Borough of Walthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1934. - .vv- j ■T?;, ;"V v. : : . 'y ' '• r ' 51A': ' , 'v". ' Borough of Walthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1934. INDEX. page Section A.—Statistics and Social Conditions of the Area 7 ,, B.—General Provision of Health Services in the Area 15 ,, C.—Sanitary Circumstances of the Area 22 ,, D.—Housing 28 ,, E.—Inspection and Supervision of Food 37 ,, F.—Prevalence of and Control over Infectious Diseases 45 ,, G.—Infectious Diseases Hospital 63 ,, H.—Maternity and Child Welfare 75 ,, I.—Thorpe Coombe Maternity Home 106 page Acreage 7 Adulteration 42 Ambulance 15 Anaesthetists 77 Ante-Natal Clinic 86, 113, 115 Antitoxin 55 Bacteriological Analyses 37 Bakehouses 26 Biological Tests 37 Births 9, 79 ,, Notification of 79 ,, Registration of 79 Birth Rate 9 Breast Feeding 84 Brookfield Hospital 89 Cancer 13 Caravans 27 Cerebro-Spinal Meningitis 57 Chicken Pox 58 Children Act 88 Clinies 16, 83 Closet Accommodation 23 Committees 4, 76 Comparability Factor 9 Connaught Hospital 18 Consultants 69, 98 Cowsheds 26 Cream 39 Cremation 71 Dampness 25 Deaths 9,13 ,, Infant 82 ,, Institutional 14 Death Rate 9 Dental Treatment 90 Dick Tests 51 Diphtheria 46, 54, 66 Diseases of Animals Acts 43 Disinfection 25 District Midwife 114 Drainage 23 page Encephalitis Lethargica 45 Enteric Fever 46, 55 Erysipelas 57 Essex Public Medical Service 20 Factories and Workshops Acts 43 Fishmongers 26 Food and Drugs 42 Foot Clinic 16 Health Education 71 ,, Week and Exhibition 72 ,, Visitors 77 Home Helps 95 Hospital Accommodation 18, 96 ,, , Infectious Disease 63 ,, , Smallpox 53 House-to-House Inspection 31 Housing 28 Act, 1930 34, 35 ,, Conditions 31 ,, Register 33 ,, Shortage 33 ,, Statistics 28 ,, (Tuberculosis Cases) 32 Ice Cream 26, 39 Immunisation 49 Infant Life Protection 88 ,, Mortality 81 Infectious Diseases 25, 45 ,, ,, Clinic 47 Inquests 70 Invalid Children's Aid Asscn. 91 Isolation Hospital 63 Laboratory Work 51, 69 Legislation in Force 20 Massage 88 Maternal Mortality 21, 102 Maternity and Child Welfare 75 ,, Homes and Hospitals 22, 96, 106 page Maternity Outfits 106 Measles 59, 68 Meat Inspection 41 Medical Aid 99,116 ,, Examinations 70 Midwives 21, 97, 114, 116 Milk, Assisted Scheme 95 ,, and Dairies Order 40 ,, ,, Amend. Act 40 ,, Shops 26 ,, Special Dasig. Order 40 ,, Supply 37 Miscellaneous 70 Mortuary 70 Neo-Natal Mortality 81 Notices, Sanitary 24 Nurse Children 88 Nursery School 95 Nursing 16 ,, Homes Registration Act 22 Obstetric Consultant 98 Offensive Trades 42 Ophthalmia Neonatorum 102 Ophthalmic Treatment 91 Orthopædic Treatment 89 Outworkers 44 Overcrowding 35 Parks 8 Pasteurisation 41 Pneumonia 55 Poliomyelitis 45 Population 7 Post Mortems 70 Propaganda 71 Prosecutions 42 Public Assistance 18, 20 ,, Cleansing 23 Puerperal Fever and Pyrexia 46, 99, 117 ,, Sepsis 9 Pupil Midwives 114 Rag Flock Act 28 Rainfall 73 page Rateable Value 7 Recreation Grounds 8 Refuse Disposal 23 Rent Restrictions Act 42 Rheumatism Clinic 48 Rickets 86 Rivers and Streams 22 Sanitary Inspection 24 Scarlet Fever 46, 53, 67 Schick Tests 49 Schools 27 Sewerage 23 Slaughterhouses 26 Smallpox 46, 53 Smoke Abatement 27 Social Conditions 7 Special Premises 25 St. John Ambulance 15 Staff 4,63,77,112 Statistics 9, 12 Stillbirths 79 Swimming Baths 73 Tents, Vans and Sheds 27 Thorpe Coombe Maternity Home 106 Tonsils and Adenoids 91 Tuberculosis 11, 60, 70 Tuberculous Meat 41 Unemployment 7 Unhealthy Areas 35 Vaccination 52 Variola Minor 52 Venereal Diseases 19 Vital Statistics 9, 12 Walthamstow Child Welfare Society 92 Walthamstow District Nursing Association 96 Water 22 Women's Clinic 17 Zymotic Diseases 11 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Alderman G. Gibbons, J.P. Ex-officio: His Worship The Mayor—Councillor G. R. Lowton, J.P. The Deputy Mayor—Alderman W. H. Shaw. Chairman of Finance Committee—Alderman Ross Wyld. Alderman J. C. Hammond. Alderman Mrs. M. Norrish. ,, Mrs. C. McEntee, J.P. ,, W. J. Sharp. Councillor Mrs. L. P. Bailey. Councillor Mrs. E. M. Miller ,, A. G. Bottomley. (Chairman, Sanatorium Visiting ,, W. B. Ellis. Committee.) ,, Mrs. B. M. Friedberg. ,, G. M. Page. ,, P. Friedberg. ,, E. C. Redhead. ,, W. Gillett. ,, Mrs. E. M. Richards. ,, Mrs. E. M. Hammond. 5 TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, I beg to present the following report on the work of the Public Health Department for the year 1934. The report is arranged in the form required by the Ministry of Health. The outstanding event of the year was the Health Week which was held in November. Although organised by the Central Council for Health Education, a large amount, of extra work was entailed for the staff of the Department. It is gratifying to record the excellent team work of the Public Health staff and also the friendly co-operation of the Education Department and that of many others. I would again record the unfailing consideration I have received from you, and in particular, from your Chairman. Mr. Cunningham has again contributed the sections dealing with Water, Rivers and Streams, Drainage and Sewerage, and Housing Statistics; Mr. Bell that dealing with Public Cleansing; Mr. West that dealing with Housing and particularly with the rehousing of Tuberculous oases, and Mr. Camp that dealing with the Municipal Ambulance Service. The staff of the Department have continued to work well and many have assisted in the compilation of the report. Mr. Rose, Chief Clerk, has worked unremittingly and loyally. I would again particularly thank Mr. Duncan, Chief Sanitary Inspector, for his help and for contributing those sections of the report dealing with Sanitary Inspection of the Area, Smoke Abatement, Special Premises, Tents, Vans and Sheds, Housing Inspection, etc., House-to-house Inspections, Overcrowding, Inspection and Supervision of Food, Rent Restrictions Acts, Diseases of Animals Acts, and Factories and Workshops Acts. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health, etc. 6 STAFF. Medical Officer of Health, School Medical Officer, and Medical Superintendent, Isolation Hospital, and Maternity Home. 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., Barrister-at-Law. Miss Mary C. Clarke, M.B., B.Ch., B.A.O. Consultants, Puerperal Fever and Pyrexia Regulations: (See Maternity and Child Welfare Section.) Resident Medical Officer—Isolation Hospital. Miss Mary Hamilton, M.B., B.Ch., B.A.O. Matron—Isolation Hospital. Miss V. M. Wilson, S.R.N. Infectious Disease Nurse: Miss I. H. Jennings, S.R.N., S.C.M. Foot Clinic: Chiropodists—MissM. McCallum, S.R.N., C.S.M.M.G., M.C.Ch.A. Miss L. K. Thomas, M.C.Ch.A. Clerk (part-time)—Mrs. N. Moger. Women's Clinic: Surgeon-in-Charge (part-time)—Miss M. M. Basden, M.D., F.R.C.S., F.C.O.G. 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). H. D. Perrin, (b), (d) (from R. C. Bland, A.R.S.I., (b), (d), 13/8/34). (from 1/7/34). W. R. Robinson, (b), (d) (to F. W. Kemp, A.R.S.I., (a), 30/6/34). (b), (c). T. Vaughan, (b), (c), (e). F. Northcote, A.R.S.I., (b), (c). H. A. Whipp, (b), (c). Miss 0. J. Panther, (a), (half-time to Factory and Workshops Act duties). (а) Cert. S.I.E.B. (London). (b) Cert. Inspector Meat and other Foods. (c) S.I. Cert. of R.S.I. (d) S.I. Cert. of R.S.I. and S.I.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: Dr. Bernard Dyer. Chief Clerk: R. Rose. Clerks: G. W. West, L. R. W. Kemp, R. C. Bland (to 30/6/34), Miss E. Ogilvie (from 1/7/34), R. A. C. Green, L. Rushton, F. J. Aylward, A. T. Wade, A. R. Kiggins (from 27/7/34). 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) 4,313 Population (Registrar-Generals Estimate, mid-year 1934) 135,090 Number of Assessments, 1st April, 1934 33,236 Rateable value £784,235 Sum represented by penny rate £3,165 Population .—The Registrar-General's estimate of the population at mid-year, 1934, is 135,090, a reduction of 510 on the previous figure. During the calendar year 1933 there was a natural increase of 313 in the population and 322 during 1934. The reduction in the population estimate can therefore only be correct if there was an excess of emigration over the immigration. In view, also, of the fact that a total of 578 houses was completed during 1933 and 756 during 1934, the reduction of population appears to be open to some doubt. Social Conditions.—No change from 1931 Report. Unemployment.—The degree of unemployment in the area during 1934 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 25,000, and a test showed that roughly two-thirds of the figures given below related to persons residing in Walthamstow (excluding Juveniles). The following data refer to the whole Exchange Area. Date. Men. No. remaining on Register. Amount of benefit paid during month. £ Women. Total 1934. Total 1933. 22-1-34 6,383 1,169 7,552 10,377 30,469 20-2-34 6,222 1,073 7,295 10,670 21,341 19-3-34 5,417 962 6,379 10,178 19,136 23-4-34 4,910 947 5,857 9,831 21,781 28-5-34 4,507 817 5,324 8,852 15,967 25-6-34 4,328 830 5,158 8,322 16,059 23-7-34 4.226 952 5,178 7,989 19.185 20-8-34 3,971 821 4,791 7,473 15,203 24-9-34 4,371 678 5,049 7,285 15,175 22-10-34 4.400 742 5,142 7,625 19,885 26-11-34 4,562 941 5,504 7,777 17,065 31-12-34 5,404 1,266 6,670 7,618 11,379 8 Mr. Dempsey states that the following were the registrations at the Juvenile Employment Bureau:— Fresh Applications:— Boys. Girls. Total. Insured (over 16 years) 423 298 721 Not insured (under 16 years) 618 651 1,269 Re-registrations :— Insured 519 200 719 Not insured 624 417 1,041 Total Registrations, 1934 2,184 1,566 3,750 ,, ,, 1933 2,266 1,907 4,173 Parks and Recreation Grounds :— Date Acquired. Acreage. a. r. p. Selborne Road 1873 4 0 22 Lloyd Park 1899 19 0 31 ,, ,, (Aveling Park Addition) 1912 16 3 5 Higham Hill (North Side) 1904 2 1 0 ,, ,, (Set out under an Award made under Enclosure Act, 1845) 6 2 0 ,, ,, (Spion Kop) 1912 9 1 13 Queen's Road (Set out under an Award made under Enclosure Act, 1845) 2 0 0 St. James Park — 8 2 0 Stoneydown Garden (opened 1920) — 1 1 0 Manor House — 9 0 32 Low Hall Farm Sports Ground — 52 0 0 Total 131 0 23 Epping Forest (Walthamstow portion) 383 0 0 Grand Total 514 0 23 Progress has been made in the laying out of the new Sports Ground at Low Hall Farm, and the following works are completed :— 1. South Access Road, including bridge over the Dagenham Brook. 2. Running Track and Terracing. 3. Football and Cricket Pitches. 9 Extracts from Vital Statistics.—The Registrar-General's mid-year, 1934, estimate of population (viz., 135,090) has been used for the calculation of all vital statistics:— Total. Males. Females. Live Births Legitimate 1,678 852 826 Birth rate per 1,000 of the estimated resident population 12.6 Illegitimate 37 17 20 Total 1,715 869 846 Stillbirths 60 Rate per 1,000 total (live and still) births 33.8 Deaths 1,393 Death rate per 1,000 of the estimated resident population 10.3 Deaths from puerperal causes :— Rate per 1,000 (live and still) births. Puerperal Sepsis Deaths 7 3.94 Other Puerperal Causes 5 2.81 Total 12 6.75 Death-rate of infants under one year of age:— All infants per 1,000 live births 44 Legitimate infants per 1,000 legitimate live births 44 Illegitimate infants per 1,000 illegitimate live births 54 Deaths from Measles (all ages) 22 ,, ,, Whooping Cough (all ages) 2 ,, ,, Diarrhoea (under 2 years of age) 6 The following extract is from a circular issued by the RegistrarGeneral:— Comparability Factor for adjusting the Local Death Rates of 1931 and subsequent years. " A factor is given by which the crude death-rate of the area should be multiplied in order to make it comparable, from a mortality point of view, with the crude death-rate of the country as a whole or with the mortality of any other local area, the crude death-rate of which should be similarly modified with its own factor for the purpose. " If the populations of all areas were similarly constituted as regards the proportions of their sex and age group components, their crude death-rates (deaths per 1,000 population) could be 10 accepted as valid comparative measures of the mortalities experienced by the several populations. " In practice, however, populations are not thus similarly constituted and their crude death-rates fail as true comparative mortality indexes in that their variations are not due to mortality alone but arise also from differences in their population constitution, the two elements being combined in indistinguishable proportions. In order to isolate the mortality factor it. is first necessary to identify and remove the population variable. " One of the methods commonly adopted for this purpose is to select a set of mortality sex-age rates as a standard and to ascertain the hypothetical population death-rates yielded by applying the standard mortality to the appropriate sex-age sections of the populations under review; variations in the hypothetical deathrates thus produced can only arise from differences in population constitutions and they thus provide a means of assessing the extent to which the ordinary crude death-rates should be modified in order to provide a valid mortality comparison as between one population and another. " For the present purpose, the average mortality rates experienced in England and Wales during the three years 1930/2 divided into 11 sex-age groups have been adopted as the standard and have been applied to the corresponding sex-age groups in the 1931' census population of every Borough, Urban District and Rural District in the country. The adjusting factor now supplied in respect of a given area represents the ratio of the resulting deathrate for the national 1931 census population to the similarly obtained hypothetical death-rate for the said area. The factor may be said to represent the population handicap to be applied to the area and, when multiplied by the orude death-rate experienced in the area, modifies the latter so as to make it comparable with the crude death-rate for the country as a whole or with the similarly adjusted death-rate for any other area. Strictly, the adjusting factor applies only to death-rates experienced in the year 1931 on which the several population handicaps have been measured, but population constitutions change relatively slowly, and save in exceptional circumstances, the 1931 factor may be used for practical purposes until fresh population constitutions are available from the next census." The factor for Walthamstow is 1.11 which, applied to the crude death-rate of 10.3 for 1934 yields an adjusted death-rate of 11.4 as against the figure of 11.8 for England and Wales. 11 Ratio of local crude death-rate to national crude death-rate, 0.87. Ratio of local adjusted death-rate to national crude deathrate, 0.97. The latter ratio means the adjusted death-rate for Walthamstow during 1934 was 3 per cent. below that for England and Wales. 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 0.29 against 0.24 in 1933. The Pulmonary Tuberculosis Death-rate was 0.61 per 1,000 population, and the Non-Pulmonary Death-rate was 0.11 per 1,000 population. The natural increase of population, i.e., excess of births over deaths, was 322. 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 Registrar-General's classification of causes of death by sex totals is given. These have been sub-divided locally, as accurately as possible, into age and ward groups. 12 Birth-rates, Death-rates and Analysis of Mortality in the Year 1934. England and Wales, 121 County Boroughs and Great Towns, and 135 Smaller Towns. (Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1934, but those for London and the Towns have been calculated on populations estimated to the middle of 1933.) – – – Rate per 1,000 Population . Annual Death-rate per 1,000 Population. Rate per 1,000 Live Births Percentage of Total Deaths. All Causes. Typhoid and Para-typhoid Fevers. Smallpox. Measles. Scarlet Fever. WhoopingCough Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 years). Total Deaths under 1 year. Certified by Registered Medical Practitioners Inquest Cases Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. StillBirths. England and Wales 14.8 0.62 11.8 0.00 0.00 0.09 0.02 0.05 0.10 0.14 0.64 5.5 59 90.4 6.5 2.1 1.0 121 County Boroughs and Great Towns, including London 14.7 0.66 11 .8 0.00 0.00 0.12 0.02 0.06 0.11 0.12 0.47 7.4 63 90.5 6.1 2.9 0.5 135 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) 15.0 0.67 11 .3 0.00 – 0.07 0.02 0.04 0.09 0.14 0.42 3.6 53 91.2 6.1 1.6 1.1 London 13.2 0.50 11.9 0.00 0.00 0.20 0.02 0.07 0.11 0.12 0.56 12.6 67 87.7 6.3 6.0 0.0 Walthamstow 12.6 0.44 10.3 0.00 0.00 0.16 0.00 0.01 0.05 0.15 0.44 3.5 44 89.8 5.8 4.4 0.0 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales were as follows: ,, ,, ,, Walthamstow ,, ,, Per 1,000 Live Births ,, ,, Total Births ,, ,, Live Births ,, ,, Total Births 2.03 1.95 4.03 3.94 2.57 2.46 2.91 2.81 4.60 4.41 6.99 6.75 13 Causes of and Ages at Death during the year 1934. Whole District and Wards . Causes of Death Net Deaths at the subjoined ages of " Residents " whether occurring within or without the district Wards All Ages Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards St. James Street High Street Hoe Street Wood Btreet Hale End Higham Hill No. 1 M. F. 3 4 5 6 7 8 9 10 1 Typhoid and Para-typhoid Fevers – 1 – — – — — — 1 — – – — – 1 — 2 Measles 11 11 4 6 6 6 — — — — 5 — 3 2 5 7 3 Scarlet Fever — 1 — — 1 — — — — — — — — — — 1 4 Whooping Cough 1 1 1 – – 1 – – – – 2 – – – – – 5 Diphtheria 3 5 – 2 – 6 — — — – 2 — 2 2 1 1 6 Influenza 11 10 – – – – – 3 6 12 4 3 5 3 2 4 7 Encephalitis Lethargica 2 2 — — — 1 1 1 1 — 1 1 1 — — 1 8 Cerebro-spinal Fever 1 1 – – – – – 1 1 — — — 1 1 — — 9 Tuberculosis of Respiratory System 55 28 — — 2 — 17 34 28 2 15 16 16 7 15 14 10 Other Tuberculous Diseases 6 9 1 2 3 4 2 1 1 1 4 2 1 1 2 5 11 Syphilis 3 — 1 — — — — 1 1 — — 1 — 1 — 1 12 General Paralysis of the Insane, tabes dorsalis 4 1 1 2 1 1 1 — 1 13 Cancer, malignant disease 115 102 — — — — 1 25 84 107 37 27 39 32 41 41 14 Diabetes 10 12 – – – – – 5 3 14 4 1 5 2 6 4 15 Cerebral Haemorrhage, etc. 36 20 – – – – – 2 14 40 9 2 22 5 9 9 16 Heart Disease 154 157 1 — — 5 7 15 94 189 56 47 61 52 43 52 17 Aneurysm 6 1 — — — — — 3 4 2 — — 1 3 1 18 Other Circulatory Diseases 21 33 — — — — — 5 22 27 9 5 9 10 9 12 19 Bronchitis 37 21 1 — — — — 1 14 42 8 6 12 9 13 10 20 Pneumonia (all forms) 65 53 17 6 4 2 1 12 27 49 22 21 16 13 9 37 21 Other Respiratory Diseases 3 7 — — 1 — 2 1 2 4 2 — 2 1 4 1 22 Peptic Ulcer 8 3 – – – – – 2 6 3 3 — 3 — 3 2 23 Diarrhoea, etc. (under 2 years) 4 2 6 — — — — — — — 1 — 1 — 2 2 24 Appendicitis 6 7 — — 1 — 3 2 4 3 2 2 1 3 4 1 25 Cirrhosis of Liver 3 2 – – – – – – 2 3 1 — 1 1 1 1 26 Other Diseases of Liver, etc. 4 1 1 – – – – – 1 3 2 — 1 — 1 1 27 Other Digestive Diseases 13 19 — — — 1 1 — — 30 5 2 8 3 4 10 28 Acute and Chronic Nephritis 20 23 – – – – – 3 14 26 8 6 6 7 10 6 29 Puerperal Sepsis — 7 – – – – – 7 — — 2 1 1 1 — 2 30 Other Puerperal Causes — 5 — — — — 2 3 — — 1 1 2 — 1 — 31 Congenital Debility and Malformation, Premature Birth, etc. 23 16 39 – – – – – – – 9 2 4 7 7 10 32 Senility 13 25 – – – – – – – 38 5 6 9 11 5 2 33 Suicide 12 10 — — — — — 7 11 4 4 4 2 3 4 5 34 Other Deaths from Violence 26 8 – — 1 8 6 6 7 6 7 7 2 3 6 9 35 Other Defined Causes 62 52 6 4 1 4 7 14 45 34 16 13 19 27 19 20 36 Causes ill-defined or unknown — — — — — — — — — — — — — — – – Totals 738 655 77 20 20 38 50 152 393 643 248 177 256 209 230 273 14 The total number of deaths in 1934 (1,393) compares with 1,357 during 1933, the respective death-rates per 1,000 population being 10.3 and 10.0. The main classification of deaths—those for 1933 being given in parentheses—was as follows:— Whooping Cough, 2 (7); Diphtheria, 8 (7); Pulmonary Tuberculosis, 83 (89); Non-Pulmonary Tuberculosis, 15 (11); Cancer, 217 (187); Cerebral Haemorrhage, 56 (75); Heart Disease, 311 (264); Bronchitis, 58 (62); Nephritis, 43 (33); Congenital Debility, etc., 39 (48); Suicide, 22 (21); Violence, 34 (40). Infant deaths are analysed by causes, ages and wards under the Maternity and Child Welfare Section of the Report. Institutional Deaths. Whipps Cross Hospital 231 Central Homes, Leytonstone 201 Connaught Hospital 81 Brentwood Mental Hospital 21 Queens Hospital, Hackney Road 18 St. Bartholomew's Hospital, London 17 Walthamstow Isolation Hospital 15 Forest Gate Sick Home 13 North Middlesex Hospital, Edmonton 10 London Fever Hospital, Islington 8 Victoria Park Chest Hospital, Bethnal Green 8 Middlesex Hospital, London 7 Epping Infirmary 7 Prince of Wales's Hospital, Tottenham 6 London Hospital, Whitechapel 6 German Hospital, Dalston 5 University College Hospital 5 Clock House, Walthamstow 4 St. Joseph's Hospice, Hackney 4 Queen Mary's Hospital, Stratford 4 Heathfield Nursing Home, Highams Park 4 Royal Free Hospital, Gray's Inn Road 4 Battersea General Hospital 4 East London Children's Hospital, Shadwell 4 Forest Hydro, Walthamstow 3 Guy's Hospital London 3 Mothers' Hospital, Clapton 3 Great Ormond Street Hospital 2 Royal Northern Hospital, Holloway Hackney Hospital Westminster Hospital Thorpe Coombe 2 Other Institutions 70 15 B. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. (i) Public Health Officers of the Authority.—The names and qualifications of officers employed by your Authority are given at the beginning of the Report and also in the Maternity and Child Welfare Section of the Report. 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. The Ambulance Services in the area appear to be quite adequate. 1. Municipal Service. Superintendent Camp, A.M.I.Fire E., reports as follows on the work done during 1934:— Removals Accidents Maternity False Alarm Total Mileage 1,389 526 117 3 2,035 12,720 39 maternity cases have been removed to Thorpe Coombe. The oxygen breathing apparatus, with a mixture of 7 per cent, carbon dioxide has been in use six times, for cases of gas poisoning, and collapse. It was successful on five occasions, one case proving fatal, the patient being too far gone before the oxygen could be administered. 2. Removal of Patients to Whipps Cross Hospital is carried out by Hospital Ambulances. 3. St. John Ambulance Corps. The Corps Superintendent, Mr. W. W. Perriton, reports as follows: — First Aid cases attended 1,271 Number of patients removed 813 Mileage 15,728 Number of road accidents 25 (Excluding the Epping Road post, at the Robin Hood, where there were 146 cases attended). 16 " Removed to hospital during week-end duties, 35. " Duties in the Metropolitan area included—Olympia, White City, Royal Albert Hall, St. Martin's Limbless Men's Outing, Lord Mayor's Show, Hyde Park, the Royal Wedding (there our members on duty in Whitehall had a busy time), and Walthamstow Stadium. The Dominion, Carlton, Empire Cinemas are covered every night and the Granada and Palace when required. " At Willow Walk Ambulance Station, members have attended their course of Lectures on gas attacks and received instructions on how to carry out the task of assisting the public in such an emergency. First Aid and Home Nursing classes have been held, also Lectures on " Worms " and " Blood Transfusion " by way of diversion. Two members, Ambulance Officer W. Hussey and Pte. Henrico have given blood to Hospital patients. " On Bank Holidays, in addition to Willow Walk, the substations at 'Buxton Club,' Duncan Memorial (Highams Park) and the Cardo Memorial Hut (opposite the Water Works, Forest Road) are manned. Tents are erected on the Marsh near the L. & N.E. Railway Bridge with Men and Nurses on duty. Old Folk's Dinner Parties and Sports duties have been oarried out as usual. The number of efficient members for these duties are:— No. 11. Nursing Division, 50. East and West Divisions, Men, 96." (iv) Nursing in the Home:— (a) General.—No change since 1931. (b)Infectious Diseases.—No change since 1931. (v) Clinics and Treatment Centres.—No change since 1931. Foot Clinic. Attendances at the Foot Clinic showed a weekly average of approximately 159 up to the end of March, after which they inoreased to an average of about 192 per week until the end of July and then for the remainder of the year the average dropped to 144 per week. An assistant chiropodist was engaged for four evening sessions per week during the period April to July, 1934. The maximum attendances in any one week was 210. Total attendances were 8,508 (6,392 in 1933), and of these 2,391 were by new patients, and 6,117 were re-attendances by old patients. The receipts were £356 15s. 8d. During July, 1934, No. 71, Hoe Street, the house adjoining the Foot Clinic premises, and also in the ownership of the Council, 17 was vacated, and a communicating door was made in the party wall. The two ground-floor rooms at No. 71 were made into waiting-rooms, and two new chiropodist's cubicles were provided in the vacated waiting-room at No. 69. The expansion in the premises has materially assisted in the work of the Clinic. Renewed acknowledgment must be made of the excellent work of the staff. Women 's Clinic.—MissM.Basdeu, M.D., F.R.C.S., F.C.O.G., kindly reports as follows: — "The Women's Clinic, judging from the numbers attending it, continues to meet a definite need. We have been glad to welcome 104 new patients during the year, and the average attendance has been 17.5 per session. "Contraceptive cases form only a very small proportion of those attending, and the Clinic is becoming mainly a gynaecological one. Four oases desiring contraceptive advice have attended during the year, but only two could be treated because there was no medical justification in the other oases for using contraceptive methods. It is evidently not quite understood by some doctors and patients that this Clinio, being administered under the conditions laid down by the Ministry of Health, is allowed to give contraceptive advice only where pregnancy would be detrimental to the patient's health, and that the law does not allow social and economic difficulties to be taken into consideration. "Only about 15 patients were sent with doctors' letters. It is always a pleasure to co-operate with the patient's own doctor, and to give any help possible, and all letters sent by doctors are replied to. "Twenty-eight patients were referred to Hospital, nearly all to the South London Hospital for Women, and I have operated on many patients from the Clinic at that Hospital during the year. I think they have felt it an advantage to be able to remain under the care of the Medical Officer of the Clinic, but it would be still better if this could be done without going so far from their homes, and it suggests the need for a women's hospital, possibly in the form of an extension of the new Maternity Hospital. "All are grateful for the Council's recent decision to supply medicine at the Clinic at cost price, and also to arrange for certain necessary apparatus to be obtainable at cost price. This has done much to add to the popularity of the Clinio, but I still have to refer patients to Hospital when they require such things as surgical belts, for the Clinic is not recognised by the H.S.A. or allied 18 bodies, and hardly any patients are able to pay the full price. The kindness of the Council in supplying medicine free to necessitous patients (of whom there are many) is very much appreciated." The total attendances have been as follows :— New Old Total Ante-Natal Cases 15 23 38 Gynaecological 85 260 345 Contraceptive 4 16 20 Total 104 299 403 (vi) Hospitals.—There were no changes during 1934 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 bods 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, 1934 :— Institution, Men. Women Children Total. Central Home 190 186 40 416 Whipps Cross Hospital 615 639 288 1542 Forest Gate Hospital 4 85 8 97 Margate Convalescent Home — — 9 9 Aldersbrook — — 40 40 55 infants were born to Walthamstow mothers in the Forest Gate Hospital. The number of patients from Walthamstow in Mental Hospitals was 428 on the. 31st December, 1934. 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 910 were residents of the Borough. Comparative Figures. " The following figures show the progress of the Hospital during 1934, as compared with the previous year:— 19 In-Patients. Out-Patients. No. Admitted. Average stay. Daily Average. New Cases. Attendances. 1933 1,430 22.61 88.42 13,210 69,591 1934 1,787 22.37 108.65 14,523 77,253 " Staff.—(Medical). Six Honorary Medical and Surgical Consultants and fifteen 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 (Combined post), Home Sister and Ward Sister (Combined post), twelve Sisters, including six in special departments, five Staff Nurses and thirty-eight Probationers. "Beds.—The complement of 118 beds is allocated as follows: — Medical cases, 31; Surgical, 43; Children, 30; Private Beds, 10; Observation Beds, 4. "Departments.—There are facilities for operative surgery, X-Ray work, dental, ophthalmic, massage, and electrotherapy. Pathological work is carried out partly at the Hospital and partly at other Institutions. "Operations and Treatments.—During 1934, 913 major, and 3,973 minor operations were performed, making a total of 4,886. 8,720 radiographs were taken. There were 10,876 massage treatments, also 16,047 electrical treatments, 47 special treatments, and 2,412 artificial sunlight treatments at the Comely Bank Clinic; a total of 29,382 treatments at this Clinic. "Bed Complement.—During the year the complement of beds was increased from 116 to 118 through the re-organisation of Worton Ward.'' 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 9 a.m. and 8 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.I; West London Hospital, W.6. In addition, treatment is available at special times at eleven other hospitals. 20 Outfits for taking specimens from patients are provided for practitioners, on request, by the Whitechapel (London County Council) Clinio. Essex Public Medical Service. The above Service, now some eleven years old, brings to its members benefits roughly analogous to those of the National Health Insurance Act. About 22 of the Medical Practitioners of the Borough are members of the scheme, and the Secretary kindly states that there are approximately 2,817 Walthamstow subscribers. (vii) Legislation in Force.—The Town Clerk reports that the following Legislation, etc., came into force during 1934:— 1. Essex County Council Act, 1933. 2. Local Government Act, 1933 (1st June, 1934). 3. Water Supplies (Exceptional Shortage Orders) Act, 1934. 4. Protection of Animals Act, 1934. 5. Unemployment Act, 1934. 6. Shops Act, 1934. 7. Milk Act, 1934, and Scheme made thereunder for supplying milk to Schools. 8. Order repealing Chickenpox regulations (1st December, 1934). 9. Numerous Agricultural Produce (Grading and Marking) Regulations. 10. Orders under Diseases of Animals Acts. 11'. Regulations under Children and Young Persons Act, 1933. 12. Walthamstow Corporation Act, 1934. (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, 1934, was as follows:— 1934. 1933. £ s. d. £ s. d. Total amount of out-relief granted to Walthamstow residents during year ended 31st December 54,225 1 4 53,482 16 1 21  1934. 1933. Average weekly number of Walthamstow residents in receipt of relief during year ended 31st December Men 862 890 Women 1,247 1,243 Children 1,122 1,202 Total 3,231 3,335 The reduction in the total number of persons in receipt of relief when considered along with the reduction in the number of unemployed is gratifying. The total amount of relief is £742 higher. (ix) Midwives.—(Also referred to in Maternity and Child Welfare Section.) Number of Notices of Intention to Practice January, 1934 18 Number of Notices of Intention to Practice during 1934 20 Total 38 Number of Midwives ceasing practice during 1934 10 Number of Midwives practising at end of 1934 28 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. 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. (ii) Institutional Provision for Mothers or Children. (iii) Health Visitors. (iv) Infant Life Protection. (v) Orthopædic Treatment. See Maternity and Child Welfare Section. 22 (xi) Maternity and Nursing Homes.—The total registered accommodation available in the Borough at the end of 1934 was as given in the 1933 Report. With the opening of the Municipal Maternity Home at Thorpe Coombe, the total number of maternity beds available in the town was raised from 29 to 68. The following table gives information required by the Ministry of Health:— 1. Number of applications for registration (for additional beds) Nil. 2. Number of Houses registered Nil. 3. Number of Orders made refusing or cancelling registration Nil. 4. Number of appeals against such Orders Nil. 5. Number of cases in which such Orders have been made:— (a) Confirmed on appeal Nil. (b) Disallowed Nil. 6. Number of applications for exemption from registration Nil. 7. Number of cases in which exemption has been:— (a) Granted Nil. (b) Withdrawn Nil. (c) Refused Nil. 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: Cecil Road, Holly Crescent, Forest Road (by Hale End Road), Belle Vue Road, Forest Glade, Hillcrest Road, Staffa Road (Lea Bridge Factory Estate), Forest Rise, Tamworth Avenue, Sutherland Road, Church Avenue, Yerulam Avenue. 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 the Dagenham Brook was carried out to the requirement of the Essex Sewers Commissioners. 23 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 almost completed. Closet Accommodation.—The number of cesspools in use is eight, seven of which are situated in The Avenue. It is anticipated that a new sewer will be constructed in The Avenue next year, which will reduce the number of cesspools to one. Public Cleansing. The Cleansing Superintendent, Mr. Eric Bell, M.I.P.C., reports as follows:— " The collection of house and trade refuse is carried out by means of horse-drawn vans and mechanical vehicles. " All premises are cleared once a week at least, more frequent collection being given as and when required. " Any bulky articles, such as beds and bedding, are removed and destroyed under special arrangements, whilst garden refuse is collected on payment of a small fee. " Trade refuse beyond a certain quantity is charged for, and books of tickets for this service are issued by the Department. " The total house refuse collected during the year was 24,900 tons, all of which was incinerated, whilst 3,050 tons af trade refuse was collected, part, of which was incinerated and part tipped. " Street market cleansing carried out by the Department accounted for the collection of 2,134 tons of refuse, this being disposed of in a similar manner to trade refuse. '' Street cleansing is carried out by a combination of hand labour and mechanical methods, and 2,158 tons of street refuse was collected during the year from 172,761,040 square yards of roads swept. " Mechanical gulley cleansing was introduced during the year, and one such clearance of all gulleys resulted in the removal of 750 tons of sludge." 24 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. 1934 11204 9849 1335 2501 2424 113 24053 1933 10628 10205 1828 2437 2449 115 24653 Of the 113 Statutory Notices served during 1934, 102 were complied with. The nature and variety of the work done during 1934 is shown in the following tables:— Drains tested 546 ,, reconstructed or repaired 570 ,, obstructions removed 212 ,, means of access provided 48 ,, ventilation provided or improved 93 ,, ventilation repaired 217 Soil pipes repaired 20 ,, ,, new, provided 57 Rain water pipes renewed 273 ,, ,, ,, disconnected from drains 63 Roofs repaired or renewed 809 Gutterings repaired or renewed 506 W.C. pans or traps provided 487 Gully traps provided 114 W.C. flush cisterns provided 89 ,, ,, ,, repaired 235 W.C. floors concreted 90 W.C.'s repaired and cleansed 651 W.C.'s light and ventilation improved 5 Waste pipes renewed or trapped 252 ,, ,, repaired 144 New sinks provided 162 Water supply reinstated 7 ,, ,, taken off main 7 Cisterns cleansed and covered 37 Conveniences cleansed or repaired 36 Sculleries paved 86 Yards and forecourts paved and repaired 545 Dirty houses cleansed 96 ,, rooms cleansed 3,759 Floors repaired 339 Ventilations under floors provided 267 New damp-proof courses provided 356 25 Sites concreted 9 Offensive accumulations removed 55 Animals improperly kept, removed 4 Manure receptacles provided — Stables cleansed, paved and drained 48 Manholes repaired or re-sealed 92 Other cases of dampness remedied 461 Separate Sanitary Conveniences provided to shops where both sexes are employed 2 Miscellaneous repairs 2,674 Infectious Disease. Visits to premises 1,335 Re-visits to premises 157 Visits in connection with Smallpox 97 Premises disinfected 1,151 Articles disinfected at Low Hall 11,642 Articles destroyed at Low Hall 214 Dampness in Houses. Sites concreted 9 Damp-proof courses provided 356 Yards and forecourts paved and drained 545 Roofs made watertight 809 Rain-water pipes made good 273 Guttering repaired or renewed 506 Other cases of dampness remedied 461 Ventilation under floors provided 267 House-to-house inspections 1,159 Special Premises. Number. Visits paid. Factories 152 385 Workshops 145 248 Outworkers 472 288 Slaughterhouses 10 386 Butchers' Shops 97 936 Bakehouses 49 185 Fishmongers, fish friers and curers, etc. 61 465 Eating-houses and Coffee Stalls 86 223 Ice Cream Vendors 128 58 Cowsheds 1 14 Dairies and Milkshops 177 251 Laundries 9 49 Rag and Bone Dealers 9 35 Elementary Schools 31 14 Private Schools 8 Piggeries 4 54 Street Stalls Numerous 98 Greengrocers „ 175 Stables „ 304 26 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers' Shops and Slaughterhouses. Special cleansings, 39; Paving repaired, 6; Accumulations removed, 5; New Galvanised Bins provided, 4; Drains repaired, 5; W.C.'s repaired and cleansed, 5; Yard paving repaired, 1; Floors repaired and ventilated, 3; Roofs repaired, 1. Bakehouses. Special cleansings, 58; Drains repaired, 1; W.C.'s cleansed and doors repaired, 13; Yards repaved, 3; Obstructions from drains removed, 1; W.C. cisterns repaired, 1; Floors repaired, 1; New ceilings fixed, 2; Roofs repaired, 3; Premises general repairs, 2; New W.C. pans and traps, 1. Fishmongers. Special cleansings, 42; Yards repaved, 7; Accumulations removed, 5; Roofs repaired, 2; Gutters renewed, 2; Other improvements, 12. Coffee and Eatinq Houses. Special cleansings, 23; Yard pavings repaired, 5; W.C. cisterns repaired, 1; Floors renewed, 2; Drains repaired, 3. Ice Cream Vendors. Special cleansings, 7; Special cleansing of utensils, 2; Yard paving repaired, 2; W.C. Hush improved, 1. Cowsheds and Milkshops. Special cleansings, 14; Pavings relaid, 1; Fittings and other improvements, 4; Roofs repaired, 1; W.C.'s repaired, 1; Light improved, 1. Stable Premises. Cleansings, 44; Accumulations removed, 19; Roofs repaired, 2; Pavings repaired, 6; W.C.'s repaired, 1. Laundries. Special cleansings, 6; Roofs repaired, 2; Other improvements, 6. Rag and Bone Dealers. Cleansings, 10; Paving repaired, 1. Piggeries. Cleansings, 5; Pavings relaid, 2; Re-drained, 2. 27 Smoke Abatement.— Much attention was directed during the year to this matter, and 34 nuisances were observed where the duration of smoke emission exceeded five minutes covering a period of one hour. Personal visits to the factory premises concerned have resulted in a cessation of this nuisance. In one instance, two new boilers of the Lancashire type were substituted for the vertical boiler, and in another steam injectors were fitted. Overloading boilers appears to be a false economy, and owners are recognising that in such cases the mechanical stoking apparatus works at a 50 per cent, loss in fuel consumption and fails to take the place of additional boilerage. 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 42 Slaughterhouses 9 Rag and Bone Dealers 9 Bakehouses 49 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. The Essex County Council Act, 1933, gives certain powers to the Local Authority which enables it to clear certain sites occupied by van dwellers. At the time of going to Press, the Council took advantage of these powers, and upon appeal by dwellers in three of these areas, the Court of Summary Jurisdiction—after hearing evidence on both sides and visiting the areas concerned—dismissed the appeals. This matter will be more fully dealt with in the Report for the year 1935. Schools.— The sanitary condition of schools is more fully discussed in the School Medical Officer's Report. A detailed 28 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 1934. 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 1934 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 number given separately under (b):— (i) By the Local Authority 144 (ii) By other Authorities Nil (iii) By other bodies or persons 61'2 756 (b) With State Assistance under the Housing Acts:— (i) By the Local Authority:— (a) For the purpose of Part II of the Act of 1925 Nil (b) For the purpose of Part III of the Act of 1925 and under the Financial Provision Act, 1924 144 (c) For the purpose of the Act of 1930 ... Nil (d) For other purposes Nil (ii) By other bodies or persons Nil The 756 houses are situated as follows:— Hale End Ward 354 (a) High Street Ward 1 Higham Hill Ward 207 (b) Hoe Street Ward Nil St. James Street Ward 104 (c) Wood Street Ward 90 (a) Including 12 Flats; (b) including 16 Flats; (c) including 24 Flats. N.B.— Each flat is counted as one house. 29 A scheme for the erection of 8 houses and 12 flats at Priors Croft has been submitted to the Ministry of Health for approval. The Council have under consideration the development of various other sites for housing purposes. The following information is given in the form required by the Ministry of Health:— 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) 4,579 (b) Number of inspections made for the purpose 12,835 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,159 (b) Number of inspections made for the purpose 3,917 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 80 (N.B.— These comprise individual unfit houses and those 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 2,501 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 2,424 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 98 30 (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) By owners 86 (b) By local authority in default of owners (at a cost of £32 11s. 11d.) 1 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 14 (b) By local authority in default of owners 1 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 In connection with repairs to houses under the Housing Acts, your Chief Sanitary Inspector recently reported to the Public Health Committee showing the approximate values of repairs for a given year. An extract from the report is given below:— "The Committee have had before them during the past five months estimates to the total of £3,759, dealing with 99 premises. The estimates range from £2 10s. 0d. per house upwards. This, as can be seen at a glance, works out at over £37 per house, and having regard to the fact that 2,424 Notices were complied with during the year, estimated at a cost of £37 per house, gives a figure of £88,688. If the overhead charges of 10 per cent, are deducted from this figure, a net figure of about £80,000 is obtained showing what amount is spent on the repairs to properties in this town through your Sanitary Staff. To this can be added a figure 31 of about £20,000 which is expended on various items of work by suggestion and verbal arrangements, making a total of about £100,000 compulsorily spent on the maintenance of properties through the Sanitary Department. "The Committee will remember that when presenting to the Council the five years' programme in 1930, it was estimated that 11,575 houses would be repaired during the next five years. "Each quarter a return, showing my progress in this matter, is requested by the Ministry of Health, and up to the end of December, 1934, the number of houses repaired was 10,106. "This figure represents 17 quarterly returns, and on the foregoing basis, the number of houses which will be repaired in the next' three quarters, viz., to the end of September this year, added to the foregoing, will slightly exceed my estimate given five years ago." House-to-House Inspections. During 1934, house-to-house inspections were carried out in the following streets:— Woodend Road. Kitchener Road. Marlowe Road. Ruby Road. Oakfield Road. Higham Hill Road. Pasquier Road. Renness Road. Carlton Road. Fairfield Road. Colville Road. Hamilton Road. Worcester Road. Queen Elizabeth Road. Parts of:— Exmouth Road. Edinburgh Road. Chelmsford Road. Maynard Road. Somers Road. Campbell Road. Jewel Road. Glenthorne Road. (b) General. During the year all 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. Housing Department. Mr. J. E. West, your Council's Housing Manager, has contributed the following:— "The Housing Register, which was closed by resolution of the Council in December, 1933, has diminished only very slightly in the number of applicants still requiring houses, and the Register 32 still remains closed. The only additions made have been applicants for a type of flat not considered suitable for young children, the rents of which are above the normal paid for a Council House, and also recommendations submitted by the Medical Officer of Health on medical grounds. "Approximately 1,000 names could be added to the list of registered applicants quoted below if it had been permissible to grant the requests of persons either calling at, or writing to, the Estate Office during the year. "If the correspondence received, or the number of enquiries made at the Estate Office could be considered as any criterion of the need of houses, then I regret to report that it would appear that the housing situation in Walthamstow is unsolvable. "It must be admitted that the large number of seriously overcrowded cases have been rehoused by the Council, but it is regretted that the need for still more houses is as great as ever. "Lack of available building land is now the cause of much anxiety to the Council, and as a consequence a sub-committee has been appointed to view all available vacant sites in the Borough. Steps are also being taken again to approach the Ministry of Health in order to acquire the vacant land at Salisbury Hall for the purpose of erecting further houses. "Another proposal before the Council is to explore the possibility of erecting some form of living accommodation on the vacant land in Cbuntess Road, which has been considered unfit at present for the erection of the normal type of structure. Tuberculous Cases. "So far as has been possible every consideration has been given to all oases for rehousing submitted by the Medical Officer of Health, and any vacancies arising on the Estates throughout the year have, in the first instance, been considered for such cases owing to the lack of new schemes where greater opportunities were possible to allot the appropriate type of house. The number of cases submitted in total amount to 24, of which 11 have already been rehoused, 5 have had to be deferred owing! to lack of income with which to meet the appropriate normal rent, and 8 remain on the waiting list for the appropriate type of house required. "With regard to the deferred cases, this does not necessarily mean that, the families and patients cannot be rehoused by the 33 Council, as arrangements have been made to rehouse such cases in houses which are expected to be available within the next twelve months at a very much lower rent than the normal, due to the increased subsidy which will be available on that particular type of house. This being an entirely administrative matter, it is not considered necessary nor advisable to enlarge upon this subject at the present time. Housing Register. " The present state of the Housing Register is as follows:— Number of registered applicants at time of closing of register in December, 1933 3,835 Number of new applicants up to and including 31.12.34 27 Total 3,862 Cases investigated during 1934—650. Cases rehoused 1933-1934 213 Cases rehoused 1931-1933 347 Applicants not approved 730 1,290 Balance remaining to be rehoused 2,572 The final figure can be analysed as follows:— Applicants living at a standard of over 3 per room 14 ,, ,, ,, ,, 2 and less than 3 per room 40 2 per room 51 ,, ,, ,, ,, less than 2 per room 2,003 Applicants with 2 or less in family 232 Applications deferred for various reasons 159 ,, on approved waiting list 60 Medical cases referred to above 13 2,572 "A careful study of the foregoing analysis of the Housing Register would appear to show a still large demand for houses which, as has been previously pointed out, would be much increased if consideration could be given to non-registered applicants. These latter, of course, will no doubt have to be taken into consideration if the proposed Housing Bill on overorowding eventually becomes an Act of Parliament. The demand for houses at cheaper rents is 34 also made manifest, on examination of the incomes as shown on the application forms. For example:— Per week. There are 125 applicants with incomes ranging from 30s. to 40s. „ 596 ,, ,, ,, ,, 40s. to 60s. „ 648 ,, „ ,, ,, 60s.to 70s. „ 516 ,, ,, ,, ,, 70s. to 80s. "The applicants analysed in this connection also show the number in family to be supported on the income given. Eight in family is quite a frequent number. It would appear obvious, therefore, that cheaper rents are very desirable if a decent standard of living is to be maintained. If a minimum of 60s. per week be taken as an average wage, then 25 per cent, of that income is required to pay the prevailing rent, of a five-roomed Council house. To support a family of eight on the balance is a matter which would appear to require the most careful management of a buying genius. "Another faot that has been noted is the demand for one or two bed-roomed type houses or flats. Such types are required by: — (1) Ageing couples. (2) Ageing persons. (3) Married couples with one child or two children of the same sex. "It has been the practice of the Department to keep records of applications received from our tenants who for various reasons appear to require transfer to larger or smaller houses. Such requests are most carefully scrutinised, and where possible a transfer is effected so long as the Council are not involved in any expense whatever, and providing the tenants are mutually agreed to the conditions laid down. For example:— "Tenants allocated houses seven or eight years ago may in one ease be a large adult family allotted a five-roomed house, and in another case, a small, young family allotted a three-roomed house. In the former case the children have grown up and some of them made homes of their own elsewhere. In the latter case the family have outgrown their surroundings and require segregation of the sexes. A mutual transfer is arranged. Variations of this principle are obvious, and are carried out wherever possible, even to the extent of co-operation with other landlords. 1930 Act—Slum Clearance. "The Billet Road area has, of course, already been cleared and the tenants rehoused. In the Wood Street area, Jefferies Square, Hilton Grove and Spring Gardens, these tenants have been rehoused 35 wherever possible in houses which have become vacant under other schemes. The whole of the balance remaining are anticipated to be rehoused in the scheme of 20 houses to be built in Priors Croft, and which it is hoped will be available for occupation within three months; that is in June. "Markhouse Place area tenants are anticipated to be rehoused on a scheme being prepared on the Chestnuts Farm Estate, and it is also anticipated on this Estate that accommodation will be available for all other cases which have been represented and await confirmation from the Ministry of Health. "So far as the ordinary applicant is concerned, there are no building schemes at present before the Council owing to lack of available building land." 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. The Housing Manager continued 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 anyovercrowding being permitted in the vacated rooms. .'In this connection, during the year 111' visits were made to premises from which the Council have rehoused tenants. HOUSING ACT, 1930. Second Programme. During the year your Council approved the representations of the programme which had been drawn up provisionally in the previous year. 36 The Ministry of Health held an inquiry in the matter on 2nd April, 1935, the particulars being as follows:— Walthamstow (Marlowe Road) Clearance Order, 1934. Nos. 72 to 78, Marlowe Road 4 houses Walthamstow (Brunner Road) Clearance Order, 1934. Nos. 84 to 88, Brunner Road, and Nos. 1 to 5, Lillyfield Cottages 8 „ Walthamstow (Back Road) Clearance Order, 1934. Nos. 17 to 20, Back Road 4 „ Walthamstow (College Place) Clearance Order, 1934. Nos. 2 to 34, College Place 17 „ Walthamstow (Wood Street) Clearance Order, 1934. Nos. 202 to 216, Wood Street 8 „ Walthamstow Compulsory Purchase (College Place) Order, 1934. Nos. 16 to 23, College Place 7 „ Walthamstow Compulsory Purchase (Church Lane) Order, 1934. Nos. 5 to 13, Church Lane 5 „ Walthamstow Compulsory Purchase (Mitchells Cottages) Order, 1934. Nos. 4 to 6, Mitchells Cottages 3 „ Walthamstow Compulsory Purchase (Higham Street) Order, 1934. Nos. 38, to 40a, and 42 to 48, Higham Street 6 „ Walthamstow Compulsory Purchase (Chingford Lane) Order, 1934. Nos. 1 to 4, Mill Lane, and 40 to 42, Chingford Lane 6 „ Total 68 houses Six of the houses were practically derelict at the date of the inquiry. In addition, the representation of certain other properties was approved in individual unfit houses. These totalled twelve. The properties were as follows:— 28, Shernhall Street. 52, St. Andrew's Road. 817, Forest Road. 47a, Worcester Road. 88-96, Wood Street (even Nos.). 192-194, Wood Street (even Nos.) 9, Hilton Grove, Wood Street. Steven's Cottage, Wood Street. Of these, the first three mentioned properties were demolished by the owners. Only nine now remain to be dealt with. 37 E.—INSPECTION AND SUPERVISION OF FOOD, (a) Milk Supply. The average number of cows kept in the district is 7. There is only one cowshed and 14 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 177, most of whom carry on a general shop and sell milk in bottles as they receive it. Two hundred and fifty-one visits were paid to registered premises of purveyors of milk during the year and a general improvement in the standard of cleanliness was observed. During the year 73 samples of milk were taken for bacteriological count and of these 15 were biologically tested for the presence of the tubercle bacillus with negative results. Of these 73 samples, six were obtained from schools. It is anticipated that a sample of milk will be obtained from at least one of the departments of each school during 1935. The samples taken are summarised below. Grade of Milk. No. of Samples. No. tested for T.B Grade A (T.T.) 34 12 Grade A 3 3 Pasteurised 33 — Raw 3 — Total 73 15 The following table gives the results of the analyses: — BACTERIOLOGICAL ANALYSIS OF MILK SAMPLES. Bate. Grade of Milk. Total Bacteria per c.c. Bacillus Coli absent in. Presence of Tubercle Bacillus (biological test). Remarks. 18.1.34 Pasteurised 16,000 1.0 c.c. No test Satisfactory. 17.4.34 Grade A. 30,000 0.01 c.c. Absent ,, ,, Pasteurised 11,000 — No test ,, ,, ,, 33,000 — ,, ,, ,, ,, 39,000 — ,, ,, ,, ,, 25,000 — ,, ,, 24.5.34 ,, 4,500 — ,, ,, ,, Grade A (T.T.) 3,000 0.01 c.c. Absent ,, ,, Pasteurised 11,000 — No test ,, ,, Grade A (T.T.) 5,000 0.01 c.c. Absent ,, ,, Pasteurised 12,500 — No test ,, 4.7.34 ,, 48,000 — ,, ,, ,, ,, 27,000 — ,, ,, ,, ,, 19,000 — ,, ,, ,, ,, 5,300 — ,, ,, 38 Date. Grade of Milk. Total Bacteria per c.c. Bacillus Coli absent in. Presence of Tubercle Bacillus (biological test). Remarks 11.7.34 Grade A (T.T.) 3,800 0.01 c.c. Absent Satisfactory. ,, Pasteurised 24,000 — No test „ ,, Grade A (T.T.) 9,000 0.01 c.c. Absent „ 28.8.34 Grade A 20,000 0.01 c.c. 9 9 „ ,, Pasteurised 39,000 — No test „ ,, „ 45,000 — „ „ ,, „ 37,000 — „ „ ,, „ 24,000 — „ „ ,, „ 5,200 — „ „ „ 4,000 — „ „ ,, Grade A 3,400 0.01 c.c. Absent „ 25.9.34 Pasteurised 4,300 — No test „ ,, „ 9,000 — „ „ ,, „ 3,800 — „ „ ,, „ 3,600 — „ „ ,, Grade A (T.T.) .. 5,000 0.01 c.c. Absent „ ,, „ 2,900 0.01 c.c. „ „ ,, Pasteurised 20,000 — No test „ ,, „ 18,000 — „ „ ,, Raw 31,000 0.01 c. c. „ „ 16.10.34 Pasteurised 4,700 — „ „ ,, „ 5,450 — „ 19.10.34 Grade A (T.T.) 24,000 0.01 c.c. Absent „ ,, „ 16,000 0.01 c.c. „ „ ,, Raw 13,000 1.0 c.c. No test „ 25.10.34 Grade A (T.T.) 330,000 0.001 c. c. Absent Unsatisfactory. ,, „ 280,000 0.001 c.c. „ „ ,, „ 1,800 0.01 c.c. „ Satisfactory. ,, 99 610 0.001 c.c. „ Unsatisfactory, on Coli Count. 30.10.34 „ 5,600 0.01 c.c. No test Satisfactory. ,, „ 6,800 0.01 c.c. „ „ ,, „ 6,500 0.01 c.c. „ „ ,, „ 2,200 0.01 c.c. „ „ ,, „ 2,900 0.01 c.c. „ „ ,, „ 1,080 0.01 c.c. „ „ ,, „ 2,900 0.01 c.c. „ „ ,, „ 6,800 0.01 c.c. „ „ ,, „ 2,700 0.01 c.c. „ „ ,, „ 7,800 0.01 c.c. „ „ ,, „ 2,600 0.01 c.c. „ „ ,, „ 10,700 0.01 c.c. „ „ ,, „ 11,300 0.01 c.c. „ „ 31.10.34 Raw 280,000 0.01 c.c. No test Satisfactory. 6.11.34 Grade A (T.T.) .. 2,100 0.01 c.c. „ „ „ 920 0.01 c.c. „ „ „ „ 1,980 0.01 c.c. „ „ „ „ 3,300 0.01 c.c. „ „ „ „ 8,000 0.01 c.c. „ „ „ „ 5,600 0.01 c.c. „ „ „ „ 5,200 0.01 c.c. „ „ „ „ 2,300 0.01 c.c. „ „ „ „ 6,700 0.01 c.c. „ „ 4.12.34 Pasteurised 29,000 — „ „ „ „ 27,000 — „ „ „ „ 18,000 — „ „ „ „ 48,000 — „ „ ,, „ 17,000 — „ „ „ 9,800 — „ „ 39 In addition, 9 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 Remarks. 25.10.34 13,000,000 0.0001 c.c. Not of standard of bacterial purity to be expected of a clean pasteurised cream. „ 1,000,000 0.00001 c.c. Not of standard of bacterial purity to be expected of a clean pasteurised cream. „ 5,100 1.0 c.c. High standard of bacterial purity. „ 40,200 1.0 c.c. „ „ „ 31.10.34 210,000 0.01 c.c. Purity satisfactory. „ 400 1.0 c.c. High standard of bacterial purity. „ 3,700 1.0 c.c. „ „ „ 1.12.34 4,850 1.0 c.c. „ „ „ „ 6,500 1.0 c.c. „ „ „ Nineteen 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. 14.6.34 180,000 0.01 c.c. Satisfactory, but not of high standard. „ 61,000 1.0 c.c. Satisfactory bacterial purity. „ 130,000 0.1 c.c. Satisfactory, but not of high standard. „ 64,000 1.0 c.c. Satisfactory bacterial purity. „ 15,400 0.1 c.c. „ „ „ „ 13,400 0.1 c.c. „ „ „ 21.8.34 8,300 0.1 c.c. „ „ „ „ 15,000 1.0 c.c. „ „ „ „ 210,000 1.0 c.c. Not dirty, but not of standard of bacterial purity which can be obtained. „ 460,000 0.001 c.c. Low grade of bacterial purity. „ 38,000 1.0 c.c. Satisfactory bacterial purity. „ 18,000 1.0 c.c. „ „ „ 6.9.34 4,200 1.0 c.c. High standard of bacterial purity. 20.9.34 24,000 1.0 c.c. „ „ „ „ 24,000 0.01 c.c. Satisfactory bacterial purity. „ 180,000 0.01 c.c. Count high, but as B. Coli number small considered satisfactory. „ 180,000 0.01 c. c. Count high, but as B. Coli number small considered satisfactory. „ 11,000 0.01 c. c. Satisfactory bacterial purity. „ 3,800 1.0 c.c. High standard of bacterial purity. 40 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 marked improvement in this direction. The Milk and Dairies (Amendment) Act, 1922. One purveyor of milk—having his premises outside this town —sold to your Chief Sanitary Inspector a bottle of milk to which the vendor referred as pasteurised milk. The vendor was not licensed to sell pasteurised milk, and in fact the milk was not pasteurised. Four summonses were issued arising out of this sale—two against father and son as joint defendants for referring to the milk as pasteurised contrary to Section 3 of the above Act, and two against the same defendants for not being registered with the Walthamstow Borough Council as purveyors of milk contrary to Section 6 (3) of the Milk and Dairies Order, 1926. A conviction was obtained on each count, and is recorded under "Legal Procedure." One purveyor of milk was refused registration by reason of the condition of his premises. There was no appeal against the Council's refusal. In addition to the foregoing, three purveyors of milk were warned by the Council for infringements under the Milk and Dairies (Consolidation) Act, 1915. 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:— Dealers' Licences. Supplementary Licences. In respect of:— In respect of:— Certified Milk 1 Certified Milk 2 Grade A (T.T.) Milk 6 Grade A (T.T.) Milk 5 Grade A Milk 2 Grade A Milk 1 Pasteurised Milk 32 Grade A (Pasteurised) Milk 2 Pasteurised Milk 5 Bottling Licences:— In respect of Grade A (T.T.) Milk, 2; Pasteurised Milk, 4. 41 Pasteurisation and Milk-Borne Diseases. (Extract from "Public Health January, 1935.) According to a recent report of the United States Public Health Service, 41 outbreaks of milk-borne disease were reported in the United States in 1533. In not a single outbreak had the milk been pasteurised. Milk-borne outbreaks of disease were of frequent occurrence in New York City twenty to thirty years ago. Since compulsory pasteurisation of the milk supply has been enforced, not a single milk-borne outbreak has occurred. (b) Meat and other Foods. A total of 386 visits were paid to slaughterhouses. The following were condemned and destroved:— (a) Tuberculosis. 66 Ox Lungs. 52 Ox Hearts. 21 Ox Skirts. 6 Ox Livers. 11 Ox Fats. 9 Ox Heads. 4 Ox Tripes. 2 Forequarters Beef. 3 Clods Beef. 1 Cow's Skirt. 2 Loins Beef. 1 Rump Beef. 1 Thick Flank Beef. 3 Cow Carcases and all Organs. 7 Pig 35 Pigs' Fats. 24 Pigs' Heads. 7 Pigs' Plucks. 2 Pigs' Livers. 1 Leg Pork. 2 Loins Pork. (b) Other Reasons. 32 Ox Livers. 10 Ox Tripes. 3 Ox Kidneys. 1 Ox Spleen. 1 Flank Beef. Top Ribs Beef. 1 Calf's Liver. 1 Calf's Pluck. 4 Cows' Tripes. 1 Cow's Udder. 52 Sheep's Livers. 10-lb. Tin Sheep's Livers. 4 Sheep's Lungs. 5 Sheep's Plucks. 3 Necks Mutton. 4 Breasts Mutton. 1 Saddle Mutton. 3 Legs Mutton. 31 Pigs' Livers. 8 Pigs' Plucks. 2 Pigs' Spleens. 2 Legs Pork. 4 Loins Pork. 1 Cow Carcase and all Organs. 4 Sheep Carcases and all Organs. 4 Pig Carcases and all Organs. 40 Rabbits. 3 Fowls. 1 Catfish. 1 Box Dabs. 1 Halibut (140lbs.). 6 Stones Monkfish. 5 stones Skate. 5 stones Hake. 1 trunk Cod. 2 sacks Winkles. 1 basket Shrimps. 1 barrel Crabs. 6,755 tins Cream. 6 boxes Tomatoes. 32 boats Black Currants. 500 lbs. Canadian Apple Rings. 22 rolls Celery. 42 (c) Adulteration, etc. (Food and Drugs Adulteration Act, 1928) Seventy-seven samples were submitted for analysis during the year. All were genuine. Of these 77 samples, one was in respect of a sample of tea, and another was of jam. The remaining 75 samples were of milk, two of which were informal samples. Although Walthamstow is not the Food and Drugs Authority, such good work has been carried out in the past by continuous sampling under this Act and the Milk and Dairies (Amendment) Act that no real relaxation in this matter is contemplated. Since the inception of the supply to sohool children under the Milk Marketing Board's Scheme, samples of milk so supplied are taken at the schools under this Act, and will be duly recorded in the 1935 Annual Report. OFFENSIVE TRADES. During the year, the Council sanctioned the establishing of one Fish Frier, and refused their sanction to the establishing of two Fish Friers and Curers. Legal Procedure. Milk and Dairies Order. 1926:— Fine. Total. Two Informations against two purveyors jointly for non-registration £1 each. £2. Milk and Dairies (Amendment) Act, 1922:— Two Informations against the above purveyors jointly for selling milk as pasteurised without a licence £1 each. £2. £4. THE RENT AND MORTGAGE RESTRICTIONS ACTS, 1920-1923. During the year sixteen certificates were granted to tenants and three certificates have been issued to owners upon completion of the scheduled works. In addition, four certificates were granted to owners during 1934 in respect, of original certificates granted to occupiers during 1933—the works having been completed subsequent to the end of 1933. 43 DISEASES OF ANIMALS ACTS, 1894-1928. The Importation of Dogs and Cats Order, 1928.— During the year six performing Lions were admitted under Licence into the area. The conditions of the Licence were duly observed. 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, no sheep were admitted into the area under Licences for Slaughter. The Regulation of Movement of Swine Order, 1922.— Under this Order, 940 pigs for slaughter were admitted into this Borough during the year. All notices of such movements have, as far as practicable, been followed up. In addition, six detention and isolation licences afiecting 69 pigs were in operation during the year. The conditions of the licences were duly observed in all cases. Tuberculosis Order, 1925.— Routine quarterly inspections were carried out by your Veterinary Surgeon and Chief Sanitary Inspector. No instance has arisen calling for mention. 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. (i) Number of Inspections. (2) Written Notices. (3) Ocoupiers Prosecuted. (4) factories (Inoluding Factory Laundries.) 385 12 Nil. Workshops (Including Workshop Laundries.) 248 5 Nil. Workplaces (Otherthan Outworkers' premises.) 130 7 Nil. Total 763 24 Nil. 44 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (6) Nuisances under the Public Health Acts:— Want of cleanliness 33 33 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors 4 4 — — Other nuisances 47 47 — — Sanitary accommodation insufficient 5 5 — — unsuitable or defective 11 11 not separate for sexes 2 2 — — Offences under the Factory and Workshops Acts— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences — — — — Total 103 103 Nil Nil NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1934. Wearing Apparel, making of 405 Furs 8 Brush Making 38 Artificial Flowers 2 Boxes 8 Umbrellas, etc. 1 Christmas Crackers 2 Toys 1 Furniture and Upholstery 1 Handbags 6 Total 472 45 OUTWORKERS WERE NOTIFIED FROM THE FOLLOWING AREAS. City of London 145 Bethnal Green 15 Finsbury 54 Hackney 37 Islington 8 Leyton 51 Poplar 10 St. Marylebone 4 Stepney 9 Shoreditch 12 Tottenham 5 Walthamstow 103 Westminster 10 Other Areas 9 A total of 319 visits were paid in connection with outworkers as follows:—To Homes, 283; Factories, 21; Workshops, 15. F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. General.— The accompanying tables show the age and ward incidence of the various infectious diseases which are discussed separately in later pages of the Report:— Disease. All ages. Under 1 yrs. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. 1934 1933 Smallpox 1 — — — — — 1 — — Scarlet Fever 605 681 2 118 385 56 40 4 — Diphtheria 274 334 7 57 171 26 11 2 — Enteric Fever 2 5 — — - 1 — 1 — Pneumonia 180 169 8 29 36 15 44 31 17 Puerperal Fever 13 8 — — — 2 11 — — Puerperal Pyrexia 28 22 — — — 12 16 - — Ophthalmia Neonatorum 5 7 5 — — - - - — Erysipelas 69 73 1 4 3 5 17 28 11 Encephalitis Lethargica 1 — — — 1 - - - — Cerebro-spinal Meningitis 1 7 — — 1 - - - — Chickenpox 530 409 9 112 386 17 6 — — Tuberculosis 196 156 — 6 14 50 79 45 2 Poliomyelitis — 3 — — — — — — — Measles 870 58 48 822 - - - - - Totals 1934 2775 - 80 1148 997 184 225 Ill 30 1933 - 1932 47 390 958 177 243 93 24 46 Disease. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals Smallpox 1 — - — — — 1 Scarlet Fever 96 47 70 73 175 144 605 Diphtheria 25 20 44 54 50 81 274 Enteric Fever — — — — 2 — 2 Pneumonia 49 27 18 24 25 37 180 Puerperal Fever 3 1 1 2 4 2 13 Puerperal pyrexia 5 3 9 6 1 4 28 Ophthalmia Neonatorum — 2 — 1 1 1 5 Erysipelas 9 8 16 6 8 22 69 Encephalitis Lethargica — — — — — 1 1 Cerebro-spinal Meningitis — — — — 1 — 1 Chickenpox 88 26 90 107 104 115 530 Tuberculosis 34 29 22 28 36 47 196 Measles 182 108 100 110 130 240 870 Totals 1934 492 271 370 411 537 694 2,775 1933 320 252 274 252 318 516 1,932 From the foregoing tables it will be seen that the outstanding features of 1934, were:— Increases in notification of Pneumonia, Puerperal Fever and Pyrexia, Chickenpox and Measles, and decreases in the number of cases of Scarlet Fever and Diphtheria. The statistics given in the foregoing table are those for the calendar year 1934. The Registrar-General gives the statistics for the 52 weeks ended 29th December, 1934, and these are given in the following table together with the case rates per 1,000 population both for England and "Wales and for Walthamstow:— Disease. Smallpox. Scarlet Fever. Diphtheria. Enteric Fever. Pneumonia. Puerperal Fever. Puerperal Pyrexia. Erysipelas Number 1 600 273 2 177 11 29 65 Case Rate— Walthamstow 0.007 4.44 2.02 0.01 1.31 0.08 2.14 0.48 England and Wales 0.004 3.76 1.70 0.03 Not given 0.06 0.15 0.51 The rates for Puerperal Fever and Pyrexia are better expressed in relation to the number of births (i.e. live and stillbirths) registered than to population. When calculated on this basis the rates are:— Puerperal Fever. Puerperal Pyrexia. Walthamstow 6.19 16.33 England and Wales 4.0 9.6 47 Disease. Total. Removed to Hospital. Per cent, removed to Hospital. Deaths. Deaths per cent. of cases notified. Smallpox 1 1 100.0 Nil. Nil. Scarlet Fever 605 455 75.2 1 0.16 Diphtheria 274 249 90.8 8 2.9 Enteric Fever 2 2 100.0 1 50.0 Pneumonia 180 54 30.0 118 65.5 Puerperal Fever 13 10 76.9 6 Note (i) 14.6 Puerperal Pyrexia 28 17 60.7 Ophthalmia Neonatorum 5 4 80.0 Nil. Nil. Erysipelas 69 32 46.3 Note (ii) — Cerebro-spinal Meningitis 1 1 100.0 2 Note (iii) — Chickenpox 530 — — Nil. Nil. Tuberculosis 196 138 70.4 98 50.0 Measles 870 41 4.7 22 25.2 Encephalitis Lethargica .. 1 — 4 Note (iv) — The percentage of oases of scarlet fever and diphtheria removed to Hospital remained almost identical with the 1933 percentage. Note (1)—These deaths refer only to those occurring in notified fever and pyrexia cases. The total number of maternal deaths in the area was 12. Note (ii).—Erysipelas is not a classified cause of death. Note (iii).—One fatality occurred in a non-notified case. Note (iv).—The excess of deaths over oases notified is due to cases notified in previous years. Infectious Disease Clinic.— As in previous years this Clinic was held weekly on Tuesdays at 2 p.m. The work done at the Clinic is roughly that of an Out-Patient Department to the Infectious Disease 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 oases. (c) Examination of patients after discharge from the Isolation Hospital and the reference of all doubtful heart oases to the Education Committee's Rheumatism Clinic (see School Medical Officer's Report) and "following; up" generally. (d) Diphtheria Immunisation. This Clinic is taken personally by your Medical Officer of Health. 48 The following table gives particulars of the work done during 1934:— Number of sessions held 51 Number of patients attended 2,405 Number of attendances made 3,632 Average attendance per session 47.1 Number of Scarlet Fever cases discovered 3 Number of Diphtheria cases discovered 19 Number of virulence tests taken in Diphtheria carriers 24 Number of children referred to Rheumatism Clinic 32 Number of children referred to Ear Clinic 27 Number of attendances for Diphtheria Immunisation (included above) 826 Average attendance per session 16 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 1934:— "Prevention.— The follow up of ohildren who have been discharged from the Sanatorium after scarlet fever and diphtheria, and the reference to the Rheumatism Clinic of any such who are suspected of early cardiac or other rheumatic manifestations, has now become a regular part of the Clinic's work, and I have no doubt at all that this has resulted in the detection and immediate treatment of many children whose rheumatism might otherwise have progressed to more serious and crippling degrees. Of the 15 ohildren who came to the Clinic after scarlet fever, no less than 9 were thought to have some cardiac effect, while of 11 children who had diphtheria, 7 were found to have some abnormality of the heart. With the help of Mr. Rushton I have analysed the after history of all those children attending the Clinic since 1931, whose rheumatism had first been noted nfter scarlet fever or diphtheria. The results are shown in the following table:— 1931 1932 1933 1934 Number of cases referred to Clinic 41 41 32 25 Number discharged after 1 attendance 6 8 8 3 Number kept under observation for several months, now discharged with normal heart 20 22 9 15 Number discharged on account of over age or through reference to private Doctor or Hospital 12 4 5 - Number remaining under observation with cardiac defect 3 7 10 7 49 "From the point of view of the utility of the clinic, perhaps the most interesting group of these children is the last, namely, those who have been kept under observation on account of their persistent cardiac defects. The history of these 27 children is as follows:— 15 of them are remaining under observation because of a persistent mitral murmur, but all are not only attending school full time, but are able to join in the school games and exercises, and are in fact leading a normal life. It is particularly interesting that one of these children was at one time sufficiently crippled with rheumatism to have to attend the Physically Defective School. 4 children are able to put in full attendance at their school, but are still held to be unfit to do games or exercises, while 2 children are at present attending the Physically Defective Centre. Lastly, 5 children are remaining under observation at the Clinic for heart defects which are regarded as having dated from birth. The purpose of this analysis has been to see whether the follow up of these children suspected of rheumatism after scarlet fever and diphtheria is worth while, and it seems to me that the evidence is in favour of continuing this preventive work, for it is a striking thing that of the 27 children sent to the Clinic in this way, and all of them found to have cardiac mischief, no less than 16 are now able to lead perfectly normal lives." Diphtheria Immunisation.— The Clinic was carried along the lines detailed in the report for 1933. As far as possible, many children under five years of age were Schick tested in addition to all children over that age. These pre-Schicks in young children were done mainly as a control in the use of alum precipitated toxin which was brought into use in children under eight years of age at the end of the year. In the few cases done with this prophylactic, there was no failure to obtain a negative post Schick four weeks after the injection. Children over eight years of age were immunised either with toxoid antitoxin or flocoules (three doses at weekly intervals with a post Schick one month after the last). A summary of the work done during the year is given below:— Diphtheria Immunisation, 1934. Shick tested for the first time 339 Negative and pseudo and negative 119 339 Positive and pseudo and positive 220 Immunised without being Schick tested 34 Number of partly-immunised cases brought forward from 1933 19 273 Number having one or more immunisation doses 273 Total number of Schick tests 490 50 Results of Schick Tests following Immunisation. Negative Schick after 1 dose of A. P. T. 9 ,, ,, ,, 3 doses of T.A.M. orT.A.F. 134 ,, ,, ,, 4 ,, ,, ,, 18 ,, ,, ,, 5 ,, ,, ,, 2 Number of immunisations not completed at end of year 75 Number leaving area before completion 29 Number not completing immunising course 6 Total 273 Number of children of school age immunised 192 ,, ,, pre-school age immunised 79 The total number of children who gave negative Schick tests or whose immunisation wag completed during 1934 was 373. These were made up as follows:—Immunisation Clinic, 211; Forest Hall, 76; Brookfield Hospital, 76; Northcott's School, 25. The names and addresses of the 27 children leaving the area before the completion of their immunisation were reported forward to the Medical Officers of Health of the respective areas. The various means in use for drawing the attention of parents to the facilities of the immunisation scheme were detailed in the report for 1933 and were continued during the year under review. In addition, a film depicting the work in progress at the Heston & Isleworth Clinic, was exhibited during the Health Week. Consideration of the average attendances per clinic before and after Health Week is of some interest:— Average attendances to November 6th (beginning of Health Week) 13.4 Average attendances for 6 weeks preceding November 6th 221 Average attendances for 6 weeks following November 6th 36.8 The increased attendances may be partly due to personal recommendations by the parents who have brought their children to the clinic but, on the other hand, it is frequently observed that the parents have attended solely as a result of the Health Week propaganda. The same factor is being observed during the beginning of the present year, but in addition, of course, there has been the recent publicity with regard to the Leeds epidemic. Whatever the cause, the average attendance per clinic since the beginning of 1935 has been 54, in spite of the fact that the clinics have been duplicated to two per week. In addition, up to the end of February 195 new oases have attended the clinic, which is only 16 cases less than the total done during the whole of 1934. 51 It must be stressed that immunisation on the scale which is current at present will only protect the individual immunised and can only lessen the incidence of diphtheria in the community to a very slight degree, if at all. It is stated that between thirty and fifty per cent, of the pre-school population must be protected before any marked lessening of the incidence of diphtheria can be expected. The experience of certain cities where immunisation has been carried out on a wide scale is given below:— City of Providence (U.S.A.): Population 271,000.—The annual report for 1933 states that the last death of a resident from diphtheria occurred in April, 1932. Some 50 per cent, of the population aged 0—4 years and some 95 per cent, of those aged 5—14 years are protected. During the nine years 1924-1932 the average number of cases of diphtheria per annum was 278.5 with 23.7 deaths. In 1933 there were 73 cases with 3 deaths. Of these, 19 cases were among non-residents who yielded all the fatalities. St. Auburn (U.S.A.)—In 1920 the diphtheria mortality was 28 deaths per 100,000 and diphtheria immunisation was started, and by 1924 85 per cent, of the children had been immunised. From 1925 to 1930 there was not a single death from diphtheria in St. Auburn. In Hamilton, on Lake Ontario, with a population of 160,000 the mortality rate for eighteen years was twenty-four per 100,000. Isolation, disinfection and detection of carriers were equally ineffective dn controlling the disease. Immunisation of children from one to fifteen years of age was begun in 1922. By 1927, the local authority found that the diphtheria hospital had gone out of use, and it was permanently closed. Dick Tests.—52 children were tested, 13 being positive. MUNICIPAL LABORATORY. The following numbers of diphtheria swabs were examined during 1934:— Swabs Negative Positive Totals Private Practitioners 1,500 144 1,644 Health Department 406 62 468 School Medical Department 682 24 706 Totals 2,588 230 2,818 The total number of diphtheria specimens compares with 3,533 in 1933. 52 From 25th September onwards, smears of all diphtheria swabs were examined directly. Up to the end of the year, 732 were so examined, 670 being negative. Of the remaining 62, 24 were positive on direct examination and a further 38 were positive on culture, although negative on direct examination. In spite of the additional work entailed for Mr. West the practice has been continued in view of the fact that on the 24 cases the diagnosis was established at least 17 to 18 hours earlier than under the old arrangements with an equal acceleration in the time at which antitoxin was given to the patient. In addition, 180 specimens of Urine were examined as compared with 161 in 1933. A total of 5,219 tubes of culture media were made by Mr. West and of these 2,160 were sent to the Sanatorium. The Essex County Council also provide facilities for examination of pathological specimens and the County Medical Officer states that 692 specimens were examined for local Practitioners during 1934 as follows:— Diphtheria Swabs, 66; Sputa, 566; Typhoid Specimens, 13; Ringworm Specimens, 7; Miscellaneous Specimens, 40; Diphtheria Virulence Tests, 8. The total for the previous year was 763. VARIOLA MINOR. One case was notified during 1934. The patient was a male aged 29, working for himself as a rag and bone merchant. He was unvaccinated and the source of infection was unknown. Although he had traded in the district for some three days while infectious, no further cases came to light. Approximately half a ton of rags was disinfected in Walthamstow and another large quantity was disinfected in a Yorkshire town to which they had been sent before the case was discovered. VACCINATION. Mr. E. Sharp, Vaccination Officer for the Area, has furnished the following return for 1934:— Births Registered. Successfully Vaccinated. Percentage Vaccinated. Insusceptible. Exemptions. Deaths before Vaccinated. Post poned 1,424 241 16.9 1 802 43 31 In addition to the above, 133 primary vaccinations were recorded, and 13 revaccinations. 53 During 1934 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 26.9 per cent, were vaccinated. HOSPITAL TREATMENT OF SMALLPOX. No case of Smallpox was 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 February to admit the Walthamstow case, which was discharged on March 9th. SCARLET FEVER. A total of 605 cases of Scarlet Fever was notified in 1934, as compared with 681 in 1933. The following tables show the incidence by months, ages and wards:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 80 1 14 54 6 5 — — February 43 — 11 25 3 4 — — March 46 — 7 28 7 4 — — April 31 — 5 15 7 4 — — May 41 — 10 25 2 4 — — June 46 — 11 25 4 5 1 — July 32 — 3 26 2 — 1 — August 33 1 9 19 4 — — — September 58 — 9 42 4 2 1 — October 72 — 15 46 5 5 1 — November 63 — 13 42 5 3 — — December 60 — 11 38 7 4 — — Totals 1934 605 2 118 385 56 40 4 - 1933 681 1 144 425 64 44 3 — 54 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 7 10 9 8 23 23 February 6 6 4 5 13 9 March 8 5 5 3 15 10 April 3 3 4 7 7 7 May 3 1 1 9 12 15 June 5 — 4 7 16 14 July 4 1 5 9 12 1 August 6 1 5 3 7 11 September 20 3 3 7 16 9 October 15 6 12 5 17 17 November 13 4 11 6 13 16 December 6 7 7 4 24 12 Totals 1934 96 47 70 73 175 144 1933 90 105 76 93 114 203 The percentage of cases removed to Hospital during 1934 was 75.2 against 76.3 in 1933. No case was refused admission. DIPHTHERIA. A total of 274 cases of Diphtheria was notified during 1934 as compared with 334 in 1933. The following tables show the incidence by months, ages and wards:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 29 - 8 17 2 1 1 — February 30 1 8 19 1 1 — — March 25 1 6 16 1 1 — — April 10 — 2 6 1 1 — — May 19 1 3 10 3 2 — — June 19 — 3 10 6 — — — July 14 — 5 5 4 — — — August 19 1 2 11 5 — — — September 32 — 5 24 1 2 — — October 26 — 5 19 1 1 — — November 20 — 3 15 1 1 — — December 31 3 7 19 — 1 1 — Totals 1934 274 7 57 171 26 11 2 — 1933 334 7 76 199 25 23 4 — 55 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 5 3 7 2 4 8 February 2 3 8 4 4 9 March 2 3 3 1 3 13 April 3 3 1 — 2 1 May — 2 2 8 2 5 June 1 1 — 4 7 6 July 1 — 2 2 4 5 August 2 1 1 3 6 6 September 1 — 3 18 4 6 October - 2 1 8 4 11 November 4 — 5 2 1 8 December 4 2 11 2 9 3 Totals 1934 25 20 44 54 50 81 1933 56 56 50 36 45 91 The percentage of cases removed to Hospital in 1934 was 90.8 against 90.1 in 1933. No case was 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 unless the disease is extremely mild. 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 1934, a total of 206 phials containing 1,432,000 units of Diphtheria Antitoxin and 46 phials containing 460 c.c.s. of Scarlet Fever Antitoxin was issued. ENTERIC FEVER. Two cases were notified. In one case the patient progressed well and made a complete recovery. The second case proved fatal, the infection probably being introduced from abroad. 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. 56 Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 23 - 2 3 1 8 6 3 February 24 1 4 9 — 4 4 2 March 45 4 13 9 7 7 1 4 April 21 1 5 4 1 2 5 3 May 8 — 1 3 — 3 1 — June 10 — 1 1 1 6 1 — July 3 — — 1 — 1 1 — August 6 — 2 — — 1 1 2 September 8 1 — 2 — 3 1 1 October 7 — — — — 2 5 — November 15 1 — — 2 5 5 2 December 10 — 1 4 3 2 — — Totals 1934 180 8 29 36 15 44 31 17 1933 169 5 23 25 20 46 34 16 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 10 4 3 — 2 4 February 5 4 2 1 1 11 March 11 7 1 11 7 8 April 6 4 3 — 4 4 May 1 3 — 1 1 2 June 2 — — — 4 4 July — — 1 2 — — August 3 — — 2 1 — September 2 1 3 1 — 1 October 2 2 — — 2 1 November 4 1 2 5 1 2 December 3 1 3 1 2 — Totals 1934 49 27 18 24 25 37 1933 37 23 27 19 27 36 PUERPERAL FEVER AND PYREXIA. See Maternity and Child Welfare Section. OPHTHALMIA NEONATORUM. See Maternity and Child Welfare Section. 57 ERYSIPELAS. The following tables show the incidence by months, ages and wards:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 13 1 1 1 1 4 5 — February 5 — — — 1 2 2 - March 7 — — — — 1 4 2 April 7 - — — — 3 2 2 May 3 — — 2 — 1 — - June 5 — 2 — - 1 1 1 July 4 — — — — — 3 1 August 6 — 1 — — 1 2 2 September 2 - - - - - 2 — October 4 — — - - — 3 1 November 5 - - - 2 1 1 1 December 8 - — - 1 3 3 1 Totals 1934 69 1 4 I! 5 17 28 11 1933 73 2 — 4 5 32 25 5 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 2 1 4 1 - 5 February — 1 1 — — 3 March 1 — 1 1 2 2 April — 3 1 — — 3 May 1 — — — — 2 June 2 — 1 1 — 1 July 1 — 1 1 1 — August 1 1 1 2 — 1 September — — — — 1 1 October — 1 2 — 1 - November — — 2 — 1 2 December 1 1 2 — 2 2 Totals 1934 9 8 16 6 8 22 1933 18 10 11 7 11 16 CEREBRO-SPINAL MENINGITIS. One case was notified in a female aged 7 years. She was notified from Whipps Cross Hospital and transferred to Chingford Sanatorium for suspected Scarlet Fever. She progressed well at first and then relapsed, but finally recovered. 58 CHICKEN POX. Chicken Pox remained notifiable except in vaccinated children under 10 years of age, until the Walthamstow (Chicken Pox Regulations) Rescission Order came into force on December, 1st, after which date the disease was not notifiable. The incidence by months, ages and wards was as follows:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 112 4 25 75 7 1 - - February 45 — 13 29 2 1 - - March 75 2 16 54 2 1 - - April 37 1 7 27 2 — - — May 20 — 6 13 — 1 - — June 42 — 10 31 1 — - — July 67 1 13 52 — 1 - — August 39 1 5 31 2 — - - September 11 — 4 5 1 1 - - October 33 — 3 30 — - - November 49 — 10 39 - - - - December — Not notifiable. — — - - Totals 1934 530 9 112 386 17 6 - - 1933 409 15 92 278 20 4 - - Month. St. James Street High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 14 8 13 52 10 15 February 7 3 5 21 3 6 March 31 3 1 17 16 7 April 7 2 4 8 9 7 May — — 3 2 3 12 June — 3 11 1 17 10 July 1 2 18 — 21 25 August 2 — 6 4 15 12 September 1 2 3 — 2 3 October 7 3 6 - 5 12 November 18 - 20 2 3 6 December Not notifiable. Totals 1934 88 26 90 107 104 115 1933 76 19 69 78 64 103 Except in a few secondary cases, all cases notified by private practitioners were visited by a Medical Officer. 59 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 1934 was an epidemic year, the number of notifications being 870 against 753 in the last 10 months of 1932 (the last epidemic year). Only 11 cases were notified by parents. In addition there were 1,909 cases of Measles reported by Head Teachers, and mainly in schoolchildren of 5-14 years, against only 1,525 in 1932. Month. Total. Under 1 yr. 1-5 yrs. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 16 1 15 2 4 1 1 6 2 February 41 3 38 6 8 7 3 2 15 March 337 12 325 80 36 32 74 42 73 April 312 20 292 58 33 43 27 45 106 May 121 8 113 29 18 15 3 26 30 June 31 2 29 6 5 2 2 6 10 July 4 — 4 1 2 — — — 1 August 2 — 2 — — — — 1 1 September 3 — 3 — 1 — — 1 1 October 1 1 — — 1 — — — - November 1 1 — — — — — — 1 December 1 — 1 — — — — 1 — Totals 1934 870 48 822 182 108 100 110 130 240 1933 58 8 50 2 9 6 1 16 24 Forty-one children were admitted to the Sanatorium for treatment, and in addition a considerable number were admitted to Whipps Cross Hospital. In view of the insufficient accommodation available at the Sanatorium during an epidemic of Measles, only complicated cases could be admitted, but, fortunately, no case had to be refused admission. The death-rate per 1,000 registered live births was 12.8, against nil in 1933. The deaths occurred as follows:— at Isolation Hospital, 9; at Whipps Cross Hospital, 9; at home, 4; Total, 22. Measles Serum.— The arrangements detailed in the report for 1932 were continued and under which the local practitioners were asked to notify the names of any healthy convalescent adults 60 willing to give blood for the preparation of serum. Four such donors were forthcoming and the serum was prepared by Dr. Nabarro at Great Ormond Street Hospital, one-half being earmarked for use in Walthamstow patients. Serum was used at the Sanatorium and at the Connaught Hospital. In 15 cases complete protection was obtained, in 10 partial, and in one no protection. The serum was of inestimable value in dealing with cross infection in the wards at the Sanatorium, more particularly in view of the shortage of cubicle beds. Prevention of Blindness.— No action was necessary under Seotion 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 1934 :— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary . Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 yr. — — — — — — 1 - 1— 5 yrs. 1 — 2 3 2 - 2 3 5—10 yrs- — 2 4 2 — — — 2 10—15 yrs. — 1 3 2 — — 2 — 15—20 yrs. 7 11 2 3 1 5 1 — 20—25 yrs. 10 14 1 2 5 6 - 1 25—35 yrs. 29 11 6 1 15 4 - — 35—45 yrs. 20 11 1 — 11 4 - 1 45—55 yrs. 22 5 — — 15 6 - — 55—65 yrs. 14 3 — 1 6 1 - 1 65 yrs. and upwards 1 — 1 — — 2 — 1 Totals 104 58 20 14 55 28 6 9 162 34 83 15 196 98 The 98 deaths represent a death-rate of 0.72 per 1,000 population. 61 The returns for the past two years are compared below:— Year. New Cases. Total. Deaths. Total. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. 1934 104 58 20 14 196 55 28 6 9 98 1933 56 55 27 18 156 47 42 5 6 100 The periods elapsing between notification and death and the number of cases not notified were as follows:— Under 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. Over 12 months. Not Notified. Notified after death. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 9 3 8 — 7 — 1 1 46 — 8 6 4 5 The ratio of deaths in non-notified oases (i.e., columns 11-14 above) to total deaths from Tuberculosis was 23 to 98 or 1 to 4.2. Appropriate action was taken, when necessary, with regard to non-notification. The table given below shows the number of cases on the Register at the beginning and end of 1934:— Pulmonary. Total. NonPulmonary . Total. Grand Total. No. on Register m. f. m. f. 1st January 928 841 1,769 487 443 930 2,699 Notified during 1934 104 58 162 20 14 34 196 Total 1,032 899 1,931 507 457 964 2,895 Removed from Register, 1934 64 40 104 17 13 30 134 No. on Register 31st December 968 859 1,827 490 444 934 2,761 62 134 removals from the Register were made up as follows:— Deaths. Removals. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. 44 23 5 4 20 17 12 9 67 9 37 21 76 58 134 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 oases not notified prior to death. Treatment of Tuberculosis. Treatment is given under the Essex County Council's Scheme. The admissions to Hospital during 1934, were:— Pulmonary. Non-Pulmonary. Total. M. F. M. F. Adults 78 42 3 2 125 Children 3 5 2 3 13 No action was necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or Section 62 of the Public Health Act, 1925. An Outbreak of Somnambulistic Fits.— In the middle of July a number of boys at a residential industrial school in the town showed symptoms of an epileptiform type of illness. In all 18 boys were removed to Hospital and sporadic cases arose up till about October. The first child affected appears to have had a definite epileptie attack. In the early stages, in the absence of a definite diagnosis, the possibility of botulism was considered, but this was soon removed by the fact that faecal swabs gave negative results. Neurological and Psychological consultants were called in by the Home Office and the School Authorities. It was considered that the first cases showed purposely simulated fits followed by a general outbreak of somnambulistic fits. The state of apprehension affected a group of boys peculiarly susceptible to the emotional influences surrounding them, with the result that the resulting individual reactions were somnambulistic manifestations of the state they feared. 63 Adequate treatment was initiated largely on psycho-therapeutic lines with the result that no further trouble occurred after October. Infectious Diseases Notified by Medical Staff.— Chickenpox, 64; Diphtheria, 54; Scarlet Fever, 8; Measles, 8. Total, 134. G.— INFECTIOUS DISEASES HOSPITAL. Renovations, etc.— The following works of renovation and maintenance were carried out during 1934 :— Redecoration and renovation of Blocks B and C. Redecoration and renovation in Administrative Block. Provision of wash basins in B, C, D, and F Blocks. Alterations to sluice room G Block. Alterations to rear verandah, T Block. Remodelling of Laundry. Extensive replacement of fencing. Extensive repair of roadways. Staff.—The staff at the end of the year consisted of a Resident Medical Officer, Matron, 7 Sisters (1 Home, 1 Tutor, 5 Ward), 11 Staff Nurses, 18 Probationers, 1 Needlewoman and 18 Domestics. The non-resident staff consisted of 2 Clerical, 1 Assistant Needlewoman, 4 Laundry, 6 Charwomen and 10 Males. Twelve Probationers were successful in the first part of their Fever Certificate examination and 7 obtained this Certificate on completion of training. General.— The death-rate per hundred admissions of infectious disease patients was 2.18. During the year the County Council oontinued the amount of the grant payable by them in respect of infectious disease beds. The 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 (final payment) 100 Total £525 The negotiations with the Essex County Council with a view to the relinquishment of the Tuberculosis Block having proved 64 abortive, your Council then instructed that draft plans be prepared for a cubicle block. The draft plans have been agreed to in principle between the Ministry of Health and your Council, and provide 12 cubicle beds and an operating suite. The County Council have now formulated their scheme for Isolation Hospital accommodation in the County, and this provides for a Joint Hospital of 261 beds to serve the Boroughs of Walthamstow and Leyton. A conference of the representatives of the two Boroughs was held at the Ministry of Health during 1934 and negotiations are still proceeding. Provided a scheme of management satisfactory to both Authorities can be arranged, then the enlarged hospital should solve the present shortage of accommodation and should provide a reserve of beds to meet the difficulties arising from the admission of patients with diseases other than Scarlet Fever or Diphtheria. This is particularly true of complicated oases of Measles and of Whooping Cough. In addition, oases of Enteric Fever could be treated instead of being sent to another hospital as at present, and possibly cases of Puerperal Fever and Pyrexia. Staffing on the medical side could be augmented and rendered adequate for internal relief purposes. Financial Statement.—A financial statement for the year ended 31st March, 1934, is given below:— Loan Charges. £ s. d. Amount of Loan outstanding on 31st March, 1934 12,420 0 0 Expenditure. Repayment of Loan 564 0 0 Interest on Loan 451 0 0 Structural Repairs 1,295 0 0 Food for Patients and Staff 4,571 0 0 Establishment and other Expenses 12,216 0 0 £19,097 0 0 Income. Patients 800 0 0 County Council 3,040 0 0 Other sources 39 0 0 £3,879 0 0 Fees for cases from other Authorities are included. 65 The following table shows the admissions, discharges and deaths during 1934:— Scarlet Fever. Diphtheria. Measles. Mixed Infection. Tuberculosis. Totals. Remaining in Hospital 1st January 62 16 - 13 18 109 Admitted during year 465 266 41 9 45 826 Discharged during year 493 256 32 13 42 836 Died during year 1 5 9 2 1 20 18 81 Remaining in Hospital 31st December 33 21 — 7 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL, (including Tuberculosis cases.) January 120.4 July 60.0 February 123.3 August 57.9 March 115.4 September 70.4 April 106.1 October 89.5 May 84.3 November 98.8 June 69.8 December 92.1 Average whole year 90.6 The average figure for 1934 shows a big reduction from that of 1933 (113.2). The number of beds oocupied was particularly low from May to October inclusive. The average number of patients in July was only 60.0. Dr. Hamilton, Resident Medical Officer, reports as follows:— AGE AND SEX OF PATIENTS ADMITTED DURING 1934. 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 35 34 58 57 27 22 12 21 132 134 266 Scarlet Fever 33 55 99 113 52 45 28 40 212 253 465 Measles 19 9 7 6 — — — — 26 15 41 Pulmonary Tuberculosis - - - - - - - 45 - 45 45 Whooping Cough 2 - - - - - - - 2 — 2 Mixed Infection — — 3 4 — — — — 3 4 7 Totals 89 98 167 180 79 67 40 106 375 451 826 66 AGE AND SEX AT DEATH. Under 5 years. 5-10 years. 10-15 years. Over 15 years. Total. Total. M. F. M. F. M. F. M. F. M. F. Diphtheria — - 2 3 — — — — 2 3 5 Scarlet Fever and complications - 1 - - - - - - 1 - 1 Measles and Diphtheria — 1 1 - - - - - 1 1 2 Pulmonary Tuberculosis - - - - - - - 1 — 1 1 Measles and BronchoPneumonia 4 1 1 1 - - - - 5 2 7 Septic Pneumonia - - - 1 - - - - 1 1 Septicaemia 1 - - - - - - - 1 — 1 Totals 5 3 4 5 - — - 1 10 8 18 MONTHLY ADMISSIONS OF DIPHTHERIA CASES. Under 5 years. 5 to 10 years. 10 to 15 years. Over 15 years. Total. Total. M. F. M. F. M. F. M. F. M. F. January 5 4 6 3 3 5 1 3 15 15 30 February 2 5 6 8 1 — — 2 8 15 23 March 3 3 7 3 1 2 1 1 12 9 21 April — 3 2 5 — — 1 — 3 8 11 May 4 — 1 4 3 2 1 4 9 10 19 June 1 2 3 1 3 2 2 4 9 9 18 July 2 2 2 1 1 2 1 3 6 8 14 August 1 1 2 4 4 4 2 1 9 10 19 September 4 3 8 7 4 3 2 — 18 13 31 October 3 3 9 6 3 2 1 1 16 12 28 November 6 2 5 9 2 — — 2 12 13 25 December 5 6 8 6 2 — — — 15 12 27 Totals 35 34 58 57 27 22 12 21 132 134 266 Complications.— Paralysis of lower limbs, 2; (one complete, one partial). Palatal paresis, 6; late cardiac paralysis, 1. One case notified as diphtheria proved on investigation to be a case of Vincent's Angina. Only one case of Cross infection occurred during the year. A patient- developed Scarlet Fever when she had been in the ward for a fortnight. The cases of Diphtheria were classified as follows:— (1) Bacteriological, 64. (2) Moderate Faucial and/or nasal diphtheria, 163. (3) Severe Faucial and/or nasal diphtheria, 36. (4) Mild laryngeal diphtheria, 3. 67 Ten patients were given intravenous antitoxin, the dosage being as follows:— 8,000 units, two cases; 16,000 units, six cases; 24,000 units, two cases. Seven of these patients recovered and three died. Cases Transferred from Diphtheria Block to Cubicle Block. Septic Throat, 2; Patients desquamating, 12 (three of these cases were confirmed as scarlet fever); Measles, 2; Chickenpox, 2; Serum Abscess, 1. 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 6 6 10 20 6 7 5 3 27 36 63 February 2 6 4 8 5 4 1 4 12 22 34 March 3 1 11 6 6 2 7 4 27 13 40 April — 5 5 7 4 1 1 4 10 17 27 May 4 3 7 4 5 4 4 2 20 13 33 June 3 4 8 8 2 2 1 3 14 17 31 July 1 2 6 6 2 4 1 1 10 13 23 August 1 5 6 3 3 2 1 2 11 12 23 September 2 5 9 11 8 2 1 5 20 23 43 October 6 6 10 15 5 7 3 5 24 33 57 November 2 9 13 13 4 6 1 4 20 32 52 December 3 3 10 12 2 4 2 3 17 22 39 Totals 33 55 99 113 52 45 28 40 212 253 465 Complications.— The number of complications, directly attributable to the initial infection, were remarkably few. Cases of measles arose during the period of epidemicity and the two diseases then ran concurrently. Some cases of chickenpox followed the admission of a child in the incubation period of this disease. Other complications were:— Severe suppurative cervical adenitis, 2; cervical adenitis of a lesser degree occurred in some 25 per cent, of the cases admitted. Otitis media with otorrhœa, 6 (four gave swabs positive to K.L.B.); purulent rhinitis, 12 (diphtheria 3, streptococcal 9); vaginal discharge, 1'; acute nephritis, 2; acute mastoid disease, 2; acute infective jaundice, 2; acute rheumatism, 2; acute infection of antrum of Highmore (exacerbation of a mild chronic condition), 1. Cases Transferred to Cubicle Block from Scarlet Fever Block.—Twenty-two patients were transferred for the following reasons:—Chickenpox, 6; Rubella, 2; Rhinorrhoea yielding swabs 68 positive to K. L. B., 3; observation cases possibly developing morbilli (unconfirmed), 2; observation case possibly developing rubella (unconfirmed), 1; Whooping Cough, 1; Mastoiditis, 1; Acute Rheumatism, 1; Measles, 2; Septic Pneumonia, 1; Septic Soarlet Fever, 1; Vaginal discharge, 1. MEASLES. On the diphtheria block 15 patients contracted measles within the inoubation period after admission to the ward; that is, infection had taken place before entering hospital. One of these developed severe broncho-pneumonia. Ten were inoculated prophylactically with convalescent measles serum. All ten developed mild measles without complications. On the scarlet fever block two patients developed measles within the inoubation period. Fifteen patients were prophylactically inoculated. Eight patients developed very mild measles, the remaining seven being completely protected. The convalescent serum was found to be much more effective in aborting or preventing measles in children who were at the same time suffering from scarlet fever, than in children suffering from diphtheria, assuming that there was no exposure to infection from a mild, unsuspected case occurring before the first case actually found in the ward. A total of forty-one cases of measles, mostly with bronchopneumonia, were admitted. Two unusual complications arose, one child proving on examination to be a typical case of lobar pneumonia. Another developed enteritis which had not reoovered after several weeks and was transferred to Whipps Cross Hospital. In another case severe orbital cellulitis supervened. The outcome following operation was complete recovery. This patient was in a very weak condition, diphtheria and measles running their course concurrently. Two oases of acute mastoiditis arose. One, which was transferred to Whipps Cross Hospital, and another arose in a child after she had left the Sanatorium. This child had originally been very ill. Staff.— Members of the Staff were admitted to hospital beds suffering from the following complaints.—Coryza, 3; Acute Infective Jaundice, 1; Influenza, 2; Simple Tonsillitis, 4; Contused Hip, 1; Cystitis, 1; Carbuncle of Breast, 1; Whooping Cough, 1; Synovitis, 1; Double Quinsies, 1. 69 Staff were transferred to General Hospitals as follows:— To Guy's Hospital, Acute Appendicitis, 2. To Connaught Hospital, Acute Appenditicis, 1; Pelvic Tumour, 1. Carbuncle of face, 1; for Tonsillectomy, 1; Acute Constipation, 1. Operations at Hospital.— Tracheotomy, 1; Tonsillectomy, 1; Mastoidectomy, 1. Specialist Consultations.— Twenty-eight visits were made by specialists at the Sanatorium during 1934 for the following conditions:- Cerebro-spinal meningitis, 8; Cardiac Complications, 5; Otorrhœa, 5; Orbital Cellulitis, 2; Panophthalmia, 2; complicated Measles and Diphtheria, 2; Tracheotomy operation, 1; Spinal Caries, 1; Appendicitis, 1; Uræmia, 1. Swabs.— 1,848 swabs were taken and examined during the year in the laboratory at the Hospital. Number of Outside Authorities' Cases and Nature.— Diphtheria. Scarlet Fever. Total From Whipps Cross Hospital 10 2 12 From Epping U.D.C. 9 10 19 From Lough ton U.D.C. — 2 2 Total 19 14 33 The following cases were transferred to Whipps Cross Hospital:— Valvular Disease of the Heart, 2; Tubercular Enteritis, supervening on Measles, 1; Whooping Cough (both admitted 1 Scarlet Fever unconfirmed), 2; Mastoiditis with facial paralysis, 1; Paroxysmal Tachycardia, 1; Acute Mastoiditis following Measles, 1; Acute Dementia (notified as Scarlet Fever, unconfirmed), 1; Acute Rheumatic Fever (Staff), 1; Hysteria, 1; Total, 9. One case of sub-aoute Mastoiditis was transferred to Connaught Hospital. One case of Pott's Disease was transferred to the Alton Hospital for Crippled Children. Duration of Treatment.— The average duration of treatment in Hospital was as follows :— Diphtheria 28.2 days. Scarlet Fever 29.3 days. Measles 32.6 days. Mixed Infections 24.3 days. 70 The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1934:— Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.). In Hospital on 1st January, 1934. Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1934. T.B. Minus 3 13 11 - 5 T.B. Plus Group I 1 — 1 — — T.B. Plus Group II 13 31 30 - 14 T.B. Plus Group III 1 1 — 1 1 Totals 18 45 42 1 20 Eight of the <1-5 admissions were Walthamstow cases. MEDICAL EXAMINATIONS. During the year 111 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 Mortuary.— A Coroner's Court mortuary (with special provision for Infectious Disease cases) and a post-mortem room is provided by your Council at Queen's Road Cemetery. The number of inquests and post-mortems is given below:— Inquests only 43 Post-Mortems 58 Post-Mortems and Inquests (not included in above) 16 Total 117 71 CREMATION. Facilities for cremation are available at the Crematorium provided by the Corporation of the City of London, at Manor Park, Little Ilford. Full particulars can be obtained from the Superintendent, City of London Cemetery, Little Ilford. PROPAGANDA. (a) Posters.— 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. The following posters were displayed during the months shown:— Date. Title. Published by. January ''Food and Fruits'' Central Council for Health Education. February "Venereal Diseases" British Social Hygiene Council. March ''Health Promotion'' British Red Cross Society. April ''Drink More Milk'' National Milk Publicity Council. May "Healthy Childhood" National Council for Maternity and Child Welfare. June ''No Needless Noise'' Anti-Noise League. July ''Take Care of Your Teeth'' Dental Board of U. K. August ''Safety on the Roads'' National Safety First Association. September ''Cleanliness—Health'' Health and Cleanliness Council. October ''Early Treatment—Cures'' National Association for the Prevention of Tuberculosis. November "For Health's Sake—Stop that Smoke'' National Smoke Abatement Society. December "Building a Healthy People'' Central Council for Health Education. (b) Health Education.— Every opportunity is taken by all the Staff of the Department to give individual instruction in Health Education as a normal part of their routine work. 72 In addition several members of the Staff have lectured on various subjects to organisations in the town. (c) Health Week.— During the week November 6th to 10th a "Health Week" was organised for the Council by the Central Council for Health Education. Previous to the actual Health Week, some 20,000 leaflets ("Health Week—What it Means") had been given out in the schools, and Health Week lectures had been given. In addition, a Health Week Poster Competition had been held, the winning efforts being rewarded by the gift of prizes. The Exhibition was advertised before the opening date by the distribution of posters and by the kindness of the cinema managers of the town, who displayed without charge short trailer films announcing the Health Week, The opening meeting was held at the Granada Cinema (by kind permission of Messrs. Bernstein Theatres, Ltd.) under the chairmanship of the Mayor. The address was given by Dr. Fenton, Chairman of the Central Council for Health Education. Following the address two films were shown, one of which illustrated a typical nursery school. Still photographs of your Council's Nursery School were also shown. The opening meeting of the Health Exhibition was held in the Conway Hall, when the Chairman of the Public Health Committee presided, the meeting being addressed by Sir Francis Fremantle. The Exhibition was arranged in the Baths Hall, and included displays by the following exhibitors:—British Social Hygiene Council, the Cremation Society, the Dental Board of U.K., the Eugenics Society, the Fruit Trades Federation, Health and Cleanliness Council, Institute of Hygiene, Kodak, Ltd. (Medical Department), Ministry of Agriculture and Fisheries, National Association for the Prevention of Tuberculosis, National Council for Maternity and Child Welfare, National Council for Mental Hygiene, National Milk Publicity Council, National Smoke Abatement Society, Wesleyan and General Assurance Society (Health Service Bureau). Parties of school children numbering approximately 400 were conducted round the stands on four mornings and were given short talks at the various stands. In addition, approximately 400 children from Junior Schools attended the display of health films in the Conway Hall on four mornings. The total number of children visiting the exhibition in organised parties was approximately 3,200. 73 Children from Joseph Barrett Senior Boys and Girls, and from St. Mary's Girls' Schools, presented a health play, "To the Rescue," on five evenings and one afternoon. This feature was undoubtedly the most successful single item of the whole week, and drew crowded houses at each presentation. The players were warmly congratulated by the authoress, who remarked that she had not previously seen it presented so well. The total number of persons attending the health play and the evening film displays was 6,944, many of whom, of course, were school children with their parents. Amongst the 13,330 persons visiting the Exhibition (apart from the conducted parties of school children) a considerable proportion was made up of school children revisiting the Exhibition with their parents. The grand total of attendances was over 24,000, the cost being £191. Reference to the results of propaganda have already been referred to under the subject of Diphtheria Immunisation. Rainfall.— In view of the deficient rainfall of the last two years, the following information has been obtained from the Meteorological Office, Air Ministry, and refers to the rainfall at the Ferry Lane recording station:— Average rainfall, 1900-1909 23.21 inches. Average rainfall, 1910-1919 24.82 inches. Average rainfall, 1920-29 28.23 inches. which represents a yearly average of 25.2 inches over the 30 years. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Year. 1930 2.30 .98 1.36 1.53 2.82 1.79 1.66 2.66 2.90 1.15 4.48 2.03 25.66 1931 1.21 1.78 .14 3.20 2.54 1.04 2.24 5.11 2.20 .58 1.81 .78 22.63 1932 1.52 .15 1.15 2.11 2.79 .61 2.16 2.52 2.25 4.81 1.08 .49 21.64 1933 1.35 1.02 2.09 .70 1.43 3.45 .85 .41 2.84 1.30 .72 .28 16.44 1934 1.22 .08 1.77 1.82 .51 1.01 1.36 1.92 1.09 .92 1.70 4.73 18.13 The yearly average of the years 1930-2 is 23.31, so that on this basis there was, during 1933 and 1'934, a total deficiency of 12.05 inches or 25.8 per cent. SUPERVISION OF SWIMMING BATH WATER. Eight bacteriological and chemical analyses of water samples taken from swimming baths were done during the year. Four were from the Municipal Baths and three from a privately-owned bath. Both of the Swimming Baths were provided with purification plants and the final analysis in each case was satisfactory. In addition, one sample was taken from a Bath attached to a School in the district. , MATERNITY AND CHILD WELFARE. 76 SECTION H. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs. E. M. Richards. Ex-Officio: His Worship The Mayor—Councillor 6. R. Lowton. The Deputy Mayor—Alderman Shaw. Chairman of Finance Committee—Alderman Ross Wyld. Alderman G. Gibbons, J. P. Councillor Mrs. E. M. Hammond. „ J. C. Hammond. „ F. J. Jeanes. „ Mrs. C. McEntee, J. P. „ Mrs. A. L. Meadows. „ Mrs. M. Norrish. „ Mrs. E. M. Miller. „ W. J. Sharp. „ G. M. Page. Councillor Mrs. L. P. Bailey. „ E. C. Redhead. ,, S. N. Chaplin. „ Mrs. E. A. Smith. ,, Mrs. B. M. Friedberg. „ R. E. Smith. Co-opted Members: Dr. Cecilia Cohen. Mr. W. H. Kindell. Mrs. V. Cossey. Mrs. W. H. Kindell. Mrs. M. A. Cross. Mrs. W. J. Sharp. Mrs. I. M. Jackson. Mrs. W. F. Toynbee. 77 STAFF. Medical Officer of Health and Administrative Maternity and Child Welfare Officer and Medical Superintendent, Maternity Home. 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 Officer and Inspector of Midwives: Miss Mary C. Sheppard, B.A., M.B., B.Ch., B.A.O., D.P.H., Barristcr-at-Law. Obstetric and Puerperal Fever and Pyrexia Consultants [part-time). Miss M. M. Basden, M.D., F.R.C.S., F.C.O.G. G. F. Gibberd, Esq., M.S., F.R.C.S., M.C.O.G. Eardley Holland, Esq., M.D., F.R.C.S., F.R.C.P. V. Lack, Esq., F.R.C.S., M.C.O.G. W. McAllister, Esq., F.R.C.S., M.C.O.G. W. McKim H. McCullagh, Esq., 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. H. G. Everard Williams, Esq., M.D. Maternity Home. Resident Medical Officer: Miss Helen Rod way, M.R.C.S., L.R.C.P., M.C.O.G. (from 2.4.35). Anaesthetists (part time): D. R. Blunn, Esq., M.R.C.S., L.R.C.P. J. H. T. Challis, Esq., M.R.C.S., L.R.C.P. A. D. Woolf, Esq., M.D., L.R.C.P., L.R.C.S., L.R.F.P.S. Matron: Miss F. Bambridge, S.R.N., S.C.M. Health Visitors: Miss A. C. Keenan, S.R.N., S.C.M., H.V. Cert. (Superintendent). Miss M. B. Cassidy, S.R.N., S.C.M., H.V. Cert. Miss C. R. Douglas, S.R.N., S.C.M., H.V. Cert. Miss H. M. Gurnett, S.R.N., S.C.M., H.V. Cert. (Half-time). Miss D. G. Legg, S.R.N., S.C.M., H.V. Cert. (Full-time to April, 1934, then Half-time). Miss M. Page, S.R.N., S.C.M., H.V. Cert. Miss O. J. Panther, Cert. S.I.E.B. (Lond.), (Half-time). Miss M. A. Young, S.R.N., S.C.M., H.V. Cert. (Half-time). Miss A. Stuart, S.R.N., S.C.M., H.V. Cert.. T.B.Cert. (Halftime from April, 1934). (Four of the Half-time Nurses give the remainder of their time to School Nursing Duties and the fifth to Public Health Duties.) Masseuse (Half-time): Miss Kathleen M. Hill, C.S.M.M.G. Record Clerk: Miss E. Ogilvie (to 30.6.34). Miss V. LeComber (from 6.6.34). 78 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE, Ladies and Gentlemen, I beg to present the following report on the Maternity and Child Welfare work in the Borough during 1934. The outstanding event of the year was the opening of Thorpe Coombe Maternity Home in April. Within a year of opening 456 cases have been admitted and the Home has been recognised as a training school for midwive.s. These two facts alone are sufficient indication of its success, to which the Matron, Miss Bambridge, has contributed in no small measure. A site has been secured for permanent premises to house the Highams Park Welfare Centre and it is hoped that building will be commenced without undue delay. I wish again to record my appreciation of your Committee's help, the assistance of the voluntary workers in the Centres, and the good work of the Staff generally. • I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health, etc. 79 I. NOTIFICATION OF BIRTHS. 1,532 births (93 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, 673. Mid wives, 859. Included in the above are 406 births which were notified as having occurred outside the Borough. Also included are 38 stillbirths, 3 of which did not belong to the area. Twenty-three were notified by doctors and 15 by Midwives. Of the total, 17 occurred outside the area. The stillbirth rate per 1,000 population was 0.44. 2. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year: — (a) Live Births. Males. Females. Totals. Legitimate 852 826 1,678 Illegitimate 17 20 37 Total 869 846 1,715 (b) Stillbirths. Males. Females. Totals. Legitimate 23 30 53 Illegitimate 2 5 7 Total 25 35 60 Of 1,411 birth registrations received in the Department between 31st. December, 1933, and 29th December, 1934, a total of 371 were not notified in this area, but some may possibly have been notified elsewhere, especially in view of the fact that of the 1,411 registrations 121 referred to births which belonged to other areas. In addition it will be seen that the Registrar-General's figure (1,715) is 304 more than the local registrations. Presumably these were births registered and notified in other areas. The early visiting of newly-born infants by the Health Visitors is entirely dependent upon efficient notification. Of the 1,411 local registrations, 121 are excluded, leaving a net total of 1,290, which are allocated to the Wards as follows:— 80 The local registrations for 1934 were 36 more than in 1993. Births Registered Locally, 1934. 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 5 12 11 7 3 7 7 6 6 9 12 5 44 46 90 February 7 6 3 3 8 9 4 11 12 6 4 9 38 AQ 44 82 March 11 6 5 16 16 7 6 6 14 11 16 15 68 51 119 April 9 11 6 4 4 7 11 9 12 10 8 12 50 53 103 May 8 5 5 4 13 16 6 3 14 7 14 14 60 54 109 June 8 10 11 8 8 7 7 5 13 8 15 16 62 55 116 July 13 2 8 6 8 10 10 7 9 14 15 16 63 71 118 August 6 7 12 11 10 13 9 12 11 13 15 10 63 37 134 September 4 5 10 3 8 4 7 7 12 4 10 14 51 60 88 October 14 11 4 8 8 10 11 10 10 9 19 12 66 58 126 November 5 10 8 5 8 6 5 9 9 7 8 21 43 58 101 December 4 8 6 10 10 9 8 9 9 10 7 14 44 60 104 Totals 94 93 89 75 104 105 91 94 131 108 143 163 652 638 1,290 Grand Totals 187 164 209 185 239 306 1,290 81 3. INFANT MORTALITY. The deaths of infants under one year of age were:— Males. Females. Total. Legitimate 45 30 75 Illegitimate - 2 2 Total 45 32 77 The death-rates of infants under one year of age per 1,000 live births when calculated on the totals given by the Registrar-General are therefore:— Legitimate, 44. Illegitimate, 54. Total, 44. The Infant Mortality Bate for other areas during 1934 was as follows:— England and Wales 59 121 County Boroughs and Great Towns (including London) 63 135 Smaller Towns (25,000 to 50,000) 53 London 67 Neo-Natal Mortality. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1934, 35 infants died in the first four weeks of life yielding a rate of 20.4. Infant deaths under one year were 77. The failure to reduce the neo-natal mortality is common to most areas. For the last ten years in England and Wales the neo-natal deaths have been approximately one-half of the total deaths under one year of age. During the 10 years 1924-33 there were 508 deaths of infants under four weeks in Walthamstow out of 1,058 deaths under one year of age, yielding a neo-natal mortality rate of 25.2. Beduotion in the rate can only be expected from intensive and skilled ante-natal care. The following table shows the causes of death of children under one year of age during 1934:— SUMMARY, 1934. Causes of Death of Children under 1 year of age. Cause of Death Under 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 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 - - - - - - - 1 3 - 2 - - - 1 1 Scarlet Fever - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - Erysipelas - - - - - - 1 - - 1 - - - - 1 - Tuberculous Meningitis - - — - - - 1 - 1 - - - - - 1 Abdominal Tuberculosis (b) - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) 1 - — — 1 - - - 1 2 2 - - - - - Convulsions 3 9 — — 5 - 1 - - 6 3 - - - 1 2 Laryngitis - - - - - - - - - - - - - - - - Bronchitis — 1 — 1 - - - - 1 - - 1 - - - Pneumonia (all forms) — — 2 - 2 3 4 3 5 17 5 4 2 1 1 4 Diarrhœa - - - - - - - - - - - - - - - - Enteritis — — - - - 1 3 - - 6 - - 1 - - 3 Gastritis - - - - - - - - - - - - - - - - Syphilis — 1 — — 1 - - - - 1 - - - 1 - - Rickets - - - - - - - - - - - - - - - - Inattention at Birth, wilful neglect - - - - - - - - - - - - - - - - Suffocation, overlaying 2 — - — 2 - - - - 2 - 1 - - - 1 Injury at Birth - - - - - - - - - - - - - - - - Atelectasis 3 - - — 3 - - - - 3 - - - 1 1 1 Congenital Malformations 4 - 1 - 5 2 - - - 7 1 - 2 3 - 1 Premature Birth 9 1 - - 10 3 - - - 13 4 1 1 1 5 1 Atrophy, Debility and Marasmus 1 - — — 1 1 4 - - 6 1 - - 1 1 3 Inanition 1 — — — 1 — — — — 1 - - - - - 1 Heart Failure — - — — — — — 1 — 1 - - - - - 1 Other Causes 3 - — — 3 — 1 — l 6 1 — 2 — — 2 Totals 27 5 3 — 35 10 15 7 10 77 19 6 9 8 13 22 82 83 The death-rate from Diarrhoea and Enteritis in children under one year of age per 1,000 live births was 3.5. 4. CHILD WELFARE. The equivalent of whole time Municipal Health Visitors now is 6.5, equal to one whole time Health Visitor per 236 notified births and one whole time Health Visitor per 273 registered births during 1934. 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. 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. In addition, the Walthaiustow Child Welfare Society at "Brookscroft" have "special" Clinics, e.g., massage and light sessions on days other than those specified. A. MUNICIPAL SCHEME. The detailed findings at first visits paid during 1934 are given in the following table:— The 1933 figures were 538 and 46 respectively. Ward. How Fed. Kind of Food. Sleeping Accommodation. Condition of Baby. Accommodation. Breast. Breast and Hand. Hand. Cow's Milk. Patent Foods. Condensed Milk. With Mother. Cot or Cradle. Good. Fair. Bad. Whole House. Flat. 1 Half-house. 3 Rooms. 2 Rooms. Room. St. James Street 204 13 28 10 21 10 38 207 234 7 4 35 27 20 106 54 3 High Street 176 6 20 4 13 9 15 187 182 17 3 27 78 87 5 5 — Hoe Street 221 18 38 23 21 12 26 251 244 29 4 43 42 173 3 14 2 Wood Street 180 16 38 23 20 11 13 221 218 16 — 72 6 129 6 18 3 Hale End 266 23 71 34 50 10 16 344 304 51 5 192 24 112 2 24 6 Higham Hill 281 31 61 47 30 15 46 327 307 61 5 198 93 53 3 20 6 Total 1,328 107 256 141 155 67 154 1,537 1,489 181 21 567 270 574 125 135 20 84 From the above table it will be seen that of 1,691 children, 1,328, or 78.5 per cent., were breast-fed on first being visited, but 154, or 9.1 per cent., had no separate sleeping accommodation. The particulars in respect of housing accommodation show that only 567 of the families visited had a house to themselves, while 20 families were living in one room. 85 The following table stows the number and nature of visits paid in Wards during 1934:— 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. First. Re-visits. Total. Not at home. 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 245 451 696 651 1,347 168 9 92 57 293 59 6 65 147 2,178 High Street 202 197 399 681 1,080 40 3 32 103 38 28 1 29 140 1,465 Hoe Street 277 216 493 646 1,139 101 7 95 80 77 24 6 30 106 1,635 Wood Street 234 230 464 779 1,243 137 7 83 33 228 6 11 17 63 1,811 Hale End 360 712 1,072 1,419 2,491 113 10 157 213 310 37 14 51 155 3,500 Higham Hill 373 587 960 1,472 2,432 134 24 163 252 221 53 19 72 270 3,568 Total 1934 1,691 2,393 4,084 5,648 9,732 693 60 622 738 1,167 207 57 264 881 14,157 Total 1933 1,675 2,797 i 4,472 5,792 10,264 1,054 78 634 908 1,760 222 72 294 134 15,126 86 CLINICS. Dr. Sheppard reports as follows:— "During 1934 Thorpe Coombe Maternity Home opened and consequently for a time there was a diminution in the average number of attendances at the Council's Ante-Natal Clinic in Markhouse Road. The total number of attendances for the year was, however, 1,188 as compared with 1,287 during 1933. "The routine at the Ante-Natal Clinic has not been altered during the year as it has been found to work admirably. When first seen each patient is given a thorough general medical examination as well as a special examination dealing with her pregnancy. A letter is then sent to the doctor or midwife engaged by the patient and a further note is sent about the 36th week. Should any interim complications arise the doctor or midwife is notified. "Midwives accompanying their patients to the Clinic are always cordially welcomed. "The year 1934 saw the opening of the Tuesday morning Clinic. This is an extremely useful Clinic and it has greatly facilitated the work on Monday afternoons. At this Clinic a Health Visitor takes, as far as possible, the histories of all new cases, tests urine, and takes blood pressures, etc. "Home Helps are supplied in suitable eases and Maternity Outfits at 3s. and 6s. each can be obtained for weekly payments, or free in necessitous cases. Patterns and knitting instructions for babies' garments can also be obtained at the Centre. "Unfortunately, one is compelled to record that the incidence of rickets among our babies is still rather high. The work of the Orthopaedic Clinic is an index in this respect. During the past year four additional clinics have been established to cope with the increased attendances mainly of children under' five years. When considering this regrettable fact one's thoughts naturally turn to the nutrition of the expectant and nursing mother. The Council supplies milk, but one wonders whether a dining centre for mothers would not be a help as it is doubtful if the milk supplied is taken by the mother herself where there is a family of little ones, whereas in the case of the dinner there would be supervision. Miss Keenan, the Superintendent Health Visitor, has supplied me with the following observations on the subject:— 87 "The feeding of pregnant women is a great problem. The varied diet which can be obtained from a nice, good dinner given daily is, of course, ideal. Unfortunately, the psychological, effect of receiving the dinner frequently destroys all the good that should be obtained from it. A mother is usually very sensitive at these times. Many women would prefer to go hungry rather than expose themselves in a public dining-room for the sake of a free meal—humiliation would deprive many mothers of the much needed nourishment. "When there is a big family and other children returning from school, the mother could not be expected to leave home during the dinner-hour to go and get her own meal. "Our variable climate and lack of proper clothing places another difficulty in the way. These are just a few commonsense reasons. There are many grave medical ones which unfortunately rob the daily dinner of much of its value. "The Council supplies the expectant mother with milk three months before confinement. Apart from the fact of health building, the mental relief obtained from this practice is quite wonderful. The anxiety of the weekly milk bill is removed and the mother feels she is able to do her duty to the "little one" ever present in her mind, without hurting the rest of the family. Butter and eggs, although considered to be of such high nutritional value, are at the moment practically unknown in these homes and one cannot overestimate the benefit to be derived from the addition of these fortifying foods to the expectant mother's diet." To Messrs. Virol, Ltd., we owe thanks for a very interesting series of research carried out during the year on 72 children of various ages below five years The research furnished valuable data regarding diet supplements for children as well as enabling us to give these 72 children well over £50 worth of Virol, halibut liver oil, cod liver oil, and dried milks, etc., free of charge to the Council. The 72 children were divided into four groups. Each child was known by a number. There were four different treatments, each lasting six weeks. Total period of trial, six months. 1st treatment—Halibut Oil and Dried Milk. 2nd „ —Cod Liver Oil. 3rd „ —Virol. 4th „ —No treatment. "Proper instructions as to amounts and times to be taken were given to each mother. 88 The only assistance asked for from the mother was that the child should be weighed weekly, and also that at the end of the sixth week, before changing treatment, a specimen of fæcal matter should be obtained from the child. Butter muslin and air-tight tins were supplied for this purpose. The child's number was marked on the tin and given to the mother. When returned to Welfare they were immediately despatched to the laboratories. "A full report of this research was published in the ''Medical Officer" in April, 1935. "The attendances at the various Welfare Centres can be seen from the following table :— SUMMARY OF ATTENDANCES AT WELFARE CENTRES. Centre. First Attendances of New Cases. Re-attendances. Grand Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Low Hall Lane 706 38 744 9922 9659 19581 20325 Higham Hill 222 113 335 3355 3503 6858 7193 Highams Park 162 60 222 2675 2652 5327 5549 Total 1034 1090 211 1301 15952 15814 31766 33067 1933 1169 275 1444 17728 15347 33075 34519 "Miss Hill, the Council's Masseuse, attends on five afternoons weekly, and both she and Miss Keenan attend the Orthopædic Sessions held at the Physically Defective Centre, thus maintaining close co-operation between the work of the two centres. "To the Voluntary Workers the Council's grateful thanks are again due for their loyal and efficient service during the year." Nurse Children.—At the end of 1934 there were 144 nurse children on the Register as compared with 180 at the end of 1933 and 134 in 1932. During the year 147 removed, 2 were adopted, 8 reached the age of nine years and 4 ceased to come under the Act. 126 new children were registered. There was one death among nurse children during 1934. Massage.—137 cases attended for massage and these made 1,844 attendances. 89 Sale of Milk, etc., at Clinics.—The quantity and value of milk and food sold and issued free during 1934 was as follows: — Sales. Value. £ s. d. Free Issue. Virol 1,068 lbs. 4 ozs. . 107 1 8 10 lbs. 4 ozs. Prune and Banana Syrup 87 lbs. 6 ozs. 11 3 5 6 ozs. Parrish's Food 197 lbs. 9 7 0 1 lb. 4 ozs. Malted Honey 4 lbs. 0 3 4 3 lbs. Maltoleine 19 lbs. 1 5 4 4 lbs. Cod Liver Oil 320 lbs. 6 ozs. 14 14 6 11 lbs. 12 ozs. Cod Liver Oil Emulsion 611 lbs. 30 11 0 71 lbs. Glaxo and Ambrosia 108 lbs. 9 0 0 27 lbs. Virol Containers 2,041 8 10 1 10 Ostermilk 803 lbs. 66 18 4 226 lbs. Almata 169 lbs. 18 3 6 2 lbs. Roboleine 512 lbs. 38 8 0 38 lbs Cod Liver Oil and Malt.. 754 lbs. 21 19 10 9 lbs. Cow and Gate 8,280 lbs. . 655 17 5 1,197 lbs. Lactogen Dunne's Milk 345 lbs. 27 19 2 42 lbs. 8 lbs. 0 12 0 — Hemolac 143 lbs. 12 15 0 46 lbs. Trufood .. 118 lbs. 12 15 8 1 lb. £1,047 5 3 5. TREATMENT. (a) Orthopaedic.—The facilities provided by the Education Authority's Orthopaedic Scheme is available for 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 OrthopÆdic Clinic in Children under Five Years of Age. Anterior Poliomyelitis 2 Spastic Paralysis 9 Rickets—(a) Genu Varum 83 Congenital Defects 13 (b) Genu Valgum 71 Torticollis 6 Erb's Paralysis 1 Epiphysitis 1 Scoliosis, Kyphosis, Coxa Vara 2 Lordosis 7 Miscellaneous 12 Pes Piano Valgus 35 Total 242 Admissions to Brookfield Orthopedic Hospital (under Five Years of Age). Rickets—Genu Varum 1 Spastic Paralysis 2 Baker's Cyst 1 Congenital Talipes Equino Anterior Poliomyelitis 1 Varus 1 Total 6 90 Number and Classification of Operations at Brookfield Hospital. (under Five Years of Age). Tenotomy Tendo Achilles.. 1 Excision of Baker's Cyst.. 1 Osteoclasis 2 Osteotomy—Rotation of Tibia .. .. .. 1 (b) Dental.—The following work was done by the Education Committee's Dental Surgeons:— Mothers. Children under 5. Cases Treated 109 240 Attendances 164 299 Fillings 24 211 Extractions 199 299 General Anaesthetics 86 156 Scalings .. .. .. .. 24 1 Dressings 8 53 Dentures 8 — Mrs. W. R. Thorne, L.D.S., reports as follows: — "Since the opening of Thorpe Coombe Maternity Home there has been an increase in the number of maternity cases treated. These patients are sent with all degrees of defect and noticeably not merely those suffering pain. ''These cases are dealt with up to the end of pregnancy and during lactation. If a mother has commenced treatment during pregnancy and the treatment is not completed before the birth of her child, she is eligible for her completed treatment afterwards. "Any necessary treatment is given. "Dentures are being fitted and it is now possible for the pregnant and nursing mother to have her masticating powers fully restored. "The reduced rate for prosthetic work is a great boon to the poorer patient and is much appreciated. "One session a week is allotted to Maternity and Child Welfare treatment. The Child Welfare work is very much as in previous years. Toddlers are brought to the Clinic when there has been a complaint of toothache. Some few parents take a pride in the toddlers' teeth and request, conservative treatment. They are a small minority. It is curious that mothers should so readily agree 91 to the removal of deciduous teeth and be diffident when offered conservative treatment. The mother is in some cases rather fearful lest the small patient may dislike the operation. To create a wish for something worth while to the child is at times baffling. "Many factors work against the clinics. Extraction is even ordered for the child before he arrives at the clinic. "The failures of appointments and re-appointments are great, especially in the latter respect when fillings are required." Mr. L. W. Elmer, L.D.S., reports as follows:— "Only two mothers were supplied with artificial dentures during the last year. This number would have been exceeded had it been more widely known that early attention is highly desirable. Many women only attended for treatment a short while before their baby's birth; indeed, in some cases whilst nursing. These, of course, only received surgical treatment, but if they had attended during the early months of pregnancy, not only could the treatment have been of greater advantage to both mother and child, but any teeth that were inefficient could have been replaced speedily by artificial substitutes. "An encouraging feature of this work has been the increasing number of small children who have been brought by their parents for preventive treatment before they have actually suffered from toothache. This is the true criterion of the efficiency of a Dental Scheme if it is to be, as it should be, preventive in its scope. "The thanks for this improvement are due to the advice given at the Clinics and to a more general enlightenment in the subject of Dental Hygiene." (c) Tonsils and Adenoids.—Six cases were operated on under the arrangement made by the Education Committee with 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:— 92 Referred by:— Medical Men, Hospitals and Dispensaries 18 Medical Officer of Health 1 School Medical Officers 12 Infant Welfare Centres 1 Orthopaedic Clinics 98 Public Assistance M.O. 7 Tuberculosis Officer 1 I.C. A. A Other Voluntary Agencies 3 Parents 1 Others 1 147 Suffering from:— Anaemia and Debility 4 After effects of illness 1 Marasmus and Malnutrition 5 Pneumonia, Bronchitis, Asthma, etc. 9 Bones, non-T.B. 4 Congenital Deformities 12 Paralysis 5 Rheumatism, Chorea and Heart 2 Hernia 3 Various 12 147 Help Given to Old and New Cases, 1934. Sent to Special Hospitals and Convalescent Homes *21 Provided with Surgical Boots and Appliances 85 Referred for Visiting and Advice 84 190 * Includes 6 admissions to Brookfield Hospital. B. 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 pensary Treatment. Thursday, 1—6 p.m. Infant Consultations. 93 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. -5 yrs. Total. 1934 400 275 675 5720 4737 10457 11132 1933 372 79 451 5843 4786 10629 11080 • Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1934 363 1303 1666 2736 4402 4407 1933 336 1128 1464 2943 Attendances at Lectures. Massage Treatments . Sunlight Treatments . Total cases admitted to Observation Ward. Local Authority's cases admitted to Observation Ward. 1934 713 1919 2292 32 1 1933 707 1602 1508 31 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 table gives the total number of attendances at Clinics and home visits:— 94 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 1090 211 1301 15952 15814 31766 33067 Voluntary Scheme 400 275 675 5720 4737 10457 11132 Total 1934 1490 486 1976 21672 20551 42223 44199 1933 1541 354 1895 23571 20133 43704 45599 Home Visits. To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Municipal Scheme 1691 2393 4084 5648 9732 Voluntary Scheme 363 1303 1666 2736 4402 Total 1934 2054 3696 5750 8384 14134 1933 2011 3925 5936 8735 14671 Percentage of notified live births repre- sented by number of children under 1934 97.2 one year of age who attended the , Centres for the first time (i.e., new 1933 108.5 cases) Percentage of total notified births repre1934 44.1 sented by number of expectant mothers attending Ante-Natal Clinics 1933 25.6 The large increase under the latter heading is due to the number of patients attending the Ante-Natal Clinic at the Maternity Home. 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. 95 NURSERY SCHOOL AND CLASSES. Apart from the children at the Nursery School, 448 children born in 1930/31 (i.e., under 5 years of age) were on the School Registers on 31st December, 1934. 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 the 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 1934:— Number of applications during 1934 5,759 Number of families assisted 1, 024 Of the 5,759 applications, approximately 54 per cent. were from families where the father was unemployed. Scale Amount Approximate cost to Authority £ s. d. Free 280 pints. 3 7 4 ½d. per pint 107,410 „ 1,153 16 4 1d. per pint 69,710 „ 607 12 1 1½d. per pint 364 „ 3 0 8 Half-cost 18,602 „ 116 6 11 196,366 pints. £1,884 3 4 7. HOME HELPS. Applications for the provision of Home Helps are considered by the Milk Rota Committee and, if approved, a payment of 12s. 6d. per week for two weeks is made. In addition to the 21 Home Helps approved during 1934, many mothers attending the Clinic made their own arrangements to obtain the help of suitable women whose names were supplied by the Health Visitors. 96 8. INSTITUTIONAL TREATMENT, ETC. A total of 14 children were sent to Institutions under arrangements approved by your Committee. The details were as follows:— Brookfield Orthopaedic Hospital, 2; St. Margaret's Hospital, 6; Lennox Home, 4; Streatham Babies' Hospital, 1; Brookscroft, 1. 9. HOSPITAL ACCOMMODATION FOR CONFINEMENTS. The following numbers of confinements occurred at the Institutions specified (Walthamstow residents only):— Mothers' Hospital, Clapton 148 Nursing Homes in Walthamstow* 198 Forest Gate Hospital 55 Queen Mary's Hospital 18 Other Hospitals, etc. 11 430 (*Excluding Thorpe Coombe Maternity Home.) There are five Nursing Homes in the Borough with a total maximum accommodation of 29 beds for maternity cases. In addition, the Municipal Maternity Home has 35 lying-in beds and 4 isolation beds. 10. WALTHAMSTOW DISTRICT NURSING ASSOCIATION. Mrs. Drury, the Honorary Secretary, kindly reports as follows:— "The work of the Association continues to increase. "During 1934, 154 in-patients were admitted, as against 88 in 1933, and all went out in good health, well satisfied and delighted with their treatment and comforts. "158 Midwifery and Maternity oases were attended on the District; a decrease on 1933 owing to the fact that mothers now prefer to come into the Home. "The general work on the District also shows an increase. 97 "The new contributory scheme launched in December, 1933, now has a membership of 130. "The staff now oonsists of Matron, Home Sister, Staff Nurse and six other fully trained Nurses. "The Association is grateful to the Corporation for the confidence placed in the staff, and the financial help given. "The Association's increase in general work on the District is largely due to 'after-care' cases, sent by a great number of Hospitals in connection with the 'King Edward Fund.' "Lectures are again being arranged for the Midwives of the District which, we feel sure, will continue to be appreciated. " 'Angela,' weighing only 11b. ¾oz. at birth, has been surprisingly reared by the wonderful skill, care and attention of Matron and her staff, and now, at six months, weighs 9½lbs. A great achievement." (Correction.—By a clerical error in the Annual Report for 1933 the number of confinements attended by the Association was wrongly stated. These should have read: Inpatients, 88; District, (a) Maternity, 65; (b) Midwifery, 153; Total, 306.) Dr. Cecilia Cohen, Acting for the Association, arranged a further course of post-graduate lectures for midwives. The lectures were as follows:— 1934. January 25th "The General Practitioner Dr. A. P. Eldred. and the Midwife" February 22nd "The Puerperium" A. Galletly, Esq., M.C., M.B. March 22nd "Ante- and Post-Partum A. McAllister, Esq., Haemorrhage" F.R.C.S. April 26th "Puerperal Sepsis" Miss M. E. Landa, M.D. F.R.C.S. May 31st "Contracted Pelvis" Miss M. M. Basden, M.D., F.R.C.S. June 28th "Pemphigus and Ophthal- A. T. W. Powell, M.B., mia Neonatorum" B.S., D.P.H. November 22nd "The Toxaemias of Preg- Miss Gladys Hill, M.D., nancy." F.C.O.G. December 13th "The Management of a T. B. Davis, Esq., M.D., Normal Labour" M.R.C.P., F.R.C.S. The lectures are being continued during 1935. The average attendance was 22 per lecture, made up equally of midwives and pupils from Walthamstow and Leyton. 98 11. CONSULTANT OBSTETRICIANS. The services of a Consultant Obstetrician were requested by General Practitioners on seven occasions (i.e., apart from the Maternity Home). The table below gives particulars in respect of each case: — No. Diagnosis. Where treated. Infant. 1. Excessive vomiting of pregnancy Admitted to Hospital Live Baby. 2. Prolonged labour—forceps delivery „ „ „ „ 3. Placenta Praevia „ „ Stillbirth. 4. Albuminuria, Toxaemia „ „ Premature (4 lbs.). 5. Post-partum haemorrhage At Home Baby died from intracranial haemorrhage. 6. Ante-partum haemorrhage Molar pregnancy Admitted to Hospital Foetus not viable 7. Toxaemia „ „ Live baby. There were no maternal deaths in any of these cases. 12. MIDWIVES ACTS, 1902—1926. Dr. Sheppard has acted as Inspector of Midwives and has carried out the routine quarterly inspections, the results of which have been generally satisfactory. Additional inspections in respect of emergencies such as Ophthalmia Neonatorum, Puerperal Fever and Pyrexia, and Maternal Mortality, have been made by your Medical Officer of Health. Eighteen midwives gave notice of intention to practice in January, 1934, and 20 further notices were received in the course of the year. Ten left the District during the year. The following table shows the work done by the midwives, inoluding those employed at Thorpe Coombe, during 1934:— No. of confinements attended as a midwife 720 „ confinements attended as a maternity nurse 180 „ Medical Aid Notices sent 207 „ Notifications of Deaths 1 „ Twin Births 3 „ Stillbirths 12 „ Notifications of liability to be a source of infection 9 „ Notifications of laying out a dead body 2 „ Notifications of Artificial Feeding 4 „ Notifications of Disinfection 9 99 During 1934, 720 cases were attended as Midwives and 180 as Maternity Nurses (including cases at Maternity Homes). The numbers of cases attended by midwives in active private practice in the Borough were 86, 78, 37, 33, 29, 22, 14 and 4. Several had 2, 1 or none. It is obvious that if the status of the midwife is to be improved some scheme such as that formulated by the Joint Council of Midwifery must be adopted. The conditions for which Medical Aid was summoned by Midwives have been summarised and were as follows:— Pregnancy:— Labour:— Albuminuria 1 Rigid Cervix 2 Abdominal Pain 2 Delayed Labour 14 Varicose Veins 1 Ante-partum Haemorrhage 6 Abortion 1 Malpresentation 3 Contracted Outlet 2 Inertia 2 5 29 Puerperium — Infants:— Ruptured Perineum 25 Prematurity 7 Pyrexia 7 Inflamed Eyes 5 Post-partum Haemorrhage 5 Feebleness 2 Retained Placenta 2 Stillbirth 2 Adherent Placenta 2 Other conditions 4 Other conditions 6 47 20 The percentage of midwives' oases in which medical aid was summoned was 14.0. Details of medical aid notices issued by midwives employed at Thorpe Coombe are given in the Maternity Home report. Nursing Homes Registration Act, 1927.—See Public Health Section of the Report. 13. PUERPERAL FEVER AND PYREXIA. Particulars are tabulated with regard to the 41 cases of Puerperal Fever and Pyrexia notified during 1934. Fourteen were notified from Hospitals outside the area. The puerperal fever and pyrexia rate for 1934 was 23.9 per 1,000 live births, and the fatality due to puerperal sepsis was 17.0 per cent, of the oases of puerperal fever and pyrexia notified. PUERPERAL FEVER AND PYREXIA—1934. No. of Case. Date of Notification. Date Notification Received. Age. Ward. Fever or Pyrexia. Facilities required as per Notification Form. Date of Birth of Child, or miscarriage. Date of Onset. Date removed to Hospital. Remarks. 1. 1.1.34 2.1.34 23 J. Pyrexia All facilities available 28.12.33 28.12.33 Not removed Influenza. 2. 8.1.34 9.1.34 26 J. Fever „ „ •? 8.1.34 3.1.34 Died. Puerperal Septi caemia. Retained pro. ducts—Empyema. 3. 12.1.34 12.1.34 25 W. Pyrexia Second opinion 5.1.34 11.1.34 Not removed Consultant visited. 4. 17.1.34 22.1.34 21 Ho. „ „ All facilities available 5.1.34 9.1.34 Already in Hospital Pyelitis—Caesarean Section. 5. 5.2.34 7.2.34 32 Ho. „ „ Removed to Hospital 28.1.34 ? 6.2.34 Recovered. 6. 3.2.34 15.2.34 27 J. y » All facilities available 27.1.34 (born in Hospital) 31.1.34 27.1.34 Pyelitis. 7. 25.2.34 26.2.34 36 J. Fever „ „ 16.2.34 22.2.34 Not removed .. Scarlet Fever. 8. 27.2.34 28.2.34 40 H.E. „ „ Second opinion 20.2.34 (born in Hospital) 27.2.34 27.2.34 Scarlet Fever. Consultant visited. 9. 7.3.34 8.3.34 34 H.H. Pyrexia Nil 1.3.34 5.3.34 16.4.34 Died. Puerperal Parametritis following lapar otomy 10. 13.3.34 14.3.34 25 J. Fever Second opinion 2.3.34 5.3.34 14.3.34 Consultant visited. Died 11. 14.3.34 14.3.34 24 H.H. Pyrexia Removed to Hospital 13.3.34 13.3.34 14.3.34 Puerperal Septicaemia Recovered. 12. 19.3.34 21.3.34 31 H.H. Fever All facilities available 13.3.34 11.3.34 11.3.34 Died. Puerperal Fever. 13. 21.3.34 22.3.34 25 J. Pyrexia Trained Nurse required 13.3.34 18.3.34 Not removed .. ? Illegal abortion. Influenza. 14. 23.3.34 24.3.34 30 H.E. Fever Removed to Hospital 15.3.34 20.3.34 20.3.34 Recovered. 15. 2.4.34 6.4.34 23 W. Pyrexia All facilities available 28.3.34 (born in Hospital) 31.3.34 28.3.34 Sapraemia. 16. 24.4.34 24.4.34 22 > y y y y y • • 16.4.34 20.4.34 Remained at home Influenza. 100 17. 12.5.34 14.5.34 27 Hi. Fever All facilities available 2.5.34 6.5.34 8.5.34 Died. Self-induced abortion. 18. 8.5.34 14.5.34 23 Ho. Pyrexia „ „ 3.5.34 4.5.34 2.5.34 Pyelitis. 19. 23.5.34 24.5.34 23 Ho. t 1 > > »» 9.5.34 17.5.34 Remained at Bacillus Coli. Urinary 20. 28.5.34 1.6.34 30 Hi. t t it »> 25.5.34 27.5.34 home 23.5.34 infection. Due to Pyelitis. 21. 4.6.34 5.6.34 40 H.E. Fever ,, 1.6.34 1.6.34 Already in Hospital Recovered. 22. 26.5.34 6.6.34 Ho. Pyrexia > j > > 22.5.34 25.5.34 Remained at home Torn perineum. 23. 24. 9.6.34 18.6.34 11.6.34 22.6.34 24 23 W. Ho. Fever Pyrexia Second opinion All facilities available 1.6.34 9.6.34 7.6.34 10.6.34 14.6.34 8.6.34.. Mastitis. Consultant visited. Local Uterine sepsis. 25. 18.7.34 19.7.34 25 H.E. i » > > > j 4.7.34 7.7.34 Already in Hospital 26. 20.7.34 20.7.34 22 H.E. Fever Second opinion 12.7.34 17.7.34 Remained at home Consultant visited. 27. 25.7.34 25.7.34 30 Ho. Pyrexia „ „ 23.7.34 24.7.34 „ „ 28. 31.7.34 3.8.34 30 Hi. „ „ 25.7.34 29.7.34 29. 31.7.34 2.8.34 29 H.H. „ All facilities available 19.7.34 27.7.34 Already in Hospital Mastitis. 30. 17.8.34 17.8.34 20 W. „ Second opinion 15.7.34 19.7.34 „ „ Pyrexia, unknown origin. 31. 20.8.34 22.8.34 25 Ho. „ Patient already removed 13.8.34 16.8.34 17.8.34 Consultant visited. Recovered. 32. 21.8.34 21.8.34 24 W. „ All facilities available 18.8.34 19.8.34 Already in Mastitis. 33. 10.9.34 10.9.34 26 W. „ 27.8.34 7.9.34 pital 34. 1.10.34 1.10.34 J. „ 22.9.34 27.9.34 Not removed Recovered. 35. 6.10.34 8.10.34 39 H.H. Fever Already removed 22.9.34 30.9.34 30.9.34 Abortion. 36. 3.10.34 6.10.34 24 Hi. Pyrexia All facilities available 23.9.34 25.9.34 Already in Renal calculi. 37. 27.10.34 27.10.34 21 H.H. „ „ „ 13.10.34 27.10.34 pital Not removed Mastitis. 38. 11.10.34 17.10.34 21 W. „ „ „ 4.10.34 5.10.34 Already in Hospital Pyelitis. 39. 23.11.34 23.11.34 40 W. Fever To be removed 16.11.34 19.11.34 21.11.34 Died Puerperal mia. Cardiac disease. Consultant visited. 40. 26.11.34 28.11.34 36 Ho. Pyrexia Second opinion 16.11.34 22.11.34 Not removed 41. 29.11.34 30.11.34 29 Ho. Fever To be removed 23.11.34 24.11.34 27.11.34 Died Puerperal Septicaemia. 101 102 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. 1934 5 — 1 1 1 1 1 1933 7 1 3 — — 1 2 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1934 1 4 5 — — — 1933 4 3 7 — — — Four cases were admitted to St. Margaret's Hospital (London County Council) and made a good recovery . 15. MATERNAL MORTALITY. Particulars are given of eleven maternal deaths for which Maternal Mortality forms were completed, while the RegistrarGeneral states that 7 were due to Puerperal Sepsis and 5 to other Puerperal causes. The Registrar-General has excluded case No. 4 given in the table of particulars which is counted as a suicide. He has, on the other hand, included the following cases in which no maternal mortality enquiries were made because in the first case, it was considered locally that the death would not be counted as being due to "Other Puerperal Causes" and because in the second case there was no reference on the death certificate as to any association with child bearing. The particulars of death in these two cases are as follows:— Date. Sex. Age. Married or Single. Ward. Cause of Death. Classification. 6.2.34 F. 18 M. Hoe Street 1. (a) Toxaemia (b) Empyema Other puerperal causes. 2. Breast abscess and normal labour 1 month previously. 10.3.34 F. 30 M. Higham Hill Generalised Peritonitis Salpingitis (right) Septic endometritis Coroner's inquest without Post Mortem. Puerperal Sepsis. deaths due to puerperal sepsis and other puerperal causes. Case No. Date of Death. Certified Cause of Death. Age. Ward. Circumstances. Pregnancy. Ante-Natal Care. Physical Condition. Date of Confinement or Abortion. Doctor called. Admission to Hospital. Remarks. Prev. Duration of Present. Doctor. Midwife. Hospital. 1. 8.1.34 (a) Septicaemia 26 J. Poor 1 8 weeks - Subinv. following first confinement 2.1.34 3.1.34 Husband in regular work. Suggestion re drug taking. Refused to go to Hospital till 3.1.34. Septic retained products removed. Empyema right knee due Haemolytic Streptococcus. (b) Miscarriage 2. 19.3.34 Puerperal Fever 31 H.H. Comfortable - 10 ,, — — — Good 13.3.34 11.3.34 11.3.34 Unmarried. Instrumental removal of placenta. Thrombosis following abortion in Hospital. Reported to police as suspected illegal abortion. 3. 28.3.34 Puerperal Septicaemia 25 J. Poor 2 Term Yes — - Atrophic Rhinitis and Pyorrhoea .. 2.3.34 2.3.34 14.3.34 Husband in regular work. Forceps delivery 3rd day. Perineal tear. Pyrexia 4th March. Rigor 9th. Consultant called 13th'and Hospital removal advised. Pyaemia. 4. 14.5.34 Streptococcal Septicaemia. Incomplete abortion. Felo-de-se 27 Hi. Poor — 2½ months — — — Good 2.5.34 2.5.34 8.5.34 Husband in regular work. Unaware wife pregnant on marriage. Selfinduced abortion. 5. 2.6.34 Puerperal Parametritis 34 H.H. Poor 5 Term Yes — — Fair 1.3.34 B.B.A. 16.4.34 Influenza month before delivery. Cough and Pyrexia before labour. Laparotomy May 11th.—Sub-total, Hysterectomy, then faecal fistula. 6. 11.7.34 Shock. Obstructed labour 35 Ho. Poor Term — — — Asthma. Albumen 9.7.34 6.7.34 6.7.34 Unmarried mother of low mentality. Craniotomy. Adherent placenta. Asthma. 7. 11.7.34 Post-partum Haemorrhage. Retained placenta 32 H.E. Comfortable - Post-mature Yes Yes — Good 11.7.34 11.7.34 11.7.34 Labour induced for post-maturity. Adherent placenta, manual removal, instrumental delivery. 8. 3.9.34 Surgical shock. Instrumental delivery; difficult labour and retained placenta 26 J. Poor - „ Yes — — Good 3.9.34 2.9.34 Nil Husband in regular work. Instrumental delivery—retained placenta. 9. 11.11.34 Fulminant Puerperal Eclampsia 26 H.E. Poor — Term — Yes — Malnourished 10.11.34 11.11.34 10.11.34 Husband in regular work. Adequate ante-natal care. No warning signs of any kind. Unavoidable death. 10. 3.12.34 Puerperal Septicaemia 40 W. Poor 9 Post-mature — Yes — Heart Disease 16.11.34 21.11.34 21.11.34 Husband in regular work. Advice of doctor re termination of pregnancy because of heart disease not accepted. Delay by midwife in calling in Medical aid. 11. 3.12.34 Puerperal Septicaemia. Miscarriage 29 Ho. Poor 4 ? - - - Malnourished 23.11.34 25.11.34 27.11.34 Much unemployment of husband. Milk from Council's Assisted Scheme for last 4 years. Evidence of induced abortion. Difficulty in obtaining patient's consent for removal to Hospital. 105 The following table shows the position with regard to Maternal Mortality compared with that for England and Wales:— Births Registered. Deaths of women due to Pregnancy and Child-Bearing. WALTHAMSTOW. England and Wales. Puerperal Sepsis. Other Puerperal Causes. Total. Rates per 1,000 Births Registered. Rates per 1,000 Births Registered. Puerperal Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal causes. Total. Live 1,715 ,, and 7 5 12 4.08 2.91 6.99 2.03 2.57 4.60 Stillbirths 1,775 7 5 12 3.94 2.81 6.75 1.95 2.46 4.41 The average Maternal Mortality rate for the ten years 1924 to 1933 (inclusive) was 3.32 against 4.21 for England and Wales. The table opposite 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. Of the 12 women dying in, or in connection with, child birth, 7 were due to sepsis, five had obtained no ante-natal care of any kind, and one only had come under the Council's Services. The latter died from fulminant puerperal eclampsia—there was no warning sign of any kind, and the death was quite unavoidable. Unemployment and/or malnutrition was only noted in one case. In four cases reasonably definite suggestion of induced (and illegal) abortion was obtained. Two were unmarried mothers. From statements made by medical practitioners, health visitors and district midwives working in the town, there can be no question but that practices such as drug taking and illegally induced abortions are being increasingly undertaken with a view to the termination of pregnancy. The 1934 Maternal Mortality rate for Walthamstow will render it one of the "black-listed" areas, but it is felt that this unenviable position is due more to the neglect and folly of expectant mothers, than to any omission by the Council to provide every conceivable obstetric service. 106 16. MISCELLANEOUS. (a) Maternity Outfits.—A set was selected at random in January, 1934, and was sent away for bacteriological tests to be carried out for sterility. The laboratory reported that the outfits could be regarded as reasonably sterile for practical purposes. (b) Provision of Artificial Dentures.—Towards the end of 1933 your Council approved a scheme for the supply of artificial dentures for necessitous expectant and nursing mothers attending the Municipal Ante-Natal Clinics. The scale of recovery is based on the scale approved with regard to the Maternity Home fees. I. THORPE COOMBE MATERNITY HOME. Historical.—"Thorpe Coombe" and the adjoining lodge, with about four acres of land, was bought by the Council in June, 1929, for the purpose of erecting a maternity home. Some reference to the former history of Thorpe Coombe will not be without interest and the following is taken from the Walthamstow Antiquarian Society's Official Publication No. 20 (1928), "MoreWalthamstow Houses," by George F. Bosworth. "'Thorpe Coombe' or 'North Bank,' as it was called till about forty years ago, was the home of one of the sons of Sir Robert Wigram, of Walthamstow House. The original building of the mid-eighteenth century is of reddish-brown stocks which are as good to-day as when they were first laid. The house was nearly square in plan, three storeys high, with a lead and tile roof, and underground kitchens. It has a handsome panelled and decorated porch with columns on either side. Two wings were built later to match the original work but they are only two storeys high. These two wings balanced each other in outside appearance on either side of the mansion, but only one was an addition to the house accommodation, the other being a coach-house with rooms over for the coachman. This coach-house has windows facing front, matching the other wing, but they are blocked up, owing presumably to the window tax of those days. At a later date the underground kitchens were disused and another addition was built on the east end for domestic offices, which are paved with York stone. There is a verandah at the back of the house, over the area which lighted the underground offices. 107 (Note by Medical Officer of Health: The coach-house is now the pupil midwives' classroom and the coachman's rooms over are the Resident Medical Officer's quarters.) "At the west end, opposite the coach-house, is another building which was the stable and cowhouse. This has a brick with the date '1789' cut in it. The upper part of this building was fitted with storage room for fruit, etc. The cows used to graze in the meadows opposite, where Spruce Hills Road now runs. (Note by Medical Officer of Health: This building is now referred to as the lodge and accommodates the ante-natal clinic on the ground floor and six staff bedrooms on the first floor.) "The garden possesses a varied selection of trees including oak, chestnut, silver birch, copper beech, cedar, acacia, larch, cypress and mulberry. Even in 1928 there were owls, wood pigeons and hedgehogs in the grounds." After several alterations to the draft plans, building was finally begun by contract on the 20th February, 1933, and the Home was officially opened by Dame Janet Campbell, D.B.E., on the 21st April, 1934. Following the opening, the Home was thrown open for public inspection and, excluding the opening day, 1,386 persons signed the visitors' book. Adaptation.—There are four separate blocks—Thorpe Coombe and the lodge—both used for staff accommodation together with ante-natal clinic premises in the latter, and two blocks of new construction, viz., the Maternity Block and the laundry. In addition, a small building is at present under construction to aocommodate a water softening plant. Thorpe Coombe has on the ground floor the Matron's office, four staff dining and sitting rooms, and kitchen (electrically equipped). The first floor has nine single bedrooms and the second floor seven single bedrooms. Both floors have bathrooms, etc., in addition, and the basement is used for storage purposes. The old house has been completely modernised by the installation of central heating, electric lighting and fitted wash-basins and wardrobes in each bedroom. The lodge has on the ground floor the ante-natal clinic comprising waiting-room, dispensary, dressing cubicles and examination room. In addition, one room is used as a District Midwife's office. The first floor provides six single bedrooms modernised as previously described. 108 The Maternity Block is of two storeys—the lay-out of each being identical except that on the ground floor there is a receiving room and bathroom adjoining, while the first floor has, instead, a two-bed ward. The bed accommodation is as follows:— Ground No. Floor. Beds. First No. Floor. Beds. Isolation— Single-bed Wards 2 2 2 2 Lying-in— Four-bed Wards 2 8 2 8 Two-bed Wards 2 4 3 6 Single-bed Wards 4 4 5 5 Total 18 21 In addition there are the following beds:—Receiving, labour and waiting labour, 7. A line drawing kindly supplied by the Engineer and Surveyor is reproduced together with a key explaining the use of the various rooms. In addition, four photographs are reproduced. 109 THORPE COOMBE MATERNITY HOME. Reference to Rooms. Bathroom B. Patients' Lavatory P.L. Emergency Labour Ward E.L.W. Receiving Ward R.W. Doctor's Room D. Sluice Room S. Duty Room D.R. Sterilising Room S.R. Linen Store L.S. Single-bed Ward W.l. Labour Ward L. W. Two-bed Ward W.2. Night Nursery N.N. Four-bed Ward W.4. 110 Maternity Block, Labour Ward and View into Sterilizing Room. 111 Four Bed Ward. 112 Cost.—The cost has worked out as follows (provisional figures only):—Land, £5,213; Building, £24,842; Equipment, £4,015; Total, £34,070. On the basis of forty beds the total cost amounts to £852 per bed. Actually, one of the single bed wards on the ground floor is used as a Sister's room because owing to its proximity to the heating chamber it is unsuitable for patients. The loan charges amount to £2,573 3s.. Od. per annum. Equipment.—Reference must be made to the fact that the oldfashioned bed-pan sluices have been entirely discarded in the equipment of the Home and instead three steam bed-pan washers have been provided on each floor. After much preliminary investigation it was decided to try two types, and although both types proved bacteriologically efficient with regard to sterilisation, one type proved much more satisfactory in practice. Before the Home was opened stringent bacteriological tests were carried out and which proved that streptococci, staphylococci and even B.Coli communis were killed by two minutes' exposure to steam at 71bs pressure. The use of these bed-pan washers has been an unqualified success and represents only one of the many measures which have been used to cut out the risk of sepsis. Staffing—(a) Nursing and Domestic.—Within a short period of the opening it was obvious that the Home had established a good reputation in the town and the chief credit for this must be given to the Matron, Miss F. Bambridge, and her staff. Miss Bambridge assumed duty on 1st January, 1934, in ample time to bear the brunt of the work of equipping the Home in conjunction with Mr. A. Whitehead, your Council's Buyer. At the end of the year the staff consisted of the following:— Matron, Senior Sister, 4 Sisters (including 1 District Sister), 4 Staff Nurses, 4 Probationers; Total, 14. Clerk, cook, 6 maids, 2 laundresses, 3 stokers (plus half-time relief) and 1 gardener. The daily average number of patients in the Home in December, 1934, was 23.2. It has been found that the smaller ward units and the rather long corridors have made it necessary to staff the Home to a greater degree than is usual in maternity hospitals with larger wards. 113 (b) Medical.—Your Council decided in the first instance to invite the Medical Practitioners of the town to co-operate in the clinical work of the Home and a scheme of Administration was discussed with a Consultative Committee set up to represent the local doctors. A General Practitioners Ante-Natal Scheme was evolved under which each midwife's case booking at the Home was given the choice between attendance for medical examination at the Clinic or from any doctor whose name appeared upon the medical aid rota. A total of 29 doctors elected to act on this rota and have given excellent and efficient service. The Home opened for the reception of patients on the 1st May but, unfortunately, the approval of the Ministry of Health of the General Practitioners Ante-Natal Scheme (which being a new departure in the area, required approval) was not received until the 30th May, 1934. It is a matter of regret that only some ten midwives' cases chose to come under the scheme up to the end of 1934. A fee of 5s. for each of three ante-natal examinations is payable, and one of 5s. for a post-natal examination. In the case of insured women a fee of 5s. is paid for the report. A memorandum issued by the Medical Officer of Health to Medical Practitioners in the area stated that the Home was principally intended for the following types of patients:— (а) Complicated midwifery cases. (b) Women whose home circumstances are unsuitable for finement. (c) Complicated cases of pregnancy which require observation and treatment. It was stated that cases of puerperal sepsis and abortion would not be admitted; that the services of the Council's panel of Consultants and Anaesthetists would be available, and that the use of masks and gloves would be compulsory. (c) Ante -Natal.—Your Council were fortunate enough to secure the services of Dame Louise McIlroy, D.B.E., to take charge of the Ante-Natal Clinic and to act on the panel of Consultants. The Clinics held were progressively increased from one per month to one per fortnight, and then one per week. Later in 1934, and in order to cope with the increased bookings, Dr. Helen Rodway, M.C.O.G., was appointed to take charge of an additional weekly Ante-Natal Clinic. 114 General.—A summary of the work done during the first 12 months, i.e., up to April 30th, 1935, is given below:— Number of patients admitted 456 (а) Confinements 415 (b) Ante-Natal 47 Average duration of stay 14.4 days. Number of patients delivered by— (a) Doctors 57 (b) Midwives 358 The maximum number of patients on any one day was 29, and the daily average numbers of patients was as follows:— May 3 September 16.8 June 8.4 October 17.6 July 12.3 November 17.3 August 11.4 December 23.2 The daily average for the year was 14. Fees.—Patients from outside the Borough are charged a fee of 5 guineas per week, plus a non-returnable booking fee of 10s. 0d. plus any Specialist medical fees. Patients resident in the Borough pay 5 guineas per week for a single-bed ward and 4 guineas per week for a bed in a two-bed ward. If midwives' cases, they are not charged any extra fees if medical aid or Consultant services have to be summoned. If doctors' cases, they are responsible for their doctor's fees, but not for operation fees. Patients resident in the Borough may, if they so wish, be assessed at reduced fees on the scale in operation. District Midwife.—A District Midwife was appointed on the 4th May, 1934, but the bookings have not been numerous. Up to the end of the year eight midwifery cases were attended and one maternity. Pupil Midwives.—The Home was inspected by the Chairman of the Central Midwives' Board in March, 1935, and approval was given for the training of six pupil midwives at any one time with effect from 1st April, 1935. 115 CLINICAL REPORT. The following clinical report on the work done at the Home between the date of opening (May 1st, 1934) and the 31st December, 1934, has been kindly compiled by the Resident Medical Officer, Dr. Helen Rodway, M.C.O.G., who assumed duty in April, 1935:— Ante-Natal Supervision.—Number of Ante-Natal Clinics held:— Doctors' Clinics, 39; Midwives' Clinics, 126; Total, 1'65. Number of expectant mothers who attended the Ante-Natal Clinics:— Primiparæ, 187; Multiparas, 184; Total, 371. Total attendances made:— New cases, 371; old cases, 1,745; Total, 2,116. Average attendance per session, 12.8. Number of cases in which medical assistance was sought by a midwife resulting in the admission of the patient for ante-natal treatment in the Maternity Home (i.e., excluding doctors' booked oases), 22. Milk Supplied to Expectant Mothers.—Number of expectant mothers supplied with milk at the 30th—31st week, 5; 32nd week, 5; 34th week, 2; 36th—37th week, 9; Total, 21. In-Patient Treatment.—Number of cases admitted during the period reported (this includes Ante-Natal cases):— Ante-Natal cases, 29; Deliveries, 229; Total, 258. (Primiparæ, 112; Muitiparae, 117.) Twenty of these patients were from without the Borough. Of the 229 cases, a number of patients were delivered by private doctors: — Doctors' cases, 34; Midwives' cases, 195; Total, 229. Average duration of stay in the Maternity Home in days, 14.0. Number of cases in which medical assistance was sought by a midwife:—(a) During pregnancy, 22; (6) in labour, 22; (c) during puerperium, 52; (d) for the infant, 10; Total, 106, representing 54.4 per cent. of midwives' cases. 116 Indications:— (a) During Pregnancy. (b) In Labour. Albuminuria 6 Premature Labour 1 Albuminuria and High Uterine Inertia 2 Blood Pressure 3 Breech Presentation 5 High Blood Pressure 1 Transverse Lie 1 Oedema 1 Twins 1 Oedema and Vaginal Dis- Delay in 2nd stage 5 charge 1 Adherent Placenta 2 Vaginal Discharge 1 Retained Placenta 2 Toxaemia 1 Post - partum haemAnte-partum haem- orrhage 3 orrhage 1 Disproportion 2 22 Abdominal Pain in early Pregnancy 1 Glycosuria 1 Debility 1 Respiratory Distress 1 Premature Rupture of Membranes 1 22 (c) During Puerperium. (d) For the Infant. Ruptured Perineum 41 Malformation of Finger 1 Albuminuria and High Prematurity 2 Blood Pressure 1 Blue Asphyxia 1 Pyrexia 6 Pyrexia 1 Persistent Red Lochia 2 Discharging Eye 4 Septic Thumb 1 Anencephaly 1 Eclampsia 1 52 10 Number of cases in which a Consultant was called in by a doctor in charge of a case, 12. Indications:—External version, 2; previous Cæsarean section, 2; adherent placenta, 1; puerperal pyrexia, 1; eclampsia, 1; uterine fibroids complicating labour, 2; uterine inertia, 1; retained placenta, 1; re infant, 1. Number of cases in which delivery was terminated by the application of forceps, 7. 117 Indications:—Delay in second stage in each case. Number of cases in which Cæsarean section was performed, 4. Indications:—Previous Cæsarean section, 2; uterine fibroids complicating labour, 2. Puerperal Morbidity.—The standard adopted for the estimation of puerperal morbidity is that of the Puerperal Fever and Pyrexia Regulations, viz., a temperature of 100.4 deg. Fahrenheit (38 deg. centigrade) or more, sustained during a period of 24 hours, or recurring within that period, during the first 21 days of puerperium. Number of cases notified, 3. (a) Puerperal Fever, 0. (b) Puerperal Pyrexia, 3. (i) Engorged breasts, 2. (ii) Cause unknown, 1. Number of maternal deaths, 1. Cause—Fulminant puerperal eclampsia, after delivery. This patient, a primipara, aged 26, who had attended the AnteNatal Clinic from the 20th week of pregnancy, was a thin, illnourished subject. During her pregnancy she complained of headache and nose-bleeding at the 32nd week. The maximum systolic blood pressure was 140 m.m. at the 34th week. Albumen was not found in the urine at any time. Oedema was absent. Labour was short lasting five hours and a quarter. The infant was still-born. Three hours after delivery the patient complained of headache and pain in her chest; following this she had a series of thirteen fits at intervals of ten to twenty minutes. She was treated with luminal, morphine and rectal salines. The patient did not recover consciousness after the first fit. Death occurred seven hours after the onset of the attack. A post-mortem examination was not held. Infants.—Total number of live births, 225. Stillbirths and Infantile Mortality (a) Still-born, 6. Cause of death in each caseMacerated foetus, 4 (cause unknown); Anenoephalic, 1; following difficult forceps delivery, 1 (no post-mortem held). (b) Within 10 days of birth, 1 (a premature twin). Number of cases of ophthalmia neonatorum, 1. Result of treatment—Vision unimpaired. 118 The following particulars are given in the form required by the Ministry of Health:— 1. Name and address of Institution—Thorpe Coombe Maternity Home, 714, Forest Road, Walthamstow, E.17. 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds)—35. 3. Number of maternity oases admitted during the year ing Ante-Natal cases)—258. 4. Average duration of stay—14.0 days. 5. Number of cases delivered by:— (а) Midwives—195. (b) Doctors—34. 6. Number of oases in which medical assistance was sought by a midwife in emergency—106. 7. Number of oases notified as:— (а) Puerperal fever—Nil. (b) Puerperal pyrexia—3 (2 due to breasts, 1 P.U.O.) 8. Number of cases of pemphigus neonatorum—Nil. 9. Number of infants not entirely breast-fed while in the Institution—3. 10. (a) Number of cases notified as ophthalmia neonatorum—1. (b) Result of treatment in each case—vision unimpaired. 11. (a) Number of maternal deaths—1. (b) Cause of death in each case—Fulminant Puerperal Eclampsia. 12. (a) Number of infant deaths:— (i) Stillborn—6. (ii) within 10 days of birth—1. (b) Cause of death in each case, and results of post-mortem examination (if obtainable): — (i) 4 macerated. 1 anencephalic. 1 difficult forceps delivery. (ii) Premature twin.