EAS 19 COUNTY BOROUGH OF EAST HAM. aNNUAL REPORT OF THE medical OFFICER OF health. FOR THE YEAR 1 9 4 2. Malcolm E. Barker, M.R.C.S. (Eng)., L.R.C.P., d.p.h., (Lond). MEMBERS OP THE COUNCIL. The Mayor:- Aldernan Richard John Fell, J.P. The Deputy Mayor:Councillor Leslie Alfred VIotor Bennett. Aldermen:- Joseph Walter Bart on, J.P. Charles William Brading, C.R.P., J.P. Thomas William Burden, M.P. J.P., Herbert Percy Jackson Edward Francis Mar key, J.P. Thomas Irwin Lethaby, J.P. (3) Annie Taylor, (Mrs.) J.P. Frederick Welch Beatrice Wilkens (Mrs.) J.P. Councillors:- Charles Edward Beckett William Henry Whittock Beecham Leslie Alfred Victor Bennett Ethel Maud Charlotte Brace (Mrs.) (4) Lendor anna Minnie Brignell (Mrs.) Annie Maud Clark (Mrs.) (2) William James Davis Charles William Dixon Eric Cyril Boyd Edwards, LL.B. (1) Sydney Arnold Elson Bertie George Goodenough John Albert Hart, Frank H. Howard Halter Edwin Hurford William I. Jackson, J.P. Harold Joseph, F.A.L.P.A. Bertram Arthur Keene John Alfred Kemp. Winifred May Knight (Mrs,) John LInsley Linsley-Thomas Robert William Moger, J.P. George Horace Moncar Robert Wilfred Payne Alfred Prior Prank Owen Reynolds 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 Merfcal Deficiency Uommlttees Mrs. E.M.Devenay) Maternity Mrs. C.J. Cross ) Mrs. E.M.Pell ) and Child Mrs. A.M. Gray ) Mental Mrs. I.. Watson ) Welfare. Mrs. B.A. Wheeler ) 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 " " " " " " COUNTY BOROUGH OF EAST HAM. Public Health Department, Town Hall Annexe, E.6. May, 1945. To The Worshipful the Mayor, the Aldermen and Councillors of the County Borough of East Ham, Mr, Mayor, Ladies and Gentlemen, I have the honour to submit my annual report as Medical Officer of Health and School Medical Officer for the year 1942, In accordance with the direction of the Ministry of Health and Board of Education, the report is again presented in an abbreviated form. Vital statistics indicate a higher birth rate (17.4), a lower death rate (14.09), and a larger population for 1941, It will be seen that the health of the Borough has been generally maintained, although the annual rates in respect of maternal mortality, and infant mortality especially during the first month of life,shew an increase in comparison with recent years. The number of stillbirths Is considerably in excess of the previous two years, but this is accounted for partly by the lack of statistical returns in respect of mothers who made their own arrangements for evacuation during those periods. The percentage of stillbirths,however, is higher than for many years, and there is no doubt that the effects of war-time conditions are largely responsible. During the year, a mild epidemic of measles occurred, and the cases of scarlet fever were more numerous, otherwise the notifications of infectious disease remained at the same level as in previous years. There were no cases of typhoid or paratyphoid fever. The demand by mothers engaged in industry for war-time nursery accommodation for their children, has necessitated further provision. The nursery at School Road is now available, making three in tho Borough, and It Is proposed to erect two others in the immediate future, subject to the Ministry's sanction, I am pleased to report that the net hospital and treatment block at Harts Sanatorium was opened for tho use of patients In October last, and the facilities permit of the most modern and scientific treatment. The new Cleansing Baths for scabies and similar complaints situated at Durban House, Katherine Road, serve tho needs of the Borough in this respect, and afford opportunities for treatment greater than is possible in the home. The return of many mothers and children from evacuation has resulted in the full operation of all Services and Clinic attendances approximating a pre-war basis: much benefit is being derived. The M,D,Occupation Centre at the Labour Hall, Katherine Road, and the completion of the Ockendon Colony, has been of immense advantage to the Council in the care and training of persons coming within this category. My thanks are due to the Chairman, Councillor Elson,J,P. for his help and support on very many occasions,also to the Chairmon and members of the other Committees with which I am associated, and to my colleagues and members of the staff who have so greatly contributed to the efficient organisation and maintenance of the Public Health, School Medical,. Hospital, and Casualties Services, I have the honour to be, Your obedient Servant, M. BARKER, Medical Officer of Health, STATISTICAL CONDITIONS OF THE ARBA. Area (in statute acres) land and inland water 3,324 Population. Census. - 1931 142,394 Estimated Civilian Population-1942 89,200 Number of inhabited houses (end of 1942, according to rate books. (Including terements and shops.)Approx 27,000 Rateable value at 31st December, 1942 £704,117 Sum represented by a penny rate for the year 1942/43. £2,550. Extracts from Vital Statistics. For Birth Rate. Total. Males. Female s. Live (Legitimate 1,487 788 699 Births. (Illfigitamsfce 66 35 31 Still (Legitimate 66 38 28 Births. (Illegitimate 3 1 2 Deaths: Total: 1, 157. Males: 635 Females: 522 Deaths from Puerperal causes:- Rate per 1,000 Total Deaths. (Live and Still Births . ) Puerperal Sepsis 2 1.23 Other purperal causes 4 2.46 6 3.69 Death Rate of infants under one year of age:- All infants per 1,000 live births 54 Legitimate infants per 1,000 legitimate live births 55 Illegitimate infants per 1,000 illegitimate live biths 29 Deaths from Cancer (all ages) 218 Deaths from Measles(all ages) 2 Deaths from Whopping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age). 13 Still Births. Still births registered numbered 69 compared with 38 for 1941. The rate per 1^000 total (live and still) births was 42.5 the figure for the previous year being 29.1. Births. The number of live births registered was 1,553 compared with 1,267 for the year 1941, equivalent to a birth rate of 17.4 per 1,000 of the Registrar General's estimated population. The rate for 1941 was 15.81. 3. Deaths. During the year the number of East Ham civilian residents dying was 1,157. This figure is equal to a death rate of 14.09 per 1,000 of the Registrar General's estimated population. For the previous year the rate was 16.1 Infantile Mortality. Tho number of deaths of children under one year of age was 85, equal to an Infantile mortality rate of 54 per 1,000 live births (45 for 1941) , the rate of England and Wales being 49 per 1,000 live births. Noo-Natal Mortality. Children dying under the age of one month totalled 55,equal to a neomatal mortality rate of 35.4 per 1,000 live births. The rate for the previous year was 20.5 Maternal Mortality. Maternal deaths numbered 6, the rate for 1942 being 3.86 per 1,000 live births and 3.69 per 1,000 live and still births. Per 1,000 Total Births (live and still.) Puerperal Infection. Other Causes. TOTAL England & Wales. East Ham England & Wales. East Ham England & Wales. East Ham 0.42 1.23 1.59 2.46 2.01 3.69 Population. The Registrar General's estimate of the civilian population for 1942 is 89,200. The figure for the year 1941 was 80,130. 4. 5 BIRTH RATE, K1ATH RATE AM) ANALYSIS OF MORTALITY, 1943. Rate per 1,000 civilian population Annual Death Rate per 1,000 Civilian Population. Rate per 1,000 Live B5.rths. i Live Births Still Births ! All Causes. ! Typhoid and Pa?a-typhoid Povers .Scarlet Fovor. Whooping Cough. Diphtheria ' Influenza Smallpox Jioaslos Tot 3.3 Deafctis under 1 yea Diarrhoea & Enteritis (under two years). England and wales 15.8 0.54 . 11.6 0.00 . 0.00 0.02 0.05 0.09 - 0.01 49 5.2 126 County Boroughs and Great Towns, including London. 17.3 0.66 13.3 0.00 0.00 0.03 0.06 0.09 - 0.02 59 7.5 148 Smaller T owns ( esti mated resident populations 25,000 - 50,000 at Census 1931.) 18.4 0.62 12.1 0.00 0.00 0,02 0,04 0.10 - 0.01 46 4.8 London - Administrative County. 14.0 0.48 13.9 0.00 0.00 0.04 0.02 0.07 - 0,01 60 8.6 east ham. 17.4 0.77 14.09 - - - 0.01 0.06 - 0.02 54 8a3 A dash (-) signifies that there were no deaths. ' ' CAUSES OF DEATH IN AGE-GROUPS, 1941. Cause of Death. All Ages. Deaths at different period of life of residents(civilians),whether occurring within or without the district. Under 1 Year 1-5 Years 5-15 Ye sirs 15-45 Years 45-65 Years 65 and Upwards M F M F M F M F M F M F M F X.Typhoid and - - - - - - - - - - - - - - oara-typhoid Fevers - - - - - - - - - - - - - - 2. Cerebro-Spinal Fever 3 - 1 - - - 1 - 1 - - - - - 3-Scarlet Fever - - - - - - - - - - - - - - 4,Whooping Oough - - - - - - - - - - - - - - 5.Diphtheria - 1 - - - - - 1 - - - - - - 5.Tuberculosis of Respiratory System. 30 23 - - - - - - 17 18 31 5 2 - 7.Other forms of Tuberculosis. 9 6 - — 2 — — 1 3 3 3 2 1 - 8.Syphilitic Diseases. 5 2 - - - - - 1 1 4 1 - 9.Influenza 2 3 - 1 1 - - - - 1 1 — — 1 10.Me asle s 1 1 - 1 1 11.Acute Polio-myelitis and Polio-encephalitis - - - - - - - - - - - - - 12.Acute infective encephalitis. 4 1 - — -• — — — 3 — 1 — - 1 13.Cancer of buccal cavity and oseophagus (m) uterus (f) 9 15 - - - - - - - - 2 7 7 8 14.Cancer of Stomach and duodenum. 26 26 - - - - - - - 1 16 8 10 17 15.Cancer of Breast- 14 - - - - - - - 2 - 6 - 6 16.Cancer of all other sites 73 55 - - - - - - 5 7 23 19 45 29 17.Diabetes 4 8 - - - - - - - 1 1 1 3 6 18.Intracranial vascular lesions. 56 60 - - - - - - 3 - 9 31 44 49 3.9..Heart Disease 125 137 - - - - - - 3 7 34 25 88 305 20.Other Diseases of Circulatory System. 19 16 - - - - - - 3 - 4 5 312 11 21.Brcnchitis 43 28 3 1 - 1 - - 1 1 16 6 23 19 22.Pneumonia 36 19 7 6 3 1 1 1 1 4 5 20 6 23. Other Respiratory Diseases 9 7 - - - - - - 1 - 4 4 4 3 24.Ll.cer of Stomach and duodenum. 10 1 - - - - - - 1 — 7 1 2 - 25.Diarrhoea under 2 years 8 5 8 5 - - - - - - - - - - 26•Appondi c it i s 6 1 - - - 2 - 2 - - 1 2 - 27. Other Digest ive Dise ase s 10 13 1 - - - - - 1 2 7 3 1 8 28.Ivephritis. 20 8 - - - - - - 3 1 8 5 9 2 33.Puerperal and Post abortive sepsis. - 2 . - - — — — — - 2 — — — — 30.Other Maternal causes - 4 - - - - - - - - - - - - 31.Premature Birth 24 7 24 7 - - - - - - - - - - 32.Congenital malformations, birth injury, infantile diseases. 12 6 11 5 - - - - 1 1 - - - - 33.Suicide. 3 5 - - - - - - - 4 1 - 2 1 34.Road Traffic Accidents 11 3 — - 2 - - 1 2 1 5 - 2 1 35.Other violent causes. 12 5 — - 1 - - - 6 1 1 1 4 3 3S.All other causes. 65 40 3 1 - - - - 5 4 17 8 38 26 TOTALS: 635 522 158 27 10 2 6 4 63 63 179 124 319 302 6. DEATHS IN WARDS - 1942. Cause of Be at h. Mancr Park Little Dfrrti Wood-j grange Plashet Kensington. Castle. Central. Wall End. Greatfield South Total 1.Typhoid and para-typhoid Fevers. - - - - - - - - - - 2»Cerebro-Spinal Fever. 1 1 - - - - - - - - 3 3.Soarlet Fever - - - - - - - - - - - 4 .Whooping Cough - - - - - - - - - - - 5.Diphtheria - 1 - - - - - - - - 1 6.Tuberculosis of Respiratory System 4 11 7 - 6 5 3 6 7 - 53 7.Other forms of Tuberculosis 1 4 1 1 1 1 2 1 - 3 15 8.Syphilitic diseases. - - 2 - 2 2 - 1 - - 7 9oInfluenza. 1 1 - 1 - - 1 1 5 10,Measlea - 1 - - 1 - - - — - 2 11 .Acute Poliomyelitis & polioencephalitis - - - - - - - - - - - 12. Acute infective encephalitis - - 1 - - 1 1 1 - 1 5 13. Canoer of buccal cavity and oseophagus (M) uterus (F) 6 3 2 1 4 3 2 1 1 1 24 14.Cancer of Stomach & duodenum 4 9 12 2 4 7 2 4 2 6 52 15.Cancer of Breast 3 1 1 1 1 1 2 2 1 1 14 16.Cancer Of all other sites 14 15 12 12 7 11 9 21 14 13 128 17.Diabetes - - 1 1 1 1 2 4 1 1 12 19.Intracranial vascular lesions. 13 17 14 11 8 7 17 10 12 7 116 19. He art Disease 30 21 29 27 21 23 34 26 24 27 262 20.other Diseases of circulatory system 5 4 3 2 3 7 4 2 2 35 21.Bronchitis 7 5 3 9 5 15 10 9 5 3 71 22.Pneumonia 5 8 5 4 6 6 5 4 7 5 55 23.Other respiratory diseases 5 1 1 3 1 1 3 - 1 - 16 24. Ulcer ofSfcanach & duodenum 1 1 3 2 - 1 1 - 1 1 11 25.Diarrhoea under 2 years 2 2 1 - - 2 2 3 - 1 13 26.Appendicitis - - 2 1 - - 2 1 - 1 7 27. Other digestive Diseases. 2 3 3 2 3 2 4 - 3 1 23 28.Nephritis. 4 4 2 3 4 2 2 2 3 2 28 29.Puerperal and Post-abortive sepsis. 1 - - 1 - - - - - - 2 30.Other maternal causes. 1 - - - - - 2 - 1 - 4 Sl.Premture Birth 6 4 3 4 3 2 5 1 2 2 31 18 32-.Congenital Malformations, birth injury infantile diseases. - 2 3 2 3 2 4 1 1 - 33.Suicide. 2 1 1 - 1 - - 1 - 2 8 14 17 105 34.Road Traffic accidents. 3 1 1 1 2 2 2 1 - 1 35. Other violent causes. - 1 2 3 1 2 2 2 2 2 36.All other causes 11 18 11 8 4 14 12 9 S 9 TOTALS: 131 140 126 101. 93 121 133 116 99 97 1,157 7 8 PREVALENCE OP, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for the 52 weeks ending 2.1.43. 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 I If or d Woodgrange Plashet Kensington Castle Central Wall End Greatileld 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 210 2 72 108 14 6 6 1 1 - 29 39 15 8 20 19 29 16 10 25 174 - Diphtheria 49 4 14 12 16 1 2 - - - 3 19 5 1 3 4 4 2 3 5 49 1 Enteric Fever - - - - - - - - - - - - - - - - - - - - - - Erysipelas 37 - - - 3 2 23 9 7 5 5 3 3 1 2 4 2 5 7 - Puerperal Pyrexia 15 - - - - - 15 - - - - 2 1 2 1 - 1 5 3 10 2 Pneumonia 37 1 _ ..... 3 1- - 1 2 8 3 13 , 6 2 2 5 - 4 6 4 3 10 22 45 Ophthaimda Neonatorum 1 1 - - - - - - _ - - - - - - - 1 - - - 1 - Menining ococcal Meningitis 12 - 3 2 3 2 2 - - - - 2 - 3 3 - 1 - 3 12 3 * Measles 1091 417 85 564 15 " 5 ——( 5 - - - 74 91 51 137 102 92 131 121 46 L86 29 2 * Whooping Cough 227 24 121 79 1 - 1 - - 1 20 3 11 24 10 13 46 43 14 33 £0 - * Notifiable for Duration of War. ; ' ' r" INFECTIOUS DISEASES. Zymotic Death Rate. The deaths from the seven principal zymotic diseases, (Small pox, Whooping Cough, Measles, Diphtheria, Diarrhoea Scarlet Fever, and Enteric Fever) during the year numbered 16. The death rate was 0.17 per 1,000 population, as compared with a rate of 0.17 for 1941. No cases of Smallpox were reported during the year under review. INFECTIOUS DISEASES HOSPITAL. Dr. Palmer's observations are contained in the following report upon the work of the hospital:- PREFACE. 293 patients were admitted to the Isolation Ward, Harts Hospital and Sanatorium during 1942, this being an increase of 111 over the previous year. It is interesting to compare the admissions for the past four years, viis:- 1939 - 325 1940 - 161 1341 - 182 1942 - 293 where the effect of the evacuation of children is clearly seen during the two years, 1940 and 1941. The increase in Scarlet Fever was the chief reason for the rise in cases admitted to the hospital, and it was noted that though this disease continued to be non-fatal, the severity was definitely increased, as compared with the mild type tnat has been prevalent during recent years. The number of deaths from all causes was three giving a mortality rate of 1.02% as compared with 4.39% for the previous year. Cases continue to be admitted suffering from Scabies and Impetigo as a concomitant disease and it is evident that these troublesome and annoying skin complaints are in no way decreasing in incidence. It is a cause for satisfaction that the year 1942 produced^no cases of enteric fever. One case of Paratyphoid Fever was notified but all investigations proved negative. Cerebro-spinal Meningitis, which is essentially a disease of war-time, gave rise to only two cases, both of which completely recovered with Sulphapyridine therapy. STATISTICS. (A) DIPHTHERIA (Uncorrec.ted for Diagno s i s) In Hospital on December 3.941 8 Admitted during 1942 56 Discharged during 1942 50 Died duri ng 1942 1 Remaining in Hospital on December 31st, 1942 13 (B) SCARLET FSVER (Uncorrected for Diagnosis) In Hospital on December 31st 1941 7 Admitted during 1942 172 Discharged during 1942 154 Died during 1942 0 Remaining in Hospital on December 31st 1942. 25 (C) MISCELLANEOUS (Uncorrected for Diagnosis) In Hospital on December 31st 1941 10 Admitted during 1942 65 Discharged during 1942 72 Died during 1942 2 Remaining in Hospital on December 31st 1942. 1 DIPHTHERIA. Number of Notified Cases 56 Revision of Diagnosis 18 Tonsillitis 9 No evidence of Diphtheria 2 Transient Diphtheria Carrier 6 Scarlet Fever 1 Final number of Diphtheria Cases 38 Number of Cases of Diphtheria occuring in immunised children 4 10. ( TABLE SI-IOV/ING TYPES OF DIPHTHERIA & MORTALITY. Type. Total. Died. Mortality Rata Faucial 28 - - Fauoial and Nasal 6 1 16.6% Nasal 2 - - Laryngeal 2 - - 58 1 2.6% Table Showing Serum Administration. 8,000 0-00 24, 000 32,000 48,000 Total 5 4 10 7 12 58 Serum was given intravenously on six1 occasions* Table Showing Age Incidence of Diphtheria. 0 + 5+ 10+ 15+ 20+ 25+ Total 12 14 9 - 1 2 38 Complications and Paralysis. Palatal Paralysis 3 Cervical Paralysis 1 Pharyngeal Paralysis 1 Myocarditis 1 Bradycardia 1 Tonsillitis 1 Bnc-toriologloal Examlna»ions . 629 Swabs were examined for Diphtheria Bacilli and 54 ware found to bo positive. Sorm Reaction. There were no cases of any reaction due to administration of anti-diphtheritic Serum. SCARLET FEVER. Number of Notified Cases 172 Revision of Diagnosis 8 Tonsillitis 2 Scabies 2 Measles and Scabies 1 Chicken Pox 1 Suppurative Adenitis 1 Rheumatic Purpura 1 Other Notified Diseases proving to be Scarlet Fever 1 1 Final number of Scarlet Fever cases 165 11. Cases with Concomitant Disease. Scarlet Fever and Mumps 2 Scarlet Fever and Impetigo 3 Scarlet Fever and Scabies 8 Scarlet Fever and Excema 1 Scarlet Fever and Chicken Pox 3 For the eighth successive year there were no deaths. Complieatlong. Tonsilliti s 13 Septic fingers, spots, etc 14 Rhinitis 4 Abscesses 3 Adenitis 6 Otitis Media 5 Mastoiditis 3 Tachycardia 2 Oedema of feet and hands 1 Nephritis 1 Endocarditis 1 Reinfection 1 54 Serum Complications. There were six cases of Serum Urticaria. Treatment. No. of cases receiving Sulphonamide alone 72 No. of cases receiving Serum alone 18 No. of eases receiving Sulphonamxdo & Serum. 70 No. of oases receiving no specific treatment 5 Total: 165 whooping cough. Number of notified Cases 18 Revision of Diagnosis 4 Otitis Media 1 Measles Infection 2 No evidence of Disease 1 Final number of Whooping Cough cases 14 Of these 14 cases Uncomplicated Whooping Cough cases 6 Whooping Cough with Scabies 1 Whooping Cough with Broncho Pneumonia 7 There were no deaths. Specific Treatment consisted of Sulphapjridi.no by mouth and Pertussis Antigen intramuscuxarly. MEASLES. Number of Notified Cases 20 Revision of I/iagnosis 4 Bronchitis 1 S oab i e s 1 No evidence of infectious disease 2 Other notified cases proved to be suffering from measles 4 Final number of Measles cases 20 Of these Measles and Scabies 1 Measles and Broncho Pneumonia 6 Measles and Marasmus 1 Uncomplicated Measles 12 There was one death in the case of the child suffering from Marasmus, whose condition was further complicated by congenital hydrocephalus. 12 • GEREBRO SPIRAL MENINGITIS. Number of Notified Gases 5 Revision of Diagnosis 3 No evidence of infec 'clous disease 1 Measles 1 Tuberculous Meningitis 1 Two cases proving to be cases of Gerebro Spinal Meningitis. Both recovered well with Sulphapyr iline tre atment. Operations. Lumbar punctures 8 Incision of abscesses 3 Laboratory Work Bacteriological examination of faeces 2 Bacteriological examination of urine 2 Blood. Widal Tests 2 Cerebro Spinal Examinations 8 TABLE of ADMISSIONS and DISC TARGES for 1942 (after correction for Diagnosis) DISEASE. Remaining at end of 1941. Admitted during 1942 Died during 1942 Discharged during 1942. Remaining at end of 1942. Diphtheria 8 38 1 33 12 TrcuAnient Diphtheria Carrier 6 5 1 Scarlet Fever 7 165 149 23 Acute Anterior Poliomyelitis 1 1 Acute Otitis Media 1 1 Acute Rheumatic Purpura 1 1 Acute Bronchitis 1 1 Chicken Pox 2 1 1 Chldkenpax., Sbabies, & Impetigo 1 1 Cerebro Spinal Meningitis 2 2 Cellulitis of Foot 1 1 Enema Rash 1 1 Erysipelas 1 1 Impetigo 2 2 Measles 12 12 Miasles and Scabies 1 1 Measles and BronehoPneumonia 6 5 1 Measles and Marasmus 1 1 No evidence of Disease 9 9 Parotitis 1 1 Scabies 7 7 Scabies and Impetigo 2 2 Stomatitis 1 1 Suppurative Adenitis 1 1 Tonsillitis 14 13 1 T.B. Msningitis 1 1 Whooping Cough 1 6 7 Whooping Cough and Broncho Pneumonia 7 7 14 Whooping Cough, Scabies, and Impetigo 2 1 3 TOTAL: 25 293 3 276 39 13 DIPHTHERIA PROPHYLAXIS. RETURN FOR PERIOD ENDING 31ST DECEMBER, 1942. Age under 5 years. Age 5 years & over but under 15 Total. Number of children (Including temporary residents) who completed the full course of immunisation in the Authority's area between 1st Jan. and 31st Dec.1942 1,071 2,617 11. Under 5. Between 5 and 15. (A) Approximate estimated number of children in the Authority's area at: 31st December, 1942 5,722 11,662 (B) What percentage of the child population shown under (A) is it considered were immunised at 31st December, 1942? 60% 40% (This estimate should include so far as can be assessed, children immunised in the Authority's area by private arrangement, and children who have come into the area after being immunised else- where 111. (A) Number of cases of Diphtheria in children under 15 years of age notified between 1st January and 31st December, 1942. 47 (B) Number of cases included in (A) in which the child is known to have completed the course of immunisation not less than 12 weeks before the onset of the disease 2 (C) Number of deaths from Diphtheria registered in the Authority's area between 1st January and 31st December, 1942, of children under 15 years of age. 1 (D) Number of deaths included in (C) in which the child is known to have completed the course of immunisation not less than 12 weeks before the onset of the disease APPLICATIONS FOR INOCULATION AGAINST TYPHOID FEVER. No applications made in 1942, compared with 6 in 1941. MIDWIVES ACTS, 1902-1956. The number of midwives who notified their intention to practice in the area during 1942 was 24. Of this number 18 worked in connection with the Maternity Hospital and District Nurses Home,Plaistow, and Its Branches, and 6 practised independently, including three Municipal Midwives. SUMMARY OF VISITS PAID DURING 1942 BY NURSES OF PLAISTOW MATERNITY PIOSPITAL & DISTRICT NURSES HOME. Midwifery 236 Monthly 90 Hospital 206 14. LABORATORY FACILITIES. The same facilities exist as detailed in previous reports for the examination of specimens. During 1942, 604 specimens were examined at tho East Ham Memorial Hospital, and 19 pathological examinations were carried out by the 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. Postive Negative. Town Hall Annexe 447. 1,077 20 72 427 1005 Infectious Diseases Hospital. 630 52 578 AMBULANCE FACILITIES. The two Town Ambulances which formerly operated from the Fire Station, wore handed over to the A.R.P. Ambulance Section on tho outbreak of war and are now available at the Ambulance dopot (Napier Road) Grange wood 3419. Two Ambulances, in addition, are used for the removal of infectious cases. PUBLIC ASSISTANCE DOMICILIARY MSDICAL SERVICE. Statistical Return for the Year ending 31.12.42 Number of Attendance s at Homes-. Number of Attendances. At Surgery. Total Number of Attendances. Number of Medicines Wit hout OccasionsSupplied Seeing Patients. 1.572 6,210 7,782 308 Number of applications to Medical Officer of Health for Hospital Treatment. ) 1 Number of requisitions received for attendance of Nurse. 13 15 VBNEREAL 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 (East Ham figures are not given separately) are abstracted:- Figures for preceding year are shown in brackets. The number of new patients dealt witn oy the Hospitals and Hostels in the scheme was 17,106 (16,042) of whom 2,286(2,154) were suffering from syphilis, 4,526 (5,287) gonorrhoea, and 157 (217) soft chancre, whilst 10,137 (8,384) were diagnosed as not suffering from venereal disease. Attendance of all patients totalled 378,423 (347,446) and the number of in-patient days of treatment was 16,019(14,647) Pathological examinations in connection with, the clinics totalled 164,459(135,152) and 61,897 (34,981) examinations were made for private practitioners. As regards the hostels the number of patients accommodated from the areas of the participating authorities was 164(132)'the aggregate number of days in residence being 15,929 (14,604) 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-Rea. Statistics and other information relating to the Hospital are contained in the Annual Report for 1942. EAST HAM MEMORIAL HOSPITAL. The work of the Hospital and Public Health Department becomes more olosely associated each year, and I ackncv-rlcdgo with gratitude the help of the Committee and honorary medical staff. Reference should be made to the Annual Report. BLIND PERSONS ACTS, 1920 - 1958. The following figures are abstracted from the statistical record of the registration of blind persons, as at 31. 3. 43:- Males. Females. Total. 1941. Total. 1942. Number on Registor 113 122 222 235 Total employed 20 7 29 27 Undergoing trainig 3 1 1 4 Trained but unemployed - 3 4 3 No training, but trainable 4 1 6 5 Unemployable 85 108 178 19 3 Children (5 to 16 years) 1 2 4 3 16 . . . MENTAL DEFICIENCY ACTS, 1915 - 1938. Ascertainment. The number of cases dealt with for the first time during the year 1942 was 37, and they were dealt with as under:- 4 placed in Institutions (under Order) 1 " under Guardianship (" " ) 17 " " Statutory Supervision. 1 " " Friendly Care 1 dealt with under Mental Treatment Act, 1930. 1 referred back to Education Committee for treatment at an Epileptic Colony. 7 no action taken (two liability refused) 5 removed to other areas. Provision of Institutional Accommodation. The difficulty experienced in obtaining Institutional accommodation has been relieved by the completion of South Ockendon Colony. Guardianship. There are 40 cases under Guardianship, of whom seven have evacuated to other areas. Three males, on licence, were transferred under Varying Orders from Guardianship to Institutional Care. Supervision. There are 113 mental defectives under Supervision in their own homes in East Ham, plus 21 who have evacuated to other areas. All the cases are visited at varying intervals, and reports filed, helpful advice being given with regard to their management,training, etc. It is very rare that the parents show any resentment at, or opposition to, these visits. Occupation Centre. The Occupation Centre was re-opened on 4th May, 1942. The whole day sessions commenced on 29th June, with the provision of a mid-day meal consisting of moat, vegetables, and a pudding which is cooked at the nearby Centre for providing dinners for the Elementary Schools and brought round hot in metal containers.There has been an average daily attendance of 22, of varying ages and of both sexes. Handwork of all types form the chief part of the curriculum, and the articles made are definite orders for sale. In many instances work is taken home to complete. More orders have been received than can be accepted owing to the present difficulty of obtaining necessary materials. A certain amount of physical training is given daily, together with a small amount of domestic training incurred in connection with the preparation etc. of the tables before and after the mid-day meal. Licence, Discharge and After-Care. Out of 17 defectives (10 males and 7 females) on licence during the year from Institutions and Guardians, nine are at work and doing fair]y well, one was transferred to a Residential Special School, three were transferred from Guardianship to Institutional Caro, one died, and three were discharged from the operation of the M.D.Acts. Occasional visits are paid to all cases discharged from the operation of the M.D.Acts and still within this area. All removals are notified to the respective areas. 17 PARTICULARS OP MENTAL DEFECTIVES AS ON 1ST. JANUARY, 1943. STATISTICS. 1941. 1942. A. M. F. Total M. F. Total X. Under CRBER. (a)(1)In Institutions (excluding cases on Licence.) Under 16 years of age 17 14 31 12 9 21 Aged 16 years and over 47 34 81 57 51 108 (2) On Licence fr om InstLtuUons. Under 16 years of age - - - 1 - 1 Aged 16 years and over 1 6 7 4 4 8 (b)(1)Under Guardianship (excluding cases on Licence) Under 16 years of age 1 - 1 1 - 1 Aged 16 years and over 21 19 40 20 19 39 (2)On Licence from Guardianship Under 16 years of age - - - - - - Aged 16 years and over - - - - - - 2. In "PLACES OF SAFETY". Under 16 Years of age 5 4 9 - - - Aged 16 yetxra and over 2 1 5 - - - 3. Under "STATUTORY SUPERVISION". 53 57 110 65 48 113 Of Whom Awaiting removal to an Institu- tion 1 - 1 1 - 1 4. Action not yet taken under any one of the above Headings: of the above Headings; Notified by Local Education Authorities.(Sec.2 (2) 9 6 15 4 5 9 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:- - - - - - - 2. Reported to the Local Authority from any reliable source, and recognised by them as mentally defective, but as to whom no action under the M.D. Acts has been taken:- (a) Children between the ages of 14 and 16 years 4 3 7 1 1 2 Of Whom, number, if any under voluntary supervision. - 1 1 - - - (b) All other cases 32 18 50 25 15 40 Of whom, number, if any under voluntary supervision 32 18 50 17 13 30 18. M. 1941. M. 1942. F. Total F. Total Number of ubovo Cases on the Registers of Occupation and Industrial Centres:- Closed. 15 13 28 Cases notified by Local Education Authorities (Sec. 2 (2) during the year 1942:- Method of Disposal:- Sent to Institutions (by Order) - - - 3 1 4 Placed under Guardianship (by Orfer) - - - - - - Placed under Statutory Suporvision 2 2 4 9 1 10 Planed in "Places of Safety" 1 - 1 - - - Died or removed from area. 5 2 7 2 2 4 Action not yet taken: (a) In receipt of poor relief - - - - - - (b) Others 1 2 3 2 4 6 9 6 15 16 8 24 Cf the total number of M.D's known to Local Authority:- (a) Number who have given birth to children during 1942:- (1) After Marriage 2 (2) While unmarried. 2 (b) number who have married during 194 2:- Males. Females. 1 * Re-opened on 4.5.42. THE INVALID CHILDREN'S AID ASSOCIATION. As in previous years, the Authority and Public Health Department arc 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 1942 were, as follows:- Tuberculosis 11 Anaemia and Debility 6 Rheumatism, heart and Chorea, 3 Lung conditions (non-tuberculous) 64 Marasmus and Malnutrition 6 Various 34 124 19 ) WAR-TBE NURSERIES . In accordance with the instructions of tho Ministry of Hoalth and Board of Education, tho Comicil docidod to establish war-time nurseries in the Borough. At the commencement of the Scheme it was proposed to open two nurseries - one in tho Infants' Department of tho Brampton Road School, and the other in the Infants' Department of Kensington Avenue School. Brampton Road Nursery was opened on 9. 3. 1942 and Kensington on 11,6,1942. Within a few weeks, the accommodation at both these nurseries was fully taken up and later on in the year plans and specifications for a third nursery on a bombed site in School Road, Manor Park, were approved by tho Ministry of Health, This Nursery was opened on 15,6,1943, and tho children are accommodated in a pre-fabricated hut of official design, which provides all the amenities for the various age groups. At the three Nurseries there is accommodation for babies, tweenies, and toddlers (2 to 5 years of age.) Tho permitted accommodation is as follows:- Brampton Road - 70,(originally 60) Kensington - 50. School Road - 50. The success of this service was asstired within a short time of the opening of the first nursery, so much so that there is a waiting list of children under 5 years of ago at each nursery. It is proposed to open a nursery at St. Stephens Road and another in Wall End Road. Although in the first place, the Ministry of Health approved Kensington Avenue for the accommodation mentioned above, subsequently on a further inspection it was decided that the premises were not exactly suitable for the recaption of young babies, and consequently an alternative scheme whereby a bombed sito near Kensington School could be utilised for the erection of another pre-fabricated hut, has been submitted for approval. There have been considerable staffing difficulties, and in view of tho fact that the nurseries sire recognised as training centres by the National Society of Day Nurseries, it is hoped to attract a larger number of suitable probationers anxious and willing to be trained as certificated nursery nurses. It is appreciated that the nurseries are intended for the children of mothers engaged in industry, and of those who can effect the release of other women for war work. 19a. 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: (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 Soction 1 of the Midwives Act, 1936 18 - 18 (ii) Others - - - (a) In privste prsctice 3 - 3 Totals: 24 - 24 Number of cases in the area of the Local Supervisory Authority attended during the year by Midwives:- (a)Employed by the Council. As Midwives 185 185 As Maternity Nurses 12 - 12 (b) Normally employed by other Local Supervisory A uthorities but temporarily work ing in the area As Midwives - - - As Maternity Nurses - - - (c)Employed by othor Wolfaro Councils: (i) Under Arr angements made with the Local Supervi sory Authority in pursuance of Secl. of the Midwives Act 1936. As Midwives - - - As Maternity Nurses - - - (ii) Others As Midwives - - - As Maternity Nurses - 20. - - Do iciliary Midwives. Midwives in Institutions. Totals. (d) Employed by Voluntary Aasociati ons:- (I) Under arrange me nt s wi t h the Local As Midwives. 228 - 228 visory Authority in pursuance of Section 1 of the Midwives Act, 1936. As Maternity Nurses. 89 - 89 (ii) Others As Midwives. \ - - - As Maternity Nurses. - - - (e) In Private As Midwives 63 - 63 Practice As Maternity Nurses 13 - 13 TOTALS As Midwives 476 - 476 As Maternity Nursos 114 - 114 Number of cases in which medical aid was summoned during the year under Secti on 14 (i) of the Midwives Act,1918, by a midwifes (i) For domiciliary cases 97 Total: 97 (ii) For cases in Institutions HEALTH VISITING. (a) Number of Health Visitors employed at the end of the year. (i) by the Council oc working inthe 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 corvod by tho 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) Inthe case of Health Visit or s employed by the Council - 7 (ii) In the case of Health Visitors employed by Voluntary Associations. - Nil (c) Number of visits paid during the year by all Health Visitors working in the area:- (i) To expectant mothers. First Visits. 807 Total Visits. 878 (ii)To children under one year of age. First Visits. 1,366 Total Visits. 6,213 (iii)To children between the ages of 1 and 5 years Total Visits 7,318 HEANT WELFARE CENTRES. (a) Number of Centres provided and maintained by the Council) ) Open at 31. 12. 42.)- 2 (b) Number of Centres provided and maintained by Voluntary ) Associations. Open at 31. 12. 42.)- Nil (c) Total number of children under 5 years of age who first attended at the Centres during the ye?r and who, on the date of their first attendance were - (i) Under one your of age 1,206 (ii) Botween the ages of one five yoare 532 (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 years of age 950 (ii) over one year of age 1,749 ANTE-NATAL AND POST-NATAL SERVICES. AnteNatal Post Natal (a) Ante-natal and Post-natal Clinics (whothor held at Infant Welfare Centres or at other premises) (i) Number of Clinics provided and maintained by the Council. Open on 31.12.42. 2 - (ii) Number of Clinics provided and maintained, by Voluntary Organisations, open at 31. 12. 42. - - (iii)Total number of women who attended at the Clinice during the year 1321 22 (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 above. - - SUPPLY OF MILK AND FOOD. (otherwise than under the National Milk and. Vitamins Scheme.) (i) Arrangements made for the provision of meals free or at reduced price in necessitous cases for - (a) Expectant mothers (b) Nursing " Yes. - No cases applied, (c) Children under 5 years of age State whether special Dining Centres, British Restaurants, or other Restaurants usedi Scheme approved in 1937 - meals to be taken at School Feeding Centres. (ii) Is other food (proprietary dried mi 11c or other preparations) supplied to (a) Expectant Mothers Yes (b) Nursing Mothers Yes (c) Children under 5 years of ago. Yes State whether supplied - Free or at loss than cost price in necessitous cases. Yes At cost price in other cases. Yes 22 CASES OF OPHTHALMIA NEONATORUM notified during the year in which:- (a) Vision was unimpaired 1 (b) " " impaired (c) " „ lost - (d) the patient was still under treatment at the end of the year 1 (e) the patient died (f) tiis patient removed from tho diastrict (g) classification under the above ueads cannot be made (details of these Oases should be attached) - Total: 2 v- Patient discharged 1943 - Vision unimpaired. MATERNITY ACCOMMODATION. As set out in my 1941 Report, the accommodation for women whoa homes are unsuitable for their confinements, and those who require in-patient treatment on medical grounds, is Forest Gate Hospital, 'Laternity and District NJrses Home, Plaistow, and Queen Mary's Hospital, Stratford. During 1942 467 cases were admitted to Forest Gate Hospital. Other mothers were evacuated to Maternity Hospitals outside London. INSPECTION OF MIDWIVES. Visits of inspection, as nocossary were paid during the year, and the midwives' work, including records, was satisfactory. CHILD LIFE PROTECT I ON Sections 202 to 220 of the Public Health Act, 1956* (a) Number of persons who were recaiving children for reward at the end of the year. 12 (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 (o) above, or societies authorised to visit under the proviso to Section 209(2)of the the Public Health Act, 1936 Nil (e) Proceedings taken during Act and Section under which the year proceedings were taken Nil. 23 ORTHOPAEDIC TREATMENST. 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 1942. 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 the year - - - - Dr. MacLaron submits the following observations:- During 1942 the most outstanding features of the work of the Maternity and Child Welfare Department Is the large number of mothers who attended the Ante-natal Clinics, and the problem of providing Maternity Hospital accommodation, as the majority of the patients wished to be admitted to Maternity Homes in the district, very few mothers being willing to take advantage of the Government Evacuation Scheme under the L.C.c. The great demand for hospital accommodation in preference to domiciliary treatment is due to war conditions, and the acute shortage of Home Helps. This situation must necessarily involve a great strain on the existing Maternity Hospital accommodation provided by the local authority. INFANT WELFARE CLINICS. In spite of war time difficulties experienced by housewives the Infant Welfare Clinics were well attended, and the general health of the children attending the clinics satisfactory. It Is gratifying to note the number of parents who have taken advantage of the Immunisation Clinics. Over 60 per cent of the children in East Ham between the ages of 1-5 years have been immunised against Diphtheria. SUNLIGHT CLINIC. During 1942 the Sunlight Clinic was re-opened:- two sessions per week are held for Infants under 5 years. 24. TUBERCULOSIS AND CHEST CLINIC. Notifications. The number of primary notifications during the year 1942 was 244, as compared with 224 for 1941. Of the primary notifications of pulmonary tuberculosis , in 37.41 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, 1942 was 860 (pulmonary and non-pulmonary) or 9.6 per 1,000 estimated population, as opposed to 809 or 10.9 per 1,000 population in the previous year. Deaths. The number of deaths (1938 - 1942) from tuberculosis is shown below:- Pulmonary Non-Pulmonary Of Cases on the Clinic Register. 1938 81 8 67 1939 71 12 59 1940 88 13 81 1941 78 8 58 1942 53 15 55 New Cases. The following are the comparative figures for the year 19381942:- 1938 1939 1940 1941 1942 New Cases and Contacts 629 486 582 657 997 Number proved, after complete investigation to be tuberculous 23.5% 30.4% 21.99% 19.77% 15.65% Attendances and Medical Examinations. Attendances. Medical Examinations. 1938 3,970 3,590 1939 3,467 2,982 1940 2,413 1,901 1941 2,874 2,133 1942 4,768 3,238 Consultations at Homes of Patients. During the year twenty-four 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. 1958 1939 1940 1941 1942 1599 1394 1132 1220 1575 25. DR. PHILIP ELLMAN, Consultant Physician, reports on the work of the Chest Clinic, as follows:- Once again during the war period the necessity to be brief enables me to deal with essentials only and to forego our peacetime practice of dealing with many other fundamental problems. ATTENDANCES. Not only are the number of attendances the highest of the war, but they are, in fact, increased by nearly 1,000 over 1938. This Increase is to some extent due to the increase in the number of cases (male and female) being referred by various medical recruiting boards for the Services. This year there has been a marked increase in the number of examinations of new cases, including contacts. The figures for tils year are the highest on record and 50% higher than in 1938.Another interesting feature is that the percentage of these new cases proving tuberculous is 15.65, the lowest we have yet recorded. It follows, therefore, that some 85% of our new cases prove to be nontuberculous. Chronic bronchitis, emphysema, bronchiectasis, cancer, and simple growths of the lung, heart disease with secondary lung changes, thyrotoxicosis, acute anxiety Scates and other functional nervous disorders being among the cases encountered. It will,therefore be seen that the diagnostic service provided by the Chest Clinic is being fully utilised by the local practitioners. Contact Examinations. As I have previously stated, this is an extremely important" aspect of our work. For the war years the percentage of contacts proved to be tuberculous Is as follows:- 1939 1940 1941 1942 11.3% 6.87% 7.59% 7.33% Active. Inactive . Active. Inactive. Active. Inactive. Active.Inactlve . 5.02% 6.28% 2.57% 4.3% 1.68% 5.91% 1.83% 5.5% making an average for the war years of 8.27% of which 2.77% were active cases and 5.5% inactive cases. It will therefore be seen that this group of the population forms an extremely important and unfortunately all too fruitful source in the detection of the disease in its comparatively early stages. It is noteworthy that the actual percentage of contact cases proved to be tuberculous has decreased during the war years. The exact significance of this is difficult to assess, but it must be remembered that quite an appreciable number of our cases have heen evacuated to other areas during the war period. COLLAPSE THERAPY AND THORACIC SURGERY. Artificial pneumothorax refills are now, as in pre-war years, being done at the Clinic in ever-increasing numbers. These cases are all carefully controlled with X-Ray examinations. Thoracoscopy with adhesion section and several thoracoplastic operations have been done during the year. X-RAY EXAMINATIONS OF THE CHEST. The number of these examinations, 1575 for 1942, is the highest recorded since the war. We continue to lay the greatest stress on the Importance of first class technique for correct interpretation, as it is impossible to interpret a chest film which is not technically satisfactory. These X-Ray examinations, In conjunction with careful clinical, bacteriological and ancillary examinations, have greatly assisted us In classifying the various pulmonary diseases 26. encountered and have afforded a means of selecting them for appropriate treatments. Control by serial skiagrams is part and parcel of treatment by collapse therapy or surgical methods and an integral part both of diagnosis and treatment of the disease. It must, however, be remembered that even today radiology is not infallible. The exact interpretation of chest radiographs requires experience. Nor, be It remembered, Is radiology a diagnostic aid that rules out the stethoscope the X-Ray and the stethoscope are, in fact, complementary. MASS X-RAY EXAMINATIONS OF THE CHEST. I do not propose to go into details regarding this important method of examination of large numbers of presumably healthy citizens, as I have referred to it in detail in my previous reports since 1940, particularly with reference to symptomless cases of pulmonary tuberculosis. The method is the greatest contribution which radiology has made to preventive medicine. To be done successfully it will obviously require a special organisation with a team of radiographers and secretarial assistants. It must, therefore, be carefully differentiated from the examinations of individual subjects performed at the Chest Clinic. Mass radiography has tremendous social and economic implications and will be of immense importance in the medicine of the future. The early discovery of disease in the presumably healthy subject Increases the possibility of cure, always providing that, as a result of the discovery, the worker is not victimised. THE PROPOSED MEW FINANCIAL ALLOWANCES IN TUBERCULOSIS. This Scheme 13 closely linked to the discovery of the early case of pulmonary tuberculosis. It should assist enormously in our work and prove a valuable Incentive to the patient to accept treatment at an early stage and be free from anxiety and worry instead of, as in present conditions, continuing to work at the risk of complete breakdown. As a long term programme it should greatly assist in restoring patients to health and to their normal working capacity. DIET AND TUBERCULOSIS. The dietetic history of most of our cases is now being made an important feature of our work both at the Clinic and in the homes of the patients, where the visiting nurses lay the greatest stress on a well-balanced, nutritious diet, compatible with wartime possibilities. Any obvious vitamin deficiency is dealt with, advice about the correct cooking of vegetables being frequently necessary and persuasion to replace liquid milk and shell eggs with powdered milk and eggs, both of first class food value. We are greatly indebted for their help in this work. WAR AND TUBERCULOSIS. Pulmonary tuberculosis is the most important chronic infectious disease affected by war and in spite of all recent advances, is still responsible far the highest death rate in young adult life, The influence of under-nourishment, overwork, prolonged physical or mental stress or strain are responsible for the infected becoming the clinically tuberculous. In war the disease affects two main groups of the population; those engaged on active military service and those remaining in civil life whether as industrial workers or merely carrying on, as far as is possible, In their ordinary occupations. We are more particularly concerned with young women called into industrial services, who have proved, in this war, as in the last, the principal victims of pulmonary tuberculosis. The increase in adolescent and childhood tuberculosis as well as tuberculosis in older men has been fairly general 27. throughout the country (of. Report of Medical Research Council, 1942). Long hours, little opportunity Tor fresh air and well-regulated leisure, black-out conditions and new environment are no doubt in no small measure responsible. In children evacuation with accompanying exposure to unaccustomed unpasteurised milk, is largely held to blame. ACCOMODATION FOR TREATMENT OF TUBERCULOSIS IN CHILDREN. The lack of facilities for treating cases: of pulmonary tuberculosis in children has been a source of great anxiety, particularly as such cases have been on the increase since the war. Various sanatoria on the East Coast are no longer available and local authorities who have sanatoria for children have their beds filled to capacity with their own cases and are, in consequence, unable to admit cases from the Borough. It is to be hoped that the Ministry of Health will take this matter in hand as a wait of three to six months for a case of childhood tuberculosis may lead to disastrous results. ACCOMMODATION FOR ADVANCED CASES. This is still a vexed problem, and the position remains as outlined in my report last year. OCCUPATIONAL THERAPY. The attendances at these classes are up to pre-war standard. The difficulty In obtaining suitable materials is a handicap, but in spite of restrictions, Miss Ross Smith has succeeded in maintaining a high degree of enthusiasm among selected groups of our patients. Close contact is kept with these patients in their homes and they visit the Chest Clinic to receive supplies and continue, in many cases, tho work they learnt at the Sanatorium. The standard of work is so high that the donand far exceeds the supply. Our contribution to the war effort is to try to make as many utility products as possible, i.e., shopping bags (netting) baskets, etc. and a certain amount of knitting,weaving, etc.,for the Forces. The aim for these patients is to rehabilitate them through sheltered workshops, where they can increase their working hours in a group under medical supervision. The effect on the morale of these cases In the knowledge that they are to some extent useful citizens, is tremendous. THE SOCIAL, ECONOMIC AND PSYCHOLOGICAL ASPECTS OF TUBERCULOSIS. The importance of this aspect of our work and the value of keen and enthusiastic home visiting by competent tuberculosis health visitors cannot bo over-emphasised. Since Sister Mallon's departure this side of our work has been carried out under the general direction of Sister Williams to whose untiring efforts and devotion to duty it is impossible to pay sufficient tribute. Now that we are able to look forward to the much-needed return of a full staff of tuberculosis health visitors, this aspect of our work should receive even greater attention. The family as the unit in treatment :For we must recognise that we waste time and money if we treat the tuberculous patient only and neglect the family. Moreover, the patient's mode of life after he has left the sanatorium is a major problem.Our visiting nurses regard the homes of the patients as a primary concern. The After-care arrangements are equally important and, last but not least, tho every-day economics of the home may deter early cases from seeking treatment .We endeavour to deal with the psychological make-up of the patient by trying to get him to appreciate that he is going to have our help and not our interference. In this way our visiting nurses soon become welcomed In the patients' homes, not as public health officials, but as friend guide and counsellor. As an illustration, an extremely aggressive and non co-operative patient, suffering from active pulmonary tuberculosis, who had refused all forms of treatment was, In spite of all forms of abuse, continually visited by one of our Sisters. She was repeatedly subjected to abuse, but was finally Invited indoors. After prolonged discussions concerning the finances, work, family and conditions, reason began to prevail. Ultimately the patient saw the light and actually apologised to Sister for his behaviour, his own words being "I could cut out my tongue for the way I spoke to you."Since this incident a more co-operative patient would be impossible to find. I am indebted to Dr. Palmer and all the members of the staff of the Chest Clinic for their help and co-operation throughout the year I am also indebted to Miss Webber of the Invalid Children's Aid Association for her most helpful co-operation. 28. HARTS SANATORIUM. DR. PALMER, the Medical Superintendent, reports as follows:- The chief event during 1942 was the restoration and opening for the admission of patients of the new Pavilion Block which had been burnt out by enemy action two years earlier. This ward is composed of single, double, and four-bedded cubicles, and with the adjoining Administrative, X-Ray and Consultation Rooms, the whole block forms a very up-to-date Treatment Centre for Pulmonary Tuberculosis. Dr. Ellman continues his fortnightly visits to the Sanatorium for consultation and I wi3h to take this opportunity of acknowledging his very valuable help and co-operation. the complete liaison that exists between the Sanatorium and the Chest Clinic is of the greatest advantage to the Tuberculosis Service. The Dental Department continues its excellent work and I wish to thank Mr. Blake, the Visiting Dental Surgeon for his services. Since 1941 the Reverend Canon Hodson has paid a weekly visit to the Sanatorium and I desire to place on record how greatly the patients and Staff welcome his visits. His cheerful and hope inspiring little talks are an antidote against depression. The Departments of Occupational Therapy and of Radiography continue their work in a most efficient manner, and to Miss Ross Smith, Occupational Therapist, and Mrs. MacDonald, Radiographer, I express my thanks for their high standard of work and willing cooperation at all times. The nature and scope of the work of the Sanatorium increases year by year, details of which are found in the following Statistical Report:- STATISTICS. Discharges (including Deaths) 131 Deaths 10 Insured Patients 106 Non-Insured Patients 25 Number of beds available 43 to October 1942 62 October to December, 1942. Average number of beds occupied. 40.65 to end of September 54.15 October to December Admissions by Ambulance:- Male. Female. From Hospitals 11 18 29 From Home 5 13 18 Total: 47 Immediate Results of Treatment of Pulmonary Tuberculosis cases:- Discharged Quiescent 29 (18 Male & 11 Female) (including 8 observation cases found to be suffering from Pulmonary Tuberculosis.) Discharged Non-Quiescent 85 (42 Male & 43 .Female ) (including 4 observation cases found to be suffering from Pulmonary Tuberculosis.) Of These Improved 60 (27 Male & 33 Female) Not Improved 25 (15 Male & 10 Female) 29. OBSERVATION CASES:- Of the 16 Observation Cases 12 were found to be suffering from Pulmonary Tuberculosis 2 were found to be suffering from Spontaneous Pneumothorax with no evidence of Pulmonary Tuberculosis. 1 was found to be suffering from Carcinoma of lung , and 1 was found to be suffering from Pulmonary Fibrosis following an old empyema operation. NON-PULMONARY CASES. 3 T.B. Cervical Adenitis 2 T.B. Right Sacro Iliac Joint 1) ARTIFICIAL PNEUMOTHORAX Number of Inductions 19 Number of Attempted Inductions 6 Number of Refills given 537 Number of Air Withdrawals 3 Number of Gas Replacements 5 CASES SENT FOR SURGICAL TREATMENT AND INVESTIGATION. For Cauterisation of Adhesions 7 For Thoracoplasty 2 For Bronchoscopy 1 For Orthopaedic treatment 1 GOLD SALTS Number of Courses commenced 28 Number of Courses completed from 1941 7 Number of Courses terminated during 1942 34 Of these 34; Complete Courses 21 Incomplete Courses 13 LIPIODAL INVESTIGATIONS 3 RADIOGRAPHY. Number of films taken during 1942 465 BACTERIOLOGY. Number of Sputum Specimens examined 294 Number of Blood Sedimentation Rates done 376 30. RETURN RELATING TO THE WORK OF THE TUBERCULOSIS AND CHEST CLINIC. DURING THE QUARTER ENDING 31ST, DECEMBER, 1942. 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 Tuberculous on the Dispensary Register at the beginning of the Quarter. 347 300 23 10 63 80 18 1 410 380 41 11 842 Transfers from other Authorities during the Quarter. 16 13 - 1 1 1 - - 17 14 - 1 32 L.S.O. cases returned during the Quarter 2 1 - - 1 1 - - 3 2 - - 5 B. Number of new cases diagnosed as Tuberculosis during the Quarter (1) Class T.B. minus 9 9 - 1 - - - - 9 9 - 1 19 (2) Class T.B. plus 6 2 - - - - - - 6 2 - - 8 (3) Non-Pulmonary - - - - 4 1 1 - 4 1 1 - 6 C. Number of cases included in A & B written off the Dispensary Register during the Quarter as (1) Recovered 1 - - - - - - 1 1 - - 1 2 (2) Dead (all causes.) 5 8 - - - - - - 5 8 - - 13 (3) Removed to other areas 3 4 - - 1 1 - - 4 5 - - 9 (4) For other reasons. 10 5 3 1 1 2 6 - 11 7 9 1 28 D. Number of definite cases of Tuberculous on the Dispensary Register at the end of the Quarter 361 308 20 11 67 80 13 - 428 388 33 11 860 31. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from 1st January 1942, to the 31st December, 1942. Age Periods Formal Notifications. Total Notifications Number of Primary Notifications of New Cases or Tuberculosis. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (All Ages) Pulmonary Males - 6 7 2 11 10 11 17 14 7 2 87 91 Pulmonary Females - 2 4 5 9 15 17 10 5 3 1 71 73 Non-Pulmonary Males - 2 2 1 3 1 3 1 - - - 13 14 Non-Pulmonary Females - - 1 - 1 - 3 1 - 1 1 8 8 SUPPLEMENTAL RETURN. New Cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the abovementioned period, otherwise than by formal notification. Age Periods 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total. Pulmonary Males - - - 1 2 6 10 8 2 2 2 33 Pulmonary Females - - - 1 2 6 5 5 2 2 - 23 Non-Pulmonary Males - - - - - 1 2 - - 1 - 4 Non-Pulmonary Females - - 1 - 1 1 2 - - - - 5 Total: 65 The source or sources from which information as to the above-mentioned cases was obtained should, be stated below:- SOURCE OF INFORMATION. Number of Cases. Pulmonary NonPulmonary. Death Returns (From Local Registrars 2 - (Transferable deaths from Registrar General 7 1 Posthumous notifications 1 1 "Transfers" from other areas (other than transferable deaths 46 7 Other Sources, If any, (specify) - - Total: 56 9 32. TREATMENT OF TUBERCULOSIS. 1, Number of Beds provided and available in Residential Institutions belonging to the Authority on 31st December, 1942. (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. NonPulmonary. M F Ch. M F Ch. M F Ch. M F Ch. M F Ch. M F Tuberculosis Institutions and Public Health Hospitals. Harts Sanatorium, Woodford Green. 57 40 2 - - - 23 12 2 - - - 3 - - - - - Name of Institution. Reason for Non-availability. Reason for non-availability of beds included in Col. (iii) e.g. damage by enemy action, shortage of nursing staff, evacuation, etc. Harts Sanatorium Woodford Green, Essex. Part of one Ward given over to use of East Ham Infectious Diseases Hospital. 2. Number of Patients receiving treatment in Residential Institutions under the arrangements of the Authority for treatment of Tuberculosis on 31st December, 1942. TYPE OF INSTITUTION. Ex.-Service Mon{Memo. 146/T.Rev. & Ciro, 2334) OTHER PATIENTS. Pulmonary. Non-Pulmonary. Pulmonary Non-Pulmonary Males Females Children Males Females Children A. Institutions belonging to the Authority (wholly or jointly with other Local Authorities.) (A) Tuberculosis and Public Health Hospitals. 4 - 27 28 - - - - (B) Public Assistance Hospitals & Institutions. - - 1 1 - - - - B. Voluntary Institutions. 3 1 2 5 7 2 2 2 7 1 30 34 7 2 2 2 3. Waiting List, i.e. number of Patients recommended by the Tuberculosis Officer for and ready to enter upon residential treatment, who, on 31.12.42. had been waiting for a bad for more than ten days. 2 - - 1 - 3 1 - 33. SANITARY SECTION AND HOUSING. Mr. J. E. Austin, M.B.E., Chief 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 1942 continued to be one of increased activity for the Sanitary Inspectors, Improvement of housing and other environmental conditions after war damage, demanded an intensive effort on the part of the staff. It is unfortunate that it is not possible to include any statistics in this report of emergency work carried out, and the succeeding comments deal only briefly with the emergency duties of the staff. First Aid Repairs to Houses. The reclamation of housing accommodation after war damage became more pressing during the year. The prosecution of a policy of early and complete first aid repairs amply justified itself by the gradual but sure satisfaction of demands for housing by a returning pre-blitz population. Perhaps one of the most outstanding and gratifying features of the work was the reinstatement of glazing of war damaged houses. The continuance of "blacked-out" windows with felt and the resultant lack of natural light began to have its effect upon the population, and a local Ministry of Information 'quiz' indicated the urgency of reinstatement of glazing. At the conclusion of the year this work was well in hand and on grounds of public health, physically and mentally, it was decided to proceed with 100% reinstatement of all essential rooms. There were numerous expressions of gratitude from the population in response to this work of reinstatement. It Is estimated incidentally that the vigorous prosecution of the policy of early repair of war-damaged houses has saved many properties from destruction which would have been inevitable through the depredations of unauthorised and unorthodox demolition gangs. With the increasing acuteness of the housing situation the policy of reinstatement has more than justified Itself. The work of supervising repairs constituted an important duty of the Inspectors. Towards the close of the year, however, the work assumed a new phase and more pressure had to be brought to bear on property owners who had consistently carried out no maintenance works during the war and who wore too readily inclined to believe that all maintenance work could be carried out as a first aid repair. Fortunately prewar records of this Department facilitated the differentiation "between the two types of necessary work. The labour head engaged on first aid repairs and under supervision by the Inspectors was reduced from 2,500 at the beginning of the year to 850 at the conclusion of the year. There has 'been a general and ready acceptance of a "utility" standard of repairs,but how long this will continue it is not easy to estimate. Emergency Drainage Repairs. As in the case of normal first aid repairs a considerable amount of time was expended in supervising the correction of defects, many of which appear to be latent war damage defects and are only now manifesting themselves. Despite the completion of a considerable amount of work, much remains to be done in connection with drainage "fork, and a very careful investigation is being made of each and every case whore complaints arise. Unlike the general housing defects drainage defects are not visible, and this particular problem of sanitary circumstance, it Is believed, will continue to demand considerable attention for some long time in the future. 34. With the completion of first aid repairs and reoccupation of housing and othor accommodation, man;; of the insanitary conditions arising from unoccupied promises were removed. During the year the supervision of the reconstruction of approximately 575 yards of drainage was carried out by the Inspectors. Emergency Water Supply. During the year opportunity was taken to review the arrangements for emergency supples from local wells in conjunction with the Metropolitan Water d. Disposal of Civilian War Dead» The arrangements under tide Scheme wore satisfactorily maintained. Removal of Furniture from Damaged Houses. This Department is responsible for the scheme of removal and storage of furniture from war damaged houses, the scheme being an extension of that obtaining in pre-war days in connection with slum clearance. During the year 393 removals were effected. The number of stores was reduced from 19 to 7 and disinfestation measures were systematically carried out in all stores. Public Shelters. The use of public shelters fell naturally during the year under review, but the sanitary conditions were maintained at a high level. It is difficult to assess the extent to which public shelters were responsible for the increasing incidence of Scabies, but a new Cleansing Station complete with disinfecting plant was installed during the year and proved of great value in the control of cases. The personal cleanliness of shelterers upon occasion was checked during the year. Rehousing. The rehousing and billeting of persons displaced by war damage to their homes oontinued to necessitate considerable work of certification of fitness of houses. Incidentally during the year many hundreds of enquiries of a similar nature from the War Damage Commission and numerous other Government Departments were dealt with. Other Emergency duties. The enforcement of and investigation under Pood Control Orders and. Defence Regulations are shared by the Inspectors of this Department and those of the Weights and Measures Department. Reconstruction. During the year much consideration was given to the subject of replanning and redevelopment and your Chief Inspector served as a member of a local technical officers sub-committee to examine and report upon the various aspects of reconstruction. An interim report on "Housing in its relationship to Reconstruction" was in preparation at the conclusion of the year and was presented in January 1943 to the special Committee of the Council. It is obvious that as East Ham is, at present, a dormitory town that housing will form an important part of any replan, and careful and detailed attention is being given to this aspect. Routine Work. Whilst the emergency duties of the Department in connection with the repair of housing and maintenance of sanitary circumstances h&a demanded priority, it has been possible and necessary to resume torn of the more routine work. It is unfortunate that the statistical data in respect of the emergency work cannot, for obvious reasons, 35. be included in this Report, and therefore the subjoined statements only relate to routine sanitary inspections and are generally exclusive of the special and emergency duties. 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 19,199 (i) Housing. House-to-House - Under Public Health Act 2,351 Re-inspections 1,989 (ii) Sanitary Circumstances. Yards and Passages 2 Draining and Sanitary Accommodation — Factories (excluding Bakehouses 4 Workplaces and Outworkers 13 Caravans 8 Re Offensive Fumes 6 Billets and Posts 8 Miscellaneous 452 War Damage 12,616 (iii) Food Supply. Slaughterhouses 341 Dairies 10 Food Premises 410 Bakehouses 4 Re sampling 321 Food Control 248 Food Decontamination 29 (iv) Infectious Disease. Visits 387 (b) Notices. The number of notices served during the year totalled 1758 of which 23 were statutory notices. The number or notices complied with in the same period was 781. (c) Rat Extermination. During the year 2,527 visits were made to properties in the Borough and 2,187 rats were destroyed. In one area of the Borough over 29.000 baits were laid in the sewers. Of these 4,679,or approximately 16% were taken. In consequence of the initial baiting, treatment was continued of certain sewer manholes. Unfortunately the problem of labour precluded any extension of this work. As has been recorded in previous reports the presence of these vermin upon private properties has generally been taken as an index of drainage defects, and our attention has been devoted to an investigation of these defects and the supervision of repairs when necessary. Housing. (a) Overcrowding. In the succeeding housing statistical tables the statistics previously submitted in respect of overcrowding have been omitted. These statistics became almost valueless in the light of changing circumstances of war. During the year succeeding that under review it is hoped that information will be collated on the overcrowding position. There was abundant evidence during the year under review that families were returning to the repaired housing accommodation, but there was also evidence accumulating of an increase in dual occupation of houses. This however was difficult to assess in the aggregate and nothing short of a complete survey will reveal its extent. With the assistance however of the Civil Defence Wardens' Service and the household census maintained by that Service, it is hoped to obtain in 1943 some general picture of the overcrowding position. It Is obvious, however,that whatever the position revealed by such a general examination of statistics available, the position can only be regarded as an Index of the trend of the housing situation and is no reflex of the ultimate position when absent members of families return. 36. The housing statistics are included in the following statement:(b) Housing Statistics. 1. Inspection of dwellinghouses during the year:- (1) (a) Total number of dwellinghouses inspected for defects (under Public Health or Housing Acts.) 2,351 (b) Number of inspections made for the purpose 4,340 (2) (a) Number of dwellinghouses (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 dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for humen habitation - (4) Number of dwellinghouses (exclusive of those referred to under the preceding Sub-head) found not to be in all respects reasonably fit for human habitation 2,284 II. Remedy of Defects during the year without service of formal notices:- Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their Officers. 765 III. Action under Statutory Powers during the year:- (a) Proceedings under Sections 9,10 & 16 of the Housing Act, 1936. (1) Number of dwellinghouses inrespect of which Notices were served requiring repairs - (2) Number of dwellinghouses which were rendered fit after service of formal noticess:- (a) By owners - (b) By Local Authority in default of owners - (b) Proceedings under Public Health Acts:- (1) Number of dwellinghouses in respect of which Notices were served requiring defects to be remedied 23 (2) Number of dwellinghouses in which defects were remedied after or service of formal notices:- (a) By owners 16 (b) By Local Authority in default of owners - (c) Proceedings under Section 11 and 13 of the Housing Act, 1936. .. (1) Number of dwellinghouses in respect of which Demolition Orders were made - (2) Number of dwellinghouses demolished in pursuance 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. - 37. I Inspection and Supervision of Food. (a) Milk Supply. Graded Milk. The licenses in force on 31st December 1942 were as follows:- Tuberculin Tested Milk Bottling Establishment Licence Dealers' Licences 8 Supplementary Licences 3 Pasteurised Milk Establishment Licence 1 Dealers' Licences 17 Supplementary Licences 3 The Council decided in December 1936 to change no fees in respect of licences granted under the Milk(Special Designations)Order, 1936. (b)Meat and Other Foods. (1) Meat Inspection. The Sanitary Inspectors made 341 visits to the calauzhterhouse for the purpose of carrying out post mortem inspection of animals slaughtered. The following is a statement of the work done in this connections:- Horses Ponies Foals Donkeys Goats Numbered of Animals slaughtered 2751 154 1 2 1 Number of animals Inspected 2751 154 1 2 1 All diseases except Tuberculosis; Whole carcases condemned. 25 1 — — — Carcases of which some part or organ was condemned 1124 10 — — — Percentage of number inspected affected with disease other than T. B. 41.8 7.1 — — — Periodically visits are made to butchers' shops, market stalls and moat vehicles. (2) Food Premises. The number of inspections made of food premises included 10 dairies 4 of bakehouses, and 410 of other premises. (3) Slaughterhouses. In respect of two premises in the Borough the Council refused to renew the licence to use such premises as slaughterhouses .In one case the Court adjourned the hearing sine die with leave to restore the case if the Council refused to grant the licence in respect of the premises which had suffered war damage and which necessitated rebuilding. The other appeal was adjourned subject to the business then being carried on at the slaughterhouse (slaughtering of horses for human consumption) being discontinued on and after 31st December, 1942. These latter premises were the subject of a further application for a licence in the succeeding year. (4) Bacteriological Samples. 33 samples were submitted for bacteriological examination during the year including 7 of ice cream, 19 of milk, 2 of domestic water, and 5 of swimming bath water. (5) Other Foods. Inspection of other foods resulted in the condemnation for human consumption of 13,242 tins including 419 tins of meat and meat products, 1708 tins of fruit, 374 tins of Vegetables, 205 tins of fish 10,355 tins of milk and 181 tins or packages of other foods. 38. 'I (e) Adulteration. _ Details of the various samples obtained by the Sanitary Inspectors and the results are included in the following tabular statements:- Number of Samples. Percentage of samples adulterated. Examined. Found adulterated or below standard Butter 9 - - Cheese 1 - - Cocoa 3 1 33 Coffee 3 - - Confectionery 4 1 25 Jam 1 1 100 Lard 7 - Margarine 6 - - Milk 123 3 2.4 Sausage 17 1 6 Vinegar 3 - - Wines & Spirits 3 2 67 Drugs 20 - - Other Articles 96 5 5 296 14 4.7 Details of samples adulterated or below standard are described as follows, together with the resultant action:- Number . I or F Article. Adulteration or Deficiency. Action Taken. 3073 I Toffees Negligible quantity of quartz sand and glass. Examination revealed that no further stock contaminated. 3075 F Apple and Blackberry Jam. 20% deficient in fruit. Manufacturers prosecuted. 3082 I Sweetened Custard Powder. No cane sugar, only a trace of saccharine . * Nil 3089 I Gin 44° under proof, addod water. Formal sample taken and Vendor cautioned. 3100 I Sweetened Custard Powder. As for sample No. 3082. * Nil 3130 F Gin 36.9° under proof. Added water. Vendor cautioned 3134 F Milk 6% deficient in milk fat. Vendor cautioned 3143 F Milk 10% deficient in milk fat. Vendor cautioned 1349 F Cordial Lemon Flevour Absence of sugar Vendor prosecuted 3153 F Milk 2% deficient in milk fat Vendor cautioned 3203 F Cordial Lemon Flavour. Absence of sugar. Vendor cautioned. 3205 I Milky Cocoa Absence of milk solids Vendor cautioned 3261 I Vanilla Ground rise pudding Mixture of ground rice & whosten flour. Vendor cautioned 3342 • I Beef Sausages. 16% deficenec in meat. Formal sample taken Vendor subsequently prosecuted. *• Samples taken at request of Social Welfare. 39. " • I \ "V .J [ i