EAS 21 COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1944 MALCOLM E. BARKER M.R.C.S. (Eng.)r L.R.C.P., D.P.H. (Lond). Medical Officer of Health; School Medical Officer ; General Medical Superintendent; Medical Officer to the Maternity and Child Welfare Committee and Statutory Committee for Mental Deficiency; Chief Tuberculosis Officer. . COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1944 MALCOLM E. BARKER M.R.C S. (Eng.), L.R.C.P., D.P.H. (Lond). Medical Officer of Health; School Medical Officer; General Medical Superintendent; Medical Officer to the Maternity and Child Welfare Committee and Statutory Committee for Mental Deficiency; Chief Tuberculosis Officer. 3 MEMBERS OF THE COUNCIL The Mayor: Mr. Councillor Sydney A. Elson, J.P. The Deputy Mayor: Mr. Alderman Charles W. Brading, J.P., C.R.P. Aldermen: (3) Joseph Walter Barton, J.P. Thomas William Burden, M.P., J.P. Richard John Fell. Herbert Percy Jackson. Thomas Irwin Lethaby, J.P. Edward Francis Markey, J.P. (1) 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.) Lendoranna Minnie Brignell (Mrs.) Annie Maud Clark (Mrs.) Edward John Davey. Charles William Dixon. Eric Cyril Boyd Edwards, LL.B. Bertie George Goodenough. John Albert Hart. Frank H. Howard. Walter Edwin Hurford. William I. Jackson, J.P. Harold Joseph, F.A.L.P.A. Bertram Arthur Keene. John Alfred Kemp. (2) Winifred May Knight (Mrs.) John Linsley Linsley-Thomas. Robert William Moger, J.P. George Horace Moncar. Robert Wilfred Payne. Alfred Prior. Frank Owen Reynolds. (4) Alice Beatrice Spencer (Mrs.) William Thompson. William Bertram Warncken. Alfred Tom Yates Watson. Ernest Albert Wood. Co-opted Members of the Maternity and Child Welfare and Mental Deficiency Committees. Mrs. E. M. Devenay J Maternity Mrs. C. J. Cross 1 Mental Mrs. E. M. Fell Vand Child Mrs. A. M. Gray ^Deficiency. Mrs. I. Watson ) Welfare. Mrs. B. A. WIieeler J (1) Chairman of Public Health and, Maternity and Child Welfare Committee. (2) Vice-Chairman ,, ,, ,, ,, ,, ,, (3) Chairman of Committee for the Care of the Mentally Defective. (4) Vicn-Chairman ,, ,, ,, ,, ,, 4 COUNTY BOROUGH OF EAST HAM Public Health Department, Town Hall Annexe, E.6. October, 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 1944. At the request of the Ministry of Health, the report is again abbreviated and confined largely to statistical information. The birth rate (20.9) is the highest since the year 1922. The death rate is slightly above that of the preceding year. The estimated population for the Borough as given by the Registrar General is 91,060 as against 92,800, the decrease being due to movements of the population resulting from war conditions. It will be seen that the infant mortality rate stands at 31 per 1,000 live births, the lowest recorded in the history of the Borough. The maternal mortality rate, always a variable figure, is slightly higher than last year, viz., 3.06 per 1,000 total births (live and still)—all the deaths occurred in hospital. The neo-natal mortality rate has decreased from 23.5 to 17.3 per 1,000 live births. The prevention and control of epidemic and infectious disease is always the most pressing and urgent matter in any health department. Notifications in respect of infectious diseases have markedly decreased. The cancer death rate is lower, although the ratio of males to females is somewhat higher than in previous years. Difficulty has been experienced in providing accommodation for tuberculous patients, especially the advanced cases. Destruction 5 and damage to property has necessitated the admission of more sufferers to sanatorium, and the number of beds has proved insufficient to meet requirements without a period of waiting. Unfortunately, hospitals to which seriously ill patients were formerly sent, have not been available to us, and plans for increasing accommodation temporarily could not be proceeded with owing to building restrictions. The war-time nurseries provide for the care and instruction of the children whilst the mothers are engaged in war work. Attendances have been maintained and all the places continuously filled. It is with deep regret that I record the death of Dr. F. E. Bendix, who was for many years Deputy Medical Officer of Health and Senior Assistant School Medical Officer. His loss is mourned by a wide circle of friends and patients. I am grateful to the Chairman, Alderman Mrs. A. Taylor, J. P., and members of the Public Health Committee, and to Chairmen and members of other Committees with which I am associated, for their interest and continued support throughout the year, and to my staff and colleagues who have contributed so much to the maintenance of the Public Health, School Medical, Hospital and Casualty Services. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Malcolm Barker, Medical Officer of Health and School Medical Officer. 6 Statistical Conditions of the Area. Area (in statute acres) land and inland water 3,324 Population. Census—1931 142,394 Estimated Civilian Population—1944 91,060 Number of inhabited houses (end of 1944, according to rate books. (Including tenements and shops.) Approx. 30,000 Rateable value at 31st December, 1944 £713,746 Sum represented by a penny rate for the year 1944-45 £2,660 EXTRACTS FROM VITAL STATISTICS. For Birth Rate. Total. Males. Females. Live Births. Legitimate 1,826 941 885 Illegitimate 82 38 44 Still Births. Legitimate 43 18 25 Illegitimate 2 1 1 Deaths: Total, 1,316; Males, 715; Females, 601. Deaths from Puerperal causes:— Deaths. Rate per 1,000 Total (Live and Still Births) Puerperal Sepsis 4 2.04 Other Maternal causes 2 1.02 6 3.06 Death rate of infants under one year of age:— All infants per 1,000 live births 31 Legitimate infants per 1,000 legitimate live births 30 Illegitimate infants per 1,000 illegitimate live births 48 Deaths from Cancer (all ages) 203 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 2 7 STILL BIRTHS. Still births registered numbered 45 compared with 50 for 1943. The rate per 1,000 total (live and still) births was 23.04, the figure for the previous year being 26.1. BIRTHS. The number of live births registered was 1,908, compared with 1,865 for the year 1943, equivalent to a birth rate of 20.9 per 1,000 of the Registrar-General's estimated population. The rate for 1943 was 20.09. BIRTH RATES IN TWO WAR PERIODS. 1914 1915 1916 1917 1918 1919 England and Wales 23.8 21.8 21.0 17.8 17.7 18.5 East Ham 23.5 23.1 20.7 18.0 15.3 16.2 1939 1940 1941 1942 1943 1944 England and Wales 14.9 14.6 14.2 15.8 16.5 17.6 East Ham . 14.4 14.29 15.81 17.4 20.09 20.9 The 1944 rate for England and Wales was the highest recorded since 1925, whereas that for East Ham was the highest recorded since 1922 (21.0). DEATHS. During the year the number of East Ham civilian residents dying was 1,316. This figure is equal to a death rate of 14.4 per 1,000 of the Registrar-General's estimated population. For the previous year the rate was 13.27. DEATH RATES IN TWO WAR PERIODS. 1914 1915 1916 1917 1918 1919 England and Wales 13.6 14.8 14.4 14.4 17.6 13.8 East Ham 10.4 11.7 11.0 12.4 15.1 9.8 1939 1940 1941 1942 1943 1944 England and Wales 12.1 14.3 12.9 11.6 12.1 11.6 East Ham 11.4 16.2 16.1 14.09 13.27 14.4 It will be noted that of the 1,316 deaths, 700, or 53 per cent. occurred in the age-group 65 years and upwards, and 314 of the total deaths or 23 per cent. died from heart disease. Cancer was the cause of 203 or 15 per cent. of the deaths. 8 INFANTILE MORTALITY. The number of deaths of children under one year of age was 59, equal to an infantile mortality rate of 31 per 1,000 live births (48 for 1943), the rate for England and Wales being 46 per 1,000 related births. NEO-NATAL MORTALITY. Children dying under the age of one month totalled 33, equal to a neo-natal mortality rate of 17.3 per 1,000 live births. The rate for the previous year was 23.5. MATERNAL MORTALITY. Maternal deaths numbered 6, the rate for 1944 being 3.14 per 1,000 live births and 3.06 per 1,000 live and still births. Table 1 Puerperal Infection. Other Causes. TOTAL. England and Wales. East Ham. England and Wales. East Ham. England and Wales. East Ham. Per 1,000 Total Births (live and still.) 0.59 2.04 1.34 1.02 1.93 3.06 POPULATION. The Registrar General's estimate of the civilian population for 1944 is 91,060. The figure for the year 1943 was 92,800. Table 3.—CAUSES OF DEATH IN AGE GROUPS. 9a 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 Y ears. 5—15 Years. 15—45 Years. 45—65 Years. 65 and Upwards. M F M F M F M F M F M F M F 1. Typhoid & para-typhoid Fevers 1 - - - - - - - - - 1 - - - 2. Cerebro-Spinal Fever 1 — 1 - - - - - - - - - - - 3. Scarlet Fever - - - - - - - - - - - - - - 4. Whooping Cough 1 - - - 1 - - - - - - - - - 5. Diphtheria 2 1 — — — 1 2 - - - - - - - 6. Tuberculosis of Respiratory System 36 25 - - - 1 1 - 17 16 14 4 4 4 7. Other forms of Tuberculosis 5 9 — 1 2 2 1 2 2 3 — 1 — — 8. Syphilitic Diseases 4 1 - - - - - - - - 3 1 1 — 9. Influenza — 2 - - - - - - - - - - - 2 10. Measles - - - - - - - - - - - - - - 11. Acute Polio-myelitis and Polio-encephalitis - - - - - - - - - - - - - - 12. Acute infective encephalitis 1 - - - 1 - - - - - - - - - 13. Cancer of buccal cavity and oesophagus (M) uterus (F) 7 6 - - - - - - - - 2 2 5 4 14. Cancer of Stomach & duodenum 29 16 - - - - - - 1 — 14 7 14 9 15. Cancer of Breast 1 26 - - - - - - - 2 — 11 1 13 16. Cancer of all other sites 72 46 - - - - - - 1 3 38 15 33 28 17. Diabetes 7 9 - - - - - - 1 — 2 3 4 6 18. Intracranial vascular lesions 60 65 - - - - - - - - 18 14 42 51 19. Heart Disease 167 147 - - - - - 2 6 8 54 20 107 117 20. Other Diseases of Circulatory System 15 19 - - - - - - 1 - 3 7 11 12 21. Bronchitis 34 32 1 — — 1 — — — 1 13 5 20 25 22. Pneumonia 35 24 6 8 1 — — 1 3 — 8 4 17 11 23. Other Respiratory Diseases 6 6 - - - - - - - 1 2 4 4 1 24. Ulcer of Stomach & duodenum 20 2 3 1 11 — 6 1 25. Diarrhoea under two years 2 — 2 - - - - - - - - - - - 26. Appendicitis 4 — — — — — — — — — 2 — 2 - 27. Other Digestive Diseases 12 11 — — 1 — — — — — 7 4 4 7 28. Nephritis 10 11 - - - - - - 2 3 2 2 6 6 29. Puerperal & Post abortive sepsis - 4 - - - - - - - 4 - - - - 30. Other maternal causes — 2 - - - - - - - 2 - - - - 31. Premature birth 12 7 12 7 - - - - - - - - - - 32. Congenital malformations, birth injury, infantile diseases 18 5 12 4 2 - - - 2 1 1 - 1 - 33. Suicide 6 — — — — — - — 2 — 3 — 1 — 34. Road Traffic Accidents 4 1 — — — — 1 — 1 — 1 — 1 1 35. Other violent causes 76 66 1 1 — 2 7 2 18 25 35 19 15 17 36. All other causes 67 58 — 3 — 1 — 2 10 4 10 9 47 39 TOTAL 715 601 35 24 8 8 12 9 70 74 244 132 346 354 9 Table 2.—BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1944. Rate per 1,000 Civilian Population. Annual Death Rate per 1,000 Civilian Population. Rate per 1,000 Live Births. Live Births. Still Births. All Causes. Typhoid and Paratyphoid Fevers. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Smallpox. Measles. Total Deaths under one year. Deaths from Diarrhoea and Enteritis (under two years.) England and Wales 17.6* 0.50* 11.6* 0.00 0.00 0.03 0.02 0.12 0.00 0.01 46† 4.8 126 County Boroughs and Great Towns, including London. 20.3 0.64 13.7 0.00 0.00 0.03 0.03 0.10 0.01 52 7.3 148 Smaller Towns (resident populations 25,000 to 50,000 at Census, 1931.) 20.9 0.61 12.4 0.00 0.00 0.02 0.03 0.11 - 0.01 44 4.4 London—Administrative County 15.0 0.42 15.7 0.00 0.00 0.04 0.01 0.08 — 0.00 61 10.1 East Ham 20.9 0.49 14.4 0.01 — 0.01 0.03 0.02 — — 31 1.04 * Rates per 1,000 total population. † Per 1,000 related births. A dash (—) signifies that there were no deaths. 9b Table 4.-DEATHS IN WARDS, 1944. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. Total. ??? fevers - - - - 1 - - - - - 1 .. - - - - - - - - - 1 1 .. - - - - - - - - - - - .. - - - - - 1 - - - - 1 ???iratory 2 - - - - - 1 - - - 3 .. 8 11 7 2 4 7 4 5 6 7 61 ???losis 2 1 3 1 2 - 3 1 1 - 14 .. - 2 1 - - 1 1 - - - 5 .. - - 2 - - - - - - - 2 ???d polio - - - - - - - - - - - .. - - - - - - - - - - - ???litis - - - - - - - 1 - - 1 ??? and ??? (F) - 3 1 5 - 2 - 1 - 1 13 ???d 2 4 1 7 7 6 4 8 4 2 45 .. 2 1 4 5 4 3 2 3 3 - 27 .. 13 12 11 12 16 8 12 10 11 13 118 .. 2 3 3 1 1 - 3 2 - 1 16 ???sions 23 14 13 9 9 9 10 18 11 9 125 ???ulatory 43 31 28 26 33 28 30 41 19 35 314 .. 3 5 5 1 2 4 6 4 - 4 34 .. 6 13 7 7 11 4 3 2 6 7 66 .. 5 4 5 10 8 3 8 4 2 10 59 ???ses 2 1 3 1 2 - 1 - 2 - 12 ???denum 2 4 4 2 2 1 4 1 2 - 22 ??? - - - - 1 - - - - 1 2 ??? 1 - 1 1 - 1 - - - 4 ??? 4 2 2 3 2 2 4 1 1 2 23 .. 6 2 1 2 4 1 3 1 - 1 21 ???bortive 2 - - - - 1 - - 1 - 4 .. 1 - - - - - 1 - - - 2 .. 3 1 3 - 1 3 1 4 - 3 19 ??? 3 1 1 2 4 2 3 1 2 4 23 .. - - 1 - 1 - 1 1 1 1 6 .. 1 - - - 1 1 1 - 1 - 5 .. 21 16 16 13 4 3 22 20 18 9 142 .. 19 19 8 7 14 9 11 17 12 9 125 .. 175 151 130 117 135 99 140 146 103 120 1,316 10 TABLE 5—INFANT DEATHS UNDER ONE YEAR OF AGE, 1944. Cause of Death. Total deaths. Age and Sex. Total under 1 year. Wards. Deaths in Institutions. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Manor Park. Little Ilford Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. M F M F M F M F M F M F M F M F M F Cerebro-spinal Meningitis 1 — — — — — — — — — — — — 1 — — — 1 — 1 1 Tuberculous Meningitis 1 — — — — — — — — — — — — — — — 1 — 1 i 1 Bronchitis 1 — — — — — — — — 1 — — — — — — — 1 — 1 1 Pneumonia 14 — — — 1 — — — — 1 1 5 4 — 1 — 1 6 8 2 1 2 1 1 3 1 2 11 Diarrhoea, etc. 2 — — — — — — — — 1 — 1 — — — — — 2 — 1 1 2 Congenital Debility and Malformations, Premature Births 35 19 8 2 2 — 1 — — — — 2 — 1 — — — 24 11 5 2 4 2 5 4 I 5 1 6 28 Other Defined Causes 5 — — — — — — — — — — 1 3 — 1 — — 1 4 1 — — — — — 1 1 2 3 All Causes 59 19 8 2 3 — 1 — — 3 1 9 7 2 2 — 2 .15 24 8 3 5 5 7 5 5 7 3 11 47 11 Table 6.-PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for the 52 weeks ending 30th December, 1944. DISEASE. Cases Notified in Whole District. Ward Distribution of Cases. Number of cases Removed to Hospital. Total Deaths in Borough. At all ages - years. Manor Park Little Ilford. 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 132 - 35 51 30 11 5 - - - 8 11 8 15 15 16 12 31 15 11 110 - Diphtheria 33 - 9 8 7 7 2 - - - 7 5 1 2 1 4 5 3 - 5 33 3 Typhoid Fever - - - - - - - - - - - - - - - - - - - - - 1† Para-Typhoid Fever - - - - - - - - - - - - - - - - - - - - - Erysipelas 18 1 - - - 5 - - 12 - - 5 2 5 1 1 3 - - 1 5 - Puerperal Pyrexia 8 - - - - - 8 - - - - - 1 - 1 - 2 2 1 1 6 - Pneumonia 50 5 - 4 - 16 - - 15 10 7 7 5 2 10 4 2 5 2 6 15 59 Ophthalmia Neonatorum 4 4 - - - - - - - - - 2 1 - - - - - - 1 2 - Dysentery 5 - - 4 - - - 1 - - - - 1 - - - 1 3 - - 5 - Meningococcal Meningitis 3 1 - 1 - 1 - - - - - - - - - 3 - - - - 3 1 *Measles 258 6 72 81 48 37 14 - - - 5 8 20 9 5 23 25 80 44 39 21 - *Whooping Cough 293 35 176 71 2 4 5 - - - 32 38 23 10 34 48 38 23 38 14 22 1 * Notifiable for Duration of War. † Inward transferable death. 12 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 7. The death rate was 0.07 per 1,000 population, as compared with a rate of 0.15 for 1943. 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: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 and over 672 254 63 989 Whooping Cough Immunisation. In March 1944, immunisation against Whooping Cough was commenced and up to 31.12.44, the number of children dealt with was as follows:— No. of inoculations No. of children completely immunised Manor Park Clinic 1,049 11,494 228 [331 Town Hall Annexe Clinic 445 103 All under 5 years of age. Cancer. No investigations have been undertaken, as requested in the Ministry of Health's series of Circulars on Cancer. Patients are 13 referred to the general hospitals for investigation and special treatment. Classification. Carcinoma 196 Sarcoma 3 Rodent Ulcer 1 Unstated 3 Total 203 Cancer Deaths, 1944. Total deaths 203 Males 109 Females 94 14 Tabls 7.—CANCER DEATHS—PARTS OF BODY AFFECTED. Parts of Ages Body Affected Sex 0—1 1—2 2—5 5—15 15—25 25—35 35—45 45—55 55—85 65—75 75 and upward Total M F M F M F M F M F M F M F M F M F M F M F M F Buccal cavity and Pharynx - - - - - - - - - - - - - - - - - - - 1 - - - 1 Digestive Organs and Peritoneum - - - - - - - - - - 2 - - - 8 3 14 13 20 14 10 6 54 36 Respiratory Organs - - - - - - - - - - - - - - 5 - 19 1 5 1 5 1 34 3 Uterus - - - - - - - - - - - - - - - 1 - 1 - - - 4 - 6 Other female genital organs - - - - - - - - - - - - - 1 - - - - - 2 - 1 - 4 Breast - - - - - - - - - - - - - 2 - 4 - 7 1 4 - 9 1 26 Male Genitourinary Organs - - - - - - - - - - - - - - - - 4 - 4 - 1 - 9 - Skin - - - - - - - - - - - - - - - - 1 - - - 1 - 2 - Other or unspecified organs - - - - - - - - - - - - - 2 1 1 2 4 5 8 1 3 9 18 Total - - - - - - - - - - 2 - - 5 14 9 40 26 35 30 18 24 109 94 15 INFECTIOUS DISEASES HOSPITAL. Observations are contained in the following report on the year's work:— PREFACE. The incidence of infectious disease was remarkably low during 1944. The daily average number of patients in the Isolation Block was only 14. This is probably partly due to the large scale evacuation of children, but it must also be the result of increased resistance to infection. I attribute this to the Government provision of milk, codliver oil, and orange juice for the children and the good work of the Infant Welfare Clinics. The Staff, both indoor and outdoor, have worked loyally and well throughout the year, to the complete and expressed satisfaction of the patients and their relatives. STATISTICS. (A) Diphtheria (Uncorrected for Diagnosis): In hospital on December 31st, 1943 10 Admitted during 1944 38 Discharged during 1944 39 Died during 1944 2 Remaining in Hospital on December 31st, 1944 7 (B) Scarlet Fever (Uncorrected for Diagnosis): In Hospital on December 31st, 1943 14 Admitted during 1944 114 Discharged during 1944 123 Died during 1944 - Remaining in Hospital on December 31st, 1944. 5 (C) Miscellaneous (Uncorrected for Diagnosis): In Hospital on December 31st. 1943 7 Admitted during 1944 53 Discharged during 1944 60 Died during 1944 - Remaining in Hospital on December 31st, 1944 - 16 DIPHTHERIA. Number of Notified Cases 38 Revision of Diagnosis 9 Tonsillitis 4 Scarlet Fever 1 Pertussis 1 Peritonsillar Abscess 1 No evidence of Infectious Disease 2 Final number of Diphtheria Cases 29 Number of Cases of Diphtheria occurring in immunised children 6 Table 8.—SHOWING TYPES OF DIPHTHERIA AND MORTALITY. Type. Total. Died. Mortality Rate. Faucial 20 - - Laryngeal 5 1 20% Faucial and Nasal 3 — - Faucial, Nasal and Laryngeal 1 1 100% 29 2 6.9 Table 9.—SHOWING SERUM ADMINISTRATION. 8,000 16,000 24,000 32,000 64,000 128,000— Total. 7 5 8 9 3 6 38 The operation of tracheotomy was performed on one occasion. Table 10.—SHOWING AGE INCIDENCE OF DIPHTHERIA. 0— 5— 10— 15— 20— 25— Total. 8 7 8 2 2 2 29 17 Serum Reaction. There were 2 cases of reaction due to administration of antidiphtheritic Serum. Bacteriological Examinations. 400 Swabs were examined for Diphtheria Bacilli and 33 were found to be positive. Cases of Concomitant Disease. There were two cases of Diphtheria with Pertussis. Scarlet Fever. Number of Notified Cases 114 Revision of Diagnosis 15 Rubella 6 Infantile Erythema 3 Camphorated Oil Rash with Mastoiditis 1 No evidence of Infectious Disease 5 Other Notified Cases proving to be Scarlet Fever 1 Final number of Scarlet Fever Cases 100 Cases with Concomitant Disease—23. Complications. Cervical Adenitis 1 Rhinitis 11 Otorrhoea 3 Endocarditis 1 Myocarditis 1 Mastoiditis 1 Rheumatism 1 Total 19 Serum Complications. There were 3 cases of Serum Urticaria out of 21 cases treated with Anti-streptococcal Serum. 18 I treated the 79 other Scarlet Fever patients with sulphonamides and an alkaline mixture with excellent results. The number of complications is considerably less than in those treated with serum and the pain and discomfort of an injection, and the frequent serum rash are thus avoided. There were no deaths. Whooping Cough. Number of Notified Cases 16 Revision of Diagnosis 1 Of these 15 Cases:— Uncomplicated Whooping Cough Cases 5 Whooping Cough and Broncho Pneumonia 10 There were no deaths. Measles. Number of Notified Cases 11 Of these 11 Cases:— Uncomplicated Measles 9 Measles and Broncho Pneumonia 1 Measles and Nasal Diphtheria 1 There were no deaths. Cerebro Spinal Meningitis. Number of Notified Cases 5 Revision of Diagnosis 3 Otitis Media with vomiting and Pyrexia 1 Rubella 1 Central Pneumonia 1 Two patients proved to be cases of Cerebro Spinal Meningitis Both completely recovered with Sulphapyridine treatment. Operations. Lumbar punctures 4 Incision of Abscesses 2 Tracheotomy 1 Laboratory Work. Bacteriological examination of faeces 4 Bacteriological examination of urine 4 Cerebro Spinal Fluid examinations 4 19 4 Cases of pulmonary tuberculosis were admitted and later transferred to Naburn, Yorks. There were no return cases of Infectious Disease throughout the year. Table 11 .—ADMISSIONS AND DISCHARGES FOR 1944. (After correction for Diagnosis). Disease. Remaining at end of 1943. Admitted during 1944. Died During 1944. Discharged during 1944 Remaining at end of 1944. Diphtheria 10 29 2 30 7 Scarlet Fever 14 100 — 109 5 Cerebro-spinal Meningitis. - 3 - 3 - Chicken Pox — 1 — 1 - Otitis Media with Vomiting and Pyrexia - 1 - 1 - Central Pneumonia — 1 — 1 - Rheumatic Fever — 1 — 1 - Acute Anterior Poliomyelitis - 1 - 1 - Acute Bronchitis — 2 — 2 - Follicular Tonsillitis — 4 — 4 - Peritonsillar Abscess — 1 — 1 - Infantile Erythema — 3 — 3 - Malnutrition — 1 — 1 - Measles — 9 — 9 - Measles and Bronchopneumonia - 1 - 1 - Measles and Rhinitis — 1 — 1 - No evidence of Disease — 7 — 7 - Rubella — 7 — 7 - Scabies and Scarlet Fever — 2 — 2 - Camphorated Oil Rash plus Mastoiditis - 1 - 1 - Tonsillitis — 5 — 5 - Whooping Cough — 6 — 6 - Whooping Cough and Broncho-pnuemonia 7 10 17 - Pulmonary Tuberculosis — 4 — 4 - Infective Parotitis — 2 2 - Urticaria — 1 — 1 - Domestic Rash — 2 — 2 - Total 31 208 2 223 12 20 Table 12.—DIPHTHERIA PROPHYLAXIS. Return for Period Ending 31st December, 1944. Age under 5 years. Age 5 years and 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 January and 31st December, 1944. 583 406 989 II. Under 5. Between 5 and 15. (A) Approximate estimated number of children in the Authority's area at 31st December, 1944. 8,400 9,200 (B) What percentage of the child population shown under (A) is it considered were immunised at 31st December, 1944. 55% 70% III. (A) Number of cases of Diphtheria in children under 15 years of age notified and diagnosis confirmed between 1st January and 31st December, 1944 24 (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, 1944, of children under 15 years of age 3 (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. One application made in 1944, compared with none in 1942 and 1943, and 6 in 1941. MIDWIVES ACTS, 1902-1936. The number of midwives who notified their intention to practise in the area during 1944 was 28. Of this number 14 worked in connection with the Maternity Hospital and District Nurses Home, Plaistow, and its Branches, 1 from Tate's Nurses' Home, Silvertown, 7 from East Ham Memorial Hospital, and 6 practised independently, including three Municipal Midwives. 21 PLAISTOW MATERNITY HOSPITAL AND DISTRICT NURSES HOME. Summary of Cases 1944. Midwifery 213 Monthly 91 Hospital 188 LABORATORY FACILITIES. The same facilities exist as detailed in previous reports for the examination of specimens. East Ham Memorial Hospital. Sputa for Tuberculosis 639 Sputa for Malignant Cells 4 Sputa for Asbestosis 6 Blood Sedimentation Rate 70 Mantoux Test for Tuberculosis 22 Other specimens for Tuberculosis 35 Wassermann (Venereal Diseases) 1 Cervical Smears for Gonococci 6 Other specimens 18 Total 801 Oldchurch County Hospital. Faeces for Food Poisoning 1 Cervical Smear for Gonococci 1 Total 2 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 549 729 5 25 544 704 Infectious Diseases Hospital 180 20 160 AMBULANCE FACILITIES. The two Town Ambulances which formerly operated from the Fire Station, were handed over to the A.R.P. Ambulance Section on the outbreak of war and are now available at the Ambulance Depot (Napier Road), Grangewood 3419. Two Ambulances, in addition, are used for the removal of infectious cases. 22 SOCIAL WELFARE DOMICILIARY MEDICAL SERVICE. Table 13.—Statistical Return fob the Year Ending 31st December, 1944 Number of Attendances at Homes. Number of Attendances at Surgery. Total Number of Attendances. Number of Occasions Medicines supplied without seeing Patients 1,350 5,585 6,935 322 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. Syphilis 18 Soft Chancre 1 Gonorrhoea 48 Not Venereal 101 Total 168 Total attendances of all patients 2,786 Total number of in-patient days — Pathological Examinations. For, or at the Centres:— Spirochaetes — Gonococci 665 Wassermann 343 Others 972 Total 1,980 For practitioners:— Spirochaetes — Gonococci 1 Wassermann 14 Others 14 Total 29 23a TABLE 14. STATISTICAL RETURN OF REGISTERED BLIND PERSONS AS AT 31st MARCH, 1945. Number of Home Teachers Engaged in Area—One. AGE PERIODS OF REGISTERED BLIND PERSONS. Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Unknown Total of all Age Groups 0—1 1—5 5—16 16—21 21—40 40—50 50—65 65—70 70 and over M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. — — — 1 — 1 — 1 1 2 3 5 12 8 20 14 12 26 20 24 44 8 16 24 41 63 104 — — — 98 127 225 AGES AT WHICH BLINDNESS OCCURRED. Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Total of all 0—1 1—5 5—10 10—20 20—30 30—40 40—50 50—60 60—70 70 and over Unknown Age Groups M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 15 13 28 — 1 1 5 5 10 6 4 10 12 6 18 8 10 18 13 14 27 10 17 27 16 25 41 10 29 39 3 3 6 98 127 225 CHILDREN OF SCHOOL AGE, 5—16. TRAINING AND EMPLOYMENT AND UNEMPLOYMENT. Age Period 16 and upwards. Normal Mentally Defective Physically Defective Employed Undergoing Training Unemployed (k) Total (1) "Unemployables" in (j) over age 70 M. F. M. F. M. F. By Blind Organisations (c) All others not included in (a) and (b) (d) Total Employed (e) Industrial (f) Secondary (g) Professional and University (h) Trained but unemployed (i) No Training but Trainable (j) Unemployable In Schools for the Blind — — — — — — (a) (b) Other Schools — — — — — — M. F. T. M. F. T. M. F. T. M. F T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Not at School — — — 1 — — 6 5 11 2 1 3 13 3 16 21 9 30 2 2 4 — — — — — — — 1 1 2 1 3 72 113 185 97 126 223 40 63 103 OCCUPATIONS OF EMPLOYED BLIND PERSONS. Agents, Collectors, etc. Basket Workers Bedding (including Divans and Ottomans) and Upholstering Boot Repairers Braile Copyists and Proof Readers Brush Makers Carpenters and Woodworkers Chair Seaters Clerks and Typists Coal Bag Makers Dealers, Tea Agents, Newsagents Shopkeepers Firewood Workers Gardeners Hawkers, Newsvendors, etc. Home Teachers Knitters Labourers Massage Mat Makers Ministers of Religion Musicians and Music Teachers Netting Makers Porters, Packers Cleaners Poultry Farmers School Teachers Ships Fender (Fendoff) Makers Telephone Operators Tuners Weavers Miscellaneous In Sighted Industry Total Mattress Makers Machinists. Upholsterers Hand Machine (a) Within Institutions for the Blind 3 2 — — — — 1 — — — — — — — — — — 3 — — — — — — — — — — — — 2 — — 11 (b) In approved Home Workers' Schemes — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — 2 — — — 3 (c) Others (not Pastime Workers) — 1 — — — 2 — — — — 1 — 1 — — — — — — 2 2 — — — — 1 — — — 4 — — 1 1 16 (d) Total — 4 2 — — 2 — 1 — — 1 — 1 — — — — — 3 2 2 — — 1 — 1 — — — 4 2 2 1 1 30 PHYSICALLY AND MENTALLY DEFECTIVE (including those Children 5—16). UNEMPLOYABLE PERSONS RESIDENT IN HOMES FOR THE BLIND. MENTAL HOSPITALS OR PUBLIC ASSISTANCE INSTITUTIONS. (a) Mentally Defective (b) Physically Defective (c) Deaf Combinations of (a) and (b) Combinations of (a) and (c) Combinations of (b) and (c) Combinations of (a), (b), (c) Total Deaf Mutes included in (c) Homes for the Blind Sunshine Homes Mental Hospitals Public Assistance Institutions M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. T. M. F. T. M. F. T. M. F. T. 5 6 11 5 6 11 6 10 16 1 2 3 — — — — — — — — — 17 24 41 1 1 2 2 2 — — — 3 4 7 3 12 15 NEW CASES REGISTERED (NOT TRANSFERS FROM OTHER REGISTERS) DURING THE YEAR ENDED 31st MARCH, 1945. AGE PERIODS. Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Unknown Total of all Age Groups 0—1 1—5 5—16 16—21 21—40 40—50 50—65 65—70 70 and over M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. F. M. F. T. M. F. T. — — — — — — — — — — — — — — — — 2 2 — — — — — — 3 3 6 — — — 3 5 8 NEW CASES REGISTERED (NOT TRANSFERS FROM OTHER REGISTERS) DURING THE YEAR ENDED 31st MARCH, 1945. AGES AT WHICH BLINDNESS OCCURRED. Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Total of all 0—1 1—5 5—10 10—20 20—30 30—40 40—50 50—60 60—70 70 and over Unknown Age Groups M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. — — — — — — — — — — — — — — — — — — — 2 2 — — — — — — 3 3 6 — — — 3 5 8 23 Venereal Diseases Rules, 1942—33B. Contacts notified to the Medical Officer of Health during the period 1st January, 1944, to 31st December, 1944:— M. F. (1) Total number in respect of whom Form I was received — 10 (2) Number of cases in (1) in which attempts were made outside the scope of the Regulation to persuade the contact to be examined before the latter had been named on a second Form I:— Contacts found — 4 Contacts examined — 4 (3) Number of those in (1) in respect of whom two or more Forms I were received 2 (4) Number of those in (3) who were:— (a) found — 2 (b) examined after persuasion — — (c) served with Form 2 — 2 (d) examined after service of Form 2 — 2 (e) prosecuted for failure:— (i) to attend for, and submit to, medical attention — — (ii) to submit to and continue treatment — — RUNWELL MENTAL HOSPITAL. Mental patients are accommodated in Runwell Mental Hospital, Essex, belonging to the Joint Authority of County Boroughs of East Ham and Southend-on-Sea. Statistics and other information relating to the Hospital are contained in the Annual Report for 1944. 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. BLIND PERSONS ACTS, 1920-1938. The attached Tables shew the statistical record of the registration of blind persons, as at 31.3.45:— 24 MENTAL DEFICIENCY ACTS, 1913-1938. Ascertainment. The number of cases ascertained for the first time during the year 1944 was 16, and they were dealt with as under:— 4 placed in institutions (under Order) (one admission pending). 7 placed under statutory supervision. 2 placed under friendly care. 1 declared uncertifiable. 1 referred to Essex County Council. Provision of Institutional Accommodation. Whilst the difficulty experienced in obtaining institutional accommodation generally has been relieved by the erection of South Ockendon Colony, this continues in respect of the placing of low grade cases. Guardianship. There are 35 cases under guardianship, of whom seven have evacuated to other areas. During the year six males were transferred under Varying Orders to institutional care. Supervision. There are 125 mental defectives under statutory supervision in their own homes plus 15 who are still evacuated to other areas. A number have removed since the war began and are untraceable. A fair percentage of the cases are absorbed into unskilled employment. All the cases are visited at varying intervals and reports filed, helpful advice being given with regard to their management, training, etc. Parents rarely show any resentment to these visits. 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. 25 In some 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 20 defectives (11 males and 9 females) granted licence during the year, 10 are at work and doing fairly well, 7 have been recalled to institutional care, and 2 have been 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. 26 Statistics. Table 15.—COMPARISON WITH PREVIOUS YEAR : 1944. 1943. M. F. Total. M. F. Total. A.I. Under Order: (a) (1) In Institutions (excluding cases on licence): Under 16 years of age 12 7 19 11 5 16 16 years and over 65 59 124 64 54 118 (2) On Licence from Institutions: Under 16 years of age 1 — 1 — — — 16 years and over 4 4 8 5 7 12 (b) (1) Under guardianship (excluding cases on licence): Under 16 years of age 2 — 2 — — — 16 years and over 14 18 32 19 18 37 (2) On Licence from guardianship: Under 16 years of age — — — 1 — 1 16 years and over 1 — 1 — — — 2. In ''places of safety'' Under 16 years of age — — — — — — 16 years and over — — — — — — 3. Under statutory supervision 67 58 125 71 63 134 (of whom awaiting removal to Institutions) — 1 1 1 1 4. Action not yet taken under any one of the above headings 5 7 12 4 4 8 B. No. 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 section 3 — — — — — — 2 Reported to local authority from any reliable source and recognised by them as m.d., but as to whom no action under the M.D. Acts has been taken:— (a) children between ages of 14— 16 years — — — — — — (of whom, number, if any, under voluntary supervision) — — — — — — (b) all other cases 20 23 43 18 19 37 (of whom, number, if any, under voluntary supervision) 16 19 35 18 12 30 Number of above Cases on Register of Occupation Centre: 17 12 29 17 12 29 Cases notified by Local Education Authorities (section 2 (2)) during the year:— Method of disposal:— Sent to Institutions (By Order) — 1 1 4 — 4 Placed under Guardianship (By Order) — — — — — — Placed under Statutory Supervision 3 2 5 2 3 5 Placed in "places of safety'' — — — — — — Died or Removed from area — 1 1 — — — Action not yet taken:— (a) in receipt of poor relief — — — — — — (b) others — — — 1 — 1 Of the total number of mental defectives known to the local authority:— (a) Number who gave birth to children during:— 1944 1943 (1) After marriage One Nil (2) While unmarried Nil Nil (b) Number who married 2 males 1 female 27 Table 16.—MENTAL DEFICIENCY ACTS, 1913-1938. Statistics—January, 1938-January 1945. YEAR Under Order In places of safety Under statuary supervision Under permissive powers. Under Friendly Care TOTAL In Institutions Under Guardianship. 1938 112 33 1 157 5 50 358 1939 109 39 10 154 5 51 368 1940 109 41 26 111 5 49 341 1941 119 41 12 110 4 50 337 1942 138 40 — 113 5 40 336 1943 146 38 — 134 6 34 359 31/12/44 al53 b35 — cl25 d5 e35 353 a including 9 on Licence, 4 deceased during year, 2 discharged during year, 1 case awaiting admission to Ockendon. b including 1 on licence and 7 evacuated other areas, 6 transferred to institutional care during the year, c excluding 13 evacuees, 3 joined H.M. Forces, (many removed and untraceable d 1 deceased. e 3 joined H.M. Forces, (several removed and untraceable.) 28 THE INVALID CHILDREN'S AID ASSOCIATION. The Authority is indebted to the local branch of the Association for its invaluable service to the invalid children of the Borough. The types of new cases dealt with in 1944 were as follows:— Tuberculosis 6 Anaemia and Debility 7 Rheumatism, Heart and Chorea 7 Lung conditions (non-tuberculous) 46 Marasmus and Malnutrition 18 Various 43 Total 127 SCABIES CLINIC AND TREATMENT CENTRE. The following statistics are appended:— Number of New Cases Attending. 1942 1943 1944 Scabies Clinic 478 969 520 Treatment Baths: Patients. No. of Baths. 1942 674 1,947 1943 622 1,689 1944 584 1,481 WARTIME NURSERIES. As indicated in my last report, 2 new nurseries were opened during 1944:— Wall End Road/Caledon Road on 12.6.44. St. Stephen's Road on 24.7.44. The accommodation of the five war-time nurseries is as follows:— No. of Places. Brampton Road 70 Kensington Avenue 50 School Road 50 Wall End Road/Caledon Road 50 St. Stephen's Road 74 Total 294 I have previously commented on staffing difficulties. This problem, particularly as regards wardens, still persists. 28a RETURN RELATING TO MATERNITY HOSPITAL (WARD) SUBSIDISED BY THE COUNCIL DURING THE YEAR 1944. 1. Name and address of Institution—East Ham Memorial Hospital, Shrewsbury Road, E.7. la. Whether Municipal or Voluntary—Voluntary. 2. Number of Maternity beds in the Institution (exclusive of isolation and labour beds) at 31st December, 1944—16. 2a. Number of beds, if any, included under item 2, which have been reserved for expectant mothers in need of hospital treatmentNil.* 3. Number of maternity cases admitted during the year—377.Ø 3a. Number of women treated during the year in the ante-natal beds shown against item 2a. (These women should be included also against item 3)—50* 3b. †Average duration of stay of expectant mothers shown against 3a.—8.0 days. 4. †Average duration of stay of cases in the lying-in wards—14.5 days. 5. ‡Number of cases delivered by— (a) Midwives 302 (b) Doctors 25 327. 6. Number of cases in which medical assistance was sought by a midwife in emergency—25. 7. Number of cases admitted after delivery—1 8. Number of cases notified as—- (а) §Puerperal fever—Nil. (б) ||Puerperal pyrexia—Nil. 9. Number of cases of pemphigus neonatorum—-Nil. 10(a) Number of infants, who have at any time received a supplementary or complementary feed while in the Institution—12. (b) Number of infants wholly breastfed on leaving the Institution— 308. 11. Number of cases notified as Ophthalmia Neonatorum—Nil. 12. Number of maternal deaths—Nil. 13(a) No. of Stillbirths—-5 13(b) Cause in each case and results of post-mortem examination (if obtainable). 1. Eclampsia of mother. 2. Macerated premature infant—emergency from district. 3. Prolapsed cord. 4. 2nd Twin—prolapsed cord. 5. Cord round neck 4 times—died from asphyxia before delivery. 14(a) Number of infant deaths within 10 days of birth—8. (b) Cause of death in each case and results of post-mortem examination (if obtainable). 1. Prematurity 28 weeks due to pregnancy toxaemia. 2. Spina bifida. 3. Intercranial haemorrhage. 4. Prematurity 30 weeks. 5. Numerous deformities. 6. Prematurity due to pregnancy toxaemia. 7. 2nd twin died prematurely. 8. Prematurity 30 weeks. *Although no beds were reserved for expectant mothers, 50 such cases received hospital treatment in the 16 maternity beds. †Based on the actual number of days each patient stayed. ‡Students cases should be included under (a) unless they were delivered by a doctor. §In London only. ||i.e., rise of temperature to 100.4° F. for 24 hours, or its recurrence within that period. ØThis represents number of admissions not number of individual cases. 29 Maternity and Child Welfare. TABLE 17. 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 (6) Normally employed by other Local Supervising Authorities but temporarily working in the area — — — (c) Employed by other Welfare Councils:— (i) Under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 — — — (ii) Others — — — (d) Employed by Voluntary Associations:— (i) Under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 15 — 15 (ii) Others — 7* 7* (e) In private practice 3 — 3 Totals 21 7 28 Number of cases in the area of the Local Supervising Authority attended during the year by Midwives:— (a) Employed by the Council:— As Midwives 211 — 211 As Maternity Nurses 31 — 31 (b) Normally employed by other Local Supervisory Authorities but temporarily working in the area As Midwives — — — As Maternity Nurses — — — (c)Employed by other Welfare Councils:— (i) Under arrangements made with the Local Supervisory Authority in pursuance of Section 1 of the Midwives Act, 1936 As Midwives — — — As Maternity Nurses — — — (ii) Others As Midwives — — — As Maternity Nurses — — — (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 218 — 218 As Maternity Nurses 91 — 91 (ii) Others:— As Midwives — 302 302 As Maternity Nurses — 25 25 (e) In Private Practice:— As Midwives 89 — 89 As Maternity Nurses 15 — 15 TOTALS:— As Midwives 518 302 820 As Maternity Nurses 137 25 162 *Employed by Voluntary Hospital (East Ham Memorial). 30 Medical Aid. 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 141 (ii) For cases in Institutions 25 Total 166 Health Visiting. (a) Number of Health Visitors employed at the end of the year:— (i) by the Council 6 full time and 1 part-time (ii) by Voluntary Associations 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 6 full time and 1 part-time (ii) In the case of Health Visitors employed by Voluntary Associations Nil. (c) Number of visits paid during the year by all Health Visitors working in the area:— (i) To expectant mothers First Visits 1,293 Total Visits 1,379 (ii) To children under one year of age First Visits 1,791 Total Visits 6,254 (iii) To children between the ages of 1 and 5 years Total Visits 6,165 Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council (Open at 31.12.44) 2 (b) Number of Centres provided and maintained by Voluntary Associations. (Open at 31.12.44) 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 1,116 (ii) Between the ages of one and five years 210 (d) Total number of children under five years of age who attended at the Centres during the year and who, at the end of the year, were:— (i) under one year of age 905 (ii) over one year of age 1,537 There were 13,108 attendances at the Clinics and 4,248 consultations. Ante-Natal and Post-Natal Services. AnteNatal PostNatal (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 at 31.12.44 2 — (ii) Number of Clinics provided and maintained by Voluntary Organisations, open at 31.12.44 2 — (iii) Total number of women who attended at the Council Clinics during the year 1,701 48 (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 — — There were 5,890 ante-natal and 48 post-natal consultations at the Clinics. 31 Maternity Fees Collected and Sale of Dried Milk, etc. It is interesting to note that during the year the following amounts were collected at the Clinics:— £ s. d. Fees for Maternity Hospital Accommodation 2,560 3 10 Fees for Municipal Midwifery 151 14 3 Sale of Dried Milk and Ancillaries 1,333 19 11 Total £4,045 18 0 Cases of Ophthalmia Neonatorum notified during the year in which:— (a) Vision was unimpaired 3 (b) Vision was impaired — (c) Vision was lost — (d) The patient was still under treatment at the end of the year 1 (e) The patient died — (/) The patient removed from the district — (g) Classification under the above heads cannot be made — Total 4 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. During 1944, 327 cases were admitted to East Ham Memorial Hospital, 335 to Forest Gate Hospital, and 1 to Queen Mary's Hospital. Other mothers were evacuated to Maternity Hospitals outside London. Inspection of Midwives. Visits of inspection, as necessary, were paid during the year and the midwives' work, including records, was satisfactory. 32 CHILD LIFE PROTECTION. Child Life Protection (Section 206 to 220 of the Public Health Act, 1936). TABLE 18 (i) Individual fostermothers . (ii) Persons in charge of Voluntary Homes and Institutions. (iii) Persons in charge of Residential Nurseries, etc. run for profit. (iv) Total (a) Persons who were receiving children under nine for reward apart from their parents at the end of the year: 14 — — 14 (b) Number of children: (i) at end of year 14 — — 14 (ii) who died during the year 1 — — 1 (iii) on whom inquests were held during the year Nil. — — Nil. The number of foster-mothers (if any) who are guaranteed payment by the Welfare Authority—Nil. (c) Number of premises which were wholly or partially exempted under Section 219 (1) (b), (2) or (3) of the Public Health Act, 1936— Nil. (d) Number of Child Protection Visitors at the end of the year who were Health Visitors—7. (e) Number of persons (in addition to or in lieu of Visitors under (c) above) or societies authorised to visit under the proviso to Section 209 (2) of the Public Health Act, 1936—Nil. (f) Proceedings taken during the year—Nil. Adoption of Children (Regulation) Act, 1939. (а) Number of persons who gave notice under Section 7 (3) during the year—23. (b) Total number of children in respect of whom notice was given under Section (3) during the year—23. (c) Number of children notified under Section 7 (3):— (i) Under supervision at the end of the year—10. (ii) Who died during the year—Nil. (iii) On whom inquests were held during the year—Nil. (d) Particulars of any proceedings taken during the year—Nil. Orthopaedic Treatment. Cases are referred to the East Ham Memorial Hospital, and Queen Mary's Hospital, Stratford, under similar arrangements to the School Medical Service. 33 Table 19.—REGISTRATION OF NURSING HOMES. (Sections 187 to 194 or the Public Health Act, 1936.) Return of the Work of the Council during 1944. 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 — — — — Premature Infants. Care of Premature Infants—Circular 20/44. (a) Do the Notification of Birth Cards provide space for the weight at birth when this is 5½ lbs. or less? No.* (6) If so, (i) the date on which these cards came into use. — (ii) The number of babies notified who weighed 5½ lbs. or less at birth — (c) Which of the recommendations in (i) Paragraph 2 (b) to (f) and (ii) Paragraph 3 of the Circular have the Council been able to implement? (b) to (d)—No. (e) and (/)—Yes. Infants would be admitted to Plaistow Maternity Hospital. (d) Has a special form of transport for the conveyance of these infants to hospital been provided? No. (e) What arrangements have been made between the hospitals and the Welfare Authority to insure the follow-up of the infants on discharge? Reports received from hospitals on every mother and child discharged and cases followed up. *Cards have now been printed. 34 Dental Treatment—M. & C. W., 1944. Expectant and Nursing Mothers:— No. of Patients Treated 63 No. of Scalings 18 No. of Teeth filled 26 No. of Teeth extracted 182 Children under 5:— No. Treated 82 No. of Teeth filled 27 No. of Teeth extracted 322 Home Helps. (i) Is a Home Help Scheme in operation?—Yes. (ii) How many Home Helps are employed? (a) whole-time—1. (b) part-time—1 at end of year. (iii) In how many cases were Home Helps provided under the above arrangements during the year?—54. Administration of Analgesics. (a) Number of midwives in practice in the area qualified to administer analgesics in accordance with the requirements of the Central Midwives Board:— (i) in institutions—1 (ii) domiciliary—Nil Total—1. (b) Are facilities provided to enable midwives practising in the area to attend courses of instruction in the administration of analgesics in institutions approved by the Central Midwives Board for the purpose? Nat possible to arrange courses at present. (c) Is apparatus for the administration of analgesics supplied to domiciliary midwives by the Council? See reply to (b) above. (d) In how many cases were analgesics administered by midwives in domiciliary practice during the year?—Nil. Dr. MacLaren submits the following observations:— During the year 1944 the general physical condition of the children under 5 years of age has been good, and on the whole the 35 standard of cleanliness satisfactory. There is little doubt that the thorough supervision, help and educational work carried out by the Health visiting staff in the homes, often under difficult conditions, has been responsible for the high standard of health amongst the infant population. Infant Welfare Clinics. Throughout the year the attendances at the Infant Welfare Clinics have been surprisingly high in spite of the difficult domestic problems the mothers require to face, and the fact that many mothers are working, and their children being cared for in Day Nurseries. Sunlight Clinic. Two sessions per week are held for infants under 5 years, who have been referred for treatment. Immunisation Clinics. Two clinics are held for immunisation against Diphtheria and Whooping Cough. Intensive propaganda has been carried out by the Health Visiting Staff with the result that the clinics are well attended and a high percentage of children under 5 years have been protected against these diseases. Ante-Natal Clinics. During 1944 the number of expectant mothers attending the ante-natal clinics has steadily increased, partly due to the great demand for maternity hospital accommodation. 1943 1944 No. of cases referred to East Ham Memorial Hospital 24 327 No. of cases referred to Forest Gate Hospital 441 335 No. of cases referred to Queen Mary's Hospital 1 1 466 663 It was anticipated that the opening of the Maternity Block of the East Ham Memorial Hospital would do much to alleviate the 36 Council Ante-Natal Clinics; this has not proved to be the case as is shown by the following statistics:— 1943 1944 Total number of individual expectant mothers who attended the Council Ante-natal Clinics 1,575 1,701 The housing shortage, and the lack of domestic help available in the homes continue to be a serious problem as it of necessity limits the number of patients referred to the Municipal Midwives. PULMONARY TUBERCULOSIS. Memorandum 266/T. Maintenance allowances to patients suffering from pulmonary tuberculosis receiving treatment from the Tuberculosis and Chest Clinic, and Institutional treatment commenced on 1.7.43. From that date to 31.12.44, 140 patients received such allowances in accordance with the terms of the above Memorandum. TUBERCULOSIS AND CHEST CLINIC. Notifications. The number of primary notifications of all forms of tuberculosis during the year 1944 was 198, as compared with 264 for 1943. Of the primary notifications of pulmonary tuberculosis, in 13.0 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, 1944, was 979 (pulmonary and non-pulmonary) or 10.7 per 1,000 estimated population, as opposed to 949 or 10.2 per 1,000 population in the previous year. Deaths. The number of deaths (1940-1944) from tuberculosis is shown below:— Pulmonary. Non-Pulmonary. Of Cases on the Clinic Register. 1940 88 13 81 1941 78 8 58 1942 53 15 55 1943 80 7 73 1944 61 14 63 37 New Cases. The following are the comparative figures for the years 1940-1944: 1940 1941 1942 1943 1944 New Cases and Contacts 582 657 997 1,317 1,034 Number proved after complete investigation to be tuberculous % % % % % 21.99 19.77 15.65 17.61 15.75 Year. Number of Notified Cases on Clinic Register on 31st December Number of Attendances During Year Number of Medical Examinations During Year 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 1944 979 6,057 3,969 Consultations at Homes of Patients. During the year 30 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. 1940 1941 1942 1943 1944 1,132 1,220 1,575 1,844 1,628 Dr. Philip Ellman, Consultant Physician, reports on the work of the Chest Clinic, as follows:— Attendances. 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 amongst the highest on record. The percentage of these new cases proving to be tuberculous is 15.75, i.e., less than one in six cases. The diagnostic service provided by the Chest Clinic continues to be fully utilised by the local practitioners, as well as the diagnosis and advice on treatment of the large number of non-tuberculous pulmonary cases. Chest Service. 38 Problems in differential Diagnosis.—The large number of Chest cases referred during the year as suspected cases of Pulmonary Tuberculosis which have proved on investigation to be due to diseases of the lungs other than tuberculosis is noteworthy. Cancer of the Lung continues to figure high in the list in the 40-60 age period. Some of these cases in their early stages are amenable to Thoracic Surgery. Several such cases have been successfully operated upon during the year, and such operations as lobectomy and pneumonectomy are now a not unusual procedure. Streptococcal Infections of the Lungs. The possibility of a non-tuberculous inflammatory reaction of the lung closely simulating pulmonary tuberculosis has constantly to be borne in mind. I have now come to recognise a clinico-radiological group in which a streptococcus viridans has been a constant bacteriological finding in the sputum in which tubercle bacilli have been conspicuous by their absence. Such cases referred by various observers under the heading of "Pneumonitis", "atypical pneumonia", "Disseminated focal pneumonia" have been a not unfrequent experience during the year. ' 'Virus Pneumonia''. Attention should be drawn to the increased frequency of this condition which may in some cases closely simulate pulmonary tuberculosis. The rapid resolution of the lung infiltration is in striking contrast to that of lung tuberculosis, and wherever a suitable sample of sputum shows repeated absence of tubercle bacilli this condition requires to be borne in mind. Progressive Primary Tuberculosis in adults, even where the initial phases of the disease present all the intense and violent symptoms of the fatal cases, may sometimes show complete recovery. It has to be remembered that there is an apparent increase in the number of persons reaching adult life without becoming tuberculin positive. Hence the significance of the Primary infection in such adults with a progressive lesion which is often not associated with symptoms. Further clinical research on the question of primary tuberculous infection in adult life and its clinical behaviour is bound to result from an increased clinical experience of the condition. Serial Mantoux testing of children and young adults together with routine serial chest radiography should help in this direction. 39 Lobar Consolidation has also been frequently encountered at the Chest Clinic; apart from tuberculosis, pneumonia, cancer and abscess formation have been among the conditions encountered. Excavation of the Lung, apart from tuberculosis has been found to be due to abscess, gangrene, cancer or bronchiectasis. Miliary Deposits in the lung have on investigation proved, apart from tuberculosis, to be due to carcinoma, silicosis, vascular engorgement with heart disease (Mitral Stenosis), bronchiolitis, and in two of our cases Boeck's Sarcoidosis, so that it can be readily seen that there is hardly any X-ray picture which can be produced by pulmonary tuberculosis which cannot be simulated by nontuberculous disease. It follows that no Physician dealing with Chest Disease, can afford to confine his attention purely to the narrower sphere of tuberculosis only, if accurate diagnosis and accurate statistics of the incidence of pulmonary tuberculosis is to be achieved. 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 1944 % % % % % % 11.3 6.87 7.59 7.33 7.32 7.45 Active 5.02 2.57 1.68 1.83 3.9 5.5 Inactive 6.28 4.3 5.91 5.5 3.42 1.95 making an average for the war years of 7.97 per cent., of which 3.41 per cent. were active cases and 4.56 per cent. inactive cases. This group of the population continues to form an extremely important source for detecting 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 symptoms, who are discovered to have early pulmonary tuberculosis. Collapse Therapy and Thoracic Surgery. Artificial pneumothorax refills continue to be done at the Clinic in ever-increasing numbers. These cases are all carefully controlled with X-ray examinations. 40 X-Ray Examinations of the Chest. The number of these examinations, 1,628 for 1944, is, excluding 1943, the highest recorded since the war. These X-ray examinations in conjunction with careful clinical, bacteriological and ancillary examinations, continue to assist us in classifying the various pulmonary diseases encountered, and afford a means of selecting them for appropriate treatments. Technically satisfactory radiographs continue to be our aim, thanks to the high standard maintained by our Radiographer. Treatment of Cases Found Through Mass Radiography. It was only to be expected that with the extension of mass radiography there would be an increased demand for admission to sanatoria. This has added to our waiting list, more particularly among women, but it is important to note that most cases thus discovered are in the early stages of the disease and accordingly very amenable to treatment. Financial Allowances in Tuberculosis. This scheme, closely linked to the discovery of the early case of pulmonary tuberculosis, assists enormously in our work, and has proved a valuable incentive to the patient to accept treatment at an early stage and be free from anxiety and worry instead of 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. As stated in my last report, its extension to a wider variety of cases of pulmonary tuberculosis, other than the very early ones, and a more generous allowance, would greatly add to its real value. Moreover, if the scheme were extended to cover cases of non-pulmonary tuberculosis it would greatly assist us in our work. Investigation into the Value of Sulphapyridine in the Treatment of Pulmonary Tuberculosis. (M. &B.693). The use of the sulphonamide group of drugs has proved so successful in many infections due to pyogenic organisms that it has been a natural development for these chemical agents to be used in lesions due to the tubercle bacillus. Practically all previous work has been conducted on animals or on cultures of the bacillus, but an attempt has been made to treat pulmonary tuberculosis in the human 41 subject with sulphapyridine. The treatment of a condition such as pulmonary tuberculosis presents so many problems that the results of investigations carried out on a limited number of cases cannot, according to Bradford Hill, be put forward as definitely significant. It is felt that the results of our observations are not altogether discouraging and, moreover, they open a number of avenues for further work. One of the main problems has been the difficulty patients have experienced in taking sulphapyridine. We have tried the effects of 2 gms. per day, four days a week, over prolonged periods, even up to six months, on advanced and moderately advanced cases. These doses are, of course, low judged by ordinary standards, and are referable to the cases on whom it has been tried. The efficacy of the dose should be tested by estimations of free and total sulphapyridine in the sputum, and a concentration of less than 2 mgms. per cent. of free sulphapyridine should be regarded as unsatisfactory. Short periods of treatment appear valueless. A decrease in the number of secondary invading organisms should not be expected, particularly when a number of patients are together in one ward. The results may be summarised:—Cases of moderate or slight severity treated with the drug have shown a higher rate of recovery although the mortality rate has been very similar in both treated and control groups. Tubercle bacilli disappeared more frequently in the treated group, but, contrary to our expectations, pyogenic organisms were not affected in either group. The estimation of sulphapyridine in the sputum has offered a guide to the efficacy of the treatment, and where the concentration is high there has been a corresponding improvement in the condition of the patient. Patients severely affected with the disease showed no improvement. 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, and it is to be hoped that this matter will soon be overcome. Accommodation for Advanced Cases. This continues to be a very urgent problem as facilities for dealing with such cases have become more difficult than ever before. 42 Occupational Therapy. Remarkable enthusiasm exists among a certain selected group of our patients, whose morale is particularly high; one can say 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, the work they learnt at the Sanatorium. The standard of work is so high that the demand continues to exceed the supply. We aid the war effort by making as many utility products as possible, bags (netting), baskete. etc., plus a certain amount of knitting, weaving, etc., for the Forces. Thanks to the co-operation of the Technical College, shorthand and typing instruction has been available for a number of our cases with promising results. 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 . As I stated in my last report, and it can bear repetition, 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, to whose untiring efforts and devotion I have previously paid tribute. The results of the thorough and painstaking work of all three Sisters has to be seen and experienced to be fully appreciated, and no tribute can be too high for the quality of the work carried on by them. HARTS SANATORIUM. Dr. Duff Palmer, the Medical Superintendent, was called to the Forces, and Dr. Mary Belt n replaced him on the 2nd February, 1944. Dr. Belton reports as follows:— The chief feature of the year under review was the evacuation of the male patients to Naburn L.C.C. Hospital, Yorks, on the 23rd August. The Sanatorium had suffered blast damage from two flying bombs, and the Government subsequently ordered the removal of the patients and staff. The women were also to have gone, but arrangements had not been completed when their removal was cancelled owing to lack of suitable accommodation. 43 The morale of the patients was excellent during the whole trying period of V1 and V2 attacks. I cannot speak too highly of their courage and of that of the nursing and domestic staff. Thanks to the Matron's excellent organisation and the loyalty of the staff, all beds were kept open in 1944, in spite of temporary under-staffing and the addition of fire-watching duties to the ordinary work. Every patient admitted was seen by Dr. Philip Ellman, and the treatment prescribed by him was carried out with excellent results. Increased use has been made of artificial pneumothorax treatment, and in this connection our grateful thanks are due to the Surgeons of the London Chest Hospital. Our cases for operation have been treated with great efficiency and with the least possible delay. This has been of incalculable benefit to the patients concerned. Tuberculin injections were given to 11 cases towards the end of the year with apparently good results. This treatment has been more generally used lately, and definite conclusions as to its effects should soon be available. The patients also benefited from occupational therapy, both indoor and outdoor. It is hoped that in the near future educational correspondence courses will be available for those interested. STATISTICS. Admissions 151 Discharges (including deaths) 154 Deaths 10 Insured Patients 123 Non-insured Patients 31 Number of Beds available 62 Immediate Results of Treatment of Pulmonary Tuberculosis Cases:— Discharged Quiescent 43 (20 Male and 23 Female) (including 10 observation cases found to be suffering from Pulmonary Tuberculosis) Discharged Non-Quiescent 96 (47 Male and 49 Female) (including 6 observation cases found to be suffering from Pulmonary Tuberculosis). Note :—In the 21 Observation cases, 5 were diagnosed as non- T.B. Of these:— Improved 53 (25 Male and 28 Female) Not improved 43 (24 Male and 19 Female) 44 Observation Cases. Of the 21 Observation cases:— 16 were found to be suffering from Pulmonary Tuberculosis. 2 were found to be non-tuberculous. 2 were doubtful. 1 was found to be suffering from Cancer of the Lung. Artificial Pneumothorax. Number of Inductions (all successful) 24 Number of Refills given 671 Number of Gas Replacements 15 Pneumoperitoneum Cases 3 Tuberculin treatment commenced 11 Cases sent for Surgical Treatment. For Cauterisation of Adhesions 11 For Thoracoplasty 2 For treatment of T.B. Empyema 1 For Orthopaedic treatment 1 Gold Therapy. Number of Courses commenced 21 Number of Courses completed (inc. 3 from 1943) 10 Number discontinued for various reasons 14 Radiography. Number of Films taken in 1944 475 Bacteriology. Number of sputum specimens examined 376 Number of blood sedimentation rates done 608 45 Table 20.—RETURN RELATING TO THE WORK OF THE TUBERCULOSIS AND CHEST CLINIC DURING THE QUARTER ENDING 31st DECEMBER, 1944. 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.—(1) Number of definite cases of Tuberculosis on the Dispensary Register at the beginning of the Quarter 398 356 20 15 67 92 13 3 465 448 33 18 964 (2) Transfers from other Authorities during the Quarter 3 6 – – 1 – – – 4 6 – – 10 (3) Lost sight of cases returned during the Quarter 5 7 1 – – – – – 5 7 1 – 13 B.—Number of New Cases diagnosed as tuberculous during the Quarter:— (1) Class T.B. minus 14 9 2 3 – – – – 14 9 2 3 28 (2) Class T.B. plus 2 1 – – – – – – 2 1 – – 3 (3) Non-pulmonary – – – – 1 – – – 1 – – – 1 C.—Number of eases included in A. and B. written off the Dispensary Register during the Quarter as:— (1) Recovered 1 2 – 1 – – – – 1 2 – 1 4 (2) Dead (all causes) 6 10 – – – – – – 6 10 – – 16 (3) Removed to other Areas 3 9 – – – 3 – 1 3 12 – 1 16 (4) For other reasons 2 – – – 1 1 – – 3 1 – – 4 D.—Number of definite cases of Tuberculosis on the Dispensary Register at the end of the Quarter 410 358 23 17 68 88 13 2 478 446 36 19 979 46 Table 21.—PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary or Notifications during the period from 1st January, 1944, to the 31st December, 1944. Age Periods Formal Notifications Total Notifications Number of Primary Notifications of new cases of tuberculosis 0— 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— Total (all ages) Pulmonary Males '1 4 2 .3 10 14 13 9 7 6 7 76 79 Pulmonary Females 1 4 5 2 12 17 19 4 6 4 2 76 77 Non-Pulmonary Males — 2 2 — 2 — 1 1 1 1 — 10 12 Non-Pulmonary Females — — 1 1 — — 1 - 3 3 SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age Periods 0- 1— 5— 10— 15— 20- 25— 35— 45— 55— 65— Total Pulmonary Males — — 1 1 – 3 3 — 2 2 2 14 Pulmonary Females — 3 1 1 1 3 3 — 1 1 1 15 Non-Pulmonary Males — — — — — — 1 — — — — 1 Non-Pulmonary Females — — 1 — — — 1 — — 1 — 3 Total 33 The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of Information No. of Cases Pulmonary Non-Pulmonary Death Returns From local Registrars 7 1 Transferable deaths from Registrar-General 7 – Posthumous notifications 3 – "Transfers'' from other areas (other than transferable deaths) 12 3 Other Sources, if any (specify) — — Total 29 4 46a Table 22.—TREATMENT OF TUBERCULOSIS. 46a I. Number of beds provided and available in Residential Institutions belonging to the Authority (wholly or jointly with other Local Authorities) on 31st December, 1944. (i) Name of Institution (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 Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M F Ch M F Ch M F Ch M F Ch M F Ch M F Ch Tuberculosis Institutions and Public Health Hospitals Harts Sanatorium 57 40 2 – – – 57 12 2 – – – – – – – – – Totals 57 40 2 — — — 57 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. Harts Sanatorium, Woodford Green Reason for non-availability. Infectious Diseases Hospital, evacuated to Harts Sanatorium (September, 1939) (37 beds). Male patients returned from Naburn Hospital to Grove Park Hospital, Lee Green, S.E., December, 1944 (34 Beds). 2. Number of Patients receiving treatment in Residential Institutions under the arrangements of the Authority for treatment of Tuberculosis on 31st December, 1944. Type of Institution Ex-Service Men (Memo. 146/T. Rev. and Circular 2334) OTHER PATIENTS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Males Females Children Males Females Children A. Institutions belonging to the Authority (wholly or jointly with other Local Authorities) (a) Tuberculosis and Public Health Hospitals. 5 – 24 26 – – – – (b) Public Assistance Hospitals and Institutions. – – – 1 – – – – B. Institutions belonging to other County or County Borough Councils or Tuberculosis Joint Boards. – – – – 3 – – – C. Institutions belonging to Local Authoritites other than A and B – – – – – – – – D. Voluntary Institutions. 2 — 2 7 6 1 3 9 Totals 7 — 26 34 9 1 3 9 3. Waiting List, i.e., number of Patients recommended by the Tuberculosis Officer for, and ready to enter upon residential treatment, who, on 31st December, 1944, had been waiting for a bed for more than 10 days. — — 11 8 — 1 — — 47 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 proved one of the most exceptional of the war years, opening with a gradual resumption of routine duties but ending with emergency duties dominant. In the early months there was much preparation and consultation in connection with the invasion measures, matters of camp hygiene and water supply. The latter half of the year witnessed further heavy damage to housing and environmental services which demanded the continuous attention of the inspectorate. Completion of repairs sustained in the earlier blitzes had almost been effected when from June onwards further extensive damage occurred and housing conditions seriously deteriorated. Brief details of the emergency work of the sanitary section are subjoined and precede the report on routine duties of the inspectors. First Aid Repairs. The repair of war damaged housing has been supervised throughout the war by the sanitary inspectors, their intimate knowledge of local housing and sanitary circumstances being invaluable. The organisation was severely tested and night and day it became the rule to go into action within half an hour of the civil defence services. A scheme of mobilisation was designed to provide immediate attendance of 2,500 operatives at incidents to ensure shelter for the people. It is easy, and perhaps natural, to forget the work of blitz days when thoughts and complaints turn more to decorative treatment of houses, but it should not go unrecorded that the Housing Repair Service contributed in no small measure to the maintenance of public health, public morale and public service (it was notable the number of war-workers who returned to their work happy in the knowledge that their damaged houses were at least receiving early ' 'field dressing''). Since 1939 and until 31st December, 1944, immediate "field dressing" works had been carried out to 111,902 houses in the 48 Borough. Each house had been damaged nearly four times during the period. Damage by V1' s resulted in 21,400 houses damaged in 1944. The winter of 1944 might well have proved disastrous from a public health standpoint with housing conditions damaged as they were, and the value of the repair service will for ever remain unknown- The extent of work and responsibility can be judged from the following labour statistics:— In May, 1941 Labourhead 3,300 Dec., 1941 ,, 2,500 Dec., 1942 ,, 850 Dec., 1943 ,, 470 Dec., 1944 ,, 3,330 Licensing of Building Works. An increase of maintenance work was possible in the early part of the year but even this was seriously curtailed by labour diminished by the demands of H.M. Services. 178 Certificates of essentiality were granted during the year. The extensive war damage in the latter half of the year demanded the services of all available labour and materials. Emergency Drainage Repairs. The "sealing off" of drainage from demolished houses and the reinstatement of drainage and sanitary fitments of war-damaged buildings was supervised by the department. 379 yards of drainage was relaid. Emergency Water Supplies. A review of arrangements for emergency water supplies was made in conjunction with the Metropolitan Water Board with whom the department co-operated in connection with emergency chlorination and distribution measures. Disposal of Civilian War Dead. The direction by the department of this service continued during the year and regrettably the period of enemy action brought a period of activity to this service. The execution of these painful duties earned much gratitude and favourable comment for the very efficient mortuary staff. 49 Salvage of Furniture. The emergency service for the salvage, removal and storage of furniture continued to be supervised by the department. During the year, a period of exceptional activity, 1818 removals were effected and 382 lots of Government furniture supplied to the homeless. The furniture stores, increased during the year from three to fourteen, were subjected to periodic inspection and disinfestation measures were carried out. Public Shelters. The high standard of cleanliness in the 252 public shelters was maintained throughout the year. The regulation of occupants by the Wardens' Service assisted in the prevention of overcrowding and any insanitary conditions. Certificates of Housing War Damage. During the year 10,695 certificates of war damage were issued to householders requiring rehousing or other post-raid service. Other Emergency Duties. The enforcement of Food Orders was carried out jointly by the Food Inspectors in conjunction with the Weights and Measures Officers. During the year 2,046 investigations were carried out by the officers of the department. In connection with war damaged food shops and the salvage of food therefrom 258 visits were made. ROUTINE WORK. The more routine work of sanitary inspection, resumed in the previous year, was continued until mid 1944 when enemy action and serious housing and other damage demanded the attention of the inspectorate. Whilst in certain directions increased routine work can be reported yet other matters, e.g., compliance with sanitary notices, became secondary to the remedial measures to meet the extensively distressing environmental conditions. 50 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 27,331 (i) Housing. House-to-house — Under Public Health Act 3,271 Re-inspections 2,811 Housing Act, 1936 175 (ii) Sanitary Circumstances. Yards and Passages 2 Draining and Sanitary Accommodation 417 Factories (excluding Bakehouses) 16 Workplaces and Outworkers 9 Caravans 21 Re Offensive Fumes 14 Billets and Posts — Miscellaneous 477 War Damage 18,384 (iii) Food Supply. Slaughterhouses — Dairies 30 Food Premises 774 Bakehouses 4 Re Sampling 504 Food Control 39 Food Decontamination 3 (iv) Infectious Disease. Visits 380 (b) Notices.—The number of notices served during the year totalled 1,338 of which 46 were statutory notices. The number of notices complied with in the same period was 639. 51 (c) Rat Extermination.—The Council has for many years provided a free service to householders and no variation has been made during the year. In nearly all cases of complaint investigation has revealed defective drainage and immediate steps have been taken to remedy defects. During the year 8,115 visits were made by the ratcatchers and 6,436 rats were destroyed. (d) Legal Proceedings.—The following statement indicates the legal proceedings undertaken during the year:— Public Health Act, 1936.—Abatement of Nuisances— Cases withdrawn (Nuisance abated) 1 Food Control.—Contravention of Rationing Orders— Penalties inflicted 3 Dismissed on payment of costs 7 (e) Drainage.—A special investigation of pollution of a ditch involved considerable expenditure of time and revealed improper connection of foul water drain to storm water drainage. Steps were taken to correct these conditions. HOUSING. At the conclusion of the year the housing situation was more acute than at any time during the war in as much as despite the further housing damage the population tended to remain. Apart from the extensive programme of house repair it is obvious that the housing situation has been made the more serious by the loss of further houses. By the end of the year nearly 2,000 houses had been demolished (since 1939) which means that approximately 2,500 families are homeless. With 5-6,000 marriages in the Borough the housing need may prove quite insoluble unless rehousing outside the Borough be undertaken. During the year consideration was given to the future use of the North Woolwich area for housing purposes, the area having been extensively damaged by enemy action. (a) Overcrowding.— During the year 21 cases of overcrowding were investigated but such investigations and surveys will be useless unless and until new housing becomes available. It is obvious that serious overcrowding will manifest itself so soon as evacuees and service men return. 52 (b) Housing Statistics. I. Inspection of dwelling houses during the year:— (1) (a) Total number of dwelling houses inspected for defects (under Public Health or Housing Acts) 3,446 (b) Number of inspections made for the purpose 6,257 (2) (a) Number of dwelling houses (included under Subhead (1) above) which were inspected and recorded under the Housing Consolidation 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 human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,189 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 fficers. 614 III. Action under Statutory Powers during the year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936. (1) Number of dwelling houses in respect of which Notices were served requiring repairs — (2) Number of dwelling houses which were rendered fit after service of formal notices:— (i) By owners — (ii) By Local Authority in default of owners — 53 (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 46 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (i) By owners 25 (ii) By Local Authority in default of owners — (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936. (1) Number of dwelling houses in respect of which Demolition Orders were made — (2) Number of dwelling houses molished in pursuance of Demolition Orders — (d) 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 — INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Graded Milk.—The licences in force on 31st December, 1944, were as follows:— Tuberculin-Tested Milk— Bottling Establishment Licence — Dealers' Licences 7 Supplementary Licence 1 54 Tuberculin-Tested (Pasteurised) Milk— Dealers' Licence 1 Pasteurised Milk— Establishment Licence 1 Dealers' Licences 14 Supplementary Licence 1 The Council decided in December, 1936, to charge no fees in respect of licences granted under the Milk (Special Designations) Order, 1936. (b) Meat and Other Foods. (1) Meat Inspection.—Periodic visits to butchers shops and market stalls were made during the year. The slaughterhouse at the rear of 524, Romford Road was substantially damaged by enemy action during 1944. In the previous year this had been in use for the slaughter of horses. (2) Food Premises.—The number of inspections made of food premises included 30 dairies, 4 of bakehouses and 774 of other premises. In the latter figure are included 258 visits necessitating examination of foodstuffs affected by enemy action. (3) Slaughterhouses.—No slaughterhouse was in use during 1944. (4) Bacteriological Samples.—128 samples were submitted for bacteriological examination during the year, including 118 of milk, 4 of domestic water, 4 of swimming bath water and 2 of ditch water. (5) Other Foods.—Inspection of other foods resulted in the condemnation for human consumption of 5,148 tins, including 447 tins of meat and meat products, 62 tins of fruit, 145 tins of vegetables, 804 tins of fish, 1,448 tins of milk and 2,242 tins or packages of other foods. In addition, the following foods were condemned as unfit for human consumption, due to enemy action: 1344 lbs. meat, 995½ lbs. fish, 175 lbs. fruit, 1,227 lbs. vegetables, 20,890 lbs. miscellaneous. 55 (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 8 – – Cheese 7 – – Cocoa 2 – – Coffee 10 – – Confectionery 2 – – Jam 1 – – Lard 8 – – Margarine 8 – – Milk 133 2 1.5 Sausage 47 4 8.5 Vinegar 8 – – Wines and Spirits 1 — – Drugs 12 – – Other Articles 139 13 9.3 386 19 4.9 56 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 3757 F Milk 1% added water Vendor cautioned. 3761 I Pork Sausage Deficient in meat 34% Formal sample taken. Vendor cautioned. 3773 I Gelatine Undesirable quantity of sulphur dioxide and arsenic. Formal sample taken. Vendor prosecuted. 3782 I Gelatine 9 parts per million of arsenic. Formal sample taken. Vendor prosecuted. 3794 F Gelatine Contained arsenic 6 parts per million sulphur dioxide 1,250 parts per million. Vendor prosecuted. 3814 F Pork Sausage Deficient in meat, 36% Vendor cautioned. 3876 F Gelatine 6 parts per million of arsenic. Vendor prosecuted. 3874 I Egg Substitute. Deficient in available carbon dioxide. Withdrawn from sale. Vendor cautioned. 3920 I Gelatine Contained sulphur dioxide to extent of 1,250 parts per million. Vendor cautioned. 3941 I Pork sausage Meat. Meat content in excess of permitted amount 50%. Vendor cautioned. 3943 F Powder for Jelly-making. Sulphur dioxide to extent of 1,300 parts per million. Manufacturers cautioned. 3962 I Suet 26% deficient in fat content. Vendor cautioned. 3984 F Milk 2% added water Vendor cautioned. 4005 I Egg Substitute. Deficient in available carbon dioxide to extent of 30%. Withdrawn from sale and surrendered by retailer. Vendor cautioned. 4047 I Egg Substitute. Deficient in available carbon dioxide to extent of 90%. Withdrawn from sale. Vendor cautioned. 4090 I Oatmeal Not oatmeal—consisted of cereal mixture of nature of rye flour containing no appreciative quantity of oatmeal. Vendor cautioned. 4093 I Baking Powder. Deficient in available carbon dioxide to extent of 15%. Withdrawn from sale. Vendor cautioned. 4094 F Pork Sausage 20% deficient in meat content. Vendor prosecuted. 4121 I Egg Substitute. Deficient in available carbon dioxide to extent of 26%. Withdrawn from sale. Vendor cautioned. 57 Members of the Council. The Mayor: *Councillor Sidney Arnold Elson. The Deputy Mayor: * Alderman Charles William Brading, J.P., C.R.P. Aldermen: *Joseph Walter Barton, J.P. (Vice-Chairman of the Education Committee). *Thomas William Burden. *Richard John Fell, J. P. Herbert Percy Jackson. *Thomas Irwin Lethaby, J.P. *Edward Francis Markey, J.P. *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.) (Chairman of the Education Committee). *Lendoranna Minnie Brignell (Mrs.) Annie Maud Clark (Mrs.). Edwin John Davey. *Charles William Dixon. Eric Cyril Boyd Edwards, LL.B. Bertie George Goodenough. *John Albert Hart. *Frank Herbert Howard. *Walter Edwin Hurford. *William Innes Jackson, J. P. *Harold Joseph, J.P., F.A.L.P.A. Bertram Arthur Keene. *Winifred May Knight (Mrs.). *John Linsley Linsley-Thomas. *Robert William Moger, J.P. George Horace Moncar. Robert Wilfred Payne. Alfred Prior. Frank Owen Reynolds. *Alice Beatrice Spencer (Mrs.). *William Thompson. William Bertram Warncken. Alfred Tom Yates Watson. *Ernest Albert Wood. *John Alfred Kemp. * Denotes Members of the Education Committee. Co-opted Members of the Education Committee. Mrs. L. A. Lethaby. Mr. C. E. Caton. Rev. J. C. Heenan, D.D., Ph.D. 58 County Borough of East Ham Education Committee Mr. Chairman, Ladies and Gentlemen, I have the honour to present the Annual Report on the School Medical Service for the year 1944. It will be appreciated that insufficient time has elapsed for the provisions of the new Education Act to become effective, and the report, mainly statistical, is submitted in a form similar to that of recent years. In 1944 there was a minimum of 6,583 and a maximum of 12,110 children on the Elementary School Roll. The numbers for 1943 showed fluctuation from a minimum of 10,317 to a maximum of 11,307. Elementary school children examined totalled 2,844, of whom 1,368 were re-examined at the time of re-inspection in the schools; the inspection of scholars in the secondary schools was not completed by the end of the year. Medical examinations prior to evacuation increased during the year and involved 1,839 as compared with 102 children in the year 1943. Diphtheria immunisation clinics were continued at the various centres and it is estimated that 70 per cent. of scholars have received protective inoculations. It was decided to continue the policy whereby re-admission and admission to school should be subject to medical certification of fitness. 1,617 children were examined for this purpose at the school clinics. In other directions, the full activities of the School Medical Service have been maintained and adequate supervision has ensured a high standard of health enjoyed by the school children. I desire to express my gratitude to the Chairman Mrs. Councillor Brace and Members of the Education Committee for their help and continued support during a difficult period. I am also indebted to Mr. A. A. Garrard, Mr. L. J. Dyer and the Head Teachers for their invaluable assistance and willing co-operation throughout the year. My thanks are also due to the School Medical and Nursing Staff for their efficient services. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, Malcolm Barker, School Medical Officer. 59 MEDICAL INSPECTION. The following is a synopsis of School Medical Work for the year 1944, as compared with previous statistics. COMPARATIVE STATEMENT OF WORK. 1940 1941 1942 1943 1944 Routine and Special Inspection (on school premises):— Secondary Nil 224 442 815 46 Elementary 3,888 5,526 3,803 4,453 2,844 Re-Inspection 1,254 2,852 3,400 2,795 1,368 Consultations at Inspection Clinic 1,047 2,765 10,786 12,378 10,574 Number of Treatments at Clinic 639 3,425 11,746 9,757 8,935 General Cleanliness Visits to Schools 92 110 175 276 227 Nurses' Visits to Homes 390 4,680 3,781 4,124 2,955 Children examined for cleanliness 10,503 12,107 15,769 28,427 22,573 FINDINGS OF MEDICAL INSPECTIONS. There are no outstanding features to report in regard to the findings of medical inspections, but war-time conditions and rationing do not appear to have affected the physical or nervous condition of the children to any appreciable extent and the general health of the scholars examined is satisfactory. The general maintenance of good health may be ascribed, in no small measure, to the scheme for the provision of milk in school, the improvement in arrangements for the supply of school meals, and the resumption of regular physical training, gymnastics and games. The following comparative table serves to indicate the number and percentage of children found to be in need of medical or surgical treatment in those scholars inspected during the year 1944. Number of Children *Percentage of Children found to require treatment Inspected. *Found to require treatment 1943 1944 1943 1944 1943 1944 4,453 2,844 617 315 13.8 11.07 * Excluding defects of Nutrition, Uncleanliness and Dental Diseases. 60 (a) Uncleanliness. The School Nurses have carried out cleanliness surveys of all children in the elementary schools during the year 1944. On the whole the high standard of personal hygiene has been maintained. Reference has been made to the measures adopted in order to prevent the introduction of infection into the schools and the School Nurses are exercising the utmost vigilance during cleanliness surveys. COMPARATIVE TABLE. Year Number Examined Number with Nits Number with Head Vermin Number of Exclusion Certificates 1940 10,503 216 17 15 1941 12,107 178 23 91 1942 15,769 549 54 98 1943 28,427 1,044 93 93 1944 22,573 584 68 68 (b) Minor Ailments. Having regard to the increased number of children inspected, the incidence of minor ailments is not unduly high. (c) Tonsils and Adenoids. 3.2 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids", either separately or combined, as compared with 10.15 per cent. in the year 1943. (d) Tuberculosis. Boys Girls Total Pulmonary Tuberculosis 24 20 44 Other forms of Tuberculosis 22 8 30 46 28 74 (e) Skin Disease and (f) External Eye Disease. At medical inspections during the year 24 children were found to be suffering from skin affections (as compared with 91 in the year 1943) and 4 cases of external eye disease were discovered (as compared with 5 in the year 1943) 61 The majority of children suffering from skin disease and external eye disease were dealt with before entry or re-entry to school, which accounts for the fact that less than 1 per cent. of such cases were discovered at routine medical inspections. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 52. In addition, there were 14 children in whom there was evidence of a lesser degree of visual defect and these are being kept under observation. (h) Ear Disease and Hearing. 0.62 per cent. of the children examined were found to be suffering from otitis media (0.87 per cent. in 1943). The percentage of deaf children was 0.24, the corresponding figure for last year being 0.87. (i) Dental Defects. The percentage of children found, as the result of dental inspection in the schools, to be in need of dental treatment was 55.65 per cent., as compared with 57.11 per cent. for last year. (j) Nutrition. No children were found at the routine medical inspection to be suffering from malnutrition in any degree. (See Table II.) The following table gives a comparative statement in regard to the nutrition of school children during the past five years:— Year Number of Children Inspected Excellent Normal Slightly Subnormal Bad No. % No. % No. % No. % 1940 3,888 509 13.09 3,354 86.26 25 0.64 — – 1941 5,526 1,124 20,34 4,350 78.71 52 0.95 – – 1942 3,803 694 18.3 3,096 81.4 13 0.3 — – 1943 4,453 446 10.01 4,000 89.83 7 0.16 – – 1944 2,471 301 12.2 2,162 87.48 8 0.32 – – INFECTIOUS DISEASES. The incidence of chicken-pox, diphtheria, whooping cough and mumps was below the average and less than last year. 62 FOLLOWING UP. The School Nurses have paid 2,955 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. MEDICAL TREATMENT. During the year 1944 8,935 attendances were made for treatment at the various clinics, and there were 10,574 attendances for consultation with the Medical Officers. (a) Minor Ailments. An analysis of the chief minor ailments treated at the School Clinics, and otherwise, will be found in Table IV, Group I. (b) Tonsils and Adenoids. Of the children referred for treatment, 207 received operative treatment during the year 1944, as against the figure of 473 for 1943. The scheme for treatment remained the same as detailed in previous reports. (c) Tuberculosis. The arrangements for the treatment of tuberculosis have been continued on the lines fully set forth in the reports for previous years. (d) Skin Diseases. For the most part these are treated at the General Clinic, but some cases of chronic and of the rarer skin diseases are referred to the dermatological department of the London Hospital. The treatment of scabies at the Cleansing Centre has been continued successfully. (e) External Eye Disease. Sixty-one cases (90 in 1943) of external eye disease were treated at the School Clinics. (f) Vision. During the year 1944 the Ophthalmic Clinic was held twice a week. 180 accepted treatment in respect of visual defect during the year 1944 (of these 3 children with markedly defective vision had not 63 been seen by the Ophthalmic Surgeon) and, including 9 cases awaiting treatment at the end of the year 1943, 186 cases have been treated in the past year. Mr. S. C. Reeve-Flaxman, the Ophthalmic Surgeon, reports as follows:— General Clinic Baby Clinic Number of new cases 186 43 Glasses prescribed 113 14 Glasses not necessary 73 29 Glasses obtained 112 14 Special treatment 112 16 Re-examinations 773 25 Discharged 124 6 Referred to Hospitals 9 1 Sent to Swanley — — The Sight-Saving Class at Monega Road School has been discontinued since the outbreak of war. (g) Ear Disease. During the year 1944, 28 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 843, making an average attendance at each session of 30 patients. Mr. H. V. O,Shea, F.R.C.S., the Aural Surgeon, reports as follows:— Twenty-eight clinics were held during the year, with a total attendance of 843, 22 per cent. of the cases were, after treatment, discharged cured. The statistical report is as follows:— Cases of Chronic Otitis Media 51 Discharged 32 Cases of Deafness 5 ,, 1 Other Ear Cases 58 ,, 35 Cases of Chronic Rhinitis 235 ,, 103 Other Nose Cases 28 ,, 20 Cases of Enlarged Tonsils and Adenoids 221 ,, 105 Other Throat Cases 31 ,, 5 64 (h) Dental Defects. The age groups inspected were from four years to sixteen years inclusive, which totalled 6,863. Those referred for treatment number 3,964, and the "specials" cases referred by the School Medical Officer and Head Teachers were 260. The number of attendances at the dental clinics was 2,502. (See Table IV, Group V—Dental Defects.) There has been a slight decrease in the number of children presented for dental treatment, viz., 54.6 per cent. of the children referred, as compared with 62.05 per cent. for the year 1943. Maternity and Child Welfare Centres. Details of the dental work done for the Maternity and Child Welfare Centres are shown in the following table:— Number of Sessions Devoted to Treatment Number of Attendances Number of Permanent Teeth Number of Temporary Teeth Adult Children Extracted Filled Extracted Filled 44 151 344 187 23 303 27 Total Number of Extractions Total Number of Filling9 Number of Administrations of General Anaesthetics Number of other Operations Permanent Teeth Temporary Teeth 490 50 13 25 36 (i) The Light Clinic. The following table furnishes a brief summary of the cases treated by general and local irradiation throughout the year:— Number of children treated (general) 53 Number of children treated (local) 2 Number of attendances (general) 1,910 Number of attendances (local) 29 Number of attendances (local and general) 1,939 OPEN-AIR EDUCATION. Residential Open-Air Schools. The following statistical table gives particulars of the number of children resident in these schools during the year 1944. 65 PARTICULARS OF THE NUMBER OF CHILDREN WHO WERE RESIDENT IN SCHOOLS OF RECOVERY BETWEEN 1st JANUARY AND 31st DECEMBER, 1944, AND THE PERIODS OF THEIR STAY BETWEEN THOSE TWO DATES. School Number of Months Totals 1 2 3 4 5 6 7 8 9 10 11 12 B G B G B G B G B G B G B G B G B G B G B O B G B G St. Catherine's _ _ 1 _ _ 1 _ 1 _ _ _ _ _ 1 _ 1 _ _ 1 _ _ _ 2 _ 3 3 St. Dominic's _ _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ 1 _ 1 — 4 _ Oak Bank _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ 1 SYNOPSIS OF CASES REFERRED TO EAST HAM I.C.A.A. BY SCHOOL MEDICAL SERVICE DURING 1943. Diseases from which the Children were Suffering. Bronchitis, bronchial catarrh and asthma 21 Debility following illnesses and accidents 4 Debility, marasmus and malnutrition 7 Debility following infectious illnesses 5 Chorea and endocarditis 1 T.B. pleural effusion 2 Pre T. B. 13 T. B. Spine 1 T.B. glands 2 Total 56 Action Taken:— Sent to convalescent homes 44 Sent to sanatoria 4 Children evacuated by parents 4 Parents refused treatment offered 4 Total 56 Delicate, debilitated and physically defective children who require change of air and environment and the regulation and routine of a healthy life have derived great benefit as the result of the keen activity of the Local Branch of the Invalid Children' a Aid Association. 66 PROVISION OF MEALS. Despite the shortage of certain items of diet considered of importance during the period of growth, in general the nutrition of the scholars is good. Cases manifesting signs of early malnutrition show marked improvement as the result of attendance for the dinners thus provided. Under present circumstances, as many parents as possible are being encouraged to allow children to remain at school for the mid-day meal, and a largely increasing number have availed themselves of the school facilities. During the years 1943 and 1944 meals were supplied to school children as follows 1943 1944 Elementary 531,166 443,842 Secondary 72,594 70,497 School of Building 4,845 18,113 Total 608,605 532,452 CO-OPERATION OF PARENTS. During the year 1944 the number of parents who were present at the routine medical inspections was 1,984 (3,133 in 1943), that is, 69.7 per cent. of the cases examined (70.3 per cent. in 1943). CO-OPERATION OF VOLUNTARY BODIES. The National Society for the Prevention of Cruelty to Children has been of great assistance in our efforts on behalf of children whose parents have proved indifferent to their needs. More recently difficult cases have been referred to the Welfare Officer of the Education Department. Such cases have been dealt with by the Society's Inspectors as the result of direct reference from the School Medical Service during the year 1944. The following table indicates the work performed by the Society:— 67 Condition Number of Cases Treatment obtained Treatment arranged Cases under observation Moved out of area Tonsils and adenoids 5 3 2 – – Dental caries 3 3 – – – General neglect 26 20 improved 3 3 – Others 7 7 – – — 41 33 5 3 – The fact that court proceedings were avoided in every case is deserving of special mention. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN Mentally Defective Children. Total number of children notified during the year ended 31st December, 1944, by the Local Education Authority to the Local Mental Deficiency Authority under the Mental Deficiency (Notification of Children) Regulations 1928 8 During the year 1944 the number of cases examined for the purposes of the Mental Deficiency Acts was 22. Of these 18 were classified as mentally deficient and 4 as dull and backward, recommendations being made as shown in the following table:— Number examined 22 Classified as mentally deficient 18' 18 Classified as morally deficient — Classified as imbeciles — Classified as idiots — Classified as dull and backward 4 Recommended for Special School 10 Recommended for transfer to the Committee for the Care of the Mentally Defective 8 The Day Special School for Mentally Defective Children was closed at the outbreak of war and many of the children were evacuated to Banstead or by private arrangements. Many of these scholars are returning and it is not uncommon to find that some have been admitted to Ordinary Elementary Schools, whilst others have remained without education for considerable 68 periods. Children are now being admitted to Knox Road Day Special School, West Ham, and Faircross Day Special School, Barking. SECONDARY SCHOOLS. The figures relating to the work carried out in connection with these schools during the year 1944 are shown in a separate column in the statistical tables. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS Ten boys have been specially examined in accordance with the Bye-Laws, and they were found to be fit for employment. Five schoolchildren were examined under the Regulations dealing with the Employment of Children at Entertainments. TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY AND SECONDARY SCHOOLS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Elementary Secondary Groups Entrants (5 to 7 years inclusive) 967 Second Age Group (8 to 11 years inclusive) 959 Third Age Group (12 plus) 545 Total 2,471 46 Number of other Routine Inspections 373 Grand Total 2,844 B.—OTHER INSPECTIONS. Number of Special Inspections and ReInspections 1,368 – 69 TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR. Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Elementary 2,425 297 12.24 2,120 87.42 8 0.32 – – Secondary 46 4 8.7 42 – – – – – TABLE III. BLIND CHILDREN AND DEAF CHILDREN. There are no totally or almost totally blind children or deaf children who are not at the present time receiving education suitable for their special needs. TABLE IV. TREATMENT TABLES. GROUP I.—MINOR AILMENTS, (excluding Uncleanliness, for which see Table VI.) Disease or Defect Number of Defects Treated or under Treatment during the Year. Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Elementary Secondary Elementary Secondary Elementary Secondary Skin. Ringworm scalp:— (i) X-Ray treatment – – – – – – (ii) Other treatment – – – – – – Ringworm body – – – – – – Scabies 175 – – – 175 – Impetigo 45 – – – 45 – Other skin disease 728 – 3 – 731 – Minor Eye Defects. (External and other, but excluding cases falling in Group II) 40 – 1 – 41 – Minor Ear Defects. (Treatment for more serious diseases of the ear (e.g., operative treatment in hospital) is recorded in the body of the Annual Report) 35 – — – 35 – Miscellaneous. (e.g., minor injuries, bruises, sores, blains, etc.) 615 – 8 – 623 – Total 1,638 – 12 – 1,650 – 70 GROUP II.—DEFECTIVE VISION AND SQUINT, (excluding Minor Eye Defects treated as Minor Ailments—Group I). Number of Defects Dealt With Under the Authority's Scheme Otherwise Total Elementary Secondary Elementary Secondary Elementary Secondary Errors of Refraction (including squint) 124 — — — 124 — (Operations for squint are recorded separately in the body of the Annual Report). Other defect or disease of the eyes (excluding those recorded in Group I) 26 — — — 26 — Total 150 — — — 150 — Number of children for whom spectacles were— (a) Prescribed 97 16 — — 97 16 (b) Obtained 96 16 — — 96 16 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. NUMBER OF DEFECTS Received Operative Treatment Received other forms of Treatment Total number Treated Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital apart from the Authority's Scheme Total (1) (2) (3) (4) (5) Element ary Secondary Element ary Secondary- mentary Secondary Element ary Secondary Element ary Secondary 203 1 3 – 206 1 25 – 231 1 71 GROUP IV. -ORTHOPAEDIC AND POSTURAL DEFECTS . Postural defects which received non-residential treatment otherwise than at an orthopaedic clinic are not recorded in this Table. A child may be recorded in more than one category and therefore the total number of children treated will not necessarily be the same as the sum of the figures in the separate categories. Under the Authority's Scheme (1) Otherwise (2) Total Number Treated (see note above) Residential treatment with Education (i) Residential Treatment without Education (ii) Non-residential Treatment at an orthopaedic Clinic (iii) Residential Treatment with Education (i) Residential Treatment without Education (ii) Non-residential Treatment at an orthopaedic Clinic (iii) – – 28 – 3 5 36 TABLE V. DENTAL INSPECTION AND TREATMENT. The heading "Specials" in this Table relates to all children inspected by the School Dentist otherwise than in the course of the routine inspection of children in one of the age groups covered by the Authority's approved scheme, namely, to children specially selected by him, or referred by Medical Officers, parents, teachers, etc., on account of urgency. The number inspected in each routine age-group is separately shown, as well as the total, but under "Specials" only the total number is given. Temporary fillings, whether in permanent or temporary teeth, are recorded as other operations. (1) Number of children inspected by the Dentist. (a) Routine age-groups. Age 4 5 6 7 8 9 10 11 12 13 14 15 16 Total Number 49 554 652 660 624 680 627 751 785 845 369 183 84 6,863 (b) Specials (see note above) 260 (c) Total (Routine and Specials) 7,123 (2) Number found to require treatment 3,964 (6) Fillings (see note above) Permanent teeth 692 Temporary teeth 272 (3) Number actually treated 2,167 Total 964 72 (4) Attendances made by children for treatment 2,502 (7) Extractions:— Permanent teeth 363 Temporary teeth 2,481 Total 2,844 (5) Half-days devoted to:— Inspection 54 Treatment 328 (8) Administrations of general anaesthetics for extractions 120 Total 382 (9) Other operations:— Permanent teeth 107 Temporary teeth 73 Total 180 TABLE VI. UNCLEANLINESS AND VERMINOUS CONDITIONS. All cases of uncleanliness, however slight, are recorded. The Return relates to individual children and not to instances of uncleanliness. (i) Average number of visits per school made during the year by the School Nurses 12 (ii) Total number of examinations of children in the schools by School Nurses 22,573 (iii) Number of individual children found unclean (see note above) 679 (iv) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 Nil (v) Number of cases in which legal proceedings were taken— (a) Under the Education Act, 1921 Nil (b) Under School Attendance Bye-Laws Nil 73 INDEX. A Acts—Blind Persons, 1920- 1938 23, 230, 42-46 Act—Midwives, 1936 29 Act—Public Health, 1936 Child life Protection 32 Acts—Housing 52-53 Acts—Mental Deficiency 24-27 Acts—Midwives, 1902-36 20 Adenoids 60 Adoption of Children (Regulation) Act 1939 32 Adulteration of Foodstuffs 55-56 Ambulance Facilities 21 Analgesics, Administration of 34 Ante and Post-Natal Clinics 30, 35 Area 6 Artificial Sunlight 35 Aural Surgeon, Report of 63 Aural Treatment 6f), 63 B Bacteriological Examinations 17, 54 Baths—Swimming 54 Birth Rate 7, 9 Birth Rates, Two War Periods 7 Births 6, 7 Births, Illigitimate 6 Births, Premature 33 Births, Still 6, 7, 9 Blind Persons Act, 1920 23-23a Blind Children 69 C Cancer 6, 12, 13 Centre, Training and Occupation M.D 24-25 Chemical Examination of F ood 55-56 Chief Sanitary Inspector, Report of 47-56 Child Life Protection 32 Children—Invalid Aid Association 28, 65 Cleansing Centre 28 Clinics, Ante and Post-Natal 30, 35 Clinics, Artificial Sunlight 35 Clinics, Aural 63 Clinics, Dental 64 Clinics, Immunisation 12, 20, 35 Clinics, Infant 30, 35 Clinics, Ophthalmic 62-63 Clinics, Scabies 28 Clinics, School 62-64 Clinics, Toddlers' 30 Clinic, Tuberculosis & Chest 36-42 Committees 3, 57 Cripples 65 D Dairies 50 Deaf Children 69 Deaths 6, 9a, 9b, 10, 11, 13, 14. 36 Death-rate, General 7, 9 Death-rate, Infantile 6, 8, 9 Death-rate, Maternal 6, 8 Death-rate, Zymotic 9. 12 Death - rates, Two War Periods 7 Deaths, Causes of 9a, 9b Deaths, Infants 8, 10 Deaths, in Wards 9b Dental Treatment 34, 61, 64, 71 Dental Surgeons, Report of 64 Diphtheria 12, 15 Drainage and Sewerage 48 E Ear Diseases 60, 63 East Ham and Southendon-Sea Joint Hospital Board 23 East Ham Memorial Hospital 21, 23, 28a Education Committee 57 Emergency Repairs 48 Employment of Children 68 Enteric Fever 20 Epileptic Children 67 Eye Diseases of Children 60, 62 Exceptional School Children 65 Extracts from Vital Statistics 6 F First Aid Repairs 47-48 Following-up 62 Food and Drugs Adulteration 55-56 Food, Chemical and Bacteriological Examination 54 Food Inspection 53-56 Food Premises 50 Forest Gate Hospital 31 Foster Mathers 32 74 INDEX—continued. G General and Special Hospitals -3 Graded Milk 53-54 H Harts Sanatorium 42-44 Health Committee 3 Health Visitors 30 Home Helps 34 Homes—Nursing 33 Hospital, Forest Gate 31 Hospitals — General and Special 23 Hospital,Infectious Diseases 15-19 Hospital, East Ham Memorial 21, 23, 280 Hospital, Maternity 21, 28a, 31 Hospital, Mental 23 Houses—Inhabited 6 Housing 51-53 Housing Statistics 52-53 I Illegitimate Births 6 Immunization 12, 20 Immunization Clinics 12, 35 Infant Deaths 8, 10 Infant Welfare Clinics 30, 35 Infantile Mortality 6, 8, 10 Infectious Diseases Hospital 15-19 Infectious Diseases 11, 12, 15-19, 50, 61 Inhabited Houses 6 Inspection of and Supervision of Food 53-56 Inspections 50 Inspection of School Children 68 Institutional Provision for Mental Defectives 24 Invalid Childrens Aid Association 28, 65 L Laboratory Facilities 18, 21 Legal Proceedings 51 Light Treatment 35, 64 M Mass Radiography 40 Maternal Mortality 6, 8 Maternity and Child Welfare 29-36 Maternity and Child Welfare Committee 3 Maternity Homes and Hospitals 21, 28a, 31 Meals, Provision of 66 Measles 18 Meat, and other Foods 53-56 Meat Inspection 54 Medical Inspection and Findings of School Children 59-61, 68 Medical Officer of Health's Report 1-56 Medical Relief, Social Welfare 22 Mental Defects, School Children 67 Mental Defectives, Training Centre 24-25 Mental Deficiency 24-27, 67 Mental Deficiency Committee 3 Mental Hospital 23 Midwives Act, 1936 29 Midwives 29, 31 Midwives, Municipal 29 Milk, Bacteriological Examination of 54 Milk, Graded 53-54 Milk (Special Designation) Order 53-54 Milk Supply 53-54 Minor Ailments 60, 62, 69 Mortality, Analysis of 9 Mortality, Infantile 6, 8, 10 Mortality, Maternal 6, 8 Mortality, Neo-natal 8 Municipal Midwives 29 N National Society for the Prevention of Cruelty to Children 66-67 Neo-natal Mortality 8 Notification of Births 7 Nurseries, War Time 28 Nursing Homes — Public Health Act, 1936 33 Nutrition 61, 69 O Occupational Therapy — Tuberculosis 42 Open Air Education 64-65 Operations 18 Ophthalmic Neonatorum 31 Ophthalmic Clinic 62-63 Ophthalmic Surgeon, Report of 63 75 INDEX—continued. O Ophthalmic Treatment 63 Orthopaedic Treatment 32, 71 Overcrowding 51 P Parents, Co-operation of 66 Physical Features of Area 6 Physically Defective Children 65 Plaistow Maternity Hospital and District Nurses' Home 21 Pools—Swimming 54 Population 6, 8 Post-Natal Work 30 Premature Infants 33 Prosecutions 56 Provision of Meals 66 Public Cleansing 28 Public Health Act, 1936— Child Life Protection 32 Public Health Act, 1936— Nursing Homes 33 Public Health Committee 3 Public Shelters 49 Puerperal Fever and Pyrexia 8 R Radiography 40 Rat Extermination 51 Rateable Value 6 Residential Schools 64-65 Run well Mental Hospital 23 S Sanatoria 41-44 Sanitary Circumstances 50-51 Sanitary Inspection 50-51 Sanitary Section and Housing 47-56 Scabies 28 Scarlet Fever 15, 17 Schick Immunisation Clinics 12, 35 School Blind Children 69 „ Children, Blind, Deaf, Defective and Epileptic 67 „ Children, Minor Ailments 60, 62, 69 „ Children, Medical Inspection 59-61, 68 Children. Mentally Defective 67 School Children, Physically Defective 65 „ Children, Verminous Conditions 60, 72 „ Cripples 65 „ Exceptional Children 65 „ Meals 66 „ Medical Officer's Report 57-72 „ Medical Treatment 62-64 „ Nursery 28 „ Open Air 64 Schools of Recovery 64-65 Schools, Secondary 68 Serum Administration 16 Sewerage 48 Skin Diseases 60, 62 Slaughterhouses 54 Social Conditions of Area 6 Social Welfare Domiciliary Medical Service 22 Special Schools—Physically Defective Children 65 Statistical and Social Conditions of Area 6-11 Still Births 6, 7, 9 Swimming Baths and Pools 54 T Table, Birth-rate, etc. 9 „ Blind Persons 23a „ Cancer 14 „ Child Life Protection 32 „ Death Rate, etc. 9 „ Deaths, Causes of 9a „ Deaths, Ward 9b „ Dental Treatment 71-72 „ Diphtheria 16 „ Diphtheria Immunization 20 „ Domiciliary Midwifery 29 „ East Ham Memorial Hospital 28a „ Food and Drugs Adulterations 55 „ Housing 51-53 „ Infant Deaths 9, 10 „ Infectious Diseases, Notifiable 11 „ Infectious Diseases, Removed to Hospital 11, 19 „ Maternal Mortality 8 „ Mental Defectives 26, 27 „ N.S.P.C.C., Cases Referred to 67 „ Nursing Homes 33 76 INDEX—continued. T Table, Ophthalmia Neonatorum 31 „ Samples, Food and Drugs 55 „ School Children, Defects of 69-71 „ School Children Examined 59, 68 „ School Children found to require Treatment 59 „ School Children- Malnutrition 61, 69 „ School Children, Treatment carried out 69-72 „ Schools of Recovery 65 „ Secondary School Examinations 68 „ Social Welfare Domiciliary Medical Service 22 „ Serum Administration 16 „ Tuberculosis and Chest Clinic 45 „ Tuberculosis Notifications 46 „ Tuberculosis, Residential Treatment 46a ,, Verminous Condition of School Children 60 „ Work of Home Visitor to the Blind 23a Tonsils and Adenoids 60, 62 Training Centre, Mental Defectives 24-25 Tuberculosis 36-46a, 60, 62 Tuberculosis and Chest Clinic 36-42 Tuberculosis—Occupational Therapy 42 U Uncleanliness 60. 72 V Verminous Conditions— School Children 60, 72 Venereal Diseases 22-23 Vital Statistics, Extracts from 6 Vision 60, 62, 70 Visits, Health Visitors 30 Visits, School Nurses 62 Voluntary Associations 28, 65, 66 W War Casualties 48 War Damage Repairs 47-48 War Periods, Comparative Birth and Death Rates 7 War-time Nurseries 28 Wards, Deaths in and Rates 9b Water Supply 48, 54 Whooping Cough 12, 18 Welfare of the Blind 23 X X-Ray Examinations 37, 40 Z Zymotic Diseases 11