EAS 23 COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1946 MALCOLM B. BARKER, M R C.S., (Eng.), L.R.C.P., D.P.H. (Lond ) Medical Officer of Health; School Medical Officer; General Medical Superintendent; Medical Officer to the Maternity and Child Welfare Committee and Statutory Committee for Mental Deficiency; Chief Tuberculosis Officer 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 1946 MALCOLM E. BARKER, M R C.S., (Eng.), L.R C.P., D.P.H. (Lond.) Medical Officer of Health; School Medical Officer; General Medical Superintendent; Medical Officer to the Maternity and Child Welfare Committee and Statutory Committee for Mental Deficiency; Chief Tuberculosis Officer PRINCIPAL CONTENTS. Sections:— Page Constitution of Council 3 Public Health Staff 4 Introduction 7 Statistical and Social Conditions of Area 9 General Provision of Health Services 14 General and Special Hospitals and Children's Homes 20 Mental Deficiency 26 Welfare of the Blind 29 Voluntary Associations 31 Maternity and Child Welfare 33 Infectious Diseases 45 Tuberculosis 54 Sanitary Section and Housing 65 Meteorological Record 66 Inspection and Supervision of Food 72 School Health Service:— Introduction 75 Report 78 EAST HAM CORPORATION. COUNCIL (shewing Chairmen and Vice-Chairmen of Health, M. & C. W., Mental Health *and Education Committees). The Mayor: Mr. Councillor Ernest Albert Wood, J. P. The Deputy Mayor: Mr. Alderman Sydney Arnold Elson. Aldermen: Charles William Brading, J.P., C.R.P. Thomas William Burden, J.P., M.P. Charles William Dixon. Richard John Fell. Herbert Percy Jackson. (5) Thomas Irwin Lethaby, J. P. Edward Francis Markey, J. P. (1) Annie Taylor (Mrs.), J.P. Frederick Welch, J. P. Councillors: William Henry Whittock Beecham. Leslie Alfred Victor Bennett. Joseph John Gillard Bishop. (4) Ethel Maud Charlotte Brace (Mrs.). Agnes Ann Bradshaw (Mrs.). Lendoranna Minnie Brignell (Mrs.). Annie Maud Clark (Mrs.). Edwin John Davey. Elsie Mary Devenay (Mrs.). Eric Cyril Boyd Edwards, LL.B. Eleanor Mary Fell (Mrs.). John Albert Hart. Henry Joseph Hooper. Walter Edwin Hurford. William Innes Jackson, J.P. Albert Edward Johnson. (6) Bertram Arthur Keene. John Alfred Kemp. (2) Winifred May Knight (Mrs.). John Linsley-Thomas. Robert William Moger, J.P. Arthur George Murrell Oakes. John O'Connor. Alfred Prior. (3) Alice Beatrice Spencer (Mrs.) Lily Sutton (Mrs.). James Ernest Taylor. William Bertram Warncken. Alfred Tom Yates Watson. Co-opted Members of the Maternity and Child Welfare and Mental Health Committees. Mrs. F. M. Goodchild Maternity Mrs. B. A. Wheeler Mental Mrs. S. Jackson and Child Mrs. C. Boar Health Mrs. C. Robertson Welfare. Mrs. E. Tansley (1) Chairman of Health and Maternity and Child Welfare Committees. (2) Vice-Chairman of Health and Maternity and Child Welfare Committees to 2-7-46. (4) Vice-Chairman of Health and Maternity and Child Welfare Committees from 3-7-46. (3) Chairman of Committee for the Care of the Mentally Defective. (4) Vice-Chairman of the Committee for the Care of the Mentally Defective. (5) Chairman of Education Committee. (6) Vice-Chairman of Education Committee to 2-7-46. (2) Vice-Chairman of Education Committee from 3-7-46. 4 Public Health Officers of the Authority. A. Medical—whole-time. Malcolm E. Barker, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health, General Medical Superintendent, School Medical Officer. J. S. Coleman, M.B., B.S., M.R.C.S., L.R.C.P., D.P. H. Deputy Medical Officer of Health and Senior Assistant School Medical Officer (temporary). Jessie A. MacLaren, 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, Harts Sanatorium and Infectious Diseases Hospital. Ernst Cohn, M.D. (as above) temporary. 1 G. H. R. Curnock, M.B., B.S.(Lond.), M.R.C.S., L.R.C.P., Obstetrical Officer to Aldersbrook Maternity Hospital and Assistant Medical Officer for M. & C. W. (temporary). 23 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. 2 G. F. Newbold, M.R.C.S., L.R.C.P., Assistant Medical Offioer (temporary). Medical—part-time. Philip Ellman, M.D., F.R.C.P., Consultant, Tuberculosis and Chest Clinic and Harts Sanatorium. S. C. Reeve-Flaxman, M.R.C.S., L.R.C.P., Ophthalmic Surgeon. R. Saveoe, M.B., Ch.B., F.R.C.S.fEdin.). M. E. O'Moore, M.B., B.Ch., B.A.O. N. J. Lawler, M.B., B.Ch., B.A.O. Public Vaccinators. B. Dental Surgeons:— 29 Hilda T. Smith, L.D.S., R.C.S. 3 C. E. Maytum, L.D.S., R.C.S. 4 A. Smith, L.D.S., F.P.S.G., (temporary). C. Sanitary and Food Inspectors:— R. A. Baskett, B.E.M., M.S.I.A., Chief Sanitary Inspector, Food and Shops Act Inspector. W. H. Thurston, M.S.I.A., A.R.S.I., R.P. D. G. Tonkin, M.S.I.A. W. J. Worley, M.S.I.A., A.R.S.I. L. plnouey, M.S.I.A. R. Daw, M.S.I.A. 5 C. Lockley, M.S.I.A. 28 V. C. Quin, M.S.I.A. Shops Acts Inspector:— C. H. Pursall, A.R.S.I. D. Nursing Staff:— 7 Matron, Infectious Diseases Hospital:— G. A. W. Smallridoe, S.R.N., S.F.N., S.C.M. Matron, Harts 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. Pressey, S.R.N., S.C.M., R.S.I., (H.V's. Cert.). 5 Nursing Staff (Health Visitors)—contd. 26 J. Pbtrie, 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.). M. Golden, S.R.N.. S.C.M., (H.V's. Cert.). 24 K. G. Garrard, S.R.N., (H.V's. Cert.). 25 D. M. Clarke, S.R.N., S.C.M., (H.V's. Cert.). 27 E. A. Payne, S.R.N.. S.C.M., R.F.N., (H.V's. Cert.). Senior School Nurse:— M. A. Sorrell. S.R.N., A.R.S.I. School Nurses:— A. I. Childs, S.R.N., S.C.M., A.R.S.I. D. Young, S.R.N., S.C.M. M. H. Nunn, S.C.M. C. G. Case, R.F.N., A.R.S.I. V. Olifent, R.F.N. 8 E. M. Garnham, S.R.N., R.F.N., (Temporary). 9 C. M. Yeates, S.R.N., S.C.M., R.F.N., (Temporary). Physiotherapist and Light Sister:— E. B. Broome, S.R.N., C.S.M., L.E.T., M.S.R., (Temp Tuberculosis Nurses:— F. M. Williams, S.R.N., T.A., (Cert.). 10 C. Jenkin, S.R.N., S.C.M., T.A., (Cert.). M. Stokes, S.R.N., S.C.M., T.A., (Cert.). 11 M. M. Sammon, S.R.N., S.C.M., T.A., (Cert.), (H.V's. ( Social Welfare Nurse and Assistant Social Welfare Officer:— E. E. Kelley, S.R.N., S.C.M., Fever Trained. Municipal Midwives:— M. Law, S.C.M. 12 E. I. Hake, S.R.N., S.C.M. M. E. Kinsella, S.R.N., S.C.M. 13 G. I. Harris, S.R.N., S.C.M. 30 S. J. Miller, S.C.M. (Temporary). 31 E. Gilton, S.C.M. (Temporary). E. Other Staff:— A. H. Bleaden, Supervising Officer, M. D. Training Centre. H. L. Kingston, Home Teacher, Blind Persons Acts. W. L. Narborough, Dispenser (Temporary). 14 I. Wurmfeld, Ascertainment and Supervisory Officer, M.D. (Temporary). 15 L. B. Cooney, Assistant Supervising Officer "(Temporary), M.D. Training Centre. A. W. Lywood, Guide and Assistant (Temporary), M.D. Training Centre. F. Clerical Staff:— Chief Administrative Clerk, T. B. Clark. Senior Clerk and Vaccination Officer, B. E. R. Hartley, A.C.I.S. Male Clerks:— C. J. Hayes. 16 H. J. Horsnell. 18 J. C. Childs. 17 E. A. Bloomfield. B. G. Boar. * D. E. Ross. * R. Gunning. 19 A. Smith. And Temporary Clerks. 6 Clerical Staff—contd. Shorthand Typists:— D. Gordon. 20 V. H. Nicol. D. G. Cannell, And Temporary Staff. Female Clerks:— 21 M. A. McCall. M. A. R. Gaster. F. C. Wells. 22 B. Clandillon. * J. Mackintosh. B. H. White. And Temporary Staff. * In H. M. Forces. 1 Commenced 17.6.46. 2 Commenced 2.9.46. 3 Commenced 26.8.46. 4 Commenced 27.5.46. 5 Terminated 12.11.46. 7 Commenced 5.3.46. 8 Terminated 6.11.46. 9 Terminated 27.12.46. 10 Terminated 8.2.46. 11 Commenced 11.2.46. 12 Terminated 22.11.46. 13 Commenced 1.11.46. 14 Terminated 15.4.46. 15 Terminated 21.12.46. Acted as temporary Ascertainment Officer for approximately 4½ months. 16 Returned H.M. Forces 4.3.46. 17 Returned H.M. Forces 1.5.46. Commenced Sanitary Inspector's Course 17.6.46. 18 Returned H.M. Forces 29.4.46 19 Terminated 29.6.46. 20 Terminated 9.2.46. 21 Terminated 4.11.46. 22 Returned H.M. Forces 6.8.46. 23 Terminated 24.7,46. 24 Commenced 4.11.46. 25 Commenced 7.8.46. 26 Terminated 30.6.46. 27 Commenced 24.4.46. 28 Commenced 1.4.46. 29 Senior Dental Officer from 1.7.46. 30 Commenced 22.1.46. 31 Commenced 17.8.46. 7 COUNTY BOROUGH OF EAST HAM Public Health Department, Town Hall Annexe, E.6. October, 1947. To the Worshipful the Mayor, The Aldermen and Councillors of the County Borough of East Ham. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report as Medical Officer of Health and School Medical Officer for the year 1946. The report is comprised very largely of statistics, but these, with the accompanying references, indicate the scope and measure of success of the various health services of the Borough. The Registrar General's estimate of the population—113,570— shows a considerable increase over the previous year although, according to my researches this figure is much exceeded. Vital statistics are again very satisfactory. The birth rate— 22.69 per 1,000 live births—is the highost, and the. death rate—10.6 per 1,000 of the population—the lowest for many years. The most outstanding feature, however, is the infantile mortality rate—30 per 1,000 live births—which is the lowest in the history of East Ham and compares favourably with that for England and Wales for the period—i.e. 43 per 1,000. The maternal mortality rate continues to fall and is reduced by half in comparison with that of last year. I submit that both these records reflect great credit on the Council's Maternity and Child Welfare Services which, in order to meet the exceptional demands, have been greatly augmented by additional sessions and more medical and nursing attention. The opening of the Emergency Unit at Aldersbrook for maternity cases has provided the additional facilities so urgently required. This attractive, well-equipped and adequately staffed hospital has proved of inestimable benefit to mothers and admission has been much sought after by them. The incidence of infectious illness throughout the year, except for measles, was remarkably low, and it will be seen that no deaths occurred in respect of any of the common notifiable diseases. The unification of the health visiting and school nursing staffs, foreshadowed by recent legislation, was effected during the year and 8 has as its object the promotion of efficiency and the prevention of overlapping in their respective activities. Plans to implement the requirements of the Education Act, 1944, are well advanced and measures calling for joint action with neighbouring authorities are receiving urgent consideration. It is anticipated that by this means, provision for the reception of individuals in the various categories of handicapped pupils will be more readily forthcoming and that such facilities will attain a high standard of day or residential accommodation. In regard to housing, much assistance has been rendered in assessing priority on health grounds and has entailed considerable investigation and correspondence. The day nurseries continue to function satisfactorily. The demand for accommodation at each of the centres greatly exceeds the number of places, with the inevitable result—a long waiting list. Additional sessions have been instituted at the Chest Clinic to deal particularly with the constantly increasing number of artificial pneumothorax cases discharged from the sanatorium. Arrangements recently completed with the North Middlesex Hospital for surgical intervention in tuberculosis have proved of exceptional value to the patient and have expedited such treatment. The shortage of nursing staff has occasioned much anxiety at Harts Sanatorium and the Infectious Diseases Hospital, and, at times, in the case of the former, necessitated beds being put out of commission temporarily. It should be noted that every possible consideration is given by the appropriate committee in the matter of rehousing of sufferers from tuberculosis. In conclusion, I respectfully submit that despite the influx of population, the shattered condition and overcrowding of many houses, and the prolongation of food rationing, a combination of factors calculated to foster disease and illness, the vital statistics of the borough more than indicate the adequacy of the health services. I wish to express to you, Mr. Mayor, to the Chairman of the Health Committee, and to all who have contributed to this end, my grateful thanks for your continued help and support. 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—1946 113,570 Number of inhabited houses (end of 1946 according to rate books) (Including tenements and shops) Approximately 30,000 Rateable value at 31st December, 1946 £706,908 Sum represented by a penny rate for the year 1946 £2,758 Extracts from Vital Statistics. Total For Birth Rate Males Females Live Births Legitimate 2,469 1,274 1,195 Illegitimate 108 63 45 Still Births Legitimate 62 30 32 Illegitimate 2 1 1 Deaths—Total 1,212. Males 660. Females 552. Deaths from Puerperal causes:— Death Rate per 1,000 Total s (Live and Still) Births Puerperal Sepsis — — Other Maternal Causes 2 0.75 Total 2 0.75 Deaths of infants under one year of age All infants per 1,000 live births 30 Legitimate infants per 1,000 legitimate live births 31 Illegitimate infants per 1,000 illegitimate live births 18 Deaths from Cancer (all ages) 225 Death from Measles (all ages) — Death from Whooping Cough (all ages) — Death from Diarrhoea (under 2 years) 8 10 Still Births. The number of still births registered was 64 compared with 51 for the previous year. The rate per 1,000 total (live and still) births was 24.2, the figure for 1945 being 28.4. Since 1942 the statistics in relation to still births is shewn below: 1942 1943 1944 1945 1946 No. of still births .. 69 50 45 51 64 Rate per 1,000 total (live and still) births 42.5 26.1 23.04 28.4 24.2 Births. The number of live births registered was 2,577 as compared with 1,742 for the year 1945, equivalent to a birth rate of 22.69 per 1,000 of the population—the figure for the previous year—18.2. A comparison of the statistics for the period since 1942 is appended below:— 1942 1943 1944 1945 1946 No. of Births (East Ham) 1,553 1,868 1,908 1,742 2,577 Birth rate (East Ham) 17.4 20.09 20.9 18.2 22.69 ,, (England & Wales) 15.8 16.5 17.6 16.1 19.1 Deaths. The number of deaths was 1,212 as compared with 1,235 for the year 1945. The death rate was 10.6, that for the previous year being 12.9. Of the total deaths 620 or 51% died in institutions. The number of residents who died outside the area and whose deaths were assigned to the Borough was 590. The number of deaths of non-residents in the district was 37. The percentage of total deaths in the age groups was as follows:— Under 1 year 1—5 years 5—15 years 15—45 years 45—65 years 65 and over 6.52 0.74 0.41 8.91 25.98 57.41 For the period 1942—1946 the rates for England and Wales and East Ham are shewn:— 1942 1943 1944 1945 1946 England and Wales 11.6 12.1 11.6 11.4 11.5 East Ham 14.09 13.27 14.4 12.9 10.6 Infantile Mortality. Deaths of infants under one year numbered 79—equivalent to an infant mortality of 30 per thousand live births—compared with a rate of 36 for the previous year. The rate for England and Wales was 43. 11 The number of deaths of illegitimate children was 2 out of a total1 of 108 illegitimate births, giving a mortality rate of 18 as compared with a figure of 38 per 1,000 illegitimate live births for the year 1945. Infantile mortality rates since 1942 are as follows:— 1942 1943 1944 1945 1946 East Ham 54 48 31 36 30 England & Wales 49 49 46 46 43 Illegitimate births and the illegitimate mortality rates since 1942 are tabulated below:— 1942 1943 1944 1945 1946 No. of illegitimate births 66 71 82 105 108 Mortality rate per 1,000 illegitimate live births 29 56 48 38 18 Neo-Natal Mortality. Children dying under the age of one month totalled 50 equal to a neo-natal mortality of 19.4 per 1,000 live births. These rates from 1942 are indicated below:— 1942 1943 1944 1945 1946 35.4 23.5 17.3 19.5 19.4 Maternal Mortality. The number of maternal deaths was 2, the maternal mortality rate for 1946 was 0.75 per 1,000 live and still births. In the subjoining tables these rates are shown since 1942:— Per 1,000 total births, live and still. Puerperal Infections Other Causes Total England & Wales East Ham England & Wales East Ham England & Wales East Ham 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 1946 1.24 — 0.19 0.75 1.43 0.75 Population. The Registrar-General's estimate of the population to the middle of 1946 is 113,570, which is an increase of 18,340 compared with that for the year 1945. The rates per 1,000 of the population mentioned in. this report are based on this estimate. 12 Table 1.—BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1946. 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 Fevers. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Smallpox. Measles. Total Deaths under one year. Deaths from Diarrhoea and Enteritis (under two years.) England and Wales ‡19.1 ‡0.53 ‡11.5 0.00 0.00 0.02 0.01 0.15 0.00 0.00 †43 4.4 126 County Boroughs and Great Towns, including London. 22.2 0.67 12.7 0.00 0.00 0.02 0.01 0.13 0.00 0.01 46 6.1 148 Smaller Towns (resident populations 25,000 to 50,000 at Census, 1931.) 21.3 0.59 11.7 0.00 0.00 0.02 0.01 0.14 0.00 0.00 37 2.8 London—Administrative County 21.5 0.54 12.7 0.00 0.00 0.02 0.01 0.12 – 0.01 41 4.2 East Ham 22.69 0.56 10.6 – – – – 0.07 – – 30 3.1 † Per 1,000 related births. A dash (—) signifies that there were no deaths. ‡ Rates per 1,000 total population. 12a Table 2.—CAUSES OF DEATH IN AGE GROUPS, 1946, AND TOTAL DEATHS FOR 1942-1946. 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. All Ages. Total deaths in Instns. 1946 1945 1944 1943 1942 M F M F M F M F M F M F M F M F 1. Typhoid and Para-typhoid Fevers – – – – – – – – – – – – – – – – – – – – – 2. Cerebro-Spinal Fever – – – – – – – – – – – – – – – – – 1 1 1 3 3. Scarlet Fever – – – – – – – – – – – – – – – – – – – 1 – 4. Whooping Cough – – – – – – – – – – – – – – – – – – 1 1 – 5. Diphtheria – – – – – – – – – – – – – – – – – 1 3 – 1 6. Tuberculosis of Respiratory System – – 1 – – – 17 22 13 5 3 1 34 28 17 13 62 52 61 80 53 7. Other forms of Tuberculosis – – 2 – 1 1 – 1 1 – 1 1 5 3 4 3 8 9 14 7 15 8. Syphilitic Diseases – – – – – – – – 4 – 2 2 6 2 2 – 8 5 5 9 7 9. Influenza – 1 – – 1 – 1 – 1 1 1 2 4 4 2 1 8 4 2 27 5 10. Measles – – – – – – – – – – – – – – – – – 1 – 1 2 11. Acute Polio-myelitis and Polio-encephalitis – – 1 – – – – – – – – – 1 – 1 – 1 – – – – 12. Acute infective Encephalitis – – – – – – 1 – – – – – 1 – 1 – 1 – 1 – 5 13. Cancer of the Buccal Cavity and Oesophagus (M) Uterus (F) – – – – – – – 1 3 4 12 6 15 11 9 6 26 16 13 14 24 14. Cancer of Stomach and Duodenum – – – – – – 2 1 7 8 13 5 22 14 13 5 36 44 45 50 52 15. Cancer of Breast – – – – – – – 2 – 8 – 11 – 21 – 7 21 17 27 19 14 16. Cancer of all other sites – – 1 – – – 8 8 34 25 31 35 74 68 49 41 142 129 118 130 128 17. Diabetes – – – – – – 1 1 1 2 1 1 3 4 3 2 7 4 16 8 12 18. Intracranial Vascular Lesions – – 1 – – – – 2 15 12 39 47 55 61 29 22 116 110 125 110 116 19. Heart Disease – – – – – – 6 2 37 31 118 109 161 142 59 44 303 286 314 237 262 20. Other Diseases of Circulatory System – – – – – – – – 12 4 19 19 31 23 16 5 54 58 34 34 35 21. Bronchitis 1 – – – – – 1 1 20 6 27 18 49 25 20 6 74 75 66 99 71 22. Pneumonia 11 7 – 1 – – 2 – 5 4 22 16 40 28 23 21 68 68 59 75 55 23. Other Respiratory Diseases – – – – – – 2 1 1 1 5 9 8 11 4 5 19 20 12 19 16 24. Ulcer of Stomach & Duodenum – – – – – – 2 – 9 2 2 – 13 2 11 2 15 17 22 18 11 25. Diarrhoea (under 2 years) 6 2 – – – – – – – – – – 6 2 5 2 8 7 2 11 13 26. Appendicitis – – 1 – – – – 1 1 – – 3 2 4 2 4 6 6 4 6 7 27. Other Digestive Diseases – 2 – – – – 1 1 3 3 5 7 9 13 7 7 22 30 23 21 23 28. Nephritis – – – – – – 1 1 4 3 7 3 12 7 10 . 2 19 16 21 20 28 29. Puerperal and Post - abortive Sepsis – – – – – – – – – – – – – – – – – 2 4 3 2 30. Other Maternal causes – – – – – – – 2 – – – – – 2 – 1 2 – 2 2 4 31. Premature Birth 5 11 – – – – – – – – – – 5 11 4 9 16 13 19 23 31 32. Congenital malformations, birth injury, infantile diseases 24 7 1 – – – 1 – – – 1 – 27 7 20 3 34 23 23 22 18 33. Suicide – – – – – – 2 1 3 3 2 1 7 5 1 2 12 8 6 11 8 34. Road Traffic Accidents – – – – – – 2 1 1 – 3 — 6 1 6 – 7 16 5 10 14 35. Other violent causes – – – – – – 3 – 5 1 2 5 10 6 5 6 16 67 142 32 17 36. All other causes – 2 – – 2 – 4 2 5 7 43 36 54 47 42 36 101 130 125 131 105 TOTALS 47 32 8 1 4 1 57 51 185 130 359 337 660 552 365 255 1,212 1,235 1,316 1,232 1,157 12b Table 3.—DEATHS IN WARDS, 1946. Cause of Death. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Great field. South. Total. 1. Typhoid & para-typhoid fevers – – – – – – – – – – – 2. Cerebro-spinal Fever – – – – – – – – – – – 3. Scarlet Fever – – – – – – – – – – – 4. Whooping Cough – – – – – – – – – – – 5. Diphtheria – – – – – – – – – – – 6. Tuberculosis of respiratory System 9 4 3 3 4 10 7 11 4 7 62 7. Other forms of Tuberculosis 1 1 2 1 — 1 – 1 1 — 8 8. Syphilitic Diseases 1 — — — — — 1 4 1 1 8 9. Influenza 2 2 1 — 1 — 1 — — 1 8 10. Measles – – – – — — — — — — — 11. Acute Polio-myelitis and polio tncephalitis – 1 – – – – – – – – I 12. Acute infective encephalitis — — — – – — — — 1 – 1 13. Cancer of buccal cavity and oesophagus (M) uterus (F) 3 2 3 – 3 2 2 5 1 5 26 14. Cancer of Stomach and Duodenum 4 2 4 3 5 8 1 3 4 2 36 15. Cancer of Breast 3 6 2 2 1 — 3 3 1 21 16. Cancer of all other sites 13 13 14 8 16 14 21 16 12 15 142 17. Diabetes – 1 2 – 1 1 – 1 – 1 7 18. Intracranial vascular lesions 18 13 11 13 12 15 5 14 8 7 116 19. Heart Disease 44 30 36 18 21 32 33 35 23 31 303 20. Other diseases of circulatory system 5 4 3 1 2 9 6 12 8 4 54 21. Bronchitis 7 9 6 8 7 5 6 8 10 8 74 22. Pneumonia 6 8 8 6 5 4 11 5 6 9 68 23. Other respiratory diseases 4 1 1 – 1 2 3 1 4 2 19 24. Ulcer of Stomach & duodenum 3 – 1 – 4 1 – 2 2 2 15 25. Diarrhoea under 2 years – 2 2 – – – 1 1 – 2 8 26. Appendicitis 1 – 1 – 3 – – – – 1 6 27. Other digestive diseases 1 4 1 5 – 2 1 3 2 3 22 28. Nephritis 1 1 1 3 1 2 3 5 1 1 19 29. Puerperal and Post-abortive Sepsis – – – – – – – – – – – 30. Other maternal causes – 1 1 – – – – – – – 2 31. Premature Birth 2 9 – – 2 – 2 1 – – 16 32. Congenital Malformations, birth injury, infantile diseases 2 3 – 3 4 3 5 4 4 6 34 33. Suicide 1 – 2 – 2 2 – 1 3 1 12 34. Road Traffic Accidents 1 – – – – 1 – 2 1 2 7 35. Other violent causes 1 1 – 3 1 – – 4 1 5 16 36. All other causes 7 9 12 11 9 11 10 10 11 11 101 Totals 140 121 121 88 106 126 119 152 111 128 1,212 13 Table 4—INFANT DEATHS UNDER ONE YEAR OF AGE, 1946. 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 1 – – – – – – – – – – – – – – – – 1 – 1 Pneumonia 18 1 1 3 – 1 – – – – 1 3 3 2 2 1 – 11 7 2 2 3 1 2 1 2 1 4 14 Diarrhoea, etc. 8 – – 1 – – – – – 1 1 3 – – – 1 1 6 2 2 2 1 1 2 7 Congenital Debility and Malformations, Premature Births 47 22 15 4 – 1 – – – 1 2 1 1 – – – – 29 18 4 12 3 5 3 7 4 4 5 34 Other Defined Causes 5 – 1 – – – – – – – – – 3 – 1 – – – 5 1 1 1 1 1 4 All Causes 79 23 17 8 – 2 – – – 2 4 8 7 2 3 2 1 47 32 7 18 5 4 7 4 10 7 5 12 59 14 General Provision of Health Services. PROFESSIONAL NURSING IN THE HOME. A. General. The Council makes a grant in aid of the East Ham District Nursing Association, 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 state 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 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. MIDWIVES ACTS, 1902 to 1936. The number of midwives who notified their intention to practice in East Ham during 1946 was 43. Of this number 25 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches—3 at Sir Henry Tate Nurses' Home, Silvertown—8 at East Ham Memorial Hospital—and 7 practised independently, including 6 Municipal Midwives. Plaistow Maternity Hospital and District Nurses Home. Summary of cases, 1946:— Midwifery 311 Monthly 194 Hospital 228 15 Laboratory Facilities. As detailed in previous reports the majority of the specimens are sent for examination to the East Ham Memorial Hospital. During 1946, 1,688 specimens were examined and the nature of these examinations is shewn below:— Specimen Number. Blood (Sedimentation Rate) 163 268 Blood (Widal Test) 1 Blood (Count) 67 Blood (Wassermann) 11 Blood (Other) 26 Sputa (for Tuberculosis, Direct method) 921 972 Sputa (for Tuberculosis, Antiformin method) 38 Sputa (for Tuberculosis Culture) 6 Sputa (for Asbestosis) 5 Sputa (for Malignant cells) 2 Mantoux test (for Tuberculosis) 100 Swabs (for Diphtheria) 7 Swabs (rectal for Enteritis) 129 218 Swabs (for haemolytic Strepts.) 39 Swabs (for Gonococci) 2 Swabs (other) 41 Gastric Lavage (for Tuberculosis) 36 Faeces (for various exams.) 11 Other 83 Total: 1,688 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 351 12 339 Town Hall Annexe 733 11 722 Totals: 1,084 23 1,061 16 Ambulance Facilities. The Council's ambulance section of the Public Health Dept. functioned throughout the year and the following information in respect of the work performed in 1946 is given below:— Nature of Call— Journeys Mileage Sickness 2,090 15,960 Maternity 846 7,464 Accident, Sudden Illness 567 3,304 T.B. Transfers 168 2,388 Hospital Transfers 41 580 Social Welfare 254 9,592 Conveying Midwives 57 238 Malicious Calls 3 11 Miscellaneous 83 570 Maintenance 153 524 Scarlet Fever 151 2,445 Diphtheria 52 802 Discharges Infectious Diseases 143 2,311 Miscellaneous Infectious Diseases 60 965 Infectious Diseases Hospital (Swabs) 122 1,694 Calls for other Boroughs:— West Ham 53 321 Ilford 18 222 Barking 73 820 Dagenham 3 58 Wanstead and Woodford 2 36 Calls by other Boroughs:— West Ham 26 137 Barking 8 67 Ilford 28 190 Wanstead and Woodford 1 7 17 Clinics and Treatment Centres. These are all provided by the Council. The sessions at the Centres (as on 31/12/46) 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. Tuesday 2 p.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. Alternate Thursdays 9 .30 a. m. ,, ,, ,, Toddler's Clinic Ear Clinic Tuesday 10.30 a.m. Wednesday and Friday 2 p. m. ,, ,, ,, Ante-natal Clinic Monday 9 a.m., Tuesday 2 p. m., Wednesday 2 p. m. Thursday 10 a.m. and Friday 10 a.m. ,, ,, ,, Scabies Clinic Tuesday 5 p.m. and Friday 2 p.m. ,, ,, ,, Church Road, Manor Park Dental Clinic Infant Welfare Clinic By Appointment Mondays and Thursdays 2 p.m. ,, ,, ,, General Clinic (Minor Ailment & Observation cases) Tuesday and Friday 9.30 a. m. ,, ,, ,, Ante - natal Clinic (and Post-natal) Monday 9 a.m., Tuesday 2 p.m., Wednesday 9.30 a.m. (double sessions). ,, ,, ,, Immunization Clinic Wednesday 2 p.m. (School Health), Thursday 10 a. m. (M. & C. W.) ,, ,, ,, Toddler's Clinic Friday 2 p.m. ,, ,, ,, Dental Clinic By Appointment North Woolwich—Fernhill Street Baths General Clinic (Minor Ailment & Observation cases) Friday 2 p. m. ,, ,, ,, Infant Welfare Tuesday 9.30 a. m. Tuberculosis and Chest Clinic, Katherine Road Tuberculosis and Chest Diseases 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). 18 SOCIAL WELFARE DOMICILIARY MEDICAL SERVICE, This scheme was described in my report for 1934. See also the amendment as set out in the report for 1945. The successful service is administrated with the minimum of trouble. TABLE 6. SOCIAL WELFARE DOMICILIARY MEDICAL SERVICE. Statistical Return for the Year Ending 31/12/46. 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 1,039 1,861 5,242 7,103 287 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 5 Total attendances at home by Nurse 1,982 Venereal Diseases. Facilities for treatment have continued as in previous years. From the official tables supplied by the London County Council the following figures are abstracted and are compared with statistics for the year 1945:— New Patients. 1945 1946 Syphilis 22 21 Soft Chancre 1 — Gonorrhoea 43 63 Not Venereal 133 225 Total 199 309 Total attendances 2,726 3,251 19 Pathological Examinations. For, or at the Centres:— Spirochaetes — Gonococci 1,012 Wassermann 658 Others 1,560 Total 3,230 For Practitioners:— Spirochaetes — Gonococci 12 Wassermann 10 Others 4 Total 26 No East Ham patients were admitted to hostels under the scheme. Venereal Diseases Rules, 1942—Regulation 33B. Contacts notified to the Medical Officer of Health during the period 1/1/46 to 31/12/46. M. F. (1) Total number in respect of whom Form 1 was received 1 1 (2) Number of cases in (1) in which attempts were made outside of the scope of the Regulations to persuade the contact to be examined before the latter had been named on a second form 1 1 Contacts found 1 1 Contacts examined 1 1 (3) Number of those in (1) in respect of whom two or more Forms 1 were received — — (4) Number of those in (3) dealt with Nil Mental Deficiency. Statistics are given later in the Report. 20 GENERAL AND SPECIAL HOSPITALS AND CHILDREN,S HOMES. ARRANGEMENTS FOR TREATMENT. (a) Provided by Local Authority, (6) Maternity, (c) Orthopaedic, (d) Ear, Nose and Throat, (e) Puerperal Pyrexia, (f) Ophthalmia Neonatorum. There are no further comments to make on existing arrangements. Particulars have been set out in previous reports. (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 County Boroughs of East Ham and Southend on-Sea. Statistics and other information relating to the Hospital are contained in the Annual Report for 1946. (h) Smallpox. (i) East Ham Memorial Hospital. Statistics from the Hospital report for the year 1946 are as follows:— 21 TABLE 7. A. In-Patients. Number of Beds and In-Patients. Numbers in 1946 Numbers in previous year. 1. Beds:— (a) Complement at 31st December 131 151* (b) Average Daily Complement during the year 131 170.8 (c) Average Daily Number Closed during the year owing to :— (i) Rebuilding — – (ii) Repairs, Redecoration, Cleaning or Infection 4 — (iii) Other Causes (enemy action) — 47.8 (d) Average Daily Number Open during the year:— (i) Emergency Hospital Scheme, Casualty beds.. 16.7 29.0 (ii) Other beds 113.9 94.0 (e) Average Daily Number occupied during the year (i) Emergency Hospital Scheme Casualty Beds 3.0 11.2 (ii) Other Beds 90.3 75.9 2. Number of In-Patients in the Hospital at beginning of year 82 80 3. Number of In-Patients admitted during the year 2,553 2,321 4. Number of In-Patients in Hospital at end of year 95 82 6. Average Number of days each Patient was resident .. 13.4 13.7 6. Number of Patients admitted and discharged during the year who were resident for (i) only 1 day 262 364 (ii) 2 and 3 days 605 344 *Including 20 Beds for Emergency Hospital Scheme. B. Out-Patients. Number. Numbers in 1946 Numbers in previous year. 1. Total Number of new Out-Patients 17,142 17,092 2. Total Number of Out-Patient attendances 89,463 86,301 (a) Number of Patients on books at the beginning of the year Not ascertainable Not ascertainable (6) Number of Casualty Patients included in No. 1 above 5,550 5,350 (c) No. of Maternity Patients included in No. 1 above 379 403 (d) No. of attendances of Maternity Patients included in No. 2 above 3,269 2,708 22 (j) Whipps Cross Hospital and Institutions controlled by West Ham. Beds allocated to East Ham on a ' 'user basis''. 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. (l) Tolmers Park, Herts. Statistical information in respect of this Home is appended below: TABLE 9. Chargeable on 31-12-45 Admitted during 1946 Total Discharged Died Transferred to other Institutions Chargeable on 31-12-46 70 24 94 10 15 4 65 23 TABLE 10. Cases Admitted to West Ham Institutions from East Ham. Institution. Chargeable on 31/12/45 Admitted during 1946 Born during 1946 Total Discharged Died Transferred to other Instutions. Chargeable on 31/12/46 Whipps Cross Hospital 168 1,525 — 1,693 1,289 258 38 108 Forest Gate Hospital 48 427 371 846 677 13 110 46 Harold Wood Hospital 29 16 — 45 5 5 3 32 Central Home 155 230 — 385 71 126 35 153 Forest House 28 8 — 36 1 — 4 31 24 (k) Aldersbrook Homes and Scattered Homes. I am indebted to Mr. Pitt Steele, Superintendent, for the following information relative to the year ended 31/12/46 and for the half-years 1945 and 1939:— 6 months ending Corresponding. 31-12-46 1945 1939 Highest number in residence was 475 520 496 Lowest number in residence was 398 455 437 Numbers in residence on 30-6-46 were 456 481 450 Aldersbrook and Scattered Homes 375 121 450 Cornwall 36 252 Hutton 43 104 Other billets 2 4 Numbers in residence 31-12-46 were 421 464 460 Aldersbrook and Scattered Homes 409 158 Cornwall 11 207 460 Hutton — 96 Other billets 1 3 – Total number of admissions 416 505 277 From East Ham 84 127 60 From West Ham 190 206 130 From Essex County Council 142 172 87 From Education Authorities (included in totals) 41 25 – Total number of discharges 461 524 291 From East Ham 100 158 — From West Ham 197 181 — From Essex County Council 164 181 — From Education Authorities (included in totals) 57 17 Average number of admissions weekly 16 19.4 10 Average number of discharges weekly.. 17.7 20 10 Greatest number admitted on any one day 9 11 10 Number of children under 3 years admitted .. 118 170 77 Chargeability to Authorities on 31-12-46:— East Ham 78 101 83 West Ham 168 182 225 Essex County Counoil 165 181 152 Education Authorities:— East Ham 2 3 — West Ham 21 13 — Walthamstow 6 5 — Leyton 5 14 — Essex County Council 4 5 — Number of deaths in the Homes — — 2 Transfers to other institutions not under control of East or West Ham or Essex County Council 6 30 14 Transfers to or from Reception Areas:— To 44 172 — From 111 218 — Total number of days maintenance 78,637 85,676 83,775 Number in residence on 1-1-47 411 464 460 Infants under 3 years 75 107 39 Children over 3, under 5 years 55 59 41 Children over 5, under 8 years 93 95 90 Boys over 8, under 14 years 96 102 123 Girls over 8, under 14 years 58 63 91 Boys over 14, under 16 years 16 17 36 Girls over 14, under 16 years 18 21 40 25 6 months ending C orresponding 31-12-46 1945 1939 Number of boys sent to situations 4 5 10 Number of boys returned from situations — – – Number of girls sent to situations 4 8 12 Number of girls returned from situations 1 1 – Accommodation, i.e. beds provided:— Receiving Homes 240 507 501 Scattered Homes 157 Cornwall 15 Bacton 25 An extract from Mr. Steele's Report is appended:— As pointed out in my previous reports the number of children in residence shows a decrease, but the number of children actually dealt with shows an increase of 60 per cent. on admissions and 70 per cent. discharges compared with 1939. This means that we are rendering a service to half as many again of the community compared with 1939 and yet if only figures of children remaining in residence were taken it would appear that we were doing less work than before the war. All the extra work involved in changing ration documents, entering up records of all kinds, answering a never ending stream of inquiries from relatives, and other departments, throws a great strain on my office staff. I have again to point out that we are carrying the responsibility for this particular service of two County boroughs, three large boroughs, with three separate social welfare departments and fiva education departments and this multiplicity of Authorities involving the necessity of separate records and sections adds to the general difficulties. The medical examinations, treatments, the keeping of medical records, the attendance of children at hospitals and clinics, has, too, increased out of all knowledge compared with pre-war practice. The greater interest of the public in our activities has created much additional work, the would-be social aunts and uncles, the persons anxious to adopt children or enquire about our work, all of whom have to be interviewed, has, too, added to our tasks. 26 MENTAL DEFICIENCY ACTS, 1913-1938. The ascertainment and supervision of persons coming with in 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 11. Visits Number of Interviews[/ ] Statutory Supervision Guardianship Institution Training Centre Friendly Care Total 311 121 107 33 49 621 18 Note: The above figures are below those of a normal year, as for approximately 4 months the post of Ascertainment and Supervisory Officer was vacant. MENTAL DEFICIENCY ACTS, 1913-1938. Particulars of Mental Defectives as on 1st January, 1947. STATISTICS.—Comparison with Previous Year. A.—Number of Mental Defectives ascertained to be "Subject to be Dealt With". 1945 1946 M. F. Total. M. F. Total. A.I.—Under Order:— (a) (1) In Institutions (excluding cases on licence): Under 16 years of age 8 7 15 11 7 18 16 years and over 75 55 130 71 58 129 (2) On Licence from Institutions: Under 16 years of age — — — — — — 16 years and over 6 8 14 5 7 12 (6) Under Guardianship (including cases on Licence): under 16 years of age 1 — 1 1 — 1 16 years and over 14 23 37 11 25 36 2. In ''places of safety" : Under 16 years of age — 1 1 — 1 1 16 years and over — — — — — — 3. Under Statutory Supervision 74 57 131 78 54 132 of whom awaiting removal to Institutions – 1 1 – 1 1 4. Action not yet taken under any one of the above headings 8 12 20 5 11 16 B. No. of Mental Defectives not at present "Subject to be Dealt With", but for whom the Local Authority may subsequently become liable 23 19 42 29 25 54 of whom, number under voluntary supervision 21 18 39 28 22 50 Number of cases on Register of Occupation Centre 11 12 23 12 14 26 27 CASES REPORTED BY LOCAL EDUCATION AUTHORITIES. (Section 57, Education Act, 1944.) 1945 1946 M. F. Total M. F. Total Reported under Sees. 2(2) & 57(3) &(5) 3 4 7 Reported under Sec. 57(3) 6 3 9 Reported under Sec. 57(5) 1 1 2 Total reported during 1946 7 4 11 Method of Disposal:— Sent to Institutions (By Order) — 1 1 2 1 3 Placed under Guardianship (By Order) – – – – – – Placed under Statutory Supervision 2 1 3 4 2 6 Taken to "place of safety'' — 1 1 — 1 1 Died or Removed from Area – – – – – – Action not yet taken 1 1 2 — — — Referred back to Education Committee — — — 1 — 1 Total 3 4 7 7 4 11 Of total number of mental defectives known to local authority:— (a) Number who have given birth to children during:— 1945 1946 (a) After Marriage one two (b) While unmarried one two (6) Number who have married 1 male 1 female 1 male 1 female Ascertainment. The number of cases dealt with for the first time during the year 1946 was 19, and they were dealt with as under:— 6 placed in Institutions. 3 placed under Guardianship. 7 placed under Statutory Supervision. 1 placed under Friendly Care. 1 referred back to Education Committee. 1 "action pending." Provision of Institutional Accommodation. Whilst the difficulty experienced in obtaining institutional accommodation generally has been relieved by the erection of South Ockendon Colony, additional facilities are urgentl required for low grade defectives under 5 years, and also for cases of Spastic Diplegia. Guardianship. There are 37 cases under Guardianship, of whom three are still evacuated to other areas. During the year, two were transferred 28 under Varying Orders to Institutional Care, and in three cases the Orders were discharged and the patients transferred to Friendly Care. Supervision. There are 132 mental defectives under statutory supervision in their own homes in this area. A number removed during the war are still untraceable, and some are still evacuated to other areas. A fair percentage of the cases are being 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 or relatives 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 are 26 on the Register, with an average daily attendance of 20 of varying ages and of both sexes. Handwork of all types form the main part of the curriculum, and all articles made are sold. 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 otherwise be taught. A certain amount of physical training is given daily together with a small amount of domestic training incurred in connection with the preparation and clearance of tables before and after the midday meal. The meal is conveyed to the Centre, from a nearby 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. The Annual Seaside Outing, by coach, was resumed this year, when a very happy and successful day was enjoyed at Walton-on-the-Naze. Licence, Discharge and After-care. Out of 17 defectives (7 males and 10 females) granted licence during the year, 3 were recalled to institutional care, 9 are working and doing fairly well, 4 are residing satisfactorily with their parents, 1 girl married. Three were discharged from the operation of the M.D. Acts. Occasional visits are paid to all cases discharged from orders and still within this area. All removals are notified to the respective areas. 29 TABLE 13. MENTAL DEFICIENCY ACTS, 1913—38. (Statistics for 1942—1946). YEAR 31 Deo. UNDER ORDER In places of Safety Under Statutory Supervision Under Permissive Powers Under Friendly Care. Total In Institutions Under Guardianship 1942 138 40 – 113 5 40 336 1943 146 38 — 134 6 34 359 1944 153 35 — 125 5 35 353 1945 159 38 1 131 4 44 377 (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.) 1946 *159 †37 1 132 4 50 383 * Including 12 on Licence. † Including cases on Licence. Training Centre. The arrangements outlined in the report for 1945, have continued The attendances during 1946 are indicated below:— Morning Session:— Number on register 21 (11 males and 10 females) Number of Sessions 235 Total attendances.. 4,157 Average attendance 17 Afternoon Session:— Number on register 23 (10 males and 13 females) Number of sessions 235 Total attendances.. 4,413 Average attendance 18 BLIND PERSONS ACTS, 1920-1938. The work of acertainment 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. I wish to express appreciation and thanks to the local Welfare Association for their beneficient services to the blind. 30 TABLE 14. Work of the Visitor to the Blind, 1946. Year No. of Blind on Register, 31-12-46 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 Manua 1946 214 2,184 64 52 181 78 2,507 373 185 88 59 28 13 30a TABLE 15. BLIND PERSONS ACTS, 1920/38. REGISTRATION AS AT 31st MARCH, 1947, Note: M=Males. F=Females. T=Total. 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 — 2 2 1 1 2 9 10 19 12 7 19 24 23 47 10 14 24 37 59 96 — — — 93 117 210 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 M. F. T. M. F. T. M. F T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F T. M. F. T. M. F. T. 15 16 31 — 2 2 4 4 8 5 3 8 12 5 17 8 12 20 11 13 24 9 15 24 14 15 29 13 29 42 2 3 5 93 117 210 CHILDREN OF SCHOOL AGE, 5—16. TRAINING AND EMPLOYMENT AND UNEMPLOYMENT. Age Period 16 and upwards. Normal Mentally Defective Physically Defective Employed Undergoing Training Unemployed (k) Total (l) Those over 70 who are employed (already included in total (k)). M. F. T. M. F. T. M. F. T. By Blind Organisations (c) All others not included in (a) and (b) (d) Total Employed (e) Industrial (f) Secondary (g) Professional and University (h) Trained but unemployed (i) No Training but Trainable (i) Unemployable In Schools for the Blind — — — — — — — — — (a) Workshops (b) Home Workers 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 — — — — 2 2 — — — 8 6 14 2 1 3 13 3 16 23 10 33 1 2 3 — — — — — — — 1 1 1 1 2 68 100 168 93 114 207 — — — Total — — — — 2 2 — — — OCCUPATIONS OF EMPLOYED 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 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 Workshops for the Blind — 4 3 — — — — 1 — — — — — — — — — — 4 — — — — — — — — — — — — 2 — — 14 (b) In approved Home Workers' Schemes — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — 2 — — — 3 (c) Others (not Pastime Workers) — 1 — — — 2 — — — — 1 — 1 — — — — — — 1 2 — — — — 1 — — — 4 — — 1 2 16 (d) Total — 5 3 — — 2 — 1 — — 1 — 1 — — — — 1 4 1 2 — — — — 1 — — — 4 2 2 1 2 33 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 Hospitals Public Assistance Institutions M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 4 6 10 9 11 20 6 13 19 2 2 4 — — — — — — — — — 21 32 53 — — — — — — — — — 2 4 6 3 9 12 NEW CASES REGISTERED (NOT TRANSFERS FROM OTHER REGISTERS) DURING THE YEAR. 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 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. — — — — — — — — — — — — — — — — — — — — 2 1 — 1 6 6 12 — — — 0 6 15 NEW CASES REGISTERED (NOT TRANSFERS FROM OTHER REGISTERS) DURING THE YEAR. 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 M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. — — — — — — — — — — — — — — — — — — — — — 2 — 2 3 — 3 4 6 10 — — — 9 6 15 Since 1942 the number of blind persons on the register are shewn below :— 31-3-42 31-3-43 31-3-44 31-3-45 31-3-46 31-3-47 222 235 230 225 213 210 31 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 continued efforts on behalf of the children; the nature and extent of the services rendered will be seen from the following statistics. I wish again 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 1946 was 289. The following are the particulars :— Children referred by:— Local Voluntary Hospital 7 Private Doctors and Hospitals 95 Chest Clinic 45 M. & C.W. Centres 23 Education Dept. and School Health Service 107 Parents applied 4 Social Welfare 1 Others 7 Total 289 The children suffered from:— Tuberculosis (Pulmonary) 5 Tuberculosis (Non-Pulmonary) 11 Anaemia, Debility and Malnutrition 43 Rheumatism, Chorea and Heart 15 Bronchitis and Bronchial Catarrh 92 Asthma 3 Debility following illness, operations and accidents 43 Crippling Defects 40 Nervous conditions 12 Diseases of Ear, Eye and Skin 12 Various 13 Total 289 32 Assistance was given as follows:— Sent to Convalescent Homes and Sanatoria 198 Provided with surgical appliances 35 Referred for visiting and advice 25 Cases withdrawn on re-examination 8 Parents refused treatment offered 8 Transferred to other associations 4 Awaiting treatment at end of 1946 11 Total 289 Number of home visits paid during the year—925. EAST HAM DISTRICT NURSING 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. The Council is very appreciative of the work undertaken by the Association and the sympathetic service rendered. Summary of cases, 1946 :— Bronchitis and Pneumonia 71 Tuberculosis 35 Cardiac 53 Rheumatism, Arthritis, etc. 51 Cerebral 65 Diabetes 58 Burns and Scalds 19 Other medical 197 Various surgical 115 Cancer 110 Senility 109 Total 883 Patients on books, 1/1/46 130 New patients nursed during 1946 753 Total 883 Total number of visits during 1946—18,943. 33 East Ham Tuberculosis After-Care Committee. The After-Care Committee has been enabled during the past year to increase its grants for the provision of bedding, clothing, etc., and has thus afforded much help to tuberculosis patients. Each year shows a greater demand and a desire to take advantage of the facilities available, which only can be met by augmentation of funds. National Society for the Prevention of Cruelty to Children. Ready help and co-operation is provided in respect of cases referred to the Inspectors. Scabies and Treatment Centre. The following statistics are appended :— Number of new cases attending 1942 1943 1944 1945 1946 Scabies Clinic 478 969 520 268 237 Treatment Baths:— Patients No. of baths 1942 674 1,947 1943 622 1,689 1944 584 1.481 1945 501 1,511 1946 389 1,128 Maternity and Child Welfare. Midwifery Services. As indicated in my last report, the Authority appointed 3 municipal midwives under the Midwives Act, 1936 and the establishment was increased to four during 1946. The number of cases booked rapidly increased from the beginning of the year as is shown by the figures in the table printed below. Two temporary midwives have been employed for varying periods during the year and in order that the midwives could devote more of their time to attending the actual confinements, 3 nurses were engaged temporarily to assist in the visiting and nursing of mothers. Number of cases attended by them since 1942 is shewn below:— 1942 1943 1944 1945 1946 As Midwives 185 225 211 172 543 As Maternity Nurses 12 34 31 14 59 Totals 197 259 242 186 602 34 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 6* – 6 (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 28 – 28 (ii) Others — 8† 8 (e) In private practice 1 – 1 Totals 35 8 43 Number of cases in the area of the Local Supervising Authority attended during the year by Midwives:—- (a) Employed by the Council:— As Midwives 543 – 543 As Maternity Nurses 59 – 59 (b) Normally employed by other Local Supervising 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 Supervising 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 Supervising Authority in pursuance of Section 1 of the Midwives Act. 1936:— As Midwives 336 — 336 As Maternity Nurses 194 — 194 (ii) Others:— As Midwives – 363 363 As Maternity Nurses — 54 54 (e) In Private Practice:— As Midwives 8 — 8 As Maternity Nurses 6 — 6 TOTALS:— As Midwives 887 363 1,250 As Maternity Nurses 259 54 313 * 3 Temporary. † Employed by Voluntary Hospital (East Ham Memorial). 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 .. 240 ii) For cases in institutions 57* Total 297 * East Ham Memorial Hospital. Maternity Hospital Accommodation. The following statistical information in respect of the year ended 31/12/46 is given:— East Ham Memorial Hospital. Number of maternity cases admitted 490* Average duration of stay of cases in lying-in wards.. 12 days Number of cases delivered by:— (a) Midwives 363 (b) Doctors 54 417 Number of cases in which medical assistance was sought by midwife in an emergency 57 Number of cases admitted after delivery 4 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) 43 Number of infants wholly breastfed on leaving the institution 381 Number of cases notified as Ophthalmia Neonatorum — Number of Maternal Deaths — Number of Still Births 7 Number of infant deaths within ten days of birth 13 * These include cases admitted on more than one occasion and patients from outside the area. Aldersbrook Maternity Hospital. It became apparent at the beginning of the year under review from the heavy booking list for hospital treatment for maternity cases, that further accommodation must be provided. 36 The first patient was admitted to the Aldersbrook Maternity Unit on 19/10/46. Statistics for the period 19/10/46 to 31/12/46 are appended below:— Number of maternity beds in institution 20 Number of maternity cases admitted 68 Average duration of stay in the lying-in wards 14 days Number of cases delivered by:— (a) Midwives 64 (b) Doctors 2 66 Number of cases in which medical assistance was sought by a midwife in emergency 2 Number of cases admitted after delivery 1 Number of cases notified as Puerpual Pyrexia 1 Number of infants who have received a supplementary or complementary feed whilst in the institution (excluding those given during the first 3 or 4 days while breast feeding is being established) 5 Number of infants wholly breastfed on leaving the institution 60 Number of stillbirths 1 Number of infant deaths within 10 days of birth nil In addition to Aldersbrook, East Ham Memorial and Forest Gate Hospitals, a certain number of patients were admitted for their confinements during 1946 to Queen Mary's Hospital, Stratford, Howards Road, Plaistow, East End Maternity Hospital, 3 Nursing Homes in close proximity to the Borough and Emergency Maternity Homes outside London. The number of cases (officially admitted by the Council) and the hospitals or homes to which they were admitted is shewn below:— Institution No No. of cases. Forest Gate Hospital 401 East Ham Memorial Hospital 412 Aldersbrook Hospital 68 East End Maternity Hospital 44 Howards Road Hospital 6 Queen Mary's Hospital, Stratford 5 Maycroft Nursing Home, Woodfood 19 Devonia Nursing Home, Ilford 2 High Chase Nursing Home, Chingford 1 Emergency Maternity Homes 84 Total 1,042 37 Provision for Unmarried Mothers and Homeless Children. Already detailed in report for 1930. Illegitimate Children. The Council have not yet implemented their policy under Ministry of Health Circular 2866—no social worker has been appointed for the purpose and the arrangements at present are undertaken by the Social Welfare Committee. Maternity Fees and Sales of Dried Milk and Ancillaries. During the year ended 31/12/46, the following amounts were collected at the clinics:— £ s. d. Fees for Maternity Hospital accommodation . . 5,140 17 11 Fees for Municipal Midwifery Service 433 13 0 Fees for Home Help Service 247 3 0 Fees for *Other Services 57 7 3 Sale of dried milk and ancillarics 2,151 10 9 Total £8,030 11 11 *T & A. operations, dental and opthalmie treatment (provision of spectacles). In addition the following H.S.A., H.S.F., and other Societies Vouchers were collected and taken as full or part payment for services rendered:— For Maternity Hospital accommodation 169 For Municipal Midwifery service 35 T. & A. operations and provision of spectacles 80 Total 284 Ophthalmia Neonatorum. One case of Ophthalmia Neonatorum was notified during the year, with the following result:— Vision was unimpaired 1 38 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 11 – – – – – – 11 (b) Number of children under nine (i) received during the year 12 — — — — — — 12 (ii) at end of year 12 – – – – – – 12 (iii) who died during the year 1* — — – – – — 1 (iv) on whom inquests were held during the year — — — — — — — — * Coroner certified death due to natural causes. 39 (c) Number of Child Protection Visitors at the end of the year who were:— (i) Health Visitors 8 (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:— Under Sub-sections (a) (b) & (c) Nil Care of Premature Infants (Circular 20/44). Number of babies notified during 1946 whose mothers are normally resident in the borough 95 (a) The total number of premature babies as above who were born at:— Home 37 Hospital 58 95 (b) The number of these born at home :— (i) Who were nursed entirely at home 31 (ii) Who died during the first 24 hours 4 (iii) Who survived at the end of one month 27 (c) The number of those born in hospital:— (i) Who died within the first 24 hours 7 (ii) Who survived at the end of one month 45 The notification of birth cards provide space for the weight at birth when this is 5½ lbs. or less, bads 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. 40 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 12 (b) Total number of children in respect of whom notice was given under Section 7(3) during year 12 (c) Number of children notified under Section 7(3):— (i) Under supervision at the end of the year 4 (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 31/12/46, dealt with the following cases:— (a) Number of applications before Juvenile Court 58 (b) Number of applications before Bow County Court 6 (c) Number of interim orders made subject to vision of Local Education Authority 1 (d) Number of Adoption Orders made 57 (e) Number of applications dismissed 1 (f) Number of applications withdrawn 4 (g) Number of applications standing adjourned 1 Registration of Nursing Homes. The return of the work of the Council during 1946, under Sections 187 to 194 of the Public Health Act, 1936:— Table 18. Number of Homes Number of Patients provided for Maternity Patients Others Totals Homes first registered during the year Homes on the Register at the end of the year — – — – Homes deleted during the year — — — — 41 Home Helps. (i) Is a Home Help Scheme in operation? Yes. (ii) How many Home Helps are employed? (а) Whole-time—2. (b) Part-time—6 (at end of year). (iii) In how many cases were Home Helps provided under the above arrangements during the year? 85 There were no daily Guardians employed. Dental Treatment—M. & C.W. 1946. Expectant and Nursing Mothers:— 1. Number of patients treated 523 2. Number of scalings 38 3. Other operations 171 4. Number of teeth filled 171 5. Number of teeth extracted 492 6. Number of administrations of general anaesthetics 79 Children under 5:— (a) Number treated 279 (b) Number of teeth filled 34 (c) Number of teeth extracted 363 (d) Number of other treatments 71 The number of sessions devoted to treatment of mothers and children was 110. 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 1* (ii) In institutions 4† (b) Are facilities provided to enable midwives practising in the area to attend courses of instruction in the administration of Analgesics in institutions approved by the Central Midwives' Board for the purpose? Facilities are being provided. * Employed by Voluntary Association (Burges Road). † East Ham Memorial Hospital. 42 (c) Is apparatus for the administration of Analgesics supplied todomiciliary midwives by the Council? Apparatus purchased. (d) In how many cases were Analgesics administered by midwives in domiciliary practice during the year? None by Municipal midwives. Inspection of Midwives. Visits of inspection, as necessary, were paid during the year and the midwives' work, including records, was satisfactory. Health Visitors. (a) Number of Health Visitors employed by Council at end of year 8 (b) Number of visits paid during the year by Health Visitors:— (i) To expectant mothers—1st visits 1,366 Total Visits 1,416 (ii) To children under 1 year—1st visits 2,345 Total Visits 5,023 (iii) To children between the ages of 1 and 5 years Total Visits 4,106 Total of all visits to mothers and children 10,545 (iv) Other visits 1,946 (v) Grand Total (Visits) 12,491 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 1,516 (ii) Over 1 year of age 256 Total number of children under 5 years of age who attended at he Centres during the year and who, at the end of the year, were:— (i) Under 1 year of age 1,251 (ii) Over 1 year of age 1,397 Ante- and Post- Natal Clinics. Total number of women who attended:— (i) Ante-natal clinics 2,898 (ii) Post-natal clinics 48 (iii) Total attendances (ante-natal) 11,324 (iv) Total attsndancas (post-natal) 54 43 The attendances at Infant Welfare Clinics, etc., are shown below:— (a) Attendances (including all infants under 5 except those shown under toddlers) 18,546 (b) Consultations (included in (a) above) 5,376 (c) Immunisation 2,447 (d) Whooping cough 182 (e) Ophthalmic 144 (f) Sunlight 2.142 (g) Toddlers 924 Dr. J. A. MacLaren submits the following observations: The general health of the infant under five years continues to remain good and the standard of cleanliness high, when one takes into account the difficulties the mothers have to overcome, and the overcrowding, which still exists. The majority of children attending the Infant Welfare Clinics, are well nourished and their physical condition above the average, although a small percentage were found to be suffering from subnormal nutrition, a large proportion of children in this category had either attended the clinic for the first time or had not attended for a long period. Under existing conditions, the Health Visitors' work still remains very arduous, as many of the mothers' problems and difficulties arise out of the housing and other post-war conditions which are frequently almost impossible to solve. Infant Welfare Clinics. During the year, the Infant Welfare Clinics have been well attended, though many mothers find it very difficult to attend regularly as their domestic affairs still present many difficulties and so much time requires to be spent in procuring the necessities of life. Premature Child. A special notification is sent to the Health Visiting Staff to enable them to contact mothers as soon as possible, in order to give her special advice regarding the care of the premature child. These infants are frequently visited, until their general condition is satisfactory and their progress normal. Council midwives also send reports on the condition, feeding, and progress during the first 14 days, of all premature infants, which are forwarded to the Health Visitors. Sunlight Clinic. Two sessions per week are held for infants under five years, who are referred for treatment. This clinic is well attended and popular with the mothers who show a definite interest in the clinic. 44 Tonsils and Adenoids. Children suffering from enlarged tonsils and adenoids are referred to Queen Mary's Hospital, East Ham Memorial Hospital and St. Mary's Hospital, Plaistow. During 1946 114 have been referred to hospital. Orthopaedic cases. 48 cases have been referred to Queen Mary's Hospital for treatment. Ophthalmic Clinic. 30 children suffering from defective vision or external eye disease have been referred to the Ophthalmic clinic during 1946. Immunisation Clinic. Two clinics are held for immunisation against diphthrria and propaganda is carried out by the Health Visiting Staff, also cards on the child's first birthday are sent to the mothers, explaining the necessity for protection against diphtheria. The clinics have been well attended, though unfortunately, there still remains a large number of unprotected children. Ante-Natal Clinics. During 1946, a marked increase in the number of patients attending the Ante-Natal Clinics has continued during the year, with a corresponding greater request for maternity accommodation which still remains a source of anxiety as the demand exceeds the available number of maternity beds. The opening of Aldersbrook at the end of October has helped very considerably to alleviate the situation. At the same time, unfortunately, the number of beds in Forest Gate Hospital has been unavoidably curtailed. Total number of individual mothers who attended the Council Ante-Natal Clinics during 1946 2,898 Total number of Ante-Natal attendances 11,324 Day Nurseries. The following day nurseries functioned throughout 1946:— No. of places. School Road 60 Wall End/Caledon Road 60 St. Stephen's Road 89 Roman Road 84 Total 293 45 There was a waiting list at the nurseries practically all during the year. The staffing problem for wardens still persisted. Statistics for 1946 are shown below:— Nursery. Total Attendances. Daily Average* Daily Average† (excluding Saturdays) School Road 11,793 39 47 Roman Road 16,415 54 65 St. Stephen's Road 17,445 57 69 Wall End/Caledon Road. 11,979 39 48 *Including Saturdays, average attendance based on 365 days, less Sundays (52), and Statutory Bank Holidays (11), when Nurseries were closed = 302 days. † Excluding Saturdays (302 days, less 52 = 250). INFECTIOUS DISEASES. The quarterly returns to the Registrar General were as follows:— Disease Qtr. ending 31-3-46 Qtr. ending 30-6-46 Qtr. ending 30-9-46 Qtr. ending 31-12-46 Total Scarlet Fever 63 47 33 50 193 Whooping Cough 63 99 68 28 258 Measles 8 521 239 47 815 Diphtheria 3 6 5 5 19 Pneumonia 26 26 22 23 97 Dysentery 1 1 2 1 5 Erysilpelas 9 6 6 4 25 Cerebro-Spinal Fever 5 — 1 2 8 Puerperal Pyrexia 2 2 1 3 8 Ophthalmia Neonatorum — — 1 — 1 Malaria 1 2 — — 3 It will be seen that the incidence of measles was greater in the 2nd and 3rd quarters. 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 8. Note.—The 8 deaths all occurred from from Diarrhoea. The death rate was 0.07 per 1,000 population, as compared with a rate of 0.09 for 1945. No cases of Smallpox were reported during the year under review. The Zymotic death rates, per 1,000 population since 1942, are enumerated below:— 1942 1943 1944 1945 1946 0.17 0.15 0.07 0.09 0.07 46 The following statistics shew the notification rates per 1,000 civilian population. Table 19. England and Wales. 126 County Boroughs & Great Towns including London 148 Smaller Towns Resident Population 25,000-50,000 at 1931 Census. London Adm. County. East Ham Notifications:— Rates per 1 ,000 Civilian Population Typhoid Fever 0.01 0.01 0.01 0.01 — Paratyphoid Fever 0.02 0.02 0.01 0.01 — Cerebro-Spinal Fever 0.05 0.05 0.04 0.06 0.07 Scarlet Fever 1.38 1.51 1.33 1.42 1.69 Whooping Cough 2.28 2.48 2.05 2.22 2.27 Diphtheria 0.28 0.32 0.31 0.24 0.16 Erysipelas 0.2 0.25 0.22 0.27 0.22 Small Pox 0.00 0.00 0.00 0.00 — Measles 3.92 4.73 3.70 7.35 7.17 Pneumonia 0.89 1.02 0.74 0.75 0.85 A dash (—) signifies there were no notifications. Diphtheria Immunisation Clinics. The six-monthly returns to the Ministry of Health in respect of immunisation are as follows:— Number of children who completed a full course of primary immunisation. Total number of children who were given a secondary or reinforcing injection (i.e. subsequent to complete full course). Age at final injection. Under 5 5—14 Total 6 months ending 30-6-46 623 222 845 11 6 months ending 31-12-46 542 119 661 34 Totals 1,165 341 1,506 45 Table 20.—VACCINATION. Statistics relating to the Vaccination of Children whose births were registered from 1st January to 31st December, 1045, are appended below:— 46a 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, 1945 Number of these births duly entered by 31st January, 1947, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1947, remained unentered in the ''Vaccination Register" on account (as shown by "Report Book") of Number of these Births remaining on 31st January, 1947, 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 1946 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 1946 Col. I. Successfully Vaccinated Col. II Col. IV Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Died unvaccinated. 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. Insusceptible of Vaccination. Had Small Pox. 1 2 3 4 5 6 7 8 9 10 11 12 13 North East Ham 624 Less 1 re-regn., 1931 - Less 1 re-regn., 1941 - Less 1 re-regn., 1942 - Less 1 re-regn., 1943 - Less 1 re-regn., 1945 5 619 241 1 — 268 14 — 8 22 65 508 342 South East Ham 270 • Less 1 re-regn., 1927 - Less 1 re-regn., 1944 2 268 89 — — 127 7 — 2 15 28 413 359 Total 887 330 1 — 395 21 — 10 37 93 921 701 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 in 1946 418 47 Table 21.—DIPHTHERIA IMMUNISATION, 1946. Year of Birth 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 All Ages No. given secondary or re-inforcing injection. Age 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 No. of children who have completed a full course of primary immunisation during 1946:— (a) at Infant Welfare Clinics 17 592 268 124 70 15 1 1 2 1 1 1 - - - 1,093 20 (b) at school Clinics — 11 25 15 22 58 69 51 44 18 23 20 15 10 10 391 25 (c) by private practitioners - 10 7 2 2 - - - - - 1 - - - - 22 — Totals ] 7 613 300 141 94 73 70 52 46 19 25 21 15 10 10 1,506 45 Group Totals 1,165 341 1,506 45 Number of children completely immunised at any time to 31-12-46:— Totals 17 724 1,026 800 770 739 810 765 815 924 904 741 818 731 704 11,288 45 Group Totals 3.337 7,951 11,288 Estimated group population 9,500 14,320 23,820 Percentage of group population completely immunised 35.1 55.5 47.4 48 Table 22.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for Year ended 31/12/46. Disease. Cases notified in whole district. Ward Distribution of Cases. No. of Cases removed to Hospital. Total Deaths. At all ages—years. Mano 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 193 2 46 87 45 6 5 2 — — 24 31 14 9 5 22 22 28 22 16 158 — Diphtheria 19 6 9 2 2 — — — — 3 1 — 5 4 2 3 1 — — 19 — Erysipelas 25 1 1 — — — 3 3 7 10 3 3 2 1 6 1 — 2 4 3 7 — Puerperal Pyrexia 8 — — — — — 7 1 — — 1 — 1 1 1 1 1 2 — • 8 — Ophthalmia Neonatorum 1 1 - - - - - - - - - - - - - - - - - 1 1 — Cerebro Spinal Fever 8 1 1 3 — — 2 1 — — 2 1 — 1 — — — 2 1 1 8 — Pneumonia 97 4 9 10 4 2 9 13 27 19 15 17 11 7 11 6 8 7 5 10 58 68 Dysentery 5 — 2 1 — — 1 1 — — — — 2 — 1 2 — — — — 3 — †Malaria 3 — — — — — 2 — 1 — 2 — — 1 — — — — — — 3 — *Measles 815 39 419 331 17 1 7 1 — — 87 45 59 77 64 43 80 155 68 137 21 — *Whooping Cough 258 27 164 63 2 — 1 1 — — 30 28 9 9 17 22 18 51 31 43 10 — * Notifiable for duration of war. † 2 Contracted abroad, 1 induced for therapeutic purposes. Table 23.—TOTAL CASES OF NOTIFIABLE DISEASES, 1923-1946. 48a Disease. 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 Small Pox - - - - - 17 25 70 51 13 1 1 - - - - - - - - - - - - Scarlet Fever 170 215 221 350 798 832 743 484 245 779 701 979 411 359 387 287 196 77 68 210 271 132 153 193 Diphtheria 160 128 246 337 464 669 578 473 196 157 180 379 254 134 149 141 91 47 45 49 59 33 31 19 Enteric Fever 3 5 9 7 2 7 2 3 8 7 5 — 2 2 13 15 8 10 3 — 4 — — — Erysipelas 32 38 41 41 38 60 49 63 54 55 69 74 55 59 53 71 41 33 23 37 28 18 14 25 Puerperal Fever 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 8 Meningococcal Meningitis 1 1 1 1 4 1 1 3 8 5 1 3 3 — 2 3 3 11 5 12 4 3 1 8 Encephalitis Lethargica — 9 6 1 2 3 1 — — — 1 1 1 — 1 1 - - - - - - - - Ophthalmia Neonatorum 11 6 8 10 12 3 8 6 6 6 9 5 5 6 7 9 7 3 4 1 1 4 2 1 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 5 Malaria - - - - - - - - — 1 1‡ - - - - - - - - - - - 1‡ 3a Measles Not Notifiable *3 *36 *460 *1091 *917 *258 *1498 *815 Whooping Cough Not Notifiable *- *19 *262 *227 *241 *293 *67 *258 Continued Fever - - - - - - - - - - - - - - - - - - Not Notifiable Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 54 79 91 70 114 82 102 59 75 77 148 100 88 101 111 85 59 42 33 37 72 50 55 97 Totals 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 1,432 § Notifiable as Puerperal Pyrexia as from 1.10.37. † Notifiable as Puerperal Pyrexia. ‡ 1 Induced in an Institution. * Notifiable for duration of war. || Not notifiable as from 1.10.37. a 1 Induced for therapeutic purposes; 2 Contracted abroad. 49 INFECTIOUS DISEASES HOSPITAL. Dr. Cohn's observations are contained in the following report upon the work of the hospital:— The number of cases admitted to the Isolation Hospital during the year 1946 was 275. The number of deaths was two, giving a mortality rate of under 1 per cent. Both occurred within 24 hours of admission. One patient died of streptococcal septicaemia and the other of whooping cough and broncho-pneumonia, confirmed by postmortem. There were no cases of typhoid fever or infantile paralysis. A number of pneumonias, 3 diphtheria, one streptococcal septicaemia and severe tonsillitis cases were treated with 3—4 hourly penicillin injections. The existing accommodation seemed to be adequate although twelve beds were separated from the infectious Diseases Hospital in March, 1946 and added to the Sanatorium. The number of patients in hospital on 1st January, 1946 was 22, the number on 31st December, 1946, was 8. Diphtheria. Admitted during 1946 54 Revision of diagnosis 32 Final number of proved diphtheria cases 22 Number of cases occurring in immunised children 6 Died during 1946 0 Remaining in hospital on 31-12-46 3 Type of diphtheria—Faucial 22 Complications and Paralysis. Cardiac weakness and post-diphtheritic toxic neuritis 1 Palatal Paralysis 2 In no case was tracheotomy indicated. Serum Administration. Up to 10,000 units A.D.S. 15 Up to 30,000 units A.D.S. 21 Up to 50,000 units A.D. S. 14 Over 50,000 units A.D.S. 4 No serum reactions of any importance were observed. 50 Bacteriological Examinations. Number of swabs examined 351 Swabs sent from outside 172 Positive Swabs 12 Scarlet Fever. Admitted during 1946 158 Died 0 Remaining in hospital on 31-12-46 4 Revision of diagnosis 3 Seborrhoeic eczema 1 Post-auricular abscess 1 Measles 1 Proved Scarlet Fever Cases 155 Complications. Carditis and Endocarditis 2 Otitis media 6 Urticaria 2 Impetigo 2 Infected Nail 1 Chicken Pox and Whooping Cough 1 Whooping Cough 3 Stye 1 Tinea 1 Bronchitis and Asthma 1 No cases of Scarlet Fever were treated with A.S.S. but all cases which showed toxaemia were given sulphadiazine. In all cases of children with enlarged and septic tonsils, tonsillectomy was advised. Miscellaneous. Admitted 63 Died 2 Remaining in hospital 31-12-46 1 Miscellaneous Notified Admissions. Chicken Pox 1 Mumps 2 Whooping Cough 16 (Revised diagnosis pneumonia—5) Typhoid I (Revised diagnosis pneumonia—1) 51 Measles 18 Dysentery 7 (Revised diagnosis enteritis—2; N.A.D.—1) Erysipelas 2 Puerperal Sepsis 1 Smallpox 1 (Revised diagnosis pneumonia—1) Ringworm 1 Tonsillitis 4 Influenza 3 Ophthalmia 1 (Revised diagnosis conjunctivitis—1) Cerebro-spinal meningitis 3 (Revised diagnosis Cystopyelitis—1; Infective Hepatitis—1) Observation 2 Operations. Incision of abscess 1 Lumbar puncture 4 Removal of nail 1 Incision of post-auricular abscess 1 FINAL DIAGNOSIS. Diphtheria 22 Tonsillitis 29 Scarlet Fever 155 Measles 21 Dysentery (Sonne) 4 Chicken Pox 1 Mumps Whooping Cough 11 Pneumonia 7 Infective Hepatitis 1 Meningitis 1 Erysipelas 2 Puerperal Sepsis 1 Streptococcal Septicaemia 1 Conjunctivitis 1 Cystopyelitis 1 52 Adenitis 1 Bronchitis 2 Post-auricular abscess 1 Seborrhoeic Eczema 1 Influenza 3 Ringworm 1 Enteritis 2 No evidence of disease 4 275 Cancer. Cancer deaths, 1946:— Total Deaths 225 Male 111 Female 114 Classification:— 1946 1945 1944 Carcinoma 209 191 196 Sarcoma 2 3 3 Rodent Ulcer — — 1 Epithelioma 2 4 — Endothelioma — — 1 Glio-blastoma 3 — — Unstated 9 7 3 Totals 225 206 203 53 Table 24.—CANCER DEATHS—PARTS OF THE BODY AFFECTED. Parts of Body Affected Ages Sex 0-1 1-2 2-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75 and upwards Total M F M F M F M F M F M F M F M F M F M F M F M F Buccal Cavity and Pharynx - - - - - - - - - - - - - - - - - - - - - - 8 — Digestive Organs and Peritoneum - - - - - - - - - - 2 — 2 4 2 8 10 11 25 21 10 14 51 58 Respiratory Organs - - - - - - - - - - 2 — 4 3 12 — 8 2 5 1 1 1 32 7 Uterus — — — — — — — — — — — — — 1 — 1 — 3 5 5 — 1 — 11 Other Female Genital Organs - - - - - - - - - - - - - - - 4 - 1 - 2 - 1 - 8 Breast — — — — — — — — — — — 1 — 1 — 3 — 5 — 6 — 5 — 21 Male Genitourinary Organs — — 1 — — — — — — — — — — — 1 — 3 — 1 — 5 — 11 — Skin - - - - - - - - - - - - - - - - - - - - 1 - 1 - Other or Unspecified Organs - - - - - - - - - - - - - 2 2 3 4 4 1 — 1 — 8 9 Totals - - 1 - - - - - - - 4 1 6 11 18 19 26 26 36 35 20 22 111 114 54 TREATMENT OF TUBERCULOSIS. Memorandum 226/T. Maintenance allowances to patients suffering from pulmonary tuberculosis receiving treatment from the Tuberculosis and Chest Clinic and Institutional treatment were paid to 133 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 1946 was 257 as compared with 258 for the previous year. Of the primary notifications of pulmonary tuberculosis 18.4 per cent. had tubercle bacilli in the sputum. The number of such notifications for the years since 1942 are shewn below:— 1942 1943 1944 1945 1946 244 264 198 258 257 Statistical. The total number of notified cases on the register of the clinic on 31-12-46 was 1,175 (pulmonary and non-pulmonary) or 10.3 per 1,000 of the estimated population as compared with 1,095 or 11.5 per 1,000 population in 1945. Clinic Register Statistics from 1942 are appended below:— 31-12-42 31-12-43 31-12-44 31-12-45 31-12-46 860 949 979 1,095 1,175 Deaths. The number of deaths (1942-1946) from tuberculosis is as follows:— Pulmonary Non-Pulmonary Clinic Register 1942 53 15 55 1943 80 7 73 1944 61 14 63 1945 52 9 58 1946 62 8 70 55 New Cases. The following are the comparative figures for the years 1942— 1946:— 1942 1943 1944 1945 1946 New cases and contacts 997 1,317 1,034 1,050 1,413 Number proved after complete investigation to be tuberculous 15.65% 17.61% 15.75% 24.85% 14.44% includes ex service cases. Attendances Medical examinations 1942 4,768 3,238 1943 6,580 4,493 1944 6,057 3,969 1945 6,877 4,566 1946 7,640 4,821 Consultations at Home of Patients. During the year 13 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. 1942 1943 1944 1945 1946 1,575 1,844 1,628 1,922 2,824 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 1,413. The figure of new cases seen is roughly 3 times that of 1939. This marked increase may be accounted for by:— (a) increased consciousness of the public in relation to preventive health examinations (b) increased demands for examination by the Services. Dr. Philip Ellman, Consultant to the Clinic, reports on the work of the Chest Clinic, as follows:— Examination of Home Contacts of Tuberculous Persons. These examinations are among the most important features of the social and medical services of the Chest Clinic and are invaluable preventive measures. They bring to light sources of infection in the home environment, they are a fruitful means of detecting early silent disease which generally responds very well to treatment. 56 In 1946, 22 cases of tuberculosis were discovered in an examination of 441 home contacts of all ages, i.e. 5 per cent. Experience of such contact examinations has shown that the highest percentage of cases of tuberculosis is found in the 0-4 and 15-25 age groups. Taking the period of the last five years, the percentages of contacts eventually notified were 13.6 and 6.3 in these two age groups respectively, which must accordingly receive special attention. In 1944 the percentages were at their highest, i.e. 21.4 and 9.3 The Medical Research Council (1942) in a discussion of contact examinations recommends that young adults should be X-rayed at three monthly intervals and continually under observation for at least two years after contact is broken. The re-examination of contacts over 30 years of age may be dispensed with if necessary through pressure of work, as being less likely to be productive of cases. Our own experience supports this view, but if we are to carry out this work it is imperative to hold at least one more routine session for dealing satisfactorily with this problem in addition to other obviously increasing demands on the staff of the Clinic. In the 0-4 age group where the Mantoux test was positive in infants under 2 years of age the sooner there was a break of contact with infection the better was the outlook. The most disquieting feature, from an analysis of deaths from tuberculosis in different age groups during the war, has been the substantial increase among children and this increase is still maintained. I referred to the increase in childhood tuberculosis in my last report and stressed the dearth of accommodation in existing institutions, which continues to be a problem. The accompanying chart analyses the incidence of pulmonary tuberculosis in these age groups for 1942-6. EXAMINATION OF HOME CONTACTS OF TUBERCULOUS PERSONS. Age Group 0—4. Age Group 15—25. Year Number Examined Notified T.B. % T.B. Number Examined Notified T.B. % T.B. 1942 37 7 19 52 5 9.6 1943 28 3 10.7 73 3 4.1 1944 42 9 21.4 54 5 9.3 1945 50 5 10 36 1 2.8 1946 49 4 8.2 70 4 5.7 Total 206 28 13.6 285 18 6.3 57 The Technique and Standardisation of Chest Radiographs. In view of the enormous increase of X-ray examinations undertaken in the Chest Clinic Service, it is important that the quality of each film taken should not be sacrificed to the quantity. Unless the film is technically satisfactory no responsible physician can attempt to interpret it. This requires time, patience and meticulous attention to detail. The following minimum criteria have to be fulfilled. (i) Confidence and co-operation from the patient. (ii) Closest possible contact between patient and film. (iii) Finest grain of film and intensifying screen, the former uniformly compressed between the latter. (iv) Fine focus tube at such distance that radiations through the patient are relatively parallel. (v) Activation of tube for shortest possible time by stabilised transformer unit. (vi) Careful dark-room technique. (vii) Inspection of films against a uniformly lighted surface which will give visualisation of higher degrees of contrast transparency. A trial drill with a careful rehearsal of the correct positioning of the patient is often advisable. All this necessarily takes up time, but is essential. Films taken in various positions are often of vital importance in diagnosis, viz, postero-anterior and antero-posterior positions, as well as lateral and sometimes apical, oblique and lordotic. The special Medical Research Council report in this connection is a valuable document. In the routine work of the Clinic a high quality of film is regarded as of no less importance than a good clinical examination, and experience repeatedly shows how dangerous it is to express any opinion on a film which is technically unsatisfactory. Collapse Therapy. In addition to the well recognised methods of collapsing the diseased lung by Artificial Pneumothorax, Phrenic Crush, Extrapleural Pneumolysis, Cavity Drainage (Monaldi operation) and Thoracoplasty, recent advances in thoracic surgery have brought still further methods into use and already both at the Chest Clinic and Harts Sanatorium these have been gradually introduced. 58 Pneumoperitoneum.—In contrast to artificial pneumo-thorax whereby air is introduced into the pleural cavity, in pneumoperitoneum the air is introduced below the diaphragm. The problem of decreasing the volume of the thoracic cage is here approached from below rather than from above the diaphragm. The idea of raising the diaphragm by injecting air into the peritoneal cavity has recently attracted much attention among tuberculosis workers. Its great value lies in its ability to enhance the rise of the diaphragm following phrenic nerve intervention. It may assist in closing certain types of apical and basal cavities and possibly in promoting healing. Cases for this treatment require careful selection and as with pneumothorax, pneumoperitoneum refills are given with careful X-ray control. The method has the advantage over pneumothorax therapy in that it is less open to complications. The potential risk of pleural infection and the formation of adhesions is ever present. Resection of Lung.—(Lobectomy, Pneumonectomy). This method of treating certain cases of cavities which are resistant to collapse therapy is still on trial. Certainly tension cavities failing to respond to other forms of treatment and tuberculomas of the lung should be eminently suitable for this type of treatment. One of our cases of tuberculoma of the lung who had a lobectomy has made an excellent recovery and attends the Clinic at regular intervals. Theoretically, this method of resection of pulmonary tissue would appear to be ideal, for the diseased lung is removed, there is no possibility of a breakdown of the old lesion, and the patient is not d isfigured. From our fairly wide experience of the removal of a lung for cancerous invasion, we know that the absence of one lung is compatible with good health, and enables the patient to return to his work. Plea for Conservatism in Relation to Collapse Therapy.— Despite all these methods of surgical approach to the lung that have been reviewed, our experience reaffirms the need for increased caution in relation to their use based upon judgment, a balanced outlook and experience. In certain cases there may be overwhelming reasons for ''masterly inactivity'' despite the mere dramatic appeal that surgical intervention may make. The sanatorium regime, observance of its principles, both in and out of the sanatorium, mental and physical rest and supporting treatment are still the essential and basic principles. The excellent results obtained in certain selected cases where surgical collapse therapy has been utilised does not justify its 59 indiscriminate use. In fact the indiscriminate use of, for example, an artificial pneumothorax which is contra-selective, is fraught with danger and the so-called "black-lobe" and pleural infection with its grave sequelae are all too frequently encountered. Collapse Therapy Refills.—There has been a very substantial increase of pneumothorax refills during the year. 1944 1945 1946 483 331 545 Moreover, pneumoperitoneum refills are now a regular feature as well as paracentesis of the pleura for diagnostic purposes. Problems in Diagnosis.—Of the 1,413 new cases which have been examined during 1946 only 14.4 per cent. were proved after complete investigation to be tuberculous. In other words at least six out of every seven cases seen are, after complete investigation, found to be cither free from disease, or have some disease, of the lungs heart or other organs. This raises a large number of diagnostic problems, and in this connection special emphasis must be made on Cancer of the Lung.—We have encountered all too many of these cases during the year and there is real evidence to suggest that this disease is increasing appreciably. The disease may not necessarily be one of old age, although cough, haemoptysis and wasting are very suspicious symptoms, especially in males in the 40-60 age period and beyond, but early symptoms are often slight. Early detection can be made by early X-ray of the chest, aided by bronchoscopy, blood examinations, sputum examinations, tomography and brochography. This of necessity involves first-class X-ray and pathological facilities which must be at the service of the chest clinic. Removal of the lung in cases detected in the early stages is a life saving device and we have had several such cases returning subsequently to work. Occupational Therapy, Vocational Guidance and Rehabilitation. This is an important aspect of our work and is never lost sight of in maintaining the morale of our patients. Modern treatment is not complete unless it is integrated with a well planned programme of rehabilitation designed to assist the tuberculous subject to be reinstated into the social fabric as a useful, self-supporting and selfrespecting member of the comunity. The need for a proper explanation to each patient on the transmission, diagnosis and treatment of 60 his or her disease, is a necessary preliminary to admission to theSanatorium and should be continued there and during after-care. Only in this way can we encourage the active co-operation of the patient in the treatment of his disease, and it will make possible a bigger percentage of arrests and a lower incidence of relapse cases. In the early stages of treatment medical rehabilitation includes reading, recreation and vocational guidance. Subsequently occupational therapy, educational films, lectures, work therapy, etc., will be instituted. Social Service. It will be seen from the figures given in relation to the number of consultations, X-ray examinations, refills, increased number of notifications, that the pre-war facilities of the Clinic which are still in existance, have outlived their usefulness. With the addition of extra clinics and the increased social problems of the patients, necessitating numerous visits to the homes and the extra time spent there by the Health Visitors, further assistance will have to be given them if they are to continue to do their work satisfactorily. Too high a tribute cannot be paid to the Sisters and the administrative staff in connection with the social and economic aspect in relation to treatment. Their help and co-operation, and the teamspirit prevailing throughout the staff of the Clinic is in no small measure responsible for the quality of the work and the result achieved. Moreover, the After-Care Committee, headed by Alderman Mrs. Taylor as its chairman, have rendered invaluable service. Finally, I should like to express my great indebtedness to Dr. Cohn, who was Acting Medical Superintendent of Harts Sanatorium during Dr. Palmer's absence in the Army, and to Sister Williams and her Staff for their help and co-operation during the year. HARTS SANATORIUM Dr. Cohn reports as follows:— In March, 1946, twelve beds were taken from the Infectious Diseases Hospital and added to the Sanatorium. Unfortunately, due to shortage of staff, these beds could not be used to full capacity during the year. The number of Service cases was still very high, and among them were quite a number of released prisoners of war. Thirtytwo males and two females from the Services were admitted. 61 The treatment consisted of Sanatorium regime, artificial pneumothorax therapy, tuberculin and gold injections, and occupational therapy. In suitable cases an artificial pneumo-peritoneum was induced, a form of treatment which has not been given previously in the Sanatorium. Educational lectures were kept up throughout the year, and the patients took great interest in them. Three patients had to be discharged because of severe breaches of discipline, but on the whole the atmosphere and the general contentedness of the patients was very satisfactory. In the first half of the year the waiting period for patients requiring surgical treatment, either thoracoscopy with adhesion section or thoracoplasty, was rather long, but after liaison had been established with the North Middlesex Hospital, the necessary surgical treatment could be carried out at very short notice. Mr. Ivor Lewis, Superintendent of the Hospital, performed the thoracoscopies and adhesiotomies; the patients remained for only one day, and then returned to the Sanatorium where the post-operative treatment was carried out. This arrangement was very satisfactory and permitted an earlier discharge of patients, and consequently a faster turnover of beds. On the other hand, the shortage of houses and good living accommodation delayed the discharge of patients. It was also impossible to transfer any advanced cases to St. Luke's Hospital. In cases where tubercle bacilli were not found in the sputa, even with concentration methods, gastric lavage was frequently resorted to, and proved to be a useful aid in diagnosis. In some cases it was found necessary to perform tomographs. Unfortunately this could only be carried out on one patient, as facilities for this type of modern X-ray diagnosis are still very restricted. Dental treatment and inspection was carried out regularly. Quite a number of pleural effusions were tapped on one or more occasions. 62 Statistics. Admissions. Males 75 Females 59 Discharges (including deaths). Males 77 Females 65 Deaths. Males 6 Females 5 Service Cases. Males 32 Females 2 Observation. Male 1 (diagnosis broncho-pneumonia) Collapse Therapy. Artificial Pneumothorax inductions 22 Artificial Pneumoperitoneum inductions 5 Number of Refills given 833 Patients on Tuberculin treatment 3 Patients on Gold treatment 39 Number of Films taken 679 Number of Sputa examined 804 Blood Sedimentation Rates 846 Phrenic Crush 2 Tomograph 1 Thoracoscopy, and adhesion section 20 Thoracoplasty 2 Bronchograms 4 63 Table 25.—PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from 1st January, 1946, to the 31st December, 1946. 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 — 3 5 4 18 16 24 17 22 16 4 129 131 Pulmonary Females 1 9 3 3 9 7 18 9 1 2 — 62 63 Non-Pulmonary Males — 1 2 1 2 - - - - - - 6 6 Non-Pulmonary Females - 1 — — - - - 1 1 - - 3 3 PART II. SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age Periods 0— 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— Total Pulmonary Males — — 1 1 1 4 8 5 2 3 2 27 Pulmonary Females — — 1 — 2 8 10 1 — 1 — 23 Non-Pulmonary Males — 1 - - - - - - 2 — — 3 Non-Pulmonary Females - - 1 — — 1 2 - - — — 4 Total 57 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— Source of Information No. of Cases Pulmonary Non-Pulmonary Death Returns From local Registrars 9 Transferable deaths from Registrar-General 10 1 Posthumous notifications 1 2 “Transfers" from other areas (other than transferable deaths) 30 4 Other Sources, if any (specify) — — Total 50 7 64 Table 26.—RETURN RELATING TO THE WORK OF THE TUBERCULOSIS AND CHEST CLINIC DURING THE QUARTER ENDING 31st DECEMBER, 1946. Diagnosis Pulmonary Non-Pulmonary Total Grand Total Adults Children Adults Children Adults Children M F M F M F M F M F M F A. (1) Number of definite cases of Tuberculosis on the Dispensary Register at the beginning of the Quarter 507 408 44 38 65 80 21 3 572 488 65 41 1,166 (2) Transfers from Authorities of area outside that of the Council during the Quarter 2 4 - 1 - - - - 2 4 - 1 7 (3) Lost sight of cases returned during the Quarter 1 2 - - - - - - 1 2 — — 3 B. Number of New Cases diagnosed as tuberculous during the Quarter:— (1) Class T.B. minus 11 10 - 4 - - - - 11 10 - 4 25 (2) Class T. B. Plus 10 1 - - - - - - 10 1 — — 11 (3) Non-pulmonary — — — — 1 1 1 — 1 1 1 - 3 C. Number of cases included in A. and B. written off the Dispensary Register during the Quarter as :— (1) Recovered - 2 - 1 - - - - - 2 - 1 3 (2) Dead (all causes) 6 5 - - - - - - 6 5 — — 11 (3) Removed to other Areas 6 3 — 1 — — — 1 6 3 — 2 11 (4) For other reasons 4 4 2 2 — 1 — 2 4 5 2 4 15 D. Number of definite cases of Tuberculosis on the Dispensary Register at the end of the Quarter 515 411 42 39 66 80 22 — 581 491 64 39 1,175 Table 27.—TUBERCULOSIS.—Institutional beds and treatment provided directly or through arrangements with other Authorities or Voluntary Institutions 64a for the Quarter ending on 31-12-46. Note: Figures are as on the last day of the quarter. (1) Institution BEDS PROVIDED FOR INSTITUTIONAL TREATMENT PATIENTS UNDER INSTITUTIONAL TREATMENT (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 Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pul. Pulmonary Non-Pulmonary 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 51 44 4 — — — 17 26 2 — — — 1 2 — — — — 9 — — — 24 16 2 — — — * †Branston Hall Sanatorium — — - - - - - - - - - - - - - - - - - - - - - - 2 - - - *†Langdon Hills Sanatorium — — - - - - - - - - - - - - - - - - - - - - - - 6 - - - †Abergele Sanatorium - - - - - - - - - - - - - - - - - - - - - - - - 4 Harpenden Sanatorium - - - - - - - - - - - - - - - - - - - - - - - - 3 - - - *Hull After-Care Colony - - - - - - - - - - - - - - - - - - - - - 1 - - - - - †Holt Sanatorium - - - - - - - - - - - - - - - - - - - - - - - - 6 - - - King George V Sanatorium - - - - - - - - - - - - - - - - - - 1 - - - 2 - - - - - Brompton Hospital - - - - - - - - - - - - - - - - - - 1 - - - - 1 - - - - London Chest Hospital - - - - - - - - - - - - - - - - - - - - - - - 2 - - - - †Lord Mayor Treloar (Alton) - - - - - - - - - - - - - - - - - - - - - - - - - - - 6 Naylands Sanatorium - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - Papworth Colony - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - *Whipps Cross Hospital - - - - - - - - - - - - - - - - - - - - - - 3 1 — — — — Royal Sea Bathing Hospital - - - - - - - - - - - - - - - - - - - - - - - - - 1 3 — †Tadworth Court Hospital - - - - - - - - - - - - - - - - - - - - - - - - 3 - - - Totals 51 44 4 — — — 17 26 2 — — — 1 2 — — — — 12 — — - 31 21 26 1 3 6 Particulars of Beds temporarily not available (Col. 3). Institution Number of Beds Closed Reason Number or Patients on Waiting List — — — — 21 6 4 2 2 Harts San. 11 12 2 — — — I.D. Hospital evacuated to the Sanatorium, September, 1939. †For children only. *Belonging to other Councils. Harts San. 6 14 — — — Shortage of Nurses 65 Water Supply. At the request of the Ministry of Health, the following information is included in regard to the water supply of the area. 1. 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's mains. No bacteriological or chemical analyses were made by this Authority of the raw water going into supply. 3. The water supplied to this district by the Metropolitan Water Board does not give rise to plumbo-solvent action. 4. There were no contamination areas. SANITARY SECTION. This section of the Report relating to sanitary circumstances and housing, and statistics as to food inspection, has been compiled by Mr. R. A. Baskett, B.E.M., Acting Chief Sanitary Inspector. Whilst every effort has been made during the year to resume the routine work of the department, the inspectorial staff is very conscious of many things which have been left undone, not through any lack of will to carry out those duties for which they are responsible, but in consequence of staff, labour and material shortages. Notwithstanding these difficulties, and the inability to verify by adequate reinspection, it is certain much more has been accomplished in remedying unsatisfactory sanitary conditions than would appear from the statistics contained in this report. The quiet and patient manner in which the public generally tolerated unsatisfactory conditions has been truly remarkable, and it is the sincere hope of all those engaged in public health work, particularly that relating to environmental hygiene, that the many frustrating agencies which at present hamper this work will soon be dissipated. The staff of the Sanitary Section during the year consisted of five District Inspectors with the Acting Chief Sanitary Inspector. There was also one disinfector, one mortuary attendant, two rodent operators and one drain cleaner. At the end of the year two of the District Inspectors, Messrs. Thurston and Tonkin, were still with the Housing Department, engaged in the supervision of the repair of war damage to housing. 66 Table 28.—METEOROLOGICAL RECORD—YEAR 1946. 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. Mean Temperature of Air. Rainfall. Highest Maximum. Lowest Minimum Mean of 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 All Highest All Lowest January 57° 24° 43°.6 35° 37°.3 8 1.18 0.15 0.41 10th February 57° 23° 50°.l 39°.4 42°.9 17 2.13 0.12 0.42 27th March 65° 26° 48°.8 35°.4 40°.5 8 1.17 0.15 0.30 4th & 21st April 78° 30° 61°.6 42°.4 50°.9 11 1.49 0.14 0.29 5th May 71° 36° 62°.6 44°.4 52°.9 15 3.19 0.21 0.88 8th June 75° 46° 66°.6 50°.7 58° 19 2.2 0.12 0.28 2nd, 8th & 26th July 86° 46° 75° 55°.3 65°.3 8 2.38 0.30 1.58 26th August 81° 45° 70° 53°.7 60°.9 13 3.58 0.28 1.13 9th September 76° 47° 65°.8 53°.2 58°. 5 18 2.44 0.14 0.45 8th October 71° 32° 57°.3 46°.3 51°.1 11 1.15 0.15 0.28 26th November 66° 36° 50°.3 43°.8 46°.9 18 2.98 0.17 0.66 14th December 52° 22° 43°.2 33°.3 37°.4 20 2.05 0.10 0.34 2nd & 8th Means & Totals for the Year 70° 34° 57°.9 44°.4 50°.2 166 25.94 0.16 1.58 26th July 67 SANITARY CIRCUMSTANCES. Sanitary Inspection. Details of the work of the Inspectors in general sanitary administration are contained in the following statements. (a) Inspections. The number of inspections of all classes 24,064 (i) Housing. House-to-house — Under Public Health Act 9,682 Re-inspections 6,738 Housing Act, 1936 3,487 (ii) Sanitary Circumstances. Yards and Passages 21 Drainage and Sanitary Accommodation 1,055 Factories (excluding Bakehouses) 12 Workplaces and Outworkers 52 Caravans 17 Re Offensive Fumes 4 Miscellaneous 720 (iii) Food Supply. Slaughterhouse 6 Dairies 6 Food Premises 806 Bakehouses 102 Re Sampling 587 (iv) Infectious Disease. Visits 769 (b) Notices.—The number of notices served during the year totalled 4,711 of which 142 were statutory notices. The number of notices complied with in the same period was 1,357. 68 (c) Rat Extermination.—Special attention during the year has been directed to the work of repression, and in October a survey of the whole of the borough was commenced in connection with the Ministry of Pood's (Infestation Division) Private Dwellings (Special Scheme) for which the Council's staff of rodent operators numbering three, was increased by one. In addition, under the supervision of the Sewage Works Manager, treatment of the sewers was carried out. From the data so far obtained from the survey the number of premises found to be infested would appear to be considerably below that obtaining in neighbouring districts. Many of the infestations found continue to arise from defective drainage, which in the majority of cases could be attributed to war damage. In accordance with the policy laid down by the council, no charge is made to the occupiers of private dwellings for work carried out by the operators. This practice, together with the continuous, active and progressive policy which the Council has always pursued in regard to rodent control work, is amply justified by the favourable results obtained. During the year 34,691 visits were made by the rodent operators and 3,064 rats destroyed. (d) Legal Proceedings.—The following statement indicates the legal proceedings undertaken during the year:— Public Health Act 1936.—Cases withdrawn (nuisance abated) 4 Food and Druqs Act 1938.—(Sample taken in 1945) 1 (e) Drainage.—During the year some 685 complaints were received of "choked" drains. In all but a few instances removal of the obstruction was expeditiously carried out by the Council's drain cleaner. The exceptions were dealt with either by the owners or by the Council in default of the owners. 69 It is unfortunately a fact that until a drain fails to function properly, few people realise the vital importance of an efficient water carriage system or that the modern system of drainage has its limitations as to the type and quantity of waste material which it can receive and carry away. In addition the condition of the drainage system of the Borough has been adversely affected by the ravages of war. Considerable work in connection with the renewal of drainage and sanitary fitments of war damaged houses and other premises was carried out in collaboration with the Housing Department. (f) Factories.—During the year 64 visits were made to factories, workplaces and outworkers. It is regretted that it was not found possible to devote more attention to this most essential work. (g) Mosquito Control.—Treatment with larvicide of mosquito infested ditches and marshland in the southern part of the Borough, and the many derelict static water tanks sited throughout the Borough was undertaken during the year with particularly satisfactory results. (h) Places of Public Entertainment.—Frequent visits of inspection usually after normal offices hours, have been made to cinemas and other places of public entertainment and a number of sanitary defects and other unsatisfactory conditions remedied. HOUSING. During the year 3,487 surveys of premises were made for the Housing Department as to the "crowded" conditions of applicants for rehousing. With the limited staff available this work of necessity retarded the activities of the inspectorate in other aspects of sanitary administration. 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) 13,938 70 (6) Number of inspections made for the purpose 20,676 (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 6,280 II. Remedy of Defects during the year without service of formal notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 1,318 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 spect of which Notices were served requiring repairs — (2) Number of dwelling houses which were rendered fit after service of formal notices:— (i) By owners — (ii) By Local Authority in default of owners — (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 142 71 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (i) By owners 39 (ii) By Local Authority in default of owners — (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936. (1) Number of dwelling houses in pect 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 — The following statistics have been supplied by the Council's Chief Housing Officer, Mr. J. E. Austin, M.B.E. HOUSING STATISTICS. Position at 31st December, 1946. 1. Accommodation made available—family units (i) By repair of war damage 6,210 (ii) By requisitioned premises 1,156 (iii) By new housing 572 (iv) By emergency hutments 100 8,038 72 2. Families rehoused since August 1945 905 3. Cases of overcrowding under Housing Act, 1936 abated by rehousing since August, 1945 (included in 2.) 235 4. Total of current applications for rehousing 6,979 5. New Housing. Dwellings projected Under construction Completed Temporary 997 121 572 Permanent 509 50 — Cost-of-Works Rebuilds 628* 50 — Total 2,134 221 572 *Subject to adjustment by the Primary Education Plan. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Graded Milk.—The licences in force on 31st December, 1946 were as follows:— Tuberculin-Tested Milk— Bottling Establishment Licence — Dealers' Licences 9 Supplementary Licences 2 Tuberculin-Tested (Pasteurised) Milk— Dealer's Licence 1 Pasteurised Milk— Establishment Licence 1 Dealers' Licences 17 Supplementary Licences 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 6 dairies, 102 of bakehouses and 806 of other premises. 73 Every effort was made to ensure increased inspection of premises used for the preparation of food and during the year, considerable attention was given to bakehouses and premises registered for the manufacture of ice-cream, resulting in a general improvement in the condition of these premises and their products. Of the former, the use of two underground bakehouses which had not been closed owing to exigencies of the war, was discontinued, and of the latter one registration to manufacture ice-cream was cancelled. (3) Slaughterhouses.—No slaughterhouse was in use during 1946. (4) Bacteriological Samples.—155 samples were submitted for bacteriological examination during the year, including 97 of milk, 1 of meat pie, 1 of fruit cordial, 1 of mackerel and 55 of ice-cream. Notwithstanding the absence of an official standard for ice-cream the examinations were of considerable help to the inspectorate in obtaining genuine improvement in the methods of production. (5) Other Foods.—Inspection of other foods resulted in the condemnation for human consumption of 3,074 tins, including 219 tins of meat and meat products, 56 tins of fruit, 406 tins of vegetables, 547 tins of fish, 1,594 tins of milk and 252 tins or packages of other foods. In addition, the following foods were condemned as unfit for human consumption: 318 lbs. meat, 773 lbs. fish, 4,623 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:— Number of Samples Percentage of samples adulterated Examined Found adulterated or below standard Butter 12 - - Cheese 6 - - Coffee 3 - - Lard 4 — - Margarine 12 — - Milk 159 1 .63 Sausage 10 — — Wines and Spirits 11 — — Drugs 44 — — Other Articles 155 6 3.9 416 7 1.7 74 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 4508 I Cake flour Deficient in available CO2 Withdrawn from sale. Vendor cautioned. 4510 I Oats Evidence of natural deterioration. Vendor cautioned. 4516 F Milk Added water at least 3 parts per cent. Vendor cautioned. 4519 I Suet Deficient in fat to extent of 6.9%. Vendor cautioned. 4662 I Savoury Meat Balls Contained only 24% of meat. Vendor cautioned. 4826 I Egg Substitute Powder Deficient in available CO2 to extent of 40%. Vendor cautioned. 4833 I Dried Milk Unfit for human consumption. Withdrawn from distribution. The wrappers of the undermentioned 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:— Number I or F Article Action taken. 4505 I Yorkshire Pudding Mixture Vendor cautioned. 4508 I Cake flour Vendor cautioned. 75 County Borough of East Ham Education Committee 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 1946. This service has laboured under an awkward handicap in that it is expected to enhance its efforts in implementing the provisions of the Education Act, 1944, without having available suitable accommodation, adequate equipment, and sufficient medical personnel. Briefly stated, the needs of the school children will best be served if— (1) Adequate accommodation and equipment are placed at the disposal of the Medical Officer in the Schools to enable the medical inspections to be carried out with completeness, care, and befitting privacy. An ante-room for disrobing and waiting, separate from the examination room, is imperative. The doctor cannot properly interrogate a mother in the sight and hearing of other mothers and children. For many obvious reasons a classroom or laboratory is not the proper place for medical inspections. (2) More frequent inspection than that required by the Act. This has been agreed to by the Education Committee and entails the appointment of additional staff. With the institution of biennial medical examination, every school child will be under continuous surveillance. (3) The enhancement of the School Health Clinics (formerly known as the Minor Ailment Clinics) to provide a comprehensive service. (4) The provision of a Central Dispensary to carry out the prescribed treatment expeditiously with a minimum of expense. (5) The provision of a Physiotherapy Department to assist in the correction of postural and other deformities and to carry out aftertreatment prescribed by consultants at various hospitals and clinics, with a minimum loss of schooling time. 76 (6) The enhancement of the School Dental Service and the appointment of a Senior Dental Officer so that treatment need not be limited to any age group and more detailed attention directed towards conservative work and orthodontics. (7) The appointment of a Consultant Anaesthetist so that the dental work is carried out under the best possible conditions of modern anaesthesia. (8) The proper classification of certain of the scholars into the various categories of Handicapped Pupils and their subsequent placement in suitable institutions or environment to meet individual needs. Special note is made of a group of maladjusted pupils who would benefit greatly from a comprehensive Child Guidance Service which should be instituted at the earliest possible moment. These are the children who if taken early in their deviation from the right social and educational road into the byways of delinquency and crime, can be treated by specialist methods and replaced, surely, on the highway to right living and good citizenship. (9) The institution of Kitchen Dining Units to obviate the transport of prepared food from central kitchens and to enable freshly cooked wholesome meals to be served to scholars in the school dining halls. This addition to the daily calory intake of pupils is a most important factor in maintaining health and assisting growth in the children of the borough. (10) The enhancement of the School Milk Service whereby all children who so desire are enabled to take at fractional cost, one-third of a pint of milk daily in the school. It has been found that the milk in schools service plays a definite role in the raising of the standard of dental development and structure which has been noted of recent years. No effort should be spared and every instrument of propaganda employed to encourage parents to allow their children to take full advantage of the School Meals and Milk Services. The growing needs of school children can be met only by a superabundance and great variety of foods to allow for the selective nutritional needs of each child, for in the problem of individual growth every human being is a law unto himself. Furthermore, it is probable that only in the ten per cent highest income class does the diet exceed in all essentials the standard food requisite. 77 All these measures to effect a full comprehensive School Health Service have been instituted, or are shortly to be brought into being, and it is certain that as the new schools rise up, the desired provisions will not be forgotten. (11) The provision of a convalescent school so that during the short stay convalescent periods of up to six weeks as now arranged in accordance with the terms of the 1944 Act, loss of schooling, with its attendant backwardness, does not result. As a footnote it must be observed that these several points are diagnostic and curative rather than prophylactic and preventive, and our chief concern for the future should be directed towards the prevention of disease and the enjoyment of positive health. To this end the hygiene of the school is of prime importance. The old barrack type of schools must go and in their place buildings planned to admit sunlight and fresh air, properly equipped with gymnasia, laboratories, specialised classrooms, dining facilities, etc., must arise. The housing programme and the measures being enacted to create freedom from want together should raise the standard of living in the home, so that comparable high levels of environmental conditions can simultaneously arise in the home and in the school to better the lot of the average scholar. School days should be for every child a succession of refreshing experiences, educative adventures, and joyful contacts with teachers and classmates, in pleasant and suitable surroundings, which stamp a lifelong impression on the individual, not a period of daily boredom, gloom and despondency, quickly to be forgotten. I wish to record my appreciation of the help and support of the Chairman and Members of the Education Committee during the past year and am also indebted to the Chief Education Officer, the Teachers and my Staff for their loyalty and invaluable 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. 78 GENERAL INFORMATION. Schools and Numbers on Roll (mid 1946). Type. Number of Schools. Number on Roll. Maintained Primary Infant 16 3,820 Junior 13 5,143 Maintained Secondary 12 3,736 Voluntary 4 694 Totals 45 13,393 Estimated number of children aged 5-14 inclusive (mid 1946) 14,320. School Clinic Premises and Purposes served:— Address. Types of Clinic. Town Hall Annexe, Barking Road. School Health Diphtheria and Pertussis Immunisation Aural Ophthalmic Physiotherapy and Sunlight Dental Manor Park Clinic, Church Road. School Health Diphtheria and Pertussis Immunisation Dental North Woolwich, School Health Fernhill Street. 79 SCHOOL CLINICS. MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY MORNING ANNEXE School Health Physiotherapy Dental Physiotherapy Ophthalmic Dental (general anaesthetics). School Health Physiotherapy Dental Physiotherapy Ophthalmic (alternate weeks) Dental Physiotherapy Ophthalmic Dental School Health Dental MANOR PARK Dental School Health Dental Dental (general anaesthetics alternate weeks) School Health Dental Dental AFTERNOON ANNEXE Immunisation Sunlight Dental Dental Physiotherapy Aural Dental Sunlight Dental North Woolwich School Health Aural Dental MANOR PARK Dental Immunisation Dental Dental 80 COMPARATIVE STATISTICS. The following table indicates briefly the work of the School Health Service during the year 1946 and shows the comparative statistics for previous years. 1942 1943 1944 1945 1946 Routine and Special inspections at School: *Maintained Secondary Schools - — — 969 1,404 *Maintained Primary Schools — — — 1,741 4,034 †Secondary Schools 442 815 46 125 — †Elementary Schools 3,803 4,453 2,844 640 — Re-inspections at School 3,400 2,795 1,368 1,795 2,834 Inspections and Re-inspections at Clinics 22,532 22,135 19,509 14,628 11,571 General cleanliness visits to schools 175 276 227 223 256 Examinations for cleanliness 15,769 28,427 22,573 25,448 30,077 Nurses' visits to homes 3,781 4,124 2,955 1,859 1,404 *Since 1-4-45. †Up to 31-3-45. SCHOOL MEDICAL INSPECTIONS. Under the Education Act, 1944, (Section 48), all pupils must be submitted for medical inspection in accordance with arrangements provided by the authority and generally that such inspection shall take place on the premises of the school attended by the pupil concerned and that, as far as practicable, parents shall be given the opportunity to be present. A similar procedure is laid down for dental inspection by experienced dental officers of the authority. The medical inspection is carried out at prescribed times in a convenient room set aside for this specific purpose in each school, prior notice having been given to both parent and pupil. The examination which is more in the nature of a comprehensive consultation, is directed towards obtaining a true assessment of the mental and physical attributes of the individual together with observations on personality and his relationship to his teachers, the school, his parents, and home life. At the same time, careful note is made of his speech, his posture, locomotion, visual acuity, bodily cleanliness, efforts at personal hygiene, and an attempt is made to engage his friendly co-operation in the full understanding of the meaning of positive health. An account of all that is observed is indexed on standard record cards, but any defects or faults noted, although 81 recorded, are not unduly stressed at the time, for it is considered undesirable to instil the idea that the purpose of the examination is only to uncover faults and failings, a notion destructive both to the ego of the pupil and the confidence of the parent. Instead, the parent is invited to attend subsequently, by appointment, with the child, at a school health clinic where the special defect is discussed with the object of remedial treatment. Whenever indicated, a brief discussion with the parent follows the examination on any problem relevant to the health or well-being of the child, and advice is proffered to the head teacher in regard to the pupil's further education, with special reference to matters either of conduct or instruction elucidated by the consultation. Arrangements are made for every pupil to be inspected at least three times during his school life, firstly as soon as possible after admission, secondly during the last year of attendance at a primary school, and thirdly during the last year at a secondary school. The medical records compiled are of great value during the pupil's school life, and the information contained therein is often a deciding factor in determining the vocation of a boy 01 girl on leaving school. School Health Clinics. As already observed, children with special defects are referred for examination at the school health clinics at Church Road Clinic for the convenience of persons resident in the north part of the borough, the Town Hall Annexe Clinic for the central and south residents, and at North Woolwich. Cases are also referred by the head teachers of the schools or brought directly by the parents. Minor ailments are competently treated at the clinic by the skilled school nurses under the direction of the medical officer, and the institution of a general dispensary has greatly broadened the base and enhanced the value of this work. More serious diseases or disabilities are dealt with in two ways: (i) by reference to a specialist clinic, and (ii) by reference to a hospital for consultation and treatment if necessary. 82 Arrangements are also made at the school health clinics for the transference of sickly children to appropriately situated convalescent homes to obtain for varying periods change of scene and air, and to encourage recuperation from various ailments under ideal conditions. It will be seen that the school health clinics are the focal points of the service. From them radiate the lines of investigation and treatment to be followed, and to them are directed all cases of difficulty and sickness from the school population. The school medical officer must be ever on the alert to detect incipient disease, deviation from the normal, and to counsel, guide, comfort, and advise pupil and parent alike, in the pursuit of positive health. Other Special Inspections. In addition to the above, special inspections are also undertaken in connection with:— (a) The ascertainment of Handicapped Pupils. (b) The employment of children. (c) The engagement of children in special courses of study, school journeys, etc. Summary of Inspections and Re-inspections. Periodic Inspections: At Schools 5,438 Special Inspections: At Schools 258 At School Health Clinics 10,951 Handicapped Pupils 199 For Employment 26 For Special Courses etc. 395 Re-inspections at Schools 2,576 83 Summary of Defects found at Medical Inspection. Defect. Periodic Inspections Special Inspections Requiring Treatment Requiring Obs'vation Requiring Treatment Requiring Obs'vation Skin 71 7 808 Eyes. a. Vision 155 19 134 4 b. Squint 11 — 7 — c. Other 51 4 98 4 Ears. a. Hearing 7 — 16 — b. Otitis Media 6 2 20 — c. Other 8 — 31 — Nose or Throat 469 397 488 15 Speech 5 1 4 — Cervical Glands 1 — 11 — Heart and Circulation 9 4 — — Lungs 32 10 56 — Orthopaedic 14 1 — — Nervous System 4 12 11 — Other 389 191 1,071 15 Medical Inspection and Re-inspection at Schools. School Infant Junior Secondary I R S I R S I R S (a) Maintained Primary and Secondary Schools: Altmore 408 108 10 - - - - - - Avenue 208 44 4 117 — 4 — — — Brampton 258 — 1 184 — 4 134 — 1 Central Park 78 23 — — — — 60 52 1 Cornwell - — - 165 269 25 171 158 2 Dersingham 76 36 7 - - - - - - Essex 128 26 5 — — — 143 73 16 Hartley 197 50 2 250 169 13 — — — Kensington 50 24 — 147 105 4 — — — Lathom — — — 236 105 7 — — — Monega 84 36 6 — — — 69 65 7 Napier 30 — 42 — — — 51 94 2 Salisbury — — — 72 198 7 — — — Sandringham 45 75 8 — — — 76 70 3 Shaftesbury 151 75 14 276 164 11 — — — Storey Street 24 5 1 22 26 — — — — Vicarage 56 58 15 168 132 7 52 59 3 Winsor 20 12 — 26 32 — — — — Wakefield Central - - - - - - 76 36 2 Boys' Grammar - - - - - - 393 — 1 Girls' Grammar - - - - - - 149 73 11 Technical School of Building - - - - - - 162 2 1 (6) Voluntary Schools (R.C.) Castle Street 41 13 2 55 22 2 - - - St. Angela's (West Ham) — —. — — — — 80 — — St. Michael's 75 12 1 52 30 2 - - - St. Winefride's 49 — — 41 — - - - - Silvertown 20 18 1 13 27 3 — — — Totals 1,998 615 119 1,824 1,279 89 1,616 682 50 I.—Periodic inspection. R.—Re-inspection. S.—Special inspection. 84 Age Groups, Nutrition, Co-operation of Parents. Group Total inspected Parents present Requiring treatment Nutrition A B C D No. % No. % No. % No. % No. % No. % I. 2472 1767 71.5 594 24.0 246 10.0 2076 84.0 150 6.0 - - II. 1562 1196 76.6 299 19.1 187 12.0 1347 86.2 28 1.8 - — III. 1404 524 37.3 265 18.8 339 24.1 1013 72.2 52 3.7 — — Totals 1946 5438 3487 64.1 1158 21.3 772 14.2 4436 81.6 230 4.2 — — 1945 3604 2178 60.4 706 19.6 412 12.3 2894 86.4 44 1.3 - - 1944 2471 1984 80 ? 315 11.1 301 12.2 2162 87.5 8 0.3 1943 4453 3133 70.4 617 13.8 446 10.0 4000 89.8 7 0.2 - — 1942 3803 2698 70.9 578 15.2 694 18.3 3096 81.4 13 0.3 - — HANDICAPPED PUPILS. No special schools for the treatment of handicapped pupils are maintained by the Authority. Arrangements are made by the Chief Education Officer with schools outside the area for the admission of children as recommended. Under the provisions of Sec. 34 of the Education Act, 1944, 199 special examinations have been carried out by approved medical officers, as a result of which, 76 children, ascertained to be within the various categories were recommended for special educational treatment as indicated in the following table:— Category. Number ascertained Recommendation Day Special School Boarding Special School Ordinary School with special treatment Blind - - - — Partially Sighted — - — — Deaf 1 - 1 — Partially Deaf — - — — Delicate 35 - 35 — Diabetic - - — — Educationally Sub-normal 22 12 *2 9 Epileptic 5 — 5 — Maladjusted 5 — 1 4 Physically Handicapped 6 5 †1 — Suffering from Speech Defect 2 1 ‡l — *Includes one previously attending a day special school. †Recommended for Hospital School. ‡Recommendation not approved by Minister. Special arrangements made for conveyance to a Speech Therapy Clinic. 85 Ten cases were found to be subject to be dealt with under the provisions of Sec. 57 of the Act:— Recommended for report to the Mental Health Committee under the provisions of: Sec 57(3) 8 Sec 57(5) 2 MEDICAL TREATMENT. Summary of Defects treated at School Health Clinics. Skin:- Ringworm 49 Scabies 66 Impetigo 48 Other Diseases 714 Eye Disease 62 Ear Defects 21 Other Defects 2,609 Total 3,569 Total attendances at School Health Clinics, 14,782. Aural Clinic. Mr. R. M. Savege, F.R.C.S., M.B., Ch.B., D.L.O., who is approved by the Minister under the provisions of Regulation 53(c) for the treatment of diseases of the ears, nose and throat and defective hearing attended the Aural Clinic on two sessions weekly during the year. The following are the statistical details:― Number of clinic sessions 87 Number of children attending 614 Number of attendances 1,608 Number of children discharged 396 86 Defects and Treatment Defect Number Observed Number Treated Referred for Operation Discharged after treatment Tonsils and Adenoids 386 126 273 223 Other Throat conditions 3 3 — 5 Deafness 21 21 — 18 Otitis Media and Discharging Ears 52 50 1 54 Defects of Membrane 39 39 — 9 Other Ear Conditions 48 39 1 33 Nasal Deformities 6 6 - 3 Rhinitis 36 35 - 26 Catarrh 29 28 - 23 Other Nose Conditions 14 13 - 13 Totals 634 360 275 407 Note:- Included in figures "Discharged after treatment" are some defects still remaining under treatment at the end of 1945. Of the cases referred for operative treatment, 273 were for the removal of tonsils and adenoids, one for mastoidectomy and one for the removal of a polypus in the ear of, a deaf child. The mastoidectomy was performed by Mr. Savege at the Children's Hospital, Balaam Street; the polypus was still awaiting treatment at the end of the year. Mr. Savege is also approved by the Minister under Regulation 53 (a) and (b) for the ascertainment, examination and treatment of deaf and partially deaf pupils. As reported on page 84 one child was examined during the year, ascertained, and recommended for a boarding special school for deaf pupils. Ophthalmic Clinic. Mr. S. C. Reeve-FIaxman, M.R.C.S., L.R.C.P., approved for the treatment of defective vision and eye disease under the provisions of Regulation 53 (c), now attends the Ophthalmic Clinic on five sessions fortnightly, an additional session in alternate weeks having been introduced during the year. The following statistics shew the work carried out:— Number of clinic sessions 106 Number of children attending 857 Number of attendances 1,946 Number of children discharged 250 87 Defective Vision and Squint isease New cases 287 Treated at Clinic 107 Glasses prescribed 221 Referred to Hospital 10 Glasses obtained 221 Glasses not required 67 Referred to Hospital 3 Re-examinations 887 Of the ten cases of eye disease referred to hospital, three were admitted to the White Oak Hospital (L.C.C.) Swanley. Spectacles are provided free of charge in three styles for children over the age of seven years, the younger children are supplied with nickel frames. The optician, who is appointed under contract to the Council, attends each Clinic, and fitting is carried out under the supervision of the Ophthalmic Surgeon. Diphtheria Immunisation Clinic. Immunisation Clinics are held weekly at the Town Hall Annexe and Manor Park. Every opportunity is taken during medical inspection at schools and in the course of School Health clinics, to impress upon the parents the efficacy of immunisation. The need for re-inoculation of children admitted to school for the first time is stressed by teachers and by the use of posters, leaflets, etc. The work of the clinics is shewn in the following summary:— Number of clinic sessions 99 Number of children completely immunised 391 Number of children re-inoculated 25 Percentage of children of school age completely immunised 55.5 Chest Clinic. As in previous years a considerable number of children have been referred to the Tuberculosis and Chest Clinic for full pathological and radiological investigation of doubtful chest conditions. The number of tuberculosis notifications during the year in children of school age was:— Pulmonary 18 Non-pulmonary 4 88 Physiotherapy and Light Clinic. Attendances continue to increase. Many forms of radiation and electrical treatment are now given for diverse conditions, together with massage, corrective and developmental exercise. Attendances for artificial sunlight have been the highest for some years. Cases. Treatments. Artificial sunlight (General) 274 5,010 Local light 34 517 Electrical and Massage 102 1,410 Remedial exercises 126 2,569 Total attendances—7,410 The appointment of an Orthopaedic Consultant has not yet been made and when necessary, cases are referred to general hospitals. Child Guidance Clinic. Children in need of advice and treatment are referred, after investigation at the School Health Clinic, to the Child Guidance Clinic at East Ham Memorial Hospital. This is held weekly and attended by medical and other staff of the Runwell Mental Hospital. When suitable accommodation becomes available, a clinic will be established as an integral part of the School Health Service—a psychiatrist, an educational psychologist, and a social worker will comprise the team. East Ham Memorial Hospital. During the year, agreement was concluded with East Ham Memorial Hospital by which the Authority assumes financial responsibility, in accordance with the provisions of Circular 102, for all East Ham school-children treated as in- or out-patients. The scheme came into operation on 1st October, and is functioning satisfactorily. 89 Details of the cases treated are given in the following summary:— Type of case In-patients Out-patients Number of children Days maintenance Number of children Number of attendances Medical 4 82 16 38 Surgical-Tonsils & Adenoids Other 155 399 — — 3 27 18 57 Casualty — — 126 365 Dental 1 9 7 9 Ear, Nose and Throat 2 11 — — Gynaecological — — 1 1 Neurological 1 3 — — Ophthalmic 3 19 — — Orthopaedic 1 16 54 226 Skin — — 2 3 Total 170 566 224 699 Operative treatment for tonsils and adenoids is carried out during two sessions weekly of up to eight cases per session. The Children's Hospital, Balaam Street. Upon the re-opening of the Children's Hospital during October, a similar agreement was concluded, mainly for the operative treatment of tonsils and adenoids which is performed by Mr. Savege, F.R.C.S., Consultant to the Aural Clinic. 163 children were admitted for such operation and spent 347 days in the hospital. One mastoidectomy was performed. Other Hospitals. Pending the negotiation of agreements with special and general hospitals which will make provision for all forms of medical treatment, children whose treatment cannot be undertaken satisfactorily at the school clinics and cases in which the opinion of a specialist is required, are referred to appropriate institutions. Under arrangements which were in force before the 1944 Act came into operation the following cases received treatment:— (a) Tonsils and Adenoids. East Ham Memorial Hospital 267 (prior to 1-10-46) Queen Mary's Hospital, Stratford 119 St. Mary's Hospital, Plaistow 62 90 In all, 766 children have had operative treatment for tonsils and adenoids during the year. This figure shows a very large increase over previous years and a most satisfactory reduction in the arrears due to war conditions can be reported. (b) Ringworm. Ringworm of the scalp, in suitable cases, is treated by X-Rays at the London Hospital. Treatment has been given in 13 cases. (c) Other Conditions. As in the past, the Authority has accepted responsibility for the provision and maintenance of surgical appliances prescribed by hospitals and in particular cases has also financed in-patient treatment. In approved cases travelling expenses are paid in respect of children attending hospitals outside the district. CONVALESCENT HOME TREATMENT. Children recovering from severe operation or illness and others not considered to be handicapped pupils within the meaning of the Regulations and who are in need of convalescence, are sent away for short periods of treatment arranged through the Invalid Children's Aid Association. Such treatment has been provided in the following 107 cases:— Non-tuberculous chest conditions 38 Debility following illness or operation 31 General debility and anaemia 23 Cervical adenitis 4 Rheumatism and Chorea 6 Other conditions 5 GENERAL CLEANLINESS. Routine visits have been paid to all schools by the school Nurses for examination of the persons and clothing of the pupils. Willing co-operation of the parents in the treatment of children found to be verminous has obviated the necessity for formal proceedings On the whole, a high standard of personal hygiene has been noted in the schools. On the whole, a high standard of personal hygiene has been noted in the schools. 91 Number of visits paid to schools 256 Number of examinations 30,077 Number of pupils found unclean 764 Number of cleansing notices (Sec. 54(2)) 18 Number of cleansing orders (Sec. 54(31) _ Four children attended the Cleansing Baths Centre for treatment and the remaining 14 of the seriously infested cases were treated at the school clinics. HOME VISITS BY SCHOOL NURSES. The nurses paid 1,404 visits to homes during the year to give advice on cases of infectious disease and post-operative tonsils and adenoids cases and for routine investigation in connection with the clinics. The co-ordination of the School Nursing and Health Visiting Services is planned for the coming year. DENTAL INSPECTION AND TREATMENT. Miss H. T. Smith, L.D.S., R.C.S., has submitted the following report on the Dental Service:— To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I have the honour to present my report on the work done in the Dental Clinics during the year 1946. This past year has seen great developments in the dental service. For the first time in the history of the Borough a Senior Dental Officer has been appointed. This has greatly increased efficiency, and the three dental clinics are now working very smoothly together to form a complete Dental Unit. Great difficulty was experienced in obtaining suitable equipment for the third dental surgery, which was opened on November 19th, 1946. Two new dental officers were appointed during the year, Mr. C. E. B. Maytum, L.D.S. (Eng.) who commenced his duties at Church Road Clinic on August 27th, and Mr. A.Smith, L.D.S., R.F.P.S., (Glas.), who is working in the new surgery at the Annexe, and is assisting us in a temporary capacity. 92 The age groups inspected were from 4 to 18 years inclusive the total being 11,550—those referred for treatment numbered 5,473. These figures show that slightly over 50% of the children inspected had sound mouths; this is most satisfactory after a war, with all its inherent difficulties, especially those of a nutritional nature. The "specials", that is to say, cases referred by the school medical officer and head teachers, numbered 1,072. The number of attendances at the dental clinics during the year was 5,560. Details will be found in Table IV—Returns to the Ministry of Education. All children in the routine age groups are inspected once a year, and treatment offered where necessary. With the recent increase in the dental staff it will now be possible to inspect all school children twice a year, a principle advocated by the Ministry of Health, and all who are interested in the dental health of the younger generation. The extraction of some temporary teeth, and nearly all permanent teeth is done under gas. In the past a great many temporary teeth were extracted under local anaesthesia, this is not an ideal method for children. However, during the coming year nearly all extractions of both temporary and permanent teeth will be done under gas as we now have on the staff a specialist in dental anaesthetics, an example which could be followed with advantage by other authorities. Dr. Marsden, M.B.,B.S., D.P., was recently appointed and attends three sessions a fortnight. The results even in such a short time have been most gratifying. During the year the number of administrations ???. gas was 540. A certain number of permanent teeth were extracted for regulation purposes. This is done in cases where the teeth are very overcrowded, and it allows the remaining teeth room to fall back naturally into their appropriate position in the mouth. In other cases where this type of treatment was not suitable, regulation plates were made. Very difficult and prolonged cases were referred to hospital for treatment. Every endeavour is being made to educate parents and children in the benefits of dental treatment by means of talks, and leaflets full of useful information. During this coming year there will be for the first time three fulltime clinics in operation, and we confidently hope that the standard of treatment provided will more than fulfil our high expectations. 93 Maternity and Child Welfare Centres. Details of the dental work carried out in the Maternity and Child Welfare centres are shown in the health section of the report. Two sessions a week are devoted to the cases referred by the medical officers of the Maternity and Child Welfare Clinics. Extractions of temporary and permanent teeth are done under gas and local anaesthesia, and fillings inserted wherever possible. May I thank the medical officers, nurses, and clerical staff for their co-operation during the past year. MEDICAL INSPECTION AND TREATMENT RETURNS (as rendered to the Ministry of Education). TABLE I. Medical inspection of pupils attending Maintained Primary and Secondary Schools. A—Routine Medical Inspections. (1) Number of Inspections:— Entrants 2,472. Second age group 1,562. Third age group 1,404 Total 5,438 (2) Number of other routine Inspections: Nil Grand Total 5,438 B—Other Inspections. Number of special Inspections and Re-inspections 14,405 TABLE II. Classification of the nutrition of pupils inspected during the year in the routine age groups. Number of Pupils Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. %[ 5,438 772 14.2 4,436 81.6 230 4.2 - - 94 TABLE III. (Authority's Scheme). Group I.—Treatment of Minor Ailments (excluding uncleanliness). Total number of Defects treated or under treatment during the year under the Authority's Scheme 3,569 Group II.—Treatment of Defective Vision and Squint. Group III.—Treatment of Defects of Nose and Throat. Errors of Refraction (including squint) 750 Received Operative Treatment 766 Other defects or disease of the eyes (excluding those recorded in Group I). 107 Received other forms of treatment 211 Total 857 Number of Pupils for whom spectacles were:— (a) Prescribed 221 Total number treated 977 (b) Obtained 221 TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Dentist: (a) Routine age groups 11,550 (6) Fillings: (b) Specials 1,072 Permanent Teeth 1,439 Temporary Teeth 480 (c) Total 12,622 Total 1,919 (7) Extractions: (2 Number found to require treatment 5,463 Permanent Teeth 955 Temporary Teeth 5,646 (3) Number actually treated 4,361 Total 6,601 (4) Attendances made by pupils for treatment 5,560 (8) Administration of general anaesthetics for extractions 540 (5) Half-days devoted to: (9) Other operations: Inspection 109 Permanent Teeth 600 Treatment 583 Temporary Teeth 519 Total 692 Total 1,119 TABLE V. VERMINOUS CONDITIONS. (i) Total number of examinations of pupils in the Schools by School Nurses 30,077 (ii) Number of individual pupils found unclean 764 1 CRUSHA & SON, LTD, Tottenham, Wood Green, Southgate & Enfield 1 1