EAS 25 LIBRARY COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1948 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 Health; Chief Tuberculosis Officer. CORRIGENDUM Page 10, Third Paragraph, Sixth Line, for "apprisal" read "appraisal." COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1948 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 Health ; Chief Tuberculosis Officer. PRINCIPAL CONTENTS. Sections:— Page Constitution of Council 3 Public Health Staff 4 Introduction 7 Statistical and Social Conditions of Area 11 General Provision of Health Services 18 Infectious Diseases 32 National Health Service Act, 1946:— Sec. 22 Care of Mothers and Young Children 45 Sec. 23 Midwifery Services 50 Sec. 24 Health Visiting Services 53 Sec. 25 Home Nursing Services 54 Sec. 26 Vaccination and Immunisation 54 Sec. 27 Ambulance Services 56 Sec. 28 Prevention of Illness, Care and After- Care 57 Sec. 28 & 51 Mental Health Services 59 Sec. 29 Domestic Help Services 64 Sanitary Section and Housing 66 Inspection and Supervision of Food 72 School Health Service:— Introduction 77 Report 79 EAST HAM CORPORATION. COUNCIL (shewing Chairmen and Vice-Chairmen of Health, M. & C. W., Mental Health and Education Committees). The Mayor: Mrs. Councillor Winifred May Knight, J.P. The Deputy Mayor: Mrs. Councillor Eleanor Mary Fell. Aldermen: Charles William Brading, J.P., C.R.P. Thomas William Burden, C.B.E., J.P., M.P. Charles William Dixon. (1) Sydney Arnold Elson. (5) Richard John Fell. Herbert Percy Jackson. (7) Thomas Irwin Lethaby, J.P. Edward Francis Markey, J. P. (6) Annie Taylor (Mrs.), J.P. Frederick Welch, J.P. Councillors: William Henry Whittock Beecham. Leslie Al.fred Victor Bennett. (2) Joseph John Gillard Bishop. Ethel Maud Charlotte Brace (Mrs.). Agnes Ann Bradshaw (Mrs.). Charles Frederick Chapman. (3) Annie Maud Clark (Mrs.). Frederick George Pryer Clayton. Edwin John Davey. Elsie Mary Devenay (Mrs.). Eric Edward Thomas Digby. Francis William French. (4) Florence Matilda Goodchild (Mrs.). Leonard Lewis Griffiths. John Albert Hart, J.P. Henry Joseph Hooper. Frank Herbert Howard. Walter Edwin Hurford. William Innes Jackson, J.P. Albert Edward Johnson. John Alfhred Kemp. Arthur George Murrell. Oakes. Idris Glyndwr Price. Alfred Prior. Frank Owen Reynolds. Lily Sutton (Mrs.). James Ernest Taylor. (8) Ernest Albert Wood, J.P. Co-opted Members of the Maternity and Child Welfare and Mental Health Committees:— Mrs. A. M. Burrell, E.C.C. Coun. Mrs. S. Candy Maternity Mrs. D. A. Phillips"! .. . Mrs. S. Jackson and Child Mrs. C. Boar j."™ Mrs. C. Robertson Welfare Mrs. E. Tansley J ealttl Mrs. D. Turner (1) Chairman of Health Committee. (2) Vice-Chairman of Health Committee. (3) Chairman, Maternity and Child Welfare Committee to 21/12/48. (4) Chairman, Maternity and Child Welfare Committee from 22/12/48. (5) Chairman of Mental Health Committee. (6) Vice-Chairman of Mental Health Committee. (7) Chairman of Education Committee. (8) 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., B.S., M.R.C.S., L.R.C.P., D.P.H., Deputy Medical Officer 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. 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., M.R.C.S., L.R.C.P., D.R.C.O.G., D.C.H., Obstetrical Officer to Aldersbrook Maternity Hospital and Assistant Medical Officer for M. & C. W. Ernst Cohn, M.D., Assistant Medical Officer (temporary). Katiierine H. Foley, M.R.C.S., L.R.C.P., Temporary Medical Officer, Aldersbrook Maternity Hospital and Children's Homes. Sylvia MacMii.lan, M.B., B.S., M.R.C.S., L.R.C.P., Assistant School Medical Officer. Stella Margaret Beryl Perry, M.B., Ch.B., D.P.H., Assistant Medical Officer. Medical—part-time. Philip Ellmam, M.D., F.R.C.P., Consultant, Tuberculosis and Chest Clinic and Harts Sanatorium. S. C. Reeve-Fi.axman, M.R.C.S., L.R.C.P., Ophthalmic Surgeon. R. Savege, M.B., Ch.B., F.R.C.S. (Edin.), Aural Surgeon. E. O'Moore, M.B., B.Ch., B.A.O. N. J. Lawler, M.B., B.Ch., B.A.O. | Public \ accinators. H. Bevan Jones, M.R.C.S., L.R.C.P., Psychiatrist. B. Dental Surgeons:— Hilda T. Smith, L.D.S., R.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 Inspectors:— R. A. Baskett, B.E.M., M.S.I.A., Chief Sanitary Inspector, Food and Shops Act Inspector. W. H. Thurston, M.S.I.A., A.R.S.I., R.P. D. G. Tonkin, M.S.I.A. W. J. Worley, M.S.I.A., A.R.S.I. L. Pinguey, M.S.I.A. R. Daw, M.S.I.A. V. C. Quin, M.S.I.A. J. A. Dawson, M.S.I.A. 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:— Vacant. Matron, Harts Sanatorium:— M. J. King, S.R.N. Superintendent Health Visitor:— A. A. Woodman, M.B.E., S.R.N., S.C.M., M.R.S.I. (H.V.'s Cert.). 5 Unified Nursing Service (Health Visitors and School Nurses):— 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.). 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.). P. Cullis, S.R.N., S.C.M. (H.V.'s Cert.). D. M. Sisman, S.R.N., S.C.M. (H.V.'s Cert.). W. M. White, S.R.N., S.C.M. (H.V.'s Cert.). A. I. Childs, S.R.N., S.C.M., A.R.S.I. M. H. Nunn, S.C.M. C. G. Case, R.F.N., A.R.S.I. V. Olifent, R.F.N. C. M. Strachan. Physiotherapist and Light Sister:— E. 13. Broome, S.R.N., C.S.M., L.E.T., M.S.R. G. O. Sainsbury, C.F.P., D.P.T., R.I.P.H. & H. Tuberculosis Nurses:— F. M. Williams, S.R.N., T.A. (Cert.). M. Stokes, S.R.N., S.C.M., T.A. (Cert.). H. O. Ford, S.R.N., T.A. (Cert.). E. I. Sayers, 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. M. E. Kinsella, S.R.N., S.C.M. S. J. Miller, S.C.M. (temporary). E. Gii.ton, S.C.M. (temporary). E. Lloyd-Owen, S.C.M. M. F. Brady, S.R.N., S.C.M. (temporary). M. A. Reynolds, S.R.N., S.C.M. E. Mental Health :—- Duly Authorised Officers :— W. R. Elledge. S. Rapson. J. H. wlckens. Mrs. M. A. Pearce. E. J. Steadman (Petitions Officer). F. Other Staff :— A. H. Bleaden, Supervising Officer, M.D. Training Centre. H. L. Kingston, Home Teacher, Blind Persons Acts. W. L. Narborough, Dispenser (temporary). A. W. Lywood, Guide and Assistant (temporary), M.D. Training Centre. G. Clerical Staff Chief Administrative Clerk, T. B. Clark. Senior Clerk, B. E. R. Hartley, A.C.I.S, 6 Male Clerks:— C. J. Hayes. H. J. Horsnell. J. C. Childs. B. G. Boar. D. E. Ross. T. J. Gilbert. B. J. Curling. R. C. Thorogood. J. F. J. Thomas (Mental Health). And Temporary Clerks. Shorthand Typists:— D. Gordon, Senior. D. G. Cannell. F. Burton. F. A. Perkins. E. R. A. Paddon. G. C. MacLean. And Temporary Staff. Female Clerks:— M. A. R. Gaster. F. C. Wells. B. Clandillon. J. Mackintosh. M. D. Ubee. B. H. White. F. M. Clark. L. L. Cundai.l. S. A. Moss. And Temporary Staff. 7 COUNTY BOROUGH OF EAST HAM Public Health Department, Town Hall Annexe, E.6. July, 1949. 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 nay Annual Report as Medical Officer of Health and School Medical Officer for the year 1948. The Minister, in a memorandum dealing with its preparation, states that as regards some aspects of the health services the Medical Officer of Health will report in regard to the first half of the year before the changes which took effect under the National Health Service Act, 1946. If a local health authority under the Act, his report should include a review of the working of all the local health services provided under Part III of the Act since 5th July. 1948—for this reason it will be seen that the report is submitted in two parts. The Registrar-General's mid-year estimate of the population was 121,100, an increase of 2,430 persons. The number of inhabited houses has risen during the year by 1,188. The building programme and generous rehousing schemes undertaken by the Council have already made a considerable contribution towards improving the health of rehoused families in the community. The effect of housing on health cannot be over-estimated. Much personal, mental and physical disability is engendered or accentuated by overcrowded or inadequate living conditions. As was anticipated, the birth rate has not reached the high level of last year but at 18.1 per 1,000 of the population it gives a favourable indication of the age incidence of residents of the borough. The infant mortality rate shews further decline from 30 to 26 per 1,000, whereas that for England and Wales is 34. Similar statistics for the past three years have been the lowest respectively in the history of East Ham, and for 1948 I have pleasure again in recording this fact, a laudatory commentary on the health work of the borough. Fifty years ago in this borough one baby in seven did not survive the first year of life—today not one infant in forty shares this unhappy fate ! 8 In many cases day-nursery provision played some part in the reduction of infant mortality and also in the maintenance of health in older groups of children. Many mothers longed for a dayminding creche, which afforded a break in the daily routine of their lives. A strong plea is made for the continuance of day nurseries. Whilst appreciating the influence of the home, the demand in East Ham for places in nurseries is so overwhelming that in addition to the many applications from mothers desirous of engaging in industry there are waiting lists of children for whom admission is sought on priority grounds. The neo-natal mortality (deaths of children under one month) was 14.5 per 1,000 live births. The actual figure was 32 of which 15 fall into the category of "prematurity" and others were due to congenital malformation or birth injuries. Much can yet be accomplished to prevent the hazards of prematurity in the improved ante-natal supervision of diet and hygiene of the gestation period. To relieve the expectant mother of the heavy tasks of daily housework during the last weeks must reduce the number of premature births and in this the home help scheme should play an increasingly important part. The introduction of scientific methods of blood testing has undoubtedly saved the lives of a number of so-called " Rhesus " babies and spared the mothers much unnecessary suffering. It is recognised that we are down to bedrock in the battle for the reduction in neo-natal mortality and morbidity, and only the finest weapons of medical science and painstaking clinical study will protect infants in these categories. Such statistics mirror the sustained high standard of our maternity and child welfare services despite the continued shortage of trained health visitors. However, new schemes are coming into operation for the training and employment of selected nurses as health visitors, the ultimate result envisaged being the enhancement of our child welfare educative and advisory service within the home, and it is hoped thereby to achieve a still further reduction in infantile mortality and morbidity. Indirect reference has already been made to the advent of the National Health Service Act on July 5th, 1948, and we are now able to present a profit and loss account to the burgesses, since the appointed day. 9 Gone is the exclusive use of the hospital for infectious diseases, the sanatorium for tuberculosis at Woodford, and the Chest Clinic. Gone is the great boon to the borough in the lien on half ownership of the Runwell Mental Hospital now transferred as a leading south of England research and mental treatment centre under the Regional "Hospital Board. Tolmers Park Hospital where our chronic sick could find respite from their sufferings amidst idyllic surroundings is available no longer. The benefits of these carefully planned and ably administered institutions are now shared in true democratic manner with neighbouring boroughs which, through lack of funds, forethought or initiative, made no such provision for themselves. As a result, there is a four-fold increase in waiting time for admission of adults to sanatorium, and great difficulty is experienced in finding beds in hospital for cases of chronic sickness, and we are beginning to feel the pinch in the disposition of mental and mentally defective patients in available institutions. On the credit side, children suffering from all forms of tuberculosis are more expeditiously placed in appropriate institutions and the home help and home nursing services have been augmented to assist households burdened by the presence of acute or chronic illness The comprehensive free ambulance service has also remedied an outstanding social need, whilst the strengthening of the maternity and child welfare service has already been noted in effecting signal advances in health education. For the time being the Aldersbrook Maternity Hospital is still available exclusively for the use of East Ham mothers, and is administered by the Health Committee. Lastly, plans are being formulated for the establishment of health centres, the focal points of community medical practice of the future, where general practitioners and local authority staffs will work together in harmony under one roof for the first time, to give a comprehensive medical service to every family in the borough. The loan cupboard service for nursing equipment and medical and surgical ancillaries will further increase the benefit and efficiency of sick nursing within the home. Arrangements for the prevention of illness in the provision of convalescence and short-stay recuperative rests in suitable country and seaside homes for both children and adults, together with the 10 good preventive and after-care work of the duly authorised officers in the mental health service, have contributed not a little to the happiness and maintenance of health of a section of the community. To some it would appear that even within the short period of the duration of the Act, there is some measurable compensation for the material losses incurred, but looking into the immediate future one sees immense potentialities for good in the development of the health services of the borough under the new legislation. The Council's proposals were approved by the Minister without material alteration and these now constitute the basis for the implementation of the National Health Service Act, 1946, applicable to the County Borough of East Ham as a local health authority. The requirements necessitated a survey of all health services over a wide field with an accurate apprisal of present needs and future expansion. In the compilation of data and consideration of appropriate recommendations, I desire to acknowledge the invaluable help of Dr. J. S. Coleman, Deputy Medical Officer of Health, and Mr. T. B. Clark, Chief Administrative Clerk. I am grateful to the Chairman and members of the Health Committee and to those of the Sub-Committees for their continued confidence and assistance. I wish also to thank the members of my staff and other colleagues who have contributed so much to the success of the health services. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Malcolm Barker, Medical Officer of Health. 11 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—1948 121,100 Number of inhabited houses (end of 1948 according to rate books) (including tenements and shops) 32,688 Rateable value at 31st December, 1948 £717,972 Sum represented by a penny rate for the year 1948 £3,000 (estimated) Extracts from Vital Statistics. Total Males Females Live Births Legitimate 2,129 1,126 1,003 Illegitimate 65 33 32 still births Legitimate 45 23 22 Illegitimate 1 1 — Deaths—Total 1,172. Males 617. Females 555. Deaths from Puerperal causes:— Rate per 1,000 Total Deaths (Live and Still) Births Puerperal Sepsis 1 0.446 Other Maternal Causes 1 0.446 Total 2 0.892 Deaths of infants under one year of age:— All infants per 1,000 live births 26 Legitimate infants per 1,000 legitimate live births 26 Illegitimate infants per 1,000 illegitimate live births 15 Deaths from Cancer (all ages) 202 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years) 3 12 Still Births. The number of still births registered was 46 compared with 61 for the previous year. The rate per 1,000 total (live and still) births was 20.5, the figure for 1947 being 21.06. The still birth mortality rates for England and Wales and East Ham are shewn in the following table:— Still births per 1,000 population. 1938 1944 1945 1946 1947 1948 England and Wales 0.60 0.50 0.46 0.53 0.50 0.42 East Ham 0.52 0.49 0.53 0.56 0.51 0.38 The rates for East Ham per 1,000 total (live and still) births for the past five years are indicated below:— 1044 1945 1946 1947 1948 No. of still births 45 51 64 61 46 Rate per 1,000 total births 23.04 28.4 24.2 21.06 20.5 Births. The number of live births registered was 2,194, as compared with 2,835 for the year 1947, equivalent to a birth rate of 18.1 per 1,000 of the population — the figure for the previous year—28.8. A comparison of the statistics for the period since 1944 is appended below:— 1944 1945 1946 1947 1948 No. of Births (East Ham) 1,908 1,742 2,577 2,885 2,194 Birth rate (East Ham) 20.9 18.2 22.69 28.8 18.1 „ (England & Wales) 17.6 16.1 19.1 20.5 17.9 Deaths. The number of deaths of residents dying within or without the district was 1,172, as compared with 1,400 for the year 1947. The death rate was 9.67, that for the previous year being 11.79. Of the total deaths, 581 or 49 per cent. died in institutions. The number of residents who died outside the area and whose deaths were assigned to the Borough was 574. The number of deaths of persons non-resident in the area was 46. The percentage of total deaths in the age groups was as follows:— Under 1—5 5—15 15—45 45—65 65 and 1 year years years years years over 5% 0.7% 1.1% 9.5% 23.5% 60% 13 For the period 1944—1948 the death rates for England and Wales and East Ham are compared:— 1944 1945 1946 1947 1948 England and Wales 11.6 11.4 11.5 12.0 10.8 East Ham 14.4 12.9 10.6 11.79 9.67 Infantile Mortality. Deaths of infants under one year numbered 58—equivalent to an infant mortality rate of 26 per 1,000 live births, the rate for the previous year was 30. The rate for England and Wales for 1948 was 34. The number of deaths of illegitimate children under one year of age was one out of a total of 65 illegitimate live births, giving a mortality rate of 15 as compared with a figure of 49 per 1,000 illegitimate live births for the year 1947. The infantile mortality rates since 1944 are as follows:— 1944 1945 1946 1947 1948 England and Wales 46 46 43 41 34 East Ham 31 36 30 30 26 Illegitimate births and mortality rates for the Borough since 1944 are tabulated below:— 1944 1945 1946 1947 1948 No. of illegitimate births 82 105 108 102 65 Mortality rate per 1,000 illegitimate live births 48 38 18 49 15 Neo-Natal Mortality. Children dying under the age of one month totalled 32, equal to a neo-natal mortality rate of 14.5 per 1,000 live births. These rates from 1944—1948 are compared below:— 1944 1945 1946 1947 1948 17.3 19.5 19.4 17.6 14.5 The causes of death of these children under one month of age were as follows:— Cause. No. of Deaths Pneumonia 1 Diarrhoea and Enteritis 1 Premature Births 15 Congenital Malformations, Birth Injury, Infantile Diseases 15 Total 32 14 Maternal Mortality. The number of maternal deaths was 2, the maternal mortality rate per 1,000 live and still births for 1948 was 0.892. Population. The Registrar-General's estimate of the population to the middle of 1948 was 121,100, an increase of 2,430 compared with that for the previous year. The rates per 1,000 of the population mentioned in this report are based on this estimate. POPULATION OF EAST HAM—1851—1948. (Population in Thousands.) Populations for 1851, 1861, 1941 and 1948 are estimated, all others census populations. Decrease in 1941 due to enemy action involving evacuation. 15 INFANTILE MORTALITY RATES (per 1,000 live births) EAST HAM Table 1.—BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 194S. 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. Acute Poliomyelitis & Polioencephalitis. Pneumonia. Whooping Cough. Diphtheria. Influenza. Smallpox. Tuberculosis. Total Deaths under one year. Deaths from Diarrhoea and Enteritis (under 2 years). England and Wales †l7.9 †0 .42 †10.8 0.00 0.01 0.41 0.02 0.00 0.03 — 0.51 34* 3.8 120 County Boroughs and Great Towns, including London 20.0 0.52 11.6 0.00 0.01 0.38 0.02 0.00 0.03 - 0.59 39 4.5 148 Smaller Towns (resident populations 25,000 to 50,000 at Census, 1931) 19.2 0.43 10.7 0.00 0.01 0.36 0.02 0.00 0.04 - 0.4.6 32 2.1 London—Administrative County 20.1 0.39 11.6 0.00 0.00 0.54 0.01 0.01 0.02 - 0.63 31 2.4 East Ham 18.1 0.38 9.67 — 0.00 0.37 0.01 — 0.02 - 0.59 26 1.3 †Rates per 1,000 total population. *Per 1,000 related births. A dash (—) signifies there were no deaths. 16 16A Table 2.—CAUSES OF DEATH IN AGE GROUPS, 1948, AND TOTAL DEATHS FOR 1944-1848. 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 l Year. 1—5 Years. 5—15 Years. 15—45 Years. 45—65 Years. 65 and Upwards. Total deaths in Instns. 1948 1947 1946 1945 1944 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 - — — — — — — — — - — - — — — — — — — — — 4. Whooping Cough 1 1 1 1 — — — — — - — - — — 1 1 2 3 — — 1 5. Diphtheria — — — — — — — — — - — - — — — — — 3 — 1 3 6. Tuberculosis of Respiratory System 37 24 - - - - - 1 15 17 16 5 6 1 19 18 61 75 62 52 61 7. Other forms of Tuberculosis 8 3 - — — 1 2 2 4 — 1 — 1 — 7 3 11 7 8 9 14 8. Syphilitic Diseases 6 2 - — — - — — — — 5 1 1 1 5 1 8 7 8 5 5 9. Influenza 1 1 - — — — — — — — 1 1 — — 1 1 2 12 8 4 2 10. Measles 2 — 1 — 1 — - — — - — — — — 1 — 2 — — 1 — 11. Acute Poliomyelitis and Polio-encephalitis 1 - - - - - - - 1 - - - - - 1 1 1 2 1 - - 12. Acute infective Encephalitis 1 — - — — — — — — — 1 — — — 1 — 1 1 1 — 1 13. Cancer of the Buccal Cavity and Oesophagus (M) Uterus (F) 6 7 - - - - - - - 2 1 2 5 3 2 4 13 15 26 16 13 14. Cancer of Stomach and Duodenum 21 17 - - - - - - 3 2 6 6 12 9 7 11 38 46 36 44 45 15. Cancer of Breast 1 21 - - — — — — — 5 - 11 1 5 1 11 22 22 21 17 27 16. Cancer of all other sites 84 45 - - — — - — 4 4 33 17 47 24 48 23 129 153 142 129 118 17. Diabetes 1 6 - - - - - — — - - 3 1 3 - 5 7 15 7 4 16 18. Intracranial Vascular Lesions 41 66 - - - - - — 1 1 9 11 31 54 16 31 107 146 116 110 125 19. Heart Disease 176 162 - — — — — — 2 42 42 14 132 139 67 52 338 360 303 286 314 20. Other Diseases of Circulatory System 28 29 - - 1 - - - 2 - 4 4 21 25 10 12 57 43 54 58 34 21. Bronchitis 46 20 - 1 — — — — 1 - 16 3 29 16 14 3 66 115 74 75 66 22. Pneumonia 19 26 3 6 — 1 1 — — 1 8 3 7 15 13 14 45 70 68 68 59 23. Other Respiratory Diseases 8 12 — — — - — 1 2 3 1 2 5 6 6 8 20 22 19 20 12 24. Ulcer of Stomach and Duodenum 8 4 - - - - - - - - 3 1 5 3 7 3 12 15 15 17 22 25. Diarrhoea (under 2 years) 1 2 1 2 - - - - - - - - - - 1 2 3 9 8 7 2 26. Appendicitis 1 — — — - — — — — - — — 1 — 1 — 1 7 6 6 4 27. Other Digestive Diseases 13 19 - — 1 1 — — — - 4 4 8 14 12 14 32 39 22 30 23 28. Nephritis 17 10 - - - - - - 4 2 5 4 8 4 14 7 27 23 19 16 21 29. Puerperal and Post-Abortive Sepsis - 1 - - - - - - - 1 - - - - - - 1 1 - 2 4 30. Other Maternal causes - 1 — - - — - — — 1 - — — — - 1 1 1 2 — 2 31. Premature Birth 9 6 9 6 — — — — — - — — — — 7 5 15 17 16 13 19 32. Congenital malformations, birth injury, infantile diseases 14 16 11 12 - - - 1 2 3 1 - - - 12 11 30 32 34 23 23 33. Suicide 6 4 — — - — — — 3 2 — 2 3 — — 1 10 10 12 8 6 34. Road traffic accidents 6 4 — - - 1 1 — 1 — 3 1 1 2 6 2 10 14 7 16 5 35. Other violent causes 11 7 1 - - - - — 3 - 3 1 4 6 6 4 18 22 16 67 142 36. AH other causes 42 39 1 1 1 1 3 1 5 6 4 14 28 16 25 25 81 92 101 130 125 TOTALS 617 555 29 29 4 5 7 6 53 59 167 110 357 346 312 268 1,172 1,400 1,212 1,235 1,316 TABLE 3.—INFANT DEATHS UNDER ONE YEAR OF AGE, 1948. Cause of Death. Total deaths. Age and Sex. Total under 1 year. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. M F M F M F M F M F M F M F M F M F Cerebro-Spinal Fever 1 - - - - - - - - - - - - 1 - - - 1 — Whooping Cough 2 - - - - - - - - - 1 - - 1 - - - 1 1 Measles 1 - - - - - - - - 1 - - - - - - - 1 — Bronchitis 1 - - - - - - - - - - - - - - - 1 — 1 Pneumonia 9 - - - - - - - 1 — 2 3 3 — - — — 3 6 Diarrhoea and Enteritis 3 — — — — — - — 1 — 1 1 — — — — — 1 2 Premature Births 15 9 6 - - - - - - - - - - - - - - 9 6 Congenital Malformations, Birth Injury, Infantile Diseases 23 4 5 3 2 — - — 1 3 — 1 2 — 2 — — 11 12 Other Causes 3 — - — — — — - - — 1 1 — 1 — — — 2 1 Totals 58 13 11 3 2 — — - 3 4 5 6 5 3 2 — 1 29 29 17 18 General Provision of Health Services. Full details of the Council's services have been given in previous reports. As the National Health Service Act, 1946, came into operation on the 5th July, 1948, only brief particulars are given of the services before this date. East Ham District Nursing Association. From the "appointed day" by arrangements with the Council, this work was carried out on an agency basis. Hospitals. Harts Sanatorium, The Infectious Diseases Hospital and the accommodation at Oakleigh, Sunset Avenue, Woodford Green, were vested in the Regional Hospital Board, as from 5/7/48. Midwives Acts, 1902-1936. The number of midwives who notified their intention to practise in East Ham during 1948 was 39—of these 7 also indicated that they would act as Maternity Nurses. Of the 39, 21 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 8 practised independently, including 7 Municipal Midwives. Plaistow Maternity Hospital and District Nurses' Home. Summary of cases, 1948:— Midwifery 222 Monthly 97 Hospital 75 Silvertown & North Woolwich District Nursing Association. Midwifery 17 19 Laboratory Facilities. Up to 4/7/48, the following specimens were examined at the East Ham Memorial Hospital:— Specimen Number Blood (Sedimentation Rate) 15 Blood (Count) 52 77 Blood (Wassermann) 9 Blood (Other) 1 Sputa (Tuberculosis, Direct Method) 559"" Sputa (Tuberculosis, Antiformin method) 28 Sputa (Tuberculosis, Culture) 45 649 Sputa (Malignant Cells) 15 Sputa (Other) 2 Mantoux Test (Tuberculosis) 30 Urine (AZ Test) 2 Urine (Sugar) 1 32 Urine (Other) 29 Faeces (Tuberculosis) 1 Faeces (Dysentery and Typhoid) 5 Faeces (Other) 1 Others 25 Total 818 Ambulance Facilities. Full details, including statistics, will be found in that portion of the report dealing with the Services carried out under the National Health Service Act, 1946. 20 Clinics and Treatment Centres. These are all provided by the Council. The sessions at the Centres (as on 31/12/48) were as follows TABLE 4.—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 and Friday 2 p.m. (School Health), Wednesday 10 a.m. (M. & C.W.). Infant Welfare Clinic Monday, Thursday and Friday 2 p.m. Physiotherapy Clinic Continuous. Child Guidance Clinic Tuesday and Thursday 9.30 a.m. and 2 p.m. Eye Clinic Tuesday and Friday 9.30 a.m. Alternate Thursdays 9.30 a.m. Toddlers' Clinic Tuesday 10 a.m. Ear Clinic Wednesday and Friday 2 p.m. Ante-Natal Clinic (and Post-Natal) Monday 9 a.m., Tuesday 2 p.m., Wednesday 2 p.m., Thursday 10 a.m. and Friday 10 a.m. Scabies Clinic Friday 2 p.m. Dental Clinic By appointment. Church Road, Manor Park General Clinic (Minor Ailment cases) Tuesday and Friday 9.30 a.m. and Wednesday 2 p.m. Immunization Clinic Wednesday 2 p.m. (School Health), Thursday 10 a.m. (M. & C.W.). Infant Welfare Clinic Monday and Thursday 2 p.m. Physiotherapy Clinic Monday, Tuesday, Thursday and Friday 9.30 a.m. Toddlers' Clinic Friday 2 p.m. Ante-Natal Clinic (and Post-Natal) Monday 9 a.m., Tuesday 2 p.m. Wednesday 9.30 a.m. (double sessions). Dental Clinic By appointment. fNorth Woolwich—Fernhill Street Baths General Clinic (Minor Ailment cases) Friday 2 p.m. Infant Welfare Clinic Tuesday 10 a.m. (alternate weeks after Ante-Natal Clinic). Ante-Natal Clinic ... Alternate Tuesdays 10 a.m. †By arrangement with L.C.C. 21 Situation Purpose used Sessions *Tuberculosis and Chest Clinic, Katherine Road. Tuberculosis and Chest Diseases Monday and Thursday 2 p.m. (new cases for consultation), Tuesday and Friday 10 a.m. (pneumothorax and pneumoperitoneum cases and secondary examinations), Tuesday and Friday 2 p.m. (secondary and x-ray examinations), alternate Thursdays 5 p.m., alternate Saturdays U.30 a.m. (children only), Wednesday 9.30 a.m. (physiotherapy). Durban House, Katherine Road. Treatment Centre (Baths) Tuesday, Thursday and Saturday 9 a.m. (schoolchildren), Tuesday and Thursday 2 p.m. (adults and children under 5 years). * Position at 4/7/48. Social Welfare Domiciliary Medical Service. Up to 4/7/48, when this service ceased to function, the statistics as from 1 /1 /48 were as follows:— No. of individual patients 2,607 No. of attendances at homes 1,171 No. of attendances at surgery 3,196 Total No. of attendances 4,367 No. of occasions medicines supplied without seeing patients 175 Venereal Diseases. Up to the "appointed day" facilities for the treatment of these diseases were provided on behalf of the Council by the London County Council. For the year 1948, the following statistics have been abstracted from forms V.D. (R):— 22 New patients:— 1948 1947 Syphilis 20 19 Soft Chancre 1 2 Gonorrhoea 40 40 Not Venereal 144 168 Totals 205 229 Total attendances 2,756 2,411 Aldersbrook Homes and Scattered Homes. Dr. J. S. Coleman's report is submitted herewith:— After many years beneficent administration by the Ministry of Health these Homes now come under the aegis of the Home Office. No marked changes can at once be expected, but the basic policy to be adopted following the lines of the Curtis Report will be the break up of large institutional groups of children and their substitution by small home units under the care of selected women (mother surrogates), or married couples (parent surrogates) in order to give the children an upbringing in an environment approximating as near as possible to conditions in the normal happy home. The direct responsibility for the care of the children now falls to the Children's Committee, and is no longer a function of the Welfare Services. The Children's Officer, newly-appointed by the Council, interprets the new legislation in regard to the nurture and welfare of deprived children and others admitted to the Homes. The Superintendent and Matron continue in their combined function in the detailed day to day administration, and play no small part in the happiness and well-being of the children in every age group. The medical supervision and treatment is ably encompassed by Dr. Curnock assisted by Dr. Foley, and I have carried out the usual annual medical inspection and three-monthly report to the Children's Committee. In general, the health of the children and staff has been well maintained, in spite of small seasonal epidemics 23 of infectious disease inseparable from the bringing together of comparatively large numbers of infants and young persons under institutional conditions. With some temerity, two observations are offered. Firstly, the children themselves do not appear to be willing or capable to give to each other, and in the case of adolescents to the community, as much as they are prepared to receive. And secondly, in the last twenty years the old type of warm-hearted foster mother and charge nurse, brimful of genuine love for, and infinite patience with her children, has passed away, to be replaced by efficient, punctilious women with not such marked vocational aptitude, but who nevertheless make excellent institution staff. For these reasons also it is possible that the impending dissolution of the large Children's Homes may be a wise move. Oil an average about five hundred children have been in residence in Aldersbrook and the Scattered Homes, of whom eighty to ninety are chargeable to East Ham. About eighteen children are admitted each week with approximately the same number discharged. It might fairly be stated that in spite of the change of ministerial policy, the Aldersbrook Homes remain a model of institutional grouping of its kind, for the welfare of each child in it, is the intimate concern of the capable staff and the controlling Children's Committee. Blind Persons Acts, 1920-1938. On 5/7/48, the functions relating to blind persons were transferred to the Welfare Committee. The statistics given below refer to the period ending on 4/7/48, and relate to the work of the Visitor to the Blind. No. of daily visits 1,171"| No. of evening visits 32 1,252 No. of special visits 49 No. of lessons given 188 No. of blind persons on register (on 30/6/48) 218 The services of the Council's Ophthalmic Surgeon were made available for the certification of cases throughout the year. 24 Voluntary Organisations. These organisations, mentioned in previous reports, carried on their beneficient work :— (a) The Invalid Children's Aid Association. Particulars appended below up to 4/7/48 :— Cases referred by the following agencies—- Hospitals 52 School Health Service 140 Chest Clinic 23 Maternity and Child Welfare 15 Private Doctors 9 Others 3 242 The diseases from which the children suffered— Bronchiectasis, bronchitis, asthma, etc. 55 Debility following operations 85 Debility following illness 80 Crippling defects 14 Malnutrition, marasmus and debility 41 Cervical adenitis 9 Nervous c'ebility 24 Rheumatism, chorea and heart disease 9 Pulmonary tuberculosis 4 Other forms of tuberculosis 7 Coeliac disease 2 Others 12 242 25 Assistance was given as follows :— Sent to Convalescent Homes 165 Sent to Sanatoria 10 Home reports submitted to hospitals 5 Surgical appliances provided 10 On Waiting list on 4/7/48 52 242 (b) District Nursing. Statistics from 1/1/48 to 4/7/48:— TABLE 5. East Ham District Nursing Assoc. Silvertown & North Woolwich District Nursing Assoc. Patients on books on 1/1/48 176 4 New patients from 1 /1/48 to 4/7/48 431 24 Summary of New Cases :— Bronchitis, Pneumonia & Pleurisy 32 — Cardiac 32 — Tuberculosis 19 — Cerebral 37 — Rheumatism, Arthritis, etc. 18 — Diabetes 24 — Other medical 122 17 Burns 6 — Various Surgical 62 7 Cancer 39 — Senility 37 — Miscarriage 3 — Totals 431 24 Total number of visits 16,314 205 (c) East Ham Tuberculosis After-Care Committee. The functions of this voluntary organisation were taken over by the Council on the " appointed day " under their Care and After-Care Scheme. Up to that date (5/7/48), 17 patients received clothing allowances at a cost of £59 16s. 9d., and 3 patients were allowed bed and bedding. This Committee, renamed the East Ham Chest Clinic Amenities Fund, by its voluntary efforts are paying fares to relatives to visit patients in institutions, and at Christmas 1948, 108 cases received a gift of 10s. Od. each. 26 Scabies and Treatment Centre. The following statistics are appended for the year under review :— Number of new cases attending— 1944 1945 1946 1947 1948 520 268 237 77 67 Maternity and Child Welfare. A full and comprehensive statement on this service is given later in this report. (a) Midwifery Services. During the whole of the year, seven full-time municipal midwives were engaged. Number of cases attended by them since 1944 is shewn below:— 1944 1945 1946 1947 1948 As Midwives 211 172 543 543 414 As Maternity Nurses 31 14 59 49 32 Totals 242 186 602 592 446 The services of one temporary midwife were terminated on 31/12/48. TABLE 0. Number of Maternity Cases attended by Midwives during the year 1948. Domiciliary Cases. Cases in Institutions. Total. As Midwives As Maternity Nurses As Midwives As Maternity Nurses As Mid- wives As Maternity Nurses Midwives employed by the Authority 414 32 — — 414 32 Midwives employed by Voluntary Organisations 239 97 — — 239 97 Midwives in Institutions 441+ 15+ 441 15 Midwives in Private Practice 5 — — 5 — Totals 658 129 441 15 1,099 144 + Aldersbrook Maternity Hospital. 27 (b) Maternity Hospital Accommodation. The numbers of maternity cases admitted to the institutions named below, during the year under review, were as follows :— Institution No. of Cases Aldersbrook Maternity Hospital 461 East Ham Memorial Hospital 421 Forest Gate Hospital 157* Queen Mary's Hospital 5t East End Maternity Hospital 38f * No information available for period 11/7/48 to 20/10/48. + For period 1/1/48 to 4/7/48 inclusive. (c) Maternity Fees and Sale of Dried Milk and Ancillaries. For the period 1/1/48 to 4/7/48, the following amounts were collected at the clinics :— £ s. d. Fees for Maternity Hospital Accommodation 1,567 0 9 Fees for Municipal Midwifery Service 135 3 3 Fees for +Other Services 37 18 10 Total 1,740 2 10 + T. and A. operations, dental and ophthalmic treatment (provision of spectacles). 83 vouchers from various Societies were collected and taken as full or part payment as follows :— For maternity hospital accommodation 29 For municipal midwifery service 3 T. and A. operations and provision of spectacles 51 Total 83 The amount collected for the whole of the year in respect of the sale of dried milk and ancillaries was £2,160 14s. 4d., and for the Home and Domestic Help service—£404 13s. l0d. 28 (d) Child Life Protection and Adoption of Children. By Section 39 (1) of the Children Act, 1948, the functions of the welfare authority were referred to the Children's Committee. A Children's Officer was appointed by the Council and this department through the medium of the Health Visitors afforded some help until 1/12/48, when adequate staffing arrangements had been made by the Children's Officer. (e) Care of Premature Infants. 1. Number of premature babies notified during the year ended 31/12/48, whose mothers were normally resident in the area 105 2. Number of premature babies notified during the year who were born :— (а) at home 25 (б) in hospital or nursing home 80 3. Number of those born at home who were nursed entirely at home 20 4. Number of those born at home :— (a) Who died during the first 24 hours 4 (b) Who survived at the end of one month 20 5. Number of those born in hospital or nursing home :— (a) Who died during the first 24 hours 5 (b) Who survived at the end of one month 67 (/) Registration of Nursing Homes. There were no registered homes in the Borough at the beginning of 1948, and there were none registered during the year. (g) Home Helps. A report on the Council's work will be found under the National Health Service Act, 1946, section. (h) Administration of Analgesics. At the end of the year, all the Council midwives were qualified to administer analgesics and during the year the number of cases dealt with was 67. 29 (i) Health Visitors. Number of visits paid during the year by Health Visitors :— (i) to expectant mothers— 1st visits 323 total visits 339 (ii) to children under 1 year— 1st visits 2,070 total visits 8,652 (iii) to children between the ages of 1 and 5 years— total visits 11,971 total of all visits to mothers and children 20,962 (iv) other visits 291 (v) grand total (visits) 21,253 (j) Infant Welfare Centres. Total number of children under 5 years of age who first attended at the centres during the year and who on the date of their first attendance were :— (i) under 1 year of age 1,593 (ii) over 1 year of age 230 Number of children who at the end of the year were :— (i) under 1 year of age 1,175 (ii) over 1 year of age 871 Total attendances at the centres made by children :— (i) under 1 year of age 18,686 (ii) over 1 year of age 5,711 (k) Ante- and Post-Natal Clinics. Total number of women who attended and attendances made during 1948 :— (i) ante-natal clinics 1,852 (ii) post-natal clinics 325 (iii) total attendances (ante-natal) 9,849 (iv) total attendances (post-natal) 356 30 (l) Consultations and Other Attendances. Number of consultations 6,844 Number of attendances at Immunisation Clinics 6,869 Number of attendances at Ophthalmic Clinic 170 Number of attendances at Sunlight Clinics 3,129 Number of attendances at Toddlers' Clinics 1,549 (m) Ophthalmia Neonatorum. There were no cases of this disease notified during 1948, and the one case that was still under treatment at the end of 1947, recovered with vision unimpaired. (n) Inspection of Midwives. Visits of inspection, as necessary, were paid throughout the year and the midwives' work, including records, was satisfactory. (o) General. Children were referred, as required, to the Physiotherapy, Light and Ophthalmic Clinics. The number of children under five years dealt with at the Diphtheria Immunisation Clinics is shewn in another section of the report. Cases of Tonsils and Adenoids were admitted for operation to the hospitals previously given. Aldersbrook Maternity Hospital. The report of Dr. Curnock in respect of the above hospital for the year under review is appended below :— I beg to submit the Annual Report for 1948, and would venture to make the following observations :— Heavy demands have been made upon accommodation during the Maternity Hospital's second year. More patients were admitted than in the previous year and the increased work has fallen largely upon the Matron, Assistant Matron and Nursing Staff, who have responded at all times with willing cheerfulness. The birth of the baby is usually the most dramatic part of the confinement, but the routine care of a large number of mothers and small babies is just as exacting ; none the less the care bestowed individually on each mother and baby has maintained the high standard of breast-feeding and management established in 1947. 31 With the introduction of the National Health Service Act on 5th July, 1948, the Hospital passed to the North-East Metropolitan Regional Hospital Board (No. 11 Hospital Management Group) but East Ham County Borough Council continues administration on an agency basis. We have continued to enjoy the collaboration of the Staff of East Ham Memorial Hospital, and in particular we are indebted to the Consultant Obstetrician, Mr. D. G. Wilson Clyne, F.R.C.S., M.R.C.O.G. Statistics— No. of maternity cases admitted for confinement 461 No. of cases admitted for ante-natal treatment 53 No. of patients delivered by midwives 441 No. of patients delivered by doctors 15 No. of patients admitted after delivery 5 461 Average duration of stay in lying-in wards (days) 12—14 No. of cases notified as Puerperal Pyrexia 7 No. of cases of Pemphigus Neonatorum 2 No. of cases notified as Ophthalmia Neonatorum _ No. of maternal deaths — No. of still births 2 No. of infant deaths within 10 days of birth 4 No. of infants who received a supplementary or complementary feed whilst in hospital (excluding those given during the first 3 or 4 days whilst breast feeding was established) 30 No. of infants wholly breast fed on leaving the hospital 436 Day Nurseries. The following nurseries were open throughout the year under review :— No. of places. School Road 60 Wall End/Caledon Road 60 St. Stephen's Road 89 Roman Road 84 Total 293 32 Applications for admission far exceeded the number of places available, and the Council decided upon priority classes for admission, which are shewn below :— Husband unemployed or frequently ill and unable to work full-time. Widow. Husband in the Forces. Wife separated or deserted. Mother in hospital. Unmarried mother. Married mother working full-time/part-time, and husband in full employment. There were long waiting lists for admittance to all the nurseries at the end of the year. Of the four nurseries, three will eventually be taken over by the Education Department for Nursery Schools, the site of the one remaining to the Health Committee—Wall End/Caledon Road has been bought by the Authority. Negotiations are pending at the present time to acquire a site at Rancliffe Road for nursery purposes. Statistics are shewn below :— Nursery. Total Attendances. Daily Average. School Road 11,617 45 Roman Road 17,499 68 St. Stephen's Road 18,295 71 Wall End /Caledon Road 12,266 48 Daily average based on 257 days nurseries were open. NOTE.—The nurseries are closed on Saturdays. Infectious Diseases. The quarterly returns to the Registrar-General were as follows :— Disease Qtr. ending 31/3/48 Qtr. ending 30/6/48 Qtr. ending 30/9/48 Qtr. ending 31/12/48 Total. Scarlet Fever 70 64 31 57 222 Whooping Cough 95 166 201 116 578 Acute Poliomyelitis 3 2 2 1 8 Measles 167 810 368 214 1,559 Diphtheria 11 1 — 2 14 Pneumonia 55 22 11 23 111 Typhoid Fever — — — 1 1 Erysipelas 2 6 7 6 21 Cerebro-Spinal Fever 2 2 — 1 5 Puerperal Pyrexia — 3 1 — 4 33 As compared with 1947, the notifications for Scarlet Fever increased from 179 to 222, Diphtheria decreased from 46 to 14, Measles increased from 964 to 1,559, and Whooping Cough from 430 to 578. The one case of Typhoid Fever notified was ascertained upon enquiry to have been infected on passage from Australia. The deaths from the seven principal zymotic diseases (Smallpox, Whooping Cough, Measles, Diphtheria, Diarrhoea, Scarlet Fever and Enteric Fever) numbered 7, as compared with 15 for 1947. The zymotic death rate was 0.05 per 1,000 population as compared with a rate of 0.12 for the previous year. No cases of Smallpox were reported. In the following table the notification rates per 1,000 civilian population are shewn :— TABLE 7. Notifications England and Wales 126 County Boroughs & Great Towns including London 148 Smaller Towns Besident Population 25,000-50,000 at 1931 Census London Adm. County East Ham Scarlet Fever 1.73 1.90 1.82 1.37 1.83 Whooping Cough 3.42 3.51 3.31 3.13 4.77 Acute Poliomyelitis... 0.04 0.05 0.04 0.04 0.06 Acute Polioencephalitis 0.00 0.00 0.00 0.00 Measles 9.34 9.75 8.84 9.17 12.77 Diphtheria ... 0.08 0.10 0.09 0.10 0.11 Pneumonia ... 0.73 0.84 0.60 0.57 0.91 Typhoid Fever 0.01 0.00 0.01 0.00 0.00 Paratyphoid Fever ... 0.01 0.01 0.01 0.01 — Erysipelas 0.21 0.23 0.21 0.22 0.17 Smallpox — — — — — Cerebro-Spinal Fever 0.03 0.03 0.02 0.03 0.04 A dash (—) signifies no notifications. 34 Table 8.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for Year ended 31/12/48. 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 222 — 40 93 65 14 6 1 3 — 30 25 21 20 13 14 24 44 15 16 88 — Diphtheria 14 — 6 4 4 — — — — — — — — — 1 1 2 7 1 2 14 — Erysipelas 21 — — — — — 3 3 9 6 2 1 — 3 2 3 5 1 2 2 1 — Puerperal Pyrexia 4 — — — — 1 3 — — — 2 1 — — — — — — — 1 4 — Cerebro Spinal Fever 5 1 2 — — — 1 — 1 — 1 1 2 1 — — — — — — 5 1 Pneumonia 111 5 10 10 6 1 15 21 23 20 17 14 6 9 14 10 10 13 5 13 63 45 Acute Poliomyelitis 8 1 4 — 2 1 — — — — 1 2 1 — — — 1 — 1 2 7 1 Measles 1,559 86 898 543 23 5 4 — — — 190 305 144 117 103 99 113 173 138 177 27 2 Whooping Cough 578 70 329 169 2 2 3 3 — — 89 56 56 22 38 39 49 83 62 84 27 1 Typhoid Fever 1 — — — — — — — 1 — 1 — — — — — — — — — 1 — 34a Table 9.—TOTAL CASES OF NOTIFIABLE DISEASES, 1925-1948 . 34a Disease. 1925 1920 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 Small Pox _ — — 17 25 70 51 13 1 1 — — — — — — — — — — — — — — Scarlet Fever 221 350 798 832 743 484 245 779 701 979 411 359 387 287 196 77 68 210 271 132 153 193 179 222 Diphtheria 246 337 464 669 578 473 196 157 180 379 254 134 149 141 91 47 45 49 59 33 31 19 46 14 Enteric Fever 9 7 2 7 2 3 8 7 5 — 2 2 13 15 8 10 3 — 4 — — — — 1 Erysipelas 41 41 38 60 49 63 54 55 69 74 55 59 53 71 41 33 23 37 28 18 14 25 23 21 Puerperal Fever 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 4 Meningococcal Meningitis 1 1 4 1 1 3 8 5 1 3 3 — 2 3 3 11 5 12 4 3 1 8 1 5 Encephalitis Lethargica 6 1 2 3 1 — _ — 1 1 I — 1 1 — — — — — — — — — — Ophthalmia Neonatorum 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 — 5 — 2 — 1 7 2 5 13 2 4 — 2 1 — — — — 1 — 7 8 Acute Polio Encephalitis — — — — — — — 3 2 1 — — — — — — — — — — — — 1 — Dysentery — — — — — — — — — 1 — — 3 18 — — — — 6 5 7 5 2 — Malaria — — — — — — — 1 1+ + — — — — — — — — — — — 1+ + 3 a — — Measles Not Notifiable 3 36 460 1091 917 258 1498 815 964 1,559 Whooping Cough Not Notifiable — 19 262 227 241 293 67 258 430 578 Continued Fever — — — — — — — — — — — — — Not Notifiable Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia 91 70 114 82 102 59 75 77 148 100 88 101 111 85 59 42 33 37 72 50 55 97 143 111 Totals 629 822 1,455 1,689 1,531 oc 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 2,523 * Notifiable as Puerperal Pyrexia as from 1/10/37. || Not notifiable as from 1/10/37. + Notifiable as Puerperal Pyrexia. + 1 Induced in an Institution. a 1 Induced for therapeutic purposes ; 2 Contracted abroad. 35 Cancer. Deaths, 1948 :— Total deaths 202 Male deaths 112 Female deaths 90 Classification :— 1948 1947 1946 1945 1944 Carcinoma 181 214 209 191 196 Sarcoma 3 2 2 3 3 Rodent Ulcer — — — — 1 Epithelioma 2 2 2 4 — Endothelioma — — — 1 — Glio-blastoma 1 1 3 — — Chloroma — 1 — — — Hyponephroma 1 1 — — — Papilloma 1 1 — — — Myeloma 1 — — — — Seminoma 1 — — — — Melanoma 1 — — — — Unstated 10 14 9 7 3 Totals 202 236 225 206 203 36 Table 10.—CANCER DEATHS—PARTS OF BODY AFFECTED. Parts of Ages Body Affected Sex 15-25 25-35 35-45 45-55 55-65 65-75 75 and upwards Total M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Buccal Cavity and Pharynx — — — — — — — — 2 — 2 — 4 — Digestive Organs and Peritoneum ... — — 2 2 2 — 5 3 8 11 14 10 9 7 40 33 Respiratory Organs ... — — — 1 1 — 7 2 10 — 8 3 1 — 27 6 Uterus — — — — — 2 — — — 2 — 1 — 2 — 7 Other Female Genital Organs 1 — 2 3 6 Breast — 1 — — — 4 — 7 — 4 — — 1 5 1 21 Male Genital Organs — — — — — — — — 1 — — — — 1 — Urinary Organs — — — — — — — 1 2 1 7 2 5 1 14 5 Skin — — — — — — — — — — — — 1 — 1 — Brain and other parts of Nervous System — — — — 1 — 1 — 2 — Other or Unspecified Organs — — 1 — — 2 2 1 4 2 10 5 5 2 22 12 Totals — 1 3 3 4 9 15 14 25 22 41 24 24 17 112 90 87 Infectious Diseases Hospital. No. of cases in hospital on 1/1/48 80 No. of cases admitted during period 1/1/48 to 4/7/48 112 The 112 cases admitted were diagnosed as follows :— Acute Anterior Poliomyelitis 4 Acute Articular Rheumatism 1 Acute Laryngitis 2 Cerebro-Spinal Meningitis 3 Cervical Adenitis 1 Chicken Pox 6 Diphtheria 12 Diphtheria Carrier 1 Gastric Enteritis 4 Infantile Eczema 1 Malnutrition 1 Measles 12 Measles with Broncho-Pneumonia 5 Measles with Encephalitis 1 Mumps 1 No evidence of Infectious Disease 1 Nutritional Anaemia 1 Tonsillitis 8 Tuberculous Meningitis 1 Vaccinia 1 Whooping Cough 5 Whooping Cough, Measles and Broncho-Pneumonia 1 Whooping Cough and Broncho-Pneumonia 3 Pharyngeal Abscess 1 Scarlet Fever 35 Total 112 Harts Sanatorium. No. of cases in sanatorium on 1/1/48 64 No. of cases admitted during period 1/1/48 to 4/7/48 70 Of the 70 cases admitted, 66 were suffering from pulmonary tuberculosis and 4 were observation cases. Mass Radiography. The Unit centred on West Ham, visited the Borough during the period 29/11/48 to 9/12/48, and operated from the Drill Hall, Vicarage Lane. The applicants were dealt with at the rate of 150—200 per session for five days per week—mornings for males, afternoons for females. Over 200 letters were sent to firms and approximately 50 replied. The small response made was due in some measure to the distance applicants would hare to travel and interference with normal working, especially in view of the export drive. 38 As the Unit was available for only a short period it was considered inadvisable to advertise extensively. The facilities, however, were available to employees of the firms who replied, Council staff and certain schoolchildren. It is understood that later a mobile unit will be allocated to this area, when a drive will be inaugurated for comprehensive " mass " radiography for every section of the community. (а) Persons X-rayed on miniature films 3,008 (б) Persons recalled for X-ray on large films 263 (or 8.7 % of (a) ) (c) Persons interviewed by Medical Director 81 (or 2.6 % of (a) ) (d) Persons suspected of having Tuberculosis 29 (or 0.96% of (a) ) Of the total X-rayed on miniature films, 1,840 were males and 1,168 females. Chest Clinic. Under the terms of Memorandum 266/T, and for the period 1 /I /48 to 4/7/48, maintenance allowances to patients suffering from pulmonary tuberculosis were paid to 117 cases. The following statistical data for the Chest Clinic is appended :— 1. No. of notified cases on register at 31/12/48 1,284 2. New cases and contacts examined during 1948 1,780 3. Number in 2 found tuberculous 219 4. Number of attendances during 1948 10,322 5. Number of medical examinations 6,165 6. Number of consultations at homes of patients 33 7. Number of X-ray examinations 4,292 8. Number of visits made by tuberculosis nurses 6,711 38A Table 11.—PUBLIC HEALTH (TUBEBCULOSIS) REGULATIONS, 1930. 38A Summary of Notifications during the period from 1st January, 1918, to the 31st December, 1948. Age Periods Formal Notifications Number of Primary Notifications of new cases of tube rculosis 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total (all ages) Respiratory, Males 1 6 9 13 6 11 10 21 12 17 11 5 1 123 Respiratory, Females 1 2 5 7 5 12 16 26 16 5 2 1 — 98 Non-Respiratory, Males — 1 — 8 — — 1 1 — — 1 — — 7 Non-Respiratory, Females — — 2 2 3 1 2 2 1 — — — — 13 PART II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Source of Information Number of cases in age Groups 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65 — 75— Total Death Returns from Local Registrars... M Respiratory F M Non-Respiratory F — — — — — — — — — — 1 1 — 2 (A) — — — — — — — 1 — — — 1 — 2 (B) — — — — — — — — — — 1 — — 1 (C) — — — — — — — — — — — — — — (D) Death Returns from Registrar-General (Transferable deaths) ... M Respiratory F M Non-Respiratory F — — — 1 — — — — 1 — 1 — 1 4 (A) — — — — — — — 1 — — — — — 1 (B) — — — — — — — — — — — — — — (C) — — — — — — — — — — — 1 — 1 (D) Posthumous Notifications ... M Respiratorv F M Non-Respiratory F — — — — — — — — — — — — — — (A) — — — — — — — — — — — — — — (B) — — — — — — — — — — — — — — (C) — — — — — — — — — — — — — — (D) "Transfers" from Other Areas (excluding transferable deaths) ... M Respiratory F M Non-Respiratory F — — — 2 — — 1 2 1 2 — — 8 (A) I 6 7 14 (B) — — — — 1 — 1 — — — — — — 2 (C) — — — — — — — 1 — — — — — 1 (D) Other Sources M Respiratory F M Non-Respiratory F — — — — — — — — — — — — — — (A) — — — — — — — — — — — — — — (B) — — — — — — — — — — — — — — (C) — — — — — — — — — — — — — — (D) Totals (A) 14 (B) 17 (C) 3 (D) 2 39 The number of tuberculous patients receiving in-patient treatment and the institutions concerned as on 30/6/48, are shewn below :— Adults Children Alton Hospital — 5 Fairlight Sanatorium 1 — Highgate Hospital — 1 Holt Sanatorium — 1 Hull After-Care Committee 1 — King George V Sanatorium 1 — London Chest Hospital 1 — Papworth Hall 2 — Preston Hall 1 — Royal National Orthopaedic Hospital, Stanmore 2 1 Royal Sea Bathing Hospital 8 — St. Joseph's Hospice 2 — St. Mary's, Broadstairs — 15 Queen Elizabeth Hospital for Children — 1 St. Thomas's Hospital 1 — Church Army Lads' Sanatorium — 2 Abergele Sanatorium — 8 Dagenham Sanatorium 8 — VVhipps Cross Hospital 2 — Langdon Hills Sanatorium — 1 North Middlesex Hospital 1 — Harts Sanatorium ... 65 5 Totals 91 35 Water Supply. (i) The water supply of the Borough in its several parts has been satisfactory both in quality and quantity. (ii) All houses in the area 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. (iii) The water supply of this district from the Metropolitan Water Board does not give rise to plumbo-solvent action. (iv) There were no contamination areas. 40 Meat and Other Foods. As will be seen in the Report no slaughterhouse in this Borough was in operation during the year. There are no statistics with regard to meat inspection. Food Poisoning. There were no outbreaks during 1948. Factories Acts, 1937 and 1948. In accordance with the Factories Act, 1937, and at the request of the Minister of Labour and National Service, the following information is included in this report :— 40a Table 12. 40a PART I OF THE ACT 1.—INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors) Premises I 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 105 114 23 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 364 301 40 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 19 19 2 — Total 488 434 65 — 2.—Cases in which DEFECTS were found (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more " cases ") Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l) 24 17 2 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 6 4 4 — — Inadequate ventilation (S.4) 2 — — 2 — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) insufficient 6 6 — 4 — (6) Unsuitable or defective 48 25 — 3 — (c) Not separate for sexes 15 6 — 1 — Other offences against the Act (not including offences relating to Outwork) ... 22 11 7 14 — Total ... 123 69 13 25 — Table 13. PART VIII OF THE ACT OUTWORK (Sections 110 and 111) Nature of Work Section 110 Section 111 No. of out-workers in August list required by Sect. 110(l)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel Making, etc. 5 2 — 1 1 — Cleaning and washing... — — — — — — 41 TABLE 14. METEOROLOGICAL RECORD—YEAR 1948. 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 Maximumf 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 — — — — 42.95 21 2.86 0.14 0.47 23rd February — 16 — 32.58 40.41 11 1.29 0.12 0.37 21st March — 27 — 35.84 45.76 5 0.66 0.13 0.25 17th/31st April — 32 — 38.63 51.48 13 1.20 0.92 0.34 3rd May — 30 — 40.90 54.79 9 1.99 0.22 0.44 11th June — 41 — 47.30 58.11 19 5.06 0.27 2.41 14th July — 42 — 50.42 61.80 — 0.92 0.13 0.30 4th August — 42 — 50.03 61.03 14 3.79 0.27 1.47 6th September — 34 — 48.40 59.02 9 1.18 0.13 0.48 12th October — 24 — 40.03 50.10 10 1.85 0.19 0.44 25th November — 24 — 36.23 44.45 8 1.38 0.17 0.50 6th December — 19 — 34.90 43.10 17 2.07 0.12 0.61 30th Means & Totals for the Year — 30 — 41.4 51.1 143 24.25 0.17 2.41 14th June f The Highest Maximum Thermometer was stolen at the beginning of the year and has not yet been replaced by the Meteorological Office. NATIONAL HEALTH SERVICE ACT, 1946 PROPOSALS APPROVED BY THE MINISTER OF HEALTH FOR HEALTH SERVICES The proposals approved by the Minister of Health for the health services of the borough have been published in booklet form, and are available for reference upon application to the Town Clerk or Medical Officer of Health. It suffices here to indicate the extent of the implementation which has been accomplished in each of the appropriate sections of the proposals. 44 NATIONAL HEALTH SERVICE ACT, 1946. ESSENTIALS OF THE ADMINISTRATION AND FUNCTIONS IN SCHEMATIC FORM. All within dotted lint—regional activities. 45 Section 22—Care of Mothers and Young Children. The implementation of the proposals under this section at the end of the year were as follows:— Augmentation of the dental care of expectant mothers whereby examination and treatment is afforded to every case when found necessary. The services of a consultant anaesthetist are available for such treatment. Similarly, supervision of nursing mothers is maintained throughout the lactation period. Special sessions for dental inspection, advice and treatment arc held for children under two years of age. Arrangements for toddlers have also been made through the school health dental service. Maternity outfits are now provided free on application. Nursery provision—a site has been acquired and plans have been approved for the erection of a day nursery at Rancliffe Road in the south of the borough : provision will be afforded in the plans for the day-minding of children. Unmarried mothers—arrangements with the Essex Voluntary Committee for the care of the unmarried mother and her child have been completed. For details of times and places of various clinics, reference should be made to Table 4. It should be noted that reciprocal arrangements with the L.C.C. and West Ham were concluded whereby mothers and children may attend the clinic nearest to their homes. The senior dental officer reports as follows in regard to the dental treatment provided for expectant and nursing mothers and young children during the year 1948:— Two sessions per week are devoted to the dental treatment of patients under the M. & C.W. scheme. Owing to shortage of staff the treatment offered is of a very limited character. We are unable to provide dental officers for routine examination of mothers and babies and those patients needing treatment are referred to the dental clinics by the M.O.'s of the welfare centres. A great many of these patients are in pain when referred and in nearly every case teeth have to be extracted. However, the demand for conservative treatment is gradually increasing and an average of 3.8 fillings per session during the past year is a great improvement on the previous year's figures. 46 There has not been any noticeable increase in the demand for treatment since the inception of the Health Service in July of last year. Although an excellent scheme for the provision of inspection and treatment of M. & C.W. patients has been formulated and approved by the Ministry of Health, we have been unable to implement these proposals owing to the fact that the present dental staff is quite inadequate to cope with the amount of work involved and we have been unable to appoint any new dental officers. Complete treatment has been offered where possible, but those patients needing dentures have to be referred to a private practitioner as we are not yet in a position to provide these appliances. Every effort is made in the ante-natal clinics to advise young mothers on the dental conditions which occur during pregnancy. In the dental clinics, mothers are instructed in the proper way to clean the children's teeth and instructive pamphlets are given to those mothers who are anxious to preserve their children's teeth. Expectant Mothers 1/1/48 to 4/7/48 5/7/48 to 31/12/48 Total Examined 104 121 225 Needing treatment 94 104 198 Treated 86 95 181 Made dentally fit 79 82 161 Nursing Mothers Examined 22 34 56 Needing treatment 18 32 50 Treated 13 26 39 Made dentally fit 12 20 32 Children Under 5 years Examined 155 180 335 Needing treatment 150 162 312 Treated 144 150 294 Made dentally fit 144 150 294 47 Section 22—Statistics for period 5/7/48 to 31/12/48. 1. Number of births notified during the period under Section 203 of the Public Health Act. 1936. as adjusted by any transferred notifications :— (a) live births 972 (b) still births 23 (c) total 995 2. Care of Premature Infants:— (a) Number of premature babies born during the above period whose mothers are normally resident in the Authority's area 40 (b) Total number of such babies who were born:— (i) at home 10 (ii) in hospital or nursing home 30 (c) Number of those born at home who were nursed entirely at home 10 (d) Number of those born at home and nursed entirely at home:— (i) who died during the first 24 hours 2 (ii) who survived at the end of one month 8 (e) Number of those born in hospital or nursing home:— (i) who died during the first 24 hours 3 (ii) who survived at the end of one month 23 3. Infectious Diseases:— Number of cases of infectious diseases notified during the period:— (i) Ophthalmia Neonatorum Nil (ii) Pemphigus Neonatorum Nil (iii) Puerperal Pyrexia 1 NOTE.—One case of Ophthalmia Neonatorum still under treatment at the end of 1947, recovered with vision unimpaired. 48 4. Maternal Deaths. There were no maternal deaths of women confined at home, in hospitals or nursing homes, during the above period. 5. Ante-Natal and Post-Natal Clinics. TABLE 15. Local Health Authority Clinics Number of clinics provided at end of year (whether held at Infant Welfare Centres or other premises) Number of sessions held on 31st December, 1948 per month at clinics included in column (2) Number of women who attended during the period 5th July, 1948 to 31st December, 1948 Number of women included in column (4) who had not previously attended an ante-natal clinic during current pregnancy or a postnatal clinic after last confinement Total number of attendances made by women included in column (4) in period 5th July, 1948 to 31st December, 1948 (i) (2) (3) (4) (5) (6) Ante-natal clinics 2 32 1,446 975 4,729 Post-natal clinics Seen at Antenatal clinics — 164† 157† 175† †These figures are included in those for Ante-natal clinics. By arrangement with the L.C.C. an ante-natal clinic is held on alternate weeks at Fernhill Street Baths, North Woolwich, E.16. The total number of mothers attending this clinic during the period 5th July, 1948, to 31st December, 1948, was 9 (including 1 post-natal), the number of new cases was 7 (including 1 post-natal) and the total number of attendances was 60 (including 1 post-natal). 6. No ante-natal or post-natal examinations were carried out by General Practitioners at the mother's home or the practitioner's surgery under arrangements made by the Authority. 49 7. Infant Welfare Centres. TABLE 16. Provided by Number of Centres provided at end of year Number of Infant Welfare Sessions now held per month at Centres in column (2) Number of children who attended Centres in column (2) during period 5/7/48 to 31/12/48 Number of children who first attended the Centres during the period 5/7/48 to 81/12/48 and who, on the date of their first attendance were :— Number of children included in column (4) who at the end of the year were :— Total number of attendances made by Children included in column (4) in the period 5/7/48 to 31/12/48 Under 1 year of age Over 1 year of age Under 1 year of age Over 1 year of age Under 1 year of age Over 1 year of age (1) (2) (8) (4) (5) (6) (7) (8) (9) (10) Local Health Authority Centres 2 20 2,074 710 86 1,175 871 8,402 2,578 Centres provided by Voluntary Organisations - - - - - - - - - By agreement with the L.C.C. a Centre is held once weekly at Fernhill Street Baths, North Woolwich, E.16. Total number of children attending between 5/7/48 and 31 /12/48—73. Number of children who at the end of the year were:— Under 1 year Over 1 year Total 32 34 66 Total number of attendances made during the period 5/7/48 to 31/12/48 Under 1 year Over 1 year Total 269 78 347 NOTE.—The difference in the figures in columns (4) and (7) and (8) is accounted for by the transfer of children who had attained the age of 5 years before 31/12/48, to the School Health Service and the same applies to the North Woolwich Clinic. 50 8. Day Nurseries. TABLE 17. Provided by No. No. of Approved Places No. of children on the Register at the end of the year Average daily attendance since 5th July, 1948 (1) (2) 0-2 (3) 2-5 (4) 0-2 (5) 2-5 (6) 0-2 (7) 2-5 (8) Nurseries maintained by the Council 4 132 161 102 195 79 159 Nurseries maintained by Voluntary Organisations - - - - - - - There were no daily minders provided by the Authority at 81 /12/48. 9. Unmarried Mothers and Illegitimate Children. No cases were sent to the Hostels mentioned previously in this report and illegitimate children are under the supervision of the Superintendent Health Visitor. 10. Mother and Baby Homes. No eases in this category were dealt with during the period under review. Section 23—Midwifery Service. The implementation of the proposals under this section at the end of the year were as follows:— General administrative arrangements—the Council have agreed to the early appointment of a Superintendent Nursing Officer who will combine the duties of lay inspector of midwives with the co-ordination of the general nursing and ancillary services. It is felt that this appointment will thereby strengthen the domiciliary midwifery service. Comprehensive provision for the transport of the midwife and her equipment, including analgesia apparatus, has been afforded. In regard to analgesia for the confinement of mothers in their homes, all our midwives have received the prescribed training and have passed the required examinations. Five sets of apparatus have been provided for use. 51 Section 23—Statistics for period 5th July, 1948, to 31st December, 1948. (a) Midwives Acts, 1902-1936. Maternity Cases attended. TABLE 18. Number of maternity cases in the area of the Local Supervising Authority attended by Midwives during the period 5/7/48 to 31/12/48. Domiciliary Cases Cases in Institutions. Total. As Midwives. As Maternity Nurses. As Midwives. As Maternity Nurses. As Midwives. As Maternity Nurses. Midwives employed by the Authority 178 9 - - 178 9 Midwives employed by Voluntary Organisations:— (a) under arrangements with Council in pursuance of Section 23 of the National Health Service Act 110 44 - - 110 44 (6) otherwise (including hospitals not transferred to the Minister under the National Health Service Act, 1946) - - †226 †5 226 5 Midwives employed by Hospital Management Committees or Boards of Governors under the National Health Service Act - - *206 - 206 - Midwives in private practice 2 — — — 2 — Totals 290 53 432 5 722 58 † Aldersbrook Maternity Hospital. * East Ham Memorial Hospital. (b) Midwives. Number of midwives practising at the end of the year in the area of the Local Supervising Authority who were:— 52 (i) employed by Voluntary Organisations as domiciliary midwives otherwise than under arrangements made with a Health Authority under Section 23 of the National Health Service Act Nil (ii) in private practice as— domiciliary midwives 1 midwives in institutions (i.e., nursing homes) — — 1 (c) Medical aid under Section 14 (1) of the Midwives Act, 1918. Number of cases in which medical aid was summoned during the period 5/7/48 to 31/12/48, by a midwife:— (i) for domiciliary cases where the medical practitioner had arranged to provide the patient with maternity benefit under the National Health Service:— Nil Others 105 105 (ii) for cases in institutions 72 (d) Administrations of Analgesics. (i) number of midwives in practice in the area qualified to administer analgesics in accordance with the requirements of the Central Midwives Board domiciliary 12 in institutions 10 - 22 (ii) are facilities provided to enable domiciliary midwives practising in the area to attend courses of instruction in the administration of analgesics in institutions approved by the Central Midwives Board for the purpose ? Yes (iii) are facilities provided to enable domiciliary midwives practising in the area to attend courses of instruction in the administration of analgesics on the district under schemes approved by the Central Midwives Board ? No 53 (iv) number of domiciliary midwives trained under (iii) above during the period 5/7/48 to 31 /12/48 None (v) how many sets of apparatus for the administration of analgesics are in use by domiciliary midwives employed by the Authority or employed by Voluntary Organisations in the Authority's area ? 7 (vi) in how many cases were analgesics administered by midwives in domiciliary practice during the period 5/7/48 to 31 /12/48 ? 75 Section 24—Health Visiting Service. The implementation of our proposals under this section has been greatly curtailed by the continued dearth of trained health visitors. As already mentioned in the preface of this report, a scheme for the training and employment of student health visitors in conjunction with neighbouring local health authorities has been inaugurated and will assist us, it is hoped in the course of time, to achieve our full complement of staff. The work of the health visitor has been more precisely defined and now embraces the educational, preventive and advisory aspect of the health of all members of the family. Section 24—Statistics for period 5/7/48 to 31/12/48. TABLE 10. Provided by Number of Health Visitors employed at end of year Equivalent of Whole-time Services devoted by Health Visitors included in Cols. (2) & (3) to Health Visiting (all classes including attendance at Infant Welfare Number of visits paid by Health Visitors included in columns (2) and (3) during period 5th July, 1948, to 31st December, 1948 Expectant Mothers Children under 1 year of age Children between the ages of 1 and 5 Other Classes Wholetime on Health Visiting Parttime on Health Visiting First Visits Total Visits First Visits Total Visits First Visits Total Visits First Visits Total Visits (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) Local Health Authority 6 6 80 80 918 2,537 — 4,147 12 12 Voluntary Organisations - - - - - - - - - - - 54 Section 25—Home Nursing. The implementation of the proposals under this section at the end of the year were as follows:— The Council by negotiation have obtained the services of the East Ham District Nursing Association to conduct home nursing throughout the borough. This service has been strengthened by the organisation of loan cupboards for the provision of surgical, medical and nursing equipment and ancillaries freely available where needed. In addition the Silvertown and North Woolwich District Nursing Association service a small area south of the Docks. Section 25—Statistics for period 5/7/48 to 31/12/48. TABLE 20. Provided by Number of Home Nurses employed at 31st December, 1948 Equivalent of whole-time services devoted by Home Nurses included in Cols. (2) & (3) to Home Nursing Number of visits paid by Home Nurses included in Cols. (2) & (3) during the period 5/7/48 to 31/12/48 Number of cases attended by Home Nurses included in Cols. (2) & (3) during the period 5/7/48 to 31/12/48 Wholetime on Home Nursing Parttime on Home Nursing (1) (2) (3) (4) (5) (6) Local Health Authority — — - - — Voluntary Organisations by agreement with Authority 7 6 10½ 17,269 613 The grand total of cases and attendances by the two voluntary organisations throughout the year 1948, were as follows :— Period from 1/1/48 to 4/7/48 Period from 5/7/48 to 31/12/48 Total. Patients on books at the beginning of period 180 178 358 New patients during period 455 435 890 Total No. of visits 16,519 17,269 33,788 Section 26—Vaccination and Immunisation. In regard to this section, arrangements for immunisation against diphtheria were already highly organised in the borough and no extensive change is contemplated. Vaccination against smallpox is carried out by the general practitioners and in the event of an epidemic, plans have been laid for full clinic facilities to be available in addition. 55 Section 26—Statistics. Diphtheria Immunisation Clinics. The six-monthly returns to the Ministry of Health in respect of immunisation are as follows:— TABLE 21. 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 30/6/48 944 372 1,316 1,697 6 months ending 31/12/48 953 206 1,159 226 Totals 1,897 578 2,475 1,923 TABLE 21A—DIPHTHERIA IMMUNISATION. Number of children at 31/12/48 who had completed a course of immunisation at any lime before that date (i.e. at any time since 1/1/34). Age at 31/12/48 i.e. born in year Under 1, 1948 1 1947 2 1040 3 1045 4 1044 5—0 1939—1043 10—14 1934—1938 Total under 15 Number immunised... 124 1,440 1,530 1,005 1,147 4,576 4,438 14,278 Estimated mid-year child population, 1948 10,966 14,352 Of the 14 cases of diphtheria notified (see table 8 for age groups) 4 had completed a full course of immunisation—at date of notification these 4 children were aged as follows:— 1—4 years, 1—5-9 years, 2—10-14 years. There were no deaths from this disease. With reference to Table 21, the children immunised were apportioned between the Authority's medical staff and general practitioners as follows:— Age at final injection. Reinforcing injections. Under 5 5—14 Total 6 months ending 30/6/48:— (a) Council staff 944 372 1,316 1,697 (b) General practitioners — — — — 6 months ending 31/12/48:— (a) Council staff 869 185 1,054 226 (b) General practitioners 84 21 105 — Totals 1,897 578 2,475 1,923 56 Vaccination. The following return for the first six months of 1948, was completed and submitted to the Registrar-General:— Total number of certificates and copies of certificates of successful primary vaccination of children under 14 (irrespective of the year of birth) received during the six months ended 30/6/48 (including those of which copies have been sent to Vaccination Officers of other districts) 503 Total number of copies of certificates of successful primary vaccination received during the six months ended 30/6/48, which have been sent to Vaccination Officers of other districts 206 The statistics for the period 5/7/48 to 31/12/48, are as follows:— Under 1 1—2 2—3 3—4 4—5 5-14 15 & Total. year over By General Practitioners 104 3 — — — 3 26 136 By Council Staff — — — — — — 1 1 Of the total (137) 118 were primary vaccinations and 19 re-vaccinations. Section 27—Ambulance Services. The implementation of these proposals has been outlined in previous reports. A new ambulance station, the better to serve the needs of an expanding service, is proposed on a site in Wellington Road close to the Annexe. Section 27—Statistics. Number of journeys and mileage for two separate periods From 1/1/48 to 4/7/48, the total number of journeys was 4,275 and the mileage covered was 38,243 miles. Included in the above figures were the following journeys made by East Ham vehicles on behalf of:— West Ham 26 — 199 miles Ilford 21 — 306 miles Barking 46 — 485 miles 57 In addition, other authorities provided ambulances or cars on behalf of East Ham residents as follows:— West Ham 13 journeys Ilford 6 journeys Barking 5 journeys L.C.C. 1 journey For the period 5/7/48 to 31/12/48, the following statistics are appended :— Total No. of calls. Total No. of patients carried (a) Ambulances 4,034 (a) Ambulances 3,417 (b) Cars 1,776 (b) Cars 1,570 No. of accident or emergency calls included in total calls:— (a) Ambulances 541 (b) Cars 35 Total mileage—(a) Ambulances 36,671, (b) Cars 18,327 (Total 54,998). The above figures include calls for other areas as follows:— Essex C.C. 15, West Ham 32, Ministry of Pensions 9, East Ham Memorial Hospital to other areas 69—total 125. Section 28—Prevention of Illness, Care and After-Care. The After-Care Sub-Committee of the Health Committee deals with all aspects of prevention of illness, care and after-care, including tuberculosis. A voluntary Amenities Committee continuing certain residual functions of care and after-care in tuberculosis still exists and affords further help in these cases. In regard to mental illness, efforts were made to appoint a whole-time medical officer with special qualifications and experience to undertake this work and to act as psychiatrist to the child guidance clinic which has been established. Only part-time assistance was available for this purpose, but in spite of this the work of the occupation centre for mental defectives has been augmented and the social therapy club for ex-Runwell patients brought largely under the control of this Committee. The appointment of Duly Authorised Officers has contributed greatly towards the supervision and care of both mentally defective and mental cases in the borough, and in the re-orientated services they operate a twenty-four hours schedule of duty. 58 Arising out of the implementation of our proposals under this section, a number of mental cases have been transferred from hospital to appropriate rest homes where their further maintenance as a local authority function calls for closer scrutiny. It has been found possible to transfer a certain number of cases from guardianship to statutory supervision, thus enabling their continued financial provision to become a responsibility of the National Assistance Board, with consequential relief to the local health authority and the rates. Convalescence.—It has been found possible to provide convalescence of the holiday home and rest home type for every age group of case. In this connection the services of the Invalid Children's Aid Association are still being utilised to a considerable extent. Reference has already been made to the value of " loan cupboards " in affording additional comfort and nursing facilities to many sick persons being nursed in their homes. Loan cupboards will be sited as follows :— Town Hall Annexe. Church Road Clinic. East Ham District Nursing Association. †East Ham Chest Clinic. †For tuberculous cases only. Section 28—Statistics. (a) Tuberculosis. (1) No. of visits to homes by nurses for clinic purposes during 1948 6,711 (2) No. of persons on clinic register on 31/12/48:— Adults Children Total Diagnosis completed 1,014 270 1,284 Diagnosis not completed 79 55 134 (3) Extra nourishment supplied to patients from 5/7/48 to 31/12/48 :— Milk 330 Food 32 Total 362 (4) The Committee from 5/7/48 to 31/12/48. approved the purchase of various items of clothing and bedding to 16 patients. 59 (6) Convalescent Home Treatment. (1) Adults. For the period 5/7/48 to 31/12/48, 2 males and 8 females received periods of treatment as follows :— M. F. Southern Convalescent Home, on-Sea 2 weeks - 1 Loughton Lodge, Loughton ,, — 2 Fairby Grange, Dartford „ - 1* Bell Memorial Home, Lancing-on-Sea „ - 1 Bell Memorial Home, Lancing-on-Sea 3 weeks - 1 Essex Convalescent Home, Clacton „ - 1 St. Michael's Convent, Clacton ,, - 1 Rustington Convalescent Home. Little- hampton ,, 1 - †Metropolitan Convalescent Home, Walton-on-Thames 4 weeks 1 - * Mother and Child. † Regional Hospital Board Home. In addition to the above, 2 males and 3 females received treatment for ex-mental patients in After-Care Homes, for periods varying from one to six months. (2) Children. During the same period treatment was provided free in various Homes for the periods stated :— TABLE 22. Age Group Sex Up to 1 week 1-2 wks. 2-3 wks. 3-4 wks. 4-5 wks. 5-0 wks. 0-7 wks. 7-8 wks. 8-9 wks. 9-10 wks. 10-11 wks. 11-12 wks. Over 12 wks. Total Under M. 1 — 2 1 — 5 1 1 — — — — — 11 5 years F. 1 1 3 4 — 4 1 4 1 3 3 1 — 20 M. — 6 4 10 3 21 2 6 - 1 — 1 — 54 children F. 10 2 4 14 3 31 1 2 — 5 1 1 — 74 8 Children under 5 years, in addition to above, received treatment in Regional Hospital Homes. Sections 28 and 51. These sections were implemented from the appointed day by a mental health sub-committee properly constituted to carry out all the functions of the now combined mental health and mental deficiency services under the Act. 60 The re-orientated services formed a section of the health department under the immediate direction and control of the Medical Officer of Health. The Council has agreed to the appointment at the earliest possible moment of a psychiatrist to act as a whole-time medical officer for mental health. Reference has already been made to the appointment of Duly Authorised Officers and five men and one woman officer are engaged on the special duties now appertaining to these posts. The duties embrace the ascertainment, arrangements for certification, appropriate measures for the care of voluntary and temporary patients, and transport to suitable institutions. The follow-up and after-care of all types of mental and mentally defective cases is dealt with by these specially trained officers in a tactful and sympathetic manner which has been much appreciated both by people and general medical practitioners in the community. The proposals envisage complete centralisation of the service at the Town Hall Annexe and this has almost been accomplished. The ambulance service is available for the transport of mental and mentally deficient patients to their destination. Sections 28 and 51—Statistics. (a) Mental patients—Lunacy and, Mental Treatment Acts. Number on register on 5/7/48:— (1) Certified— Males 156 Females 201 Total 357 (2) Temporary— Males 3 Females 1 Total 4 (3) Voluntary— Males 83 Females 76 Total 159 Grand Total 520 Admissions to institutions from 5/7/48 to 31/12/48:— (1) Certified— Males 10 Females 17 Total 27 (2) Temporary— Males 2 Females — Total 2 (3) Voluntary— Males 30 Females 29 Total 59 Grand Total 88 61 Discharges from institutions from 5/7/48 to 31/12/48:— (1) Certified— Males 3 Females 9 Total 12 (2) Temporary— Males 2 Females 1 Total 3 (3) Voluntary— Males 28 Females 34 Total 62 Grand Total 77 Deaths in institutions from 5/7/48 to 31/12/48 :— (1) Certified— Males 2 Females 2 Total 4 (2) Temporary— Males — Females — Total — (3) Voluntary— Males 2 Females 3 Total 5 Grand Total 9 Number on register on 31/12/48 :— (1) Certified— Males 161 Females 207 Total 368 (2) Temporary— Males 3 Females — Total 3 (3) Voluntary— Males 83 Females 68 Total 151 Grand Total 522 Table 23. MENTAL HOSPITALS FOR PERIOD 5/7/48 TO 31/12/48. Hospital On Register at 5/7/48 Admissions Discharges Deaths On Register at 31/12/48 M. F. M. F. M. F. M. F. M. F. Runwell 234 272 42 46 33 44 4 5 239 269 Other Institutions 8 6 - - - - - - 8 6 Totals 242 278 42 40 33 44 4 5 247 275 62 (b) Mental defectives—Mental Deficiency Acts, 1913-1938. A. Particulars of mental defectives as on 1/1/49:— (1) No. of mental defectives "subject to be dealt with" :— M. F. Total (a) Under Guardianship (under Order)* Under 16 years of age 1 - 1 Aged 16 years and over 11 31 42 (b) In "places of safety" — - — (c) Under Statutory Supervision (excluding cases on licence)— Under 16 years of age 17 30 47 Aged 16 years and over 68 43 111 (d) Action not yet taken under any one of the above headings 1 2 3 No. of cases included in (a) to (d) above awaiting removal to an institution 3 4 7 (2) No. of mental defectives not at present "subject to be dealt with" but for whom the L.H.A. may subsequently become liable 30 19 49 Of whom, number under Voluntary Supervision Under 16 years of age — — — Aged 16 years and over 30 19 49 (3) Number of mental defectives receiving training:— (a) In day training centres— Under 16 years of age 7 5 12 Aged 16 years and over 8 9 17 (b) At home — — — Total 15 41 29 B. Particulars of mental defectives ascertained during the year 1948:— M. F. Total (1) Ascertainment :— (a) Cases reported by Local Education Authority—(Section 57, Education Act, 1944)— Under Section 57 (3) 6 6 12 Under Section 57 (5) 3 2 5 (6) Other cases reported during 1948 and ascertained to be "subject to be dealt with" 1 13 14 Total cases ascertained to be "subject to be dealt with " during the year 10 21 31 (c) Other cases reported during 1948, who are not at present "subject to be dealt with" but for whom the L.H.A. may become liable - - - Total number of cases reported during the year 10 21 31 (2) Disposal of cases reported during the year: Cases ascertained to be " subject to be dealt with"— (i) Admitted to institutions (by order) - 12 12 (ii) Placed under guardianship (by order) — — — (iii) Taken to " places of safety " — — — (iv) Placed under statutory supervision 8 8 16 (v) Died or removed from area - - - (vi) Action not yet taken (awaiting mission to institution) 2 1 3 10 21 31 * Dealt with under the provisions of Section 8 or 9—Males 3, Females —. 63 C. Number of mental defectives under community care including voluntary supervision or in "places of safety" on 1/1/48, who have ceased to be under community care or in "places of safety" during 1948:— M. F. Total (a) Admitted to institutions — — — (b) Ceased to be under care — 1 1 (c) Died or removed from area — — — Total — 1 1 D. Of the total number of mental defectives known to the L.H.A.:— (а) Number who have given birth to children during 1948 :— (i) After marriage — (ii) While unmarried — (b) Number who married during 1948, Males 1, Females 2. Menial Defective Occupation Centre. No. of sessions held during the year:— Morning 232 Afternoon 232 Attendances—morning sessions:— Males 2,615 Average attendance 11.3 Females 2,666 ,, „ 11.5 Attendances—afternoon sessions:— Males 2,473 Average attendance 10.7 Females 3,070 „ „ 13.2 Total attendances—Males 5,088, Females 5,736. No. of defectives awaiting admission to Centre on 31 /12/48 :— Males 8 Females 3 Total 11 64 Section 29—Domestic Help. A full-time organiser for the home and domestic help service was appointed and little difficulty has been experienced in recruiting the right type of personnel to carry out the duties required. A clerk has also been found necessary to encompass the clerical work and to interview callers. The expansion of the service has been somewhat more rapid than was envisaged. Whereas on July 5th, 1948, the staff comprised five full-time permanent helps and 12 casual helps on the register, the number employed on December 31st, 1948, was eight full-time and one part-time permanent and seventeen casual helps, and subsequently the Minister of Health approved the increase in the establishment of the service as necessary to a maximum of sixty full-time or an equivalent number of part-time staff : this figure is being rapidly approached. Recruitment of home helps by the usual methods of propaganda and house canvass has not been found necessary. A distinctive badge has been issued to persons appointed permanently and the hours of work were reduced in 1949 to forty-four per week. It should be noted that there is an alteration in designation of all those employed, from " home and domestic helps " to " home helps," and no helps are specifically allocated to maternity or sickness cases. There has been a wide and gratifying demand for home helps and the service has proved a great boon to all sections of the community. Section 29—Statistics. TABLE 24.—Helps provided in Sickness eases from 5/7/48 to 31/12/48. No. of weeks Service provided No. of hours per week Totals Under 4 hours Over 4 and under 8 Over 8 and under 12 Over 12 and under 16 Over 16 and under 20 Over 20 and under 24 Over 24 and under 28 Over 28 and under 32 Over 32 and under 36 Over 36 and under 40 Over 40 and under 44 Over 44 and up to 48 1— 2 weeks 2 5 4 2 4 2 - - - - - 1 20 3— 4 „ 3 3 3 — 1 — — — 1 — — — 11 5— 6 „ — 2 1 — 2 — — 1 — — — — 6 7— 8 „ 1 3 1 — 3 - - - - - 1 — 9 9—10 „ — 2 1 — 1 - - - - - - 1 5 11—12 „ — 1 — 1 1 1 1 1 — — — 1 7 13—14 „ — — 2 — 1 — — — — — — — 3 15—16 „ 1 - - - 1 - - - - - - - 2 17—18 „ — — — 1 1 — — — — — — — 2 19—20 „ - - - - - - - - - - - - - 21—22 „ - - - - - - - - - - - - - 23—24 „ - - - - - 1 - - - - - - 1 25—26 „ - - - - - - - - - - - - - Totals 7 16 12 4 15 4 1 2 1 - 1 3 66 No. of cases receiving Help on 31/12/48 6 14 8 2 11 3 - 1 - - 1 1 47 65 No. of maternity cases who received help during period 5/7/48 to 31/12/48 37 No. of maternity cases receiving help on 31/12/48 3 NOTE.—Maternity cases had 14 days' service following confinement. For the period 1/1/48 to 4/7/48, helps were provided as follows:— Maternity cases 45 Sickness cases 7 Total 52 For the whole of the year, helps were provided to:— Maternity cases 82 Sickness cases 73 Total 155 During the period 5/7/48 to 31/12/48, with the approval of the Health Committee, in 38 cases the help was provided free. The demand for this service continues to grow rapidly as the following statistics for approximately the first half-year of 1949 indicate TABLE 25. 2nd Jan. 1949 to 29th Jan. 1949 30th Jan. 1949 to 26th Feb. 1949 27th Feb. 1949 to 26th Mar. 1949 27th Mar. 1949 to 11th June 1949 Totals Maternity Sickness Maternity Sickness Maternity Sickness Maternity Sickness Number of applications received and dealt with 10 23 19 32 12 35 19 81 231 Number of cases being attended by a help at the commencement of the period 3 47 2 62 4 74 6 89 - Number of cases where help commenced during the period 2 26 7 27 11 37 21 104 235 Number of cases being attended by a help at the end of the period 2 62 4 74 6 89 5 146 — 66 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. As compared with some neighbouring authorities the establishment of the Sanitary Section was well maintained throughout the year. There was but one resignation and one new appointment of District Sanitary Inspector. It has in consequence been possible to resume much more of the Department's routine work and to devote more attention to re-inspections and food premises. It is, however, to be regretted that notwithstanding the greater attention given to follow-up work, results are somewhat disappointing. There would appear to be three main causes for this absence of marked progress viz.:—(1) Continued difficulties in obtaining both labour and certain materials for house repairs ; (2) Protracted negotiations by owners with the War Damage Commission as to responsibility for payment of repair costs, and (3) Reluctance of some owners to carry out repairs at present costs. It has in consequence been necessary to resort to legal proceedings more frequently to effect compliance with sanitary notices. During the year the number of inspections of all classes totalled 33,201 including 8,034 under the Public Health Act, 17,518 re-inspections and 1,808 under the Housing Act, 1936, as compared with 29,117, 9,202, 12,945 and 2,377 respectively last year. The number of sanitary notices complied with was 5,229. The continued co-operation of the Council's Housing Department in the issue of building licences has facilitated the work of the Sanitary Inspectors. The personnel of the Sanitary Section comprised one Assistant Inspector, one Shops Inspector, six District Inspectors, a Deputy and a Chief Sanitary Inspector. Together with one disinfector, one lorry driver, one mortuary attendant, one rodent operator, one drain cleaner, one clerk and two typists. Lectures and talks to local organisations on sanitary administration have been given during the year and the training of selected ex-service men as Sanitary Inspectors has been continued. 67 SANITARY CIRCUMSTANCES. Sanitary Inspection. Details of the work of the inspectors in general sanitary administration are contained in the following statements:— (a) Inspections. The number of inspections of all classes 33,201 (i) Housing. House-to-house — Under Public Health Act 8,034 Re-inspections 17,518 Housing Act, 1936 1,808 (ii) Sanitary Circumstances. Yards and Passages 229 Drainage and Sanitary Accommodation 1,712 Factories (excluding Bakehouses) 434 Workplaces and Outworkers 420 Caravans 4 Re Offensive Fumes 20 Miscellaneous 485 (iii) Food Supply. Slaughterhouses — Dairies 79 Food Premises 1,575 Bakehouses 72 Re Sampling 313 (iv) Infectious Disease. Visits 498 (b) Notices.—The number of notices served during the year totalled 5,339 of which 666 were statutory notices. The number of notices complied within the same period was 5,229. Complaints made to the Department with regard to sanitary circumstances, disrepair, infestations, obstructed drains, etc., totalled 3,779. (c) Rat Extermination.—Following upon last year's survey of the whole of the Borough with its intensive attack on the rodent population of the Borough, further satisfactory results can be reported. During the year 341 complaints 68 were received of the presence of rats. The Council's rodent operator made some 4,149 visits in consequence of these complaints and it is estimated that 1,883 rats were destroyed. The Council's policy of providing a "free" service to occupiers of infested private dwellinghouses and maintenance treatment of the sewers was continued and authorised by the Ministry of Agriculture and Fisheries. Costs of rodent control work were recovered from business premises only. (d) Disinfection and Disinfestation.—Disinfection of premises and articles after infectious disease was carried out in 294 premises and 490 library books were disinfected. Methods employed were in accordance with modern practice and where necessary included steam disinfection. Disinfestation of 91 verminous premises was effected by the use of D.D.T. insecticides in the form of smoke or spray. Infestation of woodworm with or without dry rot in wooden floors and furniture would appear to be on the increase. Remedial measures have been prescribed with, in most instances, successful results. (e) Legal Proceedings.—It was necessary to institute legal proceedings as under:— Public Health Act, 1936—Section 94 44 „ „ „ Section 154 1 Food and Drugs Act, 1938—Section 3 1 (f) Drainage.—547 complaints of choked and defective drains were received. In most cases it was possible for the Council's drain cleaner to remove the obstruction. In addition, repairs or renewals to " public sewers" and drains were carried out in respect of 499 premises, either at the request of the owners or in consequence of statutory action under the Public Health Act, 1936. The costs of these repairs or renewals were recoverable from the owners of the properties concerned. In connection with rodent control 465 drain tests and examinations were made. Co-operation with the Housing Department has continued with the examination and testing of drains both for rebuilt war damaged houses and the Council's new housing estates. 69 (g) As indicated last year, it has been possible to extend the work of factory inspection, and during the year 854 inspections were made of factories, workplaces and outworkers. (h) Mosquito Control.—Larvicidal treatment of the ditches and marshland in the southern part of the Borough was repeated and notwithstanding the use of this land for the Council's temporary housing estates, no complaint of the presence of mosquitoes was received. It is, however, a matter of regret to report that in spite of periodical clearing, much unwanted household equipment and refuse is deposited in the ditches for subsequent removal. (i) Places of Public Entertainment.—During the year it has been possible to effect further improvement of sanitary accommodation, cleansing, decoration and ventilation to more premises used for public entertainment. Visits of inspection to cinemas and kindred places have been made not less than once per week throughout the year. (j) Rent and Mortage Interest Restrictions Acts, 1920-1938.— During the year, 50 applications were received for certificates in respect of the sanitary conditions of houses and 29 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 21 applications. (k) Shops Acts, 1912-1936.—The following is a summary of the work carried out:— Visits re Registers 3,765 „ „ Closing Hours 1,265 „ „ Other matters 379 Total 5,409 (l) Pharmacy and Poisons Act, 1933.—579 visits were made in connection with the Council's list of persons entitled to sell poisons included in Part II of the Poisons List. Thirty additional applications were granted. (m) Explosives Act, 1875.—Registrations for the storage of mixed explosives (fireworks) necessitated 470 visits. 70 HOUSING. Survey of premises for the Housing Department was continued and during the year 1,808 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 spected for defects (under Public Health or Housing Acts) 10,340 (b) Number of inspections made for the purpose 27,858 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidation Regulations, 1925 — (b) Number of inspections made for the purpose — (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonable fit for human habitation 6,420 II. Remedy of Defects during the year without service of formal notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 4,763 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 — 71 (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 666 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (i) By owners 466 (ii) By Local Authority in default of owners — (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made — (2) Number of dwelling houses 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 — 72 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, 1948. 1. Accommodation made available—family units:— (i) By repair of war damage 6,827 (ii) By requisitioned premises 1,237 (iii) By new housing 1,432 (iv) By emergency hutments — 9,496 2. Families rehoused since August, 1945 2,347 3. Cases of overcrowding under Housing Act, 1936, abated by rehousing since August, 1945 (included in 2) 567 4. Total of current applications for rehousing 7,022 5. New Housing:— Dwellings projected Under construction Completed Temporary 934 — 934 Permanent 615 252 250 Cost-of-Works Rebuilds *517 144 248 Total 2,066 396 1,432 * 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, 1948, were as follows:— Tuberculin-Tested Milk— Bottling Establishment Licence — Dealers' Licences 9 Supplementary Licences 3 78 Tuberculin-Tested (Pasteurised) Milk— Dealer's Licence 1 Pasteurised Milk— Establishment Licence 1 Dealers' Licences 17 Supplementary Licences 3 The Council decided in December, 1936, to charge no fees in respect of Licences granted under the Milk (Special Designations) Order, 1936. (b) Meat and Other Foods. (1) Meat Inspection.—Routine visits have been made to butchers' shops and market stalls. In no instance was it necessary to effect the seizure of unsound meat and only 426 lbs. of meat unfit for human consumption were surrendered. Complaints of poor quality were, however, received from both butchers and members of the public. In view of the trend of events it is unfortunate that the Public Health (Meat) Regulations do not include horseflesh in the term " meat." Methods of transport and handling of this much sought after commodity leave much to be desired. Whalemeat in limited quantities has been available to supplement the meat ration but would appear to be less popular with the public than horseflesh, mainly, I think, because of the higher price. The observance of hygienic conditions in connection with the sale, transport and handling of whalemeat is on the whole much better than that appertaining to horseflesh. (2) Food Premises.—During the year it has been possible to give more attention to the inspection of food premises. Inspections included 79 visits to dairies, 72 to bakehouses and 1,575 to other food premises. Special attention has been given to catering establishments and considerable improvements obtained generally in kitchen hygiene and washing facilities for the staffs employed. At the end of the year the Council were considering the provision of free washing facilities in the public conveniences for outdoor food handlers. 74 (3) Slaughterhouses.—No slaughterhouse was in use during the year. There is at present only one licensed slaughterhouse in the Borough. Under the Slaughter of Animals Act, 1933, seven licences were applied for and granted to slaughtermen. (4) Bacteriological Sampling.—135 samples were submitted for bacteriological examination, 92 milk, 32 ice-cream and 11 water. Milk samples submitted for examination are summarised as follows:— Unsatisfactory Ungraded 3 — Tuberculin Tested (Pasteurised) 2 — Tuberculin Tested (Certified) 1 — Pasteurised 55 3 Heat treated other than pasteurised 31 3 92 6 The 32 samples of ice-cream were obtained from 24 different sources of manufacture and were graded by the Council's bacteriologist in accordance with the Ministry of Health's Provisional Grading as follows:— TABLE 26 Place of Manufacture Within the Borough Other Districts Total Grade I 9 1 10 „ II 2 5 7 ,, III 3 1 4 „ IV 7* 4 11 21 11 32 * This number of Grade IV includes repeat samples taken in order to check and improve methods of production of the few less satisfactory manufacturers. During the year 22 registrations for the sale of and 2 for the manufacture of ice-cream were effected. 75 (5) Fertilisers and Feeding Stuffs.—2 satisfactory samples were taken during the year. (6) Other Foods.—The quantity of unsound food examined and surrendered shows no sign of diminishing. More fish and eggs were dealt with than in the previous year. From these examinations the following foodstuffs were condemned as unfit for human consumption :—Fish 795 tins, fruit 510 tins, meat and products 460 tins, milk 1,761 tins and 1,961 tins or packages of other foods. In addition, the following foodstuffs were condemned as unfit for human consumption:— cheese 36 lbs., eggs 2,394, fats 46 lbs., fish 6,275 lbs., fruit 1,811 lbs., meat 426 lbs., sugar 131 lbs., tea 172 lbs., other foodstuffs 2,109 lbs. (c) Adulteration. A wide variety of foodstuffs were sampled and submitted to the Public Analyst for analyses. The number of samples found adulterated or below standard was much less than usual. Systematic sampling has continued throughout the year, involving Sunday and evening work and special attention has been given to school milk supplies, the quality of which has been well maintained by the suppliers throughout the year. Examinations of the milk have also been made for the presence of dirt or other foreign matter but with negative results. Commodities in short supply have received particular attention. Quick porridge oats with a pronounced bitter taste were submitted to the Public Analyst who reported that the bitter taste was natural to the oats or to the method of preparation before marketing. Similarly, the unusual flavour of a portion of jam roll was said to be due to an excessive proportion of synthetic flavouring. Milk sampling necessitated a scientific check on one of the few remaining rural aspects of the Borough. Arising from an unsatisfactory sample of milk it was necessary to take "Appeal to Cow" samples from the one and only dairy farm. As the cows were not a party to the deficiency of milk fat of the sample in question, the retailer was prosecuted. 76 The number of samples taken and the Public Analyst's findings are set forth in the following table:— TABLE 27 Number of Samples Percentage of samples adulterated Examined Found adulterated or below standard Butter 4 — — Cheese 2 — — Cocoa 2 — —. Coffee 6 — — Confectionery 4 — — Jam 4 — — Lard 4 — — Margarine 4 — — Milk 132 1 0.8 Sausage 17 I 5.9 Vinegar 10 — — Wine and Spirits 32 — — Drugs 22 — — Other Articles 91 1 1.1 Total 334 3 0.9 Details of samples adulterated or below standard are described as follows, together with the resultant action:— TABLE 28 Number Informal or Formal Article Adulteration or Deficiency Action taken 5467 I Liver Sausage 21% deficient in meat. Unable to obtain formal sample. Supply discontinued. 5632 F Milk 11% deficient in fat Vendor prosecuted. 5564 I . Jam Roll Excessive quantity of synthetic flavouring—bitter taste. Vendor cautioned. 77 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 1948. As was anticipated in this foreword last year, the interim provisions of the Education Act, 1944, have proved a great buffer to the National Health Service Act in providing continuous and adequate medical supervision of all school children under the care of this Authority. All the problems that have arisen, inseparable from such sweeping legislation, have not yet been solved. The interlocking of the Regional Hospital Board Specialist Service with the School Health Service is not yet completed, and in regard to the newly established Child Guidance Clinic, the Local Authority virtually have to make their own arrangements for the provision of psychiatric specialists to carry out the necessary therapy and supervision. The general practitioner too, still stands somewhat bewildered at the cross roads. Is the School Health doctor to direct selected cases of abnormality or illness to the family doctor for further treatment, or to act himself in conjunction with the hospitals, specialist services and dispensary at his disposal ? Is the family doctor already too overburdened to undertake this added load of responsibility ? One thing is certain, whilst the question is still sub judice, the children will not be allowed to suffer by any indecision and we will assuredly keep the general practitioner well informed of what is happening to these particular patients on his lists. It is further anticipated a system of close co-operation between hospitals, Local Authorities and general practitioners now under discussion, will soon be brought into being. Reference has already been made to the establishment of a Child Guidance Clinic as an integral part of the School Health Service. On the educational side this should supply a long felt need in vocational guidance, psychological assessment and assist the teacher in breaking down some emotional and personality 78 barriers to proper education. From the medical aspect, many behaviour disorders, aberrations, tics, speech defects and serious personality and emotional complex problems "will be elucidated and treated. The team will comprise the Psychiatrist, Psychiatric Social Worker, Educational Psychologist and selected Health Visitors, who have shown particular aptitude for this work. It is felt that the necessity for such a Clinic has been engendered by many convergent factors arising out of the War. The break up of many homes by evacuation and military service, the stress of bombing and shelter life, the weakening of the family bond by neglect of the Church, and possibly an over abundance of too readily accessible social services sapping individual independence and moral integrity. Nor must the great shadow east by the housing problem be ignored, for indeed it darkens the lives of many of our school children. The School Health Service of the Borough has stood the test of time and abundantly proved its worth both in preventive and remedial measures to raise the standard of well being of all school children, and at this crucial period in our history when additional age groups are swelling the ' numbers on roll ' at both ends of school life, the service will bring forth new efforts in the drive for positive health. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, Malcolm Barker, School Medical Officer. 79 GENERAL INFORMATION Schools and Numbers on Roll (mid 1948). TABLE 29. Type. Number of Schools. Number on Roll. Maintained Primary: Infant 17 8,982 Junior 15 Maintained Secondary 11 5,000 Voluntary (Infant and Junior) 4 720 Totals *44 14,702 * (3 maintained schools are combined Infant and Junior). Estimated number of children aged 5-14 inclusive (mid 1948) 14,352 School Clinic premises and purposes served:— Address. Town Hall Annexe. Barking Road. Manor Park Clinic, Church Road. North Woolwich, Fernhill Street. Types of Clinic. School Health Child Guidance Diphtheria and Pertussis Immunisation Aural Ophthalmic Physiotherapy and Sunlight Dental School Health Diphtheria and Pertussis Immunisation Physiotherapy and Sunlight Dental School Health TABLE 30.—SCHOOL CLINICS. MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY MORNING ANNEXE School Health Physiotherapy Dental Child Guidance Physiotherapy Ophthalmic Dental (general anaesthetics) School Health Child Guidance Physiotherapy Dental Physiotherapy Ophthalmic (alternate weeks) Dental Physiotherapy Ophthalmic Dental School Health Dental MANOR PARK Physiotherapy Dental School Health Physiotherapy Dental Physiotherapy Dental (general anaesthetics alternate weeks) School Health Physiotherapy Dental Dental AFTERNOON ANNEXE Immunisation Sunlight Dental School Health Child Guidance Dental Child Guidance Physiotherapy Aural Dental Sunlight Dental North Woolwich School Health Immunisation Aural Dental MANOR PARK Dental School Health Immunisation Physiotherapy Dental Dental 80 81 School Health Clinics. It will be seen from Table 30 that the number of clinics has been increased to meet the demand for physiotherapy, child guidance and immunisation. The coming into operation of the National Health Service Act appears to have had little effect on attendances at school health sessions and the facilities available for remedial and other measures both in the north and south of the borough have relieved the local hospitals of cases which can now be treated effectively at our special centres. This has been appreciated by busy mothers accompanying their children and has resulted in shorter absences from school. Simple medicaments may be obtained at the dispensary and those children requiring additional vitamins, etc., are thereby more adequately supervised. Vaccine and other preparations are given in suitable cases. The school health clinics are closely associated with arrangements for convalescent treatment and the appointment of an administrative officer for this purpose has ensured easy working and successful placement. Information relating to the work of the specialist clinics is given later in the report. COMPARATIVE STATISTICS. The following table indicates briefly the work of the School Health Service during the year 1948, and shows the comparative statistics for previous years. TABLE 31. 1944 1945 1946 1947 1948 Routine and Special Inspections at School: *Maintained Secondary Schools — 969 1,404 2,614 1,932 *Maintained Primary Schools — 1,741 4,034 3,600 4,941 †Secondary Schools 46 125 — — — †Elementary Schools 2,844 640 — — — Re-inspections at School 1,368 1,795 2,834 3,209 2,675 Inspections and Re-inspections at Clinics 19,509 14,628 11,571 11,141 10,748 General cleanliness visits to schools 227 223 256 281 284 Examinations for cleanliness 22,573 25,448 30,077 48,514 38,561 Nurses' visits to homes 2,955 1,859 1,404 1,212 3,691 * Since 1/4/45. t Up to 81/3/45. 82 SCHOOL MEDICAL INSPECTIONS. The arrangements for the routine medical inspection of all school children as required by Section 48, of the Education Act, 1944, have proved very satisfactory and it was possible in addition to carry out the biennial examination agreed upon by the Council. Attention may be focussed on several points, the better to assist in improving the service and in evaluating its results. The presence of parents at these inspections is cordially welcomed and it is satisfactory to report that despite the largenumber who are in employment, 71.6% of parents attended in all age groups and 93.5% in the first group. These figures compare with 60.8% and 87.1% for 1947. There has been little change in the provision of adequate accommodation and suitable equipment for the proper conduct of medical inspections in school. It must be insisted that a classroom with the distraction of lessons going on all round, is not the most suitable place for the physical and mental assessment of the scholars. Comment must be made on the attitude of a proportion of mothers towards their children during the examination. Too often the parent tries to transpose her own head on to the child's shoulders and answer questions obviously put to the latter with a set purpose. This may arise from the fear of the mother that the child will fail or, more often, prolongation of the phase of protection, associated and partly necessary in the pre-school mother-child relationship. Parents must be taught to be rid of their fears, and to encourage independence in their children, and this can begin with the first medical examination for entrance to school. Further, emphasis can be laid on the good physical condition of many new entrants to school coupled with good personal hygiene in the care of skin, hair, teeth and nails and considerable improvement in the standard of shoes and clothing. 83 Reference is made to the value of school meals and milk in the improved physical and dental condition of many age groups. I have no doubt this factor plays a great part in the robust development of the scholars, and would strongly urge any possible improvement in the quality of the meals to attract yet a greater number of pupils who refrain at present from participation in them. The social value of meals and mealtimes, especially to new entrants, is not yet fully appreciated, for it is only by increasing his range of human contacts and experiences, that the child develops as a social creature and thus loses the tyrannical sway he often holds over the home in the pre-school years. In general all defects uncovered during routine medical inspections have been appropriately referred to hospitals, practitioners or clinics, and thereby remedied, and the service continues to play an important part in preventing loss of schooling time through sickness and sub-normal health. Summary of Inspections and Re-inspections. Periodic Inspections : At Schools 6,665 Special Inspections : At Schools 208 At School Health Clinics 3,342 Handicapped Pupils 147 For Employment 34 For Special Courses, etc 227 Re-inspections at Schools 2,675 Re-inspections at Clinics 7,125 84 Medical Inspection and Re-inspection at Schools. TABLE 32 School Infant Junior Secondary I R S I R S I R S (a) Maintained Primary and Secondary Schools: Altmore 244 119 3 — — — — — — Avenue 174 122 7 270 108 48 — — — Brampton 70 40 — 354 84 2 126 — 1 Central Park 85 14 3 — — — 136 — 2 Cornwell — — 225 156 — 198 111 — Dersingham 65 59 1 — — — — — — Essex 85 65 1 — — — 242 110 21 Hartley 310 137 8 574 290 22 — — — Kensington 56 43 3 168 155 8 — — — Lathom — — — 263 46 9 — — — Monega 83 55 — — — — 202 103 5 Napier 102 31 2 — — — 342 73 3 Roman Road 85 — 89 — 1 — — — Salisbury 86 31 2 190 175 10 — — — Sandringham 64 49 3 — — — 169 53 4 Shaftesbury 82 49 1 174 — 1 — — — Storey Street 51 — 45 46 6 — — Vicarage 69 29 1 237 62 4 144 48 — Winsor 58 — — 89 69 11 — — — Boys' Grammar — — — — — — 183 — — Girls' Grammar — — — — — — 88 — 7 Technical School of Building — — — — — — 59 — — (b) Voluntary Schools (B.C.) : Castle Street 24 — — 49 24 — — — — St. Michael's 55 — — 84 78 3 — — — St. Winefride's 28 — — 39 — — — — — Silvertown 17 — — 33 41 5 — — Totals 1,893 843 35 2,883 1,334 130 1,889 498 43 I.—Periodic inspection. R.—Re-inspection. S.—Special inspection. 85 Age Groups, General Condition, Co-operation of Parents. TABLE 33. Group Total inspected Parents present Requiring treatment General Condition. A B C No. % No. % No. % No. % No. % I. 2001 1870 98.5 523 26.1 901 45.0 1082 54.1 18 0.9 11 1443 1111 77.0 281 12.5 259 18.0 1149 79.6 35 2.4 III 489 86 17.6 44 9.0 56 11.5 428 87.5 5 1.0 Age 7- 8 1383 1121 81.1 229 16.6 251 18.2 1076 77.8 56 4.0 Age 12-13 1349 581 43.1 155 11.5 230 17.1 1105 81.9 14 1.0 Totals 1948 6665 4769 71.6 1232 18.5 1697 25.5 4840 72.6 128 1.9 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 HANDICAPPED PUPILS. No special schools for the treatment of handicapped pupils are maintained by the Authority. Arrangements arc 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, 147 special examinations have been carried out by approved medical officers, as a result of which, 85 children, ascertained to be within the various categories, were recommended for special educational treatment as indicated in the following table:— TABLE 34. Category Number ascertained Recommendation Day Special School Boarding Special School Ordinary School with special treatment Blind Partially Sighted — — — — Deaf 2 2 — — Partially Deaf — — — — Delicate 36 — 36 — Diabetic — — — — Educationally Sub-normal 19 9 — 10 Epileptic — — — — Maladjusted — — — — Physically Handicapped 28 3 25 — Suffering from Speech Defect — — — — 86 Eleven eases were found to he 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) 8 Section 57 (5) 3 MEDICAL TREATMENT. Summary of Defects treated at School Health Clinics. Skin : Ringworm 26 Scabies 8 Impetigo 46 Other Diseases 499 Eye Disease 97 Ear Defects 108 Other Defects 246 Total 1,030 Total attendances at School Health Clinics 14,533 NOTE:-Defects treated (see Table 38) refer to cases treated " under the Authority's scheme and otherwise." Aural Clinic. Mr. R. M. Savege, F.R.C.S., M.B., Ch.li., 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 92 Number of children attending 387 Number of attendances 983 Number of children discharged 346 87 Defects and treatment TABLE 35. Defect Number observed Number treated Referred for operation Discharged after treatment Tonsils and Adenoids 238 140 94 232 Other throat conditions 10 10 — 11 Deafness 18 18 — 12 Otitis Media and discharging cars 17 17 — 12 Defects of membrane 12 12 — 14 Other ear conditions 51 50 1 29 Nasal deformities 5 4 1 5 Rhinitis 9 9 — 7 Catarrh 19 19 — 18 Other nose conditions 12 11 1 '8 Totals 391 290 97 348 Note:—Included in figures "Discharged after treatment" are some defects which remained under treatment at the end of 1947. Of the cases referred for operative treatment, 94 were for the removal of tonsils and adenoids, one for the correction of a broken nose and one each for removal of polypi in the ear and nose. The operations 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 58 (c). attends the Ophthalmic Clinic on five sessions fortnightly. The following statistics shew the work carried out :— Number of clinic sessions 118 Number of children attending 1,446 Number of attendances 2,004 Number of children discharged 277 Defective Vision and Squint Eye Disease New cases 204 Treated at clinic 136 Re-examinations 1,14.5 Referred to hospital 7 Glasses prescribed 1,168 * Glasses obtained ... See note below Glasses not required 37 Referred to hospital 14 * It is impossible to state the number of spectacles obtained, as from 5/7/48. 88 The following cases were referred to hospital for treatment:— Squint 14 Photophobia 1 Cyst 4 Foreign body 1 Corneal ulcer 1 Upon the inauguration of the National Health Service the provision of spectacles by the Authority through a contracting optician ceased and parents now have a free choice of optician. One considerable disadvantage of this arrangement is that " on the spot " adjustments of a minor nature can no longer be carried out in the clinic. The fitting of new glasses under the supervision of the ophthalmic surgeon is also impracticable. 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. An intensive campaign carried out during the year in Infant and Junior Schools was highly successful particularly in regard to re-inoculation which increased nearly ten-fold over the 1947 figure. The work of the clinics is shewn in the following summary:— Number of clinic sessions 148 Number of children completely immunised 599 Number of children re-inoculated 1,812 Percentage of children of school age completely immunised 62.8 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 received during the year for children of school age was:— Pulmonary 34 Non-pulmonary 9 89 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) 390 3,944 Local light 132 1,579 Electrical and massage 98 110 Remedial exercises 217 1,712 Total attendances—5.804. The appointment of an Orthopaedic Consultant has not yet been made and. when necessary, cases are referred to general hospitals. Child Guidance Clinic. The Child Guidance Clinic at East Ham Memorial Hospital, which had been used for some time by the Authority for cases requiring treatment, ceased when the National Health Service Act, 1946, came into operation. With the (part-time) appointment of Dr. H. Bevan Jones as Psychiatrist, sessions were commenced at the Town Hall Annexe. It is anticipated that new premises will be available during this year with greatly increased facilities for ascertainment and treatment. Mr. H. J. Wright, B.Sc., Educational Psychologist, assists in the work of the clinic—the post of Psychiatric Social Worker has not yet been filled. The following is a summary of the work of the clinic since its inception on 9/9/48 :— Number of treatment sessions 59 *Number of cases referred for treatment 148 Number of cases treated 45 Number of attendances 207 Number of cases discharged 82 * Includes cases who had previously been under treatment at East Ham Memorial Hospital. 90 HOSPITAL TREATMENT. Apart from the financial implications the change in administration of the hospitals has made little difference to the treatment of East Ham pupils. Cases requiring specialist services are referred to an appropriate hospital and the provision of all forms of treatment is thus maintained. Operative treatment of tonsils and adenoids has been carried out as follows *East Ham Memorial Hospital 130 Children's Hospital, Balaam Street 655 Queen Mary's Hospital, Stratford 22 St. Mary's Hospital, Plaistow 69 * Up to 15/7/49 only. 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 284 Number of examinations 38,561 Number of pupils found unclean 499 Number of cleansing notices (Section 54 (2) ) 89 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. 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 3,691 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. 91 DENTAL INSPECTION AND TREATMENT. Miss H. T. Smith, L.D.S., R.C.S., has submitted the following report on the Dental Service:— The School Medical Officer, Education Committee, County Borough of East Ham. Sir, I have the honour to present my report of the work carried out in the dental clinics during the year 1948. The year which has just ended has been rather a difficult one for the dental staff. It has seen the introduction of the Health Service, and I had hoped that this would be the most successful year in the history of the dental clinics in the Borough. Arrangements had been made to extend the dental services for expectant, and nursing mothers, and young children ; unfortunately, we have been unable to carry out this plan owing to the acute shortage of dental staff. At the beginning of the year, there were three dental officers providing treatment for the school children, and patients under the M. & C.W. scheme ; later in the year one dental officer resigned, and all plans for extending existing services had to be abandoned. However, in spite of these problems the figures for the year show an improvement upon 1947. This is particularly noticeable in the number of permanent teeth filled, the figure for the year being 3,197, an increase of 426 on the previous year. The number of temporary teeth filled was also increased by 38 on the previous year. The number of children inspected during the year was 21,835, the number found to require treatment being 8,708—the number of patients actually treated was 5,030. The interest of parents in orthodontic treatment has been maintained, and during the year 27 orthodontic appliances were supplied. The more difficult cases and those requiring prolonged treatment were referred to hospital. During the year 80 permanent teeth were extracted to facilitate orthodontic treatment. Details of figures will be found in Table IV returns to the Ministry of Education. The School Dental service is passing through a very difficult time, but the Local Authorities could alleviate this problem of acute staff shortage, and the drift of dental officers to private practice, by making conditions of service more attractive to the 92 profession. There are quite a number of young dental surgeons who would prefer to work in the School service but economic conditions force them into the more lucrative sphere of private practice. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. TABLE 36. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups : Entrants 2,001 Second age group 1,443 Third age group 489 Total 3,933 Number of other Periodic Inspections 2,732 Grand Total 6,665 B.—Other Inspections. Number of Special Inspections 3,958 Number of Re-inspections 9,800 Total 13,758 C.—Pupils found to Require Treatment. Number of individual pupils found at periodic medical inspections 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 37A Total individual pupils Entrants 14 514 523 Second age group 59 238 281 Third age group 23 21 44 Total (prescribed groups) 96 773 848 Other periodic inspections 107 295 384 Grand Total 203 1,068 1,232 93 TABLE 37. A.—Return of Defects found by Medical Inspection in the year ended 31st December 1948. 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 71 36 709 53 Eyes—a. Vision 203 229 123 126 b. Squint 27 45 22 53 c. Other 43 57 203 73 Ears—a. Hearing 9 21 21 7 b. Otitis Media 15 17 46 5 c. Other 16 19 114 29 Nose or Throat 379 498 705 456 Speech 18 35 23 22 Cervical Glands 20 80 33 29 Heart and Circulation 2 34 8 15 Lungs 58 95 7 30 Developmental— a. Hernia 8 19 9 7 b. Other 21 59 12 23 Orthopaedic— a. Posture 55 52 0 12 b. Flat Foot 85 46 55 19 c. Other 88 79 35 32 Nervous system— a. Epilepsy 5 5 5 12 b. Other 20 44 69 28 Psychological— a. Development 22 40 26 28 b. Stability 15 33 20 7 Other 148 287 1,490 365 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. °/ /o No. °/ /o No. °/ /o Entrants 2,001 901 45.0 1,082 54.1 18 0.9 Second age group ... 1,443 259 18.0 1,149 79.6 35 2.4 Third age group 489 56 11.5 428 87.5 5 1.0 Other Periodic Inspections 2,732 481 17.6 2,181 79.8 70 2.6 Total ... 6,665 1,607 25.5 4,840 72.6 128 1.9 94 TABLE 38. 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 — (ii) Other treatment 1 Ringworm—Body 31 Scabies 43 Impetigo 50 Other skin diseases 578 Eye Disease—external and other but excluding errors of refraction, squint and cases admitted to hospital 191 Ear Defects—excluding treatment for serious diseases (operative treatment in hospital) which are recorded in the body of the Report ... 179 Miscellaneous (minor injuries, bruises, sores, chilblains, etc.) 304 Other conditions not classifiable under the above headings 2,251 Total 3,628 (b) Total number of attendances at Authority's minor ailment clinics 14,533 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) 1,349 Other defect or disease of the eyes (excluding those recorded in Group I) 103 Total 1,452 Number of Pupils for whom spectacles were: (a) Prescribed 1,168 (b) Obtained* See note below (* Since 5/7/48 when the issue of spectacles through the school clinic was discontinued, it is assumed that spectacles have been obtained in all cases where prescribed.) 95 GROUP III.—Treatment of Defects of Nose and Throat. Total number treated. Received operative treatment : (a) for adenoids and chronic tonsillitis 876 (b) for other nose and throat conditions 3 Received other forms of treatment 113 Total 992 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 outpatients departments 324 GROUP V.—Child Guidance Treatment and Speech Therapy. Number of pupils treated : (a) under Child Guidance arrangements 103 (b) under Speech Therapy arrangements 31 TABLE 39. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Authority's Dental Officers :— (a) Periodic age groups 21,835 (b) Specials 1,551 (c) TOTAL (Periodic and Specials) 23,386 96 (2) Number found to require treatment 8,708 (3) Number actually treated 5,030 (4) Attendances made by pupils for treatment 9,422 (5) Half-days devoted to:- (a) Inspection 189 (b) Treatment 1,009 Total (a) and (b) 1,198 (6) Fillings: Permanent teeth 3,197 Temporary teeth 270 Total 3,467 (7) Extractions : Permanent teeth 844 Temporary teeth 8,017 Total 8,861 (8) Administration of general anaesthetics for extraction 1,565 (9) Other Operations : (a) Permanent teeth 1,002 (b) Temporary teeth 1,027 Total (a) and (b) 2,029 TABLE 40. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorised persons 38,561 (ii) Total number of individual pupils found to be infested 499 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 89 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) – Printed by G. W. DRAY & SON, LTD. Market Street, East Ham, E.6