AC 44113 COUNTY BOROUGH OF EAST HAM. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1938. MALCOLM E. BARKER, M.R.C.S. (Eng.), L.R.C.P., D.P.H., (Lond.) COUNTY BOROUGH OF EAST HAM. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1938. 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. (T.U.), 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 Provisions of Health Services 17 General & Special Hospitals & Children's Homes 23 Mental Deficiency 34 Welfare of the Blind 37 Invalid Children's Aid Association 40 Maternity and Child Welfare 42 Infectious Diseases 54 Tuberculosis 70 Sanitary Section and Housing 102 Inspection and Supervision of Food 112 Unemployment and Out-Door Assistance 118 Meteorological Record 119 School Medical Service: — Introduction 125 Report 127 Index 170 3 EAST HAM CORPORATION PUBLIC HEALTH COMMITTEE. Also Committee under Blind Persons Acts, 1920/38. The Mayor (Alderman Mrs. A. Taylor, J.P.). The Deputy-Mayor (Alderman F. Welch). 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 J. W. Barton. Alderman R. J. Fell. Councillor W. H. W. Beecham. Councillor L. A. V. Bennett. Councillor C. W. Brading, C.R.P., J.P. Councillor Mrs. E. M. C. Brace. Councillor Mrs. L. M. Brignell. Councillor W. T. Bush. Councillor W. J. Davis. Councillor H. B. Harper, J.P. Councillor H. Joseph, J.P. Councillor Mrs. W. M. Knight. . Councillor R. W. Moger, J.P. Councillor Mrs. A. B. Spencer. Councillor W. Thompson. Also Member of the Institutions and General Sub-Committee. MATERNITY AND CHILD WELFARE SUB-COMMITTEE. Public Health Act, 1936. Same members as Public Health Committee, with—• Mrs. E. M. Fell (co-opted). Mrs. E. M. Devenay (co-opted). Mrs. E. R. Orsen (co-opted). 4 COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. Mental Deficiency Act, 1913, Sec. 28. The Mayor (Alderman Mrs. A. Taylor, J.P.). The Deputy-Mayor (Alderman F. Welch). Councillor Mrs. W. M. Knight (Chairman). Councillor Mrs. A. B. Spencer (Vice-Chairman). Alderman Mrs. B. Wilkens. Councillor A. Prior. Councillor Mrs. L. M. Brignell. Councillor E. A. Wood. Councillor C. W. Dixon. Mrs. C. J. Cross (co-opted). Councillor B. G. Goodenough. Mrs. A. M. Gray (co-opted). Councillor H. B. Harper, J.P. Mrs. M. Podd (co-opted). EAST HAM EDUCATION COMMITTEE. The Mayor (Alderman Mrs. A. Taylor, J.P.). The Deputy-Mayor (Alderman F. Welch). Alderman T. I. Lethaby, J.P. (Chairman). Councillor J. A. Hart (Vice-Chairman). Alderman Mrs. B. Wilkens. Councillor S. A. Elson. Alderman J. W. Barton Councillor H. B. Harper, J.P. Alderman T. W. Burden. Councillor E. C. Howlett. Alderman R. J. Fell. Councillor H. P. Jackson. Alderman E. F. Markey. Councillor H. Joseph, J.P. Alderman W. T. Newling, J.P. Councillor B. A. Keene. Alderman J. J. Pope, J.P. Councillor R. W. Moger, J.P. Councillor Mrs. E. M. C. Brace. Councillor G. H. Moncar. Councillor Mrs. W. M. Knight. Councillor W. Thompson. Councillor R. Bailey. Councillor E. A. Wood. Councillor C. W. Brading, Mrs. W. F„ Hyland. C.R.P., J.P. Mrs. L. A. Lethaby. Councillor W. T. Bush. Mr. A. E. Francis. Councillor C. W. Dixon. Mr. E. J. Sullivan 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. Jessie A. MacLaren, M.B., Ch.B., D.P.H., Assistant Medical Officer. J. Craweord, 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 Medicatl 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. Jane Druker, M.B, Ch.B., M.R.C.S., D.P.H. M edical—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:— 2A. E. Hall, L.D.S. (Liverpool). C. S. Neame, L.D.S., R.C.S. 3N. T. Smith, L.D.S., R.C.S., B.Sc. 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.IA., 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. Skeggs, 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). I. Thomas, 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. E. M. Jones, S.R.N., S.C.M., R.F.N. 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. D. Young, S.R.N, S.C.M. Radiographer and Light Sister:— O. Davies, S.R.N, C.S.M.M.G, M.E, L.E.T, M.S.R. Tuberculosis Nurses:— L. E. Mali.on, 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 Acts— 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. Bloomfiei.d. C. L. Durbin, A.C.I.S. G. W. Friend. 5G. H. Green, Cert. R.S.I. 6R. A. Goff, D.P.A. 8J. C. Childs. B. E. R. Hartley, A.C.I.S. C. J. Hayes. Shorthand Typists:— D. Gordon. C. Goodman. 80. E. Griffin. 9V. H. Nicol. E. M. Pritchard. H. E. Ritterspack. E. M. Walton. Female Clerks:— J. M. Fi.ynn. A. R. Gaster. F. E. Hales. W. M. Hales. M. A. McCall. F. C. Wells. Resigned 13-8-38. 1 Retired as District Medical Officer on superannuation, 31-12-38. 2 Terminated duty 12-11-38. 3 Commenced duty 7-11-38. 4 Retired on superannuation 12-11-38. 5 Appointed District Sanitary Inspector 6-12-38. 6 Terminated duty 22-8-38. 7 Commenced duty 22-8-38. 8 Terminated duty 22-8-38. 9 Commenced duty 22-8-38. 10 Commenced duty January, 1938. 7 Public Health Department, Town Hall, East Ham, E.G. May 1939. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you my Annual Report on the health of the County Borough of East Ham for the year 1938, together with the Annual Report to the Education Committee on the School Medical Service. As a measure of economy, only essential statistics are given and comment is limited to important features of the year's work. In comparison with last year, the mortality and other rates shew some slight variation, but the figures generally are lower than those for England and Wales as a whole, and reference to Table 41 indicates the relative position of East Ham as regards the effectiveness of its health measures with that of other boroughs. There was a lessened incidence of notifiable infectious disease despite a limited outbreak of enteric fever, and a number of mild cases of dysentery which at the time, was somewhat prevalent throughout the country. Similarly to last year, the percentage of admissions to hospital remained high and no deaths occurred from scarlet fever. The appointment of municipal midwives has met with an increasing demand for such services and, in conjunction with the clinics, has provided greater facilities for antenatal care and skilled nursing in the home. There is, however, need for more post-natal supervision, and the number of toddlers examined falls short of the requirements considered satisfactory. The provision of maternity accommodation by the Council in the new block, in course of construction at the East Ham Memorial Hospital, will augment the facilities for many residents of the Borough, and comply with the Ministry of Health's recommendation for a complete maternity scheme. 8 The addition of a new sanitary block and other improvements to B Ward at the Infectious Diseases Hospital, now provides two excellent series of cubicles for observation and treatment of mixed cases of infection. Much attention has been paid to the need for admission to hospital of children suffering from measles, whooping cough, and bronchopneumonia, where home conditions do not permit of adequate nursing. A period of convalescent treatment, is essential if full restoration to health is to be obtained, and I desire to stress that such provision by the Council directly, would ensure better physique and freedom from the many sequelae of these debilitating illnesses and other infectious diseases. The Town Hall Annexe, which is to provide better office accommodation and full facilities for the holding of the various clinics, is nearing completion, and both staff and patients await with interest and enthusiasm the additional opportunities for care, advice, and propaganda which are the fundamental principles of a public health service. The new Pavilion and Treatment Block at Harts Sanatorium and extensions to the Home, which have been commenced, will place this Hospital in the forefront of institutions for the treatment of Tuberculosis and allied conditions. The clearing of the caravan sites was practically completed by the end of the year, many of the families being housed in new modern dwellings. The benefit to residents of a change of environment and improved conditions of sanitation is already apparent. I desire to endorse Dr. Ellman's plea for houses suitable for sufferers from tuberculosis. Representations were made by me on previous occasions, but the requirements of overcrowding surveys and clearance areas have had a prior claim'. I trust that the opportunity of providing ideal houses for such patients may not be lost sight of, despite the many other demands. The responsibility for the A.R.P. Casualties Services has been accepted by the department in full measure, and 9 to a slight extent only at the expense of the Public Health Services. The organisation of Hospital and First Aid Services and the training of personnel has necessitated much additional work. Every effort is being made, however, to maintain the health of the Borough in its entirety and to meet the personal requirements of its residents in matters of health which, in the past, has been an outstanding feature of this department. The Council will, I hope, appreciate the multitude of detail involved, from the public health standpoint, in the planning, preparation and carrying out of three large schemes of hospital and clinic provision, simultaneously with routine work and A.R.P. I wish to express my thanks to the Chairman and members of the Public Health Committee and to those of other Committees, for their help and support during a difficult period. My thanks are also due to my colleagues and to the members of the Public Health Staff for their1 efficient service and willing co-operation at all times. 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 1938, 129,500. Number of inhabited houses (end of 1938) according to rate books (including tenements and shops), approx. 30,275. Rateable value at 31st December, 1938, £762,631. Sum represented by a penny rate for the year 1938/9 £3,050 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 1,777 934 843 Birth rate per 1,000 of the estimated population 14.1. Illegitimate 56 33 23 Still Births 68 43 25 Rate per 1,000 total (live and still) births 35.7. Deaths 1,383 726 657 Death rate per 1,000 of the estimated population 10.6. Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.52 Other puerperal causes 3 1.57 Total 4 2.09 11 Death rate of infants under one year of age :— All infants per 1,000 live births 51 Legitimate infants per 1,000 legitimate live births 50 Illegitimate infants per 1,000 illegitimate live births 71 Deaths from Cancer (all ages) 221 Deaths from Measles (all ages) 5 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under 2 years of age) 8 No unusual or excessive mortality occurred during the year. Any causes of Sickness or Invalidity which have been specially noteworthy in the Borough during the year; 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. As will be seen later in the report, a few sporadic cases of typhoid and para-typhoid fever occurred during the months of July to October; despite minute enquiries, no definite connection could be found with cases arising similarly in other areas contiguous to or at a distance from the borough. These cases were generally mild in character, and all recovered. The outbreak in December, limited to a small area on the north-western boundary of the district, was of more serious import, and pointed to a common source of infection associated with food. Ten cases of true typhoid fever were notified in somewhat rapid succession; the patients were extremely ill and shewed all the characteristics of a virulent affection. Pathological and bacteriological examination substantiated the findings and gave serum agglutination in high dilutions to both typhoid and para-typhoid B. One patient, the first case to be reported, succumbed to the illness. Extensive investigations involving the collation of very considerable detail, established the origin of infection as beyond the confines of this borough, and in conjunction with other authorities approppriate 12 measures were taken to eliminate any possible cause of the epidemic. A few patients infected at this time, shewed signs of illness in the New Year, after the maximum incubation period, thus giving rise to additional cases not recorded here. Special action taken to arouse public interest in the prevention of ill-health and the importance of Early Treatment. The Authority's scheme to stimulate interest in health matters followed closely that advocated by the Central Council for Health Education. A series of large posters changed monthly, were displayed on carefully chosen hoardings throughout the borough. Attention was directed thereby to the prevention of ill-health, the need for early treatment and the greater use of the various health services. Leaflets were distributed to school children and short talks given on appropriate subjects. Pictures stressing the importance of hygiene and health were posted in halls, cinemas and clinics. Use was also made of the Council's vehicles for advertising purposes. A series of lectures was arranged, and every opportunity taken to disseminate information and to arouse public interest in the Council's activities. Still-Births. The number of still-birth registered was 68, compared with 58 for the previous year. The rate per 1,000 total (live and still) births was 35.7, the figure for 1937 being 28.8. Births. The number of live births registered was 1,833 as compared with 1,952,for the year 1937, equivalent to a birth rate of 14.1 per 1,000 of the population—14.8 for the previous year. The live birth rates in the various Wards were as follows Manor Park Little Ilford Woodgrange Plashet 14.5 18.0 11.7 12.4 Kensington Castle Central Wall End Greatfield South 15.5 10.6 10.0 12.0 10.0 13.5 13 Deaths. The number of deaths was 1,383 as compared with 1,422 for the year 1937. The death rate was 10.6 or 0.2 less than that of the previous year. Of the total deaths 789 or 56.1 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- five deaths of non-residents occurred. The standardised death rate, that is the rate adjusted to compare with the crude death rate of the country as a whole, or with the mortality of any local area, was 11.6 (1937—11.8). This figure is arrived at by multiplying the crude death rate (10.6) by an adjusting factor, that for East Ham being 1.10. The percentage of total deaths in the various age groups was as follows :— Under 1-2 2-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75 Years Year Years Years Years Years Years Years Years Years Years and upwards 6.8 0.6 1.0 1.2 3.5 4.3 6.0 8.8 16.8 24.3 26.5 Infantile Mortality. Deaths of infants under one year of age numbered 94—equivalent to an infant mortality rate of 51 per thousand live births— compared with the rate of 48 for the previous year. The rate for England and Wales was 53. Four deaths of illegitimate children occurred out of a total of 56 illegitimate births, giving a mortality rate of 71 as compared with a figure of 80 per 1,000 illegitimate live births for the year 1937. 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 :— 1934—22.5, 1935—23.4, 1936—21.7, 1937—25.6, 1938-22.9. 14 Maternal Mortality. The number of maternal deaths were 4, the maternal mortality rate for 1938 was therefore 2.18 per 1,000 live births and 2-09 per 1,000 live and still-births. TABLE 1. Puerperal Sepsis Other Causes Total England & Wales East Ham England & Wales East Ham England & Wales East Ham Per 1,000 Live Births 0.89 0.54 2.19 1.64 3.08 2.18 Total Births (Live & Still) 0.86 0.52 2.11 1.57 2.97 2.09 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. Obstetrical Specialist. The services of a Consultant Obstetrician were requested by a General Practitioner on two occasions. Particulars are given below:— No. Diagnosis. Where treated. Result. 1. Puerperal Fever Home Recovered. 2. Mastitis of right breast and Thrombosis of pelvic veins Queen Chailotte's Hospital , , Population. The Registrar-General's estimate of the population to the middle of 1938, is 129,500, which is a decrease of 1,600 compared with that for the year 1937. 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. 15 TABLE 2.—BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1938. 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. Diarrhoea and Enteritis (under two years). Total Deaths under One Yr. England & Wales 15.1 0.60 11.6 0.00 0.00 0.04 0.01 0.03 0.07 0.11 5.5 53 126 County Boroughs & Great Towns including London 15.0 0.65 11.7 0.00 — 0.05 0.01 0.03 0.07 0.10 7.8 57 148 Smaller Towns (estimated resident populations 25,000 -50,000 at census 1931) 15.4 0.60 11.0 0.00 0.00 0.03 0.01 0.02 0.06 0.11 3.6 51 London—Administrative Co'ty 13.4 0.48 11.4 0.00 — 0.06 0.01 0.03 0.05 0.06 13.1 57 EAST HAM 14.1 0.52 10.6 0.007 — 0.03 — 0.02 0.07 0.07 4.3 51 16 TABLE 4.—Ward Distribution of Deaths, and Ward Death Rates, 1938. 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 — — — — — — 1 — 1 3 5 5 3. Scarlet Fever — — — — — — — — — — — — 4. Whooping Cough 1 1 — — — — 1 — — — 3 1 5. Diphtheria 1 — 1 2 1 3 1 — — 1 10 10 6. Influenza — — — — — 4 1 1 2 2 10 7 7. Encephalitis Lethargica — — — — — 1 — — 1 — 2 2 8. Cerebro-Spinal Fever 1 1 — — — — — — — — 2 2 9. Tuberculosis of Respiratory System 7 7 6 7 8 6 5 9 13 13 81 43 10. Other Tuberculous Diseases — 1 1 — — 1 1 2 1 1 8 6 11. Syphilis — — — — — — — — 1 1 2 1 12. General Paralysis of the Insane, Tabes Dorsalis — 1 — — — 1 — — — — 2 2 13. Cancer 19 27 24 30 18 22 17 22 22 20 221 108 14. Diabetes — 1 4 1 1 — 3 3 1 3 17 10 15. Cerebral Haemorrhage, etc. 10 3 8 11 5 7 8 12 13 6 83 49 16. Heart Disease 30 25 38 44 44 43 38 27 33 38 360 177 17. Aneurysm 1 2 1 — — 2 1 — 1 — 8 4 18. Other Circulatory Diseases 5 9 6 5 6 2 11 7 3 9 63 27 19. Bronchitis 3 8 2 4 3 7 3 3 2 9 44 25 20. Pneumonia (allforms) 4 13 5 6 9 8 10 14 5 6 80 46 21. Other Respiratory Diseases 5 2 3 2 1 1 2 2 1 2 21 13 22. Peptic Ulcer — 5 1 1 1 — 3 1 — 2 14 12 23. Diarrhoea, etc. — — — — — 3 1 1 1 2 8 5 24. Appendicitis — — — 1 — — 1 1 — — 3 3 25. Cirrhosis of Liver — — 2 1 1 — — — — — 4 4 26. Other Diseases of Liver, etc. — — 1 1 1 1 — 2 2 — 8 6 27. Other Digestive Diseases 2 1 3 4 2 3 1 2 3 5 26 17 28. Acute and Chronic Nephritis 5 3 4 9 4 2 7 2 1 3 40 27 29. Puerperal Sepsis — 1 — — — — — — — — 1 1 30. Other Puerperal Causes — — — — — 1 — — — 2 3 3 31. Congenital Debility, Premature Birth, Malformations, etc. 4 10 4 4 7 3 1 4 3 3 43 30 32. Senility 6 3 4 1 1 4 7 9 3 3 41 32 33. Suicide — — 2 1 1 — 2 2 — 1 9 3 34. Other violence 6 5 2 3 3 3 5 7 4 3 41 36 35. Other defined causes 12 8 16 5 9 15 14 16 7 17 119 71 36. Causes ill-defined or unknown — — — — — — — — — — — — Totals 122 137 138 144 126 143 145 149 124 155 1,383 789 TABLE 5. 16a Infant Deaths Under One Year of Age, 1938. CAUSE OF DEATH. Total Ages and Sex Total under 1 year Wards Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Manor Park Little Ilford Woodgrange Plashet Kensington Castle Central Wall End Greatfield South Deaths in Institutions Tuberculosis, Respiratory 1 M F M F M F M F M F M F M F M F M F — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — Whooping Cough 2 — —— —- — —— —— —— —- —- 1 1 —— —— —— —— —- 1 1 1 — — — — — 1 — — — 1 Diphtheria 1 — — — — — — — — — — — — — — 1 —- 1 —- — — — 1 — — — — — — 1 Bronchitis 5 1 — — — — —- — — — 1 — 2 — — — 1 1 4 — 1 — — — 0 — — — 2 2 Pneumonia 15 — — —— —— 1 — — — 2 2 1 3 2 3 — 1 6 9 1 3 1 2 — 1 — 3 1 3 10 Diarrhoea, etc. 8 — — — — — — — — — 1 2 1 1 1 1 1 4 4 — — — — — 3 1 1 1 2 7 Congenital Debility and Malformations, PrematureBirths 43 14 10 2 1 1 1 4 2 4 2 2 — — — — — 27 16 4 10 4 4 7 3 1 4 3 3 27 Other defined causes 19 2 2 — — 1 — — — 4 —— 2 2 2 1 2 1 13 6 — 1 5 2 — 3 — 3 — 5 14 AllCauses 94 17 12 2 1 3 1 4 2 10 7 8 8 5 6 4 4 53 41 6 15 10 9 7 12 3 11 5 16 62 Infantile Mortality Rates per 1,000 live births 51 — — — — — — — — — — — — — — — — — — 29 51 67 53 39 83 21 53 35 76 — 17 General Provision of Health Services Professional Nursing in the Home. A. GENERAL. The Council makes a grant in aid of the services of the Plaistow District Nurses attached to the Branch Home at Ascot Lodge, Shrewsbury Road. The services of Nurse Kelley are available for public assistance cases. B. INFECTIOUS DISEASE Hospital treatment is advised in all cases of diphtheria and scarlet fever. No provision is made for the nursing of infectious disease in the home but many cases of measles, whooping cough and bronchial pneumonia are admitted to hospital where the home conditions are inadequate. G., MIDWIVES. The sister midwives and nurses from Plaistow Maternity Hospital and those attached to the Burges Road Home and the 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 1938, was 53. Of this number 33 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches—4 at Sir Henry Tate Nurses' Home, Silvertown—2 at the Kelvingrove Nursing Home Windsor Road—and 14 practised independently, including 3 Municipal Midwives. Summary of Visits Paid during 1938 by Nurses of Plaistow Maternity Hospital and District Nurses Home. Midwifery 334, Monthly 181, Hospital 275. 0 18 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 1938 are shown below:— Specimen Number Blood (Sedimentation Rate) 53 Blood for Widal Test 15 Urine (for Typhoid) 21 Faeces (For Typhoid) 30 Mantoux Skin Test (Tuberculosis) 46 Pleural Effusion 7 Sputa (for Asbestosis) 3 Sputa (for Tuberculosis) 989 Sputa (for Tuberculosis-Antiformin method) 30 Swabs (for Tuberculosis) 1 Pus (Cervical Gland) 1 Sputa Culture 6 Sputa (Malignant Cells) 16 Cerebro-Spinal Fluid 3 Total 1,221 Pathological examinations carried out by Counties P.H. Laboratories during 1938 total 86. The number of diphtheria swabs examined at the Infectious Diseases Hospital and the Town Hall Laboratory was as follows, viz.— Number. Positive. Negative. 4,084 402 3,682 Of the above total 2,635 were examined at the hospital. Ambulance Facilities. General. The two ambulances operating from the Fire Station carried out the following work during 1938 :— 19 Ordinary Police East Ham 1527 532 West Ham 7 9 Ilford 4 16 Barking 12 16 East Ham for :— West Ham 3 20 Ilford — — Barking 52 46 1605 639 Calls (as above) 2244 Not required on arrival 102 Malicious calls 2 Special service calls — Maintenance journeys, etc 77 Total number of journeys 2425 Total mileage: 21,132. Average mileage per journey: 8.7. 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: — 20 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.; " " Ante-Natal Clinic day, 9.30 a.m.; Friday, 2 p.m. 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, Ferndale 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, Ferndale St. General Clinic Monday; and Friday, 2 p.m. Town Hall, East Ham Immunization Clinic Friday, 3 p.m. " " Ear Clinic Thursday and Friday, 2 p.m. " " Eye Clinic Tuesday, Thursday and Friday, 9 a.m. " " Light Clinic Monday (Boys), 2 p.m.; Wednesday (Girls), 2 p.m. Durban House, Katherine Road and Church Road, Manor Park Dental Clinics By appointment. 21 Local Government Act, 1929. A brief synopsis of the Council's administrative schcme 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 "open-choice" scheme of medical relief was adopted by the Council in 1933 and was described in my report for the year 1934. It has operated throughout the whole of the borough with the exception of a small area beyond the King George V and Royal Albert Docks in North Woolwich. Slight amendments to the regulations were made recently after consultation "with the medical practitioners of the district. The scheme has proved highly successful, is immensely popular with all concerned, and is administered with the minimum of trouble. The Council have given directions that upon the retirement of Dr. Brews, District Medical Officer for the North Woolwich area, on 31/12/38, the scheme shall be extended to the whole of the borough. TABLE 7. Public Assistance Domiciliary Medical Service. Statistical Return for the Year Ending 31.12.38. 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. 2,483 5,5*2 16,682 22.214 1,010 Number of cases urgently admitted to hospital 5 Number of applications to Medical Officer of Health for hospital treatment 50 22 Public Assistance Nurse and Assistant Relieving Officer Number of requisitions received for attendance of nurse 43 Total attendances at homes by nurse 1519 Total visits to Maternity cases for enquiry and registration 322 Dr. Brews, the District Medical Officer, for the North Woolwich area, dealt with the following cases during 1938 :— Number of individual patients 72 Number of attendances at homes 357 Number of attendances at surgery 307 Total number of attendances 664 Number of occasions medicines supplied without seeing patients 12 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 18 Soft Chancre 2 Gonorrhoea 84 Not Venereal 136 Total 240 Total attendances of all patients 11,020 Number of in-patient days during 1938 182 The total attendances decreased and in-patient days in hospitals increased. 23 Pathological Examinations. For or at the Centres— Spirochaetes 43 Gonococci 2037 Wassermann 464 Others 992 Total 3536 For Practitioners— Spirochaetes — Gonococci 2 Wassermann 40 Others 21 Total 63 During 1938, 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. Statistics are given later in the Report. General and Special Hospitals and Children's Homes. Arrangements for Treatment. (a) Provided by Local Authority, (b) Maternity, (c) Orthopaedic, (d) Ear, Nose, andThroat, (e) Puerperal Fever and Pyrexia, (f) Ophthalmia Neonatorum. The Council are in negotiation with the East Ham Memorial Hospital for the erection of a maternity and children's block at the hospital. There are no further comments to make on the existing arrangements. Particulars have been sent out in previous reports. (g) Runwell Mental Hospital. East Ham and Southend-on-Sea Joint Hospital Board. The folowing statistics have been supplied by Dr. R. StromOlsen, Physician Superintendent:— 24 Males. Females. Movement of East Ham Patients. Year ended 31st December, 1938. Admissions. Voluntary Temporary Certified Voluntary Temporary Certified Transferred from other Mental Hospitals 1 Received direct. 43 7 10 41 11 14 Discharges. Recovered 22 2 4 30 5 2 Relieved 7 2 3 1 Not improved 5 — 2 3 — 2 Died 2 3 2 3 — 11 Accepted by other authorities 7 — 2 3 1 3 Recovery Rate Calculated upon the Direct Admissions 51.1 % 28.6% 40% 73.2% 45.5% 14.3% Recovery rate for 1938 calculated upon direct admissions=53.2% (55.2% for males and 52.1°/o for females). Corresponding figure for all English and Welsh County and Borough Mental Hospitals for 1937=31.6"/o. 25 TABLE 8 DISPOSITION OF MENTAL PATIENTS ON 31.12.1938. Certified T emporary Voluntary Total M. F. M. F. M. F. Runwell 204 228 3 6 39 36 516 Brentwood 1 1 — — 1 — 3 Severalls — 3 — — — — 3 Colchester — 2 — — — — 2 Goodmayes 1 — — — — 1 2 Gateshead 1 - — — — — Bexley 1 — — — — — — Hay wards Heath — — — — 1 — — Long Grove — 1 — — — — — Park Prewitt — 1 — — — — — Totals 207 237 3 6 41 37 531 F emal 5s 280 Males 251 (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 is 104. The following tables are abstracted from the hospital report for 1938: — 26 TABLE 9. 1.—In-Patients. Number of Beds and In-Patients. Numbers in 1938 Numbers in pfevicus year. 1. Beds :— (a) Complement at 31st December 104 100 (b) Average Daily Complement during the year 102.1 100 (c) Average Daily Number Closed during the year, owing to:— (i) Rebuilding or Extension Schemes _ (ii) Repairs, Redecoration, Cleaning or Infection 1.4 1.2 (iii) Other Causes (National Crisis) .1 (d) Average Daily Number Open during the year 100.6 98 8 (e) Average Daily Number Occupied during the year 92 6 90. 2 2. Number of In-Patients in the Hospital at beginning of year. 90 91 3. Number of In-Patients admitted during year 2,047 1,957 4. Number of In-Patients in the Hospital at the end of the year 93 90 5. Average number of days each Patient was resident (ascertained by dividing the yearly total of daily counts, viz.:— 33 790 by the number of Patients treated to a conclusion, i.e., (2) plus (3) - (4).) 16.5 16.8 6. Number of Patients admitted and discharged during the year who were resident for— (i) only 1 day 179 162 (ii) 2 and 3 days 300 245 2.—Out-Patients. Numbers. Numbers in 1938 Numbers in previous year 1. Total number of new Out-Patients 15,135 15,164 2. Total number of Out-Patient Attendances 84,659 82 272 (a) Number of Patients on books at the beginning of the year Not ascertainable Not ascertainable (ft) Number of Casualty Patients included in No. 1 above 4,289 4,361 (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 — — 27 (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. 28 TABLE 10. Cases Admitted to West Ham Corporation Public Assistance Institutions from East Ham. Institution. Chargeable on 31.12.37 Admitted during 1938 Born during 1938 Total. Discharged. Died. Transferred to other Instns. Chargeable on 31.12.38 Whipps Cross Hospital 154 1585 1 1740 1185 259 187 109 Central Homes 252 438 — 690 126 157 145 262 Forest Gate Hospital 138 318 261 717 572 22 21 102 Forest House and Cottages 40 19 — 59 1 16 42 •Harold Wood Hospital 12 30 — 42 4 8 3 27 * Aged and Chronic Cases. 29 (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 30-6-38 474 6 months ending 31.12.38 496 Lowest „ „ „ 441 „ „ „ 437 In Receiving Homes on 1st January, 1938 289 1st July, 1938 277 „ Scattered „ „ „ 178 „ „ „ 183 467 460 In Receiving Homes on 1st July, 1938 277 1st January, 1939 272 „ Scattered „ „ „ 183 „ „ „ 188 460 450 On 1st July, 1938, chargeability was apportioned as follows:— To the County Borough of East Ham 80 1st January, 1937 83 „ „ „ West Ham 261 „ „ „ 22S „ Essex County Council 129 „ „ „ 152 460 460 Average No. of admissions weekly —6 months ending 30-6-38 11 6 months ending 31.12.38 10.8 „ ,, discharges „ „ 12 „ „ „ 10.8 Greatest No. of admissions on any one day—6 months ending 30-6-38 10 „ „ „ 10 Number of deaths in institutions— 6 months ending 30-6-38 „ „ „ Number of children admitted from East Ham—6 months ending 30-6-33 62 „ „ „ 52 Number of children admitted from West Ham—6 months ending 30-6-38 142 „ „ „ 125 Number of children admitted from Essex C.C.—6 months ending 30-6-33 85 „ „ „ 104 30 Extracts from the six-monthly Reports of the Medical Officer (Dr. J. S. Coleman) : September, 1938. It is pleasing to note that the general health of the children has been very good, the number of cases of serious injury and illness small and there have been no deaths. The number of cases of infectious disease during the period under review has been rather high, chiefly owing the incidence of measles during the epidemic whidh swept the country in the spring. 29 cases occurred, and as I have previously reported, few cases arose on the Nursery, for by good fortune only the toddlers and older children, who are better able to withstand its ravages, took the infection. There was also an outbreak of Chicken Pox which involved the Nursery and the older children. 15 cases occurred, but happily most of the cases were of a very mild character. I must note that amongst the infants, inflammation of the eye (purulent conjunctivitis) was a troublesome complication and in one of the older children the disease was of a serious (semi-confluent) type. The remainder of the infectious diseases comprise 5 each of Scarlet Fever and Mumps, 2 cases of Diphtheria and 4 of German Measles, bringing the total number for the half-year up to 60 cases. In view of this rather high figure I would again bring to your notice, that with admission of children to the various blocks no system of quarantine is possible, and I can trace with certainty, many of our outbreaks of infection to new admissions. The physical development of the children has progressed along modern lines in uniformity with the vogue throughout the country. Sports Day and the various physical culture displays given from time to time, have amply exemplified the strides our boys and girls have made. The P.T. Instructor and his assistants are surely to be complimented in their sustained effort to achieve the best possible results with the material at their disposal. The nursing staff continues in its untiring way to make the children happy and comfortable. I have detected no slackness of any description throughout a rather trying period, and the well-being of the children and their clean trim appearance on all 31 occasions is a credit to the members of the nursing staff. Nothing one asks of them, is too much to do. The supply of medical and surgical requisites has been adequate, but I would strongly urge the completion of the surgery and dispensary. The diet of the children I consider to be excellent in its variety and food value, but I would make a plea for some revision of the diet of the nurses which on several occasions I have noted to be inadequate, in that the food was unappetizing and the preparation entirely devoid of imagination. I am sorry to lose Mr. Rose, our dentist, who for so many years worked assiduously to maintain the dental health of our children at such a high level. He was always thorough and painstaking in his work and our best wishes go with him on his retiring from the staff. Our new dentist has made an energetic start in a complete re-examination of the dental condition of all the children under our care. There has been ample accommodation for children of all age groups and good use is made of the Scattered Homes to relieve pressure on the blocks when occasion demands. I have visited the Scattered Homes as and when required and can state with confidence that in these homes, the children are well housed, well fed and live happy and peaceful lives. The discipline amongst the Fosters-Mothers remains excellent. I have examined all cases on admission and discharge as demanded by the regulations,- visited all cases of injury and accident as promptly as possible and cared for the sick amongst the children and staff to the utmost of my ability. February, 1939. HEALTH OF THE CHILDREN. In conformity with my monthly reports, I am glad to reaffirm that the general health and well-being of the children at Aldersbrook and the Scattered Homes has been maintained at a high standard. Taking into consideration hereditary and environmental factors in the sources from which these children are drawn, I am of the opinion that it would be difficult to find another institutional body of children with better general physical endowment. 32 INFECTIOUS DISEASES. There has been no serious epidemic, and sporadic cases of German Measles, Chicken ,pox, and Erysipelas have been reported from time to time. Ringworm of the scalp and body has been the most prevalent disease with a total of 21 cases, confined chiefly to the Nursery and toddler groups. NURSING. The general standard of nursing continues to be good. I am quite confident that owing to the devotion and diligence of the nursing staff, our sick children are restored to health as expeditiously as possible. THE NURSERY. The work here continues quietly and efficiently. Elsewhere I have recorded my observations after a complete examination of every child. Good progress has been made, and we are often sorry to have to discharge infants we have built up from sickly undernourished babies to thriving contented infants. THE SURGERY. Work in the new Surgery has now commenced. I am grateful to the Committee in their efforts to make this unit as functionally perfect as possible. The supply of medical and surgical requisites is adequate for all our needs. ACCOMMODATION. There is ample accommodation in the Blocks and Scattered Homes for all age groups. By judicious movement of children as required, congestion at any one block is avoided, yet no child is uprooted from an environment where he or she is happily settled. VISITING. I have visited Aldersbrook every day at least once, and often twice, answered all calls and emergencies as urgently as possible, and examined all children on admission and discharge. I have visited the Scattered Homes when required by sickness or 33 accident, and at sudh other times as I thought necessary to satisfy myself as to the well-being and physical comfort of the children, VACCINATIONS. Thirteen children were successfully vaccinated during the past six months. Parental consent was obtained in every case. THE DENTIST. The work of the Dentist continues in a highly satisfactory manner as reported on several previous occasions. I give dental general anaesthetics at arranged sessions, and if required for emergency. The children like the new Dentist, and I am pleased to state that there is not the awful dread exhibited by the children in visiting the Dentist, such as is usually associated with such procedures. In conclusion I thank the Matron and her Staff for the very willing help and loyal co-operation at all times, to maintain efficiency and create an atmosphere of happiness and tranquillity for the children to live in. 34 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 886 149 132 79 123 1,369 1013 169 TABLE 13. Particulars of Mental Defectives as on 1st January, 193 9. (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 19 13 32 Aged 16 years and over 41 30 71 (2) On Licence from Institutions— Under 16 years of age Aged 16 years and over 8 1 9 (b) (1) Under Guardianship (excluding cases on Licence)— Under 16 years of age 2 1 3 Aged 16 years and over 16 9 25 (2) On Licence from Guardianship— Under 16 years of age Aged 16 years and over 1 — 1 35 2. In " places of safety " :— Under 16 years of age 1 — 1 Aged 16 years and over — — — 3. Under Statutory Supervision 77 82 159 Of whom Awaiting removal to an Institution 5 4 9 4. Action not yet taken under any one of the above headings:— (o) Notified by Local Education Authorities (Sec. 2 (2)) 10 7 17 (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 1 6 7 (c) Otherwise " ascertained " 2 4 6 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 3 1 4 (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 29 20 49 Of whom, number, if any, under Voluntary Supervision 29 20 49 Number of above Cases on the Registers of Occupation and Industrial Centres :— Under Statutory Supervision 11 13 24 Under Voluntary Supervision — — — On Licence from Institutions 1 — 1 Under Guardianship 4 4 8 On Licence from Guardianship — — — 36 DURING THE YEAR 1938. 1. (a) Number of instances in which Licence was granted during 1938- M. F. T. (1) From Institutions 5 — 5 (2) From Guardianship 1 — 1 (b) Number of instances in which cases on Licence have been returned to Institutions or transferred to Guardianship during the year 1938— (1) To Institutions 1—1 (2) To Guardianship 1 — 1 2. Cases notified by Local Education Authorities (Section 2 (2)) during the year 1938;— Method of disposal— M. F. T. Sent to Institutions (by Order) — 1 1 Placed under Guardianship (by Order) — — — Placed under Statutory Supervision 9 5 14 Placed in " Places of Safety" — — — Died or Removed from Area 1 — 1 Action not yet taken— (а) In receipt of Poor Relief — — — (б) Others 1 — 1 Total 11 6 17 3. Of the total number of mental defectives known to the Local Authority:— (a) Number who have given birth to children during 1938— (1) After marriage — (2) While unmarried — Males. Females. (b) Number who have married during 1938 3 2 Training and Occupation Centre. The work of the Centre has been progressive at both sessions. The boys are shewing greater independence and, in some instances, carry out their duties with a minimum of supervision. One lad has since commenced work at a cane factory. The attendance at the morning class has improved, and the boys are interested and attentive. The girls' class shews satisfactory results, although for a time some appeared at a standstill. Change of work arouses new interests, and one girl who was making little progress, now undertakes Italian quilting with ability and keenness which is not confined to her attendance at the Centre. Many orders for embroidery have been received and the work has been excellent. Absentees are mainly limited to younger children. 37 TABLE 14. Statistics of Training Centre, 1938. Morning Session—Males. Afternoon SessionGirls and Juniors. Grand Total Attendances No. on Register No. of Sessions held Total Attendances Average Attendance j No. on ' Register 1 No. of Sessions held Total Attendance3 Average Attendance 13 20C 1,900 9.2 21 206 3,066 14.9 4,966 Blind Persons Acts, 1920/38 The objects of the East Ham Welfare Association for the Blind are as follows :— 1. To compile a register of all Blind Persons living in the Borough. 2. To co-operate with the Education Committee regarding necessary investigations and arrangements for the education of children and adults. 3. To assist all efforts for the prevention of Blindness. 4. To approach the Borough Council when necessary respecting any cases requiring consideration. 5. To obtain Old Age and other Pensions as cases become eligible. 6. To assist deserving Blind Persons and to do all such other things as are considered to be for the general welfare of the Blind. 7. To supply materials to those engaged in pastime occupations and to market the articles they make. 8. To brighten the lives of the Blind by means of entertainments, visiting, etc. 38 The Report of the Executive Committee for the year ending March 31st, 1939, contains much information relative to Blind Persons and the work of the Association. Preventive treatment is of vital importance and no expense is spared; advice is given to applicants, also assistance with fares to hospitals. The Council put into operation on April 1st, 1939, a scheme for the domiciliary assistance of blind Persons having regard to the need of the blind person and that of sighted members of the household. The Association appreciates the additional financial benefits that have been granted to all blind persons under this new scheme. Braille and Moon literature continue to be supplied and Braille books are obtainable through the Borough Libraries. Reference is made in the Report to the work of Miss Kingston, the Home Teacher, especially in regard to the training of the deaf blind. 38a M =Males F = Females. T = Total. .TABLE 18. Welfare of the Blind.—Registration. As at 31.3.39. In the following tables, the registration of the blind, ages at which blindness occurred, training and employment and occupations, as at 31.3.39, are set out:- 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. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. • T. M F. T. — — — — 1 1 3 1 4 1 3 4 14 11 2 5 16 11 27 24 18 42 16 14 30 40 49 89 (i) 114 (ii) - 108 1 222 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 M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M F. T M. F. T. M. F. T. M. F. T. 15 10 25 1 2 3 5 6 11 4 6 10 13 6 19 7 10 17 14 12 26 18 14 32 20 24 44 11 15 26 6 4 10 Children of School Age 5-16* Normal. Mentally Defective Physically Defective M F M F M F In Schools for the Blind 1 — — — — 1 Other Schools — — — — — — Not at School — — 2 — — — Training and Employment. Age period 16 and upwards. Employed Undergoing Training Trained but Unemployed (h) No Training but Trainable M Unemployable m Total Ik) By Blind Organisations. All others not included in (a) & (b) (c) Total employed (d) Industrial (el Secondary (f) Professional and University (g) Workshops (a) Home Workers (b) M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 8 6 14 5 2 7 10 2 12 23 10 33 3 1 4 — — — 1 — 1 2 — 2 2 — 2 80 96 176 Ill 107 218 Occupations of Employed Blind Persons Agents, Collectors, etc. Basket Workers Bedding(including Divans and Ottomans) and Upholstering. Boot repairers Braille copyists 6 Proof Readers | Brush Makers , Carpenters and Woodworkers Chair Seaters Clerks and Typists Coal Bag Makers Dealers, Tea Agents, NewsAgents, Shopkeepers. Firewood Workers 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 (Fendoff) Makers Telephone Operators T uners Weavers Miscellaneous Total | Hand Machine Mattress Makers Machinists Upholsterers Within Institutions for the Blind 1 4 3 — — — — — — — 1 — — — — — — — 1 — — — — — — — — — — — — 5 — 15 In approved Home Workers Schemes 1 — — — — 1 — — — — — — — — — — — — 1 — — — — 1 — — — — — — 3 — — 7 Others (not pastime Workers) — 1 — — —| 2 — — — — — — 1 — — 2 — — — — 1 — — — — — — — — 1 — — 3 11 Total 2 5 3 — — 3 — — — — 1 — 1 — — 2 — — 2 — 1 — — 1 — — — — — 1 3 5 3 33 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 fiil Deaf-mute Combinations of (a) and (b) Combinations of (a) and (c) Combinations of (b) and (c) Combinations of (a), (b), (c). Total Homes for the Blind Mental Hospitals Poor Law Institutions M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M I ?_ T. 7 5 12 5 7 12 (i) 7 (ii) — (i) 12 (ii) 3 + (i) 19 (ii) 3 — — 1 — 1 — — — — — — 20 24 44 — — — 2 3 5 8 6 1 j 14 * Plus 1 Child under 5 f Deaf Mutes are also shown in the Deaf column. 38d TABLE 16.—Continued. Number of persons over 70 years of age unemployable (j) and total (k) in Training and Employment Table M. F. T. 39 49 88 Blind Persons Registered as New Cases (Not Transfers from other Registers) during the year ended 31. 3. 39. 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) 9 (i) 8 (i) 17 — — — — — — — — — — — — — — — 2 — 2 1 — 1 2 1 3 4 7 11 (ii) - (ii) - (ii) - Blind Persons Registered as New Cases (Not Transfers from other Registers) During the Year ended 31. 3. 39, 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. — — — — — — — — — — — — — — — — — — 3 — 3 1 1 2 2 3 5 3 4 7 — 39 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. bag making Daily. Eve'ng. 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 — 1938 223 2,027 35 156 218 — 2,280 386 — 195 85 52 29 — 25 — 40 Prevention of Blindness. A full and complete report on the Prevention of Blindness was submitted to the Council last year—no further action has taken place. The Invalid Children's Aid Association. The Committee report another successful year's work in their efforts on behalf of the children. Alderman Mrs. A. Taylor, Chairman of the East Ham branch and her colleagues, have rendered invaluable help in placing the large number of children in suitable homes and hospitals. Close co-operation with appropriate Institutions has ensured adequate treatment or convalescence and the Council is appreciative of the great service rendered. The Committee acknowledge the continued support of the Council and Education Committee and the willing help of the Borough Officials. An appeal is made for new workers to fill vacancies that have recently occurred in order that the Association may continue to function with its usual vigour and success. The following is abstracted from the Annual Report for the year 1938:— Number of cases dealt with 310, of which 206 were New Cases. The 206 new cases were referred by:— Hospitals and Medical Practitioners 91 Medical Officer of Health and Infant Welfare Centre 31 School Medical Officer and Education Department 39 Unemployment Assistance Board and Public Assistance Committee 3 Tuberculosis and Chest Clinic 31 Parents, other Agencies, etc. 11 206 41 The types of new cases were as follows:— Tuberculosis 12 Rheumatism, heart and chorea 1 Anæmia and debility 35 Lung Conditions (non-tuberculous) 37 Marasmus and Malnutrition 15 Various 106 206 The 310 cases dealt with during the year have been assisted as follows:— Sent to Sanatoria, Nursing and Convalescent Homes 198 Extensions from previous years 43 Surgical instruments provided 34 Clothing 20 Referred to other Agencies 2 Referred for Visiting and Advice 10 Parents refused treatment offered 3 310 42 Maternity and Child Welfare. Midwifery and Maternity Services. The Council's scheme, submitted and approved under the Midwives Act, 1936, was contained in my report for last year. The demand for the services of the Municipal Midwives is increasing with beneficient results. 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 30 — 30 (ii) others (d) In private practice 12 4 16 Totals 45 4 49 43 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 139 — 139 As Maternity Nurses 35 — 35 (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 355 285 640 As Maternity Nurses 182 — 182 (ii) others (d) In private practice As Midwives 196 2 198 As Maternity Nurses 45 23 68 Totals As Midwives 690 287 977 As Maternity Nurses 262 23 285 44 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—172. Total 172 (ii) in institutional practice— Number of women sent by Council per the Ante-Natal Clinics, to Forest Gate Hospital, for confinement—229, 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—21. (b) Number of children: (i) at the end of the year—27. (ii) who died during the year—1. (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. 45 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. TABLE 18. REGISTRATION OF NURSING HOMES (SECTIONS 187 to 194 OF THE PUBLIC HEALTH ACT, 1936). Return of the work of the Council during 1938. Number of Homes. Number of patients provided for:— Maternity Patients. Others. Totals. Homes first registered during the year — — — — Homes on the register at the end of year 1 4 10 14 Action during 1938:— Number of applications for registration refused (i) under proviso (a) to Section 187 (3) — (ii) „ „ (b) „ „ „ — (iii) „ „ (c) „ „ „ — (iv) „ „ (d) „ „ „ — Number of registrations cancelled under Section 188 — Number of appeals by aggrieved persons to a Court of Summary Jurisdiction, under Section 189 (3) — Number of cases in which fines were imposed — Number of inspections 3 Number of registered homes not inspected — 46 Milk. During the year under review, 11,578 lbs. of dried milk and 7,214 gallons of fresh milk were issued free, and 20,562 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, 1938, was £1,705, 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 490 Number of individual children who attended the Clinics 3,103 Total number of attendances at all Centres. (including toddlers and specials) 31,194 Total number of children who attended the Clinics for the first time during the year:— (a) Children under 1 year 1,382 (b) Children between the ages of 1—5 years (excluding examination of toddlers) 378 Number of medical consultations at general Clinics 7,366 Number of medical consultations at special Clinics 943 The daily average attendances at the Clinics were as follows: Central Clinic, Monday afternoon 69 Church Road, Monday afternoon 75 Plashet Grove, Tuesday morning 61 North Woolwich, Tuesday afternoon 16 Central Clinic, Wednesday afternoon 63 Church Road, Wednesday afternoon 60 Central Clinic, Thursday morning 58 Church Road, Thursday afternoon 72 Plashet Grove, Friday afternoon 68 Central Clinic, Friday afternoon 61 47 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 65.2. During; 1938, 3,103 children attended the centres. The total attendance of infants from 0—5 was 31,194. 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 1938, 714 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. Tonsils and Adenoids During 1938, 116 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. Ninety-six mothers and one hundred and eighty-nine infants were referred to the Dental Department during 1938. 48 Ophthalmic Treatment Ophthalmic defects requiring special treatment are seen at the special clinic each week by the School Ophthalmic Surgeon. During 1938, 54 cases were referred to the School Ophthalmic Clinic. Aural Treatment Aural cases requiring special treatment are referred to the School Aural Surgeon. During 1938, 9 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 clinics, also defects and cases of difficult feeding, and children who have been referred to the Medical Officer by the Health Visitors from their district visits. The statistics for 1938 are as follows:— Number of medical consultations 943 Notification of Births The Notification of Births Act, l915, 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. 49 The visits made by the Health Visitors during 1938 were 15,270. Visits to infants under one year of age 6171 Visits to children over one year of age 7892 Visits to tonsils and adenoid cases 59 Visits to ante-natal cases, first visits 641 Visits to ante-natal cases, revisits 45 Visits to foster mothers 149 Special visits not included in the above group 313 15270 The work of the health visitors in the Homes of the Borough. Given in the Report for the year 1937. Still Births The number of still births registered during 1938 was 68. The proportion of still births to live births was as 1 to 27. The still birth rate was 35.7 per 1,000 live and still births. On investigation it was found that in 55 cases the months of pregnancy at which the still births took place were as follows:— 7th month 3 8th month 15 9th month 37 An analysis of the causes to which the still births were attributable will be found in the following table:— Malpresentation 4 Prolonged labour 3 Contracted Pelvis 1 Excessive size of foetus (including post maturity) 2 Congenital Deformity 3 Prolapse of Cord 3 Ante-partum haemorrhage 3 Albuminuria 3 Prematurity 14 Causes unknown 32 68 50 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. During the year the following attendances were recorded:— Ante-Natal. Total number of cases attended 772 Number of new cases 653 Subsequent attendances 2055 Total number of attendances 2708 Average attendance of expectant mothers per session (excluding North Woolwich) 25.7 Post-Natal. Total number of cases attended 5 Total number of attendances 11 The following table gives an analysis of the pre-maternal cases found to be slightly or seriously abnormal:— Contracted pelvis 9 Albuminuria 14 Hyperemesis gravidarum 5 Ante-partum hæmorrhage 5 Malpresentation 8 Cervicitis 8 Valvular disease of heart 7 Varicose veins 14 Phlebitis 2 Anaemia 13 Pulmonary tuberculosis 3 Hernia 1 Fibroids 2 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 51 ante-natal supervision with care and accuracy, conditions may be present or develop which can only be discovered by medical examination. The detection and treatment of these conditions would minimise many dangers and prevent unavoidable difficulties at the confinement, thus safeguarding both mother and child. Expectant mothers are visited by the Health Visitors in their homes and given advice regarding arrangements for confinement and general hygiene of the mother. The following-up of cases also ensures regular attendance at the Clinic. During 1938, 686 visits were paid to expectant mothers. Maternity Accommodation Under the provisions of the Maternity and Child Welfare Act 1918 (Public Health Act, 1936), empowering Local Authorities to make arrangements for the institutional treatment of complicated midwifery cases, and for women whose homes are unsuitable for their confinements, the East Ham County Borough Council have provisional arrangements for the accommodation of necessitous cases requiring inpatient treatment at Forest Gate Hospital, the Maternity District Nurses' Home, Plaistow, and Queen Mary's Hospital, Stratford. During 1938, 229 cases were admitted to Forest Gate Hospital. Inspection of Midwives Fifty-three midwives notified the Local Supervising Authority of their intention to practise within the Borough during 1938—45 were on the register on 31.12.38, 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 52 hours if she has summoned medical aid during pregnancy, in a confinement, or within 10 days afterwards. During the year help was obtained in 172 cases as follows:— Mother. Ruptured perineum 73 Prolonged labour 15 Ante-partum haemorrhage 5 Post-partum haemorrhage 1 Retained placenta 10 Rise of temperature 11 Malpresentations 2 Breech 4 Albuminuria 1 Other causes 28 150 Child. Prematurity and dangerous feebleness 4 Unsatisfactory condition of infant 4 Discharging eyes 8 Other causes 6 22 Puerperal Fever and Puerperal Pyrexia. Eighteen cases of Puerperal Pyrexia were notified during the year. Maternal Mortality There were four deaths associated directly with pregnancy. The Maternal mortality rate was, therefore, 2.09 per 1,000 live and still births. Ophthalmia Neonatorum During 1938, nine cases of Ophthalmia Neonatorum were notified. 53 Voluntary Associations Appreciation and thanks are again gratefully accorded to the Invalid Children's Aid Association. Thirty-one cases were referred and received treatment. Home Helps. During 1938, 21 suitable applicants were registered as Home Helps, and 33 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. 54 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 0.2 for 1937. No cases of smallpox were reported during the year under review. Vaccinations 1938. The following figures shew the vaccinations carried out by the Public Vaccinators from 1/1/38 to 31/12/38:— Dr. O'Moore Dr. Brews Total Number of successful primary vaccinations of children under one year of age 296 17 313 Number of successful primary vaccinations of persons one year and upwards 38 1 39 Total primary vaccinations 334 18 452 Number of successful re-vaccinations 80 2 82 Scarlet Fever. Two hundred and eighty-seven notifications of this disease were received during 1938, as compared with 387 for the previous year. No deaths occurred from this cause, and 253 cases or 88.1 per cent. received hospital treatment as against 87.1 per cent. for the previous year. Diphtheria. Notifications for the year totalled 141, a decrease of 8 cases when compared with 1937. 140 cases were removed to and treated in hospital, 100 per cent. being the percentage removed for the previous year. The number of deaths was 10 or a case mortality of 7.09 per cent. There is no change in the arrangements for the supplying of antitoxin to Medical Practitioners as set out in previous years. 55 Diphtheria Immunisation Clinics. During the year 1938, 559 infants and children have been completely immunised. The total number of inoculations performed has been 1,614, of which 512 were carried out at the Town Hall Clinic, 1,025 at the Maternity and Child Welfare Clinics, 62 at the Infectious Diseases Hospital, and 15 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 512 Number inoculated three times 164 Number inoculated twice 3 Number inoculated once 2 In addition to the above, three children were inoculated four times. Maternity and Child Welfare Clinics. Total number of inoculations 1025 Number inoculated three times 307 Number inoculated twice 11 Number inoculated once 11 In addition five children received five inoculations, ten children four inoculations and one child six inoculations. Infectious Diseases Hospital. Total number of inoculations 62 Number inoculated once with A.P.T. 62 Private Practitioners. In addition to the above, during the same period 1 child was inoculated three times by a private practitioner, and six children twice. 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 136 103 72 76 63 26 19 28 19 18 11 7 7 1 450 110 26 586 56 N.B.—In considering the combined totals it will be noticed that 76.79 per cent. of the case.; are in the age group 1—5 years, 18.78 per cent. in the age group 0—10 years, and 4.43 per cent. in the group over 10 years. The Schick test for susceptibility to Diphtheria was performed during the year in 488 of completed cases, of which 466 proved negative. In 22 of the cases positive results were obtained and further inoculations were carried out. The total number of children completely immunised from 27/9/29 to 31/12/38 was 6,294, made up as follows:— Town Hall 3092 Maternity and Child Welfare 2487 Hospital 412 General Practitioners 303 Total 6294 Enteric Fever. Fifteen cases were notified as follows:—2 in July, 1 in August, 1 in September, 1 in October and 10 in December—1 death occurred. Erysipelas. Seventy-one notifications received, 22 removed to hospital, and there were no deaths. Dysentery. Eighteen cases were notified as follows:—January, 11; February, 3; June, 1; September, 2; October, 1. The cases that occurred in January were generally mild in character and corresponded in type to dysenteric cases prevalent at this time throughout the country. Bacteriological investigation was carried out in most instances. One death occurred in the Infectious Diseases Hospital. Puerperal Pyrexia. Eighteen notifications received, 14 were admitted to hospital; one death occurred. 57 Notes. Diphtheria. One hundred and forty-eight cases admitted to Infectious Diseases Hospital; 140 cases received hospital treatment. The reason for this difference is that patients were admitted from Aldersbrook Homes and Whipps Cross Hospital. Scarlet Fever. Hospital report gives 234 admissions, whereas 253 cases received hospital treatment. Nineteen cases were treated in other Authorities' Hospitals. Erysipelas. The number of notified cases of Erysipelas treated in hospitals was 22— Borough Infectious Diseases Hospital 8 Whipps Cross Hospital 11 L.C.C. Hospitals 2 London Hospital 1 22 Enteric Fever. Fifteen cases were removed to hospital, 14 to Infectious Diseases Hospital (1 case diagnosis not confirmed) 1 to St. Barts. Hospital and 1 case to East Ham Memorial Hospital. The case admitted to the Memorial Hospital died during the year 1938. 58 TABLE 19. 58 Total Cases of Notifiable Diseases, 1915-1938. Disease. 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Smallpox — — — 3 1 10 — — — — — — — 17 25 70 51 13 1 1 — — — — Scarlet Fever 499 267 341 272 530 718 1,355 502 170 215 221 350 798 832 743 484 245 779 701 979 411 359 387 287 Diphtheria 204 225 279 273 451 426 309 198 160 128 246 337 464 669 578 473 196 157 180 379 254 134 149 141 Enteric Fever 5 7 9 2 15 10 7 4 3 5 9 7 2 7 2 3 8 7 5 — 2 2 13 15 Erysipelas 96 86 66 52 72 72 57 34 32 38 41 41 38 60 49 63 54 55 69 74 55 59 53 71 Puerperal Fever 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 18 Meningococcal Meningitis 8 6 7 3 3 3 4 — 1 1 1 1 4 1 1 3 8 5 1 3 3 — 2 3 Encephalitis Lethargica Not Notifiable 4 5 7 — — 9 6 1 2 3 1 — — — 1 1 1 — 1 1 Ophthalmia Neonatorum 16 16 7 11 13 30 3 11 11 6 8 10 12 3 8 6 6 6 9 5 5 6 7 9 Ac. Polio Myelitis 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 18 Malaria Not Notifiable — — 1 — — — — — — — — — — 1 1* — — — — — Measles do do 1,650 1,404 1,538 Not Notifiable German Measles do do 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 88 101 111 85 Total 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 1,568 858 677 742 648 * Induced in an Institution. ‡ Notifiable as Puerperal Pyrexia as from 1.10.37 * Not notifiable as from 1.10.37 59 TABLE 20. Prevalence of and Control over Infectious Disease.—Notified Cases for the 52 Weeks ending 31st December, 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 287 2 78 135 138 16 16 1 1 — 31 24 29 20 15 31 16 38 29 54 253 — Diphtheria 141 2 36 66 19 7 9 1 1 — 20 15 15 19 2 23 10 6 13 18 140 10 Erysipelas 71 1 — — 3 5 7 19 27 9 9 4 5 7 7 4 8 10 9 8 22 — Puerperal Pyrexia 18 — — — — — 14 4 — — — 2 4 2 — 3 3 — 2 2 14 1 Pneumonia 85 5 8 8 1 9 5 15 12 19 4 10 10 6 6 4 9 8 8 5 19 55 80 Ophthalmia Neonatorum 9 9 — — — — — — — — 1 — — — 1 3 1 — — 3 3 — Enteric Fever 15 — — 1 4 4 4 2 — — — 1 8 4 — 2 — — — — 15 1 Meningococcal Meningitis 3 1 — — — 2 — — — — 1 1 — 1 — — — — — — 3 2 Encephalitis Lethargica 1 — — — — — — — 1 — — — — — — 1 — — — — — 2 Dysentery 18 — 2 6 3 1 3 1 2 — — 1 — 2 — 7 1 5 1 1 2 1 60 TABLE 21. Ophthalmia Neonatorum. Vision Unimpaired. Vision Impaired. Vision Lost. Still under treatment at end of year. Died. Removed from District. Not Classified. 9 — — — — — — Borough Infectious Diseases Hospital Dr. Palmer's observations are contained in the following report upon the work of the hospital:— Admissions. The number of patients admitted during the year was 544 as compared with 608 in 1937. The diminution in the number of admissions was due to the lower incidence of Scarlet Fever. The daily average number of patients in hospital during 1938 was 50. The greatest number of patients in Hospital at any one time was 85 and this figure was reached during the month of January. The number of deaths which occurred in the hospital from all causes during the year was 14 and this gives a mortality of 2.27 per cent as compared with 1.40 per cent. in the preceding year. Structural Alterations. During the year alterations were carried out in one of the cubicle wards, block B, which have resulted in a great improvement of this ward, thus making for more efficient nursing and treatment. Statistics. (a) Diphtheria. In hospital on December 31st 1937 26 Admitted during 1938 148 Discharged during 1938 143 Died during 1938 8 Remaining on December 31st 1938 23 61 (b) Scarlet Fewer. In hospital on December 31st 1937 34 Admitted during 1938 233 Discharged during 1938 244 Died during 1938 — Remaining on December 31st 1938 23 (c) Miscellaneous. In hospital on December 31st 1937 12 Admitted during 1938 162 Discharged during 1938 156 Died during 1938 5 Remaining on December 31st 1938 13 The miscellaneous admissions are set out below. Bronchitis 4 Meningitis 1 Cellulitis of leg 1 Miscellaneous observations 6 Chicken Pox 9 Dysentery 2 Mumps 9 Enteric Fever 14 No evidence disease 4 Erysipelas 8 Otitis Media 1 Erythema 3 Pneumonia 15 Hysteria 1 Rubella 10 Impetigo 2 Septic spots 2 Marasmus 1 Tonsillitis 6 Measles 55 Urticaria Papulara 1 Whooping Cough 7 Total 162 Diphtheria. One hundred and forty-eight patients were admitted to the hospital as compared with 138 during 1937 and 142 during 1936. Thus the incidence of Diphtheria remains much the same as previously. Considered as a whole the type of infection while still remaining of a moderate virulence inclined to be somewhat more severe in character than the previous year. Severe complications including pharyngeal and diaphragmatic paralysis occurred and proved fatal in three cases. Acute toxaemia resulting in circulatory collapse, was the cause of five deaths. The average duration of treatment was 50 days, the maximum being 124 days. 62 Concurrent Infections occurred as follows:— Diphtheria and concurrent Scarlet Fever 7 Diphtheria and concurrent Measles 3 Diphtheria and concurrent Whooping Cough 1 Deaths. Eight deaths occurred from Diphtheria as follows:— (a) Four cases of very severe Diphtheria (faucial). In one of these, the patient, a Woman aged 42 years died a few hours after admission to hospital. The death certificate was issued by the Coroner, after a Post Mortem examination. (b) Faucial and Nasal Diphtheria accounted for two deaths. In both cases there was very severe toxaemia. (c) Two cases of Diphtheria and concurrent Measles proved fatal. The association of Diphtheria and Measles is well known and these cases serve to emphasise its importance, two out of three cases with this double infection having a fatal termination. Serum administered: Units 8,000 16,000 24,00 32,000 48.000 up. Totals 5 12 35 47 45 144 4 cases, being carriers, and not cases of clinical Diphtheria, did not receive serum. The Serum reaction rate was 25.67 per cent. Post Diphtheritic complications occurred as follows:— Palatal paralysis, Pharyngeal paralysis, Diaphragmatic paralysis, Ciliary paralysis, Myocarditis, Arhythmia, and Others. Complications occurred in 35 patients, all of whom recovered giving a complications rate of 25 per cent. Complications occurred in eight fatal cases. The total complications rate was 25.13 per cent. Scarlet Fever. During the year 234 patients were admitted as compared with 336 during 1937. 23 patients remained under treatment at the end of the Year. The type of disease on the whole continues to be mild with occasional severe cases occurring. 63 Concurrent Infection. Four of the cases of Scarlet Fever had also Whooping Cough as an accompanying infection. The average duration of treatment was four weeks, the longest case being in hospital 107 days. The Principal Complications. Complications No. Percentage Incidence Adenitis 11 4.2 Mastoid 3 1.1 Otorrhoea 15 5.4 Rhinorrhoea 7 2.7 Endocarditis 6 2.3 Nephritis 2 0.7 Tonsillitis 4 1.5 Bronchitis 1 0.3 Pneumonia 1 0.3 Other Complications 8 3.1 Total 58 — Under other complications are included septic fingers, boils, etc. and conditions not directly due to Scarlet Fever. Serum Number of cases receiving serum 210 Number of cases not receiving serum 24 The serum reaction rate was 17.61 per cent. Enteric Fever. During the year 14 patients were admitted suffering from Enteric Fever. Nine of the cases of Typhoid Fever formed part of a small epidemic of cases that occurred in the Borough during the final fortnight of the year. Patients were discharged after bacteriological examination had shown them to be free from infection. Meningitis. One case of Pneumococcal Meningitis was admitted. The child, a girl of five years was extremely ill. She was treated by intra-muscular injections of Protosil Soluble. 80c.c. in all being 64 given. A complete recovery was made and she was discharged after five weeks in hospital. Dysentery. Two cases of Dysentery occurred in two children, a brother and sister. The causative organism was found to be B Dysenteriae Flexner. The boy who was very ill on admission died four days later. Whooping Cough. In contrast to 1937 when 37 cases were admitted to hospital, only 7 were admitted in 1938. Six of these were uncomplicated cases while one was complicated by Broncho-Pneumonia. All patients made a good recovery. Erysipelas. Eight cases of facial Erysipelas were admitted, all of whom recovered. Pneumonia and Bronchitis. Fourteen cases of primary Broncho-Pneumonia and one case of Lobar Pneumonia were admitted, all making a successful recovery. Four cases of Bronchitis were admitted of which two died. One death occurred within 18 hours of admission in a man of 53 years, who had Bronchitis and Myocardial Degeneration. In this case the death certificate was furnished by the patient's private Doctor. The second death occurred in a child of 11 months on whom a post mortem examination was performed and death was found due to Pericarditis and Pleurisy following Bronchitis. Measles. The year 1938 was a "Measles" year, fifty-five cases being admitted. These were made up as follows:— Measles 42 Measles with Pneumonia 12 Measles with Chicken Pox 1 65 The number of deaths was two, which gives a death rate of 3.64 per cent. for hospital treated cases. The cause of death in both cases was Broncho-Pneumonia. It is hoped that in future the seriousness of this disease will be more fully realized. In the treatment of Pneumonia which is the most important complication of Measles, the use of the new oxygen tent has been very successful in several cases. Operations. The following operations were performed:— Exploration of Chest 1 Lumbar Puncture 5 Mastoidectomy 3 Incision of abscesses 6 Bacteriological Examinations. During the year 2635 Swabs were examined in the Hospital for Diphtheria Bacilli and of this number 335 were found to be positive. Laboratory Work. Examination of Cerebro Spinal fluid 3 Bacteriological examination of faeces 26 Blood, Bacteriological examination 2 Bacteriological examination of Urine 10 Histological and Bacteriological examination of post mortem specimems 1 Blood Widal test and other Agglutination reactions 6 Virulence tests for Diphtheria Bacilli 8 Diphtheria Immunisation. During the year 57 patients were immunised by means of a single dose of Alum-precipitated Diphtheria Toxoid. Diphtheria Carriers. Three patients who proved to be virulent carriers following an attack of Diphtheria, were sent to the Guy's Hospital Diphtheria carrier clinic, which later reported them free from infection. 66 Infection among Staff. Six cases of Faucial Diphtheira occurred in the Staff during the year—five Nurses and one Maid. All made an uneventful recovery. TABLE 22 Admissions, Discharges, Etc., 1938—Borough Infectious Diseases Hospital. Disease. Remaining at end of 1937 Admitted during 1938 Died during 1938 Discharged during 1938 Remaining at end of 1938 Diphtheria 26 137 6 134 23 Diphtheria and Scarlet Fever — 7 — 7 — Diphtheria and Measles — 3 2 1 — Diphtheria and Whooping Cough — 1 — 1 — Scarlet Fever 33 229 — 243 19 Scarlet Fever & Chicken Pox l — — 1 — Scarlet Fever and Whooping Cough — 4 — — 4 Bronchitis — a 2 2 — Cellutis of Leg — l — 1 — Chicken Pox — 9 — 9 — Dysentery — 2 1 1 — Enteric Fever — 14 — 5 9 Erysipelas l S — 9 — Erythema — 3 — 3 — Hysteria — 1 — 1 — Impetigo — 2 — 2 — Marasmus — 1 — 1 — Measles 2 42 — 44 — Measles and B. Pneumonia 1 12 2 11 — Measles and Chicken Pox — 1 — 1 — Meningitis — 1 — 1 — Mumps 2 9 — 10 1 No evidence disease — 4 — 4 — Otitis Media — 1 — 1 — Observation 2 6 — 5 3 Pneumonia 1 15 — 16 — Rubella 2 10 — 12 — Septic Spots — 2 — 2 — Tonsillitis — 6 — 6 — Urticaria Papulara — 1 — 1 — Whooping Cough 1 7 — 8 — Stomatitis and Mastoid — 1 1 — — 72 544 14 543 5 9 67 TABLE 23 Borough Infectious Diseases Hospital Year ended 31st March, 1939. Expenditure Cost per Patient per week £ s. d. Salaries and Wages 5793 48 0 Superannuation 205 1 8 Provisions 2684 22 3 Anti-toxin 404 3 4 Disinfectants, Drugs and Appliances 289 2 5 Coal, Coke and Firewood 821 6 10 Electricity, Gas and Water 1154 9 7 Furniture, Bedding and Linen 200 1 8 Uniforms and Dresses 106 0 11 Chandlery and Sundries 557 4 7 General Repairs 354 2 11 Special Repairs and Alterations 1053 8 9 Garden Implements, Seeds, etc. 65 0 6 Maintenance and Upkeep of Ambulances 730 6 1 Printing, Stationery and Advertisements 104 0 10 Rent of Telephone 50 0 5 Rates, Taxes and Insurance 384 3 2 Cinematograph Apparatus—Films, etc. 5 — £14958 123 11 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, 1938: Total deaths 221 Males 116 Females 105 68 Classification: 1938 1937 Carcinoma 199 198 Epithelioma 6 8 Sarcoma 6 9 Malignant Parotid Tumour 1 — Malignant Papilloma 1 1 Unstated 8 3 Total 221 219 69 Table 24. 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 2 2 — — 2 3 Digestive Organs & Peritoneum — — — — — — — — — — 1 — 2 3 4 — 17 11 18 25 17 12 59 51 Respiratory Organs — — — — — — — — — — — — 1 — 6 2 8 2 9 — 2 1 26 5 Uterus — — — — — — — — — — — 1 — — — — — 2 — 2 — 1 — 6 Other Female Genital Organs — — — — — — — — — — — — — 1 — — — 2 — — — 1 — 7 Breast — — — — — — — — — — — 1 — 3 — 4 — 3 — 7 — 1 — 19 Male Genitourinary Organs — — — — — — — — — — — — — — 2 — 7 — 9 — 3 — 21 — Skin — — — — — — — — — — — — 1 — — — — — — — — — 1 — Other or Unspecified Organs — — 1 — — 1 — — 1 — — — 1 1 — 1 1 4 1 7 2 — 7 14 Totals — — 1 — — 1 — — 1 — 1 2 5 8 12 7 33 25 39 46 24 16 116 105 Note.—50°/o of deaths were from Digestive Organs and Peritoneum and an increasing number from Respiratory Organs. 70 Tuberculosis. Notifications: The number of primary notifications during the year il938 was 203 as compared with 264 for 1937. Of the primary notifications of pulmonary tuberculosis, in 29.05 per cent, tubercle bacilli were found in the sputum. In other words, 29.05 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, 1938, was 973 (pulmonary and non-pulmonary), or 7.51 per 1,000 estimated population, as opposed to 969 or 7.39 per 1,000 population in the previous year. Of these 333 (or 34.2 per cent.) were definitely infectious, i.e. cases in which tubercle bacilli have been found in the sputum at some period of the illness. Deaths: The number of deaths (1933-1938) from tuberculosis is shown below. Pulmonary Non-Pulmonary Of Cases on the Clinic Register 1933 99 16 75 ,1934 92 15 80 1935 80 16 76 1936 97 10 77 1937 80 13 84 1938 81 8 67 New Cases: The following are the comparative figures for the years 19331938:— 1933 1934 1935 1936 1937 1938 New Cases (and Contacts) 504 510 548 618 697 629 Number proved, after complete investigation, to be tuberculous 33.9% 36.4% 35.0% 29.4% 28.4% 23.5% 71 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 31.1% of new patients proving, after close investigation, to be tuberculous. Attendances and Medical Examinations. Total Attendances. Medical Examinations 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 1938 3,970 3,590 Consultations at Homes of Patients: During the year 65 visits (including 10 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. 1933 1934 1935 1936 1937 1938 533 633 762 1322 1652 1599 The increased use of these examinations since 1933, is readily observed. Dr. Philip Ellman, Consultant to the Chest Clinic, reports on the work of the Clinic as follows:— Co-operation with Local Medical Practitioners. The fact that 75.4% of cases were sent to the Clinic for an opinion before notification shows the extent of this co-operation, and this opportunity is taken of expressing indebtedness to them. 72 Co-operation with Thoracic Surgical Units at London Hospitals. The number of cases who received specialised thoracic surgical treatment during the year was twenty-five. The bulk of our cases are treated at the Thoracic Surgical Unit at the London Hospital and the Brompton Hospital, to whom we are particularly indebted. A limited number of cases have bean referred to the Royal National Hospital, Ventnor, and Papworth for such treatment. All our cases have had the great advantage of being treated by one of the Thoracic Surgeons at Brompton. The closest co-operation has been maintained with them and special points peculiar to individual cases have been discussed in detail. This co-operation between physician and surgeon is of the utmost importance and makes for continuity of treatment and the best possible results. Co-operation with Harts Sanatorium. Close follow-up of all treatments of patients initiallyseen and diagnosed at the Chest Clinic is possible by reason of the close association between the Medical Superintendent and myself. This is found to be of enormous advantage to the patients and to the ultimate results of treatment. In this connection we may not unreasonably claim that this close contact by the same physicians with the patient throughout his "tuberculosis" career i.e. in an institution and in the out-patient follow-up department, is of the greatest value. Rehabilitation and the Tuberculous Subject— The Relapse Case. It would be a wise plan, in addition to considering the tuberculous patient's lungs, to consider also his livelihood. This often causes him, not unnaturally, so much anxiety as to affect his progress. Failure to give adequate consideration to the economic position of the patient must also hold some responsibility for relapse, after so much has been spent on his treatment in the Sanatorium. It is well known that once a patient is labelled tuberculous, this may be responsible for loss of his employment, and this often spells financial ruin. The tuberculous 73 patient cannot be expected—as he so often has to do—to compete in the open market, but this does not mean that a tuberculous subject, following a full course of institutional treatment, is not employable. Many relapse cases that we have to encounter would be eliminated if an adequate rehabilitation system was established as part of the tuberculosis scheme. The prospects of the tuberculous patient require earnest consideration, and Heaf's scheme for the formation of a National Board comprising medical and industrial experts to found industrial settlements throughout the counrty for the tuberculous and to act as a labour bureau, might in the long run, prove—through an increased sense of security —as important in preventing relapse in pulmonary tuberculosis, as the closure of cavities. As Sir James Kingston Fowler used to say, "Hope and work produce vitality." There is much to be said for the wisdom of these words. An obvious necessity both for the patient with active tuberculosis and for those who have returned from sanatoria, is separate and airy sleeping quarters. Sheffield, Wakefield and Middlesborough each have special housing schemes, which might well serve as an example for us. The present compulsory reporting on housing conditions is of no appreciable value unless it leads to action. Environmental Factors in Care and After-Care. Recognising the great importance of these factors, the absence of which has often been responsible for much of the disease we meet, the greatest stress is laid on this aspect, both in treatment at the Sanatorium and in the follow-up and subsequent care of cases at the Chest Clinic. The close co-operation of the medical, nursing and clerical staff in this connection is of the utmost value, and the work of the After-Care Committee speaks for itself. It should be a first principle with tuberculosis authorities that no patient should ever return to conditions identical to those on which his breakdown originally took place. The ex-sanatorium patient needs light work, short hours and healthy conditions. It is in only a very limited number of individual cases that patients can find such work in the ordinary labour market or through the personal efforts of members of care committees. 74 Healing by Natural Resolution in Pulmonary Tuberculosis: Absolute Rest. The value of Absolute Rest in promoting natural healing of the lung in racent active cases of pulmonary tuberculosis, is now no longer questioned. In every new case of pulmonary tuberculosis seen at the Chest Clinic an initial period of Absolute Rest in bed is recommended as a routine procedure. The strict discipline of absolute rest may not be possible in all cases, but a modified form of rest is always possible. Clinical and radiological observations of the chest have shown that any fresh tuberculous, pneumonic or broncho-pneumonic process, with or without cavitation, may actually heal in a manner comparable to that observed in lobar pneumonia and broncho-pneumonia. There is, however, this distinction; the time factor for resolution in a tuberculous lung lesion is much more prolonged requiring MONTHS instead of days and weeks of complete BED REST. In the consideration of the treatment of an early case of pulmonary tuberculosis that we see both at the Clinic and the Sanatorium, the following problems arise:— 1. Is this the type of disease which is likely to show a natural tendency to resolution. 2. Under what conditions is this resolution most likely to be achieved. 3. What time factor is likely to be required. It is essential for this treatment to be successful that:— 1. Serial clinical and X-ray investigations be done. 2. The personality of the physician in securing the co-operation of the patient by a careful explanation before treatment, of all that is involved, is a sine qua non for success. Every patient should, in our view, be given an opportunity of healing by simple methods with careful X-ray control as an initial measure. By this means, some of our results have proved to be astonishing. In this type of case, therefore, collapse therapy by artificial pneumothorax, which may lead to a thoracoplasty operation later, is not justifiable, and we hold the view very strongly that if complete and prolonged rest can, unaided, 75 produce the desired results, it should be the method of choice. On the other hand, however, in selected chronic bacilliferous cases of the moderately active type, surgical intervention has proved to be a labour-saving device. Collapse Therapy: Artificiai Pneumothorax. Of those cases which fail to respond to bed rest and the Sanatorium regime alone, collapse of the diseased lung by artificial pneumothorax is invariably tried. Some 20% of our cases are subjected to this treatment. If the contra-lateral lung is diseased, a course of gold salt therapy is given simultaneously. Many remarkable results have been obtained in this way and our artificial pneumothorax follow-up service from the Sanatorium to the Chest Clinic is an established feature of the tuberculosis service in the Borough. Contra-Selective Artificial Pneumothorax. Cauterisation of Adhesions. In our experience an artificial pneumothorax, for it to be effective, must achieve the result for which it was induced, namely, such effective relaxation of the lung as to be responsible for (a) As positive sputum becoming negative; (b) effective closure of any existing cavities. Not infrequently the existence of multiple adhesions prevents these desirable objects from being achieved. If the adhesions are not too numerous, they may be cauterised with excellent results. Many of our cases have responded in this way. Extra-Pleural Pneumothorax. In selected cases the operation of extra-pleural pneumothorax will be able to deal satisfactorily with multiple adhesions. During the year about six of our cases of contra-selective artificial pneumothorax with non-cauterisable adhesions have been treated in this way. In two cases very good results were achieved. In two cases a massive hydropneumothorax resulted; the fluid gradually absorbed and inactive fibrothorax resulted. Of the remaining two cases, irregular attendances, inability to follow out instructions, and social and economic factors, were responsible 76 for unsatisfactory results. In my experience, in view of the close supervision required; the necessity for frequent refills with big pressures, and serial radiological control, these cases, after operation, should remain in Sanatorium for some months if satisfactory results are to be obtained. Early experience of the application of extra-pleural pneumothorax leads us to the view that its application is a limited one, and careful institutional control is essential for good results. Thoracoplasty. An effective partial or complete thoracoplasty in selected unilateral fibrocaseous disease with cavitation—for which BED REST or ARTIFICIAL PNEUMOTHORAX has no place—is undoubtedly the operation of choice. In association with an adequate period of post-Sanatorium treatment, the operation often proves a life-saving device. It is now our routine procedure —in collaboration with the thoracic surgeon—to inform the patient that the operation necessitates an adequate period of Sanatorium treatment subsequently. If the patient refuses this, he is informed that the operation is worthless. With such preliminary explanation, no real difficulty in obtaining the patient's co-operation has arisen. In consequence most of our results have been excellent: the collapse has been effective, cavities have been closed, a positive sputum has been rendered negative and the general health of the patient has vastly improved. Regular supervision and follow-up of these cases at the Clinic has maintained these results in the bulk of our cases. The mechanism of the closure of cavities is a complex problem which cannot here be discussed and it is only fair to point out here that in a very limited number of cases a cavity, even with what appears to be a perfect artificial pneumothorax or thoracoplasty, may not close. List of Cases subjected to thoracic surgery during the year. Twenty-five cases were submitted in all, as follows:— Thoracoplasty, 6; Extrapleural pneumothorax, 6; Cauterisation of Adhesions, 9; Bronchoscopy, 3; Lobectomy, 1. X-ray Examination of the Chest. So much of our modern knowledge of chest disease is attributable to this important method of examination that, year by year, increased use is being made, as an examination of the 77 yearly figures shows, of this procedure. There is no more exact method. (1) In diagnosis. (2) In treatment (in the exact assessment of healing). In consequence, serial films are required at intervals in order to control the patient's progress. It is sometimes said that we may possibly be too lavish in utilising X-ray facilities. Our reply must be that our first duty is to our patients. If we are unable to provide them with those essential facilities which a close study and follow-up of their diseased condition demands in the light of modern developments, the purpose of our existence is not justified. No responsible person would wish us to fail to provide these essential facilities, compatible with the needs of the patient. Tomography. This method of taking sectional radiographs of the chest was discussed in last year's report. Experience has shown that this method, whilst of undoubted value in certain cases, is a costly procedure. An average of 6/8 films may be required for each case in addition to the straight films. We have yet to be certain that the expenditure is justifiable, and for the present our method in selected cases is to study certain cases which would be suitable for tomography if we had the apparatus, by an examination in various planes according to the needs of the cases. In the close study of dense opacities, varied degree of penetration may offer greater detail and definition. In this way we have been trying to overcome any disadvantages from the lack of facilities for tomography certainly with a big financial saving. It is therefore to be hoped that this explanation of the utilisation of X-ray facilities in diagnosis and treatment will show how discriminately X-rays are used. Bronchography. The X-ray visualisation of the bronchial tree, i.e. bronchography, is a very important procedure in the diagnosis and treatment of certain chronic pulmonary diseases. The differential diagnosis of selected cases of lung tuberculosis, bronchiectasis, lung abscess and lung cancer, may depend on this examination. Various methods have been employed for the injection of 78 the iodised oil into the bronchial tree, but we have adopted a method of injecting the solution directly into the nose with the tongue held so that the mechanism of swallowing cannot take place. Prior to this, the patient's sensitivity to iodine and cocaine is tested. Given that this is satisfactory before the oil is introduced into the bronchial tree, the nose and laryngo-pharynx are anaesthetised. This simplified technique of introducing an iodised oil into the bronchial tree by direct nasal injection under local anaesthesia causes the patient the minimum of discomfort and has enabled us to solve the diagnosis of some of the most difficult of our chronic chest cases. In this way cases sent up as being suggestive of pulmonary tuberculosis, have been proved to be due, among other conditions, to lung cancer, bronchiectasis and lung abscess. Bronchoscopy. This method of examining the interior of large and even smaller bronchi by a bronchial speculum, i.e. a bronchoscope, has proved to be invaluable in certain chronic chest cases. It has been responsible for the diagnosis in many cases of (1) lung cancer arising from the bronchus, (2) simple tumours, (3) obtaining a positive sputum in certain difficult chest cases, where every known method has failed to detect this, etc. In cases of foreign bodies inhaled by children, it has been invaluable and sometimes a life-saving device. We are greatly indebted to Mr. Ormerod of the Bronchoscopic Clinic at Brompton Hospital for his help and co-operation. Cancer of the Lung. I have in previous reports emphasised the increased number of cases of cancer of the lung that are seen at the Chest Clinic. The symptons and signs often closely resemble those of pulmonary tuberculosis, and local practitioners, not unreasonably, refer them as suggestive of pulmonary tuberculosis. The assistance derived from X-ray films in varied planes, bronchograms and bronchoscopy in these cases is invalauble. These procedures in the numerous obscure cases seen at the Chest Clinic are the only definite means of establishing an accurate diagnosis and enabling us definitely to dismiss the question of pulmonary tuberculosis. 79 Dental Treatment in Pulmonary Tuberculosis. A large proportion of our cases of pulmonary tuberculosis who are recommended for Sanatorium treatment, have septic mouths and additional facilities for treatment are under consideration. Adolescent Contacts. Preventive Examinations. It is still, all too unfortunately, a fact that the most fruitful source of all contact work lies more particularly in the examination of all adolescent patients, especially girls of the 15—25 age period who have been in contact with a case of pulmonary tuberculosis. As I have emphasised on previous occasions, whilst we are able to get hold of child contacts with little difficulty, a very insignificant number of cases of pulmonary tuberculosis is found among this source. Most unfortunately there is much more difficulty in getting the adolescents to attend the Clinic for investigation. Often the parents, who are more than willing that they should attend, have no control over them, and in numerous instances at a later date we experience the tragedy of this failure of preventive examination. The Sisters are all more than aware of the importance of the complete examination of all adolescent contact cases of pulmonary tuberculosis with a positive sputum and ready acknowledgment is due to them for their invaluable efforts in this important field of preventive medicine. Quite recently, for example, a young girl of twenty-three was found to be suffering from pulmonary tuberculosis with a positive sputum. A few days later, on examination of the contacts, a brother and sister, aged twenty-one and eighteen respectively, were found also to be suffering from pulmonary tuberculosis. 80 TABLE 25. Return showing the work of the Tuberculosis and Chest Clinic, 1938. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 62 42 1 — 2 6 4 2 64 48 5 2 119 (b) Diagnosis not completed — — — — — — — — 16 15 2 — 33 (c) Non-tuberculous — — — — — — — — 88 101 20 17 226 B.—Contacts examined during the year:— (a) Definitely tuberculous 3 16 4 5 — — 1 — 3 16 5 5 29 (b) Diagnosis not completed 3 6 5 3 17 (c) Non-tuberculous — — — — — — — — 55 72 36 42 205 C.—Cases written off the Clinic Register as:— (a) Recovered 2 4 1 — 1 2 5 1 3 6 6 1 16 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Clinic Register as tuberculous) — — — — — — — — 153 186 60 63 462 D.—Number of Cases on Clinic Register on December 31st, 1938 (a) Definitely tuberculous 370 347 24 12 62 90 51 17 432 437 75 29 973 (b) Diagnosis not completed — — — — — — — — 19 21 7 3 50 81a TABLE 26. Pulmonary Tuberculosis. Supplementary Annual Return showing in summary form (a) the condition at the end of 1938 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 1928 1928 1929 1930 1931 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total(Class T.B. Plus) Group 1 Group 2 Group 3 Total(Class T.B. Plus) Group 1 Group 2 Group 3 Total(Class T.B. Plus) Group 1 Group 2 Group 3 Total(Class | T.B. Plus) Group 1 Group 2 Group 3 Total(Class T.B. Plus) (a) Remaining on Dispensary Register on 31st December. 1 Disease Arrested Adults M. 16 5 5 — 10 1 1 1 — 1 1 2 1 — 3 1 — — — — F. 6 — 4 4 1 — — — 2 — — — — 1 1 — — 1 — — — — — Children 6 — — — — 1 — — — — 3 — — — — 1 — — — — — — — — — Disease not Arrested Adults | M. 11 4 14 1 19 3 3 2 — 5 2 1 2 — 3 8 2 5 — 7 5 2 2 — 4 P. 13 6 12 — 18 3 5 2 7 2 3 1 2 6 8 — 8 — 8 7 3 6 — 9 Children 6 — — — — 1 — — — — 2 — — — — 1 — — — — — — — — — Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st Dec. 58 15 35 1 51 11 9 4 — 13 11 4 4 2 10 20 5 14 — 19 13 5 8 — 13 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults | M. 24 5 1 — 6 2 — — — — 2 — — — — 1 — — — — — — — — — P. 23 2 — — 2 4 — — — — 3 — — — — — — — — — — — — — — Children 28 — — — — 1 — — — — — 1 — — 1 1 — — — — 1 — — — — Lost sight of or otherwise removed from Dispensary Register 447 62 107 6 175 65 19 23 3 45 53 10 28 — 38 28 9 13 4 26 22 11 19 4 34 Dead Adults M. 56 15 113 52 180 10 3 25 10 38 5 4 25 16 45 7 6 17 22 45 4 1 17 6 24 F. 35 12 71 42 125 4 6 10 10 26 7 3 10 6 19 3 4 13 11 28 7 6 19 10 35 Children 10 1 1 2 4 1 — 1 1 2 — — — — — — — — 2 2 — — — — — Total written off Dispensary Register 623 97 293 102 492 87 28 59 24 111 70 18 63 22 103 40 19 43 39 101 34 18 55 20 93 Grand Totals 681 112 328 103 543 98 37 63 24 124 81 22 67 24 113 60 24 57 39 120 47 23 63 20 106 1932 1933 1934 1935 1936 | (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 3 1 1 — 2 4 — — — — 1 — — — — — — — — — — — — — — F. 1 2 — — 2 — — — — — 1 — — — — — — — — — — — — — — Children — — — — — 1 — — — — 1 — — — — — — — — — — — — — — Disease not Arrested Adults M. 6 1 4 — 5 9 1 2 — 3 7 4 11 2 17 18 6 8 1 15 23 1 16 4 21 F. 6 — 4 — 4 13 — 4 — 4 6 4 9 1 14 16 — 10 — 10 23 2 13 1 16 Children 2 — — — — 8 — — — — 6 1 1 1 3 8 — — — — 8 — — — — Condition not ascertained during the year 1 — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st Dec. 19 4 9 — 13 35 1 6 — 7 22 9 21 4 34 42 6 18 1 25 54 3 29 5 37 (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 37 5 25 — 30 28 8 31 3 42 23 9 14 1 24 23 5 17 2 24 27 1 16 4 21 Dead Adults M. 4 4 21 6 31 4 1 21 10 32 4 1 17 18 36 4 1 11 19 31 2 — 8 7 15 F. 5 3 13 9 25 6 2 9 6 17 1 1 12 10 23 1 1 9 8 18 3 1 5 7 13 Children 1 — 2 — 2 — — — — — 3 — — — — 1 — — 1 1 — — — — — Total written off Dispensary Register 47 12 61 15 88 38 11 61 19 91 31 11 43 29 83 29 7 37 30 74 32 2 29 18 49 Grand Totals 66 16 70 15 101 73 12 67 19 98 53 20 64 33 117 71 13 55 31 99 86 5 58 23 86 1937 1938 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. — — — — — — — — — — F. — — — — — — — — — — Children — — — — — — — — — — Disease not Arrested Adults M. 23 6 25 2 33 32 3 22 1 26 F. 22 3 25 2 30 35 4 18 — 22 Children 14 — — — — — — — — — Condition not ascertained during the year — — — — — — — — — — Total on Dispensary Register at 31st Dec. 59 9 50 4 63 76 7 40 1 48 (b)Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — F. — — — — — — — — — — Children — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 14 4 10 3 17 1 — — — — Dead Adults M. 4 — 5 7 12 1 — 3 7 10 F. — — 1 4 5 1 — — 1 1 Children — — — — — 1 — — — — Total written off Dispensary Register 18 4 16 14 34 4 — 3 8 11 Grand Totals 77 13 66 18 97 80 7 43 9 59 81b TABLE 27. Non-pulmonary Tuberculosis. Supplementary Annual Return showing in summary form (a) the condition at the end of 1938 of all remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. patients Condition at the time of the last record made during the year to which the return relates Previous to 1928 1928 1929 1930 1931 Bones and |Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December, Disease Arrested Adults M. 3 — 1 — 4 1 — — — 1 1 — — — 1 — 1 — — 1 — — — — — F. 2 — — 1 3 — — — 1 1 — — — — — — — — — — — — — — — Children 2 — — 10 12 2 — — 3 5 — — — 1 1 1 — 1 2 4 — — — — — Disease not Arrested Adults M. 2 — 4 — 6 1 — 1 — 2 1 — — — 1 — — — — — — — — — — F. 3 — 1 2 6 — — — 1 1 — — — — — — — 1 1 2 — 2 2 — 4 Children 7 1 — 10 18 2 — — 3 5 2 2 — 1 5 — — — 1 1 1 — — — 1 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st Dec. 19 1 6 23 49 6 — 1 8 15 4 2 — 2 8 1 1 2 4 8 1 2 2 — 5 Transferred to Pulmonary 2 — 1 2 5 — — — 1 1 1 — — — 1 — — — — — — — — — — (b) Not now on Dispensary Register | and reasons for removal therefrom. Discharged as recovered Adults M. 6 — 2 2 10 — — — — — — — — — — — — — 2 2 — — — 1 1 F. 4 1 1 2 8 — — — — — — 1 — — 1 — — — — — — — 1 — 1 Children 9 4 3 24 40 — — — — — 1 — — 3 4 1 — — 1 2 — — — — — Lost sight of, or otherwise removed from Dispensary Register 83 15 28 125 251 — 2 5 15 22 9 3 4 25 41 1 4 4 17 26 7 1 3 12 23 Dead Adults M. 2 1 1 — 4 1 — — — 1 — — — — — 1 — 2 — 3 — — — — — F. 4 — — — 4 1 — — — 1 — — — — — — — — — — — — — — — Children 4 — 1 — 5 — — — — — — — — 1 1 — — — 1 1 1 — — — 1 Total written off Dispensary Register 112 21 36 153 322 2 2 5 15 24 10 4 4 29 47 3 4 6 21 34 8 1 4 13 26 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 131 22 42 176 371 8 2 6 23 39 14 6 4 31 55 4 5 8 25 42 9 3 6 13 31 1932 1933 1934 1935 1936 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. — — — — — — — — 1 1 — — — — — — — — — — — — — 1 1 F. — — — — — — — — — — — — — 1 1 — — — — — 1 1 1 — 3 Children 1 — — 2 3 2 — — 3 5 1 — — 6 7 — 1 — 5 6 — — — 6 6 Disease not Arrested Adults M. — — — — — 1 1 — — 2 1 — — — 1 2 — 1 1 4 1 — 1 — 2 F. 2 — — 1 3 2 — — 1 3 3 — — 2 5 2 — 1 1 4 2 — — 3 5 Children 5 4 — 3 12 3 1 — 2 6 — 1 1 — 2 2 1 — 5 8 1 — — 2 3 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st Dec. 8 4 — 6 18 8 2 — 7 17 5 1 1 9 16 6 2 2 12 22 5 1 2 12 20 Transferred to Pulmonary — — — — — — — — — — — — — — — — — — — — — — — — — (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — 1 1 — — — — — Lost sight of, or otherwise removed from the Dispensary Register 8 2 3 7 20 4 5 4 6 19 4 1 2 7 14 — 1 2 3 6 2 1 1 3 7 Dead Adults M. 2 — — — 2 — — — — — 2 — — — 2 — — 1 — 1 — — 1 — 1 F. 1 — 1 — 2 — — 1 1 2 — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — — — 1 2 Total written off Dispensary Register 11 2 4 7 24 4 5 5 7 21 6 1 2 7 16 — 1 3 4 8 3 1 2 4 10 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 19 6 4 13 42 12 7 5 14 38 11 2 3 16 32 6 3 5 16 30 8 2 4 16 30 1937 1938 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. — — — — — — — — — — F. — — — — — — — — — — Children — — — 2 2 — — — — — Disease not Arrested Adutls M. 1 — 2 2 5 — — 2 — 2 F. 2 3 2 3 10 3 — 2 1 6 Children 3 1 — 7 11 — 1 — 5 6 Condition not ascertained during the year — — — — — — — — — — Total on Dispensary Register at 31st Dec. 6 4 4 14 28 3 1 4 6 14 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 6 — 1 — 1 2 Dead Adults M. — — — — — — — — — — F. — — — — — — — — — — Children — — — — — — — — — — Total written off Dispensary Register 1 1 1 3 6 — 1 — 1 2 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 7 5 5 17 34 3 2 4 7 16 81 1. Number of cases on Clinic Register on January 1st, 1938 1000 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 39 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 10 4. Cases written off during the year as Dead (all causes) 67 5. Number of attendances at the Clinic (including Contacts) 3709 6. Number of Insured Persons under Domiciliary Treatment on the 31st December, 1938 27 7. Number of consultations with medical practitioners:— (a) Personal 10 (b) Other 498 8. Number of visits by Tuberculosis Officers to Homes ing personal consultations) 65 9. Number of visits by Nurses or Health Visitors to Homes for Clinic purposes 5400 10. Number of (a) Specimens of sputum, &c., examined 911 (b) X-ray examinations made (inclusive of both film and screen examinations) 1599 in connection with Clinic work. 11. Number of "Recovered" cases restored to Clinic Register, and included in A (a) and A (b) above — 12. Number of "T.B. plus" cases on Clinic Register on the 31st December, 1938 333 Number of Clinics for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 1 82 After History for five years of 249 New Gases of Tuberculosis reported from all sources in 1933. 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 Country Council Report, of the cases to show how they fared during the five years succeeding 1933, that is to 1938, 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, 1933, has been followed up (if living and still tuberculous) until May, 1938. The following noteworthy features are presented 1. 78.7 per cent of the gross number of new tuberculous cases coming to our knowledge in the County Borough of East Ham during 1933 were dealt with under the tuberculosis scheme. A further 3.6 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 17.66 per cent. of the gross number did not come directly under the Council scheme were: (a) Cases reported at death only 8.03 per cent.; (b) cases dying within several weeks (average three weeks) of notification, 3.21 per cent. ; (c) cases removing from the County Borough area several days after notification, 2.41 per cent.; and (d) patients declining to have treatment under the official Council scheme 4.01 per cent. 3. Of the 162 pulmonary cases, 74 per cent. received one or more periods of sanatorium or hospital treatment; of 34 nonpulmonary cases, about nine-tenths received special treatment at a hospital (e.g. orthopaedic and artificial light). 4. Of the net number (109 of definite pulmonary cases, removals from the area, etc., excluded) 66 died from tuberculosis within the five years (43.9 per cent dying in the first year, 21.2 in the second year, 15.1 per cent. in the third, 10.6 per cent. in the fourth, and 9.1 per cent. in the fifth). 83a TABLE 28 CHART SHOWING HISTORY FOR FIVE YEARS OF 249 NEW CASES OF TUBERCULOSIS REPORTED FROM ALL SOURCES IN 1933. 83 It is estimated that 57 cases of the 249 new cases were cases of adolescent phthisis, and as noted in last year's annual report the fact is again verified that at least one in every five occurred between the 15—25 years period. Dental Treatment of Tuberculous Patients. Subject to the approval of the Committee, Dental Treatment, including the provision of dentures, is given in certain instances to non-insured patients and help is afforded in respect of some insured patients. The amount expended during- the year totalled £19 19s. 6d. Harts Sanatorium. STATISTICS. Discharges, including deaths: 157 (89 M., 66 F., 2 Ch.). Deaths: 14 (12 M., 2 F.). Insured patients: 114 (73 M., 41 F.). Non-insured patients: 43 (16 M., 25 F., 2 Ch.). Average duration of treatment: 24.56 weeks. Number of patient-days: 25,229. ,, ,, beds available at end of year: 80 (78 Ad., 2 Ch.). Average number of beds occupied: 69.12 (86.4%). Admissions by ambulance: 49 (25 M., 24 F.). From Hospitals 25 (15 M., 10F.) From Home 24 (10 M., 14 F.) Of the cases discharged or deceased, 22 had already had one course of treatment at Harts (11 M., :11 F.) ; and 12 (9 M., 3 F.) had had two courses. Immediate Results of Treatment. Discharged Quiescent, including 1 observation case notified as tuberculous 62 (31 M., 31 F.) Discharged Non-quiescent including 2 observation cases notified as tuberculous 60 (32 M., 27 F., 1 Ch.) Of these were Improved 46 (24 M., 21F., 1 Ch.) Not Improved including one nonpulmonary case of tuberculous Irido-Cyclitis 14 ( 8 M., 6 F.) 84 Observation Cases. Of the 16 observation cases: 3 were found to be suffering for Pulmonary losis ; 5 were cases of Bronchiectasis; 4 were diagnosed as cases of chronic focal pneumonia- non-Tuberculous; 1 patient discharged himself against advice after 9 days stay and before investigations could be completed; 1 patient who died, was found after examination to have been suffering from Cancer of the right lung; 2 cases found to be suffering from lung carcinoma were transferred. Eleven lipiodol examinations were carried out in order to facilitate diagnosis. Complications. (a) Tuberculous. Larynx, 4; Bowel, 3; Epididymitis, 1; Otitis Media, 1; Ischo-restal fistula, 1; Teno-synovitis left hand, 1. (b) Non-tuberculous. Bronchitis and Emphysema, 5; Bronchiectasis, 2; Diabetes, 2; Psoriasis, ,1; Asbestosis, 2; Anaemia, 1; Arterio-sclerosis, 1; Rheumatic Carditus, 1. 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. Artificial Pneumothorax. Twenty-seven inductions were performed, 10 of which were discontinued after a short period, since adhesions, impracticable 85 to divide, prevented good collapse. In addition 2 attempted inductions were tried, without success. In all, 527 refills were given during the year. Continual use of the X-ray plant has been made in controlling these cases. Where complete collapse of the lung is prevented on account of small adhesions a division of these is often possible by means of the cautery. Ten cases were admitted to Hospital for this treatment; two, where the diagnosis was doubtful, were sent for Bronchoscopy, and one case was admitted to the London Hospital for Thoracoplasty. Gold Salts. Twenty courses of treatment commenced in 1937, were completed. 68 courses were commenced in 1938, of which 18 were current at the end of the year. 70 courses ended during the year, of which 49 were full courses. 21 courses were imcomplete for the following reasons:— (a) Complications of the treatment: albuminuria, 4; buccal ulcers, 1; loss of weight, 1. Complications were fewer during the year, and where signs of development were observed, the addition of Calcium Gluconate, injected intra-muscularly at the same time as the Gold Salts, was thought to have a beneficial effect in preventing them. (b) Marked deterioration in general condition, 4. (c) Patients who discharged themselves, 5. (d) Transferred, 1. (e) Short courses of 1 gm., 5. Of the 49 full courses given to patients discharged during the year, 10 cases were considered quiescent; 37 improved, and 2 not improved. Tuberculin Courses of Tuberculin were continued in selected cases, in order to promote fibrosis, and where carefully given, were thought to have a beneficial effect. Insulin Continued use of this preparation was made to stimulate appetite, in cases which it was hoped to benefit. In a number of cases, good results were obtained; a few patients derive no benefit. 86 Bacteriology. A monthly sputum examination is dons at each routine clinical examination, and including special examinations, 727 specimens of sputum were examined. All pleural fluids withdrawn are also examined microscopically. With the provision of a laboratory in the new building, it is hoped that adequate provision in material and personnel will be made so that the scope of this very necessary service may be enlarged to suit the needs of a modern sanatorium. Radiography. The Radiographer visits every Wednesday afternoon, and deals with all films required. During 1938, 439 films were taken. Dental Treatment. Numerous patients come to the Sanatorium suffering from pyorrhoea and carious teeth, which are detrimental to health, and prevent proper mastication and digestion of food. It is a good opportunity for such dental cases to be dealt with while they are in the Sanatorium; necessary extractions might be done in twos or threes over a period, with the necessary rest for healing between. The provision of a regular dental service for inspection and extractions is strongly urged, so that this important aspect of the patients' well-being may not be further neglected. Occupational Therapy: Every patient who is considered fit enough, and who has been graded to a certain stage, is expected to undertake some form of handicraft work under the guidance of Miss Ross Smith. It is rare for a patient to intimate his want of appreciation of this feature of the treatment. Work is done by patients sitting up in bed, as well as by those who are up, and there is no doubt that the work is of great value in lessening the tedium of bed rest. 87 Consultations Dr. Philip Ellman continues his fortnightly visit to the Sanatorium, and sees and discusses cases and their treatment. Complete liaison exists between the Sanatorium and the Chest Clinic, and is of the utmost value in furthering the good of the service. The continued kindness of the Greatfield Players and others is greatly appreciated, for their able presentation of entertainments, for the patients' amusement. TABLE 29. HARTS SANATORIUM—Year ended 31st March, 1939. Expenditure Cost per Patient per week £ s. d. Salaries and Wages 3987 21 8 Superannuation 133 0 9 Provisions 2763 15 0 Disinfectants, Drugs and Appliances 301 1 8 Coal, Coke and Firewood 434 2 4 Electricity, Gas and Water 797 4 4 Furniture, Bedding and Linen 200 1 1 Uniforms and Dresses 61 0 4 Chandlery and Sundries 397 2 2 General Repairs 197 1 1 Special Repairs and Alterations 280 1 6 Garden Implements, Seeds, etc. 75 0 5 Haulage 25 0 2 Printing, Stationery and Advertisements 75 0 5 Rent of Telephones 34 0 2 Rates, Taxes and Insurance 297 1 8 Motor Car Allowance—Resident M.O. 60 0 4 X-Ray Examinations 74 0 5 Occupational Therapy 165 0 11 Lopping and Felling Trees 120 0 8 10475 57 1 88 TABLE 30. Number of Beds available for the Treatment of Tuberculosis on the 31st December 1938 in Institutions belonging to the Council. Name of Institution For Pulmonary For Non- Cases Pulmonary Cases Total Adults Children under 15 Adults Children under 15 The Harts Sanatorium, Woodford Green, Essex 78 2 - — 80 89 TABLE 31. Return showing the extent of Residential Treatment and Observation during the Year 1938 in Harts Sanatorium. In Institution on J an. 1 Admitted during the year. Discharged during the year Died in the Institution. In Institution on Dec. 31. (1) (2) (3) (4) (5) Number of doubtfully tuberculous cases admitted for observation Adults Children M. 1 11 11 1 - F. 1 2 3 — — ... 1 — 1 — — Total ... ... 3 13 15 1 — Number of ents suffering from pulmonary tuberculosis Adults Children M. 40 78 66 11 41 ...F. 28 64 60 2 30 ... 1 — 1 — — Total ... ... 69 142 127 13 71 Number of patients suffering from nonpulmonary tuberculosis Adults Children M. - - - - - F. — 1 1 - — ... — — — - — Total ... ... — 1 1 — — Grand Total 72 156 143 14 71 TABLE 32. RETURN SHOWING THE RESULTS OF DOUBTFULLY TUBERCULOUS CASES DISCHARGED DURING THE YEAR 1938 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 — — — 2 1 — — — — — — — 2 1 — Non-tuberculous 3 2 — 3 — 1 — — — — — — 6 2 1 Doubtful +1 — — *3 — — — — — — — — 4 — — Totals 4 2 — 8 1 1 - - - - - - 12 3 1 †Subsequently died of Bronchiectasis. * 2 subsequently notified as Pulmonary Tuberculosis. 1 subsequently diagnosed and died of Carcinoma. TABLE 33. Return showing the immediate Results of Treatment of definitely Tuberculous patients discharged during the Year 1938 from Harts Sanatorium. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months, but exceeding 28 days. 3-6 months. 6—12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Pulmonary Tuberculosis. | Class T.B. minus. Quiescent 5 4 - 9 5 - 3 4 - - - - 17 13 30 Not quiescent — — — 2 — — — 1 1 — — — 2 1 1 4 Died in Institution — — — 2 — — — — — — — — 2 — — 2 Class T.B. plus Group 1. Quiescent - - - - 1 - 2 2 - - - - 2 3 - 5 Not quiescent — — — 1 — — 1 2 — — — — 2 2 — 4 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus Group 2. Quiescent 3 1 - 4 7 - 1 6 - 2 1 - 10 15 - 25 Not quiescent 7 4 — 9 5 — 4 6 — 2 2 — 22 17 — 39 Died in Institution 1 — — 3 1 — — — — 1 — — 5 1 — 6 Class T.B. plus Group 3. Quiescent - - - 1 - - - - - 1 - - 2 - - 2 Not quiescent — 1 — 2 2 — 4 3 — — — — 6 6 — 12 Died in Institution — 1 — 1 — — 1 - - - - - 2 1 — 3 Totals (pulmonary) 16 11 — 34 21 — 16 24 1 6 3 — 72 59 1 132 90 TABLE 33—continued. Classification on admission to the Institution. Condition at time of discharge Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months, but exceeding 28 days. 3-6 months. 6-12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Non-Pulmonary Tuberculosis. Bones and Joints. Quiescent Not quiescent — — — — — — — — — — — — — — — - Died in Institution — — — — — — — — — — — — — — — - Abdominal. Quiescent - - - - - - - - - - - - - - - - Not quiescent - — — - - - - — - - - - - — — - Died in Institution — — — — — — — — — — — — — — — — Other Organs. Quiescent - - - - - - - - - - - - - - - - Not quiescent - 1 — — — — — — — — — — — 1 — 1 Died in Institution - — — — — — — — — — — — — — — Peripheral glands. Quiescent - - - - - - - - - - - - - - - - Not Quiescent - — — — — — — — — — — — — — — - Died in Institution - — — — — — — — — — — — — — — - Totals (non-pulmonary) — 1 — — — — - — — — — — — 1 — 1 91 92 TABLE 34. Return showing the extent of Residential Treatment and Observation during the Year 1938 in Institutions (other than Poor Law Institutions) approved for the Treatment of Tuberculosis (including Harts Sanatorium). In Institutions on J an. 1 Admitted during the year. Discharged during the year. Died in the Institutions. In Institutions on Dec. 31. (1) (2) (3) (4) (5) Number of doubtfully tuberculous cases admitted for' observation Adults M. 1 11 11 1 - F. 1 2 3 — — Children ... 1 — 1 - — Total ... ... 3 13 15 1 — Number of patients suffering from pulmonary tuberculosis Adults M. 44 97 76 20 45 F. 35 81 72 3 41 Children ... 8 17 17 — 8 Total ... ... 87 195 165 23 94 Number of patients suffering from nonpulmonary tuberculosis Adults M. 5 1 4 — 2 F. 7 6 12 — 1 Children ... 16 3 14 — 5 Total ... ... 28 10 30 — 8 Grand Totals (a), (b) & (c) ... ... 118 218 210 24 102 TABLE 35. Return showing the extent of Residential Treatment provided during the year 1938 in poor law institutions for Persons Chargeable to the Council. In Institutions on J an.1 Admitted during the year. Discharged during the year. Died in the institutions. In Institutions on Dec. 31. (1) (2) (3) (4) (5) Number of patients suffering from pul-) m onary tuberculo-■ sis j \dults M. 3 13 7 6 3 F. 3 14 11 5 1 Childien ... — 1 1 — Total 6 28 19 11 4 Number of patients suffering from non-1 pulmonary tuber- j culosis ' vaults M I I F. — 2 1 — 1 Chil- df (n — — — — — Total ... — 3 2 — 1 Grand Total ... 6 31 21 11 5 93 TABLE 36 Return showing the Results of Observation of Doubtfully Tuberculous Cases Discharged during the year 1938 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. T uberculous — — — 2 1 — — — — — — — 2 1 — Non-tuberculous 3 2 — 3 — 1 — — — — — — 6 2 1 Doubtful +1 — — *3 — — — — — — — — 4 — — Totals 4 2 8 1 1 - - - - - - 12 3 1 †Subsequently died of Bronchiectasis. * 2 subsequently notified as Pulmonary Tuberculosis. 1 subsequently diagnosed and died of Carcinoma. TABLE 37. RETURN SHOWING THE IMMEDIATE RESULTS OF TREATMENT OF DEFINITELY TUBERCULOUS PATIENTS DISCHARGED DURING THE YEAR 1938 FROM INSTITUTIONS (OTHER THAN POOR LAW INSTITUTIONS) APPROVED for the TREATMENT OF TUBERCULOSIS (including HARTS SANATORIUM). Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months, but exceeding 28 days. 3-6 months. 6-12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Pulmonary Tuberculosis. Class T.B. minus. Quiescent 5 4 - 9 5 1 3 5 2 - - 2 17 14 11 42 Not quiescent 1 — 1 2 — — — 1 3 — 1 1 3 2 5 10 Died in Institution — — — 2 - - - - - - - - 2 — — 2 Class T.B. plus Group 1. Quiescent - - - - 1 - 2 2 - - - - 2 3 - 5 Not quiescent — — — 1 1 - 1 2 — — — — 2 3 - 5 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus Group 2. Quiescent 3 1 - 4 7 - 2 6 - 2 1 - 11 15 - 26 Not quiescent 12 8 — 9 6 — 4 6 - 2 2 - 27 - 49 Died in Institution 1 1 — 4 1 — — — — 1 — — 6 2 — 8 Class T.B. plus Group 3. - - - 1 - - - - - 1 - - 2 - - 2 Not quiescent — 2 — 2 2 — 4 3 - - - - 6 7 — 13 Died in Institution 2 1 — 3 — 2 - - - - - 7 1 — 8 Totals (pulmonary) 24 17 1 37 23 1 18 25 11 6 4 3 85 69 16 170 94 TABLE 37—continued. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months, but exceeding 28 days. 3-6 months. 6-12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Non-Pulmonary Tuberculosis. Bones and Joints. Quiescent - - - - 1 2 - 3 - 1 2 3 1 6 5 12 Not quiescent — 1 - 1 — — — — 1 1 2 Died in Institution - - - - - - - - - - - - - - - — Abdominal. Quiescent - - - - - - - 1 2 - - - - 1 2 3 Not quiescent - - — — — 1 - - - - - - - - 1 I Died in Institution - - — — — - — - — - — - — — — — Other Organs. Quiescent - 1 - - - - - - - - - - - 1 - 1 Not quiescent 1 - — — — - 2 - - - - - 3 1 — 4 Died in Institution - - - - - - - — - — - - — — — — Peripheral Glands. Quiescent - - 1 - - 2 - 2 - - - 2 - 2 5 7 Not quiescent - - — — — - - — — — — — — — — — Died in Institution - - — — — - - — - — - — — — — — Totals (non-pulmonary) ... 1 3 1 — 1 5 2 6 3 1 2 5 4 12 14 30 95 96 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 Pulmonary Males — — — — 1 2 3 3 2 1 — 12 „ Females — 1 — — 2 1 4 3 1 — 1 13 Non-pulmonary Males — 1 3 3 — 1 — 1 — 1 - 10 „ Females 1 1 — — — 1 2 - — — 1 6 TABLE 38. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications During the period 1.1.38 to 31.12.38. Age periods. Formal Notifications. Number of Primary Notifications of new cases of tuberculosis. Total notifications. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35—45 45-55 55-65 65 & over Total (all ages) Pulmonary Males - - 4 — 9 17 20 9 10 9 1 79 81 ,, Females 1 1 2 — 15 15 18 11 — 2 2 67 68 Non-pulm. Males — 1 5 — 1 — — 1 — — 8 9 „ Females - 1 - - 1 1 2 3 - - - 8 11 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 3 transferable deaths from Registrar General 3 1 Posthumous notifications 1 2 "Transfers" from other areas (other than transferable deaths) 19 10 Other sources if any (specify) — — 97 Notification Register. Number of cases of Tuberculosis remaining at the 31st December 1938, on the Registers of Notifications kept by the Medical Officer of Health Pulmonary Non-pulmonary Total Males Females Total Males Females Total Cases 507 461 968 149 135 284 1.252 Number of cases removed from Registers during the year by reason of:— 1. Withdrawal of notification 1 1 2 3 — 3 5 2. Recovery from the disease 3 4 7 6 3 9 16 3. Death (all causes) 53 29 82 8 3 11 93 4. Otherwise 29 18 47 5 18 23 70 TABLE 39. Notified Cases of Tuberculosis, 1938. Ages. Pulmonary Abdominal. Meninges. Bones and Joints. Glands. Other Organs. Disseminated. All forms. Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Under 1 year — 1 1 - 1 1 - - - - - - - - - - - - - - - - - — 1 and under 2 — 1 1 - - - - - - - - - - - - - - - - - — — 2 2 2-3 - - - - - - - - - - - - - - - - - — - - — — 1 1 3-4 — — - - - - - - - - - - 1 1 2 - - — - - — 1 1 2 4-5 — 1 1 - - - - - - - - - - - - - - - - - — 1 1 2 5-10 4 2 6 - - - 2 - 2 - - - - - - - - - - - — — 1 1 10-15 - - - 1 - 1 - - - - - - - - 5 - - - - - — 12 2 14 15-20 10 17 27 - - - - - - - - - - - — - - — - - — 3 - 3 20-25 19 16 35 - - - - - - - - - - 1 1 1 - 1 - - - 11 18 29 25-35 ?3 9? 45 - - - - - - - 2 2 - - — 1 - 1 - - — 20 18 38 35-45 12 14 26 - - - - - - - 2 2 2 - - — - 1 1 - - — 23 26 49 45-55 12 1 13 - - - - - - - - - - - - - - 2 - - — 13 17 30 55-65 10 2 12 - - - - - - - - - - - - 1 - 1 - — — 13 1 14 Over 65 1 3 4 - - - - - - - - - - - - - - - - - — 11 2 13 - - - - - - - - - - - - - - - - - - - - — 1 4 5 Totals 91 80 171 1 2 3 2 — 2 3 6 9 7 4 11 5 2 7 - — — 109 94 203 98 99 Table 40. Tuberculosis. New Cases and Mortality, 1938. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. M. F. M. F. M. F. M. F. Under 1 year - 1 - - - 1 - - 1—5 yrs - 2 2 2 — — 3 1 5—15 „ 4 2 11 — — — 1 — 15—25 „ 29 33 2 3 7 8 — 1 25—45 „ 35 36 1 7 22 16 1 1 45—65 „ 22 3 2 — 20 4 — — 65 and upward ,, 1 3 - 1 - 3 - - Totals 91 80 18 14 49 32 5 3 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. 100 East Ham Tuberculosis After Care Committee. The Committee under the Chairmanship of Mrs. Councillor E. M. C. Brace has continued to do excellent work. One hundred and twenty-two 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 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 48 sessions have been held in the Tuberculosis and Chest Clinic, the attendances being 299 males and 298 females, or an average attendance of 12.4 per session. This shows an increase on last year's figure which was 7.4 per session. Since the recent arrangements by which patients were allowed a profit on the sale of their work, attendances have been more regular, patients have taken a greater interest, and work has retained its high standard. Also patients are now given tea during the session and this is much appreciated. It is found that patients take a greater interest in providing articles which are on order than in making articles which are not a definite requirement. A steady sale continues on Wednesday afternoons when visitors can buy articles which are on view. One of the greatest benefits of Occupational Therapy has been the improved outlook and morale of patients who are now able to earn a little money by their work. In addition Miss Ross-Smith has held 48 sessions for men and 46 sessions for women at Harts Sanatorium, with an attendance of 956 and 669 respectively, or an average of 19.9 male and 14.5 female attendances per session. 1Ola 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 Bolton Bournemouth Derby Dundee Hudders. field Middlesbrough Norwich Oldham | Preston Southampton Southend. on.Sea Stockport Sunderland Walsall Wolverhamp ton York Population as estimated by Registrar General, Middle 1938 129,500 144,400 113,000 169,400 122,100 139,000 177,962 125,630 139,800 122,300 126,100 113,200 180,100 138,100 134.S00 182,400 107,300 1 145,300 100,800 Comparability Factor 1.10 1.09 1.03 1.09 0.75 1.04 1 1.03 1.18 0.92 1.12 1.11 0.99 0.91 1.05 1.12 1.12 I 1.08 101 Birth Rate per 1,000 population 14 1 17.0 12.2 13.5 11.17 14.2 17.6 14.13 19.77 13.07 13.3 15.60 16.57 10.84 14.35 19.19 18.62 | 16.9 15.5 Crude Death Rate do. do. 10 6 12.1 14.6 13.1 13.98 11.6 14.40 13.12 12.3 11.98 14.4 13.01 11.86 12.48 13.03 12.75 10.99 11.3 10.6 Death Rate as adjusted by Factor 11.6 13.1 15.0 14.2 10.485 12.1 14.40 13.51 14.73 11.02 16.13 14.44 11 .74 11 .35 13.68 14.28 12.30 12.2 10.7 Death Rates per 1,000 population from:— Smallpox — - — — — — — — — — — — — — — 0.0000 — - — Measles 0.03 0.20 — 0.05 0.00 82 0.014 0.40 — 0.01 1 0.033 0.063 0.11 0.02 0.029 0.03 0.04 0.01 0.01 0.01 Scarlet Fever — 0.00 0.02 0.01 — 0.007 0.04 - 0.01 — 0.016 — — 0.007 0.01 0.03 — - 0.02 Whooping Cough 0 02 0.18 0.01 0.00 0.0163 — 0.03 0.01 0.02 0.033 0.008 0.009 0.01 — 0.01 0.03 0.07 0.06 — Diphtheria 0 07 0.07 0.08 0.12 0.0245 0.043 0.07 0.02 0.08 ; 0.074 0.095 0.053 0.03 0.029 0.12 0.09 0.03 0.05 0.03 Typhoid and Para.Typhoid 0 007 0.00 0.00 - 0.008 2 0.014 0.02 — 0.00071 — — — 0.005 0.021 0.01 0.005 - 0.01 — Diarrhoea under 2 years 0 06 0.20 2.88 0.01 0.0327 0.094 0.08 0.01 0.17 0.041 0.048 0.035 0.055 0.051 0.10 0.28 0.11 0.10 0.10 Influenza 0 07 0.07 0.07 0.14 0.18 0.072 0.07 0.06 0.11 0.057 0.151 0.09 0.03 0.072 0.12 0.12 0.25 0.10 0.10 Tuberculosis—Pulmonary 0 62 0.67 0.68 0.44 0.434 0.55 0.62 0.42 0.94 0.51 0.63 0.61 0.61 0.5 0.53 0.77 0.60 0.67 0.51 do. Other Forpis 0.06 0.11 0.14 0.10 0.114 0.09 0.20 0.10 0.15 0.049 0.12 0.17 0.076 0.042 0.15 0.10 0.06 0.10 0.11 Infantile Mortality Rate 51 75 67 44 44.72 61.3 77 66 75 35.04 61.27 71 50.6 34 56.36 67 64.6 55 43.5 Maternal Mortality per 1,000 Total Births. From Sepsis 0 32 0.78 0.68 1.65 0.70 — 4.2 2.70 2.08 1.21 2.28 1.70 1.00 0.000 — 0.82 0.97 1.57 1.86 ,, Other Causes 1.57 1.16 3.41 4.55 0.70 0.97 2.56 1.62 2.08 | 1.81 — — 1.34 2.567 2 94 3.03 1.93 1.96 — Total 2.09 1.94 4 .09 6.20 1.41 0.97 5.76 4.32 4.16 3.02 2.28 1.70 2.34 2.567 2.94 3.86 2.90 3.53 1.86 101 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. City of London Cemetery Crematorium. The City Corporation has again requested that the attention of the public be drawn to the facilities available at the Cemetary for Cremations. 102 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. Six samples from domestic supplies were obtained during the year and submitted for bacteriological examination. Herein is a statement of the results. No. of Sample Colonies p. c.c. on Agar at 37%C. B. coli. absent in c.c's. After 1 day After 2 days After 3 days A.348 0 2 80 100 A.396 2 9 30 100 A.413 0 3 5 100 A.420 11 48 70 100 A.425 1 1 7 100 A.433 5 9 12 100 Domestic storage is requently found unsatisfactory during housing inspection by the Sanitary Inspectors, and at 285 houses a supply tap on the rising main to the storage cistern was provided at the instance of the Department. Drainage and Sewerage. No extensions of sewerage were made during the year but consideration is being given to a scheme of improvement of the sewage works. Involved in this scheme are proposals to relieve flooding in certain areas of the Borough. The remedying' of drainage defects at 886 houses was carried out at the request of the officers. The works not infrequently involved complete reconstruction of drainage. 103 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. Closet Accommodation. The water carriage system prevails generally 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 43 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 ol all classes (41,499) showed an increase as compared with the number for 1937. (i) Housing:— House-to-House 5221 Under Public Health Act 1824 Other Visits 310 Reinspections 24682 (ii) Sanitary Circumstances:— Draining and Sanitary Accommodation 792 Factories (excluding Bakehouses) 199 Workplaces and Outworkers 246 Caravans 3141 Re offensive fumes 590 Miscellaneous 1078 104 (iii) Food Supply:— Slaughterhouses 1337 Dairies 183 Food Premises 320 Bakehouses 90 Re sampling 466 (iv) Infectious Disease:— Visits 1020 (b) Notices. The number of notices served during the year totalled 5,995, of which 528 were statutory notices. Of the total, 4,997 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 is as follows:— Manor Park 385 Castle 652 Woodgrange 555 Central 594 Little Ilford 815 Wall End 882 Kensington 938 Greatfield 463 Plashet 403 South 308 (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 1446 Roofs repaired 1457 Rain water gutters repaired 968 Ventilation improved— Windows (including cords)) repaired 1357 Water supply improved— Service tap provided on main—Ordinary, 108; House to House, 177 285 Sanitary Conveniences repaired 916 Washing facilities provided or improved(coppers) 216 Drainage improved or reconstructed 886 Paving of yards repaired 697 105 Disrepair remedied— Stoves and firegrates repaired or renewed 757 Plasterwork repaired or renewed .... 1306 Floors repaired or renewed 463 Cleansing- executed 2261 Miscellaneous defects remedied 4717 (d) Complaints. During the year 1938, complaints totalling 2,232 were received and where justified appropriate action taken. Many of the complainants requested the services of the drain cleaner or rat catcher. (e) Factories. Inspections of factories and outworkers' premises numbered 535. Eighty-eight defects found necessitated the service of 29 notices, and during the year 73 defects were remedied. The register of factories was completely revised during the year. (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 maintained on Corporation lands which have been subject to serious infestation of recent years. During the year 2,568 visits were made to properties in the Borough and 2,014 rats were destroyed. Special attention was also directed to the public sewers, and some 43,675 baits were laid with, is is believed, satisfactory results. (h) Atmospheric Pollution. Investigations of complaints of offensive fumes arising from industrial plants continue to engage our attention, and during the year 590 observations were made. 106 (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. Coincident with the clearance of the caravan encampment and its re-development will be carried out the transfer of the fat melting business and also a number of piggeries. This transfer will mean the disappearance of an ill-disposed and badly constructed and equipped offensive trade. The rag-sorting businesses have continued to demand constant vigilance by the inspectorate. (k) Caravan Encampment. As indicated in the previous annual report, 1937 witnessed the beginning of the end of the encampment. At the 1st January, 1938, 97 caravans or one half the colony remained and in consequence of legal proceedings early in 1938 many of these nomads left the district. Clearance Orders were confirmed during 1938 in respect of 48 vans, and at the conclusion of the year only 16 vans remained awaiting rehousing. To those who knew this caravan encampment of forty years standing, the visible change to-day in this part of East Ham could be best described as a change from nomad's land to noman's land. The yards once frequented by numerous families in vans are deserted. (1) Rag Flock Acts. There are no manufacturers of flock in the Borough but systematic sampling from users' premises is carried out. Fourteen samples were submitted for analysis and two samples failed to comply with the regulations : in one case reported to contain 90 parts of Chlorine per 100,000 parts of flock, a letter of caution was sent to the vendor and in the other case where the chlorine content was reported to be 160 parts per 100,000 parts of flock a prosecution was instituted, the vendor being fined £2 and £1 Is. costs. 107 (m) Rent Restriction Acts—Certificates of Disrepair. Fourteen applications ware received for certificates which ensured speedy execution of repairs. (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) 18 Order made with penalty 1 Cases adjourned to 1939 1 (ii) Exchanging articles for rags— Penalty inflicted 1 (iii) Water Supply— Case withdrawn (water reinstated) 1 (iv) Unsound Food— Cases adjourned to 1939 2 (v) Movable Dwellings: Allowing land to be used for camping purposes without licence— Cases withdrawn (vans removed) 1 (vi) Bye Laws respecting Tents, Vans, and Sheds— Cases withdrawn (Vans removed) 15 Penalty inflicted 9 (vii) Food and Drugs (Adulteration) Act— Penalty inflicted 2 (viii) Milk and Dairies (Consolidation) Act, 1915— Penalty inflicted 2 (ix) Milk and Dairies (Amendment) Act, 1922— Penalty inflicted 2 (x) Rag Flocks Acts— Penalty inflicted 1 Shops Act, 1934. The following is an extract from the Annual Report of the Chief Shops Inspector for the year 1938:— Arrangements for health and comfort of workers. The arrangements at 1,333 shops were investigated, and in 194 instances were found unsatisfactory. Verbal intimation notice was given in 97 cases and 89 written intimations were ser- 108 ved. Re-inspections in connection with these notices of requirements totalled 1,662. In consequence of the requisitions of your Inspectors, the following; improvements were carried out:— (1) Ventilation and Temperature of Shops:— Means of heating provided 53 (2) Sanitary conveniences:— Provided 7 Reconstructed 14 Repaired, etc. 130 (3) Lighting:— Improved 13 (4) Washing Facilities:— Provided 12 Reconstructed 20 Repaired, etc. 18 (5) Other Sanitary Defects:— Remedied 216 Offices. A survey of offices was commenced during the year but was not completed. Smoke Abatement During the year, 21 observations of factory chimneys were made and in 4 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. At one manufactory the whole of the boiler plant which in previous years had given rise to nuisance from emission of black smoke was modernised, but unfortunately a new nuisance from grit has arisen. Efforts are being made to eliminate the nuisance. 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 examinations. 109 The results of the examinations were on one occasion unsatisfactory and the attention of the appropriate department directed to them. Subsequent samples proved satisfactory. Eradication of Bed Bugs The number of Council Houses disinfested during the year was 23, and the number of other houses disinfested by the Corporation for owners was 33. The method employed by the Corporation consits of fumigation by a 5 per cent. by volume concentration of sulphur di-oxide, and supplementary spraying with contact insecticides, "zaldecide" or "pyagra." Hydrogen cyanide was employed in the disinfestation of household effects of 104 families transferred to Council houses. This work is carried out by contractors under the supervision of Sanitary Inspectors, the van method being employed. All new tenants so transferred are subsequently circularised on methods of preventing re-infestation. Housing The 74 houses of the adjustable type for persons displaced from clearance areas and overcrowded houses were completed and occupied in the year. (a) Overcrowding. Since the housing survey 84 per cent. of the houses then found overcrowded have been de-crowded. In the same period a further 116 have become overcrowded, and at 31st December, 1938, 248 dwellings remained overcrowded. During the year, 62 families were de-crowded consequent upon alternative accommodation being offered by the Council. The 32 houses erected in the year and designed for large families enabled the Council to de-crowd many of its own houses. Although the reduction in known overcrowded families is so markedly progressive, it is believed that unless further large type houses are built, a static stage in overcrowding is bound to be reached. Chronic cases of overcrowding remain, and a further complement of the original plan of 132 de-crowding houses is necessary. 110 The supply of information as to permitted numbers continues and this function though in many caes of academic important appears undoubtedly to have a salutary practical effect in that a marked caution on the part of landlords is noticeable in letting houses to-day. (b) Slum Clearance. Upon the representation of the Medical Officer of Health, the following clearance areas were declared by the Council. Order Area Houses Families Population C.P.O. High Street, North Woolwich, No. 17 51 73 272 C.P.O. Claremont Street, North Woolwich, No. 18 43 65 262 The Orders have been confirmed by the Minister of Health but the rehousing of the families in Clearance Area No. 17 has been somewhat protracted. (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 in previous years, 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. During 1938, 5,221 house-to-house inspections were made in accordance with the Housing Regulations, and 2,134 other inspections of houses were made. Of these, 7,355 houses, 5,623 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 103 were effected. The 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) 7,355 (b) Number of inspections made for the purpose 32,037 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 6,221 (b) Number of inspections made for the purpose 19,089 111 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 103 (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 5,623 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 4,394 III.—Action under Statutory Powers during the Year:— (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1935:— (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 — (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 528 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 352 (b) By Local Authority in default of owners — (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 8 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 (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 IV.—Housing Act, 1936, Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 248 (ii) Number of families dwelling therein 253 (iii) Number of persons dwelling therein 1,868 (b) Number of new cases of overcrowding reported during the year 58 (c) (i) Number of cases of overcrowding relieved during the year 239 (ii) Number of persons concerned in such cases 1,464 (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 1938:— By Private Enterprise 48 By the Local Authority 74 112 Inspection and Supervision of Food. (a) Milk Supply. (1) Dairies. All dairies are fully equipped, 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 further dairies was discontinued, this tendency to dispose of milk businesses being most marked during the last two years. During the year 18 additions were made to register of retail purveyors, the majority being made in respect of the sale of milk in unopened receptacles. Two applicants for registration as retail purveyors were given notice to show cause why they should not be registered. Both were refused registration. One registered purveyor was removed from the register. 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, 12,000 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 83 45 1 32 — 5 Unsatisfactory 11 11 — — — — Biological Samples— Satisfactory 43 23 — 16 — 4 Unsatisfactory — — — — — — 113 Once again the unsatisfactory bacteriological samples were confined solely to the ordinary milks. It is gratifying however to note a decrease in adverse reports, denoting generally cleaner and more efficient dairy management. One sample contained excess pus cells and streptococci, 1 excess pus cells and red blood corpuscles, 6 bacillus coli in .01 c.c., 3 B. coli in .001 c.c. and 1 B. coli in .0001 c.c. The average bacterial count of the samples of ordinary milk was 90,780 p.c.c. as compared with 10,800 p.c.c. the average of pasteurised milk samples. The highest count of ordinary milk was 3,600,000 p.c.c. and that for pasteurised, 84,000, the lowest for the respective milks being 2,800 p.c.c. and 1,200 p.c.c. Appropriate action was taken in respect of all unsatisfactory bacteriological reports, and in some instances communications were transmitted to the responsible authorities. (3) Craded Milk. The licences in force on 31st December, 1938, were as follows:— Tuberculin Tested Milk— Bottling Establishment Licence 1 Dealers' Licences 9 Supplementary Licences 3 Pasteurised Milk— Establishment Licence 1 Dealers' Licences 30 Supplementary Licences 3 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 1,337 visits to the slaughterhouses for the purpose of carrying out post mortem inspection of animals slaughtered. The following is a statement of the work done in this connection:— 114 MEAT INSPECTION. Cattle (excluding Cows) Cows Calves Sheep and Lambs Pigs Number of animals slaughtered 564 1,285 443 4,286 23,801 Number of animals inspected 564 1,285 443 4,286 23,801 All diseases, except Tuberculosis:— Whole carcases condemned — 2 — 3 4 Carcases of which some part or organ was condemned 30 206 — 32 1,153 Percentage of number inspected affected with disease other than Tuberculosis 5 16 — 1 5 Tuberculosis only:— Whole carcases condemned 1 16 — — 2 Carcascs of which some part or organ was condemned 70 772 — — 201 Percentage of the number inspected with Tuberculosis 13 61 — — 1 115 Periodically visits are made to butchers' shops, market stalls and meat vehicles. (2) Food Premises. The number of inspections made of food premises included 183 dairies, 90 of bakehouses, and 320 of other premises. During the year, a number of small manufacturers of ice cream ceased manufacturing on account of the unsatisfactory nature of their premises and equipment and proceeded to retail the prepacked article from reputable firms. A survey of public houses and off-licencced houses was carried out and in consequence a number of communications sent to the licencees regarding unsatisfactory conditions. Attention was particularly directed to the facilities for cleansing glasses, disposal of waste beer, cellarage, food preparation, and sanitary condition of premises. It was found that 20 out of 34 Public Houses had no hot water supply in the bars for cleansing purposes—apparently a cold rinse for beer glasses was deemed sufficient. Requests for installation of running supplies of hot and cold water have been made. Steps to ensure the proper disposal to drain off residue of glasses were also taken. During an inspection of a market stall, 23 unsound rabbits were seized and subsequently condemmed. A prosecution resulted in the occupier of the stall being fined £20. (c). Adulteration. Four hundred and fifty-six samples of foodstuffs were obtained by the Sanitary Inspectors and submitted to the Public Analyst. Details of the various samples and the results are included in the following tabular statements. The adulteration included (i) Ammoniated tincture of quinine sold as dill water—in this case a prosecution was instituted (ii) Mineral Water having a taste of disinfectant—a communication was sent to the district in which the manufactory was situated, as improper cleansing of the bottle was indicated. (iii) Fruit Wine which was water, pleasantly flavoured and coloured—the stock was withdrawn from sale and the vendor cautioned. 116 In the previous annual report, reference was made to certain adulterated milk being sold in the Borough. The freezing point test and nitrate test gave an indication that the milk was reconstituted. Prolonged investigation and sampling resulted in proceedings being instituted against 3 vendors who subsequently were refused registration or removed from the register of retail purveyors. Number of Samples. Examined. Found adulterated or below standard. Percentage samples adulterated. Bread 3 Butter 23 1 4 Cheese 2 — — Cocoa 4 1 25 Coffee 3 — — Confectionery 5 — — Jam and Marmalade 7 — — Cream 5 — — Flour 11 2 18 Lard 9 1 11 Margarine 8 — — Milk 167 11 7 Sausage 18 — — Tea 1 — — Vinegar 5 — — Wines, Spirits 8 1 12 Drugs 17 3 18 Other Articles 160 3 2 456 23 5 Details of samples adulterated or below standard are described as follows, together with the resultant action:— 117 DETAILS OF ADULTERATION. No. L or F. Article. Adulteration or Deficiency. Action Taken. 1228 F. Milk 1.5% Added Water Vendor prosecuted. 1232 F. Milk Presence of added water was indicated by freezing point test „ „ 1247 F. Milk Presence of added water indicated by freezing point nitrate tests „ „ 1254 F. Milk Presence of added water indicated by freezing point nitrate tests „ „ 1263 F. Milk 3% Added Water Vendor cautioned. 1291 F. Milk 1% „ „ „ „ 1309 F. Dill Water Not dill water but ammoniated tincture of quinine Vendor prosecuted. 1311 I. Dill Water Ditto See Sample 1309. 1318 I. Self-raising Flour Was alkaline containing an excess of bicarbonate of soda to the extent of 1½% Vendor cautioned. 1319 F. Self-raising Flour „ „ „ 1359 I. Cocoa Poor quality containing only 7.1% fat „ „ 1364 F. Milk Deficient in milk fat at least 3% „ „ 1365 F. Milk „ „ „ „ „ 5% „ „ 1373 F. Milk „ „ „ „,, 3% Taken in course of delivery—Letter to County Sampling Officer. 1374 F. Milk „ „ „ „ „ 6% 1391 I. Mineral Water The sample had a faint taste of disinfecting fluid Letter to Borough in which the manufactory was situate. 1425 I. Mustard Contained as an admixture 40°/o wheaten flour Vendor cautioned. 1462 I. Apple Tarts Shewed mould growth—unfit for consumption „ „ 1474 I. Lard Was not lard but a lard substitute Formal Sample proved genuine. 1501 F. Milk l½°/o Added Water Vendor cautioned. 1516 I. Sweet Spirits of Nitre Deficiency of ethyl nitrite to the extent of 92% Formal Sample proved genuine. Vendor cautioned. 1527 I. Fruit Wine Was not wine but a non-alcoholic beverage consisting of sugar and water, pleasantly flavoured and coloured and containing preservatives within the prescribed limit Vendor cautioned. 1587 I. Butter Excess of 4% of water „ „ I. = Informal Sample. F. = Formal Sample. 118 (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 examination was made of a sample of Mussels. The mussels were reported to shew evidence of pollution by sewage, and the attention of the authority of the district wherein the mussels were collected was drawn to the adverse report. Unemployment and Outdoor Assistance Extent of Unemployment during 1938. The Manager, East Ham Employment Exchange, has kindly supplied the following statistics:—(see page 1.17a) Outdoor Assistance—Public Assistance Committee. The following statement 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 31-12-38:— 1938 Men Women Children Total 1938 Total 1937 January 968 1,668 1,155 3,791 4,472 February 976 1,680 1,159 3,815 4,541 March 998 1,688 1,161 3,847 4,422 April 955 1,646 1,054 3,655 3,653 May 942 1,633 1,009 3,584 3,609 June 913 1,609 980 3,502 3,530 July 901 1,569 942 3,412 3,471 August 962 1,665 1,008 3,635 3,552 September 963 1,626 996 3,585 3,480 October 952 1,604 977 3,533 3,544 November 1,004 1,678 992 3,674 3,699 December 1,015 1,703 993 3,711 3,798 118A Number of Persons Registered as Unemployed during 1938 at East Ham Employment Exchange. (1) Live Register. January. February March. April. May. June. Men Boys Wmn. Girls Men Boys Wmn. Girls M en Boys Wmn. Girls Men Boys Wmn. Girls Men Boys Wmn. Girls Men Boys Wmn. Girls (2) Persons normally in Full Time Employment 1,995 54 418 38 1,979 59 441 38 1859 66 431 15 1,782 55 434 24 1,690 52 349 27 1,762 44 334 27 (3) Non-Claimants to Benefit (i.e. persons registered for work only) 199 82 86 53 230 58 84 28 254 26 96 22 269 36 98 17 260 45 103 38 261 27 99 36 4) Persons normally in Casual Employment 512 — 13 — 936 — 18 — 768 3 14 — 729 — 11 — 528 1 12 — 608 1 7 — (5) Temporarily stopped — 1 140 14 3 — 68 6 — 1 62 6 — 1 45 3 — — 53 3 2 1 93 5 Total—1938 2,666 137 657 105 3,148 117 611 72 2,881 96 603 43 2,780 92 588 44 2,478 98 517 68 2,633 73 533 68 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 (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 1,714 45 321 24 1,545 47 319 24 1,710 85 312 20 1,945 67 402 20 2,002 62 442 21 1,851 44 423 29 (3) Non-Claimants to Benefit (i.e., persons registered for work only) 230 63 95 33 229 129 108 82 226 105 118 61 271 91 139 51 254 60 113 36 259 35 88 19 (4) Persons normally in Casual Employment 623 1 6 — 557 2 7 — 730 2 6 — 712 — 7 — 655 1 9 — 806 1 7 — 5) Temporarily stopped 5 — 136 13 13 — 101 9 132 — 89 4 41 1 85 2 5 — 70 5 3 — 141 14 Total—1938 2,572 109 558 70 2,344 178 535 115 2,798 192 525 85 2,969 159 633 73 2,916 123 634 62 2,919 80 659 62 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 34 119 METEOROLOGICAL RECORD—YEAR 1938. Rain Gauge 5-in. in diameter, placed 1 foot above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Mean Temperature of Air. Rainfall. Highest Maximum. Lowest Minimum. Mean of No of Days on which Rain fell, 0.01 and over Amount collected in inches. Mean rate of fall for Rainy Days. Greatest fall in 24 hours. Date of greatest fall. All Highest. All Lowest. January 56° 33° 48°.7 39°.2 43°.9 22 2.49 0.11 0.30 29th February 57° 30° 46°.7 36°.4 41°.6 9 0.66 0.07 0.17 13th & 26th March 67° 34° 59°.7 41°.4 50°.6 3 0.33 0.11 0.16 25th April 65° 31° 55°.6 39°.1 47°.3 2 0.10 0.05 0.08 2nd May 77° 33° 61°.0 44°.9 52°.9 13 1.54 0.12 0.29 14th&17th June 79° 45° 70°.6 53°. 6 62°.1 4 0.38 0.10 0.16 27th July 84° 47° 71°.0 55°.0 63°.0 11 1.34 0.12 0.21 8th August 85° 46° 72°.9 55°.8 64°.3 12 1.43 0.12 0.29 9th September 82° 43° 68°.5 52°.3 60°.4 18 2.72 0.15 0.74 27th October 65° 30° 58°.6 45°.6 52°.2 17 2.42 0.14 0.39 15th November 68° 34° 55°.7 45°.7 50°.7 16 2.81 0.18 1.13 25th December 56° 20° 44°.9 35°.7 40°.3 18 2.56 0.14 0.44 16th Means and Totals for the Year 85° 20° 59°.5 45°.4 52°.4 145 18.78 0.13 1.13 25th Nov. The Rainfall for the Year was 10.39 ins. below, and the number of days on which rain fell 22 below the year 1937, at East Ham. 120 FACTORIES ACT, 1937. 1.—Inspections for purposes of provisions as to health. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories with mechanical power 170 15 — Factories without mechanical power 112 12 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 7 2 — Total 289 29 — 2.—Defects found. Particulars. Number of Defects. Number of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Want of cleanliness (S.l) 47 43 1 — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) 1 — 1 — Inadequate ventilation (S.4) 2 1 — — Ineffective drainage of floors (S.6) — — — Sanitary Conveniences (S.7):— Insufficient 3 2 — — Unsuitable or defective 9 6 — — Not separate for sexes 2 2 — — Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937) 24 19 — — Total 88 73 2 — 121 OUTWORK IN UNWHOLESOME PREMISES. (Section 108 of Act of 1901; Section III of Act of 1937) Nature of Work. (1) Instances. (2) Notices served. (3) Prosecutions. (4) Wearing Apparel:— Making, etc. 5 4 — Cleaning and washing — — — 123 EDUCATION COMMITTEE Annual Report OF THE School Medical Officer FOR THE YEAR 1938 125 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, 1938. There were 15,737 children on the Elementary School Roll as compared with 16,208 for the year 1937. The number of routine and special cases of elementary school children examined, totalled 8,168, showing a decrease on the previous year of 896. Of this total 3,385 were re-examined at the time of re-inspection in the schools. A routine medical examination of 931 pupils attending the Secondary Schools has also been carried out. The inspection included all scholars at the Grammar Schools. The information contained in my report this year is mainly statistical and no new developments or departures have occurred during the period. It is satisfactory that the work of the department was completed in spite of some degree of disorganisation in the latter half of the year. From the data which will be found under the separate sections of this report, 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. Consideration has been given to Circular 1457 and the arrangements to be made for the medical examination of scholars obtaining employment; my suggestions are included under 4 (a) "Medical Inspection and Re-inspection" (see page 127). 126 I wish to express my appreciation of the keen interest and loyal co-operation of all the members of my staff, and 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, School Medical Officer. 127 1. Staff. A list of the Staff of the School Medical Department will be found at the beginning of this Report. 2. Co-Ordination. The system outlined in my previous reports has continued with beneficial results alike to staff and scholars. 3. The School Medical Service in relation to Public Elementary Schools. A complete survey of the sanitary and hygienic conditions of all the schools has been carried out and reports submitted to the Committee. 4. Medical Inspection. The following is a synopsis of School Medical Work for the year 1938, as compared with previous statistics. COMPARATIVE STATEMENT OF WORK. 1934. 1935. 1936 1937 1938 Routine & Special Inspection (on School premises):— Secondary 1,017 1.093 1,016 700 931 Elementary 9 186 8,914 9.037 9,064 8186 Re-Inspection 3,203 3,115 3,664 3,063 3385 Consultations at Inspection Clinic 17,750 17,612 16.708 15,327 14124 Number of Treatments at Clinic 13,770 22,073 27,976 21,387 20954 General Cleanliness Visits to Schools 296 339 281 292 338 Nurses' Visits to Homes 3,206 3,563 3,558 3,408 4686 Children Examined for Cleanliness 47,550 45,356 44.145 41,725 40821 (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 128 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 and in each case the school was visited subsequently for the purpose of re-inspection of all scholars found to present defects. With reference to Circular 1457 and the raising of the school leaving age to 15 years, the following matters require consideration:— (a) Employment Certificates. It is estimated that between 150 and 200 scholars will require examination for Employment Certificates during each term and it is proposed to arrange for these examinations as the occasion arises. (b) Co-operation between the School Medical Service and the Juvenile Employment Committee. The Education Committee have approved arrangements for effecting co-operation between the School Medical Department and the Juvenile Advisory Committee so far as concerns the question of giving advice in regard to the unsuitability of certain children for particular types of employment. In this connection attention has been directed to the lapse of two years which normally takes place between the date of the last Medical Inspection and the date of attaining the school leaving age. With the raising of this age to 15 years the interval may be increased to three years and the information submitted to the Juvenile Advisory Committee quite out-of-date in consequence. It appears very desirable that all scholars should be examined during tiheir last year at school and it is strongly recommended that this additional examination should be carried out as a routine measure. (b) Exceptional Children. Towards the termination of routine medical inspection in each school, teachers are requested to bring before the School Medical Inspector any special cases for examination, and to include 129 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 1938 was 4,424, or 28.2 per cent., of the number on the school roll. In addition 3,762 children were referred for soma special reason by parents, nurses, teachers or attendance officers. The total number of children medically examined was therefore 8,186 or 52.0 per cent. of those on the school roll. The number of re-inspections carried out was 3,385. 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 1938:— 130 FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. *Percentage of Children found to require Treatment. Inspected. *Found to require Treatment. 1933 1934 1935 1936 1937 1938 1933 1934 1935 1936 1937 1938 1933 1934 1935 1936 1937 1938 Entrants 2,040 1,747 1,898 1,719 2,162 1,401 250 447 299 234 257 245 11.2 25.5 15.7 13.6 11.8 17.4 Second Age Group 2,006 1,873 1,622 1,786 1,717 1,427 230 230 200 189 153 185 12.4 12.2 12.3 10.5 8.9 12.9 Third Age Group 2,079 1,895 1,713 1,636 1,556 1,268 180 193 196 208 120 134 8.6 10.1 11.4 12.7 7.7 10.5 Totals 6,125 5,515 5,233 5,141 5,435 4,096 660 870 695 631 530 564 10.7 15.7 13.1 12.2 9.7 13.7 *Excluding defects of Nutrition, Uncleanliness and Dental Diseases. 131 (a) Uncleanliness. The School Nurses have carried out three cleanliness surveys of all children in the elementary schools during the year 1938. During the year the School Nurses made 40,821 examinations, as compared with 41,725 in 1937. Of this number 153 children showed vermin and many nits in the hair (146 in 1937), whilst 1,144 children showed only a few nits (1,349 in 1937). Comparative table Year Number Examined Number with Nits Number with Head Vermin No. of Exclusion Certificates 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 1938 40,821 1,144 153 317 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. 132 TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. Schools. Dept. Number Exam'd Few Nits Many Nits and Vermin Schools. Dept. Number Exam'd Few Nits Many Nits and Vermin Altmore S. Mixed 760 8 Monega S. Boys 709 1 — Myope 45 2 — Napier Infants 500 42 — Avenue Infants 499 16 8 J. Boys 1167 9 — J. Girls 750 39 17 S. Boys 719 16 — J. Boys 781 12 6 Plashet Infants 420 14 1 Brampton Infants 1094 9 — J. Boys 870 10 2 J. Girls 1254 45 6 S. Boys 539 3 — S. Girls 739 10 4 Salisbury Infants 518 18 2 Castle Street R.C. Mixed 524 9 — J. Mixed 1025 20 — Central Park Infants 592 6 1 S. Mixed 635 9 — J. Boys 1284 1 — Sandringham Infants 482 1 3 S. Boys 741 — — J. Mixed 893 14 4 Cornwell Infants 951 69 13 Sandringham Central 398 1 1 S. Girls 806 30 9 Shaftesbury Infants 750 14 — S. Boys 658 8 1 J. Girls 977 19 1 Dersingham Mixed 930 41 7 S. Girls 639 19 — Essex Infants 705 19 2 Shrewsbury Special 129 8 1 J. Boys 1054 3 — Storey Street J. Mixed 356 9 5 S. Boys 340 5 — S. Mixed 672 30 3 Hartley Infants 583 19 — St. Michael's R.C. Mixed 550 32 6 J. Girls 825 34 2 St. Winifride's R.C. Mixed 737 51 10 S. Girls 507 22 1 Vicarage Infants 716 56 3 Kensington Infants 466 4 — J. Girls 1161 114 6 J. Girls 1041 27 11 S. Girls 639 40 6 S. Girls 562 19 3 Winsor Mixed 1262 71 5 Lathom Infants 785 12 2 Wakefield C. Girls 200 3 — J. Girls 874 35 — Boys 190 — — J. Boys 886 — — Grammar Girls 200 – – Monega Infants 622 11 1 J. Boys 1010 5 – Total 40821 1144 153 Per cent. in 1938 2.82 0.3 Per cent. in 1937 3.23 0.3 133 (b) Minor Ailments. Chief Minor Ailments. Discovered at Routine Medical Inspection Discovered by Teachers and Nurses and sent to Clinic 1937 1938 1937 1938 Scabies 3 7 37 27 Impetigo 7 4 188 327 Conjunctivitis 3 4 51 51 Blepharitis 6 16 25 44 Ear Diseases 45 21 175 182 Ringworm (Scalp) — — 3 3 Ringworm (Body) – — 21 27 (c) Tonsils and Adenoids. 4.3 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids," either separately or combined, as compared with 4.1 per cent: in the year 1937. Of these, much enlarged tonsils accounted for 0.4 per cent.; definite adenoids were present in 0.3 per cent.; and the combined defect was diagnosed in 3.6 per cent.; the figures for 1937 were 0.9 per cent., 0.1 per cent.; and 3.0 per cent. respectively. The percentage of children moderately affected and requiring to be kept under observation was 3.5, the corresponding percentage in 1937 being 9.0. In this case 2.9 cent. had moderately enlarged tonsils, 0.1 per cent. exhibited signs of the presence of adenoids, while 0.5 per cent. showed enlarged tonsils and adenoids of moderate degree, as compared with 8.6 per cent.; 0.1 per cent.; and 0.3 per cent. respectively in the year 1937. (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 Other forms of Tuberculosis. 4 11 2 – 6 11 15 2 17 134 (e) Skin Disease and (f) External Eye Disease. At medical inspections during the year, 507 children were found to be suffering from skin affections (as compared with 568 in the year 1937) 115 cases of external eye disease were discovered, as compared with 85 in the year 1937. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 357. In addition, there were 260 children in whom there was evidence of a lesser degree of visual defect and these are being kept under observation. (h) Ear Disease and Hearing. 0.9 per cent. of the children examined were found to be suffering from otitis media. (1.2 per cent. in 1937.) The percentage of deaf children was 0.11, the corresponding figure for last year being 0.43. (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 60.7 per cent, as compared with 62.8 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. Although the position is still far from satisfactory there has been a definite improvement in the number of children presented for dental treatment, viz., 57.6 per cent. of the children found to be suffering from dental disease as compared with 41.9 per cent. in the year 1937. (j) Crippling Defects. Reference to Table III will furnish information with regard to the occurence of crippling defects in the area. Thirty-one cases were discovered at routine medical inspection during the year. 135 (k) Nutrition. Children found at the routine medical inspection to be suffering from malnutrition, in any degree, numbered 124, or approximately 2.8 per cent. of the children inspected (See Table 11B). 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 1938. 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 Brampton February Measles & Chicken Pox Brampton December Whooping Cough Winsor May Chicken Pox Sandringham March Measles & Whooping Cough Hartley March Measles Shaftesbury March Measles & Chicken Pox Napier February Measles Monega February Measles Vicarage February Measles Dipthheria Detection and Prevention. The bacteriological examination of swabs from the throats and noses of school children is carried out:— 136 (a) Prior to the admission of children to Schools of Recovery, Convalescent Homes, etc., in order to ensure freedom from infection. Three hundred and thirty-four swabs were taken for this purpose, three of which proved positive. (b) In suspicious cases seen at the Clinics or Schools, 111 swabs were taken, and four proved to be positive. (c) In cases where an undetected source of infection appears to be present in a class or school. Fifteen 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. 7. FOLLOWING UP. The School Nurses have paid 4,686 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. Of the 712 children referred for treatment 530, or 73 per cent., have obtained treatment. The School Nurses have also paid 230 special visits to the Schools, and have undertaken 28 journeys in connection with the admission and discharge of children to Institutions. All children referred for the operative treatment of tonsils and adenoids (458) have been visited prior to and after the operation. 137 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 185 29 42 5 16 11 February 198 29 19 7 13 12 March 361 52 14 6 14 8 April 90 6 19 1 12 3 May 7 44 1 1 9 8 June 3 60 2 23 12 13 July August 2 7 5 4 30 3 September October — 13 4 3 29 8 November 5 2 28 — 17 8 December — — 21 — 14 9 Totals (281) 851 (223) 242 (231) 155 (103) 50 (236) 166 (84) 83 The totals in brackets are those for the year 1937 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, although ascertainment has improved during the past year. 138 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. (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 1938, 20,954 attendances were made for treatment at the various clinics, and there were 14,124 attendances for consultation with the Medical Officers. 139 (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 304 received operative treatment during the year 1938. The scheme for treatment remained the same as detailed in previous reports. (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 the dermatological departments of the London Hospital, East Ham Memorial Hospital and Queen Mary's Hospital, West Ham. (e) External Eye Disease. One hundred and fifteen cases (85 in 1937) of external eye disease were treated at the School Clinics. (f) Vision. During the year 1938, the Ophthalmic Clinic was held on five sessions per fortnight. Four hundred and fifty-five accepted treatment in respect of visual defect during the year 1938 (of these 13 children with markedly defective vision had not been seen by the Ophthalmic 140 Surgeon) and, including 15 cases awaiting treatment at the termination of the year 1937, 453 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 General Clinic— . Number of new cases 453 Glasses prescribed 239 Glasses not necessary 214 Glasses obtained 230 Special treatment 42 Re-examinations 1357 Discharged 100 Strabismus operation at Hospitals 9 Sent to Swanley (Blepharitis) 2 Baby Clinic. Number of new cases 54 Glasses prescribed 18 Glasses obtained 17 Special treatment 8 Re-examinations 31 Discharged 7 Lachrymal obstructions treated at Hospitals 2 Other Cases referred to Hospitals 7 Sight-Saving Class. Number of pupils 13 Most of the treatment and operation cases were successfully dealt with. A few chronic lid inflammations are still under treatment. The sight-saving class has done very useful work. The School Medical Service and optical and clerical staff have given extremely kind and efficient help. 141 (g) Ear Disease. During the year 1938, 82 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 1,500, making an average attendance, at each session, of 18 patients. Ionisation treatment was carried out in 20 cases, 71 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 1,500. Fifty-eight per cent. of the cases were, after treatment, discharged cured. I operated on 326 East Ham children for septic tonsils and adenoids. The statistical report is as follows:— Cases of Chronic Otitis Media 151. Discharged 85 Cases of Deafness 37. ,, 21 Other Ear Cases 50. ,, 43 Cases of Chronic Rhinitis 54. ,, 31 Other Nose Cases 18. ,, 14 Cases of Enlarged Tonsils and Adenoids 242. ,, 128 Other Throat Cases 11. ,, 7 Mastoid Operations 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:— I have the honour to submit my eighteenth annual report on the work done in the School Dental Service during the year 1938. 142 The age groups inspected were from five years to twelve years inclusive, which totalled 11,481: those referred for treatment number 6,970, and the "specials," cases referred by the School Medical Officer, and Head Teachers, were 283. The number of attendances at the dental clinics was 7,426. Details will be found in the following statistics:— Table IV. Group V. Dental Defects. All the children in the routine age groups are inspected once a year, and treatment offered where necessary. Great stress is laid on the conservation of teeth, especially the first or six-year molars. The temporary teeth are filled when the cavities are small. The number of permanent teeth filled was 1887. The extraction of temporary teeth is chiefly done under local anaesthesia, but gas is used for most permanent teeth, and in cases of sepsis, etc., and is the better anaesthetic for nervous children. The number of administrations of gas was 755. A great number of permanent teeth were extracted for regulation purposes, that is, in mouths where the teeth are overcrowded, making the front teeth irregular and ugly, certain teeth were extracted to allow the others to fall back into their normal arch. In other cases where teeth would not fall naturally into their places, regulation plates were made to bring the teeth into line. The number of regulation plates I made was 40. The sepsis from bad teeth definitely undermines the health of the school child, and hinders normal progess at school. At one school I inspected the teeth of 20 bright boys and teeth of 20 dull boys of the same age, and found that the average number of decayed teeth per head of the former was 1.7 and in the latter was 2.85, figures which speak for themselves. The School Dental Service is incomplete when the 13 year, 14 year and subsequently the 15 year age groups are left uninspected and untreated. This means that the children leaving school are not dentally fit and a great deal of the good work done up to 12 years is undone by lack of treatment later. It is very urgent for the health and ultimate well-being of the children of East Ham, that another School Dentist be appointed. 143 Some Local Authorities have found it necessary to appoint one of their Dental Officers as Senior, and make him responsible for the Dental Service to the Medical Officer of Health. May I suggest that this be done in our own County Borough, in order to insure greater co-ordination, greater efficiency and a really complete Dental Service. MATERNITY AND CHILD WELFARE CENTRES. Details of the dental work done for the Maternity and Child Welfare Centres are shown in the following table:— No. of Sessions devoted to Treatment No. of Attendances No. of Permanent Teeth No. of Temporary Teeth Adults Children Extrac ted Filled Extrac ted Filled 85 303 533 415 77 669 110 Total No. of Extractions Total No. of Fillings No. of Adminis trations of General Anaesthetics No. of other Operations Permanent Teeth porary Teeth 1084 187 96 163 92 Two sessions per week are devoted to the cases referred by the Medical Officers of the Maternity and Child Welfare Clinics. Extractions of temporary and permanent teeth are done under gas or local anaesthesia, and fillings inserted where possible. Dentures have been made for the mothers where necessary. I would urge a more suitable anaesthetic than nitrous-oxide for the babies under five years of age, and improved apparatus. May I thank that Medical Officers Nurses, Head Teachers, and Clerical Staff for their co-operation during the year 1938. (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. 144 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. Five out-patients have received treatment during the year. The total out-patient attendances were 113. 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 Medical Department to refer several cases to this Hospital under the general terms of agreement between the East Ham Corporation and the Hospital Authorities. (]) 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 be obtained. The following table furnishes a brief summary of the cases treated by general and local irradiation throughout the year. 145 Condition Boys Girls Babies Anaemia 7 12 — Anaemia and Debility 7 — — Backache — 1 — Bronchitis 14 14 1 Bronchial Catarrh 20 14 — Bronchial Catarrh and Anaemia 3 7 — Cervical Adenitis 3 8 — Bronchial Catarrh and Sub-normal Nutrition — 1 — Cough 2 4 — Chorea 3 — — Debility 74 60 131 Debility and Cervical Adenitis — 3 — Debility and Malnutrition 2 4 — Debility and Bronchial Catarrh 2 2 — Eczema 1 – — Eneuresis 4 1 — Malnutrition 21 29 19 Loss of Weight 1 1 7 Nervous Debility 5 3 — Pulmonary Fibrosis — 1 — Rheumatism 16 22 — Rickets — — 6 Rachitis 2 — — Urticaria 3 7 — Tabes Mesenterica 1 — — Adenitis 35 23 6 Acne 1 2 — Alopecia 5 4 — Asthma 1 1 — Asthma and Bronchitis 1 1 — Chilblains — 1 – Conjunctivitis — 1 — Cervical Adenitis and Debility 6 2 — Chronic Nephritis — 1 — Frequent Colds 2 2 15 Gastro-enteritis — 1 — Infantile Paralysis 2 — — Nasal Catarrh 3 1 — Neuritis 1 — — Pes Planus 2 7 — Spinal Curvature 1 1 — Other — 1 3 251 243 188 Number of Children Treated (General) 617 Number of Children Treated (Local) 65 Number of Attendances (General) 11,797 Number of Attendances (Local) 834 Number of Attendances (Local and General) 12,631 146 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 20th May to 3rd June at the Hopton Constitutional Holiday Camp. Seventy-nine boys and seventy-one 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. School Journeys were undertaken by the undermentioned Schools:— Brampton Senior Girls' School: Hythe—29th April to 6th May—28 girls. Wimeraux—23rd to 30th June— 20 girls. Central Park Senior Boys': Weald of Kent and Sussex—5th to 16th September—30 boys. Cornwell Senior Girls': Hythe—13th to 20th May—14 girls. Plashet Senior Boys': Ryde—13th to 27th May—50 boys. Winsor Senior Mixed: Weald of Kent—13th to 25th June—12 girls and 14 boys. A party of sixty boys from East Ham Elementary Schools took part in a School Journey to Cologne from 17th to 27th June, 1938. The boys benefited considerably by the experience. 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 147 cal 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 continued to send a certain number of children, for whom such treatment would be beneficial, to the Ogilvie School of Recovery at Clacton-on-Sea. Arrangements have also been made for the admission of children to the Russell-Cotes School of Recovery at Parkstone, St. Dominic's School of Recovery at Godalming, St. Patrick's Open-Air School at Hayling, St. Catherine's School at Ventnor, Suntrap School at Hayling Island, St. Mary's School of Recovery at Dover, and to the Institutions of the Invalid Children's Aid Association. The following statistical table gives particulars of the number of children admitted to these schools during the year 1938:— 148 Particulars of the number of Children who were resident in Schools of Recovery between 1st January and 31st December, 1938, 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 1 3 1 1 1 1 6 3 — — 2 1 — — 5 3 1 — 1 — — 1 1 18 14 32 I.C.A.A. (hdqts.) — — — — 2 1 — 3 — — — — — — — — — — — — — — — — 2 4 6 St. Catherines — 4 1 1 2 1 — 1 — — 2 — — — — — 1 i 1 1 — — 1 1 8 10 18 St. Dominic's 3 — — — 1 — 4 — 3 — 1 — 7 — — — — — 1 — — — 3 — 23 — 23 Suntrap — — 2 1 1 1 — — 2 2 — — — — — — — — — — — — — — 5 4 9 No. of Weeks 6 12 14 24 26 Total RussellCotes B. G. B. G. B. G. B. G. B G B G 1 — 22 12 9 4 5 — 1 — 38 16 149 SYNOPSIS OF CASES REFERRED TO EAST HAM I.C.A.A. BY SCHOOL MEDICAL SERVICE DURING 1938. Disease from which the children were suffering: Anaemia and debility 17 Debility following pneumonia 2 Debility following infectious illnesses 3 Debility following street accident 1 Debility following tonsillectomy 3 Debility following influenza 1 Debility following mastoidectomy 2 Bronchitis and catarrh 4 Malnutrition 1 Anterio-poliomyelitis 3 Heart disease 2 Rheumatism 3 Cervical adenitis 2 Biliousness 1 Blepharitis 1 46 Action taken: Convalescence 40 Surgical Instruments provided 4 I.C.A.A. unable to assist 1 Parents refused treatment offered 1 46 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. Six 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 40 children of school age and for whom the Association has undertaken full financial responsibility. 150 The School of Recovery cases sent by the Education Committee through the I.C.A.A. (Headquarters) cost the Authority £1 8s. 6d. per week per case. The 40 cases referred from the School Medical Department to the local I.C.A.A. received convalescent treatment totalling 216 weeks. The total cost of this treatment was £151 17s., the average length of stay per child was 5 weeks, and the average cost per case was £3. (f) Day Special Schools for Physically Defective Children There are no Schools of this type in the Borough, 10. PHYSICAL TRAINING. Physical training has been continued on the lines reported last year and is a highly satisfactory feature of the educational system in East Ham. 11. PROVISION OF MEALS. During the year 134,750 meals were provided for children, as compared with 130,749 in 1937. 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 1938 the number of parents who were present at the routine medical inspections was 3,710 (4,201 in 1937), that is, 83.8 per cent. of the cases examined (72.3 per cent. in 1937). 151 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 Inspectors 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 14 were medically examined, reports and advice in each case being sent to the Secretary of the Education Committee. 16. CO-OPERATION OF VOLUNTARY BODIES. Reference to 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. Ninety-nine 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 1938. The Inspectors have made 441 visits in regard to these cases and the following table indicates the work performed by the Society:— Condition Number of Cases Treatment Obtained Trratment arranged Cases under Observation Tonsils and Adenoids 13 5 3 5 Defective Vision 9 8 — 1 Dental Carieg 6 4 — 2 General Neglect 49 11 improved — 8 Ill-Treatment 4 4 improved — — Others 18 16 improved — 2 99 78 3 18 152 The fact that Court Proceedings were avoided in every case is deserving of special mention, and the Society is to be congratulated upon the excellent results achieved. 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. (See Table III), Eight children are suffering from physical defects which prevents them attending public elementary schools. One hundred and sixty-two children considered physically defective and 78 children suffering from glandular and noninfectious pulmonary tuberculosis, are attending ordinary elementary schools. Mentally Defective Children. During the year, 1938, the number of cases examined for purposes of the Mental Deficiency Acts was 39 (23 in 1937). Of these, 8 were classified as mentally deficient and 31 as dull and backward, recommendations being made as shown in the following table:— Number examined 3 Classified as mentally deficient 6 8 Classified as morally deficient — Classified as imbeciles 2 Classified as idiots — Classified as dull and backward 31 Recommended for Special School 6 18. NURSERY SCHOOLS. There are at present no Nursery Schools in East Ham. 153 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-nine 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 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. (See also 4 (a) page 6.) 22. SPECIAL ENQUIRIES. No special enquiries were carried out during the year 1938. 23. MISCELLANEOUS. During the year 1938, the following special medical examinations were made in connection with the appointment of staff:— Teachers 27 Assistant Teachers 11 Caretakers 2 Domestic Science Teacher 1 Organizer of Physical Training 1 154 TABLE I. RETURN OF MEDICAL INSPECTIONS. CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups— Entrants 1401 Second Age Group 1427 Third Age Group 1268 Total 4096 Number of other Routine Inspections 328 Grand Total 4424 B.—OTHER INSPECTIONS. Number of Special Inspections 3762 Number of Re-Inspections 3385 Total 7147 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 11A Total (1) (2) (3) (4) Entrants 1 244 245 Second Age Group 75 119 185 Third Age Group 65 82 134 Total (Prescribed Groups) 141 445 564 Other Routine Inspections 14 18 28 Grand Total 155 463 592 Note:—No individual child is counted more than once in any column of this table. 155 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1938. 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 — — 27 — (3) Scabies 7 1 27 1 (4) Impetigo 4 1 327 — (5) Other Diseases (NonTuberculous) 31 20 381 1 Total (Heads 1 to 5) 42 22 765 2 Eye (6) Blepharitis 16 3 44 – (7) Conjunctivitis 4 1 51 — (8) Keratitis — — — — (9) Corneal Opacities — – — — (10) Other Conditions (excluding Defective Vision and Squint) 3 1 62 – Total (Heads 6 to 10) 23 5 157 — (11) Defective Vision (excluding Squint) 155 203 119 12 (12) Squint 17 19 19 — Ear (13) Defective Hearing 5 2 27 1 (14) Otitis Media 4 1 90 — (15) Other Ear Diseases 17 9 92 — Nose and Throat (16) Chronic Tonsillitis only 32 244 4 1 (17) Adenoids only 15 13 14 1 (18) Chronic Tonsillitis and Adenoids 145 33 150 1 (19) Other Conditions 26 23 58 2 156 TABLE II.—continued. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects No. of Defects. Requiring Treatment. Requiring to be kept under obser vation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under obser vation, but not requiring Treatment. (1) (2) (3) (4) (5) 20) Enlarged Cervical Glands (NonTuberculous) 31 160 40 — (21) Defective Speech 3 32 12 77 Heart and Circulation Heart Disease: (22) Organic 2 5 3 — (23) Functional 2 46 — — (24) Anaemia 7 13 45 — Dungs (25) Bronchitis 20 60 77 3 (26) Other Non-Tuberculous Diseases 5 9 4 — Tuberulosis Pulmonary:— (27) Definite — 1 — — (28) Suspected 1 — 1 — Non-Pulmonary:— (29) Glands — 1 — 1 (30) Bones and Joints — 1 — 1 (31) Skin — — — — (32) Other Forms 2 4 — 2 Total (Heads 29 to 32) 2 6 — 4 Nervous System (33) Epilepsy — 1 1 2 (34) Chorea 1 2 8 — (35) Other Conditions 1 8 1 — Deformities (36) Rickets — 18 1 — (37) Spinal Curvature 2 1 2 — < (38) Other Forms 33 43 15 3 39) Other Defects and Diseases (excluding defects of Nutrition, Uncleanliness and Dental Diseases) 196 101 764 57 Total 790 1080 2469 166 157 B. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age-groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants 1,401 163 11.63 1,201 85.72 37 2.64 - - Second Agegroup 1,427 195 13.67 1,187 83.18 44 3.08 1 0.08 Third Agegroup 1,268 278 21.93 963 75.95 26 2.05 1 0.08 Other Rou'ine Inspections 328 52 15.85 261 79.57 14 4.27 1 0.3 Total 4,424 688 15.55 3,612 81.64 121 2.77 3 0.07 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Blind Children. A blind child is defined by Section 69 of the Education Act, 1921, as one who is "too blind to be able to read the ordinary school books used by children." This definition covers some children who are totally, or almost totally, blind and can only be appropriately taught in a school for blind children, and others who have partial sight and can be appropriately taught in a school for partially sighted children. Only the first class is included in this section. At Certified Schools for the Blind At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 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. 158 Table III—continued. Children who are able by means of suitable glasses to read the ordinary school books used by children without fatigue or injury to their vision are not included in this Table. At Certified Schools for the Blind. At Certified Schools for the Partially Sighted. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 2 12 1 1 — 16 Deaf Children. A deaf child is defined by Section 69 of the Education Act, 1921, as one who is "too deaf to be taught in a class of hearing children in an elementary school." This definition covers some children who are totally, or almost totally, deaf and can only be appropriately taught in a school for deaf children, and others who have partial hearing and can be appropriately taught in a school for partially deaf children. 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. 15 — — — 15 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 and Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 — — — 1 Mentally Defective Children. Feeble-Minded Children. Mentally Defective children are children who, not being imbecile and not being merely dull or backward, are incapable by reason of mental 159 Table III—continued. defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools but are not incapable by reason of that defect of receiving benefit from instruction in Special Schools for mentally defective children. The following Table includes all such children except those who have been notified to the Local Authority under the Mental Deficiency Act in accordance with Article 3 of the Mental Deficiency (Notification of Children) Regulations, 1928. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At At other i no School Institutions, j or 1 Institution. Total. 55 — 4 59 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. 3 — — — 3 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.) 160 Table III—continued. jJ At Certified Special Schools. At Public Elementary Schools. At other Institutions. At'' no School or Institution. Total. 5 29 3 2 39 II.—Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in I. above.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 6 49 1 2 58 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. 44 117 — — 161 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 161 Table III—continued Section 55 of the Eduction Act, 1921, that they are incapable by reason of such physical defect of receiving proper benefit from the instruction in the ordinary ^ublic Elementary Schools. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 5 18 7 1 31 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 11 27 — 3 41 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.P Blind and M.D. — — — 1 1 162 TABLE IV. TREATMENT TABLES. GROUP I.—MINOS. 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— 2 — — eatment. 2 — 2 (ii.) Other — — — Ringworm-Body 19 — 19 Scabies ... 34 — 34 Impetigo 297 1 298 Other skin disease 330 2 332 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 132 I 133 Minor Ear Defects 187 — 187 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc) 400 6 406 Total 1401 10 1411 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) 419 — 419 Other defect or disease of the eyes (excluding those recorded in Group 1) — — — Total 419 — 419 No. of Children for whom spectacles were (a) Prescribed 222 — 222 (6) Obtained 213 9 222 163 TABLE IV.—continued. GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Defects. Received Operative Treatment. Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. Received other forms of of Treatment. Total number treated (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 1 9 189 78 — 2 4 2 1 11 193 80 14 299 (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. Otherwise. (1) (2) Residential treatment with education. Residentialtreat- ment without education. Non-residential treatment at an orthopaedic clinic. Residential treatment with education. Residentialtreat- ment without education. Non-residential treatment at an orthopaedic clinic. number treated (i) (ii) (iii) (i) (ii) (iii) Number of children treated — — 3 — — 5 8 164 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 1254 1362 1342 1573 1517 1529 1687 1217 - — 11481 (b) Specials 283 (c) Total (Routine and Specials) 11764 (2) Number found to require treatment 6970 (3) Number actually treated 4018 (4) Attendances made by children for treatment 7426 (5) Half-days devoted to :— (7) Extractions:— Inspection 106 Permanent Teeth 1008 Treatment 660 Temporary Teeth 6275 Total 766 Total 7283 (8) Administrations of general anaesthetics for extractions 755 (6 Fillings:— (9) Other Operations:— Permanent Teeth 1887 Permanent Teeth 861 Temporary Teeth 391 Temporary Teeth 308 Total 2278 Total 1169 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 40821 (iii) Number of individual children found unclean 541 (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 — 165 TABLE I. RETURN OF MEDICAL INSPECTIONS CHILDREN ATTENDING SECONDARY SCHOOLS. A.—ROUTINE MEDICAL INSPECTIONS. All Ages: Boys Girls Total 423 508 All Secondary School Children are examined every year. B.—OTHER INSPECTIONS. Boys Girls Number of Special Inspections — — Number of Re-Inspections 49 26 Total 49 26 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 B G B G B G Total 16 31 8 76 24 96 166 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1938. 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) B G B G B G B G Skin I (1) Ringworm—Scalp — — — — — — — — (2) „ Body — — — — — — — — (3) Scabies — — — — — — — — (4) Impetigo — 1 — — — — — — (5) Other Diseases (NonTuberculous) 2 5 2 3 — — — — Total (Heads 1 to 5) 2 6 2 3 — — — — (6) Blepharitis — 2 — — — — — — j Eye (7) Conjunctivitis — — — — — — — — (8) Keratitis — — — — — — — — (9) Corneal Opacities — — — — — — — — (10) Other Conditions (ex eluding Defective Vision and Squint) 2 — — 1 — — — — Total (Heads 6 to 10) 2 2 — 1 — — — — (11) Defective Visionfexcluding Squint) 16 31 15 11 — — — — (12) Squint — — 1 — — — — — Ear (13) Defective Hearing — 3 — 1 — — — (14) Otitis Media — — 1 — — — — — (15) Other Ear Diseases — — — 1 — — — — Nose and Throatj (16) Chronic Tonsillitis only — 1 11 14 (17) Adenoids only — 1 — — — — — — (18) Chronic Tonsillitis and Adenoids — 1 — 2 — — — — (19) Other Conditions 1 3 2 3 — — — — 167 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 Tre atmnt. Requiring Treatment. Requiring to be kept under obser vation but not requiring Treatment. (1) (2) (3) (4) (5) B G B G B G B G (20) Enlarged Cervical Glands (NonTuberculous) — 1 3 11 — — — — 21) Defective Speech — 1 1 — — — — — Heart Disease: Heart and Circulation (22) Organic — — 1 — — — — — (23) Functional — 3 I 9 — — — — (24) Anaemia — 2 1 2 — — — — Lungs (25) Bronchitis 1 3 2 2 — — — — (26) Other Non-Tuberculous Diseases — — — 2 — — — — Pulmonary:— 1 1 (27) Definite — — — — — — — — (28) Suspected — — — — — — — — Tuber- Non-Pulinonary :— culosis i (29) Glands ... — — — — — — — — (30) Bones and Joints — — — — — — — — (31) Skin — — — — — — — — (32) Other Forms — — — — — — — — Total (Heads 29 to 32) — — — — — — — — Nervous System (33) Epilepsy — — — — — — — — (34) Chorea — — — — — — — — (35) Other Conditions — — — — — — — — Defor- | mities ( (36) Rickets — — — — — — — — (37) Spinal Curvature — — — — — — — — (38) Other Forms 2 42 — 26 — — — — (39) Other Defects and Diseases (excluding defects of Nutrition, Uncleanliness and Dental Diseases) 10 2 16 — — — — Total 24 110 43 107 — — — — 168 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. % Boys 423 61 14.42 360 85.11 2 0.47 — — Girls 508 122 24.01 374 73.62 12 2.36 — — TABLE IV. TREATMENT TABLES GROUP I.—MINOR AILMENTS (excluding Uncleanliness, for which see Table VI) Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) B G B G B G Skin— Ringworm-Scalp— (i). X-Ray Treatment — — — — — — (ii.) Other — — — — — — Ringworm-Body — — — — — — Scabies — 1 — — — 1 Impetigo 1 2 — — 1 2 Other skin disease — 7 — — — 7 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 2 1 — — 2 1 Minor Ear Defects 2 8 — — 2 8 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 9 24 1 — 10 24 Total 14 43 1 — 15 43 160 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 13 — — 21 13 Other defect or disease of the eyes (excluding those recorded in Group I) — — — — — — Total 21 13 — — 21 13 No. of Children for whom spectacles were (a) Prescribed 10 7 — — 10 7 (b) Obtained 10 6 — — 10 6 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (i) (ii) (in) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) B G B G B G B G B G B B G B G B G B G B G B G B G B G 1 — — — 3 2 4 4 — — — — 1 1 — — — 3 2 4 4 — — 9 6 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. INDEX 171 INDEX A. Acts—Blind Persons, 1920-38 37-39 Act—Factories, 1937 120-121 Act—Local Government, 1929 21 Act—Public Health, 1936 Child Life Protection 44 Act—Housing. 1936 109-111 Acts—Mental Deficiency 34-37 Acts—Midwives, 1902-36 17, 42-44 Act—Rag Flock 106 Act—Rent Restriction 107 Act—Shops, 1934 107-108 Adenoids 47, 133, 139 Adulteration of Foodstuffs 115-116 After-Care Committee 73, 100 Aldersbrook Homes 29-33 Ambulance Facilities 18-19 Attendance Officers, Co-operation of 151 Ante and Post-Natal Clinics 50-51 Area 10 Artificial Sunlight 138,141-145 Atmospheric Pollution 105 Aural Surgeon, Report of 141 Aural Treatment 23,48,163 B. Bacteriology 18, 86 Bacteriological Examinations 65, 112-113, 118 Baths—School 150 Baths—Swimming 101,108-109 Bed Bugs—Eradication of 109 Birth Rate 15 Births 12, 48 Births. Illegitimate 11 Births, Still 12, 49 Blind Persons Acts, 1920-38 37-39 Blind Children 152 Blindness—Prevention of 40 Bronchitis 64 C. Camps—School 146 Cancer 67-69,78 Caravans 106 Centre, Training and Occupation M.D. 36-37 Chemical Examination of Food 118 Child Life Protection 44 Children's Homes 29-33 Children—Invalid Aid Association 40-41, 53,151 Cinemas 105 Classrooms. Open Air 147 Cleansing, Public 103 Clinics, Ante and Post-Natal 50-51 „ Artificial Sunlight 138,141-145 Aural 138 Dental 47,134 141-143,164 „ Immunization 55-56,138 „ Infan 46 „ Morning 48 „ Ophthalmic 138 „ School 138 ,, Toddlers' 47 Clinic, Tuberculosis & Chest 71-79 Clinics and Treatment Centres 19-20 Closet Accommodation ... 103 Committees 3-4 Complaints 105 Contents—Principal 2 Continuation Schools 153 Co-ordination 127 Crematorium, City of London 101 Cripples 134, 143-144,160-161 D. Dairies 112 Day-Schools, Open Air 147 Deaf Children 152, 158 Deaths 13,16-16a Death-rate, General 15 „ Infantile 13 „ Zymotic 54 Deaths, Causes of 15a „ Infants 13, 16a „ in Wards and Rates 16 Dental Treatment 47,134,141-143,164 Dental Treatment—Tuberculous Patients 79,83,86 Dental Surgeons, Report of 141-143 Diarrhoea 11 Diphtheria 54, 57, 60, 61 Drainage and Sewerage 102 Dysentery 56, 64 E. Ear Diseases 134, 141 East Ham and Southend-on- Sea Joint Hospital Board 23a East Ham Memorial Hospital 25-26 Education Committee' 4 Employment of Children 153 Enteric Fever 56,57,63 Epileptic Children 152, 159 Erysipelas 56,57,64 Eye Diseases of Children 134,139 Exceptional School Children 128-129 Extracts from Vital Statistics 10-16a F. Factories Act, 1937 105,120-121 Findings of Medical Inspection of School Children 129-135 172 INDEX—continued. F. Following-up 136-137 Food and Drugs Adulteration 115-116 Food, Chemical and Bacteriological Examination 118 Food Inspection 112-118 „ Premises 115 Free Supplies of Milk 46 Forest Gate Hospital 27-28 G. General Provision -Health Services 17-23 General and Special Hospitals and Children's Homes ... 23-33 Graded Milk 113 H. Harts Sanatorium 83-91 Health Committee 3 Health Services—General Provision of 17-23 Health Visitors 49 Heart Disease 161 Home Helps 53 Home—Nursing in 17 Homes—Aldersbrook and Scattered 29-33 Homes—Nursing 45 Homeless Children 44 Hospital, Forest Gate 27-28 Hospitals General and Special 23-33 Hospital, Infectious Diseases 60-67 „ ast Ham Memorial 25-26 „ Maternity 23.51 „ Mental 23-25 „ Smallpox 25 Whipps Cross 27-28 Houses—Inhabited 10 Houses, Maintenance of 110 Housing 109-111 Housing Statistics 111 I. Illegitimate Births 11 Immunization 65 Immunization Clinics 55-56,138 Improvements 104 Increase of Rent (Restriction) Act 107 Infant Deaths 13,16a „ Welfare Clinics 46 Infantile Mortality 13, 16a Infectious Diseases Hospital 60-67 Infectious Diseases 54-67,135-136 Inhabited Houses 10 Inspection of and Supervision of Food 112-118 Inspections 103-104 Inspection of School Children 127-129 Institutional Provision for Unmairied Mothers and Homeless Children 44 Institutions controlled by West Ham 27-28 Invalid Children's Aid Association 40-41,53,151 L. Laboratory Faci'ities 18, 65 Legal Proceedings 107 Light Treatment 138,141-145 Local Government Act, 1929 21 M. Maternal Mortality 14, 52 Maternity and Child Welfare 42-53 Maternity and Child Welfare Committee 3 Maternity Boxes 53 Maternity Homes and Hospitals 23, 51 Meals, Provision of 150 Measles 64 Meat and other Foods 113-115 Meat Inspection 113 Medical Examinations, Miscellaneous 153 Medical Inspection of School Children 127-129 Medical Officer of Health's Report 1-122 Medical Relief, Public Assistance 21-22 Mental Defects, School Children 152,158-159 Mental Defectives, Training Centre 36-37 Mental Deficiency 23,34-37 „ Deficiency Committee 4 „ Hospital 23-25 Meteorology 119 Midwives Acts, 1902-36 17 „ 17,42-44,51 „ Municipal 42-44 Milk, Bacteriological Examination of 112-113 Milk—Free Supplies 46 „ Graded 113 ,, (Special Designation) Order, 1936 13 „ Supply 12-113 Minor Ailments 33,139,162 Mortality, Analysis of 5 „ Infantile 3, 16a „ Maternal 4,32 „ Neo-natal 3 Mosquito Control 06 Municipal Midwives 2-44 173 INDEX—continued. N. Neo-natal Mortality 13 Noteworthy Causes of Sickness or Invalidity 11 Notices served and complied with 104 Notification of Births 48 N.S.P.C.C. 151 Nursery Schools 152 Nursing Arrangements 17 „ Homes—Public Health Act, 1936 45 Nutrition 135 O. Obstetrical Specialist 14 Occupations and Premises subject to control of Local Authority 106 Occupational Therapy—Tuberculosis 86, 100 Offensive Trades 106 Offices, Survey of 108 Open Air Education 146-150 Ophthalmia Neonatorum 23,52,60 Ophthalmic Clinic 138 „ Surgeon, Report of 140 „ Treatment 48 Orthopaedic Treatment 23,45,163 Outdoor Assistance 118 Overcrowding 109 P. Parents, Co-operation of 150 Physical Features of Area 10 „ Training 150 Physically Defective Children 150, 152 Plaistow Maternity Hospital and District Nurses Home 17 Playground Classes 146 Pneumonia 64 Pools, Swimming 101 Population 14 Post-Natal Work 50-51 Premises and Occupations subject to control of Local Authority 106 Prevention of Blindness 40 Principal Contents 2 Propaganda 12 Prosecutions 107 Provision of Meals 150 Public Assistance Domiciliary- Medical Service 21-22 „ Assistance Institutions 27-28 „ Cleansing 103 „ Health Act, 1936— Child Life Protection 44 „ Health Act, 1936— Nursing Homes 45 „ Health Committee 3 Puerperal Fever and Pyrexia 23,52,56 R. Rag Flock Ac 106 Rat Extermination 105 Rateable Value 10 Rent Restriction—Certificates of disrepair 107 Residential Schools 147-150 Ringworm 47 Rivers and Streams 103 Runwell Mental Hospital 23-24 S. Sanatoria 88-95 Sanitary Circumstances 102-107 „ Inspection 103-107 „ Section and Housing 102-111 Scarlet Fever 54,57,61.62 Scattered Homes 29-33 Schick Immunization Clinics 55-56 School Attendance Officers— Co-operation of 151 „ Baths 150 „ Blind Children 157 „ Camps 146 „ Children, Blind. Deaf, Defective and Epileptic 152 „ Children, Minor Ailments 133 „ Children, Medical Inspection 127-129 „ Children, Mentally Defective 152,158-159 „ Children, Physically Defective 150,152 „ Children, Verminous Conditions132 „ Continuation 153 „ Cripples 143-144 „ Exceptional Children 128-129 „ Meals 150 „ Medical Officer's Report 123-169 „ Medical Service in Relation to Public Elementary Schools 127 „ Medical Treatment 138-145 „ Nursery 152 „ Open Air 147 Schools of Recovery 147-150 Schools, Secondary 153 Senior Sanitary Inspector. Report of 102-111 Sewerage 102 Shops Act. 1934 107-108 Sickness or Invalidity, any Noteworthy Causes 11 Skin Diseases 134,139 Slaughterhouses 113 Slum Clearance 110 Smallpox 25 Smoke Abatement 108 174 IN DEX—continued. S. Social Conditions of Area 10 Special Enquiries 153 Special Schools—Physically Defective Children 152,159-160 Staff 5-6. 53, 127 Statistical and Social Conditions of Area 10-16a Still Births 12,49 Streams 103 Survey of Offices 108 Swimming Baths and Pools 101,108-109 T. Table, Aldersbrook and Scattered Homes 29 „ Birth-rate, etc. 15 ,, Blind Persons 38a-39 „ Cancer 69 ,, Clinics and Treatment Centres 20 „ Cost at Institutions 67,87 „ Death Rate, etc. 15 „ Deaths, Causes of 15a „ Deaths, Ward — Rates 16 „ Dental Treatment 134 „ Domiciliary Midwifery 51 „ East Ham Memorial Hospital 26 „ Exceptional Children 157-161 „ Factories Act, 1937 120-121 „ Findings of Medical Inspection 130 „ Food and Drugs Adulteration 116-117 „ Housing 110-111 „ Infant Deaths 16a „ Infectious Diseases, Notifiable 58,59 „ Infectious Diseases, Removed to Hospital 66 „ Infectious Diseases in School Children 137 „ Maternal Mortality 14 „ Meat Inspection 114 „ Mental Defectives 34-37 „ Mental Patients—disposition of 25 „ Meteorology 119 „ Midwifery & Maternity Services 42-44 „ Ophthalmia Neonatorum 60 „ Out-door Assistance 118 „ Public Assistance Domiciliary Medical Service 21 „ Public Assistance Institutions 27-28 „ Registration of Nursing Homes 45 „ Samples, Food and Drugs 116 Table, School 1 Children, Defects of 154-156 „ School Children Examined 154 „ School Children found to require Treatment 154-156 „ School Children—Malnutrition 157 „ School Children, Treatment carried out 162-164 „ Schools of Recovery 148-149 „ Secondary School Examinations 165-169 „ Sunlight Treatment 145 „ Tuberculosis Deaths 99 „ Tuberculosis and Chest Clinic 80-81b „ Tuberculosis, Five years After-History 83a „ Tuberculosis Notifications 96-99 „ Tuberculosis, Residential Treatment 88-95 „ Unemployed 118a „ Vaccination 54 „ Verminous Condition of School Children 132 „ Vital Statistics of certain County Boroughs 101a „ Work of Home Visitor to the Blind 39 Teaching Staff. Co-operation of 151 Toddlers' Clinic 47 Tonsils and Adenoids 47,133.139 Training Centre. Mental Defectives 36-37 Treatment Centres 19-20 Tuberculosis 70-100.133.139 Tuberculosis and Chest Clinic 71-79 Tuberculosis After Care Committee 73.100 Tuberculosis, Five years After-History 82-83a T uberculosis—Occupational Therapy 86.100 U. Uncleanliness 131 Unemployment and out-door Assistance 118 Unmarried Mothers 44 V. Vaccination 54 Verminous Conditions— School Children 132 Venereal Diseases 22-23 Vital Statistics, Extracts from 10-16a Vision 134,139,162 Visits, Health Visitors 49 Visits. School Nurses 136 Voluntary Associations 40-41. 53.151 175 INDEX—continued. W. Wards. Deaths in and Rates 16 Water Supply 102 Whipps Cross Hospital 27-28 Whooping Cough 64 Welfare of the Blind 37-39 z. Zymotic Diseases 54 JR1/68