ESA15 COUNTY BOROUGH OF EAST HAM. ANNUAL REPORT OF THE. MEDICAL OFFICER OF HEALTH FOR THE YEAR 1 9 3 9. Malcolm E. Barker, M.R.C.S.(Eng).,L.R.C.P.,D.P.H.( Lond) MEMBERS OP THE COUNCIL. The Mayor:- Alderman Edward Francis Markey,J.P. The Deputy Mayor Councillor William James Davis. Aldermen:- Joseph Walter Barton, Thomas William Burden Richard John Pell Thomas Irwin Lethaby, J.P. Walter Thomas Newling,J.P. Jesse James Pope, J,P. Annie Taylor (Mrs.)J.P. Frederick Welch (1) Beatrice wilkens (Mrs.) Councillors:- Charles Edward Beckett William Henry Whittock Beecham Leslie Alfred Victor Bennett Ethel Maud Charlotte Brace (Mrs) Charles William Brading,C.R.P.,J.P. Lendoranna Minnie Brignell (Mrs.) Charles William Dixon Eric Cyril Boyd Edwards, LL.B. (2) Sydney Arnold Elson Bertie George Goodenough Harper Bernard Harper, J.P. John Albert Hart Henry Joseph Hooper Walter Edwin Hurford Herbert Percy Jackson Harold Joseph, J.P., F.A.L.P.A. Bertram Arthur Keeno (3) Winifred May Knight (Mrs.) John Linsley Linsley-Thomas Robert William Moger, J.P. George Horace Moncar William Henry Pooley Alfred Prior (4) Alice Beatrice Spencer (Mrs) William Thompson William Bertram Warncken Alfred Tom Yates Watson Thomas William Williams Ernest Albert Wood Co-opted Members of the Maternity & Child Welfare and Mental Deficiency Committees. Mrs. E.M.Devenay Mrs. E.M.Pell Mrs. I. Watson Maternity Mrs. C.J.Cross and Child Mrs. A.M.Gray Welfare. Mrs. M. Podd Mental Deficiency (1) Chairman of Public Health and Maternity & Child Welfare Committee (2) Vice Chairman " " " " " (3) Chairman of Committee for the Care of the Mentally Defective (4) Vice Chairman " " " " " 1 PUBLIC HEALTH DEPARTMENT, Town Hall Annexe,' East Han, E.6. MAY,1940. To His Worship the Mayor, Aldermen and Councillors of the County Borough of East Ham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you my Annual Report on the health of the County Borough of East Ham for the year 1939, together with the Annual Report to the Education Committee on the School Medical Service. It is with much regret that I record the death of Dr. James Crawford, for several years Assistant Medical Officer of Health and Medical Superintendent of the Harts Sanatorium. The report is mainly statistical and, in accordance with the request of the Minis try of Health, is confined to essential features of the year's work. The tabular matter, in many instances, is abridged, but sufficient detail is given to permit of a comparison with previous years, and, at the same time, to form a continuous record of the public health activities of the Borough. The incidence of infectious disease has been noticeably low, and the health of the Borough generally shows further improvement in almost all respects. Early investigation of illness and close supervision of contacts have contributed largely to this end.The facilities available in all directions for inspection, examination and treatment have produced material results,and,had not the war supervened,would,this year have established a record in the health of the Borough. Additional and extended services in operation during the year enhanced the benefits obtainable. Although latterly some curtailment was necessary, clinics were continued throughout the whole period, and I wish to record appreciation of tthe help afforded to the staff by the people of this Borough during the difficult times. The medical arrangements in connection with the evacuation of maternity cases, school children and others, were carried out with the maximum of efficiency, resulting in little inconvenience to those participating. Much credit is due to the medical, technical and clerical staffs for their work in the organisation of the Casualties Services etc.,and to the Health Visitors andSchool Nurses for their assistance at the First Aid Posts as Sisters-in-Charge. I acknowledge with gratitude the help afforded by the personnel of the various A.R.P. Posts and Depots. I desire again to express my thanks to the Chairman and members of the Public Health Committee, and to those of other Committees with which I am associated. My thanks are also due to my colleagues and to members of the Public Health Staff for their efficient service and willing co-operation. I have the honour to be, Your obedient Servant, Medical Officer of Health. 2. STATISTICAL CONDITIONS OP THE AREA. Area (in stature acres) land and inland water 3,324 Population. Census- 1931 142,394 Estimated - 1939 for Birth Rate 127,600 " Death Rate 122,800 Number of inhabited houses (end of 1939)according to rate books (including tenements & shops. Approx. 33,000 Rateable value at 31st December, 1939 £762,862 Sum represented by a penny rate for the year 1939/40. £3,065 Extracts from Vital Statistics. _ . For Infant & Maternal Mortality. Total. Males. Females, .Males. Females. Total. Live Legitimate 1,804 934 870 922 857 1,779 Births Illegitimate 41 20 21 20 21 41 Still Births Deaths 57 1,400 28 752 29 648 Deaths from Puerperal causes Deaths. Rate per 1,000 total (live & still births) Puerperal Sepsis 3 1.57 Other Puerperal causes 3 1.57 6 3.14 Death rate of Infants under one year of age:- All infants per 1,000 live "births 41 Legitimate infants per 1,000 legitimate live births 41 Illegitimate " " " illegitimate " " 48 Deaths from Cancer (all ages) 235 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) 6 Deaths from Diarrhoea (under 2 years of age) 9 Still Births. Still births registered numbered 57 compared with 68 for 1938. The rate per 1,000 total (live and still) births was 29.9, the figure for the previous year being 35.7. Births. The number of live births registered was 1,845 compared with 1,,083 for the year 1938, equivalent to a birth rate of 14.4 per 1,000 of the Registrar General's estimated population calculated for the birth rate. The rate for 1938 was 14.1. Deaths. During the year the number of East Ham residents dying was 1,400. This figure is equal to a death rate of 11.4 per 1,000 of the Registrar General's estimated population calculated for the death rate. For the previous year the rate was 10.6. 3. Infantile Mortality. The number of deaths of children under one year of age was 76, equal to an infantile mortality rate of 41 per 1,000 live births (51 for 1938), the rate for England and Wales being 50 per 1,000 live births. Neo-Natal Mortality. Children dying under the age of one month totalled 39,equal to a neo-natal mortality rate of 21.1 per 1,000 live births. The rate for the previous year was 22.9. Maternal Mortality. Maternal deaths numbered 6, the rate for 1939 being 3.25 per 1,000 live births and 3.14 per 1,000 live and still births. Puerperal Sepsis Other Causes. Total. England & Wales. East Ham. England & Wales East Ham. England & Wales East Ham. Per 1,000 live births 0.77 1.62 2.16 1.62 2.93 3.25 Per l.,000 Total Births (live and still.) 0.74 1.57 2.08 1.57 2.82 3.14 Population. The Registrar General's estimate of the population for 1939 is 127,600 for the birth rate and 122,800 for the death rate. His figure for the year 1938 was 129,500. 4. 5 BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1939. Rate per 1000 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 year England, and. Wales 15.0 0.59 12.1 0.00 - 0.01 0.01 0.03 0.05 0.21 4.6 50 126 County Borough3 and Great Towns including London. 14.8 0.59 12.0 0.00 - 0.01 0.00 0.03 0.05 0*19 6.3 53 148 Smaller Towns (estimated resident populations 25,000 - 50,000 at census 1931. 15.6 0.57 11.2 0.00 - 0.01 0.00 0.02 0.04 0.20 3.0 40 London - Administrative County. 12.3 0.44 11.9 0.00 - 0.00 0.00 0.03 0.02 0.18 8.2 48 EAST HAM 14.4 0.44 11.4 0.02 - - - 0.04 0.04 0.23 4.8 41 CAUSES OF DEATH IN AGE GROUPS, 1939. Cause of Death. All 1 Deaths at different periods of life of residents whether occurring within or without the district. Under 1 year 1- 2 yrs 2-5 yrs. 5-13 yrs. 15-25 yrs 25-35 yrs 3cr45 yrs 45-55 yrs. 55-65 yrs. 65-75 yrs 75 yrs up ward ages M F M F M F M F M F M F M F M F M F M F M F M ] 1, Typhoid - Para typhoid fevers 2 1 - - - - - - - - - - - - - - - - - - - - - - 2. Measles - - - - - - - - - - - - - - - - - - - - - - - - 3. Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - - 4. Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - 5. Diphtheria 3 3 - - 1 - - 1 2 1 - - - - - - - 1 - - - - - - 6. Influenza 19 10 2 - - - 1 - 1 - - 2 2 - - - 2 2 4 1 3 5 4 2 7. Encephalitis Lethargica 1 - -.- - - - - - - - - - - - - - - - - - - - - - 8. Spinal Fever' - 1 - - - - - - - - - - - - - - - - - 1 - - - - 9. Tuberculosis of Respiratory System. 44 27 - - - - - - 1 - 2 10 11 5 10 4 10 2 5 1 5 3 - 2 10. Other Tuberculous Diseases 8 4 1 - _ - 1 1 3 1 1 - 1 - - - 1 1 - - - - - 1 11. Syphilis - 1 - - - - - - - - - - - - - - - - - - - - - - 12. General Paralysis of the Insane (Tabc.s Dorsalis.) 1 - - - - - - - - - - - - - - - - - 1 - - - - - 13.Cancer 116 119 - - - - - - - 1 1 - 4 1 4 9 14 21 24 25 45 . 32 24 30 14.Diabetes 10 12 - - - - - - - - - - - - - - - 2 4 4 2 6 3 - 15. Cerebral Haemorrhage, etc . 26 27 - - - - - - - - - 1 1 1 1 3 4 5 7 9 . 12 7 18 16.Heart Disease 191 170 - - - - - - 1 - 1 1 3 10 5 3 14 7 44 15 77 59 46 75 17.Aneurysm 3 1 - - - - - - - - - 1 - - - - 1 - 1 - 1 - - 18.Other circulatory Diseases. 33 29 - - - - - - - - - - - - - - 2 1 5 8 16 , 7 10 13. 19.Bronchitis 32 16 2 - - - - - - - - - - 1 - - 4 1 2 _ 9 4 15 10 20. Pneumonia(all forms ) 38 26 11 3 - 1 — 1 - - - - 2 2 1 _ 3 — 10 5 3 8 8 6 21.Other respiratory diseases 9 6 - - - - - - - - - - 2 1 1 1 1 2 1 2 1 2 l 22.Peptic Ulcer 13 2 - - - - - - _ - 1 - _ - — _ 2 — 4 - 6 1 - - 23.Diarrhoea,etc. 8 2 6 1 1 1 _ — - _ — - - - - - - - - - 1 _ — - 24.Appendicitis 1 4 - - - - - - _ 1 - - - 1 1 - - 1 - 1 - - - - 25. Cirrhosis of Liver 1 3 - - - - - - - - - - - - -1 - - 2 - 1 - - - - 26. 0ther diseases of Liver, etc. 1 8 - - - - - - - - - - - - 1 1 - - - 2 - 4 - 1 27.Other digestive Diseases. 20 13 1 - - - - 2 - - - - 1 1 2 1 - - 7 2 5 7 4 - 28.Acute & Chronic Nephritis 13 20 _ - - - - - 1 - - 1 2 1 1 - 1 3 2 2 3 11 3 2 29. Puerperal Sepeis - 3 - - - - - - - - - 2 - 1 - - - - - - - - - - 30. Other Purperal Causes - 3 - - - - - - - - - 1 - - - 2 - - - - - - - - 31. Congenital debility Premature Birth, Malformations, etc, 26 19 25 18 - - - - - - - 1 1 - - - - - - - - - - - 32.Senility 41 34 - - - - - - - - - - - - - - - - - - 7 6 34 28 33.Suicide 13 5 - - - — — _ _ 3 1 2 - 3 3 5 - - 1 - - 34.Other Violence 29 16 - 1 — _ — 1 1 1 7 _ 6 1 2 1 2 5 2 4 1 2 8 35. Other defined causes 50 47 1 1 - — 2 — 3 1 4 7 1, 2 4 3 6 10 6 11 14 6 9 6 36. Causes ill-defined or unknown. - - - - - - - - - - - - - - - - - - - - - - - - Totals 752 648 49 27 2 2 4 9 13 6 19 27 41 28 36 26 69 63 136 89 212 173 171 198 6 DEATHS IN WARDS. Cauuse of Death. Manor Park Little ???ford Woodgrange shet Kensing ton. Castle Centra1. Wall End. Great field South Total 1.Typhoid & Pera Typhoid Fevers - - 1 2 - - - - - - 3 2.Measles. - - - - - - - — - - - 3.Scarlet Fever - - - - - - - - - - - 4.Whooping Cough - 2 - - 2 1 - 1 - 6 5.Diphtheria 1 2 - 1 1 - 1 - - - 6 6.Influenza 3 3 6 2 2 1 4 2 4 2 29 7.Encephalitis Lethargica - - - - _ 1 - _ - - 1 8.Cerebrospinal Fever _ - - _ 1 - - - - - 1 9.Tuberculosis of Respiratory System 6 9 4 14 4 8 4 10 4 8 71 10. Other Tuberculous Diseases. - 2 1 1 2 . 2 - 1 3 12 11. Syphilis - - - - - - - - - 1 1 12.General Paralysis of the Insane Tabes Dorsalis - 1 - - - - - - - - 1 13. Cancer 31 28 26 34 22 16 15 17 20 26 235 14.Diabetes 3 1 4 2 2 1 3 2 2 2 22 15. Cerebral Haemorrhage, etc 6 3 7 5 4 7 7 11 7 6 63 16. Heart Disease 35 39 37 41 33 30 37 37 26 46 361 17. Aneurysm - - 1 - - - 1 1 1 - 4 18. Other Circulatory Diseases. 6 7 3 5 3 10 4 9 10 5 62 19. Bronchitis 6 8 4 36 2 6 7 5 4 3 48 20.Pneumonia (all forms.). 9 8 4 4 7 5 5 7 5 10 64 21.Other Respiratory Diseases. - 1 2 - 2 3 3 2 - 2 15 22. Peptic Ulcer 4 1 1 3 2 1 1 1 - 1 15 23.Diarrhoea, etc. 1 4 - _ - - 4 1 — — 10 24.Appendicitis 1 - - - - 1 — 2 1 - 5 25. Cirrhosis of Liver 1 - 1 - 1 — - - - 1 4 26.Other diseases of Liver, etc. - 1 - 2 1 - 1 2 2 - 9 27.0ther digestive diseases. 5 1 5 2 5 2 3 4 3 3 33 28.Acute & Chronic Nephritis. 1 2 3 9 4 1 1 4 2 6 33 29.Puerperal Sepsis. - 1 - - - 1 - - - 1 3 30.Other Puerperal Causes. 1 - - 1 - 1 - - - - 3 31.Congenital D???bility Prematura Birth, Malformations,etc. 11 8 2 4 2 4 1 6 3 4 45 32.Senility 9 11 8 9 3 12 2 7 4 10 75 33.Suicide 3 - 2 2 1 2 2 2 3 1 18 34.Other Violence 2 7 2 4 4 8 5 3 1 9 45 35.Other defined Causes. 7 14 12 8 4 13 12 11 10 6 97 Causes 36. Ill-defined or unknown. - _ - - - - _ - - - - TOTALS: 152 164 136 158 ll4 134 l20 146 114 156 1400 6 8 PREVALENCE OP, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for the 52 weeks ending 30.12.39. DISEASE. Cases notified in whole district Ward Distribution of Cases. No.of oases recoved to Hospital Total Deaths in Borough at all ages - years. Manor Park. Little Hford Woodgrange Plashet Kcnsington Castlel Central Wall End. ???eatfisd . 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 up Scarlet Fever 196 1 44 88 35 12 9 5 1 1 22 21 14 16 17 37 13 32 ,8 16 - - Diphtheria 91 2 27 34 11 7 8 2 - - 9 28 10 8 3 8 5 8 2 10 91 6 Enteric Fever 8 - - - - 4 1 1 1 1 - - 4 3 - - 1 - - - 8 3 Erysipelas 41 - - - 1 2 4 4 22 8 4 4 2 5 2 5 3 2 5 9 9 - Puerperal Pyrexia 16 - - - - 1 13 2 - - 1 7 1 1 1 1 1 1 2 7 3 Pneumonia 59 3 4 3 - 3 10 6 23 7 5 4 3 8 1 11 8 S 3 8 22 64 Opthalmia Neonatorum 7 7 - - - - - - - - - 2 1 1 - - - - 1 2 1 _ Meningoecal Meningitis 3 1 1 - - - - - - 1 - - - - 2 — - 1 3 1 Acute Poliomyelitis 2 - - 1 - - 1 - - - - - - - - 1 - 1 - - 2 - * Measles 3 1 1 1 - - - - - - - - - - - 2 - -- 1 - i *Notifiable for duration of war. 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 23. The death rate was 013 per 1,000 population, as compared with a rate of 0.2 for 1938. No cases of smallpox were reported during the year under review. Diphtheria Immunisation Clinics. Number inoculated in the various age groups 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. Pabients are referred to the general hospitals for investigation and special treatment. Classification. Carcinoma 206 Epithelioma 3 Sarcoma 4 Neoplasm 2 Papilloma 1 Adenoma 1 Unstated 18 Total: 225 Cancer Deaths 1939:- Total deaths 235 Maxes 115 Females 119 9 BOROUGH INFECTIOUS DISEASES HOSPITAL. Dr. Palmer's observations are contained in the following report upon the work of the Hospital:- PREFACE. During the year 325 patients were admitted to the wards, as compared with 544 in 1938. This diminution was due to a big decrease in the numbers of infectious diseases of all types, and particularly with regard to Scarlet Fever and Diphtheria cases. There has been a yearly falling off in the total number of cases treated in tho Hospital and it is certainly most satisfactory that a Borough the size of East Ham should show such a low incidence of infectious diseases. The outbreak of war particularly affected the Hospital by making evacuation necessary to a place of greater safety. Accordingly, on 1st September, the patients were removed to the Hospital Block at Harts Sanatorium, woodford. It is interesting to note what effect the evacuation of children from the Borough had on the number of admissions of infectious cases. For the first eight months of the year, 287 patients were admitted, whereas during the final four months, from 1st September to 31st December, only 38 new cases were admitted. The number of deaths which occurred from all cases was ton, giving a mortality rate of 3.07 per cent. STATISTICS. (A) DIPHTHERIA. (Uncorrected for Diagnosis.) In Hospital on December 31st, 1238 23 Admitted during 1939 87 Discharged during 1939 103 Died during 1939 5 Remaining on December 31st, 1939 2 (B) SCARLET FEVER. ( Uncorrected for Diagnosis.) In Hospital on December 31st 1938 23 Admitted during 1939 175 Discharged during 1939 195 Died during 1939 0 Remaining on December 31st, 1939 3 (C) MISCELLANEOUS. ( Uncorreted for Diagnosis) In Hospital on December 3lst 1938 13 Admitted during 1959 63 Discharged during 1939 70 Died during 1939 5 Remaining on December 31st, 1939 1 10. DIPHTHERIA. Number of notified cases 87 Revision of diagnosis 17 Other notified diseases proving to be Diphtheria 2 Final Number of Diphtheria cases 72 Table Showing Types of Diphtheria and Mortality. Type. Total Died. Mortality Rate. Facia1 52 1 1.92% Facial and Nasal 12 3 25% Nasal 7 1 14.28% Facial and Laryngeal 1 - - TOTALS: 72 5 6.94% Table showing Serum Adminstration. 4,000 , 8,000 16,000 24,000 31,000 48,000 TOTAL 2 5 8 15 15 27 72 The Serum Reaction Rate: 8.3% The Total Complication Rate was 23.61% SCARLET FEVER. Number of notified cases 175 Revision of diagnosis 9 Other notified diseases proving to be Scarlet Fever 4 Final number of Scarlet Fever cases 170 Complications: Adenitis 10 Tonsillitis 4 Otorrhoea 7 Rhinitis 4 Endocarditis 3 Albuminuria 3 Broncho Pneumonia 1 Minor Septic conditions. 7 Total: 39 For the fifth successive year there were no deaths from Scarlet fever. Serum and Prontosil Therapy. Number of cases receiving Serum alone 95 " '' '' '' '' & Prpntosil 21 ''Prontosil alone. 48 '' " " no specific therapy. 6 The Serum Reaction Rate was 19.28% OPERATIONS. Exploration of Chest 3 Mastoidectomy 1 Incision of Abscesse 6 Minor Operations 4 BACTEROLOGICAL EXAMINATIONS. 1397 swabs were examined for Diphtheria Bacci1li and of this number 157 were found to be positive. LABORATORY WORK. Bacteriological Examination of Faeces 45 Urine 49 Blood Widal Tests and other Agglutination reactions. 17 Virulence Tests for Diphtheria Baccilli 1 DIPHTHERIA.IMMUNISATION. Patients Immunised:- 37 11. TABLE OP ADMISSIONS AND DISCHARGES, ETC. FOR 1959. DISEASE. Remaining at end of 1938. Admitted During 1939. Died During 1959. Discharged During 1959. Remaining at end of 1939. Diphtheria 23 71 5 87 2 Diphtheria and Scarlet Fever - 1 - - 1 Scarlet Fever 19 168 - 186 1 Scarlet Fever and Wooping Cough 4 2 _ 6 - Balanitis - 1 - 1 - Bronchitis - 1 - 1 - Chicken Pox - 3 - 5 - Conjunctivitis - 1 - 1 - Diphtheria Carrier - 1 - 1 - Enteric Fever 9 6 2 15 - Erysipelas - 3 - 5 - Erythema - 4 - 4 - Iodine Burn - 1 — 1 — Laryngitis - 2 - 2 - Measles - 3 - 5 - Mumps 1 3 - 4 - Nephritis - 2 - 2 - No Evidence of Disease - 5 - 5 - Observation 3 3 - 6 - Pemphigus - 2 — 1 1 Pentonsillar Abscess - 2 - 2 _ Pneumonia - 3 1 2 - Pulmonary T.B. - 1 - 1 - Rheumatism - 1 - 1 - Rhinitis _ 1 - 1 - Ringworm - 3 - 5 - Rubella - 2 - 2 - Serum Sickness - 1 - 1 - Tonsillitis - 7 — 7 - Urticaria _ 1 — - 1 Whooping Cough - 20 2 18 - TOTALS: 59 325 10 568 6 12 MIDWIVES ACTS 1902 - 1936. The number of midwives who notified their intention to practice in the area during 1939 was 54. Of this number 36 worked in connection with the Maternity Hospital and District Nurses Homes ,Plaistow and Its branches, - 6 at Sir Henry Tate's Nurses Home, Silvertown,1 at the Kelvingrove Nursing Home, Windsor Road, - and 11 practised independently, including 3 Municipal Midwives. SUMMARY of VISITS PAID DURING 1939 BY NURSES OP PLAISTOW MATERNITY HOSPITAL & DISTRICT NURSES HOME Midv/ifery 313 Monthly 149 Hospital 204. LABORATORY FACILITIES. The same facilities exist as detailed in previous reports for the examination of specimens. During 1939, 973 specimens were examined at the East Ham Memorial Hospital and 56 pathological examinations were carried out by the Ministry of Health Laboratory and Counties Public Health Laboratories. The number of diphtheria swabs examined at the Infectious Diseases Hospital and the Town Hall Annexe Laboratory, was as follows:- Number. Positive. Negative. 2,095 178 1,917 AMBULANCE FACILITIES. Since the war started, the two Town ambulances which operated from the Fire Station, were handed over to the A.R.P. Ambulance Section and are worked from one of the Ambulance Depots. Two ambulances, in addition, are still available for the removal of infectious cases. PUBLIC ASSISTANCE DOMICILIARY MEDICAL SERVICE. Statistical Return for the year ending 31.12.39. Numbe r of attendances Number of attendances Total number of attendances. Number of occasions medicines supplied without seeing patients. 4,285 14,987 19,272 858 Numbor of applications to Medical Officer of Health for hospital treatment. 14 Number of requisitions received for dance of nurse. 41 13. VENEREAL DISEASES. The sane facilities are available as in recent years for the treatment of those diseases, and from the official tables supplied by the London County Council the following figures are abstracted:- New Patients. 1939. 1938. Syphilis 13 18 Soft Chancre 1 Gonorrhoea 61 84 Not venereal 110 136 185 240 1939. 1938. Total attendances of all patients 4,716 11,020 Total number of in-patient days 42 182. The decrease in attendances and in-patient days as compared with the year 1938 is not due solely to the War and resulting evacuation, but to a lessened incidence of disease. PATHOLOGICAL EXAMINATIONS. 1939. 1938. For or at the Centres:- Spirochaetes 2 43 Gonococci 2,119 2,037 Wasserman 370 464 Others 839 992 Total: 3,330 3,536 For practitioners:- Spirochaetes - - Gonococci 5 2 "Wasserman 14 40 Others 11 21 Total: 30 63 14. RUNWELL MENTAL HOSPITAL. Mental patients are now accommodated in Runwell Mental Hospital, Essex, the institution belonging to the County Boroughs of East Ham and Southend-on-Sea. Statistics and other information relating to the Hospital are contained in the Annual Report for 1939. 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 honary medical staff. Reference should be made to the Annual Report. BLIND PERSONS ACTS, 1920 - 1938. The following figures are abstracted from the statistical record of the registration of blind persons, as at 31. 3. 40. Males. Females. Total. Number on register 116 108 224 Total employed 14 7 21 Undergoing training 3 1 4 Trained but unemployed 2 2 4 No training but trainable. 1 1 2 Unemployable 94 95 189 Children (5 to 16 years.) 2 2 4 15. MENTAL DEFICIENCY ACTS, 1913 - 1938. ANNUAL REPORT FOR THE YEAR ENDED 31st December,1939. Article 12 Mental Deficiency Regulations, 1935. STATISTICS. 1939 1938. . , Under ORDER." Total. M F Totel (a)(1) In institutions(excluding cases on Licence.) Under 16 years of age 19 16 35 13 32 Aged 16 years and over 43 31 74 41. 30. 71 (2) On Licence from Institutions Under 16 years of age - - - - - - Aged 16 years and over. 4 - 4 8 1 9 (b)(1) Under Guardianship(excluding cases on Licence.) under 16 years of age 2 1 3 2 1 3 Aged 16 years and over. 16 13 29 16 9 25 (2) On Licence from Guardianship Under 16 years of age - - - - - - Aged 16 years and over. 4 — 4 1 — 1 2. In "PLACES OF SAFETY". Under 16 years of age 1 1 2 1 - 1 Aged 16 years and over 5 3 8 - - - 3. UNDER STATUTORY SUPERVISION. Of whom- 79 75 154 77 82 159 Awaiting removal to an Institution 7 7 14 5 4 9 4. Action not yet taken under any one of the above headings: (a) Notified by Local Education Authorities (sec.2(2) 1 - 1 10 7 17 (b) Mental Defectives in receipt of poor relief: (1) Institutional: (a) In Public Assistance Institutions ,& 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 Section 3 1 1 2 - 1 1 (2) Other Cases - - - - - - (2) Domiciliary. 2 5 7 1 6 7 (a) Otherwise ascertained. 8 7 15 2 4 6 16.  1939. 1938. M F. Total M F Total 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: 4 1 5 3 1 4 (b) Maintained wholly or 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 M.D 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 of whom number,if any, under oluntary supervision. 32 19 51 29 20 49 Number of above cases on the Registers of Occupation and Industrial Centres:- Under Statutory Supervision 11 10 21 11 13 24 Under Voluntary Supervision - - - - - - On Licence from Institutions - - - 1 - 1 Under Guardianship 4 6 10 4 4 8 On Licence from Guardianship - - - - - - DURING THE YEAR 1939. l(a)Number of instances in which Licence was granted in 1939: (1) from institutions: — — - 5 5 (2) from guardianship: 3 - 3 1 - 1 (9 cases were granted annual holiday at Seaford & Bognor Regis) (b)Number of instances in which cases on licence have been returned to Institutions or transferred to Guardianship, during the year 1939:- (1) To Institutions 1 - 1 1 - 1 (2) To Guardianship 3 1 4 1 - 1 17.  1939. 1938 M F Total M. F Total Statistics.(Contd.) ' 2. Cases notified by Local Education Authorities (Sec.2(2) during the year 1939;- Method of Disposal:- Sent to Institutions (by Order) - 1 1 - 1 1 Placed under Guardainship byOrder) - - - - - - Placed under Stat. Supervision. 7 1 8 9 5 14 Placed in "Places of Safety. 1 - 1 - - - Died or removed from area. 2 - 2 1 . 1 Action not yet taken: (a) In receipt of poor relief - - - - - - (b) Others . - - - - - 10. 2. 12. 11. 6. 17 3. Of the total number of M.D's.known to Local Authority:- (a) number who have given birth to children during 1939:- (1) After marriage Two (2) While unmarried Nil (b) number who have married during 1939 One male. Four Females. Ascertainment The number of canes dealt with for the first time during the year was 27, and they were dealt with as under:- 10 placed under Supervision 3 " in Institutions 5 " in "Places of Safety" (Sec.15.) 1 " under Sec.15.(with view to guardianship) 2 " under Guardianship 4 removed to other areas 1 uncertifiable 1 not yet examined. Provision of Institutional Accommodation. The Council are still experiencing great difficulty in obtaininginsttutional accommodation especialy for the lower grade cases. This will be relieved by the completion of South Ockendon Colony. Guardianship. There are 36 cases under guardianship. (Two cases were transferred on licence from guardianship to institutional care pending Varying Orders being made; one case on licence was returned to institutional care; one case was discharged from the operation of the M.D.Acts, and two were granted licence to parents.) Supervision. There are 151 mental defectives under supervision in their own homes in East Ham. All of these are visited at varying intervals by the Supervisor, and reports filed, helpful advice being given with regard to their management, training, etc. It is very rare that the parents show any resentment at, or opposition to, these visits. Training and Occupational Centre. The usual satisfactory progress was being maintained until the outbreak of hostilities in September when the Centre was closed, and statistics are therefore omitted from this Report. Licence, Discharge and After Care. There are five East Ham mental defectives (males) on licence from institutions, all of whom are at work and doing fairly well. All cases discharged from the operation of the M.D.Acts, and still within this area, are kept in touch with by the Supervisor. 18. THE INVALID CHILDREN'S AID ASSOCIATION. As in previous years the Authority and Public Health Department are indebted to the local branch of this Association for their invaluable service rendered to the invalid children of the Borough. The types of new cases dealt with in 1939 were, as follows:- Tuberculosis 9 Anaemia & Debility 10 Rheumatism,heart and chorea 23 Lung conditions (non tuberculous) 32 Marasmus and Malnutrition 23 Various 83 Total 180 MATERNITY AND CHILD WELFARE. Domiciliary Midwives Midvrives in Institutions. Totals. 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 2 - 2 (b) Normally employed by other Local Supervising Authorities but temporarily working in the area (c) 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 - - - (d) Employed by Voluntary Associations: (i) Under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1036 36 36 (ii) Others - 1 1 (e) In private practice 6 - 6 Totals: 44 1 45 19.  Domiciliary Midwives. Midwives in Institutions Totals. Number of ca30s in the area of the Local Supervisory Authority attended during the year by midwives:- (a)Employed by the ) Council ) As Midwives 194 194 A3 Maternity Nurses 37 - 37 (b) Norma1ly employed, by other Local Super vising Authorities but temporarily working in the area) l As Miaw.ives As Maternity Nurses (c)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 1', As Maternity Nurses 1 • . ;• .. . *. (d)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 332 - 332 As Maternity Nurses 150 - 150 (ii) Others As Midwives - - - As Maternity Nurses - 28 28 (o)In private practice As Midwives 222 - 222 As Maternity Nurses 45 - 45 TOTALS: As Midwives 748 - 748 As Maternity Nurses 232 28 260 Number of cases in which medical aid was summoned during the year under Section 14 (i) of the Midwives Act, 1918, by a midwife: (1) for domiciliary cases 160 Total: 160 (ii) for cases in institutions Nil 20. HEALTH VISITING. (a) Number of Health Visitors employed at the end of the year: (i) by the Council and working in the area served by the Council - 7 (ii) By the Council and working in the areas of other Local Authorities - Nil. (iii) by Voluntary Associations and working in the area served by the Council - Nil. (iv) by Voluntary Associations and working in the areas of other Local Authorities. - Nil. (b) Equivalent of whole-time services devoted by the whole staff to health visiting in the area (including attendance at infant welfare centres.) - (i) in the case of Health Visitors employed by the Council. - Pull Time. (ii) in the case of Health Visitors employed by Voluntary Associations. - Nil. (c) Number of visits paid during the year by all Health Visitors working in the area: (i) to expectant mothers. First visits. 620 Total visits. 642 (ii) to children under First visits. 1659 one year of age. Total visits. 5264 (iii) to children between the ages of 1 and 5 years. Total visits. 5072 INFANT WELFARE CENTRES. (a) Number of Centres provided and maintained by the Council - 4* Number of Centres provided and maintained by Voluntary Associations. - Nil. (c) Total number of children who first attended at the Centres during the year and who, on the date of their first attendance, were - (i) tinder 1 year of age - 1051 (ii) between the ages of 1 and 5 years. - 301 (d) Total number of children under 5 years of age who attended at the Centres during the year and who, at the end of the year, were- (i) under 1 year of ago - 918 (ii) Over 1 year of ago. - 2634 *Two only after September 3rd, 1939. 21. ANTE-NATAL AND POST-NATAL SERVICES. AnteNatal Post ' Natal (a) Ante-natal and Post-natal Clinics (whether held at Infant Welfare Centres or at other premises)- (i) Number of Clinics provided and maintained by the Council 3 - (ii) Number of Clinics provided and maintained by Voluntary Associations - - (iii) Total number of women who attended at the Clinics during the year 813 29 (b) Total number of expectant mothers ante-natally examined and of cases po3t-natally examined during the year, under arrangements made by the Council with private medical practitioners, excluding cases included under 5 (a) (iii) - - SUPPLY OF MILK AND FOOD. Total quantity of milk supplied during the year to expectant mothers and nursing mothers and young children:- Liquid Gallons. Dried Pounds. Under arrangements approved in accordance with Circular 1840. Otherwise . (i) By the Council - 9,123 28,104 (ii) By Voluntary Associations operating in the area of the Council - - - Totals: - 9,125 28,104 Cases of Opthalmia Neonatorum notified during the year in which - (a) vision was unimpaired 7 (b) " impaired - (c) '' '' lost - (d) the patient was still under treatment at the end of the year - (e) the patient died - (f) the patient removed from the district - (g) classification under the above heads cannot be made (details of these cases should be attached. - Total: 7 22. HOME NURSING. (a) Number of Nurses employed at the end of the year (otherwise than for purposes of the Midwives Act,1936 for the nursing of expectant mothers and children under five years of age, maternity nursing, or the nursing of puerperal pyrexis (i) by the Council - Nil (ii) by Voluntary Associations - Nil. (b) Total number of cases attended during the year by these nurses. - Nil. MATERNITY ACCOMMODATION. As set out in my 1938 Report, the accommodation for women whose homes are unsuitable for their confinements and require in-patient treatment is Forest Gate Hospital, Maternity and District Nurses Home, Plaistow, and Queen Mary's Hospital, Stratford. During 1939, 163 cases were admitted to Forest Gate Hospital. INSPECTION OF MIDWIVES. Visits of inspection, as necessary, were paid during the year and the midwives work, including records, was satisfactory. 23. CHILD LIFE PROTECTION. Sections 206 to 220 of the Public Health Act, 1956. (a) Number of persons who were receiving children for reward at the end of the year - 11. (b) Number of children: (i) at the end of the year - 13 (ii) who died during the year - Nil (iii) on whom inquests were held during the year - Nil. (c) Number of Child Protection Visitors at the end of the year who were: (i) Health Visitors - 7 (ii) Female, other than Health Visitors - Nil (iii) Male. - Nil. (d) Number of persons (in addition to or in lieu of Visitors nder (c) above) or societies authorised to visit under the proviso to Section 209 (2) of the Public Health Act, 1936. - Nil. (e) Proceedings taken during Act and Section under the year: which proceedings were taken Nil. Nil. 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. REGISTRATION OF NURSING HOMES (SECTIONS 187 to 194 OF THE PUBLIC HEALTH ACT,1936) Return of the work of the Council during 1939. Number of Homes. Number of patients provided for:- Materrity Patients Others. Totals. Homes first registered during the year - - - - Homes on the register at the end of the year. 1 5 14 19 The number of cases admitted and treated at the Nursing Home (Kelvingrove) in the Borough during 1939, was as follows:Maternity 28, others 36. 24. TUBERCULOSIS AND CHEST CLINIC. NOTIFICATIONS. The number of primary notifications during the year 1939 was 217 as compared with 203 for 1958. Of the primary notifications of pulmonary tuberculosis, in 31.69 per cent tubercle bacilli were found in the sputum. STATISTICAL. The total number of notified cases on the register of the Clinic on 31st December, 1939 was 974 (pulmonary & non-pulmonary) or 7.67 per 1,000 estimated population, as opposed to 973, or 7.51 per 1,000 population in the previous year. DEATHS. The number of deaths(1955-1959) from tuberculosis is shown below:- Pulmonary Non-Pulmonary Of Cases on the Clinic Register 1955 80 16 76 1956 97 10 77 1937 80 13 84 1938 81 8 67 1939 71 12 59 NEW CASES: The following are the comparative figures for the years 1955-1959:- 1935 1956 1957 1958 1959 New Cases (and Contacts.) 548 618 697 629 486 Number proved,after complete investigation to be tuberculous 550.% 29.4% 28.4% 25.5% 50.4% ATTENDANCES AND MEDICAL EXAMINATIONS. Attendances. Medical Examinations 1955 3,737 5,006 1956 3,753 5,297 1957 3,739 5,457 1958 3,940 5,590 1959 3,467 2,982 CONSULTATIONS AT HOMES OF PATIENTS. During the year thirty visits,(including twelve personal consultations) to homes of patients who were too ill to attend the Clinic, were made. NUMBER OF X-RAY EXAMINATIONS AT THE CHEST CLINIC. 1956 1957 1958 1959 1522 1652 1599 1594 25. Dr. Philip Ellman, Consultant Physician to the Chest Clinic, reports on the work of the Clinic, as follows:- The nature of the report this year has necessarily had to be curtailed and it is therefore proposed to comment principally on features of tho work which have a war-time significance, and to express certain personal views thereon. The figures under the separate headings, such as "Attendances" "Medical Examinations" "X-Ray Examinations", etc. are self-explanatory and require no special comments except to add that, despite some curtailments in the first few months of the war, the work has been well maintained. Close co-operation with Harts Sanatorium, Thoracic Surgical Units and General Hospitals continues' to be well maintained. THE EXAMINATION OF RECRUITS. An important feature of our work since tho war has been the large number of recruits referred to us by the Medical Boards for a consultant opinion, where any diseo.se of the chest is suspected.All these cases have been subjected to routine clinical, X-ray and bacteriological investigations. Only in a small percentage of these cases has lung tuberculosis boon detected. THE NUTRITIONAL PROBLEM IN TUBERCULOSIS IN WAR TIME. The nutritional .aspect of pulmonary tuberculosis has been emphasised in previous reports. It is indeed unfortunate that under the National Scheme of Rationing tho tuberculous patient is for tho most part left without any special dietary provision. The Special Pood Rationing Advisory Committee appointed by tho Minister of Food to investigate the diet of patients suffering from various diseases, has advised him that, provided there is an increased consumption of milk, cheese and eggs, tuberculous patients need not suffer from lack of "first class" protein. Hence no extra ration of meat was advised. Repeated cheese dishes are likely to bo monotonous and therefore not stimulating for the often impaired appetite of tho tuberculous subject; whilst free and cheap milk is limited to nursing mothers and children under five. NEED FOR FREE AND CHEAP MILK FOR TUBERCULOUS PATIENTS. Surely the tuberculous patient whose means are limited, is entitled to this too in addition to those who come under the extra nourishment category of local authorities. Our experience since the beginning of the war has shown that tho need for a full supply of cheap milk for tho tuberculous population of the Borough is eminently desirable, and in many cases, a crying need. MASS X-RAY EXAMINATION OF THE CHEST IN RELATION TO EARLY DIAGNOSIS IN RECRUITS AND INDUSTRY. It is generally accepted that under present conditions not more than 5% of cases are diagnosed in that stage of the disease when the lesion is minimal, curable, and essentially suitable for treatment at a sanatorium. The result is that our sanatoria are often crowded with cases which wo cannot hope to cure and which are a constant strain on the financial sources of the community. How are we to get early minimal curable cases to fill our sanatoria? The war has brought to light the value of mass X-ray examinations of the chest by a recent development in technique as a possible practical solution. The recent recommendations of the Horder Committee support the value of mass X-ray examinations of tho chest in tho early detection of tuberculosis in recruits. The available methods for such examinations are, as follows:- 26. (1) Pull sizcd X-ray filns. (2) The use of sensitised paper instead of the X-ray film. (3) Screening (fluoroscopy) (4) Miniature X-ray Screen Photography Methods 1, 2, and 3, are all being fully utilised in the services of the Chest Clinic. Whilst the full sized film is probably the most efficient from the point of view of mass work, it has the disadvantage that it is costly and is a comparatively slow process. The Paper Flim has been utilised by us during the last few months, more particularly for the follow-up of cases of artificial pneumothorax and for the serial examination of secondary cases. The cost, compared with the X-ray film, is extremely low and involves a considerable financial saving. This method has, of course, its limitations, but in the selected cases outlined it can serve the same purpose as the ordinary film. SCREENING (FLUOROSCOPY) I have always found this to bo a most economical and practical method for mass examinations. In an investigation of 3229 X-ray screen examinations which I have done at the Chest Clinic during the last few years, with an equal number of control films, the interpretation of 94% of cases has coincided with the interpretation of the film. Whilst, therefore, the method is not foolproof it can, in the hands of an experienced observer, be of immense value in mass X-ray work. The risk to the examiner of too much screening has, of course, always to be borne in mind. MINIATURE SCREEN PHOTOGRAPHY. The miniature film represents a new and efficient Public Health instrument destined to be of the greatest value as an aid to the detection of minimal disease in presumably healthy members of the industrial population, The method involves the technical combination of a satisfactory camera and X-ray Screen apparatus, and the miniature film is made by focussing down the image on to a fluorescent screen. Those small films are interpreted by enlarging them almost to the full sized film on a projector.lt has boon calculated that with an adequately trained staff and good team work, some 200 subjects'can be examined per hour. The extension of this method in the future to periodic health examinations for the whole industrial community, may prove an invaluable contribution to Preventive Medicine. The principal object of the method in mass surveys is to detect early pulmonary disease before the appearance of symptoms or signs, by which time, experience has shown that the disease is comparatively advanced. Whilst the method has its limitations and requires to be Used with discrimination, it has the advantage of being very inexpensive, reasonably accurate, expeditious and a rapid and efficient selector of cases requiring full investigation. OCCUPATIONAL THERAPY. Tho Class at the Clinic was opened in October 1936. Crafts taught have been so useful to patients that regular pocket money has been earned by thorn, profits over costs of finished articles being their payment. The patients have expressed their gratitude at the opportunity given thorn of earning small sums, and in spite of the exceptionally bad winter, attendances wore kept up. Men's crafts include carpentry, basketry and stool seating: women's crafts are dressmaking, embroidery of all types, knitting and toy-making. The benefit of classes has been specially felt during the black-out as creative work has provided an outlet of psychological value. 27. HARTS SANATORIUM. PREFACE. On September 1st twenty five patients returned home in order to make the Hospital Block available for the transference of cases from the Infectious Diseases Hospital. This, of course, means that now there is only half the previous accommodation available for the treatment of pulmonary tuberculosis. Although dealing with lesser numbers, the work of the sanatorium is proceeding as formerly. Modern methods of treatment are carried out, which include graduated rest, artificial pneumothorax, gold salts, tuberculin, insulin, drug, medicinal and vitamin therapy. Increasing use is being made of the Thoracic Surgical Units of the London Hospitals. In the control and assessment of pulmonary disease, serial radiograms, monthly sputum examinations, and when required other bacteriological investigations, are now an established routine. Toward the end of the year, the technique of measuring the blood sedimentation rate was introduced: this is proving a most valuable additional aid in assessing the amount of activity present and in estimating the prospects of recovery. Mention must be made of the Occupational Therapy, which is just as necessary in the scheme of successful treatment as the other therapeutic measures. Finally, there continues to be complete co-operation and co-ordination of the work at the Chest Clinic and the Sanatorium. STATISTICS. Discharges, including deaths 169 (95M. 73F. 1Ch.) Deaths 15 (11M. 4F.) Insured Patients 124 (82M. 42F.) Non-insured Patients 45 (12M. 52F. 1Ch.) Number of Bods available at end of Year 43 Average number of beds occupied(Jan.-Aug) 74 (94.86%) " " " " " (Sep.-Doc) .. 39.75 (92.44%) Admissions by Ambulance 37 (15M. 22F.) From Hospitals 21 ( 9M. 12F.) From Home 16 ( 6M. 10F.) Immediate Results of Treatment (of Tuberculosis Cases) Discharged quiescent 47 (28M. 19F.) (inc. 1 obsn. case notified as tuberculous.) Discharged not quiescent 98 (48M. 49 1Ch.) (inc. 2 obsn.cases notified as tuberculous.) Of these:- Improved 78 (37M. 40F. 1Ch.) Not improved 20 (11M. 9F.) Observation Cases. Of the 12 observation cases:- 3 were found to be suffering from pulmonary tuberculosis 4 were cases of bronchiectasis 1 was a case of unresolved pneumonia 4 cases were doubtful for pulmonary tuberculosis. 28. Artificial Pneumothorax Number of Inductions 23 Number of attempted Induction 4 Number discontinued 9 Number of Refills given 536 Number of Gases sent for Surgical Treatment. 14 For cauterisation of 8 For Thoracoplasty 6 Gold Salts. Number of Courses commenced 78 " completed from 1938 18 " " " terminated during 1939 71 Of those 71:- Complete courses 42 Incomplete courses 29 Radiography. Number of Films taken during 1939 457 Bacteriology. Number of sputum specimens examined 658 Number of Blood Sedimentation Rates done 42. 29 RETURN RELATING TO THE WORK OP THE TUBERCULOSIS & CHEST CLINIC DURING THE QUARTER ENDING 31ST. DECEMBER, 1939. 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.- Number of definite cases of 'Tuberculosis on the Dispensary Register at the beginning ' of the Quarter 381 354 24 12 61 93 39 12 442 447 63 24 976 B.- Number of New Case.s. diagnosed as Tuberculosis during the Quarter:- (1) Class T.B. minus 7 4 2 3 1 - 1 - 8 4 3 3 18 (2)Class T.B.plus 6 1 - - - - - - 6 1 - - 7 C.- Number of cases included in A & B written off the Dispensary Register during the quarter as (l)Recovered - - - - - - - _ - _ _ _ - (2)Doad(all causes] 5 7 - - - - - - 5 7 - - 12 (3)Removed to other areas 4 5 - 1 1 - 3 1 5 5 3 2 15 (4)For other reasons - - - - - - - - - - - - - D.- Number of definite cases of Tuberculosis on the Dispensary Register at the end of the Quarter 385 347 26 14 61 93 37 11 446 44 0 63 25 974 30. ] AGE PERIODS. Formal Notifications. Total Notifications Number of Primary Notifications of new cases of Tuberculosis 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages) Pulmonary Males - 3 2 - 8 15 16 16 14 8 3 85 91 Pulmonary Females - 3 3 1 11 15 14 9 4 1 4 65 66 Non-pulmonary Males 3 1 1 1 2 1 9 9 i Non-pulmonary Females 3 1 2 2 1 2 1 1 1 14 15 SUPPLEMENTAL RETURN NEW Cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the abovementioned period OTHERWISE than by formal notification. AGE PERIODS. 0- 1- 5- 10- — 15- 20- 25- 35- 45- 55 65- TOTAL.] I Pulmonary Males 1 1 4 3 3 3 1 3 19 Pulmonary Females 1 1 9 2 1 14 Non-pulmonary Males 1 2 2 1 I 6 Non-pulmonary Females 2 1 1 1 5 The source or sources from which information as to the above-mentioned cases was obtained: SOURCE OF INFORMATION. Number of Cases. Pulmonary NonPulmonary Death Returns (From local Registrars 2 - (transferable deaths from Registrar- General 5 2 Posthumous notifications 2 1 "Transfers" from other areas (other than transferable deaths.) 24 8 (Other Sources, if any (specify) j - - 31. TREATMENT OF TUBERCULOSIS. 1. NUMBER OP BEDS PROVIDED AND OF PATIENTS receiving treatment in Residential Institutions (other than Poor Law Hospitals or Institutions) on the 31st December, 1939. Patients receiving Treatment. Total beds ded Numbe of vacant beds (if any) available for tuberculous patients Ex Service Men (Mono 146/T and Circu• lor 1365). Other Patients. Pulmonary. Non-Pulmonary Adults. Children. Adults. i Children. In Institutions "belonging to:- ( a) The Authority (whelly or jointly with other Local Authorities. ) - 39 - - - 43 4 (b) Other County or County Borough Councils or Tuberculosis Joint Boards - - - - - - - (c) Local Authorities other than (a) or (b) - - - - - - - (d) Voluntary Bodies - 17 6 1 2 26 _ TOTAL: - 56 6 1 2 69 4 _i 32. SANITARY SECTION AND HOUSING. Mr. J. E. Austin, Senior Sanitary Inspector, has compiled this section of the report relating to Sanitary Circumstances and Housing and Statistics in regard to Pood Inspection. Duties in connection with Air Raid Precautions diverted certain members of the staff from their normal duties and much of the systematic work of the Department was thereby reduced. Much time was spent devising schemes for dealing with the following emergency matters:- Emergency Water Supplies First-aid Repairs to Houses Emergency Drainage repairs Disposal of civilian war dead Salvage of foodstuffs Cleansing & decontamination of civilian clothing. Removal of furniture from homes. Apart from the special sanitary duties arising out of the war, many of the staff undertook voluntary duties in connection with Civil Defence proper. It has not been found possible to prepare the report as in previous years and only statistical information is submitted herein. SANITARY CIRCUMSTANCES. SANITARY INSPECTION. Details of the activities of the inspectorate in general sanitary administration are contained in the subjoined statements. (a) Inspections. The number of Inspections of all classes - 24,172 ( i) Housing:- House-to-house 1679 Under Public Health Act 1714 Other visits 1420 Re-inspections 13879 (ii) Sanitary Circumstances. Draining and Sanitary Accommodation 456 Factories (excluding Bakehouses) 72 Workplaces and Outworkers 194 Caravans 188 Ee offensive fumes 8 Billots and Posts 157 Miscellaneous 843 (iii) Food Supply:- Slauglhterhouses 1276 Dairies 269 Food Premises 611 Bakehouses 103 Re sampling 436 (iv) Infectious Disease Visits 867 33. (b) Notices. The number of notices served during the year totalled 3,054 of which 310 were statutory notices. Of the total, 2,954 were complied with at the end of the year, and the requisitions of many of the remainder were in process of being complied with. (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 1042 Roofs repaired 1003 Rain water gutters repaired 649 Ventilation improved:- Windows (including cords) repaired 794 Water supply improved:- Service tap provided on main (Ordinary 40 House to House 28 ) 68 Sanitary conveniences repaired 586 Washing facilities provided or improved (coppers.) 77 Drainage improved or reconstructed 379 Paving of yards repaired 335 Disrepair remedied Stoves and firegrates repaired or renewed 455 Plasterwork repaired or renewed 639 Floors repaired on renewed 218 Cleansing Executed 1151 Miscellaneous defects remedied 1620 (d) Rat Extermination. During the year 1,980 visits were made to properties in the Borough and 1,657 rats were destroyed. (e) Rag Flock Acts. 11 samples from users' premises wore submitted for analysis and 4 failed to comply with the regulations, the chlorine contents per 100,000 parts of flock being, as follows:- 150, 130, 40 and 45 parts. In the two former cases prosecutions were instituted. HOUSING. (a) Overcrowding. During the year a further 107 cases of overcrowding were relieved and 32 new cases were reported. With the evacuation of school children the position of many families tending to overcrowding has been relieves. (b) Slum Clearance. The Minister of Health held an enquiry in connection with the Compulsory Purchase Order in Claremont Street, North Woolwich Area, but at the close of the year the 65 families comprising 262 persons had not been re-housed, the construction programme having boon deferred consequent upon the war. The housing statistics are included in the following statement:- 34. HOUSING STATISTICS. 1. - Inspection of Dwellinghouses during the Year:- (1) (a) Total number of dwellinghouses inspected for defects (under Public Health of Housing Acts.) 4,813 (b) Number of inspections made for the purpose 18,692 (2) (a) Number of dwellinghouses( included under Sub-head(l) above)which were inspected & recorded under the Housing Consolidated Regulations, 1925 1,679 (b) Number of inspections made for the purpose 7,300 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Number of dwellinghouses (exclusive of those referred to under the preceding sub-head)found not to be in all respects reasonably fit for human habitation 3,001 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 1,923 III.- Action under Statutory Powers during the Year:- (a) Proceedings under section 9,10,and 16,of the Housing Act, 1936:- (1) Number of dwellinghouses in respect of which notices were served requiring repairs - (2) Number of dwellinghouses 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 dwellinghouses in respect of which notices were served requiring defects to be remedied 310 (2) Number of dwellinghouses in which defects were remedied after service of formal notices:- (a) By owners 276 (b) By Local Authority in default of owners - (c) Proceedings under Section 11 & 13 of the Housing Act,1936 (1) Number of dwellinghouses in respect of which Demolition Orders were made - (2) Number of dwellinghouses demolished in pursuance pf Demolition Orders - (d) Proceedings under Section 12 of tho Housing Act, 1936:- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made - (2) Number of separate tenements or underground rooms in , respect of which Closing Orders were determined the tenement or- room having been rendered fit - IV. - Housing Act, 1936. Part IV. - Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 173 (ii) Number of families dwelling therein 177 (iii)Number of persons dwelling therein 1,287 (b) Number of new cases of overcrowding reported during the year 32 (c) (i) Number of cases of overcrowding relieved during the year 107 (ii) Number of persons concerned in such cases 748 (d) Particulars of any cases in which dwellinghouses have again become overcrowded After the Local Authority have taken steps for tho abatement of overcrowding 2 (e) For other comments on overcrowding see report. Number of New Houses erected during the Year 1939:- By Private enterprise Nil By the Local Authority 77 35. m INSPECTION AND SUPERVISI0N OF FOOD. (a) MlIk Supply. (1) Dairies. Dairies were systematically visited and sampling for bacteriological examination, carried out. The results of the bacteriological examinations are contained in the subjoined statement:- Total Ungraded Sterilised ised. Accredited. T.T. Bacteriological samples Satisfactory 82 37 2 35 - 8 Unsatisfactory 11 9 - - - 2 Bio1ogical Samples Satisfactory 44 22 - 17 — 5 Unsatisfactory _ - - - - - (2) Greded Milk. The lie arises in force-on 31st December 1939, wore a3 follows:- Tuberculin Tested Milk Bottling Establishment Licence 1 Dealers' Licenses 8 Supplementary Licenses 3 Pasteurised Milk Establishment License 1 Dealers' Licenses 26 Supplementary Licenses 3 The Council decided in December,1936,to charge no fees in respect of licenses granted under the Milk (Special Designations) Order,1936. (b) Meat and Other Foods. (1) Moat Inspection. The Sanitary Inspectors made 1,276 visits to the slaughterhouses for the purpose of carrying out post mortam inspecition of animals slaughtered. The following is a statement of the work done in this connections:- Cattle (excluding Cows.) Cows. Calves, sheep and Lambs. Pigs. Number of animals slaughtered 1646 1426 388 £920 20,885 Number of animals inspected 1646 1426 388 2920 20,885 All diseases except Tuberculosis Whole carcases condemned. - 2 1 2 3 Carcases of which some part or organ was condemned 94 157 - 64 979 Percentage of number inspected affected with disease other than T.B. 5 11 0.3 2 4 Tuberculosis only:Whole carcases condemned 4 28 - - 3 Carcases of which some part or organ was condemned. 164 866 - - 275 Percentage of the number inspected with T.B. 10 62 - - 1 36. Periodically visits are made to "butchers' shops, market stalls and neat vehicles. (2) Food Premises. The number of inspections made of food premises included 269 dairies, 103 of bakehouses, and 611 of other premises. c) Adulteration. Details of the various samples obtained by the Sanitary Inspectors and the results are included in the following tabular statement: Number of Samples. Percentage samples adulterated Examined. Found alderated or below standard. Bread 1 1 100 Butter 47 - - Cheese 2 - - Cocoa 4 - - Coffee 3 - - Confectionery 5 - - Jam and Marmalade 7 - - Cream 7 - - Flour 1 - - Lard 9 2 22 Margarine 19 — — Milk 155 3 2 Sausage 32 1 3 Tea - — - Vinegar 5 - — Wines, Spirits 3 - - Drugs 10 - — Other Articles 152 1 0.6 462 8 1.7 Details of samples adulterated or below standard are described as follows, together with the resultant action:- No. I. or F. Article Adulteration or Deficiency Action Taken. 1170 1 Milk. Deficient in milk fat at least 3%. Formal sample taken proved genuine. 1790 F. Milk Ditto. 43% Vendor prosecuted. 1946 I. Bread. Blackish lump proved to bo mixed rice flour held together by bleb of mineral oil. Vendor cautioned. 1966 F. Milk Deficient in milk fat at least 15%. Vendor cautioned. 2007 I. Sugar. Slight trace of soda Vendor cautioned. 2326 I. Lard Not lard but compound cooking fat prepared with fats and oils other than lard. Formal sample taken; subsequently Vendor cautioned. 2341. F. Lard Ditto. Vendor cautioned. 2417 I. Sausages Contained Preservative Vendor cautioned. 37.