EAS 20 LIBRARY COUNTY BOROUGH OF EAST HAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1943. / Malcolm E. Barker, M.R.C.S. (Eng.) L.R.C.P.,D.P.H. (Lond.) MEMBERS OF THE COUNCIL. The Mayor :- Mrs. Alderman Beatrice Wilkens, .J.P. The Deputy Mayors Alderman Joseph Walter Barton, J.P. Aldermen :- Charles William Brading, J.P., C.R.P. Thomas William Burden , M.P ., J.P. Richard John Fell Herbert Percy Jackson Thomas Irwin Lethaby, J.P. Edward Francis Markoy, J.P. (3) Annie Taylor, (Mrs.) J.P. Frederick Welch Council1ors:- Charles Edward Beckett William Henry Whit took Boecham Leslie Alfred Victor Bennett Ethel Maud Charlotte race (Mrs.) (4) Lendoranna Minnie Brignoll (Mrs.) Annie Maud Clark (Mrs.) Edward John Davey Charles Willian Dixon Eric Cyril Boyd Edwards, LL.B. (1) Sydney Arnold Els on Bertie George Goodenough John Albert Hart, Frank H. Howard Walter Edwin Plurford William I. Jackson, J.P. Harold Joseph, F.A.L.P.A. Bertram Arthur Keene John Alfred Kemp. (2) Winifred May Knight (Mrs.) John Linsloy Linsloy-Thomas Robert William Moger, J.P. George Horace Moncar Robert Wilfred Payne Alfred Prior Frank Owen Reynolds Alice Beatrice Spencer (Mr3.) Willian Thompson Williar Bertram warncken Alfred Tom Yates Watson Ernest Albert Wood Co-opted Members of the Maternity & Child Welfare and Mental Deficiency Committees. Mrs.E.M.Devenay) Maternity Mrs. C.J.Cross ) Mrs.E.M.Fell. ) 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 " " " " " 1 COUNTY BOROUGH OP EAST HAM. Public Health Department, Town Hall Annexe ,E.6. October, 1944. 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 1943. The Report is again submitted in an abbreviated form. Vital statistics show a higher birth rate (20.09),a lower death rate (13.27), and a larger estimated population for the Borough, as given by the Registrar General. I am pleased to report that the infant mortality rate (48)and the maternal mortality rate (2.60) are lower than for the previous year. There has also been a decrease in the number of still births. It will be seen that notifications in respect of infectious diseases have increased but no death has occurred from Diphtheria. The maternity wing at the East Ham Memorial Hospital, completed in 1939, was made available for the admission of patients in November,1943. This accommodation for expectant mothers, provided by the Council within the Borough, is greatly appreciated, and the maternity beds - 15 in number - are continuously occupied. The Cleansing Centre for the treatment of Scabies and similar conditions, has served a useful purpose, and has been the means of limiting the extent of ,??? skin affections. Little difficulty is being experienced in getting patients to attend for treatment, and. the special clinics arranged have permitted of supervision and the adequate following-up of family contacts. In respect of all forms of tuberculosis, the number of primary notifications and cases on the register shews a definite increase during the year occasioned largely by Service patients, those referred by Medical Boards,and returned evacuees. A comparison with pre-war years, however, does not indicate any considerable variance in these statistics and it may be assumed, generally, that the civil population is not succunbing to this malady in greatly increased numbers. It will be noted that the deaths of pationts on the Clinic register exceeds that given for each of the previous two years which may be due in some measure to a restricted dietary and worsened environment al conditions. The maintenance allowances provided by the Ministry of Health for persons suffering from pulmonary tuberculosis, have been of inestimable benefit and enabled many to accept sanatorium treatment without the delay occasioned by financial anxiety. It is to be regretted that cases of non-pulmor&ary tuberculosis are not Included In the Scheme. The time required to ensure complete healing is so prolonged that resumption of work cannot be anticipated and the patient is in evon greater need of maintenance allowances. Owing to the demand for nursery accommodation, the Council decided to increase the number of Wartime Nurseries in the Bosrough to five: details are given in the Report. I an grateful to the Chairman (Alderman Mrs. A. Taylor, J.P.) and membere of the Public Health Committee, for their help and support throughout the year, also to the Chairman and members of other Committees with whom I am associated, and to my colleagues who have contributed to the satisfactory maintenance of the Public Health,School Medical, Hospital and ???? Sorvices. I have the honour to be, Your obedient Servant, M. BARKER. Medical Officer of Health. 2 STATISTICAL CONDITIONS 0F THE AREA. Area (in statute acres ) land and inland water Population. Census. 1931 142,394 Estimated Civilian Population 1943 92,800 Number of inhabited houses (end of 1S43, according to rate books. (Including tenements and shops.) Approx. 31,000 Rateable value at 31st December, 1943 £704,117 Sum represented by a penny rate for the year 1943/44. £2,706 Extracts from Vital Statistics. For Birth Rate Total. Males. Females. Live Births. Legitimate 1,794 921 873 Illegitimate 71 46 25 Still Births. Legitimate 49 27 22 Illegitimate 1 1 Deaths: Total: 1,232 Males: 705. Females: 527. Deaths from Puerperal causes:- Deaths . Rate per 1,000 Total (Live and Still Births.) Puerperal Sepsis 3 1.56 Other Puerperal causes 2 1.04 5 2.60 Death Rate of infants under one year of age:- All infants per 1,000 live births 48 Legitimate infants per 1,000 legitimate live births 47 Illegitimate infants per 1,000 illegitimate live births 56 Deaths from Cancer (all ages) 213 Deaths from Measles(all ages) 1 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 11 Still Births. < Still births registered numbered 50 compared with 69 for 19.42. The rate per 1,000 total (live and still) births was 26.1 the figure for the previous year being 42.5. Births The number of live births registered was 1,865 compared with 1,553 for the year 1942, equivalent to a birth rate of 20.09 per 1,000 of the Registrar General's estimated population. The rate for 1942 was 17.4. 3 , Deaths. During the year the number of East Ham civilian residents dying was 1,232, This figure is equal to a death rate of 13.27 per 1,000 of the Registrar General's estimated population. For the previous year the rate was 14.09. Infantile Mortality. The number of deaths of children under one year of age was 90, equal to an infantile mortality rate of 48 per 1,000 live births (54 for 1942), the rate of England and Wales being 49 per 1,000 related births. Neo-Natal Mortality:- Children dying under the age of one month totalled 44 equal to a neo-natal mortality rate of 23.5 per 1,000 live births. The rate for the previous year was 35.4. Maternal Mortality. Maternal deaths numbered 5, the rate for 1943 being 2.68 per 1,000 live births and 2.60 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. ) 0.71 1.56 1.56 1.04 2.27 2.60 Population. The Registrar General's estimate of the civilian population for 1943 is 92,800. The figure for the year 1942 was 89,200. 4 BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1943. Rate per 1000 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. Scarlet Fever. Whooping Cough. Diphtheria Influenza. Smallpox. Measles. Total Deaths under 1 year Deaths from Diarrhoea & Enteritis (under two years.) England and Wales 16.5 0.51 12.1 0.00 0.00 0.03 0.03 0.37 - 0.02 49+ 5.3 126 County Boroughs and Great Towns, including London. 18.6 0.63 14.2 0.00 0.00 0.03 0.04 0.36 — 0.02 58 7.8 146 Smaller Towns(residentpopulations 25,000-50,000 at Census, 1931.) 19.4 0.81 12.7 0.00 0.00 0.03 0.04 0.37 — 0.02 46 4.4 London- Administrative County. 15.8 0.45 15.0 0.00 0.00 0.03 0.02 0.27 — 0.02 58 10.4 EAST HAM 20.09 0.53 13.27 — 0.01 0.01 — 0.29 — 0.01 48 5.8 † Per 1,000 related births A dash (-) signifies that there were no deaths. 5 . CAUSES OP DEATH IN AGE-GROUPS. 1943. 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 year 5-15 Years 15-45 Years 45-65 Years 65 and Upward M F M F M F M F M F M F M F 1.Typhoid and para-typhoid Fevers – – – – – – – – – – – – – – 2.Cerebro-Spinal Fever 1 – – – – – – – – – – – – – 3.Scarlet Fever 1 – – – – – – – – – – – – – 4.Whooping Cough – 1 – 1 – – – – – – – – – – 5.Diphtheria – – – – – – – – – – – – – – 6.Tuberculosis of Respiratory System. 46 34 – 1 – – – – 22 25 18 6 6 2 7.Other forms of Tuberculosis 2 5 – – – 2 – 2 1 1 1 – – – 8. Syphilitic Diseases. 8 1 – – – – – – – 1 4 – 4 – 9.Influenza 9 18 3 – 1 1 – – – 2 4 5 1 10 10. Measles 1 – – – 1 — – – – – – – – – 11.Acute Polio-myelitis and Polk)-encephalitis – – – – – – – – – – – – – – 12Acute Infective encephalitis – – – – – – – – – – – – – – 13.Cancer of buccal cavity and oseophagus (M) uterus (F) 11 3 – – – – – – – 1 2 – 9 2 14.Cancer of Stomach and duodenum 33 17 – – – – – – – 1 18 6 15 10 15.Cancer of Breast – 19 – – – – – – – 2 – – – 8 16.Cancer of all other sates 81 49 – – – – – – 5 6 32 18 44 25 17.Diabetes 5 3 – – – – – – 1 mm 4 3 18.Intracranial vascular lesions. 57 53 – – – – – – – 1 16 12 41 40 19.Heart Disease 132 105 – – – – – – 9 4 37 24 86 77 20.Other Diseases of Circulatory System 17 17 – – – – – – – 1 3 3 14 13 21.Bronchitis 59 40 1 2 – – – – 2 2 17 4 38 32 22.Pneumonia 45 30 14 7 1 1 – 2 5 12 5 15 13 23.Other Respiratcry Diseases 12 7 – – – – – – 1 2 6 – 5 5 24.Ulcer of Stomach and duodenum. 13 5 – – – – – – 2 1 8 1 3 r, I 3 | 25.Diarrhoea under 2 years 8 . 3 7 3 1 – – – _ – – – – W | 26.Appendicitis 5 1 – – – – – – 2 1 1 – 2 – 27.Other Digestiva Diseases 9 112 1 – – – – 1 1 1 5 4 2 6 23.Nephritis. 8 12 – – – – – – – 4 3 2 5 5 29.Puerperal and Post – 3 – – – – – – 1 abortive sepsis 30 j Other Maternal causes – 2 – – – – – – – – – –– – – 31.Premature Birth 15 8 15 8 – – – – – – – – 32.Congenital tions, birth injury, 10 12 9 10 – 1 1 – – – – 1 – – infantile diseases 33.Suicide, 6 5 – – – – – – 1 – 1 2 4 – 34.Road Traffic Accidents 7 – – – – 1 – 1 1 – 3 1 3 – 35.Other violent causes. 20 12 – – – 1 1 1 7 1 7 6 5 3 36.A11 other causes. 84 47 5 3 1 1 – 1 7 6 14 13 57 23 . TOTALS 706 527 55 35 7 7 8 6 63 76 214 122 363 £81 60 Deaths in Wards-1945 Cause of Death Mano???Park ??? ??? Pla- ahet Kensing t on. Castle Central Wall End Greatfield South Tata. 1. Typhoid and para-typhoid fevers – – – – – – – – – – — 2 Cerebro- spinal. Fever – – – – – 1 — – – – 1 3. Scarlet Fever – 1 – – – – – – – – 1 4 Whooping Cough – – – – – – – – – 10 5.Diphtheria – – – – – – – – – – – 6.Tuberculosis of resoirotary System 8 10 5 7 12 7 8 7 9 *7 80 7. Other forms of Tuberculosis 1 – 1 1 – – – – – – 7 8 Syphilitic Diseases 1 – 1 _ .– 1 2 – 3 1 9 9.Influenza 6 3 1 2 2 4 2 1 4 8 27 10.Measles 1 – – – – – – – – – 1 11.Acute Poliomyelitis and polioonccphalitis – – – – – – – – – – – 12. Acute infective encephalitis – – – – – – – – – – – 13. Cancer of buccal cavity & oseophagus (M)uterus(p) 2 2 1 3 1 2 2 1 – – 14 11.Cancer of Stomach and Duodenum... 4 9 7 1 4 5 4 6 6 4 50 15. Cancer of Breast 2 2 2 1 1 2 4 1 2 2 19 16.Cancer of all other sites 16 12 23 12 7 8 10 10 18 14 130 17.Diabetes 1 1 1 1 1 1 – – – 2 8 18.Intracranial vascular lesions 13 15 11 7 6 7 12 20 11 8 110 19.Heart disease . 34 32 24 21 9 23 26 25 20 23 237 20.Other diseases of circulatory system 5 2 2 4 2 5 4 4 4 2 34 21.Bronchitis. 13 14 7 9 7 9 14 12 2 12 99 22.Pneumonia 6 9 7 5 7 6 6 8 9 12 75 23.Other respiratory diseases 5 3 3 2 – – 2 2 1 19 24. Ulcer of Stomach and duodenum 2 2 1 4 – 1 1 4 3 – 18 25,Diarrhoea under 2 years 1 2 – – 1 1 – 6 11 26.Appendicitis 2 — 1 1 — 1 – – 1 6 27.Other digestive Diseases 5 2 3 2 1 5 – 3 21 28.Nephritis 3 4 1 1 1 2 2 1 1 3 20 29. Puerperal and Post abortive Sepsis – 1 – – – – – – 2 3 30. Other maternal causes 1 1 – – – – – – – – 2 31. Premature Birth 4 5 1 3 3 1 — 2 2 2 23 32.Congenital Malformation birth injury infantile diseases 2 3 3 2 2 2 5 1 1 1 22 33.Suicide 2 1 2 – 2 – 1 1 – 2 11 10 32 34. Road. Traffic Accidents 1 1 1 2 – 1 1 2 1 – 35. Other violent causes 36.All other 4 4 3 2 6 3 3 1 5 1 cAUSES 18 11 12 11 6 16 18 15 5 19 131 totals 163 152 123 105 84 109 132 114 113 139 1232 PREVALENCE OF, AND CONTROL OVER, INFECTION , DISEASE. Notified Cases for the 52 weeks ending 1.1.44 DISEASE Cases Notified in whole District. Ward Distribution of Cases. Number of eases Removed to Hospital. Total Deaths in Borough At all ages - years. Manor Park Little IIford Woodgrange Plashet kensington Castle Central Wall End Greatfield. South. At all ages Under 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and Up. Scarlet Fever 271 1 92 130 27 3 14 3 1 - 60 44 20 23 8 13 32 35 11 25 197 1 Diphtheria 53 1 16 17 9 3 6 7 - - 7 13 9 4 5 4 4 4 5 4 59 - Typhoid Fever 3 - - - - - 1 2 - - - - - - - 2 1 - - - 3 - Para-Typhoid Fever 1 - - - 1 - - - - - 1 - - - - - - - - - 1 - Erysipelas 28 - - - - - 5 6 9 8 6 8 1 2 3 - 1 1 4 2 8 - puerperal Pyrexia 8 - - - - 1 4 3 - - - 1 - 1 1 - - 3 1 1 4 3 Pneumonia 72 2 7 11 4 2 12 8 13 13 10 14 5 7 6 5 8 5 7 5 28 75 ??? Neonatorum 1 1 - - - - - - - - - 1 - - - - - - - - 1 - ???ontory 6 - 1 4 1 - - - - - - - - 1 2 - 1 2 1 - 6 - Meningococcal Meningitis 4 - 2 - - - 1 - 1 - 1 - - - - 1 - 2 - - 4 1 Measles 917 21 415 445 20 10 5 - - - 120 247 121 74 56 88 56 72 50 33 31 1 Whooping Cough 241 28 133 72 3 3 2 - - - 41 22 30 24 8 24 26 18 29 19 35 1 * Notifiable for Duration of War. 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 14. The death rate was 0.15 per 1,000 population, as compared with a rate of 0.17 for 1942. No cases of Small Pox were reported during the year under review. Diphtheria Immunisation Clinics. Number inoculated In the various age groups:Ages in years: Cancer. No investigations have been undertaken, as requested the Ministry of Health's series of Circulars on Cancer, Patients are referred to the general hospitals for Invest, tion and special .treatment. Classification. Carcinoma 188 Epithel ioma 1 Sarcoma 6 Glioma 1 Hypernephroma 1 Neoplasm 2 Endothelioma 1 Unstated 13 Total: 213 Cancer Deaths, 1945. Total deaths 213 Males 125 Females 88 INFECTIOUS DISEASES HOSPITAL-, Dr, Palmer's observations are contained, in the following-report upon the work of the hospital PREFACE. The number of cases admitted each year to the Isolation Ward, Harts Sanatorium, continues to increase. Daring 1943, 354 patients were admitted as compared with 293 in the preceding year. The number of deaths was 2, giving a mortality rate of 0,56$. It is very satisfactory to note that no deaths occurred from Diphtheria The Incidence of Scabies and Impetigo still appears to be on the increase, and many cases of Infectious Disease are complicated by these skin complaints. For the second successive year there were no cases of Enteric Fever, and there were only two cases of Cerebro Spinal Meningitis, both of which completely recovered with Sulphapyridine treatment. The year produced an increase in the number of Whooping Cough and Measles cases admitted to Hospital, At times the existing accommodation was very heavily taxed, and it is hoped that more beds will be available in the future, STATISTICS. (A) DIPHTHERIA (Uncorrected for Diagnosis) In Hospital on December 31st, 1942 13 Admitted during 1943 72 Discharged during 1943 * 75 Died during 1943 - Remaining in Hospital on December 31st,1943 10 (B) SCARLET FEVER (Uncorrected for Diagnosis) In Hospital on December 31st,1942 25 Admitted during 1943 194 Discharged during 1943 204 Died during 1943 1 Remaining In Hospital on December 31st,1943 14 (C) MISCELLA NEOUS (Uncorrected for Diagnosis) In Hospital on December 31st, 1942 1 Admitted during 1943 88 Discharged during 1943 81 Died during 1943 1 Remaining in Hospital on December 31st, 1943 7 DIPHTHERIA. Number of Notified Cases 72 Revision of Diagnosis Tonsillitis 17 Transient Diphtheria Carrier 5 Scarlet Fever 1 Laryngitis 1 Streptococcal Rhinitis 1 No evidence of Infectious Disease 4 Final number of Diphtheria Cases 43 Number of Gases of Diphtheria occurring in immunised children 2 10 i - TABLE SHOWING TYPES OF DIPHTHERIA & MORTALITY. Type Total. Died. Mortality Rate. Faucial 36 — — Laryngeal 1 — — Faucial and Nasal 5 — — Faucial,Nasal & Laryngeal 1 — — 43 — — There were no Deaths from. Diphtheria during the year. Table Showing Serum Administration. 8, 000 16,000 24,000 32,000 48,000 Total. 4 4 4 9 22 43 Serum was given intravenously on seven occasions. Table showing age incidence of Diphtheria + 0 5 + 10 + 15 + 20 + 25 + Total 11 13 8 5 2 6 43. COMPLICATIONS AMD paralysis Palatal Paralysis 2 Ciliary Paralysis 1 Pharyngeal Paralysis 1 Tonsillitis 2 Otorrhoea 1 bacteriological examinations. 921 Swabs were examined for Diphtheria Bacilli and 65 were found to be positive. serum reaction. There wore no cases o^ any reaction due to administration of anti-diphtheritic Serum. cases of concomitant disease. There were two cases of Diphtheria with Scabies. SCARLET FEVER Number of Notified Cases 194 Revision of Diagnosis 6 Tonsillitis ........ *..... 1 Chicken Pox 1 Erysipelas of Face 1 Rubella 1 j No evidence of Infectious Disease . 2 Other Notified Cases proving to be Scarlet Fever .•• 1 Final number of Scarlet Fever cases ... ... 189 t Cases with Concomitant Disease. Scarlet Fever and Scabies 20 Scarlet Fever and Impetigo 6 Scarlet Fever and Whooping Cough Scarlet Fever and Chicken Pox 2 Complicationsi Cervical Adenitis 18 Tonsillitis 11 Rhinitis 9 Septic Fingers,spots,etc 9 Abscesses Otorrhoea 2 Endocarditis 1 Myocarditis 1 Orbital Cellulitis 1 Conjunctivitis 1 Albuminuria 1 Oedema of hands and feet 1 Total: 57 Serum Complications. Serum Urticaria 23 Serum Arthritis 1 Total: 24 For the first time for eight years there was one death from Scarlet Fever. This was a case of intense Toxaemia, which did not respond in any way to serum and sulphonamido therapy. Such cases are fortunately very rare nowadays. WHOOPING COUGH. Number of notified Cases 30 Revision of Diagnosis 1 No evidence of Whooping Cough or Infectious Disease 1 Final number of Whooping Cough Cases 29 Of these 29 Cases:- Uncomplicated Whooping Cough Cases 14 Whooping Cough and Measles 1 Whooping Cough and Broncho Pneumonia 11 Whooping Cough and Meningismus 1 Whooping Cough and Bronchitis 2 There was one death from Broncho Fneumonia complicating a very severe case of Whooping Cough in a child aged 18 months. MEASLES . Number of Notified Cases 23; Revision of Diagnosis 3 Erythema Multiforme 1 Sulphapyridine Rash 1 No evidence of Measles or Infectious Disease 1 Final number of Measles Cases 20 Of these 20 Cases :- Uncomplicated Measles 7 Measles and Broncho Pneumonia 5 Measles and Bronchitis 4 Measles and Scabies 2 Measles and Stomatitis 2 There were no Deaths. 12. V CEREBRO SPINAL MENINGITIS Number of Notified Cases 6 Revision of Diagnosis 4 Acute Anterior Poliomyelitis 1 Epilepsy 1 Acute Meningismus 1 No evidence of Cerebro Spinal Meningitis or Infectious Disease 1 Two patients proved to be cases of Cerebro Spinal Meningitis. Both completely recovered with Sulphapyridine treatment. OPERATIONS. Lumbar punctures10 Incision of Abscesses 2 LABORATORY WORK. Bacteriological examination of faeces 5 Bacteriological examination of urine 5 Blood Widal Tests 3 Cerebro Spinal Fluid examinations 10 Examination for Haemolytic Streptococci. 2 TABLE of ADMISSIONS and DISCHARGES for 1943. after correction for Diagnosis) Disease Remaining at end of 1942. Admitted during Died during 1943. Discharged during 1943. Remaining. atend of 1943. Diphtheria 12 43 45 10 Transient Diphtheria Carrier 1 5 6 - Scarlet Fever 23 189 1 197 14 Acute Anterior Poliomyelitis - 1 - 1 Acute Bronchitis - 2 2 — Acute Meningismus 1 - 1 - Cellulitis of Arm — 1 - 1 - Cerebro Spinal Meningitis 2 - 2 — Chicken Pox 1 — 2 3 mm Constipation — 2 - 2 mm Epilepsy - 1 - 1 M Erysipelas - 4 4 — Erythema Multiforme - 1 - 1 M Haemolytic Streptococcal Carries - 1 mm 1 Influenza — 3. — 3 *—• Infective Parotitis 1 - 1 mm Laryngitis - 1 - 1 - Marasmus - 1 - 1 mm Measles - 15 - 15 - Measles and Broncho-Pneumonia 1 5 - 6 mm No evidence of Disease - 10 - 10 - Rubella - 6 - 6 - Scabies - 2 - 2 - Scabies and Impetigo — 3 - 3 - Stomatitis - 1 — 1 - Streptococcal Rhinitis — 1 - 1 - Sulphapyridine Rash - 1 - 1 — Tonsillitis 1 20 - 21 — Whooping Cough - 14 - 14 - Whooping Cough and Bronchitis - 2 - 2 — Whooping Cough and Broncho- Pneumonia - 11 1 3 7 Whooping Cough and Measles - 1 - 1 - Whooping Cough and Meningismus . - 1 - 1 - TOTAL 39 354 2 360 31 13. DIPHTHERIA PROPHYLAXIS. RETURN FOR PERIOD ENDING 31ST DECEMBER 1943. 1. Age under 5 years. Age 5 years & over but under . ; 15 1 ' 4 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.1943. 866 1,272 2,138. 11. Under 5 Be Between 5 and 15. (A.) Approximate estimated number of children in the Authority's area, at 31st December,1943. 7,000 11,050. (B) What percentage of the child population shown under (A) is it considered were immunised at 31st December, 1943. 62.5% 52% (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 elsewhere ). 1ll, (A) Number of cases of Diphtheria in children under 15 years of age notified and diagnosis confirmed between 1st January and 31st December, 1942 43. (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. 4. (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 - (D) Number of deaths included in (C) in which the child is known to have completed the course of immunisation not loss than 12 weeks before the onset of the disease APPLICATIONS FOR INNOCULATION AGAINST TYPHOID FEVER. No applications made in 1943, compared with none in 1942 and 6 in 1941. MIDWIVES ACTS, 1902 - 1936. The number of midwives who notified their intention to practice in the area during 1943 was 27. Of this number 12 worked In connection with the Maternity Hospital and District Nurses Home, Plaistow, and its Branches, 3 from Tates Nurses Home, Silvertown, 1 from Forest Gate Hospital, 5 from East Ham Memorial Hospital, and 6 practised independently, including three Municipal Midwives. SUMMARY OF VISITS PAID DURING 1943 BY NURSES OF PLAISTOW MATERNITY HOSPITAL & DISTRICT NURSES HOME_ Midwifery 292 Monthly 115 Hospital 235. 14. LABORATORY FACILITIES. The same facilities exist as detailed in previous reports for the examination of specimens. During 1943, 805 specimens were examined at the East Ham Memorial Hospital, and 15 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. Positive. Negative. Town Hall Annexe 769 26 743) 1,690 91 1,599. Infectious Diseases Hospital 921 65 856 AMBULANCE . FACILITIES. The two Town Ambulances which formerly operated from the Fire Station, we re handed over to the A.K.P. Ambulance Section on the outbreak of war and are now available at the Ambulance Depot (Napier Road) Grangewood 3419. Two Ambulances, in addition, are used for the removal of infectious cases. PUBLIC ASSISTANCE DOMICILIARY MEDICAL SERVICE. Statistical Return for the Year ending 31,12.43. Number of Attendances at Homes. Number of Attendances at Surgery. Total Number of Attendances. Number of Occasions Medicines Supplied Without Seeing Patients. 1,820 6,465 8,285 418 Number of applications to Medical Officer of Health for Hospital Treatment. 2 Number of requisitions received for attendance of Nurse. 16 15. . . 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. 1943. Syphilis 15. Soft Chancre 2. Gonorrhoea 26. Not Veneral 104. 145. Total attendances of all patients 2,648. Total number of in-patient days 41 PATHOLOGICAL EXAMINATIONS. For or at the Centres:- 1943. Spirochaetes 2. Gonococci 674. Wassermann 526. Others 995. Total: 1,997. For practitioners:- Spirochaetes - Gonococci 1. Wassermann 10. Others 10. Totals 21. Utilisation of facilities at Hostels 1943:- East Ham 1. Number of days residence 24. Venereal Diseases Rules 1942 - 33B. - In no instance were two forms received in respect of one case during the year 1943. 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 1945, EAST HAM MEMORIAL HOSPITAL. The work of the Hospital and Public Health Department becomes more closely associated each year, and I acknowledge with gratitude the help of the Committee and honorary medical staff. Reference should be made to the Annual Report. 16. BLIND PERSONS ACTS, 1920 - 1958. The following figures are abstracted from the statistical record of the registration of blind Persons, as at 31.5.44:- Males. Females. Total 1942. Total 1945. Number on Register 108 122 255 250 Toatal employed 22 8 27 50 Undergoing training 5 2 4 5 Trained but unemployed - 1 5 1 No training, but trainable 5 - 5 5 Unemployable 78 109 195 187 Children (0 to 16 years) 2 2 5 4 MENTAL DEFICIENCY ACTS, 1915 - 1938. Ascertainment. The number of cases dealt with for the first time during the year 1943 was 23, and they were dealt with as Under:- 7 placed in Institutions (under Order)& lin an approved home. 13 " under Statutory Supervision. 1 “ " Friendly Care. 1 dealt with under Mental Treatment Act, 1930. Provision of Institutional Accommodation. The difficulty experienced in obtaining Institutional accommodation has been relieved by the completion of South Ockendon Colony, but groat difficulty is being experienced in the placing of low grade cases. Guardianship. There are 39 cases under Guardianship of whom six have evacuated to other areas. One male was transferred under a Varying Order from Guardianship to Institutional Care. One female died during the year. Supervision. There are 134 mental defectives under Supervision in their own homes in East Ham, plus 18 who are still 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. A fair percentage of the cases are absorbed into unskilled employment. Occupation Centre. The whole day sessions at the Occupation Centre, with the provision of a hot midday meal, are being satisfactorily continued. There has been an average daily attendance of 22 of varying ages and of both sexes. Handwork of all types forms the main part of the curriculum, and all articles made are definite orders for sale. In many instances work Is taken home to complete. More orders are received than can be accepted owing to the present difficulty of obtaining the 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 and clearance of tables before and after the midday meal. in suitable weather, outdoor games, and also simple gardening instruction form part of a day's occupation. Licence. Discharge and After-Care. Out of 12 defectives (5 males" and 7 females) granted licence during the year, 11 are at work, and doing fairly well, and one was 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 of MENTAL DEFECTIVES AS Oil 1ST JANUARY, 1944. STATISTICS. 1945. 1942. A. M. F. Total M. F. Total 1. Under (a) (1) Institutions (excluding cases on Licence.) Under 16 years of age 11 5 16 12 9 21 Aged 16 years and over 64 54 118 57 51 108 (2)on Licence from Institutions Under 16 years of age - - - 1 - 1 Aged 16 years and over 5 7 12 4 4 8 (b) (l)Under Guardianship (excluding cases on Licence ) Under 16 years of age - - - 1 - 1 Aged 16 years and over 19 18 37 20 19 39 (2)on Licence from Guardianship Under 16 years of age 1 - 1 - - - Aged 16 years and over - - - - - - 2. In "PLACES OF SAFETY". Under 16 years of age - - — - - Aged 16 years and over - — - — - - 5. Under "STATUTORY SUPERVISION". 71 63 134 65 48 113 Of whom Awaiting removal to an Institu- tion 1 1 1 - 1 Action not yet taken under any one of the above Headings: Notified by Local Education Authorities. (sec.2 (2)) 4 4 8 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 - - - 1 1 2 Of Whom, number, if any under voluntary supervision — — - - - - (b) All other cases 18 19 37 25 15 40 Of whom, number, if any under voluntary supervision 18 12 30 17 13 30 18.  1943. 1942. M. F. Total. M. F. Total. B.2.(b) (Contd) Number of above Cases on the Registers of Occupation and Industrial Centres:- 17 12 29 15 13 28 Cases notified by Local Education Authorities (Sec.2 (2)) during the year 1943:- Method of Disposals:- Sent to Institutions (by Order ) 4 - 4 3 1 4 Placed under Guardianship - - mm - - Placed under Statutory 2 3 5 9 1 10 Placed in "Places of Safety" - *m mm - mm Died or removed from area. - - - 2 2 4 Action not yet taken: (a) In receipt of poor relief - - - - - (b) Others 1 1 2 4 6 7 3 10 16 8 24 " Of the total number of M.D's known to Local Authority:- (a) Number who have given birth to children:- 1943. 1942. (1) After marriage •0 2 (2) While unmarried mm 2 Males. Female s-. Males. F emales. (b) Number who have marrieds:- - 1 1 - THE INVALID CHILDREN'S AID ASSOCIATION. As in previous years, the Authority and Public Health Department are indebted to the local branch of this Association for their invaluable service rendered to the invalid children of the Borough. The types of new cases dealt with in 1943 were as follows:- Tuberculosis 10 Anaemia and Debility 13 Rheumatism, Heart and Chorea 8 Lung conditions (non-tuberculous) 39 Marasmus and Malnutrition. 8 Various 38 116 19. SCABIES CLINIC AND TREATMENT CENTRE. The following statistics are appended:- Number of new cases attending. 1942. 1943. Scabies Clinic 478 969 Patient s: Number of Baths. Treatment Baths: l942 674 1,947 1943 622 1,689 WARTIME NURSERIES. Since my last report, the two new Nurseries mentioned therein have been opened:- Wall End Road/Caledon Road on 13. 6. 44. St. Stephens Road on 24. 7. 44. The total permitted accommodation of the five wartime nurseries is as follows:- Brampton Road 70 Kensington Avenue 50 School Road 50 Wall End Road/Caledon Road 50 St. Stephens Road 74 Total: 294 Both the new nurseries are accommodated in an improved type of pre-fabricated but of official design. Staffing difficulties continued to a lesser extent, due to Improved salaries and conditions, relaxation of regulations in respect of previous experience and qualifications for the posts of Nursery Assistants and the promotion to higher posts of Nursery Nurses and Nursery Assistants. In addition, the Ministry of Health lowered the age at which Student Nurses could enter the Service from 16 years to 14 years. During 1943, the three Nurseries then operating were generally full to the permitted accommodation, and in addition each had a waiting list. The opening of the two new nurseries in 1944 eased the position considerably and those children on the waiting list were practically all absorbed. 20. EAST HAM MEMORIAL HOSPITAL. MATERNITY WARD. (Opened 1.11.45) 1. Number of maternity beds in the Institution (exclusive of isolation and labour beds) at 31st December 1943. 16. la Number of beds, if any, included under item which have been reserved for expectant mothers in need of hospital treatment. 2. Number of maternity cases admitted during the year. (1.11.43 - 31.12.43) - 24 2a. Number of women treated during the year in the ante-natal beds shown' against item a. (These women should be included also against item) 2b. Average duration of stay of expectant mothers in the ante-natal beds shown against item 2a. 3. Average duration of stay of cases in the lying-in wards. 14-15 days. 4. Number of cases delivered by- (a) Midwives. 23. (b) Doctors. - 5. Number of cases in which medical assistance was sought by a midwife in emergency. 2. 6. Number of cases admitted after delivery - 1. 7. Number of cases notified as- (a) Puerperal fever.. (b) Puerperal Pyrexia - 8. Number of cases of pemphigus neonatorum - 9. (a) Number of infants who have at any time received a supplementary or complementary feed while in the Institution - 2. (b) Number of Infants wholly breastfed on leaving the Institution - 23 10. (a) Number of cases notified as ophthalmia neonatorum. (b) Result of treatment in each case. 11. ( a) Number of maternal deaths (b) Cause of death in each case 12. (a) Number of stillbirths. (b) Cause in each case, and results of post-mortem examination (if obtainable). - 13. (a) Number of infant deaths within 10 days of birth. - (b) Cause of death in each case, and results of post-mortem examination (if obtainable) 21. 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 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) Other - - - (d) Employed by Voluntary Associations:- (i) Under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 16 - 16 (ii) Others - 5 5* \ (e) In perivate practice 4 - 4 Totals: 23 5 28 * Employed by Voluntary Hospital (East Ham Memorial) Number of cases in the area of the Local Supervising Authority attended during the year by Midwives:- (a) Employed by the Council. As Midwives 225 - 225 As Maternity Nurses. 34 - 34 (b) Normally employed by other Local Supervisory Authorities but temporarily wo rising in the area. As Midwives - - - As Maternity Nurses. - - - (c) Employed by other Welfare Councils: (i) Under arrange ments made with the Local Supervisory Authority In pursuance of Sec. l of the Midwives Act 1936. As Midwives. - - - As Maternity Nurses. - - - (ii) Others As Midwives. — - - ) As Maternity Nurses. - — 22.  Domiciliary Midwives. Midwives in Institutions. Totals (d) Employed by Voluntary Associations: (i) Under arrangements with the Local Supervisory Authority in pursuance of Section 1 of the Midwives Act, 1936. As Midwives. 300 - 300 As Maternity Nurses. 118 - 118 (ii) Others As Midwives. - 23 23 As Maternity Nurses - - - (o) In Private Practice. As Midwives 98 - 98 As Maternity Nurses. 16 - 16 TOTALS: As Midwives 623 23 646 As Maternity Nurses 168 - 168 Number of cases in which medical aid was summoned during the year under Section 14 (i) of the Midwives Act, 1918, by a midwife:- (i) For domiciliary cases 97 Total - 142. (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 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 1,180 total Visits 1,249 (ii) To children under one year First Visits 1,710 of age. Total Visits 5,596 (iii) To children between the ages of 1 and 5 years. Total Visits 5,068 23 INFANT WELFARE CENTRES. (a) Number of Centres provided and maintained by the Council Open at 31. 12. 43.- 2 (b) Number of Centres provided and maintained by Voluntary Associations. Open at 31. 12. 43.- Nil (c) Total number of children under 5 years of age 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 1,264 (ii) Between the ages of one and five years 359 (d) Total number of children under 5 years of ago who attended at the Centres during the year and who, at the end of the year, were - (i) Under one year of age 1,021 (ii) over one year of age 1,690 ANTE-NATAL AND POST-NATALSERVICES. Ante - Post Natal Natal (a) Ante-natal and Post-natal Clinics (whether held at Infant Welfare Centres or at other premises) (i) Number of Clinics provided and maintained by the Council. Open on 31.12.43 2 (ii) Number of Clinics provided and maintained by Voluntary Organisations, open at 31. 12. 43. 1 - (iii)Total number of women who attended at the Clinic during the year 1575 19 (b) Total number of expectant mothers ante - natally examined and of eases 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. (1) Otherwise than under the National Milk and Vitamins. Scheme.) (1) 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 used: Scheme approved in 1937 - meals to be taken at School Feeding Centres. (ii) Is other food (proprietary dried milk or vitamins.) supplied to:- (a) Expectant Mothers Yes (b) Nursing Mothers Yes (c) Children under 5 years of ago Yes State whether supplied - Free- or at less than cost price in, necessitous cases Yes At cost price in other cases. Yes. 24. CASES OP OPHTHALMIA NEONATORUM notified during the year in which:- (a) Vision was unimpaired 1 (b) " " impaired - (c) " " lost - (d) the patient was still tinder treatment at the end of the year - (e) the patient died - (f) the patient removed from the district - (g) classification under the above heads cannot be made (details of these cases should be attached) - Total: 1 MATERNITY ACCOMMODATION. The accommodation for women whose homes are unsuitable for their confinements, and those who require in-patient treatment on medical grounds, is East Ham Memorial Hospital, Forest Gate Hospital, Maternity and District Nurses Home, Plaistow, and Queen Mary's Hospital, Stratford. Daring 1943*24 cases were admitted to East Ham Memorial "Hospital, 441 to Forest Gate Hospital and one to Queen Mary's Hospital. Other mothers were evacuated to Maternity Hospitals outside London. *Opened 1.11.43. INSPECTION OF MIDWIVES Visits of inspection, as necessary,wore paid during the year, and the midwives' work, including records, was satisfactory. CHILD LIFE PROTECTION. Sections 206 to 220 of the Pub1ic Health Act, 1936. (a) Number of persons who were receiving children for reward at the end of the year.19 (b) Number of children: (i ) at the end of the year 20 (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 (a) above, or societies authorised to visit under the proviso to Section 209(2)of the Public Health Act, 1936.NIL (e) Proceedings taken during Act and Section under which the year. proceedings were taken. NIL. 25. Adoptton of Children (regulation act, 1939. 1. Number of persons who gave notice under Section 7(3) during the year 3 2. Total number of children "adopted"under the Section during the year 3 3. Number of such children:- (a) Under supervision at the end of the year 3 (b) who died during the year (c) on whom inquests were held during the year - 4 Particulars of any proceedings during the year Nil NOTE: Fourteen children under five, and five over five years have been adopted through the Education Department. ORTHOPAEDIC TREATMENT. Cases are referred to the East Ham Memorial Hospital, and Queen Mary's Hospital, Stratford, under similar arrangements to the School Medical Service. REGISTRATION OF NURSING HOMES. (SECTIONS 187 to 1S4 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 - - - - MATERNITYAND CHILP WELFARE CIRCULAR 2831 DATED 2,7.45. The above Circular deals with the general standard of cleanliness and habits and infestation by head-lice. Instructions wore given to all Health Visitors to carry out an intensive survey of mothers and children attending the vlinics and in their homes. Those enquiries elicited few cases of verminous conditions and infestation by head lice was most infrequent. Patients found to be suffering received prompt treatment. 26. HOME HELPS. A Scheme of Home Helps has been in operation for many years. Difficulty has always been experienced in getting sufficient suitable women to act as such to cover the applications received. During the year 49 cases were attended by Home Helps. The number of Home Helps on the Register at 31.12.43. was:- Whole Time 1 part Time 8 Dr. MacLaren submits the following observations During the year 1943 all the Infant Welfare Clinics have been well attended and the general health of the children on the whole has been satisfactory, though the standard of cleanliness has somewhat deteriorated. Ante-Natal Clinic. This year there has been an increasing request from expectant mothers for admission to hospital. This demand has been accentuated by the serious housing shortage, the lack of available domestic help, and the absence of relatives who might provide assistance. These claims have been met either by reference to local maternity hospitals or through the L.C.C. Evacuation Scheme. This situation has resulted in increasingly heavy attendances at the clinics as all ante-natal cases are required to attend for examination before reference and booking for hospital. Immunisation Clinic. This clinic has been well attended for immunisation against Diphtheria, also many mothers are taking advantage of the facilities provided for protection against whooping cough. Sunlight Clinic Two sessions per week are held for Infants under five years who have been referred for treatment. PULMONARY TUBER CULOSIS. MEMORANDUM 266/T. Maintenance allowances as authorised by the Ministry of Health under the terms and conditions of the above memorandum, were commenced in this area in July 1943 up to 31.12.43, 76 patients were granted these allowances. 27. • • • ' ' ' • ' - . ' TUBERCULOSIS AMD CHEST CLINIC. Notifications. The number of primary notifications of all forms of tuberculosis during the year 1943 was 264,as compared with 24.4 for 1942. Of the primary notifications of pulmonary tuber culosis, in 26.7 per cent tubercle baccilli were found in the sputum. Statistical. The total number of notified cases on the register of the Clinic or December,1943 was 949 (pulmonary and non-pulmonary)or 10.2 per 1,000 estimated population, as opposed to 860 or 9.6. per 1,000 population in the previous year. Deaths. The number of deaths (1939-1943)from tuberculosis is shown below Pulmonary. Non-Pulmonary. Of Cases on the Clinic Register. 1939 71 12 59 1940 88 13 81 1941 78 8 58 1942 53 15 55 1943 80 7 73 Now Cases. The following are the comparative figures for the year 1939-1943:- 1939 1940 1941 1942 1943 New Cases & Contacts4 86 582 657 997 1317 Number proved after comelete investigation to be tuberculous. 30.4% 21,99% 19,77% 15.65% 17.61% Year Number of Notified Cases on Clinic Register on 31st December Number of Attendances During Year Number of Medical Examinations During Year. 1933 947 4,051 3,360 1934 959 4,030 3,265 1935 974 3,737 3,006 1936 953 3,733 3,297 1937 969 3,793 3,437 1938 973 3,970 3,590 1939 974 3,467 2,982 1940 879 2,413 1,901 1941 809 2,874 2,133 1942 860 4,768 3,238 1943 949 6, 580 4,493 Attendances and Medical Examinations. Attendances. Medical Examinations. 1939 3,467 2,982 1940 2,413 1,901 1941 2,874 2,153 1942 4,768 3,238 1943 6,580 4,493 Consultations at Homes of Patients. During the year twenty-six visits wore made to the homes of patients who were too ill to attend the Clinic. Number of X-Ray Examinations at the Chest Clinic. 1939. 1940. 1941. 1942 1943. 1394 1132 1220 1575 1844 28. DR. PHILIP ELLMAN, Consultant Physician, reports on the work of the Chest Clinic, as follows:- This report is ncccssarily a brief one, dealing purely with essentials and foregoing our normal peacetime practice. ATTENDANCES. Despite the war period and the trying times we have undergone, not only are the number of attendances the highest of the war, but they are in fact, increased by 2,610 over 1938, due to some extent to the increase in the number of cases (male and female) being referred by various medical recruiting boards for the Services, and also perhaps to an increased extent, an appreciation among the lay community of the value of preventive health examinations® There has been a marked increase in the number of examinations of new cases, including contacts, during the year. The figures for this year are the highest on record and 20.9% higher than in 1938. The percentage of these new cases proving tuberculous is 17.61. The diagnostic service provided by the Chest.Clinic is being fully utilised by the.local practitioners, and the diagnosis and advice on treatment of the large number of non-tuberculous pulmonary cases is fully recognised. Contact Examinations This continues to be 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 1943 11.3% 6,87% 7.59% 7.33% 7.32% Active. 5.02% 2.57% 1.68% 1.83% 3.9% In-active. 6.28% 4.3% 5.91% 5.5% 3.42% making an average for the War years of 8.8% of which 3.0% were active cases and 5.08% inactive cases This group of the population continues to form.an extremely important source in the detection of the disease in its comparatively early stages. We have been particularly struck during the year with the comparatively large number of contact examinations entirely free from symptons, who are discovered to have early pulmonary tuberculosis. Tuberculoma of the Lung. This condition of a well defined granulomatous mass in the lung substance is extremely rare. We have during the year encountered our first case. The affected lobe of the lung was removed with the complete cure of the patient. 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, and the value of pneumoperitoneum, so recently introduced as an additional means of collapse therapy,Is being carefully assessed, 29. X-RAY EXAMINATIONS OF THE CHEST. The number of these examinations, 1344 for 1943, is the highest ever recorded siace the war These X-Ray examinations in conjunction with carefal clinical, bacteriological and ancillary examinations, continue 1 o assist us in classifying the various pulmonary diseases encomtored, "and afford a means of selecting them for appropriate treatments, Technically satisfactory radiographs continue to be or aim, and an increasingly high standard will continue to be maintaired with the appointment of Miss R.Saldanha of Guy's Hospital as was the case with Mrs.MacDonald, as our radiographer. TREATMENT OF CASES FOUND THROUGH MASS RADIOGRAPHY. It was only to he expected that with the improved establishment of mass radiography there would be an increased demand for admissions to sanatorium. This added to the burden on our waiting list, more particularly among women but the effort is well worth while, since most cases thus discovered are in the early stages of the disease and hence very amenable to treatment. NEW FINANCIAL ALLOWANCES INTUBERCULOSIS. This scheme is Solosely linked to the discovery of the early case of pulmonary tubculosis, It assists enormously in work, and has proved valuable incentive to the patient to accept treatment at an early stage and be free from anxiety an worry instead of continuing to work at the risk of complete As a long term prpgrame it should greatly assist in restoring patients to health ar1 to their normal working capacity.its extension to a wider riety of caaos of pulmonary other than the very early ones, and a more generous allow greatly add to its reel value. Moreover if the Scheme to cover cases of non pulmonary tuberculosis it woula grea y us in our work. DIET AND TUBERCULOSIS, The dietic history of most of our cases is continuing to be an important feature of our work both at the Clinic and in the homes of the patients, where tho visiting nurses lay the greatest stress on a well-balanced, nutritious diet, compatible with war-time possibilities. Any obvious vitamin deficiency is stressed, advice about the correct cooking/vegetables is frequently necessary, and the replacement of liquid milk and shell eggs with powdered milk and eggs, both of first class food value,is encouraged WAR AND TUBERCULOSIS. The disease affects two main groups of the population; those engaged on active military service and those remaining In civil life whether as industrial workors or merely carrying on, as far as is possible, in their ordinary occupations. We are more particularly concerned with:- a. Young women called into industrial services, who have proved in this war, as in the last, the principal victims of pulmonary tuberculosis, b. The Increase in adolescent and childhood tuberculosis, moreso this year perhaps than any time since tho war# Long hours little opportunity for fresh air and wellregulated leisure, black-out conditions,and now environment,are no doubt in no small measure responsible. In children evacuation with accompanying exposure to unaccustomed unpasteurised milk, is In our experience an important factor 30. ACCOMMODATION FOR TREATMENT OF TUBERCULOSIS IN CHILDREN. The lack of facilities for treating cases of pulmonary tuberculosis in children continues to be a source of great anxiety. It is to be hoped that this matter will soon be overcome, as a wait of three to six months for a case of childhood tuberculosis may lead to disastrous results. ACCOMMODATION FOR ADVANCED CASES This has become a very urgent problem as facilities now for dealing with such cases, owing to war damage, have become more difficult than ever before. OCCUPATIONAL THERAPY. This work continues to flourish and Miss Ross Smith continues to maintain a high standard of efficiency. The attendances at these classes are still up to pre-war standard despite the increasing difficulty in obtaining materials. Licences have been secured from the various Government Departments to enable us to purchase the main items in use, e.g., wool, leather, cane, piggy, velvet and organdie. Remarkable enthusiasm exists among a certain selected group of our patients whose morale is particularly high, one can say with veracity,as a direct result of their increasing usefulness as citizens. Close contact is kept with these patients and they visit the Chest Clinic to receive supplies and continue, in the majority of cases, tho work they learnt at the Sanatorium, the standard of work is so high that the demand continues to exceed supply. We aid the war effort by making as many utility products as possible, i.e. shopping bags (netting), baskets, etc., plus 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 SOCIAL. ECONOMIC AND PSYCHOLOGICAL ASPECTS OF TUBERCULOSIS. The value of keen and enthusiastic home visiting by competent tuberculosis health visitors such as we now have available cannot be over emphasised. This side of our work, to an increased extent, is being carried out under the general direction of Sister Williams, The results of the thorough and painstaking work of all three Sisters has to be seen and experienced to be fully appreciated. I am again 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-operati on. 31. . . HARTS SANATORIUM. DR. PALMER, the Modical Superintendent, reports as follows. preface. During the year under review, the new extensions to the Sanatorium were opened by Mr. Alderman Barton. That the increased bod accommodation has been well used is shown by a study of the Statistics. Fifty-two more patients were treated than during the previous year, a total of 183 as against 131 in 1942. In the field of collapse therapy, more and more use is being made of artificial pneumothorax, and,where the collapse is held up by adhesions, for these cases to bo sent for the appropriate surgical treatment. As far as tuberculosis is concerned, 1943 will be remembered as the year when Mass Radiography and Financial Allowances were introduced by the Government. Tuberculosis is a huge social problem, and it is hoped that the prevention and cure of the disease will be greatly advanced by the establishment of these schemes. STATISTICS. Discharges (including Deaths) 183 Deaths (including three observation cases) 27 Insured Patients 139 Non—Insured Patients 44 Number of beds available 62 IMMEDIATE RESULTS of treatment of PULMONARY TUBERCULOSIS CASES:- Discharged Quiescent 56 (36 Male and 20 Female) (including 15 observation cases found to be suffering from Pulmonary Tuberculosis.) Discharged Non-quiescent94 (50 Male and 44 Female) (including 5 observation cases found to be suffering from Pulmonary Tuberculosis.) Of these:- Improved 70 (34 Male and 36 Female) Not improved 24 (16 Male and 8 Female) NON-PULMONARY CASES 1 (Found to bo suffering from Spinal Tuberculosis) OBSERVATION CASES. Of the 28 Observation Cases - 23 were found to be suffering from Pulmonary Tuberculosis. 3 were found to be non-tuberculous. 2 were doubtful, but did not remain long enough in the Sanatorium for the diagnosis to be established. ARTIFICIAL PNEUMOTHORAX. Number of Inductions 23 Number of Attempted Inductions 10 Number of Refills given 774 Number of Gas Replacements 21 32. CASES sent for SURGICAL TREATMENT. For Cauterisation of Adhesions 9 For Thoracoplasty 4 For treatmentof T.3. Empyema 3 For Orthopaedic treatment 1 GOLD THERAPY. Number of courses commenced 32 Number of courses completed from 1942 1 Number of courses terminated in 1943 27 Of these 27 - Complete Courses - 22. Incomplete Courses - 5. RADIOGRAPHY. Number of Films taken in 1943 544 BACTERIOLOGY. Number of sputum specimens examined 325 Number of blood sedimentation rates done 597 33. . RETURN RELATING TO THE WORK OF THE TUBERCULOSIS .AND CHEST CLINIC DURING THE CUARTER ENDING 31ST DECEMBER, 1943. 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 393 340 23 10 67 88 12 3 460 428 35 13 936 Transfers from other Authorities during the Quarter 2 1 - 1 1 - 1 - 3 1 1 - 5 L.S.O.cases returned during the Quarter 3 2 - - - - - - 3 2 - - 5 B.Number of new cases diagnosed as Tuberculosis during the Quarter. (1) Class T.B. minus 15 9 1 1 - - - - 15 9 1 1 26 (2) Class T.B. 9 5 1 - - - - - 9 5 1 - 15 (3) Non- Pulmonary. - - - - - 1 1 - - 1 1 - 2 C.Number of casesincluded in A & B written off the Dispensary Register during the Quarter as (l) Recovered. - 2 - 1 - - - - - 2 - 1 3 (2) Dead (all causes) 13 7 - - - - - - 13 7 - - 20 (3) Removed to other areas. 4 3 - - - - 1 - 4 3 1 - 8 (4) For other reasons. 3 2 - - 1 - - 1 4 2 - 1 7 D.Number of definite cases of Tuberculosis on the Dispensary Register at the end of the Quarter 400 343 25 10 67 89 13 2 467 432 38 12 949 34. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from 1st January, 1943, to the 31st December, 1943. Age Periods Formal Notifications Total Notifica tions. 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 - 1 1 3 22 9 24 17 12 11 5 105 107 Pulmonary Females - 2 1 1 9 18 34 11 6 5 4 91 93 Non-Pulmonary Males - 1 1 3 1 1 1 - - - - 8 9 Non-Pulmonary Females 1 1 1 1 3 3 1 3 - - - 14 14 SUPPLEMENTAL RETURN. Now 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 - - - - 2 1 8 4 3 - 3 21 Pulmonary Females - - - - 1 2 5 3 1 - - 12 Non-Pulmonary Males - - 3 2 - 1 2 - 1 - - 9 Non-Pulmonary Females 2 - - 1 - - - - - - 4 Totals 46 The source or sources from which information as to the above-mentioned cases was obtained should be stated belows:- SOURCE OF INFORMATION. Number of Cases. Pulmonary NonPulmonary Death Returns From Local Registrars 3 2 Transferable deaths from Registrar General 4 1 Posthumous notifications 2 - "Transfers"from other areas (other than transferable deaths) 23 10 Other Sources, if any (Specify) 1 - Totals 33 13 35. treatment OF tuberculosis. 1. Number of beds provided and available in Residential Institutions belonging to the Authority (wholly or jointly with other Local Authorities on 31. 12. 43. (i) (ii) Total Number of Beds Provided. (iii) Number of beds included in (ii) temporarily not available (iv) Number of beds vacant and ready for use. NAME OP INSTITUTION Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary. M F Ch M F Ch M F Ch M F ch M F Ch M F Ch. Harts Sanatorium, Woodford Green, Essex. 57 40 2 - - - 23 12 2 - - - - - - - - - Reason for non-availability of beds included in Col. (iii) e.g. damage by enemy action,shortage of nursing staff, evacuation, etc. Name of Institution. Reason for Non-availability. Harts Sanatorium, Woodford Green, Essex. Infectious Diseases Hospital evacuated to the Sanatorium since September, 1939. 2. Number of Patients receiving treatment in Residential Institutions under the arrangements of the Authority for treatment of Tuberculosis, on 31. 12. 43. TYPE OB INSTITUTION. Ex-Service Men (Memo 146/1 Rev. and Circular 2334 OTHER PATIENTS. Pulmonary. N on-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 8 - 24 27 - - - - (B)Puolic Assistance Hospitals & Institutions — - - 1 — — — B.Institutions belonging to other County or County Borough Councils,or Tuberculosis Joint Boards. - - - - 2 - - - C.Institutions belonging to Local Authorities other than A and B. - - - - - - - - D. Volutary Institutions 1 - 2 6 2 3 4 7 Totals. 9 - 26 34 4 3 4 7 3.Waiting List, i.e.number of Patients recommended by the Tuberculosis Officer for,and ready to enter upon residential treatment,who,on 31. 12.43 had been waiting fora bed for more than ten days. - - 2 4 - 2 - - SANITARY SECTION AID ROUSING 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. Circumstances arising from the war continued to dominate the activities of the inspectorate. War damage in the four years of war has demanded our unremitting attention to housing and environmental conditions. It is hoped in a subsequent report to be able to include statistics of such work done but in this report only brief comments are submitted. i. First Aid Repairs. Considerable progress in the reclamation of housing had been made in the previous year but final reinstatement of certain items of repair had been deferred. During the year reinstatement of all glazing was undertaken, and this improvement of natural light and ventilation proved perhaps tho most satisfactory feature of the first aid repair work. Unfortunately further damage occurred during the year, but the repair of this damage had been substantially completed at the year end. Even after a period of comparative lull the first aid repair service had lost none of its speed and efficiency when damage again came and the 24 hours immediate repair' service was maintained. The labourhead on first aid repairs and supervised by tho Sanitary Inspectors had still further diminished by tho end of the year. Tho following figures are an index of the progress of the work:- In May 1941 Labourhoad 3300 Doc.1941 do. 2500 Dec.1942 do. 350 Dec.1943 do. 470 The problem of latent war damago defects manifesting themselves began to arise, but fortunately tho experience of the inspectorial staff over many years and tho records of this department were of material assistance in tho settlement of those problems. During the yoar a gradual change of the tide of responsibility for housing repairs took place and tho inspectorate were able to require normal maintenance to be undertaken by owners. ii. Essential Housing Repairs. Difficulties were experienced in enforcing maintenance of housing by owners who themselves were unable to obtain labour and materials, and the introduction of tho schemo for Certificates of Essentiality promised to prove of inestimable value in this connection. iii. Emergency Drainage Repairs. The investigation of damago defects duo to war damage continued to occupy considerable time and a further 456 yards of house drainage was reconstructed under supervision of tho department during the yoar. iv. Emergency Water Supplies. Further review of arrangements for emergency water supplies was undertaken in conjunction with the Civil Defence Authorities. In ono instance arising out of war damage, water supply to a housing area was cut off, but this was reinstated in reasonably quick time. This incident demanded however tho vigilant attention of the department. v. Disposal of Civilian War Dead. Tho few occasions when this service operated proved that the scheme was well maintained. vi. Removal of Furniture from War Damaged Housing. During the year 385 removals were effeeted. Furniture Stores had been reduced to three at the end of the yoar, and these were subject to periodic disinfestation. Vehicles in use numbered three and staff engaged on the work numbered ten vii. Public Shelters Despite the diminution in use the sanitary condition and readiness of public shelters were maintained. 37. viii. Rehous ing. During the year 550 certificates of habitability were issued to householders requiring rehousing or billeting. Considerable time was devoted to the investigation of housing conditions of persons applying for rehousing on account of their being inadequately housed. In 164 cases reports were submitted to the rohousing department. ix. Other Emergency Duties. The administration of the multifarious orders of the Ministry of Pood is carried out in part by the inspectorial staff. The Sanitary Inspectors carried out during the year 2040 investigations. Reconstruction. In January 1943 an Interim Report on "Housing" was submitted to the Planning and Redevelopment Committee of the Council. The report was a diagnosis of the housing position in the Borough and was also an endeavour to crystallize some of the local housing problems in relation to replanning. Routine Work. Whilst the improvement and maintenance of environmental conditions has constituted the greater part of the emergency work, much of the routine work of the department has been resumed during the year. Details of this routine work are contained in the following statements. 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 23,061 (i) Housing. House-to-House - Under Public Health Act 3,644 Re-inspections 5,625 Housing Act 1936 473 (ii) Sanitary Circumstances Yards and Passages 3 Draining and Sanitary Accommodation 214 Factories (excluding Bakehouses) 73 Workplaces and Outworkers 10 Caravans 20 Re Offensive Fumes 12 Billets and Posts - Miscellaneous 601 War Damage 10,428 (iii) Food Supply Slaughterhouses 109 Dairies 8 Food Premises 614 Bakehouses 28 Re sampling 420 Food Control 297 Food Decontamination 14 (iv) Infectious Diseaso Visits 480 (b) Notices. The number of notices served during the year totalled 2300 or which 93 were statutory notices. The number of notices complied with in the same period was 1625. 38 * (c) Rat Extermination During the year 3,162 visits were made to properties in the borough and 4,227 rats were destroyed During the year a rat infestation survey was carried out, which survey indicated one reservoir infestation, three major infestations and seventy-four minor infestations. Coincident with the survey a publicity campaign sponsored by the Ministry of Food resulted in the submission to this department of 191 complaints of rats and mice infestations during the last three months of the year. In connection with the treatment of the sewers in the North Woolwich area, the first treatment indicated the estimated kill was 285 rodents and the second treatment an estimated kill of 140 rodents. These figures do not indicate that any serious infestation exists, and in fact many of the existing infestations are deemed mainly due to defective drainage caused by enemy action. This drainage is tho subject of constant investigation by the department, and essential repairs are executed so soon as defects are revealed. (d) Legal Proceedings. The following statement indicates the legal proceedings undertaken during the year:- Public Health Act 1956. Abatement of Nuisances- Cases withdrawn (Nuisance abated) 4 Food Control. Contravention of Rationing Orders Penalties inflicted 6 Dismissed on payment of costs 3 Housing. (a) Overcrowding. During the year an analysis of the household census maintained by the Civil Defence Wardens' Service was made with a view to obtaining a picture of overcrowding in the borough. This investigation however did not reveal any serious overcrowding. During this statistical investigation consideration was given to possible cases of overcrowding which would occur upon the return of members in H.M.Forces, but this only revealed that 216 cases of overcrowding would result. Whilst it is difficult to assess at this stage of the war the post-war overcrowding position it is believed that with the return of evacuees there will be a serious deterioration in the position and much overcrowding will become manifest. During the year consideration was given to the first year housing p rogramme and an initial programme of 152 houses was prepared but this was extended early in the succeeding year. The most acute problem of housing in East Ham is the matter of land shortage, and unless and unti. cleared war damaged sites can be acquired for this purpose, the preparation of any programme will remain one of difficulty. In presenting a Special Report on Housing to the Planning and Redevelopment Committee an effort was made to resolve the problem into an immediate policy and a long term policy, the latter involving planning needs, whilst the former would have regard to the immediate needs of the community. The housing statistics, exclusive of those relating to overcrowding are included in the foilowing statement:- (b) Pious ing Statistics. I. Inspection of dwellinghouses during the year (1) (a) Total number of dwellinghouses inspected for defects (under Public Health or Housing Acts.) 4,124 (b) Number of inspections made for the purpose 9,749 (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 - 39 (5) Number of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Number of dwellinghousos (exclusive of those referred to under the preceding Sub-hoad) found not to be in all respects reasonably fit for human habitation 3,810 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 1,549 III. Action under Statutory Powers during the year:- (a) Proceedings under Sections 9,10 & 16 of the Housing Act, 1936» (1) Number of dwellinghouses in respect of which Notices wore served requiring repairs - (2) Number of dwellinghouses which were rendered fit after service of formal notices i- (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 bo remedied 93 (2) Number of dwellinghouses in which defects were remedied after service of formal notices:- (a) By owners 76 (b) By Local Authority in default of owners - (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936 (1) Number of dwellinghouses in respect of which Demolition Orders wore 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 wore determined, the tenement or room having been rendered fit - Inspection and Supervision of Food (a) Milk Supply. Graded Milk. The licenses in force on 31st December 1943 were as follows:- Tuberculin Tested Milk Bottling Establishment Licence - Dealers' Licences 5 Supplementary Licences 3 Pasteurised Milk Establishment Licence 1 Dealers' Licences 14 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. 40. (b) Meat and Other Foods. (1) Meat Inspection. The Sanitary Inspectors made 113 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 Goats Number of animals slaughtered 191 3 — 8 — Number of animals inspected 191 3 - 8 - All diseases except Tuberculosis Whole carcases condemned - - - - - Carcases of which some part or organ was condemned 52 - - - - Percentage of number inspected affected with disease other than T.B. 26.1 - - - - Periodically visits are made to butchers' shops, market stalls and meat vehicles. (2) Food Premises. The number of inspections made of food premises included 7 dairies, 31 of bakehouses and 540 of other premises. (3) Slaughterhouses . One slaughterhouse which had been the subject of a refusal to grant a licence in the previous year was again the subject of two applications, and In both instances licences were refused. One applicant however appealed against the decision of the Council and the Council were ordered to grant a licence subject to certain works being carried out within a specified time. These works were not carried out within the period specified. A further application for the renewal of the licence w&s pending at the close of the year. (4) Bacteriological Samples. 47 samples were submitted for bacteriological examination during the year including 36 of milk, 2 of domestic water, 4 of swimming bath water, 2 of tinned milk, 1 of tinned herrings, 1 of cooked ox liver and 1 of ice blancmange. (5) Other Foods V Inspection of other foods resulted in the condemnation for human consumption of 4,298 tins including 342 tins of meat and meat products, 482 tins of fruit, 439 tins of vegetables, 422 tins of fish, 1915 tins of milk and 698 tins or packages of other foods® (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 of samples adulterated. Examined. Found adulterated or below standard Butter 10 — - Cheese 5 - - Cocoa 2 - - Coffee 7 - - Confectionery - - - Jam 4 - - Lard 10 - - Margarine 16 1 6.2 Milk 145 1 .69 Sausage 24 1 4.0 Vinegar 7 - - Wines & Spirits 16 1 6.2 Drugs 3 - - Other Articles 129 7 5.4 378 11 2.9 41 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. 3386 F Beef Sausages Deficient in meat 26%. Vendor prosecuted 3417 F Milk 3.5% added water Vendor cautioned. 3511 I Lemonade Powder Undesirable quantity of acid sodium phosphate. Vendor cautioned. 3636 I Gelatine 12 parts per million of arsenic. withdrawn from sale & surrendered by retailer. 3651 / I Table Cream Contained zinc to the extent of.05% Formal sample taken. 3668 I Margarine l½% excess of water. Vendor cautioned 3676 I Gelatine 8 parts per million of arsenic Withdrawn from sale and surrendered by retailer. 3677 I Gelatine 6 parts per million of arsenic. Withdrawn from sale and surrendered by retail. 3684 F Table Cream Contained zinc 0.07% No further stock no action. 3691 I Egg substitute Deficient in available C.O2by 1/3. Stock withdrawn from sale and returned to manufacturers. 3742 F Whisky 49° under proof. Vendor prosecuted. (1944) 42.