EAS 29 COUNTY BOROUGH OF EAST HAM ANNUAL REPORT of the Medical Officer of Health and School Medical Officer For the Year 1952 JOHN S. COLEMAN, m.b., b.s. (lond.) m.r.c.s. (eng.) l.r.c.p. (lond.), d.p.h. (eng.) Medical Officer of Health & School Medical Officer. COUNTY BOROUGH OF EAST HAM ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1952 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 21 Infectious Diseases 24 National Health Service Act, 1946:- Special Survey of the Local Health Services 35 Sec. 22 Care of Mothers and Young Children 5k Sec. 23 Midwifery Services 61 Sec. 24 Health Visiting Services 65 Sec. 25 Home Nursing Services 66 Sec. 26 Vaccination and Immunisation 68 Sec. 27 Ambulance Services 70 Sec. 28 Prevention of Illness, Care and After-Care 72 Sec 28 & 51 Mental Health Services 80 Sec. 29 Home Help Services 84 Sanitary Section and Housing 86 Inspection and Supervision of Food 90 School Health Service:- Introduction 95 Report 98 3 EAST HAM CORPORATION COUNCIL (shewing Chairmen and Vice-Chairmen of Health, M. & C. W., Mental Health and Education Committees) THE MAYOR: Mr. Alderman Alfred Prior, J .P. THE DEPUTY MAYOR: Mr* Alderman John Albert Hart, J.P, ALDERMEN: Mr. William Henry Whittock Beecham, Mr. Leslie Alfred Victor Bennett, (4) Mr. Charles William Brading, J.P., C.R.P. Mr. Charles William Dixon, (5) Mr. Walter Edwin Hurford. Mr. Herbert Percy Jackson, J.P. Mrs, Winifred May Knight, Mr. Ernest Albert Wood, J.P. COUNCILLORS: Mrs. Agnes Ann Bradshaw, (6) Mr. Charles Frederick. Chapman, Mr. Frederick George Bryce Clayton, Mrs. Ruby Lilian Collett, Mrs. Amy Beatrice Cowlan, (3) Mrs, Daisy May Davey, Mr. Edwin John Davey, (2) Mrs. Elsie Mary Devenay, Mr. William Doran, Mr. Sidney Arnold Elson, Mr. Francis William French, Mr. Leonard Lewis Griffiths, Mr. William Hogarth, Mr. Frank Herbert Howard, Mr. Arthur Henry Richard Huggett, Mr. Thomas Alfred Jenkinson, (1) Mr. John Alfred Kemp, Mr. George Charles Lay, Mr. George Edward Marshall, Mr, Arthur Richard Miller, Mr. Arthur George Murrell Oakes, Mr. John Henry Pagett, Mr. Frank Owen Reynolds, Mr. Reuben Frederick Ricketts, Mr. Albert Cyril Smith, Miss Florence Louise Stevens, Mrs. Lily Sutton, Mr. James Ernest Taylor, Mr. Joseph Charles Taylor, Mr. Norman Roy Thomas, Co-opted members of the Health, M. & C, W., Mental Health and Education Committees:- Dr. O. Thomas Health Mr. L. Bax 4 Mrs. I.F. MacDonald Mrs, M. Page Maternity Alderman Mrs, D. Parsons, J.P. and Mrs, C, Robertson Child Welfare Mrs. A.A. Woodman, M.B.E. Mr, S.C. Foreman Mr. W. Harman Mental Health Mr. H.F. McNeil Rev, V. Hurley Mrs. M.E. Bennett Mr. F.J. Phillips Education Mr. H.J. Pitt Dr. L.Q. Whitehead. Ph.D., B,Sc. Mr. L.S.J. Witter, B.Sc. (1) Chairman, Health Committee (2) Vice-Chairman, Health Committee (3) Chairman, Maternity & Child Welfare Sub-Committee (4) Chairman, Mental Health Sub-Committee (5) Chairman, Education Committee (6) Vice-Chairman, Education Committee. 5 PUBLIC HEALTH OFFICERS OF THE AUTHORITY. A. Medical - whole-time. 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, D.E. CULLINGTON, M.A., M.B., Ch.B., M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health and Senior Assistant School Medical 0fficer. JOHN JOSEPH DUFFY, M.B., Ch.B,, D.P.H., Assistant Medical 0fficer. FREDA GASKELL, M.R.C.S., L.R.C.P,, Assistant Medical Officer, GERALDINE O'CALLAGHAN, M.B., Ch.B., B.A.O., D.P.H., Assistant Medical Officer, STELLA MARGARET BERYL PERRY, M.B., Ch.B., D.P.H., Assistant Medical Officer, J. TWELLY REES, M.R.C.S., L.R.C.P., Assistant Medical Officer, Medica - part-time. H. BEVAN JONES, M.R.C.S., L.R.C.P., Psychiatrist. P. ELLMAN, M.D., F.R.C.P., M.R.C.S., Consulting Physician, East Ham Chest Clinic, + J. EVANS, M.D., F.R.C.S., E.N.T. Registrar. Miss E. HUBAND, M.A., M.R.C.S., L.R.C.P., D.P.M., Psychiatrist. J.H.P. JOHNSON, M.B., M.R.C.P., Assistant Chest Physician, East Ham Chest Clinic. K,W. LEON, M.R.C.S., L.R.C.P. Anaesthetist, † + D. MCDONALD, M,B., Ch.B., E.N.T. Registrar, Mrs, A. MARSDEN, M.B., Ch.B,, D.A. Anaesthetist. R.A. MORRIS, M.R.C.S., L.R.C.P., D.O.M.S., Ophthalmic Surgeon. R. SAVEGE, M.B., Ch.Bo, F.R.C.S. (Edin)., Aural Surgeon. † + W. A. SULTANA, E.N.T. Registrar. 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. IRE SCHACHTER, M.D. (Vienna). C. Sanitary and Food Inspectors:- 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. + E.A. BLOOMFIELD, M.S.I.A., A.R.S.I. † L.W. COLE, M.S.I.A., A.R.S.I. R. DAW, M.S.I.A. † A.J, GOFFIN, M.S.I.A. + G.A. HAGEDORN, M.S.I.A. F.W. REEVE, M.S.l.A. J.H. RILEY, M.S.I.A. † A.S. WHITE, M.S.I.A. H.F. WILLIAMS, M.S.I.A., M.R.S.I. Shops Act Inspector:- T. GILBERT. D. Nursing Staff:- Superintendent Nursing Officer:- B.M.A. Newman-Pilkington, S.R.N., S.C.M. H.V.'s Cert. (R.S.I.) Superintendent Health Visitor:- B.L. MARYON, S.R.N., S.C.M., H.V.'s Cert. (R.S.I.) 6 Unified Nursing Service (Health Visitors and School Nurses):- E.M. ABRAHAM, S.R.N., S.C.M., H.V.'s Cert. † K.M. BOLT, S.R.N., C.M.B. (Part 1), H.V.'s Cert. S.P. BURRCWS, S.R.N., C.M.B. (Part 1), H.V.'s Cert. A. CARTER, S.R.N., C.M.B, (Part 1), H.V.!s Cert. C.G. CASE, R.F.N., A.R.S.I. P. CULLIS, S.R.N., S.C.M., H.V.'s Cert. M. GOLDEN, S.R.N., S.C.M., H.V.'s. Cert. S. GOLDEN, S.R.N., C.M.B. (Part 1), H.V.'s Cert. (R.S.I.) † W.J. HUNTING, S.R.N., S.C.M., H.V.'s Cert. G. KAVANACH, S.R.N., S.C.M., H.V.'s Cert. F. KEVILL, S.R.N., C.M.B. (Part 1), H.V.'s Cert. E.M. PHILLIPS, S.R.N., S.C.M., H.V.'s Cert. † C.C. PLANT, S.R.N., S.C.M., H.V.'s Cert. M.K. PRESSEY, S.R.N., S.C.M., H.V.'s Cert. (R.S.I.) M. PRESTON, S.R.N., S.C.M., H.V.'s Cert. (R.S.I.) V.R. PRUDDEN, S.R.N., S.C.M., H.V.'s Cert. M.J. PYE, S.R.N., C.M.B. (Part 1), H.V.'s Cert. (.R.S.I.) B. WALTERS, S.R.N., S.C.M., H.V.'s Cert. † J. WATT, S.R.N., C.M.B. (Part 1), H.V.'s Cert. V. WILDBORE, S.R.N., S.C.M., H.V.'S Cert. Tuberculosis Nurses:- F.M. ROGERS, S.R.N., R.A. (Cert.) (Senior) † D.N. CHILTON, S.R.N., T.A. (Cert.) A.C. COUTTS, S.R.N. H.O. FORD, S.R.N., T.A. (Cert.) S.T. ROBERTS, S.R.N., S.C.M. M. STOKES, S.R.N., S.C.M., T.A. (Cert.) Municipal Midwives:- M.E. KINSELLA, S.R.N., S.C.M. M. LAW, S.C.M. E. LLOYD-OWEN, S.C.M. † L.E. STEVENS, S.C.M. M.A. SULLIVAN, S.R.N., S.C.M. Dental Nurses:- F.E. HUNT. M. LOBSENZER. C.M. STRACHAN. E. Mental Health:- Duly Authorised Officers:- W.R. ELLEDGE. J.M. WICKENS. Mrs. M.A. PEARCE. R.C. HOAD. J.C. HILLIER. A.H. BLEADEN, Supervising Officer, M.D). Training Centre. I. ALLOTT, Assistant Supervisor, M.D. training Centre. A.W. LYWOOD, Guide and Assistant (Temporary), M.D. Training Centre. 7 F. Child Guidance:- + Mrs. K. BARKER, Child Therapist † Hiss E. DAUNTON, B.A., Child Therapist Miss P.N. GLOVER, L.C.S.T., Speech Therapist (on leave in Canada whole of year.) Mrs. M.H. MILLS, Psychiatric Social Worker. Mrs. J.F. STEVENS, M.A., Educational Psychologist. Miss E. WESTLEY, L.C.S.T., Speech Therapist (during temporary absence of Miss Glover.) G. Administrative and Clerical Staffs- Chief Administrative Clerk - 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. MANISIER. R.C. THOROGOOD. and Temporary Clerks. Shorthand Typists:- D. GORDON, Senior D.G. LIGHTLEY. V.G. NUNN. E.R.A. PADDON. P.J. TOWNROW. † D.G. WHEAL. and Temporary Staff. Female Clerks:- M.A.R. GASTER. J. MACKINTOSH † E. BRYAN. F.M. CLARK, † E.G. DODDEMEADE. S. DORAN. and Temporary Staff. H. Other Staff:- Physiotherapists and Light Sisters:- E.B. BROOME, S.R.N., C.S.M., L.E.T., M.S.R. E.F.M. BOSS, S.R.N., M.S.R., C.S.P. C. HAYWARD, Oral Hygienist. † G.M. KNIGHT, Home Help Organiser. W.L. NARBOROUGH, Dispenser. H.H.L. WEBBER, Care and After-Care Assistant. † Commenced during year. + Terminated during year. 8 COUNTY BOROUGH OF EAST HAM Public Health Department. Town Hall Annexe. East Ham. E.6. TO THE WORSHIPFUL THE MAYOR, THE ALDERMEN AND COUNCILLORS OF THE COUNTY BOROUGH OF EAST HAM. Mr. Mayor, Ladies and Gentlemen. I have the honour to present the Annual Report on the health of the borough for the year 1952, and In so soing reflect that despite of financial stringency, the Council In their wisdom have pursued several measures which in their full medico-soclal application must raise up the shield of preventive medicine over an increasing number of our people. The Registrar. General's estimate of the population at the 30th June, 1952, stands at 120,000, pointing a further decline of 500 over the year, which coupled with 123 fewer registered live births and a drop in the birth rate to 12.7 leads one earnestly to contemplate the changing structure and dwindling potential of our community. The death rate has fallen a little to 11.4 and stands a fraction above the corrected death rate for England and Wales which is given as 11.3 per 1,000 of the population, and attention is drawn to the age group distribution of our people with 12,400 persons over the age of 65 years. Further more detailed statistical analysis can be pursued elsewhere in the report, but here I would pause to look back on the observations made in 1951 and ask. what has been done to encourage young people to stay In the borough and raise up sturdy families to strengthen and vitalize the fabric of our society. It would appear the time has come to add selected newly wed couples to the priority housing lists, and I believe this relief would toughen the moral fibre which tends to sag a little in the community, and restore the family unit once more to its focal point in good living. An account of the services provided under the National Health Service Act may be read in the body of the report. Here it will suffice to draw attention to a new custom and the decline of a tradition. Hospitals continue to serve a great need in the life of the borough, but greater efforts should be made to preserve our ag-long habit of home confinement. Housing conditions, although steadily improving, do not readily allow many women to be confined at home, and there are other circumstances which prompt expectant mothers to ask. for hospital accouchement. In this way the old tradition of home confinement gradually is being thrust aside and the homely birth and fireside nurture replaced by the mechanistic ritual and chromium plated crib of the "sterile white" maternity hospital. No longer is a child born to a newly wed couple the consummation of their hopes and longings, an immediate and imperative stimulus in their home to renewed mutual devotion and upsurging effort to create a stronger and better family life. Instead, Mrs. Newlywed is delivered in hospital of a baby labelled to ensure he is properly claimed to suckle his mother, made aware of his presence at appropriate intervals by the officiating nurse. 9 Mr. Newlywed is supposed to be at home pacing the floor in anxious expectancy, but may well be in the 'pub' or the cinema,, There is thus a hiatus in the full realization of the true creative nature of the birth, and this lull often deadens in the parents the feeling of wanting and striving, and acts as a drag on the drive to build up a secure family. Much is done in hospital to mitigate this unnatural state, and mother, father and babe are brought together as often and as happily as possible. But the Impact of the birth on the family is almost lost, like a squib in the next street, instead of a cracker on the hearth. There is no question that the maternity hospital must continue to carry out an important function in childbirth to safeguard mothers from the medical and obstetric hazards which can arise, but generally, good antenatal care can ensure safe delivery in the home, and when the time comes and living conditions are more in keeping with the dignity of the family the tradition of having the baby at home will be no more and we will have struck away another support to the tottering edifice of family life. Attention must also be focussed on a small but significant rise in the infantile mortality rate over last year's record low figures. Of the 37 infants who died in the first year of life 28 succumbed in the first month, and of these neo-natal deaths 12 were directly attributable to prematurity,, Our social services have done much to close the gap in the standards of life between different classes, but it may well be that the figures for infant mortality, especially the neo-natal death rate, could indicate the degree of true social advance in any cultured community. So that we have little cause for complacency in East Ham, and much has to be done in health education and community effort to raise our standard of family life and ensure a permanent decline in the wastage of infant life. In ray last report I referred to the possibility of establishing graded accommodation for certain old people who drag out a miserable existence in their homes,, In squalor, in loneliness, in semi-starvation, a number of these aged persons pray daily for death to release them from their earthbound sufferings. We do what is possible with our ancillary social services, but are well aware that our efforts fall far short in supplying many of these old folks1 daily needs in feeding, domestic service, physical help and companionship. In my opinion the problem in many cases cannot be solved in the homes, for many of their living quarters are ill suited even to vigorous young people and cannot properly be adapted to the needs of senile and decrepit ~ persons. I do not consider the Council should lightly turn aside the possibility of the utilization of some part of the disbanded Aldersbrook Children's Homes for the new purpose of graded accommodation for old persons. Such provision will surely represent the greatest single advance in social service it is possible to make, for the care of old people is a challenge to community life equalled only by cancer and heart disease. Much has been written of atmospheric pollution, and East Ham suffered most grievously in the 'smog' at the close of the year. Our borough is sandwiched between the great industrial area of West Ham, and the Beckton Gas Works, Woolwich, and Thames estuary industrial undertakings. Thus, whichever way the prevailing winds blow we are likely to experience heavy concentrations of smoke and noxious substances in the air which our denizens must breathe. 10 It is possible that some small diminution of atmospheric pollution might be achieved by improvement in domestic fire appliances, but let us deal with prime causes first, and by local and national legislation ensure that every industrial concern diverts a fraction of its profits to the prevention of smoke emission and destruction of noxious gases which could be led back into the furnaces or otherwise consumed or rendered harmless0 The creation of smokeless zones without the inclusion of our neighbouring industrial undertakings, is as fatuous as asking the housewife to buy smokeless fuel which she simply cannot afford, or to bank her open fire at night, at which operation she is already expert. Yet, in spite of these various difficulties, East Ham remains a good residential borough without wide divergence of social class and with good community amenities. In the body of the report will be found detailed survey of those services which come under the surveillance of the Health Committee whose Chairman and Members have spared no effort in the public weal. To them I extend grateful thanks for encouragement and support in many projects. I owe a debt of gratitude to Dr. D.E. Cullington, my Deputy, for his Industry, thoughtfulness and meticulous application to every task. and to Mr. H.J. Horsnell, the department's Chief Administrative Assistant, who has given me considerable assistance in the preparation of this report and throughout the year. It would be invidious to single out individual members of the staff. All have worked well to ensure that the Health Department gives to the people good medico-social services 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. 1952 120,000 Number of inhabited houses (end of 1952 according to rate books) (including tenements and shops) 33,918 + Rateable value at 31st December, 1952 £771,810 Sum represented by a penny rate for the year 1952/3 £3,l82 + Excludes factories, cinemas, government properties, corporation properties (offices and works), utility undertakings and other miscellaneous heriditaments not actually occupied as dwellings. EXTRACTS FROM VITAL STATISTICS. Males Females  Live Births Legitimate Illegitimate 822 736 l,558 27 24 51 Still Births Legitimate 18 10 28 Illegitimate 2 2 Deaths - Males 723. Female s 607. Total 1,330 Deaths from Puerperal causes:- Deaths Rate per 1,000 Total (Live and Still) Births Puerperal Sepsis - — Other Maternal Causes 2 1.22 Total 2 1.22 Deaths of infants under one year of age:- All infants per 1,000 live births 22.9 Legitimate infants per 1,000 legitimate live births 23.1 Illegitimate infants per 1,000 illegitimate live births 19.6 Deaths from Cancer (all ages) 249 TABLE 1 Still births per 1,000 population 1948 1949 1950 1951 ] England and Wales .. 0.42 0.39 0.37 0.36 0.35 East Ham .. .. 0.38 0.39 0.37 0.29 0.25 12 STILL BIRTHS The number of still births registered was 30 compared with 35 for the previous year, The rate per 1,000 total (live and still) births was 18.3 the figure for 1951 being 19.8. The still birth mortality rates for England and Wales and East Ham are shewn in the following table The rates for East Ham per 1,000 total (live and still) births for the past five years are indicated below 1948 1949 1950 1951 1952 No. of still births 46 48 46 35 30 Rate per 1,000 total births 20.5 24.2 25.5 19.8 18.3 BIRTHS. The number of live births registered was 1,609, as compared with 1,732 for the year 1951, equivalent to a birthrate of 13.4 per 1,000 of the population - the figure for the previous year being 14.3. The Registrar General has computed an Area Comparability Factor to facilitate comparision 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 13.4 x 0.95 = 12.7. This corrected rate is used in all comparison tables in this report. A comparison of the statistics for the period since 1948 is appended 1948 1949 1950 1951 1952 No. of Births (East Ham) 2,194 1,934 1,753 1,732 1,609 Birth rate (East Ham) 18.1 15.8 l4.4 13.6 12.7 Birth rate (England & Wales) 17.9 16.7 15.8 15.5 15.3 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 1,330, as compared with 1,433 for the year 1951. The death rate per 1,000 of the population was 11.0, that for the previous year being 11.8. Of the total deaths, 632 or 47.5 per cent. died in Institutions. The number of residents who died outside the area and whose deaths were assigned to the Borough was 568. The deaths of persons non-resident in the area totalled 66. 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 ft, F. M. F. M. F. M. F. M. F. M. F. 24 13 5-42 42 10 9 30 22 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. H. F. M. F. 69 35 140 78 207 165 174 212 53 63 3 6 13 14 The crude death-rate was 11.0. 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 (11.0) multiplied by 1.04 = 11.4. For the period 1948 - 1952 the death rates for England and Wales and East Ham are compared 1948 1949 1950 1951- 1952 England and Wales 10.8 11.7 11.6 12.5 11.3 East Ham 9.67 11.55 11.13 12.2 11.4 INFANTILE MORTALITY. Deaths of infants under one year numbered 37 ~ equivalent to an infant mortality rate of 22.9 per 1,000 live births, the rate for the previous year being 18.4. The rate for England and Wales for 1952 was 27.6. The number of deaths of illegitimate children under one year of age was 1 out of a total of 51 illegitimate live births, giving a mortality rate of 19.6 as compared with a figure of 33.5 per 1,000 illegitimate live births for the year 1951. The infantile mortality rates since 1948 are as follows 1948 1949 1950 1951 1952 England and Wales 34 32 29.8 29.6 27.6 East Ham 26 24 25 18.4 22.9 Illegitimate births and mortality rates for the Borough since 1948 are tabulated below 1948 1949 1950 1951 1952 No. of illegitimate births 65 65 64 60 51 Mortality rate per 1,000 illegitimate live births 15 30 62 33.3 19.6 NEO-NATAL MORTALITY Children dying under the age of one month totalled 28, equal to a neo-natal mortality rate of 17.4 per 1,000 live births, These rates from 1948 - 1952 are compared below 1948 1949 1950 1951 1952 14.5 14.9 16.6 13.8 17.4 The causes of death of these children under one month of age were as follows Cause No. of Deaths Atalectasis 7 Premature Births 12 Congenital Malformations, Birth Injury, Infantile Diseases 4 Other causes 5 Total 28 15 16 MATERNAL MORTALITY The number of maternal deaths was 2. the maternal mortality rate per l.000 live and still births for 1952 being 1.22. POPULATION The Registrar-General's estimate of the papulation at the 30th June, 1952, was 120,000 as compared with 120,500 for the previous year. The rates per 1,000 of the population mentioned in this report are based on this estimate,. During 1952 the Registrar General issued the first section of the one per cent sample tables of the Census of 1951. These are concerned with ages and marital condition, occupations, industries, and the housing of private households. These figures, being compiled from only 1% of the forms completed in each area are not absolutely accurate, and, in due course, will be replaced by exact figures when the analysis of all Census forms is complete. The errors, however, will be only of the order of 1 to 2 per cent. and the figures are sufficient to give a reasonable estimate for each area. The agg group distribution of the population of East Ham in April, 1951, was as follows Age (last birthday) Males Females Total 0-4 4,400 4,700 9,100 5-14 7,200 9,200 16,400 15-24 6,700 8,200 14,900 25-34 10,100 9,300 19,400 35-44 10,100 11,300 21,400 45-54 7,800 7,400 15,200 55-64 4,900 7,200 12,100 65 and over 5,900 6,500 12,400 Totals 57,100 63,800 120,900 Of the 57,100 males, 23,000 were single, 31,900 were married, and 2,200 widowers or divorced,, The corresponding figures for the females were 25,400 single, 31,200 married, and 7,200 widowed or divorced, The analysis of population by occupations and by industries is not sufficiently detailed to enable figures to be quoted in respect of this area alone. The information on housing arrangements shows that in East Ham there were 37,500 households, i.e. "Single persons living alone or groups of individuals voluntarily living together under a single menage in the sense of sharing the same living room or eating at the same table." Boarders and demestic servants are included within the household, but lodgers or groups of lodgers having separate accommodation are regarded as separate households. Of these 37,500 households, 13,200 were living in shared dwellings, 7,100 were without the exclusive use of a water closet, 18,700 without the exclusive use of a fixed bath, and 3,100 without the exclusive use of both stove and sink. The 37,500 households occupied 151,700 rooms, and the population in households totalled 117,000. The average number of persons per household was 3.12 as compared with 3.71 in 1931. The average number of 17 persons per room was 0.77 as against 0.93 In 1931, and l45% of the household population was living more than two persons to the room, the 1931 figure being 6.23% It must again be emphasised that the above figures are derived from an analysis of one per cent of the Census forms completed in East Ham, and may be subject to amendment when the final figures are available. TABLE 2. - BIRTH RATE, DEATH RATE AND ANALYSIS OF MORTALITY, 1952. 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 15.3 0.35 11.3 0.00 O.Ol 0.47 0.00 0.00 0.04 0.00 '0.24 27.6 l.l 160 County Boroughs and Great Towns, including London 16.9 0.43 12.1 0.00 0,01 0.52 0.00 0.00 0.04 - 0.28 31.2 1.3 160 Smaller Towns (resident populations 25,000 to 50,000 at Census, 1951) 15.5 0.36 11.2 0.00 0„00 0.43 0.00 0.00 0.04 - 0.22 25.8 0.5 London - Administrative County 17.6 0.34 12.6 - 0.01 0.58 0.00 0.00 0„05 - 0.31 23.8 0.7 j EAST HAM 12.73 0.25 12.4 - 0.01 0. 66 - - 0.02 - 0.23 22.9 0.6 A dash (-) signifies there were no deaths0 18 19 TABLE 3. -CAUSES OF DEATH IN AGE GROUPS 1952. Deaths at different periods of life of residents (including non-civilians) whether occurring within or without the district Total deaths in Institutions Total deaths for the years All Ages Under 1 Year 1-4 Years 5-14 Years 15 - 24 Years 25 - kk Years 45-64 Years 65 - 74 Years 75 Years and above 1952 1951 1950 M F M F M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratory 19 7 - - - - - - - - 2 2 10 4 6 1 1 - 12 2 26 29 33 2. Tuberculosis, other forms 2 - - - 1 - - - - - - - - - 1 - - - 1 — 2 7 3 3. Syphilitic Disease 5 3 - - - - - - - - - - 3 1 1 1 1 1 2 2 8 10 13 4, Diphtheria - - *- - - - - - - - - - - - - — - - — - — - — 5. Whooping Cough - - - - - — - - - - - — - — ~ — ~ — — — — 1 2 6. Meningococcal Infections - - - - - - - - - - — - - - — ~ ~~ — — — ~ — 7. Acute Poliomyelitis 1 1 - - - - 1 1 - - - — - - - — - — 1 1 2 - 1 8. Me asles - - - - - - - - - - - - - - - - - - - — — - - 9. Other Infective and Parasitic Diseases - 2 - - - - - - - - - - 1 - 1 - - — 2 2 - 1 10. Malignant Neoplasm, Stomach 28 21 - - - - - - - - - - 14 4 7 5 7 12 14 7 49 58 37 11. Malignant Neoplasm, Lung, Bronchus 46 8 - - - - - - - 2 - 29 3 11 4 4 1 23 4 54 50 47 12. Malignant Neoplasm, Breast — 23 - - - - - - - - 1 - 11 - 6 - 5 - 10 23 21 24 13. Malignant Neoplasm, Uterus - 6 - - - - - - - - - - 4 — 1 — 1 — 3 6 16 11 14. Other Malignant & Lymphatic Neoplasms 67 50 - - - - - - 2 1 5 5 20 12 20 13 20 19 37 25 117 126 120 15. Leukaemia, Aleukaenia 6 4 - - - -- - - - - - - 2 4 3 - 1 - 4 4 10 12 9 16. Diabetes 4 8 - - - - - - - - - - 3 4 — 3 1 1 2 4 12 12 8 17. Vascular Lesions of the Nervous System 66 95 - - - - - - - - 1 2 17 17 25 28 23 48 33 32 161 140 174 18. Coronary Disease Angina 108 69 - - - - - - - 3 1 42 12 33 29 30 27 26 19 177 154 144 19. Hypertension with Heart Disease 13 22 - - - - - - - - - 1 3 1 4 5 6 15 9 12 35 71 48 20. Other Heart Disease 93 108 - - - - - - - - 5 4 11 13 17 19 60 72 29 43 201 233 261 21. Other Circulatory Disease 32 22 " - - - - - - - 1 - 8 4 13 6 10 12 20 12 54 53 39 22. Influenza 1 2 - - - - - - - - - - - - - 1 1 1 - - 3 27 8 23. Pneumonia 41 36 3 - - - - - - 1 1 6 4 10 9 21 22 35 25 77 71 49 24. Bronchitis 74 35 - - - - - - - 1 4 - 15 3 31 12 24 19 26 9 109 120 82 25. Other Diseases of Respiratory System 6 9 - - - - - - - - - 2 3 1 3 3 - 3 4 5 15 11 15 26. Ulcer of Stomach and Duodenum 9 1 - - - - - - - - l - 3 - 4 - 1 1 7 1 10 21 16 27. Gastritis, Enteritis and Diarrhoea 1 4 1 - - - - - - - - - - - - 3 - 1 1 3 5 2 6 28. Nephritis and Nephrosis 12 6 1 - - - - - 1 - 2 1 4 3 3 1 1 1 4 3 18 10 17 29. Hyperplasia of Prostate 7 - - - - - - - - - - - - - 2 - 5 - 5 - 7 15 4 30. Pregnancy, Childbirth, Abortion - 2 - - - - - - - - - 2 - - - - - - - 2 2 1 1 31. Congenital Malformations 4 5 3 3 1 - - - - - - 2 — - — - - - 2 3 9 14 10 32. Other Defined and 111 Defined Diseases 52 41 16 9 3 - - - - - 7 6 8 3 10 10 8 13 45 27 93 104 90 33. Motor Vehicle Accidents 11 3 - - -• - 3 - 1 - 4 - 1 - - 1 2 2 10 3 14 11 3 34. All Other Accidents 10 8 - 1 - - - - - - l - 5 - 1 3 3 4 8 5 18 24 16 35. Suicide 5 6 - - - - - 1 - - l 1 2 4 2 - - - 1 3 11 8 11 36. Homicide and Operations of War _ - ~ — - ~ — - - - - - — — ~ - — — — - - 1 1 TOTALS 723 607 2k 13 5 - 4 2 4 2 40 31 209 113 207 165 230 281 361 271 1330 1433 1304 TABLE 4. - INFANT DEATHS UNDER ONE YEAR OF AGE, 1952 Cause of Death Total deaths AGE AND SEX 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 Pneumonia 3 - - - - - - - - - - 2 - 1 - - - 3 - Gastro-Enteritis 1 - - - - - - - - 1 - - - - - - - 1 - Atalectasis 6 4 2 - - - - - - - - - - - - - 4 2 Congenital Malformation 6 2 - - - 1 - - - - 1 - 2 - - - - 3 3 Premature Births 11 6 3 - - - - 1 1 - - - - - - - - 7 4 Other Causes 10 2 2 1 1 1 - - - 1 1 - - 1 - - - 6 4 TOTALS 37 14 7 1 1 2 - 1 1 2 2 2 2 2 - - - 24 13 20 21 GENERAL PROVISION OF HEALTH SERVICES MIDWIVES ACTS, 1902 - 1950. The number of midwives who notified their intention to practise in East Ham during the 13 months ending 31/1/53 was 26 - of these 18 also indicated that they would act as Maternity Nurses. Of the 26, 7 worked in connection with the Maternity Hospital and District Nurses Home, Plaistow, and its branches - 2 at Sir Henry Tate Nurses' Home, Silvertown - 10 at East Ham Memorial Hospital - and 7 practised independently^ including k Municipal Midwives and the Supervisor of Midwives. PLAISTOW MATERNITY HOSPITAL AND DISTRICT NURSES' H0ME. Summary of cases, 1952:- Midwifery 114 Maternity Nursing 31 Hospital 107 SILVERTOWN & NORTH WOOLWICH DISTRICT NURSING ASSOCIATION. Midwifery 3 Maternity Nursing 1 CLINICS AND TREATMENT CENTRES. With the exception of North Woolwich these are all provided by the Council. The clinics at Roman Manor are held in the Community Centre, by permission of the Education Committee. The sessions at She Centres (as on 31/12/52) were as follows 22 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. Immunization Clinic Infant Welfare Clinic Tuesday 2 p.m. Friday 2 p.m. Monday, Thursday and Friday 2 p.m. Physiotherapy Clinic Continuous. Eye Clinic Monday 2 p.m., Tuesday and Friday 9.30 a.m. Toddlers Clinic Tuesday 10 a.m. and Wednesday 2 p.m. Ear Clinic Ante-Natal Clinic (and Post-Natal) Wednesday and Friday 2 p.m. Monday 9 a.m., Tuesday 2 p.m. Thursday 10 a.m. and Friday 10 a.m. Dental Clinic Daily by appointment Church Road, Manor Park General Clinic (Minor Ailment Cases) Tuesday and Friday 9.30 a.m. Immunization Clinic Infant Welfare Clinic Thursday 10 a.m. 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. (double session). Dental Clinic Daily by appointment. +North Woolwich Fernhill Street Baths General Clinic (Minor Ailment cases) Alternate Fridays 2 p.m. Maternity & Child Welfare Clinic Tuesday 10 a.m., Shrewsbury Road School, Forest Gate Child Guidance Clinic Psychiatrist Present: Tuesday a.m. and p.m. Thursday a.m. and p.m. Roman Manor Speech Therapy Maternity & Child Welfare Clinic Continuous. Wednesday 10 a.m. General Clinic (Minor Ailment Cases) Thursday 10 a.m. + By arrangement with L.C.C. 23 VENEREAL DISEASES. The following statistics have been abstracted from copies of form V.D.(R) (1952), which have been received from the Hospitals named and total figures for 1951 and 1950 are also shewn:- Patients dealt with for the first time during 1952. Syphilis Gonorrhoea Other Conditions Total Whitechapel Clinic, London Hospital 3 21 100 124 Queen Mary's Hospital, Stratford E. 15 11 1 16 28 Albert Dock Hospital - 7 23 30 Totals 14 2.9 139 182 Totals for 1950 23 23 128 174 Totals for 1951 6 25 132 163 ALDERSBROOK HOMES AMD SCATTERED HOMES. The statistics for the year 1952 are appended 1 Average number in homes throughout the year 353 2. No. chargeable to East Ham on 1/1/52 118 3. No. chargeable to East Ham on 31/12/52 130 4. Average weekly admissions 16 5. Average weekly discharges 16 6. Greatest number of children admitted on anyone day (28.4.52) 13 7. Total number of children admitted in 1952 0-3 yrs. 219 Over 3 yrs 585 Total 804 From the medical aspect, the administration of these Children's Homes has presented few problems. Inspection on admission and discharge ensures that as far as possible, children receive appropriate medical treatment and nursing care whilst resident in our Homes. For long-stay residents, medical inspection is carried out as required by Home Office Regulations, and any defects uncovered are remedied by referral to hospital or clinic. Vaccination and immunisation against diphtheria and whooping cough are also vigorously pursued, and generally speaking, infection with the common zymotic diseases is well controlled, and despite frequent admissions and discharges, has never given cause for alarm, Accidents and injuries were all promptly dealt with by the nursing staff and the medical officer on duty, and children with more severe injuries, transferred to hospital. The dietary in all the blocks and scattered homes is excellent, and the level of personal hygiene well maintained. Every effort is made to cater for the social life of this semi immured community , by organised games, attendance at every kind of local social function,cinemas, shows, amateur theratricals, scouts, church attendance and hobbies, All the children of school age attend local schools and there is 24 no distinction between them and the children of local residents,, In fact, the children have quite a full life and broadly speaking are happy and contented in what, for some of them, is the only home they will know possibly for many years to come These children are given as much individual freedom as is possible consistent with the basic discipline of community life, and it is probable that in this environment they suffer the minimum of psychic trauma which was so damaging a feature of old type children's homes„ INFECTIOUS DISEASES. The quarterly returns to the Registrar-General were as follows:- Qtr. ending 31/3/52 Qtr ending 30/6/52 Qtr. ending 30/9/52 Qtr. ending 31/12/52 Total Scarlet Fever 109 57 53 124 343 Whooping Cough 95 162 82 22 361 +Acute Poliomyelitis 1 1 7 1 10 Measles 18 57 257 1551 1883 Diphtheria 1 — — — 1 Pneumonia 19 14 5 23 61 Dysentery 1 l 1 — 3 Typhoid Fever - l — - 1 Paratyphoid Fever — l - - 1 Erysipelas 4 5 2 5 16 Meningococcal Infection — 2 1 1 4 Food Poisoning — — 8 - 8 Puerperal Pyrexia 3 1 1 2 7 Ophthalmia Neonatorum — 1 — — 1 + Of the 10 cases finally diagnosed as Acute Poliomyelitis 9 were paralytic and one was non-paralytic. It was hoped that the absence of diphtheria in East Ham during 1951 would continue during the year under review, but one case was confirmed during the first quarter of the year. Notifications of whooping cough and measles decreased considerably as compared with those for the previous year, thus following the national trend. Of the seven cases of puerperal pyrexia, three occurred in domiciliary confinements and four were notified by hospital medical officers in respect of mothers having in-patient treatment. In the one case of ophthalmia neonatorum, the child's vision was not impaired by the disease. No cases of pemphigus neonatorum were reported during the year. The notifications of cases of tuberculosis during the year were:- Pulmonary Males 60 101 Females 41 Non-pulmonary Males 8 14 Females _6 Total: 115 Details of these notifications are set out in Table 7. 25 There were no deaths from the seven principal zymotic diseases (Smallpox, Whooping Cough, Measles,Diphtheria, Diarrhoea, Scarlet Fever and Enteric Fever), as compared with one death for the previous year and 4 for 1950. The zymotic death rate for 1951 was 0.008 per 1,000 population. No cases of smallpox were reported In the following table the notification rates for 1952 per 1,.000 population are show:- TABLE 6. INFECTIOUS DISEASES - NOTIFICATION RATES. Notifications England and Wales 160 County Boroughs & Great Towns including London 160 Smaller Towns Resident Population 25,000-50,000 at 1951 Census London Adm. County EAST HAM Typhoid Fever 0.00 0.00 0.00 0.00 0.00 Paratyphoid Fever 0.02 0.02 0.03 0.01 0.00 Meningococcal Infection 0.03 0.03 0.03 0.02 0.03 Scarlet Fever 1.53 1.75 1.58 l.56 2.85 Whooping Cough 2.61 2.74 2.57 1.66 3.00 Diphtheria. 0.01 0.01 0.03 0.01 0.00 Erysipelas 0.14 0.15 0.12 0.14 0.13 Smallpox 0.00 0.00 0.00 - — Measles 8.86 10.11 8.49 9.23 15.69 Pneumonia. 0.72 0.80 0.62 0.57 0.50 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.06 0.06 0.06 0.06 0.07 Non-Paralytic 0.03 0.03 0.02 0.03 0.00 Food Poisoning. 0.13 0.l6 0.11 0.18 0.06 +Puerperal Pyrexia 17.87 23.94 10.22 30.77 4.27 + Per 1,000 total (Live and Still) Births. The notif icat ion rate per 1,000 of the population for all forms of tuberculosis was 0.95, that for 1951 being 1.10 The deaths from all forms of tuberculosis totalled 28, giving a death rate of 0.23 per 1,000 papulation as against 0.29 in 1951. 26 TABLE 7- - PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952. SUMMARY OF NOTIFICATIONS DURING THE PERIOD FROM 1ST JANUARY, 1952 TO THE 31ST DECEMBER, 1952. 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 2 1 3 6 11 15 4 6 7 4 - 60 Respiratory, Females - 1 5 1 - 6 8 9 6 3 2 - - 41 Non-Respiratory, Males - - 1 2 - 2 1 1 - 1 - - - 8 Non-Respiratory, Females - - 2 - - - 1 2 - 1 - - - 6 PART 11 „ - NEW CASES OF TUBERCULOSIS COMING TO THE KNOWLEDGE OF THE MEDICAL OFFICER OF HEALTH DURING THE YEAR, 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 - - - - - - - - - - - - 1 1 (A) F - - - - - - - - - - - 1 - 1 (B) Non-Respiratory M - - - - - - - - - - - - - -(C) F - - - - - - - - - - - - - - (D) Death Returns from Registrar-General (Transferable deaths) Respiratory M - - - - - - - - - - 1 2 - 3 (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - 1 - - - - - - - - - - 1 (C) F - - - - - - - - - - - - - (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - 1 - - 1 (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) "Transfers" from Other Areas (excluding transferable deaths) Respiratory M - - - V - 1 1 2 1 - - - 5 (A) F - - - 1 - 3 2 - - - - - 6 (B) Non-Respiratory M - - - 1 - - - 1 - - - - - 2 (C) F — - - - — - - 1 - - - - - 1 (D) Other Sources Respiratory M - (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - (D) Totals (A) 9 (B) 8 (C) 3 (D) 1 27 TABLE 8„ - PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASEo Notified Cases for Year ended 31/12/92 DISEASE Cases notified in whole district Ward Distribution of Cases NOo of Cases removed to Hospital Total Deaths At all ages - years Manor 1 Park Little Ilford Woodgrange Plashet Kensington Castle Central Wall End Greatfield South At all ages Under 1 1 to 4 5 t 0 10 10 to 14 15 to 24 25 to 34 35 to 44 45 to 64 65 and up Scarlet Fever 343 1 67 222 37 13 2 l - -- 34 42 25 32 28 16 31 55 35 45 186 - Diphtheria 1 - - - - - 1 - - - - l -- - - - - - - - 1 - Erysipelas 16 - - - - - - 4 9 3 2 4 2 1 2 - 1 2 1 1 1 -- Puerperal Pyrexia 7 - - - - 3 3 l - - 1 2 - - - 1 - 1 - 2 4 - Typhoid Fever 1 - - - - - - - - 1 - - - - - - - - 1 1 - Paratyphoid Fever 1 - - - - - - - - 1 1 - - - - - - - - - 1 - Pneumonia 61 2 2 5 1 1 5 7 20 18 2 7 5 4 19 4 4 10 3 3 10 77 Acute Poliomyelitis 10 - 2 3 1 1 3 - - - 1 - 1 l 2 - 1 2 - 2 10 2 Meningococcal Infection 4 1 1 - 1 - 1 - - 1 - l - l - 1 - - 4 — Ophthalmia Neonatorum 1 1 - - - - - - - - - - - - - - - - - - - - Dysentery 3 - 1 1 - - 1 - - - - - - l - •- l - - 1 - - Food Poisoning 8 •- - 2 - - 2 1 1 2 2 - - - - - 2 4 - - 3 - Measles 1883 42 714 1089 14 3 2 1 - 186 257 120 190 202 168 166 262 146 186 20 - Whooping Cough 361 29 176 149 2 2 1 - 2 - 40 84 17 20 32 34 33 71 16 14 15 - 28 The hospitals to which the 256 patients suffering from Infectious diseases were admitted are named below:- Name of Hospital No, of cases admitted Plalstow Hospital, Samson Street, E.13. 149 Illford Isolation Hospitalp Chadwell Heath 51 Eastern Fever Hospital, Homerton, E.9 22 Chingford Isolation Hospital, Homerton,E.4 10 Waltham Abbey Isolation Hospital, Waltham Cross 5 Whipps Cross Hospital, Leytonstone, E.11 5 Queen Mary's Hospital for the East End, E.15 2 St. Mary's Hospital for Women & Children E.13. 2 Brook Hospital, Shooters Hill, S.E.l8. 1 Coppetts Wood Hospital Coppetts Road, N.10. 1 East Ham Memorial Hospital, E.7. 1 Jubilee Hospital Woodford Green, 1 London Hospital, Whitechapel, E.1. 1 Rush Green Hospital, Romford 1 St. Andrew's Hospital, Devons Road, Bow, E.3. 1 St. Ann's General Hospital, St, Ann's Road, N.15. 1 South Lodge Hospital World's End, N.21. 1 Thurrock Hospital Grays 1 Total 256 29 TABLE 9. - TOTAL CASES OF NOTIFIABLE DISEASES, 1928 - 1952 DISEASE 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 Small Pox 17 25 70 51 13 1 1 - - - - - - - - - - - - - - - - - Scarlet Fever 832 743 484 245 779 701 979 411 359 387 287 196 77 68 210 271 132 153 193 179 222 289 270 203 343 Diphtheria 669 578 473 196 157 180 379 254 134 149 141 91 47 45 49 59 33 31 19 46 14 2 1 - 1 Enteric or Typhoid Fever 7 2 3 8 7 5 - 2 2 13 15 8 10 3 - 4 - - - - 1 /- 3 - 1 Paratyphoid Fever - - - - - - " - - - - - - - - - - - r 1 1 1 Erysipelas 60 49 63 54 55 69 74 55 59 53 71 41 33 23 37 28 18 14 25 23 21 24 21 19 16 Puerperal Fever 4 8 9 10 4 4 7 12 7 5+ † † † † † † † † † † † † † † † Puerperal Pyrexia 11 12 14 6 23 10 11 14 7 7 18 16 8 6 15 8 8 2 8 5 4 2 3 2 7 Meningococcal Meningitis 1 1 3 8 5 1 3 3 - 2 3 3 11 5 12 4 3 1 8 1 5 6 1 1 4 Encephalitis Lethargica 3 1 - - 1 1 1 » 1. 1 - - - - - - - - - - — - - Ophthalmia Neonatorum 3 8 6 6 6 9 5 5 6 7 9 7 3 4 1 l 4 2 1 2 - 4 2 1 1 Acute Poliomyelitis - 2 - 1 7 2 5 13 2 4 2 i - - - - 1 - 7 8 13 10 7 10 Acute Polio Encephalitis - - 1 - - 3 2 1 - - - - - - - - - - - - 1 - - - - - Dysentery - - - - - - 1 - - 3 18 - - - - 6 5 7 5 2 - 1 10 321 3 Malaria - - - - 1 it - - - - - - - - - - - 1‡ 3a - - - - - - Measles Not Notifiable 3 36 460 1,091 971 258 1,498 815 964 1,559 1,098 988 2,198 1,883 Whooping Cough Not Notifiable - 19 262 227 241 293 67 258 430 578 498 1,027 625 361 Food Poisoning Not Notifiable 4 5 23 8 Tophus Fever - - «- - - - - - - - - /- - - - - - - - - - - - - - Pneumonia 82 102 59 75 77 148 100 88 101 Ill 85 59 42 33 37 72 50 55 97 143 111 88 41 58 61 Tuberculosis Pulmonary 232 211 165 197 185 164 174 184 186 188 149 157 130 139 164 200 156 205 194 211 211 148 142 117 101 Non-Pulmonary 46 48 38 49 47 35 33 37 31 39 20 24 30 22 22 23 15 16 9 26 20 11 14 16 14 Totals 1,967 1,790 1,387 906 1,369 1,333 1,774 1,079 894 969 817 607 447 1,070 1,865 3,834 975 2,053 1,635 2,040 2,754 2,188 2,538 3,592 2,815 + 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. 30 CANCER. Deaths, 1952:- Total deaths 249 Male deaths 141 Female deaths 108 TABLE 10. - CANCER DEATHS - LOCATION OF THE DISEASE Parts of Body Affected Ages Under 15 15-24 25-34 35-44 45-54 55-64 65-74 75 and upwards Total Sex M F M F M F M F M F M F M F M F M F Buccal Cavity and Pharynx - - 1 - - - - 1 - - - 1 1 1 - 1 2 4 Digestive Organs and Peritoneum - - - - - 1 1 1 13 4 12 4 12 8 10 18 48 36 Lungs, Bronchus - - - - 1 — 1 - 7 2 22 1 11 4 4 1 46 8 Other Respiratory Organs . - - - - - - - - - - - - - - - - - - Uterus - - - - - - - - - 3 - 1 - 1 - 1 - 6 Other Female Genital Organs - - - - - - - 1 - 2 - 1 - 2 - 1 - 7 Breast - - - - - - - 1 - 3 - 8 - 6 - 5 - 23 Male Genital Organs - 1 - - - - - - - - - - - 1 -- Urinary Organs - - - - - - - - - - 3 1 7 - 5 2 15 3 Skin - - - - - - - - - - - - - - - - - -- Brain and other parts of Nervous Systems - - - 1 - 1 l 1 2 Other or Unspecified Organs - - 1 - 1 - l - 2 - 4 3 7 7 12 9 28 19 TOTALS - - 2 1 3 2 4 4 22 14 41 20 38 29 31 38 141 108 31 NATIONAL ASSISTANCE ACT, 1948 - SECTION 47 o 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. 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 on the raw water going into supply. (iii) The water supply of this district, from the Metropolitan Water Board does not give rise to plumbo-solvent action. (iv) There were no contamination areas. 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 POlSONlNG. In accordance with Ministry of Health Circular 46/49, the following information was supplied (1) Food Poisoning Notifications (Corrected) Return to RegistrarGeneral r 1st Quar0000ter Nil 2nd Quarter Nil 3rd Quarter 8 4th Quarter Nil Total 8 (2) There were no outbreaks during the year due to identified agents,, (3) There was one outbreak of undiscovered cause during the year* (4) Single cases:- Agent identified Nil Unknown cause Total 4 CLEAN FOOD CAMPAIGN Reference was made in the 1951 report to the formation of a Food Hygiene Guild in the borough. 1 am now able to write that the Guild is formly established and will play no small part in banishing food poinoning from the borough A large measure of praise is due to Mr.D.G. Tonkin, the Chief Sanitary Insepctor, and his staff, who have not spared themselves in the heavy spade-work necessary to win over the more hostile sections of the food distributing trades and to advise other shopkeepers how their 32 premises, equipment and methods could be improved to qualify for the Guild's certificate of membership. Yet much remains to be done in the general field of education to teach every man, woman and child capable of understanding the problem, that food poisoning is preventable. Mothers are taught the hygiene of breast-feeding and infant feeding but there after It would appear the child is left to wander through what remains of the 'Seven ages of man', and at any stage to fall a prey to the ravages of dysentery and other serious germ-transmitted disorders. He receives no clear teaching on how to defend himself against the host of predatory bacteria seeking to invade his unguarded portals, enter his system and work, havoc and destruction,, The child must be taught, first, by precept and example, the need for personal cleanliness, to wash the hands after using the W.C. and how to prevent contamination of food by dabbling fingers, use of the handkerchief, and controlled coughing and sneesing. In school these lessons will be amplified and the social duty to neighbours and the community inculcated., Here, the part played by rats and mice, domestic animals, dirt, dust and flies can be learnt and the application of individual hygiene to community health studied and absorbed. The subject of domestic science, so interesting to boys and girls alike at school, should properly embrace explicit Instruction on how food poisoning germs multiply in certain prepared foods under appropriate conditions of temperature and moisture, as well as the hazards to health of faulty techniques in washing up". School hygiene should rival that of the home as the standard for individuals to aim at, and both should strive to build up an educated public, whose members will not accept anything but clean food from shops, restaurants and canteens. It follows that the lessons learnt throughout the formative years will be taken into the food factories, food-handling shops, eating houses and canteens, by the food handlers themselves, so that the hygienic circle of contact involving producer - conveyor - handler - and consumer - will be complete and the housewife and her family surely protected from contaminated foods. The Food Hygiene Guild has made a year of steady progress in approving 140 tradesmen out of 238 who applied for certificates of membership. It is apparent that we are gearing our educational machine in reverse by Instructing adult food handlers and others who should already have learnt to apply the lessons of food hygiene in the formative years; but so urgent is the problem that we cannot wait on ideal procedures, but must use all possible means to achieve the desired end. Enough has been said to emphasize that Acts of Parliament and the vigilance of the Sanitary Section of the Health Department are powerless alone to reduce the problem of food poisoning to vanishing point. An educated co-operative public is an imperative necessity, to bring a blaze of light, knowledge and vigour, where obscurity, ignorance and slothfullness now foster dirt, and breed disease. 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 11). Vx TABLE 11. FACTORIES ACTS, 1937 AND 1948. PART I OF THE ACT I. - 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 51 24 3 - (ii) Factories not included in (I) In which Section 7 is enforced by the Local Authority ,. 365 118 9 - (ill) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 5 - - - Total 421 142 12 - 2. CASES IN WHICH DEFECTS WERE FOUND (If defects are discovered at the premises on two,, three or more separate occasions they should be reckoned as two, three or more "cases") Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M,. Inspector Want of cleanliness (S.l) - - - - - Overcrowding (S,2) - - - - Unreasonable temperature (S,3) 1 1 - - - Inadequate ventilation (S,4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S,7) (a) insufficient - - - - — (b) unsuitable or defective 13 3 - 1 - (c) not separate for sexes - - - - - Other offences against the Act (not including offences relating t.o Outwork) 3 2 - - - Total 17 6 - 1 - PART VIII OF THE ACT OUTWORK (Sections 110 and 111) Section 110 Section 111 Nature of Work No„ of out-workers in August list required by Sect, 110(1)(c) No„ of cases of default in sending lists to the Council No„ of prosecutions for failure to supply lists No. of Instances of work in unwholesoms premlses Notices served Prosecutions Wearing Apparel (Mailing etc. 177 - - - - - Shopping bags 3 - - - - - Tin Caps 29 - - - - - Christmas crackers, cosaques, Christmas stockings, etc. 57 - - - - - Total 266 34 TABLE 12. METEOROLOGICAL RECORD . YEAR 1952 Rain Gauge 5 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 ground0 Months Temperature of Air during the Month Mean Temperature of Air ? Rainfall. Highest Maximum Lowest Minimum Mean of No. of Days on which Rain Fell. 0.01 and over Amount collected in inches Mean rate of fall for Rainy Days Greatest fall in 24 hours Date of greatest fall All Highest All Lowest January 54 24 43.8 35.2 37.65 15 1.29 0.09 0.28 4th &16th February 52 29 44.3 34.0 36. 85 7 0.75 0.11 0.28 10th March 59 30 50.0 40.0 43.2 20 2.34 0.12 0.90 29th April 74 31 59.6 43.5 51.4 11 0.69 0.06 0.19 7th May 83 42 67.2 50.1 58.35 8 0.77 0.09 0.60 4th June 86 40 70.8 52.7 61.45 8 1.07 0.13 0.37 2nd July 86 49 74.4 64.2 64.6 4 0.64 0.l6 0.31 3rd August * * * * * 13 2.21 0.17 0.75 6th September 72 38 61.3 46.8 52.6 15 2.33 0.15 0.68 30th October 61 32 55.3 44.0 49.25 15 2.22 0.l5 0.52 12th November 57 23 45.8 36.3 39.85 15 3.68 0.24 0.69 21st December 53 25 42.9 34.1 37.4 17 2.31 0.14 0.42 18th Means & Totals for the Year 67 33 55.9 43.7 47.78 148 20.30 0.13 0.90 29th March * Instruments Stolen 7/8.8.52. Replaced 21.8.52. 35 NATIONAL HEALTH SERVICE ACT, 1946 SECTIONS 22, 23, 24, 25, 26, 27, 28, 29 and 51. Full details of the Council's proposals approved by the Minister of Health, as indicated In my report for 1948, have been published in booklet form and are available for reference. SPECIAL SURVEY OF THE LOCAL HEALTH SERVICES IN THE COUNTY BOROUGH OF EAST HAM PROVIDED UNDER THE NATIONAL HEALTH SERVICE ACTS. (Ministry of Health Circular 29/52). In the pages that follow a short account is given of the various services provided by the Council under the National Health Service Acts. Stress is laid on the degree of co-ordination achieved with the General Practitioner Service and the Hospital Service and wherever relevant suggestions are made for the improvement of liaison or of individual services. Statistical details are not included in this resume. For each service these will be found elsewhere In the report under the appropriate sectional heading of the National Health Service Act, 1946 It is hoped that this section will prove of value to councillors and others who have come recently Into the field of local government, for it is notoriously difficult to gather information concerning the services provided by a health authority without considerable study and research. In general the local health services for the borough have closely followed the proposals submitted to the Minister of Health in 1947. GENERAL, 1„ Administration All the administrative organisation under the Medical Officer of Health is centred in the Town Hall Annexe which houses also the headquarters offices of the Education Department. The control of the services is effected through departmental organisation under medical or non-medical officers. The supervision is through departmental officers as indicated in the chart on page 47. Co-ordination at OFFICER LEVEL on the medical and nursing side is through the Superintendent Nursing Officer Superintendent Health Visitor and Deputy Medical Officer of Health with the Chief Administrative Assistant. 2. Co-ordination and co-operation with other parts of the E&tlonal Health Service. (a) Local Health Authority and Specialist Servlces. In general coordination and co-operation is good. The Local Health Authority is represented on Hospital Management Committees of the Local Groups Nos. 9, 10 and 22, but have no representation on the Regional Hospital Board, and I consider it a great drawback that the Medical Officer of Health is not a committee member of any of these groups. 36 Good personal relationships have been established with the consultant staff of the hospitals, and reports on patients discharged are regularly rendered. After-care is ensured by co-ordination of almoners with the Public Health Department through the Superintendent Nursing Officer and the Superintendent Health Visitor. Members of the health visiting staff visit children's wards of local hospitals with the paediatrician to ensure complete liaison. Regional Hospital Board consultants come to the Local Health Authority clinics as part of the School Health Service for :- (1) Ear, nose and throat work including examination of children referred after audiometric group testing: (ii) Ophthalmic work. and it is hoped arrangements will be concluded for similar attendances at:(iii) An orthoptic clinics (iv) An orthopaedic clinic. Referral to hospital from local authority clinics for investigation and treatment is easy and appointments are made by the clerical staff through the hospital appointments officers. Pathological investigations 9 including comprehensive blood examination of expectant mothers, is carried out by arrangement with the pathologists to East Ham Memorial Hospital and Whipps Cross Hospital. These laboratories also deal with large numbers of swabs and specimens during epidemics and other local epidemiological investigations. No difficulty is experienced in admission to hospital of cases of infectious disease on medical or medico-social grounds. Children are often referred back from hospital out-patient departments to our school health, physiotherapy, sunlight and speech therapy clinics for treatment and general surveillance. This excellent measure of co-ordination prevents loss of valuable schooling time and parents' working hours. It is anticipated that before the end of this year the follow-up and after-care of diabetics will be undertaken by specially trained health visitors in close co-operation with the hospital diabetic clinics. (b) Local Health Authority and General Practitioners. The Medical Officer of Health and representatives of the Local Authority are members of the Local Executive Counclls and very good liaison has been established. Every assistance is given to general practitioners in diagnosis and investigation of infectious diseases and cases of food poisoning, as well as in the hospitalisation of persons on medico-social grounds. In many instances a member of the public health staff will collect and despatch specimens and telephone results of bacteriological examinations to general practitioners. Co-operation with general practitioners had been furthered by all possible means to ensure the best available medical services to young and old alike in the borough. Arrangements have been made to assist general practitioners in the investigation of cases of food poisoning, and their close co-operation ensured in preventing the spread of such types of illness. 37 Better liaison has been effected in the medical and dental care of the priority groups which is so desirable a feature of the National Health Service Act. This applies to - (a) Expectant and nursing mothers and their young children. (b) School-children and has been effected by - (1) Referral to the family doctor of cases of illness or physical defect uncovered in our clinics or during routine school medical inspections, so that the general practitioner has the opportunity to treat the case himself or arrange further investigation at his discretion through the hospital services. (il) Enabling general practitioners to refer to the Council's clinics cases first seen by them, which would benefit by specialist investigation or treatment: this facility embraces blood taking for routine examination, the antenatal care of expectant mothers and their referral to our ante-natal exercise classes so that women who desire domiciliary confinement share the benefits of all available services offered to mothers who will go eventually to hospital to be delivered. Through the Superintendent Nursing Officer the care of old people in the home is ensured, especially in the assessment of the need for admission to hospital as 'chronic sick1 and the elucidation of other medicosocial problems. Here the District Nurse, the Home Help Service, the Loan Cupboard Service, and the Health Visitor all play a part in liaison with the family doctor. In the after-care of persons discharged from hospital,, the health visitors have close contact with the physicians and the staff of the children's ward at the East Ham Memorial Hospital and act as a link between the hospital, the local health services, and the general practitioner. In general terms, this health visitor liaison is also effective in the rendering to hospitals of reports concerning home circumstances which have a bearing on therapy, and assists the family doctor in the follow-up and treatment of individual cases after discharge from hospital. The health visitor on request will assist general practitioners in the advices to a household on epidemiological problems, the nurture of sickly and backward infants, breast-feeding and premature baby problems. Special equipment is available in the loan cupboards for the temporary or permanent home care of premature infants. In like manner the health visitor will assist the general practitioner in the care of problem families and with children exhibiting emotional and other psychological disturbances. In this way suitable cases can be referred to the Child Guidance clinic for appropriate investigation and treatment. Arrangements are also being made for the assistance of general practitioners in the care of diabetic subjects in close liaison with their attendance as out-patients at hospital diabetic clinics. Unison has been achieved between the general practitioner, the school the sanitary inspector and the health visitor, in relation to infectious diseases, in the application of the necessary epidemiological measures. Through the Superintendent Nursing Officer all possible assistance is given to the general practitioners in their care of cancer cases. 38 Harmonious relationships exist between the general practitioners and the Duly Authorised Officers of our Mental Health Service. All doctors are kept informed of the duty rota of duly authorised officers to cover times outside normal office hours. lastly, personal contact with individual practitioners in the day-today problems affecting the public health has made possible a better understanding between the general practitioners and the health department in the carrying out of their combined duties under the National Health Service Act. The local practitioners have a greater sense of working with a team of preventive health workers, and value the services put at their disposal In general, the arrangements are effective and have resulted in uniformity of procedure, in exclusion from school and work, and control of epidemics in the borough,, In particular, they have resulted in increased medical care for the 'priority groups', a most desirable feature of the National Health Service Act. The greatest single step forward for the integration of the Local Authority and General Practitioner Services, in my opinion, will be through the establishment of a Health Centre. General practitioners now realise the true meaning of the preventive aspect of local authority work, and the unification of preventive and remedial sides of medicine can best take place under one roof, where barriers of buildings, space, and outworn traditions, need no longer hinder the advance of social medicine. Steps taken to inform (i) General Practitloners. (1) By discussion and consultation at Local Medical Committees. (2) By arranging meetings of general practitioners with health visitors at which each health visitor wears a small badge indicating the area of the borough she serves, and especially seeks to make herself known to the general practitioners in her area. (3) By inviting the general practitioners to visit the clinics of the local authority during a normal working day. (As many as 25 general practitioners attended one of these clinic 'open days'.) (4) By circularising the general practitioners in agreed methods of dealing with epidemiological problems Exclusion from school Exclusion from work Immunisation Care of the aged. and other problems that arise. !ii) The Publico (1) By press announcements. (2) By health visitor 'education' in the clinic and in the home. (3) By lectures to women's meetings, church guild meetings. (4) A Guide to the local health services has been issued, but needs revision. (5) By exhibitions organised by the various Council's services,, 3. Joint use of Staff. (a) Nil by general practitloners. (b) Consultants of Regional Hospital Board work in - 39 (1) Ear, nose and throat clinics of the Council. (2) Child guidance clinics of the Council. (3) Ophthalmic clinics of the Council. (4) Part-time use of the Consultant to the Regional Hospital Board's Chest Clinic In preventive tuberculosis work and af ter-care. (5) Anaesthetists (Regional Hospital Board) in local authority dental clinics for expectant and nursing mothers and their children, and for children of school age. +(6) In orthopaedic clinics of the Council. +(7) In orthoptic clinics of the Council,, + agreed but not yet in practice. An exchange of officers is proposed between the Registrar of the local Maternity Hospital and the Assistant Medical Officer of Health for maternity and child welfare, but negotiations with the Regional Hospital Board are still going on. 4. Voluntary Organisations (1) Women's Voluntary Services who assist in sale of Ministry of Food welfare foods and vitamin supplements, etc. Six distribution points have beene stablished in the borough to facilitate this work, (five of them in local authority clinics). (2) The N.S.P.C.C. give valuable help in the care of problem families. (3) The church organisations, especially the Chelmsford Diocesan Moral Welfare Association. ib) The National Baby Welfare Council. (5) The National Association for Mental Health and Mental After-Care Association. (6) The National Association for Prevention of Tuberculosis. (7) The Central Council for Health Education. (8) The Royal Society for Prevention of Accidents. (9) King Edward's Hospital Fund for London. (10) The National Smoke Abatement Society. (11) The National Society of Children's Nurseries. (12) The National Association for Maternity and Child Welfare. All these bodies lend valuable aid in helping the Local Health Services to deal with individual cases or problem families. PARTICULAR SERVICES. 5„ Care of Expectant and Nursing Mothers and children unfler school age. Expectant and Nursing Mothers. Comprehensive facilities for ante-natal and post-natal care is afforded in four .local authority clinics with doctors, midwives of the domiciliary service and health visitors in attendance. No specialist clinics have been arranged but difficult cases are referred to local hospitals for consultation. Blood-taking, ante-natal exercise classes, physiotherapy, breast-feeding instruction, and modified mothercraft training are carried out. Facilities also exist for the comprehensive dental care in the Council's clinics, including oral hygienist's overhaul and dental X-ray. No assistance is given in general practitioners' own premises but the family doctors are freely invited to send their patients to any or all of the above. Maternity outfits are supplied at the clinics to women who are to have domiciliary confinement. Unmarried expectant mothers are given precisely the same care as married 40 women. In addition, arrangements are made through either the Chelmsford Diocesan (Church of England) Home, Local Moral Welfare Workers or the Salvation Army to house those who cannot stay at home after the 32nd week, in which case special arrangements are made for their continued ante-natal care and hospital delivery. Rehabilitation and after-care (in conjunction with the Children's Officer) is scrupulously followed up. Child We If are o Regular clinics for Child Welfare are held at four clinics as above. These include special clinics for infants and 'toddlers, the latter by six-monthly appointments system. There are no separate con. sultant clinics unless children are referred to the specialist clinics outlined in paragraph (3) and children are referred to the Council's physiotherapy, dental and sunlight clinics as necessary. Care of Premature Infants. Domiciliary Provision - A comprehensive scheme exists for the home care of premature infants including loan of equipment and scales, screens and fully equipped special cots.There is an arrangement with local hospitals for the reception of premature babies on request, and special arrangements with our ambulance service for transport. (Ambulance service depot holds special premature baby cot for transport) Supply of Dried Milks. etc. Arrangements for distribution of Ministry of Food welfare foods, etc. already referred to under paragraph (4). Other dried milks and nutrients advised by the medical staff are available at all the Council's clinics at special prices plus a small percentage for overheads,, Dental Care. Already referred to under paragraph (5). Priority is given to the dental care of expectant and nursing mothers and their young children. (i) Special appointment are given at three dental clinics. (ii) X-rays are available. (iii) Consultant anaesthetist is available for extraction. (iv) Oral hygienlst given treatment and advice. (v) Full dentures are provided when necessary. (vi) Emergency treatment always given. Other Provisions. Home Help Service and Day Nursery Service brought into the picture whenever necessary. 6. Domiciliary Midwifery. General Arrangements for the Service. Area divided Into four districts- one to each midwife. Midwives work in pairs for relief purposes. Cases are allocated from the booking clinic. The number of midwives has been decreased from six to four with the fall in bookings. Arrangements for medical and non-medical supervision and extent of supervision of midwives not employed in the authority's domiciliary service. The Superintendent Nursing Officer acts as non-medical supervisor supervising and inspecting work. equipment and records, investigating cases of ophthalmia neonatorum, puerperal pyrexia, still-births, etc. Midwives not in direct employ of the authority are visited quarterly for inspection of records, equipment, also for discussion of special cases, technique and the service in general. The Superintendent Nursing Officer is on call by telephone for advice and direction in all cases of difficulty, contact with infection, emergency out of office hours. Administration of analgesics by midwives. All Midwives are qualified to administer gas and air analgesia, and this is given to all cases requesting its use, where the necessary conditions have been fulfilled and a doctor's certificate is available. Pethidine is being used with very good effect in a fairly large proportion of cases. 41 Arrangements for ante-natal supervision by midwives, Midwives conduct their own ante-natal clinics, but there is always a doctor on the premises to see patients at the 36th week and at any time when the midwife requires another opinion. Co-operation with general practitioners undertaking maternity medical services. The number of maternity cases is relatively small, approximately five per cent. Good relationship and a co-operative spirit appears to exist between general practitioners and midwives. Arrangements for selecting women whose confinement in hospital is recommended on social grounds, Selection is in accordance with Ministry of Health circular No. L,H.A.L. 1/51, but it would appear that in this area any expectant mother can obtain admission to hospital for her confinement by direct application to the hospital concerned, without liaison with the Medical Officer of Health, Refresher courses for midwives, Midwives attend post-graduate courses arranged by the Royal College of Midwives, Arrangements, if any for training pupil midwives. There are no arrangements for the training of pupil midwives, but such arrangements are envisaged for this area in the near future, 7. Health Visiting, This service is under the direct control of the Medical Officer of Health, The staff is made up of the Superintendent Health Visitor and twenty-one certified health visitors who carry out the combined duties of school health nurse and maternity and child welfare and general health work. The borough is divided into twenty-one areas to each of which a health visitor is allocated, A weekly rota of duties for the staff is prepared by the Superintendent Health Visitor, Beyond visiting expectant and nursing mothers and young children. health visitors visit the homes to - (a) Advise on epidemiological problems in connection with infectious disease (as detailed in instruction and advice sheets issued also to all general practitioners) ( See pages 48 - 53). (b) Assist problem families, (c) Advise in domestic difficulties with adolescents, (d) Pursue follow-up or after-care of persons (old age groups) discharged from hospital, (e) Assist general practitioners, on request, with special cases, (f) Undertake the management and guidance of unmarried mothers, (g) Supervise child-minding, (h) Help the Children's Officer in adoptions, children to be taken into care, etc, (i) Assist in the care of some old people, H (j) Give advice to some households with a mentally defective child. (k) Compile reports re housing problems. The link-up with general practitioners and .hospitals is referred to under heading (2), Facilities to obtain Health Visitor's certificate. The Council participates in a County scheme to select and send for training at the SouthEast Essex Technical College suitable nurses who wish to take the Health Visltor's certificate. The scheme includes loan of monies to the student part of which is repayable. Facilities are freely offered for studenthealth visitors to take part in the clinic work and other health activities in the borough in collaboration with the Senior Health Visitor Tutor of the College, 42 Facilities for Refresher' Courses for health visitors are afforded by the Council to selected staff nominated by the Medical Officer of Health. 8. Home Nursing. (a) General arrangements for the service. The Council has entered into an agreement with the East Ham District Nursing Association to provide a comprehensive Home Nursing Service for the greater part of the borough. A similar agreement is in operation for the extreme southern part of the area, where the Silvertown and North Woolwich District Nursing Association act on behalf of the Council. (b) Co-operation with general practitloners. Liaison with general practitioners is excellent. (c) Description of any arrangements for liaison with hospitals. Good liaison between hospital almoners and staff, particularly with the Geriatric Unit at Langthorne Hospital. Difficult cases are referred to the Superintendent Nursing Officer for co-ordination with other services and reference, where necessary, to the Medical Officer of health. (d) Classification and proportions of main types of cases attended by Home Nurses. Reference to table 25 shews details of statistics of work carried out by the East Ham District Nursing Association and the Silvertown & North Woolwich District Nursing Association (e) Particulars of any night service. Two nurses are on call each evening for late visits where required,, Night service is only available in especially difficult cases - not for 'sitting in'. (f) Refresher courses for nursing staff. Staff attend refresher courses arranged by the Queen's Institute of District Nursing. It should be appreciated that the Superintendent Nursing Officer Is responsible for the co-ordination of- The Domiciliary Midwifery Service,, The Health Visiting Service. The Home Nursing Service, and The Domestic Help Service,, with the Hospital and General Practitioner Service, and other personal health services. 9. Vaccination and Immunisation. Organised effort is sustained to secure a high vaccinal state and level of immunisation in the child population by- (a) Educative and propaganda efforts of the medical staff and health visitors, by bringing the matter through the Local Executive Council to the notice of all general practitioners. (b) Press campaigns (in conjunction with West Ham County Borough) (c) Provision of special sessions for immunisation against diphtheria and whooping cough at all clinics in the borough (17,000 approximately of 30,000 children under 15 years of age have been immunised.) (d) Combined immunisation against diphtheria and whooping cough is advocated at four months. No child should reach the first birthday without Immunisation against diphtheria. It has been the custom to send out a printed birthday greeting card to every child reminding the parents of the necessity for immunisation. (e) 'Boosting injections' are given prior to school entry and appointments are given to the special immunisation clinics from a register of children kept for this purpose. Boosting injections are also given (with parental consent) at the age of ten. 43 (f) Arrangements are made to immunise against whooping cough alone at the request of parents or on the advice of doctors, (1,300 were immunised in 1952). (g) Prophylactic is supplied on request to any general practitioner who wishes to carry out the immunisations at his surgery or in the patients's home. 10. Ambulance Service. The comprehensive ambulance service has been able to cope with the entire demands made on them from all quarters. Thus in a total of 34,510 calls nine cases were transported by rail, and twenty-four by cars from private hire or the transport pool of the Council,, The trend is for even wider use of the service by hospitals and all sections of the public. Strong efforts are made to enlist the co-operation of hospital transport officers and other staff, to effect economy in the use of the service and prevent abuses. Personal contact is maintained with medical and almoner staffs to ensure no case shall have special transport when public transport would suffice. The Superintendent Nursing Officer visits patients in the home to report direct to me in cases of doubt, where transport has been requested by general practitioner or hospital. Abuses of the service have been practically eliminated. 11o Prevention, Care and After-Care. (1) Tuberculosis (a) B.C.G, Vaccination is being advocated in selected cases and groups and carried out with the help of the Chest Clinic and the Children's Officer. (166 vaccinations in 1952). (b) The Council have co-operated with the Medical Research Council in trials of B.C.G. vaccination in 'school leavers' and this is still going on. (c) The Council insist by stringent regulation on the special examination (which includes an X-ray of the chest) of all persons entering their employment who will come in contact with children. (d) The Council have placed most suitable central premises at the disposal of the visiting Mass Radiography Unit to ensure the greatest possible attendance at periodic public surveys,, (e) Care and after-care are fostered in close liaison with the Chest Clinic staff. Occupational therapy at the clinic and in the home is provided, and free milk, extra diet, clothing and bedding, etc. provided when necessary,, Garden shelters and other necessary items are provided free of charge from the Council's loan cupboards. The Council maintains suitable nominees for rehabilitation at the Training Settlements and Tuberculosis Colonies at Papworth, Preston Hall and Andovera (f) Apart from the health visiting service the Council employs five nurses whose duties combine home visiting and the preventive aspects of tuberculosis, with chest clinic attendance. (M) Illness generally. See (b) above, also ~ (a) The Medical Officer of Health advises the Chief Housing Officer on preventive aspects of rehousing in individual cases and certain population groups. (b) A Food Hygiene Guild has been formed to foster clean handling in preparation, sale and service of all varieties of food, to reduce the incidence of food poisoning,, 44 (c) Poster propaganda and lectures to selected groups are undertaken. (d) A comprehensive convalescence service is available for all age groups to ensure recuperative convalescence after debilitating illness and to build up resistance to disease in selected individuals. (e) Provision has been made to assist the domiciliary nursing of sick persons by the loan of sick room equipment from loan cupboards. 12. Home Help Service. This service is under the control of a Home Help Organiser with an Assistant and one clerk. To strengthen the service the Superintendent Nursing Officer undertakes review of special cases and advises on domestic needs and co-operation with other services. Four permanent home helps (two full-time and two part-time) are employed and 108 casual home helps. In 1952, 738 persons were attended for varying periods. On an average, 2,189 hours per week were given to persons and families by home helps0 Maternity and sickness cases form a small proportion of this number (about four per cent), the majority (over eighty per cent) being old people and chronic sick nursed in the home by relatives, friends and the Council's nursing services. In a number of these cases, free services of the home help are sanctioned by the Health Committee. The Home Help Organiser has drawn attention to a special problem with the following observation:- "There is also the question of cleansing supplies and equipment for these old people. Many of them have been living for years at subsistence level and cannot replace such things as brushes, pots and pans, and cleaning materials. It would be a tremendous help to this service If there could be some arrangements with the appropriate authority to provide such things, either directly to the people needing them or to some sort of pool, from which we could draw when necessary." No facilities exist for the training of home helps. 13. Health Education. (a) This difficult problem is tentatively approached by - (i) Occasional talks to selected groups on chosen subjects (e.g. kitchen staffs, food handling, etc.) (ii) The sale and distribution of selected literature. (b) Accidents in the Home. Prevention of accidents is advocated by - (I) Special efforts by health visitors to advise in the homes. (ii) Films shown and talks by experts from the Crusader Insurance Company to mixed audiences. (iii) Distribution of pamphlets to Old People's Clubs and old people through the Women's Voluntary Services (who run the clubs), Welfare Services, Home Help Service, and the Health Visitors. (iv) Lectures to old people (organised in conjunction with the W.V.S.) to Old People's Clubs and 'Darby and Joan' Clubs by selected lecturers. 14. Mental Health (i) Admlnistrationo (a) The Mental Health Committee - a Sub-Committee of the Health Committee - is responsible for the service. 45 (b) The Medical Officer of Health and the Deputy Medical Officer of Health, and part-time services of three Assistant Medical Officers who have received special training, are employed in this work. The Mental Health Department comprises a Senior Clerk who is also Petitions Officer, five Duly Authorised Officers, and some clerical assistance from the general office. There is no Psychiatric Social Worker. The work, however, is Integrated with the Child Guidance Clinic where - Two part-time psychiatrists Two Psychiatric Social Workers Two Educational Psychologists One Play Therapist (or Child Therapist) are employed (c) Co-ordination with Regional Hospital Boards and Hospital Management Committees is not very strong in certain aspects. Admission of defectives to institutions should be easier when specifically requested by the Medical Officer of Health. It should not be necessary to wait long periods for admission when home conditions have become intolerable. It is now difficult to obtain short term admissions to give parents a little respite or for other reasons. (d) No visiting of defectives under Guardianship or on Licence is undertaken on our behalf by voluntary bodies. Some help is given with holiday placements and care of defectives and in finding employment for suitable individuals. (e) Staff are seconded for training at appropriate courses as and when opportunity offers. (ii) Account of work undertaken in the community. (a) l. The medical staff, the superintendent nursing officer, the duly authorised officers, and health visitors combine to & educate, encourage, help, advise and guide individuals and families in mental health. 2. Mothers with young babies are taught right attitudes towards recognized or potential defective infants, and all are seen by me at least twice a year. 3. Close contact is maintained with the Association of Parents of Backward Children. Parents are encouraged to visit the Mental Deficiency Occupation Centre and take part in 'sale of work' days, outings and parties. 4. A Mental Health After-Care Club known as the Park View Therapeutic Social Club is run by the Council. The members are either ex-mental hospital patients recommended admission by the hospital psychiatrists or persons attending as out-patients to psychiatric clinics. The senior clerk to the mental health section and the duly authorised officers attend the meetings of the club regularly, and socials, dances, 'brains trusts', and other activities help to reintroduce many of these men and women to normal community living. (c) Under the Mental Deficiency Acts, 1913-38:- (1) Arrangements are made for - 1. Close observation from birth as outlined above. 2. Special examination on entry to school with aid of child guidance clinic team. 46 3. Special examination by medical staff of cases referred from school. 4. All cases finally referred to me for scrutiny and if necessary re-examination. 5. Wherever possible prolonged trial in special classes in school or special schools before report to Education and Mental Health Committees as defective. 6. Re-examination before reaching school-leaving age, and appropriate action. 7. Supervision by joint medical staff, and committee visiting and report to Committee. Interim surveillance by duly authorised officers and senior clerk to the Mental Health Section. (ii) An Occupation Centre for day-to-day reception and training of defectives is provided. The staff consists of- One Supervisor. One Assistant Supervisor. One Guide Assistant. Some thirty-five persons of varying ages are accommodated, and a coach is provided by the Council for any transport necessary. A fair degree of socialisation and training is achieved. In addition, the occupation centre run by the Welfare Services received some nine defectives of high grade who cannot be accommodated in the mental deficienty centre. No home teaching is undertaken at the present time. 47 48 INFECTIOUS DISEASES AND EXCLUSION FROM SCHOOL Disease Incubation Period in days Early Symptoms Interval between onset & appear ance of rash Period of Exclusion of Case Procedure for Dealing with Contacts. (1) (2) (3) (4) (5) (6) Diphtheria 2-7 (Average 3-4) Sore throat discharge from nose or other symptoms according to location of disease Until certified free from infection by School Medical Officer or by Medical Super intendent of Isolation Hospital. Contacts to be excluded pending consultation with School Medical Officer Scarlet Fever 2-5 Headache, sickness, sore inflamed throat. 1-2 Minimum of 14 days from onset. Longer if child has persistently Inflamed throat, running nose or discharging ear. Contacts should be examined by the Health Visitor and any with inflamed throats should be excluded pending laboratory Investigation. Other contacts should NOT be excluded unless and until any symptoms develop. Measles 7-14 (Average 10) Bloodshot eyes, running nose, sneezing and cough 3-4 Minimum of 14 days from appearance of rash Contacts should be kept under close observation by the teacher, and the School Medical Officer or Health Visitor consulted in any case of doubt. Children developing suspicious symptoms should be sent home to bed and the parents advised to call In the family doctor. Whooping Cough 7-21 (Average 10) Irritative cough - 28 days from onset of paroxysmal cough Chicken Pox 10-21 (Average 15) Rash is usually first symptom 0-1 Minimum of 7 days from appearance of rash. Longer if severe scabbing still present. German Measles 10-21 (Average 13) Running nose, slightly bloodshot eyes, swollen neck glands 1-2 Minimum of 7 days from appearance of rash 49 (1) (2) (3) (4) (5) (6) Mumps 12-28 (Average 18) Swelling below ear or under jaw usually first sign. - Minimum of 14 days from onset. Longer if swelling persists. As for Measles PolioMyelitis 7-14 or more (Average 12) Headache, pain In neck or back. - Until physically fit to return. Consult School Medical Officer Other Diseases Consult School Medical Officer. 50 INFECTIOUS DISEASE PROCEDURE DISEASE FORM EXCLUSION OF CASE FROM WORK OR SCHOOL. EXCLUSION OF CLOSE FAMILIAL OR HOUSEHOLD CONTACT FROM WORK OR SCHOOL. EXCLUSION OF HOUSEHOLD FROM USE OF LAUNDRIES, CLEANERS & LIBRARIES. NOTES (1) (2) (3) (4) (5) (6) SCARLET FEVER 1 14 days from onset or longer in presence of persistently inflamed throat, running nose or discharging ears. Adults working in contact with food or with maternity or surgical cases should not be allowed to resume work until nose & throat swabs are reported free from haemolytic streptococci. ADULTS working in contact with food or maternity or surgical cases should be excluded until nose and throat swabs are reported as containing "no haemolytic streptococci". Children and other adults need not be excluded unless and until any symptoms develop. Any Children with sore or inflamed throats should be excluded from school pending laboratory investigation. Those whose swabs yield a growth of haemolytic streptococci should be treated, and not allowed to resume school until nose & throat swabs have been reported negative. Yes. PURPOSES OF VISIT BY HEALTH VISITOR (1) To advise re measures of isolation and concurrent disinfection where the case is nursed at home, and to report to M.O.H. any factors favourable to spread of infection. (2) To list all contacts and, where appropriate, to obtain the necessary swabs or specimens for examination. To advise re early symptoms and necessity for calling in G.P. should these develop. (3) Advice on nursing of actual cases should only be given in close collaboration with the G.P. although the Health Visitor may properly interpret instructions already given by the doctor. (4) To advise re measures for terminal disinfection. In general this should consist of a thorough cleaning and airing of the sick room with particular emphasis on the scrubbing of all floors and horizontal surfaces together with washing of bedlinen, curtains, etc., and thorough airing and sunning of blankets, carpets, etc. Spraying will be discontinued as a routine measure, but may be requested at the discretion of the Health Visitor. 51 (1) (2) (3) (4) (5) (6) ERYSIPELAS 1 Until clinically cured ADULTS working in contact with food, maternity or surgical cases should be excluded for one week. OTHERS need not be excluded in absence of clinical symptoms. Yes As Scarlet Fever DIPHTHERIA 1 Until certified free from infection by M.O.H. or Medical Superintendent of Isolation Hosp. ADULTS working with food or young children should be excluded pending report on nose and throat swabs. If report shows presence of C.Diphtheria, exclusion should be continued until such time as nose & throat swabs are reported negative. Yes -do— CHILDREN should be excluded from school pending consultation with M.O.H. In general, fully immunised Schick negative children will be allowed to resume under close surveillance, whilst unprotected children will be excluded and given antitoxin plus a first immunising injection of the appropriate antigen. POLIOMYELITIS 2 Until clinically cured. Consult with M.O.H. re each individual contact - in general exclusion will NOT be practised. NO -do- MENINGITIS 2 -do- -do- No —do- MEASLES 2 Minimum of l4 days from onset of rash. Nil - but contacts should be kept under surveillance by Health Visitor in home (in case of pre-school children) or by Teacher in school (school-children). Immediately any suspicious symptoms develop, contacts should be excluded and G.P. notified. No -do— WHOOPING COUGH 2 Minimum of 28 days from onset of paroxysmal cough. -do- No -do- ACUTE PRIMARY OR INFLUENZAL PNEUMONIA 3 Until clinically cured. Nil No -do- PUERPERAL PYREXIA 3 -do- Nil No -do- 52 (1) (2) (3) (4) (5) (6) OPHTHALMIA NEONATORUM 3 Until Clinically cured. Nil No As Scarlet Fever GERMAN MEASLES Not notifiable Minimum of 7 days from onset of rash Schoolchildren should be allowed to attend school under the surveillance of the Head Teacher who will exclude the child should suspicious symptoms develop -do- MUMPS -do- Minimum of 14 days from onset, or longer if swelling persists. -do- - -do- CHICKEN POX -do- Minimum of 7 days from onset of rash - longer if severe scabbing persists. N.B. Where the nature of the rash is In doubt, please consult M.O.H. —do- -do- TYPHOID 4 Until certified free from infection by Medical Supt. of Isolation Hospital, or until 3 stool and 3 urine specimens taken at intervals of 1 week are reported free from pathogens. ADULTS (other than food handlers) should be kept under surveillance and excluded only If symptoms develop. Yes PURPOSES OF VISIT BY SANITARY INSPECTOR. (1) to Ascertain source of infection by taking history and by obtaining samples of food and drink from home, shops, restaurants, dairies, etc. (2) To list contacts, to exclude those engaged in food handling, etc., and to Food handlers and children should be excluded pending investigation. Food handlers must submit 3 specimens of faeces and of urine each at Intervals of 1 week, all of which must be reported negative before the contact is allowed to resume work. 53 (1) (2) (3) (4) (5) (6) TYPHOID continued obtain specimens for examination if necessary In conjunction with Health Visitor, (e.g. rectal swabs). (3) To take all measures necessary to prevent recurrence (e.g. education of individuals in principles of food hygiene, correction of sanitary defects, rodent control, etc., etc.) PARATYPHOID 4 Until 2 stool specimens, taken at interval of 1 week, are reported free from pathogens. In absence of symptoms, exclude food handlers and children pending one stool examination. In presence of symptoms, exclude until (a) clinically asymptomatic, (b) 2 negative stool examinations at interval of 1 week. Yes As Typhoid DYSENTERY 4 -do- -do- Yes As Typhoid FOOD POISONING (Bacterial) 4 -do— -do- Yes As Typhoid (Toxic) 4 Until clinically cured NIL No. As Typhoid 54 SECTION 22 - CARE OF MOTHERS AND YOUNG CHILDREN DENTAL CARE. Dr. Allan Ross, the Senior Dental Officer, submits the following report on the dental treatment provided for expectant and nursing mothers and pre-school children In 1952:- "The year was a difficult one for the two full-time Dental Officers employed by this Authority, At the beginning of the year, energetic steps were being taken to reduce a large waiting list, but a constant stream of patients were continually adding to it. Children under school age had the greatest difficulty In obtaining treatment outside the priority service. The necessity for providing dentures to expectant and nursing mothers was a real burden to the depleted staff, but any lessening of our responsibility in this connection would be strongly deprecated. An X-ray unit was installed during the year. As far as mothers and young children were concerned, its use was small. On the other hand it was used extensively for school children. Our efforts were extended during the year to obtain the services of another full-time dentist, but only a small amount of part-time help was obtained. It is felt that the advantages of part-time help have been exaggerated and the solution appears to rest in full-time staff working additional evening sessions. Toward the end of the year this method of dealing with the work was put into effect and had given a measure of relief to the dental services of the borough." TABLE 13 NUMBERS PROVIDED WITH DENTAL CARE, 1952 Examined Needing treatment Treated Made dentally fit Expectant & Nursing Mothers 317 283 201 108 Children under five 590 525 479 329 TABLE 14 FORMS OF DENTAL TREATMENT PROVIDED, 1952 Extrac tions Anaesthetics Fillings Scalings or scaling and gum treatment Silver Nitrate treatment Dressings Radiographs Dentures provided Local General Complete Partial Expectant & Nursing Mothers 520 147 73 363 194 3 93 2 16 57 Children under five 767 47 376 170 10 74 121 1 - - 55 PUBLIC HEALTH ACT 1936 - SECTION 203 Number of births notified during the period 1/1/52 to 31/12/52, as adjusted by transferred notifications (a) Live births:- (b) Still births:- (c) Totals (i) Domiciliary 335 (i) Domiciliary 5 (i) Domiciliary 340 (ii) Institutional 1,261 (ii) Institutional 24 (ii) Institutional 1,285 Premature Births Number of premature infants notified ) (1) born at home 14 during the year (including transferred) notifications) whose mothers normally ) (2) born in hospital reside in the area:- or nursing home 88 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 Services- TABLE 15 PREMATURE INFANTS BORN AT HOME Birth Weight Transferred to hospital Nursed Entirely at Home Total Premature Still Births Died in first 24 hours Died on 2nd to 7th day Died on 8th to 28th day Survived 28 days 2lbs. 3 ozs. or less 1 - - - - 1 2 Over 2lbs. 3 ozs. and up to 3 lbs. 4 ozs. - - - - - - 1 Over 3 lbs. 4 ozs. and up to 4 lbs. 6 ozs. - - - - 2 2 1 Over 4 lbs. 6 ozs. and up to 4 lbs. 15 ozs. - - - - 2 2 - Over 4 lbs. 15 ozs. and up to 5 lbs 8 ozs. - - - - 9 9 1 Totals 1 - - - 13 14 5 Note:- The weight groupings quoted above differ from those used prior to 1951, and have been adopted to render British statistics comparable to those of other nations. 56 TABLE 16 PREMATURE INFANTS - BORN IN HOSPITALS Birth weight Died in first 24 hours Died on 2nd to 7th day Died on 8th to 28th day Survived 28 days Total 2 lbs 3 ozs. or less 2 1 - - 3 Over 2 lbs 3 oz. and up to 3 lbs 4 ozs. - 2 1 5 8 Over 3 lbs. 4 ozs. and up to h lbs 6 ozs. 2 1 - 12 15 Over 4 lbs. 6 ozs. and up to 4 lbs 15 ozs. - 2 - 13 15 Over 4 lbs. 15 ozs. and up to 5 lbs. 8 ozs. 1 - 1 45 47 TOTALS ALL WEIGHTS 5 6 2 75 88 57 TABLE 17 ANTE-NATAL AND POST-NATAL CLINICS, 1952 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) No0 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 1,599 1,165 8,090 Post-natal clinics - - 405† 402† 456† Clinic belonging to other L.H.A.+ Ante-natal clinics 1 4 37 28 176 Post-natal clinics - - 8† 8† 9† + By arrangements with L.C.C. at Fernhill Street Baths, North Woolwich, E.l6. † Post-natal patients seen at ante-natal clinics and these numbers are not included In the ante-natal figures. Note:- No clinics were discontinued or new premises opened during the year. No ante-natal or post-natal examinations were carried out by General Practitioners at the mother's home or the practioner's surgery under arrangements made with the Local Health Authority. 58 TABLE 18 CHILD WELFARE CENTRES, 1952 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 of 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 2,496 1,213 84 1,126 1,359 14,693 4,473 Centre belonging to other L.H.A. † 1 4 76 32 3 28 45 328 77 † By arrangement with L.C.C. at Fernhill Street Baths, North Woolwich, E.l6. + Excluding children who attended before 1/1/52 or who were known to have previously attended a centre in another districtc Note:- No clinics were discontinued or new premises opened during the year. 59 This important work is now centred at three clinics each of which serves approximately the north, the centre and the south of the borough. The clinic in the Fernhill Street Baths copes with the small riverside population south of the "bridges". It has long been known that considerable hardship is experienced by many women In bringing small children to our clinics from the north-west part of the borough, and by reason of the long distances to be traversed, the problem presents even greater poignancy In regard to expectant mothers, and for these reasons It is proposed to open a temporary maternity and child welfare clinic in the vacant premises at Shrewsbury Road School, I feel sure this temporary clinic, eventually to be replaced by clinics In the Health Centre on the Durban House site, will be well attended and fulfil a great need. DAY NURSERIES, 1952 TABLE 19 Number at 31/12/52 No. of approved places No. of children on the register at the end of the year. Average daily attendance during the year 0-2 years 2-5 years 0-2 years 2-5 years 0-2 years 2 -5 years 4 75 154 41 97 32 103 There are no Nurseries in the borough provided by Voluntary Organisations, all nurseries being operated by the authority. No new nurseries were opened during the year, neither were any closed, but on 1st April, 1952, the number of places provided at the Roman Road Nursery was reduced from 84 to 20. The nurseries are open from Monday to Friday each week, with the exception of public Holidays, and the total attendances during 1952 were as follows:- Nursery Total attendances Average daily attendance Roman Road ( 1.1.52 - 31.3.52) 2,475 38.0 ( l.4.52 - 31.12.52) 2,627 13.7 School Road 7,358 28.7 St. Stephen's Road 10,628 41.5 Wall End/Caledon Road 9,380 36.6 Total 32,468 126.8 The total attendances for 1952 decreased by 13,647 as compared with the 1951 total of 46,115. Comment must be made on the dwindling numbers of parents who still find it necessary to place one or more children In a day nursery. High wages, full employment and a greater sense of parental responsibility have together resulted in a steady decline in the use of our day nurseries. It is true that the Increased charges allowed under the National Health Service Act came into force in October, but to my knowledge only six children were withdrawn from the nurseries ostensibly by reason of the additional charges. 60 Our day nurseries hitherto have been regarded as models of efficiency and economy, but with the falling attendance and continuance of the overhead costs, it is difficult to see how they can be run on an economic basis. The question of closure of one or more nurseries will have to be considered, for whilst it is agreed the necessity for this service still remains, yet it must be conceded sufficient provision can be made in two of the nurseries to meet this need. Admission to the nurseries under the Council's regulations requires proof of medico social stress in a household which can be relieved only by the mother going out to work. So that each case is judged on its merits and it cannot be said the 'good neighbour' policy is being unduly laboured and the ratepayers generally, asked to shoulder a burden which rightly should be born by individuals. The easement of medico social stress In a household by ordered action of the local authority, is today the hallmark of a civilised community, and East Ham must not yield her place to the fore, in the march of cultural progress, 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. CARE OF UNMARRIED MOTHERS. During the year the Council was responsible for the maintenance of 3 unmarried mothers in homes of the Chelmsford Diocesan Moral Welfare Association. NURSERY AND CHILD-MINDERS REGULATION ACT, 1948 There were no daily minders provided by the Council at the 31st December, 1952 and there were no premises or daily minders registered under the above Act at 31/12/52 The Authority were not paying any fees to daily minders under section 22 of the National Health Service Act, 1946, at 31st December, 1952. REGISTRATION OF NURSING HOMES Under Sections 187 to 194 of the Public Health Act, 1936, there were no homes registered during the year 1952, and there were no homes on the register at the end of the year 1952. 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 1952:- Institution No. of patients Aldersbrook Maternity Hospital 478 East Ham Memorial Hospital 211 Forest Gate Hospital 108 797 ALDERSBROOK MATERNITY HOSPITAL There is little doubt of the continued need for the retention of 61 this group of obstetric beds to be used by East Ham mothers. A glance at the appended statistics shows that two out of three of the births in hospital take place in the Aldersbrook Maternity Hospital,, A fairly high rate of bed occupancy is maintained to ensure as far as possible an economic usage. The hospital is visited regularly by a member of the staff of Forest Gate Hospital who is also on call for difficulties that may arise in labour and for emergencies. The high level of nursing and general care has won for this unit a secure place in the affections of East Ham residents, and numerous letters and expressions of gratitude and thanks have been received from women who have had temporary residence in its wards. ALDERSBROOK MATERNITY HOSPITAL STATISTICS 1952 Number of beds on 31/12/52 20 „ „ midwives employed on 31/12/52 7 „ „ patients confined during the period 1/1/52 to 31/12/52:- (a) midwifery 472 478 (b) maternity nursing 6 „ „ midwives qualified on 31/12/52 to administer gas and air analgesia 6 „ „ sets of apparatus of gas and air analgesia In use on 31/12/52 2 „ „ patients to whom gas and air analgesia was administered by midwives during the period 1/1/52 to 31/12/52:- (a) when acting as a midwife 450 454 (b) „ „ „ „ maternity nurse 4 „ „ patients to whom pethidine was administered by midwives during period 1/1/52 to 31/12/52:- (a) when acting as midwife 291 297 (b) when acting as maternity nurse 6 „ „ occasions, medical aid sought by midwives under section 14(1) of the Midwives Act, 1951 25 „ „ infant deaths during the year 6 „ „ premature infants born during the year 18 „ „ still births during the year 4 SECTION 23 - MIDWIFERY SERVICE The midwifery service has now been reorganised by the Superintendent Nursing Officer who is also the lay Inspector of Midwives to this Council. - All the midwives have had refresher courses in the modern methods of obstetric technique, and their equipment has been completly overhauled and brought up-to-date. Co-operation with the general practitioners on the one hand, and the health visitors on the other, is excellent, and the midwives attend special ante-natal sessions in the Council's clinics to get to know their "own mothers" and take part in ante-patal supervision. They give gas and air analgesia whenever the indications are present, but it is found that the inception of relaxation and ante-natal exercise groups for expectant women has resulted in a decided tendency to lessen the need for analgesics in childbirth. However, Pethidine also is employed and it may well be the comparative simplicity of the Pethidine technique has been a contributory factor in reducing the number of cases in which gas-oxygen analgesia is employed. 62 It is pleasing to report that the domiciliary midwives are working as a happy team and have won high praise from the mothers of East Ham for the excellence of their work and the individual kindliness and humanity they bring to their task. TABLE 20 MIDWIVES ACTS, 1902 - 1951 Number of midwives practising in the area at 31st December, 1952. 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 2 6+ 8 Midwives in private practice 1 — 1 Totals 9 6 15 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 2 domiciliary midwives employed by the Hospital Management Committee are from the Plaistow Maternity Hospital and District Nurses Home. (local branch - Burges Road). 63 TABLE 21 MATERNITY CASES ATTENDED Number of maternity cases in the area attended by Midwives during the year ended 31/12/52. Domiciliary Cases Cases In Institutions. Total As Midwives As Maternity Nurses As Midwives As Maternity Nurses As Midwives As Maternity Nurses Midwives employed by the Authority 177 14 - - 177 14 Midwives employed by Voluntary Organisations:- (a) under arrangements with Council in pursuance of Section 23 of the N.H.S. Act 3 - - - 3 - (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 128 27 †283 †6l 411 88 Midwives in private practice 2 - - - 2 - Totals 310 41 283 61 593 102 † 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, 1951, by a midwife (a) for domiciliary cases - (i) where the medical practitioner had arranged to provide the patient with maternity medical services under the N.H.S. Act 11 (ii) others 80 Total 91 (b) for cases in institutions 97+ + East Ham Memorial Hospital. 64 DOMICILIARY MIDWIVES TABLE 22 GAS AND AIR ANALGESIA AND ADMINISTRATION OF PETHIDINE 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 31/12/52 who were qualified to administer gas and air analgesia in accordance with the requirements of the Central Midwives Board 4 2 2 1 9 No. of sets of apparatus in use by domiciliary midwives at 31/12/52 4 1 2 - 7 No. of cases in which gas and air was administered by domiciliary midwives during the period 1/1/52 to 31/12/52:- (a) when acting as a midwife 82 3 45 - 130 (b) when acting as a maternity nurse 11 - 13 - 24 No. of cases in which Pethidine was administered by domiciliary midwives during the period 1/1/52 to 31/12/52:- (a) when acting as midwife 85 - 12 - 97 (b) when acting as maternity nurse 11 - 3 - 14 INSTITUTIONAL MLDWIVES Five midwives employed at the East Ham Memorial Hospital at the end of the year were qualified In accordance with the requirements of the Central Midwives Board to administer gas and air analgesia. 65 SECTION 24 - HEALTH VISITING SERVICE Reference must be made to trends In the health visiting service which marches in step with progress In modern pediatrics. Great stress is laid on a more Informed approach to child care, and mothers are advised on the handling of their little ones, especially infants with problems associated with emotional and psychological development, as well as their physical nurture. To this end and to ensure from the beginning good relationship between mother and child, a system of ante-natal instruction classes has been started, in which selected mothers are given ante-natal exercises designed as a preparation for easier childbirth, and detailed instruction in breast-feeding, early care of the infant, and the founding of good relations. In the clinics the mechanistic approach to child birth is not stressed so much as It was a decade or so ago, and each expectant mother is regarded not as a piece of machinery destined to expel a foetus at the end of the gestation period, but as a creative being with emotions to be played out, fears to be stilled, and hopes to be fulfilled. The health visitor also is playing a greater part In the co-operation with the hospitals, especially in the follow-up of patients discharged, and the rendering to the physician of reports on patients giving valuable details of social background, environment, developmental difficulties, and constitutional disturbances which often have a great bearing on treatment. Lastly more time must be found for the health visitor to go into the homes of the families on her district, to discuss with the mothers problems of child nurture, a variety of domestic difficulties, safety in the home, food values, nutritition, immunisation, and better health,, The field of endeavour for the health visitor is admittedly vast, but her enthusiasm and energies must leap up to meet and encompass the task. TABLE 23 HEALTH VISITING, 1952 Number of Health Visitors employed at end of year Equivalent Whole-time Health Visitor Services provided under Col. (2) (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 oh Hea1th 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) 5+ 18 9 863 971 1,659 8,690 - 11,818 - 1809 + Includes Superintendent Health Visitor All Health Visiting Services are provided by the Authority. There are no agency arrangements with voluntary organisations. 66 SECTION 25 - HOME NURSING This service continues to play a valuable part in the domiciliary care of sick persons of all ages. The treatment of tuberculosis with streptomycin and P.A.S. can be started in the home and continued until a sanatorium bed is available. Many non-tuberculous conditions are dealt with by injections of the chosen antibiotic, carried out by the district nurse under the direction of the general practitioner or surveillance of the Chest Clinic,, In the care of old people in a number of instances the only physical attention bestowed on them is given by the district nurses, who will not only bath the patient but, as a labour of love, wash the hair and attend to the feet and toe nails as well. There is little doubt this humanitarian service not only greatly augments the efforts of the family doctor, but spares many hospital beds for cases which require more highly specialized nursing care and treatment. In my opinion this type of domiciliary nursing should be developed for the treatment of young children in their homes to obviate the necessity for hospitalisation and separation which is known to have so distressing an effect on the mental and emotional life of childhood. This may require close liaison with the hospital pediatrician and his children's ward, but such co-ordination of effort should not be beyond us. The details of the work clearly set out in tables 24 and 25 show that a vast field of medical surgical and obstetrical endeavour has been undertaken by these nurses, and support is given on the administrative side by the Superintendent Nursing Officer in co-ordinating the work with the other medico-social services0 TABLE 24 HOME NURSING, 1952 Provided by No. of home nurses employed at 31/12/52 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 Wholelime on home nursing Parttime on home nursing Local Health Authority - - - - - Voluntary Organisations by agreement with the Authority 10 7 3½ 2,824 60,930 67 TABLE 25 HOME NURSING 1952 East Ham District Nursing Association Silvertown & North Woolwich District Nursing Association Adults Children Total Adults Children Total Males Females Males Females Patients on books on 1/1/52 114 267 11 392 2 4 - 6 New patients from 1/1/52 to 31/12/52 755 1,117 454 2,326 21 51 28 100 Patients on books on 31/12/52 118 284 5 407 - 3 - 3 Total number of visits during year 19,759 37,772 2,512 60,043 253 449 155 857 Summary of new cases East Ham District Nursing Association Silvertown & North Woolwich District Nursing Association Bronchitis, pneumonia and pleurisy 410 5 Cardiac 241 7 Tuberculosis 92 2 Rheumatism, arthritis, etc. 43 - Cerebral 92 Diabetes 58 1 Burns and Scalds 14 1 Cancer 133 2 Senility 43 2 Erysipelas 15 - Prolapse 12 15 Other Medical 472 28 Various surgical 580 33 Ante-natal 15 - Post-natal 30 - Miscarriage 14 4 Other causes 62 - Total new cases 2,326 100 A comparision of statistics in regard to the work of the East Ham District Nursing Association is appendedj- From 5/7/48 to 31/12/48 1949 1950 1951 1952 Patients on books at beginning of period 178 206 272 371 392 New patients during period 435 1,468 1,689 2,081 2,326 Patients on books at end of period 206 272 371 392 407 Total number of visits during period 17,269 40,647 46,976 58,523 60,043 68 SECTION 26-VACCINATION AND IMMUNISATION Smallpox Vaccination Only a very small fraction of our child population is vaccinated, although I believe a slightly better vaccinal state exists among the older age groups. However, in view of the riparian nature of our borough the low vaccinal state of our people gives cause for considerable anxiety. Ocean-going ships from the four corners of the earth tie up in the large docks every day, and the danger thereby of importing virulent small pox is ever present. We have had some sharp lessons in recent epidemics elsewhere in the country with a number of deaths, and the burgesses of East Ham would do well to heed yet another appeal to seek vaccination now. The family doctor will gladly give the service, and in protecting your own life from this dread disease you will at the same time be doing a public-spirited action in minimizing the possible spread of contagion during an epidemic. Diphtheria Immunisation Immunisation of the child population against diphtheria has been well maintained, but complacency in this matter might prove very serious. Some 9,000 children still remain unprotected, and should the disease strike in a virulent form there is little doubt it would find ready victims in this unimmunised group. Every effort will be made to keep this matter in the public eye, so that no mother might plead ignorance of the fact that diphtheria is still a "killing disease", and sure protection for any child can be given in two or three spaced injections which are harmless and nearly painless. The family doctor will carry out the injections either in his surgery (or in some cases at home) or the immunisation can be effected in one of the Council's clinics. TABLE 26 DIPHTHERIA IMMUNISATION, 1952. 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 30/6/52 756 30 786 237 " " " 31/12/52 629 33 662 243 Totals 1,385 63 1,448 480 Note:- The 1001 children shewn at the foot of the Whooping Cough table of statistics are included in the above figures. The comparable figures for 1951 were 1,208 (Under 5) 101 (5-14) 1,309 (total) 182 (re-inforcing injections) 69 TABLE 27 WHOOPING COUGH PROPHYLAXIS WITH PERTUSSIS VACCINES FOR YEAR ENDING 31/12/52 No. of children who completed a course of inoculation with pertussis vaccines (including alum-precipitated vaccines and vaccines combined with diphtheria prophylactic). Total Age at date of final injection Under 1 year 1-4 years 5-14 years 674 571 71 1316 NOTE:- Of the above figures, 315 children received the whooping cough vaccine only and 1,001 the combined whooping cough and diphtheria prophylactic. TABLE 28 DIPHTHERIA IMMUNISATION Number of Children at 31st December, 1952, who had completed a course of Immunisation at any time before that date (i.e. at any time since 1st January, 1938) Age at 31/12/52 i.e. Born in Year Under 1 1952 1 1951 2 1 1950 3 1949 4 1948 5 to 9 1943-1947 10 to 14 1938-1942 Total under 15 No. Immunised 384 944 980 1,359 1,639 7,173 4,676 17,155 Estimated midyear child population 1952 Children under five Children 5-14 25,900 9,400 l6,500 TABLE 29 SMALLPOX VACCINATION No. of persons vaccinated or re-vaccinated during 1952 Total Age at date of vaccination Under 1 1-4 5-14 15 or over No. vaccinated 364 (400) 54 (53) 27 (29) 76 (83) 521 (565) NO. re-vaccinated 6 (11) 5 (9) 13 (18) 177 (211) 201 (249) Totals 370 (4ll) 59 (62) 40 (47) 253 (294) 722 (814) The figures in brackets are those for 1951. All vaccinations were carried out by general practitloners. 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). 70 SECTION 27-AMBULANCE SERVICE. This valuable medico social service still operates under the depressing handicap of a completely inadequate ambulance station for the vehicles, and poor staff accommodation. However the loyal staff overcome all difficulties, and under their officer-in-charge, Miss Finch, give to both the public and the hospitals a most efficient and courteous service. It is pleasing to note the Ministry of Health have given approval to plans for the new station in Wellington Road, and the starting date, April 1st, 1953, has been fixed. It is possible, therefore, that the new station may be completed by the end of 1953. Meanwhile close co-operation must be sought with the hospitals to ensure a more economical use of this form of patient transport, and to prevent abuses of the service. 71 TABLE 30 AMBULANCE SERVICE. STATISTICS FOR YEAR ENDING 31ST MARCH 1953 AMBULANCE SERVICE Cars from Council's Transport Pool and by Private Hire Transport by Rail Grand Total Ambulances Sitting Case Vehicles (upto 4 Passenger Seats) Sitting Case Vehicles (over 4 Passenger Seats) Total-All Vehicles 1. No. of Operational Vehicles on 31st March 5 - +5 10 2. No. of such Vehicles fitted with Wireless - - - - 3. No. of Patients carried:- (a) Accident or Emergency 1,019 - 89 1*106 - - 1,108 (b) Others 14,325 - 23,394 37,719 98 - 37,821 (c) Total (a & b), 15,344 - 23,483 38,827 98 - 38,929 4. No. of Journeys by Vehicles:- (a) Patient carrying Journeys 5,990 - 5,419 11,409 73 - 11,482 (b) Abortive & Service Journeys 253 - 122 375 1 - 376 (c) Journeys for Transport of Analgesia Apparatus, Midwives, Home Nurses etc. 21 - 146 167 - 167 (d) Total (a & b & c) 6,264 - 5,687 11,951 74 - 12,025 5. Total Mileage 71,010 - 101,027 172,037 3,354 292 175,683 6. No. of Operational Staff on 31st March - - - 29 +Includes 4 Dual Purpose Vehicles, to carry 8 Sitting Cases or 1 Stretcher Case and 4 Sitting Cases. 72 TABLE 31 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 Year ending 31st March 1953 22,094 219 3 22,316 TABLE 32 UNIT COSTS-AMBULANCE SERVICE YEAR ENDING 31ST MARCH, 1953 Ambulance Service Cars from Transport Pool etc. All Services £ S. d. £ S. d. £ S. d. Cost per Vehicle mile 2. 7. l. 2. 7. Cost per Patient 11. 5. 2. 4. 8. 11. 6. Cost per Journey 1. 17. 0. 2. 19. 2. 1. 17. 1. Cost per 1,000 Population 186. 0. 0. No. of Patients carried per 1,000 Population 324 No. of Journeys per 1,000 Population 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. 73 TABLE 33 Article No. of occasions items loaned Total Cupboard at Town Hall Annexe East Ham Chest Clinic Church Rd. Clinic Air bed rings (adults) 15 9 8 32 Bed Blocks 1 1 - 2 Bed Boards 1 - - 1 Bed cradles 3 - 3 6 Bed pans 36 7 13 56 Bed rests 34 3 8 45 Blankets 2 - - 2 Commodes 5 - - 5 Crutches 3 - - 3 Douche Cans 2 - 1 3 Dunlopillo Mattresses 1 - - 1 Dunlopillo Rings 5 - - 5 Feeding Cups - 1 - 1 Higginson's Syringes 1 - - 1 Hospital Bedsteads 1 - - 1 Mattresses 2 - - 2 Pillow Slips 3 - - 3 Rubber Sheets 12 3 - 15 Sheets 3 - - 3 Sputum mugs 1 7 - 8 Urinals (male) 16 8 5 29 Water beds 4 - - 4 Wheel Chairs 55 - - 55 Totals 206 39 38 283 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 6 Scales and weights 30 TUBERCULOSIS No. of attendances at East Ham Chest Clinic 24,327 No. of visits to homes of patients by Tuberculosis Visitors 4,008 No, of notified cases on clinic register on:- 1.1.52: Adults 933 Children 302 l,235 31.l2.52: Adults 941 Children 303 l,244 No. of patients under observation on 1.1.52: Adults 465 Children 300 765 31.120.52: Adults 692 Children 431 1,123 74 No. of occasions No. of occasions on which free extra nourishment was supplied:- Milk 493 Food 24 517 There is no change in the procedure outlined on page 53 of my report for 1949 in respect of the provision of free extra nourishment (milk and food) and free convalescent treatment to tuberculous patients. With the inception of the loan cupboard scheme, bedding for the use of tuberculous patients is now loaned from these cupboards, and assistance towards the purchase of such bedding is given. Clothing for tuberculous patients is now provided by the National Assistance Board, and it has not been necessary for the Authority to assist in such cases. During the year the Authority accepted responsibility for the provision of rehabilitation for five male tuberculous patients in British Legion Village Settlements as shown (a) Papworth Village Settlement, Cambridge: One patient for 26 weeks and 4 days, and one for 23 weeks. (b) British Legion Village, Preston Hall, Maidstone, Kent: One patient for 37 weeks and 2 days, and one for 17 weeks and 4 days. (c) Enham-Alamein Village Settlement, And over, Hants: One patient for 33 weeks and one day. B.C.G. vaccination continued to be carried out at the East Ham Chest Clinic, and during the year 166 persons were so vaccinated. Dr. Philip Ellman, Consulting Physician of the East Ham Chest Clinic, has submitted the following observations on the work of the Clinic, with particular reference to the after-care and preventive aspects:- "Tuberculosis remains one of the greatest problems of World Medicine today. The Chest Clinic must continue to be the pivot of all activities in the prevention as well as the treatment of this disease, whose social and economic factors weigh almost equally with the medical factors. Every member of the Chest Clinic staff, medical, nursing and administrative is encouraged to regard prevention, diagnosis, treatment and after-care as one continuous process. Narrow lines of specialisation in treatment which cover the more dramatic aspects are strongly discouraged, and close contact with the machinery for prevention in conjunction with the Medical Officer of Health and his staff is a first essential. It is necessary to emphasise that we regard the divorce of the purely therapeutic side of our work from the preventive and social aspects as a retrograde step. Furthermore, our liaison with the general practitioner is of the closest, and he is encouraged to be in the forefront of the attack against tuberculosis. The fall in both the incidence and mortality rate in the Borough In recent years is encouraging but leaves no room for complacency. We aim at continuing with a full programme directed at Tuberculosis control, utilising every available source of help. PREVENTIVE SCHEMES. It is estimated that 75 per cent of the work of the Chest Clinic is 75 of a preventive nature, but preventive schemes vary with different age periods, e.g,:- In Infants and pre-School-Children we stress the importance of B.C.G. vaccination, separating the Infant at birth from an active tuberculous mother, routine X-ray examination of midwives, health visitors, day nursery staff and foster parents, and periodic tuberculin testing with X-ray examination of positive reactors. Schoolchildren. Separation of active cases in the home, or if this is not possible, arranging with the Children's Officer for the boarding-out of the child, regular tuberculin testing and B.C.G. vaccination and X-ray examination of the chest where indicated; X-ray examination of the School Teachers and others with whom the child may be in contact, Adolescents. Attention is paid to adolescents of the 15 to 25 age period, whose morbidity and mortality rates, especially among females, Is known to be high, B.C.G. vaccination of school leavers, students, teachers, nurses, ambulance workers and factory workers whose tuberculin test is negative is strongly encouraged. CONTACT EXAMINATIONS, The discovery of any "open" case-whether by Mass Radiography or routine examination at the Clinic-involves the immediate Instigation of a so-called "zone of hygiene" to discover the possible source of infection and to minimise any further dissemination, A mass attack on "contacts" is initiated, not only in the home but also, whenever possible, among the working associates if a worker is involved. Where a teacher is concerned, in close co-operation with the Medical Officer of Health the contact pupils would of necessity undergo routine X-ray examination Attention is also paid to adults, especially those whose work renders them more liable to the risk of infection; periodic X-ray or Mass Radiography, tuberculin testing and B.C.G. vaccination where indicated are encouraged. The assistance of a full-time Almoner, especially in "contact" factory work, would be of enormous value. MASS RADIOGRAPHY. It is felt that more adequate facilities for routine X-rays would greatly enhance the efficiency of our preventive and case-finding programme. The need for a fixed Mass Radiography Unit within reach of the Borough is an urgent necessity, as X-ray examination of the chest must be repeated at intervals during those years of life when the incidence of pulmonary tuberculosis is known to be greatest if cases are to be detected at the earliest stage; many hitherto unsuspected sources of infection may also be brought to light, THE CHRONIC SPUTUM-POSITIVE CASE. An important problem in the prevention of tuberculosis is the chronic sputum-positive case. Adequate training through the chest Clinic team can do much, by securing the patient's co-operation, to minimise the risk to others. We emphasise the need, as a preventive measure, for the patient with a cough to cover the mouth with a handkerchief and to use a sputum flask whenever possible. The care of the flask, the disposal of the sputum and a high level of social behaviour in the interests of himself, his family and the community are constantly being taught by our Tuberculosis Visitors, It is, however, imperative that facilities should be made available for him, from a social point of view, to shoulder this responsibility effectively. The availability of "Remploy factories and workshops" for the sputumpositive case would be a valuable asset. Where there are crowded home conditions, especially with young children and adolescents, the provision of 76 Night Hostels or Dormitories for the chronic sputum-positive case would be invaluable. This need is already recognised but far from satisfactorily implemented. EMPLOYMENT OF THE QUIESCENT OR ARRESTED TUBERCULOUS PATIENT. The rehabilitation of the tuberculous patient is intimately linked with the prevention of relapse and adequate financial provision for him throughout the whole period of his illness until the day when his rehabilitation is complete is a matter which constantly brings us to the difficult problem of the resumption of employment. The patient should, wherever possible, be encouraged to resume his original occupation, unless this proves to be unsuitable for hygienic reasons or where the work is beyond the patient's physical capacity. The Disabled Persons Act, 1944 is to a limited extent helpful in assisting industrial rehabilitation and vocational training, but in our experience obtaining employment through the Ministry of Labour Scheme via the Disablement Resettlement Officer is of limited value. Its effective application is often prejudiced by the lack of suitable occupations in local industry, by deficiencies in the patient's education and by long waiting lists for training centres. Facilities for work under sheltered conditions are, in fact, few and far between. It is desirable that part-time or modified work for the quiescent case before resuming full-time employment under industrial conditions should be available. The well-trained quiescent and arrested case of tuberculosis should not be considered a "social leper", for the training he has received at a sanatorium of ten renders him a safer member of the community than an ordinary worker without this advantage. In this connection a more enlightened view of the problem by employers and the general public would be of enormous help. Education of the public by lectures and propaganda should be intensified and B.B.C. broadcasts on the subject are steps in the right direction. Colonisation of patients, in many cases with their families, at Enham Alamein and Papworth Settlements has provided the final stage in the rehabilitation of many patients. This had proved valuable in selected cases, but the numbers that can be dealt with in this way are few and there is a case for extending the s cheme further. The standard of living of the tuberculous patient. This must be kept high; priority housing for the tuberculous patients In the Interests of the community and suitable work in a good environment are all good preventive measures. The Home Help Service. the service provided by the District Nurses and the Occupational Therapy service. all provided by the Council are of enormous value to our patients. We hope that better facilities for occupational therapy in the home and wider opportunities for vocational guidance going on to training centres nearer to the patients' home may be available in the not too distant future. CO-OPERATION BETWEEN THE CHEST CLINIC AND THE PUBLIC HEALTH DEPARTMENT. Our constant aim at the Chest Clinic is the closest co-operation between ourselves and the Public Health Department in the interest of the prevention of tuberculosis and the care of the tuberculous patient when at home or at work. Finally it is our firm conviction that on return from a sanatorium education,selected patients whose condition is quiescent or arrested can be reabsorbed into normal Industry and the whole period from diagnosis to reinstatement into industrial work must be regarded as one continuous process* To assist the smooth functioning of this process, there must be the closest co-operation between those concerned with the prevention and treatment of this disease and in the after-care and rehabilitation of those afflicted by it. To this end we have afforded every facility for 77 the interchange of information and discussion of individual problems with the Medical Officer of Health and the Disablement Resettlement 0fficer. Our aim is to have regular conferences at which representatives of the Housing Department, the Children's Officer, the School Medical Service and the General Practitioner service, should also be present. In this way a greater degree of understanding of each others' problems and a closer integration of the forces now deployed against tuberculosis will be achieved During the period 1.1.52 to 30.9.52, the part-time occupational therapist employed by the Council carried out the following sessions:- (a) At the Chest Clinic 71 (b) At the homes of patients 66 No. of attendances at Clinic sessions 773 " " " " patients' homes 427 No statistics are available for the period 1st October to 31st December owing to the Therapist's absence following an accident. mass radiography. The Mass Radiography Unit (no. 6b) again visited East Ham and conducted a public survey from 20th May to 20th June, 1952. The Unit was accommodated in the Minor Hall of the Town Hall and a total of 6,912 persons attended for examination. The following is an extract from the report by the Unit's Medical Director, Dr. D.J. Lawless, on this survey:- Males Females Total No. of attendances for miniature X-ray 3,245 3*667 6,912 No. passed as normal on miniature or subsequent large film examination 3,082 3,527 6,609 No. showing some abnormality 163 140 303 Percentage showing some abnormality 4.8 3.9 4.5 Classifications of abnormalities noted Abnormalities of Bony thorax (congenital) 1 1 2 Chronic bronchitis and emphysema 38 13 51 Bronchiectasis 4 - 4 Pulmonary fibrosis (non-tuberculous) 2 2 4 Basal fibrosis 22 14 36 Pleural thickening 8 1 9 Intra-thoracic tumours 1 - 1 Cardiovascular lesions-Congenital 2 - 2 Cardio-vascular lesions-Acquired 6 10 16 Miscellaneous minor abnormalities 16 21 37 Pulmonary Tuberculosis-all types 63 78 141 Totals: 163 140 303 The tuberculous lesions noted are further analysed as follows:- Tuberculous lesions Males Females Total Inactive Tuberculosis Primary 20 34 54 Post-Primary 38 35 73 Totals 58 59 127 Active Tuberculosis Primary - - - Post-Primary 5 9 14 Totals 5 9 14 78 There were thus l4 active cases of pulmonary tuberculosis disclosed by the survey. This gives a ratio of 2.08 per 1000 examinations. This is considerably better than on our previous visit when the incidence was 3.84 per 1000. All necessary action had been taken in respect of the cases, both tuberculous and non-tuberculous, requiring further medical attention. I would like to take this opportunity of thanking you for your kind assistance in procuring the Minor Hall, and for the very valuable help of your Department in the conduct of the survey." Reference to my report for 1950 will show that on the last survey by this Unit, which lasted from 29th November, 1950, to 5th February, 1951, only 4,160 attendances were made for X-ray examination, whereas in 1952, in a much shorter period, the attendances were 6,912. This is due, I feel, not only to the increasing public awareness of the desirability of periodic X-ray examination of the chest, but also to the location of the Unit at the Town Hall, the focal point of the borough, rather than at the Church Road Clinic and the Drill Hall, Vicarage Lane, as was the case in 1950/51. The Medical Research Council's trials of B.C.G. vaccine mentioned in my reports for 1950 and 1951 continue. The final inoculation of volunteers took place from 22nd to 28th February and on this occasion 163 school-leavers volunteered to take part in the trials. Forty-six of these were inoculated with B.C.G. vaccine and forty were held as controls. Since the inception of these trials in 1950, therefore, 657 schoolleavers have volunteered to assist, and of these 175 have been inoculated with B.C.G. vaccine and 172 are acting as controls. Each volunteer either vaccinated or acting as a control will be kept under surveillance for three years, and for this purpose the Medical Research Council Team will return to East Ham periodically to re-examine groups of volunteers. The first of these follow-up visits took place from 8th to 17th July, 1952, when 194 volunteers were due to be seen. In co-operation with the neighbouring County Borough of West Ham, visited by the team immediately prior to the above dates, appropriate publicity was arranged in the local press, and through some of the local cinemas. 143 volunteers attended for re-examination and arrangements were made for the local Mass Radiography Unit to contact the remaining 51. In addition to these follow-up visits by the Medical Research Council staff, the Health Visitors also maintain contact with the volunteers and report on their state of health. The trials continue, and further reports will be made. 79 TABLE 34 CONVALESCENT HOME TREATMENT PERIOD OF TREATMENT-1932 Age Groups Sex Up to 1 week 1-2 weeks 2-3 weeks 3 - 4 weeks 4 - 5 weeks 5-6 weeks over 6 weeks Total Under 5 years M - - 9 9 1 - - 19 F - - 1 4 - - - 5 School children M - - 14 24 5 3 - ke F - - 14 16 2 - 1 33 Adults M - - 14 24 3 - - 41 F 1 - 23 45 1 - - 70 Totals 1 - 75 122 12 3 1 214 TABLE 35 The recommendations for this form of treatment were submitted by:- Referred by Children 0-5 School Children Adults Total[/] General Practitioners. 10 19 70 99 Hospitals. 1 7 20 28 East Ham Chest Clinic. 1 22 14 37 School Health Service. - 30 - 30 M. & C.W. Section. 11 — 6 17 Child Guidance Clinic 1 1 1 3 Totals 24 79 111 214 For comparision the numbers of children and adults receiving this form of treatment in previous years are appended:- 1949 1950 1951 1952 Children 0-5 years 86 47 20 24 Schoolchildren 326 180 112 79 Adults 49 52 82 111 80 PARK VIEW THERAPEUTIC CLUB. This club the chief purpose of which is the rehabilitation within the community of persons whose mental illness has for a time deprived them of normal social intercourse-now boasts some 50 members. They select their own committee of management, and hold regular social evenings, dances and other normal club functions. Some assistance and support is given by Mr. Steadman and the Duly Authorized Officers, and these members of the Mental Health Service staff are to be complimented on their deep sense of duty and humanity in giving so much of their leisure time to the smooth running of the club. The Mayor and members of the Health Committee have also on occasion attended the club, and their visits have been warmly appreciated by the members. 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 time has come when serious consideration should be given to the provision of additional accommodation for the community care of mental defectives in an occupation centre. A number of defectives await urgent admission, and their parents experience Increasing difficulty in occupying them throughout the day. Each case in fact presents two problems, to relieve the parents for some part of each day of the burden of constant supervision of the child, and to teach the child the elements of socialization. And both problems are solved by daily admission to an occupation centre. I have attempted to place some of these children in centres In neighbouring boroughs, without success, so that we must seek, either to expand our own premises at Katherine Road, or find a suitable site for a new building. 81 PARTICULARS OF MENTAL DEFECTIVES REPORTED DURING 1952 Males Females Total Particulars of cases reported during the year 1952 (1) Ascertainment- (a) Cases reported by Local Education Authorities (Section 57, Education Act, 1944) (i) Under Section 57(3) 2 2 4 (ii) Under Section 57 (5) On leaving special schools 3 1 4 On leaving ordinary schools — 1 1 (b) Other ascertained defectives reported during 1952 and found to be "Subject to be dealt with" 2 4 6 Total ascertained defectives found to be "Subject to be dealt with" during the year 7 8 15 (c) Other reported cases ascertained during 1952 who are not at present "Subject to be dealt with" 1 2 3 (d) Cases reported but not confirmed as defectives by 31st December and thus excluded from (a), (b) or (c) 3 2 5 Total No. of cases reported during the year 11 12 23 (2) Disposal of cases reported during the years (a) Ascertained defectives found to be "Subject to be dealt with"- (i) Admitted to institutions 1 3 4 (ii) Placed under guardianship - - - (iii) Taken to "places of safety" - (iv) Placed under statutory supervision 6 5 11 Total ascertained defectives found to be "Subject to be dealt with" 7 8 15 (b) Cases not at present "Subject to be dealt with"- (i) Placed under voluntary supervision 1 2 3 (ii) Action unnecessary — - - Total cases not at present "Subject to be dealt with" 1 2 3 No. of cases in institutions, under community care including voluntary supervision or in "places of safety" on 1/1/52 who have ceased to be under any of these forms of care during 1952 (a) Ceased to be under care - - - (b) Died, removed from area, or lost sight of 2 8 10 Of the total No. of defectives known to the L.H.A.- (a) No. who have given birth to children during 1952 while married - - - (b) No. who have married during 1952 - 2 2 During 1952, no guardianship orders were discharged with the approval of the Board of Control in accordance with Circular 177/48 (Ministry of Health) 82 TABLE 37 MENTAL DEFICIENCY ACTS, 1913-1938 PARTICULARS OF MENTAL DEFECTIVES AS ON 1/1/53 Males Females Total 1. No. of ascertained mental defectives found "Subject to be dealt with":- (a) In Institutions (including cases on licence therefrom) Under 16 years of age 9 8 17 Aged 16 years and over 87 93 180 (b) +Under guardianship (including cases on licence therefrom) Under 16 years of age - - - Aged 16 years and over 5 6 11 (c) In "places of safety" - - - (d) Under statutory supervision (excluding cases on licence) Under 16 years of age 22 15 37 Aged 16 years and over 87 67 154 Total ascertained cases found to be "subject to be dealt with" 210 189 399 M F T No. of cases included in (b) to (d) above awaiting removal to an institution 8 3 11 2. No. of mental defectives not at present "subject to be dealt with" but over whom some form of voluntary supervision is maintained:- Under 16 years of age - - - Aged 16 years and over 25 26 51 Total number of mental defectives (1) plus (2) 235 215 450 3. No. of mental defectives receiving training:- (a) In day training centres under 16 years of age 13 10 23 under 16 years and over 13 8 21 (b) At home - - - Total 26 18 44 +No defectives under guardianship were dealt with during the year under the provisions of section 8 or 9. 83 All guardianship cases are supervised either directly or indirectly by the Authority. No. on register on 1/1/52 11 NO. admitted to institutions No. of orders discharged by Board of Control - No. on register on 1/1/53 11 + NO. visited by members of Mental Health Committee 6 + No. " " Medical Officer of Health 5 + Outside area + Inside area The number of mental defectives on the register of the Occupation Centre on 31/12/52 was 35 (22 males, 13 females). With the exception of 1 female who attended afternoons only, all attended for the whole day. TABLE 38 MENTAL DEFECTIVE OCCUPATION CENTRE SESSIONS AND ATTENDANCES, 1952. No. of sessions held during the year Morning Afternoon 217 217 Male Female Male Female Total attendances 4,229 2,571 4,229 2,770 Average attendances per session 19.49 11.85 19.49 12.73 Total attendances, males 8,458, females 5,341, total 13,799 There were 16 defectives awaiting admission to the Centre on 31/12/52. (8 of these defectives were attending the Occupation Centre at Arragon Road). TABLE 39 MENTAL PATIENTS - LUNACY AND MENTAL TREATMENT ACTS Type of patient Number on register on 1/1/52 Admissions to institutions during the year 1952 Discharges from Institutions during the year 1952 Deaths in institutions during the year 1952 Number on register on 31/12/52 Certified - Males 163 22 16 11 158 Females 211 49 30 18 212 Total 374 71 46 29 370 Temporary - Males 1 - - - 1 Females 2 5 6 1 - Total 3 5 6 1 1 Voluntary - Males 71 55 50 10 66 Females 61 70 72 5 54 Total 132 125 122 15 120 Grand Totals 509 201 174 45 491 No. of patients released on trial during 1952 - 10 Males, 16 Females, Total 26. " " " returned from " " 1952 - 3 " 3 " " 6 84 Of the above cases, on 1/1/52, 495 were inmates at Runwell Hospital and 14 in other institutions,, During the year, 187 were admitted to Runwell and 14 to other hospitals, 165 were discharged from Runwell and 9 from other Institutions, 42 of the deaths occured in Runwell and 3 elsewhere and on 31/12/52 the cases were accommodated as follows:- 476 Runwell and 15 other hospitals. The Mental Health Service has gradually broadened its basis of operation., The duly authorized officers in liaison with the child guidance team, medical staff and health visitors all have a part to play in educating the family or individuals in mental health, and supporting those households threatened by the shadow of mental breakdown,, They deal with every type of case from the young pre-school child with neurotic fears induced by wrong handling, to the old man with senile decrepitude and insidious mental deterioration. They have won high praise from the general practitioners in their handling of mental cases and for the willing assistance in making all necessary preparation for removal of persons to hospital. Such a simple statement gives little indication of the difficulties often to be surmounted before hospital placement is effected,, But the D.A.o. Is not deterred by difficulties. His lodestone is "the welfare of his patient" and many families and doctors in East Ham will testify to his unshaken determination to follow this course. TABLE 40 DULY AUTHORISED OFFICERS DETAILS OF VISITS, ETC., 1952 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 I No. of visits and attendances 38 l,423 88 206 102 1,857 1,392 854 85 2,331 41,188 SECTION 29 - HOME HELP SERVICE. The functions of this medico-social service have now crystallised more or less into an ancillary service for the care of old people, for of 738 cases to which a home help was sent, 469 ( 64 per cent) were aged persons. The old people rely implicitly on the home help for cleaning, washing, and attention to many of their physical comforts as well. Whenever possible the help also prepares a meal for the recipient of the servic. It is to be noted with great regret that as the home help service has progressed, the amount of assistance given to the old people by relatives, neighbours and friends has diminished. This callousness and indifference Is a corollary of the 'welfare state' which demonstrates the loss of filial 85 and familial responsibility induced by certain kinds of legislation. The five great Acts were woven to strengthen and support family life, and it Is distressing to find that such are the vagaries of social reactions that in this instance the opposite result is to be observed, for the ready acceptance of responsibility by the local authority has tended to weaken the family fabric. The service continues to meet an increasing demand and in 1952, 738 applicants received the services of a home help as compared with 710 for the previous year. Of these 738 persons or householders, 348 (47%) had between 9 and 12 months service, as against 292 (41%) in 1951. The approved establishment remains at 60 full-time helps or their equivalent in part-time helps, and on 31st December, 1952, the staff employed comprised 3 full-time permanent helps and 108 casual helps (including 21 helps on probation and not then registered), a total of 111. The hours worked by these helps (including allowances for sickness, holidays and travelling time) are appended:- Period No. of hours. 5 weeks ending 3.2.52 10p566¼ 4 " " 2.3.52 9,220 4 " " 30.3.52 9,055¾ 4 " " 27.4.52 8,32¾ 5 " " 1.6.52 11,066½ 4 " " 29.6.52 8,l4l¼ 4 " " 27.7.52 8,56o½ 5 " " 31.8.52 10,856½ 4 " " 28.9.52 8„882¼ 5 " " 2.ll.52 11,204 4 " " 30.11.52 9,482¾ 5 " " 4.1.53 10,651¾ 116,010¼ The total hours permissible equal 2,640 per week (60 x 44) i.e. 139,920 for the 53 weeks period above, whereas the hours actually worked totalled 1l6,010¾, a saving on the hours permissible of 23,90¼ The average number of hours worked per week was 2,189. TABLE 41 HOME HELP SERVICE TABULATION OF CASES, 1952 Illness or other cause for which help provided Period of service provided Under 1 week 1-2 weeks 2-3 weeks 3 - 4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Total Maternity 1 38 — - 4 - - — 43 Tuberculosis 3 2 2 — 7 5 3 12 34 Cancer — - - 1 5 8 4 8 26 Old Age 9 8 8 15 65 44 48 272 469 Other Sickness 5 4 12 9 40 21 19 56 166 Totals 18 52 22 25 121 78 74 348 738 86 SANITARY SECTION This section of the report relating to sanitary circumstances, housing, food inspection and the general routine work of this section of the Department has been compiled by the Chief Sanitary Inspector, Mr. D.G. Tonkin, M.S.I.A. Changes amongst the personnel of the Inspectorate unfortunately continued. Messrs. White, Cole and Goffin commenced service with the Corporation during the year and Messrs. Hagedorn, Bloomfield and White left to take up appointments with other Authorities. Frequent changes in the staff do have an unsettling influence on policy (and of course show a reflection in the amount of work carried out), but in each case the Inspectors who left secured appointments on better terms than we were able to offer in East Ham. During the year a resumption was made in the programme for the clear— ance of unfit houses. In January representations were made with regard to a small area of 4 old houses at Dukes Head in Barking Road and 7 houses In the Park Road areas this latter may be said to have dealt with the last of the old 'courts' in the Town as some of the houses had no frontage to a made-up street. Later in the year, the Minister confirmed both Orders In their entirety. In December further representations were made in respect of Greenhill Grove area, comprising 13 dwellings and Colston Road area of 8 houses containing 24 separate tenements,, The Public Inquiry into objections received was not held by the end of the year. As previously, the Department carried out inspections of accommodation occupied by applicants for Council houses, and over 4,000 visits were paid for this purpose, and reports were supplied to the Housing Department. Work In connection with the Improvement of the preparation, handling and sale of foodstuffs continued to play a leading part in the programme of work carried out, and a solid start was made in the formation of the Food Hygiene Guild; and by the end of the year well over 200 applications for membership were received from traders in practically all branches of the food trade. The Inspection of houses arising out of complaints from tenants, continues to occupy the bulk of the Inspector's time. Fortunately the number of complaints received showed a decrease of 236 compared with 1951. (2638 2874) as with the staff depleted for long periods it became even more difficult to ensure that the necessary repairs were carried out. The number of preliminary or intimation notices served showed little change from last year (2270 - 2286) 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 31,367 (1) Housing Under Public Health Act 6,827 Re-inspect ions 14,600 Housing Act, 1936 4,l63 (11) Sanitary Circumstances Yards, passages and stables 131 Drainage and sanitary accommodation 1,962 Factories (excluding bakehouses) 147 Workplaces and outworkers 153 Caravans 8 Re offensive fumes 80 Miscellaneous 484 87 (iii) Food Supply Slaughterhouses - Dairies 2 Food premises 1,615 Bakehouses 59 Sampling 483 (iv) Infectious Disease - Visits 638 (v) Food Poisoning - Visits 15 (b) Notices The number of notices served during the year totalled 2,836 of which 593 were statutory notices. The number of notices complied with in the same period was 2718. Complaints made to the Department with regard to sanitary circumstances, disrepair, infestations, obstructed drains etc., totalled 2,638. (c) Rodent Control The number of complaints received in respect of rat and mice infestations totalled 281, and 299 premises were inspected in detail. There were no major infestations of rats, but war-damaged drains still continued to be a source of concern to the Department, and numerous tests of drains were carried out, the majority of these being in connection with rat infestationS. The co-operation of owners is usually readily forthcoming in connection with repair of damaged drains where rat infestations occur and the Department carried out most of this repair work on behalf of the owners. It was not necessary to serve any formal notices on owners or occupiers of premises under the Prevention of Damage by Pests Act 1951. The Rodent Operative made 3,059 visits and it is estimated that l,099 rats were destroyed. Treatment of the main sewers continued to be carried out under the direction of the Sewage Works Manager. (d) Disinfection and Disinfestation It was found necessary or desirable to disinfect rooms and their contents at 401 premiseso In addition 1,500 library books were disinfected. The use of the steam disinfector for disinfection of bedding was carried out on 108 days of the year. There was only one instance where a Certificate was presented to the Committee in respect of articles and premises being in such a filthy condition as to render their destruction necessary. Vermin (bugs) infestation of premises was slightly less than last years 133 premises against 142 were treated by the Department, but there is an increasing demand on the services of the Department in helping to eradicate other forms of infestation such as beetles, moths and flies. Help and advice is readily given in these matters. (e) Drainage There was a slight decrease in the number of complaints received in connection with choked or defective drains 648 against 689 in the previous year and the Departments Drain Cleaner was able to remove obstructions In most cases Examination tests by smoke, colour or water were carried out in 226 instances and the Department continued to test all new. drainage in connection with new houses built for the Corporation. The services of the Drain Cleaner have been made available during weekends, when it is surprising to note a number of cases where emergency calls are made on Saturday afternoons or Sundays, upon attendance by the Drain Cleaner revealed the fact that the drainage has in f act been choked for two to three days. (f) Fertilisers and Feeding Stuffs Act, 1926 Eleven samples were taken under this Act during the year, and three samples of fertilisers were found to be unsatisfactory. The Agricultural 88 Analyst reported as follows on these samples:- Fish Meal (Fertiliser) - Undesirably large deviation from figures in statutory statement Fish Meal (Fertiliser) - Below vendor's statutory statement. "Growmore" Fertiliser - Constituent parts not specifically described. It is now the practice to call the attention of the Inspector under the Act in the district where the product; is manufactured to any discrepancies, this procedure being in accordance with advice given by the Ministry of Agriculture and Fisheries. (g) Rag Flock and Other Filling Materials Act 1951 Owing to the late appointment of an approved Analyst under this Act, no samples were submitted for examination during the year but the premises using filling materials did receive visits of inspection which are included in the statistics given under the heading for Workplaces. There were 8 applications for Registration of Premises under the new Act and one application for Licence to Store Rag Flock. All the premises concerned were found to be satisfactory. (h) Pet Animals Act 1951 This was also a piece of new legislation, upon which report is made for the first time. 16 applications to keep a Pet Shop were received and after Inspection of the premises and in some cases the carrying out of minor alterations9 licences were issued. The Health Committee recommended that the Conditions of Licence as approved by the Association of Municipal Corporations be adopted for licensing in East Ham. The Act has proved very useful, affording a measure of control over this type of shop. (i) Factories, Workplaces and Outworkers An increase number of inspections (300 against 193 last year) was carried out of these premises, and It was found that generally conditions in them continued to improve, although It was necessary to draw the attention of occupiers to a few minor defects* The number of persons engaged as outworkers in the Borough remain at a fairly low level and It was not found necessary to prohibit any person from carrying out this work by reason of dirty or unwholesome premises* (j) Mosquito Control During the summer season a number of complaints were received from houses adjoining stream areas with regard to infestation of mosquitoes, and urgent attention was given to these matters. The usual systematic spraying of ditches and contiguous areas was carried out, but undoubtedly the position in regard to the question of nuisance from mosquitoes has considerably improved, compared with the position a few years back. (k) Places of Public Entertainment These premises continue to receive attention from the Department, and generally the position is found to be most satisfactory. (1) Rent and Mortgage Interest Restrictions Acts 1920-1939 There were 39 applications received from tenants for Certificates as to state of repair of houses. The practice is to inform Landlords that application for a Certificate has been received and unless the necessary work is carried out by the time the matter is reported to the Council, a Certificate will be issued* Actually 16 Certificates were issued during the year* In 2 cases no Certificate was issued by reason of the fact that the premises concerned were due for early demolition and the occupants rehoused* In the remaining cases the work was carried out. 89 (m) Legal Proceedings Legal proceedings were Instituted in the following instances:Public Health Act, 1936 Section 94 - Landlords failing to comply with Statutory Notices served 32 Food & Drugs Act, 1938 Section 3 - In respect of food not being of the nature, quality or substance demanded 4 Section 9 - In respect of unsound food 1 Explosives Act 1875 Sections 31 and 39 - Selling fireworks to children under the age of 13 years 2 HOUSING Housing Statistics I. Inspection of dwelling houses during the years:- (1) (a) Total number of dwelling-houses inspected for defects (under Public Health or Housing Acts) 11,628 (b) Number of Inspections made for the purpose 26,228 (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 48 (4) Number of dwelling-houses (exclusive of those referred to under preceding sub-heading) found not to be in all respects reasonably fit for human habitation 2,796 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 2,053 III. Action under Statutory Powers during the years:- (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936s:- (1) Number of dwelling houses in respect of which Notices were served requiring repairs - (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (i) By owners - (ii) By Local Authority In default of owners - (b) Proceedings under Public Health Actss:- (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 593 (2) Number of dwelling houses in which defects were remedied after service of formal notices:- (i) By owners 665 (ii) By Local Authority in default of owners (c) Proceedings under Section 11 and 13 of the Housing Act 1936:- (1) Number of dwelling houses in respect of which Demolition Orders were made - (2) Number of dwelling houses demolished in pursuance of Demolition Orders - (d) Proceedings under Section 12 of the Housing Act 1936s :- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made - 90 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room haying been rendered fit - IV. Visits in connection with housing circumstances of applicants for rehousing 4,069 REHOUSING STATISTICS Position at 31st December. 1952 The following statistics have been supplied by the Council's Chief Housing Officer, Mr. J.E. Austin, M.B.E. 1. Accommodation made available family units:- (i) By repair of war damage 6,233 + (ii) By requisitioned premises Q. 1,283 (iii) By new housing (including 503 cost of works rebuilds and 7 additional units under the Housing Act 1949) 2,246 9,762 +This figure includes 3,307 houses classified Cb (War Damage) and rebuilt by Local Authority. 2. Families rehoused since August, 1945 3,980 3. Cases of overcrowding under Housing Act, 1936 abated by rehousing since August, 1945 (Included in 2) 975 4. Total of current applications for rehousing 8,554 5. New housings:- Dwellings Projected Under Construction Completed Temporary + 915 - + 915 Permanent 2,552 355 821 Cost-of-Works Rebuilds ø 537 12 503 Housing Act, 7 - 7 4,011 367 2,246 ø After adjustment by Primary Education Plan + 19 Bungalows deleted from total of 934 and sites being redeveloped for permanent housing. INSPECTION AND SUPERVISION OF FOOD (a) Milk Supply - The number of milk distributors registered at the close of the year was 141 and the number of dairies ll. The following licences were issued to use special designations prescribed in the Milk (Special Designation) Regulations 1949-50:Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations: Pasteurised: Dealer's Licence 102 Supplementary Licence 12 Dealer's (Pasteuriser's Licence) 2 Tuberculin Tested 1 Sterilised: Dealer's Licence 128 Supplementary Licence 12 Dealer's (Steriliser's) Licence 2 Milk (Special Designation)(Raw Milk) Regulations:- Tuberculin Tested Dealer's Licence 22 Supplementary Licence 11 Milk samples submitted for bacteriological examination are summarised as follows:- Unsatisfactory Pasteurised 67 - Sterilised 16 - T.T. Pasteurised 5 2 2 The two unsatisfactory samples failed to satisfy the Phosphatase test. Investigations of records at dairies and repeat samples showed that pasteurising plants were working efficiently. 91 (b) Meat and Other Foods (i) Meat Inspection Conditions in butchers' premises generally continued to show an improvement and it was found that traders are most receptive to suggestions put forward by the Inspectors for the more hygienic handling of their commodities, but it is a matter for regret that the transport and handling of meat, before it reaches the butchers premises, still leaves much to be desired. The attention of the appropriate authority is called to any instances of unhygienic handling and transport that come to the notice of the Inspectors. During the year the attention of the Ministry of Food was called to an excessive amount of meat that was condemned as being unfit for human consumption during the particularly warm period, and which appeared to have been delayed in transport. (ii) Food Premises Included among the visits to food premises there were 32 visits to dairies, 59 to bakehouses and .1,615 to other food premises. All these figures show a slight increase in the figures for the previous year. There are two very large dairies and bottling establishments situated in the borough, from which hundreds of thousands of bottles or cartons of milk are sent weekly. Many of these are retailed in other districts, and it is an indication of the care that is taken at these dairies, that very few complaints are received with respect either to the nature of the milk or the cleanliness of the containers. In fact such complaints as are received are usually the result of the unhygienic practice of previous users of the bottles. As stated earlier in this Report the Food Hygiene Guild was formed during the year, and it is pleasing to record that the large majority of applicants qualified for full membership of the Guild and were subsequently awarded an attractive certificate. The standards laid down as a condition of membership are capable of being attained in all, or nearly all, food premises, and in a large number of cases improvements were carried out to this end. It was not necessary to institute legal proceedings in any case to ensure compliance with the requirements of the Food and Drugs Act insofar as cleanliness was concerned, but a great deal of time was spent by the Inspectors in their endeavour to Improve the conditions at premises below Guild standard. (c) Slaughterhouses The one licensed slaughterhouse in the Borough was not in operation during the year. (d) Bacteriological Sampling During the year the following samples were submitted for examination:- Ice Cream - 40 Milk - 88 Drinking Water - 1 Baths water - 9 Mussels - 1 Marshmallows - 1 Jellied Veal - 1 Two samples of Tuberculin Tested Pasteurised milk failed to satisfy the Phosphatase Test and Ice cream samples were graded as follows :- Grade 1-25. Grade II - 12. Grade III - 2. Grade IV - 1 (Total 40) 92 The samples of drinking water and bath water were satisfactory; the sample of mussels contained excessive numbers of bacteria. The sample of marshmallows was stale. The sample of jellied veal was satisfactory. (e) Ice Cream As will be seen from the figures quoted above the proportion of Grade 1 Ice-cream (25 out of 40) shows an improvement over the previous year. 22 premises remain on the Register for the manufacture of Ice-cream9 and particular attention is paid to these premises. In all cases It is found that the occupiers are very responsive to suggestions made to them for the improvement of their premises. There were 16 new applications for the registration of premises for the sale of ice-cream during the year and at the end of the year 254 premises remained on the register for the sale of ice-cream. (f) Other Foods The services of householders and shopkeepers alike were often sought with respect to the condition of various foodstuffs, which generally continued to be of a good quality. Particular attention was paid to one itinerant trader trading from a lorry in a piece of waste ground, and a large number of tins of fruit of doubtful quality were surrendered by him. The following foodstuffs were surrendered and certified as unfit for human consumption:- 5,836 tins, comprising- Milk-322; Fish 155; Fruit 2,830; Meat 910. + Ham 108; Other foods 1,511. and Meat-nearly 4,000 lbs. Fruit-370 lbs; Fish-57 st.; Confectionery-786 lbs. Cheese-36 lbs. and various quantities of 12 other foods. + A number of these were very large tins of the total weight of 1,148 lbs. There was one prosecution against a trader for unsound food (one loaf of bread) and a fine of £15 was imposed. 93 Food and Drugs Act Sampling During the year 328 samples were submitted for analysis in accordance with the following table:- TABLE 42 Samples Number of Samples Percentage of samples adulterated Examined Found adulterated or below standard Butter 1 - - Tea 1 - - Coffee 1 - - Confectionery 4 - - Jam and Marmalade 7 - - Milk 82 - - Sausage 52 8 15.2 Vinegar 4 - - Wine and Spirits 15 - - Drugs 16 - - Other Articles 145 5 3.4 Totals 328 13 - Details of samples not satisfactory, together with action taken, are as follows:- TABLE 43 Number Informal or formal Article Adulteration or Deficiency Action taken 6719 Inf. Thyme Amount of sand 4.4% 1.4% above normal Stock withdrawn from sale. 6873 Inf. Chopped Suet Fat 75% Deficient to extent of 8% Unable to obtain formal sample 6940 Inf. Tea Cake Mixture Mis-statement re Benzoic Acid Referred to Islington B.C. 6996 Inf. Tea Cake Mixture 270 pts per Million Benzoic Acid present in small packets. -ditto- 7008 Inf. Orange Curd Mould growth on paper disc., also on curd near the sides of jar. Out of condition and no longer suitable for human consumption Stock withdrawn from sale. 6723 Formal Pork Sausage Meat 57%. Deficient to extent of 8% Prosecution Fine. 6728 Inf. Pork Sausage Meat 48%. Deficient to extent of 17% Formal sample taken 6771 Formal Pork Sausage Meat 53%o Deficient to extent of 12% Prosecution Dismissed on payment of costs 6772 Formal Pork Sausage Meat 60%. Deficient to extent of 5% Further sample taken. (genuine) 6795 Inf. Pork Sausage Meat 50%. Deficient to extent of 15% Formal sample taken. 6855 Inf. Pork Sausage Meat Meat 58%. Deficient to extent of 7% Formal sample taken. 6877 Formal Pork Sausage Meat Meat 51%. Deficient to extent of 14% Prosecution. Fine 6913 Formal Pork Sausage. Meat 40%. Deficient to extent of 25% Prosecution. Fine 94 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 follows:- Number of shops in the Borough subject to the Act 2,055 „ „ „ „ „ „ open 1,959 „ „ „ „ „ „ closed 96 „ „ „ with change of occupier 168 Number of assistants employed:- Males 1,090 Females 1,784 Young Persons-Males 84 Females 142 Total 3,100 Visits-Shops Register 1,773 - Arrangements for health and comfort of Shop workers, Records etc 890 Visits and observations-Closing Hours 1,175 Visits-Holiday Closing 468 - Late Night Closing 1,130 Total 5,436 It was necessary to caution shopkeepers on some 58 occasions for serving customers after hours, although the vast majority complied with the provisions of the Act respecting Closing Hours. This shows a decrease of 33 compared with the previous year, but it was not found necessary to prosecute any trader for persistently offending in this direction during the year. The direction of the Home Office with regard to winter closing hours was in operation until the 20th 0ctober, 1952. 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 175 (159 renewals and 16 new applications). 366 inspections were made in the enforcement of this Act. EXPLOSIVES ACT 1875 145 Licences (118 renewals and 27 new applications) were issued for the storage of mixed explosives (fireworks). Inspections of premises used for this purpose totalled 215. One retailer was prosecuted for serving fireworks to a child under 13 years of age and a fine was imposed. 95 COUNTY BOROUGH OF EAST HAMEDUCATION COMMITTEE TO THE CHAIRMAN AND MEMBERS OF THE EUDCATION COMMITTEE. Mr. Chairman, Ladies and Gentlemen, The year has been one pointing considerable progress in the various activities of the School Health Service. After protracted negotiations agreement has been reached with the Regional Hospital Board on the conduct of the Specialist Clinics which under the new arrangements continue to be held in Local Authority premises whilst served by the Board's Consultants. In theory, the clinics can be regarded as extensions of the hospitals out-patients departments, whilst in practice the 'priority groups' they serve retain the advantages and privilege of not having to attend the various hospitals to obtain consultation and a good deal of specialist treatment. The premises, services and non-medical staff are provided by the Council, and the professional staff and equipment by the Regional Hospital Board. The day-to-day administration rests with the School Medical Officer, and such periodic statistics and reports as are required, are rendered to the Board's officers. With the expanded school population It is hoped to extend the scope of the Ophthalmic Clinic by the introduction of an associated Orthoptic Clinic, for it is known that many of our children wait long periods before treatment for squint can be commenced In the orthoptic clinics attached to the hospitals. In like manner expansion of the Ear, Nose & Throat Clinic is envisaged to cope with the steady flow of referrals including those schoolchildren found to need further investigation after surveys by the Group Audiometric team. The influx of children into the schools concomitant with the post-war rise in the birth rate, has made it increasingly difficult with the available staff, to carry out the routine medical Inspections required under the Education Act and the Council's regulations. Consideration will have to be given to the proposal to omit one of the routine inspections,, It is possible the 'fit for entry to school' examination could be organized to take the place of that carried out soon after admission to school. This would have several distinct advantages to the pupils a number of whom have not had a medical 'check-up' for several years, and save doctors, parents' and schooling time by merging the two examinations, which in most instances are held within a short time of each other. In my opinion the 'fitness for school' examination should be most searching and comprehensive, and should enquire not only into the physical state of the child but ensure the normality of speech, hearing, vision, mental condition and locomotion. Detractors of the school health service should take heed of the part played in the fight against tuberculosis. Every care is taken to protect the children against Infection by annual X-ray of all persons, teachers and others, who come in contact with the scholars in the schools. Known 'pupil contacts' are segregated whenever deemed necessary by the Consultant to the Chest Clinic and offered B.C.G. vaccination when practicable. Should infection with tuberculosis manifest itself in a child or member of the staff, 96 all contacts are investigated, and when any considerable number is involved the aid of Mass Radiography is invoked. The Medical Research Council's trials in B.C.G. with school leavers is continuing, and an extension of the use of this prophylactic vaccination can be envisaged in the near future. The increased help given by the Child Guidance Clinic to the school medical staff in the ascertainment of handicapped pupils has resulted in the weeding out of a number of maladjusted children, and their placement in appropriate residential schools or elsewhere has proved one of our biggest tasks. Discriminatory select-ion by school governing bodies against admission of all but the most manageable type of child together with the high cost of maintenance and surveillance by the Council's officers have led me to ponder the need for placement on a regional basis. For it can never be wholly satisfactory to rely on surveillance and report by officers of a distant Local Education Authority or Children's Committee. The Essex Education Authorities should pool their resources and finances to solve the problem of placement of handicapped pupils, for the expense involved by the present methods of dealing with such children is unwarranted and insupportable. The need also for additional 'special classes' in ordinary schools for E.S.N. pupils has been demonstrated by more painstaking ascertainment than has been possible hitherto. The desirability of retaining pupils not so seriously retarded within the schools is generally acknowledged, for such children often value the company of other scholars who live in their neighbourhood and benefit also from the support of home life. Reference must be made to the extension of the Church Road Clinic designed to include two more dental surgeries. This additional accommodation would enable us to employ another dental surgeon to reinforce this greatly depleted service. Many hundreds of children await dental treatment and only the most urgent cases can be dealt with by the existing staff. Routine dental inspections in the schools cannot be undertaken and evening sessional work will have to be resorted to in an effort to deal with the outstanding work. Years of neglect have resulted in the truly appalling 'dental state' of our schoolchildren, for it is believed that three out of four schoolchildren require dental treatment and the condition often will have advanced to serious decay before the necessary measures can be undertaken. But in spite of difficulties, staff shortages, and financial stringency, a year of progress in the school health service has been experienced. This would not have been possible without the support of the Chairman and members of the Education Committee and the Chairman of the Care and Welfare Committee whose valued constructive criticism and deep interest in every aspect of the work was a constant stimulus to all the officers. I owe a great deal to Dr. D.E. Cullington whose penetrating insight into the various problems which confronted us during the year played no small part in the smooth running and efficiency of the school health service. Our best wishes go to him for happiness and success in his new post of Medical Officer of Health to the Borough of Barking. May I conclude with sincere thanks to all those members of the Education Committee whose energy and wisdom have given this borough education services of the highest order, and express thanks and gratitude to the Chief Education Officer, his staff and the Head Teachers of all schools, for for their ready and willing co-operation at all times. 97 Lastly to all members of my own staff I would say thank you for unswerving loyalty and industry throughout the year. I have the honour to be, Ladies and Gentlemen, Your obedient servant, J.S. COLEMAN. School Medical Officer. 98 GENERAL INFORMATION The average number on the school rolls during the year was 16,655 made up as follows:- Type of School Number of Schools Average number on Roll County Primary: Infant 17 ) 10,965 Junior 15 ) County Secondary 11 4,790 Voluntary (Infant and Junior) 4 900 Totals 44 16,655 + 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 1952, and shows the comparative statistics for previous years. 1948 1949 1950 1951 1952 Routine and Special Inspections at SChOOl 6,873 8,603 7,196 8,016 7,300 Re-inspections at School 2,675 3,142 2,436 2,906 2,510 Inspections and Re-inspections at Clinics 10,748 9,686 10,369 8,676 7,831 Examinations for cleanliness 38,561 42,040 37,569 39,868 41,392 Nurses' visits to homes 3,691 8,012 4,496 4,156 3,123 ROUTINE INSPECTIONS IN SCHOOLS. A. Routine 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 47 to 52). 99 MEDICAL INSPECTION AND RE-INSPECTION AT SCHOOLS TABLE.44 School Infant Junior Secondary I R S I R S I R S (a) County Primary & Secondary Schools Altmore 233 207 - - - - — - - Avenue 197 23 - - — - — — — Brampton 160 33 2 273 102 - 229 100 - Burges Manor - - - - - - 263 113 3 Central Park ao 137 41 2 - - - 269 69 - Cornwell - - - - - - 192 - - Dersingham 144 35 - - - - - - - Essex 41 - - - - - 151 - 6 Hartley 239 50 5 417 210 2 - - - Kensington 72 21 - 271 131 - - - - Lathom - - - 340 160 1 - - - Monega 119 30 - - - - 209 80 - Napier 148 49 - - - - 306 75 - Roman Road - - - - - - - - - St. Stephens 184 28 - - — — — — — Salisbury 82 23 4 445 95 1 — - — Sandringham 78 23 - — - - 204 — 4 Shaftesbury - - - 464 178 - - — — Storey Street 30 - - 14 - 2 - - - Vicarage 136 70 - 310 114 1 - - - Winsor - - - - - - - - - Boys' Grammar - - - - - - 272 85 4 Girls' Grammar - — — - - — 74 159 15 Technical School of Building - - - - - - 32 19 — (b) Voluntary Schools (R.C.) St. Edward's 76 40 - 128 56 3 - - - St. Michael's 36 18 - 76 31 - - - - St. Winefride's 62 11 - 82 28 - - - - Silvertown - - - - - - - - - (c) Independent Schools: The Maude Wells Schools 28 - - 15 3 2 5 - - 2,202 702 13 2,835 1,108 12 2,206 700 32 I.-Periodic inspection, R. - Re-Inspection. S.-Special inspection B. Routine Dental Inspections Since June some dental inspection was possible in the schools. 4,907 children were inspected and 4,307 scholars were found to need treatment. Of this number 3,546 were referred to the Council's dental clinics. These figures illustrate the serious results which followed the flight of dental surgeons from the service of local authorities following the introduction of the National Health Service Act. The harm done to the teeth of a large number of children cannot be repaired, but a similar catastrophe can be prevented by the assiduous preservation of 'priority groups' for dental services in our community. In view of the small possibility of regular overhaul many of our younger scholars are likely to have had, the value of dental inspection at the present time is greatly enhanced. 100 C. Audiometric Surveys Group testing of the hearing of children in their last year at primary school has continued during the year. 1,797 were tested and of these 121 were referred for further investigation* Of 354 who failed the first test, 233 passed on an immediate re-test, indicating that the failure was due to some cause other than a defect of hearing. Details of cases referred for examination by the specialist are Included in the report of the Ear, Nose and Throat Clinic. D. Cleanliness Inspections Health visitors attend every school once in each term in order to examine the children for cleanliness and infestation. 41,392 such examinations were carried out during the year, and as a result 608 were found to be harbouring nits or head lice. The Infestation rate of 1.4% compares favourably with that in some other areas, but at the same time warns against complacency. The health visitors undertook the task of personal instruction of the parent in the-necessary hygienic measures for the eradication of head lice and nits and the prevention of spread. If needed all infested members of the same family were given the necessary medicaments and instructions and only on rare occasions was full co-operation not achieved. The sanitary inspectors carried out such measures of disinfestation in the home that were occasionally indicated, and sterilization of clothing and bed linen etc. is done in a steam disinfector at very small cost. No prosecution or threat of salutory action has been necessary and it has been found to be uneconomic to maintain a cleansing centre. SCHOOL HEALTH CLINICS Minor Ailment Clinics These clinics remain as valuable assets to the School Health Service* In addition to the function of giving treatment to numerous minor ailments, preliminary diagnosis of a variety of more serious conditions is often made and referral to hospital or specialist clinic is then undertaken* There has been a marked fall in attendance at these clinics which might indicate an all-round improvement in physique and resistance to illness in the rising generat-ion. School meals, school milk and improved hygiene in a number of schools, together with full employment and the benefits of the Welfare State to the working classes, may also be contributory factors to an all-round improvement in the nutrition of the children* These clinics can be regarded as the 'out-patient departments' of the School Health Service, and the more experienced the doctors and health visitors who serve them, the greater the value to the scholars and the community. Total attendances at School (Minor Ailment) Clinics during 1952 were as followss:- Central (Town Hall Annexe) 4,727 Manor Park (Church Road) 3,141 North Woolwich (Fernhill St. Baths) 197 Roman Manor (Community Centre) 263 Total 8,328 101 Dental Clinics Dr. Allan Ross, Senior Dental Officer, submits the following report "I have the honour to present my report on the work carried out in the Dental Clinics during the year 1952. During the year under review, the dental staff consisted of two fulltime Dental Officers and one Oral Hygienist. Some intermittent parttime help was obtained, but it was not as beneficial as had been hoped. It is now felt that if the authorised establishment cannot be filled it is preferable to ask for additional evening work from the existing fulltime staff. Steps were taken towards the end of the year to put this into effect. The number of routine inspections at school reached what is hoped will be the lowest ever figure and as this report is written there is already evidence that this is indeed so. In this County Borough we are fortunate in having the full co-operation of our medical colleagues who refer a large number of cases to us. In this way all the urgent cases are treated and this is reflected in the very high number of special inspections. Thus, it must be emphasized that a large number of the special inspections are not cases requiring urgent treatment for the relief of pain, but cases that obviously require dental treatment when seen at routine medical insepctions. These cases often require many visits. The X-ray apparatus was installed during the year and it has proved of inestimable value. The number of conservations especially in the deciduous teeth has greatly increased as compared with the previous yearQ The number of permanent extractions Is also greater0 These figures reflect a very difficult year of transition when an entirely new staff were attempting to grapple with a huge problem. It is anticipated that these rather abnormal figures will settle down to something more normal in subsequent yearso. 1952 will probably stand out as one of the most anxious years in the story of the dental services for the borough. We were fortunate to appoint Dr. Ross, an energetic and skilled dental surgeon, to the post of School Dental Officer, and immediately great difficulty was experienced in finding a suitable dentist to fill .the remaining vacancy. An appeal was made to the local dental committee for dental practitioners to come Into the Council's clinics on a sessional basis, but this met with no response as most of the local dentists were far too busy with their own practices;. Repeated advertisement in the dental journals also yielded no results, for the only dentists available were over agep or coloured men who were seeking dental experience before returning to Africa, India or the West Indies. Meanwhile the two available staff and such temporary help as could be procured from time to time, carried on a skeleton service mainly for the most urgent dental cases, and a huge waiting list of about 1000 cases piled up with little hope for many of them ever being attended to at our clinics. It Is possible evening sessions for dental work may alleviate somewhat this disturbing situation, for there is little possibility of recruitment to our dental staff at the present time. 102 Immunisation Clinics. Immunisation clinic 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 101 Number of children completely immunised 1,022 Number of children re-inoculated 450 Percentage of children of school age completely immunised 71.8 Physiotherapy Clinics The physiotherapy clinics continue to fill a big gap in the hospital services. It is well recognized that the waiting time before the commencement of treatment in hospital physiotherapy clinics can be many weeks, and for this reason alone many consultants refer back for treatment in our clinics a number of children seen in hospital 'out patients'. A full range of equipment is maintained and local and general ultraviolet light is also available to selected cases. I consider an enormous amount of good comes out of the efforts of the two highly skilled physiotherapists who serve this department. Asthmatics and sufferers from a variety of chest diseases derive considerable benefit from breathing exercises, postural and remedial drills, and many faults of posture are prevented from developing into fixed deformities by early recognition and treatment. Attendances - Town Hall Annexe 2,500 Manor Park 1,138 Treatment given:- Patients Treatments Sunlight - local and general 146 1,859 Remedial exercises 257 2,859 Electrical and massage 36 471 Child Guidance Clinic Statistics. Number of sessions worked:- Dr. H. Bevan Jones (Psychiatrist) 88 Dr. E. Huband (Psychiatrist) 90 Miss K. Daunton (Child Therapist) 120 The Educational Psychologist and Psychiatric Social Worker are full-time members of the staff. Number of attendances at Clinic (parents and children:- Psychiatrists and Child Therapist 857 Educational Psychologist 680 Psychiatric Social Worker 691 Analysis of Cases New cases referred 168 New cases seen by Psychiatrists 112 New cases seen by Educational Psychologist 135 New cases seen by Psychiatric Social Worker 116 Cases waiting to be seen 119 Cases discharged 116 103 The number of new cases seen includes many cases referred to the clinic in 1950-51. Visits School visits made by Psychologist 97 School visits made by Psychiatric Social Worker 12 Home visits made by Psychologist 10 Home visits made by Psychiatric Social Worker 48 Mrs. J.F. Stevens, Educational Psychologist, submits the following observations:- "It has been possible this year to enlist the help of the Health Visitor for some of the home visits which would normally be made by the Psychiatric Social Worker. This has proved most effective and is of benefit to both services. The proportion of unco-operative parents has been considerably reduced over the past year, although it appears inevitable that a small-proportion of parents will never be willing for our help. Many of our parents are apprehensive on first attending the clinic, thinking it to be a place for the insane or mentally defective, but it is usually possible to alleviate their anxieties about this in the first interview. With the spread of knowledge to the general public about the function of a Child Guidance Clinic, this attitude of parents is slowly being broken down. Staff This year we have been fortunate in having a full clinic team for the whole year which has made it possible for us to function at our maximum strength. Unfortunately It has not been possible for us to cope with our' long waiting lists of children and parents, but we hope that with increased staffing next year we will be able to reduce the waiting time considerably, and of course, deal with more families. Dr. Bevan Jones and Dr. Huband work two psychiatric sessions a week each. Mrs. J.F. Stevens, Educational Psychologist, is in charge, assisted by Mrs„ Mills, the Psychiatric Social Worker, and Miss Daunton, the Child Therapist, who conducts four sessions weekly." Speech Therapy Clinic Miss P.N. Glover, Speech Therapist, has submitted the following report:- "During the year 1952 the Speech Therapy Clinic was in the charge of Miss Elizabeth Westley who very kindly took over the case load during my leave of absence period. There were 76 new cases referred in 1952 and altogether 90 children were attending for treatment. There were several cases referred with only slight speech defects, these were given a preliminary examination and then kept under observation being seen every three or four months, during which time the speech defect often cleared up successfully without the child having actually received any intensive treatment. Many of the old cases were released gradually, being given first fortnightly and then monthly treatment according to the progress they had made. This procedure is most advisable with cases of stammering, when the children often come to rely on the help of the clinic so 104 completely that a too sudden ceasation of treatment might easily result in a temporary set back. There were no cases of cleft palate treated in 1952, and the majority of children were referred for treatment for Dyslalia. This term includes giving exercises for almost any defect of articulation whether it is a simple lisp or a completely meaningless jargon. There were only four cases who refused treatment, the parent's explanation was generally along the lines that they felt they could give their children any help that was necessary at home or else that they considered the defect so slight that they would rather not take up the therapist's valuable time when another child might be benefitting from her attention. The Speech Clinic had no new equipment during my absence in 1952, and it is hoped that at some future date we shall be fortunate enough to acquire a gramophone and recording apparatus which would be invaluable t us in our work." Statistics:- Number of cases referred 76 Number of cases treated 90 Attendances for treatment 1,821 Ophthalmic Clinic Mr. R.A. Morris, Ophthalmic Surgeon, attends at the Town Hall Annexe three sessions per week. Statistics are as fallows:- Number of clinic sessions 148 Number of children attending 1,515 Number of attendances 3,128 Defective Vision and Squint Eye Disease New cases 317 Treated at clinic 134 Re-examinations 1,342 Referred to hospital 11 Glasses prescribed 856 Glasses obtained 856 Glasses not required 92 Referred to hospital 45 The following cases were referred to hospital for treatment:- High Myopia 1 Cataract and Opacities 2 Squint 43 Cyst 2 Other conditions for investigation 8 Total 56 Ear, Nose and Throat Clinic The following are the statistical details:- Number of clinic sessions 87 Number of children attending 837 Number of attendances 1,460 105 Defects and Treatment:- TABLE 45 Defect Number observed Number treated Referred for operation Tonsils and Adenoids 523 272 251 Other throat conditions 127 127 - Defective Hearing 139 139 - Otitis Media and discharging ears 50 50 - Other ear conditions 58 53 5 Nasal deformities 9 9 — Rhinitis 16 16 - Catarrh 25 25 - Other nose conditions 33 33 — Totals 980 724 256 Of the cases referred for operative treatment, 251 were for the removal of tonsils and adenoids, one for removal of a polypus in the ear, and four for mastoidectomy. Included in the above statistcs, the following relate to cases referred for investigation following failure in speech audiometer tests in school:- Number of children examined 253 Number of attendances 490 Discharged as not requiring treatment 146 Treated 107 Home Visiting Home visits made by health visitors and school nurses during the year numbered 3,l23. These visits were for the purposes detailed In my report for 1951. Handicapped Pupils It is pleasing to report that during the year Dr.F. Gaskell, Assistant Medical Officer, was approved by the Ministry for the ascertainment of handicapped pupils. This work is now shared by my Deputy and myself and three Assistant Medical Officers. 118 special examinations were carried out during the year and recommendations for special educational treatment were made in respect of 72 children as follows:- TABLE 46 Category Number ascertained. Recommendation Ordinary School with special treatment Day Special School Boarding Special School Blind 1 - - 1 Partially Sighted 1 — 1 - Deaf 1 — 1 - Partially Deaf 1 - — 1 Delicate 11 — 2 9 Educationally sub-normal 31 14 14 3 Epileptic - - - - Maladjusted 14 — — 14 Physically Handicapped 10 - 3 6 Suffering from Speech Defect 76 76 - — E.S.N. and Maladjusted 1 — — 1 Delicate and Maladjusted 1 — - 1 106 + 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, One child ascertained as Physically Handicapped was recommended for home tuition. Nine cases were found to be subject to be dealt with under the provisions of Section 57 of the Act:- Recommended for report to the Mental Health Committee under the provisions of: Section 57 (3) (Ineducable) 3 Section 57 (5) (Requiring supervision after leaving school) 6 107 STATISTICAL APPENDIX MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS PERIODIC MEDICAL INSPECTIONS Number of Inspections in the prescribed Groups: Entrants 2,202 Second age group 1,206 Third age group 1,284 Total 4,692 Number of other Periodic Inspections 2,551 Grand Total 7,243 OTHER INSPECTIONS Number of Special Inspections Number of Re-inspections 5,761 4,637 Total 10,398 TABLE 47 Group For defective vision (excluding squint) For any of the other conditions recorded in Table 48 Total individual pupils Entrants 34 433 460 Second age group 121 148 250 Third age group 161 110 261 Total (prescribed groups) 316 691 971 Other periodic inspections 233 333 537 Grand Total 549 1,024 1,508 PUPILS FOUND TO REQUIRE TREATMENT Number of individual pupils found at periodic medical inspections to require treatment (excluding dental diseases and infestation with vermin): 108 RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER, 1952 TABLE 48 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 Ski11 90 32 171 44 Eyes- a. Vision 549 94 601 76 b. Squint 109 20 129 27 c. Other 40 24 150 27 Ears- a. Hearing 21 15 48 14 b. Otitis Media 16 14 11 1 c. Other 46 11 97 26 Nose or Throat 270 487 530 353 Speech 26 58 54 57 Cervical Glands 9 138 14 73 Heart and Circulation 12 41 21 33 Lungs 35 62 19 31 Developmental- a. Hernia 5 5 3 4 b. Other 17 37 11 9 Orthopaedic- a. Posture 56 45 35 48 b. Flat Foot 75 53 101 43 c. Other 117 138 105 111 Nervous system- a. Epilepsy 5 4 8 4 b. Other 17 38 32 20 Psychological- a. Development 13 17 2 17 b. Stability 18 14 40 9 Other 173 165 1067 184 CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS TABLE 49 Age Groups Number of Pupils Inspected A (Good) B (Fair) C (Poor) No. % No. % NO. % Entrants 2,202 1,703 77.3 492 22.4 7 0.3 Second age group 1,206 868 72.0 329 27.3 9 0.7 Third age group 1,284 975 75.9 301 23.5 8 O.6 Other Periodic Inspections 2,551 1,926 75.5 621 24.3 4 0.2 Totals 7,243 5,472 75.6 1,743 24.1 28 0.3 109 TABLE 50 TREATMENT TABLES GROUP l.- DISEASES OF THE SKIN (excluding Uncleanliness) Number of Cases treated or under treatment during the year By the Authority Otherwise Ringworm - (i) Scalp - - (ii) Body 2 3 Scabies — - Impetigo 6 1 Other skin diseases 322 171 Total 330 175 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 85 134 Errors of Refraction (including Squint) - 1,380 Total 85 1,514 Number of Pupils for whom spectacles were: (a) Prescribed 856 (b) Obtained 856 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 - 10 (b) for adenoids and chronic tonsillitis - 559 (c) for other nose and throat conditions - 1 Received other forms of treatment 158 768 Total 158 1,338 GROUP 4.- ORTHOPAEDIC AND POSTURAL DEFECTS (a) Number treated as in-patients in Hospitals 6 (b) Number treated otherwise, e.g. in clinics or out-patients departments By the Authority Otherwise 183 296 110 TABLE 51 DENTAL INSPECTION AND TREATMENT (1) Number of pupils Inspected by the Authority»s Dental Officers;- (a) Periodic age groups 2,164 ( b ) Sp ecials a a ao oo o .» o • oo & a .oo e » oo 2,743 Total 4,907 4,307 (3) Number referred for treatment 0o o. ». ». .»« 3,546 3,556 (5) Attendances made by pupils for treatment .. 9,601 (6) Half-days devoted to:- 23 933 Total 956 (7) Fillings: Permanent teefch B0 1,819 1.072 Total 2,891 (8) Numher of teeth filled: 1,719 1,052 Total 2,771 (9) Extractions: 983 4.913 Total 5,896 (10} Administration of general anaesthetics for extraction 1,950 (11) Other Operations: 845 ~B53 Total 1.728 GROUP 5.- CHILD GUIDANCE TREATMENT Number of Cases Treated In the Authority's Child Guidance Clinics Elsewhere Number of pupils treated at Child Guidance CliniCS 236 3 GROUP 6.- SPEECH THERAY Number of Cases Treated By the Authority Otherwise Number of pupils treated by Speech Therapists 90 4 GROUP 7.- OTHER TREATMENT GIVEN Number of Cases Treated By the Authority Otherwise (a) Miscellaneous Minor Ailments 277 33 (b) Other 1. General debility 645 40 2. Disease of the digestive system 45 21 3. Disease of the nervous system 32 13 4. Disease of the respiratory system 66 69 5. Other Conditions 86 39 Total 1,151 215 1ll TABLE 52 INFESTATION WITH VERMIN (i) Total number of examinations in the schools by the school nurses or other authorised persons 41,392 (ii) Total number of individual pupils found to be infested 608 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 13 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) - E0H.C. E.6.