LIBRARY EAS 28 COUNTY BOROUGH OF EAST HAM ANNUAL REPORT of the Medical Officer of Health and School Medical Officer For the Year 1951 JOHN S. COLEMAN, m.b., b.s. (i.ond.) 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 1951 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 11 General Provision of Health Services 20 Infectious Diseases 24 National Health Service Act, 1946 Sec. 22 Care of Mothers and Young Children 36 Sec. 23 Midwifery Services 44 Sec. 24 Health Visiting Services 47 Sec. 25 Home Nursing Services 47 Sec. 26 Vaccination and Immunisation 49 Sec. 27 Ambulance Services 50 Sec. "8 Prevention of Illness, Care and After-Care 52 See. 28 & 51 Mental Health Services 55 Sec. 29 Home Help Services 60 Sanitary Section and Housing 62 Inspection and Supervision of Food 67 School Health Service:- Introduction 72 Report 73 3 EAST HAM CORPORATION COUNCIL (shewing Chairmen and Vice-Chairmen of Health, Maternity and Child Welfare, Mental Health and Education Committees). THE MAYOR: Alderman Walter Edwin Hurford, J.P„ THE DEPUTY MAYOR: Councillor John Alfred Kemp. ALDERMEN: Charles William Brading, J.P., C.R.P. Charles William Dixon. (1) Sydney Arnold Elson. (4) & (6) Richard John Fell. John Albert Hart, J.P. Herbert Percy Jackson. (5) Thomas Irwin Lethaby, J.P. (2) Frederick Welch, J.P. Ernest Albert Wood, J.P. COUNCILLORS: William Henry Whittock Beecham. Agnes Ann Bradshaw (Mrs.) Charles Frederick Chapman. Frederick George Pryer Clayton. Amy Beatrice Cowlan (Mrs,,) (3) Daisy May Davey (Mrs.) Edwin John Davey. Elsie Mary Devenay (Mrs.) William Doran. Eleanor Mary Fell (Mrs.) James Fenner. Francis William French,. Leonard Lewis Griffiths. Henry Joseph Hooper. Frank Herbert Howard. William Innes Jackson, J.P. Thomas Alfred Jenkinson. Winifred May Knight (Mrs.) George Charles Lay. George Edward Marshall. Albert Richard Miller. Arthur George Murrell Oakes. Alfred Prior, J.P. Frank Owen Reynolds. Albert Cyril Smith. Florence Louise Stevens (Miss). Lily Sutton (Mrs.) James Ernest Taylor. Ralph Reginald Turville. 4 Co-opted Members of the Maternity and Child Welfare and Mental Health Committees Mrs. F.M. Goodchild Mrs. M. Page Alderman Mrs. D. Parsons, J.P Mrs. C. Robertson Mrs. A.A. Woodman, M.B.E. Maternity and Child Welfare Mrs. C. Boar. Mr. A. Huggett. Mr. H.F. McNeil. Mental Health. (1) Chairman of Health Committee. (2) Vice-Chairman of Health Committee. (3) Chairman of Maternity and Child Welfare Committee. (k) Chairman of Mental Health Committee (5) Chairman of Education Committee. (6) Vice-Chairman of Education Committee. 5 PUBLIC HEALTH OFFICERS OF THE AUTHORITY. A. Medical - whole-time. 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. i D.E. Cullington, M.A., M.B., B.Ch., M.R.C.S., L.R.C.P., D.C.H., D.P.H. Deputy Medical Officer of Health and Senior Assistant School Medical Officer. Geraldine O'Callaghan, M.B., Ch„B., B.A.O., D.P.H., Assistant Medical Off leer. J. Twelly Rees, M.R.C„S., L„R.C.P., Assistant Medical Officer. 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. † J.J. Duffy, M„B., Ch.B., D„P„H„, Assistant Medical Officer. Medical - part-time. R„A, Morris, D.O.M.S., M.R.C.S., L.R.C.P., Ophthalmic Surgeon. R. Savege, M„B„, Ch.B., F.R.C.S. (Edin.) Aural Surgeon. H„ Bevan Jones, M.R.C.S„, L.R.C.P., Psychiatrist, Elizabeth Huband, M.A., M.R.C.S., L.R.C.P. D.P.M. Psychiatrist. B. Dental Surgeons:- † Allan Ross, M.R.C.S., L.R.C.P., B.D„S., L.D.S., R.C.S., Senior Dental Officer. * Hilda T. Smith, L.D.S., R,C.S., Senior Dental Officer. * Pauline Osis, D.D.D., University of Latvia. † Ire Schachter, M.D. (Vienna). C. Sanitary and Food Inspectors;- R.A. Baskett, B.E,M„, MCS.I„A., Chief Sanitary Inspector, Food and Shops Act Inspector. † D.G. Tonkin, M.S.I.A., Chief Sanitary Inspector, Food and Shops Act Inspector. L. Pinguey, M.S.I.A., M.R.S.I. R. Daw, M.S.I.A. E.A. Bloomfield, M.S„I.A„, M.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. † A„ White, M.S.I.A. G. Hagedorn, M.S„I.A. Shops Act Inspector:T. Gilbert. D. Nursing Staff:- Superintendent Nursing Officer and Supervisor of Midwives:B.M„A. Newman-Pilkington, S.R.N., S.C.M., H.V's Cert. (R.S.I.). Superintendent Health Visltor: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., R.F.N.. H.V's. Cert. (R.S.I.). M. Golden, S.R.N., S.C.M., H.V's. Cert. (R.S.I.). P. Cullls, S.R.N., S.C.M., H.V's. Cert. (R.S.I.). 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.K.N., H.V's. Cert. (R.S.I.). E.M. Abraham, S.R.N., S.C.M., H.V's. cert. (R.S.I.). S.P. Breen, S.R.N., C.M.B. (Part 1), H.V's Cert. (R.S.I.). † S. Carter, S.R.N., R.F.N., C.M.B. (Part 1), H.V's. Cert. (R.S.I.). † G. Kavanach, S.R.N., S.C.M., H.V's. Cert. (R.S.I.). † F. Kevill, S.R.N., C.M.B. (Part 1), H.V's Cert. (R.S.I.). E.M. Phillips, S.R.N., S.C.M., H.V's. Cert. (R.S.I.). † V.R. Prudden (Mrs.), S.R.N., S.C.M., H.V's. Cert. (R.S.I.)„ V. Wildbore, S.R.N., S.C.M., R.F.N., H.V's. Cert. (R.S.I.). †† M.H. Nunn, S.C.M. C.G. Case, R.F.N., A.R.S.I. Dental Nurses C.M. Strachan. M. Lobsenzer (Mrs.) F.E. Hunt. Physiotherapist and Light Sister:- E.B. Broome, S.R.N., C.S.M., L.E.T., M.S.R. E.F.M. Boss, S.R.N., C.S.P., L.E.T., M.S.R. Tuberculosis Nurses:- F.M. Williams, S.R.N., T.A. (Cert.) M. Stokes, S.R.N., S.C.M., T.A. (Cert.) H.O. Ford, S.R.N., T.A. (Cert.) † A.C. Coutts (Mrs.) S.R.N. Municipal Mldwives;- E.M. Law, S.C.M. M.E. Kinsella, S.R.N., S.C.M. S.J. Miller (Mrs.) S.C.M. (Temporary) E. Lloyd Owen (Mrs.) S.C.M. M,A. Sullivan (Mrs.) S.R.N., S.C.M. E. Mental Health:- Duly Authorised Officers;- W.R. Elledge. J.H. Wlckens. M.A. Pearce (Mrs.) R.C. Hoad J.C. Hlllier F. Other Staff:- A.H. Bleaden (Miss), Supervising Officer, M.D. Training Centre. W.L. Narborough (Miss), Dispenser. A.W. Lywood (Miss), Guide and Assistant (Temporary) M.D. Training Centre. I. Allott (Miss), Assistant Supervisor, M.D. Training Centre. 7 H.H.L. Webber (Miss), Care and After-Care Assistant. * D.H. Belle-Vue (Miss), Home Help Organiser. G. Child Guidance:- † F.J. Stevens, (Mrs.) M.A., Educational Psychologist. * H.J. Wright, B.Sc., Educational Psychologist. Miss P.Glover, L.C.S.T., Speech Therapist, Mrs. K. Barker, Play Therapist. H. Clerical Staff Chief Administrative Clerk †† T.B. Clark. † H.J. Horsnell. Senior Clerk - B.E.R. Hartley, A.C.I.S. Male Clerks:- C.J. Hayes. E.J. Steadman (Petitions Officer). B.G. Boar. J.F.J. Thomas. † T.J. Bird. B.J. Curling. S.C. Manlsler. R„C. Thorogood. and Temporary Clerks. Shorthand Typlsts;- D. Gordon, Senior. D.G. Cannell. E.R.A. Paddon. P.J. Asplnall. V. Nunn. * T. Canty, and Temporary Staff. Female Clerks:- M.A.R. Gaster. * F.C. Wells. J. Mackintosh. x B.H. White. F.M. Clark. x S.A. Moss / S. Doran. t E. Hammond (Mrs.) and Temporary Staff. f Commenced during year †† Retired during year. x Terminated during year. 4 Deceased during year. 8 COUNTY BOROUGH OF EAST HAM Public Health Department, Town Hall Annexe, E.6. TO THE WORHIPFUL THE MAYOR, THE ALDERMEN AND JCUNCILLORS OF THE COUNTY BOROUGH OF EAST HAM„ Mr. Ma or, Ladles and Gentlemen, I -ave the honour to present the Annual Report on the health of the Borougi a'd other attendant matters. The hegistrar General, following the fifteenth census of the population of England u Kales on 8th April, 1951, gave the population of East Ham as 120,873 and estimated that this would stand at 120,500 at 30th June. This shews a decline of 1,400 since midsummer 1950, and points to a decrease of 15.1% of the 1931 population. There was also a small but significant decrease in the numbers of live births registered - 1,732 - with a corresponding fall in the birth rate from 14.4 to 14.3 (corrected by an area comparability factor by the Registrar General to 13.6) so that the Council's policy of reducing the number of inhabitants to an optimum for the area of 108,000 Is in unsought measure assisted by the decline In the birth rate. A little reflection brings out the disquieting conclusion that the triad of a falling birth rate, raised age at marriage and increasing longevity may well lead to a loss of vigour In our people, for it is our most virile and intelligent young people who hold back from marriage and reproduction through the pressure of economic circumstances and lack of good cheap housing. In my last report I made a plea for the revision of our methods of allocation of new dwellings and to this I would add substantial reduction of rent to young married couples who have two children within the first four years of marriage. The death rate shews a slight rise, but generally Is lower than that for England & Wales or the administrative County of London, whilst cardio vascular disease followed by cancer still stand in the van as 'Captains of the Men of Death'. There was only one maternal death attributable to childbirth and the infant mortality and neo-natal mortality have fallen respectively to 18.4 and 13.8 per 1,000 live births. These record low figures, in general, are an index of the efficiency of the maternity and child welfare services given to the burgesses, and particularly reflect the enhanced ante-natal care now available in our clinics. Turning now to local epidemiology, it is pleasing to record that for the first time in local history no case of diphtheria was reported during the period. Measles was prevalent in the first and second quarters of the year and we must Increase our efforts to educate the public that, by all possible means, young babies should be shielded from this disease until they are 2-3 years old and better able to withstand the more severe symptoms and complications. Early in the year a sharp outbreak of Sonne dysentery occurred centred in our day nurseries. Vigorous action was taken in investigation, exclusion and treatment, with the active co-operation of the local general practitioners. The Superintendent Nursing Officer and a section of the Public Health office staff organized and ensured the systematic bacteriological investigation of all cases, suspects and contacts. Detailed instruction was given to all members of the staff on the importance of personal and 9 environmental hygiene in limiting the spread of infection, and by midsummer the outbreak had subsided. Twenty-three cases of 'Food Poisoning' also were notified during the first quarter, and here again faults In personal hygiene would surely be uncovered as the main vehicle of spread of the Illness. Many of our houses have outside W.C's, in most Instances gloomy unventllated insanitary structures, and It Is not hard to see that the probability of hand washing after the use of the toilet Is very remote, as is also the possibility of Inculcating elsewhere this habit which cannot be perpetuated In the home. In how many of our new houses and flats Is a wash-hand basin with towel rail and running water Installed as a standard fitting in the W.C.? Our clean food campaign will progress but little until this lesson of personal hygiene acquired in the home, is carried into the shops and milk and food processing factories. 1951 must stand out as the peak year for the notification of Infectious diseases, and of the 3,459 certified cases one in 13 was treated in hospital, often for social or domestic reasons rather than the severity of the Illness. The Council's attention Is once more directed to the problem of the old people. Great difficulty is often experienced In securing admission to hospital for aged persons who suffer acute or chronic illness. This Is a Regional Hospital Board problem, but results in a number of aged sufferers being nursed and indifferently cared for in their own homes. In like manner we have Insufficient hostel accommodation to meet the needs of the ablebodied elderly who for various reasons can no longer find a haven at home. And between these two groups is a growing number of old infirm people, not ill enough to require admission to hospital, and needing medical and nursing care too often to warrant placement in our hostels as at present staffed and managed. Many in this category drag out a miserable existence in their homes and fall a ready prey to sickness and heartbreaking loneliness with much attendant suffering which could surely be prevented. The Council have agreed, as a matter of policy, In the near future, to the discontinuance of the Aldersbrook Homes for the Institutional care of children. Here then is a golden opportunity to adapt fine buildings to the care of a section of the community for which fresh policy must be formulated, and no section of our burgesses yearns more for our compassion and sympathy. We are rapldy approaching the day when one in seven of our borough's population will be over 65 years of age, and social provision will have to be made to ease somewhat the Intolerable burden of old age both to the harassed family and the unfortunate individual, and deferring the problem will not lighten the eventual solution. The District Nurses, the Health Visitors, the ancillary Home Help and Day Nursery Services, together with the Ambulance Service, have all played their part in supplying the manifold social needs of a modern community, whilst the Chief Sanitary Insepctor, Mr. D.G. Tonkin, and his loyal team, have contributed not a little to the maintenance of a good standard of hygiene and sanitation in every part of the borough. In the body of the report will be found details and statistical analysis of the various services which fall to the supervision of the Health Committee, and to its Chairman and all Its hard-working members I tender thanks for their consideration and encouragement throughout a difficult year. 10 To my deputy, Dr„ D.E„ Culllngton, I would also give thanks and gratitude for valuable and detailed assistance in the Clinic and School Health Services, and I owe much to Mr„ T.B Clark and his successor Mr„ H.J. Horsnell, the department's chief asministrative assistant, and to the clerical staff for their loyal support at all times. Much to be done has been limited by financial stringency but our altering social structure brings fresh problems of the new medicine which cannot always wait on finance„ for to live up to our motto 'Progresslo Cum Populo' at this time in the borough's history, needs courage and hardihood „ I have the honour to be, Mr. Mayor, Ladies and Gentlemen. Your obedient Servant,, J. S. COLEMAN, Medical Officer of Health. 11 STATISTICAL AND SOCIAL CONDITIONS OF THE AREA SOCIAL. Area (in statute acres) land and water 3,324 Population. Census - April 1951 120,873 Estimated civilian population - Mid. 1951 120,500 Number of inhabited houses (end of 1951 according to rate books) (including tenements and shops) 33,560 Rateable value at 31st December, 1951 £766,433 Sum represented by a penny rate for the year 1951/2 . £3,110 EXTRACTS FROM VITAL STATISTICS. Total Males Females Live births Legitimate 1,672 848 824 Illegitimate 60 37 23 Still births Legitimate 33 21 12 Illegitimate 2 2 - Deaths - Total 1,433 Males 758 Females 675 Deaths from Puerperal causes Deaths Rate per 1,000 Total (Live and Still) Births Puerperal Sepsis - - Other Maternal Causes 1 0.565 Total 1 0.565 Deaths of Infants under one year of age All infants per 1,000 live births 18 Legitimate infants per 1,000 legitimate live births 18 Illegitimate Infants per 1,000 illegitimate live births 33 Deaths from Cancer (all ages) 271 Deaths from Measles (all ages) Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years) 12 STILL BIRTHS The number of still births registered was 35 compared with 46 for the previous year. The rate per 1,000 total (live and still) births was 19.8 the figure for 1950 being 25.5. 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 1946 1947 1948 1949 1950 1951 England and Wales 0.53 0.50 0.42 0.39 0.37 0.36 East Ham 0.56 0.51 0.38 0.39 0.37 0.29 The rates for East Ham per 1,000 total (live and still) births for the past five years are indicated below 1947 1948 1949 1950 1951 No. of still births 61 46 48 46 35 Rate per 1,000 total births 21.06 20.5 24.2 25.5 19.8 BIRTHS. The number of live births registered was 1,732, as compared with 1,753 for the year 1950, equivalent to a birth rate of 14.3 per 1,000 of the population - the figure for the previous year - 14.4. The Registrar General has computed an Area Comparability Factor to facilitate comparison of the birth rates In the various Local Authority Areas, and the factor for East Ham Is 0.95. The corrected birth rate is therefore 14.3 x 0.95 = 13.6. This corrected rate is used in all comparison tables in this report. A comparison of the statistics for the period since 1947 is appended:- 1947 1948 1949 1950 1951 No. of Births (East Ham) 2,835 2,194 1,934 1,753 1.732 Birth rate (East Ham) 23.8 18.1 15.8 14.4 13.6 Birth rate (England & Wales) 20.5 17.9 16.7 15.8 15.5 NOTE:- The rates for' East Ham to 1950 are not corrected. DEATHS. The number of deaths of residents dying within or without the district was 1,433, as compared with 1,304 for the year 1950. The death rate per 1,000 of the civilian population was 11.8, that for the previous year being 10.7. Of the total deaths, 678 or 47 per cent. died in institutions. The number of residents who died outside the area and whose deaths were assigned to the Borough was 620. The number of deaths of persons nonresident in the area was 61. resident in the area was 61. The number of deaths in various age groups was as follows:- Under 1 year 1-5 years 5-15 years 15-25 years 25-35 years 35-45 years M. F. M. F. M. F. M. F. M. F. M. F. 10 22 3 6 5 1 2 7 7 12 32 25 45-55 years 55-65 years 65-75 years 75-85 years 85-95 years 95 & over M. F. M. F. M„ F. M. F. M. F. M. F. 70 46 142 84 221 192 215 194 50 86 1 - 13 Birth and Death Rates (per 1.000 population) 1879- 1951 BIRTH RATE DEATH RATE 14 The crude death rate was 11.8. The Registrar-General has again supplied an area comparability factor and that for East Ham is 1.04. The corrected death rate is therefore, the crude death rate (11.8) multiplied by 1.04 - 12.2, For the period 1947 - 1951 the death rates for England and Wales and East Ham are compared 1947 1948 1949 1950 1951 England and Wales 12.0 10.8 11.7 11.6 12.5 East Ham 11.79 9.67 11.55 11.13 12.2 INFANTILE MORTALITY Deaths of infants under one year numbered 32 - equivalent to an infant mortality rate of 18.4 per 1,000 live births, the rate for the previous year was 25. The rate for England and Wales for 1951 was 29.6 The number of deaths of illegitimate children under one year of age was 2 out of a total of 60 illegitimate live births, giving a mortality rate of 33.3 as compared with a figure of 62 per 1,000 illegitimate live births for the year 1950. The infantile mortality rates since 1947 are as follows :- 1947 1948 1949 1950 ] England and Wales 41 34 32 29.8 29.6 East Ham 30 26 24 25 18.4 Illegitimate births and mortality rates for the Borough since 1947 are tabulated below 1947 1948 1949 1950 1951 No. of illegitimate births 102 65 65 64 60 Mortality rate per 1,000 illegitimate live births 49 15 30 62 33.3 NEO-NATAL MORTALITY. Children dying under the age of one month totalled 24, equal to a neo-natal mortality rate of 13,8 per 1,000 live births. These rates from 1947 - 1951 are compared below:- 1947 17.6 1948 14.5 1949 14.9 1950 16.6 1951 13.8 The causes of death of these children under one month of age were as follows ;- Cause No, of Deaths Pneumonia - Diarrhoea and Enteritis - Premature Births 13 Congenital Malformations, Birth Injury, Infantile Diseases 6 Other causes 5 Total 24 MATERNAL MORTALITY, The number of maternal deaths was 1, the maternal mortality rate per 1,000 live and still births for 1951 being 0.565. 15 Infanti/e *ff7or/or///y jRarfes/. ooo //vt> />/'r//rsJ 1935-195 ENCL.ANO AND WALES COUNTY BOROUGHS AND GREAT TOWNS EAST HAM — - 16 POPULATION. On 8th April 1951, the fifteenth Census of the population of England and Wales was conducted, the first for twenty years. The preliminary report of the Registrar General, published in June 1951, quotes the following figures for East Ham with comparative statistics for 1931. 1951 1931 Males 58,669 68,923 Females 62,204 73,471 Total 120,873 142,394 Since 1931 therefore, the population of East Ham has decreased by 21,521 or 15.1% of the 1931 population. The Registrar General has also supplied an estimate of population as at 30th June 1951, which shows that the home population (all ages) Including members of the armed forces stationed In the area totalled 120,500,. The rates per 1,000 population quoted in this report are based on this estimate. TABLE 2„ - BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1951. 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 Smallpox Tuberculosis Total Deaths under one year Deaths from Diarrhoea and Enteritis (under 2 years) England and Wales 15.5 0.36 12.5 0.00 0.00 0.61 0.01 0.00 0.38 0.00 0.31 29.6 1.4 126 County Boroughs and Great Towns, Including London 17.3 0.45 13.4 0.00 0.01 0.65 0.01 0.00 0.36 0.00 0.37 33.9 1.6 148 Smaller Towns (resident populations 25,000 to 50,000 at Census, 1931 16.7 0.38 12.5 0.00 0.01 0.63 0.01 0.00 0.38 0.00 0.31 27.6 1.0 London - Administrative County 17.8 0.37 13.1 - 0.00 0.61 0.01 0.00 0.23 - 0.38 26.4 0.7 13.6 0.29 12.2 - - 0.58 0.00 - 0.22 - 0.29 18.4 - 17 A dash (-) signifies there were no deaths. TABLE 3. - CAUSES OF DEATH IN AGE GROUPS 1951, AND TOTAL DEATHS FOR YEARS 1950-1951 Deaths at different periods of life of residents (Including non-civilians) whether occurring within or without the district Total Deaths for the Years All Ages Under 1 Year 1-5 Years 5-15 Years 15-25 Years 25 - 45 Years 45 - 65 Years 65-75 Years Over 75 Years Total deaths In Institutions M F M F M F M F M F M F M F M F M F M F 1951 1950 1. Tuberculosis, respiratory 13 16 - - - - - - - 2 1 7 9 4 3 1 _ 2 4 10 29 33 2. Tuberculosis, other forms 3 4 - - 1 3 - - - 1 1 - 1 - - - - - 3 4 7 3 3- Syphilitic Disease 8 2 - - - - - - - - - 1 3 - 3 - 2 1 4 1 10 13 -4, Diphtheria - - - - - - - - - - - - - - - - - - - - - - 5. Whooping Cough - 1 - 1 - - - - - - - - - - - - - - - l 1 2 6„ Meningococcal Infections - - - - - - - - - - - - - - - - - - - - - - 7. Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - 1 8. Measles - - - - - - - - - - - - - - - - - - - - - - 9. Other Infective and Parasitic Diseases - - - - - - - - - - - - - - - - - - - - - 1 10. Malignant Neoplasm, Stomach 36 22 - - - - - - - - 4 - 18 5 8 9 6 8 16 11 58 37 11. Malignant Neoplasm, Lung, Bronchus 41 9 - - - - - - - - l 1 19 6 16 2 5 - 16 6 50 47 12. Malignant Neoplasm, Breast - 21 - - - - - - - - - 4 - 8 - 5 - 4 - 6 21 24 13. Malignant Neoplasm, Uterus - 16 - - - - - - - - - - - 8 — 6 - 2 - 7 16 11 14. Other Malignant & Lymphatic Neoplasms 73 53 - - - - 2 - 1 2 4 3 19 17 20 21 27 10 40 32 126 120 15. Leukaemia, Aleukeamia 6 6 - 1 1 - - - - - 3 - 1 3 - 2 1 - 5 5 12 9 16. Diabetes 2 10 - - - - - - - - - 1 1 2 1 5 - 2 - 6 12 8 17„ Vascular Lesions of the Nervous system 62 78 - - - - - - - - 1 1 14 10 22 25 25 42 37 31 140 174 18. Coronary Disease Angina 112 42 - - - - - - - - 1 1 44 5 44 19 23 17 41 9 154 144 19. Hypertension with Heart Disease 19 52 - - - - - - - - 1 - 4 6 7 26 7 20 7 19 71 48 20. Other Heart Disease 96 137 - - - - 1 - - - 3 4 15 20 18 33 59 80 41 60 233 261 21. Other Circulatory Disease 23 30 - - - - - - - - - - 5 4 8 8 10 18 13 13 53 39 22,. Influenza 19 8 - - - - - - - - 1 - 3 - 6 1 9 7 2 1 27 8 23. Pneumonia 43 28 2 1 - - - - - - 1 - 9 4 13 7 18 16 29 21 71 49 24. Bronchitis 78 42 - - - 1 - - - - 5 2 20 6 27 12 26 21 23 6 120 82 25. Other Diseases of Respiratory System 10 1 - - 1 - - - - - 1 - 3 - 2 1 3 - 6 1 11 15 26. Ulcer of Stomach and Duodenum 19 2 - - - - - - - - 1 - 7 - 8 - 3 2 15 2 21 16 27. Gastritis, Enteritis and Diarrhoea 1 1 - - - - - - - - - 1 - - 1 - - - - 1 2 6 28. Nephritis and Nephrosis 5 5 - - - - - - - - 1 1 3 4 1 - - - 3 4 10 17 29. Hyperplasia of Prostate .. 15 - - - - - - - - - - - - - 3 - 12 — 13 - 15 4 30„ Pregnancy, Childbirth, Abortion - 1 - - - - - - - - - 1 - - - - - - - l 1 1 31. Congenital Malformations 4 10 1 7 - - - - - 1 1 1 2 l - - - - 3 8 14 10 32. Other Defined and 111 Defined Diseases 42 62 7 12 - 1 2 - - - 3 6 6 13 7 8 17 22 21 39 104 90 33. Motor Vehicle Accidents 5 6 - - - 1 - 1 1 1 1 - 1 1 - - 2 2 4 6 11 3 34. All Other Accidents 18 6 - - - - - - - - 3 1 4 - 2 1 9 4 13 5 24 16 35. Suicide 4 4 - - - - - - - - - 1 l 3 1 - 2 - - 2 8 11 36. Homicide and Operations of War 1 - - - - - - - - - 1 - - - - - - - 1 - l 1 TOTALS 758 675 10 22 3 6 5 1 2 7 39 37 212 130 221 192 266 280 360 318 1433 1304 TABLE 4. - INFANT DEATHS UNDER ONE YEAR OF AGE, 1951. 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 Whooping Cough 1 - - - - - - - - - - - - - - - - - 1 Pneumonia 3 - - - - - - - - 2 - - 1 - - - - 2 1 Premature Births 13 2 10 1 - - - - - - - - - - - - - 3 10 Congenital Malformations, Birth Injury, Infantile Diseases 8 - 6 - - - - - - 1 - - 1 - - - - 1 7 Other Causes 7 4 1 - - - - - - - - - - - - - - 4 3 TOTALS 32 6 17 1 - - - - - 3 3 - 2 - - - - 10 22 19 20 GENERAL PROVISION OF HEALTH SERVICES. MIDWIVES ACTS, 1902 - 1951. The number of midwives who notified their Intention to practise in East Ham during the period 1,2.51 to 31.1.52, was 30 - of these 17 also indicated that they would act as Maternity Nurses. Of the 30, 12 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches - 2 at Sir Henry Tate Nurses' Home, Sllvertown - 9 at East Ham Memorial Hospital - and 7 practised Independently, including 4 Municipal Midwives, and the Supervisor of Midwives. PLAISTOW MATERNITY HOSPITAL AND DISTRICT NURSES' HOME. Summary of cases, 1951:Midwifery 139 Maternity Nursing 55 Hospital 143 SILVERTOWN & NORTH WOOLWICH DISTRICT NURSING ASSOCIATION. Midwifery 4 Maternity Nursing 1 CLINICS AND TREATMENT CENTRES, These are all provided by the Council. The sessions at the Centres (as on 31.12.51) were as follows 21 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. 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 Friday 2 p.m. Ante-Natal Clinic (and Post-Natal) Monday 9 a.m., Tuesday 2 p.m., Thursday 10 a.m. and Friday 10 a.m. Dental Clinic By appointment. Church Road, Manor Park General Clinic (Minor Ailment cases) Tuesday and Friday 9.30 a.m. Immunization Clinic Thursday 10 a.m. Infant Welfare Clinic Monday, Wednesday 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. 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 and Thursday. Speech Therapy Continuous + Roman Manor Community Centre Infant Welfare and Ante-Natal Clinics Wednesday 9 a.m. General Clinic (Minor Ailment cases) Thursday 9 a.m. Ø By arrangement with L.C.C. + Commenced 6.6.1951. 22 VENEREAL DISEASES. The following statistics have been abstracted from copies of form VaD.(R) (1951), which have been received from the Hospitals named and total figures for 1949 and 1950 are also shewn Patients dealt with for the first time during 1951 Syphilis Gonorrhoea Other Conditions Total Whltechapel Clinic, London Hospital 5 20 103 128 St. Thomas' Hospital, S„E„1 - - 3 3 Albert Dock Hospital 1 5 26 J2 Totals ~6 25 132 163 Totals for 1950 23 23 128 174 Totals for 1949 31 33 158 222 ALDERSBROOK HOMES AND SCATTERED HOMES. The statistics for the year 1951 are appended:- l. Average number in homes throughout the year 389 2. No, chargeable to East Ham on 1,1,51. 102 3. No, chargeable to East Ham on 31.12.51o 118 4. Average weekly admissions 11 5. Average weekly discharges 12 The Council In their wisdom have decided that the best method of dealing with the 'deprived child' is by placement whereever possible in a 'small home' or foster home. This will entail the disbanding of the Aldersbrook Children's Homes as an institution, retaining only the Nursery for the reception of children up to two years of age. This step has become imperative with the rising cost per child in the Homes consequent to the withdrawal of children by Essex.and West Ham, The Council already own a sufficient number of scattered homes to accommodate all the East Ham children, and the Nursery could be used as a reception 'observation' unit without further expenditure. It is intended that the closure of Aldersbrook will be effected by 1955, but Is possible that all the blocks might be emptied sooner. Meanwhile the work at Aldersbrook continues on an even tenor. There is a constant traffic of short stay children and efforts have been made to bring the nursery children into small groups to obviate 'handling' by too many staff. In various ways these Homes remain a pattern for the better type of Institution for the reception and bringing up of large groups of 'deprived' children. The Inexorable march of progress In child welfare demands a 'home life' for every child, but there is a real danger at the moment that the unfortunate child may be made to fit the home, rather than the home be selected and prepared with painstaking exactitude to receive and nurture the child. 23 The staff of Aldersbrook should be praised for their steadfast devotion to the needs of their charges under very trying conditions. It must be difficult to cope with the day to day problems of child care when figuratively, collapse of the very roof above your head appears imminent. 24 INFECTIOUS DISEASES. The quarterly returns to the Registrar-General were as follows Disease Qtr. ending 31/3/51 Qtr. ending 30/6/51 Qtr. ending 30/9/51 Qtr. ending 31/12/51 Total Scarlet Fever 41 51 38 73 203 Whooping Cough 387 116 70 52 625 +Acute Poliomyelitis 1 1 4 1 7 Measles 1501 665 24 8 2198 Diphtheria - - - - - Pneumonia 39 10 5 4 58 Dysentery 260 55 1 5 321 Paratyphoid Fever - - 1 - 1 Erysipelas 9 5 3 2 19 Meningococcal Infection - - 1 3 4 Food Poisoning 20 2 1 - 23 Puerperal Pyrexia - - 1 1 2 Ophthalmia Neonatorum 1 - – - 1 + Of the seven cases finally diagnosed as Acute Poliomyelitis, three were paralytic and four non-paralytic. A report on the cases of food poisoning will be found on page 33. It Is pleasing to note that for the first time no cases of Diphtheria were reported within the borough. In the early part of the year an outbreak, of Sonne Dysentery occurred in the Day Nurseries, and Investigation of all children and staff was undertaken. The outbreak of the disease was first reported In the Roman Road Nursery, and subsequently all nurseries were found to be affected. Some 189 notified cases did not attend, nor were they directly connected with the nurseries; 94 of this number being school-children and 52 under five years of age. With the co-operation of the general practitioner, bacteriological examinations were carried out for all cases, and contacts where appropriate. Whooping Cough and Measles followed the trend throughout the country. The deaths from the seven principal zymotic diseases (Smallpox, Whooping Cough, Measles, Diphtheria, Diarrhoea, Scarlet Fever and Enteric Fever) numbered 1, as compared with 4 for the previous year and 6 for 1949. The zymotic death rate was 0.008 per 1,000 population as compared with a rate of 0.032 for 1950. No cases of smallpox were reported. In the following table the notification rates per 1,000 population are shewn :- 25 TABLE 6. YEAR 1951 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 - Paratyphoid Fever 0.02 0.03 0.02 0.01 0.00 Meningococcal Infection 0.03 0.04 0.03 0.03 0.03 Scarlet Fever 1.11 1.20 1.20 1.10 1.68 Whooping Cough 3.87 3.62 4.00 3.11 5.18 Diphtheria 0.02 0.02 0.03 0.01 - Erysipelas 0.14 0.15 0.12 0.15 0.15 Smallpox 0.00 0„00 0.00 - - Measles 14.07 13.93 14.82 14.64 18.24 Pneumonia 0.99 1.04 0.96 0.72 0.48 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.03 0.03 0.03 0.02 0.02 Non-Paralytic 0.02 0.02 0.03 0.02 0.03 Food Poisoning 0.13 0.15 0.08 0.23 0.19 A dash (-) signifies no notification TABLE 7. " PREVALENCE OF, AND CONTROL OVER:, INFECTIOUS DISEASE. Notified Cases for Year ended 31/12/51, Cases notified in whole district Ward Distribution of Cases No, of Cases removed to Hospital Total Deaths. DISEASE At all ages - years. Manor Park Little Ilford Woodgrange Plashet Kensington Castle Central Wall End Greatfield South At all ages Under 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and up Scarlet Fever 203 - 43 139 17 3 1 - - - 21 15 17 15 30 26 17 39 11 12 117 - Diphtheria - - - - - - - - - - - - - - - - - - - - - - Erysipelas 19 - - 1 - - 2 3 10 3 2 1 3 1 1 1 1 3 3 3 2 - Puerperal Pyrexia 2 - - - - - 2 - - - 1 1 - - - - - - - - 1 - Typhoid Fever - - - - - - - - - - - - - - - - - - - - - - Paratyphoid Fever 1 1 - - 1 - - - - - - - 1 - Pneumonia 58 - 7 6 2 2 10 2 13 16 8 7 5 9 7 2 7 4 3 6 17 71 Acute Poliomyelitis 7 1 1 3 1 1 - - - - 1 - - 1 - - l - - 4 7 - Meningococcal Infection 4 1 1 1 - - - 1 - - 1 2 - - - - - - - l 4 - Ophthalmia Neonatorum l 1 - - - - - - - - - - - - 1 - - - - - - - Dysentery 321 14 162 83 16 11 20 6 7 2 14 38 20 47 17 15 41 29 5 95 37 - Food Poisoning 23 - 10 4 2 1 2 1 3 - - 1 - 5 1 4 6 4 - 2 1 - Measles 2198 61 1218 894 11 5 8 1 - - 148 135 185 295 202 197 231 226 182 397 30 - Whooping Cough 625 60 388 167 4 - 3 2 1 - 41 61 43 92 72 26 45 124 32 89 21 1 TABLE 8. - TOTAL CASES OF NOTIFIABLE DISEASES, 1927-1951. DISEASE 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 Small Pox - 17 25 70 51 13 1 1 – – – – – – – – – – – – – – – – – Scarlet Fever 798 832 743 484 245 779 701 979 411 359 387 287 196 77 68 210 271 132 153 193 179 222 289 270 203 Diphtheria 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 2 7 2 3 8 7 5 - 2 2 13 15 8 10 3 - 4 - - - - 1 - 3 - Paratyphoid Fever - - - - - - - - - - - - - - - - - - - - - - - 1 1 Erysipelas 38 60 49 63 54 55 69 74 55 59 53 71 41 33 23 37 28 18 14 25 23 21 24 21 19 Puerperal Fever 5 4 8 9 10 4 4 7 12 7 5 + + + + + + + + + + + i i + Puerperal Pyrexia 11 11 12 14 6 23 10 11 14 7 7 18 16 8 6 15 8 8 2 8 5 4 2 3 2 Meningococcal Meningitis 4 1 1 3 8 5 1 3 3 - 2 3 3 11 5 12 4 3 1 8 1 5 6 1 1 Encephalitis Lethargica 2 3 1 - - - 1 1 1 - 1 1 - - - - - - - - - - - - - Ophthalmia Neonatorum 12 3 8 6 6 6 9 5 5 6 7 9 7 3 4 1 l 4 2 1 2 - 4 2 1 Acute Poliomyelitis .. 5 - 2 - 1 7 2 5 13 2 4 - 2 1 - - - - 1 - 7 8 13 10 7 Acute Polio Encephalitis - - - - - 3 2 1 - - - - - - - - - - - - 1 - - - - Dysentery - - - - - — - 1 - - 3 18 - - - - 6 5 7 5 2 - 1 10 321 Malaria - - - - - 1 It It 3a - - - - - Measles Not Notifiable 3 36 460 1/391 917 258 1,498 815 964 1,559 1,098 988 2,198 Whooping Cough .. Not Notifiable - 19 262 227 241 293 67 258 430 578 498 1,027 625 Food Poisoning .. Not Notifiable 4 5 23 Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 114 82 102 59 75 77 148 100 88 101 1ll 85 59 42 33 37 72 50 55 97 143 1ll 88 41 58 Totals .. 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 3,459 + 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. 28 The hospitals to which the 238 patients suffering from infectious diseases were admitted are named below Name of Hospital No. of cases admitted Plaistow Fever Hospital, Samson Street, E.13 113 Ilford Isolation Hospital, Chadwell Heath 53 Eastern Fever Hospital, Homerton, E.9 14 East Ham Memorial Hospital, E.7. 9 Chingford Isolation Hospital, Chingford, E,4 6 Whipps Cross Hospital, Leytonstone, E.ll 6 Rush Green Hospital, Romford .. 6 St. Ann's General Hospital, St. Ann's Road, N.15 5 Joyce Green Hospital, Dartford 5 Park Hospital, Hither Green Lane, S.E.13 4 Waltham Abbey Isolation Hospital, Waltham Cross 2 Queen Elizabeth Hospital, Hackney Road, E,2. 2 Chelmsford Isolation Hospital, Chelmsford 2 Children's Hospital, Great Ormond Street, W.C.I. 2 South Lodge Hospital, Worlds End, Enfield, N.21. 1 Poplar Hospital East India Dock Road, E.liu 1 St„ Charles Hospital, Ladbroke Grove, W„10 1 Western Fever Hospital, Fulham, W.6 1 Wanstead Hospital, Hermon Hill, E.ll. 1 Children's Hospital, Balaam Street, E.13. 1 Brook Hospital, Shooters Hill, S.E.18. 1 Westcliff Isolation Hospital, Westcliff 1 Royal Free Hospital, Grays Inn Road, W,C.l 1 238 SCABIES TREATMENT CENTRE. This Centre remained closed throughout the year under review (See Report for 1950, page 22). CANCER. Deaths 1951 i~ Males 150 Females 121 271 TABLE 9. - CANCER DEATHS - LOCATION OF THE DISEASE Parts of Body Affected Ages Sex Under 15 15-25 25-35 35-45 45-55 55-65 65-75 75 and upwards Total M F M F M F M F M F M F M F M F M F Buccal Cavity and Pharynx - - - - - - - - - - 1 1 - _ 6 1 7 2 Digestive Organs and Peritoneum - - - - 2 - 5 1 8 2 16 7 11 11 9 10 51 31 Respiratory Organs - – – – – – – – – – – – – – – – – – Uterus - - - - - - - - - 3 - 5 - 6 - 2 - 16 Other Female Genital Organs - - - - - - - - - 1 - 1 - 1 - - - 3 Breast - - - - - - - 4 - 5 - 3 - 5 - 4 - 21 Male Geni tal Organs – – – – – – – – – – – – – – – – – – Urinary Organs – – – – – – – – – 1 - 1 8 2 11 2 19 6 Skin - - - - - - - - - - - - - - - - - - Brain and other parts of Nervous System 2 - - 1 - - - - 1 - 2 - - - - - 5 1 Other or Unspecified Organs - - 1 1 - 1 1 l 3 1 6 7 9 16 7 5 27 32 Lungs, Bronchus - - - - - - 1 l 7 2 12 4 16 2 5 - 41 9 TOTALS 2 - 1 2 2 1 7 7 19 15 37 29 44 43 38 24 150 121 30 NATIONAL ASSISTANCE ACT, 1948 - SECTION 47. The above section of the National Assistance Act, 1948, deals with the removal to suitable premises of persons in need of care and attention, I am informed by the Chief Officer of Welfare Services it has not been found necessary for action to be taken under this section during the year„ EAST HAM CHEST CLINIC. The following information has been obtained from this clinic No. of attendances at clinic 24,677 No. of visits to homes of patients by tuberculosis nurses 5,778 No. of tuberculous persons on register on 1/1/51 31/12/51 Adults 986 941 Children 269 302 No. of persons under observation on - Adults 137 436 Children 77 276 The notifications received during the year under review total pulmonary 67 males, 50 females, a total of 117 and non-pulmonary 11 males and 5 females, a total of 16, The rate per 1,000 of the population was 1.10 for all forms of tuberculosis, that for 1950 being 1,49. 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 1951 "During the year, 165 vaccinations with B.C.G. have been carried out, on contacts of tuberculosis, the age groups being as follows :- TABLE 10. Age Groups Males Females Totals 0-4 yrs. 35 39 74 5-14 yrs. 37 43 80 15-25 yrs. 6 5 11 TOTALS 78 87 165 In addition 2 hospital workers (one male and one female) have been vaccinated making a total of 167". There have been no noteworthy complications in relation to these vaccinations and there has been excellent co-operation as far as the families of the vaccinated subjects are concerned: there has been no resistance from the vaccinated group, but there have been a few persons who have refused vaccination and a limited number of others have agreed to be vaccinated and have then changed their minds. It is hoped that some of these might be persuaded to become more co-operative. 31 (b) The Medical Research Council trials mentioned in my report for 1950 tontlnued during 1951. A total of 368 children (172 boys and 196 girls) volunteered to take part in trials held on 23,2.51 to 1.3.51, 12,6.51 to 18.6.51, and 9.11.51 to 15.11.51j Ninety-one were inoculated with B.C.G, vaccine, and one hundred were treated as controls. At each series, those children who had participated in the previous trials, and who were due to leave school at the end of term, were seen again. After leaving school, follow-up visits have been paid by Health Visitors, and each volunteer will be kept under surveillance for three years. The trials will continue in 1952. TABLE 11. - PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930 SUMMARY OF NOTIFICATIONS DURING THE PERIOD FROM 1ST JANUARY, 1951 TO THE 31ST DECEMBER, 1951 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 1 1 2 5 2 6 11 6 13 8 11 1 - 67 Respiratory, Females - 3 2 1 2 6 8 9 8 6 2 2 1 50 Non-Respiratory, Males - - 1 3 1 5 - - - 1 - - - 11 Non-Respiratory, Females - 1 2 2 - - - - - - - - - 5 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 - - - - - - - - - - - - - -(A) F - - - - - - - - - - - - 1 1 (B) Non-Respiratory M - - - - - - - - - - - - - -(C) F - - - - - - - - - - - - - -(D) Death Returns from Registrar-General (Transferable deaths) Respiratory M - - - - - - - - - - - 1 1 2 (A) F - - - - - - - - - - 1 - - 1 (B) Non-Respiratory M - - - - - - - - 1 - - - - 1 (C) F - - - - - - - - - - - - -(D) Posthumous Notifications Respiratory M - - - - - - - - - - - 1 - 1 (A) F - - - - - - - - - - - - 1 1 (B) Non-Respiratory M - - - - - - - - - - - - - -(C) F - - - - - - - - - - - - - -(D) "Transfers'' from Other Areas (excluding transferable deaths) Respiratory M - - - - - - 2 2 - - 1 - - 5 (A) F - - - - - - 1 2 1 l - - - 5 (B) Non-Respiratory M - - - - - - - - - - - - - -(C) F - - - - - - - - - - - - - -(D) Other Sources Respiratory M - - - - - - - - - - - - - -(A) F - - - - - - - - - - - - - -(B) Non-Respiratory M - - - - - - - - - - - - - -(C) F - - - - - - - - - - - - - -(D) Totals (A) 8 (B) 8 (C) 1 (D) - 33 WATER SUPPLY. (i) The water supply of the Borough in its several parts has been satisfactory both in quality and quantity. (ii) All houses in the area have water services laid on from the Metropolitan Water Board's mains. No bacteriological or chemical analyses were made by this Authority of the raw water going into supply. (iil) 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 during the year. Details 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 :- 1st Quarter 20 2nd Quarter 3rd Quarter 1 Total 23 (2) Outbreaks due to identified agents There were no outbreaks during the year. (3) Outbreaks of undiscovered cause There were 3 such outbreaks during the year. (4) Single cases Agent identified Nil Unknown cause 13 Total 13 CLEAN FOOD CAMPAIGN. The initial steps have been taken in the formation of a Food Hygiene Guild but owing to pressure of work and shortage of staff, visitation of food shops and other premises for the purposes of detailed inspection for admission to the Guild has been rather slow. However, it is hoped that ultimately requests for admission will come from a high proportion of tradesmen, and every means will be employed to foster a co-operative spirit so that certificates when Issued will indicate not only a high standard of hygiene in the premises concerned, but bear witness to the contributory effort of the owner of the shop In the Interests of public health. TABLE 12. METEOROLOGICAL RECORD - YEAR 1951. Rain Gauge 5 in. in diameter, placed 1 foot above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Mean Temperature of Air Rainfall. Highest Maximum Lowest Minimum Mean of No. of Days on which Rain fell. 0.01 and over Amount collected in inches. Mean rate of fall for Rainy Days Greatest fall in 24 hours Date of greatest fall All Highest All Lowest 0 0 0 0 0 January . 53 26 48.3 36.7 40.5 20 2.18 0.11 0.67 1st February 50 29 46.8 35.9 39.3 25 5.74 0.23 0.83 8th March 57 29 47.5 36.8 40.6 15 2.26 0.15 0.56 18th April .. 73 35 54.3 39.4 44.5 15 2.8 3 0.19 0.49 7th May 72 38 59.6 45.9 50.9 20 2.01 0.10 0.44 26th June 74 43 68.5 51.4 57.4 8 1.06 0.13 0.42 11th July 82 50 74.0 57.0 66.0 10 0.79 0.08 0.43 12th August .. 76 51 69.0 57.0 61.2 17 2.93 0.17 0.86 6th September + 46 - 54.7 58.9 11 2.72 0.25 1.20 27th October + 30 - 44.5 49.5 11 0.83 0.08 0.23 31st November 59 33 54.3 44.8 48.5 20 3.95 0.20 0.74 17th December 55 21 49.1 39.3 42.8 16 1.58 0.10 0.35 28 th Means & Totals for the Year 82 21 Ø57.1 45.3 50.0 188 28.88 0.15 1.20 27th September + Thermometer under repair. Ø Mean for 10 months. FACTORIES ACTS, 1937 and 1948. In accordance with the Factories Act, 1937, and at the request of the Minister of Labour and National Service, the following information is included in this report. (See Table 13). TABLE 13. FACTORIES ACTS, 1937 AND 1948. PART I OF THE ACT 1. - INSPECTIONS for purposes of provisions as to health (including inspections made by Sanitary Inspectors) Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 42 31 - - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 337 162 6 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 3 - - - Total 382 193 6 - 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 Ref e To H.M. Inspector rred By H.M. Inspector Want of cleanliness (S.l) - - - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) 3 1 - 2 - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) insufficient 2 - - - - (b) unsuitable or defective 12 7 - 1 - (c) not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) 7 - - - - Total 24 8 - 3 - PART VIII OF THE ACT OUTWORK (Sections 110 and 111) Section 110 Section 111 Nature of Work No. of out-workers in 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 Umbrellas Aug. Feb. 6 - - - - - Shopping bags .. - 2 - - - - - Metal Caps - 18 - - - - - Christmas crackers, cosaques, Christmas stockings, etc. 93 84 - - - - - Totals 93 110 - - - - - 36 NATIONAL HEALTH SERVICE ACT, 1946 SECTIONS 22, 23, 24, 25, 26, 27, 28, 29 and 51. Full details of the Council's proposals approved by the Minister of Health, as Indicated in my report for 1948, have been published in booklet form and are available for reference. SECTION 22 - CARE OF MOTHERS AND YOUNG CHILDREN. Dr. Allan Ross, the Senior Dental Ofiicer submits the following report in respect of the dental treatment provided for expectant and nursing mothers and young children :- During the year under review, there were more considerable changes in the dental staff. There was a tremendous demand for dental treatment and the difficulty in obtaining treatment for young children outside the Priority Service, was more marked. The charges imposed for dentures provided under the General Dental Services were eventually reflected in the dentures constructed in the Authority's Clinics. Although only 8 partial dentures were made most of them were inserted towards the end of the year. There were no facilities for X-ray examination and I regret to say that the local hospital did not see their way to co-operate in this matter. TABLE 14 NUMBERS PROVIDED WITH DENTAL CARE, 1951 Examined Needing treatment Treated Made dentally fit Expectant & Nursing Mothers Children under five 209 517 179 447 154 447 109 362 TABLE 15 FORMS OF DENTAL TREATMENT PROVIDED, 1951 Extrac tions Anaesthetics Fillings Scalings or scaling and gum treatment Silver Nitrate treatment Dressings Radiographs Dentures provided Local General Complete Partial Expectant & Nursing Mothers 353 46 91 102 55 - 32 - - 8 Children under f ive 1,195 27 371 82 20 23 78 - - - 37 Number of births notified during the period 1/1/51 to 31/12751, under Section 203 of the Public Health Act, 1936, as adjusted by transferred notifications :- (a) Live births ;- (b) Still births j- (c) Totals (i) Domiciliary 430 (i) Domiciliary 2 (i) Domiciliary 432 (ii) Institutional 1,274 (Ii) Institutional 36 (iI) Institutional 1,310 Number of premature Infants notified ) (1) born at home 20 during the year (including transferred ) notifications) whose mothers normally ) (2) born in hospital reside in the area ) or nursing home 77 Premature babies born in area (whether their mothers normally reside in area or not) excluding those born in maternity homes and hospitals in the National Health Service TABLE 16 PREMATURE INFANTS BORN AT HOME Birth Weight Transferred to nospital Nursed Entirely at Home Grand Total Died in first 24 hours Died on 2nd to 7th day Died on 8th to 28th day Survived 28 days Total 2 lbs. 3ozs or less 1 - - - - - 1 Over 2 lbs. 3 ozs. and up to 3 lbs 4 ozs. - 1 - - - 1 1 Over 3 lbs. 4 ozs. and up to 4lbs 6 ozs. 2 - - - 2 2 4 Over 4 lbs. 6 ozs. and up to 4 lbs 15 ozs. - - - - - - - Over 4 lbs. 15 ozs. and up to 5 lbs 8 ozs. 1 2 - - 11 13 14 Totals 4 3 - - 13 16 20 Note The weight groupings quoted above differ from those used in previous years, and have been adopted to render British statistics comparable to those of other nations. 38 TABLE 17. PREMATURE INFANTS - BORN IN HOSPITALS. Birth weight Died in first 2h hours Died on 2nd to 7th day Died on 8th to 28th day Survived 28 days Total 2 lbs 3 ozs. or less 2 - - - 2 Over 2 lbs 3 oz. and up to 3 lbs k ozs. 1 - 1 3 5 Over 3 lbs. h ozs. and up to U lbs 6 ozs. 5 - - 12 17 Over h lbs. 6 ozs. and up to k lbs 15 ozs. 1 - - 19 20 Over k lbs. 15 ozs. and up to 5 lbs. 8 ozs. 3 - - 30 33 TOTALS ALL WEIGHTS 12 - 1 64 77 39 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 18. INFECTIOUS DISEASE Ophthalmia Neonatorum Pemphigus Neonatorum Puerperal Pyrexia Domiciliary Conf 1 nements Institutional Confinements Domiciliary Conf inements Institutional Conf inements Domiciliary Conf inements Institutional Confinements Number of cases notified during 1951] 1 - - - 1 2 Number of cases removed to hospital - - - - - - Number of cases of Ophthalmia Neonatorum notified during the year, in which (a) vision was unimpaired l (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 year (1) from sepsis attended at home Nil. attended in nursing homes Nil, (11) from other causes attended at home Nil. attended in nursing homes Nil. (b) Number of women in (a) who died (1) at home Nil. (l1) in nursing homes Nil. (1ll) after removal to hospital Nil. (c) Total maternal deaths whether attended in the area or outside the Borough (1) from sepsis Nil. (11) from other causes 1 TABLE 19, ANTE-NATAL AND POST-NATAL CLINICS, 1951. 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 & for 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 3 40 1,618 1,197 8,313 Post-natal clinics - - 379 + 377 + 445 + Clinic belonging to other L.H.A.+ Ante-natal clinics 1 2 17 11 99 Post-natal clinics - - 6 + 6 + 7 + + 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 practitioner's surgery under arrangements made with the Local Health Authority. The clinics mentioned in previous reports continued in use and in addition, by agreement with the Local Education Authority a combined Ante-Natal and Infant Welfare Clinic is held at the Roman Manor Community Centre, E.6. every Wednesday morning. This extra clinic commenced on 6.6.51„ 40 TABLE 20 CHILD WELFARE CENTRES, 1951. 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. No. 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 attendances made by children Included In col. (4) during the year. Under 1 year Over 1 year Under 1 year Between the ages 1 and 5 Under 1 year Over 1 year (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Local Health Authority Centres 3 58 2,660 1,283 211 1,094 1,433 14,007 5,017 Centre belonging to other L.H.A.i' 1 4 73 15 7 14 53 285 140 t By arrangement with L.C.C. at Fernhlll Street Baths, North Woolwich, E.16. + Excluding children who attended before 1/1/51, or who were known to have previously attended a centre in another district. Note:- No clinics were discontinued during the year, but one clinic session per week, commenced at the Roman Manor Community Centre. 41 42 TABLE 21. DAY NURSERIES, 1951 Provided by Number at 31/12/51 No. of approved places No. of children on the register at the end of the year. Average dally attendance during the year 0-2 2-5 0-2 2-5 0-2 2-5 Maintained by the Council 4 95 198 79 158 51 136 Maintained by Vol. Organisations - - - - - - - Note:- No new nurseries were opened or any nurseries closed, during the year. The total attendances at the nurseries during 1951 are appended Nursery Total Attendances Average daily attendance School Road 9,717 38 Roman Road 14,036 54 St. Stephen's Road 11,390 44 Wall End/Caledon Road 10,972 42 Total 46,115 Note:- The Nurseries are closed on Saturdays. The total attendances at the Nurseries decreased in 1951, as compared with 1950, by 8,968. The steady decline in the use of the Day Nurseries has been remarked upon in most urban areas. High wages, full male employment and limitation of the size of families may be contributory factors. The need for the mother to go out to work to augment the family income appears to have receded and In many instances this must be a good thing, enabling the young mother fully to devote herself to the nurture of the children and the proper care of her household. The time must come when a limited number of nursery places only will be required for medico-social reasons, for admission on purely financial grounds is being sought with decreasing frequency. NURSERY AND CHILD-MINDERS REGULATION ACT, 1948. There were no daily minders provided by the Council at the 31st December, 1951, and there were no premises or daily minders registered under the above Act at 31/12/51. The Authority were not paying any fees to daily minders under section 22 of the National Health Service Act, 1946, at 31st December, 1951. 43 MOTHER AND BABY HOMES. During the year uncier review, 4 unmarried expectant mothers were sent to homes or hostels; 3 to St. Agatha's Home, Stratford, E.15 and one to 38 The Drive, Walthamstow, E.17. In each case the Authority was responsible for payment of maintenance. 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 1951 :- Institution Aldersbrook Maternity Hospital East Ham Memorial Hospital .. Forest Gate Hospital No. of patients 494 234 128 856 REGISTRATION OF NURSING HOilES. Under Sections 187 to 194 of the Public Health Act, 1936, there were no homes registered during the year 1951, and there were no homes on the register at the end of the year 1551. ALDERSBROOK MATERNITY HOSPITAL. This unit continues as a great boon to the mothers of East Ham. The maternity service provided is of a uniform high standard and the Matron, Mrs. Steele, and the Deputy Matron, Miss Fuller, are to be complimented on the golden opinions the hospital has won for the individual care and attention bestowed on all mothers who come here for confinements. If a woman must go into hospital for confinement, and there are many who deprecate this policy, then at least she should be compensated for the deprivation of having her loved ones around her at home, by a cheerful and cosy environment, good food, every comfort and complete rest for body and mind. It is believed that the staff at Aldersbrook do their utmost to ensure that this end is attained and the proof of their success lies surely in the number of women who seek to return to the unit for a second confinement.. ALDERSBROOK MATERNITY HOSPITAL. STATISTICS 1951. Number of beds on 31/12/51 20 " " midwives employed on 31/12/51 6 " " East Ham patients confined during the period 1/1/51 to 31/12/51:- (a) Midwifery 489 ) 501 (b) Maternity nursing 12 ) " " midwives qualified on 31/12/51 to administer gas and air analgesia 6 " " sets of apparatus of gas and air analgesia in use on 31/12/51 2 " " East Ham patients to whom gas and air analgesia was administered by midwives during the period 1/1/51 to 31/12/51 :- (a) when acting as a midwife 464 ) 472 (b) " " " " Maternity nurse 8 ) occasions, Medical aid sought by midwives under section 14 (1) of the Midwives Act, 1918 31 44 SECTION 23 - MIDWIFERY SERVICE, Under their supervisor, Miss Pilkington, the domiciliary midwives employed by the Council now constitute a strong team whose work reaches a high level of efficiency. There is some evidence that this service will be Increasingly used by the mothers in the years to come and should again play a more important role in re-establishing the home and family life as the centre of community well-being. TABLE 22 MIDWIVES ACTS, 1902 - 1951 Number of midwives practising in the area at 31st December, 1951. Domiciliary Midwives Midwives in Institutions Total Midwives employed by the Council 4 - 4 Midwives employed by Voluntary Organisations (a) Under arrangements made with the L.H.A. in pursuance of Section 23 of the N.H.S. 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 3 5 + 8 Midwives in private practice 2 - 2 Totals 11 5 16 Notes :- Figures for Aldersbrook Maternity Hospital have not been included in the above table. + 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 3 Domiciliary Midwives employed by the Hospital Management Committee are from the Plaistow Maternity Hospital and District Nurses Home. (local branch - Burges Road). 45 TABLE 23 MATERNITY CASES ATTENDED Number of maternity cases in the area attended by Midwives during the year ended 31/12/51 Domiciliary Cases Cases in Institutions Total As Midwives As Maternity Nurses As Midwives As Maternity torses As Midwives As Maternity Nurses (1) (2) (3) (4) (5) (6) Midwives employed by the Authority 208 18 - - 208 18 Midwives employed by Voluntary Organisations :- (a) under arrangements with Council in pursuance of Section 23 of the N.H.S. Act 4 1 - - 4 1 (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 139 55 297 + 61 + 436 116 Midwives in private practice 2 2 - - 2 2 No. of cases in cols. 3 or 4 attended by Domiciliary Midwives after discharge from hospital and before the fourteenth day. 1 - - - 1 - Totals 354 76 297 61 651 137 + East Ham Memorial Hospital. 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 Midwives Act, 1918, by a midwife:- (a) for domiciliary cases - (i) where the medical practitioner has arranged to provide the patient with maternity medical services under the N.H.S. Act 11 (ii) others 107 Total 118 (b) for cases in institutions 96 + East Ham Memorial Hospital. 46 TABLE 24 GAS AND AIR ANALGESIA DOMICILIARY MIDWIVES Domiciliary Midwives employed directly by Council Domiciliary Midwives employed under Sec. 23 by voluntary organisations as agents of Council Domiciliary Midwives employed under Sec. 23 by hospital authorities as agents of Council Domiciliary Midwives in private practice Total No. of domiciliary midwives practising in the area at 31/12/51. who were qualified to administer gas and air analgesia in accordance with the requirements of the Central Midwives Board 4 2 3 2 11 No. of sets of apparatus in use by domiciliary midwives at 31/12/51. 4 1 3 - 8 No. of cases in which gas and air was administered by domiciliary midwives during the period 1/1/51 to 31/12/51:- (a) when acting as a midwife 125 - 57 - 182 (b) when acting as a maternity nurse 14 - 16 - 30 No. of cases in which Pethidine was administered by domiciliary midwives during the period 1/1/51 to 31/12/51 (a) when acting as midwife 29 - 18 - 47 (b) when acting as maternity nurse - - 15 - 15 47 SECTION 24- HEALTH VISITING SERVICE TABLE 25 HEALTH VISITING, 1951 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 5+ 17 8½ 604 703 1762 7608 - 10675 - 1088 Voluntary Organisations - - - - - - - - - - - + Includes Superintendent Health Visitor. SECTION 25- HOME NURSING. The demands on this service from the general practitioners steadily increase and reference to the statistical table (page 48 ) indicates a 25% rise in the number of new cases undertaken and a corresponding increase in the number of visits. Hospital policy and social trends would point to the necessity for a number of persons with tuberculosis and chronic illness to be treated and nursed in their homes. This is especially so for old people, and this shift of locus for treatment and nursing of a skilled nature brings new problems to the Council and may involve extension of the Home Nursing Service and its closer administration and supervision by the Health Depart- TABLE 26 HOME NURSING, 1951. Provided by No. of home nurses employed at 31/12/ 51 Equivalent of wholetime service provided by part-time home nurses No. of cases attended by home nurses during the year No. of visits paid by home nurses during the year Wholetime on home nursing Parttime on home nursing Local Health Authority - - - - - Voluntary Organisations by agreement with the Authority 8 10 5 2,535 59,562 48 TABLE 27 HOME NURSING 1951 East Ham District Nursing Association Silvertown & North Woolwich District Nursing Association Adults Adults Males Females Children Total Males Females Children Total Patients on books on 1/1/51 101 255 15 271 - 3 - 3 New patients from 1/1/51 to 31/12/51 708 1,022 351 2,081 12 51 17 80 Patients on books on 31/12/51 114 267 11 392 2 3 - 5 Total number of visits during year 19,761 36,599 2,163 58,523 262 646 119 1,027 Summary of new cases Bronchitis, pneumonia and pleurisy 374 8 Cardiac 153 2 Tuberculosis 99 7 Rheumatism, arthritis, etc 49 - Cerebral 80 - Diabetes 49 2 Burns and Scalds 17 1 Cancer 138 - Senility 58 2 Erysipelas 5 1 Prolapse 26 14 Other Medical 457 14 Various surgical 452 22 Ante-Natal 7 - Post-Natal 26 - Miscarriage 7 4 Other causes 84 3 Total new cases 2,081 80 A comparision of statistics in regard to the work of the East Ham District Nursing Association is appended:- [ From 5/7/48 to 31/12/48 1949 1950 1951 Patients on books at beginning of period 178 206 272 371 New patients during period 435 1,468 1,689 2,081 Patients on books at end of period 206 272 371 392 Total number of visits during period 17,269 40,647 46,976 58,523 49 SECTION 26 - VACCINATION AND IMMUNISATION In regard to vaccination against Smallpox, there is evidence that the vaccinal state of the people in this borough is steadily declining. In view of the proximity of the docks, a warning must again be given that for this reason alone the burgesses are subject to higher risk than certain other sections of the population, and vaccination should be a duty selfimposed by every thinking man on himself and his family. Should there be an indication that it would appear to be more desirable to carry out vaccination of infants in our clinics, and some mothers are loth to take their babes to the doctor's surgery for this purpose, then in the best interests of the community this method of enhancing our vaccinal state will be adopted. Fortunately, no case of Diphtheria has occured during the year, but this must not lead to complacency or diminish our efforts to maintain a high level of immunization against this disease. The danger of Poliomyelitis arising after the injection Is very small and can be further minimized by good technique. TABLE 28. DIPHTHERIA IMMUNISATION, 1951. 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 30/6/51 589 51 640 64 " " " 31/12/51 619 50 669 118 Totals 1,208 101 1,309 182 The comparable figures for 1950 were :- 1,453 (Under 5) 126 (5 - 14) 1,579 (total) 136 (re-inforcing injection) TABLE 29. DIPHTHERIA IMMUNISATION. Number of Children at 31st December, 1951, who had completed a course of Immunisation at any time before that date (i.e. at any time since 1st January, 1937) Age at 31/12/51 Under 1 1 2 3 4 5 to 9 10 to 14 Total i.e. Born in Year 1951 1950 1949 1948 1947 1942-1946 1937-1941 under 15 No. Immunised 189 809 1,321 1,616 1,879 6,298 4,597 16,709 Estimated midyear child population 1951 Children under five Children 5-14 26,089 10,610 15,479 50 TABLE 30. SMALLPOX VACCINATION No. of persons vaccinated or re-vaccinated during 1951 Total Age at date of vaccination Under 1 1 - 4 5-14 15 or over No. vaccinated 400 (366) 53 (59) 29 (24) 83 (47) 565 (496) No. re-vaccinated 11 (6) 9 (2) 18 (13 211 (81) 249 (102) Totals 411 (372 62 (61) 47 (37) 294 (128 814 (598) The figures in brackets are those for 1950, and it will be seen that there was in the year 1951 an increase in the number of patients vaccinated. All these vaccinations were carried out by general practitioners. 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). SECTION 27 - AMBULANCE SERVICES. At the request of the Ministry of Health, statistics of work carried out by the Ambulance Service are now incorporated with financial information in a cost statement rendered in respect of the year ending on 31st March. Statistics are not now maintained in respect of the calendar year only and the figures quoted in this section of the report are extracted from the annual costing returns for the years ending 31st March 1951 and 31st March, 1952. It should be noted that the Hospital Car Service does not operate in the area of the Authority, and the Ambulance Service is not responsible for the transport of children to schools or occupation centres. Mutual Assistance arrangements with the London County Council for the removal of typhus and smallpox patients, and with the West Ham County Borough and Essex County Councils for general assistance were in operation throughout the year. 51 TABLE 31. AMBULANCE SERVICE. STATISTICS FOR YEARS ENDING 31st MARCH 1951 AND 31st MARCH 1952. AMBULANCE SERVICE Cars from Council's Transport Pool and by Private Hire Transport by Rail Grand Total Ambulances Sitting Case Vehicles (up to 4 Passenger Seats) Sitting Case Vehicles (over 4 Passenger Seats) Total - All Vehicles 1. No. of Operational Vehicles on 31st March 1950/1 1951/2 1950/1 1951/2 1950/1 1951/2 1950/1 1951/2 1950/1 1951/2 1950/1 1951/2 1950/1 1951/2 5 5 1 - 3 + 5 9 10 2. No. of such Vehicles fitted with Wireless - - - - - - - - 3. No. of Patients carried:- (a) Accident or Emergency 944 1,479 19 3 17 89 980 1,571 - - - - 980 1,571 (b) Others 18,269 13,095 3,888 624 9,491 18,967 31,648 32,686 185 244 4 9 31,837 32,939 (c) Total (a & b) 19,213 14,574 3,907 627 9,508 19,056 32,628 34,257 185 244 4 9 32,817 34,510 4. No.of Journeys by Vehicles:- (a) Patient carrying Journeys 6,546 6,464 1,735 265 2,600 4,725 10,881 11,454 185 183 11,066 11,637 (b) Abortive & Service Journeys 200 181 27 3 29 86 256 270 - - 256 270 (c) Journeys for Transport of Analgesia Appartus, Midwives, Home Nuraes etc. 50 29 141 28 26 142 217 199 - - 217 199 (d) Total (a & b & c) 6,796 6,674 1,903 296 2,655 4,953 11,354 11,923 185 183 11,539 12,106 5. Total Mileage 91,932 74,761 24,336 3,676 43,726 81,059 159,994 159,496 6,888 7,787 - 414 ?66,882 167,697 6. No. of Operational Staff on 31st March - - - - - - 28 26 - - - - + Includes 4 Dual Purpose Vehicles, to carry 8 Sitting Cases or 1 Stretcher Case and 4 Sitting Cases. 52 TABLE 32. COST OF SERVICE. Period Ambulance Service Cars from Transport Pool etc. Transport by Rail Total £ £ £ £ Year ending 31st March 1951 19,057 463 3 19,523 Year ending 31st March 1952 19,522 677 7 20,206 TABLE 33. UNIT COSTS - AMBULANCE SERVICE Ambulance Service Cars from Transport Pool etc. Total 1950/1 1951/2 1950/1 1951/2 1950/1 1951/2 Cost per Vehicle mile £ s. d. 2. 5. £ s. d. 2. 5. £ s. d. 1. 4. £ s. d. 1. 9. £ s. d. 2. 4. £ s. d. 2. 5. Cost per Patient 11. 8. 11. 5. 2 10. 1. 2 15. 6. 11. 10. 11. 8. Cost per Journey 1 13. 7. 1 12. 9. 2 10. 1. 3 14. 0. 1.13. 10. 1 13. 4. Cost per 1,000 Population 156 6. 8. 161.10.0. 3 15. 11. 5.10. 0. 160.2. 7. 167.0. 0. No. of Patients carried per 1,000 Population 267 283 1 2 268 285 No. of Journeys per 1,000 Population 93 99 1 1 94 100 SECTION 28 - PREVENTION OF ILLNESS, CARE AND AFTER CARE Loan Cupboards. The scheme for the loan of articles to aid in the domiciliary nursing of the sick remains as detailed in my report for 1950. Details of the items loaned during the year are shown in the following table. 53 TABLE 34. Article No. of occasions Items loaned Total Cupboard at Town Hall East Ham Church Road Annexe Chest Clinic Clinic Air bed rings (adults) 25 19 9 53 Bed cradles 3 - - 3 Bed pans 46 15 13 74 Bed rests 27 7 9 43 Bedsteads (Hospital) 4 - - 4 Blankets 5 - - 5 Commodes 3 - - 3 Crutches 2 - - 2 Feeding cups 2 2 - 4 Higginsons Syringes 1 - - l Hot water bottles (rubber) - 3 - 3 Inhalers (one pint) - 1 - 1 Mattresses 4 - - 4 Pillow Cases 1 - - l Rubber sheets 25 7 - 32 Sheets 10 - - 10 Sputum mugs 1 19 - 20 Steam kettles 3 - - 3 Thermometers - 1 - 1 Urinals (female) 1 1 - 2 Urinals (male) 7 13 3 23 Water Beds 5 - - 5 Wheel chairs 42 - - 42 Totals 217 88 34 339 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 Premature baby outfits 3 Scales and weights 17 TABLE 35. TUBERCULOSIS 1951. No. of visits to homes of patients by nurses during 1951 No. of notified cases on East Ham Chest Clinic register on 31/12/51. No. of occasions on which free extra nourishment supplied to patients during the year Adults Children Total Milk Food Total 5,778 941 302 1,243 489 38 527 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. 54 With the inception of the Loan Cupboard Scheme, bedding for the use of tuberculous patients is now loaned from these cupboards, and the provision of assistance towards the purchase of necessary bedding has ceased. During the year 1951, the part-time occupational therapist employed by the Council carried out the following sessions:- (a) At the Chest Clinic 102 (b) At the homes of patients 53 No„ of attendances at Clinic sessions 1,084 " " " patients' homes 362 It was found during the year that the time alloted for visits to the homes of patients needing occupational therapy - One session per week was insufficient and from November 1951 an additional session per fortnight was allowed for this work to give extra instructional time to each patient. From April 1952, two sessions per week were devoted to home visits in addition to the two sessions per week in the Chest Clinic,, TABLE 36 CONVALESCENT HOME TREATMENT PERIOD OF TREATMENT - 1951 Age Croups 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 M — 5 8 1 1 - - 15 years F - 2 2 - 1 - - 5 School M - 45 19 3 - - - 67 children F - 33 10 2 - - - 45 Adults M 2 16 12 2 - _ 32 F 1 25 24 - - - - 50 Totals 3 126 75 8 2 - - 214 The recommendations for this form of treatment were submitted by:- TABLE 37. Referred by Children 0-5 School Children Adults Total General Practitioners 4 22 44 70 Hospitals 4 6 19 29 East Ham Chest Clinic 3 18 16 37 School Health Service - 66 - 66 M. & C.W. Section 9 - 3 12 Totals 20 112 82 214 For comparlsion the number of children and adults receiving this form of treatment are appended:- 5/7/48 to 31/12/48 1949 1950 1951 Children 0-5 years 37 86 47 20 School children 128 326 180 112 Adults 10 49 52 82 55 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 6 months, 1 for 6 weeks, and 2 for 2 weeks. PARK VIEW THERAPEUTIC CLUB. This club was transferred to the control of the Council on 3.9.51., and is now administered from the Health Department. On that date there were 48 members of the register, and on 31.12.51 there were 44. Since the staff of the Runwell Mental Hospital ceased to play an active part in the administration of the club, the numbers have been well maintained by personal recommendation of the Psychiatrists attached to East Ham Memorial Hospital and Runwell. The social activities have continued under an elected committee of club members, and the Duly Authorised Officers have assisted in every possible way. Regular socials and dances are held and at all club meetings the atmosphere of friendliness and tranquillity does much to turn introverted personalities, at least for a while, into social men and women, eager for the comfort and warmth of human companionship. The Chairman of the Mental Health Committee takes a keen interest in this work, and it is hoped all Council members will find time to come and lend support, as occasion may arise, to a splendid effort at self-help in rehabilitation for sufferers from mental illness. 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 present centre at Katherine Road is overcrowded, and proper provision for segregation into 'training groups' for different types of defectives Is difficult or impossible. To add to the problem the waiting list of children for admission to the centre is growing, and parents now are more clamant in their demands for some daily respite from the constant care of their defective children. A second centre, or one larger and more comprehensive, must soon be provided to answer the needs of this section of the community. All guardianship cases are supervised either directly or indirectly by the Authority. No. on register on 1/1/51 13 No. admitted to institutions 2 No. of orders discharged by Board of Control No. on register on 1/1/52 11 + No. visited by members of Mental Health Committee 6 + No. " " Medical Officer of Health 5 No. supervised on 31/12/51 by National Association for Mental Health - + Outside area + Inside area 56 TABLE 38 MENTAL PATIENTS - LUNACY AND MENTAL TREATMENT ACTS Type of patient Number on register on 1/1/51 Admissions to institutions during the year 1951 Discharges from institutions during the year 1951 Deaths in institutions during the year 1951 Number on register on 31/12/51 Certified - Males 166 20 13 10 163 Females 206 40 25 10 211 Total 372 60 38 20 374 Temporary - Males 1 3 3 - 1 Females 1 3 2 - 2 Total 2 6 5 - 3 Voluntary - Males 93 44 62 4 71 Females 61 46 44 2 61 Total 154 90 106 6 132 Grand Totals 528 156 149 26 509 No„ of patients released on trial during 1951 -8 Males, 13 Females, Total 21 " " " returned from " " 1951 - 2 " 1 " "3 Of the above cases, on 1/1/51, 512 were inmfates at Runwell Hospital and 16 in other institutions. During the year, 144 were admitted to Runwell and 12 to other hospitals, 137 were discharged from Runwell and 12 from other institutions, 24 of the deaths occurred in Runwell and two elsewhere and on 31/12/51 the cases were accommodated as follows 495 Runwell and 14 other hospitals. The Duly Authorised Officers report considerable difficulty on occasion in obtaining admission to a mental hospital for urgent cases of mental illness. This is a very trying aspect of regionalisation to a Council who formerly had provided a mental hospital to serve the community. Admission is particularly difficult for old people whose mental disorder is secondary to senile decay. Hospitals are loth to block their beds with cases which do not admit of response to treatment fairly rapidly. It is apparent no cure is possible in gerontic cases, yet these old people must have suitable hospital provision in their own interest and to ease the intolerable burden for their households. This problem in geriatrics is truly one to be tackled in a more practical manner by the Regional Hospital Boards. 57 TABLE 39 MENTAL DEFICIENTY ACTS, 1913 - 1938 PARTICULARS OF MENTAL DEFECTIVES AS ON 1/1/52 Males Females Total 1. No. of ascertained mental defectives found "Subject to be dealt with":- (a) In institutions (in- (Under 16 years of age 9 9 18 eluding cases on (Aged 16 years and over licence therefrom) 82 90 172 (b) +Under guardianship (Under 16 years of age - - - (including cases on (Aged 16 years and over licence therefrom) ( 5 6 11 (c) In "places of safety" - 1 1 (d) Under statutory (Under 16 years of age 21 16 37 supervision (ex- (Aged 16 years and over eluding cases on ( licence) ( 89 68 157 (e) Action not yet taken under one of the above headings - - - Total ascertained cases found to be "subject to be dealt with" 206 190 396 M F T No. of cases included in (b) to (e) above awaiting 8 1 9 removal to an institution 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 23 23 46 Total number of mental defectives (1) plus (2) 229 213 442 3. No. of mental defectives receiving training :- (a) In day training (Under 16 years of age 13 8 21 centres (Aged 16 years and over 12 7 19 (b) At home - - - Total 25 15 40 + No defectives under guardianship were dealt with during the year under the provisions of section 8 or 9. 58 TABLE 40 PARTICULARS OF MENTAL DEFECTIVES REPORTED DURING 1951. Males Females Total A. Particulars of cases reported during the year 1951:- (1) Ascertainment - (a) Cases reported by Local Education Authorities (Section 57, Education Act, 1944) - (i) Under Section 57 (3) 4 1 5 (ii) Under Section 57 (5) :On leaving special schools 4 4 8 On leaving ordinary schools - - - (b) Other ascertained defectives reported during 1951 and found to be "Subject to be dealt with 2 2 Total ascertained defectives found to be "Subject to be dealt with" during the year 10 5 15 (c) Other reported cases ascertained during 1951 who are not at present "Subject to be dealt with" - 1 1 Total No. of cases reported during the year 10 6 16 (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 (11) Placed under guardianship - - - (iii) Taken to "places of safety" - - - (iv) Placed under statutory supervision 9 4 13 (v) Died or removed from area - - — (vi) Action not yet taken - - - Total ascertained defectives found to be "Subject to be dealt with" 10 5 15 (b) Cases not at present "Subject to be dealt with" - (i) Placed under voluntary supervision - 1 l (ii) Later found not to be defective - - - (111) Died or removed from area - - - (iv) Action unnecessary - - - (v) Action not yet taken - - - Total cases not at present "Subject to be dealt with" - 1 1 B. No. of cases in institutions, under community care including voluntary supervision or in "places of safety" on 1/1/51 who have ceased to be under any of these forms of care during 1951 :- (a) Ceased to be under care 1 - 1 (b) Died, removed from area, or lost sight of 5 6 11 C. Of the total No. of Defectives known to the L.H.A.- (a) No. who have given birth to children during 1951:While unmarried 1 (b) No. who have married during 1951 .. - - - 59 The number of mental defectives on the register of the Occupation Centre on 31/12/51, was 36 (22 males, 14 Females,,) TABLE 41. MENTAL DEFECTIVE OCCUPATION CENTRE, SESSIONS AND ATTENDANCES, 1951. No. of sessions held during the year Morning 242 Afternoon 242 Male Female Male Female Total attendances 3,793 3,006 3,793 3,230 Average attendances per session 15.7 12.4 15.7 13.4 Total attendances, males 7,586, females 6,236, total 13,822. There were two defectives awaiting admission to the Centre on 31/12/51. During the year under review, the defectives attending the Centre made the following articles:- needle cases, teapot stands, soft toys, pairs gloves, knitting bag, peg bags, string bags, shopping bags, 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,, 1951. Mental Deficiency Acts 1913 - 38 Lunacy and Mental Treatment Acts Grand Total of visits and attendances Guardianship Statutory Supervision Friendly Care Home reports for patients detained in institutions Occupation Centre Total visits or attendances Patients reported to be in need of treatment After-Care Park View Therapeutic Social Club Total visits or attendances No. of visits and attendances 41 1.541 90 171 116 1,959 1,314 877 71 2,262 4,221 60 SECTION 29 - HOME HELP SERVICE. This socio-medical service has now crystallised into one tending to grow bigger to serve ane xpandlng need. The appended figures demonstrate the high proportion of old people given some dally domestic help, and the number of aged persons in the community steadily increases. We are aware that the provision of Home Helps to many of these gerontic households does not always solve the problem, and to prevent considerable physical suffering and alleviate distressing loneliness, much more must be done in many instances. Reflections of this kind need not detract from the value of the service at present offered, but without an awareness of the wider issues little progress will be made to come to terms with the problem of the aged in our midst. In 1950, 679 applicants received varying periods of service, as against 710 for the year under review. It will also be noted that in 1951, 292 cases had periods of service of between 9-12 months as compared with 205 for 1950. Two hundred and thirty seven of the 292 applicants mentioned above were aged persons. The establishment of home helps approved by the Ministry of Health, as on 31/12/51, 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 4 permanent (3 whole-time and 1 part-time) and 95 registered casual helps. In addition 17 casual helps were employed on probation, prior to registration. Full-time helps work 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 number of hours worked (these nclude sickness, holidays and travelling time) Period No. of Hours. 4 weeks ending 28.1.51. 8,503 4 " " 25.2.51. . 9,130¼ 5 " " 1.4.51. 10,832¼ 4 " " 29.4.51. 9,3783¾ 5 " " 3.6.51. 10, l48¼ 4 " " 1.7.51. 8,250¾ 4 " " 29.7.51. .. 7.404¾ 5 " " 2.9.51. 9,324¼ 4 " " 30.9.51. 7,998½ 4 " " 28.10.51. 8,501½ 4 " " 25.11.51. 7,965½ 5 " " 30.12.51. 9,402¾ Total 106, 840½ The total hours worked during 1950 totalled 117,669, and the total hours possible with a full establishment of 60 helps amount to 137,280. 61 TABLE 43 HOME HELP SERVICE TABULATION OF CASES, 1951. Illness or other cause for which help provided Period of service provided Total Under 1. week 1-2 weeks 2-3 weeks 3-4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Maternity 4 44 - - - - - - 48 Tuberculosis 1 2 1 3 7 5 4 11 34 Cancer 1 1 2 - 6 8 4 10 32 Old Age 9 11 14 16 64 72 37 237 460 Other Sickness 5 11 12 4 38 23 9 34 136 Totals 20 69 29 23 115 108 54 292 710 Of the 710 applicants, with the prior approval of the Chairman and subsequent confirmation by the Health Committee, in 90 cases home helps were provided free of cost as compared with 169 for the previous year,, 62 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 complied by the Chief Sanitary Inspector, Mr. D.G. Tonkin, M.S.I.A. The Section suffered a severe loss during the year by the untimely death in May of Mr. R„A. Baskett, Chief Inspector. Mr. Baskett served the Corporation zealously for many years, and his passing was a grievous blow to his colleagues and a tragic loss to the Corporation generally. Mr. Tonkin was appointed Chief Inspector in September, and in his stead, Mr. Pinguey was appointed Deputy Chief Inspector. The resultant vacancy for a District Inspector had not been filled by the end of the year, and the Department was, therefore, working under the handicap of one Inspector short of establishment for the greater part of the year. There were no inspections or surveys in connection with unfit areas made during the year, but the Department continued to supply Information to the Housing Department in respect of the overcrowding position and sanitary condition of accommodation occupied by applicants for Council houses. The visits paid for this purpose showed an enormous increase to a figure approximating 5,000. Food handling and food premises continued to receive vigilant attention, and with the help of the Bye-laws made by the Corporation under the Food and Drugs Act, much ground work was carried out preparatory to the formation of a Food Hygiene Guild amongst local food traders. By far the greater part of the Inspectorate's time is concerned with the investigation of complaints relating to housing defects, together with the follow-up action to ensure that necessary repairs are carried out. It is becoming increasingly difficult to persuade owners, particularly those in receipt of controlled rents, to carry out these repairs, and much extra time was spent in this direction. Partly by reason of this fact and the shortage of staff, together with the extra time spent on housing inspections (4,983 compared with 1,886 in 1950) allowing less time for re-inspections (16,422 22,442) the total number of inspections of all classes shows a decrease compared with the previous year (34,614 - 39,856). 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 34,614 (1) Housing Under Public Health Act 6,846 Re-Inspections 16,422 Housing Act, 1936 4,983 (ii) Sanitary Circumstances Yards and passages 181 Drainage and sanitary accommodation 1,834 Factories (excluding bakehouses) 193 Workplaces and outworkers 428 Caravans 1 Re offensive fumes 42 Miscellaneous 427 63 (iii) Food Supply Slaughterhouses - Dairies 29 Food Premises 1,611 Bakehouses 45 Re sampling 537 (iv) Infectious Diseases Visits 836 (v) Food Poisoning Visits 37 (b) Notices The number of notices served during the year totalled 3,734 of which 848 were statutory notices. The number of notices complied within the same period was 3,145. Complaints made to the Department with regard to sanitary circumstances, disrepair, infestations, obstructed drains, etc., totalled 2,874. (c) Rodent Control The number of complaints received in respect of rat and mice infestations totalled 229, and 291 premises were inspected in detail. Of these one was found to have a major infestation of rats, and 127 minor infestations were discovered. There were also 45 major infestations of mice. In all cases appropriate action was taken, but it was not found to be necessary in any case to serve formal notice on owners or occupiers under the Prevention of Damage by Pests Act, 1951. The Rodent Operative made 3,643 visits, and it is estimated that 1,383 rats were destroyed. This, of course, is in addition to the treatment of the main sewers carried out by personnel of the Sewage Works. (d) Disinfection and Disinfestatlon It was found necessary or desirable to disinfect rooms and their contents at 347 premises. In addition, 562 library books and 6 gramophone records were disinfected. Steam disinfection of bedding was carried out on 133 days of the year. It was also found necessary to present certificates to the Health Committee in respect of the filthy condition of 8 premises. These were cleansed by the occupiers after service of formal notices, and 2 certificates were presented to the Committee in respect of articles in premises being in such a filthy and verminous condition as to render their destruction necessary. Removal of these articles and their subsequent destruction was effected by the Department. There continued to be a steady call on the services of the Department in respect of disinfestation of premises for vermin, but it is pleasing to record that such infestations still show a marked decrease over the pre-war period. Insecticides having a D.D.T. base are mostly in use and disinfestation was carried out at 142 premises. (e) Drainage Complaints of choked or defective drains were received in respect of 689 premises, and in practically all cases removal of obstructions was carried out by the Council's Drain Cleaner. Examinations and tests by smoke, colour or water were carried 64 out in 162 instances, and the Department was responsible for testing all new drainage in connection with new houses built for the Corporation. The week-end rota of drain cleaners on duty for emergency work has continued to operate and has proved very useful on occasions. (f) Factories, Workplaces and Outworkers. During the year, 193 inspections of these premises were carried out. This is a decrease in the numbers as compared with the previous year, when a special survey of all factory premises, etc. was carried out. As a result of previous inspections, many of the deficiencies found in the sanitary accommodation and other matters for which the Department is responsible were remedied, and conditions generally tend to improve in these premises. As in the previous year, the number of outworkers in the Borough continued to be small as compared with the immediate postwar years, and the majority of such workers were still engaged in the manufacture or assembly of fancy goods. It was not found necessary to prohibit any person from carrying out this work in dirty or unwholesome premises. (g) Mosquito Control As in previous years, the Department carried out systematic treatment of ditches and low-lying land in the Borough, but probably owing to the fact that much of this land has now been built on, complaints of mosquito infestation were not large, although the Department did deal with one bad infestation of mosquitoes in Council premises adjoining the stream area. (h) Places of Public Entertainment Frequent visits were paid to these premises, both with regard to sanitary accommodation and general cleanliness, and also, as Authorised Officers, in connection with the Council's licensing regulations. Complaints are very seldom received, but the managements are found to be most co-operative in carrying out the suggestions and requests of the Corporation staff. (i) Rent and Mortgage Interest Restrictions Acts 1920-1939. There were 27 applications received from tenants for certificates as to the state of repair of houses. 12 certificates were actually issued; in the remaining 15 cases, the necessary repairs were carried out as a result of informal action taken by the Department. (j) Fertilisers and Feeding Stuffs Act. 1926 15 samples were taken under this Act during the year. 2 samples of feeding stuffs were found to be unsatisfactory. The Agricultural Analyst reported that by reason of their constituent parts, the samples were incorrectly labelled as Fish Meal. Letters of caution were sent to the vendors, and position in both cases was rectified. (k) 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 130 parts of chlorine per 100,000 parts of flock. 65 The vendor of this sample was prosecuted, and a fine of £5 with £l.ls.Od. costs imposed on the vendor's warrantor. On the 1st November, 1951, the Rag Flock and Other Filling Materials Act came into operation. This had been a long needed piece of legislation, as it brings within the scope of control practically all other filling materials used in the manufacture of bedding, toys, etc. (1) Legal Proceedings Legal proceedings were instituted in the following instances:- Public Health Act. 1936. Section 94 57 Section 95 2 Food & Drugs Act. 1938 Section 3 1 Rag Flock Act, 1911 1 Shops Act. 1950 1 Total 62 It is interesting to note that one owner appealed against the decision of the Stipendiary Magistrate to make Nuisance Orders arising out of non-compliance with the statutory abatement notice served in respect of housing premises. The Appeal was held at the Essex Quarter Sessions. The Corporation was represented by Counsel, and it is satisfying to record that the Appeal was dismissed in all respects and costs were awarded to the Corporation. HOUSING. Housing Statistics. I. Inspection of dwelling houses during the year (1) (a) Total number of dwelling-houses inspected for defects (under Public Health or Housing Acts) 12,665 (b) Number of inspections made for the purpose 29,087 (2) (a) Number of dwelling-houses (included under sub-heading (1) above) which were inspected and recorded under the Housing Consolidation Regulations, 1925 - (b) Number of inspections made for the purpose - (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 3,900 66 II. Remedy of Defects during the year without service of formal notices:- Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 2,280 III. Action under Statutory Powers during the year:- (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:- (1) Number of dwelling houses in respect of which Notices were served requiring repairs - (2) Number of dwelling houses which were rendered fit after service of formal notices:- (1) By owners (11) 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 848 (2) Number of dwelling houses in which defects were remedied after service of formal notices:- (1) By owners 862 (11) By Local Authority in default of owners 3 (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 - i. (d) Proceedings under Section 12 of the Housing Act, 1936 : (1) Number of separate tenements or under-ground rooms in respect of which Closing Orders were made - (2) Number of separate tenements or under-ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit - iv. Visits in connection with housing circumstances of applicants for rehousing 4,983 REHOUSING STATISTICS The following statistics have been supplied by the Councils Chief Housing Officer, Mr. J. E. Austin, M.B.E. Position at 31st December. 1951. 1. Accommodation made available - family units :- (i) By repair of war damage 6,233 + (ii) By requisitioned premises 1,305 (iii) By new housing (including 499 cost of works rebuilds) .. 2,098 (iv) By emergency hutments - 9,636 + This figure includes 3,307 houses classified Cb (War Damage) and rebuilt by Local Authority. 67 2, Families rehoused since August, 1945 3,473 3. Cases of overcrowding under Housing Act, 1936 abated by rehousing since August, 1945 (included in 2) 920 4. Total of current applications for rehousing 7,850 5, New housing Dwellings Projected Under Construction Completed Temporary 934 - 934 Permanent 2,457 220 661 Cost-of-Works Rebuilds 533 + 2 499 Housing Act, 1949 4 - 4 Total 3,928 222 2,098 + 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 128 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 99 Supplementary Licence 11 Dealer's (Pasteuriser's) Licence 2 Tuberculin Tested 1 Sterilised - Dealer's Licence 112 Supplementary Licence 11 Dealer's (Steriliser's) Licence 2 Milk (Special Designation) (Raw Milk) Regulations: Tuberculin Tested - Dealer's Licence 24 Supplementary Licence 10 Milk samples submitted for bacteriological examination are summarised as follows:- Pasteurised 53 - Unsatisfactory 3 Sterilised 12 - - T.T. Pasteurised 8 - - 73 3 The three unsatisfactory samples failed to satisfy the Methylene Blue test. Investigations of records at dairies and repeat samples showed that pasteurising plants were working efficiently. 68 (b) Meat and Other Foods. (i) Meat Inspection. Adequate inspection was maintained of all butchers' premises throughout the year, and as materials and equipment became easier to obtain, many improvements were effected. A total of 813 lbs. of meat was surrendered as being unfit for human consumption. It was observed that vehicles used for transport of meat showed some improvement, but many of the vans leave much to be desired from a hygiene standpoint. (II) Food Premises. Inspections of food premises included 27 visits to dairies, 45 to bakehouses and 1,611 to other food premises. Much attention was paid to educating and encouraging "backward" food traders to higher standards of hygiene, with a view to their inclusion in the Food Hygiene Guild to be formed at a later date. The response generally was encouraging, but much work remains to be done before the position can be regarded as entirely satisfactory. A source of much concern to the Department is the itinerant food trader. Whilst the Bye-laws made by the Corporation lay down certain measures to be taken to safeguard food supplies sold in the open air, it is found that many of this type of trader are not amenable to instruction, and after being cautioned their "pitches" are often occupied by others of similar types on the next occasion. During the year a special investigation was carried out with respect to the sale of dried fruit and mincemeat, which, at the particular time was being prominently and, in some cases, unhygienlcally, displayed in shops. Samples were submitted for bacteriological and chemical analysis and were reported upon satisfactorily, but the investigation did serve to bring to the attention of traders the necessity for taking elementary precautions for preventing contamination by flies and other insect pests. (c) Slaughterhouses. The one licensed slaughterhouse in the Borough was not in operation during the year. (d) Bacteriological Sampling. During the year, in addition to the 73 samples of milk, the following samples were submitted for examination : Ice Cream - 32. Milk - 73. Drinking Water - 9. Bath Water - 3. Dried Mixed Fruit - 2. 3 samples of Pasteurised milk did not satisfy the Methylene Blue Test, and Ice Cream samples were graded as follows Grade I - 14. Grade II - 10. Grade III - 5. Grade IV - 3 (Total - 32 The samples of drinking water, bath water and the two samples of dried mixed fruit were stated to be satisfactory. (e) Ice Cream. The impetus given to the sale of this commodity during the immediate 69 post-war years has resulted in an increasing number of traders seeking registration, and emphasizes the need for constant vigilance by the Department. It was not found necessary to refuse any applications for registration during the year and 28 new applications were approved,, The number of premises on the register at the end of the year was 139 including 21 equipped for the manufacture of ice cream. During the year, the Food Standards (Ice Cream) Order, 1951 came into operation, and for the first time prescribed a chemical standard for ice cream, viz, all ice cream should contain at least 5% fat, 10% sugar and 7½% milk solids other than fat. All samples submitted for analysis satisfied the standards; the highest fat content was 13.8%, the lowest 7%, and the average 10.2%. The samples submitted for bacteriological examination showed a higher percentage in the Ministry of Health's Provisional Grade I, and indicates that the constant attention given by the Inspectors to manufacturers' premises, coupled with the co-operation of traders organisations, is showing beneficial results. (f) Other Foods. The foodstuffs retailed In the Borough continued to be of a good general quality. Advice is often sought by householders with regard to particular purchases and the co-operation of the traders is invariably readily given* The following food stuffs were surrendered and certified as unfit for human consumption :- 4,986 tins, comprising - Milk - 773; Fish - 239; Fruit - 1,1*66; Meat - 609; Ham - 5Z+3; Other foods - 1,356, and Meat - 8l3i lbs.; Fruit - 287 lbs.; Fish - 133i St.; Confectionery - 35i lbs.; Cheese - 115 lbs. and various quantities of 13 other foods. There were no prosecutions against traders in respect of unsound food during the year. FOOD C: PRUGS ACT SA1.PLING During the year 326 samples were submitted for analysis in accordance with the following table :- TABLE Samples Number of Samples Percentage of samples adulterated Examined Found adulterated or below standard Butter.. 2 - - Cheese.. 2 - - Coffee.. 3 - *- Confectionery 4 - - Jam & Marmalade 6 — - Cooking Fat 2 - - Margarine 2 — Milk „. 100 - — Sausage 33 8 25.1 Vinegar 7 ~ Wines & Spirits 20 Drugs 3 ~ ~~ Jelly Crystals .. 3 ■"* "" Other Articles .. 139 k 2.9 Totals .. 326 12 - 70 Details of samples not satisfactory, together with action taken, are as follows:- TABLE 45. Number Informal or formal Article Adulteration or Def iciency Action taken 6398 Inf. Pork Sausage Deficient in meat to extent of 8 per cent. Formal sample (6415) 6415 For. Pork Sausage Deficient in meat to extent of 16 per cent Prosecution; Fined. 6436 For. Pork Sausage Contained 50 parts per million sulphur dioxide,. Letter of caution 6476 Inf. Pork Sausage Deficient in meat to extent of 6 per cent. Letter of caution 6481 Inf. Portion of Apple Tart with foreign matter. Iron Oxide or rust. (Not Rodent Excreta). Submitted by house holder. Cautioned. 6500 Inf. Pork Sausage Deficient in meat to extent of 17 per cent. Unable to obtain formal sample. 6518 Inf. Pork Sausage Deficient in meat to extent of 6 per cent, Unable to obtain f ormal sample, 6522 Inf. Pork Sausage Contained 180 parts per million sulphur dioxide. Letter of caution 6538 Inf. Pork Sausage Contained 125 parts per million sulphur dioxide. Letter of caution 6564 Inf. Fairy Cake Mixture. Contained 3 living maggots & insect web. Not suitable for human consumption. Stock withdrawn from sale. +6629 Inf. Mincemeat Both jars out of condition and no longer suitable for human consumption. Stock withdrawn f rom use. 6657 Inf. Table Jelly Outer surfaces in mouldy condition. No longer suitable f or human consumption. Stock withdrawn + From a Corporation kitchen. SHOPS ACT, 1950. Particulars with regard to the administration of the Act and other Acts concerning commodities over which there Is some registration control are as f ollows :- Number of shops in the Borough subject to the Act 2,065 „ „ „ „ „ „ open 1,950 „ „ „ „ „ „ closed 115 71 Number of assistants employed:- 1,167 Females 1,714 Young Persons - Males 87 „ „ Females 130 Total 3,098 Visits - Shops Register 2,244 „ - arrangements for health and comfort of Shop Workers, Records, etc. 632 Visits and observations - Closing Hours 1,027 Visits - Holiday Closing 239 " - Late Night Closing 331 Total 4,473 It was necessary to caution shopkeepers on some 91 occasions for serving customers after hours. Host of these contraventions occurred during the "Winter Hours of Closing" period. Arising out of representations from certain traders, the Council caused an enquiry to be made amongst representative organisations of traders and workers, and a token canvass was taken of all shops in the Borough with respect to late night closing. The result of this referendum showed a majority of approximately 4 to 1 in favour of Friday as the late night for closing during the winter months, and the Council made an Order accordingly, One retailer was prosecuted for persistently selling goods during prohibited hours. A penalty of 20s, was imposed, and there is no doubt that the publicity given to this, the first prosecution under the Shops Act since the War, has a salutary effect on other shopkeepers. Generally speaking it can be said that the retailers of the Borough do conform with the provisions of the Shops Act, but there are still a few on whom it is necessary to keep continual observations to ensure that they do not indulge in this unfair means of trading. PHARMACY AND POISONS ACT, 1933. The number of persons in the Council's list entitled to sell poisons included in Part II of the Poisons List was 180 (163 renewals and 17 new applications),337 inspections were made in the enforcement of this Act, EXPLOSIVES ACT, 1875, 143 licences (99 renewals and 44 new applications) were issued for the storage of mixed explosives (fireworks). Inspections of premises used for this purpose totalled 172. 72 COUNTY BOROUGH OF EAST HAM EDUCATION COMMITTEE TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE. Mr. Chairman, Ladles and Gentlemen, The Annual Report of the School Medical Officer has, for each of the past four years, made reference to the need for a satisfactory integration of the Specialist Clinics within the School Health Service. Responsibility for these Clinics formerly lay with the Authority, but passed to the Regional Hospital Board when the National Health Service Act came into operation in 1948. As an interim measure the Authority has continued to administer the Ophthalmic and Aural Clincs, whilst the Board has provided the services of the specialists. Negotiations were commenced during the year in an effort to achieve agreement, but were protracted owing to the unwillingness of the Board to concede the principle that the day to day administration of these clinics should remain in the hands of the School Medical Officer. National agreement on the salaries of Dental Officers employed by Local Authorities gave some encouragement to the Dental Services and towards the end of the year the appointment of a Senior and also an Assistant Dental Officer brought the staff up to full strength. This establishment was short lived since the third Dental Officer resigned, with no prospect in view of the vacancy being filled,. Satisfaction must be recorded however, in the far sighted decision of the Authority to employ an Oral Hyglenist, who will relieve the dentists of much routine work, of scaling and polishing and who, by the educative side of her work, will help to restore the preventive bias to the School Dental Service. The Medical Research Council's trials of B.C.G. (anti-tuberculosis) vaccine, mentioned in the report of the Medical Officer of Health last year, have continued during 1951 with the co-operation of the staff of the Secondary Modern Schools. Should the results prove favourable we may eventually be able to offer this protection to all school leavers who are judged not to have acquired sufficient natural immunity. A further progressive step was made during the year by establishing liaison with the East Ham Memorial Hospital for the after-care of both school and pre-school children admitted to the Children's Ward. The Superintendent Health Visitor attends the Paediatrician's weekly ward round and is able to supply vital information concerning home background as well at to initiate action for the after-care of children due to be discharged. An indirect but important result of this co-operation between hospital and local authority has been that the Chief Education Officer now provides some education for those children remaining inpatients for long periods. May I conclude by thanking the Chairman and Members of the Education Committee for their continued help and in particular Councillor Mrs. Fell, Chairman of the Care and Welfare Sub-Committee for the unremitting interest she has shown in all aspects of the School Health Service. Thanks are also due to the Chief Education Officer and to the Head Teachers for their co-operation, and above all to Dr. Cullington, the Senior Assistant School Medical Officer and the members of my staff whose work is reflected in this report. I have the honour to be, Ladies and Gentlemen, Your obedient servant, J. S. COLEMAN, School Medical Officer. 73 GENERAL INFORMATION. At mid-1951 the estimated child population aged 5-14 years inclusive was 15,479. The average number on roll was 15,724 made up as follows TABLE 46. Type of School Number of Schools Average Number on Roll County Primary: Infant 17 9,950 Junior 15 County Secondary 11 4,921 Voluntary (Infant and Junior) 4 853 Totals + 44 15,724 + (3 county schools are combined Infant and Junior) COMPARATIVE STATISTICS The following table indicates briefly the work of the School Health Service during the year 1951, and shows the comparative statistics for previous years. TABLE 47. 1947 1948 1949 1950 1951 Routine and Special Inspections at School 6,214 6,873 8,603 7,196 8,016 Re-Inspect ions at School 3,209 2,675 3,142 2,436 2,906 Inspections and Re-inspections at Clinics 11,141 10,748 9/686 10,369 8,676 Examinations for cleanliness 48,514 38,561 42,040 37,569 39,868 Nurses' visits to homes 1,212 3,691 8,012 4,496 4,156 ROUTINE INSPECTIONS IN SCHOOLS. A. Routine Medical Inspections. The routine medical Inspections still form the backbone of the School Health Service, although their character has changed somewhat since the Inception of the system over forty years ago. Originally the primary object was to detect the many cases of malnutrition and of serious physical defect, amongst the pupils, and to arrange the necessary treatment, Nowadays the examination usually enables the Medical Officer to give the parent the welcome assurance of a "clean bill of health" leaving time for discussion and to give advice on the multifarious problems of handling children. In this way a service which commenced by concentrating on the detection and treatment of illness is now able to devote itself more and more to fundamental preventive work in the sphere of mental as well as physical health. In a previous report, reference was made to the necessity for adequate accommodation in which to carry out these examinations. 74 Conditions, particularly in some of the older schools, are still far from satisfactory. A mother will obviously be unwilling to discuss a child's behaviour problems within earshot of other parents, and it is similarly difficult for the health visitor to obtain certain information without a degree of privacy for her interview. In order to obtain full benefit from the inspections the following accommodation is needed (1) Waiting space for pupils and parents. (2) Health Visitor's room for interviewing parents, weighing children, testing eyesight, etc., (3) Undressing room. (4) Doctor's examination room, which should provide hand-washing facilities. Some Head Teachers put themselves to considerable inconvenience in order to afford these facilities, and they may be assured that this results in a greatly enhanced value of the medical inspections. The inspections carried out during the year in the various schools are tabulated below, A detailed analysis of the findings appears in the Appendix. (Tables 51-53). MEDICAL INSPECTION AND RE-INSPECTION AT SCHOOLS. TABLE 48. School I nf ant Junior Secondary I R s I R S I R S (a) County Primary and Secondary Schools: Altmore 190 - - - - - - - - Avenue 152 77 - 344 144 4 - - - Brampton 164 56 - 126 53 l 101 - - 1. Burges Manor - - - - - - 268 105 3 Central Park 123 54 1 - - - 263 105 5 Cornwell - - - 336 105 4 240 64 1 Dersingham 85 42 - - - - - - - Essex 90 35 - - - - 240 80 - Hartley 237 138 1 400 150 - - - - Kensington 57 35 - 239 91 2 - - - Lathom - - - 371 118 4 - - - Monega 136 65 - - - - 216 75 1 Napier 118 41 5 - - - 287 91 - Roman Road 77 48 - 98 65 2 - - - St„ Stephens 175 74 1 - - - - - Salisbury 127 29 2 227 141 2 - - - Sandringham 90 40 - - - - 208 67 2 Shaftesbury - - - 331 112 2 - - - Storey Street 29 20 - 56 29 - - - - Vicarage 176 25 - 280 116 - - - - Winsor 61 12 - 85 18 6 - - - Boys' Grammar - - - - - - 291 94 - Girls' Grammar - - - - - - 436 133 9 Technical School of Building - - - - - - 31 40 - (b) Voluntary Schools (R.C.): St. Edward'S - - - - - - - - - St. Michael's - - - - - - - - - St. Winefride's 91 41 1 203 55 7 - - - Silvertown 35 12 - 21 11 - - - - (c) Independent Schools: The Maude Wells Schools 28 - - 7 - - 4 - - 2241 844 11 3124 1208 34 2585 854 21 I. - Periodic inspection. R. - Re-inspection. S. - Special inspection, 1. Burges Manor Secondary School for Girls opened September 1951 replacing Vicarage Secondary 2. St. Stephens Infants School opened September 1951 replacing Shaftesbury Infants. 75 B„ Routine Dental Inspections. Owing to shortage of staff the number of children inspected in school by Dental Officers fell to about half the number inspected during the previous year. The total of 4,438 children whose teeth were examined comprises only 28% of the total school roll, and is equivalent to a rate of one examination for each child in every 3½ years. This is a matter for serious concern for without regular inspection at least once and preferably twice each year, the preventive bias of the School Dental Service will be lost. Teeth which might otherwise have been saved will further decay and extraction will become inevitable. This in its turn may result in other teeth coming through out of line, and the orthodontic treatment needed to correct the lie of the teeth involves a considerable and quite unnecessary wastage of both time and money. It may be asked: "why not devote more sessions to inspection in the schools?" The answer is simple - even at present there is a considerable waiting list for children needing relatively urgent treatment, and there is little point in adding large numbers to the list without any hope of treating them. From the statistics in table 55 in the appendix, it will be seen that of the children examined in school or in the clinics 78% needed treatment, and that for every tooth filled over four were extracted. These facts form a sad commentary upon a "priority" dental service. B. Audiometric Surveys. Group testing of the hearing of children in their last year at primary school has continued during the year. 1,734 were tested and of these 165 (9.5%) were referred for further investigation, It has been our experience that of those who fail approximately half pass on re-testing, the original failure being due to factors such as nervousness, difficulty in understanding instructions, inattention or excessive extraneous noise. Those failing a second test are referred to the E.N.T. Clinic, where the majority are found to have wax or simple catarrhal blockage of the Eustachian tubes and only a few have any serious defect , I hope to present a detailed examination of such cases in my next report, D, Cleanliness Inspections. Health visitors attend every school once in each term inl order to examine the children for cleanliness and infestation. 39,868 such examinations were carried out during the year, and as a result 745 pupils were found to be harbouring nits or head lice. The infestation rate of 1.9% compares favourably with that in some other areas, but at the same time warns against complacency. SCHOOL HEALTH CLINICS Minor Ailment Clinics. Attendances at these Clinics have ueen decreasing for the past two years, which In part may be due to the fact that medical attention is now available from general practitioners under the National Health Service Act. During the year it was found necessary to discontinue one of the three clinics held each week at Manor Park in order to provide accommodation for an extra Infant Welfare Clinic needed to relieve serious overcrowding at the 76 existing sessions. It is hoped to sesume this minor ailment session as soon as the new wing of the Church Road Clinic has been built. Advantage was taken of the facilities available in the Roman Manor Community Centre to provide clinic services for residents in the Beckton area of the Borough, a minor ailment clinic being provided every Thursday morning. Attendances were low at first and the clinic was temporarily suspended during the school summer holidays. On resumption it was decided to see a limited number of "Toddlers" for routine examination at this Clinic and thus ensure more economic use of staff until such time as the attendances of school children increased. This arrangement has worked well, and mothers appreciate the convenience of being able to bring their younger children for examination at the same time as those attending school. Total attendances at School (minor ailment) Clinics during 1951 were as follows:- Central (Town Hall Annexe) 5,935 Manor Park (Church Road) 3,555 North Woolwich (Fernhill St. Baths) 331 Roman Manor (Community Centre) 72 (part year only) Total 9,893 Dental Clinics. In October we were pleased to welcome Dr. Allan Ross as Senior Dental Officer, in place of Miss Smith who finally resigned in July, Dr. Schacter also joined the staff towards the end of the year, but we were not to remain at full establishment for long, Mrs. Osis left us in November, without there being any prospect of an early replacement. Dr. Ross has submitted the following report: I have the honour to present my report on the work carried out in the Dental Clinics during the year 1951. (1) The year was marked by a complete change in the dental staff. For only a very short period was the dental service staffed with the authorised complement of three full-time officers; for most of the year the staff consisted of one full-time dental officer and one parttime dental officer. Efforts to obtain further full-time help were unsuccessful. (2) The fall in the number of routine inspections continued, thus there were 18,040 in 1994, 9,074 in 1950 and 4,438 in 1951. I feel the whole question of routine inspections at school is a difficult one. For instance, the conditions under which inspections are carried out are seldom ideal and one has to contend with the attitude of parents who, on learning that only a very short time was spent on the individual inspection, have been known to take their child to a private practitioner for a "proper examination". Again, cases which are not referred for treatment, although technically requiring it, may give rise to misunderstandings if the position is not explained. Ideally, I feel the dental inspections should be carried out in a dental surgery with a parent present and this would undoubtedly enhance the status of the service in the eyes of both the public and the private dental practitioners. (3) The number of temporary teeth filled showed a marked increase. The majority of these were second molars and it is hoped by concentrating on these teeth, to reduce overcrowding in the permanent dentition. 77 During the year under review, parents appear to have had some difficulty in obtaining treatment outside the local authority service for children under seven years of age. This resulted in a larger percentage of children in the lower age groups receiving treatment at. the dental clinics, thus accounting for the increased number of fillings in temporary teeth. (4) With regard to general anaesthetics, this Authority was fortunate in having the services of specialist anaesthetists for their weekly sessions and this enabled over 30 'gas administrations' to be given in one session, if necessary, (5) The problem of orthodontic treatment remained a difficult one. Prior to 1951, virtually all cases were referred to the London Teaching Hospitals. Of these, only a small percentage persisted with the treatment given due in some cases to indifference and in others, to travelling difficulties. The solution obviously lies in providing a comprehensive orthodontic service in the dental clinic where the child can, for instance, keep an appointment on the way home from school for adjustments to appliances etc. This would minimise the loss of school time and considerably improve the prospects of successful completion. The Teaching Hospitals are now used (with very few exceptions) only for an opinion In a particularly difficult case and it is a pleasure to record that their attitude has been most co-operative. There is at present no entry relating to orthodontic treatment in the official return, an omission which is discouraging to those in the local authority's services who spend considerable time, effort and patience in this specialised branch of dentistry, (6) The absence of an X-ray unit during 1951 made diagnosis and treatment sometimes extremely difficult and it was unfortunate that the local hospital felt unable to co-operate in this matter. It has been agreed to instal an X-ray unit at one of the clinics during 1952. (7) In October 1951 consequent upon the revised organisation, there was a change of policy regarding the treatment of emergency cases, From then onwards all such cases were seen the same day. Relief from pain coupled with elimation of sepsis remain the guiding principles and whilst the provision of emergency treatment can cause inconvenience to the Dental Officer and also to other patients, any difficulties, can be minimised by tact and co-operation. It is to be borne 'in mind that in this locality the mother has almost invariably taken time off from work in order to obtain relief from pain for her child and sometimes their arrival at the Clinic has been preceded by unfruitful calls at private practitioners with consequent loss or morale and an increased sense of frustration. This part of the service given at the clinics remains of prime importance and the extent of emergency treatment will only be reduced when the staffing position is improved considerably thereby ensuring that the maximum amount of routine treatment is performed. Immunisation Clinics. Owing to decreasing attendances at these clinics it was found desirable to merge the previously separate sessions and hold a combined clinic for both school and pre-school children. These sessions for children of all ages are held weekly both at the Town Hall Annexe and at Church Road Clinic, The work of the clinics is shewn in the following summary Number of clinic sessions 94 Number of children completely immunised 463 Number of children re-inoculated 166 Percentage of children of school age completely immunised 70.4 78 Physiotherapy Clinics. The services provided in these Clinics have continued at a high level of efficiency during the year. Their value is accentuated by the fact that treatment can be given without the long waiting period for similar services in hospital out-patient departments, and by the minimal loss of school time which results from avoiding the necessity for undue travel to and from hospital. Attendances - Town Hall Annexe 4,726 Manor Park1,626 Treatment given - number of patients:- Sunlight - local and general 337 Remedial exercises 470 Electrical and massage 33 Child Guidance Clinic. The work of the Child Guidance Clinic during 1951 was somewhat handicapped by staffing difficulties. Dr. E.Huband joined the team as parttime Psychiatrist (2 sessions per week) to repliace Dr. Craike, but we were without the services of a Psychiatric Social Worker until Mrs. M,H. Mills was appointed in November. Mr. Wright resigned at the end of October and Mrs. J.F. Stevens was appointed as temporary Educational Psychologist in charge. Mrs. Barker (part-time Play Therapist) left in December, but it was expected to replace her early in 1952. Despite an almost complete change of staff and the lack of a Psychiatric Social Worker for the greater part of the year, much valuable work was carried out. 105 children were discharged as no longer requiring treatment (20 more than in the previous year). However, more children were referred for treatment and at the end of the year there was a waiting list of 84 children - which means that many will have to wait up to 8 or 9 months before treatment can be commenced. Should the present rate of referral continue there is little prospect of reducing this waiting list without augmenting the staff. The following statistics relate to the work of the Child Guidance team in 1951, although they can give little idea of that accomplished owing to the individual and time consuming nature of this form of treatment. Sessions worked: Psychiatrists 170 Play Therapist 88 Educational Psychologist Full-time Psychiatric Social Worker Attendances by parents and children at Clinic: Psychiatrists 675 Play Therapist 291 Educational Psychologist 578 Psychiatric Social Worker 64 Home Visits: Educational Psychologist 21 Psychiatric Social Worker 47 School Visits: Educational Psychologist 65 79 Child Guidance Cases: New Cases referred .. .. 171 Cases in treatment .. .. 101 Cases under observation .. .. 71 Cases discharged .. .. 105 Cases waiting to be seen .. .. 84 Maladjusted Children: Cases placed in special schools .. .. 7 Cases fostered out .. .. 5 Cases awaiting placement .. .. 11 Education Cases: E.S.N, children seen .. .. 21 Cases treated .. .. 29 Cases waiting .. .. 25 It is hoped that in 1952 the full and reconstituted team will perform an even more valuable function in the treatment of children's problems and hence serve to prevent much emotional disturbance and even mental illness in later life, Speech Therapy Clinic This Clinic continues to be housed in the old Shrewsbury Road schools, thus ensuring close co-operation between Speech Therapist and the staff of the Child Guidance Clinic - so essential when treating a disability which often has its roots in emotional disturbance. In September Miss P.N, Glover commenced a years' leave of absence, granted to enable her to study methods in Canada, Miss E. Westley was appointed temporarily to carry on the worK or the clinic. Number of cases referred 63 Attendances for treatment 1,759 Cases discharged 46 Cases awaiting treatment 14 Ophthalmic Clinic. I regret to report that the need for an orthoptic service has not yet been met. Negotiations with the Regional Hospital Board, like those concerning the wider issues of the Specialist Clinics in general have proved protracted. Mr. R.A. Morris, Ophthalmic Surgeon, attends at the Town Hall Annexe 3 sessions per week. Statistics are as follows Number of clinic sessions 152 Number of children attending 1,375 Number of attendances 3,143 Defective Vision and Squint Eye Disease New cases 419 Treated at clinic 100 Re-examlnations 972 Referred to hospital 17 Glasses prescribed 790 + Glasses obtained 632 Glasses not required 82 Referred to hospital 101 + Information from Local Executive Council. 80 The following cases were referred to hospital for treatment:- High Myopia 2 Cataract and Opacities 5 Squint 99 Cyst 2 Blepharitis 1 Conjunctivitis 2 Other conditions for investigation 7 Total 118 Ear, Nose and Throat Clinic. Reference has already been made to the Audiometric Surveys carried out in the schools. The extra work of investigating cases picked out by this procedure could not be encompassed in the weekly session attended by Mr. Savage, and in November a second weekly session was commenced.This is also attended by an E.N.T. Surgeon employed by the Regional Hospital Board. The following are the statistical details Number of clinic sessions 54 Number of children attending 724 Number of attendances 1,289 Defects and treatment: TABLE 49. Defect Number observed Number treated Referred for operation Tonsils and Adenoids 293 29 264 Other throat conditions 160 160 - Defective Hearing 121 121 - Otitis Media and discharging ears 47 47 - Other ear conditions 63 61 2 Nasal deformities 7 7 - Rhinitis 14 14 - Catarrh 43 43 - Other nose conditions 43 43 - Totals 791 525 266 Of the cases referred for operative treatment, 264 were for the removal of tonsils and adenoids and two for removal of polypi in the ear. The operations were performed by Mr. Savege at the Children's Hospital, Balaam Street. Home Visiting. Home visits made by health visitors and school nurses during the year numbered 4,156. These visits were for such purposes as following up cases of defects or uncleanliness discovered during routine examinations in schools or in the clinics, to obtain reports on home conditions requested by hospital Specialists or by our own Medical Officers, and to advise upon cases of infectious disease and medico-social family problems reported to me as Medical Of ficer of Health. Handicapped Pupils. At present no special schools are maintained by the Authority although it 81 is hoped that building of the Day Special School for Educationally Subnormal children will soon commence„ The work, of "ascertaining" children who need special educational provision as handicapped pupils is perhaps one of the less well known functions of the Medical Officers, although it is of paramount importance to the welfare of the children concerned and always calls for wide clinical knowledge and sound judgement. 98 special examinations were carried out during the year and recommendations for special educational treatment were made in respect of 42 children, as follows TABLE 50 Category Number ascertained Recommendation Ordinary School with special treatment Day Special School Boarding Special School Blind 1 - - 1 Partially Sighted - - - - Deaf 1 - - 1 Partially Deaf - - - - Delicate 12 - 3 9 Diabetic - - - - Educationally Sub-normal 15 6 7 2 Epileptic - - - - Maladjusted 3 - - 3 ØPhysically Handicapped 9 - 2 5 †Suffering from Speech Defect 67 67 - - E.S.N, and Maladjusted 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. Two children ascertained as Physical Handicapped were recommended for home tuition. Twelve cases were found to be subject to be dealt with under the provisions of Section 57 of the Act :- Recommended for report to the Mental Health Committee under the provisions of : Section 57 (3) (Ineducable) 3 Section 57 (5) (Requiring supervision after leaving school) 9 82 STATISTICAL APPENDIX MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS„ PERIODIC MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups : Entrants 2,241 Second age group 1,289 Third age group l,407 Total 4,937 Number of other Periodic Inspections 3,013 Grand Total 7,950 OTHER INSPECTIONS. Number of Special Inspections 6,017 Number of Re-inspections 5,631 11,648 PUPILS FOUND TO REQUIRE TREATMENT, Number of individual pupils found at periodic medical Inspections to require treatment (excluding dental diseases and infestation with vermin). TABLE 51 Group For defective vision (excluding squint) For any of the other conditions recorded in Table 52 Total individual pupils Entrants 18 461 468 Second age group 130 203 316 Third age group 227 115 314 Total (prescribed groups) 375 779 1,098 Other periodic inspections 257 510 732 Grand Total 632 1,289 1,830 RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER, 1951. TABLE 52 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 27 503 47 Eyes - a. Vision 632 95 610 87 b. Squint 117 18 123 20 c. Other 49 20 184 26 Ears - a. Hearing 25 13 37 10 b. Otitis Media 19 13 22 3 c. Other 22 16 78 25 Nose or Throat 340 478 515 341 Speech 29 30 38 52 Cervical Glands 10 144 6 45 Heart and Circulation 22 55 16 42 Lungs 76 82 25 42 Developmental - a. Hernia 9 4 1 2 b. Other 12 47 17 16 Orthopaedic - a. Posture 62 75 31 35 b. Flat Foot 85 32 77 46 c. Other 179 165 110 118 Nervous system - a. Epilepsy 5 7 6 5 b. Other 12 17 47 31 Psychological - a, Development 8 16 12 16 b. Stability 20 44 46 9 Other 289 191 1,081 240 CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS. TABLE 53 Age Groups Number of Pupils Inspected A (Good) B (Fair) C (Poor No. % No. % No. % Entrants 2,241 1,510 67.4 711 31.7 20 0.9 Second age group 1,289 834 64.7 447 34.7 8 0.6 Third age group 1,407 1,116 79.3 287 20.4 4 0.3 Other Period Inspections 3,013 2,148 71.3 844 28.0 21 0.7 Totals 7,950 5,608 70.5 2,289 28.8 53 0.7 83 84 TABLE 54 TREATMENT TABLES GROUP 1. - DISEASES OF THE SKIN (excluding Uncleanliness). Number of Cases treated or under treatment during the year By the Authority Otherwise Ringworm - (i) Scalp 1 - (ii) Body 3 2 Scabies - - Impetigo 14 1 Other skin diseases 256 173 Total 274 176 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 110 91 Errors of Refraction (including Squint) 416 887 Total 526 978 Number of Pupils for whom spectacles were: (a) Prescribed 259 531 (b) Obtained 248 384 + Information received from the East Ham Executive Council. 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 - - (b) for adenoids and chronic tonsillitis - 604 (c) for other nose and throat conditions - 3 Received other forms of treatment 96 565 Total 96 1,172 GROUP 4.ORTHOPAEDIC AND POSTURAL DEFECTS. (a) Number treated as in-patients in Hospitals 5 By the Authority Otherwise (b) Number treated otherwise, e.g. in clinics or out-patients departments 62 68 85 GROUP 5. - CHILD GUIDANCE TREATMENT. Number of Cases Treated In the Authority's Child Guidance Clinics Elsewhere Number of pupils treated at Child Guidance Cllnics 299 - GROUP 6. - SPEECH THERAPY. Number of Cases Treated By the Authority Otherwise Number of pupils treated by Speech Therapists 137 - GROUP 7 - OTHER TREATMENT GIVEN. Number of Cases Treated By the Authority Otherwise (a) Miscellaneous Minor Ailments 163 32 (b) Other 1. General debility 377 71 2. Disease of the digestive system 50 17 3. Developmental Defects 6 64 4. Asthma and Respiratory Diseases 104 117 5. Nervous Disorders 41 21 6. Other Conditions 37 35 Total 778 357 TABLE 55 DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Authority's Dental Officers (a) Periodic age groups 4,438 (b) Specials 1,498 Total 5,936 (2) Number found to require treatment 4,622 (3) Number referred for treatment 3,037 (4) Number actually treated 3,064 (5) Attendances made by pupils for treatment 4,718 (6) Half-days devoted to (a) Inspection 49 (b) Treatment 654 Total 703 (7) Fillings : Permanent teeth 1,207 Temporary teeth 279 Total 1,486 (8) Number of teeth filled : Permanent teeth 1,047 Temporary teeth 274 Total 1,351 86 (9) Extractions: Permanent teeth 444 Temporary teeth 5,920 Total 6,364 (10) Administration of general anaesthetics for extraction 1,491 (11) Other Operations: (a) Permanent teeth 556 (b) Temporary teeth 728 Total 1,284 TABLE 56 INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorised persons 39,868 Total number of Individual Pupils examined Approx 15,000 (11) Total number of individual pupils found to be infested 745 (ill) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 30 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) -