WAL 9 C.I. AC 4411 (1) WALTHAMSTOW Borough of Walthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1933 The Walthamstow Press, Ltd., E.17 Borough of Walthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1933 INDEX. PAGES Section A.—Statistics and Social Conditions of the Area 7-12 „ B.—General Provision of Health Services in the Area 12—19 „ C.—Sanitary Circumstances of the Area 19-23 „ D.—Housing 23-30 „ E.—Inspection and Supervision of Food 30-38 „ F.—Prevalence of and Control over Infectious Diseases 38-53 „ G.—Infectious Diseases Hospital 53-60 „ H.—Maternity and Child Welfare 62—88 page Acreage 7 Adulteration 35 Ambulance 13 Ante-Natal Clinic 73, 78 Antitoxin 46 Bacteriological Analyses 31 Bakehouses 22 Biological Tests 33 Births 8 „ Notification of 65 „ Registration of 65 Birth Rate 8 Breast Feeding 71 Cancer 11 Caravans 23 Cerebro spinal Meningitis 49 Chicken Pox 49 Children Act 74 Clinics 14, 73 Closet Accommodation 19 Committees 4, 62 Complaints 19 Confinements 81 Consultants 63, 82 Cowsheds 22 Cremation 60 Dampness 21 Deaths 8, 11, 12 „ Institutional 12 Death Rate 8 Dental Treatment 76 Diphtheria 45, 56 Diseases of Animals Acts 35 Disinfection 21 Drainage 19 Enteric Fever 46 Erysipelas 48 page Factories and Workshops Acts 36 Fishmongers 22 Food and Drugs 30 Food Poisoning 50 Foot Clinic 14 Health Visitors 63 Home Helps 81 Hospital Accommodation 14 „ , Infectious Disease 53 „ , Smallpox 43 Housing 23 Act, 1930 29 „ Conditions 25 „ Shortage 27 „ Statistics 24 Ice Cream 22, 32 Immunisation 41 Infant Mortality 9, 67 Infectious Diseases 21, 38 „ „ Clinic 39 Isolation Hospital 53 Laboratory Work 13, 42 Legislation in Force 16 Maternal Mortality 17, 86 Maternity and Child Welfare 62 „ Homes and Hospitals 18, 70, 81 Maternity Outfits 87 Measles 9, 50 Meat Inspection 34 Midwives 17, 82 Milk 30 Assisted Scheme 80 Milk and Dairies Order 33 „ „ „ , Amend. Act. 33 „ Special Desig. Order 33 „ Shops 22 page Notices, Sanitary 19 Nuisances 19 Nurse Children 74 Nursing 13 Offensive Trades 35 Ophthalmia Neonatorum 86 Ophthalmic Treatment 77 Orthopaedic „ 75 Outworkers 38 Overcrowding 27 Parks 8 Pneumonia 47 Poisons and Pharmacy Act 36 Population 7 Prosecutions 35 Public Assistance 14, 17 Public Cleansing 19 Puerperal Fever and Pyrexia 48, 83 Rag Flock Act 23 Rateable Value 7 Refuse Disposal 19 Rent Restrictions Act 35 Rivers and Streams 19 Sanitary Inspection 19 Scarlet Fever 44, 57 page Schools 23 Slaughterhouses 21 Smallpox 43 Smoke Abatement 22 Social Conditions 7 Special Premises 21 Staff 6, 54, 63 Statistics 7, 8 Stillbirths 8, 65 Tents, Vans and Sheds 23 Tonsils and Adenoids 77 Tuberculosis 51 Tuberculous Meat 34 Unemployment 7 Unhealthy Areas 29 Vaccination 43 Venereal Disease 16 Vital Statistics 8, 10 Walthamstow Child Welfare Society 78 Walthamstow District Nursing Association 82 Water 19 Whooping (tough 9 Women's Clinic 14 Zymotic Diseases 9 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Alderman G. Gibbons, J.P. Ex-Officio: His Worship the Mayor—Alderman B. Cole, J.P. The Deputy Mayor—Councillor G. E. Lowton. Chairman of Finance Committee—Councillor E. C. Redhead. Alderman J. C. Hammond. Alderman Mrs. M. Norrish. „ Mrs. C. McEntee, J.P. Councillor Mrs. E. M. Miller (Chairman, Sanatorium Visiting Committee). Councillor Mrs. L. P. Bailey. Councillor C. E. Longley. „ A. G. Bottomley. „ Mrs. A. L. Meadows. „ W. B. Ellis. „ G. Page. „ Mrs. B.M.Friedberg. „ Mrs. E. M. Richards. „ P. Friedberg. „ R. Smith. „ W. Gillett. 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 for the year 1933. The Report is given in the form prescribed by Circular 1346 of the Ministry of Health. The Report on Maternity and Child Welfare follows as a separate section. Again I have to acknowledge the consideration which I have always experienced at your hands. In particular, your Chairman has ever been ready to help. No summary of the Departmental activities would be complete without reference to the retirement on superannuation of Miss L. Pratchett who has given your Council faithful and unstinted service at the Sanatorium since its erection in 1901. I have to thank Mr. Cunningham for the Section of the Report dealing with Water, Rivers and Streams, Drainage and Sewerage and the Housing Statistics. Mr. West has kindly contributed information on housing and has left no stone unturned in his efforts to ameliorate the lot of the tuberculous under the scheme for re-housing on medical grounds. He has also co-operated in the new scheme for the abatement of overcrowding in those houses vacated by new tenants of Council houses. The Staff of the Department have worked well and have assisted in the compilation of statistics for the Report. I would particularly thank Mr. Duncan, Chief Sanitary Inspector, for his co-operation generally, and his work in connection with the Housing Act, 1930. The excellent illustrations of the various clearance areas are produced from photographs taken by Mr. Duncan for the purpose of the Inquiry. He has again contributed those Sections of the Report dealing with Sanitary Inspection of the Area, Inspection of Dwelling Houses, etc., Inspection and Supervision of Food, Legal Procedure, Diseases of Animals Acts, Factories and Workshops, etc. I also wish to express my grateful appreciation of the friendly co-operation experienced from my professional colleagues who are in practice in the Borough and the kindness of the Medical Superintendent of Whipps Cross Hospital in admitting various cases from the Sanatorium. 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 Mary C. Clarke, M.B., B.Ch., B.A.O. Resident Medical Officer—Isolation Hospital: Miss Mary Hamilton, M.B., B.Ch., B.A.O. Consultants, Puerperal Fever and Pyrexia Regulations: See page 63 Matron—Isolation Hospital: Miss L. Pratchett, S.R.N. (to 31-3-33). Miss V. M. Wilson, S.R.N. (from 1-4-33). Infectious Disease Nurse: Miss I. H. Jennings, S.R.N., Certified Midwife. Foot Clinic: Chiropodists: Miss M. McCallum, S.R.N., C.S.M.M.G., M.C.Ch.A. Miss L. K. Thomas, M.C.Ch.A. (Part-time). From 6-6-33. Clerk (part-time): Mrs. N. Moger. Women's Clinic: Surgeons-in-Charge (part-time): Mrs. M. H. F. Ivens Knowles. C.B.E., M.S., Ch.M., F.C.O.G. (to 26-9-33), Miss M. M. Basden, M.D., F.R.C.S., F.C.O.G. (from 10-10-33). Nurse (part-time): Miss A. M. Duncan, S.R.N. 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), (c). 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 O. J. Panther, (a), (half-time to 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.E.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: Chief Clerk: Dr. Bernard Dyer. R. Rose. Clerks: G. W. West; L. R. W. Kemp; R. C. Bland, A.R.S.I. (b),(d); R. A. C. Green; L. Rushton; F. J. Aylward; A. T. Wade. 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 1933) 135,600 Number of Assessments, 1st April, 1933 133,247 Rateable value £692,124 Sum represented by penny rate £2,775 Social Conditions.—No change from 1931 Report. Unemployment.—The degree of unemployment in the area during 1933 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 twothirds 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 £ 23 1 33 8,705 1,672 10,377 26,963 20 2 33 9,007 1,663 10,670 28,772 20 3 33 8,470 1,708 10,178 28,092 24 4 33 8,105 1,726 9,831 31,911 22 5 33 7,291 1,561 8,852 24,395 26 6 33 6,988 1,334 8,322 27,664 24 7 33 6,683 1,306 7,989 20,862 21 8 33 6,385 1,088 7,473 19,102 25 9 33 6,355 930 7,285 22,856 23 10 33 6,730 895 7,625 17,845 20 11 33 6,737 1,040 7,777 17,713 25 12 33 6,465 1,153 7,618 23,132 8 It will be seen that a gradual decline has taken place in unemployment during the year. £89,863 less unemployment benefit was paid during the vear 1933 as asainst 1932. Mr. Dempsey states that the following were the registrations at the Juvenile Employment Bureau:— Fresh Applications:— Boys Girls Total Insured (over 16 years) 548 524 1,072 Not insured (under 16 years) 512 570 1,082 Re-registrations:— Insured 754 332 1,086 Not insured 452 481 933 Total Registrations, 1933 2,266 1,907 4,173 1932 2,390 1,819 4,209 Parks and Recreation Grounds.—No change since 1931, except that the laying-out of a new sports ground, having an area of 52 acres, at Low Hall Farm has been commenced. Extracts from Vital Statistics.—The Registrar-General's mid-year, 1933, estimate of population (viz. 135,600) has been used for the calculation of all vital statistics:— Total Males Females Live Births Legitimate 1,624 782 842 Birth rate per 1,000 of the estimated resident population 12.3 Illegitimate 46 17 29 Total 1,670 799 871 Stillbirths 65 Rate per 1,000 total (live and still) births 37.4 Deaths 1357 Death rate per 1,000 of the estimated resident population 10.0 Deaths from puerperal causes:— Deaths Rate per 1,000 (live and still) births Puerperal Sepsis 7 4.0 Other Puerperal Causes 2 1.1 Total 9 5.1 9 Death-rate of infants under one year of age:— All infants per 1,000 live births 53 Legitimate infants per 1,000 legitimate live births 51 Illegitimate infants per 1,000 illegitimate live births 130 Deaths from Measles (all ages) Nil „ „ Whooping Cough (all ages) 7 „ „ 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 0.24 against 0.03 in 1932. The Pulmonary Tuberculosis Death-rate was 0.65 per 1,000 population, and the Non-Pulmonary Death-rate was 0.081 per 1,000 population. The natural increase of population, i.e., excess of births over deaths, was 313. The usual comparison of vital statistic rates with those for the whole country, is shown in the table on the following page. Births.—Births are dealt with under the Maternity and Child Welfare Section of the Report. Deaths.—The table on page 11 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. 10 TABLE IX.—Birth-rates, Death-rates and Analysis of Mortality in the Year 1933. England and Wales, 118 County Boroughs and Great Towns, and 132 Smaller Towns. (Provisional figures. The rates for England and Wales and for London, have been calculated on a population estimated to the middle of 1933, but those for the towns have been calculated on populations estimated to the middle of 1932. Rate 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 Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 years) Total Deaths under 1 year. Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P M. No Inquest. Uncertified Causes of Death. Live Births StillBirths England and Wales 14.4 0.62 12.3 0.01 0.00 0.05 0.02 0.05 0.06 0.57 0.54 7.1 64 90.9 6.3 1.9 0.9 118 County Boroughs and Great Towns including London 14.4 0.67 12.2 0.00 0.00 0.06 0.02 0.06 0.08 0.55 0.49 9.4 67 91.0 6.0 2.5 0.5 132 Smaller Towns Estimated Resident Populations 25,000 to 50,000 at Census 1931) 14.5 0.63 11.0 0.00 0.00 0.04 0.02 0.04 0.04 0.53 0.44 4.9 56 91.7 5.8 1.5 1.0 London 13.2 0.45 12.2 0.00 0.00 0.02 0.02 0.08 0.08 0.51 0.58 11.6 59 88.3 6.3 5.4 0.0 Walthamstow 12.3 0.47 10.0 0.00 0.00 0.00 0.02 0.05 0.05 0.36 0.45 8.9 53 89.8 6.1 4.1 0.0 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales were as follows: Per 1,000 Live Births 1.79 2.63 4.42 „ „ Total Births 1.71 2.52 4.23 „ „ „ Walthamstow „ „ „ „ Total Births 4.0 1.1 5.1 „ „ Live Births 4.1 1.2 5.3 11 Causes of and Ages at death during the year 1933. Whole Districts and Wards Causes of Death Net Deaths at the subjoined ages of "Residents" whether occurring within or without the district. Wards All Ages Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards St. James Street High Street Hoe Street Wood Street Hale End Higham Hill No. 1 M. F. 3 4 5 6 7 8 9 10 1 Typhoid and Para-Typhoid Fevers - - - - - - - - - - - - - - - - 2 Measles - - - - - - - - - - - - - - - - 3 Scarlet Fever 2 2 — — 2 2 — — — — 1 — 1 1 — 1 4 Whooping Cough 3 4 2 2 2 1 — — — — — 2 1 3 — 1 5 Diphtheria 5 2 — 1 1 5 — — — — 1 1 1 — 1 3 6 Influenza 14 36 — — — — — 9 11 30 8 7 12 6 8 9 7 Encephalitis Lethargica 1 — — — — 1 — — — — — — 1 — — — 8 Cerebro-spinal Fever 1 3 1 — 1 — 2 — — — 1 1 1 — 1 — 9 Tuberculosis of Respiratory System 47 42 — — — 3 13 43 25 5 17 21 11 10 14 16 10 Other Tuberculous Diseases 5 6 1 2 — — 3 3 2 — 4 - 1 — 4 — 11 Syphilis 2 — — — — — — 1 1 — — 1 — — — 1 12 General Paralysis of the Insane, tabes dorsalis 3 1 - - - - - 1 2 1 1 1 1 - - 1 13 Cancer, malignant disease 78 109 — — — — 3 12 74 98 32 29 37 32 27 30 14 Diabetes 3 7 — — — 1 1 1 2 5 4 1 1 2 1 1 15 Cerebral Haemorrhage, etc. 35 40 — — — — 1 3 13 58 8 12 20 6 16 13 16 Heart Disease 132 132 5 — 1 2 11 14 62 169 37 35 70 36 41 45 17 Aneurysm 2 1 — — — — — 1 2 — 1 — 1 — 1 — 18 Other Circulatory Diseases 31 25 - - - - - 3 23 30 9 10 9 10 9 9 19 Bronchitis 35 27 — — — — 1 3 13 45 8 6 13 13 11 11 20 Pneumonia (all forms) 67 47 16 9 4 6 3 11 24 41 33 15 27 10 14 15 21 Other Respiratory Diseases 9 3 — — — — — 3 6 3 1 1 4 — 4 2 22 Peptic Ulcer 14 5 - - - - - 5 11 3 3 — 4 2 6 4 23 Diarrhoea, etc. (under 2 years) 7 8 13 2 - - - - - - 6 — 3 1 4 1 24 Appendicitis 4 3 — — — — 1 1 — 5 1 — 1 1 — 4 25 Cirrhosis of Liver 1 1 — — — — — — — 2 — 1 — 1 — — 26 Other Diseases of Liver, etc. 1 5 - - - - - 2 2 2 2 — 1 1 2 — 27 Other Digestive Diseases 18 15 — — 1 1 — — 10 21 8 7 4 5 4 5 28 Acute and Chronic Nephritis 17 16 — — — — 3 4 9 17 13 3 5 3 5 4 29 Puerperal Sepsis — 7 - - - - - - - - - 1 1 — 3 2 30 Other Puerperal Causes — 2 — — — — 1 1 — — — — 1 1 — — 31 Congenital Debility and Malformation, Premature Birth, etc. 32 16 46 - 2 - - - - - 8 5 10 5 13 7 32 Senility 18 33 - - - - - - - 51 5 9 10 14 7 6 33 Suicide 11 10 - - - - - 7 14 — 1 9 4 1 1 5 34 Other Deaths from Violence 27 13 — — — 3 12 9 9 7 5 6 6 3 11 9 35 Other Defined Causes 62 49 5 1 2 3 6 13 25 56 20 18 24 19 15 15 36 Causes ill-defined or unknown — — — — — — — — — — — — — — — — Totals 687 670 89 17 16 28 61 157 340 649 238 204 286 186 223 220 12 The 1933 total deaths (1,357) compares with 1,348 during 1932, the respective death-rates per 1,000 population being 10.0 and 9.9. The main classification of deaths—those for 1932 being given in parentheses—was as follows— Whooping Cough 7 (3); Diphtheria, 7 (5); Pulmonary Tuberculosis, 89 (87); Non-pulmonary Tuberculosis, 11 (14); Cancer, 187 (182); Cerebral Hæmorrhage, 75 (79); Heart Disease, 264 (287); Bronchitis, 62 (63); Nephritis, 33 (48); Congenital Debility, etc., 48 (49); Suicide, 21 (14); Violence, 40 (33). Infant deaths are analysed by causes, ages and wards under the Maternity and Child Welfare Section of the Report. Institutional Deaths. Whipps Cross Hospital 258 Central Homes, Leytonstone 150 Connaught Hospital, Walthamstow 51 Brentwood Mental Hospital 18 St. Bartholomew's Hospital, London 18 Forest Gate Sick Home 14 Walthamstow Isolation Hospital 13 Queen's Hospital, Bethnal Green 12 Prince of Wales' Hospital, Tottenham 8 Clock House, Walthamstow 7 London Fever Hospital, Islington 6 London Hospital, Stepney 6 St. Joseph's Hospice, Hackney 6 Forest Hydro, Walthamstow 6 Queen Charlotte's Hospital, Hammersmith 6 Chest Hospital, Bethnal Green 5 Middlesex Hospital, St. Marylebone 4 German Hospital, Hackney 4 Great Ormond Street Hospital 4 Queen Mary's Hospital, Stratford 4 University College Hospital, St. Pancras 3 Epping Infirmary 3 Heathfield Nursing Home, Highams Park 2 St. Paul's Hospital, Holborn 2 North Middlesex Hospital, Edmonton 2 Other Institutions 61 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 ar d also in the Maternity 13 and Child Welfare Section. All are whole-time officers unless otherwise stated. (ii) Laboratory Facilities.— These facilities are detailed under the Infectious Diseases Section of the Report. There were no changes in the arrangements detailed in previous years. (iii) Ambulance Facilities.— (a) Infectious Cases.—No change since last report. (b) Non-Infectious and Accident Cases, and (c) Maternity Patients see below 1. Municipal Service. Superintendent Camp, A.M.I.Fire E., reports as follows on the work done during 1933:— Removals Accidents Maternity Total 811 405 45 1261 The oxygen breathing set, with a mixture of 7 per cent. of carbon dioxide, has been in use on two occasions for cases of gas poisoning, and was successful each time. 2. Removal of Patients to Whipps Cross Hospital is carried out by the Hospital Ambulances. 3. St. John Ambulance Brigade. Mr. W. W. Perriton, Corps Officer, reports as follows:— "First aid cases attended, 1,021. Number of patients removed, 920. Road Accidents, 27. Total mileage of cars, 15,525. Early in the year, one permanent driver had to be dismissed on account of lack of funds. In addition to Willow Walk Station, the sub-station at the Buxton Club, the Duncan Memorial, Highams Park, and during the summer months, the Epping Road tent and the Cardo Memorial Hut have been maintained, and staffed. Duties have been done at Clapton Stadium every Saturday and at special meetings, and at Lea Bridge Speedway, six men at every meeting. The Dominion, Carlton and Bell Cinemas are covered every night. Also, Old Folks' functions, and the usual football and sports duties have been carried out, and all London duties when applied for by Headquarters." (iv) Nursing in the Home. (a) General.—No change since 1931. (b) Infectious Disemes.—No change since 1931. 14 (v) Clinics and Treatment Centres.— No change since 1931. Foot Clinic.—Attendances at the Foot Clinic continued at a weekly average of approximately 100 up to the last week in April, when they increased to an average of about 133 per week for the remainder of the year. An assistant chiropodist was then engaged for four sessions per week up to mid-June after which assistance was given on 9 sessions per week. The maximum attendances in any one week was 168. Total attendances were 6,392, and of these 2,139 were by new patients, and 4,253 were re-attendances by old patients. The receipts were £283 9s. 10d. The cases seen included 607 warts—of which 196 were in school children—351 bunions, 173 ingrowing nails, and 151 septic conditions. Renewed acknowledgment must be made of the excellent work of the staff. Women's Clinic.—The staffing and scope of this Clinic were detailed in the Report for 1932, and remained unaltered up to the end of September, when Miss M. Basden, M.D., F.R.C.S., F.C.O.G., was appointed to succeed Mrs. Ivens-Knowles who, unfortunately, resigned for personal reasons. In February, the sessions were increased from one to two per month. Total attendances have been as follows:— New Old Total Ante-Natal Cases 14 9 23 Gynaecological 115 246 361 Contraceptive 11 41 52 Total 140 296 436 Contraceptive advice is only given to married women in whose cases further pregnancy would be detrimental to health. It is hoped that private practitioners will utilise the Clinic particularly for Consultant ante-natal advice for those of their patients requiring it. (vi) Hospitals.— There were no changes during 1933 in the Hospital services used by the inhabitants of the Borough. Public Assistance in Walthamstow is provided by the SouthWest Area Committee of the Essex County Council, which retains a certain proportion of beds in each of the local institutions formerly provided by the West Ham Board of Guardians. 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, 1933:— Institution Men Women Children Total Central Home 164 158 *49 371 Whipps Cross Hospital 688 702 342 1732 Forest Gate Hospital 5 113 12 130 Margate Convalescent Home — — 6 6 Aldersbrook — — 54 54 (*—These children were ultimately transferred to the Homes at Aldersbrook, and are included in the latter number. 67 infants were born to Walthamstow mothers in the Forest Gate Hospital. The number of patients from Walthamstow in Mental Hospitals was 400 on the 31st December, 1933. The Connaught Hospital. Captain Ellison, Secretary to the Hospital, has kindly supplied the following information:— Of the total number of In-patients admitted during the year, 676 were residents of the Borough. Comparative Figures.— The following figures show the progress of the Hospital during 1933, as compared with the previous year:— In-Patient Department. Out-patient Department. Patients Admitted Average stay in Hospital Beds Occupied Daily. New cases Attendances 1932 1,529 22.2 92.50 12,105 60,042 1933 *1,430 22.6 *88.42 13,210 69,591 * Wards closed during building operations. Staff.—(Medical). Five Honorary Medical and Surgical Consultants and seventeen Honorary Visiting Specialists are on the Staff, and there are four Resident Medical Officers. Staff.—(Nursing). The Nursing Staff consists of the Matron, the Assistant Matron and Sister Tutor (one Post), thirteen Sisters, including six special departments, six Staff Nurses and thirtythree Probationers. Beds.— The complement of 116 beds is allocated as follows: Medical cases, 91; Surgical, 43; Children, 28; Private Beds, 10; Observation Beds, 4. Facilities.— There are facilities for operative surgery, X-ray work, dental, ophthalmic, massage, and electro-therapy. 16 logical work is carried out partly at the Hospital, and partly at other Institutions. Operations and Treatments.— During 1933 , 742 major, and 2,893 minor operations were performed, making a total of 3,635. 8,712 radiographs were taken, and 206 X-ray treatments given. There were 9,107 massage treatments, also 9,801 electrical treatments, and 2,878 artificial sunlight treatments at Comely Bank Annexe. Extensions.—During the year the complement of beds was increased from 100 to 116 owing to the generosity of Alderman A. M. Mathews, J.P., E.C.C., who provided funds for a new Ward. In addition, a new Massage Department was built at the Comely Bank Clinic with money kindly placed at the disposal of the hospital by Mrs. J. K. Keene in memory of her husband. The Hospital provides, at an annual retaining fee of thirty 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. 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: Guy's Hospital, Whitechapel (London County Council) Clinic, Turner Street, Mile End. Miller General Hospital, Greenwich, St. George's Hospital, St. Paul's Hospital, Endell Street, W.C.2., St. Thomas' Hospital, University College Hospital, W.C.l, West London Hospital, W.6. In addition, treatment is available at special times at eleven other hospitals. Outfits for taking specimens from patients are provided for practitioners, on request, by the Whitechapel (London County Council) Clinic. Essex Public Medical Service. The above Service, now some ten years old, brings to its members benefits roughly analogous to those of the National Health Insurance Act. About twenty of the Medical Practitioners of the Borough are members of the scheme, and the Secretary kindly informs me that there are approximately 2,833 Walthamstow subscribers. (vii) Legislation in Force.— The Town Clerk reports that the following Legislation, etc., came into force during 1933:— 1. Children and Young Persons Act, 1933. 2. Dangerous Drugs Act, 1932 (came into operation by Order in Council on 9th July, 1933). 3. Housing (Financial Provisions) Act, 1933. 4. Pharmacy and Poisons Act, 1933. 17 5. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. 6. Slaughter of Animals Act, 1933. 7. S.R.O. 1933, No. 20. Diseases of Animals. 8. Regulations made by the Walthamstow Borough Council, under the Sheep Scab Order of 1928 (came into force 1st August, 1933). (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, kindly states that the amount of relief provided in Walthamstow during the two years ended 31st December, 1933, was as follows:— 1933 1932 £ s. d. £ s. d. Total amount of out-relief granted to Walthamstow residents during year ended 31st December, 1933 53,482 16 1 43,815 9 10 1933. 1932. Average weekly number of Walthamstow residents in receipt of relief during year ended 31st December, 1933. Men 890 692 Women 1243 1067 Children 1202 987 Total 3335 2746 (ix) Midwives. Number of Notices of Intention to practice January, 1933 18 Number of Notices of Intention to practice during 1933 8 Total 26 Number of Midwives ceasing practice during 1933 8 Number of Midwives practising at end of 1933 18 There was no change in the arrangements for the employment or subsidy of Midwives by the Council. (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. 18 Further reference to Maternal Mortality and Puerperal Fever and Pyrexia is made in the Maternity and Child Welfare Section of the Report. (i) Midwifery and Maternity Services. See Maternity and Child Welfare Section. (ii) Institutional Provision for Mothers or Children. (iii) Health Visitors. (iv) Infant Life Protection. (v) Orthopaedic Treatment. (xi) Maternity and Nursing Homes.— During the year -one additional maternity bed was registered at the Walthamstow District Nursing Association's Home. The total registered accommodation available in the Borough at the end of 1933 was as follows:— Ante- General Natal Maternity Total Walthamstow District Nursing Association, 19, Carisbrooke Rd. - - 12 12 Heathfield Nursing Home, 91, Falmouth Avenue, E.4 4 1 7 12 Forest Hvdro, Forest Road 5 — 2 7 Kingswood Maternity Home, Forest Rise - - 5 5 St. Margaret's Nursing Home, 3, East Avenue, — — 3 3 Total 9 1 29 39 The following table gives information required by the Ministry of Health:— 1. Number of applications for registration (for additional beds) 1 2. Number of Houses 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. (6) 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. 19 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 : Mason Road, Lichfield Road, Keynsham Avenue, a new road (not yet named) on the Montalt Estate (Highams Park), Hillside Gardens, Montserrat Avenue, Oak Hill Close, The Avenue, Hollywood Way, Farm Lodge Estate (Chingford Road), Markmanor Avenue, Billet Road (Housing extension), The Mile End, Frinton Drive, Richmond Avenue, Durban Road (Housing extension), Cheney Row, Ascham End, Alma Avenue and Belle Vue Road. The supply is provided by the Metropolitan Water Board and 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 system other than minor ones, necessitated by the development of various building estates, were carried out. The construction of a relief sewer from Hale End Road at the junction with Wadham Road to the Sewage Works has been approved. Closet Accommodation.— The use of the cesspool at "Essex Hall" has been discontinued, the drains having been connected to the sewer constructed in connection with the Essex Hall Housing Scheme. The number of cesspools remaining is nine. Public Cleansing.—Your Cleansing Superintendent reports as follows:— The collection of house refuse is carried out by means of horse-drawn vans and mechanical vehicles. House refuse is disposed of by incineration and tipping. The total amount of refuse collected by the Council was 25,929 tons, giving an average daily weight of 86.6 tons. Cesspools are cleansed by pumping out the contents, which are carted to and discharged into the nearest sewer. 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 1933 10628 10205 1828 2437 2449 115 24653 1932 10130 10700 1675 2527 2582 132 25169 20 Of the 115 Statutory Notices served during 1933, 88 were complied with. The nature and variety of the work done during 1933 is shown in the following tables:— Drains tested 575 „ reconstructed or repaired 583 „ obstructions removed 275 „ means of access provided 48 „ ventilation provided or improved 84 „ ventilation repaired 167 Soil pipes repaired 28 „ „ new provided 27 Rain water pipes renewed 255 „ „ „ disconnected from drains 49 Roofs repaired or renewed 706 Gutterings repaired or renewed 411 W.C. pans or traps provided 407 Gully traps provided 101 W.C. flush cisterns provided 74 „ „ repaired 211 W.C. floors concreted 79 W.C.'s repaired and cleansed 511 W.C.'s light and ventilation repaired 13 Waste pipes renewed or trapped 215 „ „ repaired 125 New sinks provided 100 Water supply reinstated 6 „ „ taken off main 14 Cisterns cleansed and covered 62 Conveniences cleansed or repaired 29 Sculleries paved 100 Yards and forecourts paved and repaired 480 Dirty houses cleansed 109 „ rooms cleansed 3,423 Floors repaired 280 Ventilations under floors provided 248 New damp-proof courses provided 278 Sites concreted 12 Offensive accumulations removed 83 Animals improperly kept, removed 7 Manure receptacles provided 8 Stables cleansed, paved and drained 45 Manholes repaired or re-sealed 115 Other cases of dampness remedied 500 Separate Sanitary Conveniences provided to shops where both sexes are employed 4 Miscellaneous repairs 2213 21 Infectious Disease. Visits to premises 1393 He-visits to premises 148 Visits in connection with Smallpox 154 Premises disinfected 1189 Articles disinfected at Low Hall 13582 Articles destroyed at Low Hall 243 Dampness in Houses. Sites concreted 12 Damp-proof courses provided 278 Yards and forecourts paved and drained 480 Hoofs made watertight 706 Bain-water pipes made good 255 Guttering repaired or renewed 411 Other cases of dampness remedied 500 Ventilation under floors provided 248 House-to-house inspections 952 Special Premises. Number. Visits paid. Slaughterhouses 12 620 Butchers' Shops 93 921 Bakehouses 47 184 Fishmongers, fish friers and curers, etc. 59 466 Eating-houses and Coffee Stalls 71 129 Ice Cream Vendors 111 129 Cowsheds 1 16 Dairies and Milkshops 219 350 Laundries 10 46 Bag and Bone Dealers 8 21 Elementary Schools 31 10 Private Schools 13 Piggeries 4 56 Street Stalls Numerous 114 Greengrocers „ 192 Stables „ 336 Factories 482 Workshops 302 Outworkers 327 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers' Shops and Slaughterhouses. Special cleansing, 38; Paving repaired, 7; Accumulations removed, 6; New Galvanised Bins provided, 11; Drains 22 repaired, 5; W.C.'s repaired and cleansed, 14, Yard paving repaired, 3; Floors repaired and ventilated, 6; Roofs repaired, 3. Bakehouses. Special cleansing, 84; Drains repaired, 3; W.C.'s cleansed and doors repaired, 15; Yards repaved, 4; Obstructions from drains removed, 4; W.C. cisterns repaired, 2; Floors repaired, 1; New ceilings fixed, 1; Roofs repaired, 9; Premises general repairs, 4; New W.C. pans and traps, 5. Fishmongers. Special cleansings, 35; Drains cleared of obstruction, 5; Yards repaved, 12; Accumulations removed, 7; Roofsrepaired, 2; Other improvements, 23. Coffee and Eating Houses. Special cleansings, 24; Yard pavings repaired, 2; W.C. cisterns repaired, 2; Floors renewed, 2; Drains repaired, 1. Ice Cream Vendors. Special cleansings, 12; Special cleansing of utensils, 4; Yard paving repaired, 2. Cowsheds and Milkshops. Special Cleansings, 16; Pavings relaid. 5; Fittings and other improvements, 6; Roofs repaired, 1; W.C.'s repaired, 3. Stable Premises. Cleansings, 36; Accumulations removed, 10; Roofs repaired,. 2; Pavings repaired, 5; Manure Receptacles provided, 5; W.C.'s repaired, 3. Laundries. Special cleansings, 8; Roofs repaired, 3; Other improvements, 4. Rag and Bone Dealers. Cleansings, 11; Paving repaired, 1. Piggeries. Cleansings, 5; Pavings relaid, 1; Re-drained, 3. Smoke Abatement.—Fourteen instances of nuisances arising from smoke have been observed and remedied. Personal visits to the factories concerned have proved that 23 in nine 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:— Fish Curers 28 Fish Friers 44 Rag and Bone Dealers 8 Slaughterhouses 12 Bakehouses 47 Tents, Vans, Sheds, etc.— There are four areas in Higham Hill Ward where numerous 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. Schools.— The sanitary condition of schools is more fully discussed in the School Medical Officer's Report. A detailed sanitary survey is made of each school by the School Medical Inspector at the conclusion of Medical Inspection. Recommendations are sent to the Director of Education. The School Medical Officer's Report gives a detailed account of the sanitary improvements effected during 1933. 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 1933 are given in the form prescribed for previous years. The following are the figures 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 84 (ii) By other Authorities Nil. (iii) By other bodies or persons 494 Total 578 24 (6) With State Assistance under the Housing Acts:— (i) By the Local Authority:— (a) For the purpose of Part II of the Act of 1925 Nil. (b) For the purpose of Part III of the Act of 1925 and under the Housing Financial Provision Act, 1924 84 (c) For the purpose of the Act of 1930 Nil. (d) For other purposes Nil. (ii) By other bodies or persons Nil. The 578 houses were situated as follows:— Hale End Ward 243 (а) High Street Ward 20 (b) Higham Hill Ward 116 Hoe Street Ward 21 St. James Street Ward 20 (c) Wood Street Ward 158 (a) 20 flats over shops; (b) including 8 flats; (c) including 34 flats. N.B.—Each flat is counted as one house. Essex Hall and Kimberley Road Housing Schemes which were commenced during the year, are nearing completion and no further schemes have been submitted to the Ministry of Health for approval. The following information is given in the form required by the Ministry of Health (Circular 1346):— I.—Inspection of Dwelling-Houses during the Year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 4,037 (b) Number of inspections made for the purpose 12,389 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 983 (b) Number of inspections made for the purpose 3,521 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 51 (N.B.— These are all situated in Clearance Areas) (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 2,381 25 II.—Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 2,193 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 101 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 76 (b) By local authority in default of owners (at a cost of £72 2s. 11d.) 2 B. Proceedings under the Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 15 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 15 (b) By local authority in default of owners Nil. 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 Nil. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. D. Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. (b) General During the year 67 letters addressed to the Public Health Department in support of applications for rehousing were acknowledged and forwarded to the Housing Manager for the attention of the Housing Committee. 26 Rehousing of Tuberculous Families. Your Council continued to allocate ten per cent. of all available houses for special rehousing on medical grounds. Recommendations have been confined to urgent cases of pulmonary tuberculosis and Dr. Sorley, the Tuberculosis Officer, has again co-operated enthusiastically in the Scheme. The Housing Manager in making a special report to your Council remarked that in order to safeguard the interests of the Council as landlord a very large number of cases had to be rejected by the Lettings Committee. Mr. West pointed out that larger houses than would ordinarily be required will have to be offered if the patient is to have a bedroom for his or her sole use. The larger house entails higher rent and reduction in the amount) available for adequate nutrition. This danger, he considered, could probably be reduced by allotting a type of house normal to the size of the family and providing a shelter for the patient. The matter was taken up with the County Medical Officer who pointed out that such shelters could only be provided when ancillary to the treatment of the disease and that five shelters were at that time provided by the County Council for the use of Walthamstow patients. It was further pointed out that there was no assurance that the shelter would be used in inclement weather. Shelters can also be provided bv the Borough Council under Article 12 (1) of the Public Health (Tuberculosis) Regulations, 1930. A suggestion was then made to the County Medical Officer that the County Council, as the Authority responsible for the treatment of tuberculosis, should bear any loss of rent which might accrue to the Borough Council in the event of the latter Authority rehousing cases of tuberculosis which would otherwise have to be rejected owing to inability to pay the rent of a Council house. Up to the present, the County Council have not admitted this principle. The whole matter was discussed at a meeting with Dr. Sorley, Tuberculosis Officer, and the Housing Manager and it was agreed that the Tuberculosis Officer would recommend the provision of shelters in suitable cases where the patients could not pay the normal rent of a Council house of suitable size. Your Council later agreed to provide a bell service between the house and the shelter in order to overcome any possible complaint as to lack of means of communication. Mr. West reports that since the inception of the scheme under which ten per cent. of houses have been available for tuberculous patients the following number of cases have been dealt with in the manner shown up to the end of 1933:— 27 No. of cases recommended for rehousing on medical grounds 53 No. of cases rehoused 21 No. of cases rejected or withdrawn 32 No. of cases on waiting list Nil. The large proportion of cases rejected or withdrawn, practically all on economic grounds, stresses the very real need for some solution of the difficulty and representations are still being made by your Council to the County Council on the matter. Recently issued reports on nutrition have drawn attention to the claim that if a more liberal dietary had been possible then many children would have overcome spontaneously their tuberculous infection without presenting any definite symptoms or signs of the disease. Mr. West is satisfied that the rent of many Council houses is often paid at the expense of the necessary nutrition and that the obvious danger to health is intensified in tuberculous cases. Overcrowding.— Mr. West has kindly furnished the following report:— " Housing Register on 31st December, 1933 :— No. of applicants on Register at 31.12.33 3,835 No. of new applications received during year 1933 949 No. of new tenancies effected during the year 116 No. of registered cases investigated during the year 749 No. of cases recommended by Medical Officer of Health on medical grounds during the year 18 No. of such cases rehoused during year 6 No. of such cases which have been approved but still awaiting tenancies Nil. No. of such cases rejected owing to inability to pay rent 12 No. of such cases remaining to be dealt with Nil. The Council have continued to rehouse only bona fide residents in the Borough, who have lived for at least seven consecutive years in Walthamstow, and so far as is humanly possible tenancies have been granted in accordance with the known requirements of the applicants, that is the minimum number of bedrooms required, according to the sex of the family, and not exceeding two persons per room. In the case of tuberculous patients, of course, additional accommodation has been offered where possible in order that the patient should have the sole use of one room for his or her accommodation. 28 The following figures show the position at the end of the financial year, that is, 31st March, 1934:— 228 houses have been built and tenancies granted during the year. The whole of the cases recommended on medical grounds, including T.B. negative cases, have been offered accommodation on the Council's estates, and the practice has been to avoid any suggestion of segregation. The Department has been intensely interested in the question of rehousing tuberculous patients and submitted a report for the consideration of the Council with a view to rehousing all tuberculous patients, particularly those cases where the wage earner was the patient or the income was very low, and it was decided that the Council should approach the County Council with a view to their giving rent relief in any such cases. The Slum Clearance schemes have been dealt with by the Department and in some cases the tenants were actually rehoused from compulsory purchase areas prior to the site being actually purchased. All the tenants from the Billet Road compulsory purchase area have been rehoused. In Hilton Grove there only remain three houses to be dealt with, and these tenants are requiring one-bedroom type accommodation only. The Council have before them a scheme for the erection of appropriate accommodation in order to rehouse the whole of the remaining tenants in Hilton Grove, Spring Gardens, and Jeffrey's Square areas, and they are negotiating with other landowners with a view to purchasing additional land for the erection of houses under the 1930 Act, when no doubt the Markhouse Place area will also be dealt with. The Council's housing estates at this date (31.3.34) comprise 1,480 properties, being made up as follows:— 527 houses built under 1919 Act 912 houses built under 1924 Act Total 1,443. 4 houses built under 1930 Act 23 General Properties. 14 Shops. The maintenance of the property under the Council's Rota Scheme was successfully dealt with for the first time during the year, and has been the means of reducing complaints from tenants, the amenities of the estates being generally maintained. The properties are situated on various estates, as follows:— Priors Croft, 198 houses; Higham Hill and Millfield, 338 houses; Essex Hall, 136 houses; Kimberley Road, 98 houses; Spion Kop, 260 houses; Priory, 162 houses; Highams Park, 151 houses; Fitzwygram, 50 houses; Chestnuts, 50 houses; General Properties, Flats and Shops, 37. 29 The whole of the houses recently erected are not provided with a parlour, in accordance with the requirements of the Ministry of Health. It has been found that a number of applicants when offered accommodation without a parlour have refused the allotment of a house on these grounds." Overcrowding.—It has been obvious that the maximum relief of overcrowding in the Borough by the erection of Council houses has not been attained in the past because the vacated rooms have in most instances been again sublet and so leading to a repetition of overcrowding. The vacated rooms may be sublet to people from outside the Borough and the rooms in question can become " stepping stones " to Council houses. Your Council, therefore, instructed the Housing Manager to notify the Public Health Department in advance of any rooms which are to be vacated owing to the rehousing of the tenant in a Council house. A visit is then paid to the rooms by the District Sanitary Inspector and a letter is sent either to the landlord of the house or to the principal tenant threatening proceedings in the event of any overcrowding being permitted in the vacated rooms. The results of the 1931 Census showed that the degree of" overcrowding in the Borough was generally worse in 1931 than in 1921. All available and suitable building land is rapidly becoming used up in the Borough so that any real solution of the problem of overcrowding by local effort appears impossible. The formation of a co-ordinating housing authority for the whole of Greater London would appear to be long overdue. HOUSING ACT, 1930. (a) First Programme.– The enquiry of the Ministry of Health into the Orders madein 1932 by your Council with regard to areas which had been represented under the 1930 Act was held on June 1st, 1933. The table below gives the names of the areas, the number of houses involved, the number of inhabitants in August, 1933, and the decision of the Ministry of Health:— A. Walthamstow—Hilton Grove Clearance Order, 1932. Nos. 1 to 8 inclusive. 24 persons. Order confirmed. B. Walthamstow—Compulsory Purchase (Spring Gardens) Order, 1932. Nos. 1 to 6 inclusive. 23 persons. Order confirmed. C. Walthamstow—Compulsory Purchase (Jeffrey's Square) Order, 1932. Nos. 1 to 7 inclusive. 24 persons. Order confirmed. 30 D. Walthamstow—Compulsory Purchase (Billet Road) Order, 1932. Nos. 1 to 15 inclusive. 60 persons. Order confirmed. E. Walthamstow—Compulsory Purchase (Markhouse Place No. 1) Order, 1932. Nos. 1 to 21 odd. (Nos. 13-21—44 persons). Order confirmed but Nos. 1 to 11 excluded. F. Walthamstow—Compulsory Purchase (Markhouse Place No. 2) Order, 1932. Nos. 29 to 57 odd. Order confirmed but Nos. 53, 55, 57 excluded and Nos. 39 and 41 excluded from Clearance Area but remain in order on lands to be purchased under Section 3 of the Housing Act, 1930. 65 persons. The total number of houses confirmed for clearance was 51, accommodating 240 persons. Eight houses represented as individual unfit houses have already been dealt with by demolition and rehousing of the tenants where required. The eight photographs reproduced have been selected from a larger series taken by Mr. Duncan in order to demonstrate the various areas at the Ministry's enquiry. (b) Second Programme.— During 1933 a second programme of clearance areas to be -dealt with under the 1930 Act was drawn up and was meant to cover the requirements of the area up to 1938. The programme was as follows:— Part I. Section 1. Clearance Areas:— 59 inhabited houses and 6 unoccupied houses in 8 areas. Ascertained population 224. Part II. Section 19. Individual Unfit Houses:— 9 houses. Ascertained population 63. E.—INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The average number of cows kept in the district was 7. There is only one cowshed and 16 visits were paid by the Sanitary Inspectors in addition to special visits paid by your Chief Sanitary Inspector. The number of retail purveyors of milk is 219, most of whom carry on a general shop and sell milk in bottles as they receive it. Three hundred and fifty visits were paid to registered premises BILLET ROAD rear of Close-up view of outbuildings at rear BILLET ROAD rear of Showing outbuildings and strutting to No. 4 HILTON GROVE In foreground on right is the building containing washing copper Communal Tap is near Dust-bin HILTON GROVE from entrance Note.—Drinking Water Cistern behind Fishing Net and Wash-house at end of picture MARKHOUSE PLACE Showing the “lay-out ” of road and houses JEFFREY'S SQUARE The three doorways facing are the frontages of three houses, Nos. 5, 6 and 7 JEFFREY'S SQUARE Showing rear of Nos. 1,2, 3 and 4. Note sagging roofs and strutted-up W.C.'s in foreground SPRING GARDENS Showing in the foreground the roof of two W.C's. in Jeffrey's Square area 31 of purveyors of milk during the year and a general improvement in the standard of cleanliness was observed. During the year 24 samples of milk were taken for bacteriological count and of these 3 were biologically tested for the presence of the tubercle bacillus with negative results. The samples taken are summarised below. Grade of Milk. No. of Samples. No. tested for T.B. Grade A (T.T.) 3 — Grade A (Pasteurised) 1 — Grade A 1 1 Pasteurised 15 — Raw 4 2 Total 24 3 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. 9.2.33 Pasteurised 12,000 1 c.c. No test Satisfactory. 13.2.33 Raw 56,000 0.001 c.c. „ „ 25.4.33 „ 32,000 1 c.c. Absent „ 23.5.33 Pasteurised 320,000 0.001 c.c. No test Unsatisfactory. 30.5.33 „ 16,000 0.001 c.c. „ Satisfactory. „ „ 7,800 0.1 c.c. „ „ 9.6.33 „ 57,000 1 c.c. „ „ 28.6.33 Grade A (T.T.) 14,000 0.01 c.c. „ „ „ Pasteurised 39,000 0.01 c.c. „ „ „ „ 31,000 0.01 c.c. „ „ „ Raw 64,000 0.001 c.c. „ „ 19.7.33 Pasteurised 37,000 1 c.c. „ „ „ „ 320,000 1 c.c. „ Unsatisfactory. 2.8.33 „ 73,000 1 c.c. „ Satisfactory. „ „ 176,000 0.0001 c.c. „ Unsatisfactory. 4.8.33 Raw 960,000 0.00001 c.c. Absent „ 24.8.33 Grade A. 156,000 0.001 c.c. „ „ 25.8.33 Grade A (T.T.) 12,000 0.01 c.c. No test (Coli Count). Satisfactory. „ Grade A. Pastd. 3,300 0.1 c.c. „ „ „ Pasteurised 68,000 0.1 c.c. „ „ „ „ 9,100 1 c.c. „ „ 26.9.33 Grade A (T.T.) 9,200 0.01 c.c. Absent „ „ Pasteurised 15,600 1 c.c. No test „ „ „ 4,600 1 c.c. „ „ 32 In addition, 4 samples of cream were analysed and the results are given below:— BACTERIOLOGICAL ANALYSIS OF CREAM SAMPLES Date. Total Bacteria. per c.c. Bacillus Coli absent in Presence of Tubercle. Bacillus (biological test). Remarks. 16.10.33 41,000 0.01 c.c. No test High standard of bacterial purity. „ 720,000 0.01 c.c. „ Good standard of bacterial purity. „ 74,000 1 c.c. „ Very high standard of bacterial purity. „ but kept and sent to Lab. 19.10.33 8,000,000 approx. 0.00001 c.c. „ Was probably a good cream and results are due to multiplication of bacteria owing to keeping. (N.B. Retained for comparative purposes. ) Eleven 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. 19.7.33 1,300,000 0.00001 c.c. Unsatisfactory product. „ 90,000 0.0001 c.c. Total bacterial count not excessive but coli count not up to standard. „ 72,000 0.01 c.c. Satisfactory bacterial purity — clean product. „ 4,400 1 c.c. Counts very low—highest standard of bacterial purity. 2.8.33 132,000 0.01 c.c. Not of high standard but passably satisfactory. „ 2,100,000 1 c.c. Excessive number of bacteria but coli satisfactory. Result suggests dirty vessels on exposure to air or dust. „ 21,000 0.1 c.c. Satisfactory bacterial purity. „ 36,000 0.1 c.c. „ „ „ „ 9,200 1 c.c. „ „ „ „ 21,400 1 c.c. „ „ „ 25.8.33 960,000 1 c.c. Total bacterial count high but coli satisfactory. Result suggests sample unpasteurised 33 Of the eleven samples only six 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. There is a general improvement in the standard of purity of this food. Biological Examination of Milk Samples by County Council :— The County Medical Officer states that during 1933 it was felt desirable to pay more attention to sampling direct from farms, particularly from those which had not been sampled within recent years. In these circumstances no samples were obtained in the Borough. 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 of the town and there is a general improvement in this direction. In addition to the convictions detailed under " Legal Procedure " the Council issued two warnings to dairymen in connection with breaches of this Order by their employees. The Milk and Dairies (Amendment) Act, 1922 (Section 2). In connection with a prosecution for a prejudicial sale referred to under " Legal Procedure," application was made to the Court to remove a defendant from the Register of Purveyors of Milk. A heavy penalty was imposed instead. The same defendant was prosecuted in respect of aiding, abetting and procuring offenders against the Milk and Dairies (Consolidation) Act, 1915. He was fined for these offences. He transferred the business over to his son who applied to the Council for Registration as a Purveyor of Milk. The Council refused the application and there was no appeal against this refusal. A further application for Registration in respect of this dairy was made by another purveyor of milk, and the Council refused that application. An appeal was made to the Petty Sessional Court and at the hearing it was given in evidence that the objection of the Council had been removed. The appeal was allowed without costs. In connection with the above prosecution for aiding, abetting, and procuring offenders, three purveyors of milk were convicted for carrying on the trade without being registered. The Milk (Special Designations) Order, 1923. 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 :— 34 Dealers' Licences. In respect of:— Certified Milk 1 Grade A (T.T.) Milk 4 Grade A Milk 3 Pasteurised Milk 23 Supplementary Licences. In respect of:– Certified Milk 2 Grade A (T.T.) Milk 4 Grade A. Milk 2 Grade A (Pasteurised Milk 2 Pasteurised Milk 5 Bottling Licences:— In respect of Grade A (T.T.) Milk, 2; Pasteurised Milk, 4. (b) Meat and Other Foods. A total of 620 visits were paid to slaughterhouses. The following were condemned and destroyed:— (a) Tuberculosis. (b) Other Reasons. 73 Ox Lungs. 57 Ox Livers. 58 Ox Hearts. 6 Ox Lungs. 38 Ox Skirts. 5 Ox Tripes. 17 Ox Livers. 2 Ox Tongues. 14 Ox Fats. 1 Ox Pluck. 10 Ox Heads. 1 Ox Kidney. 1 Ox Tripe 1 Calf's Liver. 1 Ox Tongue. 1 Flank Beef. 5 Forequarters Beef. 2 Cow's Udders. 4 Loins Beef. 97 Sheep's Livers. 2 Clods Beef. 6 Sheep's Lungs. 2 Top Ribs Beef. 3 Sheep's Plucks. 2 Middle Ribs Beef. 4 Breasts Lamb. 1 Cow Carcase and all organs 1 Leg Lamb. 1 Pig Carcase and all organs. 2 Forequarters Mutton. 80 Pigs' Fats. 1 Neck Mutton. 41 Pigs' Heads. 1 Breast Mutton. 37 Pigs' Plucks. 1 Sheep Carcase. 4 Pigs' Livers. 2 Pig Carcases and all organs. 1 Pig's Spleen. 88 Pigs' Livers. 4 Loins Pork. 3 Pigs' Plucks. 1 Sheep's Pluck. 2 Loins Pork. 2 Bellies Pork. 1 Chine Pork. 1 Fowl. 6 lb. tin Compressed Beef. 1 box Skate. 6 boxes Kippers. 10 stones Haddocks. 6 stones Halibut. 5 stones Plaice. 40 boats Apricots. 22 boxes Apples. 20 boxes Tomatoes. 290 lbs. Chocolates and other sweets. 35 (e) Adulteration, etc. (Food and Drugs Adulteration Act, 1928). Ninety-three samples of milk were submitted for analysis during the year. Of these, 4 were not genuine. One prosecution followed and is reported under " Legal Procedure." OFFENSIVE TRADES. During the year the Council sanctioned the establishing of the following:— Fish Curers, 2; Fish Friers, 2. During the year the Council refused to sanction the following Offensive Trades:— Fish Friers, 5; Fish Curers, 2. Legal Procedure. Food and Drugs (Adulteration) Act, 1928:— Fine. Costs. Sample of Milk which contained 15% added water £10. - Milk and Dairies Order, 1926:— Information against purveyor for nonregistration 10s. - „ „ „ 10s. - „ „ „ 10s. - Information against purveyor for aiding, abetting, and procuring in the above three offences £5. £1. Petroleum Consolidation Act, 1928:— For keeping petroleum spirit without a Licence 40s. THE RENT AND MORTGAGE RESTRICTIONS ACTS, 1920-1923. During the year ten certificates were granted to tenants and two certificates have been issued to owners upon completion of the scheduled works. In all cases work which can be enforced by the Housing Acts has been carried out, but the Rent Acts permit of requirements in excess of those which can be demanded under the Housing Acts and which cannot be enforced under them. If owners do not comply fully with requirements specified on the certificate granted to the tenants, no clearance certificates are issued. DISEASES OF ANIMALS ACTS, 1894-1928. The Importation of Dogs and Cats Order, 1928.— During the year five performing Tigers were admitted under Licence into the area. The conditions of the Licence were duly observed. 36 Sheep Scab Order, 1920.—No case of this disease occurred in the Borough during the year. The Sheep Scab Order, 1928.—(Adopted by the Council).— During the year, 123 sheep were allowed into the area under Licences for Slaughter. The Regulation of Movement of Swine Order, 1922.— Under this Order, 1,788 pigs for slaughter were admitted into this Borough during the year. All notices of such movements have, as far as practicable, been followed up. Foot and Mouth (Regulation of Movement) Order, 1933. —By an Order of the Ministry of Agriculture and Fisheries, Essex became a controlled area on 11th January, 1933. The Order was removed as from midnight on 18th—19th January, 1933. During this period, Licences were granted by your Chief Sanitary Inspector for the movement of 83 cattle. 225 sheep, and 221 pigs to destinations for immediate slaughter. 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. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories (Including Factory Laundries.) 464 12 Nil. Workshops (Including Workshop Laundries.) 306 4 Nil. Workplaces (Other than Outworkers' premises.) 108 10 Nil. Total 878 26 Nil. 37 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. ® C © o| & s-s * • ° o w S <H ^ 5 3 0 -*3.2 1 8.S1 7: QC © -a H © m 3 O £.5(5 T3 d 3 O T3 TJ ■ e ■ PH o ■» t. T3 . S 0 h-l ft 3! ® C <& H (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :— Want of cleanliness 31 31 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors 5 5 — — Other nuisances 56 56 — Sanitary accommodation insufficient 2 2 — — unsuitable or defec| tive .27 27 not separate for sexes 3 3 — — Offences under the Factory and Workshops Acts— Illegal occupation of underground bakehouse (s. 101) Other offences — — — — Total 125 125 Nil Nil 38 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1933. Wearing Apparel, making of 422 Furs 10 Artificial Flowers 1 Brush Making 34 Umbrellas, etc. 1 Boxes 13 Toys 46 Christmas Crackers 1 Handbags 5 Furniture and Upholstery 2 Total 535. OUTWORKERS WERE NOTIFIED FROM THE FOLLOWING AREAS. City of London 175 St. Marylebone 9 Bethnal Green 24 Stepney 6 Chingford 8 Shoreditch 8 Finsbury 58 Tottenham 9 Hackney 50 Walthamstow 138 Islington 5 Westminster 10 Leyton 27 Other Areas 3 Poplar 5 A total of 374 visits were paid in connection with outworkers as follows:—To Homes, 321; Factories, 31; Workshops, 22. P.— 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. 1933 1932 Smallpox — 10 - — — — — — — Scarlet Fever 681 445 1 144 425 64 44 3 — Diphtheria 334 356 7 76 199 25 23 4 — Enteric Fever 5 6 — — 1 2 1 1 — Pneumonia 169 188 5 23 25 20 46 34 16 Puerperal Fever 8 6 — — — 1 7 — — Puerperal Pyrexia 22 20 — — — 4 18 — — Ophthalmia Neonatorum. 7 9 7 — — - — — — Erysipelas 73 49 2 — 4 5 32 25 5 Encephalitis Lethargica . — — — — — — — — — Cerebro-spinal Meningitis 7 2 1 1 1 2 2 — — Chicken Pox 409 694 15 92 278 20 4 — — Tuberculosis 156 186 1 4 22 34 66 26 3 Poliomyelitis 3 7 — — 3 — — — — Measles 58 753 8 50 - - - - - Dysentery — 9 — — — — — — — Totals 1933 1932 - 47 390 958 177 243 93 24 1932 - 2740 83 1012 1155 166 208 91 25 39 Disease. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Smallpox — — — — — — Scarlet Fever 90 105 76 93 114 203 Diphtheria 56 56 50 36 45 91 Enteric Fever — — 3 — — 2 Pneumonia 37 23 27 19 27 36 Puerperal Fever 2 1 1 — 3 1 Puerperal Pyrexia 3 5 3 2 6 3 Ophthalmia Neonatorum 1 3 — — 1 2 Erysipelas 18 10 11 7 11 16 Encephalitis Lethargica — — — — — — Cerebro-spinal Meningitis 2 1 1 — 1 2 Chicken Pox 76 19 69 78 64 103 Tuberculosis 33 20 26 15 30 32 Poliomyelitis — — 1 1 — 1 Measles 2 9 6 1 16 24 Dysentery — — — — — — Totals 1933 320 252 274 252 318 516 1932 451 366 409 283 526 705 From the foregoing tables it will be seen that the outstanding features of 1933 were:— Increases in Scarlet Fever, Erysipelas and Cerebro-spinal Meningitis. Absence of Smallpox. Decreases in Chicken Pox, and Measles. Disease. Total. Removed to Hospital. Per cent. removed to Hospital. Deaths. Deaths per cent. of cases notified. Smallpox - - - - - Scarlet Fever 681 520 76.3 4 0.58 Diphtheria 334 301 90.1 7 2.1 Enteric Fever 5 5 100.0 Nil. Nil. Pneumonia 169 76 45.0 114 67.6 Puerperal Fever 8 8 100.0 9 30.0 Puerperal Pyrexia 22 18 81.8 Ophthalmia Neonatorum. 7 3 42.8 Nil. Nil. Erysipelas 73 24 32.8 Nil. Nil. Cerebro-spinal Meningitis 7 7 100.0 4 57.1 Chicken Pox 409 1 0.2 Nil. Nil. Tuberculosis 156 110 70.5 100 64.1 Poliomyelitis 3 2 66.6 Nil. Nil. Measles 58 2 3.4 Nil. Nil. The increase from 31.4 in 1932 to 45 in 1933 in the percentage of cases of Pneumonia removed to Hospital is gratifying in view of the skilled nursing which is so essential in these cases. Of the total notifications the following were made by the Medical Staff of the Department:— Diphtheria, 118; Scarlet Fever, 29; Chicken Pox, 118. Infectious Disease Clinic.—As in previous years this Clinic was held weekly on Tuesdays at 2 p.m. The work done at the 40 Clinic is roughly that of an Out-Patient Dept. to the Hospital and 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) Examination of other close contact 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). (d) Diphtheria Immunisation. This Clinic is taken personally by your Medical Officer of Health. The following table gives particulars of the work done during 1933: — No. of sessions held 52 No. of patients attended 2,047 No. of attendances made 3,222 Average attendance per session 39.3 No. of Scarlet Fever cases discovered 7 No. of Diphtheria cases discovered 49 No. of virulence tests taken in Diphtheria carriers 25 No. of children referred to Rheumatism Clinic 32 No. of children referred to Ear Clinic 12 No. of children referred to Orthopaedic Clinic 3 Particular care was taken to refer all cases with any suspicion either of rheumatism or of cardiac involvement to the next following rheumatism clinic. The following extract from Dr. Sheldon's report of the work of the Clinic is taken from the School Medical Officer's report for 1933 :— “ In my report last year I mentioned the follow-up children who had been discharged from the Sanatorium after Scarlet Fever or Diphtheria, and the reference to the rheumatism clinic of any of these children who were suspected of early rheumatism or other cardiac abnormalities. This has been continued, and I have no hesitation in saying that by this means much early rheumatism has been detected and offered immediate treatment—either by being referred from the clinic to the private Practitioner or by admission to hospital—while previously many of these cases must almost certainly have drifted on untreated until irreparable damage to the heart had been done. The value of such a follow-up after these infectious fevers seems to me undoubted. 41 “ During the year, 13 children were referred to the clinic in this way after Scarlet Fever; of these, 11 were found to show some evidence of cardiac defect. Thirteen children were referred after Diphtheria, and 10 of these showed some cardiac abnormality. Thus as a result of the ' Post-Infectious Disease Clinic,' 21 children with early cardiac mischief came under treatment at the earliest opportunity." Diphtheria Immunisation.— During the year facilities for immunisation against Diphtheria were continued. 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 toxoid-antitoxin mixture are given subcutaneously and a Schick test is done in every case one month after the last injection. A summary of the immunisation work done during the year is given below:— Diphtheria Immunisation, 1933. Schick Tested for first time 267 Negative (including 2 pseudo negative) 157 Positive 110 150 Immunised without being Schick tested (under 5 years of age) 40 No. having one immunising injection 6 150 ,, ,, two immunising injections 5 ,, ,, three ,, ,, 130 four ,, ,, 6 „ „ five „ ,, 3 No. of partly immunised cases brought forward from 1932 17 Total No. given one or more immunising doses during 1932 167 Results of Schick Tests Following Immunisation. Negative after 3 doses 112 „ „ 4 „ 6 „ „5 „ 3 No. of immunisations not completed at end of year 21 No. left area or not yet finally Schick tested 19 No. not completing immunising course 6 Total 167 42 127 children of school age immunised. 40 children of pre-school age immunised. All children leaving the area before the final Schick Tests were done were reported forward to the appropriate Medical Officer of Health. These 167 cases required a total of some 1,100 separate injections. DICK TESTS. Dick Tests 79 Positive 12 Doubtful 5 Negative 62 These tests were done at an Industrial School and of the 12 children positive, 7 (not given serum) contracted Scarlet Fever while 5 were protected by passive immunisation. In addition, materials were supplied to a local practitioner for Dick Testing. The cost of immunisation material per completed case (averaged over the 121 completed cases) was 3s. 9d. per case. The attention of parents has been drawn to the facilities which are available by the following means:— (a) Display of notices at all clinics. (b) Distribution of leaflets by Infectious Disease Nurse during removal of all Scarlet Fever and Diphtheria cases to Hospital. (c) Distribution of leaflets at all routine medical inspections. (d) Distribution of leaflets during a localised outbreak of diphtheria at any particular school. MUNICIPAL LABORATORY. The following numbers of specimens were examined during 1933: — Swabs. Negative. Positive. Totals. Private Practitioners 1,828 191 2,019 Health Department 606 108 714 School Medical Department 753 47 800 Totals 3,187 346 3,533 The total number of Diphtheria specimens compares with 3,769 in 1932. 43 The following specimens were also examined:— Urine, 161; Ringworm, 1; Miscellaneous, 1; Total 163, as compared with 222 in 1932. A total of 7,010 tubes of culture media were made by Mr. West and of these 3,324 were sent to the Sanatorium. The Essex County Council also provide facilities for examination of pathological specimens and the County Medical Officer states that 763 specimens were examined for local Practitioners during 1933 as follows:— Diphtheria Swabs, 88; Sputa, 616; Typhoid Specimens, 27; Ringworm Specimens. 10; Miscellaneous Specimens, 22; Diphtheria virulence tests, 4. The total for the previous year was 891. SMALLPOX. No case of Smallpox was notified during 1933. Vaccination.—Mr. E. Sharp, Vaccination Officer for the Area, has furnished the following return for 1933:— Births Registered Successfully Vaccinated Percentage Vaccinated Insusceptible Exemptions Deaths before Vaccinated Postponed 1,344 234 17.4 4 782 41 29 In addition to the above, 129 primary vaccinations were recorded and 7 revaccinations. The percentage vaccinated compares with 15.4 in 1932 and 16.7 in 1931. Eour revaccinations were done by your Medical Officer of Health in connection with staff at the Smallpox Hospital. During 1933 the vaccinal condition of all school children examined at Routine Medical Inspection was recorded and a summary of the findings for the year showed that 26.6 per cent, were vaccinated. HOSPITAL TREATMENT OF SMALLPOX. Two cases of Smallpox were admitted to your Smallpox Hospital under the agreement 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 opened on the 20th March to admit the first case which was discharged on 16th April ; and again re-opened 44 on 17th May. The second case was discharged on 3rd June since when the Hospital remained closed until the end of the year. SCARLET FEVER. A total of 681 cases of Scarlet Fever were notified in 1933 as compared with 445 in 1932. The following tables show the incidence by months, ages and wards:— Month. All ages. Under 1 yr. 1-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 & over. January 43 - 12 26 2 3 - - February 48 — 10 27 6 5 — — March 51 1 14 24 7 5 — — April 52 — 13 29 5 4 1 — May 63 — 10 43 7 3 — — June 49 — 8 36 4 1 — — July 60 — 10 43 4 3 — — August 33 — 11 16 5 1 — — September 39 — 8 26 3 2 — — October 62 — 17 34 5 5 1 — November 86 - 12 61 8 5 - - December 95 — 19 60 8 7 1 — Totals 1933 681 1 144 425 64 44 3 1932 445 4 122 250 42 27 — - Month. St. James. Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 3 17 2 1 7 13 February 5 15 8 4 6 10 March 3 8 9 10 14 7 April 5 8 12 11 3 13 May 14 8 11 4 9 17 June 7 6 3 8 6 19 July 17 3 4 13 14 9 August 5 5 3 5 6 9 September 1 5 2 9 7 15 October 9 8 5 10 3 27 November 9 13 4 7 21 32 December 12 9 13 11 18 32 Totals 1933 90 105 76 93 114 203 1932 85 61 53 58 68 120 The percentage of cases removed to Hospital during 1933 was 76.3 against 82.2 in 1932. 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. 45 Scarlet Fever at Brookfield Hospital. The outbreak of Scarlet Fever which began in the Autumn of 1931, continued throughout 1932, and up to March, 1933. Five cases occurred in 1933. Dr. Griffith of the Ministry of Health Laboratory again continued to examine the swabs which were taken in connection with the outbreak. During the latter half of 1932 the types oi haemolytic streptococci isolated from swabs had been Carter Type, 1; Franklin's Type, 63T, Type 1, and Heterogenous (one of each). On January 4th, 1933, one of the nursing staff complained of a Quinsy (due to a haemolytic streptococcus Type 1) and was put off duty till the 17th. On 27th January a suspected case of Scarlet Fever was removed to Hospital and both he and the nurse, who was again swabbed, showed Type 1. The nurse had been instructed to wear a face mask while on duty and subsequently consented to tonsillectomy. On the 28th another case occurred (Type 3) and a child who had contracted Scarlet Fever in November, 1932, also complained of sore throat due to Type 3 streptococci. On the 4th February another case occurred and 11 swabs were taken for examination from the nursing, massage and domestic staff. The patient yielded Type 3, all the staff being negative except one, a domestic, who yielded Type 63T. This typing agreed with one found in a patient in December, 1932. The two remaining cases occurred on March 6th and 8th and both showed haemolytic streptococci of Scarlatinal Type 3. DIPHTHERIA A total of 334 cases of Diphtheria were notified during 1933 as compared with 356 in 1932. The following tables show the incidence by months, ages and wards:- Month. All ages. Under 1 year. 1-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 & over. January 29 3 6 16 1 3 - - February 31 - 6 18 4 3 - - March 40 - 10 24 2 3 1 - April 23 1 4 14 1 2 1 - May 30 - 8 16 2 3 1 - June 28 - 8 16 3 - 1 - July 23 - 2 16 3 2 - - August 25 2 6 12 3 2 - - September 54 - 12 36 3 3 - - October 22 - 7 13 1 1 - - November 12 - - 11 1 - - - December 17 1 7 7 1 1 - - Totals 1933 334 7 76 199 25 23 4 - 1932 356 8 96 217 18 14 3 - 40 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 3 3 1 3 5 14 February 4 4 3 3 4 13 March 7 1 7 13 2 10 April 5 5 7 1 5 May 7 6 7 2 2 6 June 6 13 3 1 1 4 July 5 5 3 1 5 4 August 7 4 4 3 4 3 September 10 6 2 8 9 19 October 2 4 5 2 5 4 November - 3 2 - 3 4 December - 2 6 - 4 5 Totals 1933 56 56 50 36 45 91 1932 86 30 53 36 78 73 The percentage of cases removed to Hospital in 1933 was 90.1 against 91.3 in 1932. 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 parents and patients realise the necessity for absolute recumbency during the early stages of the disease. 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 1933 a total of '208 phials containing 1,524,000 units of Diphtheria Antitoxin and eight phials containing 80 c.cs. of Scarlet Fever Antitoxin were issued. ENTERIC FEVER. Two cases were notified in June, two in July and one in October. The last case was certified as dying of Acute Encephalitis and was probably not a case of Enteric Fever. Of the others 3 were treated at the Connaught Hospital and one at Whipps Cross Hospital. One of the former cases died. All the cases were apparently unconnected and no definite source of infection could be ascertained. 47 In addition, three observation cases were admitted to Hospital-two to the Connaught Hospital and one to Whipps Cross Hospital. The diagnoses were not confirmed in these cases. 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 year. 1-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 & over. January 57 1 9 10 6 20 8 3 February 19 2 - 2 2 8 2 3 March 12 - 2 2 1 3 4 - April 16 1 1 1 3 4 5 1 May 15 - 4 1 1 1 5 3 June 11 - 5 2 2 - 1 1 July 6 1 - 2 - - 1 2 August 6 - - 2 1 1 - 2 September 1 - - - - - 1 - October 5 - - 2 1 1 1 - November 10 - 1 - 2 6 1 - December 11 - 1 1 1 2 5 1 Totals 1933 169 5 23 25 20 46 34 16 1932 188 2 29 36 27 35 40 19 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 10 8 7 8 8 16 February 8 3 3 - 3 2 March 3 2 2 2 1 2 April 5 2 1 - 4 4 May 5 2 3 - 2 3 June 2 - 1 4 1 3 July 1 1 2 - 2 - August 1 - 3 - 1 1 September - - - - - 1 October - 1 - 2 - 2 November 2 1 2 2 2 1 December - 3 3 1 3 1 Totals 1933 37 23 27 19 27 36 1932 39 36 27 11 29 46 48 PUERPERAL FEVER AND PYREXIA. See Maternity and 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 year. 1-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 & over. January 4 - - - - 3 1 - February 7 1 - - 1 2 2 1 March 7 - - - - 4 3 - April 10 - - - 1 5 3 1 May 8 - - 1 - 2 3 2 June 6 - - - 1 4 1 - July 5 - - - 1 3 1 - August 3 - - 1 - 1 1 - September 5 1 - - 1 - 3 - October 5 - - 1 - 1 2 1 November 3 - - - - 2 1 - December 10 - - 1 - 5 4 - Totals 1933 73 2 - 4 5 32 25 5 1932 49 1 2 5 2 17 18 4 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 2 1 - 1 - - February 3 1 2 1 - - March 4 - 1 - 1 1 April 1 1 1 2 3 2 May 2 1 1 1 1 2 June 1 2 - 1 1 1 July 1 - 2 - - 2 August - - - - 1 2 September 1 1 1 - 1 1 October - 2 2 - 1 - November - - - - - 3 December 3 1 1 1 2 2 Totals 1933 18 10 11 7 11 16 1932 10 7 7 4 7 14 49 CEREBRO-SPINAL MENINGITIS Of the 7 cases, 6 were notified from the Hospitals to which the patients had been admitted (Whipps Cross Hospital 5, Queen's Hospital, Hackney Road 1), and the other case was notified by a private practitioner before admission to Whipps Cross Hospital. Four deaths occurred. Special schedules were completed in respect of each case and were forwarded to the Ministry of Health. CHICKEN POX. In view of the continuation of Smallpox in the Greater London area, Chicken Pox remained notifiable under the Walthamstow (Chicken Pox) 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 year. 1-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 & over. January 23 2 4 15 2 - - - February 10 - 5 5 - - - - March 26 - 3 21 2 - - - April 31 1 8 18 4 - - - May 47 4 14 27 2 - - - June 22 1 3 17 - 1 - - July 57 1 14 40 - 2 - - August 16 - 4 11 1 - - - September 22 2 4 15 1 - - - October 12 - 1 11 - - - - November 69 2 12 53 1 1 - - December 74 2 20 45 7 - - - Totals 1933 409 15 92 278 20 4 - - 1932 694 18 130 524 15 7 - - Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 5 1 5 6 1 5 February 5 - 3 2 - - March 6 1 1 6 7 5 April 8 - 4 7 9 3 May 9 4 3 14 8 9 June 3 2 1 11 2 3 July 9 1 16 14 5 12 August 5 1 4 2 - 4 September 7 - 2 1 7 5 October - 1 1 4 5 1 November 10 5 10 8 4 32 December 9 3 19 3 16 24 Totals 1933 76 19 69 78 64 103 1932 89 71 110 82 180 162 50 Except in a few secondary cases, all cases notified by private practitioners were visited by a Medical Officer. MEASLES. Under the Walthamstow (Measles) Regulations, 1932, all cases of Measles in children under 5 years of age are notifiable, except secondary cases in the same household or institution within two months of the primary case. The year 1933 was an inter-epidemic year and the 58 cases were distributed as follows:- Month Total Under 1 year. 1-5 yrs. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Jan. 3 1 2 - 1 - - 2 - Feb. 1 1 - - - - - - 1 March 1 - 1 - - 1 - - - April - - - - - - - - - May 4 1 3 - - - 1 3 - June 17 1 16 - 5 - - 9 3 July 10 - 10 1 - - - - 9 Aug. 7 - 7 - 1 2 - - 4 Sept. 3 1 2 1 1 - - 1 - Oct. 2 1 1 - - 1 - - 1 Nov. 7 2 5 - - 2 - 1 4 Dec. 3 - 3 - 1 - - - 2 Totals 1933 1932 58 8 50 2 9 6 1 16 24 753 37 619 103 122 118 59 112 239 ANTERIOR POLIOMYELITIS (Infantile Paralysis) Three cases of poliomyelitis occurred in Walthamstow residents. Two were notified from Hospitals and one by a private practitioner. There were no deaths. Food Poisoning. For the third year in succession food poisoning by Bacillus Aertryke followed the consumption of duck and four duck eggs. Dr. B., the family doctor, reported on the 25th July that he had been called to see two brothers with symptoms suggesting food poisoning. On visiting it was found that nine out of 17 persons had eaten duck at a picnic on July 23rd. 51 The duck was originally supplied from Norfolk but the exact origin could not be determined owing to the fact that the Smithfield trader dealt with some 6,000 to 8,000 weekly. It was killed on the 18th, sold and stored till 22nd, and drawn at a stall, stuffed and cooked by the purchaser on the same day and eaten at the picnic at meals at 2.30 p.m., 6 p.m. and again at supper at home. In this way it is possible that Mr. and Mrs. B and their 3 children had more duck than the other four persons who also ate duck at the picnic. S.B., aged 27 years, and H.B., aged 17 years, were taken ill on the 24th and 25th July respectively and C.B., aged 25 years, on the 26th. The latter had a temperature of 104°F. In addition, Mrs. B. had slight symptoms and Mr. G., a neighbour, who partook of duck, had moderate symptoms. Rectal swabs from the three children of family B. all yielded Bacillus Aertryke when examined by Dr. Scott at the Ministry's laboratory. 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 1933:- Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M F M F M F M F Under 1 yr. - - 1 - - - 1 - 1- 5 yrs. - 1 1 2 - - - 2 5-10 yrs. 2 - 7 2 - - - - 10-15 yrs. 1 4 3 3 - 3 - - 15-20 yrs. 6 8 5 4 3 1 1 1 20-25 yrs. 4 5 3 - 4 5 - 1 25-35 yrs. 14 19 2 3 12 13 1 2 35-45 yrs. 14 9 3 2 9 9 - - 45-55 yrs. 5 4 1 - 7 7 2 - 55-65 yrs. 11 3 - 2 9 2 - - 65 yrs. and upwards 2 1 - 3 2 - - Totals 1 56 55 27 18 47 42 5 6 111 45 89 11 156 100 52 The 100 deaths represent a death rate of 0.73 per 1,000 population. The returns for the past two years are compared below:- Year. New Cases. Total. Deaths. Total. Pulmonary. NonPulmonary. Pulmonary. Non. Pulmonary. m. f. m. F. M. f. m. f. 1933 56 55 27 18 156 47 42 5 6 100 1932 82 70 21 13 186 54 33 9 5 101 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 1 5 6 7 8 9 10 11 12 13 14 Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 16 2 11 - 1 3 - 3 - 39 - 12 7 5 2 The ratio of deaths in non-notified cases (i.e., columns 11 to 14 above) to total deaths from Tuberculosis was 26 to 100 or 1 to 3.8. Appropriate action was taken, when necessary, with regard to non-notification. The table given below shows the number of cases on the Eegister at the beginning and end of 1933:- Pulmonary. Total. NonPulmonary. Total. Grand Total. No. on Register 1st January Notified during 1933 m. f. m. f. 939 56 849 55 1,788 111 471 27 449 18 920 45 2,708 156 Total 995 904 1,899 498 467 965 2,864 Removed from Register, 1933 67 63 130 11 24 35 165 No. on Register 31st December 928 841 1,769 487 443 930 2,699 53 The 165 removals from the Register were made up as follows:- Deaths. Removals. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. 40 34 3 2 27 2.) 8 22 74 5 50 30 79 86 165 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 1933 were:- Pulmonary. Non-Pulmonary Total M. F. M. F. Adults 44 41 10 3 98 Children 3 1 3 5 12 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. Renovations, etc.— The following works of renovation and maintenance were carried out during 1933:- Redecoration and renovation of Blocks D, E, F, and T. and of Mortuary. Redecoration and renovation of kitchens in Administrative Block. Provision of new bathroom in E Block. Provision of 30 new ward lockers. Provision of new boiler for main hot water system. Provision of two new tennis courts. Adaptation of former power house as laundry drying room. 54 Staff.—The most notable event of the year was the retirement on superannuation of Miss L. Pratchett, S.E.N., who had been Matron of the Isolation Hospital since its erection in 1901. Miss Pratchett had rendered your Council loyal and faithful service for 32 years and had witnessed the growth of the Hospital from its original three blocks to the present fine institution with seven ward blocks and accommodating a total of 174 patients. Miss V. M. Wilson, S.E.N., was appointed as Matron and assumed duty in April. The nursing staff was increased by the appointment of a Sister Tutor, two Staff Nurses, and one Probationer. General.— The death rate per hundred admissions of infectious disease patients was 1.49. Towards the end of 1933 a special report was made to the Public Health and Sanatorium Visiting Committeesastotheaccommodation available for infectious disease patients. The report stated that, at times, dangerous overcrowding of the wards had to be resorted to and that there was an extreme shortage of cubicle accommodation. Your Committee is at the moment awaiting a reply from the Essex County Council as to their relinquishing the Tuberculosis Pavilion which could easily be converted into a new cubicle block. Alternatively, the provision of a new cubicle block, including an up-to-date operating theatre, should be considered. During the year the County Council revised the amount of the grant payable by them in respect of infectious disease beds. The new grant was made up as follows:- £ 1. £5 per bed on a basis of 2,000 cubic feet per bed (i.e., 81 beds) 405 2. £10 per ambulance 20 3. Special additional grant in view of extension to Administration Block 100 Total £525 Financial Statement.—A financial statement for the year ending 31st March, 1933, is given below:- Loan Charges. £ s. d. Amount of Loan outstanding on 31st March, 1932 12,871 0 0 The following table shows the admissions, discharges and deaths during 1933: — Scarlet Fever. Diphtheria. Measles. Mixed Infection. Tuberculosis. Totals. Remaining in Hospital 1st January. . 69 42 6 19 136 Admitted during year Discharged during year 551 555 311 329 1 1 17 9 58 57 938 951 Died during year 3 8 — 1 2 14 Remaining in Hospital 31st December 62 16 — 13 18 109 55 Expenditure. Repayment of Loan 440 0 0 Interest on Loan 556 0 0 Structural Repairs 694 0 0 Food for Patients and Staff 4,467 0 0 Establishment and other Expenses 12,115 0 0 £18,272 0 0 Income. Patients 1,076 0 0 County Council 3,055 0 0 Other sources 107 0 0 £4,238 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. DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL, (including Tuberculosis cases) January 131.0 July 103.4 February 134.0 August 91.5 March 126.1 September 104.7 April 103.5 October 113.2 May 108.0 November 122.1 June 103.4 December 118.3 Average whole year 113.2 56 Dr. Hamilton, Resident Medical Officer, reports as follows: - AGE AND SEX OF PATIENTS ADMITTED DURING 1933. 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 42 33 70 54 37 37 16 22 165 146 311 Scarlet Fever 69 72 96 112 48 75 32 47 245 306 551 Pulm'y. Tuberculosis - - - - - - - 58 - 58 58 Measles 1 - - - - - _ _ 1 _ 1 Mixed Infection - 1 3 7 2 1 2 1 7 10 17 Totals 112 106 169 173 87 113 £0 128 418 520 938 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 3 1 - - - - 4 2 6 Scarlet Fever and Complications 1 1 1 - - 1 - - 2 2 4 Pneumonia and Meningitis 1 - - - - - - - 1 - 1 Septicaemia and Septic Pneumonia - - - - - - 1 - 1 - 1 Pulmonary Tuberculosis - - - - - - - 2 - 2 2 Totals 3 2 4 1 - 1 1 2 8 6 14 MONTHLY ADMISSIONS OF DIPHTHERIA CASES. Under 5 years. 5-10 years. 10-15 years. Over 15 years. Total. Total. m. f. m. f. m. f. m. f. m. f. January 5 6 5 6 5 3 2 2 17 17 34 February 3 1 7 6 2 2 5 1 17 10 27 March 5 3 9 6 2 3 - 3 16 15 31 April 1 5 8 4 4 2 1 2 14 13 27 May 3 2 4 3 4 5 2 2 13 12 25 June 4 2 4 4 6 3 2 2 16 11 27 July 2 - 6 4 2 2 1 2 11 8 19 August 6 2 6 4 1 2 1 2 14 10 24 September 7 2 11 8 9 9 - 2 27 21 48 October 3 6 5 6 1 2 2 11 14 25 November - - 3 2 1 4 - 2 4 8 12 December 3 4 2 1 - - - 2 5 7 12 Totals 42 33 70 54 37 37 16 22 165 146 311 57 In addition to the cases transferred after admission the following cases notified as Diphtheria were isolated on admission: — In contact with Scarlet Fever during previous six days, 13, Complicated by Pertussis, 2; complicated by broncho-pneumonia, 1; complicated by scabies, 1; Tonsillitis only, 2. Complications.—Cardiac paralysis, 3; other types of paralysis, 7; diphtheritic otitis, 17. The cases of Diphtheria were classified as follows:—Severe faucial diphtheria, 20; Severe laryngeal diphtheria, 6; Mild laryngeal diphtheria, 4; Diphtheria of moderate severity, 165; Bacteriological diphtheria, 116. Cases transferred to Cubicle Block from Diphtheria Side.—Thirty three cases were transferred in all for the following reasons:—Scarlet Fever, 17; Scarlet Fever developed after admission, 2; Pertussis, 2; Scabies, 1; Parotitis developed after admission, 4; Rubella developed after admission, 1; Asthma, 1; Influenza developed after admission, 1; Others, 2; As observation cases for possible Scarlet Fever, 2. These last two cases were not confirmed. 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 4 5 8 7 9 3 2 2 23 17 40 February 6 5 6 4 11 5 2 7 25 21 46 March 10 6 3 11 1 4 4 5 18 26 44 April 3 9 9 8 3 1 3 3 18 21 39 May 5 5 12 9 5 4 2 4 24 22 46 June 5 3 8 12 3 4 2 3 18 22 40 July 6 8 9 10 2 7 3 1 20 26 46 August 4 9 6 6 1 2 5 1 16 18 34 September 3 5 6 10 2 4 1 3 12 22 34 October 8 6 7 6 1 12 2 4 18 28 46 November 7 5 14 17 6 14 2 8 29 44 73 December 8 6 8 12 4 15 4 6 24 39 63 Totals 69 72 96 112 48 75 32 47 245 306 551 Ten of the admissions were of the septic type. The following cases notified as Scarlet Fever were isolated on admission.—As observation cases (12 unconfirmed), 36; in contact with specific parotitis, 2; complicated with pertussis, 3; in contact with typhoid fever, 1; complicated by asthma, 1; complicated by varicella, 2; rubella only, 5; tonsillitis only, 2; complicated by severe rheumatism, 1. 58 Complications.— Suppurative adenitis, 4 (some degree of adenitis was present in practically all cases); Otitis, 46; Purulent rhinitis, 40 (diphtheritic 10, streptococcal 30); Vaginal discharge, 4; Nephritis, 6 (3 cases very severe); Septic Meningitis, 1; Acute Rheumatism, 3 (one fatal case). Cases transferred to Cubicle Block from Scarlet Fever side.— forty-two patients were transferred in all for the following reasons :—Scarlejt Fever with Diphtheria, 6; Scarlet Fever with vaginal discharge, 4; As observation cases possibly Scarlet Fever, 10 (Eight cases subsequently confirmed); Scarlet Fever with Nephritis, 3; Scarlet Fever with Influenza, 2; Septic Scarlet Fever, 4; Rubella subsequent to admission 10; Others, 2; Convalescent Scarlet Fever, 1. Staff.— Members of the Staff were admitted to hospital beds suffering from the following complaints:—Colds, 7; Tonsillitis, 4; Rheumatism (post-scarlatinal), 1; Gastritis, 1; Scarlatina, 1; Rubella, 1; Injured foot, 1; Cystitis, 1. Operations at Hospital.— Tonsillectomy (Virulent Diphtheria carriers), 4; Wilde's incision, 1; Radical Mastoid, 2; Tracheotomy, 1; Drainage of extra-dural abscess, 1; Drainage of Antrum, 1. Specialist Consultants were called in for 20 patients, viz: — Otologist, 10; Surgeon 6; Physician, 4 Swabs.—2,790 swabs were taken and examined during the year in the laboratory at the Hospital. Number of Outside Authorities' Cases and. Nature. Scarlet Diphtheria. Fever. Total. From Whipps Cross Hospital 8 1 9 From Epping U.D.C. 1 24 25 From Loughton U.D.C. 1 3 4 Total 10 28 38 The following cases were transferred to Whipps Cross Hospital:—Tabes mesenterica, 1; Congenital heart disease, 1; Valvular disease of the (heart,, 1; Tachycardia, 4; Tumour of cervical glands, 1; Deep cervical abscess and quinsy, 1; Acute mastoid disease, 1; Empyema, supervening on Scarlet Fever, 1; Gangrenous throat, 1; For removal of foreign body from thigh, 1. 59 One case of sub-acute mastoid disease was transferred to Guy's Hospital. One case of severe endocarditis supervening on diphtheria was transferred to Cheyne Hospital. Duration of Treatment.—The average duration of treatment in Hospital was as follows:- Diphtheria 41.7 days. Scarlet Fever 28.2 days. Mixed Infectrions 57.2 days. The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1933:- Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.) In Hospital on 1st January, 1933 Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1933 T.B. Minus 2 14 13 - 3 T.B. Plus Group I 1 3 3 - 1 T.B. Plus Group II 16 39 40 2 13 T.B. Plus Group III - 2 1 - 1 Totals 19 58 57 2 18 Only 19 of the 58 admissions were Walthamstow cases. MEDICAL EXAMINATIONS. During the year 37 examinations were carried out by the Medical Staff in respect of the Superannuation and Sick Pay Schemes. 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 60 CREMATION. Facilities for cremation are available at tihe 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. PROPAGANDA. Your Council have arrt«uged with the Central Council for Health Education for the organisation of a Health Week and Exhibition at the Baths from November 5th to 11th, 1934. In addition, a poster hoarding at the corner of Farnan Avenue and Forest Road has been taken over from the late Empire Marketing Board for the display of health posters supplied by the Central Council for Health Education. MATERNITY AND CHILD WELFARE 62 SECTION H. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs. E. M. Richards. Ex-Officio: His Worship tiie Mayor—Alderman B. Cole, J.P. The Deputy Mayor—Councillor G. E. Lowton. Chairman of Finance Committee—Councillor E. C. Redhead. Alderman G. Gibbons, J.P. Councillor F. J. Jeanes. ,, J. C. Hammond. ,, Mrs. A. L. Meadows. ,, Mrs. C. McEntee, J.P. ,, Mrs. E. M. Miller. Councillor Mrs. L. P. Bailey. ,, G. M. Page. ,, J. J. Ford. ,, It. E. Smith. ,, Mrs. B. M. Friedberg. ,, G. H. Spaceman, J.P. ,, Mrs. E. M. Hammond. ,, T. H. Tee. ,, Miss B. A. Henderson. Co-opted Members: Mrs. V. Cossey. Mrs. W. H. Kindell. Mrs. M. A. Cross. Mrs. W. J. Sharp. Mrs. I. M. Jaceson. Mrs. W. F. Toynbee. Mr. W. H. Kindell. 63 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. Mcdical Officer and Inspector of Midwivcs: Miss Mary C. Sheppard, B.A., M.B., B.Ch., B.A.O., D.P.H. Obstetric and Puerperal Fever and Pyrexia Consultants: Miss M. M. Basden, M.D., F.R.C.S., F.C.O.G. Mr. G. F. Gibberd, M.S., F.R.C.S., M.C.O.G. Mr. Eardley Holland, M.D., F.R.C.S., F.R.C.P. Mr. Y. Lack, F.R.C.S., M.C.O.G. Mr. A. McAllister, F.R.C.S., M.C.O.G. Mr. W. McKim H. McCullagii, D.S.O., M.C., F.R.C.S., M.C.O.G. Dame Louise McIlroy, D.B.E., M.D., D.Sc., F.R.C.S. Mr. H. G. Everard Williams, M.D. Health Visitors : Miss A. C. Keenan, S.R.N., Certified Midwife, H.Y. Cert. (Superintendent). Miss M. B. Cassidy, S.R.N., Certified Midwife, H.V. Cert. Miss C. R. Douglas, S.R.N. Certified Midwife, H.V. Cert. Miss H. M. Gurnett, S.R.N., Certified Midwife, H.V. Cert. (from 12/6/33—Half-time). Miss D. G. Legg, S.R.N., Certified Midwife, H.V. Cert. (Half- time to 11/6/33 then full-time). Miss M. Page, S.R.N., Certified Midwife, H.V. Cert. Miss O. J. Panther, Cert. S.I.E.B. (Lond.) (Half-time). Miss M. A. Young, S.R.N., Certified Midwife, H.V. Cert. (Halftime). Masseuse (Half-time): Miss Kathleen M. Hill, C.S.M.M.G. Record Clerk: Miss E. Ogilvie. 64 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen. I beg to present herewith a Report on the Maternity and Child Welfare services of your Borough during 1933. During the year under review an additional session was begun at the Guildsway centre. An additional Health Visitor was appointed following the cancellation by the Woodford Urban District Council of the agreement for the Woodford Side area. I would urge the necessity of proceeding with the erection of a new building to house the Highams Park Welfare Centre. During the current year the coping stone has been added to the structure of your Council's Maternity and Child Welfare Scheme by the opening of the new Maternity Home, an institution of which you may justly feel proud. Grateful acknowledgment must be made to the Committee representing the Practitioners of the Borough in securing the general acceptance of the administrative scheme drawn up for the Maternity Home. I wish to record my appreciation of your Committee's support the assistance 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. 65 1. NOTIFICATION OF BIRTHS. One thousand four hundred and sixty-six births (70 of which belonged to other areas) were notified during the year under the Notification of Births Acts, 1907 and 1915, as follows: — Doctors and Parents 785 Midwives 681. Included in the above are 390 births which were notified as having occurred outside the Borough. Also included are 46 stillbirths, 5 of which did not belong to the area. Twenty-two were notified by Doctors and 24 by Midwives. Of the total, 14 occurred outside the area. The stillbirth rate per 1,000 population was 0.47. 2. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:- (a) Live Births. Males Females Totals Legitimate 782 842 1,624 Illegitimate 17 29 46 Total 799 871 1,670 (b) Stillbirths. Legitimate 38 2361 Illegitimate 2 2 4 Total 40 25 65 Of 1,345 birth registrations received in the Department between 1st January, 1933 and 30th December, 1933, a total of 305 were not notified in this area, but some may possibly have been notified elsewhere, especially in view of the fact that of the 1,345 registrations 91 referred to births which belonged to other areas. In addition it will be seen that the Registrar-General's figure (1,670) is 325 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. Of the 1,345 local registrations 91 are excluded, leaving a net total of 1,254, which are allocated to the Wards as follows:- 66 The local registrations for 1933 were 90 less than in 1932. Births Registered Locally, 1933. 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 11 9 10 6 11 9 10 5 4 10 7 16 53 55 108 February 10 7 6 5 9 8 8 8 6 9 8 11 47 48 95 March 9 14 7 11 12 12 13 13 10 18 11 17 62 85 147 April 7 6 5 2 5 8 2 7 9 9 12 9 40 41 81 May 4 3 3 15 8 10 15 12 14 10 18 19 62 69 131 June 7 3 10 9 11 8 4 10 7 10 10 12 49 52 101 July 12 8 2 5 10 13 6 8 7 11 20 11 57 56 113 August 13 9 9 3 14 7 5 7 11 21 13 9 65 56 121 September 6 12 6 4 6 4 3 6 9 9 5 11 35 46 81 October 5 5 6 8 6 10 4 7 7 6 10 5 38 41 79 November 6 8 4 7 6 7 7 8 18 19 13 14 54 63 117 December 7 4 2 1 13 8 6 2 5 13 7 12 40 40 80 Totals 97 88 70 76 111 104 83 93 107 145 134 146 602 652 1,254 Grand Totals 185 146 215 176 252 280 1,254 67 3. INFANT MORTALITY. The deaths of infants under one year of age were:- Males Females Total Legitimate 49 34 83 Illegitimate 5 1 6 Total 54 35 89 The death-rates of infants under one year of age per 1,000 live births when calculated on the totals given by the RegistrarGeneral are therefore:— Legitimate, 51. Illegitimate, 130. Total, 53. The Infant Mortality Rate for other areas during 1933 was as follows:- England and Wales 64 118 County Boroughs and Great Towns 67 132 Smaller Towns 56 London 59 The following table shows the causes of death of children under one year of age during 1933:- 68 SUMMARY, 1933 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 - - - - - - 2 - - 2 - 1 - 1 - - Diptheria and Croup - - - - - - - - - - - - - - - - Erysipelas - - - - - - - - 1 1 - - - - 1 - Tuberculous Meningitis - - - - - - - 1 - 1 - - 1 - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - 1 1 1 - - - - - Convulsions 4 1 - - 5 - 1 - 1 7 - 1 2 1 3 - Laryngitis - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - Pneumonia (all forms) - - 2 - 2 4 6 - 4 16 6 2 4 1 3 - Diarrhoea - - - - - 1 - - - 1 1 - - - - - Enteritis - 1 1 1 3 4 4 - - 11 5 - 3 3 - Gastritis - - - - - - 1 - - 1 1 - - - - - Syphilis - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - Inattention at Birth, wilful neglect 2 - - - 2 - - - - 2 - 1 - Suffocation, overlaying 1 - - - - Injury at Birth - - - - - - - - - - - - - - - - Atelectasis 1 1 - - 2 1 - - - 3 - 1 1 - 1 - Congenital Malformations 7 2 1 1 11 - - - - 11 9 - 2 3 4 - Premature. Birth 10 2 - - 12 - - - - 12 2 - 3 1 2 4 Atrophy, Debility and Marasmus 1 - 2 1 4 2 1 - 1 8 1 3 2 - 1 1 Inanition 1 - 1 - 2 - - - - 2 - - - 1 1 - Heart Failure 2 1 - - 3 1 - 1 - 5 9 - 1 1 - 1 Other Causes 3 - - - 3 - 1 1 - 5 - - 2 1 2 Totals 31 8 7 3 49 13 16 3 8 89 21 9 21 9 21 8 69 The death rate from Diarrhoea and Enteritis in children under 1 year of age per 1,000 live births was 7.1. 4. CHILD WELFARE. The general arrangements for Child Welfare were fully detailed in the 1930 Report. (a) Municipal Scheme.— The arrangement with the Woodford Urban District Council with regard to the health visiting in the Woodford Side area was terminated in May, 1933 by the Woodford Authority. An additional Health Visitor was appointed in order to cope with the work and to assist at the new Welfare and Ante-Natal sessions which had been commenced during the year. U]p to the cancellation of the Woodford arrangement the Woodford Health Visitor had paid 16 first visits to children under 1 year of age and 113 subsequent visits; and 139 visits to children between 1 and 5 years of age, a total of 268 visits. The equivalent of whole time Municipal Health Visitors now is 6.5, equal to one whole time Health Visitor per 225 notified births and one whole time Health Visitor per 257 registered births during 1933. During the year the Higham Hill Centre was transferred from rented premises to the former Estate Office in Guildsway. The premises, consisting of a large waiting room, a weighing room and a consulting room, were adapted, redecorated and furnished at a cost of approximately £200 and have proved to be a very great improvement on the premises previously used. An additional weighing session was commenced soon after moving into the new premises. The following table gives a list of the current Ante-Natal and Welfare Clinics:- MATERNITY AND CHILD WELFARE CLINICS. Monday 2 to 4 p.m. Expectant Mothers Low Hall Lane, Markhouse Road. Tuesday 9.30 a.m. „ „ (new cases only) Low Hall Lane, Markhouse Road. Wednesday 2.30 p.m. Expectant Mothers " Brookscroft," 564, Forest Road. Tuesday 2 to 4 p.m. Child Welfare Estate Office, 1, Guildsway, Billet Road. Tuesday 2 to 4 p.m. „ „ The Memorial Hall, Winchester Road, E.4 Wednesday 2 to 4 p.m. „ „ Low Hall Lane, Markhouse Road. Thursday 2 to 4 p.m. „ „ Low Hall Lane, Markhouse Road. Thursday 2 to 4 p.m. „ „ Estate Office, 1, Guildsway, Billet Road. Thursday 1.30 to 5 p.m. „ „ " Brookscroft," 564, Forest Road. Friday 2 to 4 p.m. „ „ Low Hall Lane, Markhouse Road. 70 In addition, the Walthamstow Child Welfare Society at Brookscroft have "special" clinics, e.g., massage and light session on days other than those specified. During the year 1934 your Council's Maternity and Child Welfare Scheme will be brought to completion by the opening of the Maternity Home at Thorpe Coombe. The ground floor, with accommodation for 20 beds, will be opened for the reception of patients from the beginning of May. In addition, a Municipal Midwife has already been appointed to carry out District Midwifery from the Home. The detailed findings at first visits paid during 1933 are given in the following table:— 71 Ward. How Fed. Kind of Food. Sleeping Accommodation. Condition of Baby. Accommodation. Breast. Breast and Hand. Hand. Cow's Milk. Patent Foods. Condensed Milk. With Mother. Cot or Cradle. Good. Fair. Bad. Whole House. Flat. Half-house. 3 Rooms. 2 Rooms. 1 Room. St. James Street 198 20 20 12 21 7 53 185 217 20 1 41 38 11 79 63 6 High Street 149 4 16 5 9 6 12 157 151 15 3 16 54 84 7 6 2 Hoe Street 229 16 27 17 11 15 37 235 237 29 6 54 17 166 6 21 8 Wood Street 201 20 31 20 18 13 33 219 218 27 7 61 11 129 1 44 6 Hale End 283 28 65 25 57 11 23 353 333 38 5 190 17 115 11 28 15 HighamHill.. 303 17 48 23 32 11 52 316 302 65 1 176 87 39 16 41 9 Total 1,363 105 207 102 148 63 210 1,465 1,458 194 23 538 224 544 120 203 46 From the above table it will be seen that of 1,675 children, 1,363, or 81.3 per cent., were breast fed on first being visited, but 210, or 12.5 per cent., had no separate sleeping accommodation. The particulars in respect of housing accommodation show that only 538 of the families visited had a house to themselves, while 46 families were living in one room. The 1932 figures were 609 and 72 respectively. 72 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 Visits. The following table shows the number and nature of visits paid by Wards during 1933:— First. Re-visits. Total. Not at homo. Dead. Removed. First Visits. Subsequent Visits. Total Visits. 1 2 3 4 5 6 7 8 9 10 11 12 Cols. 5-12. St. James Street 238 588 826 854 1,680 162 6 65 60 418 51 11 62 6 2,459 High Street 169 205 374 708 1,082 94 10 42 128 71 26 7 33 28 1,488 Hoe Street 272 252 524 692 1,216 143 7 211 75 123 18 5 23 29 1,827 Wood Street 252 387 639 880 1,519 184 9 81 73 369 41 3 44 — 2,279 Hale End 376 839 1,215 1,356 2,571 107 19 91 232 314 36 19 55 45 3,434 Higham Hill 368 526 894 1,302 2,196 361 27 144 340 465 50 27 77 26 3,639 Total 1933 1,675 2,797 4,472 5,792 10,264 1,054 78 634 908 1,760 222 72 294 134 15,126 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 73 CLINICS. Dr. Sheppard reports as follows:— "There are now six weekly Municipal Welfare sessions held in the Borough and that they are all well attended, can be seen from the following Table. The new Higham Hill Centre at No. 1, Guildsway was opened on June 1st, and is proving very popular, in fact so popular has it become that it was found necessary to start a second weekly weighing session there. The new premises are very comfortable and easily worked. The Masseuse now attends on five half days weekly. Towards the end of the year the fifth half day had to be started owing to the large waiting list. Unfortunately, a slight amount of bone weakness causing bowing of the legs has become more common during the past few years. Breast fed babies seem to suffer, if anything more, in this respect than those artificially fed and even very young babies are affected suggesting that the underlying cause is malnutrition of the mother before the baby's birth. I fear the cause is almost impossible to tackle although your Council help as far as they can by a milk grant during the last three months of pregnancy and during lactation. Fortunately, however, with careful feeding and massage the defect is soon remedied. Thanks are again due to the voluntary workers who have so ably and conscientiously assisted your staff during the past year." SUMMARY OF ATTENDANCES AT WELFARE CENTRES. Centre. First Attendances of New Cases. Re-attendances. 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 723 38 761 11884 10135 22019 22780 Higham Hill 236 157 393 2674 3088 5762 6155 Highams Park 210 80 290 3170 2124 5294 5584 Total 1933 1169 275 1444 17728 15347 33075 34519 1932 1124 251 1375 16069 12486 28555 29930 "Ante-Natal.— The increase in the numbers attending the Ante-Natal Clinic necessitated the starting of an extra session on 74 Tuesday mornings. This session is not attended by a doctor, but is for re-inspection of the cases by a Health Visitor. It has considerably helped to relieve the Monday afternoon doctor's session and therefore gives more time for individual attention. 344 new cases attended during 1933 and these made 1,297 attendances or an average of 27.2 per session, as against 24.3 per session in 1932 and 21.8 in 1931. During the year it was found necessary to refer 57 cases to a lying-in hospital for their confinement and, therefore, the completion of Thorpe Coombe is eagerly awaited. In addition to these cases, 59 patients were attended by general practitioners and 228 by midwives. Twenty sterilised maternity outfits were supplied during 1933 at cost price." Part I, Children Act, 1908.— At the end of 1933 there were 180 nurse children on the Register as compared with 134 at the end of 1932 and 143 in 1931. During the year 139 removed, 3 were adopted and 5 reached the age of nine years and consequently ceased to come under the Act. 175 new children were registered and 20 children were re-registered. There were two deaths among nurse children during 1933. Massage.—140 new cases attended for massage and these made 1,779 attendances. Sale of Milk, etc., at Clinics.— The quantity and value of Milk and Food sold and issued free during 1933 was as follows:— Sales. Value. Free Issue. £ s. d. Virol 1,290 lbs. 8 ozs. 132 0 6 25 lbs. 4 ozs. Prune and Banana Syrup 96 lbs. 8 ozs. 12 17 4 Parrish's Food 240 lbs. 11 18 3 1 lb. 12 ozs. Malted Honey 2 lbs. 0 1 8 — Maltoleine 81 lbs. 8 ozs. 4 13 4 11 lbs. 8 ozs. Cod Liver Oil 183 lbs. 3 ozs. 9 19 3 - Cod Liver Oil Emulsion 714 lbs. 2 ozs. 30 1 6 138 lbs. 8 ozs. Glaxo and Ambrosia 491 lbs. 33 15 0 86 lbs. Virol Containers 2486 10 6 11 3 Ostermilk 938 lbs. 61 16 8 196 lbs. Almata 453 lbs. 48 17 2 2 lbs. Roboleine 579 lbs. 40 19 0 33 lbs. Cod Liver Oil and Malt 496 lbs. 15 0 6 10 lbs. Cow and Gate 12,143 lbs. 816 17 9 1,980 lbs. Lactogen 201 lbs. 15 1 8 20 lbs. Dunne's Milk 16 lbs. 1 1 0 2 lbs. Hemolac 336 lbs. 25 4 2 61 lbs. £1,270 11 8 75 5. TREATMENT. (a) Orthopaedic.—The facilities provided by the Education Authority's Orthopaedic Scheme is available lor all children attending the welfare Centres. Miss Garratt 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 Poliomyelitis 2 Congenital Defects 4 Rickets (a) Genu Varum 75 Torticollis 7 (b) Genu Valgum 27 Foot Deformities 6 Erb's Paralysis 1 Pseudo Hypertrophic Scoliosis, Kyphosis, Lor- Paralysis 1 dosis 6 Osteomyelitis 1 Pes Piano Valgus 29 Miscellaneous 8 Spastic Paralysis 8 Total 175 Admissions to Brookfield Orthopaedic Hospital. (under 5 years of age). Rickets (a) General 1 (b) Genu Varum 5 (c) Genu Valgum 4 Anterior Poliomyelitis 2 Total 12 Number and Classification of Operations at Brookfield Hospital. (under 5 years of age). Osteotomy— Median Stoffel 1 (a) Femoral (1 Ball and Open Elongation Tendo Socket, 1 Sliding) 6 Achilles 1 (b) Cuneiform 2 Tenotomy of Osteoclasis 8 Tendo Achilles 1 The following figures are quoted from the School Medical Officer's Report for 1933 in order to show that the majority of defects are now being discovered at the earliest possible moment under the Maternity and Child Welfare Scheme. 76 NEW CASES SEEN. Of School Age, 49. Under School Age, 87. Total, 136. (b) Dental.— The following work was done by the Education Committee's Dental Surgeons:— Mothers. Children under 5. Cases treated 51 256 Attendances 84 270 Fillings 19 149 Extractions 178 294 General Anaesthetics 52 156 Local ,, — 10 Scalings 6 1 Dressings 3 80 Mrs. W. R. Thorne, L.D.S. reports as follows:— "In the treatment of these cases the mothers and infants attending the centres do not come under periodic dental inspection. The cases treated at the clinics under the Maternity and Child Welfare Scheme come from various sources, some are referred from the local welfare centres, some are sent by health visitors and are referred to the clinic to see what can be done; others come on their own initiative. These cases are mostly suffering from pain and are very grateful for relief. Both mothers and children are given the opportunity for complete treatment but few avail themselves of it. In the treatment of the toddler, parents are very reluctant to agree to any operation other than the extraction of the teeth. The percentage of conservative treatment is small compared with extractions. The period when the mother may receive treatment is limited and any following up of cases is out of the question. It is difficult to arrive at any accurate findings since the cases are few and may not be representative of the average mother. In the Borough there are many mothers who are wholly or partially edentulous and who have no prospect of being able to afford dentures. Unfortunately, these are neither expectant, nor nursing mothers." Mr. L. W. Elmer, L.D.S. reports as follows:— There is only one matter to which I would like to refer concerning dental treatment of expectant and nursing mothers. Up to the present this treatment has consisted to a great extent of the relief of pain. Inasmuch as this must have a certain beneficial effect upon the coming generation this is to the good, but I should 77 like to see greater numbers attending in the early days of pregnancy in order that the children may be benefited to a much greater extent than is possible at present." (c) Tonsils and Adenoids.— Nine cases were operated on under the arrangement made by the Education Committee with the Walthamstow Dispensary and one case at the Connaught Hospital. (d) Ophthalmic Defects and Minor Ailments—Children are given treatment either at the School Clinics or by special appointment. (e) Invalid Children's Aid Association.—Miss Lewis, Secretary of the local branch of the Invalid Children's Aid Association kindly reports that the following cases under five years of age were dealt with by her Association:— Table of Cases for 1933. Referred by: School Medical Officers 95 Medical Men, Hospitals, Dispensaries 39 I. C. A. A. 1 C. O. S. and other Voluntary Agencies 1 136 Suffering from: Anaemia and Debility 5 After effects of illness 1 Marasmus and Malnutrition 1 Pneumonia, Bronchitis, Asthma, etc., 2 Bones, non-T.B. 88 Congenital Deformities 16 Paralysis 10 Rheumatism, Chorea and Heart 3 Diseases of Nervous System 1 Mental Deficiency 2 Hernia 3 Diseases of the Eyes 2 Various 2 136 78 Help Given to Old and New Cases 1933. Sent to Special Hospitals and Convalescent Homes *26 Extensions from Previous Years — Provided with Surgical Boots and Appliances 84 Referred for Visiting and Advice 43 153 (*—Includes 9 admissions to Brookfield Hospital). WALTHAMSTOW CHILD WELFARE SOCIETY. The organisation, staffing and accommodation of the Society was 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. During the year an ante-natal clinic was started under the care of Dr. May Belton and 32 expectant mothers made a total of 46 attendances. 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. 1933 372 79 451 5843 4786 10629 11080 1932 388 124 512 5112 4625 9737 10249 Visits to Children under 1 year. Visits to Children 1—5 years. Grand Total. First. Subsequent. Total. 1933 336 1128 1464 2943 4407 1932 346 907 1253 2537 3790 79  Attendances at Lectures. Massage Treatments. Sunlight Treatments. Total cases admitted to Observation Ward. Local Authority's cases admitted to Observation Ward. 1933 707 1602 1508 31 1 1932 951 2173 2274 30 1 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:— 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 1169 275 1444 17728 15347 33075 34519 Voluntary Scheme 372 79 451 5843 4786 10629 11080 Total 1933 1541 354 1895 23571 20133 43704 45599 1932 1512 375 1887 21181 17111 38292 40179 Home Visits. To 1 Children unc year of age ler To Children 1-5 years, of age. Total. First. Subsequent. Total. Municipal Scheme . . Voluntary Scheme . . 1675 336 2797 1128 4472 1464 5792 2943 10264 4407 Total r1933 .. 1932 .. 2011 2153 3925 3780 5936 5933 8735 8853 14671 14786 In addition, 268 visits were paid by Woodford U.D.C. Health Visitor. 80 Percentage of notified live births represented by number of children under one 1933 108.5 year of age who attended the Centres 1932 95.8 for the first time (i.e. new cases) This percentage is unduly high because of the number of children normally resident in the area, but born outside it. Percentage of total notified births repre- 1933 25.6 sented by number of expectant mothers 1932 22.9 attending Ante-Natal Clinics This percentage has shown a gratifying increase during the last few years as is shown below:— 1933, 25.6; 1932, 22.9; 1931, 16.5; 1930, 16.7; 1929, 11.2 The figures do not represent the total amount of ante-natal care which is given, because of the number of Walthamstow mothers receiving ante-natal attention from their private doctors and from the institutions in which they are confined, both within and without the area. The Municipal figures should show a large increase in 1934 following the opening of the Maternity Home. 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 1933 :— Number of applications during 1933 6,129 Number of families assisted 1.079 Of the 6,129 applications approximately 65 per cent. were from families where the father was unemployed. 81 Scale. Amount. Approximate cost to Authority £ s. d. Free 361 pints 4 17 9 ½d. per pint 112,710 „ 1,291 9 4 Id. per pint 55,331 „ 518 14 6 l½d. per pint 644 „ 4 13 11 Half Cost 12,452 „ 84 6 2 181,498 ,, £1,904 1 8 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 18 Home Helps approved during 1933, 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 9 children were sent to Institutions under arrangements approved by your Committee. The details were as follows:—Brookfield Orthopaedic Hospital, 3; St. Margaret's Hospital, 3; Ophthalmic Convalescent Home, Mayfield 1; Lennox Home, 1; Babies Emergency Hospital, Paddington, 1. 9. HOSPITAL ACCOMMODATION FOR CONFINEMENTS. The following numbers of confinements occurred at the Institutions specified:— Mothers' Hospital, Clapton 182 Nursing Homes in Walthamstow 222 Forest Gate Hospital 67 Queen Mary's Hospital 32 Total 503 There are five Nursing Homes in the Borough with a total maximum accommodation of 29 beds for maternity cases. 82 10. WALTHAMSTOW DISTRICT NURSING ASSOCIATION. The Association continued to do good work during 1933. Mrs. Drury, the Hon. Secretary, reports that the Staff consists of the Sister-in-Charge and seven trained nurses. Eight of the eleven beds for which the Home is registered were in use during the year and a total of 84 mothers were confined as in-patients. On the District 76 Maternity cases, 249 midwifery cases and 883 general cases were attended. The total number of visits paid was 12,210. Your Council continued to make the same financial allowances to the Association as were done during 1932. During the year Dr. Cecilia Cohen, acting for the Association, arranged an excellent course of Post Graduate lectures for midwives which were well attended. Details of the lectures are given below:— Prolonged Labour Mr. R. Christie Brown. Modern Improvements in Obstetrics Mr. McKim McCullagh. Ante-Natal Care Dr. M. Sheppard. Toxaemias of Pregnancy Dr. H. W. Harding. Breach Delivery Mr. G. F. Gibberd. The lectures are being continued during the current year. 11. CONSULTANT OBSTETRICIANS. The services of the panel of Consultants under the Puerperal Fever and Pyrexia Regulations (referred to earlier in the Report) are available to Practitioners in any difficulty arising during pregnancy, labour or the puerperium. Consultants' services were provided on four occasions. Two of the patients were admitted to Hospital under the Consultant called. All the four patients made good recoveries. Recovery of fees is dccided according to the scale which has been adopted in connection with the new Maternity Home. 12. MIDWIVES ACTS, 1902—1926. Dr. Sheppard has acted as Inspector of Midwives and has carried out the routine quarterly inspections, the result 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. Eighteen midwives gave notice of intention to practice in January 1933 and 8 further notices were received in the course of the vear. The following table shows the work done by the midwives during 1933:— 83 No. of confinements attended as a midwife 603 ,, confinements attended as a maternity nurse 161 ,, Medical Aid Notices sent 110 ,, Notifications of Deaths 4 ,, Twin Births 5 ,, Stillbirths 16 ,, Notifications of liability to be a source of infection 11 ,, Notifications of laying out a dead body 1 ,, Notifications of Artificial Feeding 1 ,, Notifications of Disinfection 11 During 1932, 590 cases were attended as Midwives and 159 as Maternity Nurses. The conditions for which Medical Aid was summoned by Midwives has been summarised and were as follows:— Pregnancy:— Albuminuria 2 Ante-partum Haemorrhage 3 Advice 1 Cerebral Haemorrhage 1 Heart Trouble 1 Threatened Miscarriage 1 Total 9 Puerperium:— Pyrexia 4 Post partum Haemorrhage 4 Abdominal pain 1 Breast Abscess 1 Collapse 1 Gastritis 1 Inflamed Leg 2 Backache 1 Total 15 Labour:— Ruptured Perineum 23 Mai presentation 7 Adherent Placenta 4 Prolonged Labour 24 Placenta Praevia 1 Total 59 Infant:— Convulsions 2 Neo-natal death 1 Abnormality 4 Prematurity and Feebleness 7 Stillbirth 4 Discharge from Eye 5 Asphyxia 1 Total 24 Miscellaneous 3 Nursing Homes Registration Act, 1927.— See Public Health Section of the Report. 13. PUERPERAL FEVER AND PYREXIA. The following tables give details of the 30 cases of Puerperal Fever and Pyrexia during 1933. Of the 30 cases, a total of 8 were notified from Hospitals outside the area. The puerperal fever and pyrexia rate during 1933 was 17.2 per 1,000 births, whilst the fatality due to puerperal sepsis was 23.3 per cent. of cases of fever and pyrexia notified. 84 PUERPERAL FEVER AND PYREXIA-1953 No. of Case. Fever or Pyrexia. Date of Notification. Date Notification. Received. Age. Ward. Facilities required as per Notification Form. Date of Birth of Child, or miscarriage. Onset of Pyrexia. Date removed to Hospital Remarks. 1. Fever 9.1.33 11.1.33 28 J. All facilities available 3.1.33 5.1.33 Already in Hospital Notified from Hospital. 2. „ 11.1.33 13.1.33 23 Hi. „ „ „ not given not given „ „ „ „ 3. 4. Pyrexia „ 16.1.33 28.1.33 18.1.33 30.1.33 27 21 Hi. Hi. „ „ „ „ „ „ 11.1.33 24.1.33 14.1.33 26.1.33 Not removed „ „ Due to Influenza. - 5. Fever 18.2.33 20.2.33 37 J. „ „ „ 12.2.33 12.2.33 Already in Hospital Notified from Hospital. 6. Pyrexia 21.2.33 25.2.33 36 H.E. „ „ „ 10.2.33 14.2.33 „ „ Notified from Hospital. Femoral thrombosis. 7. „ 2.3.33 2.3.33 28 H.H. Consultant required 26.2.33 29.2.33 2.3.33 Died 4.3.33. Septicaemia. Laparotomy. 8. „ 6.3.33 6.3.33 27 H.E. „ „ 3.3.33 6.3.33 6.3.33 from Nursing Home. Died 10.3.33. Septicaemia Laparotomy. 9. Fever 9.3.33 10.3.33 26 Ho. All facilities available. Consultant visited. 27.2.33 3.3.33 not given 8.3.33 Already in Hospital Notified from Hospital. 10. Pyrexia 8.3.33 10.3.33 ? Ho. — - 8.3.33 from Nursing Home Died 15.3.33. Septicaemia Laparotomy. 11. „ 25.3.33 27.3.33 ? W. Consultant required 6.3.33 not given Not removed — 12. „ 20.3.33 21.3.33 27 H.H. „ „ not given not given Already in Nursing home — 13. „ 18.4.33 18.4.33 36 H.H. Removed to Hospital not given not given 18.4.33 85 14 Pyrexia 17.4.33 20.4.33 22 Hi All facilities available 12.4.33 15.4.33 Already in Hospital Notified from Hospital. Due to Mastitis. 15. „ 30.4.33 3.5.33 27 H.E. Consultant required 26.4.33 29.4.33 Not removed — 16. „ 24.5.33 29.5.33 36 J. All facilities available 19.5.33 20.5.33 17.5.33 Notified from Hospital. Due to Uterine Sepsis. 17. Fever 13.6.33 15.6.33 31 H.E. „ „ „ 1.6.33 not given 5.6.33 Died 12.6.33. Ruptured Perineum. 18. Pyrexia 24.6.33 26.6.33 30 Hi. Admit to Hospital 9.6.33 19.6.33 23.6.33 — 19. Fever 6.7.33 7.7.33 29 H.E. „ „ „ 29.6.33 1.7.33 3.7.33 In-patient, Nursing Home. 20. Pyrexia 14.7.33 18.7.33 39 H.E. All facilities available 9.7.33 11.7.33 8.7.33 Notified from Hospital. Due to Pyelitis. 21. „ 13.7.33 18.7.33 30 J. „ „ „ 29.6.33 30.6.33 13.7.33 Notified from Hospital. Due to Pulmonary Tuberculosis. 22. „ 6.10.33 7.10.33 26 W. „ „ „ Consultant visited 28.9.33 5.10.33 Already in Nursing Home Recovered. 23. „ 27.10.33 1.11.33 29 H.E. All facilities available 19.10.33 22.10.33 Already in Hospital Notified from Hospital. Cause Unknown. 24. „ 15.11.33 16.11.33 24 Ho. Admit to Hospital 1.11.33 14.11.33 14.11.33 — 25. „ 26.11.33 27.11.33 34 Hi. „ „ „ 22.11.33 24.11.33 25.11.33 Died. Septicaemia. Normal Labour. 26. Fever 2.12.33 4.12.33 30 H.E. In Nursing Home. Consultant visited. 29.11.33 2.12.33 3.12.33 — 27. Pyrexia 8.12.33 11.12.33 28 J. Already in Hospital not given 2.12.33 not given Abscess of Breast. Notified from Hospital. 28. „ 14.12.33 18.12.33 21 Ho. „ „ „ 29.11.33 12.12.33 29.11.33 Notified from Hospital. 29. „ 16.12.33 20.12.33 30 H.E. „ „ „ 9.12.33 not given 12.12.33 Notified from Hospital. Normal Labour. Died. 30. Fever 22.12.33 27.12.33 41 H.H. „ „ „ 14.12.33 not given 20.12.33 Notified from Hospital. Thrombosis. Died. 86 14. OPHTHALMIA NEONATORUM. The number of cases notified during the last two years were:— Year. Totals. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. 1933 7 1 3 - - 1 2 1932 9 2 1 3 1 1 1 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1933 4 3 7 - - - 1932 6 3 9 - - - Three eases 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 1933, 9 inquiry forms were completed and details are given in the accompanying table. The Registrar-General, under the "Rules for the selection of one from two or more jointly stated causes of death" allocated 7 deaths to puerperal sepsis and 2 to other puerperal causes. The rates per 1,000 are, therefore, calculated on the former figure. The following table shows the position with regard to Maternal Mortality compared with that for England and Wales:— 87 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 1,670 „ and Stillbirths 1,735 7 2 9 4.1 1.2 5.3 1.79 2.63 4.42 7 2 9 4.0 1.1 5.1 1.71 2.52 4.23 The table following this page gives full particulars of all the Maternal Deaths in respect of which inquiry forms were completed and sent to the Ministry of Health. 16. MISCELLANEOUS. (a) Propaganda.— The National Milk Publicity Council showed a film on "Milk" at the Low Hall Lane Centre on 28th September, 1933. (b) Maternity Outfits.— Following the receipt of a circular letter from the Chief Medical Officer to the Ministry of Health in November, 1932, all existing stocks of maternity outfits were returned to the makers for resterilisation. A set was selected at random in December, 1933, and was sent away for bacteriological tests to be carried out for sterility. The laboratory reported that the results were satisfactory and that the outfits were of good quality, clean and adequately sterilised. (c) Provision of Artificial Dentures.— Towards the end of the year your Council approved a scheme for the supply of artificial dentures for necessitous expectant mothers attending the Municipal Ante-Natal Clinics. The scale of recovery is based on the scale approved with regard to the Maternity Home fees. (d) Summary.— A summary of the services for Maternity and Child Welfare provided by your Council which was published in the 1932 Report applies equally to the year 1933. 88 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. 4.3.33 Septicaemia and Peritonitis 28 H.H. 2.3.33 Normal labour. Pyrexia on 3rd day. Removed to Hospital. Laparotomy for general peritonitis. Post Mortem. Peritonitis and pericarditis. Thrombosis of veins. 2. 10.3.33 Septicaemia and Peritonitis ? H.E. 6.3.33 Normal labour. Admitted to Hospital 3rd day. Immediate Laparotomy performed for peritonitis. 3. 15.3.33 Septicaemia and Peritonitis 31 H.E. 8.3.33 Normal labour. Sudden onset of Pyrexia on 5th day. Laparotomy performed. P.M. Heart slightly dilated. Lungs oedematous. 4. 12.6.33 Eclampsia 26 W. 11.6.33 Patient admitted to Hospital at commencement of fits. Died 9 hours later. Undelivered. P.M., Fatty degeneration of heart, liver and kidneys. 5. 12.6.33 Puerperal Sepsis ? H.E. 5.6.33 Five stitches in perineum. Deep sloughing occurred. 6. 6.8.33 Pulmonary Embolism 22 Ho. Nil Pregnancy and labour normal. Post Mortem revealed clot in left lung. 7. 28.11.33 Puerperal Sepsis 34 Hi. 25.11.33 Labour normal. Pyrexia 3rd day. Placenta expelled but pus found in uterus. 8. 18.12.33 Puerperal Sepsis 30 H.E. 12.12.33 B.B.A. General Septicaemia. 9. 24.12.33 Puerperal Sepsis 41 H.H. 20.12.33 Thrombosis of veins, Cellulitis and haemorrhoids.