WAL 7 AC 4411(1) NACTHAMSTOW Borough of Walthamstow. REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1932. Borough of Walthamstow. REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1932. INDEX. pages Section A.—Statistics and Social Conditions of the Area 7-26 „ B.—General Provision of Health Services in the Area 27-37 „ C.—Sanitary Circumstances of the Area 37-42 „ D.—Housing 42-46 „ E.—Inspection and Supervision of Food 46-57 „ F.—Prevalence of and Control over Infectious Diseases 57-80 „ G.—Infectious Diseases Hospital 80-88 „ H.—Maternity and Child Welfare 90-118 page Acreage 7 Adulteration 52 Ambulance 30 Ante-Natal Clinic 101 Antitoxin 68 Bacteriology 61 Bacteriological Analyses 47 Bakehouses 40 Biological Tests 49 Births 22 „ , Notification of 93 Birth Rate 22 Breast Feeding 99 Byelaws 27 Cancer 25 Caravans 41 Census 5,7 Cerebro-Spinal Meningitis 71 Chicken Pox 5,71 Clinics 32 Closet Accommodation 37 Committees 4,90 Complaints 38 Confinements 108 Consultants 108 Cowsheds 46 Cremation 88 Dampness 38 Deaths 22 „ Institutional 26 Death Rate 22 Dental Treatment 103 Diphtheria 23,66 Diseases of Animals Acts 54 Disinfection 39 Drainage 37 Dwellings 7, 8, 16 Encephalitis Lethargica 57 Enteric Fever 69 Erysipelas 70 page Families 7, 16, 17 Fair Grounds 41 Factories & Workshops Acts 55 Fishmongers 40 Food and Drugs 52 Health Visitors 91 Home Helps 107 Hospital Accommodation 27, 64, 80 „ , Infectious Diseases 80 „ ,Smallpox 64 House Refuse Removal 37 Housing 42 Act, 1925 43 „ 1930 44 „ Conditions 45 „ Shortage 10 „ Statistics 7,42 Ice Cream 49 Immunization 60 Infant Mortality 95 Infectious Diseases 57 „ „ Clinic 59 Isolation Hospital 80 Laboratory Work 61 Legal Proceedings 53 Legislation in force 27 Maternal Mortality 35 Maternity & Child Welfare 90 „ Homes & Hospitals 36 Maternity Outfits 102 Measles— 22,27,72 Meat Inspection 51 Midwives 35,109 Milk 46 „ Assisted Scheme 107 Milk and Dairies Order 51 „ „ ,Amend. Act 51 „ Special Desig. Order 51 „ Shops 40 page Notices, Sanitary 38 Nuisances 38 Nurse Children 102 Nursing 27 Offensive Trades 53 Ophthalmia Neonatorum 114 Ophthalmic Treatment 104 Orthopaedic „ 102 Outworkers 56 Overcrowding 12 Parks 22 Pneumonia 69 Poisons and Pharmacy Act 55 Population 7, 8, 14 Prosecutions 53 Public Assistance 27,35 Puerperal Fever and Pyrexia 22, 110 Rag Flock Act 42 Rateable Value 7 Refuse Disposal 37 Rent Restrictions Act 53 Rivers and Streams 37 Rooms 7 Sanitary Inspection 38 Scarlet Fever 23,65 page Schools 41 Slaughter-houses 41 Smallpox 5,23,62 Smoke Abatemont 41 Social Conditions 7 Special Premises 41 Staff 5,91 Stillbirths 22 Tents, Vans and Sheds 41 Tonsils and Adenoids 104 Tuberculosis 22,78 Tuberculous Meat 52 Unemployment 21 Unhealthy Areas 46 Vaccination 65 Vital Statistics 22 Walthamstow Child Welfare Society 104 Walthamstow Dispensary 30 Walthamstow District Nursing Association 108 Water 37 Whooping Cough 22,23,75 Workshops 55 Zymotic Diseases 22 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Councillor G. H. Spaceman, J.P. Ex-officio: His Worship The Mayor.—Alderman T. W. Smith, J.P. The Deputy Mayor—Councillor Bertram Cole. Councillor E. C. Redhead, Chairman of Finance Committee. Alderman G. Gibbons, J.P. Alderman Mrs. M. Norrish. „ J. C. Hammond. Councillor Mrs. E. M. Miller. (Chairman, Sanatorium Visiting Committee). „ Mrs. C. McEntee, J.P. Councillor Mrs. L. P. Bailey. Councillor C. E. Longley. „ A. G. Bottomley. „ Mrs. A. L. Meadows. „ W. Gillett. „ G. M. Page. „ Miss B. A. Henderson. „ Mrs. E. M. Richards. „ R. R. B. Lester. „ 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 1932. The Report is presented as suggested by Circular 1269 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 again showed an increase under most headings and, in addition, to the visits recorded by the Sanitary Staff, a total of 2069 home visits were paid by the Medical Staff—997 being in respect of Smallpox and Chickenpox. The Staff of the Department was increased by the appointment of an additional Junior Clerk. The Census Returns have been included in detail, together with additional tables in which I have endeavoured to compare the various findings of 1931 and 1921, particularly with regard to housing. It is hoped that by inclusion in this Report these statistics will be made more easily available when required. Acknowledgment must again be made of the support I have invariably received from the Chairman and Members of your Committee and the co-operation of my colleagues in other Departments. Mr. Furness has again contributed those sections dealing with the following matters:—Water, Rivers and Streams, Drainage, Sewerage and Scavenging, and the New Housing Statistics. My thanks are also due to the Staff of the Department who have all worked well and have assisted in the compilation of the Report. Mr. Duncan, Chief Sanitary Inspector, has again contributed the following sections: Closet Accommodation (page 37), Sanitary Inspection of the Area (pages 38-41), Inspection of Dwelling Houses (pages 43-45), Inspection and Supervision of Food (pages 46-49 and 51-53), Legal Procedure (page 53), Diseases of Animals Acts (pages 54-55), Factories and Workshops (pages 55-56). I have the honour to be, Your obedient servant, A. T. W. POWELL, Medical Officer of Health, etc. 6 STAFF. Medical Officer of Health, School Medical Officer and, Medical Superintendent, Isolation Hospital: A. T. W. Powell, m.c., M.B., B.S. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (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 Mart C. Clarke, M.R., B.Ch., B.A.O. Resident Medical Officei—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., Ch.M., F.C.O.G. (also in charge of Women's Clinic). Mr. W. McKim H. McCullagh, d.s.o., M.c., F.R.C.S., M.C.O.G. 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. Women's Clinic: Miss A. M. Duncan, S.R.N. (part-time). Chief 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), (e). W. R. Robinson, (b), (d). F. W. Kemp, A.R.S.I., (a), (b), (c). T. Vaughan, (b), (c), (e). F. Northcote, A.R.S.I., (b), (c). H. A. Whipp, (b), (c). Miss 0. J. Panther, (a), (half-time for Factory and Workshops Act duties). (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, A.R.S.I., (a), R. A. C. Green, L. Rushton, F. J. Aylward, A. T. Wade (from 29-2-32V Ambulance Drivers and Disinfecting Staff: W. H. Dunn, E. E. Harber, R. High, B. Winter. 7 A—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1932, 135,010 Number of inhabited houses, 31st December, 1932 33,000 Rateable value £684,047 Sum represented by penny rate £2,723 CENSUS, 1931. The tables referred to under the various sub-headings are given at the end of this section. (a) Population. The Report for 1931 stated that, according to the Preliminary Report of the Census, Walthamstow ranked 35th on the list of 113 towns in England and Wales with a population of over 50,000. As in 1921, Walthamstow remained the third largest town in Essex, and was, on Census night, the most populous non-County Borough in England and Wales. The Census population has now been amended to 132,972, an increase of 7 on the former figure. Table 2 shows that this figure represents an increase of 3,577, or 2.8 per cent. over the 1921 population. (b) Usual Residence. Table 6, a novel feature of the 1931 Census, gives experimental data as to residence and also provides material for use in connection with Exchequer grants under the Local Government Act, 1929. (c) Parliamentary Constituencies. Table 7 gives particulars of the electors in the East and West Divisions of Walthamstow. (d) Dwellings, Rooms and Families. The principal results of the Census are set out in Tables 10 and 11. 8 A comparison of the details of Tables 3, 10 and 11 for 1931 and 1921 shows the following:— Structurally separate dwellings occupied:— 1931. 1921. Increase or Decrease (—) No. Percent. Walthamstow 28,639 24,616 4,023 16.3 Hale End 5,369 3,628 1,731 47.58 Higham Hill 6,684 5,105 1,579 30.93 High Street 4,191 3,730 461 12.35 Hoe Street 4,645 4,657 — 12 —0.259 St. James Street 4,473 4,384 89 2.03 Wood Street 3,277 3,102 175 5.64 Rooms occupied 146,317 128,289 18,028 14.04 Private Families 34,973 29,461 5,512 18.70 Population in private families 131,350 128,627 2,723 2.11 Nearly half of the new houses erected in the Borough during the intercensal period were situated in Hale End Ward. Although there was a total increase of 4,023 occupied dwellings, the intercensal increase of population is given as 3,577, i.e., an average of less than one per new house. Average. Walthamstow. England and Wales. 1931. 1921. 1921. Rooms per dwelling occupied and vacant 5.11 5.21 5.15 Private families per occupied dwelling 1.22 1.20 1.12 Rooms occupied per family 4.18 4.35 4.55 Persons per room 0.9 1.0 0.91 Persons per private family 3.76 4.36 4.14 From the above Table it will be noted that the number of families per occupied dwelling has increased from 1.20 in 1921 to 1.22 in 1931. There were less rooms occupied per family but fewer persons per room, and smaller private families. The following Table analyses the percentage distribution of families to dwellings:— No. Per cent. Families living in single occupation of separate premises 22,763 65.1 Families living two to a dwelling 10,928 31.2 Families living three or more to a dwelling 1,282 3.7 34,973 100.0 9 Size of Family Units of Occupation. The essential aspects of housing and overcrowding are given in Table 11 and a comparison between the finding of 1931 and 1921 is given below:— DISTRIBUTION OF PRIVATE FAMILIES ACCORDING TO NUMBER OF ROOMS OCCUPIED. Units of Occupation. (Rooms) Private Families. Number 1931. Distribution per cent. Number 1921. Distribution per cent. Increase or Decrease (-) 1 1,183 3.4 897 2.7 286 2 3,344 9.6 1,929 6.5 1,415 3 7,635 21.8 6,148 20.9 1,487 4 6,618 18.9 5,930 20.2 688 5 10,455 29.0 9,014 30.7 1,441 6-7 5.268 15.1 4,935 16.9 333 8-9 355 1.0 440 1.5 — 85 10 and over 115 0.3 168 0.6 — 53 Total 34,973 100.0 29,461 100.0 — 34.8 per cent. of families have only up to 3 rooms, against 30.1 in 1921. The following Table compares the units of occupation (i.e., the number of rooms inhabited by the family irrespective of whether this forms the whole or part of a structurally separate dwelling) with the actual number of dwellings available. It will be seen that there is still an enormous need for structurally separate dwelling units, especially in respect of accommodation of 3 rooms or lessif the ideal of one dwelling per family is ever to be reached. Number of Rooms. Units of Occupation Inhabited by Individual Families.* Structurally Separate Dwellings. Number. Per cent. Number. Per cent. 1-3 10,561 32.03 2,421 8.35 4-5 16,760 50.83 16,828 58.02 6 or more 5,654 17.09 9,756 33.63 Total 32,975 100.0 29,005 100.0 * Exclusive of units in the occupation of single person families. 10 The following Table shows the changes in the sizes of family and that families of 2, 3 and 4 persons now total 66.0 per cent. of all private families, against 54.7 per cent. in 1921:— DISTRIBUTION OF PRIVATE FAMILIES ACCORDING TO NUMBER OF PERSONS IN FAMILY. No. of persons in family. Private Families. Persons per Room. No. 1931. No. 1921. Increase or Decrease (—) Distribution per cent. 1931. 1921. 1921-31. 1931. 1921. 1 1,998 1,214 784 5.7 4.1 0.42 0.39 2 7,274 4,404 2,870 20.9 14.9 0.54 0.54 3 8,621 5,838 2,873 24.7 19.8 0.73 0.73 4 7,109 5,872 1.237 20.4 20.0 0.89 0.89 5 4,600 4,543 57 13.1 15.4 1.08 1.06 6-7 4,035 5,097 — 1,062 11.5 17.3 1.32 1.32 8-9 1,027 1,839 — 812 2.9 6.3 1.70 1.67 10 and over 309 654 — 345 0.8 2.2 2.12 2.02 Total 34,973 29,461 100.0 100.0 0.90 1.00 Summary op Housing Position. Table 3 gives the detailed findings by wards and compares the number of persons per room and per house in 1931 and 1921. Although there was an all-round improvement in the number of persons per house at the last Census, there was a marked deterioration in the number of persons per room in High Street and St. James' Street Wards. The over-all persons per room density has been reduced from 1.0 to 0.90 persons per room. The Table above shows that the density of persons per room actually increased in the case of families of 1, 5, 8 to 9, and 10 and over persons. while that of 2, 3, 4 and 6 to 7 persons remained unaltered, and it was merely the fact that these latter families comprised 77.5 per cent, of all families which resulted in the total figure showing an improvement from 1.00 persons per room in 1921 to 0.90 in 1931. The following commentary on the over-all reduction in density (which also applied to the County generally, viz. : 0.92 persons per room in 1921 and 0.84 in 1931) is taken from the Census Report:— "So far as concerns this large component element in the over-all redaction of density it is doubtful whether the numerical reduction has been accompanied by an equivalent improvement in 11 actual housing conditions. It is obvious from superficial consideration that large families can be housed more economically than small in the matter of average room density; the larger families include, as a rule, an over-normal average proportion of children for whom the necessary space provision cannot be as high as that of a corresponding proportion of adults; while in the matter of sex separation in sleeping rooms, the chance of being able to utilise the available accommodation to its full capacity will clearly be greater when the family is a large one. It may normally be inferred, for example, that in the case of both three-person families and six person families housed at the same numerical density ratio of persons per room, the six-person families will be the better housed. Similarly, as the numerical density ratio in the case of the larger families tends to represent their true housing conditions unfavourably, so with regard to the population transferred from the larger to the smaller families, an arithmetical comparison of the lower densities of the latter with the higher densities of the former tendsi to over state the real measure of improvement in housing conditions. "So far, therefore, as the reduction in the over-all average density is due to a transfer of population from the larger to the smaller families, the reduction only partially reflects a real improvement in housing conditions. Stated conversely. the continued break up of families into smaller units has made the population harder to house by reducing the proportion of those types of family which are more economically housed and increasing those which are less economically housed. The continued reduction in the average size of the family has thus in itself amortised a portion of the additional housing provision made within the last ten years, some portion of that provision having been absorbed in coping with the effects of changes adverse in themselves to the maintenance of satisfactory housing conditions." HOUSING OF PRIVATE FAMILIES. Increase in Occupied Dwellings. c.f. 1921 Census. Increase in Private Families. c.f. 1921 Census. Vacant unfurnished Dwellings. More than 2 per room Density. Private Families. Population. 1931. 1921. No. % No. % No. % No. % No. % No. % 4023 16.34 5512 18.71 247 0.85 1109 3.17 7388 5.62 9606 7.47 The above Table brings out several conflicting facts. The increase in private families was greater than the actual intercensal increase of population, viz., 3,577. 12 On the other hand, definite evidence of improvement is shown in the findings as regards relative incidence of excessive room densities. Thus, 2,218 fewer persons were living at a density of more than two persons per room, which represents one accepted standard of overcrowding. The table following compares the findings in Table 10 with those published in the 1921 Census Report:— Year. Dwellings occupied by one private family. Dwellings occupied by two private families. Dwellings occupied by three private families. Total private families in following No. of rooms. 1-3 4-5 6-8 9 or more rooms. 1-3 4-5 6-8 9 or more rooms. 1-3 4-5 6-8 9 or more rooms. 1-3 4-5 6-8 9 or more rooms. 1931 2353 14666 5543 201 40 1902 3445 77 — 62 285 65 2433 18658 13307 575 1921 1574 12984 5228 263 11 1006 3217 86 2 35 192 18 1602 15103 12256 500 Comparing the information in Table 11 with that given in 1921, the following is the position:— Year. Persons living at following densities per room. Over 3 Over 3.3 Over 2 and under 3 Over 2 and under 3.3 Over 1.5 and under 2 Over 1.4 and under 2 Over 1 and under 1.5 Over 1 and under 1.4 1931 1315 - 6073 - 15937 - 29740 - 1921 - 518 - 9088 — 29759 — 28219 (N.B.—The basis of calculation of density varied in 1931 and 1921.) Additional comparisons of the findings of 1931 and 1921 are given below:— Year. Number of private families of 2 persons and over occupying number of rooms stated. 1 room 2 rooms 3 rooms 4 rooms 5 rooms 6-7 rooms 8-9 rooms 10 rooms or more 1931 487 2845 7229 6433 10327 5187 353 114 1921 454 1690 5932 5801 8902 4804 438 166 13 Total number of private families and population occupying following number of rooms. 1 room 2 rooms 3 rooms 4 rooms 5 rooms 6-7 rooms 8-9 rooms 10 rooms or more Families: 1931 1183 3344 7635 6618 10455 5268 355 115 1921 897 1929 6148 5930 9014 4935 440 168 Population: 1931 2127 8836 25775 25358 44864 22099 1676 615 1921 1640 5225 23802 25841 44868 24133 2198 920 The following tables compare local age and condition distribution in 1931 and 1921. LOCAL AGE AND CONDITION DISTRIBUTION. Year. Average Age. Age distribution per 1,000 of each sex. (Ages last birthday.) M. F. Males. Females. 0-4 5-19 20-39 40 & over 0-4 5-19 20-39 40 & over 1931 31.1 32.5 75 266 338 321 68 243 345 344 1921 28.4 29.3 91 331 288 290 82 305 321 292 Year. Marital condition distribution per 1,000 of each sex. Number of Married Women aged less than 45 per 1,000 Females of all ages. Number of Females per 1,000 Males. Males. Females. Single Married Widowed and Divorced Single Married Widowed and Divorced 1931 510 460 30 491 427 82 247 1095 1921 556 416 28 543 387 70 238 1093 Table 12 classifies by habitation those people not included in private families. Table 13 shows the number of persons in institutions, etc. Tables 14 and 16 show the distribution of population according to age, sex and marital condition. The whole of the information for the above summary has been taken from the tables and text of Part I, County of Essex, Census of England and Wales, 1931. TABLE 2.—POPULATION 1911-1931 AND INTERCENSAL VARIATIONS. Population. Increase or Decrease (—). 1911 1921 1931 1911-21 1921-1931 Persona. Persons. Males. Females. Persons. Males. Females. Per cent. Amount. Per cent. Total. By births & deaths. By Immigration. 124580 129395 61824 67571 132972 63468 69504 3.9 3577 2.8 7.0 — 4.2 TABLE 3.—ACREAGE, POPULATION, PRIVATE FAMILIES AND DWELLINGS (BY WARDS). Acreage (Land and water). Total Population. Private Families and Dwellings, 1931. 1921 1931 Persons Persons Males Females Persons per acre Private families Population in private families Structurally separate dwellings occupied Rooms occupied Persons per room Persons per house 1931 1921 1931 1921 Walthamstow 4342 129395 132972 63468 69504 30.6 34973 131350 28639 146317 0.90 1.0 4.59 5.23 Hale End 1326 18072 23467 11136 12331 17.7 6354 23259 5369 29589 0.79 1.10 4.33 4.96 Higham Hill 977 24423 29113 14158 14955 29.8 7254 28752 6684 31239 0.92 0.98 4.30 4.78 High Street 688 20480 18258 8797 9461 26.5 4818 18108 4191 18765 0.96 0.92 4.32 5.49 Hoe Street 355 23895 22328 10372 11956 62.9 6316 21948 4645 26538 0.83 1.13 4.73 5.12 St. James Street 486 24936 22568 10906 11662 46.4 5844 22481 4473 21770 1.03 0.86 5.03 5.69 Wood Street 510 17589 17238 8099 9139 33.8 4387 16802 3277 18416 0.91 1.02 5.12 5.65 14 Table 6.—COMPARISON OF CENSUS AND RESIDENT POPULATIONS. Enumerated Population 1931. Enumerated in the Area but resident elsewhere in England and Wales. Resident in the Area but enumerated elsewhere in England and Wales. Excess of Residents in relation to enumerated. Numbers. Per 1,000 enumerated. Persons. Males. Females. Males. Females. Males. Females. Persons. Males. Females. Persons. 132972 63468 69504 431 668 864 1105 870 433 437 7 Table 7.—POPULATION AND PARLIAMENTARY ELECTORS (1931 REGISTER). Parliamentary Constituency. Acreage. Population. Parliamentary Electors 1931 Register. Residence Qualifications per 1,000 Population (Persons). Other Qualifications per 1,000 Population (Persons). 1921. 1931. All qualifications. Residential Qualifications. Persons. Persons. Males. Females. Persons. Males. Females. Persons. East Division 2191 59556 63033 29607 33426 41890 19533 22357 41598 660 5 West „ 2151 69839 69939 33861 36078 43027 20925 22102 42814 612 3 15 Table 10. —DWELLINGS, ROOMS AND FAMILIES. Structurally Separate Dwellings of All sizes Number of Rooms. 1 Room 2 Rooms 3 Rooms 4 Rooms 5 Rooms 6-8 Rooms 9 or more Rooms Total. Occupied. Vacant. Furnished Others Dwellings occupied by 1 private family 29 193 2131 4629 10037 5543 201 22763 112289 111720 260 309 Dwellings occupied by 2 private families — 1 39 271 1631 3445 77 5464 31767 31723 18 26 Dwellings occupied by 3 or more private families - - - 4 58 285 65 412 2889 2874 2 13 Total dwellings occupied 29 194 2170 4904 11726 9273 343 28639 146965 146317 280 348 Dwellings whollv furnished 1 1 4 26 48 36 3 119 610 — 610 — vacant others 1 2 19 41 83 97 4 247 1303 — — 1303 Total dwellings occupied and vacant 31 197 2193 4971 11857 9406 350 29005 148858 146317 890 1651 Number of private families therein 29 195 2209 5183 13475 13307 575 34973 — — — — Miscellaneous habitations and institutions housing non-private families 190 16 Table 11.—PRIVATE FAMILIES, CLASSIFIED BY SIZE OF FAMILY, ROOMS OCCUPIED, AND DENSITY OF POPULATION. Number of Persons in Family. Number of Private Families occupying the following number of Rooms. Total Private Families. Population in Private Families. Rooms Occupied. Density of Occupation. Average Number of Persons per Room. Population at following densities of occupation (Persons per Room). 1 2 3 4 5 6-7 8-9 10 or more. Over 3. 3 and over 2. 2 and over 1½. 1½ and over 1. 1 696 499 406 185 128 81 2 1 1998 1998 4814 0.42 - - - - 2 218 1289 2253 1254 1397 814 40 9 7274 14548 26953 0.54 - - 436 - 3 150 903 2092 1833 2374 1204 52 13 8621 25863 35397 0.73 - 450 - 2709 4 79 386 1346 1488 2451 1945 92 22 7109 28436 31812 0.89 316 - 1544 5384 5 23 167 762 879 1841 838 62 28 4600 23000 21372 1.08 115 835 3810 4395 6 12 59 368 471 1081 513 47 15 2566 15396 12270 1.25 72 354 2208 9312 7 3 21 231 267 610 298 32 7 1469 10283 7064 1.46 168 1617 1869 5901 8 — 15 91 128 300 140 13 11 698 5584 3402 1.64 120 728 3424 1120 9 - 3 43 58 147 69 7 2 329 2961 1611 1.84 27 909 1323 675 10 1 - 26 31 77 41 3 1 180 1800 879 2.05 270 310 1070 140 11 1 1 12 20 31 13 3 2 83 913 401 2.28 154 561 143 55 12 — 1 4 4 14 8 2 1 34 408 179 2.28 60 216 96 36 13 — — 1 - 3 2 - 2 8 104 55 1.89 13 65 - 13 14 - - - - 1 2 - 1 4 56 34 1.65 - 28 14 - 15 and over - - - - - - - - - - - - - - - - 2 Persons and over 487 2845 7229 6433 10327 5187 353 114 32975 129352 141429 0.91 1315 6073 15937 29740 Total Private Families 1183 3344 7635 6618 10455 5268 355 115 34973 — — — — — — — Population in private families 2127 8836 25775 25358 44864 22099 1676 615 — 131350 — 0.90 1315 6073 15937 29740 Rooms occupied 1183 6688 22905 26472 52275 32520 2918 1282 — — 146243 — — — — — 17 TABLE 12.—POPULATION IN NON-PRIVATE FAMILIES, CLASSIFIED IN HABITATIONS. Total Enumerated Population. Population in Dwellings Occupied by Private Families. In Hotels, Boarding Houses, Lodging Houses, etc. In Schools, Orphanages and Other Educational Institutions (excluding Reformatories). In Civilian Hospitals, Nursing Homes and Other Institutions for the Temporarily Sick. In Institutions for Insane or Mentally Deficient, Cripples, Blind and Other Permanently Disabled. In Workhouses and Other Poor Law Institutions (excluding Infirmaries and Educational Institutions). In Prisons, Police Stations and other places of Detention (including Reformatories) In Naval, Military and Air Force Premises (including) Ships and Hospitals). In Civilian Ships, Boats and Barges. All Others (including Vagrants). Persons. % Persons. % Persons. % Persons. % Persons. % Persons. % Persons. % Persons. % Persons. % Persons. % 132972 131350 98.8 707 0.5 241 0.2 291 0.2 51 0.0 — — 89 0.1 — — — — 243 0.2 Table 13.—INSTITUTIONS AND SPECIAL PREMISES, NUMBER. TOTAL POPULATION AND INMATES. Number of Institutions. Total Population. Inmates only. Persons. Males. Females. Persons. Males. Females. Homes for Insane, etc. 1 51 — 51 41 — 41 Hospitals (Non-Military, etc.) 3 185 64 121 117 61 56 Convalescent and Nursing Homes 8 106 38 68 70 36 34 Other Places of Detention (Police Stations, Reformatories, etc.) 3 89 83 6 77 77 — 18 Table 14.—AGES (GROUPED) BY MARITAL CONDITION Age last Birthday. Males. Females. Persons. Total. Single. Married. Widowed. Divorced. Total. Single. Married. Widowed. Divorced. All ages 132972 63468 32353 29197 1873 45 69504 34159 29668 5635 42 0-4 9450 4757 4757 - - - 4693 466 3 - - - 5-9 10720 5415 5415 - - - 5305 5305 — — — 10-14 10620 5338 5338 - — — 5282 5282 — — — 15-19 12407 6129 6115 14 - — 6278 6212 66 — — 20-24 13006 6269 5533 732 4 — 6737 5254 1478 3 2 25-29 12437 6026 2815 3191 18 2 6411 2683 3691 33 4 30-34 10832 4693 861 4065 26 11 5869 1441 4332 89 7 35-39 9170 4179 385 3723 66 5 4991 870 3942 171 8 40-44 8580 3964 272 3629 56 7 4616 670 3630 311 5 45-49 8043 3673 223 3346 97 7 4370 490 3425 445 10 50-54 7776 3650 230 3248 169 3 4126 411 3146 566 3 55-59 6669 3217 149 2854 210 4 3452 264 2529 658 1 60-64 5085 2384 102 2003 276 3 2701 200 1706 793 2 65-69 3693 1712 93 1306 312 1 1981 145 1007 829 — 70-74 2356 1006 39 702 264 1 1350 103 483 764 — 75-79 1321 497 21 281 194 1 824 89 193 542 - 80-84 556 207 3 74 130 — 349 32 30 287 — 85-89 214 74 2 25 47 — 140 13 10 117 — 90-94 30 6 — 3 3 — 24 2 — 22 — 95 & over 7 2 — 1 1 — 5 - - 5 — 19 TABLE 16.—AGES (INDIVIDUAL YEARS) UNDER 21. Age last Birthday. 0-21 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Males 22816 922 958 968 952 957 1023 1004 1091 1107 1190 1276 1296 798 869 1099 1166 1204 1260 1242 1257 1177 Females 22818 886 910 969 973 955 1000 999 1062 1067 1177 1317 1301 837 824 1003 1151 1245 1301 1326 1255 1260 20 21 Social Conditions.—No change from 1931 Report. Unemployment.—The degree of unemployment in the area during 1932 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 during month £ Men. Women. Total. 25-1-32 8,237 1,336 9,573 29,772 22-2-32 8,353 1,402 9,755 31,125 21.3-32 8,270 1,404 9,674 31,243 25-4-32 8,073 1,454 9,527 37,772 23-5-32 7,845 1,466 9,311 29,920 27-6-32 7,889 1,402 9,291 36,577 25-7-32 7,683 1,449 9,132 29,279 22-8-32 7,642 1,282 8,924 28,665 26-9-32 7,873 1,105 8,978 34,756 24-10-32 8,000 1,051 9,051 27,510 21-11-32 8,077 1,259 9,336 26,519 26-12-32 8,967 1,677 10,644 36,032 Between 25th January, 1932, and 26th December, 1932, a total of £379,170 was paid out in benefits, two-thirds of this amount (approximately representing the Walthamstow proportion) being £252,780. The corresponding figures for 1931 were £312,872 and £208,580 respectively and the large increases during 1932 plainly show the continued 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:— Boys. Girls. Total. Insured (over 16 years) 474 427 901 Not insured (under 16 years) 524 474 998 Re-registrations:— Insured 811 392 1,203 Not insured 581 526 1,107 22 Parks and Recreation Grounds.—No change since 1931. Extracts from Vital Statistics.— Death-rate of infants under one year of age:— All infants per 1,000 live births 57 Legitimate infants per 1,000 legitimate live births 56 Illegitimate infants per 1,000 illegitimate live births 122 Deaths from Measles (all ages) 20 „ „ Whooping Cough (all ages) 3 „ „ Diarrhoea (under 2 years of age) 15 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 0.03 against 0.27 in 1931. The Pulmonary Tuberculosis Death-rate was 0.64 per 1,000 population, and the Non-Pulmonary Death-rate was 0.10 per 1,000 population. The natural increase of population, i.e., excess of births over deaths was 441. 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:— The Registrar-General's mid-year, 1932, estimate of population (viz. 135,010) has been used for the calculation of all vital statistics:— Total. Males. Females Live Births Legitimate 1,748 889 859 Birth rate per 1,000 of the estimated resident population 13.2 Illegitimate 41 20 21 Total 1,789 909 880 Stillbirths 82 Rate per 1,000 total (live and still) births 43.8 Deaths 1,348 Death rate per 1,000 of the estimated resident population 9.9 Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal Sepsis 2 1.0 Other Puerperal Causes 6 3.2 Total 8 4.2 TABLE IX.—Birth-rates, Death-rates and Analysis of Mortality in the Year 1932. England and Wales, 118 County Boroughs and Great Towns, and 126 Smaller Towns. (Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1932, but those for the towns have been calculated on populations estimated to the middle of 1931. The mortality rates for England and Wales refer to the whole population, but for London and the towns to civilians only.) Bate per 1,000 Total Population. Annual Death-bate per 1,000 Population. Rate per 1,000 Live Births Percentage of Total Deaths. All Causes. Typhoid and Para-typhoid Fevers. Smallpox. Measles. Scarlet Fever. WhoopingCough Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 years). Total Deaths under 1 year. Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. still- Births. England and Wales 15.3 0.66 12.0 0.01 0.00 0.08 0.01 0.07 0.06 0.32 0.53 6.6 65 91.1 6.2 1.8 0.9 118 County Boroughs and Great Towns including London 15.4 0.70 11.8 0.00 0.00 0.11 0.01 0.08 0.07 0.28 0.48 8.9 69 91.3 5.9 2.3 0.5 126 Smaller Towns Estimated Resident Populations 25,000 to 50,000 at Census 1931) 15 4 0.69 10.8 0.00 - 0.06 0.01 0.06 0.03 0.31 0.42 45 58 91.9 5.8 1.3 1.0 London 14.2 0.51 12.3 0.00 0.00 0.19 0.02 0.08 0.07 0.27 0.53 126 66 89.4 6.2 4.4 0.0 Walthamstow 13.2 0.60 9.9 0.00 0.00 0.14 0.01 0.02 0.03 0.20 0.34 8 3 57 92.5 4.6 2.9 0.0 Puerperal Sepsis. Others. Total. Per 1,000 Live Births 1.61 2.63 4.24 The maternal mortality rates for England and Wales were as follows: „ „ Total Births 1.54 2.52 4.06 „ „ Live Births 1.1 3.3 4.4 „ „ „ Walthamstow „ „ Total Births 1.0 3.2 4.2 23 24 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. 25 Causes of and Ages at Death during the year 1932. Whole District and Wards . Causes of Death Net Deaths at the subjoined ages of " Residents " whether occurring: within or without the district Wards St. James Street High Street Hoe Street Wood Street Hale End Higham Hill All Ages Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years lf> and under 25 years 2ft and under 45 years 45 and under 65 years 65 and upwards No. 1 M. F. 3 4 5 6 7 8 9 10 1 Typhoid and Para-typhoid Fevers i - - - - - — — — — — — — — — — — 2 Measles 11 9 — 12 7 1 — — — — 4 5 4 6 — 1 3 Scarlet Fever - 2 — — 1 1 — — — — 1 1 — — — — 4 Whooping Cough 2 1 2 1 - - - - - - - 1 1 — — 1 5 Diphtheria 3 2 — — 2 3 — — — — — — 1 1 1 2 6 Influenza 8 20 — — — — 2 9 8 9 5 4 4 5 4 6 7 Encephalitis Lethargica 1 - - - - - - - - - - - - - 1 — 8 Cerebro-spinal Fever 1 1 1 — — — 1 — — —- — — 1 — 1 — 9 Tuberculosis of Respiratory System 54 33 1 — 1 1 16 39 26 3 14 14 16 6 21 16 10 Other Tuberculous Diseases 9 5 3 — 2 2 3 3 1 — 1 3 4 2 2 2 11 Syphilis 1 2 2 1 - - - - - - 1 1 — — — 1 12 General Paralysis of the Insane, tabes dorsalis 2 1 - - - - - - 1 2 - - 1 1 - 1 13 Cancer, malignant disease 81 101 — — — — — 16 90 76 32 28 36 35 27 24 14 Diabetes 1 8 - - - - - - 4 5 4 — — — — 5 15 Cerebral Haemorrhage, etc. 35 44 . — — — — 2 4 15 58 10 13 15 11 15 15 16 Heart Disease 130 157 6 1 — 5 8 23 85 159 44 42 60 47 50 44 17 Aneurysm 1 — — — — — — — — 1 — — 1 — — — 18 Other Circulatory Diseases 20 30 — - — 1 — 10 16 23 8 6 11 7 12 6 19 Bronchitis 35 28 1 2 1 — 1 4 16 38 12 12 9 9 12 9 20 Pneumonia (all forms) 46 48 18 7 4 6 3 14 17 25 15 14 18 15 12 20 21 Other Respiratory Diseases 11 6 — 1 — — — 1 7 8 2 3 4 2 2 4 22 Peptic Ulcer 10 1 3 5 3 2 2 4 1 1 1 23 Diarrhoea, etc. (under 2 years) 9 6 13 2 — — — — — — 2 1 4 2 4 2 24 Appendicitis 9 4 — — 1 3 3 — 5 1 2 1 4 — 1 5 25 Cirrhosis of Liver 3 1 - - - - - - 2 2 1 1 1 — — 1 26 Other Diseases of Liver, etc. 2 4 — — 1 — — — 1 4 1 — 1 2 2 — 27 Other Digestive Diseases 15 19 1 — — — 2 1 9 21 6 5 5 5 7 6 28 Acute and Chronic Nephritis 27 21 — — 1 — 7 3 15 22 6 11 8 10 7 6 29 Puerperal Sepsis — 2 — — — — — 2 — — 1 — — — 1 — 30 Other Puerperal Causes — 6 — — — — — 6 — — o — 1 2 — 1 31 Congenital Debility and Malformation, Premature Birth, etc. 28 21 49 - - - - - - - 10 6 8 6 6 13 32 Senility 19 38 - - - - - - - 57 12 5 13 9 9 9 33 Suicide 8 6 — — — — — 6 6 2 1 3 5 — 2 3 34 Other Deaths from Violence 19 14 — — 1 2 5 6 8 11 5 6 7 3 6 6 35 Other Defined Causes 62 44 6 — 2 8 2 8 29 51 15 17 19 14 14 27 36 Causes ill-defined or unknown — — — — — — — — — — — — — — — — Totals 663 685 103 27 24 33 55 159 366 581 219 205 266 201 220 237 26 The 1932 total deaths (1,348) compares with 1,403 during 1931, the respective death-rates per 1,000 population being 9.9 and 10.4. The chief differences in the classification of deaths—those for 1931 being given in parentheses—were as follows:— Whooping Cough, 3 (14); Diphtheria, 5 (11); Pulmonary Tuberculosis, 87 (95); Non-Pulmonary Tuberculosis, 14 (13); Cancer, 182 (176); Cerebral Hæmorhage, 79 (83); Heart Disease, 287 (313); Bronchitis, 63 (86); Nephritis, 48 (44); Congenital Debility, etc., 49 (58); Suicide, 14 (31); Violence, 33 (40). Infant deaths are analysed by causes, ages and wards under the Maternity and Child Welfare Section of the Report. Institutional Deaths. Whipps Cross Hospital 245 Central Homes, Leytonstone 186 Connaught Hospital, Walthamstow 57 Brentwood Mental Hospital 23 Prince of Wales's Hospital, Tottenham 18 St. Bartholomew's Hospital, London 18 Forest Gate Sick Home 14 Queen's Hospital, Bethnal Green 11 Walthamstow Isolation Hospital 7 Middlesex Hospital, St. Marylebone 7 German Hospital, Hackney 6 Chest Hospital, Bethnal Green 6 London Fever Hospital, Islington 5 Great Ormond Street Hospital 5 University College Hospital, St. Pancras 4 Queen Mary's Hospital, Stratford 4 London Hospital, Stepney 3 St. Joseph's Hospice, Hackney 3 Guy's Hospital, Soufchwark 3 Forest Hydro, Walthamstow 3 National Hospital, Queen's Square 2 Queen Charlotte's Hospital, Hammersmith 2 Carisbrooke Nursing Home, Walthamstow 2 Other Institutions 41 27 B.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. (i) 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. (ii) Nursing in the Home. (a) General.—No change since 1931. (b) Infectious Diseases.—No change since 1931. (iii) Laboratory Facilities.—These facilities are detailed under the Infectious Diseases Section of the Report. There were no changes in the arrangements from those in force during 1931. (iv) Legislation in Force. (a) The Walthamstow (Measles) Regulations, 1932, came into operation on the 18th March, 1932. The effect of the Regulations was to make notifiable all cases of Measles in children under five years of age, excepting secondary cases occurring within two months. Following notification all oases were visited by a Health Visitor or School Nurse. (b) Bvelaws made under the Nursing Homes Registration Aot, 1927. (c) The Walthamstow Corporation Act, 1932 (received Royal Assent on the 12th May, 1932) and regulates street trading within the Borough. (d) Byelaws with regard to New Streets and Buildings (made by the Council on the 23rd March, 1932, allowed by the Ministry of Health on the 25th August, 1932). (e) Byelaw with regard to Fouling of Pavements by Dogs (made by the Council on the 27th May, 1932). (v) Hospitals.—There were no changes during 1932 in the Hospital services used by the inhabitants of the Borough. Public Assistance in Walthamstow is now provided by the SouthWest Area Committee of the Essex County Council, which retains a certain proportion of beds in each of the 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 31st December, 1932:— 23 Institution. Men. Women. Children. Infants. Total. Central Home 200 214 94 — 508 Whipps Cross Hospital 631 624 258 173 1,686 Forest Gate Hospital 11 116 10 — 137 Aldersbrook Home — — 101 — 101 Margate Convalescent Home — — 5 — 5 Ninety-seven children were born to Walthamstow mothers in Forest Gate Hospital. The number of patients from Walthamstow in Mental Hospitals on the 31st December, was 394. The Connaught Hospital. Captain Ellison, Secretary to the Hospital, has kindly supplied the following information:— "Of the total number of 1,529 in-patients admitted during the year, 737 were residents of the Borough. "The following comparative figures show the work of the Hospital during the last two years:— Patients admitted. Average stay in Hospital. Average Beds occupied daily. Out-patients New Cases. Department. Attendances. 1932 1,529 22.2 92.5 12,105 60,042 1931 1,515 21.29 88.3 11,186 50,201 "Staff.—Four Honorary Medical and Surgical Consultants and sixteen Honorary Visiting Specialists are on the Staff, and there are three Resident Medical Officers!. "The Nursing Stafi consists of the Matron, the Assistant Matron and Tutor, twelve Sisters (including six in special departments), four Staff Nurses and thirty-three Probationers. "Beds.—The complement of 100 beds is allocated as follows: — Medical cases, 21; Surgical, 32; Children, 34; Private Beds, 10; Observation Beds, 3. "Facilities.—There are facilities for operative surgery, X-Ray work, dental, ophthalmic, massage and electro-therapy. Pathological work is carried, out partly at the Hospital and partly at other Institutions. "Operations and Treatments.—During 1932, 694 major and 2,574 minor operations were performed, making a total of 3,268. 8,074 radiographs were taken and 112 X-Ray treatments were given. There were 9,114 massage treatments and also 8,156 electrical treatments, and 4,502 artificial sunlight treatments at Comely Bank Annexe. 29 " New Department.—A Gynaecological Out-patient Department was opened early in the year, with Mr. A. Galletly, m.c., F.R.C.S., as Honorary Surgeon-in-Charge. " Extensions.—During 1933 a new ward, to contain 16 beds, will be built through the generosity of Mr. A. M. Matthews, J.P., E.C.C., in memory of his wife. " In addition, massage accommodation will be constructed at the Comely Bank Clinic. The funds for this much-needed improvement have been most kindly provided by Mrs. J. H. Keena in memory of her husband, Mr. J. H. Keene." The pressure on the hospital accommodation is well shown by the extremely high average percentage of beds occupied daily, viz. : 92.5. This figure represents about the quickest turnover of beds possible. The Hospital provides, at an annual retaining fee of 30 guineas, the use of three beds when required for your Council's Enteric cases and further admissions up to two per ward at the discretion of the Hospital Authorities. Tonsil and Adenoid cases are also done for your Council at the Hospital under in-patient conditions. A revised list of out-patient times issued during 1932 stated that general clinics were available every morning at 9 a.m. and every afternoon at 2 p.m. In addition, the following special clinics were available:— X-Ray, Monday 9 a.m., Friday 2 p.m.; Medical, Monday, Wednesday and Thursday 2 p.m.; Surgical, Monday and Wednesday 2 p.m., and Friday at 4 p.m.; Ear, Nose and Throat, Tuesday 10.30 a.m. and Thursday 4 p.m.; Ophthalmic, Wednesday 4 p.m.; Dental, Tuesday 2 p.m.; Gynaecological, Thursday 10 a.m.; Electro-Therapeutio, Tuesday and Thursday 2.30 p.m.; Fracture, Saturday 10.30 a.m.; Massage, Monday and Friday 9 a.m. Venereal Disease Treatment. Treatment is provided by the Essex County Council, and all the facilities of the London County Council are available. Daily treatment is available between 8 a.m. and 9 p.m. at the following Clinics:—1, Guy's Hospital; 2, Whitechapel (London County Council) Clinic, Turner Street, Mile End; 3, Miller General Hospital, Greenwich; 4, St. George's Hospital; 5, St. Paul's Hospital, Endell Street, W.C.2; 6, St. Thomas' Hospital; 7, University College Hospital, W.C.I; 8, West London Hospital, W.6. In addition, treatment is available at special times at eleven other Hospitals. 30 Outfits for taking specimens from patients are provided for practitioners, on request, by the Whitechapel (London County Council) Clinic. The Walthamstow Dispensary. The Dispensary is a Charity founded in 1873, and during 1932 gave treatment to 974 patients, who made 3,126 attendances. In addition, 88 operations for removal of Tonsils and Adenoids were done for your Education and Maternity and Child Welfare Committees. (vi) Ambulance Facilities. (a) Infectious Cases.—No change since last report. (b) Non-Infectious and Accident Cases, and (c) Maternity Patients. (A) Municipal Service. During the year your Council provided two Austin ambulances, which are staffed by firemen under the supervision of the Superintendent of the Fire Brigade. The ambulances are garaged at the Fire Station, and the following scale of fees is in force:— (i) That no charge be made for the use of the ambulances in connection with cases of street accidents. (ii) That for the removal of an accident case from a factory to a local hospital, the employer be charged a fee of 2s. 6d. (iii) That in the case of an ambulance being utilised for the removal of a patient from home to a local hospital, or vice versa, a charge of 2s. 6d. be made. (iv) For the removal of patients to a destination outside the district, that a charge of Is. 3d. per mile be made. (v) That for the purpose of this Scale of Charges, Whipps Cross Hospital be considered a local hospital. Superintendent Camp, A.M.I.Fire E., reports as follows on the work done during 1932 :— "The ambulance service came into operation on 21st October, 1932, and up till 31st December last 166 cases have been dealt with, 6 of which were removals from home to hospital, or vice versa, and 80 were accidents. Six maternity cases are included in the removals, the patient in each case being accompanied by a female relative or friend. 31 "There are two Austin 20-h.p. machines, painted white inside and out, and heated from the exhaust. T*wo stretcher cases can be carried and three seated. The usual first-aid equipment is carried, also spare blankets, waterproof sheeting and a canvas sheet for carrying persons downstairs. An oxygen breathing set, with a mixture of 7 per cent. of carbon dioxide, is carried in each machine, and every man has undergone a course of instructions with regard to its use. " Two gas poisoning cases and one of pneumonia have been treated by means of this apparatus, and in each case very successfully. ' The ambulances are attached to the Fire Brigade and manned by firemen." The use of the oxygen-carbon dioxide apparatus represents the latest life-saving practice in gas poisoning cases, and is entirely physiological in its principles, inasmuch as the carbon dioxide is used to stimulate the respiratory centre of the brain. Superintendent Camp states he is convinced that the use of this apparatus saved the lives of the two gas poisoning cases. Following enquiries as to the practice amongst 13 neighbouring Local Authorities, only 4 of which provided a midwife to accompany maternity patients, it was decided that all such cases must be accompanied by a responsible adult female relative or friend. (B) Removal of Patients to Whipps Cross Hospital is carried out by the hospital ambulances. (C) St. John Ambulance Brigade. During the year Mr. A. G. Mattacks was appointed Corps Superintendent in place of Mr. Kemp (now District Officer Kemp on Headquarter's Staff). Mr. Mattacks states that it is his greater' desire for the Walthamstow and District Corps of St. John Ambulance Brigade to be of still greater service to the people of Walthamstow, should occasion arise, and reports as follows:— " During 1932 we had 2 Motor Ambulances, the day drivers being the only paid men in the Walthamstow and District Corps, otherwise our services were entirely voluntary. Our headquarters at Willow Walk, High Street, are open both day and night for the service of the public, whom we have served for over 30 years. " We have a sub-station at Highams Park and also one at the Buxton Club, both of which have proved most successful. We have another station on the Epping Road, open on week-ends and holidays in the summer months. Commencing at Easter, 32 we also erect a station every holiday on the Marshes, and, situate as it is near the Fair Ground, it fills a great need. We hope in the year 1933 to place another hut on the Woodford Road near the Water Works for the further service of the public. "During 1932 the number of cases receiving First Aid treatment was 1,863, and the number of cases removed to hospitals 1,123; mileage totalled 7,713. "The number of road accidents receiving treatment was 188, and the mileage incurred on these cases was 269 miles. "Several successful First Aid and Home Nursing Classes have been organised, and also our members have taken a course of instruction in Defence against Gas, and these continued Lectures should, and have, proved of great service, not only to the Students themselves, but also to those with whom they work, be it factory or elsewhere. "We have also carried out the greatest number of public and local duties known for many years." (vii) Clinics and Treatment Centres.—No change since 1931. Foot Clinic. Details of the organisation, staffing and work of the Foot Clinic were given in the 1931 report, and have remained unaltered during 1932. The attendances at the Clinic steadily increased until they reached a maximum of 185 during the week ending 18th June. By the end of February it was necessary to obtain student assistance from the Chelsea Polytechnic School of Chiropody, by kind permission of the Principal, Mr. Bride, and later, in May, the assistance of a qualified Chiropodist on three evenings per week, increased in June to four evenings per week. For several weeks during the peak period in May to July from 15 to 60 patients per week were being turned away from the Clinic without treatment. Curiously, after August, the weekly attendances settled down at a steady rate of about 100 per week, and the services of the assistant and students were dispensed with. By this time the most satisfactory way of dealing with patients had been found to be by giving definite appointments and allocating 15 minutes to each. This scheme enabled 10 patients per session of 2½ hours to be dealt with, or 100 per week. The total attendances for the year was 6,318, or an average of 121.5 per week. 33 Repeated acknowledgment has been made by patients as to the relief afforded by the Chiropodist—Miss McCallum. An unusually large number of patients with warts was seen. As a matter of interest, the cost of maintenance and receipts are specified below for the calendar year. Expenditure. £ s. d. Salaries—Chiropodist, Clerk and Caretaker 357 0 0 Drugs 46 18 7 Rates 16 13 5 Heat, Light and Water 25 17 o Miscellaneous 11 2 3 Total £457 11 5 Receipts 299 3 4 Nett cost £158 8 1 The gross cost per treatment was just under Is. 6d., against 2s. 6d. in 1932. The reduction is due entirely to the increased attendances. Women's Clinic.—Towards the end of 1931 your Council decided to set up a Women's Clinic under Section 131 of the Public Health Act, 1875. The upper floor of No. 69, Hoe Street, was adapted so as to provide a room for taking case-history, a consulting room and a treatment room with three oubicles. In addition, the general waiting room of the Foot Clinic on the ground floor was used for a similar purpose, the sessions being held, of course, at different times. Mrs. Ivens-Knowles, C.B.E., M.S., Ch.M., F.C.O.G. (who is also on your Council's panel of Obstetric and Puerperal Consultants) took clinical charge, and a monthly session has been held during 1932. Patients are seen for the following conditions:— (a) Ante and Poet-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. 34 The attendances during 1932 may be summarised thus:— New. Old. Total. Ante-Natal Cases 7 4 11 Gynaecological Cases 59 105 164 Contraceptive Cases 14 26 40 Total 80 135 215 The expenditure for the calendar year was as follows:— £ s. d. Salaries—Consultant, Nurse, Clerk, Caretaker 84 15 6 Drugs and Appliances 6 3 6 Rates 1 17 1 Heat, Light and Water 2 17 6 Miscellaneous 1 0 6 Total 96 14 1 Receipts 5 11 6 Nett cost £91 2 7 The attendances at the monthly sessions at the end of the year had increased to 25 so that in February 1933 the olinios were duplicated and arei now held on the first and third Wednesdays in each month at 2.0 p.m. The increasing co-operation of private practitioners was a feature during 1932 and it is to be hoped that this co-operation will continue, more particularly with regard to the reference of consultative ante-natal cases. Another feature was the number of appreciative letters received by the Consultant from both doctors and patients. Mrs. Ivens-Knowles kindly reports as follows:— "The Walthamstow Women's Clinic, opened in November, 1931, has been attended during 1932 by 80 new patients, and 215 attendances have been made. The numbers are steadily increasing. "Twenty per cent. of the cases have been sent by their doctors for advice in respect of abnormal conditions of pregnancy, for sterility, gynaecological disorders, or for contraceptive information and treatment on medical grounds. Four patients who attended for gynaecological ailments were found to be also suffering from diabetes, and were referred to hospital for full investigation and insulin treatment. "Twenty-four patients were recommended to hospital for operative treatment for fibroid tumours, dysmenorrhcea, hernia, 35 displacements, appendicitis, possible cancer of the cervix, uterine polypi, Bartholini cyst, and carcinoma of the scalp associated with endometritis. Twenty-two cases have been treated for prolapse, or retroversion of the uterus. "Of 14 patients who were given contraceptive advice on medioal grounds, eight were sent by their respective doctors." (viii) 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, kindlv states that the amount of relief provided in Walthamstow during the two years ended 31st December, 1932, was as follows:— 1932. 1931. £ s. d. £ s. d. Total amount of out-relief granted to Walthamstow residents during year ended 31st December, 1932 43,815 9 10 28,796 1 4 1932. 1931. Average weekly number of Walthamstow residents in receipt of relief during year ended 31st December, 1932 I Men - Women J Children 692 450 1,067 837 987 700 Total 2,746 1,987 ix) Midwives. Number of Notices of Intention to practice January, 1932 15 Number of Notices of Intention to practice during 1932 5 Total 20 Number of Midwives ceasing practice during 1932 2 Number of Midwives practising at end of 1932 18 There was no change in the arrangements for the employment or subsidy of Midwives by the Council. Full particulars of the supervision of Midwives is given in the Maternity and Child Welfare Section of the Report. (x) Maternal Mortality.—All maternal deaths are reported upon by your Medical Officer of Health, with the co-operation of the private practitioners and of the Hospital concerned (if any). The investigations and reports are made on the lines suggested by the Ministry of Health. All cases of puerperal fever and pyrexia are visited by the Health Visitors and also by the Inspector of Midwives or Medical Officer of Health as and when necessary. 36 Further reference to Maternal Mortality and Puerperal Fever and Pyrexia is made in the Maternity and Child Welfare Section of the Report. Health Visiting. . See Children Act, 1908. Maternity Orthopaedic Treatment. V and Child Institutional Treatment for Unmarried Welfare Mothers, etc. Section. (xi) Maternity and Nursing Homes.—The Byelaws adopted by your Council at the end of 1931 were approved by the Ministry of Health on 30th March, 1932, and prescribe the method of keeping records of (a) patients received into and children born in the homes; (b) dates of admission and discharge; (c) payments; (d) fatal cases; (e) details of confinements; (/) clinical records; (g) infectious diseases; (h) removal of children ; and (i) inquest findings. During the year 7 additional maternity beds were registered at the Walthamstow District Nursing Association's Home, bringing the total accommodation there to 11 maternity beds, and 2 maternity beds at Heathfield Nursing Home, bringing the total accommodation there to 4 general, 7 maternity and 1 ante-natal beds. The total accommodation in the Borough at the end of 1932, therefore, was 29 beds for maternity cases, 9 beds for general cases, and 1 ante-natal bed. The following table gives information required by the Ministry of Health :— 1. Number of applications for tion (for additional beds) 2 2. Number of Homes registered No new registrations. 3. Number of Orders made refusing or cancelling registration Nil. 4. Number of appeals against such Orders Nil. 5. Number of cases in which such Orders have been made : (a) Confirmed on appeal Nil. (b) Disallowed Nil. 6. Number of applications for exemption from registration Nil. 7. Number of cases in which exemption has been— (a) Granted Nil. (b) Withdrawn Nil. (c) Refused Nil. 37 Periodical quarterly inspections are made to each Home, in addition to any visits necessary for special inquiries. C.—SANITARY CIRCUMSTANCES OF THE AREA. Water.—New mains have been installed in the following roads— Loxham Road; Wadham Road, Richmond Avenue, Oak Hill Close, Hollywood Way, Montserrat Avenue, Sky Peals Road, Winchester Road, Forest Drive, Williams Avenue and Millfield Avenue. The supply has been entirely satisfactory in quality and quantity. No action has been necessary in respect of any form of contamination. Rivers and Streams.—Periodical cleaning of Dagenham Brook was carried out to the requirements of the Essex Sewers Commissioners. Drainage and Sewerage.—No extensions of the sewerage, other than minor ones necessitated by the development of various building estates, were carried out. Closet Accommodation.—A septic tank was constructed at the "'Ferry Boat" P.H. in lieu of the existing cesspool. The number of cesspools remaining is 7. The construction of a sewer in The Avenue, Highams Park to obviate the necessity for 5 of the above is at present under consideration. The number of pail closets in use—on Sports and Gipsy Grounds—is 45. During the year 10 pail closets were converted into water closets on the L.G.O.C. Sports Grounds, and 2 were converted on Sports Grounds near Epping Forest, making a total of 12 pail closets converted to water closets. Public Cleansing. (a) The collection of house refuse is carried out by means of horse-drawn vans and mechanical vehicles. Two new vans of an improved type have been acquired during the year. (b) House refuse is disposed of by incineration. The total amount of refuse received at the Destructor was 25,060 tons. (c) Cesspools are cleansed by pumping out the contents, which are— (d) Carted to and discharged into the nearest sewer 38 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. 1932 10130 10700 1675 2527 2582 132 25169 1931 9992 12924 1461 2641 2705 165 25760 Of the 132 Statutory Notices served during 1932, 110 were complied with. The nature and variety of the work done during 1932 is shown in the following tables:— Drains tested 507 „ reconstructed or repaired 453 „ obstructions removed 250 „ means of access provided 47 „ ventilation provided or improved 68 „ ventilation repaired 182 Soil pipes repaired 41 „ „ new provided 29 Rain water pipes renewed 349 „ „ „ disconnected from drains 73 Roofs repaired or renewed 797 Gutterings repaired or renewed 502 W.C. pans or traps provided 437 Gully traps provided 144 W.C. flush cisterns provided 69 „ „ „ repaired 248 W.C. floors concreted 65 W.C.'s repaired and cleansed 564 W.C.'s light and ventilation repaired 11 Waste pipes renewed or trapped 202 „ „ repaired 146 New sinks provided 132 Water supply reinstated 9 „ „ taken off main 11 Cisterns cleansed and covered 47 Conveniences cleansed or repaired 29 Sculleries paved 99 Yards and forecourts paved and repaired 595 Dirty houses cleansed 126 „ rooms cleansed 3855 Floors repaired 272 Ventilations under floors provided 223 New damp-proof courses provided 338 Sites concreted 14 39 Offensive accumulations removed 51 Animals improperly kept, removed 7 Manure receptacles provided 3 Stables cleansed, paved and drained 50 Manholes repaired or re-sealed 91 Other cases of dampness remedied 569 Separate Sanitary Conveniences provided to shops where both sexes are employed 2 Miscellaneous repairs 2293 Infectious Disease. Visits to premises 1195 Re-visits to premises 997 Visits in connection with Smallpox 830 Premises disinfected 954 Articles disinfected at Low Hall 11433 „ destroyed at Low Hall 238 Dampness in Houses. Sites concreted 14 Damp-proof courses provided 338 Yards and forecourts paved and drained 595 Roofs made watertight 797 Rain-water pipes made good 349 Guttering repaired or renewed 502 Other cases of dampness remedied 569 Ventilation under floors provided 223 House-to-house inspections 1187 Special Premises. Number. Visits paid. Slaughterhouses 12 628 Butchers' shops 88 835 Bakehouses 46 191 Fishmongers, fish friers and curers, etc. 57 445 Eating-houses and Coffee Stalls 72 147 Ice Cream Vendors 103 102 Cowsheds 2 31 Dairies and Milkshops 218 405 Laundries 12 47 Rag and Bone Dealers 8 23 Elementary Schools 311 27 Private Schools 13 Piggeries 4 47 Street Stalls Numerous 125 Greengrocers „ 198 Stables „ 308 Factories 453 Workshops 314 Outworkers 323 40 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers' Shops and Slaughterhouses. Special cleansing, 67; Paving repaired, 7; Accumulations removed, 5; New Galvanised Bins provided, 6; Drains repaired, 4; W.C.'s repaired and cleansed, 8; Drains cleared of obstructions, 5; Yard paving repaired, 3; Floors repaired and ventilated, 7; Roofs repaired, 5. Bakehouses. Special cleansing, 67; Drains repaired, 8; W.C.'s cleansed and doors repaired, 15; Yards repaved, 6; Obstructions from drains removed, 3; W.C. cisterns repaired, 1; Floors repaired, 4; New ceilings fixed, 1; Roofs repaired, 4; Premises general repair, 19. Fishmongers. Special cleansings, 26; Drains cleared of obstruction, 4; Yards repaved 10; Accumulations removed, 9; Gutters renewed, 1; Roofs repaired, 3; Other improvements, 14. Coffee and Eating Houses. Special Cleansings, 24; Yard pavings repaired, 4; W.C. cisterns repaired, 2; Floors renewed, 4; Kitchen light and ventilation improved, 3; New sink provided, 1. Ice Cream Vendors. Special oleansings, 10; Special cleansing of utensils, 4; Yard paving repaired, 6; W.C. flush improved, 2. Cowsheds and Milkshops. Special cleansings, 19; Pavings relaid, 5; Fittings and other improvements, 9; Roofs repaired, 3; Drains repaired or reconstructed, 2 ; W.C.'s repaired, 3. Stable Premises. Cleansings, 45; Accumulations removed, 36; Roofs repaired, 6; Pavings repaired, 8; Manure Receptacles provided, 5; Drains reconstructed, 4; Walls repaired, 1; W.C.'s repaired, 4 Laundries. Special oleansings, 5; Roofs repaired, 1; Other improvements, 1. Rag and Bone Dealers. Cleansings, 11 ; Pavings repaired, 1 ; Accumulations removed, 2. 41 Piggeries. Cleansings, 3. Private Schools. W.C.'s repaired and cleansed, 2; W.C. flush cisterns repaired, 1. Smoke Abatement.—Eleven instances of nuisances arising from smoke have been observed and remedied. 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. Premises and Occupations which can be Controlled by Bye-Laws or Regulations.—The number of Offensive Trades in the area was:— (a) Fish Curers '28 (b) Fish Friers 43 (c) Rjig and Bone Dealers 8 Slaughterhouses 12 Bakehouses 46 Tents, Vans, Sheds, etc.—There are four areas in Higham Hill Ward where numerousi van dwellers have congregated and to which the Byelaws apply. 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. Special Inspection of the District re Dust Receptacles :—During the year much attention was given to discovering what premises were without suitable dustbins, and for that purpose several streets were inspected at the time of dust collection by the Sanitary Inspectors. This inspection resulted in 1,007 visits being paid to houses and in 427 it was found that a proper dust receptacle was required. These figures are not included in the table giving the total number of Inspections, Notices Served, etc., under "Sanitary Inspection of the Area." 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 42 Inspector at the conclusion of Medical Inspection. Recommendations made are sent to the Dirctor of Education. The School Medical Officer's Report gives a detailed account of the sanitary improvements effected during 1932. The Rag Flock Acts, 1911 and 1928.—There are no known premises in the Borough on which rag flock is manufactured or sold. D—HOUSING. (a) Statistics. The particulars of new houses erected during 1932 are given in the form prescribed for previous years. The following are the figures and notes supplied by the Engineer and Surveyor: — Number of New Houses erected during the year:— (a) Total (including numbers given separately under (b):— (i) By the Local Authority 144 (ii) By other Authorities Nil. (iii) By other bodies or persons 498 Total 642 (b) With State Assistance under the Housing Acts:— (i) By the Local Authority: — (а) For the purpose of Part II of the Act of 1925 Nil. (б) For the purpose of Part III of the Act of 1925 and under the Housing Financial Provision Act, 1924 137 (c) For the purpose of the Act of 1930 7 (d) For other purposes Nil. (ii) By other bodies or persons Nil. The 642 houses were situated as follows:— Hale End Ward 293 High Street Ward 2 *Higham Hill Ward 208 Hoe Street Ward 11 St. James Street Ward 3 Wood Street Ward 125 *Inoludes 20 Flats 43 No Council houses are at present (February, 1933) in course of erection. Tenders have been received for the erection of 136 houses on the Esses Hall site and an application in respect of these houses is at present before the Ministry of Health. The following information is given in the form required by the Ministry of Health (Circular 1269):— I.-—Inspection of Dwelling-Houseis during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 4,030 (b) Number of inspections made for the purpose 15,469 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,186 (b) Number of inspections made for the purpose 4,524 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 1,968 II.—Remedy of Defects During the Year without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Offioers 2,692 III.—Action under Statutory Powers During the Year. A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs 124 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— *(a) By owners 95 (b) By Local Authority in default of owners (at a cost of £81 11s. 6d.) 7 *One of these was demolished by the Owner. 44 B. Proceedings under the Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 8 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 6 (b) By Local Authority in default of owners (at a cost of £20 19s. 4d.) 2 C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 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 became operative requiring repairs Nil. (2) Number of dwelling-houses which were dered 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. 45 F. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which Closing Orders became operative Nil. (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 became operative Nil. (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. (b) General Your Council during the year continued to allocate 10 per cent. of the new houses erected for special consideration in respect of rehousing on medical grounds. Recommendations have been confined to urgent cases of infectious pulmonary tuberculosis {i.e., T.B. plus cases) and urgent cases of non-pulmonary tuberculosis. Dr. Sorley, the Tuberculosis Officer, has co-operated heartily in providing the fullest information about the housing conditions of the patients. 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, 114 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. Mr. J. E. West, your Council's Housing Manager, has kindly supplied the following information:— No. of applicants on Register at 31.12.32 2,887 No. of new applications received during the year 939 No. of new tenancies effected during the year 180 No. of registered cases investigated 728 No. of ordinary applications referred by M. O.H. 114 In addition to the above:— No. of cases recommended by M. O.H. on Medical Grounds 30 No. of such cases rehoused 10 No. of such cases which have been approved but still awaiting tenancies . 46 No. of such cases turned down owing to inability to pay rent, etc. 9 No. of such cases remaining to be dealt with 7 The Council have at all times only rehoused bona fide residents of the Borough of Walthamstow, but having regard to the large influx of other residents into the Borough of Walthamstow and who have subsequently applied for Council houses it has been found necessary to restrict the allocation of houses to residents who have resided in Walthamstow at least seven years consecutively up to the time the allocation is made." In addition, the Council have recently adopted a maximum scale of income to apply to future applications. General Observations. The extent of overcrowding in the Borough is fully discussed under the Census returns earlier in the Report. Unfortunately, the Scheduled Clearance Areas referred to in the two previous Reports have not yet been dealt with and the necessary enquiries by the Ministry of Health have not yet been held. The new houses and flats which had been erected to meet the needs of the Housing Act, 1930, have, therefore, been let to ordinary tenants except for seven which have been earmarked to rehouse families from individual unfit houses. Investigations recently carried out in another area have disclosed the unexpected fact that the death rate amongst families rehoused under ideal conditions from a slum area was 8.5 per thousand above that of similar families in a comparable uncleared slum area. The increased death rate was chiefly found in the age group 65-75, closely followed by the age groups 25-45 and 45-55. Analysis of the dietaries of the families concerned showed a general deficiency in protein, directly due to the increased rent demanded under the new housing conditions. The definite conclusion was reached that rehousing was not advantageous unless the family budget allowed 7s. per adult per week for food. In many of the families reviewed it was found that only 2s. 10£d. was being spent per person per week. Rehousing at the expense of nutrition cannot be too carefully guarded against. The results of the 1931 Census as to the general housing position in the Borough is fully discussed earlier in the report. E.—INSPECTION AND SUPERVISION OF FOOD, (a) Milk Supply The average number of cows kept in the district was 14. The cowsheds numbered two and 31 visits were paid by the Sanitary 47 Inspectors in addition to special visits paid by your Chief Sanitary Inspector. The number of retail purveyors of milk is 218, most of whom carry on a general shop and sell milk in bottles as they receive it. Four hundred and five visits were paid to the registered premises of purveyors of milk during the year and a general improvement in the standard of cleanliness was observed. During the year 36 samples of milk were taken for bacteriological count and of these 7 were biologically tested for the presence of the tubercle bacillus. The samples taken are summarised below:— Grade of Milk. No. of Samples. No. tested for T. B. Grade A (T.T) 6 6 Grade A (Pasteurised) 1 — Grade A 1 1 Pasteurised 23 — Raw 5 — Total 36 7 The following table gives the results of the analyses:-— 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. 2.2.32 Grade A (T.T.) 9,800 0.01 c.c. Absent Satisfactory. „ Pasteurised 32,000 Not stated No test „ „ „ 17,000 „ „ „ „ „ „ 42,000 „ „ „ „ „ „ 63,000 „ „ „ „ „ „ 40,000 „ „ „ „ 21.3.32 „ 16,000 „ „ „ „ „ „ 33,000 „ „ „ „ „ „ 13,800 „ „ „ „ Raw 9,600 0.01 c.c. „ „ „ Pasteurised 19,000 Not stated „ „ „ „ 21,000 „ „ „ „ 11.4.32 Grade A. 8,200 0.01 c.c. Absent „ „ Raw 4,100 Not stated No test „ 20.4.32 Pasteurised 1,760 „ „ „ „ „ Grade A (T.T.) 3,700 0.01 c.c. Absent „ „ „ 3,300 0.01 c.c. „ „ 14.6.32 Pasteurised 142,000 Not stated No test Unsatisfactory. 14.6.32 „ 93,000 „ „ „ Satisfactory. „ Raw 289,000 „ „ „ „ „ Pasteurised 48,000 „ „ „ „ „ „ 27,000 „ „ „ „ „ „ 25,000 „ „ „ „ Date. Grade of Milk. Total Bacteria per c.c. Bacillus Coli absent in. Presence of Tubercle Bacillus (biological test). Remarks. 7.7.32 Pasteurised 38,000 Not stated No test Satisfactory, „ 36,000 „ „ , , „ 12.7.32 Grade A (T.T.) 11,000 0.01 c.c. Absent „ „ „ 67,000 0.001' c.c. „ Unsatisfactory (Bacillus Coli) Pasteurised 28,000 Not stated No test Satisfactory. 24.8.32 Grade A (T.T.) 4,000 * * Absent „ „ Raw 42,000 „ No test „ 1.9.32 Pasteurised 20,000 0.1 c.c. „ „ „ „ 12,000 0.001 c.c. „ „ „ „ 19,000 0.001 c.c. „ „ „ „ 256,000 0.0001 c.c. „ Unsatisfactory „ Grade A Pasteurised 15,000 0.01 c.c. „ (Bacillus Coli) 8.12.32 Raw 9,600 0.1 c.c. „ Satisfactory. In addition, 7 samples of cream were analysed and the results are given below:— BACTERIOLOGICAL ANALYSTS OF CREAM SAMPLES. Date. Total Bacteria per c.c. Bacillus Coli absent in Presence of Tubercle Bacillus (biological test). Remarks. 29.11.32 9,800,000 0.01 c.c. Absent Clean product but bacteria count should be lower. „ 96,000 0.01 c.c „ Clean product and of a high standard. „ 1,700,000 1 c.c. „ Clean product—satisfactory. „ 184,000 1 c.c. „ Clean product and of a high standard. 1.12.32 15,000 0.1 c.c „ Clean product—satisfactory bacterial purity. „ 48,000 0.1 c.c, „ „ „ 7,000 1 c.c. „ „ In the absence of any standard no exception could be taken to the first sample, especially in view of the fact that a qualitative bacteriological analysis showed the absence of pathogenic microorganisms. The producer was, however, seen and asked for an explanation which was that this sample was from a quantity which had inadvertently not been pasteurised. 49 Ten samples of Ice Cream were taken for analysis, the results being given below:— BACTERIOLOGICAL ANALYSIS OF ICE CREAM SAMPLES. Date. Total Bacteria per c.c. Bacillus Coli absent in Remarks. 7.7.32 55,000 0.001 c.c. Satisfactory bacterial purity. " 140,000 0.0001 c.c. Not dirty but does not attain standard which can reasonably be obtained. " 46,000 0.1 c.c. Satisfactory bacterial purity. " 3,600 1 c.c. Highest standard of bacterial purity and cleanliness. " 310,000 0.000001 c.c. Unsatisfactory and does not attain standard which can reasonably be obtained. " 280,000 0.00001 c.c. Low grade of bacterial purity. 14.7.32 l10 ,000 0.0001 c.c. " 320,000 0.00001 c.c. Unsatisfactory sample. Considerably below standard of a high grade product. " 160,000 0.0001 c.c. Low grade of bacterial purity. Does not quite attain standard which can readily be obtained. " 80,000 0.001 c.c. Satisfactory bacterial purity. Clean product. Of the ten samples only three were really satisfactory. Any necessary action was taken in respect of the others but the absence of any bacteriological standard for Ice Cream is again to be deplored. Of the three satisfactory samples, two were from large firms which employed mass production and distribution. The remainder were from the "back parlour" type of manufacture—a type which can rarely give satisfactory results. Biological Examination of Milk Samples. 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 1932 with the following results:— 28 were found to be free from tubercle bacilli. 2 were found to contain tubercle bacilli. As a result of the latter finding the County Medical Officer reports as follows:— 50 (1) From a Farm in the County of Hertfordshire. The County Medical Officer for Hertfordshire reported that the herd of cows "have been examined and, with the exception of three cows with slight induration of the udder, the herd was in good condition. Samples of milk from the three cows with induration of the udder were examined at the Royal Veterinary College Laboratory but the results have been negative. Since the sample of milk was obtained by your Inspector four cows from the milk-producing herd at the farm have been disposed of.'' In these circumstances, a further sample of milk from this farm was obtained in Walthamstow on 10th October, 1932. This sample was examined biologically, and was considered to have been free from tubercle bacilli. (2) From a Farm in Essex. The County Council's Veterinary Surgeon reported that there were no means of tracing any particular animal and in order to carry out a satisfactory test an examination was made of every animal on the farm. "The total number of cows kept was 93 (ninety-three); of this number five cows (dry) had mammitis in one or more quarters but showed no clinical evidence of tuberculosis. The farmer does not purpose keeping these five. "Three cows have been sold from the farm since the milk sample was taken and were bought by the slaughterer, viz., September 6, 1932-—1 cow; September 15t.h, 1932—2 cows. "I do not think it possible to run a dairy farm more strictly than these farms are managed. Every attention is apparently given to cleanliness and sanitation and any cow which they are doubtful of in regard to its health is immediately removed, and there is no desire to keep any animal except the healthiest. "I can definitely say that there is not a single cow on the premises but that I could clinically consider as sound." In view of the above circumstances, two further samples of the bulk supply from this farm were obtained on 17th October, 1932, and 27th November, 1932. These samples were submitted to biological examination, and each was found to be free from tubercle bacilli. 51 The Milk and Dairies Order, 1926. Much attention was again directed to this Order during the year with a view to minimising the risk of contamination, infection and alteration of the milk supply to the town and as a result three summonses under Section 31 (2) of this Order were issued against offenders. In addition to the convictions detailed under "Legal Procedure," the Council issued one warning to a dairyman in connection with a breach of this Order by his employee. The Milk and Dairies (Amendment) Act, 1922 (Section 2). Upon a special report by your Chief Sanitary Inspector, one retail purveyor of milk was removed from the Register by the Council. There was no appeal against this removal. The Milk (Special Designations) Order, 1923. For offences against this Order, the Council issued four warnings to dairymen in the town. The number of licences granted for the Sale of Milk under Special Designations classified in the Fourth Schedule of the above Order was as follows:— Dealers' Licences. Supplementary Licences. In respect of:— In respect of:— Certified Milk 1 Certified Milk 3 Grade A (T. T.) Milk .. 9 Grade A (T.T.) Milk 5 Grade A Milk 1 Grade A Milk 2 Grade A (Pasteurised) Milk 3 Pasteurised Milk 16 Pasteurised Milk 5 Bottling Licences:— In respect of Grade A (T.T.) Milk, 2; Pasteurised Milk, 4. The Public Health (Meat) Regulations, 1924. In connection with these Regulations, the Council issued four warnings to Meat Traders in the town for offences against the Regulations. 52 (b) Meat and other Foods. A total of 628 visits were paid to slaughterhouses. The following were condemned and destroyed:— (a) Tuberculosis. (b) Other Reasons. 126 Ox Lungs. 54 Ox Livers. 52 Ox Hearts. 8 Ox Flanks. 33 Ox Skirts. 4 Ox Lungs. 16 Ox Livers. 2 sets Ox Tripes. 14 Ox Heads. 1 Ox Skirt. 11 sets Ox Fats. 1 Ox Carcase and all Organs. 4 sets Ox Mesenteric Fats. 1 Ox Pluck. 1 Ox Carcase and all Organs. 1 Ox Heart. 3 Cow Carcases and all Organs. 1 Calf's Pluck. 8 Forequarters Beef. 2 Fore Ribs Beef. 7 Loins Beef. 1 Clod and Sticking Beef. 4 Thick Flanks Beef. 1 Piece Beef. 4 Clods and Sticking Beef. 1 Thick Flank. 3 Briskets Beef. 106 Sheep's Livers. 2 Flanks Beef. 2 Sheep's Carcases and all Organs. 2 Fore Ribs Beef. 2 Heifer Carcases and all Organs. 3 Breasts Mutton. 1 Calf's Pluck. 8 Lambs. 61 sets Pigs' Fats. 12 Legs Lambs. 42 Pigs' Heads. 3 Lambs' Livers. 27 Pigs' Plucks. 126 Pigs' Livers. 19 Pigs' Lungs. 7 Pigs' Livers. 6 Pigs' Lungs. 9 Pig Carcases and all Organs. 5 Pig Carcases and all Organs. 2 Legs Pork. 2 sets Pigs' Mesenteric Fats. 1 Pig's Pluck. 100 lbs. Lamb and Beef. 6 Cows' Udders. 56 lbs. Bacon. Half Barrel Pears. 16 boxes Apples. 8 stones Skate. 2 boxes Skate. 1 box Dogger Fillets. 1 trunk Plaice. 1 box Soles. 10 stones Haddocks. 2 boxes Kippers. (c) Adulteration, etc. (Food and Drugs Adulteration Act, 1928.) Eighty samples of milk and one of baked beans were submitted for analysis during the year. 53 Of these, 80 were genuine, and one sample of milk was not up to standard. One prosecution followed and is reported under ' 'Legal Procedure.'' OFFENSIVE TRADES. During the year the Council sanctioned the establishing of the following:— Fish Curer, 1; Fish Friers, 4; Rag and Bone Dealer, 1. During the year the Council refused to sanction the following Offensive Trades:— Fish Friers, 7; Fish Curers, 3. In addition, the Council granted two licences to establish the trade of a Fish Frier, but these were not taken advantage of by the applicants, and the trades were not established. Legal Procedure. Food and Drugs (Adulteration) Act, 1928:— Fine. Costs. Sample of Milk which was 25% deficient in fats Dismissed 10s. on payment of costs. Milk and Dairies (Order) 1926 (Section 31 (2:)— Information against three employees for 20s. — filling bottles with milk other than on 40s. registered premises 10s. — Petroleum Consolidation Act, 1928, and the Regulations made thereunder:— Information of an infringement of these Regulations as to the amount of petroleum stored without notification to the Local Authority 20s. — THE RENT AND MORTGAGE RESTRICTIONS ACTS, 1920-1923. During the year six certificates were granted to tenants and two certificates have been issued to owners upon completion of the scheduled works. 54 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. The Importation of Dogs and Cats Order, 1928.—During the year, one performing cat and six performing dogs were admitted under Licence into the area. The conditions of the Licence were duly observed. The Importation of Animals and Poultry Order, 1923.— Under this Order two Licences were granted by your Chief Inspector for the transfer of two dogs to Ireland. Sheep Scab Order, 1920.—No cases of this disease occurred in the Borough during the year. The Sheep Scab Order, 1928 (Adopted by the Council).— During the year, 191 sheep were allowed into the area under Licences for Slaughter. The Regulation of Movement of Swine Order, 1922.— Under this Order 2,423 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, 28 pigs were admitted on detention licences and the periods of detention carried out. One case of suspected Swine Fever was discovered in a slaughterhouse but was not confirmed by the Ministry of Agriculture and Fisheries. On the 31st May, the Ministry of Agriculture and Fisheries declared a certain area in the town to be a Swine Fever Infected Place, 15 pigs having died, and six of which were definitely diagnosed as having had Swine Fever. The Council did not take legal proceedings against the Owner, but issued a severe warning to him. The Ministry of Agriculture and Fisheries withdrew the Order and declared the area free from Swine Fever on 8th September. No cases have since arisen in the area. 55 Tuberculosis Order, 1925.—Routine quarterly inspections were carried out by your Veterinary Surgeon and Chief Sanitary Inspector. No instance has arisen calling for mention. Poisons and Pharmacy Act, 1908.—No licences were issued during the year. FACTORY AND WORKSHOP ACT, 1901. The following tables show the work done under the Act during the year:— 1 .—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories (Including Factory Laundries.) 506 7 Nil. Workshops .. (Including Workshop Laundries.) 276 7 Nil. Workplaces (Other than Outworkers' premises.) 118 1 Nil. Total 900 15 Nil. 56 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 25 25 — — Want of ventilation 7 7 — — Overcrowding — — — — Want of drainage of floors 4 4 — — Other nuisances 27 27 — — Sanitary accommodation insufficient 3 3 — — unsuitable or defective 28 28 - - not separato for sexes 1 1 — — Offences under the Factory and Workshops Acts— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences — — — — Total 95 95 Nil Nil Outwork in Unwholesome Premises, Section 108. Notices Nature of Work. Instances. served. tions. Wearing Apparel, making of 9 9 — Paper, etc., Boxes, Paper Bags 1 1 — Brush Making 1 1 — Total 11 11 — 57 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1932. Wearing Apparel, making of 379 Brush Making 23 Paper, etc., Boxes, Paper Bags 17 Carding, etc., of Buttons 2 Christmas Crackers 1 Total Furniture and Upholstery 2 Fur Pulling 5 Artificial Flowers 1 Umbrellas, etc. 1 Stuffed Toys 10 Handbags 7 448 OUTWORKERS WERE NOTIFIED FROM THE FOLLOWING AREAS. City of London 167 Bethnal Green 21 Finsbury 67 Hackney 51 Islington 8 Leyton 20 Poplar 4 Stoke Newington 4 Stepney 10 Shoreditch 7 Tottenham 7 Walthamstow 60 Westminster 10 Other Areas 9 A total ot 375 visits were paid in connection with outworkers as follows:—To Homes, 323; Factories, 32; Workshops, 20. F—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. 1932 1931 Smallpox 10 67 — — 1 3 3 3 — Scarlet Fever 445 451 4 122 2i0 42 27 — — Diphtheria 356 324 8 96 217 18 14 3 — Enteric Fever 6 38 — — 3 2 1 — — Pneumonia 188 211 2 29 36 27 35 40 19 Puerperal Fever 6 11 — — — 1 5 — — Puerperal Pyrexia 20 30 — — — 3 17 — — Ophthalmia Neonatorum 9 8 9 — — — — — — Erysipelas 49 61 1 2 5 2 17 18 4 Encephalitis Lethargica — 2 — — — — — — — Cerebro-spinal Meningitis 2 1 1 — — 1 — — — Chicken Pox 694 1260 18 130 524 15 7 — — Tuberculosis 186 190 2 8 15 50 82 27 2 Poliomyelitis 7 1 — 3 4 — — — — Measles 753 .—. 37 619 95 2 — — Dysentery 9 — 1 3 5 — — — — Totals f 1932 2740 83 1012 1155 166 208 91 25 1931 — 2655 53 490 1484 247 242 111 28 58 Disease. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Smallpox - 7 - 2 1 - Scarlet Fever 85 61 53 58 68 120 Diphtheria 86 30 53 36 78 73 Enteric Fever 1 3 1 — 1 Pneumonia 39 36 27 11 29 46 Puerperal Fever 2 — — — 1 3 Puerperal Pyrexia 1 2 3 3 7 4 Ophthalmia Neonatorum.. 2 1 3 1 1 1 Erysipelas 10 7 7 4 7 14 Encephalitis Lethargica — — — — — — Cerebro-spinal Meningitis — — 1 — 1 — Chicken Pox 89 71 110 82 180 162 Tuberculosis 32 21 32 26 40 35 Poliomyelitis 1 3 — 1 1 1 Measles 103 122 118 59 112 239 Dysentery — 2 1 — — 6 Totals 1932 451 336 409 283 526 705 1931 439 440 286 239 447 804 From the foregoing tables it will be seen that the outstanding features of 1932 were:— The marked decreases in the incidence of Smallpox, Chicken Pox, Enteric Fever, Puerperal Fever and Pyrexia. On the other hand Measles became notifiable in March, a total of 753 cases being notified during the remainder of the year. Disease. Total. Removed to Hospital. Per cent, removed to Hospital. Deaths. Deaths per cent. of cases notified. Smallpox 10 10 100.0 Nil. Nil. Scarlet Fever 445 366 82.2 2 0.4 Diphtheria 356 325 91.3 5 1.4 Enteric Fever 6 6 100.0 Nil. Nil. Pneumonia 188 59 31.4 94 50.0 Puerperal Fever 6 5 83.3 I 8 l 30.7 Puerperal Pyrexia 20 18 90.0 Ophthalmia Neonatorum.. 9 3 33.3 Nil. Nil. Erysipelas 49 19 38.8 — — Cerebro-spinal Meningitis 2 2 100.0 2 100.0 Chicken Pox 694 2 0.3 Nil. Nil. Tuberculosis 186 123 66.1 101 54.3 Poliomyelitis 7 6 85.7 Nil. Nil. Measles 753 36 4.8 20 55.5 Dysentery 9 9 100.0 — — 59 Of the total notifications the following were made by the Medical Staff of the Department:— Smallpox, 6; Diphtheria, 186; Scarlet Fever, 31; Chicken Pox, 266; Dysentery, 6. Infectious Disease Clinic.—As in previous years this Clinic was held weekly on Tuesdays at 2 p.m. The work done at the Clinic is as follows:— (a) Examination of all school and pre-school contacts of notified cases of Infectious Disease and determination of date of return to school in the former. (b) Discovery of "missed" cases of infectious disease amongst immediate contacts of cases. (c) Examination of patients after discharge from the Isolation Hospital and the reference of all doubtful heart cases to the Education Committee's Rheumatism Clinic (see School Medical Officer's Report). Determination of date of return to school in school children. (d) Diphtheria Immunisation. This Clinic is taken personally by your Medical Officer of Health. The following table gives particulars of the work done during 1932:— Number of sessions held 52 Number of patients attended 1,798 Number of attendances made 3,059 Average attendance per session 34 Number of Scarlet Fever cases discovered 6 Number of Diphtheria cases discovered 47 Number of patients given antitoxin at Clinic 34 Number of virulence tests taken in Diphtheria carriers 15 Number of children recommended for Rheumatism Clinic 42 Number of children recommended for Convalescent Home Treatment 12 Of the children referred to the Rheumatism Clinic following discharge from the Fever Hospital 24 were kept under observation on account of irregularities of the heart. Dr. Sheldon, Physicianin-Charge of the Clinic, states that some of the irregularities proved to be temporary whilst others needed prolonged care, and considers it likely that this close follow-up will lead to the prevention or amelioration of a certain amount of subsequent rheumatism. 60 Diphtheria Immunisation.—During the year your Council determined to give facilities for immunisation against Diphtheria and the work was begun both at the infectious Disease Clinic and at two children's institutions in the Borough. Immunisation proved very successful at both institutions and it was very significant that each reported only one case of diphtheria after the commencement of Immunisation. Both patients were not immunised at the time owing to parental refusal. The scheme in operation was briefly as follows:—All children over the age of five years are first of all Schick tested and the results read on the third day. Immunisation is advised in all Schick positive cases over 5 years of age and in all children between one and five years of age. Three weekly doses of toxin-antitoxin mixture are given subcutaneously and a Schick test is done in every case one month after the last injection. Up to the end of the year 36 cases had completed the course of injections and in each case the resultant Schick test was negative. In one case immunised, a suspicious sore throat was notified as ? Diphtheria. After investigation, however, it proved to be a streptococcal throat clinically and bacteriologically. As a result of a virulence test the diphtheria-like germs which were also present in the throat were proved to be non-virulent. A summary of the immunisation work done during the year is given below:— Number of children Schick tested positive 33 „ „ „ negative 17 Number of children immunised without being Schick tested 51 Number of children given 3 doses of T. A.M. 70 „ „ „ 2 „ „ „ 5 „ „ „ 1 „ „ „ 4 Total 79 Number of children Schick tested after immunisation (a) positive — (b) negative 36 Number of children not Schick tested at end of year after immunisation 25 Number of children left area before final Schick test 18 Total 79 61 In addition, materials were supplied to a local practitioner for gratuitous injection and 8 children were successfully immunised by him. The cost of immunisation material per completed case (averaged over the 36 completed cases) was 5s. The attention of parents has been drawn to the facilities which are available by the following means:— (а) Advertisement in local press. (б) Display of notices at all clinics. (c) Distribution of leaflets by Infectious Disease Nurse during removal of all Scarlet Fever and Diphtheria cases to Hospital. (d) Distribution of leaflets at all routine medical inspections. (e) Distribution of leaflets during a localised outbreak of diphtheria at any particular school. The lack of response, even under item (e), has been truly amazing. 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." Thirty-four patients seen at the Clinic and suspected of suffering from Diphtheria were given a total of 304,000 units of Diphtheria antitoxin pending the result of swabbing. Twelve children were recommended for convalescent home treatment following discharge from the Isolation Hospital. MUNICIPAL LABORATORY. The following numbers of specimens were examined during 1932:— Swabs. Negative. Positive lit Incubation. Positive 2nd Incubation, Totals. Private Practitioners 1,604 83 53 1,740 Health Department 1,222 162 54 1,438 School Medical Dept. 943 61 22 1,026 Totals 3,769 306 129 4,204 62 The total number of Diphtheria specimens compares with 3.119 in 1931. The following specimens were also examined:— Urine, 214; Ringworm, 3; Blood, 1; Miscellaneous, 4; Total, 222, as compared with 103 in 1931. A total of 8,404 tubes of culture media were made by Mr. West and of these 4,032 were sent to the Sanatorium. The practice of re-examining swabs after incubation for a second night, which was begun in October, 1931, was continued during 1932 with the result shown above. The fact that 129 or 29.6 of the total would have been missed but for the re-incubation demonstrates the usefulness of the additional care. The Essex County Council also provide facilities for examination of pathological specimens and the County Medical Officer states that 891 specimens were examined for local Practitioners during 1932 as follows:— Diphtheria Swabs, 101; Sputa, 703; Typhoid Specimens, 36; Ringworm Specimens, 24; Miscellaneous Specimens, 27. The total of the previous year was 1,161. SMALLPOX. Ten cases of Smallpox were notified during 1932, in marked contrast with the 67 cases during 1931 and the 189 in 1930. Incidence by months, ages and wards is shown in the following table:— All ages. Under 1 y- 1-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 & over. January 7 — — 1 2 2 2 — February 1 — — — 1 — — — March 1 — — — — — 1 — April — — — — — — — — May 1 — — — — 1 — — Totals (1932 10 - - 1 3 3 3 - (1931 67 - 2 24 18 17 6 - 63 St. James' Street. High Street Hoe Street. Wood Street. Hale End. Higham Hill. January — 7 - — — February — — - 1 — — March — — - 1 — — April — — - — — — May — — - — 1 — Totals 1932 - 7 - 2 1 1931 12 4 20 13 4 14 Cases 1,2,4 and 5 were secondary to Case 67 of the 1931 series. Cases 3 and 6 were of unknown origin. Case 7 was secondary to Case 6. Case 8 was infected at a laundry in a neighbouring area and in turn infected her mother, case 9. Case 10 was also infected in a neighbouring area. Three of the cases were primarily notified by private practitioners and seven by your Medical Officer of Health. Only one case was of school age and this patient fortunately had not been at school whilst infectious. Six cases were unvaccinated and the remaining 4 patients, aged 55, 53, 44 and 30 years, were vaccinated in infancy. The 10 cases were notified from five different households accommodating five families. Multiple cases occurred in three households (4 cases in one and 2 cases in two). The most constant period between onset and rash was four days, the extreme limits being 2 and 5 days—one case each. Amongst the successful vaccinations performed on home contacts two of these subsequently developed Smallpox, in one case the onset being 8 days later and in the other the rash (there was no onset) developing 11 days later. Allowing the usual incubation period of 12 days, the experience of 1931 was again borne out, viz., that successful vaccination within 3 days of initial exposure to infection protected contacts. In spite of the failure of vaccination being done too late to protect the contacts, the severity of the attacks were so modified that the patients were only in Hospital for short periods. No case was erroneously notified as Chicken Pox. 64 The patients were sent to Hospital on the following days relative to the appearance of their rashes:—two days before, 1; on actual day, 2; two days after, 4; three days after, 3. The number of contacts notified by outside authorities was 107 as compared with 134 in 1931. A total of 265 visits were made by the Medical Staff and 830 by the Sanitary Staff in connection with Smallpox. HOSPITAL TREATMENT OF SMALLPOX. Twelve cases of Smallpox were admitted to your Smallpox Hospital (10 from Walthamstow and 2 from Leyton) and seven observation cases. All observation cases were vaccinated either immediately before or after admission, and two cases, after showing evidence of the successful vaccination, were nursed with definite cases of Smallpox in the general ward without any ill effect. The average stay in Hospital was 18.3 for actual cases, 9.6 for observation cases and 15.1 for all cases. No case caused any real anxiety. The worst case clinically— the case which had been admitted to Hospital during the prodromal illness and two days before the appearance of the eruption—had a temperature of 103.2° on admission. A profuse eruption appeared subsequently and over 400 pustules were counted. In spite of the intensity of the rash the patient only required detention for 29 days. During the year your Council received enquiries from two other Authorities as to the reception of cases of Smallpox from their Areas. These Authorities, however, continued their arrangements with the Orsett Joint Hospital Board. Later, however, an agreement was reached with the Corporation of Leyton for 6 beds to be retained for the use of Smallpox patients from their area at a retaining fee of £100 per annum and a maintenance charge of £6 per patient per week. The Hospital was closed from the 15th March to the 27th May and again from 16th June till 11th July, when it was re-opened for the admission of a Leyton case, and again from the 3rd August till the 2nd December when it was again re-opened for the admission of a Leyton case which was discharged on 23rd December. As in previous years the Hospital was staffed and maintained from your Council's Infectious Disease Hospital and acknowledgment must again be made to the Matron and Nursing Staff for the continued efficiency displayed. 65 Vaccination.—Mr. E. Sharp, Vaccination Officer for the Area, has furnished the following return for 1932:— Births Registered. Successfully Vaccinated. Percentage Vaccinated. Insusceptible. Exemptions. Deaths before Vaccinated or exempted. Postponed 1,413 217 15.4 3 832 53 37 In, addition to the above, 103 primary vaccinations were recorded. The percentage vaccinated compares with 16.7 in 1931 and 18.0 in 1930. One primary and 7 re-vaccinations were done by your Medica Staff during 1932 in cases of direct Smallpox contacts. During 1932 the vaccinal condition of all school childrer examined at Routine Medical Inspection was recorded and e summary of the findings for the year showed that 30.4 per cent, were vaccinated. SCARLET FEVER. A total of 445 cases of Scarlet Fever were notified in 1932 a; compared with 451 in 1931. The following tables 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 24 — 6 11 4 3 — — February 34 1 10 14 7 2 — — March 26 — 5 17 3 1 — — April 40 — 7 26 4 3 — — May 29 1 8 10 6 4 — — June 23 1 4 15 — 3 — — July 28 — 12 12 3 1 — — August 22 — 7 11 1 3 — — September 38 — 13 23 2 — — — October 51 — 12 32 4 3 — — November 72 — 17 48 6 1 — — December 58 1 21 31 2 3 — — Totals 1932 445 4 122 250 42 27 - - 1931 451 3 92 269 48 36 3 — 66 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 5 2 6 1 3 7 February 13 2 4 3 4 8 March 7 6 2 2 — 9 April 7 3 7 3 10 10 May 8 — 3 4 8 6 June 2 3 3 — — 15 July 6 5 4 1 6 6 August 10 2 4 — 2 4 September 8 2 4 8 7 9 October 7 6 4 11 13 10 November 7 17 7 16 6 19 December 5 13 5 9 9 17 Totals 1932 85 61 53 58 68 120 1931 120 48 57 28 85 113 The percentage of cases removed to Hospital during 1932 was 82.2 against 79.6 in 1931 and 68.2 in 1930. No cases were refused admission although, in view of the increased incidence towards the end of the year, several cases were nursed at home by arrangement. \ As was stressed in last year's report, while the prevailing mildness of the disease continues, all patients who can be adequately isolated in a separate room and properly nursed at home should not be removed to Hospital unless there are special circumstances requiring removal. Force is given to this contention when it is realised that during 1932 eleven patients suffered "relapses" or second attacks either about the fourth to sixth week in hospital or soon after discharge. Such relapses are in no way due to want of medical or nursing care but solely to the unavoidable re-infection from other patients. No extensive use was made of the Dick test (i.e., for susceptibility to Scarlet Fever) and no active immunisation was carried out. Fifty-four visits were paid by the Medical Staff in connection with cases of Scarlet Fever. DIPHTHERIA. A total of 356 cases of Diphtheria were notified during 1932 as compared with 324 in 1931. The following tables show the incidence by months, ag ;es and wards:— 67 Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 27 - 7 15 3 - 2 - February 38 1 12 22 1 1 1 - March 35 1 13 21 — - — - April 43 2 17 18 3 3 - — May 20 1 6 9 1 3 - - June 19 — 6 12 — 1 - — July 10 — 3 6 — 1 — — August 19 1 4 13 — 1 — — September 43 — 10 29 3 — — October 33 1 6 22 3 1 - - November 33 - 6 24 1 2 - - December 36 1 6 26 3 — — — Totals 1932 356 8 96 217 18 14 3 — 1931 324 7 65 203 30 14 5 — Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 5 1 9 1 9 2 February 2 3 2 2 22 7 March 2 2 7 2 11 11 April 8 6 8 2 12 7 May 4 — 2 4 6 4 June 5 2 1 7 1 3 July — — 1 — 5 4 August 9 1 4 1 2 2 September 7 8 7 1 3 17 October 23 2 3 2 3 - November 9 3 4 10 1 6 December 12 2 5 4 3 10 Totals 1932 86 30 53 36 78 73 1931 58 54 47 40 47 78 The percentage of cases removed to Hospital in 1932 was 91.3 against 93.3 in 1931. No cases were refused admission and whenever possible pressure was exerted to secure the admission of all cases to Hospital unless cases were of the non-clinical variety. It is felt that home treatment of diphtheria can rarely be adequate owing to the difficulty of making patients realise the necessity for absolute recumbency during the early stages of the disease. The only notable feature during the year was an outbreak in February at Chapel End Junior Mixed School where 10 cases occurred in one class. Between February 4th and March 5th, 20 cases were 68 discovered—13 in the Junior Department and 7 in the Infants' Department. Of these, 14 were found by means of the routine swabbing done by the Medical Officer of Health. Six of the cases were "bacteriological" and had no clinical signs. A total of 97 visits were made by the Medical Staff in connection with Diphtheria. Antitoxin continued to be available for free issue to medical practitioners at the Public Health Department during office hours and at all times at the Fire Station, Forest Road and at Mr. Gaze's, 10, The Avenue, Highams Park. During 1932 a total of 204 phials containing 1,420,000 units were issued. Diphtheria and Scarlet Fever at an Institution.—A small institution in the Borough showed a heavy incidence of Scarlet Fever and Diphtheria. A total of 12 definite cases of Scarlet Fever and 3 observation cases occurred. The cases occurred in two separate series—January to April and September to December. A considerable number of swabs were taken from the patients, staff (nursing and domestic) and other contacts. These were examined and typed at the Ministry of Health Laboratory by Doctors Griffith and Scott. The typings were as follows:—Type 1, two ; Type 2, one; Type 63T, one; Haemolytic Streptococci present but not typed, 7; negative, 4. No staff were involved as patients but five nurses at one time or another were carriers of Type 2. One case was a persistent carrier who gave at least 12 Type 2 swabs and the carrier state was only terminated by tonsillectomy. Two of the five nurses later became Type 1 carriers. At the same institution between January and May, 19 of the patients gave positive Diphtheria swabs. Only two were definite clinical cases, seven were indefinite and ten were non-clinical or bacteriological cases. These clinical findings agreed with the results of 15 virulence tests which only showed two to be fully virulent, the remainder being non-virulent. In July a series of nine cases occurred, all of which yielded positive Diphtheria swabs and four of which yielded Haemolytic Streptococci of the Franklin type. Two nurses were involved. In three cases there were no symptoms. The remainder had temperatures varying from 100.4° to 103.6°, no vomiting, no rash, and obvious tonsillitis in only two cases. The patients made a quick recovery and the clinical findings agreed with the usual experience 69 that infection with Haemolytic Streptococci of the Franklin type rarely produces a rash. The outbreak seemed clearly to be primarily streptococcal amongst Diphtheria carriers. After this series it was decided to press for parental permission to immunise against Diphtheria and, beginning in July, no failure occurred in the immunisation of susceptible children. Only one other case of Diphtheria followed during the remainder of the year and this was in the only patient in the Hospital at the time for whom immunisation had been refused. ENTERIC FEVER. Six cases of Enteric Fever were notified between 29th August and 24th October, 1932. One was a case of typhoid, one paratyphoid A, and three were paratyphoid B, whilst the sixth case was not definitely proved. All the patients were either notified from a Hospital after admission there or removed to Hospital after notification. Three patients were treated at the Connaught Hospital, two at Whipps Cross Hospital, and one at Middlesex Hospital. All patients recovered. In no case was a definite source of infection discovered in spite of the most careful enquiry. The sex, age and ward of each patient was as follows, Male, 27, High Street; Male, 8, Higham Hill; Male, 21, High Street; Male, 6, High Street; Female, 5, High Street; Female, 20, St. James' Street. PNEUMONIA. The tables following show the incidence by months, ages and wards. Most of the cases removed to Hospital received treatment at Whipps Cross Hospital. Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 27 - 2 4 5 7 7 2 February 15 — 1 4 3 3 2 2 March 29 1 2 5 6 4 6 5 April 24 1 9 2 5 4 2 1 May 17 — 2 3 2 3 5 2 June 13 — 1 6 — — 4 2 July 5 — — 1 — 1 1 2 August 4 — 1 3 — — — — September 5 — — — 1 1 2 1 October 14 — 1 3 1 6 3 — November 22 — 8 3 2 5 2 2 December 13 — 2 2 2 1 6 — Totals 1932 188 2 29 36 27 35 40 19 1931 211 3 30 37 37 51 35 18 70 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 5 5 4 2 3 8 February 5 1 3 — 5 1 March 9 5 6 2 1 6 April 3 9 2 2 4 4 May 3 1 3 2 4 4 June 4 5 1 1 — 2 July 1 — 1 — 2 1 August — — 1 — — 3 September 1 — — — 2 2 October — 2 3 2 7 November 4 5 1 1 5 6 December 4 3 2 1 1 2 Totals 1932 39 36 27 11 29 46 1931 59 44 16 19 32 41 PUERPERAL FEVER AND PYREXIA. See Maternity $ind Child Welfare Section. OPHTHALMIA NEONATORUM. See Maternity and Child Welfare Section. ERYSIPELAS. The following tables 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 3 - - - 1 - 2 - February 1 — — — — 1 — March 6 1 — 1 — — 3 1 April 6 — 1 — — 2 2 1 May 1 — — — — — 1 — J une 6 — — 1 — 1 4 - July 4 — — — — 2 2 — August 5 — — — — 2 2 1 September 2 — — — 1 — 1 — October 7 — 1 - - 6 - - November 4 - - - - 2 1 1 December 4 — — 3 — 1 — — Totals 1932 49 1 2 5 2 17 18 4 1931 61 — 3 4 2 11 37 4 71 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. J anuary — 1 — — — 2 February - - - - - 1 March 2 1 1 1 — 1 April 1 — 2 1 1 1 May — — — — 1 — June 1 — 2 — 1 2 July 2 — 1 1 — — August 1 2 — 1 — 1 September — 1 — — — 1 October 2 2 1 — 1 1 November 1 — — — 1 2 December — — — — 2 2 Totals 1932 10 7 7 4 7 14 1931 10 14 7 6 5 19 CEREBRO-SPINAL MENINGITIS. Two cases were notified from Hospitals. CHICKENPOX. In view of the continuation of Smallpox in the Greater London area, Chickenpox remained notifiable under the Walthamstow (Chickenpox) Regulations, 1931, except in vaccinated children under 10 years of age. The incidence by months, ages and wards was as follows:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 47 2 9 34 2 — — — February 64 1 11 52 — — — — March 55 2 10 39 4 — — — April 64 — 12 50 — 2 — — May 75 4 13 57 1 — - — June 174 2 21 146 2 3 - — July 84 4 19 58 3 — - — August 12 — 3 8 1 — - — September 21 — 7 13 1 — - — October 22 1 1 20 — — - — November 60 1 20 36 1 2 - — December 16 1 4 11 - - - - Totals 1932 694 18 130 524 15 7 — — 1931 1260 29 282 912 32 4 1 — 72 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. J anuary 3 10 6 - 4 24 February 6 12 29 4 1 12 March 7 9 18 7 2 12 April 8 6 23 15 6 6 May 6 5 14 14 26 10 J une 12 12 7 2 87 54 J uly 7 7 4 2 32 32 August 3 — 2 — 1 6 September 7 7 — 1 5 1 October 11 1 1 3 5 1 November 15 1 3 31 8 2 December .. 4 1 3 3 3 2 Totals 1932 89 71 110 82 180 162 1931 133 228 89 108 220 482 A total of 732 visits were paid to cases of Chickenpox—38 visits more than the total cases notified—due to secondary visits in doubtful cases and to the fact that some non-notifiable cases were visited owing to lack of information as to their vaccinal condition. Two instances of associated Chickenpox and Shingles were recorded, viz.—(a) D.K., aged 7 years, said to have had Chickenpox when 9 months old. Facial shingles on 7th May, 1932. Sister developed Chickenpox on 21st and brother on 24th May. (6) I). B., aged 3| years. Chickenpox eruption 17th October, 1932. Father had shingles 25th September 1932. MEASLES. Under the Walthamstow (Measles) Regulations, dated February 25th, 1932, all cases of Measles in children under 5 years of age became notifiable, except secondary cases in the same household or institution within two months of the primary case. The year 1932 was an epidemic year and the 753 cases were distributed as follows:— 73 Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January - - - Not Not ifiable - - - February - - - ditto - - - March 178 1 126 43 2 — — — April 274 10 216 48 — — — — May 210 13 196 1 — — — — June 72 4 66 2 — — — — July 8 1 7 1 — — — — August 3 — 3 - - - - - September 1 — 1 - - - - - October 4 3 1 — — — — — November 1 - 1 - - - - - December 2 — 2 - - - - - Totals 1932 75 37 619 95 o - - - 1931 3 - - Not Not ifiable - - - Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January - - Not No tifiable - - February dit to March 47 27 32 31 23 18 April 30 55 44 16 41 88 May 18 27 28 9 40 88 June 7 12 12 — 5 36 July — 1 2 1 1 3 August — — — — — 3 September 1 — — — — — October - - - 1 1 2 November - - - 1 - - December — — — — 1 1 Totals . 1932 103 122 118 59 112 239 < 1931 Not No tifiable A total of 36 cases were known to have been admitted to Hospital, 28 of these being treated at your Council's Isolation Hospital, where 14 beds on one side of the convalescent Diphtheria ward were allocated between January 30th and April 15th for the use of cases of Measlea with complications—mostly pneumonia. Of the 753 cases only 51 or 6.7 per cent, were notified by parents, a disappointing proportion because these are the cases in which the family doctor has not been called in and which, therefore, require the greater supervision. There appears considerable doubt, therefore, if the continuation of notification is justifiable. A scheme of voluntary notification with the provision of more adequate arrangements for hospitalisation of the serious cases would probably be more effective. 74 All notified cases were, as far as possible, visited either by a Health Visitor or School Nurse in the case of children of school age. Through the kindness of Dr. Nabarro of Great Ormond Street Hospital, a quantity of convalescent measles serum was obtained and used in 13 cases. It is claimed that this serum when injected in the dose appropriate to the age of the patient within 6 days of exposure, will afford complete protection in some 90 per cent, of cases. The immunity is passive and lasts for some three weeks. The same dose of serum injected between the sixth and ninth day after exposure produces a modified or attenuated attack of measles which confers lifelong immunity. In the 13 cases treated, complete protection was obtained in 9 cases. In 3 other cases the serum was injected too late to afford complete protection and very mild attacks resulted whilst in the remaining case an attenuated attack was deliberately aimed at and obtained. In this case there was a slight eruption but no rise of temperature. There is no question that if sufficient supplies of serum become available, here is the method of controlling measles. Unfortunately, the production of sufficient serum is very difficult. Some attempt was made to assist by circularising local doctors requesting them to notify all cases of adult measles and to persuade such patients to give blood for the preparation of serum. Only two volunteers were forthcoming and these were taken to Dr. Nabarro for the preparation of serum from their blood. It must be clearly understood that such donors are carefully examined before acceptance and the blood is tested to eliminate the possibility of certain diseases and the final serum is made up with a small percentage of antiseptic. The only means of organising a really satisfactory supply of serum would appear to be on the lines of the blood transfusion services which have now been so successfully organised by such societies as the British Red Cross Society. The main difficulty is the paucity of healthy adult donors convalescent from recent attacks of measles. A total of 20 deaths from measles were registered locally during 1932 as being due to measles. Of these 14 took place in Hospital (Whipps Cross Hospital, 12), 3 at a children's institution, and 3 at home. The deaths were made up as follows:—1 to 2 years—11. 2 to 3 years—3, 3 to 4 years—1, 4 to 5 years—4, 5 to 10 years, 2. 75 In order to focus attention on the death rate from measles a table has been prepared showing the death rate per 1,000 live births every year between 1901 and 1932 and a five-yearly average is shown:— Year. Population. Registered live births. Deaths from Measles. Rate per 1,000 Registered live births. 5-yearly average. 1901 95,125 3,210 43 13.39 11.51 1902 101,318 3,426 14 4.08 1903 106,290 3,535 52 14.71 1904 111,282 3,649 55 15.07 1905 116,300 3,389 35 10.32 1906 121,334 3,594 39 10.85 8.97 1907 126,397 3,629 31 8.54 1908 131,486 3,482 36 10.33 1909 136,602 3,369 30 8.90 1910 141,748 3,197 20 6.25 1911 125,334 3,107 32 10.29 9.88 1912 128,480 3,104 22 7.08 1913 131,636 3,210 21 6.54 1914 134,825 3,134 21 6.70 1915 131,718 2,867 54 18.83 1916 139,425 2,854 24 8.40 6.62 1917 132,994 2,167 24 11.07 1918 127,701 2,034 19 9.34 1919 133,008 2,384 9 3.77 1920 132,912 3,286 5 1.52 1921 127,441 2,814 3 1.06 5.02 1922 129,700 2,545 40 15.71 1923 130,000 2,349 1 0.42 1924 131,100 2,138 11 5.14 1925 130,800 2,131 6 2.81 1926 125,500 2,218 4 1.80 5.12 1927 124,330 2,025 1 0.49 1928 122,400 1,991 17 8.53 1929 124,800 1,934 1 0.51 1930 129,395 1,959 28 14.29 1931 134,420 1,947 — 0.00 1932 135,010 1,789 20 11.17 From the five-yearly average it will be seen that there is a definite decline in the measles mortality rate—a finding in close agreement with that of other areas for which statistics have been published. WHOOPING COUGH. Whooping Cough was not notifiable during 1932 but 282 school cases were notified by Head Teachers. The total number of deaths was 3, or a mortality of 1.06 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. 76 ANTERIOR POLIOMYELITIS (Infantile Paralysis). Although only two cases of poliomyelitis were notified locally, seven cases occurred in Walthamstow residents during the period August to November. This seasonal prevalence was in close agreement with the fact that 34 out of a total of 42 cases occurred in Essex during the same period. All were notified from Hospital except one from a residential boys' school, where all necessary precautions were taken and wheree fortunately, no further cases developed. There was some evidenc, of case to case infection in two children from different parts of the Borough who had met whilst away on holiday. BACILLARY DYSENTERY. Early in June one of the local Doctors drew the attention of your Medical Officer of Health to the fact that in a family of seven persons no fewer than 5 had complained of diarrhoea and sickness which began about June 1st. In addition, a sixth member of the family who had been discharged from a Hospital in a neighbouring area on 24th May had suffered from profuse diarrhoea immediately after her return home. The symptoms and signs at once suggested the possibility of Dysentery and faecal swabs were immediately sent to the Ministry of Health. Dr. Scott reported the presence of B. Dysenteriae (Flexner) W. type within 24 hours and the patient was removed to Hospital. Later a sister was also reported to give a similar result and was also removed to Hospital. On the 13th June another family living in quite a different part of the Borough were reported as possibly suffering from paratyphoid. On visiting, the child was seen to be critically ill and was immediately sent to Hospital with a tentative diagnosis of Bacillary Dysentery. Death occurred within 24 hours. The history obtained was that a baby of the same family had been taken away from the same Institution by the parents, against medical advice, on 26th May. Diarrhoea had been noticed while the child was in Hospital. The sister at home, who had contracted measles a month previously and was very debilitated, was suffering from pneumonia, diarrhoea, and vomiting by June 8th. Afterwards she had green, slimy, blood-stained stools. In addition, four other children in the same family had a certain degree of diarrhoea. Faecal swabs were again sent to Dr. Scott who later reported that three of the children, including the fatal case, showed the presence of B. Dysenteriae (Flexner W). Later a fourth child became affected. The authorities of the Hospital from which the two patients had been discharged had been communicated with as soon as the diagnosis of Dysentery in the first family was definitely established and again when the second series of cases were discovered. Both 77 cases had been nursed in the same ward and all children who had been recently discharged from that ward were visited and, fortunately, found to be well. On the 17th June the doctor attending the second family drew attention to suspicious symptoms in two children in the adjoining house who had played with the latter. Later two of these children were found to be suffering from Dysentery of the same type (Flexner W.). Later in the year a further case of Bacillary Dysentery of the same type was notified from another Hospital but no further cases developed. All the nine bacteriologically proved cases were treated in Hospital with one death—primarily due to pneumonia following Measles. The general severity of the disease was definitely below that which has been met with in a similar epidemic in another area. The seven cases admitted to your Council's Isolation Hospital made good recoveries and responded well to treatment with the appropriate serum. Grateful acknowledgment must be made to two local Doctors but for whose help this small outbreak would probably never have been discovered. Food Poisoning.—A medical practitioner notified on June 3rd that one of his patients had symptoms suggestive of Food Poisoning. On visiting, the patient was found to be gravely ill with an almost continuous watery diarrhoea and arrangements were made by his own doctor for immediate removal to Hospital where a good recovery was made. After investigation of specimens at the Ministry of Health Laboratory Dr. Scott reported the illness to be due to infection with Bacillus Aertrycke. The patient had consumed about 3 duck eggs on and after May 27th and sickened on June 2nd. No eggs from the same consignment could be obtained but a dozen eggs from the same source (Dutch) were examined by Dr. Scott with negative results. A fatal case of food poisoning reported last year and in all probability due to duck eggs will be recalled to mind. Antimony Poisoning.—The Ministry of Health have recently issued a Memorandum on the subject of Antimony Poisoning due to the use of enamelled vessels of inferior quality for the preparation of acid drinks such as lemonade. In such cases the enamel coating of the vessel is attacked by the acid with the result that the lemonade contains antimony in solution. 78 The issue of the Memorandum recalls a previously unexplained outbreak of vomiting amongst 19 girls attending the South Walthamstow Central Girls' School in November 1931. The matter was investigated at the time but nothing definite could be found—the enamel of the jug used appeared intact and no residue of the lemonade, nor the crystals used, was available for analysis. In the light of the knowledge now available there can be no reasonable doubt that the vomiting was due to antimony poisoning. Thus the lemonade had been prepared from crystals of a well-known brand for an ''old girls'" party on November 15th. A considerable amount was left over and stood overnight in the enamelled jug. The lemonade was consumed at playtime next morning and vomiting began by dinner time; some girls were absent during the afternoon but all had recovered and were back at school on November 17th. 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. TUBERCULOSIS. The table given below shows particulars of new cases of Tuberculosis and of all deaths from the disease in the Borough during 1932 Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary. M F M F M F M F Under 1 yr. — 1 1 - — 1 3 - 1—5 yrs. 1 2 2 3 — 1 — 2 5—10 yrs. — — 6 2 1 — 1 1 10—15 yrs. 2 2 2 1 — — — — 15—20 yrs. 8 11 2 2 1 5 1 — 20—25 yrs. 15 10 1 1 7 3 2 — 25—35 yrs. 21 23 5 2 14 12 1 2 35—45 yrs. 16 13 2 — 9 4 - - 45—55 yrs. 6 4 — 2 9 4 1 — 55—65 yrs. 12 3 — — 12 1 - — 65 yrs. and upwards 1 1 — — 1 2 - - Totals 82 70 21 13 54 33 9 5 152 34 87 14 186 101 The 101 deaths represent a death rate of 0.74 per 1,000 population. 79 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. 1932 82 70 21 13 186 54 33 9 5 101 1931 97 53 23 17 190 63 32 5 8 108 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 14 2 5 — 8 1 4 — 43 3 9 3 4 5 The ratio of deaths in non-notified cases (i.e., columns 11 to 14 above) to total deaths from Tuberculosis was 21 to 101 or 1 to 4.8. Appropriate action was taken, when necessary, with regard to non-notification. The table given below shows the number of cases on the Register at the beginning and end of 1932:— Pulmonary. Total. NonPulmonary. Total. Grand Total. No. on Register M. F. M. F. 1st January 938 838 1,776 466 450 916 2,692 Notified during 1932 82 70 152 21 13 34 186 Total 1,020 908 1,928 487 463 950 2,878 Removed from Register, 1932 81 59 140 16 14 30 170 No. on Register 31st December 939 849 1,788 471 449 920 2,708 80 The 170 removals from the Register were made up as follows:— Deaths. Removals. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. 51 29 6 5 30 30 10 9 80 11 60 19 91 79 170 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 1932 were:— Pulmonary. Non-Pulmonary. Total. M. F. M. F. Adults 63 30 7 1 101 Children 3 4 10 6 23 No action was necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or Section 62 of the Public Health Act, 1925. G.—INFECTIOUS DISEASES HOSPITAL. The accommodation at the Isolation Hospital was increased during 1932 by a total of 14 beds. Six of these were provided in the playroom attached to "F" Ward which had previously been used for maids' sleeping quarters and 8 were provided in the small "E" block previously used for night nurses' sleeping quarters. The accommodation became available on the completion of the extension of the Administrative Block which provided the following accommodation directly or indirectly—34 single bedrooms, 8 bathrooms, 3 dining rooms (Matron, Nursing Stall and Domestic Stafi), lecture room, linen store, sewing room, store room, Office, Matron's office, waiting room and telephone exchange with extensions to each ward block. "E" block provides two small wards of 4 beds each and a duty room between. It has already proved invaluable for accommodating excess cases of either Diphtheria or Scarlet Fever as need arose, or 81 cases of dual infection. In the future it is intended to use it for similar purposes or for the admission of complicated cases of Measles and Whooping Cough as required. The total accommodation at the end of 1932 was 64 beds for Scarlet Fever, 56 beds for Diphtheria, 24 Cubicle beds (12 cubicles), 20 beds for Tuberculosis, Mixed, 10, Total 174. Staffing.—Comparing the nursing stafi at the end of 1932 with that at the end of 1930 there was a nett increase of two Staff Nurses and one Probationer. This additional staff has enabled the working hours of the night staff to be reduced to 52 hours. The hours worked by the day staff at the end of 1932 were Sisters, 54 hours; Staff Nurses and Probationers, 56 hours. A female telephone operator and assistant to the storekeeper was appointed towards the end of the year. The ratio of Nurses to total patient beds was 1 to 5.8 and of domestics to total patient beds was 1 to 9.7. General.—The Essex County Council have announced a scheme under Section 63 of the Local Government Act, 1929, for a Joint Hospital Board to provide a Hospital of 261 beds for the Boroughs of Walthamstow and Leyton on the site of and including your Council's present Hospital. Your Council have re-affirmed their opposition to the proposal. The agreement with the Epping Urban District Council was renewed subject to 6 months' notice of termination on either side. During the year a total of eleven "relapses" or second attacks of Scarlet Fever occurred in patients originally admitted with this disease. The majority occurred, as expected, in the autumn when the wards were full. There is no known method of avoiding this complication unless cases can be nursed in separate cubicles. At certain periods of the year when pressure on the Diphtheria beds became heavy, virulence tests were resorted to in all cases which, on admission, showed only non-clinical or "bacteriological" Diphtheria. In addition, virulence tests were done in most cases which gave persistently positive swabs after about 6 weeks. Thus a total of 90 virulence tests were done during the year for patients in the Hospital and a further 15 for patients attending the Infectious Disease Clinic. Of the 105 swabs taken for virulence tests in 1932, 6 gave no growth. The remaining 99 showed only 12 to have been fully virulent although the great majority had been taken from patients 82 admitted to the Isolation Hospital for Diphtheria. The proportion of virulent swabs appears to be surprisingly low and, when time permits, it is hoped to correlate the swab results with the clinical condition of the patients on admission to Hospital. The ward of 14 beds in the convalescent Diphtheria block was used between January 30th and April 15th for the reception of complicated cases of Measles. The accommodation proved to be insufficient and cases had to be refused. The death rate per hundred admissions of infectious disease cases created a new low record during 1932, viz., 0.9. For comparison a summary of the figures for previous years is tabulated below:— Year. Cases Admitted (Infectious Disease). Deaths (Infectious Disease). Death Rate per cent, admitted. 1932 781 7 0.9 1931 719 15 2.1 1930 914 24 2.6 1929 784 15 1.9 1928 763 10 1.3 1927 738 14 1.9 1926 614 9 1.5 1925 480 6 1.25 1924 429 10 2.3 1923 453 7 1.5 1922 673 25 3.7 1921 817 13 1.6 1920 612 17 2.8 1919 484 15 3.1 1918 283 14 4.9 1917 399 17 4.3 1916 526 17 3.2 1915 426 13 3.0 1914 519 20 3.9 1913 599 12 2.0 1912 411 16 3.9 1911 307 28 9.1 1910 305 15 4.9 1909 528 16 3.0 1908 592 22 3.7 1907 602 34 5.6 1906 546 46 8.4 1905 437 27 6.2 1904 336 25 7.4 1903 258 19 7.4 1902 226 16 7.1 1901 210 3 1.4 (291 days) 83 Financial Statement.—A financial statement for the year ending 31st March, 1932, is given below:— Loan Charges. £ s. d. Amount of Loan outstanding on 31st March, 1931 12,194 0 0 Expenditure. Repayment of Loan 424 0 0 Interest on Loan 387 0 0 Structural Repairs 769 0 0 Food for Patients and Staff 4,487 0 0 Establishment and other Expenses 11,216 0 0 £17,283 0 0 Income. Patients 914 0 0 County Council grant 455 0 0 ,, ,, for Tuberculosis patients 2,600 0 0 Other sources 116 0 0 £4,085 0 0 The statistics given include fees for cases from other Authorities. In each case there is a loss on maintenance under the scales of the agreements in operation. The following table shows the admissions, discharges and deaths during 1932:— Scarlet Fever. Diphtheria. Measles. Other Diseases. Tuberculosis. Totals. Remaining in Hospital 1st January 56 24 - - 20 100 Admitted during year 392 353 28 8 48 829 Discharged during year 377 332 26 2 48 785 Died during year 2 3 2 — 2 9 Remaining in Hospital 31st December 69 42 — 6 18 135 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL, (including Tuberculosis cases.) January 92.9 July 62.0 February 80.6 August 56.9 March 111.5 September 84.8 April 113.5 October 134.0 May 112.6 November 141.3 June 74.8 December 141.5 Average whole year 85.7 84 Dr. Hamilton, Resident Medical Officer, reports as follows:— AGE AND SEX OF PATIENTS ADMITTED DURING 1932. Disease. 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 70 37 82 65 36 31 6 26 194 159 353 Scarlet Fever 59 52 65 94 32 36 22 32 178 214 392 Measles 11 10 2 5 — — — — 13 15 28 Dysentery 1 2 1 2 — 1 — — 2 5 7 Whooping Cough — — I — — — — — 1 — 1 Pulmonary Tuberculosis - - - - - - - 48 — 48 48 Totals 141 101 151 166 68 68 28 106 388 441 829 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 1 - - 1 - 1 — - 1 2 3 Broncho-Pneumonia and Measles 2 - - - - - - - 2 - 2 Acute gastro-enteritis and Scarlet Fever - 1 - - - - - - - 1 1 Scarlet Fever - - - - - - - - - 1 1 Pulmonary Tuberculosis - - - - - - - 2 — 2 2 Totals 3 1 — 2 — 1 — 2 3 6 9 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 5 6 3 6 5 3 — 3 13 18 31 February 8 4 6 7 6 2 — 3 20 16 36 March 8 4 8 4 2 4 — 1 18 13 31 April 11 9 9 5 1 2 2 5 23 21 44 May 2 2 3 3 2 2 — 4 7 11 18 June 6 2 2 4 3 — - 1 11 7 18 July 6 — 4 3 1 — — 1 11 4 15 August 5 — 4 3 1 4 — 1 10 8 18 September 6 4 13 9 4 6 2 1 25 20 45 October 5 - 15 2 3 3 1 3 2 4 8 32 November 4 3 11 12 2 2 1 1 18 18 36 December 4 3 4 7 6 3 — 2 14 15 29 Totals 70 37 82 65 36 31 6 26 194 159 353 85 Complications.—During the year cases of Diphtheria tended to run uncomplicated courses. Three very severe cases which developed late Cardiac Paralysis recovered. Three cases of Ocular Paralysis were noticed. One case of Paralysis of Accommodation. The symptoms being entirely subjective, this can only be diagnosed in older children. Probably the one case noted is not an accurate reflection of its incidence. Two cases of Palatal Paralysis occurred. One case of very severe serum sickness was observed in a child who had had serum on two previous occasions. One case in which severe Marasmus complicated the Diphtheria made a good recovery. Diphtheria Cases transferred to Cubicle Block.—From Acute Diphtheria Ward—Diphtheria and concurrent Scarlet Fever, 6; Diphtheria and Scarlatinal desquamation, 3; Diphtheria and Morbilli, 1; Diphtheria and Varicella, 1; Diphtheria in contact with Varicella, 1; Diphtheria and Pertussis, 2; For observation, 4; Tonsillitis, 1; Total, 19. From Convalescent Diphtheria Block—Diphtheria and Scarlet Fever, 6; Diphtheria and Measles, 3; Diphtheria, Measles and Impetigo, 1; Diphtheria, Measles and Broncho-Pneumonia, 1; Diphtheria and Diarrhoea, 1; Tonsillitis, 1; For Tonsillectomy, 1; Total, 14. 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 4 4 2 — 5 3 14 10 24 February 4 7 7 3 — 3 3 4 14 17 31 March 4 2 5 5 3 1 2 2 14 10 24 April 4 5 6 11 2 6 3 2 15 24 39 May 3 5 3 6 1 1 1 7 8 19 27 June 4 — 3 6 3 1 2 1 12 8 20 July 6 3 1 10 1 3 — 2 8 18 26 August 5 2 4 2 1 3 1 1 11 8 19 September 9 3 7 9 3 5 1 1 20 18 38 October 6 3 9 12 7 4 1 4 23 23 46 November 4 7 12 16 4 2 1 2 21 27 48 December 7 12 4 10 5 7 2 3 18 32 50 Totals 59 52 65 94 32 36 22 32 178 214 392 Complications.—One patient notified as Scarlet Fever developed Measles six days after admission to Hospital. Both diseases were of a severe form and were later complicated by a panophthalmia which necessitated the enucleation of the eye. This operation was performed at the Western Ophthalmic Hospital. One patient developed a concurrent ophthalmoplegia and otorrhoea of the same side. This patient was removed to Whipps Cross Hospital. 86 Three very severe cases of Scarlatina Anginosa were admitted. All three made good recoveries. One case notified as Scarlet Fever proved to be a case of food rash. One patient developed acute mastoiditis and was operated on by Dr. Friel. Some degree of cervical adenitis was present in practically all cases. Suppurative rhinitis 18 (Diphtheritic, 14; Streptococcal 4). One case of Scabies occurring in a patient with Scarlet Fever proved so intractable that it was sent to Whipps Cross Hospital. One patient developed tubercular dactylitis. One case of Phthisis was admitted from Black Notley Sanatorium. The phthisical condition was not aggravated by the attack of Scarlet Fever. Scarlet Fever cases transferred to Cubicle Block.—From Acute Scarlet Fever Block—Scarlet Fever with K.L.B. infections, 23; Scarlet Fever with Morbilli,7; Scarlet Fever in contact with Morbilli,l; Scarlet Fever in contact with Tubercular Diathesis,1; Scarlatina Anginosa,2; Scarlet Fever and Tubercular Dactylitis, 1; Scarlet Fever with vaginal discharge,1; Scarlet Fever with Asthma,1; Scarlet Fever with Pertussis,2; Scarlet Fever in contact with Diphtheria,1; Scarlet Fever (uncomplicated), 4; Notified as Scarlet Fever and proving to be Rubella,1; Notified as Scarlet Fever and proving to be food poisoning,1; Notified as Scarlet Fever, atypical,2; Scarlet Fever with Otitis Media, 3; For Tonsillectomy,3; Total, 51. From Convalescent Scarlet Fever Block—Relapse of Scarlet Fever,1; Scabies,1; Abortive Appendicitis, 1; Total,3. Scarlet Fever complicated by the presence of K.L.B.— During the last three months of the year 1932, all cases of Scarlet Fever were swabbed on admission to hospital with a view to ascertaining whether the patient harboured K.L.B. or not. During the month of November 75 per cent, of such cases were found to give positive results. As it was impossible to segregate these patients, an alternative method of injecting each patient with anti-diphtheritic serum has been adopted and is now in use. The majority of the patients who harboured K.L.B. were found to be of the carrier type and the organism non-virulent. There is as yet no rational approach to the problem of the diphtheria carrier and it is pre-eminently the nasal carrier who 87 gives rise to this difficulty. The organism would appear to be very wide-spread in an avirulent form among the general public. Staff.—Members of the Staff were admitted to hospital beds suffering from the following complaints:—Pleurisy, 1; Quinsy, 1; Tonsillitis, 1; Mumps, 1; Scarlet Fever, 3; Diphtheria, 1; Rubella, 1. Operations at Hospital.—Tonsillectomy, 5; Cauterisation of Corneal Ulcer, 1; Wilde's operation, 2; Schwartz's operation, 1; Paracentesis of drum, 1. Specialist Consultants were called in on 18 occasions, viz. :— Otologist, 9; Ophthalmologist, 5; Surgeon, 1; Physician, 1; Orthopaedic Surgeon, 2. Swabs.—3,457 swabs were taken and examined during the year in the laboratory at the Hospital. Number of Outside Authorities' Cases and Nature.— Diphtheria. Scarlet Fever. Total. From Whipps Cross Hospital 11 7 18 From Epping U. D. C. 5 15 20 From Loughton U. D. C. 14 2 16 Total 30 24 54 Transfers to Other Hospitals.—Patients were transferred on account of the following conditions:—Mastoiditis, 3; Heart Disease, 3 ; Chronic Abscesses, 2 ; for resumption of previous treatment, 2 ; enucleation of eye, 1; cerebral abscess, 1; Scabies, 1; Total, 13. The Hospitals to which patients were transferred were as follows:—Whipps Cross Hospital, 10; Connaught Hospital, 2; Western Ophthalmic Hospital, 1. Duration of Treatment.—The average duration of treatment in Hospital was as follows:— Diphtheria 37.9 days. Scarlet Fever 35.5 days. Measles 28.7 days. Dysentery 23.7 days. Mixed Infections 37.8 days. 88 The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1932:— Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.). In Hospital on 1st January, 1932. Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1932. T.B. Minus - 3 1 - 2 T.B. Plus Group I 1 4 4 — 1 T.B. Plus Group II 18 40 40 2 16 T.B. Plus Group III 1 1 2 - - Totals 20 48 47 2 19 Only 12 of the 48 admissions were Walthamstow cases. MEDICAL EXAMINATIONS. During the year 26 examinations were carried out by the Medical Staff in respect of the Superannuation Scheme and 47 in respect of the Sick Pay Scheme. MISCELLANEOUS. Your Council made the following grants during the year to voluntary organisations:— Invalid Children's Aid Association £100 Walthamstow Association of Tuberculosis Care Helpers £25 CREMATION. Facilities for cremation are available at the Crematorium provided by the Corporation of the City of London, at Manor Park, Little Ilford. Full particulars can be obtained from the Superintendent, City of London Cemetery, Little Ilford. MATERNITY AND CHILD WELFARE. 90 SECTION H. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs. E. M. Richards. Ex-Officio: His Worship The Mayor—Alderman T. W. Smith, J. P. The Deputy Mayor—Councillor B. Cole. Councillor E. C. Redhead—Chairman—Finance Committee Alderman G. Gibbons, J. P. Councillor F. J. Jeanes. ,, J. C. Hammond. ,, Mrs. A. L. ,, Mrs. C. McEntee, Meadot J.P. ,, Mrs. E. M. ,, Mrs. M. Norrish. Miller. Councillor Mrs. L. P. Bailey. ,, G. M. Page. ,, Mrs. B. M. ,, W. J. Poynter Friedberg. ,, R. E. Smith. ,, Mrs. E. M. Hammond. ,, G. H. Spackman ,, Miss B. A. Hen- ,, T. H. Tee. derson. 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. 91 STAFF. Medical Officer of Health and Administrative Maternity and Child Welfare Officer. A. T. W. Powell, M.C., M.B., B.S. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (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., F.C.O.G. Mr. W. McKim McCullagh, d.s.o., m.c., F.R.C.S., M.C.O.G. 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. (Half-time). Miss M. Page, S.R.N., C.M.B., H.V. Cert. Miss 0. J. Panther, Cert. S.I.E.B. (Lond.) (Half-time). Miss M. A. Young, S.R.N., C.M.B., H.V. Cert. (Half-time). Masseuse (Part-time): Miss Kathleen M. Hill, C.S.M.M.G. Record Clerk: Miss E. Ogilvie. 92 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen, I beg to present a report on the Maternity and Child Welfare Service during 1932. No expansion of service was undertaken but the new Clinics begun in 1931 operated over the whole of 1932 with the result that there was a very large increase in the number of Clinic attendances. In spite of the additional Clinics the number of home visits remained about the same. During the year a commencement was made with the combined nursing service. I wish to record the continued support of your Committee, the excellent work of the voluntary helpers at the clinics and the good work of the Staff. I have the honour to be, Your obedient servant, A. T. W. POWELL, Medical Officer of Health, etc. 93 1. NOTIFICATION OF BIRTHS. One thousand six hundred and fifty births (55 of which took place outside the area) were notified during the year under the Notification of Births Acts, 1907 and 1915, as follows:— Doctors, 1,005. Midwives, 633. Parents, etc., 12. Included in the above are 463 births which were notified as having occurred outside the Borough. Also included are 73 stillbirths, 1 of which did not belong to the area. Forty-five were notified by Doctors and 28 by Midwives. Of the total, 36 occurred outside the area. The stillbirth rate per 1,000 population was higher than for 1931, viz., 0.60 against 0.43. 2. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Males. Females. Totals. Legitimate 889 859 1,748 Illegitimate 20 21 41 Total 909 880 1,789 (b) Stillbirths. Legitimate Males. 37 Females. 41 Totals. 78 Illegitimate 2 2 4 Total 39 43 82 Of 1,406 birth registrations received in the Department between 2nd January 1932, and 31st December, 1932, a total of 253 were not notified in this area, but some may possibly have been notified elsewhere, especially in view of the fact that of the 1,406 registrations 91 referred to births which belonged to other areas. In addition it will be seen that the Registrar-General's figure (1,789) is 383 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. 94 Of the 1,406 local registrations 91 are excluded, leaving a nett total of 1,315, which are allocated to wards as follows:- Births Registered Locally, 1932. 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 7 5 3 4 3 4 1 5 11 9 7 36 32 68 February 12 7 4 5 5 8 8 4 5 9 9 10 43 43 86 March 17 8 9 12 9 6 12 7 7 22 19 14 73 69 142 April 9 11 9 7 12 11 5 11 5 8 20 9 60 57 117 May 12 10 6 2 11 10 8 6 9 8 18 15 64 51 115 June 12 9 8 10 9 5 12 5 14 11 12 10 67 50 117 July 11 13 6 13 10 14 9 7 16 14 16 9 68 70 138 August 5 11 7 13 11 8 10 8 13 13 14 8 60 61 121 September 4 5 6 11 7 10 7 5 13 9 9 11 46 51 97 October 6 7 5 — 11 6 4 2 4 13 15 11 45 39 84 November 10 10 15 13 8 16 7 10 11 12 22 12 73 73 146 December 5 2 6 7 5 11 7 4 10 9 7 12 39 45 84 Totals 112 100 85 96 102 108 93 70 112 139 170 128 674 641 1,315 Grand Totals 212 181 210 163 251 298 1,315 The local registrations for 1932 were 234 less than in 1931. 95 3. INFANT MORTALITY. The deaths of infants under one year of age were:— Males. Females. Total. Legitimate 57 41 98 Illegitimate 4 1 5 Total - - - 61 42 103 The death-rates of infants under one year of age per 1,000 live births when calculated on the totals given by the Registrar-General are therefore:— Legitimate, 56. Illegitimate, 122. Total, 57. The Infant Mortality Rate for other areas during 1932 was as follows:— England and Wales 65 118 County Boroughs and Great Towns 69 126 Smaller Towns 58 London 66 The following table shows the causes of death of children under one year of age during 1932:— 96 SUMMARY 1932 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 Influenza - - - - - - - - - - - - - — - - Smallpox - - - - - - - - - - - - - - - - Chickenpox - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - Whooping Cough - — — — — 1 — — 1 2 - - 1 - - 1 Diphtheria and Croup - - - - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - 1 - - 1 - - 1 - - - Abdominal Tuberculosis (b) - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - 2 - - 2 1 - 1 - - Phthisis - - - - - - - 1 - 1 - - - - - - Meningitis (not Tuberculous) - 1 — - 1 — 2 - - 3 - - 1 - 1 1 Convulsions 2 1 1 1 5 — — - 1 6 - - 2 1 2 1 Laryngitis — - — - — — — - - —- - - - - - - Bronchitis - — — 1 1 — — - - 1 1 - - - - - Pneumonia (all forms) 2 — 1 2 5 4 5 2 2 18 4 3 2 5 1 3 Diarrhoea — - — — — 1 — — — 1 - - - 1 - - Enteritis — 1 — — 1 1 2 — 1 5 2 - 2 1 - - Gastritis — 1 1 1 3 1 2 2 — 8 — — 3 - 3 2 Syphilis 2 - — — 2 — — — — 2 1 - - - - 1 Rickets - - - - - - - - - - - - - - - - Inattention at Birth, wilful neglect - - - - - - - - - - - - - - - - Suffocation, overlaying — - — — — — — 1 — 1 — - - - 1 - Injury at Birth 1 1 — — 2 — — — — 2 — - 2 - - - Atelectasis 3 1 1 — 5 — — — — 5 — 1 - 1 - 3 Congenital Malformations 1 - 1 2 4 4 — — — 8 — 1 1 - 2 4 Premature Birth 16 1 — — 17 — — — — 17 6 1 2 1 5 2 Atrophy Debility and Marasmus — - 1 1 2 1 2 1 1 7 1 2 1 3 - - Inanition 1 1 — — 2 — 1 — — 3 1 — — — 2 Heart Failure 3 - — — 3 — 1 2 — 6 — 2 2 1 - 1 Other Causes — 1 1 — 2 1 1 — — 4 1 1 1 1 - - Totals 31 9 7 8 55 14 19 9 6 103 17 13 21 16 15 21 97 The death-rate from Diarrhoea and Enteritis per 1,000 live births was 8.3. 4. CHILD WELFARE. The general arrangements for Child Welfare were fully detailed in the 1930 Report. (a) Municipal Scheme.—Your Council 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. The Woodford Urban District Council gave 3 months' notice, with effect from 22nd February, 1933, to terminate the existing agreement. In order to cope with the visits necessitated by the development of this part of your Borough and with the expansion of services your Council have recently sanctioned the appointment of an additional Health Visitor. Dr. R. A. Vere Hodge, Medical Officer Health, kindly states that the Woodford Nurse paid the following visits during 1932:— Children under 1 year—first visits, 30; subsequent visits, 233; total, 263. Children 1 to 5 years, 296. Total, 559. The system of visiting followed was detailed in the 1931 Report. Following the resignation of one of the School Nurses in July, opportunity occurred to put into operation the previously determined policy to combine the Health Visiting and School Nursing Staffs. The Education Authority, therefore, advertised for a School Nurse with Health Visitor's qualifications and after appointment this Nurse gave half time to both School and Welfare duties. In order to equalise the allocation of time to both duties one of the existing Health Visitors was detailed to give half time to School duties. The two nurses now divide the Higham Hill ward between them and carry out all home visits both for school and pre-school children and infants. In addition to the smaller areas covered by each nurse, duplication of visits to the same household by separate nurses is avoided and additional qualified staff is available to assist at the Welfare Centres. The full benefit of this policy will not be felt until a completely unified nursing staff is obtained. The equivalent of whole time Health Visiting Staff remains at 5.5, equal to one whole time Health Visitor per 300 notified births and one per 340 registered births during 1932. 98 Circular 1167 and Memorandum 156—M.C.W.—The following extensions of the Maternity and Child Welfare services were sanctioned by your Council during the year 1931 and were in full operation during 1932:— 1. Weekly Infant Welfare sessions at Higham Hill and Highams Park with massage facilities at the former. 2. Appointment of an additional Health Visitor. 3. 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. 4. 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. 5. Provision of a panel of Consulting Obstetricians to act in cases of difficulty during pregnancy, labour, or the puerperium. 6. The provision of a monthly consultative Ante-Natal Clinic (provided under the Public Health Act). 7. 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 erection of the Maternity Home was begun in February, 1933. The detailed findings at first visits paid during 1932 are given in the following table:— From the above table it will be seen that of 1,807 children, 1,484, or 82.1 per cent., were breast fed on first being visited, but 280, or 15.5 per cent, had no separate sleeping accommodation. The particulars in respect of Housing accommodation show that only 609 of the families visited had a house to themselves, while 72 families were living in one room. The 1931 figures were 583 and 72 respectively. There has been a progressive decline in the number of families living in one room, the 1930 total being 168. 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. 1 Half-house. 3 Rooms. 2 Rooms. 1 Room. St. James Street 251 11 32 3 32 8 74 220 272 22 — 62 51 22 84 59 16 High Street 184 9 18 8 12 7 23 188 180 30 1 28 69 88 6 17 3 Hoe Street 228 19 32 22 15 14 62 217 248 29 2 59 16 143 6 45 10 Wood Street 176 16 36 22 22 8 35 193 201 21 6 58 8 87 — 59 16 Hale End 310 29 50 22 39 18 27 362 320 64 5 197 20 64 55 44 9 Higham Hill 335 11 60 23 34 14 59 347 344 52 10 205 75 76 13 19 18 Total 1,484 95 228 100 154 69 280 1,527 1,565 218 24 609 239 480 164 243 72 99 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. Other Visits. Total Vis its. First Visits. Subsequent Visits. Total Visits. First. Re-visits. Total. 1 Not at home. Dead. Removed. 1 2 3 4 5 6 7 8 9 10 11 12 Cols. 5-12. St James Street 294 550 844 1,041 1,885 228 11 184 63 302 55 12 67 145 2,885 High Street 211 346 557 921 1,478 223 9 76 158 110 28 — 28 82 2,164 Hoe Street 279 314 623 746 1 ,369 229 17 125 79 175 29 5 34 57 2,085 Wood Street . 228 418 646 1,053 1,699 184 6 83 62 417 34 — 34 19 2,504 Hale End 389 740 1,129 1,356 2,485 223 13 130 165 223 38 22 60 35 3,334 Higham Hill 406 475 881 1,199 2,080 343 24 107 281 513 43 13 66 281 3,685 Total 1932 1,807 2,873 4,680 6,316 10,996 1,430 80 705 808 1,740 227 52 279 619 16,657 Total 1931 1,939 2,769 4,708 5,322 10,030 1,503 48 710 833 931 180 33 213 87 14,355 100 Visits to children increased from 10,030 in 1931 to 10,996 in 1932 while the visits increased from 14,355 to 16,657. The 1,807 first visits compared with a total of 1,789 registrations of births. 101 CLINICS. Dr. Sheppard reports as follows:— “The work of the Maternity and Child Welfare Clinics continues to progress and in spite of the extra Welfares at St. Andrew's Road and Hale End there is, at present, no diminution in the numbers attending Low Hall Lane. The Hale End and St. Andrew's Road Centres, however, are flourishing as can be seen by the numbers attending and even higher numbers are expected in future owing to the migration to the new Council houses from the St. James' Street and High Street wards. "The Voluntary workers continue to render your Council faithful service which is much appreciated by the Staff. "The results from the Massage Department are very gratifying. Miss Hill attends four times weekly including one weekly attendance at St. Andrews Road. "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 767 109 876 11829 9603 21432 22308 Higham Hill 179 83 262 1902 1585 3487 3749 Highams Park 178 59 237 2338 1298 3636 3873 Total 1932 1124 251 1375 16069 12486 28555 29930 1931 868 275 1143 11632 9549 21181 22324 "The large increase in total attendances is due to the fact that the Higham Hill and Highams Park Centres were in operation for the whole year. "Ante-Natal.—The Ante-Natal Clinic is held each Monday at Low Hall Lane. 378 new cases attended, and these made 1,214 attendances, or an average attendance of 24.3 per session as against 21.8 in 1931 and 15.7 in 1930. 102 "The numbers attending the Ante-Natal Centre and the numbers sent by Midwives and Doctors continued to increase during 1932. "Twenty-six sterilised accouchement outfits were supplied during 1932 at cost price. “Massage.—136 new cases attended for massage and these made 1,568 attendances. "Part I, Children Act, 1908.—At the end of 1932 there were 134 nurse children on the Register as compared with 143 at the end of 1931 and 139 in 1930. During the year 81 removed, 4 were adopted and 13 reached the age of 7 years and consequently ceased to come under the Act. 89 new babies were registered. There were no deaths among nurse children during 1932. "One hundred and nine foster parents were registered at the beginning of the year and 114 at the end." Sale of Milk, etc., at Clinics.—The quantity and value of Milk and Foods sold and issued free during 1932, was as follows:— Sales. Value. Free Issue. £ s. d. Virol 1,469 lbs 150 12 10 20 lbs. Prune and Banana Syrup 108 lbs. 9 ozs 14 9 6 — Parrish's Food 291 lbs. 5 ozs 14 11 4 — Malted Honey 3 lbs 0 2 6 — Maltoline 50 lbs 3 6 8 — Cod Liver Oil 123 lbs 8 3 4 8 ozs. Cod Liver Oil Emulsion 547 lbs. 3 ozs. 36 6 11 2 lbs. Glaxo and Ambrosia 487 lbs 38 5 0 28 lbs. Virol Containers 2,298 9 11 3 3 Ostermilk 630 lbs 41 11 8 131 lbs. Almata 433 lbs 46 3 0 7 lbs. Roboline 846 lbs 52 14 6 143 lbs. Cod Liver Oil and Malt Extract 396 lbs 15 6 0 2 lbs. Cow and Gate 10,744 lbs. 778 9 4 1,078 lbs. Lacta and Lactogen 55 lbs. 2 1 8 30 lbs. Dunne's Milk 14 lbs 1 1 0 — Hemolac 157 lbs 14 7 10 — £1,227 4 4 5. TREATMENT. (a) Orthopaedic.—The facilities provided by the Education Authority's Orthopaedic Scheme is available for all children attending the Welfare Centres. 103 Miss Theobald has kindly furnished the following information with respect to children under five years of age:— Defects seen at Orthopaedic Clinic in Children under Five Years of Age. Anterior Polio-myelitis 1 Knock Knee and Bow Leg 17 Rickets 57 Spinal Curvature 6 Congenital Dislocation of Hip 1 Congenital Defects 2 Fracture 1 Foot Deformities 20 Miscellaneous 9 Wryneck 3 Paralysis 5 Total 122 Cases discharged by Surgeon 12 The number of new cases in which these defects occurred was 67, whereas the number of new cases over 5 years of age referred by the School Medical Service was 61. In other words, more than half the cases were found before entering school, which in itself, is a tribute to the ascertainment of orthopaedic defects at the Welfare Centres. Admissions to Brookfield Orthopaedic Hospital (under 5 years of age). Number of admissions, 15 Number of discharges, 14 Talipes 2 Rickets 7 Torticollis 1 Anterior Poliomyelitis 1 Spastic Diplegia 1 Congenital Deformities 2 Epiphysitis 1 Total 15 Number and Classification of Operations at Brookfield Hospital (under 5 Years of Age). (Including Cases remaining over from 1931.) Osteoclasis 10 Tenotomies 2 Manipulations 2 Osteotomies 4 Total 18 (b) Dental.—The following work was done by the Education Committee's Dental Surgeons:— Mothers. Children under 5. Cases treated 55 207 Attendances 60 248 Fillings 15 128 Extractions 122 319 General Anaesthetics 48 156 Local ,, 1 3 Scalings 6 1 Dressings 40 104 Mrs. W. R. Thorne, L.D.S., reports as follows:— "The number of dental cases referred from the Welfare Centres to the clinic has been small and there are too few from which to form any opinion of the dental condition of nursing and pregnant mothers to which two classes of treatment are confined. "Only by inspection of the whole group attending the Welfare Centres could any findings relative to dental disease and general health be arrived at. The few who find their way to the clinic come usually as sufferers and with marked oral sepsis. If these cases be typical there is urgent need for more treatment. “Mothers rarely desire any treatment other than extraction and anticipate artificial dentures as being very desirable and the cure for all dental and many other troubles. "Prophylactic treatment is not valued and advice on oral hygiene rarely intelligently followed. Every mother is given the opportunity of having complete treatment. The need for treatment of the mother is greater than that of the toddler, who automatically comes under routine inspection at school age. “If there is to be any benefit to the coming race from dental treatment of the mother, that treatment should be accorded to the potential mother and not shelved until pregnancy or even later until lactation." (c) Tonsils and Adenoids.—Ten cases were operated on under the arrangement made by the Education Committee with the Walthamstow Dispensary and two 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 and 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—6 p. m. Infant Consultations. 105 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. 1932 388 124 512 5112 4625 9737 10249 1931 455 111 566 5270 4535 9805 10371 Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1932 346 907 1253 2537 3790 1931 409 1093 1502 2146 3648 Attendances at Lectures. Massage Treatments. Sunlight Treatments. Total cases admitted to Observation Ward. Local Authority's cases admitted to Observation Ward. 1932 951 2173 2274 30 1 1931 1420 1650 2080 28 2 No Ante-Natal work is carried out by the Society and no dried foods are supplied at the Clinics. Your Council, under the scheme approved by the Ministry of Health, make an annual grant of £644 1s. 8d. towards the funds of the Society. Summary.—The following tables give the total number of attendances at Clinics and home visits:— 106 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 1124 251 1375 16069 12486 28555 29930 Voluntary Scheme 388 124 512 5112 4625 9737 10249 Total 1932 1512 375 1887 21181 17111 38292 40179 1931 1323 386 1709 16902 14084 30986 32695 Home Visits. To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Municipal Scheme 1807 2873 4680 6316 10996 Voluntary Scheme 346 907 1253 2537 3790 Total 1932 2153 3780 5933 8853 14786 1931 2370 4041 6411 7522 13933 In addition, 559 visits were paid by Woodford U.D.C. Health Visitor. Average attendance of children per session at all Centres during year 1932 97.5 1931 117.5 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) 1932 95.8 1931 74.6 The percentages are unduly high because of the number of births not notified. Percentage of total notified births represented by number of expectant mothers attending Ante-Natal Clinics 1932 22.9 1931 16.5 107 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 Centres, 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 1932:— Number of applications during 1932 4,709 Number of families assisted 922 Scale. Amount. Appoximate cost to Authority. £ s. d. Free 355 pints 4 8 9 |d. per pint 106,796 ,, 1,112 9 2 Id. ,, 42,103 ,, 350 17 2 2d. ,, ,, 56 ,, 0 4 8 Half-cost 8,029 ,, 50 3 7 Total 157,339 „ £1,518 3 4 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 12 Home Helps approved during 1932, 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 15 children were sent to Institutions under arrangements approved by your Committee. The details were as follows:— Brookfield Orthopaedic Hospital, 7; Lennox Home, 3; Benhilton Babies' Home, 2; Brookscroft, 1; Susan Fairlie Home, 1; Cheyne Hospital, 1. 108 9. HOSPITAL ACCOMMODATION FOR CONFINEMENTS. The following numbers of confinements occurred at the Institutions specified:— Mothers' Hospital, Clapton 208 Nursing Homes in Walthamstow 153 Forest Gate Hospital 96 Queen Mary's Hospital 30 Total 487 Of the 153 confinements in Walthamstow Nursing Homes, 96 resided in the area and 57 outside the area. There are five Nursing Homes in the Borough with a total maximum accommodation of 29 beds for maternity cases. 10. WALTHAMSTOW DISTRICT NURSING ASSOCIATION. The Association has continued its successful work during 1932. At the end of the year the Staff consisted of six State Registered Nurses holding the Certificate of the Central Midwives Board, and one Maternity Nurse. The Nursing Home was registered for 11 maternity beds at the end of the year and in order to allow this expansion from the 4 beds provided in 1931 and to accommodate the additional staff, additional premises were acquired at No. 17, Carisbrooke Road. Sister Ross reports that during 1932, 163 District midwifery cases were attended, and 57 District maternity cases. Fifty-six patients were confined in the Home as midwives' cases and a further 10 as Doctors' cases. 646 general nursing cases were dealt with on the District, involving 6,071 visits. Your Council continued to pay a retaining fee of ten guineas per annum for the services of a Nurse in cases of Puerperal Fever and Pyrexia or in case of emergency midwifery. In addition, tramway discount tickets to the value of £10 16s. were provided during the year. 11. CONSULTANT OBSTETRICIAN. During 1932 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. Consultants' services were provided on six occasions. 109 12. MIDWIVES ACTS, 1902—1926. Early in 1932 your Committee decided that no recovery of fees was to be made in respect of Pemphigus Neonatorum. 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 and Maternal Mortality, have been made by your Medical Officer of Health. There were 18 midwives in active practice on the 31st December, 1932. The following table shows the work done by the midwives during 1932:— No. of confinements attended as a midwife 590 ,, confinements attended as a maternity nurse 159 ,, Medical Aid Notices sent 112 ,, Notifications of Deaths 6 ,, Twin Births 9 ,, Stillbirths 9 ,, Notifications of liability to be a source of infection 6 ;, Notifications of laying out a dead body 3 ,, Notifications of Artificial Feeding 5 During 1931, 648 cases were attended as Midwives and 136 as Maternity Nurses. The conditions for which Medical Aid was summoned by Midwives has been summarised and were as follows:— Pregnancy:— Labour:— Excessive Sickness 1 Malpresentation 8 Congested Labia 1 Adherent Placenta 5 Threatened Miscarriage 1 Prolonged or Difficult Miscarriage 3 Labour 21 Small Measurements 1 Post-partum rhage Ante-partum Haemorrhage 4 5 Threatened Eclampsia 1 Ruptured Perineum 19 Fainting and Debility 1 Total 58 Total 13 110 Puerperium:— Infant:— Pain 4 Prematurity and Oedema 1 Feebleness 11 Rash 1 Stillbirth 3 Collapse 1 Death 2 Fainting 1 Bronchitis 1 Pyrexia 1 Enteritis 1 Asthma 1 Discharge from Eyes 10 Jaundice 1 Total 10 Congenital malities 2 Total 31 Nursing Homes Registration Act, 1927.—See Public Health Section of the Report. 13. PUERPERAL FEVER AND PYREXIA. The following tables give details of the 26 cases of Puerperal Fever and Pyrexia during 1932 by ages, wards and months:— Month. All ages. 15-25 yrs. 25-45 yrs. January 2 — 2 February 3 — 3 March 3 1 2 April 4 - 4 May — — — June 1 — 1 July 4 1 3 August 2 - 2 September - — — October 2 1 1 November — — — December 5 1 4 Total 26 4 22 Ill Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Removed to Hospital. January - - - 1 1 - 2 February 2 — — — 1 — 2 March — — — 1 2 — 3 April 1 1 — — 1 1 4 May — — — — — — — June — — 1 — — — 1 July — 1 1 — — 2 4 August — — — 1 — 1 2 September October — — — — 1 1 2 November - - - - - - - December — — 1 — 2 2 3 Total 3 2 3 3 8 7 23 A further table gives particulars of the details given in the various notifications received. Thus, of the 26 cases, a total of 9 were notified from Hospitals outside the area, i.e., 8 from the Mothers' Hospital, Clapton (where the confinements had been carried out) and 1 from the City of London Hospital. The puerperal fever and pyrexia rate during 1932 was 13.8 per 1,000 births, whilst the fatality due to puerperal sepsis was 7.7 per cent, of cases of fever and pyrexia notified. PUERPERAL FEVER AND PYREXIA—1932. 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. Remarks. 1. Pyrexia 7.1.32 7.1.32 30 W. Second opinion 2.1.32 3.1.32 7.1.32 Instrumental delivery. Dead foetus. Admitted Hospital following Consultant's visit. 2. ” 27.1.32 29.1.32 28 H.E. Facilities available 16.1.32 19.1.32 16.1.32 Sapraemia—Notified from Hospital. 3. ” 12.2.32 13.2.32 35 J. • • 16.1.32 17.1.32 19.1.32 Pneumonia— ,, ,, 4. Fever 17.2.32 17.2.32 26 J. Admit to Hospital 29.1.32 16.2.32 17.2.32 Removed to Hospital. Heart Disease. 5. " 20.2.32 22.2.32 31 H.E. Second opinion 14.2.32 20.2.32 Not removed P.P.H. Manual removal of some retained membranes. 6. Pyrexia 12.3.32 15.3.32 20 W. Already removed 5.3.32 10.3.32 12.3.32 Removed to Hospital. ? Scarlet Fever. 7. " 8.3.32 9.3.32 32 H.E. Second opinion obtained privately 6.3.32 8.3.32 Already in Nursing Home P.P.H. Thrombosis. 8. " 19.3.32 22.3.32 32 H.E. Admit to Hospital 17.3.32 18.3.32 19.3.32 Died in Hospital. Retained products. Septicaemia. 9. Fever 6.4.32 7.4.32 36 J. Already removed 28.2.32 31.3.32 15.3.32 Died 4.4.32—Retained placenta, Pulmonary complications, Puerperal Septicaemia. Notified from Hospital. 112 10. Pyrexia 13.4.32 18.4.32 30 H.H. Facilities available 7.4.32 10.4.32 6.4.32 Notified from Hospital— Sapracmia. 11. ” 17.4.32 20.4.32 27 Hi. ” ” 27.3.32 8.4.32 27.3.32 Septic perineum. Notified from Hospital. 12. 27.4.32 29.4.32 34 H.E. ” ” 4.4.32 5.4.32 5.4.32 Adherent placenta. Delayed and prolonged third stage. Notified from Hospital. 13. " 12.6.32 15.6.32 27 Ho. ” ” 9.6.32 11.6.32 8.6.32 Sapraemia—Notified from Hospital. 14. ” 8.7.32 12.7.32 25 H.H. ” 1.7.32 7.7.32 22.6.32 Mastitis— ,, ,, 15. 14.7.32 14.7.32 28 Hi. Second opinion 19.6.32 4.7.32 Already in Nurs ing Home Left femoral thrombosis. 16. Fever 20.7.32 21.7.32 23 H.H. Already removed 17.7.32 17.7.32 17.7.32 ? 3 months' abortion. Notified from Hospital. 17. Pyrexia 28.7.32 29.7.32 27 Ho. Second opinion 25.7.32 28.7.32 30.7.32 Admitted to Hospital following Consultant's visit. 18. Fever 11.8.32 12.8.32 26 H.H. Facilities available 9.8.32 9.8.32 9.8.32 ? 3 months' abortion. Notified from Hospital. 19. Pyrexia 26.8.32 29.8.32 39 W. ” ” 24.8.32 26.8.32 26.8.32 2 months' abortion. 20. ” 18.10.32 19.10.32 21 H.E. Already in Hospital 12.10.32 17.10.32 17.10.32 Local uterine infection. Notified from Hospital. 21. Fever 22.10.32 24.10.32 31 H.H. Admit to Hospital 17.10.32 20.10.32 21.10.32 Removed to Hospital. 22. Pyrexia 5.12.32 6.12.32 29 H.H. Second opinion 27.11.32 3.12.32 Not removed Consultant provided. »» i > 23. ” 7.12.32 8.12.32 25 H.H. Facilities available 13.11.32 3.12.32 ” ” 24. ” 10.12.32 13.12.32 28 H.E. 1.12.32 3.12.32 28.11.32 Vaginal Sepsis. Notified from Hospital. 25. ” 18.12.32 21.12.32 23 Ho. ” ” 14.12.32 15.12.32 13.12.32 Pyelitis— ,, ,, 26. ” 18.12.32 21.12.32 39 H.E. ” ” 14.12.32 16.12.32 7.12.32 Uterine Sepsis ,, ,, 114 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. 1 1932 9 2 1 3 1 1 1931 8 3 1 3 — — 1 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1932 6 3 9 — — — 1931 7 1 8 — - — Three cases were admitted to St. Margaret's Hospital (London County Council) and made a good recovery. 15. 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 1932, 10 inquiry forms were completed and details are given in the accompanying table. In addition, two other deaths occurring after recent childbirth were due to other causes. The Registrar-General, under the "Rules for the selection of one from two or more jointly stated causes of death" allocated 2 deaths to puerperal sepsis and 6 to other puerperal causes. The rates per 1,000 are, therefore, calculated on this figure. Following the publication of the Final Report of the Departmental Committee on Maternal Mortality and Morbidity an extract was made from the Summary of Recommendations made and copies of this were circularised to all medical practitioners in the area. A note was added to the effect that every service specified in the Report was provided by your Council. The following table shows the position with regard to Maternal Mortality compared with that for England and Wales:— MATERNAL MORTALITY AND DEATHS ASSOCIATED WITH CHILDBIRTH. Case No. Date of Death. Certified Cause of Death. Age. Ward. Date of Admission to Hospital. Remarks. 1. 12.1.32 Pneumonia 36 Hi. — Associated heart disease. Delay in summoning medical aid by relatives 2. 4.2.32 1. (a) Syncope 36 J. - Seven months miscarriage. Death due to Chronic Bronchitis and weakness of heart muscle. (b) Myocardial Degeneration (c) Asthma and acute bronchitis 2. Miscarriage 3. 24.3.32 Puerperal Septicaemia 32 H.E. 19.3.32 Retained products. Died from Septicaemia. 4. 4.4.32 1. (a) Puerperal Septicaemia 36 J. 15.3.32 In Hospital 13 days before Miscarriage. Retained placenta. Died from lung involvement and septicaemia. (6) Miscarriage 5. 25.4.32 Ruptured Ectopic Pregnancy 30 Hi. 22.4.32 Operation at Hospital. Transfusion. 6. 8.5.32 Eclampsia 26 J. 7.5.32 Admitted to Hospital in coma. Forceps delivery. 7. 2.7.32 1. (a) Syncope 33 W. - Haemorrhage. Placenta Praevia. Version, Traction : ? Embolism. (6) Placenta Praevia 8. 5.7.32 1. (a) Pulmonary Embolism 34 W. — Pulmonary Embolism 2 days after confinement. (b) Childbirth 9. 13.9.32 Eclampsia 26 Ho. 12.9.32 Normal pregnancy. Forceps delivery. No delay in Hospital Treatment. 10. 13.11.32 Ruptured Uterine Artery 42 H.H. — B.B.A. (Stillbirth) Post Mortem Inquest. 11. 26.12.32 1. (a) Cardiac failure ? H.E. Nursing Home Death classed as due to Mitral Valve disease. (b) Mitral disease (c) Rheumatic fever 2. Cardiac Asthma 12. 27.12.32 Pulmonary Embolism, following Caesarean Section ? H.E. Before 14.12.32 Caesarean Section 14.12.32 in Hospital. Ovarian dermoid. Death classed as due to "non-malignant tumours.'' 115 116 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 Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal causes. Total. Live 1,789 ,, and 2 6 8 1.1 3.3 4.4 1.61 2.63 4.24 Stillbirths 1,871 2 6 8 1.0 3.2 4.2 1.54 2.52 4.06 The table facing this page gives full particulars of all the Maternal Deaths in respect of which enquiry forms were completed and sent to the Ministry of Health. Some are not classed as Maternal Deaths by the Registrar-General. 16. MISCELLANEOUS. (a) Pemphigus Neonatorum.—Your Council decided to make no recovery in respect of medical aid summoned by midwives in respect of suspected pemphigus. (b) Cookery Demonstrations.—A series of cookcry demonstrations were given at the Low Hall Lane Welfare Centre on October 5th, 6th and 7th by a demonstrator of the National Milk Publicity Council. (c) Children and Young Persons Act, 1932.—Your Council's Medical Officer of Health, Assistant Medical Officers and Health Visitors were designated as Infant Protection Visitors under the Act. (d) Diphtheria Immunisation.—Your Council approved of these facilities being extended to children over the age of one year attending Welfare Centres. 117 Summary of Services for Maternity and Child Welfare provided by your council. 1. Ante-Natal Supervision. (a) Weekly Ante-Natal Clinics. (b) Consultative Ante-Natal Clinic (fortnightly). (c) Home visits by Health Visitors. (d) Difficult cases referred to London Hospitals. (e) Provision of Milk and Food. (f) Dental Treatment. (g) Provision of Doctor's services at cost of Council in necessitous and abnormal midwives' cases. (h) Transport facilities. 2. Facilities during and after childbirth. (а) Lying-in accommodation (see note a). (b) Provision of accouchement outfits at cost price. (c) Provision of home helps. (d) Boarding out children during confinement. (e) Provision of midwife in necessitous cases and scheme for medical aid in abnormal cases (see note b). (f) Provision of consultant obstetrician in difficult cases (at any time during pregnancy, labour or puerperium). (g) Provision of consultants for puerperal fever and pyrexia. (h) Hospital treatment, bacteriological investigation and home nursing for cases of puerperal fever and pyrexia. (i) Home nursing or hospital treatment for cases of Ophthalmia Neonatorum. (j) Investigations into all cases of Maternal death, puerperal fever and pyrexia, stillbirths, deaths of newlyborn children. (k) Provision of milk and food. 118 3. Post-Natal Care and Child Welfare. (а) Regular home visits by qualified Health Visitors. (b) Nine weekly child Welfare Clinics. (c) Post-natal consultative Clinic (fortnightly). (d) Provision of milk and food for nursing mothers and children up to three years of age. (e) Provision of Nursery School (provided by Education Authority). (f) Provision of hospital and convalescent home treatment. (g) Treatment—Minor ailment, sunlight, tonsils and adenoids, dental, eyes, orthopaedic and rheumatism (provided by Education Authority). (h) Provision of accommodation for children of widowed and deserted mothers and for illegitimate children. (i) Hospital treatment and home nursing of cases of measles, whooping cough and diarrhoea. 4. General Services. (a) Inspection and Supervision of Midwives. (b) Infant Life Protection. (c) Administration of Nursing Homes Registration Act. Notes.-—(a) Pending completion of the Municipal Maternity Home urgent or exceptional cases can be given Hospital accommodation on demand. (b) A Municipal midwife will work from the Maternity Home when completed.