EAS 22 COUNTY BOROUGH OF EAST HAM. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1945. 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 Metal Deficiency; Chief Tuberculosis Officer. Norman, Hopper & Co.. Green Street, London E.18 County Borough of East Ham. Public Health Department. With the Compliments of the Medical Officer of Health. COUNTY BOROUGH OF EAST HAM. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1945. 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 Metal Deficiency : Chief Tuberculosis Officer. Norman, Hopper & Co. Green Street, London E.13 PRINCIPAL CONTENTS Sections :— Page. Constitution of Council 3 Public Health Staff 4 Introduction 7 Statistical and Social Conditions of Area 9 Mortality due to enemy action 15 General Provisions of Health Services 17 General and Special Hospitals and Children's Homes 24 Mental Deficiency 29 Welfare of the Blind 34 Voluntary Associations 36 Maternity and Child Welfare 38 Infectious Diseases 57 Tuberculosis 63 Meteorological Record 74A Sanitary Section and Housing 75 Inspection and Supervision of Food 79 School Medical Service :— Introduction 84 Report 86 3 EAST HAM CORPORATION COUNCIL (shewing Chairmen and Vice-Chairmen of Public Health, M. & C.W., Mental, Health and Education Committees) THE MAYOR: Me. Alderman Frederick Welch, J.P. THE DEPUTY MAYOR : Mr. Councillor William Henry Whittock Beecham. ALDERMEN: (3) Joseph Walter Barton, J.P. Charles William Brading, J.P., C.R.P. (6) Thomas William Burden, J.P., M.P. Richard John Fell. Herbert Percy Jackson. Thomas Irwin Lethaby, J.P. Edward Francis Markey, J.P. (1) Annie Taylor (Mrs.), J.P. Beatrice Wilkens (Mrs.), J.P. COUNCILLORS : Charles Edward Beckett. Leslie Alfred Victor Bennett. (5) Ethel Maud Charlotte Brace (Mrs.). Lendoranna Minnie Brignei.i. (Mrs.). Annie Maud Clark (Mrs.). Edwin John Davey. Charles William Dixon. Eric Cyril Boyd Edwards. LL.B. Sydney Arnold Elson, J.P. Bertie George Goodenough. John Albert Hart, Frank Herbert Howard. Walter Edwin Hurford. William Innes 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 MATER NITY AND CHILD WELFARE AND MENTAL DEFICIENCY COMMITTEES. Mrs. E. M. Devenay Maternity Mrs. B. A. Wheeler Mental Mrs. E. M. Fell and Child Mrs. A. M. Gray : "Deficiency. Mrs. L. Watson Welfare. Mrs. C. J. Cross J (1) Chairman of Public Health and Maternity and Child Welfare Committee. (2) Vice-chairman of Public Health and Maternity and Child Welfare Committee. (3, Chairman of Committee for the Care of the Mentally Defective. ^ (4) Vice-Chairman of Committee for the Care of the Mentally Defective, (5) Chairman oi Education Committee. (6) Vice-Chairman of Education Committee. Deceased 10/10/45, 4 PUBLIC HEALTH OFFICERS OF THE AUTHORITY. A. Medical—whole-time. Malcolm E. Banker, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health, General Medical Superiniendent, School Medical Officer. J. S. Coleman, M.B., B.S., M.R.C.S., L.R.C.P., Deputy Medical Officer of Health and Senior Assistant School Medical Officer (temporary). Jessie A. MacI.aren, M.B., Ch.B., D.P.H., Assistant Medical Officer and Supervisor of Midwives. J. Twelly-Rees, M.R.C.S., L.R.C.P., Assistant Medical Officer. H. Duff-Palmer, M.B., Ch.B., D.P.H., Assistant Medical Officer and Resident Medical Officer, Hart's Sanatorium and Infectious Diseases Hospital. Mary K. Belton, M.B., Ch.B., B.A.O., D.P.H. (as above) (temporary). Ernst Cohn, M.D. (as above) (temporary). Mary E. Long, M.R.C.S., L.R.C.P., D.R.C.O.G., Temporary Assistant Medical Officer and Temporary Medical Officer. Aldersbrook and Scattered Children's Homes. Medical—part-time. Philip Ellman, M.D., F.R.C.P., Consultant, Tuberculosis and Chest Clinic and Hart's Sanatorium. S. C. Reeve-Flaxman, M.R.C.S., L..R.C.P., Ophthalmic Surgeon. 2 R. Savege, M.B., Ch.B., F.R.C.S. (E.din.). 3 H. V. O'Shea, F.R.C.S., Temporary Aural Surgeon. M. E. O'Moore M.B B.Ch B A.O., | Public Vaccinators. N. J. Lawler, M.B., B.Ch., B.A.O.. J B. Dental Surgeons : 4 C. S. Neame, L.D.S., R.C.S. Hilda T. Smith, L.D.S.. R.C.S. (temporary). C. Sanitary and Food Inspectors :— 5 J. E. Austin, M.B.E., F.S.I.A., Cert., S.I.J.B., Cert, Meat Insp., Chief Sanitary Inspector, Food and Shops Act Insp. 6 R. A. Basket. B.K.M., M.S.I.A. W. H. Thurston, M.S.I.A.. A.R.S.I., R.P. D. G. Tomkin, M.S.I.A. W. J. Worley, M.S.I.A., A.R.S.I. L. Pinguey, M.S.I.A. 7 R. Daw, M.S.I.A. 8 C. Lockley, M.S.I.A. Shops Act Inspector : — C. H. Pursell, A.R.S.I. 5 D, Nursing Staff: — Matron, Infectious Diseases Hospital, k. Peacock, S.K.N. (Deceased October, 1945). Matron, Hart's Sanatorium, G. E. Sharpe, S.R.N. Senior Health Visitor, A. A. Woodman, S.R.N. S.C.M., M.r.S.I (H.V's.Cert.). Health Visitors :— M. Preston, S.R.N., S.C.M., R.S.I. (H.V's.Cert.). M. K. Pkessey, S.R.N., S.C.M., R.S.I. (H.V's.Cert.). I. Petkie, S.R.N., S.C.M. (H.V's.Cert.). M. Harry, S.R.N., S.C.M. (H.V's.Cert.). B. Walters, S.R.N., S.C.M. (H.V's.Cert.). 9 M. Golden, S.R.N., S.C.M. (H.V's.Cert.). 15 Senior School Nurse, A. R. Kekwick, S.R.N., A.R.S.I. School Nurses :— M. A. Sorrell, S.R.N., A.R.S.I. A. I. Childs, S.R.N., S.C.M., A.R.S.I. D. Young, S.R.N., S.C.M. M. II. Nunn, S.C.M. 16 V. Ruebens, S.R.N., S.C.M., R.S.I. (H.V's.Cert.). C. G. Case. R.F.N., A.R.S.I. V. Olifent, R.F.N. 17 E. M. Garnham, S.R.N., R.F.N. 18 C. M. Yeates, S.R.N., S.C.M., R.F.N, Temporary. 10 Physio—Therapist and Light Sister : — E. B. Broome, S.R.N., C.S.M., L.E.T., M.S.R. (Temporary). Tuberculosis Nurses :— F. M. Williams, S.R.N., T.A.(Cert.). C. Jenkiw S.R.N.. S.C.M., T.A.(Cert.). M. Stokes, S.R.N., S.C.M., T.A.(Cert.). Social Welfare Nurse and Asst. Social Welfare Officer : — E. E. Kelly, S.R.N., S.C.M., Fever Trained. Municipal Midwives :— M. Law, S.C.M. E. I. Hake, S.R.N., S.C.M. M. e. Kinsella, S.R.N., S.C.M. E. Other Staff- — A. H. Bleaden, Supervising Officer, M.D. Training Centre. H. L. Kingston, Home Teacher, Blind Persons' Acts. 14 W. L. Narborough, Dispenser (Temporary). I. Wurmfeld, Ascertainment and Supervisory Officer, M.D. (Temporary). 19 L. B. Cooney, Asst. Supervising Officer (Temporary), M.D. Training Centre. 20 A. W. Lywood, Guide and Assit. (Temporary), M.D. Training Centre. 6 F. Clerical Staff- Chief Administrative Clerk, T. B. Clark. Senior Clerk and Vaccination Officer, B. E. 15. Hartley, A.C.I.S. Male Clerks :— 12 C. J. Hayes. H. J. Horsnell. B. J. Boar. E. A. Bloomfield. J. C. Childs. D. E. Ross. R. Gunning. 21 A. Smith. And Temporary Clerks. Shorthand Typists :— D. Gordon. V. H. Nicol. 22 H. E. Ritterspack. D. G. Cannell. And Temporary Staff. Female Clerks M. A. McCall. A. R. Gaster. F. C. Wells. B. Clandillon. J. Macintosh. 13 B. H. White. And Temporary Staff. In H.M. Forces. Terminated 9-8-45. 1 Commenced 1-1C-45. 2 Returned H.M. Forces 10-9-45 3 Terminated 8-9-45. 4 Returned H M. Forces 1-10-45. Terminated 31-12-45 5 Appointed Chief Housing Officer and terminated Chief Sanitary Inspector 10-7-45. 6 Commenced Chief Sanitary Inspector 11-7-45. 7 Commenced 12-11-45. 8 „ 9-11-45, 9 „ 3-9-45. 10 ,, 1-10-45. 11 Returned H.M. Forces 17-12-45 12 ,, ,, 26-11-45. 13 „ „ 29-12-45. 14 Commenced 1-10-45. 15 Terminated J 9-12-45. 16 „ 8-4-45. 17 Commenced 2-7-45. 18 „ 26-9-45. 19 Commenced Course of of M.D Trainiug 4-9-45 20 ,, 10-9-45. 21 ,. 13-8-45. 22 Terminated 28-9-45. 7 Public Health Department, Town Hall Annexe, East Ham. October, 1946. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit herewith my Annual Report on the Health and Sanitary Circumstances of the County Borough of East Ham for the year 1945, together with my Annual Report to the Education Authority on the work of the School Health Service. In accordance with the instructions of the Minister ot Health, the report is mainly statistical, although some sections are dealt with in greater detail. The Registrar General's estimate of the population was 95,230. It is apparent, however, that this figure was exceeded during the latter half of the year, owing largely to the return of evacuated persons. Vital statistics generally bear favourable comparison with similar authorities and with England and Wales as a whole. The infantile mortality rate shows only a slight increse over that of the previous year, the lowest recorded in the history af the borough. The maternal mortality rate was much below that of many other boroughs. There were no deaths from typhoid, scarlet fever, whoping cough, and one death only from each of the contagions, diphtheria and measles, although the latter illness was prevalent during the months of March and April. Reference is made to the increase in attendances at the maternity and child welfare clinics, and to the demand for maternity hospital accommodation. With the termination of hostilities, it may be considered appropriate to make reference to the activities of the public health department which, in spite of the additional burdens placed upon it by the exigencies of war, was yet able to maintain in a high degree of efficiency, the established services for the welfare of ihc people of this county borough. It is remarkable to note that, notwithstanding the destruction of numerous homes, the re- 8 strictions in diet, and the perils of day-to-day existence, the individual and public health continued at a most satisfactory level. During the whole period there was no serious outbreak of infectious or epidemic disease, so dreaded in time of war. It will be generally acknowledged that in the organisation of the Casualty, First Aid, and Hospital Services, all sections of the staff of this department—medical, nursing and lay—played an indispensable part in providing facilities for the succour of the shocked, sick and wounded, and for the care of those residents who made nightly excursion to the public shelters. It is impossible to express adequately the deep appreciation one feels is owing to all those men and women associated with the Casualties Services as a whole, who gave so magnanimously of their time and effort, with complete abnegation of self, in the darkest days when this borough was in the area which bore the brunt of the enemy's air assault. I desire to express my gratitude to the Chairman and Members of the Public Health Committee, and to the Chairman and Members of other Committees, for their assistance and support throughout the year; also to my staff and colleagues who have contributed so much to the efficiency of the department. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your Obedient Servant, Malcolm Barker, Medical Officer of Health. 9 Statistical and Social Conditions of the Area Social. Area (in statute acres) land and water 3,324 Population. Census—1931 142,394 Estimated civilian population—1945 95.230 Number of inhabited houses (end of 1945 according to rate books) (Including tenements and shops) Approximately 30,000 Rateable value at 31st December, 1945 £704,494 Sum represented by a penny rate for the year 1945/6 £2,725 Extracts from Vital Statistics. For Total Birth Males Rate Females Live Births Legitimate 1,637 846 791 Illegitimate 105 63 42 Still Births Legitimate 47 26 21 Illegitimate 4 — 4 Deaths—Total 1,235. Males 644. Females 591. Deaths from Puerperal causes:— Death 2 Rate fer 1,000 Total Live and Still Births) Puerperal Sepsis 2 1.11 Other Maternal causes — — Total 2 1.11 Deaths of infants under one year of age :— All infants per 1,000 live births 36 Legitimate infants per 1,000 legitimate live births 36 Illegitimate infants per 1,000 illegitimate live births 38 Deaths from Cancer (all ages) 206 Death from Measles (all ages) 1 Death from Whooping- Cough (all ages) — Death from Diarrhoea (under 2 years) 7 10 Still Births. The number of still births registered was 51 compared with 45 i'or the previous year. The rate per 1,000 total (live and still) births was 28.4, the figure for 1944 being 23.04. Since 1939 the statistics in relation to still births is shewn below:— 1939 1940 1941 1942 1943 1944 1945 No. of still births 57 35 38 69 50 45 51 Rate per 1,000 total (live and still) births 29.9 21.7 29.1 42.5 26.1 23.04 28.4 In England and Wales there are at present about 20,000 still births a year, a figure equivalent to 65% of the total infant deaths under 1 year of age. This large wastage of life at birth is particularly serious in view of the declining birth-rate. Births. The number of live births registered was 1,742 as compared with 1,908 for the year 1944, equivalent to a birth rate of 18.2 per 1,000 of the population—the figure for the previous year— 20.9. A comparison of the statistics for the period since 1939 is appended below:— No. of Births (East Ham) 1939 1940 1941 1942 1943 1944 1945 1,845 1,572 1,267 1,553 1,868 1,908 1,742 Birth rate (East Ham) 14.4 14.29 15.81 17.4 20.09 20.9 18.2 England and Wales 14.9 14.6 14.2 15.8 16.5 17.6 16.1 Deaths. The number of deaths was 1,235 as compared with 1,316 for the year 1944. The death rate was 12.9 that for the previous year being 14.4. Of the total deaths 690 or 56% died in institutions. The number of residents who died outside the area and whose deaths were assigned to the Borough was 672. The number of deaths of non-residents in the district was 41. The percentage of total deaths in the age groups was as follows :— Under 1 year 1—5 years 5—15 years 15—45 45—65 years 65 and over 5.1 1.3 1.1 9.7 25.1 57-6 Reference to table 5 indicates the number of deaths due to enemy action. If the deaths due to this cause are deducted from the total deaths a true conception is obtained of the death rates from 11 natural causes during the war and the following information is therefore given:— Year Total No. of deaths No. of deaths due to enemy action Nett deaths Total death rate Nett death rate 1939 1,400 — 1,400 11.4 11.4 1940 1,684 215 1.469 16.2 13.6 1941 1,296 167 1,129 16.1 13.9 1942 1,157 1 1,156 14.09 14.09 1943 1,232 10 1,222 13.27 13.1 1944 1,316 124 1,192 14.4 13.08 1945 1,235 50 1.185 12.9 12.4 1939 1940 1941 1942 1943 1944 1945 England & Wales 12.1 14.3 12.9 11.6 12.1 11.6 11.4 East Ham 11.4 16.2 16.1 14.09 13.27 14.4 12.9 Infantile Mortality. Deaths of infants under one year numbered 63—equivalent to an infant mortality of 36 per thousand live births—compared with a rate of 31 for Ihe previous year. The rate for England and Wales was 46. The number of deaths of illegitimate children was 4 out of a total of 105 illegitimate births, giving a mortality rate of 38 as compared with a figure of 48 per 1,000 illegitimate live births for the year 1944- Infantile mortality rates since 1939 are as follows:— 1939 1940 1941 1942 1943 1944 1945 East Ham 41 41 46 54 48 31 36 England & Wales 5° 55 59 49 49 46 46 Illegitimate births and the illegitimate mortality rates since 1939 are tabulated below:— 1939 1940 1941 1942 1943 1944 1945 No. of illegitimate births 41 45 57 66 71 82 105 Mortality rate per 1,000 illegitimate live births 48 111 58 29 56 48 38 Neo=Natal Mortality. Children dying under the age of one month totalled 34, equal to a neo-natal mortality of 19.5 .per 1,000 live births. These rates from 1939 are indicated below:— 1939 1940 1941 1942 1943 1944 1945 21.1 21.6 20.5 35.4 23.5 17.3 19.5 12 Maternal Mortality. The number of maternal deaths was 2, the maternal mortality rate for 1945 was 1.11 per 1,000 live and still births. In the subjoining table these rates are shown since 1939:— Per 1,000 total births, live and still. Puerperal Infection Other Causes Total England & Wales East Ham England & Wales East Ham England & Wales East Ham 1939 0.74 1.57 2.08 1.57 2.82 3.14 1940 0.52 0.62 1.64 1.24 2.16 1.86 1941 0.48 — 1.75 1.04 2.23 1.04 1942 0.42 1.23 1.59 2.46 2.01 3.69 1943 0.71 1.56 1.56 1.04 2.27 2.60 1944 0.59 2.04 1.34 1.02 1.93 3.06 1945 0.49 1.11 1.30 — 1.79 1.11 Population. The Registrar-General's estimate of the population to the middle of 1945 is 95,230, which is an increase of 4,170 compared with that for the year 1944. The rates per 1,000 of the population mentioned in this report are based on this estimate. The estimated populations issued by the Registrar-General for the war period are as follows:— 1939 1940 1941 1942 1943 1944 1945 127,600 110,000 80,130 89,200 92,800 91,060 95,230 The population as revealed by the local Food Control Committee in May 1946, was stated to be 111,206. TABLE 2. Causes of Death in Age Groups, 1945, and Total Deaths for 1939-1945. Cause of Death All ages Deaths at different periods of life of residents (civilians), whether occurring within or without the district. Institutional Deaths Total deaths for the years :— Under 1 year 1-5 years 5-15 years 15-45 years 45-65 years 65 and upwards Total Deaths in Institutions 1945 1944 1943 1942 1941 1940 1939 M F M F M F M F M F M F M F M F 1. Typhoid and Para-typhoid Fevers — — — — — — — — — — — — — — — — — 1 — — — — 3 2. Cerebro-Spinal Fever — 1 — — — — — — — — — — — — — — 1 1 1 3 — 3 1 3. Scarlet Fever — — — — — — — — — — — — — — — — — — 1 — — — — 4. Whooping Cough — — — — — — — — — — — — — — — — — 1 1 — 6 — 6 5. Diphtheria — 1 — — — — — — — — — — — — 1 1 3 — 1 3 4 6 6. Tuberculosis of Respiratory System 26 26 1 — — — — — 8 20 11 4 6 2 13 12 52 61 80 53 78 88 13 71 7. Other forms of Tuberculosis 7 2 — — 1 2 — — 2 — 2 — 2 — 5 2 9 14 7 15 8 12 8. Syphilitic Diseases 4 1 — — — — — — — — 2 — 2 1 3 — 5 5 9 7 7 11 2 9. Influenza 3 1 1 1 — — 1 — — — 1 — — — 2 1 4 2 27 5 15 7 29 10. Measles — 1 — — — 1 — — — — — — — — — 1 1 — 1 2 3 — — 11. Acute Polio-Myelitis and Polio- Encephalitis — — — — — — — — — — — — — — — — — — — — — — — 12. Acute Infective Encephalitis — — — — — — — — — — — — — — — — — 1 — 5 3 3 1 13. Cancer of Buccal Cavity and Oesophagus (M) Uterus (F) 10 6 — — — — — — — 1 — 4 10 1 8 5 16 13 14 24 15 24 235 14. Cancer of Stomach and Duodenum 29 15 — — — — — — 4 3 12 2 13 10 18 8 44 45 50 52 35 35 15. Cancer of Breast — 17 — — — — — — — — — 12 — 5 — 7 17 27 19 14 25 1/ 16. Cancer of all other sites 71 58 — — — 1 — — 6 6 28 23 37 28 47 35 129 118 130 128 104 132 17. Diabetes 2 2 — — — — — — 1 — — — 1 2 1 — 4 16 8 12 14 10 22 18. Intracranial Vascular Lesions 49 61 — — — — — — 1 2 13 18 35 41 32 33 110 125 110 116 124 134 63 19. Heart Disease 134 152 — — — — — — 4 5 32 18 98 129 46 53 286 314 237 262 292 393 365 20. Other Diseases of Circulatory System 26 32 — — — — — — 4 — 8 8 14 24 20 19 58 34 34 35 47 27 62 21. Bronchitis 53 22 1 1 — — — — 1 1 18 2 33 18 22 9 75 66 99 71 62 135 48 22. Pneumonia 34 34 8 6 1 1 — 1 3 — 9 7 13 19 24 17 68 59 75 55 45 88 21 64 23. Other Respiratory Diseases 13 7 — — — — — — 2 — 5 2 6 5 6 6 20 12 19 16 18 15 24. Ulcer of Stomach and Duodenum 15 2 — — — — — — 1 — 10 2 4 — 15 1 17 22 18 11 16 16 15 25. Diarrhoea (under two years) 6 1 6 1 — — — — — — — — — 5 1 7 2 11 13 2 5 10 26 Appendicitis 5 1 — — — — 1 — 2 — 2 1 — — 5 1 6 4 6 7 7 11 5 27. Other Digestive Diseases 16 14 1 — — — — — 2 — 4 1 9 13 12 12 30 23 21 23 23 26 46 28. Nephritis 8 8 — — — — 1 1 — — 2 1 5 6 6 5 16 21 20 28 9 26 33 29. Puerperal and Post Abortive Sepsis — 2 — — — — — — — 2 — — — — — 2 2 4 3 2 — 1 3 30. Other maternal causes — — — — — — — — — — — — — — — — — 2 2 4 1 2 3 31. Premature Birth 6 7 6 7 — — — — — — — — — — 5 5 13 19 23 31 14 13 45 32. Congenital Malformations, Birth Iniurv. Infantile Diseases 17 6 14 4 1 — — — 1 — 1 2 — — 13 3 23 23 22 18 14 21 33. Suicide 5 3 — — — — — — — 2 3 1 2 — 3 2 8 6 11 8 14 18 18 34. Road Traffic Accidents 9 7 — — — — 3 — — 2 4 3 2 2 8 5 16 5 10 14 13 21 } 45 35. Other violent causes 28 39 1 2 3 1 3 1 10 12 4 12 7 11 6 13 67 142 32 17 186 245 36. All other causes 68 62 1 1 1 1 1 — 7 6 10 6 48 48 61 45 130 125 131 105 93 134 172 Totals 644 591 40 23 7 9 10 3 59 62 181 129 347 365 386 304 1,235 1,316 1,232 1,157 1,296 1,684 1,400 13a. TABLE 1.—BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1945. Rate per 1,000 Civilian Population Annual Death Rates per 1,000 Civilian Population Rate per 1,000 Live Births Live Births Still Births All Causes Typhoid and Paratyphoid Fever Scarlet Fever Whooping Cough Diphtheria Influenza Smallpox Measles Total Deaths under one year Deaths from Diarrhoea and Enteritis (under 2 years England and Wales 16.1 0.46 11.4 0.00 0.00 0.02 0.02 0.08 — 0.02 46 5.6 126 County Boroughs and Great Towns, including London 19.1 0.58 13.5 0.00 0.00 0.02 0.02 0.07 — 0 .02 54 7.8 148 Smaller Towns (resident populations 25,000 to 50,000 at Census, 1931) 19.2 0.53 12.3 0.00 0.00 0.01 0.02 0.07 — 0.02 43 4.5 London—Administrative County 15.7 0.40 13.8 0.00 0.00 0.02 0.01 0.07 — 0.01 53 7.6 EAST HAM 18.2 0.53 12.9 — — — 0.01 0.04 — 0.01 36 4.01 Per 1,000 related births. A dash (—) signifies that there were no deaths. Rates per 1,000 total population. 13 TABLE 3.—Deaths in Wards, 1945. Cause of Death. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. Total. 1. Typhoid and Para-typhoid Fevers — — — — — — — — — — — 2. Cerebro-Spinal Fever — 1 — — — —- — — — — 1 3. Scarlet Fever — — — — — — — —- — — — 4. Whooping Cough — — — — — — — — —- — — 5. Diphtheria — — — — — — 1 — — — 1 6. Tuberculosis of the Respiratory System 8 5 6 3 10 5 3 4 5 3 52 7. Other forms of Tuberculosis 1 2 — 1 2 1 1 1 — — 9 8. Syphilitic Diseases — 1 1 2 — — - — — 1 — 5 9. Influenza — — 1 — — 1 — — — 2 4 10. Measles — — — — — 1 — — — — 1 11. Acute Polio-Myelitis and PolioEncephalitis — — — — — — — — — — — 12. Acute infective Encephalitis — — — — — — — — — — — 13. Cancer of Buccal Cavity and Oesophagus (M.) Uterus (F.) — 7 1 1 — 1 1 1 2 2 16 14. Cancer of Stomach and Duodenum — 7 5 7 3 4 8 4 1 5 44 15. Cancer of Breast 1 3 2 3 1 2 2 2 1 — 17 16. Cancer of all other sites 17 18 18 10 13 12 12 13 7 9 129 17. Diabetes — — — — .— 1 1 1 — 1 4 18. Intracranial Vascular Lesions 9 11 11 13 10 6 11 18 12 9 110 19. Heart Disease 35 24 23 32 28 27 24 35 31 27 286 20. Other Diseases of Circulatory System 5 7 6 5 7 5 8 3 5 7 58 21. Bronchitis 11 7 6 6 7 4 8 7 8 11 75 22. Pneumonia 11 8 5 7 7 7 5 9 5 4 68 23. Other Respiratory Diseases 5 — 2 1 — 2 3 2 3 2 20 24. Ulcer of Stomach and Duodenum 1 1 1 3 1 2 — 2 2 4 17 25. Diarrhoea (under 2 years) 1 1 3 — — 1 — — — 1 7 26. Appendicitis — 1 — — 1 — 1 1 1 1 6 27. Other Digestive Diseases 4 1 1 2 2 4 5 3 6 2 30 28. Nephritis 4 1 2 — 2 3 1 — 1 2 16 29. Puerperal and Post Abortive Sepsis — — 1 1 — — — — — — 2 30. Other maternal causes — — — — — — — — — — — 31. Premature Birth — 2 — 3 2 1 2 — 3 — 13 32. Congenital Malformations, Birth Injury, Infantile Diseases 2 4 2 1 5 1 — 4 2 2 23 33. Suicide 1 — — 1 — 2 — 1 1 2 8 34. Road traffic accidents 2 2 1 — 2 3 3 — 1 2 16 35. Other violent causes 3 1 5 2 5 19 14 3 13 5 67 36. All other causes 15 16 12 13 6 13 16 15 8 16 130 Totals 136 131 115 117 111 128 130 129 119 119 1,235 14 TABLE 4. Infant Deaths Under One. Year of Age, 1945. 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 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Bronchitis 2 — — — — — — — — 1 — — — — — — — 1 1 — 1 — — 1 — — — — — 2 Pneumonia 14 1 — 1 — 1 — 1 1 — 2 1 2 1 — 2 1 8 6 1 4 1 2 — — 2 2 1 1 10 Diarrhoea, etc. 7 — — — — — — — — 3 — 3 — — 1 — — 6 1 1 1 3 — — 1 — — — 1 6 Congenital Debility and Malformations, Premature Births 31 15 8 1 2 — 1 1 — — — 1 — 2 — — — 20 11 2 5 2 4 5 2 2 3 — 2 22 Other defined causes 9 — — — — — — — 1 4 2 — — 1 — — 1 5 4 — 2 — 1 — 2 1 — 1 2 3 All causes 63 16 8 2 2 1 1 2 2 8 4 5 2 4 1 2 3 40 23 4 13 6 7 6 5 5 5 6 6 43 15 DEATHS DUE TO ENEMY ACTION. The number of deaths recorded in the borough during the war was 523 (residents and non-residents). Of this number, 75 were non-residents, leaving a itotal of 448. It must be appreciated, however, that this figure (448) does not represent the actual number of residents whose deaths resulted from enemy action. A number of those injured in incidents in the area, subsequently died in institutions outside the area, and are not included in the above figures. In addition, others were killed outside the area, and must be added to the total. The actual number of civilians belonging to East Ham whose deaths were due to enemy action, was 567. Statistics relating to this total are set out in tabular form as attached. The first civilian death due to war operations, occurred outside the borough, a member of the Merchant Navy who died on 14/7/40, in an institution at Dover. The first death in East Ham occurred on 31/8/40 at Milton Avenue, and the last was at Boundary Road on 16/3/45. SUMMARY OF DEATHS DUE TO ENEMY ACTION. Age Males Females Total 0—5 years 12 8 20 5—15 years 20 18 38 15-25 Years 33 35 68 25—45 years 75 90 165 45—65 years 108 84 192 65—75 years 29 25 54 Over 75 years 12 18 30 Totals 289 278 567 Year Males Females Total 1940 109 106 215 1941 88 79 167 1942 1 — 1 1943 8 2 10 1944 64 60 124 1945 19 31 50 Totals 289 278 567 16  Males Females Total Deaths occurring in area 207 241 448 Deaths occurring outside area 82 37 119 Totals 289 278 567 NO. OF CASUALTIES TREATED AT FIRST AID POSTS (Fixed and Mobile). Fixed Posts. Town Hall Annexe 600 Church Road 336 Chest Clinic 106 Infectious Diseases Hospital 146 East Ham Memorial Hospital 490 Total 1,678 Closed 1/0/43 Opened 1/10/43 Mobile Posts. Heavy Mobile Unit No. 1 211 Heavy Mobile Unit No. 2 38 Total 240 Discontinud March 1912. Fixed Posts 1,678 Mobile Units 249 1,927 E.M.S. HOSPITALS. The number of patients treated in these hospitals, arising from incidents in this area, were as follows :— In-patients Out-patients Total East Ham Memorial 561 628 1,189 Aldersbrook 290 159 449 Essex County, Wanstead 27 — 27 Queen Mary's, Stratford 2 — 2 Whipps Cross 1 — 1 Albert Docks 1 — 1 Totals 882 787 1,669 17 FIRST AID AND ANTI-GAS TRAINING. The late Dr. F. E. Bendix, and Mr. A. J. Ambler, First Aid Commandant, were responsible to the Medical Officer of Health for the above training. From 1938 to the end of the war, the number trained was as follows:— First Aid 9.757 Anti-Gas 2,103 Before training undertaken by Warden's Service. In addition to those trained by the St. John Ambulance Association in First Aid, 370 were allocated by the B.R.C. for combined training in both subjects. Members of all the Civil Defence Services received training. General Provision of Health Services. Professional Nursing in the- Home. A. GENERAL. The Council makes a grant in aid of the Shrewsbury Road District Nurses' Home, Ascot Lodge, Shrewsbury Road. The services of Nurse Kelley are available for social welfare cases. B. INFECTIOUS DISEASE. Owing to the situation of the Authority's hospital and the danger of enemy air attack, the staff and patients were removed in September 1939, to Woodford Green. One of the wards at the Harts Sanatorium was (and still is) used for the patients, and the staff were accommodated in premises adjacent to the institution. The bed slate was considerably decreased. Hospital treatment is advised in all cases of diphtheria and in scarlet fever when accommodation is available. No provision is made for the nursing of infectious disease in the home. C. MIDWIVES. In addition to the three Council midwives mothers are attended by the sister midwives and nurses from Plaistow Maternity Hospital and those attached to the Burges Road Home. The Midwives from the Sir Henry Tate Home attend a few mothers in the North Woolwich area. 18 MIDWIVES ACTS, 1902 to 1936. The number of midwives who notified their intention to practise in East Ham during- 1945 was 29. Of this number 13 worked in connection with the Maternity Hospital and District Nurses' Home, l'laistow, and its branches—1 at Sir Henry Tate Nurses' Home, Silvertown—9 at East Ham Memorial Hospital —and 6 practised independently, including 3 Municipal Midwives. PLA1STOW MATERNITY HOSPITAL AND DISTRICT NURSES HOME Summary of cases, 1945 :— Midwifery 161 Monthly 95 Hospital 170 Laboratory Facilities As detailed in previous reports the majority of the specimens are sent for examination-to the East Ham Memorial Hospital. During- 1945, 1,230 specimens were examined and the nature of these examinations is shewn below:— Specimen A umber Blood (Sedimentation Rate) roS ■45 Blood (Widal Test) 1 1 Blood (Count) 26 Blood (Wasserinann) 7 1 Blood (Other) 3 ) Sputa (for Tuberculosis, Direct method) 958 993 Sputa (for Tuberculosis, Antiformin method) 14 1 Sputa (for Tuberculosis, Cultures) 16 ! Sputa (for Tuberculosis, Concentration method Sputa (for Asbestosis) ... 3 Sputa (for Malignant cells) 3 Mantoux test (for Tuberculosis) 18 45 Swabs (for Tuberculosis) 2 \ Swabs (rectal for enteritis) 16 | Swabs (for haemolytic Strepts.) 10 Swabs (for Gonococci) 4 I Swabs (other) 13 J Fae:"« (for various exams.) 14 Other 13 Total : 1,230 10 The number of diphtheria Swabs examined at the Infectious Diseases Hospital and Town Hall Annexe Laboratory, was as follows— Number Positive Negative Infectious Diseases Hospital ... 644 6S 579 Town Hall Annexe 58I 11 57o Totals: 1,225 76 1,149 Ambulance Facilities. At the beginning- of the war, (he 2 public ambulances were transferred from the Fire Brigade and operated with the Civil Defence Ambulance section. The 2 infectious diseases ambulances continued to operate separately from the Infectious Diseases Hospital. With the disbandment of Civil Defence, the ambulance service reverted to Public Health. The Council decided to create an ambulance section of the Public Health Dept. and to pool all the ambulances (including the 2 from the Infectious Diseases Hospital) and on Sunday, 1st July, 1945, this section commenced to function and the Ju'y. I945. this section commenced to function and the following information in respect of the work performed from 1/7/45 to 31/12/45 is given below:— 30 Nature or Call Journeys Mileage Sickness 1030 8182 Maternity 393 4107 Accident, Sudden Illness 439 2065 T.B. Transfers 113 2104 Hospital Transfers 70 "57 Social Welfare 132 5880 Air Raid Casualties 10 213 Malicious Calls 6 13 Miscellaneous 165 1610 Scarlet Fever 86 1385 Diphtheria 18 286 Discharges Infectious Diseases ... 56 9T3 Miscellaneous Infectious Diseases 21 309 Calls for other Boroughs:— West Ham 2 3 168 11 ford 11 "33 Barking 57 657 Dagenham 1 J9 Calls by other Boroughs :— West Ham 13 72 Barking 7 73 Ilford 10 9i Wanstead & Woodford ... 2 11 L.C.C. I 15 21 Clinics and Treatment Centres. These are all provided by the Council. The sessions at the Centres (as on 31/12/45) were as follows:— TABLE 5. CLINIC AND TREATMENT CENTRES. Situation Purpose used Sessions Town Hall Annexe General Clinic (Minor Ailment & Observation cases) Monday, Wednesday and Saturday, 9.30 a.m. Immunization Clinic Monday 2 p.m. (School Health) Wednesday 10.30 a.m. (M. & C.W.). ,, ,, ,, Infant Welfare Clinic Monday, Thursday and Friday, 2 p.m. ,, ,, ,, Light Clinic Monday, Tuesday, Thursday and Friday 2 p.m. ,, ,, ,, Eye Clinic Tuesday and Friday 9.30 a.m. ,, ,, ,, Toddlers' Clinic Tuesday 10.30 a.m. ,, ,, ,, Ear Clinic Wednesday and Friday 2 p.m. ,, ,, ,, Ante-natal Clinic Wednesday 2 p.m. and Thursday 9.30 a.m. ,, ,, ,, Scabies Clinic Tuesday 5 p.m. and Friday 2 p.m. ,, ,, ,, Dental Clinic By Appointment Church Koad, Manor Park Infant Welfare Clinic, General Clinic (Minor Ailment & Observation cases) Monday and Thursday 2 p.m. Tuesday and Friday 9.30 p.m. ,, ,, ,, ,, Ante-natal Clinic (and Post-natal) Tuesday 2 p.m., Wednesday 9.30 a.m. ,, ,, ,, ,, Immunization Clinic Wednesday 2 p.m. (School Health), Thursday 9.30 a.m. (M. & C.W.) ,, ,, ,, ,, Toddlers' Clinic Friday 2 p.m. ,, ,, ,, ,, Dental Clinic By Appointment North Woolwich—Storey Street School General Clinic (Minor Ailment & Observation cases) Friday 2 p.m. Tuberculosis and Chest Clinic, Katherine Road Tuberculosis and Chest Clinic Monday, Tuesday, Thursday and Friday 2 p.m., alternate Thursday 6 p.m., alternate Saturday (children only) 9.30 a.m. Durban House, Katherine Rd. Treatment Centre Every morning (Mon.—Sat.), Schoolchildren, 9 a.m. Monday, Wednesday and Friday 2 p.m. and Tuesday and Thursday 6 p.m. (adults and children under 5 years) 22 Social Welfare Domiciliary Medical Service. The "open choice" scheme of medical relief was adopted by the Council in 1933 and was described in my report for the year 1934. It operated throughout the whole of the Borough with the exception of a small area beyond the King George V and Royal Albert Docks in North Woolwich until 31/12/38, when Dr. Brews, District Medical Officer, for that small area, retired. On 1/1/39 the whole of the Borough was included in the scheme. The service continues successfully, is popular with all concerned and is administrated with the minimum of trouble. TABLE 6. SOCIAL WELFARE DOMICILIARY MEDICAL SERVICE. Statistical Return for the Year Ending 31/12/45. No. of Individual Patients No. of Attendances at Homes. No. of Attendances at Surgery. Total No. of Attendances. No. of occasions Medicines supplied without seeing Patients 2,922 1,450 4,985 6,435 206 Number of applications to Medical Officer of Health for hospital treatment 3 Social Welfare Nurse and Assistant Social Welfare Officer. Number of requisitions received for attendance of Nurse 7 Total attendances at home by Nurse 1,958 Venereal Diseases. The facilities available were the same as in recent years for the treatment of these diseases. From the official tables supplied by the London County Council the following figures are abstracted and arc compared with statistics since 1939:— 23 New Patients:— 1945 1944 1943 1942 1941 1940 1939 Syphilis 22 18 13 Not Available 17 10 13 Soft Chancre 1 1 2 — — 1 Gonorrhoea 43 48 26 40 47 61 Not Venereal 133 101 104 62 70 110 Total 199 168 145 125 127 185 Total attendances 2726 2786 2648 1716 2015 4716 — — 41 — 23 42 Pathological Examinations:— For or at the Centres— Spirochaetes — Gonococci 727 Wassermann 396 Others 1158 Total 2281 For Practitioners— Spirochaetes — Gonococci 6 Wassermann 13 Others 13 Total 32 Venereal Diseases Rules, 1912— Regulation 33B. Contacts notified to the Medical Officer of Health during the period 1/1/45 to 31/12/45. M. F. (1) Total number in respect of whom Form 1 was received — 9 24 (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 - 4 Contacts found — — Contacts examined 1 — — (3) Number of those in (1) in respect of whom two or more Forms 1 were received - 5 (4) Number of those in (3) who were:— (a) found — 4 (b) examined after persuasion — 4 (c) served with Form 2 — — (d) examined after service of Form 2 — — (e) prosecuted for failure :— (i) to attend for, and submit to, medical attention - - (ii) to submit to and continue treatment — - Mental Deficiency. Whilst the difficulty formerly experienced in obtaining institutional accommodation has been relieved by the provision of South Ockendon Colony, the placing of low grade cases is still a problem- Statistics are given later in the Report. General and Special Hospitals and Children's Homes ARRANGEMENTS FOR TREATMENT. (a) Provided by Local Authority, (b) Maternity, (c) Orthopaedic, (d) Ear, Nose and Throat, (e) Puerperal Pyrexia, (f) Ophthalmia Neonatorium. In my last report (1938) before the war, I stated that the Council were in negotiation with the East Ham Memorial Hospital for the erection of a maternity and children's block at the hospital. The maternity block was opened on 1/11/43, with 15 beds. There are no further comments to make on existing arrangements. Particulars have been set out in previous reports. 25 (g) Runwell Mental Hospital. (East Ham and Southend=on Sea Joint Hospital Board). 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 1945. (h) Smallpox. (i) East Ham Memorial Hospital. Statistics from the hospital report for the year 1945 are as follows:— TABLE 7. A. In-Patients Number of Beds and In-Patients. Beds:— N umbers in 1945 N umbers in previous year. (a) Complement at 31st December *151 †211 (b) Average Daily Complement during the year 170.8 211 (c) Average Daily Number Closed during the year owing to:— (i) Rebuilding — — (ii) Repairs, Redecoration, Cleaning or Infection - - (iii) Other Causes (enemy action) 47.8 88 (d) Average Daily Number Open during the year (i) Emergency Hospital Scheme, Casualty beds 29.0 36.0 (ii) Other beds 75.9 61.7 2. Number of In-Patients in the Hospital at beginning of year 80 61 3. Number of In-Patients admitted during the year 2,321 2.098 4. Number of In-Patients in Hospital at end of year 82 80 5. Average Number of days each Patient was resident 13.7 12.6 6. Number of Patients admitted and dischirged durine the year who were resident for (i) only 1 day 364 315 (ii) 2 and 3 days 344 285 Including 20 Beds for Emergency Hospital Scheme, ,, 80 ,, ,, ,, ,, 26 B. Out=patients Numbers. N umbers in 1945 Numbers in previous year. 1. Total Number of new Out-Patients 17,092 14,532 2 Total Number of Out-Patient attendances 86,301 77,236 (a) Number of Patients on books at the beginning of the year Not ascertainable Not ascertainable (b) Number of Casualty Patients included in No. 1 above 5,350 4,277 (C) No. of Maternity Patients included in No. 1 above 405 419 (d) No. of attendances of Maternity Patients included in No. 2 above 2,708 2,049 EAST HAM ANNUAL HEALTH REPORT.—NINE (i) Whipps Cross Hospital and Institutions Controlled by West Ham. Beds allocated on "user basis" to East Ham. TABLE 8. Institution. No. of Beds Type. Whipps Cross Hospital 131 Medical and Surgical. Central Homes 254 Able-bodied and Sick. Forest Gate Hospital 74 Sick, Maternity & Mental Defectives. Forest House & Cottages 50 Chronic Cases. (1) Tolmers Park, Herts. This institution comprising 100 beds for chronic sick patients from the County Borough of East Ham was opened by the Corporation on 7/5/40. Statistical information in respect of this Home is appended below:— TABLE 9. Chargeable on 31-12-44 Admitted dining 1945 Total Discharged Died T ransferred to other Institutions Chargeable on 31-12-45 94 27 121 22 29 - 70 27 TABLE 10. Cases Admitted to West Ham Institutions from East Ham. Institution. Chargeable on 31/12/44 Admitted during 1945 Born during 1945 Total Discharged Died Transf'd. to other Instns. Chargeable on 31/12/45 Whipps Cross Hospital 128 1461 - 1589 1121 276 24 168 Forest Gate Hospital 47 526 459 1032 970 5 9 48 Harold Wood Hospital 23 13 - 36 1 5 1 29 Central Home 157 260* - 417 65 131 66* 155 Forest House 34 21 - 55 8 1 18 28 *Includes admission to and transfer from Central Home to Aldersbrook of 45 children. 28 (k) Aldersbrook Homes and Scattered Homes. I am indebted to Mr. Pitt Steele, Superintendent, for the following information relative to the years ended 31/12/45:— This year Corresonding 1944/5 1939 Highest number in residence during year 520 515 496 Lowest number in residence during year 460 428 437 Numbers in lesidence on 1/1/45:— Aldersbrook and Scattered Homes 79 66 450 Cornwall 298 265 — Hutton 115 95 - Other areas 11 11 — Numbers in residence 31/12/45:— Aldersbrook and Scattered Homes 151 79 Cornwall 210 298 Hutton 100 115 Other areas 3 11 Total number of admissions 820 621 570 From East Ham 233 203 114 From West Ham 309 217 267 From Essex County Council 278 201 189 From Education Authorities (included in totals) 39 14 - Total number of discharges 859 555 570 From East Ham 281 170 From West Ham 292 201 From Essex County Council 286 184 From Education Authorities (included in totals) 32 - Average number of admissions weekly 15.7 12.33 10 Average number of discharges weekly 16.5 10.6 10 Greatest number admitted on any one day 13 12 10 Number of children under 3 years admitted 307 250 166 Chareeabilitv to Authorities on 31/12/45:— East Ham 98 149 83 West Ham 169 155 225 Essex County Council 157 172 152 Education Authorities:— East Ham 3 — — West Ham 13 10 — Walthamstow 5 6 — Ley ton 14 6 - Essex County Council 5 5 — Number of deaths in the Homes — 3 — Transfers to other institutions not under control of East or West Ham or Essex County Council 45 30 32 Transfers to or from Reception Areas:— To 306 417 — F rom 417 358 — Total number of davs maintenance 173419 171332 168314 29 In residence 31/12/45:— Infants under 3 years 85 103 39 Children over 3, under 5 years 68 67 41 Children over 5, under 8 years 103 109 90 Boys over 8, under 14 years 104 107 123 Girls over 8, under 14 years 64 81 91 Boys over 14, under 16 years 21 17 36 Girls over 14, under 16 years 15 19 40 Boys over 16 2 — — Girls over 16 2 - - Number of boys sent to situations 7 9 21 Number of boys returned from situations and replaced 1 1 1 Number of girls sent to situations 11 11 23 Number of girls returned from situations and replaced 1 2 - Number of boys and girls whose wages were subsidized - - - Mental Deficiency Acts, 1913/27 The ascertainment and supervision of persons coming within the scope of these Acts, and the examination, certification, and completion of reports for the Board of Control and other authorities, have been carried out satisfactorily. TABLE II. VISITS Statutory Supervision Guardianship Institution Training Centre Friendly Care Total Number of Interviews 898 122 186 25 137 1368 93 30 TABLE 12. MENTAL DEFICIENCY ACTS, 1913—1938. ANNUAL REPORT for the year ended 31st December, 1945 (vide Article 12 of the Mental Deficiency Regulations, 1935). STATISTICS (Comparison with previous year):— A.1.—Under Order:— 1945 1944 (a) (1) In Institutions: (excluding cases on Licence)— M. F. T. M. F. T. Under 16 years of age 8 7 15 12 7 19 16 years and over 75 55 130 65 59 124 (2) On Licence :— Under 16 years of age - - - 1 - 1 16 years and over 6 8 14 4 4 8 (4) Under Guardianship: (including cases on Licence)— under 16 years of age 1 1 2 2 16 years and over 14 23 37 15 18 33 2. In "places of safety":— Under 16 years of age - 1 1 - - - 16 years and over - - — - - - 3. Under Statutory Supervision:— 74 57 131 67 58 125 (of whom awaiting removal to Inst.). - 1 1 1 1 2 4. Action not yet taken under any one of above headings 8 12 20 5 7 12 B. Number of mental defectives not at present " subject to be dealt with," but for whom the local authority may subsequently become liable 23 19 42 20 23 43 (Of whom, number under voluntary supervision) 21 18 39 16 19 35 Number of Cases on Register of Occupation Centre 11 12 23 17 12 29 CASES REPORTED BY LOCAL EDUCATION AUTHORITIES DURING THE YEAR 1945 (Reported under sec. 2(2) & 57(3) & (5) 1945 1944 sec.2(2) 4 3 7 3 4 I Method of Disposal:— Sent to Institutions (by Order) — 1 1 — 1 1 Placed under Guardianship (by Order) — — - - - - Placed under Statutory Supervision 2 1 3 3 2 5 Taken to "place of safety" — 1 1 - - - Died or Removed from Area — — — — 1 1 Action not yet taken 1 1 2 — — — Total 7 4 7 3 4 7 Of total number of mental defectives known to local authority:— (a) Number who have given birth to children during 1945 1944 (a) After Marriage one one (b) While unmarried one nil (b) Number who have married 1 male 2 males 1 fem. 1 fem. 31 ASCERTAINMENT. The number of cases dealt with for the first time during the year 1945 was 19, and they were dealt with as under:— 4 placed in institutions (under Order). 1 in a "place of safety"—admission pending elsewhere. 11 placed under statutory supervision. 1 placed under friendly care. 1 declared uncertifiable. 1 referred to Essex County Council. GUARDIANSHIP. There are 38 cases under guardianship, of whom 4 are still evacuated to other areas. During the year three males were transferred under Varying Orders to institutional care (2 having proved no longer suitable for guardianship, and in one instance, the guardian, an elderly mother, died suddenly) and one female (high-grade) married, and was subsequently transferred to friendly care. SUPERVISION There are 131 mental defectives under statutory supervision in their own homes, plus 14 who are still evacuated to other areas. A number who removed during the war are still 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. It is very rare that parents 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. A conveyance is provided to facilitate the attendance of a large number of the defectives. There has been an average daily attendance of 22 of varying ages and of both sexes. Handwork of all types form the main part of the curriculum, and all articles made are definite orders for sale. In some instances work is taken home for completion. More orders are received than can be accepted owing to the difficulty of obtaining the necessary material, which difficulty also restricts more variation in the handicrafts which could be taught, A certain amount of 32 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. The meal is conveyed to the Centre, from a nearby Local Centre which supplies the School Dinners, in hot metal containers, and is varied daily. In suitable weather, outdoor games and also simple gardening instruction, form part of a day's occupation. Each defective also assists, at the closing of the Centre each day, in the orderly clearing of tables and storing away of their work. LICENCE, DISCHARGE AND AFTER-CARE. Out of 21 defectives (11 males and 10 females) granted licence during the year, 3 were recalled to institutional care, 14 are at work and doing fairly well, 2 are residing satisfactorily with their parents, and 2 were discharged from the operation of the M.D. Acts. Occasional visits are paid to all cases discharged from the operation of the Acts and still within this area. All removals are notified to the respective areas. 33 TABLE 13. MENTAL DEFICIENCY ACTS, 1913—38. (STATISTICS for period December 1939—December 1945). YEAR 31/Dec. UNDER ORDER In places of Safety. Under Statutory Supervision. Under Permissive Powers. Under Friendly Care. Total. In Institutions. Under Guardianship. 1939 109 39 10 154 5 51 363 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 1944 153 35 — 125 5 35 355 1945 *159 *38 1 *131 4 *44 877 (inclusive 14 on licence). 2 died during year 2 orders discharged 2 awaiting admission (inc. 4 still evacuated) 2 transferred to Ockendon 1 Order discharged exc, those still evac. and 3 in H.M.F. Many removed during wartime still untraceable (1 transferred to Ockendon) (many removed and untraceable, 3 in H.M.F.) -34 Training Centre. The Occupation Centre for mental defectives was closed at the beginning of the last war, and was re-opened in new premises, the Labour Hall, Katherine Road, E.6, on 4/5/42, and whole day sessions commenced on 29/6/42 with the provision of a mid-day meal. These arrangements have continued since that date. The attendances during 1945 are indicated below:— Morning Session:— Number on register 21 (15 males and 6 females) Number of sessions 208 Total attendances 3,628 Average attendance 17 Afternoon Session:— Number on register 22 (14 males and 8 females) Number of sessions 208 Total attendances 3,677 Average attendance 17 Note.—One male attended 3 mornings weekly and two females on afternoons only. Blind Persons Acts, 1920/38 The work of ascertainment and medical examination has continued and blind persons are under the constant supervision and care of Miss Kingston. Lectures and instruction in Moon and Braille are given during the day, and evening visits are paid when required. All blind persons and dependants are now entitled to free medical treatment under the Council's Social Welfare Domiciliary Medical Service Scheme. A tribute is due to the local Welfare Association for their interest and Social activities on behalf of the blind, 35a Note : M = Males. F = Females T = Total. TABLE 15. Blind Persons Acts, 1920/38. Registration. (As at 31.3.46.) Age Periods of Registered Blind Persons. Age Period 0—1 Age Period 1—5 Age Period 5—16 Age Period 16—21 Age Period 21—40 Age Period 40—50 Age Period 50—65 Age Period 65—70 Age Period 70 and over Age Unknown Total of all 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. — 1 1 — 1 1 1 1 2 1 2 3 11 9 20 11 9 20 23 24 47 9 15 24 37 58 95 — — — 93 120 213 Ages at which Blindness occurred. Age Period 0—1 Age Period 1—5 Age Period 5—10 Age Period 10—20 Age Period 20—30 Age Period 30-40 Age Period 40—50 Age Period 50—60 Age Period 60—70 Age Period 70 and over Age Period Unknown Total of all 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. 16 16 32 — 1 1 4 4 8 5 4 9 10 5 15 8 12 20 11 12 23 9 17 26 17 20 37 11 27 38 2 2 4 93 120 213 Children of School Age, 5—16. Training and Employment and Unemployment. Age Period 16 and upwards. In Schools for the Blind Normal Mentally Defective Physically Defective Employed Undergoing Training Unemployed (k) (1) M. F. M. F. M. F. By Blind Organisations (c) (d) (e) (f) (g) (h) (i) (j) All others not included in Total Industrial Secondary Professional and University Trained but unemployed No Training but Trainable Unemployable Total " Unemployables " in (j) over age 70 (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 1 — — 7 6 13 2 1 3 13 3 16 22 10 j 32 2 1 3 - - - - - - - 1 1 1 1 2 67 104 171 92 117 209 37 58 | 95 Occupations of F.mployed Blind Persons. Agents, Collectors, etc. Basket Workers Bedding (including Divans and Ottomans) and Upholstering Boot Repairers Braille Copyists and Proof Readers Brush Makers Carpenters and Woodworkers Chair Seaters Clerks and Typists Coal Bag Makers Dealers, Tea Agents, Newsagents, Shopkeepers Firewood Workers j 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 3 - - - - 1 - - - - - - - - - - 4 - - - - - - - - - - - - 2 - - 13 (b) In approved Home Workers' Schemes - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - 2 - - - 3 (c) Others (not Pastime Workers) — 1 - - 2 - - - - 1 - 1 - - - - - - - - - - - - - - - - - 4 - - 4 1 16 (d) Total — 4 3 — — 2 — 1 — — 1 - 1 — — — — 1 4 — 2 — — — — — — — — 4 2 2 4 1 32 1 35b Physically and Mentally Defective. 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 HosDitals 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. F. T. M. F. T. M. F. T. M. F. T. 5 6 11 6 6 12 5 10 15 3 2 5 - - - - - - - - 19 24 43 - - - - - - - - - 3 4 7 3 7 10 New Cases Registered (not Transfers from other Registers) during the year ended 31st March, 1946. Age Periods. Age Period 0—1 Age Period 1—5 Age Period 5—16 Age Period 16—21 Age Period 21—40 Age Period 40—50 Age Period 50—65 Age Period 65—70 Age Period Age Unknown Total of all 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. — 1 1 — 1 1 — — — — — - — 1 1 — — — 2 1 3 2 1 3 2 — 2 — — — 6 5 11 New Cases Registered (not Transfers from other Registers) during the year ended 31st March, 1946. Ages at which Blindness occurred. Age Period 0—1 Age Period 1—5 Age Period 5—10 Age Period 10—20 Age Period 20—30 Age Period 30— 40 Age Period 40—50 Age Period 50—60 Age Period 60—70 Age Period 70 and over Age Period Unknown Total of all Age Groups M. F. T. M. F. T. M. F. T. M. F. L. 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 — — — — — — — — — — 1 1 — 1 1 — — — 1 — 1 3 1 4 2 — 2 — — — 6 5 11 Since 1939, the number of blind persons on the Register are shown below :— As at 31.3.40 As at 31.3.41 As at 31.3.42 As at 31.3.43 As at 31.3.44 As at 31.3.45 As at 31.3.46 224 223 222 235 230 225 213 1 35 TABLE 14. Work of the Visitor to the Blind, 1945. Year No. of Blind on Register 31-12-45 No. of visits to same No. of partially Blind Persons No. of Visits to same Other Visits Total Visits No. of Lessons given Lessons given in Day Evening Braille Moon Knitting Crochet Manual 1945 214 2,133 91 (56 102 66 2,392 351 148 69 80 31 23 36 Prevention of Blindness A full and complete report on the Prevention of Blindness was submitted to the Council in 1937—no further action has taken place. The Invalid Children's Aid Association The Local Authority is indebted to the Association for its beneficial work on behalf of the Children and the nature and extent of the services rendered will be seen from the following statistics. i wish to express my thanks to the Committee and to Miss Webber for their invaluable assistance in obtaining vacancies in Convalescent Homes and for their help in the administration of the arrangements generally during the past year. The number of cases dealt with during 1945 was 204. The following are the particulars:— Children referred by:— Private Doctors and Hospitals 46 Chest Clinic 47 M. & C.W. Centres 15 Education Dept. and School Health Service 81 Parents applied 9 Others 6 Total 204 The children suffered from:— Tuberculosis 16 Anaemia and Debility 27 Rheumatism, Chorea and Heart 9 Bronchitis 56 Asthma 7 Debility following illness, operations and accidents 35 Crippling Defects 21 Nervous conditions 15 Congenital deformities 8 Various 10 Total 204 37 Assistance was given as follows:— Sent to Convalescent Homes and Sanatoria 142 Provided with surgical appliances ... 16 Referred for visiting and advice ... 3 Cases cancelled 26 Awaiting treatment at end of 1945 17 Total 204 Number of home visits paid during the year-—860. East Ham District Nursing Association As a member of the Committee of the East Ham District Nursing Association, 1 am personally conversant with the munificient work of the Association. The number of visits paid by the nursing staff gives some indication of the nursing care afforded to residents in the Borough and the calls are still increasing. Summary of cases, 1945:— Bronchitis and Pneumonia 54 Tuberculosis 16 Cardiac 56 Rheumatism, Arthritis, etc. 52 Cerebral 39 Diabetes 60 Burns with scalds 16 Other medical 187 Various Surgical 110 Cancer 113 Senility 88 Total 791 Patients on books, 1/1/45 115 New patients nursed during 1945 676 Total 701 Total number of visits during 1945—18,755. 58 Scabies and Treatment Centre. East Ham Tuberculosis After=Care Committee. The After-Care Committee is of inestimable benefit to both patients and dependants in providing bedding-, clothing, etc., and is helpful in giving personal advice to ex-sanatorium cases who experience difficulties in connection with their homes or work. Much kind help is thus afforded to the tuberculosis sufferer. National Society for the Prevention of Cruelty to Children. Ready help and co-operation is provided in respect of cases referred to the Inspectors. The following statistics are appended :— Number of new cases attending' 1942 :943 1944 1945 Scabies Clinic... 478 969 520 268 Treatment Baths:— Patients No. of baths !942 674 1.947 J943 622 1,689 1944 584 1,4Sl 1945 5DI i,5u Maternity and Child Welfare Midwifery Services. The Council under the Midwifery Act, 1936, appointed 3 municipal midwives. Three such midwives were employed during the year under review and although the demand for their services in some of the war years decreased owing to evacuation and bombing, the number of cases booked was rapidly increasing towards the end of 1945. Number of cases attended by them since 1939 is shewn below :— '939 1940 1941 1942 1943 !944 I94S As Midwives ... ... 194 149 100 225 211 172 As Maternity Nurses ... 37 21 9 12 34 3i 14 Total 231 170 109 197 259 242 186 39 TABLE 16. 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 5 — 3 (b) Normally employed by other Local Supervising Authorities but temporarily working in the area — — — (c) Employed by other Welfare Councils :— (i) Under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives' Act, 1936 — — — (ii) Others — — — (d!) Employed by Voluntary Associations :— (i) Under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives' Act, 1936 14 — 14 (ii) Others — 9† 9† (e) In private practice 3 — 3 T otals 20 9 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 172 — 172 As Maternity Nurses 14 — 14 (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 165 — 165 As Maternity Nurses 5 — 5 (ii) Others :— As Midwives — 325 325 As Maternity Nurses — 44 44' (e) In Private Practice :— As midwives 65 — 65 As Maternity Nurses 12 — 12 TOTALS :— As Midwives 402 325 727 As Maternity Nurses 31 44 75 tEmployed by Voluntary Hospital (East Ham Memorial). 40 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 117 (ii) For cases in institutions 40* Total 157 *East Ham Memorial Hospital. Maternity Hospital Accommodation. The maternity ward in the East Ham Memorial Hospital was opened on 1/11/43, the accommodation is 16 beds (exclusive of isolation and labour beds) and the following statistical information in respect of the year ended 31/12/45 is given:— East Ham Memorial Hospital. Number of maternity cases admitted 405* Average duration of stay of cases in lying-in wards 13.9 days Number of cases delivered by:— (a) Midwives 325 (b) Doctors 44 369 Number of cases in which medical assistance was sought by a midwife in an emergency 40 Number of cases admitted after delivery 1 Number of cases notified as Puerperal Pyrexia 1 Number of cases of Pemphigus Neonatorum — Number of infants who received a supplementary or complementary feed while in the institution (excluding those given during the first 3 or 4 days whilst breast feeding is being established) :— Supplementary 10 Complementary 21 31 Number of infants wholly breastfed on leaving the institution 345 Number of cases notified as Ophthalmia Neonatorum — Number of Maternal Deaths — Number of Still Births 8 Cause in each case and results of post-mortem examination (if obtainable) :— 1. Mother acute Hydramnious; infant 41 formed, confirmed by X-Ray, premature labour, 30 weeks. 2. Termination of pregnancy, 28 weeks, mother pre-edamptic and pregnancy insanity. 3. Brow presentation. 4. Breech presentation. 5. Breech presentation. 6. Cord prolapse. 7. Cord prolapse. 8. Distress of Foetus due to prolonged labour. Number of infant deaths within 10 days of birth 8 Cause of death in each case and results of postmortem examination (if obtainable) :— 1 and 2, 4, 5 and 6, Prematurity and Atelectosis. 3. Spina Bifida and Hydrocephalic. 7. Cerebral haemorrhage. 8. Broncho Pneumonia. *This represents number of admissions not number of individual cases. As detailed in my 1944 report, hospital accommodation for women whose homes are unsuitable or who require in-patient treatment on medical grounds is provided at East Ham Memorial Hospital, Forest Gate Hospital, Plaistow Maternity Hospital and District Nurses' Home, and Queen Mary's Hospital, Stratford. The number of cases admitted to institutions in the London Area during 1945, is given below:— Note.-—With the exception of East Ham Memorial and Forest Gate Hospitals and the last item, this information has been abstracted from births notified to the Public Health Dept. Institution No. of East Ham Cases Admitted No of cases in which admission was arranged by P.H.D. East Ham Memorial Hospital 370(4) 370 Forest Gate Hospital 395(6) 395 Queen Mary's Hospital for the East-End 37(2) 5 Plaistow Maternity Home, Howards Road, E.13 33(1) Sunt rap Hospital 141(2) — Other London Hospitals 43(2) — Private Nursing Homes (London) 10 — Emergency Maternity Homes outside London 35 35 Totals 1073(17) 805 Figures in brackets indicate number of still births included in main figures. 42 Provision for Unmarried Mothers and Homeless Children. Already detailed in report for 1930. Illegitimate Children. The Council have not yet decided their policy under Circular 2866, no social worker has been appointed for the purpose and the arangements at present are undertaken by the Social Welfare Committee. Maternity Fees and Sales of Dried Milk and Ancillaries. During the year ended 31/12/45, the following amounts were collected at the clinics :— Fees for maternity hospital accommodation 3,840 5 1 Fees for municipal midmifery 140 10 6 Sale of dried milk and ancillaries 1,699 4 3 Total £5,679 19 10 Ophthalmia Neonatorum. Two cases of Ophthalmia Neonatorum was notified during the year, with the following result:— (a) Vision was unimpaired 1 (b) Vision was impaired — (c) Vision was lost — (d) The patient was still under treatment at the end of the year — (e) The patient removed from the district 1† (f) Classification under above heads cannot be made — Total 2 † Patient notified in East Ham belonged to West Ham. 43 TABLE 17. CHILD LIFE PROTECTION (Sections 206 to 220 of the Public Health Act, 1936). Individual Foster Mothers Homes, Institutions, etc. Total Exempted under Section 219 (i) b, of the Public Health Act, 1936 Exempted from visiting under Section 219 (3) of the Public Health Act, 1936 Not Exempted Voluntary Private and Others Voluntary Private and Others Voluntary Private and Others (a) Receiving children under nine for reward apart from their parents at the end of the year 19 — — — — — — 19 (b) Number of children under nine (i) at end of year 19 — — — — — — 19 (ii) who died during year — — — — — — — (iii) on whom inquests were held during the year — — — — — — — — 44 (c) Number of Child Protection Visitors at the end of the year who were :— (i) Health Visitors 7 (ii) Female, other than Health Visitors — (iii) Male — (d) Number of persons (in addition to or in lieu of Visitors under (c) above) or Societies authorised to visit under the proviso to Section 209(2) of the Public Health Act, 1936 Nil (e) Proceedings taken or orders applied for during the year Nil (f) Number of cases in which sanction has been given during the year under Section 210 of the Public Health Act, 1936:— (i) (ii) (iii) under Subsection (a) (b) & (c) Nil Care of Premature Infants (Circular 20/44). Number of babies notified during 1945 who weighed 5^ lbs. or less at birth 45 (a) The total number of premature babies as above who were born at:— Home 15 Hospital 30 45 (b) The number of these born at home:— (i) Who were nursed entirely at home 12* (ii) Who died during the first 24 hours 3 (iii) Who survived at the end of one month 12 (c) The number of those born in hospital:— (i) Who died within the first 24 hours 4 (ii) Who survived at the end of one month 26 *One child removed to Aldersbrook Children's Home—mother removed to Runwell Hospital. The notification of birth cards provide space for the weight at birth when this is 5½ lbs. or less, beds are available (when necessary) in Howard's Road Maternity Home, there is no special form of transport provided for conveyance to hospital and all cases (including those in hospital when discharged) are followed up. 45 Adoption of Children (Section 7 of the Adoption of Children (Regulation) Act, 1939). (a) Number of persons who gave notice under Section 7(3) during the year 19 (b) Total number of children in respect of whom notice was given under Section 7(3) during year 24 (c) Number of children notified under Section 7(3) (i) Under supervision at the end of the year 5 (ii) Who died during the year — (iii) On whom inquests were held during the year — (d) Particulars and results of any proceedings taken during the year Nil Note.—The local Education Authority under the Adoption of Children Act, 1926, during the year ended 31/12/45, dealt with 1 he following cases :— (a) Number of applications dealt with by the Juvenile Court 44 (b) Number of Adoption Orders made 39 (c) Number of Interim Orders made (Subject to Supervision of the Local Education Authority) 2 (d) Number refused 1 (e) Number withdrawn 1 (f) Number standing adjourned 1 Registration of Nursing Homes. The return of the work of the Council during 1945, under Sections 187 to 194 of the Public Health Act, 1936:— TABLE 18. Number of Homes Number of patients provided for Maternity patients Others Total Homes first registered during the year — — — — Homes on the Register at the end of the year — — — — Homes deleted during the year — — — — 46 Home Helps. (i) Is a Home Help Scheme in operation Yes. (ii) How many Home Helps are employed? (a) Whole-time—1 (part of year). (b) Part-time—2 (at end of year). (iii) In how many cases were Home Helps provided under the above arrangements during the year? 14 Dental Treatment—M. & C.W. 1945. Expectant and Nursing Mothers:— (i) Number of patients treated (ii) Number of scalings Other operations (iii) Number of teeth filled (iv) Number of teeth extracted Children under 5 :— (a) Number treated (b) Number of teeth filled (c) Number of teeth extracted 224 45 142 47 322 149 30 219 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) Domiciliary Nil (ii) In institutions 1 (b) Are facilities provided to enable midwives practising in the area to attend courses of intruction in the administration of Analgesics in institutions approved by the Central Midwives' Board for the purpose? Facilities will be provided when available. (c) Is apparatus for the administration of Anaglesics supplied to domiciliary midwives by the Council? Apparatus purchased. (d) In how many cases were Anaglesics administrated by midwives in domiciliary practice during the year? None. Inspection of Midwives. Visits of inspection, as necessary, were paid during the year and the midwives' work, including records, was satisfactory. 47 Health Visitors. (a) Number of Health Visitors employed by Council at end of year 7 (b) Number of visits paid during the year by Health Visitors :— (i) To expectant mothers—1st visits 1,182 Total Visits 1,248 (ii) To children under 1 year—1st visits 1,744 Total Visits 5,734 (iii) To children between the ages of 1 and 5 years Total Visits 6,323 Grand total of all visits to mothers and children 13,305 (iv) Other visits 507 Infant Welfare Centres. Total number of children under 5 years of age who first attended at the Centres and who, on the date of their first attendance, were:— (i) Under 1 year of age 1,212 (ii) Over 1 year of age 256 Total number of children under 5 years of age who attended at the Centres during the year and who, at the end of the year, were:— (i) Under 1 year of age 948 (ii) Over 1 year of age 1,471 Ante and Post Natal Clinics. Total number of women who attended :— (i) Ante-natal clinics 1,766 (ii) Post natal clinics 55 Dr. MacLaren submits the following observations:— During the year, 1945, the general physical condition of 1he child under 5 years of age remained good, no child attending the clinics was found to be suffering from malnutrition, and the standard of cleanliness was satisfactory, despite the fact that the housing conditions in many families, largely due to the acute shortage of houses, caused serious overcrowding. This situation has necessarily entailed greater supervision, and a high tribute is due to the Health Visitors for the untiring efforts they have made to help, and advise the mothers 48 with the numerous difficulties they are at present experiencing. This intensive supervision and educational work has done much to maintain the high standard of health amongst the infant population. Infant Welfare Clinics.* Throughout the year the attendances at the Infant Welfare Clinics has been maintained at a high level, notwithstanding the difficult domestic problems, which still exist. During 1945 there has been a considerable increase in the number of children suffering from minor ailments, especially skin, and ophthalmic conditions. Premature Child. Special attention and supervision is given to the premature child and frequent visits paid until the child's general condition is completely satisfactory. Sunlight Clinic. Two Sessions per week arc held for infants under 5 years, who are referred for treatment. Immunisation Clinic. Two Clinics are held for immunisation against Diphtheria and Whooping Cough. Intensive propaganda has been carried out during the year by the Health Visiting Staff. The Clinics have been well attended, and a large number of children under 5 years have been immunised against Diphtheria, though there still remains a considerable number of unprotected children. A limited number of children have also been protected against Whooping Cough. Ante=Natal Clinics. During 1945, the number of expectant mothers attending the Ante-Natal Clinics is the highest on record. The large number of applications for Maternity Hospital accommodation continues to be an urgent problem, and has been so great, that it has been found impossible to meet the demand, with the result that many mothers have required to accept domiciliary treatment. 49  1944 1945 Number of cases referrd to East Ham Mem. Hosp. 32/ 370 ,, ,, ,, Forest Gate Hosp. 335 395 ,, ,, ,, Queen Mary's Hosp. 1 5 ,, ,, ,, Emg. Maternity Homes — 35 1944 1945 Total number of individual expectant mothers who attended the Council Ante-natal Clinics 1701 1766 War-time Nurseries Owing to the needs of the Education Committee, Kensingon Avenue and Brampton Road nurseries were closed on 18/8/45. The Ministry of Health eventually agreed to the Conversion of one of the blocks at the Infectious Diseases Hospital, Roman Road, into a nursery and the children were transferred from Brampton Road to Roman Road on 6/9/45. Those from Kensington were tranferred to School Road and Wall-End Road Nurseries. Although the staffing problem eased somewhat, that for wardens still persisted. Statistics for 1945 are shewn in the following two tables:— TABLE 19. Children on Register (on last day of month). Brampton & Roman Road Kensington School Road Wall-End St. Stephens 0—2 2—5 0—2 2-6 0—2 2—5 0—2 2—5 0—2 2—5 January 14 47 7 36 11 23 8 23 14 31 February 13 50 7 37 16 21 16 25 21 32 March 13 47 6 40 17 21 16 25 21 34 April 12 52 7 34 19 29 20 28 19 42 May 17 55 8 39 20 30 18 28 20 44 June 18 62 8 37 ao 31 22 28 24 44 July 18 57 7 33 20 31 24 26 27 44 August 21 61 — — 20 38 27 28 29 49 † September 18 58 — — 21 39 22 30 23 49 † October 20 64 — — 19 37 25 32 24 56 † N ovember 16 66 — — 20 34 25 32 24 56 † December 18 66 — — 21 35 23 30 24 52 †Roman Road, 50 TABLE 20. Attendance Record. Brampton & Roman Road Kensington School Road Wall-End St. Stephens 1† 2* 1† 2* 1† 2* 1† 2* 1† 2* January 46 52 28 38 22 31 13 28 37 41 February 50 58 36 38 29 30 24 33 48 55 March 45 57 32 38 20 27 30 40 25 55 April 53 61 27 40 39 44 23 36 43 56 May 63 69 38 43 41 45 33 37 52 59 June 64 73 34 41 42 48 43 48 55 60 July 49 63 28 39 44 49 42 46 53 53 August 51 68 — — 39 55 44 50 54 69 ‡September 69 75 — — 34 48 38 50 56 72 ‡October 72 78 — — 44 48 49 52 56 67 ‡N ovember 64 76 — — 45 51 47 51 61 74 ‡December 72 81 — — 43 48 32 44 61 76 ‡Roman Road. †Average attendance. *Highest attendance on any one day. The accommodation of the four nurseries is as follows:— No. of Places Roman Road 70 School Road 50 Wall End/Caledon Road 50 St. Stephen's Road 74 Total 244 Note.—The number of places can be increased by 20%. Infectious Diseases The statistics are shewn in Tables. The quarterly returns to the Registrar General were as follows :— Disease. Qtr. ending Qtr. ending Qtr. ending Qtr. ending Total. 31-3-45 30-6-45 30-9-45 31-12-45 Scarlet Fever 12 24 44 73 153 Whooping Cough 12 3 8 44 67 Measles 484 937 61 16 1498 Diphtheria 11 13 3 4 31 Pneumonia 22 4 4 25 55 Dysentery 1 — — 6 7 Erysipelas 3 2 7 2 14 Cerebro-Spinal Fever 1 — — — 1 Puerperal Pyrexia 1 — — 1 2 Ophthalmia Neonatorum — I — l 2 Acute Poliomyelitis — — 1 — 1 Malaria — — 1 — 1 It will be seen that the incidence of Scarlet Fever tended to rise in the last two quarters, 51 Zymotic Death Rate. The deaths from the seven principal Zymotic diseases (Smallpox, Whooping Cough, Measles, Diphtheria, Diarrhoea, Scarlet Fever and Enteric Fever) during the year numbered 9. The death rate was 0.09 per 1,000 population, as compared with a rate of 0.07 for 1944. No cases of Smallpox were reported during the year under review. Towards the end of the year when troops commenced to return from the East, contacts of cases of Smallpox, on leave in the Borough or demobilized, were visited and offered, if necessary, facilities for vaccination or re-vaccination. A large number of visits were paid and reports submitted. The Zymotic death rates, per 1,000 population since 1939, are enumerated below:— 1939 1940 1941 1942 1943 1944 1945 0.18 0.08 0.17 0.17 0.15 0.07 0.09 52 The following Statistics shew the notification rates per 1,000 civilian population. TABLE 21. England and Wales. 126 County Boroughs & Great Towns including London. 148 Smaller Towns Resident Pop. 25,000-50,000 at 1931 Cen. London Adm. County. East Ham. Notifications :— Rates per 1,000 Civilian Population. Typhoid Fever 0.01 0.01 0.01 0.01 — Paratyphoid Fever 0.01 0.00 0.01 0.00 — Cerebro-Spinal Fever 0.05 0.05 0.05 0.06 0.01 Scarlet Fever 1.89 2.02 2.03 1.57 1.60 Whooping Cough 1.64 1.65 1.47 1.25 0.70 Diphtheria 0.46 052 0.56 0.31 0.32 Erysipelas 0.25 0.28 0.24 0.31 0.14 Small Pox 0.00 0.00 — 0.00 — Measles 11.67 10.89 11.19 9.03 15.37 Pneumonia 0.87 1.03 0.72 0.78 0.57 A dash (—) signifies there were no notifications. 52a TABLE 22. Vaccination. Statistics relating to the Vaccination of Children whose births were registered from 1st January to 31st December, 1944, are appended below :— Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st December, 1944 Number of these Births duly entered by 31st January, 1946, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz. : Number of these Births which on 31st January, 1946, remained unentered in the " Vaccination Register " on account (as shown by " Report Book ") of Number of these Births remaining on 31st January, 1946, neither duly entered in the "Vaccination "Register" (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9 and 10 of this Return) Total number of Certificates and copies of Certificates of Successful Primary Vaccination of Children under 14 received during the Calendar Year 1945 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate, during the Calendar Year 1945 Col. I. Col. II Col. IV Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Postponement by Medical Certificate Removal to Districts the Vaccination Officers of which have been duly apprised Removal to places unknown, or which cannot be reached ; and Cases not having been found. Successfully Vaccinated Insusceptible of Vaccination. Had Small Pox. Died unvaccinated 1 2 3 4 5 6 7 8 9 10 11 12 13 North East Ham 656 Less 1 re-regn., 1931 1 655 211 — — 283 19 5 30 48 59 367 259 South East Ham 335 Less 1 re-regn., 1901 2 Less 1 re-regn., 1943 333 98 — — 165 6 4 4 33 23 297 247 Total 988 309 — — 448 25 9 34 81 82 664 506 Number of children successfully vaccinated after declaration of conscientious objection 2 Copies of certificates of successful primary vaccination sent to Vaccination Officers in other areas 321 53 Diphtheria Immunisation Clinics. The six monthly returns to the Ministry of Health in respect of immunisation are as follows:— Number of children who completed the full course of immunisation. Age at final injection:— 0—4 years 5—14 years Total 6 months ending 30/6/45 279 117 396 ,, ,, 31/12/45 967 180 1,147 Totals 1,246 297 1,543 The annual return for diphtheria immunisation for year ended 31/12/45, in respect of all children under 15 years who had completed a full course of immunisation at any time up to the end of the year, is appended below:— 54 TABLE 23. I—IMMUNISATION IN RELATION TO CHILD POPULATION Number of Children who had completed a full course of Immunisation at any time up to 31st December, 1945. Age at 31.12.45 Under 1 1 2 5 4 5 to 9 10 to 14 Total i.e., Born in Year 1945 1944 1943 1942 1941 1936—1940 1931—1935 under 15 Number Immunised 14 534 590 630 632 3,791 3,495 9,606 Estimated mid-year population 1945 7,990 13,330 II.—DIPHTHERIA NOTIFICATIONS AND DEATHS IN RELATION TO IMMUNISATION Note.-—Notifications to be shown on basis of corrected notifications. Deaths are those finally registered in the Authority's area after allowing for inward and outward transfers. NOTIFICATIONS DEATHS Age at date of Notification Number of Cases Notified Number of cases included in preceding column in which the child had completed a full course of immunisation Age at date of Death Number of Deaths Number of cases included in preceding column in which the child had completed a full course of immunisation Under 1 1 — Under 1 — — 1 2 — 1 1 — 2 3 — 2 — — 3 2 1 3 — — 4 5 3 4 — — 5 to 9 9 5 5 to 9 — — 10 to 14 2 — 10 to 14 — — Totals 24 9 Totals 1 — 55 TABLE 24. Prevalence of, and Control over, Infectious Disease Notified Cases for Year ended 31/12/45. Disease. Cases notified in whole district. Ward Distribution of Cases. No. of Cases removed to Hospital. Total Deaths. 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 153 — 43 79 25 — 5 — 1 — 10 16 7 21 11 17 13 28 14 16 119 — Diphtheria 31 1 12 10 3 1 4 — — — 1 5 — 4 1 5 11 — 2 2 31 1 Erysipelas 14 — — — — — 1 2 9 2 2 4 1 1 1 1 1 2 1 — 3 — Puerperal Pyrexia 2 — — — — — 2 — — — 1 — — — — — 1 — — — 1 2 Ophthalmia Neonatorum 2 2 — — — — — — — — — — — — — 1 1 — — — — — Cerebro Spinal Fever 1 1 — — — — — — — — — — — — — — — 1 — — 1 1 Poliomyelitis 1 — — 1 — — — — — — — — — — — — — — — — — — Pneumonia 55 3 17 5 2 1 7 1 11 8 4 12 1 2 5 4 2 4 5 16 3 68 Dysentery 7 — 4 1 1 — — — — 1 — 1 2 — — 1 2 — 1 — 3 1 Malaria (induced for therapeutic purposes) 1 — — — — — — — 1 — 1 — — — — — — — — — 1 — *Measles 1,498 78 799 580 39 1 1 — — — 117 243 120 197 112 164 147 152 104 142 38 1 *Whooping Cough 67 8 33 23 1 — 1 — 1 — 8 6 3 5 5 7 6 16 3 8 6 — * Notifiable for duration of war. 56 TABLE 25. Total Cases of Notifiable Diseases, 1922-1945. Disease. 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 Small Pox — — — — — — 17 25 70 51 13 1 1 — — — — — — — — — — — Scarlet Fever 502 170 215 221 350 798 832 743 484 245 779 701 979 411 359 387 287 196 77 68 210 271 132 153 Diphtheria 198 160 128 246 337 464 669 578 473 196 157 180 379 254 134 149 141 91 47 45 49 59 33 31 Enteric Fever 4 3 5 9 7 2 7 2 3 8 7 5 — 2 2 13 15 8 10 3 — 4 — — Erysipelas 34 32 38 41 41 38 60 49 63 54 55 69 74 55 59 53 71 41 33 23 37 28 18 14 Puerperal Fever 3 5 5 5 5 5 4 8 9 10 4 4 7 12 7 5§ † † † † † † † † Puerperal pyrexia Not Notifiable 11 11 12 14 6 23 10 11 14 7 7 18 16 8 6 15 8 8 2 Meningococcal Meningitis ... — 1 1 1 1 4 1 1 3 8 5 1 3 3 — 2 3 3 11 5 12 4 3 1 Encephalitis Lethargica — — 9 6 1 2 3 1 — — — 1 1 1 — 1 1 — — — — — — — Ophthalmia Neonatorum 11 11 6 8 10 12 3 8 6 6 6 9 5 5 6 7 9 7 3 4 1 1 4 2 Acute Poliomyelitis ... — 3 1 1 — 5 — 2 — 1 7 2 5 13 2 4 — 2 1 — — — — 1 Acute Polio Encephalitis — — — — — — — — — — 3 2 1 — — — — — — — — — — — Dysentery — — — — — — — — — — — — 1 — — 3 18 — — — — 6 5 7 Malaria ... — — — — — — — — — — 1 1‡ — — — — — — — — — — — 1‡ Measles Not Notifiable *3 *36 *460 *1091 *917 *258 *1498 Whooping Cough Not Notifiable *— *19 *262 *227 *241 *293 *67 Continued Fever — — — — — — — — — — — — — — — — Not Notifiable — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia 92 54 79 91 70 114 82 102 59 75 77 148 100 88 101 111 85 59 42 33 37 72 50 55 Totals 844 439 487 629 822 1,455 1,689 1,531 1,184 660 1.137 1,134 1,567 858 677 742 648 426 287 909 1,679 1,611 804 1,832 § Notifiable as Puerperal Pyrexia as from 1.10.37. † Notifiable as Puerperal Pyrexia. ‡ Induced in an Institution. * Notifiable for duration of war. || Not notifiable as from 1.10.37. 67 Infectious Diseases Hospital Dr. Cohn's observations are contained in the following report upon the work of the hospital:— General Observations. The number of cases admitted to the Isolation Ward during the year 1945 were 237; the number of deaths were 3—giving a mortality rate of 1.27%. One death occurred from diphtheria, another from subphrenic and liver abscesses, and the third from measles complicated by pneumonia. There were no cases of enteric fever, cerebro spinal meningitis or anterior poliomyelitis. In the last three months every case of scarlet fever which showed toxic symptons was treated with sulphadiazine and no complications were encountered. Sporadic cases of impetigo were treated with penicillin cream and cleared generally within 48 hours. The existing accommodation seemed to be adequate. The greater part of the Isolation Hospital was closed for 4 weeks (February '45) due to damage caused by a rocket bomb. STATISTICS. A. Diphtheria (Uncorrected for diagnosis). Admitted during 1945 54 Died during 1945 1 Remaining in hospital on December 31st, 1945 3 B. Scarlet Fever (Uncorrected for diagnosis). Admitted during 1945 122 Died during 1945 — Remaining in hospital on December 31st, 1945 12 C. Measles with Pneumonia (Uncorrected for diagnosis). Admitted during 1945 35 Died during 1945 1 Remaining in hospital on December 31st, 1945 — 1). Miscellaneous (Uncorrected for diagnosis). Admitted during 1945 26 Died during 1945 1 Remaining in hospital on December 31st, 1945 15 58 Diphtheria. Number of notified cases 54 Revision of diagnosis (tonsilitis) 27 Final number of proved diphtheria cases 27 Number of cases of diphtheria occurring in immunised children 8 TABLE 26. SHOWING TYPES OF DIPHTHERIA AND MORTALITY. Type Total Died Mortality Rate Faucial 23 — 3.7% Laryngeal 4 1 TABLE 23. SHOWING SERUM ADMINISTRATION. 15 patients under 16,000 A.D.S. 23 patients from 16,000 to 48,000 A.D.S. 2 patients from 48,000 to 64,000 A.D.S. 7 patients from 64,000 to 140,000 A.D.S. Complications and Paralysis. Cardiac weakness 1 Palatal Paralysis and diaphragmatic paralysis 1 Ciliary Paralysis 1 The diaphragmatic paralysis was treated with a Bragg Paul apparatus, borrowed from Ilford Isolation Hospital. One late laryngeal tracheotomy was performed (died). Serum Reaction. 4 patients developed serum reaction. Bacteriological Examinations. Number of swabs examined 644 Swabs sent from outside 109 65 were found to be positive; among them was one aural swab. 59 Scarlet Fever. Number of notified cases 122 Revision of diagnosis 5 Urticaria 1 Measles 1 No evidence of infectious disease found 3 Final number of Scarlet Fever cases 117 Cases with Concomitant Disease. Scarlet Fever with Mumps 1 ,, ,, ,, Chicken Pox 1 ,, ,, ,, Impetigo 2 ,, ,, ,, Whooping Cough 1 ,, ,, ,, Diphtheria 1 No cases of Scarlet Fever were treated with A.S.S., but 5 were given A.D.S. 13 cases of Scarlet Fever developed Cervical Adenitis. Measles. With Pneumonia 35 Revision of diagnosis 2 Bronchitis 1 P.U.O. 1 Final number of measles and pneumonia 33 Miscellaneous. 26 miscellaneous cases consisted of:— Chicken Pox 4 Mumps 4 Whooping Cough with Broncho-pneumonia 6 Pneumonia 1 Urticaria 1 Jaundice 1 Depression 1 Eczema 1 Quinsy 1 Typhoid 3 Revision of Diagnosis :— Appendicitis 1 Sub-phrenic and liver abscesses 1 Cystitis 1 60 C.S.F. 1 Revision of diagnosis :— Scarlet Fever 1 Anterior Poliomyelitis 2 Revision of diagnosis :— Bruised Hand 1 Bruised Leg 1 Operations. 1 Tracheotomy. 2 Incisions of abscesses. There were no return cases of infectious diseases throughout the year. TABLE 27. FINAL DIAGNOSIS. Diphtheria 27 Tonsillitis 28 Scarlet Fever 117 Urticaria 1 Measles 33 No evidence found of infectious disease 3 Chicken Pox 4 Mumps 4 Whooping Cough 6 Pneumonia 1 Jaundice 1 Eczema 1 Depression 1 Quinsy 1 Appendicitis 1 Sub-phrenic and Liver Abscesses 1 Cystitis 1 Trauma 2 Bronchitis 1 P.U.O. 1 Total 235 61 Cancer The provisions of the Cancer Act have been suspended during the war although discussions and tentative proposals for a joint scheme have been under consideration. Cancer deaths 1945 :— Total Deaths 206 Male 110 Female 96 Classification :— 1945 1944 Carcinoma 191 196 Sarcoma 3 3 Rodent Ulcer — 1 Epithelioma 4 — Endothelioma 1 — Unstated 7 3 Totals 206 203 62 \ TABLE 28. Cancer Deaths—Parts of the Body Affected. Parts of Body Affected Ages 0-1 1-2 2-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75 and upwards Total Sex 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 4 — 3 — 7 1 Digestive Organs and Peritoneum — — — — — — — — — — — — 5 4 5 2 16 10 21 14 7 13 54 43 Respiratory Organs — — — — — — — — 1 — 1 — 2 — 5 — 8 3 5 2 2 1 24 6 Uterus — — — — — — — — — — — — — 1 — 1 — 3 — 1 — — — 6 Other Female Genital Organs — — — — — — — — — — — — — 2 — 1 — 4 — 2 — 1 —• 10 Breast — — — — — — — — — — — — — — — 6 — 6 — 4 — 1 — 17 Male Genitourinary Organs — — — — — — — — — — — — — — — — 1 — 3 — 5 — 9 — Skin — — — — — — — — — — — — — — — — — — — — — — — — Other or Unspecified Organs — — — 1 — — — — 1 — — 1 — 2 2 2 3 2 8 4 2 1 16 13 Totals — — — 1 — — — — 2 — 1 1 7 9 12 12 28 29 41 27 19 17 110 96 63 Treatment of Tuberculosis Memorandum 266/T. Maintenance allowances to patients sufferings from pulmonary tuberculosis receiving treatment from the Tuberculosis and Chest Clinic and Institutional treatment were paid to 131 patients during the year in accordance with the terms of the Circular. TUBERCULOSIS AND CHEST CLINIC. Notifications. The number of primary notifications of all forms of tuberculosis during 1945 was 258 as compared with 198 for the previous year. Of the primary notifications of pulmonary tuberculosis 11.1% had tubercle bacilli in the sputum. The number of such notifications for the years since 1939 are shewn below :— 1939 1940 1941 I942 J943 1944 J945 217 204 224 244 264 198 258 Statistical. The total number of notified cases on the register of the clinic on 31/12/45 was 1,095 (pulmonary and non-pulmonary) or 11.5 per 1,000 of the estimated population as compared with 979 or 10.7 per 1,000 population in 1944. Clinic Register Statistics from 1939 are appended below:— 31-12-39 31-12-40 31-12-41 31-12-42 31-12-43 31-12-44 31-12-5 974 879 809 860 949 979 1,095 Deaths. The number of deaths (1939-1945) from tuberculosis is as follows:— Pulmonary Non-Pulmonary Clinic Register 1939 71 12 59 1940 88 13 81 1941 78 8 58 1942 53 15 55 1943 80 7 73 1944 61 14 63 1945 52 9 58 64 New Cases. The following are the comparative figures for the years 1939—1945;— 1939 1940 1941 1912 1943 1944 1945 New cases and contacts 486 582 657 997 1,317 1,034 1,034 Number proved after] complete investigation, to be tuberculosis ) 30'4% 2t'99% 19'77% 15-65% 17-61% 1 5-75% 24-85% includes ex service cases Attendances Medical examinations 1939 3.467 2,982 1940 2.4I3 l,901 1941 2,874 2.133 1942 4,768 3.238 *943 6,580 4-493 1944 6,057 3.969 1945 6,877 4,566 Consultations at Homes of Patients. During the year 23 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. 1939 1940 I94I 1942 !943 r944 I945 1.394 1,132 1,220 1.575 1,844 1,628 1,922 Attendances. The number of attendances and medical examinations are the highest on record and are practically twice those of 1939. The number of new cases, including contacts, was 1050. The percentage of these which proved to be tuberculosis was higher than since 1940, being 24.85%. X-Ray examinations of the chest contine to increase in number, so much so, that the present facilities are becoming inadequate for the purpose. Dr. Philip Ellman, Consultant to the Clinic, reports on the work of the Chest Clinic as follows :— The Government White Paper on the National Health Scheme has reviewed past achievements and the present situation available to the community, and has put forward ideas for improved amenities which should be established. As far as the 65 culosis services are concerned, it has crystallised some ideas tliat many ot us have held and, in this Borough, have endeavoured to put into practice, with special reference to the need for its co-ordination and integration with other medical sources, both preventive and therapeutic. The necessity for a much wider conception of the services in the interests of the patient and the national economy have always been one of our main objects. It is satisfactory to note that our pioneer conception of the Chest Clinic and its changing functions is being widely adopted. Its future recognition as the basis of a complete Chest Service being closely linked up with— (a) A Mass Radiography Unit for the detection of early cases of pulmonary tuberculosis and other intra thoracic diseases, and (b) Inpatient Services in the form of Chest Units and Sanatoria, cannot be over emphasised. The further close affiliation of such a Chest Service with a good Rehabilitation Scheme and a complete Social Service Department, will go far towards our aim for a wider conception of the Tuberculosis Service in the best interests of the Tuberculosis sufferer, the community and the Public Health. It is customary to comment on certain outstanding features and impressions on the work of the year, and on this point I propose to make a few comments this year chiefly on childhood tuberculosis,non-tuberculous sub-acute pulmonary infections simulating pulmonary tuberculosis, and bacteriological investigations in pulmonary tuberculosis. CHILDHOOD TUBERCULOSIS. The number of children under 15 years of age suffering from pulmonary tuberculosis has, I think, definitely increased during the War years throughout the country. In 1939 we had 10 children notified and in 1945 the figure has risen to 24. The bulk of our cases have been those of enlarged hilar glands, but in addition pulmonary lesions of varying degrees have presented themselves. I think contact infection has played an appreciable part in the increase. The dearth of accommodation in institutions has probably played an appreciable part here. Any scheme for preventive inoculation of the childhood population deserves serious consideration. Enquiries into recent 66 improvements in the manufacture of B.C.G. vaccine as the means of acquiring active immunisation is worthy of serious consideration for the tuberculin negative infant or child contacts, where separation from the source is impracticable, and even in children and adults who are still tuberculin negative. Primary Tuberculosis, which is the principal condition we meet in children, is the disease which follows the first infection by the bacilli. Briefly, we encounter in childhood at the Clinic— (a) Uncomplicated primary infection followed by calcification and quiesence, (b) Complicated primary infection :— (a) Epituberculosis (so-called) with either—■ (1) A non-ceseating pneumonia, or (2) Segmental collapse following stenosis of a bronchus, due to a mediastinal gland. The collapsed area usually re-expands following treatment. (b) In a few cases cavitation may occur in a primary lung focus. The post-primary tuberculosis in childhood may show either a haematogenous spread (acute or chronic miliary tuberculosis) or a bronchogenic type, especially in adolescents. Of the latter, during and since the War, we have seen all too many,—the socalled acute adolescent phthisis with a bad prognosis. Pleurisy with Effusion in Childhood. The War years have shown an appreciable number of these cases at the Clinic. The lymphocytic fluid with a characteristic exudate cytology, usually clears up with a full sanatorium regime, and the prognosis is usually good, following a complete course of treatment. Without treatment, pulmonary disease is much more likely to ensue. Erythema nodosum in childhood. We have had quite a number of these cases with recent primary tuberculosis. Whilst this may be due to other causes than tuberculosis, the latter must be carefully excluded. Phlyctenular conjunctivitis also demands a careful investigation to exclude, in the first place, primary tuberculosis. 67 Diagnosis of the complicated Primary Infection demands-— (a) Tuberculin testing— We employ the following methods:— (1) Patch Test (Vollmer. (2) Tuberculin Jelly, which I have found very satisfactory. In 100 cases, with controls by the Mantoux Test, 95% have been positive. (3) Mantoux Intracutaneous Test. This is the most reliable and is carried out where the above tests are negative in a suspected case. (b) X=Ray examination. This is of great importance in the diagnosis and management of the disease. (c) Examination of sputum, gastric contents or faeces. (d) Blood sedimentation rate. All these methods are employed where indicated and are of great value in diagnosis. Non=Tuberculous Subacute Pulmonary Infections simulating Pulmonary Tuberculosis. The existence of an infiltration of lung tissue, giving rise to radiological shadows almost identical with those of pulmonary tuberculosis but not apparently connected with the tubercle bacillus, is well known. In a consideration of the aetiology of sub-acute pulmonary infections attention has been drawn to the fact that many pulmonary lesions are now brought to light which, before the days of adequate X-ray examinations, passed undetected, and, while in most of these the nature of the disease is not in doubt, in many the differential diagnosis is still a matter of considerable difficulty. In other words, as has been repeatedly stated, radiological diagnosis, no less than physical diagnosis, has its limitations; nor does it always provide a short cut to that understanding of the morbid anatomy of disease which can be reachcd only by a synthesis of all the available data. We are constantly seeing such cases at the Clinic, which could easily be regarded as tuberculous, but where the negative bacteriology of the sputum and the rapid resolution, following serial radiograms, soon shows the nature of their course. o ; The role of the streptococcus in pulmonary infections of an acute pneumonic or bronchopneumonic character, as well as 68 varied sub-acute pulmonary infiltrations of similar aetiology, is significant, although is some cases debatable, and I think quite a number of these cases are probably streptococcal in origin. One such case resembling miliary tuberculosis has recently been under our care, but has responded admirably to treatment. Bacteriological diagnosis in pulmonary tuberculosis. The most reliable single piece of evidence of active tuberculous disease is provided by the demonstration of tubercle bacilli in the sputum. For obvious active cases the simplest methods of examination are required from the laboratory point of view; in other words, a person with established pulmonar} tuberculosis in an active state discharges tubercle bacilli in such numbers that they are easily demonstrated by the microscope in direct films made from sputum selected at random. Certain patients, however, come under observation in the early stages of the disease with suspicious histories, and possible clinical and X-ray abnormalities. Very often in these cases no genuine specimen of sputum is produced and the ordinary routine method of examination will fail to reveal tubercle bacilli. The bacteriological diagnosis in such cases may only be revealed after repeated examinations, using varying techniques. This bacteriological diagnosis may be of decisive importance, and hence, other methods than the routine simple method of direct microscopic examination may be required. Such methods are:— (a) The anti-formin concentration method, which we invariably use where the direct method has failed to reveal bacilli, (b) Examination of the sputum by artificial culture. The isolation of tubercle bacilli in pure culture from the sputum has developed remarkably since this method was first introduced. Special equipment for the preparation of these culture media is necessary, and where the anti-formin method in a suspected case is negative, we invariably send the sputum to the pathological laboratory to be examined bv the culture method. (c) Animal Inoculation Method. Inoculation of a guinea pig is the most sensitive method of detecting the tubercle bacillus, and this method may require to be employed in certain selected cases, and it 69' is the general opinion that no culture medium method in common use equals the guinea pig inoculation in sensitivity for small numbers of tubercle bacilli, so that this may have to be used as a final resort. Methods employe-d when no sputum is available. Since many patients swallow a part of their sputum, and in children probably all their sputum, it may be possible to demonstrate bacilli from swallowed sputum in the faeces or gastric contents, and occasionally directly from the larynx by the laryngeal swab. Such methods then as (i) examination of the faeces, (2) gastric wash, more particularly applicable in insitutions, and (3) laryngeal swab, may have to be used; so that before a patient can truly be regarded as having a negative sputum, complicated procedures may be required which involve careful co-operation with bacteriological experts. These methods, either singly or completely, may be required to be employed for our patients. Thoracic Surgery. The work in this sphere from the point of view of treatment, continues to increase, and we are at a very grave disadvantage because of the enormous waiting list for major and minor surgery at all the chest hospitals. Some of our patients for thoracoplasty, have had to wait over a year before this could be carried out. This is due to some extent, to the shortage of thoracic surgeons throughout the country, and a shortage of beds for this work. It might be well worth considering, in the near future, doing the minor surgery, such as cauterisation of adhesions, phrenic crush, etc., in the theatre which already exists at the sanatorium. This might involve collecting a series of cases from 4—6 times a year, so that a thoracic surgeon can come out and have a '' field day " at the sanatorium once every 2—3 months to complete this work. It might also, in the patient's best interests, involve the addition of a Resident House Physician, as complications in these cases some times arise. Certainly, it is worthy of serious consideration by the Public Health Committee if we are to solve this very difficult problem. Occupational therapy department. Since materials are becoming more readily available it is now possible to give a varied type of work to the patients who are attending the classes which are held here regularly every 70 Wednesday. Attendances are quite satisfactory and patients are deriving benefit from this type of work, both from a mind deterrent point of view, and from the point of view of vocational guidance. The average attendances at these classes are 12 patients, and in view of the increased work being done, a double session has been necessitated. We are extremely grateful to Miss Ross-Smith for her invaluable work here and for the enthusiasm which she displays. I cannot conclude my report without expressing my very real appreciation of the work of the nursing and clerical staff; in particular I must pay tribute to our Senior Sister, Sister Williams, for the invaluable work she has done and for shouldering the responsibility of training new members of the nursing staff. Finally, the co-operation of Miss Saldanha in the radiological work cannot be too highly commended. It is because of the team spirit which prevails at the clinic, that our work has been carried through so successfully. Harts Sanatorium Dr. Colin reports as follows:— Preface. During the year under review there were 62 beds available for male and female patients. The male patients spent the first few months in Grove Park Hospital, Lee, S.E.12, where they were evacuated during the flying bomb and rocket attack. They returned to Harts on May 8th, 1945. The treatment consisted of sanatorium regime, collapse therapy, tuberculin injections, gold injections and occupational therapy. Educational lectures were started at the end of 1945, and these were greatly appreciated by the patients. No specified subjects were dealt with, because it was thought that this form of education would not serve any useful purpose, but topics of general interest and general knowledge were dealt with. From 25 to 50 patients as a rule took part at these educational meetings, which were held under the guidance of Mr. Dee of the East Ham Educational Office, twice a week in the Sanatorium. Occasional concerts also were held for entertainment purposes and to create a contented and cheerful atmosphere. 71 Quite a number of eases were admitted which had been discovered by mass radiography, and this obviously is going- to play a more and more important part in the early diagnosis of the disease. The number of service cases admitted seemed to increase and to consist mainly of released prisoners of war. 29 males and 3 females from the Forces were admitted. It is very regrettable that the waiting period for patients requiring surgical treatment is rather long, as this prevents a quicker turn-over of beds. The shortage of houses and bedroom conditions often delays the discharge of patients. It is increasingly difficult to find suitable home accommodation to enable the patients to continue the sanatorium regime under hygenic conditions, and provide some protection against contact infection of relatives. STATISTICS. Number resident on 31/12/44 55 Admissions (including 29 re-admissions from Grove Park) 114 Discharges (including deaths) 118 Deaths 6 Number of beds available 62 Cases complicated by diabetes 3 Observation Cases: Of the 11 observations cases— 5 were found to be suffering from Pulmonary Tuberculosis. 6 were found to be non-tuberculous. Artificial Pneumothorax: Number of inductions 28 (8 male 20 female). Number of refills given 563 Number of gas replacements 6 72 Dental Treatment: For extraction of septic teeth—penicillin tablets were used prophylactically. Patients on Tuberculin treatment 22 Patients on Gold treatment 9 (6 male 3 female). Number of films taken 545 Number of sputum specimens examined 606 Number of blood sedimentation rates done 591 6 Pleural Effusions were tapped on one or more occasions. Cases Sent for Surgical Treament: For division of adhesions 8 (2 male 6 female). For thoracoplasty 3 (x male 2 female). 73a TABLE 30. PUBLIC HEALTH (Tuberculosis) REGULATIONS, 1930. Summary of notifications during- the period from 1/1/45 to 31/12/45. 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 — 5 5 4 16 20 19 16 15 18 3 121 126 Pulmonary Females 2 3 5 — 16 14 14 12 6 4 1 77 79 Non-pulmonary Males — — 2 2 1 — 1 1 — — 7 7 N on-pulmonary F emales — 1 3 1 — 1 2 1 — 1 — — 9 9 PART II. SUPPLEMENTAL RETURN New cases of Tuberculosis coming to the koowledge 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 — 2 — 2 2 2 4 — 2 5 20 Pulmonary Females I 2 1 — — 2 6 2 2 — 1 17 Non-pulmonary Males — — — — — — 1 — 2 — 1 4 Non-pulmonary Females — — — 1 — — 2 — — — — 3 Total 44 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 NonPulmonary Death Returns From local Registrars. 6 2 Transferable deaths from Registrar-General 4 1 1 osthumous notifications 1 - " Transfers " from other areas (other than transferable deaths) 26 4 Other Sources, if any (specify) - - Total 37 7 73b TABLE 31. Tuberculosis-—Institutional Beds and Treatment provided directly or through arrangements with Other Authorities or Voluntary Institutions for the Quarter ending on 31.12.45. Note : Figures are as on the last day of the quarter. (1) BEDS PROVIDED FOR INSTITUTIONAL TREATMENT PATIENTS UNDER INSTITUTIONAL TREATMENT INSTITUTION (2) Total Beds Provided (3) Number of Beds included in Col. (2) temporarily not available (4) Number of Beds included in Col. (2) vacant but ready for use (5) Ex-Service cases (6) Other Patients NAME* See Note 1 Pi llmonai y Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pul. Pulmonary Non-Pulmcnary M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. M. F. M. F. Ch. M. F. Ch. Harts Sanatorium A 57 40 2 — — — 23 12 2 — — — — — — — — — 7 1 — — 24 24 — — — — Branston Hall C — — — — — — — — — — — — — — — — — — — — — — — 5 — — — Langdon Hills C — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — Ashridge Hospital D — — — — — — — — — — — — — — — — — — — — — — — 1 — — — Douglas House D — — — — — — — — — — — — — — — — — — 1 — — — — — — — — Hull Aftcr-Care Colony D — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — Holt Sanatorium D — — — — — — — — — — — — — — — — — — — — — — — — 3 — — — King George V San. D — — — — — — — — — — — — — — — — — — — — — — 2 — — — — — L'head Emergency D — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — London Chest Hospital D — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — Lord Mayor Treloar D — — — — — — — — — — — — — — — — — — — — — — — — — — — 5 Naylands Sanatorium D — — — — — — — — — — — — — — — — — — — — — — — 3 — — — — Preston Hall D — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 Royal National Orth. D — — — — — — — — — — — — — — — — — — — — — — — — — — — Royal National Hospital D — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — Royal Sea Bathing D — — — — — — — — — — — — — — — — — — — — — — — — — 1 3 — St. Luke's Hospital D — — — — — — — — — — — — — — — — — — — — — — — 2 — — — — Tad worth Court D — — — — — — — — — — — — — — — — — — — — — — — — — — — — Totals D 57 40 2 — — — 23 12 2 — — — — — — — — — 9 1 — — 28 32 12 1 3 6 Par ticulars of Be ds temporaril y not available (Col. 3). (Reason to be shown as follows : S.N.= Shortage of nurses. S.D. = Shortage of domestics. W.D. = War Damage.) INSTITUTION (Indicate by above Serial Number) Number of Beds Closed Reason Number of Patients on Waiting List (See Note 4). 2 — — — 9 5 9 — — — 1 I.D. Hospital evacuated to the Sanatorium, September, 1939. 73 TABLE 29. Return relating to the work of the Tuberculosis and Chest Clinic during the quarter ending 31st December, 1945. — Pulmonary. Non-Pulmonary. Total. Diagnosis. Adults. Children. Adults. Children. Adults. Children. Total. 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 444 389 29 22 68 85 15 5 512 474 44 27 1057 (2) Transfers from Authorities of area outside that of the Council or Board during the Quarter 6 1 — 3 — 2 1 1 6 3 1 4 14 (3) Lost sighi of cases returned during the Quarter — — — — — — — — — — — — — B.—Number of New Cases diagnosed as tuberculous during the Quarter :— (1) Class T.B. minus 22 16 4 1 — — — — 22 16 4 1 43 (2) Class T.B. plus 1 5 — — — — — — 1 5 — — 6 (3) Non-pulmonary — — — — 1 1 5 2 1 1 5 2 9 C.—Number of cases included in A. and B. written off the Dispensary Register during the Quarter as :— (1) Recovered — — — — — — 1 — — — 1 — 1 (2) Dead (all causes) 6 10 — — 1 1 — — 7 11 — — 18 (3) Removed to other Areas 4 8 — 1 — — — 1 4 3 — 2 9 (4) For other reasons 1 2 — — — 1 2 — 1 3 2 — 6 D.—Number of definite cases of Tuberculosis 011 the Dispensary Register at the end of the Quarter 462 396 33 25 68 86 18 7 530 482 51 32 1095 74 Water Supply. At the request of the Ministry of Health, the followinginformation is included in regard to the water supply of the area. x. The water supply of the Borough and its several parts has been satisfactory both in quality and quantity. 2. All houses in this Borough have water services laid on from the Metropolitan Water Board mains. No bacteriological or chemical analyses were made by this Authority of the raw water going into suply. 3. The water supplied to this district by the Metropolitan Water Board does not give rise to plumbo-solvont action. 4. There were no contamination areas. 74a TABLE 32. 74a METEOROLOGICAL RECORD—YEAR 1945. Rain Gauge 5-in. in diameter, placed 1 foot above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Rainfall. Mean of Mean Temperature of Air. No. of Days on which Rain fell, 0.01 and over. Amount collected in inches. Mean rate of fall for Rainy Days. Greatest fall in 24 hours. Date of greatest fall. Highest Maximum. Lowest Minimum. All Highest. All Lowest. January 49° Thermometer under repair 38°.5 — — 16 1.64 0.10 0.47 29th February 61° 32° 52°.7 40°.6 46°.5 11 1.32 0.12 0.46 11th March 68° 32° 55°.8 40°.6 48°.2 11 1.13 0.10 0.62 25th April 79° 32° 61°.5 43°.7 53°.0 8 0.31 0.04 0.31 28th May 85° 33° 66°.0 47°.5 56°.7 13 2.13 0.16 0.52 3rd June 80° 45° 69°.5 Thermometer under repair part of month — 16 1.9 0.12 0.45 21st July 86° 47° 74°.1 56°.0 65°.1 9 2.8 0.31 1.32 14th August 86° 49° 71°.1 53°.9 62°.5 8 1.3 0.16 0.62 9th September 77° 39° 66°.7 53°.3 60°.2 12 0.72 0.06 0.39 1st October 73° 40° 62°.3 47°.0 59°.8 9 1.72 0.19 0.53 23rd November 61° 32° 50°.8 42°.0 45°.9 7 0.11 0.02 0.02 1st, 4th, 12 th December 55° 26° 47°.0 36°.4 40°.4 15 2.68 0.18 0.65 22nd 27th Means and Totals for the Year 86° 26° 59°.7 *46°.1 *53°.8 135 17.76 0.13 1.32 14th July * Mean for 10 months. 75 Sanitary Section Mr. R. A. Baskett, Acting Chief Sanitary Inspector, has compiled this section of the Report relating to sanitary circumstances and housing, and statistics in regard to food inspection. For the first half of the year the duties of the inspectorate were directed almost entirely to emergency work in connection with the repair of war damage to housing and drainage, the supervision of the salvage and storage of furniture, the enforcement of Food Orders and other emergency duties. Upon the cessation of hostilities immediate steps were taken to resume the routine work of sanitary inspection. The supervision of the repair of war damage to houses, the salvage and storage of furniture and other emergency work connected therewith were taken over by a newly formed Housing Department of which the Chief Sanitary Inspector Mr. J. E. Austin, M.B.E., was appointed Chief Housing Officer. Four of the District Sanitary Inspectors were seconded to assist in the supervision of the repair of war damaged housing. Details of the emergency work carried out by the Sanitary Section have therefore been omitted from this Report. Resumption of the normal work of the Sanitary Section was impeded by the difficulty experienced in obtaining the services of suitably qualified Sanitary Inspectors to fill vacancies. This position was aggravated considerably owing- to the inability of candidates to obtain housing accommodation locally. There was, of course, the further difficulty of effecting compliance with sanitary notices consequent upon the shortage of both labour and materials for this work. Sanitary Circumstanccs Sanitary Inspection. Details of the activities of the inspectorate in general sanitary administration are contained in the subjoined statements. 76 (a) Inspections. The number ol' inspections of all classes 23,617 (i) Housing. House-to-house — Under Public Health Act 5,304 Re-inspections 1,683 Housing Act, 1936 173 (ii) Sanitary Circumstances. Yards and Passages 4 Draining and Sanitary Accommodation 691 Factories (excluding Bakehouses) 9 Workplaces and Outworkers - Caravans 18 Re Offensive Fumes — Billets and Posts - Miscellaneous 374 War Damage 13,715 (iii) Food Supply. Slaughterhouses 1 Dairies 16 Food Premises .625 Bakehouses 6 Rc Sampling 490 Food Control 36 Food Decontamination — (iv) Infectious Disease. Visits 472 (b) Notices.—The number of notices served during the year totalled 2;no of which 71 were statutory notices. The number of notices complied with in the same period was 379. (c) Rat Extermination.—The Council has continued its policy of providing a free service to householders. Investigations of complaints have in most cases revealed defective drainage, usually caused by enemy action. Essential repairs were executed immediately defects were found. The services of the official ratcatchers were supplemented during the year by the employmentof an additional ratcatcher at the Corporation'sSewage 77 Works. During ihe year 8,111 visits were made by the ratcatchers and 5,341 rats were destroyed. (d) Legal Proceedings.—The following statement indicates the legal proceedings undertaken during the year:— Public Health Act, 1936.—Abatement of Nuisances Nil Food Control. — Contravention of Rationing Orders—Penalties inflicted 2 (e) Drainage.—Improper connections of foul water drains to storm water drainage were found in several parts of the Borough. The necessary alterations were effected. Work in connection with the supervision of "sealing off" of drainage from demolished houses and the renewal of drainage and sanitary fitments of war damaged buildings was retained by the Sanitary Section. This arrangement with the Housing Department facilitated the work of both departments in ameliorating the distressing local housing and environmental conditions arising from the war. 324 yards of drainage was relaid. (f) Mosquito Control.—Treatment of mosquito infested ditches with larvicide was undertaken during the year with satisfactory results. (g) Places of Public Entertainment.—The sanitary conditions at cinemas and other places of public entertainment were inspected during the year and a number of defects and unsatisfactory conditions remedied. Housing During the year the housing situation had been made more serious by the loss of further houses. The total number of houses demolished in the Borough during the war amounted to 2,107. With the reutrn of evacuees and service men and women serious overcrowding was inevitable. At the end of the year the number of applications for housing accommodation exceeded 4,000. The housing need is such that it cannot be solved by houses within the Borough on account of land shortage. External development is therefore essential. 78 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 5,949 (b) Number of inspections made for the purpose .7,632 (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 5,435 II. Remedy of defects during the year wilthout service of formal notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 372 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 which Notices were served requiring repairs — (2) Number of dwelling houses which were rendered fit after service of formal notices:— (i) By owners— 79 (ii) By Local Authority in default of owners — (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 71 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (i) By owners 7 (ii) By Local Authority in default of owners — (c) Proceedings under Sections 11 and 13 of Housing Act, 1936. (1) Number of dwelling houses in respect of which Demolition Orders were made — (2) Number of dwelling houses demolished in pursuance of Demolition Orders — (d) Proceedings under Section 12 of the Housing Act, 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, 1945, were as follows :— Tuberculin-Tested Milk— Bottling Establishment Licence — Dealer's Licences 9 Supplementary Licence .2 80 Tuberculin-Tested (Pasteurised) Milk— Dealers' Licence 1 Pasteurised Milk— Establishment Licence 1 Dealers Licences 18 Supplementary Licence 2 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. (2) Food Premises.—The number of inspections made of food premises included 16 dairies; 6 of bakehouses and 625 of other premises. (3) Slaughterhouses.—No slaughterhouse was in use during '945- (4) Bacteriological Samples.—132 samples were submitted for bacteriological examination during the year, including 97 of milk, 1 of tinned milk, 1 of dried milk and 33 of ice cream. A prescribed standard for the latter product is long overdue. (5) Other foods.—Inspection of other foods resulted in the condemnation for human consumption of 4,236 tins, including 409 tins of meat and meat products, 73 tins of fruit, 467 tins of vegetables, 686 tins of fish, 949 tins of milk and 1,632 tins or packages of other foods. In addition, the following foods were condemned as unfit for human consumption due to enemy action. 267J lbs. meat, 927I lbs. fish, 8183 lbs. of fruit and other foodstuffs. (c) Adulteration. Details of the various samples obtained by the Sanitary Inspectors and the results are included in the following tabular statement:— 81 Number of Samples Percentagt of samples adulterated Examined Found adulterated or below standard Butter 10 - - Cheese 5 - - Coffee 3 - - Lard 8 - - Margarine 9 - - Milk 128 1 .8 Sausage 16 1 6.2 Wines & Spirits 16 4 25.0 Drugs 27 -- - Other Articles 136 0 6.6 358 15 4.2 82 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 4141 I. Soya Flour Genuine but infested with mould to such an extent as to render it unfit for human consumption. Withdrawn from sale. Vendor cautioned. 4153 F. Gin 39 degs. under proof and contained 0.22% methyl alcohol. Unfit for human consumption. Vendor prosecuted. 4158 I. Whisky 35.60 degs. under proof and contained 0.46% methyl alcohol. Vendor prosecuted. 4185 F. Whisky 39 degs. under proof. Vendor prosecuted. 4188 I. Whisky 36.5 degs. under proof. Formal sample taken. 4204 I. Pork Sausage Deficient in meat content to extent of 10%. Formal sample taken. 4260 F. Milk 94% milk. 6% added water. Vendor prosecuted. 4299 I. Campden Tablets Deficient in sulphur dioxide due to deterioration of stock. Withdrawn from sale. 4320 I. Campden Tablets Deficient in sulphur dioxide due to deterioration of stock. Withdrawn from sale. 4334 I. Baking Powder Deficient in available C.O2 by 73%. Formal sample taken. 4346 F. Baking Powder . Deficient in available C.O2 by 72%. Vendor prosecuted. 4448 I. Suet Deficient in fat to extent of 7%. Formal sample taken. 4477 I. Almond Cake Flour J Wheaten flour infested with mites and deficient in available carbon dioxide. Withdrawn from sale and surrendered by retailer. Letter of caution. 4489 F. Shredded Beef Suet Deficient in fat to extent of 1.8%. Vendor cautioned. 4490 F. Shredded Beef Deficient in fat to extent of 14%. Vendor prosecuted (1946). 83 The wrappers of the following samples did not comply with the requirements of the Labelling of Food (No. 2) Order, 1944, in that the appropriate designation of each ingredient was not stated. The samples were of satisfactory composition:— Number I. or F. Article Action Taken 4456 I. Bouillon Cubes. Vendor cautioned. 4466 I. Salad Cream. Vendor cautioned. 84 TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I beg to present my Annual Report on the School Health Service for the year 1945. The requirements of the Education Act, 1944, especially in regard to the examination, classification, and arrangements for treatment of Handicapped Pupils, have increased the work of the department in no small measure. Some difficulty has been experienced in placing children in suitable homes, residential or hospital schools, owing to lack of accommodation, but it is hoped that greater facilities to meet these needs will be forthcoming in the near future. The number of children referred to the Child Guidance Clinic has exceeded that for any previous year, and more cases of maladjustment are evident. The team work of the clinic is of immense value in the elucidation of these difficult problems, and I wish to express appreciation of the help afforded. School Medical Inspections and Minor Ailment Clinics have been carried out with greater attention to detail and have necessarily taken up more time of the medical and nursing staff. In conjunction with the Light Clinic, the Physiotherapy Clinic has added to the amenities of the School Health Service, and now forms a treatment unit of considerable value. During the year a Dispensary was established at the Annexe for the purpose of supplying necessary medicaments to the school health and other services, and for the distribution of drugs, etc., to the Council's hospitals. The Dispensary has been amply justified by its results. Despite shortage of both medical and nursing staff, the full activities of the School Health Services have been maintained. The augmentation of the Dental Department services will permit of increased facilities for treatment and propaganda. School Meals and Milk have played a large part in the continuance of a satisfactory standard of nutrition, 85 I desire to express my sincere thanks to the Chairman and Members of the Education Committee for their help and support during this transitional period, and am indebted to the Chief Education Officer, the teachers, and my staff, for their invaluable assistance and co-operation in the work of the School Health Service. I have the honour to be, Ladies and Gentlemen, Your Obedient Servant, Malcolm Barker, School Medical Officer. 86 Medical Inspection The following' is a synopsis of the work of the School Health Service for the year 1945, as compared with previous statistics: COMPARATIVE STATEMENT OF WORK. 1941 1942 1943 1944 ] Routine and Special Inspection (on school premises) : — *Maintained Secondary Schools - - - - 969 *Maintained Primary Schools - - - - 1,741 †Secondary Schools 224 442 815 46 125 †Elementary Schools 5,526 3,805 4,453 2,844 640 Re-Inspection 2,852 3,400 2,795 1,368 1,795 Consultations at School Clinics 2,765 10,786 12,37R 10,574 9,616 Treatments at School Clinics 3,425 11,746 9,757 8,935 5,012 General Cleanliness Visits to Schools 110 175 276 227 223 Nurses' Visits to Homes 4,680 3,781 4,124 Children Examined for Cleanliness 12,107 15,769 28,427 2,955 22,573 1,859 25,448 *Since 1/4/45. †UP to 31/3/4 51 FINDINGS OF MEDICAL INSPECTION. The continuing conditions of rationing do not appear to have affected the physical condition of the children to any appreciable extent and the general health of the scholars examined is satisfactory. This encouraging condition is due in no small measure to the provision of milk and meals in schools and the emphasis placed on physical training, gymnastics and games. Increased provision for medical treatment at the Minor Ailment Clinics is also responsible for the maintenance of the standard of fitness. The following' comparative table indicates the number and percentage of children inspected during the year 1945, found to be in need of medical or surgical treatment:— NUMBER OF CHILDREN *Percentage of children found to require treatment Inspected "Found to require treatment 1944 1945 1944 1945 1944 1945 2,844 3,604 315 706 11.07 19.59 *Excluding Defects of Nutrition, Uncleanliness and Dental Diseases. 87 (a) Uncieanliness. The school nurses have carried out cleanliness surveys in all schools during the year, and a high degree of personal hygiene has been observed. At these surveys and at other inspections, care is taken to detect the presence of verminous conditions. COMPARATIVE TABLE. Year N umber Examined Number with Nits Number with Head Vermin Number of Exclusion Certificates edings nnder tSec. 54 1941 12,107 178 23 91 1942 15,769 549 54 98 1943 28,427 1,044 93 93 1944 22,573 584 89 68 1945 25,448 579 62 65 — *Sec. 54, Education Act, 1944, from 1/4/45. (b) Minor Ailments. The number of children referred for treatment of minor ailments was 284 or 40.2 per cent. of the total requiring treatment. (c) Tonsils and Adenoids. 272 children were found to require treatment of tonsils and adenoids either combined or separately. This unusually high figure, representing 38.5 per cent. of the total requiring treatment is largely due to the decrease in the facilities for operation on pre-school children during the war years, and must be expected to form a considerable proportion of the defects requiring attention until more normal conditions prevail. (d) Tuberculosis. Boys Girls Total Pulmonary Tuberculosis 11 6 17 Other forms of Tuberculosis 4 5 9 Five cases of suspected tuberculosis were referred to the Chest Clinic during the year. (e) Skin Diseases and (f) External Eye Disease. Twenty-five cases of skin diseases were discovered. There were no cases of external eye disease found at Routine Medical Inspections. 88 (g) Vision. The number of cases of defective vision referred to the Ophthalmic Clinic was 103 including one case of squint. Twenty-three children, with less marked visiual defect are being kept under observation. (h) Ear Disease and Hearing. Four children were found to be suffering from otitis media, four exhibited slight hearing defect and eight other cases of ear disease were noted. (i) Dental Defects. Of a total of 9,163 children examined at routine dental inspection, 3,537 or 38.6 per cent. were in need of dental treatment. (j) Nutrition. No children were found to be suffering from defects of nutrition; the member and percentage of slight subnormality shews a small increase over recent years as indicated by the following tables:- Year Number of Children Inspected Excellent Normal Slightly Sub normal Bad No. % No. % No. % No. % 1941 5526 1124 20.3 4350 78 7 52 0.9 — — 1912 3803 694 18.3 3096 81 4 13 03 — — 1943 4453 446 100 4000 89 8 7 0-2 — — 1944 2471 301 12 2 2162 87 5 8 03 — — 1945 3604 412 12 3 2894 86 4 44 13 — — INFECTIOUS DISEASES. The incidence of infectious diseases among children attending the schools remained low. FOLLOWING UP. The School Nurses have paid 1,859 visits during the year to the homes of children in whom defects were found at medical inspection and for special investigations. 89 MEDICAL TREATMENT. During the year 5,012 attendances were made for treatment at the various clinics and there were 9,616 consultations with the Medical Officers. (a) Minor Ailments. A total of 1,531 defects were treated or under treatment during the year at the Minor Ailment Clinics. (b) Tonsils and Adenoids. The number of cases in which operative treatment was provided totalled 299, compared with 207 during the previous year. The scheme for treatment is the same as detailed in previous reports. (c) Tuberculosis. Arrangements for the treatment of tuberculosis have been continued on the lines set forth in previous reports. (d) Skin Diseases. In general, cases are treated at the minor ailment clinics, but some chronic and less common skin diseases have been referred to the dermatological department at the London Hospital. X-ray treatment of ringworm has also been provided. The Borough Cleansing Centre continues to deal with cases of scabies. (e) External Eye Disease. Thirty-nine cases, compared with 61 in 1944 were treated at the School Clinics. (f) Vision. Eighty-five Ophthalmic Clinic sessions were held during 1945 334 cases accepted treatment in respect of visual defect during the year, and 243 cases were treated. 90 W. S. C. Reeve-Flaxman, the Ophthalmic Surgeon reports as follows :— School Clinic Baby Clinic Number of new cases 243 25 Glasses prescribed 214 19 Glasses not necessary 29 6 Glasses obtained 214 19 Special treatment 86 12 Re-examinations 803 28 Discharged 90 2 Referred to hospitals 4 4 Admitted to Swanlev 1 1 The Sight Saving Class held at Monega School before the war has not been re-opened. (g) Ear Disease. The number of Aural Clinic Sessions held during the year was 47, with a total attendance of 840. (h) Dental Defects. A total of 9,163 children were inspected in age groups from four to 16 years. Of these 3,537 were found to require treatment together with 533 " specials " referred by the Medical Officers or the Head Teachers. The number of attendances for treatment was 3,067, and 2,399 children were treated. Mr. Ronald Savege, F.R.C.S., resumed his appointment as Consultant Aural Surgeon on his return from H.M. Forces. The following is the statistical report:— Treated Discharged Chronic Otitis Media 45 36 Deafness 6 3 Other Ear Cases 47 iS Chronic Rhinitis 176 9i Other Nose Cases 23 17 Enlarged Tonsils and Adenoids 315 278 Other Throat Cases 28 15 91 (i) Light Clinic. The number of children treated at the Light Clinic was 215. The following are the details of treatment:— Treated Attendances General application 197 2,270 Local application 10 48 Electrical treatment 8 59 SCHOOL MEALS. The School Meals Service has proved of great value to pupils, and facilities for the preparation and serving of meals have been extended during the year. CO OPERATION OF PARENTS. The number of parents who were present during routine medical inspections was 2,178, representing 65 per cent. HANDICAPPED PUPILS. (a) Blind and (b) Partially Sighted Pupils. One blind and one partially sighted child are maintained in residential special schools. (c) Deaf and (d) Partially Deaf Pupils. Of six deaf pupils three are attending day special school and three are maintained in residential schools. (e) Delicate and (j) Physically Handicapped Pupils. Fifteen pupils are suffering from disease or crippling defect which render them unfit for education in an ordinary school. Of these nine are attending special day schools and five are maintained at special boarding schools. One child is awaiting admission to a special boarding school. Delicate pupils and pupils requiring short periods of convalescence are referred to the local branch of the Invalid Children's Aid Association for the necessary treatment. The 92 following cases have received convalescent home treatment under these arrangements during the year:— Post-tonsillectomy 11 Debility 16 Air-raid shock 1 Nervous debility 10 Asthma 3 Post-operative cases 8 Rheumatic Carditis 2 Cervical Adenitis 2 Bronchitis 23 Otitis Media 2 Chorea 2 (g) Educationally Subnormal Children. Twenty-one educationally subnormal children are attending day special schools and one child is maintained in a special boarding school. (f) (h) (i) (k) Other categories of Handicapped Pupils. One child suffering from epilepsy is maintained at a special boarding school and two are awaiting admission. MENTALLY DEFECTIVE CHILDREN, Up to 1/4/45, the number of children examined for the purposes of the Mental Deficiency Acts was 6 who were classified as :— Mentally deficient 5 Morally deficient Imbeciles - Idiots - Dull and Backward 1 Recommended for special School Recommended for transfer to Committee for the care of the Mentally Defective 5 Children in respect of whom special examination was carried out as from 1/4/45 'n accordance with Sec. 57 (1) of the Education Act, 1944, numbered 25. 93 Of these:— Recommended for report to the Mental Health Committee under Sec. 57 (3) 2 Sec. 57 (5) — Classed as Educationally Subnormal Pupils >7 No disability of mind 4 For re-examination after a period '» EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Twelve boys were examined in accordance with the Bye-laws and found to be fit for employment. Six children were also examined as required by the Employment of Children in Entertainments Provisional Amending Rules, 1945. TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. (Regulations 49(2) of the Handicapped Pupils and School Health Service Regulations, 1945). A. Routine Medical Inspections:— (1) Number of Inspections: Entrants 1,061 Second Age Group 1.035 Third Age Group 1.254 Total 3,350 (2) Number of other Routine Inspections 254 Grand Total 3,604 B. Other Inspections. Number of Special Inspections and Re-Inspections 1,795 Inspections in Secondary Schools 1/1/45 to 31/3/45 125 94 TABLE II. Classification of the Nutrition of Pupils Inspected During the Year in the Routine Age Groups. No. of Pupils I spected A (Excellent) B (Normal) C (Slightly Sun-normoly n (Bad) 0. % No % No. % No. % 3350 412 12.3 2894 86 4 44 1 3 — — TABLE III. GROUP I.—Treatment of Minor Ailments (excluding uncleanliness). Total Number of Defects treated or under treatment during the year under the Authority's Scheme 1531. GROUP II.—Treatment of Defective Vision and Squint. the Authority's Scheme Errors of Refraction (including squint) 213 Other defect or disease of the eyes (excluding those recorded in Group I) 30 Total 243 Number of Pupils for whom spectacles were (a) Prescribed 214 (b) Obtained 214 GROUP III.—Treatment of Defects of Nose and Throat. Under the Authority's Scheme Received Operative Treatment 299 Received other forms of Treatment 3 Total number treated 302 95 TABLE IV. DENTAL INSPECTION AND TREATMENT (1) Number of Pupils inspected by the Dentist:— (6) Fillings :— 1 ermanent Teeth 820 (a) Routine Age-Groups 9163 Temporary Teeth 403 (b) Specials 533 Total 1223 (c) Total (Routine and Specials 9596 (7) Extractions :— Permanent Teeth 676 (2) Number found to require treatment 4070 Temporary Teeth 2763 (3) Number actually treated 2399 Total 3439' (4) Attendances made by pupils for treatment 3067 (8) Administration of general anætheties for extractions 172 (5) Half-days devoted to :— Inspection 77 (9) Other Operations :— Permanent Teeth 431 Treatment 376 Temporary Teeth 102 Total 453 Total 533 TABLE V. (i) Average number of visits made during the year by the School Nurses or other authorised persons 12 (ii) Total number of examinations in the Schools by School Nurses or other authorised persons 25,448 (iii) Number of individual pupils found unclean 64I TABLE VI BLIND AND DEAF PUPILS. Number of totally or almost totally blind and deaf pupils who are not at the present time being educated in a Special School. 1 At a Maintained Primary or Secondary School 2 At an Institution other than a Special School 3 At no School or Institution Blind Pupils — — — Deaf Pupils — — —