EAS 27 LIBRARY COUNTY BOROUGH OF EAST HAM ANNUAL REPORT of the Medical Officer of Health and School Medical Officer For the Year 1950 JOHN S. COLEMAN, m.b., b.s. (lond.) m.r.c.s. (eng.) l.r.c.p. (lond.), d.p.h. (eng.) Medical Officer of Health & School Medical Officer. COUNTY BOROUGH OF EAST HAM ANNUAL REPORT of the Medical Officer of Health and School Medical Officer For the Year 1950 JOHN S. COLEMAN, m.b., b.s. (lond.) m.r.c.s. (eng.) l.r.c.p. (lond.), d.p.h. (eng.) Medical Officer of Health & School Medical Officer. PRINCIPAL CONTENTS. SECTIONS PAGES Constitution of Council 3 Public Health Staff 5 Introduction 8 Statistical and Social Conditions of Area 10 General Provision of Health Services 19 Infectious Diseases 23 National Health Service Act, 1946 Sec. 22 Care of Mothers and Young Children 35 Sec. 23 Midwifery Services 43 Sec. 24 Health Visiting Services 46 Sec. 25 Home Nursing Services 47 Sec. 26 Vaccination and Immunisation 50 Sec. 27 Ambulance Services 52 Sec. 28 Prevention of Illness, Care and After-Care 54 Sec. 28 & 51 Metal Health Services 58 Sec. 29 Home Help Services 63 Sanitary Section and Housing 64 Inspection and Supervision of Food 70 School Health Service Introduction 75 Report 7 3 east hapi corporation COUNCIL (shewing Chairmen and Vice-Chairmen of Health, M„ & C. W., Mental Health and Education Committees) THE MAYOR: Mr. Alderman John Albert Hart, J„P. THE DEPUTY MAYOR: Mr. Alderman Sydney Arnold Elson. ALDERMEN: Mr. Charles William Bradlng, J.P., C.R.P. Mr. Charles William Dixon, (4) Mr. Richard John Fell, Mr. Walter Edwin Hurford, Mr. Herbert Percy Jackson, J.P., (5) Mr. Thomas Irwin Lethaby, J.P., (2) Mr. Frederick. Welch, Mr. Ernest Albert Wood, J.P., COUNCILLORS: Mr. Robert Cecil Beadle, Mr. William Henry Whittock Beecham, Mr. Leslie Alfred Victor Bennett, (1) Mr. Joseph John Gillard Bishop, Mrs. Agnes Ann Bradshaw, (6) Mr. Charles Frederick Chapman, Mr. Frederick George Pryce Clayton, Mrs. Daisy May Davey, Mr. Edwin John Davey, Mrs. Elsie Mary Devenay, Mr. Eric Edward Thomas Digby, Mr. William Doran, Mrs. Eleanor Mary Fell, Mr. James Fenner, Mr. Francis William French, (3) Mrs. Florence Matilda Goodchild, Mr. Leonard Lewis Griffiths, Mr. Henry Joseph Hooper, Mr. Frank Herbert Howard, Mr. William Innes Jackson, J.P., Mr. Thomas Alfred Jenkinson, Mr. John Alfred Kemp, Mrs. Winifred May Knight, Mr. Arthur Richard Miller, Mr. Arthur George Murrell Qakes, Mr. Alfred Prior, J.P., Mr. Frank Owen Reynolds, Mrs. Lily Sutton, Mr. James Ernest Taylor, Mr. Ralph Reginald Turville. Co-opted members of the Health, M, & C. W., Mental Health and Education Committees Dr. 0. Thomas Mr. L. A. Wyborn. Health. k Mrs. B. A. Dixon ) Mrs. M. Page ) Maternity Alderman Mrs. D. Parsons, J.P., ) and Mrs. C. Robertson, ) Child Mrs. Ac A. Woodman, M.B.E. ) Welfare Mrs. Co Boar ) Mr. W. A. Cole ) Mental Mr. H. F. McNeil ) Health Rt. Rev. Monslgnor W. O'Grady ) Mr. G. W. Aherne ) Mrs. M. E. Bennett ) Mr. L. A. Matthews ) Education Mr. R. Ricketts ) Mr. L. S. J. Witter, B.Sc. ) (1) Chairman, Health Committee (2) Vice-Chairman, Health Committee (3) Chairman, Maternity & Child Welfare Sub-Committee (4) Chairman, Mental Health Sub-Committee (5) Chairman, Education Committee (6) Vice-Chairman, Education Committee 5 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 (to 5.8.50) J. S. COLEMAN, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health and School Medical Officer (as from 6.8.50) 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. 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. D. E. CULLINGTON, M.A., M.B., CH.B., M.R.C.S., L.R.C.P., Assistant Medical Officer. GERALDINE O'CALLAGHAN, M.B., Ch.B., B.A.O., D.P.H., Assistant Medical Officer. Medical - part-time. 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. Miss C. M. FITCHPATRICK, M.B., Ch.B., B.A.O., D.O.M.S., Ophthalmic Surgeon J. B. O'MAHONEY, L.R.C.P & S.E., D.L.O. Ophthalmic Surgeon. R. A. MORRIS, M.R.C.S., L.R.C.P., D.O.M.S. Ophthalmic Surgeon. 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. C. Sanitary and Food Inspectors :- R. A. BASKETT, B.E.M., M.S.I.A., Chief Sanitary Inspector, Food and Shops Act Inspector. 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. E. A. BLOOMFIELD, M.S.I.A., A.R.S.I. J. H. RILEY, M.S.I.A. F. W. REEVE, M.S.I.A. H. F. WILLIAMS, M.S.I.A., M.R.S.I. G. A. HAGEDORN, M.S.I.A. Shop Acts Inspector :- T. GILBERT. D. Nursing Staff :- Superintendent Health Visitor B. L. MARYON, S.R.N., S.C.M., H.V..'s Cert. (R.S.I.) 6 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.). 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.). V. WILDBORE, S.R.N. S.C.M., H.V.'s Cert. S. P. BREEN, S.R.N., S.C.M. (Part 1) H.V.'s. Cert. E. M, PHILLIPS, S.R.N. S.C.M., H.V.'s. Cert. E. M. ABRAHAM, S.R.N., S.C.M., H.V.'s. Cert. 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. E. F. M. BOSS, S.R.N., M.S.R., C.S.P. 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,). G. M. GRANT, S.R.N., T.A. (Cert.). S, T. ROBERTS, S.R.N., S.C.M., Municipal Midwives :M. LAW, S.C.M. M. E. KINSELLA, S.R.N., S.C.M. 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, NARBOROUGH, 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. D. 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. 7 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. B. J. 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. P. J. ASPINALL and Temporary Staff. Female Clerks M. A. R. GASTER. F. C. WELLS. J. MACKINTOSH. B. H. WHITE. F. M. CLARK. L. L. CUNDALL. S. A. MOSS. J. S. WOOD. and Temporary Staff. Commenced during year. Retired during year. Terminated during year. Deceased during year. 8 COUNTY BOROUGH OF EAST HAM Public Health Department, Town Hall Annexe, E.6. July, 1951. TO THE WORSHIPFUL THE MAYOR, THE ALDERMEN AND COUNCILLORS OF THE COUNTY BOROUGH OF EAST HAM, MR, MAYOR, LADIES AND GENTLEMEN, I have the honour to present for the first time since my appointment as Medical Officer of Health and School Medical Officer, the Annual Report on the health of the Borough. In so doing, I reflect on the changed and changing nature of the office of Medical Officer of Health since the enactment of the National Health Service Act and comment on certain trend? in the application of medical knowledge to the practice of individual and community care. The health of the community has remained good, no serious epidemic has occurred, and in no disease does our morbidity or mortality rate exceed the average of 126 County Boroughs and Great Towns including London. Details of the various service may be found in the body of the report Together with epidemiological and morbidity statistics,, Statistical analysis shows no change in the population, 121,900, with a small decline in the number of births and steady increase in the survival rate for males and females over the age of 60 years. This survival of an aging population follows the trend noted in most parts of the country, and whether the care of the aged is regarded as a family responsibility or a community problem it is our duty to ensure that every aged person receives a measure of care, comfort and tranquility. The steady decline in the birth rate must be viewed with some concern, for better education and benevolent legislation in a "Welfare State" have created as never before conditions eminently suited to the rearing of healthy children. High taxation can be borne, and the shadow of war will pass away, but the immediate need to house young married couples Is so pressing that in my opinion we should revise our methods of allocation of new dwellings, Our present practice is sowing the seeds of mental, illness which will reap for our people a distressful harvest of neurotics and psychotics to swell the hordes that must be treated in mental hospitals and burden the national effort in the industrial field. The number of persons suffering mental illness shows a small increase, but this small Increase is of significance considered side by side with the shorter stay of cases in hospital and the greatly improved methods of treatment now available. Similarly, the increase in the number of mental defectives points to the national and universal need to pursue with increased vigour the causes of mental deficiency and to root out those social and biological evils which are known to hold back family and community well-being. A start has already been made in the application of the knowledge gained of the relation of German Measles, and the Rhesus Factor In the mother, to the production of mental defectiveness in her child. But a greater surge forward is needed to acquire the scientific information which points the chemical, physical, biological and environmental reasons for the 9 genesis of defectiveness and how to eliminate it from our communities. Meanwhile, we must do all we can to alleviate the distress and guilt feelings which tend to overwhelm the parents of defectives, and educate individuals and families in environmental hygiene and mental health, to form proper person relationships and to prevent mental and emotional stresses which may lead to breakdown. This useful work should be started in the maternity and child welfare clinics and, pursued successfully in our schools, could make a useful contribution in the application of preventive medicine to a medico-social evil. We should not dissipate our energies by striving to regain the therapeutic services that we have lost to the Regional Hospital Boards. Rather should we concentrate on those preventive aspects of community and environmental hygiene which have won golden opinions for the Public Health services in the past and will gain for us equal success in the mental health field in the future. To this generalisation one exception could boldly be asserted. The control of the "Chest Clinic" by the Regional Hospital Board has created difficulties in the carrying out of preventive measures in tuberculosis. The medical staff come under the administrative control of the Board, the nurses remain the responsibility of the Local Authority. This anomaly Is overcome by good relations and co-operation with the able Chest Clinic staff, but the fact remains, the therapeutic, radiological and general diagnostic work of the Clinic can hardly meet the heavy demands of the practitioners in the area, and little remains in effort and opportunity and even working space, to devote to preventive tuberculosis. In my opinion this is a grave error of policy. The diagnostic and therapeutic aspects of tuberculosis could be dealt with adequately in the out-patient departments and wards of general and special hospitals and sanatoria. The prophylactic, educational and community aspects of this disease surely should be centred in the "Chest Clinic" free from the trammels of dichotomized administration, and under the control of the medico-social specialist, the Medical Officer of Health. During the greater part of 1950 I was without the assistance of a Deputy and I owe to the Council and to the Chairman of the Health Committee and the Sub-Committees my grateful thanks for the consideration and painstaking study they have given to the many problems set before them. To my colleagues in other Departments for their advice and willing co-operation, to.my Chief Clerk Mr. T.B. Clark, who has prepared the statistical sections of this report and all members of my staff for their loyalty and industry, I tender my grateful thanks for a year's work which I hope will prove productive of good to the burgesses of East Ham. I have the honour to be, Mr. Mayor, Ladles and Gentlemen, Your obedient Servant, J. S. COLEMAN, Medical Officer of Health. 10 STATISTICAL AND SOCIAL CONDITIONS OF THE AREA SOCIAL, Area (In statute acres) land and water 3,324 Population. Census 1931 142,394 Estimated civilian population 1950 121,900 Number of inhabited houses (end of 1950 according to rate books) (including tenements and shops) 33,513 Rateable value at 31st December, 1950 £761,003 Sum represented by a penny rate for the year 1950 £3,094 Excludes factories, cinemas, government properties, corporation properties (offices and works), utility undertakings and other miscellaneous heriditaments not actually occupied as dwellings. EXTRACTS FROM VITAL STATISTICS. Total Males Females Live births ( Legitimate 1,689 878 811 ( Illegitimate 64 32 32 Still births ( Legitimate 44 27 17 ( Illegitimate 2 1 1 Deaths - Total 1,304. Males 66.3. Females 641. Deaths from Puerperal causes;- Deaths Rate per 1,000 Total (Live and Still) Births Puerperal Sepsis - - Other Maternal Causes 1 0.571 Total 1 0.571 Deaths of infants under one year of age All Infants per 1,000 live births 25 Legitimate infants per 1,000 legitimate live births 24 Illegitimate infants per 1,000 illegitimate live births 62 Deaths from Cancer (all ages) 239 Deaths from Measles (all ages) - Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years) 2 11 STILLBIRTHS. The number of still births registered was 46 compared with 48 for the previous year. The rate per 1,000 total (live and still) births was 25.5 the figure for 1949 being 24.2. The still birth mortality rates for England and Wales and East Ham are shewn In the following table:- TABLE 1 Still births per 1,000 population. 1945 1946 1947 1948 1949 1950 England and Wales 0.46 0.53 0.50 0.42 0.39 0.37 East Ham 0.53 0.56 0.51 0.38 0.39 0.37 The rates for East Ham per 1,000 total (live and still) births for the past five years are Indicated below t- 1946 1947 1948 1949 1950 No. of still births 64 61 46 48 46 Rate per 1,000 total births 24.2 21.06 20.5 24.2 25.5 BIRTHS. The number of live births registered was 1,753, as compared with 1934 for the year 1948, equivalent to a birth rate of 14.4 per 1,000 of the population - the figure for the previous year - 15.8. A comparison of the statistics for the period since 1946 is appended below :- 1946 1947 1948 1949 1950 No. of Births (East Ham) 2,577 2,835 2,194 1,934 1,753 Birth rate (East Ham) 22.69 23.8 18.1 15.8 14.4 Birth rate (England & Wales) 19.1 20.5 17.9 16.7 15.8 DEATHS. The number of deaths of residents dying within or without the district was 1,304 as compared with l,342 for the year 1949. The death rate per 1,000 of the population was 10.7, that for the previous year being 11.0. Of the total deaths, 554 or 42 per cent died in institutions. The number of residents who died outside the area and whose deaths were assigned to the Borough was 534. 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. F. M. F. M. F. M. F M. F. 27 10 1 5 5 1 5 4 12 11 18 26 45-55 years 55-65 years 65-75 years 75-85 years 85-95 years 95 & over M. F. M. F. M. F. F. F. M F. 66 20 128 80 201 175 163 214 36 76 1 3 12 13 The crude death rare was 10.7. The Registrar-General has now again supplied an area comparability factor and that for East Ham is 1.04. The corrected death rate is, therefore, the crude death rate (10.7) multiplied by 1.04 - 11.13. For the period 1945- 1949 the death rates for England and Wales and East Ham are compared :- 1946 1947 1948 1949 1950 England and Wales 11.5 12.0 10.8 11.7 11.6 East Ham 10.6 11.79 9.67 11.55 11.13 Reference to table 3 will shew a different classification of the deaths occurring in 1950 from that of previous years, such changes in practice arise from the implementation of the World Health Organisation Nomenclature Regulations 1948. It is important to note that 1950 deaths include "non civilians" which were not included previously. INFANTILE MORTALITY. Deaths of Infants under one year numbered 45 - equivalent to an infant mortality rate of 25 per 1,000 live births, the rate for the previous year was 24. The rate for England and Wales for 1950 was 29.8. The number of deaths of illegitimate children under one year of age was 4 out of a total of 64 Illegitimate live births, giving a mortality rate of 62 as compared with a figure of 30 per 1,000 Illegitimate live births for the year 1949. The infantile mortality rates since 1946 are as follows :- 1946 1947 1948 1949 1950 England and Wales 43 41 34 32 29.8 East Ham 30 30 26 24 25 Illegitimate births and mortality rates for the Borough since 1946 are tabulated below 1946 1947 1948 .1949 1950 No. of Illegitimate births 108 102. 65 65 64 Mortality rate per 1,000 illegitimate live births 18 49 15 30 62 NEO-NATAL MORTALITY Children dying under the age of one month totalled 29, equal to a neo-natal mortality rate of 16.6 per 1,000 live births. These rates from 1946 - 1950 are compared below :- 1946 1947 1948 1949 1950 19. 17.6 14.5 14.9 16.6 The causes of death of these children under one month of age were as follows :- Cause. No. of Deaths Pneumonia 4 Diarrhoea and Enteritis - Premature Births 17 Congenital Malformations, Birth Injury, Infantile Diseases 6 Other causes 2 Total 29 14 15 maternal mortality The number of maternal deaths was 1, the maternal mortality rate per 1,000 live and still births for 1550 was 0.571. POPULATION The Registrar-General's estimate of the population at the 30th June, 1950, was 121,900 as compared with 122,000 for the previous year. The rates per 1,000 of the population mentioned in this report are based on this estimate. TABLE 2. BIRTH RATE, DEATH RATE AMD ANALYSIS OF MORTALITY, 1950. Rate per 1,000 Population Annual Death Rates per 1,000 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 1 Smallpox Tuberculosis Total Deaths under one year Deaths £rom Diarrhoea and Enteritis (under 2 years) England and Wales +15.8 +0.37 +11.6 0.00 0.02 0.46 0.01 0.00 0.10 - 0.36 29.8 1.9 126 County Boroughs and Great Towns, including London 17.6 0.45 12.3 0.00 0.02 0.49 0.01 0.00 0.09 - 0.42 33.8 2.2 148 Smaller Toms (resident populations 25,000 to 50,,000 at Census, 1931) 16.7 0.38 11.6 0.00 0.02 0.45 0.01 0.00 0.10 - 0.33 29.4 1.6 London - Administrative County 17.8 0.36 11.8 0.00 0.01 O.48 0.01 0.00 0.07 - 0.39 26.3 1.0 East. Ham 14.3 0.37 11.13 - 0.00 0.40 0.01 - 0.06 - 0.29 25 1.1 Rates per 1,000 total population Per l,000 related births. A dash (-) signifies there were no deaths. 16 17 TABLE 3. CAUSES OF DEATH IN AGE GROUPS 1950 Deaths at different periods of life of residents (including non-civilians) whether occurring within or without the district All Ages Under 1 Year 1-5 Years 5-15 Years 15 - 25 Years 25 - h5 Years 45 " 65 Years 65 - 75 Years Over 75 Years Total deaths In Institution M F M F M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratory 20 13 - 1 - - - - - 2 - 4 12 3 6 2 2 1 6 5 2. Tuberculosis, other forms 2 1 - - - - - - - 1 2 - - - - - - - 2 1 3. Syphilitic Disease 8 5 - - - - - - - - 1 - 4 1 3 1 - 3 4 - 4. Diphtheria - - - - - - - - - - - - - - - - - - - - 5. Whooping Cough 1 1 1 1 - - - - - - - - - - - - - - l 1 6. Meningococcal Infections - - - - - - - - - - - - - - - - - - - - 7. Acute Poliomyelitis - 1 - - - - - - - - - 1 - - - - - - - 1 8. Measles - - - - - - - - - - - - - - - - - - - - 9. Other Infective and Parasitic Diseases 1 - — - - - - - - - - - l - - - - - - - 10. Malignant Neoplasm, Stomach 22 15 - - - - - - - - 1 - 7 6 10 3 4 6 12 5 11. Malignant Neoplasm, Lung, Bronchus 38 9 - - - - - - - - - - 24 1 11 3 3 5 26 6 12. Malignant Neoplasm, Breast - 24 - - - - - - - - - 2 - 7 - 11 - 4 - 12 13. Malignant Neoplasm, Uterus - 11 - - - - - - - - - 1 - 6 - 3 - l - 6 14. Other Malignant & Lymphatic Neoplasms 60 60 - - - - - - - - 4 4 21 16 27 20 8 20 28 27 15. Leucaemia, Aleukeamia 5 4 - - - 1 1 - - - l - 1 3 2 - - - 5 4 16. Diabetes 3 5 - - - - - - - - - - - 2 2 2 1 1 1 3 17. Vascular Lesions of the Nervous System 64 110 1 - - - - - - - 2 - 10 14 29 41 22 55 21 44 18. Coronary Disease Angina 92 52 - - - - - - - - - 1 36 7 32 19 24 25 27 16 19. Hypertension with Heart Disease 19 29 - - - - - - - - 1 2 4 6 8 8 6 13 8 9 20. Other Heart Disease 116 145 - - - - - - - - 3 7 21 10 28 34 64 94 35 56 21. Other Circulatory Disease 21 18 - - - - - - - - - 1 4 2 4 3 13 12 8 7 22. Influenza 5 3 - - - - - - - - - 2 l - 1 1 3 - 1 1 23. Pneumonia 24 25 5 2 - 1 1 1 - - 1 2 6 1 - 10 11 8 15 16 24. Bronchitis 59 23 - - - - - - - - - - 17 4 21 3 21 16 11 1 25. Other Diseases of Respiratory System 7 8 - - - 1 - - - - 2 2 2 l 3 - - 4 6 3 26. Ulcer of Stomach and Duodenum. 12 4 - - - - - - - - - - 8 - 1 2 3 2 5 3 27. Gastritis, Enteritis and Diarrhoea 3 3 - 1 1 - - - - - - - - l - - 2 1 1 1 28. Nephritis and Nephrosis 12 5 - - - - 1 - 1 - 2 1 3 3 1 - 4 1 6 3 29. Hyperplasia of Prostate 4 - - - - - - - - - - - 1 - 1 - 2 - 1 30. Pregnancy, Childbirth, Abortion - 1 - - - - - - - - - 1 - - - - - - l 31. Congenital Malformations 8 2 5 2 - - - - - - 1 - 2 - - - - - 8 2 32. Other Defined and 111 Defined Diseases 38 52 15 10 - i 2 - 2 1 3 5 3 10 7 8 6 17 32 34 33. Motor Vehicle Accidents 3 - - - - - - - 1 - - - 2 - - - 3 - 34. All Other Accidents 8 8 - - - 1 - - 1 - 1 - 2 2 3 1 1 4 2 6 35. Suicide 8 3 - - - - - - - - 5 1 2 2 1 - - - 3 2 36. Homicide and Operations of War - 1 - 1 — - ~ - - - - — — - — — - - - — TOTALS 663 641 27 18 1 5 5 1 5 u 30 37 194 108 201 175 200 293 278 276 TABLE 4. INFANT DEATHS UNDER ONE YEAR OF AGE, 1950. 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 Tuberculosis, Respiratory 1 - - - - - - - - - - - - - - - 1 - 1 Whooping Cough 2 - - - - - - - - 1 - - - - - - 1 1 1 Measles - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - - - Pneumonia 7 1 - - 1 - - - 1 2 - 2 - - - - - 5 2 Enteritis 1 - - - - - - - - - - - 1 - - - - - 1 Congenital Malformation 7 2 1 - - - - - - 1 - 1 - 1 1 - - 5 2 Premature Births 17 8 8 1 - - - - - - - - - - - - - 9 8 Other Causes 10 5 1 - - - - - - 1 - 1 2 - - - - 7 3 TOTALS 45 16 10 1 1 - - - 1 5 - 4 3 1 1 - 2 27 18 18 19 GENERAL PROVISION OF HEALTH SERVICES. MIDWIVES ACTS, 1902 - 1950. The number of midwlves who notified their intention to practise in East Ham during the 13 months ending 31/1/51 was 33 - of these 19 also indicated that they would act as Maternity Nurses. Of the 33, 11 worked in connection with the Maternity Hospital and District Nurses' Home, Plalstow, and its branches - 2 at Sir Henry Tate Nurses' Home, Sllvertown - 12 at East Ham Memorial Hospital - and 8 practised Independently, Including 6 Municipal Midwives and the Supervisor of Midwives, who is also the Superintendent Nursing Officer. PLAISTOW MATERNITY HOSPITAL AND DISTRICT NURSES' HOME. Summary of cases, 1950 Midwifery 161 Monthly 55 Hospital 167 SILVERTOWN & NORTH WOOLWICH DISTRICT NURSING ASSOCIATION. Midwifery 7 Maternity Nursing 2 CLINICS AND TREATMENT CENTRES. With the exception of North Woolwich these are all provided by the Council. The sessions at the Centres (as on 31/12/50) were as follows :- 20 TABLE 5. - CLINICS AND TREATMENT CENTRES. Situation Purpose used Sessions Town Hall Annexe General Clinic (Minor Ailment cases) Monday, Wednesday and Saturday 9.30 a.m. Tuesday 2 p.m. Immunization Clinic 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 9.30 a.m. Alternate Thursdays 9.30 a.m. Toddlers' Clinic Tuesday 10 a.m. and Wednesday 2 p.m. Ear Clinic Ante-Natal Clinic (and Post-Natal) Friday 2 p.m. 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. By arrangement with L.C.C. 21 VENEREAL DISEASES. The following statistics have been abstracted from copies of form V.D.(R) (1950), which have been received from the Hospitals named and total figures for 1949 and 1948 are also shewn Patients dealt with for the first time during 1950 Other Syphilis Gonorrhoea Conditions Total Whitechapel Clinic, London Hospital Queen Mary's Hospital, Stratford 8 18 98 124 E. 15 10 1 25 36 St. Thomas' Hospital, S.E.I. 1 - 1 2 Albert Dock Hospital 4 4 4 12 Totals 23 23 128 174 Totals for 1948 20 23 145 205 Totals for 1949 31 33 158 222 — — — _ ALDERSBROOK HOMES AM) SCATTERED HOMES. The statistics for the year 1950 are appended 1. Average number in homes throughout the year 432 2. No. chargeable to East Ham on 1/1/50 110 3. No. chargeable to East Ham on 31/12/50 102 4. Average weekly admissions 10 5. Average weekly discharges 11 The high level of medical care provided for the children, both in Aldersbrook and the scattered homes, has been maintained throughout the year. Study of the bi-monthly reports submitted to the Children's Committee indicates that the incidence of sickness among the children and staff does not exceed that in the community generally, and when one considers the initial handicaps of neglect under which many of these children labour, the medical picture takes on a brighter hue. The Essex County Council and the County Borough of West Ham have steadily pursued their policy of removing children from the homes and placing them in foster homes or Institutions under their own control, but obviously It will be several years before full implementation of this policy is possible. Meanwhile efforts must be made to appraise anew the sociological problems involved in the mass care of children, apart from their physical welfare. On all sides it is agreed that preoccupation with the latter can blunt the effort expended on Individual development and social readjustment that is so often necessary before some of these children can be returned to domestic and community life. It is recognised that many new admissions are children emotionally disturbed to varying degree, and rapidly to form new and harmonious relationships to a large group is for them a heavy added burden, difficult and often Impossible to bear without understanding and support from the staff. 22 Many members of the staff have a deep understanding of these problems and do not spare themselves to make the lives of these youngsters as tranquil and happy as is humanly possible. The appointment of married couples, trained and experienced in the handling of children deprived of a normal home life, is an experiment that will be observed with hopeful expectation, for parent surrogates to comparative large groups do not seem psychologically possible. Hitherto this work has been done exclusively by Charge Nurses and female staff,, With the nursery children too,, the Home Office have suggested the establishment of small groups, each 6 or 8 in number, embodying children of different age and sex and including one or two babies and one bigger girl of 11 or 12 years. To each group, constituted in this way, one nurse (with one relief) would be allocated so that the handling of the children would always be done by the same person and the whole group in its social behaviour would approximate as near as possible to a family. This fragmentation of the nursery might contribute much to the development of the younger infants in their first 2 or 3 years, in that a "mother figure" could exist for the little ones who need this anchorage for normal emotional, physical and psychological development. The present system of ward or room care by a "staff" who come and go according to a prepared rota is confusing to infants and militates against the natural march of their full physical and mental development. The experiment may be costly in that more skilled staff will be needed, but if the foundations of a better life are laid for some of these Infants the expense will count for little against the saving in mental ill health, which so often arises from unloved frustrated childhood. Just as the infra-red camera is used from a great height to trace out the ancient path through an overgrown field, so those responsible for the welfare and nurture of these children should sometimes stand a little apart and view synoptically and with an understanding eye, the life of the institution child tethered with the tares of time-worn legislation and stunted by the Inflexible fumbling fingers of those who fashion his future. SCABIES AND TREATMENT CENTRE. Owing to the small number of cases attending this Centre, the Council decided (vide Minute No. 611) at it's meeting held on 26/9/50, to close the centre temporarily, with the proviso that the Chairman of the Health Committee be empowered to authorise its re-opening if necessary. The number of patients attending for the past five years 1946 1947 1948 1949 1930 (part year only) 237 77 67 46 52 23 INFECTIOUS DISEASES. The quarterly returns to the Registrar-General were as follows :- Disease Qtr. ending 31/3/50 Qtr. ending 30/6/50 Qtr. ending 30/9/50 Qtr. ending 31/12/50 Total Scarlet Fever 111 74 47 38 270 Whooping Cough 18 80 374 555 1027 Acue Poliomyelitis - - 6 4 10 Measles 180 564 114 130 988 Diphtheria - - 1 - 1 Pneumonia 17 10 6 8 41 Dysentery 10 - - - 10 Typhoid Fever 1 - 1 1 3 Paratyphoid Fever - - - 1 1 Erysipelas 9 4 4 4 21 Meningococcal Infection - 1 - - 1 Food Poisoning - - 5 - 5 Puerperal Pyrexia 2 1 - - 3 Ophthalmia Neonatorum - 2 - - 2 Of the ten oases notified and subsequently diagnosed as poliomyelitis, 8 were paralytic and 2 non-paralytic. It will be noted that 10 cases of dysentery were notified during the first quarter. Of this number 9 occurred in the East Ham Memorial Hospital. A report on the food poisoning cases will be found on page 32. In respect of the typhoid fever notifications, one patient arrived from Australia a few days before case diagnosed in Hospital, another was admitted to hospital with enteritis and the third was notified direct from hospital. The paratyphoid case was in hospital one month with kidney disease and was due to be discharged when diagnosis made. Whooping Cough and Measles followed the trend throughout the country. The deaths from the seven principal zymotic diseases (Smallpox, Whooping Cough, Meales, Diphtheria, Diarrhoea, Scarlet Fever and Enteric Fever) numbered 4, as compared with 6 for the previous year and 7 for 1948. The zymotic death rate was 0.032 per 1,000 population as compared with a rate of 0.049 for 1949. No eases of smallpox were reported. In the following table the notification rates for 1950 per 1,000 population are shewn :- 24 TABLE 6. 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 Typhoid Fever 0.00 0.00 0.00 0.01 0.02 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Meningococcal Infection 0.03 0.03 0.02 0.03 0.00 Scarlet Fever 1.50 1.56 1.61 1.23 2.21 Whooping Cough 3.60 3.97 3.15 3.21 8.42 Diphtheria 0.02 0.03 0.02 0.03 0.00 Erysipelas 0.17 0.19 0.16 0.17 0.17 Smallpox 0.00 0.00 - - - Measles 8.39 8.76 8.36 6.57 8.10 Pneumonia 0.70 0.77 0.61 0.50 0.33 Acute Poliomyelitis (Including Polioencephalitis Paralytic 0.13 0.12 0.11 0.08 0.06 Non-Paralyt1c 0.05 0.05 0.06 0.05 0.01 Food Poisoning 0.17 0.16 0.14 0.25 0.04 25 TABLE 7. - PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notified Cases for Year ended 31/12/50. DISEASE Cases notified In whole district. Ward Distribution of Cases. No. of Cases removed to Hospital Total Deaths. At all ages - years. Manor Park Little Ilford Woodgrange Plashet Kensington Castle Central . . Wall End Greatfield South At all ages UaJ der 1 1 to 5 5 to 10 10 to 15 15 to 20 ; 20 i to 1.35 35 to 45 45 to 65 65 and Up Scarlet Fever 270 1 110 122 22 5 8 1 1 - 28 33 14 15 24 26 28 37 20 45 156 - Diphtheria 1 - - 1 - - - - - - - - - - - - - 1 - 1 - Erysipelas 21 - - - 1 - 4 7 9 - 3 2 - - - 2 1 3 4 6 3 - Puerperal Pyrexia 3 - - - - - 3 - - - - - - 1 - 1 - - - 1 3 - Typhoid Fever 3 - 1 1 - - - 1 - 2 1 - - - - - - - - 3 - Paratyphoid Fever 1 - - - - - - l - - - - - - - - - 1 - - 1 - Pneumonia 41 - 2 2 3 1 8 6 13 5 9 11 - 5 3 3 1 2 2 5 18 19 Acute Poliomyelitis 10 - 3 1 3 1 2 - - - 2 - - - 1 4 - - 1 2 10 1 Meningococcal Infection 1 - - - - - - — 1 - - - 1 - - - - - - - 1 - Ophthalmia Neonatorum 2 2 - - - - - - - - - - - - 1 - - 1 - - 1 - Dysentery 10 - 5 3 1 - - - 1 - - 1 1 4 1 1 - 2 - - 9 - Food Poisoning 5 - - - 2 - 1 " 2 - - - 1 1 - l 1 - 1 - 4 - Measles „„ 988 39 550 390 6 2. 1 - 138 190 2.6 29 55 34 72 270 54 120 24 - Whooping Cough 00 j 1027 86 569 356 7 1 4 5 1 - 108 145 100 94 90 51 88 135 77 139 33 2 26 TABLE 8. - TOTAL CASES OF NOTIFIABLE DISEASES, 1927-1950. 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 1950 - - 17 25 70 51 13 1 1 - - - - - - - - - - - - - - - - Scarlet Fever 350 798 832 743 484 245 779 701 979 411 359 387 287 196 77 68 210 271 132 153 193 179 222 289 270 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 1 Enteric Fever 7 2 7 2 3 8 7 5 - 2 2 13 15 8 10 3 - 4 - - - - 1 - 3 Paratyphoid Fever - - - - - - 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 21 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 3 Meningococcal Meningitis 1 4 l 1 3 8 5 1 3 3 - 2 3 3 11 5 12 4 3 1 8 1 5 6 1 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 2 Acute Poliomyelitis - 5 - 2 - 1 7 2 5 13 2 4 - 2 1 - - - - 1 - 7 8 13 10 Acute Polio Encephalitis - - - - - - 3 2 1 - - - - - - - - - - - - 1 - - - Dysentery - - - - - - - - 1 - - 3 18 - - - - 6 5 7 5 2 - 1 10 Malaria - - - - - - 1 1‡ - - - - - - - - - - - 1‡ 3a - - - - Measles Not Notifiable 3 36 460 1,091 917 258 1,498 815 964 1,559 1,098 988 Whooping Cough Not Notifiable - 19 262 227 241 293 67 258 430 578 498 1,027 Food Poisoning Not Notifiable 4 5 Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 70 114 82 102 59 75 77 148 100 88 101 111 85 59 42 33 37 72 50 55 97 143 111 88 41 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 2,382 + Notifiable as Puerperal Pyrexia as from 1/10/37. †Notifiable as Puerperal Pyrexia ‡ 1 Induced in an Institution. a 1 Induced for therapeutic purposes : 2 Contracted abroad. 27 The hospitals to which the 267 patients suffering from Infectious diseases were admitted are named below Name of Hospital. No. of cases admitted Plaistow Hospital, Samson Street, E.13 136 East Ham Memorial Hospital, E.7. 11 Aldersbrook Maternity Hospital, E.ll. 1 Ilford Isolation Hospital, Chadwell Heath. 42 King George Hospital, Ilford 2 Chingford Isolation Hospital, E.4. 21 Wanstead Hospital, Hermon Hill, E.ll. 1 Whipps Cross Hospital, Leytonstone, E.ll. 5 Waltham Abbey Isolation Hospital, Waltham Cross 1 Eastern Fever Hospital, Homerton, E.9. 24 St. Ann's Hospital, N.15. 6 Rush Green Hospital, Romford 10 North Middlesex Hospital, N.18. 1 St. Andrew's Hospital, Bow, E.3. 3 Brook. Hospital, Shooters Hill, S.E.18. 1 Park Hospital, Hither Green, S.E.13. 1 St. George's Hospital, Hornchurch 1 Total 267 CANCER. Deaths, 1950:- Total death 239 Male deaths 120 Female deaths 119 TABLE 9. - CANCER DEATHS - LOCATION OF THE DISEASE Ages Under 15 15-25 25-35 35-45 45-55 55-65 65-75 75 & upwards Total Sex M F M F M F M F M F M F M F M F M F Buccal cavity & pharynx - - - - - - - - 1 - - 1 1 - 2 - 4 1 Digestive organs & peritoneum - - - - - 1 2 - 3 - 13 16 23 18 7 20 48 58 Lungs, bronchus - - - - - - - - 8 - 16 1 11 3 3 5 38 9 Other respiratory organs - - - - - - - - 1 - 1 - 2 1 - - 4 1 Uterus - - - - - 1 - - - 1 - 5 - 3 - 1 - 11 Other female genital organs - - - - - - - 1 - 2 - - - 1 - 2 - 6 Breast - - - - - - - 2 - 2 - 5 - 11 - 4 - 24 Male genital organs - - - - 1 - - - - - - - - - - - 1 - Urinary organs - - - - - - 1 - 1 — 4 - 9 1 1 18 2 Skin - - - - - - - - - - 1 - - - - - 1 Brain & other parts of nervous system - - - - - - - - 1 - 1 1 - - - - 2 1 Other or unspecified organs - - - - 1 - - - 1 - 1 - 2 2 - 3 5 5 Totals - - - - 2 2 3 6 16 5 36 30 48 40 15 36 120 119 28 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 19,085 No. of visits to homes of patients by tuberculosis nurses 5,858 No. of tuberculous persons on register on 1/1/50 31/12/50 Adults 1,000 986 Children 283 269 No. of persons under observation on - Adults 109 137 Children 32 77 The notifications received during the year under review total pulmonary 80 males, 87 females, a total of 167 and non-pulmonary 6 males and 9 females, a total of 15. the rate per 1,000 of the population was 1.49 for all forms of tuberculosis. The number of deaths assigned to all forms of tuberculosis for the year was 36 and the death rate was 0.29 per .1,000 population. B.C.G. VACCINATION. (a) Dr. P. Ellman, Consultant Physician, East Ham Chest Clinic, has provided me with the following information in respect of the year 1950 2- Twenty-fIve patients have been vaccinated. Twenty-three were contacts and two were employees - one at this clinic and the other at East Ham Memorial Hospital. Of these 25 vaccinated patients, 24 have had Mantonx conversion after the first vaccination. In one case, Mantonx conversion was achieved after re-vacclnatlon. Details of age group and sexes are appended :- Age Group Males Females Total 0-4 4 6 10 5-14 6 4 10 15 - 25 2 3 5 Totals 12 13 25 (b) The Medical Research Council invited this Authority to co-operate In its controlled clinical trials of anti-tuberculosis vaccine and after consideration by the Education Committee, East Ham agreed to participate. Other selected authorities throughout the country have been included In these trials. The reasons for undertaking this trial - as set out by the Medical Research Council - are, broadly as follows:- 29 TABLE 10. - PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. SUMMARY OF NOTIFICATIONS DURING THE PERIOD FROM 1ST JANUARY, 1950 TO THE 31ST DECEMBER, 1950. Age Periods Formal Notifications Number of Primary Notifications of new cases of tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory, Males - 3 2 3 3 1 9 13 11 7 10 4 - 66 Respiratory, Females 3 3 3 9 2 13 15 10 9 6 2 1 - 76 Non-Respiratory, Males - - 1 1 1 1 - 1 - 1 - - - 6 Non-Respiratory, Females - - - 1 - 1 1 2 1 1 - - 1 8 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 Respiratory M - - - - - - - - - - - 2 1 3 (A) F - - - - - - - - - - - - 1 1 (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - 1 - - - 1 (D) Death Returns from Registrar-General (Transferable deaths) Respiratory M - - - - - - - - - 1 1 1 - 3 (A) F 1 - - - - - - 1 - - - - - 2 (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Posthumous Notifications Respiratory M - - - - - - - - - 1 - - - 1 (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) "Transfers" from Other Areas (excluding transferable deaths) Respiratory M - - - - 1 - 1 2 1 1 - 1 - 7 (A) F - - - - - 1 - 5 2 - - - - 8 (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Other Sources Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Totals (A) 14 (B) 11 (C) - (D) 1 30 "the B.C.G, vaccine distributed at present by the Ministry of Health is intended essentially for use in groups who may be heavily exposed to tuberculosis. This is because there is strong suggestive evidence from investigators abroad that in selected groups exposed to high contact risks (persons in tuberculous families, hospital workers, etc.) B.C.G. vaccine affords some protection against the type of disease which may immediately follow natural primary infection. It is on this basis that the administration of B.C.G. vaccine to selected groups Is Justifiable. However, there is little direct unequivocal evidence of the vale of B.C.G. vaccine in persons exposed to the ordinary conditions of life in this country. There is certainly nothing which would allow a public health administrator to weigh the advantages quantitatively of mass immunisation of school leavers, or of any other general section of the population in Great Britain. against the money, manpower and effort involved, which might be devoted to other anti-tuberculosis measures. There are, in fact, very few controlled trials on the ordinary population anywhere. In short, the question as to whether anti-tuberculosis vaccine should be used as a method of mass immunisation in countries such as our own, has not been satisfactorily answered. It is this question with which we are particularly concerned, and which we would like to answer through the trial now being planned, the trial has the full approval of the Ministry of Health. The trial involves at the outset children leaving secondary modern schools at the age of 15 and it is proposed to follow them up by regular examinations for at least three years. Participants In the trial will be volunteers." As a preliminary before the trials commenced, a meeting took place on 25th October 1950, at which were present the Medical Officer of Health, the Chief Education Officer, the Head Teachers concerned, and Dr. W. Pointon Dick, Director of the Tuberculosis Research Unit of the Medical Research Council, Dr. Dick outlined the reasons for and the method of these trials in school ieavers. The Head Teachers of the secondary schools agreed to co-operate in the scheme. The schoolchildren involved in the trial were those due to leave school at Easter 1951 at the age of 15 years and accordingly a list of such "leavers" was prepared the parents of whom were sent a printed pamphlet from the Research Council and a personal letter from the Medical Officer of Health, requesting them to allow their children to participate as volunteers in the trial, and if willing to complete a circulated questionnaire. The Head Teachers were active In their co-operation, convened meetings of parents to explain the scheme and at some of these meetings the Medical Officer of Health also attended and talked to them. The general practitioners in the area were also notified. As a result, out of 307 school leavers, 126 volunteers (boys and girls) completed all the three tests, of which 45 were positive to either of the two tuberculin tests, 38 had B.C.G. vaccination and 32 were held as controls. The tests were carried out at the Town Hall Annexe on December 1st, 4th and 7th and the children whose parents allowed them to volunteer are pupils at the following schools, Napier Modern for Boys, Central Park Modern for Boys, Cornwell Modern for Boys, Sandringham Modern for Boys, and girls from Monega, Essex, Vicarage and Brampton Modern Schools, The trials proceed, and further reports will be rendered from time to time. 31 MASS RADIOGRAPHY UNIT. The Unit from the West Ham Hospital Management Committee operated from Church Road Clinic from 29/11/50 to 3.8/1/51 and from the Drill Hall, Vicarage Lane, from 24/1/51 to 5/2/51. Dr. Lawless, the Medical Director, who kindly provided the following information, Intimated the response had been very disappointing. Church Road Clinic Drill Hall Grand Total M F Total M F Total Factories, Workplaces &c 951 774 1,725 567 532 1,099 2,824 Doctors' cases 17 38 55 11 21 32 87 Public Sessions 436 500 936 105 208 313 1,249 Totals 1,404 1,312 2,716 683 761 1,444 4,160 Males Females Total No. of attendances for miniature Xray 2,087 2,073 4,160 No. passed as normal on miniature or subsequent large film examination 1,929 1,969 3,898 Percentage normal 92.43 94.98 93.7 No. showing some abnormality 158 104 262 Percentage showing some abnormality 7.57 5.02 6.3 Classification of abnormalities noted Congenital bony abnormalities 11 3 14 Chronic bronchitis and emphysema 24 6 30 Other respiratory disease 28 9 37 Heart disease - congenital or acquired 6 8 14 Tuberculous lesions - all forms 58 61 119 Miscellaneous 31 17 48 Totals 158 104 262 The 119 tuberculous lesions are further analysed as follows:- Males Females Total Inactive Primary 14 26 40 Tuberculosis Post primary 35 28 63 Totals 49 54 103 Radiologically Primary l - 1 Active Tuberculosis) Post primary 7 7 14 T.B. pleural effusion 1 - l Totals 9 1 16 There were therefore, 16 cases of active tuberculosis discovered by the survey a ratio of 3.84 per 1,000 examinations, which is slightly below the national figure for Mass Radiography Surveys. There was no untoward incidence of respiratory disease in any group examined. WATER SUPPLY. (i) The water supply of the Borough in its several parts has been satisfactory both in quality and quantity. 32 (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. (ill) 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. MEAT AND OTHER FOODS. No slaughterhouse was in use in the Borough daring the year. Derails of the work, carried out in the inspection of premises, stalls and vehicles used for the storage, preparation and sale of food, including ice-cream, are included in the 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 RegistrarGeneral 8- lst Quarter Nil 2nd Quarter Nil 3rd Quarter 5 4th Quarter Nil Total 5 (2) Outbreaks due to identified agents There were no outbreaks during the year. (3) Outbreaks of undiscovered cause There were no outbreaks during the year. (4) Single cases :- Agent identified 3 2 Total 5 CLEAN FOOD CAMPAIGN. The Council has agreed to the formation of a Clean Food Guild, and arrangements are in hand to put the scheme into operation during the forthcoming year. 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 12). 33 TABLE 11. METEOROLOGICAL RECORD - YEAR 1950. Rain Gauge 5 in. in diameter, placed 1 foot above ground, 15 feet above pea level. Temperature taken In the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Mean Temperature of Air Rainfall. Highest Maximum Lowest Minimum Mean of No. of Days on which Rain fell. 0.01 and over Amount collected in Inches. Mean rate of fall for Rainy Days Greatest fall in 24 hours Data of greatest fall All Highest All Lowest January 54 24 46.5 36.1 40.35 8 1.13 0.14 0.67 31st February 62 27 51.0 38.0 42.4 18 2.96 0.16 0.60 2nd March 63 24 55.1 40.2 45.15 11 0.64 0.06 0.12 18th 66 32 55.8 40.2 46.7 20 2.28 0.11 0.59 25th May 75 38 62.1 49.0 53.45 13 1.45 0.11 ' 0.35 5th June 87 49 73.9 55.9 64.5 11 1.37 0.12 0.38 14th July 85 53 71.5 59.1 64.1 19 3.49 0.18 0.93 9th August 81 51 72.1 57.4 63.25 17 1.60 0.09 0.35 17th September 73 50 64.4 56.3 56.3 24 2.42 0.10 0.28 15th October 73 35 58.7 46.5 50.2 6 0.34 0.06 0.12 30th November 59 24 51.4 33.6 44.2 24 4.84 0.20 0.91 20th December 53 19 41.5 30.7 35.05 14 1.48 0.11 0.47 1st Means & Totals for the Year 69 35 58.6 45.2 50.47 185 24.00 0.12 0.93 9th July 34 TABLE 12. 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 78 91 8 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 333 286 22 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 11 4 1 - Total 422 381 31 - 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.1) 10 9 - 1 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) 3 1 - 2 - Inadequate ventilation (S.4) 2 2 - 1 - Ineffective drainage of floors (S.6) 1 1 - - - Sanitary Conveniences (S.7) (a) insufficient 4 3 - 1 - 21 14 - 3 - (c) Not separate for sexes 4 2 - - - Other offences against the Act (not Including offences relating to Outwork) 15 10 6 1 - Total 60 42 6 9 - 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(1) (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 Artificial flowers 1 - - - - — Shopping bags 4 - - - - - Kites 3 - - - - - Christmas crackers, cosaques, Christmas stockings, etc. 44 - - - - - Total 52 - - - - - 35 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 book-let form and are available for reference. SECTION 27 - AMBULANCE SERVICES. The revised plans for the new ambulance station have now been approved by the Ministry of Health and when the building has been completed and equipped, this service should function with greater efficiency and will provide suitable and comfortable quarters for the personnel. SECTION 28 - PREVENTION OF ILLNESS, CARE AND AFTER-CARE. B.C.G. vaccine. See comments on page 28. SECTION 22 - CARE OF MOTHERS AND YOUNG CHILDREN. Unmarried mothers have been admitted to the following hostels for periods of 4 - 6 weeks before their confinements :- One to "Ardmore," Loughton, Essex (Essex C.C.) Two to 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 :- "The year just ended has seen another great increase in the demand for dental treatment. Hie children under school age do not have a routine dental inspectlo ??? referred for advice, and treatment from the M. & C.W. Clinics by the doctors. In nearly every case the children have had toothache In a greater or lesser degree and nearly all suffered from gross caries. Hie decline in the condition of the teeth has been very rapid in the last three years. There appears to be no resistance to dental caries and 95% of the teeth are broken down to gum level, with acute or chronic abscesses. The attendance number for toddlers In 1950 was 800, inspections totalled 440, of this number 410 required treatment, and the number of teeth extracted was 1,200 - an average of 3 extractions per child. When it is realised that approximately 97% of these teeth were molars, of which there are eight in the temporary dentition, it will be obvious that each of the children loses an average of nearly 50% of masticating efficiency before the age of five, an appalling state of affairs. A complete table of figures is appended" 36 TABLE 13 NUMBERS PROVIDED WITH DENTAL CARE, 1950. Examined Needing treatment Treated Made dentally fit Expectant 4 Nursing Mothers 139 104 103 99 Children under five 440 410 405 402 TABLE 14. FORMS OF DENTAL TREATMENT PROVIDED, 1950. Extrac tions Anaesthetics Fillings Stealings or scaling and gum treatment Silver Nitrate treat ment Dressings Radiographs Dentures provided Local General Complete Partial Expectant & Nursing Mothers 418 24 61 59 3 - 21 - - - Children under five 1,200 56 324 9 - - 80 - - - Number of births notified during the period 1/1/50 to 31/12/50, under Section 203 of the Public Health Act, 1936, as adjusted by transferred notifications (a) Live births:- (1) Domiciliary 494 (11) Institutional 1,308 (b) Still births:- (1) Domiciliary 7 (11) Institutional 36 (c) Totals (1) Domiciliary 501 (11) Institutional 1,344 Number of premature infants notified during the year (including transferred ) notifications) whose mothers normally reside In the area (1) born at home 16 (2.) born In hospital or nursing 96 TABLE 15. Premature babies born in area (whether their mothers normally reside in area or nor) excluding those born in maternity homes and hospitals in the National Health Service:- Born at Home Transferred to hospital Nursed entirely at home Died in first 24 hours Died on 2nd to 7th day Died on 8th to 28th day Survived 28 days Total Grand Total Under 3 lbs. 1 - - - 1 1 3-4 lbs. 5 - - - - - 5 4-5½ lbs. 3 - - - 7 7 10 Total 8 1 - - 7 8 16 Note:- There are no maternity homes (not In the National Health Service) or Mother and Baby Homes in the Borough. 37 TABLE 16. PREMATURE INFANTS - BORN IN HOSPITALS. Name of Hospital Birth weight Died in first 24 hours Died on 2nd to 7th day Died on 8th to 28th day Survived 28 days Total East Ham Memorial Hospital Under 3 lbs — 1 - - 1 Aldersbrook Maternity Hospital do. 2 - - - 2 Plaistow Maternity Hospital do. 1 - - - 1 Forest Gate Hospital do. 1 - - - 1 London Hospital do. - - - 1 1 Totals 4 1 - 1 6 East Ham Memorial Hospital 3-4 lbs. - - 1 1 2 Plaistow Maternity Hospital do. 1 - - 1 2 Forest Gate Hospital do. 1 - - - 1 Queen Mary's Hospital, Stratford, E.15. do. 1 - - 2 3 East End Maternity Hospital do. - - - 1 1 Totals 3 - 1 5 9 East Ham Memorial Hospital. 4-5½ lbs - 1 - 21 22 Plaistow Maternity Hospital do. - - - 13 13 Forest Gate Hospital do. - - - 17 17 Aldersbrook Maternity. Hospital do. 1 - - 17 18 Queen Mary's Hospital, Stratford, E.15. do. - - - 3 3 East End Maternity Hospital do. - - - 1 1 London Hospital do. - - - 1 1 St. Andrew's Hospital, Bow do. - - - 3 3 Mothers' Hospital, Clapton do. - - - 1 1 St. Alfrege's Hospital, Greenwich do. - - - 1 1 Totals 1 1 - 78 80 GRAND TOTAL All weights 8 2 1 84 95† †In addition to the above number, 1 premature infant born in East Ham Memorial Hospital and not weighed at birth, survived 28 days. 38 ILLEGITIMATE CHILDREN (Circular 2866) The Council do not employ a social worker for the purpose of the above Circular. These duties are undertaken by the Superintendent Health Visitor, and close co-operation is maintained with the Children's Officer. TABLE 17. INFECTIOUS DISEASE Ophthalmia Neonatorum Pemphigus Neonatorum Puerperal Pyrexia Domiciliary Confinements Institutional Confinements Domiciliary Confinements Iastitutional Confinements Domiciliary Confinements Institutional Confinements Number of cases notified during 1950 2 - - - - 3 Number of cases removed to hospital 1 - - - - - Number of cases of Ophthalmia Neonatorum notified during the year, in which :- (a) vision was unimpaired 2 (b) vision was impaired (c) vision was lost — (d) the patient died — (e) the patient was still under treatment at the end of the year — (f) the patient removed from district — (g) classification under above heads cannot be made — (a) Number of women attended in the area at home or in nursing homes whose deaths were ascribed to pregnancy or childbirth during the years:- (1) from sepsis attended at home Nil. attended In nursing homes Nil. (ii) from other causes attended at home Nil. attended in nursing homes Nil. (b) Number of women in (a) who died :- (1) at home Nil. (11) In nursing homes Nil. (ill) after removal to hospital Nil. (c) Total maternal deaths whether attended In the area or outside the Borough :- (i) from sepsis Nil. (11) from other causes 1 39 TABLE 18 ANTE-NATAL AND POST-NATAL CLINICS, 1950. No. of clinics provided at end of year (whether held at Child Welfare Centres or other premises) No. of sessions held at end of year per month at clinics included in col. (2) No. of women In attendance Total No. of attendances made by women included in col. (4) during the year. No. of women who attended during the year No. of new cases included in col. (4) i.e. for A.,N. clinics women who had not previously attended any clinic during current, pregnancy & f or P.N. clinics women who had not previously attended any P.N. clinic after last confinement. (1) (2) (3) (4) (5) (6) Local Health Authority Clinics Ante-natal clinics 2 36 1,735 1,338 7,453 Post-natal clinics - - 275† 271† 320† Clinic belonging to other L.H.A.+ . Ante-natal, clinics 1 2 29 10 19 Post-natal clinics - - 6† 6† 8† + By arrangement with L.C.C. at Fernhill Street Baths, North Woolwich, E.16. † Post-natal patients seen at ante-natal clinics and these numbers are not included in the ante-natal figures. Note:- No clinics were discontinued or new premises opened during the year. 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. 40 TABLE 19 CHILD WELFARE CENTRES, 1950 No. of centres provided at end of year No. of child welfare sessions held at end of year per month at centres in col. (2) No. of children who attended centres in col. (2) during the year. Nc. of children who first attended the centres during the year and who 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 attendance made by children included In col. (4) during the year. Under 1 year Over 1 year Under 1 year Over 1 year Under 1 year Over 1 year (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Local Health ority Centres 2 56 2,780 1,170 212 1,011 1,712 12,506 5,464 Centre belonging to other L.H.A.† 1 4 77 36 3 33 40 334 112 † By arrangement, with L.C.C. at Fernhill Street Baths, North Woolwich, E.l6. + Excluding children who attended before 1/1/50, or who were known to have previously attended a centre in another district. Note:- No clinics were discontinued or new premises opened during the year. 41 TABLE 20 DAY NURSERIES, 1950 Provided by Number at 31/12/50 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 93 164 61 154 Maintained by Vol. Organisations - - - - - - - Note:- No new nurseries were opened or any nurseries closed, during the year. The total attendances at the nurseries during 1950 are appended below Nursery Total Attendances Average daily attendance School Road 9,624 37 Roman Road 17,866 70 St. Stephen's Road 15,955 62 Wall End/Caledon Road ll,638 45 Total 55,083 Note:- the Nurseries are closed on Saturdays. The total attendances at the Nurseries decreased In 1950, as compared with 1949s, by 8,439. 42 MOTHER AND BABY HOMES. During the year under review, 3 unmarried expectant mothers were sent to homes or hostels* One of these was admitted to "Ardmore" Hostel, Buckhurst Hill, and two to St. Agatha's Home, Stratford, E.15. MATERNITY HOSPITALS, East Ham mothers booked per the Council's ante-natal clinics were admitted for their confinements to the Institutions named below during the year 1950 s- Institutlon No. of patients Aldersbrook Maternity Hospital 394 East Ham Memorial Hospital 390 Forest Gate Hospital 166 Mile End Hospital 39 989 REGISTRATION OF NURSING HOMES. Under Sections 187 to 194 of the Public Health Act, 1936, there were no homes registered during the year 1950, and there were no homes on the register at the end of the year 1950. ALDERSBROOK MATERNITY HOSPITAL. By agreement with the Regional Hospital Board, this Unit was transferred to the West Ham Group Hospital Management Committee on 1st April, 1950, so that greater efficiency in the medical services might be possible. No change is envisaged in the catchment area for the admission of mothers, and East Ham will continue to give the bulk of the bookings. Admission to hospital for confinement is arranged: (i) Where the doctor indicates that there are medical or obstetrical grounds necessitating hospital supervision. (ii) When housing conditions make home confinement difficult or impossible. (iii) When there are pressing social reasons. The effect of the transfer on the services given to the Borough will be watched with lively interest. 43 ALDERSBROOK MATERNITY HOSPITAL. STATISTICS 1950. Number of beds on 31/12/50 20 " " midwives employed on 31/12/50. 7 " " East Ham patients confined during the period 1/1/50 to 31/12/50:- (a) midwifery 391 ) 394 (b) maternity nursing 3 ) " " midwives qualified on 31/12/50 to administer gas and air analgesia 6 " " sets of apparatus of gas and air analgesia in use On 31/12/50. 2 " " East Ham patients to whom gas and air analgesia was administered by midwives during the period 1/1/50 to 31/12/50 (a) when acting as a midwife 386 ) 389 (b) " " " " maternity nurse 3 ) " " occasions, medical aid sought by midwives under section 14 (1) of the Midwives Act, 1918 25 " " sets of twins born during the year 7 " " still births during the year 5 " " infant deaths " " " 3 " " instrumental deliveries during the year 3 8 " " premature Infants born during the year 20 SECTION 23 - MIDWIFERY SERVICE. The domiciliary midwifery service continues to fill a great social need. Many women adhere to deep rooted tradition and strongly desire to have their babies at home. In my opinion this idea should be encouraged. A woman wishes to be In her own bed, in familiar surroundings, and close to her loved ones at times of crisis such as this; and a few days later the move from hospital to home is avoided, for it is this homecoming with Its accompanying emotional upset that often interferes with breast feeding and throws additional stress on the mother at a time when tranquility should be the watchword. There is also a closer liaison between Health Visitor and Midwife than between Hospital and Local Authority, so that follow up by the Health Visitor is smoother and more effective. After all, childbirth is a natural process, and hospitals should deal only with deviations from the normal. 44 TABLE 21 MIDWIVES ACTS, 1902 - 1950 Number of midwives practising in the area at 31st December, 1950. Domiciliary Midwives Midwives in Institutions Total Midwives employed by the Council 5/ - 5 Midwives employed by Voluntary Organisations - (a) Under arrangements made with the L.H.A. in pursuance of Section 23 of the N.H.A. Act 2 - 2 (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 9 6+ 15 Midwives in private practice 1 - 1 Totals 17 6 23 Notes Figures for Aldersbrook Maternity Hospital have not been included in the above table. / One terminated on 31/12/50. + These midwives are employed at East Ham Memorial Hospital. The 2 midwives in (a) above carry out part-time Midwifery service in the North Woolwich area and are employed by the Silvertown and North Woolwich District Nursing Association. The 9 midwives (7 of whom only gave part-time service in the area) employed by the Hospital Management Committee are from the Plaistow Maternity Hospital and District Nurses Home, (local branch - Burges Road). 45 TABLE 22 MATERNITY CASES ATTENDED Number of maternity cases in the area attended by Midwives during the year ended 31/12/50 Domiciliary Cases Cases in Institutions. Total As Midwives. As Maternity Nurses. As Midwives. As Maternity Nurses. As Mid- wives. As Maternity Nurses. Midwives employed by the Authority 256 16 - - 256 16 Midwives employed by Voluntary Organisations (a) under arrangements with Council in pursuance of Section 23 of the N.H.S. Act .. 7 2 - - 7 2 (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 161 55 /336 /54 497 109 Midwives in private practice 3 - - - 3 - Totals 427 73 336 54 763 127 / East Ham Memorial Hospital. (Local residents) Aldersbrook. Maternity Hospital, figures not included in above table. Number of cases in which medical aid was summoned during the year under Section 14 (1) of the Midlives Act, 1918, by a midwife (a) for domiciliary cases- (i) where the medical practitioner had arranged to provide the patient with maternity medical services under the N.H.S. Act. 11 (ii) others 146 Total 157 (b) for cases in institutions 78+ + East Ham Memorial Hospital. 46 TABLE 23 GAS AND AIR ANALGESIA. DOMICILIARY MIDWIVES Domicllary Midwives employed directly by Council Daniclliary Midwives employed under Sec. 23 by voluntary organlsaaioru 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 31/12/50, who were qualified to administer gas and air analgesia in accordance with the requirements of the C.M. Board 5 2 9 1 17 No. of sets of apparatus in use by domiciliary midwives employed in the Authority's service at 31/12/50. 4 2 3 - 9 No. of cases in which gas and air was administered by domiciliary midwives during the period 1/1/50 to 31/12/50:- (a) when acting as a midwife 155 - 92 - 247 (b) when acting as a maternity nurse 7 - 42 - 49 East Ham Memorial Hospital Aldersbrook Hospital No. of midwives qualified on 31/12/50 to administer gas and air analgesia 4 6 No. of sets of apparatus used by the above as on 31/12/50 1 2 No. of cases in which gas and air analgesia was administered during the year 1950:- (a) when acting as a midwife 277 386 (b) when acting as a maternity nurse - 3 SECTION 24 - HEALTH VISITING SERVICE. A year of good progress has been made in the crystallisation of the work of the Health Visitor in the unified service. 47 Four newly trained Health Visitors have been absorbed in our staff to bring to bear the most modern teaching on the problems of mental health in relation to maternity and child care, the life of childhood, and the family as a unit of socialization. Routine tasks of lesser importance are being allocated to staff with more limited training, and the work of health education and prevention of illness is being concentrated in these fully trained Health Visitors whose wider knowledge of the problem better fits them for the job. The Superlntendent Health Visitor in her wisdom does not overload her staff with one track assignments,, but varies the work to turn all facets of family life towards the Health Visitor who thus can give full scope to her opportunities for health teaching. In the person of the Health Visitor the strongest single link can be forged to bind the Local Authority, the Hospitals, and the General Practitioner Service into a unified instrument to shape our effort in the prevention of illness. TABLE 24 HEALTH VISITING, 1950 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 & 5 Other Classes Wholetime on Health Visiting Parttime on Health Visiting First Visits Total Visits First Visits Total Visits First Visits Total Visits First Visits Total Visits (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) Local Health Authority 14+ 7 2 512 556 1884 7011 - 10581 - 742 Voluntary Organisations - - - - - - - - - - - + Includes Superintendent Health Visitor. SECTION 25 - HOME NURSING. The negotiations commented upon in the last annual report have now come to fruition and "Ascot Lodge" and the adjacent property, "Charnwood", have been acquired by the Council for use as headquarters and Nurses Home for the staff of the District Nursing Service. Agreement has been reached with the East Ham District Nursing Association and the service will be operated under a joint committee of the Council and District Nursing Association representatives, whilst the inspectorate of the Queen's Institute of District Nursing will continue as heretofore. ua The work, has increased almost threefold, mainly due to the calls on the nurses by general practitioners, who are hard pressed to treat in their own homes many persons who could properly be hospitalised. Additional staff have been recruited under the direction of the resident Matron, Miss W.A. Evans, whilst our Superintendent Nursing Officer, Miss B.M.A, Newman Pilkington, will ensure the best deployment of the service in co-ordination with the other nursing services of the Council, A nucleus of resident nurses would appear to be essential to the smooth running of the service but with shortages and the difficulty of recruitment, part-time staff will play an increasing part in this nursing field, and continued vigilance must ensure that the valuable time of the nurses is not dissipated on tasks which could well be carried out by relatives and friends. For here also it is not our aim to replace family effort but to augment it in those households where sickness or injury threaten to overwhelm the family. TAB1E 25, HOME NURSING, 1950 Provided by No, of home nurses employed at 31/12/50 Equivalent of wholetime service provided ty part-time home nurses No. of cises attended by home nurses during the year No, of visits paid by home nurses during the year Wholetime on home nursing Parttime on home nursing Local Health Authority - - - - - Voluntary Organisations by agreement with the Authorlty 11 5 2i 2,026 50,774 49 TABLE 26 HOME NURSING 1950 East, Ham District Nursing Association Silvertown & North Woolwich District Nursing Association Adults Children Total Adults Children Total Males Females Males Females Patients on books on 1/1/50 71 197 4 272 2 4 - 6 New patients from 1/1/50 to 31/12/50 513 884 292 1,689 6 40 3 59 Patients on books on 31/12/50 101 255 15 371 - 3 - 3 Total number of visits during year 16,120 29,017 1,839 46,976 289 456 53 798 Summary of new cases East Ham District Nursing Association Silvertown & North Woolwich District Nursing Association. Bronchitis, pneumonia and pleurisy 173 1 Cardiac 142 Tuberculosis 56 4 Rheumatism, arthritis, etc„ 44 o. Cerebral 90 — Diabetes 45 1 Burns and Scalds 10 i Cancer 95 1 Senility 78 — Erysipelas 6 - Prolapse 35 17 Other Medical 527 17 Various surgical 343 13 Ante-natal 7 Post-natal 18 2 Miscarriage 7 Other causes 13 2 Total new cases 1,689 59 A comparision of statistics in regard to the work of the East Ham District Nursing Association is appended below:- +From 5/7/48 to 31/12/48 1949 1950 Patients on books at beginning of period 178 206 272 New patients during period 435 1,468 1,689 Patients on books at end of period 206 272 371 Total number of visits during period 17,269 40,647 46,976 + Approx. 6 months. 50 SECTION 26 - VACCINATION And IMMUNISATION There has been a sharp decline in the number of children immunised against diphtheria. This is most regrettable, especially in view of the fact that the injections can now be carried our with equal facility by general practitioners in their surgeries, as well as in the established clinics of the Council, The burgesses are warned that an outbreak of virulent death dealing diphtheria in an unprotected community can still be a very dreadful possibility, and every parent should guard against this disaster by having the children protected by immunisation before the first birthday. With whooping cough too, the suffering experienced in the paroxysms and the baneful after effects to the child's lungs are, widely known, and although full protection cannot be guaranteed, yet a large measure of protection can be achieved by immunisation, which may be carried out alone or in combination with diphtheria immunisation. TABLE 27. DIPHTHERIA IMMUNISATION, 1950. 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 Six months ending 30/6/50 825 67 892 84 „ „ „ 31/12/50 628 59 687 52 Totals 1,453 126 1,579 136 Of the above totals number of children Immunised by:- (a) Council staff 835 100 935 122 (b) General practitioners 618 26 644 14 Note:- The 165 children shewn at the foot of the Whooping Cough table of statistics are included in the above figures. he comparable figures for 1949 were :- 1803 (Under 5) 333 (5 - 14) 2136 (total) 296 (re-inforclng injection) 51 TABLE 28. WHOOPING COUGH. PROPHYLAXIS WITH PERTUSSIS VACCINES FOR YEAR ENDING 31/12/50. No, of children who completed a course of inoculation with pertussis vaccines (including alum-precipitated vaccines and vaccines combined with diphtheria prophylactic). Totle. Age, at date of final Injection. Under 1 year 1- 4 years 5-14 years 61 121 4 186 NOTE. - Of the above figures, 21 children received the whooping cough vaccine only and 165 the combined whooping cough and diphtheria prophylactic. All the above were carried out by general practitioners. TABLE 29. DIPHTHERIA IMMUNISATION. Number of Children at ,31st Decembers, 1950, who had completed a course of Immunisation at any time before that date (i.e. at any time since 1st January, 1936) Age at 31/12/50 i.e. Born in Year Under 1 1950 1 1949 2 1948 3 1947 4 1946 5 to 9 1941-1945 10 to 14 1936-1940 Total under 15 No. Immunised 72 1,112 1,416 1,800 1,666 5,438 4,629 16,133 Estimated midyear child population 1950 Children under five Children 5-14 26,060 10,740 15,320 TABLE 30. SMALLPOX VACCINATION No. of persons vaccinated or re-vaccinsted during 1950 Total Age at date of vaccination Under 1 1 - 4 5 - 14 15 or over No. vaccinated (235) 366 (17) 59 (14) 24 (37) 47 (303) 496 No, re-vaccinated (3) 6 (-) 2 (5) 13 (37) 81 (45) 102 Totals (238) 372 (17) 61 (19) 37 (74)128 (348) 596 The figures in brackets are those for 1949, and it will be seen that there was for the year 1950 an increase in the number of patients vaccinated. All these vaccinations were carried out by general practitioners. 52 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). An appeal was made in the last annual report, urging vaccination as a moral obligation on all burgesses in East Ham. There was a slight response, but it is obvious that the vaccinal state of the whole community is declining to a perilously low level. We live in a riparian borough adjacent to great docks where ocean-going ships tie up from the four corners of the earth. Heroic last minute efforts to limit the spread of "imported" small pox will not suffice, and one death would shame us in the neglect of our duty to ensure 100% vaccinal state in our people. Parents are again asked to have their children vaccinated against small pox, and to ensure that they themselves are adequately protected. Your family doctor will gladly advise and help you. SECTION 27 - AMBULANCE SERVICES. Although plans for the new ambulance station have been agreed by the Ministry, difficulties with steel allocation are holding up progress, and it is extremely disappointing to see personnel working under such bad conditions and valuable vehicles parked in the open. Two new 2-stretcher ambulances have been received to replace old worn out vehicles, and a highly efficient fleet is gradually being built up. Study of working conditions lead to the conclusion that the staff composed of drivers and attendants is not ideal for operational efficiency. It would appear that female attendants are not best suited to lifting loaded stretchers, and the interchange of drivers and attendants would be far more economical and prevent wastage of crews. The possible reconstitution of the staff will be studied carefully with a view to obtaining higher efficiency without uneconomical increase of staff. TABLE 31. AMBULANCE SERVICES, No. of vehicles at 31st December 1950 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 whole- time staff at 31/12/50 Directly pro- vided by Council Ambulances Cars 6+ 8,069 16,813 849 86,724 29 4 4,600 12,468 78 68,050 Totals 10 15,669 29,281 927 154,774 29 + Includes 1 sitting vehicle. 53 TABLE 32. AMBULANCE SERVICES Journeys and Mileage Analysis, 1950. Nature of Journey Ambulances Cars No. of journeys Mileage No. of journeys Mileage Accidents 849 3,273 78 596 Sickness + 5,547 69,326 3,659 55,928 Maternity 878 5,636 30 182 Tuberculosis 325 2,336 288 2,693 Mental 37 1,534 102 3,888 Midwives 54 241 169 650 Hospital transfers 89 1,832 20 364 Ministry of Pensions 12 517 54 1,989 Maintenance 86 311 52 265 Miscellaneous 16 118 71 512 Other 86 887 71 983 For Essex C.C. 48 388 2 Shared For West Ham 42 325 4 Shared Totals 8,069 86,724 4,600 68,050 + 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 41 occasions involving 48 patients, and from the Corporation's Transport Department, on 115 occasions Involving 151 patients. 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 1950 these vehicles were not used on behalf of East Ham. West Ham and Essex C.C. Cars. Ambulances . Total /East Ham for Essex 2 48 50 /East Ham for West Ham 4 42 46 +Essex for East Ham 1 27 28 +West Ham for East Ham 3 72 75 / Journeys and mileage included in tables 31 and 32 + Journeys and mileage not included in tables 31 and 32. 54 Comparable statistics for the periods stated are set out below:- +5/7/48 to 31/12/48 1949 1950 Total number of callss:- (a) ambulances 4,034 6,559 8,069 (b) cars 1,776 4,845 4,600 Total number of patients carried:- (a) ambulances 3,417 10,200 16,813 (b) cars 1,570 12,292 12,468 No. of accident or emergency calls included in total calls:- (a) ambulances 541 801 849 (b) cars 35 117 78 Total mileage:- (a) ambulances 36,671 61,900 86,724 (b) cars 18,327 63,066 68,050 (c) total 54,998 124,966 154,774 + approximately 6 months NOTE:- The above figures do not include calls from East Ham to Essex and West Ham. SECTION 28 - PREVENTION OF ILLNESS, CARE AND AFTER-CARE. Loan Cupboards. The loan of articles from the cupboards to aid in the nursing of sick persons In the home continues to be a great boon. The service must not end with the issue of a piece of equipment. We must ensure that the article or apparatus is properly used and does in fact make a contribution to sick nursing. The Superintendent Nursing Officer has played an invaluable part in assisting sick persons, especially old people, in their homes to make the fullest use of equipment loaned, and in advising when it is no longer of benefit. The loan cupboards which functioned from 1/1/50, are sited at the following places:- 1. East Ham District Nursing Association, Shrewsbury Road, E.7. 2. Town Hall Annexe. 3. East Ham Chest Clinic. 4. Church Road Clinic. A central register is kept for all articles loaned from cupboards 2-3-4 and in addition the Superintendent Health Visitor is responsible for a small additional cupboard in the Town Hall Annexe in respect of premature baby outfits,, The following table shews the number of occasions articles were issued from 3 of these cupboards during the year 1950 55 TABLE 33. Article No. of occasions items loaned Cupboard at Total Town Hall Annexe East Ham Chest Clinic Church Rd. Clinic Air bed rings (adults) 22 15 17 54 Bed cradles 1 1 - 2 „ pans 33 24 16 73 „ rests 24 14 11 49 Commodes 2 - - 2 Crutches 1 - - 1 Electric blankets 1 - - 1 Feeding cups - - 1 1 Garden shelters - 3 - 3 Hot water bottles (rubber) 2 3 - 5 Rubber sheets 10 12 - 22 Sand bags (small) - 1 - 1 Sheets 1 - - 1 Sputum mugs 1 24 - 25 Steam kettles 5 - - 5 Thermometers - 1 - 1 Urinals (male) 3 11 - 14 Water beds 1 - - 1 Wheel chairs 40 - - 40 Totals 147 109 45 301 NOTE;- With the exception of garden shelters stored in sections on other Council premises, all large articles (owing to storage space) are kept at the Town Hall Annexe. In addition from the premature baby outfit cupboard, the following articles were issued No. of occasions Cost 1 Premature baby outfits 1 Scales and weights 13 Tube feeders 1 TABLE 34. TUBERCULOSIS 1950. No. of visits to homes of patients by nurses during 1950 No. of notified cases on East Ham Chest Clinic register on 31/12/50. No. of occasions on which free extra nourishment supplied to patients during the year No. of occasions financial help given for purchase of bedding Adults Children Total Milk Food Total 5,858 986 269 1,255 580 34 614 9 There is no change in the procedure outlined on page 53 of the Annual. Report for the year 1949 in respect of the provision of free extra nourishment (milk and food) to tuberculous patients; bedding and free convalescent home treatment. 56 During the year 1950, the part-time occupational therapist employed by the Council carried out the following sessions:- (a) At the Chest Clinic 97 (b) At the homes of patients 49 No. of attendances at Clinic sessions 1,100 „ „ „ „ patients' homes 37S TABLE 35 CONVALESCENT HOMES PATIENTS TREATED 1950 Name of Home Children 0-5 years SchoolChildren Adults Total M F M F M F M F Children's Conv, Home, Beaconsfield - 6 - - - - - 6 Webbery „ „ Bideford - - - 3 - - - 3 Surrey „ „ Bognor Regis - - 6 3 - - 6 3 The House Beautiful, Bournemouth - - 2 2 - - 2 2 St. Joseph's Home, Bournemouth - - - - 3 1 3 1 Cliffe Combe, Broadstairs - - 17 10 - - 17 10 "Broadlands", Broadstairs - - 4 - - - 4 - St. Michael's Convent, Clacton-on-Sea - - - 12 - 12 - 24 All Saints Conv. Home, Eastbourne - - - - 2 2 2 2 Princess Christian Home, Englefield Green - - 5 - - - 5 - Children's Seaside Home, Exmouth - - - 8 - - - 8 St. Mary's Home, Haslemere - - - 8 - - - 8 Home for Invalid Children, Hove - - 11 14 - - 11 14 Hunstanton Convalescent Home - - 19 - - 2 19 2 Tapley Court, Instow 1 2 - 1 - - 1 3 "Batesholme", Heme Bay - - 1 2 - - 1 2 Beach Court, Lancing 1 4 - - - - 1 4 Sunbeam Home, Lancing 9 13 6 8 - - 15 21 Belgrave House, Littlehampton - - 3 - - - 3 - Bunce Court, Ottenden - - 2 2 - - 2 2 Myrtle Grove House, Patching - - 4 - - - 4 - Brabazon House, Redhill - - - 3 - - - 3 Andrew Duncan House, Shiplake-on-Thames - - 3 - - - 3 - Bannow Home for the Blind, St. Leonards on-Sea - - - - 2 - 2 - Quarry House Conv. Home, „ „ „ - - - - 8 - 8 - Stamford Hill Cripples Home, Thorpe Bay 1 - 2 5 - - 3 5 Samuel Lewis Home, Walton-on-Naze - - - 1 4 1 4 / Other Homes 7 3 12 2 4 11 23 16 Totals 19 28 97 83 20 32 136 143 / A few of these patients were admitted to Regional Hospital Board Homes at no cost to the Council. 57 TABLE 36. CONVALESCENT HOME TREATMENT PERIOD OF TREATMENT - 1950 Age Groups Sex Up to 1 week 1-2 weeks 2-3 weeks 3-4 weeks 4-5 weeks 5 - 6 weeks over 6 weeks Total Under 5 years M 1 4 4 4 - 3 3 19 F - 5 9 10 1 2 1 28 School children M 3 10 31 25 4 21 3 97 F 1 13 28 19 6 13 3 83 Adults M 1 15 3 1 - - - 20 F 2 17 9 4 - - - 32 Totals 8 64 84 63 11 39 10 279 The recommendations for this form of treatment were submitted by:- TABLE 37. Referred by Children 0-5 School Children Adults Total General Practitioners 9 15 34 58 Hospitals 13 17 16 46 East. Ham Chest. Clinic 3 26 1 30 School Health Service - 122 - 122 M. & C.W. Section 22 - 1 23 Totals 47 180 52 279 For comparision the number of children and adults receiving this form of treatment are appended:- + 5/7/48 to 31/12/48 1949 1950 Children 0 - 5 years 37 86 47 Schoolchildren 128 326 180 Adults 10 49 52 + Approximately 6 months. The cost of the actual treatment of children and adults in convalescent homes (including travelling expenses i.e. fares) for the period 1/1/50 to 31/12/50, compared with that for 1949 is shewn below 1949 1950 £ s. d. £. s. d. Children under five years 1,945. 9. 6. 758. 11. 10. Schoolchildren 4,826. 15. 8. 1,966. 10. 2. Adults 460. 5. 7. 515. 6. 5. Fares (Including escorts) - - - 84. 8. 8. Totals 7,232. 10. 9. 3,324. 17. 1. 58 In addition, the parents of 3 schoolchildren received financial aid in the provision of clothing before admission to convalescent homes. During the year under review, the Council accepted financial responsibility for after-care treatment for ex-mental patients in After Care Homes, as follows:- Four patients were admitted to or already in homes belonging to the Mental After-Care Association, for varying periods - 1 was resident for the whole of year, 1 for 5 months, 1 for 3 months, and 1 for 6 weeks. PARK VIEW THERAPEUTIC CLUB. This club continues its excellent work under the aegis of medical staff from Runwell Hospital, who select the members from ex-patients, and out-patients of the East Ham Memorial Hospital Psychiatric Clinic. The activities of this club so closely lntermesh true therapeutic measures and after-care that it is almost, impossible to decide what part of the financial burden of its costs should properly be borne by the Councils Whatever decision is reached, the club must go on so that this opportunity for social rehabilitation is not lost to the members, many of whom regain their self confidence and find in the club activities a portal of re-entry to normal community living. SECTIONS 28 and 51 The plans for the provision of a second occupation centre for mental defectives remain as detailed on page 54 of the report for 1949, The centre in use is overcrowded and the work is hampered by difficulty in segregating for instructional purposes the very young from the adult defectives. This problem is becoming more urgent and measures must be sought to train these unfortunate children so that they do not form an intolerable burden to family life. All guardianship cases are supervised either directly or indirectly by the Authority. No. on register on 1/1/50 17 No. admitted to institutions 1 No. of orders discharged by Board of Control 3 No. on register on 1/1/51 13 + No. visited by members of Mental Health Committee 8 / No. „ „ Medical Officer of Health 5 No, supervised on 31/12/50 by National Association for Mental Health 1 + Outisde area / Inside area 59 TABLE 38. MENTAL PATIENTS - LUNACY AND MENTAL TREATMENT ACTS. Type of patient Number on register on 1/1/50 Admissions to institutions during the year 1950 Discharges from institutions during the year 1950 Deaths in institutions during the year 1950 Number on register on 31/12/50 Certified - Males 165 28 15 12 166 Females 208 35 24 13 206 Total 373 63 39 25 372 Temporary - Males - 1 - - 1 Females 1 3 3 - 1 Total 1 4 3 - 2 Voluntary - Males 84 60 46 5 93 Females 62 61 57 5 61 Total 146 121 103 10 154 Grand Totals 520 188 145 35 528 No. of patients released on trial during 1950 - 5 Males, 19 Females, Total 24 „ „ „ returned from „ „ 1950 - 3 „ 1 „ „ 4 Of the above cases, on 1/1/50, 504 were inmates at Runwell Hospital, and 16 in other institutions. During the years, 182 were admitted to Runwell and 6 to other hospitals, 140 were discharged from Runwell and 5 from other institutions, 34 of the deaths occurred in Runwell and one elsewhere and on 31/12/50 the cases were accommodated as follows 512 Runwell and 16 other hospitals. Difficulty is occasionally experienced by our Duly Authorised Officers in finding a hospital bed for cases of acute mental illness. It might be argued that with the comparatively short stay in hospital now made possible by modern methods of therapy, a rapid turnover of cases should ensure free beds for urgent sufferers. It must be remembered however that Runwell Hospital now has a greatly increased "catchment area" and East Ham must pay the price of regionalisation with philosophic fortitude, for this is an example of altruism that comes out of the democratic way of life. 60 TABLE 39 MENTAL DEFICIENCY ACTS, 1913 - 1938 PARTICULARS OF MENTAL DEFECTIVES AS ON 1/1/51 Males Females  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 8 12 20 Aged 16 years and over 78 87 165 (b) +Under guardianship (including cases on licence therefrom) Under 16 years of age - - - Aged 16 years and over 5 8 13 (c) In "places of safety" - 2 2 (d) Under statutory supervision (excluding cases on licence) Under 16 years of age 21 17 38 Aged 16 years and over 86 65 151 (e) Action not yet taken under one of the above headings - - - Total ascertained cases found to be "subject to be dealt with" 198 191 389 M F T No. of cases included in (b) to (e) above awaiting removal to an institution 11 2 13 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 26 23 49 Total number of mental defectives (1) plus (2) 224 214 438 3. No. of mental defectives receiving training:- (a) In day training centres Under 16 years of age 7 8 15 Aged 16 years and over 11 9 20 (b) At home - - - Total 18 17 35 + No.defectives under guardianship were dealt with during the year under the provisions of section 8 or 9 61 TABLE 40. PARTICULARS OF MENTAL DEFECTIVES REPORTED DURING 1950. Males Females Total II. Particulars of cases reported during the year 1950:- (1) Ascertainment- (a) Cases reported by Local Education Authorities (Section 57, Education Act, 1944)- (i) Under Section 57 (3) 6 4 10 (ii) Under Section 57 (5):- On leaving special schools 1 2 3 On leaving ordinary schools - - - (b) Other ascertained defectives reported during 1950 and found to be "Subject to be dealt wtth" 6 4 10 Total ascertained defectives found to be "Subject to be dealt with" during the year 13 10 23 (c) Other reported cases ascertained during 1950 who are not at present "Subject to be dealt with" - - - Total No. of cases reported during the year 13 10 23 (2) Disposal of cases reported during the year:- (a) Ascertained defectives found to be "Subject to be dealt with"- (i) Admitted to Institutions 1 1 2 (iii) Placed under guardianship - - - (iii) Taken to "places of safety" - 1 1 (iv) Placed under statutory supervision 12 8 20 (v) Died or removed from area - - - (vi) Action not yet taken - - - Total ascertained defectives found to be "Subject to be dealt with" 13 10 23 (b) Cases not at present "Subject to be dealt with"- (i) Placed under voluntary supervision - - - (ii) Later found not be defective - - - (ii) Died or removed from area - - - (iv) Action unnecessary - - - (v) Action not yet taken - - - Total cases not at present "Subject to be dealt with" - - - ILL No. of cases in institutions, under community care including voluntary supervision or in "places of safety" on 1/1/50 who have ceased to be under any of these forms of care during 1950:- (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 1950:- (i) After marriage 1 (ii) While unmarried 1 (b) No. who have married during 1950 - - - During 1950, 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 2 males and 1 female. 62 The number of mental defectives on the register of the Occupation Centre on 31/12/50, was 35 (18 males, 17 females). With the exception of 1 female who attends afternoons only, all attend for the whole day. TABLE 41. MENTAL DEFECTIVE OCCUPATION CENTRE. SESSIONS AND ATTENDANCES, 1950. No. of sessions held during the year Morning Af ternoon 233 233 Msle Female Male Female Total attendances 2,805 3,140 2,859 3,415 Average attendances per session 12.04 13.47 12.27 14.66 Total attendances, males 5,664, females 6,555, total 12,219 There was one defective awaiting admission to the Centre on 31/12/50. During the year under review, the defectives attending the Centre made the following articles:- settee backs, needle cases, teapot stands, soft toys, pairs gloves, piano runner, knitting bag, peg bags, string bags, shopping bags, oak stools, small mats, tea cosies, cushion covers, wool rugs, rag rugs, tray cloth, trays, repairs to rugs etc. TABLE 42. DULY AUTHORISED OFFICERS. DETAILS OF VISITS, ETC., 1950. Mental Def iclency 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 93 1,435 96 140 80 1,844 1,334 839 51 2,224 4,068 63 SECTION 29 - HOME HELP SERVICE. This service, which has come through many "teething troubles", is playing a most valuable part to ensure a useful degree of help to those households, burdened by sickness, or the presence of an aged person, or threatened by domestic disaster from a variety of causes. It was never anticipated that the care of the aged in their own homes would make such heavy demands in working hours from our Home Helps. Indeed this has brought into sharp focus the fact of our aging community, for over one in ten of our burgessts is more than 65 years of age. The efforts made by the Local Authority to ease the lot of these old people should not mask, the pressing need for hospitalisation where sickness is an added burden. The figures shewn in the table (tabulation of cases) indicates the continued growth and necessity for this service. In 1949, 575 applicants received varying periods of service, as against 679 for the year under review. It will also be noted that in 1950, 205 cases had periods of service of between 9-12 months as compared with 57 for 1949. One hundred and sixty of the 205 applicants mentioned above were aged persons. The establishment of home helps approved by the Ministry of Health, as on 31/12/50, remained the same as for the previous year, i.e. 60 full-time or their equivalent in part-time service. The number employed at the end of 1950, was 6 permanent (4 whole-time and 2 part-time) and 91 casual. Full-time helps works a 44 hour week and the maximum number of hours permitted for the service per week, equals 60 x 44 = 2,640. The following statistics indicate the monthly number of hours worked (these include sickness, holidays and travelling time):- Month No. of hours. January 9,374¼ February 9,922¼ March 11,971 April 8,743¼ May 9,181 June 10,841¾ July 8,477¾ August 10,900 September 8,655 October 9,386½ November 11,764¼ December 8,448¾ Total 117,669 The maximum permitted number of hours for the year was 2,640 (per week) x 52 = 137,280, so it will be noted that for the period under review there was a difference between the maximum and the actual hours worked of 19,611 or a saving of 377 hours per week or the equivalent of , 8i full-time helps on the establishment 64 TABLE 43. HOME HELP SERVICE TABULATION OF CASES, 1950. Illness or other cause for which help provided Period of service provided Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Total Maternity 4 61 - - - - - - 65 Tuberculosis - 3 3 1 14 8 4 5 38 Cancer - - 1 - 2 5 5 3 16 Old Age 1 33 13 15 69 62 40 160 393 Other Sickness 3 20 20 6 40 23 18 37 167 Totals 8 117 37 22 98 67 205 679 Of the 393 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 - of this number 30 were serviced on grounds of senility only. Those receiving help for senility only are set out in the table below. Of the 679 applicants, with the prior approval of the Chairman and subsequent confirmation by the Health Committee, in 169 cases home helps were provided free of cost as compared with 269 for the previous year. TABLE 44. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Total Senility only 1 4 1 4 4 5 3 8 30 The above figures are included in the main table. SANITARY SECTION This section of the report relating to sanitary circumstances, housing, food inspection and the general routine work of this section of the Department has been compiled by the Chief Sanitary Inspector, Mr. R. A. Baskett, B.E.M., M.S.I.A. Staff changes during the year were fortunately at a minimum Mr. W. J. Worley, Deputy Chief Sanitary Inspector, retired in May and the Council appointed one of the District Inspectors, Mr. D. G. Tonkin as his successor. Mr. Hagedorn from Tottenham was appointed to fill the resulting District vacancy. The establishment of the sanitary section otherwise is the same as last year. Because of other demands upon the Inspectors' services, unfortunately it was not possible to follow up and expand to the extent anticipated the detailed work in connection with the hygiene of food premises and a clean food campaign. 65 In collaboration with the Coancil's Housing Department, special attention was given to housing under Part III of the Housing Act 1936. During the year as a result of the surveys and Inspections carried out, the Medical Officer of Health made official representations in respect of the following four areas Order Area Houses Families Population C.P.O. Telham Road and Mountifeld Road 94 110 370 C.P.O. Vicarage Lane (part of) 6 4 16 C.P.O. Wakefield Street (No. 1) 9 7 17 C.P.O. „ „ (No. 2) 6 7 21 Public Inquiries were held by the Minister of Health and in October the Minister confirmed with modification the order in respect of the Telham Road and Mountfield Road area. The Minister's decision in respect of the other three orders is not yet to hand. Environmental hygiene continues to be adversely affected by the reluctance of owners, in receipt of controlled rents, to carry out repairs at present costs, and to a lesser degree to protracted or belated negotiations by owners with the War Damage Commission. In consequence it was necessary to invoke statutory action and legal proceedings in many instances in order to effect compliance with sanitary notices. These factors would be more obvious in their effect but for the extensive and often substantial war damage repairs carried out generally throughout the Borough. Inspections made during the year totalled 39,856 including 8,445 inspections and 22,442 re-inspections under the Public Health Act and 1,886 inspections under the Housing Act 1936 as compared with last year's figures of 35,106 - 8,700 - 17,277 - 2,255. 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 39,856 (i) Housing. Under Public Health Act 8,445 Re-inspections 22,442 Housing Act, 1936 1,886 (ii) Sanitary Circumstances. Yards and Passages 187 Drainage and Sanitary Accommodation 2,559 Factories (excluding Bakehouses) 381 Workplaces and Outworkers 507 Caravans 12 Re Offensive Fumes 41 Miscellaneous 560 66 (iii) Food Supply. Slaughter houses - Dairies 21 Food Premises 1,487 Bakehouses 86 Re Sampling 550 (iv) Infectious Disease. Visits 692 (b) Notices. The number of notices served during the year totalled 5,074, of which 1,143 were statutory notices. The number of notices complied with in the same period was 4,727. Complaints made to the Department with regard to sanitary circumstances, disrepair, infestations, obstructed drains, etc., totalled 3,133. (c) Rodent Control. The number of complaints received in respect of rat and mice infestations totalled 329. This is a slight increase over last year's figure, which might be thought to indicate a worsening of such conditions in the Borough. Fortunately this is not so, for there were fewer complaints of rats, but more from occupiers of houses infested with mice. No opportunity is lost to impress upon the public the dangers to health likely to arise from the presence of mice, but rarely is the department notified of mice infestations until the infestation has reached such proportions as to cause both alarm and inconvenience to the occupier of the premises. The Council's systematic treatment of the sewers and the prompt application of control methods to surface infestations had reduced the rat population of the Borough to a very low level. The objective of course, is complete extermination, but such an objective does not appear possible under present circumstances. (d) Disinfection and Disinfestation. It was found necessary or desirable to disinfect rooms and their contents at 340 premises. In addition 440 library books were disinfected. The steam disinfection of bedding was carried out on 170 days df the year. The disinfestation of 164 premises was successfully carried out by the use of D.D.T. insecticide either in the form of spray or smoke supplemented by steam disinfection of the bedding where necessary. Comparisons with figures prior to the last war indicate that verminous premises in the Borough are considerably less in number. (e) Legal Proceedings. It was necessary to resort to legal proceedings in the following instances:- Public Health Act 1936 - Section 94 94 Food & Drugs Act 1938 - Section 3 1 Rag Flock Act 1911 1 Total 96 6? (f) Drainage. Complaints of choked or defective drains were received in respect of 674 premises. Wherever possible the removal of obstructions was effected by the Council's drain cleaner. Examinations and tests of house drainage were made in 285 instances. Arising from the number of urgent requests at weekends for the services of the drain cleaner to attend to obstructed drains, the Council, as and from the 1st April, arranged to meet this demand, the necessity for such emergency arrangements so far, appears to be justified, (g) Factories, Workplaces and Outworkers, During the year 888 inspections were made of such premises, a considerable increase over the figures recorded for last year. Conditions generally continue to improve. The number of outworkers in the Borough showed a marked decrease. The majority of them were engaged in the manufacture of fancy goods. (h) Mosquito Control, Systematic treatment of the ditches and low lying land in the Borough was continued. Fewer complaints were received of nuisances arising from the presence of mosquitoes or flies. Apart from the effectiveness of any treatment carried out, it would appear that the weather generally was less favourable for their propagation and consequent nuisance effect, (i) Places of Public Entertainment. Frequent periodic inspections were made of these premises, and special attention given to the cinemas. Adverse reports upon the sanitary conditions prevailing, or failure to conform to the Council's Regulations were almost negligible. The difficulty of maintaining such places in a state of reasonable cleanliness is now much greater than in pre-war days. The amount of rubbish in the form of peanut shells, orange peel and ice-cream cartons deposited by the public, where they sit or stand, is a serious reflect ion upon the habits and conduct of many of the patrons of these and other public places. (j) Rent and Mortgage Interest Restrictions Acts 1920 - 1939. Applications for certificates in respect of the sanitary condition of houses totalled 30. the number of certificates issued was 21. In the remaining 9 instances the existing defects were remedied in consequence of informal action taken by the Department and no certificate was issued. (k) Shops Act 1950. Particulars with regard to the administration of the Act are summarised as follows:- Number of shops in the Borough subject to the Act 2,113 „ „ „ „ „ „ open 1,931 „ „ „ „ „ „ closed 182 Number of assistants employed Males 1,309 Females 1,829 Young Persons - Males 89 „ „ - Females 154 Total 3,381 68 Visits - Shops Register 1,975 „ - arrangements for health and comfort of Shop Workers, Records etc. 679 Visits and observations - Closing Hours 1,052 Visits - Holiday Closing 301 Total 4,007 It was necessary to caution shop keepers on some 189 occasions for serving customers after hours. Most of these contraventions occurred during the "Winter Hours of Closing" periods The demand for the late night to be on Friday, particularly in regard to food shops, appears to be justified. In response to local demands the Council changed the "late" night from Saturday to Friday during the winter months in respect of the trades of (a) Hairdressers and Barbers (b) Fruiterers and Greengrocers. (l) Pharmacy & 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 186 (157 renewals and 29 new applications,,) 307 inspections were made in the enforcement of this Act. (m) Explosives Act 1875. 123 licences (88 renewals and 35 new applications) were issued for the storage of mixed explosives (fireworks). Inspections of premises used for this purpose totalled 146, (n) Fertilisers and Feeding Stuffs Act 1926. 10 samples of fertilisers and 3 of feeding stuffs were taken during the year. Only 2 samples of fertilisers were reported lay the Council's Agricultural Analyst to be unsatisfactory. Analysis showed a deficiency of phosphoric acid in each case. The vendors were cautioned. The significance of the particulars required in statutory statements is generally appreciated by both vendors and the public but unfortunately rarely understood by either. (o) Rag Flock Act 1911. 5 samples of rag flock were submitted to the Analyst during the year. One sample failed to conform to the Regulations. This contained 140 parts of chlorine per 100,000 parts of flock. The vendor of this sample was prosecuted. HOUSING. Survey of premises for the Housing Department was continued and during the year 1,311 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) 11,023 (b) Number of inspections made for the purpose 33,465 (2) (a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidation Regulations, 1925 115 69 (b) Number of inspections made for the purpose 460 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 112 (4) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not be in all respects reasonably fit for human habitation 5,646 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 3,764 III. Act ion 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 services 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 1,143 (2) Number of dwelling houses in which defects were remedied after service of formal notices:- (i) By owners 951 (ii) By Local Authority in default of owners 12 (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 - 70 The following statistics have been supplied by the Council's Chief Housing Officer, Mr. J. E„ Austin, M. B. E. HOUSING STATISTICS Position at 31st December, 1950. 1. Accommodation made available - family units (i) By repair of weir damage 6,233+ (ii) By requisitioned premises 1,324 (Hi) By new housing (including 474 cost of works rebuilds) 2,019 (iv) By emergency hutments - 9,576 + This figure includes 3,307 houses classified Cb (War Damage) and rebuilt by Local Authority. 2. Families rehoused since August, 1945 3,182 3. Cases of overcrowding under Housing Act, 1936 abated by rehousing since August, 1945 (included in 2) 859 4. Total of current applications for rehousing 7,137 5. New housing Dwellings Projected Under Construct lor l Completed Temporary 934 - 934 Permanent 1,731 82 611 Cost-of-Works Rebuilds 527+ 27 474 Totals 3,192 109 2,019 + After adjustment by Primary Education Plan. INSPECTION AND SUPERVISION OF FOOD (a) Milk Supply. The number of milk distributors registered at the close of the year was 125 and the number of dairies 11. The following licences were issued to use special designations prescribed in the Milk (Special Designation) Regulations 1949 Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations. Pasteurised - Dealer's Licence 94 Supplementary Licence 10 Dealer's (Pasteuriser's) Licence 2 Tuberculin Tested 2 Sterilised Dealer's Licence 106 Supplementary Licence 10 Dealer's (Steriliser's) Licence 2 71 Milk. (Special Designation) (Raw Milk) Regulations - Tuberculin Tested Dealer's Licence 21 Supplementary Licence 10 Milk samples submitted for bacteriological examination are summarised as follows :- Unsatisfactory Pasteurised 67 5 Sterilised 9 T.T„ Pasteurised 7 Heat Treated 1 84 J5 The five unsatisfactory samples failed to satisfy the methylene blue test. Investigations in respect of these samples did not provide any satisfactory explanation. It Is a fact and apparent from the foregoing figures, that the bulk of the milk sold and consumed in the Borough Is subjected to a prescribed form of heat treatment and complies with the requirements of the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949. (b) Meat and Other Foods. (1) Meat Inspection. Routine inspections of butchers' shops in the Borough were maintained throughout the year and particular attention given to manufactory premises. Improvements were observed and effected in shops and factories. Some 1,895 lbs of meat were surrendered by local butchers as unfit for human consumption* Observations and inspections were also ma.de of the transport and methods of delivery of meat in the Borough. The improvement effected towards the end of last year was well maintained, Unfortunately the ideal porter and delivery van have yet t.o materialise. (2) Food Premises. Inspections of food premises included 21 visits to dairies, 86 to bakehouses and ls487 to other food shops. Food hygiene standards tend to improve, if somewhat slowly, but the failure of foodhandlers to take full advantage of the washing facilities provided is to be regretted. In this connection, the Council continued to provide free washing facilities at the public conveniences for outdoor foodhandlers. Employers were asked to encourage their staffs to use these facilities, but there is no indication that such an appeal had any effect. In April the confirmation of the Minister of Food was received in respect of byelaws for the Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air. These byelaws give an essential Impetus to the provisions of Section 13 of the Food and Drugs Act 1938, and have already been found extremely useful in the prevention of food contamination and the furtherance of food hygiene. 72 During the year the Council decided to plan a clean food campaign and organise a "Food Hygiene Guild". The Guild is to be administered through an Advisory Committee consisting of the Chairman of the Health Committee as an ex-officio member, four members nominated by each of the Council and the local Chamber of Trade and Commerce, one member nominated by each of the London Co-operative Society Limited and the Union of Shop Distributive and Allied Workers, together with other members representative of traders in the Borough as the Committee may approve. Draft codes of practice are in preparation, and it is hoped during the forthcoming year to launch both the Guild and clean food campaign. (3) Slaughterhouses. There is only one licensed slaughterhouse in the Borough which was not in use during the year. (4) Bacteriological Sampling. In addition to the -85 samples of milk, the following were submitted for examination : 46 ice-cream, 1 tinned ham, 1 portion of meat, 1 sponge cake, 1 tin of cherries, 3 ice-cream lollies and 1 lolly stick, 2 drinking water and 6 samples of water from the public swimming baths. The ice-cream samples were graded by the Council's bacteriologist in accordance with the Ministry of Health's Provisional Grading as follows ;- Grade I 14 " II 16 " III 9 " IV 7 Total 46 The fat content of the ice-cream samples varied from 1.5 per cent. to 16 per cent. and the total solids from 12 per cent to 41 per cent. The average fat and total solids contents were 9.1 per cent. and 32.1 per cent. respectively. The tinned ham was normal in appearance and the gelatine solid. It had however a slight fetid odour. The ham was found to contain excessive numbers of organisms including some of excremental origin and was therefore regarded as potentially dangerous for human consumption. It would seem that the meat was inefficiently sterilised during production or than canning was imperfect. Samples of meat, sponge cake and tinned cherries were submitted for examination in connection with suspected food poisanlng. All were found to be satisfactory. The ice-cream lollies manufactured by a local vendor contained ice-cream. Hie lollies were reported by the Council's Bacteriologist as of a fair standard of bacterial purity but that a reduction of the content of coliform organisms was necessary. The spatulas or lolly sticks contained more bacteria than was considered desirable. The manufacture of this particular type of "lolly" on the advice of the Department was discontinued. The samples of drinking water and public swimming bath water were said to be satisfactory. (5) Ice-Cream. Constant vigilance In regard to the sale and manufacture of' ice-cream was maintained throughout the year. 28 additional premises were registered for the sale of ice-cream and one for manufacture and sale. One application was refused and one registration cancelled. 73 The number of premises on the Council's register at the end of the year was 111, of these 21 were equipped for the manufacture of ice-cream. The number of itinerant vendors in the Borough of this delectable but vulnerable foodstuff showed a sharp decline. This may nave been due to (1) the unfavourable summer season (2) the often informal but constant pressure and supervision exercised by the Depart™ ment In regard to the activities of these unregistered traders. (6) Other foods. Foodstuffs sold in the Borough were generally of good quality. The co-operation of local traders was readily forthcoming tn this respect and the following foodstuffs were surrendered by them and condemned as unfit for human food Canned goods Milk. 1,456 tins, fish 1,520, fruit 390, meat 366, other foods 2,758 tins or packages. Others Meat 1,895 lbs.s fish 1,400 lbs., fruit. 749 lbs., cheese 106 lbs., confectionery 69 lbs., vegetables 1,792 lbs., spaghetti 91i lbs., pearl barley 56 lbs., coconut 130 lbs.. Ice-cream 18 gallons. One local trader was prosecuted and fined £15. and £l.ls.0d. costs for selling a macaroon tart containing rodent excreta. This offence occurred In December 1949. (c) Adulteration. Three hundred and forty three samples of foodstuffs were obtained by the Sanitary Inspectors and submitted to the Public Analyst. Details of the various samples and the results of the analyses are set forth in the following tabular statements. Of the samples reported as unsatisfactory, 2 were due to deficiencies, 4 to some form of contamination, 5 to the presence of preservative, which although within the permitted limits, was not disclosed to the purchaser. One sample was mlsdescrlbed as non-brewed vinegar instead of artificial vinegar and in another instance rye flour was erroneously sold as oatmeal TABLE 45. Number of Samples Percentage of samples adulterated Exami ned Found adulterated or below standard Beverages (non-alcoholic) 2 - - Cheese 2 - - Confectionery 7 - - Drugs 15 - - Fats 2 - — Meat and meat products 58 5 8.6 Milk 107 1 0.9 Preserves 11 - - Vinegar 10 2 20.0 Wines and Spirits 13 - - Others 116 5 4.3 Totals 343 13 3.8 74 Details of samples adulterated or below standard, together with resultant action j- TABLE 46. Number Informal or formal Article Adulteration or Deficiency Action taken 6026 I Port Sausages Contained 190 parts per million of sulphur dioxide. Letter of caution 6034 I Bread Contained some form of dirt. -ditto- 6038 F Salad Cream Deficient In oil 2„6 per cent. Manufacturers In liquidation. Stock Withdrawn from sale. 6039 I Bread Rodent excreta adhering to side of loaf. Place of contamination not ascertainable. 6115 I Liver Sausage Contained 70 parts per million of sulphur dioxide. Letter of caution 6164 I Sterilised Milk Minute trace of volatile phenolic compounds. Letter of caution 6185 I Non-brewed Vinegar Deficient in acetic acid .3 per cent. Letter of caution 6226 I Pork Sausages Contained 45 parts per million of sulphur dioxide. Letter of caution 6230 I Non-brewed Vinegar Not properly described as vinegar. Letter of caution 6242 I Bread Presence of rodent excreta. Unable to ascertain where contamlnated. 6256 I Pork Sausages. Contained 200 parts per million of sulphur dioxide. Letter of caution 6317 I Oatmeal Not oatmeal but rye flour. Letter of caution 6327 I Beef Sausages. Contained 200 parts per million of sulphur dioxide. Letter of caution 75 COUNTY BOROUGH Of EAST HAM EDUCATION COMMITTEE TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE. Mr. Chairman;, Ladles and Gentlemen, I beg to present my Annual Report on the School Health Service. The integrity and continuity of this service at a high level of efficiency has been an important factor In ensuring that ill health should not handicap any child in our schools from receiving the benefits of education within his potential. Efforts are being made to raise the standards of medical inspection carried out in the schools, and to combine with the physical examinations, instruction to the parents and scholars on health education. It is felt that the seed of health education ideas thus sown at a most opportune time and in good soil is bound to bear a rich harvest,, for what better soil than the parent who voluntarily attends the medical inspection? The school health clinics and the specialist clinics complement and augment the work thus begun, and nothing has transpired which would alter our belief that dichotomy of the clinic services between the Regional Hospital Board and the Local Authority would be a retrograde step. Reference was made in the last report to the medico-social trend of school milk, school meals and school health on which the well-being of the scholars was truJy founded. It can only be maintained If dental health Is fostered among the children, for with the threatened disruption of the school dental services one of the mainstays of the trend will be so weakened that the whole edifice might crumble and decay. We must win back the competent young dental surgeon to his place at the apex of the phalanx of those who strive for prevention of illness amongst our children. Financial considerations should not mask our vision of vigorous and strong school-children, the pearls of our national treasure. I wish to express my sincere thanks to the Chairman and members of the Education Committee for their continued encouragement and support, and to the Chairman of the Care and Welfare Sub-Committee who by her industry, patience and discriminating criticism has done much to further this worth-while work. I have the honour to be. Ladies and Gentlemen, Your obedient servant, J. S. COLEMAN, School Medical Officer. 76 GENERAL INFORMATION. Schools and Numbers on Roll (mid 1950). TABLE 47. Type Number of Schools Number on Roll County Primary: Infant .. 17 9,817 15 County Secondary 11 5,276 Voluntary (Infant and Junior) 4 878 Totals +44 15,971 + (3 county schools are combined Infant and Junior). Estimated number of children aged 5-14 Inclusive (mid 1950) 15,320 School Clinic premises and purposes served:- Address. Types of Clinic Town Hall Annexe, School Health Barking Road, Diphtheria Immunisation Aural Ophthalmic Physiotherapy and Sunlight Dental Manor Park Clinic, Church Road, North Woolwich, Fernhill Street. Shrewsbury Road School School Health Diphtheria Immunlcatlon Physiotherapy and Sunlight Dental School Health Child Guidance Speech Therapy 77 TABLE 48. - 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 Ophthalmlc Physiotherapy Physiotherapy Ophthalmic Physiotherapy Ophthalmic Dental Bental (general anaesthetics) Dental Dental Dental Dental MANOR PARK School Health School Health Physiotherapy Physiotherapy Physiotherapy Physiotherapy Dental (general anaesthetics) AFTERNOON ANNEXE Sunlight Dental Shrewsbury Rd. Child Guidance North Woolwich School Health School Health Physiotherapy Aural Dental Sunlight Immunisation Aural MANOR PARK School Health Immunisation Physiotherapy Dental 78 SCHOOL HEALTH CLINICS. We have been fortunate to maintain our clinics fully staffed throughout the year. The Health Visitors see every child and refer to the doctor only those in need of detailed examination. No opportunity is missed to inculcate lessons in health education, and it is found that parents and pupils alike are avid recipients of the 'new learning'. I consider the Health Visitor's time is nor. ill spent in conducting these clinics, for her nursing skill is a good introduction to a refractory youngster, and her clinical knowledge can relieve much anxiety in harassed parents. It would be wrong to delegate this work to nurses who have not received the wide training of the health visitor of to-day. COMPARATIVE STATISTICS. The following table indicates briefly the work of the School Health Service during the year 1950, and shows the comparative statistics for previous years. TABLE 49. 1946 1947 1948 1949 1950 Routine and Special Inspections at School: Maintained Secondary Schools 1,404 2,614 1,932 2,331 1,385 Maintained Primary Schools 4,034 3,600 4,941 6,272 5,811 Re-inspections at School 2,834 3,209 2,675 3,142 2,436 Inspections and Re-Inspections at Clinics 11,571. 11,141 10,748 9,686 10,369 General, cleanliness visits to schools 256 281 284 28? 269 Examinations for cleanliness 30,077 48,514 38,561 42,040 37,569 Nurses' visits to homes 1,404 1,212 3,691 8,012 4,496 SCHOOL MEDICAL INSPECTIONS. Every effort was made during the year to make these inspections worth while. To the doctor, negative findings enable him to give words of praise and encouragement to the parent and spend a few minutes on 'health talk'. Mothers often come to the examination with some anxiety and loaded with secret feelings of guilt that they have not done this or that for the child or have mishandled or actually ill-treated him. the School Medical Officer can do much to resolve these anxieties and relieve the guilt feelings by careful and pointed instruction In the basic truths of mental health. Similar tasks can be undertaken for scholars suffering from nocturnal enuresis or known to masturbate. 79 The active Interest of the Head Teachers In this work Is so gratifying that one feels the era of hostility between teachers and doctors has passed away to be replaced by an understanding comradeship in the field of child health. SUMMARY OF INSPECTIONS AND RE-INSPECTIONS. Periodic Inspections: At Schools 7,123 Special Inspections: At Schools 73 At School Health Clinics 6,753 Handicapped Pupils 117 For Employment 57 For Special Courses, etc. 504 Re-lnspectlons at Schools 2,436 Re-inspections at Clinics 3,616 MEDICAL INSPECTION AND RE-INSPECTION AT SCHOOLS, TABLE 50, School Infant Junior Secondary I R s I R S I R s (a) County Primary and Secondary Schools: Altmore 323 77 6 – – – – – – Avenue 137 43 — 251 61 — - - — Brampton 120 46 — 221 91 6 17 «=* - Central Park 188 77 2 - – - 25 - - Cornwall - — 183 44 3 185 70 11 Dersingham 178 41 3 - - Essex 169 52 1 - - - 36 - - Hartley 265 - - 375 145 2 - - Kensington 92 21 - 226 78 - — - - Lathom - - — 364 125 - - - - Monega 91 39 2 - – — 37 87 4 Napier 207 58 — - - - 270 94 1 Roman Road 45 30 - 84 35 - - - Salisbury Sandringnam 96 150 34 52 3 2 311 69 215 50 3 Shaf tesbury 294 90 - 389 130 1 – – – Storey Street 25 12 — 53 25 - - - - V) car age 116 40 283 98 1 32 - - Winsor 95 25 — 62 17 7 - - - Boys' Grammar - - - - - - 271 104 - Girls' Grammar - - - - — 231 151 8 Technical School of – – – – – Building - - - - - - 37 28 2 (b) Voluntary Schools (R.Co): St, Edward's 64 36 - 59 22 - - - - St, Michael's 78 56 — 115 69 4 - — - St, Wlnefride's - - - - Sllvertown 23 10 - 35 4 1 - - - 2,756 839 19 3,011 1,013 25 3,356 584 29 I. - Periodic inspection, R. - Re-inspectlon, S, - Special inspection. 80 AGE GROUPS, GENERAL CONDITION, COOPERATION OF PARENTS, TABLE 51. Group Total inspected Parents present Requiring. treatment General Condition A B C No. % No. % No. % No, % No. % I 1832 1731 94.5 547 29.8 1146 62.6 658 35.9 28 1.5 II 1499 1070 71.3 395 26.3 889 59.3 590 39.4 20 1.3 III 752 116 15.4 171 22.7 523 69.5 229 30.5 - 0.0 Age 6-7 924 874 94.5 205 22.2 635 68.7 281 30.4 8 0.9 Age 7 - 8 1512 1323 87.5 452 29.9 869 57.5 627 41.4 16 1.1 Age 12 - 13 604 163 27.0 110 18.2 519 85.9 85 14.1 0.0 Totals 1950 7123 5277 74.8 1880 26„4 4581 64,3 2470 34.7 72 1.0 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 GROUP AUDIQMETRIC TESTS. Audiometrlc tests were carried out during the year on children In the final primary-school year, and those failing to reach the required standard of hearing are being referred to the E.N.T. clinic for investigation. Owing to the large number of cases attending this clinic there is considerable delay in the treatment of these children, but it is hoped that arrangements will shortly be made for an additional weekly session. Runber of children tested - 1,203. Number referred for further investigation - 208. 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, 3.17 special examinations have been carried out by approved medical off leers, as a result of which, 129 children, ascertained to be within the various categories, were recommended for special educational treatment as Indicated In the following table 81 TABLE 52. Category Number ascertained Recommendation Day Special School Boarding Special School Ordinary School with special treatment Bli nd — Partially Sighted 1 1 — - Deaf — - — — Partially Deaf - - - ■■ De11cate 15 - 10 5 D1abetic - - - — Educationally Sub-normal 26 - 12 Epileptic - - - — Maladjusted - - — — Physically Handicapped 9 2 7 — +Suffering from Speech Defect 77 - - 77 E,S.N. and Physically Handicapped 1 1 - - + 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, Fifteen 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 provision of : Section 57 (3) 9 Section 57 (5) 6 MEDICAL TREATMENT. SUMMARY OF DEFECTS TREATED AT SCHOOL HEALTH CLINICS. Skin: Ringworm 6 Scabies 6 Impetigo 21 Other Diseases 354 Eye Disease 236 Defects of Ear, Nose and Throat 73 Other Defects 1,294 Total 1,990 Total attendances at School Health Clinics 11„201 82 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 a'tend 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 49. Number of children attending 538. Number of attendances 1,163. Number of children discharged 524. Defects and treatment: TABLE 53. Defect Number observed Number treated Referred for operation Discharged after treatment 373 152 221 370 Other throat conditions 28 28 - 26 Deafness 91 91 - 86 Otitis Media and discharging ears 44 44 - 43 Other ear conditions 80 76 4 79 Nasal deformities 5 5 - 5 Rhinitis 17 17 - 17 Catarrh 32 32 - 30 Other nose conditions 61 61 59 Totals 731 506 225 715 Of the cases referred for operative treatment, 221 were for the removal of tonsils and adenoids and four for removal of polypi in the ear. The operations were performed by Mr. Savege at the Children's Hospital, Balaam Street. OPHTHALMIC CLINIC. The need for an orthoptic clinic to deal with the large number of squint cases which cannot, be treated at the recognised eye hospitals, has become abundantly manifest. The waiting list for appointments is so long that many children cannot hope to begin treatment for over a year. The Regional. Hospital Board have bs&n approached and it is expected that agreement will be reached to enable us to hold an orthoptic clinic at the Annexe. The Clinic is at present organised in accordance with the interim arrangements outlined in Circular 179/48. 83 The number of sessions has been Increased to three per week Statistics are as follows Number of clinic sessions 150 Number of children attending 1,491 Number of attendances 2,972 Number of children discharged 77 Defective Vision and Squint Eye Disease New cases 238 Treated at clinic 86 Re-examinations 1,167 Referred to hospital 16 Glasses prescribed 888 +Glasses obtained 904 Glasses not required 66 Referred to hospital 75 + Information from Local Executive Committee. The following cases were referred to hospital for treatment :- Defective vision 3 Squint 69 Defect of Retina 2 Nystagmus 1 Cyst 4 Blepharitis Conjunctivitis 1 Other conditions for investigation 8 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 80 Number of children completely immunised 112 Number of children re-inoculated 94 Percentage of children of school age completely immunised 65.7 CHEST CLINIC. As In previous years a considerable number of children have been referred to the East Ham 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 15 Non-pulmonary 1 84 CHILD GUIDANCE CLINIC. 1. No. of sessions attended by Dr. H. Bevan Jones during 1950 96 2. No. of sessions attended by Dr„ W„ H. Cralke during 1950 34 3. No. of cases under treatment on 1/1/50. 80 4. No. of cases referred for treatment during 1950. 136 5. Total number of new cases who received treatment in 1950. 133 6. No. of cases discharged or not requiring treatment, removals etc. during the year 85 7. No. of cases under treatment on 31/12/50. 128 8. Total attendance of C. G. cases at sessions attended by Psychiatrist 756 9. No. of cases seen by Psychologist 133 Attendances 551 10. No. of visits to schools by Psychologist 93 11. No. of sessions attended by Playtherapist 90 Attendances 298 The Child Guidance Clinic opened in 1950 with a full team, having a Psychiatric. Social Worker on the staff for the first time since its transfer from the Memorial Hospital. The full team therefore comprise Dr. Bevan Jones (Psychiatrist - 2 sessions a week) Dr. Cralke (Psychiatrist - one session a week) Mrs. Barker (Play-Therapist - 2 sessions a week) Miss Van Gorder (Psychiatric Social Worker) and Mr. Wright (Educational Psychologist). The work during the first half of the year reflected the usefulness of the full team. The Psychiatric Social Worker made a valuable contribution in diagnostic work, by support and help to parents, and by home visits, particularly with cases tending to fail appointments and also those needing follow-up work prior to closing. Unfortunately for the Clinic Miss Van Gorder, married at midsummer and left to take up an appointment near her husband's work in Oxford. The staff was further reduced when Dr. Cralke resigned in October and a promising year finished with only two full Psychiatric sessions weekly. The loss of the Psychiatric Social Worker was severely felt, the more so as the value of the full team had begun to make itself very evident. In spite of these later handicaps the team were able to see as many new cases as referrals. However discharges lagged behind referral rate so that, the number of cases under treatment rose from 80 at the beginning of the year to 128 at the end, thus diminishing the prospects for treatment of new cases in 1951. This however, it was hoped, would be offset by the appointment of a successor to Dr. Cralke. The trend towards early referral continued during the year. In this connection the clinic welcomed the visits of student Health Visitors and the opportunity to tell them something about the work undertaken. Health Visitors very obviously have a most Important function in the early referral, and prevention, having access to the homes of pre-school children and being In a position to assess the development of unfavourable attitudes at a time when they are most easily adjusted and when such adjustments are likely to have great effect. The Clinic looks forward to a future of close co-operation with Health Visitors for In this co-operation lies the foundation of much valuable preventative work. Co-operation with the Speech Therapist has continued to be a valued aspect of our work - the informal discussions made possible by the sharing of the same premises were particularly useful. 85 SPEECH THERAPY. 1. No. of Cases referred in 1950 69 2. No. of Cases under treatment on 31/12/50 84 3. No. of Cases discharged or not requiring treatment, removals etc., during the year 31 4. No. of Cases waiting treatment 31/12/50 29 5. Total attendances for treatment 1,690 The Speech Therapy Clinic has run its firs, full vear and has dealt with many defects of speech ranging of cases of stammering and cleft palate to lisping and "Baby-Talk". Cases are referred by School Medical Officers, Head-Masters of schools, parents and any other body officially dealing with the pre-school and school population. On reference, the patient is given a preliminary examination to determine whether he is In need of immediate treatment or, if the defect is nor severe, the mother is given advice on how to help him at home and his name is Included in the waiting list. The patients generally attend the clinic for treatment, once a week, the duration of which is from twenty minutes to half an hour. The school is informed so that the teachers know when to send the child out of his class. After treatment has begun, visits of parents to the clinic and of the therapist to the school are frequent, In order that continuous contact may be maintained between home, school and clinic. In cases of suspected deafness or of possible nasal obstruction the child is referred to the Aural or the E.N.T. clinics where the necessary examination is made by the specialists. If tonsillectomy and adenoldectomy are Indicated, treatment Is suspended until after the operation. Other referrals may be for orthodontic treatment or if, as in many cases of stammering, the patient shows signs of considerable emotional disturbance, then he is referred to the Child Guidance Centre and Speech Therapy Is resumed after he has been treated by the Psychiatrist. The most common defect to be dealt with in School Clinics is Dyslalla - which is an acute form of lisping or lalllng accompanied trycomplete or partial disco-ordination of the muscles governing speech. Cleft palate is quite frequent, which may or may not be accompanied by cleft-lip; here It Is Important that the flexibility of the muscles affected by the operation should be induced. Lip and tongue exercises are given for the child to practise at hlme and exercises for breath direction and palate jerking are also included in the treatment. There are now 23 stammerers receiving treatment, the basis of which is relaxation. This enables us to relieve the mental strain and help them acquire the greater ease of mind which will In turn restore self confidence, self respect and by degrees eliminate the fear of speech. HOSPITAL TREATMENT. Apart from the financial implications the change in administration of the hospitals has made little difference to the treatment of Ease Ham pupils. Cases requiring specialist services are referred to an appropriate hospital and the provision of all forms of treatment is thus maintained. Operative treatment of tonsils and adenoids has been carried out as follows Children's Hospital, Balaam Street 411 St. Mary's Hospital, Plalstow 115 86 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 cooperation 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, with a marked reduction In the number of Infested children. Number of visits paid to schools 269 Number of examinations 379569 Number of pupils found unclean 819 Number of cleansing notices (Section .54 (2)) 69 Number of cleansing orders (Section 5k (3)) Very few cases requiring more than simple hygienic measures plus the use of a modern larvlcal 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 4,496 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 1950. The minimum number of dental officers required to provide an efficient service for the school-children and the maternity and child welfare scheme, is four. Early in 1950 the number of officers was reduced to two, and at the end of October to the equivalent of one and a half officers. It will be obvious therefore that the condition of the children's teeth is certain to deteriorate. The demand for dental treatment is greater than ever owing to the fact that few children can be treated by the overworked practitioners in the General Dental Service. In addition, the condition of the teeth of the children under school age shows marked deterioration which may be due to a dietary deficiency. As will be seen from the statistical details in Table 58, the depleted dental staff has made a very great effort to cope with the enormous demand for- their services. 87 MEDICAL INSPECTIOK OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. TABLE 54. A. - PERIODIC MEDICAL INSPECTIONS, Number of Inspect ions In the prescribed Groups : • Entrants 1,832 Second age group 1,499 Third age group 752 Total 4,083 Number of other Periodic Inspections 3,040 Grand Total 7,123 B. - OTHER INSPECTIONS. 7,50k 6,052 Total 13,556 C„ - PUPILS FOUND TO REQUIRE TREATMENT0 Number of Individual pupils found at periodic medical inspections to require treatment (excluding dental diseases and Infestation with vermin). TABLE 55o Group For defective vision (excluding squint) For any of this other conditions recorded in Table 56A Total individual pupils Entrants 8 542 547 Second age group 163 271 395 Third age group 97 82 171 Total (prescribed groups) 268 895 1,113 Other periodic inspections 209 597 667 Grand Total 477 1,492 1,780 88 TABLE 56o A. - RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER 1950. 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 124 28 480 26 Eyes - a. Vision 477 113 391 80 b. Squint 74 15 104 ' 7 c. Other 57 12 245 23 Ears - a. Hearing 27 10 26 5 b. Otitis Media 19 6 31 3 c. Other 17 10 94 20 Nose or Throat 341 363 602 325 Speech 35 32 42 41 Cervical Glands 12 51 28 32 Heart and Circulation 28 44 9 29 Lungs 83 98 32 30 Developmental - a. Hernia 8 9 3 5 b. Other .. 24 40 9 25 Orthopaedic a. Posture 111 68 33 33 b. Flat Foot .. 190 64 86 36 c. Other .. 278 172 151 77 Nervous system a. Epilepsy 4 3 11 7 b. Other .. 17 22 28 25 Psychological a. Development 16 17 12 18 b. Stability .. .. 17 33 38 10 OJher .. .. 352 224 1,246 241 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 1,832 1,146 62.6 658 35.9 28 1.5 Second age group 1,499 889 59.3 590 39.4 20 1.3 Third age group 752 523 69.5 229 30.5 - 0.0 Other Periodic Inspectic >ns 3,040 2,023 66.5 993 32.7 24 0.8 Total 7,123 4,581 64.3 2,470 34.7 72 1.0 89 TABLE 57. TREATMENT TABLES. GROUP 1, - DISEASES OF THE SKIN (excluding Uncleanliness). Number of Cases treated or under treatment during the year By the Authorlty Otherwise Skin - Ringworm - Scalp: (i) X-Ray treatment - - (ii) Other treatment 3 1 Ringworm - Body 3 - Scabies 6 2 Impetigo 21 3 Other skin diseases 354 74 Total 387 80 GROUP 2. - EYE DISEASES, DEFECTIVE VISION AND SQUINT. No. of Cases dealt with By the Authority Otherwise External and Other, excluding errors of Refraction and Squint 322 18 Errors of Refraction (including Squint 1,394 72 Total 1,716 90 Number of Pupils for whom spectacles were : (a) Prescribed 888/- (b) Obtained+ 904/- + Information received from the East Ham Executive Council. i Including cases dealt with under arrangements with the Supplementary Ophthalmic Services. GROUP 3. - DISEASES AND DEFECTS OF EAR, NOSE AND THROAT. Number of Cases Treated By the Authority Otherwise Received operative treatment : (a) for diseases of the ear .. - 1 (b) for adenoids and chronic tonsillitis - 526 (c) for other nose and throat conditions - 4 Received other forms of treatment 73 507 Total 73 1,038 90 GROUP 4. - ORTHOPAEDIC AND POSTURAL DEFECTS. (a) Number treated as In-patients In Hospitals 2 By the Authority Otherwise (b) Number treated otherwise, e.g. in clinics or out-patients departments 624 209 GROUP 5. - CHILD GUIDANCE TREATMENT. Number of Cases TreatPd In the Authority's Child Guidance Clinics Elsewhere Number of pupils treated at Child Guidance Clinics 213 3 GROUP 6. - SPEECH THERAPY. Number of Cases Treated By the Authority Otherwi se Number of pupils treated by Speech Therapists 182 2 GROUP 7. - OTHER TREATMENT GIVEN. Number of Cases Treated By the Authority Otherwise (a) Miscellaneous Minor Ailments 199 28 (b) Other 1. General debility 916 59 2. Diseases of the digestive system 45 197 3. Enuresis 69 5 4. Developmental Defects - 37 5. Asthma and Respiratory Diseases 37 93 6. Rheumatism, Heart and Circulation 10 22 7. Nervous Disorders 18 30 Total lp294 471 91 TABLE 58. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils Inspected by the Authority's Dental Officers 9,074 (b) Spedals 1,568 Total 10,642 (2) Number found to require treatment 5,477 (3) Number referred for treatment 4,105 (4) Number actually treated 3,660 (5) Attendances made by pupils for treatment 6,151 (6) Half-days devoted to:- (a) Inspeciton 72 (7) Treatment 862 Total 934 (7) Fillings: permanent teeth 2,153 Temporary teeth 92 Total 2,245 (8) Number of teeth rilled: Permanent teeth 2,076 Temporary Teeth 90 Total 2,166 (9) Extractions: Permanent teeth 706 Temporary Teeth. 6,498 Total 7,204 (10) Administration of general anaesthetics for extraction 1,111 (11) Other Operations: (a) Permanent Teeth 534 (a) Temporary teeth 627 Total 1,161 TABLE 59. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorised persons 37,569 (11) Total number of individual pupils found to be Infested 819 (ill) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 69 (lv) Number of Individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) ..