COUNTY BOROUGH OF EAST HAM. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1941 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.) Councilors:- Charles Edward Beckett William Henry Whittock Beecham Leside Alfred Victor Bennett ??? Maud ??? 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 Frank H, Howard Walter Edwin Hurford , Herbert Percy Jackson William I. Jackson, J. P. 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 Alfred Prior (4) Alice Beatrice Spencer (Mrs.) William Thompson William- Bertram Warncken Alfred Tom Yates Watson Ernest Albert Wood. Co-opted, Members of the Maternity & Child Welfare and Mental Deficiency Comittees. / Mrs. E.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 " " " " n " (3) Chairman of Committee for the Care of the Mentally Defective. (4) Vice Chairman " " " " " 1. COUNTY BOROUGH OF EAST HAM. Public Health Department, Town Hill Annexe, Barking Road, East Ham,E.6. May, 1942. To Hi3 Worship the Mayor, the Aldermen and Councillors of the County Borough of Bast Ham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit, as Medical Officer of Health and School Medical Officer,my Annual Report for the year 1941. In accordance with the instructions of the Ministry of Health and Board of Education this Report is presented. in an abbreviated form and is for this reason mainly statistical It is noteworthy that the incidence of serious infectious disease was the lowest for many years despite adverse conditions during the early part of the year, and that whilst the birth and death rates snow little variance, the maternal mortality rate was 1.04 for East Ham as compared with 2.23 for England and Wales and the infant mortality rates were 46 and 59 respectively. Both the Public Health and School Medical Services have had to deal with an increase in verminous and skin conditions, particularly scabies and impetigo. Special Clinics and bathing facilities have been made available for treatment. Attention was drawn in my last Report to the fact that extended immunization was very desirable. I am pleased to state that the number of children, immunised against diphtheria has greatly increased, and that every effort is being made to afford protection in this respect. It will be seen that, despite the limitations of wartime, the Public Health Services have been maintained successfully and that deleterious factors normally affecting the health of the Borough have not assumed unusual proportions. During the latter part of the year consideration was given to the establishment of two wartime Nurseries, one in the north and the other in the south of the Borough., These are now functioning efficiently and serve the needs of many mothers engaged on war work. The Ministry of Labour has introduced an interim scheme for the training and re-settlement, of disabled persons, including sufferers from Tuberculosis, This affords rehabilitation to those whose physical condition necessitates employment under protected circumstances and in a suitable environment. lt is hoped that advantage will be taken of these facilities. The help afforded by the East Ham District Nursing Association, the Invalid Children's Aid Association, and the Tuberculosis After-Care Committee, are worthy of special praise, and I record appreciation of their services. The work associated with the E.M.S. Hospitals, Casualties and Sholter Services has continued with efficiency as heretofore, and I am grateful to the personnel and to members of the Public Health and School Medical Staffs for their valued assistance. My thanks are due also to Alderman Mrs. Wilkens, and Councillor Elson, the Chairmen, and to the members of the Public Health Committee and to those of other Committees, to Chief Officers and Heads of Services, for their cordial co-operation on very many occasions. I have the honour to be. Your obedient Servant M. BARKER. 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 - 1941 80,130 Number of inhabited houses (end of 1941 according to rate books. (Including tenements and shops.)Approx, 29,000 Rateable value at 31st December, 1941 £719,416 Sum represented by a penny rate for the year 1941/42 £2,552 Extracts from Vital Statistics. For Birth Rate, For Infant & Maternal Mortality. Total Males _Females Males Females Total Live (Legitimate 1,210 650 560 468 410 878 Births. (Illegitimate 57 31 26 27 25 52 Still Births 38 16 22 12 17 29 Deaths Total: 1,296 Males, 673. Females, 623. Deaths from Puerperal causes:- Deaths. Rate per 1,000 Total (Live & still births.) Puerperal Sepsis - - Other Puerperal causes 1 1.04 1 1.04 Death rate of infants under one year of ages- All infants per 1,000 live births 46 Legitimate infants per 1,000 legitimate live births 45 Illegitimate " " " illegitimate" 58 Deaths from Cancer (all ages) 179 Deaths from Measles(all ages) 3 Deaths from Whooping Cough (all ages) 6 Deaths from Diarrhoea (under 2 years of age) 2 Still Births. Still births registered numbered 38 compared with 35 for 1940. The rate per 1,000 total (live and still) births was 29.1, the figure for the previous year being 21.7. Births. The number of live births registered was 1,267 compared with 1,572 for the year 1940, equivalent to a birth rate of 15.81 per 1,000 of the Registrar General's estimated population. The rate for 1940 was 14.29. 3. Deaths. During the year the number of East Earn Ham civilian residents dying was 1,296. This figure is equal to a death rate of 16.1 par 1,000 of the Registrar General's estimated population. For the previous year the rate was 16.2 Infantile Mortality. The number of deaths of children under one year of age was 43, equal, to an infantile mortality rate of 46 per 1,000 live births (41 for 1940), the rate for England and Wales being 59 per 1,000 live births. Neo-Natal Mortality. Children dying under the age of one month totalled 26 equal to a neo-natal mortality rate of 20.5 per 1,000 live births. The rate for the previous year was 21.6. Maternal Mortality. Maternal deaths numbered 1, the rate for 2.941 being 1.08 per 1,000 live births and 1.04 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.) 0.48 - 1.75 1.04 2.23 1.04 Population. The Registrar General's. estimate of the civilian population for 1941 is 80,130. The figure for the year 1940 was 110,000 4. 5* BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1941. Rate per 1,000 Civilian Population Annual Death 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. Diarrhœa & Enteritis (under two years.) Total Deaths under 1 year. England and Wales 14.2 0.51 . 12.9 0.00 - 0.03 0.00 0.06 0.07 0.19 5.1 59 126 County Boroughs and Great Town including London. 14.7 0.58 14.9 0.00 - 0.03 0.00 0.07 0.08 0.17 7.5 71 143 Smaller Towns (estimated resident populations.. 25,000 - 50,000 at census,1951.) 16.4 0.60 13.0 0.00 - 0.03. 0.01 0.06 0.06 0.20 » 4.6 56 London - Administrative Comity, 8.9 0.33 16.3 0.01 - 0.02 0.00 0.04 0.03 0.15 6.8 68 EAST HAM 15.81 0.46 16.1 - - 0.03 - 0.07 0.03 0.18 1.5 46 A dash (-) signifies that there were no deaths. CAUSES OP DEATH IN AGE-GROUPS, 1941. 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 - - - - - - - - - - - - - - 3. Scarlet Fever - - - - - - - - - - - - - - 4. Whooping Cough 3 3 3 2 - 1 - - - - - - - - 5. Diphtheria 2 1 - - 1 1 - - - - - - 1 - 6. Tuberculosis of Respiratory System. 47 31 - - - - - - 33 29 10 2 4 - 7. Other forms of Tuberculosis 5 3 1 - 2 - - 1 2 1 - - - 1 8. Syphilitic Diseases. 3 4 - - - 1 - - - - 2 - 1 3 9. Influenza 6 9 - 1 - - - - - 1 2 2 4 5 Measles 3 - 1 - - - 1 - 1 - - - - - Acute Polio-myelitis and Polioencephalitis. - - - - - - - - - - - - - - 12. Acute infective encephalitis 1 2 - - - - - - - - 1 2 - - 115. Cancer of buccal cavity and oseophagus(M) uterus(F) 11 4 - - - - - - - 1 3 2 8 1 14. Cancer of Stomach and duodenum 17 18 - - - - - - 1 - 8 9 8 9 15. Cancer of Breast - 25 - - - - - - - 4 - 13 - 8 16. Cancer of all other sites 64 40 - - - l - - 6 5 27 16 31 18 17. Diabetes 4 10 - - - - 1 - - - 1 1 2 9 18. Intracranial vascular lesions 60 64 - - - - - - - 1 15 15 45 48 19. Heart Disease 129 163 - - - - - - 6 12 33 26 90 125 20. Other Diseases of Circulatory System 24 23 - - - - - - 1 - 6 6 17 17 21. Bronchitis 41 21 - - - - 1 - 2 - 17 3 21 18 22. Pneumonia 19 26 3 5 1 2 1 - 1 3 6 2 7 14 23. Other Respiratory Diseases 10 8 - - - - - - 1 - 4 4 5 4 24. Ulcer of Stomach and duodenum 16 - - - - - - - 2 - 9 - 5 - 25, Diarrhoea under two years. 1 1 1 - - 1 - - - - - - - 26. Appendicitis 3 4 - - - - - - 1 1 - 2 2 1 27. Other Digestive Diseases 13 10 - - - - - 1 3 - 6 3 4 6 28. Nephritis 5 4 - - - - - - 1 1 1 1 3 2 29. Puerperal & Post abortive sepsis - - - - - - - - - - - - - - 30. Other maternal causes. - 1 - - - - - - - - - - - - 31., Premature birth 9 5 9 5 - - - - - - - - - - 32, Congenital malformations, birth injury, infantile diseases. 11 3 7 2 1 - - - 2 1 1 - - - 33. Suicide 10 4 - - - - - - 4 1 2 3 4 - 34. Road Traffic Accidents. 10 3 - - - - 1 3 - 3 - 4 2 35. Other- violent causes 100 86 - - 4 - 8 11 42 40 36 23 10 12 3. All other causes. 46 47 1 2 - 1 2 3 10 9 6 32 27 TOTAL 1673 623 26 17 9 7 13 16 115 112 202 141 308 330 6. DEATHS IN WARDS - 1941. Cause of Death ??? Park ??? ??? ??? ??? ??? Central Wall End Greatfield South Total 1. Typhoid and para-typhoid Fevers. - - - - - - - - - - - 2. Cerebro-Spinal Fever. - — - - - - - - - - - 3. Scarlet Fever - - - - - - - - - - - 4. Whooping; Cough 4 - 1 - - 1 - - - - 6 5. Diphtheria - 1 l - - - 1 - - - 3 6. Tuberculosis, of Respiratory System 8 12 4 6 5 7 7 14 5 10 78 7. Other forms of Tuberculosis 1 1 - - 1 3 - - 2 - 8 8. Syphilitic Diseases 4 1 - - 1 1 - - - - 7 9. Influenza 1 2 1 - - 1 6 1 1 2 15 10, Measles 1 1 - - - - - - - 1 3 11. Acute Poliomyelitis and encephalitis - - - - - - - - - - - 12. Acute Infective encephalitis - - 2 - - - - - - 1 3 13. Cancer of buccal cavity and oseophagus (M) uterus(F) 4 1 1 1 3 - 3 1 - 1 15 14. Cancer of Stomach and duodenum 5 6 4 2 7 2 4 2 2 1 35 15. Cancer of Breast 4 2 2 1 1 - 3 6 4 2 25 16. Cancer of all other sites 16 11 14 9 10 5 7 9 13 10 104 17. Diabetes 3 3 1 1 - 2 1 1 - 2 14 18. Intracranial vascular lesions 14 22 10 15 13 7 20 12 4 7 124 19. Heart Disease 37 30 32 29 35 22 26 31 21 29 292 20. Other,diseases of circulatory system 4 7 8 6 3 4 4 5 2 4 47 21. Bronchitis 5 13 5 7 1 7 3 10 5 6 62 22. Pneumonia 3 6 9 4 5 - 7 2 6 3 45 23. Other respiratory diseases 4 2 1 3 - 1 2 3 2 - 18 24. Ulcer of stomach and duodenum 2 2 1 - 3 1 1 2 3 1 16 25. Diarrhoea under two years - - - - - - 1 - 1 - 2 26. Appendicitis 2 - 1 1 - - - 1 1 1 7 27. Other digestive diseases 4 4 1 2 1 5 1 1 2 2 23 28. Nephritis 3 1 2 - 1 - - 1 - 1 9 29. Puerperal and post-abortive sepsis. - - - - - - - - - - - 30. other Maternal causes - - - - - - 1 - -- - 1 31. Premature Birth 4 3 - - - 1 3 - 1 2 14 32. Congenital formations, birth injury infantile diseases - - 2 2 3 1 4 - - 2 14 33. Suicide. 2 5 - - 1 1 - 2 1 2 14 34. Road Traffic accidents 1 3 2 1 - 1 3 2 - - 13 35. Other violent causes 11 42 13 15 27 7 3 17 32 19 186 36. All other causes 16 15 8 9 9 6 9 8 6 7 93 TOTAL: 163 196 126 114 130 86 120 131 114 116 1,296 7. 8, PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases. for the 52 weeks ending 3. 1. 42. DISEASE. Cases notified in whole District Ward Distribution of Cases. No. of cases removed to Hospital. Total Deaths In Borough. At all arjes - years. Manor Park. Little ILford Woodgrange Plashet Kensington Castle Central Wall End Great- field 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 68 - 19 35 - 3 2 2 - 16 11 4 4 - 5 2 10 12 4 59 - Diphtheria 45 1 13 ■ 17 3i 3 8 - 1 - 10 15 3 - 1 3 5 3 - 5 43 3 Enteric Fever 3 — - - 2 - - 1 - - - - 1 1 - 1 - - - - 3 - Erysipelas 23 - - - - 1 6 - 14 2 3 3 3 3 2 1 - 3 - 5 6 - Puerperal Pyrexia 6 - - - 1 4 1 - - - - 1 4 - - - - - 1 2 - Pneumonia 33 4 4 - - 2 5 6 8 4 4 2 4 3 - 6 1 6 1 6 14 45 Ophthalmia Neonatorum 4 4 - - - - - - - - - - - 1 1 1 - - 1 - 4 — Meningococcal Meningitis 6 - 1 2 1 - 2 - - - 2 1 1 2 - - - - - - 3 - Measles 460 1.6 233 200 5 2 4 - - - 48 114 38 15 35 37 35 51 24 63 15 3 *Whooping Cough 262 32 149 96 1 2 .1 - - 50 35 16 18 11 25 23 34 13 37 34 6 Notifiable for duration of war. ??? diagnosed as Sub Meningitis ??? 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 14. The death rate was 0.17 per 1,000 population, as compared with a rate of 0.08 for 1940. 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 5 4 5 471 6 7 8 9 10 617 11 12 15 14 & Over 127 1,215 Cancer. No investigations have been undertaken, as requested in the Ministry of Health's series of Circulars on Cancer. Patients are referred to the general hospitals for investigation and special treatment. Classification. Carcinoma 158 Epithelioma 5 Sarcoma 5 Papilloma 1 Glioma 1 Unstated 11 Total 179 Cancer Deaths, 1941;- Total deaths 179 Males 92 Females 87 9. BOROUGH INFECTIOUS DISEASES HOSPITAL. Dr. Palmer's observations are contained in the following report upon the work of the Hospitals- PREFACE. One hundred and eighty-two patients were admitted to the Isolation Ward, Harts Sanatorium, during 1941, this being an increase of 21 over the previous year, when 161 admissions constituted the lowest number on record. The number of deaths from all causes was 8, giving a mortality rate of 4.39% as compared with 4.34% for the preceding year. A perusal of the correctod Table of Admissions and Discharges will reveal that there was a definite increase of scabies and impetigo in the cases admitted. This was found to be the case all ever the country and with regard to scabies, this disease has now become so widespread that compulsory notification, similar to that of measles and whooping cough, has been advocated for the duration of the war. Various administrative difficulties make this proposal impracticable at present. Formerly the chief method of treatment of scabies was by sulphur ointment and baths. Recently new methods have been introduced and in the Hospital excellent results are now obtained by the application of Benzyl Bonzoate. Derris Root or Rotenone has also been tried but the results with this preparation have not been so spectacular, although in early cases it is undoubtedly of value. Whether it be sulphur or the newer preparations, the fact remains that there is no easy and magical method of cure. The treatment must be carried out with care and thoroughness on the part of the nursing staff to obtain good and speedy results. It is encouraging to note that the cases of diphtheria aro still decreasing. Four children with a history of immunisation developed diphtheria, but all four recovered. When diphtheria does occur in an immunised person, it tends to be of a mild character. For the seventh successive year there were no deaths from scarlet fever. Sulphonamide therapy continues to be used as a routine method and only the more severe cases now receive serum. It is interesting to note that during 1940 no cases of whooping cough came into the Hospital, whereas in 1941 30 cases were admitted. I would particularly draw attention to the importance of whooping cough, especially with regard to its chief complication, broncho pneumonia. The presence of pneumonia always makes the outlook unfavourable and the younger the child the more grave does the prognosis become. This is well shown in the 4 deaths that occurred out of 20 cases of whooping cough with broncho pneumonia - all 4 cases were under one year of age. Unfortunately there is no reliable method of immunisation against v/hooping cough comparable to the prevention that can be obtained against diphtheria. The results obtained so far with various vaccines and antigens, while encouraging on the whole, have at times been rathor conflicting, and it is hoped that out of the research work going on at present some reliable form of prophylactic against this serious disease of infancy and childhood will be evolved. Chemotherapy continues to play an important part in the treatment of infectious diseases. 10. 1 STATISTICS. A. DIPHTHERIA (Uncorrected for Diagnosis). In Hospital on December 31st., 1940, 2 Admitted during 1941 46 Discharged during 1941 37 Died during 1941 3 Remaining on December 31st, 1941 8 B. SCARLET FEVER (Uncorrected for Diagnosis). In Hospital on December 31st, 1940 3 Admitted during 1941 61 Discharged during 1941 57 Died during 1941 0 Remaining on December 31st, 1941 7 C. MISCELLANEOUS (Uncorrected for Diagnosis). In Hospital on December 31st', 1940 3 Admitted during 1941 75 Discharged during 1941 63 Died during 1941 5 Remaining on December 31st, 1941 10 DIPHTHERIA. Number of notified cases 46 Revision of Diagnosis 9 Other notified diseases proving to be Diphtheria 0 Final number of Diphtheria cases 37 Table Showing Types of Diphtheria and Mortality. Total Died Mortality Rate Faucial 29 1 3.44% Faucial and Nasal 2 - - Faucial and Laryngeal 2 1 50% Laryngeal 3 1 33.3% Nasal 1 - - 37 3 8.1% Table Showing Serum Administration. 8,000 16,000 24,000 32,000 48,000* TOTAL 1 2 7 7 V 20 37 ! *Serum was given intravenously on six occasions. Bacteriological Examinations. 382 swabs were examined for Diphtheria Baccilli and 36 were found to be positive. Complications. Paralysis 4 (Palate 2 Pharynx 2) Myocarditis 3 Tachycardia 1 Otorrhoea 1 9 The total complication rate was 24,3% 11. SCARLET FEVER. Number of notified cases 61 Revision of diagnosis 8 Other notified diseases proving to be Scarlet Fever 2 Final number of Scarlet Fever Cases 55 For the seventh successive year there were no deaths Complications. Tonsillitis 4 Cervical Adenitis 6 Rhinitis 1 Nephritis 1 Tachycardia 1 Stomatitis 1 Endocarditis 1 Myocarditis 1 Axillary abscess 1 17 Serum and Prontosil Therapy. Number of cases receiving Prontosil alone 41 " " " " " & Serum 14 WHOOPING COUGH. Number of notified cases 33 Revision of diagnosis 3 Final number of Whooping Cough, cases 50 Whooping Cough (Uncomplicated) 6 Whooping Cough and Broncho-Pneumonia 20 Whooping Cough, Scabies and Impetigo 3 Whooping Cough and Malnutrition . 1 Deaths. Whooping Cough and Broncho-Pneumonia 4 MEASLES. Number of notified cases 17 Revision of diagnosis 3 Other notified cases proving to be measles 1 Final number of measles cases 15 Measles (Uncomplicated) 12 Measles and Broncho-Pneumonia 3 OPERATIONS. Lumbar punctures 10 Intubation 1 Tracheotomy 1 LABORATORY WORK. Bacteriological Examinations of Faeces 12 " " " Urine 15 Blood Widal Tests 7 Wassermann Reaction Tests 3 Cerebro spinal fluid examinations 3 12. TABLE OF ADMISSIONS AND DISCHARGES FOR 1941. (AFTER CORRECTION FOR DIAGNOSIS) Remaining at end of 1940. Admitted during 1941. Died during 1941. Discharged during 1941. Remaining at end of 1941. Diphtheria 2 34 3 25 8 Diphtheria Scabies and Impetigo - 3 - 3 - Scarlet Fever 3 54 - 50 7 Scarlet Fever and Scabies - 1 — 1 - Broncho Pneumonia - 1 - 1 - Cerebro Spinal Meningitis 2 - — 2 - Acute Anterior Poliomyelitis - 3 - 3 - Acute Rheumatic Purpura - 1 - 1 — Erysipelas - 3 - 3 - Mumps - 2 - 2 - Measles 1 12 - 13 - Measles and Bronchopneumonia - 3 - 3 - Chronic Nephritis - 1 - 1 - Acute Otitis Media and Mastoiditis - 1 - 1 - Paratyphoid Fever - 3 - 3 - Scabies - 3 - 3 - Whooping Couch - 6 - 5 1 Whooping Couch and Broncho-Pneumonia - 20 4 9 7 Whooping Cough and Malnutrition - 1 - 1 - Whooping Couch, Scabies and Impetigo - 3 - 1 2 Tonsillitis - 8 - 8 - Tuberculous Meningitis - 1 1 - - Urticaria - 1 - 1 - Urticaria Papulosa - 1 - 1 - No evidence of disease - 8 - 8 - Miscellaneous and Staff Illness. - 8 - 8 - TOTALS: 8 132 8 157 25 13. 'diphtheria prophylaxis. return for period ending 31st december, 1941. 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. Number of children who at 31st December 1941 had received a full course of immunisation (whether with subsequent Schick Test or not). Course completed between 16th December 1940, and 31st December, 1941. Age under 5 years. Age 5 years and over but under 15. 371 864 At 31st December, 1941. Age under 5 years. Age 5 years and over, but under 15. Approximate estimated population of children. 5,000 6,919 Estimated percentage of child population who at date shown had received complete course of immunisation *14.4 47.7 To 30th June 1942 - Approximately 40.0% midwives ACTS 1902 - 1936. The number of midwives who notified their intention to practice in the area during 1941 was 18. Of this number 13 worked in connection with the Maternity Hospital and District Nurses Home, Plaistow, and its Branches, - 1 at Sir Henry Tate's Nurses Home, Silvertown, - and 4 practised independently, including three Municipal Midwives. SUMMARY OF VISITS PAID DURING 1941 BY NURSES OF PLAISTOW MATERNITY HOSPITAL AND DISTRICT NURSES HOME. Midwifery 119 Monthly 39 Hospital 123 laboratory facilities. The same facilities exist as detailed in previous reports for the examination of specimens. During 1941, 725 specimens were examined at the East Ham Memorial Hospital and 2 pathological examinations were carried out by the Counties Public Health Laboratories. The number of diphtheria swabs examined at the Infectious 14. Diseases Hospital and the Town Hall Annexe Laboratory, was as follows:- Number. Positive. Negative. Town Hall Annexe 285 Infectious Diseases Hospital 382 667 2 36 38 283 346 629 AMBULANCE FACILITIES. The two Town Ambulances which formerly operated from the Fire Station, were handed over to the A.R.P. Ambulance Section on the outbreak of war and. are now available" at the Ambulance Depot (Napier Road) Grangewood 3419. Two Ambulances, in ??? used for the removal of infectious cases. PUBLIC ASSISTANCE DOMICILIARY MEDICAL SERVICE. Statistical Return for the Year ending 31.12.41. Number of attendances at homes. Number of attendances at Surgery. Total Number of attendances. Number of occasions medicines supplied without seeing patients, 1,277 6,041 7,318 398 Number of applications to Medical Officer of Health for Hospital treatment. 3 Number of requisitions received for . attendance of nurse. 12 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. 1941 1940 Syphilis 17 10 Soft Chancre Nil Nil Gonorrhoea 46 47 Not venereal 62 70 Totals 125 127 Total attendances of all patients 1,716 2,105 Total number of in-patient days Nil 23 PATHOLOGICAL EXAMINATIONS. 1941 1940 For or at the Centress- Spirochaetes 4 8. Gonocooci 697 816 Wassermann 369 204 Others 192 376 Total: 1,262 1,404 15. For practitioners:- Spirochaetes Nil Nil Gronococc Nil 1 Wasserman Nil 10 Others Nil 4 Total: Nil 15 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 1941, EAST HAM MEMORIAL HOSPITAL. The work of the Hospital ad Public Health Department becomes more closely associated each year. and 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 are abstracted from the statistical record or the registration of blind persons, as at 31.3.42:- Males. Females. Total. Total 1941. 1940 Number on register 115 107 222 223 Total employed 23 6 29 21 Undergoing training - 1 1 - Trained but unemployed 1 3 4 7 No training but trainable 5 1 6 4 Unemployable 85 93 178 188 Children (5 to 16 years). 1 3 4 3 MENTAL DEFICIENCY ACTS, 3.913 - 1938. PARTICULARS OF MENTAL DEFECTIVES AS ON 1ST JANUARY, 1942, STATISTICS. 1941. 1940. M. F. Total. M. F. Total. 1. Under ORDER (a)(1) In Institutions (excluding cases on Licence). Under 16 years of age 17 14 31 18 15 33 Aged 16 years and over 47 34 81 40 31 72 (2) On Licence from Institutions Under 16 years of age - - - - - - Aged 16 years and over 1 6 7 3 — 3 16. 1941. 1940. M. F. Total. M. F. Total. (b)(1) Under Guardianship (excluding cases on Licence) Under 16 years of age 1 - 1 2 1 3 Aged 16 years and over 21 19 40 21 17 38 (2) On Licence from Guardianship Under 16 years of age - - - - — Aged 16 years and over - - - 4 1 5 2. In "PLACES OF SAFETY". Under 16 years of age 5 4 9 5 4 9 After 15 years and over 2 1 3 7 6 13 3. UNDER STATUTORY SUPERVISION.* 53 57 110 66 60 126 Of whom Awaiting removal to an Institution 1 - 1 11 1 12 4. Action not yet taken under any one of the above headings: (a)Notified by Local Education Authorities. (Sec 2 (2) 9 6 15 1 - 1 (b)Mental Defectives in receipt of poor relief:- (1) Institutional; (a) In Public Assistance Institutions, and Municipal General Hospitals not approved Under Sec. 37 - - - - - - (b) In Institutions certified under the M.D. Acts (including those approved under Sec. 37,):- (1) Cases "placed tinder Section 3 — - - - - - (2) Other Cases - - - - - - (2) Domiciliary. 4 3 7 2 5 7 (c) Otherwise ascertained - - - - - - 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: 3 2 5 4 1 5 (b) Maintained wholly or by parents, relatives or others * Plus 28 evacuated to other areas - - - - - - 17.  1941. 1940. M. F. Total. M. F. Total. 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:- 1 (a) Children between the ages of 14 and 16 years 4 2 6 4 1 5 Of whom, number." if any under voluntary super- - 1 1 - 1 1 (b) All other cases 32 18 50 26 17 43 Of whom, number,, if any under voluntary supervision. 32 18 50 26 17 43 Number of above cases on the Registers of Occupation and Industrial Centres Under Statutory Supervision Centre closed Under Voluntary Supervision 5.9.39. On Licence from Institutions Re-opened Under Guardianship 22.1.40 On Licence from Guardianship Closed 1.4.40 DURING THE YEAR 1941. 1941. 1940. M. F. Total. M. P. Total. 1. (a)Number of instances in which Licence was granted during 1941:- (1) Prom Institutions 2 6 8 2 - 2 (2) From Guardianship - - - 3 1 4 (b)Number of instances in which cases on licence have beer returned to Institutions or transferred to Guardianship, during the year 1941:- (1) To Institutions 2 2 1 1 (2)To Guardianship - - - 2 - 2 2. Cases notified by Local Education Authorities (Sec, 2 (a) during the year 1941:- Method of Disposal:- Sent to Institutions (by Order) - - - - - - Placed under Guardianship (by Order) - - - - - - 18. ] 1941. 1940. M. F. Total. M. F. Total. Placed under Statutory Supervision 2 2 4 4 1 5 Placed in "Places of Safety" 1 - 1 1 - 1 Died or removed from area 5 2 7 1 - 1 Action not yet taken: (a) In receipt of poor relief - - - - - - (b) Others 1 2 3 - - - 9 6 15 6 1 7 3. Of the total number of M.D.'s known to ??? Authority:- (a) number who have given birth to children during 1941: - (1) After marriage 1 (2) While unmarried Nil. (b) number who have married Males. Females. during 1941:- 3 1 THE INVALID CHILDREN'S AID ASSOCIATION. As in previous year 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 1941 were, as follows Tuberculosis 6 Anaemia & Debility 5 Rheumatism heart and chorea 3 Lung conditions (non-tuberculous) 37 Marasmus and Malnutrition 4 Various 24 79 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) Normally employed by other Local Supervising Authorities, but temporarily working in the area - - - (c) Employed by other Welfare Councils 19.  Domiciliary Midwives. Midwives in Institutions. Totals. (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, 1936. 13 - 13 (ii) Others - - - (e) In private practice 3 - 3 Totals: 19 - 19 Number of cases in the area of the Local Supervisory Authority ??? during the year by Midwives:- (a) Employed by the Council. Midwives 100 - 100 Maternity Nurses 9 - 9 (b)Normally employed 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 - - - (ii)Others As midwives - - - As ??? Nurses - - - (d)Employed by Voluntary Associations: (1)Under arrangements made with ??? Midwives As midwives 134 - 134 As maternity Nurses 42 - 42 (ii) Others As Midwives - - - As Maternity Nurses - - - 20.  Domiciliary Midwives. Midwives in Institutions. Totals (e)In private practice As Midwives 82 - 82 As Maternity Nurses 8 - 8 TOTALS: As Midwives 316 - 316 As Maternity Nurses 59 - 59 Number of cases' in which medical aid was summoned during the year under Section 14 (i) of the Midwives Act', 1913, by a midwife: (i) for domiciliary cases 64 Total 64. (ii) for cases in Institutions. Nil 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 - Full 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. 689 Total Visits. 745 (ii) to children under one First Visits. 598 year of age. Total Visits. 6,338 (iii) to children between the ages of 1 and 5 Total Visits 8,667 years. INFANT WELFARE (a) Number of Centres provided end maintained by the Council - 2, (b) Number of Centres provided and maintained by Voluntary Associations. - Nil. 21. (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) under one year of age 801 (ii) between the ages of one and five years 390 (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 624 (ii) over one year of age 1,347 ANTE-NATAL AND POST-NATAL SERVICES. Ante-Natal Post-Natal. (a) Ante-natal and Post-natal Clinics (whether hold at Infant Welfare Centres or at other premises) (i) Number of Clinics provided and maintained by the Council 2 - (ii) Number of those Clinics open at 31st December, 1942 2 — (ill) Total number women who attended at the Clinics during the year 784 20 (b) Total number of expectant mothers ante-natally examined and of cases post-natally examined during the year, under arrangements made by the Council with private medical practitioners, excluding cases included lander 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. (i) by the Council - 7,066 (ii) by Voluntary Associations operating in the area of the Council Totals: - 7,066 Cases of Ophthalmia Do-rum notified during the year in which (a) Vision was unimpaired 4 (b) „ „ impaired - (c) the patient was, still under treatment at the end (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: 4 22. MATERNITY ACCOMMODATION. (i) Health Visitors - 7 (ii) Health Visitors - Nil (iii) Male. - Nil. (d) Number of persons (in addition to in lieu of Visitors under (c) above) or ??? authorised to visit under the proviso to Section 202 (ii) of the Public. Health Act, 1936. - Nil. (e) Proceeding taken during Act and Section under the year which proceedings were taken. Nil. ORTHOPAEDIC TREATMENT Cases are referred to the Fast Ham Memorial Hospital and Queen Mary's Hospital Stratford, under similar arrangements to the School Medical Service. REGISTRATION OF NURSING HOMES. (SECTIONS 167 bo 194 OF THE PUBLIC HEALTH ACT. 1936) Return, of the work of the Council during 1941. 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. - - - - Homes deleted during year 1 - - - 23. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. SUMMARY OF NOTIFICATIONS DURING THE PERIOD PROM 1ST JANUARY 1941 TO THE 31ST December 1941. 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 - - 2 - 22 12 22 10 10 6 3 87 90 Pulmonary Females - 1 2 - 11 12 14 1 5 - 1 47 49 Non-pulmonary Males - - 1 - 3 1 - 1 - 1 1 8 9 Non-pulmonary Females - 2 - 2 2 2 3 - 1 - - 12 13 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 - - 1 - 2 1 2 5 2 2 4 19 Pulmonary Fema1es - - - - 7 9 13 5 2 2 1 39 Non-pulmonary Males - 3 1 - - - 1 1 - - - 6 Non-pulmonary Females - - - 1 1 1 1 - 2 - - 6 Dr. MacLaren submits the following observations:- During 1941 many difficulties were experienced as the result of frequent air raids. One of the most serious problems was not only the contacting of families who had been obliged to vacate their homes to other areas in the borough, but the influx of children from surrounding districts. This moving population presented great difficulties to the Health Visiting staff but their untiring efforts resulted in a large number of these children being traced. Attendances at Infant Welfare Clinics were small from January April, only children requiring special treatment or constant attention were advised to attend regularly. In the succeeding months of the year the attendances steadily increased. Ante-Natal Clinics. The attendances at ante-natal clinics have been much greater than in previous years. This is probably due to expectant mothers taking advantage of the Government Evacuation Scheme, and also the greater desire on the part of many expectant mothers to enter Maternity Homes on account of wartime conditions. Immunisation Clinics. Two clinics are held weekly, one at Manor Park Clinic, the other at the Central Clinic for children under five years of age. During the year 657 children were immunised against Diphtheria. TUBERCULOSIS AND CHEST CLINIC. NOTIFICATION The number of primary notifications during the year 1941 was 224 as compared with 204 for 1940. Of the primary notifications of pulmonary tuberculosis, in 31.86 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, 1941 was 809 (pulmonary and non-pulmonary) or 10.9 per 1,000 estimated population, as opposed to 879, or 7.9 per 1,000 population in the previous year. Deaths. The number of deaths (1937-1941) from tuberculosis is shown belows- Pulmonary. Non-Pulmonary. Of cases on the Clinic Register. 1937 80 13 84 1938 81 8 67 1939 71 12 59 1940 88 13 81 1941 78 8 58 New Cases. The following are the comparative figures for the years 19371941 :- 1937 1938 1939 1940 1941 New Cases (& Contacts ) 697 629 486 582 657 Number proved, after complete investigation l to be tuberculous 28.4% 23.5% 30.4% 21.99% 19.77% 24. Attendances and Medical Examinations. 1937 3,793 3,437 1938 3,970 3,590 1939 3,467 2,982 1940 2,413 1,901 1941 2,874 2,133 Consultations at Homes of Patients. Daring the year twenty visits were made to the homes of patients who were too ill to attend the Clinic. Number of x-Ray Examination at the Chest Clinic. 1938 1939 1940 1941 1599 1.394 1132 1220 Dr. Philip Ellman, Consultant Physician, reports on the work of the Chest Clinic as follows:- The war-time necessity to be brief makes it important to deal purely with essentials, although other problems which have arisen during the year are not without significance. ATTENDANCES: The number of attendances and medical examinations is the highest of the war period, and the number of new cases examined is as high as, if not higher than the pre-war figures. The percentage of these cases which in this area have proved to be tuberculous, namely, 19.77$, is the lowest on record: i.e. over 80% of new cases examined are non-tuberculous. The number of cases of cancer of the lung among the nontuberculous in the 40 - 60 group, continues to be quite appreciable. X-RAY EXAMINATIONS; These Continue to be an important aspect of our activities" and the department is working at full pressure. Many of the 1220 examinations are contact cases wherein, as our experience has shown from previous years, the incidence of pulmonary tuberculosis is exceptionally high. Moreover, many early, symptomless cases have been detected in this way. It must be emphasised that good technique and careful and adequate interpretation of the films are essential for any successful X-ray service. It need hardly be emphasised that a complete clinical examination, aided by pathological investigations where necessary, in addition to X-ray investigations, must bo part of the clinical procedure in each case if a correct diagnosis is to be made and the prognosis assessed. SYMPTOMLESS PULMONARY TUBERCULOSIS: Pulmonary tuberculosis may be regarded as the main important chronic infectious disease affected by war, and in spite of all recent advances it is still responsible for the highest death rate in young adult life, for during the war of 1914 - 18 statistics show that some 25,000 more deaths, mainly confined to young people, occurred than would have done had the 1913 death rate continued. From the figures so far obtained, there is evidence that the death rate has already increased in the present war from 26,176 in 1938 to 28,669 in 1941. As I have noted in previous Annual Reports, in young adolescents in particular, early pulmonary disease may occur despite the complete absence of symptoms and even extensive lung changes may be accompanied by comparatively few clinical 25. manifestations. The great obstacle in the past to the early discovery of these cases has been the fact that patients have rarely visited their doctor until confronted with symptoms, by which time some 70% of oases are moderately advanced. It follows, therefore, that improvement in early diagnosis with a corresponding improvement in the recovery rate, must depend upon the recognition of the disease before it has produced symptoms of impaired health. The Ministry are now well aware of the importance of Mass Radiographer and the National Association for the Prevention of Tuberculosis issued their policy in this connection in January, 1942, but in point of fact we have practised in this Borough the main features of this policy for some time, as reference to the Annual Reports of 1939 and 1940 will testify. In this Clinic every contact case, especially adolescents, has an X-ray examination of the chest as a routine, and in 2,681 of those contact cases 6.75% have shown evidence of pulmonary tuberculosis in symptomless subjects, as mentioned in the Annual Report for 1940. This work is being continued in full measure. We are continuing the X-ray examination of symptomless subjects as above outlined, but it is to be hoped that when satisfactory mobile mass radiography apparatus becomes more generally available, it will be transported widely and bo available in this Borough as part of a general health examination for the whole population. This wider use of chest radiology will greatly assist in the prevention and treatment, not only of pulmonary tuberculosis, but of other forms of chest disease, such as cancer of the lung, cardiac disease, etc. THE ASSOCIATION OF WAR, INDUSTRY, LONG HOURS OP WORK AND TUBERCULOSIS. The close correlation between war, industry, long hours of work and tuberculosis, has been strikingly apparent among the histories of some of our cases and we are again learning that tuberculosis provides a barometer of social conditions. The pre-war steady decline In mortality has already been converted Into a rise, as the figures throughout the country clearly show. The reasons are, of course, not far to seek: fatigue, due to long hours of work, the black-out interfering with ventilation, the problem of transport, etc. are among the contributory factors. Hours in the factory in excess of 60 a week lead to absentee-ism from sickness and to a fall in production, as the Industrial Health Research Board has frequently demonstrated. That, at any rate, has been our experience, both in the cases being discovered and the relapse cases. THE NUTRITIONAL PROBLEM IN WAR-TIME. In our view a healthy protective diet for the tuberculous subject in time of war should include, broadly speaking, the following factors:- 1. Milk - 2 pints Household milk may be used for puddings. 2. Vegetables - cooked in a little boiling, salted water: potatoes in skin; raw vegetables - something raw every day, e.g. finely shredded raw cabbage, sprigs of parsley, etc, 3. Meat, Cheese, Eggs Dried Eggs: Pull rations of these. Fish especially herrings as often as possible. 4. National, Hovis, scofa Bread. 5. Bemax: 3 tablespoons daily. These are the general outlines we have endeavoured to give to our patients during the war period and ensures a well balanced diet with a full supply of vitamins A B C D. 26. Milk rationing being introduced during the winter of the year under review, made the position more acute, particularly for patients who were working and called upon to do longer hours. The grant of extra milk being given only to active cases, the quiescent patients were thus deprived of milk which formerly, to a certain extent, had made up for the already reduced fats and meat ration. This was particularly disturbing in cases where, although the lung lesion was quiescent, the nutritional state left a great deal to be desired; longer working hours and reduced rations tended to bring about a relapse. A case of pulmonary tuberculosis in a moderately large family tends to fare rather better than a similar case living alone or in a very small family, as the amount of meat, fats„ eggs and milk going into the household gaves him emple opportunity of availing himself of the necessary diets fifth member of the family either having canteen meals at work or milling to give up their portion of essential rations to the sick one. Assistance: The question of adequate assistance being available for member's of a family where the bread winner is afflicted and has to undergo sanatorium, treatment, still remains acute: with the high cost of living it still seems as if the assistance granted is not adequate. Again, as in the case of insufficiency of essential foods, it is the small family that suffers most for want of adequate assistance. THE EXAMINATION OF RECRUITS. Increasingly large numbers of recruits have been referred to us by the Medical Boards for a Consultant opinion during the year; several were subsequently notified as tuberculous. The recruiting of women to the various Services is likely still further to increase the number of examinations of recruits in the coming year. OCCUPATIONAL THERAPY. In spite of the Blitz, attendances have been fairly regular although evacuation has at times diminished the numbers. During April and May, when raids were particularly bad, the numbers fell, but they are now back to normal. Most article made by the patients are immediately sold and a large sale of patients' work was effected at Xmas 1941. Up to date no difficulties have been experienced in getting materials, as special arrangement have been made for supplies to hospitals. New crafts introduced for women patients during the year were cord knotting belts and glove making, together with further varieties of soft toys. Occupational Therapy has, since the beginning of the war, been widely used for cases of neurosis, orthopaedic and general surgery, rheumatism and tuberculosis, It is essential that the patient should be given a definite objective in connection with his work, particularly if there is no likelihood of his returning to normal work, but the work should at all times bo suited to his individual needs and capabilities. Moreover, although the sale of finished goods may serve as encouragement, the choice of articles made must be subordinated to the. patient's needs. Finally, occupational therapy is of psychological value by the very fact that the department is conducted, as a general rule, in such a way that the patient is able to get away from the atmosphere of hospitalisation; hence the need for an Occupational Therapy Department. 27. +. REPORT ON THE WORK OF HARTS SANATORIUM FOR 1941. PREFACE. During the year the work of the Sanatorium continued along the linos detailed in the Report of 1940, The chief difficulty has been shortage of beds as the forty-three, beds available have not been sufficient to cape quickly with the waiting list of patients. The New Pavilion Ward will be restored during the present year. When ready for use, it is the intention to remove the patients from the old dining hall, now in use as a male ward, and also from the two rooms in the administrative block, thus facilitating the structural alterations still required in that building. The total number of beds then available for the treatment of tuberculous patients will be sixty-two a welcome increase of nineteen. Towards the end of the year under review, routine dental inspection and treatment became an established part of the Sanatorium regime. In reviewing the cases admitted to the Sanatorium during last year, one is perturbed to find a definite increase of patients, particularly girls and young women, who come within the age group of 15 - 25 years. Unfortunately, too many of these are cases of acute adolescent phthisis and have advanced disease with often a hopeless prognosis. Out of sixteen deaths from pulmonary tuberculosis, ten were in this age group, five male and five female. Dr. Percy Stocks- Medical Statistical Officer, has shown that deaths from tuberculosis have increased during the past two years. He is of the opinion that "the increased mortality is due to the additional stresses, physical and psychological, imposed by war conditions and that these have proved too much for many patients already ill with phuntsis, so that they have died in 1940 or 1941 before they otherwise would have done." In view of the fact that an increase in deaths has begun to show itself, it is reasonable to anticipate an increased incidence in the number of cases and for this reason we welcome the policy advocated by the National Association for the Prevention of Tuberculosis for the introduction of Mass Radiography of the chest. To prevent the disease in future it is essential to discover cases of symptomless pulmonary tuberculosis in their early stages, before they have become advanced and infectious to others. STATISTICS. Discharges including deaths 124 Deaths 16 (8M. 8F.) Insured Patients 108 (69M. 39F.) Non-insured Patients 16 (5M. 11F.) Number of Bed available at end of year 43 Average number of beds occupied 40 (93.00%) Admission by Ambulance 69 (37M. 32F.) From Hospitals 37 (19M. 18F.) From Home 32 (18M. 14F.) 28. Immediate Results of Treatment (of Tuberculosis Cases) Discharged quiescent 39 (26M. 13F.) *(including seven observation cases found to be suffering from pulmonary tuberculosis) Discharged Non-quiescent 65 (39M. 26F.) Of these:- Improved 49 (29M. 20F.) Not improved 16 (10M. 6F. ) *Included In 11 observation cases below. Observation Cases. Of the 11 Observation Cases:- 7 were found to be suffering from pulmonary tuberculosis 2 " " " " " " carcinoma of lung 1 was " " " " " " tuberculous bursitis of hip joint 1 " " " " " " ??? disease with tuberculous cervical adenitis. Artificial Pneumothorax Number of Inductions 12 Number of attempted Inductions 3 Number of refills given 561 Number of air withdrawals 12 Number of Gas Replacements 6 Number of Cases sent for Surgical Treatment and Investigation. For cauterisation of achasions 7 For thoracoplasty 4 For orchidectomy 1 For deep X-Ray therapy 2 Gold Salts. Number of Courses commenced 44 Number of Courses completed from 1940 9 Number of Courses terminated during 1941 39 Of these 39:- Complete Courses 21 Incomplete Courses 18 29. Lipiedel Examinations. 3 Radiography. Number of films taken during 1941 439 Bacteriology Number of Sputum specimens examined 336 Number of Blood Sedimentation Rates done 383 RETURN RELATING TO THE WORK OP THE TUBERCULOSIS & CHEST CLINIC. DURING THE QUARTER ENDING 31ST DECEMBER, 1941. 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 323 288 17 6 67 83 22 5 390 371 39 11 811 Inward Transfers daring Quarter 1 3 - - 1 - - 1 4 - - 5 L.S.O. cases returned during Quarter 8 - - - - - - - 8 - - - 8 B.- Number of new cases diagnosed as Tuberculosis during the Quarter (1) Glass T.B. minus 13 10 1 1 - - - - 13 10 1 1 25 (2) Class T.B. plus 5 1 - - - - - - 5 1 - - 6 (3) Non-Pulmonary - - - - - 3 - - - 3 - - 3 C.— Number of cases included in A & B written off the Dispensary Register during the quarter as:- (1) Recovered - 1 - - - - - - - 1 - - 1 (2) Dead (all causes) 11 5 - - - - - - 11 5 — - 16 (3) Removed to other areas 5 9 - 1 - - 1 - 5 10 - 1 16 (4) For other reasons. 3 4 1 - 2 2 3 1 5 6 4 1 16 IV- Number of definite cases of Tuberculosis on the Dispensary Register at the end of the Quarter. 331 283 17 - 6 65 84 19 4 396 367 36 10 809 30. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. SUMMARY OF NOTIFICATIONS DURING THE PERIOD PROM 1ST JANUARY 1941 TO THE 31ST December 1941. 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 - - 2 - 22 12 22 10 10 6 3 87 90 Pulmonary Females - 1 2 - 11 12 14 1 5 - 1 47 49 Non-pulmonary Males - - 1 - 3 1 - 1 - 1 1 8 9 Non-pulmonary Females - 2 - 2 2 2 3 - 1 - - 12 13 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- 30- 15- 20- 25- 35- 45- 55- 65- TOTAL. Pulmonary Males - - 1 — 2 1 2 5 2 2 4 19 Pulmonary Fema1es - - - - 7 9 13 5 2 2 1 39 Non-pulmonary Males - 3 1 - - - 1 1 - - - 6 Non-pulmonary Females - - - 1 1 1 1 - 2 - - 6 The source or from which information as to the above mentioned cases was obtained: SOURCE OF INFORMATION Number of Cases Pulmonary Nonpulmonary Death Returns (From Local Registrars 1 1 (Transferable deaths from Registrar General. 12 4 Posthumous notifications 4 1 "Transfers" from other areas (other than transferable deaths 41 6 Other Sources, if any, (specify) (Merchant Navy) - - 31. TREATMENT OF TUBERCULOSIS. 1.Number of Beds provided and available in Residential Institutions belonging to the Authority on 31st December, 1941. (1) Name of Institution (ii) Total number of beds provided (iii) Number of beds (included in ii) temporarily not available (iv) Number of available beds vacant Pulmonary. _ _NonPulmonary. Pulmonary. „ -NonPulmonary. Pulmonary. Non- Pulmonary. M F Ch. M F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Tuberculosis Institutions and Public Health Hospitals. Harts Sanatorium,Woodford Green 47 31 2 - - - 23 12 2 - - - - - - - - - Name of Institution. Reason for nonavailability Reason for non-availability of beds included in Col, (iii) e.g. damage by enemy action shortage of nursing staffs evaluation, etc. Harts Sanatorium, Woodford Green, Essex. Part of one Ward given over to use of East Ham Infectious Diseases Hospital. 2.Number of paments receiving treatment in Residental Institutions under the arrangements of the Authority for treatment of Tuberculosis on 31st December, 1941 . TYPE OF INSTITUTION. Ex- Service Men (Memo. 146/T.Rev. and Circular 2334) OTHER PATIENTS Pulmonary Non Pulmonary Pulmonary/ Non Pulmonary Males Females Children Males Females Children A. Institutions belonging to the Authority (wholly or jointly the other Local Authorities 2 - 22 19 - - - - (A) Tuberculosis and Public Health Hospitals. - - 2 - - - - - (B) Public Assistance Hospitals & Institutions B• Voluntary Institations - - 6 3 - 4 6 1 TOTALS. 2 - 30 22 - 4 6 1 3. Waiting List, i.e., number of Patients. recommended by the Tuberculosis officer for and ready to enter upon residential treat ment, who, on 31.12.41, had been waiting for a bed for more than 10 days. 1 - 4 3 - - - 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. The year was one of unprecedented activity. Normal routine duties were limited and the repair and maintenance of environmental conditions consequent upon war damage became manifestly of prime importance. The inspectoral and other staff worked, unremittingly to ensure the recovery of a reasonable' standard, of housing and sanitary conditions following the intensive air raids. First Aid Repairs to Houses The early execution of repairs to houses apart from the public morale standpoint must inevilably have had an influence on public health. The psychological effect of early reinstatement of housing circumstances has been noted and is indicated, not only in the absence of disease and in the maintenance of war effort, but in the return of population. A serious Population decline occurred early in the year but towards the close an increase of nearly 50% had been recorded. As housing accormodation was reclaimed so the population returned. The work of supervising housing repairs constituted a very heavy burden on the inspectorate. At one period a labour head of approximately 3000 was employed. Despite numerous problems the progress has been, gratifying and a reasonable standard of fitness has been attained. Emergency Drainage Repairs. Considerable and detailed attention was devoted to war damaged drainage, the, extent of which ha3 been difficult to define. There remained a considerable amount of reconstruction to bo carried out at the end of the year and the problem of sanitary circumstances at vacated and damaged commercial premise's 'remained acute. Emergency Water Supplies. Emergency distribution of water was again undertaken, during two short periods of dislocation of supplies. Supplies of chloros and 'hypo' were obtained for distribution to wardens' posts' - in case of need of chlorination of 'supplies for domestic use Five samples of emergency supplies from local wells- were Obtained for analysis. Disposal of Civilian War Dead The scheme was again severely tested in the early part of the year and in the subsequent period of bull the arrangements have been maintained satisfactorily. Removal of Furniture from Damaged Houses. This scheme which is an extension of the arrangements made in connection with slum clearance removal's, is supervised by the department. Some 3865 removals were effected and 19 stores were in use Close surveillance of effects, was maintained and disinfestation carried out where essential. Public Shelters. Sanitary conditions were maintained satisfactorily in publicshelters. A high standard of cleanliness maintained by the Borough Engineer's shelter cleansing staff was amply rewarded in the response of shelterers themselves. Frequent removal of bedding was demanded. The installation of a new -steam disinfecting plant should prove an asset in case of future extensive reoccupation of shelters. 33. Rehousing, Certification of unfitness of war damaged houses to facilitate using and billeting of displaced persons and for other official resulted in considerable work for the Inspectors. Other Emergency Duties. Enforcement of Food Control Orders and Defence Regulations continued as part of the duties of certain of the inspectors. The Report upon the more routine work of the Section follows. Consequent upon raid damage the emergency work of repair of housing and sanitary circumstances has demanded priority and it is unfortunate that statistical data must for obvious reasons be excluded from this report. The subjoined statements therefore relate only to normal sanitary work and exclude special housing emergency work. It is to be regretted that owing to staff depletion and other reasons much of the systematic sanitary inspection had to be curtailed. 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 6895 (i) Housing:- House-to-house - Under Public Health Act 716 Re-inspections 307 (ii) Sanitary Circumstances Yards and Passages - Draining and Sanitary Accommodation Factories (excluding Bakehouses) - Workplaces and Outworkers 15 Caravans 4 Re Offensive Fumes - Billets and Posts - Miscellaneous 222 War Damage 4743 (iii) Food Supply Slaughterhouses 154 Dairies 4 Food Premises 198 Bakehouses 6 Re sampling 224 Food Control 34 Food Decontamination 3 (iv) Infectious Disease:- Visits 243 34. w (b) Notices. The number of notices served during the year totalled 468 of which one-was a statutory notice. The number of notices complied with in the same period was 69. (c) Rat Extermination. During the year 2125 visits were made to properties in the Borough, and 2918 rats were destroyed. HOUSING. (a) OVERCROWDING-. During the year a further 7 cases of overcrowding were relieved and no new 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:HOUSING STATISTICS I. Inspection of Dwelling-houses during the year:- (1) (a) Total Number of dwelling-houses inspected for defects (under Public Health or Housing Acts 716 (b) Number of inspections made for the purpose 1023 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 (b) Number of inspections made for the purpose (3) Number of dwellings-houses found to be in a state so dangerous or injurious to health as to bo unfit for human habitation (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 685 II. Remedy of Defects During the Year without Service of Formal Notice's :- Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 69 III. Action under Statutory Powers During the Year (a) Proceedings under Sections 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 1 35. HOUSING STATISTICS Continued (2) Number of dwelling-houses in which defects were remedied after service of formal notices (a) By owners (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 Proceedings under Section 12 of the Housing Act, 1936 :- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit IV. Housing Act, 1956. Part IV. - Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 48 (ii)Number of families dwelling therein 49 (iii) Number of persons dwelling there in 401 (b) Number of new cases of overcrowding reported during the year (c) (i) Number of cases of overcrowding relieved & during the year 7 (ii) Number of persons concerned in such cases 52 (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 1941 By private enterprise Nil By the Local Authority Nil INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply Graded Milk. The licences in force on 31st December 1941 were, as follows:- Tuberculin Tested Milk Bottling Establishment Licence 1 Dealers' Licence 6 Supplementary Licences 3 Pasteurised Milk Establishment Licence 1 Dealers! Licences 24 Supplementary Licences 3 The Council decided in December 1936 to charge no fees in respect of licences granted under the Milk (Special Designations) Order 1936. 36. T INSPECTION AND SUPERVISION OF FOOD. (Continued) (b) Meat and Other Foods. (1) Meat Inspection. The Sanitary Inspectors made 154 visits to the slaughterhouse for the purpose of carrying out post mortem inspection of animals slaughtered, The following is a statement of the work done in this connection:- Horses Ponies Foals Donkeys Number of animals slaughtered 1045 78 55 2 Number of animals inspected 1045 78 55 2 All Diseases except Tuberculosis:- Whole carcases condemned 50 - 2 - Carcases of which some part or organ was condemned 386 2 2 - Percentage of number inspected affected with Disease other than T.B. 42 3 7 - During the year proceedings were instituted against butchers for having in their possession diseased meat. In one instance a considerable quantity of diseased beef from a knackers yard in a country district was found on slaughterhouse premises used for the slaughter of horses. Periodically visits are made to Butchers' shops, market stalls and meat vehicles, (2) Food Premises. The number of inspections made of food premises included 4 dairies, 6 of bakehouses and 198 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 10 - - Cheese 1 - - Cocoa 2 - - Coffee 2 - - Confectionery 1 - - Egg Powder 2 2 100 Jam 4 2 50 Lard 6 - - Margarine 10 - - Milk 89 2 2 Rice 5 - - Sausage 3 - - Tea 5 - - Vinegar 1 - - Drugs 3 - - Other Articles 62 3 5 206 9 4.4 37. Details of samples adulterated or below standard are described as follows, together with the resultant actions- Number I or F Article Adulteration or Deficiency Action Taken 2865 F Milk Small quantity of added water. Vendor cautioned. 2909 F Milk Added water to at least 10%. Vendor prosecuted. 2945 I Dried Egg Powder Absence of dried egg. Vendor cautioned. 3008 F Milk Substitute Not a milk substitute. / ■ Vendor cautioned. 3015 I Egg Powder Deficient in dried egg. Vendor cautioned. 3042 I Apple and Blackberry Jam. Deficient in fruit to at) least 25%. Formal sample subsequently taken and manufacturer prosecuted. 3063 Apple and Blackberry Jam. Deficient in fruit. 58.