WAL 5 4411 (1) WALTHAMSTOW Borough of Maltbametow. REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1931. Borough of Walthamstow. REPORT « OF THE MEDICAL OFFICER OF HEALTH For the Year 1931. INDEX. pages Section 1.—Statistics and Social Conditions of the Area 8-15 ,, 2.—General Provision of Health Services in the Area 16-24 ,, 3.—Sanitary Circumstances of the Area 24-29 ,, 4.—Housing 30-35 ,, 5.—Inspection and Supervision of Food 35-41 ,, 6.—Prevalence of and Control over Infectious Diseases 45-65 7.—Infectious Diseases Hospital 65-71 ,, 8.—Maternity and Child Welfare 74-101 page Acreage 8 Adulteration 39 Ambulance 20 Ante-Natal Clinic 86 Antitoxin 57 Bacteriology 16,48, 70 Bacteriological Analyses 36, 37 Biological Tests 36,37,38 Births 10,13,77,78 ,, , Notification of 77 ,, , Registration of 77 Birth Rate 10, 12 Brookfield Hospital 54 Caravans 29 Census 5,8,9 Cerebro-Spinal Meningitis 61 Chicken Pox 61 Children Act 24,86 Closet Accommodation 25 Committees 4,74 Complaints 26 Confinements 91,94 Consultants 75,92 Cowsheds 35 Connaught Hospital 17 Dampness 27 Deaths 10, 13, 14 ,, .Institutional 15 Death Rate 10, 12 Dental Treatment 88 Diphtheria 5, 12,55 Diseases of Animals Acts 42 Disinfection 27 Drainage 25 Encephalitis Lethargica 61 Enteric Fever 5, 12, 57 Erysipelas 60 Factory & Workshops Acts 43, 44 page Food and Drugs 35,39,40 Food Poisoning 40 Foot Clinic . 5,21,22,23 Home Helps 91 Hospital Accommodation 17 ,, , Infectious Diseases 65 ,, , Smallpox 52 House Refuse Removal 25 Housing 8,33,35 ,, Conditions 31, 33 ,, Shortage 34 ,, Statistics 30 Ice Cream 37 Infant Mortality 12, 79, 80 Infectious Diseases 27, 4 5 ,, ,, Clinic 47 Influenza 12 Isolation Hospital 65 Institutional Treatment 91 Laboratory Work 16, 48, 70 Legal Proceedings 41, 42 Legislation 16 Maternal Mortality 12,24, 101 Maternity & Child Welfare 74, 101 Clinics 21, 85, 89 Maternity & Nursing Homes 18, 19 Maternity Outfits 86 Measles 12, 63 Meat Inspection 39 Medical Aid 94 ,, Examinations 71 Midwives 16,93 Milk and Dairies Orders 38 ,, ,, , Amend. Act 38 ,, Special Desig. Order 38 ,, Shops 35 ,, , Assisted Scheme 91 ,, Samples 35, 38 ,, Supply 35 page Mortality Analysis 12 Notices, Sanitary 26 Nuisances 26 Nurse Children 24,86 Nursing 16 Nursing Homes Registration Act 18,20, 95 Offensive Trades 29,41 Ophthalmia Neonatorum 100 Ophthalmic Consultant Clinic 21 Orthopaedic Treatment 87 Outworkers 44,45 Parks and Recreation Grounds 10 Pasteurisation of Milk 5,6 Pemphigus Neonatorum 100 Pneumonia 59 Poisons and Pharmacy Act 43 Population 8 Public Assistance 16,17 Puerperal Fever and Pyrexia 92, 96, 98 Rag Flock Acts 29 Rateable Value 8 Refuse Disposal 25 Rent Restrictions Act 42 Rivers and Streams 25 Rheumatism Clinic 21,47 page Sanitary Inspection 26 Scarlet Fever 5, 12, 53 Schools 29 Sewerage 2-3 Smallpox 5,12,48 Smoke Abatement 29 Social Conditions 8,9 Special Premises 27, 28 Staff 7,16,75 Stillbirths 10 Tents, Vans and Sheds 29 Tonsils and Adenoids 89 Tuberculosis 11,63 Tuberculous Meat 89 Unemployment 9,10 Vaccination 52,53 Vital Statistics 10 Walthamstow Child Welfare Society 89 Walthamstow District Nursing Association 92 Walthamstow Dispensary 18 Water 24 Whooping Cough 6,12,63 Women's Clinic 5,21,24 Workshops 43,44 Zymotic Diseases 11 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Alderman Mrs. C. McEntee, J.P. Ex-officio: His Worship The Mayor—Councillor G. H. Spaceman, J.P. The Deputy Mayor—Alderman T. W. Smith. Councillor Ross Wyld Chairmen of Finance Committee. ,, E. C. Redhead Alderman G. Gibbons, J.P. ,, J. C. Hammond. ,, Mrs. M. Norrish. Councillor Mrs. L. P. Bailey. ,, W. B. Fitt. ,, W. Gillett. ,, Miss B. A. Henderson. Councillor Miss N. W. Hix. (Chairman, Sanatorium Visiting Committee.) Councillor R. R. B. Lester. ,, C. E. Longley. ,, W. H. Morris. ,, Mrs. E. M. Miller. ,, Mrs. E. Richards. ,, R. Smith. 5 TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, I beg to present herewith a Report on the work of the Public Health Department during 1931. The. Report is presented as suggested by Circular 1206 of the Ministry of Health. The Report on Maternity and Child Welfare work is given as a separate section. The routine work of the Department shows an increase under most headings and, in addition, to the visits recorded by the Sanitary Staff, a total of 2,967 visits were paid by the Medical Staff— mostly by myself. Additional work was involved by the inauguration of the Foot Clinic and the Women's Clinic. The former has proved an unqualified success, but an opinion on the latter must be deferred because only two sessions were held before the close of the year. The administration of the Nursing Homes Registration Act also increased the Departmental duties. The Staff of the Department was increased by the appointment of an additional Sanitary Inspector. The Census returns showed that Walthamstow was the most populous Municipal Borough in the country, while the RegistrarGeneral's table of comparative Vital Statistics is generally favourable to the Borough. Reviewing the incidence of infectious disease there was, happily, a diminished incidence in respect of the three main diseases. Thus, Smallpox only showed one-third of the incidence of 1930, Scarlet Fever three-quarters, and Diphtheria some three-fifths. Enteric Fever, however, accounted for a total of 38 cases, 33 of which were a part of the "Epping" outbreak. As a result of this experience I have no hesitation in stressing the necessity for the compulsory pasteurisation of all raw and ungraded milk. At least two important cities in the country intend to promote the necessary legislation. The position may well be summed up in an extract from a recent article from the Public Health press:— “The Americans, who are ahead of all nations in the hygiene of food handling, insist upon pasteurisation of all milk except of what corresponds to our certified milk, and, be it noted, the American drinks five times as much milk as the Englishman. But, be it noted also, in the States pasteurising plants are as closely watched by the health authorities as distilleries are 6 watched by the revenue officers in England. In England, pasteurisation has many opponents; for one thing it is often inefficiently done, but its unpopularity here is mainly due to prejudice. Theoretically the process is open to objection, but there is a growing feeling that the drawbacks of pasteurisation are a small matter indeed when weighed against the obvious advantages of getting an abundant supply of milk which, if not perfect, is yet good and quite trustworthy." Fourteen deaths were recorded from Whooping Cough, a fact which should stress the high mortality from this dangerous disease. I gratefully acknowledge the support I have invariably received from the Chairman and Members of your Committee and the cooperation of my colleagues in other Departments. Mr. Furness has again contributed those sections dealing with the following—Water, Rivers and Streams, Drainage, Sewerage and Scavenging, and new Housing Statistics. The Staff of the Department have all worked well and have assisted in the compilation of the Report. The Senior Sanitary Inspector has contributed the following sections—Closet Accommodation, Sanitary Inspection of the Area, Smoke Abatement, Premises and Occupations which can be controlled by Byelaws or Regulations, Inspection of houses, Inspection and Supervision of Food (excluding Food Poisoning). I have the honour to be, Your obedient servant, A. T. W. POWELL, Medical Officer of Health, etc. 7 STAFF. Medical Officer of Health, School Medical Officer and Medical Superintendent, Isolation Hospital: A. T. W. Powell, M.C., M.B., B.S. (Lond.), D.P.H. Assistant Medical Officers: D. Broderick, M.B., B.Ch., B.A.O., D.P.H., Barrister-at-Law. 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 Mary Hamilton, M.B., B.Ch., B.A.O. Consultants (Puerperal Fever and Pyrexia Regulations): Mr. G. F. Gibberd, M.S., F.R.C.S. Mrs. M. H. F. Ivens-Knowles, C.B.E., M.S. (also in charge of Women's Clinic). Mr. W. McKim H. McCullagh, D.S.O., M.C., F.R.C.S. Matron—Isolation Hospital: Miss L. Pratchett, S.R.N. Infectious Disease Nurse: Miss I. H. Jennings, S.R.N., C.M.B. Foot Clinic: Chiropodist:—Miss M. McCallum, S.R.N., C.S.M.M.G. Clerk (part-time):-—Mrs. N. Moger. 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). W. R. Robinson, (b), (d). F. W. Kemp, (a), (b), (c). T. Vaughan, (b), (c), (e). F. Northcote, (b), (c), (from H. A. Whipp, (6), (c). 1-5-31). (a) 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.V.S. (Lond.). Public Analyst (part time): Dr. Bernard Dyer. Chief Clerk: R. Rose. Clerks: G. W. West, L. R. W. Kemp, R. C. Bland, R. A. C. Green, L. Rushton, F.J. Aylward. Ambulance Drivers and Disinfecting Staff: W. H. Dunn, E. E. Harber, R. High, B. Winter. 8 I —STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343 Population (Census, 1931) 132,965 ,, (Registrar-General's Estimate, mid-year 1931) 134,420 No. of inhabited houses of resident population (Census, 1921) 25,526 No. of families or separate occupiers (Census, 1921) 29,461 Rateable value £663,694 Sum represented by penny rate £2,700 Population.—The population as shown by the Census taken on the 26th-27th April, 1931, was 132,965, which ranks thirty-fifth in England and Wales, including London (City and Administrative County). The intercensal increase was 3,570 or 2.8 per cent, of the 1921 population. 9 The same relative position in England and Wales was occupied by Walthamstow as a result of the 1921 Census and now, as then, Walthamstow remains the third largest town in Essex, being exceeded only by the County Boroughs of East and West Ham. Walthamstow was, on Census night, the largest Municipal Borough in England and Wales as regards population. At the moment of writing only the .Preliminary Report of the Census is to hand and the full available comparisons with the 1921 figures are given below:— Year. Persons. Males. Females. Parliamentary Electors Autumn Register, 1930 Persons. Males. Females. 1931 132.965 63,522 69,442 1921 129,395 61,824 67,571 1931, East Parliamentary Division 63,023 29,628 33,395 40,324 18,890 21,344 1931, West Parliamentary Division 69,942 33,894 36,048 42,314 20,748 21,566 Social Conditions.—The social conditions have not changed to any material extent since those detailed in last year's Report which recapitulated the main occupations of the inhabitants as disclosed by the 1921 Census and which emphasised the industrial nature of the Borough. There is no known particular occupation which has any influence on public health. Unemployment.—The degree of unemployment in the area during 1931 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 related to persons residing in Walthamstow (excluding Juveniles). The following data refer to the whole Exchange Area:— Date. No. remaining on Register. Amount of benefit paid. £ Men. Women. Total. 26-1-31 5,950 1,893 7,843 6,078 23-2-31 6,148 1,863 8,011 6,280 23-3-31 6,098 1,881 7,979 6,467 27-4-31 5,907 1,883 7,790 6,181 18-5-31 5,743 1,876 7,619 5,950 22-6-31 5,848 1,817 7,665 5,965 27-7-31 5,739 1,826 7,565 6,022 24-8-31 5,960 1,724 7,684 6,029 21-9-31 6,257 1,610 7,867 6,268 26-10-31 7,012 1,740 8,752 6,226 23-11-31 7,194 1,447 8,641 6,302 21-12-31 6,971 1,194 8,165 5,997 10 Between 30th December, 1930, and 21st December, 1931, a total of £312,872 was paid out in benefits, two-thirds of this amount (approximately representing the Walthamstow proportion) being £208,580. The corresponding figures for 1930 were £117,935 and £78,623 respectively and the very large increases during 1931 plainly show the increased unemployment with its consequent menace to the public health. Mr. Dempsey states that the following were the registrations at the Juvenile Employment Bureau:— Fresh Applications:— Insured (over 16 years) Boys. Girls. Total. 540 429 969 Not insured (under 16 years) 551 560 1,111 Re-registrations:— Insured 693 416 1,109 Not insured 550 611 1,161 Employment was obtained for 1,104 boys and girls. Parks and Recreation Grounds.—In addition to those specified in the 1930 Report, the North Walthamstow Sports Ground was purchased during the year by the Education Authority, a loan of £2,700 being raised for the purpose. A further loan of £1,887 was sanctioned for the provision of children's playground equipment at Lloyd and St. James' Parks and at the Higham Hill, Queens Road and Selborne Road Recreation Grounds and Chestnuts Farm. The equipment included slides, ocean waves, rowing pendulum swings, whirling platforms and cradle swings. Extracts from Vital Statistics.-The Registrar-General's mid-year, 1931, estimate of population (viz., 134,420) has been used for the calculation of all vital statistics:— Males. Females. Live Births Legitimate 1,898 949 949 Birth rate per 1,000 of the estimated resident population 14.5 Illegitimate 49 17 32 Total 1,947 966 981 Stillbirths 59 Rate per 1,000 total (live and stillbirths) births 29.4 Deaths 1,403 Death rate per 1,000 of the estimated resident population 10.4 Percentage of total deaths occurring in Institutions 45.1 Deaths from diseases and accidents of pregnancy and childbirth From sepsis 1 ,, other causes Nil 11 Death-rate of infants under one year of age:— All infants per 1,000 live births 56 Legitimate infants per 1,000 legitimate live births 54 Illegitimate infants per 1,000 illegitimate live births 122 Deaths from Measles (all ages) Nil ,, Whooping Cough (all ages) 14 ,, Diarrhoea (under 2 years of age) 8 The Zymotic Disease Death-rate, i.e., 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, was 0.27 against 0.50 in 1930. The Pulmonary Tuberculosis Death-rate was 0.70 per 1,000 population, and the Non-Pulmonary Death-rate was 0.097 per 1,000 population. The natural increase of population, i.e., excess of births over deaths was 544. The Registrar-General's comparative figures for towns in the 'Outer Ring" cannot be given as they have not been issued in time. The usual comparison of vital statistic rates with those for the whole country is shown in the following table:— Birth-rate, Death-rate, and Analysis of Mortality during the Year 1931. (Provisional figures.) (The mortality rates for England and Wales refer to the whole population, but for London and the Towns to civilians only.) Rate per 1,000 Total Population . Annual Death-rate pee 1,000 Population. Rate per 1,000 Live Births Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 years). Total Deaths under 1 year. Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. still- Births. England and Wales 15.8 0.67 12.3 0.01 0.00 0.08 0.01 0.06 0.07 0.36 0.54 6.0 66 91.18 6.17 1.70 0.95 107 County Boroughs and Great Towns including London 16.0 0.67 12.3 0.00 0.00 0 .10 0.01 0.07 0.08 0.33 0.48 8.4 71 91 .43 5.84 2.24 0.49 159 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 15.6 0.73 11.3 0.00 0.00 0.07 0.01 0.05 0.05 0.36 0.43 4.0 62 92.17 5.49 1.25 1.09 London 15.0 0.50 12.4 0.01 0.00 0.03 0.02 0.07 0.06 0.26 0.57 9.7 65 89.52 6.23 4.24 0.01 Walthamstow 14.5 0.43 10.4 0.00 0.00 0.00 0.01 0.10 0.07 0.14 0.52 4.1 56 89.68 7.55 2.70 0.07 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales were as follows: Per 1,000 Live Births 1.66 2.45 4.11 ,, ,, Total Births 1.59 2.35 3.95 ,, ,, ,, Walthamstow ,, ,, | ,, ,, Total Births 0.49 - 0.49 ,, ,, Live Births 0.51 — 0.51 12 13 Births.— Births are dealt with under the Maternity and Child Welfare section of the Report. Deaths.—The following table shows the Registrar-General's classification of causes of death by sex totals. These have been sub-divided locally, as accurately as possible, into age and ward groups. The new classification given by the Registrar-General shows 36 main causes of death as compared with 32 in previous years:— Causes of and Ages at Death during the year 1931. Whole District and Wards. Causes or 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 45 and under 65 years 65 and upward* 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 Typhoid and Para-typhoid Fevers — 1 — — — — — — — 1 — 1 — — — — 2 Measles — — — — — — — — — — — — — — — — 3 Scarlet Fever — 2 — — — 1 — 1 — — 2 — — — — — 4 Whooping Cough 9 5 7 6 1 — — — — — 3 2 1 — 2 6 5 Diphtheria 5 6 1 — 4 4 1 1 — — 4 1 — — 3 3 6 Influenza 8 12 — 3 1 6 2 3 1 4 5 4 2 1 4 4 7 Encephalitis Lethargica 1 2 — — — — 2 1 — — 1 — — 1 1 8 Cerebro-spinal Fever — — — — — — — — — — — — — — — — 9 Tuberculosis of Respiratory System 63 32 — 1 1 — 22 46 22 3 20 21 17 9 11 17 10 Other Tuberculous Diseases 5 8 1 2 — 2 6 2 — — 3 1 1 3 2 3 11 Syphilis 5 1 — — — — — — 4 2 1 1 1 1 — 2 12 General Paralysis of the Insane, tabes dorsalis 4 — — — — — — — 2 2 1 — 1 1 1 13 Cancer, malignant disease 85 91 — — — 1 — 14 86 75 32 17 36 23 27 41 14 Diabetes 3 7 — — — — — 2 2 6 2 3 3 — — 2 15 Cerebral Haemorrhage, etc. 35 48 — — 1 — — 1 21 60 18 11 15 16 13 10 16 Heart Disease 122 191 4 — 1 8 6 25 71 198 60 33 78 45 49 48 17 Aneurysm 5 2 — — — — — 1 4 2 1 — 3 2 1 — 18 Other Circulatory Diseases 15 22 2 4 — 1 — 1 8 21 5 7 8 6 6 5 19 Bronchitis 37 49 2 — 1 — 1 1 18 63 15 7 18 16 16 14 20 Pneumonia (all forms) 63 45 20 4 3 1 1 12 27 40 19 10 29 14 15 21 21 Other Respiratory Diseases 6 8 — — 1 — — 3 4 6 3 3 3 3 2 — 22 Peptic Ulcer 9 4 — — — — — 1 9 3 2 3 2 4 1 1 23 Diarrhoea, etc. (under 2 years) 5 3 6 2 — — — — — — 2 — 1 — 2 3 24 Appendicitis 4 4 — — — 1 2 1 2 2 1 3 1 1 2 — 25 Cirrhosis of Liver 4 — — — — — — — 2 2 1 — 1 1 1 — 26 Other Diseases of Liver, etc. — — — — — — — — — — — — — — — — 27 Other Digestive Diseases 15 20 — — 4 — 6 3 9 13 4 7 5 8 7 4 28 Acute and Chronic Nephritis 19 25 — — — 1 2 4 17 20 9 5 10 7 7 6 29 Puerperal Sepsis — 1 — — — — — 1 — — — — 1 — — — 30 Other Puerperal Causes — — — — — — — — — — — — — — — — 31 Congenital Debility and Malformation, Premature Birth, etc. 37 21 58 — — — — — — — 10 12 8 8 11 9 32 Senility 16 28 — — — — — — — 44 1 8 13 6 9 7 33 Suicide 22 9 — — — — 1 12 14 4 8 6 4 3 4 6 34 Other Deaths from Violence 29 11 3 2 — 7 9 7 4 8 10 3 6 5 5 11 35 Other Defined Causes 61 52 6 1 2 7 5 11 27 54 23 16 23 13 22 16 36 Causes ill-defined or unknown 1 — — — — 1 — — — — — — — — — 1 Totals 693 710 110 25 20 41 66 154 354 63 266 185 291 197 224 240 14 15 The 1931 total deaths (1,403) compares with 1,160 during 1930, the respective death-rates per 1,000 population being 10.4 and 9.3. The chief differences in the classification of deaths—-those for 1930 being given in parentheses—were as follows:— Whooping Cough, 14 (2); Diphtheria, 11 (22); Pulmonary Tuberculosis, 95 (80); Non-Pulmonary Tuberculosis, 13 (9); Cancer, 176 (167); Cerebral Haemorrhage, 83 (51); Heart Disease, 313 (224); Bronchitis, 86 (42); Nephritis, 44 (37); Congenital Debility, etc., 58 (45); Suicide, 31 (14); Violence, 40 (34). Infant deaths are analysed by causes, ages and wards under the Maternity and Child Welfare Section of the Report. Institutional Deaths. Whipps Cross Hospital, Leytonstone 220 Central Homes, Leytonstone 160 Connaught Hospital, Walthamstow 32 Brentwood Mental Hospital 28 Prince of Wales's Hospital, Tottenham 19 Forest Gate Sick Home 19 Walthamstow Isolation Hospital 14 London Hospital, Stepney 13 London Fever Hospital, Islington 12 Queen's Hospital, Bethnal Green 12 St. Bartholomew's Hospital, London 10 Queen Mary's Hospital, Stratford 6 German Hospital, Hackney 4 Middlesex Hospital, St. Marylebone 4 Great Ormond Street Hospital 4 St. Joseph's Hospice, Hackney 3 "Brookscroft," Forest Road, Walthamstow 3 Forest Hydro, Forest Road, Walthamstow 3 Severalls Hospital, Colchester 3 Royal Northern Hospital, Islington 3 Chest Hospital, Bethnal Green 2 Central London Throat, Nose and Ear Hospital 2 London Jewish Hospital, Stepney 2 St. Peter's Hospital, Stepney 2 St. John and St. Elizabeth Hospital, St. Marylebone 2 Elizabeth Garrett Anderson Hospital, St. Pancras 2 St. Columba's Hospital, Hampstead 2 North Middlesex Hospital, Edmonton 2 Guys' Hospital, Southwark 2 Other Hospitals 43 Total 633 16 II. 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 at the beginning of the Report and also in the Maternity and Child Welfare Section. All are whole-time officers unless otherwise stated. 2. Nursing in the Home. (a) General.—The Walthamstow District Nursing Association took over the Nursing Home and the Staff formerly provided by the Essex County Nursing Association. The work done in 1931 is reviewed in the Maternity and Child Welfare Section of the Report. 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.—On taking over the administration of the Midwives Acts from the County Council on 1st April, 1931, there were 17 trained and qualified midwives practising in the area. During the year three further qualified midwives gave notice of intention to practice. The work involved under the Midwives Acts is detailed in the Maternity and Child Welfare Section. 4. 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 December, 1931, was £28,796 Is. 4d. The average weekly number in receipt of relief was—Men, 450; Women, 837; Children, 700; Total. 1,987. 5. Laboratory Facilities.—These facilities are detailed under the Infectious Diseases Section of the Report. 6. Legislation in Force (additional). (a) The Walthamstow (Chicken Pox) Regulations, 1931, dated 2nd November, 1931, and made by the Ministry of Health, were brought into force on that date. The effect of the Regulations was to continue to make Chicken Pox a notifiable disease, except those cases under 10 years of age who had been vaccinated. ''The following comparative figures show the progress of the Hospital from the year 1927 to 1931:— Patients admitted. Average stay in Hospital. Beds occupied daily. Out-patients Department New Cases. Attendances. 1931 1,515 21.29 88.3 11,186 50,201 1930 1,406 22.84 88.10 13,470 49,988 1929 1,341 23.98 87.29 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 17 The previous compulsory notification of Chicken Pox was thus continued except that the vaccinated cases, who could therefore not be suffering from Smallpox, were excluded from notification and so leading to economy of money and of time previously wasted by the medical staff in verification of diagnosis. When the Regulations came into force copies were sent to all practitioners in the Borough. They have answered their purpose well. (b) The Walthamstow Corporation Act, 1931, which received Royal Assent on 27th March, 1931, was an Act promoted to make provision for the annual audit. (c) The Walthamstow (Supervision of Midwives) Order, 1931. 7. Hospitals.—There were no changes during 1931 in the Hospital services used by the inhabitants of the Borough. Public Assistance in Walthamstow is now provided by the South-West Area Committee of the Essex County Council, which retains a certain proportion of beds in each of the local 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 December, 1931:— Institution. Men. Women. Children. Total. Central Home 176 219 72 467 Whipps Cross Hospital 553 585 312 1,450 Forest Gate Hospital 10 125 5 140 Aldersbrook Home — — 62 62 Fifty-eight children were born to Walthamstow mothers in Forest Gate Hospital, in addition to 7 stillbirths. The number of patients from Walthamstow in Mental Hospitals on the 31st December was 385 (335 at Brentwood and 50 at Severalls). The Connaught Hospital. Captain Ellison has kindly supplied the following information:— "Of the total number of in-patients admitted during the year, 684 were residents of the Borough. 18 "Twenty-three highly qualified honorary Specialists are in regular attendance and there are three Resident Medical Officers, The Nursing Staff consists of the Matron, the Sister Tutor, 12 Sisters, 5 Staff Nurses and 30 Probationers. "The complement of 100 beds is allocated as follows:—Medical cases, 21; Surgical, 32; Children, 34; Private Beds, 10; Observation Beds, 3. "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. "During 1931, 609 major, and 2,822 minor operations were performed, a total of 3,431. 5,544 radiographs were taken, and 6,928 massage treatments were given. There were also 6,192 electrical treatments, and 3,287 artificial sunlight treatments given during the year at Comely Bank Annexe. “A Gynaecological Out-Patient Department will be opened early in 1932 with Mr. Alistair Galletly, M.C., F.R.C.S., as Honorary Surgeon-in-Charge.'' The returns of the various Hospitals show that full use was made of the facilities available. There is no question that if more beds were available at the Connaught Hospital and Whipps Cross Hospital, full use could be made of the added facilities. Co-operation exists between the Local Authority and the Connaught Hospital chiefly in respect of the schemes for the admission of the Education Committee's Tonsils and Adenoid cases, and the Borough Council's Enteric Fever cases. Future plans for the improvement of the Hospital services include the provision of a Municipal Maternity Home and of an additional 12 beds at the Infectious Diseases Hospital. The Walthamstow Dispensary. The Dispensary is a Charity founded in 1873, and which, during 1931, gave treatment to 976 cases, who made 3,162 attendances. In addition, 285 operations for removal of Tonsils and Adenoids were done for your Education and Maternity and Child Welfare Committees. 8. Maternity and Nursing Homes.—The application made by your Council some time ago to the Essex County Council, i.e., for the delegation of powers of administration under the Nursing Homes Registration Act, 1927, was successful. The administration of the Act was taken over on the 1st October on which date the following Homes were registered:— 19 Address. *Kingswood Maternity Nursing Home, Forest Rise, Whipps Cross. *The Forest Hydro, Forest Road St. Margaret's Maternity Home, 3, East Avenue. Heathfield Nursing Home, 91, Falmouth Avenue, Highams Park. Walthamstow District Nursing Association, 19, Carisbrooke Road. Particulars of Registration. Registered as Maternity Home. (5 beds.) Registered as a Nursing Home for the reception of general as well as maternity cases, provided that for general cases a resident qualified Nurse is employed, and that for maternity patients a resident qualified Nurse (with Doctor) or a certified Midwife is employed for each confinement and the subsequent 10 days' nursing. (7 beds, including 2 maternity.) Registered as Maternity Home. (3 beds.) Registered as Nursing and Maternity Home. A certified Midwife or doctor should attend each confinement. (10 beds, including 6 maternity.) Registered as Maternity Home. (2 beds.) * These Homes were registered under Part II of the Midwives and Maternity Homes Act, 1926, and therefore became automatically registered under the Nursing Homes Registration Act, 1927. The approved number of beds at the Walthamstow District Nursing Association was increased to four, with effect from the 27th November. The total number of beds registered under the Act at the close of the year was, therefore, 29, of which 20 were for maternity and 9 for general cases. A review of the maternity work carried out in the Homes is given under the Maternity and Child Welfare Section of the Report. Towards the end of the year your Council approved the adoption of Byelaws under the Act and made application for confirmation to the Ministry of Health. 20 The following table gives information required by the Ministry of Health 1. No. of applications for registration 1 (for additional beds). 2. No. of Homes registered No new registrations. 3. No. of orders made refusing or cancelling registration Nil. 4. No. of appeals against such orders Nil. 5. No. of cases in which such orders have been made:— (a) Confirmed on appeal Nil. (b) Disallowed Nil. 6. No. of applications for exemption from registration Nil. 7. No. of cases in which exemption has been (a) Granted Nil. (b) Withdrawn Nil. (c) Refused Nil. Periodical quarterly inspections are made to each Home, in addition to any visits necessary for special inquiries. The Chief Officer of the Fire Brigade carried out a detailed inspection of the fire appliances at each Home during the year. 9. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children.—There is no change to record from the provision detailed in the 1930 Report. 10. Ambulance Facilities. (a) For Infectious Diseases.—The ambulance facilities remained as detailed in the 1930 Report. All the ambulances were either repainted or revarnished during 1931. New garage accommodation was erected during the year on the site of the old garage. (b) For Non -Infectious and Accident Cases.—Your Council provided no facilities for non-infectious cases. A proposal to enter into an agreement with the St. John Ambulance Brigade proved abortive, and a scheme for the provision of two ambulances to be located at the Fire Station has now been approved. 1. Mr. A. G. Mattacks, the Corps Secretary of the Walthamstow and District Corps of the St. John Ambulance Brigade, reports as follows:— "We have two Motor Ambulances, the day drivers being the only paid men in the Walthamstow Corps. Otherwise our services 21 are entirely voluntary. Our headquarters at Willow Walk, High Street, are open both day and night for the service of the public. We have also a sub-station at Highams Park doing valuable work and another station on the Epping Road during week-ends and holidays and in the summer months. "During 1931, the number of cases receiving First Aid treatment was 1,811, and the number of cases removed to hospitals 1,057. Mileage incurred by Motor Ambulance in these cases was 17,259. "The number of road accidents in this District receiving treatment was 226, and the mileage incurred on these cases alone, 1,258. We have also organised several First Aid classes and also classes in Home Nursing which have been exceedingly successful, and we hope of great benefit to those who qualified for certificate and to the firms by whom they are employed, be it factory or office." 2. Removal of patients to Whipps Cross Hospital is carried out by the Hospital's Ambulances. 11. Clinic and Treatment Centres.—In addition to the Clinics detailed in the 1930 Report, all of which were continued, the following were provided during 1931:— Nature. Day and Time. Situation. Accommodation. By whom provided. Rheumatism Th., 2-4 p.m. Lloyd Park Waiting, Consulting and Treatment Room Walthainstow Education Committee. Consultant Ophthalmic 1st Th., 10-12 noon, monthly Blind School Classroom " Maternity and Child Welfare Tu., 2-4 p.m (a) The Institute, St. Andrew's Road, Higham Hill Waiting, Weighing and Consulting Rooms Borough Council. '' '' ” ” (b) The Memorial Hall, Winchester Road, Highams Park Foot Mon., Tu., Th., Fri., 2-4.30 p.m., 5.30-8 p.m., Wed. & Sat., 9.30-12 noon 60, Hoe Street Waiting Room, Treatment Room Women's 1st Wed., 2-4 p.m., monthly. Waiting Room, Consulting Room, Examination Room 22 11a. Foot Clinic.—The Foot Clinic is apparently the second Municipal Clinic to be set up in the country. The authority for setting up the Walthamstow Clinic was obtained under Section 131 of the Public Health. Act, 1875. Suitable premises were available at 69, Hoe Street, which had previously been acquired by your Council for the purpose of using its forecourt for street widening purposes. The Foot Clinic suite is situated on the ground floor of the house, which is situated in a main street and on tramway and omnibus routes. Such ground floor facilities and accessibility are essential. The suite consists of a waiting-room which also accommodates a lady clerk, a treatment room of three cubicles and a staff rest room. The adaptation and redecoration of the premises amounted to £270 and included the erection of a platform along one side of the room to take three ordinary heavy armchairs for patients, who are screened from one another by wooden partitions. Suitable lighting on a flexible arm, a cupboard and a sink, supplied with running hot and cold water, are the only other essentials. The equipment required for one chiropodist consisted of a Tan-sad operating chair, an electric nail drill, an electric vibrator, a heat lamp, an instrument table, and minor accessories. The total cost was just over £20. Staffing was considered both from the whole-time and parttime aspect. The whole-time arrangement was finally adopted and the Clinic was placed in charge of Miss Mary McCallum who trained as a chiropodist at the Chelsea School and is, in addition, a trained nurse and masseuse, both of which qualifications are of very great value. A lady clerk was appointed on a part-time basis and her duties are to record the names and addresses of patients attending, to fill in simple treatment record cards, and to collect fees. A parttime woman cleaner is also employed. Ten weekly sessions of two and a half hours each are held and after various trials these have been fixed on Monday, Tuesday, Thursday and Friday afternoons and evenings and Wednesday and Saturday mornings. The attendances have been found to vary considerably on similar sessions in successive weeks. The maximum number of patients treated by one chiropodist should not exceed 10, which allows 15 minutes for each. During a recent week, however, 121 patients were treated, but this number is far more than it is fair to expect one chiropodist to treat and has already, after only four months' experience, raised the question of employing additional assistance. Although only one chiropodist is at present employed the two spare cubicles are frequently occupied by patients receiving foot baths or radiant heat. 23 The conditions treated include corns, warts, bunions, ingrowing toenails, dropped arches, inflamed bursae, minor foot injuries and rheumatic conditions of the feet. Treatment is limited to residents in the Borough, and a fee of 1s. per attendance is charged, but is remitted in the case of old-age pensioners and unemployed persons. On the other hand, patients are invited to pay more than the fixed fee if they can afford it. Miss McCallum stresses the very real need for skilled treatment for foot ailments and states that the amount of avoidable suffering is far greater than is commonly realised. A surprising experience has been the number of school children attending for treatment in respect of multiple warts on the soles of the feet—a crippling condition and a painful one to treat. Frequently cases of an orthopaedic nature have attended and have been referred elsewhere for appropriate treatment. It has not been uncommon again to find patients suffering from interdigital ringworm—a condition often mistaken for soft corns. The chiropodist also advocates the provision of additional facilities for foot bathing and states that many patients attend who could afford to pay bigger fees which, in any case, should be charged if any considerable amount of dressing is required or if radiant heat is given. Reviewing the working of the Clinic from its inception on 19th September, 1931, up to the end of the year, 347 new patients attended and made 697 re-attendances or a total of 1,044 in 15 weeks. The total receipts were £50 12s. 6d., an average of nearly Is. per attendance, in spite of a considerable number of remitted fees. The cost of equipment and maintenance is briefly summarised below and, on the basis of the 15 weeks' working, the nett cost was iust over £91. The actual gross cost of each treatment was 2s. 6d. Equipment, etc. Maintenance (15 weeks). £ s. d. £ s. d. Appliances, etc. 20 8 6 Salaries:— Drugs and Dressings 12 2 11 Chiropodist 69 4 7 Miscellaneous 8 16 3 Part-time Clerk 20 5 0 Advertising 2 10 2 ,, Cleaner 13 10 0 Furnishing 39 13 0 Drugs 7 19 0 Part Cost of Adaptation and Redecoration 270 0 0 Rates Heat, Light and Water 9 6 12 14 5 10 Miscellaneous 1 1 9 Total £353 10 10 Total £128 7 7 Receipts 50 12 6 Nett Cost £77 15 1 24 lib. Women's Clinic.—Your Council decided during the year to set up a Women's Clinic, and the first floor of the Foot Clinic premises at 69, Hoe Street, was adapted and redecorated for this purpose. A monthly session was provided for in the scheme, and the first session was held in November. The Clinic was placed in charge of Mrs. Ivens-Knowles, C.B.E., M.S., one of the Consultants under the Puerperal Fever and Pyrexia Regulations. The functions of the Clinic are as follows:— (а) Ante and Post-Natal consultations. (b) Consultant advice and treatment for women suffering from gynaecological conditions. (c) Provision of advice on contraceptive methods for married women who attend the Clinic for such medical advice or treatment and in whose cases pregnancy would be detrimental to health. 12. Maternal Mortality.—Maternal Mortality is fully discussed in the Maternity and Child Welfare Section. 13. Children Act, 1908. The administration of Part I of the Act was taken over from the late Board of Guardians on 1st April, 1930. The arrangements then made for discharging the necessary functions were that the Medical Officer of Health was appointed the person to whom the required Notices must be sent and the Health Visitors were appointed as Infant Protection Visitors. All applicants for registration are visited and reports made to a Sub-Committee of the Maternity and Child Welfare Committee which meets weekly to deal with applications. Full details of the number of registrations and visits paid are given in the Maternity and Child Welfare Section of the Report. III. SANITARY CIRCUMSTANCES OF THE AREA. Water.—New mains have been installed in the following roads— Hollywood Way, Malvern Avenue, The Avenue, Minerva Road, Cogan Avenue, Valognes Avenue, Manor Road, roads (not yet named) on Highams Park Estate (No. 2 Section), Waller Avenue, Warwick Road, Harman Avenue, Nesta Road, The Charter Road, and St. Peter's Avenue. The supply has been entirely satisfactory in quality and quantity. No action has been necessary in respect of any form of contamination. 25 Rivers and Streams.—No action has been necessary to check the pollution of rivers and streams. Periodical cleaning of Dagenham Brook was carried out and certain works were carried out for the Essex Sewers Commissioners. Drainage, Sewerage and Sewage Disposal.—No extension of the sewerage system other than minor ones necessitated by the development of various building estates, were carried out. Consequent on the publication of the 1931 Census figures the permissible discharge of the London County Council Mains Drainage System has been increased to 6,648,250 gallons per day. The outlet from the storm-water beds at the Sewage Works has been reconstructed in an improved form. Closet Accommodation.—The number of premises draining to cesspools has been increased by four (one a sports pavilion). Fifty-five earth closets were in use at Sports Grounds at the end of the year. Scavenging and Refuse Disposal.—No alterations in the former of the above services have been carried out. The purchase of two house-refuse collection vehicles of an improved type, is at present under consideration, tenders for these having been received. With regard to refuse disposal, an additional (4-grate) unit has been installed at the existing Destructor to act as a stand-by when one or other of the original units is closed down for repairs or inspection. This is capable of destroying 54 tons of crude refuse per 24 hours. The house and trade refuse received at the Destructor amounted to 25,800 tons. Except in the case of the refuse destroyed in the new unit the tins, metal, etc., were recovered from the refuse before destruction and, so far as possible, sold. Your Council decided to take legal proceedings against any person found contravening Section 42 of the Public Health Act, 1875, which prohibits unauthorised persons from removing matter from dustbins placed out for collection, a practice more popularly known as "totting." Warning posters were exhibited and the attention of the Police and all Outdoor Staff of the Corporation was drawn to the matter. 26 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. 1931 9992 12924 1461 2641 2705 165 25760 1930 8904 7336 1703 2379 2206 119 22823 Of the 165 Statutory Notices served during 1931, 108 were complied with. The nature and variety of the work done during 1931 is shown in the following tables:— Drains tested 357 ,, reconstructed or repaired 248 ,, obstructions removed 249 ,, means of access provided 42 ,, ventilation provided or improved 41 ,, ventilation repaired 171 Soil pipes repaired 26 ,, ,, new provided 25 Rain water pipes, renewed 220 ,, ,, ,, disconnected from drains 42 Roofs repaired or renewed 711 Gutterings repaired or renewed 375 W.C. pans or traps provided 405 Gully traps provided 59 W.C. flush cisterns provided 29 ,, ,, ,, repaired 227 W.C. floors concreted 73 W.C. 's repaired and cleansed 502 Waste pipes renewed or trapped 171 ,, ,, repaired 107 New sinks provided 80 Water supply reinstated 4 ,, ,, taken off main 13 Cisterns cleansed and covered 64 Conveniences cleansed and covered 29 Sculleries paved 91 Yards and forecourts paved and repaired 466 Dirty houses cleansed 172 ,, rooms cleansed . 4,001 Floors repaired 290 Ventilations under floors provided 180 New damp-proof courses provided 276 Sites concreted 2 27 Offensive accumulations removed 47 Animals improperly kept, removed 10 Manure receptacles provided 3 Stables cleansed, paved and drained 43 Manholes repaired or re-sealed 69 Other cases of dampness remedied 361 Separate Sanitary Conveniences provided to shops where both sexes are employed 3 Miscellaneous repairs 1,605 Infectious Diseases. Visits to premises 1,500 Re-visits to premises 154 Visits in connection with Smallpox 3,690 Premises disinfected 1,067 Articles disinfected at Low Hall 12,138 ,, destroyed at Low Hall 219 Dampness in Houses. Sites concreted 2 Damp-proof courses provided 276 Yards and forecourts paved and drained 466 Roofs made watertight 711 Rain-water pipes made good 220 Guttering repaired or renewed 375 Other cases of dampness remedied 361 Ventilation under floors provided 180 House-to-House Inspections 1,015 Special Premises. Number. Visits paid. Slaughterhouses Butchers' Shops 13 576 79 673 Bakehouses 45 153 Fishmongers (fish frying and curing), etc. 62 410 Eating-houses and Coffee Stalls 61 128 Ice Cream Vendors 111 87 Cowsheds 2 22 Milkshops 202 391 Laundries 31 49 Rag and bone dealers 7 36 Elementary Schools 28 44 Private Schools 13 Piggeries 6 56 Street Stalls Numerous 108 Greengrocers 181 Factories 392 Workshops 356 Outworkers 322 28 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers' Shops and Slaughterhouses. Special cleansings, 56; Paving repaired, 8; Accumulations removed, 8; New Galvanised Bins provided, 19; Drains repaired, 3; W.C.'s repaired and cleansed, 7; Drains cleared of obstructions, 5; Yard paving repaired, 9; Floors repaired and Ventilated, 7. Bakehouses. Special cleansings, 69; Drains repaired, 2; W.C.'s cleansed and doors repaired, 13; Yards repaved, 4; Obstructions from drains removed, 1; W.C. cisterns repaired, 1; Floors repaired, 4; New ceilings fixed, 4; Roofs repaired, 2; Premises general repair, 7. Fishmongers. Special cleansings, 34; Drains cleared of obstruction, 3; Yards repaved, 7; Accumulations removed, 7; Gutters renewed, 2; Roofs repaired, 1; Other improvements, 7. Coffee and Eating Houses. Special cleansings, 18; Yard pavings repaired, 7; W.C, cisterns repaired, 1; Floors renewed, 1 Ice Cream Vendors. Special cleansings, 7; Special cleansing of Utensils, 5; Yard paving repaired, 5. Cowsheds and Milkshops. Special cleansings, 24; Pavings relaid, 6; Fittings and other improvements, 4; Roofs repaired, 2; Drains repaired, 4; Stable Premises. Cleansings, 40; Accumulations removed, 23; Roofs repaired, 6; Pavings repaired, 9; Manure receptacles provided, 1; Drains reconstructed, 1; Other repairs, 1. Laundries. Special cleansings, 11; Roofs repaired, 1; Other improvements, 6. Rag and Bone Dealers. Cleansings, 14; Pavings repaired, 1; Accumulations removed, 3. Piggeries. Cleansings, 5; Paving relaid, 1. 29 Smoke Abatement.—Seven instances of nuisances arising from smoke have been observed and dealt with. Personal visits to the factories concerned have proved that in six cases bad stoking and/or wrong fuel was the cause of the nuisances. The persons responsible carried out all suggestions made to abate the nuisances. One Factory Bakehouse was the cause of repeated complaints of Smoke Nuisance and several observations were made by your Senior Sanitary Inspector between the hours of 6 p.m. and 6 a.m. when the factory was in use and serious nuisances were observed. In this instance it was found that the life of the furnace was past, and legal proceedings were authorised but suspended, due to the owners' promise to provide new ovens and furnaces without delay. This was done and no complaints have since been made. Premises and Occupations which can be Controlled by Bye-Laws or Regulations.—The number of Offensive Trades in the area was:— (а) Fish Curers 24 (b) Fish Friers 40 (c) Rag and Bone Dealers 7 Slaughterhouses 13 Bakehouses 46 (35 of these are Factory premises.) Tents, Vans, Sheds, etc.—There are four areas in Higham Hill Ward where numerous van dwellers have congregated and to which the Byelaws apply. The total number of vans in the area is 53. In addition, certain areas of land are used periodically by showmen as Fair Grounds, and at such times the Byelaws are put into operation in respect thereof. The "permanent" caravan sites have been repeatedly inspected. 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 School Medical Officer's Report gives a detailed account of the sanitary improvements effected during 1931. The Rag Flock Acts, 1911 and 1928.—There are no known premises in the Borough on which rag flock is manufactured or sold. 30 IV. HOUSING. (a) Statistics. The particulars of new houses erected during 1931 are given in the form prescribed by Circular 1119 for the 1930 Report in view of the absence of any prescribed form for the current report. In addition, the Engineer and Surveyor has kindly given separate particulars as to houses erected up to and following the Census night, viz., 26th/27th April. When the detailed Census returns become available it will then be possible to estimate at the end of each year the number of inhabited houses in each Ward—due allowance being made for any demolitions, either Statutory or voluntary. The total of 695 houses erected during 1931 compares favourably with the 663 houses built during 1930. The following are the figures and notes supplied by the Engineer and Surveyor:— Number of New Houses erected during the vear:— (a) Total (including numbers given separately under (b):- 1.1.31 to 26.4.31. 27.4.31 to 31.12.31. 1.1.31 to 31.12.31. (i) By the Local Authority 40 66 106 (ii) By other Authorities Nil. Nil. Nil. (iii) By other bodies and persons 158 431 589 (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. Nil. Nil. (b) For the purpose of Part III of the Act of 1925 and under the Housing Financial Provision Act, 1924 40 *66 *106 (c) For other purposes Nil. Nil. Nil. (ii) By other bodies or persons Nil. Nil. Nil. The 695 houses were situated as follows:— 1.1.31 to 26.4.31. 27.4.31 to 31.12.31. 1.1.31 to 31.12.31. Hale End Ward 141 340 481 High Street Ward 2 — 2 Higham Hill Ward 44 *102 *146 Hoe Street Ward — 13 13 St. James Street Ward — — — Wood Street Ward 11 42 53 *Includes four Flats, counted as two Houses. 31 The number of Council houses in course of erection (or about to be erected) at the end of the year was 76, these being on the Spion Kop (No. 2) Site; while preparation is being made for a further 70 houses at Higham Hill No. 1 Site (Millfield Avenue) (1930 Act), and for 136 houses at Essex Hall Site. The erection of 90 houses at Kimberley Road Site and 136 houses at The Chestnuts Estate is under consideration. The following information is given in the form required by the Ministry of Health (Circular 1206):— I .—Inspection of Dwelling-houses during the Year. (1) (a) Total number of dwelling-houses inspected (for housing defects under the Public Health or Housing Acts) 4,273 (6) Number of inspections made for the purpose 16,749 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,015 (b) Number of inspections made for the purpose 4,038 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,668 II.—Remedy op 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 2,705 III.—Action Under Statutory Powers During the Year. A. Proceedings under Section 17 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 145 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (а) By owners 86 (b) By Local Authority in default of owners (at a cost of £17 10s. 9d.) 3 32 B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 20 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 20 (b) By Local Authority in default of owners Nil C. Proceedinqs under Sections 19 and 21 of the Housinq Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 3 (2) Number of dwelling-houses demolished in suance of Demolition Orders Nil. D. Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. E. Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil F. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which Closing Orders were made Nil 33 (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling- houses having been rendered fit Nil (3) Number of dwelling-houses in respect of which Demolition Orders were made Nil (4) Number of dwelling-houses demolished in suance of Demolition Orders Nil (b) General. Your Council decided during the course of the year to allocate, for special consideration in respect of rehousing, on medical grounds, 10 per cent, of the new houses erected. Up to the end of the year recommendations had been confined to urgent cases of infectious pulmonary tuberculosis (i.e., T.B. plus cases). Dr. Sorley, the Tuberculosis Officer, has co-operated heartily in providing the fullest information about the housing conditions of the patients. At the end of the year four tuberculous cases had been rehoused, one case had been rejected, whilst in two cases the rent of a Council house could not be paid. Unfortunately, the most needy cases, both on grounds of health and overcrowding, are only too frequently those which cannot pay the necessarily higher rent. The provision of accommodation at between eight and ten shillings per week is an increasingly urgent problem for such cases. In addition to cases recommended for rehousing on medical grounds, 112 letters of application for Council houses which have been sent to the Public Health Department have been replied to and forwarded for the attention of the Housing Committee. Plans are now before the Ministry of Health, awaiting approval, in respect of 70 houses (20 special type for aged couples, 24 of two bedrooms, 20 of three bedrooms, and 6 of four bedrooms), for the purpose of rehousing tenants to be displaced from the various areas and individual houses which have been scheduled for clearance under Part I of the Housing Act, 1930. No new applications for Council houses had been accepted for some years until the register was reopened on 1st October. Mr. J. E. West, your Council's Housing Manager, has kindly supplied the information for the following:— 34 No. of tenancies on Rental Register, 31.12.31 1,096 No. of applicants on Housing Register, 31.12.31 1,948* Deduct—No. of applicants allotted houses 61 No. of applications remaining on Register 1,887 (* Including 114 applications brought forward from the old register.) Early in 1932 a new scheme of analysing applications was brought before the Housing Committee by Mr. West and was adopted. Briefly, each category defines the average number of persons per room (including kitchen, but excluding scullery) in the existing accommodation. An analysis of the 1948 applications on 31st December, 1931, showed the position to be as follows:— Category A. (Over 3 persons per room) 109 „ B. ( „ 2 „ ,, ) 236 „ C. ( „ 2 ,, ,, ) 244 „ D. (Less than 2 persons per room) 1,091 ,, O. (Ample existing accommodation, unmarried persons or childless couples).. 153 ,, E. Applicants allotted houses 61 ,, F. Deferred cases 9 ,, G. Cancelled applications 45 Total 1,948 By the 11th January, 1932, the Category A cases had increased to 106 out of a total of 1931 applications and an analysis of these cases made by Mr. West on this date was as follows:— Unsuitable Not clean 37 Unable to pay minimum rent of approximately 15s. 17 Doubtful ability to pay rent 10 Transferred to other categories 10 Unsatisfactory enquiries—no reply after two visits 8 82 Allotted houses handed over during enquiry period 10 Suitable for allotment subject to satisfactory references 14 24 Total 106 The analysis given above cannot be viewed with equanimity inasmuch as 82 out of 106 applicants were found to be unsuitable for 35 tenancies. When it is remembered that each was a Category A case, i.e., over three persons per room, the practical difficulties in abating overcrowding will be apparent. General Observations. The average type of house contains three bedrooms, kitchen and scullery. The primary defects found were dirty premises, general dilapidations and dampness. How far dampness was prevalent in houses was evidenced by the number of houses in which new damp courses were inserted during the year, viz., 276. The neglect to insert proper damp proof courses in main, dwarf and sleeper walls during construction of houses was more apparent than ever, and a considerable amount of good and sound work of a structural nature in this connection was accomplished during the year under review. These works were of a costly nature and much patience had to be shewn and many interviews with property owners were necessary to accomplish such improvements. V. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The average number of cows kept in the district was 14. The cowsheds numbered two and 22 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 202, most of whom carry on a general shop and sell milk in bottles as they receive it. Three hundred and ninety-one 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 72 samples of milk were taken for bacteriological count and of these 36 were biologically tested for the presence of the tubercle bacillus. In addition, two samples of Pasteurised Milk were tested for tubercle only. The samples taken are summarised below:— Grade of Milk. No. of Samples. No. tested for T. B. Grade A (T.T.) 14 10 Grade A (Pasteurised) 1 1 Grade A 2 1 Pasteurised 36 12 Raw 19 14 Total 72 38 Only one sample—a raw milk—proved tuberculous. The necessary information was sent to the County Medical Officer of 36 Health, as a result of which a herd in another area was inspected and the diseased animal was slaughtered. The following table gives the actual bacteriological findings in the 72 samples:- BACTERIOLOGICAL ANALYSIS OF MILK SAMPLES. Date. Grade of Milk. Total Bacteria per c.c. Bacillus Coli absent in. Presence of Tubercle Bacillus (biological test). Remarks. 20.1.31 Raw 38,000 0.001 c.c. No test Satisfactory. „ „ 36,000 0.001 c.c. Present Satisfactory count. „ „ 21,000 0.01 c.c. No test Satisfactory. „ „ 240,000 0.0001 c.c. Absent Unsatisfactory. „ „ 19,000 0.01 c.c. „ Satisfactory. „ ,, 28,000 0.01 c.c. „ „ 27.1.31 Grade A (T.T.) 17,000 0.01 c.c. „ „ ,, Pasteurised 19,000 0.1 c.c. No test „ „ „ 16,000 0.01 c.c. „ „ „ „ 31,000 0.01 c.c. „ „ 3.2.31 Grade A (T.T.) 5,200 0.01 c.c. Absent „ „ ,, 310,000 0.001 c.c. „ Unsatisfactory count. „ Pasteurised 420,000 0.00001 c.c. „ „ „ 5.2.31 ,, 6,300 1.0 c.c. „ Satisfactory. „ ,, 300,000 0.00001 c.c. „ Unsatisfactory count. „ „ 210,000 0.001 c.c. „ „ „ „ „ 240,000 0.01 c.c. No test „ „ 5.3.31 Raw 22,000 1.0 c.c. Absent Satisfactory. „ „ 21,000 1.0 c.c. „ „ „ „ 17,200 1.0 c.c. „ „ „ „ 15,600 0.1 c.c. „ „ „ „ 26,000 0.01 c.c. „ „ 23.4.31 Grade A. (T.T.) 63,000 0.01 c.c. „ „ 28.4.31 Raw 34,000 0.01 c.c. „ „ „ ,, 15,000 1.0 c.c. „ „ „ Grade A. (Past.) 6,700 0.1 c.c. „ „ „ Pasteurised 26,000 0.1 c.c. „ „ „ „ 31,000 0.1 c.c. No test „ „ „ 16,000 0.1 c.c. Absent „ „ „ 24,000 0.1 c.c. „ „ „ „ 44,000 0.01 c.c. „ „ „ Grade A. 35,000 0.01 c.c. „ „ „ Grade A. (T.T.) 13,000 0.01 c.c. „ „ 12.5.31 Pasteurised 410,000 0.001 c.c. No test Unsatisfactory. „ „ 22,000 0.1 c.c. „ Satisfactory. „ Grade A. (T.T.) 310,000 0.001 c.c. Absent Unsatisfactory. 21.5.31 Pasteurised 73,000 1.0 c.c. ,, Satisfactory. „ „ 53,000 0.1 c.c. No test „ „ Grade A. (T.T.) 26,000 0.01 c.c. Absent „ „ Pasteurised 72,000 0.01 c.c. No test „ „ Grade A. (T.T.) 44,000 0.01 c.c. Absent „ 28.5.31 Raw 54,000 0.01 c.c. No test „ ,, Grade A. (T.T.) 17,000 0.01 c.c. „ „ 37 Date. Grade of Milk. Total Bacteria per c.c. Bacillus Coli absent in. Presence of Tubercle Bacillus (biological test). Remarks. 28.5.31 Pasteurised 25,000 1.0 c.c. No Test Satisfactory. „ „ 31,000 0.1 c.c. „ „ 18.6.31 Grade A. (T.T.) 11,000 0.01 c.c. „ „ „ Pasteurised 11,500 1.0 c.c. „ „ ,, Raw 179,000 0.0001 c.c. „ „ 7.7.31 Pasteurised 9,300 Not stated „ „ „ „ 11,000 „ „ „ „ „ 300,000 „ „ Unsatisfactory. „ „ 3,200 „ „ Satisfactory. 23.7.31 „ 58,000 „ „ „ „ „ 13,600 „ „ „ ,, Grade A. 91,000 0.001 c.c. „ Unsatisfactory. „ Pasteurised 54,000 Not stated „ Satisfactory. 27.8.31 Grade A. (T.T.) 9,800 0.01 c.c. „ „ „ Pasteurised 32,000 1.0 c.c. „ „ „ Grade A. (T.T.) 16,000 0.01 c.c. „ „ „ Pasteurised 14,900 1.0 c.c. „ „ 29.10.31 „ 6,400 Not stated „ „ „ „ 4,900 „ „ „ „ „ 3,900 „ Absent „ „ Raw 36,000 „ „ „ „ „ 6,100 „ „ „ 14.11.31 Pasteurised 180,000 „ No test Unsatisfactory. „ ,, 320,000 „ „ „ 3.12.31 Grade A. (T.T.) 13,800 0.01 c.c. Absent Satisfactory. „ „ „ 20,300 0.01 c.c. „ „ „ Pasteurised 9.400 1.0 c.c. No test „ 22.12.31 Raw 100 1.0 c.c. Absent „ „ „ 120 1.0 c.c. „ „ 29.12.31 „ — — „ „ " Pasteurised — — „ „ Eight samples of Ice Cream were analysed with one unsatisfactory result. The manufacturer was warned and his premises were improved and cleansed with the result that later samples proved satisfactory. The following were the analyses of the samples:— Date. Total Bacteria per c.c. Remarks. 23.7.31 7,200,000 Excessive number of bacteria; not a clean product. „ 150,000 Bacterial count not excessive, but less than 100,000 can readily be obtained. „ 170,000 „ „ „ „ 15,800 Satisfactory product. „ 23,000 „ „ 27.8.31 31,000 „ „ „ 45,000 „ „ „ 210,000 Bacterial count not excessive, but would be too high for a pasteurised product. 38 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 1931 with the following results:— 29 were found to be free from tubercle bacilli. 5 gave inconclusive results owing to the death of the guinea-pigs from intercurrent infection. Your Council during the year supported a resolution made by another Authority to the effect that all vendors of Ice Cream should be compulsorily registered, but added that a definite standard of bacteriological purity should be defined by the Minister of Health. One important Authority is already presenting a Bill seeking powers of registration in respect of all premises manufacturing or selling "processed" food of any kind. Support was also given to a further resolution by another Authority urging the Minister of Health to state a definite bacteriological standard for raw milk. 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 five summonses under Section 31 (2) of this Order were issued against offenders. In addition to the convictions detailed under ' 'Legal Procedure'' the Council issued two warnings to dairymen in connection with breaches of this Order by their employees. The Milk and Dairies (Amendment) Act, 1922 (Section 4). One summons was issued against an employee of a dairy firm for an offence under this Section, and although no actual sample of the milk so adulterated was obtained, the Justices imposed a penalty of 50s. and 6s. costs on the defendant. (See "Legal Procedure.") 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 as follows:— Dealers' Licences. Supplementary Licences. In respect of:— In respect of:— Certified Milk 6 Certified Milk 1 Grade A (T.T.) Milk 15 Grade A (T.T.) Milk 3 Grade A Milk 2 Grade A Milk 3 Pasteurised Milk 13 Pasteurised Milk 5 39 Bottling Licences:— In respect of Grade A (T.T.) Milk,2; Pasteurised Milk, 4. (b) Meat and other Foods. A total of 576 visits were paid to slaughterhouses. The following were condemned and destroyed:— (1) Tuberculosis. (2) Other Reasons. 173 Ox Lungs. 27 Ox Livers. 42 Ox Livers. 2 Ox Kidneys. 14 Ox Heads. 2 Sets Ox Fats. 17 Sets Ox Fats. 1 Hindquarter of Chilled Beef. 5 Sets Ox Tripes. 4 Forequarters of Beef. 5 Forequarters Beef. 3 Flanks Beef. 2 Hindquarters Beef. 1 Ox Head. 25 Ox Hearts. 3 Thick Flanks Beef. 1 Ox Skirt and Mesentery. 2 Ox Loins. 24 Ox Skirts. 144 Pigs' Lungs. 4 Rumps Beef. 2 Pigs' Heads. 1 Ox Mesentery. 2 Forequarters Pork. 1 Side Beef. 22 Pigs' Livers. 2 Sets Ox Intestines. 2 Joints Pork. 1 Carcase Beef and all Organs. 1 Whole Pig and Offal. 1 Brisket Beef. 1 Pig's Belly. 22 Pigs' Heads. 143 Sheeps' Lungs. 9 Sets Pigs' Fats. 57 Sheeps' Livers. 4 Pig Carcases, all Organs and Fats. 1 Sheep's Carcase. 1 Lamb's Pluck. 32 Pigs' Livers. 5 stones Fresh Haddocks. 4 Pigs' Lungs. 11 stones Skate. 5 Pigs' Hearts. 5 stones Monk Fish. 3 Pigs' Mesenteries. 2 stones Cod. 2 Pigs' Plucks. 31 Sacks Potatoes. 2 Forequarters Pork. 30 Californian Plums. 2 Hindquarters Pork. 4 Cow Carcases, all Organs and Fats. 2 Forequarters Cow Beef. 3 Sets Tripes. 1 Set Mesenteric Fats. 1 Cow's Udder. 2 Cows' Heads. 1 Thick Skirt. 1 Calf's Pluck. (c) Adulteration, etc. (Food and Drugs Adulteration Act, 1928.) Eighty-nine samples of milk were submitted for analysis during the year. 40 Of these, 81 were genuine, and 8 were not up to the standard. One prosecution involved five of these latter samples, and the others were of a minor character and were followed up and further samples proved genuine. (d) Food Poisoning. Particulars were received by your Medical Officer of Health on 25th July from H.M. Coroner of a fatal case of suspected food poisoning. Arrangements were made for obtaining post-mortem specimens and these, on examination at the Ministry of Health's Laboratory, showed death to have been due to food poisoning caused by Bacillus Aertrycke. Detailed enquiries showed that the patient, his wife, his married daughter and her daughter (the latter from a separate household) all suffered from gastro-enteritis. The articles of food most under suspicion were pork, veal, and ducks eggs, and the relevant information is set out in tabular form below. Deceased. Deceased's wife. Deceased's single daughter. Deceased's married daughter. Deceased's son-inlaw. Deceased's granddaughter. Pork eaten 11th & 13.7.31 11.7.31 11.7.31 Nil Nil Nil. Veal eaten 12.7.31 12.7.31 12.7.31 Nil Nil Nil. Ducks' eggs eaten Two on Nil Nil One on Two on (?). 13.7.31 12th & 12 & 13.7.31 13.7.31 Illness began 13.7.31 12.7.31 Nil 21st.7.31 Nil Yes. Investigations P.M. specimens Blood agg. Faeces negative Blood negative Nil done Faeces B. aertrycke. B. aertrycke 1/120 faeces B. aertrycke faeces negative Infection was probably carried by the pork and ducks' eggs and not by the veal (the single daughter ate most of this). The deceased had not only eaten a double quantity of pork, but had also consumed two ducks' eggs. The finding of Bacillus Aertrycke (one colony only) in the grand-daughter's faeces is inexplicable— unless she was given a spoonful of duck's egg. No other cases of suspicious illness were found in spite of enquiries at the shops where each of the three articles of food were sold. The pork was from a pig slaughtered locally on the 9th July and passed for consumption when inspected after slaughter. It was one of a batch bought in an adjoining area, removal of which had been sanctioned by the Local Authority of the area under the Regulation 41 of Movement of Swine Order of 1922. A case of swine fever had occurred at an adjoining piggery some time previously. The ducks' eggs had been freshly delivered on 7th and 8th July to the local multiple shop which had supplied them and were from Suffolk and Ireland respectively. The veal had been supplied from Smithfield Market. The occurrence of swine fever at the piggery adjoining the one from which the pig slaughtered in the Borough was supplied is suggestive, but even if this was the source of infection there would be little likelihood of naked eye evidence of contamination or of unfitness for food. Ducks' eggs have frequently been proved to be a common vehicle of infection for B. Aertrycke and here again there would probably be no signs of unfitness. OFFENSIVE TRADES. During the year the Council sanctioned the establishing of the following:— Fish Curer, 1; Fish Frier, 1; Rag and Bone Dealer, 1; and granted renewal licences as follows:— Fish Friers, 4. During the year one licensed establishment for rag and bone trading was permanently closed down. During the year the Council refused to sanction the following Offensive Trades Fish Friers, 4; Fish Curer, 1. Proceedings were instituted against a fish curer for carrying on the trade without a Licence from the Council. A penalty of 20s. was imposed and a licence refused. Legal Procedure. Fine. Costs. Food and Drugs (Adulteration) Act, 1928:— Sample of Milk containing 6% of added water 20s. 12s. The Milk and Dairies Order, 1926 (Section 31) (2):— Information against three employees for 20s. — filling bottles with Milk other than on 50s. 6s. registered premises 40s. Information against two Dairymen for filling bottles with Milk otherwise than 20s. — on registered premises 20s. — 42 The Milk and Dairies (Amendment) Act, 1922 (Section 4):— Fine. Costs. Information against employee for adding water to Milk with the intent that it would be sold as Milk 50s. 6s. The Public Health Acts, 1875 (Section 112) and 1925 (Section 44), and the Byelaws, 1913:— Information against a Fish Curer for establishing the trade of a Fish Curer without the sanction of the Council 20s. — The Petroleum Consolidation Act, 1928:— Information against Garage Proprietor for Storing Petroleum Spirit without a Licence from the Council £5 £2 7s. Od. THE RENT AND MORTGAGE RESTRICTIONS ACTS, 1920-1923. During the year 16 certificates were granted to tenants and 7 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 comply fully with requirements specified on the certificate granted to the tenants, no clearance certificates are issued. DISEASES OF ANIMALS ACTS, 1894-1928. Great Britain (Foot and Mouth Disease) Regulation of Movement Order, 1931.—The Minister of Agriculture and Fisheries issued the above Order in June, and as a result the following animals were allowed into the Borough under Licence as follows:— Sheep and Lambs 430 Cattle 112 Pigs 128 Total 670 All the above Licences were issued by your Inspector under the above Acts. Twenty-one milch cows were admitted under an Occupation Licence under this Order. 43 Sheep Scab Order, 1920. —No cases of this disease occurred in the Borough during the year. The Council adopted the Sheep Scab Order of 1928 during the year, and under licence of this Order 496 sheep were admitted into this Town for slaughter. The requirements as to dipping have been carried out. The Regulation of Movement of Swine Order, 1922.—Under this Order 1,468 pigs for slaughter were admitted into this Borough during the year. All notices of such movements have, as far as practicable, been followed up. In addition, 7 pigs were admitted on detention licences and the periods of detention carried out. Tuberculosis Order, 1925.—Routine quarterly inspections were carried out by your Veterinary Surgeon and three samples of Milk from a suspected cow were submitted for biological tests, but each gave a negative result. Poisons and Pharmacy Act, 1908.—No licences were issued 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. (i) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories (Including Factory Laundries.) 427 11 Nil. Workshops (Including Workshop Laundries.) 335 9 Nil. Workplaces (Other than Outworkers' premises.) 56 2 Nil. Total 818 22 Nil. 44 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) Nuisances under the Public Health Acts:— Want of cleanliness 29 29 — — Want of ventilation 5 5 — — Overcrowding — — — — Want of drainage of floors 6 6 — — Other nuisances 28 28 — — Sanitary accommodation insufficient 5 5 — — unsuitable or defective 25 23 - - not separate for sexes 1 1 — — Offences under the Factory and Workshops Acts— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences — — — — Total 99 97 — - NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1931. Wearing Apparel, making of 352 Furniture and Upholstery 2 Brush making 26 Fur Pulling 2 Paper, etc., Boxes, Paper Artificial Flowers 2 Bags 21 Umbrellas, etc. 1 Carding, etc., of Buttons 5 Stuffed Toys 1 Cosaques, Christmas Crackers and Stockings 3 Total 415 45 OUTWORKERS WERE NOTIFIED FROM THE FOLLOWING AREAS:— City of London 128 Leyton 41 Bermondsey 3 Poplar 6 Bethnal Green 18 St. Marylebone 4 Battersea 3 Stoke Newington 5 Finsbury 29 Stepney 5 Hackney 56 Shoreditch 13 Islington 5 Tottenham 5 Walthamstow 63 Westminster 9 A total of 337 visits were paid in connection with outworkers, as follows:—To Homes, 282; Factories, 37; Workshops, 18. VI. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. General.—The accompanying tables show the age and ward incidence of the various infectious diseases which are discussed separately in later pages of the Report:— Disease. All ages Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. 1931 1930 Smallpox 67 189 — 2 24 18 17 6 — Scarlet Fever 451 607 3 92 269 48 36 3 — Diphtheria 324 509 7 65 203 30 14 5 2 — Enteric Fever 38 5 — 9 14 6 6 1 Pneumonia 211 139 3 30 37 37 50 36 18 Puerperal Fever 11 14 — — — 4 7 — — Puerperal Pyrexia 30 8 — — — 7 23 — — Ophthalmia Neonatorum 8 8 8 — — — — — — Erysipelas 61 57 — 3 4 2 11 37 4 Encephalitis Lethargica 2 2 — - — — 2 — — Cerebro-spinal Meningitis 1 3 — — 1 — — — — Chicken Pox 1260 693 29 282 912 32 4 1 — Tuberculosis 190 159 3 6 20 63 72 21 5 Poliomyelitis 1 — — 1 — — — — — Totals 1931 2655 — 53 490 1484 247 242 1ll 28 1930 — 2393 43 420 1329 335 233 96 35 46 Disease. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Smallpox 12 4 20 13 4 14 Scarlet Fever 120 48 57 28 85 113 Diphtheria 58 54 47 40 47 78 Enteric Fever 11 7 5 2 4 9 Pneumonia 59 44 16 19 32 41 Puerperal Fever 2 1 1 2 2 3 Puerperal Pyrexia 3 3 8 3 8 5 Ophthalmia Neonatorum 3 1 3 — — 1 Erysipelas 10 14 7 6 5 19 Encephalitis Lethargica — — — — 2 — Cerebro-spinal Meningitis — — — — — 1 Chicken Pox 133 228 89 108 220 482 Tuberculosis 28 36 33 18 38 37 Poliomyelitis — — — — — 1 Totals 1931 439 440 286 239 447 804 1930 592 430 381 260 286 444 Disease. Total. Removed to Hospital Per cent. removed to Hospital. Deaths. Deaths per cent. notified. Smallpox 67 67 100.0 Nil. Nil. Scarlet Fever 451 359 79.6 2 0.44 Diphtheria 324 303 93.3 11 3.4 Enteric Fever 38 37 97.3 1 2.6 Pneumonia 211 41 14.6 108 51.2 Puerperal Fever 11 7 63.6 1 2.4 Puerperal Pyrexia 30 20 66.6 Ophthalmia Neonatorum 8 1 12.5 Nil. Nil. Erysipelas 61 19 31.1 — — Encephalitis Lethargica o 1 50.0 1 50.0 Cerebro-spinal Meningitis 1 1 100.0 Nil. Nil. Chicken Pox 1260 2 0.01 Nil. Nil. Tuberculosis 190 138 72.2 108 56.8 Poliomyelitis 1 1 100.0 Nil. Nil. The 1930 totals are inserted for the purpose of comparison and show welcome decreases, except in respect of Enteric Fever, Pneumonia, Puerperal Fever and Pyrexia and Chicken Pox. The very large increase in the incidence of the latter was of minor importance as regards the public health, but took up a great amount of time which could have been employed far more profitably in other directions. Of the total notifications the following were made by the Staff of the Department:— Smallpox, 28; Diphtheria, 93; Non-Clinical Diphtheria, 22; Scarlet Fever, 22; Chicken Pox, 313; Enteric Fever, 3. 47 Infectious Disease Clinic.—This Clinic was held weekly as in previous years but, owing to alterations in times of other Clinics, it is now held on Tuesday at 2 p.m. instead of 9 a.m. as before. The statistics for 1931 are shown in tabular form:— Number of sessions held 52 Number of patients attended 2,481 Number of attendances made 2,824 Average attendance per session 54.3 Number of Scarlet Fever cases discovered 6 Number of Clinical Diphtheria cases discovered 19 Number of Non-Clinical Diphtheria cases discovered 22 Number of patients given antitoxin at Clinic 27 Number of virulence tests taken in Diphtheria carriers 21 Number of tonsillectomies performed on chronic virulent Diphtheria carriers 4 Number of Children recommended for Rheumatism Clinic 43 Number of Children recommended for Convalescent Home Treatment 20 The number of contacts attending was 2,481 against 1,780 last year. Attendances were 2,824 against 2,352, the average attendance per session increasing from 45.2 in 1930 to 54.3 in 1931. The value of the Clinic was proved beyond doubt by the number of actual cases of infectious disease discovered. The 27 cases to which antitoxin was given were "bacteriological" cases who either could not or would not enter Hospital. Virulence tests totalling 21 were done in all chronic carriers, and following proved virulence four cases had their tonsils removed with successful results in terminating the carrier state. All these operations were done in the cubicle block of the Sanatorium. The establishment of the Rheumatism Clinic by the Education Authority has proved a very real advantage for the purpose of referring cases of Rheumatism and Heart Disease following infectious disease. Altogether, since June, 1931, 40 cases were referred as follow:— No. of Hospital No. of cases No. with early Disease. discharges from referred. Rheumatic Heart which selected. Disease. Scarlet Fever 198 30 11 Diphtheria 200 10 5 There is every reason to hope that cardiac crippling will be reduced to a minimum by the supervision and treatment given at the Rheumatism Clinic. 48 MUNICIPAL LABORATORY. The following work was carried out during the year:— Total. Positive. Negative. Medical Health Practitioners. Dept. Diphtheria Swabs 3,119 294 2,825 1,487 1,632 The number of swabs examined during the previous year was 3,936. In view of the number of Diphtheria swabs which were found to give negative results after 24 hours incubation and positive results after 48 hours, it was decided, in October, 1931, to incubate all specimens for the longer period. If. after 48 hours incubation, the specimen shows the presence of Klebs Loeffier Bacillus, a corrected report is sent immediately. The results have more than justified the additional work involved. During 1931 a total of 5,770 culture media were made by Mr. West, the Laboratory Assistant, as compared with 7,840 during 1930. In addition to Diphtheria swabs, the following specimens were also examined:— Urine, 97; Ringworm, 4; Tuberculosis, 1; Gonococcus, 1. The Essex County Council also provide facilities for examination of pathological specimens and the County Medical Officer states that 1,161 specimens were examined for local Practitioners during 1931 as follows:— Diphtheria Swabs, 213; Sputa, 749; Typhoid Specimens, 144; Ringworm Specimens, 33; Miscellaneous Specimens, 22; Total, 1,161. The total of the previous year was 882. (A) SMALLPOX. A total of 67 cases were notified during 1931 and of these 31 occurred during January and February in several different portions of the Borough and suggesting spread by Christmas festivities. Thirty-four cases were notified by private Practitioners and 33 by the Staff of the Public Health Department. In particular, there were during these months, two definite series of cases originating from Winns Avenue Senior Girls' School and Wood Street Junior Boys' School. The first case from Winns Avenue School had attended there while in an infectious condition between the 12th and 16th January 49 and gave rise to six secondary school cases—four of which showed a prolonged incubation period of 16 days. The Wood Street case had attended school while infectious between 16th and 21st January, and gave rise to two further school cases. One of these cases in turn gave rise to four further cases at his home. During the same period two other families (unconnected with the school cases detailed above) showed multiple cases—five in one instance and four in another. Later in the year another school child had attended Mission Grove Infants' School for five days whilst infectious but no further cases apparently arose. In each of the schools the detailed supervision outlined in the 1930 Report was adopted and worked admirably with the co-operation of the School Attendance Department. Four other scholars had attended their various schools on the day of onset only of their Smallpox, but in each case no further cases were found. The table shows the monthly incidence by ages and wards:— All ages. Under 1 yr. 1-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 & over. January 13 — 1 4 4 2 2 — February 18 — — 11 2 4 1 — March 5 — — 1 2 1 1 — April 5 — — 1 2 2 — — May 3 — — — 2 1 — — June - - - - - - - - July 5 — — — 3 2 — — August 2 — — — 1 — 1 — September 1 — — — — 1 — October 8 — — 4 1 2 1 — November 3 — 1 2 — — — — December 4 — — 1 1 2 — — Totals 1931 67 - 2 24 18 17 6 - 1930 189 1 11 71 56 34 14 2 50  St. James' Street. High Street Hoe Street. Wood Street. Hale End. Higham Hill. January — 2 — 7 — 4 February — — 5 5 1 7 March 1 — 2 1 — 1 April — — 3 — 2 — May 1 1 1 — — — June — — — — — — July 5 — — — — — August 2 — — — — — September 1 — — — - — October 2 — 5 — 1 — November — — 3 — — — December — 1 1 — — 2 Totals 1931 1930 12 57 25 20 44 13 13 4 11 14 39 Of the 67 cases, 58 were unvaccinated, the ages of the remaining 9 (vaccinated in infancy) being 61, 60, 55, 55, 52, 51, 40, 30 and 21 years. Thirty-four patients were infected by previous cases in the Borough and 12 cases were infected outside the Borough, leaving 21 unaccounted for. Of the 12 outside infections, 4 were probably at a billiard saloon in an adjoining area and gave rise to 2 further cases in Walthamstow. One of this series was actually sent to the Isolation Hospital as a case of Scarlet Fever. Presumably a scarlatiniform prodromal rash had been present. Fortunately the patient was only in a general ward for some two hours before he was transferred to the cubicle block where the correct diagnosis soon became obvious. All contacts not recently vaccinated were either vaccinated or revaccinated and no further cases arose. Three cases were infected at one place of employment outside the Borough. Only 2 of the 12 cases infected elsewhere had previously been notified as having been contacts at their place of employment. 51 One patient, aged 21 years, and successfully vaccinated in infancy, was notified as suffering from Chicken Pox. Onset was on the 8th April, the rash appeared on the 10th, and she was removed to Hospital with a tentative diagnosis of Smallpox on the 11th and revaccinated as a precautionary measure on the same day. Although the revaccination was successful the case was counted as one of Smallpox. Eight cases were sent into Hospital during their prodromal illness, i.e., before the appearance of the rash, which appeared in due course. In this way dissemmination of infection in the home was reduced to an absolute minimum. The number of contacts notified by other Authorities was 134 as compared with 1,175 during 1930—a very welcome decrease. The following Authorities sent notifications of contact in respect of Walthamstow residents employed in their areas:—City of London, 12; Borough of: Hackney, 10; West Ham, 8; Shoreditch, 8; Finsbury, 8; Poplar, 4; Stepney, 2; Leyton, 2; Bethnal Green, Southend-on-Sea, Holborn, Ilford, Chelsea, Islington and Chelmsford, 1 each: Loughton U.D.C., 1; and Merton and Morden U.D.C., 1. The series of 67 cases represented 46 households with 63 families and 299 "home" contacts. Multiple cases occurred in 10 of these households thus:—6 cases (once), 5 cases (twice), 4 cases (once), 2 cases (in 6 households). In 11 of these cases vaccination had been performed (and successfully in 9), but not sufficiently early to prevent the development of Smallpox. The earliest date at which these vaccinations had been done was 8 days before the onset of symptoms (3 cases), so that it is fair—assuming the average incubation period to be 12 days—to claim that successful vaccination within 3 days of the initial exposure to infection protected these contacts. From a perusal of the case papers the most infectious period appeared to be the day of the appearance of the rash and only 2 cases appeared to have been infected on the day preceding the rash. No evidence was found pointing to infectivity before this period. The general scheme of control was detailed in the 1930 report. Unfortunately, some of the confidential information contained in the circulars sent to other areas was misused with the result that not only were many contacts (living in Walthamstow but working elsewhere) suspended from work without pay, but some were dismissed. Frequently contacts are aware of the risk attending the disclosure of the nature and place of their employment, and in one case information as to contact was deliberately withheld with the result that Smallpox was carried into an adjoining area. This case 52 was reported to your Committee, but legal proceedings were not deemed to be advisable and a written caution was sent. A notice was later exhibited in the local press drawing attention to the penalties for failure to give information. A total of 879 visits was made by the Medical Staff and 3,690 by the Sanitary Staff. HOSPITAL TREATMENT OF SMALLPOX. Sixty-seven cases of Smallpox were admitted for Isolation and treatment, and 5 further cases for observation—the diagnosis not being confirmed in the latter. All the observation cases were vaccinated either before or immediately after admission. The average stay in Hospital was 20.2 days for actual cases, 10.2 days for observation cases, and 19.3 days for all cases. Although several cases showed a semi-confluent eruption, only one case caused any anxiety. This patient, on his 16th day in Hospital, developed Appendicitis and one of the small huts was hastily improvised as an operating theatre. The appendix, on examination after removal, showed a small area of early inflammation due to a single thread worm. The patient made an uneventful recovery. The only complication of note was conjunctivitis, of which 13 cases occurred. Some were severe but responded to treatment and there was no apparent impairment of vision. The Hospital was closed for two hours on 23rd March; for 31 days from 23rd May; for 24 days from 4th September, and for two days from 24th December. The longer periods of closure were utilised for renovation and redecoration, for which special provision, amounting to £100, was made. The approximate cost of Smallpox treatment during the calendar year was estimated to be £1,476. Grateful acknowledgment must again be made to the Matron and the Nursing Staff for the smooth and efficient working of the Hospital. Vaccination.—Mr. E. Sharp, Vaccination Officer for the area, has furnished the following return for 1931:— Births Successfully Unsusceptible. Exemptions. Deaths before Registered. Vaccinated. Vaccinated or exempted. 1,637 274 1 932 51 In addition to the above, 386 primary and 152 revaccinations were recorded. 53 The percentage vaccinated during 1931 represented 16.7 of the births registered against 18.0 during 1930. There were 1,886 primary and 1,802 revaccinations in 1930, the decrease during 1931 being probably almost entirely due to the lowered incidence of Smallpox. The number of vaccinations done by your Medical Staff was 10 primary and 11 revaccinations. Detailed vaccinal returns were obtained in respect of the three school outbreaks and the findings were as follows:— School. No. on Books. No. Vaccinated. Percentage Vaccinated. Winns Avenue Senior Girls 249 67 26.9 Wood Street Boys 411 109 26.5 Mission Grove Infants 213 47 22.6 (B) SCARLET FEVER. The total incidence of Scarlet Fever during 1931 amounted to 451 cases, as compared with 607 during 1930. The weekly incidence was remarkably constant throughout the year. Thus, while the average incidence was 8.5 per week, the highest was 18 and the lowest 2. At no time was there any epidemic prevalence. The tables following show the incidence by months, ages and wards:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 35 - 8 21 6 — — — February 34 — 6 23 3 2 — — March 39 1 10 18 7 2 1 — April 39 — 9 22 2 6 — — May 37 1 3 27 — 5 1 — June 45 — 8 29 5 3 — — July 42 — 10 25 6 1 — — August 30 — 9 17 2 2 — — September 40 — 8 27 2 2 1 — October 28 — 7 15 2 4 — — November 34 — 6 22 5 1 — — December 48 1 8 23 8 8 — — Totals 1931 451 3 92 269 48 36 3 1930 607 1 104 413 56 32 1 — 54 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 9 1 5 2 6 12 February 6 2 9 2 3 12 March 13 1 6 1 11 7 April 12 3 7 3 6 8 May 7 8 2 2 9 9 June 16 5 — 2 3 19 July 17 6 2 4 8 5 August 12 1 3 2 4 8 September 9 10 3 1 7 10 October 4 6 6 1 7 4 November 6 2 5 1 11 9 December 9 3 9 7 10 10 Totals 1931 120 48 57 28 85 113 1930 162 101 73 65 80 126 The percentage of cases removed to Hospital during 1931 was 79.6 against 68.2 in 1930. No cases were refused admission. The death rate for Scarlet Fever during 1931 (per 1,000 population) was 0.01. Seventy-seven visits were paid by the Medical Staff in connection with Scarlet Fever. Reference to the use of the Dick test (i.e., for susceptibility to Scarlet Fever) is made later, but no active immunisation was carried out. Eleven cases were notified following Tonsillectomy at various Hospitals, the eruptions occurring respectively after one day in two cases, after two days in two cases, after three days in six cases, and after five days in one case. With the prevailing mild type of Scarlet Fever all cases which can be adequately isolated and nursed at home should be so treated in preference to removal to Hospital, where relapse frequently occurs. There now seems to be no doubt that such relapses are due to reinfection with a different type of scarlatinal streptococcus and, frequently, the new attack is more serious and is attended by more complications than the original one. In order to hospitalise cases ideally and adequately, all admissions should be to cubicles, after which the cases should be grouped according to the bacteriological typings of their infecting organism. Scarlet Fever at Brookfield Orthopaedic Hospital.—From the 7th October onwards a troublesome outbreak of Scarlet Fever occurred at Brookfield Hospital, and up to the end of the year a total of 9 definite cases had been notified. Following the notification 55 of the second case (21 days after the first) the Hospital was visited and the Cook was found to have suffered from a sore throat which proved to be streptococcal. Pending the result of a swab she was suspended from duty. On the occurrence of the third case 11 days later all the patients and staff were swabbed and of 34 swabs 16 showed streptococci to be present. These 16 cases, and the 3 cases in the Isolation Hospital, were re-swabbed and the swabs were sent to Dr. F. Griffith, who had kindly offered to type them at the Ministry of Health's laboratory. Prophylactic doses of Scarlet Fever Antitoxin were given to 15 of the patients on 8th October and Dick testing was attempted on the 10th, but the results were probably vitiated by the antitoxin given two days before. Case 4 occurred seven days after Case 3 and this again proved to be a Type 2 infection. Case 5 was notified on 8th December (23 days after Case 4) and Cases 6, 7, 8 and 9 on the 9th, 11th, 12th. and 17th December respectively, all these cases, except the last, being again Type 2 infections. Following the notification of the cases on and after 8th December, the nursing and domestic staffs were re-sw'abbed and the swabs were again typed by Dr. Griffith, who found that two of the Nurses were carrying Type 2 scarlatinal haemolytic streptococci. These Nurses were suspended from duty until, after local treatment, they had given negative swabs. One of the Nurses later proved to be a persistent carrier. Nothing further occurred until the 13th January, 1932, when a new case of an indefinite type was notified, and this was followed by a Type 2 case on 4th February and an indefinite type case on 8th February. The nursing and domestic staff were again swabbed for typing by Dr. Griffith on each occasion ; on the first, both Nurses were again carrying Type 2 streptococci, and on the second occasion one of the Nurses only (i.e., the one who had proved a persistent carrier during 1931). Both were suspended for as long as necessary, while later the persistent carrier was sent away for three weeks' holiday and, proving to be still a carrier, she has recently had tonsillectomy performed with the termination of the carrier state. (C) DIPHTHERIA. The incidence of Diphtheria showed a welcome decrease from 509 cases during 1930 to 324 during 1931. The weekly incidence was at an average rate of 6.62 cases with a maximum of 17 for the week ending 18th July. 56 Two small localised outbreaks, one of 11 cases at Blackhorse Road Girls' School in July, and one of 8 cases at Coppermill Road Junior School in December, both of nasal type, were controlled by repeated "class" inspections and the swabbing of all suspects. The percentage of cases removed to Hospital increased to 93.5, a figure higher than any since 1926. During 1931 no cases were refused admission. Three cases of Diphtheria were notified 4, 10 and 4 days after tonsillectomy. Eleven deaths were due to Diphtheria, representing a death rate of 0.08 per 1,000 population. The monthly incidence by Wards was as follows:— Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 4 3 8 7 8 4 February 7 3 3 5 13 9 March 2 3 2 3 6 4 April 7 4 2 4 6 6 May 5 2 1 3 5 5 June 7 2 5 1 1 2 July 6 11 2 2 — 21 August 3 4 2 5 1 2 September 4 4 7 4 2 6 October 5 6 4 4 5 2 November 1 1 6 — — 7 December 8 11 5 2 10 Totals 1931 58 54 47 40 47 78 1930 118 93 89 50 60 99 The monthly incidence is given in the following table:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 34 1 6 25 1 1 — — February 40 — 9 21 4 4 2 — March 20 — 4 13 1 1 1 — April 29 2 9 13 4 1 — — May 21 — 6 12 1 2 — — June 18 — — 14 3 1 — — July 41 1 7 28 3 — 2 — August 17 1 2 11 2 1 — — September 27 — 6 19 2 — — — October 26 1 7 17 1 — — — November 15 — 3 9 2 1 — — December 36 1 6 21 6 2 — — Totals 1931 324 7 65 203 30 14 5 — 1930 509 4 113 322 41 26 3 — 57 Sixty-four visits in connection with Diphtheria were paid by the Medical Staff. No use was made of the Schick test (for susceptibility to Diphtheria) nor of immunisation. Sir George Newman, Chief Medical Officer to the Ministry of Health, has stated that ' 'no Local Authority responsible for the health of children should be satisfied that it has done its duty until every parent knows that children can be protected against Diphtheria with safety and reasonable certainty of complete protection." The adoption of a comprehensive scheme of immunisation should be carried out as soon as possible. The cost of testing and immunising each child can be put at approximately 5s. for the cost of materials. 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 1931 a total of 173 phials representing a total of 1,096.000 units were issued. (D) ENTERIC FEVER. Thirty-eight cases of Enteric Fever were notified during the year—37 being Paratyphoid B. The first case, in which full information as to its variety was not available, was probably infected outside the Borough. The series—Case 2 (notified on 6th February) to Case 34 (notified on 13th March), i.e., 33 in all—represented the local portion of the great ' 'Epping'' outbreak, although in three of these the milk supply appeared to be unconnected. Investigation of Cases 2 and 3 (notified 9th February) showed that milk was obtained from the same dealer, and inquiries were at once made as to his sources of supply, and when these proved to be from Epping Rural District it was apparent that a milk-borne epidemic was imminent. This information was immediately sent to the Ministry of Health and the County and District Medical Officers of Health concerned. All milk purveyors in the Borough were immediately circularised advising the pasteurisation of all milk from Epping and neighbourhood, or, if this were not possible, asking them to instruct their customers to boil all milk before use. All medical practitioners were the same day circularised drawing their attention to the prevalence of Para-typhoid Fever in the Borough and requesting early notification. By the 11th February all available beds in the Connaught Hospital had been filled, and arrangements were made with the 58 London County Council to admit cases to their Hospftals at a charge of 10s. 6d. per day, plus 1s. per mile ambulance fee. On 14th February two cases were notified which were apparently •connected with a fresh milk supply, and in view of this fact, notices were issued to the Press advising the public to boil all milk before use, and drawing attention to the symptoms of the disease. In addition, it was decided to allocate a Scarlet Fever Ward at your Isolation Hospital for the treatment of cases of Enteric, and cases were admitted on the 17th February, 1931. All the central dairy hands of both milk firms were seen, and Widal tests were taken. In one case a man who had been away for seven days with Influenza had returned to work on the 15th February, 1931, gave a positive Widal on the 18th inst., and was immediately suspended from work. A faeces test proving positive, he was sent to Hospital, but the source of his infection could not be traced. Of the four remaining, notified from May to October, nothing definite could be made out except that cases 37 and 38 appeared to have become infected in a local Institution from a common source which could not be traced. The 38 cases were treated at the following Institutions, etc.:— Chingford Sanatorium. L.C.C. Hospitals. Connaught Hospital. Whipps Cross Hospital. Prince of Wales Hospital. Home Isolation. 13 13 9 1 1 1 Sixteen cases occurred during the week ended 14th February, 8 during the week ended 21st February, and 5 during the week ended 28th February. One fatal case occurred in a patient aged 70 years—the real cause of death being due to pulmonary complications. Twenty-four of the 34 cases of the Epping series, in which Widal results are known, showed uniform agglutination titres of 1 in 50 against B. Paratyphosus B. A total of 157 specimens were examined in connection with Enteric Fever and the results are summarised below:— Public Health Department Sanatorium. Private Practitioners. Blood. Faeces. Blood. Faeces. Urine. Blood. Faeces. Pos. Neg. Pos. Neg. Neg. Neg. Neg. Pos. Neg. Pos. Neg. 9 62 2 6 1 18 9 13 23 2 11 And 78 visits were paid by the Medical Staff. The milk-borne series of cases emphasises the need for the compulsory pasteurisation of all raw milk (except, possibly, graded 59 milk) and for compulsory periodical tests to ensure freedom from Enteric infection in all persons engaged in the production and distribution of milk. Your Council agreed to the latter suggestion and have asked the Ministry of Health to consider the advisability of making the necessary regulation. The following table shows the ward and age incidence during the year:— All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. Removed to Hospital. St. James Street 11 - 4 4 2 1 - — 11 High Street 7 — 1 3 1 1 — 1 7 Hoe Street 5 — 1 1 — 2 1 — 5 Wood Street 2 - 1 — — 1 — — 2 Hale End 4 - — 1 3 — — — 3 Higham Hill 9 - 2 5 — 1 1 — 9 Totals 38 - 9 14 6 6 2 1 37 (E) PNEUMONIA. The tables following show the incidence by months, ages and wards:— Month. All ages. Under 1 yr. 1-5 yrs. 5—15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 36 2 8 3 5 8 8 2 February 33 — 4 8 4 9 5 3 March 17 — 1 I 2 7 5 1 April 20 — 3 4 6 3 3 1 May 10 — — 4 3 3 — — June 6 — 1 — 1 3 1 — July 9 — — 1 3 3 1 1 August 11 — 2 2 2 2 1 2 September 5 — — 1 1 2 1 — October 11 — 2 1 — 2 4 2 November 21 — 4 5 4 4 1 3 December 32 1 5 7 6 5 5 3 Totals 1931 211 3 30 37 37 51 35 18 1930 139 3 17 22 10 33 32 22 60 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. January 7 9 1 3 10 6 7 February 10 9 — 4 4 6 9 March 5 3 2 — 3 4 1 April 11 6 — — — 3 5 May 6 2 — — — 2 2 June 3 — 1 1 1 — 1 July 4 2 1 1 — 1 3 August 5 2 1 1 — 2 1 September — — 3 1 — 1 — October 1 4 4 - - 2 2 November 4 2 2 2 4 7 5 December 3 5 1 6 10 7 5 Totals 1931 59 44 16 19 32 41 41 1930 31 25 16 11 25 31 31 (F) PUERPERAL FEVER AND PYREXIA. See Maternity and Child Welfare Section. (G) OPHTHALMIA NEONATORUM. See Maternity and Child Welfare Section. (H) ERYSIPELAS. The tables following show the incidence by months, ages and wards:— Month. All ages. Under 1 yr- 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 8 — - - — 2 6 - February 10 — 1 1 — 2 6 — March 6 — — 2 — 1 3 — April 4 — — — — 1 3 — May 7 — — 1 — 2 3 1 June 3 — — — — 1 2 — July 9 — 2 — — — 5 2 August 2 — — — — — 2 — September 2 — — — — 1 1 — October 4 — — — 1 - 2 1 November 6 - — - 1 1 4 - December - - - - - - - - Totals 1931 61 — 3 4 2 11 37 4 1930 57 2 — - 6 18 22 9 61 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. January 2 1 1 — 1 3 3 February 2 3 1 2 1 1 1 March 1 1 — — — 4 2 April — 1 — 1 — 2 1 May 2 4 — — — 1 5 June — — 1 — - 2 — July 1 1 2 2 1 2 5 August 1 — — — 1 — — September — 1 — 1 — — — October 1 1 — — — 2 1 November — 1 2 — 1 2 1 December - - - - - - - Totals 1931 10 14 7 6 5 19 19 1930 11 7 9 14 5 11 22 (I) ENCEPHALITIS LETHARGICA. Two cases, both females resident in the Hale End Ward, and aged 26 and 33 years, were notified. One case was removed to Hospital and recovered. The other case died at home. (J) CEREBRO-SPINAL MENINGITIS. One case, aged 6 years and resident in Higham Hill Ward, was notified and removed to Hospital. (K) CHICKEN POX. The compulsory notification of all cases of Chicken Pox was continued during 1931 up to 1st November, 1931, when the Walthamstow (Chicken Pox) Regulations, 1931, came into force. The effect of the Regulations was to exclude from notification vaccinated cases under 10 years of age. The following tables show the incidence during the year:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 45 — 13 20 2 — — — February 60 — 10 48 2 — — — March 45 2 18 25 — — — — April 75 — 20 51 4 — — — May 68 1 11 53 3 — — — June 228 2 42 183 1 — — — July 165 9 40 112 3 1 — — August 88 — 19 66 2 1 — — September 52 2 15 35 — — — — October 119 2 8 107 2 — — — November 192 4 52 128 6 1 1 — December 123 7 34 74 7 1 - - Totals 1260 29 282 912 32 4 1 — 62 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 10 6 5 6 2 16 February 13 1 7 5 19 15 March 4 1 5 4 20 11 April 2 7 3 1 21 41 May 6 12 5 1 11 33 June 2 54 13 21 44 94 July 4 28 16 24 55 38 August 1 4 7 12 17 47 September 8 8 6 5 11 15 October 33 45 9 12 3 17 November 34 44 7 14 11 82 December 16 18 7 3 6 73 Totals 133 228 89 108 220 482 The heaviest incidence of Chicken Pox was during the four weeks ending 27th June, when 274 cases were notified—87 of these being during the first week. Two cases of Chicken Pox were admitted to Hospital because of special circumstances in the homes. Except for a few secondary cases in the same household, every case was visited by a Medical Officer of the Department for verification of diagnosis and a total of 1,265 visits were paid. One case notified as Chicken Pox was removed to Hospital for observation as a case of suspected Smallpox. The following table gives information as to cases of associated Shingles and Chicken Pox which were found:— Primary Case. Secondary Case. Mother had Shingles—2.3.31. Child developed Chicken Pox— 17.3.31. Mother had Shingles—1.3.31. Child developed Chicken Pox— 29.3.31. Mother had Shingles at beginning of March. Three children developed Chicken Pox—27 & 28.3.31. Herpes some days previous to 23.3.31. Brother developed Chicken Pox —8.4.31. One interesting feature is that three of the four cases apparently occurred within a few days and in widely separated portions of the Borough. 63 (L) MEASLES. Measles was not a notifiable disease during 1931, which was an inter-epidemic year. Only 37 cases were notified by Head Teachers as having occurred amongst children of school age. No deaths were certified as having been caused by Measles. At the time of writing the biennial epidemic has got well under way, and your Council have decided to make notifiable the first case in each household under five years of age. Arrangements have been made for 13 beds at the Isolation Hospital to be made available for severe cases of complicated Measles. A certain number of cases have also been admitted to Whipps Cross Hospital. (M) WHOOPING COUGH. Whooping Cough was not notifiable during 1931, but 520 school cases were notified by Head Teachers. The total number of deaths was 14, or a mortality of 2.7 per 100 cases. This mortality compares with 11 deaths from Diphtheria amongst 324 cases notified (or 3.4 per 100 cases) and 2 deaths from Scarlet Fever amongst 451 cases notified (or 0.44 per 100 cases). No requests for Hospital removal were received, and it must again be stressed, as with Measles, that the seriousness of this disease is not sufficiently appreciated. (N) TUBERCULOSIS. The table given below shows particulars of new cases of Tuberculosis and of all deaths from the disease in the Borough during 1931:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary. m f m f 11 f m f Under 1 yr. — — 3 - — - 1 — 1— 5 yrs. 1 1 3 1 1 1 — 2 5—10 yrs. 1 2 3 8 — - — — 10—15 yrs. 1 — 3 2 — - 1 1 15—20 yrs. 11 9 5 3 5 3 — 2 20—25 yrs. 19 14 1 1 9 5 2 2 25—35 yrs. 28 13 4 — 14 14 1 1 35—45 yrs. 19 7 — 1 12 6 - — 45—55 yrs. 9 2 1 1 12 3 - — 55—65 yrs. 7 1 — — 7 — - - 65 yrs. and upwards 1 4 — — 3 — - — Totals 97 53 23 17 63 32 5 8 150 40 95 13 190 108 64 The 108 deaths represent a death rate of 0.80 per 1,000 population The returns for the past two years are compared below:- Year. New Cases. Total. Deaths. Total. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. m. f. m. f. m. f. m. f. 1931 97 53 23 17 190 63 32 5 8 108 1930 72 57 18 16 159 62 21 4 2 89 The periods elapsing between notification and death, and the number of cases not notified were as follows:— Under 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. Over 12 months. Not Notified. Notified after death. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 23 5 4 1 5 — 8 - 39 - 13 4 3 3 The ratio of non-notified Tuberculosis cases plus notifications after death to total Tuberculosis deaths was 23 to 108, or 1 to 4.7. Appropriate action with regard to non-notification was taken, when necessary. The table given below shows the number of cases on the Register at the beginning and end of 1931:— Pulmonary. Total. NonPulmonary. Total. Gkand Total. No. on Register 1st January M. F. M . F. 905 825 1,730 447 442 889 2,619 Notified during 1931 97 53 150 23 17 40 190 Total 1,002 878 1,80 470 459 929 2,809 Removed from Register, 1931 64 40 104 4 10 14 118 No. on Register 31st December 938 838 1,776 466 450 916 2,691 65 The 118 removals from the Register were made up as follows:— Deaths. Removals. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary. m. F. m. F. m . F. m . f. 48 30 1 2 16 10 3 8 78 3 26 11 81 37 118 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 931 were:— Pulmonary. Non-Pulmonary. Total. M . f. m. f. Adults 69 29 13 5 116 Children 5 2 9 6 22 No action was necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or Section 62 of the Public Health Act, 1925. Prevention of Blindness.—No action was necessary under Section 66 of the Public Health Amendment Act, 1925, for the prevention of blindness or the treatment of persons suffering from any disease of or injury to the eyes. VII INFECTIOUS DISEASES HOSPITAL. The situation, accommodation and staffing of the Infectious Diseases Hospital was fully described in the 1930 Report. Improvements.—Gas utensil sterilisers were installed in five blocks. Two new bathrooms and 8 new washbasins were provided in the cubicle block. A new Kelvinator refrigerator, with automatic control, was installed at a cost of £265. 66 Preparations were made for laundry extensions by tlie removal of disused plant from the engine room. A new electric incubator was provided at a cost of £14 10s. 0d. Extensions.—Good progress was made during the year on the extension to the Administrative Block. The estimated cost is £9,669, which will provide 24 extra bedrooms, 8 bathrooms, storeroom and a general office, and a large dining and rest room for the domestic staff. On completion of the extension the existing accommodation can be re-allocated for improved staff quarters and to provide a nurses' lecture room for training purposes. The Council, during the year, decided to apply to the Ministry of Health for sanction for a loan of £1,117 in order to complete the top floor of the new wing, so adding a further 10 bedrooms and 2 bathrooms. The completion of this extension will enable the Hospital to be more adequately staffed, so reducing the working hours of all staff to approximately 48 hours per week. It will also enable the small E Block now used for staff sleeping quarters to be adapted for 8 additional patient beds and will liberate the convalescent room in F Block (now also used as staff sleeping quarters) for some 6 patient beds. The additional 14 beds will be of great value for the reception of bad cases of Measles and Whooping Cough. General.—Paratyphoid cases were admitted during the milkspread epidemic in the spring of the year, the convalescent Scarlet Fever Ward being cleared in order to accommodate them. For the latter half of the year, the convalescent Diphtheria Ward remained closed. This has continued during 1932 and has enabled a limited number of cases of severe measles with complications to be admitted. The agreement with the Loughton Urban District Council to receive and treat their cases was renewed for a period of two years from March, 1932. Notification was received during the year from the Essex County Council stating that the County Council were of opinion that a Joint Hospital Board should be constituted for the Boroughs of Walthamstow and Leyton and that your Council's Sanatorium should be taken over by the proposed Board and extended. Your Council decided to give notification of opposition to the formation of a Joint Hospital Board. 67 Financial Statement.—A financial statement for the year ending 31st March, 1931, is given below:— Loan Charges. £ s. d. Amount of Loan outstanding on 31st March, 1931 2,586 9 9 Expenditure . Repayment of Loan 239 17 0 Interest on Loan 88 10 11 Structural repairs 1,062 0 0 Food for Patients and Staff 5,167 0 0 Establishment and other Expenses .. 11,376 0 0 £17,933 7 11 Income. Patients 533 0 0 County Council Grant 3,165 0 0 Other sources 37 0 0 £3,735 0 0 The statistics given include cases from other Authorities. The following table shows the admissions, discharges and deaths during 1931:— Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Tuberculosis. Totals. Remaining in Hospital 1st January 61 53 - 5 20 139 Admitted during year 393 311 13 2 58 777 Discharged during year 394 330 12 7 53 796 Died during year 4 10 1 — 5 20 Remaining in Hospital 31st December 56 24 — — 20 100 The total admissions during 1931 were lower than any preceding year as far back to 1926, when the total was 661. 68 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL (including Tuberculosis cases). January 128.9 July 101.4 February 123.5 August 98.0 March 103.3 September 89.4 April 81.4 October 91.5 May 100.4 November 89.2 June 95.0 December 72.0 Average whole year 98.2 Dr. Hamilton has contributed the following report:— AGES AND SEX OF PATIENTS ADMITTED DURING 1931. Disease. Under 5 years. 5 to 10 years. 10 to 15 years. Over 15 years. Total. Total. M. F. M . F. M. p. M . F . M. F. Scarlet Fever 41 51 83 95 31 29 20 43 175 218 393 Diphtheria 39 32 66 71 25 32 14 32 144 167 311 Para-typhoid Fever 2 2 2 1 — 1 2 3 6 7 13 Chickenpox — — 2 — — — — — 2 — 2 Tuberculosis - - - - - - - 58 - 58 58 Totals 82 85 153 167 56 62 36 136 327 450 777 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 2 2 — 4 - - 1 1 3 7 10 Enterio Fever & BronchoPneumonia - - - - - - - 1 - 1 1 Scarlet Fever 1 1 — 1 - - - 1 1 3 4 Pulmonary Tuberculosis - - — - - - - 5 ~ 5 5 Totals 3 3 — 5 — — 1 8 4 16 20 The deaths occurred after the following periods in Hospital:— Diphtheria—14 hours, 35 hours, 36 hours, 27 hours, 48 hours, 5 days (2), 8 days, 8 weeks. Diphtheria and Broncho-pneumonia—23 hours. Enteric Fever and Broncho-pneumonia—4 days. Scarlet Fever—4 days, 10 hours, 65 days, 56 days. 69 MONTHLY ADMISSIONS OF DIPHTHERIA CASES. 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 January 7 3 7 10 4 9 2 4 20 26 46 February 6 1 6 5 2 4 1 4 15 14 29 March 3 3 5 1 — 1 1 2 9 7 16 April — 7 7 2 2 1 1 4 10 14 24 May 3 1 2 3 1 4 1 3 7 11 18 June — — 6 6 3 1 2 3 11 10 21 July 3 6 8 11 5 2 1 3 17 22 39 August 1 3 3 6 4 — — 2 8 11 19 September 6 1 6 10 1 1 — 2 13 14 27 October 4 4 8 5 1 3 1 — 14 12 26 November 3 — 2 7 — - 2 2 7 9 16 December 3 3 6 5 2 6 2 3 13 17 30 Totals 39 32 66 71 25 32 14 32 144 167 311 Of the cases notified as Diphtheria, one proved to be a case of Perforated Gastric Ulcer notified as Haemorrhagic Diphtheria, and one a Glossal abscess. One case developed Acute Appendicitis during convalescence. Three cases notified as Diphtheria proved, on admission, to have both Diphtheria and Scarlet Fever. Cross Infection.—38 cases were transferred from the Diphtheria blocks to cubicle block—10 cases with Scarlatiniform rashes (2 confirmed as Scarlet Fever), 5 cases with desquamation, 10 observation cases, 4 Smallpox contact cases, 5 Chickenpox contact cases, 2 Measles contact cases, 2 with venereal complications. Complications.—Cardiac Paralysis, 5; other types of Paralysis, 15. MONTHLY ADMISSIONS OF SCARLET FEVER CASES. 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 January 3 3 7 12 4 1 2 5 16 21 37 February 2 3 3 5 3 3 — 1 8 12 20 March 4 6 5 2 3 3 1 4 13 15 28 April 2 1 12 7 1 3 2 2 17 13 30 May 1 2 10 2 1 5 — 3 12 12 24 June 10 8 4 12 6 4 3 4 23 28 51 July 3 4 5 9 1 1 5 2 14 16 30 August 4 4 11 6 2 2 2 2 19 14 33 September 2 7 5 8 3 3 1 1 11 19 30 October 2 7 4 13 1 — — 5 7 25 32 November 2 3 9 8 2 1 1 5 14 17 31 December 6 3 8 11 4 3 3 9 21 26 47 Totals 41 51 83 95 31 29 20 43 175 218 393 70 In the case of one patient who was admitted suffering from Scarlet Fever, death was directly due to Congenital Heart Disease, Scarlet Fever being only a remote contributory cause. Complications.-Otitis, 23; Mastoid Disease, 2: Pyaemia, 1; Chorea, 1; Suppurative Adenitis, 10 (some degree of Cervical Adenitis was present in practically all cases); Recurrent Erysipelas, 1; Purulent Rhinitis, 12 (Diphtheritic, 8, Streptococcal, 4); Septic Foot, 2. In one case the Scarlatiniform rash proved to be the Prodromal rash of Smallpox. One case notified as Scarlet Fever proved to be Acute Rheumatic Fever with Erythema Nodosum. Cross Infection.—During the year 53 cases were transferred from the Acute Scarlet Fever block to the cubicle block, and 16 from the convalescent Scarlet Fever block. The patients were transferred for the following reasons:— Ringworm, 1; K.L.B. Throat or Nose, 17; Erysipelas, 1; Severe Septic Scarlet Fever, 1: Impetigo Contagiosa, 9; Mastoiditis, 2; Vaginal Discharge, 6; Adenitis, 10; Contact with Chickenpox, 2; contact with Diphtheria, 2; observation cases, 2. From Convalescent Block—Chorea, 1; Otorrhoea, 4 ; Adenitis, 4; K.L.B., 5; observation cases, 2. Total, 16. Relapses of Scarlet Fever occurred in seven cases. In one of these cases fatal ear complications supervened. Staff.—Members of the Staff were admitted to Hospital beds suffering from the following complaints:—Tonsillitis, 4; Rheumatism, 1; Influenza, 1; Diphtheria, 1: Sprained Ankle, 1. Total, 8. Swabs.—1,306 swabs were taken and examined during the year in the laboratory at the Hospital. Operations at Hospital.—Tonsillectomy, 4; Wilde's operation, 1; Deep Abscesses, 2; Specialist Consultants were called in on seven occasions. Number of Outside Authorities' Cases and Nature:— Diphtheria. Scarlet Fever. Enteric Fever. Total. From Whipps Cross Hospital 4 1 3 8 From Edmonton and Enfield Joint Hospital District - 6 - 6 From Epping U.D.C. 6 21 — 27 From Loughton U.D.C. — 3 — 3 Total 10 31 3 44 71 The following cases were transferred to Whipps Cross Hospital:— Erysipelas, 1; Pyaemia supervening on Septic Scarlet Fever, 1; Perforated Gastric Ulcer, 1; Mastoid Disease, 2; Pyogenic Cervical Adenitis, 1; Septic Foot, 2; Rheumatism, 1; Paratyphoid Fever, 1; Appendicitis (to Connaught Hospital), 1. Duration of Treatment.—The average duration of treatment in Hospital was as follows:— Diphtheria 40.4 days. Scarlet Fever 35.2 days. Paratyphoid Fever 26.5 days. Chickenpox 21.0 days. Mixed Infections 37.5 days. The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1931:— Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.). In Hospital on 1st January, 1931. Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1931. T.B. Minus 2 13 12 - 3 T.B. Plus Group I 3 3 5 — 1 T.B. Plus Group II 13 36 31 2 16 T.B. Plus Group III 2 6 5 3 - Totals 20 58 53 5 20 MEDICAL EXAMINATIONS. During the year 56 examinations were carried out by the Medical Staff in respect of the Superannuation Scheme and 103 in respect of the Sick Pay Scheme. MATERNITY AND CHILD WELFARE. 74 MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Miss B.A. Henderson. Ex-Officio: His Worship The Mayor—Councillor G. H. Spaceman, J. P. The Deputy Mayor—Alderman T. W. Smith. Councillor Ross Wyld E. C. Redhead Chairmen-Finance Committee. Alderman A. Eve, J. P. ,, G. Gibbons, J. P. ,, J. C. Hammond. ,, Mrs. C. McEntee, J. P. ,, Mrs. M. Norrish. Councillor Mrs. L. P. Bailey. ,, B. Cole. Councillor H. C. Dowell. ,, P. Friedberg. Miss N. W. Hix. ;, Mrs. E. M. Miller. ,, G. M. Page. ,. Mrs. E. M. Richards. T. H. Tee. Co-opted Members: Mrs. V. Cossey. Mrs. W. H. Kindell. Mrs. M. A. Cross. Mrs. J. H. Lester. Mrs. I. M. Jackson. Mrs. W. J. Sharp. Mr. W. H. Kindell. Mrs. W. F. Toynbee. 75 STAFF. Medical Officer of Health and Administrative Maternity and Child Welfare Officer: A. T. W. Powell, M.C., M.B., B.S. (Lond.), D.P.H. Medical Officer and Inspector of Midwives: Miss Mary C. Sheppard, B.A., M.B., B.Ch., B.A.O., D.P.H. Obstetric and Puerperal Fever and Pyrexia Consultants: Mr. G. F. Gibberd, M.S., F.R.C.S. Mrs. M. H. F. Ivens-Knowles, C.B.E., M.S. Mr. W. McKim McCullagh, D.S.O., M.C., F.R.C.S. 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. Miss C. R. Douglas, S.R.N., C.M.B., H.V. Cert. Miss D. G. Legg, S.R.N., C.M.B., H.V. Cert, (from 28-9-31). Miss M. Page, S.R.N., C.M.B., H.V. Cert. Miss 0. 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 (to 4-7-31). Miss E. Ogilvie (from 23-6-31). 76 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen, I beg to present herewith a report of the work performed for your Committee during 1931. A considerable expansion of the service occurred during the year—thus the Staff was increased by the appointment of an additional Health Visitor; new centres were opened at Higham Hill and Highams Park and the services of a Consultant Obstetrician were made available. Home visits increased by 1,113 under the Municipal Scheme, and 835 under the Voluntary Scheme, while attendance at Clinics increased by 3,517 and 1,531 respectively, as compared with 1930. Your Council became the Local Supervising Authority under the Midwives Acts during the year. The work involved has meant a very considerable increase in the work of the Department. The Infant Mortality figure is, unfortunately, not so favourable as that of last year which was inexplicably low. A series of cases of Pemphigus Neonatorum occurred towards the end of the year. Notifications of Puerperal Fever and Pyrexia were much increased—probably due to better notification rather than to increased incidence. On the other hand, only one maternal death was certified as being due to Puerperal Sepsis as against 6 in 1930. Grateful acknowledgment must be made of the co-operation of your Committee, of the help given by the voluntary helpers at the Clinics, and to the good work of the Staff. I have the honour to be, Your obedient servant, A. T. W. POWELL, Medical Officer of Health, etc. 77 1. NOTIFICATION OF BIRTHS. One thousand six hundred and sixty-two births (61 of which were excluded) were notified during the year under the Notification of Births Acts, 1907 and 1915, as follows:— Doctors, 931. Midwives, 683. Parents, etc.. 48. Included in the above are 333 births which were notified as having occurred outside the Borough. In addition 59 stillbirths were notified, 6 of which did not belong to the area. Forty were notified by Doctors, 18 by Midwives and 1 by a parent. Of the total, 16 occurred outside the area. The stillbirth rate per 1,000 population was lower than for 1930, viz., 0.43 against 0.54. 2. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Males. Females. Total. Legitimate 949 949 1,898 Illegitimate 17 32 49 Total 966 981 1,947 (b) Stillbirths. Males. Females. Total. Legitimate 37 22 59 Illegitimate — — — Total 37 22 59 Of 1,640 birth registrations received in the Department between 4th January, 1931, and 2nd January, 1932, a total of 267 were not notified in this area, but some may possibly have been notified elsewhere, especially in view of the fact that of the 1,640 registrations 95 referred to births which belonged to other areas. In addition it will be seen that the Registrar-General's figure (1,947) is 307 more than the local registrations. Presumably these were births registered and possibly notified in other areas. The early visiting of newly-born infants by the Health Visitors is entirely dependent upon efficient notification. 78 Of the 1,640 local registrations 95 are excluded, leaving a ntt total of 1,545, which are allocated to wards as follows:— Births Registered Locally, 1931. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals. Grand Total. m . f. m. f. m. f. m. f. m. f. m. f. m . f. January 9 10 12 5 12 12 16 8 9 7 15 10 73 52 125 February 5 9 12 12 16 6 11 15 8 9 8 15 60 66 126 March 7 5 11 7 15 10 7 8 14 6 19 7 73 43 116 April 8 11 6 11 9 10 5 8 14 15 8 12 50 67 117 May 12 12 5 10 18 12 13 9 8 7 15 10 71 60 131 June 16 11 13 12 5 7 8 10 18 14 16 13 76 67 143 July 10 9 8 7 8 8 6 9 16 17 17 16 65 66 131 August 16 19 14 15 11 16 7 15 18 18 17 20 83 103 186 September 7 10 9 11 4 8 9 3 7 10 8 9 44 51 95 October 17 18 9 12 8 11 8 10 13 10 15 13 70 74 144 November 14 21 8 10 8 10 4 2 13 10 5 12 52 65 117 December 7 7 8 9 13 7 6 9 9 13 12 14 55 59 114 Totals 128 142 115 121 127 117 100 106 147 136 155 151 772 773 1,545 Grand Totals 270 236 244 206 283 306 1,545 79 3. INFANT MORTALITY. The deaths of infants under one year of age were:— Males. Females. Totals. Legitimate 63 41 104 Illegitimate 4 2 6 Total 67 43 110 The death-rates of infants under one year of age per 1,000 live births when calculated on the totals given by the RegistrarGeneral in paragraph 2 are therefore:— Legitimate, 54. Illegitimate, 122. Total, 56. The Infant Mortality Rate for other areas during 1931 was as follows:— England and Wales 66 107 County Boroughs and Great Towns 71 159 Smaller Towns 62 London 65 The increased infant mortality for 1931 as compared with 1930 is, unfortunately, in accordance with the increased general death rate. The chief increases for 1931 compared with those for 1930 (given in parentheses) were as follow:— Whooping Cough, 7 (Nil); Convulsions, 12 (5); Pneumonia, 20 (13); which account for 21 of the additional deaths during 1931 out of a total increase of 32. The following table shows the causes of death of children under one year of age during 1931:— 80 SUMMARY, 1931 . 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 Wood Street Hale End Higham Hill Infiuenze - - - - - - - - - - - - - - - - Small Pox - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - Whooping Cough - - - - - 1 1 — 5 7 1 1 1 — 1 3 Diphtheria and Croup - - - - - - - - 1 1 1 - - - - - Erysipelas - - - - - - - - - - - - - - - - Tuberculous Meningitis — - - - - - - 1 — 1 - - — — — 1 Abdominal Tuberculosis (b) - - - - - - - - - - - - - - - - Other Tubereuious Diseases - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - — Meningitis (not Tuberculous) - - - - - - - - 1 1 1 - — — — — Convulsions 4 1 1 1 7 1 1 2 1 12 - 3 1 2 3 3 Laryngitis — - - - - - - - - - - - — — — — Bronchitis — - - - — 1 - 1 — 2 - — — 1 — 1 Pneumonia (all forms) 1 - - - 1 4 8 3 4 20 - 2 8 2 7 1 Diarrhœa - - - - - - 1 1 — 2 1 — — — 1 — Enteritis - - - - - - 3 1 — 4 - — 2 - - 2 Gastritis - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - Inattention at Birth, wilful neglect - - - - - - - - - - - - - - - - Suffocation, overlaying — - - - — 2 — — — 2 - 1 — 1 - — Injury at Birth 2 - - - 2 — — — — 2 1 — 1 — - — Atelectasis 4 - - - 4 — — — — 4 1 2 1 - - - Congenital Malformations 1 - - - 1 — — 1 — 2 1 - - 1 - - Premature Birth 20 - 1 - 21 — — — — 21 2 6 1 3 4 5 Atrophy, Debility and Marasmus 1 3 - - 4 4 4 — 1 13 3 2 - 1 4 1 Inanition 1 1 1 - 3 - - - - 3 — — 1 1 1 — Heart Failure 3 — - - 3 — — 1 — 4 — - 1 2 1 - Other Causes 3 2 - - 5 1 — 2 1 9 4 1 — 2 — 2 Totals 40 7 3 1 51 14 18 13 14 110 16 18 19 16 22 19 81 The death-rate from Diarrhoea and Enteritis per 1,000 live births was 4.1. 4. CHILD WELFARE. The arrangements for Child Welfare were fully detailed in the 1930 Report. An additional Health Visitor was appointed during the year and assumed duty on 28th September. The additional appointment was chiefly made in order to staff the extra clinics which your Council decided to open at the Institute, St. Andrew's Road, Higham Hill and the Memorial Hall. Winchester Road. Highams Park. One session per week was held at each Clinic on Tuesdays at 2 p.m. and the first sessions were held on 13th October. (a) Municipal Scheme.—The normal staff of Health Visitors is six, one of whom devotes approximately half-time to the supervision of outworkers under the Factory and Workshops Acts. 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 1931 Children under 1 year—first visits 22, subsequent visits 179, total 201; Children 1 to 5 years, 54. Total, 255. 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. In addition, visits in connection with the following matters are also carried out:—Supervision of Nurse Children, 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. Circular 1167 and Memorandum 156—M.C.W.—The following extensions of the Maternity and Child Welfare services were sanctioned by your Committee during the year:— 82 1. Weekly Infant Welfare sessions at Higham Hill and Highams Park and increased massage facilities. Appointment of an additional Health Visitor. 2. An arrangement for the admission of certain cases of Puerperal Fever and Pyrexia to Queen Charlotte's Hospital Isolation Block at Hammersmith provided the patient pays the necessary fees. 3. The payment of a subsidy to the Walthamstow District Nursing Association for the provision of (a) Home nursing in certain cases of Puerperal Fever and Pyrexia. (b) An emergency midwife. 4. Provision of a Consulting Obstetrician in case of difficulty during pregnancy, labour, or the puerperium. 5. The provision of a monthly consultative Ante-Natal Clinic (provided under the Public Health Act). 6. Assistance in the provision of qualified midwives in order to eliminate the handywoman. The service cannot be considered to be really complete until the proposed Maternity Home has been brought into use. The appointment of a municipal midwife has been postponed until the home is ready. The detailed findings at first visits paid during 1931 are given in the following table:— 83 From the above table it will be seen that of 1,939 children, 1,577, or 81.3 per cent. were breast fed on first being visited, but 338, or 17.4, had no separate sleeping accommodation. The particulars in respect of Housing accommodation show that only 583 of the families visited had a house to themselves, while 113 families were living in one room. The 1930 figures were 612 and 168 respectively. Ward. 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. 1 Room. St. James Street 303 17 53 17 32 21 80 293 316 40 17 83 30 72 33 111 44 High Street 244 6 21 4 16 7 47 224 235 32 4 46 74 59 21 54 17 Hoe Street 250 16 48 19 33 12 49 265 275 35 4 78 23 127 22 53 11 Wood Street 196 12 44 21 24 11 53 199 215 27 10 70 14 89 13 53 13 Hale End 247 30 53 32 35 16 37 293 264 55 11 138 7 77 35 56 17 Higham Hill 337 16 46 28 22 12 72 327 354 42 3 168 97 59 30 34 11 Total 1,577 97 265 121 162 79 338 1,601 1,659 231 49 583 245 483 154 361 113 84 Visits to children increased from 9,230 in 1930 to 10,030 in 1931, while the total visits increased from 13,242 to 14,355. The following table shows the number and nature of visits paid by Wards during 1931:— Ward. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. Unsuccessful Visits. Visits to Nurse Children. Visits re Milk Scheme. Ante-Natal Visits. Ophthalmia Neonatorum Visits. Puerperal Fever etc., Visits. Special Visits. Total Visits. First Visits. Subsequent Visits. Total Visits. F irst. Re-visits. Total. Not at home. Dead. Removed. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Cols. 5-14. St James Street 373 265 638 666 1,304 185 10 69 134 150 25 9 34 5 2 19 1,912 High Street 271 519 790 1,039 1,829 185 10 118 181 97 28 1 29 7 1 6 2,463 Hoe Street 314 428 742 930 1,672 279 5 223 65 75 22 5 27 11 — 5 2,362 Wood Street 252 430 682 874 1,556 247 11 107 71 164 22 — 22 — 3 1 2,182 Hale End 330 591 921 894 1,815 201 5 82 175 194 35 5 40 — 6 7 2,525 Higham Hill 399 536 935 919 1,854 406 7 111 207 251 48 13 61 4 10 2,911 Total 1931 1,939 2,769 4,708 5,322 10,030 1,503 48 710 833 931 180 33 213 23 16 48 14,355 Total 1930 1,961 2,096 4,057 5,173 9,230 1,381 98 803 647 786 221 40 18 14 13,242 85 CLINICS. Dr. Sheppard reports as follows:— "The work carried out at the Welfare Centres was of the usual routine character during 1931. The masseuse attended 105 patients and gave 1,073 treatments. Sixteen cases were seen by Mr. Friel for your Committee, 2 children were sent to Brookscroft and 41 children attended the Orthopaedic Clinic. '' The numbers attending the Welfare sessions continue to be large as can be seen by the following tables:— Markhouse Road:- New Cases. Old Cases. Toddlers. Totals. Under 1 year. Over 1 year. Under 1 year. Over 1 year. January 41 30 910 370 193 1544 February 46 22 618 433 176 1295 March 70 29 915 370 225 1609 April 85 19 1051 618 300 2073 May 73 13 838 479 245 1648 June 60 10 954 416 261 1701 July 79 25 1178 550 305 2137 August 59 20 898 367 303 1647 September 74 15 1192 586 312 2179 October 55 20 780 742 283 1880 November 93 32 1026 571 321 2043 December 50 11 886 470 319 1736 Totals 785 246 11246 5972 3243 21492 Higham Hill:— New Cases. Old Cases. Toddlers. Totals. Under 1 year. Over 1 year. Under 1 year. Over 1 year. October 10 4 37 12 20 83 November 14 8 92 55 29 198 December 4 — 95 51 39 189 Totals 28 12 224 118 88 470 86 Highams Park:— New Cases. Old Cases. Toddlers. Totals. Under 1 year. Over 1 year. Under 1 year. Over 1 year. October 18 2 14 4 3 41 November 21 7 65 21 17 131 December 16 8 83 40 43 190 Totals 55 17 162 65 63 362 ''Ante-Natal.—The Ante-Natal Clinic takes place each Monday at Low Hall Lane. 285 new cases attended, and these made 1,050 attendances, or an average attendance of 21.8 per session as against 15.7 in 1930 and 9.0 in 1929. ''There was no maternal death among mothers attending the Clinic, and it was only found necessary to refer two cases to Hospital. "Fifteen sterilised accouchement outfits were supplied during 1931 at cost price, and one was supplied free of cost." Part I, Children Act, 1908.—At the end of 1931 there were 143 nurse children on the Register as compared with 139 at the end of 1930. During the year 59 removed, 4 were adopted, 1 died and 21 reached the age of 7 years and consequently ceased to come under the Act. One hundred and fourteen foster parents were registered at the beginning of the year and 109 at the end. Your Committee instructed that the following conditions should be fulfilled by foster parents:— 1. The foster parent shall not be aged or decrepit. 2. She shall take only one child. 3. A cot must be provided. 4. A fireguard must be provided. 5. There must be a cupboard for storing food. 6. The foster mother must attend the Maternity and Child Welfare Centre with the infant. 7. The Sanitary Inspector must visit the home. 8. No case of Tuberculosis shall be accommodated. 87 The following figures show the work done at the Centres during the past year:— Summary of Attendances at Welfare Centres. Centre. First Attendances of New Cases. Re-attendances. Grand Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Low Hall Lane 785 246 1031 11246 9215 20461 21492 Higham Hill 28 12 40 224 206 430 470 Highams Park 55 17 72 162 128 290 362 Total 868 275 1143 11632 9549 21181 22324 N.B.—Only 12 sessions each were held at Higham Hill and Highams Park during 1931. Sale of Milk, etc., at Clinics.—The quantity and value of Milk and Foods sold and issued free during 1931 was as follows:— Sales. Value. Free Issue. £ s. d. Virol 1.541 1bs.4 ozs 161 14 4 5½ 1b3. Prune and Banana Syrup 154 1bs. 5 ozs 20 11 2 — Parrish's Food 238 1bs. 14 ozs 11 18 3 10 ozs. Malted Honey 9 1bs 7 6 12 1bs. Cod Liver Oil 114 1bs. 4 ozs 7 12 0 4 ozs. Cod Liver Oil Emulsion 475 1bs. 11 ozs 31 1 3 7 1bs. Glaxo and Ambrosia 1,005 1bs. 65 18 4 214 1bs. Virol Containers 1,884 7 16 7 5 Ostermilk 672 1bs 50 11 8 65 1bs. Almata 682 lbs 64 11 4 86 1bs. Roboleine 891 1bs 61 14 6 68 1bs. Cod Liver Oil and Malt Extract 310 1bs 12 17 6 1 1b. Cow and Gate 10,133 1bs. 767 6 8 925 1bs Locta and Lactogen 23 1bs 1 1 8 10 1bs. Dunne's Milk 144 lbs. 8 14 0 28 1bs. £1,273 16 9 5. TREATMENT. (a) Orthopaedic.—The facilities provided by the Education Authority's Orthopaedic Scheme is available for all children attending the Welfare Centres. 88 Miss Theobald has kindly furnished the following information with respect to children under five years of age:— Cases Seen at Orthopaedic Clinic. Anterior Polio-myelitis 2 Pseudo -hypertrophic Paralysis 1 Rickets 40 Congenital Dislocation of Hip 1 Spastic Paralysis 2 Scoliosis, Kyphosis, Lordosis 3 Talipes 12 Torticollis 1 Congenital Defects 2 Kohlers Disease 1 Miscellaneous 9 Total 74 Admissions to Brookfield Orthopaedic Hospital. Talipes 1 Genu Valgum 3 Torticollis 1 Genu Varum 4 Spastic Hemiplegia 2 Anterior Poliomyelitis 1 Total 12 Number and Classifications of Operations at Brookfield Hospital. (Including Cases remaining over from 1930.) Osteoclasis 4 Osteotomies 4 Manipulations 1 Reductions of Congenital Dislocation if Hip 5 Tenotomies 4 Others 1 Total 19 The foregoing figures refer to all children under five years of age and include those children who have already commenced school. (b) Dental.—The following work was done by the Education Committee's Dental Surgeons—Mrs. W. Rosa Thorne and the late Mr. G. Picton Evans:— Mothers. Children under 5. Cases treated 36 141 Attendances 55 185 Fillings 19 107 Extractions 108 310 General Anaesthetics 30 149 Local ,, 2 4 Scalings 9 1 Dressings 4 11 89 (c) Tonsils and Adenoids.—Thirteen cases were operated on under the arrangement made by the Education Committee with the Walthamstow Dispensary and three cases at the Connaught Hospital. (d) Ophthalmic Defects and Minor Ailments are given any necessary treatment either at the School Clinics or by special appointment. WALTHAMSTOW CHILD WELFARE SOCIETY. The organisation, staff and accommodation of the Society were fully detailed in the 1930 report. 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—6p.m. Infant Consultations. The work done during the calendar year is shown in the following table compiled from information kindly supplied by Miss Coulston:— First Attendances of New Cases. Re -attendances. Grand Total. Under 1 yr. 1-5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1931 455 111 566 5270 4535 9805 10371 1930 453 106 559 4688 3593 8281 8840 Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1931 409 1093 1502 2146 3648 1930 - - - - 2813 Home Visits to Children. Attendances at Lectures. Massage Treatments. Sunlight Treatments. Total eases admitted to Observation Ward. Local Authority's cases admitted to Observation Ward. 1931 3548 1420 1650 2080 28 2 1930 2813 1740 992 2215 32 2 90 No Ante-Natal work is carried out by the Society and no dried foods are supplied at the Clinics. Summary.—The following tables give the total number of attendances at Clinics and home visits:— Attendances at Clinics. First Attendances. Re-attendances. Grand Total. Under 1 year of age. 1-5 years of age. Total. Under 1 year of age. 1-5 years of age. Total. Municipal Scheme 868 275 1143 11632 9549 21181 22324 Voluntary Scheme 455 111 566 5270 4535 9805 10371 Total 1323 386 1709 16902 14084 30986 32693 Home Visits. To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Municipal Scheme 1961 2948 4909 5376 10285* Voluntary Scheme .. 409 1093 1502 2146 3648 Total 2370 4011 6411 7522 13933* *Includes 255 visits paid by Woodford U.D.C. Health Visitor. Average attendance of children per session at all Centres during year 1931 117.5 1930 110.0 Percentage of notified live births represented by number of children under one year of age who attended the Centres for the first time (i.e., new cases) 74.6 Percentage of total notified births represented by number of expectant mothers attending Ante-Natal Clinics 1931 16.5 1930 16.7 91 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, many do so. Applications are made on special forms which give particulars of income and rent and are scrutinised each week by lady members of the Maternity and Child Welfare Committee who attend in rotation. Milk may be either granted free or at reduced cost, and the following shows the amount and approximate cost of milk granted by the Committee during 1931:— Number of applications during 1931 2,874 Number of families assisted 557 Scale. Amount. Cost to Authority. £ s. d. Free 756 pints 9 9 0 ½d. per pint 51,327 ,, 534 13 1½ 1d. ,, ,, 29,048 ,, 242 1 4 2d. ,, ,, 28 ,, 2 4 Half-cost 11,977 ,, 74 17 1½ Total 93,136 ,, £861 2 11 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 three home helps approved during 1931, 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. A total of 22 children were sent to Institutions under arrangements approved by your Committee. The details were as follows:— Brookfield Orthopaedic Hospital, 12 (of these 2 were Education Committee's cases); Brookscroft, 2; Streatham Babies' Hospital, 2; Swanley, Mayfield, St. Margaret's, Cheyne, Sutton and Lennox Hospitals, 1 each. 9. HOSPITAL ACCOMMODATION FOR CONFINEMENTS. (a) Of 1,721 notified births where information was available, 1,263 occurred at home, and 458, or 26.6 per cent., in Institutions. 92 There is thus no question as to the urgent need ot adequate maternity beds in the Borough. The plans for the proposed Municipal Maternity Home are in course of revision to comply with the Ministry's requirements. The following numbers of confinements occurred at the Institutions specified:— Mothers' Hospital, Clapton 177 Nursing Homes in Walthamstow 148 Forest Gate Hospital 58 Queen Mary's Hospital 23 Total 406 There are five Nursing Homes ill the Borough with a total maximum accommodation of 20 maternity beds. 10. WALTHAMSTOW DISTRICT NURSING ASSOCIATION. The Walthamstow Nurses' Home of the Essex County Nursing Association was taken over as from 1st July, 1931, by the District Nursing Association, the staff being four qualified midwives. By this date the Home had been completely redecorated and a two-bed maternity ward and a labour ward had been provided. Later in the year an additional two-bed ward was provided. Your Council assist the Association by granting £10 worth of tramway tokens per annum and also pay a retaining fee of ten guineas per annum for the services of a Nurse for Puerperal Fever and Pyrexia nursing or emergency midwifery. Sister Ross states that the following work was done during 1931:—Maternity cases, 63; Midwifery cases, 179; total Confinements attended, 242; Visits paid, 13,266. During the last six months of 1931, 26 midwifery and maternity cases had to be refused owing to insufficient accommodation. 11. CONSULTANT OBSTETRICIAN. During 1931 the services of the panel of Consultants 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. A Consultant's services were provided on eight occasions. 93 12. MIDWIVES ACTS, 1902-1926. Your Council took over the supervision of Midwives from the Essex County Council with effect from 1st April, 1931, under the Borough of Walthamstow (Supervision of Midwives) Order, 1931. The administration of the Order was left to the Maternity and Child Welfare Committee which decided to adhere to the County Council's scale of income for assessment or recovery of fees where medical aid is summoned by Midwives in emergency. The scale is as follows:— Parents' Weekly Income after deducting 5s. in respect of each parent and each dependent member of the household. Fee to be recovered. Not exceeding £1 weekly Nil. Exceeding £1 and not exceeding £2.. 10s. 6d., or actual fee if less than this amount. Exceeding £2, and not exceeding £3 £1 1s., or actual fee if less than this amount. Exceeding £3 weekly Actual fee. It was agreed that no recovery should be made in cases of Ophthalmia Neonatorum and, during the current year, it has been decided that no recovery of fees is to be made in respect of Pemphigus Neonatorum. An arrangement was made during the year with the Walthamstow District Nursing Association in order to provide a qualified midwife in cases of emergency, e.g., to replace any midwife who might be suspended from duty. The Association agreed to provide these services on condition that a grant of five guineas be paid for the provision of an emergency midwife, plus a fee of one guinea per confinement or 2s. 6d. per visit. Dr. Sheppard has acted as Inspector of Midwives and has carried out the routine quarterly inspections, the results of which have been generally satisfactory. Additional inspections in respect of emergencies such as Ophthalmia Neonatorum, Puerperal Fever and Pyrexia, Maternal Mortality, have been made by your Medical Officer of Health. There were 17 midwives in active practice on the 1st April, and three others gave notice of intention to practice during the year, making a total of 20. All held the Certificate of the Central Midwives Board. 94 The following table shows the work done by the midwives during 1931:— Up to 31.3.31. After 31.3.31. Total. No. of confinements attended as a midwife 208 440 648 ,, confinements attended as a maternity nurse 51 85 136 ,, Medical Aid Notices sent 32 84 116 ,, Notifications of Deaths (all children) 3 1 4 ,, Twin births — 3 3 ,, Stillbirths 2 5 7 ,, Notifications of liability to be a source of infection 1 4 5 During 1930, 680 cases were attended as Midwives and 149 as Maternity Nurses. The conditions for which Medical Aid was summoned by Midwives up to 31st March has been summarised by Dr. Bullough and were as follows:— Conditions. No. of Notices received. Conditions. No. of Notices received. Prolonged or difficult labour 10 Miscellaneous:— Ruptured Perineum 6 Gastric pains 1 Discharging Eyes or Ophthalmia Neonatorum 4 Prolapse of cord 1 Slight Convulsions 1 Ante-partum Haemorrhage 3 Haemorrhage from Bowels 1 Puerperal Pyrexia 2 Pleurisy 1 Dangerous feebleness of Infant 2 Total .. 32 The reasons for summoning Medical Aid during the remainder of the year were:- Pregnancy:— Puerperium:— Ante-partum Haemorrhage 4 Rise of temperature 3 Hyperemesis 1 Weakness of Mother 1 Albuminuria 1 Vomiting 1 Bronchitis 1 Total 7 Total 5 95 Labour:— Child:— Prolonged or difficult labour 13 Stillbirth 3 Dangerous Feebleness 3 Post-partum Haemorrhage 5 Discharge from Eyes 5 Ruptured Perineum 13 Jaundice 2 Precipitate Labour 1 Meningocele and Spina Bifida 1 Retained Placenta 6 Premature Labour 4 Pemphigus 4 Abnormal presentations 2 Convulsions 1 (Edema of Vulva 1 Cyst of Penis 1 (Edema of Cervix 1 Rash 1 Abortion 1 Haemorrhage 1 Cardiac trouble 1 Death of Baby 1 Partial Asphyxia 1 Total 48 Total 24 Recovery of Fees.—When a midwife summons medical aid a printed form is made out in triplicate. One is retained by the midwife, one is sent to the patient's Doctor, and one is sent to the Medical Officer of Health. On receipt of the latter the midwife is sent a form which she is requested to have completed in her presence by the head of the household, giving particulars as to income and outgoings and then to witness his signature. If the patient wishes to settle the account for himself, the form is endorsed "able and willing to pay," in which case the Doctor recovers his fee direct from the patient. If otherwise, the amount of the husband's weekly income is verified from his employers and an assessment is then made by the Sub-Committee on the scale already detailed. On several occasions it has been found that midwives have been loth to send for medical aid until the patient's temperature has reached 100.4 degrees as defined by the Rules of the Central Midwives Board. There is no question that the rule should be amended to specify a limit of at least a degree lower. Further reference is made to the matter under Puerperal Fever and Pyrexia. A contribution of 15s. was paid towards the fee of the midwife in one case. Nursing Homes Registration Act, 1927.—See Public Health Section of the Report (pages 18-20). 96 13. PUERPERAL FEVER AND PYREXIA. The following tables give details of the 41 cases of Puerperal Fever and Pyrexia during 1931 by ages, Wards and months:— Month. All ages. 15-25 yrs. 25—45 yrs. 45-65 yrs. January 4 - 4 - February 2 — 1 1 March 5 1 4 - April 3 1 2 - May 3 2 1 - June 3 3 - - July 5 — 5 - August 6 1 5 - September 6 2 4 - October 1 - 1 - November 2 1 1 - December 1 - 1 - Total 41 11 29 1 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. January — — 1 1 2 - 1 February 1 — — — — 1 2 March 1 1 2 — 1 — 4 April — — 2 — 1 — 2 May — — 2 — — 1 2 June 1 — — — — 2 3 July 2 1 — 1 — 1 3 August — — 2 — 3 1 5 September — 1 — 2 2 1 3 October — 1 — — — — 1 November — — — 1 — 1 2 December — — — — 1 — — Total 5 4 9 5 10 8 28 A further table gives particulars of the details given in the various notifications received. Thus, of the 41 cases, a total of 13 were notified from Hospitals outside the area, i.e., 11 from the Mothers' Hospital, Clapton (where the confinements had been carried out) and 2 from Whipps Cross Hospital, following confinement in Walthamstow. Four cases were notified from Nursing Homes in the Borough leaving 24 notifications of Pyrexia following confinements at homes 97 of patients. The notifications were endorsed as follows:—Facilities available, 23; removed to Hospital, 10; second opinion required, 8. Of the 28 cases nursed in Hospital, 14 were admitted to Whipps Cross Hospital, 11 were already at the Mothers' Hospital, and 1 each were admitted to Queen Charlotte's Hospital, University College Hospital and the Sanatorium. The latter case had typical Scarlet Fever which showed on the fourth day after confinement. Your Council decided to pay a retaining fee of five guineas to the Walthamstow District Nursing Association for the services of a Nurse in any case requiring home nursing. In addition, a fee of 2s. 6d. per visit is payable or three guineas per week for the fulltime services of a Nurse. During the year one case only required five nursing visits. Reference has been made under the appropriate section to the reluctance of some midwives to call in medical aid until the patient's temperature reached 100.4 degrees, the limit prescribed by the Rules of the Central Midwives Board. A revision of this Rule to the effect that medical aid should be called in earlier in cases of Puerperal Pyrexia is urgently necessary. Such a revision would help to reduce maternal mortality and morbidity and would tend to secure the earlier admission of patients to Hospital where more adequate treatment is available. 98 PUERPERAL FEVER AND PYREXIA—1931. 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. 1. Pyrexia 4.1.31 5.1.31 26 W. Facilities available .. 23.12.30 3.1.31 Not removed. 2. „ 6.1.31 7.1.31 29 Ho. „ „ 4.1.31 5.1.31 „ „ 3. „ 24.1.31 26.1.31 29 H.E. „ „ 18.1.31 20.1.31 „ „ 4. Fever 24.1.31 26.1.31 37 H.E. Removed to Hospital „ 23.1.31 24.1.31. 5. Pyrexia 11.2.31 13.2.31 45 J. Admit to Hospital 9.2.31 11.2.31 13.2.31. 6. „ 15.2.31 16.2.31 40 H.H. ,, ,, 11.2.31 10.2.31 15.2.31. 7. „ 8.3.31 9.3.31 42 J. ,, ,, 5.3.31 7.3.31 9.3.31. 8. „ 12.3.31 12.3.31 38 H.E. Second opinion 4.3.31 7.3.31 12.3.31. 9. „ 17.3.31 17.3.31 29 Ho. Facilities available 13.3.31 16.3.31 18.3.31. 10. „ 27.3.31 27.3.31 32 Ho. Admit to Hospital 23.3.31 24.3.31 27.3.31. 11. „ „ 31.3.31 31.3.31 17 Hi. Facilities available 28.3.31 30.3.31 Not removed. 12. Fever 14.4.31 14.4.31 21 Ho. Admit to Hospital 3.4.31 14.4.31 17.4.31. 13. Pyrexia 27.4.31 28.4.31 33 Ho. Facilities available 25.4.31 26.4.31 Not removed. 14. „ 21.5.31 22.5.31 24 Ho. Second opinion 30.4.31 13.5.31 „ „ 15. „ 15.6.31 15.6.31 24 H.H. Facilities available 31.5.31 13.6.31 15.6.31. 16. „ 20.4.31 24.4.31 27 H.E. ,, ,, 30.3.31 10.4.31 Already in Hospital. 17. „ 6.5.31 11.5.31 20 Ho. ,, ,, 25.4.31 3.5.31 „ „ 18. „ 25.5.31 28.5.31 30 H.H. „ „ 19.5.31 21.5.31 „ „ 19. „ 30.5.31 5.6.31 24 H.H. „ „ 31.5.31 1.6.31 „ „ 20. „ 29.6.31 30.6.31 20 J. Admit to Hospital 24.6.31 27.6.31 29.6.31. 21. Fever 18.7.31 20.7.31 27 J. Second opinion 16.7.31 17.7.31 Not removed. 22. „ 18.7.31 20.7.31 25 J. Facilities available 14.7.31 16.7.31 Already in Hospital. 23. Pyrexia 22.7.31 23.7.31 26 W. Second opinion 18.7.31 21.7.31 Not removed. 24. „ 27.7.31 30.7.31 29 Hi. Facilities available 14.7.31 16.7.31 Already in Hospital. 99 25. Pyrexia 27.7.31 30.7.31 35 H.H. Facilities available 9.7.31 16.7.31 Already in Hospital. 26. „ 3.8.31 5.8.31 25 Ho. „ „ 29.7.31 30.7.31 „ „ 27. „ 3.8.31 5.8.31 27 Ho. „ „ 26.7.31 29.7.31 „ „ 28. Fever 8.8.31 10.8.31 35 H.H. „ „ 4.8.31 4.8.31 „ „ 29. „ 12.8.31 12.8.31 23 H.E. Second opinion 5.8.31 9.8.31 12.8.31. 30. Pyrexia 26.7.31 14.8.31 26 H.E. „ „ 6.7.31 10.7.31 Not removed. 31. „ 26.8.31 29.8.31 28 H.E. Facilities available 18.8.31 21.8.31 Already in Hospital. 32. Fever 1.9.31 1.9.31 41 Hi. Admit to Hospital 30.8.31 28.8.31 30.8.31. 33. „ 3.9.31 3.9.31 23 W. Facilities available — 10.9.31 Not removed. 34. „ 10.9.31 11.9.31 23 W. „ „ 7.9.31 10.9.31 „ „ 35. Pyrexia 8.9.31 10.9.31 26 H.E. „ „ 17.8.31 17.8.31 Already in Hospital. .36. Fever 23.9.31 24.9.31 38 H.H. Admit to Hospital 17.9.31 21.9.31 21.9.31. 37. Pyrexia 27.9.31 28.9.31 26 H.E. Second opinion 21.9.31 14.9.31 Not removed. 38. ,, 26.10.31 27.10.31 33 Hi. Admit to Hospital 4.10.31 6.10.31 6.10.31. 39. Fever 31.10.31 2.11.31 30 H.H. Facilities available 28.10.31 30.10.31 31.10.31. 40. Pyrexia 26.11.31 30.11.31 24 W. „ „ 8.11.31 18.11.31 Already in Hospital. 41. „ 30.12.31 31.12.31 37 H.E. Second opinion 27.12.31 28.12.31 Not removed. 100 14. OPHTHALMIA NEONATORUM. The numbers of cases notified during the last two years were:— Year. Totals. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. 1931 8 3 1 3 — — 1 1930 8 2 - - — 1 5 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1931 7 1 8 - — — 1930 5 3 8 - — — One case was admitted to St. Margaret's Hospital (London County Council) and made a good recovery. Treatment was given either at home or at the Clinics by your Council's Medical Officers and Health Visitors in three of the cases. 15. PEMPHIGUS NEONATORUM. Six cases of this disease were reported during the year, and three proved fatal. The first case occurred in May (Midwife C), the second in November (Midwife V) and cases 3, 4, 5 and 6 (Midwife E) in December. There was no connection between any of the midwives and no causative factor could be discovered except that Case 3 had recently been circumcised—the first bleb appeared on the inside of the upper part of the thigh. Midwife E, who acted as a Maternity Nurse in cases 5 and 6, was found to be perfectly normal when examined on three occasions. All the midwives were suspended until the usual disinfection of person, clothing and equipment had been carried out and, in addition, Midwife E voluntarily agreed not to practice midwifery for one month which was later extended to four months. Date of Death. Certified Cause of Death. Age. Ward. No. of Pregnancy. Previous obstetric history. j Duration of 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. 18.2.31 1. (a) General Peritonitis and Puerperal Septicaemia following Haemolytic Streptococcal infection of the uterus following full term delivery 25 Hoe Street 1 Nil 40 8.2.31 Dr. and M. Normal 6.2.31 9.2.31 9.2.31 Uterine infarct due to embolus. Pus in left fallopian tube. General Peritonitis due to Haemolytic Streptococcus. Second degree laceration. Rigors 3 hours after delivery. 12.1.31 1. (a) Lobar Pneumonia (6) Childbirth; no P.M. 41 Wood Street 6 Not obtainable. ? 12.1 .31 Dr. Instrumental Delivery 10.2.31 Nil 11.1.31 Collapsed 5 minutes after delivery. Shoulder presentation. Internal version performed. Premature dead foetus. 14.2.31 1. (a) Debility after parturition (6) Bronchitis (c) Valvular Disease of the Heart 2. Syncope; no P.M. 23 Hale End 1 Nil 39 19.1.31 Dr. Instrumental Delivery 18.1.31 Nil 18.1.31 Left Hospital at own request—7.2.31. Malignant Endocarditis. Perineal Tear Second Degree. 16.8.31 1. (a) Heart Failure (b) Caesarean Section 2. Mitral Stenosis; P.M. 28 Hale End 1 Nil 40 16.8.31 Dr. and M. Caesarean Section * 10.8.31 Nil 15.8.31 Old Mitral Stenosis. Passive Congestion of Liver. Acute Oedema of Lungs and Dilation of Heart. Died 2 hours after delivery by Caesarean Section. Seen by Consultant and removed to Hospital. 101 16. MATERNAL MORTALITY. Maternal mortality inquiry forms have been completed for the Ministry of Health in each case where the certified cause of death showed any connection with recent childbirth. Thus, during 1931, four inquiry forms were completed and full details are given in the accompanying table. All four deaths occurred in Institutions— one each at four different Institutions outside the area. One of the confinements took place in Walthamstow, the patient being moved to Hospital subsequently. The Registrar-General, however, under the "Rules for the selection of one from two or more jointly stated causes of death," only allocated one death to puerperal causes. The rates per 1,000 are therefore calculated on this figure. The following table shows the position with regard to Maternal Mortality compared with England and Wales:— Births Registered. Deaths of women due to Pregnancy and Child-Bearing. WALTHAMSTOW. England and Wales. Puerperal Sepsis. Other Puerperal Causes. Total. Rates per 1,000 Births Registered. Rates per 1,000 Births Registered. Puerperal SepsiB. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal causes. Total. Live 1 ,947 ,, and 1 — 1 0.51 - 0.51 1.66 2.45 4.11 Stillbirths 2,006 1 — 1 0.49 — 0.49 1.59 2.35 3.95 The table facing this page gives full particulars of all the Maternal Deaths.