EAS 16 AC 44113 COUNTY BOROUGH OF EAST HAM, ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. FOR THE YEAR 1940. Malcolm E. Barker, M.R.C.S. (Eng)., L.R.C.P., D.P.H., (Lond) MEMBERS OF THE COUNCIL. The Mayor:Alderman Edward Francis Markey, J.P. The Deputy Mayor:Councillor William James Davis. Aldermen:- Joseph Walter Barton, Charles William Brading, C.R.P., J.P. . Thomas William Burden Richard John Fell. Thomas Irwin Lethaby, J.P. Walter Thomas Newling,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.) 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 Keene (3) Winifred May Knight (Mrs.) John Linsley Linsley-Thomas Robert William Moger, J.P. George Horace Moncar Robert Wilfred Payne 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. S.M. Devenay Maternity Mrs. C.J. Cross Mrs. E.M. Fell and Child Mrs. A.M. Gray Mrs. I. Watson 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 Ham, E.6. MY, 1941. 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 the Annual Reports for the year 1940 required by the Ministry of Health and Board of Education. The information contained therein is, at the request of the Ministry, confined to statistical matter, although much could be written of Public Health and School Medical activities during the year. It is presented in stencilled form for reasons of economy. No outbreak of epidemic illness occurred, and the most noteworthy feature of the Health Report is perhaps the low incidence of Infectious Disease, which is all the more remarkable considering wartime conditions, and the movement of persons. The infant mortality rate shows no increase over the previous year. The maternal mortality rate is less than formerly,and lower than that for England and Wales as a whole. The birth rate is relatively the same as last year. All the Public health Services have been maintained, although some curtailment was deemed advisable during the early part of the year. The Report indicates that both as regards the health and sanitary circumstances of the Borough the position is satisfactory, but protective measures such as immunisation have not met with the response expected. I venture to suggest that tho Civil Defence and other Services offer a unique opportunity for health propaganda. The dissemination of such knowledge by their members nay bo of vital ??? to the community. The E.M.S.Hospitals, Casualties and Shelter Services have entailed much additional work, and all tho staff of the Public Health Department have voluntarily undertaken as a contribution to the National Emergency, duties in connection with Civil Defence. I desire to record appreciation of their valuable services and am grateful for their assistance and support in every direction. I also wish to thank all members of the Casualties Services under my control for their excellent work in difficult time3, and for tho courage and endurance displayed on numerous occasions. My thanks are due to Alderman Mrs. Wilkens, the Chairman, and to members of the Public Health Committee, and to those of other Committees, to Chief Officers and Heads of Services with whom I am closely associated. I have the honour to be, Your obedient Servant, Medical Officer of Health. 2. STATISTICAL CONDITIONS OF THE AREA. Area (in statute acres) land and inland water - 3,324 Population. Census - 1931 142,394 Estimated Civilian Population - 1940 110,000 * Number of inhabited houses (end of 1940 according to rate books. (Including tenements and shops.)Approx. 33,000 Rateable value at 1st April, 1941 £736,130 * Sum represented by a penny rate for the year 1940/41 £2,924 * Based upon normal conditions in the Borough. Extracts from Vital Statistics. For Birth Rate. For Infant & Maternal Mortality. Total Males Females Males Females Total Live Legitimate 1,527 775 752 724 716 1,440 Births. Illegitimate 45 20 25 20 25 45 Still Births 35 25 10 23 10 33 Deaths Totals 1,684: Males, 894. Females, 790. Deaths from Puerperal causes:- Deaths. Rate per 1,000 Total (Live still births.) Puerperal Sepsis 1 0.62 Other Puerperal causes 2 1.24 3 1.86 Death rate of infants under one year of ages:- All infants per 1,000 live births 41 Legitimate infants per 1,000 legitimate live births 39 Illegitimate " " " illegitimate " " 111 Deaths from Cancer (all ages) 208 Deaths from Measles(all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age) 5 Still Births. Still births registered numbered 35 compared with 57 for 1939 The rate per 1,000 total (live and still) births was 21.7, the figure for the previous year being 29.9. Births. The number of live births registered was 1,572 compared with 1,845 for the year 1939, equivalent to a birth rate of 14.29 per 1,000 of the Registrar General's estimated population. The rate fac 1939 was 14.4. 3. Deaths. During the year the number of East Ham civilian residents dying was 1,684. This figure is equal to a death rate of 16.2 per 1,000 of the Registrar General's estimated population. For the previous year the rate was 11.4. Infantile Mortality. The number of deaths of children tinder one year of ago was 66, equal to an infantile mortality rate of 41 per 1,000 live births (41 for 1939), the rate for England and Wales being 55 per 1,000 live births. Neo-Natal Mortality. Children dying under the age of one month totalled 34 equal to a neo-natal mortality rate of 21.6 per 1,000 live births. The rate for the previous year was 21.1. Maternal Mortality. Maternal deaths numbered 3, the rate for 1940 being 1.90 per 1,000 live births and 1.86 per 1,000 live and still births. Puerperal Infection Other Causes. Total. England & Wales East Ham. England & Wales East Ham England & Wales East Ham. Per 1,000 Total Births (live and still.) 0.52 0.62 1.64 1.24 2.16 1.86 Population. The Registrar General's estimate of the civilian population for 1940 is 110,000 . His figure for the year 1939 was 127,600 (birth rate) and 122,800 (death rate). 4. 5. BIRTH RATE, DEATH RATE AND ANALYSIS OP MORTALITY, 1940. Rate per 1,000 Civilian Population. Annual Di^ath Rate per 1,000 Civilian 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 & Enteritis (under two years.) Total Deaths under 1 year England and Wales 14.6 0.55 14.3 0.00 - 0.02 0.00 0.02 0.06 0.32 4.6 53 126 County Boroughs and Great Towns including London. 16.0 • 0.64 15.8 • 0.00 - 0.02 0.00 ■ 0.02 0.07 0.29 5.9 61 143 Smaller Terms (estimated residant populations 25,000 - 50,000 at census 1931.) 15.7 ' 0.55 ' 12.8 0.00 - 0.02 . 0.00 0.02 0.05 0.30 ' 4.4 54 London - Administrative County. 13.7 0.44 17.8 0.00 . _ 0.01 0.00 0.00 0.01 0.18 5.8 50 EAST HAM 14.29 0.32 ' 16.2 - — - - - 0.03 0.03 3.1 41 A dash (-) signifies that there were no deaths. CAUSES OF DEATH IN AGE-GROUPS, 1940. \ Cause of Death. All Ages. Deaths at different periods of life of residents (civilians), whether occurring within or without the district. Under 1 Year 1 - 5 Years 5 - 15 Years 15 - 45 Years. 45 - 65 Years. 65 and Upwards M F M F M F M F M F M F M F 1. Typhoid and Para-typhoid Fevers - - - - - - - - - - - - - - 2. Cerebro-Spinal Fever 1 2 - - - 1 1 - - 1 - - - - 3. Scarlet Fever - - - - - - - - - - - - - - 4. Whooping Cough - - - - - - - - - - - - - - 5. Diphtheria - 4 - - - 1 - 3 - - — - - — 6. Tuberculosis of Respiratory System. 54 34 - - — - - - 32 24 16 8 6 2 7. Other forms of Tuberculosis 5 8 - - 3 2 1 - 1 4 - 2 - - 8. Syphilitic Diseases. 9 2 - - - - - - - - 5 1 4 1 9. Influenza 6 1 l - - - - - - - 4 - 1 1 10. Measles - - - - - - - - - - - - - - 11. Acute Polio-myelitis and Polioencephalitis. - - - - - - - - - - - - - - 12. Acute infective encephalitis 2 1 - 1 - - - - 1 - 1 - - - 13. Cancer of baccal cavity and oseophagus (M) uterus (F) 16 8 - - - - - - - - 4 5 12 3 14. Cancer of Stomach and duodenum 14 21 - - - - - - 1 1 8 7 5 13 15. Cancer of Breast - 17 - - - - - - - 3 - 7 - 7 16. Cancer of all other sites 71 61 - - - - - 1 7 6 24 21 40 33 17. Diabetes 5 5 1 ' 4 5 18. Intracianial vascular lesions 57 77 - - - -- - - 4 2 16 19 37 56 19. Heart Disease 200 193 - - - - 1 1 9 5 56 37 134 150 20. Other Diseases of Circulatory System 18 9 - - - - - - - - 9 3 9 6 21. Bronchitis 86 49 7 - - - - - 3 2 30 17 46 30 22. Pneumonia 55 33 7 2 2 2 - - 8 1 19 10 19 18 23. Other Respiratory Diseases 9 12 - - - - - - 1 1 5 6 3 5 24. Ulcer of Stomach and duodenum 14 2 - - - - - - 1 1 9 1 4 - 25. Diarrhoea under two years. 3 2 3 2 - - - - - - - - - - 26. Appendicitis 5 6 - - 2 2 - 1 1 - 2 - - 3 27. Other Digestive Diseases 7 19 - 1 1 - 1 1 - 1 4 - 4 4 10 28. Nephritis 14 12 - - — — - 1 1 1 8 5 5 5 29. Puerperal &Post abortive sepsis - 1 - - - - - - - 1 - - - - 30. Other natural causes. - 2 - - - - - - - - - - - - 31. Premature birth 9 4 9 4 - - - - - - - - - - 32. Congenital mal- formations, birth injury, infantile diseases. 33. Suicide 8 13 8 13 - - - - - - - - - - 12 6 - 5 1 4 5 3 - 34. Road Traffic Accidents. 17 4 - - - - 3 1 5 - 5 - 4 3 35. Other violent causes 127 118 1 3 3 3 4 6 47 53 45 33 27 20 36. All other causes. 70 64 2 2 - 2 1 1 7 9 11 10 49 40 TOTAL. 894 790 38 28 11 13 12 15 135 122 282 201 416 412 6. DEATHS IN WARDS - 1940. Cause of Death. Manor Park. Little Ilford garage Plashet sington. Castle Central Wall End. field. South Total 1. Typhoid and Para-typhoid Fevers. - - - - - - - - - - - 2. Cerebro-Spinal Fever. - 2 - - - - - - 1 - 3 3. Scarlet Fever - - - - - - — — — — — 4. Whooping Cough - - - - - - - - - - - 5. Diphtheria 1 2 — — — — 1 - - - 4 6. Tuberculosis of Respiratory System 7 8 3 12 8 13 12 8 8 9 88 7. Other forms of Tuberculosis 2 2 3 - 1 1 3 1 - - 13 8. Syphilitic Diseases 1 1 1 2 - 2 — 3 — 1 11 9. Influenza - - 1 1 — - 1 - 3 1 7 10. Measles — - - - - - - - - - - 11. Acute Poliomyelitis and encephalitis - - - - - - - - - - - 12. Acute infective encephalitis 1 - 1 - - - - - - 1 3 13. Cancer of buccal cavity and oseophagus(M) uterus (F) 2 6 1 2 3 1 3 2 2 2 24 14. Cancer of Stomach and duodenum 3 2 5 2 3 4 6 4 4 2 35 15. Cancer of Breast 1 1 1 - 6 1 3 1 2 1 17 16. Cancer of all other sites 13 14 20 14 10 8 14 19 9 11 132 17. Diabetes. 1 1 2 1 — 1 2 1 — 1 10 18. Intracianial vascular lesions 14 20 12 10 17 10 11 20 9 11 134 19. Heart Disease. 38 35 39 36 32 54 43 38 34 44 393 J 20. Other diseases of circulatory system. 3 2 3 1 2 1 3 7 1 4 27 21. Bronchitis 10 9 10 18 15 19 15 20 8 11 135 22. Pneumonia 10 11 2 9 9 13 5 9 7 13 88 23. Other respiratory diseases 3 3 2 1 3 2 3 1 1 2 21 24. Ulcer of stomach and duodenum 4 1 - 1 1 3 2 1 3 - 16 25. Diarrhoea under two years. 2 1 - - - - - 1 - 1 5 26. Appendicitis. — 1 1 — 1 1 4 1 1 1 11 27. Other digestive diseases. 2 3 1 5 4 2 1 5 1 2 26 28. Nephritis. 3 5 1 2 - 4 4 1 1 5 26 29. Puerperal and' post-abortive sepsis. - 1 - - - - . - - - - 1 30. Other natural causes. — - — — - 2 — — — — 2 31. Premature Birth 1 3 1 — 2 1 1 2 - 2 13. 32. Congenital Malformations , birth injury infantile diseases. 3 3 1 1 2 2 3 3 2 1 21 33. Suicide. 2 - 2 - 3 - 1 3 2 5 18 34. Road Traffic accidents. 1 2 2 2 2 4 1 3 1 3 21 35. Other violent causes. 34 30 11 24 20 32 27 26 14 27 245 36. All other causes. 15 14 12 16 16 14 19 12 6 10 134 . TOTAL; 177 183 138 160 160 195 188 192 120 171 1,684 7 8. PREVALENCE OP, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for the 52 weeks ending 28.12.40. 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 Ilfard. 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 & Up. Scarlet Fever 77 - 25 25 14 5 6 2 - - 8 16 10 8 5 12 5 5 6 2 65 Diphtheria 47 - 17 20 4 3 2 1 - - 11 16 - 6 1 2 4 3 1 3 47 Enteric Fever 10 - 1 2 1 1 4 - - 1 1 2 2 1 - 2 1 - - 1 10 - Erysipelas 33 2 - - - 1 3 4 15 8 6 - 1 2 2 3 4 2 4 9 10 - Puerperal Pyrexia 8 - - - 6 2 - _ - 2 1 - - . 1 - 3 - 1 4 - Pneumonia 42 2 2 2 - 3 2 12 13 6 3 7 4 8 2 12 4 1 1 30 - Opthalmia Neonatorum 3 3 - - - - - - - - 2 - - - 1 - - - 2 - Meningoccal Meningitis 11 - 3 1 1 - 3 2 1 - 2 4 1 - - - 1 - 3 11 - Acute Poliomyelitis 1 - - - - 1 - - — - - - - 1 - - - - - - 1 - * Measles 36 1 17 6 2 2 8 - - - 3 4 5 2 1 1 5 4 8 3 2 - *Whooping Cough 19 3 15 1 - - - - - - 3 3 1 - 3 1 4 2 1 1 3 - 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 9. The death rate was 0.08 per 1,000 population, as compared with a rate of 0.18 for 1939. No cases of Smallpox were reported during the year under review. Diphtheria Immunisation Clinics. Number inoculated in the various age groups:Ages in years 1 2 3 4 5 68 6 7 8 9 10 54 11 12 13 14 & Over 52 174 Cancer. No investigations have bean tinder taken, 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. Classification. Carcinoma 187 Epitholioma 4 Sarcoma 8 Papilloma 1 Adenoma 2 Unstated 6 Total 208 Cancer Deaths, 1939:- Total deaths 208 Males 101 Females 107 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 161 patients were admitted to the Hospital Block at Harts Sanatorium, Woodford Green, where the Infectious Diseases Hospital was transferred at the beginning of the war. This is the lowest number of eases ever admitted to the Hospital and the low incidence of infectious disease is most gratifying and welcome. In 1939 the number of cases admitted was 325. While the number of notified cases of Diphtheria was low (45), the disease when it does occur, continues to be severe, proving that parents must continue to take advantage of the immunisation schemes against Diphtheria for their children. Per the sixth successive year there were no deaths from Scarlet Fever and the disease continues to be generally mild in character. Cases of Paratyphoid Fever and Cerebro Spinal Meningitis occurred, but these fortunately were not many in number, with no deaths. In connection with the treatment of Cerebro-Spinal Meningitis, the results obtained from the chemo-theurapeutic use of Dagenan, better known as M & B 693, have been most successful. The number of deaths from all cases was 7, giving a mortality rate of 4.34 per cent. STATISTICS. A. DIPHTHERIA (Uncorrected for Diagnosis ). In Hospital on December 31st, 1939 2 . Admitted during 1940 45 Discharged during 1940 42 Died during 1940 3 Remaining on December 51st, 1940 2 B. SCARLET FEVER (Uncorrected for Diagnosis). In Hospital on December 31st, 1939 3 Admitted during 1940 66 Discharged during 1940 66 Died during 1940 0 Remaining on December 31st, 1940 3 C. MISCELLANEOUS (Uncorrected for Diagnosis & including Staff illness.) In Hospital on December 31st, 1939 1 Admitted during 1940 50 Discharged during 1940 44 Died during 1940 4 Remaining on December 31st, 1940. 3 DIPHTHERIA. Number of notified cases 45 Revision of Diagnosis 5 Other notified diseases proving to be Diphtheria 1 Final number of Diphtheria cases 41 10 Table Showing Types of Diphtheria and Mortality. Faucial 29 1 3.44% Nasal 1 - - Laryngeal 4 - - Faucial and Nasal 7 2 28.57% 41 3 7.31% Table Showing Serum Administration. 8,000 16,000 24,000 32,000 40,000+ TOTAL 4 4 6 5 22 41 Serum was. given intravenously on six occasions. Bacteriological Examinations. 435 swabs were examined for Diphtheria Baccilli and 30 were found to be positive. The Serum Reaction Rate: 7.31% Complications. Otorrhoea 1 Myocarditis 2 Palatal Paralysis 2 Pharyngeal Paralysis 1 Strabismus 2 8 The total complication rate was 19.51%. SCARLET FEVER. Number of notified cases 66 Revision of diagnosis 3 Final number of Scarlet Fever Cases 63 For the sixth successive year there were no deaths. Complication.s Tonsillitis 3 Adenitis. 7 Otorrhoea 3 Septic Spots 4 Rheumatism 1 18 Serum and Prontosil Therapy: Number of cases receiving Prontosil alone 57 " " " " " & Serum 6 OPERATIONS. Lumbar punctures 15 Intubation 1 Post Mortem 1 Birth 1 LABORATORY WORK; Bacteriological Examinations of Faeces 17 " " Urine 19 Blood Widal Tests 7 Wassermann Reaction Tests 2 11. TABLE OP ADMISSIONS AND DISCHARGES FOR 1940. (AFTER CORRECTION FOR DIAGNOSIS) Remaining at end of 1939. Admitted during 1940. Died During 1940. Discharged During 1940. Remaining at end of 1940. Diphtheria 2 41 3 38 2 Diphtheria and Scarlet Fever 1 - - 1 - Scarlet Fever 1 63 - 61 3 Broncho Pneumonia - 2 - 2 - Cerebro Spinal Meningitis - 5 - 3 2 Chicken Pox - 5 - 5 - Common Cold - 2 - 2 - Erysipelas - 1 1 - - Marasmus - 2 2. - - Measles - 2 - 1 1 Meningism - 2 2 - Miscellaneous and Staff Illness. - 15 - 15 -" Mumps. - 1 - 1 - No evidence of Disease - 4 - 4 - Paratyphoid Fever - 7 - 7 - Pemphigus 1 - - 1 - Puerperal Pyrexia - 1 - 1 " Rubella 3 - 3 - Tonsillitis - 4 - 4 - Tuberculous Meningitis - 1 1 - - Urticaria 1 - - 1 - TOTALS: 6 161 7 152 8 12. DIPHTHERIA PROPHYLAXIS. RETURN FOR PERIOD ENDING 30TII SEPTEMBER, 1941. PART I. Number of children permanently or temporarily resident in the Authority's area dealt with under arrangements made by the Authority or by the County Council. Course completed between 1st January 1940, and 15th December,1940. Course compacted between 16th December 1940, and 30th September,1941. Age under 5 years. Age 5 yrs. & over but under 15 Age under 5 years. Ago 5 yrs & over but under 15. Number of children who at 30th Septr. 1941 had received a full course of immunisation (whether with subsequent Schick Test or not). - - 252 742 Inoculation begun between 1st January, 1940, and 15th December, 1940. Inoculation begun between 16th December, 1940 and 30th September,1941. Age under 5 years. Age 5 years & over, but under 15. Age under 5 years. Age 5years & over, but lander 15. Number of children who had. been inoculated but had not completed full coureo of immunisation 30th September ,1941 - - 27 23 *PART II Percentage of child population immunised. At 31st Dec ember, 1940 At 30th September, 1941. Age under 5 years. Age 5 years & over, but under 15. Age under five years. Age 5 years & over, but under 15. Estimated population of children 3,422 5,840. Estimated perceniege of child population who at date shown (a) Had received complete course of Immunisation - - - - (b) Had been inoculatod but had no completed course - - - - 13. PART III. Analysis of notified cases of diphtheria in children under 15 Period Period 1st January, 1940 to 31st December,1940 1st January,1941, to 30th September, 1941. (A)Number of notifications ( children under the ago of 15) 41 23 (B)Kumber of children included in (A) who had received a complete course of immunisation 1 2 (C)Number of children included in (A) who had been hoculated but had not completed the course - - PARTICULARS OF CASES ENTERED UNDER (C) OF PART III ABOVE. Cases under (B) Cases under (C). Case (l,2,3 etc) Dates of Inoculation Prophylactic Used. Probable date of infection Case(1,2,3 etc) Dates of Inoculation. Prophylactic Used. Probable date of Infection 1 10. 12.37 14. 1.38. 21. 1.38. T.A.F. 12.9.40. - - - 2 21. 8.36 28. 8.36 4. 9.36 T.A.F. 4.6.41. - - - 3. In 1935 in previous area, but no information of type of prophylactic used available 8.7.41. - - * PART II. PERCENTAGE OF CHILD POPULATION IMMUNISED. It is impossible to give even an estimated child population as at 31.12.40. The only figures that can be shown are as at 31.3.40:- (Age under 5 years 7,325. Age 5 years but under 15 years 10,496.) During the continuous air-raids on East Ham in September, October November and December, 1940, many children were evacuated: some had, however, returned to East Ham before the end of December. In fact, one can almost say that there was a continual ebb and flow,which makes it very difficult to give an estimate approximating to correct numbers. Having regard to the correct figures given for 30.9.41. you may be able to arrive at some basis for calculation. Therefore, seeing that it is impossible to give the estimated population, it is also impossible to give the estimated percentage of child population under (a) and (b). With regard to the figures as at 30.9.41. these are approximately one-third of our normal peace-time population. It is therefore impracticable to give any percentages in the appropriate columns under (a)and (b). The total number of children immunised against diphtheria between 27.9.39. the date diphtheria prevention commenced in this area, and 31.12.40. is 6,680. 14. MOTIVES ACTS 1902 - 1936. The number of midwives who notified their intention to practice in the area during 1940 was 31. Of this number 19 worked in connection with the Maternity Hospital and District Nurses Home, Plaistow, and its Branches, - 4 at Sir Henry Tate's Nurses Home, Silvertown, - 1 at the East Ham Memorial Hospital,-and 7 practised independently, including two Municipal Midwives. SUMMARY OF VISITS PAID DURING 1940 BY NURSES OF PLAISTOW MATERNITY HOSPITAL AND DISTRICT NURSES HOME. Midwifery 222 Monthly 130 Hospital 236. LABORATORY FACILITIES. The same facilities exist as detailed in previous reports for the examination of specimens. During 1940, 591 specimens were examined at the East Ham Memorial Hospital and 19 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. 858 38 820 AMBULANCE FACILITIES. Since the War started, th, 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 31.12.40. Number of attendances at homes. Number of attendances at Surgery. Total Number of attendances. Number of occasions medicines supplied without seeing patients, 2,523 10,736 13,259 568 Number of applications to Medical Officer 1l of Health for Hospital treatment. Number of requisitions received for attendance of nurse. 33 16. VENEREAL DISEASES. The same facilities are 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. 1940 1930. Syphilis 10 13 Soft Chancre Nil 1 Gonorrhoea 47 61 Not venereal 70 110 Total 127 185 Total attendances of all patients 2,105 4,716 Total number of in-patient days 25 42 The decrease in attendances and in-patient days as compared with the year 1939 is not due solely to the War and resulting evacuation, but to a lessened incidence of disease. PATHOLOGICAL EXAMINATIONS. 1940. 1939. For or at the Centres;- Spirochaetes 8 2 Gonocooci 816 2,119 Wasserman 204 370 Others 376 839 Total; 1,404 3,330 For practitioners:- Spirochaetes Nil Gonococci 1 5 Wasserman 10 14 Others 4 11 Totals 15 30 16. RUNWELL MENTAL HOSPITAL Mental patients are now accommadated 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 1940. east ham immortal 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. Reference should be made to the Annual Report. BLIND PERSONS ACTS, 1920 - 1938. The following figures arc abstracted from the statistical record of the registration of blind persons, as at 31.3.41:- Males. Females. Total. Number on register 117 106 223 Total employed 15 6 21 Undergoing training - - - Trained but unemployed 4 3 7 No training but trainable 3 1 4 Unemployable 94 94 188 Children (5 to 16 years). 1 2 3 17. MENTAL DEFICIENCY ACTS, 1913 - 1938. PARTICULARS OF MENTAL DEFECTIVES AS ON 1ST. JANUARY, 1941, STATISTICS. 1939. 1940. M. F. Total M. F. Total. 1. Under ORDER (a)(l) In Institutions (excluding cases on Licence). Under 16 years of age 19 16 35 18 15 33 Aged 16 years and over 43 3,1 74 40 32 72 (2) On Licence from Institutions Under 16 years of age - - - - - - Aged 16 years and over 4 - 4 3 - 3 (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 21 17 38 (2) On Licence from Guardianship Under 16 years of age - - - - - - Aged 16 years and over 4 - 4 4 1 5 2. In "PLACES OF SAFETY". Under 16 years of age 1 1 2 5 4 9 Aged 16 years and over 5 3 8 7 6 13 3. UNDER STATUTORY SUPERVISION. 79 75 154 66 60 126 Of whom Awaiting removal to an Institution 7 7 14 11 1 2 4. Action not yet taken under any one of the above headings; (a)Notified by Local Education Authorities. (Sec 2 (2) 1 - 1 1 - 1 (b)Mental Defectives in receipt of poor reliefs- (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 Section 3 1 1 2 - - - (2) Other Cases - - - - - - 18.  1939. 1940. M. F. Total M. F. Total (2) Domiciliary. 2 5 7 2 5 7 (c) Otherwise ascertained 8 7 15 — — - 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 contributed under its permissive powers: 4 1 5 4 1 5 (b) Maintained wholly or by parents, relatives or others - - - - - - 2. Reported to the Local - Authority from any reliable scarce, 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 4 1 5 Of whom, number, If any under voluntary supervision - - - - 1 1 (b) All other cases 26 17 43 Of whom, number, if any under voluntary supervision. 32 19 51 26 17 43 Number of above cases on the Registers of Occupation and Industrial Centres Under Statutory Supervision 11 10 21 Centre closed 5. 9. 39 Under Voluntary Supervision - - - Re-opened On Licence from Institutions - - - 22. 1. 40. Under Guardianship 4 6 10 Closed 1. 4. 40 for duration of hostilities On Licence from Guardianship - — — 19. DURING THE YEAR 1940. 1939. 1940 M. F. Total. M. F. Total. 1. (a) Number of instances in which Licence was granted during 1940:- (1) From Institutions - - - 2 - 2 (2 ) From Guardianship 3 - 3 3 1 4 (b) Number of instances in which cases on licence have been returned to Institutions or transferred to Guardianship, during the year 1940;- (1) To Institutions 1 - 1 1 — 1 (2) To Guardianship 3 1 4 2 - 2 2. Cases notified by Local Education Authorities (Sec. 2 (2) during the year 1940:- Method of Disposal • Sent to Institutions (by Order) - 1 1 - - - Placed under Guardianship(by Order ) - - - - - - Placed under Statutory Supervision 7 1 8 4 1 5 Placed in "Places of Safety" 1 - 1 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. 6. 1. 7. 3. Of the total number of M.D.'s known to Local Authority (a) number who have given birth to children during 1940:- (1) After marriage 1 Still-born (2) While unmarried Nil. (b) number who have married during 1940:- Nil. 20. 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 1940 were, as follows Tuberculosis 8 Anaemia & Debility 7 Rheumatism, heart and chorea 1 Lung conditions (non-tuberculous) 9 Marasmus and Malnutrition 4 Various 33 62 MATERNITY AND CHILD WELFARE. Domiciliary Midwives. Midwives 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 3 - 3 (b) Noramlly employed by other Local Supervising Authorities, but temporarily working in the area (c) Employed by other Welfare Cornells (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 arrangement s made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 20 - 20 (ii) Others - - - (e) In private practice 4 - 4 Totals: 27 - 27 21.  Domiciliary Midwives Midwives in Institutions Totals. Number of cases in the area of the Local Supervisory Authority attended during the year by Midwives : - (a)Employed by the Council. As Midwives 149 - 149 As Maternity Nurses 21 - 21 (b) Norma1ly emp1oyed by other Local Supervisory Authorities, but temporarily working in the area. As Midwives - - - As Maternity Nurses - - - (c)Employed by other Welfare Councils: (i)Under arrangements made with the Local Supervisory Authority] in pursuance of Section 1 of the Midwives Act, 1936 as Midwives - - - As Maternity Nurses - - - (11) Others AsMidwives - - - As Maternity Nurses — — (d)Employed by Voluntary Associations: (i)Under arrangements made with the Local Supervisory Authority in pursuance of Section 1 of the Midwive s Act, 1936 As Midwives. 222 - 222 as Maternity Nurses 130 - 130 (ii) Others As Midwives. - - - As Maternity Nurses — - - } (e)In private practice As Midwives 161 - 161 as Maternity Nurses 29 "- 29 TOTALS: As Midwives 532 - 532 As Maternity Nurses 100 - 180 Number of cases in which medical aid was summoned during the year under Section 14 (i) of the Midwive3 Act, 1918,by a midwife: (i) for domiciliary cases 136 Total 136. (ii) For cases in Institutions. Nil 22. HEALTH VISITING-. (a) Number of Health Visitors employed at the end of the year. (1) 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 areas (i) to expectant mothers. First Visits. 496 Total Visits. 530 (ii) To children under one First Visits. 1216 year of age. Total Visits. 6714 (iii) to children between the ,.ages of 1. and 5 Total Visits. 7067 years. INFANT WELFARE CENTRES. (a) Number of Centres provided and maintained by the Council-2 (b) Number of Centres provided and maintained by Voluntary Associations. - Nil. (c) Total number of- children who first attended at the Centres during the year & who, on the date of their first attendance were - (I) under one year of age 1094 (ii) between the ages of one and five years. 358 (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 one year of age 791 (ii) over one year of age 1715 23. 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 2 - (ii) Number of these Clinics open at 31st December, 2 - (iii) Total number of women who attended at the Clinic during the year 706 - (b) Total number of expectant mothers ante- natally examined & of cases post- natally examined during the year,under arrangements made by the Council with private medical practitioners, excluding - - SUPPLY OF MILK AND FOOD. Total quantity of milk supplied during the year to expectant mothers & nursing mothers & young children;- Liquid Gallons. Dried Pounds. 1,816 17,970 (ii) by Voluntary Associations operating in the area of the Council - - Totals: 1,816 17,970 Cases of Ophthalmia Neonatorum notified during the year in which:- (a) Vision was unimpaired 2 - (d) the patient was still under treatment at the end (e) the patient died 1 (f) the patient removed from the district - (g) classification under the above heads cannot be made (details of these cases should be attached) — Total : 3 MATERNITY ACCOMkODAT1ON. As sot out in my 1939 Report, tho 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 1940 108 cases were admitted to Forest Gate Hospital. INSPECTION OF MIDLIVES.' Visits of inspection, as necessary, wore paid during the year ana the midwives' work, including records, was satisfactory. 24 CHILD LIFE PROTECTION. Sections 206 to 220 of the Public Health Act,1936. (a) Number of persons who we.ro receiving children for reward, at the end of the year.- 13. (b) Number of children: (i) at the end of the year - 12 (ii) who died during the year - Nil (iii) on whom inquests were held during the year - Nil. (c) Number of Child Protection Visitors at the end of the year who were: (i) Health Visitors - 7. (ii) Female, other than Health Visitors - Nil (iii) Male. - Nil. (d) Number of persons (in addition to or in lieu of Visitors under(c) above) or societies authorised to visit under the proviso to Section 209 (2) of the Public Health Act, 1936. - Nil. (e) Proceedings taken during Act and Section under the year . which proceedings were taken. 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 1940. 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 the year 1 6 14 20 The number of cases admitted and treated at the Nursing Home, (Kelvingrove) in the Borough during 1940, was as follows:- Maternity 9 Others 39. 25. TUBERCULOSIS AND CHEST CLINIC, Notifications. The number of primary notifications during the year 1940 was 204 as compared with 217 for 1939. Of the primary notifications of pulmonary tuberculosis, in 35.24 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, 1940 was 879 (pulmonary and non-pulmonary or 7.9 per 1,000 estimated population, as opposed to 974, or 7.67 per 1,000 population in the previous year. Deaths. The number of deaths (1936-1940) from tuberculosis is shown below:- Pulmonary. Non-Pulmonary. Of Cases on the Clinic Register 1936. 97 . 10 77 1937 80 13 84 1938 31 8 67 1939 71 12 59 1940 88 13 81 New Cases. The following are the comparative figures for the years 19361940;- 1936 1937 1938 1939 1940 New Cases (& Contacts) 618 697 629 486 582 Number proved, after complete investigation to be tuberculous 29.4% 28.4% 23.5% 30.4% 21 99% Attendances and Medical Examinations. 1936 3,753 3,297 1937 3,793 3,437 1938 3,970 3,590 1939 3,467 2,982 1940 2,413 1,901 Consultations at Homes of Patients. During the year seventeen visits were made to the homes of patients who were too ill to attend the Clinic. Number of X-Ray Examinations at the Chest Clinic. 1937 1938 1939 1940 1652 1599 1394 1132 26. Dr. Philip Ellman, Consult ant to the Chest Clinic, reports on the work of the Clinic, as following:- The Report this year, apart from the war-time necessity of it having to be brief, follows so closely on the previous annual report, that it calls for very few additional comments, and the features outlined then still hold good. A few further comments, however, are indicated. Attendances. With regard to the attendances and medical examinations it will be noted from the figures that although the attendances and examinations are less than in the previous year, the number of new cases and contacts has, in fact, increased by about 20%. over the figures for the last year. The number of secondary cases examined has been considerably reduced by reason of the fact that many of these cases are evacuated to safe areas and are therefore not being seen and supervised by us. There are also a number of what might be called "fleeting cases" which come into the area, but these may stay only a comparatively short time in the district. The reverse also obtains that is, some of our patients go out of the area and return again after a short period. X-Ray Examinations. The number of X-ray examinations is well maintained,despite the critical year through which we have passed. Economy is, however, being encouraged as far as possible and paper films described in last year's Report, with their marked reduction of cost, are being utilised wherever it is compatible with efficiency. Mass X-Ray Examination of the Chest. This was dealt with in considerable detail in last year's Report and advances are proceeding with this important war-time measure, which makes one hope that its value as a practical public health and preventive measure will be fully utilised in the future peace-time service. The most Important,practical and reliable method of mass x-ray examinations, namely, by miniature screen photography, is now being used as a means of examining recruits to the services and it is hoped that in the near future it will be available for the examination of female adolescent recruits to war industry, especially in view of our experience in the Great War, when statistics showed that a larger number of deaths,mainly confined to young people, occurred during that period,and according to the annual report of the Ministry of Health for 1920, tho greater industrial employment of women was partly responsible for this increase. As in the Groat War, we must be constantly on our guard against the influence of under-nourishment associated with the food problem, overwork and prolonged physical and mental stress and strain, which may be responsible for the infected becoming the clinically tuberculous. The possible extension of miniature screen photography in peace-time, to include periodic health examinations of adolescent industrial workers, those engaged in certain trades where the pneumokonioses are common, groups of the population where tuberculosis is high and ospecially a contact service, raises a new and extensive problem in the domain of public health. Its significance will be appreciated by the record of the examination of 2,681 of our contact cases, wherein 6.75$ showed evidence of pulmonary tuberculosis in subjects who were presumably 27. free from symptoms. In point of fact, in 65% of these cases physical signs were almost completely absent and x-ray examination of the chest is the only means of determining the pulmonary disease. Spread of Tuberculosis in Shelters. This is being adequately controlled by the new scheme now prevailing in this Borough, by which no notified cases of pulmonary tuberculosis are permitted to use a public shelter. The Nutritional Problem in War- Time This question was dealt with in our last Report, and the points then emphasised are still relevant: the difficulty experienced by many of our patients in obtaining adequate first class proteins in the form of milk, cheese and eggs, still persists. It is particularly unfortunate that no concessions whatsoever are made to our tuberculous patients and the increasing needs for such concessions is very real indeed. The Examination of Recruits. These continue to an increasing degree and large numbers are referred to us by the Medical Boards for a Consultant opinion where any disease of the chest is suspected. It has, moreover, been our experience that several of cur known cases of pulmonary tuberculosis have managed to get into the Army without disclosing their history. Some of these have subsequently been discharged from tho Army and referred to Us. Occupational Therapy. Attendances have been fairly normal, although there was a slight fall in the numbers during September. Patients who are too ill to attend the Occupational Therapy Class are given work to do at home and the nursing sisters kindly help in the distribution of this. Toy making is a new craft which has been introduced and is much enjoyed by the women patients, whilst the men continued to do cane work, rug making, seagrass seating, tapestry, woodwork and toy carving. Most of the articles made by the patients are sold immediately; this encourages the patients and the psychological effect is marked, as they naturally like to think that their work Is wanted and that they are doing something useful. 28. HARTS SANATORIUM. PREFACE. Although having only half the pro-war accommodation, the work of the Sanatorium is proceeding ay formerly. Modern methods of treatment include graduated rest, artificial pneumothorax, gold salts, tuberculin, insulin, drug and medicinal and vitamin therapy. We continue to send cases requiring surgical intervention or investigation to the Thoracic Surgical Units of the London Hospitals. The Blood Sedimentation Rate, introduced in 1939, is now a routine method used in assessing the amount of activity present and in estimating the prospects of recovery, In 3pite of wartime difficulties, the occupational therapy class continues and the patients greatly appreciate this creative work, which is invaluable from a psychological point of view, as well as lessening the tedium of bed rest. STATISTICS. Discharges including deaths 114 (63M. 50F. 1Ch.) Deaths (including 1 observation case) 11 (7M. 4F.) Insured Patients 89 (56M. 33F) Non-insured Patients 25 (7M. 17F. 1Ch.) Number of Beds available at end of year 43 Average number of beds occupied 41 (95.35%) Admission by Ambulance 27 (11M. 16F.) From Hospitals 14 (5M. 9F.) From Home 13 (6M. 7F.) Immediate Results of Treatment (of Tuberculosis Cases.) Discharged quiescent 47 (25M. 22F) (including three observation cases found to be suffering from Tuberculosis) Discharged Non-quiescent 53 (30M. 23F) (including one observation case found to bo suffering from Tuberculosis.) Of theses- Improved 39 (21M. 18F) Not improved 14 (9M. 5F.) 29. Observation Cases . Of the 8 Observation Cases 5 were found to be suffering from pulmonary tuberculosis 2 " " " " " " asbestosis 1 was " " " " " " spontaneous pneumothorax (cause unkown.) Artificial Pneumothorax. Number of Inductions 15 Number of attempted Inductions 4 Number of refills given 581 Number of Gas Replacements 8 Number of Cases sent for Surgical Treatment and .Investigation. For cauterisation of adhesions 8 For thoracoplasty 2 For bronchoscopy 2 Gold Salts. Number of Courses commenced 36 " " completed from 1939 15 " " terminated during 1940 40 Of these 40:- Complete Courses 28 Incomplete Courses 12 Lipiodol Examinations. 6 Radiography. Number of films taken during 1940 451 Bacteriology. Number of sputum specimens examined 409 Number of Blood Sedimentation Rates done 476 30. RETURN RELATING TO THE WORK OF THE TUBERCULOSIS & CHEST CLINIC. DURING THE QUARTER ENDING 31ST DECEMBER, 1940. DIAGNOSIS. Pulmonary. Non-Pulmonary Total. GRAND TOTAL Adults Children Adults. Children Adults Children M P M F M F M F M F M F A.- Number of definite cases of Tuberculosis on the Dispensary Register at the beginning of the Quarter. 382 338 25 13 62 91 33 11 444 429 58 24 955 Inward Transfers during Quarter. 3 2 - - - - - - 3 2 - - 5 L.S.e. cases returned during Quarter 3 2 - - - - - - 3 2 - - 5 B.- Number of new cases diagnosed as Tuberculosis during the Quarter (1) Class T.B. minus 4 6 - - - - - - 4 6 - - 10 (2) Class T.B. plus 6 2 - - - - - 6 2 - - 8 (5) Non-Pulmonary - - - - 1 1 - - 1 1 - - 2 C.- Number of cases included in A & B written off the Dispensary Register during the quarter as;- (1) Recovered - - - - - - - - - - - - - (2) Dead (all causes) 11 4 - - - - - - 11 4 - - 15 (3) Removed to other areas 24 27 2 4 - 4 - 3 24 31 2 7 64 (4) For other reasons. - - - - - - - - - - - - - D.- Number of definite cases of Tuberculosis on the Dispensary Register at the end of the Quarter. 349 | 309 23 9 63 87 31 8 412 396 54 17 879 31 PUBLIC HEALTH (TUBERCULOSIS)REGUIATIONS. 1930. SUMMARY OF NOTIFICATIONS DURING THE PERIOD FROM 1ST. JAN, 1940 TO THE 31ST.DEC. 1940. AGE PERIODS. Formal Notifications. Total Notifications. Number of Primary Notifications of new Cases of Tuberculosis. 0- 1- 5- 1 15- 20- 25- 35- 45- 55- 65- Total (all ages) Pulmonary Males - 3 - - 10 10 14 13 8 11 2 71 78 Pulmonary Females - - 2 1 8 8 18 9 - 4 - 50 52 Non-pulmonary Males - 2 - 1 1 - 3 2 1 1 1 12 12 Non-pulmonary Females 1 3 1 1 - 3 4 2 - 1 1 17 18 SUPPLEMENTAL RETURN. NEW cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned OTHERWISE than by formal notification. AGE PERIODS. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- TOTAL. Pulmonary Males - - - 2 1 3 7 4 2 1 2 22 Pulmonary Females - - - - 2 5 3 3 2 3 1 19 Non-pulmonary Males - 1 - 3 - 1 1 - 1 - - 7 Non-pulmonary Females - 1 - - - - 3 - 1 - - 6 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 6 4 Transferable deaths from Regstrar- General 1 1 Posthumous notification 4 3 "Transfers" from other areas(other than transferable deaths 29 5 Other Sources, if any, (specify) (Merchant. Navy) 1 - Number of beds (a) occupied, (b) unoccupied, in Institutions approved by the Minister of Health for treatment of tuberculosis on the 31.12.40. Name of Institution. PULMONARY cases NON -PULMONARY cases Total. Adults Children under 15 Adults. Children under 15 Harts Sanatorium (a) Number of beds occupied. 42 - - 42 (b) Number of beds Unoccupied. 1 - - - 1 32. SANITARY SECTION AND HOUSING. Mr. J. E. Austin, M.B.E., Senior Sanitary Inspector, has compiled this section of the Report relating to Sanitary Circumstances and Housing, and Statistics in regard to Food Inspection. Emergency Work. For the first eight months of the year the normal duties of the Department were fulfilled although during that period opportunity was taken to complete the scheme of operations in the event of an emergency arising from air raids. In the succeeding months those schemes were well tested, and the value of thorough and practical preparations realised. Before proceeding with the normal report which again this year has been abridged, a brief note of the emergency schemes in operation is included. It would be impossible to refer to these critters without making reference to the untiring efforts of the Inspectorate and other staff who have worked unremittingly to maintain reasonable housing and sanitary circumstances throughout an unprecedented period. First Aid Repairs to Houses. The early execution of first aid repairs to war damaged houses following raids proved of enormous value in maintaining the morale of the public in the early raids, and the Department and contractors worked successfully to this end. The supervision of this work was carried out wholly by the Sanitary Inspectors during this period. The number of men engaged at the 31st December 1940 was 800. Emergency Drainage Repairs. The sewerage system was never so seriously damaged as to necessitate the introduction of a conservancy system. The damage to drainage necessitated close supervision by the Inspectors of sealing off and extensive repairs of damaged drainage at dwelling houses. Emergency Water Supplies. On a number of occasions water for drinking and domestic purposes has been distributed, from milk churns deposited at wardens' posts. Fortunately, the period of dislocation of supplies has never been lengthy. The milk churns were sterilised before use and although the system is not now practised it proved eminently satisfactory at the time. Disposal of Civilian War Dead. The scheme for the collection, reception and disposal of civilian war dead was supervised by an Inspector .The emergency mortuaries ,which are of new construction,proved of value in maintaining hygienic conditions. The arrangements proved adequate and disposal was carried out with dignity and respect, a feature appreciated by the public. Removal of Furniture from Damaged Houses. The scheme for transfer of persons from clearance areas was extended and the experience gained as municipal furniture removers was invaluable in the post raid periods. The supervision and administration of the work of removal,and recording storage was carried out by an assistant acting under an Inspector. Public Shelters. Sanitary conditions in public shelters at no time degenerated seriously. Instances of dampness in trench systems were remedied, ventilation in the same system was improved and the bunking of the shelters did much to eliminate any tendency to overcrowd. Through the Wardens' Service the frequent removal of bedding from shelters was enforced, and in only two instances had disinfestation to be carried out. The necessity for a station whereat bedding could be disinfected and persons cleansed became apparent, and a scheme was approved in 1941 for this provision.It is pleasing to record that a high state of cleanliness was maintained in the public shelters generally through the good work of the shelter cleansing staff of the Borough Engineer. Rehousing. Considerable work fell to the Inspectors in ensuring repairs to houses requisitioned for rehousing purposes. 53. Other Emergency Duties The enforcement of Food Control Orders and Defence Regulations was undertaken in part by the Inspectors. Many other emergency duties were carried out by the Inspectorate and one fools bound to record one's appreciation of their readiness at all times of the day and night to undertake. emergency duties to maintain healthy envirenimental conditions. No statistical Information has been included, in those notes on emergency duties. The Report upon the normal work of the Section follows, but 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 18920 (i) Housing:- House-to-house 302 ' Under Public Health Act 2243 Other visits 1194 Re-inspections 9420 (ii) Sanitary .Cireumstanes. Yards and Passages 308 Draining and Sanitary Accommodation 397 Factories (excluding Bakehouses) 61 Workplaces and Outworkers 188 Caravans 44 Re Offensive Fumes 5 Billets and Posts 318 Miscellaneous 706 War Damage 316 (iii) Food Supply. Slaughterhouses 68 Dairies 51 Food Premises 1581 Bakehouses 75 Re sampling 589 Food Control 221 (iv.) Infectious Disease:- Visits 833 (b) Notices. The number of notices served during the year totalled 1931 of which 249 were statutory notices. The number of notices complied with in the same period was 2432. 34. (c) Improvements In consequence of the service of the foregoing requisitions the following improvements were effected at the number of houses shown Dampness remedied:- Repointing executed 388 Roofs repaired 896 Rain water gutters repaired 605 Ventilation improved:- Windows (including cords) repaired 851 Water Supply Improved Service tap provided on main 280 Sanitary conveniences repaired 490 Washing facilities provided or improved(coppers) 97 Drainage improved or reconstructed 253 Paving of yards repaired 366 Disrepair remedied Stoves and firegrates repaired or renewed 385 Plaster work repaired or renewed 662 Floors repaired or renewed 201 Cleansing Executed 936 Miscellaneous defects remedied 441 (d) RAT EXTERMINATION During the year, 1748 visits were made to properties in the Borough, and 1,592 rats wore destroyed. (e) RAG FLOCK ACTS. 11 samples from users' premises were submitted for analysis and two failed to comply with the regulations, the chlorine contents per 100,000 parts of flock being, as follows:- 170 and 50 parts. In the former case legal proceedings were instituted. BOUSING. (a) OVERCROWDING. During the year a further 128 cases of overcrowding were relieved and 6 now cases were reported. With the evacuation of school children the position of many families tending to overcrowding has been relieved. The housing statistics are included in the following statements- 35 HOUSING STATISTICS. 1. Inspection of Dwelling houses during the year (D(a)Total Number of dwelling houses inspected for defects(under Public Health or Housing Acts 3739 (b)Hunber of inspections made for the purpose 13159 (2) (a) Number of dwelling houses(included under Sub-head (l)above) which were inspected and recorded under the Housing Consolidated Regulation,1925 302 (b)Number of inspections made for the purpose 2052 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitat ion (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 2458 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 2164 III. Action under Statutory Powers During the Year:- (a) Proceedings under Section 9,10,& 16 of the Housing Act, 1936 (1) Number of dwelling houses in respect of which notices were served requiring repairs (2) Number of dwelling houses which were rendered fit after service of formal notices:- (a) By owners - (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 249 (2)Number of dwelling houses in which defects were remedied after service of formal notices:- (a) By owners 268 (b) By Local Authority in default of owners (c) Proceedings under Section 11 & 13 of the Housing Act, 1936 (1)Number of dwelling houses in respect of which Demolition Orders were made (2)Number of dwelling houses demolished in pursuance of Demolition Orders (d) Proceedings under Section 12 of the Housing Act, 1936s- (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 54 (ii)Number of families dwelling therein 55 (iii)Number of persons dwelling therein 454 (b) Number of now cases of overcrowding reported during the year 6 (c)(i)Number of cases of overcrowding relieved during the year 123 (ii)Number of persons. concerned in such cases 894 (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 1940:- By private enterprise Nil By the Local Authority Nil 36. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. (1) Dairies. Dairies were systematically visited and sampling for bacteriological examination carried but. The result of the bacteriological examinations are container in the subjoined statement Total. Ungraded Sterilised Pasteurised. Accredited T.T. Bacteriological samples Satisfactory 70 34 1 27 1 7 Unsatisfactory 18 17 - 1 - - Biological Samples Satisfactory - 20 - 10 - 5 Unsatisfactory - - - - - - (2) Graded Milk. The licenses in force on 31st December 1940 were, as follows:- Tuberculin Tested Milk Bottling Establishment Licence - Dealers' Licenses 9 Supplementary Licenses 3 Pasteurised. Milk: Establishment License 1 Dealers' Licenses 28 Supplementary Licenses 3 The Council decided in December 1935 to charge no fees in respect of licenses granted under the Milk (Special Designations)Order 1936. (a)Meat and Other Foods. (1) Moat Inspection. The Sanitary inspectors made 68 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 connections- Cattle (excluding Cows.) Cows Calves. Sheep and Lambs. Pigs Number of animals slaughterd 178 104 3 14 1 837 Number of animals inspected 178 104 3 14 837 All Diseases except Tuberculosis:Who1e carcases condemned - - - - - Carcases of which sane part or organ was condemned 25 9 - - 44 Percentage of number inspected affected with Disease other than T.B. 14 9 - - 5 Tuberculosis only:Whole carcases condemned - 3 - - - Carcases of which some part organ was condemned 16 89 - - 8 Percentage of the number inspected with T.B. 9 88 - - 1 37. Periodically visits are made to batchers' shops, market stalls and mo at vehicles. (2) Food Premises. The number of inspect:.ons made of food premises included 51 dairies, 75 of bakehouses, and 1581 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 adulterated or below standard Butter 50 - - Choose 1 - - Cocoa 12 - - Coffee 5 - - Confectionery 6 - - Jam and Marmalado 7 - - Flour 4 1 25 Lard * 8 " - Margarine 9 - - Milk 167 11 6 Sausage 46 6 13 Tea 4 — - Vinegar 5 - Wines, Spirits 3 1 33 Drugs 13 - - Other Articles 101 5 5 441 24 5.4. Details of samples adulterated or below standard are described as follows, together with the resultant action:- 38. Number. I or F. Article. Adulteration or Deficiency. Action Taken. 2430 I. Pork Sausage Sulphur Dioxide 250 parts per million. No declaration Vendor cautioned. 2440 I. Ginger Boor Strong smell and taste of disinfectant Vendor cautioned. 2451 P. Milk Added water to at least 20% Vendor prosecuted 2452 P. Milk Deficient in milk fat of at least 5% Vendor cautioned 2534 I. Anchovy Paste Glass found in paste Manufacturer cautioned. 2551 I. Sausages Sulphur Dioxide 150 parts per million. No declaration Vendor cautioned. 2646 I. Flour Contained an appreciable amount of dust. Vendor cautioned. 2658 P. Milk Deficient in milk fat at least 45% Vendor prosecuted. 2664 I. Beef Suet. 3.3% rice flour in excess Vendor cautioned. 2687 I. Beef Suet. 2% rice flour in excess. Vendor cautioned 2722 F. Milk Deficient in milk fat at least 6%. Vendor cautioned. 2752 F. Milk Added water at least 1%, Vendor cautioned. 2753 F. Milk Added water at least 1% Vendor cautioned. 2722 I. Pork Sausages Grade"A" Grade "B" Sausages Formal sample taken Vendor subsequently prosecuted. 2796 F. Milk. Added water at least 1% Vendor cautioned. 2803 F. Milk. Deficient in milk fat at least 25% Vendor prosecuted. 2813 F. Milk Added water at least 5% Vendor prosecuted. 2815 F. Milk Addod water at least 1% Vendor cautioned. 2817 F. Pork Sausages Grade "A" Grade "B" Sausages Vendor prosecuted 2823 F. Pork Sausages Grade"A" Grade "B" Sausages Vendor prosecuted 2824 I. Mixed Herbs. 1.5% sand above usual quantity Vendor cautioned. 2839 I. Beef Sausages Grade ''B" Sulphur dioxide 60 parts per million. No declaration Vendor cautioned. 2846 F. Milk Small quantity of added water. Further sample satisfactory. 2862 F. Whisky. 43.9% under proof added water. Vendor prosecuted. 39. ° '' '