of complications at childbirth. Facilities for ante-natal supervision and advice are available at the special clinics held at the High Street, Manor Park, and North Woolwich Centres. 14 Obstetrical Specialist. The services of a Consultant Obstetrician were requested by a General Practitioner on one occasion. Particulars are given below:— No. Diagnosis. Where treated. Result. 1. Puerperal Fever Whipps Cross Hospital Recovered. Population. The Registrar-General's estimate of the population to the middle of 1937, is 131,100, which is a decrease of 2,300 compared with that for the year 1936. 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 3. 15a Causes of Death in Age Groups, 1937. Cause of death. All ages. Deaths at different periods of life of residents whether occurring within or without the district. Under 1 year 1-2 years 2-5 years 5-15 years 15-25 years 25-35 years 35-45 years 45-55 years 55-65 years 65-75 years 75 years and upwards. 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 92 58 5 3 1 – 2 1 5 – 5 11 17 9 10 4 11 9 19 5 11 9 6 7 B.—Cancer and Other Tumours 123 101 1 – – – – – – – 1 – 1 2 7 5 15 16 31 28 46 31 21 19 C.—Rheumatism, Diseases of Nutrition and of Endocrine Glands and other General Diseases 13 36 – – – – – 1 – 1 2 1 1 3 1 4 – 3 1 5 2 11 6 7 D.—Diseases of the Blood and Blood-forming Organs 3 7 – – – – – – – – – 1 – – – 2 l 1 – 1 2 1 – 1 E.—Diseases of the Nervous System and Sense Organs 57 61 – 1 1 – – – 1 – – 1 1 4 1 3 8 5 16 8 17 22 12 17 F.—Diseases of the Circulatory System 210 220 – – – – – – – 2 1 2 3 2 4 10 21 11 39 32 64 65 78 96 G.—Diseases of the respiratory System 96 82 13 9 1 1 2 – 2 2 1 1 3 2 3 3 8 3 19 8 26 12 18 41 H.—Diseases of the Digestive System 49 32 8 4 1 2 – 1 – – – 3 1 – 3 3 8 4 : 10 6 11 5 7 4 I.—Non-Venereal Diseases of the Genitourinary System and Annexa 27 24 – – – – – – – – – – – 3 3 1 – – 8 2 7 6 9 12 j —Diseases of Pregnancy, Childbirth and the Puerperal State – 1 – – – – – – – – – – – 1 – – – – – – – – – – K.—Diseases of the Skin and Cellular Tissue 2 5 – – – – – –– 1 – – – – – – – – – – 1 2 – 1 L.—Congenital Malformations 8 10 5 9 – – – 1 – 1 1 1 – – – – – – – – – – – M.—Diseases of Early Infancy 17 19 17 19 – – – – – – – – – – – – – – – – – – – – N.—Old Age 7 14 – – – – – – – – – – – – – – – – – 2 – 5 13 O.—Deaths from Violence 32 16 – 1 – – 1 – 1 – 4 1 7 2 4 – 1 – 5 2 4 6 5 4 Totals 736 686 49 46 4 3 5 3 10 6 15 22 35 29 36 35 74 52 148 97 193 171 167 222 A.—Infectious and Parasitic diseases. 1. Typhoid Fever 1 - – – – – – – – – – – – – – – 1 – – – – – – – 2. Whooping Cough 4 1 3 1 – – 1 – – – – – – – – – – – – – – – – – 3. Diphtheria 2 1 1 — – – – 1 1 – – – – – – – – – – – – – – – 4. Influenza 20 16 1 — – – – – – – – – 1 – 1 – 1 1 7 4 5 6 4 5 5. Encephalitis Lethargica - 1 - - – – - - - - - - - 1 - - - - - - - - - - 6. Cerebro-Spinal Fever 1 1 – 1 1 – – – – – – – – – – – – – – – – – – – 7. Tuberculosis—Respiratory System 51 29 – — – – – – – — 3 10 15 7 9 4 9 5 9 1 5 1 1 1 8 ,, Central Nervous System 5 1 – 1 – – 1 – 3 – 1 – – – – – – – – – – – – – 9. ,, Vertebral Column – 4 – – – – – – – – – 1 – – – – – 3 – – – – – – 10. ,, Disseminated 3 – – – – – – – 1 – – – – – – – – – – – – – 1 – 11. Syphilis 3 – – – – – – – – – – – – – – – – – 2 – 1 1 – – 12. Purulent Infection—Septicaemia 1 2 – – – – – – – – – – – 1 – – – – 1 – – 1 — 1 13. Mycoses – 1 – – – – – – – – – – – – – – – – – – – – – – 14. Other Infectious Diseases 1 – – – – – – – – – – – – – – – – – – – – – – – B.—Cancer and other Tumours 15. Cancer, Malignant Disease Buccal Cavity and Pharynx 16 1 – – – – – – – – – – – – 1 – 4 – 4 – 5 1 2 – 16. ,, ,, ,, ,, Digestive Organs and Peritoneum 63 43 – – – – – – – – – – 1 – 1 1 6 4 15 16 23 12 17 10 17. ,, ,, ,, ,, Respiratory Organs 16 3 – – – – – – – – – – – – – – – – 7 2 1 1 1 – 18. ,, ,, ,, ,, Uterus – 15 – – – – – – – – – – – – – – – 6 – 3 – 3 – 3 19. ,, ,, ,, ,, Other Female Genital Organs – 3 – – – – – – – – – – – – – – – 1 – 1 – 1 – – 20. ,, ,, Breast – 20 – – – – – – – – – – 1 – 4 – 3 – 3 – 5 – 4 21. ,, ,, ,, ,, Male Genito- Urinary Organs 16 - – – – – – – – – – – – – 2 – – – 4 – 10 – – – 22. ,, ,, ,, Skin 1 – – – – – – – – – – – – – – – – – – – – – 1 – 23. ,, ,, ,, ,, Other or Un- specified Organs 8 14 – – – – – – – – – – – – – – – – – 3 6 8 - 2 24. Non-Million.nit 1 umours ... 25. Tumours of Undetermined Nature 2 1 1 1 - C—Rheumatism, Diseases of Nutrition and of Endocrine Glands, and other General Diseases. 26. Rheumatic Fever 1 1 1 3 1 1 1 2 27. Chronic Rheumatism, Osteo-Arthritis ■1 2 3 3 4 28. Diabetes 4 1 2 1 2 5 3 30. ,, ,, Thyroid 1 31 „ ,, Adrenals 32. Other General Diseases ~ ~ 1 ~ " - - ~ ~ ~ ~ ~ ~ D.—Diseases of the Blood and Blood-forming Organs. 33. Haemorrhagic Conditions ... l 1 — 34. Anaemia, Chlorosis - 35. Leukaemia, Aleukaemia ... 3 1 1 36. Other Diseases ~ ~ ~ ~ ~ ~ ~ 1 1 "" ~ E.—Diseases of the Nervous System and Sense Organs. 37. Meningitis 4 1 1 - — — - 1 — 38. Tabes Dorsalis (Locomotor Ataxy) 3 39. Other Diseases of the Spinal Cord 2 1 40. Cerebral Haemorrhage, Apoplexy, etc. ... 39 49 3 5 12 8 14 21 10 15 42. Epilepsy - b 1 2 1 2 — 43. Other Diseases of the Nervous System ... 4 2 — — - 1 1 44. Diseases of the Ear and Mastoid Sinus . ■. 1 2 ~ ~ ~ " 1 1 1 F.—Diseases of the Circulatory System. 45. Acute Endocarditis 1 — 1 - - — ■ — 46 Chronic Endocarditis, Valvular Disease ... 20 35 1 2 2 3 2 7 7 12 7 10 47. Diseases of the Myocardium 110 122 - 1 5 8 2 22 9 28 38 51 67 48. Diseases of the Coronary Arteries, Angina Pectoris 38 23 _ 1 8 1 8 10 13 5 7 6 49. Other Diseases of the Heart 17 19 - 1 1 1 1 1 3 1 2 10 4 3 7 50. Aneurysm 6 • ~ ' - 51. Arterio-Sclerosis 16 14 — 2 1 8 6 52. Diseases of the Veins 2 - 1 - 53. Gangrene 1 54. Abnormalities of Blood Pressure i G — Diseases of the Respiratory System. _ . _ 55. Bronchitis 31 32 2 1 — 1 1 1 7 3 10 2 10 22 56. Broncho-Pneumonia 46 31 10 6 1 - 1 - 1 1 1 - 2 - - 2 7 li 91 5 11 7 3 9 57. Lobar-Pneumonia ... 11 8 1 2 2| 3 2 5 58. Pneumonia (not otherwise defined) 4 2 1 — - — - - - — 2 2 59. Congestion and Haemorrhagic-Infarct of Lung, etc. 2 7 1 - 1 1 5 60. Pulmonary Emphysema ... 1 61. Pleurisy l l 62. Other Diseases of the Respiratory System ' - H — Diseases of the Digestive System. 63. Diseases of the Buccal Cavity, Pharynx, etc. j 1 64. Ulcer of the Stomach or Duodenum 18 6 1 1 4 4 1 6 3 2 1 65. Diarrhoea and Enteritis (under 2 years) ... 9 5 8 3 1 2 - 66. ,, „ (over 2 years) 2 2 1 1 67. Appendicitis... 2 4 _ — — - — — _ _ 1 — — 1 1 1 — - — 1 ~ - 68. Hernia, Intestinal Obstruction 10 7 1 1 1 2 3 2 69. Cirrhosis of the Liver 2 2 _ - - - - _ _ — - - - - 2 2 - - - - 70. Other Diseases of the Liver 5 _ — _ — - _ _ _ — 1 — 1 - 1 — 1 — 1 - 71. Other Diseases of the Gall Bladder and Ducts - 2 72. Biliary Calculi - 1 _ - — - — _ _ _ _ _ - - - - - - - 1 - _ - - 73. Peritonitis without Stated Cause 2 - ~ ~ ~ 1 - - " - I.—Non-Venereal Diseases of the Genitourinary System and Annexa. 74. Chronic Nephritis 10 17 - 3 1 - - 1 z 3 3 3 9 75. Acute Nephritis 2 1 - 2 76. Nephritis (not stated to be acute or chronic) 2 1 1 — 77. Other Diseases of the Kidney and Annexa 2 1 1 78. Diseases of the Bladder 2 2 1 - — 1 - 1 79. Diseases of the Prostate 8 1 4 3 80. Calculi of the Urinary Passage 1 j.—Diseases of Pregnancy, Childbirth and the Puerperal State. 81. Other accidents of Childbirth - 1 - " " T - - - ... " 1 " - - K.—Diseases of the Skin and Cellular Tissue. 82. Cellulitis, Acute Abscess 1 83. Carbuncle, Boil 84. Other Diseases of the Skin and its Annexa " 4 ~ 2 1 L.—Congenital Malformations. 85. Congenital Malformations ... 8 10 I 9 - - 1 " 1 1 1 M.—Diseases of Early Infancy. 86. Congenital Debility 1 3 1 3 87. Premature Birth 13 7 13 7 88. Injury at Birth 2 89. Other Diseases peculiar to Early Infancy ... 1 9 9 N.—Old age. 90. Old Age 7 14 " 2 5 13 O.—Deaths from Violence. 91. Suicide—By Solid or Liquid Poisons or Corrosive Substances 3 4 j 1 ! _ j 1 1 1 92. „ By Poisonous Gas 4 ] 1 2 1 95. Other Acute Accidental Poisoning (not by Gas) j 97.. Accidental Burns (Conflagration excepted) 1 99. ,, Injury by Fall or Crushing, etc. 19 11 1 4 1 2 1 3 4 5 3 2 100. Violent Deaths of Unstated Origin 15a 15 TABLE 2.—BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1937. Rate per 1,000 Population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. Live Births. Still Births. All Causes Typhoid and Para-typhoid Fevers. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under two years). Total Deaths under One Yr. England & Wales 14.9 0.60 12.4 0.00 — 0.02 0.01 0.04 0.07 0.45 0.54 5.8 58 125 County Boroughs & Great Towns including London 14.9 0.67 12.5 0.01 — 0.03 0.01 0.04 0.08 0.39 0.45 7.9 62 148 Smaller Towns (estimated resident populations 25,000 -50,000 at census 1931) 15.3 0.64 11.9 0.00 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 London—Administrative Co'ty 13.3 0.54 12.3 0.00 — 0.01 0.01 0.06 0.05 0.38 0.51 12.0 60 EAST HAM 14.8 0.44 10.8 0.00 — — — 0.03 0.02 0.27 0.36 7.1 48 16 TABLE 4.—Ward Distribution of Deaths, and Ward Death Rates, 1937. Cause of death. Wards. Total. Deaths in Institutions. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle Central. Wall End. Greatfield. South. 1. Typhoid & Paratyphoid Fevers — — — — — — — — — 1 1 1 2. Measles — — — — — — — — — — — — 3. Scarlet Fever — — — — — — — — — — — — 4. Whooping Cough 1 1 1 — — — — — 1 1 5 2 5. Diphtheria 2 — — — — — — — — 1 3 3 6. Influenza 5 4 6 1 9 4 7 4 2 1 36 s 7. Encephalitis Lethargica — — 1 — — — — — — 1 1 8. Cerebro-Spinal Fever — — 1 — — — — — 1 2 1 9. Tuberculosis, of Respiratory System 10 7 9 6 9 13 9 9 4 4 80 39 10. Other Tuberculous Diseases — 2 — 2 2 2 — 1 3 1 13 13 11. Syphilis ... 1 — — — 1 1 — 1 — — 4 2 12. General Paralysis of the Insane, Tabes Dorsalis — 1 — 2 — 1 — — 1 1 6 5 13. Cancer 27 21 20 17 18 23 19 31 24 19 219 115 14. Diabetes 4 1 1 1 2 2 2 1 2 2 18 12 15. Cerebral Haemorrhage, etc. 7 5 6 8 7 11 11 11 12 10 88 53 16. Heart Disease 38 39 36 42 42 46 42 40 29 31 385 150 17. Aneurysm — 2 1 1 1 1 — — 1 2 9 4 18. Other Circulatory Diseases 4 — 1 4 3 6 9 4 1 4 36 10 19. Bronchitis 6 10 9 4 7 3 4 12 3 5 63 22 20. Pneumonia (all forms) 6 12 7 11 13 9 14 11 6 13 102 57 21. Other Respiratory Diseases 2 2 — 1 — 2 3 1 2 — 13 6 22. Peptic Ulcer 5 — 4 2 4 2 3 2 1 1 24 22 23. Diarrhoea, etc. 3 2 3 1 2 — 2 3 1 1 18 14 24. Appendicitis 1 2 — — — 1 2 — — — 6 6 25. Cirrhosis of Liver 1 — — 1 — 1 — — — 1 4 3 26. Other Diseases of Liver, etc. 1 — — — 3 1 2 — 1 — 8 5 27. Other Digestive Diseases 3 2 1 2 4 3 2 2 1 1 21 14 28. Acute and Chronic Nephritis 4 3 2 2 6 3 7 4 1 3 35 20 29. Puerperal Sepsis — — — — — — — — — — — — 30. Other Puerperal Causes — — — — — 1 — — — — 1 — 31. Congenital Debility, Premature Birth, Malformations, etc. 6 12 3 6 5 4 6 3 6 3 54 28 32. Senility 8 1 1 1 1 — 2 3 2 2 21 7 33. Suicide 1 2 — 2 3 — 2 1 1 1 13 4 34. Other violence 4 6 5 2 2 2 1 5 4 4 35 32 35. Other defined causes 11 9 11 12 11 7 6 10 7 14 98 64 36. Causes ill-defined or unknown — — — — — — — — — — — — Totals 161 146 129 131 148 149 155 159 116 128 1,422 723 Rates (Census population for wards) 11.7 8.1 10.1 9.6 12.7 11.0 11.2 9.3 8.3 8.2 10.8 – 16a TABLE 5. Infant Deaths Under One Year of Age, 1937. CAUSE OF DEATH. Total Ages and Sex Total under 1 year Wards Deaths in Institutions Under 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 Woodgrange Plashet Kensington Castle Central Wall End Greatfield South M F M F M F M F M F M F M F M F M F Cancer 1 — — — — — — — — 1 — — — — — — — 1 — — — — — 1 — — — — — 1 Tuberculous Meningitis 1 — — — — — — — — — — — — — — — 1 — 1 — — — 1 — — — — — — 1 Whooping Cough 4 — — — — — — — — — — 1 — 2 1 — — 3 1 1 — 1 — — — — — 1 1 1 Influenza 1 — — — — — — — — — — — — 1 — — — 1 — — 1 — — — — — — — — — Diphtheria 1 — — — — — — — — 1 — — — — — — — 1 — 1 — — — — — — — — — 1 Cerebro Spinal Fever 1 — — — — — — — — — — — 1 — — — — — 1 — — 1 — — — — — — — 1 Bronchitis 5 — — — — — — — — 1 1 1 1 — 1 — — 2 3 1 — — — — 2 1 1 — — 1 Pneumonia 16 1 — 1 1 — 2 — — 1 1 2 1 2 1 3 — 10 6 1 1 1 2 — 2 3 3 1 2 11 Diarrhoea, etc. 11 — — — — — — — — 4 2 1 1 1 — 2 — 8 3 3 1 3 1 1 — 1 1 9 Congenital Debility and Malformations, Premature Births 50 12 20 2 1 2 2 1 1 1 1 1 2 2 1 1 — 22 28 7 10 4 5 4 5 3 3 4 5 28 Other defined causes 4 — 2 — 1 — — — — — — 1 — — — — — 1 3 — 1 — — 1 — — 2 — — 1 All Causes 95 13 22 3 3 2 4 1 1 9 5 7 6 8 4 6 1 49 46 14 14 10 9 7 9 8 10 6 8 54 Infantile Mortality Rates per 1,000 live births 48 — — — — — — — — — — — — — — — — — — 74 48 68 50 40 52 47 40 41 36 — 17 Special Reports submitted to the Council during the year 1937. Date. Subject. 17th February. Measures adopted in Paratyphoid Fever Cases. 22nd February. Supervision of Children under School Age—Ministry of Health Circular 1550. 15th March. Joint report of Medical Officer of Health and Borough Treasurer re issue of Extra Nourishment to patients upon discharge from Harts Sanatorium and other sanatoria. 17th March. Salaries and Hours of Duty of Staff at Harts and Infectious Diseases Hospital. 31st May. Report of Advisory Committee on Nutrition. 25th June. Suggested scheme for collection of maternity fees at clinics. 29th September. Congress of Royal Sanitary Institute. 1st October. Synopsis of report on an investigation into Maternal Mortality. 1st October. 23rd Conference of National Association for Prevention of Tuberculosis. 4th October. Circular 1621—Prevention of Blindness. 19th November. Report on Conferences, Lectures, etc., suggested by the British Social Hygiene Council. 19th November. Report on manner in which patients are returned to their homes on discharge from hospital. 18 General Provision of Health Services Professional Nursing in the Home. A.. GENERAL. The services of the Plaistow District Nurses attached to the Branch Home at Ascot Lodge, Shrewsbury 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. G, 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. MIDWIVES ACTS, 1902 to 1936 The number of midwives who notified their intention to practise in East Ham during 1937, was 71. Of this number 46 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 20 practised independently, including 3 Municipal Midwives recently appointed. Summary of Visits Paid during 1937 by Nurses of Plaistow Maternity Hospital and District Nurses Home. Midwifery 384, Monthly 196, Hospital 293. 19 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 1937 are shown below:— Specimen Number Blood (Sugar estimation) 1 Blood for Widal Test 11 Blood Clot (Tuberculosis) 1 Faeces 9 Mantoux Skin Test (Tuberculosis) 47 Pleural Effusion X Sputa (for Asbestosis) 3 Sputa (for Tuberculosis) 982 Sputa (for Tuberculosis-Antiformin method) 37 Swabs (for Tuberculosis) 3 Urine (for Typhoid) 1 Total 1096 Pathological examinations carried out by Counties P. H. Laboratories during 1937:— Blood (for Widal Test) 4 Faeces (for Dysentery) 3 Faeces (for Typhoid) 8 Swabs (for Haemolytic Streptococci) 56* Virulence Test (for Diphtheria) 5 Total 76 *Increase due to larger number of nurses engaged in midwifery sent from Plaistow Maternity Hospital to cases in this area and also to Municipal midwives. One specimen of blood for Widal Test was examined by the Royal Institute of Public Health. The same arrangements exist for the examination of suspected diphtheria swabs as in previous years. 20 The number examined at the Infectious Diseases Hospital and the Town Hall Laboratory was as follows, viz:— Number. Positive. Negative. 3,390 236 3,154 Of the above total 2,440 were examined at the hospital. Ambulance Facilities. General. The two ambulances operating from the Fire Station carried out the following work during 1937:— Ordinary Police East Ham 1714 491 West Ham 3 2 Ilford 12 6 Barking 24 14 East Ham for:— West Ham 5 16 Ilford — — Barking 24 16 1782 545 Calls (as above) 2327 Not required on Arrival 93 Malicious calls 10 Special service calls 1 Maintenance journeys, etc. 69 Total number of journeys 2500 Total mileage: 18,665. Average mileage per journey: 8.02. Owing to the reciprocal arrangements with adjoining authorities in the event of breakdown or emergency, the two ambulances have so far met the needs of the Borough. Infectious Cases. Two ambulances are available for this purpose at the Infectious Diseases Hospital. Clinics and Treatment Centres. These are all provided by the Council. The sessions at the centres are as follows, viz:— 21 TABLE 6. Clinics and Treatment Centres. Situation. Purpose Used. Sessions. Central Clinic, High Street South Schools Special Clinics Monday & Saturday, 9.30 a.m. „ „ Toddlers' Clinics Thursday, 2 p.m. „ „ Infant Welfare Monday, 2 p.m.; Wednesday, 9.30 a.m. and 2 p.m.; Thursday, 9.30 a.m.; Friday, 2 p.m. „ „ Ante-Natal Clinic Friday, 9.30 a.m. „ „ Immunization Clinic Tuesday, 9.30 a.m. Church Road, Manor Park Toddlers' Clinics Monday, 9.30 a.m. „ „ Special Clinics Alternate 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. „ „ Ante-Natal Clinic Alternate Tuesdays, 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. High St. Schools, 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. lown 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. 22 Legislation in Force. 1 he following Special Acts of Parliament have been obtained by the Council:— The East Ham Improvement Act, 1898. The East Ham Improvement Act, 1903. The East Ham Corporation Act, 1914. The East Ham Corporation Act, 1919. 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 Ditto, Sec. 51 Jan. 27, 1936 (b) Home Office— Public Health Acts Amendment Act, 1907, Part 7, S'ec. 85 Mar. 6, 1929 Acts of Parliament Adopted. Name of Act adopted Date of Adoption Date of Coming into Operation Infectious Diseases (Notification) Act, 1889 Nov. 12, 1889 Jan. 1, 1890 Infectious Diseases (Prevention) Act, 1890 Oct. 14, 1890 Nov. 18, 1890 Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5 Jan. 13, 1891 Feb. 18, 1891 Public Baths and Washhouses Acts Mar. 16, 1897 Mar. 16, 1897 Housing of the Working Classes Act, 1890, Part 3 Feb. 16, 1897 Feb. 16, 1897 Public Libraries Act, 1892 June 18, 1895 Aug. 1, 1895 Infectious Disease (Notification) Act, 1889 (Extension) 23 Education (Provision of Meals) Act, 1906 Nov. 24, 1908 Nov. 24, 1908 Local Government and Other Officers' Superannuation Act, 1922 July 17, 1923 Oct. 1, 1923 Public Health Act, 1925, Part 2, Sec. 25 Apl. 13, 1926 June 1, ,1926 Public Health Acts Amendment Act, 1907, Part VI Public Health Act, 1925, Part VI July 12, 1932 Dec. 19, 1932 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. 24 REGULATIONS. Administration of Outdoor Assistance. Blind Persons Act, 1920. 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. Scheme for Registration of Births, Deaths and Marriages. Scheme in relation to Domiciliary Service of Midwives. 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 7. Public Assistance Domiciliary Medical Service. Statistical Return for the Year Ending 31.12.37. 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. 2,380 5,347 15,435 20,782 1,218 1,271 Number of cases urgently admitted to hospital .... 4 Number of applications to Medical Officer of Health for hospital treatment .... .... .... 69 25 Public Assistance Nurse and Assistant Relieving Officer Number of requisitions received for attendance of nurse 45 Total attendances at homes by nurse 2071 Number of Maternity cases 271 Total visits to such cases 468 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 1937:— Number of individual patients 63 Number of attendances at homes 220 Number of attendances at surgery 285 Total number of attendances 505 Number of occasions medicines supplied without seeing patients 15 Number of recommendations for extra nourishment 31 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 13 Soft Chancre 2 Gonorrhoea 93 Not Venereal 123 Total 231 Total attendances of all patients 13,770 Number of in-patient days during 1937 110 26 There were fewer cases of specific disease in comparison with the previous year, and a less attendance of non-venereal cases. The total attendances and in-patient days in hospitals decreased. Pathological Examinations. For or at the Centres— Spirochaetes 15 Gonococci 2315 Wassermann 460 Others 764 Total 3554 For Practitioners— Spirochaetes — Gonococci 2 Wassermann 33 Others 6 Total 41 During 1937, there were no East Ham patients in residence under the Hostel Scheme. Mental Deficiency. As stated in previous reports, a number of cases are admitted to the South Ockendon Colony for Mental Defectives—the Cell Barnes Colony, Herts, and similar institutions. Low and medium grade defectives are accommodated at Forest Gate Hospital. 27 General and Special Hospitals and Children's Homes. Arrangements for Treatment. (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 new hospital for mental and nervous diseases at Runwell is situated on a site of 500 acres between Wickford and Rettenden, Essex, about 24 miles from East Ham and 12 miles from Southend. The various units are magnificently placed on a slight slope open to the south and sheltered from the east, north and west by rising and well-wooded ground, and are widely spaced so as to allow for ample admission of sunlight to the grounds and buildings. In this way, it is hoped that an atmosphere may be engendered of light and airy buildings without obtrusive restraint and with a freedom from the institutional feeling. Wide verandahs with large solaria and airy rooms with French windows enable the patients to feel that they are in a sanatorium rather than a great institution. The hospital accommodates 1,010 patients, and forms a fully equipped community of approximately 1,400 people, with some twenty-five to thirty separate units each specially planned for its purpose. The central administrative unit contains the PhysicianSuperintendent's office, committee rooms, clerical offices and waiting rooms, with a well-equipped library for the use of patients and staff, a lecture theatre and sister tutor's demonstration room. 28 A central corridor leads directly to the Recreation Hall, and has a large supper room at one end which is used as a gymnasium for patients and staff, as well as during other times for recreation. The Hall has a properly equipped stage with dressing rooms and modern cinema projector with sound reproduction. In the kitchen and stores an endeavour has been made to depart from stereotyped lines, and initiate a system of stores, preparation room, cooking units, and service bays which will all lead naturally to the despatch of the food trolleys. A wellequipped bakery is placed adjacent to the kitchen. The power house is situated to the north of the administrative unit, the laundry to the east of the stores. Occupational therapy workshops for male and female patients are constructed to facilitate observation and the teaching by trained instructors of numerous handicrafts; also metal work, carpentry, etc. The admission hospital is sunny and airy, with ample verandahs and solaria so as to give every facility for open-air treatment. In the central portion of this unit are situated the X-Ray department, the U.V. Ray department and social worker's office, also pathological and bio-chemical research laboratories. Facing south in the centre of the unit is a large common room for both sexes, used also for recreation and occupational therapy. In the east and west wings are the male and female wards respectively, examination rooms, and a well-equipped hydrotherapy and plombiere department, with laboratories for experimental psychology and chemical pathology which permit of the thorough investigation of new cases. Nerve units designed to receive voluntary patients suffering from milder forms of nervous disorders are in the form of detached villas pleasantly situated away from other units. Private bedrooms and small homelike sitting rooms with French windows engender a feeling of personal comfort and security which cannot be attained in a large ward of mixed patients. This experiment in the treatment of such cases has proved an unqualified success. The Harper unit, or sick hospital, is designed for medical and surgical treatment. At the extremity of each wing, separate 29 pavilions have been planned for patients suffering from tuberculosis and infectious diseases. Units for quiet and employable patients of both sexes are placed east and west respectively of the administrative buildings, giving ample room for exercise and recreation. Parole units are placed in close proximity to the workshops, kitchen garden, farm, etc. Boundary House—in a detached position to the extreme west and some distance away—accommodates patients suffering from the more severe forms of mental disorder. This is arranged to permit of some classification into groups, and the whole building is designed and equipped to dispel any idea of a "refractory block." A chapel, nurses' home, chief officers' residences, and cottages with farm buildings, complete the hospital. It is the intention to employ female nurses in a number of male wards, particularly the Admission, Nerve, Convalescent, Sick and Infirm units. Runwell Mental Hospital was opened by the Rt. Hon. Sir Kingsley Wood, M.P., Minister of Health, on June 14th, 1937, in the presence of the Mayor and Mayoress of East Ham (Alderman J. W. Barton, J.P., and Mrs. Barton) and the Mayor and Mayoress of Southend-on-Sea (Alderman Wm. Miles, O.B.E., J.P., and Mrs. Miles). Councillor H. B. Harper, J.P., Chairman of the Joint Hospital Committee since its inception, presided, supported by members of the Joint Committee and by Dr. R. Strom-Olsen, Physician-Superintendent. Of the 353 direct admissions during 1937 (135 males and 218 females), 91 males (86 voluntary, 5 temporary) and 115 females (92 voluntary, 23 temporary) were admitted under the Mental Treatment Act, 1930. Males Females Beds provided 422 574 Nos. in residence on 1st January, 1938 363 539 Available bed accommodation 59 35 Day accommodation 422 574 Available day accommodation 59 35 30 The charge to the East Ham and Southend-on-Sea Public Assistance Committees was 35s. per head per week. A Psychiatric Clinic in association with Runwell Hospital has been established at the East Ham Memorial Hospital, patients attend on Fridays, 2 p.m. The East Ham out-patient clinic statistics are as follows :— Attendances during 1937:— New Cases. Old Cases. Male 57 Male 345 Female 61 Female 202 118 547* Admitted to Runwell: *Outpatients treated by psychotheraphy Male 17 Female 11—Total 28. TABLE 8 Disposition of East Ham Mental Patients on 31.12.1937 Institution Male Female Total Brentwood 3 1 4 Colchester — 3 3 Gateshead — 3 3 Runwell 237 266 503 Miscellaneous Hospitals 3 1 4 Totals 243 274 517 (h) Smallpox. The Council is in negotiation with the London County Council for the provision of hospital accommodation. (i) East Ham Memorial Hospital. The work of the Hospital and Public Health Department becomes more closely associated each year, and I acknowledge with gratitude the help of the Committee and Honorary Medical Staff. The number of beds remains the same, viz., 100. The following tables are abstracted from the hospital report for 1937:— 31 TABLE 9. 1.—In-Patients. Number of Beds and In-Patients. Numbers in 1937 Numbers in previous year 1. Beds:— (a) Complement at 31st December 100 100 (b) Average Daily Complement during the year 100 100 (c) Average Daily Number Closed during the year, owing to:— (i) Rebuilding or Extension Schemes — — (ii) Repairs, Redecoration, Cleaning or Infection 1.2 1.5 (iii) Other Causes — — (d) Average Daily Number Open during the year 98.8 98.5 (e) Average Daily Number Occupied during the year 90.2 94.2 2. Number of In-Patients in the Hospital at beginning of year. 91 96 3. Number of In-Patients admitted during year 1,957 1,850 4. Number of In-Patients in the Hospital at the end of the year 90 91 5. Average number of days each Patient was resident (ascertained by dividing the yearly total of daily counts, viz.:— 32 937 by the number of Patients treated to a conclusion, i.e., (2) plus (3) — (4).) 16.8 18.6 6. Number of Patients admitted and discharged during the year who were resident for— (i) only 1 day 162 94 (ii) 2 and 3 days 245 144 2.—Out-Patients. Numbers. Numbers in 1937 Numbers in previous year 1. Total number of new Out-Patients 15,164 14,134 2. Total number of Out-Patient Attendances 82,272 80,113 (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 4,361 3,970 (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 31.12.36 Admitted during 1937 Born during 1937 Total. Discharged. Died. Transferred to other Instns. (Chargeable on 31.12.3.7 Whipps Cross Hospital 132 1663 4 1799 1170 263 212 154 Central Homes 246 449 — 695 156 157 130 252 Forest Gate Hospital 133 314 252 699 513 19 29 138 Forest House and Cottages 40 25 — 65 2 1 22 40 *Harold Wood Hospital 2 10 — 12 — — — 12 * Aged and Chronic Cases. 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 30-6-37 500 6 months ending 31.12.37 480 Lowest „ „ „ 455 „ „ „ 455 In Receiving Homes on 1st January, 1937 270 1st July, 1937 280 „ Scattered „ „ „ 189 „ „ 199 —459 —479 In Receiving Homes on 1st July, 1937 280 1st January, 1933 289 „ Scattered „ „ „ 199 „ „ 178 —479 — 467 On 1st July, 1937, chargeability was apportioned as follows:— To the County Borough of East Ham 77 1st January, 1933 77 West Ham 260 „ „ 246 „ Essex County Council 142 „ „ 144 479 —467 Average No. of admissions weekly —6 months ending 30-6-37 13 6 months ending 31.12.37 11 „ „ discharges „ „ 8 „ „ „ 12 Greatest No. of admissions on any one day—6 months ending 30-6-37 8 „ „ „ 9 Number of deaths in institutions— 6 months ending 30-6-3 — „ „ „ 1 Number of children admitted from East Ham—6 months ending 30-6-37 53 „ „ „ 53 Number of children admitted from West Ham—6 months ending 30-6-37 124 „ „ „ 138 Number of children admitted from Essex C.C.—6 months ending 30-6-37 63 „ „ „ 99 35 Extracts from the six-monthly Reports of the Medical Officer (Dr. J. S. Coleman): September, 1937. HEALTH OF THE CHILDREN. The general health of the children has been excellent, the number of cases of serious illness very small, and there have been no deaths. INFECTIOUS DISEASES. During the period under review there have occurred 6 cases of Scarlet Fever, 1 of Measles, 6 of Diphtheria (all sporadically), and two definite epidemics of whooping cough, with 26 cases, and Mumps with 14 cases. It must be pointed out that in both these diseases isolation of contacts is almost impossible, the incubation periods are spread over several weeks, and premonitory symptoms of a specific nature non-existent. We still owe much of our infectious disease incidence to children being admitted directly to the various Blocks where no system of quarantine is possible. (The number of children admitted to the East Ham Infectious Diseases Hospital was 26—one death resulted from Diphtheria, which occurred in the second half of the year.) NURSING. The general nursing and care of the children has progressed along modern lines, and the physical fitness of the older boys and girls has been amply exemplified to all who witnessed their physical culture displays, and abundantly demonstrated in their sports records. A word of praise is due to the Physical Drill Instructor in his devotion to the children and the help he has accorded me in improving the physique of children I have found to be suffering with postural deformities and other orthopaedic infirmities. SUPPLY OF MEDICAL & SURGICAL REQUISITES. The supply of medical and surgical requisites has been adequate, but we look forward with keen anticipation to the benefits to be derived from our own dispensary. CAMP. I am anxious to record the definite physical improvement and elevation of general morale of all the children who visited Camp 36 this year. Never before have I noted such marked advance, and I attribute it in no small measure to all those members of the staff who have spared no effort in a personal endeavour to make "Camp" a robustly happy period for the boys and girls. DISCIPLINE. The discipline amongst the children has been maintained at a high standard. This difficult task, accomplished with tact and understanding by the staff, is reflected in the few serious accidents we have had. ACCOMMODATION. There has been adequate accommodation for all age groups of children, both at Aldersbrook and in the Scattered Homes. To the former Institution I paid 170 visits, and to the Homes 50 visits during the period under review. I am pleased to report on the general well being of the children under the care of the Foster Mothers. Only occasionally has it been necessary to enforce disciplinary measures to augment the harmonious routine of the Scattered Homes to ensure the continuance of the exceptionally high standard in which these Homes are conducted. DIET AND CLOTHING. The Diet and Clothing of the children I consider to be appropriate and satisfying, avoiding monotony and stressing nutritional values with the former, and drabness and conspicuous uniformity with the latter. DENTAL TREATMENT. The Dental care of the children has continued with methodical exactitude by Mr. Rose, and I can still maintain that the dental condition existent at Aldersbrook could not be matched by any other Institution. 1 have attended cases of sickness which have arisen amongst the Staff, and have examined all candidates for appointment. I am pleased to report we have a happy, healthy, and loyal staff, deeply interested in the welfare of the children with whom they come in such intimate daily contact. 37 January, 1938. The high level in general health and well-being amongst the children has been steadily maintained, and is regarded in many quarters as a standard to be achieved by similar Institutions throughout the Country. No effort is spared to make the children feel that they are being prepared for citizenship on equal terms with any other group of boys and girls. A few cases of serious illness have arisen, and there has been one death, which is fully reported upon elsewhere. Twenty cases of Mumps and eleven of Whooping Cough constitute the bulk of the infectious diseases; the remainder, eight cases of Scarlet Fever and three each of Diphtheria and Measles, bring the total up to 45. (The number of cases admitted to the East Ham Infectious Diseases Hospital was 24.) The supply of medical and surgical requisites has been adequate for our needs. There has been ample accommodation for all age groups, and we are fortunate to possess in the Nursery sufficient room for the large number of admissions in recent months. As reported elsewhere, I have completed a systematic examination of all the children under my care, and the defects discovered are being remedied as soon as possible. I have examined all cases on admission and discharge, and have vaccinated children when required, after obtaining parental consent. I have visited sick children in the Scattered Homes as and when required, and am assured of the general well-being of the children in these Homes. The diet, clothing, and daily routine of the children I consider to be well suited to the various age groups. A word of praise is due to the Charge Nurses in their vigilant endeavour to clothe the children adequately, having due regard to the ever changing weather. Minor illness and accidents amongst the staff have been treated as occasion demanded, and one is impressed by the sincere desire to return to duty at the earliest possible moment. 38 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. TABLE 12. VISITS. No. of reports— register, files, &c. Number of interviews Statutory Supervision Guardianship Institution Training Centre Friendly Care Total 960 153 175 94 121 1,503 1026 149 TABLE 13. Particulars of Mental Defectives as on 1st January, 1938. (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 15 29 Aged 16 years and over 40 31 71 (2) On Licence from Institutions— Under 16 years of age — — — Aged 16 years and over 6 1 ? (b) (1) Under Guardianship (excluding cases on Licence)— Under 16 years of age 2 1 3 Aged 16 years and over 16 8 24 (2) On Licence from Guardianship— Under 16 years of age — — — Aged 16 years and over — 1 1 39 2. In "places of safety ":— Under 16 years of age 1 — 1 Aged 16 years and over 2 1 3 3. Under Statutory Supervision 75 83 158 Of whom:— Awaiting removal to an Institution 4 2 6 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 (b) In Institutions certified under the M.D. Acts (including those approved under Sec. 37):- — — — (1) Cases "placed" under Sec. 3 — 1 1 (2) Other Cases — — — (2) Domiciliary — 5 5 (c) Otherwise "ascertained" 1 3 4 B.—Number of mental defectives not at present "subject to be dealt with" but for whom the Local Authority may subsequently become liable:— 1. In Institutions or under Guardianship—dealt with under Sec. 3:— (a) In regard to whom the Local Authority contributes under its permissive powers 2 1 3 (b) Maintained wholly by parents, relatives or others 1 — 1 2. Reported to the Local Authority from any reliable source and recognised by them as mentally defective but as to whom no action under the Mental Deficiency Acts has been taken:— (a) Children between the ages of 14 and 16 years — — — Of whom, number, if any, under Voluntary Supervision (b) All other cases 27 25 52 Of whom, number, if any, under Voluntary Supervision 27 25 52 Number of above Cases on the Registers of Occupation and Industrial Centres:— Under Statutory Supervision 11 15 26 Under Voluntary Supervision — — — On Licence from Institutions — — — Under Guardianship 4 4 8 On Licence from Guardianship — — — 40 DURING THE YEAR 1937. 1. (a) Number of instances in which Licence was granted during 1937 — M. F. T. (1) From Institutions 5 — 5 (2) From Guardianship 1 1 2 3 institutional and 4 Guardianship cases were granted 2 weeks holiday at Seaford and Bognor Regis. (b) Number of instances in which cases on Licence have been returned to Institutions or transferred to Guardianship during the year 1937— (1) To Institutions — — — (2) To Guardianship 2 — 2 2. Cases notified by Local Education Authorities (Section 2 (2)) during the year 1937:— Method of disposal— M. F. T. Sent to Institutions (by Order) 1 1 2 Placed under Guardianship (by Order) — — — Placed under Statutory Supervision 4 1 5 Placed in "Places of Safety" — — — Died or Removed from Area — — — Action not yet taken— (a) In receipt of Poor Relief — — — (b) Others 1 — 1 Total 6 2 8 3. Of the total number of mental defectives known to the Local Authority : — (a) Number who have given birth to children during 1937— (1) After marriage — (2) While unmarried — Males. Females. (b) Number who have married during 1937 — 1 Training and Occupation Centre. The morning session is held from 9.30 to 12 noon, and is for boys and young men who are taught various forms of handicraft. These include basketry, wrapped canework, stool-weaving, caneseating, and rug-making. The afternoon session is held from 2 to 4 p.m., and is for young women and girls and junior boys. The older pupils are engaged in embroidery work, plain sewing, knitting and physical drill. The juniors are taught personal hygiene and physical exercises, and they devote much time to musical games and ball games. They also make small articles which are saleable. 41 The class of work done by the pupils is of a very high standard, and there is a ready sale for all the goods made at the Centre. A happy and cheerful atmosphere prevails, and every encouragement is given to the pupils in their work. The trainees receive a small percentage from the sale of articles. The transfer of the Centre to St. John's Church Hall has furnished better accommodation and improved the facilities for training. TABLE 14. Statistics of Training Centre, 1937. Morning Session—Males. Afternoon Session— Girls and Juniors. Total Attendances No. on Register No. of Sessions held Total Attendances Average Attendance No. on Register No. of Sessions held Total Attendances Average Attendance 11 207 1,604 7.7 22 207 3,363 16.2 4,967 42 Blind Persons Act, 1920 The East Ham Welfare Association for the Blind reports a year of continued effort in that all activities have been well maintained. The social and entertainment side of the Association is considered of first importance to the blind, and the enjoyment derived from the weekly meetings and other functions has helped to contribute in some measure to their happiness. The average attendance at the former is 90, and in addition seven socials were held in the Minor Hall during the winter months. All the blind have radio sets, and maintenance is undertaken by the Association. Much help is afforded by the Ladies' SubCommittee who make themselves responsible for the weekly club and much social work. Considerable expense is incurred in preventive treatment, and grants for glasses are not sanctioned unless the applicant has been previously examined by a qualified Ophthalmic Surgeon. The Committee announce the resignation of the Hon. Secretary, Mr. T. E. Williams, who has rendered enthusiastic and devoted service for the past 15 years. The Council's Ophthalmic Specialist (Mr. S. C. ReeveFlaxman, M.R.C.S.) examines all new cases and certifies where necessary. Number of cases examined 1/1/37 to 31/12/37 25 Number of cases certified 1/1/37 to 31/12/37 16 Number of cases not certified 1/1/37 to 31/12/37 9 M = Males F = Female T - Total. TABLE 16. Welfare of the Blind.—Registration. As at 31.3.38. In the following tables, the registration of the blind, ages at which blindness occurred, training and employment and occupations, as at 31.3.38, are set out :— 43a 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) lotal 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. — — — — 1 1 2 1 3 2 2 4 15 15 30 18 11 29 27 25 52 16 14 30 36 41 77 (i) 116 (ii) 110 1 226 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. r. M. F. T. M. F. T M F. T. M. F. T. M. F. T. 16 12 28 1 2 3 5 7 12 4 6 10 13 9 22 10 9 19 11 12 23 19 14 33 22 25 47 10 12 22 5 3 8 Children of School Age 5-1 Training and Employment. Age period 16 and upwards. Normal. Mentally Defective Physically Defective Kmployed Undergoing Training Trained but Unemployed No Training but Trainable Unemployable Total In M F M F M F By Blind Organisations. All others not included in (a & (b) ) Total employed Industrial Secondary Professional or University Schools for the Blind 1 — — — - -1 Workshops (a) Ho me Wc (b) >rkers (c) (d) (e) (f) (g) (h) (i) (i) (k) M. F T M F T. M. F. T M F T M. F. T. M. F. T. M. F T. M. F. T. M. F. T. M. F. T. M. F. T. Other Schools - - - - - - 5 6 11 5 3 8 10 3 13 20 12 232 J 3 2 5 - - - - - - 4 — 4 3 2 5 84 94 178 116 1l1 227 Not at — - 1 — - - — 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, NewsAgents, Shopkeepers. Firewood Workers j Gardeners Hawkers, Newsvendors etc. Home Teachers Knitters Labourers Massage Mat Makers Ministers of Religion Musicians and Music Teachers Netting Makers Porters, Packers Cleaners Poultry Farmers School Teachers vShip's Fender (Pendoff) Makers] Telephone Tuner Weavers Miscellaneous Total | Hand Machine Mattress Makers Machinists Upholsterers Within Institutions for the Blind - 2 3 - - - - - - - - - - - - - - - - 5 - - - - - - - - - - - - 1 — 11 In approved Home Workers Schemes 1 - - - - 1 - - - - - - - - - - - - - 2 - - - - 1 - - - - - - 3 - - 8 Others (not pastime Workers) 1 1 - - - 2 - - 1 - 1 - 1 - - - 2 - - - - 1 - - - - - - - - 1 - - 2 13 Total 2 3 3 — — | 3 — — 1 — 1 — 1 — — 2 — — 7 — 1 - — 1 — - — — — - 3 1 2 32 Physically and Mentally Defective (including those children 5-16). Unemployable persons resident in Homes for the Blind, Mental Hospitals or Poor Law Institutions. (a) Mentally Defective (b) Physically Defective (c) (i Deaf (ii) Deaf-mute Combinations of (a)nd (b) Combinations of (a) and (c) Combinations of (b) and (c) Combinations of (a), (b), (c). Total Homes for th Blind Mental Hospitals Poor Law Institutions M. F. T. M F. T. M. P. T. M. F. T. M. F. T. M F. T. M F. T. M. F. T. M. F. T. M. F. T. M F. T. 6 5 11 6 9 15 (i) 8 (i) (ii) — (ii) 9 3* (i) 17 (ii) 3 — — — 1 — 1 — — — — - - — 21 23 44 — — 2 2 4 3 5 8 * Deaf Mutes are also shown in the Deaf column. 43b TABLE 16.—Continued. Number of persons over 70 years of age. M. F. T. 35 39 74 Blind Persons Registered as New Cases (Not Transfers from other Registers) during the year ended 31. 3. 38. 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. (i) 5 (i) 13 (i) 18 – – – – 1 1 – – – – – – 2 2 4 – 1 1 2 4 6 – 2 2 1 3 4 (ii) – (ii)– (ii)– Blind Persons Registered as New Cases (Not Transfers from other Registers) During the Year ended 31.3. 38, 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 2 1 2 3 – — — 1 3 4 1 3 4 1 2 3 — — — 43 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. 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 — 1937 223 2,061 34 178 217 — 2,312 442 — 230 94 57 31 — 30 — 44 Prevention of Blindness. Powers conferred on local authorities are set out in Section 66 of the Public Health Act, 1925, which was repealed by Section 176 of the Public Health Act, 1936, on the 1st October, 1937. Section 176 of the Public Health Act, 1936, reads as follows:— (Sub-Section 1). A County Council or Local Authority may make such arrangements as they think desirable for assisting in the prevention of blindness, and in particular for the treatment of persons ordinarily resident within their area, who are suffering from any disease of, or injury to, the eyes. (Sub-Section 3). For the purposes of this section, a person who becomes an inmate of a hospital or institution shall be deemed to continue to be ordinarily resident within the area within which he was ordinarily resident before he became an inmate of the hospital or institution. The model scheme of the Ministry of Health and the Council's recommendations are appended herewith. MODEL SCHEME. REMARKS. 1. Arrange for the ascertainment, through a system of voluntary notification to the Council by medical practitioners or otherwise, of persons threatened with blindness, and in respect of each such notification may pay the sum of 2/6 or such other sum as it may from time to time determine. Provided that only one payment may be made in respect of any one person, and provided also that no payment shall be made to any person or body who is required by any statutory enactment or regulations for the time being in force or by any terms of service or otherwise to give the notification. No action. 45 2. Arrange for the systematic visiting of persons ascertained to be threatened with blindness to secure that they avail themselves of the facilities provided for expert treatment and supervision. In operation. 3. Provide or arrange for the provision of treatment for the prevention of blindness to persons ordinarily resident within the County Borough, either as in-patients or outpatients at hospitals, dispensaries, clinics or other approved places or otherwise. Cases of Ophthalmia Neonatorum are admitted to special London County Council Hospital. Out-patient cases continue under the care and supervision of the Medical Officer to the Clinic, and Health Visitors. School children. Treatment of Myopes in special class Monega Road School. Agreement with the Royal Westminster Ophthalmic Hospital for Strabismus operations; Phlyctenular cases, when recommended, are sent to Swanley. Children 0—5 years, schoolchildren, found at routine medical examinations and the Minor Ailment Clinic, and cases of alleged blindness in adults coming within the meaning of the Act, are all examined by the Ophthalmic Specialist and appropriate treatment recommended. In the case of adults, where necessary, they are certified as coming within the meaning of the Blind Persons Act, 1920. 4. Provide means to enable suitable cases to take advantage of facilities for treatment, including the provision of financial assistance for that purpose. Public Assistance cases requiring treatment are referred to the East Ham Memorial Hospital and, if necessary, spectacles are provided. Optical Benefit is obtained by National Health Insurance patients through the various Societies. 5. Agree with any person for him to contribute the whole or part of the cost of any treatment given under this Scheme. No action. 46 6. Disseminate or arrange for the dissemination of information regarding the prevention of blindness, including the issue and distribution of literature having this object. Suggest suitable literature be obtained, if possible, from the Union of Counties Association for the Blind. 7. In the carrying out of this scheme and without restricting the generality of the pregoing clauses, the Council may do all such acts and things as are incidental or conducive to the attainment of the objects of such scheme. Agreement as above. 47 The Invalid Children's Aid Association. The report of the East Ham Branch for 1937 shews another year's beneficient work. Many of the debilitating illness from which the children suffered were of such a character that ill-health or some permanent defect would have resulted had not the services of the Association been available. The opportunity afforded of placing sufferers in an environment suitable to their conditions, whether on the South or East Coast, or again, in the country, confers the maximum amount of benefit upon each child, and ensures in the majority of instances complete restoration to health. A further decline in the number of crippled children has been effected, and a noteworthy feature of the year's work has been the reduction in the number of cases requiring long periods of convalescence. I desire to express my thanks to the Chairman (Councillor W. Thompson) and Officers for their material help in arranging convalescent and special home treatment on numerous occasions, and assistance in many other respects throughout the year. The following is abstracted from the Annual Report for the year ,1937 Number of cases dealt with 305 New Cases 210 Re-application for assistance 38 Referred for clothing 20 Extensions from 1936 37 305 The 210 new cases were referred by :— Hospitals and Medical Practitioners 86 Medical Officer of Health and Infant Welfare Centre 20 School Medical Officer and Education Committee 33 Unemployment Assistance Board 1 Tuberculosis and Chest Clinic 52 Parents, other Agencies, etc. 18 210 48 The types of new cases were as follows :— Tuberculosis 28 Rheumatism, heart and chorea 15 Anaemia and debility 33 Lung Conditions (non-tuberculous) 45 Marasmus and Malnutrition 9 Various 80 210 The 305 cases dealt with during the year have been assisted as follows:— Sent to Sanatoria, Nursing and Convalescent Homes 179 Extensions from previous years 37 Surgical instruments provided 31 Clothing 30 Referred to other Agencies 3 Referred for Visiting and Advice 25 305 49 Maternity and Child Welfare. Midwifery and Maternity Services. In pursuance of the Midwives Act, 193G, the following scheme was adopted by the Council:— COUNTY BOROUGH OF EAST HAM. Midwives Acts, 1902 to 1936. Domiciliary Midwifery Scheme. Appointment of Midwives by the Authority. The Authority shall appoint midwives up to a maximum number of 5 to undertake attendance as Midwives or as maternity nurses on women in their own homes during childbirth and from time to time thereafter during a period of not less than the "lying-in period," as defined by any rule for the time being in force under Section 3 of the Midwives Act, 1902. The Midwives appointed will be required to devote the whole of their time to the services of the Authority and act under the supervision and direction of the Medical Officer of Health. In appointing Midwives, preference, will be given to candidates not exceeding 40 years of age who are both State Registered Nurses and State Certified Midwives and who are in actual practice as Midwives at the time of appointment. The salary for Midwives holding both qualifications will be £205 per annum, rising by annual increments of £15 to £295 per annum, and for Midwives not being State Registered Nurses, £155 per annum rising by annual increments of £15 to £245 per annum. No allowance will be made in respect of the provision of uniform or in respect of travelling expenses. The posts will be designated as "established" under the provisions of the Local Government and Other Officers Superannuation Act, 1922. The Midwives appointed shall be required to live within the County Borough of East Ham, and their residences shall be suitable both as to situation and otherwise to the needs of their work. The Authority may provide a residence for any or all of the Midwives, and in such case or cases an appropriate deduction will be made from the salary in respect of rent. 50 A telephone will be installed and maintained at the residence of each Midwife at the expense of the Authority. Each Midwife will be granted one whole day off duty per week and three weeks' annual leave. Fees. The fee for the provision of domiciliary midwifery or maternity nursing service shall be 40/-. In any case where a patient is unable, owing to financial circumstances, to pay this fee, the amount chargeable shall be assessed in accordance with the Authority's income scale in force for the time being after ascertainment of the financial circumstances of the patient and the amount of the Maternity Benefit receivable. The income scale at present is as follows:— With single Maternity benefit With double Maternity benefit No maternity benefit— insufficent contributions Not exceeding 3/3 per unit 10/- 20/- 7/6 From 3/4 to 4/3 ,, ,, 17/6 27/6 13/- From 4/4 to 5/3 ,, ,, 23/- 33/- 17/6 From 5/4 to 6/3 ,, ,, 28/6 38/6 21/6 From 6/4 to 7/3 ,, ,, 34/- 40/- 25/6 7/4 and upwards 40/- 40/- 30/- Maternity Nursing Service:— Where Doctor engaged by patient, 75% of above scale. A booking fee for the services provided under this Scheme shall be charged at the time of the application. Where application is made before the expiration of the 28th week of pregnancy, the booking fee shall be 5/-, but if application is deferred until after that period the booking fee shall be 7/6. This booking fee will form part of the total charge, and will be forfeited in the event of the applicant not utilising the services of the Midwife or Maternity Nurse. Fees shall be payable in the undermentioned cases as follows :— Where child born before arrival of Midwife Full scale fee Abortion, i.e. before 28th week of pregnancy Half scale fee Miscarriage, i.e. after 28th week of pregnancy Full scale fee 51 The Midwife shall, wherever possible, collect the balance of the fee payable during her period of attendance on the patient. Ante-natal and post-natal examinations. In any case where the expectant mother desires to be examined and kept under observation during pregnancy she may attend one of the ante-natal clinics of the Authority. The Midwife concerned should be in attendance at all anteand post-natal examinations at any of the Authority's Clinics or by a medical practitioner. Voluntary Organisations. The Authority shall enter into agreements with— The Plaistow Maternity Hospital and District Nurses' Home, Howards Road, Plaistow, E.13. The Silvertown and North Woolwich District Nursing Association, Saville Road, Silvertown, E.16. Under this scheme, three Municipal Midwives were appointed and commenced duty on 1-9-37. The cases booked by these midwives up to 31-12-37 were:— As Midwives As Maternity Nurses 35 9 TABLE 17. Domiciliary Midwives Midwives in Institutions Totals 1. Total number of Midwives practising at the end of the year in the area of the Local Supervising Authority: (a) Employed by the Local Supervising Authority 3 – 3 (b) Employed by other Welfare Councils: (i) under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 – – – (ii) others – – – (c) Employed by Voluntary Associations: (i) under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 41 — – (ii) others (d) In private practice 12 4 16 Totals 66 4 60 52 TABLE 17—continued. Domiciliary Cases Cases in Institutions Totals 2. Number of cases in the area of the Local Supervising Authority attended during the year by midwives: (a) Employed by the Council As Midwives 7 — 7 As Maternity Nurses 5 — 5 (b) Employed by other Welfare Councils: (i) under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 :— As Midwives — — — As Maternity Nurses — — — (ii) others As Midwives — — — As Maternity Nurses — — — (c) Employed by Voluntary Associations: (i) under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 :— As Midwives 692 — 692 As Maternity Nurses 196 — 196 (ii) others (d) In private practice As Midwives 299 4 303 As Maternity Nurses 78 32 110 Totals As Midwives 998 4 1002 As Maternity Nurses 279 32 311 53 TABLE 17—continued. 3. Number of cases in which medical aid was summoned during the year under Section 14 (i) of the Midwives Act, 1918, by a midwife (i) engaged in domiciliary practice—234. Total 234. (ii) in institutional practice — 4. Number of domiciliary births during the year in the area of the Local Supervising Authority— 1,110 Number of women sent by Council per the Ante-Natal Clinics, to Forest Gate Hospital, for confinement—206. Institutional Provision for Unmarried Mothers and Homeless Children. Already detailed in report for 1930. Child Life Protection. (Sections 206 to 220 of the Public Health Act, 1936). (a) Number of persons who were receiving children for reward at the end of the year—26. (b) Number of children: (i) at the end of the year—31. (ii) who died during the year—Nil. (iii) on whom inquests were held during the year—Nil. (c) Number of Child Protection Visitors at the end of the year who were: (i) Health Visitors—7. (ii) Female, other than Health Visitors—Nil. (iii) Male—Nil. (d) Number of persons (in addition to or in lieu of Visitors under (c) above) or societies authorised to visit under the proviso to Section 2 (2) of the Children Act, 1908, the proviso to Section 209 (2) of the Public Health Act, 1936.—Nil. (e) Proceedings taken during the year: No. of Cases. Act and Section under which proceedings were taken NIL. (f) Number of cases in which the local authority has given a sanction during the year: (i) under (a) of Section 3 of the Children Act, 1908, Section 210 of the Public Health Act, 1936 Nil. (ii) under (b) „ „ ,, Nil. (iii) under (c) „ „ „ Nil. (g) Number of orders obtained during the year under Section 67 of the Children and Young Persons Act, 1932, Section 212 of the Public Health Act, 1936: (i) from a court of summary jurisdiction—Nil. (ii) from a single justice—Nil. 54 Orthopaedic Treatment. Cases are referred to the East Ham Memorial Hospital and Queen Mary's Hospital, Stratford, under similar arrangements to the School Medical Service. Maternity and Nursing Homes, Public Health Act,1936 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 Milk. During the year under review, 11,645 lbs. of dried milk and 7,191 gallons of fresh milk were issued free, and 19,538 lbs. of dried milk were sold. The expenditure in respect of free milk (fresh and dried) supplied to expectant and nursing mothers and young children during the year ending 31st December, 1937, was £1,686, which figure excludes any expenditure for administration. 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 485 Number of individual children who attended the Clinics 3468 Total number of attendances at all Centres (including toddlers and specials) 31280 Total number of children who attended the Clinics for the first time during the year:— (a) Children under 1 year 1373 (b) Children between the ages of 1—5 years (excluding examination of toddlers) 386 Number of medical consultations at general Clinics 7544 Number of medical consultations at special Clinics 719 55 The daily average attendances at the Clinics were as follows: Central Clinic, Monday afternoon 72 Church Road, Monday afternoon 80 Plashet Grove, Tuesday morning 80 North Woolwich, Tuesday afternoon 20 Central Clinic, Wednesday afternoon 57 Church Road, Wednesday afternoon 62 Central Clinic, Thursday morning 63 Church Road, Thursday afternoon 64 Plashet Grove, Friday afternoon 77 Central Clinic, Friday afternoon 43 Excluding North Woolwich Infant Welfare Centre, which supplies a very small area, the average attendance of children per session at all centres during the year is 66.4. During 1937, 3,468 children attended the centres. The total attendance of infants from 0—5 was 31,280. 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 afternoons at the Central Clinic. During 1937, 778 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 64. 56 Tonsils and Adenoids During 1937, 78 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 Dentists, two afternoons in each week being set apart for this purpose. One hundred and forty-eight mothers and 186 infants were referred to the Dental Department during 1937. Ophthalmic Treatment Ophthalmic defects requiring special treatment are seen at the special clinic each week by the School Ophthalmic Surgeon. During 1937, 41 cases were referred to the School Ophthalmic Clinic. Aural Treatment Aural cases requiring special treatment are referred to the School Aural Surgeon. During 1937, 12 patients received treatment at the School Aural Clinic. Morning Clinics Special clinics are held twice 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. 'I he statistics for 1937 are as follows :— Number of medical consultations 719 57 Notification of Births The Notification of Births Act, 1915, amended on 1.10.37 by the Public Health Act, 1936, requires that all births be notified to the Medical Officer of Health with 36 hours of their occurrence. All cases notified are visited by the Health Visitor as soon as possible after the doctor or midwife has ceased to attend. Advice is given with regard to the care, management, feeding and clothing of the child, and also the general health and care of the mother. Thereafter, periodic visits are made to the homes of infants during the first two years of life, and, as far as possible, at wider intervals during the next three years, up to the time when the child comes under the observation of the School Medical Service. The visits made by the Health Visitors during 1937 were 16,001. Visits to infants under one year of age 6731 Visits to children over one year of age 8084 Visits to tonsils and adenoid cases 53 Visits to ante-natal cases, first visits 547 Visits to ante-natal cases, revisits 73 Visits to foster mothers 122 Special visits not included in the above group 391 16001 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 (Public Health Act, 1936). 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 and reports on home ditions. 5. Visiting home helps before and whilst engaged in duties. 6. Home visiting in connection with Ante-Natal Clinics and expectant mothers. 7. Ante-natal and Post-natal Clinics for expectant mothers. 8. Infant Welfare Clinics for children up to five years of age. 58 9. Special visiting of (a) Still Births. (b) Ophthalmia Neonatorum. (c) Puerperal Fever and Pyrexia. (d) Tonsils and adenoid cases. (e) Pneumonia. (f) Infantile Diarrhœa. (g) Other special visits. Still Births The number of still births registered during the year was 58. The proportion of still births to live births was as 1 to 34. The still birth rate was 28.8 per 1,000 live and still births. On investigation it was found that in 49 cases the months of pregnancy at which the still births took place were as follows :— 7th month 4 8th month 10 9th month 35 An analysis of the causes to which the still births were attributable will be found in the following table:— Malpresentation 8 Prolonged labour 4 Contracted Pelvis 2 Excessive size of Foetus (including post maturity) 4 Congenital Deformity 1 Prolapse of Cord 1 Ante-partum haemorrhage 8 Albuminuria 4 Prematurity 9 Causes unknown 17 58 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. North Woolwich, on alternate Tuesdays at 2.30 p.m. 59 During the year the following attendances were recorded:— Ante-Natal. Total number of cases attended 582 Number of new cases 481 Subsequent attendances 1830 Total number of attendances 2311 Average attendance of expectant mothers per session (excluding North Woolwich) 22.6 Post-Natal. Total number of cases attended 8 Total number of attendances 8 The following table gives an analysis of the pre-maternal cases found to be slightly or seriously abnormal:— Contracted pelvis 14 Albuminuria 16 Hyperemesis gravidarum 9 Ante-partum hæmorrhage 9 Malpresentation 11 Cervicitis 7 Valvular disease of heart 6 Varicose veins 20 Phlebitis 1 Anaemia 11 Pulmonary tuberculosis 1 Asthma 2 Hernia 4 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. 60 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 1937, 620 visits were paid to expectant mothers. Maternity Accommodation Under the provision of the Maternity and Child Welfare Act 1918 (Public Health Act, 1936), empowing 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 inpatient treatment at Forest Gate Hospital, the Maternity District Nurses' Home, Plaistow, and Queen Mary's Hospital, Stratford. During 1937, 206 cases were admitted to Forest Gate Hospital. Inspection of Midwives Seventy-one midwives notified the Local Supervising Authority of their intention to practise within the Borough during 1937—56 were on the register on 31.12.37, including staff at Burges Road. Forty-seven 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. 61 During the year help was obtained in 234 cases as follows:— Mother. Ruptured perineum 84 Prolonged labour 30 Ante-partum hæmorrhage 8 Post-partum hæmorrhage 6 Retained placenta 7 Rise of temperature 21 Malpresentations 3 Breech 6 Albuminuria 2 Other causes 33 200 Child. Prematurity and dangerous feebleness 12 Unsatisfactory condition of infant 7 Discharging eyes 5 Other causes 10 34 Puerperal Fever and Puerperal Pyrexia. Five 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 was one death associated directly with pregnancy. The Maternal mortality rate was, therefore, 0.49 per 1,000 live and still births compared with 2.00 in ,1936. Ophthalmia Neonatorum During 1937, seven cases of Ophthalmia Neonatorum were notified. 62 Voluntary Associations Appreciation and thanks are again gratefully accorded to the Invalid Children's Aid Association for their co-operation with the Maternity and Child Welfare Department, and help in arranging Convalescent Home Treatment for delicate children. Sixteen cases were referred to the I.C.A.A. and received treatment. Home Helps. During 1937, 33 suitable applicants were registered as Home Helps, and 22 applications were received for the services of Home Helps. Maternity Boxes. Maternity Boxes containing clothing and necessities for newborn babies are available upon application to the Senior Health Visitor. Staff. The staff at present consists of two Assistant Medical Officers, seven Health Visitors and the services of three and a half Clerks. Miss Engstrom, a St. John Ambulance nurse who assisted at the Central Clinic for many years, formerly in a voluntary capacity, resigned on 17th July, 1937, owing to the acceptance of another appointment. The post has remained vacant, although some temporary help has been afforded by the municipal midwives. 63 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 27. The death rate was 0.2 per 1,000 population, as compared with a rate of 0.4 for 1936. No cases of smallpox were reported during the year under review. Vaccinations 1937. The following figures shew the vaccinations carried out by the Public Vaccinators from 1/1/37 to 31/12/37:— Dr. O 'Moore Dr. Brews Total Number of successful primary vaccinations of children under one year of age 485 29 514 Number of successful primary vaccinations of persons one year and upwards 68 4 72 Total primary vaccinations 553 33 586 Number of successful re-vaccinations 89 12 101 Scarlet Fever. Three hundred and eighty-seven notifications of this disease were received during 1937, as compared with 359 for the previous year. No deaths occurred from this cause, and 337 cases or 87.1 per cent. received hospital treatment as against 90.0 per cent. for the previous year. Diphtheria. Notifications for the year totalled 149, an increase of 15 cases when compared with 1936. All the cases notified were removed to and treated in hospital, 100 per cent. being the percentage removed for the previous year. The number of deaths was 3 or a case mortality of 2.01 per cent. 64 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 1937, 745 infants and children have been completely immunised. The total number of inoculations performed has been 2,112, of which 673 were carried out at the Town Hall Clinic, 1,345 at the Maternity and Child Welfare Clinics, 70 at the Infectious Diseases Hospital, and 24 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 673 Number inoculated three times 209 Number inoculated twice 3 Number inoculated once 13 In addition to the above, one child was inoculated four times, one five times, and three children six times. Maternity and Child Welfare Clinics. Total number of inoculations 1345 Number inoculated three times 422 Number inoculated twice 11 Number inoculated once 15 Number inoculated once with A.P.T. 2 In addition four children received five inoculations, and five children four inoculations. Infectious Diseases Hospital. Total number of inoculations 70 Number inoculated once with A.P.T. 66 Number inoculated twice 2 Private Practitioners. In addition to the above, during the same period 4 children were inoculated three times by private practitioners, three* children twice, two* children once, and one child received four inoculations. * Inoculated with A.P.T. 65 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 147 123 102 107 87 46 40 26 27 15 21 15 7 4 566 154 47 767 N.B.—In considering the combined totals it will be noticed that 73.79 per cent. of the cases are in the age group 1—5 years, 20.07 per cent. in the age group 6—10 years, and 6.12 per cent, in the group over 10 years. The Schick test for susceptibility to Diphtheria was performed during the year in 932 of completed cases, of which 897 proved negative. In 35 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 31/12/37 was 5,735, made up as follows:— Town Hall 2925 Maternity and Child Welfare 2164 Hospital 350 General Practitioners 296 Total 5735 Enteric Fever. Eleven cases of mild paratyphoid fever were notified in January and February. Of these 5 were admitted to the Infectious Diseases Hospital and, in addition, 5 cases were notified by general hospitals after investigation. One was a home case. Later in the year, 2 further cases were notified—one being admitted to the Infectious Diseases Hospital. Of those treated in the Infectious Diseases Hospital, final examination confirmed the diagnosis as typhoid 1, paratyphoid 4. All patients in this hospital recovered and were discharged with negative bacteriological results. Careful and thorough investigation of water, milk, and other possible sources of infection proved negative. Similar cases were reported at the time over a widespread area, and in districts 66 adjacent to the Borough. The only article of diet common to most cases which gave rise to suspicion was imported fruit, but no verification was possible. A special report was submitted, in response to a request from the Ministry of Health, in February, 1937. Erysipelas. Fifty-three notifications received, 25 removed to hospital, and there were no deaths. Dysentery. Three cases were notified, 2 from general hospitals and one within the district, which proved positive upon bacteriological examination. Puerperal Fever. Five cases notified, all received hospital treatment, and none died. Puerperal Pyrexia. Seven notifications received, three were admitted to hospital; no deaths occurred. Notes. Diphtheria. One hundred and thirty-eight cases admitted to Infectious Diseases Hospital; 149 cases received hospital treatment. The reason for this difference is that notifications were received from various London hospitals, and in 11 instances the patients were treated in L.C.C. institutions. Deaths from Diphtheria. Hospital report states 5, the Registrar General gives 3, which gives a case mortality of 2.01 for 149 cases, whereas hospital records 5 deaths for 138 patients admitted and a case mortality of 3.6 per cent. Of the 5 deaths in the Infectious Diseases Hospital, one was a West Ham case and the other from Aldersbrook Homes—both outward transferable deaths. 67 Scarlet Fever. Hospital report gives 336 admissions, whereas 337 cases received hospital treatment. One case was treated in the L.C.C. Eastern Hospital. Erysipelas. The number of notified cases of Erysipelas treated in hospitals was 25— Borough Infectious Diseases Hospital 11 Whipps Cross Hospital 11 Eastern Hospital 2 St. Bartholomew's Hospital 1 25 The diagnosis in one case admitted to the Borough Hospital was not confirmed. Enteric Fever. One typhoid death not mentioned in hospital report was that of a seaman who died in hospital at Hull. Inward death transfer notified to East Ham. 68 TABLE 18. Total Cases of Notifiable Diseases, 1914-1937. Disease. 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Smallpox — — — — 3 1 10 — — — — — — — 17 25 70 51 13 1 1 — — — Scarlet Fever 667 499 267 341 272 530 718 1,355 502 170 215 221 350 798 832 743 484 245 779 701 979 411 359 387 Diphtheria 319 204 225 279 273 451 426 309 198 160 128 246 337 464 669 578 473 196 157 180 379 254 134 149 Enteric Fever 21 5 7 9 2 15 10 7 4 3 5 9 7 2 7 2 3 8 7 5 — 2 2 13 Erysipelas 130 96 86 66 52 72 72 57 34 32 38 41 41 38 60 49 63 54 55 69 74 55 59 53 Puerperal Fever 4 4 1 2 1 6 6 5 3 5 5 5 5 5 4 8 9 10 4 4 7 12 7 5‡ Puerperal Pyrexia Not Notifiable 11 11 12 14 6 23 10 11 14 7 7 Meningococcal Meningitis 1 8 6 7 3 3 3 4 — 1 1 1 1 4 1 1 3 8 5 1 3 3 — 2 Encephalitis Lethargica Not Notifiable 4 5 7 — — 9 6 1 2 3 1 — — — 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 7 Ac. Polio Myelitis 4 1 10 — — 3 1 — — 3 1 1 — 5 — 2 — 1 7 2 5 13 2 4 Ac. Polio Encephalitis Not Notifiable — — — — — — — — — — — — — 3 2 1 — — — Dysentery Not Notifiable — — 1 — — — — — — — — — — — — 1 — — 3 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 — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia Not Notifiable 85 92 54 79 91 70 114 82 102 59 75 77 148 100 88 101 1ll Total 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 1,568 858 677 742 * Induced in an Institution. ‡Notifiable as Puerperal Pyrexia as from 1.10.37 ¶Not notifiable as from 1.10.37 69 TABLE 19. Prevalence of and Control over Infectious Disease.—Notified Cases for the 52 Weeks ending 1st January,, 1938. 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 387 1 97 174 63 21 24 4 3 — 36 51 33 38 33 32 36 53 34 41 337 — Diphtheria 149 2 30 72 23 5 14 2 1 — 18 10 3 18 5 34 14 20 10 17 149 3 Erysipelas 53 1 2 — 1 2 9 10 20 8 3 4 3 8 4 6 8 5 5 7 25 — *Puerperal Fever 5 — — — — — 3 2 — — — — — 1 1 1 2 — — — 5 — Puerperal Pyrexia 7 — — — — — 5 2 — — — 1 1 — — 1 2 — 1 1 3 — Pneumonia 111 8 7 10 5 2 31 13 21 14 19 10 8 15 6 6 9 18 10 10 66 102 Ophthalmia Neonatorum 7 7 — — — — — — — — — 2 1 — — — 1 — 2 1 3 — Enteric Fever 13 — 3 2 3 2 1 — 2 — — — — 3 2 1 1 3 2 1 12 1 Acute Polio Myelitis 4 — 2 1 1 — — — — — 1 1 1 — — 1 — — — — 4 — Meningococgal Meningitis 2 1 — — — — — — 1 — — — 1 1 — — — — — — 2 2 Encephalitis Lethargica 1 — — — — — 1 — — — — 1 — — — — — — — — 1 1 Dysentery 3 — — 2 — — 1 — — — — 1 — — — — 2 — — — 2 — *Notifiable as Puerperal Pyrexia as from 1.10.37 70 TABLE 20. Ophthalmia Neonatorum. Vision Unimpaired. Vision Impaired. Vision Lost. Still under treatment at end of year. Died. Removed from District. Not Classified. 7 — — — — — — Borough Infectious Diseases Hospital Dr. Landon's observations are contained in the following report upon the work of the hospital:— During 1937 the diminished incidence of infectious disease, noted in the two preceding years, was again in evidence. Although, in the main, the general type of disease was mild, many severe cases occurred, particulars of which are given below. The total number of patients admitted was 608, compared with 657 in 1936. The death rate from diphtheria was 3.6 per cent. as compared with 3.4 per cent. in the preceding year. For the third year in succession there were no deaths from scarlet fever in the Hospital. The average daily number of patients was 52.7. It is hoped that the coming year will see the proposed extensions to B (cubicle) Block carried into effect. This block, which was erected in 1909, is an extremely important part of the Hospital accommodation, and the improved conditions will add greatly to the convenience and comfort both of the patients and the staff. In recent years the conception of the role of the isolation hospital has undergone a fundamental change. Regarded previously merely as places of isolation, they have now developed into specialised institutions for the treatment of complicated diseases. The physician now has at his disposal many valuable therapeutic agents not available to his predecessors of a generation ago, and the list is still being added to. The efficacy of the above is reflected in the marked reduction in the mortality rates of diphtheria, scarlet fever and other infectious diseases, as well as in the trail of impaired health and invalidism which were once the result of these diseases. Scarlet fever was once considered 71 to be one of the chief causes of heart disease in later life, but this can hardly be said to be the case to-day. This is interesting in view of the fact that heart disease from other causes appears to be increasing. The recent addition of prontosil and other members of the sulphanilamide group of drugs to the resources of the doctor has already produced important results in the treatment of streptococcal infections (e.g. puerperal fever and streptococcal meningitis), and reports are coming in of the efficacy of these drugs in such diverse conditions as cerebro-spinal meningitis, pneumococcal meningitis, typhoid fever and bacillus coli infections. It will be seen, therefore, that modern methods of prevention and treatment are tending both towards diminished incidence and more intensive treatment of infectious disease. Diphtheria. During the year under review, 138 patients were admitted, compared with 142 during 1936. Twenty-six patients remained under treatment at the end of 1937. Taken as a whole, the prevalent infection was not of a high order of virulence, although several cases of infection with the gravis type of organism occurred. The number of deaths was five, giving a mortality rate of 3.6 per cent. compared with 3.4 per cent. in 1936. The cause of death in the cases noted above were:— (a) Faucial diphtheria with secondary laryngeal involvement. Tracheotomy was performed and relieved the obstruction. The patient died, however, 36 hours later from cardiac failure. (b) Three cases of toxic myocarditis following severe faucial infection. One of these cases was of the haemorrhagic type. (c) Nasal diphtheria, broncho-pneumonia and whooping-cough. Diphtheria played only a small part in causing this death, which is attributed to it in accordance with the RegistrarGeneral's Classification of the Causes of Death. 72 The average dose of antitoxin administered was 34,000 units, and seven patients received doses of more than 100,000 units. Intravenous injection was resorted to in five cases. Severe complications, including pharyngeal paralysis and late cardiac failure occurred in ten patients, recovery taking place in all cases. The average duration of treatment was 42 days, the maximum being 77 days. Unusually severe serum reactions occurred in many cases, and the attention of the manufacturers was drawn to this matter. The types of case admitted were as follows:— Laryngeal 8 Nasal 16 Faucial and Nasal 2 Faucial 112 The age incidence was as under:— 0—5 5—10 10—15 15 + Total 31 63 22 22 138 Scarlet Fever. During the year, 336 patients were admitted, compared with 320 during 1936. Thirty-three patients remained under treatment at the end of the year. The type of disease continues to be mild, but several severe cases with high temperature and marked faucial inflammation occurred. The wide use of anti-scarlatinal serum was continued as in former years, and has more than justified the extra cost entailed. It has been abundantly proved that discharge from hospital as early as is consistent with a satisfactory clinical condition is advantageous both from the point of view of the patient and of the hospital administration, and the use of serum helps to bring this about in a high percentage of cases. Four weeks is now regarded as being the optimum period of isolation in uncomplicated cases. The use of prontosil in the acute stages of scarlet fever has not justified the hopes of its early advocates and, at present, there appears to be no substitute for serum in bringing about an early subsidence of the disease. Prontosil has, however, been used with great success in the treatment of complications, particularly in the later weeks of the disease. 73 An investigation into the number of infecting cases discharged from Hospital gave the following result:— 289 cases discharged yielded 7 infecting cases, or 2.4 per cent. The number of return cases for this series was 11, or 3.7 per cent. Taking the country as a whole, infecting cases vary between 1.0 and 7.0 per cent., so that the above figures are well within normal limits, and are probably higher than the normal for the Hospital. As above mentioned, there were no deaths from scarlet fever in the Hospital for the third year in succession. Of a series of 240 cases treated in the open wards with anti scarlatinal serum:— 87.5% were discharged in four weeks; 3.4% were discharged in five weeks ; and 9.1% were discharged in five to nine weeks. Complications for this group totalled 30 cases, or 12.5 per cent., and were made up as follows:— Otorrhoea 2.5% Rhinorrhoea 1.2% Adenitis 2.4% Albuminuria 0.8% Endocarditis 0.9% Other complications 4.7% Under "other complications" are included septic fingers, blepharitis, and other conditions not directly due to scarlet fever. In the complications given above, only those are included which necessitated a stay in Hospital on the part of the patient of more than four weeks. The age incidence of the patients was as follows:— 0—5 5—10 10—15 15 + Total 81 147 56 52 336 Bronchopneumonia. Twenty-one cases were admitted during the year. Of this number, two followed measles, five followed whooping-cough, and 14 were unconnected with either disease. Two deaths occurred giving a mortality rate of 9.5 per cent. In one case the patient was kept in an oxygen tent for three days but, although some 74 initial improvement occurred, this was not maintained, and the patient died. It is felt that, even though the use of a tent cannot in every case avert a fatal issue, its use is indicated if only for the alleviation of symptoms it brings about. Measles. The year 1937 was not a "measles year." Seven uncomplicated cases were admitted and all recovered. One hunded c.c. of blood was withdrawn from an adult convalescent for the purpose of manufacturing a supply of convalescent measles serum. Whooping Cough. Thirty-seven uncomplicated cases were admitted, all patients making a good recovery. In addition, there was one fatal case, complicated by severe enteritis in a child aged three years. Enteric Fever. Six patients were admitted during the year with a diagnosis of enteric fever. Widal examination was carried out in each and confirmed the diagnosis in five cases, as under:— Typhoid Fever 1 Paratyphoid B 4 All the patients recovered and were discharged after bacteriological examination had shown them to be free from infection. Erysipelas. Nine cases of facial erysipelas were admitted, three being of marked severity. All cases responded well to treatment, four receiving anti-scarlatinal serum (one intravenously) and five prontosil album. In addition, a case was admitted of erysipelas of the leg, complicated by thrombosis of the internal saphenous vein, with multiple abscess formation requiring many incisions. One case was admitted but diagnosis was not confirmed. Ludwig's Angina. One patient was admitted in an advanced stage of the disease. Death occurred within six hours of admission, and the death certificate was furnished by the patient's private doctor. 75 Bacteriological Examinations. During the year 2,440 swabs were examined in the Hospital for K.L.B., and of this number 192 were found to be positive. Examinations for members of the typhoid/ para-typhoid group in faeces were done in seven cases. Laboratory Work. Widal examinations 7 Virulence tests for K.L.B. (Diphtheria) 5 Examination of cerebro-spinal fluid 2 Diphtheria Immunization. During the year 66 patients were immunized by means of a single dose of alum-precipitated diphtheria toxoid. Diphtheria Carriers. Two patients who proved to be virulent carriers following an attack of diphtheria, were sent for treatment to the Guy's Hospital Diphtheria Carrier Clinic, which later reported both patients free from infection. Operations. The following operations were performed:— Withdrawal of blood for measles serum 1 Lumbar puncture 2 Incision of pyaemic abscesses 6 Incision of glandular abscesses 17 Infection among Staff. The following cases occurred:— Diphtheria 1 Scarlet Fever 2 Tonsillitis 21 Influenza 11 76 TABLE 21 Admissions, Discharges, Etc., 1937—Borough Infectious Diseases Hospital. Disease. Remaining at end of 1936 Admitted during 1937 Died during 1937 Discharged during 1937 Remaining at end of 1937 Diptheria 11 138 5 118 26 Scarlet Fever 14 336 — 317 33 Diptheria & Scarlet Fever — 5 — 5 — Scarlet Fever and Chicken Pox 1 2 — 2 1 Angina Ludouica — 1 1 — — Acute Anterior Poliomyelitis — 4 — 4 — Bronchitis — 2 — 2 — Broncho-Pneumonia and Measles — 2 — 1 1 Chicken Pox 7 4 — 11 — Chicken Pox & Bronchitis — 1 — 1 — Chicken Pox & Pneumonia — 1 — 1 — Dental Abscess — 1 — 1 — Enteric Fever — 7 — 7 — Erysipelas — 10 — 9 1 Enteritis — 2 — 2 — Impetigo — 1 — 1 — Laryngitis — 1 — 1 — Measles — 7 — 6 2 Mumps — 10 — 8 2 Pneumonia 1 14 1 13 1 Rubella — 2 — — 2 Stomatitis — 1 — 1 — Tonsillitis — 1 — 1 — Vincent's Angina — 1 — 1 — Whooping Cough and Pneumonia — 5 1 4 — Whooping Cough — 38 1 36 1 Observation Cases — 11 — 9 2 34 608 9 561 72 77 TABLE 22 Borough Infectious Diseases Hospital Year ended 31st March, 1938. Expenditure Cost per Patient per week £ s. d. Salaries and Wages 5715 36 3 Superannuation 192 1 3 Provisions 2705 17 2 Anti-toxin 424 2 8 Disinfectants, Drugs and Appliances 236 1 6 Coal, Coke and Firewood 820 5 2 Electricity, Gas and Water 1153 7 4 Furniture, Bedding and Linen 200 1 3 Uniforms and Dresses 110 8 Chandlery and Sundries 564 3 7 General Repairs 368 2 4 Special Repairs and Alterations 586 3 9 Garden Implements, Seeds, etc. 65 5 Maintenance and Upkeep of Ambulances 635 4 0 Printing, Stationery and Advertisements 122 9 Rent of Telephone 53 4 Rates, Taxes and Insurance 374 2 5 £14322 90 10 Cancer. No investigations have been undertaken as requested in the Ministry of Health's series of Circulars on Cancer. 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. Cancer Deaths, 1937: Total deaths 219 Males 120 Females 99 78 Classification: Carcinoma 198 Epithelioma 8 Sarcoma 9 Rodent Ulcer 1 Malignant Cyst 1 Malignant Papilloma 1 Meningioma 1 Total 219 79 Table 23. 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 — 4 — 4 — 5 1 2 — 16 1 Digestive Organs & Peritoneum — — — — — — — — — — 1 — 1 1 6 4 15 16 23 12 17 10 63 43 Respiratory Organs — — — — — — — — — — — — 1 — 5 — 7 2 2 1 1 — 16 3 Uterus — — — — — — — — — — — — — — — 6 — 3 — 3 — 3 — 15 Other Female Genital Organs — — — — — — — — — — — — — — 1 — 1 — 1 — — — 3 Breast — — — — — — — — — — — 1 — 4 — 3 — 3 — 5 — 4 — 20 Male Genitourinary Organs — — — — — — — — — — — — 2 — — — 4 — 10 — — — 16 — Skin — — — — — — — — — — — — — — — — — — — — 1 — 1 — Other or Unspecified Organs 1 — — — — — — — 1 — — 1 — — — — — 3 6 8 — 2 8 14 Totals 1 — — — — — — — 1 — 1 2 5 5 15 14 30 28 46 31 21 19 120 99 80 Tuberculosis. Chest Clinic It can be truly said that an experience of two years in the new Clinic goes to show that the clinical, radiological, pathological and nursing facilities available to patients and general practitioners can compare favourably with that of any other service available in the Country. The Clinic has, moreover, since its inception attracted a number of authorities from other areas who have asked to be shown over the Clinic and to see the facilities provided for the patients. Notifications: The number of primary notifications during the year 1937 was 264 as compared with 257 for 1936. Of the primary notifications of pulmonary tuberculosis, in 28.03 per cent. tubercle bacilli were found in the sputum. In other words, 28.03 per cent. of cases were definitely infectious, and the smaller this number becomes the better the ultimate outlook for the individual sufferers. Statistical: The total number of notified cases on the register of the Clinic on 31st December, 1937, was 969 (pulmonary and non-pulmonary), or 7.39 per 1,000 estimated population, as opposed to 953 or 7.03 per 1,000 population in the previous year. Of these 348 (or 35.9 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 (1932-1937) from tuberculosis is shown below. Pulmonary Non-Pulmonary Of Cases on the Clinic Register 1932 108 16 91 1933 99 16 75 1934 92 15 80 1935 80 16 76 1936 97 10 77 1937 80 13 84 81 New Cases: The following are the comparative figures for the years 19321937:— 1932 1933 1934 1935 1936 1937 New Cases (and Contacts) 511 504 510 548 618 697 Number proved, after complete investigation, to be tuberculous 32.1% 33.9% 36.4% 35.0% 29.4% 28.4% 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 33.2% of new patients proving, after close investigation, to be tuberculous. Attendances and Medical Examinations. Total Attendances. Medical Examinations. 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 1937 3,793 3,437 Consultations at Homes of Patients: During the year 82 visits (including 21 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. No. of X-ray Examinations at the Chest Clinic. 1932 1933 1934 1935 1936 1937 454 533 633 762 1322 1652 82 The progressive increase in these figures is, to a large extent, associated with improved facilities and to the advances of diagnosis and treatment of this disease. Dr. Philip Ellman, Consultant to the Chest Clinic, reports on the work of the Clinic as follows:— Co-operation with General Hospitals: This continues as outlined in previous years, and the general medical aspect of our patients is never lost sight of, in case there should be some extra-pulmonary or non-tuberculous lesion which may re-act unfavourably, whether it be from the nutritional or any other point of view. For example, only recently a patient whose pulmonary condition has responded in a remarkable way to treatment, had a serious setback through the development of a duodenal ulcer. Primary concentration on the latter, through close co-operation with a general hospital, soon healed the ulcer, with a favourable effect on the patient's pulmonary condition from the nutritional point of view. Co-operation with Specialised Hospitals: (Thoracic Surgical Units at London Hospitals). With the increasing facilities which have very fortunately been more available for us in the new Thoracic Surgical Unit at the London Hospital, our problem of dealing with the increasing numbers of cases suitable for thoracic surgery is now being solved. This Unit is under the able supervision of Mr. Tudor Edwards, whose courtesy and special attention to our patients is greatly appreciated. Patients also have the advantage in that the Unit is nearer their own homes. Many more of these cases are able to be dealt with because of the close co-operation of the Unit with our Harts Sanatorium, where much of the necessary surgical after-care treatment can be carried out under the most favourable conditions. In consequence the short stay at the London Hospital enables them to deal with a larger number of our cases, to our mutual advantage. 83 We also have available the services of the surgeons at the surgical unit of Brompton Hospital and the Thoracic Surgical Unit at St. Mary Abbott's Hospital, L.C.C., for cases which cannot be dealt with at the London Hospital. Co-ordination of the Work of the Chest Clinic and Sanatorium: My regular visits to the Sanatorium enable me to keep in the closest touch with the valuable work which is being done there. The opportunity of discussing the treatment of all new cases and reviewing the results of treatment of old cases with the Medical Superintendent, is of very real value. It is no exaggeration to say—and this has been amply justified by the visits of other observers to the Sanatorium—that for its size the Sanatorium can, from the point of view of medical treatment and administration, compare favourably with any similar institution in this country. Advanced Cases of Pulmonary Tuberculosis. Several cases of advanced pulmonary tuberculosis, which are obviously unsuitable for institutional treatment at our Harts Sanatorium, and which are grave sources of danger in the home, are being recommended for institutional treatment at Whipps Cross Hospital, or St. Joseph's Hospice, Hackney. Patients who have been so referred have expressed their appreciation of the care and attention which has been given to them. Further Developments in the Diagnosis and Treatment of Pulmonary Tuberculosis. Last year 1 briefly outlined the advances in treatment which we were utilising with discrimination in the interests of our patients. The value of "Absolute Rest," Collapse therapy in all its phases, Drug, Tuberculin and Vitamin therapy, were all reviewed last year. Chronic Focal Pneumonia and Broncho-pneumonia. With developments in our knowledge of the disease, and with radiological advances and the increased knowledge of interpretation of radiological shadows, certain patients have been found to have X-ray evidence of infiltration closely resembling 84 tuberculous lung infiltration. It has been observed, however, that despite the expectoration of thick mucopurulent sputum, tubercle have been persistently absent, and after close investigation, these cases have proved to be due to areas of chronic Focal Pneumonia or Broncho-pneumonia of a non-tuberculous aetiology. This goes to show the necessity for the greatest care and closest possible supervision of some of these difficult atypical cases. They are by no means uncommon, and the utilisation of every new method of investigation that is likely to be of value is necessary before a patient is condemned to the very responsible diagnosis of pulmonary tuberculosis, and all the privation and suffering that it often entails. The diagnosis includes the recognition of the presence, extent, character and activity of the disease. In point of fact, increased experience goes to show that the interpretation of shadows on X-ray films with the Roentgen Tube requires as much care and attention as the older clinicians paid to the Stethoscope. Despite the pitfalls which can be associated with even the most perfect and technically satisfactory radiographs, it can be said with emphasis that the detection of tuberculous lung disease is infinitely more trustworthy now than in pre-radiological days. Newer Methods for Discovering Tubercle Bacilli in Sputum: Culture Method: By the use of Jensen's medium a growth may be obtained in 2—3 weeks, where the ordinary carbol fuchsin method, and even the concentrated antiformin methods are negative. In suspicious cases, where the sputum is persistently negative, this method will sometimes give a positive result. Its proved value is such that it is now being utilised in suspicious cases. Methods of Assessing the Activity of the Disease. The Clinical manifestations of activity, such as those of temperature, pulse, physical signs, nature and quantity of sputum, and X-ray appearances are all utilised. The Blood Sedimentation rate has, however, proved to be a most valuable additional aid, and although adequate facilities are not yet available, it is hoped to ensure increasing use of this 85 method of assessment, more particularly in cases undergoing Sanatorium treatment. The estimation of Vitamin C excretion in the urine is yet another method of assessment of activity. Tomography in Diagnosis. No branch of medicine owes more to the science of radiology than the branch concerned with diseases of the chest. The development and increased utilisation of X-rays in our Chest work has received full attention in recent annual reports. It is not surprising that this increase necessarily involves, sooner or later, added refinements and thus the ingenious method of showing added detail to that available in the ordinary flat anterior, posterior, lateral and oblique films, has been introduced, which enable us to take sectional radiographs of the chest which will no longer impair the clear vision of the lung parenchyma (such as the clavicle, caspulaie, ribs, breast shadow in women, etc.). Tomography, then, enables us to examine sections of the lung in detail and thus determine the precise depth in the lung parenchyma from which an area of disease arises. This having been determined, a close unimpeded study of the area of disease can be made. The tomograph was originally a very expensive and elaborate instrument, but thanks to Twining's researches, a simple comparatively inexpensive appliance has been devised which can be added to an ordinary X-ray apparatus like our own. The detailed physics of tomography need not be referred to here, but the main principle is that the tube and the film holder move in opposite directions during the exposure. It must, however, be admitted that the subject is in its infancy, and most general clinicians recognise that at the present stage it is advisable to await developments in its refinement, which may ensue with increased radiological experience. A discussion of tomography with the Medical Officer of Health and its possible value in our work both at the Clinic and the Sanatorium, have brought us to a similar conclusion. The developments will be awaited with interest. Artificial Pneumothorax. Artificial Pneumothorax is now an accepted method of treating certain selected cases of pulmonary tuberculosis, although in 86 itself it must be recognised that it is not a specific cure for tuberculosis. It is important, however, carefully to recognise its uses and limitations if its value is not to fall into disrepute, and our experience of it during the last ten years or so has enabled us to assess its results. If complete collapse can be obtained the results are obviously better than only a partial collapse. In some cases a collapse of only the healthy lung is obtained, the diseased lung remaining unaffected; in other words, there is a contra-selective artificial pneumothorax which is useless and which we always abandon. Results are also infinitely better if there is no contra lateral disease, and hence the greatest care is needed in the original choice of the case suitable for this type of treatment. It is generally recognised that a suitably chosen case with an effective pneumothorax has unquestionably an improved chance of survival. Wherever incomplete collapse is obtained auxiliary methods by surgical means are always employed whenever possible in the form of (a) Section of adhesions; (b) Phrenic operations; (c) Plastic operations on the chestwall, to endeavour to obtain a selective collapse of the diseased lung. As Bentley has so wisely pointed out in his admirable survey on Artificial Pneumothorax, the great majority of patients as we find them are not suitable for the treatment, and also that pulmonary tuberculosis is sometimes a disease curable by the adoption of simple methods calculated at raising the general resistance of the individual. It is in this critical manner that all our patients are reviewed before undergoing treatment in this disease. The Operation of Extra-pleural Pneumothorax, whereby the lung tissue is carefully stripped from the pleura, seeks to secure a selective collapse. Refills are then given at regulated intervals, the needle being introduced just above the site of the wound, whilst the patient is in the sitting posture. We are now treating such a case with frequent small refills, the terminal pressure being +20 +15, with very good results so far. Blocking of a bronchus by means of a balloon inserted through a bronchoscope as a means of collapsing a large cavity. The production of a selective collapse of the lung—i.e. a collapse limited to the diseased area alone—is one which we strive 87 to obtain but rarely achieve. It has the great advantage that the healthy lung tissue is conserved unimpaired. An attempt has recently been made to find a method which may secure a selective collapse of the diseased lung in the course of an artificial pneumothorax. It has been observed by American workers that when massive collapse of the diseased lobe occurs by accident, as for example sometimes happens when haemoptysis occurs, the tuberculous disease then shows a lesser tendency to activity. Attempts have been made to occlude completely the bronchus of the diseased lobe for several hours, by insertion of a bronchoscope, and a balloon which can be distended left in situ for some hours. Massive selective collapse of the involved lobe can thus be induced. A patient under my care at the present time has a large cavity which has failed to collapse with an artificial pneumothorax, and the surgeon is attempting to obliterate the cavity by completely occluding the bronchus of the corresponding lobe to induce a massive and selective collapse by this method. We are awaiting the results with the greatest interest, for if successful it promises to avoid more drastic surgical operations in the future. Pleural Effusions. So many cases of a clear pleural effusion of the type of an exudate come to our notice which have not been notified, and have subsequently developed tuberculous lung disease, that too much emphasis cannot be made on the importance of recognising the fact that every clear pleural exudate, especially in young subjects, should be treated as pulmonary tuberculosis and undergo a complete sanatorium regime. Were this to be generally recognised the prognosis in these cases would be admirable and lung tuberculosis in such cases a very rare occurrence. Diagnostic Unit. The facilities for diagnosis at the Clinic are sometimes limited because of the necessity for observation, for certain selected cases, in bed. It is here especially that our very close co-operation with the Sanatorium is of the greatest value. Quite a series 88 of cases during the year are kept in observation beds at Harts Sanatorium, and there serial X-ray investigations, prolonged clinical observations, special examinations such as the injection of lipiodol to show up the tracheo-bronchial tree by X-rays, etc., can be done. In this way the diagnosis of several cases of Cancer of the lung and pulmonary suppuration, such as bronchiectasis, etc., have definitely been confirmed. Cancer of the Lung. Examination for Cancer cells in sputum. Reference has been made in previous reports of the increased frequency of cancer of the lung. These cases are often closely simulated by pulmonary tuberculosis, and the differential diagnosis has frequently to be made among clinic patients either at the Clinic or in the Diagnostic Unit of Harts Sanatorium. The help of a bronchogram, the bronchoscope and the new special technique of the demonstration of particles of malignant growth in the sputum by means of the wet film method are all utilised. The latter examination recently introduced by Professor Dudgeon is now available for our patients, and has proved to be of very real practical value. In some cases the presence of the cancer cells in the sputum has obviated the necessity for more complicated diagnostic procedures. Prevention. Better Housing. Tuberculosis, it must be recognised, is to some extent a family disease, and it has always been our aim, in the interests of prevention, to try and get preferential treatment for families with a tuberculous sufferer who are inadequately housed. The problem is indeed a difficult one, and our efforts are by no means always successful, and in some of the worst cases it is indeed difficult, through insufficiency of income, to effect this. The assistance frequently given by the Public Assistance Committee is gratefully recognised. 89 Boarding out of Child Contacts. It not infrequently happens that parents, more particularly the mothers, feel that they cannot undertake a period of residential treatment because there would be no one left at home to care for the children in their absence. In certain circumstances arrangements are made through the Public Assistance Department for such children to be cared for in the Children's Homes at Aldersbrook, after the children have been examined and found to be free from the disease. I should be lacking in my duty were I not to express my deep sense of gratitude to the Nurses and the Clerical Staff for their ever ready help and constant co-operation, which have played no little part in the successful working of the Clinic. 90 TABLE 24. Return showing the work of the Tuberculosis and Chest Clinic, 1937. 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 79 54 4 — 6 10 8 6 85 64 12 6 167 (b) Diagnosis not completed — — — — — — — — 9 9 — 1 19 (c) Non-tuberculous — — — — — — — — 76 84 22 18 200 B.—Contacts examined during the year:— (a) Definitely tuberculous 6 11 3 9 1 — 1 — 7 11 4 9 31 (b) Diagnosis not completed — — — — — — — — 3 5 2 2 12 (c) Non-tuberculous — — — — — — — — 72 96 51 49 268 C.—Cases written off the Clinic Register as — (a) Recovered 2 4 4 2 — — 1 3 2 4 5 5 16 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Clinic Register as tuberculous) — — — — — — — 155 191 76 71 493 D.—Number of Cases on Clinic Register on December 31st, 1937:— (a) Definitely tuberculous 363 336 23 6 69 92 56 24 432 428 79 30 969 (b) Diagnosis not completed — — — — — — — — 12 14 2 3 31 91a TABLE 25. Pulmonary Tuberculosis. Supplementary Annual Return showing in summary form (a) the condition at the end of 1937 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 that time. Condition at the time of the last record made during the year to which the return relates Previous to 1927 1927 1928 1929 1930 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B, plus Group 1 Group 2 Group 3 Total(CIass T.B. Plus Group 1 Group 2 Group 3 Total (CIass T.B. Plus) Group 1 Group 2 Group 3 Tota((Class T.B. Plus) Group 1 Group 2 Group 3 Total(CIass T.B. Plus) Group 1 Group 2 Group 3 Total(CIass T.B. Plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 17 5 6 — 11 — — — — — — — — — — — — 1 — I 2 2 1 — 3 F. 5 1 4 — 5 4 — — — — 1 — — — — 2 — — — — 1 1 — — 1 Children 6 — — — — 2 — — — — 2 — — — — 3 — — — — 1 — — — — Disease not Arrested Adults M. 13 4 13 1 18 1 — 2 — 2 2 3 2 — 5 3 1 2 — 3 7 3 6 — 9 F. 11 6 14 — 20 2 — 1 1 2 3 5 2 — 7 3 3 1 2 6 6 — 9 — 9 Children 3 — — — — 3 — — — — 1 — — — — 2 — — — — 3 — — — — Condition not ascertained during the year — — — — — — — — — — 1 — — — — — — — — — — — — — — Total on Dispensary Register at 31st Dec. 55 16 37 1 54 12 — 3 1 4 10 9 4 — 13 13 4 4 2 10 20 6 16 — 22 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 21 4 — — 4 2 1 1 — 2 2 — — — — 2 — — — — — — — — — F. 20 1 — — 1 1 — — — — 4 — — — — 2 — — — — — — — — — Children 25 — — — — 3 — — — — 1 — — — — — 1 — — 1 1 — — — — Lost sight of or otherwise removed from Dispensary Register 395 49 83 4 136 48 13 21 2 36 65 19 23 3 45 53 10 28 — 38 26 9 12 4 25 Dead Adults M. 48 12 83 41 136 5 3 29 11 43 10 3 25 10 38 4 4 25 16 45 7 5 16 22 43 F. 34 11 53 33 97 1 1 17 8 26 4 5 10 10 25 7 3 10 6 19 3 4 13 11 28 Children 6 — 1 2 3 4 1 — — 1 1 — 1 1 2 — — — — — — — — 2 2 Total written off Dispensary Register 549 77 220 80 377 64 19 68 21 108 87 27 59 24 110 68 18 63 22 103 37 18 41 39 98 Grand Totals 604 93 257 81 431 76 19 71 22 112 97 36 63 24 123 81 22 67 24 113 57 24 57 39 120 1931 1932 1933 1934 1935 | (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 1 — — — — 3 1 1 — 2 4 — — — — 1 — — — — — — — — — F. — — — — — 1 2 — — 2 — — — — — 1 — — — — — — — — — Children 1 — — — — — — — — — 1 — — — — 1 — — — — — — — — — Disease not Arrested Adults M. F. 5 2 4 — 6 6 2 5 — 7 10 1 8 — 9 7 5 11 4 20 20 6 8 2 16 9 3 6 — 9 7 — 5 — 5 15 2 5 — 7 7 3 10 1 14 17 — 12 1 13 Children — — — — — 2 — — — — 8 — — — — 7 1 1 1 3 8 — — — — Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st Dec. 16 5 10 — 15 20 5 11 — 16 38 3 13 — 16 24 9 22 6 37 45 6 20 3 29 (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 21 11 19 4 34 36 5 23 — 28 25 7 26 3 36 21 8 14 1 23 20 5 17 2 24 Dead j Adults M. F. 4 1 15 6 22 4 3 21 6 30 4 1 19 10 30 4 1 16 16 33 4 1 11 18 30 6 6 19 9 34 5 3 13 9 25 6 1 9 5 15 1 1 10 10 21 1 1 7 7 15 Children — — — — — 1 — 2 — 2 — — — — — 3 — — — — 1 — — 1 1 Total written off Dispensary Register 31 18 53 19 90 46 11 59 15 85 35 9 54 18 81 29 10 40 27 77 26 7 35 28 70 Grand Totals 47 23 63 19 105 66 16 70 15 101 75 12 67 18 97 53 19 62 33 114 71 13 55 31 99 1936 1937 (a) Remaining on Dispensary Register on 31st December. Disease Arrested 1 Adults M. — — — — — — — — — — F. — — — — — — — — — Children — — — — — — — — — — Disease not Arrested Adults .. M. 28 1 20 5 26 26 6 32 8 46 F. 26 2 15 5 22 24 5 28 4 37 Children 8 1 — — 1 15 — — — — Condition not ascertained during the year — — — — — — — — — — Total on Dispensary Register at 31st Dec. 62 4 35 10 49 65 11 60 12 83 (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 20 — 14 1 15 6 2 1 — 3 Dead Adults M. 2 — 5 7 12 3 — — 2 2 F. 1 1 2 5 8 — — 1 3 4 Children — — — — — — — — — — Total written off Dispensary Register 23 1 21 13 35 9 2 2 5 9 Grand Totals 85 5 56 23 84 74 13 62 17 92 91b TABLE 26 91b Non-pulmonary Tuberculosis. Supplementary Annual Return showing in summary form (a) the condition at the end of 1937 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 1927 1927 1928 1929 1930 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and J oints Abdominal Other Organs Peripheral Glands Total Bones and J oints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensry Register on 31st December, Disease Arrested Adults M. 3 — 1 — 4 — — — — — — — — — 1 2 — — — 2 — 1 — 1 2 F. 2 — — 1 3 — — — — — — — — 1 1 — 1 — — 1 — — — — — Children — 1 — 9 10 2 — 1 2 5 2 — — 3 5 — 2 — 4 6 1 — 1 3 5 Disease not Arrested Adults M. 2 — 4 — 6 — — — — — 1 —- 1 — 2 1 — — — 1 — — — — — F. 5 — 1 — 6 — — — — — — — — 1 1 — — — 2 2 1 1 2 1 5 Children 6 1 — 10 17 — — — — — 2 — —- 3 5 2 2 — 1 5 — — — 2 2 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st Dec. 18 2 6 20 46 2 — 1 2 5 6 — 1 8 15 5 5 — 7 17 2 2 3 7 14 (b) Not now on Dispensary Register and reasons for removal therefrom Transferred to Pulmonary 2 — 1 1 4 — — — 1 1 — — — 1 1 1 — — — 1 — — — — — Discharged as recovered Adults M. 6 2 2 10 — — — — — — — — — — — — — — — — — — — — F. 4 1 1 2 8 — — — — — — — — — — — — — — — — — — — — Children 9 2 2 21 34 — 1 — 2 3 — — — — 1 — — 2 3 1 — — 1 2 Lost sight of, or otherwise removed from Dispensary Register 72 14 26 114 226 9 1 2 11 23 — 2 5 15 22 8 1 4 21 34 _ 3 3 16 22 Dead Adults M. 2 — 1 — 3 — 1 — — 1 1 — — — 1 — — — 1 — 2 3 F. 4 — — — — — — — — — — — — — — — — — — — — — — — — Children 4 — — — — — — — — — — — — — — — — — 1 1 — — — 1 1 Total written off Dispensary Register 101 17 33 139 250 9 3 2 13 27 2 2 5 15 24 9 1 4 24 38 2 3 5 18 28 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 119 19 39 159 36 11 3 3 15 2 8 2 6 23 39 14 6 4 31 55 4 5 8 25 42 931 932 1933 1934 1935 Adults M. — — — — — — — — — — — — — 1 1 — — — — — — — — — — (a) Remaining on Dispensary Register on 31st December. Disease Arrested F. — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — 1 — — 2 3 2 — — 3 5 1 — — 7 8 — 1 — 6 7 Disease not Arrested Adults M. — — — — — — — 1 — 1 1 1 1 — 3 2 — — — 2 2 — 2 2 6 F. — 3 2 — 5 2 — — 1 3 2 — — 1 3 3 — — 2 5 2 — 1 1 4 Children — — — — — 6 4 — 5 15 3 1 — 2 6 — 1 1 — 2 2 1 — 6 9 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st Dec. — 3 3 — 6 9 4 1 8 22 8 2 1 7 18 6 1 1 10 18 6 2 3 15 26 (b) Not now on Dispensary Register and reasons for removal therefrom. Transferred to Pulmonary — — — — — — — — — — — — — — — — — — — — — — — — — Discharged as Recovered Adults M — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — — Lost sight of. or otherwise removed from the Dispensary Register 7 — 3 12 22 6 2 2 5 15 4 5 3 6 18 4 1 2 5 12 — 1 2 1 4 Dead Adults M. — — — — — 2 — — — 2 — — — — — 1 — — — 1 — — — — — F. — —- — — — 1 — 1 — 2 — — 1 1 2 — — — — — — — — — — Children 1 — — — 1 — — — — — — — — — — — — — — — — — — — — Total written off Dispensary Register 8 — 3 13 2 4 9 2 3 5 19 4 5 4 7 20 5 1 2 5 13 — 1 ; 2 1 4 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 8 3 6 13 | 30 18 6 4 13 41 12 7 5 14 38 11 2 3 15 31 6 3 5 16 30 (a) Remaining on Dispensary j Register on 31st December. | 1936 1937 Disease Arrested Adults M. — — — 1 1 — — — — — F. 1 1 1 — 3 — — — — Children — — — 6 6 — — 2 2 Disease not Arrested Adutls M. 1 — 2 1 4 1 — 3 2 6 F. 2 — — 3 5 2 2 2 4 10 Children 1 1 — 2 4 3 2 — 8 13 Condition not ascertained during the year — — — — — — — — — — Total on Dispensary Register at 31st Dec. 5 2 3 13 23 6 4 5 16 31 Transferred to Pulmonary — — — — — — — — — — (b) Not now on Dispensary Register and reasons for removal therefrom Discharged as Recovered Adults M. — — — — — — — — — — F. — — — — — — — — — — Children — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 1 — 1 1 3 — — — 1 1 Dead Adults M. — — — — — — — — — — F. — — — — — — — — — — Children 1 — — 1 2 — — — — — Total written off Dispensary Register 2 — — 2 5 — — — 1 1 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 7 2 4 15 28 6 4 5 17 32 91 1. Number of cases on Clinic Register on January 1st, 1937 973 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 31 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 116 4. Cases written off during the year as Dead (all causes) 84 5. Number of attendances at the Clinic (including Contacts) 3793 6. Number of Insured Persons under Domiciliary Treatment on the 31st December, 1937 32 7. Number of consultations with medical practitioners:— (a) Personal 21 (b) Other 432 8. Number of visits by Tuberculosis Officers to Homes ing personal consultations) 82 9. Number of visits by Nurses or Health Visitors to Homes for Clinic purposes 5248 10. Number of (a) Specimens of sputum, &c., examined 824 (b) X-ray examinations made (inclusive of both film and screen examinations) 1652 in connection with Clinic work. 11. Number of "Recovered" cases restored to Clinic Register, and included in A (a) and A (b) above 1 12. Number of "T.B. plus" cases on Clinic Register on the 31st December, 1937 348 Number of Clinics for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 1 92 After History for five years of 257 New Gases of Tuberculosis reported from all sources in 1932. 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, of the cases to show how they fared during the five years succeeding 1932, that is to 1937, 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, 1932, has been followed up (if living and still tuberculous) until May 1937. The following noteworthy features are presented :— 1. 83.2 per cent. of the gross number of new tuberculous cases coming to our knowledge in the County Borough of East Ham during 1932 were dealt with under the tuberculosis scheme. A further 3.1 per cent. of the gross number related to cases in which the statutory notification was cancelled, after a period of observation. 2. The reasons why ,13.7 per cent. of the gross number did not come directly under the Council scheme were : (a) Cases reported at death only, 5.5 per cent; (b) cases dying within several weeks (average three weeks) of notification, 2.33 per cent. ; (c) cases removing from the County Borough area several days after notification, 0.8 per cent.; and (d) patients declining to have treatment under the official Council scheme, 5.05 per cent. 3. Of the 169 pulmonary cases, 78.7 per cent. received one or more periods of sanatorium or hospital treatment; of 45 nonpulmonary cases, about nine-tenths received special treatment at a hospital (e.g. orthopaedic and artificial light). 4. Of the net number (106 of definite pulmonary cases, removals from area, etc., excluded) 69 died from tuberculosis within the five years (46.4 per cent. dying in the first year, 23.2 per cent. in the second year, 13 per cent. in the third, 4.3 per cent. in the fourth, and 13 per cent. in the fifth). 93a 93 It is estimated that 62 cases of the 257 new cases were cases of adolescent phthisis, i.e. at least one in every five 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 every effort is made to get these contacts to attend the Clinic. 94 Dental Treatment of Uninsured Tuberculous Patients. TABLE 28. Case No. Date. Treatment. Cost. £ s. d. 1 2-3-37 Extractions 4, partial lower denture 1 11 6 2 30-7-37 Extractions 16, complete upper and lower dentures 6 12 6 *3 17-8-37 Extractions 22, complete upper and lower dentures 3 7 6 4 24-9-37 Extractions 10, Re-model upper denture, supply part lower denture 4 18 6 5 16-10 37 Complete upper & lower dentures 5 10 0 6 23-10-37 Remodel complete upper denture 1 16 8 7 1-12 37 Extractions 2 5 0 Total £24 1 8 * Insured person, approved by Committee, Society paid half cost of £6-15-0. Harts Sanatorium. STATISTICS. Discharges, including deaths: 163 (97 M., 65 F., 1 Ch.). Deaths: 14 (10 M., 4 F.). Insured patients: 119 (87 M., 32 F.). Non-insured patients: 44 (10 M., 33 F., 1 Ch.). Average duration of treatment: 24.26 weeks. Number of patient-days: 26,998. Number of beds available at end of year : 80 (78 adult; 2 ch.). Average number of beds occupied: 73.97 (92.46%). Admissions by ambulance: 58 (32 M., 26 F.). From Hospitals 30 (18 M., 12 F.) From Home 28 (14 M., 14 F.) Of the cases discharged or deceased, 22 had already had one course of treatment at Harts (,17 M., 5 F.) ; and 5 (4 M., 1 F.) had had two courses. Immediate Results of Treatment. Discharged Quiescent, including 4 observation cases notified as tuberculous 72 (42 M., 29 F., 1 Ch.) Discharged Non-quiescent 70 (42 M., 28 F.) Of these were Improved 62 (36 M., 26 F.) Not Improved 8 ( 6 M., 2 F.) 95 Observation Cases. Of the 11 observation cases : 4 were found to be suffering from Bronchiectasis, nontuberculous; 1 was a case of Bronchiectasis associated with Pulmonary Tuberculosis; 3 proved to be cases of Pulmonary Tuberculosis; 1 proved non-tuberculous; admitted on account of family history and symptoms; 1 was doubtful; the family history again being significant; 1 was doubtful, query malignant disease; this case on transfer to the London Hospital for further investigation proved to be a cancer of the lung. Greater use has been made of one or two beds for the purpose of keeping a patient under a short period of observation in order to determine whether he or she is suffering from Pulmonary Tuberculosis or some chest complaint whose symptoms may be similar to those of the former disease. The differential diagnosis often lies between Pulmonary Tuberculosis, Bronchiectasis, and Malignant Disease of the lung. In order to aid the diagnosis, an oil which is opaque to X-Rays is put into the trachea and allowed to flow into the bronchi. X-Ray pictures are then taken which show up clearly the bronchial tree. Nine such examinations were done at the Sanatorium during the year, eight being in observation cases, and one in a case of Pulmonary Tuberculosis. Complications. (a) Tuberculous. Larynx, 6; Meninges, 1; Ischio-rectal abscess, 2; Periostitis, 11th right rib, with abscess formation, 1. (b) Non-tuberculous. Bronchitis and Emphysema, 6; Bronchiectasis, 1; Diabetes, 2; Psoriasis, 1; Dermatitis, hands, 1 ; Angina pectoris, 1 ; Asbestosis, 1. 96 Dr. Crawford's observations are contained in the following report:— Rest The use of fairly prolonged complete rest in bed in cases where this is likely to prove of value continues to be the mainstay of treatment. Its assistance in the healing of lesions is shown in the disappearance of sputum, the great improvement in general condition, gain in weight, and the clearing of shadows seen in the X-Ray picture. The bcneficial effects of rest become more and more evident to the patients themselves. Artificial Pneumothorax. Twenty inductions were performed during the year, and were continued. In other three cases attempts were made to obtain collapse of a diseased lung, but were unsuccessful owing to old-standing pleural involvement. In all, 28 cases of unilateral collapse were treated and 326 refills were given. Five cases were discontinued, the collapse in each case being non-selective because of adhesions. Continual use has been made of the X-Ray plant in controlling these cases and in assessing the value of treatment. Where small adhesions prevent complete collapse of the lung, division of these by the cautery is often possible, and inspection of the pleural cavity by the thoracoscope permits the surgeon to decide if this is feasible. Three cases were so dealt with from the Sanatorium, two at the London Hospital, and one at Brompton Hospital. Gold Salts. This useful adjunct to Sanatorium treatment was continued throughout the year. In a number of cases, healing of the lung lesions, with cessation of sputum was noted; in others, diminution in the quantity of sputum was seen with disappearance of tubercle bacilli from it. Eighteen courses of treatment commenced in 1936 were completed. Fifty-six courses were commenced in 1937, of which nineteen were current at the end of the year. 97 Fifty-four courses ended during the year, of which thirty-seven were full courses. Seventeen courses were incomplete for the following reasons: (a) Complications of the treatment : Albuminuria, 2; buccal ulcers, 2; erythematous rashes, 2. (b) Marked deterioration in patients' conditions, 5. (c) Patients who discharged themselves, 5. (d) Transferred, ,1. Of the 37 full courses given to patients discharged during the year, 8 cases were considered quiescent, 28 improved, and 1 not improved. A cautious opinion has been given on the results of treatment, a number of cases having been considered "improved" only, although the sputum may have become negative prior to discharge. Tuberculin Fourteen courses of Tuberculin were given to selected cases during the year; in all 259 injections were given, the dilutions being made up as required. Insulin The use of Insulin continues to be of value where the nutritional state of the patient requires stimulation. While not all patients gain greatly in weight, some may put on a stone in eight to ten weeks; the majority report an increase in appetite, and an improvement in general well-being. Twenty courses of injections were given, ranging from six to ten weeks. Bacteriology. A monthly sputum examination is done at each routine clinical examination of a patient, besides special sputum examinations, and in all 670 specimens were examined in 1937. Microscopic examination of all pleural fluids withdrawn is also done. Radiography. The Radiographer has continued her weekly visit enabling all necessary films to be taken. Three hundred and eighty-one films were produced during 1937. 98 Handicraft. The work of Occupational Therapy, definitely instituted during the early part of the year, has become a welcome and highly useful part of the organisation. All patients who have reached a certain grade are expected to take part, and do so with much interest. Patients who are still in bed, but permitted to sit up are allowed to occupy part of their day with a light task. There is no doubt that this addition to the aids to treatment of the Sanatorium is very valuable. Consultations The fortnightly visits of the Consultant enable all cases to be discussed and their treatments considered. By means of the complete liaison which exists between the Chest Clinic and the Sanatorium, all matters of interest or importance affecting patients are brought to notice and attended to without delay. The value of Dr. Ellman's advice, which is always available, is gladly acknowledged. The visits of the Greatfield Players during the winter months have been very successful, and much thanks is due to them for their continued kindness in so ably presenting entertainments for the patients' amusement. 99 TABLE 29. HARTS SANATORIUM.—Year ended 31st March, 1938. Expenditure Cost per Patient per week £ s. d. Salaries and Wages 3910 20 6 Superannuation 125 0 8 Provisions 3168 16 7 Disinfectants, Drugs and Appliances 303 1 7 Coal, Coke and Firewood 423 2 2 Electricity, Gas and Water 789 4 2 Furniture, Bedding and Linen 205 1 1 Uniforms and Dresses 60 0 4 Chandlery and Sundries 408 2 1 General Repairs 456 2 5 Special Repairs and Alterations 176 0 11 Garden Implements, Seeds, etc. 75 0 5 Haulage 25 0 2 Printing, Stationery and Advertisements 77 0 5 Rent of Telephones 35 0 2 Rates, Taxes and Insurance 285 1 6 Motor Car Allowance—Resident M.O. 64 0 4 X-Ray Examinations 68 0 4 Occupational Therapy 123 0 9 10775 56 7 TABLE 30. Number of Beds available for the Treatment of Tuberculosis on the 31st December 1937 in Institutions belonging to the Council. Name of Institution For Pulmonary Cases For NonPulmonary Cases Total Adults Children under 15 Adults Children under 15 The Harts Sanatorium, Woodford Green, Essex 78 2 — — 80 100 TABLE 31. Return showing the extent of Residential Treatment and Observation during the Year 1937 in Harts Sanatorium. In Institution on Jan. 1 (1) Admitted during the year. (2) Discharged during the year (3) Died in the Institution. (4) In Institution on Dec. 31. (5) Number of doubtfully tuberculous cases admitted for observation Adults Children M. — 7 6 — 1 F. — 6 5 — 1 ... — 1 — — 1 Total — 14 11 — 3 Number of patients suffering from pulmonary tuberculosis Adults Children M. 41 93 84 10 40 F. 31 58 57 4 28 — 2 1 — 1 Total 72 153 142 14 69 Numberof patients suffering from nonpulmonary tuberculosis Adults Children M. F. — — — — — ... — — — — — Total — — — — — Grand Total 72 167 153 14 72 TABLE 32 RETURN SHOWING THE RESULTS OF DOUBTFULLY TUBERCULOUS CASES DISCHARGED DURING THE YEAR 1937 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 — — — 3 1 — — — — — — — 3 1 — Non-tuberculous 1 3 — 1 — — — — — — — — 2 3 — Doubtful — — — +1 *1 — — — — — — — 1 1 — Totals 1 3 — 5 2 — — — — — — — 6 5 — † Discharged from Clinic in 1938 as Non-T.B. * Still under observation at Chest Clinic. 101 TABLE 33. Return showing the immediate Results of Treatment of definitely Tuberculous patients discharged during the Year 1937 from Harts Sanatorium. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Under 3 months, but exceeding 28 days. 3-6 months. 6-12 months. More than 12 months. Totals. Grand Totals. M. F. Ch. M. P. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Pulmonary Tuberculosis. Class T.B. minus. Quiescent 10 6 — 16 7 1 5 2 — — — — 31 15 1 47 Not quiescent 1 1 — 3 1 — — 2 — — 1 — 4 5 — 9 Died in Institution 1 — — — — — — — — — — — 1 — — 1 Class T.B. plus Group 1. Quiescent — — — 1 — — 1 — — — — — 2 — — 2 Not quiescent 1 — — 1 1 — 1 1 — — — — 3 2 — 5 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus Group 2. Quiescent 1 1 — 3 5 — 3 6 — 1 — — 8 12 — 20 Not quiescent 5 1 — 2 3 — 13 6 — 2 1 — 22 11 — 33 Died in Institution — 1 — 1 — — — — — 2 — — 3 1 — 4 Class T.B. plus Group 3. Quiescent — — — 1 — — — 2 — — — — 1 2 — 3 Not quiescent 3 1 — 5 6 — 3 2 — 1 — — 12 9 — 2l Died in Institution — 2 — 3 — — 1 — — — — — 4 2 — 6 Totals (pulmonary) 22 13 — 36 23 1 27 21 — 6 2 — 91 59 1 151 102 TABLE 34. Return showing the extent of Residential Treatment and Observation during the Year 1937 in Institutions (other than Poor Law Institutions) approved for the Treatment of Tuberculosis (including Harts Sanatorium). In Institutions on Jan. 1 (1) Admitted during the year. (2) Discharged during the year. (3) Died in the Institutions. (4) In Institutions on Dec. 31. (5) Number of doubtfully tuberculous cases admitted for observation Adults M. — 8 7 — 1 F. — 6 5 — 1 Children — 1 — — 1 Total — 15 12 — 3 Numberof patients suffering from pulmonary tuberculosis Adults M. 43 102 91 10 44 F. 43 69 69 8 35 Children 9 8 9 — 8 Total 95 179 169 18 87 Numberof patients suffering fron non pulmonary tuberculosis Adults M. 3 7 5 — 5 F. 5 9 7 — 7 Children 14 18 15 1 16 Total 22 34 27 1 28 Grand Total 117 228 208 19 118 TABLE 35. Return showing the extent of Residential Treatment provided during the Year 1937 in Poor Law Institutions for Persons Chargeable to the Council. In Institutions on Jan.1 (1) Admitted during the year. (2) Discharged during the year. (3) Died in the institutions. (4) In Institutions on Dec. 31. (5) Number of patients suffering from pulmonary tuberculosis Adults M. 9 18 12 12 3 F. 2 24 15 8 3 Children — — — — — Total 11 42 27 20 6 Number of patients suffering from nonpulmonary tuberculosis Adults M — 2 2 — — F. — 3 2 1 Children — 2 2 — — Total — 7 6 1 — Grand Total 11 49 33 21 6 103 TABLE 36. Return showing the Results of Observation of Doubtfully Tuberculous Cases Discharged during the year 1937 from Institutions Approved for the Treatment of Tuberculosis (including 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 — — — 3 1 — — — — — — — 3 1 — Non-tuberculous 1 3 — 2 — — — — — — — — 3 3 — Doubtful — — — + 1 *1 — — — — — — — 1 1 — Totals 1 3 — 6 2 — — — — — — — 7 5 — † Discharged from Clinic in 1938 as Non-T.B. * Still under observation. 104 TABLE 37. Return showing the immediate results of Treatment of definitely tuberculous patients discharged during the year 1937 from institutions approved for the treatment of tuberculosis (including harts Sanatorium) Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. 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 11 6 — 16 7 1 5 4 3 — — 4 32 17 8 57 Not quiescent 2 1 — 3 1 — — 2 1 — 1 — 5 5 1 11 Died in Institution 1 — — — — — — — — — I — 1 1 — 2 Class T.B. plus Group 1. Quiescent 1 — — 1 — — 1 — — — — — 2 — — 2 Not quiescent 2 — — 1 1 — 1 2 — — 2 — 4 5 — 9 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus Group 2. Quiescent 1 1 — 3 5 — 4 6 — 1 — — 9 12 — 21 Not quiescent 5 2 — 2 6 — 13 7 — 2 1 — 22 16 — 38 Died in Institution — 2 — 1 — — — — — 2 i — 3 3 — 6 Class T.B. plus Group 3. Quiescent — — — 1 — — — 2 — — — — 1 2 — 3 Not quiescent 3 1 — 5 6 — 3 2 — 1 — — 12 9 — 21 Died in Institution 2 — 3 — — 1 — — — 1 — 4 3 — 7 Totals (pulmonary) 25 15 — 36 26 1 28 25 4 6 7 4 95 73 9 177 105 TABLE 37—continued. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Under 3 months, but exceeding 28 days. 3-6 months. 6-12 months. More than 12 months. Totals. Grand Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Non-Pulmonary Tuberculosis. Bones and Joints. Quiescent — 1 — — — — — — 1 1 2 2 1 3 3 7 Not quiescent — — 1 — — — — 1 — — — — — 1 1 2 Died in Institution — — — — — — — — 1 — — — — — 1 1 Abdominal. Quiescent — — 1 — — — — — — — 1 1 — 1 2 3 Not quiescent — — — — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — — — — Other Organs. Quiescent — 1 — — — — — — — — — — — 1 — 1 Not quiescent 1 — — 1 — — — — — — — — 2 — — 2 Died in Institution — — — — — — — — — — — — — — — Peripheral Glands. Quiescent — — 1 1 1 6 1 — 2 — — — 2 1 9 12 Not quiescent — — — — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — — Totals (non-pulmonary) 1 2 3 2 1 6 1 1 4 1 3 3 5 7 16 28 106 TABLE 33. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications During the period 1.1.37 to 31.12.37. Formal Notifications. Number of Primary Notifications of new cases of tuberculosis. Age periods. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 & over Total (all ages) Total notifications. Pulmonary Males — 2 4 3 8 10 19 16 15 10 3 90 97 Females — 3 5 2 18 15 24 10 7 — 1 85 91 Non-pulm. Males — 3 6 3 4 — 3 — — — — 19 19 Females — 5 3 2 1 3 2 1 2 1 — 20 20 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 6 3 1 1 1 16 ,, Females — — 1 2 2 3 4 — 3 — — 15 Non-pulmonary Males — 1 2 2 2 — 2 — — — 1 10 „ Females — — 2 — — 2 2 — 3 — — 9 107 TABLE 38—continued. The source or sources from which information as to the above-mentioned cases was obtained:— Source of Information. No. of Cases. Pulmonary. Non-pulmonary. Death returns from local Registrars 2 — transferable deaths from Registrar General 1 6 Posthumous notifications 2 3 "Transfers" from other areas (other than transferable deaths) 23 10 Other sources if any (specify) (Merchant Seamen) 3 — Notification Register. Number of cases of Tuberculosis remaining at the 31st December 1937, on the Registers of Notifications kept by the Medical Officer of Health of the County Borough Pulmonary Non-pulmonary Total Males Females Total Males Females Total Cases 502 433 935 153 145 298 1,233 Number of cases removed from Registers during the year by reason of:— 1. Withdrawal of notification — 1 I 3 1 4 5 2. Recovery from the disease 6 6 12 1 3 4 16 3. Death (all causes) 54 31 85 9 4 13 98 4. Otherwise 32 20 52 9 10 19 71 108 TABLE 39. Notified Cases of Tuberculosis, 1937. 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 — I 1 — — — — — — — — — — — — — — — — — — — 1 1 2-3 — — — 1 — 1 — — — 1 — 1 — — — — — — — — — 2 — 2 3-4 1 1 — — — — — — 1 — 1 — 5 5 — — — — — — 2 5 7 4-5 1 2 3 — — — 1 — 1 — — — — — — — — — — — — 2 2 4 5-10 5 6 11 2 1 3 2 — 2 1 1 2 3 3 6 — — — — — — 13 11 24 10-15 3 4 7 — — — 1 — 1 — 1 1 3 1 4 1 — 1 — — — 8 6 14 15-20 9 20 29 — 1 1 — — — 1 — 1 4 4 1 — 1 — — — 15 21 36 20-25 12 18 30 — 1 1 — — — — 1 1 — 2 2 — 1 1 — — — 12 23 35 25-35 25 28 53 — 1 1 — — — — 1 1 2 2 4 3 — 3 — — — 30 32 62 35-45 19 10 29 — — — — — — — 1 1 — — — — — — — — — 19 11 30 45-55 16 10 26 — — — — — — — 2 2 — — — 3 3 — — — 16 15 31 55-65 11 — 11 — — — — — — — — — — — — — 1 1 — — — 11 1 12 Over 65 4 1 5 — — — — — — 1 — 1 — — — — — — — — — 5 1 6 Totals 106 100 206 3 4 7 4 — 4 5 7 12 12 13 25 5 5 10 — — — 135 129 264 109 Table 40. Tuberculosis. New Cases and Mortality, 1937. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. M. F. M. F. M. F. M. F. Under 1 year — — — — — — — 1 1 — 5 yrs 2 3 4 5 — — 1 — 5 — 15 „ 8 10 13 7 — — 4 — 15 — 25 ,, 21 38 6 6 3 10 1 1 25 — 45 ,, 44 38 5 5 24 11 1 — 45 — 65 ,, 27 10 — 6 18 6 — 3 65 and upward ,, 4 1 1 — 6 2 1 — Totals 106 100 29 29 51 29 8 5 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths for the year was 1—7. No action has been taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925 (relating to persons suffering from pulmonary tuberculosis employed in the milk trade) or under Section 62 of the Public Health Act, 1925, or Section 172 of the Public Health Act, 1936 (relating to the compulsory removal of persons suffering from tuberculosis). From a study of statistics, there is no evidence to indicate lack of efficiency of notification in cases of tuberculosis. No proceedings were taken in cases of wilful neglect or refusal to notify. 110 East Ham Tuberculosis After-Care Committee. The After-Care Committee suffered a severe loss in the death of its Chairman, Mr. Councillor G. H. Manser, J.P. His invaluable service to the Committee must be placed on record: his time was ever at their disposal, his knowledge of the Borough's activities in all their various phases was of inestimable value, and his genial guidance at meetings entirely obviated any possibility of friction when contentious matters were under discussion. The Committee unanimously resolved that Mrs. Councillor E. M. C. Brace should succeed the late Mr. Manser, and under her chairmanship the excellent work has been continued. Eighty-six patients have been provided with clothing and bedding, and garments have been supplied to necessitous patients during their stay in the Sanatorium. Other patients have been helped by the provision of surgical appliances and repairs to artificial limbs. At Christmas 100 parcels of groceries were given to the most deserving cases. To augment our funds the Miss Maude Wells School of Dancing gave a performance, the Wakefield Dramatic Society gave us a show, and the Walenders Social Club ran a Whist Drive. Also the West Ham Football Club allowed us to make a collection on their ground. To these people the Committee's best thanks are due. The Committee itself ran a very successful dance in the Town Hall. Occupational Therapy: During the year 49 sessions were held at the Tuberculosis and Chest Clinic. The total attendances were 138 Males and 225 Females, equal to an average of 2.8 males and 4.6 females, or 7.2 attendances per session. At Harts Sanatorium, 41 sessions for men and 45 sessions for women were held, with an attendance of 510 and 514 respectively, or an average of 12.4 male and 11.4 female attendances per session. 111a TABLE 41. In the following Table a comparison of the Vital Statistics relating to certain County Boroughs of a Population between 100,000 and 200,000 is shewn: East Ham Birkenhead Blackburn Blackpool Bolton Bournemouth Derby Dundee Gateshead Huddersfield Middlesbrough Norwich Oldham Preston Reading Southampton Southendon-Sea Stockport Sunderland Swansea Walsall Wolver hampton York Population as estimated by Registrar General, Middle 1937 131,100 145,500 114,000 123,800 170,400 121,000 139,700 177,711 117,600 *121,173 139,600 123,000 127,800 113,600 100,200 178,700 137,400 133,700 182,900 161,750 106,800 144,000 100,090 Comparability Factor 1.10 1.09 1.03 0.91 1.09 0.75 1.04 — 113 1.04 1.18 0.92 1.12 1.11 0.89 0.99 0.91 1.05 1.12 1.12 1.12 1.08 1.01 Birth Rate per 1,000 population 14.8 1.71 11.7 10.3 12.7 11.16 14.8 17.6 17.7 12.78 19.5 13.63 13.18 14.00 15.6 15.87 11.3 14.14 19.7 15.14 17.90 16.9 15.0 Crude Death Rate do. do. 10.8 1.30 15.2 16.57 14.2 14.57 12.9 15.0 13.7 14.28 13.8 11.61 15.86 14.23 13.06 12.4 13.3 13.94 14.0 12.75 12.01 11.9 11.95 Death Rate as adjusted by Factor 11.8 1.41 15.6 15.08 15.4 10.92 13.4 15.0 15.4 14.85 16.3 10.68 17.76 15.79 11.62 12.2 12.1 14.64 15.7 14.28 13.45 12.8 12.1 Death Rates per 1,000 population from:— Smallpox — — — — — — — — — — — — — — — — — — — — — — — Measles — — — 0.016 0.02 — 0.02 0.006 0.02 0.02 0.07 — 0.039 0.035 — — — 0.01 0.11 0.06 0.11 0.09 0.01 Scarlet Fever — 0.00 — — — — — 0.03 — — 0.02 — — — — 0.0112 0.014 — 0.03 0.011 0.03 0.02 — Whooping Cough 0.038 0.06 0.03 — 0.08 0.03 0.057 0.29 0.04 — 0.22 0.024 0.023 0.009 0.60 0.0447 0.036 — 0.02 0.006 0.07 0.05 0.10 Diphtheria 0.022 0.17 0.10 0.0565 0.13 0.07 0.043 0.05 0.22 0.03 0.07 0.065 0.133 0.07 0.80 0.056 0.028 0.03 0.11 0.14 0.09 0.12 — Typhoid and Para-Typhoid 0.007 — — — 0.005 — 0.007 — — 0.01 — — — 0.00 — 0.0056 0.022 — 0.01 — — — — Diarrhoea under 2 years 0.106 0.15 0.02 0.032 0.02 0.03 0.057 0.11 0.16 0.02 0.21 0.073 0.015 0.09 0.11 0.0839 0.065 0.06 0.49 0.05 0.13 0.21 0.06 Influenza 0.27 0.37 0.37 0.565 0.61 0.46 0.58 0.64 0.42 0.49 0.44 0.23 0.516 0.61 0.41 0.3693 0.487 0.35 0.58 0.32 0.49 0.26 0.49 Tuberculosis—Pulmonary 0.61 0.76 0.62 0.541 0.53 0.62 0.55 0.57 1.00 0.50 0.9'7 0.5 0.64 0.68 0.54 0.7331 0.553 0.74 0.80 0.77 0.78 0.69 0.44 do. Other Forms 0.09 0.1l 0.10 0.065 0.10 0.11 0.078 0.25 0.11 0.09 0.21 0.09 0.13 0.17 0.74 0.1007 0.051 0.16 0.23 0.17 0.14 0.15 0.11 Infantile Mortality Rate 48 77 69 57.7 61 45.89 63.9 87 77 61 91 52.47 69 77 81 48.6 46 56.61 85 56 57 68 48.4 Maternal Mortality per 1,000 Total Births. From Sepsis — 0.40 — 0.78 0.87 0.71 1.39 1.92 0.91 0.65 1.77 1.155 1.12 1.20 — 0.70 0.623 3.03 1.06 2.4 2.02 — 0.65 ,, Other Causes 0.49 0.80 6.34 2.34 5.23 2.14 3.27 3.20 2.75 0.65 2.82 1.732 2.24 1.20 1.8 1.05 * 3.738 5.56 2.39 1.6 2.02 1.57 1.96 Total 0.49 1.20 6.34 3.12 6.10 2.85 4.66 5.12 3.66 1.30 4.59 2.887 3.36 2.40 1.8 1.75 4.361 8.59 3.45 4.0 4.04 1.57 2.61 * Modified estimate for 1937 statistics. Mid-year estimate as now constituted 123,030. 111 The male sessions at Harts Sanatorium commenced on 4th March, 1937. Additional crafts have been introduced, and the general standard of the patients' work has greatly improved, the various articles made being much more saleable. There can be no doubt that the patients will be encouraged by the arrangements recently made whereby they will reap some pecuniary return for their work. In some cases progress is slow, as some patients are of very limited intellect, and it is only by trial and error that work within their capacity can be ascertained. Generally speaking, they are keen to learn, and appear to brighten up after regular attendance. Some patients have actually stated that they felt better for their work, and that they look forward to their afternoon at the Clinic, while patients at the Sanatorium have expressed their hope that they will be able to continue their work at the Clinic when they have recovered sufficiently to leave. Articles made at the Clinic Centre are saleable to the General Public, and can be shown any Wednesday to interested persons. Swimming Baths and Pools. A large and small swimming bath, slipper, vapour and foam baths, are available to the public at a very moderate charge. The Council is anxious to draw attention to these facilities with the object of encouraging interest in physical education and fitness, and increasing the use of the swimming baths for sport and recreation. 112 Sanitary Section and Housing. Mr. J. E. Austin, Senior Sanitary Inspector, has compiled the section of the Report relating to Sanitary Circumstances and Housing and the statistics in regard to Food Inspection. Sanitary Circumstances Water Supply. The Metropolitan Water Board provide the public water supply in the Borough. Three samples from domestic supplies were obtained for chemical and bacteriological examination, and found satisfactory. Domestic storage is frequently found unsatisfactory during housing inspection by the Sanitary Inspectors, and at 187 houses a supply tap on the rising main to the storage cistern was provided at the instance of the Department. Drainage and Sewerage. During the year a surface water sewer was constructed to relieve flooding in the Central Park district. Soon after its completion it was revealed that a number of centrally situated premises were draining improperly to this sewer, and were disconnected and made to discharge to the foul sewer. The remedying of drainage defects on 861 houses was carried out at the request of the officers. The works not infrequently involved complete reconstruction of drainage. Considerable nuisance was again occasioned to residents of certain streets in the Borough, in particular in the Little Ilford Ward, by flooding from sewers. Rivers and Streams. The numerous ditches and watercourses continued to be a source of nuisance due to obstruction and, in the summer months, to mosquito infestation. The usual precautionary measures against serious infestation were taken, 113 Closet Accommodation. The water carriage system prevails throughout the Borough. Public Cleansing. The Borough Engineer reports that the arrangements in collection and disposal of household refuse continued as in previous years. Incineration and salvage utilisation is the method of disposal. Approximately 42 per cent. of the houses in the Borough are supplied with refuse receptacles under the hire scheme of the Corporation. Sanitary Inspection Details of the activities of the inspectorate in general sanitary administration are contained in the subjoined statements. (a) Inspections. The number of inspections of all classes (40,430) showed a substantial increase as compared with the number for 1936. (i) Housing:— House-to-house 5300 Under Public Health Act 1716 Other visits 343 Reinspections 25234 (ii) Sanitary Circumstances:— Drainage and San. Acc. 647 Factories and Workshops (exc. Bakehouses) 76 Workplaces and Outworkers 377 Caravans 2449 Re offensive fumes 287 Miscellaneous 786 (iii) Food Supply:— Slaughterhouses 1145 Dairies 313 Food Premises 338 Bakehouses 115 Re sampling 510 (iv) Infectious Disease:— Visits 794 114 (b) Notices. The number of notices served during the year totalled 5,889, of which 335 were statutory notices. Of the total, 4,638 were complied with at the end of the year, and the requisitions of many of the remainder were in process of being complied with. The ward classification of notices served is as follows:— Manor Park 665 Castle 376 Woodgrange 951 Central 395 Little Ilford 1111 Wall End 1077 Kensington 276 Greatfield 411 Plashet 3,16 South 311 (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 1,264 Roofs repaired 1,684 Rain water gutters repaired 1,168 Ventilation improved— Windows (including cords) repaired 1,455 Water supply improved— Service tap provided on main—Ord., 91; H-to-H, 96 187 Sanitary conveniences repaired 1,095 Washing facilities provided or improved (coppers) 336 Drainage improved or reconstructed 861 Paving of yards repaired 870 Disrepair remedied— Stoves and firegrates repaired or renewed 778 Plasterwork repaired or renewed 1,336 Floors repaired or renewed 457 Cleansing executed 2,420 Miscellaneous defects remedied 6,438 (d) Complaints. During the year 1937 complaints totalling 2,106 were received and where justified appropriate action taken. Many of the complainants requested the services of the drain cleaner or rat catcher. 115 (e) Factories and Workshops. Inspections of factories, workshops, and outworkers' premises numbered 568. Seventy-eight defects found, necessitated the service of 12 notices, and during the year 53 defects were remedied. (f) Cinemas. The sanitary conditions at the cinemas, theatre and public houses were inspected during the year and a number of improvements effected. (g) Rat Extermination. The services of the official ratcatcher were supplemented during the year by further assistance being employed on Corporation lands which have been subject to serious infestation of recent years. During the year 2,514 visits were made to properties in the Borough and 4,599 rats were destroyed. (h) Atmospheric Pollution. Investigations of complaints of offensive fumes arising from industrial plants continue to engage our attention, and during the year 287 visits were made. At one manufactory a plant for rendering innocuous certain fumes arising from the processes carried on was installed. (i) Mosquito Control. Spraying of mosquito infested ditches and watercourses with larvicide was again undertaken during the year and proved a satisfactory antidote against serious nuisance. (j) Special Classes of Premises and Occupations subject to control of the Local Authority. The conduct of certain offensive trades leaves much to be desired. The disposition of the gutscraping business and small fat melting business may become such that complaints of nuisance will become inevitable on account of the effluvia arising from these manufactories. The rag sorting businesses have demanded constant vigilance by the inspectorate. (k) Caravan Encampment. In the report of the Sanitary Inspector for 1898 the following appears:— 116 "Gipsies and Tent Dwellers. "During the year great difficulty has been experienced in keeping the land clear of Squatters and Tent-dwellers. Our District being in such close proximity to London, suits their convenience and pleasure, and in consequence we are frequently called upon to use compulsory measures to remove them, a work both dangerous and unpleasant. It often happens that we remove them by force from the Northern portion of the District, only to find that they wander a short distance away, and return at night to the South of the District, and vice versa." For forty years this same problem has been with East Ham, but of latter years it has assumed greater proportions. Just after the appointment of the writer in 1935, a survey of the encampment revealed nearly 200 caravans and a population of 550 persons. The circumstances of the immediate locality in which the caravans were situate were grossly insanitary. A plan of clearance of the area was evolved, and clearance began substantially to materialise during the year 1937. In 1936 one yard of 10 vans and an area including 5 vans were declared clearance areas under the Housing Acts, and the orders subsequently confirmed. Early in 1937 in consequnce of proceedings for contravention of the Bye Laws relating to Tents, Vans and Sheds, prohibition orders were made by the Magistrate and a further yard of 10 vans cleared. In September, 1937, five further clearance areas were declared, involving 17 enclosures and 55 caravans and huts. Later in the year a number of proceedings were instituted for allowing lands to be used for camping purposes without the appropriate licences being granted by the Corporation, and many van dwellers removed in consequence. At the 31st December, 1937, 91 vans and huts remained, or the encampment had been reduced by one-half since 1935. Proceedings in respect of many of those remaining had been adjourned to early in 1938, when further removals took place, and at the time of the preparation of this report only 20 remained. This ghastly encampment has been suffered all too long, and its passing will enable the proper development of this district of the Borough. 117 The task of clearance has necessitated the keeping of a mass of detailed records of the 188 vans, each of which was photographed for identification purposes, and no less than 23,812 daily and weekly entries had to be made in such records. During the year 2,449 visits were made to enclosures and individual vans. It is imperative that development should be expedited, for already no little difficulty is being experienced in maintaining the district free from the nomads who, as stated in 1898, find our district "suits their convenience and pleasure." However, the constant vigilance of the Inspectors does not allow of the old haunts of these nomads becoming too comfortable. (1) Rag Flock Acts. There are no manufacturers of flock in the Borough, but systematic sampling from users' premises is carried out. On the latter account presumably certain upholsterers ceased using rag flock, and some difficulty was experienced in maintaining systematic sampling. Nine samples were submitted for analysis and one sample failed to comply with the regulations. In this case (39 parts of chlorine) letters of caution were sent to the vendor and manufacturer. (m) Rent Restriction—Certificates of Disrepair. Only six applications were received for certificates which are notably effective in securing early execution of repairs. The probable explanation for the little usage of this provision is the timorousness of the tenants. (n) Prosecutions. The following statement gives a summary of legal proceedings instituted during the year:— Public Heath Acts, ,1875-1936— (i) Abatement of Nuisances— Cases withdrawn (Nuisance abated) 12 Order made—without penalty 2 with penalty 22 Disobeying orders—Penalty inflicted — Case withdrawn (Order obeyed) 2 (ii) Offensive Trades—Commencing without consent: Penalty inflicted 1 118 (iii) Movable Dwellings—Allowing land to be used for camping purposes without licence: Cases adjourned to 1938 10 Cases withdrawn (Vans removed) 3 (iv) Bye Laws respecting Tents, Vans, and Sheds— Cases withdrawn (Vans removed) 5 Penalty inflicted 2 Case adjourned to 1938 1 Prohibition orders made 8 Disobeying Prohibition Orders: Cases withdrawn (Vans removed) 2 (v) Food and Drugs (Adulteration) Act— Penalty inflicted 3 Shops Act, 1934. The following is an extract from the Annual Report of the Chief Shops Inspector for the year 1937:— Arrangements for health and comfort of workers. The arrangements at 1,104 shops were investigated, and in 138 instances were found unsatisfactory. Verbal intimation notice was given in 70 cases and 68 written intimations were served. Reinspections in connection with these notices of requirements totalled 806. In consequence of the requisitions of your Inspectors, the following improvements were carried out:— (1) Ventilation and Temperature of Shops:— Means of heating provided 4 (2) Sanitary conveniences:— Provided 10 Reconstructed 5 Repaired, etc. 80 (3) Lighting:— Improved 3 (4) Washing Facilities Provided 12 Reconstructed 8 Repaired, etc. 21 (5) Facilities for meals:— Improved 14 119 Smoke Abatement During the year 26 observations of factory chimneys were made, and in 3 cases contraventions of the Council's bye law limiting black smoke emission to two minutes in half-an-hour were observed. Notice of the nuisance was served in each case. Swimming Baths. The Corporation provide public swimming baths, comprising a major and minor swimming bath, and also special baths. Samples of water from each of the baths were submitted for chemical and bacteriological examination. The results of the examinations of water from the major nnd minor baths were satisfactory, but consideration should be given to extending chlorination to the small plunge bath. Eradication of Bed Bugs The number of Council houses disinfested during the year was 39, and the number of other houses disinfested by the Corporation for owners was 37. The method employed by the Corporation consists of fumigation by a 5% by volume concentration of sulphur di-oxide, and supplementary spraying with contact insecticides. Household effects of tenants transferred to Council houses are disinfested by hydrogen cyanide. The van method carried out by Contractors is employed. The tenants are circularised on methods of preventing reinfestation. Housing After prolonged consideration and delay the Council decided to proceed with the erection of 74 houses to rehouse displaced tenants from clearance areas and overcrowded houses, the requirements of both being satisfied by houses of the interlocking or adjustable types. (a) Overcrowding. The constant movement of the population is almost impossible to record, but there is evidence that this movement has resulted in a diminution of known cases of overcrowding. From 120 a re-survey at the close of the year of known cases of overcrowding 162 had been found to have become decrowded, whilst an additional 9 cases of overcrowding were observed. It would appear that one half of the cases of overcrowding revealed on the initial survey have been relieved in the past two years. This rate of progress is not unexpected, but would not continue unless rehousing provision were made for many of the remaining cases. These large families remaining constitute the real problem of overcrowding. Only 32 of the programme of 132 of houses for decrowding have been proceeded with, and at the close of the year none of these was completed. Of these 32 houses in course of construction, 17 have 5 bedrooms, 13 have 4 bedrooms, and 2 have 3 bedrooms. The task of supplying information as to permitted numbers to Owners has been heavy, and has continued to employ fully the special inspector. The appointed day was fixed for East Ham as 1st July, ,1937, and the department has since been inundated with requests for information. It is believed that the prevention of overcrowding by the mere supply of this information has been considerable, though perhaps immeasurable. (b) Slum Clearance. At the close of 1936, Clearance Orders in respect of 48 houses in certain small areas had been confirmed. At the close of 1937 none of these families had been rehoused, the replacement houses only becoming available in March, 1938. A further 55 caravans in 17 enclosures were included in five clearance areas declared by the Council. Two other small clearance areas involving 11 houses were also declared, and an additional area comprising 51 houses at North Woolwich was under consideration at the close of the year. Individual representations were also made to the Council in respect of 3 unfit dwelling-houses. (c) Maintenance of Houses. The standard of housing in this Borough is reasonably good, and one of the most important features of the inspectorial work is the maintenance of property to that standard. As indicated last year, systematising of the inspections, and the adoption of a uniform specification of repairs have been the important factors in the qualitative improvement in housing maintenance in East Ham. 121 During 1937, 5,300 house-to-house inspections were made in accordance with the Housing Regulations, and 2,059 other inspections of houses were made. Of these 7,359 houses, 5,464 were found to be suffering defects or disrepair, and in consequence of the requisitions of the department the improvements as shewn in the statement on page 114 were effected. I he Housing statistics are included in the following statement:— 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) 7,359 (b) Number of inspections made for the purpose 32,593 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 5,300 (b) Number of inspections made for the purpose 20,022 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 69 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 5,464 II .—Remedy of Defects during the Year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 4,758 III.—Action under Statutory Powers during the Year:— (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 3 (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 335 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 276 (b) By Local Authority in default of owners 1 (c) Proceedings under section 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which lition Orders were made — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders — 122 (d) Proceedings under section 12 of the Housing Act, 1936 : (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, 1936, Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 429 (ii) Number of families dwelling therein 438 (iii) Number of persons dwelling therein 3,122 (b) Number of new cases of overcrowding reported during the year 9 (c) (i) Number of cases of overcrowding relieved during the year 162 (ii) Number of persons concerned in such cases 1,038 (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 1937:— By Private Enterprise 74 By the Local Authority — 123 Inspection and Supervision of Food. (a) Milk Supply. (l) Dairies. Further substantial improvements were effected at two dairies, and the practices of cleansing and scalding by steam all milk receptacles, i.e., by steam sterilising and of preventing the milk from being contaminated, i.e., by mechanical filling and sealing of bottles, were maintained throughout the dairies. Business at four dairies was discontinued, this tendency to dispose of milk businesses being further marked since the close of 1937. During the year 118 additions were made to the register of retail purveyors, many being made in respect of the sale of milk in unopened receptacles. One applicant for registration as retail purveyor was given notice to show cause why he should not be registered, but at the hearing the application was withdrawn. The popularity of waxed cartons as a vehicle for milk is increasing, and from dairies at which milk is stassanised or heat treated, and filled into one pint and half-pint cartons, 8,000 gallons are being distributed weekly. The pasteurising establishment in the Borough was systematically visited, the process checked, and all records scrutinised. The conduct of this establishment continued satisfactorily, as was evidenced by the results of bacteriological samples and phosphatase tests. (2) Bacteriological Examination of Milk. The reports of bacteriological examination of samples of milk obtained by the Inspectors are contained in the subjoined statement:— Bacteriological Examination of Milk Samples. Total Ungraded Sterilised. Pasteurised. Accredited T.T. Bacteriological Samples— Satisfactory 116 52 1 36 — 4 Unsatisfactory 23 23 — — — — Biological Samples— Satisfactory 42 25 — 15 — 2 Unsatisfactory — — — — — — 124 The obviously outstanding feature of the statement is the high proportion of unsatisfactory ordinary milks. Three contained acid-fast bacilli, 5 excess pus cells and streptococci, 2 excess pus cells, 9 bacillus coli in .001 c.c. and 5 B coli in .01 c.c. Some contained a combination of the above and unsatisfactory bacterial counts. The average bacterial count of the samples of ordinary milk was 29,420 p. c.c. as compared with 6,600 p. c.c., the average of pasteurised milk samples. The highest count of ordinary milk was 285,000 p. c.c., and that for pasteurised 19,400, the lowest for the respective milks being 350 p. c.c. and 300 p. c.c. Appropriate action was taken in all cases of unsatisfactory bacteriological reports, communications being directed to other authorities concerned. (3) Graded Milk. The licences in force on 31st December, 1937, were as follows:— Tuberculin Tested Milk— Bottling Establishment Licence 1 Dealers' Licences 10 Supplementary Licences 2 Pasteurised Milk— Establishment Licence 1 Dealers' Licences 22 Supplementary Licences 3 Tuberculin Tested (Pasteurised)— Supplementary Licence 1 The Council decided in December, 1936, to charge no fees in respect of licences granted under the Milk (Special Designations) Order, 1936. (b) Meat and Other Foods (1) Meat Inspection. The Sanitary Inspectors made 1,145 visits to the slaughterhouses for the purpose of carrying out post mortem inspection of animals slaughtered. mortem inspection of animals slaughtered. The following is a statement of the work done in this connection:— 125  Cattle except Cows Cows Calves Sheep & Lambs Pigs Number killed 289 1567 495 2878 21488 Number inspected 289 1567 495 2878 21488 Whole carcases condemned for diseases except T.B. — 3 — 4 2 Whole carcases condemned for T.B — 17 — — 1 The following organs were also condemned:— For diseases except T.B. 22 583 3 39 1440 For T.B. 66 1241 — — 331 Periodically visits are made to butchers' shops, market stalls and meat vehicles. (2) Food Premises. The number of inspections made of food premises during the year include 313 of dairies, 115 of bakehouses, and 338 of other premises. With the completion of certain special tasks which the inspectorate have had of recent years it is hoped to expend more time in the supervision of food premises, many of which remain unsatisfactory. Substantial improvements have been effected in certain types of premises, notably those of fish fryers and of ice cream manufacturers, but many other classes of food premises are demanding more frequent inspection. A number of bakehouses continue to be unsatisfactory, and it would be much more gratifying if some of them were more in accord with the cleanly appearance of their retail shop fronts. It is a matter for regret that this industry demands such close vigilance, and unless greater response is made to persuasive methods others will have to be adopted to attain that standard of cleanliness which is to be expected in every bakehouse. Less frequently filthy stores associated with grocers' shops are found, and the compensation of having foodstuffs prepacked in tins and modern containers is poor consolation. Fortunately occupiers of these latter premises are generally appreciative of having their attention drawn to the conditions. (c). Adulteration. Four hundred and ninety-three samples of foodstuffs were obtained by the Sanitary Inspectors and submitted to the Public 126 Analyst. Details of the various samples and the results are included in the following tabular statements. The adulterations included (i) the substitution of haddock for hake, but a formal sample proved genuine; (ii) pepper, one half of which was rice flour—again formal sampling proved negative; (iii) sweet spirits of nitre deficient in ethyl nitrite; in one case a prosecution was instituted, the case dismssed under the Probation of Offenders' Act, and the vendor ordered to pay £2 2s. costs; (iv) a bottle of wine was found to contain a quantity of linseed oil; apparently the bottle had been improperly cleansed and used. At the close of the year and commencement of 1938 investigations were proceeding in respect of certain milk being retailed in the Borough and having just satisfactory fat and non-fatty solids, but on the application of freezing points and nitrate tests revealed substantial added water. Prosecutions in respect of such samples, including one in 1937, were successfully concluded in 1938. Number of Samples. Percentage samples adulterated. Examined. Found adulterated or below standard. Bread 1 — — Butter 20 — — Cheese 1 — — Cocoa 4 — — Coffee 3 — — Confectionery 11 — — Jam and Marmalade 10 — — Cream 3 — — Flour 3 1 33 Lard 9 1 11 Margarine 7 — — Milk 175 4 2 „ Condensed and Dried — — — Sausage 29 3 10 Sugar 2 1 50 Tea 2 — — Vinegar 6 — — Wines, Spirits 3 1 33 Drugs 42 5 12 Other Articles 162 10 6 493 26 5 Details of samples adulterated or below standard are described as follows, together with the resultant action:— 127 DETAILS OF ADULTERATION. No. I. or F. Article. Adulteration or Deficiency. Action Taken. 738 I. Pork Sausages Undeclared preservative—Sulphur dioxide 300 pts. Vendor cautioned. 753 I. Hake Haddock not hake „ „ 759 F. Pork Sausages Undeclared preservative—Sulphur dioxide 450 pts. „ „ 767 I. Dried Mushrooms Contained preservative— „ „ 100 pts. See Formal Sample 780. 780 F. „ „ „ „ 150 pts. Vendor fined. 784 I. Pepper 50% Pepper, 50% Rice Flour Formal sample proved genuine. 831 I. „ 2½% carbonate of magnesia Vendor cautioned. 845 I. Flour Not plain but self-raising flour „ „ 943 F. Milk Deficient in milk fat at least 12% „ „ 948 F. „ „ „ „ „ „ 8% „ „ (Taken in course of delivery) 962 F. „ „ „ „ „ „ 8% „ „ 1015 I. Sweet Spirits of Nitre 95% water Formal sample taken (proved to be genuine). 1027 I. „ „ „ Deficiency of ethyl nitrite to the extent of 85% See sample 1039. 1039 F. „ „ „ „ „ „ „ „ 90% Vendor prosecuted. 1051 I. ,, }J „ „ „ „ „ 50% Vendor cautioned. 1053 I. Minced Beef Contained preservative—Sulphur dioxide 70 pts. Formal sample taken—1056. 1054 F. Sweet Spirits of Nitre Deficiency of ethyl nitrite to the extent of 55% Vendor cautioned. 1056 F. Minced Beef Contained preservative—Sulphur dioxide 35 pts. Vendor prosecuted. 1060 I. „ „ „ „ „ „ 180 pts. Formal samples proved satisfactory. Vendors cautioned. 1062 I. „ „ „ „ „ „ 40 pts. „ „ 1075 I. Fine Old Wine Contained linseed oil „ „ 1171 I. Mixed Candied Peel Contained preservative—Sulphur dioxide 500 pts. Vendor cautioned. 1199 I. Demerara Sugar Was sugar crystals artificially coloured in imitation of Demerara Sugar „ „ „ „ 1206 I. Lard Substitute Contained 2% water „ „ 1210 F. Milk 2½% added water Vendor fined. 1213 I. Chipolata Sausages Undeclared preservative—Sulphur dioxide 240 pts. Vendor cautioned. I. = Informal Sample. F. = Formal Sample. 128 (d). Chemical and Bacteriological Examination of Food. The analysis of foodstuffs is carried out by Dr. Bernard Dyer, Public Analyst, London, and bacteriological examinations by the Counties Public Health Laboratories, London. Bacteriological examinations were made of shrimps, winkles, cockles and watercress. The watercress was reported to shew evidence of pollution by sewage, and the attention of the authority of the district wherein the watercress was grown was drawn to the adverse report. Unemployment and Outdoor Assistance Extent of Unemployment during 1937. The Manager, East Ham Employment Exchange, has kindly supplied the following statistics: 128a Number of Persons Registered as Unemployed during 1937 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 1,778 41 358 27 1,802 38 375 21 1580 28 325 9 1,592 23 280 11 1,463 23 259 8 1,425 28 244 12 (3) Non-Claimants to Benefit (i.e. persons registered for work only) 371 77 68 60 356 48 87 25 366 17 105 17 265 31 82 19 238 20 79 22 226 — 67 6 (4) Persons normally in Casual Employment 630 — 10 — 722 — 12 — 729 — 10 — 548 — 13 — 440 — 13 — 508 1 16 — (5) Temporarily stopped — — 100 12 — 1 53 2 — — 30 5 — — 25 — — 1 42 — — — 51 4 Total—1937 2,779 118 536 99 2,880 87 527 48 2,675 45 470 31 2,405 54 400 30 2,141 44 393 30 2,159 29 378 22 Total—1936 3,820 178 785 135 3,500 92 711 108 3,259 73 627 51 2,956 128 618 80 2,664 72 530 40 2,668 46 498 25 (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 1,382 25 269 11 1,371 25 241 6 1,551 36 254 7 1,671 51 279 6 1,818 49 290 15 1,659 46 263 15 (3) Non-Claimants to Benefit (i.e., persons registered for work only) 213 100 67 70 203 107 60 39 224 40 63 13 226 29 85 13 240 14 86 16 214 23 57 6 (4) Persons normally in Casual Employment 635 — 13 — 498 2 9 — 647 1 12 — 535 2 10 — 702 — 10 — 559 — 15 — (5) Temporarily stopped — 1 80 8 7 — 62 4 — — 54 — — — 64 3 5 1 113 10 63 — 133 13 Total—1937 2,230 126 429 89 2,079 134 372 49 2,422 77 383 20 2,432 82 438 22 2,765 64 499 41 2,495 69 468 34 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 41 129 Outdoor Assistance—Public Assistance Committee. The following statement, kindly provided by Mr. C. M. Ready, the Public Assistance Officer, shows the average number of persons receiving Outdoor Assistance under the Public Assistance Committee during the 12 months ending 31-12-37:— 1937 Men Women Children Total 1937 Total 1936 January 1,169 1,826 1,477 4,472 4,418 February 1,177 1,841 1,523 4,541 4,494 March 1,153 1,818 1,451 4,422 4,334 April 936 1,616 1,101 3,653 4,249 May 920 1,582 1,107 3,609 4,117 June 904 1,556 1,070 3,530 4,066 July 885 1,538 1,048 3,471 3,948 August 913 1,563 1,076 3,552 4,026 September 892 1,549 1,039 3,480 4,004 October 902 1,582 1,060 3,544 4,131 November 942 1,638 1,119 3,699 4,258 December 974 1,659 1,165 3,798 4,212 130 METEOROLOGICAL RECORD—YEAR 1937. 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 RainyDays. Greatest fall in 24 hours. Date of greatest fall. All Highest. All Lowest. January 54° 28° 47°.2 37°. 5 42°. 3 23 3.14 0.14 0.46 1st February 57° 32° 49°. 1 39°. 5 44°. 3 23 3.93 0.17 0.74 7th March 58° 27° 46°. 0 34°. 7 40°. 3 16 2.79 0.17 0.36 6th &10th April 62° 33° 56°.4 43°.1 49°.7 14 2.76 0.20 0.55 2nd May 80° 42° 63°.7 48°.5 56°.1 16 3.97 0.25 1.15 12th June 82° 46° 69°.6 52°.8 61°.1 11 1.95 0.18 0.66 18th July 84° 50° 71°.3 56°.7 64°.0 8 1.91 0.24 1.68 15 th August 88° 50° 75°.5 57°.1 66°.3 7 0.80 0.11 0.28 16th September 79° 42° 68°.0 50°.4 59°.2 14 1.13 0.08 0.32 17th October 69° 38° 60°.0 47°.4 53°.7 12 2.12 0.18 0.47 22nd November 56° 25° 47°.6 37°.4 42°.5 6 1.15 0.19 0.48 21st December 54° 26° 43°.1 35°.0 39°.0 17 3.52 0.21 0.72 13th Means and Totals for the Year 88° 25° 58°.2 45°.1 51°.5 167 29.17 0.17 1.68 15th July The Rainfall for the Year was 7.03 ins. above, and the number of days on which rain fell 4 below the year 1936, at East Ham. 131 Inspection of Factories, Workshops and Workplaces, 1937. 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) 138 9 - Workshops (including Workshop Laundries) 53 2 - Workplaces (other than Outworkers' premises) 9 1 - Total 200 12 — Defects Found in Factories, Workshops and Workplaces. Particulars. Number of defects. Number of offences in respect to which prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :—* Want of cleanliness 44 30 - - Want of ventilation 2 2 - - Overcrowding — — - — Want of drainage of floors — — - — Other nuisances Sanitary accommodation— 21 15 - — Insufficient 3 1 - — Unsuitable or defective 7 4 - — Not separate for sexes 1 1 - — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — - — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories & Workshops Transfer of Powers) Order, 1921) Total 78 53 - - *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 132 Outwork in Unwholesome Premises, Section 108. Nature of Work Instances Notices Served Prosecutions Wearing Apparel—Making, etc. 9 8 — Lifebelts 1 1 — 133 EDUCATION COMMITTEE Annual Report OF THE School Medical Dfficer FOR THE YEAR 1937 135 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, 1937. There were 16,208 children on the Elementary School Roll as compared with 16,660 for the year 1936. The number of routine and special cases of elementary school children examined, totalled 9,064, showing an increase on the previous year of 27. Of this total 3,063 were re-examined at the time of re-inspection in the schools. A routine medical examination of 700 pupils attending the Secondary Schools has also been carried out. The inspection included all scholars at the Grammar School for Boys, but only the Entrants and those up to the age of 14 years at the Grammar School for Girls: the older girls will be examined early in the year 1938. This arrangement was decided upon after careful consideration, and consultation with the Headmistress, in order to facilitate fulfilment of the school curriculum. The marked decrease in the number of defects discovered, in all age-groups, at routine medical inspection, is an outstanding feature of the year's work and the percentage of children found to be in need of treatment is the lowest recorded. This is a criterion of the excellent work performed at the Infant Welfare Centres, of the popularity and efficiency of the School Clinics, and of the increasing vigilance and care exercised by parents, teachers, nurses and attendance officers. A complete survey of the School Medical Department, in the light of the Administrative Programme of 136 tional Development (Circular 1,444) was included in the report for the year 1936. No new developments or departures have occurred during the current year. Considerable 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 complete and efficient manner. I wish to express my appreciation of the keen interest and loyal co-operation of all the members of my staff, and to record with regret the retirement of Dr. Mary Thomson after nineteen years in the service of the Authority. My thanks are also due to Mr. F. R. Thompson, Secretary to the Education Committee, and to 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. 137 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, lighting facilities, cloakrooms, etc., has been adopted by the Authority. During the year the following work has been undertaken (a) An electric lighting system has been installed at the Essex School. (b) The electric lighting installations in the Junior Boys' and Junior Girls' Departments of the Lathom School, the Senior Boys' and Infants' Departments of the Napier School, St. Winifride's R.C. School, and Storey Street Infants' School have been improved. (c) The central heating system at Central Park School has been completed. (d) A hot water supply has been installed in the cloakrooms and teachers' rooms at the Monega School. (e) I he replacement of the obsolete type of drinking fountains by the modern jet type has been completed in the playgrounds at the Provided Schools, and it has been decided to modernise the drinking fountains fixed inside schools in the near future. 138 (f) The question of the replacement of the gas lighting system at the Silvertown R.C. School by a system of electric lighting is under consideration. On the whole the sanitary and hygienic conditions of the Schools are good. 4. Medical Inspection. The following is a synopsis of School Medical Work for the year 1937, as compared with previous statistics. COMPARATIVE STATEMENT OF WORK. 1933. 1934. 1935. 1936 1937 Routine & Special Inspection (on School premises):— Secondary 812 1,017 1,093 1,016 700 Elementary 10,493 9,186 8,914 9,037 9,064 Re-Inspection 2,773 3,203 3,115 3,664 3,063 Consultations at Inspection Clinic 18,294 17,750 17,612 16.708 15,327 Number of Treatments at Clinic 13,636 13,770 22,073 27,976 21,387 General Cleanliness Visits to Schools 341 296 339 281 292 Nurses' Visits to Homes 3,124 3,206 3,563 3,558 3,408 Children Examined for Cleanliness 50,064 47,550 45,356 44,145 41,725 (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 was completed in all the Schools of the Borough, except in the case of the Grammar School for Girls as previously indicated. Re-inspection was carried out in all except five schools (Winsor, Monega, Cornwell, Sandringham and Altmore). These will be visited early in the year 1938. (b) Exceptional Children. Towards the termination of routine medical inspection in each school, teachers are requested to bring before the School Medical 139 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 1937 was 5,810, or 35.8 per cent, of the number on school roll. In addition 3,254 children were referred for some special reason by parents, nurses, teachers or attendance officers. The total number of children medically examined was therefore 9,064, or 55.9 per cent, of those on the school roll. The number of re-inspections carried out was 3,063. 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 1937:— 140 FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. *Percentage of Children found to require Treatment. Inspected. *Found to require Treatment. 1932 1933 1934 1935 1936 1937 1932 1933 1934 1935 1936 1937 1932 1933 1934 1935 1936 1937 Entrants 2,245 2,040 1,747 1,898 1,719 2,162 255 250 447 299 234 257 11.4 11.2 25.5 15.7 13.6 11.8 Second Age Group 2,028 2,006 1,873 1,622 1,786 1,717 240 230 230 200 189 153 11.8 12.4 12.2 12.3 10.5 8.9 Third Age Group 1,985 2,079 1,895 1,713 1,636 1,556 175 180 193 196 208 120 8.8 8.6 10.1 11.4 12.7 7.7 Totals 6,258 6,125 5,515 5,233 5,141 5,435 670 660 870 695 631 530 10.7 10.7 15.7 13.1 12.2 9.7 "Excluding defects of Nutrition, Uncleanliness and Dental Diseases. 141 The increasingly low percentage of children found, at routine medical inspection, to require treatment is worthy of further comment. The steadily expanding interest in health generally, and particularly in regard to the health and physical development of the growing child, which has been fostered by the persistent efforts of the School Medical Department, is tending to ensure the treatment of defects at their inception. Consequently the discovery, at school medical inspection, of gross, old-standing or neglected defects is becoming less and less common. Reference to Table II will provide additional evidence of this fact, since the routine examination of 5,810 children revealed only 858 defects requiring treatment, whereas there were 3,094 conditions referred to the School Clinics by teachers, nurses, parents, and attendance officers. There has been a noteworthy reduction in the number of cases of skin infection, especially impetigo, in the number of cases of external eye disease, and of catarrhal chest conditions. (a) Uncleanliness. The School Nurses have carried out three cleanliness surveys of all children in the elementary schools during the year 1937. During the year the School Nurses made 41,725 examinations, as compared with 44,145 in 1936. Of this number 146 children showed vermin and many nits in the hair (157 in 1936), whilst 1,349 children showed only a few nits (1,354 in 1936). Comparative table :— Year Number Examined Number with Nits N umber with Head Vermin No. of Exclusion Certificates 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 1937 41,725 1,349 146 136 142 It will be noted that the low incidence in the number of children suffering from uncleanliness is maintained, and much credit is due to those, 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. 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. 143 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 Moncga S. Boys 701 - - Altmore S. Mixed 560 6 - Myope 36 1 — Napier Infants 523 38 2 Avenue Infants 519 18 6 J. Boys 1177 13 4 J. Girls 754 37 11 S. Boys 736 12 — J. Boys 845 29 8 Plashet Infants 470 17 — Brampton Infants 1143 7 2 J. Boys 902 14 — J. Girls 1274 35 1 S. Boys 589 1 — S. Girls 735 7 — Salisbury Infants 563 13 — Castle Street R.C. Mixed 563 16 — J. Mixed 1055 24 2 Central Park Infants 661 12 — S. Mixed 655 6 — J. Boys 1274 — 1 Sandringham Infants 559 6 4 S. Boys 714 — — J. Mixed 910 21 7 Cornwell Infants 1071 141 7 Sandringham Central 409 — 2 S. Girls 795 86 4 Shaftesbury Infants 878 20 — S. Boys 681 10 — J. Girls 1037 36 — Dersingham Mixed 783 118 — S. Girls 679 13 — Essex Infants 691 23 5 Shrewsbury Special 154 12 — J. Boys 1010 10 — Silvertown J. Mixed 280 18 — S. Boys 472 2 — S. Mixed 536 23 — Hartley Infants 677 17 — Storey Street J. Mixed 321 20 — J. Girls 885 45 3 S. Mixed 725 40 2 S. Girls 608 23 — St. Michael's R.C. Mixed 451 28 1 Kensington Infants 525 9 4 St. Winifride's R.C. Mixed 762 67 3 J. Girls 1053 53 15 Vicarage Infants 757 47 33 S. Girls 582 13 3 J. Girls 1127 104 6 Lathom Infants 818 3 — S. Girls 622 4 3 J. Girls 853 19 4 Wakefield C. Girls 209 1 — J. Boys 887 1 — Boys 195 — — Monega Infants 790 8 1 Grammar Girls 495 — — J. Boys 989 2 1 Total Per cent. Per cent. 41725 in 1937 in 1936 1349 3.23 3.06 146 0.3 0.3 144 (b) Minor Ailments. Chief Minor Ailments. Discovered at Routine Medical Inspection Discovered by Teachers and Nurses and sent to Clinic 1936 1937 1936 1937 Scabies 3 15 37 Impetigo 3 7 240 188 Conjunctivitis — 3 65 51 Blepharitis 4 6 35 25 Ear Diseases 36 45 195 175 Ringworm (Scalp) — — 1 3 Ringworm (Body) — — 35 21 As has been the case in former years, few minor ailments were discovered at routine medical inspection, owing to the vigilance displayed by teachers and nurses. Such cases, frequently recognised in the early stages, have been immediately referred to the School Clinics. It is satisfactory to note that, on the whole, there is a definite reduction in the number of minor ailments and the somewhat marked increase in the incidence of scabies is regrettable : these cases occurred in a sporadic fashion, and no evidence could be found to suggest dissemination of infection in any particular school. (c) Tonsils and Adenoids. 4.1 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids," either separately or combined, as compared with 5.1 per cent. in the year 1936. Of these,- much enlarged tonsils accounted for 0.9 per cent.; definite adenoids were present in 0.1 per cent.; and the combined defect was diagnosed in 3.0 per cent.; the figures for 1936 were 1.4 per cent.; 0.1 per cent.; and 3.6 per cent. respectively. The percentage of children moderately affected and requiring to be kept under observation was 9.0, the corresponding percentage in 1936 being 7.7. In this case 8.6 per cent. had moderately enlarged tonsils, 0.1 per cent. exhibited signs of the presence of adenoids, while 0.3 per cent. showed enlarged tonsils and adenoids 145 of moderate degree, as compared with 7.4 per cent.; 0.1 per cent.; and 0.2 per cent. respectively in the year 1936. (d) Tuberculosis. The total number of cases of tuberculosis, occurring in children of school age, notified to the Medical Officer of Health during the year, was as follows:— Boys Girls Total Pulmonary Tuberculosis 8 10 18 Other forms of Tuberculosis 13 7 20 21 17 38 (e) Skin Disease and (f) External Eye Disease. At medical inspections during the year, 568 children were found to be suffering from skin affections (as compared with 559 in the year 1936). Eighty-five cases of external eye disease were discovered, as compared with 104 in the year 1936. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 425. In addition, there were 234 children in whom there was evidence of a lesser degree of visual defect and these are being kept under observation. (h) Ear Disease and Hearing. 1.2 per cent. of the children examined were found to be suffering from otitis media. (0.9 per cent. in 1936.) The percentage of deaf children was 0.43, the corresponding number for last year being 0.25. (i) Dental Defects. The percentage of children found, as the result of dental inspection in the schools, to be in need of dental treatment was 62.8 per cent. as compared with 61.7 per cent. for last year. The continued high incidence of dental defect is regrettable, and shows serious laxity in the care of the teeth, despite considerable publicity given to the subject during recent years. The School Medical and Dental Officers, the School Nurses and many of the Head Teachers are constantly stressing the 146 portance of dental hygiene and treatment, yet only 41.9 per cent. (44.8 per cent. in 1936) of the children found to be suffering from dental disease were presented for treatment at the School Dental Clinics, and Medical Inspection reveals that very few parents arrange private dental treatment for their children. It is difficult to understand the attitude of parents in regard to a matter of such great importance when due consideration is given to the harmful effect of unhygienic and septic conditions of the mouth upon general health and nutrition. Apart from the interference with digestion resulting from faulty mastication, it is obvious that the mouth provides access for infection associated with many serious diseases. (i) Crippling Defects. Reference to Table III will furnish information with regard to the occurrence of crippling defects in the area. Thirty-eight cases suffered from a degree of crippling sufficiently severe to interfere materially with the child's normal mode of life. (k) Nutrition. Children found at the routine medical inspection to be suffering from malnutrition, in any degree, numbered 178, or approximately 3.0 per cent. of the children inspected. (See Table II B.) These scholars have been kept under periodical supervision, and treatment has been afforded by the provision of school meals, milk, medicinal foods, advice in regard to diet, or admission to Convalescent Homes or Schools of Recovery. The Public Assistance Committee and the Unemployment Assistance Board have rendered valuable help in providing additional nourishment in many of these cases. 6. INFECTIOUS DISEASES. A detailed account of the scheme adopted for the detection and prevention of infectious diseases has been submitted in previous reports, and the accompanying table furnishes statistics in regard to the incidence of the acute infectious diseases during the year 1937. 147 Scarlet Fever, Diphtheria, and Mumps show some increase in incidence over the year 1936, but there has been a marked reduction in the number of cases of Measles and Chicken Pox. Certificates were issued, under Article 23 (b), where school attendance dropped below 60 per cent. of the number on the register, as follows :— School Month Disease Essex November Measles Salisbury ,, Measles Vicarage December Influenza Brampton ,, Influenza Kensington ,, Measles Cornwell ,, Measles Avenue ,, Measles Diphtheria Detection and Prevention. 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. Three hundred and thirteen swabs were taken for this purpose, one of which proved positive. (b) In suspicious cases seen at the Clinics or Schools, 187 swabs were taken, and six proved to be positive. (c) In cases where an undetected source of infection appears to be present in a class or school. Thirty-nine 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 attendances at the Immunization Clinics are fairly well maintained, and it is hoped that persistent propaganda will lead to a marked increase in the number of applicants for this form of treatment. 148 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 2 7 44 1 8 4 February 3 10 15 12 4 4 March 1 20 34 2 10 3 April — 42 41 16 13 7 May — 10 6 3 8 6 June 3 16 31 26 28 4 July 15 9 4 1 30 8 August September 4 15 6 2 33 11 October 14 47 22 7 48 12 November 124 25 15 16 28 14 December 115 22 13 17 26 11 Totals (671) 281 (382) 223 (234) 231 (32) 103 (180) 236 (56) 84 The totals in brackets are those for the year 1936 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. 149 7. FOLLOWING UP. The School Nurses have paid 3,396 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. Of the 634 children referred for treatment, 355, or 55 per cent.. have obtained treatment. The School Nurses have also paid 234 special visits to the Schools, and have undertaken 20 journeys in connection with the admission and discharge of children to Institutions. All children referred for the operative treatment of tonsils and adenoids (376) 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. In addition the School Nurses attend all medical inspections and staff the various Clinics, e.g. aural, minor ailments, ophthalmic, immunization, and light clinics, and also carry out the cleanliness surveys. Close co-operation was continued with the various voluntary hospitals, visits and reports being carried out and supplied in a large number of cases. 8. MEDICAL TREATMENT. The following Clinics are held weekly for the treatment of defects in school children:— (1) General Clinic (Minor Ailments and Observation Cases), (a) High Street Schools—Mondays, Wednesdays and Saturdays, 9 a.m. Average attendance, 80. (b) Church Road, Manor Park—Tuesdays and Thursdays at 9 a.m. Average attendance, 90. (c) 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. 150 (3) Ear Specialist Clinic. Town Hall—Thursdays and Fridays at 2 p.m. (4) Light Clinics. (a) Town Hall—Mondays (boys) and Wednesdays (girls) at 2 p.m. (b) Manor Park— 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 1937, 21,387 attendances were made for treatment at the various clinics, and there were 15,237 attendances for consultation with the Medical Officers. (a) Minor Ailments. An analysis of the chief minor ailments treated at the School Clinics, and otherwise, will be found in Table IV, Group 1. (b) Tonsils and Adenoids. Of the children referred for treatment 281 received operative treatment during the year 1937. The scheme for treatment remained the same as detailed in previous reports. The drop in the number of operations performed is accounted for by a reduction in the number of cases referred for treatment (vide Section 5 (c) ), and by the delay occasioned as the result of the closure of Balaam Street Children's Hospital for a period of some weeks during the year 1937. 151 (c) Tuberculosis. The arrangements for the treatment of Tuberculosis have been continued on the lines fully set forth in the reports for previous years. (d) Skin Diseases. For the most part these are treated at the General Clinic, but some cases of chronic and of the rarer skin diseases are referred to hospital. Children suffering from ringworm of the scalp, which does not readily respond to local treatment, are referred for X-ray treatment. (e) External Eye Disease. Eighty-five cases (104 in 1936) of external eye disease were treated at the School Clinics. (f) Vision. During the year 1937, the Ophthalmic Clinic was held on five sessions per fortnight. Four hundred and ninety-two accepted treatment in respect of visual defect during the year 1937 (of these 15 children with markedly defective vision had not been seen by the Ophthalmic Surgeon) and, including 17 cases awaiting treatment at the termination of the year 1936, 492 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, 13 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:— 152 OPHTHALMIC CLINIC, 1937. School Clinic— Number of new cases 492 Glasses prescribed 295 Glasses not necessary 197 Glasses obtained 294 Special treatment 69 Re-examinations 2572 Discharged 178 Cases treated at Hospital for strabismus 2 Other cases treated at Hospital 8 Baby Clinic. Number of new cases 48 Glasses prescribed 16 Glasses obtained 16 Special treatment 5 Re-examinations 56 Discharged 7 Cases treated at Hospital 3 Sight-Saving Class. Number of pupils 13 During the past year 492 children have been examined and treated for defective vision. In addition, 2,572 re-examinations were made in connection with children who are kept under periodical examination. This re-examination of cases adds very considerably to the work of the Clinic, but it is of the greatest importance: it brings home to all concerned, to the parents, the teachers and the children themselves that visual defect is only too liable to get worse, and that constant attention must be given both at school and at home if children with defective sight are to have good education and yet not suffer in the process so that, in spite of considerable scholastic success, their wage-earning capacities are seriously reduced by damage to the eyes before they can begin to earn their own living. Supervision consists in reexamining at regular intervals, usually of six months, and noting deterioration or otherwise of vision, prescribing fresh glasses, checking the amount of work done in school if necessary, and lastly, in keeping careful watch upon conditions specially liable to lead to increase in the degree of short sight. 153 It will be noted that 178 cases have been discharged from attendance at the Clinic, their progress having been entirely satisfactory and the need for supervision and re-examination eliminated. Sixty-nine children have attended the Clinic for the treatment of eye conditions, other than visual defect (conjunctivitis, blepharitis, keratitis, foreign bodies, cysts of the eyelids, injuries, etc.), and two cases of squint have been operated upon successfully, under the Authority's arrangement with the Royal Westminster Ophthalmic Hospital. Many of the cases of conjunctivitis and blepharitis are almost entirely preventable by improving the conditions of life, and attending to the health and hygiene of the teeth, tonsils and hair: the present reduction in the number of children suffering from these external eye conditions has resulted from the general improvement in environment, diet, cleanliness and sanitation, but the friendly co-operation of parents is essential if we are to completely eradicate these diseases—which appear so innocent at their commencement—and prevent serious impairment of vision and disfigurement. The Sight-saving Class at Monega School is an extremely satisfactory asset in the treatment of those children who show evidence of progressive myopia or other eye condition in which the strain of ordinary education tends to increase the defect. Many useful educational methods have been introduced and the conduct of the class, from the ophthalmic point of view, is very efficient. It is a pity that the girls in this Class are unable to take their places in the ordinary school for subjects which involve little or no eye strain as, apart from the fact that the outlook of the children is considerably broadened, this procedure would give them the feeling that they are not entirely cut off from the ordinary school life and thus minimise the consciousness of their defect; the opportunity for individual education of the children who remain in the special class would also be enhanced. The School Medical Service and optical and clerical staff have given extremely kind and efficient help. 154 (g) Ear Disease. During the year 1937, 82 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 1,8.14, making an average attendance, at each session, of 22 patients. Ionisation treatment was carried out in 18 cases, 65 applications being made. Mr. Ronald Savege, F.R.C.S., the Aural Surgeon, reports as follows:— Eighty-two clinics were held during the year, with a total attendance of 1,814. Fifty-three per cent. of the cases were, after treatment, discharged cured. I operated on 184 East Ham children for septic tonsils and adenoids. The statistical report is as follows:— Cases of Chronic Otitis Media 138. Discharged 77 Cases of Deafness 37. ,, 12 Other Ear Cases 88. ,, 81 Cases of Chronic Rhinitis 42. ,, 20 Other Nose Cases 35. ,, 20 Cases of Enlarged Tonsils and Adenoids 277. ,, 118 Other Throat Cases 68 ,, 35 Mastoid Operations 1 ,, 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. Mr. C. Stanley Neame, L.D.S., the School Dental Surgeon, reports as follows The age groups inspected at the schools were from 5 to 12 years inclusive. This number totalled 12,262 and the number referred for treatment was 7,834, and the attendances for treat- 155 merit totalled 7,826. The number of children actually treated was 3,285. "Specials" numbered 208; these are cases of urgent treatment (toothache, etc.), referred by the School Medical Officers or Head Teachers. For statistical details see Table V. Each child within the age-groups is dentally inspected once a year. This being a good opportunity to get into personal touch with the children, small talks are given to them, and every endeavour made to win their confidence. Teeth are saved wherever possible by fillings, and the necessary extractions are done either by gas or local anaesthesia. The regulation of permanent teeth is becoming more and more an important part of the school dentist's work, and means a great deal to the child in after life, not only in appearance but by the ability to masticate properly. This work is done by judicious extraction of permanent teeth or by the making of regulation plates. Some very striking results have been obtained in the past year. MATERNITY AND CHILD WELFARE CENTRES. Statistical details of the dental work in connection with the Maternity and Child Welfare Centres are shewn in the following table:— No. of Sessions devoted to Treatment No. of Attendances No. of Permanent Teeth No. of Temporary Teeth Adults Children Extrac ted Filled Extrac ted Filled 83 450 494 582 93 658 120 Total No. of Extractions Total No. of Fillings No. of Adminis trations of General Anaesthetics No. of other Operations Permanent Teeth Temporary Teeth 1240 213 141 107 124 Two sessions per week are devoted to dental cases referred by the Medical Officers of the Maternity and Child Welfare Centres. These cases are children under 5 years of age and pre- 156 natal and nursing mothers. Extraction of teeth is carried out under gas or by local anaesthetic. Filling of temporary and permanent teeth is done wherever possible. Dentures are supplied when necessary. The teeth of the babies on the whole show some improvement over past years. I am glad to be able to record that the mothers are making more use of this important service, which will greatly benefit their health and that of their babies. May I thank my colleague, Mr. A. E. Hall, L.D.S., and the two Dental Nurses for their valued co-operation during the year, and also the Medical Officers, Teachers, and Staff for their help. (i) Crippling Defects. 1. Orthopaedic and Postural 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. Eight out-patients have received treatment during the year. The total out-patient attendances were 205. 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 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 157 Medical Department to refer several cases to this Hospital, under the general terms of agreement between the East Ham Corporation and the Hospital Authorities. 2. Rheumatism and Heart Disease. The institutional treatment of children suffering from Rheumatism and Heart Disease 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. 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. All cases of this type are kept under frequent observation at the School Clinics in order to assess progress and ensure regular hospital attendance. Head Teachers are notified in regard to necessary modification of the normal routine in the case of children, coming within this category, who are permitted to attend school. Arrangements have also been made for the more serious and chronic cases to be admitted to Special Residential Schools at Godalming, Hayling, Lancing and Woodford. It is particularly in connection with children suffering from rheumatic and cardiac defect, who are being allowed to attend Ordinary Elementary Schools, that the need for a Day Special School is emphasized, for, whilst the Teachers have rendered invaluable assistance in carrying out and supervising the special precautions and recommendations issued from time to time by the medical staff, the majority of these children lack the routine and graduated treatment which is available in the Day Special School. On reference to Table III. D. it will be appreciated that 39 children, with definite heart defect, are in attendance at Ordinary Elementary Schools. Although it has long been the practice to give careful attention to scholars who have been discharged from Hospital after scarlet fever and diphtheria, or who have suffered from recurrent sore throat and "growing pains," there is no doubt that even greater vigilance in these cases would prove of value in the 158 vention of rheumatism and cardiac defect. For this reason it is proposed to hold a Special Consultation Clinic once per week, and to institute a scheme for ascertaining and following up all children who come within this category. (j) The Light Clinic. A full account of the arrangements and methods adopted in regard to treatment by artificial light has been included in previous reports. No variation has been made in connection with the methods described, and very satisfactory results continue to he obtained. The following table furnishes a brief summary of the cases treated by general and local irradiation throughout the year. Condition Boys Girls Babies Alopecia 2 4 — Anaemia 7 7 — Asthma 2 1 — Anaemia and Debility 5 5 — Bronchitis 3 8 4 Bronchial Catarrh 20 38 1 Bronchial Catarrh and Anaemia 1 2 - Blinking — 1 — Cough and Debility — 1 — Cervical Adenitis — 3 — Bronchial Catarrh and Subnormal nutrition - 1 - Debility and Eneuresis — 1 — Debility 74 71 160 Chorea 4 1 — Debility and Cervical Adenitis 1 - - Debility and Malnutrition 3 2 .— Debility and Bronchial Catarrh 1 - - Contact T.B 1 1 — Catarrhal Chest — — Catarrh and Nervous Debility. 1 — — Cervical Adenitis and Malnutrition 1 1 - Eczema — 1 — Eneuresis 1 — — Glands 13 12 — Lack of Appetite — 1 — 159 Malnutrition 33 22 1 Rheumatism and Malnutrition 5 5 Loss of Weight — 1 1 Nervous Debility — 1 — Pulmonary Fibrosis — 1 — Rheumatism 5 6 — Rickets 1 — 1 Rachitis 1 — .— Sinus of Face — 1 — Tabes Mesenterica 1 — — 189 199 168 Number of Children Treated (General) 529 Number of Children Treated (Local) 27 Number of Attendances (General) 11061 Number of Attendances (Local) 733 Total Number of Attendances (Local and General) 11794 9. OPEN-AIR EDUCATION. (a) Playground Classes. In a few cases playground classes continue to be held occasionally. (b) School Camps. The Camp School was held from 4th to 18th June at the Hopton Constitutional Holiday Camp. Seventy-four boys and seventy girls from Elementary Schools in the Borough attended. Every step was taken to make the facility known to and available for the children who were in the greatest need. No child was accepted who was likely to have a holiday away from home during the summer, and no child was excluded solely by the parents' inability to contribute the whole or part of the cost of maintenance. Cases referred by the School Medical Department received special consideration. It is interesting to note that the Education Authority have under consideration the purchase of a site for a Permanent Camp 160 School in co-operation with the Public Assistance Committee, the Camp School to be used jointly by the two Committees. It is hoped that this will ensure a much larger number of scholars receiving the opportunity of participating in the health-giving sojourn, of two or three weeks, in a School Camp. School Journeys were undertaken by the undermentioned Schools :— Brampton Senior Girls' School: Hythe—16th to 23rd April—26 girls. Shrewsbury—18th to 25th June—16 girls. Central Park Senior Boys' School: Tunbridge Wells—6th to 17 September—15 boys. Essex Senior Boys' School: St. Mary's Bay—4th to 18th June—50 boys. Plashet Senior Boys' School: Colwell Bay—4th to 18th June—50 boys. Sandringham Central School: Paris—31st August to 6th September—20 girls. The Teaching Staff are unanimous in their opinion in regard to the definite educational value of these School Camps and School Journeys, and the Medical Staff regret that it is not possible for more scholars to be included in this phase of educational activity, having regard to the marked improvement in the physical condition of the comparatively few children who are permitted the opportunity of a complete change of air, environment, routine and dietary. {c) Open-Air Classrooms in Public Elementary Schools. There are four open-air classrooms at the Brampton School and one at Castle Street School. (d) Open-Air Day Schools. There are 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 161 tinued 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 1937:— 162 Particulars of the number of Children who were resident in Schools of Recovery between 1st J anuary and 31st december, 1937, 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 2 2 3 2 — — 1 1 — — 3 2 4 2 1 1 1 — 2 3 2 1 3 19 17 36 I.C.A.A. (hdqts.) 2 1 — 1 — — 1 3 2 - - - - - - - - - - - - - - - 5 5 10 St.Catherines 1 — — 1 — — 4 1 1 - 1 - - 1 4 - - - 1 — 1 - 9 7 16 St. Dominic's 2 — 1 — 3 — — — — - 16 - 1 - — — - - - — - — 4 - 27 — 27 Suntrap — 1 4 1 1 - - - - - - - - - - - - - - - - - - - 7 2 9 No. of Weeks RussellCotes 9 10 12 14 18 24 26 Total B. G. B G. B. G. B. G. B. G. B. G. B G B G — 2 1 1 10 9 8 3 — 2 9 2 — 1 28 20 163 SYNOPSIS OF CASES REFERRED TO EAST HAM I.C.A.A. BY SCHOOL MEDICAL SERVICE DURING 1937. Disease from which the children were suffering: Anaemia and debility 19 Debility following illnesses and operations 11 Bronchitis and bronchial catarrh 3 Asthma 1 Cerebral diaplegia 1 Knock knees 1 Irregular teeth requiring plate 1 Anterior poliomyelitis 1 38 Action taken: Convalescence 31 Surgical Instruments provided 4 Treatment refused by parents 3 38 The provision of satisfactory treatment for delicate, debilitated and physically defective children, who require change of air and environment, and the regulation and routine of a healthy life, has been rendered possible, in a large number of cases, by the keen activity of the Local Branch of the Invalid Children's Aid Association. Ten children have been sent to Schools of Recovery through this Association, by arrangement with the Local Education Authority. In addition, the very courteous co-operation of the Association, with the Authority's Medical Officers, has secured open-air and convalescent treatment for 31 children of school age and for whom the Association has undertaken full financial responsibility. The School of Recovery cases sent by the Education Committee through the I.C.A.A. (Headquarters) cost the Authority £ 18s. 6d. per week per case. The 31 cases referred from the School Medical Department to the Local I.C.A.A. received convalescent treatment totalling 244 weeks, at an average cost of 15s. per week per case, or a cost of £183 for the year. 164 It should be appreciated that in addition to the above, children of all ages are recommended to the I.C.A.A. by private medical practitioners and hospitals for convalescent treatment. It should also be noted that surgical instruments were provided by this Association at no cost to the Council in four cases. (f) Day Special Schools for Physically Defective Children There are no Schools of this type in the Borough, and a Special Report upon this matter was included last year. 10. PHYSICAL TRAINING. The Education Committee have followed closely the policy recommended by the Board of Education in Circular 1445, and considerable progress and development have been made along the lines suggested. Special attention has been given to the appointment of Organisers of Physical Training, the training of Teachers, and the provision of equipment and adequate playing field accommodation. The physical training lessons in the schools today are characterised by a real spirit of enjoyment, with continuous activity and a complete absence of monotony. There is no doubt that the increased interest and enthusiasm produced in the scholars is resulting in a greater degree of general alertness in the school atmosphere, and there is a very evident improvement in the poise, carriage and posture of the children. Organised Cames. In regard to organised games, the Flanders Road Playing Field meets the needs of several schools, and other schools use the municipal parks and recreation grounds. In addition, the Town Council have appropriated 22¼ acres of land on the south side of Barking Road to Education purposes for use as a playing field for Elementary School children. Swimming. A comprehensive programme of swimming instruction enables all scholars attending the Elementary and Secondary Schools to attend the swimming baths throughout the year. 165 Sports and Athletics. Participation in sports and athletics has always been enthusiastically encouraged amongst East Ham School children, and the results attained are sufficient proof of the keenness of the scholars for outdoor exercise of this type. 11. PROVISION OF MEALS. During the year 130,749 meals were provided for children, as compared with 168,802 in 1936. 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 1937 the number of parents who were present at the routine medical inspections was 4,201 (4,237 in 1936), that is, 72.3 per cent. of the cases examined (76.3 per cent. in 1936). 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 16 were medically examined, reports and advice in each case being sent to the Secretary of the Education Committee. 166 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. Eighty-three such cases have been dealt with by the Society's Inspectors as the result of direct reference from the School Medical Service, during the year 1937. The Inspectors have made 406 visits in regard to these cases and the following table indicates the work performed by the Society:— Condition Number of Cases Treatment Obtained 11 tatment arranged Cases under Observation Tonsils and Adenoids 5 4 1 Defective Vision 14 13 1 — Dental Caries 1 1 — - General Neglect 42 37 improved — 5 Ill-Treatment 9 8 improved — 1 Others 12 12 improved — — 83 75 2 6 One parent was prosecuted for not providing treatment for defective vision, but subsequently agreed to treatment. 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. (See Table III). Fifteen children are suffering from physical defects which prevents them attending public elementary schools. Two hundred and eight children considered physically defective and 81 children suffering from non-infectious pulmonary 167 and non-pulmonary tuberculosis are attending ordinary Elementary Schools. Mentally Defective Children. During the year ,1937, the number of cases examined for purposes of the Mental Deficiency Acts was 23 (38 in 1936). Of these, 8 were classified as mentally deficient and 15 as dull and backward, recommendations being made as shown in the following table:— Number examined 23 Classified as mentally deficient 7 8 Classified as morally deficient — Classified as imbeciles 1 Classified as idiots — Classified as dull and backward 15 Recommended for Special School 7 Recommended for Residential Special School 1 18. NURSERY SCHOOLS. There are at present no Nursery Schools in East Ham. 19. SECONDARY SCHOOLS. There are two secondary schools in East Ham, and tables relating to the work carried out in connection with these schools are appended. 20. CONTINUATION SCHOOLS. There are at present no Continuation Schools in East Ham. 21. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Twenty-two boys have been specially examined in accordance with the Bye-laws, and these were found to be fit for employment. In addition, twenty school children were examined, under the 168 Regulations dealing with the Employment of Children at Entertainments, and certified fit for participation in such employment. During school medical inspection no children were discovered whose health was considered to be adversely affected through employment outside school hours. Arising out of the Administrative Memorandum issued by the Board of Education, the Education Committee have approved arrangements for effecting co-operation between the School Medical Department and the Juvenile Employment Committee so far as concerns the question of giving advice in regard to the unsuitability of children for particular types of employment. In this connection the Committee have directed the attention of the Board of Education to the lapse of two years which normally takes place between the date of the last routine medical inspection of scholars and the date of attaining the school leaving age. All children in their final medical examination prior to leaving school have a note placed on their medical record card if there is any special defect likely to affect the choice of employment, and parents are interviewed and advised. 22. SPECIAL ENQUIRIES. No special enquiries were carried out during the year 1937. 23. MISCELLANEOUS. During the year 1937, the following special medical examinations were made in connection with the appointment of staff:— Teachers 6 Assistant Teachers and Student Teachers 18 Caretakers, School Attendants and Cleaners 21 Assistant Cook 1 Library Assistant 1 169 TABLE I. RETURN OF MEDICAL INSPECTIONS. CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups— Entrants 2162 Second Age Group 1717 Third Age Group 1556 Total 5435 Number of other Routine Inspections 375 Grand Total 5810 B.—OTHER INSPECTIONS. Nun ber of Special Inspections 3254 Number of Re-Inspections 3063 Total 6317 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 (excluding squint) For all other conditions recorded in Table IIA Total (1) (2) (3) (4) Entrants 6 251 257 Second Age Group 88 65 153 Third Age Group 77 43 120 Total (Prescribed Groups) 171 359 530 Other Routine Inspections 22 33 55 Grand Total 193 392 585 Note:—No individual child is counted more than once in any column of this table. 170 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1937. 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) Skin (1) Ringworm—Scalp - - 3 - (2) ,, Body — — 21 — (3) Scabies 3 — 37 — (4) Impetigo 7 11 188 — (5) Other Diseases (NonTuberculous) 22 27 287 — Total (Heads 1 to 5) 32 38 536 — Eye (6) Blepharitis 6 6 25 - (7) Conjunctivitis 3 1 51 1 (8) Keratitis — — - — (9) Corneal Opacities — 1 - — (10) Other Conditions (excluding Defective Vision and Squint) 7 8 55 — Total (Heads 6 to 10) 16 16 131 1 Ear (11) Defective Vision (excluding Squint) 193 187 158 18 (12) Squint 26 11 23 1 ( (13) Defective Hearing 11 3 28 1 (14) Otitis Media 13 2 98 — I (15) Other Ear Diseases 32 40 77 — '(16) Chronic Tonsillitis only 68 780 18 2 Nose and Throat (17) Adenoids only 4 17 8 — (18) Chronic Tonsillitis and Adenoids 148 29 127 _ (19) Other Conditions 19 19 79 — 171 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. (i) (2) (3) (4) (5) 20) Enlarged Cervical Glands (NonTuberculous) 13 136 33 - (21) Defective Speech 4 16 3 2 Heart and Circulation Heart Disease; ( (22) Organic 3 4 8 (23) Functional 6 26 6 - ( (24) Anaemia 6 10 40 ~ Lungs ((25) Bronchitis 27 48 80 — (26) Other Non-Tuberculous Diseases — 4 2 — Pulmonary:- (27) Definite (28) Suspected — 1 5 — Tuberulosis Non-Pulmonary :— (29) Glands 2 — 1 — (30) Bones and Joints — — 1 — (31) Skin — - - (32) Other Forms 1 1 2 — Total (Heads 29 to 32) 3 1 4 — Nervous System (33) Epilepsy - - - - (34) Chorea 3 3 12 - (35) Other Conditions 1 14 3 — Deformities ( (36) Rickets 2 _ _ (37) Spinal Curvature 15 - 2 1 ((38) Other Forms 13 49 22 - (39) Other Defects and Diseases (excluding defects of Nutrition, Uncleanliness and Dental Diseases 202 142 1591 75 Total 858 1598 3094 101 172 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 2,162 124 5.73 1,959 90.61 79 3.65 _ - Second Agegroup 1,717 101 5.88 1,558 90.73 58 3.37 Third Agegroup 1,556 132 8.48 1,395 89.65 28 1.79 1 0.06 Other Routine Inspections 375 25 6.66 338 90.13 12 3.2 — — Total 5,810 382 6.57 5,250 90.36 177 3.0 1 0.01 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Blind Children. A blind child is defined by Section 69 of the Education Act, 1921, as one who is "too blind to be able to read the ordinary school books used by children." This definition covers some children who are totally, or almost totally, blind and can only be appropriately taught in a school for blind children, and others who have partial sight and can be annrooriatelv taueht 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. 3 — — — 3 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. 173 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. All 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. — 14 3 1 - 18 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 aoDrooriatelv taueht 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 — - — 14 5 9 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. Day - Day 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 174 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. Shrews. LCC Day — 5 — 67 5 55 2 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.) 175 Table III—continued. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 7 25 — 9 41 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 56 1 4 73 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. 59 152 — — 211 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 176 Table III—continued Section SS of the Education Act, 1921, that they are incapable by reason of such physical defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no Schocfl or Institution. Total. 7 25 5 1 38 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. 15 31 3 1 50 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 — — — 1 177 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. 3 — 3 (ii.) Other — — — Ringworm-Body 20 1 21 Scabies 36 1 37 Impetigo 188 — 188 Other skin disease 258 5 263 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 81 81 Minor Ear Defects 138 8 146 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 1729 139 1868 Total 2453 154 2607 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) 451 — 451 Other defect or disease of the eyes (excluding those recorded in Group 1) — — — Total 451 — 451 No. of Children for whom spectacles were (a) Prescribed 209 — 269 (6) Obtained 268 1 269 178 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, 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) 14 4 217 33 — — 11 1 14 4 228 34 26 306 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS. Under the Authority's Scheme. (1) Otherwise. (2) Residential treatment with education. (i) Residential treatment without education. (ii) Non-residential treatment at an orthopaedic clinic, (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Non-residential treatment at an orthopaedic clinic, (iii) Total number treated Number of children treated — — 4 — — 11 15 179 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 1732 1517 1460 1523 1600 1648 1903 879 - — 12262 (b) Specials 208 (c) Total (Routine and Specials) 12470 (2) Number found to require treatment 7834 (3) Number actually treated 3285 (4) Attendances made bv children for treatment 7826 (5) Half-days devoted to:— (7 Extractions:— Inspection 104 Permanent Teeth 1010 Treatment 673 Temporary Teeth 7032 Total 777 Total 8042 (8) Administrations of general anaesthetics for extractions 736 (6 Fillings :— (9) Other Operations :— Permanent Teeth 1920 Permanent Teeth 846 Temporary Teeth 528 Temporary Teeth 321 Total 2448 Total 1167 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 41725 (iii) Number of individual children found unclean 930 (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 — 180 TABLE I. RETURN OF MEDICAL INSPECTIONS CHILDREN ATTENDING SECONDARY SCHOOLS A.—ROUTINE MEDICAL INSPECTIONS. Boys Girls. Total 437 263 All Secondary School Children are examined every year. B.—OTHER INSPECTIONS. Boys Girls Number of Special Inspections 1 — Number of re-Inspections 6 9 Total 7 9 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). For defective vision (excluding squint) For all other conditions recorded in Table IIA Total Total B G B G B G 13 12 7 17 20 29 181 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1937. 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 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 - - - - - - - - (5) Other Diseases (NonTuberculous) 1 1 — 1 — — — — Total (Heads 1 to 5) 1 1 — 1 — — — — Eye (6) Blepharitis - - - - - - - - (7) Conjunctivitis - - - - - - - - (8) Keratitis - - - - - - - - (9) Corneal Opacities - - - - - - - - (10) Other Conditions (ex eluding Defective Vision and Squint) 1 - - - - - - Total (Heads 6 to 10) 1 — - - - - - - (11) Defective Vision(excluding Squint) 13 12 10 7 - - - - (12) Squint - - - - - - - Ear ( (13) Defective Hearing - - - - - - - (14) Otitis Media - - - - - - - - (15) Other Ear Diseases — 1 — 4 -— — — - Nose and Throat (16) Chronic Tonsillitis only _ 9 3 — - - (17) Adenoids only - - - - - - - - (18) Chronic Tonsillitis and Adenoids 1 2 - - - - - - * (19) Other Conditions - 4 - 1 - - - - 182 TABLE II.—continued. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Defect or Disease. (1) Requiring Treatment. (2) Requiring to be kept under obser vation, but not requiring Treatmn t. (3) Requiring Treatment. (4) Requiring to be kept under obser vation but not requiring Treatment (5) B G B G B G B G (20) Enlarged Cervical Glands (NonTuberculous) — — 2 1 — — — — (21) Defective Speech — — — — — — — — Heart and Circulation Heart Disease : (22) Organic - - - - - - - - (23) Functional — — 1 5 - — — (24) Anaemia - 1 1 3 - — - — Lungs (25) Bronchitis — — 1 1 - — - — (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 — — — - - — - — Deformities (36) Rickets (37) Spinal Curvature — 6 1 (38) Other Forms — — - 27 - — - — (39) Other Defects and Diseases (excluding defects of Nutrition, Uncleanliness and Dental Diseases 6 3 4 5 Total 22 32 29 60 — — — — 183 B. Classification of the Nutrition of Children Inspected during the Year. Number of children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Total Routine Inspections 700 75 10.71 602 85.85 23 3.28 — — TABLE IV. TREATMENT TABLES GROUP I.—MINOR AILMENTS (excluding Uncleanliness, for which see Table VI) Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Shin— B G B G B G 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 — 1 — — — 1 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 4 6 1 — 5 6 Total 4 7 1 — 5 7 184 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) 21 20 _ _ 21 20 Other defect or disease of the eyes (excluding those recorded in Group I) — — — — — — Total 21 20 — — 21 20 No. of Children for whom spectacles were (a) Prescribed 14 12 — — 14 12 (b) Obtained 14 12 14 12 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Defects. Received Operative Treatment. Under the Authority's Scheme, in Clinic or Hospital (1) By Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total. (3) Received other forms of Treatment. (4) Total number treated. (S) (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 1 - 1 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. INDEX 186 Act—Blind Persons, 1920 42-46 Act—Local Government, 1929 24 Act—Midwives, 1936 49-53 Act- Public Health, 1936 Child Life Protection 53 Acts of Parliament Applied and Adopted 22 Act—Housing 119-122 Act—Mental Deficiency 38-41 Act—Midwives, 1902-36 18, 49-53 Act—Rag Flock 117 Act—Rents Restriction 117 Act—Shops, 1934 118 Adenoids 56,144,150 Adulteration of Foodstuffs 125-127 After-Care Committee 110 Aldersbrook Homes 34-37 Ambulance Facilities 20 Attendance Officers, Co-operation of 165 Ante and Post-Natal Clinics 58-60 Area 10 Artificial Sunlight 150, 158 Atmospheric Pollution 115 Aural Surgeon, Report of 154 Aural Treatment 27,56,150,178 B. Bacteriology 19,75 Bacteriological Examinations 75, 123, 128 Baths—School 165 Baths—Swimming Ill, 119 Bed Bugs—Eradication of 119 Birth Rate 15 Births 12,57 Births, Illegitimate 10, 11 Births, Still 11,58 Blind Persons Act, 1920 42-46 Blind Children 166-167,172 Blindness—Prevention of 44-46 Byelaws—Regulations, etc 23-24 Camps—School 159 Cancer 77-79 Caravans 115-117 Centre, Training and Occupation M.D 40-41 Chemical Examination of Food 126 Child Life Protection 53 Children's Homes 34-37 Children—Invalid Aid Association 47-48,62 Cinemas 115 Classrooms, Open Air 160 Cleansing, Public 113 Clinics, Ante and Post-Natal 58-60 Clinics, Artificial Sunlight 150, 158 Clinics, Aural 150 Clinics, Dental 56,145,154-156,179 Clinics, Immunisation 55,150 Clinics, Infant 54 Clinics, Morning 56 Clinics, Ophthalmic 149,152 Clin'cs, School 149-150 Clinics, Toddlers' 55 Clinic, Tuberculosis & Chest 80-91b Clinics and Treatment Centres 20-21,149-150 Closet Accommodation 113 Committees 3-4 Complaints 114 Contents—Principal 2 Continuation Schools 167 Co-ordination 137,139 Cripples 146, 156-158,175 D. Dairies 123 Day-Schools, Open Air 160 Deaf Children 166-167,173 Deaths 12,15-16,1 Death-rate, General 10,12 Death-rate, Infantile 12 Death-rate, Zymotic 63 Deaths, Causes of 15a Deaths, Infants 12,16a Deaths, in Wards and Rates 16 Dental Treatment 56, 145, 154-156,179 Dental Treatment—Tuberculous Patients 94 Dental Surgeons, Report of 154-156 Diarrhoea 11 Diphtheria 63,66,71,75 Disinfestation 119 Drainage and Sewerage 112 Dysentery 66 Ear Diseases 145,154 East Ham and Southend-on- Sea Joint Hospital Board 27 East Ham Memorial Hospital 30-31 Education Committee 4 Employment of Children 167 Enteric Fever 65,67,74 Epileptic Children 166-167,174 Erysipelas 66,67,74 Eye Diseases of Children 145,151 Exceptional School Children 138, 172-176 Extracts from Vital Statistics 10-11 Excessive Mortality, Particulars of 11 Factories and Workshops 115,131-132 Following-up 149 Food and Drugs Adulteration 125-127 INDEX 187 INDEX—continued. F. Food, Chcmical and Bacteriological Examination ... 126 Food Inspection 123-128 Food Premises 125 Free Supplies of Milk 54 Forest Gate Hospital 32, 33, 53, 60 G. General Provision—Health Services 18-26 General and Special Hospitals and Children's Homes 27-37 Graded Milk 124 H. Harts Sanatorium 94-101 Health Committee 3 Health Services—General Provision of 18-26 Health Visitors 57 Heart Disease 157,176 Home Helps 62 Home—Nursing in 18 Homes, Aldersbrook and Scattered 34-37 Homes—Nursing 54 Homeless Children 53 Hospital, Forest Gate 32,33,53,60 Hospitals—General and Special 27-37 Hospital, Infectious Diseases 70-77 Hospital, East Ham Memorial 30-31 Hospital, Maternity 27, 54, 60 Hospital, Mental 27-30 Hospital, Smallpox 30 Hospital, Whipps Cross 32,33 Houses—Inhabited 10 Houses, maintenance of 120 Housing 119-122 Housing Statistics 121 I. Illegitimate Births 10,11 Immunization 75,147 Immunization Clinics 55,64-65 Improvements 114 Increase of Kent (Restriction) Act 117 Infant Deaths 12, 16a Infant Welfare Clinics 54 Infantile Mortality 10,12,16a Infectious Diseases Hospital 70-77 Infectious Diseases .63-77,148-150 Inhabited Houses 10 Inspection of and Supervision of Food 123-128 Inspections 113 Inspection of School Children 138-146 Institutional Provision for Unmarried Mothers, Illegitimate Infants, etc. 53 Institutions controlled by West Ham 32-33 Invalid Children's Aid Association 47-48,62,163 L. Laboratory Facilities 19, 75 Legal Proceedings 117 Legislation in Force 22-24 Light Treatment 150,158 Local Government Act, 1929 24 M. Maternal Mortality 10,13, 61 Maternity and Child Welfare 49-62 Maternity and Child Welfare Committee 3 Maternity Boxes 62 Maternity Homes and Hospitals 27,60 Meals, Provision of 165 Measles 11,74 Meat, and other Foods 124-125 Meat Inspection 124 Medical Examinations, Miscellaneous 168 Medical Inspection and Findings of School Children 138-146 Medical Officer of Health's Report 1-132 Medical Relief, Public Assistance 24-25 Mental Defects, School Children 167, 173 Mental Defectives, Training Centre 40-41 Mental Deficiency 26,38-41 Mental Deficiency Committee 4 Mental Hospital 27-30 Meteorology 130 Midwives Act, 1936 49-53 Midwives 18, 49-53, 60 Midwives, Municipal 49-51 Milk, Bacteriological Examination of 123 Milk—Free Supplies 54 Milk, Graded 124 Milk (Special Designation) Order 124 Milk Supply 123 Minor Ailments 144,150, 177 Mortality, Analysis of 15 Mortality, Excessive—Particulars of 11 Mortality, Infantile 10,12,16a Mortality, Maternal 10,13, 61 Mortality, Neo natal 13 Mosquito Control 115 Municipal Midwifery Scheme 49-51 Municipal Midwives 49-51 188 IN DEX—continued. N. Neo natal Mortality 13 Noteworthy Causes of Sickness or Invalidity 11 Notices served and complied with 114 Notification of Births 57 Nursing Arrangements 18 Nursery Schools 167 Nursing Homes—Public Health Act, 1936 54 Nutrition 146,172 O. Obstetrical Specialist 14 Occupations and Premises subject to control of Local Authority 115 Occupational Therapy—Tuberculosis 110 Offensive Trades 115 Open Air Education 159-164 Ophthalmia Neonatorum 27,61,70 Ophthalmic Clinic 150-153 Ophthalmic Surgeon, Report of 151-153 Ophthalmic Treatment 56 Orthopaedic Treatment 27,54,156,178 Outdoor Assistance 128, 129 Overcrowding 119 P. Parents, Co-operation of 165 Physical Features of Area. 10 Physically Defective Children 166, 174 Physical Training 164 Plaistow Maternity Hospital and District Nurses Home 18 Playground Classes 159 Pneumonia 73 Pools—Swimming Ill, 119 Population 10,14 Post-Natal Work 58-60 Premises and Occupations subject to control of Local Authority 115 Prevention of Blindness 44-46 Principal Contents 2 Prosecutions 117 Provision of Meals 165 Public Assistance Domiciliary Medical Service 24-25 Public Assistance Institutions 32 Public Cleansing 113 Public Health Act, 1936— Child Life Protection 53 Public Health Act, 1936— Nursing Homes 54 Public Health Committee. 3 Puerperal Fever and Pyrexia 27,61,66 K. Rag Flock Act 117 Rat Extermination 115 Rateable Value 10 Rents Restriction—Certificates of disrepair ... 117 Reports, Special 17 Residential Schools 160-164 Rheumatism 157 Ringworm 56 Rivers and Streams 112 Runwell Mental Hospital 27-30 S. Sanatoria 99-105 Sanitary Circumstances 112-118 Sanitary Inspection 113-118 Sanitary Section and Housing 112-122 Scarlet Fever 63,67,72 Scattered Homes 34-37 Schick Immunisation Clinics 55,64-65 School Attendance Officers— Co-operation of 165 School Baths 165 „ Blind Children 166-167,172 „ Camps 159 „ Children, Blind, Deaf, Defective and Epileptic 166-167 „ Children, Minor Ailments 144,150,177 ,, Children, Medical Inspection 138-146 ,, Children, Mentally Defective 167 ,, Children, Physically Defective 164, 166 „ Children, Verminous Conditions 143 „ Continuation 167 „ Cripples 175 ,, Exceptional Children 138,172-176 „ Meals 165 „ Medical Officer's Report 133-184 ,, Medical Service in Relation to Public Elementary Schools 137 ,, Medical Treatment 149-159 ,, Nursery 167 „ Open Air 160 Schools of Recovery 160-164 Schools, Secondary 167 Senior Sanitary Inspector, Report of 112-122 Sewerage 112 Shops Act, 1934 118 Sickness or Invalidity, any Noteworthy Causes 11 Skin Diseases 145,151 Slaughterhouses 124 189 IN DEX—continued. S. Slum Clearance 120 Smallpox 30 Smoke Abatement 119 Social Conditions of Area 10 Special Enquiries 168 Special Reports 17 Special Schools Physically Defective Children 160-164 Staff 5-6,62, 137 Statistical and Social Conditions of Area 10-16a Still Births 11,58 Streams 112 Swimming Eaths and Pools 111, 119 T. Table, Aldersbrook and Scattered Homes 34 „ Birth-rate, etc. 15 „ Blind Persons 43a, 43b „ Cancer 79 ,, Clinics and Treatment Centres 21 „ Cost at Institutions 76,99 „ Death Kate, etc.15 ,, Deaths, Causes of 15a „ Deaths, Ward — Rates 16 „ Dental Treatment 94 „ Domiciliary Midwifery 51-53 „ East Ham Memorial Hospital 31 ,, Exceptional Children 172-176 ,, Factories and Workshops Act 131-132 „ Food and Drugs Adulteration 127 „ Housing 121 „ Infant Deaths 16a „ Infectious Diseases, Notifiable 68,69 „ Infectious Diseases, Removed to Hospital 69,76 „ Infectious Diseases in School Children 148 „ Maternal Mortality 13 „ Mental Defectives 38-41 „ Mental Patients—disposition of 30 „ Meteorology 130 „ Ophthalmia Neonatorum 70 „ Out-door Assistance 129 „ Public Assistance Domiciliary Medical Service 24 „ Public Assistance Institutions 33 „ Samples, Food and Drugs 126 Table, School Children, Defects of 170-171 ,, School Children Examined 169 „ School Children found to require Treatment 140. 169 „ School Children -Malnutrition 172 ,, School Children, Treatment carried out 177-179 „ Schools of Recovery 162 ,, Secondary School Examinations 180-184 ,, Sunlight Treatment 158 „ Tuberculosis Deaths 109 ,, Tuberculosis and Chest Clinic 90-91b ,, Tuberculosis, Five years After-History 93a „ Tuberculosis Notifications 106-109 ,, Tuberculosis, Residential Treatment 99-105 „ Unemployed 128a „ Vaccination 63 ,, Verminous Condition of School Children 143 „ Vital Statistics of certain County Boroughs 111a „ Work of Home Visitor to the Blind 43 Teaching Staff, Co-operation of 165 Toddlers' Clinic 55 Tonsils and Adenoids 56,144,150 Training Centre, Mental Defectives 40-41 Treatment Centres 20-21 Tuberculosis 80-111,145,151,174 Tuberculosis and Chest Clinic 80-91b Tuberculosis After Care Committee 110 Tuberculosis, Five years After-History 92-93a Tuberculosis—Occupational Therapy 110 U. Uncleanliness 141-143,179 Unemployment and out-door Assistance 128-129 Unmarried Mothers 53 V. Vaccination 63 Verminous Conditions- School Children 143,179 Venereal Diseases 25-26 190 INDEX—continued V. Vital Statistics, Extracts from 10-11 Vision 145,151,177 Visits,Health Visitors 57 Visits, School Nurses 149 Voluntary Associations 47-48, 62,163,166 W. Wards, Deaths in and Rates 16 W. Water Supply 112 Whipps Cross Hospital 32,33 Whooping Cough 74 Workshops 115,131-132 Welfare of the Blind 42 Z. Zymotic Diseases 63