LEY 30 Borough of Leyton. HEALTH REPORT FOR THE YEAR 1935. ANDREW W. FORREST, M.A., M.D., Ch.B., D.P.H., Medical Officer of Health, School Medical Officer, :: Medical Superintendent of Isolation Hospital. :: Borough of Leyton. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, SCHOOL MEDICAL OFFICER, AND MEDICAL SUPERINTENDENT OF THE ISOLATION HOSPITAL FOR THE YEAR 1935. 2 HIS WORSHIP THE MAYOR (Mr. Alderman Turner. J.P.), ex-officio Member of Committees. PUBLIC HEALTH COMMITTEE: DISEASES OF ANIMALS ACT COMMITTEE. Chairman : Alderman Shimmin, B.Sc. Members : Alderman Bechervatse. Councillor Mrs. Hammond. „ Read, J.P. ,, Hawkins. „ Russell. J.P. ,, Hinton. Councillor Barber „ Hurry. „ Bass. „ Mrs. Mawer. „ Biles. „ Rayner. „ Cochrane. „ Mrs. Read, M.B.E. „ Mrs. Crown. ,, Rigg. ,, Gowar. ,, Mrs. Shimmin. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs. Shimmin. Members: Alderman Bechervatse. Councillor Peck. „ Read, J.P. ,, Mrs. Hammond. ,, Russell, J.P. ,, Hawkins. Councillor Bussey ,, Mrs. Mawer. „ Mrs. Crown. „ Mrs. Read, M.B.E. ,, Gowar. Co-opted Members : Mrs. Cochrane. Mrs. Smith. ,, King. „ Waller. „ Peck. EDUCATION COMMITTEE. Chairman : Alderman Bechervatse. Members : Alderman Allanson, J.P. Councillor Hawkins. ,, Fitzoerald. „ Hinton. „ Russell, J.P. ,, Hurry. „ Read, J.P. ,, Marlow „ .Shimmin, B.Sr. ,, Mrs. Mawer Councillor Bass. .. Mills. Bussey. „ Pearce. Cochrane. ,, Mrs. Read, M.B.E. Mrs. Hammond. „ Mrs. Shimmin. Co-opted Members : Or. Bricht. Mrs. Ringer. Mrs. Cochrane. ,, Waller. „ King. Mr. G. A. Grime. EDUCATION WELFARE SUB-COMMITTEE. Chairman : Councillor Mrs. Hammond. Members : Alderman Fitzoerald. Councillor Marlow. „ Russell, J.P. ,, Mrs. Shimmin. Councillor Bussey. Dr. Bright. ,. Cochrane. Mrs. Cochrane. Mrs. Hammond. ,, Ringer. Hinton. „ Waller. „ Hurry, Mr, G, A, Grime. 3 Borough of Leyton. PUBLIC HEALTH STAFF. MEDICAL OFFICERS— Whole Time : *Forrest, Andrew W., MA., M.D., M.B., Ch.B., D.P.H., Medical Officer of Health, School Medical Officer, Medical Superintendent of Isolation Hospital. *Gavin, Frederick William, M.D.. M.B., Ch.B., D.I. H., Deputy Medical Officer of Health and Deputy School Medical Officer. *Menzies, Hilda F., M.D., M.B., Ch.B., D.P.H., Assistant Medical Officer of Health (Maternity and Child Welfare). *Gilchrist, Mary Lyle, M.D., M.B., Ch. B., Assistant Medical Officer of Health. Part Time : Kennedy, John, M.B., Ch.B. (Glasg.), Emergency Medical Attendant at Isolation Hospital. *Cardell, John Douglas Magor, M.B., B.S. (Lond.), F.R.C.S. (Eng.), M.R.C.S., L.R.C.P., School Oculist. *Howell, Bernard Whitchurch, M.B., B.S. (Lond.), F.R.C.S. (Eng.), M.R.C.S., L.R.C.P. (Lond.), Orthopaedic Surgeon. *Brews, Richard Alan, F.R.C.S. (Eng.), M.D. (Lond.), M.S., M.B., B.S.. M.R.C.P. (Lond.), .M.R.C.S. (Eng.), L.R.C.P. (Lond.), Consultant Obstetrician. VETERINARY INSPECTOR UNDER THE DISEASES OF ANIMALS ACT Scott, Eustace Edward, M.R.C.V.S. MATRON, ISOLATION HOSPITAL. Miss E. Ryan. DENTAL SURGEONS—Whole Time: *Horton, James Ernest, L.D.S., R.C.S. (Eng.) *Grant, David Reginald Brash, L.D.S., R.C.S. (Edin.) Sehool Dentists. Mr. Grant also does the dental work in connection with the Maternity and Child Welfare Scheme. SENIOR SANITARY INSPECTOR. *Gray, Edward Henry, Certificate R.S.I., Meat Inspector's Certificate R.S.I SANITARY INSPECTORS. *Steeden, Edward James, Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Smith, Victor Wynn, Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Reeves, Reginald Alfred, Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Turbitt, Wilfred, Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Reeve, Frederick William. Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Barnes, Arthur Edward, Certificate R.S.I., Meat Inspector's Certificate R.S.I. *Nightingale, A. G., Certificate R.S.I., Meat Inspector's Certificate R.S.I, (commenced 8 11.35). HEALTH VISITORS. *Bratton, Maud, Trained Nurse. *Walling, Ethel Winifred, S.C.M., Trained Nurse, Health Visitor's Certificate R.S.I. *Kittering, Margery, Trained Nurse, S.C.M., Health Visitor's Certificate R.S.I. *Sizer, Aones, Trained Nurse, S.C.M., Health Visitor's Certificate R.S.I. *Neale. Barbara, Trained Nurse, S.C.M.. Health Visitor's Certificate R.S.I. SCHOOL NURSES. *Crawford, Daisy, Trained Nurse, Health Visitor's Certificate R.S.I. *Sykes, Martha, Trained Nurse. *Maye, Marie, Trained Nurse, Health Visitor's Certificate R.S.I. *Fulchf.r, Joan, Trained Nurse. *Edwards, Ruth, Trained Nurse, S.C.M. *Stiles, Eleanor, Trained Nurse, S.C.M. MASSEUSE—Part Time: *Findlay, Miss A. E., Cert. Chartered Society of Massage, etc. CHIEF CLERK. *Leserve, George Frederick. CLERKS. Jacobs, E. E„ *Hayes, Mess A., *Payne, Miss W„ Baxter, C. W., Softley, W., Brightting. G., Budd, E. W,, Freeman, A., Clarke J. * Proportion of Salary contributed under Public Health Acts or by Exchequer Grants. 4 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON. Mr. Mayor, Ladies and Gentlemen, I have the honour to present herewith my Annual Report on the health, sanitary circumstances and vital statistics of the Borough of Leyton during the year 1935, together with my Annual Report to the Education Authority on the work of the school medical service during the year. These reports are drawn up on the lines required by the Ministry of Health and the Board of Education. Meteorological. The mean temperature during the year (51.3 degrees) was 1.1 degrees above normal. The daily rainfall and duration of sunshine were both slightly below the average of previous years. The summer, though a short one, was markedly hot for the third year in succession; and there was no measurable rainfall from 21st July to 11th August—a period of absolute drought of unusual length. Vital Statistics. The number of registered births was greater than that of the preceding year by 39; and the birth rate during 1935 was the highest recorded since 1932, when the rate was 13.10 per thousand of the population. It will be seen by reference to the statistics on page 14 that the birth rate in Leyton remains at a consistently lower level than in London or in the country generally. Of the births registered, 47 per cent. occurred in institutions. The deaths of Leyton residents certified during the year numbered 1,225, a reduction of 92 compared with the number certified during the previous year. The general death rate (10.06 per thousand) is the lowest recorded in the last five years, and compares with corresponding rates of 11.7 for England and Wales and 11.4 for London. Sanitary Circumstances. In the body of the report will be found details of the action taken by the Sanitary Authority to deal with overcrowding and the demolition of existing slum property. 5 On 1st August, 1935, there came into operation new Bye-laws— made under the provisions of the Essex County Council Act, 1933 with respect to the cleanliness of hairdressers' or barbers' premises. In March, 1935, the Council's sanitary inspectors ceased to act as Inspectors under the Shops Acts, but were appointed as inspectors to enforce the provisions of the Shops Act, 1934, with respect to the ventilation, temperature and sanitary conveniences in shops. As in previous years there has been maintained a high standard in meat inspection; and strict supervision is maintained over premises where food is prepared and sold. Infectious Disease. No case of smallpox has occurred in the Borough since May, 1933; and chickenpox has ceased to be notifiable since June, 1934. Six persons were notified to be suffering from enteric fever. Scarlet fever was much less prevalent than it had been during the two previous years, and continued of the; mild type to which we have become accustomed during recent years. Although diphtheria was more prevalent than it has been for five years, there was a welcome reduction in the case fatality rate. Measles was not epidemic during 1935. The mortality from tuberculosis, both pulmonary and nonpulmonary, continues to decline. In the comparatively short space of twenty-three years the death rate from pulmonary tuberculosis has been reduced by over 30 per cent., and that from non-pulmonary tuberculosis by as much as 77 per cent. In December, 1934, 1 presented to the Council a special report drawing attention to the increase in the severity of the prevalent type of diphtheria and the need for the institution of facilities for the protection of children against the disease. The Council authorised the provision of the necessary facilities; and in February, 1935, a weekly clinic for immunisation against diphtheria was begun. A full report on the first year's working of the special clinic will be found on pages 64 to 68, from which it will he seen that parents in the area are anxious to have their children protected against diphtheria if the facilities exist. Unfortunately, it is impossible to undertake a more intensive campaign with the available staff. 6 Isolation Hospital. The Leyton Temporary Isolation Hospital, built 40 years ago, is still in existence; but it has long ceased to be adequate or suitable for the needs of the area. At the end of the year no further progress had been made to give effect to the recommendations contained in the Essex County Council Scheme, approved by the Ministry of Health, for the provision of new fever hospital accommodation by the formation of a Joint Hospital Board. In my last Annual Report there was included the result of a special investigation by Dr. F. W. Gavin of the records of scarlet fever patients treated in hospital in order to determine what correlation exists between the density of occupation of wards and the incidence rate of complications. The investigation was continued during 1935 and the results will be found in the form of a special report on pages 85 to 92. Maternity and Child Welfare. The number of deaths of infants under one year of age was (30, this being the lowest number of infant deaths ever recorded in the Borough. The infantile mortality rate—40.18 deaths of infants under one year of age per thousand live births—compares favourably with rates of 58.00 for London and 57.00 for England and Wales. Seven women died from diseases and accidents associated with pregnancy and childbirth, the maternal mortality rate being 4.68 per 1.000 live births, comparing with a rate of 4.10 for England and Wales. This is the first year since 1931 in which the Leyton maternal mortality rate has exceeded that of the country generally. During the year under review the attendances at the Council's Infant Welfare Clinics numbered 10,370, an increase of 1,003 as compared with the figure for the previous year. There was also an increase in the number of expectant mothers attending the Antenatal Clinics for supervision. Of 1,493 Leyton women who gave birth to children during 1935, some 716 (47 per cent.) had their confinements in residential institutions. With the opening of the new Park House Clinic in September, arrangements were made for the institution of special Toddlers' Clinics for the medical supervision of children from two to five years of age. One weekly Toddlers' Clinic is now held at each of the two Centres. 7 New "Park House " Clinic. In the body of the report will be found a description of the new Joint Clinic premises which were opened by the Mayoress (Mrs. E. Hayward) on 14th September last. The now Park House Clinic, like that at Leyton Green (opened in September, 1933), is a modern, well-equipped building containing accommodation for the joint clinic medical services administered by the Council as a Maternity and Child Welfare and as an Education Authority. School Medical Service. On pages 132 to 180 will be found my Annual Report to the Local Education Authority on the medical inspection and treatment of children attending public elementary schools in the area; and the Appendix to the Report contains the statistical tables required by the Board of Education. In December, 1933, the Education Authority agreed to a modification of the Regulations for exclusion of children from school on account of infectious disease. Prior to that date sixweeks had been the routine period of exclusion from school of children from homes in which a patient with scarlet fever was being treated. Since then the period of exclusion has been reduced to one week; and on pages 76 to 80 will be found details of an investigation into the results of exclusion during the two-year periods immediately before and since the modification of the regulations for exclusion. From the evidence submitted there is every reason to doubt the efficacy of and necessity for the traditional routine exclusion from school of such contacts for so long a period. It is my privilege to acknowledge again the support accorded to me by the members of the Council and the interest shown by the Chairmen and members of the Committees concerned with the work of the Health Department. It is with sincere thanks that I record my appreciation of the industry and loyalty of the members of the staff of the Health Department. I have the honour to be, Mr. Mayor, Laoies and Gentlemen, Your obedient servant. 8 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in acres 2,594 Population (Census 1931) 128,313 Population (Registrar-General's estimate, June, 1935) 121,690 Number of families (Census 1931) 34,368 Number of inhabited houses (Census 1931) 26,306 Number of persons per house (Census 1931) 4.87 Assessable value for General Rate purposes £772,390 Sum represented by a penny rate for General Rate purposes (as from 1st April, 1936) £3,067 Summary of Dwellings, Rooms and Private Families. Housing Census 1931. Dwellings occupied by private families 26,306 Percentage of vacant unfurnished dwellings 1.00 Rooms occupied by private families 143,147 Private families 34,368 Population in private families 123,522 Rooms per occupied dwelling 5.44 Families per occupied dwelling 1.31 Persons per family 3.59 Persons per room 0.86 Percentage living more than 2 persons per room— Private families 2.94 Population 5.61 9 Physical Features of the Area. See Annual Report for 1934. Social Conditions. See Annual Report for 1934, Extracts from Vital Statistics for the Year. Live Births:— Males. Females. Total. Birth Rate. Legitimate 796 652 1448 12.26 Illegitimate 21 24 45 817 676 1493  Males. Females. Total. Rate per 1000 total births. Stillbirths 20 24 44 29.47 Males Females. Total. Death Rate. Deaths 655 570 1225 10.06 Number of Women dying from diseases and accidents of pregnancy and childbirth:— From Sepsis 4 From other causes 3 Total 7 Death Rate of Infants under One year of age:— All infants per 1000 live births 40.18 Legitimate infants per 1000 legitimate live births 38.76 Illegitimate infants per 1000 illegitimate live births 88.88 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) 6 10 METEOROLOGICAL CONDI LIONS, 1935. Temperature. Mean temperature of the year, 51.3 deg., 1.1 deg. above normal. Warmest month, July; mean temperature, 66.9 deg., 3.4 deg. above normal. Coldest month, December; mean temperature, 35.8 deg., 4.1 deg. below normal. Extreme maximum for the year, 91 deg., on 22nd August. Extreme minimum lor the year, 22 deg., on 23rd December. Extreme maximum in the sun's rays, 147 deg., on August 11. Extreme minimum on the grass, 13 deg., on 23rd December. Highest daily mean temperature, 22nd August, 74.8 deg., 13.7 deg. above normal. Lowest daily mean temperature, 23rd December, 24.7 deg., 13.5 deg. below normal. Greatest daily range of temperature, 10th July, 34.0 deg. (53.1 deg. to 87.1 deg.). Months with mean temperature below the average of 1841-1930, May and December; equal to the average, October; above the average, all the rest. Rainfall. Total amount, 23.8in.; average for the year (1815-1914),24.3in. Number of days yielding at least 0.01 in., 1(59; normal for the year, 103. Wettest month, November, 3.0 in.; driest month, July, 0.5 in. Largest daily fall, 24th August, 0.78 in. Months with rainfall above the average, Eebruary, April, June, September, November; below the average, January, March, May, July, August, October, December. Sunshine. Average daily duration, 3 hours 54 minutes, representing 7 minutes a day less than the normal (1901-1930). Number of days with measurable sunshine, 284. Longest daily duration, 24th June, 14 hours 54 minutes (90 per cent. of the maximum possible). Sunniest week, 23rd-29th June; mean daily duration 11 hours 5 minutes (07 per cent. of the maximum possible). Sunniest fortnight, 23rd June-6th July, mean daily duration, 9 hours 34 minutes (58 per cent. of the maximum possible). Months with sunshine in excess of the normal, Juno, July, September, October; in defect of the normal, all the rest. Notes. The most boisterous day of 1935 was 16th February, when the total travel of the wind past the anemometer was 743 miles, representing an average speed of 31 miles per hour. On the same date the maximum wind pressure for the year was attained, this 11 being 21 lb. per square foot. A notably mild winter, giving the highest mean temperature over the period December-February since 1868-69, was followed by the coldest May since 1902. The minimum of 28.2 deg. registered on 17th May was the lowest for this month since 1877, and was 3.4 deg. lower than any hitherto reached on any date between 15th May and 26th September since records were begun in 1841. The Summer. The summer, though a short one, was markedly hot, for the third year in succession. From June to August the mean temperature was 64.6 deg.—2.4 deg. above normal. Only four times during the last seventy-five years has so high a value been recorded for the same three months: 65.9 deg. in 1868 and 1911, 65.6 deg. in 1933, and 64.7 deg. in 1899. Snow or sleet occurred on sixteen days during 1935, hail on five days, and thunderstorms on thirteen days, six of which were in June. There was no measurable rain from 21st July to 11th August, this period of twenty-two days constituting an "absolute drought" of unusual length, it is noteworthy that 1935 is the fourth consecutive year to give an extreme maximum temperature in excess of 90 deg., and the sixth consecutive year in which the extreme minimum has not been below 20 deg. Both of these events are unique in the ninety-five years covered by the lloyal Observatory records. 12 TABLE 1.—METEOROLOCxICAL TABLE FOR LONDON. 1935. (Deduced from Observations at Greenwich, under the Superintendence of the Astronomer Royal.) 1935. Barometer. Air Temperature. Hygrometer. Earth Temperature. Bright Sunshine. Mean Pressure at Station Level, 152 ft.* (Average Correction to Sea Level + 5.6 mb.) Mean of Mean of A and B Difference from Average.† Absolute Maximum and Minimum. Mean of Observations at 9 a.m. and 9 p.m. At 1 foot depth. At 4 feet depth. Dally Mean. Difference from Average.† Per cent, of Possible. A B Maximum. Day of Month Minimum. Day of Month. Dry Bulb. Depression of Wet bulb. Vapour Pressure. Humidity. Maximum. Minimum. mb. of. of. of. of. of. of. of. f. mb. % of. of. hr. hr. January 1020.3 44.1 36.5 40.3 +0.2 54 1 25 29 40.4 1.6 7.5 86 43.1 46.7 0.52 —0.77 6 February 1002.9 48.7 38.3 43.5 +3.2 57 2 28 9 42.6 2.2 7.7 81 42.5 44.8 1.53 —0.60 15 March 1017.3 52.2 36.8 44.5 + 1.2 67 21 29 9 43.7 2.4 7.9 81 43.1 44.6 3.10 —0.18 26 April 1006.3 55.9 40.1 48.0 +0.7 64 23 31 5 46.9 3.0 8.6 77 46.9 47.0 3.45 —1.30 25 May 1015.6 61.2 42.5 51.9 —2.8 76 6 28 17 50.7 4.2 9.1 71 51.2 49.9 5.56 —0.94 36 June 1010.7 71.6 52.3 61.9 + 2.7 84 24 40 9 60.9 3.8 14.3 79 58.2 54.3 6.82 + 0.09 41 July 1017.8 78.3 55.6 66.9 + 3.6 87 10. 14 46 31 65.9 6.3 14.7 67 63.7 59.6 8.58 +2.18 53 August 1013.7 76.9 53.0 64.9 + 2.4 91 22 42 28 64.2 5.5 14.6 71 62.7 60.4 5.74 —0.35 40 September 1009.5 68.2 49.7 58.9 + 1.1 77 12 38 26 58.0 3.1 13.5 81 58.0 59.0 5.14 + 0.12 41 October 1007.5 57.7 43.8 50.7 —0.4 63 16 28 21 50.3 2.6 10.4 81 52.7 55.3 3.25 + 0.08 30 November 1001.7 50.9 39.5 45.2 + 2.0 63 3 29 25 45.7 1.5 9.3 89 47.9 51.1 1.60 —0.06 18 December 999.5 42.5 35.0 38.7 —2.1 52 28 20 23 38.5 1.3 7.1 88 41.4 45.9 0.57 —0.43 7 Year 1010.2 59.0 43.6 51.3 + 1.0 91 Aug. 22 20 Dec. 23 50.7 3.1 10.4 79 51.0 51.5 3.83 —0.18 31 *The hours of observation are 9 a.m. and 9 p.m. local time. † The averages of temperature and sunshine used are obtained from observations extending over 30 years (1901-1930), those of rainfall are for the 35 years (1831-1915). Pressure is expressed in millbars (1000 mb.= 29.53l mercury-inches). Wind Force.—The summary is obtained from the records of a cup anemograph having 5 in. cups and 15 in. arms. The factor used is 3. Winds above 43 miles per hour are reckoned as gales and winds between 21 and 43 miles per hour as moderate or strong winds. Direction is not tabulated when the speed of the wind is less than 5 miles per hour and winds of less than that velocity are counted as calm. 13 TABLE 1—continued. 1935 Cloud. Rain and other forms of Precipitation. Weather Number of days of Wind. Number of Observations at 9 a.m., 3 p.m.. and 9 p.m. Mean of Observations of amount at 9 a.m. and 9 p.m. (Scale 0-10.) Total Fall. Difference from Average.† Most in a Day. Precipitation (0.2 mm and above). Precipitation (1 mm. and above). Snow. Hail. Thunderstorm. Persistently Clear. Generally Clear.* Generally Overcast.* Persistently Overcast. Fog at 9 a.m. Gale. Force. Direction. Amount. Day of Month. Gale Moderate and Strong Wind Calm. N. N.E. E. S.E. S. S.W. W. N.W. January 8.5 mm. 30 mm. — 13 mm. 7 26 15 8 6 0 0 0 0 21 2 9 0 0 92 1 31 11 3 0 5 14 12 16 February 7.7 55 + 15 10 27 16 12 3 0 0 0 2 15 0 1 0 0 84 0 3 14 2 1 9 33 18 4 March 6.9 15 — 29 6 17 7 4 2 0 0 1 1 14 0 5 0 0 92 1 5 14 14 6 12 19 15 7 April 7.5 75 + 38 12 7 21 17 2 4 1 0 0 15 3 2 0 0 90 0 18 6 3 4 16 24 14 5 May 6.7 38 — 6 13 24 10 7 1 1 0 0 3 13 1 0 0 0 93 0 19 38 17 5 6 5 2 1 June 6.1 71 + 20 18 9 19 15 0 0 6 0 5 11 1 0 0 0 90 0 1 1 12 8 20 40 8 0 July 5.0 14 — 43 8 1 5 3 0 0 2 0 6 6 0 0 0 0 93 0 11 9 18 7 5 13 23 7 August 5.1 55 — 1 19 30 7 6 0 0 2 0 3 10 0 0 0 0 93 0 8 8 5 6 14 32 15 5 September 6.1 74 + 29 15 29 19 13 0 0 1 0 1 10 0 0 1 0 90 0 5 2 5 10 12 38 15 3 October 5.9 65 + 1 21 3 14 9 0 0 0 0 3 9 1 3 0 0 93 0 9 2 2 4 15 39 20 2 November 7.1 92 + 34 16 7 19 16 0 1 1 0 1 12 1 4 0 0 90 0 3 7 7 4 29 27 11 2 December 6.9 64 + 7 12 30 20 15 2 0 0 0 4 15 2 9 0 0 91 2 9 12 5 7 12 20 24 2 Year 6.6 648 + 52 21 Oct.3 172 125 16 6 13 1 29 151 11 33 1 0 1091 4 122 124 93 62 155 304 177 54 * A day is reckoned as "generally clear" if the average of the estimates of the fraction of sky covered by cloud at 9 a.m., 3 p.m.. and 9 p.m. is less than .2, and as "generally overcast" if the average is greater than .8. Days persistently cloudless and days persistently overcast refer to the period midnight to midnight. 14 VITAL STATISTICS. Births.—Fourteen hundred and ninety-three births were registered during the year:— Males. Females. Total. Legitimate 706 652 1448 Illegitimate 21 24 45 817 676 1493 The birth rate per 1,000 of the population was thus 12.20 The following list shows the population, number of births, and the corrected birth rate per 1000 during the past five years:— Year. Population. No. of Births. Birth Rate. 1931 128,600 1812 14.09 1932 127,140 1666 13.10 1933 125,700 1499 11.91 1934 123,430 1454 11.78 1935 121,690 1493 12.26 On page 27 will be found a table showing the population, number of births and birth rate for each year since 1802—a period of 43 years. The figures below show how, during the five-year period, the birth rate in Leyton has compared with corresponding rates in the Great Towns, in London, and in England and Wales. It is evident that during each of the five years, the Leyton birth rate has remained at a lower level than in any of the other three comparative areas. 1931 1932 1933 1934 1935 Leyton 14.09 13.10 11.91 11.78 12.26 121 County Boroughs and Great Towns 10.0 15.4 12.2 14.7 14.8 London 15.0 14.2 13.2 13.2 13.3 England and Wales 15.8 15.3 14.4 14.8 14.7 15 Of the total number of births registered (1,493) during the year, 710 (47 per cent.) occurred in institutions outside the district. The figures show to what extent expectant mothers in Leyton avail themselves of institutional accommodation for their confinements. These 710 births occurred in the following institutions:— Queen Mary's Hospital 303 Mothers' Hospital, Clapton 107 Forest Gate Hospital 92 City of London Maternity Hospital 22 Plaistow Maternity Hospital 33 East End Maternity Hospital 12 Kingswood Maternity Home 20 London Hospital 7 St. Bartholomew's Hospital 3 Royal Free Hospital 8 Queen Charlotte's Hospital 5 Jewish Maternity Hospital 6 Middlesex Hospital 3 Walthamstow District Nursing Association 18 Other Institutions 77 716 16 Graph No. 1. Leyton Birth Rate, 1915-1935. 17 TABLE 2. Registered Births, 1935. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstonc. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Total. January 2 6 7 3 5 7 12 8 3 8 61 February 5 12 4 7 11 6 6 7 7 8 73 March 4 8 5 4 8 10 2 11 4 4 60 April 4 10 8 1 3 6 6 8 8 3 57 May 3 8 8 7 8 8 12 11 8 6 79 June 2 13 4 4 10 7 7 12 7 2 68 July 7 14 4 6 4 9 3 9 1 1 58 August 5 14 11 6 13 5 9 6 9 9 87 September 5 6 — 4 12 4 7 5 9 1 53 October 8 16 6 10 10 8 5 12 3 4 82 November 3 13 7 7 3 7 4 4 7 6 61 Decernber 4 5 2 3 7 1 5 3 8 - 38 Transferables 63 124 52 70 123 83 54 64 45 38 716 Totals 115 249 118 132 217 161 132 160 119 90 1,493 18 Deaths.—Twelve hundred and twenty-five deaths of Leyton residents were registered during the year, including those of 139 males and 104 females (transferable deaths) who died outside the area. Males. Females. Total. 655 570 1225 The death rate per 1000 of the population was thus 10.00. The following list shows the population, number of deaths, and the death rate per 1000 of the population during the past five years:— Year. Population. No. of Deaths. Death Rate. 1931 128,000 1,365 10.61 1932 127,140 1,341 10.54 1933 125,700 1,468 11.67 1934 123,430 1,317 10.67 1935 121,690 1,225 10.06 The figures below show how, during the five-year period, the death rate in Leyton has compared with corresponding rates in the Great Towns, in London, and in England Wales. During each of the five years, the Leyton death rate has remained at a lower level than in the case of any of the other three comparative areas. 1931 1932 1933 1934 1935 Leyton 10.61 10.54 11.67 10.67 10.06 121 County Boroughs and Great Towns 12.3 11.8 12.2 11.8 11.8 London 12.4 12.3 12.2 11.9 11.4 England and Wales 12.3 12.0 12.3 11.8 11.7 The figure of 1225 registered deaths represents a decrease of 92 (about 7.51 per cent.) when compared with the corresponding number (1317) registered during the previous year, 19 The following list shows the increase or decrease in the number of deaths from the various causes in 1935 as compared with 1934:— Decrease. Increase. — + Typhoid Fever - 1 Measles 13 - Scarlet Fever 2 - Diphtheria 3 - Cerebro-spinal Fever 1 - Encephalitis Lethargica 1 - Tuberculosis of Respiratory System - 1 Diabetes 2 - General paralysis of the insane, tabes dorsalis - 2 Cancer, malignant disease 20 - Cerebral haemorrhage, etc. - 15 Heart disease 49 - Aneurism - 3 Other circulatory diseases 5 - Bronchitis 3 - Pneumonia (all forms) - 16 Other respiratory diseases 7 - Peptic Ulcer 3 - Diarrhoea, etc. 1 - Appendicitis 5 - Cirrhosis of Liver 3 - Other diseases of Liver, etc. - 5 Other Digestive diseases 6 - Other Puerperal causes - 2 Congenital Debility, Premature Birth, Malformations, etc. 1 - Suicide - 4 Other Violence 9 - Other defined causes 4 - Causes ill-defined or unknown 1 - Acute and Chronic Nephritis - 19 Senility 21 - 160 68 92 20 It will be seen that the chief decreases were in deaths from heart disease (49), cancer (20), and measles (13). On the other hand, definite increases are shown in deaths from cerebral haemorrhage (15), pneumonia (16) and nephritis (19). Table 3, page 23, gives the official list of the principal causes of death in the different age groups. Graph 2 shows the variation in the death rate in Leyton since the year 1915. The diagram shows in striking fashion the effect of the great epidemic of Influenza in 1918, and also that of the Influenza epidemic of 1929, which was responsible in great measure for the increased mortality during that year. Distribution in Wards. The distribution of deaths and the death rates in the different wards are given below:— Ward. Total Deaths. Deaths per 1,000 of Population. Leyton 94 10.7 Lea Bridge 165 7.2 Central North 93 8.4 „ South 114 10.0 Forest 159 8.7 Leytonstone 166 12.9 Grove Green 118 ll.6 Harrow Green 99 9.4 Cannhall 120 10.6 Wanstead Slip 90 11.0 Zymotic Death Rate.—The deaths during the year from the seven principal zymotic diseases were as follows:— Smallpox — Measles — Diphtheria 8 Whooping Cough 2 Diarrhoea 6 Scarlet Fever 1 Enteric Fever 1 The zymotic death rate for 1935 was 0.14 per thousand of the population compared with a rate of 0 29 for the previous year. 21 Senile Mortality. In the List of the Principal Causes of Death (Table 3) the deaths are classified in eight age-groups, of which the last includes all deaths occurring in persons of 65 years of age and upwards. The age-group "65 and upwards" has been sub-divided in periods of five years and the following figures show the number of persons who died in each of these five-yearly sub-groups:— 65-70 149 70-75 147 75-80 150 80-85 112 85-90 64 90-95 14 95-100 4 Of the total number of deaths (1,225) during the year, 610 (52 per cent.) occurred in persons of 65 years and upwards. The figures above show the proportion of residents of the area who live to a very mature age. Infant Mortality.—Sixty children died under one year of age, giving an infant mortality rate (number of deaths under one year of age per thousand births) of 40.18. The following figures show the number of births, infant deaths and infant mortality rate during the past five years :— Year. No. of Births. No. of Infant Deaths. Infant Mortality Rate. 1931 1,812 71 39.18 1932 1,666 89 53.43 1933 1,499 76 50.70 1934 1,454 64 44.02 1935 1,493 60 40.18 The following are the corresponding rates for other Great Towns, London, and England and Wales, during the year under review:— Infant Mortality—Leyton 40.18 ,, ,, 121 County Boroughs and Great Towns, including London 62.00 ,, ,, London 58.00 „ „ England and Wales 57.00 22 Maternal Mortality.—Seven women died from diseases and aecidents of pregnancy and childbirth. The figures given below show the variation in maternal mortality during the past five years in Ley ton and in the country generally:— Year. No. of Maternal Deaths (Leyton). Maternal Mortality Rate per 1,000 live births. Leyton. England and Wales. 1931 9 4.90 4.11 1932 4 2.40 4.24 1933 2 1.33 4.42 1934 5 3.43 4.00 1935 7 4.08 4.10 Comparative Statistics—Table 4 is of a very comprehensive nature, and has been prepared with a view to throwing some light on Ley ton's progress in the matter of vital statistics since 1892—a period of 43 years. During that period the following are the outstanding facts:— 1. The population has increased from 63,000 to 121,690 2. The birth rate has decreased from 35.08 to 12.26 births per thousand of the population. 3. The death rate has decreased from 15.4 to 10.00 per thousand of the population. 4. The infantile mortality rate has decreased from 141 to 40.18 deaths of infants under one year per thousand births. 23 TABLE 3. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE BOROUGH OF LEYTON, 1935. Aces at Death in Years Wards. CAUSES OF DEATH. Male. Female. Total All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. In Public Institutions in the District. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Ward not known. Not belonging to District. Belonging to District. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Typhoid Fever ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Scarlet fever ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping cough 1 1 2 2 ... ... ... ... ... ... ... 7 1 ... ... 1 ... ... ... 1 ... ... ... ... Diphtheria 3 5 8 ... ... 5 3 ... ... ... ... 5 6 ... 1 1 1 ... 1 ... ... 4 ... ... Influenza 7 5 12 ... ... ... l ... ... 7 4 1 2 ... 2 1 2 ... 2 1 2 ... ... ... Encephalitis lethargica 1 ... 1 ... ... ... ... ... 1 ... ... 5 1 ... 1 ... ... ... ... ... ... ... ... ... Cerebro-spinal fever ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of respiratory system 45 ... 69 ... ... ... l 12 32 18 6 95 15 5 13 4 5 ... 6 8 8 7 7 ... Other tuberculous diseases 5 3 8 1 ... 1 2 1 2 1 ... 18 1 ... 1 ... ... ... 2 2 2 ... 1 ... 24 Syphilis 2 General paralysis of the insane, tabes dorsalis 5 2 7 6 1 2 3 1 2 1 1 2 Cancer, malignant disease 114 85 179 1 4 76 98 279 55 20 23 13 18 24 20 1 7 21 15 8 Diabetes 10 8 18 1 2 6 9 23 6 9 1 3 5 2 1 4 Cerebral hæmorrhage, etc. 44 51 95 1 29 65 164 50 5 9 9 14 12 10 11 4 14 7 Heart disease 169 171 240 1 13 74 251 560 120 25 45 25 34 39 44 43 22 34 24 5 Aneurism 5 4 9 1 3 5 6 1 1 1 1 2 2 1 1 Other circulatory diseases 16 10 35 12 23 43 6 2 9 1 2 6 2 4 2 4 3 Bronchitis 32 23 55 3 1 3 13 35 56 12 4 7 4 1 6 10 3 8 6 5 1 Pneumonia (all forms) 43 28 71 10 1 1 2 7 22 26 120 32 5 9 7 4 8 14 7 5 9 3 Other respiratory diseases 3 2 5 1 2 2 12 3 3 1 1 Peptic ulcer 10 3 13 6 4 3 22 5 1 1 1 3 2 2 1 1 1 Diarrhoea, etc. 4 2 6 5 l 9 1 2 l 1 1 1 Appendicitis 3 4 7 3 1 3 12 4 1 l 1 2 1 1 Cirrhosis of liver 2 2 2 1 1 1 1 Other diseases of liver, etc. 2 6 8 l 5 2 3 1 1 1 2 3 Other digestive diseases 10 7 17 2 1 l 7 6 24 5 3 2 2 2 2 1 2 3 Acute and chronic nephritis 18 19 37 2 5 16 13 54 9 1 7 2 3 6 7 3 6 1 1 Puerperal sepsis 4 4 2 2 6 2 2 1 l Other puerperal causes 3 3 1 2 6 2 3 Congenital debility, premature birth, malformations, etc. 16 18 34 33 1 8 5 1 4 3 4 6 6 2 1 2 5 Senility 11 15 26 1 25 14 7 1 4 4 1 4 3 1 1 3 4 Suicide 14 5 19 3 8 5 3 10 5 1 2 3 2 5 1 2 3 Other violence 18 17 35 2 1 3 8 4 7 10 55 17 3 4 3 7 6 2 3 1 3 2 1 Other defined causes 64 33 97 2 2 2 6 11 24 59 163 33 12 13 9 8 16 12 6 6 i 9 6 Causes ill-defined, or unknown 1 1 1 1 Totals 655 570 1225 60 4 13 17 43 108 340 640 1789 410 94 165 93 114 159 166 118 99 120 90 7 25 Graph No. 2. Leyton Death Rate 1915-1935. 26 Graph No. 3. Comparative View of the Principal Causes of Death during the Year 1935. 27 TABLE 4. Comparative Statistics or Births, Mortality, Etc. LEYTON, 1802-1935. Year. Population. Births. Birth Rate. Deaths. Death Rate. Deaths under 1 year. Infantile Death Rate. 1892 63000 2210 35.08 972 15.4 313 141 1893 64000 2316 36.18 1019 15.7 306 130 1894 70000 2224 31.7 825 11.6 258 116 1895 75000 2292 30.05 1080 14.4 346 150 1896 77000 2372 30.08 926 11.8 326 137 1897 85000 2501 29.3 1011 11.9 356 142 1898 90000 2560 28.4 1125 12.5 374 146 1899 93000 2698 29.0 1262 13.5 420 155 1900 100000 2932 29.32 1179 11.8 410 140 1901 100000 2963 29.63 1243 12.4 404 136 1902 100000 3152 31.52 1183 11.8 336 106 1903 102000 3273 32.08 1112 10.9 322 99 19l04 104000 3198 30.07 1370 13.1 444 138 1905 105000 3209 30.05 1177 11.2 303 94 1906 108000 3344 30.9 1327 12.2 382 114.5 1907 120000 3190 26.6 1269 10.6 182 86.6 1908 121200 3071 25.3 1185 9.8 242 78.8 1909 121200 2979 24.6 1208 9.9 244 81.9 1910 123300 3011 24.4 1112 9.0 191 63.4 1911 124736 2931 23.5 1473 11.8 327 116.6 1912 126700 2797 22.1 1343 10.6 223 79.7 1913 129366 2904 22.4 1336 10.3 242 83.3 1914 130847 2800 21.4 1363 10.4 219 78.2 1915 124497 2655 21.3 1510 12.1 225 84.7 1916 B132107* 2560 19.4 D121420* 1471 12.1 197 76.9 1917 B125352* 2005 16.0 Dl12452* 1414 12.6 172 85.8 1918 B125352* 1791 14.3 D112452* 1723 15.3 161 89.9 1919 B129062* 2195 17.0 D123896* 1397 11.3 154 70.16 1920 128832 3168 24.6 1330 10.3 207 65.34 1921 128432 2679 20.86 1290 10.04 182 67.94 1922 131600 2416 18.36 1420 10.79 155 64.16 1923 132800 2328 17.53 1228 9.25 106 45.53 1924 133500 2101 15.74 1325 9.92 110 52.36 1925 132700 2091 15.76 1349 10.16 114 54.51 1926 130000 2022 15.55 1261 9.7 131 64.79 1927 128920 1826 14.16 1322 10.25 80 43.81 1928 130300 1853 14.22 1290 9.90 91 49.10 1929 128300 1731 13.49 1510 11.76 100 57.77 1930 128300 1757 13.69 1222 9.52 81 46.09 1931 128600 1812 14.09 1365 10.61 71 39.18 1932 127140 1666 13.10 1341 10.54 89 53.43 1933 125700 1499 11.91 1468 11.67 76 50.70 1934 123430 1454 11.78 1317 10.67 64 44.02 1935 121690 1493 12.26 1225 10.06 60 40.18 * Population as estimated for purposes of b, Birth Rate, d, Death Rate. 28 TABLE 5 Vital Statistics of Whole District during 1935 and Previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the Borough. Transferable Deaths Nett Deaths beloncing to the Borough. Uncorrected Number. Nett. of Nonresidents registered in the Borough. of Residents not registered in the Borough. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1928 130300 1341 1853 14.22 2764 21.2 1714 240 91 49.10 1290 9.90 1929 128300 1233 1731 13.49 3008 23.4 1751 253 100 57.77 1510 11.76 1930 128300 1199 1757 13.60 2692 20.9 1688 218 81 46.09 1222 9.52 1931 128600 1264 1812 14.09 2872 22.3 1770 263 71 39.18 1365 10.61 1932 127140 1029 1666 13.10 2913 22.7 1808 236 89 53.42 1341 10.54 1933 125700 812 1499 11.91 3070 24.4 1888 286 76 50.70 1468 11.67 1934 123430 8.19 1454 11.78 2864 23.2 1774 227 64 44.02 1317 10.67 1935 121690 777 1493 12.26 2671 21.9 1789 243 60 40.18 1225 10.06 Rates in columns 5, 7 and 13 calculated per 1000 of estimated gross population. 29 TABLE 6. Birth rate, Death-rate and Analysis of Mortality During the Year 1935. (Provisional figures. The rales have been calculated on a population estimated to the middle of 1935. The mortality rales refer to the whole population as regards England and H ales, but only to civilians as regards London and the group of towns.) Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 Years). Total Deaths under 1 Year. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. Still Births. England and Wales 14.7 0.62 11.7 0.00 0.00 0.03 0.01 0.04 0.08 0.18 0.52 5.7 57 - - - - 121 County Boroughs and Great Towns, including London 14.8 0.68 11.8 0.00 0.00 0.04 0.01 0.04 0.09 0.16 0.45 7.9 62 - - - - 140 Smaller Towns. Estimated Resident Populations 25,000 to 50,000 at Census, 1931 14.8 0.64 11.2 0.00 0.00 0.03 0.01 0.03 0.07 0.17 0.41 3.8 55 - - - - London 13.3 0.52 11.4 0.00 0.00 0.00 0.01 0.04 0.06 0.11 0.51 11.2 58 — — - - LEYTON 12.26 0.36 10.06 0.01 0.00 0.00 0.01 0.02 0.06 0.09 0.44 4.01 40 89.1 4.3 6.5 0.0 30 SECTION B. GENERAL PROVISIONS OF HEALTH SERVICES FOR THE AREA. NURSING ARRANGEMENTS, CLINICS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE IN THE BOROUGH. A. Midwives.—No practising midwives are employed or subsidised by the Local Authority. There are some ten midwives residing in the district, including six attached to the Essex County Nursing Association in Beachcroft Road, Leytonstone. In addition to these, ten midwives from adjoining areas practise in the Borough. B. Clinics and Treatment Centres.—Maternity and Child Welfare Centres—Provided by the Borough Council. Ante-Natal Clinics— (1) Park House Health Clinic, Granleigh Road, E.ll.— Thursdays, 10 a.m. (2) Leyton Green Health Clinic, Leyton Green Road.— Wednesdays, 10 a.m. Infant Welfare Clinics— (1) Park House Health Clinic, Granleigh Road, E.ll.— Mondays, Tuesdays and Thursdays, 1.45 a.m. (2) Leyton Green Health Clinic, Leyton Green Road.— Mondays, Wednesdays and Fridays, 1.45 p.m. Toddlers' Clinics.— (1) Park House Health Clinic, Granleigh Road, E.ll.— Tuesdays, 10 a.m. (2) Health Clinic, Leyton Green Road.—Fridays, 1.0 a.m C. Day Nurseries.—Nil. D. School Clinics. (1) Park House Health Clinic, Granleigh Road, E.ll.— Medical Inspection and treatment of minor ailments, 31 (2) Health Clinic, Leyton Green Road.—Medical Inspection and treatment of minor ailments. (3) Park House Health Clinic.—Dental treatment. (4) Health Clinic, Leyton Green Road.—Dental treatment. (5) Health Clinic, Leyton Green Road.—Ophthalmic treatment. (0) Health Clinic, Leyton Green Road.—Diphtheria Immunisation. (7) Park House Health Clinic.—Diphtheria Immunisation. (8) Knotts Green Special School.—A special Orthopædic Clinic is held at Knotts Green Special School once a month. Provision is made by the Local Authority for the examination and treatment by the Council's Orthopaedic Surgeon of children recommended by the School Medical Officers and the Medical Officers at the Infant Welfare Centres. (9) Knotts Green Special School.—Artificial Light Clinic. Available for school children on two days a week, and for children under school age on Saturday mornings. E. Hospitals provided or subsidised by the Local Authority. (1) Fever.—Borough Isolation Hospital. (2) Smallpox.—Agreement with the Walthamstow Corporation for the treatment of cases of smallpox arising in the Borough. (3) Tuberculosis.—The County Council is the Authority responsible for the institutional treatment of Tuberculosis. (4) Ophthalmia Neonatorum.—Agreement with the London County Council for the institutional treatment of cases of Ophthalmia Neonatorum. (5) Enteric Fever.—Agreement with the Connaught Hospital, Walthamstow, for the reservation of two beds for cases of Enteric Fever. F. Maternity.—Agreement with the Queen Mary's Hospital, West Ham, for women to be received into the Margaret Lyle Wards for their confinements. G, Children.—No Hospital provided or subsidised. 32 H. Orthopaedic.—Arrangements with Brookfields Orthopaedic Hospital, Hale End, for the admission of children requiring orthopaedic treatment. I. Other.—The Whipps Cross Hospital is within the Borough area, and has accommodation for 760 patients. In addition, Leyton is served by many hospitals in the surrounding neighbourhood, viz., Walthamstow, Hackney and West Ham. J. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children.—No provision. K. Ambulance Facilities. (a) Infectious Cases.—An Austin Ambulance is provided for the conveyance of infectious cases to the Isolation Hospital. (b) Non-Infectious and Accident Cases.—Motor Ambulances for non-infectious cases are supplied by the Leyton Town Council and are under the control of the Superintendent of the Fire Brigade. LEGISLATION IN FORCE. Special Acts. Leyton Urban District Council Act, 1898. Leyton Urban District Council Act, 1904. Adoptive Acts. Date of Adoption. Date came into Force. Infectious Diseases (Notification) Act, 1889 31-12-89 10-2-90 Infectious Diseases (Prevention) Act, 1890 7-4-91 1-6-91 Public Health Acts Amendment Act, 1890 7-4-91 1-6-91 Libraries Act, 1885-1890 23-11-91 23-11-91 Private Street Works Act, 1892 20-12-92 1-2-93 Baths and Washhouses Act, 1896 7-12-97 7-12-97 Public Health Acts Amendment Act, 1907, Sections 85 and 86 and Part 8 27-10-08 17-11-08 Public Health Acts Amendment Act, 1907, whole of Part 5 and certain sections in Parts 2, 3, 4 and 10 29-9-08 4-10-09 33 Public Health Act, 1925, Parts 2-5 inclusive (certain sections) 15-12-25 1-2-26 Essex County Council Act, 1933 (Registration of Ice Cream Manufacturers, &c.) 5-9-33 6-12-33 Bye-laws, Regulations, etc. Allotments.—As to. Animals.-—For the prevention of keeping on any premises so as to be injurious to health. Common Lodging Houses. Dairies, Cowsheds and Milkshops. Diseases of Animals.—Sheep Scab Order. Employment of Children and Street Trading by Young Persons. Hairdressers' and Barbers' Premises.—As to Cleanliness of Instruments, Towels and Materials. Libraries—As to use of. Good Rule and Government of the Borough. House Refuse.—As to removal of. New Streets and Buildings. Nuisances arising from snow, filth, dust, ashes and rubbish. Nursing Homes Registration Act, 1927. Offensive and Noxious Matters.—As to nuisances in connection with removal of. Petroleum Filling Stations. Pleasure Grounds.—With respect. Employment Agencies.—For the regulation of. Massage Establishments.—For the registration of. Olfensive Trades.—For the regulation of. Public Baths.—For the management, use and regulation of. Sanitary Conveniences.—As to decent conduct of persons using. Slaughter Houses. Smoke Abatement. Tanks, Cisterns and other Receptacles used for storing water. Closing Orders for Butchers. Chemists. Hairdressers and Barbers. Bakers. Grocers, Provision Dealers, Oilmen, etc. All Shops not exempted by Shops Act. 34 ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. Since 1st April, 1934, it has been illegal for any person in this area to carry on an establishment for massage or special treatment without ft licence from the Council. During the year the Medical Officer of Health visited and inspected all such establishments of which he became aware and the following licences were granted:— For massage and electrical treatment 4 For massage and chiropody 1 For chiropody 1 PUBLIC BATHS. For description of Corporation's Public Swimming Pools see Annual Report for the year 1934. Tests of Purity of Water. In addition to the daily tests for clarity, alkalinity and chlorine content undertaken by the Baths Superintendent and his staff, periodic samples of the water from the pools were taken by the Health Department for more detailed chemical and bacteriological examination. These samples were taken at times when the bathing load was high and when the water might be expected to show the maximum amount of pollution. In all, some 11 samples were taken during the year. Attendances. The following figures show the extent to which the Corporation's Baths were used during the year:— Swimming. 1935. High Road 230,549 Cathall Road 131,659 Whipps Cross Bathing Pool 48,493 Slipper Baths. High Road 99,000 Gathall Road 45,232 Foam Baths. High Road 3,574 Public Mortuary. A public mortuary, maintained by the Corporation, is situated in Church Road, Leyton. The following are the figures for the year:— Number of bodies deposited, death being due to Natural causes 64 Suicide 12 Murder 1 Street Accidents 7 Other ,, 3 Other causes 1 88 Number of Post mortem examinations performed 82 Number of Tnquests held 23 In Go instances no inquest was considered necessary in view of the post mortem findings that death was due to natural causes. The causes of death in these cases were certified as follows:— Pneumonia 7 General Arterio-selerosis 3 Atheroma of Coronary Artery 8 Interstitial myocarditis 11 Aortic stenosis 4 Coronary thrombosis 5 Aortic incompetence 2 Fatty heart 1 Ruptured heart 3 Myocardial infarct 1 ,, degeneration 1 Rupture of aneurism 2 Purulent meningitis 1 Haemorrhage from gastric ulcer 1 Malignant glioma of cerebellum 1 Cerebral tumour 1 General peritonitis due to carcinoma of caecum 1 Nephritis 1 General thrombosis and softening 1 Haemorrhage from pulmonary tuberculosis 1 Marasmus, pancreatic non-development 2 Stillborn 2 Bronchitis 4 Cause of death unascertainable—advanced decomposition 1 Inquests. The following verdicts on Leyton residents were recorded at inquests held during the year Accidental. Knocked down by motor car 3 „ ,, tram ear 2 ,, ,, motor van 1 ,, „ motor lorry 1 Collision between pedal cycle and motor car 1 „ lorry 1 .. van 1 ,, ,, motor cycle and horse-drawn cart 1 „ ,, motor car and tram car 1 Collided with railings whilst riding motor cycle 1 Injury to spine—dived into shallow end of swimming bath 1 Fracture of skull—fall from boiler whilst at work 1 Shock following inhalation of smoke 1 Fractures and falls 10 Burns 1 Suicide. Phenol Poisoning 3 Lysol ,, 2 Creosol „ 1 Coal Gas ,, 6 Salicylate ,, 1 Hanging 2 Drowning 2 Cut Throat 1 Open Verdtct. Found drowned 2 Creosol poisoning 1 Shock due to criminally induced abortion 1 Septicaemia due to pelvic abscess following perforation of uterus by piece of wood introduced for purpose of inducing abortion 1 37 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The Leyton area is supplied from the mains of the Metropolitan Water Board. Rivers and Streams. See Annual Report for year 1932. Closet Accommodation. There are nine houses where pail-closets are still in existence. Public Cleansing. (a) Scavenging. I am indebted to the Borough Surveyor and Cleansing Superintendent for the following particulars relative to Street Cleansing:— The total mileage of streets cleansed by this section of the Borough Engineer's Department Staff is 74 miles. The staff engaged on this work is : 2 foremen, 40 sweepers, 4 men and 2 electric collecting vehicles : and one mechanical road sweeping and collecting machine with a driver and 2 attendants. The system used in Leyton is known as the "beat system" The Borough was divided into 40 beats and again into 2 divisions of one foreman and 20 sweepers with one collecting vehicle to each division. Each sweeper has a beat of approximately 1 miles, and during each day the collecting vehicle visits each sweeper on his beat 4 times. The street refuse is then emptied diroctly into the vehicle, which then conveys the refuse directly to the disposal shoot. By adopting this collecting system a great deal of time is saved, as formerly each man took his own sweepings to a Corporation Yard where they were dumped and collected later in the day. The time saved is spent by the sweepers on their work, and the effect is that all roads in Leyton are now swept not less than 3 times weekly, and where necessary 4 and 5 times weekly as against 2 and the worst roads 3 times weekly. During the coming year the Council are installing as near as possible a dustless system of emptying the street refuse barrows, and is purchasing two new lorries with special bodies and 80 new bins to suit the bodies. When these vehicles are put into service the refuso can be emptied into the vehicles without complaints of dust escaping. 38 The main roads of the Borough are cleansed twice daily—once by the mechanical road sweeping and collecting machine, which commences its work at midnight, and again directly after 3 p.m. by hand sweeping. The object of the afternoon service is to give the roads a clean appearance in the evening. Gully and street drain emptying is carried out by mechanical means— two machines of 1,150 gallons capacity are engaged every day on this work. This enables a service of main roads once each month, and district roads every 7 to 8 weeks. Each gully is sealed with clean water after being emptied. There are nearly 8,000 street gullies in the district. (B) House Refuse Collection and Disposal. The collection of house refuse is not under the control of the Public Health Department, but is carricd out under the direction of the Borough Engineer and Surveyor. There are some 27,000 houses in the Borough and refuse is collected from each house twice weekly. The collection is undertaken by mechanically propelled vehicles, of which there are 12. All refuse is burnt in the Corporation's Refuse Destructor. During the year 25,691 tons of refuse were collected and the cost of collection per ton for the financial year ended March, 1935, was 8s. 10½d. Eight hundred and forty-eight defective and unsuitable receptacles have been replaced during the year. Statistics as to Refuse Collection, 1934-35. Number of collection days 307 Aggregate number of days vehicles employed 3,377 Average number of vehicles employed per day 11 Total mileage run 49,449 Tonnage collected 25,(391 Weight in cwts. per 1,000 population per day 11.4 Average weight collected per van day 7 tons 13 cwts. Total cost of collection (including loan charges) £11,783 Cost per ton for collection 9s. 2d. Income from collection of trade refuse, etc. £375 Income per ton of refuse collected 3½d. Net cost per ton for collection 8s. 10½d. Net cost per 1,000 of population £92 4s. Net cost—equivalent rate in £ 3,69d. 39 Refuse Dumps. Permission was granted to Leyton Gravel, Ltd., to use the land at Lammas Road as a refuse dump, in accordance with the Essex County Council Act, 1933. SANITARY INSPECTION OF THE AREA. The table below gives a summary of the Inspections made by the Sanitary Inspectors:— Number of dwelling-houses inspected 3,471 Number of house-to-house inspections 972 Miscellaneous inspections 3S1 Re-inspections 9,595 Piggeries 11 Petroleum stores 173 Places of entertainment 27 Schools 36 Stables 101 Public conveniences 140 Urinals 732 Inspections under Rats and Mice (Destruction) Act 287 Visits in connection with infectious disease GOO Workshops 103 Factories 699 Outworkers' premises 334 Rag and bono dealers 14 Foster Mothers' premises 74 Hairdressers' premises 123 Nature of Wokk Executed and Improvements Effected in Dwelling-houses and other Premises under the Provisions of the Housing and Public Health Acts. Dampness retnedied 575 Sashcords renewed 364 Plaster repaired 1,025 Roofs repaired or renewed 729 Guttering repaired or renewed 280 Yards paved 241 Drains relaid or partly relaid 139 Choked drains cleared 99 New w.c. pan and traps provided 115 Sinks provided 102 W.C. cisterns repaired or ronewed 84 40 Rain water pipes repaired or renewed 131 Vent pipes repaired or renewed 55 Sink waste pipes renewed 182 Stoves repaired or renewed 137 Coppers repaired or renewed 108 Floors repaired 245 Cement-work to sink waste gullies repaired 100 Rooms redecorated 2,795 Miscellaneous defects remedied 2,486 Drainage.—The drainage of 139 houses has been reconstructed. In certain instances the drains formed portions of combined systems, and in such cases, in default of the owners, the work was carried out by the staff of the Borough Engineer and Surveyor's Department, the expenses incurred thereby being recovered from the owners. Verminous Houses. Number of houses infested 261 Number of rooms sprayed 622 Rooms sprayed twice 80 Rooms sprayed three times 10 Rooms sprayed four times 1 Rooms stripped and woodwork removed prior to spraying 245 Verminous Articles.—In one instance the Council gave authority for articles infested with vermin to be removed from certain premises and destroyed. Verminous Person.—One application was made to the Petty Sessional Court for an Order to remove a person whose clothing was infested with vermin to a cleansing station, and for his detention therein for such period as was necessary to freo such person and his clothing from vermin. Rag Flock Acts, 1911-1928. There are no premises within the Borough where rag flock is known to be manufactured. Foster Mothers. Seventy-eight visits have been made to premises occupied by foster-mothers. 41 Hairdressers. On 1st August, 1935, the following Bye-laws were made by the Council under the Essex County Council Act, 1933, Part VI, and the Sanitary Inspectors were authorised to enter any premises to examine for any contravention of these Bye-laws. One hundred and twenty-three visits were made for this purpose. Bye-laws with respect to Cleanliness of Hairdressers' or Barbers' Premises, Instruments, Towels and Materials. 1. For the purpose of securing the cleanliness of the premises used for the purpose of carrying on the business of a Hairdresser or Barber a person carrying on such a business shall cause (a) The internal walls and ceilings or the interior of the root of any rooms and every passage or staircase in the premises to be sufficiently repaired and painted or distempered as to maintain the same in a cleanly condition; (b) the floor of the premises to be cleansed at least once during every day on which business is carried on; (c) the floor of the premises to be swept as often as may be necessary to prevent the accumulation of hair clippings, neck wool or other litter; (d) a sufficient number of covered receptacles to be provided and all hair clippings, neck wool or other litter swept from the floor of the premises or otherwise accumulating in connexion with the business to be placed therein. He shall cause every such receptacle to be emptied as often as may be necessary, but at least once during every day upon which business is carried on; (e) every chair or seat provided in the premises to be cleansed as often as may be necessary; (f) every shelf, fitting or table on which instruments, towels or materials are placed to be kept clean; (g) every washbasin provided in the premises and all fixtures and fittings used in connexion therewith to be kept clean. 2. For the purpose of securing the cleanliness of the instruments, towels and materials used in premises used for the purpose of carrying on the business of a Hairdresser or Barber a person carrying on such business shall cause (a) each metal instrument to be cleansed before use upon each person; 42 (b) each hairbrush, comb or other similar instrument used in connexion with the business to be thoroughly washed at least once daily and otherwise kept clean; (c) each shaving brush, sponge or similar article, and each shaving mug or other similar utensil to be cleansed immediately after use for each person so as to ensure that no dirt, soap, lather or other matter remains adhering thereto; (d) where neck wool or other material is used any one piece of such wool or material to be used for not more than one person; Provided that if a material other than wool is used and which is capable of being cleansed this bye-law shall not operate so as to prevent the subsequent use of any one piece of material after the same shall have been clcansed; (e) any styptic, not applied by means of a spray or upon fresh cotton wool or other clean material, to be clean; (f) soap, other than liquid or powdered or tube soap or shaving cream, to be thoroughly rinsed before use for each separate person; (g) a towel or other similar article used in connexion with the business to be clean; (h) paper or linen placed on the back of the chair or headrest to be clean; (i) a fresh supply of water for each person to be used for shaving, lathering or washing. Infectious Diseases. Six hundred visits have been made by the Sanitary Inspectors. Places of Entertainment. Twenty-seven visits have been made to cinemas and other places of entertainment, and in all instances the premises were found to be satisfactory. Petroleum (Consolidation) Act, 1928. Petroleum. Carbide of Calcium. Licences granted after inspection of storage arrangements 12 1 Licences renewed 102 4 Licences lapsed 8 — 43 One application for permission to instal a swing-arm in connection with an underground tank was refused. Poisons and Pharmacy Act, 1908. Two existing licences were renewed during the year. Under the Pharmacy and Poisons Act, 1933, the Council of a Municipal Borough will cease to perform any functions in regard to the control of poisons after 1st May, 1936, and any licence issued by it under Section 2 of the Act of 1908 will cease to be valid after that date. Game Dealers. Seven renewal certificates were issued during the year. Shop Acts, 1912-1928. It was necessary to issue 36 notices regarding infringements of closing hours, and one prosecution was taken at Stratford Police Court in respect of an infringement of the Shops (Hours of Closing) Act, 1928, by a tobacconist who served cigarettes at 8.30 p.m. on a Wednesday, the hour of closing for that day being 8 p.m. The defendant was fined 10s. In March, 1935, the following Resolution was passed by the Council:—"That the appointments of the Sanitary Inspectors as Inspectors under the Shops Acts be rescinded and that they be appointed as Inspectors to enforce the provisions of the Shops Act, 1934, relating to the ventilation and temperature of shops and to sanitary conveniences." Shops Act, 1934. One thousand three hundred and sixty visits were made in connection with the above-named Act. One certificate was granted exempting a shop from Sub-section 2 of Section 10 of the Act, regarding the provision of suitable and sufficient sanitary conveniences. Smoke Abatement. Observations have been made on chimney shafts in the Borough throughout the year, and fourteen "time" observations were made in cases where infringements of the Bye-laws were suspected or alleged. Seven cautionary letters were sent and two verbal cautions given during the year. 44 Schools. Thirty-six routine inspections of the sanitary accommodation and water supply of schools were made. Rat and Mice (Destruction Act), 1919. Two hundred and eighty-seven visits were paid in connection with complaints received, and rat biscuits wore issued to the occupiers of 166 premises. At 71 premises the source of rat infestation was definitely traced and the premises freed of rats. The following report on the National Rat Week was submitted to the Ministry of Agriculture and Fisheries:— "The recommendations contained in the Circular issued by the Ministry of Agriculture and Fisheries have, as far as possible, been carried out. "Posters drawing the attention of the public to the danger of rats were exhibited throughout the Borough. "By the courtesy of the Editors, an article bearing on the subject appeared in the local Press. "The Borough Engineer and his staff co-operated in the efforts made, baits being laid in the manholes of the sewers in 74 roads, and steps were also taken at the Destructor Works, the Council's Shoot, and other places where there was likely to be rats. "Eight applications were made at the office for rat biscuits during the week. "There is no evidence forthcoming as to the actual number of rats destroyed as a direct result of the campaign, but it is known that the baits laid in the sewers were all taken. "It is difficult to estimate the practical value derived from a week's endeavour of this kind, but it is important to remember that in Leyton constant measures are taken throughout the year to deal with the question of rat infestation. "The following interesting figures show the total number of complaints received and dealt with each year during the past five years:— 1931 360 1932 337 1933 314 1934 179 1935 152 45 SECTION D. HOUSING. Complaints. During the year 1,240 complaints of nuisances were received and investigated. The nature of the complaints included sanitary defects in houses, drains choked or defective, premises infested with vermin, etc. Notices. Notices served—Informal 1,704 Statutory—Housing Acts 14 Public Health Acts 8 Re-drainage 102 Notices complied with—Informal 1,906 Statutory— Housing Acts 12 Public Health Acts 8 Re-drainage 93 Housing. Number of houses erected during the year:— (а) Total (including numbers given separately under (b)). (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons: Houses 52 Flats 58 (b) With State assistance under the Housing Acts. (i) By the Local Authority (a) For the purposes of Part iii of the Act of 1925 Nil (b) For other purposes Nil (ii) By other bodies or persons Nil I.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,471 (b) Number of inspections made for the purpose 13,066 40 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 972 (b) Number of inspections made for the purpose 3,086 (3) Number of dwelling-houses found to bo in a state so dangerous or injurious to health as to be unfit for human habitation 14 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation. 1,704 II.—Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action taken by the Local Authority or their officers 1,900 III.—-Action under Statutory Powers during the Year:— (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices (а) By owners Nil (b) By Local Authority in default of owners Nil (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1 (2) Number of dwelling-houses in which defects were remedied after service of formal notices (a) By owners 1 (b) By Local Authority in default of owners Nil 47 (c) Proceedings under Sections 10 and 21 of the Housing Act, 1930 (1) Number of dwelling-houses in respect of which demolition orders were made 13 (2) Number of dwelling-houses demolished in pursuance of demolition orders 12 (d) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Demolition. In accordance with the provisions of the Housing Act, 1930, the Local Sanitary Authority—acting on official representations made by the Medical Officer of Health—has continued to deal with the demolition and clearance of existing slum property in the area. Scheduled in 1934, demolished in 1935:— 13, 15, 17 and 19, Coopers Lane. 124, Lea Bridge Gardens. Scheduled and demolished in 1935 079, 681, 683 and 685, High Road, Leyton. 13, 15 and 15a, Harrow Road. Scheduled in 1934, but not yet demolished:— 138, Lea Bridge Gardens. Scheduled in 1935, but not yet demolished:— 99 and 101, Church Road. 24 and 26, Grange Road. 29, Holloway Road. 74, Lea Bridge Gardens. Under consideration during 1935, but no action taken before end of year:— 9, 11, 13 and 15, Lincoln Street. 3, 5, 7, 9, 11, 13 and 15, Montague Road, 43, Wilmot Road, 48 Repair of Unfit Houses. A notice in respect of 40, William Street was served under Section 17 of the Housing Act, 1930; but the necessary repairs had not been completed at the end of the year, inasmuch as the time allowed for carrying out the works had not elapsed. House-to-House Inspection. The houses in the under-mentioned roads have been inspected during the year:— Abbotts Park Road. Balmoral Road. Beacontree Road. Burchell Road. Burghley Road. Byron Road (part). Gary Road. Clarence Road. Holloway Road (part). Jersey Road. Kingston Road (part). Lincoln Street (part). Lytton Road. Lansdowne Road (part). Malta Road (continued). Montague Road. Pearcroft Road (part). Preston Road. Shelley Road. Skeltons Lane. Temple Street. Toronto Road (continued). Woodville Road. Dwelling-houses inspected and recorded under Housing Consolidated Regulations was 972. Rent and Mortgage Interest Restriction Act, 1923. No applications for certificates were received. Overcrowding. During the year the Public Health Committee of the Council has continued to deal with individual overcrowded premises brought to their notice. 49 Cases outstanding at end of 1934 15 Cases reported to Council, 1935 9 24 Cases abated by— (a) Informal action 8 (b) Statutory action 6 14 Cases outstanding at end of 1935— (a) Notices served 31 (b) Under consideration 7 10 Details of the nine cases reported to Council in 1935:— Case. Rooms Overcrowded. Total Floor Space. Occupants. 1 1 102 sq. ft. 2 ad., 3 ch. 2 2 194 sq. ft. 5 ad., 4 ch. 3 2 214 sq. ft. 5 ad., 3 ch. 4 3 229 sq. ft. 7 ad., 3 ch. 5 2 174 sq. ft. 6 ad., 2 ch. 6 2 231 sq. ft. 8 ad., 1 ch. 7 3 297 sq. ft. 8 ad., 9 ch. 8 1 122 sq. ft. 2 ad., 3 ch. 9 4 390 sq. ft. 11 ad., 4 ch. In respect of these 9 cases the Council decided on the following action:— Informal action 2 Statutory action 4 Deferred action 3 9 Of the 6 cases dealt with, overcrowding has been abated in 3 instances; in the remaining 3 cases the notices had not been complied with at the end of the year. In no case was it found necessary to institute legal proceedings. 50 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Inspections. The following visits were made to food premises during the year:— Slaughter-houses 1,743 Butchers 654 Bakehouses 129 Fishmongers 137 Milkshops and dairies 586 Provision shops 277 Dining rooms 149 Ice-cream dealers 170 Greengrocers 219 Tripe boilers 560 Gut scrapers Bone boilers Fat melters and extractors Blood driers and blood boilers Fish friers 144 MILK. Dairies and Milkshops. Number of premises on register 273 Premises added to register during year 48 Premises removed from register during year 44 Visits of inspection 586 51 Bacteriological Examinations. Undesignated Milk.—Forty-eight samples were taken and the following table shows the result of bacteriological examination:— Number of Sample. Number of bacteria per c.c. 1 7,600 2 3,555 3 32,233 4 10,200 5 16,630 6 9,470 7 55,500 8 15,535 9 2,070 10 268,700 11 20,090 12 1,564,000 13 77,350 14 65,850 15 96,500 16 1,736,000 17 11,200 18 784,000 19 14,425 20 33,490 21 36,890 22 5,775 23 10,220 24 26,085 Designated Milk. Licences. No. Granted No. of Samples taken Result. Satisfactory Unsatisfactory Certified 4 — Grade A "T.T." 11 1 — 1 Grade A Pasteurised 1 ] 1 — Grade A 4 2 1 1 Pasteurised 33 22 15 7 Supplementary Licences — — — — Certified 1 — — — Grade A "T.T." 3 — — — Grade A — — — — Pasteurised 3 — — — Totals 63 23 17 9 52 The results of the 26 samples are shown in the following table:— Grade. Sample Number. Bacteria per c.c. Grade A "T.T." 1 2,770* Unsatis. Grade A Pasteurised 2 310 Grade A 3 3,670 4 196,100* Unsatis. Pasteurised 5 5,750 6 16,900 7 4,175* Unsatis. 8 3,900 9 6,000 10 16,436 11 1,980 12 7,420 13 5,415 14 62,373 15 2,145,000* Unsatis. 16 120,200* Unsatis. 17 1,351,000* Unsatis. 18 203,000 Unsatis. 19 195,000 Unsatis. 20 7,605 21 24,185 22 23,870* Unsatis. 23 7,345 24 2,330 25 18,860 26 7,445 *B. Coli present. Four of the above samples were subjected to a tuberculin test and all proved satisfactory in that respect. Sedimentation Tests. Eight samples were taken and subjected to a sedimentation test, six of which proved satisfactory. Milk Supplied to Schools. Included in the designated milk samples listed above are eight samples of milk taken in course of delivery to schools. All of these proved satisfactory. 53 Ice Cream. Premises on Register at 31-12-1935 155 Premises registered during 1935 33 Premises removed from Register during 1935 13 Persons on Register at 31-12-35 157 Persons registered during 1935 35 Persons removed from Register during 1935 12 Visits of inspection by Sanitary Inspectors 170 Samples taken for bacteriological examination 34 Results of Samples taken for Bacteriological Examination. Number of Sample. Number of bacteria per c.c. 1 65,200 2 81,700 3 112,000 4 92,300 5 191,000 6 63,400 7 296,000 8 142,000 9 39,200 10 61,800 11 298,000 12 18,000 13 123,500 14 31,000 15 15,260,000 16 413,500 17 12,000 18 17,000 19 427,000 20 593,000 21 21,000 22 49,000 23 42,300,000 24 537,000 25 71,000 26 6,058,500 27 25,000 28 240,000 29 52,000 54 Number of Sample. Number of bacteria per c.c.[/$$$] 30 123,000 31 84,000 32 147,000 33 720,000 34 420,000 MEAT. Slaughter-Houses.—There are now eight licensed slaughterhouses in the Borough. One registered slaughter-house was demolished during 1935. One thousand seven hundred and forty-three inspections of these slaughter-houses have been made. Carcases and Viscera Inspected.—There are 2 Inspectors on duty at the London Co-operative Society's Abattoir, and the other slaughter-houses are visited regularly by the District Sanitary Inspectors. The number of animals examined and the amount of meat subsequently condemned gives some idea of the able manner in which this work is done by the Inspectors concerned. Animals Inspected. Cattle 7,894 Calves 1,229 Swine 22,982 Sheep 32,136 64,241 Meat and Other Food Condemned. Total. For Tuberculosis Ox:— Ox Carcase and offal 13 13 Carcase 4 4 Hindquarters 3 2 Forequarters 25 25 Ribs 13 3 Brisket 17 7 Clod and sticking 10 10 Top-piece 5 5 Silverside 1 1 55 Total For Tuberculosis.[/$$$] Leg 2 — Shin 2 1 Flank 36 15 Rump 14 11 Aitch-bone 2 2 Head and tongue 376 250 Head 6 3 Tongue 19 — Steak 7 7 Loin 19 11 Skirt 29 18 Foot 2 1 Heart 15 1 Intestines 98 54 Kidney 26 5 Liver 1,946 104 Lungs 629 234 Mesentery 321 232 Omentum 19 3 Pluck 5 5 Spleen 23 7 Stomach 69 16 Tail 2 1 Bung Guts 26 — Beef 6 stones. Frozen Beef 2 st. 5 lbs. Hindquarters 10 st 3 lbs. Loin 2 stones. Calves:— Carcase and offal. 3 3 Loin 1 — Liver 1 — Pluck 2 2 Head 2 1 Swine:— Carcase and offal 170 148 Carcase 28 18 Fore-end 6 4 Hindquarters 2 1 Shoulder 6 4 56 Swine— Side 1 — Leg 47½ 15 Head 1,875 1,821 Collar 107 107 Loin 23 15 Belly 16 13 Knuckle 1 — Skin 7 — Heart 206 — Intestines 163 24 Kidney 176 3 Liver 3,310 5 Lungs 2,515 1 Mesentery 1,904 1,803 Omentum 15 2 Pluck 997 263 Spleen 32 5 Stomach 51 15 Loin 4 lbs. 4 lbs. Sheep:— Total. Carcase and offal 13 Carcase 5 Forequarter 2 Breast 19 Saddle 1 Target 14 Leg 12 Shoulder 3 Shank 2 Loin 7 Head 55 Heart 12 Kidney 6 Liver 1,647 Lungs 718 Omentum 15 Pluck 63 Spleen 8 Scrag 2 57 Miscellaneous:— Mixed beef and mutton 288 lbs. Sheep trimmings 1 stone. Tinned sheep livers 50 lbs. Imported sheep livers 18 lbs. Imported ox livers 14 lbs. Rabbit 1 Rabbits liver 1 Chicken 1 Scallops 126 Monk-fish 11 stone. Skate 14 lbs. Tinned oranges 116 tins. Apples 15 boxes. Pears 80 lbs. Tinned cherries 119 tins. Flaked rice 1½ lbs. Loose cocoa 3 lbs. Oatmeal 21 lbs. Rolled Oats 24 lbs. Flaked tapioca 2½ lbs. Sago 8 lbs. Public Health (Meat) Regulations, 1924. Six hundred and fifty-four visits were made to butchers' shops and stalls. Twelve letters were sent and 33 verbal notices given in respect of minor infringements, but it was not found necessary to take any statutory action during the year. Bakehouses. One hundred and twenty-nine visits were made to the 40 registered bakehouses. Twenty-four minor infringements were observed, and these were remedied without the service of statutory notices. Restaurants, Dining Rooms and Kitchens. One hundred and forty-nine inspections of premises and utensils were made. Eleven letters were sent and eight verbal cautions given in respect of unsatisfactory conditions. 58 Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Slaughter-houses 8 Dairies, Milkshops and Dairymen 273 Butchers' shops, Stalls and Provision shops 287 Ice Cream dealers 155 Chimneys—Other than private dwelling-houses approximately 100 Hairdressers' Premises 84 Offensive Trades. Rag and Bone dealers 6 Fish friers 33 Tripe boiler 1 Fat melter 1 Fat extractor 1 Gut scraper 1 Bone boiler 1 Blood boiler and blood drier 1 An application to continue the trades of tripe boiler, fat melter, fat extractor, gut scraper, bone boiler, blood boiler and blood drier was received, and permission given to carry on the trades for a further twelve months. One application to continue the trade of a rag and bone dealer was received and granted. Two applications to continue the trade of a fish frier were received and permission given for a further limited period. Five applications for the permission of the Council to establish the trade of a fish frier were made. Two of these were refused and three granted for a period of twelve months. The application of one of the three granted was subsequently withdrawn, and the minute granting consent was afterwards rescinded. One hundred and forty-four inspections were made of the premises where fish frying is carried on. Contagious Diseases of Animals Acts, 1894-1927. Five hundred and four sheep were dipped on the Lea Bridge Marshes in July in accordance with the requirements of the Order. 59 Adulteration, etc. The Essex County Council is the responsible Authority for the administration of the following Acts and Regulations:— Food and Drugs (Adulteration) Act, 1928; Artificial Cream Act, 1929; Public Health (Condensed Milk) Regulations, 1923 and 1927; Public Health (Dried Milk) Regulations, 1923 and 1927; and the Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. I am indebted to the Chief Inspector (Mr. H. C. Card) for the following information regarding samples taken in Leyton during the year under review. Samples of milk taken 53 Samples of butter taken 64 Other samples 265 Staff. Mr. V. W. Smith, one of the Council's Meat Inspectors, was awarded the "Ollett" Gold Medal, which is awarded annually by the Sanitary Inspectors' Association for the best paper submitted during the year, and is open to all England and Wales. The paper dealt with the Humane Slaughtering of Animals and was published in full in my Annual Report for 1934. SECTION F. FACTORIES AND WORKSHOPS. Workshops and Workplaces. One hundred and three inspections were made during the year. Defects were found to exist and have been remedied in 8 cases. Six notices were received from H.M. Inspector of Factories of nuisances remediable under the Public Health Acts. One hundred and sixty-four workshops remain on the Register at the end of the year and are grouped as follows:— Accumulator charging and radio repairs 5 Bakehouses 18 Bedding manufacturers 1 Blacksmiths 3 Carried forward 27 60 Brought forward 27 Boot and shoe makers and repairers 16 Builders' merchants 1 Cabinet makers 4 Cardboard-box manufacturers 1 Confectionery manufacturers 4 Corset makers 1 Cycle repairers 1 Dressmakers 18 Dyers, cleaners and pressers 4 Enameller and plater 1 Fish packers 1 Laundries 4 Leather goods manufacturers 2 Milliners 5 Motor repairers 6 Organ builders 1 Printers 1 Paper articles and lamp shades manufacturer 1 Piano manufacturers 1 Rag sorters 2 Range repairers 1 Scale makers 1 Tailors 22 Tie makers 11 Upholsterers 4 Wire workers 1 Wood choppers 4 Miscellaneous 18 164 Homework. Three hundred and thirty-four visits were made to premises occupied by outworkers. Three hundred and sixty-seven outworkers now remain on the Register. Sanitary defects were remedied in two instances without the service of statutory notices. 61 Factories, Workshops, Laundries, Workplaces & Homework. 1. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories— Including Factory Laundries G99 14 .. Workshops— Including Workshop Laundries 103 8 ... Workplaces— Other than Outworkers premises included in Part 5 of this Report 802 22 ... 2. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. (1) Number of Defects. Found. (2) Remedied. (3) Nuisances under the Public Health Acts:— Want of Cleanliness 29 29 „ Ventilation 1 1 Overcrowding — — Want of Drainage of Floors — — Other nuisances 2 2 Sanitary Accommodation Insufficient — — Unsuitable or defective — 2 Not separate for sexes — — Offences under Factory and Workshop Acts:— Illegal Occupation of Underground Bakehouse (S. 101) - - Other Offences— Excluding offences relating to Outwork which are included in Part 5 of this Report - — 34 34 62 3. HOMEWORK. NATURE OF WORK. Outwork in Unwholesome Premises, Sec. 108. Instances. Notices served. Wearing Apparel:— Making, etc 2 2 SECTION G. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Smallpox. During the year 1935 no case of smallpox occurred in the area. Chicken Pox. On 8th June, 1934, the Minister of Health communicated to the Council that, having regard to the absence of any cases of smallpox in the Borough or its neighbourhood for a considerable period, the value of the notification of chicken-pox would now appear to be doubtful; and intimated that he was no longer prepared to approve the Order of the Council extending the Infectious Disease (Notification) Act, 1889, to chicken-pox. Under the circumstances the Council decided that, after 30th June, 1934, chicken-pox should cease to be a notifiable disease in the area. Enteric Fever. Six persons were notified to be suffering from Enteric Fever during 1935. No. Month. Sex. Age. Address. Nature of Infection. 1 February F. 20 Leybourne Road Typhoid. 2 April F. 21 Whipps Cross Hospital (Nursing Staff) Paratyphoid B. 3 May M. 16 Stewart Road Paratyphoid B. 4 August M. 16 Vernon Road Typhoid. 5 September F. 62 Huxley Road Paratyphoid B. 6 November M. 43 Highstone Typhoid. Case 1 was treated in the London Hospital and died 12 days after admission. Cases 2 and 5 were treated in Whipps Cross Hospital. Cases 3 and 4 were treated in Connaught Hospital, Case 6 was nursed at home, 63 Scarlet Fever. Year. Cases Notified. Deaths. Case Fatality per cent. 1931 297 2 0.67 1932 360 5 1.38 1933 743 4 0.54 1934 681 3 0.44 1935 409 1 0.24 From these figures it will be seen that, as compared with the two previous years, there was a marked fall in the incidence of scarlet fever (409 notified cases) during 1935. The disease continued of the mild type to which we have become accustomed during recent years. One death was certified as due to scarlet fever:— Female 11 years. Endocarditis, Scarlet Fever. This was a patient who died at home due to heart disease, the predisposing cause being an attack of scarlet fever nine months previously. Diphtheria. Year. Cases Notified. Deaths. Case Fatality per cent. 1931 231 6 2.6 1932 155 3 1.93 1933 94 7 7.44 1934 257 11 4.28 1935 276 8 2.89 These figures show that, in spite of the increase in prevalence as compared with the previous year, there was in 1935 a welcome decrease in the fatality rate. The following list shows the particulars regarding the eight deaths certified as due to diphtheria during the year:— Date of Death. Sex. Age. Cause of Death. Where death occurred. 6. 1.35 F. 3 years Diphtheria, cardiac failure Isolation Hospital. 10. 2.35 F. 5 years Diphtheria, acute bronchitis „ „ 12. 2.35 F. 54 years Cardiac failure, bronchitis, diphtheria, cancer of breast. Whipps Cross Hospital. 22. 3.35 M. 9 years Diphtheria Eastern Hospital. 30. 3.35 F. 2 years Diphtheria, cardiac failure Isolation Hospital. 1. 5.35 F. 2 years Diphtheria, cardiac failure „ „ 29.10.35 M. 6 years Diphtheria, cardiac failure „ „ 30.12.35 M. 4 years Diphtheria, cardiac failure „ „ 64 ARTIFICIAL IMMUNISATION AGAINST DIPHTHERIA. In December, 1934, I presented to the Public Health Committee a special report in which attention was drawn to the increase in the fatality rate from diphtheria during the years 1933 and 1934. The experience in Leyton during these years agreed with reports from other parts of the country to the effect that—since 1932—there had occurred a marked increase in the severity of the type of disease met with in many cases. In that report attention was directed to recent methods of protecting children against diphtheria and to the following statement of the Chief Medical Officer of the Ministry of Health:— "No Local Authority responsible for the health of children should be satisfied that it has done its duty until every parent knows that his children can be inoculated against diphtheria with safety and with reasonable certainty of complete protection." After consideration of that report the Council passed the following resolution at the end of January, 1935. "Resolved—That facilities be provided for immunisation against Diphtheria of the children of those persons who desire such treatment to be given, free of charge; that the Medical Officer of Health be authorised to prepare and carry out a scheme for giving effect to this decision and to take such steps as he may consider desirable to advertise these facilities by advertisement, poster notices or otherwise; and that, subject to the confirmation of this recommendation by the Council, the Education and Maternity and Child Welfare Committees be requested to co-operate with this Committee in the dissemination of information with reference to the matter." Diphtheria Immunisation Clinics. In the month of February, 1935, the first municipal clinic for immunisation of children against diphtheria was established. To begin with it was possible to deal with all cases at one weekly clinic, but it soon became evident that two weekly clinics would be necessary in order to deal with the large numbers of children presented for treatment. Since the opening of the new Park House Clinic in September, 1935, one special weekly session at each of the clinics has been devoted to diphtheria immunisation, viz.:- Leyton Green Clinic.—Thursday afternoons. Park House Clinic.—Friday afternoons. 65 Procedure. As soon as the Council decided to institute facilities for diphtheria immunisation, posters outlining the facilities were displayed in the Council's clinic premises and on certain public notice boards in the area. Thereafter, the following pamphlet, prepared by the Medical Officer of Health, was circulated to mothers at the Infant Welfare Centres. "Protection Against Diphtheria. "Diphtheria is a dangerous infectious disease which causes great loss of life, especially among young children. Most children are liable to take diphtheria when exposed to infection ; and the younger the child, the more likely is the disease to be severe or fatal. "There is, however, a safe and reliable means of preventing diphtheria. Any susceptible child can be protected by a course of three small inoculations administered at intervals of a fortnight. No sore is caused ; no scar is left; and the injections are an almost certain protection against recognisable clinical diphtheria. "The risk of a protected child developing diphtheria is very small ; and even if the child did become infected, the infection would almost certainly be mild. "During the past fifteen years many thousands of children in this country have been protected successfully against diphtheria, and no harmful result has ever been recorded. "The protection is not complete until a few months after inoculation; so it is not advisable to postpone this means of prevention until diphtheria occurs in your neighbourhood. It may then be too late. "The Leyton Borough Council, with the sanction of the Ministry of Health, has established a clinic where children over one year of age can be protected free of charge. "Do not wait until an epidemic reaches your neighbourhood. Start at once and make your children safe. "If you wish your child or children to be protected, please complete the attached form and return it to me. You will then be informed when and where your child should attend for treatment." 66. Later, by arrangement with the Education Committee and the Director of Education, pamphlets were given by head teachers to all children attending the Infants and Junior Departments of certain schools in the area. Owing to the limitation in the available facilities, not more than one school could be circularised at a time. Initial Test of Susceptibility. Experience has shown that, whereas the great majority of children under ten years of age are susceptible to diphtheria, the majority of urban school children have acquired a natural immunity towards the end of their school life. Therefore, in order to save time and inconvenience, the preliminary Schick Test of susceptibility has been omitted in children under ten years of ago unless the parents have expressed a definite wish to have the preliminary test carried out. Protective Inoculations. Whereas, until fairly recently, the best results were obtained by three intramuscular injections of Toxoid-antitoxin Mixture (T.A.M.), it is now recognised that equally good results may be obtained by two intramuscular injections of Toxoid-antitoxin Floccules (T.A.F.). In my last Annual Report I drew attention to the fact that preparations of Alum-precipitated Toxoid (A.P.T.)—requiring only one injection ("one-dose immunisation")—were now obtainable; but that the material had not yet reached the stage of being available for mass inoculation. Since that time larger supplies of Alumprecipitated Toxin have been available, and during the year under review opportunity has been taken of testing out this preparation. It was found that the injection of alum-precipitated toxin was followed by a hard nodular swelling at the site of injection, in some cases by an area of inflammation. An additional consideration which weighed against the more widespread use of A.P.T. was the fact that, although it is known to produce immunity after one injection, we do not know how long such immunity may last. Under the circumstances it was considered advisable to use the preparation which can be relied upon to give the maximum amount of protection with the least amount of local and general reaction. The preparation which has been in routine use throughout the year at the Council's special clinics has been T.A.F., of which two intramuscular injections are given, with an interval of four weeks between the two inoculations, 67 Final Test of Susceptibility. As a period of a few months must elapse from the time of inoculation until the child is sufficiently protected to resist an attack of diphtheria, the Final Schick Test is performed three months after the date of the last inoculation. Attendances. The great drawback to more widespread advantage being taken of immunisation against diphtheria is the number of attendances to lie made. In children submitted to the initial Schick Test and found to be susceptible, the following attendances are necessary (assuming that the first attendance he made on 1st January). 1. 1st January—Initial Schick test. 2. 8th January—Estimation of result of initial Schick test. First protective inoculation. 3. 15th January—Second protective inoculation. 4. 9th April—Final Schick test. 5. 16th April—Estimation of result of final Schick test. Grant of certificate of immunity. It will be seen that the full course of immunisation outlined above entails five attendances spread over a period of about 31 months. By dispensing with the initial Schick test the number of attendances is reduced to four, and the period is reduced by one week. Immunisation by Private Medical Practitioners. In order to encourage the protective inoculation by private medical practitioners of Leyton children whose parents do not wish to attend the municipal clinics, the Council decided that facilities should exist for the supply of diphtheria toxoid-antitoxin, free of charge, to local medical practitioners on condition that they supply the Medical Officer of Health with the necessary particulars regarding the persons immunised and adequate proof of the results of immunisation. The following are the particulars regarding Leyton children who attended private medical practitioners during the year:— Number of private medical practitioners who applied for supplies of toxoid-antitoxin 9 Number of children immunised 21 68 Record of Attendances during 1935. The following figures give particulars regarding the children dealt with at the municipal diphtheria immunisation clinics during 1935. The figures refer only to children who have finished—or failed to complete—the full course of inoculations during the year. Children who had commenced—but had not yet completed—the course at the end of the year will be shown in the report for 1936. Under 5 yrs. 5-10 years. 10-15 years. Total. Number of children who attended for immunisation 156 461 195 812 ,. „ who completed course of immunisation 151 450 190 791 „ „ naturally immune 1 5 34 40 „ „ immune after 1 injection 1 — — 1 ,, „ ,, ,, 2 injections 133 415 149 697 ,, „ ,, ,, 3 or more injections 16 30 7 53 „ „ Positive after 3 injections — 2 — 2 ,, Removed from district 3 5 4 12 „ ,, Failed to attend for Final Schick Test 1 2 1 4 „ ,, Failed to attend after 1 injection 1 2 — 3 Number of attendances during 1035 — — — 3.251 These figures show that parents in the area are anxious to have their children protected against diphtheria, and no case of diphtheria has occurred in a child who has been successfully immunised. Pemphigus Neonatorum. In 1933 the Council—with the approval of the Minister of Health—made an Order extending the application of the Infectious Disease (Notification) Act to include Pemphigus Neonatorum. During 1935 one case was notified by a local medical practitioner. The child made an uninterrupted recovery. Tuberculosis. The mortality from non-pulmonary tuberculosis has been halved since the year 1911, i.e., in a space of twenty-three years. 69 Improved Leyton Mortality Rates. The following figures have been compiled to show the marked fall in the number of deaths due to tuberculosis since the passing of the Tuberculosis Regulations (1912). For purpose of comparison the five-year period preceding 1912 is compared with the last live years. Pulmonary. Death Non-pulmonary. Death Deaths. rate. Deaths. rate. 1908 102 .84 43 .35 1909 99 .82 36 .29 1910 101 .82 32 .26 1911 118 .94 53 .42 1912 115 .90 44 .34 535 4.32 208 1.66 1931 98 .76 13 .10 1932 66 .52 8 .06 1933 78 .63 12 .09 1934 68 .55 8 .06 1935 69 .56 8 .06 379 3.02 49 .37 It will be observed that the death rate from pulmonary tuberculosis has been reduced by 30.09 per cent., and from non-pulmonary tuberculosis by as much as 77.70 per cent. in the comparatively short space of twenty-three years. Notifications.—One hundred and forty-six patients were notified for the first time in 1935 as suffering from tuberculosis. The number was made up as follows:— Males. Females. Total. Pulmonary Tuberculosis 68 49 117 Non-Pulmonary Tuberculosis 14 15 29 82 64 146 70 During the year steps were taken, in conjunction with the local Tuberculosis Officer and the Tuberculosis Consultant, Essex County Council, to review as many as possible of the persons notified to be suffering from Tuberculosis in the area. As a result it was found possible to remove from the tuberculosis register the names of eight children and 30 adults in whom evidence of active disease had ceased to exist. The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1935:— Pulmonary. Non-Pulmonary. Total M. F. Total. M. F. Total. Number on Register at commencement of year 305 225 530 77 78 155 085 Number first notified during the year 68 49 117 13 10 29 140 Number of cases entered in Register otherwise than by Notification 18 10 34 4 7 11 45 Number removed from the Register during the year 77 66 143 20 19 39 182 Number remaining at the end of the year 314 224 538 74 82 150 094 Details of cases removed from the Register during the year:— Died 36 27 63 6 4 10 73 Removed from the district 30 26 50 9 6 15 71 De-notified 11 13 24 5 9 14 38 Deaths.-Seventy-seven deaths from tuberculosis were recorded:— Males. Females. Total. Pulmonary Tuberculosis 45 24 69 Non-Pulmonary Tuberculosis 5 3 8 77 This is equivalent to a death rate of 0.03 per thousand of the population, as compared with a figure of 0.01 for the previous year. 71 The following table gives particulars regarding the new cases and deaths which have occurred during the year:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. 0 — — 1 — — — 1 — 1 — 1 2 2 — — — 1 5 2 1 6 4 1 — — 1 10 1 — — 2 — — 1 — 15 6 10 2 3 — 2 1 — 20 9 12 — 1 7 3 — — 25 22 17 3 — 8 9 1 1 35 8 3 — 2 10 5 — — 45 14 4 — 1 9 1 1 — 55 4 1 — — 6 2 — — 65 and upwards. 2 — — — 4 2 — — Totals 68 49 14 15 45 24 5 3 Dispensary.—A tuberculosis dispensary is provided by the Essex County Council at 180, High Road, Leyton. Six sessions per week are held, viz.:— Monday (2—4 p.m.), Children only. ,, (6—-8 p.m.), Adults (working). Tuesday (10—12 a.m.), Women. Thursday (10—12 a.m.), Adults. „ (2—4 p.m.), Men. Friday (2—4 p.m.), Contacts. During the year close co-operation has existed between the Tuberculosis Officer appointed by the Essex County Council (Dr. T. L. Ormerod) and the Medical Officer of Health. Institutional Treatment. During 1935 the following number of Leyton patients were sent to sanatoria or other institutions for the treatment of Tuberculosis:— Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. Adults 57 45 2 — 104 Children 2 2 8 5 17 72 Cancer. There were 179 deaths during the year, giving a death rate of 1.47 per thousand of the population. The various organs affected in their order of frequency may be gauged from the following list of deaths from cancer occurring during the year under review:— Males. Females. Stomach 14 14 Oesophagus 7 — Liver 8 7 Rectum 9 5 Intestines 8 16 Uterus — 12 Ovary — 3 Breast — 13 Tongue 2 — Pancreas 3 1 Bladder 2 — Prostate 14 — Larynx — 1 Lung 5 3 Glands 4 1 Bronchus 4 2 Other Sites 14 7 94 85 Diabetes—Supply of Insulin. In December, 1929, application was made to the Ministry of Health to sanction (under Section 133 of the Public Health Act) the provision by the Leyton Borough Council for a period of six months of a temporary supply of Insulin for patients suffering from diabetes among the poorer inhabitants of the Borough. The Insulin is issued by the Medical Officer of Health, and is supplied only to the Medical Practitioner undertaking the treatment of the patient. The Minister is furnished with a quarterly report by the Medical Officer of Health giving an abstract of the reports forwarded by the medical practitioners, the cost of the Insulin supplied by the Borough Council and any general remarks as to the working of the arrangements. 73 At the expiration of the sanctioned period of six months the sanction of the Ministry has been renewed for further periods. During the year seven patients were supplied with Insulin at a cost to the Council of £29 3s. 9d. Bacteriological Diagnosis.—The arrangements made by the County Council of Essex with the Counties' Public Health Laboratories, 91, Queen Victoria Street, E.C. 4, for the examination of specimens sent by any Authority throughout the County, is being continued. The following specimens were sent:— Diphtheria swabs 12,493 Ringworm 6 Sputum 483 Widal's test (Enteric Fever) 6 Miscellaneous 34 Biological Examinations for virulence test 7 14 TABLE No. 7. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1935. DISEASE. At All Ages. Number of Cases Notified. At Ages —Years. Total Cases Notified in each Locality—Wards. Total cases removed to Hospital. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 276 6 62 162 21 18 7 ... 15 34 20 22 54 19 17 21 46 ... 244 Erysipelas 81 ... 1 2 11 12 35 20 4 ... 3 2 11 9 1 15 12 11 26 Scarlet Fever 409 2 96 251 27 32 1 ... 35 ... 34 35 74 39 45 50 15 286 Dysentery 3 ... 1 1 ... 1 ... ... ... 1 1 1 ... ... ... ... ... ... 2 Pulmonary T.B 117 ... 1 4 38 50 22 2 9 19 14 10 16 8 7 12 11 11 ... T.B. Other forms 29 9 3 13 5 4 2 4 2 1 3 4 3 2 4 5 1 ... Pneumonia 97 ... 10 16 14 32 18 7 10 19 11 13 16 4 1 12 5 6 30 Ophthalmia Neonatorum 6 6 ... ... ... ... ... ... ... ... 2 1 1 ... 1 ... 1 5 Enteric Fever 6 ... ... ... 4 1 1 ... ... ... 1 ... 1 3 ... ... ... 1 4 Puerperal Fever 8 ... ... ... 3 5 ... ... 1 1 1 ... 1 1 ... 1 ... 2 7 Puerperal Pyrexia 12 ... ... ... 4 8 ... ... 1 4 1 1 3 1 ... ... 1 ... 4 Cerebro Spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 6 ... 4 1 ... ... 1 ... ... 1 ... ... 1 1 ... 1 1 1 5 Enc.Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus Neonatorum 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Totals 1051 17 175 440 135 164 89 31 79 i 145 89 88 182 88 73 117 96 94... 75 Terminal Disinfection. Prior to January, 1930, this Council, in common with most Sanitary Authorities throughout the country, carried out the routine and traditional programme of municipal disinfection after the removal to hospital or recovery at home of persons suffering from infectious disease. Since January, 1930, this Authority has discontinued the routine steam disinfection of bedding and clothing from households infected by the commoner infectious diseases such as scarlet fever, diphtheria, etc. Six full years have now elapsed since routine steam disinfection was discontinued, and the following table shows in summary form the results of the last six years compared with those of the six years immediately preceding, In the table the results of six years (1924-29), during which steam disinfection had been carried out, can be compared with those of six years (1930-35) during which it had been adandoned. The table shows at a glance the total number and also the percentage of secondary cases occurring in premises from which the original cases had been removed previously. By way of explanation, it should be pointed out that, in the final comparison, secondary cases occurring within a week of the primary case have been excluded, the reason being that such cases occurring within the known incubation stage of the two diseases may have been infected by the primary case before removal to hospital. Period. Steam Disinfection. Disease. Cases Notified. Cases Removed. Secondary Cases After 7th Day. Percentage of Secondary Cases. 1924/5/6/7/8/9 Practised. S.F. 2,193 1,399 86 6.14 Diph. 1,696 1,413 64 4.52 Total 3,889 2,812 150 5.33 1930/1/2/3/4/5 Abandoned. S.F. 2,951 1,969 130 6.6 Diph. 1.326 1,140 41 3.59 Total 4,277 3,109 171 5.5 76 SCARLET FEVER—SCHOOL EXCLUSION AND HOME TREATMENT. During the year 1933 there occurred in Leyton an exceptionally widespread epidemic of scarlet fever. Even after the most rigorous selection of cases for admission, it was quite impossible to provide hospital treatment for all cases in which the home circumstances were not suitable for home treatment. On the other hand, there were many parents who were able and willing to provide homo treatment, but they objected because it meant the exclusion from school for six weeks of all school children in the same house, which may include more than one family. It was therefore evident that the Education Authority's "Regulations for the Exclusion from School on account of Infectious Disease" provided a barrier in the way of more widespread home treatment, even when such treatment could be provided with relative safety to patients and immediate contacts. In December, 1933, I submitted to the Public Health and Education Committees a special report from which the following is an extract:— In the case of scarlet fever, as in other infective processes, there are from time to time great fluctuations in incidence and severity. Although scarlet fever—a generation ago—was a very fatal disease, over a fairly long period the mortality has been almost negligible. Nevertheless, its isolation and treatment still involves the expenditure of much public money and causes serious interference with the education of children. The measures taken for the treatment and control of infectious diseases have tended in the past to become established practices and fixed traditions, and that in spite of the growth of medical knowledge as to the particular channels of infection. Our methods of disease prevention call for constant and critical reconsideration as to their necessity and expediency. For example, four years ago the traditional routine steam disinfection of bedding and clothing from infected houses was discontinued in this area ; and instead of an increase in the number of secondary cases since that time we have had a decrease. Conclusions and Suggestions. The annual loss of school attendance due to the routine exclusion of contacts is enormous, and 1 am of opinion that it is in great measure unnecessary in the interests of public health. By confining the exclusion of scholars to the incubation period of the disease (e.g., a week in the case of scarlet fever and diphtheria), parents will be more willing to agree to home treatment; thus permitting of the use of available hospital beds for the more serious cases of infection. I propose to redraft the existing "Regulations for the Exclusion of Children from School " in such manner as to interfere as little as possible with school attendance while safeguarding against the conveyance of infection in accordance with modern ideas regarding epidemiology. As far as I know, there is no area in the country where school exclusion has been dispensed with to such an extent so far; but, after giving the matter serious consideration from all points of view, I am convinced that such action has much to commend it both from a public health and from an educational point of view. 77 The Education Authority endorsed that suggestion, and the "Regulations for the Exclusion of Children from School" were modified accordingly in respect of scarlet fever. Since that time scarlet fever contacts have been excluded for only a week, irrespective of whether the patient has been isolated in hospital or at home; whereas previously contacts of home-treated cases were excluded for six weeks. Over two years have now elapsed since the modified procedure was adopted, and in the following table will be found a statistical comparative analysis of the incidence of scarlet fever among school contacts during the two-year periods before and since the modification of the regulations. 78 ANALYSIS OF INCIDENCE OF SCARLET FEVER AMONG SCHOOL CONTACTS (1932-1935). 1. During the period 1932-33 school contacts of patients treated at home were excluded from school for the minimum period of six weeks. 2. During the period 1934-35 school contacts of patients treated at home were excluded from school for one week. Removed to Hospital. Treated at Home, 1932 1933 Total 1934 1935 Total 1932 1933 Total 1934 1935 Total 1. Number of Cases* 215 447 662 404 277 681 94 275 369 270 123 393 2. Contacts of School Age 259 557 816 482 264 746 66 118 214 196 65 261 3. School Attendances lost by Contacts 2,590 5,570 8,160 4,820 2,640 7,460 3,960 8,880 12,840 1,960 650 2,610 4. Ratio of Contacts (2) to Cases (1) 1.20 1.24 1.23 1.19 0.95 1.09 0.70 0.53 0.58 0.72 0.52 0.66 5. Number of School Contacts who developed Scarlet Fever. (a) 1st to 8th day 6 8 14 10 3 13 2 5 7 5 1 6 (b) 8th to 36th day 1 4 5 4 7 11 2 3 5 4 1 5 (c) Total 7 12 19 14 10 24 4 8 12 9 2 11 6. Percentage of School Contacts who developed Scarlet Fever. (a) 1st to 8th day 2.31 1.43 1.71 2.07 1.13 1.74 3.03 3.37 3.27 2.55 1.54 2.29 (b) 8th to 36th day .38 .71 .61 .83 2.65 1.44 3.03 2.03 2.33 2.04 1.54 1.91 (c) Total 2.69 2.15 2.32 2.9 3.79 3.2 6.06 5.4 5.6 4.59 3.08 4.21 * Notified cases occurring in institutions have been omitted in view of the difficulty of ascertaining the actual number of contacts. 79 The detailed analysis shown above may be summarised thus:— (1) Primary Cases (2) Contacts of School Age (3) Ratio of (2) to (1) (4) No. of contacts attacked (5) Percentage of contacts attacked 1932-3. Hospital 662 816 1.23 19 2.3 Home 369 214 .58 12 5.6 Total 1,031 1,030 .99 31 3.00 1934-5. Hospital 681 746 1.09 24 3.2 Home 393 261 .66 11 4.2 Total 1,074 1,007 .93 35 3.4 It will be observed from these figures that the two periods show no wide disparity in respect of incidence and school eon toots. The circumstances are therefore suitable as a means of comparing the efficacy of school exclusion. The one outstanding difference between the hospital-treated and home-treated groups is the ratio of contacts to primary oases. For instance, in the period 1932-33 the ratio was 1.23 for hospitaltreated cases and 0.58 for home-treated cases; in 1934-35 it was 1.09 for hospital and 0.06 for home cases. This is to be expected when one considers that many cases are admitted to hospital simply because the number of home contacts makes isolation at home difficult. However, by accepting as the basis of comparison the percentage of contacts attacked, the two groups are comparable. When comparison is made between the percentage contactattack rates of hospital-treated and home-treated cases it will be seen that in each of the two periods the percentage was greater when the primary cases were treated at home ; but although the difference is statistically significant in the first period, it is not so in the second. The important point, however, is whether the shortening of the school exclusion period was followed by any significant change in the risk, and it will be seen that such was not the case; for although the resulting contact rate during the second period was slightly greater in respect of hospital-treated cases, it was slightly less in respect of home-treated cases. 80 With regard to the loss of school attendance in the two periods, the new regulations in force during the second period apply only to contacts of home-treated cases; but it will be observed that whereas in the first period 214 contacts lost at least 12,840 school attendances, in the second period 261 contacts lost only 2,610 attendances. Of course the number of cases dealt with in this investigation is relatively small, and it is far from my purpose to contend that they afford conclusive proof one way or the other, especially as there are so many factors involved; but from the evidence accumulated so far there is every reason to doubt the necessity for the school exclusion, during the whole period of the illness, of contacts from homes in which scarlet fever patients are isolated. T. consider that the results are sufficiently encouraging to justify the continuance of the modified regulations. ISOLATION HOSPITAL. 82 Statistical Returns 1935. Admissions:— At all ages. Under 1 year. 1 year to 5 years. 5 years to 15 years. 15 years to 25 years. Over 25 years. Scarlet Fever 200 1 72 150 9 22 Diphtheria 188 1 40 113 13 15 Totals 448 2 118 269 22 37 The total number of patients admitted during the year was 448, as compared with 020 during the previous year. The following list shows the numbers of the respective diseases dealt with:— Scarlet Fever. Diphtheria. Admitted 200 188 Discharged 202 182 Died 0 6 Under treatment at end of year 38 18 Scarlet Fever.—Of <409 persons notified during the year 260 (63 per cent.) were admitted to hospital for treatment. Of that number 133 were males and 127 females. The average period of treatment in hospital was 37 days. 1931 1932 1033 1034 1935 Number of cases notified 207 360 743 681 400 Number of eases treated in Hospital 210 223 443 391 260 Percentage 7.3% 62% 50% 58% 63% Deaths in Hospital 3 4 4 I 0 Hospital ease fatality 1.30% 1.79% 0.90% 0.25% Nil. It will be seen from these figures that the incidence of scarlet fever during the year was much lower than that of the previous year (1934). 83 It was found possible to find accommodation in the Isolation Hospital for 63 percent. of the cases notified; but it it was necessary to arrange for admission to institutions outside the area of 18 Leyton residents suffering from scarlet fever. The outlying institutions to which these patients were sent were:— Institution. Number. London Fever Hospital 9 North Eastern Hospital (L.C.C.) 3 South Eastern Hospital (L.C.C.) 1 Eastern Hospital (L.C.C.) 3 North Western Hospital (L.C.C.) 2 No death occurred among patients admitted to the hospital suffering from scarlet fever. Diphtheria.—Of 276 persons notified during the year, 188 (68 per cent.) were admitted to hospital. Of that number, 106 were males and 82 females. The average period of treatment in hospital was 43 days per case. 1931 1932 1933 19 14 1935 Number of cases notified 231 155 94 257 276 Number treated in Hospital 183 115 70 193 188 Percentage 79% 74% 74% 75% 68.1% Deaths in Hospital 1 2 4 10 6 Hospital case fatality 3.27% 1.74% 5.70% 5.18% 3.19% The incidence and severity of diphtheria are liable to marked fluctuation from year to year. As regards incidence, the low water mark was reached in 1933, when only 94 cases were notified; but the tide of diphtheria incidence has been on the "flow" since that time. During the year some 276 cases were notified. Of that number accommodation was provided in Leyton Isolation Hospital for 188 (68 per cent.); but it was necessary to find accommodation for 21 cases in the following fever hospitals in the London area. Institution. Number. Eastern Hospital (L.C.C.) 7 North Eastern Hospital (L.C.C.) 1 London Fever Hospital 13 84 Deaths.—Six deaths due to diphtheria occurred in hospital during the year, the following being the relevant particulars:- No. Sex. Age in years. No. of days ill before admission. Cause of death. In In hospital 1 F. 3 years 3 Diphtheria. Cardiac failure 6 days 2 F. 5 years 4 Diphtheria. Acute bronchitis. Cardiac failure. 8 days 3 F. 2 years 4 Diphtheria Cardiac failure 6 days 4 F. 3 years 3 Diphtheria, Cardiac failure 13 days 5 M. 7 years 2 Diphtheria, Cardiac failure 1½ hrs. 6 M. 4 years 4 Diphtheria, Cardiac failure 4 days Staff. During the year the Council lost the valued services of Sister S. Barnard who retired on superannuation after a period of 30 years service at the Isolation Hospital. Massage and Special Treatment. Following a report by the Medical Officer of Health dealing with the necessity for special massage and treatment for certain patients in the Isolation Hospital, especially in the case of patients suffering from paresis of leg muscles following diphtheria, the Council decided that the services of the Council's Masseuse (Miss Findlay) should be available in these cases. Since 1st January, 1935, Miss Findlay has attended the Isolation Hospital during one morning per week, and the following list shows the numbers of the different types of patients dealt with. Number of patients treated. Number of treatments. Under School Age 33 79 School Children 101 237 Adults 19 33 153 349 Miss Findlay's services at the Isolation Hospital have been greatly appreciated; and as a result of the treatment given it has been possible to ensure that patients suffering from orthopœdic defects leave the hospital in a more fit condition. In addition, Miss Findlay has been able to follow up these cases by arranging for their attendance at the special orthopœdic clinic. 85 INCIDENCE OF COMPLICATIONS AMONG SCARLET FEVER PATIENTS IN RELATION TO OVERCROWDING OF HOSPITAL WARDS. Report by Dr. F. W. Gavin. During the year 1935 the total number of eases admitted to the Leyton Isolation Hospital diagnosed as scarlet fever was 200: 131 males and 129 females. Three of these 260 cases were discharged from hospital as definitely not scarlet fever. In the remaining 257 cases the original diagnosis of scarlet fever was confirmed. Of the 257 cases, 133 (51.75 per cent.) suffered from one or more complications either on admission or during their stay in hospital. Forty-four cases had one or more complications on admission to hospital and 17 of these developed other complications after admission and during their stay in hospital. Thus 27 cases with complications present on admission must be subtracted from our total of 133 cases, giving a total of 100 cases developing complications in hospital, i.e., 41.24 per cent. The average stay in hospital of the 260 admissions was 37 days. Of the 133 complicated cases, OS were males (51.90 per cent. of males admitted) and 05 were females (50.38 per cent. of females admitted). Age of Incidence. Seventy of the complicated cases (52.63 per cent.) were aged 5 years or under. Overcrowding of Scarlet Fever Wards in Leyton Isolation Hospital. Overcrowding of the Scarlet Fever Wards was most marked during the early months of the year 1935, viz., January to March . inclusive, in late May and early June, and during the concluding months of the year, viz., from mid-October to the end of December (see Table "A "). Based on the standard of 144 square feet per bed, the accommodation available for scarlet fever patients should be twenty-four beds. On the basis of 12 linear feet per bed the accommodation is suitable for 28 patients. During the year scarlet fever was again prevalent, although admissions numbered 131 less than the total admissions during 1934. 86 The largest numbers were admitted during the months of October (33), January (32), Decernber (31), May (27), February (25), and November (22) (see Table "C"). COMPLICATIONS. Time of Onset.—As stated previously, 27 cases with complications present on admission did not develop any further complication during their treatment in the Isolation Hospital. In Table "C" 1 have tabulated 239 complications under headings showing time of onset during the period of stay in hospita l. It will be noted that 23 per cent. of these complications were present on admission; and that a higher percentage occurred during the third and fourth weeks of their stay than during their first and second weeks. Possible Relation of Incidence to Meteorological Conditions. Complications were highest during December and in the months of January to March. In this connection 13 out of a total of 14 cases of bronchitis occurred during the periods January to March and September to December (actually six cases in December alone). It is true, however, that—excepting September and early October—overcrowding was worst during these periods of adverse weather conditions in 1935. During the summer months, and provided that the rainfall is not unduly prevalent, it is always possible to nurse scarlet fever convalescents on the verandahs attached to each ward—a valuable therapeutic measure which is not available during the winter months. (1) Nephritis, Initial and Late Albuminuria. During 1935 there was a considerable diminution in the number of patients with this complication as compared with the year 1934. Excluding seven cases of initial albuminuria, there were 20 patients with nephritis and late albuminuria during 1935, i.e., 15 per cent. of all complicated cases or 7 per cent. of all admissions. In this connection there were four cases of late albuminuria in which either scarlet fever antitoxin or anti-diphtheritic serum, or both, had been administered prior to the appearance of the albuminuria. Details of these cases arc:— (a) Late albuminuria of 9 days duration occurred 2 days after the administration of anti-diphtheritic serum. 87 (b) Late albuminuria of 4 days duration occurred 18 days after administration of anti-scarlet serum. (c) Late albuminuria of 18 days duration occurred 3 days' after administration of anti-diphtheritic serum. (d) Late albuminuria of 3 days' duration occurred 12 days after administration of anti-diphtheritic serum and antiscarlet serum. Age of Incidence.—Eighteen cases of late and initial albuminuria and nephritis occurred in children aged 5 years or under (i.e., 66 per cent. of all cases in this group). (2) Diphtheria.—Twenty-seven per cent. of the complicated cases showed positive swabs associated with clinical signs which led to the taking of these swabs. Of all cases admitted, there were 14 per cent. with Diphtheria—11 cases were females and 20 cases males. No less than 20 of these 37 cases were aged 5 years or under, i.e., 70 per cent. Diphtherial cross-infection thus constituted a considerable problem, although less severe than in 1934. (3) Otitis Media.—Thirty-two cases occurred during 1935 (57 in 1934). The incidence was 12 per cent. of all admissions. Nineteen cases, i.e., 59 per cent., were aged 5 years or under. (4) Adenitis.—Thirty-five cases were recorded, i.e., 13 per cent. of all admissions—the seasonal incidence is well seen on reference to Table " B." Twenty cases, i.e., 57 per cent., were aged 5 years and under. (5) Rhinitis.—The total incidence was very high, i.e., 20 per cent. of all admissions. Sixty-five per cent. were aged 5 years or under. (6) Arthritis occurred in 3.8 per cent. of scarlet fever admissions ; 0 cases were females and 4 cases were males. Fifty per cent. of these cases were aged 10 years or older. (7) Bronchitis.—Fourteen cases occurred=5 per cent. of admissions. Nine cases were aged 5 years and under=64 per cent. of cases. (8) Quinsy and Secondary Tonsilitis.—Four cases of Quinsy and 4 cases of Secondary Tonsilitis occurred=3 per cent. of admissions. 88 (9) Cardiac—Five cases—2 per cent. (approximately) of all admissions. (10) Varicella.—Eight cases occurred, 4 males, 4 females. The disease was imported by two cases, one male admitted on 18/12/35 and one female admitted on 20/12/35. Seven of these 8 cases were aged 5 years or under. (11) Recurrent Scarlet Fever—Four cases were recorded, all males. Two were aged 5 years. The recurrent scarlet fever rashes appeared 26, 28, 25 and 22 days after admission, i.e., 25 days on the average. (12) Miscellaneous Complications.—These included 4 cases with ocular affections; 2 cases of vaginitis; 3 cases of mastoiditis, treated successfully by Wilde's incision; 2 cases of purpura; three children with septic fingers; and one who developed a buttock abscess at an injection site. One case of erythema nodosum spent 9½ weeks in hospital—a female aged 5 years who had also a rheumatic carditis. There were 3 cases of Pertussis and 1 case of Rubella. Scarlet fever antitoxin was administered to 27 cases in 1935. One subsequently developed recurrent scarlet fever, and 13 suffered from complications. Conclusions. 1. The prevailing type of scarlet fever in 1935 was mild, as in other years during the past decade. 2. However mild a scarlet fever case may be on admission, complications may occur in convalescence causing prolonged illness and sometimes permanent disability. 3. The administration of scarlet fever antitoxin to 27 cases did not appear to have any beneficent influence on the development of complications (vide supra). 4. The high incidence of complications in the 5-years-andunder-5 children was a marked feature in the year 1935. With regard to the Arthritis and Rheumatism group, 50 per cent. of the cases were 10 years or older. 89 5. Whereas a scarlet fever patient admitted during JulyAugust made an average stay in hospital of only 29.9 days, the average stay in hospital of children admitted during December was over 41 days. 6. Rhinitis was excessively prevalent in 1935. Fifty-two cases were recorded, of whom 12 occurred in January and 11 in December admissions. The incidence is probably largely seasonal, but it also occurred when overcrowded conditions in the scarlet fever wards existed. 7. The lessened incidence of late albuminuria in 1935, as compared with 1934 (7 per cent. and 17.82 per cent. respectively) may be due to repairs carried out on the walls of two scarlet fever wards. Prior to these repairs draughts were noted. 8. Lack of sufficient side-ward isolation accommodation makes it a matter of difficulty to take adequate precautions against the spread of septic infection, which is, to some extent, responsible for such complications as Otitis Media, Rhinitis, Tonsilitis, Quinsy and Bronchitis. 9. Regarding the incidence of Diphtheria, where 70 per cent. of the cases were aged 5 years or under 5 years of age, positive swabs were so common that during the year 72 cases received anti-diphtheritic serum. 10. Finally it would appear that overcrowding scarlet fever wards is not only a danger from the individual patient's point of view, but that it also tends to defeat its own object by prolonging the average stay in hospital of the patients concerned. 90 TABLE A. Week ending 1935. Number of beds available on basis of 144 sq. ft. floor space per bed. Average daily number of Scarlet Fever patients. Number of Scarlet Fever cases admitted during week. Number of these admissions who developed complications. Males. Females. Males. Females. Jan. 5th 24 32.8 1 2 - 1 Jan. 12th 24 33.8 8 3 6 3 Jan. 19th 24 39.4 5 2 2 I Jan. 26th 24 43.1 4 2 4 1 Feb. 2nd 24 42.4 4 3 2 2 Feb, 9th 24 43.4 4 5 1 2 Feb. 16th 24 39.9 2 4 1 I Feb. 23rd 24 39.1 2 3 1 1 March 2nd 24 37.0 3 2 2 2 March 9 th 24 35.5 2 5 — 3 March 16th 24 31.8 1 2 1 — March 23rd 24 29.2 2 2 — 1 March 30th 24 23.8 2 2 1 2 April 6th 24 23.1 1 2 — — April 13th 24 23.8 3 3 1 2 April 20th 24 27.7 — 4 — 2 April 27th 24 23.2 — 3 — 2 May 4th 24 21.4 1 1 — 1 May 11th 24 21.4 2 2 1 — May 18th 24 20.0 7 2 4 1 May 25th 24 29.4 4 3 2 2 June 1st 24 35.1 2 3 1 — June 8th 24 36.2 4 2 2 2 June 15th 24 34.7 — 1 — — June 22nd 24 26.0 — — — — June 29th 24 18,4 1 — — — July 6th 24 16.8 3 1 1 1 July 13th 24 16.4 1 3 — 1 July 20th 24 17.1 1 5 —- 2 July 27th 24 17.8 2 2 — — August 3rd 24 20.0 3 2 — 1 August 10th 24 20.4 1 3 1 1 August 17th 24 18.8 — 1 — 1 August 24th 24 16.5 1 1 — — August 3lst 24 11.2 — 1 — — Sept. 7th 24 7.2 1 1 1 1 Sept. 14th 24 9.4 1 4 1 1 Sept. 21st 24 10.7 1 — — — Sept. 28th 24 11.8 2 2 2 2 Oct. 5th 24 15.2 2 6 1 5 Oct. 12th 24 20.1 2 2 — 1 Oct. 19th 24 22.5 6 4 3 1 Oct. 26th 24 29.5 3 6 1 5 Nov. 2nd 24 34.8 3 3 — — Nov. 9th 24 36.7 4 2 2 — Nov. 16th 24 37.0 1 1 1 — Nov. 23rd 24 28.42 4 2 2 1 Nov. 30th 24 24.0 3 3 2 1 Dec. 7th 24 24.2 4 2 2 1 Dec. 14th 24 28.6 7 3 7 3 Dec. 21st 24 33.8 4 4 3 3 Dec. 28th 24 37.1 6 2 6 1 Totals 131 129 68 65 Total 260 133 91 TABLE B. 1935. Renal. Diphtheria. Otitis Media. Cervical and other adenitis. Rhinitis. Arthritis. Bronchitis. Quinsey- Secondary Tonsilitis. Cardiac. Conjuncti vitis, Blepharitis and Styes. Varicella. Mastoid. Vaginitis. Purpura All cases admitted Average period in hospital. Nephritis. Albuminuria. Initial. Late. Jan-March 2 2 7 14 13 15 19 1 3 2 3 1 4 — 3 1 2 38.23 April-June — 4 1 5 5 3 6 2 1 — 1 1 — — — 1 — 35.57 July-August — 1 1 2 1 1 5 1 — 1 — — — — — — — 29.90 Sept-Nov. 4 — 4 9 7 12 11 4 4 1 — 2 — 3 — — — 34.89 December — — 1 7 6 4 11 2 6 — . — 1 — 5 — — — 41.24 Totals 6 7 14 37 32 35 52 1 10 14 4 4 5 4 8 3 2 2 Note.—The normal length of stay in hospital of a case admitted at the commencement of scarlet fever is 28 days. Some cases were admitted in the later stages of desquamation and, provided there were no complications, had correspondingly shorter periods in hospital. 92 TABLE C. 1935. Number of Scarlet Fever Admissions. Number of these Cases with Com plications. January-March 77 41 (53.24%) April-June 51 22 (43.13%) July-August 31 9 (29.03%) September-November 70 36 (51.42%) December 31 25 (80.64%) 260 133 Time of onset of Scarlet Fever Complications. On admission. During 1st week in Hospital. . During 2nd week in Hospital. During 3rd week in Hospital. During 4th week in Hospital. During 5th or succeeding week in Hospital. 55 or 23 per cent. 28 or 12 per cent. 33 or 14 per cent. 48 or 20 per cent. 38 or 10 per cent. 37 or 15 per cent. Maternity and Child Welfare. 94 MATERNITY AND CHILD WELFARE. INFANT WELFARE. Notification of Births.—Fourteen hundred and nine notifications of births were received during the year. By medical practitioners 303 By midwives 1,106 By parents and others — Infant Welfare Centres. Prior to 14th September, 1035, there were three Infant Welfare Centres in the Borough. When the New Joint Clinic premises at Park House became available in September, 1935, the Maternity and Child Welfare Authority discontinued the use for clinic purposes of the premises at the People's Hall, Harrow Green, and at Christ Church Institute, Francis Road. During the year Infant Welfare Clinics were held at these Centres as follows:— 1st January to 14th September. 1. The People's Hall, Harrow Green, Leytonstone.—Tuesdays, 10 a.m. and 1.45 p.m. 2. Health Clinic, Leyton Green Road.—Wednesdays and Thursdays, 1.45 p.m. 3. Christ Church Institute, Francis Road, Leyton.—Mondays and Fridays, 1.45 p.m. 16th September to 31st December. 1. Park House Clinic, Granleigh Road, Leytonstone.—Mondays, Tuesdays and Thursdays, at 1.45 p.m. 2. Health Clinic, Leyton Green Road.—Mondays, Wednesdays and Fridays, at 1.45 p.m. 95 Infant Welfare Clinics. ATTENDANCES, EXAMINATIONS, etc. From 1st January to 14th September, 1935. Francis Road. Harrow Green. Leyton Green. All Centres. p.m. Mon. p.m. Fri. a.m. Tues. p.m. Tues. p.m. Wed. p.m. Thurs. Under 1 year— 1st attendances 97 79 51 201 172 143 743 Subsequent attendances 1,129 919 601 1,846 1,873 1,423 7,791 Total attendances 1,226 998 652 2,047 2,045 1,566 8,534 1 -5 years— 1st attendances 20 12 12 25 25 30 124 Subsequent attendances 615 311 326 909 456 497 3,114 Total attendances 635 323 338 934 481 527 3,238 Total attendances, both age groups 1,861 1,321 990 2,981 2,526 2,093 11,772 Average attendance per session 56.39 38.85 29.11 87.67 74.29 61.55 57.99 Number examined by Clinic M.O 840 668 405 1,555 754 785 5,007 Average number examined per doctor per session 25.45 19.64 11.91 *22.86 22.17 23.08 21.12 Number weighed 1,798 1,310 985 2,944 2,510 2,117 11,664 * Two doctors in attendance, the figures shown being the average number examined by each doctor. 96 ATTENDANCES, EXAMINATIONS, etc. From 16th September to 31st December, 1935. Leyton Green. Park House. p.m. Mon. p.m. Wed. a.m. Toddlers. Fri. p.m. Fri. p.m. Mon. a.m. Toddlers. Tues. p.m. Tues. p.m. Thurs. All Centres Under 1 year— 1st attendances 40 57 — 34 40 51 39 261 Subsequent attendances 332 870 — 352 664 — 483 290 2,991 Total attendances 372 927 — 386 704 — 534 329 3,252 1-5 years— 1st attendances a 5 14 10 2 37 5 4 86 Subsequent attendances 126 283 35 110 325 51 218 112 1,260 Total attendances 135 288 49 120 327 88 223 116 1,346 Total attendances, both age groups 5D7 1,215 49 506 1,031 88 757 445 4,598 Average attendance per session 36.21 86.78 3.50 36.14 73.64 6.28 54.07 31.78 41.05 Number examined by Clinic M.O. 185 351 44 205 408 84 294 242 1,813 Average number examined per doctor per session 13.21 25.07 3.14 14.64 29.14 6.00 21.00 17.28 16.18 Number weighed 503 1,119 40 481 1,015 88 716 433 4,475 97 During the year under review, the total attendances at the Council's Infant Welfare Centres were 16,370, an increase of 1,003 compared with the figure (15,367) for the previous year. The number of children examined by the Clinic Medical Officers was 6,820 as compared with 6,644 examined during the previous year. Voluntary Workers. The following is a list of the ladies who act as Voluntary Workers at the maternity and child welfare centres:— Name. Centre. Since. Mrs. M. Hawkey Leyton Green 1918 Mrs. Wagstaff Leyton Green 1924 Mrs. E. Carter Leyton Green 1929 Mrs. E. Garton Leyton Green 1933 Mrs. V. Softley Leyton Green 1933 Mrs. D. Jacobs Leyton Green 1934 Miss M. Grant Leyton Green 1934 Mrs. Muddiman Park House 1917 Mrs. A. Tallack Park House 1917 Miss H. S. Holl Park House 1927 Miss E. H. Holl Park House 1927 Mrs. J. Oates Park House 1929 Miss Muddiman Park House 1934 During the year these ladies have continued to render valuable assistance at the infant welfare centres, where their services are greatly appreciated. Without their assistance it would be impossible to cope with the large numbers attending. Mrs. M. H. Wood, who had rendered loyal and valuable service as a voluntary worker at the Council's Infant Welfare Centres since 1917, retired in September, 1935. Health Visitors. Miss Barbara Neale, a member of the health visiting staff, was unfortunately incapacitated from duty owing to illness from August, 1935, until the end of the year. Miss Clements deputised for Miss Neale from September until December, 1935. Each of the five Health Visitors is on duty at three clinic sessions per week, 98 During the year the Health Visitors have made 16,153 visits to homes, as follows:— (a) To expectant mothers:— First visits 117 Total visits 133 (b) To children under 1 year of age:— First visits 1,476 Total visits 6,716 (c) To children between the ages of 1 and 5 years:— Total visits 8,986 (d) Visits not included above:— Children Act—Infant Life Protection 293 Whooping cough 20 Dental Treatment. During the past five years the number of expectant mothers and children under five years of age who have received dental treatment in connection with the Council's scheme for maternity and child welfare has been as follows:— 1931 265 1932 300 1933 292 1934 273 1935 283 The record of such treatment undertaken during the year 1935 is as follows Expectant Mothers. Children. patients treated 75 208 Attendances 206 300 Extractions 351 321 Fillings 37 64 Other dental operations 47 13 Advices only 14 24 Anaesthetics— General 60 32 Local 9 157 99 Dentures supplied— Full upper and partial lower 1 Full upper and lower 4 Full upper 1 Partial upper 3 9 Orthopaedic Treatment. Primary Examinations.—During the year 56 children were referred from the Infant Welfare Clinics to the Council's Orthopaedic Surgeon. The orthopaedic defects included :— Congenital. Torticollis 1 Flexion deformity knee 1 Talipes 9 Webbed digits—feet 1 Spastic diplegia 1 Acquired . Genu valgum25 Bowed tibiae 14 Bowed femora 1 Pes piano valgus 27 Deformity—digit foot1 Deformity hip joint 1 Anterior poliomyelitis 1 Baker's cyst 1 Naevus1 Re-examinations.—In addition to the 56 new cases mentioned above, 195 children under five years of age attended for re-examination by the Orthopaedic Surgeon. Treatment.—One hundred and eight children made 501 attendances at Knotts Green Special School for special treatment by the Council's Masseuse (Miss Findlay). 100 Provision of Surgical Appliances.—One hundred children were supplied with surgical appliances on the recommendation of the Orthopaedic Surgeon, and the following is a list of the appliances supplied under the Authority's scheme :— Tibial splints, pockets and wedges to boots ... 4 Genu valgum splints 2 pairs 1 single Talipes splint 6 Knee splint 1 Minor alterations to boots (wedges, etc.) 65 pairs Alterations and repairs to splints, etc. 21 Surgical Operations.—During the year three children under school age were admitted to hospital and the following operations were performed by Mr. Whitchurch Howell :—- Osteoclasis R. and L. with plaster 1 Removal of Baker's Cyst—knee 1 Investigation and splintage 1 Special Eye Clinic. During the year the Council's Ophthalmic Surgeon (J. D. Magor Cardell, M.B., F.R.C.S.) had referred to him by the Clinic Medical Officers 24 pre-school children, who made 33 attendances for examination and treatment. The following list shows the ophthalmic defects found in these 24 children :— Myopia 1 Hypermetropia 1 Hypermetropia with squint 11 Squint only 11 Various diseases (Opacity 1, Nystagmus 1) 2 26 The following forms of treatment were recommended :— Spectacles supplied 15 Spectacles not prescribed 2 Squint treated with atropin 4 Recommended ultra violet light 1 101 Artificial Sunlight Treatment. Number of cases treated—Infants 45 Number of cases treated—Adults 2 Total number of attendances 1,042 Convalescent Home Treatment. During the year 38 children recommended by the Clinic Medical Officers were sent to Convalescent Homes by the Maternity and Child Welfare Authority through the agency of the Invalid Children's Aid Association. Dr. Menzies has submitted the following clinical observations on the children recommended by her for convalescence during the year : One child's period of convalescence was curtailed because of the mother's hysterical behaviour. She threatened to commit suicide if the child were not returned to her care. This child, aged 4£ years, had been found to be unmanageable when brought to the clinic by the mother, but behaved well when the father brought him on one occasion. The hope of the child developing into a well-balanced adult is likely to be ruined by association with the mother. A second child was discharged after one day because she was discovered to be a scarlet fever contact. A third did not settle at the convalescent home and was removed by his relatives after three weeks. This was a child who had 110 mother and was cared for by an aunt who was worried by his slow progress. The remaining 35 children had periods of convalescence varying from one month to four and a half months. Two-thirds of the children were away at least eight weeks; and of these, 10 were away three months or longer. Twenty-six of the 35 children were between the ages of 2 and 4 years ; 7 were over four years and 2 were under two years. The illnesses, for which convalescence was recommended, were :— Marasmus. Pharyngitis. Abscess of leg (2 cases). Otitis Media (5 cases). Bronchitis (4 cases). Pneumonia (3 cases). Intussusception. Anaemia (2 cases). Whooping Cough (3 cases). Asthma. Scarlet Fever. The proportion following diseases of the respiratory tract is considerable. In the remainder of the cases there had been 110 definite illness, but the children were making slow progress and could only be classed as suffering from debility of unknown origin. All the children benefited by their period of convalescence. 102 Ophthalmia Neonatorum. Cases. Treated At Home. In Mosp. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified in the area. 6 2 4 6 — — — Notified outside the area. — — — — — — Totals 6 2 4 6 — — — Treatment.—These 6 cases were treated as follows :— At home 2 St. Margaret's Hospital 3 (mothers and infants) Whipps Cross Hospital 1 6 Infant and Foetal Mortality. There were 60 registered deaths of infants under one year of age, giving an infantile mortality rate of 40.18 per thousand live births. Reference to Table 4 (page 27) will show that the number of infant deaths (60) registered during 1935 is the lowest ever recorded in the history of the area. Neo-natal Mortality (deaths of infants under one month).— Of the 60 deaths under one year, 31 occurred in the first four weeks ; and of the 31 deaths under four weeks, 25 occurred in the first week. The following figures show the variations in the infantile and neo-natal mortality rates and in the number of stillbirths during the last five-year period. Year. Births. Deaths under Mortality Rate. Stillbirths. 1 year. 4 weeks. Infantile. Neo-natal. 1931 1,812 71 38 39.18 20.97 59 1932 1,666 89 51 53.42 30.61 58 1933 1,499 76 47 50.73 31.35 48 1934 1,454 64 38 44.02 26.13 46 1935 1,493 60 31 40.18 20.76 44 Reference to Tables 8 and 8a will show that the chief causes of neo-natal deaths are premature birth (14) and congenital malformations (7). 103 TABLE 8. Infantile Mortality, Year 1935—Ages. CAUSES OF DEATH. \ lapuQ 1 z—I '«>!•« « £—S 1 f~C japun pjojq •sq^uo]\r g japun pus s^aa^ f •ei{}uoj\[ 9 japun put* sq^uoH g •si[|uoj/\[ (} japun put? sqjuoj^ 9 •sifluoj^ japun pue sq^uoj>[ 0 •jsa^ x j^pun sii^a mox Smallpox ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... ... ... 1 2 Diphtheria and croup ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... ... ... ... ... 1 Abdominal tuberculosis ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous.) ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 1 ... ... 3 Pneumonia (all forms) 1 ... ... ... 1 1 2 ... 1 10 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... 1 ... ... ... 1 ... Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 2 ... ... ... 2 ... ... ... ... ... Atelectasis 2 ... ... ... 3 ... ... ... ... ... Congenital malformations 7 ... ... ... 7 ... ... ... ... 10 Premature birth 12 2 ... ... 14 ... ... ... ... 14 Atrophy, debility and marasmus ... ... ... ... ... 1 2 ... ... 3 Other causes 1 ... 2 ... 3 2 1 ... 1 7 Totals 25 3 2 1 31 9 10 6 4 60 Nett Births registered during the calendar year Legitimate 1,448 Illegitimate 45 Nett Deaths registered during the calendar year Legitimate infants 56 Illegitimate infants 4 TABLE 8a. Infantile Mortality During the Year 1935—Wards. CAUSE OF DEATH. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Ward not known. Total Deaths under 1 Year. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... 1 ... ... ... ... ... ... ... ... 2 Diphtheria and croup ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... 1 ... ... ... ... ... 1 Abdominal tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... 3 Bronchitis ... ... ... ... ... 1 ... 1 ... 1 ... 10 Pneumonia (all forms) ... ... 1 ... ... ... ... 1 ... ... ... ... Diarrhoea ... ... ... ... ... ... ... ... ... ... ... 5 Enteritis ... ... 1 ... ... ... ... ... 1 ... Gastritis ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... Bickets ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... 1 ... 2 Atelectasis ... ... ... ... 3 ... ... ... ... ... ... 3 Congenital malformations ... ... ... 1 1 5 ... ... ... 2 ... 10 Premature birth ... 1 3 1 2 3 1 1 ... 1 ... 14 Atrophy, Debility and Marasmus ... 1 ... ... ... ... 1 ... 1 ... 3 Other causes ... 1 1 ... ... ... 1 2 2 ... ... 7 Totals ...2 9 7 3 7 10 4 5 6 7 — 60 104 105 Children and Young Persons Acts, 1908-1932. Infant Life Protection. On 1st January, 1035, 45 foster mothers and 47 children were subject to inspection in the area. At the end of the year 52 foster mothers and 57 children were subject to systematic inspection by this Council's Visitors. During the year under review the Council granted permission to 1 foster mother to undertake the care and maintenance of more than one child. The Council's Infant Life Protection Visitors made 293 visits of inspection during the year. Summary, Year 1935. Number of nurse children on Register 1st January 47 Number of nurse children notified by foster mothers during the year 43 Nurse children removed :— To parents or relatives 14 To another foster mother 6 With foster mother to another area 2 Adopted 1 To National Children's Home 3 To other institutions 6 Attained 9 years of age 1 Died — Number of nurse children on Register on 31st December 57 ANTE-NATAL SUPERVISION. Ante-natal Clinics— On 14th September, 1935, the Ante-Natal Clinic formerly held at the Essex County Nursing Association Home, Beaehcroft Road, was transferred to the new Joint Clinic at Park House, Leytonstone. When the new Clinic was opened it was found possible to deal with all ante-natal cases at two clinic sessions per week, instead of at the three which had been held formerly. 106 Attendances.—During 1935, the attendances were as follows Centre. First Attendances. Subsequent Attendances. Total. Beacheroft Road 155 199 354 Park House Clinic, 37 48 85 Leyton Green Clinic- Wednesday 141 220 361 Friday 94 131 225 427 598 1,025 The total number of first attendances was 427, the corresponding figure for 1934 being 401. The total number of attendances at all clinics during the year was 1,025 the average attendance per session being 7.88. Of the 427 expectant mothers who made first attendances during 1935, 133 had not been confined by the end of the year and the results of these cases will be included in the Annual Report for 1936. Oil the other hand, 123 cases were carried over from 1934, and, when these are included, details of 417 cases are available. Of that number 11 were not pregnant, and the following table deals with the attendances of the remaining 406. Number of Expectant Mothers who attended. 406 Percentage of Primigravida1. 39.16 Percentage of Multiparae. 60.84 1. Attended before 24th week of pregnancy %* 36.47 "(37.03) %* 27.12 °(28.75) 2. Attended after 24th week and before 30th week 21.38 (22.96) 17.40 (20.83) 3. Attended after 30th woek and before 36th week 6.28 (7.40) 6.47 (7.91) 4. Transferred 27.67 (20.00) 23.48 (12.08) 5. Unsatisfactory 8.17 (12.59) 25.50 (30.41) * Figures for previous year (1934) shown in brackets. In the above table the percentages shown (1,2 and 3) include only those who continued to attend and who made from two to eight attendances. That is to say, 64 per cent, of the primigravida? and 51 per cent, of the multiparae were, on the whole, satisfactory 107 in their attendance ; (4) includes those who were transferred to hospital after one attendance, or who ceased to attend for some other known reason, e.g., removal from district, etc. The unsatisfactory group (5) includes both those who attended early in pregnancy but did not attend regularly, and those whose first attendance was made so late in pregnancy that it was possible to see them once only. Thirty-one point sixty-five per cent, of expectant mothers attended of their own accord or on the advice of a friend or relative. Fifty-seven point thirty-one per cent, were sent by their midwives and 12 cases were advised to attend by their own doctors. The number of home visits made by Health Visitors to expectant mothers during the year was 133. The results of all cases examined are tabulated below. Percentage of Finished Number. Gases. Normal 343 89.32 Prematurity 6 1.50 Stillborn 4 1.04 Instrumental delivery 14 3.04 Breech presentation 4 1.04 Miscarriage 8 2.08 Twins 2 0.52 Induction 1 0.20 Died ... 2 0.52 Total 384 Not pregnant 11 Removed 22 Grand Total 417 Two patients who had attended the ante-natal clinic died during pregnancy. One was a primigravida, aged 23 years; who was about 18 weeks pregnant when she attended for examination. She gave a history of tuberculosis, having been in a sanatorium for twelve 108 months some six years previously. She admitted that she had tubercle bacilli in her sputum at that time, but now considered she had bronchitis only in the winter, and stated that she was having treatment from her private practitioner. She was obviously gravely ill when she attended the ante-natal clinic, with rapid pulse (120130), slightly raised temperature, and an almost complete absence of subcutaneous tissue. She was referred to the Tuberculosis Dispensary, and was found to have a strongly positive sputum. She died five weeks later after a sudden haemoptysis. , The second case was a woman, age 34 years, who attended when she was 20 weeks pregnant, and was found drowned ten days later. She was not in any obvious mental distress when she attended the clinic, and nothing was known of her history apart from the fact that she had suffered from what she described as epilepsy since the birth of her first child 15 years ago. Her second pregnancy was in 1933, and the child had died at 7A- weeks from marasmus. Analyis of Abnormal Cases. (Report by: Dr. Menzies). (a) Instrumental Delivery (14 cases). All the instrumental deliveries occurred in primigravidae, Four had arranged to go into hospital for their confinements and a fifth who had booked with a midwife was referred to hospital because of general contraction of the pelvis, and was subsequently admitted for labour. One case booked with a general practitioner and therefore ceased attendance at the clinic. Of the remaining eight who had booked with midwives, two failed to attend in the last two months in spite of notifications sent to the midwives of their patient's non-attendance—one of these resulted in an oecipito-posterior presentation. The remaining six were under supervision from the early months of pregnancy. Four were watched for disproportion, but did not show definite evidence of it in pregnancy. Two were almost certainly 2-3 weeks overdue, and probably ought to have been induced. In a third case there were mild pre-cclamptic signs, and the midwife was advised to send for medical aid. A fourth case had low blood pressure and complained of faintness on standing. In three out of the six, the head was in the pelvis 2-4 weeks before labour commenced. The ages of these 14 primigravidae ranged from 19 to 35. Five were under 25 years, and only two were over 30 years of age. All the babies were born alive, but in one of the hospital cases, the baby died seven hours after delivery. (b) Miscarriage (8 cases.) Of the eight patients whose pregnancies terminated in miscarriage, two were primigravidae. One was attending hospital, was thought to have a fibroid, and had a miscarriage at five months. The second was a twin 109 pregnancy which terminated at 4] months. Of the six multiparae, four had had previous miscarriages or stillbirths, and the other two occurred in women (20 and 21 years of age respectively) who had become pregnant, one five months, and the other ten months after the birth of the first child. Of the four who had had previous miscarriages or stillbirths, one was pregnant for the fifth time in seven years, and her age was then 29. Her second pregnancy had resulted in a stillbirth, and she had ante-partum haemorrhage during her fourth. Another was having her second miscarriage within twelve months following one live birth three years previously. The third was in a woman of 37 years, in poor physical condition. She had had two live births, followed by a miscarriage, a third live birth after an interval of six years, and the present miscarriage was 4$ years later. The fourth had had a neutral fixation fi.ve years ago and this was her second miscarriage since then. She had previously had two living children. (r) Prematurity (6 cases.) Of the six cases of premature birth, three occurred in primigravidae and three in multiparae. Of the primigravidae, one developed pleurisy and a premature birth resulted at 6 A month.®, the baby living for seven hours. In the second case the pelvis was generally contracted—the patient was apprehensive and the pregnancy terminated at 37 weeks. The third case had had one miscarriage before, although this was her first labour. She had a small pelvis and the pregnancy terminated at 36 weeks. Of the three multiparae, one was a woman aged 41 who had previously had two miscarriages and three full-term children—her mouth was in a septic condition. The second had had oedema of her feet for one month before her first and only attendance at the clinic at 36-37 weeks. The pregnancy terminated the following week. In the third case there was nothing to account for the termination of pregnancy at 36 weeks. The only case in which the baby died was the case of pleurisy. (d) Stillbirths (4 cases.) Of the four stillbirths, two were premature births. One was in a woman of 39 years who had had eight previous pregnancies, resulting in four living children—two premature children who had died in a few hours, and two miscarriages. This patient was in poor physical condition—she had had all her teeth extracted earlier in pregnancy for pyorrhoea, and she was ordered free milk, cod liver oil and malt and iron when she attended the clinic. The second premature stillbirth was in a woman of 30 years who had had one miscarriage—no other pregnancy. She had had slight swelling of her feet and raised blood pressure during this pregnancy but these symptoms responded to rest and diet. Of the remaining two stillbirths, one was a case of placenta praevia in a multipara aged 41; and the second was the result of a breech presentation in a primigravida aged 21 who failed to attend the clinic during the last two months of her pregnancy. no (e) Breech Presentation (4 cases.) Of the four breech deliveries one, was not in regular attendance at the clinic. She was sent by her private practitioner for advice early in pregnancy because her three previous pregnancies had terminated at three, four and seven months respectively. This pregnancy resulted in a living child. Two of the three who attended late in pregnancy were multiparae. One, a case of extended breech, was diagnosed as such at the clinic. The second, who made one attendance at. 37 weeks, was not diagnosed. The third was a primigravida and was not diagnosed as a breech presentation in pregnaney. All the children survived. (/) Induction (1 case.) This patient supplied details of her first confinement (in 1034), which had resulted in a stillbirth after three days labour in hospital. Caesarean section had been considered in the first pregnancy, but it was decided to wait and see if the child could be born by natural means. She was referred from the clinic to hospital and surgical induction was performed at the 37t.h week, resulting in the birth of a living child. Considerable persuasion was required before the patient decided to follow the advice given, that, hospital treatment was necessary. Maternity Beds. In addition to the 427 expectant mothers who attended the Council's clinics, 308 attended the Out-patient Department of Queen Mary's Hospital, Stratford, for ante-natal supervision. These mothers had their confinements in the Margaret Lyle Wards of the hospital. The complications dealt with included— Albuminuria 11 Ante-partum haemorrhage 1 Post-partum haemorrhage 11 Ruptured perineum 42 Breech presentation 6 Forceps delivery 21 Induction 9 Caesarean section 4 Episiotomy 10 Eclampsia primary uterine inertia 1 Mastitis 2 Prolonged labour 3 Pyrexia 12 Puerperal sepsis 1 Manual rotation 1 111 High blood pressure 1 Stillborn 1 Feotal distress 3 Retroverted uterus 1 Multiple fibroids 1 Cystocele of perineum 1 Bronchitis 1 Sticky eyes 1 Macerated foetus 1 Misproportion 1 Hydramnios 1 Complete abortion 1 Prolapsed cervix 1 Internal version 1 Cardiac 4 Manual removal of placenta 2 Tlie average duration of stay in hospital was 13.48 days, and the cost per case was £4 14s. 4d., of which an average of £2 4s. Id. was paid l>v the patient and the remaining £2 10s. 3d. by the Council. Nursing Homes Registration Act, 1927. There are three registered nursing homes in the Borough. Of these, one is a maternity home only. These institutions were visited on 11 occasions. Home Helps. Under the Council's scheme for the provision of home helps, 38 applications for home helps were dealt with. In 30 cases home helps were provided, 20 of these cases having the charges remitted in accordance with the Council's scale. In the 8 remaining cases municipal home helps were not provided, as other arrangements for the confinements were made. At the end of the year there were 9 names on the Council's approved list of home helps. 112 MATERNAL MORBIDITY AND MORTALITY. (Report by Dr. Menzies.) Eight oases of puerperal fever and 12 cases of puerperal pyrexia were notified during the year. An endeavour was made in each case to obtain particulars regarding the cause of the rise of tern, perature. Puerperal Fever. Of tlie eight cases notified as puerperal fever, three followed early abortions in married women. One ended fatally. This was a two months abortion in a married woman (aged 22), who had had her first child in 1933 and her second in 1934. Home circumstances poor. Her temperature rose to 103 degs. on the day following the abortion. She was admitted to hospital four days after the abortion, in a grave condition,with an offensive uterine discharge, and in spite of treatment she died ten days later. Post-mortem examination showed evidence of pleurisy, peritonitis and endometritis with pus in the right Fallopian tube and ovary. There was no sign of injury and it was impossible to obtain a history from the relatives. Of the two non-fatal cases associated with abortion, in one the doctor who was called found the patient with abdominal tenderness and temperature 103 degs. and sent her into hospital immediately as a threatened abortion. She was a multipara (4), and recovered after two weeks in hospital. The second case occurred in a woman of 33 who had two living children—home circumstances good. In spite of the fact that she was sent into hospital on the day following the abortion, she required two months in hospital before she was fit to be discharged. Of the five notified cases following full time deliveries one ended fatally. The available information in these five cases is as follows :—- 1. Multipara (3), age 28. Septic teeth—abscesses in gums . during puerperium. Appearance suggested anaemia—normal labour —attended by midwife. Temperature rose on 6th day after confinement—seen by obstetric consultant—diagnosis, mild intra-uterine infection—treated at home;—temperature returned to normal during third week of puerperium, 113 2. Primigravida, age 19.—Homo circumstances poor—normal labour attended by midwife—laceration requiring three sutures—no rise of temperature, recorded until tenth day when T. 104 deg.— rigor—patient transferred to hospital—offensive discharge—on opening cervix pus escaped—few fragments of tissue—tube inserted in cervix. 3. Multipara (3), age 38. Home circumstances good—midwife acting as maternity nurse with doctor. Membranes ruptured before labour—rapid first and second stages—delay in third stage— placenta adherent—manually removed with difficulty—no anaesthetic—haemorrhage—pulse 96 after delivery—increased to 112 and remained rapid—obstetric consultant called in on third day, temperature 103 degs.—no signs of local infection outside genital tract—provisional diagnosis of severe oxogenous puerperal infection —admitted to hospital—clinically septicaemia although organisms could not be isolated from blood stream—in hospital more than four weeks—complete recovery. 4. Primipara, age 21. Home circumstances poor and dirty. Husband suffering from influenza at time of confinement. Attended by midwife (B.B. A.)— although one vaginal examination at beginning of labour—no laceration—small amount haemorrhage— temperature rose on fifth day—lochia normal—no tenderness—no localising signs. Medical attendant suspected tuberculosis—admitted to hospital on ninth day—diagnosis, uterine sepsis from retained products. 5. Primipara, age 21. Home circumstances comfortable— patient ignorant—decayed teeth—refused treatment. Attended by midwife—no internal examinations—labour normal—no symptoms until eighth day, but found to be severely constipated—given 01. Ricini without result—patient vomited—temperature 99 degs. on tenth day temperature 101.4 degs.—rigor—doctor called in— could find no evidence of pelvic infection and considered temperature due to constipation—ordered purgatives—patient not complaining of pain—eleventh day, no symptoms but patient looked ill and had had rigor—admitted to hospital—much offensive discharge from uterus—continued rigors—patient died six days later. In the fourth case the baby died after 3 weeks. In the others the babies survived. 114 The details available regarding these eight cases suggest (I) that if a woman has a rise of temperature following abortion she ought to be sent into hospital without delay ; (2) that a rise of temperature following labour with no localising signs and no (subjective) symptoms ought to be viewed even more gravely than a case with signs of definite local infection. There is a tendency, both on the part of midwives and of general medical practitioners, to assume that a rise of temperature without symptoms is due to a non-puerperal cause, and valuable time in instituting treatment is lost. Puerperal Pyrexia. As a result of investigations regarding the 12 notified cases of puerperal pyrexia, the causes of pyrexia were considered to be :— Pyelitis 4 Mastitis 2 Endometritis 1 Mammary Abscess 1 Uterine sepsis followed by breast abscess 1 Pulmonary tuberculosis 1 Cause unknown 2 Eleven mothers recovered. There was one stillbirth and one child died subsequently. This latter was a case where the mother (age 27) was discovered during the puerperium to be suffering from pulmonary tuberculosis and she died four months after the birth of the child. She was attended by a midwife, and during the antenatal period was noted to be pale and very thin. She refused to attend an ante-natal clinic. Her husband was in regular employment and the home conditions appeared to be satisfactory. This was the second pregnancy and resulted in a premature child ; the first child had lived for one hour. The patient developed a severe cough on the second day after labour and her morning temperature was 100.8 degs. The Council's Obstetric Consultant could find no localising signs to account for the rise of temperature and pulse rate, and advised her removal to hospital. She was subsequently discovered to have a sputum containing tubercle bacilli. The stillbirth was of a premature, slightly macerated foetus in a woman aged 25, who had previously borne two living children. The pyrexia was transient and the cause was not diagnosed. 115 Five of the twelve eases of puerperal pyrexia were confined in hospital. Six were attended by midwives (one in a maternity home), and one was attended by a doctor assisted by a midwife, in a maternity home. In one case it was considered advisable to transfer the mother and babv to hsopital. The remainder were treated at home. Tlie advice of the Obstetric Consultant was sought in three cases including the case of pulmonary tuberculosis. Obstetric Consultant. The advice of the Council's Consultant Obstetrician was sought on five occasions during the year. 1. Case described under Puerperal Fever No. 1. (40 weeks pregnancy). 2. Case described under Puerperal Fever No. 3. (40 weeks pregnancy). 3. Case described under Puerperal Pyrexia (pulmonary tuberculosis). 4. Primigravida. Home conditions poor—husband out of work—normal labour, attended by midwife—mask worn—-temperature 102 degs., pulse 104 on second day following labour—seen by consultant on third day—temperature 100.5 degs., pulse 110— no abnormal physical signs—bacteriological investigation showed presence of haemolytic streptococci—diagnosis, local puerperal infection of uterus—temperature normal three days later. Hemolytic streptococci were isolated from the midwife's throat and she wis suspended temporarily from practice. 5. Primigravida, age 20—-confined in maternity home— attended by doctor assisted by midwife—breech presentation— perineal laceration—retention of urine—catheterised—pyrexia up to 09 degs. for first 10 days—up to 100 degs. for next 3 days—severe pyrexia more than puerperal morbidity for subsequent 3(5 hours— seen by consultant. Nil abnormal in heart, throat, lungs or abdomen. Uterus mobile and well involuted. Diagnosis, puerperal pyelitis. Catheter specimen of urine grew B. Coli on culture and a cervical swab grew hemolytic streptococci and B. Coli. Throat swab from midwife grew hemolytic streptococci—patient made complete recovery. 116 Maternal Mortality. There were seven maternal deaths in Leyton during the year. Of these, four were due to sepsis, three following full time normal deliveries and the fourth following presumed natural abortion. Of the non-sepsis deaths, one was due to eclampsia ; one to retained placenta (without haemorrhage) ; and the third to ruptured ectopic gestation. The details of the deaths due to sepsis were as follows 1. Multipara (3), age 31—circumstances poor—ante-natal examination at hospital—normal labour (4| hours) in hospital—no internal examination no laceration of perineum—temperature 99 (legs, on first day after labour—temperature 102 degs. and rigor on fifth clay—cervical swab 10 days after labour showed haemolvtie streptococci in large numbers—blood contained haemolvtie streptococci. Died on twenty-third day following delivery. Post-mortem examination threw no light on mode of infection and showed no pre-existing disease. 2. One previous miscarriage. Age 29—ante-natal examinations at hospital—no signs of toxaemia or pre-existing disease except for slight discoloured vaginal discharge—normal labour (12J hours)—3 vaginal examinations—masks, gloves and gowns worn—no perineal laceration—afebrile until third day after labour —rigor, temperature 102 clegs.—patient very nervous and excited— intra-uterine glycerine given next day as uterus tender—generalised abdominal tenderness with diarrhoea sixth day after labour—transferred to Queen Charlotte's Hospital Isolation Block for operation—saparotomv and drainage of peritoneal cavity—died 12 hours later. Post-mortem examination showed generalised peritonitis—bilateral ovarian abscesses—thrombosed left ovarian vein—■ hemolytic streptococci from cervix, blood and peritoneal fluid. 3. Already dealt with as Case No. 5 under Puerperal Fever cases above. 4. Following abortion—described under Puerperal Fever cases above. The details of the non-sepsis deaths were as follows :— 5. Age 31. Circumstances comfortable—ante-natal examinations by private doctor—labour prolonged—slow and weak contractions—spontaneous delivery (at 4 p.m.) of stillborn macerated 117 foetus—placenta adherent, no hemorrhage—transferred to hospital at 7 p.m. Temperature 99 degs., pulse 90—no vaginal loss—uterus contracting well—placenta removed manually (anaesthetic—ethyl chloride and ether)—very adherent—no haemorrhage—patient pale and shocked on return to ward—pulse thready—died 6 a.m. Cause of death—retained placenta (without haemorrhage). (j. Age 23—no previous pregnancies—circumstances good— doctor called because of abdominal pain—temperature normal, pulse 70—constipated—no vomiting—abdomen not distended—pain and slight tenderness in lower abdomen to left of middle line—no amenorrhoea. On the following morning there was increase of pain with vomiting. Temperature normal, pulse 104—tenderness in right iliac fossa—transferred to hospital—immediate laparotomy —ruptured left tubal pregnancy four.d. Developed intestinal obstruction on the day following operation—second operation to relieve obstruction—died on second day after admission to hospital. 7. Primigravida, age 25. Circumstances good. Ante-natal examinations by midwife—advised to attend ante-natal clinic— did not do so—no reported abnormality until two days before labour when husband of patient called on midwife and stated that his wifo could not sleep on account of severe cramp. She was seen by her panel practitioner who reported that the case was normal. The urine was not examined on that day nor was the blood pressure recorded. The midwife had examined the urine three days earlier and reported that it was normal. An eclamptic fit occurred as the patient was being admitted to a maternity home for labour. She was transferred to a maternity hospital within 40 minutes. On examination on admission she was found to be well-nourished— heavy build—conscious—good colour—very talkative and fidgety— very little disturbed by uterine contractions—head engaged. Pulse 100—good volume—slight oedema of legs—light cloud of albumen in catheter specimen. B.P. 184/90. She gave the history that she had had very little sleep for a week on account of painful abdominal cramp. She was treated with morphia and alkaline calcium mixture with glucose by mouth. The second fit occurred 4 hours later and after a series of four fits the patient became comatose in spite of complete routine treatment of eclampsia. Delivery by forceps was effected by an obstetric consultant 71 hours after admission to hospital. There was a slight degree of disproportion. The baby weighed 10 lbs. 3 ozs.—length 23 ins — comative. The mother was very collapsed after delivery and died 13 hours later. 118 CONVALESCENT HOME TREATMENT. Nursing Mothers. Prior to 1935 no arrangement existed lor the provision of convalescent home treatment lor nursing mothers. It was felt that some women, before they had recovered sufficiently from the effects of confinement, had to expend a considerable amount of their small reserve of available energy in performing their ordinary house work and looking after the new infant ; and that a short- rest under suitable circumstances might prevent future chronic ill-health in some of these cases. During the summer three mothers and their infants wore sent away for two weeks convalescence to the West Ham Central Mission Children's Home at Hut-ton, near Brentwood. One of the practical difficulties in a scheme of this kind is that the mothers most in need of such convalescence are those who have had frequent confinements at short intervals ; and they are the mothers whom it is most difficult to persuade to leave their own families, even for the- short period of a fortnight. Such mothers find it difficult to make any arrangement for the home and children being looked after during their absence ; and it would be a boon in these cases if the Council's scheme for the provision of home helps could be extended to meet their requirements. MIDWIVES' ACTS, 1902-1926. Supervision of Midwives. During the year 46 midwives notified their intention to practise in the Borough. The existence in Leytonstone of the Beachcroft Road Training School of the Essex County Nursing Association increases considerably the return of midwives practising in the area. Seven independent midwives residing in the Borough and four resident outside the Borough notified their intention to practise in the area. Of these, three midwives did not undertake any cases during the year, and three attended less than ten cases each. That is to say, the majority of cases attended by independent midwives were undertaken by five midwives resident in the Borough. 119 Of 26 midwives (attached to the Essex County Nursing Association) who notified their intention to practise during tlie year, an average of five were in practice throughout the year. Tlie remainder were pupils who notified their intention to practise after passing the examination of the Central Midwives Board, but were not practising in the Borough for longer than six weeks before being sent to other districts in Essex. In accordance with arrangements made witli Medical Officers of Health of neighbouring Supervising Authorities for Midwives, visits of routine inspection by the Inspector of Midwives were paid only to midwives residing in the Borough. Eighteen such visits to the homes of midwives were made during the year. In addition, the Inspector made special visits to, or had interviews with, midwives on 18 occasions. Suspension of Midwives from Practice. A midwife in private practice who had been found to have haemolytic streptococci in her nose and throat during October, 1934, had a similar infection in January, 1935. A patient whom she attended developed uterine sepsis duo to h;emolytic streptococcal infection, and was removed to the Isolation Block of Queen Charlotte's Maternity Hospital for treatment. It was considered advisable to suspend the midwife from practice, and arrangements were made with the Essex County Nursing Association to undertake the midwife's work during the period of suspension. No cases occurred in this period of suspension (6 days) so the question of compensation to the midwife did not arise. In March a second patient attended by the same midwife developed puerperal pyrexia. Haemolytic streptococci were recovered from a vaginal swab of the patient, and from a throat swab of the midwife. The midwife was suspended from practice and arrangements were made with the Essex County Nursing Association as in the previous instance. During the period of the midwife's suspension from duty two cases occurred, for which she received compensation. At this time the midwife in question was disposing of her practice, and the arrangement with the Essex County Nursing Association to undertake work in her practice was terminated as soon as the incoming midwife was available for duty. 120 In May a patient attended by a different midwife developed a slight pyrexia on the sixth day after delivery. The case was examined by the Council's Obstetric Consultant on the eighth day and was diagnosed as a mild intrauterine infection not sufficiently severe for removal to hospital. The midwife preferred to continue in attendance. She was advised that she must not undertake any ,, new cases while she was in attendance on this infectious case, and arrangements were made with the Essex County Nursing Association to take over the nursing of her other patients. Seven days later the midwife was able to cease attendance 011 the original case, and after disinfection she resumed general practice 011 the following day. She received compensation for the loss of cases during the period of her suspension from practice. Medical Aid. In accordance with the Rules of the Central Midwives Board, a midwife must notify the Local Supervising Authority within 36 hours of every occasion on which she sends for medical aid. Ninetyfour such notifications were received and the following table shows the various complications for which medical assistance was summoned :— During Pregnancy. Ante-partum haemorrhage 2 Disproportion 2 Albuminuria 1 Unsatisfactory condition of mother 1 During Labour. Ruptured perineum 21 Prolonged labour 15 Post partum haemorrhage 3 Oedema of perineum 3 General condition of mother 4 Breech presentation 1 Placenta prtevia 1 Stillbirth 1 Collapse following delivery 1 Prolapsed cord 1 Mai presentation 1 During Puerperium. Rise of temperature 13 General condition of mother 3 121 Conditions Associated with Infants. Feebleness of infant 8 Discharging eyes 5 Prematurity 3 Swelling on spine and occiput 1 Haemorrhage from umbilicus 1 Unsatisfactory condition of umbilicus 1 Engorged breasts 1 94 Fees paid to Doctors under Section 14 (1) of the Midwives' Acts, 1918. Sixty-six accounts were received from general medical practitioners for assistance rendered to midwives under the provisions of this section. The details of such accounts during the year were £ s. d. Fees of Medical Practitioners 92 3 6 Proportion recoverable 33 6 6 Nett cost to Local Supervising Authority £58 17 0 REPORT OF THE JOINT COUNCIL OF MIDWIFERY. The Joint Council of Midwifery was formed in January, 1934, at the instance of the National Birthday Trust Fund. The Joint Council was composed of representatives of local authorities ; hospitals ; medical, nursing and obstetrical organisations. Subsequently the Joint Council appointed from the members a Midwifery Services Committee, whose terms of reference were to consider the whole question of the remuneration of midwives, as bearing on the efficiency of the midwifery service, and to prepare for the enlistment of midwives throughout the country in an organised service, suited to the needs of each district, and having due regard to the retention of the mother's freedom of choice of attendant. At the request of Leyton Maternity and Child Welfare Authority tlie Medical Officer of Health prepared the following summary of the Report of the Joint Council. 122 Recommendations in Previous Reports. Previous reports are unanimous in expressing the view that a National Maternity Scheme is urgently required, and there is agreement also upon tlie following points :—• That domiciliary midwifery should continue to form the basis of the maternity service. That the nursing of every maternity case in which a medical practitioner is engaged should be conducted by a qualified midwife. That the status and remuneration of midwives should be substantially improved. That the training of midwives must be lengthened, improved and standardised. That compulsory post-certificate courses are essential. That the general supervision of midwives should be carried out by senior members of their own profession. Domiciliary Midwifery. This Committee concurs with the views expressed in the reports that, although adequate hospital accommodation lor antenatal cases and for abnormal labours is essential, normal confinements, where the conditions are suitable, can be satisfactorily and safely conducted in the patient's own home. It should be clearly understood that a reduction in maternal mortality will not be secured merely by increasing the hospital provision for normal eases. Remuneration of Midwives. The remuneration of individual midwives is entirely inadequate, and compares most unfavourably even with that of nurses, who, as a class, are admittedly underpaid. The average salaries of village liurse-midwives, Queen's nurse-midwives, hospital nurses, and health visitors all considerably exceed the £80 which the committee has ascertained to represent the average yearly earnings of a midwife dependent upon her profession. In certain areas this figure may sink as low as £50, and out of this meagre sum the midwife is expected to provide equipment, necessary drugs and disinfectants, and even in some cases dressings, for her patients. There is evidence that the low standard of comfort and cleanliness in the houses or lodgings occupied by midwives in certain areas militates against the maintenance of a high standard of professional work, particularly where ante-natal examinations have to be undertaken in 123 unsuitable rooms normally utilised for other purposes. In the East End of London the fee is as low as l(5s. for multiparae, and the great majority of patients pay no more than 30s. The main causes of the low remuneration of midwives are :— (a) The economic position of those persons in the community who principally employ midwives. (b) The part-time practice carried on by large numbers of midwives as an aid to another source of income. (c\ The excessive number of midwives qualified, arising froln the shortness of the present period of training and the low educational standard required from entrants. Reforms and extensions of training designed to raise the status and efficiency of the service of midwives to its proper level will, however, inevitably involve the candidate in additional expense which cannot be met by the present type of entrant. If such extensions were introduced before other reforms had made the profession attractive to a better class of candidate, the probable result would be a shortage of midwives within a few years. Advantages of an Organised Service. The committee considered three different methods of remedying the situation ; (1) restricting the numbers of midwives in practice ; (2) increasing the remuneration of midwives otherwise than by their whole-time employment by the State or local authority ; and (3) by the establishment of a salaried midwives' service under the control of the local supervising authority. The report discusses these three proposals in detail, and concludes in favour of the third. Summary of Recommendations. The committee summarises its recommendations as follows :— 1. That this committee concurs with the views expressed in the reports that, although adequate hospital accommodation for ante-natal cases and abnormal confinements is essential, normal confinements can be satisfactorily, safely, and preferably conducted in the patient's own home, except where this is unsuitable. 2. That the nursing of every maternity case should be conducted by a qualified midwife, and unqualified persons should not be permitted to nurse maternity cases for gain. It should be the duty of the local authority to provide that midwives are available to act as maternity nurses in the case of 124 any patient who has engaged a doctor for her confinement, but is unable, in addition, to afford the services of a trained nursing attendant. 3. That a salaried midwives' service should be established under the appropriate local authority in all areas not already served by salaried midwives. It is not intended to interfere with the continuance in practice of independent midwives. 4. That it should be the duty of every appropriate local authority to provide, or secure the provision of, an adequate domiciliary service of midwives in its area , and for this purpose : («) to employ the requisite number of whole-time midwives at adequate salaries; and/or (b) to aid approved voluntary organisations (including provident societies) that employ salaried midwives for service in its area. 5. That the local supervising authority (Midwives Acts) should be the unit of administration for the proposed service. 0. That the cost of the service should so far as practicable be met by the fees charged by, and payable to, the authority or the voluntary organisation for the services of the midwife. The remaining recommendations doal with (a) The steps which should be taken by the local supervising authority before initiating a scheme in its area ; (b) The status, salary and appointment of midwives entering municipal service ; (c) The compensation of midwives not accepted for service ; (d) The necessity for refresher courses .of study by practising midwives ; (e) The right of appeal by midwives ; (f) The freedom of choice of midwife bv the patient. After consideration of the above report, the Maternity and Child Welfare Authority expressed general approval of the proposals contained in the Report of the Joint Council. 125 NUTRITION. Assisted Milk Supply. As it is a, condition of grant that the mothers or infants must attend the Authority's Centres—unless when unable to attend, in which ease the home is visited by a Health Visitor—all mothers and infants in receipt of milk free or at reduced price are under medical supervision. MILK SUPPLY, 1931-1935. Pints of Fresh Milk. Packets of Dried Milk. Cost to Council Year. £ s. d. 1931 65,149 2,006 944 13 4 1932 88,002 758 1,143 5 5 1933 87,149 645 1,119 11 6 1934 64,727 498 845 9 9 1935 63,192 762 862 13 5 Applicants Granted Free Milk During 1935. January 162 February 192 March 179 April 165 May 168 June 157 July 153 August and September 173 October 158 November 65 December 147 Meals for Expectant and Nursing Mothers. In May, 1933, the Maternity and Child Welfare Authority decided that application be made to the Ministry of Health for sanction to provide extra nourishment in the form of eggs, vegetables and fruit for expectant and nursing mothers in cases where the Medical Officer of Health is satisfied that such extra nourishment is advisable on medical grounds, the same scale of necessity to be applied as that in operation in connection with the assisted milk supply. As no adequate facilities exist in the area for the provision of meals at feeding centres the Local Authority proposed that the articles of diet recommended by the Medical Officer should be purchased by means of vouchers. 126 After repeated interviews and a somewhat protracted correspondence on the matter, the Minister of Health indicated in Dectmber, 1934, that he was unable to sanction the arrangements proposed by the Council unless he could be satisfied that the food would be supplied under conditions which would ensure that it is actually consumed by the women for whom it is prescribed. The erection of the new centralised kitchen and feeding centre for school children at Harrow Green has now enabled the Maternity and Child Welfare Authority to come to an arrangement with the Education Authority for the cooking of the meals at the centralised kitchen and their transport to the Maternity and Child Welfare Centres, where they will be available for expectant mothers. The Minister of Health has nowapproved the Council's proposals (under Section 1 of the Maternity and Child Welfare Act, 1918), for the provision of meals for necessitous expectant and nursing mothers, and it is hoped to put the scheme into operation as soon as the facilities are available. NEW JOINT CLINIC PREMISES. Park House, Granleigh Road. In 1930 the Council decided to erect in the Borough two buildings, each to accommodate the clinic services organised by the Maternity and Child Welfare and the Education Authorities and to serve one half of the area. In September, 1933, the first of the Council's combined clinics was opened at Leyton Green. The second combined clinic, at Park House, Granleigh Road, Leytonstone, was opened by the Mayoress, Mrs. E. Hayward, on 14th September, 1935. The plans of the building were prepared by the Borough Surveyor in consultation with the Medical Officer of Health. As will be seen from the plan on page 128 the shape of the site would not allow the main elevation to be seen from Granleigh Road and the plan of the building as finally adopted consists of a main Waiting Hall as the central feature with a wing on either side, brought forward so as to take the best advantage of the site. The spacious forecourt left in front of the building is laid out with shrubs and flower beds. 127 The building accommodates two Health Services (a) the School Medical Service and (b) The Maternity and Child Welfare Service, of which the former is accommodated in the wing to the left of the Waiting Hall and the latter in the wing to the right. Separate entrances have also been provided : that for School Medical Service by the left-hand side of the building from Granleigh Road and that for the Maternity and Child Welfare Service through the open courtyard on the opposite of which is a large Perambulator Store. The Main Hall seats 150 persons, and by means of a movable screen the waiting space for either service may be varied as circumstances demand. The School Medical Service section includes: Minor Ailments Treatment Clinic ; Doctor's Room; Clerk's Office; Dental Surgery, Recovery Room and Waiting Room. The Maternity and Child Welfare section accommodates the following : Weighing Room with collapsible cubicles ; Ante Room ; Doctor's Room ; and Dispensary. A Stalf Room and Kitchen are also provided. 128 29 CO-ORDINATION OF HEALTH SERVICES. Desirability of Continuous Medical Supervision. In December, 1929, a Joint Circular (1054) was addressed to all Local Authorities by the Ministry of Health and Board of Education drawing attention to the gap in the systematic medical supervision of children between one and five years of age, urging Local Authorities where necessary to extend their services in that direction, and making suggestions for the filling of the gap. After consideration of the Circular this Council decided (inter alia)— (1) That the existing Maternity and Child Welfare and School Medical Services be co-ordinated and utilised as far as possible to give effective medical supervision to all children from birth until they leave school. (2) That all clinics and facilities available for the school child be available for the pre-school child. The problems connected with health and the arrangements for dealing with disease are essentially the same, whether we happen to be dealing with a pre-school or a school child ; and each child carries its health or infirmity with it from one age group to the next. Medical supervision of the pre-school and of the school child form integral parts of the general Public Health Service of the area. It is well known that ill-health or physical defect in one member of the family intimately affects the homo and the welfare of the family as a whole. School hygiene cannot be divorced from home hygiene ; nor can the daily work of the Maternity and Child Welfare or Education Authority be divorced from that of the Sanitary Authority, which is responsible for the supervision of such matters as water and milk supply, food, housing, sanitation, infectious disease prevention and treatment, disinfection, factories and workshops, etc.—all of which have a bearing, direct or indirect, on the health of children of all ages. Present Administrative Arrangements. Nevertheless the work of the Health Department is controlled by three differently constituted Committees (Public Health, Maternity and Child Welfare and Education), whose respective and independently appointed staffs are engaged in dealing with the same problem and the same child in different ways. Under the circumstances it is inevitable that there should be difficulties. 130 Examples of Lack of Co-operation; The following examples—taken at random—may serve to show the nature and extent of the existing overlapping and confusion. When a case of infectious disease occurs in a family we may have as many as five different members of the staff of the health department visiting the house at different times and for different purposes, r.q. :— 1. Public Health, (a) Fever Hospital Nurse to arrange for removal of patient to hospital; (b) Disinfector to disinfect premises; (c) Sanitary Inspector to report on sanitary arrangements. 2. Maternity and Child Welfare. Health Visitor to deal with children under five and foster children under nine. 3. Education. School Nurse to deal with children of school age. A pre-school child may be suffering from a severe defect or deformity requiring prolonged supervision and treatment. Up to five years of age the child is under the care of the Maternity and Child Welfare Committee and its staff; but as soon as the child becomes five years old a new Committee and a new set of officials (medical, nursing and administrative) proceed to apply different methods of dealing with the same child and the same defect. Tn the same family two children may be receiving the same form of medical, orthopaedic, ophthalmic, dental or convalescent treatment; but whereas the payment for the pre-school child is assessed on one scale, the school child's liability is assessed on a quite different scale. With the ever increasing scope and activities of the health services it is becoming increasingly difficult for any one of the three committees dealing with the work of the health department to take any action which does not concern the other two, the result being delay and possible confusion occasioned by the necessity for referring matters from one Committee to another or to a Joint Committee. Suggestion. The best way to ensure co-ordination is to do away with the necessity for it, and thus bring the practice of preventive medicine into line with modern knowledge regarding it. School Medical Service. 132 SCHOOL MEDICAL SERVICE. School Population and Attendance.—I am indebted to the Director of Education for the following information regarding school population and attendance :— Elementary Schools. No. of Schools (Depa rtnimts) No. on Rolls. Average Attendance. Percentage Attendance Senior Boys' 7 1,969 1,812 92 Senior Girls' 7 1,872 1,707 91 Junior Boys' 4 1,172 1,075 92 Junior Girls' 4 1,148 1,058 92 Junior Mixed 6 2,182 2,009 92 Infants' 16* 4,727 3,936 83 Non-provided (Mixed) 1 263 224 85 Central— Boys' 1 291 275 95 Girls' 1 276 263 95 Mixed 1 432 409 95 Totals 48 14,332 12,768 89 Schools— Church of England - - - - Boman Catholic 1 263 224 85 Council 19* 14,069 12,544 89 Totals 20 14,332 12,768 89 *Including Harrow Green Infants' School, closed 3rd November, 1935. The figures given above relate to the financial year ended March 31st, 1930. During the financial year specified, attendances for a total of six weeks in the case of four Infants' Departments were disregarded under Board of Education Regulations owing to the attendance falling below 60 per cent, in consequence of epidemic sickness. 133 SCHOOL PREMISES. Alterations and Additions.—I am indebted to the Director of Education for the following list of the chief alterations and additions to school premises during the past year :— Harrow Green School.—Central kitchen. Trumpington Road School.—New domestic science rooms. Annual re-desking at various schools. Installation of new boilers at Farmer Road and Goodall Road Schools. External painting of four schools. Internal painting of two schools. Norhn'uton Road School.—Installation of central heating. Improvements to latrines at I).ivies Lane, Farmer Road, Mayville Road and Norlington Road Schools. Downsell Road School.—Forming new playground adjoining. Farmer Road School.—Erection of new craft room. Domestic hot water supply to three schools. MEDICAL INSPECTION. Arrangements for Medical Inspections in Schools. In the year 1904 the report of the Departmental Committee 011 Physical Deterioration revealed the deplorable physical state of a large proportion of the children attending public elementary schools throughout the country and stressed the necessity for organised effort 011 the part of Education Authorities to remedy the great amount of sickness and unfitness among school children. In 1907 the Education (Administrative Provisions) Act made it compulsory on all Education Authorities to make provision for the medical inspection of children attending public elementary schools; and in that year the school medical service was established. 134 Since that time great changes have taken place in the condition* under which children attend school, and during the same period there iias taken place a very great increase in the scope and functions of the school medical service—especially with regard to the provision of facilities for treatment. The arrangements for routine medical inspection, however, have remained unchanged since 1908—a period of almost thirty years. Routine medical inspection may be described briefly as a scheme of medical inspection of each school child 011 three occasions during its school career for the purpose of discovering defects, and recording these defects on schedules and in statistical tables prescribed by the Board of Education. Whereas such a survey of the actual physical defects in school children was of the greatest initial value in providing the Board of Education and Local Education Authoritieswith the necessary information on which to base schemes of medical treatment; it is questionable whether the time devoted to routine medical inspection could not be utiljsed to better advantage in the interests of the health and welfare of the children now attending public elementary schools. The statistical tables prescribed by the Board of Education are merely a catalogue of existing defects and diseases, but they provide little <>r no information regarding the state of health and physical fitness of the children inspected. Nowadays the function of the school medical service is not merely the ascertainment of defects, but the much more important medical supervision of the health and fitness of children attending school; and this latter object cannot be attained by the routine inspection of individual children at intervals of four years. During recent years much more time has been devoted to the re-inspection and following-up of defective children to ensure that they are having and deriving benefit from the medical treatment recommended on their behalf. The Leyton Education Authority's comprehensive scheme of clinic medical services and the facilities for medical treatment are now being utilised to such an extent that routine medical inspection in schools occupies a much less important position in the life of the individual scholar than it did formerly. Instead of school medical officers referring children requiring treatment to hospital out-patient departments, as was the custom formerly, there is a very marked increase in the number of school children referred by hospitals to the school clinics for special medical treatment. 135 A.—Routine Medical Inspection. This heading relates solely to the routine medical inspection of the three ordinary age groups, i.e., to medical inspection carried out:— (1) lu compliance with Article 17 of the Consolidated Regulations relating to Special Services—Grant Regulations No. 19. (2) On the school premises (or at a place specially sanctioned by the Board). (3) For the purpose of making a report on each child on the lines of the approved schedule. Number of Inspections in the proscribed groups. Entrants 1,571 Second Ago Group 1,425 Third Ago Group 1,509 Total 4,505 Number of other routine inspections 6l7 5,122 It will be seen from the above that the number of such code group inspections was 4,505 representing 31 per cent, of the number of children on the school registers. Of 4,505 children who wore examined in the code age-groups, 3,708 (or over 83 per cent.) were accompanied by their parents. Other Routine Inspections.—In addition, other routine inspections were made of 017 children who did not fall under the three code ago groups, e.g., routine inspections of a fourth age group or of other groups of children as distinct from those who are selected individually on account of some suspected ill-health for " special " inspection. The grand total number of children subjected to routine medical inspection during the year was therefore 5,122. 136 B.—Other Inspections. Special Inspections.—A special inspection is a medical inspection of a child specially selected by the Medical Officer during a visit to the school or referred to the Medical Officer by the Teachers, School Nurses, Attendance Officers, Parents or otherwise, i.e., an inspection other than a routine medical inspection. The number of such special inspections during the year was 3,804, comparing with 2,986 during the previous year. Re-inspections.—These are medical inspections of children who, as a result of a rout ine or special inspection, come up later on for subsequent re-inspection cither at the school or at the Inspection Clinic. The number of re-inspections during 1935 was 12,109. RETURN OF ROUTINE MEDICAL INSPECTIONS IN INDIVIDUAL SCHOOLS. School. Entrants. Second Age Group, Third Age Group. Code Group. Specials. Rc-inspections. Code Group. Specials. Re-inspections. Code Group. Specials. Re-inspections. Canter bury Rd. 141 2 ... 137 8 157 105 4 308 Cann Hall Rd. 68 2 ... 69 4 251 85 2 197 Capworth St. 112 ... ... 127 11 253 93 15 277 Church Road. 76 3 ... 69 7 199 82 13 191 Connaught Rd. ... ... ... 83 ... 176 76 8 147 Da vies Lane 167 2 ... 93 ... 257 102 4 114 Downseil Rd. 95 6 ... 106 4 219 82 13 249 Farmer Rd. 115 3 15 98 8 262 86 10 250 Goodall Rd. 134 ... ... 105 7 255 92 2 260 Harrow Green ... ... 30 ... ... ... ... ... ... Kirkdalc Rd. 73 ... 36 ... 1 42 ... ... 49 Lea Bridge Rd. 48 ... ... ... ... ... ... ... ... MayvilleRd. 105 7 ... 74 14 247 100 11 183 Newport Rd. 115 1 ... 104 5 238 169 2 261 Norlington Rd. 117 11 ... 110 10 292 69 4 253 Ruckholt Rd. ... ... ... ... 6 150 127 ... 160 Sybourn St. 111 3 ... 122 26 279 94 13 306 St. Joseph's 29 ... ... 26 ... 40 20 3 32 TrumpingtonRd. 85 3 ... 102 11 163 75 14 228 Tom Hood ... ... ... ... ... 170 112 ... 153 KnottsGrcenS.S. ... ... ... ... ... ... ... ... 435 Totals 1571 45 105 1425 122 3650 1509 118 4083 137 The Findings of Medical Inspection. Number or Individual Children found at Routine Medical Inspection to require treatment (excluding uncleanliness and dental diseases). Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (1) (2) (3) (4) Code Groups— Entrants 1571 321 20.43 Second Age Group 1425 341 23.92 Third Age Group 1509 241 15.97 Total (Code Groups) 4505 903 20.04 Other Routine Inspections 617 28 4.53 The percentage incidence of defects figures for the past five years has been :— 1931 25.36 per cent. 1932 23.50 1933 18.22 1934 21.67 1935 20.04 It will be seen that the percentage of children found at routine medical examination to require treatment were as follows :— Entrants 20.43 per cent. Second Age Group 23.92 „ Third Age Group 15.97 ,, The following list shows the comparative figures for the last 5 years :— 1931. 1932. 1933. 1934. 1935. Entrants 30.37 24.34 18.70 17.86 20.43 Second Age Group 26.73 27.36 17.68 25.22 23.92 Third Age Group 14.51 17.87 18.22 22.61 15.97 Total 25.36 23.50 18.22 21.67 20.04 138 Retcrn of Defects foc.vd by Medical Inspection in the Year endet 31st. December, 1935). Defect or Disease. Routine I nspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) Skin Ringworm—Scalp ... ... 7 ... Body ... ... 20 ... Scabics ... ... 30 ... Impetigo ... ... 70 ... Other diseases (non-T.B.) 4 2 108 ... Blepharitis 7 1 85 ... Conjunctivitis ... ... 59 ... Keratitis 1 ... ... Eye Corneal Opacities ... ... 3 ... Other conditions 15 1 105 ... Defective Vision 180 1 00 ... Squint 20 ... 12 ... Defective Hearing 11 3 15 ... Ear Otitis Media 15 4 00 ... Other Ear Diseases 2 3 193 ... Chronic Tonsiiitis only 66 127 43 ... Nose &, Throat Adenoids only 11 11 14 ... Chronic Tonsiiitis and Adenoids 29 15 44 1 Other Conditions 21 3 84 ... Enlarged Cervical Glands (non-T.B.) 8 30 54 ... Defective Speech 1 3 4 ... Heart and Circulation Heart Disease;— Organic 10 ... 8 ... Functional 7 60 8 7 Anaemia 31 13 05 1 Lungs (Bronchitis 35 36 00 2 Other non-T.B. Diseases 22 34 27 3 Tuber- culosis Pulmonary— Definite ... 1 ... Suspected 1 5 1 Non-Pulmonarv— | Glands 3 3 <> ... Bones and Joints ... 1 1 ... Skin ... ... ... Other Forins ... 2 ... Epilepsy 2 2 9 ... vous Chorea ... 4 10 ... System Other Conditions 5 9 23 2 Deformities Rickets 2 2 1 ... Spinal Curvature 2 1 o ... Other Forms 61 11 57 1 Other Defects and Diseases 82 55 1545 7 Totals 654 443 3039 34 139 CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN ROUTINE AGE GROUPS. Age Group. Number of Children Inspected. A (Excellent). B (Normal). C (Slightly subnormal). 1) (Had). Number. Per cent. Number. Per cent. Number. Per cent. Num. ber. Per cent. Entrants 1,571 196 12.5 1,161 74.0 200 12.7 13 0.8 Second Age Group. 1,425 183 12.8 1,044 73.2 190 13.3 8 0.5 Third Age Group 1,509 304 20.1 1.076 71.3 125 8.2 4 0.3 Other routine inspections 617 71 11.5 460 74.5 76 12.3 10 1.6 Total 5,122 754 14.7 3,742 73.0 591 11.5 35 0.7 PERCENTAGE INCIDENCE OF DEFECTS IN INDIVIDUAL SCHOOLS. School. Entrants. Second Age Group. Third Age Group. 1932 1933 1934 1935 1932 1933 1934 1935 1932 1933 1934 1935 Caim Hall 22.09 19.73 19.00 20.58 25.38 21.42 28.57 23.18 6.89 15.38 18.58 25.88 Canterbury 22.50 25.50 29.62 24.11 25.92 10.00 17.64 17.51 23.75 28.07 13.68 20.95 Capworth 30.72 21.60 22.40 31.25 30.50 14.76 27.43 29.13 15.21 25.17 37.34 12.90 Church 21.49 13.15 12.62 19.73 23.07 16.00 28.16 3 1 :88 18.47 25.40 28.69 13.41 Connaugh — — — — — — 32.50 16.86 16.27 19.81 27.02 10.52 Dav ics Lane 29.00 18.69 15.90 13.08 17.77 12.71 11.95 21.50 16.48 21.05 29.80 11.76 Downsell 28.84 14.67 22.00 15.78 16.85 16.66 20.90 32.07 21.95 21.53 24.03 10.97 Farmer 17.92 29.29 14.03 25.21 28.45 12.14 39.42 35.71 26.66 23.13 25.23 12.79 Goodall 26.31 9.91 14.06 14.17 18.51 22.07 25.86 35.23 13.92 18.75 23.45 19.56 Harrow Green 9.25 15.00 — — 29.78 — — — — — Kirkdale 21.87 10.00 17.94 27.39 35.63 15.78 — — — Lea Bridge 22.22 20.45 15.21 25.00 — — — — — — Mayville 21.89 17.52 24.00 23.80 31.57 18.68 24.00 22.97 21.68 28.18 28.71 14.00 Newport 29.36 22.00 15.00 20.86 39.09 17.33 20.28 19.23 12.04 8.84 6.97 15.59 Norlington 26.31 16.66 11.58 17.19 31.88 26.05 24.40 20.00 16.45 13.00 21.15 11.59 Ruckholt — — — — — — — — 21.25 16.29 16.66 14.17 Sybourne 27.35 17.88 18.89 17.11 31.45 26.85 24.57 21.31 23.37 15.92 25.21 21.27 St. Josephs 19.04 31.42 15.38 17.24 20.68 37.50 42.85 11.53 9.09 11.90 9.37 25.00 Trumpington 19.54 13.51 18.18 16.47 28.12 18.18 25.55 13.72 1 1.59 15.00 15.00 25.33 Tom Hood — — — — — — — — 21.76 21.95 21.09 13.39 140 INCIDENCE OF DEFECTS. (Observations by Dr. F. W. Gavin). Figures for previous Vear shown in brackets. Entrants. Oil examining the total numbers of the various defects marked as requiring treatment, we find that:— (i) Dental Defect is again, as in previous years, by far the commonest defect and amounts to 30.36 per cent, of the children examined (25.44 per cent, in 1934.) (ii) Subnormal Nutrition = 7.44 per cent. (3.15 per cent.) Malnutrition = 0.03 per cent. Cases, however slight, of subnormal nutrition are included in these figures. (iii) Nose and Throat Defects — 4.32 per cent. (4.30 per cent.) (iv) Eye Defects = 2.29 per cent. (2.29 per cent.) (v) Lungs (Bronchitis and Non-T.B. diseases) - 1.78 per cent. (1.32 per cent.) (vi) Deformities — 1.40 per cent. (2.41 per cent.) (vii) Other Defects and Diseases = 1.40 per cent. (viii) Heart = 0.00 per cent, 1.01 per cent. (1.60 per Anaemia = 0.95 per cent, cent.) (ix) Ear Defects = 0.70 per cent. (1.03 per cent.) (x) Nervous System Diseases = 0.19 per cent. (xi) Rheumatism = 0.19 per cent. (0.91 per cent.) (xii) Enlarged Cervical Glands (Non-T.B.) = 0.12 per cent. (0.91 per cent.) (xiii) Skin Defects = 0.00 per cent. It is interesting to note the similarity of the 1934 and 1935 figures for defects of nose and throat. The commonest defects are thus dental, nutritional and defects of nose, throat and eye. 141 Second Aoe Group. If wc examine the commonest defects requiring treatment in this group, we find :— (i) Again Dental Disease is by far the commonest type of defect, i.e., 21.05 per cent, of children examined (20.27 per cent.) (ii) Sulmormal Nutrition = 12.14 per cent, of the children examined (3.16 per cent.) (iii) Eye Defects = 5.33 per cent. (7.07 per cent.) and defective vision amounts to 4.35 per cent, of all the children examined in this group. (iv) Nose, and Throat Defects = 2.80 per cent. (5.08 per cent.) (v) Other Defects and Diseases = 2.31 per cent. (3.50 per cent.) (vi) Lungs (Bronchitis and Other Non-T.B. Diseases) = 1.68 per cent. (2.33 per cent.) (vii) Deformities — 1.12 per cent. (1.85 per cent.) (viii) Anaemia. = 0.70 per cent. Heart = 0.28 per cent. 0.98 per cent, for Heart and Circulation. (ix) Ear Defects — 0.42 per cent. (1.16 per cent.) (including defective hearing.) (x) Enlarged Cervical Glands (Non-T.B.) = 0.42 per cent. (0,68 per cent.) (xi) Rheumatism — 0.35 per cent. (xii) Tuberculosis = 0.21 per cent. (xiii) Epilepsy = 0.14 per cent. (xiv) Skin Diseases = 0.07 per cent. Third Age Group. On scrutinising the individual defects marked up for treatment at the " Leaver " group inspection, it is found that:— (i) Visual Defects — 7.35 per cent, of all the children inspected in the " Leaver " group, This is very similar to the figure for 1934, viz., 8.71 per cent. 142 (ii) Denial Defects = 4.04 per cent, of all children inspected and shows a remarkable improvement when compared with 11.08 per cent, in 1934. (iii) Subnormal Nutrition = 3.37 per cent, which is a slight improvement on 4.01 per cent, in 1934. (iv) Deformities = 1.72 per cent., a slight increase on the corresponding figure for 1934 (1.53 per cent.) (v) Nose and Throat Defects = 1.25 per cent., a considerable improvement on 1934 (2.17 per cent.) (vi) Heart = 0.79 per cent. Heart and Circulation = Anaemia = 0.39 per cent. 1.19 per cent. (vii) Other Defects arul Diseases = 0.79 per cent. (4.03 per cent.) (viii) Ear Defects (including defective hearing) = 0.72 per cent. (0.70 per cent.) (ix) Rheumatism — 0.39 per cent. (1.02 per cent.) (x) Malnutrition — 0.33 per cent. (xi) Lungs (Bronchitis and Other Non-T.B. Diseases.) = 0.33 per cent. (0.32 per cent.) (xii) Skin Diseases = 0.13 per cent. (0.19 per cent.) (xiii) Nervous System = 0.13 per cent. (0.19 per cent.) (xiv) Defective Speech 0.00 per cent. There were no cases of enlarged cervical glands for treatment but in 1934 there were 0.19 per cent. In conclusion it is interesting to compare the average percentage requiring treatment for each group in 1935 with the figures for 1932, 1933 and 1934 :— Second Age Third Age Entrants. Group. Oroup. 1932 24.34 27.36 17.87 1933 18.70 17.69 19.68 1934 17.86 25.22 22.61 1935 29.43 23.92 15.97 143 . Over the four years, 1032-1035, and with the exception of 1033, the Second Age Group (i.e., children whose 0th birthday falls within the year of examination) shows the worst figures, and in this connection it must be recalled that this group is examined during the spring term, January—April, which may be considered the least healthy period in S.E. England. Uncleanliness and Verminous Conditions.-—At the special inspections held by the school nurses, 1,278 children were found to be unclean out of a total number of 35,010 examined (i.e., 3 per cent.) Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Excluded. Canterbury Road 3,626 64 9 Capworth Street 3.019 84 27 Cann Hall Road 1,444 19 6 Church Road 2,194 85 12 Connaught Road 1, 243 28 10 Downseil Road 2,463 155 17 Davies Lane 2,966 105 8 Farmer Road 2,093 50 4 Goodall Road 1.746 55 7 H arrow Green 160 17 3 Kirkdale Road 426 1 2 Lea Bridge Road 299 5 — Mayville Road 1,966 165 30 Norlington Road 2,010 84 18 Newport Road 2,320 40 8 Ruckholt Road 1.569 11 4 Sy bourn Street 2,130 25 8 St. Joseph's 583 30 3 Trumpington Road 1,891 45 5 Tom Hood 379 2 — Knotts Green 499 21 6 Total 35,016 1.091 187 Number of individual children found unclean 1,278 of whom 187 were referred to the Minor Ailments Clinics. MEDICAL TREATMENT. Minor Ailments Clinic.—The schools in the area are served by two minor ailment clinics as follows : Park House—Tuesday, Thursday and Saturday mornings (Doctor in attendance). 144 Schools served: Newport Road, Connaught Road, Cam Hall Road, Downseil Road, Goodall Road, Kirkdale Road, Trumpington Road, Davies Lane, Harrow Green, Mayville Road, Tom Hood. Leyton Green—Monday, Wednesday and Friday mornings (Doctor in attendance). Schools served: Farmer Road. Lea Bridge. Sybourn Street, St. Joseph's, Canterbury Road, Capworth Street, Church Road, Knotts Green, Norlington Road, Ruekholt Road. Although a School Medical Officer is in attendance at each clinic only at the times stated above, one of the school nurses is on duty daily at each clinic for dressings and other medical treatment. Attendances. During the year 2,453 (2,223) children attended the clinic, and 12,144 (10,724) attendances were registered. The increase in attendances may be judged by comparing these figures with those of the previous year, shown in brackets. Defects Treated. Ringworm of scalp 6 Ringworm of body 20 Scabies 35 Impetigo 73 Other skin conditions 165 Blepharitis 85 Conjunctivitis 59 Corneal opacities 2 Defective vision 28 Squint 8 Other eye conditions 163 Defective hearing 15 Otitis media 65 Other ear diseases 193 Chronic tonsilitis 38 Adenoids 9 Chronic tonsilitis and adenoids 41 Other throat conditions 76 Carried forward 1081 145 Brought forward 1081 Enlarged cervical glands 53 Organic heart disease 8 Functional heart disease 6 Malnutrition 41 Uncleanliness—Head 244 Uncleanliness—Body 1 Anaemia 57 Bronchitis 66 Tuberculosis—Glands 3 Tuberculosis—Bones 1 Other non-tuberculous diseases of lungs 27 Epilepsy 7 Chorea 8 Other nervous diseases 21 Other deformities 52 Rheumatism 35 Debility 577 Defective speech 2 Miscellaneous (minor injuries, septic sores, etc.) 900 3,190 Treatment of Enlarged Tonsils and Adenoids. With regard to the existing arrangements for the postoperative treatment and transport of children who undergo operative treatment for the removal of unhealthy tonsils and adenoids, the Medical Officer of Health and School Medical Officer submitted the following suggestions to the appropriate Committees of the Council. Under this Authority's scheme, arrangements exist for the surgical removal of unhealthy tonsils and adenoids in Queen Mary's Hospital and Connaught Hospital. After operation, children are detained in the recovery room until pronounced fit to leave by the surgical staff of the hospital; but no facilities exist for the transport of children to their homes after operation or for their retention in hospital overnight. In the past no disastrous consequences have resulted, but recently the occurrence of a severe post-operative haemorrhage in the ease of a preschool child after her return home—and her subsequent removal to hospital for treatment of the haemorrhage—has led me to make further enquiries into the adequacy of the Council's arrangements with a view to safeguarding patients and the Council, 140 The Board of Education do not regard any schcme for the operative treatment of enlarged tonsils and adenoids as satisfactory unless :— (a) Suitable arrangements exist for the recovery of children from haemorrhage and from the effects of general anaesthetics. (b) Post-operative retention of patients in hospital for at least one night can be arranged. In the Board's view facilities for the transport of children to their homes should be piovided ; and—at my request—the Superintendent of the Leyton Eire Brigade has kindly arranged for such transport in tin motor ambulances under his control |>ending consideration of future arrange, ments by the Committees concerned. After consideration of the circumstances the Council decided —in January, 1935—that, subject to the approval of the Board ol' Education, arrangements be made—- (a) For post-operative retention in hospital for one night when necessary ; (b) For the conveyance of pre-school and school children, along with their parents, from hospital to their homes after operation. 1935. Recommended for removal of Tonsils and Adenoids 148 Operations performed 95 Defective Vision.—Of the 4,505 children subjected to routine code group inspection in the schools, 223 (4.94 per cent.) were found to be suffering from some eye defect requiring treatment. Of the 3,804 children referred for special inspection, 390 (10.2 per cent.) manifested some eye defect requiring treatment. The nature and incidence of such defects were :— Routine Inspections. Special Inspections. Defect or Disease. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (2) (3) (4) (6) Blepharitis 7 1 85 — Conjunctivitis — — 50 — Keratitis 1 — — — Corneal opacities — — 3 — Other conditions 15 1 165 — Defective Vision 180 1 66 — Squint 20 — 12 — 147 The number of minor eye defects treated at the Minor • Ailment Clinic was 256. Special Eye Clinic.—The Authority's Ophthalmic Surgeon (J. D. Magor Cardell, M.B., B.S., F.R.C.S.) attends on two sessions per week to examine and prescribe treatment for children referred by the school medical officers. During the year, the Ophthalmic Surgeon had referred to him 1,008 children, who made 1,201 attendances for examination and treatment. The following list shows the ophthalmic defects found in the 1,008 children examined by Mr. Cardell at the Special Eye Clinic. Myopia 144 Myopic astigmatism 139 Hypermetropia 174 Hyper astigmatism 245 Mixed astigmatism 45 Hypermetropia with squint 150 Myopia with squint 5 Squint only 18 Anisometropia 26 No defect 51 Spasm of accommodation 10 Various diseases 25 Referred to Minor Ailments Clinic 64 1,096 " Various diseases " included :— Corneal ulcer 1 Diplopia 1 Congenital cataract 4 Epicanthus 1 Meibomean cyst 4 Nystagmus 5 Ptosis 8 Ophthalmia neonatorum 1 25 148 Number of children for whom spectacles were (1) Prescribed (a) Under Authority's scheme 681 (b) Otherwise 21 (2) Obtained (a) Under Authority's scheme 677 (b) Otherwise 25 Number of children Referred to hospital 22 Referred to training clinic for squint 1 Recommended ultra-violet light 6 Recommended myope school 2 Recommended for special reading facilities in school 15 Recommended to discontinue spectacles 9 Treated with atropin for squint 60 Cured without use of spectacles 6 Details regarding the Special Eye Clinic for pre-school children will bo found on page 100. TREATMENT AND TRAINING OF CHILDREN SUFFERING FROM SQUINT. In the past the Council's Consultant Ophthalmic Surgeon (J. D. Magor Cardell, M.B., F.R.C.S.), who is a member of the consulting medical staff of the Central London Ophthalmic Hospital, has kindly arranged for Leyton children suffering from squint to attend at that Hospital for special treatment and training under his supervision. He finds, however, that this arrangement has not proved as satisfactory as he had hoped owing to the fact that most Leyton parents cannot afford the time and the money to attend the Hospital regularly. Under the circumstances Mr. Cardell submitted the following observations :— " A squinting eye is almost always defective in vision and always " fails to work properly in conjunction with the other eye. In a normal " person the ability to use both eyes together is responsible for the accurate " estimation of depth, roundness and distance—in short, for stereoscopic " vision. Without stereoscopic vision objects appear nearly flat and more " or less on the same plane—rather like a photograph. This defect is not " apparent to the person who squints, because he has never known any" thing different and therefore notices nothing abnormal in his vision. His " capability of performing fine movements requiring accurate judgment of " depth and distance is much reduced and certain types of employment are " impossible to him. 149 " The first defect in a squinting eye—poor vision—can be remedied " almost always by treatment which has been known and used for many " years. In some cases this improvement in vision will .result in a " straightening of the eye ; but when this does not occur the eye can be put " straight by operation. The second defect—lack of stereoscopic vision— " is not influenced by these forms of treatment. " Methods of training stereoscopic vision have been devised recently. " Some of these methods are good, but some are bad for the eyes. Care " is therefore needed in supervising the methods used. " It is obvious that if stereoscopic vision can be obtained in addition " to better sight and straightness in a squinting eye, the result is more " complete and—from a wage earning point of view—the jpatient is better " fitted for earning a good living. " I have for some time been dissatisfied with the position as regards " squint. An average taken of eight successive years shows that there are " about 148 cases a year. For these I am able to do a little by the use of " atropine and covering, but there is no possibility of my training their " binocular vision. Without binocular vision the value of the eyes, as " regards earning capacity, is very greatly reduced. The L.C.C. have " instituted for squint training, centres where binocular vision is trained. " 1 suggest that it is of great importance that the children of Lcvton should " receive a similar attention." Following a special report submitted by the School Medical Officer and Medical Officer of Health to the Education Authority and the Maternity and Child Welfare Authority in July, the Council decided to establish a special Squint Clinic for the treatment and training of children suffering from squint. School Dental Service. For the purposes of school dental inspection and treatment the Borough is divided into two areas, each being served by its own dental clinic in charge of a school dental surgeon. The dental staff consists of two dental surgeons, of whom one devotes the whole of his time to the school dental service, while the other also undertakes dental work in connection with the Council's Maternity and Child Welfare Scheme. As the number of children attending public elementary schools in the area is approximately 14,000, each dental surgeon is responsible for some 7,000 children, a number much in excess of that which one dental surgeon can inspect and treat efficiently each year. The result is that, instead of providing dental inspection and treatment annually, the period between one dental inspection and the next is about 14 months. Dental Inspection in Schools. The number of children belonging to the routine age groups inspected in school by the school dental surgeons was 10,921, i.e., 150 78 per cent, of the average number of children on the school rolls. The numbers inspected in each age group were :— Aged 5 900 6 954 7 1,120 8 1,030 9 1,176 10 1,261 11 1,168 12 1,280 13 1,395 14 637 In addition, the School Dental Surgeons made 2,301 special inspections of children otherwise than in the course of routine age group inspection covered by the Authority's approved scheme, i.e., children specially selected by the dental surgeons, or referred to them by school medical officers, parents, teachers, etc., on account of urgency. The total number of children submitted to routine and special dental inspection during the year was therefore 13,222, i.e., 95% of the number of children on the school rolls. Findings of Dental Inspection. The following table shows in statistical form the results of school dental inspection in individual schools and over the whole area. School. Number inspected. . Number referred for treatment. Number accepting treatment. Percentage of acceptances. Boys. Girls. Boys. Girls. Canterbury 627 364 439 266 453 64.2 Cann Hall 641 114 441 77 244 47.1 Capworth 339 625 255 480 396 53.8 Church 90 590 69 404 243 51.3 Da vies Lane 603 248 424 162 219 37.3 Downsell 644 101 369 57 222 52.1 Farmer 730 118 567 88 389 59.3 Goodall 113 723 71 496 257 45.3 Lea Bridge 41 53 29 38 48 71.6 Mayville 156 651 85 441 312 59.3 Newport 723 115 471 75 268 49.1 Ruekholt 266 255 171 170 193 56.6 Sybourn 629 291 515 234 441 58.8 St. Joseph's 118 100 77 70 78 53.0 Tom Hood 200 185 143 133 145 52.5 Trumpington 183 528 135 358 228 46.2 Knotts Green 110 93 78 64 76 53.5 6,213 5,154 4,339 3,613 4,212 52.96 151 It will be seen that, of the 11,367 children inspected, only 3,415 (30 per cent.) had perfectly sound sets of teeth, while 7,952 (70 per cent.) were found to require treatment. Of the 7,952 who were offered treatment, 4,212 accepted, the percentage of acceptance of treatment being 53 per cent. The figures show that in individual schools there is a considerable difference in the response of parents to the offers of skilled dental treatment on behalf of their children. For instance, in Canterbury Road School the percentage of acceptances was as high as 64.2 per cent., whereas in Davies Lane School it was as low as 37.3 per cent. In 1,208 cases (15 per cent.) the parents actually refused treatment, while in 2,532 cases (32 per cent.) the acceptance of treatment papers were not returned by the parents. The following figures give some idea of the dental treatment undertaken at the dental clinics during the year :— Fillings:— Permanent teeth 5,668 Temporary teeth 392 Total 6,060 Extractions:— Permanent teeth 1,244 Temporary teeth 4,817 Total... 6,061 Other operations :— Permanent teeth 1,115 Temporary teeth 383 Total 1,498 Administrations of general anaesthetics for extractions—1,247. 152 Orthopaedic Clinic. The following figures show the number of school children examined and treated during the last five years. Examinations. 1931 1932 1933 1934 1935 Primary examinations 75 110 118 115 105 lie-examinations 197 207 269 298 249 Treatment. 1931 1932 1933 1934 1935 Number of children who attended for 112 118 156 189 231 Attendances made 938 040 1,296 1,199 2,109 It will be seen that, during 1935, some 354 school children were examined or re-examined by the Council's Orthopaedic Surgeon, who attends on one session per month during the year. The following is a summary of the work of the School Medical Service Orthopaedic Clinic during the year :— Primary Examinations 105 Re-examinations 249 The findings at the primary examinations were as follows Deformities—Bones and Joints. (a) Congenital— Scoliosis 1 Shortening—lower limb 1 Cervical rib—R. and L. 1 153 (6) Acquired— Arthritis—knee 2 Deformity—digits (foot) 3 Schlatter's disease 1 Genu valgum 6 Genu varum 2 Bowed tibiae 3 Perthe's disease 1 Hallux valgus 4 Shoemaker's chest l Pigeon chest 2 Old fracture—ankle joint 1 Old fracture—elbow joint 2 Old fracture—wrist 1 Epiphysitis—Metatarsal (5) 1 Subungual exostosis digit (foot) 1 Muscular. (a) Congenital— Talipes 2 Torticollis 2 (6) Acquired— Kypho—scoliosis 1 Scoliosis 4 Kyphosis 8 Lordosis 1 Pes varus 1 Pes cavus 3 Pes piano valgus 45 Hernia—muscle 1 Paralysis. Congenital— Spastic Tetraplegia 1 Spastic diplegia 1 Hemiplegia 1 Acquired— Anterior poliomyelitis 2 154 Also— Ganglion—wrist 3 Ganglion—foot 1 .Fibro—lipoma 1 Local elephantiasis (hand) 1 Teno—synovitis (peronei) 1 Supernumerary digit (hand) 1 Treatment. Number of school children attending for treatment 231 Number of attendances for treatment 2,109 During the year, 6 school children were admitted to hospital, and the following surgical operations were performed :—- Osteotomy—femur "? Tenotomy—tendo achilles and plaster 1 Removal adherent scar—femur 1 Arthrodesis digit (1) foot 1 Amputation digit (5) foot 1 Amputation last phalanx digit (1) foot 1 Removal rudimentary digit hand 1 Plaster spica—hip 1 9 Surgical Appliances. The following have been supplied :— Caliper splint—leg 3 Iron and strap to boot 1 Surgical boots 4 pairs and 3 singles Wedges, valgus pads and stiffening to boots 3 pairs Minor surgical alterations to boots, etc. 65 pairs Alterations and repairs to surgical boots and splints 10 pairs Protective skull plate 1 155 Artificial Light Clinic. The routine application of treatment by means of ultraviolet rays is performed by the Authority's Masseuse (Miss A. E. Findlay) under the supervision of Dr. Gavin (Deputy School Medical Officer), to whom 1 am indebted for the following report on the work of the clinic during the year. (Report ky Dr. F. W. Gavin.) Number of cases treated 110 Number of new cases treated 74 Total number of attendances 3,310 The 110 cases averaged 30.09 attendances per case. The 74 new cases averaged 25.52 attendances per case. The 36 okl cases averaged 39.47 attendances per case. (22 boys and 14 girls.) Among the new cases, attendances varied from 8 to 74 with two exceptions ; these made only 3 and 4 attendances respectively. One old case made 7 attendances before proceeding to convalescent home treatment. All other old cases had attendances varying from 11 to 72 during 1935. Type of Lamp Employed.—Quartz mercury vapour. Strength of Dose.—The treatment is graduated, each patient commencing with a minimum 2/2 exposure by 3/2, 4/2, 5/2, 7/2, 9/2 to a maximum of 10/2, i.e., 10 minutes to each side of the body. Arrangements.—Schoolboys are treated twice weekly on Tuesdays and Thursdays at 2 p.m., while schoolgirls receive treatment on Tuesdays and Thursdays at 9 a.m. Other Forms of Treatment.—Of the 110 cases treated in 1935, 9 were children attending the Open Air School at Knotts Green. Five of these were new cases. Seven cases were also known to have had treatment by their private medical practitioners; seven by local hospitals; and two were ordered U.Y.R. therapy by the Authority's Ophthalmic Surgeon. 156 Cod liver oil and malt had been ordered in 33 oases; anil 4 patients had some variety of iron tonie in addition to light treatment. Forty-eight children received light treatment without any other known form of therapy. Prouress in General Health. The following summary shows the estimation of school medical officer, parents and teachers as to the results of treatment:— (a) New Cases, 1935. Medical Officer. Parents. Teachers. Very marked improvement 13 4 19 Definite improvement 42 52 26 Slight improvement 9 5 4 No improvement 4 5 17 No data available* 6 8 8 74 74 74 *Two of these cases have left the district and the others were absent at re-inspection, one being away at a Convalescent Home. (b) Old Cases, 1935. Medical Officer. Parents. Teachers. Very marked improvement 3 1 7 Definite improvement 28 27 14 Slight improvement 3 4 3 No improvement 1 1 9 No data available* 1 3 3 36 36 36 *One case was away in a Convalescent Home when due for re-inspection. 157 Progress as Regards Special Symptoms. (a) New Cases, 1935— Cured. Improved. Slight improvement. No improvement. Anaemia 21 5 2 — Debility 8 9 3 1 Styes 8 2 — — Subnormal nutrition — 5 — 1 Bronchitis 1 2 2 2 Bronchial asthma — 1 — 1 Cervical Adenitis 1 1 — — Alopecia Areata 1 — — — Nervous (Tic) — 1 — — 40 26 . 7 5 (6) Old Cases, 1935— Cured. Improved. Slight improvement. No improvement. Anaemia 7 — — — Debility 2 8 2 — Bronchitis — 1 1 4 Bronchial asthma — 4 — 1 Rheumatism — 3 — — Subnormal nutrition — 1 1 Styes 2 — — — Bronchiectasis — 1 — — Nervous (Somnambulism) — 1 — — 11 19 3 6 158 Knotts Green Open-air School Cases. Only nine children, five being new cases, received artificial light treatment during the year 1935. Medical Officer. Parents. Teachers. Very marked improvement 3 — 2 Definite improvement 4 6 1 Slight improvement 1 1 — No improvement 1 — 6 No data available — 2 — 9 9 9 Note of Unfavourable Symptoms. One child complained of feeling giddy and sick after light treatment.; after 18 attendances treatment was discontinued. This was the only case during 1935 with an unfavourable reaction to U.V.R. Children suffering from diabetes, pulmonary tuberculosis or renal disease are unsuitable subjects for the treatment. Depression, headaches, sickness, lassitude or irritability following exposure to the Ultra Violet Ray are indications for ceasing the treatment. General Conclusions. General Health. 86 cases out of 103 (83.5 %) showed definite or much improvement according to the medical officer. 84 cases out of 99 (84.8 %) showed definite or much improvement according to the parents. 66 cases out of 99 (06.6 %) showed definite or much improvement according to the teachers. Special Symptoms. 96 cases out of 116 (82.7 %) showed much improvement or were cured. 159 48 cases received ultra violet ray therapy alone and of these:— 45 cases (93.7 %) showed improvement from medical officer's review. 39 cases (81.2 %) showed improvement from parents' statements. 32 cases (06.6 %) showed improvement from teachers' reports. General Notes on the Results. The most noteworthy feature in 1935 was the expansion of the work as compared with that done in 1934. For example, the total number of attendances rose from 2,151 in 1934 to 3,310 in 1935 ; and 23 more children were treated during 1935 than in 1934, an indication of much extra work performed by the Authority's Masseuse (Miss A. E. Findlay). On comparing the results with those of the previous year we find t hat as regards general healt h the percentage of treated children who showed definite or much improvement has increased—not only according to the medical officer's assessment, but also in the estimate arrived at by the parents and teachers concerned. It will be appreciated that teachers' opinions are more concerned with the scholastic attainment of the individual child than with his or her physique. At re-inspections parents are asked particularly about any improvement in the child's appetite, whether the treatment causes any improvement in energy and has any effect on sleep. As regards special symptoms we find that, just as in 1934, the ansemic child nearly always derives benefit and is often cured (35 anaemic children cured in 1935), by exposure to artificial light : and that once again the debilitated child does well (32 such being cured or improved in 1935). Ten children suffering from recurrent styes were cured and two improved during 1935 out of 12 such children treated. On the other hand bronchial conditions were less responsive to treatment, e.g., 6 cases of chronic recurrent bronchitis made no improvement, and 2 cases of bronchial asthma did not appear to benefit ; although 5 asthmatics and 4 bronchitis cases improved. Two cases of subnormal nutrition showed no improvement, while six improved. One case of alopecia areata was cured, and this is a type of case which might well be included in the debilitated group. 160 Three boys included in the rehumatism group improved— "rheumatism is unknown as an endemic condition in hot sunny countries, whilst the value of the sun as a curative agent in rheumatic states is undoubted" (Pearson and Wyllie). To quote again from Pearson and Wyllie, "Though nothing accurate is yet known about the storing of the sun's energy in the body, there is little doubt that it occurs. The' conditions under which the Esquimaux live suggest this. These people enjoy six months of good sunshine, but during the remainder of the year live in darkness and yet keep very healthy. In this climate, owing to the uncertain amount of sunshine in the summer, it would appear that insufficient rays are stored to last over the winter months. The languid feelings, ill-health and liability to infection that are so common in the early months of the year may be due to this cause, for, when sunshine reappears, general health improves." Finally, although natural sunlight must always be preferable, the place of artificial light for treating sun-starved children is assured. PHYSICALLY AND MENTALLY DEFECTIVE CHILDREN. Mentally Defective Children : Statutory Medical Examinations. During the year, some 88 children were referred for statutory medical examination. As the result of examination these 88 children were classified as follows :— Idiots 1 Imbeciles 1 Moral defectives 0 On attaining 16 years of age—for supervision under the M.D. (Notification of Children) Regulations 10 Certified to Local Education Authority as feebleminded 17 Remained under certificate 13 Certificate withdrawn 3 Dull and backward 39 Backward 3 Borderline cases—to be re-assessed in six months 1 88 161 Knotts Green Special School for Mental Defectives. Admitted 23 Discharged 22 On roll at end of year 92 Seventeen children, certified to the Local Education Authority as feeble-minded, were admitted to Knotts Green Special School during the year and six children attending the Open Air School were transferred to the School for Mental Defectives. Of the 22 children whose names were removed from the roll, 10 reached the statutory leaving age of 16 years and were notified to the Local Control Authority for supervision in accordance with the Mental Deficiency (Notification of Children) Regulations ; 3 were allowed to leave on withdrawal of certificate of mental deficiency, and 9 removed from the district. Physically Defective Children. Knotts Green Special School. Accommodation is provided for 150 physically defectiv children. Admitted during the year 44 Discharged 46 ,, —-on withdrawal of certificates 29 ,, —on removal from district 11 ,, —on reaching statutory leaving age 4 ,, —on transfer to Epileptic Colony 1 ,, —unsuitable 1 On roll at end of year 141 162 The following table shows the types of physical defect, the number of children in each category, and the progress recorded in the cases of 153 children subjected to medical survey by Dr. F. W. Gavin (Deputy School Medical Officer) during the year. Improved. Stationary. Worse. No Data. Died. Total. Debility (including anaemia) 21 2 1 4 — 2S Bronchitis 12 3 1 3 — 19 Asthma (bronchial) 10 1 2 1 — 14 Bronchiectasis 3 1 — 1 — 5 Subnormal nutrition 0 2 — 2 — 10 Quiescent or arrested tuberculosis 5 — — 1 — 7 Major epilepsy 2 — 2 — — 4 Minor epilepsy — 9 — — — 2 Nervous (tic, etc.) 4 — — — — 4 Rheumatism (including quiescent carditis and chorea) 16 8 2 — — 31 Congenital heart disease 2 1 — — — 3 Other defects 3 1 — — — 4 Cripples (orthopaedic cases) 14 3 — 5 — 22 Totals 99 24 8 22 — 153 Number of children improved 99 (64.70%) Number of children stationary 24 (15.68%) Number of children worse 8 (5.22%) Observations by Dr. F. W. Gavin. This table is compiled from the results of medical re-inspections of the physically defective children who attended the open air school during the year 1935. Under the heading " No data," children admitted to the school since September 30th, 1935, and children absent for re-inspection are included, as well as children who left the district before re-inspection. On comparing the figures with those for the year 1934 a striking feature is the decline in the number of crippled children (orthopaedic, cases) at Knotts Green from 30 in 1934 to 22 in 1935. Cardiac cripples and cases of crippling due to quiescent or arrested tuberculosis are included in the sections labelled "Rheumatism," "Congenital Heart Disease" and "Quiescent or Arrested Tuberculosis " respectively. The Rheumatism group was the largest—again, as in 1934, 16 improved out of 31. 163 Twenty-one cases of debility (including anaemia) improved out of 28 attending the school, and 14 cripples (orthopaedic cases) improved out of 22. These figures are very similar to those for 1934, but a reduction in the total number of children attending the school in 1935 (i.e., 175 in 1934 to 153 in 1935) took place. There is no doubt that practically all the children admitted to the Open Air School derive some benefit during their attendance, a benefit which is noticeably more marked during the summer months—the most beneficent period is from April to October. The damp, cold, foggy days of winter preclude benefit in such conditions as bronchiectasis, chronic bronchitis, bronchial asthma, congenital heart disease and rheumatism. On the other hand, crippled children have no stairs to climb at Knotts Green School, arc conveyed to and from school by ambulance, and a void the rough and tumble of the ordinary school. Defective Children. Bund and Partially Blind Children. Arrangements were made for 5 children to attend a day Special School for myopic children. One child left a (lav Special School for myopic children upon withdrawal of the certificate of defect, and 2 upon removal from the area. One child left a residential blind school upon withdrawal of the certificate of defect—responsibility ceased in one case upon removal of the parent from the area. Deaf and Dumb Children. One child left a day Special School for deaf children upon attaining the statutory leaving age. Three children were transferred from a day Special School for deaf children to a residential Special School, 164 Convalescent Home Treatment. During the year under review the Education Committee accepted responsibility for the cost of maintenance and treatment of 67 children in convalescent homes, heart homes or open air schools recognised by the Board of Education. In addition, 42 children attending Leyton schools were sent away for varying periods through the agency of the Tuberculosis Care Association and 46 through the agency of the Invalid Children's Aid Association. Exceptional Children -Cost of Education.—The Director of Education has supplied the following information showing the annual cost to the Education Authority of educating the undermentioned tvpes of children. Per Child. Rate Cost Per Child. (1) Cost in Leyton Elementary Schools (based on average attendance) £16 18 3 £8 18 5 (2) Blind Child— (i) In Special Day School (a) £20 0 0 £20 0 0 (ii) In Special Residential School (a) £74 0 0 £37 0 0 (iii) In Residential Ophthalmic School (a) £144 0 0 £72 0 0 (3) Deaf Child— (i) In Special Day School (a) £26 8 0 £26 8 0 (ii) In Special Residential School(a) £75 0 0 £37 10 0 (4) Defective Child— (i) In Knotts Green Special School (b) £31 15 6 £15 17 9 (ii) Mentally Defective Child in Residential Institution (a) £61 0 0 £30 10 0 (iii) Child in Epileptic Colony (a) £67 12 0 £33 16 0 (iv) Child receiving Residential Orthopaedic Treatment (a) £109 4 0 £54 12 0 Notes.—(a) Charge made by the particular Institution or Authority —not necessarily the gross cost of education. (b) Co3t of educating both physically and mentally defective children at Knotts Green. Not possible to differentiate cost as between each type, as many of the services are common to both in varying proportions. 165 LEFT HANDEDNESS IN SCHOOL CHILDREN. During the year the Education Authority considered the question of left-handed school children and the methods which should be adopted in dealing with such children. The question had been considered during 1934 by the London County Council, and the following is the summary of a report on the subject by the School Medical Officer, London County Council. The existence of a number of children who appear to be naturally left-handed and the effects upon them of attempts to correct what appears to be a disadvantage in a world consisting mainly of right-handed persons have always been of great interest to school hygienists. The question has become rather prominent during the last three or four years owing to the struggle for work which has resulted from widespread unemployment. There has, in consequence, been a general demand on the part of the teachers in London for guidance on the subject. Mr. G. E. Wear of the Ministry of Labour addressed, at the Council's request, a special enquiry to juvenile advisory committees on the question and a summary of the results follows :— General Post Office.—In the case of candidates for appointment as telephonist or girl probationers, no applications are considered from those who cannot write easily and legibly with the right hand. Clerical.—Left-handedness was reported generally to be a bar by employers engaging staff where handwriting is essential; left-handed juveniles are stated to be poor and slow. From one area it is reported that employers will not consider left-handed juveniles where book-keeping and ledger-work is involved. It is also understood that the banks definitely will not engage left-handed persons. Engineering.—It was reported generally to be a definite bar where juveniles are required to operate machines and to work in a " team." Needle Trades.—It was reported generally a bar. It would appear to be chiefly due to the fact that left-handed and right-handed girls cannot work together. It is reported from one area that the largest employer of machinists states that his best workers are left-handed, but the difficulty is in the training; the girls take much longer to learn and require more patience in teaching. Other trades where left-handedness is reported to be a bar are cabinetmaking, piano-making, sports goods, bookbinding and hairdressing. The consultative committee of head mistresses of girls' schools drew attention to advice which had in certain cases been given to head teachers regarding the method which it was considered desirable to adopt in dealing with left-handedness in children, and asking that similar information should be conveyed to ail bead teachers. The request was referred to the chief inspector, who appointed a committee of inspectors to inquire into 166 the matter and the asertain whether, and i so in what degree, left-handedness is a handicap in industry and commerce. The question was also discussed with the medical officer, on whose advice the letters referred to by the consultative committee were written. It appeared desirable that head teachers should have some guidance in the treatment of left-handed children, and it was suggested by the chief inspector that a circular should be issued in the following terms:— There arc exceptional children who appear to be naturally left-handed. There are also many children who have acquired left-handedness, though in many of these cases the exact cause may be obscure. But whether lefthandedness in any particular case is innate or acquired, the tendency to use the left hand is often firmly fixed before school age. The conventions in writing are, however, arranged to suit right-handed people, and anyone who writes with the left hand will work under a definite, if slight, handicap all his life. There is evidence also that left-handedness is a handicap in certain commercial and industrial occupations. It would, therefore, appear to be desirable that some attempt should be made, particularly in the early stages of teaching writing, to encourage all children to use the right hand. Many left-handed children have learnt to write with the right hand without any apparent disadvantage. It will be appreciated that in cases in which the left-handedness is either natural or well established, there may be some danger in exercising any pressure in this matter. The medical officer points out that school hygienists are agreed that there certainly should be no attempt to make children right-handed by means of punishment or ridicule. He states further that pressure is likely to result in producing a harmful degree of emotional disturbance. This has been found in some cases to result in nervous symptoms, including stammering. It will be recognised, therefore, that in any attempts to encourage children to be right-handed, it is very necessary to proceed with great caution, and to desist if any signs of abnormal emotional disturbance are shown. The Council agreed that the head teachers should be advised in the above terms, but directed that stress should be laid upon the words in italics. SECONDARY SCHOOLS AND OTHER INSTITUTIONS FOR HIGHER EDUCATION. Situated within the Borough of Leyton are three schools for higher education, viz.:— Leyton County High School for Boys, Essex Road. Leyton County High School for Girls, Colworth Road. Leyton Technical Institute, Adelaide Road. The last-named Institute contains (a) a Junior Technical School, and (6) a Junior Art School. 167 These schools are administered by. the Essex County Council which is the Authority for Higher Education. Admission is by competitive examination at the age of 11 years to the two County High Schools, and at 12| years to the Technical Institute. Mr. R. J. Geldart, District Clerk, has kindly supplied the following information regarding the number of Leyton children on the roll of these schools at the end of 1935. School.» No. on Roll. Resident in Leyton. Previously attended Leyton Elementary Schools. Number Percentage. Number Percentage. Boys' High School 533 356 00.79 345 64.73 Girls' High School 449 373 83.07 355 79.06 Junior Technical School 350 44 12.57 46 13.14 Junior Art School 60 18 30.00 18 30.00 It will be seen that, of the 1,392 pupils in attendance at these secondary schools in the area, 791 (56.89 per cent.) are actually resident in Leyton, and 764 (54.56 per cent.) previously attended Leyton elementary schools. These figures do not include Leyton elementary school children who are now in attendance at County High Schools outside the Borough. Until they reached the age of 11 years these children had been eligible to take advantage of the Leyton Education Authority's comprehensive scheme of clinic medical services for the treatment of minor ailments, eye defects, orthopaedic defects, dental defects, unhealthy tonsils and adenoids, ringworm, etc. ; and arrangements are in existence for the treatment in approved convalescent homes of children in need of it. As soon, however, as a Leyton elementary school child has shown sufficient scholastic ability to gain admission to a County Secondary School, he becomes ineligible for any of the forms of medical treatment outlined above unless there should happen to be a special arrangement in existence for the treatment by the Local Education Authority on behalf of the County Authority. Although the County arranges lor the routine medical inspection 168 of secondary school children, it provides no facilities for the treatment of ascertained defects. The child of more than average ability is therefore penalised from a health service point of view owing to the fact that he has gained admission to a County High School. The secondary school child who conscientiously performs all his allotted homework belongs to one of the overworked sedentary occupations. Although Education Authorities have some control over the general hygienic conditions in schools, e.g., lighting, ventilation, etc., they do not concern themselves with the conditions in which the children have to work for two or three hours every night at home. Unfortunately these conditions are often so unsatisfactory as to impose a considerable strain on the health of the children ; and it is in the case of such children, debilitated by the lack of fresh air and exercise, that the correction of existing defects is of great importance. In after life a child may suffer no inconvenience whatever by the loss of much of the knowledge he has acquired in the classroom, but the loss of his teeth or his health will assuredly prove a handicap to him all through life. It should be recogniscd that the price of scholastic success is too great if it is bought at the expense of health. Dental Defects and their Treatment. Of 11,367 children in Leyton elementary schools subjected to routine dental inspection during 1935, some 7,952 (69.95 per cent.) were found to require dental treatment ; and there is no evidence to show that children of more than average ability are less prone than their school-fellows to develop dental caries. In Leyton County Secondary schools, however, there is no organised provision either for routine dental inspection or for dental treatment. In some cases parents are both able and willing to arrange for the regular care of their children's teeth by private dental practitioners ; but there arc many parents who allow the condition of their children's teeth to deteriorate merely because of the lack of provision by the County Council of the dental facilities to which their children had become accustomed while they attended Leyton Elementary Schools. EMPLOYMENT OF CHILDREN and STREET TRADING BY YOUNG PERSONS. In August, 1931, the Bye-laws made by the Lsyton Local Education Authority pursuant to the provisions of the Employment of Children Act, 1903, as amended by the Education Act, 1921, 169 regulating (a) the employment of children generally, and (b) street trading by persons under the age of sixteen years, within the Borough of Leyton were confirmed by H.M. Minister and put into operation forthwith. Since these Bye-laws came into operation, medical certificates have been granted as follows :— 1931 89 certificates granted. 1932 72 ,, ,, 1933 65 ,, ,, 1934 73 ,, ,, 1935 136 ,, ,, PROVISION OF MEALS. The provision of meals to children attending the elementary schoo's is undertaken by the Education Authority under powers granted by Sections 82-85 of the Education Act, 1921. The average number of children fed per week during the past five years:— 1931 289 1932 356 1933 303 1934 323 1935 327 The number of individual children fed under the Authority's arrangements during 1935 was as follows :— Ordinary Meals. Milk Meals. Free 559 882 For payment 35 — Totals 594 882 110 Number of meals supplied :— Ordinary Meals. Milk Meals. Free 90,125 185,521 For payment 3,068 — Totals 93,193 185,521 The average cost of food per ordinary meal was 3.72 pence; the total average cost (including overhead charges) being 6.84 pence. The total gross cost for the year for both ordinary and milk meal amounted to £3,044 0s. 2¼d. The above figures relate to the financial year ended 31st March, 1936. STATISTICAL APPENDIX. TABLE I.—-Returns of Medical Inspections. a. Routine Medical Inspections. Number of Code Group Inspections :— Entrants 1,571 Second Age Group 1,425 Third Age Group 1,509 Total 4,505 Number of other Routine Inspections 617 b. Other Inspections. Number of Special Inspections 3,804 Number of Re-inspections 12,109 Total 15,455 171 C. Children Found to Require Treatment. Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (1) (2) (3) (4) Code Groups— Entrants 1571 321 20.43 Second Age Group 1425 341 23.92 Third Age Group 1509 211 15.97 Total (Code Groups) 4505 903 20.04 Other Routine Inspections 017 28 4.53 Grand Total 5122 931 18.15 TABLE II—B. Classification of the Nutrition of Children Inspected durinc. the Year in the Routine Ace Groups. Age Groups. No. of Children Inspected. A. (Excellent). B. (Normal). C. (Slightly Subnormal). D. (Bad). No. % No. % No. % No. % Entrants 1,571 196 12.5 1,162 74.0 200 12.7 13 0.82 Second Age Group 1,425 183 12.8 1,044 73.2 190 13.3 8 0.56 Third Age Group 1,509 304 20.1 1,076 71.3 125 8.2 4 0.27 Other Routine Inspections 617 71 11.5 460 74.5 76 12.3 10 1.62 Total 5,122 754 14.7 3,742 73.0 591 11.5 35 0.68 172 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1935. Defect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) Uncleanliness— ... ... ... ... (See Table IV., Group VI.) ... ... ... Skin Ringworm—Scalp ... ... 7 ... Bodv ... ... 20 ... Scabies ... ... 36 ... Impetigo ... ... 76 ... Other diseases (non-T.B.) 4 2 168 ... Eye Blepharitis 7 1 85 ... Conjunctivitis ... ... 59 ... Keratitis 1 ... ... Corneal Opacities ... ... 3 ... Other conditions 15 1 165 ... Defective Vision 180 l 66 ... Squint 20 ... 12 ... Ear Defective Hearing 11 3 15 2 Otitis Media 15 4 66 ... Other Ear Diseases 2 3 193 ... Nose & Throat Chronic Tonsilitis only 66 127 43 2 Adenoids only 11 11 14 ... Chronic Tonsilitis and Adenoids 29 15 44 1 . Other Conditions 21 3 84 ... Enlarged Cervical Glands (non-T.B.) 8 30 54 2 Defective Speech 1 3 4 ... Heart and Circulation Heart Disease— Organic 10 ... 8 ... Functional 7 60 8 7 .Anaemia 31 13 65 4 Lungs Bronchitis 35 36 66 2 Other non-T.B. Diseases 22 34 27 3 Tuberculosis Pulmonary— Definite ... 1 ... ... Suspected 1 5 ... 1 Non-Pulmonary— Glands 3 3 3 ... Bones and Joints ... 1 1 ... Skin ... ... ... ... Other Forms ... 2 ... ... Nervous System Epilepsy 2 2 9 ... Chorea ... 4 10 ... . Other Conditions 5 9 23 2 Deformities Rickets 2 2 1 ... Spinal Curvature 2 1 2 ... .Other Forms 61 11 57 1 Other Defects and Diseases 82 55 1,545 7 Totals 654 443 3,039 34 173 TABLE ITT. Return of all Exceptional Children in the Area. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 3 3 PARTIALLY SIGHTED CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Sighted At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 16 — 3 — 19 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 9 — — — 9 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 2 — — — 2 MENTALLY DEFECTIVE CHILDREN. Feeble-minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 90 — 4 — 94 174 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 5 3 — 8 PHYSICALLY DEFECTIVE CHILDREN. A. Tuberculous Children. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Cert ified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 6 3 — 9 II.—Children Suffering from Non-Pulmonary Tuberculosis. (This category should include tuberculosis of all sites other than those shown in (T) above.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 2 22 11 — 35 B. Delicate Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 03 — — — 03 C. Crippled Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 33 23 — 1 57 175 D. Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 14 2 1 1 18 Children Suffering from Multiple Defects. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At School or Institution. Total. Feeble Minded and Epileptic 2 - - - 2 Feeble Minded and Crippled 1 — — 1 2 Crippled and Epileptic 1 — — i 2 Feeble Minded and Heart 1 — — — 1 TABLE IV.—Return of Defects Treated during the Vf.ar ended 31st December. 1935. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uneleanliness, for which see Group VI.) Disease or Defect. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm— Scalp—(1) X-rnv treatment 4 — 4 (2) Other 2 — 2 Body 20 — 20 Scabies 35 — 35 Impetigo 73 — 7'i Other skin diseases 1G5 — 165 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 250 1 257 Minor Ear Defects.. 273 - 273 M iscellaneons— (e.g., minor injuries, bruises, sores, chilblains, etc.) 709 7 806 Total 1,627 8 1,635 176 TABLE IV.—contd. Group II.—Defective Vision and Squint (excluding. Minor Eyp. Defects treated as Minor Ailments.—Group I.). Defect of Disease. Number of Defects dealt with. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Errors of refraction (including squint) 1007 21 1028 Other defect or disease of the eyes (excluding those recorded in Group I.) 25 1032 - 25 Total 21 1053 Under the Authority's Scheme. Otherwise. Total. No. of Children for whom Spectacles were :— (a) Prescribed 081 21 702 (b) Obtained (177 25 702 TABLE IV.—contd. Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Other Forms of Treat ment. Total Number Treated. Received Operative Treatment. Under the Authority'^ Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (1) (2) (3) (4) (1) (2) (3) (4) (1) (2) (3) (4) 44 5 38 17 22 — 20 5 66 5 58 22 282 433 (1) Tonsils only. (2) Adenoids only. (3) Tonsils and adenoids. (4) Other defects of the nose and throat. 177 TABLE IV.—contd. Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. Otherwise. Total number treated. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. (1) (2) (3) (1) (2) (3) No. of children treated 9 3 239 — 2 4 249 TABLE V. Dental Inspection and Treatment. (1) Number of children who were :— (a) Inspected by the Dentist Aged: Routine Age Groups 3 14 Total 11,367 4 300 5 900 6 954 7 1,120 8 1,030 9 1,176 10 1,261 11 1,168 12 1,280 13 1,395 14 637 15 118 16 8 Specials (Casuals) 1,855 Grand Total 13,222 (6) Found to require treatment 7,952 (c) Actually treated 4,905 (2) Half-days devoted to Inspection 63 Treatment 839— Total 902 178 (3) Attendances made by children for treatment 8,198 (4) Fillings, Permanent Teeth 5,068 Temporary „ 392—Total 6,060 (5) Extractions, Permanent Teeth 1,244 Temporary ,, 4,817—Total 6,061 (6) Administrations of general anaesthetics for extractions 1,247 (7) Other operations, Permanent Teeth 1,115 Temporary „ 383—Total 1,498 TABLE VI. Uncleanliness and Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 3 (2) Total number of examinations of children in the Schools by School Nurses 35,016 (3) Number of individual children found unclean 1,278 (4) Number of children cleansed under arrangements made by the Local Education Authority — (5) Number of cases in which Legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under the School Attendance Bye-laws — 179 STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1935, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total number of children notified: 11. Analysis of the above Total. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots 1 - (b) Imbeciles — 1 (c) Others — — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives — — (b) Others - - 2. Feeble-minde children notified on leaving a Special School on or before attaining the age of 16 ... 5 4 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases Note.—No child should be notified under Article 3 until the Board have issued a formal certificate (Form 308M) to the Authority. — — 4. Children who in addition to being mentally defective were blind or deaf Note.—No blind or deaf child should be notified without reference to the Board—see Article 2, proviso (ii). — — Grand Total 6 5 180 INDEX. page Section A. Statistics and Social Conditions of the Area 9/29 ,, B. General Provisions of Health Services for the Area 110/30 „ C. Sanitary Circumstances of the Area 37/44 „ D. Housing 45/49 ,, E. Inspection and Supervision of Food 50/59 „ F. Factories and Workshops 59/02 ,, G. Prevalence of, and Control over Infectious Diseases 02/80 Isolation Hospital 82/92 Maternity and Child Welfare 94/130 School Medical Service 132/179 public health. Acts, Adoptive 32 Adulteration 59 Ambulance service 32 Ante-natal Clinics 105 ,, „ Abnormal Cases 108 Artificial Sunlight Treatment 101 Bacteriological Examination 73 Bakehouses 57 Baths—Swimming 34 Births 14 Bye-laws and Regulations 33 Cancer 72 Chicken Pox 62 Children and Young Persons Act 105 Clinic Premises, New Joint 120 Clinics and Treatment Centres 30 Convalescent Home Treatment 101,118 Co-ordination of Health Services 129 Dairies, Cowsheds and Milksliops 50 Deaths 18 „ Maternal 22,112 ,, Infantile 21, 102 Demolition Orders 47 Dental Treatment, M. & C. W 98 Diabetes—Supply of Insulin 72 Dining Room and Restaurants 57 Diphtheria 63 ,, Immunisation 64 Diseases of Animals Acts 58 Disinfection Terminal 75 Drainage 40 181 PAGE Enteric Fever 62 Factories and Workshops 59 Foods, Inspection of 50 Foster Mothers 40,105 Hairdressers 41 Health Visitors, Visits 98 Home Helps 111 Hospital Provision 31 House to House Inspection 48 Housing Statistics 45 Ice Cream 53 Infant Welfare Centres 94 ,, ,, ,, Attendances 95, 96 ,, Mortality 21, 102 ,, Life Protection 105 Infectious Diseases 62 Inquests 36 Insulin, Supply of 72 Isolation Hospital 82 Legislation in force 32 Massage Establishments 34 Maternal Morbidity and Mortality 22,112 Maternity Beds 110 Meals for Expectant Mothers 125 Meat Inspection 54 Meteorology 10 Midwives 118/124 „ Compensation to 119 ,, Fees paid to Doctors 121 „ Medical Aid 120 ,, Report of Joint Council 121 ,, Supervision of 118 Milk, Schcme for Supply of 125 „ Special Designation Order 51 Mortuary 35 Neo Natal Mortality 102 Notification of Births 94 Nursing Homes 111 Nutrition 125 Obstetric Consultant 115 Offensive Trades 58 Ophthalmia Neonatorum 102 Ophthalmic Clinic (M. & C. W.) 100 Orthopaedic Clinic (M. & C. W.) 99 Overcrowding 48 182 PAGE Pemphigus Neonatorum 68 Petroleum Acts 42 Poison and Pharmacy Acts 43 Population 8 Public Cleansing 37 Puerperal Fever 112 „ Pyrexia 114 Rag and Flock Act 40 Rats and Mice Destruction Act 44 Refuse Collection 38 ,, Dumps 39 Rent Restriction Act 48 Restaurants and Dining Rooms 57 Sanitary Inspectors' Visits 39 Scarlet Fever 63 „ ,, School Exclusion and Home Treatment 76 ,, ,, Complications amongst Patients in Isolation Hospital 85 Scavenging 37 Schools 44 Shops Act 43 Slaughter Houses 54 Smoke Observations 43 Social Conditions 9 Staff 3 Stillbirths 9, 109 Swimming Baths 34 Terminal Disinfection 75 Tuberculosis 68 tables. Table 1—Meteorology 12 „ 2—Births 17 „ 3—Deaths 23 „ 4—Comparative Statistics 27 ,, 5—Vital Statistics of Whole District 28 „ 6—Analysis of Mortality 20 „ 7—Infectious Disease Notifications 74 ,, 8—Infant Mortality 103 Unsound Food 54 Verminous Premises 40 Voluntary Workers 97 Water Supply 37 183 PAGE school medical service. Accommodation 132 Artificial Light Clinic 155 Blind Children 163 Convalescent Home Treatment 164 Deaf Children 163 Defective Vision 146 Dental Treatment 149 Employment of Children 168 Eye Clinic 147 Knotts Green Special School 161 Left Handedness in Children 165 Malnutrition 139 Meals, Provision of 169 Medical Inspection 133 ,, Treatment 143 Mentally Defectives 160 Milk Meals 169 Minor Ailments Clinic 144 Orthopaedic Clinic 152 Physically Defective Children 161 School Population and Attendance 132 ,, Premises—Alterations and Additions 133 Secondary School Children, Medical Treatment of 166 Squint Clinic 148 Statistical Tables 170 Tonsils and Adenoids 145 Uncleanliness 143