WAL 3 Ac 4411 Co WALTHAMSLOW Borough of Malthamstow. REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1930. 67076 Borough of Walthamstow. REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1930. INDEX. pages Section 1.-Statistics and Social Conditions of the Area 7-20 ,, 2.-General Provision of Health Services in the Area 20-27 ,, 3.-Sanitary Circumstances of the Area 27-32 ,, 4.-Housing 32-39 ,, 5.-Inspection and Supervision of Food 39-43 ,, 6.-Prevalence of and Control over Infectious Diseases 47-74 ,, 7.-Infectious Diseases Hospital 74-82 ,, 8.-Maternity and Child Welfare 84-111 PAGE Acreage 7 Adulteration 40 Ambulance25 Ante-Natal Clinic 26,99 Antitoxin 63,81 Bacteriology 21,51, 81 Bacteriological Analyses 40 Bakehouses 30 Biological Tests 39,40 Births 11-15 ,, , Notification of 86 Birth Rate 11,13 Breast Feeding 94 Byelaws 22 Cancer 16, 18, 19 20 Caravans 32 Census 7,8 Cerebro-Spinal Meningitis 68 Chickenpox 69 Clinics 26,27 Closet Accommodation 27 Committees 4, 84 Complaints 28 Confinements 107 Consultants 108 Cowsheds 39 Dampness 29 Deaths11, 16, 18 ,, , Institutional 11, 12 Death Rate 5, 13, 14, 17 Dental Treatment 102 Diphtheria 5,13,14,16,18,61,78,79 Diseases of Animals Acts 5, 44 Disinfection 29 Drainage 27 Encephalitis Lethargica 16,67 Enteric Fever 14, 16, 63 Erysipelas 66 Essex County Nursing Assn. 21, 107 PAGE Fair Grounds 31 Factories and Workshops Acts 5, 45, 46 Fishmongers 30 Food and Drugs 39, 40, 42 Health Visitors 85 Home Helps 106 Hospital Accommodation 23 ,, , Infectious Diseases 74 ,, , Smallpox 57,74 House Refuse Removal 28 Housing 7, 9, 32 Act, 192532 ,, 1930 5, 36 ,, Conditions 5, 35, 37 ,, Shortage 37 ,, Statistics 5,32 Ice Cream 41 Immunization 62 Infant Mortality 5, 11, 14, 89 Infectious Diseases 5, 21, 29, 47 ,, ,, Clinic 50 Isolation Hospital74 Laboratory Work 21, 51, 81 Legal Proceedings 5, 41, 43 Legislation in Force 21 Maternal Mortality 11,110 Maternity and Child Welfare 84-92 ,, Homes and Hospitals 25,86,107 Maternity Outfits 99 Measles11, 14, 16, 18, 69 Meat Inspection 42 Midwives 21, 108 Milk 39 ,, Assisted Scheme 106 Milk and Dairies Order 41 ,, ,, , Amend. Act 41 ,, Special Desig. Order 39, 42 ,, Shops 39 PAGE Notices, Sanitary 28 Nuisances28 Nurse Children 100 Nursing 21 Occupations 10 Offensive Trades 6,43 Ophthalmia Neonatorum 66, 109 Ophthalmic Treatment 103 Orthopaedic ,, 99, 101 Outworkers 47 Overcrowding 35,37 Parks 11 Pneumonia 16,18,64 Poisons and Pharmacy Act 45 Population 7.12,13,17 Prosecutions 41,43 Public Assistance 21,23 Puerperal Fever and Pyrexia 65, 108 Rag Flock Act 32 Rateable Value 7 Refuse Disposal 28 Rent Restrictions Act 5,44 Rivers and Streams 5, 27 PAGE Sanitary Inspection 28 Scarlet Fever 13,14, 16, 59, 78, 80 Schools 32 Slaughter-houses 30 Smallpox 5,14,16,29,51 Smoke Abatement 5, 31 Social Conditions 7 Special Premises 30 Staff 6, 85 Stillbirths 11,14,86 Tents, Vans and Sheds 31, 39 Tonsils and Adenoids 103 Tuberculosis 12,16,18,71,82 Tuberculous Meat 42 Unemployment 10 Unhealthy Areas 38 Vaccination 5, 53, 58 Vital Statistics 11 Walthamstow Child Welfare Society 103 Walthamstow Dispensary 25 Water 5,27 Whooping Cough 11,12,14,16,18,70 Workshops45 Zymotic Diseases 12 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Alderman Mrs. C. McEntee, J.P. Ex-officio: His Worship The Mayor-Councillor V. L. McEntee, J.P., M.P. The Deputy Mayor-Councillor W. H. Morris. The late Alderman W. J. McGuffie, J.P. Councillor Ross Wyld. (Chairmen of Finance Committee). Alderman G. Gibbons. ,, J. C. Hammond. ,, Mrs. M. Norrish. ,, T. W. Smith. A. J. Wye. Councillor T. Edwards. ,, P. Friedberg. ,, W. Gillett. Councillor W. J. Green. Miss N. W. Hix. ,, R. R. B. Lester. ,, A. E. Manning. ,, Mrs. E. M. Miller. ,, G. M. Page. ,, T. C. Pannell. , Mrs. E. Richards. 5 TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, I beg to present herewith a Report (drawn up on the lines suggested in Circular 1119 issued by the Ministry of Health) on the work of the Health Department during 1930. Dr. J. J. Clarke, who had been your Council's Medical Officer of Health for thirty-two years, retired at the end of March, and I would take this opportunity of acknowledging the excellence of the organisation which he has created, and the willing help he has given me. The year was noteworthy for two contrasts-the lowest recorded Infant Mortality and Death Rate on the one hand and a heavy incidence of Infectious Disease on the other, notably of Diphtheria and Smallpox. The former, unfortunately, caused 22 deaths, and the latter an incredible waste of time and money which could have been employed to far better purpose. The experience of a hundred years in every part of the world has proved that we must choose between Smallpox and vaccination. I would gratefully record the support I have received from the Chairman and Members of your Committee and the co-operation of my Colleagues in other Departments. Mr. Furness has kindly contributed the sections dealing with the following matters:-Water, Rivers and Streams, Drainage and Sewerage, Scavenging and new houses built during the year. I am grateful to all sections of the Staff of the Department for their willing co-operation, efficient services, and their assistance in the compilation of this Report. The Sanitary Inspectors, under Mr. Duncan, have done particularly good work in combating Smallpox and in house-to-house visiting in connection with the preparation of a Scheme under the Housing Act, 1930. I would also stress Mr. Duncan's assistance in contributing the sections of the Report dealing with the following subjects:-Closet Accommodation, Sanitary Inspection of the Area, Smoke Abatement, Other Sanitary conditions requiring Notice, Housing Statistics (items 1-3), Housing Conditions (items 1-6), Inspection and Supervision of Food, Offensive Trades, Legal Procedure, Rent Restrictions Act, Diseases of Animals Acts, and the Factory and Workshop Acts. I have the honour to be, Your obedient servant, A. T. W. POWELL, Medical Officer of Health, etc. 6 STAFF. Medical Officer of Health, School Medical Officer and Medical Superintendent, Isolation Hospital: J. J. Clarke, J.P., L.R.C.P., D.P.H. (to 3-4-30). A. T. W. Powell, M.C., M.B., B.S., D.P.H. (from 1-7-30). Assistant Medical Officers: D. Broderick, M.B., B.Ch., B.A.O., D.P.H., Barrister-at-Law Acting Medical Officer of Health, (4-4-30-30-6-30). Miss Mary C. Sheppard, B.A., M.B., B.Ch., B.A.O., D.P.H. Miss Mary C. Clarke, M.B., B.Ch., B.A.O. Resident Medical Officer-Isolation Hospital. Miss May McGloughlin, M.B., B.Ch., B.A.O. (to 1-6-30). Miss Mary Hamilton, M.B., B.Ch., B.A.O. (from 1-6-30). Matron, Isolation Hospital. Miss L. Pratchett. Infectious Disease Nurse. Miss I. H. Jennings, S.R.N., C.M.B. Senior Sanitary Inspector, Petroleum Inspector and Chief Inspector, Diseases of Animals Acts. M. E. Duncan, M.R.S.I., (a), (b). District Sanitary Inspectors. T. J. Barnes, (b), (c). F. G. Sendell, (b), (c) to F. W. Kemp, (a), (b), (c). 13-12-30. W.R.Robinson, (b), (d) from T. Vaughan, (b), (c), (e). 1-12-30. H. A. Whipp, (b), (c). (а) Cert. S.I.E.B. (London). (b) Cert. Inspector Meat and Other Foods. (c) S.I. Cert. of R.S.I. (d) S.I. Cert. of R.S.I, and S.I.J.B. (e) Cert. of Sanitary Science, R.S.I. In addition some of the Inspectors hold special Certificates. Veterinary Surgeon (part time): Bernard Moss, M.R.C.Y.S. (Lond.). Public Analyst (part time): Dr. Bernard Dyer. Chief Clerk: H. Butters (to 30-4-30). R. Rose (from 1-5-30). Clerks: G. W. West, L. R. W. Kemp, R. C. Bland, H. T. Crisp (to 31-5-30), R. A. C. Green (from 5-2-30), L. Rushton (from 2-6-30), F. J. Aylward (from 2-6-30). Ambulance Drivers and Disinfecting Staff: E. Capon, W. H. Dunn, E. E. Harber, R. High (temporary), B. Winter. 7 1 .-STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343 Population (Census, 1921) 129,395 ,, (Estimated-mid-year, 1929) 124,800 No. of inhabited houses (1921) 25,526 No. of families or separate occupiers (Census, 1921) 29,461 Rateable value £645,572 Sum represented by penny rate £2,670 10s. 3d. Social Conditions, etc.-The 1921 Census showed Walthamstow to have then been the thirty-third largest town in England and Wales, the third largest in Essex, and ranking fourth in Essex with regard to density of population, having 29.8 persons per acre. The 1921 Census findings with regard to Ward populations are given on page 8 with a view to comparison with the 1931 figures, which, it is hoped, will be available in the annual report for 1931: Twenty-six per cent. of the population lived in but worked out of the Area, while 4.1 per cent. lived out but worked in the Area, giving a net outward movement of 21.9 per cent., representing a "day" population of 100,993. 8 CENSUS. Area. Acres. Persons. Males. Females Persons per acre. Private families Population in Private families. Structurally separate dwellings occupied. Rooms occupied. Rooms per person. Walthamstow U.D. & C.P. 4,343 129,395 61,824 67,571 29.8 29,461 128,627 24,616 128,289 1.00 Hale End Ward 1,327 18,072 8,585 9,487 13.6 4,128 18,055 3,638 19,856 1.10 Higham Hill Ward 977 24,423 11,901 12,522 25.0 5,513 24,380 5,105 23,866 0.98 High Street Ward 688 20,480 9,893 10,587 29.8 4,697 20,397 3,730 18,665 0.92 Hoe Street Ward 355 23,895 11,054 12,811 67.3 5,869 23,866 4,657 27,040 1.13 St. James' Street Ward 486 24,936 12,035 12,901 51.3 5,364 24,936 4,384 21,473 0.86 Wood Street Ward 510 17,589 8,326 9,263 34.5 3,890 16,993 3,102 17,389 1.02 9 The following were the findings in relation to Housing HOUSING. Percentage of Structurally separate Dwellings returned as Rooms per dwelling. Families per dwelling. Persons per family. Rooms per person. Increase in dwellings 1911-1921. Increase in private families. Deficiency of Rooms. Population living more than 2 persons to a room. Private House. Maisonettes, Flats, Tenements. Attached to Shops, Warehouses, etc. No. % No. % Population. % of total private family pop. 89 5 6 5.22 1.20 4.69 1.00 1,745 7.6 3,138 11.9 6,945 9,606 7.5 10 The figure of 1.00 rooms per person represented the sixth least favourable found in Essex. Occupations.-Walthamstow showed evidence of the following local industries:-Cabinet making, woodwork, printing, boot and shoe making. Together with West Ham it was the most industrial type of area in the County. There were high proportions of scientific instrument workers, tailoresses, celluloid and brush makers. The proportion of domestic servants was the lowest in the County. The following were the numbers of persons employed in the main occupations followed:- Males.-Transport, 5,937; Metal Work, 4,628; Commerce and Finance, 4,422; Clerical Work, etc., 3,801; Wood and Furniture Work, 3,354; Printing, etc., 2,117; Building, etc., 1,820; Warehousing, etc., 1,766; Public Administration and Defence, 1,383; Personal Service, 1,154; Painting, etc., 1,141. Females.-Textiles, 3,373; Clerical Work, etc., 3,247; Personal Service, 2,827; Commerce and Finance, 1,580. Unemployment.-The degree of unemployment in the area during 1930 may be estimated from the following data kindly supplied by Mr. W. H. Goodfellow, manager of the Local Employment Exchange. The total insured workpeople of both sexes in Walthamstow is approximately 24,000, and a test showed that roughly two-thirds of the figures given below (which cover the whole Exchange Area) related to persons residing in Walthamstow (excluding Juveniles). Date Week ending. No. remaining on Register Amount of benefit paid. £ Men. Women Total. 6th January 3,284 631 3,915 2,368 3rd February 3,349 772 4,121 2,710 3rd March 3,460 722 4,182 2,764 7th April 3,274 705 3,979 3,098 5th May 3,209 790 3,999 3,126 2nd June 3,141 888 4,029 3,016 7th July 3,253 969 4,222 3,095 4th August 3,395 1,138 4,533 3,328(approx.) 1st September 3,486 1,203 4,689 3,491 6th October 4,070 1,390 5,460 3,880 3rd November 4,380 1,362 5,742 4,112 1st December 4,800 1,509 6,309 4,674 29th December 5,343 1,717 7,060 4,653 11 Between 30th December, 1929, and 29th December, 1930, a total of £117,935 was paid out in benefits, two-thirds of this amount (approximately representing the Walthamstow proportion) being £78,623. Mr. Dempsey states that the following were the registrations at the Juvenile Employment Bureau:- Fresh Applications. Boys. Girls. Total Insured (over 16 years) 504 445 949 Not insured (under 16 years) 535 713 1,248 Re-registrations. Insured 538 304 842 Not insured 419 541 960 Total 1,996 2,003 3,999 Employment was obtained for 1,338 boys and girls. The Parks and Recreation Grounds available in the Borough are as follows:- Acreage. A. R. P. Selborne Road 4 0 22 Lloyd Park 35 3 36 Higham Hill (North Side) 2 1 0 Queens Road 2 0 0 St. James' Park 8 2 0 Stoneydown Garden 1 1 0 Extracts from Vital Statistics.- The Registrar-General's midyear, 1929, estimate of population (viz., 124,800) has been used for the calculation of all vital statistics:- Males Females Live ((Legitimate) Total 1,914 978 936 Birth rate 15.7 Births ((Illegitimate) ,, 45 23 22 Still Births 69 Rate per 1,000 total births 34.0 Deaths 1,160 Death rate 9.3 Percentage of total deaths occurring in Institutions 46.2 Number of women dying in, or in consequence of Child-birth From Sepsis 6 ,, other causes 3 Death-rate of Infants under one year of age per 1,000 live births:- Legitimate, 39; Illegitimate, 44. Total, 39. Deaths from Measles (all ages) 28 ,, ,, Whooping Cough (all ages) 2 ,, ,, Diarrhoea (under 2 years of age) 8 The following table compares the above statistics for the quinquennium:- 12 Year. Estimated Population. Live Births. Birth Rate. Deaths. Death Rate. Infant Mortality. Deaths from Zymotic Disease Death Rate. Natural increase of Population. Legit. Illeg. Total. Legit. Illeg. Total. Measles. Whooping Cough. Diarrhoea. and Enteritis under 2 years. M. F. M. F. 1930 124800 978 936 23 22 1959 15.7 1160 9.3 39 44 39 28 2 8 0.50 799 1929 124800 954 944 22 14 1934 15.5 1448 11.6 54 84 53 1 17 9 0.39 486 1928 122400 974 974 21 22 1991 16.2 1265 10.4 49 93 51 17 5 7 0.33 726 1927 124330 993 987 24 21 2025 16.3 1317 10.6 49 222 52 1 18 1 0.27 708 1926 125500 1094 1083 20 21 2218 17.7 1149 9.2 42 122 45 4 9 15 0.30 1069 The Zymotic Disease Death-rate is the rate per 1,000 population; of deaths from the following diseases:-Enteric Fever, Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria and Diarrhoea,, etc., under two years. The 1930 rate is high because of the increased number of deaths from Measles and Diphtheria. The Pulmonary Tuberculosis Death-rate was 0.64 per 1,000 population, and the Non-Pulmonary Tuberculosis Death-rate was 0.07 per 1,000 population. CO Town. Estimated Population Mid.1929. Rate per 1,000 living. Measles. Death Rate per 1,000 living. Death Rate per 1,000 Live Births. As in previous years, the Registrar-General's comparative figures for towns in the 'Outer Ring' for the 53 weeks ended 3rd January, 1931, are given below. The rates are provisional only. Live Births. Deaths (Civilians) Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea & Enteritis (under 2 years). Infants under 1 year. Croydon C.B. 222300 15.8 10.3 0.10 0.00 0.01 0.07 0.13 5.3 48 Willesden 172500 17.5 9.9 0.13 0.02 0.03 0.11 0.13 8.2 58 Hornsey 88450 13.7 11.7 0.04 0.02 0.00 0.04 0.12 5.7 41 Tottenham 155000 16.2 9.9 0.15 0.01 0.03 0.20 0.09 4.3 52 Edmonton 75000 18.7 9.3 0.07 0.01 0.08 0.04 0.04 7.0 53 West Ham C.B. 307600 18.2 10.8 0.27 0.01 0.06 0.10 0.06 8.2 65 East Ham C.B. 147600 15.3 9.6 0.09 0.01 0.05 0.13 0.08 5.6 52 Leyton 128300 13.7 9.5 0.19 0.02 0.01 0.09 0.08 3.9 45 Ilford 116200 15.9 8.4 0.08 0.01 0.02 0.11 0.09 4.8 34 Walthamstow 124800 15.7 9.2 0.23 0.02 0.02 0.16 0.12 4.5 38 Of the 10 towns enumerated, Walthamstow had the second lowest Infant Mortality and Death rates, and the fourth lowest Diarrhoea and Enteritis Kate. The Birth-rate was the fourth lowest. The following table shows the Registrar-General's comparison of Birth and Death rates, etc., the comparison again being generally favourable to Walthamstow. 14 Birth-rate, Death-rate, and Analysis of Mortality during the Year 1930. (Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1930, but those or the Towns have been calculated on populations estimated to the middle of 1929. The mortality rates refer to the whole population as regards England and Wales but only to civilians as regards London and the groups of towns). Rate per 1,000 Total Popuation . Annual Death-rate per 1,000 Population. Rate per 1,000 Births Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. WhoopingCough 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. StillBirths. England and Wales 10.3 0.69 11.4 0.01 0.00 0.10 0.02 0.05 0.09 0.12 0.55 6.0 60 90.4 6.9 1.7 1.0 107 County Boroughs and Great Towns including London 16.6 0.71 l1 .5 0.01 0.00 0.15 0.02 0.05 0.10 0.11 0.50 83 64 90.6 6 6 2.3 0.5 159 Smaller Towns (1921 Adjusted Populations 20,000-50,000) 16.2 0.69 10.5 0.00 0.00 0.08 0.01 0.05 0.07 0.13 0.43 44 55 91.8 5.9 1.2 1.1 London 15.7 0.56 11.4 0.01 0.00 0.23 0.02 0.03 0.10 0.08 0.55 9.9 59 88.3 7.4 4.3 0.0 Walthamstow 15.7 0.55 9.3 0.01 0.00 0.22 0.02 0.02 0.18 0.10 0.27 4.1 39 94 6 3.1 2.3 0.0 15 Births.-Births are dealt with under the Maternity and Child Welfare section of the report. The Birth-rates show a slight rise after a steady decline since 1926. Deaths.-The Death-rate is only 0.1 per 1,000 population above the lowest during the five years. The following table shows the Registrar-General's classification of causes of death by sex totals. These have been subdivided locally, as accurately as possible, into age and ward groups. 16 Causes of and Ages at Death during the year 1930. Whole District and Wards. Causes of Death Net Deaths at the subjoined ages of "Residents" whether occurring within or without. the district Wards 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 46 and under 65 years 65 and upwards St. James Street High Street Hoe Street Wood Street Hale End Higham Hill No. 1 M. F. 3 4 5 6 7 8 9 10 1 Enteric Fever 1 - - 1 - - - - - - - - - - 1 2 Smallpox - - - - - - - - - - - - - - - - 3 Measles 14 14 - 12 12 4 - - - - 7 10 3 2 2 4 4 Scarlet Fever 1 1 - - - 1 1 - - - - 1 - - 1 - 5 Whooping Cough - 2 - 1 1 - - - - - - 1 - 1 - - 6 Diphtheria 9 13 - 1 11 10 - - - - 8 2 3 2 5 2 7 Influenza 6 6 - 4 3 1 1 2 - 1 4 1 3 2 1 1 8 Encephalitis Lethargica 1 2 - - - - 2 - 1 - - 2 1 - - - 9 Meningococcal Meningitis - 2 1 - 1 - - - - - 1 1 - - - - 10 Tuberculosis of Respiratory System 57 23 - - - 1 21 38 18 2 20 15 9 5 18 13 11 Other Tuberculous Diseases 6 3 1 1 - 3 1 3 - - 1 - 4 - 1 3 12 Cancer, malignant disease 86 81 - - - 1 - 12 81 73 28 22 31 23 29 34 13 Rheumatic Fever 4 2 - - - - 3 2 - 1 - 1 3 1 - 1 14 Diabetes 6 8 - - - 1 - - 5 8 2 1 5 2 2 2 15 Cerebral Haemorrhage, etc. 31 20 - - - - - - 17 34 9 6 8 9 8 11 16 Heart Disease 106 118 4 - - 5 6 25 61 123 49 34 43 29 36 33 17 Arterio-sclerosis 19 14 - - - - - - 7 26 8 7 8 6 2 2 18 Bronchitis 20 22 2 1 - - - 2 8 29 7 8 5 9 7 6 19 Pneumonia (all forms) 48 33 13 2 3 3 1 3 26 30 22 10 13 11 10 15 20 Other Respiratory Diseases 6 2 - - - - 1 - 3 4 3 3 - 2 - - 21 Ulcer of Stomach or Duodenum 14 5 - - - - 1 3 10 5 4 1 3 3 4 4 22 Diarrhoea, etc. (under 2 years) 6 2 5 3 - - - - - - 2 1 1 2 - 2 23 Appendicitis and Typhlitis 5 3 - - 1 2 1 1 2 1 1 1 4 - 1 1 24 Cirrhosis of Liver 2 5 - - - - - 1 3 3 2 - 2 2 - 1 25 Acute and Chronic Nephritis 14 23 1 - - 2 1 3 14 16 7 7 7 8 6 2 26 Puerperal Sepsis - 6 - - - - 3 3 - - 2 2 1 - - 1 27 Other accidents and diseases of Pregnancy and Parturition - 3 - - - - - 3 - - 1 1 1 - - - 28 Congenital Debility and Malformation, Premature Birth 24 21 45 - - - - - - - 6 8 6 8 11 6 29 Suicide 10 4 - - - - 1 4 5 4 4 1 1 2 4 2 30 Other Deaths from Violence 24 10 - - 1 3 1 8 10 11 7 9 5 3 6 4 31 Other Defined Diseases 102 89 6 - 1 7 8 17 45 107 34 32 34 25 31 35 32 Causes ill-defined or unknown 1 - - - - - - - - 1 - - - 1 - - Totals 623 537 78 26 34 44 53 13 316 479 239 188 204 158 185 186 17 The Death-rates by Wards calculated on the estimated populations shown are as follows:- Ward. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Whole Boro'. No. of Deaths, 1930 239 188 204 158 185 186 1160 Est. Population 23770 19960 22550 17015 17605 23900 124800 Death-rate, 1930 10.0 9.4 9.0 9.2 10.5 7.8 9.3 ,, 1929 11.9 9.3 12.8 11.5 12.4 10.8 11.6 Infant deaths are analysed by causes, ages and wards under the Maternity and Child Welfare section of the report. 18 The main causes of death during the past five years were as follows: — Year. Heart Disease. Cancer. Pneumonia. Respiratory Tuberculosis. Cerebral Hæmorahage. Congenital Debility, etc. Bronchitis. Nephritis. Violence. Arterio Sclerosis. Measles. Diphtheria. Gastric and j Duodenal Ulcer. Diabetes. Suicide. Whooping Cough. Influenza. 1930 224 167 81 80 51 45 42 37 34 33 28 22 19 14 14 2 12 1929 269 165 121 99 78 36 97 33 51 37 1 16 21 16 21 17 74 1928 222 167 100 94 79 31 72 65 56 21 17 8 11 6 15 5 10 1927 183 185 131 94 66 52 96 52 35 29 1 11 11 9 16 18 37 1926 183 135 83 97 69 51 81 43 27 29 4 5 12 7 17 9 12 19 Cancer.-A total of 167 deaths were certified as being due to Cancer-86 males and 81 females. Details of site, age and occupation are given below:- Males. Stomach (24). Prostate (8). Aged Aged Carpenters 78, 74, 45 Boot Maker 70 French Polisher 60 General Labourer 63 Cabinet Maker 70 Hairdresser 72 Builder's Labourer 48 Clerk 71 General ,, 66, 54 Draper 66 Tailors 87, 49 Wood Turner 72 Grocer 47 Removal Contractor 70 Gas Fitter 66 Furrier 64 Warehouseman 66 Bladder (6). Umbrella Maker 45 Hairdresser 66 Porter (2) 60 Solicitor's Clerk 78 Tool Setter 58 Shop Manager 60 Turner and Polisher 67 Caretaker 67 Coal Dealer 63 Clerk 77 Printer 69 Porter 73 Gullet (6). Plasterer 70 Photographer 68 Hotel Waiter 67 Type Founder 58 Inspector 54 Insurance Agent 46 Clerk (2) 60 and 80 Intestine (11). Builder's Labourer 74 Cooper 84 Tobacconist 65 Mouth (5). Compositor 78 Commercial Traveller. . 63 Warehouseman 57 Painter 64 Army Officer 68 Tinsmith 68 Bookbinder 63 Farm Labourer 79 Labourer 60 Warehouseman 53 Builder 76 Lung (5). Cabinet Maker 68 Gasman 54 Hotel Waiter 57 Coal Porter 75 Brass Moulder 43 Caretaker 52 Umbrella Maker 50 Rectum (10). General Labourer 65 Cabinet Maker 4 2 Agricultural Labourer 77 Lip and Tongue (3). Brewer's Labourer 63 Shopkeeper 73 Labourer 58 Waiter 57 Machine Minder 77 Linotype Operator 63 Bank Manager 73 Liver (2). Carpenter 71 Engine Driver 76 Bricklayer 51 Police Inspector 72 Engineer's Fitter 65 Glove Dealer 76 Various Sites (6). Unknown 77 The preponderance of carpenters and cabinet makers and allied tradesmen is probably explained by the fact that these are local industries. 20 Females. Intestine, 19; Breasts, 15 (13 widows and housewives and 2 spinsters.) Stomach, 13; Pancreas, 7; Uterus, 6 (all widows or housewives). Rectum, 5; Bladder, 2; Various Sites, 14. The percentage of Institutional Deaths was 46.2, the places of death being given below:— Institutional Deaths. Whipps Cross Hospital, Leytonstone 184 Central Homes, Leytonstone 118 Connaught Hospital, E.17 39 Walthamstow Isolation Hospital, Chingford 25 Brentwood Mental Hospital 18 London Hospital, Stepney 15 Prince of Wales's Hospital, Tottenham 14 St. Bartholomew's Hospital, London 14 Forest Gate Sick Home 12 London Fever Hospital, Islington 10 Chest Hospital, Bethnal Green 6 German Hospital, Hackney 6 University College Hospital, St. Pancras 6 St. Joseph's Hospice, Hackney 5 Mothers' Hospital, Clapton 4 Middlesex Hospital, St. Marylebone 4 "Brookscroft," Forest Road, E.17 3 Forest Hydro, Forest Road, E.17 3 Queen Mary's Hospital, Stratford 3 Royal Hospital for Incurables, Wandsworth 3 Charing Cross Hospital, Westminster 2 Great Ormond Street Hospital 2 Queen's Hospital, Bethnal Green 2 Tooting Bee Hospital, Wandsworth 2 Westminster Hospital 2 West London Hospital, Hammersmith 2 Other Hospitals 32 Total 536 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 1. Public Health Officers of the Authority. —The names and qualifications of Officers employed by your Authority are given on pages 6 and 85 (Maternity and Child Welfare Section) of the report. All are whole-time Officers unless otherwise stated. 21 2. Nursing in the Home. (a) General.—The Essex County Nursing Association provides a Nurses' Home in your Borough and four nurses who are mainly occupied in midwifery practice. The work done in 1930 is reviewed in the Maternity and Child Welfare section of the report on page 107. As a rule the nurses do not attend cases of Infectious Disease. (b) Infectious Diseases.—No home nursing is provided by your Council, but a whole-time Infectious Disease Nurse supervises all home-nursed cases of notifiable infectious disease and the School Nurses visit all cases of non-notifiable infectious diseases of school age. 3. Midwives.—During 1930, 15 Midwives practised in the area. Your Council took over the duties of Local Supervising Authority from the Essex County Council on the 1st April, 1931. 4. National Health Insurance.—Your Council does not administer any part of this Scheme. 5. Public Assistance.—Out-relief and institutional treatment is provided by the Essex County Council. Mr. Pegram, Clerk to the Essex County Council South-west Area Guardians Committee, kindly states that the amount of relief provided in Walthamstow during the year ended 31st March, 1931, was £29,175 1s. 9d. The average weekly number in receipt of relief was: Men, 374; Women, 773; Children, 591. Total, 1,738. 6. Laboratory Facilities.—These facilities are detailed under the Infectious Diseases section of the report on pages 51 and 81 . 7. Legislation in Force. The Infectious Disease (Notification) Act, 1889 24th January, 1890. The Public Health Acts (Amendment) Act, 1890, Parts II, III and V 4th November, 1890. The Infectious Disease (Prevention) Act, 1890 4th November, 1890. The Public Libraries Act, 1892 26th February, 1892. Baths and Washhouses Act, 1846, and the Amending Acts 25th November, 1892. The Burials Acts, 1852 to 1885 27th December, 1895. The Public Health Acts (Amendment) Act, 1907, Parts II, IV, V, VI, and X 29th November, 1907. The Public Health Act, 1925, Parts II, III, IV and V 18th December, 1925. 22 Bye -Laws. Bye-laws with respect to Common Lodging- Houses 23rd November, 1883. Bye-laws with respect to Slaughter-houses 28th August, 1925. Bye-laws with respect to Nuisances 23rd November, 1883. Bye-laws with respect to Houses let in Lodgings or occupied by members of more than one family 23rd November, 1883. Bye-laws as to Nuisances in connection with the Removal of Offensive or Noxious Matters 4th November, 1892. Bye-laws as to the Decent Conduct of Persons using Sanitary Conveniences provided and maintained by the Local Authority for Public Accommodation 4th November, 1892. Bye-laws for Imposing on the Occupier of any Premises duties in connection with the Removal of House Refuse so as to facilitate the work of collection 28th April, 1903. Bye-laws for the Prevention of Nuisances from Filth, Ashes and Rubbish 29th September, 1903. Bye-laws with respect to New Streets and Buildings and the Alteration of Buildings 24th March, 1926. Bye-laws with respect to Drainage of Existing Buildings 28th November, 1928. Bye-laws with respect to Tents, Vans, Sheds and Similar Structures 3rd December, 1928. Bye-laws with respect to the Provision of Means of Escape in case of Fire in certain Factories and Workshops 30th August, 1911. Bye-laws for the Regulation of Offensive 23rd July, 1897, and Trades 28th May, 1913. Bye-laws re Employment of Children 22nd November, 1920. Bye-laws with respect to Pleasure Grounds 26th October, 1921. Bye-laws with respect to Prevention of Danger from whirligigs, Shooting Galleries, etc. 5th January, 1893. Bye-laws with respect to Pleasure Grounds 9th December, 1921. Bye-laws with respect to the Regulation of Public Baths 22nd November, 1902. Walthamstow Light Railways Order 30th September, 1911. 23 Regulations. Regulations to be observed by Occupiers of Bakehouses 20th March, 1887. Regulations with respect to the Management of Sanitary Conveniences provided and maintained by the Local Authority 4th November, 1892. Regulations with respect to Dairies, Cowsheds and Milk Shops 23rd March, 1900. Regulations pursuant to Libraries Act, 1892 28th May, 1909. Regulations with respect to Allotments 3rd April, 1925. 8. Hospitals.—The Hospital services chiefly used by the inhabitants of the area are the Connaught Hospital, Walthamstow, a voluntary general hospital serving Walthamstow, Leyton and Wanstead, and the Institutions formerly under the control of the late West Ham Board of Guardians. Of these, the Central Home and Whipps Cross Hospital, Leytonstone, Forest Gate Hospital, E.7, and the Children's Convalescent Home, Margate, were transferred to the County Borough of West Ham and the Children's Homes, Aldersbrook, Wanstead, to the County Borough of East Ham on the 1st April, 1930. Public Assistance in Walthamstow is now provided by the SouthWest Area Committee of the Essex County Council, which retains a certain proportion of beds in each of the above Institutions. Mr. Pegram, the Clerk to the Committee, has kindly supplied the following particulars of Walthamstow residents admitted to the various Institutions during the year ended the 31st March, 1931:— Institution. Men. Women. Children. Total. Central Home 162 203 106* 471 Whipps Cross Hospital 543 574 291 1,408 Forest Gate Hospital 6 129 14 149 Margate Convalescent Home Nil Nil 33 33 Aldersbrook Home Nil Nil 110 110 (*These children were ultimately transferred to the Homes at Aldersbrook.) 55 children were born to Walthamstow mothers in Forest Gate Hospital. The last ascertained number of patients from Walthamstow in Mental Hospitals was 344. Details of your Council's Infectious Diseases and Smallpox Hospitals are given on page 74. Brookfield Orthopaedic Hospital, a voluntary hospital in the Borough, provides 30 beds, approximately 50 per cent. of which are used by persons outside the town. There are facilities for operative surgery, dental and massage treatment. The Staff consists of a Matron, Sister and three Nurses. 24 The Connaught Hospital. Major Baker has kindly supplied the following information:— "During the last five years, certain large additions have been made. In 1927 a New Ward Block was added, together with additions to the Out-patients' Department, a new Casualty building, new Quarters for the Resident Medical Officers, and a new X-ray Department. Also a Nurses' Home was provided with accommodation for forty-one Sisters and Nurses. "In 1928 extensive alterations were made in the old portion of the Hospital, a new Sanitary Block being added to the Connaught Ward, and various alterations made in the Princess Mary Adelaide and Hibbert Wards, whereby our ambition to reach 100-bed accommodation was realised. "During 1930 the top floor of the Nurses' Home was completed, whereby an additional 14 bedrooms were added, waiting room and two dressing rooms, together with sanitary accommodation were provided for the X-ray Department. Also a Stoving Plant was erected. A Massage and Electro-therapeutic Clinic was secured (previously known as Comely Bank Clinic, Ltd.), situated opposite the Hospital. "The Council of the Hospital realise that the present accommodation in the Hospital is inadequate, as we serve a population of over 300,000 people, but further extensions are impossible until the finances of the Hospital warrant it. "During 1930, 674 Walthamstow residents were admitted. "The 100 beds provided are allocated as follows:—Medical cases 21, Surgical 31, Children 36, Private Beds 12. There are facilities for operative surgery, X-ray work, dental, ophthalmic and massage treatment. Pathological work is carried out partly at the Hospital and partly at other Institutions." The Staff consists of 22 Honorary Specialists, 3 Resident Medical Officers, Matron, Sister Tutor, 10 Sisters, 5 Stafi Nurses, and 30 Probationers. The annual reports show the following work to have been carriec out:— Patients admitted. Average stay in Hospital. Beds occupied Daily. Out-patients New Cases. Department. Attendances. 1930 1,406 22.84 88.10 13,470 49,988 1929 1,341 23.98 87.27 19,177 44,472 1928 1,151 22.93 70.57 10,098 41,761 1927 865 20.35 47.0 9,698 32,752 1926 961 18.42 49.0 10,196 33,175 During 1930, 568 major and 2,472 minor operations were done, a total of 3,040. 5,110 radiographs were taken and 5,779 massage treatments were given. Since April 14th, 1930, 4,652 electrical and 1,793 light treatments were given at Comely Bank. 25 Your Council pay an annual retaining fee of 30 guineas for the use of three beds for Enteric patients at any time and for the admission of further patients up to two per ward at the discretion of the Hospital Authorities. The maintenance rates have been revised during the current year to £2 16s. per patient per week. The Walthamstow Dispensary. The Dispensary is a Charity founded in 1873, and which, during 1930, gave treatment to 938 cases, who made 3,047 attendances. In addition, 326 operations for removal of Tonsils and Adenoids were done for your Education and Maternity and Child Welfare Committees. 9. Maternity and Nursing Homes.—The Local Supervising Authority under the Act of 1927 is the County Council, to whom application has been made by your Council for delegation of the necessary powers. Six Homes are registered, the number of beds provided being 27, of which 18 are maternity beds. 10. Maternal Mortality.—Maternal mortality is fully discussed in the Maternity and Child Welfare section on page 110. 11. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children.—The chief provision is at the Forest Gate Hospital of the West Ham Public Assistance Committee. Admission is arranged through the Relieving Officers, and mothers and infants can, if necessary, be accommodated until the latter are one year of age. 12. Institutional Provision for Care of Mental Defectives.— None is provided by your Council. 13. Ambulance Facilities. (a) For Infectious Cases.—Your Council provide three motor ambulances, used respectively for Smallpox, Diphtheria and Scarlet Fever. (b) For Non-Infectious and Accident Cases.—Your Council provides no facilities for non-infectious cases. 1. Mr. Kemp, Corps Superintendent of the Walthamstow and District Corps of the St. John Ambulance Brigade, states that two ambulances are provided, manned by paid drivers by day and voluntary drivers by night, and by volunteer nurses and orderlies at all times. During 1930, 1,729 First Aid cases were treated at the Ambulance Station in Willow Walk, 81 road accidents were attended to and 946 cases were removed to Hospital, the total mileage covered being approximately 15,000. 2. Removal of patients to Whipps Cross Hospital is carried out by the Hospital's Ambulances. 26 14. Clinics and Treatment Centres. Nature. Day. Time. Situation. Accommodation. By whom provided. A. Maternity & Child Welfare. 1. Municipal (a) Ante-Natal M. 2-4.30 p.m. Low Hall Lane. Waiting Hall. Borough Council. Weighing Room. Consulting Room. Treatment Room. Food Store. (b) Infant Consultation W. 2-4 p.m. Low Hall Lane. As above. „ Th. 2-4 p.m. F. 2-4 p.m. 2. Voluntary. M. 2.30-4 p.m. St. Andrew's Schoolroom. Weighing Room Walthamstow Child Welfare Society. (a) Infant Consultations Tu. 2-4.30 p.m. Brookscroft, Forest Road. Waiting Room. Weighing Room. Consulting Room. Sunlight Room. W. 2-5 p.m. „ Th. 1.30-5.30 p.ms „ F. 2-4.30 p.m. „ (b) Sunlight Tu. 2-4.30 p.m. „ F. 2-4.30 p.m. „ (c) Massage Tu. 2-4.30 p.m. „ Th. 2-4.30 p.m. „ F. 2-4.30 p.m. „ (d) Needlework Th. 2-4.30 p.m. „ (e) Lectures & Demonstrations. Th. 2-4.30 p.m. „ B. School Clinics. 1. Aural M. 2-4.30 p.m. Lloyd Park Waiting Room. Borough Council. Consulting Room. Treatment Room. 2. Minor Ailments M. 9-12 noon W. 9-12 noon F. 9-12 noon S. 9-12 noon Lloyd Park & Low Hall Lane. As above. " Lloyd Park 3. Ophthalmic Tu. 2-4.30 p.m. Th. 9-12 noon S. 9-12 noon Lloyd Park. 4. Dental Daily 9-12 a.m. 2-4 p.m. (except Thur. a.m.) " Waiting Room Two dental surgeries. „ C. Orthopaedic Consultant 3rd 1 Physically Defective School Waiting Hall Consulting and Massage Room „ Massage Th. 9.30-12.30 Daily 1.30-4.30 except Thurs.-9.30-12.30) D. Tuberculosis Children M. 2-4 p.m. Tuberculosis Dispensary, High Street, E.17. Waiting Room. Essex County Council. F. 10-12 noon Dressing Room. Women Tu. 2-4 p.m. Consulting Room. New Cases W. 10-12 noon Nurses' Room. (Adults) 6-8 p.m. Store Room. Men Th. 2-4 p.m. Office. E. Venereal Disease Any London Hospital. „ F. Infectious Disease Tu. 9-12 noon Lloyd Park As above. Borough Council. 27 The County Medical Officer's Annual Report for 1929 stated that, With the growth of the population in Dagenham, Leyton and Walthamstow, the need for increased facilities (i.e., for Venereal Disease Treatment) in these areas, particularly in regard to evening sessions, has become more pronounced. Negotiations in several directions with the object of establishing a clinic accessible to patients from these areas have so far proved unsuccessful." The provision of a local Venereal Disease Clinic on the lines of the Tuberculosis Dispensary is unquestionably required. 15. Local Government Act, 1929.—The administration of Part I of the Children Act was taken over by your Council on 1st April, 1930. from the late Board of Guardians. SANITARY CIRCUMSTANCES OF THE AREA. Water.—Water is supplied by the Metropolitan Water Board. No important extension of public water supply has been carried out during 1930. New 4-inch mains have been installed by the Board in the following roads:—Higham Hill Council Estate, Sinnott Road, Charter Avenue, Warboys Crescent. Coolgardie Avenue, Forest View Road, Forest Drive, North Circular Road, Beacontree Avenue, Forest Glade, Charter Road, Henry's Avenue, Queenswood Avenue. Rivers and Streams.—As the sewage from the Borough is now discharged into the London County Council's system there is no necessity for any action with regard to Dagenham Brook beyond periodical cleaning. Drainage, Sewerage and Sewage Disposal.—Sewage up to 6,275,000 gallons per day has been dealt with by the London County Council since 1926. Storm water overflow in excess of this amount is treated by screening, settling and surface irrigation at Low Hall Farm, the effluent being turned into Dagenham Brook. No important extension to the sewerage system was carried out in 1930. Plans are in course of preparation for the provision of a new low-level sewer which will act as a relief sewer, and will also drain low-lying land which cannot at present be drained. Closet Accommodation.—With the exception of four premises, all of which are connected to cesspools, every house in the district has a W.C. connected to the Council's sewer. Seventy-four earth closets were in use at Sports Grounds in the earlier part of the year, but 25 of them have been replaced by water closets. Of these 25, eight were converted at the instance of your Senior Sanitary Inspector. 28 Scavenging and Refuse Disposal.—No alterations in these services have been carried out during 1930. House and trade refuse amounting to 23,418 tons was received at the Destructor, where tins, metals and bones were extracted and, when possible, sold, the remainder being burnt. Sanitary Inspection of the Area. No. of inspections made. No. of nuisances detected. No. of complaints received. No. of Informal Notices. No. of Statutory Notices served. Total visits. Served. Complied with. 1930 8904 7336 1703 2379 2206 119 22823 1929 9697 7050 1884 2101 1972 90 19290 1928 9759 7066 1731 2187 2115 83 19345 1927 9273 7071 1631 2133 2188 96 18875 1926 9410 8061 1764 2400 2372 103 19004 Of the 119 Statutory Notices served during 1930, 107 were complied with. The nature and variety of the work done during 1930 is shown in the following tables:— Drains tested 292 ,, reconstructed or repaired 348 ,, obstructions removed 191 ,, means of access provided 20 ,, ventilation provided or improved 53 ,, ventilation repaired 165 Soil pipes repaired 39 ,, ,, new provided 31 Rain water pipes, renewed 252 ,, ,, ,, disconnected from drains 52 Roofs repaired or renewed 663 Gutterings repaired or renewed 401 W.C. pans or traps provided 359 Gully traps provided 55 W.C. flush cisterns provided 63 ,, ,, ,, repaired 295 W.C. floors concreted 77 W.C.'s repaired and cleansed 320 W.C.'s light and ventilation improved 7 Waste pipes renewed or trapped 150 ,, ,, repaired 130 New sinks provided 49 29 Water supply reinstated 2 ,, ,, taken off main 25 Cisterns cleansed and covered 61 Conveniences cleansed or repaired 20 Sculleries paved 33 Yards and forecourts paved and repaired 349 Dirty houses cleansed 103 ,, rooms cleansed 3,506 Floors repaired 213 Ventilations under floors provided 171 New damp-proof courses provided 88 Sites concreted 7 Offensive accumulations removed 45 Animals improperly kept, removed 8 Manure receptacles provided 4 Stables cleansed, paved and drained 15 Manholes repaired or re-sealed 63 Other cases of dampness remedied 299 Separate Sanitary Conveniences provided to shops where both sexes are employed 1 Polluted wells closed 2 Miscellaneous repairs 1,044 Infectious Diseases. Visits to premises 1,526 Re-visits to premises 288 Visits in connection with Smallpox 4,646 Premises disinfected 1,473 Articles disinfected at Low Hall 14,410 ,, destroyed at Low Hall 117 Dampness in Houses. Sites concreted 7 Damp-proof courses provided 88 Yards and forecourts paved and drained 349 Roofs made watertight 663 Rain-water pipes made good 252 Guttering repaired or renewed 401 Other cases of dampness remedied 299 Ventilation under floors provided 171 House-to-House Inspections 412 Special Premises. Number. Visits paid. Slaughterhouses 13 327 Butchers' Shops 80 574 Bakehouses 44 127 Fishmongers (fish frying and curing), etc. 57 235 30 Is umber. Visit paid. Eating-houses and Coffee Stalls 63 91 Ice Cream Vendors 125 53 Cowsheds 2 10 Milkshops 155 249 Laundries 31 43 Rag and bone dealers 6 32 Elementary Schools 28 38 Private Schools 13 Piggeries 8 49 Street Stalls Numerous 123 Greengrocers ,, 131 Factories 336 Workshops 205 Outworkers 339 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers' Shops and Slaughterhouses. Special cleansings, 25; Paving repaired, 6; Accumulations removed, 4; New Galvanised Bins provided, 5; Drains repaired, 4; W.C.'s repaired and cleansed, 6; Drains cleared of obstructions, 3; Yard paving repaired, 7; Floors repaired and Ventilated, 2. Bakehouses. Special cleansings, 65; Drains repaired, 3; W.C.'s cleansed and doors repaired, 12; Yards repaved, 4; Obstructions from drains removed, 2; W.C. cisterns repaired, 3; Floors repaired, 2; New ceilings fixed, 3; Roofs repaired, 1; Premises general repair, 2. Fishmongers. Special cleansings, 33; Drains cleared of obstruction, 2; Yards repaved, 7; Accumulations removed, 5; Gutters renewed, 2; Roofs repaired, 2; Drains repaired, 1; Other improvements, 6. Coffee and Eating Houses. Special cleansings, 21; Yard pavings repaired, 2; W.C. cisterns repaired, 1; Floors renewed, 1; Drains repaired, 2; Kitchen light and ventilation improved, 1; Roofs repaired. 1; Refuse Bins provided, 2; Ice Cream Vendors. Special cleansings, 12; Special cleansing of Utensils, 6; Yard paving repaired, 2; W.C. flush improved, 2. 31 Cowsheds and Milkshops. Special cleansings, 21; Pavings relaid, 7; Fittings and other improvements, 2; Roofs repaired, 1; Drains repaired, 3; Stable Premises. Cleansings, 14; Accumulations removed, 20; Roofs repaired, 3; Pavings repaired, 6; Manure receptacles provided, 2. Laundries. Special cleansings, 11; Roofs repaired, 1; Other improvements, 2. Rag and Bone Dealers. Cleansings, 12; Pavings repaired, 2; Accumulations removed, 1. Private Schools. W.C.'s repaired and cleansed, 2; Flush cisterns repaired, 2. Piggeries . Cleansings, 13; Paving relaid, 3; Re-drained, 1. Smoke Abatement.—Ten instances of nuisances arising from Smoke have been observed and dealt with. Personal visits to the Factories concerned have proved that in each case bad stoking and/or wrong fuel was the cause of the nuisances. The persons responsible carried out all suggestions made to abate the nuisances. Premises and Occupations which can be Controlled by ByeLaws or Regulations.—Vide "Sanitary Inspection of Area." Other Sanitary Conditions Requiring Notice.—There are several unoccupied pieces of land in the district which are a source of complaint from time to time. In Higham Hill Ward there are two such areas which are occasionally occupied as fair grounds and another in Forest Road, while in Wood Street Ward there is another piece of vacant land which gives rise to complaints. All frequently become strewn with old tins and sometimes bedding. When either of the foregoing sites are used as Fair Grounds daily visits are paid to prevent nuisances arising and the Bye-laws as to Tents, Vans, Sheds and Similar Structures are put into force, but it is to be regretted that these Bye-laws are not sufficiently drastic to meet the present requirements of the district as a whole. The 32 nomad or van-dweller can occupy any land—so long as he complies with these Bye-laws—without the sanction of the Local Authority, and thus bring about a reduction in the rateable value of the district in which he elects to dwell. There are four "established sites" in Higham Hill Ward on which caravans are placed. Of these, three are in Higham Street, the other is in Folly Lane. Schools.—The sanitary condition of schools is more fully discussed in the School Medical Officer's Report. A detailed sanitary survey is made of each School by the School Medical Inspector at the conclusion of Medical Inspection. Recommendations made are sent to the Director of Education. The general sanitary condition during 1930 was satisfactory, and the conversion of trough closets to pedestal closets was approved by the Education Committee, the work now being in hand. The Memorandum on Closure of and Exclusion from School, 1927, has been closely followed in dealing with Infectious Disease. No closure was advised during 1930. Twenty-six certificates of attendance below 60 per cent. of number on register were issued by the School Medical Officer. The work done at the Infectious Disease Clinic is referred to in a later section of the Report. The Rag Flock Acts, 1911 and 1928. —There are no known premises in the Borough on which rag flock is manufactured or sold. HOUSING. (a) Statistics. Number of New Houses erected during the year:— (а) Total (including numbers given separately under (b) ). (i) By the Local Authority 64 (ii) By other Authorities Nil (iii) By other bodies and persons 599 (b) With State assistance under the Housing Acts:— (i) By the Local Authority:— (a) For the purpose of Part II of the Act of 1925 Nil (b) For the purpose of Part III of the Act of 1925 and under the Housing Financial Provision Act, 1924 64 (c) For other purposes Nil (ii) By other bodies or persons Nil The houses were situated as follows:— Hale End Ward 483 Hoe Street Ward 15 Higham Hill Ward *147 Wood Street Ward 5 St. James' Street Ward 11 High Street Ward 2 (* Includes the 64 houses built by your Council.) 33 The number of Council houses in course of erection at the end of 1930 was 78 at the "Spion Kop" site, while a further scheme during the current year will provide another 104 houses on the same site. The following table shows the total number of houses erected during the past five years:— With StateAssistance. By the Local Authority. By other bodies and persons. By other bodies or persons. Total Houses. Flats. 1930 64 Nil Nil 599 663 1929 64 18 Nil 474 556 1928 98 340 Nil 249 687 1927 85 118 16 162 373 1926 50 32 36 96 196 Total 361 508 52 1,580 2,475 (N.B.—Two flats are counted as one house.) The preponderance of "private enterprise" houses during 1929 and 1930 will be noticed. These are mostly freehold "hirepurchase" houses ranging from £665 to £1,050—£25 deposit and 25s. per week repayment being the average for a house costing, say, £750. I.—Inspection of Dwelling-houses During the Year. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) and the number of inspections made 5,951 (2) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925, and the number of inspections made 412 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 323 Re-inspections under items (1) and (2) are included under "Total Visits" on page 28. 34 II.—Remedy of Defects During the Year without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 2,206 III.—Action Under Statutory Powers During the Year. A. Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 103 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 91 (b) By Local Authority in default of owners (at a cost of £63 14s. l1d.) 6 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 16 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 16 (b) By Local Authority in default of owners Nil C. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil IV.—Number of Houses Owned by Local Authority under:— (1) Part III of the Housing Act, 1925— (a) erected between 1919 and December 1928 (under various Acts) 835 (b) erected between January, 1929, and December, 1930 128 (2) Part II of the Housing Act, 1925 Nil (3) Other powers Nil 35 (b) Housing Conditions. Housing Act, 1930.—Following the issue of Circular 1119 in June, 1930, directing that special attention should be paid to Housing defects and to the compilation of accurate records regarding the Housing position generally, arrangements were made in October (as soon as the incidence of Smallpox had lessened sufficiently) for the District Sanitary Inspectors to commence a house-to-house census of those streets which were assumed to be the most overcrowded. Detailed particulars were taken at 1,244 houses and the findings were fully summarised by Mr. Duncan for presentation to the Special Committee set up to consider the working of the Act. In view of the fact that no actual "definition" either of Clearance or Improvement areas has yet been made pending the commencement of the rehousing scheme, it is not possible to publish the summary which would naturally indicate the areas which are to be dealt with. The Sanitary Inspectors' Census was supplemented by the fullest available information with regard to overcrowding in the Borough as a whole and compiled from the following sources:—Applications for Council houses, records of Sanitary Inspectors, Health Visitors (see tables (page 96) Maternity and Child Welfare section), School Nurses, Infectious Disease Nurse, Tuberculosis Officer, Voluntary Agencies, and, most important of all, the results of the Borough survey carried out by the School Attendance Department. The survey embraced the whole Borough over the period November, 1926-November, 1930, and was made available by the kindness of the Superintendent Attendance Officer, Mr. S. J. Longman. Houses containing more than eight persons were reckoned as "overcrowded," and care was taken to eliminate duplication of several cases reported from more than one of the above sources. The total number of overcrowded houses was 1,151. A detailed report was made by your Medical Officer of Health and Senior Sanitary Inspector to the Special Committee embodying all the available information specified above and suggesting for clearance a total of 49 houses which had been inspected by them and the Chairman of the Public Health Committee. It was stated that the clearance of these houses was more urgent than the provision of new houses under the 1924 Act. Certain streets were suggested for definition as "improvement" areas. After considering the Special Committee's report your Council made the following return to the Ministry:— 36 "Housing Act, 1930 (Section 25 (2) )." Form of Quinquennial Statement. Name of Local Authority: Walthamstow Borough Council. Population (estimated figure for middle of 1929) 124,800 A. Estimated production of houses by the Local Authority during the next five years 800 B. Estimated production of new houses of workingclass type by private enterprise during the next five years:— (i) with subsidy under the Act of 1924 Nil (ii) with arrangements made under Section 29 of the Act of 1930 Nil (iii) Otherwise 2,000 C. Estimated number of new houses to be allocated by the Local Authority during the next five years to the purposes of the Housing Act, 1930 (i.e., the purposes mentioned in E and F) 751 D. Estimated number of new houses to be allocated by the Local Authority during the next five years to the purposes of the Act of 1924 (i.e., new Housing) 49 Total 800 E. Estimated number of houses to be demolished during the next five years:— (i) in Clearance areas 116 (ii) in Improvement areas:— (a) for opening the area Nil (b) as unfit houses Nil (iii) individual houses outside clearance and improvement areas 8 Total 124 E. Estimated number of persons to be displaced during the next five years:— (i) by any of the processes mentioned in E 596 (ii) to abate overcrowding in improvement areas 3,138 Total 3,734 G. Estimated number of houses to be repaired under Part II of the Housing Act, 1930, during the next five years 11,575 37 The Clearance areas comprise the eight separate groups of four or more houses. The shortage of housing accommodation is emphasised by the fact that although no general applications for Council houses have been accepted since 1925, there were still 489 outstanding early in 1931, made up as follows:—Applicants living in one room, 28; two rooms, 97; three rooms, 140; four rooms, 70; miscellaneous, 53; other ballot cases, 101. In addition a large Estate Company in the Borough received approximately 5,000 applications for houses and flats during 1930. Two thousand five hundred of these remained on the waiting list early in 1931, in addition to approximately 350 on a list of special recommendations. It is obvious that the question of housing shortage is not a local one, but is one affecting the whole of Greater London. It can never be seriously approached until a co-ordinating supervisory Housing Authority is set up for the whole area. Housing Conditions. General Observations:— (1) The average type of house contains three bedrooms, sitting room, kitchen and scullery. Many of the houses in St. James Street Ward have seen their day, as it were, but there are many others throughout the district which are now fast showing the result of the handiwork of the "Jerry" builder. Amongst the more prevailing forms of defects are to be included the following:—(1) perished interior plasterings; (2) defective roofs due to insufficient lap and springing; (3) dampness due to perished and insufficient damp-courses and to the porosity of certain types of bricks. The conditions of premises due to overcrowding are mainly want of cleanliness. More defects exist in premises where two families reside and overcrowding occurs, by reason of the extra wear and tear the premises sustain. (2) Sufficiency of Supply of Houses. (a) The extent of house shortage in the district has already been indicated. (b) No reliable information exists as to actual or anticipated changes in population. 38 (c) Walthamstow, as an area, is fast becoming built up and the small area left may be difficult to sewer properly because it is lowlying and furthest from the sewage outfall. (3) Overcrowding. (а) See pages 35 & 37. (b) It is difficult to estimate how far overcrowding is due to inability to pay rents of available houses. (c) In seven instances the occupiers and the owners concerned in overcrowded cases were written to. As a result, five cases were abated and in many instances the Council and the Warner Estate Co. have again helped by granting a house or flat. (4) Fitness of Houses. (a) There has been no special difficulty in action under the Public Health Acts or the Housing Act, 1925, Section 3. It is sometimes difficult to find the right person on whom to serve notice by reason of Section 5 of the Housing Act, 1925, not being carried into effect by those responsible, but the difficulty is overcome by leaving notices on the premises addressed to the Owner. It is to be regretted to some extent that the Manual on Unfit Houses is only a guide and not law. (b) No circumstances have arisen where special measures have been taken to deal with insanitary property by the gradual carrying out of repairs by Owners but there is more possibility of such an arrangement under the 1930 Housing Act. (c) There are three groups of eight houses in the area which have no internal water supply, two of which have a tap in a yard used in common. The other houses have separate taps fixed in their respective gardens. There are no private water supplies. (d) One group of eight houses in Hilton Grove have four W.C.'s attached at one end thereof and used in common by the occupiers of the eight houses. (5) Unhealthy Areas. No part of the district can be said to contain an unhealthy area. 39 (6) Bye-laws relating to Houses, to Houses let in Lodgings, and to Tents, Vans, Sheds, etc. The Bye-laws relating to Houses let in Lodgings were made in 1883 and require revision. The Bye-laws relating to Tents, Vans, Sheds, etc., are of more recent date and have been enforced but are found in practice to be inadequate to meet the needs of the district. The present Bye-laws provide for W.C. accommodation to the extent of one W.C. for every 12 persons, "if not otherwise provided." These last four words, if omitted from the Bye-law, would make it so definite that W.C. accommodation must be specially provided. The provision of W.C. accommodation "within 150 feet," if omitted from the Bye-laws, would make it definite that accommodation must be provided on the site. As it is, Van-dwellers can draw on to a site and use the W.C. accommodation provided at any house (by arrangement with the occupier) situated within 150 feet of the site. It is thus made easy for van-dwellers to pitch almost anywhere they choose. A prosecution was, however, successfully sustained during the year in the Summary Jurisdiction Court on the question of W.C. accommodation, but it does not follow that success may always attend the arguments of the prosecution. Inspection and Supervision of Food. (a) Milk Supply. The average number of cows kept in the district was 14. The cowsheds numbered two and 23 visits were paid by the Sanitary Inspectors in addition to special visits paid by your Senior Sanitary Inspector. The number of retail purveyors of milk is 155, most of whom carry on a general shop and sell milk in bottles as they receive it. Two hundred and forty-nine visits were paid to the registered premises of purveyors of milk during the year and there was a general improvement in the standard of cleanliness observed. During the year 22 samples of Graded Milk and four samples of Ice Cream were submitted for Bacteriological Analysis. Of the 22 samples of Graded Milk 15 were submitted to tests for Tubercle Bacilli and in no case was the Bacillus demonstrated. In three 40 instances of Graded Milk the counts were excessive. The proprietors of the dairies were approached, cautioned and further samples taken which gave satisfactory results. The following tables give the results of the several analyses and prosecutions under the Food and Drugs (Adulteration) Act, 1928, the Milk and Dairies Order, 1926, and Bye-laws in force. BACTERIOLOGICAL ANALYSIS OF MILK SAMPLES. Date. Nature of sample. Total Bacteria per cubic centimetre. Bacillus Coli absent in Presence of Tubercle Bacillus (biological test). Remarks. 11.8.30 Pasteurised Milk 1,156,953 1/100 c.c. Unsuccessful test Unsatisfactory. 11.8.30 „ 315,840 „ Absent Unsatisfactory. 11.8.30 Grade A (T.T.) Milk 158,000 „ „ Satisfactory. 11.8.30 „ 168,000 1/1000 c.c. „ „ 3.9.30 Pasteurised Milk 485,000 1/100 c.c. „ Unsatisfactory. 3.9.30 „ 367,000 1/100 c.c. „ Unsatisfactory. 3.9.30 Grade A (T.T.) Milk 72,000 1/1000 c.c. „ Satisfactory. 16.9.30 Pasteurised Milk 13,165 „ „ „ 23.9.30 „ 31,893 1/100 c.c. „ „ 23.9.30 „ 50,820 1/1000 c.c. „ „ 23.9.30 „ 105,503 11 „ Unsatisfactory. 23.9.30 „ 31,893 1/100 c.c. „ Satisfactory. 24.9.30 „ 12,795 „ „ „ 26.9.30 „ 1,230 1/100 c.c. „ „ 26.9.30 Grade A (T.T.) Milk „ „ Absent „ 1.10.30 Pasteurised Milk 25,410 1/100 c.c. „ „ 1.10.30 „ 22,700 „ „ „ 1.10.30 „ 41,856 „ „ „ 7.10.30 Grade A Pasteurised under 100 1/10 c.c. „ „ 7.10.30 Pasteurised Milk 17,000 „ „ „ 7.10.30 „ 6,100 „ „ „ 7.10.30 „ 4,800 „ „ „ The County Medical Officer states that samples of milk were taken in the Borough by the County Food and Drugs Inspector and submitted to biological examination during 1930 with the following results:— 41 24 were found to be free from tubercle bacilli. 2 were found to contain tubercle bacilli. 4 gave inconclusive results owing to the death of the guinea pigs from intercurrent infection. One of the samples which contained Tubercle Bacilli was produced at a farm in West Suffolk. The herd was inspected by a Veterinary Surgeon and two cows found to be tuberculous were slaughtered. The remaining sample was from a farm in Essex; the dairy herd was inspected by a Veterinary Surgeon and one cow found to be tuberculous was slaughtered. BACTERIOLOGICAL EXAMINATION OF ICE CREAM SAMPLES. Date. Nature of sample. Total Bacteria per cubic centimetre. Bacillus Coli absent in Bacillus Welchii Spores in 10 ccs. Remarks. 23.9.30 Ice Cream 79,500 1 c.c. Absent Satisfactory. 23.9.30 „ „ 246,000 „ Present „ 23.9.30 „ „ 3,000 „ „ „ 23.9.30 „ „ 43,500 „ „ „ The Milk and Dairies Order, 1926. Much attention was again directed to this Order during the year with a view to minimising the risk of contamination, infection and alteration of the milk supply to the Town and as a result three summonses under Section 31 (2) of this Order were issued against offenders. In one case a fine of 40s. was imposed; in another a fine of 10s. was obtained. The third case was heard in January, 1931, and will be accounted for in the 1931 report. In addition the Council issued a warning to a dairyman and his employee for a similar breach of the Order. The Milk and Dairies (Amendment) Act, 1922, (Section 2). The Council refused to register a retail purveyor of milk who sought to be registered in respect of certain premises. No appeal was made against the refusal. 42 The Milk (Special Designations) Order, 1923. The number of Licences granted for the Sale of Milk under Special Designations classified as in the fourth Schedule of the above Order was 25, as follows:— Dealers' Licences. In respect of— Grade A Milk 2 Grade A (T.T.) Milk 8 Certified Milk 2 Pasteurised Milk 3 Bottling Licences. In respect of Grade A Milk, 2; (6) Meat and Other Foods. Supplementary Licences. In respect of— Grade A Milk 1 Certified Milk 1 Grade A (T.T.) Milk 2 Pasteurised Milk 2 Pasteurised Milk, 2. A total of 327 visits were paid to slaughter-houses. The following were condemned and destroyed:— (1) Tuberculosis. 9 Pigs' Heads. 10 Sets Ox Lungs. 7 Forequarters Beef. 2 Cows' Heads 4 Cow Carcases, all ofial and fats. 3 Pigs' Carcases, all organs and fats. 1 Pig's Head and all organs. 1 Pig's Pluck. 3 Cows' Livers. 3 Cows' Tripes and Fats. 1 Flank Beef. (2) Other Reasons. 8 Sheep's Lungs. 4 Ox Livers. 10 Sheep's Livers. 21 Sets Pigs' Lungs. 1 Pig Carcase and all organs. 2 Cow Carcases and all organs and fats. 1 Box Skate. 1 Sack Winkles. 1½ Boxes Creamy Whirls (Chocolates). 3 Stones Dog Fish. 1 Box Haddocks. 242 lbs. Cheese. 25 Bundles (100 boxes) Tomatoes. 1 Box Dabs. 5 Boxes Roe. 1 Set Ox Lungs. 1 Thin Flank. (c) Adulteration, etc. (The Food and Drugs Adulteration Act, 1928.) Fifty-four samples of food were submitted for analysis during the year. Of these 52 were in respect of Milk, one sample was in respect of Butter and one sample was in respect of Marrow Seeds. 43 Of the 52 milk samples, two were not genuine and the sample of butter was not genuine. Proceedings were instituted in respect of these three samples and convictions obtained. OFFENSIVE TRADES. During the year the Council refused to sanction the establishing of the following Offensive Trades:— Rag and Bone Dealer (2), Fish Fryer (1), Fish Curer (1). The Council sanctioned the renewal Licences in respect of Offensive Trades as follows:— Fish Fryers (7), Fish Curer (1), Rag and Bone Dealer (1). Proceedings were instituted against a Rag and Bone Dealer for carrying on the trade without a Licence from the Council. A penalty of 20s. was imposed and a renewal Licence refused. Legal Procedure. Fine. Costs. Food and Drugs (Adulteration) Act, 1928. Sample of Butter containing 2% excess of water. See The Sale of Butter Regulations, 1902 (not revoked by the 1928 Act) 40s. 6s. Sample of Milk, at least 10% deficient in Milk Fat 40s. 6s. The Milk and Dairies Order, 1926 (Section 31 (2) ). Information against Dairyman for filling Bottles with Milk otherwise than on registered premises 40s. Nil Information against employee for filling bottles with Milk otherwise than on registered premises 10s. Nil The Public Health Acts, 1875 (Section 112), and 1925 (Section 44), and the Bye-laws, 1913. Information against a Rag and Bone Dealer was laid for carrying on the trade without the sanction of the Council 20s. Nil Housing of the Working Classes Act, 1885, and the Public Health Act, 1925 (Section 43 (3) ), and the Bye-laws as to Tents, Vans, Sheds and Similar Structures. 44 Information was laid against an owner of certain land for a breach of Clause 16 of the Council's Bye-laws as to Tents, Vans, Sheds, etc. No pecuniary penalty was obtained, but an Order was made under Section 43 (3) of the Public Health Act, 1925, prohibiting the Vans on the land in question. THE RENT AND MORTGAGE RESTRICTIONS ACTS, 1920-1923. During the year 25 Certificates were granted to tenants and nine Certificates have been issued to Owners upon completion of the scheduled works. In all cases work, which can be enforced by the Housing Acts, has been carried out, but the Rent Acts permit of requirements in excess of those which can be demanded under the Housing Acts and which cannot be enforced under them. If owners do not fully comply with scheduled works specified on the Certificates granted to tenants no Clearance Certificates are issued. In connection with general repairs to property it is to be regretted that some Agents and Owners employ men who are least fitted for such work. This gives rise to a certain amount of unpleasantness, extra cost and much inconvenience to householders. If Owners would recognise the extra cost to be borne by ratepayers due to their unresponsive attitude upon receipt of informal notices, the necessity of Statutory work costing time and money would be avoided. DISEASES OF ANIMALS ACTS, 1894-1928. (Duties taken over following Incorporation.) Parasitic Mange.—During the year two cases of Sarcoptic Mange in horses were notified from one stable. One horse was slaughtered on the premises, the other was moved under Licence for detention and treatment. Two other horses on the same premises were ' 'dressed'' and segregated. Disinfection was thoroughly carried out and there has been no recurrence of the disease. The Importation of Dogs and Cats Order, 1928.—One dog was admitted into this area under this Order by Licence of the Ministry of Agriculture and Fisheries. 45 The rules applicable thereto and the conditions laid down by the Ministry were strictly observed and the animal was subsequently removed to another area under similar Licence. Sheep Scab Order, 1920.—No cases of this disease have been found in the Borough but 66 sheep and lambs were admitted, under Licence, for slaughter. Swine Fever Orders of 1908-1917.—Owing to improvements in the aSected areas the Ministry of Agriculture and Fisheries withdrew the restrictions imposed by the Orders on the 5th March. Regulation of Movement of Swine Order, 1922.—Under this Order 894 pigs have been admitted into this area for slaughter. All notices of such movements have been, as far as practicable, followed np. Tuberculosis Order, 1925.—Following Incorporation your Council assumed the powers under this Order, but, by special request, the County Council carried on the work until March 18th, 1930. No case was reported during the year. Poisons and Pharmacy Act, 1908.—One Licence was granted under this Act during the year. The following tables show the work done under the Factory and Workshop Act, 1901:— 1 .—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (i) (2) (3) (4) Factories (Including Factory Laundries.) 337 6 Nil. Workshops (Including Workshop Laundries.) 188 13 Nil. Workplaces (Other than Outworkers' premises.) 24 1 Nil. Total 549 20 Nil. 46 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H M Inspector. (1) (2) (3) (4) (5) Usances under the Public Health Acts:— Want of cleanliness 10 10 — — Want of ventilation 4 4 — — Overcrowding 1 1 — — Want of drainage of floors 1 1 — — Other nuisances 8 8 — — Sanitary commodation insufficient 1 1 — - unsuitable or defective 7 7 - - not separate for sexes 1 1 — - fences under the Factory and Workshops Acts— Illegal occupation of underground bakehouse (s. 101) 3 3 — — Other offences — — — — Total 36 36 — — 47 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1930. Tailoring 43 Millinery 11 Dresses, Robes and Blouses 99 Brushes 36 Shirts and Collars 32 Artificial Flowers 6 Ties 62 Boxes 28 Underclothing, Baby Linen, Fancy Bags 16 etc. 90 Umbrellas 3 Boots 46 Various 15 Embroidery 7 Fur Trimmings 5 OUTWORKERS WERE NOTIFIED FROM THE FOLLOWING AREAS:— City of London 181 Leyton 40 Bermondsey 3 Poplar 3 Bethnal Green 26 St. Marylebone 5 Chelsea 1 Stoke Newington 9 Finsbury 53 Stepney 8 Hackney 95 Shoreditch 22 Islington 4 Tottenham 7 Walthamstow 41 Westminster 10 A total of 406 visits were paid in connection with outworkers, as follows:—To Homes, 342; Factories, 30; Workshops, 34. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. General.—The accompanying table shows the age and ward incidence of the various Infectious Diseases which are discussed separately in later pages of the Report:— 48 The total number of cases of notifiable diseases during 1930 was 2,393, or, excluding Chickenpox (not notifiable in previous years), 1,700, as compared with 1,515 in 1929, 1,455 in 1928, 1,372 in 1927, and 1,182 in 1926. Disease. All Ages. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and over. St. James Street. High Street Hoe Street ' Wood Street . Hale End. Higham Hill. Removed to Hospital Smallpox 189 1 11 80 52 30 13 2 57 25 44 13 11 39 189 Scarlet Fever 607 1 104 413 56 32 1 — 162 101 73 65 80 126 414 Diphtheria 509 4 113 322 41 26 3 - 118 93 89 50 60 99 436 Enteric Fever 5 - 1 - - 3 1 - 1 - 2 - 1 1 5 Pneumonia 139 3 17 22 10 33 32 22 31 25 16 11 25 31 31 Puerperal Fever 14 - - - 3 11 - - 1 2 2 4 1 4 12 Puerperal Pyrexia 8 - - - 2 6 - - 2 - 2 1 2 1 8 Ophthalmia Neonatorum 8 8 - - - - - - 2 - - - 1 5 3 Erysipelas 57 2 - - 6 18 22 9 11 7 9 14 5 11 22 Encephalitis Lethargica 2 - - - 2 - - - - - - 1 - 1 1 Cerebro-spinal Meningitis 3 1 1 1 - - - - 2 1 - - - 3 Chickenpox 693 23 169 476 21 3 1 - 174 149 118 79 78 95 3 Tuberculosis 159 - 4 15 44 71 23 2 31 27 26 22 22 31 146 49 Year. Smallpox. Scarlet Fever. Diphtheria. Enteric Fever. Pneumonia. Puerperal Fever. Puer. Pyrexia. Ophth. Neon. Erysipelas. Enceph. Leth. Cerebro-spinal Meningitis. Pulmonary Tuberculosis. Non-pulmonary Tuberculosis. Polioencephalitis. Poliomyelitis. Chickenpox. Total. The following table shows the yearly notifications for the past five years:— 1930 189 607 509 5 139 14 8 8 57 2 3 125 34 — — 693 2,393 1929 10 688 325 2 222 5 7 7 51 2 2 142 52 — — Not Notifiable 1,515 1928 — 764 283 2 155 5 6 11 47 4 1 139 36 2 — 1,455 1927 — 623 285 6 172 8 13 13 56 1 - 150 42 3 - 1,392 1926 — 484 262 4 133 8 N.N. 9 57 11 1 155 55 2 1 1,182 (N.N.—Not Notifiable.) The 1930 notifications include the following cases discovered by the Staff of the Health Department:— Smallpox, 67; Diphtheria, 77; Scarlet Fever, 23; Chickenpox, 22. Total, 189. 50 Cases of Measles and Whooping Cough were not admitted to Hospital unless associated with either Diphtheria or Scarlet Fever. It is hoped that, after the erection of the 18 further cubicles now proposed, it will be possible to admit the more urgent cases of Measles and Whooping Cough. Control over Infectious Diseases.—On receipt of a Notification of a case of Infectious Disease the patient is removed to Hospital if necessary, and the room occupied is immediately disinfected with formalin. Bedding is steam disinfected and library books are destroyed. If the Notification does not request removal to Hospital the Infectious Disease Nurse visits the house to ascertain whether the case can be efficiently isolated and the necessary attention provided. A printed form of instructions as to the precautions to be adopted to prevent the spread of infection is left. Information is also obtained as to the day and Sunday Schools attended, both by the patient and any other children in the house. Children are excluded from School until certified as free from infection, the Head Teachers being notified as to the period of exclusion. Contacts attend the Infectious Disease Clinic on the following Tuesday. The source of the milk supply is ascertained and any necessary action taken. The occupations of all other inmates of the house are recorded and any contact employed in laundry work or in any way connected with food supplies is suspended from duty until seen by a Medical Officer. The District Sanitary Inspector visits the affected house, investigates sanitary conditions, and endeavours to trace the source of infection. Disinfectant is supplied free of charge for use in homes where cases are not removed to Hospital, and, following recovery, the room and bedding used by the patient is thoroughly disinfected by the Council's Staff. The following is a summary of the work done during 1930 at the Infectious Disease "Contact" Clinic:— Number of sessions held 52 Number of Cases 1,780 Number of attendances made 2,352 Average attendance per Session 45.2 Number of Scarlet Fever Cases discovered 4 Number of Diphtheria Cases discovered 6 Number of non-Clinical Cases of Diphtheria discovered 55 Number of Patients given antitoxin 20 Virulence Tests for Diphtheria 3 Number of Tonsillectomies in Chronic Diphtheria Carriers 2 51 In addition to contacts, all cases treated in Hospital are seen as to fitness for work or school on the first Tuesday following discharge. Your Council have an adequate steam disinfector at Low Hall Lane and ample transport consisting of three motor ambulances (two by W. & G. Du Cros purchased in May, 1929, and one Crossley purchased in January, 1925). The newest ambulances are used for Diphtheria and Scarlet Fever cases respectively and the oldest one for Smallpox cases. In addition two 30-cwt. Morris Commercial Vans are used for disinfecting purposes. The Ambulance and Disinfecting Staff consists of four men. During the year 1,473 premises and 14,410 articles were disinfected and 117 articles were destroyed. There are no facilities available for the cleansing and disinfection of verminous persons. MUNICIPAL LABORATORY. The following work was carried out during the year:— Total. Positive. Negative. Medical Health Practitioners. Dept Diphtheria Swabs 3,936 505 3,431 2,124 1,812 The numbers of swabs examined during the previous four years were:—1929, 2,650; 1928, 1,913; 1927, 1,912; 1926, 1,688. An interesting feature is that all the necessary blood serum for cultivation of the specimens, both at Lloyd Park and at the Sanatorium, is prepared by Mr. West, the Laboratory Assistant. During 1930 a total of 7,840 culture media were made as compared with 6,875 during 1929. The Essex County Council also provide facilities for examination of pathological specimens and the County Medical Officer states that 882 specimens were examined for local Practitioners during 1930, as follows:— Diphtheria Swabs, 294; Sputa, 549; Typhoid Specimens, 12; Ringworm Specimens, 14; Miscellaneous Specimens, 13. Total, 882. The totals of previous years were: 1929, 904; 1928, 876; 1927, 1,007; 1926, 1,085. (A) SMALLPOX. During 1930 a total of 189 cases of Smallpox was discovered in the Borough and represented the continuation of the outbreak which occurred late in 1929. After many years immunity from this disease the first case was notified in September, 1929, to be followed by nine others before the close of the year. These 10 cases showed at least four separate sources of infection, all of which were outside the Borough. 52 The following table shows the monthly incidence by ages and Wards during 1930:— SMALLPOX—1930. All ages. Under 1 yr. 1-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 & over. St. James' Street. High Street Hoe Street. Wood Street. Hale End. Higham Hill. January 29 — 1 7 16 4 1 — 4 7 4 — 2 12 February 29 — 3 8 12 4 2 — 15 3 5 — 3 3 March 15 — — 6 2 6 1 — 5 2 2 — 1 5 April 8 — — 3 3 1 1 — 3 3 1 — 1 — May 20 — 1 9 3 2 4 1 1 2 10 2 2 3 June 11 — — 6 3 1 1 — — — 5 6 — — July 25 — 4 14 2 3 2 — 2 1 13 4 — 5 August 28 — 2 17 3 5 1 — 19 1 3 1 1 3 September 15 — — — 9 5 1 — 7 — — — 1 7 October 3 1 — — 1 — 1 — 2 — — — 1 November 4 — — 1 1 2 — — 1 3 — — — — December 2 — — — 2 — — — — 1 1 — — — Totals 189 1 11 71 56 34 14 2 57 25 44 13 11 39 53 In addition to the above 189 cases, five further cases were admitted to the Borough Smallpox Hospital for observation. The final diagnoses were: Variola sine eruptione, 2; Varicella, 1; Teething Rash, 1; Acne, 1. The vaccinal condition of the 189 patients was as follows:— Unvaccinated 167 Vaccinated in Infancy 22 The ages of the patients vaccinated in infancy were as follows:— 66, 65, 63, 57, 56, 54, 53, 50 (2), 48 (2), 46, 43, 42, 37, 35 (also re-vaccinated in 1914), 33, 26, 21 (2), 18 and 16. Thus the minimum protection afforded by vaccination in this series of cases was 16 years, and in the case of the patient aged 35 (re-vaccinated in 1914) the disease was so mild that he was only detained in Hospital for 7 days. Twenty-two Primary vaccinations and 15 re-vaccinations were done by your Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917, chiefly in observation and doubtful cases prior to Hospital admission. In 91 cases the source of infection could not be traced, eight cases were infected outside the Borough, and the remaining 90 could be linked up with previous cases. The cases infected outside the Borough had not been previously reported as Contacts. A total of 1,175 contacts were reported by outside Authorities, and referred to persons living in Walthamstow, but working elsewhere. Only one of these contacts developed Smallpox. The numbers of contacts notified by the following Authorities were:—Hackney 174, Leyton 55, Finsbury 44, City 41, Poplar 26, Bethnal Green 23, Stepney 21, Shoreditch 37, Holborn 13, Tottenham 12, Islington 9, West Ham 9, St. Pancras 8, East Ham 7, Stoke Newington 6, St. Marylebone 4, Kensington 3, Chingford 3, Camberweil 3, Bermondsey 3, Port of London 3, Lambeth 2, Edmonton 2, Other Authorities 13. All the cases were of the Variola "Minor" type and no deaths were recorded. The scheme of control followed is that apparently common to most Authorities in the London area. Arrangements exist whereby actual or suspected cases are immediately visited by Medical Officers of the Department. 54 Local Practitioners were circularised on two occasions during the year as to the facilities offered and requesting that telephonic notification of cases be made. On confirmation of the diagnosis, circulars are drawn up giving the following particulars:—Name, address, occupation, place of employment, and date of last attendance, vaccinal condition, suspected source of infection, date of onset and of appearance of rash, together with a complete list of names and addresses of home and other contacts, their employment and vaccinal condition. Copies of these circulars are sent on the day of notification to all local Practitioners, Medical Officers of Health of adjoining areas and of areas affected by contacts, and totalled 70 for each case, representing 12,930 during the year. The enormous amount of clerical work alone involved can thus be realised. Lists of Contacts of "outside" cases are also periodically circularised to local Practitioners, so that they may be alive to the possibility of Smallpox when consulted by any of these contacts. Removal to Hospital is immediately effected and immediate vaccination offered by the Public Vaccinator, Dr. Mackenzie, who has co-operated, often late at night, in a most willing manner. No effort is spared in persuading contacts to be vaccinated, and the virtual cessation of the epidemic towards the end of the year was mainly due to the fact that in the latter half of the year in only one household was complete refusal met with. All four members of the family involved were ultimately removed to Hospital with Smallpox. During the same period 32 families accepted immediate vaccination with no secondary cases, while nine further families who also accepted vaccination showed secondary cases as under:— Initials. Duration of first patient's rash when second patient Vaccinated. No. of Secondary Cases. Duration of Hospital Treatment. LaP. 4 days. 1 15 days. W. 3 „ 1 12 (1 pustule only) L. 4 ,, 1 15 A. 2 „ 2 10 days each. H. 3 ,, 3 16, 18, 28 days. B. 2 ,, 4 9,11,11,16 ,, C. 2 ,, 2 15 days each. R. 2 ,, *1 4 days B. 6 ,, *1 7 ,, *"Sine eruptione." From the above it will be seen that vaccination of home contacts, when done not later than the first day after the appearance of rash in the primary case, protected them in every instance. Even in 55 the 14 definite cases recorded above the severity of the disease was very much diminished with the consequent shorter duration of Hospital treatment. Following removal to Hospital, the actual houses involved are visited daily, up to the twenty-first day, either by a Medical Officer or Sanitary Inspector. Other contacts are visited as often as possible by a Sanitary Inspector, with a minimum of visits, on alternate days up to the twenty-first after removal of the last case. The enormous amount of work entailed will be realised from the fact that 1,566 visits were paid by the Medical Staff and 4,646 visits by the Sanitary Staff. Leaflets describing symptoms, precautions and penalties were left, and similar advertisements were displayed in the local Press on two occasions. To assist in the control of Smallpox, Chicken-pox was made a notifiable disease on the 12th March, 1930, and notification was extended for a further twelve months from the 30th September, 1930. In view of the fact that five cases notified during 1930 by Practitioners as Chicken-pox were, on being visited, found to be suffering from Smallpox, there is no question that notification of Chicken-pox is fully justified. During the year all cases of Chicken-pox were visited by a member of the Medical Staff for verification of diagnosis. From the 16th March to 31st May 344 cases occurred, or an average of over 31 per week. From the clinical aspect the average incubation period was 12 days and the average period between onset and rash four days. In many cases there was no prodromal illness, while some cases showed premonitory symptoms but followed by no rash. Two cases from infected houses showing typical premonitory symptoms were admitted to Hospital for observation but developed no rash and were looked upon as cases of "variola sine eruptione." In some the premonitory symptoms included delirium, but the severity of the symptoms could not generally be taken as a guide to the severity of the subsequent rash. The difficulty of control is increased by the very mildness of the disease, especially in view of the fact that the prodromal illness is so frequently absent or so mild that patients are often not diagnosed until the rash is several days old. At least 18 patients were diagnosed on attending Practitioners' surgeries with well-developed rashes. In addition, many mild and undiagnosed cases undoubtedly remained at large. 56 The following extracts taken from the monthly reports made to the Public Health Committee show the experiences of the latter half of the year:— "Following the discovery of a case at the School Clinic on 4th July all unvaccinated absentees from the School attended (Forest Road Infants) were visited by Officers of the Health Department up to the beginning of the School holidays and three further cases were found which would otherwise have been missed. Thirteen secondary cases were later traced to those four cases." "The following examples will show the extreme susceptibility of some families:— (a) Five cases in four inter-related families. (b) Four cases in one family (the whole family), re-vaccination having been refused when advised. (c) Four cases in two inter-related families; and (d) Three cases in another family of four members. One adult patient was found to have been at large for six days (in a highly infectious condition) acting as a Bookmaker's tout until arrested and convicted at Stratford Police Court, after having travelled to and from that place by tramcar and omnibus." "Another patient was found to have been at a Sunday School while infectious. All contacts were visited and an otherwise missed case was discovered." "One patient was found to have been infected at a Girl Guides' Camp by a girl whose rash appeared on the 23rd July and who went to Camp on the 26th July and was probably infectious until returning on 8th August. Over 30 contacts required supervision from this case alone, but, curiously, no secondary case occurred." "Another un-notified case had spent a holiday at Paignton and the mother and brother were infected by him and were notified a few days after returning to Walthamstow." "One case had been infected at Maldon, Essex (determined by date of onset, etc.). The Maldon Authorities were informed and further cases were discovered at the infected house there." "On the 5th September a case was notified who had attended Gamuel Road Boys' School whilst infectious." 57 "The routine detailed above was again followed, except that the District School Attendance Officer visited absentees and reported any suspicious cases. Three further cases were discovered in this way—one of whom had visited several shops and a cinema whilst still infectious—and yet, apparently, gave rise to no further known cases." "After the first week in September the incidence of Smallpox fell rapidly, only three occurring during the remainder of the month, three in October, four in November and two at the end of December.' "There were no notifications between the 18th November and 23rd December—a period of five weeks—and, until the latter date, it was hoped that the Borough had at last been cleared of this disease." Of the 189 cases occurring during the year, 73 were discovered by the Medical Officers and Sanitary Inspectors of the Department. HOSPITAL TREATMENT OF SMALLPOX. The agreement between your Council and the West Ham Corporation having fallen through some years ago, and owing to the refusal of other Hospital authorities to accept your Smallpox cases, it became necessary in September, 1929, to hastily improvise accommodation. . With the continuance of the epidemic every opportunity has been taken of extending and improving the accommodation, with the result that there now exists a well-equipped Hospital, although comprised of temporary buildings. The table on page 74 of the Isolation Hospital Report gives further details of the Hospital as submitted for the County survey under the Local Government Act, 1929. The Hospital was closed on two occasions, viz., between 18th and 22nd October, and 2nd to 23rd December, 1930. One hundred and eighty-nine cases of Smallpox were admitted for treatment and five cases for observation. There were no deaths and, except in a minority of cases, the patients showed normal temperatures with an almost complete absence of secondary fever, even in cases with a semi-confluent rash. There were no apparent resulting disabilities. 58 The following represent the more serious cases:— F. 19 yrs. 22 days in Hosp. Profuse rash. Pulse and temp, normal No complications F. 5 ,, 57 ,, ,, Nephritis end of second week Clear in 9 days. M. 17 ,, 44 „ ,, Septic eruptions following S.P. rash F. 6 ,, 67 ,, ,, Septic spots, etc. F. 18 ,, 29 „ ,, Eye complications F. 17 ,, 39 ,, ,, , ,, M 18 ,, 42 ,, ,, Severe eruptions No complications M 21 „ 43 ,, ,, ,, ,, ,, ,, F. 10 ,, 38 ,, ,, ,, ,, ,, ,, M 42 „ 30 ,, ,, ,, ,, ,, ,, F. 7 ,, 29 ,, ,, ,, ,, ,, ,, F. 7 ,, 23 ,, ,, ,, ,, ,, ,, F. 36 ,, 32 ,, ,, ,, ,, .. .. F. 33 ,, 30 ,, ,, ,, ,, ,, ,, M 56 ,, 23 ,, ,, ,, ,, ,, ,, The minimum stay in Hospital was seven days and the maximum 67 days. The average stay in Hospital was 20.6 days and the total patient days was 3,996. The youngest patient was aged 8 months and the eldest 66 years. No account of the year's work at the Hospital would be complete without grateful acknowledgement to the Matron of your Isolation Hospital, who administered the Nursing and maintenance services, and to the excellent services of the Nurses themselves. The very frequent reluctance of patients to accept discharge from the Hospital will sound almost incredible to those who have had no personal contact with them. Dr. W. Vernon Shaw, O.B.E., of the Ministry of Health, visited the Hospital on the 2nd October to confirm the diagnosis in one case. He made suggestions, which were later carried out, with regard to the lay-out of the Huts. Mr. Sharp, the Vaccination Officer for the Area, kindly furnishes the following information:— VACCINATION RETURN, 1930. Borough of Walthamstow. Births Registered. Successfully Unsusceptible. Exemptions. Vaccinated. Deaths before Vaccinated or exempted. 1,656 298 3 1,054 53 "A comprehensive Return cannot be furnished with regard to these registrations as a great number of children have not yet attained the age when Certificates of Vaccination or Statutory Declarations are due. In addition to the above 1,886 Primary Vaccinations and 1,802 Re-vaccinations have been recorded." 59 (B) SCARLET FEVER. The following table shows the incidence of this disease during the past five years:— SCARLET FEVER. Year. All ages. Under 1 1-5 5-15 15-25 25-45 45-65 65 & over. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. Percentage . Deaths (all cases). 1930 607 1 104 413 56 32 1 — 162 101 73 65 80 126 414 68.2 3 1929 688 4 113 428 95 41 6 1 150 125 71 78 105 159 466 67.4 5 1928 764 1 160 498 73 31 1 - 159 154 117 97 80 157 490 64.1 4 1927 623 5 128 391 72 24 3 - 81 88 138 87 81 148 454 72.8 4 1926 484 — 90 334 43 14 2 1 88 72 93 32 63 136 354 73.1 4 60 As will be seen from the above table, there were no outstanding features. The number of cases during 1930 was slightly below the five-year average (633), the age incidence was remarkably similar to that of previous years, while the ward distribution showed a relative increase in St. James' Street and Hoe Street Wards. The highest and lowest percentage admissions to Hospital differ only by 9 per cent. The figure for 1930 would have been higher but for the fact that a Scarlet Fever ward had to be allocated to Diphtheria during the autumn and so necessitating an increase in home-nursed cases. The number of fatal cases is relatively stationary, showing that the disease retains its mild character. In fact, the whole picture shows an equilibrium which one would expect to find with such a population as is met with in the Borough. The monthly incidence of the disease during 1930 was as follows:— Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. Total. St. James' Street 22 15 13 8 13 7 5 7 16 11 14 31 162 High Street 23 6 25 8 6 4 3 5 5 5 3 8 101 Hoe Street 9 7 14 5 6 5 2 2 1 9 3 10 73 Wood Street 5 6 8 6 7 5 6 2 8 2 6 4 65 Hale End 13 13 5 9 12 1 13 2 2 3 4 3 80 Higham Hill 17 12 10 11 5 12 7 5 5 7 14 21 126 Total 89 59 75 47 49 34 36 23 37 37 44 77 607 The death rate from Scarlet Fever during 1930 (per 1,000 living) was 0.02—a figure shared by five other large towns in the London "outer ring." The death-rate per 100 cases notified was 0.49. The use of Scarlet Fever antitoxin is referred to under the report dealing with the Sanatorium. Antitoxin was administered to several adult cases and most cases with a temperature of over 102°F. on admission. No use was made of Schick tests or of artificial immunisation. 61 (C) DIPHTHERIA. The incidence of Diphtheria during the past quinquennium was as follows:— DIPHTHERIA. Year. All ages. Under 1 1-5 5-15 15-25 25-45 45-65 65 & over. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. Percentage . Deaths (all cases). Deaths per 100 cases. 1930 509 4 113 322 41 26 3 — 118 93 89 50 60 99 436 85.7 20 3.9 1929 325 7 57 209 32 17 3 — 53 68 43 52 44 65 272 80.4 16 4.9 1928 283 3 56 172 35 12 5 — 62 30 49 47 35 60 229 80.9 8 2.8 1927 285 4 54 171 28 26 1 1 85 51 37 33 16 63 250 87.7 9 3.2 1926 262 1 66 165 14 12 4 — 110 30 35 23 24 40 234 89.3 5 1.9 62 The ominous feature of the above table is the steadily increasing incidence of this serious disease, and especially the increase in the two age groups, 1 to 5 and 5 to 15. The death-rates per 100 cases notified show that although there were more deaths than during 1929, the rate was actually 1 per cent. lower. The death-rate per 1,000 population was 0.16, which compares with a maximum figure of 0.20 amongst the "outer ring" towns. In spite of the increased incidence 85.7 per cent. of cases notified were removed to Hospital as compared with the previous maximum figure of 89.3 per cent. in 1926. In order to secure sufficient beds one of the wards at your Isolation Hospital usually used for Scarlet Fever patients was allocated to Diphtheria cases between September 18th and November 26th, when notifications reached their maximum, as shown by the following monthly incidence:— Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov Dec. Total. St. James' Street 9 9 14 5 4 6 13 5 20 12 10 11 118 High Street 17 6 8 5 2 9 4 3 14 11 8 6 93 Hoe Street 5 3 8 6 9 5 11 7 8 1 8 18 89 Wood Street 5 1 3 2 2 2 2 4 7 9 3 10 50 Hale End — 4 4 9 4 1 1 2 11 12 3 9 60 Higham Hill 13 4 4 9 13 5 10 6 13 11 5 6 99 Totals 49 27 41 36 34 28 41 27 73 56 37 60 509 Selwyn Avenue Infants' School yielded six cases in September and nine in October. Repeated visits were paid by your Medical Officer of Health. All the children were examined on several occasions and all suspicious throats and noses were swabbed. Six cases occurred in Apsley Road in September, but no connection could be found except that of "Street" contact. A total of 13 cases occurred during the year at Forest Hall—a voluntarily provided Children's Home—the incidence being March 1, April 6, May 3, October 2, and November 1. No use was made of the Dick test for Diphtheria susceptibility and no immunisation method was used. There can be no question that the only way to control the increase in Diphtheria incidence with the resultant loss of life is by providing immunisation for all children whose parents are sufficiently enlightened to seek the protection afforded thereby. 63 Antitoxin is available for free issue to Local Medical Practitioners at the Public Health Offices; at the Fire Station; and at 10, The Avenue, Highams Park. During the year 365 phials,representing 1,968,000 units, were thus issued. (D) ENTERIC FEVER. The incidence of the enteric fevers (Typhoid and Paratyphoid A and B) has continued to be minimal. The five-yearly incidence was:— Year. 1930. 1929. 1928. 1927. 1926 Number of Cases 5 2 2 6 4 Number removed to Hospital 5 1 1 5 3 Number of Deaths 1 — — 1 — Details of the 1930 cases are as follows:— Age. Sex. Suspected cause. Where treated. 25 M. Unknown Victoria Park Hospital. 26 F. ,, Connaught Hospital. 1½ M. ,, ,, ,, 27 F. ,, Prince of Wales Hospital 46 F. ?Shell fish at seaside Whipps Cross Hospital. The patient aged 1½years died from osteomyelitis and septicaemia. 64 (E) PNEUMONIA. The number of cases notified during the five year period was as follows:— Year. All ages. Under 1 1-5 5-15 15-25 25-45 45-65 65 & over. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill Removed to Hospital. Deaths. 1930 139 3 17 22 10 33 32 22 31 25 16 11 25 31 31 81 1929 222 11 29 26 36 47 50 23 58 46 24 18 31 45 67 121 1928 155 7 32 28 20 31 28 9 40 38 15 13 16 33 46 100 1927 172 3 27 34 25 48 27 8 47 29 12 18 26 40 61 131 1926 133 2 17 19 25 28 29 13 30 20 13 25 25 20 62 83 Totals Higham Hill Hale End Wood Street Hoe Street High Street St. James' Street The very large majority of the patients removed to Hospital were sent to Whipps Cross Hospital by the Practitioners in charge. The monthly incidence was as follows:— 17 3 4 1 2 4 3 Jan. 14 3 3 1 1 4 2 Feb. 18 2 7 2 1 2 4 Mar. 18 3 1 3 — 3 8 Apr. 9 3 2 — 4 — May . 10 6 1 — — 1 2 June . 9 2 2 — 1 1 3 July 3 — - 1 — 1 1 Aug. 5 — - — — 1 4 Sep. 10 1 - 2 4 1 2 Oct 15 6 3 — 1 4 1 . Nov. 11 2 2 1 2 3 1 , Dec 139 31 25 11 16 25 31 .Total. 65 Year. All ages. 15-25 25-45 45-65 St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. Deaths from (F) PUERPERAL FEVER AND PYREXIA. The following table shows the notifications of the past five years:— Puerperal Sepsis. Other Accidents and Diseases of Pregnancy, etc. 1930 22 5 17 — 3 2 4 5 3 5 20 6 3 1929 12 2 10 — 1 2 — — 2 7 11 1 6 1928 11 2 9 — 3 — 1 1 1 5 9 1 5 1927 21 8 13 — 5 7 4 2 1 2 14 3 4 1926 8 1 6 1 2 2 1 - 2 1 5 1 3 The combined figures for puerperal fever and pyrexia are the highest since "pyrexia" was first made notifiable in 1927 under the Puerperal Fever and Pyrexia Regulations. Further details of the 1930 cases are given on page 108 of the Maternity and Child Welfare Section of the report. 66 Year. All ages. Under 1 1-5 5-15 15-25 25-45 45-65 65 & over. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. (G) OPHTHALMIA NEONATORUM. (See page 109.) (H) ERYSIPELAS. 1930 57 2 — — 6 18 22 9 11 7 9 14 5 11 22 1929 51 1 1 4 3 12 21 9 10 8 13 3 5 12 15 1928 47 — — 3 3 16 21 4 7 5 7 6 12 10 15 1927 56 1 4 9 2 15 17 8 15 8 12 6 7 8 21 1926 57 - 2 2 9 18 19 7 15 10 12 6 4 10 22 The total incidence, ward distribution and number of cases admitted to Hospital are remarkably uniform. Cases are admitted either to Whipps Cross Hospital or General Hospitals under arrangements made by the patient's doctor. 67 The deaths do not, necessarily, refer to cases notified during the same year. Year. All ages. Under 1 1-5 5-15 15-25 25-45 45-65 65 & over. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. Deaths. (I) ENCEPHALITIS LETHARGICA. 1930 2 — — — 2 — — — — — — 1 — 1 1 3 1929 2 — — — 1 1 — — 1 — — — — 1 2 2 1928 4 — — — 3 1 — — — 1 1 — — 2 2 3 1927 1 - - - - - - - - - - - - 1 1 3 1926 11 - - 2 1 5 3 - 3 2 2 3 - 1 7 4 68 Year. All ages. Under 1 1-5 5-15 15-25 25-45 45-65 65 & over. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. (J) CEREBRO-SPINAL MENINGITIS. 1930 3 1 1 1 — — — — 2 1 — — — — 3 1929 2 2 - - - - - - 2 - - - - - 2 1928 1 — — 1 — — — — — 1 — — — — 1 1927 - - - - - - - - - - - - - - - 1926 1 1 - - - - - - - - - - - 1 1 69 All the 1930 cases were notified in April—two from Whipps Cross Hospital and one from St. Bartholomew's Hospital. (K) CHICKENPOX. Chickenpox first became notifiable during the week ending 22nd March, 1930, and the following table shows the monthly incidence by Wards:— Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. Total. St. James Street — — 21 24 42 21 8 14 6 10 6 22 174 High Street — — 18 41 34 19 8 3 6 6 2 12 149 Hoe Street — — 6 12 12 30 22 15 2 7 1 11 118 Wood Street — — 9 36 19 2 5 2 — 2 1 4 80 Hale End — — 24 16 7 1 4 10 6 — 3 7 78 Higham Hill — — 3 9 11 9 14 16 7 1 8 16 94 Totals — — 81 138 125 82 61 60 27 26 21 72 693 Apart from a few secondary cases in the same houses all cases of Chickenpox were visited by a member of the Medical Staff for verification of diagnosis and, as already detailed, five cases were found to be suffering from Smallpox and not Chickenpox. (L) MEASLES. Measles is not a notifiable disease in the Borough, but the incidence can be gauged by the following totals of school children reported by Head Teachers to be suffering from this disease. These notifications are made under the Education Committee's Regulations as to Infectious Diseases in Schools:— Year. No. of eases in school children. Maximum incidence. Deaths. Measles. S.F. Diph. Total Under 1 1-2 2-5 5-15 1930 1,583 Feb./April 28 12 12 4 3 20 1929 851 Mar./May 1 1 — - - 5 16 1928 2,010 Feb./May 17 1 11 4 1 4 8 1927 49 April 1 — — 1 — 4 11 1926 1,148 Mar./April 4 2 — 1 1 4 5 Total 5,641 51 4 23 18 6 20 60 70 The deaths for the five years have been given to try to focus attention on the extreme seriousness of this disease—a fact which most parents utterly fail to appreciate. It will be seen from the above table that Measles caused 52 deaths during the quinquennium as compared with 60 from Diphtheria and 20 from Scarlet Fever. During the five years 1921-1925 there were 61 deaths from Measles as compared with only 15 from Scarlet Fever and 55 from Diphtheria. Unfortunately, the general experience is that Measles defies every method of control so far tried, and in view of the higher mortality during the pre-school period the aim should be to postpone the attack as long as possible. In most homes not the faintest attempt is usually made to isolate cases of Measles. Unfortunately, Hospital accommodation is not at present available for cases of Measles. (M) WHOOPING COUGH. This disease is also not notifiable and the quinquennial incidence as shown by school returns is given below—also to emphasise the seriousness of this disease. Deaths from Scarlet Fever and Diphtheria are again given for purposes of comparison, and all the remarks made in respect of Measles apply equally forcibly to Whooping Cough:— Year. No. of cases in School Children. Maximum incidence. Deaths. Whooping Cough S.F. Diph. Total. Under 1 1-2 2-5 5-15 1930 89 November 2 - - - - 3 20 1929 851 April/June 17 6 ? ? ? 5 16 1928 163 Nov./Dec. 5 2 1 — 2 4 8 1927 460 January 18 9 4 5 — 4 11 1926 343 Nov./Dec. 9 4 2 3 — 4 5 Total 1,906 51 20 60 During 1921-1925 the total deaths from Whooping Cough were 93, as against 15 from Scarlet Fever and 55 from Diphtheria. 71 (N) TUBERCULOSIS. The table given below shows particulars of new cases of Tuberculosis and of all deaths from the disease in the Borough during 1930:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary. m f m f m f m f Under 1 yr. — — — - - - 1 — 1— 5 yrs. — - — 4 1 — — - 5—10 yrs. 1 1 2 6 1 1 — - 10-—15 yrs- — 1 2 2 1 — 1 - 15—20 yrs. 7 5 3 1 8 2 — 1 20—25 yrs. 10 11 6 1 6 3 — - 25—35 yrs. 17 15 5 1 13 8 — 1 35—45 yrs. 17 16 — — 12 6 2 - 45—55 yrs. 12 1 — 1 10 — — - 55—65 yrs. 7 2 — — 8 1 — - 65 yrs. and upwards 1 1 - - 2 - - - Totals 72 53 18 16 61 21 4 2 125 34 83 6 159 89 The 89 deaths represent a death-rate of 0.71 per 1,000 population. The returns of the quinquennium are summarised below:— New Cases. Total. Deaths. Total Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. m. f. m. f. m. f. m. f. 1930 72 53 18 16 159 62 21 4 2 89 1929 85 57 26 26 194 59 40 12 7 118 1928 75 64 15 21 175 57 37 8 7 109 1927 82 68 15 27 192 52 42 8 6 108 1926 79 76 29 26 210 55 42 12 6 115 The number of new male pulmonary cases remained fairly constant during the quinquennium, while the new female cases showed a steady decrease. Deaths of male and female pulmonary cases showed similar features. The total number of new cases of all forms of Tuberculosis was lowest in 1930, as was the total number of deaths. 72 Year. Under 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. Over 12 months. Not Notified. Notified after death. Total. Percentage dead within 6 months of Notification. The periods elapsing between notification and death, and the number of cases not notified were as follows:— Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 1930 19 1 8 — 4 — 9 — 31 — 8 4 4 1 89 50.6 1929 17 7 7 1 12 - 8 1 41 1 12 8 2 1 118 47.5 1928 19 1 11 — 6 - 2 — 39 1 16 9 1 4 109 56.0 1927 12 2 12 2 3 1 5 — 38 1 21 7 3 1 108 55.5 1926 17 4 10 - 8 1 8 - 41 2 11 10 2 1 115 47.8 The efficiency of notification as judged by the percentage dying within six months of notification remains practically unaltered, but the total not notified or not notified until after death, showed a welcome decrease during 1930. 73 The table given below shows the number of cases on the Register at the beginning and end of 1930. No. on Register Pulmonary. Total. NonPulmonary. Total. Grand Total. m. f. m . f. 1st January 907 814 1,721 436 435 871 2,592 Notified during 1930 72 53 125 18 16 34 159 Total 979 867 1,846 454 451 905 2,751 Removed from Register, 1930 74 42 116 7 9 16 132 No. on Register 31st December 905 825 1,730 447 442 889 2,619 The 132 removals from the Register during 1930 are made up as follows:— Deaths. Removals. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary . m. f. m. f. m . f. m. f. 51 21 1 1 23 21 6 8 72 2 44 14 74 132. 58 The discrepancy between the number of deaths recorded here and the number of registered deaths during the calendar year is accounted for by transferable deaths and by cases not notified prior to death. Treatment of Tuberculosis.—Treatment is given under the Essex County Council's scheme. The admissions to Hospital during the last five years were:— Pulmonary. Non-Pulmonary. Total. m. f. m. f. 1930 67 51 11 17 146 1929 70 50 11 19 150 1928 88 60 14 12 174 1927 78 50 15 23 166 1926 73 63 17 18 171 No action was necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, and Section 62 of the Public Health Act, 1925. 74 Prevention of Blindness.—No action was necessary under Section 66 of the Public Health Amendment Act, 1925, for the prevention of blindness or for the treatment of persons suffering from any disease of or injury to the eyes. INFECTIOUS DISEASES HOSPITAL Situation and Accommodation.—The Borough Infectious Diseases Hospital—more popularly known as the Sanatorium—is situated in Chingford. The following particulars are extracted from returns made to the Essex County Council under Section 63 of the Local Government Act, 1929, in respect of the Isolation and Smallpox Hospitals:— The following particulars are extracted from returns made to the Essex County Council under Section 63 of the Local Government Act, 1929, in respect of the Isolation and Smallpox Hospitals:— Name of Hospital Walthamstow Isolation Hospital Walthamstow Smallpox Hospital. Where situated Larks Hall Road, Chingford Low Hall Farm, Walthamstow. Area of site in acres 19.47 2. Room on site for extension Yes Yes. Water Supply Public Public. Sewage Disposal Main Drainage System "Elsan" Closets. Heating Open fires and lowpressure hot water. Coke stoves and electricity. Lighting Electricity Electricity. No. of separate Buildings 10 (a) Administration Block (b) 4 large Huts, 7 small Huts and bathrooms. Materials Brick (a) Brick; (b) Wood. Total No. of Blocks 5 — ,, ,, Wards 10 4 large Huts, 4 small Huts. ,, ,, Beds at 144 sq . feet 75 19 Discharge Blocks Cubicle Block Two-bed Hut. Diseases treated Scarlet Fever, Diphtheria, Enteric Smallpox. Accommodation for Nursing Staff 28 6 Accommodation for Domestic Staff 18 2 Provision of Laundry Yes—Power No. Provision of Disinfecting Apparatus Yes. Yes. Ambulances Two One. Mortuary Yes No. Porter's Lodge Yes No. Resident Medical Officer Yes No. 75 It will be seen that the number of beds available on a basis of 144 square feet per bed is 75, while the usual provision is at the rate of one bed per 1,000 population, which would mean a total of 125 beds. In practice extra beds have to be used in each ward as occasion arises. The Hospital is well situated, designed, constructed and equipped, and no buildings of a temporary nature are used except in the Tuberculosis section, which consists of a permanent Pavilion of 14 beds and 6 single-bed wooden huts. The 20 Tuberculosis beds are additional to the 75 Infectious Disease beds and are utilised by the Essex County Council by agreement with your Council. The Tuberculosis section is under the clinical charge of a Tuberculosis Officer of the County Council. Female non-pulmonary cases were taken up to the 3rd July, 1930, and after that date advanced female cases of Pulmonary Tuberculosis. The Staff consists of a Resident Medical Officer, Matron, 6 Sisters, (State Registered and Fever trained), 7 Staff Nurses (Fever trained), and 16 Probationers; Storekeeper, Cook, 17 Maids, 4 Laundresses, 1 Needlewoman, 4 Charwomen and 8 male outdoor staff. The Hospital is recognised for Fever training and a two-year course of lectures and practical work is carried out under the Resident Medical Officer, Matron and Sister-Tutor. Improvements, etc.—No enlargement of accommodation has teen effected during the last five years, but the addition of a new wing to the Administrative Block was commenced in April, 1931. The estimated cost is £9,669, which will provide 24 extra bedrooms and other much-needed Staff accommodation. The completion of the new wing will liberate two small wards now used for Staff bedrooms and so provide 10 additional beds. Your Council have also approved a proposal to erect a 12-bed cubicle block as soon as the work now in hand is completed, and this will be a valuable addition to the present excellent Cubicle Block, which is, however, insufficient for present-day needs. During 1930 many improvements were effected, including the following:—Repainting "B" Block, installation of gas supply in place of the former production of "Dowsing" gas at the Hospital, installation of gas cookers, fires and automatic hot-water boilers in each ward. Quinquennial Review.—The following tables review (a) the Admissions, Discharges and Deaths; (b) Average number of patients in Hospital by months; (c) Monthly admission of Diphtheria and (d) Scarlet Fever. 76 TABLE A. Admissions, Discharges and Deaths, 1926—1930. 1930. 1929. 1928. 1927. 1926. Scarlet Fever. 1 Diphtheria. Other Diseases. Tuberculosis. Totals. Scarlet Fever. Diphtheria. Other Diseases. Tuberculosis. Totals. Scarlet Fever. Diphtheria. Other Diseases. Tuberculosis. t Totals. Scarlet Fever. Diphtheria. j Other Diseases. Tuberculosis. Totals. Scarlet Fever. Diphtheria. Other Diseases. Tuberculosis. j Totals. Remaining in Hospital 1st January 58 49 9 20 136 61 56 1 20 138 64 34 - 19 117 57 25 - 12 94 36 15 1 14 66 Admitted during year 434 468 12 65 979 478 288 18 35 819 514 239 10 43 806 473 260 5 58 796 384 221 9 47 661 Discharged during year 429 443 15 63 950 479 285 7 34 805 516 210 7 41 774 460 244 4 51 759 359 206 10 44 619 Died during year 2 22 — 2 26 — 11 4 1 16 1 7 2 1 11 6 7 1 — 14 4 5 — 5 14 Remaining in Hospital 31st December 61 53 5 20 139 60 48 8 20 136 61 56 1 20 138 64 34 — 19 117 57 25 — 12 94 77 The noteworthy features of the foregoing table are the increased admissions during 1930, which were 979 against the previous highest total of 819, and the greater number of deaths due entirely to the severe incidence of Diphtheria—468 cases being admitted against 288 in 1929. TABLE B. Daily Average Number of Patients in Hospital. Year. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Average whole year. 1930 137.2 149.2 147.1 144.6 120.4 113.4 116.4 104.0 101.9 125.9 133.3 131.7 127.1 1929 150.2 144.3 140.2 140.1 118.3 99.2 79.2 81.7 87.9 135.5 146.2 143.2 122.2 1928 115.9 109.2 103.7 96.9 91.4 81.1 86.6 95.3 106.6 125.2 138.8 150.3 108.2 1927 91 105 113 109 106 108 109 94 91 105 107 111 104 1926 55 66.4 62.5 59.8 64.3 59.8 66.4 71.4 86.2 90.9 96.8 80.2 71.8 The figures for 1928-1930 include Tuberculosis patients. As a rule the Tuberculosis beds are fully occupied, and were increased from 14 to 20 on 3rd March, 1927. 78 TABLE C. MONTHLY ADMISSIONS OF DIPHTHERIA CASES. Year. Jan. Feb. Mar. Apl. May Jne. Jly. Aug. Sep. Oct. Nov. Dec. Total. Average Whole Year. 1930 43 29 43 31 33 25 39 26 67 53 40 39 468 39 1929 27 29 21 22 28 13 17 14 18 45 33 21 288 24 1928 24 20 17 13 17 9 7 10 18 35 43 26 239 20 1927 19 23 19 19 20 24 22 23 28 24 20 19 260 21.7 1926 30 20 21 20 19 7 10 22 11 37 6 18 221 18.4 The admissions during the last four months of 1930 are the highest recorded. A Scarlet Fever Ward was allocated to Diphtheria cases between 18th September, 1930, to 26th November, 1930. TABLE D. MONTHLY ADMISSIONS OF SCARLET FEVER CASES. Year. Jan. Feb. Mar. Apl. May . Jne. Jly. Aug. Sept . Oct. Nov. Dec. Total. Average Whole Year. 1930 61 36 54 35 33 30 22 20 26 25 42 50 434 36.1 1929 53 35 48 31 21 31 33 27 48 62 49 40 478 40.0 1928 44 26 46 39 25 32 54 39 54 53 63 39 514 42.9 1927 44 37 44 38 43 40 43 27 35 49 35 38 473 39.4 1926 17 25 27 23 26 31 37 34 47 44 37 36 384 32 Dr. Mary Hamilton assumed duty as Resident Medical Officer in June, 1930, in succession to Dr. May McGloughlin. Dr. Hamilton contributes the following report on the work of the Sanatorium during 1930:— AGES AND SEX OF PATIENTS ADMITTED DURING 1930. Disease. Under 5 years. 5 to 10 years. 10 to 15 years. Over 15 years. Total. Total. m. f. m . f. m. f. m. f. m. f. Scarlet Fever 34 40 108 119 34 33 31 35 207 227 434 Diphtheria 64 53 109 116 30 35 20 41 223 245 468 Pulmonary T.B. — — — — — — — 57 — 57 57 Non-Pulmonary T.B. - - - - - - - 8 — 8 8 Measles & Diphtheria 1 1 - - - - - - 1 1 2 Broncho-pneumonia following Measles 1 - - - - - - - 1 1 Measles & pneumonia - 1 - 1 - - - - - 2 2 Broncho-pneumonia, Measles & Diphtheria - 1 - - - - - - - 1 1 Scarlet Fever & Diphtheria 1 - - - - 1 - - 1 1 2 Diphtheria&Chicken pox 1 1 - - - - - - 1 1 2 Chickenpox — 1 — 1 — — — — — 2 2 Totals 101 99 217 237 64 69 51 141 433 546 979 79 AGE AND SEX AT DEATH. Under 5 years. 5-10 years. 10-15 years. Over 15 years. Total. Total. m. f. m. f. m. f. m. f. m. f. Diphtheria 6 5 2 4 - 1 — — 8 10 18 Diphtheria, Measles & Pneumonia 2 2 - - - - - - 2 2 4 Scarlet Fever & Endocarditis - - - - - - - 1 - 1 1 Scarlet Fever & Measles - - - 1 - - - - - 1 1 Tuberculosis - - - - - - - 2 — 2 2 Totals 8 7 2 5 - 1 — 3 10 16 26 The deaths occurred after the following periods in Hospital:— Diphtheria, under 24 hours, 5; 24-48 hours, 2; 2-7 days, 4; 1-2 weeks, 3; 4-5 weeks, 1; 5-6 weeks, 2; 6-7 weeks, 1. Diphtheria, Measles and Pneumonia—one each at 1 \ hours, 5, 8, and 10 days. Scarlet Fever—One each at 10 and 17 days. MONTHLY ADMISSIONS OF DIPHTHERIA CASES. Under 5 years. 5 to 10 years. 10 to 15 years. Over 15 years. Total. m f m f m f m f January 4 6 12 8 2 5 1 5 43 February 4 2 5 11 1 2 1 3 29 March 9 8 7 10 1 3 - 6 43 April 9 — 7 5 2 5 1 2 31 May 5 3 5 9 2 3 1 5 33 June 2 2 5 8 2 2 2 2 25 July 4 5 13 13 1 — — 3 39 August 6 2 3 6 1 5 2 1 26 September 12 10 16 15 2 3 4 5 67 October 2 7 15 13 7 3 1 5 53 November 5 3 11 7 9 3 1 1 40 December 2 5 10 11 — 1 6 4 39 Totals 64 53 109 116 30 35 20 41 468 Twenty-two deaths occurred as a result of Diphtheria giving a case mortality of 4.7 per cent. Many very severe and apparently hopeless cases made good recoveries. Of the 22 fatal cases, four were complicated by Measles and Pneumonia. Seventeen cases of Laryngeal Diphtheria were admitted and six died. Tracheotomy was performed in one case but without avail. Four cases of spasmodic croup were admitted. One hundred and fifty-two cases were classified as "severe," 167 as "mild," and 149 as "bacteriological." One very severe case of "hæmorrhagic Diphtheria" was admitted and died within 24 hours of admission. 80 Complications.—Cardiac Paralysis, 12, three being cases of "late Cardiac Paralysis" occurring in the seventh week of the illness and were in all instances fatal. Other types of paralysis, 39. Two cases of Otorrhoea occurred in cases of Diphtheria with Measles. Acute infective Jaundice, 3. In two instances the condition was present on admission; in the third the patient developed the condition a month after admission. One patient was sent to Whipps Cross Hospital with acute Osteomyelitis of the lower end of the humerus. A girl, aged six years, admitted as a mild case of Diphtheria, died of acute Miliary Tuberculosis after eight days in Hospital. One case admitted as Diphtheria showed nasal and ear discharge from the same side and apparent facial paralysis of that side. A consultant was called in to see the case and a foreign body (a plug of newspaper) was removed from the nostril of the affected side. Non-specific inflammation of tonsils occurred in 24 cases. MONTHLY ADMISSIONS OF SCARLET FEVER CASES. Under 5 years. 5 to 10 years. 10 to ]5 years. Over 15 years. Total. M F M F M F M F January 6 5 15 17 8 4 2 4 61 February 4 1 8 12 3 3 2 3 36 March 4 3 10 16 4 2 7 8 54 April 4 1 10 9 2 3 4 2 35 May 4 5 8 6 2 1 3 5 33 June 2 8 7 4 3 2 3 1 30 July — 1 5 12 1 1 — 2 22 August 2 4 7 5 1 - 1 — 20 September — 3 6 8 — 4 — 5 26 October 2 5 6 8 1 1 — 2 25 November 3 2 12 12 4 4 3 2 42 December 3 2 14 11 5 8 6 1 50 Totals 34 40 108 119 34 33 31 35 434 In only one case could death be ascribed to a condition which was the direct outcome of Scarlet Fever. The patient, a girl of 15 years, died from the impaction of an embolus following scarlatinal endocarditis. Complications.—Otitis, 60; Otorrhoea, 52; Empyæma, 1; Retro-pharyngeal abscess, 1; Rheumatism—Acute 1, transient 12, Nephritis 2, Suppurative adenitis 14 (some degree of cervical adenitis was present in practically all cases); Endocarditis, 1; Purulent rhinitis, 20 (streptococcal 16, diphtheritic 4); Broncho-pneumonia, 10; Paralysis of left side of face and left leg, 1. This child, in the acute stage, appeared mentally defective, but the mental condition later was quite normal. 81 Twelve cases were found to be suffering from Diphtheria and Scarlatina, though notified as Scarlet Fever only. In eight cases the diagnosis of Scarlet Fever was not confirmed. One patient, admitted with a septic foot, developed phlebitis of the internal saphenous vein, with secondary abscess in calf of leg, but made a good recovery. Three cases were transferred to Whipps Cross Hospital for operative treatment, viz., mastoid disease, empyæma and retro-pharyngeal abscess. Staff.—Members of the Staff were warded during 1930 for the following complaints:—Tonsillitis, 6; Scarlet Fever, 2; Rheumatism and Tonsillitis, 1; Rheumatism, 2. Swabs.—2,854 swabs were taken and examined during the year in the laboratory at the Hospital. Operations at Hospital.—Tonsillectomy, Tracheotomy, one each. Cross Infection.—40 cases were transferred from Diphtheria wards to the Cubicle Block with scarlatiniform rashes, and in 15 cases the diagnosis of Scarlet Fever was confirmed. Four cases were removed from Scarlet Fever wards to the Cubicle Block, diphtheritic infection being present in nose or throat. Owing to the exceedingly transient character of many Scarlet Fever rashes and the absence of other concomitants of the disease, many cases escape detection and a certain amount of cross-infection is inevitable. Number of Outside Authorities' Cases and Nature.— Diphtheria. Scarlet Fever. Total. From Whipps Cross Hospital 10 — 10 ,, Epping U.D.C. 12 13 25 ,, Loughton U.D.C. 4 3 7 Total 26 16 42 Use of Antitoxin in Scarlet Fever.—Serum in the great majority of cases cuts short pyrexia, malaise and rash, shortens convalescence, and when given early reduces the occurrence of complications. In a small percentage of cases the effect is dramatic and one may then infer that the antitoxin had been prepared from a similar strain of scarlatinal streptococcus to that with which the patient has been infected. The dosage was a single intramuscular injection of 10c.es. In three cases there was local reaction, two cases only amounting to induration and redness at the site of injection. In the third case an abscess formed, but this was in a very septic case. One case of typical serum sickness occurred." Duration of Treatment.—The average duration of treatment in Hospital was as follows:— Diphtheria, 47.1 days. Scarlet Fever, 42.2 days. Mixed infections, 44.8 days. 82 Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.). In Hospital on 1st January, 1930. Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1930. The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1930:- T.B. Minus — 10 5 2 3 T.B. Plus Group I — 7 3 — 4 T.B. Plus Group II 7 31 27 — 11 T.B. Plus Group III — 6 4 — 2 Bones 8 6 14 — — Abdominal 3 — 3 — — Glands — 2 2 — - T.B. Minus (Mixed infection) 1 1 2 — — T.B. Plus (Mixed infection) 1 2 3 — — Totals 20 65 63 2 20 MATERNITY AND CHILD WELFARE. 84 MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Alderman Mrs. C. McEntee, J. P. Ex-Officio: His Worship The Mayor—Councillor V. L. McEntee, J.P., M.P. The Deputy Mayor—Councillor W. H. Morris. The late Alderman W. J. McGuffie, J. P. (Chairmen Finance Councillor Ross Wyld Committee). Alderman H. Frost, J. P. Councillor B. Cole. ,, G. Gibbons. ,, P. Friedberg. ,, J. C. Hammond. ,, W. J. Green. ,, Mrs. M. Norrish. ,, Miss B. A. ,, D. J. Quinn Henderson. ,, W. H. Shaw. ,, A. S. LeMare, ,, T. W. Smith. B.A. ,, A. J. Wye. ,, F. Watts. Councillor E. R. Wood. Co-opted Members: Mrs. C. Camp. Mrs. W. H. Kindell. Mrs. V. Cossey. Mrs. J. H. Lester, E.C.C. Mrs. M. A. Cross. Councillor Mrs. E. M. Mrs. I. M. Jackson. Richards. Mr. W. H. Kindell. Mrs. W. F. Toynbee. 85 STAFF. Medical Officer of Health and Administrative Maternity and Child Welfare Officer: J. J. Clarke, J.P., L.R.C.P., D.P,H. (to 3-4-30). D. Broderick, M.B., B.Ch., B.A. 0., D.P.H., Barrister-at-Law (from 4-4-30 to 30-6-30). A. T. W. Powell, M.C., M.B., B.S., D.P.H. (from 1-7-30). Medical Officers: Miss Mary C. Sheppard, B.A., M.B., B.Ch., B.A.O., D.P.H. Miss Mary C. Clarke, M.B., B.Ch., B.A.O. (for Relief Duty). Health Visitors: Miss A. C. Keenan, S.R.N., C.M.B., H.V. Cert. (Superintendent). Miss M. B. Cassidy, S.R.N., C.M.B., H.V. Cert. (from 11-8-30). Miss C. R. Douglas, S.R.N., C.M.B., H.V. Cert. (from 13-1-30). Miss G. Hill, S.R.N., C.M.B., H.V. Cert. (to 8-5-30). Mrs. J. Morris S.R.N., C.M.B. (from 26-4-30 to 29-8-30). Miss M. Page, S.R.N., C.M.B., H.V. Cert. (from 5-8-30). Miss O. J. Panther, Cert. S.I.E.B. (Lond.) (Half-time). Masseuse (Part-time): Miss Kathleen M. Hill, C. S.M.M.G. Record Clerk: Miss F. A. Richards. 86 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen, I beg to present herewith a report on the Maternity and Child Welfare work carried out during 1930. In this "Survey" Report I have endeavoured to do justice to the very complete scheme which Dr. Clarke has evolved and which has helped to establish a new low record in Infant Mortality during 1930. The only extension of service during 1930 was the assumption of duties under Part I of the Children Act, 1908, with effect from the 1st April. Unfortunately the erection of the Maternity Home is still unavoidably delayed, but its ultimate completion together with the proposed provision of clinics in the Higham Hill and Hale End areas will be of great value. I gratefully acknowledge the co-operation I have received from your Committee and the Staff, and would endorse Dr. Sheppard's thanks to the splendid work of the Voluntary helpers at the Municipal Clinic. I have the honour to be Your obedient servant, A. T. W. POWELL, Medical Officer of Health, etc. 1. NOTIFICATION OF BIRTHS. One thousand seven hundred and seventeen births were notified during the year under the Notification of Births Acts, 1907 and 1915, as follows:— Doctors, 956. Midwives, 733. Parents, etc., 28. Included in the above are 306 births which were notified as having occurred outside the Borough. In addition 33 stillbirths were notified, two of which did not belong to the Area. Of the remaining 31, 22 were notified by Doctors and 9 by Midwives. Of the total 11 occurred outside the Area. The stillbirth rate per 1,000 population was the same as for 1929, viz., 0.54. 87 2. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Males. Females. Total. Legitimate 978 936 1,914 Illegitimate 23 22 45 Total 1,001 958 1,959 (b) Stillbirths. Males. Females. Total. Legitimate 33 34 67 Illegitimate 1 1 2 Total 34 35 69 Of 1,679 birth registrations received in the Department between 29th December, 1929, and 27th December, 1930, a total of 388 were not notified in this Area, but some may possibly have been notified elsewhere, especially in view of the fact that of the 1,679 registrations, 111 referred to births which belonged to other areas. In addition it will be seen that the Registrar-General's figure (1,959) is 280 more than the local registrations. Presumably these were births registered and possibly notified in other areas. Again, since registrations can be effected up to six weeks after birth, whilst notification should be carried out within 36 hours, it is quite obvious that it is impossible to estimate the number of failures to notify. It is clear that failure to notify is frequent, but in view of the unsatisfactory wording of the Notification of Births Act your Committee did not take legal action. Circulars were sent out during the year to all Doctors and Midwives practising in the area drawing their attention to the provisions of the Act. The early visiting of newly-born infants by the Health Visitors is entirely dependent upon efficient notification. 88 Births Registered Locally, 1930. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals. Of the 1,679 local registrations 111 are excluded, leaving a net total of 1,568, which, are allocated to wards as follows:— m. F. m. F. m. f. m. f. m. f. m. f. m. f. January 15 9 11 14 12 13 15 10 7 6 22 15 82 67 February 13 3 8 13 11 10 10 6 9 9 12 15 63 56 March 14 9 14 9 13 8 10 12 8 14 11 19 70 71 April 15 17 12 14 16 12 13 14 14 9 25 12 95 78 May 14 3 9 5 10 6 13 8 13 12 16 11 75 45 June 12 16 6 7 14 10 8 7 7 16 13 13 60 69 July 18 10 8 9 12 16 10 9 14 16 10 12 72 72 August 16 12 7 8 3 11 6 13 8 14 11 10 51 68 September 9 11 7 6 12 8 7 12 11 5 13 9 59 51 October 7 12 11 7 10 9 7 10 13 11 15 18 63 67 November 6 6 8 7 4 10 4 6 11 6 6 5 39 40 December 15 14 14 11 12 9 8 8 14 16 16 18 79 76 Totals 154 122 115 110 129 122 111 115 129 134 170 157 808 760 Grand Totals 276 225 251 226 263 327 1,568 89 3. INFANT MORTALITY. The deaths of infants under one year of age were:— Males. Females. Totals. Legitimate 42 34 76 Illegitimate 1 1 2 Total 43 35 78 The death-rates of infants under one year of age per 1,000 live births when calculated on the totals given by the Registrar-General in paragraph 2 are therefore:— Legitimate, 39. Illegitimate, 44. Total, 39. The rates during the quinquennium have been as follows:— Legitimate. Illegitimate. Total 1930 39 44 39 1929 54 84 53 1928 49 93 51 1927 49 222 52 1926 42 122 45 Thus 1930 has established a new low record, and another pleasing feature is the remarkably low illegitimate Infant Mortality rate, showing that during 1930, at any rate, these unfortunate children were as well cared for as their legitimate contemporaries. It is a matter of regret that in view of the difficulty of reconciling the Registrar-General's figure with locally registered and notified births it is not possible to give accurate Birth and Infant Mortality rates by wards. The following table shows the causes of death of children under one year of age during 1930:— 90 SUMMARY, 1930. Causes of Death of Children under 1 year of age. Cause of Death. Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3 Months and under 6 Months 6 Months and under 9 Months 9 Months and under 12 Months Total Deaths under One Year. Wards . St. James Street High Street Hoe Street J Wood Street Hale End j Higham Hill Influenza - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - — - Chickenpox - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - 1 1 - — 1 — — - Abdominal Tuberculosis (b) - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - — 1 1 1 - - - - - Convulsions 2 - - 1 3 — 1 — 1 5 2 i — — 2 - Laryngitis - - - - - - - - - - - - - - - - Bronchitis — - - - — 1 — 1 — 2 1 — 1 — — - Pneumonia (all forme) — - - 1 1 4 3 1 4 13 3 2 3 3 1 1 Diarrhœa - - - - - - - - - - - - - - - - Enteritis - - - - - 1 4 — — 5 1 2 — 1 1 - Gastritis - - - - - 1 - - - 1 - - 1 - - - Syphilis - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - Inattention at Birth, wilful neglect .. - - - - - - - - - - - - - - - - Suffocation, overlaying - - - - - - - - - - - - - - - - Injury at Birth - - - - - - - - - - - - - - - - Atelectasis 1 - - - 1 — — — — 1 1 - - - - - Congenital Malformations - - - - - - - - - - - - - - - - Premature Birth 20 - - - 20 — — — — 20 4 4 2 5 4 1 Atrophy, Debility and Marasmus 1 1 1 1 4 5 2 — 1 12 2 1 2 3 2 2 Inanition 4 1 1 - 6 — — — — 6 1 1 1 — 3 — Heart Failure 3 - - - 3 1 — — — 4 1 — — — 1 2 Other Causes 2 1 - - 3 2 2 — — 7 — 1 2 2 — 2 Totals 33 3 2 3 41 15 12 2 8 78 17 12 13 14 14 8 Of the 78 infants dying under one year of age, only 9 attended the Welfare Centres—4 attending the Municipal Centre and 5 the Voluntary Centre. The total infant deaths by main causes for the past five years were as follows:— 91 Year. Influenza. Measles. Scarlet Fever. Whooping Cough. Tuberculous Meningitis. Other T.B. Diseases. Meningitis. Convulsions. Bronchitis. Pneumonia. Diarrhoea and Enteritis. Gastritis. Syphilis. Inattention at Birth— Wilful Neglect. Suffocation by Overlaying. Injury at Birth. Atelectasis. Congenital Malformation. Premature Birth. Atrophy, Debility and Marasmus. Inanition. Heart Failure. Other Causes. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. 1930 - - - - 1 - 1 5 2 13 5 1 — - — — 1 — 12 20 6 4 7 17 12 13 14 14 8 78 1929 1 - - 6 2 — 2 — 6 27 9 1 — — 3 2 3 2 12 13 2 — 9 25 14 16 13 14 18 100 1928 — 1 - 2 3 - 4 8 10 25 7 — — — 4 3 3 4 4 15 — 3 6 20 13 15 16 21 17 102 1927 2 — 1 9 4 3 3 4 3 17 3 — 1 — 2 — 2 7 12 28 — — 6 17 20 26 14 14 16 107 1926 — 2 — 4 1 — 1 5 6 9 15 — — 1 2 — 3 10 10 20 — — 11 16 16 15 17 9 27 100 Total 3 3 1 21 11 3 11 22 27 91 39 2 1 1 11 5 12 23 50 96 8 7 39 95 75 85 74 72 86 487 92 The chief causes of infant death will be seen to be due to Premature Birth, Bronchitis and Pneumonia, and Atrophy, Debility and Marasmus. During 1930, eight deaths of children under two years were registered from Diarrhoea and Enteritis, giving a rate of 4.0 per 1,000 live births. The previous figures were: 1929, 4.6; 1928, 7.5; 1927, 1.4; 1926, 8.0. 4. MATERNITY AND CHILD WELFARE. The Scheme in your Borough comprises the Municipal services and those provided by the Walthamstow Child Welfare Society, a Voluntary Association, to which your Council pay an annual grant of £644 1s. 8d. The work done under each agency will be discussed separately below, although there is no demarcation of the areas served. A certain amount of overlapping ensues, but this is reduced to a minimum following the first visit paid by the Municipal Health Visitor to all notified births. If, at this visit, it is found that the infant either has been or will be taken to the Voluntary Centre, the birth enquiry card is endorsed to this effect and only an occasional visit is paid thereafter to see that the child is attending. (a) Municipal Scheme.—The normal staff of Health Visitors is five, one of whom devotes approximately half-time to the supervision of outworkers under the Factory and Workshops Acts. The resignations and new appointments have been detailed previously. Your Council also have an arrangement with the Woodford Urban District Council, under which, for a payment of £20 per annum, their Health Visitor carries out the necessary visiting in the Woodford portion of your area. In addition, one of your Visitors carries out supervisory visits. Dr. R. A. Vere Hodge, Medical Officer of Health, kindly states that the Woodford Nurse paid the following visits during 1930:— Children under 1 year, 118; Children 1 to 5 years, 52. Total, 170. 93 Initial visits are paid as soon as possible after the Doctor and Midwife have ceased attending—usually about the tenth day. Children who progress favourably are, as far as possible, visited once a quarter during the first year of life and half-yearly afterwards until attaining the age of five. Infants and children who do not progress favourably are visited as frequently as possible, the maximum number of visits paid to any one child during 1930 being 15. In addition, visits in connection with the following matters are also carried out:—Supervision of Nurse Children (since 1-4-30), enquiries in connection with applications under the Assisted Milk Scheme, ante-natal work, ophthalmia neonatorum, puerperal fever and pyrexia, provision of home helps and enquiries as to Maternal Deaths, Stillbirths, and Neo-natal deaths. The detailed findings at first visits paid during 1930 are given in the following table:— 94 Ward. How Fed. Kind of Food. Sleeping Accommodation. Condition of Baby. Accommodation. Breast. Breast and Hand. Hand. Cow's Milk. Patent Foods. j Condensed Milk. With Mother. Cot or Cradle. Good. Fair. Bad. Whole House. Flat. j Half-house. 3 Rooms. 2 Booms. 3 Room. St. James Street 280 22 74 21 54 21 54 322 320 41 15 106 21 84 12 108 45 High Street 227 15 42 10 22 25 73 211 240 38 6 43 72 50 32 58 29 Hoe Street 240 19 56 30 28 17 40 275 276 32 7 78 12 129 11 68 17 Wood Street 188 15 38 22 17 14 57 184 224 14 3 69 — 79 7 59 27 Hale End 254 13 57 31 25 14 56 268 277 43 4 129 3 51 51 64 26 Higham Hill 355 12 54 28 23 15 86 335 371 47 3 187 105 38 21 46 24 Total 1,544 96 321 142 169 106 366 1,595 1,708 215 38 612 213 431 134 403 168 From the above table it will be seen that of 1,961 children, 1,544 or 78.7 per cent., were breast-fed on first being visited, but 366, or 18.7 had no separate sleeping accommodation. The particulars in respect of Housing accommodation are exceptionally interesting in view of the assessment required for the purposes of the Housing Act, and show that only 31.2 per cent. of the families visited had a house to themselves, while 8.6 per cent. of families were living in one room. One very satisfactory Feature is that 1,961 first visits were paid and, when compared with the 1,959 birth registrations given by the Registrar-General, show that practically every new-born infant must have been visited. A less satisfactory feature is that only 2,096 re-visits were paid to children under one year of age, whereas if quarterly visits had been possible this should have been higher, although an accurate estimate cannot be given because no separate figures are available of visits paid to children under one year of age by the Brookscroft Health Visitor. The need for additional Health Visitors is thus apparent. 95 The following table shows the number and nature of visits paid by wards during 1930:— Visits to Children under 1. Total Visits to j Children 1-5 years. Unsuccessful Visits. Visits to Nurse Children. Visits re Milk Scheme. Ante-Natal Visits. Ophthalmia Neonatorum Visits. Puerperal Fever etc., Visits. Visits re Home Helps. Visits re Maternal Mortality. Total Visits. Ward. First. Re-visits. Total. ! Not at home. Dead. i Removed. 1 2 3 4 5 6 7 8 9 10 ii 12 13 14 Cols. 3-14. St. Jamea Street 376 308 684 857 115 18 63 105 159 38 5 3 2 2 2,051 High Street 284 349 633 971 225 17 206 123 125 51 5 2 — — 2,358 Hoe Street 315 303 618 694 255 12 191 54 85 16 10 3 1 2 1,941 Wood Street 241 257 498 706 198 9 89 72 103 20 5 3 — - 1,703 Hale End 324 417 741 965 176 15 108 153 130 43 1 2 6 - 2,340 Higham Hill 421 462 883 980 412 27 146 140 184 53 14 5 5 - 2,849 Total 1,961 2,096 4,057 5,173 1,381 98 803 647 786 221 40 18 14 4 13,242 96 The following tables summarise the information given in the foregoing two tables for the quinquennium:— Year. How Fed. Kind of Food. Sleeping Accommodation. Condition of Baby. Accommodation. Breast. Breast and Hand, Hand. Cow's Milk. Patent Foods. Condensed Milk. With Mother. Cot or Cradle. Good. Fair. Bad. Whole House. Flat. Half-house. 3 Rooms. 2 Rooms. Room. 1930 1,544 96 321 142 169 106 366 1,595 1,708 15 38 612 213 431 134 403 168 1929 1,549 47 248 91 126 78 469 1,375 1,651 156 37 589 272 377 90 307 212 1928 1,524 46 237 85 123 75 440 1,367 1,579 207 21 565 303 353 118 294 178 1927 1,608 59 252 87 150 74 684 1,235 1,745 139 35 555 267 343 133 351 270 1926 1,845 79 318 138 166 93 1,025 1,217 2,087 128 27 594 334 469 73 422 350 The percentage breast-fed has decreased to 78.7 during 1930, the figures for previous years being: 1929, 84.0; 1928, 84.9; 1927, 83.8; 1926, 82.3. On the other hand, separate sleeping accommodation has improved consistently. 97 Year. Visits to Children under 1 year. Visits to Children 1-5 years. Unsuccessful Visits. Special Visits. Total Visits. First. Subsequent. Total. Not at Home. Dead. Removed. 1930 1,961 2,096 4,057 5,173 1,381 98 803 1,730 13,242 1929 1,844 2,400 4,244 4,287 896 68 321 - 9,816 1928 1,807 2,294 4,101 3,785 678 41 222 — 8,827 1927 1,919 2,490 4,409 4,229 864 62 299 — 9,863 1926 2,242 2,141 4,383 2,579 917 53 208 — 8,140 The total visits paid during 1930 is much increased for two main reasons—the larger staff available, and because the ' 'Special'' visits paid during previous years were apparently unrecorded. 98 CLINICS. Dr. Sheppard has kindly contributed the following report on the good work done at the Centre during 1930:— "Maternity and Child Welfare Clinics are held at the Council's Centre at Low Hall Lane on two afternoons weekly, Wednesdays and Fridays. Owing to the large numbers attending these sessions, it was decided that sufficient individual attention could not be given to the mothers in the weighing room and an extra afternoon for weighing and selling food was added. This session shows signs of becoming popular, and many mothers from the Hale End Ward have expressed the desire to have a similar session in their district. In July, 1930, a year's work was completed at the new premises in Low Hall Lane, and it is interesting to compare the numbers of cases which attended with those which attended at Truro Road during the previous twelve months.'' 1928-1929. Truro Road. 1929-1930. Low Hall Lane. New. Old. Total. New. Old. Total. July 72 1,235 1,307 99 1,395 1,494 August 86 1,710 1,796 109 1,373 1,482 September 87 1,483 1,570 108 1,462 1,570 October 81 1,769 1,850 86 1,710 1,796 November 59 1,526 1,585 62 1,502 1,564 December 26 928 954 19 922 941 January 70 1,270 1,340 105 1,660 1,765 February 53 1,016 1,069 74 1,394 1,468 March 102 1,332 1,434 76 1,510 1,586 April 66 1,234 1,300 90 1,539 1,629 May 92 1,508 1,600 92 1,595 1,687 June 69 1,329 1,398 69 1,326 1,395 Totals 863 16,340 17,203 989 17,388 18,377 "There is a doctor in attendance at the Wednesday and Friday afternoon sessions. All new cases are seen as a matter of routine, whilst all those in regular attendance are seen if medical advice is required. In this way 989 new cases and 1,833 old cases were seen, making an average of 28 cases seen per session. Two children were sent by your Committee to Brookscroft for in-patient treatment. Case 1.—D.P. Aged 1 month. Marasmus. Remained in one month and is now doing well. 99 Case 2.—P.S. Aged 16 days. Marasmus. Child did not respond to treatment and died at the end of three weeks. A Masseuse attends the Wednesday and Friday sessions for two hours and devotes an average of ten minutes to each case. Eighty-three cases, making 1,030 attendances, were treated. The more serious orthopaedic cases are referred to Mr. Whitchurch Howell, who, when necessary, admits the child to Brookfield Hospital. Dental and Ophthalmic treatment is carried out by arrangement with the Education Committee, also all operative treatment for tonsils and adenoids. Thanks are due to Dr. Friel for his attention to 41 babies suffering from Otorrhoea. The mothers much appreciate this treatment, which in many cases has prevented more serious trouble occurring later. For many years past a number of ladies have given their services voluntarily at the Welfare Sessions and have earned by their regular and unfailing devotion to the work a deep debt of gratitude from the Committee and Staff. Ante -Natal Clinic.— One afternoon weekly is devoted to the examination of expectant mothers. The numbers attending this Clinic were as follows: Sessions, 49; first attendances, 287; subsequent attendances, 483— total attendances, 770. Number of cases referred to Hospital, 36 ; the average attendance during 1930 being 15.7, as compared with 9 during 1929. Previous to this increase, Health Talks were given during this session by the Superintendent Health Visitor, and now instructions in the making of garments, etc., are given individually at all sessions. In addition, knitted garments, kindly made by voluntary helpers, are sold for the price of the wool only, to busy mothers unable to make their own. Two varieties of Sterilized Maternity Outfits are sold at cost price (3s. and 6s.) to mothers remaining at home for their confinement, and four mothers were also supplied with Home Helps during 1930. The Maternity and Child Welfare Committee have a scheme for the supply of milk to debilitated children under three years of age and to Ante-Natal mothers during the last three months of pregnancy. I am pleased to record that there has been no death referable to pregnancy occurring among the mothers attending this Clinic. 100 The following table will give some idea of the number of visits paid to the homes during the year:— No. of visits to children under 1 year 4,057 „ „ „ between 1 and 5 years 5,173 „ „ unsuccessful 2,282 „ „ re supply of milk 786 „ „ to Nurse Children 647 „ „ „ Ante-Natal mothers 221 „ „ „ Ophthalmia cases 40 „ „ „ Puerperal cases 18 „ „ re Home Helps 9 „ „ re Maternal Mortality 4 „ „ to special cases 5 Total 13,242 Nurse Children.— In April, 1930, work in connection with the Infant Life Protection section of the Children Act, 1908, was transferred from the Board of Guardians to your Council. When the work was taken over, there were 134 Nurse Children in Walthamstow; on December 31st there were 139. During the nine months 67 new children were registered, 49 removed, 8 children were adopted, 2 died, and 3, having reached the age of seven years, ceased to come under the Act.'' The following figures show the work done at the Centre during the past five years:— Year. Welfare Attendances. Total Attendances. Health Talks. New Cases. Old Cases. Sessions. Attendances. 1930 958 17,849 18,807 29 605 1929 935 16,051 16,986 39 604 1928 885 17,429 18,314 38 718 1927 930 15,827 16,757 47 638 1926 976 14,697 15,673 — — The attendances of old cases are larger than those given in previous Annual Reports owing to the addition of "incidental" children attending. The number of cases on the live register at the end of 1930 was 1,639. 101 Sale of Milk, etc., at Clinics.— The quantity and value of Milk and Foods sold and issued free during 1930 was as follows:— Sales. Value. Free Issue. £ s. d. Virol 1,690 lbs. 8 ozs. 180 9 4 9¼ lbs. Prune and Banana Syrup 204 lbs. 14 ozs. 29 16 4 Parrish's Food 259 lbs. 12 ozs. 12 19 9 Malted Honey 43 lbs 1 7 6 Cod Liver Oil 81 lbs. 15 ozs. 5 5 11 Cod Liver Oil Emulsion 295 lbs. 12 ozs. 19 14 4 Glaxo and Ambrosia 1,327 lbs. 95 18 4 188 lbs. Virol Containers 1,624 6 15 1 3 Ostermilk 605 lbs. 44 0 0 77 lbs. Almata 934 lbs. 96 3 6 28 lbs. Roboleine 997 lbs. 71 5 0 25 lbs. Cod Liver Oil and Malt Extract 353 lbs. 13 15 10 19 lbs. Cow and Gate 9,609 lbs. 751 1 8 596 lbs. Lacta and Lactogen 20 lbs. 1 12 8 Dunne's Milk 273 lbs. 12 4 6 110 lbs. £1,342 9 9 TREATMENT. (a) Orthopaedic.— The facilities provided by the Education Committee's Orthopaedic Scheme is available for all children attending the Welfare Centre. Miss Scott has kindly furnished the following information with respect to children under five years of age:— Cases seen at Clinic. Anterior Polio-myelitis 2 Genu Valgum and Varum 10 Mongolian Idiots 2 Spastic Paralysis 2 Rickets 21 Scoliosis, Kyphosis, Lordosis 2 Congenital Dislocation of Hip 1 Arthritis, polyarthritis 1 Talipes 5 Spina Bifida 1 Torticollis 3 Congenital Defects 7 Total 57 Attendances of infants and children under 5 years 102 Attendances for Orthopaedic and Massage Treatment (all ages) 2189 Admissions to Brookfield Orthopaedic Hospital. Talipes 2 Genu Valgum and Varum 4 Rickets 7 Congenital Deformities 1 Congenital dislocation of hip 2 Arthritis 1 Total 17 102 The foregoing figures refer to all children under five years of age and include those children who have already commenced school. Of the total, 33 cases were referred from the Welfare Clinic and six of these were admitted to Brookfield Hospital with your Committee's sanction. In addition, two approved cases were in Hospital at (he end of 1929. (b) Dental.— The following work was done by the Education Committee's Dental Surgeons—Mrs. W. Rosa Thorne and Mr. G. Pict on Evans—under the Maternity and Child Welfare Scheme:— Mothers. Children under 5. Cases treated 43 130 Attendances 58 137 Fillings 22 40 Extractions 114 170 General Anaesthetics 35 97 Local ,, — 4 Scalings 9 — Dressings 3 19 Mrs. Thorne reports as follows:— "During the year a large number of mothers have been referred from the Welfare Centres for dental treatment. They were chiefly nursing mothers, the expectant mother less frequently seeking treatment. Most of the cases were in a sadly neglected dental condition, the patients having no knowledge of oral hygiene. This lack of interest was in marked contrast to the general tidy appearance of the patient showing that when not causing discomfort the mouth received no attention at all. There is great need amongst the poorer mothers for some assistance in the cost of artificial dentures. Many are quite unable to pay for dentures and go for years partially or wholly without teeth. Number and Classifications of Operations at Brookfield Hospital (including Cases Remaining over from 1929). Osteoclasis 5 Reductions of congenital dislocation of hip:— Manipulations 5 Abscesses aspirated 4 1st position 2 Amputation of digits 1 2nd position 4 Tenotomies 2 3rd position 1 Osteotomies 6 Total 30 103 The attendance of mothers and infants is good and the appreciation of treatment very high." (c) Tonsils and Adenoids.—Twelve cases were operated on under the arrangement made by the Education Committee with the Walthamstow Dispensary. (d) Ophthalmic Defects and Minor Ailments are given any necessary treatment either at the School Clinics or by special appointment. B. WALTHAMSTOW CHILD WELFARE SOCIETY. This Society, a Voluntary Society, with headquarters at "Brookscroft," Forest Road, Walthamstow, was founded and organised by the late Dr. Elliott in 1914. The chief objects of the Society are the physical and moral welfare of pre-school children and to afford training for children's nursing. The facilities offered include: (a) Systematic lectures for the voluntary wbrkers and trainers; (b) Infant Consultations; (c) Sunlight Treatment and Massage; (d) Schools for Mothers; (e) Home Visiting; and (/) Addresses at Girls' Clubs, etc. The Honorary Consulting Staff includes Mr. Whitchurch Howell, F.R.C.S (Orthopaedic Surgeon), F. Hernaman-Johnson, M.D. (Actino Therapeutist), Forbes Buchan, Esq., M.B., Ch.B. (Physician and Lecturer), and W. Cuthbertson, Esq., M.B., Ch.B. (Assistant Physician). The Nursing Staff includes Miss Hughes, C.M.B. (Superintendent and Health Visitor), Miss C. Morley, S.R.N., C.M.B., and Miss Pennington, S.R.N., C.M.B. (Actino Therapeutic Department), who also act as Matron and Sister respectively of the observation wards, assisted by Miss Law, S.R.N., C.M.B., and three Probationers. During the year ending March, 1930, there were 60 Voluntary workers on the active list, 30 of whom held the Certificate of the Society. The accommodation comprises two Waiting, Weighing, Consulting, Massage, Sunlight and Lecture Rooms, a Dispensary and three Wards with a total of seven cots. Clinics are held as follows:— Tuesday and Friday, 2-4.30 p.m.—Massage and Sunlight Treatment. Wednesday, 1.30-4.30 p.m.—Weighing Clinic and Dispensary Treatment. Thursday, 1 to 6 p.m.—Infant Consultations. 104 The work done during the calendar year was as follows:— Attendances at Clinics. Total. Total. Home Visits to Children. Attendances at Lectures. Massage Treatments . Sunlight Treatments . Cases admitted to Observation Ward. New Cases. Old Cases. Under 1. 1-5 years. Total. Under 1. 1-5 years. 453 106 559 4,688 3,593 8,281 8,840 2,813 1,740 992 2,215 32 The above has been compiled from the Society's Annual Report for the year ended March, 1930, and from information kindly supplied by Mrs. Kindell and Miss Coulston. The following table compares the figures given in respect of the Society's work in previous Annual Reports:— Year. Attendances. Total. Home Visits. Lecture Attendances. Massage Treatments. Sunlight Treatments . Cases admitted to Wards. Council Cases admitted to Wards. New Cases. Old Cases. 1930 559 8,281 8,840 2,813 1,740 992 2,215 32 2 1929 566 7,984 8,550 2,588 1,838 484 2,257 73 1 1928 457 9,631 10,088 2,375 2,383 724 2,675 34 1 1927 421 7,235 7,656 2,427 2,101 528 2,794 23 — 1926 516 5,911 6,427 2,560 1,577 337 — 27 1 105 106 No Ante-Natal work is carried out by the Society and no dried foods are supplied at the Clinics. The following table gives the total of Municipal and Voluntary visits and attendances at Clinics:— Attendances at Welfare. Home Visits to Children. New Cases. Old Cases. Grand Total. Municipal Scheme 958 17,849 18807 9390* Voluntary Scheme 559 8,281 8,840 2,813 Total 1,517 26,130 27647 12203 * Includes 160 visits paid by the Woodford Nurse. 6. ASSISTED MILK SCHEME. Milk is supplied under this scheme to expectant and nursing mothers and to children under three years of age. It is not a condition that applicants should attend the Welfare Centre, although, in practice, it was found that during 1930 the majority did do so. Applications are made on special forms which give particulars of income and rent and are scrutinised each week by two lady members of the Maternity and Child Welfare Committee, members of which attend in rotation. Milk may be either granted free or at reduced cost, and the following shows the amount and estimated cost of milk granted by the Committee during 1930. 7. HOME HELPS. Applications for the provision of Home Helps are considered by the Milk Rota Committee, and, if approved, a payment of 12s. 6d. per week for two weeks is made. In addition to the four home helps Number of families assisted, 365. Scale. Amount. Cost to Authority £ s. d. Free 427 pints 5 17 6½ ½d. per pint 28,784 „ 332 17 0 1d. „ „ 22,071 „ 208 16 8 1d. „ „ 440 „ 3 4 4 Half-cost 7,159 „ 48 6 9¼ Total 58,881 „ £599 2 3¾ 107 approved during 1930, many mothers attending the Clinic made their own arrangements to obtain the help of suitable women whose names were supplied by the Health Visitors. 8. INSTITUTIONAL TREATMENT, etc. In addition to the six cases admitted to Brookfield Hospital and the two cases admitted to Brookscroft, and already referred to, two cases were sent by your Committee for convalescent home treatment, namely, one to Southborne and one to Mayfield. Instruments were supplied in two cases. 9. HOSPITAL ACCOMMODATION FOR CONFINEMENTS. (a) Of 1,705 notified births where information was available, 1,285 occurred at home and 420, or 24.6 per cent., in Institutions. There is thus no question as to the urgent need of adequate maternity beds in the Borough. The plans for the proposed Municipal Maternity Home of 30 beds are in course of revision to comply with the Ministry's requirements. (b) The County Medical Officer kindly states that there are six Nursing Homes registered under the 1927 Act, which is administered by the Essex County Council, and that all have arrangements for a Certified Midwife to attend cases of confinement. The total maximum number of Maternity beds is 18. 10. ESSEX COUNTY NURSING ASSOCIATION. The Nurses' Home at Carisbrooke Road functions as a branch of the main Home in Leytonstone. The local Staff is as follows:— 1 Sister in Charge, 2 Certified Midwives, 1 General Nurse, and 1 Pupil Midwife. After June 30th, 1931, the Walthamstow Home will be an independent unit with a similar staff, less the pupil midwife. In addition, registration is being sought for the provision of two Maternity beds. Sister Ross states that the following work was done during 1930:— Maternity cases, 62; Midwifery cases, 145. Total confinements attended, 207. Visits paid, 14,498. 11. CONSULTANT OBSTETRICIAN. During the current year the services of the Consultants acting under the Puerperal Fever and Pyrexia Regulations (referred to earlier in the Report) were made available to Practitioners in any difficulty arising during pregnancy, labour, or the puerperium. 108 12. MIDWIVES. The 13 Midwives who practice in the Borough attended 680 cases as Midwives and 149 cases as Maternity Nurses. Your Council took over the duties of Local Supervising Authority under the Midwives Acts from the County Council with effect from the 1st April, 1931. 13. PUERPERAL FEVER AND PYREXIA. The table facing this page gives full details of the 22 cases notified in 1930. Of the 22 cases, 19 were admitted to Hospital at the request of the notifying Practitioners, 18 to Whipps Cross Hospital under your Authority's scheme as laid down by the Regulations, and one —a non-resident,—to the North-Western Fever Hospital, Hampstead (London County Council) under arrangements made by the patient's Practitioner. Dr. Muir, Medical Superintendent, Whipps Cross Hospital, has kindly supplied details of Hospital treatment, etc. The notifications etc., may be summarised as follows:— Notifications. Removed to Hospital. Home Deaths Nursed. Puerperal Fever 14 12 2 6 Puerperal Pyrexia 8 7 1 3 In addition, six notifications of Puerperal Pyrexia were made in respect of Walthamstow mothers confined in Institutions outside the Borough, four being at the Mothers' Hospital, Clapton, one at the Royal Free Hospital and one at Queen Mary's Hospital, Stratford. No death was recorded amongst this group. A second opinion was requested on two occasions and both cases were nursed at home. During 1930 the Consultant under the Regulations was Dr. Frances Huxley, who, owing to pressure of other work, resigned on 11th February, 1931, The Consultants now available are Mr. G. F. Gibberd, M.S., F.R.C.S., and Mr. W. McK. H. McCullagh, D.S.O., M.C., M.B., F.R.C.S. From the 2nd to 4th March three cases of Puerperal Fever were notified from a Maternity Home in the Borough and a further case on April 10th. None were residents in the Borough and all were removed to Hospital. Full investigations were made at the Home both by the County and Borough Medical Officers of Health. No. of Case. Fever or Pyrexia. Date of Notification. Date Notification Received. Age. Ward. Facility required as per Notification Form. Date of Birth of Child or miscarriage. Onset of Pyrexia. Date of admission to Hospital. Period in Hospital. Diagnosis. Treatment. Remarks. 1. Pyrexia 5.1.30 7.1.30 19 H.E. Already in Hospital 5.1.30 5.1.30 5.1.30 11 days Incomplete abortion Evacuation and intrauterine douche Miscarriage 4 months. Recovered. 2. Fever 20.1.30 20.1.30 26 H.H. Second opinion 15.1.30 18.1.30 Nil Nil Retained products Home-nursed. Recovered. 3. Fever 31.1.30 1.2.30 22 Ho. Already in Hospital 20.1.30 17.1.30 29.1.30 10 days Puerperal Septicaemia Evacuation, douche, glycerine, etc Recovered. 4. Fever 18.2.30 19.2.30 23 Hi. Admission to Hospital 14.2.30 17.2.30 23.2.30 13 days Puerperal Septicaemia. Para metritis. Pyaemia Do. do. do. Instrumental delivery. Pulmonary complications. Died. 5. Fever 19.2.30 20.3.30 35 H.H. Admission to Hospital 14.2.30 16.2.30 20.2.30 28 days Puerperal Septicaemia Do. do. do. Normal delivery. Recovered. 6. Fever 2.3.30 3.3.30 25 W. Already in Hospital 26.3.30 28.3.30 2.3.30 3 days Puerperal Septicaemia Glycerine—S.U.P. Precipitate labour. Ruptured perineum Died. 7. Fever 5.3.30 5.3.30 31 W. Admission to Hospital 27.2.30 ? 5.3.30 7 days Puerperal Septicaemia Evacuation, douche, glycerine, S.F. serum Died. 8. Fever 5.3.30 5.3.30 29 W. Already in Hospital 26.2.30 2.3.30 4.3.30 60 days Puerperal Septicaemia Evacuation, douche, glycerine, S.F. serum S.U.P. Instrumental delivery. Recovered. 9. Pyrexia 7.3.30 8.3.30 39 J. Already in Hospital 4.3.30 5.3.30 6.3.30 4 days Puerperal Septicaemia Do. do. do. Died. 10. Fever 7.3.30 8.3.30 38 W. Already in Hospital 4.3.30 6.3.30 7.3.30 29 days Puerperal Fever Evacuation, douches Recovered. 11. Fever 7.3.30 10.3.30 29 H.H. Already in Hospital 4.3.30 6.3.30 8.3.30 21 days Puerperal Fever Intra-uterine douche Ruptured perineum. Recovered. 12. Fever 9.3.30 11.3.30 32 Ho. Already in Hospital 3.3.30 9.3.30 9.3.30 24 days Puerperal Fever Glycerine Recovered. 13. Pyrexia 10.4.30 11.4.30 27 W. Admitted to Hospital 5.4.30 7.4.30 10.4.30 10 days Puerperal Fever Intra-uterine glycerine Lacerated Cervix and perineum. Cervical swab gave pure haemolytic 14. Fever 25.4.30 26.4.30 39 Hi. Already in Hospital 22.4.30 24.4.30 25.4.30 10 days Puerperal Septicaemia. Pyaemia Intra-uterine douche and glycerine. S.F. serum streptococci. Recovered. Prolonged labour. Died. 15. Pyrexia 24.7.30 26.7.30 34 Ho. Already in Hospital 17.7.30 ?20.7.30 22.7.30 1 day Septic abortion. Pyaemia Do. do. do. Miscarriage 2 months. Comatose on J ' " | \ * J O ' / o A 16. Pyrexia 3.8.30 4.8.30 25 Ho. Second opinion 25.7.30 1.8.30 Nil Nil admission. Died 26.7 .o(j. Home nursed. Recovered. 17. Pyrexia 16.8.30 18.8.30 23 J. All facilities available 11.8.30 15.8.30 18.8.30 44 days Slight Puerperal infection. Ton- Douching, etc. Ruptured perineum. Recovered. 18. Fever 19.9.30 19.9.30 27 H.E. Second opinion 11.9.30 12.9.30 Nil Nil OllllUlC. — Home-nursed. Prolonged labour. 19. Pyrexia 22.10.30 22.10.30 28 H.H. Admission to Hospital 6.10.30 20.10.30 22.10.30 17 days Mastitis Fomentations. S.F. serum .. tured perineum. Recovered. Recovered. Home-nursed. 20. Pyrexia 23.10.30 23.10.30 25 H.E. Admitted to Hospital 21.10.30 22.10.30 24.10.30 36 days Puerperal Fever Glycerine. S.F. serum .. Normal labour. Ruptured perineum. 21. Fever 8.11.30 10.11.30 24 H.H. Already in Hospital 27.10.30 6.11.30 4.11.30 7 days Puerperal Fever and Mania Evacuation, douche and Glycerine Recovered. Certified insane. Ruptured perineum, Died 22. Fever 25.11.30 26.11.30 38 J. Already in Hospital 14.11.30 15.11.30 19.11.30 2 days Inquest. Septicaemia following self-induced a bortion Evacution, douche, glycerine, S.F.serum Died 21.11.30. 109 14. OPHTHALMIA NEONATORUM. The numbers of cases notified during the last five years were:— Year. Totals. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. Vision unimpaired. Vision impaired. Total Blindness. Deaths. 1930 8 2 — — — 1 5 3 8 — — — 1929 7 1 1 3 — 2 — 1 7 — — — 1928 11 3 1 2 — 1 4 6 10 1 — — 1927 13 3 1 2 2 1 4 4 13 — — — 1926 9 1 2 3 1 1 1 2 8 - 1 — 110 Of the three cases treated in Hospital, two occurred at the Mothers' Hospital, Clapton, while the other was admitted under your Council's scheme to St. Margaret's Hospital (London County Council) for one month. The disease has been of a mild character generally, but it is felt that Midwives are still too reluctant to call in medical aid (as required by the Rules of the Central Midwives Board) for all cases of discharging eyes, however slight. If necessary, treatment is given either at home or at the Clinics by your Council's Medical Officers and Health Visitors. 15. MATERNAL MORTALITY. Six cases died from Puerperal Sepsis and three cases from other accidents and diseases of pregnancy and parturition. Seven Maternal Mortality inquiry forms were completed in respect of these deaths and were sent to the Ministry of Health. Of the eight deaths recorded under the Puerperal Fever and Pyrexia section of the report, two, being non-residents, are excluded. The table facing this page gives particulars of maternal deaths, those from puerperal sepsis being also included in the table given under the Puerperal Fever and Pyrexia section. Date of Death. Cause of Death. Age. Ward. No. of Pregnancy. Previous obstetric history. Duration of last pregnancy (weeks). Date of Birth or Miscarriage. Midwife (M.), Mat. Nurse (Mat.), or Handywoman (H.W.). Character of Labour. Date Doctor called in. Date of receipt of any Notification of Pyrexia. Date of Admission to Hospital. Remarks. A. Puerp eral Sepsis. Instrumental Delivery ? 19th Feb. 23rd Feb. Puerperal Septicaemia. Parametritis. Pyaemia. 5th Mar. Puerperal Septicaemia 23 High Street ? ? ? 14th Feb. H.W. Pulmonary complications. 10th Mar. Puerperal Septicaemia 39 St. James Street ? ? ? 4th Mar. M. ? ? 8th Mar. 6th Mar. 5th May A. Pyaemia B. Puerperal Septicaemia 39 High Street ? ? ? 22nd April Prolonged Labour ? 26th April 25th April 23rd July A. Puerperal Pyrexia B. Miscarriage 36 Hoe Street 6 1 miscarriage 8 Twins— 17th July 19th July Nil ? 20th July 26th July 22nd July 1. Delay in obtaining medical attention. 2. Delay in accepting Hospital treatment. Septic abortion. Multiple septic emboli, including cerebral. 21st Nov. Septicaemia following self-induced abortion. (Inquest.) 18 St. James Street 3 Normal 16 14th Nov. H.W. ? 19th Nov. 26th Nov. 19th Nov. Haemorrhage on 13th Nov. Refused to have Doctor until 17th, when rigors occurred. Admitted taking abortifacient pills. 21st Nov. A. Broncho-Pneumonia B. Puerperal Fever 24 Higham Hill 1 ? ? 27th Oct. Mat. ? 27th Oct. 10th Nov. 4th Nov. Ruptured perineum. Retained placenta. Transferred to Mental Hospital 11th November. Delayed notification of Puerperal Fever. B. Other 14th Oct. Accidents, etc. Obstetric Shock following delivery 25 St. James Street ? ? Full time 14th Oct. Mat. Twins—rapid In Hospital Nil Confined and died at Institution outside Borough. 3rd Nov. Post-partum Haemorrhage 41 High Street 6 Normal 40 9th Oct. M. P.P.H. 9th Oct. Nil 27th Oct. Puerperium normal. Sudden haemorrhage 16th day, and repeated on 3rd November. 29th Dec. 1. (a) Ante- and Post-partum Haemorrhage (6) Placenta Praevia 25 Hoe Street 1 26 29th Dec. M. A. and P.P.H. 28th Oct. Nil Nil Private Practitioner and Private Consultant Obstetrician in attendance. 111 The following table shows the position with regard to Maternal Mortality during the last five years Year. No. of Births Registered. Deaths of women due to Pregnancy and Child-earing. Infant Mortality (Waltham stow). WaLTHAMSTOW. England and Wales. Puerperal Sepsis. Other Puerperal Causes. Total. Rates per 1,000 Births Registered. Rates per 1,000 Births Registered. Puerperal Sepsis. Other Puerperal causes. Total. Puerperal Sepsis. Other Puerperal causes. Total. 1930 1,959 6 3 9 3.06 1.53 4.59 Not yet available. 39 1929 1,934 1 6 7 0.52 3.10 3.62 1.80 2.53 4.33 53 1928 1,981 1 5 6 0.50 2.53 3.03 1.79 2.63 4.42 51 1927 2,025 3 4 7 1.47 1.99 3.46 1.57 2.54 4.11 52 1926 2,218 1 3 4 0.45 1.35 1.80 1.60 2.52 4.12 45 A large increase in deaths due to sepsis during 1930 is apparent, but the Walthamstow rates are not strictly comparable to the National rates owing to the small numbers involved.