EAS 26 COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1949 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 the Statutory Committee for Mental Health; Chief Tuberculosis Officer. COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1949 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 the Statutory Committee for Mental Health; Chief Tuberculosis Officer. PRINCIPAL CONTENTS. Sections :— Pages Constitution of Council 3 Public Health Staff 4 Introduction 7 Statistical and Social Conditions of Area 18 General Provision of Health Services 22 Infectious Diseases 26 National Health Service Act, 1946 Sec. 22 Care of Mothers and Young Children 36 Sec. 23 Midwifery Services 42 Sec. 24 Health Visiting Services 44 Sec. 25 Home Nursing Services 45 Sec. 26 Vaccination and Immunisation 47 Sec. 27 Ambulance Services 49 Sec. 28 Prevention of Illness, Care and After- Care 51 Sec. 28 & 51 Mental Health Services 54 Sec. 29 Home Help Services 60 Sanitary Section and Housing 61 Inspection and Supervision of Food 69 School Health Service:— Introduction 76 Report 78 EAST HAM CORPORATION. COUNCIL (shewing Chairmen and Vice-Chairmen of Health, M. & C. W., Mental Health, After-Care and Education Committees). The Mayor : Mrs. Councillor Ethel Maud Charlotte Brace, J.P. The Deputy Mayor : Councillor William Innes Jackson, J.P. Aldermen : Charles William Brading, J.P., C.R.P. Charles William Dixon. (1) Sydney Arnold Elson. (4) Richard John Fell. John Albert Hart, J.P. Walter Edwin Hurford. Herbert Percy Jackson. (6) Thomas Irwin Lethaby, J.P. Frederick Welch, J.P. (7) Ernest Albert Wood, J.P. Councillors : Robert Cecil Beadle. William Henry Whittock Beecham. Leslie Alfred Victor Bennett. (2) Joseph John Gillard Bishop. Agnes Ann Bradshaw (Mrs.). Charles Frederick Chapman. Frederick George Pryer Clayton. Daisy May Davey (Mrs.). Edwin John Davey. Elsie Mary Df.venay (Mrs.). Eric Edward Thomas Digby. (5) Eleanor Mary Fell (Mrs.). James Fenner. Francis William French. (3) Florence Matilda Goodchild (Mrs.). Leonard Lewis Griffiths. Henry- Joseph Hooper. Frank Herbert Howard. Thomas Alfred Jenkinson. John Alfred Kemp. Winifred May Knight (Mrs.) J.P. Arthur George Murrell Oakes. Alfred Prior. Frank Owen Reynolds. Reuben Frederick Ricketts. Lily Sutton (Mrs.). James Ernest Taylor. Ralph Reginald Turville. Co-opted Members of the Maternity and Child Welfare and Mental Health Committees :— Mrs. M. E. Bennett Mrs. A. M. Burrell, E.C.C. Coun. Mrs. S. Candy Mrs. B. A. Dixon Mrs. S. Jackson Maternity and Child Welfare Mrs. C. Boar Mrs. A. M. Fell Mrs. N. Griffiths Mental Health (1) Chairman of Health Committee. (2) Vice-Chairman of Health Committee. (3) Chairman, Maternity and Child Welfare Committee. (4) Chairman of Mental Health Committee. (5) Chairman of After-Care Committee. (6) Chairman of Education Committee. (7) 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. 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. *Katherine H. Foley, M.R.C.S., L.R.C.P., Temporary Medical Officer, Aldersbrook Maternity Hospital and Children's Homes. Stella Margaret Beryl Perry, M.B., Ch.B., D.P.H., Assistant Medical Officer. †Freda Gaskell, M.R.C.S., L.R.C.P., Assistant Medical Officer. Medical—part-tim e. OS. C. Reeve-Flaxman, M.R.C.S., L.R.C.P., Ophthalmic Surgeon. R. Savege, M.B., Ch.B., F.R.C.S. (Edin.), Aural Surgeon. H. Bevan Jones, M.R.C.S., L.R.C.P., Psychiatrist. †W. H. Craike, 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. †Pauline Osis, D.D.D. University of Latvia (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. *J. A. Dawson, M.S.I.A. E. A. Bloomfield, M.S.I.A., A.R.S.I. †. H. Riley, M.S.I.A. F. W. Reeve, M.S.I.A. †H. F. Williams, M.S.I.A., M.R.S.I. Shop Acts Inspectors :— ‡C. H. Pursall, A.R.S.I. †T. Gilbert. 5 D. Nursing Staff Superintendent Health Visitor :— †B. L. Maryon, S.R.N., S.C.M., H.V..'s Cert. (R.S.I.). Unified Nursing Service (Health Visitors and School Nurses) :• M. Preston, S.R.N., S.C.M., H.V.'s Cert. (R.S.I.). M. K. Pressey, S.R.N., S.C.M., H.V.'s Cert. (R.S.I.). B. Walters, S.R.N., S.C.M. (H.V.'s Cert.). M. Golden, S.R.N., S.C.M. (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.). †S. Golden, S.R.N., C.M.B. (Part 1), H.V.'s Cert. (R.S.I.). †E. G. Slennett, S.R.N., S.C.M., H.V.'s Cert. (R.S.I.). †M. J. Pye, S.R.N., C.M.B. (Part 1), H.V.'s Cert. (R.S.I.). †M. Larner, S.R.N., S.C.M., R.F.N., H.V.'s Cert. (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. B. 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.). G. M. Grant, S.R.N., T.A. (Cert.). Municipal Midwives :—• M. Law, S.C.M. M. E. Kinsella, S.R.N., S.C.M. S. J. Miller, 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. J. H. Wickens. Mrs. M. A. Pearce. †R. C. Hoad. J. C. Hillier. F. Other Staff:— A. H. Bleaden, Supervising Officer, M.D. Training Centre. W. L. Nakborougii, Dispenser (temporary). A. W. Lywood, Guide and Assistant (temporary), M.D. Training Centre, †I. Allott, Assistant Supervisor, M.D. Training Centre. †H. H. L. Webber, Care and After-Care Assistant. *F. .T. H. Jackson, Home Help Organiser. †. H. Belle-Vue, Home Help Organiser. G. Child Guidance :— H. J. Wright, B.Sc., Educational Psychologist †Miss P. N. Glover, L.C.S.T. Speech Therapist. †Mrs. K. Barker, Play Therapist. 6 H. Clerical Staff:— Chief Administrative Clerk, T. B. Clark. Senior Clerk, B.E.R. Hartley, A.C.I.S. Male Clerks :— E. J. Steadman (Petitions Officer). C. J. Hayes. H. J. Horsnell. B. G. Boar. D. E. Ross. B. .T. Curling. R. C. Thorogood. J. F. J. Thomas. and Temporary Clerks. Shorthand Typists :— D. Gordon, Senior. D. G. Cannell. E. R. A. Paddon. G. C. Croxson. †T. Canty. And Temporary Staff. Female Clerks :—M. A. R. Gaster. F. C. Wells. *B. Clandillon. J. Mackintosh. B. H. White. F. M. Clark. L. L. Cundall. S. A. Moss. And Temporary Staff. † Commenced during year. ‡ Retired during year. * Terminated during year. 0 Deceased during year. 7 COUNTY BOROUGH OF EAST HAM Public Health Department, Town Hall Annexe, E.6. July, 1950. To the WoESHIPFUL 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 1949. The Minister requests that the annual report be prepared on the lines of that for 1948, and besides dealing generally with the Medical Officer of Health's responsibilities regarding public health and preventive medicine, the report should, as appropriate, deal specifically with matters indicated below and applicable to this County Borough. As regards the National Health Service Act, 1946, information is requested in respect of local health services under Part III. The report includes a review of the working arrangements for the care of expectant and nursing mothers and young children and describes developments or changes in these arrangements during the year. Similar information is given regarding the domiciliary midwifery service ; the health visiting service ; the home nursing service ; arrangements for vaccination and immunisation ; the ambulance service ; arrangements for the prevention of illness, care and after-care; and the home help service. The report also includes in a separate section, details submitted by the Senior Dental Officer on the dental treatment provided for expectant and nursing mothers and young children. The mental health section includes details of administration and an account of work undertaken in the community. Reference is also made to Section 47 of the National Assistance Act regarding removal to suitable premises of persons in need of care and attention. Information concerning food, clean food campaigns and any food poisoning outbreaks are contained in the report. The Registrar-General's mid-year estimate of the population was 121,900, which shews a slight increase over that for last year. 8 The number of inhabited houses is 34,285, an increase of 1,597 houses. The birth rate has still further decreased and was 15.8 per 1,000 of the population as compared with 18.1 for last year. The death rate for the borough at 11.55 was slightly higher than for the corresponding period. The infantile mortality figure, i.e., the deaths of infants under one year—shews a still further reduction from 26 to 24—again the lowest infantile mortality rate in the history of East Ham. The deaths of children under one month total 29—a neo-natal mortality rate of 14.9, approximately the same as last year. The diagram on page 18 gives an indication of the causes of death which occurred in the borough, and that heart, circulatory diseases and cancer accounts for a large proportion of the deaths. In respect of treatment of infectious diseases, it will be seen that cases are admitted to hospitals within a wide radius of the borough and more patients are treated at home. This brings into focus an aspect of " Regionalisation " which is causing the Council some concern. Complaints are being received from residents who object to the removal of their children to Infectious Diseases Hospitals remote from East Ham. Considerable travelling expenses to the parents in visiting are incurred and the consequent curtailment in the frequency of the visits distresses the parents and further increases the feelings of abandonment, and loss of affection experienced by the sick child. In this matter regionalisation tends to ignore modern paediatric teaching and, in addition, the charges of the ambulance service tend to swell the overall high cost of the hospital administration. Another facet of the same problem is turned to the strong light of professional and public criticism, in the long waiting list for admission to sanatorium of early acute and active cases of pulmonary tuberculosis. Since the ' appointed day ' the waiting time has grown from four weeks to ten months and, in many instances, the living conditions have considerably worsened and the possibility of the spread of infection markedly enhanced by delay in sanatorium treatment. 9 As an alleviating and social measure, the local authority is asked to remove from the home all children who may be contacts of such infected persons, and place them in foster homes or institutions at a distance, until such time as it is safe to restore them to their families. Meanwhile, treatment is instituted for the tuberculous subject in the home, a complete reversal of established procedure which is basically at fault, for no-one can ensure rigid isolation and antisepsis under such crowded conditions of living as exist in the borough, and disruption of home life, especially for the children should be avoided. There is never the complete assurance that other children or adults will not visit the infected subject and receive from him, in a few moments contact, a heavy dose of virulent tuberculosis germs which may alter, tragically, the whole tenor of their lives. It would appear that for a circumscribed county borough, of a dormitory nature such as East Ham, a strong case could be made out for the return of its Sanatorium and Isolation Hospital. Regionalisation can best exert a beneficial action in geographically large rural and semi-urban populations, where it is manifestly uneconomic to create numerous small centres for treatment which are expensive to run and maintain. In like fashion, the specialist clinics of the local authority will henceforth be staffed by medical graded personnel from the Regional Hospital Board. Here also repercussions are to be felt in that the somewhat onerous terms of engagement asked of the individuals concerned has resulted in contractions of the services rendered to the Council. The " Dental Extraction under Anaesthesia " clinic and the Ophthalmic clinic have already suffered in this way and it is likely that the future work of the Child Guidance clinic will be affected also. It would appear that the problem must be faced, either of accepting a lower standard of professional service in some of our clinics, or the Council themselves maintaining the high level standard over the years by employing and remunerating specialists. Dual control of such services cannot make for efficiency and the social aspect of the work generally and the integrity of the School Health Service in particular, point to the great desirability of direction and control being vested in the Health Authority through the Medical Officer of Health. 10 A great forward surge is being witnessed in the field of social medicine. The development of the Home Help Service and the expansion of the Domiciliary Nursing activities have contributed not a little to the comfort of sick and ailing persons of all ages in the home and afforded some degree of respite to harassed parents and relatives. So also the continuance of the Day Nurseries has made it possible in many families to solve social and domestic problems which, without their help, would have precipitated breakdowns and upheavals in a number of individuals and families—a marked contribution to the achievement of positive personal and community health and well-being. Furthermore, a drive has been inaugurated under the auspices of the Council towards the attainment of clean food, clean shops and hygienic food handling in the borough. There is a resurgence of public conscience, and residents in every station of life are increasingly aware of the not inconsiderable illness and disability resulting from the contamination of food, at its source, during storage and in the preparation and distribution. A great medicosocial effort also is gathering momentum to master one of the ' Captains of the men of Death '—Cancer—responsible for untold misery and suffering to numerous individuals and their families. It will be seen that the Medical Officer of Health and his staff must play an increasingly active role in the elucidation of problems which have baffled scientists and sociologists for centuries and, with the reduction of infantile mortality, safe labour, the practical elimination of smallpox and other infectious illness, we can look forward with confidence to the conquest of this dread disease. The care of old people also presents an ever expanding problem. All the help which can be given by the medico-social agencies under our control often does not suffice to procure for them a reasonable standard of living and personal comfort and recourse must be had to institutional care or placement in a hostel. With the greater average expectation of life for every individual now an established fact, increased co-operation wi 11 be sought with the Regional Hospital Board and the Welfare Services to ensure to all aged persons that degree of comfort and companionship which should be every man's heritage in a civilised community. Viewing all this effort in synoptic contemplation, it would appear that the home is being made more fitting for the reception 11 of the sick and ailing and little, if anything at all, is planned for the comfort and well-being of the normal burgesses and especially the children and young persons. This vital factor, in my opinion, is the one which should never be lost sight of in the battle against juvenile delinquency now being joined between the slowly mobilising forces of the local authority and the recalcitrant youngsters who have never known real homes. After all, the home should be the abiding bastion against numerous individual and social evils, but its atmosphere must be clean, culturally wholesome and satisfying and, above all, peace and love must reign therein and radiate from the parents to the hearts and minds of the children. Only by education in the home will this victory be won : by the Health Department through its Health Visitors and Mental Health services closing their ranks with all the moral and educational forces available, all directing their concerted effort towards the achievement of health, peace and joy in the home. Comparison with previous reports gives an indication of the progress attained in recent years and the use made of the various new services. In this, my final report as Medical Officer of Health, I am happy to think that the Council's endeavours over many years have been extolled by the Regional Hospital Board and by Hospital Management Committees and that hospital and other services which have now passed to them have elicited such praise and • admiration. It is with deep regret that I record the death of Mr. ReeveFlaxman, M.R.C.S. Eng., L.R.C.P., Ophthalmic Specialist to the Education Committee for over twenty years. An appreciation of his eminent; services is contained in the school report. Reference must also be made to the long and meritorious service of Dr. Jessie A. MacLaren, Assistant Medical Officer for Maternity and Child Welfare, and Mrs. A. A. Woodman, M.B.E., Superintendent Health Visitor, who, in the course of the year, retired on superannuation. I desire to record my sincere regard for my deputy and successor, Dr. J. S. Coleman, and for Mr. T. B. Clark, Chief Administrative Clerk. I am very appreciative of the loyal and devoted service of all sections of the Health and School Medical 12 Departments and also wish to express my gratitude to members of the staff individually for the conscientious, willing and able manner in which they have carried out their duties and maintained the status of this department. I am indebted to my colleagues of other departments for their co-operation throughout the year. My thanks are due to the Chairman and Members of the Health Committee and to those of Sub-Committees for their confidence in me and help on all occasions, and to other members of the Council for their friendship and generous consideration at all times. I conclude this report with every good wish for the health, happiness and progress of the people of East Ham. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Malcolm Barker, Medical Officer of Health. 13 Statistical and Social Conditions of the Area Social. Area (in statute acres) land and water 3,824 Population. Census—1931 142,394 Estimated civilian population—1949 121,900 Number of inhabited houses (end of 1949 according to rate books) (including tenements and shops) 34,285 Rateable value at 31st December, 1949 £760,207 Sum represented by a penny rate for the year 1949 £3,050 Extracts from Vital Statistics. Total Males Females Live births Legitimate 1,869 940 929 Illegitimate 65 39 26 Still births Legitimate 43 28 15 Illegitimate 5 3 2 Deaths—Total 1,342. Males 708. Females 634. Deaths from Puerperal causes :— Deaths Rate per 1,000 Total (Live and Still) Births Puerperal Sepsis — — Other Maternal Causes 3 1.513 Total 3 1.513 Deaths of infants under one year of age :— Ail infants per 1,000 live births 24 Legitimate infants per 1,000 legitimate live births 24 Illegitimate infants per 1,000 illegitimate live births 30 Deaths from Cancer (all ages) 241 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years) 3 14 Still Births. The number of still births registered was 48 compared with 46 for the previous year. The rate per 1,000 total (live and still) births was 24.2, the figure for 1948 being 20.5. The still birth mortality rates for England and Wales and East Ham are shewn in the following table :—- Still births per 1,000 population. 1944 1945 1946 1947 1948 1949 England and Wales 0.50 0.46 0.53 0.50 0.42 0.39 East Ham 0.49 0.53 0.56 0.51 0.38 0.39 The rates for East Ham per 1,000 total (live and still) births for the past five years are indicated below :— 1945 1946 1947 1948 1949 No. of still births 51 64 61 46 48 Rate per 1,000 total births 28.4 24.2 21.06 20.5 24.2 Births. The number of live births registered was 1,934, as compared with 2,194 for the year 1948, equivalent to a birth rate of 15.8 per 1,000 of the civilian population—the figure for the previous year— 18.1. A comparison of the statistics for the period since 1945 is appended below:— 1945 1946 1947 1948 1949 No. of Births (East Ham) 1,742 2,577 2,835 2,194 1,934 Birth rate (East Ham) 18.2 22.69 23.8 18.1 15.8 „ ,, (England & Wales) 16.1 19.1 20.5 17.9 16.7 Deaths. The number of deaths of residents dying within or without the district was 1,342, as compared with 1,172 for the year 1948. The death rate per 1,000 of the civilian population was 11.0, that for the previous year being 9.67. Of the total deaths, 569 or 42 15 per cent, died in institutions. The number of residents who died outside the area and whose deaths were assigned to the Borough was 550. The number of deaths of persons non-resident in the area was 64. The number of deaths in various age groups was as follows :— Under 1 year 1-5 years 5-15 years 15-25 years 25-35 years 35-45 years M. F. M. * F. M. F. M. F. M. F. M. F. 29 19 4 6 3 3 9 8 18 9 27 20 45-55 years 55-65 years 65-75 years 75-85 vears 85-95 years 95 and over M. F. M. F. M. F. M. F. M. F. M. F. 63 44 126 91 199 168 186 198 44 67 — 1 The crude death rate was 11.0. The Registrar-General has now again supplied an area comparability factor and that for East Ham is 1.05. The corrected death rate is, therefore, the crude death rate (11.0) multiplied by 1.05—11.55. For the period 1945—1949 the death rates for England and Wales and East Ham are compared :— 1945 1946 1947 1948 1949 England and Wales 11.4 11.5 12.0 10.8 11.7 East Ham 12.9 10.6 11.79 9.67 11.55 Infantile Mortality. Deaths of infants under one year numbered 48—equivalent to an infant mortality rate of 24 per 1,000 live births, the rate for the previous year was 26. The rate for England and Wales for 1949 was 32. The number of deaths of illegitimate children under one year of age was two out of a total of 65 illegitimate live births, giving a mortality rate of 30 as compared with a figure of 15 per 1,000 illegitimate live births for the year 1948. The infantile mortality rates since 1945 are as follows :— 1945 1946 1947 1948 1949 England and Wales 46 43 41 34 32 East Ham 36 30 30 26 24 Illegitimate births and mortality rates for the Borough since 1945 are tabulated below:— 1945 1946 1947 1948 1949 No. of illegitimate births 105 108 102 65 65 Mortality rate per 1,000 illegitimate live births 38 18 49 15 30 16 Neo-Natal Mortality. Children dying under the age of one month totalled 29, equal to a neo-natal mortality rate of 14.9 per 1,000 live births. These rates from 1945—1949 are compared below :— 1945 1946 1947 1948 1949 19.5 19.4 17.6 14.5 14.9 The causes of death of these children under one month of age were as follows :— Cause. No. of Deaths Pneumonia 3 Diarrhoea and Enteritis — Premature Births 9 Congenital Malformations, Birth Injury, Infantile Diseases 16 Other causes 1 Total 29 Maternal Mortality. The number of maternal deaths was 3, the maternal mortality rate per 1,000 live and still births for 1949 was 1'513. Population. The Registrar-General's estimate of the population at the 30th June, 1949, was 122,000 total, and a civilian population of 121,900, an increase of 800 compared with that for the previous year. The rates per 1,000 of the population mentioned in this report are based on the estimate for the civilian population. The Registrar-General published in 1949, "Estimates of the sex and age distribution of the civilian population in regions and administrative areas of England and Wales at 31 st December, 1947." An extract from this volume, appended below, relates to East Ham. 17 TABLE 1. Age Males Females Total All ages 56,588 61,612 118,200 0—4 5,559 5,284 10,843 5—14 7.394 6,884 14,278 15—17 2.147 2,167 4,314 18—19 584 1,593 2,177 20—24 3,319 4,271 7,590 25—34 10,161 10,288 20,449 35—44 9,777 9,506 19,283 45—54 6,901 8,050 14,951 55—64 5,577 6,686 12,263 65—74 3,619 4,735 8,354 75—84 1,418 1,883 3,301 85 and over 132 265 397 NOTE.—For females, the age group 55—64 has been sub-divided as follows :— 55—59 ... 3,486 60—64 ... 3,200 The percentage of the total population (East Ham) divided into age-groups as on 31/12/47, was as follows Under 5 years 9.17% 5—-14 years 12.07% 15—25 years 11.91% 25—45 years 33.61% 45—65 years 23.02% 65—75 years 7.07% 75—85 years 2.79% 85 years and over 0.33% It will thus be seen that on the date given, 9 out of every 100 of the population were under 5 years, 12 were schoolchildren and 10 were 65 years and over. 18 Table 2. DEATHS 1949 Crude Death Rates—various causbs. 19 20 Table 3.—BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1949. 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 †16.7 †0.39 †11.7 0.00 0.01 0.51 0.01 0.00 0.15 0.00 0.45 32* 3.0 126 County Boroughs and Great Towns, including London 18.7 0.47 12.5 0.00 0.02 0.56 0.02 0.00 0.15 0.00 0.52 37 3.8 148 Smaller Towns (resident populations 25,000 to 50,000 at Census, 1931) 18.0 0.40 11.6 0.00 0.02 0.49 0.01 0.00 0.14 - 0.42 30 2.4 London—Administrative County 18.5 0.37 12.2 0.00 0.01 0.59 0.01 0.00 0.11 — 0.52 29 1.7 East Ham 15.8 0.39 11.55 — 0.00 0.60 — 0.01 0.14 — 0.36 24 1.5 f Rates per 1,000 total population. A dash (—) signifies there were no deaths. * Per 1,000 related births. 20a Table 4.—CAUSES OF DEATH IN AGE GROUPS, 1949, AND TOTAL DEATHS FOR 1945-1949. 20a Cause. Deaths at different periods of life of residents (civilians) whether occurring within or without the district. Institutional Deaths Total deaths for the years A11 Ages. Under l Year. 1—5 Years. 5—15 Years. 15—4,5 Years. 45—65 Years. 65 and Upwards. Total deaths in Instns. 1949 1948 1947 1946 1945 M F M F M F M F M F M F M F M F 1. Typhoid and Para-typhoid Fevers 2. Cerebro-Spinal Fever 1 — 1 — — — — — — — — — — — 1 — 1 1 1 1 3. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough — — — — — — — — — — — — — — — — — 2 3 — — 5. Diphtheria 1 1 — — 1 1 — — — — — — — — 1 1 2 — 8 — 1 6. Tuberculosis of Respiratory System 30 11 — — — — — — 9 8 18 3 3 — 11 3 41 61 75 62 52 7. Other forms of Tuberculosis 2 1 — — — — — — 1 1 1 — 2 1 3 11 7 8 9 8. Syphilitic Diseases 5 1 — — — — — — — — 2 1 3 — 2 1 6 8 7 8 5 9. Influenza 10 8 — — — — — — 1 1 4 — 5 7 2 1 18 2 12 8 4 10. Measles — 1 — 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 — 13. Cancer of the Buccal Cavity and Oesophagus (M) Uterus (F) 6 11 — — — — — — — — 2 5 4 6 3 4 17 13 15 26 16 14. Cancer of Stomach and Duodenum 29 19 — — — — — — 1 — 10 8 18 11 16 12 48 38 46 86 44 15. Cancer of Breast — 19 — — — — — — — 1 — 8 — 10 — 11 19 22 22 21 17 16. Cancer of all other sites 102 55 — — — — — — 8 5 38 24 56 26 56 29 157 129 153 142 129 17. Diabetes 3 8 — — — — — — — — 1 2 2 6 2 4 11 7 15 7 4 18. Intracranial Vascular Lesions 54 76 — — — — — — — — 8 15 46 61 24 25 130 107 146 116 110 19. Heart Disease 207 192 — — — — 1 — 9 7 42 34 155 151 62 54 399 338 360 303 286 20. Other Diseases of Circulatory System 29 42 — — — — — — — 1 10 4 19 37 14 15 71 57 43 54 58 21. Bronchitis 56 36 — 1 — — — — 1 — 10 3 45 32 8 8 92 66 115 74 75 22. Pneumonia 42 32 7 2 — 2 — — 3 1 10 3 22 24 27 19 74 45 70 68 68 23. Other Respiratory Diseases 8 10 — 1 — — — — — 5 6 1 2 3 5 3 18 20 22 19 20 24. Ulcer of Stomach and Duodenum 11 3 — — — — — — 1 — 6 1 4 2 10 3 14 12 15 15 17 25. Diarrhoea (under 2 years) 2 1 2 1 — — — — — — — — — — 2 1 3 3 9 8 7 26. Appendicitis 1 2 — — — 1 — — — — — — 1 1 1 2 3 1 7 6 6 27. Other Digestive Diseases 11 6 — — —• — — — 1 1 2 2 8 3 10 5 17 32 39 22 30 28. Nephritis 5 8 — 1 — — — — — 1 2 2 3 4 1 4 13 27 23 19 16 29. Puerperal and Post-Abortive Sepsis — — — — — — — — — — — — — — — — — 1 1 — 2 30. Other Maternal causes — 3 — — — — — — — 3 — — — — — 3 3 1 1 2 — 31. Premature Birth 4 5 4 5 — — — — — — 4 5 9 15 17 16 13 32. Congenital malformations, birth injury, infantile diseases 16 15 14 7 1 1 — 1 1 — — 5 — 1 11 4 31 30 32 34 28 33. Suicide 4 4 — — — — — — 1 — 2 3 1 1 2 1 8 10 10 12 8 34. Road traffic accidents 7 3 — — — — — — 4 1 2 1 1 1 6 2 10 10 14 7 16 35. Other violent causes 15 10 1 — 1 — — — 5 1 7 — 1 9 10 7 25 18 22 16 67 36. All other causes 46 51 — — 1 1 1 2 8 — 6 10 30 38 26 20 97 81 92 101 130 TOTALS 708 634 29 19 4 6 3 3 54 37 189 135 429 434 320 249 1,342 1,172 1,400 1,212 1,235 21 Table 5.—INFANT DEATHS UNDER ONE YEAR OF AGE, 1949. 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 — Bronchitis 1 — — — — — — — — — — — 1 — — — — — 1 Pneumonia 9 2 — 1 — — — — — — 2 1 — — — — — 7 2 Diarrhoea and Enteritis 3 — — — — — — — — 1 — 1 — — — — 1 2 1 Measles 1 — — — — — — — — — — — — — 1 — — — 1 Premature Births 9 3 4 1 1 — — — — — — — — — — — — 4 5 Congenital Malformations, Birth Injury, Infantile Diseases 21 10 5 1 — — — — — 1 1 — — — 1 2 — 14 7 Other Causes 3 — — — 1 — — — — — — 1 — — 1 — — 1 2 Totals 48 15 9 3 2 — —• — — 5 3 3 1 — 3 3 1 29 19 22 General Provision of Health Services. Midwives Acts, 1902—1936. The number of midwives who notified their intention to practise in East Ham during 1949 was 32—of these 11 also indicated that they would act as Maternity Nurses. Of the 32, 9 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches—2 at Sir Henry Tate Nurses' Home, Silvertown—13 at East Ham Memorial Hospital—and 8 practised independently, including 6 Municipal Midwives. Plaistow Maternity Hospital and District Nurses' Home. Summary of cases, 1949:— Midwifery 171 Monthly 88 Hospital 131 Silvertown & North Woolwich District Nursing Association. Midwifery 6 Clinics and Treatment Centres. These are all provided by the Council. The sessions at the Centres (as on 31/12/49) were as follows:— 23 TABLE 6.—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 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. Eye Clinic Tuesday and Friday 9.80 a.m. Alternate Thursdays 9.30 a.m. Toddlers' Clinic Tuesday 10 a.m. and Wednesday 2 p.m. Ear Clinic Friday 2 p.m. Ante-Natal Clinic (and Post-Natal) Monday 9 a.m., Tuesday 2 p.m., Thursday 10 a.m. and Friday 10 a.m. Scabies Clinic Tuesday 5 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. and Wednesday 2 p.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 session). Dental Clinic By appointment. †North Woolwich—Fernhill Street Baths General Clinic (Minor Ailment cases) Friday 2 p.m. Infant Welfare Clinic Tuesday 10 a.m. Ante-Natal Clinic Alternate Tuesdays 10 a.m. Shrewsbury Road School, Forest Gate. Child Guidance Clinic Psychiatrist Present: Tuesday a.m. and p.m. Thursday a.m. Speech Therapy Continuous. Durban House, Katherine Road. Treatment Centre (Baths) Wednesday 9.0 a.m. and 2 p.m. Saturday 9 a.m. † By arrangement with L.C.C. 24 Venereal Diseases. The following statistics have been abstracted from copies of form V.D. (R) (1949), which have been received from the Hospitals named and total figures for 1948 and 1947 are also shewn:— Patients dealt with for the first time during 1949 Syphilis Gonorrhoea Other Conditions Total Whitechapel Clinic, London Hospital 22 23 118 163 Queen Mary's Hospital, Stratford, E.15 9 6 30 45 St. Thomas' Hospital, S.E.I — — 1 1 Albert Dock Hospital — 3 7 10 St.Paul's Hospital, W.C.2 — 1 2 3 Totals 31 33 158 222 Totals for 1948 20 40 145 205 Totals for 194.7 19 40 170 229 Aldersbrook Homes and Scattered Homes. The statistics for the year 1949 are appended:— 1. Average number in homes throughout the year 468 2. No. chargeable to East Ham on 1/1/49 84 3. No. chargeable to East Ham on 31/12/49 110 4. Average weekly admissions 10 5. Average weekly discharges 11 The agreed policy in regard to the use of the facilities in the Children's Homes by the county borough of West Ham and the county council of Essex has had little effect on the general medical services and the conduct of the homes. For the greater part of the year, Dr. Curnock, with the assistance of another medical officer, was able to attend to the routine visits and emergency calls. Close co-operation with the paediatric units of neighbouring hospitals enabled a high standard of medical and surgical care to be given at all times to the children under our care and the staff. There has been a low incidence of infectious diseases and by reason of the vigilance and industry of the charge nurses the importing of infestation has been practically negligible. 25 Clothing, diet, welfare and well-being of our charges have all received the maximum of attention from the Children Committee and their officers and the tendency has been towards the solution of individual problems, by special case study, placement in foster homes, nurseries and special schools. The nursery still remains a model of its kind and stress is laid on individual nursing care wherever possible with the young babies, and on more freedom, play and nursery school type education with ' toddlers ' to develop their inborn potential. Let the baby know someone he can feel wants and loves him and let the toddler explore the possibilities of physical ' skills ' and social values. Home Office inspectors have proffered advice and guidance and the officers have received continuous support and encouragement from the visits and deliberations of the committee. Greater stress is now laid on the individual happiness of the children, rather than on physical well-being or mass discipline, and when one considers that many of these boys and girls come under our care only for a relatively short span in their lives, this is probably the best method of approach to a perennially difficult problem. One of the objects of recent legislation was undoubtedly to detach the 'Care of Children' from the stigma of the old 'Institutional Poor Law regime' and to replace this as far as possible by 'home life.' How far we have proceeded along this road and the benefits which have accrued on this enlightened journey we are not yet able fairly to assess, but this much can be said, it is improbable that we will ever fully retrace our steps. Scabies and Treatment Centre. The following statistics are appended for the year under review:— Number of new cases attending— 1945 1946 1947 1948 1949 268 237 77 67 46 26 Infectious Diseases. The quarterly returns to the Registrar-General were as follows:— Disease Qtr. ending Qtr. ending Qtr. ending Qtr. ending Total. 31/3/49 30/6/49 30/9/49 31/12/49 Scarlet Fever 43 40 69 137 289 Whooping Cough 227 215 40 10 498 Acute Poliomyelitis — 1 5 7 13 Measles 712 341 39 6 1,098 Diphtheria 1 — — 1 2 Pneumonia 55 14 3 16 88 Food Poisoning... — 1 3 — 4 Erysipelas 4 2 9 9 24 Cerebro-Spinal Fever 1 2 1 2 6 Puerperal Pyrexia — 1 — 1 2 Ophthalmia Neonatorum 2 1 1 — 4 Dysentery — — — 1 1 The deaths from the seven principal zymotic diseases (Smallpox, Whooping Cough, Measles, Diphtheria, Diarrhoea, Scarlet Fever and Enteric Fever) numbered 6, as compared with 7 for the previous year and 15 for 1947. The zymotic death rate was 0.049 per 1,000 population as compared with a rate of 0.05 for 1948. No cases of smallpox were reported. In the following table the notification rates for 1949 per 1,000 civilian population arc shewn:— TABLE 7. TABLE 7. Notifications England and Wales 126 County Boroughs & Great Towns including London 148 Smaller Towns Resident Population 25,000-50,000 at 1931 Census London Adm. County East Ham Scarlet Fever 1.63 1.72 1.83 1.46 2.36 Whooping Cough 1.39 2.44 2.39 1.70 4.09 Acute Poliomyelitis 0.13 0.13 0.12 0.18 0.10 Acute Polioencephalitis 0.01 0.01 0.02 0.01 Measles 8.95 8.91 9.18 8.54 9.00 Diphtheria 0.04 0.05 0.04 0.07 0.01 Pneumonia 0.80 0.91 0.65 0.55 0.72 Typhoid Fever 0.01 0.01 0.01 0.01 — Paratyphoid Fever 0.01 0.02 0.01 0.01 — Erysipelas 0.19 0.20 0.19 0.17 0.19 Smallpox 0.00 0.00 0.00 0.00 — Cerebro-Spinal Fever 0.02 0.03 0.02 0.02 0.04 Food Poisoning 0.14 0.16 0.14 0.19 0.03 A dash (—) signifies no notifications. Table 8.—TOTAL CASES OF NOTIFIABLE DISEASES, 1926-1949. 26a Disease. 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 Small Pox — — 17 25 70 51 13 1 1 - - - - - - - - - - - - - - - Scarlet Fever 350 798 832 743 484 245 779 701 979 411 359 387 287 196 77 68 210 271 132 153 193 179 222 289 Diphtheria 337 464 669 578 473 196 157 180 379 254 134 149 141 91 47 45 49 59 33 31 19 46 14 2 Enteric Fever 7 2 7 2 3 8 7 5 — 2 2 13 15 8 10 3 — 4 — — — — 1 — Erysipelas 41 38 60 49 63 54 55 69 74 55 59 53 71 41 33 23 37 28 18 14 25 23 21 24 Puerperal Fever 5 5 4 8 9 10 4 4 7 12 7 5* † † † † † † † † † † † † Puerperal Pyrexia Not Notif 11 11 12 14 6 23 10 11 14 7 7 18 16 8 6 15 8 8 2 8 5 4 2 Meningococcal Meningitis 1 4 1 1 3 8 5 1 3 3 — 2 3 3 11 5 12 4 3 1 8 1 5 6 Encephalitis Lethargica 1 2 3 1 — — — 1 1 1 — 1 1 - - - - - - - - - - - Ophthalmia Neonatorum 10 12 3 8 6 6 6 9 5 5 6 7 9 7 3 4 1 1 4 2 1 2 — 4 Acute Poliomyelitis — 5 — 2 — 1 7 2 5 13 2 4 — 2 1 — — — — 1 — 7 8 13 Acute Polio Encephalitis - - - - - - 3 2 1 - - - - - - - - - - - - 1 - - Dysentery - - - - - - - - 1 - - 3 18 - - - - 6 5 7 5 2 — 1 Malaria - - - - - - 1 1‡ - - - - - - - - - - - 1‡ 3a — — — Measles Not Notifiable 3 36 460 1091 917 258 1,498 815 964 1,559 1,098 Whooping Cough Not Notifiable — 19 262 227 241 293 67 258 430 578 498 Food Poisoning Not Notifiable 4 Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - eumonia 70 114 82 102 59 75 77 148 100 88 101 111 85 59 42 33 37 72 50 55 97 143 111 88 Totals 822 1,455 1,689 1,531 1,184 660 1,137 1,134 1,567 858 677 742 648 426 287 909 1,679 1,611 804 1,832 1,432 1,803 2,523 2,029 * Notifiable as Puerperal Pyrexia as from 1/10/37. †Notifiable as Puerperal Pyrexia. ‡1Induced in an Institution. a 1 Induced for therapeutic purposes: 2 Contracted abroad. 27 Tablk 9—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for Year ended 31/12/49. Diskask. 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 289 - 90 140 37 8 7 1 - — 34 72 24 26 23 18 15 21 8 48 179 — Diphtheria 2 — 1 — 1 — — — — — — 1 - — — — — 1 — 2 2 Erysipelas 24 — — — - — 2 10 8 4 3 3 2 — 1 — 2 2 6 5 6 1 Puerperal Pyrexia 2 — — — — 1 1 — — 1 — — — — — — - 1 — 1 — Cerebro Spinal Fever 6 1 3 1 1 — — — — — 1 3 1 - - - - - — 1 5 1 Pneumonia 88 6 10 4 3 1 9 12 20 23 12 9 7 9 12 10 4 4 10 11 42 74 Acute Poliomyelitis 13 — 9 2 1 — 1 — — — — — 3 2 1 3 2 — — 2 12 1 Ophthalmia Neonatorum 4 4 — — — — % — — - — 1 — — — — — - 1 1 1 — — Dysentery 1 — 1 — — — — — - — _ — — — — — — — — 1 1 — Food Poisoning 4 - — — — 1 1 1 1 — 1 1 — — 1 — 1 — — — 2 — Measles 1,098 42 639 401 4 4 7 — — 1 137 102 151 100 173 77 40 47 94 117 38 1 Whooping Cough 498 52 282 158 1 — 4 — 1 — 59 107 30 29 57 11 35 97 25 48 16 — 28 The hospitals to which the 304 cases of notifiable infectious disease were admitted are named below:— Name of Hospital No. of cases admitted Plaistow Fever Hospital, Samson Street, E.13 147 Whipps Cross Hospital, Leytonstone, E.ll 40 Chingford Isolation Hospital, Chingford, E.4 32 Eastern Fever Hospital, Homerton, E.9 16 Ilford Isolation Hospital, Chadwell Heath 17 North Eastern Hospital, St. Ann's Road, N.15 12 Brook Hospital, Shooters Hill, S.E.I8 11 Rush Green Hospital, Romford 5 Park Hospital, Hither Green, S.E.13 3 South Lodge Hospital, World's End, Enfield, N.21 3 Waltham Abbey Isolation Hospital, Waltham Cross 3 Bow Arrow Hospital, Dartford 3 Baddow Road Isolation Hospital, Chelmsford 2 Hornsey Hospital, Hornsey, N.8 2 Coppetts Wood Hospital, N.10 1 Southend Isolation Hospital, Southend 1 Isolation Hospital, Billerieay 1 Finchley Memorial Hospital, N.8 1 Lambeth Hospital, Lambeth, S.E.ll 1 London Hospital, E.l 1 East Ham Memorial Hospital, E.7 1 Children's Hospital, Holborn, W.C.I 1 Total 304 Cancer. Deaths, 1949:— Total deaths 241 Male deaths 137 Female deaths 104 Classification:— 1949 1948 1947 1946 1945 Carconima 222 181 214 209 191 Sarcoma 8 3 2 2 3 Rodent Ulcer 1 — — — — Epithelioma 1 2 2 2 4 Endothelioma — — — — 1 Glio-blastoma 1 1 1 3 — Chloroma — — 1 — — Hyponephroma — 1 1 — — Papilloma — 1 1 — — Myeloma — 1 — — — Seminoma — 1 — — — Melanoma — 1 — — — Glioma 3 — — — — Unstated 5 10 14 9 7 Totals 241 202 236 225 206 29 Table 10.—CANCER DEATHS—PARTS OF BODY AFFECTED. Parts of Body Affected Ages 15-25 25-35 35—45 45-55 55-65 65-75 75 and upwards Total Sex M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Buccal Cavity and Pharynx — — — — — — — — — — 1 — 2 — 3 — Digestive Organs and Peritoneum — — — — 1 2 7 7 14 12 23 13 20 18 65 52 Respiratory Organs — — — — 2 — 8 1 16 5 12 1 3 — 41 7 Uterus — — — — — — — 1 — 4 — 6 — — — 11 Other Female Genital Organs — — — 1 — 1 — 1 — 1 — 1 — 2 — 7 Breast — — — 1 — — — 4 — 4 — 8 — 2 — 19 Male Genital Organs — — — — — — — — 1 — 6 — 5 — 12 — Urinary Organs — — 1 — — — — 2 2 — 1 — 3 — 7 2 Skin — — 1 — 1 — — — — — — — 1 — 3 — Brain and other parts of Nervous System — — 1 — 1 1 — — 1 — — — — 1 3 2 Other or Unspecified Organs — — 1 — — — 1 1 - 2 1 1 — — 3 4 Totals — — 4 2 5 4 16 17 34 28 44 30 34 23 137 104 30 National Assistance Act, 1948—Section 47. The above section of the National Assistance Act, 1948, deals with the removal to suitable premises of persons in need of care and attention. I am informed by the Chief Officer of Welfare Services it has not been found necessary for action to be taken under this section during the year. East Ham Chest Clinic. The following information has been obtained from this clinic:— No. of attendances at: clinic 12,905 No. of visits to homes of patients by tuberculosis nurses 6,105 No. of tuberculous persons on register on— 1 /1 /49 31 /12/49 Adults 1,014 1,000 Children 270 283 No. of persons under observation on— Adults 79 109 Children 55 32 From table No. 11 it will be noted that the notifications received during the year under review total—pulmonary 92 males, 72 females, a total of 164 and non-pulmonary 5 males and 11 females, a total of 16. The rate per 1000 of the population was 1.47 for all forms of tuberculosis. The number of deaths assigned to all forms of tuberculosis for the year (see table No. 4) was 44 and the death rate was 0.36 per 1,000 population. B.C.G. Vaccination. I am informed by Dr. P. Ellman, Consultant, East Ham Chest Clinic, that it was considered inadvisable to commence vaccination in 1949, until it was certain a regular supply was available. Now that technical difficulties have been overcome, it is proposed to offer vaccination to contacts of known cases of pulmonary tuberculosis. A reference to B.C.G. vaccine was contained in my annual report for 1947. 30a Table 11.—PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. 30a Summary of Notifications during the period from 1st January, 1949, to the 31st December, 1949. Formal Notifications Number of Primary Notifications of new cases of tuberculosis Age Periods 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total (all ages) Respiratory, Males 1 2 1 8 1 8 6 18 16 10 11 2 — 84 Respiratory, Females — 2 9 3 1 10 11 19 5 2 1 1 64 Non-Respiratory, Males — — 2 1 1 — — — — — 1 — — 5 Non-Respiratory, Females — — — 2 2 — 1 1 — — — — — 6 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 (A) - - - - - - - - - - - - - - (B) - - - - - - - - - - - - - - (C) - - - - - - - - - - - - - — (D) Death Returns from Registrar-General ( Transferable deaths) M Respiratory F M Non-Respiratory F - - - - - - - - - - - - - - (A) - - - - - - - - - - - - - — (B) - - - - - - - - - - - - - - (C) - - - - - 1 - - - - 1 - - 2 (D) Posthumous Notifications ... M Respiratory F M Non-Respiratory F - - - - - - - - - - - - - - (A) - - - - - - - - - - - - - — (B) - - - - - - - - - - - - - — (C) - - - - - - - - - - - - - — (D) "Transfers" from Other Areas (excluding transferable deaths) ... M Respiratory F M Non-Respiratory F - - - - - 1 1 5 - - - - - 7 (A) - - - - - — 3 5 - - - - - 8 (B) - - - - - - - - - - - - - — (C) — — — 1 1 — — — — — — 1 — 3 (D) Other Sources M Respiratory F M Non-Respiratory F - - - - - - - - - - - - - - (A) - - - - - - - - - - - - — (B) - - - - - - - - - - - - - — (C) - - - - - - - - - - - - - - (D) Totals (A) (B) (C) (D) 8 8 — 5 31 Civic Week—17th to 22nd October, 1949. The part played by the health services in the life of the community was amply exemplified in the various stapds arranged by the health department at the Civic Week Exhibition. Posters in simple design and attractive colourings pointed to the continual need for good standards of personal hygiene in the clean food campaign now being launched. Charts, drawings and photographs made public the achievements of the health department in the various fields of epidemiology and medico-social services, including the reduction of infantile mortality, safe childbirth, victory over diphtheria and the value of the ambulance service. On the stands were colourful and attractive exhibits of the work of the mental health occupation therapy centre, a symbolic representation of the activities of the home help and home nursing services and arrangements of prepared foods illustrating ideal meals for growing children at various ages. The maternity and child welfare department made very instructive displays of baby clothes including the furnishings of a simple baby-cot, and other exhibits alluded to the work of the domiciliary midwives and the school health service. An opportunity was taken to achieve some education of all sections of the public in health matters by distribution of leaflets, personal talks by members of the staff and the use of a strip film projector. The wonderful attendance testified to the success of the exhibition generally and we feel that the health department's display made a fair contribution in bringing before the people a comprehensive presentation of their own services. Film Shows. Daily film shows over a limited period of two weeks were held at the Town Hall Annexe and the Church Road Clinic. Attendance was invited from all schools of children over 10 years of age, parents generally and interested members of the staffs of all council departments. The subject matter covered the work of district nurses and safety in the home. 32 There is little doubt that this is a useful method of education to bring home the dangers which lurk in badly planned kitchens and/or unlighted staircases, but above all it points the lesson of 'awareness' and handiness which many children never properly master, leading them into adult life to swell the numbers of accident-prone individuals in industry and of inadequate citizens, unable to make their full contribution to the home or the community. A body of well-informed opinion hold that the film possesses little value as a vehicle of propaganda and health education. There is undoubtedly the danger that the beauty of the films steals away the senses so that little is ultimately grasped by the mind of the lesson it was intended to impart. However, thanks are due to the Insurance Company who loaned their apparatus and films and realising the difficulties alluded to supplied highly trained personnel to add verbal instruction and advice at each showing. FILM SHOW ATTENDANCES (approx.). Town Hall Annexe—week commencing 24/10/49. Manor Park Clinic—week commencing 31/10/49. a.m. p.m. Totals a.m. p.m. Totals Mon. 24th 50 40 90 Mon., 31st Oct. 30 150 180 Tues. 25th 70 220 290 Tues., 1st Nov. 60 60 120 Wed. 26th 40 40 80 Wed., 2nd Nov. 80 120 200 Thurs. 27th 40 40 80 Thurs., 3rd Nov. 70 70 140 Fri. 28th 200 40 240 Fri., 4th Nov. 70 70 140 400 380 780 310 470 780 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. 33 Meat and Other Foods. As will be seen in the Report no slaughterhouse in this Borough was in operation during the year. With regard to meat inspection and other foods see report of the Chief Sanitary Inspector. Food Poisoning. In accordance with Ministry of Health Circular 46/49, the following information was supplied :— (1) Food Poisoning Notifications (Corrected) Return to Registrar-General:— 1st Quarter Nil 2nd „ 1 3rd 3 4th „ Nil Total 4 (2) Outbreaks due to identified agents: There were no outbreaks during the year. (3) Outbreaks of undiscovered cause:— There were no oubreaks during the year. (4) Single cases:— Agent identified 3 Unknown cause 1 Total 4 Clean Food Campaign. Having regard to the attention which has recently been focussed upon the subject of food hygiene through the public press and otherwise, it is proposed to place before the Council, at an early date, plans for a clean food campaign in the Borough— a campaign which it is hoped will receive not only the full support of the burgesses, but the active and enthusiastic co-operation of all classes of food traders in the Borough. 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. (See Table 13.) 34 TABLE 12. METEOROLOGICAL RECORD—YEAR 1949. 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 - 23 - 32.9 41.35 10 0.77 0.08 0.50 24th February — 17 — 31.0 41.15 6 0.75 0.75 0.23 8th March — 23 — 30.6 40.95 7 0.70 0.10 0.25 4th/14th April — 28 — 39.2 51.50 11 1.33 0.12 0.41 28th May — 30 — 40.1 57.88 11 1.62 0.15 0.71 23rd June — 39 — 46.9 61.15 5 0.59 0.12 0.28 3rd July 88 43 77.4 51.5 66.64 4 0.27 0.07 0.17 16 th August 87 41 75.9 51.9 64.98 7 1.26 0.18 0.50 1st September 89 44 73.4 52.7 63.76 5 1.15 0.23 0.57 15 th October 76 25 63.5 43.3 53.50 15 5.00 0.33 1.02 25th November 58 21 50.5 35.8 43.30 17 2.01 0.12 0.26 8th December 57 30 49.9 39.6 42.95 16 1.46 0.09 0.34 13 th Means & Totals for the Year — 30 41.3 52.44 114 16.93 0.19 1.02 25th Oct. † The Highest Maximum Thermometer was stolen at the beginning of 1948 and was replaced by the Meterological Office in June, 1949. Table 13. FACTORIES ACTS, 1937 AND 1948. PART I OF THE ACT 1.—INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors) Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 88 92 4 -- (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 331 320 15 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises)... 6 4 — — Total 425 416 19 — 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. 215 5 — — — — Cleaning and washing. — — — — — — Baskets, making 4 1 — — — — Christmas crackers 22 1 — — — — Total 241 7 — — — — 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) 6 12 — 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 2 2 — — — Inadequate ventilation (S.4) — 2 — — — Ineffective drainage of floors (S.6) 2 2 — — — Sanitary Conveniences (S.7) (a) insufficient 5 4 — — — (6) Unsuitable or defective 22 35 — 5 — (c) Not separate for sexes 7 18 — — — Other offences against the Act (not including offences relating to Outwork) 4 14 2 2 — Total 48 89 2 8 — 34a ■ 85 NATIONAL HEALTH SERVICE ACT, 1946 Sections 22, 23, 24, 25, 26, 27, 28, 29 and 51. Full details of the Council's proposals approved by the Minister of Health, as indicated in my report for 1948, have been published in booklet form and are available for reference. The modifications since the original proposals Were approved are as follows:— Section 27—Ambulance Services. Revised plans for the new ambulance station sited in Wellington Road are still under consideration by the Ministry's officers. The proposed garage will house all our vehicles and provide working accommodation for all members of the staff engaged in this day and night service. Section 28—Prevention of Illness, Care and After-Care. (a) B.C.G. vaccine. See comments on page 30. (b) Deletion of number of tuberculosis visitors (four). In the course of the year, approval was obtained to the increase in establishment to five. The additional visitor has been appointed and her value to this service greatly appreciated. Section 29—Domestic Help. Establishment of Home Helps amended from 24 to 60 fulltime or their equivalent in part-time service. NOTE.—Above amendment is indicated on page 64, 2nd para, of 1948 report. 36 Section 22—Care of Mothers and Young Children. There were no changes during 1949 and the duties have been accomplished as far as possible by the existing staff. Unmarried mothers have been admitted to the following hostels for periods of 4—6 weeks before their confinements:— "Ardmore," Loughton, Essex (Essex C.C.). St. Agatha's, Stratford, E.15 (Voluntary). The Senior Dental Officer submits the following report in respect of the dental treatment provided for expectant and nursing mothers and young children during the year under review:— Two sessions per week are devoted to the dental treatment of patients under the M. & C. W. Scheme. The year just ended has seen a great increase in the demand for treatment under the M. & C.W. Scheme. This is particularly noticeable with regard to the children. The number of children examined was almost twice that of the previous year, i.e., 658 as compared with 335. It must be remembered that these children do not have a routine dental inspection. They are referred for advice and possible treatment by the Medical Officers in the M. & C.W. Clinics. It follows, therefore, that almost all the children attending for treatment have had some pain. It would appear that the teeth of the children born in 1944 and later years are not as good as those of the children born in earlier years. This opinion is based upon the fact that of the 658 children examined, 511 required treatment and 1,133 teeth were extracted, an average of over two extractions per child. As almost all these teeth were molars of which there are eight, in the deciduous dentition this means that there is an average loss of efficiency of 25 per cent, in each child, which is a high percentage in such young children. In the ante-natal clinics, mothers are advised on the dental conditions which may occur during pregnancy. In the dental clinics, mothers are instructed in the proper way to look after their children's teeth, and instructive booklets are given to those who are interested. 37 Table 14. NUMBERS PROVIDED WITH DENTAL CARE, 1949. Examined Needing treatment Treated Made dentally fit Expectant & Nursing Mothers 374 340 319 220 Children under five 658 511 507 507 Table 15. FORMS OF DENTAL TREATMENT PROVIDED, 1949. Extrac tions Anaesthetics Killings Scalings or scaling and gum treatment Silver Nitrate treatment Dressings Radiographs Dentures provided Local General Complete Partial Expectant and Nursing Mothers 624 21 90 248 91 57 100 — — — Children under five 1,133 20 241 37 — 125 135 — — — Number of births notified during the period 1 /I /49 to 31 /12/49, under Section 203 of the Public Health Act, 1936, as adjusted by transferred notifications—live births 1,934 still-births 48, total 1,982. Number of premature infants notified (1) born at home 31 during the year (including transferred notifications) whose mothers normally (2) born in hospital reside in the area:— J or nursing home 78 TABLE 16 Premature babies born in area (whether their mothers normally reside in area or not) excluding those born in maternity homes and hospitals in the National Health Service:— Born at Home Transferred to hospital Nursed entirely at home Total Grand Total Died in first 24 hours Died on 2nd to 7th day Died on 8th to 28th day Survived 28 days Under 3 lbs. - - - - - - - 3—4 lbs. — 1 — — — 1 1 4—5½ lbs. 0 — 1 — 23 24 30 Total 0 1 1 23 25 31 Notes:—Th6re arc no maternity homes (not in the National Health Services) or Mother and Baby Homes in the Borough. Those shewn in table 21 (born outside the area) are additional to the above. 38 TABLE 17. Ophthalmia Neonatorum Pemphigus Neonatorum Puerperal Pyrexia Domiciliary Confinements Institutional Confinements Domiciliary Confinements Institutional Confinements Domiciliary Confinements Institutional Confinements No. of cases notified during the year 4 - - - 1 1 No. of cases visited by Officers of the Authority 4 - - - 1 1* No. of cases for whom home nursing was provided - - - - 1† - No. of cases removed to hospital — — — — 1 * After discharge from hospital. † District Nurse. The four cases of Ophthalmia Neonatorum recovered with vision unimpaired. The number of maternal deaths occurring during the year was 3. The causes of death were (1) from sepsis, nil; (2) from other causes, 3. All of these deaths occurred in hospital. Table 18. ANTE-NATAL AND POST-NATAL CLINICS, 1949. No. of clinics provided at end of year No. of women in attendance Total No. of attendances made during the year No. whom attended during the year No. of new cases included in previous column who had not previously attended any clinic during current pregnancy and for post-natal clinics women who had not previously attended any post-natal clinic after last confinement Local Health Authority Clinics: Antc-natal clinics 2 1,945 1,457 8,850 Post-natal clinics* — 323 317 876 Clinic belonging to another L.H.A.f : 1 30 31 128 Post-natal clinic* 5 5 8 Totals: Ante-natal clinics 3 1,981 1,488 8,978 Post-natal clinics*. — 328 322 384 * Post-natal patients seen at ante-natal clinics. † By arrangement with L.C.C. ante-natal clinic held every fortnight at L.C.C. Clinic, Fernhill Street Baths, North Woolwich, E.16. No ante-natal or post-natal examinations were carried out by General Practitioners at the mother's home or the practioner's surgery under arrangements made with the Local Health Authority. 39 Table 19. INFANT WELFARE CENTRES, 1949. No. of centres provided at end of year No. of children who attended during year No. of children who first attended the centres during the year and whom on the date of their first attendance were : No. of children in attendance at the end of the year who were then:— Total No. of attendances made by children during the year :— Under 1 year of age Over 1 year of age Under 1 Year of age Between the ages of 1 and 5 Under 1 year of age Over 1 year of age Local Health Authority Centres 2 3,115 1,370 223 1,192 1,841 15,798 5,760 Centre belonging to another L.H.A.f 1 73 26 5 21 50 370 173 Totals 3 3,188 1,396 228 1,213 1,891 16,168 5,933 † By arrangement with L.C.C. centre held weekly at L.C.C. Clinic, Fernhill Street Baths, North Woolwich, E.16. Table 20. DAY NURSERIES, 1949. Provided by Number No. of approved places No. of children on the register at the end of the year Average daily attendance during the year 0—2 years 2—5 years 0—2 years 2—5 years 0—2 years 2—5 years Maintained by the Council 4 132 161 82 195 84 171 Maintained by Vol. Organisations — — - — — — — The total attendances at the nurseries during 1949 are appended below:— Nursery Total Attendances School Road 12,050 Roman.Road 19,092 St. Stephen's Road 18,517 Wall End/Calcdon Road 13,91,3 Total 63,572 NOTE:—The Nurseries are closed on Saturdays. 40 Nursery and Child-Minders Regulation Act, 1948. There were no daily minders provided by the Council at the 31st December, 1949, and there were no premises or daily minders registered under the above Act at 31/12/49. Mother and Baby Homes. During the year under review, 3 unmarried mothers and their babies and 1 unmarried mother (expectant mother) were sent to homes or hostels. Two of these were admitted to "Ardmore" Hostel, Buckhurst Hill, and two to St. Agatha's Home, Stratford, E.15. Maternity Hospitals. East Ham mothers were admitted for their confinements to the institutions named below during the year 1949:— Institution No. of Patients Aldersbrook Maternity Hospital 463 East Ham Memorial Hospital 366 Eorcst Gate Hospital 194 Total 1,023 Registration of Nursing Homes. Under Sections 187 to 194 of the Public Health Act, 1936, there were no homes registered during the year 1949 and there were no homes on the register at the end of the year. Aldersbrook Maternity Hospital. The need for maternity hospital accommodation for East Ham patients has continued without diminishing. Slightly more mothers were admitted for delivery and for ante-natal treatment during this third year than in 1948. The effect of family planning is being seen in that Springtime has become very much the busiest 41 part of the maternity year: it is not easy to ensure an even flow in the use of the beds, but on an average, each mother has stayed a little over 12 days which has given fair time for rest after childbirth, and has allowed breast-feeding to be fully established. The Nursing Staff has remained appreciably unchanged since my last report and has continued to earn the admiration and gratitude of the patients. The policy of close collaboration with our maternity and child welfare clinics and with all departments of East Ham Memorial and Forest Gate Hospitals has continued to be most successful, and since the Borough Council has carried on the administration of this hospital it is still able to offer a complete unified maternity service. Aldersbrook Maternity Hospital Number of cases admitted for delivery 463 ,, ,, „ ,, ante-natal treatment 56 ,, patients delivered by— (a) midwives 452 (b) doctors 11 „ patients admitted after delivery 2 Average duration of stay in lying-in wards (days) 12.4 Number of cases notified as Puerperal Pyrexia 2 „ ,, of Pemphigus Neonatorum — ,, ,, of Ophthalmia Neonatorum — ,, maternal deaths — ,, still-births 6 ,, infant deaths within 10 days of birth 5 ,, infants who received a supplementary or complementary feed whilst in hospital (excluding first 3-4 days while breast feeding is being established) 41 „ infants wholly breast fed on leaving the hospital 420 ,, births during the year— (a) live 461 467 (b) still 6 Total bed complement at 31 /12/49 20 Average daily number of beds occupied over the year 17 Highest daily occupation in the year shewing dates (12th/14th March, 14th May, 19th June) 25 Lowest daily occupation in the year shewing dates (10th and 11th July) 9 42 Table 21. PREMATURE INFANTS BORN. Aldersbrook Maternity Hospital, 1949. Weight in lbs. Died in first 24 hours Died between 2nd & 8th day Died between 8th & 28th day Survived 28 days Total Under 3 lbs. — — — 1 1 3—4 lbs 3 — — 5 8 4—5½s. 1 1 — 30 32 Total 4 1 — 36 41 Section 23—Midwifery Service. Miss Newman-Pilkington, S.R.N., S.C.M., H.V. Cert., and Midwife Teachers Cert., has been appointed Superintendent Nursing Officer and commenced duty on 2/1/50. Her endeavours will be extended to supervise the Domiciliary Midwifery and District Nursing Services and to co-ordinate these services with the general nursing, ancillary and the unified health visiting services. Table 22. MIDWIVES ACTS, 1902—1936. Number of midwives practising in the area at 31st December, 1949. Domiciliary Midwives Midwives in Institutions Total Midwives employed by the Council Midwives employed by Voluntary Organisations— 6 — 6 (a) Under arrangements made with the L.H.A. in pursuance of Section 23 of the N.H.S. Act 4 — 4 (b) Otherwise (including hospitals not transferred to the Minister under the N.H.S. Act) — — — Midwives employed by Hospital Management Committees or Boards of Governors under the N.H.S. Act — 6 6 Midwives in private practice 1 — 1 Totals 11 6 17 NOTE.—Aldersbrook Maternity Hospital has not been included in above table as it is not situated in the area. The 6 institutional midwives mentioned are employed at the East Ham Memorial Hospital. 43 TABLE 28. MATERNITY CASES ATTENDED. Number of maternity cases in the area attended by Midwives during the year ended 31/12/49. Domiciliary Cases Cases in Institutions. Total. As Midwives. As Maternity Nurses. As Mid- wives. As Maternity Nurses. As Midwives. As Maternity Nurses. Midwives employed by the Authority 316 34 – – 316 34 Midwives employed by Voluntary Organisations (a) under arrangements with Council in pursuance of Section 23 of the N.H.S. Act 176 91 – – 176 91 (b) otherwise (including hospitals not transferred to the Minister under the N.H.S. Act) – – – – – – Midwives employed by Hospital Management Committees or Boards of Governors under the N.H.S. Act – – 349† 65† 349 65 Midwives in private practice 3 – – – 3 – Totals 495 125 349 65 844 190 44 Table 24. GAS AND AIR ANALGESIA. Domiciliary Midwives. Domiciliary Midwives employed directly by Council Domiciliary Midwives employed under Sec. 23 by voluntary organisations as agents of Council Domiciliary Midwives employed under Sec. 23 by hospital authorities as agents of Council Domiciliary Midwives in private practice Total No. of domiciliary midwives practising in the area at 31/12/49, who were qualified to administer gas and air analgesia in accordance with the requirements of the c.m. Board 6 4 – – 10 No. of sets of apparatus in use by domiciliary midwives employed in the Authority's service at 31/12/49 6 2 – – 8 No. of cases in which gas and air was administered by domiciliary midwives during the period 1/1/49 to 31/12/49 – – (a) when acting as a midwife 250 57 – – 307 (6) when acting as a maternity nurse 7 20 – – 27 No. of midwives qualified on 31 /12/49 to administer gas and air analgesia No. of sets of apparatus used by the above as on 31/12/49 No. of cases in which gas and air analgesia was administered during the year 1949 (а) when acting as a midwife (б) when acting as a maternity nurse East Ham Memorial Hospital 6 2 349 – Aldersbrook Hospital 7 2 450 11 Section 24—Health Visiting Service. The retirement of Mrs. A. A. Woodman M.B.E., S.R.N., S.C.M., M.R.S.I. (H.V's Cert.), and the appointment of Miss Maryon, S.R.N., S.C.M., H.V. Cert., as Superintendent Health Visitor, establishes a landmark in the story of the health visitors' services of East Ham. For the first time the health visitors service functioning as a unified whole, has become possible. The Council in their wisdom have adopted the scheme of sponsoring trainees from among selected candidates to attain through a course of study and examination full health visitor status, with the proviso that two years' service as a health visitor is given to the borough. This will have the effect, in the course of a few years, of enabling us to complete our establishment with fully trained staff to serve the needs of the 45 school health and maternity and child welfare services and implement fully the provisions of the National Health Service Act. The unified service should make a signal contribution in the education of the people in their homes towards the goal of positive health and the full enjoyment of life within the potential of every citizen. Miss B. Newnian-Pilkington, the Superintendent Nursing Officer, will co-ordinate the activities of this unified health visiting service with the general nursing service, the domiciliary maternity service and the other ancillary services, so that a great surge forward in the care of parturient women and sick persons of every age within the home will be achieved. A debt of gratitude is owed to Mrs. Woodman, for her untiring efforts to raise the status of nurses everywhere and to establish the health visitor in her rightful place as the friend and adviser of the family. Table 25. HEALTH VISITING, 1949. Provided by Number of Health Visitors employed at end of year Equivalent Whole-time Health Visitor Services provided under Col. (3) (all classes including attendance at Infant Welfare Centres) Number of visits paid by Health Visitors during the year 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) (8) (4) (5) (6) (7) (8) (9) (10) (11) (12) Local Health Authority 10 7 2 185 216 2,079 6,056 8,362 574 Voluntary Organisations – – – – – – – – – – – Section 25—Home Nursing. So far the internal organisation and administration of this service has been little affected. The employment of a male nurse is noted and appreciations of his service by residents have already been expressed. Generally the need for home nursing has increased partly due to the continued shortage of accommodation available in hospitals to sufferers from acute and chronic diseases. 46 Negotiations are going forward concerning the acquisition of the premises now used as the Nurses Home and District Headquarters together with another property suitable for expansion of the service. Table 26. HOME NURSING, 1949. Provided by No. of home nurses employed at 31/12/49 Equivalent of wholetime service provided by part-time home nurses No. of cases attended by home nurses during the year No. of visits paid by home nurses during the year Wholetime on home nursing Part- time on home nursing Local Health Authority _ _ _ _ _ Voluntary Organisations by agreement with the Authority 8 8 4 1,745 41,262 Table 27. HOME NURSING. East Ham District Nursing Association Silvertown and North Woolwich District Nursing Association Totals Patients on books on 1/1/49 206 3 209 New patients from 1/1/49 to 31/12/49 1,468 68 1,536 Patients on books on 31/12/49 272 6 278 Total visits from 1 /I /49 to 31/12/49 40,647 615 41,262 Summary of new cases :— Bronchitis, Pneumonia & Pleurisy 132 2 134 Cardiac 127 5 132 Tuberculosis 44 1 45 Rheumatism, Arthritis, etc. 32 3 35 Cerebral 82 — 82 Diabetes 55 — 55 Burns and Scalds 15 — 15 Cancer 102 9 111 Senility 100 2 102 Erysipelas 2 — 2 Prolapse — 16 16 Other medical 453 20 473 Various surgical 292 10 302 Ante-Natal 4 — 4 Post-Natal 10 — 10 Miscarriage 18 — 18 Totals 1,468 68 1,536 47 Section 26—Vaccination and Immunisation. The Minister has decided that this work rightly falls within the duty of the general practitioner to the family under his terms of contract in the National Health Service Act. However, as the result of negotiation, the local authorities are empowered to pay a fee of 5s. Od. for every ease of vaccination and immunisation for which duly completed records are submitted to the Medical Officer of Health." Whooping cough vaccine may be continued with diphtheria immunising prophylactic for use in individual cases but no fee is yet authorised in respect of pertussis immunisation alone. Table 28. DIPHTHERIA IMMUNISATION, 1949. No. of children who completed a full course of primary immunisation (including temporary residents) Total number of children who were given a secondary or re-inforcing injection (i.e., subsequent to complete full course) Age at date of final injection Under 5 5—14 Total 6 months ending 30/6/49* 937 184 1,121 167 6 months ending 31/12/49† 866 149 1,015 129 Totals 1,803 / 333 2,136 296 Of above totals No. of children immunised by:— (a) Council staff 1,292 293 1,585 286 (b) General Practitioners 511 40 551 10 Note :—The 121 children mentioned at the foot of table 29 are included in the above figures. * Includes supplementary figures for 6 months ending 31/12/48 and 30/6/49. † Includes supplementary figures for 6 months ending 31/12/49. Table 29. WHOOPING COUGH. Prophylaxis with Pertussis Vaccines for Year ending 31/12/49. No. of children who completed a course of inoculation with pertussis vaccines (including alum-precipitated vaccines and vaccines combined with diphtheria prophylactic). Total Age at date of final injection. Under 1 year 1—4 years 5—14 years 34 106 23 163 NOTE.—Of the above figures, 42 children received the whooping cough vaccine only and 121 the combined whooping cough and diphtheria prophylactic. 48 Table 30. DIPHTHERIA IMMUNISATION. Number of Children at 31st December, 1949, who had completed a course of Immunisation at any time before that date (i.e. at any time since 1st January, 1935) Age at 31/12/49 i.e. Born in Year Under 1 1949 1 1948 2 1947 3 1946 4 1945 5 to 9 1940-1944 10 to 14 1935-1939 Total under 15 No. Immunised 89 1,203 1,723 1,625 1,051 5,174 4,475 15,340 Estimated midyear child population 1949 Children under five Children 5—14 10,960 14,770 25,730 Table 31. SMALLPOX VACCINATION. Age at 31/12/49, i.e. born in years. No. of persons vaccinated or re-vaccinated during 1949. Total Under 1 1949 1—4 1945 to 1948 5—14 1935 to 1944 15 or over before 1935 No. vaccinated* 235 17 14 37 303 No. re-vaccinated* 3 — 5 37 45 Totals 238 17 19 74 348 * Includes supplementary figures for 1948 and 1949. There were no cases specially reported during the period under review of:— (a) Generalised vaccinia. (b) Post-vaccinal encephalomyelitis. (c) Death from complications of vaccination other than (a) and (b). Reference again is made to the pressing and continuing need for the vaccination of all infants and young children in this riparian borough. Our close proximity to the docks, port of entry for ocean-going vessels from all corners of the earth, brings the ever-present menace of the introduction of the dreaded disease, small-pox, into the homes of the burgesses. 49 In spite of the vigilance of the Port Sanitary Authorities, the contagion has on occasion passed from ship to shore and thereafter rapid dissemination is possible by a hundred different routes through our crowded cities. Outbreaks have occurred and the death rate in each would indicate that we are drifting towards a phase when an unvaccinated and highly susceptible population may easily fall a prey to the ravages of this highly contagious disease possibly in a virulent form. East Ham must therefore be regarded as one of the first lines of defence and it is no less than a moral obligation for every parent to ensure that his children are vaccinated as a shield against contracting and spreading small-pox. Section 27—Ambulance Services. This service, working practically to full capacity, is hampered by several old vehicles which will be replaced as the exigencies of the supply position and the stringency of finance allow. The plans for the proposed new ambulance station, foreshadowed in my last report, have been submitted to the Ministry, and after considerable discussion, agreed. Difficulties in the steel allocation and supply position and other factors arising from the need for national economy and overriding defence measures have militated against the opportunity for rapid new construction and no progress has been made. Meanwhile, valuable ambulances are inadequately housed, exposed to the vagaries of our climate and subject to rapid deterioration in fabric and equipment. Nor must it be forgotten that the staff in a service which demands a high degree of physical fitness, merit at least a modicum of comfort in their operational headquarters. Throughout the year the closest co-operation has been obtained from hospitals, clinics and general practitioners so that very few calls were made which did not entail a genuine demand for ambulance services. This close liaison has also effected a considerable saving in daily mileage and costs. 50 Alarm has been expressed in the press at isolated instances of the employment of the ambulance service in trivial and unjustifiable circumstances. The assurance is given to the Council and the public that with the system of ' call-out ' employed and careful scrutiny, abuse of the service has been negligible. Table 32. AMBULANCE SERVICES. No. of vehicles at 31st December 1949 Total No. of journeys during the year Total No. of patients carried during the year No. of accident and other emergency journeys included in total No. of journeys during the year Total mileage during the year No. of paid wholetime staff at 31/12/49 Directly provided by Council Ambulances Cars 5 6,559 10,200 801 61,900 26 5 4,845 12,292 117 63,066 Totals 10 11,404 22,492 918 124,966 26 Table 33. AMBULANCE SERVICES. Journeys and Mileage Analysis, 1949. Nature of .Journey Ambulances Cars No. of journeys Mileage No. of journeys Mileage Accidents 801 3,016 117 571 Sickness* 4,273 47,479 3,676 45,939 Maternity 880 5,180 37 367 Tuberculosis 264 2,014 299 2,998 Mental 21 1,145 119 5,645 Midwives 35 138 199 735 Hospital transfers 70 798 24 531 Ministry of Pensions 5 290 91 3,173 Maintenance 62 227 65 263 Other 85 1,018 204 2,743 For Essex C.C. 34 340 11 84 For West Ham 29 255 3 17 Totals 6,559 61,900 4,845 63,066 * Including infectious diseases. NOTE.—In addition to the above, it was necessary during the year under review for cars to be hired from a private hire firm in the district on 167 occasions involving 277 patients. 51 The Council have no arrangements with the Hospital Car Service. Mutual assistance arrangements existed throughout the year between the Authority and the L.C.C., West Ham and the Essex C.C., and particulars are as follows :— L.C.C. Removal by L.C.C. of typhus and smallpox patients within a radius of 25 miles. During 1949, these ambulances were used to remove 11 contacts of Smallpox from the S.S. " Mooltan." West Ham and Essex C.C. Cars. Ambulances. Total. †East Ham for Essex 11 34 45 †East Ham for West Ham 3 29 32 * Essex for East Ham 2 24 26 *West Ham for East Ham 5 114 119 † Journeys and mileage included in tables 32 and 33. * Journeys and mileage not included in tables 32 and 33. Section 28—Prevention of Illness, Care and After-Care. Under Sections 22 and 28 of the Act, the Council (vide Minute No. 256) approved the establishment of loan cupboards and the Ministry of Health signified their approval of the articles to be provided therein. These functioned as from 1/1/50. These cupboards are sited at:— Town Hall Annexe. Church Road Clinic. East Ham Chest Clinic (for tuberculous patients only). East Ham District Nursing Home. The articles stocked are as follows:— Air bed; Bed pans, adults' (assorted sizes), children's; Bed rings (air), adults', children's; Urinals, male, female; Rubber sheets ; Bed linen—sheets, pillow slips, mattress covers, blankets; Sets divided mattresses; Mattress; Feeding cups; Sputum mugs; Douche cans; Higginson's syringes; Steam kettles; Inhalers ; Bed cradles; Bed rests (assorted sizes) ; Water bed ; Sand bags (assorted) ; Sets of 4 bed blocks (assorted) ; Commode—stools, chairs ; Pairs crutches (assorted sizes) ; Walking sticks ; Wheel chairs ; Hot water bottles— rubber, stone ; Ice bag ; Thermometers ; Camp bed ; Wheel bed ; Garden shelter ; Electric heater blanket; Premature baby outfit. The steady demand for nursing equipment and surgical and medical comforts from the loan cupboards is a sure index of the wisdom of their inception. It is certain that this aspect of ' social medicine ' will play a not inconsiderable part in alleviating the distress of sufferers who cannot now be hospitalised owing to the shortage of beds for chronic sick and tuberculous persons. 52 Table 34. TUBERCULOSIS, 1949. No. of visits to homes of patients by nurses during 1949 No. of notified cases on East Ham Chest Clinic register on 31/12/49 No. of occasions on which free extra nourishment supplied to patients during the year No. of occasions financial help given for purchase of bedding and clothing Adults Children Total Milk Food Total 6,105 1,000 283 1,283 710 56 766 42 Table 35. CONVALESCENT HOME TREATMENT. Number Treated, 1949. Name of Home Children 0—5 years SchoolChildren Adults Total M. F M. F. M. F. M. F. Cliffe Combe, Broadstairs — — 19 15 — — 19 15 St. Mary's Broadstairs 2 2 10 16 — — 12 18 The House Beautiful, Bournemouth — — 16 6 — — 16 6 Hunstanton Convalescent Home — — 14 6 — — 14 6 St. Michaels Convent, Clacton-on-Sea — 1 — 12 — 7 — 20 " Bethany," Bournemouth 7 3 5 4 — — 12 7 Stamford Hill Home, Thorpe Bay — — 5 10 — — 5 10 Darrington House, Camberley — — 5 9 — — 5 9 St. Michael's, Southbourne — — — 12 — 1 — 13 Tapley Park, Instowe 6 5 1 1 — — 7 6 Children's Seaside Home, Exmouth — — — 13 — •— — 13 Home for Invalid Children, Hove — — 6 6 — — 6 6 Manor House, Burgh Castle, Gt. Yarmouth 1 3 7 1 — — 8 4 Burtt Home, Bognor — — 5 5 — — 5 5 St. Helen's Nursery, Letchworth 2 8 — — — — 2 8 Princess Christian's Home, Englefield Green — — 10 — — — 10 — Beach Court, Lancing-on-Sea 3 6 — — — — 3 6 Belgrave House, Littlehampton — — 9 — — — 9 — Bunce Court, Otterden, Faversham — 1 6 2 — — 6 3 North Devon Convalescent Home, Lynton — — 4 4 — — 4 4 Bell Memorial Home, Lancing-on-Sea — — — — 2 5 2 5 All Saints' Home, Eastbourne — — — — 6 — 6 — Essex Convalescent Home, Clacton-on-Sea — — — — 1 4 1 4 National Institute Blind Home, St. Leonard's-on-Sea — — — — 2 1 2 1 † Regional Hospital Boards' Homes 5 4 3 1 — — 8 5 Others 11 16 46 32 7 13 64 61 † No cost to Council. TABLE 36. CONVALESCENT HOME TREATMENT. Period of Treatment, 1949. Age Group Sex Up to 1 week 1-2 wks. 2-3 wks. 3-4 wks. 4-5 wks. 5-6 wks. 6-7 wks. 7-8 wks. 8-9 wks. 9-10 wks. 10-11 wks. 11-12 wks. Over 12 wks. Total Under M. — 1 1 3 2 6 5 5 4 3 1 1 5 37 5 years F. 3 4 2 4 2 5 4 16 5 — — 1 3 49 M. 1 6 6 48 15 72 10 9 1 2 — 1 — 171 children F. 4 6 6 30 6 85 3 5 4 2 2 1 1 155 Adults M. 1 6 4 7 — — — — — — — — — 18 F. — 9 8 14 — — — — — — — — — 31 53 The recommendations for this form of treatment were submitted by :— TABLE 37. red by Children 0—5 School Children Adults Total General Practitioners 7 14 26 47 Hospitals 13 23 20 56 East Ham Chest Clinic 8 15 3 26 School Health Service — 274 — 274 M. & C.W. Section 58 — — 58 Totals 86 326 49 461 The period for which free extra nourishment (see table 34) is granted to tuberculous patients is 13 weeks and in the case of milk this can be continued by renewal after such periods. In regard to food this is only granted for a total period of 26 weeks, to such patients on discharge from sanatoria. All applications where the income is above the Council's scale are submitted, before any grant is made, to the Chairman for approval. In addition, no bedding or clothing is supplied without the Chairman's approval. Convalescent home treatment for all children is provided free of cost. Adults or their relatives are assessed in accordance with the Council's scale and where necessary free treatment is provided with the Chairman's consent. In addition, the parents of 12 children received financial aid (£24 14s. 2d.), in providing clothing before the admission of their children to Homes, The cost (including fares where granted) of convalescent treatment, as provided under the Authority's scheme, for the period 1/1/49 to 31/12/49, is as follows:— £ s. d. Children under five years 1,945 9 6 Schoolchildren 4,826 15 8½ Adults 460 5 7 Total £7,232 10 9½ 54 During the year under review, the Council accepted financial responsibility for after-care treatment for ex-mental patients in After-Care Homes, as follows:— Six patients were admitted to homes belonging to the Mental After-Care Association, for varying periods—3 were resident for the whole of year, 1 for 5 months, 1 for 3½ months, and 1 for 5 weeks. The cost of this treatment to the Council was £317 13s. 7d. Park View Therapeutic Club. The activities of this club have continued under the auspices of the Council and staffed by a psychiatrist and psychiatric social worker of the Regional Hospital Board. Ex-patients from mental hospital selected by the medical staff form the majority of the members and regular attendance is made by our duly authorised officers to effect the closest possible personal contact in order the better to play their part in social rehabilitation. Discussions with the Regional Hospital Board to widen the scope of the club have been in progress, but so far it has been decided not to jeopardise the good chance of progress which can be achieved by introduction of a heterogeneous group of unselected cases, many of whom, in the opinion of the Regional Psychiatrist, can better be rehabilitated through the normal social channels in the community. The line between pure therapy (the concern of the Regional Hospital Board) and after-care (afforded by the Local Authority) is so difficult of definition that it is better to conjoin the effort and share the cost, in the best interests of the patients concerned. Their journey along the road to recovery is hazardous even under the best conditions and nothing should be done to bar their progress. Sections 28 and 51. No advance in the provision of a second Occupation Centre for mental defectives has been possible owing to the difficulties of finding and acquiring a suitable site within the borough. (i) Administration. (a) A mental health sub-committee, properly constituted, composed of all the members of the Health Committee, has functioned throughout the year. This sub-committee meets as and when required. 55 (b) Details of staff employed on mental health duties—see detailed list of public health staff at beginning of Report. (c) Co-ordination with the staffs and management committees of Regional Hospitals is maintained to ensure the best treatment, after-care and rehabilitation in appropriate cases. Discussions on problems and methods of supervision in mental cases and mentally defective individuals are frequent and most valuable. Reports are promptly rendered on home conditions and progress whenever asked for by the hospitals or institutions for cases on licence or where fresh action is anticipated or visiting required. (d) The National Association of Mental Health have been most helpful in finding suitable accommodation and guardians, supervising and visiting defectives and arranging holidays and transfers, and it is proposed to continue soliciting their aid whenever practicable. (e) Since the N.H.S. Act came into operation, the Petitions Officer and three of the Duly Authorised Officers have attended courses of training. (ii) Account of work undertaken in the community. (a) A considerable volume of evidence is accumulating of the helpful work carried out by the Duly Authorised Officers and psychiatric workers, with whom close liaison is effected, in connection with the prevention of onset and recrudescence of mental illness. Sufferers are helped through the stresses and strains of individual problems and domestic difficulties by the tact, understanding and guidance of these officers. They are assisted to manage their affairs and to obtain such financial aid as is possible. Suitable cases are encouraged to attend the therapeutic club and appointments are made for them whenever necessary to attend hospital out-patient departments for psychiatric investigation and re-assessment. Every assistance is given in facilitating admission and transportation of cases to hospital or institution. Hostels are found for individuals where this kind of placement is considered appropriate. A certain amount of mental health education is also undertaken by the duly authorised officers when occasion offers. 56 (b) Under the Lunacy and Mental Treatment Acts 1890-1930, by Duly Authorised Officers. See (ii) (a) and tables 38 and 42. (c) Under Mental Deficiency Acts, 1913-1938. (i) The ascertainment of defectives is carried out by the mental health section of the Health Department, and the number of defectives awaiting vacancies in institutions at the end of the year was 9 (see table 38). (ii) All guardianship cases are supervised either directly or indirectly by the department. Number supervised by National Association for Mental Health 6 Number of Orders discharged by Board of Control 27 Number provided with financial assistance by National Assistance Board 26 Number of cases visited by members of Mental Health Committee, on rota 11 Details of cases under supervision who are regularly visited by the duly authorised officers are shewn in table 38. (iii) Training of selected defectives is carried out at the Council's Occupation Centre, open for 5 days in the week, at the Labour Hall, Katherine Road, E.6. For details see table 40. Table 38. MENTAL PATIENTS—Lunacy and Mental Treatment Acts. Type of patient Number on register on 1 /I /49 Admissions to institutions during the year 1949 Discharges from institutions during the year 1949 Deaths in institutions during the year 1949 Number on register on 31/12/49 Certified —Males 161 23 16 3 165 Females 207 39 33 5 208 Total 368 62 49 8 373 Temporary—Males 3 1 4 — — Females — 4 3 — 1 Total 3 5 7 — 1 Voluntary —Males 83 58 51 6 84 Females 68 62 61 7 62 Total 151 120 112 13 146 Grand Totals 522 187 168 21 520 No. of patients released on trial during 1949—7 Males, 21 Females, Total 28. No. of patients returned from trial during 1949—1 Female. 57 Of the above cases, on 1/1/49, 508 were inmates at Runwell Hospital and 14 in other institutions. During the year, 180 were admitted to Runwell and 7 to other hospitals, 165 were discharged from Runwell and 3 from other institutions, '20 of the deaths occurred in Runwell and one elsewhere and on 31/12/49, the cases were accommodated as follows :—503, Runwell, 17 other institutions. t No defectives under guardianship were dealt with during the year under the provisions of Section 8 or 9. Table 39. MENTAL DEFICIENCY ACTS, 1913-1938. Particulars of Mental Defectives as on 1/1/50. Males Females Total 1. No. of ascertained mental defectives found " Subject to be dealt with " :— (a) In institutions (including cases on licence therefrom) Under 16 years of age 9 9 18 Aged 16 years and over 79 84 163 (6)†Under guardianship (including cases on licence therefrom) Under 16 years of age 1 — 1 Aged 16 years and over 5 10 15 (c) In " places of safety " 2 — 2 (d) Under statutory supervision (excluding cases on licence) Under 16 years of age 20 15 35 Aged 16 years and over 76 65 141 (e) Action not yet taken under any one or the above headings — — — Total ascertained cases found to be " Subject to be dealt with " 192 183 375 No. of cases included in (6) tO (C) above waiting removal to an institution M. F. Total 5 4 9 2. No. of mental defectives not at present "Subject to be dealt with " but over whom some form of voluntary supervision is maintained:— Under 16 years of age — — — Aged 16 years and over 25 23 48 Total No. of mental defectives (1) and (2) 217 206 423 3. No. of mental defectives receiving training :— (a) In day training centres Under 16 years or age 7 8 15 Aged 16 years and over 9 9 18 (b) At home — — — Total 16 17 33 58 Table 40. PARTICULARS OF MENTAL DEFECTIVES REPORTED DURING 1949. Males Females Total II. Particulars of cases reported during the year 1949 : (1) Ascertainment— (a) Cases reported by Local Education Authorities (Section 57, Education Act, 1944)— (i) Under Section 57 (3) 5 5 10 (ii) Under Section 57 (5) :— On leaving special schools 3 2 5 On leaving ordinary schools — — — (6) Other ascertained defectives reported during 1949 and found to be " Subject to be dealt with" 4 2 6 (c) Other reported cases ascertained during 1949 who are not at present " Subject to be dealt with " 1 1 Total No. of cases reported during the year 12 10 22 (2) Disposal of cases reported during the year :— (a) Ascertained defectives found to be " Subject to be dealt with "— (i) Admitted to institutions 2 — 2 (ii) Placed under guardianship — — — (iii) Taken to " places of safety " 1 — 1 (iv) Placed under statutory supervision 8 6 14 (v) Died or removed from area 1 — 1 (vi) Action not yet taken — — — (vii) Awaiting admission to institution Total ascertained defectives found to be " Subject to be dealt with " 12 3 9 3 21 (b) Cases not at present " Subject to be dealt with "— (i) Placed under voluntary supervision — 1 1 III. No. of cases in institutions, under community care including voluntary supervision or in " places of safety " on 1 /I /49, who have ceased to be under any of these forms of care during 1949— (a) Ceased to be under care — — — (b) Died, removed from area, or lost sight of... — — — IV. Of the total No. of defectives known to the L.H.A.— (a) No. who have given birth to children during 1949 : (i) After marriage — (ii) While unmarried 1 (6) No. who have married during 1949 2 1 3 During 1949, the number of guardianship orders discharged with the approval of the Board of Control in accordance with Circular 177/48 (Ministry of Health) and the financial provisions transferred to the National Assistance Board, was 6 males and 21 females. 59 The number of mental defectives on the register of the Occupation Centre on 31/12/49, was 33 (16 males, 17 females). With the exception of 2 females who attend afternoons only, all attend for the whole day. Table 41. MENTAL DEFECTIVE OCCUPATION CENTRE. Sessions and Attendances, 1940. Morning Afternoon No. of sessions held during the year 233 233 Male Female Male Female Total attendances 2,802 2,639 2,753 3,029 Average attendances per session 12.02 11.33 11.8 13.0 Total attendances, males 5,555, females 5,668, total 11,223. There were no defectives awaiting admission to the Centre on 31/12/49. During the year under review, the defectives attending the Centre made the following articles, which were sold for the sum of £128 8s. Od.—2 settee backs, 1 needle case, 3 knitting bags, 6 teapot stands, 13 soft toys, 2 pair gloves, 1 scarf, 1 canvas bag, 3 string bags, 2 oak stools, 7 small mats, 7 piano runners, 3 peg bags, 17 chair backs, 12 tea cosies, 6 shopping bags, 44 cushion covers, 17 wool rugs, 1 rag rug, repairs to rugs and baskets. Table 42. DULY AUTHORISED OFFICERS. Details of Visits, etc., 1949. Mental Deficiency Acts 1913-38 Lunacy and Mental Treatment Acts Grand Total of visits and attendances Guardianship Statutory Supervision Friendly Care Home reports for patients detained in institutions Occupation Centre Total visits or attendances Patients reported to be in need of treatment After-Care Park View Therapeutic Social Club Total visits or attendances No. of visits and attendances 160 1,148 124 169 69 1,670 1,159 576 44 1,779 3,449 60 Section 29—Home Help Service. An effort has been made during the year to effect economies in this rather costly service. By careful scrutiny and revision of the case histories, the hours of service rendered to individuals and families have been reduced without causing hardship. The establishment has not been exceeded and it has been found advisable to employ casual helps rather than to appoint women in a full-time permanent capacity as vacancies occur. By this means the danger of employing staff who are not continuously engaged for the hours for which payment has to be made is obviated. A home helps social club (run privately) has been formed with the object of bringing the personnel closer together and increasing the spirit of camaraderie within the service. As I stated in my report for 1948, the demand for services of home helps continued to grow rapidly and during the period (1949), which this report reviews, there was no falling off of applications. It was anticipated at the beginning of the year that applications would materially decrease in the summer months—this, however, did not eventuate and the demand continued throughout the year. From the " appointed day " (4/7/48) to 31/12/48, the number of cases dealt with was 37 maternity and 66 sickness patients, a total of 103, whereas for the year 1949, 575 families received such help. On 31 /12/49, the establishment of home helps approved by the Ministry of Health, was 60 full-time or their equivalent in parttime service and on the same date the number employed was :— 10 permanent (7 whole-time and 3 part-time) and 79 casual. Table 43. HOME HELP SERVICE. Tabulation of Cases, 1949. Illness or other cause for which help provided Period of service provided Total Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks 1—3 months 3—6 months 6—9 months 9—12 months Maternity 2 1 93 4 — — — — 100 Tuberculosis 3 — — 1 11 9 7 2 33 Cancer — — 2 2 2 1 — 3 10 Old age 9 5 14 12 59 68 44 37 248 Other sickness 12 4 25 12 56 38 22 15 184 Totals 26 10 134 31 128 116 73 57 575 61 Of the '248 cases of old age as shewn in the preceding table, this figure includes chronic sick (e.g., aged, suffering from arthritis, rheumatism, cardiac, diabetes, etc.) and the aged and blind—very few of these old people are serviced on grounds of senility only. Of the 575 applicants, with the prior approval of the Chairman and subsequent confirmation by the Health Committee, in 269 cases home helps were provided free of cost. SANITARY SECTION. Mr. R. A. Baskett, B.E.M., M.S.I.A., has compiled this section of the report relating to sanitary circumstances, housing and the statistics in regard to food inspection. During the past year, except for the retirement of one District Inspector—Mr. W. Thurston, and the Shops Act Inspector— Mr. C. Pursall, the Department has been particularly fortunate in maintaining its full complement of inspectorate. It has in consequence been possible to continue and follow up the improvement effected last year in environmental hygiene and to devote more detailed attention to the hygiene of food premises. The work of genera l sanitary administrat ion however, cont inues to be hampered by two main factors (a) Protracted negotiations by owners with the War Damage Commission, and (b) The reluctance of owners, in receipt of controlled rents, to carry out repairs at present costs. These matters necessitated vigilant attention to the work of re-inspection, and a more frequent resort to statutory action and legal proceedings. In order to expedite statutory action under the Public Health Act, 1936, the Council has delegated its powers with regard to the abatement of nuisances to the Health Committee. The number of inspections carried out during the year totalled 35,106 including 8,700 under the Public Health Act, 17,277 re-inspections and 2,255 inspections under the Housing Act as compared with last year's figures of 33,201—8,034—17,518—1,808 respectively. The number of sanitary notices complied was 3,591. Close co-operation with the Council's Housing Department was maintained during the year, particularly in regard to housing investigations and the issue of building licences for the compliance of sanitary notices. 62 The establishment of the Sanitary Section consisted of one Shops Inspector, seven 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. Talks to local organisations on the work of the Sanitary Section have been continued during the year, and full advantage was taken of the opportunity afforded by the Civic Exhibition to stress the importance of personal and environmental hygiene. 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 35,106 (i) Housing. Under Public Health Act 8,700 Re-inspections 17,277 Housing Act, 1936 2,255 (ii) Sanitary Circumstances. Yards and Passages 254 Drainage and Sanitary Accommodation 2,203 Factories (excluding Bakehouses) 416 Workplaces and Outworkers 165 Caravans 4 Re Offensive Fumes 20 Miscellaneous 486 (iii) Food Supply Slaughterhouses 3 Dairies 51 Food Premises 1,683 Bakehouses 62 Re Sampling 484 (iv) Infectious Disease Visits 1,048 68 (b) Notices.—The number of notices served during the year totalled 5,219, of which 909 were statutory notices. The number of notices complied within the same period was 3,591. Complaints made to the Department with regard to sanitary circumstances, disrepair, infestations, obstructed drains, etc., totalled 8,519. (c) Rat Extermination.—During the year some 294 complaints were received of the presence of rats and mice, for which the rodent operator made 3,516 visits to premises affected. Notwithstanding the Council's systematic maintenance treatment, the sewer rat showed considerable activity towards the end of the year. In almost every instance the source of rat infestation was found to be due to defective drains. In addition to those destroyed at the Council's Sewage and Refuse Disposal Works and in the maintenance treatment of the public sewers, it is estimated that some 1,674 rats were caught or poisoned. Infestations of mice in private dwelling houses present their own peculiar problems, both in time and treatment. Particularly is this so when the active co-operation of the occupier is not readily forthcoming. The necessity for protecting all foodstuffs against the ravages of these vermin is often not appreciated. Furthermore, the presence of children and pets in the household restrict and determine the type of treatment to be employed. (d) Disinfection and Disinfestation.—Disinfection of rooms and their contents was carried out to 420 premises and 445 library books were disinfected. The steam disinfector was in operation on 131 days during the year. The use of smoke or spray D.D.T. insecticide was satisfactorily and successfully employed in the disinfestation of 103 verminous premises. This method of disinfesting has not only simplified treatment but effected considerable saving in time and labour. In addition the Department has been called upon to deal with nuisances arising from ants, beetles, fleas, flies, cockroaches, etc. 64 Woodworm infestation and the presence of dry rot in timber floors continue to be the source of many complaints from both owners and occupiers. Advice is given and remedial measures prescribed. The cause and effect of dry rot and the necessity for prompt and drastic treatment is often not realised by owners or workmen engaged in the renewal of affected floors, etc. (e) Legal Proceedings.—It was necessary to institute legal proceedings as under :— Public Health Act, 1936—-Section 94 131 Food and Drugs Act, 1938—Section 3 1 Rag Flock Act, 1911 1 (/) Drainage.—The number of complaints relative to choked or defective drains totalled 533. Knowledge of the construction and capacity of drains on the part of the general public would appear to be almost negligible. Many of the unsatisfactory conditions complained of could have been avoided by proper use and elementary cleansing. Requests after normal office hours and during week-ends for the services of a drain cleaner have shown a marked increase during the year. (g) Factories, Workplaces and Outworkers.—581 inspections were made during the year and improvements effected during the past two years have been well maintained. The number of outworkers actually employed in the Borough at any given time fluctuates considerably and appears to be influenced by trade seasonal demands and of course the desire to augment the family exchequer from time to time. (h) Mosquito Control.—Effective treatment of the ditches and low-lying land in the Borough was carried out and no complaints of a serious nature arose. Complaints, however, with regard to fly nuisances were more numerous, and unfortunately more difficult and less effectively dealt with. The prolonged spell of warm dry weather was generally 65 accepted as a contributory factor, but this was poor consolation for the irritated and naturally irate householder. Many activities and sources were suspect, but in the absence of positive proof, remedial measures, often only partially successful, were of necessity restricted to local application. (i) Places of Public Entertainment.—Systematic inspection has been carried out both in regard to the sanitary condition of these premises and their use in conformity with the Council's Regulations. A considerable amount of work in the repair of war damage has been completed, but cleansing and redecoration generally has by no means reached pre-war standards. (j) Rent and Mortgage Interest Restrictions Acts, 1920-1939— Applications for certificates in respect of the sanitary condition of houses were fewer than in the previous year. There were in fact only 24 applications and certificates granted totalled 17. It was, however, necessary to issue 7 other certificates in respect of applications made at the end of last year. (k) Shops Acts, 1912-1936.—Particulars as to shop premises in the Borough, inspections, etc., are summarised as follows :— Visits re Closing Hours 1,213 „ „ Shops Act, 1934 4,240 (arrangements for Health and Comfort of Shop Workers, Records, etc.) Total 5,453 During the year the Shops' Register was maintained and kept under constant revision. At the close of the year there were 2,393 shops in the register including 297 shop premises closed. The number of shop assistants employed in the Borough totalled 3,814, comprising 1,504 males, 1,843 females, young persons (male) 170 (female) 297. 66 Shop premises classified in trades are set out below:— Bakers 52 Butchers 88 Catering 97 Chemists 40 Confectioners 193 Corn chandlers 19 Domestic Stores 40 Drapers 86 Fishmongers 51 Footwear 79 Furniture 55 Grocers 242 Greengrocers 106 Hairdressers 94 Licensed Victuallers 82 Tailors 75 Miscellaneous 697 Total 2,096 (I) Pharmacy and Poisons Act, 1933.—The number of persons in the Council's list entitled to sell poisons included in Part II of the Poisons List was 180. (142 renewals and 38 new applications.) In the enforcement of this Act, 446 inspections were made. (m) Explosives Act, 1875.—170 visits were made in connection with the storage of mixed explosives (fireworks). There were 74 applications for the renewal of registration and 29 new applications. (n) Fertilisers and Feeding Stuffs.—7 samples of fertiliser and 3 of feeding stuffs were taken during the year. Only one sample of fertiliser was reported by the Council's Agricultural Analyst to be unsatisfactory, namely—a blood and bone fertiliser which was 1.15 per cent, below the statutory statement of 13.5 per cent. This sample was sold as a prepacked article and the manufacturers were cautioned with regard to the deficiency. 67 (o) Rag Flock Act, 1911.—Of 7 samples of rag flock, the Analyst reported adversely upon two of them. One contained 65 parts of chlorine, and the other 200 parts of chlorine to 100,000 parts of flock. The vendor of the latter sample was prosecuted. HOUSING. Survey of premises for the Housing Department was continued and during the year 2,255 premises were visited and reports submitted to that Department on the housing circumstances of applicants for rehousing. Housing Statistics. I. Inspection of dwelling houses during the year:— (1) (a) Total number of dwelling-houses inspected for defects (under Public Health or Housing Acts) 11,671 (b) Number of inspections made for the purpose 28,948 (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 reasonably fit for human habitation 6,187 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 2,941 68 III. Action under Statutory Powers during the year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936. (1) Number of dwelling houses in respect of which Notices were served requiring repairs — (2) Number of dwelling houses which were rendered fit after service of formal notices:— (i) By owners — (ii) By Local Authority in default of owners — (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 909 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (i) By owners 650 (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 — The following statistics have been supplied by the Council's Chief Housing OlFicer, Mr. J. E. Austin, M.B.E. 69 Housing Statistics—Position at 31st December, 1949. 1. Accommodation made available—family units:— (i) By repair of war damage 6,233* (ii) By requisitioned premises 1,299 (iii) By new housing (including 384 cost of works rebuilds) 1,801 (iv) By emergency hutments — 9,833 * This figure includes 3,307 houses classified Cb (War Damage) and rebuilt by Local Authority. 2. Families rehoused since August, 1945 2,840 3. Cases of overcrowding under Housing Act, 1936, abated by rehousing since August, 1945 (included in 2) 749 4. Total of current applications for rehousing 6,543 5. New Housing:— Dwellings Projected Under Construction Completed Temporary 934 — 934 Permanent 677 122 483 Cost-of-Works Rebuilds 507* 67 384 Total 2,118 189 1,801 * After adjustment by Primary Education Plan. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Graded Milk.—Licences in force on the 30th September, 1949, were as follows:— Tuberculin Tested Milk— Dealers' Licences 10 Supplementary Licences 3 70 Pasteurised Milk- Establishment Licence 1 Dealers' Licences 19 Supplementary Licences 3 The Milk and Dairies Regulations and Milk (Special Designation) Regulations became operative on the 1st October, 1949. From this date until the end of the year the following applications for licences to use special designations in accordance with these regulations were received:— Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations. Pasteurised Milk— Dealer's Licence 73 Supplementary Licence 10 Dealer's (Pasteuriser's) Licence 1 Sterilised Milk— Dealer's Licence 81 Supplementary Licence 10 Dealer's (Steriliser's) Licence 1 Milk (Special Designation) (Raw Milk) Regulations. Tuberculin Tested Milk— Dealer's Licence 18 Supplementary Licence 10 Milk samples submitted for bacteriological examination are siimma.riseH as follows:— Unsatisfactory Pasteurised 47 6 Tuberculin Tested 7 – Sterilised 4 – Heat Treated 36 5 Ungraded 2 – 96 11 All the unsatisfactory samples failed to satisfy the methylene blue test. Investigations were made in respect of each of these unsatisfactory samples but as far as could be ascertained this failure to satisfy the test for keeping quality could only be attributed to some of the high atmospheric temperatures encountered during last summer. 71 (b) Meat and Other Foods. (1) Meat Inspection.—Inspections of butchers' shops in the Borough were maintained during the year and improvements effected, particularly in regard to certain manufactory premises. Fewer complaints were received of poor quality meat and in 110 instance was it necessary to seize any unsound meat. Some 908 lbs. of meat were, however, surrendered as unfit for human consumption. Towards the end of the year special attention was directed to the transport and delivery of meat in the Borough. Improvements in the cleanliness of the vans and porters' overalls were effected. This matter is being followed up and further progress in the type of vehicle used, overalls worn and methods of handling meat are aimed at. (2) Food Premises.—The number of inspections made to food premises included 51 dairies, 62 bakehouses and 1,683 other premises. Generally, it was observed that the standard of cleanliness was much improved, due in all probability to the publicity given in the Press to the necessity for practising the principles of food hygiene and to the easing of the supply position in regard to materials and equipment. It is, however, in the failure of the food-handlers to understand and apply these principles that the greatest dangers lie. These difficulties can only be overcome by continuous education and publicity in such matters. As a practical contribution, the Council, in March, adopted a scheme by which all outdoor food-handlers in the Borough could avail themselves of free washing facilities at the public conveniences. Notwithstanding the limitations of such a scheme due to the location of these conveniences, the response so far leaves much to be desired. (3) Slaughterhouses.—There is only one licensed slaughterhouse in the Borough which was not in use during the year. Under the Slaughter of Animals Act, 1933, six licences were applied for and granted to slaughtermen. (4) Bacteriological Sampling.—In addition to 96 samples of milk the following were submitted for examination: 73 ice-cream, 1 bread, 1 custard tart, 1 drinking water, 1 of subsoil water and 8 samples of water from the public swimming baths. The 73 samples of ice-cream were obtained from 37 different sources of supply including places of public entertainment and 72 were graded by the Council's bacteriologist in accordance with the Ministry of Health's Provisional Grading as follows:— Grade I 28 Grade II 24 Grade III 16 Grade IV 5 Total 73 The fat content of the samples varied from 3 to 13 per cent, and averaged 8 per cent. The sample of bread was suspected to contain rodent excreta. The custard tart was found to be contaminated with rodent excreta, but as the source of contamination could not be traced, legal proceedings were not instituted. The water samples, with the exception of one taken from the vapour plunge bath, were satisfactory. (5) Ice-Cream.—Strict attention to the sale and manufacture of ice-cream has been continued throughout the year. Applications for the sale or manufacture of ice-cream numbered 39. Two of the applications were refused and one registration cancelled. There were 152 premises in the Borough registered for the sale of ice-cream, exclusive of Clubs, Hotels, Restaurants, Theatres, etc. 22 of these are registered for the manufacture of ice-cream. In most cases the sale of ice-cream is incidental to the main business carried on at the registered premises, which comprise the following trades:— Tobacconists and Confectioners 94 Grocery and Provisions 25 Catering Establishments 21 Multiple Stores 5 Fruiterers 3 Peripatetic Vendors 3 Amusement Arcade 1 152 Seven of the Tobacconists and Confectioners also carried on the business of a lending library, but relinquished this side of their 73 business for the more profitable sale of ice-cream. The Council has in fact decided that except under special circumstances the sale of such a vulnerable foodstuff as ice-cream shall not be carried on in conjunction with the business of a lending library. The manufacture of ice-cream in the Borough although in every case carried on as a separate activity is in fact associated with the following trades:— Tobacconists and Confectioners 15 Catering Establishments 4 Ice-Cream Manufacturers only 2 Fruiterers 1 22 With the exception of one or two small confectioners where a "complete cold mix" is used, the remainder of the manufacturers submit their ingredients to heat treatment as prescribed in the Ice-Cream (Heat Treatment, etc.) Regulations, 1947/48. No great difficulty generally is experienced in complying with these regulations, although some of the operations involved are less automatic than one would desire. This, of course, is largely dependant upon the type of machinery installed, which can be both costly and complicated. Through registration, effective control is exercised over premises used for the sale or manufacture of ice-cream, but the itinerant vendor in this Borough escapes such registration, and in consequence supervision of sales by this type of trader is rendered difficult. Registration of such traders in ice-cream or any foodstuffs should be obligatory. (6) Other Foods.—The quality of foodstuffs sold in the Borough was generally well maintained. This is in no small measure due to the co-operation of the local food traders in seeking the help and advice of the Department when in doubt, and to the prompt manner in which foodstuffs, unfit for human consumption, are surrendered. The following canned foodstuffs were condemned as unfit for human food:— Meat and meat products, 449 tins, fruit 283, fish 669 milk 1,587, and 4,333 tins or packages of other foods. 74 In addition, the following foodstuffs were condemned— fish 4,029 lbs., fruit 236 lbs., fats 68 lbs., eggs 81, cheese 113 lbs., confectionery 6,838 lbs., other foodstuffs 1,500 lbs. (c) Adulteration. Whilst restricting sampling to the number falling within the estimate, efforts were directed to cover a wider range of foodstuffs, consistent with the gradual improvement in the supply position. Of the samples reported by the Public Analyst as being unsatisfactory, 6 were due to deficiencies, 4 to some form of contamination, 4 to the presence of preservative, which although permitted had not been notified to the customer, 2 were unsound and unfit for human consumption and only one adulterated. Gelatine was examined for the presence of arsenic, and potato crisps for the presence of linseed, horse or mineral oil. As a matter of interest the Analyst reports that analysis of cooking fats, frying oils, etc., now involves examination for the presence of mineral oil, for of recent years the use of mineral oil both liquid and solid for baking purposes has become somewhat frequent. The Ministry of Food has in fact issued an Order prohibiting the use of mineral oil in foods, such prohibition is said to be based upon physiological grounds. The number of samples taken and the Public Analyst's findings are set forth in the following Table TABLE 44. Number of Samples Percentage of samples unsatisfactory Examined Found adulterated or below standard Beverages (non-alcoholic) 8 —- —- Confectionery 21 1 4.8 Drugs 18 —- — Fats 8 — — Fish and Fish Products 4 1 25.0 Meat and Meat Products 79 7 8.8 Milk 101 1 1.0 Preserves 7 1 14.3 Wines and Spirits 15 — — Others 75 6 8.1 Total 336 17 5.0 75 Details of samples adulterated or below standard are described as follows, together with resultant action:— TABLE 45. No. Informal or Formal Article Adulteration or Deficiency Action taken 5683 F Potato Crisps Fat in an acid and rancid condition. Withdrawn from sale Letter of caution. 5694 I Gelatine Contained 4 parts per million of arsenic. No further supplies available. Letter of caution. 5707 I Sherbet Not an effervescing preparation. Vendor cautioned. 5806 I Pork Sausages Contained 25% meat instead of 50%. Formal sample taken. 5819 F Pork Sausages 31% deficient in meat. Vendor prosecuted. 5824 I Pork Sausages 8% deficient in meat Formal sample satisfactory. 5851 F Milk Added water at least 2 parts per cent. Letter of caution. 5868 I Jam Presence of beetle Contamination subsequent to manufacture. No action. 5910 I Bread Presence of foreign body. Vendor cautioned. 5911 I Pie Crust and Pastry Mix Incipient rancidity. Withdrawn from sale. 5913 I Fruit Preserving tablets Deficient in sulphur dioxide 20% Old stock — withdrawn from sale. 5920 I Beef Sausages Contained sulphur dioxide to extent of 240 parts per million. Letter of caution. 5934 I Tinned Fish Contaminated by tin Condemned as unfit for human consumption. 5935 F Beef Sausages Contained sulphur dioxide to extent of 200 parts per million. Letter of caution. 5958 I Macaroon Tart Presence of rodent excreta. Vendor prosecuted (1950). 5968 I Pork Sausage Contained preservative. Vendor cautioned. 5985 I Salad Cream Deficient in oil to the extent of 1.6% Vendor cautioned— withdrawn from sale. 76 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. In view of the increasing number of scholars on the registered rolls of the schools and the avowed difficulty experienced by general practitioners in giving adequate attention to children on their lists, the integrity and continuity of this service at a high level of efficiency remains a paramount necessity to the community. The policy of medical inspection and follow-up treatment established since the Education Act, 1944, has been steadily pursued and in order to give the family doctor every opportunity of taking the initiative in referring children to hospitals, close contact has been established to ensure that general practitioners are made aware of the need for investigation or treatment of school children on their lists. The medical staffs of the specialist clinics now come under the aegis of the Regional Hospital Boards in respect of remuneration and terms of service. For the time being these clinics will continue to function as heretofore in premises provided by the Local Education Authorities and it is hoped that the wisdom of this practice will prove so abundantly manifest that no attempt will be made to split off these specialist clinics from the School Health Service. The saving in "schooling time" to the scholars and "working time" to their attendant parents alone would be the strongest possible argument in favour of the retention of this system, whilst the integration of these clinics with the school medical work as a whole has proved of the greatest value to the children concerned. Dichotomy in this direction must be avoided, and our whole effort concentrated on maintaining the service as a unified whole under the School Medical Officer. 77 School milk, school meals, and school health should be regarded as a medico-social triad on which the well-being of the scholars has been truly founded; to strike away any one of them might well cause the whole edifice built up by patient local authority effort over four decades, to crumble and decay. It is with feelings of great personal loss and deep regret that reference is made to the death of Dr. Reeve Flaxman who for twenty years carried out the duties of Ophthalmic Consultant to the Council. His work was stamped with a uniform excellence and his relation with colleagues and patients always cordial yet dignified. The children and nurses adored him for his gentleness and kindness under all circumstances, and his passing will create a gap in our School Health Service. His post may be filled, but he can never be replaced. I wish to express my sincere thanks to the Chairman and Members of the Education Committee and to those of the SubCommittees, for their courtesy and kindness and their assistance on all occasions. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, Malcolm Barker, School Medical Officer. 78 GENERAL INFORMATION. Schools and Numbers on Roll (mid 1949). TABLE 46. Type. Number of Schools. Number on Roll. Maintained Primary: Infant 17 9,759 Junior 15 Maintained Secondary 11 4,909 Voluntary (Infant and Junior) 4 807 Totals *44 15,475 * (3 maintained schools are combined Infant and Junior). Estimated number of children aged 5-14 inclusive (mid 1949) 14,770 School Clinic premises and purposes served Address. Types of Clinic. Town Hall Annexe, Barking Road. School Health Diphtheria and Pertussis Immunisation Aural Ophthalmic Physiotherapy and Sunlight Dental Manor Park Clinic, Church Road. School Health Diphtheria and Pertussis Immunisation Physiotherapy and Sunlight Dental North Woolwich, Fernhill Street. School Health Shrewsbury Road School Child Guidance Speech Therapy 79 TABLE 47.—SCHOOL CLINICS. MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY MORNING ANNEXE School Health Shrewsbury Rd. Child Guidance School Health Shrewsbury Rd. Child Guidance School Health Physiotherapy Physiotherapy Ophthalmic Physiotherapy Physiotherapy Ophthalmic (alternate weeks) Physiotherapy Ophthalmic Dental Dental (general anaesthetics) Dental Dental Dental Dental MANOR PARK Physiotherapy Dental School Health Physiotherapy Dental Physiotherapy Dental (general anaesthetics alternate weeks) School Health Physiotherapy Dental Dental AFTERNOON ANNEXE Shrewsbury Rd. Child Guidance North Woolwich School Health Sunlight School Health Physiotherapy Sunlight Immunisation Dental Dental Aural Dental Dental Aural Dental MANOR PARK Dental School Health Immunisation Physiotherapy Dental Dental 80 School Health Clinics. As indicated in the foreword to this section, these clinics have continued fully staffed and well attended throughout the year. It is felt that nothing in the N.H.S. Act has yet altered the requirements of the Education Act, 1944, that a comprehensive medical service (other than domiciliary treatment) shall be provided for school children. It is better to examine and if possible treat a child in the environment of the School Health Clinic than to thrust him into the atmosphere of the hospital or the crowded waiting room of the general practitioner's surgery. Hospital staffs are well aware of the advantages offered by our Clinics and increasing use is made by them of the facilities offered in conjunction with their own periodic supervision. Our chief difficulty is to retain good medical staff owing to the low salaries School Health posts command, but it is hoped that some adjustment may be made as a result of negotiations now proceeding which will have the effect of obviating this drawback and once more attract the best type of young and vigorous doctor into this interesting and important work. COMPARATIVE STATISTICS. The following table indicates briefly the work of the School Health Service during the year 1949, and shows the comparative statistics for previous years. TABLE 48. 1945 1946 1947 1948 1949 Routine and Special Inspections at School: *Maintained Secondary Schools 969 1,404 2,614 1,932 2,331 *Maintained Primary Schools 1,741 4,034 3,600 4,941 6,272 †Secondary Schools 125 — — — — †Elementary Schools 640 — — — — Re-inspections at School 1,795 2,834 3,209 2,675 3,142 Inspections and Re-inspections at Clinics 14,628 11,571 11,141 10,748 9,686 General cleanliness visits to schools 223 256 281 284 287 Examinations for cleanliness 25,448 30,077 48,514 38,561 42,040 Nurses' visits to homes 1,859 1,404 1,212 3,691 8,012 * Since 1/4/45. †Up to 81/3/45. 81 SCHOOL MEDICAL INSPECTIONS. The reader is referred back to this section of the report in previous years and to contemplate the question raised in certain quarters that school medical inspections are both unnecessary and a waste of time. My own experience after many long years of this work lead me strongly to repudiate and refute this imputation and to state categorically that these inspections have a great value to the school, the parent and the family, and have contributed not a little to the better physique and increase in height and weight, in comparable age groups of children of pre-war years. I am sure the imputation is based largely on the knowledge that the work in some areas is indifferently accomplished by inferior personnel. In no branch of medical survey is the personal factor of the examiner more important and obviously the more highly trained he is, the keener his clinical acumen and the better the standard demanded of him by the School Health Officer, the greater will be the value of his findings and the educative effect of his contact with the parent and pupil. The presence of parents at these inspections is cordially welcomed and it is satisfactory to report that despite the large number who are in employment, 73.5 per cent, of parents attended in all age groups and 90.9 per cent, in the first group. These figures compare with 71.6 per cent, and 93.5 per cent, for 1948. In addition, special surveys have been carried out to demonstrate speech defects, the remedying of which must play an enormous part in the personal, psychological and social development of affected scholars. A highly technical group audiometric survey is being conducted t hroughout the schools to discover hearing defects which likewise would have a profound retarding effect on individual education should they remain untreated and uncorrected by appropriate measures. 82 The great volume of remedial work that is undertaken by the School Health Service as a result of the demonstration of individual defects in scholars discovered at routine inspection, extends into every field of medicine, surgery and physiotherapy. Such remedial and corrective therapy would often be applied too late but for this service, for under existing circumstances in no other way would the parent be made aware that there exists in the child a potential handicap to his normal growth, future happiness and chance of attaining useful citizenship. Summary of Inspections and Re-inspections. Periodic Inspections: At Schools 8,483 Special Inspections: At Schools 120 At School Health Clinics 4,170 Handicapped Pupils 148 For Employment 39 For Special Courses, etc. 113 Re-inspections at Schools 3,142 Re-inspections at Clinics 5,516 83 Medical Inspection and Re-inspection at Schools. TABLE 49 School Infant Junior i Secondary I R S I R S I R S (a) Maintained Primary and Secondary Schools: Altmore 170 138 4 — — — — — — Avenue 152 94 — — — — — — — Brampton 289 183 — 161 48 — 318 264 — Central Park 194 50 2 — — — 322 224 22 Cornwell — — — 262 50 — 147 — 8 Dersingham 207 126 2 — — — — — — Essex 270 136 7 — — — 188 96 2 Hartley 180 131 3 — — — — — — Kensington 130 75 — — — — — — — Lathom — — — 445 93 2 — — — Monega 294 119 5 — — — 282 — 2 Napier 107 63 3 — — — 98 2 1 Roman Road 37 — — 48 — — — — — Salisbury 224 68 6 571 — 3 — — — Sandringham 202 94 5 — — — — — — Shaftesbury 373 157 1 424 90 4 — — — Storey Street 53 29 — 111 50 1 — — — Vicarage 255 70 5 309 59 — 408 123 — Winsor 80 39 — 101 31 6 — — — Boys' Grammar — — — — — — 240 98 2 Girls' Grammar — — — — — — 239 123 8 Technical School of Building — — — — — — 44 34 — (6) Voluntary Schools (R.C.) : Castle Street 49 24 1 72 14 10 — — — St. Michael's 47 — 2 — — — — — — St. Winefride's 83 17 — 195 106 3 — — — Silvertown 34 5 — 56 19 — — — — Totals 3,442 1,618 46 2,755 560 29 2,286 964 45 I.—Periodic inspection. R.—Re-inspection. S.—Special inspection. 84 Age Groups, General Condition, Co-operation of Parents. TABLE 50. Group Total inspected Parents present Requiring treatment General Condition. A B C No. % No. % No. % No. % No. % I. 2797 2645 90.9 700 25.0 1114 39.8 1616 57.8 67 2.4 II 1051 766 72.8 237 22.5 315 30.0 713 67.8 23 2.2 III 1271 323 25.4 225 17.7 700 55.1 562 44.2 9 0.7 Age 6- 7 645 614 95.1 120 18.6 205 31.8 427 66.2 13 2.0 Age 7- 8 1704 1433 84.0 388 22.7 563 33.0 1095 64.3 46 2.7 Age 12-13 1015 458 45.1 195 19.2 452 44.5 528 52.0 35 3.5 Totals 1949 8483 6239 73.5 1865 21.9 3349 39.5 4941 58.2 193 2.3 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 HANDICAPPED PUPILS. No special schools for the treatment of handicapped pupils are maintained by the Authority. Arrangements are made by the Chief Education Officer with schools outside the area for the admission of children as recommended. Under the provisions of Section 34 of the Education Act, 1944, *148 special examinations have been carried out by approved medical officers, as a result of which, 122 children, ascertained to be within the various categories, were recommended for special educational treatment as indicated in the following table:— TABLE 51. Category Number ascertained Recommendation Day Special School Boarding Special School Ordinary School with special treatment Blind — — — — Partially Sighted — — — — Deaf 3 3 — — Partially Deaf — — — — Delicate 20 — 20 — Diabetic — — — — Educationally Sub-normal 30 14 2 14 Epileptic 1 — 1 — Maladjusted 3 — 2 1 Physically Handicapped 10 6 4 — *Suffering from Speech Defect 55 — — 55 * Examinations of children with suspected speech defects are not included in the special examinations under this paragraph, but those requiring speech therapy are classified as Handicapped Pupils. 85 Sixteen cases were found to be subject to be dealt with under the provisions of Section 57 of the Act:— Recommended for report to the Mental Health Committee under the provisions of: Section 57 (3) 11 Section 57 (5) 5 MEDICAL TREATMENT. Summary of Defects treated at School Health Clinics. Skin: Ringworm 12 Scabies 9 Impetigo 34 Other Diseases 424 Eye Disease 122 Ear Defects 95 Other Defects 200 Total 896 Total attendances at School Health Clinics 14,150 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.B., D.L.O., who was for many years the Authority's Ear Nose and Throat Surgeon, continues to attend the Aural Clinic by arrangements with the Regional Hospital Board. Mr. Savege attends one session weekly. The following are the statistical details:— Number of clinic sessions 50 Number of children attending 467 Number of attendances 1,206 Number of children discharged 520 86 Defects and treatment: TABLE 52. Defect Number observed Number treated Referred for operation Discharged after treatment Tonsils and Adenoids 248 47 201 240 Other throat conditions 20 20 — 20 Deafness 54 54 — 42 Otitis Media and discharging ears 43 43 — 39 Other ear conditions 72 68 4 88 Nasal deformities 10 9 1 8 Rhinitis 16 16 — 14 Catarrh 26 26 — 26 Other nose conditions 46 46 — 49 Totals 535 329 200 526 Note:—Included in figures "Discharged after treatment" are some defects which remained under treatment at the end of 1948. Of the cases referred for operative treatment, 201 were for the removal of tonsils and adenoids, two for mastoidectomy and two for removal of polypi in the ear. The operations were performed by Mr. Savege at the Children's Hospital, Balaam Street. Ophthalmic Clinic. Mr. S. C. Reeve Flaxman, M.R.C.S., L.R.C.P., continued to attend the Ophthalmic Clinic on five sessions per fortnight until his illness at the end of October. Miss C. M. Fitzpatrick, M.B., B.Ch., B.A.O., is continuing the Work of the clinic in a temporary capacity until arrangements are concluded with the Regional Hospital Board. The Clinic is at present organised in accordance with the interim arrangements outlined in Circular 179/48. Statistics are as follows:— Number of clinic sessions 120 Number of children attending 1,898 Number of attendances 2,051 Number of children discharged 143 87 Defective Vision and Squint New cases 350 Re-examinations 939 Glasses prescribed 966 *Glasses obtained 597 Glasses not required 48 Referred to hospital 38 Eye Disease Treated at clinic 108 Referred to hospital 11 * Information from Local Executive Committee. The following cases Were referred to hospital for treatment:— Squint 38 Conjunctivitis 3 Cyst 2 Foreign body 1 Other conditions for investigation 4 Diphtheria Immunisation Clinic. Immunisation clinics are held weekly at the Town Hall Annexe and Manor Park. Every opportunity is taken during medical inspection at schools and in the course of School Health clinics, to impress upon the parents the efficacy of immunisation. The need for re-inoculation of children admitted to school for the first time is stressed by teachers and by the use of posters, leaflets, etc. The work of the clinics is shewn in the following summary:— Number of clinic sessions 141 Number of children completely immunised 328 Number of children re-inoculated 296 Percentage of children of school age completely immunised 65.3 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 13 Non-pulmonary 7 88 Physiotherapy and Light Clinic. Attendances continue to increase. Many forms of radiation and electrical treatment are now given for diverse conditions, together with massage, corrective and developmental exercise. Cases. Treatments. Artificial sunlight (General) 437 4,345 Local light 403 4,553 Electrical and massage 88 1,267 Remedial exercises 850 5,693 Total attendances— 9,487. The appointment of an Orthopaedic Consultant has not yet been made and, when necessary, cases are referred to general hospitals. Child Guidance Clinic. Dr. H. Bevan Jones reports as follows:— At the close of 1948 the Child Guidance Clinic was working in the Town Hall Annexe with a staff of two; a Psychiatrist and an Educational Psychologist who each put in two days a week on this work. The team had to operate without a Psychiatric Social Worker in spite of repeated attempts to secure one. At the beginning of 1949, two Psychiatrists were employed, each giving one day a week and except for this change, the service continued as in 1948 until mid-summer when the Clinic moved to the Child Guidance Centre at Shrewsbury Road School. A part of this school had been converted for the purpose so that there were four consulting rooms, a conference room, waiting room and office. The Speech Therapist took over the use of one of the consulting rooms for the Speech Clinic; a happy arrangement that is proving valuable to both clinics. One of the Psychiatrists had to reduce his clinical sessions, after mid-summer, but the Clinic was fortunate at the time to secure the services of a play therapist for a day a week. By the end of the year, the Clinic had obtained the services of a full-time Psychiatric Social Worker and was looking forward to functioning with a full team for the first time since its inception. A trend that is becoming evident in the work of the Clinic is for children to be referred at a younger age. This is a most desirable tendency as it is found that greater help can be given to 89 the younger child than to the older. A secondary school child showing a marked tendency towards delinquency is a difficult case to handle on a "once weekly" treatment basis and in many such cases a Clinic can act only in a diagnostic and advisory capacity. With younger children, however, not only is treatment more effective but advice and help to parents is much more efficacious often leading to a good adjustment before an otherwise almost irremediable situation is created. At the end of 1948, there were 28 cases that had not been seen. During the year 125 new cases were referred and 35 cases discharged. This resulted in the gradual building up of a long waiting list and by the end of the year, the average waiting time betweeen referral and being taken on for treatment was at least six months. In addition to this, the rate of referral itself was showing signs of increase. It seemed, therefore, that for 1950, the waiting time would still be long unless there were special grounds for giving priority. Dr. Bevan Jones attends on two sessions weekly and in addition the Authority has secured the part-time services of Dr. W. H. Craike, M.R.C.S., L.R.C.P., D.P.M., D.C.H., who commenced in February for two sessions weekly and since September has attended once each week. The appointment of Miss J. van Gorder, psychiatric social worker, who commenced duty early in the new year, and of Mrs. K. Barker, play therapist, who has attended for two sessions weekly since September, complete the staff team. 1. No. of sessions attended by Dr. H. Bevan Jones during 1949 99 2. No. of sessions attended by Dr. W. H. Craike during 1949 65 164 (Of the above total (164) two sessions were allocated to Mental Health and the remainder to Child Guidance.) 3. No. of cases under treatment on 1/1/49 55 4. No. of cases referred for treatment during 1949 125 90 5. No. in (4) who received treatment during 1949 85 6. No. of cases discharged or not requiring treatment, removals, etc., during the year 60 7. No. of cases under treatment on 31/12/49 80 8. Total attendance of C.G. cases at sessions attended by Psychiatrist during 1949 862 9. No. of cases seen by Psychologist 98 Attendances 206 10. No. of visits to schools by Psychologist 24 No. of pupils concerned 36 11. No. of sessions attended by Play Therapist 14 Attendances 86 Speech Therapy. Miss P. N. Glover, L.C.S.T., has been appointed as Speech Therapist and commenced duty in September. Following a survey of all schools, 232 children were examined by the Assistant Medical Officers and 155 referred to attend the Clinic. Up to the end of the year, the number of attendances at the Clinic was 264. 1. No. of Cases referred to Speech Therapist 155 2. No. of cases treated during 1949 52 3. No. of cases discharged during 1949 6 4. No. of cases waiting treatment on 31/12/49 149 5. Total attendances for treatment 264 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. 91 Operative treatment of tonsils and adenoids has been carried out as follows:— Children's Hospital, Balaam Street 378 Queen Mary's Hospital, Stratford 9 St. Mary's Hospital, Plaistow 30 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 287 Number of examinations 42,040 Number of pupils found unclean 1,053 Number of cleansing notices (Section 54 (2) ) 56 Number of cleansing orders (Section 54 (3) ) Very few cases requiring more than simple hygienic measures plus the use of a modern larvical preparation, have been encountered and the vigilance of the staff has resulted in a great overall reduction of head infestation in the school population. The follow-up system is being pursued and in certain instances effective treatment has been possible at the School Health Clinics. HOME VISITS BY SCHOOL NURSES. The nurses paid 8,012 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. DENTAL INSPECTION AND TREATMENT. Miss H. T. Smith, L.D.S., R.C.S., has submitted the following report on the Dental Service:— I have the honour to present my report on the Work carried out in the Dental Clinics during the year 1949. 92 During the first six months of the year, there were only two dental officers affording treatment for the school children and patients under the M. & C.W. Scheme. This resulted in the conservative treatment of teeth being relegated to second place while efforts were made to cope with pain and oral sepsis. The minimum number of dental officers required to carry out dental treatment efficiently in a Borough with approximately 15,000 school children is four. For nearly twelve months, therefore, the dental service was only 50 per cent, efficient. A new Dental Officer, Mrs. P. Osis, D.D.D. was appointed on 9th June, 1949. However, in spite of the many difficulties encountered during the year, 18,040 school children were inspected, of whom 7,777 were found to require treatment. The number actually treated was 6,057, an increase on the previous year. We have endeavoured to abide by the ideal of inspecting adolescent children twice during the year, as at that age they need constant dental attention. The demand for fillings increases year by year, as parents are now appreciating the value of this type of treatment. The number of permanent teeth filled was 2,539 and 155 fillings were inserted in temporary teeth. These figures show a slight decrease on the previous year, owing to the shortage of staff. Those parents interested in orthodontic treatment were advised on the correct method of treating the condition, and the more difficult cases were referred to hospital. During the year 70 permanent teeth were extracted to facilitate treatment. Many children have accidents involving damage to upper front permanent teeth. These teeth can be restored to full function and the appearance made normal again by crowning. Twenty of these cases were referred to hospital for this type of treatment. Details of all figures may be found in Table IV returns to the Ministry of Education (see Table 57). The School Dental Service has achieved some prominence recently owing to the drift of dental officers into private practice. In some areas the service has completely collapsed. East Ham may be considered fortunate that they have been able to carry on the service, although in a reduced capacity. 98 MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. 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). TABLE 54 Group For defective vision (excluding squint) For any of the other conditions recorded in Table 55A Total individual pupils Entrants 13 690 700 Second age group 52 196 237 Third age group 73 158 225 Total (prescribed groups) 138 1,044 1,162 Other periodic inspections 184 534 703 Grand Total 322 1,578 1,865 TABLE 53. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 2,797 Second age group 1,051 Third age group 1,271 Total 5,119 Number of other Periodic Inspections 3,364 Grand Total 8,483 B.—Other Inspections. Number of Special Inspections 4,590 Number of Re-inspections 8,658 Total 13,248 94 TABLE 55. A.—Return of Defects found by Medical Inspection in the year ended 31st December 1949. 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 151 17 564 27 Eyes—a. Vision 322 117 188 138 b. Squint 52 28 41 43 c. Other 74 10 231 27 Ears—a. Hearing 26 12 32 11 b. Otitis Media 22 12 26 7 c. Other 20 7 107 18 Nose or Throat 425 528 491 266 Speech 22 24 49 27 Cervical Glands 14 49 34 29 Heart and Circulation 28 20 9 87 Lungs 91 86 17 66 Developmental— a. Hernia 9 3 4 8 b. Other 32 26 9 32 Orthopaedic— a. Posture 82 37 18 44 b. Flat Foot 210 50 90 52 c. Other 203 87 79 64 Nervous system— a. Epilepsy 12 6 8 7 b. Other 23 25 55 29 Psychological— a. Development 7 13 13 14 b. Stability 9 11 23 15 Other 309 171 1,330 332 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. % No. % No. % Entrants 2,797 1,114 39.8 1,616 57.8 67 2.4 Second age group 1,051 315 30.0 713 67.8 23 2.2 Third age group 1,271 700 55.1 562 44.2 9 0.7 Other Periodic Inspections 3,364 1,220 36.3 2,050 60.9 94 2.8 Total 8,483 3,349 39.5 4,941 58.2 193 2.3 95 TABLE 56. 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 2 Ringworm—Body 16 Scabies 20 Impetigo 34 Other skin diseases 476 Eye Disease—external and other but excluding errors of refraction, squint and cases admitted to hospital 347 Ear Defects—excluding treatment for serious diseases (operative treatment in hospital) which are recorded in the body of the Report 164 Miscellaneous (minor injuries, bruises, sores, chilblains, etc.) Other conditions not classifiable under the above headings 245 2,544 Total 3,848 (b) Total number of attendances at Authority's minor ailment clinics 14,150 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) 1,416 Other defect or disease of the eyes (excluding those recorded in Group I) 108 Total 1,524 Number of Pupils for whom spectacles were: (a) Prescribed 966 (b) Obtained* 597 * Information received from the East Ham Executive Council, 96 GROUP III.—Treatment of Defects of Nose and Throat. Total number treated. Received operative treatment: (a) for adenoids and chronic tonsillitis 417 (b) for other nose and throat conditions 3 Received other forms of treatment 175 Total 595 GROUP IV.—Orthopaedic and Postural Defects. (a) Number treated as in-patients in hospitals or hospital schools (b) Number treated otherwise, e.g. in clinics or outpatients departments 462 GROUP V.—Child Guidance Treatment and Speech Therapy. Number of pupils treated: (a) under Child Guidance arrangements 148 (b) under Speech Therapy arrangements 55 TABLE 57. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Authority's Dental Officers:— (a) Periodic age groups 18,040 (b) Specials 1,634 (c) TOTAL (Periodic and Specials) 19,674 (2) Number found to require treatment 7,777 (3) Number actually treated 6,057 (4) Attendances made by pupils for treatment 8,208 (5) Half-days devoted to:— (a) Inspection 133 (b) Treatment 945 Total (a) and (b) 1,078 97 (6) Fillings: Permanent teeth 2,539 Temporary teeth 155 Total 2,694 (7) Extractions: Permanent teeth 863 Temporary teeth 7,801 Total 8,664 (8) Administration of general anaesthetics for extraction 1,183 (9) Other Operations: (a) Permanent teeth 946 (b) Temporary teeth 1,147 Total (a) and (b) 2,093 TABLE 58. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorised persons 42,040 (ii) Total number of individual pupils found to be infested 1,053 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 56 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944)