EAS 24 COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1947 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. COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1947 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 1 Introduction 7 Statistical and Social Conditions of Area 9 General Provision of Health Services 16 General and Special Hospitals and Children's Homes 22 Mental Deficiency 27 Welfare of the Blind 31 Voluntary Associations 33 Maternity and Child Welfare 36 Infectious Diseases 49 Tuberculosis 60 Meteorological Record 83 Sanitary Section and Housing 84 Inspection and Supervision of Food 92 School Health Service:— Introduction 96 Report 98 EAST HAM CORPORATION. COUNCIL (shewing Chairmen and Vice-Chairmen of Health, M. & C. W., Mental Health and Education Committees). The Mayor: Mr. Alderman Charles William Dixon, J.P. The Deputy Mayor: Mrs Councillor Ethel Maud Charlotte Brace. Aldermen: Charles William Brading, J.P.. C.R.P. Thomas William Burden, J.P., M.P. (1) Sydney Arnold Elson. (3) Richard John Fell. Herbert Percy Jackson, J.P. (5) Thomas Irwin Lethaby, J.P. Edward Francis Markey, .J.P. (4) Annie Taylor (Mrs.), J.P. Frederick Welch. Councillors: William Henry Whittock Beecham. Leslie Alfred Victor Bennett. (2) Joseph John Gillard Bishop. Agnes Ann Bradshaw (Mrs.). Charles Frederick Chapman. Annie Maude Clark (Mrs.). Edwin John Davey. Elsie Mary Devenay (Mrs.). Eric Cyril Boyd Edwards, LL.B. Eleanor Mary Fell (Mrs.). Francis William French. Florence Matilda Goodchild (Mrs.). John Albert Hart. Henry Joseph Hooper. Frank Herbert Howard. Walter Edwin Hurford. William Innes Jackson, J.P. Albert Edward Johnson. John Alfred Kemp. (6) Winifred May Knight (Mrs.). John Linsley Linsley-Thomas. Arthur George Murrell Oakes. John O'Connor. Alfred Prior, J.P. Frank Owen Reynolds. Lily Sutton (Mrs.). James Ernest Taylor. William Bertram Warncken. Ernest Albert Wood. Co-opted Members of the Maternity and Child Welfare and Mental Health Committees:— Mrs. S. Jackson Mrs. C. Robertson Maternity and Child Welfare. Mrs. C. Boar Mrs. E. Tansley *Mrs. E. Wheeler Mental Health. * Deceased 29/12/47. (1) Chairman of Health and Maternity and Child Welfare Committees. (2) Vice-Chairman of Health and Maternity and Child Welfare Committees. (3) Chairman of Mental Health Committee. (4) Vice-Chairman of Mental Health Committee. (5) Chairman of Education Committee. (6) Vice-Chairman of Education Committee. 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.. U.S., M.R.C.S., L.R.C.P., D.P.H.. Deputy Medical Ollicer of Health and Senior Assistant School Medical Officer. Jessie A. MacLaren, M.B., Ch.B., D.P.H., Assistant Medical Officer for M. & C. W. and Supervisor of Midwives. J. Twelly Rees, M.R.C.S., L.R.C.P., Assistant Medical Officer. 1 H. Duff Palmer, M.B.. Ch.B., D.P.H., Assistant Medical Officer and Resident Medical Officer, Harts Sanatorium and Infectious Diseases Hospital. G. H. R. Curnock, M.B., B.S.(Lond.), M.R.C.S., L.R.C.P., D.R.C.O.G., Obstetrical Officer to Aldersbrook Maternity Hospital and Assistant Medical Officer for M. & C. W. Ernst Cohn, M.D., Assistant Medical Officer (temporary). 2 G. F. Newbold, M.R.C.S., L.R.C.P., Temporary Medical Officer, Aidersbrook Maternity Hospital and Children's Homes. 3 Katherine H. Foley, M.R.C.S., L.R.C.P., Temporary Medical Officer, Aldersbrook Maternity Hospital and Children's Homes. 4 Sylvia MacMillan, M.B., B.S.(Lond.), M.R.C.S., L.R.C.P., Assistant School Medical Officer. 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. Savege, M.B., Ch.B., F.R.C.S. (Edin.), Aural Surgeon. 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:— Hilda T. Smith, L.D.S., B.C.S., Senior Dental Officer. C. E. Maytum, L.D.S., R.C.S. A. Smith, L.D.S., F.P.S.G. (temporary). C. Sanitary and Food Inspector:— 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. Plnguey, M.S.I.A. R. Daw, M.S.I.A. V. C. Quin, M.S.I.A. 5 J. A. Dawson, M.S.I.A. 6 E. A. Bloomfield, M.S.I.A., A.R.S.I. Shop Acts Inspector:— C. H. Pursall, A.R.S.I. D. Nursing Staff:— Matron, Infectious Diseases Hospital:— 7 G. A. W. Smallridge, S.R.N., S.F.N., S.C.M. Matron, Harts Sanatorium:— 8 G. E. Sharpe, S.R.N. 9 M. J. King, S.R.N. Superintendent Health Visitor:— A. A. Woodman, S.R.N., S.C.M., M.R.S.I. (H.V.'s Cert.). 5 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.). 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.). 10 K. G. Garrard, S.R.N. (H.V.'s Cert.). D. M. Clarke, S.R.N., S.C.M. (H.V.'s Cert.). E. A. Payne, S.R.N., S.C.M., R.F.N. (H.V.'s Cert.). 11 P. Cullis, S.R.N., S.C.M. (H.V.'s Cert.). 12 D. M. Sisman, S.R.N., S.C.M. (H.V.'s Cert.). 13 W. M. White, S.R.N., S.C.M. (H.V.'s Cert.). School Nurses:— A. I. Childs, S.R.N., S.C.M., A.R.S.I. 14 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. 15 C. M. Strachan. Physiotherapist and Light Sister:— E. B. Broome, S.R.N., C.S.M., L.E.T., M.S.R. Tuberculosis Nurses:— F. M. Williams, S.R.N., T.A. (Cert.). M. Stokes, S.R.N., S.C.M., T.A. (Cert.). 16 M. M. Sammon, S.R.N., S.C.M., T.A. (Cert.), (H.V.'s Cert.). 17 H. O. Ford, S.R.N., T.A. (Cert.). 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. 18 E. I. Hake, S.R.N., S.C.M. (temporary). M. E. Kinsella, S.R.N., S.C.M. 19 G. I. Harris, S.R.N., S.C.M. S. J. Miller, S.C.M. (temporary). E. Gilton, S.C.M. (temporary). 20 E. Lloyd-Owen, S.C.M. 21 M. F. Brady, S.R.N., S.C.M. (temporary). 22 M. A. Reynolds, S.R.N., S.C.M. E. Other Staff:- A. H. Bleaden, Supervising Officer, M.D. Training Centre. H. L. Kingston, Home Teacher, Blind Persons Acts. W. L. Narborough, Dispenser (temporary). 23 M. A. Pearce, Ascertainment and Supervisory Officer, M.D. 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. H. J. Horsnell. J. C. Childs. B. G. Boar. 24 D. E. Ross. 25 R. Gunning. 26 T. J. Gilbert. And Temporary Clerks. 6 Shorthand Typists:— D. Gordon, Senior. D. G. Cannell. F. Burton. 27 F. A. Perkins. 28 E. R. A. Paddon. 29 G. C. MacLean. And Temporary Staff. Female Clerks:— M. A. R. Gaster. F. C. Wells. 30 B. Clandillon. 31 J. Mackintosh. M. D. Ubee. B. H. White. F. M. Clark. And Temporary Staff. 1 Returned H.M. Forces 1/2/47 2 Terminated 23/8/47 3 Commenced 18/10/47 4 Commenced 1/10/47 5 Commenced 18/1/47 6 Commenced 11/8/47 7 Terminated 1/11/47 8 Retired 19/7/47 9 Commenced 20/7/47 10 Terminated 7/5/47 11 Commenced 3/2/47 12 Commenced 13/5/47 13 Commenced 13/5/47 14 Retired 23/4/47 15 Commenced 12/5/47 16 Terminated 27/12/47 17 Commenced 1/12/47 18 Terminated 4/10/47 19 Terminated 31/7/47 20 Commenced 16/6/47 21 Commenced 15/9/47 22 Commenced 1/10/47 23 Commenced 12/2/47 24 Returned H.M. Forces 28/7/47 25 Terminated 30/9/47 26 Commenced 1/9/47 27 Commenced 1/4/47 28 Commenced 1/3/47 29 Commenced 5/5/47 30 Commenced Teacher's Course 12/5/47 31 Returned H.M. Forces 3/3/47 7 COUNTY BOROUGH OF EAST HAM Public Health Department, Town Hall Annexe, E.6. September, 1948. 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 1947. The statistical section of the report indicates the measure of the continued success of the health services of the borough. My report for the year 1946 made reference to the steady increase in population: this trend persists, and the RegistrarGeneral's estimate for the midyear is 118,670. The birth rate is maintained at the record high figure of 23.8 per 1,000 population (22.69 in 1946) and the infantile mortality rate 30 per 1,000 is similar to that of last year, which was the lowest in the history of the borough and again compares favourably with that for England and Wales as a whole, namely, 41 per 1,000. The maternal mortality rate is still further reduced to 0.69 per 1,000 live and still births. This extremely low figure (England and Wales 1.17) especially when taken in conjunction with the fact that 2,835 babies have been born in the borough, is a sure index of the excellence of the maternity service provided by the Council. Reference must be made to the standard of health achieved in those large sections of the community under our surveillance which reflects credit upon the clinic and institutional services and the administration of the health department. In regard to infectious disease, no serious epidemic has occurred but stress must be laid on sporadic outbreaks of diphtheria, the incidence of which could be entirely eliminated by the acceptance of immunisation for every child at one year of age and a subsequent boosting injection on entering school. The outbreaks could be attributable in most cases to the onset of the disease in unimmunised children. In spite of the heavy incidence of poliomyelitis throughout the country, only eight confirmed cases—with two deaths— occurred in this thickly populated area. Every suspected case 8 was seen and fully investigated by me and adequate provision made for immediate isolation and effective treatment. It is evident that the preventive measures initiated were responsible for confining the outbreaks to the few cases recorded. Some anxiety was occasioned in March by the pollution of the water supply due to overflow of the river Lea contaminating the pumping station and mains. Within a few hours of notification all effective measures were taken to combat the danger and ensure a safe drinking water. Thereafter, samples were submitted for investigation from various parts of the borough, until all were found satisfactory. It will be seen from the statistics relating to the care of premature infants that the attention given to children nursed at home ensures survival at the end of one month in a large percentage of cases. It is proposed to augment the facilities at present available for the saving of these young lives. In respect of the co-ordination of the nursing services, unfortunately the dearth of health visitors precludes, at the moment, any general measures envisaged by the Ministry to afford increased opportunities for instruction and advice to mothers and children in the homes. The ambulance service, which is now an integral part of the borough's activities, has proved a boon to all sections of the community: it is anticipated that rapid extension, limited only by difficulties of purchase and replacement, will be necessary to meet the heavy demands on this service during the coming year. Under the National Health Service Act, 1946, it is incumbent on local health authorities to make provision for health services covering a wide field. Proposals embodying the details for the establishment of these services were submitted to the Minister at the end of 1947, and their implementation will play no small part in the comprehensive medical services forecast by new legislation. I desire to express my gratitude to the Chairman and Members of the Health Committee, and to the Chairmen and Members of other Committees, for their assistance and support throughout the year: also to my staff and colleagues who have contributed so much to the efficiency of the department. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your Obedient Servant, Malcolm Barker, Medical Officer of Health. 9 Statistical and Social Conditions of the Area Social. Area (in statute acres) land and water 3,324 Population. Census—1931 142,394 Estimated civilian population—1947 118,670 Number of inhabited houses (end of 1947 according to rate books) (including tenements and shops) Approximately 31,500 Rateable value at 31st December, 1947 £730,000 Sum represented by a penny rate for the year 1947 £2,939 Extracts from Vital Statistics. Total Birth Rate Males Females Live Births Legitimate 2,733 1,429 1,304 Illegitimate 102 53 49 Still Births Legitimate 58 36 22 Illegitimate 3 3 - Deaths—Total 1,400. Males 770. Females 630. Deaths from Puerperal causes:— Deaths Rate per 1,000 Total (Live and Still) Births Puerperal Sepsis 1 0.345 Other Maternal Causes 1 0.345 Total 2 0.69 Deaths of infants under one year of age:— All infants per 1,000 live births 30 Legitimate infants per 1,000 legitimate live births 29 Illegitimate infants per 1,000 illegitimate live births 49 Deaths from Cancer (all ages) 236 Deaths from Measles (all ages) - Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under 2 years) 9 Still Births. The number of still births registered was 61 compared with 64 for the previous year. The rate per 1,000 total (live and still) births was 21.06, the figure for 1946 being 24.2. Since 1943 the statistics in relation to still births is shewn below:— 1943 1944 1945 1946 1947 No, of still births 50 45 51 64 61 Rate per 1,000 total (live and still) births 26.1 23.04 28.4 24.2 21.06 Births. The number of live births registered was 2,835 as compared with 2,577 for the year 1946, equivalent to a birth rate of 23.8 per 1,000 of the population—the figure for the previous year—22.69. A comparison of the statistics for the period since 1943 is appended below:— 1943 1944 1945 1946 1947 No. of Births (East Ham) 1,868 1,908 1,742 2,577 2,835 Birth rate (East Ham) 20.09 20.9 18.2 22.69 23.8 ,, ,, (England & Wales) 16.5 17.6 16.1 19.1 20.5 Deaths. The number of deaths was 1,400 as compared with 1,212 for the year 1946. The death rate was 11.79, that for the previous year being 10.6. Of the total deaths 701 or 50% died in institutions. The number of residents who died outside the area and whose deaths were assigned to the Borough was 664. The number of deaths of non-residents in the district was 56. The percentage of total deaths in the age groups was as follows:— Under 1 year 6.07 1—5 years 0.85 5—15 years 0.92 15—45 years 9.20 45—65 years 23.06 65 and over 59.90 For the period 1943—1947 the rates for England and Wales and East Ham are shewn:— 1943 1944 1945 1946 1947 England and Wales 12.1 11.6 11.4 11.5 12.0 East Ham 13.27 14.4 12.9 10.6 11.79 Infantile Mortality. Deaths of infants under one year numbered 85—equivalent to an infant mortality of 30 per 1,000 live births—similar to that of last year. The rate for England and Wales was 41. 11 The number of deaths of illegitimate children under one year of age was 5 out of a total of 102 illegitimate births, giving a mortality rate of 49 as compared with a figure of 18 per 1,000 illegitimate live births for the year 1946. Infantile mortality rates since 1943 are as follows:— 1943 1944 1945 1946 1947 East Ham 48 31 36 30 30 England & Wales 49 46 46 43 41 Illegitimate births and the illegitimate mortality rates since 1943 are tabulated below:— 1943 1944 1945 1940 1947 No. of illegitimate births 71 82 105 108 102 Mortality rate per 1,000 illegitimate live births 56 48 38 18 49 Neo-Natal Mortality. Children dying under the age of one month totalled 50 equal to a neo-natal mortality of 17.6 per 1,000 live births. These rates from 1943 are indicated below 1943 1944 1945 1946 1947 23.5 17.3 19.5 19.4 17.6 Maternal Mortality. The number of maternal deaths was 2, the maternal mortality rate for 1947 was 0.69 per 1,000 live and still births. In the subjoining tables these rates are shown since 1943:— 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 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 1947 0.32 0.345 0.85 0.345 1.17 0.69 Population. The Registrar-General's estimate of the population to the middle of 1947 is 118,670, which is an increase of 5,100 compared with that for the year 1946. The rates per 1,000 of the population mentioned in this report are based on this estimate. 12 Provisional population projections (natural growth only) have recently been issued by the General Register Office and are based on various assumptions (mortality, natality and migration). It is interesting to note the basis of projections of populations— 15 years hence (i.e.—1962). 1. Mortality: that death rates decline at the rate of 50% in 40 years at ages under 45; corresponding declines diminishing to 15% males and 25% females at ages over 75. 2. Natality: that births (which ranged in England and Wales from 580,000 in 1933 to 887,000 in 1947) are maintained at an average of 700,000 per annum from 1948 onwards. 3. Migration: Nil. An extract in respect of such populations for East Ham is appended below:— TABLE 1. PROVISIONAL POPULATION PROJECTIONS. (Natural Growth only.) Area Mid-1947 civilian estimates 1962 projections (exclusive of 500,000 non-civilians in England and Wales) All ages Under Age 15 Over Age 15 All Ages Under Age 15 Over Age 15 East Ham 119,640 25,240 94,400 135,947 32,870 103,077 12A TABLE 2.—CAUSES OF DEATH IN AGE GROUPS, 1947, AND TOTAL DEATHS FOR 1943-1947. Cause. Deaths at different periods of life of residents (civilians) whether occurring within or without the district. Institutional Deaths Total deaths for the years All Ages. Under 1 Year. 1—5 Years. 5—15 Years. 15—45 Years. 45—65 Years. 65 and Upwards. Total deaths in Instns. 1947 1946 1945 1944 1943 M F M F M F M F M F M F M F M F 1. Typhoid and Para-typhoid Fevers - - - - - - - - - - - - - - - - - - - 1 - 2. Cerebro-Spinal Fever 1 - - - - - - - 1 - - - - - 1 - 1 - 1 1 1 3. Scarlet Fever - - - - - - - - - - - - - - - - - - - - 1 4. Whooping Cough 2 1 1 - 1 1 - - - - - - - - 2 1 3 - - 1 1 5. Diphtheria 2 1 - - - - 2 1 - - - - - - 1 1 3 - 1 3 - 6. Tuberculosis of Respiratory System 45 30 - 1 - - - - 16 25 24 4 5 - 22 12 75 62 52 61 80 7. Other forms of Tuberculosis 3 4 1 - 2 - - 1 - 2 - 1 - - 3 8 7 8 9 14 7 8. Syphilitic Diseases 6 1 1 - - - - - - - 1 - 4 1 3 - 7 8 5 5 9 9. Influenza 5 7 1 - - 1 - 1 - - 1 1 3 4 1 4 12 8 4 2 27 10. Measles - - - - - - - - - - - - - - - - - - 1 - 1 11. Acute Poliomyelitis and Polio-encephalitis 1 1 - - - - 1 - - 1 - - - - 1 1 2 1 - - - 12. Acute infective Encephalitis 1 - - - - - - - 1 - - - - - 1 - 1 1 - 1 - 13. Cancer of the Buccal Cavity and Oesophagus (M) Uterus (F) 8 7 - - - - - - 1 - 3 4 4 3 6 3 15 26 16 13 14 14. Cancer of Stomach and Duodenum 23 23 - - - - - - - - 13 7 10 16 12 13 46 36 44 45 50 15. Cancer of Breast - 22 - - - - - - - 5 - 10 - 7 — 13 22 21 17 27 19 16. Cancer of all other sites 88 65 - - - 1 - - 7 7 36 15 45 42 46 32 153 142 129 118 130 17. Diabetes 1 14 - - - - - - - - - 4 1 10 1 7 15 7 4 16 8 18. Intracranial Vascular Lesions 66 80 - - - - - - 2 3 16 13 48 64 38 34 146 116 110 125 110 19. Heart Disease 195 165 - - - - - - 4 9 39 23 152 133 82 66 360 303 286 314 237 20. Other Diseases of Circulatory System 2.3 20 - - - - - - 1 1 5 5 17 14 7 9 43 54 58 34 34 21. Bronchitis 92 23 2 1 - - - - 2 - 20 2 68 20 22 3 115 74 75 66 99 22. Pneumonia 37 33 12 5 - 2 - 1 4 1 10 4 11 20 28 19 70 68 68 59 75 23. Other Respiratory Diseases 13 9 - - - - - - - 1 4 5 9 3 5 4 22 19 20 12 19 24. Ulcer of Stomach and Duodenum 11 4 - - - - - - 2 - 6 2 3 2 9 2 15 15 17 22 18 25. Diarrhoea (under 2 years) 7 2 7 2 - - - - - - - - - - 4 - 9 8 7 2 11 26. Appendicitis 4 3 - - 1 1 - - 1 - 1 1 1 1 4 3 7 6 6 4 6 27. Other Digestive Diseases 21 18 2 - - 1 1 - 1 - 5 8 12 9 17 15 39 22 30 23 21 28. Nephritis 12 11 - - - - - - 2 3 2 4 8 4 6 7 23 19 16 21 20 29. Puerperal and Post-Abortive Sepsis - 1 - - - - - - - 1 - - - - - 1 1 - 2 4 3 30. Other Maternal causes - 1 - - - - - - - 1 - - - - - 1 1 2 - 2 2 31. Premature Birth 10 7 10 7 - - - - - - - - - - 9 7 17 16 13 19 23 32. Congenital malformations, birth injury, infantile diseases 14 18 14 15 - - - - - 2 - - - 1 8 13 32 34 23 23 22 33. Suicide 7 3 - - - - - - 3 2 3 - 1 1 1 2 10 12 8 6 11 34. Road traffic accidents 10 4 - - - - 3 1 2 - 2 1 3 2 9 4 14 7 16 5 10 35. Other violent causes 16 6 1 - - - - - 7 1 3 1 5 4 9 4 22 16 67 142 32 36. All other causes 46 46 2 - - 1 - 1 4 3 6 8 34 33 34 25 92 101 130 125 131 TOTALS 770 630 54 31 4 8 7 6 61 68 200 123 444 394 392 309 1,400 1,212 1,235 1,316 1,232 TABLE 3.—BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1947. 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 ‡20.5 ‡0.50 ‡12.0 0.00 0.00 0.02 0.01 0.09 0.00 0.01 †141 5.8 126 County Boroughs and Great Towns, including London 23.2 0.62 13.0 0.00 0.00 0.03 0.01 0.09 0.00 0.02 47 8.0 148 Smaller Towns (resident populations 25,000 to 50,000 at Census, 1931) 22.2 0.54 11.9 0.00 0.00 0.02 0.01 0.08 0.00 0.02 36 3.7 London—Administrative County 22.7 0.49 12.8 0.00 0.00 0.02 0.01 0.08 - 0.01 37 4.8 East Ham 23.8 0.51 11.79 - - 0.02 0.02 0.10 - - 30 3.1 ‡ Per 1,000 related births. A dash (—) signifies that there were no deaths. ‡ Rates per 1,000 total population. 13 14 Table 4.—INFANT DEATHS UNDER ONE YEAR OF AGE, 1947. Cause of Death. Total deaths. Age and Sex. Total under 1 year. Wards. Deaths in Institutions. Under 1 week. 1—2 weeks. 1 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 Whooping Cough 1 - - - - - - - - - - - - - - 1 - 1 - - - - - 1 - - - - - 1 Pulmonary Tuberculosis 1 - - - 1 - - - - - - - - - - - - - 1 - - - - - - - - - 1 1 Other T.B. Diseases 1 - - - - - - - - - - - - 1 - - - 1 - 1 - - - - - - - - - 1 Syphilitic Diseases 1 - - - - 1 - - - - - - - - - - - 1 - - - - - - - 1 - - - 1 Influenza 1 - - - - - - - - - - 1 - - - - - 1 - - - - - - - - - - 1 1 Bronchitis 3 - - - - - - - - - 1 2 - - - - - 2 1 - - - - 1 - 1 - - 1 1 Pneumonia 17 1 - 1 - - 2 - - 5 - 4 2 - 1 1 - 12 5 2 2 2 3 1 - 2 1 3 11 Diarrhoea and Enteritis 9 - - 1 1 - - 1 - - - 1 - 4 1 - - 7 2 1 - 1 - - - 2 2 1 2 4 Premature Births 17 10 6 - 1 - - - - - - - - - - - - 10 7 2 3 2 1 3 4 1 1 - - 16 Congenital Debility, Malformations, Birth Injuries and Infantile Diseases 29 10 8 - 1 1 2 1 1 1 2 - - 1 1 - - 14 15 4 4 1 1 3 4 1 3 2 6 18 Other Causes 5 - - - - - - - - - - 4 - 1 - - - 5 - - - - 1 - 1 - 2 - 1 4 All Causes 85 21 14 2 4 2 4 2 1 6 3 12 2 7 3 2 - 54 31 10 9 6 4 11 10 6 10 4 15 59 15 INFANTILE MORTALITY RATES (per 1,000 live births) EAST HAM 16 General Provision of Health Services. PROFESSIONAL NURSING IN THE HOME. A. General. The East Ham District Nursing Association—affiliated to the Queen's Institute—provides trained nurses to attend the sick in their homes. This voluntary association has rendered excellent service for many years and under the National Health Service Act, 1946, it is proposed to continue the arrangements on an agency basis. Social Welfare cases are visited by Nurse Kelley. B. Infectious Disease. A part of one block of Harts Sanatorium is still used for infectious cases and the nursing and domestic staff are accommodated at Oakleigh, Sunset Avenue, Woodford Green. Although within reasonable distance, the provision of transport for the staff between Hospital and Home has been greatly appreciated. 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 mothers in the North Woolwich area. MIDWIVES ACTS, 1902 to 1936. The number of midwives who notified their intention to practise in East Ham during 1947 was 42. Of this number 23 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches—2 at Sir Henry Tate Nurses' Home, Silvertown—8 at East Ham Memorial Hospital— and 9 practised independently, including 8 Municipal Midwives. Plaistow Maternity Hospital and District Nurses Home. Summary of cases, 1947:— Midwifery 385 Monthly 221 Hospital 146 Laboratory Facilities. The majority of specimens are sent for examination to the East Ham Memorial Hospital. Advantage has also been taken of 17 the facilities provided at the Sector Laboratory of St. Margaret's Hospital, Epping. Detailed below are the number of specimens examined and the nature of these examinations, for the year 1947:— East Ham Memorial Hospital. Specimen Number Blood (Sedimentation Rate) 203 288 Blood (Count) 69 Blood (Wassermann) 3 Blood (Other) 13 Sputa (Tuberculosis, Direct method) 1,038 1,122 Sputa (Tuberculosis, Antiformin method) 40 Sputa (Tuberculosis, Culture) 5 Sputa (Asbestosis) 1 Sputa (Malignant cells) 17 Sputa (Other) 21 Mantoux Test (Tuberculosis) 45 Gastric Lavage (Tuberculosis) 5 Pleural Fluid (Tuberculosis) 3 15 Pleural Fluid (Malignant cells)... 1 Pleural Fluid (Other) 11. Urine (AZ test) 5 38 Urine (Sugar) 9 Urine (Tuberculosis) 3 Urine (Other) 21 Faeces (Tuberculosis) 2 7 Faeces (Dysentery and Typhoid) 2 Faeces (Other) 3 Other 49 Total 1,569 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 812 58 754 Town Hall Annexe 1,250 6 1,244 Totals 2,062 64 1,998 18 Ambulance Facilities. Details of the work carried out by the Public Ambulance section of the Health Department are appended below, shewing comparison with the year 1946:— 1947 1946 Nature of Call— Tourneys Mileage Journeys Mileage Sickness 2,554 22,820 2,090 15,960 Maternity 973 7,199 846 7,464 Accident, Sudden Illness 845 4,080 567 3,304 T.B. Transfers 401 5,396 168 2,388 Hospital Transfers 34 687 41 580 Social Welfare 304 13,39S 254 9,592 Conveying Midwives 264 928 57 238 Malicious Calls - - 3 11 Miscellaneous 88 698 83 570 Maintenance 371 1,210 153 524 Scarlet Fever 105 1,701 151 2,445 Diphtheria 69 1,099 52 802 Miscellaneous Infectious Diseases 98 1,596 60 965 Discharges Infectious Diseases 138 2,366 143 2,311 Infectious Diseases Hospital— (Swabs) etc. 85 1,123 122 1,694 (Dinners) 52 823 - - Sanitary Department 22 161 - - Calls for other Boroughs:— West Ham 67 596 53 321 Ilford 25 338 18 222 Barking 139 1,698 73 820 Dagenham 2 34 3 58 Wanstead and Woodford 2 27 2 36 Totals 6,635 67,978 4,939 50,305 Calls by other Boroughs:— West Ham 26 170 26 137 Barking 13 127 8 67 Ilford 22 173 28 190 Wanstead and Woodford - - 1 7 Totals 61 470 63 401 19 Clinics and Treatment Centres. These are all provided by the Council. The sessions at the Centres (as on 31/12/47) were as follows:— TABLE 5.-CLINICS AND TREATMENT CENTRES. Situation Purpose used Sessions Town Hall Annexe General Clinic (Minor Ailment 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. " " " Physiotherapy Clinic Continuous. " " " Eye Clinic Tuesday and Friday 9.30 a.m. Alternate Thursdays 9.30 a.m. " " " Toddlers' 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. " " " Dental Clinic By appointment. Church Road, Manor Park Infant Welfare Clinic Mondays and Thursdays 2 p.m. " " " " General Clinic (Minor Ailment cases) Tuesday and Friday 9.30 a.m. and Wednesday 2 p.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.). " " " " Toddlers' Clinic Friday 2 p.m. " " " " Dental Clinic By appointment. North Woolwich—Fernhill Street Baths General Clinic (Minor Ailment 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., Tuesday and Friday 10 a.m. (Pneumo-thorax cases) alternate Thursday 6 p.m. alternate Saturday (childdren only) 9.30 a.m. Durban House, Katherine Rd. Treatment Centre (Baths) 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). 20 Social Welfare Domiciliary Medical Service. The scheme and amended provisions were described in my reports for 1934 and 1945. TABLE 6. SOCIAL WELFARE DOMICILIARY MEDICAL SERVICE. Statistical Return for the Year Ending 31/12/47. 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. 1,028 2,322 5,752 8,074 295 Venereal Diseases. The facilities available for the treatment of these diseases are the same as in recent years and from the official tables supplied by the London County Council Centres the following figures are abstracted:— New Patients. 1945 1946 1947 Syphilis 22 21 19 Soft Chancre 1 - 2 Gonorrhoea 43 63 40 Not Venereal 133 225 168 Total 199 309 229 Total attendances 2,726 3,251 2,411 Pathological Examinations. For, or at the Centres:— 1947 Spirochaetes - Gonococci 685 Wassermann 697 Others 1,189 Total 2,571 21 For Practitioners:— Spirochaetes - Gonococci 1 Wassermann 4 Others - Total 5 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 1/1/47 to 31/12/47. M. F. (1) Total number in respect of whom Form 1 was received Nil (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 - - Contacts found - - Contacts examined - - (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. 22 GENERAL AND SPECIAL HOSPITALS AND CHILDREN'S HOMES. ARRANGEMENTS FOR TREATMENT. (a) Provided by Local Authority, (b) Maternity, (c) Orthopaedic, (d) Ear, Nose and Throat, (e) Puerperal Pyrexia, (/) 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 1947. (h) Smallpox. (i) East Ham Memorial Hospital. Statistics from the Hospital report for the year 1947 are as follows:— 23 TABLE 7. A. In-patients. Number of Beds and In-patients. Numbers in 1940 Numbers in 1947 1. Beds:— (a) Complement at 31st December 131 138 (6) Average Daily Complement during the year 131 134.4 (c) Average Daily Number Closed during the year owing to:— (i) Rebuilding or extension schemes — — (ii) Repairs, Redecoration, Cleaning or Infection .4 — (iii) Other Causes — — (d) Average Daily Number Open during the year:— (i) Emergency Hospital Scheme, Casualty beds 16.7 10 (ii) Other beds 113.9 124.4 (e) Average Daily Number occupied during the year:— (i) Emergency Hospital Scheme Casualty Beds 3.0 .5 (ii) Other Beds 90.3 100 2. Number of In Patients in the Hospital at beginning of year 82 95 3. Number of In Patients admitted during the year 2,553 2,839 4. Number of In Patients in Hospital at end of year 95 107 5. Average Number of days each Patient was resident 13.4 13 6. Number of Patients admitted and discharged during the year who were resident for (i) only 1 day 262 339 (ii) 2 and 3 days 605 629 B. Out-Patients. Number. Numbers in 1946 Numbers in 1947 1. Total Number of new Out Patients 17,142 17,706 2. Total Number of Out Patient attendances 89,463 92,085 (a) Number of Patients on books at the beginning of the year Not ascertainable Not ascertainable (b) Number of Casualty Patients included in No. 1 above 5,550 7,330 (c) Number of Maternity Patients included in No. 1 above 379 417 (d) Number of attendances of Maternity Patients included in No. 2 above 3,269 3,420 24 (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. (k) Tolmers Park, Herts. Statistical information in respect of this Home is appended below:— TABLE 9. Chargeable on 31/12/46 Admitted during 1947 Total Discharged Died Transferred to other Institutions Chargeable on 31/12/47 65 78 143 18 25 17 83 25 TABLE 10. Cases Admitted to West Ham Institutions from East Ham. Institution. Chargeable on 31/12/46 Admitted during 1947 Born during 1947 Total Discharged Died Transferred to other Institutions. Chargeable on 31/12/47 Whipps Cross Hospital 108 1,312 2 1,422 989 269 44 120 Forest Gate Hospital 47 256 248 551 468 5 41 87 Harold Wood Hospital 32 8 — 40 — 8 — 32 Central Home 153 198 — 351 41 129 24 157 Forest House 30 16 — 46 3 — 11 32 26 (l) Aldersbrook Homes and Scattered Homes. I am indebted to Mr. Pitt Steele, Superintendent, for the following information relative to the six month period 1/7/47 to 31/12/47 and for comparable statistics for corresponding periods in 1946 and 1939. STATISTICAL 6 months ended Corresponding Half-year 31/12/47 1946 1939 The highest number in residence was 464 475 496 The lowest number in residence was 404 398 437 The numbers in residence on 30/6/47 404 456 450 In Aldersbrook and Scattered Homes 404 375 450 In Cornwall — 36 — In Hutton — 43 — In other billets — 2 — The numbers in residence on 31/12/47 416 411 460 In Aldersbrook and Scattered Homes 416 409 — In Cornwall — 11 — In Hutton — — 460 In other billets — 1 — The total number of Admissions was 467 416 277 From East Ham 78 84 61 From West Ham 215 150 130 From Essex County Council 174 142 87 From Education Authorities (included in totals) 33 41 — The total number of Discharges was 455 461 291 From East Ham 90 100 — From West Ham 195 197 — From Essex County Council 170 164 — From Education Authorities (included in totals) — — — The average number of Admissions weekly was 17.9 16 10 The average number of Discharges weekly was 17.5 17.7 10 The highest number admitted on any one day was 17 9 10 The number of children admitted under 3 years was 160 118 77 The chargeability to Authorities on 31/12/47 was:— East Ham 80 78 83 West Ham 166 168 225 Essex County Council 170 165 152 Education Authorities:— East Ham 6 2 — West Ham 10 21 — Walthamstow 4 6 — Leyton 10 5 — Essex 8 4 — The number of Deaths occurring was — — 2 Transfers to other Institutions not under the control of the East Ham or West Ham Authorities or of the Essex County Council 27 6 12 Total number of day's maintenance 79,696 78,637 83,775 Number in residence on 1/1/48 416 411 460 Infants under 3 years 57 75 59 Children over 3 and under 5 71 55 41 Children over 5 and under 8 66 93 90 Boys over 8 and under 14 104 96 123 27 STATISTICAL 6 months ended Corresponding Half-year 31/12/47 1946 1939 Girls over 8 and under 14 77 58 91 Boys over 14 and under 16 32 16 36 Girls over 14 and under 16 9 18 40 Accommodation, i.e. beds provided:— Receiving Homes 250 240 501 Scattered Homes 170 157 — Cornwall — 15 — Bacton 30 25 — Number of boys sent to situations 4 4 10 Number of boys returned from situations 1 — — Number of girls sent to situations 4 4 12 Number of girls returned from situations — 1 — MENTAL DEFICIENCY ACTS, 1913-1938. The ascertainment and supervision of persons coming within the scope of these Acts, and the examination, certification, and completion of reports for the Board of Control and other authorities, have been carried out satisfactorily. TABLE 11. Visits Number of Interviews Statutory Supervision Guardianship Institution Training Centre Friendly Care Total 678 178 4 58 92 1,010 169 28 TABLE 12. MENTAL DEFICIENCY ACTS, 1913-1938. Particulars of Mental Defectives as on 1st January, 1948. STATISTICS.—Comparison with Previous Year. A.—Number of Mental Defectives ascertained to be " Subject to be Dealt With." 1947 1946 M. F. Total M. F. Total A.l.—Under Order:— (a) (1) In Institutions (excluding cases on licence): Under 16 years of age 11 13 24 11 7 18 16 years and over 67 58 125 71 58 129 (2) On Licence from Institutions: Under 16 years of age — — — — — — 16 vears and over 4 5 9 5 7 12 (b) Under Guardianship (including cases on Licence): Under 16 years of age 1 — 1 1 — 1 16 years and over 12 30 42 11 25 36 2. In " places of safely ": Under 16 years of age — — — — 1 1 16 years and over — — — — — — 3. Under Statutory Supervision 82 55 137 78 54 132 Of whom awaiting removal to Institutions 4 3 7 — 1 1 4. Action not yet taken wider any one of the above headings 5 10 15 5 11 16 13. No. of Mental Defectives not at present " subject to be Dealt With," but for whom the Local Authority may subsequently become liable 35 28 63 29 25 54 Of whom, number under voluntary supervision 32 24 56 28 22 50 Number of cases on Register of Occupation Centre 13 15 28 12 14 26 29 CASES REPORTED BY LOCAL EDUCATION AUTHORITIES. (Section 57, Education Act, 1944.) 1947 1946 M. F. Total M. F. Total Reported under Sec. 57(3). 5 4 9 6 3 9 Reported under Sec. 57(5) 3 3 6 1 1 2 Total reported during 1947 8 7 15 7 4 11 Method of Disposal:— Sent to Institutions (By Order) — 1 1 2 1 3 Placed under Guardianship (By Order) — 1 1 — — — Placed under Statutory Supervision 6 2 8 4 2 6 Taken to "place of safety" — — — — 1 1 Died or Removed from Area — Action not yet taken 2 3 5 — — — Referred back to Education Committee — — — 1 — l Total 8 7 15 7 4 l1 Of total number of mental defectives known to local authority:—(a) Number who have given birth to children during:— 1947 1940 (a) After Marriage five two (b) While unmarried nil two (b) Number who have married 2 females 1 male 1 female Ascertainment. The number of cases dealt with for the first time during the year 1947 was 17, and they were dealt with as under:— 1 placed in Institution. 14 placed under Statutory Supervision. 1 placed under Friendly Care. 1 attending Special School (Besford Court). 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 urgently required for low grade defectives under 5 years, and also for cases of Spastic Diplegia. 30 Guardianship. There are 43 cases under Guardianship, of whom three are still evacuated to other areas. During the year, one female was transferred under Varying Order to Institutional Care (death of guardian) and in one case the Order was discharged and the patient transferred to Friendly Care, one male died and the application for guardianship of one case was deferred at the end of the year. Supervision. There are 137 mental defectives under statutory supervision in their own homes in this area. During the year, 3 cases were transferred to Institutional Care, 9 to Guardianship, 1 to Friendly Care, 1 to Runwell and one case referred back to the Education Committee. 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. Occupation Centre. The Centre is open for five whole day sessions per week and there are 29 on the register, with an average daily attendance of 27 pupils of varying ages and both sexes. A hot midday meal is provided. The instruction takes the form of all types of handicrafts and there is a great demand for completed articles. In some instances materials for homework are issued. Physical and domestic training is part of the curriculum and includes the preparation and clearance of tables and other duties in connection with the meal. The trainees indulge in outdoor games and simple gardening. A vehicle conveys most of the pupils to the Centre. The annual seaside outing was continued as in previous years and was much appreciated. In view of the demand for places, the Council propose providing a second Centre in the south of the Borough. Licence, Discharge and After-Care. Out of 5 defectives (1 male and 4 females) granted licence during the year, 3 were recalled to institutional care and 2 are working and doing fairly well. Occasional visits are paid to all cases discharged from orders and still within this area. All removals are notified to the respective areas. 31 TABLE 13. MENTAL DEFICIENCY ACTS, 1913—38. (Statistics for 1942—1947.) YEAR 31 Dec. 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 1946 159 37 1 132 4 50 383 1947 *158 43 — 137 3 56 397 * Including 9 on Licence. Occupation Centre. The arrangements outlined in the report for 1945 have continued. The attendances during 1947 are indicated below:— Morning Session:— Number on register 19 (10 males and 9 females) Number of Sessions 234 Total attendances 4,525 Average attendance 19 Afternoon Session:— Number on register 21 (10 males and 11 females) Number of Sessions 234 Total attendances 4,886 Average attendance 20 BLIND PERSONS ACTS, 1920-1938. The work of ascertainment and medical examination has continued and blind persons are under the constant supervision and care of Miss Kingston. Lectures and instruction in Moon and Braille are given during the day, and evening visits are paid when required. All blind persons and dependants are now entitled to free medical treatment under the Council's Social Welfare Domiciliary Medical Service Scheme. I wish to express appreciation and thanks to the local Welfare Association for their beneficent services to the blind. 32 TABLE 14. Work of the Visitor to the Blind, 1947. Year No. of Blind on Register 31/12/47 No. of Visits to same No. of partially Blind Persons No. of Visits to same Other Visits Total Visits No. of Lessons given Lessons given in Day Evening Braille Moon Knitting Crochet Manual 1947 213 2,116 64 40 97 75 2,352 341 147 73 91 18 12 32A TABLE 15. BLIND PERSONS ACTS, 1920/38. REGISTRATION AS AT 31st MARCH, 1948. AGE PERIODS OF REGISTERED BLIND PERSONS. Mole : M=Males. F=Female. T= Total. 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—455 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 2 3 — 1 1 13 9 22 13 9 22 26 25 51 7 16 23 35 57 92 — — — 95 119 214 AGES AT WHICH BLINDNESS OCCURRED. Age Period 0—1 Age Period 1—5 Age Period 5—10 Age Period 10—20 Age Period 20—30 Age Period 30—40 Age Period 40—50 Age Period 50—60 Age Period 60—70 Age Period 70 and over Age Period Unknown Total of all Age Groups M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 16 14 30 — 1 1 4 4 8 5 3 8 11 6 17 10 13 23 10 15 25 8 18 26 11 14 25 18 28 46 2 3 5 95 119 214 CHILDREN OF SCHOOL AGE, 5—16. TRAINING AND EMPLOYMENT AND UNEMPLOYMENT. Age Period 16 and upwards. Normal Mentally Defective Physically Defective Employed Undergoing Training Unemployed (k) Total (1) 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 (j) 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 — — — 1 2 3 — — — 8 6 14 2 1 3 14 2 16 24 9 33 2 1 3 — — — — 1 1 —- 1 1 1 1 2 67 104 171 94 117 211 1 — 1 Total — — — 1 2 3 — — — 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 Hand Machine Mattress Makers Machinists Upholsterers (a) Within Workshops for the Blind — 4 1 — — — — 1 — — — — — — — — — — 4 — — 2 — — — — — — — — — 2 — — 14 (b) In approved Home Workers' Schemes — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — 2 — — — 3 (c) Others (not Pastime Workers) — 1 — — — 2 — — — — 1 — 2 — — — — — — — 1 — — — — 1 — — — 2 — — 3 3 16 (d) Total — 5 1 — — 2 — 1 — • — 1 — 2 — — — — 1 4 — 1 2 — — — 1 — — — 2 2 2 3 3 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). (f) Total Deaf Mutes included in (c) Homes for the Blind Sunshine Homes Mental HosDitals Public Assistance Institutions M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 6 5 11 6 7 13 6 11 17 2 — 2 — — — — — — — — — 20 23 43 1 — 1 — 1 1 — — — ' 1 2 3 3 6 9 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. — — — — — — 1 — 1 — — — 3 — 3 2 2 4 2 2 4 — 3 3 4 4 8 — — — 12 11 23 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 Age Groups M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 1 — 1 — — — — — — — — — 3 — 3 1 1 2 1 2 3 1 2 3 3 2 5 2 4 6 — — — 12 11 23 Since 1943 the number of blind persons on the register are shewn below:— 31/3/43 235 31/3/44 230 31/8/45 225 31/3/46 213 31/3/47 210 31/3/48 214 33 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 Association has continued to help the Local Authority in obtaining convalescent and sanatorium treatment when required for children, and again I wish to record the invaluable assistance of the Committee and Miss Webber, Secretary to the local branch during the year. The number of cases dealt with during 1947 was 365. The following are the particulars:— Children referred by:— Local Voluntary Hospital and Private Doctors 83 Chest Clinic 57 M. & C.W. Centres 17 Education Dept. and School Health Service 201 Parents applied 3 Social Welfare 3 Others 1 Total 365 The children suffered from:— Tuberculosis (Pulmonary) 23 Tuberculosis (Non-Pulmonary) 20 Anaemia, Debility and Malnutrition 85 Rheumatism, Chorea and Heart 13 Bronchitis and Bronchial Catarrh 58 Asthma 7 Debility following illness, operations and accidents 75 Crippling Defects 15 Nervous conditions 22 Diseases of Ear, Eye and Skin 18 Various 29 Total 365 34 Assistance was given as follows:— Sent to Convalescent Homes and Sanatoria 292 Provided with surgical appliances 18 Referred for visiting and advice 32 Parents refused treatment offered 4 Awaiting treatment at end of 1947 15 Referred to Jewish Board of Guardians 4 Total 365 Number of home visits paid during the year—1,365. East Ham District Nursing Association. Summary of Cases:— 1945 1946 1947 Bronchitis and Pneumonia 54 71 83 Tuberculosis 16 35 31 Cardiac 56 53 55 Rheumatism, Arthritis, etc. 52 51 43 Cerebral 39 65 73 Diabetes 60 58 67 Burns and Scalds 16 19 23 Other Medical 187 197 213 Various Surgical 110 115 120 Cancer 113 110 118 Senility 88 109 115 Totals 791 883 941 Patients on books, 1 /1/45 115 New patients nursed, 1945 676 791 Patients on books, 1 /1 /46 130 New patients nursed, 1946 753 883 Patients on books, 1/1/47 149 New patients nursed, 1947 792 941 1945 1946 1947 Total number of visits 18,755 18,943 23,784 35 East Ham Tuberculosis After-Care Committee. During the year the voluntary Committee provided the following items to patients:— Clothing (30 patients) at a cost of £78 l1s. 0d. Beds and bedding on loan to 6 patients. Fares of relatives. Christmas gifts of 10s. 0d. each to 100 patients. Mrs. Rogers, Occupational Therapist, was in charge of this department, and a new scheme was introduced whereby the materials were sold to the patients and the finished articles became their property—180 such purchases were made. £237 15s. 3d. was the cost of the various handicraft materials purchased, £227 13s. 8d. was received and the value of the stock in hand at the end of the year was approximately £80. The tuberculosis sufferers have benefited greatly by the unselfish and beneficient work carried out by the Committee and their honorary officials. National Society for the Prevention of Cruelty to Children. Owing to the welfare work undertaken by the Education Committee, the number of cases referred has considerably decreased. The Society is always ready and willing, however, to carry out tactful enquiries and assist in those cases where their help is particularly indicated. Scabies and Treatment Centre. The following statistics are appended:— Number of new cases attending 1943 1944 1945 1946 1947 Scabies Clinic 969 520 268 237 77 Treatment Baths:— Patients No. of baths 1943 622 1,689 1944 584 1,481 1945 501 1,511 1946 389 1,128 1947 123 352 36 Maternity and Child Welfare. Midwifery Services. At the end of the year there were 4 permanent and 3 temporary midwives engaged full-time carrying out domiciliary duties as municipal midwives. The three nurses engaged temporarily to assist in the visiting and nursing of mothers as stated in my report for 1946 terminated duty in September and were replaced by full-time temporary midwives. Number of cases attended by them since 1943 is shewn below:— 1943 1944 1945 1946 1947 As Midwives 225 211 172 543 543 As Maternity Nurses 34 31 14 59 49 Totals 259 242 186 602 592 37 TABLE 10. 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 7 7* 14 (b) Employed by Voluntary Associations:— (i) Under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 25 — 5 (ii) Others — 8† 8† (c) In private practice 1 — 1 Totals 33 15 48 Number of cases in the area of the Local Supervising Authority attended during the year by Midwives:— (a) Employed by the Council:— As Midwives 543 408 951 As Maternity Nurses 49 24 73 (b) Employed by Voluntary Associations:— (i) Under arrangements with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936:— As Midwives 403 — 403 As Maternity Nurses 221 — 221 (ii) Others:— As Midwives — 358† 358 As Maternity Nurses — 85† 85 (c) In Private Practice:— As Midwives 7 — 7 As Maternity Nurses 4 — 4 TOTALS:— As Midwives 953 760 1,719 As Maternity Nurses 274 109 383 * Aldersbrook Maternity Hospital. † Employed by Voluntary Hospital (East Ham Memorial). 38 Number of cases in which medical aid was summoned during the year under Section 14 (i) of the Midwives Act, 1918, by a midwife:— (a) For domiciliary cases 250 (b) For cases in institutions 102 Total 352 Maternity Hospital Accommodation. The following statistical information in respect of the year ended 31/12/47 is given:— East Ham Memorial Hospital. Number of maternity cases admitted 512* Average duration of stay of cases in lying-in wards 12 days Number of cases delivered by:— (a) Midwives 358 443 (b) Doctors 85 Number of cases in which medical assistance was sought by midwife in an emergency 73 Number of cases admitted after delivery 7 Number of cases notified as Puerperal Pyrexia — 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) 52 Number of infants wholly breastfed on leaving the institution 396 Number of cases notified as Ophthalmia Neonatorum Number of Maternal Deaths 1 Number of Stillbirths 26 Number of infant deaths within ten days of birth 4 * These include cases admitted on more than one occasion and patients from outside the area. 39 Aldersbrook Maternity Hospital. This institution was opened by the Council on 19/10/46, with a complement of 20 beds. It comprises two wards of six and seven beds respectively, three double cubicles and a single cubicle together with admission unit, labour rooms, sterilizing and bathrooms for the infants, a night nursery and other facilities and equipment to be found in a modern obstetrical hospital. The Unit has provided the additional accommodation urgently required for mothers and has proved of inestimable benefit in those cases where treatment is so necessary on medical or social grounds. Statistics for the year ended 31/12/47 are appended below:— Number of maternity cases admitted 432 Average duration of stay in the lying-in wards 12-14 days Number of cases delivered by:— (a) Midwives 408 432 (b) Doctors 24 Number of cases in which medical assistance was sought by a midwife in emergency 29 Number of cases admitted after delivery 1 Number of cases notified as Puerperal Pyrexia — Number of cases of Pemphigus Neonatorum — 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) 15 Number of infants wholly breastfed on leaving the institution 415 Number of cases notified as Ophthalmia Neonatorum 1 Number of Maternal Deaths — Number of Stillbirths 3 Number of infant deaths within 10 days of birth 4 Dr. Curnock reports as follows:— The Maternity Unit enjoys the hospitality of the Aldersbrook Children's Homes and this pleasant environment has been much appreciated by our patients; their admission has been arranged 40 precisely because their own homes are unsuitable or because they need medical treatment. The Unit is a temporary one, and in order to provide a comprehensive service we have been fortunate to secure the willing collaboration of the pathological, X-ray, and Maternity departments of East Ham Memorial Hospital. Great care has been taken in ante-natal examination and in this connection we wish to acknowledge our indebtedness to Mr. D. G. Wilson Clyne, F.R.C.S., M.R.C.O.G., who has freely given of his time to a number of patients each week in consultation. During the year, 35 patients were admitted for ante-natal treatment prior to their confinement, and this greatly minimised the hazards of labour and ensured smooth convalescence. Analgesics were available to all and were pronounced effective by the large majority. Each mother was instructed in the day to day care of her baby and none went home until she had showed herself confident in its feeding and management; the high percentage of entirely breastfed babies is considered good evidence of the success of this work.. Finally, I would express my gratitude to Matron, Miss G. V. Fuller Assistant Matron, and the nursing team, for loyal, untiring, skilled devotion to duty. During 1947, maternity patients were also admitted to the following hospitals as Council cases:— Institution. No. of cases. Forest Gate Hospital 250 East End Maternity Hospital 64 Queen Mary's Hospital 7 Plaistow Maternity Hospital 8 Whipps Cross Hospital 2 Oldchurch Hospital, Romford 1 Poplar Hospital 1 St. John's Hospital, Chelmsford 1 Essex County Hospital, Wanstead 1 Emergency Maternity Homes 10 Total 345 41 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 31/12/47, the following amounts were collected at the clinics:— £ s. d. Fees for Maternity Hospital accommodation 7,269 2 2 Fees for Municipal Midwifery Service 452 5 2 Fees for Home and Domestic Help Service 338 4 4 Fees for *Other Services 59 9 11 Sale of dried milk and ancillaries 2,961 16 5 Total £11,080 18 0 * T. & A. operations, dental and ophthalmic 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 105 For Municipal Midwifery service 35 T. & A. operations and provision of spectacles 78 Total 218 Ophthalmia Neonatorum. Two cases of Ophthalmia Neonatorum were notified during the year, with the following results:— Vision was unimpaired 1 Patient still under treatment at end of year 1 42 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 19 — — — — — — 19 (ii) at end of year 10 — — — — — — 10 (iii) who died during the year — — — — — — — (iv) on whom inquests were held during the year — — — — — — — — 43 (c) Number of Child Protection Visitors at the end of the year who were:— (i) Health Visitors 10 (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) and (c) Nil Care of Premature Infants (Circular 20/44). Number of babies notified during 1947 whose mothers are normally resident in the borough 170 (a) The total number of premature babies as above who were born at:— Home 64 170 Hospital 106 (b) The number of these born at home:— (i) Who were nursed entirely at home 54 (ii) Who died during the first 24 hours 1 (iii) Who survived at the end of one month 55 (c) The number of those born in hospital:— (i) Who died within the first 24 hours 5 (ii) Who survived at the end of one month 93 The notification of birth cards provide space for the weight at birth when this is lbs. or less, beds are available (when necessary) in Howard's Road Maternity Home. There is no special form of transport provided for conveyance to hospital and all cases (including those in hospital, when discharged) are followed up. 44 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 24 (b) Total number of children in respect of whom notice was given under Section 7 (3) during year 24 (c) Number of children notified under Section 7 (3):— (i) Under supervision at the end of the year 16 (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 Registration of Nursing Homes. The return of the work of the Council during 1947, 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 Nil — — — Homes on the Register at the end of the year Nil — — — Homes deleted during the year Nil — — — Home and Domestic Helps. Daily Guardians as at 31/12/47 Nil Home and Domestic Helps:— No. employed as at 31/12/47—Whole-time 4 Part-time 6 No. of instances such helps provided during 1947 Home helps 106 Domestic helps 6 45 Dental Treatment—M. & C.W. 1947. Expectant and Nursing Mothers :— 1. Number of patients treated 672 2. Number of scalings 117 3. Other operations 264 4. Number of teeth filled 205 5. Number of teeth extracted 829 6. Number of administrations of general anaesthetics 202 Children under 5:— (a) Number treated 329 (b) Number of teeth filled 13 (c) Number of teeth extracted 481 (d) Number of other treatments 99 The number of sessions devoted to treatment of mothers and children was 96. Administration of Analgesics. Number of midwives in practice in the area qualified to administer analgesics in accordance with the requirements of the Central Midwives' Board:— (i) Domiciliary 6 (ii) In institutions 5 The Central Midwives Board during the year approved Aldersbrook Maternity Hospital as an institution to give courses of instruction in the administration of analgesics and at the end of 1947 two of the municipal midwives had undertaken such courses (2 midwives appointed during the year already held the certificate). No facilities are provided for midwives to undertake courses of instruction on the district. Five sets of apparatus have been provided for the use of the municipal midwives. During 1947, no analgesics were administered in domiciliary practice. NOTE.—In the early part of 1948 the remaining municipal midwives attended the above courses of instruction and are now qualified to administer analgesics. 46 East Ham Memorial Hospital was also approved by the Central Midwives' Board on the 5th December. 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 10 Full-time 7 Part-time (25%) (b) Number of visits paid during the year by Health Visitors :— (i) To expectant mothers—1st visits 575 Total Visits 595 (ii) To children under 1 year—1st visits 3,056 Total Visits 8,895 (iii) To children between the ages of 1 and 5 years Total Visits 9,968 Total of all visits to mothers and children 19,458 (iv) Other visits 1,113 (v) Grand Total (Visits) 20,571 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 2,078 (ii) Over 1 year of age 357 Total number of children under 5 years of age who attended at the Centres during the year and who, at the end of the year, were :— (i) Under 1 year of age 1,663 (ii) Over 1 year of age 1,577 Ante- and Post -Natal Clinics. Total number of women who attended :— (i) Ante-natal clinics 2,472 (ii) Post-natal clinics 301 (iii) Total attendances (ante - natal) 11,326 (iv) Total attendances (post-natal) 316 47 The attendances at Infant Welfare Clinics, etc., are shown below:— (a) Attendances (including all infants under 5 except those shown under toddlers) 22,859 (b) Consultations (included in (a) above) 6,676 (c) Immunisation 5,556 (d) Ophthalmic 144 (e) Sunlight 2,502 (f) Toddlers 1,247 Dr. J. A. MacLaren submits the following observations : Infant Welfare Clinics. With the rise in the Birth-rate, there has been a corresponding increase in the number of attendances at Infant Welfare Clinics. Great interest is taken by mothers in Infant Welfare, and a greater number of parents attend the Clinic for guidance and education in infant feeding and food values, also Child Hygiene and the Care and Training of Infants and Young Children. The average mother appears to be coming more diet conscious, and shows more initiative in finding out what to do and what not to do, and is usually very conscientious in carrying out the advice given to her. The health and physique of the average child attending the Infant Welfare Clinics are good, especially under 18 months, as the child is under regular supervision. After that age the attendances at the Clinic are less frequent. Toddlers Clinic. Medical Examinations are arranged at regular intervals for children between the ages of 2 years and 5 years. The mother is invited to attend by appointment with the child so that she may be consulted in order to obtain accurate and valuable information regarding the child. Medical reports are recorded on Special cards and transferred to the School Health Service when the child is five years of age. All defects or serious disease are dealt with in the following way :— 1. At the Clinic (minor defects or ailments). 2. Referred to Specialist Clinic. 3. Referred to Hospital for treatment. 48 Physiotherapy and Light Clinic. Two sessions per week are held for infants under five years who are referred for treatment. During 1947 the total attendances were 2,502. Diphtheria Immunisation Clinic. Two immunisation clinics are held weekly at the Town Hall Annexe and Manor Park. There has been a marked increase in the number of parents who have taken an interest in immunisation against Diphtheria—probably largely due to the amount of recent propaganda on this subject :— 1946 1947 Attendances 2,447 5,556 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 1947—113 cases referred to hospital. Orthopaedic Cases. 42 cases have been referred to Queen Mary's Hospital for treatment. Ophthalmic Clinic. 49 children suffering from defective vision or other ophthalmic conditions have been referred to this clinic. Ante-Natal Clinic. During 1947 the number of patients attending the Ante-Natal Clinics, though very high, was rather less than 1946 which was a record year. Unfortunately, the Maternity Hospital accommodation remains very difficult owing to the large number of applications which still exceeds the number of Maternity Beds available. Total number of individual mothers who attended the Council's Ante-Natal Clinics 2,472 Total number of Ante-Natal Attendances 11,326 49 Day Nurseries. Throughout 1947, the following nurseries were open :— No. of places. School Road 60 Wall End/ Caledon Road 60 St. Stephen's Road 89 Roman Road 84 Total 293 The demand for admission exceeded the number of places available and there was a waiting list at all the nurseries. During the year the numbers attending on Saturdays was small, and in consequence the Committee decided to close the nurseries on these days. Statistics are shewn below : Nursery. Total Attendances. Daily A verage. School Road 12,692 49 Roman Road 18,261 71 St. Stephen's Road 17,194 67 Wall End/ Caledon Road 13,010 50 INFECTIOUS DISEASES. The quarterly returns to the Registrar-General were as follows :— Disease Qtr. ending 31/3/47 Qtr. ending 30/6/47 Qtr. ending 30/9/47 Qtr. ending 31/12/47 Total. Scarlet Fever 47 41 31 60 179 Whooping Cough 147 181 71 31 430 Measles 160 636 164 4 964 Diphtheria 4 6 4 32 46 Pneumonia 61 30 15 37 143 Dysentery — — 1 1 2 Erysipelas 7 6 1 9 23 Cerebro - Spinal Fever 1 — — — 1 Puerperal Pyrexia 1 1 — 3 5 Ophthalmia Neonatorum — — — 2 2 Malaria — — — — — Acute Poliomyelitis — — 6 1 7 Acute Polio-encephalitis — — 1 — 1 50 It will be noted that the incidence of Whooping Cough and Measles sharply declined in the fourth quarter and that there were more than double the notifications of Diphtheria in the last quarter, in comparison with the totals for the first nine months of the year. 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 15. NOTE.—Nine deaths occurred from Diarrhoea, 3 from Diphtheria and 3 from Whooping Cough. The death rate was 0.12 per 1,000 population, as compared with a rate of 0.07 for 1946. No cases of Smallpox were reported during the year under review. The Zymotic death rates, per 1,000 population since 1943, are enumerated below :— 1943 1944 1945 1946 1947 0.15 0.07 0.09 0.07 0.12 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 Po pulation Typhoid Fever 0.01 0.01 0.00 0.01 — Paratyphoid Fever 0.01 0.01 0.01 0.01 — Cerebro - Spinal Fever 0.05 0.06 0.05 0.05 0.00 Scarlet Fever 1.37 1.54 1.37 1.31 1.50 Whooping Cough 2.22 2.41 2.02 2.80 3.62 Diphtheria 0.13 0.15 0.14 0.14 0.88 Erysipelas 0.19 0.21 0.18 0.22 0.19 Smallpox 0.00 0.00 0.01 0.00 — Measles 9.41 9.13 9.58 5.29 8.12 Pneumonia 0.79 0.89 0.68 0.64 1.20 A dash (—) signifies there were no notifications. 51 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. Age at final injection. Total number of children who were given a secondary or reinforcing injection (i.e. subsequent to complete full course). Under 5 5—14 Total 6 months ending 30/6/47 538 146 684 73 6 months ending 31/12/47 1,102 180 1,282 111 Totals 1,640 326 1,966 184 52 Table 20.—DIPHTHERIA IMMUNISATION, 1947. Age at 31/12/47 Under 1 1 2 3 4 5 to 9 10 to 14 Total i.e. Born in Year 1947 1946 1945 1944 1943 1938-1942 1933-1937 under 15 Number Immunised 132 1,233 924 1,101 856 4,079 4,225 12,550 Estimated mid-year child population 1947 Children under five Children 5—14 25,240 10,670 14,570 Diphtheria Notifications and Deaths in Relation to Immunisation. notifications Deaths Age at date of Notification Number of Cases Notified Number of cases included in preceding column in which the child had completed a full course of immunisation Age at date of Death Number of Deaths Number of cases included in preceding column in which the child had completed a full course of immunisation Under 1 — — Under 1 — — 1 2 — 1 — — 2 — 2 — — 3 5 2 3 — — 4 2 — 4 — — 5 to 9 17 8 5 to 9 — — 10 to 14 10 2 10 to 14 2 — Totals 36 12 Totals 3 — 52a Table 21.—VACCINATION. Statistics relating to the Vaccination of Children whose births were registered from 1st January to 31st December, 1946, are appended below :— 52a 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, 1946 Number of these births duly entered by 31st January, 1948, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1948, remained unentered in the "Vaccination Register" on account (as shown by "Report Book") of Number of these Births remaining on 31st January, 1948, 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 1947 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 1947 Col. I Successfully Vaccinated Col. II Col. IV Number in respect of whom Statutory Declarations of Conscientious Objection have been received Col. V Died unvaceinated 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 North East Ham 1,007 Less 1 re -regn., 1924 — Less 1 re-regn., 1926 — Less 2 re-regn., 1945 — Less 1 re-regn., 1946 — Less 1 entry not complete 6 1,001 474 1 — 382 28 6 16 21 73 744 517 South East Ham 555 Less 1 re-regn., 1923 — Less 1 re-regn., 1925 — Less 1 re-regn., 1933 3 552 213 1 — 246 17 1 2 20 52 708 418 Total 1,553 687 2 — 628 45 7 18 41 125 1,452 935 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 1047 614 52b Table 22.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for Year ended 31/12/47. 52b Disease. Cases notified in whole district. Ward Distribution of Cases. No. of Cases removed to Hospital. Total Deaths. At all ages—years. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. At all ages Under 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and Up Scarlet Fever 179 1 55 84 31 4 4 — — — 22 21 15 20 23 15 15 16 13 19 93 — Diphtheria 46 — 9 17 10 2 6 1 1 — 5 3 1 5 5 3 4 14 1 5 45 3 Erysipelas 23 1 — — 1 1 4 — 14 2 3 2 2 2 4 3 — 2 1 4 6 — Puerperal Pyrexia 5 — — — — — 4 1 — — 1 1 1 — 1 — — — — 1 4 — Ophthalmia Neonatorum 2 2 — — — — — — — — — — — 1 — — — 1 — — 2 — Cerebro Spinal Fever... 1 — — — — 1 — — — — — — — 1 — — — — — — 1 1 Pneumonia 143 6 13 13 4 6 20 18 37 26 15 24 9 20 10 13 17 10 9 16 89 70 Dysentery 2 — — — 1 — — 1 — — — — 1 — 1 — — — — — 2 — Acute Poliomyelitis 7 — 2 2 — — 2 1 — — — 1 1 1 1 1 1 1 — — 6 1 Measles 964 52 505 361 31 10 4 1 — — 103 124 35 100 80 67 91 124 81 159 14 — Whooping Cough 430 62 233 121 6 1 6 — 1 — 49 72 22 30 46 25 36 64 33 53 28 3 Acute PolioEncephalitis 1 — — — — — 1 — — — — — — — — — — — 1 — 1 1 52c Table 23.—TOTAL CASES OF NOTIFIABLE DISEASES, 1924-1947. Disease. 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 Small Pox — — — 17 25 70 51 13 1 1 — — — — — — — — — — — — — Scarlet Fever 215 221 350 798 832 743 484 245 779 701 979 411 359 387 287 196 77 68 210 271 132 153 193 179 Diphtheria 128 246 337 464 669 578 473 196 157 180 379 254 134 149 141 91 47 45 49 59 33 31 19 46 Enteric Fever 5 9 7 2 7 2 3 8 7 5 — 2 2 13 15 8 10 3 — 4 — — — — Erysipelas 38 41 41 38 60 49 63 54 55 69 74 55 59 53 71 41 33 23 37 28 18 14 25 23 Puerperal Fever 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 5 Meningococcal Meningitis 1 1 1 4 1 1 3 8 5 1 3 3 — 2 3 3 11 5 12 4 3 1 8 1 Encephalitis Lethargica 9 6 1 2 3 1 — — — 1 1 1 — 1 1 — — — — — — — — — Ophthalmia Neonatorum 6 8 10 12 3 8 6 6 6 9 5 5 6 7 9 7 3 4 1 1 4 2 1 2 Acute Poliomyelitis 1 1 — 5 — 2 — 1 7 2 5 13 2 4 — 2 1 — — — — 1 — 7 Acute Polio Encephalitis — — — — — — — — 3 2 1 — — — — — — — — — — — — 1 Dysentery — — — — — — — — — — 1 — — 3 18 — — — — 6 5 7 5 2 Malaria — — — — — — — — 1 1† — — — — — — — — — — — 1† 3a — Measles Not Notifiable 3 36 460 1091 917 258 1498 815 964 Whooping Cough Not Notifiable — 19 262 227 241 293 67 258 430 Continued Fever — — — — — — — — — — — — — — Not Notifiable Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia 79 91 70 114 82 102 59 75 77 148 100 88 101 111 85 59 42 33 37 72 50 55 97 143 Totals 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 1,803 * Notifiable as Puerperal Pyrexia as from 1/10/37. † Notifiable as Puerperal Pyrexia. † 1 Induced in an Institution. Not notifiable as from 1/10/37. a 1 Induced for therapeutic purposes ; 2 Contracted abroad. 53 INFECTIOUS DISEASES HOSPITAL. Dr. Palmer's observations are contained in the following report upon the work of the hospital :— Preface. During the year 1947, 256 cases were admitted to the Infectious Diseases Hospital. The number of deaths were 11 giving a mortality rate of 4.2%. During the last four months of the year there was a small outbreak of virulent diphtheria, and the available accommodation was very heavily taxed. A study of the final table of admissions after correction for diagnosis reveals the wide variety of cases treated. Diphtheria, though much reduced in morbidity andVnortality, still remains a killing disease and it is essential that the general public be kept aware of its deadly nature and of the value of immunisation. Scarlet Fever remains mild in type, but Whooping Cough still takes its toll of young children. Though the value of immunisation here is not so marked as in Diphtheria, nevertheless I am of the opinion that it is worth doing, as it appears to minimise the severity of the disease. Parents must be made to realise the seriousness of whooping cough and that much chest and heart illness in later life is often due to a severe attack of whooping cough in infancy. Gastro Enteritis in infants and acute poliomyelitis are serious diseases and cases should be hospitalised as soon as suspected. Diphtheria. Number of notified cases 70 Revision of diagnosis 26 Acute Streptococcal Tonsillitis 17 Scarlet Fever 2 Non-Diphtheritic Laryngitis 2 Whooping Cough 1 Cheiropompholyx l Cervical Adenitis l Post Tonsillectomy l Glandular Fever l Final Number of Diphtheria Cases 44 Uncomplicated cases 33 Complicated cases 11 Deaths 2 54 Showing types of Diphtheria and Mortality. Type. Total. Died. Faucial 34 1 Nasal 1 — Laryngeal 2 — Faucial and Nasal 6 1 Faucial, Nasal and Laryngeal 1 — 44 2 Showing Serum Administration. 8,000 16,000 24,000 32,000 48,000 + Total. 1 4 3 6 30 44 Serum was given intravenously on seven occasions. Showing age incidence of Diphtheria. 0 + 5 + 10 + 15 + 20 + 25 + Total. 9 16 9 2 5 8 44 Complications and Paralysis. Palatal Paralysis 6 Internal Strabismus 1 Persistent Albuminuria 1 Myocarditis 4 Sinus Arythymia 1 Facial Paralysis 1 Ciliary Paralysis 1 Pharyngeal Paralysis 2 Diplopia 1 Polyneuritis 1 Tonsillitis 2 Bacteriological Examinations. 812 Swabs were examined for diphtheria bacilli and 58 were found to be positive. 55 Diphtheria Occurring in Immunised Children. 17 cases occurred where there was a history of previous immunisation but in several of the cases it could not be verified whether the complete course of injections had been given. ' There were no deaths. One boy of 11 years was a hypertoxic case of Nasal and Faucial Diphtheria and developed Palatal, Facial, Ciliary, Pharyngeal Paralysis, Diplopia and Polyneuritis. Two other cases presented complications while in the remainder their convalescence was uneventful. In ten cases the Schick test was found to have relapsed from negative to positive. Thus, since the immunity conferred by artificial immunisation is not permanent, a child immunised in infancy should be given a reinforcing dose when it begins school. It has also been advocated that a second " booster " dose should be given at the age of ten years. Scarlet Fever. Number of notified cases 92 Revision of diagnosis 6 Tonsillitis 1 Rubella 2 Measles 2 No evidence of infectious disease 1 Final number of Scarlet Fever cases 86 18 Cases were recommended for tonsillectomy. The disease continued to be of a mild type and responded well to sulphadiazine therapy. There were no deaths. 70 cases were uncomplicated and 16 cases had the following complications. The heart and lung complications responded well to sulphadiazine and penicillin therapy. Complications. Abscess 3 Articular Rheumatism 3 Albuminuria 1 Cervical Adenitis 1 Acute Pulmonary Streptococcal infection ... 1 Endocarditis 1 Icterus 1 Myocarditis 1 Otitis Media 1 Pericarditis 1 Rhinitis 1 Secondary Infection 1 Tonsillitis 2 Total 18 56 Showing age incidence of Scarlet Fever. 0 + 5 + 10 + 15 + 20 + Total 4 3 7 1 1 16 Complicated 23 34 10 2 1 70 Uncomplicated Whooping Cough. Number of notified cases 24 Revision of diagnosis 1 Acute Catarrhal Laryngitis 1 Final number of Whooping Cough cases 23 Deaths 2 Uncomplicated cases 9 Complications:— Broncho Pneumonia 11 Measles 1 Gastro- Enteritis 1 Cerebral Haemorrhage 1 Measles. Number of notified cases 20 Revision of diagnosis 4 Urticaria 1 Rubella 1 Scarlet Fever 1 No evidence of infectious disease 1 Uncomplicated cases 7 Complications:— Broncho Pneumonia 5 Capillary Bronchitis 3 Mastoiditis 1 Penicillin was found to be very effective, combined with sulphadiazine therapy, in the pulmonary complications of Measles and Whooping Cough. Meningitis. Number of notified cases 11 Revision of diagnosis 9 Acute Nephritis 1 Tonsillitis 1 Constipation 1 Bronchitis 1 Cervical Adenitis 1 Idiopathic Epilepsy 1 No evidence of infectious disease 3 There were two deaths. Cerebro spinal meningitis 1 Tuberculous meningitis 1 57 Gastro- Enteritis. Number of notified cases 17 Revision of diagnosis 6 Nervous Dyspepsia 1 Marasmus 1 Mal feeding 1 No evidence of infectious disease 3 Final number of Gastro Enteritis cases 11 Number of deaths 8 Acute Anterior Poliomyelitis. Number of notified cases 11 Revision of diagnosis 6 Sonne Dysentery 1 Measles 1 Mitral Stenosis 1 Influenzal Chill 1 Acute Rheumatism with Endocarditis 1 No evidence of infectious disease 1 Final number of Poliomyelitis cases 5 Number of deaths 2 Cases transferred for Physiotherapy 3 Paralysis:— Diaphragm 1 Intercostals 1 Facial 1 Strabismus 1 Pharynx 1 Palatal 1 Limbs 5 Total 11 Bacteriological examinations, carried out at St. Margaret's Hospital, Epping. Cerebro Spinal fluids 11 Faecal specimens 21 Urine specimens 2 Gastric Juice specimens 1 Blood specimens 4 Pus 2 Final table of admissions during 1947 after correction for diagnosis. Diphtheria 44 Scarlet Fever 89 Acute Dermatitis 1 Acute Nephritis 1 Acute Poliomyelitis 5 Acute Rheumatism 1 Acute Tonsillitis 23 Bronchial Catarrh 1 Broncho Pneumonia 2 Catarrhal Laryngitis 3 Cerebro Spinal Meningitis 1 Cervical Adenitis 8 58 Cheiropompholyx 1 Constipation 1 Gastro Enteritis 11 Glandular Fever 1 Idiopathic Epilepsy 1 Influenzal Chill 1 Mal feeding 1 Marasmus 1 Measles 19 Mitral Stenosis 1 Mumps 2 Nervous Dyspepsia 1 No disease 9 Post tonsillectomy 1 Rubella Sonne Dysentery 1 Spinal Abscess 1 Tuberculous Meningitis 1 Urticaria 1 Whooping Cough 24 Total 256 Cancer. Cancer deaths, 1947 :— Total Deaths ... ... ... 236 Male ... ... ... 119 Female ... ... ... 117 Classification :— 1947 1946 1945 1944 Carcinoma 214 209 191 196 Sarcoma 2 2 3 3 Rodent Ulcer — — — 1 Epithelioma 2 2 4 — Endothelioma — — — 1 Glio- blastoma 1 3 — — Chloroma 1 — — — Hyponephroma 1 — — — Papilloma 1 — — — Unstated 14 9 7 3 Totals 236 225 206 203 59 Table 24.—CANCER DEATHS—PARTS OF BODY AFFECTED. Parts of Body Affected Ages 0-1 1-2 2-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75 and upwards Total Sex M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Buccal Cavity and Pharynx — — — — — — — — — — — — 1 1 — 1 1 1 1 — 1 1 4 4 Digestive Organs and Peritoneum — — — — — — — — — — — — 1 1 10 3 14 12 22 22 12 22 59 60 Respiratory Organs — — — — — — — — — —- 1 1 3 1 7 — 10 1 6 1 1 2 28 6 Uterus — — — — — — — — — — — — — — — 1 — 3 — 1 — 2 — 7 Other Female Genital Organs — — — — — — — — — — — — — 1 — — — — — 1 — 1 — 3 Breast — — — — — — — — — — — 1 — 4 — 3 — 7 — 1 — 6 — 22 Male Genital Organs — — — — — — — — — — — — — — — — 1 — 6 — 5 — 12 — Urinary Organs — — — — — 1 — — — — — — — 1 1 1 6 — 1 3 2 — 10 6 Skin — — — — — — — — — — — — — — — — — — — — 2 — 2 — Brain and other parts of Nervous System — — — — — — — — — — — — — — — — — — — — — — 1 — Other or Unspecified Organs — — — — — — — — — — — — 1 1 — 1 2 2 — 2 — 3 3 9 Totals — — — — — 1 — — — — 1 2 7 10 18 10 34 26 36 31 23 37 119 117 60 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 141 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 1947 was 300 as compared with 257 for the previous year. Of the primary notifications of pulmonary tuberculosis 20.5 per cent, had tubercle bacilli in the sputum. The number of such notifications for the years since 1943 are shewn below :— 1943 1944 1945 1946 1947 264 198 258 257 300 Statistical. The total number of notified cases on the register of the clinic on 31/12/47 was 1,242 (pulmonary and non-pulmonary) or 10.4 per 1,000 of the estimated population as compared with 1,175 or 10.3 per 1,000 population in 1946. Clinic register statistics from 1943 are appended below :— 31/12/43 31/12/44 31/12/45 31/12/46 31/12/47 949 979 1,095 1,175 1,242 Deaths. The number of deaths (1943-1947) from tuberculosis is as follows :— Pulmonary Non-Pulmonary Clinic Register 1943 80 7 73 1944 61 14 63 1945 52 9 58 1946 62 8 70 1947 75 7 78 61 New Cases. The following are the comparative figures for the years 1943—1947 :— 1943 1944 1945 1946 1947 New cases and contacts 1,317 1,034 1,050 1,413 1,541 Number proved after complete investigation to be tuberculous 17.61% 15.75% 24.85% 14.44% 14.47% Attendances Medical examinations 1943 6,580 4,493 1944 6,057 3,969 1945 6,877 4,566 1946 7,640 4,821 1947 9,111 5,406 Consultations at Home of Patients. During the year 21 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. 1943 1944 1945 1946 1947 1,844 1,628 1,922 2,824 3,881 Attendances. The number of new eases, including contacts, was 1,541. Dr. Philip Ellman, Consulting Physician to the Chest Clinic, reports as follows :— This final annual report before the establishment of the National Health Service marks also the completion of my 20th year of service to the Borough, a year that has been memorable, too, for the opportunity the Public Health Committee of the Borough have afforded me of studying in Norway, Sweden and Denmark, antituberculosis measures and, more particularly, methods of prophylactic inoculation against pulmonary tuberculosis. It was my privilege there to meet the pioneers of such methods, notably Professor Wallgren and Dr. Wassen in Sweden, Dr. Heimbeck in Norway and Dr. Winge in Denmark, and I am deeply indebted not only for their hospitality but also for the facilities they afforded me of acquiring practical knowledge of their methods of inoculation in their various hospitals and sanatoria, to which I 62 shall later refer under the heading " Prophylactic inoculation against Tuberculosis." Another outstanding feature of this year has been the introduction of new chemotherapeutic measures in the treatment of tuberculosis which may prove of quite exceptional importance and which merit the detailed description I propose later to give them. At this juncture of time it would seem to me appropriate to review certain statistical features presented by a survey of the work of the Chest Clinic over the past twenty years and illustrated by a series of graphs that are self-explanatory. The actual number of cases notified, no less than the number per 1,000 population, fell steadily until the outbreak of war. The figures of the war years may be a little misleading owing to evacuation and other emergency conditions entirely beyond our control. Moreover, the increases in the post-war years 1946-47 represent the effects of the war on account of the time lag before complete restoration of normal conditions. The increase can also be partly explained by the profitable examination of contacts, made easier by the better co-operation of the general public, for to-day there are few who refuse the opportunity for clinical and radiological examination offered to every home contact. Furthermore, wherever necessary, contacts, especially those of the 0-5 and 15-25 age groups, are kept under a period of supervision, over and above the initial routine examination. Mass radiography is a means of discovering early cases—and ipso facto those more amenable to treatment—which would otherwise have probably gone undetected until such time as the disease had become advanced and was manifesting definite symptoms. It will be seen that the increase is wholly in respiratory cases and that non-respiratory cases have declined generally. The figures for non-respiratory cases among female children during the war are again misleading but the true state is shown by the figures for 1947. Deaths from pulmonary tuberculosis have not followed the post-war upward trend. Here also, however, there must be a lapse of time before the war-time increase in tuberculosis is reflected in an increased number of tuberculosis deaths. 63 Finally, the co-operation of general practitioners in utilising the consultant and other facilities of the Chest Clinic has contributed greatly to the early detection of disease. On the other hand this same co-operation has produced the following interesting and encouraging result : namely that although nearly three times as many contacts and new cases now come to the Chest Clinic the percentage of cases notified as tuberculous has dropped by half. Here can be seen in operation the important psychological factor that a visit to the one-time " T.B. dispensary " is no longer dreaded but is even welcomed and the value of the manifold investigations carried out on the many types of chest disease encountered there is appreciated. The number of X-ray examinations has in 20 years risen from negligible proportions to some 4,000, all of which are now made in the Chest Clinic. These figures illustrate dramatically the astonishing rise in importance of radiology as a part of the work of the Clinic. It will be seen that the number of medical examinations has increased annually, particularly since the war. During 1947 there were nearly three times as many examinations as in 1928 while the actual figures for attendance were multiplied fourfold. Despite advances in radiology and its extended use, thorough clinical examination remains of paramount importance. Unfortunately our record of artificial pneumothorax refills remains incomplete as, prior to 1939 and again from the outbreak of war until October, 1942, clinic cases received this treatment at Hart's Sanatorium. However, the rapid rise during the years for which we have a record illustrates how collapse therapy has come to occupy an increasingly important position in the work of the Chest Clinic. Some Newer Drugs in the Treatment of Tuberculosis. Whilst the sulphonamide era marks the beginning of modern rational drug treatment, we may take it that the sulphonamides have been of negligible activity in experimental tuberculosis, and, although such sulphonamides as promin and diasone have been carefully investigated they are, speaking generally, regarded as too toxic for humans. That, at least, has been our experience in the Sanatorium. 64 With the discovery of antibiotics, among them streptomycin, newer and more promising fields have been opened. More recently some new synthetic chemical substances have been used in experimental tuberculosis, including para-amino-salicylic acid (P.A.S.) which is of low toxicity and may prove more effective than the sulphone derivatives. The combination of P.A.S. and Streptomycin promises favourable results. The historical background of chemotherapy in general and of tuberculosis in particular, has been summarised recently by Hart. Gold, the sulphones, chaulmoogra oil, calciferol and streptomycin are described in detail. Gold salts were shown to have an inhibitory effect in vitro, but this was not confirmed clinically. Sulphones exercise a deterrent effect on animals and on local application, but toxic reactions (e.g. anaemia) render them undesirable. Chaulmoogra oil was tried in view of the morphological and chemical similarities of the bacillus of tuberculosis and that of leprosy, but has not been successful. Large doses of calciferol help in lupus vulgaris, but there is a danger of metastatic calcification. However, a case treated with calciferol showed remarkable results. Streptomycin gives the more promising results: toxic effects (histamine-like responses, "venal irritation," eighth nerve deafness, neuritis and dermatitis) are known but are unusual. So much has been written in the medical and lay press on streptomycin and so often hopes have been falsely raised, that some reference must be made to the subject. American workers, more particularly Hinshaw, Feldman and their colleagues, have well summarised the situation to the present time, and have demonstrated the effectiveness of streptomycin in certain cases of tuberculosis, notably in miliary tuberculosis where its beneficial effect on the clinical and pathological course of the disease was marked. In pulmonary tuberculosis exudative lesions are known to undergo some spontaneous resolution by simple bed rest and hence, in this type of lesion, the part played by streptomycin is not easy to assess. However, the work of several American observers seems to indicate promising results in the treatment of pulmonary tuberculosis where recent exudative disease is the predominant feature. There is reason to believe that streptomycin has some place in tuberculous pneumonia. In extra-pulmonary lesions such as tuberculous lesions of the trachea and larger bronchi, American workers report favourably on 65 streptomycin as a therapeutic agent. Here the combined use of intramuscular and aerosol inhalation treatment appears to be promising. They stress the importance of dosage and technique in the administration of streptomycin. Although the results so far reported have been promising, it is recognised that much remains to be learned concerning the mechanism of action of streptomycin. Whilst in certain cases it has been a life-saving device in others it has proved of little value. The location and age of the lesion rather than its extent or character, appear to be significant. Fresh, acute miliary disseminations may resolve completely and tuberculous meningitis may show prolonged remissions although resistant forms with fatal results can and do occur. In recent acute exudative lung lesions results may be good. In chronic fibro-caseous lesions there may be little if any response. It is to be hoped that, apart from the small quantity of streptomycin available in this country for experimental purposes, a larger supply as in several other countries, will be available for more general use. Some Personal Experiences of the Prophylactic Inoculation against Tuberculosis in Scandinavia. I found the enthusiasm for B.C.G. in Norway, Sweden and Denmark widespread, and most people were convinced of its efficacy as a valuable adjunct in the control of tuberculosis, although several public-health experts emphasised that vaccination should in no way interfere with established anti-tuberculosis measures. I was struck, too, with the little control work done on B.C.G. in any of the three countries, and while I can understand and appreciate the difficulties encountered in this connection, I hope that in this country We shall have an opportunity for remedying this defect in order to produce reliable statistical evidence of the value of immunisation. Such control work as I saw—admittedly the figures were comparatively small—was convincing; but I am of the opinion that "only the most carefully compiled figures in significant quantity will satisfy the statisticians." Although we rightly look to chemotherapy for striking results in the future, I think it is true that in this country a somewhat neglected field of preventive medicine has been protection against tuberculosis by active immunisation in tuberculin-negative 66 jects, more particularly among persons in areas of high tuberculosis morbidity and mortality—e.g. children of tuberculous families, students, nurses, and other young employees in general hospitals and sanatoria where exposure is great and protection difficult. Taking into account the difference in the clinical features of tuberculosis in this country from those I noted in Scandinavia, I felt that their work was highly encouraging. Few will question Heimbeck's original assertion—for which he deserves the highest credit—that tuberculin-negative nurses show a higher incidence of tuberculosis than those who are tuberculin-positive. I was privileged to see with him in Oslo a further extension of this work which more than corroborated his earlier observations. Nothing that I saw impressed me more than the work of Professor Arvid Wallgren, now professor of paediatrics in Stockholm, who has certainly been the pioneer of B.C.G. vaccination in Sweden, having started his work in Gothenburg in 1926. His confidence in the clinical value of B.C.G. remains undaunted although he recognises its limitation and admits that it is not of use except in primary lung tuberculosis. Unfortunately, even Wallgren has, however, had little opportunity for control work. With regard to the respective merits of B.C.G. vaccine and the vole-bacillus vaccine of Wells of Oxford, which is a close competitor of B.C.G., Wallgren's observations to me are not without interest. He urged, from his own experience of vole vaccine, that it would be of the greatest scientific interest and value if we in this country were to use it. He gave me the impression that it would eventually supersede B.C.G. I think there is good evidence of the belief that both methods of inoculation (a) are harmless to humans, (b) increase resistance to tuberculosis, and (c) are of value only in tuberculin-negative subjects. B.C.G. has stood the test of time in many countries and its harmlessness has been established by its practical application on a large scale in many parts of the world. Nevertheless, there is good evidence that the vole-bacillus vaccine has the following advantages over B.C.G.: (a) it is apparently a more potent immunising agent, (b) its virulence is more stable (the varying virulence of B.C.G. in Norway, Denmark and Sweden was noteworthy, and I was told on more than one occasion that some of the strains were losing their virulence), and (c) there is reason to believe that tuberculin allergy following vaccination with it was greater and occurred earlier than that following B.C.G. 67 Let me add a word about the method of administration of the vaccine. Wherever I went in the three countries the intracutaneous method devised by Wallgren was regarded as the quickest, most reliable and practical; and it afforded a more accurate measure of the dosage. All observers were emphatic that complications such as significant abscesses never arose when the injection was truly an intradermal one, but did arise when the technique was bad and some of the solution had been injected subcutaneously. I was given, especially in Denmark, an opportunity of assisting at the B.C.G. vaccinc clinic and I can corroborate this view from what I saw. Such authorities as Herzberg in Oslo, Wallgren in Stockholm, Anderson in Gothenburg, and Winge in Copenhagen strongly favoured this method. The so-called trancutaneous method, cither by scarification or multiple puncture with the Birkhaug-Rosenthal instrument, seemed to meet with little favour for a variety of reasons which space will not permit me to deal with here, and I had an excellent demonstration of it by a great authority. From these impressions I think one is justified in urging that enthusiasm should be tempered with caution. Wisely handled, there is little doubt that immunisation should prove a useful weapon. We have a unique opportunity for starting afresh with adequate control experiments and filling in the gaps which Continental and other workers, often through lack of opportunities and no fault of their own, have omitted. We must furnish sound statistical proof, beginning for preference with a selected group of the population who are exposed to unusual risks of tuberculous infection. It is to be hoped that the Ministry of Health will set up, as soon as practicable, an authoritative committee under the auspices of a body such as the Medical Research Council to institute a clinical trial of what they regard as the most effective method of tuberculosis vaccination. Occupational Therapy. Occupational Therapy continues satisfactorily. The patients attend with great enthusiasm, and the sphere of activity covers a wide range, and attention is paid particularly to the following items:— (a) Individual tuition in craftwork, e.g., basketry, leatherwork, stool seating, embroidery, toymaking, etc. 68 (b) Discussion of future careers of patients and advising re learning of new trade, studying commercial subjects, accountancy, etc. (c) Linking patient up with Education Officer or Ministry of Labour. (d) Approaching new patients with a view to interesting them in some form of occupation, bearing in mind their individual needs. It is hoped that with a full-time Therapist, the work in this field will become more objective, and that the very important task of preparing the patient after Sanatorium treatment to take his place as a useful citizen in the outside world and fit him for productive work to suit his physical condition, will be the normal work of the department. Rehabilitation. In view of the large number of non-tuberculous pulmonary cases which are seen at the Clinic, the problem of physiotherapy and chest remedial exercises is of increasing importance. These cases suffer from chronic bronchitis, emphysema and bronchiectasis, and a large number which are seen at this Clinic now attend the chest remedial exercise class with very satisfactory results. Priority Re-Housing for Tuberculous Patients. In view of the importance of the preventive aspect of the work and taking particularly into account the very real need for patients who have been discharged from a sanatorium to follow the sanatorium regime as advised by us, in their own homes, it is imperative that priority in re-housing should be given to tuberculous subjects if this disease is to undergo any measure of control. Our work is virtually futile unless this matter is treated as of almost war emergency significance. In conclusion, in reviewing 20 years of activity at the Chest Clinic, the progress from the dispensary at Durban House with its primitive facilities to the opening in 1935 by the then Minister of Health, the Rt. Hon. Mr. Arthur Greenwood, of the Chest Clinic which afforded so many modern facilities, clinical, radiological, surgical, administrative and social, gives no little cause for satisfaction. And yet we are aware of deficiencies which still require 69 to be met. The Clinic is dealing with vaster numbers than originally planned. We may look forward under the forthcoming regime to augmented facilities. One positive achievement, of which the Borough of East Ham may well feel proud, is that it was the first Borough to designate the "T.B. dispensary," a term that is now falling into disrepute, by the more comprehensive term "Chest Clinic." Their example is being followed extensively in all parts of the country. May we not also take pride in having been informed recently by a senior physician at the Brompton Hospital that our Out-Patient routine compared favourably with any Out-Patient clinic at the premier chest hospital in the country? This surely embodies the principles formulated by the future National Health Service in its scheme for upgrading and regionalisation. One feature, however, which causes us no little anxiety is the possible complications that may arise from the division of responsibility between the preventive and the therapeutic Health services, the former to be run by the Minister of Health with its staff, the latter to be under the aegis of the local authority, whereas at the Chest Clinic the work of prevention and treatment has hitherto been happily integrated. Finally, I wish to express my very great indebtedness to all my colleagues, without whose help and co-operation the standard of work at the Chest Clinic could never have been achieved. 70 Table 25. ALL FORMS OF TUBERCULOSIS—NOTIFIED CASES ON CLINIC REGISTER. Total No. per 1,000 Pop. Pulmonary Non-Pulmonary Deaths New Cases & Contacts %age found T.B. Attendances Med. Exam. Visits to homes by Drs. X-ray Exam. A.P. Refills M. F. MC FC M F MC FC Pul. NonPul. 31/12/28 1,070 7.35 384 337 55 44 74 50 79 47 117 18 631 28.2 2,398 1,935 15 29 - 31/12/29 1,076 7.29 400 343 41 39 72 49 75 57 124 5 740 26.9 3,120 2,395 34 97 - 31/12/30 1,035 7.00 394 304 37 26 79 51 84 60 123 17 578 29.0 3,796 2,434 53 302 - 31/12/31 991 6.94 371 291 40 30 77 56 75 51 100 15 693 20.5 3,447 2,433 50 352 - 31/12/32 909 6.42 347 275 38 9 62 68 75 35 108 16 511 32.1 3,836 2,788 92 454 - 31/12/33 947 6.79 348 292 34 11 71 77 80 34 99 16 504 33.9 4,051 3,360 98 533 - 31/12/34 959 6.87 351 305 34 9 73 80 74 33 92 15 510 36.4 4,030 3,265 95 663 - 31/12 35 974 7.19 369 327 30 10 68 78 63 29 80 16 548 35.0 3,737 3,006 148 762 - 31/12/36 953 7.03 361 331 22 6 65 82 55 31 97 10 618 29.4 3,733 3,297 96 1,322 - 31/12/37 969 7.39 363 336 23 6 69 92 56 24 80 13 697 28.4 3,793 3,437 82 1,652 - 31/12/38 973 7.51 370 347 24 12 62 90 51 17 81 8 629 23.5 3,709 3,590 65 1,599 - 31/12/39 974 7.67 385 347 26 14 61 93 37 11 71 12 486 30.4 3,467 2,982 30 1,394 105* 31/12/40 879 7.9 349 309 23 9 63 87 31 8 88 13 582 21.99 2,413 1,901 17 1,132 - 31/12/41 809 10.9 331 283 17 6 65 84 19 4 78 8 657 19.77 2,874 2,133 20 1,220 - 31/12/42 860 9.6 361 308 20 11 67 80 13 - 53 15 997 15.65 4,768 3,238 24 1,575 39 31/12/43 949 10.2 400 343 25 10 67 89 13 2 80 7 1,317 17.61 6,580 4,493 26 1,844 419 31/12/44 979 10.7 410 358 23 17 68 88 13 2 61 14 1,034 15.75 6,057 3.969 30 1,628 483 31/12/45 1,095 11.5 462 396 33 25 68 86 18 7 52 9 1,034 24.85 6,877 4,566 23 1,922 331 31/12/46 1,175 10.3 515 411 42 39 66 80 22 - 62 8 1,413 14.44 7,640 4,821 13 2,824 545 31/12/47 1,242 10.4 510 401 79 75 52 61 39 25 75 7 1,541 14.47 9,111 5,406 21 3,831 1,015 * Discontinued 1.9.39. 71 72 73 74 HARTS SANATORIUM. Dr. Palmer reports as follows:— In the statistics of this report I have compared the work done in 1947 with that of 1937. It will be seen how much the work has increased and developed in those ten years. The chief increase is in the amount of active treatment now carried out, and this in spite of the fact that far too many advanced cases have to be admitted since there is no other place for them to go. These cases are really not suitable for a Sanatorium and their deaths upset the morale of other patients besides holding up the admission of suitable cases. Besides early and moderate cases of tuberculosis, I would like to see more cases of lung disease admitted for observation and investigation from the Chest Clinic. A well equipped sanatorium should be able to isolate such cases in cubicles and should offer full clinical, bacteriological, radiological and pathological facilities in order to establish the diagnosis. If proved non-tuberculous, the patient is discharged home or transferred to an appropriate hospital. As is well-known, many diseases simulate Pulmonary Tuberculosis and the diagnosis can only be arrived at after careful assessment. Dr. Philip Ellman, Consulting Physician to the Sanatorium, continues his visits and I wish to express my appreciation of his great help and co-operation. The complete liaison that exists between the Sanatorium and the Chest Clinic is of the greatest advantage to the tuberculous patient. Recently, this association has been further developed. Sister Williams, Sister i/c from the Chest Clinic, now visits the Sanatorium to discuss with the patients any difficulties or problems that can be put right while they still remain an in-patient. These visits are much appreciated. Provision of a House Physician. The great increase of active treatment means that I have to limit and curtail other aspects of Sanatorium treatment that I hold to be essential for the well being of the patient. I wish to spend more time at the bed-side of the patient, giving them more detailed clinical examinations and discussing with them the many difficulties that arise in the life of a tuberculous patient. I wish to have time to give more talks and lectures on the meaning of 75 tuberculosis and the problems that face our patients when they leave the Sanatorium. These patients have many troubles— social, economic and psychological as well as medical, and we wish to help them all we can in these matters. Further, I wish to develop and take an active part in the Occupational Therapy Department and supervise this work more closely. There is definitely too much work for one person to do in detail as it should be done. Besides the clinical work there is a large amount of administration of the various staffs, personnel and grounds that must be done if the Sanatorium is to run smoothly and efficiently. I therefore make a plea for the provision of a House Physician in order that, in the light of present day conception of tuberculosis, every detail of care and attention can be made possible for our patients. Thoracic Surgery. The necessary surgical treatment is performed by Mr. Ivor Lewis, Medical Director of the North Middlesex Hospital, and I desire at this point, to record an appreciation of his work. The patient requiring operative intervention has now only to wait a few weeks instead of many months. The patient, in the case of adhesiotomy and phrenic crush cases, is taken to the North Middlesex Hospital in the morning, and if fit enough, is returned to the Sanatorium the same day. More and more use is being made of surgical intervention in the treatment of Pulmonary Tuberculosis. Laboratory Investigations. A routine monthly sputum examination is done on every patient. When the direct smear is repeatedly negative, then recourse is made to concentration and cultural methods and animal inoculation. Gastric washings and faecal specimens are also investigated when the sputum remains negative. During the year 187 specimens were examined for tubercle bacilli at the laboratory, St. Margaret's Hospital, Epping, and I wish to thank Dr. Frank Marsh, Pathologist, and his staff at St. Margaret's Hospital, for their excellent work and keen and helpful co-operation. Monthly E.S.R. estimations are also performed and are a definite help in assessing progress. Since the laboratory plays a vital part in the diagnosis and treatment of Pulmonary Tuberculosis, the provision of a full-time 76 technician is required. This would enable complete haemotological investigations to be performed much more frequently than is possible at present. A post-mortem room is also required to carry out pathological examinations. Tomography. In some patients, particularly where surgical intervention is being considered, the normal serial postero anterior films, or lateral and oblique films, do not give all the required information re the presence of cavities. At present it is very difficult to get tomographs carried out and I feel that this service should be available for our patients so that they can have the maximum amount of investigation and treatment for their complaint. Occupational Therapy. Occupational Therapy is an essential and special form of treatment and assists and hastens cure and improvement. The Occupational Therapist works under the direct supervision of myself and carries out her treatment on a prescription as to the duration and type of work. Psychologically, it makes the patients feel normal people, which otherwise many of them would not feel. It rouses their interest and attention and it helps to keep up their self esteem which is all important. The recent decision of the Health Committee to recommend the appointment of a full-time Occupational Therapist is excellent and shows appreciation of Occupational Therapy as an essential part of the rehabilitation of the tuberculous patient. The Sanatorium is in urgent need of a proper Occupational Therapy Department. Besides teaching and demonstrating craftwork, the Occupational Therapist links the patient with the Education Officer and the Disabled Resettlement Officer of the Ministry of Labour, and assists the patient in the important aspect of vocational guidance. Dental Department. STATISTICS. Sessions Cases Inspected Cases "Fit" (Dentally) Cases Completed Total Extractions Total Fittings Other Treatment 27 95 M. F. 45 36 30 Dressings 5 Scalings 19 10 16 Denture Easings 3 77 The importance of oral hygiene in disease is well known and especially so in Pulmonary Tuberculosis. The patients much appreciate the work of the Dental Department and are ready to avail themselves of its services. Patients' and Staff Amenities. During the year several concert parties visited the Sanatorium to entertain the patients and they Were much appreciated. The Sanatorium has now become better known in the district and we are having increasing numbers of offers of entertainment. The Sanatorium Library, now incorporated in the Library Department of the Order of St. John and British Red Cross, continues to play an important part in the Sanatorium life. We are, however, in need of a permanent Librarian, and I am communicating with various local voluntary bodies for a volunteer in this respect. At this stage I wish to put forward a plea that the grounds will in future receive adequate attention. I refer particularly to the land surrounding the new Pavilion Ward, where the necessary landscaping and levelling was held up by the war. The present gardening staff is inadequate to undertake this extra work. Also, as there are few amenities for the Nursing and Domestic staffs, could not the old tennis court be renovated? For the past three years, Mr. Dean, from the Education Department, has been attending twice a week, and I wish to thank him for his excellent work and assiduous attendance. He gives the patients talks on general knowledge, arranges quizzes and competitions, etc., and the patients much appreciate his visits. It is hoped in the future to provide facilities for Art Therapy, with the help of the National Association for the Prevention of Tuberculosis. This form of creative and diversional therapy is being successfully carried out at many Sanatoria. The internal and external decorations of the Wards and Nurses' Home and Administrative Offices are in a bad state of repair and it is sincerely hoped that these repairs and repainting, now long overdue, will be executed as soon as possible. 78 Statistics. Admissions. Males 71 Females 58 Discharges (including deaths). Males 73 Females 43 Deaths. Males 7 Females 3 Service Cases. Males 37 Females — Observation and Investigation Cases. Males 2 Females 3 Details of Treatment and Investigations for 1947 as compared with 1937. 1947 1937 Artificial Pneumothorax Inductions 42 28 Artificial Pneumothorax Refills 737 326 Pneumoperitoneum Inductions 27 Not done Pneumoperitoneum Refills 376 Not done Division of Adhesions 14 3 Phrenic Crush Operations 16 — Thoracoplasty Operations 2 — B.S.R. Estimations 791 Not done Sputum examinations 827 670 Pleural Aspirations and Wash outs 25 — Gas Replacements 17 — X-rays 725 381 Screenings 1,500 — 79 TABLE 26.—PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from 1st January, 1947, to the 31st December, 1947. Age Periods Formal Notifications Total Notifications Number of Primary Notifications of new cases of tuberculosis 0— 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— Total (all ages) Pulmonary Males 1 9 8 9 12 11 23 10 14 12 2 111 118 Pulmonary Females 2 11 3 8 14 15 16 9 7 3 1 89 93 Non-Pulmonary Males — 3 2 2 2 — 4 — — — — 13 13 Non-Pulmonary Females — 2 2 — 4 2 1 2 — — — 13 13 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 2 2 3 3 2 5 9 3 3 1 — 33 Pulmonary Females 1 2 1 1 1 2 7 3 1 1 — 20 Non-Pulmonary Males 1 2 2 2 — — — — — — — 7 Non-Pulmonary Females 2 3 3 2 — 1 1 — — 1 1 14 Total 74 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 — — Transferable deaths from Registrar-General 5 2 Posthumous notifications 1 1 "Transfers" from other areas (other than transferable deaths) 47 18 Other Sources, if any (specify) — — Total 53 21 80 Table 27.—RETURN RELATING TO THE WORK OF THE TUBERCULOSIS AND CHEST CLINIC DURING THE QUARTER ENDING 31st DECEMBER, 1947. 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 505 397 76 70 53 62 42 23 558 459 118 93 1,228 (2) Transfers from Authorities of area outside that of the Council during Quarter 3 4 — — — 1 — — 3 5 — — 8 (3) Lost sight of cases returned during the Quarter — — — — — — — — — — — — B. Number of New Cases diagnosed as tuberculous during the Quarter:— — — — — — — — — — — — — (1) Class T.B. minus 15 12 2 8 — — — — 15 12 2 8 37 (2) Class T.B. plus 6 4 1 — — — — — 6 4 1 — 11 (3) Non-pulmonary — — — — 1 1 1 2 1 1 1 2 5 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) 8 9 — 1 — 1 — — 8 10 — 1 19 (3) Removed to other Areas 8 6 — 2 1 — 2 — 9 6 2 2 19 (4) For other reasons 1 1 — — 1 1 2 — 2 2 2 — 6 D. Number of definite cases of Tuberculosis on the Dispensary Register at the end of the Quarter 510 401 79 75 52 61 39 25 562 462 118 100 1,242 80a Table 28.-—TUBERCULOSIS.—Institutional beds and treatment provided directly or through arrangements with other Authorities or Voluntary Institutions 80a for the Quarter ending on 31/12/47. Note : Figures are as on the last day of the quarter. Institution BEDS PROVIDED FOR INSTITUTIONAL TREATMENT PATIENTS UNDER INSTITUTIONAL TREATMENT Total Beds Provided Number of Beds included in previous Column temporarily not available Number of Beds included in second Column vacant but ready for use Ex-Service cases 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 34 40 — — — — 2 7 — — — — — — — — — — 8 — — — 23 30 4 — — — *Dagenham Sanatorium — — — — — — — — — — — — — — — — — — — — — — — — — — — — *†fLangdon Hills Sanatorium — — — — — — — — — — — — — — — — — — — — — — — — — — — — *Abergele Sanatorium — — — — — — — — — — — — — — — — — — — — — — — — — — — Church Army Lads Sanatorium — — — — — — — — — — — — — — — — — — — — — — — — — — — — *Hull After-Care Colony — — — — — — — — — — — — — — — — — — — — — — — — — — — — †Holt Sanatorium — — — — — — — — — — — — — — — — — — — — — — — — — — — — King George V Sanatorium — — — — — — — — — — — — — — — — — — — — — — — — — — — Royal National Orthopaedic Hospital — — — — — — — — — — — — — — — — — — — — — — — — — — 2 1 London Chest Hospital — — — — — — — — — — — — — — — — — — — — — —— — — — — — †Lord Mayor Treloar (Alton) — — — — — — — — — — — — — — — — — — — — — — — — — — — 5 Naylands Sanatorium — — — — — — — — — — — — — — — — — — — — — — — — — — — Papworth Colony — — — — — — — — — — — — — — — — — — — — — — — — — — — — *Whipps Cross Hospital — — — — — — — — — — — — — — — — — — — — — — 2 — — 1 — — Royal Sea Bathing Hospital — — — — — — — — — — — — — — — — — — — — 1 — — — — 4 4 — †St. Mary's Broadstairs — — — — — — — — — — — — — — — — — — — — — — — — — — — †Beech Hill Convalescent Home — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — Totals 34 46 — — — — 2 7 — — — — — — — — — — 10 — 1 — 31 31 29 5 6 6 Particulars of Beds temporarily not available (Col. 3). Institution Number of Beds Closed Reason Number of Patients on Waiting List 1 — — 7 10 6 1 1 — Harts San. 11 12 2 — — — I.D. Hospital evacuated to the Sanatorium, September, 1939. Harts San. 2 7 — — — — Shortage of Nurses † For children only. * Belonging to other Councils. 81 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. On Saturday, March 13th, intimation was given to the public by wireless that the filter beds at the River Lea Works of the Metropolitan Water Board had become contaminated by the overflow of the River Lea. The Board stated that some pollution of the mains had occurred. Immediate arrangements were made locally to publicise the necessity "to boil water before use" and with the willing co-operation of a local printer and an advertising agent posters were prepared and actually posted on hoardings throughout the Borough the next day, Sunday, 14th March. At the same time contact was made with all churches and cinemas and their co-operation sought in warning the public. Later public houses, cafes, restaurants, chemists' shops, Council's institutions, including schools, were visited by the District Inspectors and information given as to the methods necessary to avoid infection. The supply position in this Borough was much less acute than in some of the neighbouring districts. Generally, there was little evidence of lack of supply except at some institutions and factories where consequent upon loss of pressure, it was not possible to fill storage tanks. Measures were taken by the Metropolitan Water Board to meet these requirements. In conjunction with the Board samples of water were taken in various parts of the Borough and all were found to be satisfactory. 82 Factories Act, 1937. The following particulars were supplied to the Director of Statistics, Ministry of Labour and National Service, on the administration of the Factories Act, 1937:— TABLE 29. 1. INSPECTIONS. Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 59 - - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 301 39 22 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 7 - - - Total 366 39 22 - 83 Table 30.—METEOROLOGICAL RECORD—YEAR 1947. 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 56° 11° 40°.9 31°.0 34°.2 16 1.42 0.09 0.20 11th February 42° 13° 33°.4 26°.5 29°.5 7 0.84 0.12 0.24 3rd March 57° 22° 47°.6 35°.3 40°.1 18 4.79 0.26 0.98 29th April 71° 31° 58°.4 42°.2 48°.8 10 1.30 0.13 0.29 2nd & 3rd May 86° 40° 68°.5 48°.8 58°.7 14 0.96 0.07 0.22 3rd June 92° 44° 71°.8 54°.4 64°.5 10 2.59 0.26 1.22 27th July 89° 51° 75°.3 58°.6 65°.9 11 1.69 0.15 0.74 16th August 90° 50° 78°.7 57°.5 68°.5 3 0.20 0.06 0.10 2nd September 82° 41° 71°.7 53°.6 62°.5 8 1.34 0.17 0.91 17th October 71° 32° 61°.1 44°.6 51°.8 1 0.10 0.10 0.10 22nd November 62° 31° 52°.0 42°.6 46°.6 8 0.88 0.11 0.33 9th December Thermom eter under repair 42°.1 16 2.24 0.72 0.47 25th Means and Totals for the Year 92° 11° *59°.9 *45°.0 51°.1 122 18.35 0.19 1.22 27th June * Mean for 11 months. 84 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., M.S.I.A., Chief Sanitary Inspector. With additional inspectorial staff efforts were directed to the resumption of the routine work of the Department and to effect some further recovery from the ravages of war. Follow-up work was more effectively carried out and as a result of 12,945 reinspections 5,460 sanitary notices Were complied, as compared with 1,357 the previous year. Notwithstanding the priority given to work required by sanitary notice, it has to be acknowledged that much energy has been expended to obtain but little improvement. The co-operation of the Council's Housing Department in the prompt issue of building licences has in the majority of cases ensured the completion of works with the minimum of delay. By way of health education, lectures and talks to local organisations were given by the Inspectors, to the mutual benefit of both staff and public. In addition the Department has participated in the training of selected ex-service men as Sanitary Inspectors under the Government rehabilitation scheme. It is pleasing to report that all the students trained in this Department were successful in obtaining the qualifying certificate of the Royal Sanitary Institute and Sanitary Inspector's Examination Joint Board. The staff of the Sanitary Section during the year consisted of one Assistant Inspector, one Shops' Inspector, six District Inspectors, a Deputy and Chief Sanitary Inspector. Of this staff the Assistant Inspector commenced duty in August,1947, and Messrs. Tonkin and Thurston (District Sanitary Inspectors seconded to the Housing Department for the repair of war damage to houses) returned on the 3rd March, 1947, and 17th November, 1947, respectively. There were also one disinfector, one mortuary attendant, two rodent operators, one drain cleaner, one clerk and two typists. The work of the Department was facilitated by the tolerance of the public in realising that only essential work can be carried out in these days of shortage and austerity. 85 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 29,117 (i) Housing. House-to-house — Under Public Health Act 9,202 Re-inspections 12,945 Housing Act, 1936 2,377 (ii) Sanitary Circumstances. Yards and Passages 41 Drainage and Sanitary Accommodation 1,469 Factories (excluding Bakehouses) 39 Workplaces and Outworkers 12 Caravans 4 Re Offensive Fumes 13 Miscellaneous 1,253 (iii) Food Supply. Slaughterhouse 1 Dairies 18 Food Premises 851 Bakehouses 38 Re Sampling 286 (iv) Infectious Disease. Visits 568 (b) Notices.—The number of notices served during the year totalled 5,598 of which 395 were statutory notices. The number of notices complied within the same period was 5,460. 86 (c) Rat Extermination.—A survey of the whole of the Borough under the Ministry of Food—Private Dwellings— Special Scheme commenced in October, 1946, was completed in February of this year. Briefly the work carried out may be summarised as follows Number of premises visited 30,067 Number of premises prebaited 1,231 Number of premises found infested 189 Number of notices served to remedy defects likely to provide egress or ingress 591 Number of notices served in connection with infestations arising from defective drains 115 Of the total number of premises visited 4.1 per cent. were suspected as infested whereas only 0.6 per cent. were found infested. The staff employed on this work comprised: three rodent operators, one clerical/general assistant and the part-time assistance of a drain cleaner, all under the direct supervision of the Shops Act Inspector. The survey and baiting were carried out simultaneously with treatment of the public sewers and indicates in no uncertain manner that this Council's active policy in regard to rodent control work is amply justified, and further that a "free" service to occupiers of private dwelling houses is essential. During the year 2,537 rats were destroyed and 394 complaints received of the presence of rats. Subject to the exigencies of the service the number of rodent operators in the department has been reduced to one. (d) Disinfection and Disinfestation.—Disinfection of premises and articles following infectious disease was carried out in 532 instances and 418 library books were disinfected. The methods employed were consistent with routine practice including steam disinfection when necessary. 87 Disinfestation for vermin of various types was effected at 205 premises, an unusual feature being the number of complaints of beetle infestations. The general application of D.D.T. has considerably simplified the treatment of bug infested houses. (e) Legal Proceedings.—The following statement indicates the legal proceedings undertaken during the year:— Public Health Act 1936—Cases withdrawn (nuisance abated) 7 Food and Drugs Act 1938 2 (/) Drainage.—761 complaints of choked drains were received and in the majority of cases the removal of the obstruction was promptly effected by the Council's drain cleaner. Many and various are the causes of these obstructions, and if more care were exercised by the users, fewer drains would be affected. During the year considerable works of maintenance and repair were carried out, either at the request of or in default of owners. In all cases of war damaged houses rebuilt under the direction of the Housing Department, the existing drainage has been tested and renewed when found defective. (g) Factories.—During the year 51 visits were made to factories, workplaces and outworkers. In cases where reports from H.M. Inspector of Factories were received regarding sanitary disrepair or lack of sanitary accommodation, immediate inspection was made and remedies effected. It is hoped to extend this work of factory inspection during the forthcoming year. 88 TABLE 31. 2. CASES IN WHICH DEFECTS WERE FOUND. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector Hy H.M. Inspector Want of cleanliness (S.l) 4 3 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7)— (a) insufficient 4 2 — — — (6) Unsuitable or defective 10 5 — 4 — (c) Not separate for sexes 4 2 — 2 — Other offences against the Act (not including offences relating to Outwork) 3 1 — 1 — Total 25 13 — 7 — (h) Mosquito Control.—Treatment with larvicide of suspected and infested mosquito ditches and marshlands in the southern part of the borough was again carried out, with apparently successful results. (i) Places of Public Entertainment.—These have been frequently visited for inspection of sanitary accommodation, overcrowding, ventilation and compliance with the standing orders of the Council. Much of this inspection is carried out after normal office hours. (j) Rent and Mortgage Interest Restrictions Acts 1920-1938.— During the year 31 applications were received for certifi- 89 cates in respect of the sanitary condition of houses and 20 certificates were issued. In every instance owners or agents were informally notified that an application had been received, and an opportunity afforded to remedy the defects. Resulting from this informal action it was not necessary to issue certificates in respect of 11 applications. (k) Shops Acts 1912-1936.—The following is a summary of the work carried out:— Visits re Registers 3,857 ,, ,, Closing Hours 1,427 ,, ,, Other matters 424 Total 5,708 (l) Pharmacy and Poisons Act 1933.—948 visits were made in connection with the Council's list of persons entitled to sell poisons included in Part II of the Poisons List. Fifty additional applications were granted. (m) Explosives Act 1875.—Registrations for the storage of mixed explosives (fireworks) necessitated 540 visits. HOUSING. Survey of premises for the Housing Department was continued and during the year 2,377 premises were visited and reports submitted to that Department on the housing circumstances of applicants for rehousing. 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) 12,147 (b) Number of inspections made for the purpose 25,092 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidation Regulations, 1925 - 90 (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 7,808 II. Remedy of Defects during the year without service of formal notices:— Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their officers 5,221 III. Action under Statutory Powers during the year (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936. (1) Number of dwelling houses in respect of which Notices were served requiring repairs - (2) Number of dwelling houses which were rendered fit after service of formal notices:— (i) By owners - (ii) By Local Authority in default of owners - (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied ... 395 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (i) By owners 239 (ii) By Local Authority in default of owners - 91 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936. (1) Number of dwelling houses in respect of which Demolition Orders were made - (2) Number of dwelling houses 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, 1947. 1. Accommodation made available—family units (i) By repair of war damage 6,626 (ii) By requisitioned premises 1,189 (iii) By new housing 949 (iv) By emergency hutments 40 8,804 2. Families rehoused since August, 1945 1,562 3. Cases of overcrowding under Housing Act, 1936, abated by rehousing since August, 1945 (included in 2) 364 4. Total of current applications for rehousing 6,077 92 5. New Housing. Dwellings projected Under construction Completed Temporary 934 94 840 Permanent 571 183 50 Cost-of-Works Rebuilds *628 194 59 Total 2,133 471 949 *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, 1947, 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 were made to butchers' shops and market stalls. No seizure of unsound meat was found necessary and the incidence of surrendered meat was practically negligible. Occasionally, joints have been submitted by customers after cooking, but chiefly their complaints related to the inferior quality and not to the unsoundness of the meat. 93 (2) Food Premises.—The number of inspections made to food premises included 18 dairies, 38 bakehouses and 851 of other premises. Special attention was given to ice cream manufacturers and with the advent of the Ice Cream (Heat Treatment) Regulations, 1947, greater power was vested in the local authority for the more rigid control of ice cream manufacture, thus ensuring better protection of the public against the risk of infection. The prescription of a legal standard for quality is long overdue. (3) Slaughter Houses.—No slaughter house was in use during the year, but seven licences to slaughter animals under the Slaughter of Animals Act, 1933, were applied for and granted. An exploratory committee formed of local authority representatives in South-West Essex considered the provision of a municipal abattoir but deferred their deliberations for the time being, at the suggestion of the Minister of Food. (4) Bacteriological Sampling.—175 samples were submitted for bacteriological examination, 86 milk, 40 ice cream, 1 shepherds pie, 1 liver sausage, 47 water (tap-water 15, swimming baths 27, Wanstead Flats lake 2, wells 3). Special attention was directed to Public Baths water and the Wanstead Flats lake in consequence of the prevalence of poliomyelitis. The following is a summary of milk samples submitted for examination Unsatisfactory Ungraded 1 — Tuberculin Tested (Pasteurised) 2 — Tuberculin Tested (Certified) 4 1 Pasteurised 44 5 Heat treated other than pasteurized 35 11 86 17 Of the 40 ice cream samples, 11 were found to be bacteriologically unsatisfactory. In consequence of inspection and action taken, marked improvement was effected, and only in one instance was it necessary to cancel the registration of premises used for the sale and manufacture of ice cream. 94 (5) Fertilisers and Feeding Stuffs.—3 samples were taken during the year, and were found to be satisfactory. (6) Other Foods.—Considerable time and attention was given to the examination of tinned foods and the co-operation of the local tradesmen in notifying this Department of any foodstuffs which they suspected as being unsound, was appreciated. This examination resulted in the condemnation for human consumption of 6,606 tins, including 561 tins of meat and meat products, 248 tins of fruit, 1,040 tins of fish, 3,111 tins of milk and 1,646 tins or packages of other foods. In addition, the following foodstuffs were condemned as unfit for human consumption, meat 833 lbs., fish 498 lbs., fruit 1,465 lbs., sugar 436 lbs., fats 137 lbs., eggs 1,882, cheese 136 lbs., other foodstuffs 263 lbs. (c) Adulteration. Systematic sampling has been carried out during the year including Sundays and special attention has been directed to obtaining samples of all supplies of milk coming into the borough. The number of samples taken and the Public Analyst's results are shown in the following table:— TABLE 32. Number of Samples Percentage of samples adulterated Examined Found adulterated or below standard Butter 4 — — Cheese 4 — — Coffee 6 — — Lard 3 — — Margarine 6 1 16.6 Milk 152 1 .6 Sausage 23 — — Wines and Spirits 28 1 3.6 Drugs 32 3 9.4 Other Articles 175 10 5.7 Total 433 16 3.7 95 Details of samples adulterated or below standard are described as follows, together with the resultant action:— TABLE 33. Number Informal or Formal Article Adulteration or Deficiency Action taken 4909 F Milk Added water 9% Vendor prosecuted 4943 I Ammoniated Tincture of Quinine Ammonia deficient 70% Formal sample taken 4960 F Ammoniated Tincture of Quinine Deficient in ammonia two-thirds of minimum quantity Vendor cautioned 4969 I Peppermint tablets No appreciable amount of oil of peppermint Formal sample taken. Vendor cautioned. 4983 I Cough Syrup Mould growths Vendor cautioned 5059 I Mixed Herbs 7.1% of sand Formal sample taken. Vendor cautioned 5086 I Dried Parsley 6.2% of sand Formal sample taken. Vendor cautioned 5108 I Fish Cakes Deficient in fish, 7% Formal sample taken. Vendor cautioned. 5111 F Dried Parsley Excess quantity of sand Vendor cautioned 5210 I Salad Dressing Did not comply with standard Old stock—withdrawn 5233 I Margarine Rancid Remainder of stock surrendered 5239 I Melon and Ginger Jam 2.1 grams of tin per pound Remainder of stock surrendered 5250 F Gin 39° under proof Vendor prosecuted 5318 I Malt Vinegar Not pure malt vinegar Vendor cautioned 5323 I Lemon flavouring Flavouring very poor Vendor cautioned 5338 1 Powdered Salad Dressing Did not comply with standard Old stock withdrawn 96 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 1947. The Education Act, 1944, envisaged certain interim provisions in the School Health Services which would have to be reviewed and revised with the coming into operation of the National Health Service Act on July 5th, 1948. These temporary arrangements with General and Special Hospitals, Clinics and Voluntary bodies, took some time to complete, and it could be said that in 1947 they worked smoothly and efficiently within the general organisation of the School Health Service. Details of these measures for a comprehensive diagnostic and therapeutic service are enumerated elsewhere : it suffices here to say that no child under our care suffered for the lack of expert attention, and the free and comprehensive facilities placed at the disposal of the school-children were greatly appreciated and employed. It is apparent that after "the appointed day," the treatment of the sick school-child will form part of the family doctor's duty, for every child will have been placed on the "list" of the practitioner of choice of the parent or guardian. It would be folly, however, to destroy or set aside the system which has been carefully built up for the diagnosis and treatment of sickness, minor ailments, ophthalmic defects, and ear, nose and throat disorders, which entail a minimum loss of schooling time and wastage of parental effort. It is anticipated, therefore, that agreement between the Ministries of Education and Health will enable our School Health Service to continue uninterruptedly to give the best and most efficient medical attention, but some modification of administrative 97 detail might ensue. Proper proportion of the cost of the service will, however, rightly be placed with the Regional Hospital Board and the Local Executive Council of the General Practitioners' Service with whom the financial responsibility ultimately must reside. Looking further into the future it is possible to glimpse the scene where the general medical practitioner takes an integral part, working with colleagues of the School Health Service, in the Health Centres to be provided by the Council. The general practitioners will combine with the School Health staff in a united endeavour, by health education, prophylactic measures, and preventive immunisation, to stamp out much of the incapacitating sickness which is a considerable factor in retarding general scholastic advance in many children. My grateful thanks are due to the Chairman and members of the Education Committee for their invaluable help and support during the year and I am indebted to the Chief Education Officer and teachers, to my Deputy and all the members of the medical, dental, nursing and lay staff for their unremitting co-operation in the maintenance of an efficient school health service. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, Malcolm Barker, School Medical Officer. 98 GENERAL INFORMATION. Schools and Numbers on Roll (mid 1947). TABLE 34. Type. Number of Schools. Number on Roll. Maintained Primary: Infant 16 3,805 Junior 14 5,342 Maintained Secondary 12 3,926 Voluntary 4 700 Totals 46 13,773 Estimated number of children aged 5-14 inclusive (mid 1947) 14,570. 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, Fernhill Street. School Health 99 TABLE 35.—SCHOOL CLINICS. MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY MORNING ANNEXE School Health School Health School Health Physiotherapy Physiotherapy Physiotherapy Physiotherapy Physiotherapy Ophthalmic Ophthalmic (alternate weeks) Ophthalmic Dental Dental (general anaesthetics) Dental Dental Dental Dental MANOR PARK School Health School Health Dental Dental Dental (general anaesthetics alternate weeks) Dental Dental AFTERNOON ANNEXE Immunisation School Health North Woolwich School Health Sunlight Physiotherapy Sunlight Aural Aural Dental Dental Dental Dental Dental MANOR PARK Dental School Health Immunisation Dental Dental 100 COMPARATIVE STATISTICS. The following table indicates briefly the work of the School Health Service during the year 1947 and shows the comparative statistics for previous years. TABLE 36. 1943 1944 1945 1946 1947 Routine and Special Inspections at School: *Maintained Secondary Schools — — 969 1,404 2,614 *Maintained Primary Schools — — 1,741 4,034 3,600 †Secondary Schools 815 46 125 — — †Elementary Schools 4,453 2,844 640 — — Re-inspections at School 2,795 1,368 1,795 2,834 3,209 Inspections and Re-inspections at Clinics 22,135 19,509 14,628 11,571 11,141 General cleanliness visits to schools 276 227 223 256 281 Examinations for cleanliness 28,427 22,573 25,448 30,077 48,514 Nurses' visits to homes 4,124 2,955 1,859 1,404 1,212 *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 Council in their wisdom have decided that biennial inspection of all school-children shall be carried out, to detect incipient disease, faulty posture and early degrees of maladjustment in pupils, and to obviate too long a gap between the onset of these conditions and their discovery and correction. Additional Routine Medical Inspection sessions were arranged to embrace this work, and the rich harvest of this labour will be manifest with the passage of years in a higher level of physique and mental alertness in our pupils, and progressive diminution in "schooling time" lost through minor ailments, mental aberration and behaviour problems. 101 To ensure the attainment of this ideal, insistence must be laid on the continuing need for proper medical inspection rooms, where the doctor can work in privacy, with at least the minimum equipment for the observance of hygienic technique, and a modicum of quiet. Thanks are due to many head teachers who make every endeavour to place the best possible accommodation at the disposal of the visiting medical officers to facilitate this important work. SCHOOL HEALTH CLINICS. The establishment of comprehensive facilities for medical treatment (other than domiciliary care) has resulted in a considerable expansion of the School Health Clinic service. Additional sessions were devoted to the work and the services of a second medical officer employed to relieve the congestion and avoid too great a loss of school time on the part of pupils and " shopping or business time " for parents. The field of activity in these clinics has widened to include the diagnosis and treatment of a variety of medical and minor surgical disabilities. The clinical routine and special examination of school-children, following trends directed by the problems of nutrition which arose during the war, have now been standardised to allow elasticity of interpretation to individual workers in this field. Nevertheless certain basic criteria must be observed and are universally accepted as indicative either of general nutritional defects or a degree of particular avitaminosis. The indelible impress of skeletal rickets, early postural deformities associated with lack of tone in the muscles and bad habits of breathing and standing, constitute a group for selection and treatment. Clinical assessment is notoriously subjective and fallible, but examination of the skin, hair, mouth and tongue, the teeth for caries, the gums for gingivitis, pyorrhoea or bleeding, the eyelids for blepharitis, the eyes for conjunctivitis and corneal vascularisation, and the limbs and neuro-muscular system for muscle tenderness, diminution of co-ordination and vibratory sense, taken in conjunction with other clinical findings, help the school medical officer to arrive at a true summation of the physical 102 assessment for any child in the new A.B.C. grouping required by the Ministry of Education. Gross physical disorders will rarely pass undetected, but incipient conditions such as anaemia which may have a marked retarding effect on the whole of a child's school life will require careful investigation and complete correction. Lastly the effects of rationing on the heights, weights and rate of growth in different age groups of scholars must be carefully assessed in order to ensure that the intake of " protective foods," especially those containing first-class proteins, is sufficient to maintain optimum growth and 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 6,033 Special Inspections: At Schools 181 At School Health Clinics 3,065 Handicapped Pupils 195 For Employment 28 For Special Courses, etc. 143 Re-inspections at Schools 3,209 Re-inspections at Clinics 8,076 103 Medical Inspection and Re-inspection at Schools. TABLE 37. School Infant Junior Secondary I R S I R S. I R S (a) Maintained Primary and Secondary Schools: Altmore 61 — 1 — — — — — — Avenue 67 82 2 198 177 10 — — — Brampton 183 78 1 333 206 17 218 103 4 Central Park 74 22 5 — — — 186 119 2 Cornwell — — — — — — 174 38 — Dersingham 44 — — — — — — — — Essex 121 37 2 — — — 223 178 19 Hartley 186 67 6 176 137 15 — — — Kensington 46 — — 104 — — — — — Lathom — — — 265 234 7 — — — Monega 90 35 1 — — — 222 87 12 Napier 57 25 — — — — 200 179 4 Salisbury 98 33 1 190 123 2 — — — Sandringham 76 49 10 — — — 186 1ll 3 Shaftesbury 141 76 — 391 357 11 — — — Storey Street 27 6 1 36 33 3 — — — Vicarage 85 62 — 137 94 5 130 158 2 Winsor 38 8 — 47 18 4 — — — Wakefield Central — — — — — — 231 — — Boys' Grammar — — — — — — 229 114 — Girls' Grammar — — — — — — 399 44 24 Technical School of Building — — — — — — 145 20 1 (b) Voluntary Schools (R.C.): Castle Street 29 5 — 13 22 — — — — St. Michael's 36 — — 6 1 2 — — — St. Winefride's 60 16 — 33 31 4 — — — Silvertown 28 4 14 20 — — — — Totals 1,547 605 30 1,943 1,453 80 2,543 1,151 71 I.—Periodic inspection. R.—Re-inspection. S.—Special inspection. Age Groups, General Condition, Co-operation of Parents. TABLE 38. Group Total inspected Parents present Requiring treatment *General Condition. A B C No. % No. % No. % No. % No. % I. 1755 1529 87.1 394 22.5 260 14.8 1476 84.1 19 1.1 II. 2910 1768 60.7 522 17.9 334 11.5 2535 87.1 41 1.4 III. 1368 373 27.3 185 13.5 115 8.4 1241 90.7 12 0.9 Totals 1947 6033 3670 60.8 1101 18.3 709 11.7 5252 87.1 72 1.2 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 80.2 315 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 *Described as Nutrition prior to 1947. 104 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 Section 34 of the Education Act, 1944, 195 special examinations have been carried out by approved medical officers, as a result of which, 82 children, ascertained to be within the various categories, were recommended for special educational treatment as indicated in the following table :— TABLE 39. Category Number ascertained Recommendation Day Special School Boarding Special School Ordinary School with special treatment Blind — — — — Partially Sighted — — — — Deaf 3 1 2 — Partially Deaf — — — — Delicate 34 — 34 — Diabetic — — — — Educationally Sub-normal 28 14 — 14 Epileptic 2 — 2 — Maladjusted 1 — 1 — Physically Handicapped 14 6 8 — Suffering from Speech Defect — — — — Nine cases were found to be subject to be dealt with under the provisions of Section 57 of the Act:— Recommended for report to the Mental Health Committee under the provisions of : Section 57 (3) 5 Section 57 (5) 4 105 MEDICAL TREATMENT. Summary of Defects treated at School Health Clinics. Skin: Ringworm 43 Scabies 15 Impetigo 77 Other Diseases 599 Eye Disease 83 Ear Defects 113 Other Defects 208 Total 1,138 Total attendances at School Health Clinics, 13,238. NOTE :—Defects treated (see Table 43) refer to cases treated "under the Authority's scheme and otherwise." 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 90 Number of children attending 528 Number of attendances 1,313 Number of children discharged 399 Defects and Treatment: TABLE 40. Defect Number Observed _ __ Number Treated Referred for Operation Discharged after treatment Tonsils and Adenoids 330 150 132 282 Other Throat conditions 5 5 — 3 Deafness 21 21 — 20 Otitis Media and Discharging Ears 19 16 3 38 Defects of Membrane 29 29 20 Other Ear conditions 43 40 — 17 Nasal Deformities 7 5 2 2 Rhinitis 21 21 — 27 Catarrh 36 36 — 36 Other Nose conditions 17 17 — 15 Totals 528 340 137 460 Note:—Included in figures "Discharged after treatment" are some defects still remaining under treatment at the end of 1946. 106 Of the cases referred for operative treatment, 132 were for the removal of tonsils and adenoids, three for mastoidectomy and two for the removal of a deviating nasal septum. Operations on the mastoid cases were performed by Mr. Savege at the Children's Hospital, Balaam Street. 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. Ophthalmic Clinic. Mr. S. C. Reeve-Flaxman, 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 1946. The following statistics shew the work carried out:— Number of clinic sessions 103 Number of children attending 903 Number of attendances 1,891 Number of children discharged 287 Defective Vision and Squint Eye Disease New cases 373 Treated at Clinic 276 Re-examinations 868 Referred to Hospital 1 Glasses prescribed 638 Glasses obtained 626 Glasses not required 29 Referred to Hospital 5 The case of eye disease referred to hospital was a cyst on the eyelid. The five cases of squint were treated at the Royal London Ophthalmic Hospital. 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. 107 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 101 Number of children completely immunised 326 Number of children re-inoculated 184 Percentage of children of school age completely immunised 57.0 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 36 Non-pulmonary 15 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. Cases. Treatments. Artificial sunlight (General) 386 3,912 Local light 137 1,603 Electrical and Massage 82 104 Remedial exercises 220 1,724 Total attendances—5,892. The appointment of an Orthopaedic Consultant has not yet been made and, when necessary, cases are referred to general hospitals. 108 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 at 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. Hospital Treatment. Agreements in accordance with the provisions of Circular 102 are now in force with the following hospitals:— East Ham Memorial Hospital. Whipps Cross Hospital. The Children's Hospital, Balaam Street. Hospital for Sick Children. Queen Elizabeth Hospital, Hackney. King George Hospital, Ilford. St. Mary's Hospital, Plaistow. Queen Mary's Hospital, Stratford. A comprehensive service embracing all forms of treatment is established. (a) Tonsils and Adenoids. Operative treatment is carried out chiefly at the following hospitals, the number of cases dealt with during the year being indicated:— East Ham Memorial Hospital 283 Children's Hospital, Balaam Street 590 Queen Mary's Hospital, Stratford 45 St. Mary's Hospital, Plaistow 37 (b) Ringworm. Ringworm of the scalp, in suitable cases, is treated by X-Rays at the London Hospital. Treatment has been given in seven cases. 109 (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 in need of convalescence, are recommended for short periods of treatment arranged through the Invalid Children's Aid Association. Such treatment has been prescribed in the following 235 cases:— Non-tuberculous chest conditions 67 Debility following illness or operation 105 General debility and anaemia 40 Cervical adenitis 15 Rheumatism and Chorea 5 Other conditions 3 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. Number of visits paid to schools 281 Number of examinations 48,514 Number of pupils found unclean 676 Number of cleansing notices (Section 54 (2) ) 87 Number of cleansing orders (Section 54 (3) ) — Facilities for treatment of verminous conditions are available at the Cleansing Baths Centre and a routine procedure and investigation of the family as a whole is in operation. 110 A follow-up system has been adopted with the result that the number of children affected has greatly diminished and the sessions for baths treatment thereby materially reduced. In less serious cases treatment has been afforded at School clinics. HOME VISITS BY SCHOOL NURSES. The nurses paid 1,212 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. Reference has been made to the combined service of Health Visitors and School Nurses. DENTAL INSPECTION AND TREATMENT. Miss H. T. Smith, L.D.S., R.C.S., has submitted the following report on the Dental Service :— I have the honour to present my report on the work carried out in the Dental Clinics during the year 1947. The year just ended has seen, for the first time, three full-time Clinics in operation. In my last report, I expressed the hope that with the increase in staff, it would be possible to inspect the school-children in the Borough twice during the year, thereby greatly benefiting the children, particularly those in the higher age groups. A year is too long for an adolescent patient to wait for a routine inspection, as dental caries progresses very rapidly at this age. An annual inspection has one great weakness, notably, if the child were absent at the time of inspection, or for some reason the parents ignored the notice offering treatment, a period of two years would elapse before another opportunity of having treatment would occur and in that time, one or more permanent teeth may have become unsaveable due to lack of conservative treatment. Inspection carried out at six-monthly intervals does give the child a second chance, and the results obtained from the first year have been most gratifying. The number of school-children is approximately 15,000 and during the year, every child has been inspected once and those in 111 the higher age groups—12 to 18 years—twice, the number inspected being 21,033, those referred for treatment numbering 9,240. The number of attendances at the Clinics during the year was 8,733. The above figures show that more than 50 per cent, of the children inspected had sound mouths, an improvement even on the previous year's high percentage. The detailed figures for each age group show that the highest number of sound mouths occurs at the ages of 9 and 10 years. This is probably due to the fact that by the time a child reaches this age, the temporary molars have either fallen out in the normal way or have been extracted, leaving the average mouth with the four first permanent molars and the upper and lower incisors. If the molars have been filled where necessary, the child can hope for a period when the mouth will be free from caries, as very often the upper incisors do not need any attention until adolescence. In the Borough, there has been in the past a definite antipathy towards conservative treatment, this has been mainly due to fear and ignorance, and also the belief that fillings fall out and the teeth have to be extracted later, proving that fillings are a waste of time. The ignorance of the parents may possibly be attributed to the fact that prior to the war, only children up to the age of 11 years were inspected and treated in the Dental Clinics, the older children were not treated at all unless they reported with toothache and had to have the inevitable extraction. During the War, owing to shortage of staff, bombing and other difficulties, treatment was of the simplest. It will be seen, therefore, that the dental education of parents and children in the Borough has been sadly neglected. In the near future, everybody, young and old alike, will have the opportunity of obtaining dental treatment without cost to themselves and it is very important that everybody should realise the value of this part of the Health Service. We do not want this to be a negative form of treatment existing solely for extractions and the provision of dentures. The public must be taught to preserve their teeth and this is where the school service can play such a valuable role. Here in East Ham, we are very conscious of the important part we play in the education of the children and every endeavour is made to enlighten the parents and children in the benefits to be derived from regular conservative treatment. 112 During the past year, talks have been given to parents' Associations and to the children, also each child who attends the Clinics for treatment is given a small booklet telling in simple language " The Story of a Tooth." It explains how a small cavity appears, how the tooth can be saved and the dire results if the little hole is neglected. Explanatory leaflets are also sent out with every notification for treatment. Education of any kind is slow and it is therefore of interest to note that the number of fillings in permanent teeth this year is almost double that of the previous year. The number of permanent teeth extracted has also been rcduced by one-third, the figures being 2,771 permanent fillings and 747 permanent teeth extracted. Included in this last figure are 45 teeth extracted for regulation purposes. These figures, although not yet high enough, give us hope for the future and there are already indications that this improvement is being more than maintained in the year just starting. The number of temporary teeth extracted during the year was 8,122 and the number of anaesthetics given was 1,399. There has been a noticeable increase in the interest taken by parents in orthodontic work. Thirty appliances were supplied and the more difficult and prolonged cases were referred to hospital for treatment. During the year, 27 sessions were devoted to the treatment of patients in Harts Sanatorium. 86 Social Welfare patients were also seen. 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 these patients, who are referred by the Medical Officers of the Maternity and Child Welfare Clinics and they are in general cases of acute pain or discomfort. The question of conservative treatment does not therefore arise, although fillings have been inserted wherever possible. Extractions of temporary and permanent teeth are done under gas or local anaesthesia. Dentures were provided where necessary. Mothers and babies have quite rightly been termed one of the priority classes for dental treatment and plans have accordingly been made to provide a comprehensive service for them. This, 113 however, depends upon two factors, first the acquisition of suitable premises and secondly, the availability of dental surgeons for this work, both, unfortunately, difficult to obtain under present conditions. May I thank the medical and dental officers, nurses and clerical staff for their co-operation during the past year. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. TABLE 41. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups : Entrants 1,755 Second age group 2,910 Third age group 1,368 Total 6,033 Number of other Periodic Inspections — Grand Total 6,033 B.—Other hispections. Number of Special Inspections 3,473 Number of Re-inspections 11,285 Total 14,758 C.—Pupils found to Require Treatment. Number of individual pupils found at periodic medical inspection to require treatment (excluding dental diseases and infestation with vermin). Group For defective vision (excluding squint) For any of the other conditions recorded in Table 42A Total individual pupils Entrants 13 385 394 Second age group 127 405 522 Third age group 6O 129 185 Total (prescribed groups) 200 1,919 1,101 Other periodic inspections — — — Grand Total 200 1,919 1,101 114 TABLE 42. A.—Return of Defects found, by Medical Inspection in the year ended 31 st December 1947. Defect or Disease Periodic Inspections Special Inspections No. of defects No. of defects Requiring treatment Requiring to be kept under observation, but not requiring treatment Requiring treatment Requiring to be kept under observation, but not requiring treatment Skin 64 15 880 38 Eyes—a. Vision 200 184 170 126 b. Squint 5 15 14 26 c. Other 50 86 169 122 Ears—a. Hearing 7 5 34 15 b. Otitis Media 4 3 44 4 c. Other 20 9 127 23 Nose or Throat 401 399 1,139 538 Speech 8 14 9 19 Cervical Glands 8 13 60 24 Heart and Circulation 13 12 7 24 Lungs 31 34 38 30 Developmental— a. Hernia 3 9 3 4 b. Other 8 14 13 22 Orthopaedic— a. Posture 38 24 8 16 b. Flat Foot 39 22 33 35 c. Other 38 34 35 37 Nervous system— a. Epilepsy 3 4 7 14 b. Other 31 30 66 54 Psychological— a. Development 12 15 20 24 b. Stability 4 4 11 4 Other 182 182 1,673 303 B.—Classification of the General Condition of Pupils Inspected during the year in the Age Groups. Age Groups Number of Pupils Inspected A (Good) B (Fair) c (Poor) No. 0/ /o No. 0/ /o No. °/ /o Entrants 1,755 260 14.8 1,476 84.1 19 1.1 Second age group 2,910 334 11.5 2,535 87.1 41 1.4 Third age group 1,368 115 8.4 1,241 90.7 12 0.9 Other Periodic Inspections - - - - - - - Total 6,033 709 11.7 5,252 87.1 72 1.2 115 TABLE 43. TREATMENT TABLES. GROUP I.—Minor Ailments (excluding Uncleanliness). (a) Number of Defects treated or under treatment during the year Skin—Ringworm—Scalp : (i) X-Ray treatment 7 (ii) Other treatment 6 Ringworm—Body 49 Scabies 61 Impetigo 77 Other skin diseases 649 Eye Disease—external and other but excluding errors of refraction, squint and cases admitted to hospital 83 Ear Defects—excluding treatment for serious diseases (operative treatment in hospital) which are recorded in the body of the Report 113 Miscellaneous (minor injuries, bruises, sores, chilblains, etc.) 244 Other conditions not classifiable under the above headings 1,511 Total 2,800 (b) Total number of attendances at Authority's minor ailment clinics 13,238 GROUP II.—Defective Vision and Squint (excluding Eye Disease treated as Minor Ailments—Group I.) No. of Defects dealt with. Errors of Refraction (including squint) 1,241 Other defect or disease of the eyes (excluding those recorded in Group I) 126 Total 1,367 Number of Pupils for whom spectacles were : (a) Prescribed 638 (b) Obtained 626 116 GROUP III.—Treatment of Defects of Nose and Throat. Total number treated. Received operative treatment: (a) for adenoids and chronic tonsillitis 956 (b) for other nose and throat conditions 3 Received other forms of treatment 328 Total ... 1,287 GROUP IV.—Orthopaedic and Postural Defects. (a) Number treated as in-patients in hospitals or hospital schools 4 (b) Number treated otherwise, e.g. in clinics or out-patients departments 74 GROUP V.—Child Guidance Treatment and Speech Therapy. Number of pupils treated : (a) under Child Guidance arrangements 88 (b) under Speech Therapy arrangements 27 TABLE 44. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Authority's Dental Officers :— (a) Periodic age groups 21,033 (b) Specials 1,315 (c) TOTAL (Periodic and Specials) 22,348 117 (2) Number found to require treatment 9,240 (3) Number actually treated 4,671 (4) Attendances made by pupils for treatment 8,733 (5) Half-days devoted to :—(a) Inspection 182 (b) Treatment 1,034 Total (a) and (b) 1,216 (6) Fillings : Permanent teeth 2,771 Temporary teeth 232 Total 3,003 (7) Extractions : Permanent teeth 747 Temporary teeth 8,122 Total 8,869 (8) Administration of general anaesthetics for extraction 1,399 (9) Other Operations : (a) Permanent teeth 1,039 (b) Temporary teeth 569 Total (a) and (b) 1,608 TABLE 45. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorised persons 48,514 (ii) Total number of individual pupils found to be infested 676 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 87 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) - Printed by the G. W. DRAY & SON, LTD. Market Street, East Ham, E.6