WALIS M AC 4411 (1) WALTHAMSTOW Borough of Walthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1936. Borough of Walthamstow. REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1936. INDEX. page Section A.—Statistics and Social Conditions of the Area 8 ,, B.—General Provision of Health Services in the Area 13 ,, C.—Sanitary Circumstances of the Area 20 ,, D.—Housing 30 ,, E.—Inspection and Supervision of Food 42 ,, F.—Prevalence of and Control over Infectious Disease 48 ,, G.—Infectious Disease Hospital 68 ,, H.—Maternity and Child Welfare 78 ,, I.—Thorpe Coombe Maternity Home 108 page Acreage 8 Adulteration 44 Albuminuria 115 Ambulance 14 Anaesthetics and Analgesia 137 Ante-Natal Clinic 85, 88, 96, 112 Antitoxin 58 Bacteriological Analyses 27, 44 Bakehouses 25 Biological Tests 42, 43 Births 9 ,, Notification of. 81 ,, Registration of 81 Birth-Rate 9 Breech Delivery 120 Breast Feeding 86 Brookfield Hospital 90 Caesarean Section 124 Cancer 12 Caravans 29 Cerebro-Spinal Meningitis 62 Child Welfare 85 Children Act 89 Clearance Areas 39 Clinics 15, 85. 88, 94, 95, 136 Closet Accommodation 21 Committees 4, 78 Comparability Factor 10 Compensation (Midwives) 102 Connaught Hospital 18 Consultants 79, 100, 114 Contracted Pelvis 125 Cowsheds 26 Cremation 76 Dampness 24 Deaths 9, 12 ,, Infant 83, 84 ,, Infectious Diseases 11 ,, Institutional 13 De^th Rate 9 Dental Treatment 90 page Diarrhoea . 10, 85 Dick Tests 54 Diphtheria 57, 72 ,, Immunisation 51 Diseases of Animals Acts 45 Disinfection 24 Disinfestation 28, 39 District Midwife 11l Drainage 21 Dysentery 59 Encephalitis Lethargica 62 Enteric Fever 58 Erysipelas 61 Essex Public Medical Service 19 ,, County Council Act 20 Factories and Workshops Acts 46 Fishmongers 26 Food and Drugs 44 ,, Poisoning 62 Foot Clinic 15 Forceps Delivery 123 Haemorrhage— Ante-Partum 117 Post-Partum 126 Health Education 76 ,, Visitors 79 Home Helps 97 Hospital Accommodation 17, 98 ,, Infectious Disease 68 ,, Smallpox 55 House-to-House Inspection 33 Housing 30 Act, 1930 32, 34 Act, 1935 33, 34, 36, 39 ,, Conditions 35 ,, Inspection 31 ,, Register 37 ,, Shortage 36 ,, Statistics 30 ,, Tuberculous Cases 39 page Ice Cream 43 Immunisation 51, 52, 53, 54 Industrial Activity 9 Infant Life Protection 89 ,, Mortality 9, 83, 84, 135 Infectious Diseases 11,48 ,, ,, Clinic 50 Institutional Treatment 97 Inquests 75 Invalid Children's Aid Asscn. 93 Isolation Hospital 68 Laboratory Work 14, 54, 74 Massage 89,94 Maternal Mortality 11, 106, 109,136 Maternity and Child Welfare 78 ,, Homes .98 Measles 9, 63 ,, Serum 65 Meat Inspection 43 Medical Aid 102, 115 ,, Examinations 75 Midwives 101, 102 Milk, Assisted Scheme 89, 96 ,, and Dairies Order 42 ,, Shops 26 ,, Special Designation Order 42 ,, Supply 42 Miscellaneous 75 Mortuary 75 Neo-Natal Mortality 83 Notices, Sanitary 23 Notifications and Rates 11 Notification of Births 81 Nurse Children 89 Nursery School 96 Nursing 15,60,64 ,, Homes Registration Act 20 Nutrition 45 Obstetric Consultants.. 79, 100 Ophthalmia Neonatorum 61, 106 Ophthalmic Treatment 92 Orthopaedio Treatment 90 Outworkers 47 Overcrowding 33 Parks 9 Perineal Lacerations 131 Placenta Praevia 118 Pneumonia 59 Poliomyelitis 62 Population 8 Posters 76 Post-Mortems 75 Post-Natal Clinic 88, 117, 136 Propaganda 76 Publio Assistance 17,19 ,, Cleansing 21 page Puerperal Fever and Pyrexia 61, 103, 105, 128 ,, Sepsis 9 Rainfall 76 Rateable Value 8 Rats and Mice Destruction Act, 1919 46 Recreation Grounds 9 Refuse Disposal 21 Rent Restriction Acts 45 Rheumatism Clinic 50 Rivers and Streams 21 Sanitary Inspection 23 Scarlet Fever 55, 73 ,, ,, Immunisation 54 Schick Tests 51 Schools 30 Sewerage 21 Shellfish 45 Shops Act 26 Slaughterhouses 25 Smallpox 55 Smoke Abatement 26 Social Conditions 8 Special Premises25 Staff 6, 7, 74, 79, 109 Statistics 9, 11, 30, 49 Stillbirths 9, 81, 132 Sunlight Treatment 92 Swimming Baths 27 Tents, Vans and Sheds 29 Thorpe Coombe Maternity Home 108 Tonsils and Adenoids 92 Tuberculosis 10. 65, 75 ,, Order, 1925 45 Tuberculous Meat 43 Twins Delivery 124 Unemployment 8 Unhealthy Areas 34 Vaccination 55 Venereal Diseases 19 Vertex, Posterior 118 Vital Statistics 9, 11 Walthamstow Child Welfare Society 94 Walthamstow District Nursing Association 98 Water 20 Whooping Cough 10 Women's Clinic 15 Zymotic Diseases 10 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Alderman Mrs. C. MoEntee, J.P., E.C.C. Ex-Officio: His Worship the Mayor—Alderman Ross Wyld, J.P. The Deputy Mayor—Alderman G. Gibbons, J.P. Chairman of Finance Committee—Councillor E. C. Redhead. Alderman J. C. Hammond. Alderman Mrs. M. Norrish. ,, P. Friedberg. ,, W.J. Sharp. Councillor Mrs. L. P. Bailey. Councillor Mrs. E. M. Miller ,, Mrs . B. M. Friedberg . (Chairman, Sanatorium ,, W. Gillett. Visiting Committee.) ,, Mrs. E. M. Hammond. ,, Mrs. E. M. Richards. ,, V. S. King. ,, R.E.Smith. ,, G. R. Lowton. ,, J. H. Thomason. ,, Mrs. E. B. Toynbee. Town Clerk: F. G. Garner, Esq. 5 TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, I beg to present herewith a report on the work of the Department during 1936, arranged in the form suggested by the Ministry of Health. Maternal and Child Welfare has been dealt with in a separate section. The adjusted death rate of 10.8 per 1,000 resident population compares favourably with that of 12.1 for England and Wales. The incidence of Diphtheria appears to be the lowest recorded, whilst the number protected was the highest. Diphtheria notifications were only 0.77 per 1,000 population against 1.39 for England and Wales. Attendances at the Foot Clinic and the Women's Clinic again increased. A great deal of additional work followed from the operation of the Housing Act, 1935. Your Engineer and Surveyor, Housing Manager, Cleansing Superintendent and the Superintendent of the Ambulance Service have again kindly contributed reports on matters dealt with by their Departments. The Chief Sanitary Inspector has given every assistance and has contributed those sections of the report dealing with the work of the Sanitary Inspectorate. The staff of the Department have worked well and have assisted in the compilation of the report. I have to acknowledge the consideration and help received from your Committee and from your Chairman. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 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. H. W. Harding, M.D., D.P.H. (part-time relief work). Matron—Isolation Hospital: Miss V. M. Wilson, S.R.N. Women's Clinic: Consultant Surgeon (part-time)—Miss M. M. Basden, M.D., F.R.C.S., F.C.O.G. Medical Officer—Miss Helen Rodway, M.R.C.S., L.R.C.P., M.C.O.G. Nurse (part-time)—Miss A.M. Duncan, S.R.N. Foot Clinic: Chiropodists—Miss M. McCallum, S.R.N., C.S.M.M.G., M.C.Ch.A. Miss M. Smith, M.C.Ch.A. Clerk (part-time)—Mrs. N. Moger. 7 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). F. Northcote, A.R.S.I, (b), (c). R. C. Bland, A.R.S.I. (b), (d). H. D. Perrin (6), (d). F. W. Kemp, A.R.S.I. (a), (b), T. Vaughan (b), (c), (e). (c). H. A. Whipp (b), (c). Miss O.J. Panther (a) (half-time to Factories and Workshops Act duties). (а) Cert. 8.1.E.B. (London). (б) 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. Miss I. H. Jennings, S.R.N., S.C.M. (Infectious Disease Nurse). 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, Miss E. Ogilvie, R. A. C. Green, L. Rushton, F.J. Aylward, A. T. Wade, A. R. Kiggins. Ambulance Drivers and Disinfecting Staff: W, H. Dunn, E. E. Harber, R. High, B. Winter, 8 A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1936) 133,600 Number of Assessments, 1st April, 1936 34,885 Rateable value £825,068 Sum represented by penny rate £3,283 Population.—The Registrar-General's estimate of the population at mid-year, 1936, is 133,600, a decrease of 890 on the previous figure. Social Conditions.—No appreciable change from 1931 Report. Unemployment.—The degree of unemployment in the area during 1936 may be estimated from the following data kindly supplied by Mr. W. H. Goodfellow, Manager of the Local Employment Exchange. The total insured work-people of both sexes in Walthamstow is approximately 30,000, and a test showed that roughly two-thirds of the figures given below related to persons residing in Walthamstow (excluding Juveniles). The following data refer to the whole Exchange area. Date No. remaining on Register. Total Total Amount of benefit paid during month. Men. W omen. 1936. 1935. 27.1.36 6,191 1,255 7,446 8,254 20,763 24.2.36 5,696 1,148 6,844 7,637 16,053 23.3.36 5,277 1,117 6,394 7,548 19,873 20.4.36 4,838 1,037 5,875 6,791 16,969 25.5.36 4,118 843 4,961 6,215 18,743 29.6.36 3,792 908 4,700 6,149 16,926 27.7.36 3,509 868 4,377 5,882 12,144 31.8.36 3,528 735 4,263 5,448 14,430 28.9.36 3,717 555 4,272 5,618 1] ,308 26.10.36 3,918 531 4,449 5,705 10,023 23.11.36 4,150 722 4,872 6,060 12,664 21.12.36 3,829 727 4,556 6,711 13,269 Mr. Dempsey states that the following were the registrations at the Juvenile Employment Bureau:— Live Register at beginning of Bovs. Girls. Total. year 48 96 144 Fresh Registrations during year 1,076 1,171 2,247 Registrations during year 805 670 1,475 Live register at end of year 44 20 64 9 Industrial Activity.—Considerable industrial activity has been apparent in the erection of new factories and in the extension of existing works. Particular reference must be made to the new industrial developments on the Lea Bridge site, where factories of attractive design have been built and are worked entirely by electric power. Parks and Recreation Grounds.—Low Hall Farm-. Sports Ground.—The construction of the North Access Road, including bridge over the Dagenham Brook, has been completed, and the construction of a Sports Pavilion, Groundsman's House and 12 Tennis Courts have been commenced. Extracts from Vital Statistics.—The Registrar-General's mid-year, 1936, estimate of population (viz., 133,600) has been used for the calculation of all vital statistics:— Total. Males. Females. Live Births Legitimate 1,684 885 799 Birth rate per 1,000 of the estimated resident population 12.4 Illegitimate 31 17 14 Total 1,715 902 813 Stillbirths. 54 Rate per 1,000 total (live and still) births 30.5 Deaths 1,321 Death rate per 1,000 of the estimated resident population 9.8 Deaths from puerperal causes:— Rate per 1,000 (live and still) births. Puerperal Sepsis Deaths 1 0.56 Other Puerperal Causes 2 1.13 Total 3 1.69 Death rate of infants under one year of age:— All infants per 1,000 live births 42 Legitimate infants per 1,000 legitimate live births 41 Illegitimate infants per 1,000 illegitimate live births 97 Deaths from Measles (all ages) 8 ,, ,, Whooping Cough (all ages) 4 ,, ,, Diarrhoea (under 2 years of age) 11 10 The comparability factor (see page 9 of 1934 Report) for Walthamstow for 1936 is 1.11, which, applied to the crude deathrate of 9.8 for 1936, yields an adjusted death-rate of 10.8 as against the rate of 12.1 for England and Wales. Ratio of local crude death-rate to national crude death-rate, 0.81. Ratio of local adjusted death-rate to national crude deathrate, 0.89. The latter ratio means the adjusted death-rate for Walthamstow during 1936 was nearly 11 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 0.19 against 0.13 in 1935. The Pulmonary Tuberculosis death-rate was 0.54 per 1,000 population, and the Non-Pulmonary death-rate was 0.104 per 1,000 population. The natural increase of population, i.e., excess of births over deaths, was 394. 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. The total number of deaths in 1936 (1,321) compares with 1,236 during 1935, the respective death-rates per 1,000 population being 9.8 and 9.2. 11 Birth-rates, Death-rates, Analysis of Mortality, Maternal Death -rates and Case -rates for certain Infectious Diseases in the year 1936. England and Wales, London, 122 Great Towns and 143 Smaller Towns (Provisional figures based on Weekly and Quarterly Returns.) England and Wales. 122 County Boroughs and Great Towns (including London). 143 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Walthamstow. Ratesper 1,000 po pulation. Births:— Live 14.8 14.9 15.0 13.6 12.8 Still 0.61 0.67 0.64 0.53 0.40 Deaths:— All Causes 12.1 12.3 11.5 12.5 9.8 Typhoid and Para-typhoid Fevers 0.01 0.01 0.00 0.01 0.00 Smallpox — — — — Measles 0.07 0.09 0.04 0.14 0.06 Scarlet Fever 0.01 0.01 0.01 0.01 0.00 Whooping Cough 0.05 0.06 0.04 0.06 0.03 Diphtheria 0.07 0.08 0.05 0.05 0.01 Influenza 0.14 0.14 0.15 0.14 0.19 Violence 0.52 0.45 0.39 0.52 0.35 Notifications:— Smallpox 0.00 0.00 — — — Scarlet Fever 2.53 2.18 2.48 2.57 2.39 Diphtheria 1.39 1.31 1.26 1.69 0.77 Enteric Fever 0.06 0.05 0.06 0.06 0.06 Erysipelas 0.40 0.38 0.35 0.44 0.38 Pneumonia 1.11 1.10 0.96 0.99 1.15 Ratesper 1,000 Live Births. Deaths under 1 year of age 59 63 55 66 42 Deaths from Diarrhoea and Enteritis under 2 years of age 5.9 8.2 3.4 14.4 6.4 Maternal Mortality:— Puerperal Sepsis 1.40 Not available 0.58 Others 2.41 1.16 Total 3.81 1.74 Rates per 1,0 00 Total Births (i .e. Live and Still) Maternal Mortality:— Puerperal Sepsis 1.34 Not av ailable 0.56 Others 2.31 1.13 Total 3.65 1.69 Notifications:— Puerperal Fever 3.27 3.46 2.80 3.03 2.82 Puerperal Pyrexia 9.64 9.52 7.57 11.15 16.96 12 Causes of Death as given by the Registrar -General for the year 1936. Whole District. Causes of death. Males. Females. Total. Total 1935. 1. Typhoid and Para-typhoid Fevers - - - - 2. Measles 5 3 8 1 3. Scarlet Fever - 1 1 — 4. Whooping Cough 1 3 4 6 5. Diphtheria 2 — 2 4 6. Influenza 13 13 26 10 7. Encephalitis Lethargica. 2 — 2 1 8. Cerebro-spinal Fever 2 — 2 2 9. T. B. of respiratory system 43 30 73 69 10. Other Tuberculous diseases 12 2 14 6 11. Syphilis 3 1 4 1 12. General paralysis of the insane, (tabes dorsalis) 7 1 8 6 13. Cancer, malignant disease 96 96 192 204 14. Diabetes 8 8 16 14 15. Cerebral Haemorrhage, etc. 43 42 85 61 16. Heart disease 179 195 374 344 17. Aneurysm 4 3 7 7 18. Other circulatory diseases 19 24 43 48 19. Bronchitis 37 21 58 38 20. Pneumonia (all forms) 39 34 73 72 21. Other respiratory diseases 8 10 18 11 22. Peptic Ulcer 17 4 21 12 23. Diarrhoea, etc. (under 2 years) 8 3 11 7 24. Appendicitis 10 5 15 5 25. Cirrhosis of Liver 1 — 1 — 26. Other diseases of liver, etc. 2 3 5 7 27. Other digestive diseases 12 11 23 26 28. Acute and Chronic Nephritis 22 24 46 45 29. Puerperal Sepsis — 1 1 3 30. Other Puerperal causes — 2 2 2 31. Congenital Debility and Malformation, Premature Birth, etc. 16 21 37 40 32. Senility 2 15 17 26 33. Suicide 8 7 15 12 34. Other violence 24 9 33 39 35. Other defined causes 49 33 82 106 36. Causes ill-defined or unknown 2 — 2 1 Totals 696 625 1321 1236 13 The main classification of deaths—those for 1935 being given in parentheses—was as follows:— Whooping Cough, 4 (6); Diphtheria, 2 (4); Pulmonary Tuberculosis, 73 (69); Non-pulmonary Tuberculosis, 14 (6); Cancer, 192 (204); Cerebral Haemorrhage, 85 (61); Heart, 374 (344); Bronchitis, 58 (38); Nephritis, 46 (45); Congenital Debility, etc., 37 (40); Suicide, 15 (12); Violence, 33 (39). Institutional Deaths. Whipps Cross Hospital 263 Central Homes, Leytonstone 168 Connaught Hospital 72 Brentwood Mental Hospital 21 Forest Gate Sick Home 17 The Clock House, Wood Street, Walthamstow 10 Prince of Wales's General Hospital, Tottenham 10 Walthamstow Isolation Hospital 9 Queen's Hospital, Bethnal Green 9 German Hospital, Dalston 9 Children's Hospital, Great Ormond Street 9 Epping Infirmary 8 London Hospital, Whitechapel 8 St. Bartholomew's Hospital, London 7 University College Hospital, London 6 St. Joseph's Hospice, Hackney 5 Middlesex Hospital, London 4 The Forest Hydro, Walthamstow 4 Royal Free Hospital, London 4 Jubilee Hospital, Woodford 4 Heathfield Nursing Home, Walthamstow 3 North Middlesex County Hospital, Tottenham 3 London Fever Hospital, Islington 2 Several Is Hospital, Colchester 2 St. Luke's Hospital, London 2 King George Hospital, Ilford 2 Royal Masonic Hospital, London 2 Central London Throat, Nose and Ear Hospital 2 Other Institutions 27 B.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 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. 14 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. 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 1936:— Removals Accidents Maternity Total Mileage Receipts £ s. d. 1,681 601 174 2,456 14,400 209 4 6 113 maternity cases have been removed to Thorpe Coombe Maternity Home. The oxygen-carbon dioxide breathing apparatus, giving a mixture of 7 per cent, carbon dioxide, has been in use 13 times for cases of gas poisoning and collapse. It was successfully used on 11 occasions. 2. Whipps Cross Hospital. Removal of patients is carried out by ambulances attached to the Hospital. 3. St. John Ambulance Corps. The Corps Superintendent, Mr. W. W. Perriton, reports as follows:— First Aid cases attended 1,122 Number of patients removed 938 Mileage 19,326 Number of road accidents 9 15 Local duties at cinemas, sports meetings, cricket, football, outings and functions of all kinds have been covered by request as usual. A new division has been formed at Chingford and eight of our trained men transferred with the hut situated at Highams Park and called the "Duncan Memorial." The Corps arranged, in conjunction with the British Social Hygiene Council, a well attended course of three film lectures on Venereal Diseases. Nursing in the Home. (a) General.—No change since 1931. (b) Infectious Diseases.—No change since 1931. Clinics and Treatment Centres. Foot Clinic.—Total attendances were 9,705, and of these 1,716 were by new patients and 7,989 were re-attendances by old patients. The receipts were £375 13s. 8d. A part-time chiropodist was employed when necessary in addition to the two full-time chiropodists. Women's Clinic.-—Sessions were held weekly with one consultant session monthly. Miss Basden continued as Consultant-in-Charge and Miss Helen Rodway, M.C.O.G., took charge of the weekly sessions. The attendances have been as follows:— New cases. Old cases. Monthly consultation clinic 17 108 Weekly clinic 259 589 Total 276 697 Thirty-six cases were referred to the clinic by private practitioners. Dr. Rodway contributes the following report:— 16 SUMMARY OF NEW CASES. 1. Ante -Natal:— For diagnosis of pregnancy 49 For diagnosis of position of foetus 5 Cardiac failure associated with pregnancy 1 Pulmonary tuberculosis associated with pregnancy 1 2. Sterility 19 3. Contraceptive:— Cases advised 8 Advice not given owing to lack of medical reason 7 4. Diseases of external Generative Organs:— Urethral carbuncle 1 Pruritus 2 Senile vulvitis 1 Leukoplakia 1 5. Diseases of Vagina:— Vaginitis 1 Dyspareunia 3 Bartholin's cyst 2 Rectovaginal fistula 1 Haematocolpos 1 6. Diseases of Cervix Uteri:— Erosion 7 Mucous polypus 2 Carcinoma 1 Laceration 2 7. Diseases of the Body of the Uterus:— Fibroids 2 Endometrial polypus 1 Interstitial endometritis 1 8. Diseases of the Fallopian Tubes and Ovaries:— Ovarian cyst 2 Salpingo-oophoritis 2 9. Displacements:— Retroversion 14 Prolapse 51 10. Diseases of Breast:— Mastitis 2 Schimmelbusch's disease.. 1 11. Disorders of Menstruation:— Dysmenorrhoea 6 Primary amenorrhoea 2 Secondary amenorrhoea 5 Menorrhagia 4 Menopausal haemorrhage 5 Irregular menstruation 8 12. Miscellaneous:— Abdominal pain 7 Backache 7 Hernia 1 Appendicitis 2 Haematuria 1 Dysuria . 8 Visceroptosis 3 Anal fissure 1 Haemorrhoids 3 Leucorrhoea 8 13. Medical:— Referred to private doctor or hospital 14 Total 276 17 The following operations were performed by Miss Basden at the South London Hospital for Women on patients referred from the Clinic:— Diagnosis. No. Operation. Multilocular ovarian cyst 1 Oophorectomy. Menorrhagia 2 Dilatation and curettage. Prolapse uteri 5 Vaginal hysterectomy in one case. Anterior and posterior colpoperineorrhaphy in four cases. Urethral carbuncle 1 Cauterization of carbuncle. Fibroid uteri 1 Sub-total hysterectomy. Tubo-ovarian cyst 1 (i) Right salpingooophorectomy. (ii) Ventral suspension of uterus. Dysmenorrhoea 1 Dilatation of cervix. Cystic mastitis 1 Local amputation of breast. Sterility 1 Dilatation. Cervical laceration 1 Trachelorrhaphy. The fifteen in-patients spent a total of 247 days in hospital. In addition, 25 out-patients made 33 attendances. The Council made a grant of £25 to the Hospital. Hospitals.—There were no changes during 1936 in the Hospital services used by the inhabitants of the Borough. Public Assistance in Walthamstow is provided by the Southwestern Area Guardian's Committee of the Essex County Council, which retains a certain proportion of beds in each of the local institutions provided by the County Borough of East Ham and West Ham. 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, 1936:— Institutions. Men. Women. Children. Total Central Home 152 172 49* 373 Whipps Cross Hospital 672 697 339 1,708 Forest Gate Hospital 8 79 7 94 Harold Wood Hospital 4 4 — 8 Forest House 15 6 — 21 Aldersbrook Children's Homes - — 47 47 * These children were ultimately transferred to Aldersbrook. 18 52 infants were born to Walthamstow mothers in Forest Gate Hospital during the year. The number of patients from Walthamstow in Mental Hospitals was 357 on'the 31st December, 1936. 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, 1,021 were residents of the Borough. "The following figures show the progress of the Hospital during 1936, as compared with the previous year:— In-Patients. Daily Average. Out-Patients. No. Admitted. Ave' age Stay. New Cases. Attendances. 1935 1,798 22.29 109.68 16,192 87,296 1936 2,039 20.09 111.55 14,987 79,595 "Staff (Medical).—There were five Honorary Medical and Surgical Consultants, and sixteen Honorary Visiting Specialists on the Staff, and four Medical Officers were resident. "Staff (Nursing).—The Nursing Staff consists of the Matron, the Assistant Matron and Sister Tutor (combined post), Home Sister and Ward Sister (combined post), Night Sister, 12 Sisters (including 7 in special departments), 9 Staff Nurses and 35 probationers, also Assistant Nurse in X-ray Department. "Beds.—The complement of 118 beds is allocated as follows:— Medical cases, 31; Surgical, 43; Children, 30; Private one-bed Wards, 10; Observation Beds, 4. "Departments.—There are facilities for operative surgery, X-ray work, dental, ophthalmic, massage, and electro-therapy. Pathological work is carried out partly at the hospital and partly at other institutions. "Operations and Treatments.—During 1936, 1,046 major operations and 2,776 minor operations were performed, making a total of 3,822. 17,126 radiographs were taken. There were 11,956 massage treatments, also 21,008 electrical treatments, 83 special treatments, and 3,056 artificial sunlight treatments at the Comely Bank Clinic; a total of 36,103 treatments at this Clinic." 19 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:— Albert Dock Hospital, E.16; Guy's Hospital; Hospital for Sick Children, W.C.I; London County Council (Whitechapel) Clinic, Turner Street, Mile End; Miller General Hospital, Greenwich; Royal Free Hospital; St. Thomas's Hospital; West London Hospital, W.6. In addition, treatment is available at special times at ten other hospitals. Outfits for taking specimens from patients are provided for practitioners, on request, by the Whitechapel (London County Council) Clinic. Essex Public Medical Service. The above service, now some fourteen years old, brings to its members benefits roughly analogous to those of the National Health Insurance Act. Twenty-two of the medical practitioners of the Borough accept patients under the scheme. Public Assistance. Out-relief and institutional treatment is provided by the Essex County Council. Mr. Pegram, Clerk to the Essex County Council South-Western Area Guardian's Committee, kindly states that the amount of relief provided in Walthamstow during the two years ended 31st December, 1936, was as follows:— 1936. 1935. £ s. d. £ s. d. Total amount of out-relief granted to Walthamstow residents during year ended 31st December 54,034 19 4 53,522 0 0 Average weekly number of Walthamstow—Men 821 811 residents in receipt of relief during year—Women 1,232 1,187 ended 31st December.—Children 882 927 Total 2,935 2,925 20 Nursing Homes Registration Act, 1927.—The following table gives information required by the Ministry of Health:— 1. Number of applications for registration (for additional beds) One 2. Number of Homes registered .. No new registrations 3. Number of Orders made refusing or cancelling registration Nil 4. Number of appeals against such Orders Nil 5. Number of cases in which such Orders have been made:— (a) Confirmed on appeal Nil (b) Disallowed Nil 6. Number of applications for exemption from registration Nil 7. Number of cases in which exemption has been:— (a) Granted Nil (b) Withdrawn Nil (c) Refused Nil Periodical quarterly inspections are made to each Home, in addition to any visits necessary for special inquiries. The application for the registration of additional beds was in respect of two beds. In accordance with Circular 1574, issued by the Ministry of Health in September, 1936, a circular was sent to all general practitioners practising in the area giving particulars of Nursing Homes registered under the Act in the Borough, and requesting particulars of any unregistered premises known to them. None were reported. Essex County Council Act.—Two licences to practice chiropody were granted by your Council. C.—SANITARY CIRCUMSTANCES OF THE AREA. 1. (i) Water.—New mains have been installed in the following roads:—Cooper Avenue, Highfield Avenue, Higham Street, Stirling Road, Sturge Avenue, Sutherland Road. The supply is provided by the Metropolitan Water Board and has been entirely satisfactory in quality and quantity. No action has been necessary in respect of any form of contamination. 21 (ii) Drainage and Sewerage.—The construction of soil and surface water sewers on the Chestnut Farm Housing Estate has been completed, and minor extensions of the sewerage system necessitated by the development of various building estates were carried out. 2. Rivers and Streams.—Periodical cleaning of the Dagenham Brook was carried out to the requirement of the Essex Sewers Commissioners. 3. (i) Closet Accommodation.—The number of cesspools in use is fifteen, 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 eight. (ii) Public Cleansing.—The Cleansing Superintendent, Mr. Eric Bell, M.I.P.C., reports as follows:— "House Refuse Collection.—-During the year the use of horsedrawn vans for the collection of house refuse has ceased except for emergency work or after public holidays when the normal collection has been discontinued. "The last four vehicles commissioned were rear loaders equipped with movable floors and having a nominal capacity of 18 cubic yards. "On the normal collection of house refuse there are now employed:— 4 side-loading vehicles of 10 cu. yds. capacity. 4 rear-loading vehicles of 18 cu. yds. capacity. "The usual weekly collection of house refuse has taken place except on Bank Holidays, etc., when the collection has been made the first working day afterwards. In every case the householders affected have been notified by handbills of the altered day of collection. "Very few requests have been received for the removal of special articles of a bulky nature. The total weight of refuse collected was 27,426 tons, an increase of 254 tons over the previous year, whilst there was an increase of 322 in the number of premises from which collections were made. 22 "The average weight of refuse collected per day per 1,000 population has been 11.13 cwts. (an increase of .11 cwts.), as against an average throughout the country of over 14 cwts. per 1 ,000. In bulk, however, the increase over the previous year has been remarkable, and has resulted at times in problems which have not been easy to solve. Owing to the increased capacity of the collecting vehicles, however, it has been possible to effect a slight reduction in the cost of the service in spite of the increased loan charges to be made for this service. "Trade Refuse.—In January the department commenced entering into annual contracts with traders who requested the removal of their trade refuse, and arrangements were made for payment for this service to be made in advance through the Borough Treasurer. This proved so successful that certain carts are employed full time on this work. It is impossible to ascertain exactly the total weight of refuse so collected, as some of this was dealt with by the vehicles on the ordinary house refuse collection, in accordance with the normal procedure. "Refuse delivered by traders in their own vehicles amounted to 3,288 tons, an increase of 136 tons over last year. "Market Refuse.—No alteration was made in the arrangements for the collection of market refuse during the year, collections being made during marketing hours where necessary and a final clearance being made after the market closed at night. The total weight of refuse collected from the markets amounted to 1,554 tons, a reduction of 391 tons on the previous year. "Refuse Disposal.—During the year some rather extensive repairs were required, especially to the brickwork of No. 2 boiler, the exterior seams of the rear end being entirely exposed for inspection, whilst a serious breakdown of the elevator also occurred during the early part of the year. Consequent upon the reduction in burning capacity, it was necessary to tip 2,099 tons of refuse more this year, whilst the amount burnt was 24,792 tons, being a reduction of 1,709 tons on the previous year, with a slight increase in the cost of disposal. Practically the whole of the tip was brought under control during the year. "Sales of salvage were, on the whole, disappointing, markets remaining on a fairly low level throughout the period, whilst on several occasions difficulties were experienced in the movement of materials. 23 "Street Cleansing.—In August an additional 26 sweepers were employed and the work so arranged that every road in the town is now swept at least five times per fortnight, whilst a very large increase was made in the number of roads swept daily. Mechanical methods of cleansing were continued in conjunction with hand sweeping. The total area of road cleansed was 307,196,027 square yards, exclusive of footpaths. "Gully Cleansing.—The mechanical cleansing of gullies was continued by contract until the delivery of the new vehicle purchased by the Council to undertake this work. This was delivered in September, 1935, and immediately put into use. "The total number of gullies cleansed was 12,233, every one of which was completely emptied and sealed with clean water, the total weight of sludge removed being 1,216 tons." (iii) SANITARY INSPECTION OF THE AREA. Mr. M. E. Duncan, Chief Sanitary Inspector, reports as follows:— 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. 1936 14270 11413 2030 2229 2222 104 25749 1935 11286 11491 1968 2664 2641 140 26466 Of the 104 Statutory Notices served during 1936, 92 were complied with. The nature and variety of the work done during 1936 is shown in the following tables:— Drains tested 467 ,, reconstructed or repaired 411 ,, obstructions removed 194 ,, means of access provided 69 ,, ventilation provided or improved 93 ,, ventilation repaired 99 Soil pipes repaired 35 ., ,, new, provided 46 24 Rain water pipes renewed 232 ,, ,, ,, disconnected from drains 21 Roofs repaired or renewed 882 Gutterings repaired or renewed 379 W.C. pans or traps provided 401 Gully traps provided 100 W.C. flush cisterns provided 94 ,, ,, ,, repaired 173 W.C. floors concreted 65 W.C.'s repaired and cleansed 437 W.C.'s light and ventilation improved 9 Waste pipes renewed or trapped 252 ,, ,, repaired 112 New sinks provided 207 Water supply reinstated 6 ,, ,, taken off main 7 Cisterns cleansed and covered 24 Conveniences cleansed or repaired 26 Sculleries paved 64 Yards and forecourts paved and repaired 425 Dirty houses cleansed 43 ,, rooms cleansed 2,562 Floors repaired 301 Ventilations under floors provided 169 New damp-proof courses provided 303 Sites concreted 5 Offensive accumulations removed 40 Animals improperly kept, removed 1 Manure receptacles provided 2 Stables cleansed, paved and drained 50 Manholes repaired or re-sealed 84 Other cases of dampness remedied 444 Separate Sanitary Conveniences provided to shops where both sexes are employed 1 Miscellaneous repairs 2,017 Infectious Disease. Visits to premises 980 Re-visits to premises 93 Premises disinfected 707 Articles disinfected at Low Hall 8,273 Articles destroyed at Low Hall 289 Dampness in Houses. Sites concreted 5 Damp-proof courses provided 303 Yards and forecourts paved and drained 425 25 Roofs made watertight 882 Rain-water pipes made good 232 Guttering repaired or renewed 379 Other oases of dampness remedied 444 Ventilation under floors provided 169 House-to-house inspections 715 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— i Butchers' Shops and Slaughterhouses. Special cleansings, 36; Paving repaired, 5; Accumulations removed, 1; New Galvanised Bins provided, 8; Drains repaired, 6; W.C.s repaired and cleansed, 2; Yard paving repaired, 3; Floors repaired and ventilated, 3; Roofs repaired, 2; Drains cleared, 4. Bakehouses. Special cleansings, 64; Drains repaired, 1; W.C.s cleansed and doors repaired, 7; Yards repaved, 4; W.C. cisterns repaired, 2; Floors repaired, 3; Roofs repaired, 1; Premises general repairs, 5; New W.C. pans and traps, 1; Obstruction from drains removed, 1. Special Premises . Visits Number. paid. Factories 201 457 Workshops 148 289 Outworkers 461 469 Slaughterhouses 11 592 Butchers' Shops 101 730 Bakehouses 45 163 Fishmongers, fish fryers and curers, etc. 53 268 Eating-houses and Coffee Stalls 61 117 Ice Cream Vendors 150 362 Cowsheds 1 14 Dairies and Milkshops 180 133 Laundries 8 52 Rag and Bone Dealers 7 29 Elementary Schools 31 4 Private Schools 8 Piggeries 4 91 Street Stalls Numerous 81 Greengrocers ,, 105 Stables ,, 215 26 Fishmongers . Special cleansings, 49; Yards repaved, 14; Accumulations removed, 5; Roofs repaired, 1; Other improvements, 5. Coffee and Eating Houses. Special cleansings, 16; Yard pavings repaired, 1; W.C. cisterns repaired, 2; Drains repaired, 3; Kitchen light and ventilation improved, 1; Other improvements, 3. Ice Cream Vendors. Special cleansings, 13; Special cleansing of utensils, 1; Yard pavings repaired, 4; Other improvements, 1. Cowsheds and Milkshops. Special cleansings, 11; Pavings relaid, 1; Fittings and other improvements, 2; Roofs repaired, 2; W.C.s repaired, 2. Stable Premises. Cleansings, 29; Accumulations removed, 9; Roofs repaired, 3; Pavings repaired, 7; W.C.s repaired, 1; Manure receptacle provided, 1; Drains reconstructed, 1. Laundries . Special cleansings, 11; Roofs repaired, 1; Other improvements, 1. Rag and Bone Dealers. Cleansings, 12; Paving repaired, 1; Accumulations removed, 1. Piggeries . Cleansings, 4. (iv) Shops Act, 1934.—During the year there were no breaches of the Act calling for action by the Chief Sanitary Inspector. (v) Smoke Abatement.—Two cases have arisen during the year where smoke emission from factory chimneys called for intervention. Most of the modern factories are equipped with automatic stoking, each being fitted with recording instruments indicating the amount of carbon dioxide passed through the shafts. 27 Nuisances do occasionally arise where pressure on boilerage is exerted due to trade recovery, particularly during clinkering operations, and if several factories in close proximity to one another effect clinkering at about the same time, there is definite atmospheric pollution which sometimes brings complaints in its train. (vi) Swimming Baths and Pools. (a) Public. (i) Municipal Baths, High Street.—This is a covered swimming bath for which details were given in the 1935 report. The Baths Superintendent kindly gives the following particulars :— The chlorination and filtration plant has a turnover of three hours (50,000 gallons per hour), 0.3 to 0.5 parts per million of free chlorine being aimed at. The plant was kept in operation for an average of 16 hours on 108 week-days and for 6 hours on 15 Sundays during 1936. The approximate number of swimmers in 1936 was 46,379 and the estimated maximum load was 1,049. Prior to re-opening in the spring new surrounds were constructed and new teak dressing boxes were provided. A new scum channel was also provided to take off the polluted water from the surface of the pool. Bacteriological and chemical analyses were carried out on three occasions, with excellent results. (ii) Whipps Cross Bathing Pool.—This is a large open-air pool situated in Epping Forest, in the area of the Borough of Leyton and a few hundred yards from the Walthamstow boundary. It is administered by a joint committee representing the twoBoroughs. There is no continuous chlorination and filtration plant. Consideration is now being given to the matter. The pool is supervised by the Medical Officer of Health for Leyton, who kindly sends a copy of the analytical findings when samples are taken. Sampling was carried out in June (satisfactory) and in July (twice unsatisfactory). 28 {b) Private. The Kingfisher Pool.—This is an open-air pool in Epping Forest. Details were given in the 1935 report. The Managing Director kindly gives the following particulars :— The chlorination and filtration plant has a turnover of eight hours, with a possible speeding up to six hours. 0.2 parts per million of free chlorine are aimed at for the deep end and 0.6 at the shallow end. The plant was kept in operation all day and night over the week-ends, if found necessary, the pool being open for 170 days. The approximate number of swimmers in 1936 was 47,600 and the estimated maximum load was 630. Bacteriological and chemical analyses were carried out on four occasions, with results which were excellent. (vii) Eradication of Bed Bugs.—As heretofore, all known infested premises have received attention. In cases where the intervention of the owner has been found necessary, architraves and skirtings of infested rooms have been removed, followed by the use of insecticide and/or a blow-lamp. Insecticide solution has been distributed gratis to occupiers where its use has been deemed advisable, in addition to which a spray has been at their service. It is to be regretted that after so much has been expended both as regards material and labour, there is a yearly repetition in quite 50 per cent. of infestation cases. This is particularly noted in the older part of the town, and also where the term "jerry-built" can be applied to existing buildings. In the former instances, many of the flank walls of houses— above plate level—are only of 4½ in. brick structure, giving quite an easy access for wild bird life to enter and breed between the actual roof and ceiling of the top floor. To what extent the use of the mortar-mill in "jerry-built" houses, aided by lax definitions of mortar in the past, is responsible for the early decay of such mortar, allowing free access to bug infestation, is not difficult to conjecture. Where roofs have necessarily to be stripped, it is not uncommon to find a considerable amount of straw and litter used by birds for 29 nesting purposes. Such accumulation is just filth and is unquestionably the forerunner of bug infestation of the whole premises, and no proper remedial measures can be effected by occupiers or anyone else simply by the spraying of walls, etc., with an insecticide. Until every house is provided with a manhole giving access to the underside of roofs which would allow of periodical inspection by the owner for the removal of such filth, if present, much energy and material is wasted and repeated attacks of infestation are most highly probable. In my opinion, one cannot too highly stress the importance of correct bonding of brickwork, particularly near the roof, as this is a primary factor of infestation one way or the other. In substitution for the general pointing of verges of roofs— often of doubtful material and workmanship—a sufficient bargeboard should be fixed which would prevent the ingress and egress of birds. Such would, in my opinion, prevent any accumulation of filth by bird-life. This would definitely locate infestation to the lower part of the structure, where the application of insecticide—combined with cleanly habits—would give satisfactory results. The insecticide used by the Public Health Department costs 5s. 6½d. per gallon, and as much as 10 gallons have been distributed in one week for bug disinfestation. During the year 302 cases of verminous premises have been dealt with, and approximately 100 gallons of insecticide used in the course of disinfestation of premises. (Note by Medical Officer of Health .) The methods employed for ensuring that the belongings of tenants are free from vermin before removal to Council houses was described in detail in the contribution made by your Housing Manager on page 36 of the Annual Report for 1935. A report on the action taken during 1936 by the Housing Manager in respect of the eradication of bugs in Council houses is included in his report under Section D. Tents, Vans, Sheds, etc.—It is gratifying to note that on the site of one area cleared of van dwellers a number of nice houses have been built, giving the area a totally different aspect, which reflects credit on all concerned. 30 One area remains to be dealt with, and proceedings are to be commenced as soon as practicable. 4. Schools.— The sanitary condition of schools is more fully discussed in the School Medical Officer's Report. A detailed sanitary survey is made of each school by the School Medical Inspector at the conclusion of Medical Inspection. Recommendations are sent to the Director of Education. The School Medical Officer's Report gives a detailed account of the sanitary improvements effected during 1936. D.—HOUSING. (a) Statistics. The particulars of new houses erected during 1936 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):— (1) By Local Authority 14 houses 8 flats By other Authorities Nil By other bodies or persons 222 houses 30 flats 274 (b) With State Assistance under the Housing Acts:— (1) By the Local Authority:— (a) For the purpose of the Act of 1930 14 houses 8 flats The 274 houses are situated as follows:— Hale End Ward 102 (a) High Street Ward 10 Higham Hill Ward 64 (6) Hoe Street War Nil St. James Street Ward 7 Wood Street Ward 91 (c) (a) Including 10 flats; (b) including 10 flats; (c) including 18 flats. N.B.—Each flat is counted as one house. 31 The erection of 130 houses at Chestnuts Farm is now proceeding, and schemes for the erection of 78 houses at Millfields Avenue (No. 2), 14 houses at Essex Hall, 6 houses at Fulbourne Road, 4 flats at Carlton Road and 4 flats at Billet Road, have been submitted for approval. (b) Inspection. The following information is given in the form required by the Ministry of Health, and is supplied by the Chief Sanitary Inspector:— 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) 3,697 (b) Number of inspections made for the purpose 13,189 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 715 (6) Number of inspections made for the purpose 2,583 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 25 (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 2,398 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 2,222 32 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 82 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 70 (b) By local authority in default of owners Nil B. Proceedings under the Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 22 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 22 (b) By local authority in default of owners Nil C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 7 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 3 D. Proceedinqs under Section 20 of the Housinq Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil 33 (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 IV.— Housing Act, 1935—Overcrowding:—• A. (1) Number of dwellings overcrowded at the end of the year 622 (2) Number of families dwelling therein 622 (3) Number of persons dwelling therein 4225 B. Number of new cases of overcrowding reported during the year 660 C. (1) Number of cases of overcrowding relieved during the year 38 (2) Number of persons concerned in such cases 280 D. Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil E. Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil House-to-House Inspections. During the year, house-to-house inspections were carried out in the following streets :— Walpole Road. Parts of :— Suffolk Park Road. Colchester Road. St. Stephen's Road. Cambridge Road. Side Road. Chelmsford Road. Arkley Crescent. Barclay Road. Pearl Road. Rosebank Grove. Shrubland Road. Selborne Road. Rosebank Villas. Forest Road. Cedars Avenue. Daventry Avenue. Stirling Road. Somers Road. Church Road. Blackhorse Lane. Beresford Road. Cumberland Road. St. Andrew's Road. Carlton Road. Oatland Rise. St. John's Road. 34 (c) Housing Act, 1930. Third Programme. During the year representations were made to and adopted by your Council with regard to the following properties:— Nos. 1 and 2, Lavers, Myrtle and George Cottages, Chingford Road 4 houses Nos. 8, 9, 10 and 10a, Weston Cottages, Chingford Road 4 houses Nos. 1 to 7, Preston Cottages, and Norfolk House, Chingford Road 8 houses Nos. 219 and 221, Blackhorse Road 2 houses Demolition Orders were made in respect of the following individual unfit houses :— No. 92, Wood Street. No. 47a, Worcester Road. No. 9, Hilton Grove. No. 15, Eden Road. No. 6, Sky Peals Road. No. 10, Willow Walk. Stevens Cottage, Wood Street. (d) Housing Act, 1935. The preliminary survey and the subsequent measurements were completed by 2nd March, 1936, and the results were included in the annual report for 1935. The appointed day for Walthamstow with regard to Section 6 of the Act (i.e., the insertion of permitted numbers in rent books) was January 1st, 1937. In order to estimate the permitted numbers, some of the temporary staff employed for the preliminary survey were re-engaged in the latter half of 1936. Up to the 4th June, 1937, a total of 19,743 dwellings had been dealt with for the estimation of permitted numbers. As far as possible it is intended to deal with every house in the Borough used as a separate dwelling by members of the working classes or of a type suitable for such use. 35 Many difficulties have become apparent in the administration of the overcrowding provisions of the Act, and a great deal of extra work has been entailed over and above the routine work involved in measurements for permitted numbers. Not the least has been the frequent and repeated alterations in the housing circumstances of the overcrowded cases, necessitating the closest co-operation between the Public Health and Housing Departments. In particular, the Housing Manager reports to the Public Health Department in advance each batch of overcrowded cases intended to be re-housed. The particulars are checked up by the special staff, and copies of Form B and full information as to the occupants of the overcrowded dwelling are sent to the Housing Manager as soon as possible. In many cases the circumstances have so altered since the original survey that the overcrowding has become abated, and all such cases are then deleted from the overcrowded list. Follow-up visits are paid by the District Sanitary Inspectors in all cases where the overcrowding has become abated by re-housing. (e) General. Mr. J. E. West, your Council's Housing Manager, kindly contributes the following statement:— (Period 1st January to 31st December, 1936.) Number of additional properties available for letting 22 ,, vacancies arising 52 ,, actual lettings 74 ,, cases re-housed from Scheduled areas 18 ,, ,, ,, on medical grounds 7 (a) ,, ,, ,, from overcrowding schedule 27 (b) as registered applicants 22 74 (a) Includes 3 cases which also appear on the Overcrowding Schedule. (b) Includes 6 cases of Council tenants transferred to the appropriate accommodation. The total number of actual lettings includes transfers of tenants in the re-distribution scheme adopted by the Council.Z 36 Abatement of Overcrowding. Number of cases on original survey 583(c) ,, additional cases found subsequent to survey 77 660 ,, re-lioused 30(d) ,, struck off as result of re-distribution, etc. 8 38 622 (c) Includes 60 cases of Council properties. (d) Includes 6 Council tenants re-housed. In so far as Council properties are concerned, abnormal requirements are noted as follows:— 10 cases of families of 9 units; 6 cases of families of 9½ units; 5 cases of families of 10 units; one case each of 10½, 11, 11½ and 13½ units. The results of 393 cases already investigated on the overcrowding schedule show the following abnormal requirements in order to comply with the standard of re-housing provided for in the Housing Act, 1936, section 136:— 40 cases requiring 4 bedrooms; 37 cases requiring 5 bedrooms; 25 cases requiring 6 bedrooms; 4 cases requiring 7 bedrooms. The total number of houses erected under the various Housing Acts, or otherwise acquired for the purpose of re-housing the working classes, is as follows:— 50 Two bedroom non-parlour type. 242 Three ,, ,, ,, 54 Four ,, ,, ,, 40 Two ,, Parlour type. 1,053 Three ,, ,, ,, 2 Four ,, ,, 40 One ,, non-parlour type flats. 4 Three ,, ,, ,, ,, 29 Miscellaneous properties. 1,514 58 Two-bed non-parlour In course of erection on the 72 Three-bed ,, Chestnuts Farm Estate. 1,644 Total properties. 37 "The obligation of re-housing under the Act of 1935 was of such a dimension, having regard to vacant building sites available within the borough boundaries of Walthamstow, that the Council once again had to review the question of future allotment of Council houses becoming vacant or newly erected houses available for letting. "It may be remembered that in December, 1933, the Council decided to close the Housing Register, which then contained over 4,000 names of applicants requiring accommodation. No further applications were therefore accepted. "In October, 1936, it was further decided that all future lettings be reserved primarily for the completion of the Council's Slum Clearance programme, to be followed on completion by any further lettings being granted solely to abate cases scheduled as overcrowded by the Medical Officer of Health. "The Housing Register, therefore, is now superseded by this schedule, although it may well be that some cases appeared on the Housing Register as well as the schedule. "There appears to be little prospect of any subsidy forthcoming for houses provided in Walthamstow for the relief of overcrowding. Consequently unless steps are taken to pool all rents of Council houses and so equalise them in an appropriate manner, there will also be little prospect of houses being erected to let at rents which would be within the means of the prospective tenants without creating hardship and possible malnutrition of the family. "There appears also to be small prospect of re-housing within the borough boundaries all the known cases of overcrowding. "The decision taken by the Council in October, 1936, therefore' does appear to have been the only possible course that could be taken. No applications for Council houses can now be entertained. On the other hand all lettings are made to cases of slum clearance and overcrowding according to:— (1) The family being appropriate for the accommodation available. (2) Urgency in degree of overcrowding. "The problem of re-housing the large families is one that requires to receive its due need of consideration. The average three-bedroom non-parlour type of Council house is agreed as being suitable to accommodate five persons and no more. There are a very large number of families in Walthamstow in excess of that number and who are at present badly overcrowded and in 38 dire need of adequate accommodation. There are a number of cases reported where the families find it impossible to segregate adult sexes. On the other hand the families are too large to be accommodated in any house under the ownership of the Council. "Whilst the surveys made disclosed that there is a certain amount of overcrowding, they also disclosed a percentage of unoccupied dwellings. The local authority has no powers to deal with the latter, however, but it is believed that much could be done by co-operation with the owners. A certain amount of success has already been achieved in this direction and tribute is hereby acknowledged to those property owners who have co-operated. ' 'The proper course has obviously been taken by such authorities in the original letting by giving preference to large families when letting their houses. At the same time it is also known that other Council tenants now find their present accommodation in excess of requirements due to natural reduction in numbers of the family during their tenancy. Re-distribution is therefore effected by transfers amongst tenants or by houses becoming vacant and Council tenants being transferred according to requirements. "It has been found during normal investigations that elderly couples and aged persons are still occupying the same accommodation as when their families lived with them—a real waste of accommodation and energy spent in its maintenance. "As the families on the overcrowding schedule and persons to be displaced under the clearance orders now supersede the list of applications on the Housing Register in the allotment of houses a very real social problem has to be faced, in addition to the problem of providing adequate accommodation. "Heretofore, and no doubt for good and sufficient reasons, it has been the comparatively well-to-do applicant who has been successful in obtaining suitable accommodation. His rent was reasonably assured by virtue of his better financial circumstances and he was more likely to keep the premises in a cleanly condition. The only qualification for a Council house now, however, is that the family must either be scheduled under a clearance order or as being overcrowded—irrespective of the rent being reasonably assured or expectation of their keeping the premises clean. "The allocation of a vacancy arising on an established estate to families who have been less fortunate in obtaining a sufficiency of the necessities of life than their prospective neighbours frequently gives rise to much unpleasantness. On the other hand, to segregate these families into one section on the Estate or block of property is to classify them and cannot be too strongly deprecated. Every 39 effort is therefore being made to arrange redistribution in order to avoid the newer Estates becoming reserved for one particular class, though much welfare work must be anticipated to overcome not insurmountable difficulties. "The re-housing of families recommended on medical grounds by the Medical Officer of Health still continues to be dealt with as rapidly as the appropriate accommodation becomes available. There has been a marked decrease in the number of cases submitted for consideration during the year, and there can be no doubt whatever that very satisfactory results have been obtained by carefully re-housing those families where one or more members are suspected to be or actually suffering from tuberculosis. Especial care is taken to ensure that such families are not re-housed in any way as to classify the family, house, or block of houses as a reservation. Slum Clearance. "During the year 1936 only 14 houses and 8 flats were erected and as a consequence it was not possible to complete the clearance orders confirmed. "These newly-erected properties were in many instances not available as being inappropriate for the families awaiting to be re-housed from clearance areas. '"The whole of the families concerned in the orders already confirmed have, however, at the time of writing this report (April, 1937) with the exception of one, been offered appropriate accommodation. The exception is a family requiring at least five bedrooms. Abatement of Overcrowding Act, 1935. "Although no houses whatever have been erected as yet under this Act, 27 families scheduled as overcrowded have been re-housed in vacancies arising on the estate during the year. Eradication of Bed Bugs. "Infestation by bed bugs is undoubtedly prevalent in houses on the Council's estates, but I have no reason to consider that the position is worse or better than in any other town. "Various methods have been adopted to eradicate these pests when found, either by virtue of an inspection, report or complaint, that bugs are present. Tenants are invariably advised to keep in touch with the Department wherever there is any suspicion of infestation. Cases are followed up for a period of not less than three weeks after first treatment. 40 "I have found no certain cure for infestation; in fact, I would go further and say there is no cure without the complete co-operation of the tenants themselves. It is well known in housing circles that even with the treatment of hydrocyanic acid gas, which is a very serious weapon not only for the eradication of bed bugs but also for human beings, a tenant can very quickly become infested again unless constant attention to cleanliness is maintained. I am definitely opposed to the use of this poisonous gas for eradication purposes, even with the strictest supervision and care. "An experiment has been made with a form of non-poisonous gas which certainly has many advantages, but the experiment made was not completely successful. This without question satisfied me that it would eradicate the bug pest, but not the bug in embryo in all cases. The experiment was carried out in an empty house, and after treatment some of the eggs which the bugs had laid were collected and placed in an incubator. These eggs hatched out, but I am of opinion that subsequent death was caused not necessarily by the gas treatment, but was more probably due to lack of nutrition which was unobtainable in the incubator. "A spray solution has proved reasonably satisfactory, but here, again, constant application is necessary over a long period, together with the co-operation of the tenant in constant scrubbing with carbolic soap and water. It is rarely possible to obtain this co-operation, and the Department, of course, is not staffed to supervise this type of work. "Only two really bad cases have come to my notice during the year. One was treated with non-poisonous gas by diffusion in the burning of a proprietary article. The other case was treated extensively by means of a spray. "Spray solution is more expensive than treatment by nonpoison gas, but can be used with absolute safety even though tenants are living in the house during the whole of the period the spray is in use. It is not recommended to use even non-poisonous gas unless vacant possession is obtained. "The application of a blow-lamp to eradicate vermin is also a useful palliative, but here, again, the blow-lamp can only be applied in accessible positions, whereas more often than not the bug is in hiding in such positions as to make it impossible to apply the blow-lamp flame. There is also to be considered the danger of fire and the damage caused by removal and subsequent refixing of woodwork after the flame has been applied. 41 "There are many other contact insecticides on the market which in light infestations may effect cure, but here, again, a cure can only be effected if contact is made and followed up by the tenant concerned completely co-operating with the disinfestation process. "Where bedding is infested the only satisfactory process that I would be prepared to recommend would be that of steam disinfestation . Two such cases have been dealt with by the co -operation of the Public Health and the Housing Departments where a prospective tenant of a Council house was found to be in possession of verminous bedding. The bedding was collected from the old house, treated by the steam disinfestation process and delivered direct to the new premises. "Eighteen cases have been treated over a long period by the spray process and a number of light cases of infestation have been treated by the tenants themselves making application to the Maintenance Department for the loan of a sprayer and solution provided. "I am still of the opinion I expressed some six years ago that greater care should be utilised by prospective tenants in the method adopted of transporting their furniture to their new homes, as infestation can very rapidly occur by storage and transportation of furniture in vans which are not thoroughly clean. It will be obvious that if a furniture van is removing infested furniture and is not thoroughly cleaned afterwards, the next lot of furniture, which may be clean, may very speedily become infested through any bugs or eggs which may be left behind from the previous removal. "When furniture is found to be badly infested, when investigating the home of a prospective tenant, the tenant is encouraged to surrender the infested furniture, such as pictures, old tables, chairs and chests of drawers. Facilities are offered him for the supply of any new furniture or bedding that may be necessary. The infested furniture surrendered is then collected and destroyed at the Council's destructor." Note by Medical Officer of Health. Section 4 A. of the Maternity and Child Welfare Section of the report appears to show that amongst the child-bearing section of the population the proportion of families adequately housed increased satisfactorily, but the proportion of families inadequately housed remained stationary. 42 E.—INSPECTION AND SUPERVISION OF FOOD. (Contributed by Chief Sanitary Inspector.) (a) Milk Supply. The average number of cows kept in the district is seven. 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 180, most of whom carry on a general shop and sell milk in bottles as they receive it. One hundred and thirty-three visits were paid to registered premises of purveyors of milk during the year, and a general improvement in the standard of cleanliness was maintained. During the year 21 samples of milk were taken for bacteriological examination, with satisfactory results. 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 marked improvement in this direction is maintained. 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:— The samples taken are summarised below. Grade of Milk. No. of Sam/ple. Grade "A" (T.T.) 4 Grade "A" 1 Pasteurised 15 Raw 1 Total 21 43 Dealers' Licences. In respect of:— Certified Milk 3 Grade "A" (T.T.) Milk 10 Grade "A" Milk 4 Pasteurised Milk 27 Bottliny Licences. In respect of Grade "A" (T.T.) Milk, 2; Pasteurised Milk, 3. (b) Ice Cream. Four samples of Ice Cream were taken for bacterial analysis, the results being satisfactory. (c) Meat and other Foods. Two tins of oysters were submitted for bacteriological examination and proved satisfactory. During the year 592 visits were paid to the various slaughterhouses in the district during the process of slaughtering. The number of animals slaughtered for human consumption was as follows:— Cattle. Calves. Sheep. Pigs. 455 612 4,200 2,666 The following were condemned and destroyed as unfit for human food:— Affected with T.B. 68 Pigs' Fats. 25 Pigs' Plucks. 24 Pigs' Heads. 4 Pigs' Livers. 11 Pigs' Mesenteric Fats. 1 Leg Pork. 3 Pig Carcases and all Organs. 88 Ox Lungs. 39 Ox Hearts. 11 Ox Skirts. 10 Ox Livers. 28 Ox Fats. 18 Ox Heads. 2 Ox Spleens. 1 Ox Tripe. 1 Ox Tongue. 1 Calf Carcase and all Organs. 10 Ox Carcases and all Organs. 2 Flanks Beef. 9 Forequarters Beef. 1 thick Flank Beef. 4 Fore Ribs Beef. 2 Middle Ribs Beef. 1 Shoulder Beef. 1 Clod Beef. 2 Loins Beef. 1 Aitchbone Joint. 1 Thick Skirt Beef. 5 Stone Beef. 44 Miscellaneous. 62 Sheep's Livers. 15 Sheep's Plucks. 2 Sheep Carcases and all Organs. 3 Lamb Carcases and all Organs. 25 Pigs' Plucks. 84 Pigs' Livers. 4 Pig Carcases and all Organs. 1 Calf Carcase and all Organs. 1 Belly Pork. 1 Hand and Spring Pork. 2 Loins Pork. 2 Legs Pork. 1 Saddle Mutton. 1 Shoulder Mutton. 1 Leg Mutton. 3 Forequarters Mutton. 1 Side Mutton. 1 Cow's Udder. 33 Ox Livers. 1 Ox Tripe. 1 Calf's Liver. 1 Calf's Pluck. 1 Shin Beef. 10 lbs. Neck Beef. 1 Loin Veal. 6 stone Large Dabs. 10 boxes Fillets (Haddocks). 20 boxes Kippers. 1 tin Prawns. • 2 sacks Cabbages. 4 bags Turnip Tops. 5 boxes Pears. 48 sacks Chestnuts. (d) Adulteration, etc. (Food and Drugs Adulteration Act, 1928). Eighty-five samples were submitted for analysis during the year. Five were not genuine. With regard to the five samples of milk which were unsatisfactory, two summonses were taken out against two employees of a dairy firm in respect of four of these milks. A considerable number of samples were taken on delivery anent this matter, and one defendant was ordered to pay £2 12s. costs, and the other defendant was ordered to pay 4s. In the case of the remaining sample, other samples were taken in course of delivery at the defendant's request, and at the hearing of the information the Justices ordered the dairyman to pay £2 6s. costs. Although the Council is not a 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. (e) Chemical and Bacteriological Examination of Food. Chemical examination is carried out by the Public Analyst, Dr. Bernard Dyer, at Great Tower Street, E.C.3. 45 Bacteriological examination of milk is carried out either at The Counties Public Health Laboratories, E.C.4, or at Queen Mary's Hospital, E.15. Specimens of food suspected of causing food poisoning are, when necessary, sent to the Laboratory of the Ministry of Health. (f) Nutrition. All available means for the dissemination of knowledge with regard to nutrition have been followed. The nutritional condition of the school children in the Borough, on the whole, shows improvement. Details are given in the Report of the School Medical Officer. (g) Shell Fish. There are no shell-fish beds or layings in the Borough. THE RENT AND MORTGAGE RESTRICTIONS ACTS, 1920-1923. During the year twelve certificates were granted to tenants and five certificates have been issued to owners upon their application and completion of the scheduled works. DISEASES OF ANIMALS ACTS, 1894-1928. Sheep Scab Order, 1920. —No case of this disease occurred in the Borough during the year. The Sheep Scab Order, 1928.—During the year, no sheep were admitted into the area under Licence for Slaughter. The Regulation of Movement of Swine Order, 1922.— Under this Order, 1,761 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, 25 detention and isolation licences affecting 268 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. 46 RATS AND MICE DESTRUCTION ACT, 1919. During the year numerous complaints as to the presence of rats have been received. Each case was investigated with the result that where necessary poison was used (Red Squill), in many cases drains were repaired, in several instances rat-proofing of premises and out-buildings was enforced, and in other instances traps were used. It is difficult to estimate the number of rats destroyed, but it is only fair to state the number must be considerable. The Council did not set aside one week specially as a ' 'Rat Week," having regard to the general action in rat repression throughout the whole of the year, and to the free distribution of Red Squill Poison with instructions in its use to responsible persons upon their complaints. 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. Inspections. Slumber of Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories (Including Factory Laundries.) 467 7 Nil. Workshops (Including Workshop Laundries.) 244 11 Nil. Workplaces (Other than Outworkers' premises.) 93 3 Nil. Total 804 21 Nil. 47 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. (i) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 36 36 — — Want of ventilation 4 4 — — Overcrowding — — — — Want of drainage of floors 4 4 — — Other nuisances 65 65 — — Sanitary Accommodation insufficient 6 6 — — unsuitable or defective 29 29 — — not separate for sexes 1 1 — — Offences under the Factory and Workshop Acts— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences — — — — Total 145 145 Nil Nil NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1936. "Wearing Apparel, making of 371 Furs 5 Brush Making 27 Artificial Flowers 7 Boxes 14 Toys 27 Christmas Crackers and Handbags 3 Carnival Hats 7 Total 461 48 Outworkers were notified from the following areas:— City of London 136 St. Marylebone 3 Bethnal Green 8 Stepney 8 Finsbury 59 Shoreditch 9 Hackney 38 Tottenham 6 Islington 7 Walthamstow 71 Leyton 85 Westminster 10 Poplar 5 Other Areas 16 A total of 421 visits was paid in connection with outworkers as follows:—To Homes, 374; Factories, 28; Workshops, 19. F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. General.—The accompanying tables show the age and ward incidence of the various infectious diseases which are discussed separately in later pages of the Report:— Disease. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. 1936 1935 Scarlet Fever 315 569 3 65 188 36 23 — — Diphtheria 106 163 — 21 67 8 1 9 1 — Enteric Fever 8 4 — 1 5 1 — — Pneumonia 151 131 4 19 37 16 38 20 17 Puerperal Fever 5 4 — — — — 5 — — Puerperal Pyrexia 30 31 — — — 9 21 — — Ophthalmia Neonatorum 2 1 2 — — — — — — Erysipelas 52 54 1 — 2 5 11 25 8 Encephalitis Lethargica — 2 — — — — — — — Polio-encephalitis 1 — — 1 — — — — — Cerebro-spinal Meningitis 1 4 — — — 1 — — — Anterior Poliomyelitis 5 5 — 1 4 — — — — Measles (under 5 years) 671 27 39 632 — — — — — Dysentery 5 1 — 2 2 — — 1 — Tuberculosis 141 163 — 3 25 42 48 19 4 Totals 1936 1493 — 49 745 330 118 156 66 29 1935 — 1159 10 228 483 155 173 76 34 49 Disease. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals Scarlet Fever 37 50 66 19 41 102 315 Diphtheria 29 14 10 6 11 36 106 Enteric Fever — — 2 1 4 1 8 Pneumonia 24 13 18 26 26 44 151 Puerperal Fever 1 — 3 — 1 — 5 Puerperal Pyrexia 4 4 6 3 8 5 30 Ophthalmia Neonatorum — — 1 1 — — 2 Erysipelas 9 13 10 4 7 9 52 Encephalitis Lethargica — — — — — — — Polio-encephalitis — 1 — — — — 1 Cerebro-spinal Meningitis — — — — 1 — 1 Anterior Poliomyelitis — — 1 — — 4 5 Measles (under 5 years) 143 75 95 74 119 165 671 Dysentery 4 — — 1 — — 5 Tuberculosis 26 16 21 14 28 36 141 Totals 1936 277 186 233 149 246 402 1,493 1935 162 147 146 129 227 348 1,159 From the foregoing tables it will be seen that the outstanding features of 1936 were decreases in the incidence of Scarlet Fever and Diphtheria. The statistics given in the foregoing table are those for the calendar year 1936. The Registrar-General gives the statistics for the 53 weeks ended 2nd January, 1937, 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. Scarlet Fever. Diphtheria. Enteric Fever. Pneumonia. Puerperal Fever. Puerperal Pyrexia. Erysipelas. Number 320 103 8 154 5 30 62 Case Rate— Walthamstow 2.39 0.77 0.06 1.15 0.03 2.24 3.89 England and Wales 2.53 1.39 0.06 1.11 (Not available) 0.40 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 2.82 16.96 England and Wales 3.27 9.64 50 Disease. Total notified. Removed to Hospital. Per cent. removed to Hospital. Deaths. Deaths per cent. of cases notified. Scarlet Fever 315 287 91.1 1 0.31 Diphtheria 106 101 95.2 2 1.8 Enteric Fever 8 7 87.5 Nil Nil Pneumonia 151 51 33.7 73 48.3 Puerperal Fever 5 5 100.0 Nil Nil Puerperal Pyrexia 30 8* 26.0 1 3.3 Ophthalmia Neonatorum 2 1 50.0 1 50.0 Erysipelas 52 16 30.7 Not a classified cause of death Polio-encephalitis 1 1 100.0 Nil Nil Cerebro-spinal Meningitis 1 1 100.0 1 100.0 Anterior Poliomyelitis 5 4 80.0 1 20.0 Measles (under 5 years) 671 52 7.7 8 1.19 Dysentery 5 1 20.0 Nil Nil Tuberculosis 141 170† - 87 61.7 * In addition, many of the cases were already in Hospital, f This figure also includes cases notified during previous years. Infectious Diseases Clinic.— The weekly clinic on Tuesday at 2 p.m. was continued, and all the children of school age who had been close contacts with cases of infectious diseases were seen prior to their return to school. As in previous years, all children discharged from the Isolation Hospital or after home isolation for infectious disease were seen, and particular care was taken to refer all cases with any suspicion of rheumatism or of cardiac defect to the next rheumatism clinic. The following extract is from Dr. Sheldon's report on the rheumatism clinic:— "Prevention.— During the year the practice of following up children who have been discharged from the Sanatorium after Scarlet Fever and Diphtheria has been continued. Twenty-four children were referred to the clinic in this way, and of these, 14 were judged to have some cardiac disability. Were this follow up system not in existence, it is fair to assume that these 14 children would have run a risk of considerable and permanent cardiac injury, whereas by getting their trouble dealt with in its early stage it is probable that they will be spared from some degree of heart disease." 51 The following table shows the work done at the Infectious Disease Clinic, the large majority of patients being of school age:— Number of clinics held in connection with Infectious Diseases and Immunisation 60 Number of attendances made 4,546 Average attendance per session 75.8 Number of Scarlet Fever cases discovered 3 Number of Diphtheria cases discovered 5 Number of virulence tests taken in Diphtheria cases 67* Number of children recommended to Rheumatism Clinic 23 Number of children recommended to Ear Clinic 14 *Includes virulence tests done at Sanatorium. Diphtheria Immunisation.— Immunisation was carried out at the weekly clinic on Tuesdays at 3 p. m., and at Infants' Departments, along the lines detailed in the 1935 report. The practice has been to Schick test children over 8 years of age, and only to immunise those yielding a positive result. All children under 8 years of age were immunised without a pre-Schick test. The following summarises the work done:— Schick tested for first time 222 Negative (including pseudo and negative) 87 Positive (including pseudo and positive) 135 Immunised after positive Schick (14 refusals) 121 Immunised without being Schick tested 1,664 Partly immunised cases brought forward from 1935, etc. 184 Total number given one or more immunising doses during 1936 1,969 Results of Schick tests following immunisation:— Negative (including 184 from 1935) 1,186 Awaiting final Schick test 721 Not completing immunisation course 62 Total 1,969 Number of children of school age, immunisation completed 699 Number of others, immunisation completed (mostly of pre-school age) 303 Number of 1935 cases completed 184 Total 1,186 52 Diphtheria Immunisation at Schools.— The scheme of diphtheria immunisation begun at Infants' Departments (and described in the 1935 report) was continued during 1936. The 15 schools remaining from 1934 were visited, and out of 3,072 children in average attendance at the dates of the visits the parents of 1,332 children, or 43.4 per cent., agreed to their children being protected. The maximum percentage acceptance was 53.4, and the minimum 26.7. In addition, 3 other schools were visited, at which there were a considerable number of children under 8 years of age. A total of 1,612 children (1,410 of school age and 202 of preschool age) were given a single dose of 0.5 c.c. alum precipitated toxoid (A.P.T.) intramuscularly. This procedure occupied a weekly session into mid-October, when Schick testing was begun in order to test the efficiency of the prophylactic given. By the end of the year testing had been carried out at 12 schools. The experience of 1935 had suggested that one dose of A.P.T. would be sufficient to protect 92.1 per cent., but as testing continued during 1936 it became obvious that the immunity obtained varied widely from school to school and was, on the whole, disappointing. The results varied from 87.2 per cent, protected at Winn's Avenue Infants to only 60.4 per cent, at Forest Road Infants. Of 929 completed immunisations, only 73.5 per cent, were successful after a single dose. The response to artificially induced immunity will vary with the efficiency not only of the particular prophylactic used, but also with each batch, and also with the basic natural immunity of the sample population—in this case the children at the particular school. The natural immunity will again depend on several factors, notably the percentage of diphtheria carriers normally present at each school. It is obvious from the results obtained that the protection afforded by a single dose of A.P.T. is not satisfactory and that under no circumstances should the subsequent Schick test be omitted with the single dose method. The parents of all children found to be insufficiently protected by one dose were invited to bring them to the Immunisation Clinic, and all of the 143 who attended were fully protected after being given a further half-dose (i.e., 0.25 c.c.). 53 In the light of this experience the practice is now to give an initial dose of 0.1 c.c. A.P.T. followed in 14 days by 0.5 c.c. By this method 97.8 per cent, are fully protected after one month and 99.1 per cent, after two months. Fifty-five persons Schick negative after immunisation in previous years—or naturally so—were re-tested during 1936. Three of these were Schick positive after the original single dose of 0.5 c.c. A.P.T. and two had lost their previous natural immunity. Since commencing immunisation in March, 1932, and up to December, 1936, a total of 592 persons has been found to be naturally Schick negative and a total of 2,182 has been protected, a grand total of 2,774, or 9 per cent, of the population under 14 years of age as ascertained at the last census. Immunisation by General Practitioners.—Diphtheria prophylactic is available to general practitioners. During 1936, 19 c.c.s of alum precipitated toxoid and 4 c.c.s of toxoid anti-toxin floccules were issued. During the year several cases were reported amongst immunised or naturally Schick negative children as having sore throats suggestive of diphtheria. The routine in such cases has been for the patients to be swabbed (a) for the presence of diphtheria bacilli, and if found positive for a virulence test to be carried out, and (b) for the presence of streptococci—particularly haemolytic streptococci, and for a repeat posterior Schick test to be done. Of these cases only one need be referred to as being suggestive of clinical diphtheria. The notes are as follows:— P. M., aged 7 years. 0.5 c.c.s A.P.T., 14.2.36. Schick negative, 3.12.36. Sore throat, 26.2.36. Schick negative, 28.2.36, Klebs-Loeffier bacillus present and virulent, haemolytic streptococci also present. Patient discharged from hospital in eleven days. Condition gave rise to no anxiety. Final diagnosis—either a mild case of diphtheria or more probably streptococcal tonsillitis in a diphtheria carrier. A second patient, J.K., aged 10 years, is of interest. She was found to be Schick positive in January, 1934, and in view of previous heart trouble, the parents were strongly advised to allow her to be protected against diphtheria. They declined, and in September, 54 1936, she contracted severe diphtheria. After some weeks of anxiety she was transferred to a special heart hospital and now has a permanently damaged heart. Scarlet Fever Immunisation and Testing.— Dick testing and immunisation of susceptibles were carried out at Brookfield Orthopaedic Hospital, 6 cases being completed, and yielding negative posterior Dick tests. The full immunising course consists of five doses, and in several cases the course had to be discontinued after the third injection owing to rather troublesome reactions. Of 57 Dick tests, 36 were negative and 21 positive. Immunisation was begun in 21 cases, but 15 were discharged from hospital before completion. MUNICIPAL LABORATORY. The following numbers of diphtheria swabs were examined during 1936:— Swabs Negative Positive Totals Private Practitioners 847 62 909 Health Department 340 32 372 School Medical Department 440 14 454 Totals 1,627 108 1,735 The total number of diphtheria specimens examined in 1935 was 2,223. Direct examinations were done on 772 diphtheria specimens, and 9 were positive; 24 were positive on culture, although negative on direct examination. In addition, 159 specimens of urine were examined, as compared with 198 in 1935. A total of 2,887 tubes of culture media were made by Mr. West, and of these, 1,116 were sent to the Sanatorium. The Essex County Council also provides facilities for examination of pathological specimens, and the County Medical Officer states that 1,465 specimens were examined for local practitioners during 1936 as follows 55 Diphtheria Swabs, 145; Sputa, 546; Typhoid Specimens, 54; Ringworm Specimens, 52; Miscellaneous Specimens, 667; Diphtheria Virulence Tests, 1. A total of 249 specimens were examined for the Connaught Hospital (included above). The total for the previous year was 482. VACCINATION. Mr. E. Sharp, Vaccination Officer for the Area, has furnished the following return for 1936 Births Successfully Percentage Insusceptible Exemptions. Deaths before Postponed Registered. Vaccinated. Vaccinated. Vaccinated. 1,679 263 15.7 2 1036 43 47 In addition to the above, 13 primary vaccinations were recorded, and 11 re-vaccinations. During 1936 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 27.9 per cent, were vaccinated. HOSPITAL TREATMENT OF SMALLPOX. The scheme made by the County Council under Section 63 of the Local Government Act, 1929, now covers the hospital treatment of smallpox. The cost of treatment of cases sent with the approval of the County Medical Officer of Health into hospital is now a general charge upon the county, excluding the Borough of Colchester. At the same time, your Council continues to maintain the temporary buildings at Low Hall Farm formerly used as a hospital for smallpox cases. No case of smallpox occurred in 1936. SCARLET FEVER. A total of 315 cases of Scarlet Fever was notified in 1936, as compared with 569 in 1935. 56 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 37 - 12 18 4 3 - - February 26 — 2 15 7 2 — — March 32 — 8 18 2 4 — — April 23 — 5 13 1 4 — — May 36 – 9 20 4 3 — — June 25 — 3 17 3 2 — — July 24 — 5 14 5 — — — August 15 2 5 5 2 1 — — September 19 — 5 13 — 1 — — October 34 1 4 24 3 2 — — November 25 — 6 18 1 - - — December 19 — 1 13 4 1 — — Totals 1936 315 3 65 188 36 23 - - 1935 569 1 132 344 58 32 2 - Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 6 9 1 4 3 14 February 5 6 5 — 2 8 March 2 2 12 3 5 8 April 3 2 6 1 4 7 May 3 6 4 2 10 11 June — 9 4 1 3 8 July 6 3 5 — 4 6 August 5 2 5 2 — 1 September 1 2 7 2 2 5 October 1 3 5 2 1 22 November 3 1 8 5 December 2 5 4 2 2 4 Totals 1936 37 50 66 19 41 102 1935 64 66 58 45 134 202 The percentage of cases removed to Hospital during 1936 was 91.1, against 80.1 in 1935. No case was refused admission. The continued fall in the incidence of Scarlet Fever will be noted (i.e., 1936, 315; 1935, 569; 1934, 605), and the increase in the percentage of patients removed to Hospital. It is very questionable if the routine admission to Hospital of the average uncomplicated case of Scarlet Fever is justified, provided certain criteria are satisfied. Amongst the most important of these 57 are: adequate isolation facilities (i.e., a separate room), no other inmate of the house to be employed in the preparation or distribution of food to the public and adequate medical supervision to be available. DIPHTHERIA. A total of 106 cases of Diphtheria was notified during 1936, as compared with 163 in 1935. The following tables show the incidence by months, ages and wards:— Month. All ages. Under 1 yrs- 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 12 - 1 8 2 1 - - February 19 — 3 11 2 3 - - March 11 — 2 7 1 1 - - April 6 — 2 3 1 - - - May 14 — 4 8 1 - 1 - June 7 — 1 6 - - - - July 5 — 1 2 1 1 - - August 5 — 2 3 - - - - September 4 — 1 3 - - - - October 6 — - 6 - - - - November 9 - 3 4 - 2 - - December 8 — 1 6 - 1 — — Totals 1936 106 — 21 67 8 9 1 — 1935 274 7 57 171 26 11 2 — Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 6 - - - 1 5 February 8 2 — 2 3 4 March 1 1 - 1 - 8 April — — — 2 - 4 May 3 1 3 1 3 3 June 2 1 - - - 4 July 2 — 1 — - 2 August — 1 2 - 2 - September — 1 1 - - 2 October 3 — 2 - - 1 November 1 4 1 - 1 2 December 3 3 — — 1 1 Totals 1936 29 14 10 6 11 36 1935 25 20 44 54 50 51 58 The percentage of cases removed to Hospital in 1936 was 95.2, against 92.7 in 1935. 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. 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 1936, a total of 81 phials, containing 544,000 units of Diphtheria Antitoxin, and 16 phials, containing 160 c.c.s of Scarlet Fever Antitoxin, was issued. Diphtheria notifications have again shown a decline. In view of the comparatively small number of immunisations carried out in the area, it would not be fair to claim more than a contributory effect for this practice. At the same time, in the absence of immunisation to the extent of some 50 per cent, of the population under, say, 15 years, the incidence of diphtheria will almost certainly show an increase in future years. The table below shows the number of immune (i.e., Schick negative and protected) persons each year, diphtheria notifications, attack rates and mortality:— Year. Number immunised +Schick neg. Notified Cases. Attack rate per 1,000 population. Deaths. Percentage of deaths to notifications. 1936 1,273 106 0.79 2 1.8 1935 840 163 1.21 4 2.4 1934 282 274 2.03 8 2.9 1933 278 334 2.47 7 2.1 1932 53 356 2.64 5 1.4 1931 — 324 2.44 11 3.4 ENTERIC FEVER. Eight cases of enteric fever were notified in 1936 (two typhoid and six para-typhoid B.). The para-typhoid cases were notified between 29th January and 17th February. In spite of the most careful inquiries no connection could be established between the cases and no source of infection could be found. 59 A subsequent crop of cases has occurred in the corresponding period of 1937—again without any obvious source of infection. •The same experience has been met with in adjoining areas. The following table gives particulars:— No. Ward. Age. Date of Notification Diagnosis. Where Treated. Result. 1 Hale End 11 29.1.36 Para-typhoid B. Hospital Recovered. 2 Wood Street 16 30.1.36 ,, „ 3 Hale End 12 2.2.36 „ At home „ 4 Higham Hill 2* 13.2.36 „ Hospital „ 5 Hale End 6½ 17.2.36 „ „ „ 6 Hoe Street 12 17.2.36 „ „ „ 7 Hale End 26 23.7.36 Typhoid „ „ 8 Hoe Street 11 5.9.36 „ „ „ BACILLARY DYSENTERY. Five cases of Bacillary Dysentery were notified. Cases 3 to 5 (below) occurred in one family and were very mild. The parents declined removal to hospital. No. Ward. Age. Date of notification. Where treated. Result. 1 St. James Street 7 23.1.36 Hospital Recovered. 2 Wood Street 54 4.2.36 At home „ 3 St. James Street 4 17.3.36 „ „ 4 „ 2 „ „ „ 5 „ 8 ,, „ „ PNEUMONIA. The tables show the incidence by months, ages and wards. Most of the cases removed to Hospital received treatment at Whipps Cross Hospital:— 60 Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 25 — 5 5 4 5 5 1 February 28 3 6 4 6 4 1 4 March 27 1 2 10 2 6 2 4 April 17 — 3 5 1 3 3 2 May 6 — — 1 2 2 1 - June 9 — — 1 1 3 3 1 July 3 — — 2 — 1 — — August j — — 0 — — 1 1 September 6 — — 2 — 2 2 — October 11 — 2 2 — 5 — 2 November 7 - - 1 - 5 — 1 December 8 - 1 2 — 2 2 1 Total 1936 151 4 19 37 16 38 20 17 1935 131 2 9 20 17 36 29 18 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 6 2 3 4 2 9 February 3 1 6 7 6 5 March 3 3 4 1 4 12 April 5 2 — 5 3 2 May 2 — 1 1 1 1 June 2 1 1 1 3 1 July — — 1 2 — — August — — — 2 2 — September 1 1 — 1 — 3 October 1 2 1 — 3 4 November - 1 1 — 2 3 December 2 — — 2 — 4 Totals 1936 24 13 18 26 26 44 1935 20 10 25 19 24 33 Your Council decided to continue the grant to the Walthamstow District Nursing Association, in return for which the Association was, amongst other services, required to provide home nursing facilities for cases of pneumonia. Bacteriological examination of sputum and typing is available through the medium of the excellent laboratory service provided by the Essex County Council. The local practice is for the District Sanitary Inspector to visit on receipt of a notification and to make the necessary inquiries. A leaflet of advice is left at the house, and opportunity is taken to deal with any obvious defect in sanitation which may be found. 61 PUERPERAL FEVER AND PYREXIA See Maternity and Child Welfare Section. OPHTHALMIA NEONATORUM. See Maternity and Child Welfare Section. ERYSIPELAS. The following tables show the incidence by months, ages and wards:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 7 — — 1 — 1 2 3 February 4 3 I March 7 - — 1 1 1 4 - April 4 — — — 1 3 — May 8 1 — — — 3 3 1 June 3 - - - 1 - 1 1 July 6 - - - 2 1 3 - August 2 - — - - 1 - 1 September 2 - - - - 2 - - October 5 - - - 1 3 1 November 1 - — - - 1 - - December 3 - - - - - 3 — Totals 1936 52 1 — 2 5 11 25 8 (1935 54 - — 5 5 12 25 7 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 1 - 2 1 - 3 February 2 — 1 1 — — March 2 — 1 1 2 1 April 1 2 - - 1 - May 2 4 1 - 1 — June 1 1 1 — — — July — 1 - — 1 2 August — — 1 — — 1 September — 2 — — — — October — 3 1 - — 1 November — — — — 1 — December — — — 1 1 1 Totals 1936 9 13 10 4 7 9 1935 10 8 6 7 9 14 62 CEREBRO-SPINAL MENINGITIS. Three cases were notified, two being later withdrawn. No. Ward. Age. Date of Notification . By whom Notified. Result. 1. Hale End 16 26.3.36 Hospital Died. *2. Wood Street 10 2.4.36 Private Practitioner Died in Hospital P. M. diagnosis— Tubercular Meningitis. *3. High Street 7 13.5.36 Hospital Died in Hospital P. M. diagnosis— Pneumococcal Meningitis. *Notification withdrawn. ANTERIOR POLIOMYELITIS. Five cases were notified No. Ward. Age. Date of Notification. By whom Notified. Result. 1. Hoe Street 7 4.9.36 Private practitioner Recovered. 2. Higham Hill 13 22.9.36 Hospital In hospital at end of year. 3. Higham Hill 6 19.9.36 Private practitioner & hospital Died. 4. Higham Hill 7 30.9.36 Hospital In hospital at end of year. 5. Higham Hill 3 1.10.36 Private practitioner & hospital In hospital at end of year. ENCEPHALITIS LETHARGICA. One case was notified on September 17th after the death of the patient. The notification was withdrawn on October 16th. FOOD POISONING. Two absentees from work were reported from a Metropolitan Borough in connection with an illness possibly caused by food at a staff canteen. In one case the symptoms were slight and the patient returned to work in a few days. The second patient had a more severe attack, but the bacteriological investigation proved to be negative to micro-organisms of the Salmonella group. 63 MEASLES. Under the Walthamstow (Measles) Regulations, 1932, all cases of Measles in children under five years of age are notifiable, except secondary cases in the same household or institution within two months of the primary case. The year 1936 was an epidemic year, the number of notifications being shown below. In addition, there were 1,656 cases of Measles reported by Head Teachers, and mainly in school children for 5-14 years. Month. Total. Under 1 yr. 1-5 yrs. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 14 1 13 - 1 - 2 10 1 February 115 8 107 25 6 18 17 39 10 March 268 12 256 36 27 45 43 38 79 April HO 13 177 64 31 19 9 20 46 May 60 3 57 17 3 12 2 5 21 June 17 1 16 1 5 — — 6 5 July 2 — 2 — — — — — 2 August — — — — — — — — — September 2 — 2 — 1 — 1 — — October 2 1 1 — — 1 - 1 - November — - - - - - - - - December 1 — 1 — — — — — 1 Totals 1936 671 39 632 143 75 95 74 119 165 1935 27 4 23 2 6 2 1 1 15 1934 870 48 822 182 108 100 100 130 240 1933 58 8 50 2 9 6 1 16 24 1932 753 37 619 103 122 118 59 112 239 In addition, 47 other cases were notified by general practitioners. The "peak" months were April (274 cases) and May (210 cases) in 1932, March (337 cases) and April (312 cases) in 1934, and March (268 cases) in 1936, illustrating the biennial character of the epidemic. The following shows the cases reported during March, 1936, by doctors and Head Teachers (there is probably some overlapping in respect of cases under five years of age attending school):— Doctors (Cases 0-5 years) Head Teachers (cases 5-14 years) Week ending 7.3.36 29 145 ,, 14.3.36 62 156 ,, 21.3.36 75 244 ,, 28.3.36 69 215 ,, 4.4.36 70 104 52 patients were admitted to the Sanatorium, and in addition a considerable number was admitted to Whipps Cross Hospital. 64 The death rate per 1,000 registered live births was 4.66. The deaths occurred as follows:— Sanatorium, 3; Whipps Cross Hospital, 1; at home, 4; total, 8. Home nursing is provided, where necessary, by the Walthamstow District Nursing Association. In order to focus attention on the death rate from Measles a table has been prepared showing the death rate per 1,000 live births every year between 1901 and 1936, and a five-yearly average is shown:— Year. Population. Registered Live Births. Deaths from Measles. Rate per 1,000 Registered Live Births. 5-yearly Average. 1901 95,125 3,210 43 13.39 11.51 1902 101,318 3,426 14 4.08 1903 106,290 3,535 52 14.71 1904 111,282 3,649 55 15.07 1905 116,300 3,389 35 10.32 1906 121,334 3,594 39 10.85 8.97 1907 126,397 3,629 31 8.54 1908 131,486 3,482 36 10.33 1909 136.602 3,369 30 8.90 1910 141,748 3,197 20 6.25 1911 125,334 3,107 32 10.29 9.88 1912 128,480 3,104 22 7.08 1913 131,636 3,210 21 6.54 1914 134,825 3,134 21 6.70 1915 131,718 2,867 54 18.83 1916 139,425 2,854 24 8.40 6.62 1917 132,994 2,167 24 11.07 1918 127,701 2,034 19 9.34 1919 133.008 2,384 9 3.77 1920 132,912 3,286 5 1.52 1921 127,441 2,814 3 1.06 5.02 1922 129,700 2,545 40 15.71 1923 130,000 2,349 1 0.42 1924 131,100 2,138 11 5.14 1925 130,800 2,131 6 2.81 1926 125,500 2,218 4 1.80 5.12 1927 124,330 2,025 1 0.49 1928 122,400 1,991 17 8.53 1929 124,800 1,934 1 0.51 1930 129,395 1,959 28 14.29 1931 134,420 1,947 - 0.00 4.89 1932 135,010 1,789 20 11.17 1933 135,600 1,670 — 0.00 1934 135,090 1,715 22 12.82 1935 134,490 1,670 1 0.59 1936 133,600 1,715 8 4.66 65 From the five-yearly average it will be seen that there is a definite decline in the Measles mortality rate—a finding in close agreement with that of other areas for which statistics have been published. Measles Serum— The arrangements detailed in the report for 1932 were continued. Local practitioners were asked to notify the names of any healthy adults convalescent after Measles and willing to give blood for the preparation of serum. Seven such donors were forthcoming in 1936. The serum was prepared at Great Ormond Street Hospital, one-half being earmarked for use in respect of Walthamstow patients. It is gratifying to record the great help received from the private practitioners of the town in persuading the adult convalescents to act as donors. The donors have the satisfaction of having performed a great public service. A total of 1,300 c.c.s of serum was obtained from the seven donors, and of this amount 150 c.c.s were used for Walthamstow patients, principally in preventing cross infection in the wards of the Connaught and Whipps Cross Hospitals and at the Sanatorium. Reports were returned in respect of 16 cases for which serum had been used. In five of these an attenuated attack was aimed at in order to confer permanent immunity, and this was achieved in 4 cases. In the remaining 11 cases complete protection was aimed at and obtained in 3 cases. Mild attacks resulted in 5 cases and severe attacks in 3 cases. It is possible that complete protection was not obtained in a larger number of cases owing to the serum not having been given sufficiently early. PREVENTION OF BLINDNESS. No action was necessary under Section 66 of the Public Health (Amendment) Act, 1925, for the prevention of blindness or the treatment of persons suffering from any disease of, or injury to, the eyes. TUBERCULOSIS. The following table shows particulars of new cases of Tuberculosis and of all deaths from the disease in the Borough during 1936:— 66 Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. m. f. m. f. m. f. m. f. Under 1 year — — — — —. — — 1— 5 years 1 1 — 1 — — 1 — 5—10 years 1 5 4 2 — 1 2 — 10—15 years 2 3 5 3 — — 2 — 15—20 years 9 16 1 2 2 8 2 — 20—25 years 5 9 — — 5 3 — — 25—35 years 11 13 4 2 7 5 3 — 35—45 years 12 3 1 2 5 5 1 — 45—55 years 7 2 — — 6 4 — 1 55—65 years 7 3 — — 11 1 — 1 65 years and upwards 3 1 - — 7 3 1 — Totals 58 56 15 12 43 30 12 2 114 27 73 14 141 87 The 87 deaths represent a death-rate of 0.65 per 1,000 population. The returns for the past two years are compared below:— Year. New Cases. Total. Deaths. Total. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. m. f. m. f. m. f. m. f. 1935 58 56 15 12 141 43 30 12 2 87 1936 64 58 25 16 163 39 30 3 3 75 The periods elapsing between notification and death, and the number of cases not notified were as follows:— Under 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. Over 12 months. Not Notified. Notified after death. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 12 3 10 1 5 — 5 — 32 2 8 6 1 2 67 The ratio of deaths in non-notified cases (i.e., columns to the right of the double line) to total deaths from Tuberculosis was 17 to 87, or 1 to 5.1. 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 1936:— Pulmonary. Total. NonPulmonary . Total. Grand Total. No. on Register m. f. m. f. 1st January 960 857 1,817 489 435 924 2,741 Notified during 1936 58 56 114 15 12 27 141 Total 1,018 913 1,931 504 447 951 2,882 Removed from Register, 1936 206 209 415 58 82 140 555 No. on Register 31st December 812 704 1,516 446 365 811 2,327 Five hundred and fifty-five removals from the Register were made up as follows:— Deaths. Removals. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. m . f. m . f. m. f. m. f. 42 30 5 1 164 179 53 81 72 6 343 134 78 477 555 The discrepancy between the number of deaths recorded here and the number of registered deaths during the calendar year is accounted for by transferable deaths and by cases not notified prior to death. Treatment of Tuberculosis. Treatment is given under the Essex County Council's Scheme. The admissions to Hospital during 1936 were:— 68  Pulmonary. Non-Pulmonary. . M . F. m. F. Adults 68 70 8 3 149 Children 2 4 8 7 21 No action was necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or Section 62 of the Public Health Act, 1925. The arrangements detailed in the report for 1935 were continued during 1936. Amongst other measures taken to prevent tuberculosis are the following:— (a) Re-housing of patients with infectious pulmonary tuberculosis. The re-housing is subject to the patient occupying, as far as possible, a separate bed and bedroom, and attending the Tuberculosis Dispensary regularly. (b) When a patient is notified to be suffering from nonpulmonary tuberculosis an inquiry is made as to the milk supply, and in any case of doubt the milk is biologically tested for the tubercle bacillus. Infectious Diseases notified by Medical Staff.—Scarlet Fever, 6 ; Diphtheria, 29 ; Dysentery, 3; Ophthalmia Neonatorum, 1. Total, 39. G.—INFECTIOUS DISEASES HOSPITAL. Renovations, etc.—The following works of renovation and maintenance were carried out during 1936:— Interior renovations to kitchen, scullery, vegetable store, refrigerator room, maids' cupboards, matron's office and dining room; also exterior renovations to Administrative Block. Interior renovations and provision of new concrete floor to male bathroom of B Block. Interior renovations to C Block. Extensive under-pinning of E and F Blocks. Exterior and interior renovations to E Block. 69 Provision of new door and flag paving to front and rear of F Block. Interior renovations and re-enamelling bedsteads and cots of G Block. Exterior renovations to Discharge Hut. Interior renovations to T Block. Exterior and interior renovations and repairs to Laundry Block. General renovations and repairs to Store Shed, Messroom, lamp posts, steam boiler house and shed, heating chamber (Administration Block), lodge entrance gates and boundary fences. Extensive repairs to fences, roads and paths. Staff.—The staff at the end of the year remained the same as that detailed in the Report for 1935. Three probationers were successful in the first part of their Fever Certificate examination, and eight obtained the Certificate on completion of training. Genderal—The death rate per 100 admissions of infectious disease patients was 2.24. During the year the County Council continued 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 Total £425 The draft plans of a new cubicle block have been agreed to in principle between the Ministry of Health and your Council, and provide twelve cubicle beds and an operating suite. The completion of this block is a continued and urgent necessity. The County Council has formulated a scheme for Isolation Hospital accommodation in the county, which provides for a Joint Hospital of 261 beds to serve the Boroughs of Walthamstow and Leyton. Negotiations are proceeding. 70 Financial Statement.—A financial statement for the year ended 31st March, 1936, is given below:— Loan Charges. £ s. d. Amount of Loan outstanding on 31st March, 1936 12,299 19 0 Expenditure. Repayment of Loan 572 5 4 Interest on Loan 554 12 2 Structural Repairs 1,485 19 2 Food for Patients and Staff 3,972 6 1 Establishment and other Expenses 12,040 2 7 £18,625 5 4 Income. Patients 646 16 10 County Council 3,025 0 0 Other sources 122 17 5 £3,794 14 3 Fees for cases from other Authorities are included. The following table shows the admissions, discharges and deaths during 1936:— Scarlet Fever. Diphtheria. Other Diseases. Tuberculosis. Totals. Remaining in Hospital 1st January 44 13 19 76 Admitted during year Discharged during year 2^8 320 127 126 75 64 44 41 534 551 Died during year 1 1 7 3 12 Remaining in Hospital 31st December 11 13 4 19 47 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL, (including Tuberoulosis cases.) January 69.7 July 51.9 February 67.7 August 42.2 March 95.2 September 38.9 April 82.0 October 56.0 May 67.1 November 59.7 June 61.1 December 54.6 Average whole year 62.2 71 Epping Urban District Council.— The agreement with this Authority was extended to 31st March, 1937. CLINICAL REPORT. Dr. Hamilton, Resident Medical Officer, reports as follows:— AGE AND SEX OF PATIENTS ADMITTED DURING 1936. 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 18 11 29 19 16 18 8 8 71 56 127 Scarlet Fever 25 32 66 48 25 33 33 26 149 139 288 Measles 26 24 7 1 — — — — 33 25 58 Whooping Cough 4 - - - - - - - 4 — 4 Pulmonary Tuberculosis - - - - - - - 44 - 44 44 Staff - - - - - - - 12 — 12 12 Other diseases 2 — 3 1 1 3 1 2 7 6 13 Totals 75 67 105 69 42 54 42 92 264 282 546 Other diseases include Observation cases (8), Chorea (1), Laryngitis (1), Paratyphoid Fever (2) and Puerperal Pyrexia (1). AGE AND SEX AT DEATH. Eleven deaths occurred, details of which are given below:— 4 Measles and Broncho-Pneumonia 2 Females aged 1 year and 1 year and 2 months. 2 Males aged 1 year and 3 months and 3 years. 1 Scarlet Fever and Pneumonia Female aged 2 years and 6 months. 1 Septic Broncho-Pneumonia Female aged 2 years and 7 months. 1 Diphtheria (Haemorrhagic) Male aged 4 years. 1 Streptococcal Meningitis Male aged 2 years. 1 Septic Meningitis (Otitis Media, Scarlet Fever) Female aged 6 years. 2 Pulmonary Tuberculosis 2 Females aged 18 years and 19 years. 72 MONTHLY ADMISSIONS OF DIPHTHERIA CASES. Month. Under 5 years. 5 to 10 years. 10 to 16 years. Over 15 years. Total. Total. M f M F m F m f M f January — 1 3 2 5 1 — 2 8 6 14 February 1 1 6 3 3 2 2 2 11 8 19 March 2 1 6 — — 2 1 — 9 3 12 April 3 — 2 1 — 1 1 — 6 2 8 May 3 3 4 2 2 2 1 1 10 8 18 June 1 — — 1 2 3 — — 3 4 7 July — 1 1 — — 1 1 1 2 3 5 August — 2 2 1 — — — — 2 3 5 September 2 — — 3 2 2 — — 4 5 9 October 1 1 1 1 1 3 1 — 4 5 9 November 3 1 1 2 1 1 1 2 6 6 12 December 2 — 4 3 — — — — 6 3 9 Totals 18 11 29 19 16 18 8 8 71 56 127 The cases of Diphtheria were classified as follows:— Nine patients were regarded as dangerously ill. This group included one case of haemorrhagic diphtheria. In all these cases some degree of nasal infection accompanied the faucial lesion. Laryngeal diphtheria (1), mild nasal diphtheria (12), bacteriological diphtheria (20), mild faucial (69) and severe faucial (20). Eight of the dangerously ill patients were given serum intravenously. In two cases 32,000 units were administered, and in six cases 16,000, in addition to the appropriate intramuscular dose. Complications.—Complete paralysis of lower limbs, 1. Early cardiac paralysis with subsequent recovery, 2. In all the cases classified as severe and as dangerously ill a considerable amount of paresis of the lower limbs followed:— Palatal paresis, 4. Complete palatal paresis, 1. Diphtheria Cases transferred to Cubicle Block.—For isolation prior to transfer to a convalescent home, 1; Streptococcal Tonsillitis, 1; Vaginal Discharge, 1; Scarlet Fever suspects (one case confirmed), 3; Otorrhoea, 1; Acute Nephritis, 1; suspects (both cases confirmed), 2. 73 MONTHLY ADMISSIONS OF SCARLET FEVER CASES. Month. 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 2 7 4 7 4 3 3 6 13 23 36 February 1 1 9 5 1 3 7 — 18 9 27 March 2 5 7 4 3 5 3 4 15 18 33 April 1 3 3 1 4 2 3 1 11 7 18 May 4 3 7 4 4 3 2 3 17 13 30 June 1 2 6 8 1 4 1 2 9 16 25 July 2 3 9 — 2 2 3 2 16 7 23 August 6 2 4 1 — — 2 1 12 4 16 September — 2 3 3 1 2 — 2 4 9 13 October 2 2 6 8 1 7 3 4 12 21 33 November 3 2 6 6 2 1 2 - 13 9 22 December 1 — 2 1 2 1 4 1 9 3 12 Totals 25 32 66 48 25 33 33 26 149 139 288 During 1936 it was possible, owing to the relatively small number of cases admitted, to transfer all patients in whom complications arose to the cubicle block. Also the practice was followed of admitting to the general ward for not more than ten days, while waiting until cubicle accommodation became available, any doubtful cases of Scarlet Fever. Such cases were protected by 10 c.c.s of Scarlet Fever antitoxin. Scarlet Fever Cases transferred to Cubicle Block.—The following patients were transferred to the cubicle block for the reasons stated:—Septic Scarlet Fever (a fatal case); at expiration of period of passive immunity (4); Streptococcal Rhinitis (1); abscess of thigh—cause unknown—incised (1); two children developed sharp attacks of Measles—they had been exposed to infection in the ward—both developed a non-specific vulvo-vaginitis (2); a child who was stated to have had measles developed a second attack, which was further complicated by a faucial condition, clinically indistinguishable from severe diphtheria, although followed by none of the usual sequelae and not found positive to K.L.B.—the patient developed multiple abscesses on the scalp and forehead and double otorrhoea (1); Secondary Tonsillitis (2); Otitis Media (5), three developed mastoiditis and were operated upon—two of these operations were preceded by paracentesis tympani and in two other cases this operation was found sufficient; Contact Measles (1); Acute Endocarditis—recrudescence of old-standing disease—transferred to Cheyne Hospital (1); Scarlet Fever (late septicaemic formv —this case responded dramatically to prontosil treatment (1); Scarlet Fever and suspected Tuberculosis (1); Arrhythmia (1). 74 Staff.—Members of the StaS were admitted to hospital beds suffering from the following complaints:— 'Colds," 2; Tonsillitis, 7; Acute Bronchitis, 1; Gastritis, 1; Acute Appendicitis (removed to Connaught Hospital for operation), 1. Operations at Hospital.—Twelve operations were performed. Mastoid operations, 5; Incision of drum, 4; Lumbar puncture, 1; Abscess in thigh incised, 1; Tracheotomy, 1. Specialist Consultations.—Eight Consultants attended on 43 occasions to see 18 patients for the following reasons:—Ear Complications, 9; Puerperal Phlebitis, 1; Heart Complications, 5; observation for cerebral complications, 3. Swabs.—802 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 5 5 10 From Epping U.D.C. 1 29 30 Totals 6 34 40 The following cases were transferred to Whipps Cross Hospital:—Laryngitis following Measles, 1; Acute Glossitis with severe dyspnoea, 1; Chronic Gastritis, 1; Rheumatic Endocarditis, 1; Convalescence following mastoid operation, 1; Chorea, 1. The following cases were transferred to the Connaught Hospital:—Debility following Measles, 1; Scarlet Fever (after recovery), admitted from Connaught Hospital with fractured femur, returned for further treatment, 1. Duration of Treatment.—The average duration of treatment in Hospital was as follows:— Diphtheria 49.8 days. Scarlet Fever 27.7 days. Measles 20 days. Other diseases 19 days. 75 The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1936:— Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.). In Hospital on 1st January, 1936." Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1936. T.B. Minus I 8 7 2 T.B. Plus Group I — 4 2 1 1 T.B. Plus Group II 17 27 29 — 14 T.B. Plus Group III 1 5 3 2 2 Totals 19 44 41 3 19 Twelve of the 44 admissions were Walthamstow cases. MEDICAL EXAMINATIONS. During the year, 120 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 Cemetery Superintendent reports that the number of inquests and post-mortems were as follows:— Inquests only 94 Post-Mortems 66 Post-Mortems and Inquests (not included in above) 18 Total 178 76 CREMATION. Adequate 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. Your Council makes an annual grant of five guineas to the Central Council. (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. In addition, several members of the Staff have lectured on various subjects to organisations in the town. Your Council subscribes one guinea per annum to the Industrial Health Education Society. Three lectures were arranged by the Society in Walthamstow during 1936 on the following subjects:— 1. Diseases affecting general and municipal workers. 2. Dermatitis. 3. Teeth in relation to health. Rainfall.—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, 1920-192928.23 inches which represents a yearly average of 25.2 inches over the 30 years. The rainfall during 1936 was as follows:— January 4.22 inches July 2.52 inches February 1.34 ,, August 0.36 ,, March 1.10 ,, September 2.18 ,, April 1.34 ,, October 1.75 ,, May 0.31 ,, November 3.11 ,, June 3.48 ,, December 1.84 ,, Total 23.55 inches. MATERNITY AND CHILD WELFARE. 78 SECTION H. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs. E. M. Richards. Ex-Officio: His Worship the Mayor—Alderman Ross Wyld, J.P. The Deputy Mayor—Alderman G. Gibbons, J.P. Chairman of Finance Committee—Councillor E. C. Redhead. Alderman J. C. Hammond. Councillor Mrs. A. L. Meadows ,, Mrs. C. McEntee, J.P. ,, Mrs. E. M. Miller. ,, Mrs. M. Norrish. ,, G. M. Page. ,, W. J. Sharp. ,, Mrs. E. A. Smith. Councillor Mrs. L. P. Bailey. ,, R. E. Smith. ,, Mrs. B. M. Friedberg. ,, A. W. Stannard. ,, Mrs. E. M. Hammond. ,, T. H. Tee. Councillor Mrs. E. B. Toynbee. Co-opted Members: Dr. J. L. Mackenzie Brown. Mr. W. H. Kindell. Mrs. V. Cossey. Mrs. W. H. Kindell. Mrs. M. A. Cross. Mrs. W. J. Sharp. Mrs. Hatton. Mrs. O. Waterman. 79 STAFF. Medical Officer of Health, Administrative Maternity and Child Welfare Officer, and Medical Superintendent, Maternity Home: A. T. W. Powell, m.c., M.B., B.S., M.R.C.S., L.R.C.P., 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., Barrister-at-La w. Obstetric and Puerperal Fever and Pyrexia Consultants (part-time): J. B. Banister, Esq., M.D., F.R.C.S., F.C.O.G. Miss M. M. Basden, M.D., F.R.C.S., F.C.O.G. Alan Brews, Esq., M.D., 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., F.R.C.P., F.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.C.O.G. H. G. Everard Williams, Esq., M.D., M.R.C.P., M.C.O.G. Maternity Home. Resident Medical Officer: Miss Helen Rodway, M.R.C.S., L.R.C.P., M.C.O.G. Miss Helen Jardine, M.B., Ch.B., M.M.S.A. (part-time relief). 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., D.A. (Eng.). 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. E. Laidler, S.R.N., S.C.M., H.V. Cert. (Half-time). Miss D. G. Legg, S.R.N., S.C.M., H.V. Cert. (Half-time). Miss O.J. Panther, Cert. S.I.E.B. (Lond.) (Half-time). Miss A. Stuart, S.R.N., S.C.M., H.V. Cert., T.B. Cert. (Halftime) . Miss A. O. Wright, S.R.N., S.C.M., H.V. Cert. (Half-time). Miss M. A. Young, S.R.N., S.C.M., H.V. Cert. (Half-time). (Six of the Half-time Nurses give the remainder of their time to School Nursing Duties and one to Public Health Duties). Masseuse (Half-time): Miss Kathleen M. Hill, C.S.M.M.G. Record Clerk: Miss V. Lecomber. 80 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen, I beg to present herewith a report on the work of the Department during 1936 in respect of Maternity and Child Welfare. The salient features include the following:—A slight increase in the birth-rate; a maternal mortality rate of 1.74 (England and Wales, 3.81); an infant mortality rate of 42 (England and Wales, 59); a new low record in the neo-natal death-rate (16.9); an increase of over 1,500 in welfare attendances (all centres); an increase in the use made of the Home Help Scheme (from 3 to 87 in six years); and an increase in the number of in-patient confinements to 1,041. The Maternity Home, in spite of a short closure, showed an increase in the number of confinements from 646 in 1935 to 660 in 1936. The Home is fully booked up at the time of writing, and plans for the much needed extensions have been passed by the Ministry of Health. Grateful acknowledgments must be made to the help of the Voluntary workers at all the Centres and the good work of all voluntary Bodies concerned with Maternity and Child Welfare in the town. The staff have worked hard and conscientiously and have assisted in the compilation of this report. I beg to thank your Committee for the sympathetic consideration which I have always experienced. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 81 1. NOTIFICATION OF BIRTHS. 1,704 births (131 of which belonged to other areas) were notified during the year under the Notification of Births Acts, 1907 and 1915. Notifications were received as follows:—doctors and parents, 374; midwives, 1,330. Included in the above are 217 births which were notified as having occurred outside the Borough. Also included are 47 stillbirths, three of which did not belong to the area. Ten were notified by doctors and 37 by mid wives. Of the total, six occurred outside the area. The stillbirth rate per 1,000 population was 0.40. 2. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:— a) Live Births. Males. Females. Totals. Legitimate 885 799 1,684 Illegitimate 17 14 31 902 813 1,715 (b) Stillbirths. Males. Females. Totals. Legitimate 26 25 51 Illegitimate 3 — 3 29 25 54 Of the 1,685 birth registrations received in the Department between 29th December, 1935, and 2nd January, 1937, a total of 253 were not notified in this area, but some may possibly have been notified elsewhere, especially in view of the fact that of the 1,685 registrations, 189 referred to births which belonged to other areas. In addition, it will be seen that the Registrar-General's figure (1,715) is 30 more than the local registrations. Presumably these were births registered and notified in other areas. Of the 1,685 local registrations, 189 are excluded, leaving a net total of 1,496, which are allocated to the wards as follows:— 82 The local registrations for 1936 were 38 more than in 1935. Births Registered Locally, 1936. 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 18 16 11 7 15 8 4 11 24 11 15 15 87 68 155 February 7 13 6 4 12 17 7 10 13 6 7 12 52 62 114 March 7 9 11 10 6 4 8 9 14 16 15 10 61 58 119 April 13 10 7 3 12 13 10 6 16 11 19 15 77 58 135 May 9 7 10 10 6 9 8 12 14 10 9 15 56 63 119 June 11 10 6 4 8 14 7 6 11 14 15 12 58 60 118 July 16 14 10 15 10 9 6 12 10 14 16 11 68 75 143 August 12 9 6 5 11 10 6 6 8 7 11 10 54 47 101 September 10 7 11 12 14 12 7 9 20 12 10 17 72 69 141 October 10 8 8 5 12 11 4 7 14 14 15 13 63 58 121 November 7 8 10 9 15 10 4 5 7 5 11 9 54 46 100 December 9 6 6 8 9 13 8 11 17 7 20 16 69 61 130 Totals 129 117 102 92 130 130 79 104 168 127 163 155 771 725 1,496 Grand Totals 246 194 260 183 295 318 1,496 83 3. INFANT MORTALITY. The deaths of infants under one year of age were:— Males. Females. Total. Legitimate 33 36 69 Illegitimate 3 — 3 Total 36 36 72 Infant Deaths, Neo-Natal Mortality and Stillbirths. Year. Live Births. Birth Bate. Stillbirths. Neo-Natal Deaths. Infant Deaths. No. Per 1,000 live births. Per 1,000 population. No. Per 1,000 live births. No. Per 1,000 live births. 1936 1,715 12.8 54 31.4 0.40 29 16.9 72 42 1935 1,670 12.4 57 34.1 0.42 36 21.5 62 37 1934 1,715 12.6 60 33.8 0.44 35 20.4 77 44 1933 1,670 12.3 65 37.4 0.47 49 29.3 89 53 1932 1,789 13.2 82 43.8 0.60 55 30.8 103 57 1931 1,947 14.5 59 29.4 0.43 51 26.2 110 56 The neo-natal mortality for England and Wales for the decennium 1921-30 was 33. Reduction 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 1936:— 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, 41; Illegitimate, 97; Total 42. The Infant Mortality Rate for other areas during 1936 was as follows:— England and Wales 59 122 County Boroughs and Great Towns (including London) 63 143 Smaller Towns (25,000 to 50,000) 55 London 66 Neo-Natal Mortality. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1936, 29 infants died in the first four weeks of life, yielding a rate of 16.9. 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. 84 SUMMARY, 1936. Causes of Death of Children under 1 year of age. Cadse of Death. Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3 Months and under 6 Months 6 Months and under 9 Months 9 Months and under 12 Months Total Deaths under One Year. Wards. St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Influenza - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - Chickenpox - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - Whooping Cough - - - - - — — 1 1 2 — 1 - - - 1 Diphtheria and Croup - - - - - — — - - — — - - - - - Erysipelas - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - — — - - - - - Phthisis - - - - - - - - - — — - - - - - Meningitis (not Tuberculous) .. - - - - - 1 2 - - 3 — - 3 - - - Convulsions 2 - - - 2 2 — - 2 6 2 - 2 - 1 1 Laryngitis - - - - - - - - - - - - - - - - Bronchitis — - - - — 2 — - — 2 1 - — - - 1 Pneumonia (all forms) — - - - — 6 1 1 4 12 3 3 3 1 - 2 Diarrhœa - - - - - - - - - - - - - - - - Enteritis — - - - — 4 3 2 — 9 3 — — 2 1 3 Gastritis - - - - - - - - - - - - - - - - Syphilis — - - - — — — — — — — — — — - — Rickets - - - - - - - - - - - - - - - — Inattention at Birth, wilful neglect - - - - - - - - - - - - - - - - Suffocation, overlaying - - - - - - - - - - - - - - - - Injury at Birth - - - - - - - - - - - - - - - - Atelectasis 2 - - - 2 — — — — 2 1 — — 1 - — Congenital Malformations 2 - 1 - 3 — 2 1 — 6 — 1 1 — 2 2 Premature Birth 7 1 1 1 10 1 — — — 11 3 — 2 2 2 2 Atrophy, Debility and Marasmus 3 - - 1 4 2 1 - - 7 1 - 2 2 1 1 Inanition 8 - - - 4 - - -- - 4 1 - 2 - 1 - Heart Failure — - - - — — — — — — — — — — — — Other Causes 1 1 - 2 4 1 1 1 1 8 1 1 1 2 2 1 Totals 20 2 2 5 29 19 10 6 8 72 16 6 16 10 10 14 85 The death-rate from Diarrhoea and Enteritis in children under one year of age per 1,000 live births was 5.24. 4. CHILD WELFARE. The new Scheme made by the Minister of Health under Section 93 of the Local Government Act, 1929, for the period 1937-42 increases the grant from the County Apportionment to £3,800 per annum. The previous grant for the preceding five-year period was £1,864. The apportionment to Walthamstow is now the second highest in the county. The equivalent of whole-time Municipal Health Visitors is 6.5, equal to one whole-time Health Visitor per 262 notified births, and one whole-time Health Visitor per 272 registered births during 1936. 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) ,, ,, ,, 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, Mark- house Road. Thursday 2 to 4 p.m. ,, ,, ,, ,, Thursday 2 to 4 p. m. ,, ,, Estate Office, 1, Guildsway, Billet Road. Thursday 1.30 to 6 p.m. ,, ,, "Brookscroft," 564, Forest Road, E.17. Friday 2 to 4 p.m. ,, ,, Low Hall Lane, Mark- house Road. In addition, the Walthamstow Child Welfare Society at "Brookscroft" holds "special" clinics, e.g., massage and light sessions. A. MUNICIPAL SCHEME. The detailed findings at first visits paid during 1936 are given in the following table:— From the above table it will be seen that of 1,678 children, 1,367 or 81.4 per cent., were breast-fed on first being visited, but 101, or 6.0 per cent., had no separate sleeping accommodation. The particulars in respect of housing accommodation show the following comparison:— Ward. How Fed. Sleeping Accommodation. Condition of Baby. Accommodation. Breast. Breast and Hand Hand. With Mother. Cot or Cradle. Good. Fair. Bad. Whole House. Flat. Half-house. 3 Rooms. 2 Rooms. 1 Room. St. James Street 263 28 23 20 294 267 46 1 94 84 88 26 21 1 High Street 146 22 18 5 181 158 28 — 39 93 27 22 5 — Hoe Street 220 9 20 3 246 239 7 3 44 98 42 51 11 3 Wood Street 176 15 33 3 221 209 14 1 90 18 91 8 17 — Hale End 266 30 40 16 320 298 37 1 200 40 84 2 7 3 Higham Hill 296 37 36 54 315 316 50 3 180 114 42 5 22 6 Total 1,367 141 170 101 1,577 1,487 182 9 647 447 374 114 83 13 86 87 House or Half 1-3 Flat. House. Rooms. Total. 1936 1,094 374 210 1,678 1935 893 567 217 1,677 The findings appear to show that the proportion of families adequately housed in a separate house or flat increased satisfactorily and that of families inadequately housed remained stationary. 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. First Visit. Subsequent Visits. Total Visits. 1 2 3 4 5 6 7 8 — — 9 10 Cols. 5-10. St. James Street 314 477 791 580 1,371 100 70 177 47 26 73 198 1,989 High Street 186 209 395 406 801 111 49 85 25 7 32 115 1,193 Hoe Street 249 361 610 587 1,197 263 44 167 31 6 37 90 1,798 Wood Street 224 403 627 1,067 1,694 352 46 186 3 — 3 122 2,403 Hale End 336 1,072 1,408 2,190 3,598 237 173 283 29 10 39 283 4,613 Higham Hill 369 961 1,330 2,251 3,581 231 160 198 42 22 64 370 4,604 Total, 1936 1,678 3,483 5,161 7,081 12,242 1,294 542 1,096 177 71 248 1,178 16,600 Total, 1935 1,677 3,419 5,096 7,680 12,776 1,891 665 1,151 229 69 298 274 17,055 88 CLINICS. Dr. Sheppard reports as follows:— "The work of the Ante-Natal Clinic continued satisfactorily during the past year. A very pleasing sign was the increase in post-natal cases, and it is hoped that this number will be much increased during 1937. It is very difficult to make the mothers realise the importance of a post-natal examination; they promise to attend on a certain date, but are so occupied looking after the baby that they are very prone to fail their appointment. The Health Visitors are impressing on them the seriousness of neglect, and their advice, I am glad to say, appears to be bearing fruit lately. ''The Maternity and Child Welfare Clinics continue to be very well attended, and Tuesday afternoons at Hale End are becoming too crowded for effective work. (Note by M.O.H.:—An additional session is being started in 1937.) "The massage sessions continue to do good. "At all these Welfare Centres a special weighing machine in the outer hall is used for toddlers. The mothers avail themselves very freely of this benefit and find it much more convenient than if they were compelled to attend a separate session for toddlers. Our attendance of children between 2 and 5 years is surprisingly good. "The voluntary workers have again been of great assistance, and are deserving of your best thanks." The attendances at the various Centres can be seen from the following table:— Summary of Attendances at Ante- and Post-Natal Clinics. New Patients:— Ante-Natal Post-Natal Thorpe Coombe Maternity Home 691 453 Low Hall Lane Clinic 272 7 Total 963 460 Total Attendances:— Thorpe Coombe Maternity Home 6,045 630 Low Hall Lane Clinic 985 27 Total 7,030 657 The total number of new patients attending the clinics represent the following percentages of total notified births (live and still):— Ante-Natal, 56.6; Post-Natal, 27.7. 89 Quite apart from the patients receiving ante- and post-natal care under the Municipal Scheme, most of the remaining expectant and nursing mothers have received ante- and post-natal medical care either at a hospital or from a private practitioner. Summary of Attendances at Welfare Clinics. 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 632 151 783 11515 6006 17521 18304 Higham Hill 262 102 364 4264 3541 7805 8169 Highams Park 193 53 246 3367 3320 6687 6933 Total 1936 1087 306 1393 19146 12867 32013 33406 1935 1186 201 1387 17698 17866 35564 36951 The attendances at Highams Park Centre have increased as shown since the commencement of the clinic in 1931:— 1931 (part-year) 362 1934 5,549 1932 3,873 1935 7,009 1933 5,584 1936 6,933 During the current year a second weekly session is to be commenced. The erection of the proposed new clinic is an urgent necessity. Nurse Children.—At the end of 1936 there were 122 nurse children on the Register, i.e., the same number as at the end of 1935. During the year, 104 removed, 2 were adopted, 13 reached the age of nine years, and 1 ceased to come under the Act. 117 new children were registered and 3 re-registered. There were no deaths among nurse children during 1936. Massage.-—Five massage sessions per week were held at the Welfare Centres, i.e., Low Hall Lane, Monday, Thursday and Friday; Highams Park, Tuesday; and Higham Hill, Wednesday. 181 cases attended for massage, and these made 2,025 attendances. 90 Sale of Milk, etc., at Clinics.—The quantity and value of milk and food sold and issued free during 1936 was as follows:— Sales. Value. Free Issue. lbs. ozs. £ s. d. lbs. ozs. Virol 1,919 12 162 1 0 Prune and Banana Syrup 143 10 14 7 3 Nil. Parrish's Food 425 8 14 3 8 Nil. Cream of Magnesia 51 12 3 9 0 Nil. Cod Liver Oil 529 12 17 13 2 Nil. Cod Liver Oil Emulsion 1,042 0 52 2 0 0 8 Ambrosia 718 0 59 16 8 201 0 Virol Containers 2,845 0 11 16 11 5 Ostermilk 2,477 0 206 8 4 462 0 Almata 239 0 17 18 6 38 0 Trufood 705 0 72 13 0 107 0 Roboleine 331 0 24 16 6 14 0 Malt and Oil 1,085 0 31 12 11 5 0 Maltoline 25 0 0 16 8 Nil. Cow and Gate 6,254 0 495 0 0 1,122 0 Lactogen 2,185 0 164 13 7 165 0 Hemolac 736 0 61 6 8 224 0 £1,410 15 10 5. TREATMENT. (a) Orthopaedic.—The facilities provided by the Education Authority's Orthopaedic Scheme is available lor all children attending the Welfare Centres. Miss Garratt has kindly furnished the following information with respect to children under five years of age:— Defects seen at Orthopaedic Clinic in Children under Five Years of Age. Anterior Poliomyelitis 2 Scoliosis 5 Rickets— Pes Piano Valgus 36 (a) Genu Varum 71 Spastic Paralysis 11 (b) Genu Valgum 56 Congenital Defects 7 Torticollis 12 Miscellaneous 10 Talipes 15 Total 225 Admission to Brookfield Orthopaedic Hospital (under Five Years of Age). Anterior Poliomyelitis .. 2 Various 4 Rickets 3 Total 9 Seven operations were performed. 91 (b) Dental.—The following work was done by the Education Committee's Dental Surgeons in respect of Maternity and Child Welfare patients:— 1934 1935 1936 Mothers. Children under 6. Mothers. Children under 6. Mothers. Children under 5. Cases Treated 109 240 174 187 283 142 Attendances 164 299 276 263 654 270 Fillings 24 21] 73 132 149 117 Extractions 199 299 485 278 661 169 General Anaesthetics 86 156 190 148 237 98 Scalings 24 1 10 3 61 — Dressings 8 53 13 78 32 361 Dentures 8 — 12 — 13 The Senior Dental Surgeon submits the following report from Mrs. W. R. Thorne, L.D.S., with regard to the dental treatment under the Maternity and Child Welfare Scheme:— ''The review of the work for the scheme during the past year may be summarised as a steady and definite advance in the dental health of the mothers who come under the observation and care of the dental clinic, and fully justifies this branch of public service. After analysing the work of the year, its expansion can be anticipated. "During the year 283 mothers have attended at the clinic for treatment, making 654 attendances. The work done was as follows— 149 fillings inserted; 661 extractions; 237 nitrous oxide and oxygen inductions; 61 scalings; 32 dressings; 13 dentures. "282 mothers have been referred for dental treatment from Thorpe Coombe Maternity Home. All of these have been duly sent for; 182 have attended and received treatment. Some have not received complete treatment, owing to the failure to keep subsequent appointments. The acceptance rate cannot be considered to be good. It must be borne in mind that patients who take the trouble to have treatment in the ordinary course of life would rarely require to be referred for treatment from the maternity clinic. The clientele of the Dental Clinic will almost always consist of those who have been neglected, either through their own indifference or to lack of means to pay for treatment. It is disappointing to find so many failing to avail themselves of this benefit especially when the mother must be fully aware that her health is coupled with that of her unborn child. "To encourage attendance special sessions are allotted for maternity cases and urgent cases are treated at the first visit. "There is a groundless fear of treatment in pregnancy. This is being dispelled by the very fact of the satisfactory results of the treatment given. ''The numbers who appreciate conservative treatment are slowly increasing and gladly attend and express themselves strongly in favour of the retention of the natural dentition. Conservative work is not as spectacular as the prosthetic side of dental treatment; but it must be regarded as the greatest advance yet made in the dental 92 education of the mothers. This steady increase might be called a 'demand' for treatment. Dental treatment suggests to the mothers the necessity for improvement in her general health; the clinic is organised to include advice on prophylaxis, which advice forms a working basis for a well-regulated life. The focussing of attention on the almost forgotten function of the teeth and how that function may be maintained unimpaired is gaining ground. ''Since the period of dental benefit for the provision of dentures under the Council's scheme is limited to pregnancy and nursing it is not possible, under the present scheme, to follow up the cases. It is imperative that the patient should be under treatment at the earliest stage to ensure the best results. When extensive extractions are required the delay in applying for treatment militates against the fitting of dentures as early as might be desired. It is to be deplored that, during some period of pregnancy, the patient may have a partially or wholly edentulous mouth and be unable , for some considerable time, to masticate her food; apart from the loss of pleasure in enjoying a meal. Thus it follows, since few of the patients can afford the extra cost of having dentures remodelled, there must be a period of waiting between the extraction of the teeth and the construction of dentures. This cannot be avoided. ''Few of the patients are free from some infection of the mucous membrane of the mouth. ''Mothers suffering from periodontal disease should be under treatment during both pregnancy and nursing. During the latter period, the mother, with her many household duties, is inclined, unless suffering pain, to neglect her own treatment. It is difficult to insist on the continuation of treatment after the birth of the child. The patients do not fully understand that repeated visits are necessary to clear up long-standing septic conditions, whereas they never fail to return for the fitting of dentures. It has been possible in the special maternity sessions to set apart time for the treatment of these obstinate conditions and with the co-operation of the patient success is obtained in the most advanced cases." (c) Tonsils and Adenoids.—Seven 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) Sunlight.—Four infants were referred for sunlight treatment during 1936. There was definite improvement recorded in two of the cases. 93 (f) 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:— Referred by:— Medical men, Hospitals and Dispensaries 44 Orthopaedic Clinics 97 Others 4 145 Suffering from:— Anaemia and Debility 8 Marasmus and Malnutrition 6 Pneumonia, Bronchitis, Asthma, etc. 14 Bone Disease (non-T.B.) 69 Congenital Deformities 23 Paralysis 5 Hernia 2 Diseases of:- Glands (non-T.B.) 2 Nervous Conditions 3 Ear 2 Rheumatism 3 Various 8 145 Help Given to Old and New Cases, 1936. Sent to Special Hospitals and Convalescent Homes *32 Provided with Surgical Boots and Appliances 46 Referred for Visiting and Advice 69 147 *Includes 7 admissions to Brookfield Hospital. Miss Lewis in forwarding her report remarked upon the increased proportion of children under 5 years of age referred for Convalescent Home treatment, and the increased difficulty in placing them, especially in the Autumn of 1936. Miss Lewis considers that children under 5 years of age do not receive the same degree of benefit as the older children sent for convalescence. The risk of acquiring a series of infectious diseases is not the least of the disadvantages of sending young children away. 94 B. WALTHAMSTOW CHILD WELFARE SOCIETY. The organisation and staffing of, and the accommodation provided by the Society was fully dealt with in the 1935 Report. The staff remains unchanged except that Miss M. Tomlin, S.R.N., S.C.M., H.V.Cert., succeeded Miss Hughes, as Superintendent and Health Visitor, and Mrs. Love, S.R.N., succeeded Miss Dockree as Ward Sister. Clinics are held as follows:— Tuesday and Friday, 2 to 4 p.m.—Massage and Sunlight Treatment. Wednesday, 2 to 4.30 p.m.—Weighing Clinic and Dispensary Treatment. Thursday, 1.30 to 6 p.m.—Infant Consultations. The work done during the calendar year is shown in the following table compiled from information kindly supplied by Miss Coulston:— Clinics. First Attendances of New Cases. Re - atten dances. Grand Total. Under 1 yr. 1—5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1936 427 81 508 5483 3402 8885 9393 1935 387 81 468 5526 4759 10285 10753 1934 400 275 675 5720 4737 10457 11132 Special Treatment, Etc. Attendances at Lectures. Massage Treatments . Sunlight Treatments. Total eases admitted to Observation Ward. Local Authority's cases admitted to Observation Ward. 1936 281 2107 1461 28 10 1935 608 2197 1727 27 - 1934 713 1919 2292 32 1 95 Home Visits. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1936 380 1251 1631 2639 4270 1935 338 1441 1779 2672 4451 1934 363 1303 1666 2736 4402 Your Council, under the Scheme approved by the Ministry of Health, for the grant period 1937-42, make an annual grant of £700 to the Society, i.e., £550 per annum as to child welfare work and £150 per annum as to the infants' "observation" ward. SUMMARY OF MUNICIPAL AND VOLUNTARY SCHEMES. The following tables give the total number of attendances at clinics and home visits:— Attendances at Clinics. First Attendances. Re-attendances. Grand Total. Under 1 year of age. 1-5 years of age. Total. Under 1 year of age. 1-5 years of age. Total. Municipal Scheme 1087 306 1393 19146 19292 38438 39831 Brookscroft 427 81 508 5483 3402 8885 9393 Total l936 1514 387 1901 24629 22694 47323 49224 1935 1573 282 1855 23224 22625 45849 47704 Home Visits. To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Municipal Scheme 1678 3483 5161 7081 12242* Brookscroft 380 1251 1631 2639 4270 Total 1936 2058 4734 6792 9720 16512 1935 2015 4860 6875 10352 17227 *4,358 other visits were paid for special reasons. 96 Percentage of notified live births represented by number of children under 1 year of age who attended the Centres for the first time (i.e., new cases) Percentage of total notified births represented by number of expectant mothers attending Ante-Natal Clinics 1936 1936 91.3 56.5 Nursery School and Classes.—Apart from the children at the Nursery School, 479 children born in 1932-33 (i.e., under 5 years of age) were on the School Registers on 31st December, 1936. 6. ASSISTED MILK SCHEME. One pint of milk per day was granted to expectant mothers at any time during pregnancy. A medical or midwife's certificate as to pregnancy is required. Milk is granted free to nursing mothers for the first 14 days following confinement. One pint of milk per day is granted to children up to 3 years of age. In breast-fed infants this is equivalent to a grant to the nursing mother. Children between 3 and 5 years of age are granted milk on medical certificate only. In all cases where milk is granted it has been limited to one pint daily for 28 days when a further application is required. Dried Milk, Cod Liver Oil, Parrish's Food, Virol, Cod Liver Oil and Malt, etc., are supplied at the Welfare Centres at cost price. Free issues are made on medical certificate. 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 in order to assess the applications on the scale which has been approved. 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 1936:— Number of applications during 1936 6,497 Number of families assisted 1,131 97 Of the 6,497 applications, approximately 40 per cent. were from families where the father was unemployed. Scale Amount Approximate cost to Authority £ s. d. Free 168 pints 2 5 6 ½d. per pint 71,621 ,, 828 19 10 1d. per pint 101,777 ,, 954 3 2 l½d. per pint 56 ,, 0 8 2 Half cost 27,450 ,, 185 17 2 201,072 ,, £1,971 13 10 The following is a summary of the applications for milk for the past four years:— Milk. Dried Milk. Unemployed. 0/ /o Unemployed. Average per week. Milk. Dried Milk. 1933 (27th Feb.-31st Dec. ) 4,690 447 3,273 61.74 106.0 10.1 1934 5,370 389 3,106 53.9 101.3 7.3 1935 5,539 512 2,836 46.8 106.5 9.8 1936 5,947 550 2,589 39.8 114.4 10.6 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 87 Home Helps approved during 1936, many mothers attending the Clinic made their own arrangements to obtain the help of suitable women whose names were supplied by the Health Visitors. Sixteen applications were rejected by the Rota Committee. The demand for Home Helps has grown progressively during the past six years: 1931 (3), 1932 (12), 1933 (18), 1934 (21), 1935 (60) and 1936 (87). 8. INSTITUTIONAL TREATMENT, ETC. A total of 14 children were sent to Institutions under arrangements approved by your Committee. One mother was sent away for post-natal convalescent home treatment. 98 9. HOSPITAL ACCOMMODATION FOR CONFINEMENTS. The following numbers of confinements occurred at the Institutions specified (Walthamstow residents only):— Thorpe Coombe Maternity Home 660 Nursing Homes in Walthamstow 228 Mothers' Hospital, Clapton 59 Forest Gate Hospital 52 City of London Maternity Hospital 12 Other Hospitals, etc. 30 1,041 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, making a total for the Borough of 64 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 has made rapid progress during the year April 1st, 1936 to March 31st, 1937. "The accommodation being inadequate to house the increased Staff necessary at Carisbrooke Road, the Committee decided to open a branch home at Highams Park, and a flat was taken at 8, Castle Avenue. "The pressure remained acute and it was decided to rent the whole house at Castle Avenue and to place more Nurses there. "The Provident Scheme made very good progress, over 7,000 members being enrolled. "The collections are made by a splendid band of voluntary workers. "The Groups so collected represent all the activities of the Borough—Churches, Chapels, social and political. "In addition to the Groups the employees of certain firms subscribe and there are various street collectors. "The Staff at the end of March was as follows:— ''1 Queen's Superintendent; "1 Sister in Charge (Queen's); ''7 Queen's Nurses; "4 Nurse-Mid wives; ''3 temporary Nurses. 99 "New cases attended by Queen's Nurses for year 1936-37 939 "Visits paid by Queen's Nurses 19,011 "Cases attended for Borough Council 156 "Midwifery and Maternity Cases (1936-37):— "Attended in Home 202 "Attended on the District 165 "The rule of the Association in regard to the free nursing of necessitous cases remains the same. The Association must still depend on the generosity of Subscribers and Donors to help in this important part of the work. "Dr. Cecilia Cohen has again arranged a series of Post-Graduate Lectures for the Midwives of the Borough and surrounding districts, and these have been well attended. "The Association is very grateful to the Council for their generous grant." Following representations by the Association with regard to the inauguration of a provident scheme your Council in January, 1936, decided to replace the annual retaining fee of £10 per annum by a grant of £100. The Superintendent reports that during the period 1st January to 31st August, 1936, the visits specified below were paid by the nursing staff:— Nature of Disease No. Cases. No. Visits. Measles 41 535 Mumps 2 18 Pertussis 2 10 Erysipelas 1 26 Ophthalmia Neonatorum 4 51 Pneumonia 14 101 Pulmonary 3 22 Surgical 4 119 Abscess of Buttock 1 10 „ Breast 5 57 Pyrexia 2 27 Phlebitis 2 11 Hyperemesis Gravidarum 1 14 Totals 82 1,001 The ascertained cost per visit paid by the Queen's Institute of District Nursing, to which the Association is affiliated, is 1s. 7½d. On this basis, 1,001 visits amounts to £81 6s. 7½d., i.e., for eight months' work. 100 The revised scheme made under the Local Government Act, 1929, for the grant period 1937-42 allocates £55 5s. 0d. per annum to the Association in respect of Maternity and Child Welfare work and to replace the retaining fee of five guineas per annum in respect of a relief for the Council's Municipal Midwife. The numbers of midwifery and maternity patients stated to have been attended during the calendar year 1936 were as follows:— Residents. Non-Residents (in-patients only) Intern. Extern. Midwifery 136 105 22 Maternity 29 34 1 Totals 165 139 23 Dr. Cecilia Cohen, acting for the Association, kindly arranged the following post-graduate lectures for midwives in the Borough, an invitation to attend also being extended to the midwives in adjoining areas:— 1936. Nov. 5th "Ante- and Post-Natal Care" Dame Louise Mcilroy, D.B.E., M.D., D.Sc., F.C.O.G. „ 26th .. "Malnutrition and Abnormalities" E. E. Davis, Esq., M.S., F.R.C. S. 11. CONSULTANT OBSTETRICIANS. The services of a Consultant Obstetrician were requested by General Practitioners on five occasions (i .e., apart from the Maternity Home). The table below gives particulars in respect of each case:— No. Diagnosis. Where treated. Result. 1 Primary uterine inertia Admitted to Hospital Recovery. 2 Puerperal Sepsis „ „ Recovery. 3 Puerperal Pyrexia Nursing Home— transferred to own home Recovery. 4 Phlebitis Admitted to Hospital Recovery. (There were two consultations with regard to the last case.) 101 12. MIDWIVES ACTS, 1902-1926. Number of Notices of Intention to Practice, January, 1936 27 Number of Notices of Intention to Practice during 1936 25 Total 52 Number of Midwives ceasing practice during 1936 18 Number of Midwives practising at end of 1936 34 There was no change in the arrangements for the employment or subsidy of midwives by the Council. Dr. Sheppard has acted as Inspector of Midwives and has carried out the routine quarterly inspections, the results of which have been 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. Of the midwives in active practice during 1936, an average of 12 were employed at the Maternity Home and 8 by the Walthamstow District Nursing Association, leaving 14 independent midwives in active practice. Of these 14, one practised at her own registered maternity home, and the other 13 had the following number of cases:—83, 81, 43, 41, 34, 12, 4, 4, 2, 1, 1, 1 and nil within the Borough (midwifery and maternity). The following table shows the work done by midwives (including those employed at Thorpe Coombe Maternity Home) during 1936:— No. of confinements attended as a midwife 1,122 „ „ „ „ maternity nurse 194 „ medical aid notices sent 471 „ notifications of deaths 4 „ twin births notified 13 „ stillbirths notified 12 „ notifications of liability to be a source of infection 4 „ laying out a dead body 1 „ „ „ artificial feeding 1 „ „ „ disinfection 4 The table includes the following numbers with regard to work done at Thorpe Coombe:— Midwifery cases, 584 in Home and 35 on District. Maternity cases, 76 in Home and 4 on District. Medical Aid Notices, 365. The percentages of medical aid notices were:— Total, 41.8. Maternity Home, 58.5. Domiciliary midwives, 21.0. 102 The conditions for which medical aid was summoned by midwives in domiciliary practice have been summarised and were as follows:— For complications during pregnancy Albuminuria 3 Diagnosis of presentation 1 Contracted pelvis 1 Hydramnios 1 Total 6 For complications during labour:— Delayed 1st and 2nd stage 24 Post-partum haemorrhage 9 Perineal laceration 21 Ante-partum haemorrhage 6 Malpresentation 3 Twins 2 Retained placenta 3 Pyrexia 2 Abdominal pain 2 Other conditions 14 Total 86 For complications in regard to the infant:— Prematurity and feebleness 8 Anencephaly 1 Asphyxia 1 Convulsions 1 Infant death 1 Injury 1 Haemorrhage 1 Total 14 Details of medical aid notices issued by midwives employed at Thorpe Coombe are given in the Maternity Home report. Midwives resident in Walthamstow also attended 155 midwifery patients and 72 maternity patients who were resident outside the Borough. Compensation for Loss of Cases.—During the year the Council decided to compensate midwives by the payment of 10s. per confinement lost by reason of the reference of the patient from the Council's Ante-Natal Clinic to hospital on account of any abnormality. Four claims for compensation were made during 1936. The conditions requiring hospital treatment were: (a) severe varicose veins, (b) syphilis, (c) breech presentation, (d) toxaemia. Assistance re Midwives' Fees.—In order to endeavour to eliminate the handywoman by the provision of a certified midwife acting as a maternity nurse, the Council adopted a scale of fees for the assessment of any application so received. The scale adopted 103 was similar to the one in use for the assessment of medical aid fees under the Midwives Acts. One application was received during 1936. Nursing Homes Registration Act, 1927.—See Public Health Section of the Report. 13. PUERPERAL FEVER AND PYREXIA. Thirty-five cases of Puerperal Fever and Pyrexia were notified during 1936. The notifications were received from the following sources:—Maternity Home, 25; Hospitals outside the area, 3 (in 2 of these the confinements occurred in Walthamstow): and General Practitioners, 7. The puerperal fever and pyrexia rate for 1936 was 19.78 per 1,000 births, and the mortality due to puerperal sepsis was 3.0 per cent. of the cases of puerperal fever and pyrexia notified. The Registrar-General has issued the following rates with regard to the notification of Puerperal Fever and Pyrexia. The Walthamstow rates are set out in comparison:— Area Per 1000 live and still births. Puerperal Fever. Puerperal Pyrexia. Total. England and Wales 3.27 9.64 12.91 122 County Boroughs and Great Towns, including London 3.46 9.52 12.98 143 Smaller Towns (25-50,000 population) 2.80 7.57 10.37 London Administrative County 3.03 11.15 14.18 Walthamstow 2.82 16.96 19.78 Of the 35 notifications (Puerperal Fever, 5, and Puerperal Pyrexia, 30) received during 1936, 25 (all Puerperal Pyrexia) were from the Maternity Home. Many of the cases at the Maternity Home would not have been notified if temperatures had been taken twice daily instead of four-hourly. It can be claimed that a large number of the notifications are due rather to more accurate notification than to an excess in the incidence of puerperal morbidity when compared to other areas. The notifications and rates for Walthamstow for the past six years have been as follows:— 104 Per 1000 Total Births (live and still). Year. Puerperal Fever Puerperal Pyrexia Total No. Rate No. Kate No. Rate 1936 5 2.82 30 16.96 35 19.78 1935 4 2.31 31 17.95 35 20.26 1934 13 7.31 28 15.78 41 23.09 1933 8 4.61 22 12.61 30 17.22 1932 6 3.39 20 11.29 26 14.68 1931 11 5.43 30 14.90 41 20.33 PUERPERAL FEVER AND PYREXIA INCIDENCE, 1936 (Excluding Maternity Home). No. of Case. Fever or Pyrexia. Date of Notification. Date Notification Received. Age. Ward. Facilities requisitioned as per notification. Date of Birth or Miscarriage. Onset of Pyrexia. Date removed to Hospital. Remarks. 1 Fever 21.1.36 22.1.36 26 Hoe Street All facilities available 9.1.36 11.1.36 15.1.36 Notified from Hospital. 2 Fever 9.3.36 10.3.36 26 Hoe Street „ „ 3.3.36 6.3.36 8.3.36 Due to inverted uterus. Notified from Hospital. 3 Pyrexia 10.3.36 14.3.36 21 Wood Street „ „ 28.2.36 8.3.36 Not removed Due to Measles. 4 Fever 22.4.36 23.4.36 28 St. James Street Second opinion and removal to Hospital 18.4.36 19.4.36 21.4.36 5 Pyrexia 4.9.36 5.9.36 29 High Street Removal to Hospital 28.8.36 3.9.36 4.9.36 Due to Sapraemia. 6 Fever 15.9.36 16.9.36 32 Hale End All facilities available 12.9.36 14.9.36 15.9.36 Due to prolonged labour and poor physique. 7 Pyrexia 23.9.36 24.9.36 30 Hoe Street „ „ 7.9.36 22.9.36 Not removed Due to Mastitis. 8 Pyrexia 16.11.36 18.11.36 29 Hoe Street „ „ 7.11.36 9.11.36 In Hospital Due to urinary infection. Notified from Hospital. 9 Fever 5.12.36 7.12.36 26 Hoe Street „ „ 23.11.36 28.11.36 do. Due to Post-Partum Haemorrhage. Notified from Hospital. 10 Pyrexia 23.12.36 24.12.36 42 Wood Street Second opinion 8.12.36 24.12.36 24.12.36 Due to Phlebitis. 105 106 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. 1936 2 — — 1 1 — — 1935 1 — — 1 — — — Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1936 1 1 1 - — 1 enteritis 1935 1 — 1 - — — 15. MATERNAL MORTALITY. During 1936 a total of three maternal deaths was investigated for the completion of inquiry forms. Particulars relating to the three deaths are given in the accompanving table. The following table shows the maternal mortality rates for 1936 (calculated on three deaths):— 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 1 2 3 0.58 1.16 1.74 1.40 2.41 3.81 Live and Stillbirths, 1,769 1 2 3 0.56 1.13 1.69 1.34 2.31 3.65 DEATHS DUE TO PREGNANCY AND CHILDBEARING AND ASSOCIATED THEREWITH. Case No. Date of Death. Certified Cause of Death, and Classification. Age. Ward. Circumstances. Pregnancy. Ante-Natal Care. Physical Condition. Date of Confinement or Abortion. Doctor called. Admission to Hospital. Prev. Duration of Doctor. Midwife. 1 27.3.36 Post-partum Shock following manual removal of retained placenta 29 H.H. Comfortable Nil 40 weeks Yes Yes Hyperpiesis 27.3.36 27.3.36 In Hospital 2 3.4.36 Eclampsia 41 J. Poor 12 28 weeks ( ?) Nil Nil (?) Undelivered 3.4.36 3.4.36 3 14.7.36 Puerperal Septicaemia 27 H.E. Poor Nil 40 weeks Yes Yes (?) 3.7.36 3.7.36 In Hospital Remarks:—1. Adherent placenta. Hyperpiesis considered to be a contributory cause of death. 2, General Practitioner called to see patient during a severe fit. Immediate removal to Hospital. Urine loaded with albumin. Death in 5 hours. 3. Pyrexia up to 10 days before delivery. Normal labour. Lethargia following delivery. Bacteriological investigation negative. 107 108 The following table sets out the maternal mortality, stillbirth and neo-natal death-rates for the past five years. The maternal mortality rates for the past five years have been as follows:— Year. Total Births Registered. Deaths. Bates per 1,000 Births. Puerperal Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal Causes. Total. 1936 1,769 1 2 3 0.56 1.13 1.69 1935 1,727 3 2 5 1.73 1.16 2.89 1934 1,775 6 5 11 3.37 2.81 6.18 1933 1,735 7 2 9 4.0 1.1 5.1 1932 1,871 2 6 8 1.0 3.2 4.2 The normal expectation is that these three rates should have some correlation:— Rate (per 1,000 live births). 1936. 1935. 1934. 1933. 1932. Maternal Mortality 1.74 3.00 6.40 5.39 4.47 Stillbirths 31.4 34.1 33.8 37.4 43.8 Neo-Natal Deaths 16.9 21.5 20.4 29.3 30.8 I. THORPE COOMBE MATERNITY HOME. Alterations and Extensions.—No alterations of major character were carried out. The extensions specified below have been approved by the Minister of Health, and tenders will shortly be invited:— Two 4-bed wards attached to existing block. Two nurseries, each for 4 infants. Two sick nurseries, each for 1 infant. Two milk preparation rooms. New 6-bed isolation (or post-natal) block with single wards and separate quarters for nurses on 1st floor. New ante-natal block, laboratory, etc. Extension of existing nurses' home. 109 The total accommodation of the Home when these extensions are completed will be:— Lying-in beds, 47. Isolation beds, 6. Total, 53. Staff.—An additional Staff Nurse and an additional part-time cleaner were authorised during the year. General.—(a) Maternal Mortality.—Two maternal deaths (for which clinical particulars are given in the report) occurred amongst patients delivered in the Home. One occurred after transfer. The following table sets out the position since the Home was opened:— Year. Deliveries. Live Births. Maternal Deaths. Cause. 1936 660 665 2 Adherent placenta Puerperal septicaemia (a) 1935 646 631 2 Eclampsia (b) Non-malignant tumour (c) 1934 229 225 1 Puerperal eclampsia Totals 1,535 1,521 5* *Representing a rate of 3.26 per 1,000 deliveries and 3.29 per 1,000 live births and not excluding (c), which is excluded by the Registrar-General and classified as associated with pregnancy and child-bearing. Case (a) died after transfer to another hospital, and case (b) was an unbooked emergency admission from another area. Excluding cases (a) and (c), the net maternal mortality rate since the Home opened was 1.97 per 1,000 live births. (b) Form M .C .W. 96A (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 cases admitted during the year—769 (including ante- and post-natal cases). 4. Average duration of stay—13.4 days. 5. Number of cases delivered by:— (a) Midwives—584. (b) Doctors—76. 6. Number of cases in which medical assistance was sought by a midwife in emergency—365. 7. Number of cases notified as:— (a) Puerperal fever—Nil. (b) Puerperal pyrexia—25. 110 8. Number of cases of pemphigus neonatorum—Nil. 9. Number of infants not entirely breast-fed while in the Institution—95. 10. Number of cases notified as ophthalmia neonatorum—Nil. 11. (a) Number of maternal deaths—1. (b) Cause of death in each case—Post-partum shock following manual removal of retained placenta. 12. (a) Number of infant deaths:— (i) Stillborn—22. (ii) Within 10 days of birth—8 (amended from 7). (b) Cause of death in each case, and results of post-mortem examination (if obtainable)—See Clinical Report. The stillbirth rate was 33.1 per 1,000 live births, and the neo-natal mortality within 10 days of birth was 12.0 per 1,000 live births. (c) Occupation of Beds.—The average daily occupation of beds was as follows:— January 32.4 February 33.3 March 31.3 April 30.8 May 32.6 June 30.0 July 16.4 August 20.6 September 27.6 October 27.5 November 31.4 December 24.0 The average for the whole year was equal to 73 per cent. beds occupied (based on 39 beds). (d) Financial.—Costing returns in respect of Maternity Homes are required by the Ministry of Health for each financial year. The return for the year ending 31st March, 1936, is as follows:— Average number of beds 35 Percentage of beds occupied 82.0 Number of patients 793 Average stay 13.3 days Average number of nursing staff 21 Average number of resident staff 32 111 Average cost per patient per week (in shillings)— Salaries:— s. d. Medical 9 0.13 Nursing 22 0.02 Other staff 25 1.37 Provisions 21 5.34 Drugs and appliances 10 1.20 Fuel, light and laundry 19 8.80 Domestic renewals 14 5.63 Structural additions, etc. 6 11.24 Transport 0 1.25 Rent, rates, taxes, etc. 2 0.11 Loan charges 33 4.32 Other expenditure 6 3.77 Totals—Including loan charges 170 7.18 Excluding loan charges 137 2.86 (e) Closure.—Following a small series of cases of puerperal pyrexia in July, 1936, it was decided to close the Home to further admission between 15th and 26th July. Alternative accommodation was arranged for those patients who could not be admitted, and the Home was re-opened after cleansing and disinfection. (f) Research.—1. Dame Louise Mcilroy, Consultant Obstetrician to the Ante-Natal Clinic, and Dr. Helen Rodway, M.C.O.G., Resident Medical Officer, have utilised material obtained during the ante-natal supervision of patients at the Home, together with that obtained from another maternity unit, in the compilation of a paper on the weight changes during and after pregnancy and published in the Journal of Obstetrics and Gynaecology (Vol. 44, No. 2). 2. Dr. Helen Rodway is co-operating with the investigation initiated by the People's League of Health into the deficiency in diet in maternal mortality and morbidity. District Maternity and Midwifery.—A total of 39 cases were attended by the District Sister working from the Maternity Home. 35 were midwifery cases and 4 were maternity cases. The following very full clinical report has been compiled by Dr. Helen Rodway, M.C.O.G., Resident Medical Officer. 112 THORPE COOMBE MATERNITY HOME CLINICAL REPORT. The statistical detail has been arranged, as far as possible, in the form recommended by the Sub-Committee of the Section of Obstetrics and Gynaecology of the Royal Society of Medicine for the unification of Maternity Hospital Reports. Statistics for the years 1934 and 1935 are included in the report for comparison with the present year. Ante-Natal Supervision. Number of Ante-Natal Clinics held:— 1936. 1935. 1934. Consultants' Clinics 12 21 39 Doctors' Clinics 117 125 — Midwives' Clinics:— (a) Booking 202 121 — (b) Examination 150 104 165 Total 481 371 204 Number of expectant mothers who attended the Ante-Natal Clinics:— (i) Primiparae 434 457 187 (ii) Multiparae 257 305 184 Total 691 762 371 Total attendances made:— (a) New patients 691 762 371 (b) Old patients 5,354 4,543 1,745 Total 6,045 5,305 2,116 Average attendance per session:— (a) Booking Clinic 3.4 14.3 12.8 (b) Examination Clinic 19.1 Number of patients admitted to the Maternity Home during the antenatal period 137 97 29 113 Summary of Patients. Albuminuria, hyperpiesis and oedema 40 Lumbo-sacral pain 4 Miscarriage 1 Hyperemesis 2 Threatened miscarriage 3 Hyperemesis and Albuminuria 2 Prolapse 1 Observation following a fall 1 Hydramnios 4 Pyelitis 6 Observation—sub-acute appendicitis 1 Phlebitis 1 Cardiac Disease 6 Patients admitted for observation and discharged because not in labour 49 Premature rupture of membranes 3 Ante-partum haemorrhage 5 Debility; anaemia 8 Total 137 1936. 1935. 1934. Number of confinements:— (i) Primiparae 417 380 112 (ii) Multiparae 243 266 117 Total 660 646 229 Number of patients delivered by:— (i) a doctor 76 82 54 (ii) a midwife 584 564 195 Total 660 646 229 Number of patients admitted in the post-natal period 1 4 - Total number of patients admitted:— (i) Booked patients 755 735 258 (ii) Unbooked patients 14 12 — Total 769 747 258 Private Practitioners' booked cases 33 Reasons for the admission of unbooked patients:— Pre-eclamptic toxaemia 4 Obstructed labour 1 Hyperemesis 1 Extended breech 1 Hydramnios; toxaemia 1 Arrangement for confinement not made 2 Ante-partum haemorrhage 2 Disproportion 2 Total 14 114 The apparent anomaly between the number of admissions during the ante-natal period and those for confinement arises because one patient is included in both categories in some cases. Numerical Summary of all Cases. (i) Presentations during Labour. Primiparae. Multiparae. Total No. of Cases. Vertex left occipito-anterior 240 157 397 Vertex right occipito-anterior 143 64 207 Vertex right occipito-posterior 12 3 15 Vertex left occipito-posterior 4 3 7 Breech 21 15 36 Shoulder — 1 1 Face 1 — 1 Unknown — 1 1 Total 421 244 665 The above includes the presentations of five cases of twins. (ii) Complications. Albuminuria, hyperpiesis, oedema 40 Cardiac disease Ante-partum 6 Hyperemesis 2 rhage Premature rupture of 5 Hyperemesis and albuminuria 2 membranes 3 Hydramnios 4 Prolapse of cord 1 Pyelitis 6 Post-partum Haemorrhage 12 Phlebitis (ante-natal, 1; post-natal,1) 2 Puerperal pyrexia 25 Total 108 (iii) Operations. Application of forceps 36 Induction of premature labour:— Caesarean Section 1 Manual removal of placenta 6 (i) Medical 5 (ii) Surgical 5 Perineal suture 275 Total 328 (iv) Consultations. (i) Disproportion; failed forceps, pyrexia. Caesarean Section (2 visits). (ii) Pre-eclamptic toxaemia. 115 (iii) Pre-eclamptic toxaemia. Surgical induction of labour. (iv) Pyrexia (2 cases). (v) Hyperpiesis; retinitis. Ophthalmic consultation. (vi) Pyrexia of infant. A total of eight visits was paid to the Maternity Home for the purpose of consultation. (v) Medical Aid Notices.—In 365 cases medical aid was sought by midwives in the Home. Treatment was given by the Resident Medical Officer or the relieving Medical Officer. For complications during pregnancy:— Abortion 1 Ante-partum haemorrhage 2 3 For complications during labour:— Breech presentation 21 Retained placenta 4 Face presentation 1 Cardiac failure 1 Shoulder presentation 1 Prolapsed cord 1 Obstructed labour 2 Pre-eclampsia; Hyperpiesis 2 Ante-partum haemorrhage 3 Perineal and vaginal laceration 268 Delayed 1st and 2nd stage 32 Cervical laceration 1 Delay in 3rd stage 8 345 For complications in regard to the infant:— Asphyxia 6 Haemorrhage from circumcision 1 Feeble condition 6 Stillbirths 2 Pyrexia 1 Convulsions 1 17 Grand Total, 365. ALBUMINURIA. Analysis of Cases.—Every patient attending the Ante-Natal Clinic has the urine tested, the blood pressure recorded and the weight taken at each visit. Where there is the slightest albuminuria, hypertension or excessive gain in weight, the patient is seen twice weekly. If the condition does not improve, the patient is admitted to the Maternity Home. It is of interest to note that in some cases a marked increase in weight due to an occult oedema may be the earliest sign of pregnancy toxaemia. 116 Booked. Unbooked. Total. Number of patients admitted 30 4 34 Number of these patients confined in the Home 28 4 32 Number of infants 30 4 34 (this includes two cases of twins) Number of stillbirths 1 1 2 Foetal mortality 3.3% 2.5% 5.8% Termination of pregnancy:— Spontaneous 24 2 26 Medical induction 2 — 2 Surgical induction 2 2 4 CASES OF ALBUMINURIA ADMITTED FOR TREATMENT. Booked Cases. Reg. No. Case No. Gravida. Age of patient. Past History. Onset of Symptoms. Headaches. Eye Symptoms. Oedema. Albumin. Maximum Blood Pressure. Blood Urea. No. of days in Home before labour or discharge. Maturity of child when delivered. Type of Delivery. Result. M. C. Years. Weeks. Percentage. Weeks. 1071 1 1 25 — 34 Yes — Yes Heavy cloud 170/100 29 mgms. 18 38 Spontaneous L. L. 1106 2 1 28 — 32 Yes — — Trace 170/90 28 „ 12 40 „ L. L. 1167 3 3 31 — 36 - — Yes Trace 180/110 27 „ 7 40 „ L. L. 1193 4 1 31 — 38 — — Yes Trace 160/110 - 7 40 „ L. L. 1199 5 2 31 — 34 — — Yes Cloud 180/90 30 mgms. 14 40 „ L. L. 1262 6 5 44 — 36 Yes — Yes Cloud 142/98 21 „ 6 40 „ L. L. 1323 7 6 35 — 38 Yes Yes - Trace 162/112 21 „ 4 40 „ L. L. 1174 8 3 36 — 39 Yes — — Faint trace 160/90 22 ,, 7 40 „ L. L. 1320 9 1 23 — 34 — — Yes Cloud 160/110 28.5 „ 11 38 „ L. L. 16 1390 10 2 35 — 36 - — Yes Trace 162/100 33 „ 9 40 „ L. L. 1391 11 1 30 — 38 — — Yes Trace 152/100 — 12 40 „ L. L. 1356 12 1 28 — 37 Yes — Yes Trace 152/100 23 „ 4 40 „ L. L. 1329 13 1 26 — 36 Yes — Yes Cloud 186/110 18 „ 16 40 „ L. L. 7 L. 1432 14 1 26 - 37 - - - Trace 144/90 30 ,, 2 40 „ L. L. 1528 15 2 34 — 33 — — Yes Trace 152/86 16.5 „ 9 40 „ L. L. 1605 16 1 28 — 38 Yes — Yes Cloud 160/90 21.0 „ 10 40 „ L. L. 1475 17 2 30 (a) Scarlet Fever; Hyperpiesis Yes Yes Yes L. (b) Albuminuria and throughout Trace 265/160 24.0 „ 14 Hyperpiesis last pregnancy (once only) 16.5 ,, 11 38 „ L. L. week of 1st pregnancy 17 1589 18 1 38 — 34 — — — Trace 154/100 — 5 40 „ L. L. 1693 19 1 32 — 36 — — — Cloud 164/94 — 7 40 „ L. L. 1686 20 1 30 — 32 Yes Yes Yes Cloud 200/100 33 „ 20 38 „ L. L. 1809 21 1 30 — 37 Yes — Yes Trace 180/110 15 „ 9 38 L. L. 1763 22 1 29 Scarlet Fever 39 Yes - Yes Trace 150/102 17 „ 3 40 „ L. L. 1762 23 1 39 — 36 Yes — Yes Trace 160/100 20 „ 3 36 L. L. 1685 24 1 28 Scarlet Fever 38 — Yes Cloud 19 /100 27 „ 2 40 L. L. 1611 25 1 30 — 40 - — - Trace 158/90 1 40 „ L. L. 1178 26 1 32 — 34 Yes Yes Yes Cloud 190/110 28 „ 27 38 L. S.B. 1440 27 2 32 — 34 - - - Trace 144/94 22 „ 10 40 L. L. 1351 28 1 30 Scarlet Fever 32 Yes Yes Cloud 152/110 28 „ 30 36 „ L. L. 1441 29 1 28 — 34 Yes — — Cloud 158/110 42 „ 15 Delivered elsewhere L. L. 33 „ 1345 30 1 43 — 36 Yes — Yes Trace 175/102 31.5 8 „ „ L. L. Remarks—Case 2. Medical induction. Case 13. Surgical induction. Twins. Case 16. Twins. Case 17. Unsuccessful medical induction. One fit during third stage. Case 26. Private case. Surgical induction. Unbooked Cases. Reg. No. Case No. Gravida. Age of patient. Past History. Onset of Symptoms. Headaches. Eye Symptoms. Oedema. Albumin. Maximum Blood Pressure. Blood Urea. No. of days in Home before labour or discharge. Maturity of child when delivered. Type of Delivery. Result. M. C. Years. Weeks. Percentage. Weeks. 1272 1 2 34 — 38 Yes — — Trace 138/80 54 mgms. 6 40 Spontaneous L. L. 26 „ 1412 2 1 24 - 34 Yes - Yes Cloud 194/110 33 „ 12 36 „ L. L. 1632 3 1 34 — 38 Yes - Yes Cloud 176/96 — 5 40 „ L. L. 1680 4 5 29 Kidney trouble in last pregnancy 32 Yes - Yes Solid 130/90 28 „ 1 32 „ L. S.B. Remarks—Case 1. Hyperemesis also. Case 2. Surgical induction. Case 4. (a) Concealed haemorrhage. (6) Surgical induction. 117 An attempt is being made to follow up all cases of albuminuria admitted to the Maternity Home. The following summary shows the condition of these patients when seen at the Post-Natal Clinic:— Number of patients followed up (56 per cent. of total treated):— Primiparae. Multiparae. All Cases. Number of patients with hyperpiesis 4 4 8 Number of patients with albuminuria 1 - 1 Number of patients with albuminuria and hyperpiesis 2 - 2 Number of patients apparently in good health 7 1 8 Totals 14 5 19 Minimum interval since confinement—6 weeks. Maximum interval since confinement—13 months. ANTE-PARTUM HAEMORRHAGE. Number of cases:— Booked. Unbooked. (a) Accidental Ante-Partum Haemorrhage 1 1 (b) Placenta Praevia 1 2 Total 2 3 Number of stillbirths, 1. ACCIDENTAL ANTE-PARTUM HAEMORRHAGE. Reg. No. Case No. Age of Patient. Gravida. Maturity. Condition on Admission. Treatment. Result. Mother. Child. 1674 1 3 30 36 weeks Good Morphine gr. ¼ L. L. 1680 2 5 29 32 „ Very poor. Urine: Solid with albumin . Morphine gr. ¼ Calc. gluconnate alkalies. L. S.B. Rupture of membranes after six hours Case 2 was an emergency admitted on account of anuria. Concealed haemorrhage. 118 PLACENTA PRAEVIA. Reg. No. Case No. Gravida. Age of Patient. Maturity. Condition on Admission. Treatment. Result. Variety. Mother. Child. 1070 1 9 38 40 weeks Good Thymophysin for induction of labour L. L. Marginal 1164 2 6 39 32 „ Good Thymophysin. Scalp forceps L. L. Infant lived six days 1308 3 2 35 38 „ Good Quinine and Thymophysin L. L. Cases 1 and 3 were emergency admissions. TREATMENT AND RESULT OF PERSISTENT POSTERIOR POSITION OF THE VERTEX. Method of Delivery. Number of Cases. All Cases. Mother. Results. Primiparae. Multiparae. Child. L. L. S.B. I. D. Spontaneous delivery Face to pubes 5 3 8 8 7 1 — Manual rotationForceps delivery 11 3 14 14 12 2 — Total 16 6 22 22 19 3 — Foetal mortality, 13.6 per cent. Maternal mortality, nil. 119 PERSISTENT POSTERIOR POSITION OF VERTEX. Reg. No. Case No. Gravida. Age of Patient. Method of Treatment. Duration of Labour. Weight Infant. Result. 1st stage. 2nd stage. 3rd stage. M. C. h m h m h m. lb. oz. 1069 1 1 21 Spontaneous delivery. Face to pubes 9 30 2 20 0 7 6 7 L. L. 1124 2 1 34 Manual rotation—Forceps delivery 72 + 2 10 0 35 6 11 L. L. 1143 3 1 35 „ „ „ „ 27 + - - 0 20 7 12 L. L. 1145 4 1 27 Spontaneous delivery. Face to pubes 12 15 4 0 0 5 7 11 L. L. 1191 5 1 23 Manual rotation—Forceps delivery 31 0 3 45 0 20 8 2 L. L. 1201 6 3 30 Spontaneous delivery. Face to pubes 11 30 0 15 0 5 6 5 L. L. 1283 7 1 23 Manual rotation—Forceps delivery 39 0 3 15 0 15 7 13 L. L. 1288 8 2 33 „ „ „ „ 33 0 1 45 0 45 6 15 L. L. 1353 9 1 28 „ „ „ „ 30 15 1 35 0 13 6 8 L. L. 1568 10 1 28 „ „ „ „ - - - - 0 25 7 15 L. L. 1585 11 2 22 „„ „ „ 11 30 3 20 0 30 8 2 L. L. 1613 12 1 28 „ „ „ „ 29 0 3 20 0 20 10 1 L. L. 1702 13 1 26 Spontaneous delivery. Face to pubes 9 0 2 55 0 20 6 15 L. L. 1746 14 1 33 Manual rotation—Forceps delivery - - - - 0 20 10 4 L. S.B. 1228 15 1 25 Spontaneous delivery. Face to pubes - - 3 15 0 30 Not weighed L. S.B. 1605 16 1 28 „ „ „ „ 9 30 3 50 2 55 4 8½ L. L. 1070 17 9 38 „ „ „ „ 7 30 1 5 0 20 8 1 L. L. 1456 18 1 23 Manual rotation—Forceps delivery - - - - 0 15 8 14 L. L. 1149 19 1 19 „ „ „ „ 77 15 3 5+ 0 15 6 3 L. L. 1563 20 1 28 „ „ „ „ 21 30 0 25 0 10 7 9 L. L. 1754 21 2 29 „ „ „ „ 17 15 1 30 0 20 10 9 L. S.B. 1399 22 3 37 Spontaneous delivery. Face to pubes 12 30 1 20 0 25 10 4 L. L. Remarks:— Case 4.—Post-partum Haemorrhage. „ 8.—First weighed on sixth day. „ 15.—First infant of twins. „ 16.—Second infant of twins. Manual removal of placenta. 120 PRIMARY BREECH PRESENTATION. Version was not attempted in any one of the following cases. The complicated cases are those in which there was an additional risk to the life of the foetus owing to an abnormality of the maternal condition. Uncomplicated:— Primiparae. Multiparas. Total. Number of breech deliveries 18 11 29 Number of stillbirths and infant deaths 1 - 1 Foetal mortality 5.5% — 3.3% Complicated:— Number of breech deliveries 3 4 7 Number of stillbirths and infant deaths 2 1 3 (1) Macerated foetus. (2) Anencephalie. (3) 28 weeks infant multiple mal¬formations Foetal mortality 66% 25% 42.8% Total breech deliveries, 36. There was no maternal death. PRIMARY BREECH PRESENTATIONS. Reg. No. Case No. Gravida. Age of Patient. Maturity. Arms. Legs. Method of Delivery. Weight of Infant. Result. M. C. weeks. lbs. ozs. 1045 1 1 29 36 Flexed Extended Spontaneous 4 0 L. L. 1054 2 2 26 38 „ „ Flexed „ „ „ „ 5 11 L. L. 1063 3 2 28 40 „ „ Extended „ „ „ 6 6 L. L. 1079 4 1 20 38 „ „ Flexed „ „ „ 5 15 L. L. 1077 5 1 21 40 „ „ Extended „ „ „ 8 4 L. L. 1147 6 4 29 38 „ „ Flexed „ „ „ 4 5 L. L. 1237 7 1 19 40 Extended Extended „ „ „ 6 10 L. L. 1238 8 2 30 38 Flexed Flexed „ „ „ 5 2 L. L. 1241 9 2 24 40 Extended Extended „ „ „ 6 7 L. L. 1301 10 1 28 40 „ „ Legs and arms brought down 6 0 L. L. 1331 11 2 28 40 Flexed „ Flexed „ Spontaneous „ „ 5 10 L. L. 1398 12 1 25 40 „ „ Extended „ „ „ 6 6 L. L. 1417 13 1 32 40 One arm extended Flexed Assisted 5 11¼ L. L. 1416 14 1 26 40 Flexed Extended Spontaneous 6 6 L. L. 1427 15 1 28 40 „ „ Flexed „ 8 13 L. L. 1437 16 1 30 40 Extended Extended „ 8 4 L. L. 1436 17 1 27 40 Flexed Flexed 7 5 L. L. 1447 18 1 40 40 Extended Extended Assisted Not weighed L. S.B. 1790 19 1 28 40 Flexed „ Spontaneous 6 0 L. L. 1469 20 2 35 40 „ Flexed „ 6 15 L. L. 1744 21 1 16 38 „ Extended „ 6 0 L. L. 1737 22 1 21 40 Extended „ Assisted 8 4 L. L. 1659 23 1 25 40 „ „ 7 4 L. L. 1653 24 3 21 40 Flexed Flexed Spontaneous 7 9 L. L. 1639 25 2 36 40 „ Extended „ 6 8 L. L. 1604 26 2 26 40 „ Flexed „ 9 9 L. L. 1557 27 1 27 40 „ „ „ 6 11 L. L. 1454 28 2 27 40 „ „ „ 8 4 L. L. 1531 29 1 24 36 Extended Extended „ 3 7 L. L. 121 * Delay in birth of head. Multiple malformations. COMPLICATED BREECH DELIVERY. Reg. No. Case No. Gravida. Age of Patient. Maturity. Complication. Method of Delivery. Weight of Infant. Result. Mother. Child. weeks. lbs. ozs. 1004 1 2 38 32 Albuminuria Spontaneous Not weighed L. Macerated s.B. 1214 2 1 24 28 Premature labour. Hydramnios „ 1 15 L. Multiple malformations. I.D. 1262 3 5 44 40 Albuminuria „ 7 2 L. L. 1426 4 1 26 40 Albuminuria. Twins— both breech presentations „ 4 5 8 2 L. l. L. 1478 5 2 35 40 Second of twins „ 5 10 L. L. 1599 6 1 21 40 Hydramnios Anencephalic „ Not weighed L. s.B. 122 123 FORCEPS DELIVERY. Forceps were applied 36 times when the vertex was presenting; details of each case are given in the following tables. Number of stillbirths and infant deaths, 5. Foetal mortality, 13.6 per cent. Maternal mortality, nil. Forceps rate for all cases, 5.4 per cent. Analysis of Forceps Cases. Number of Cases. Primiparae, Multiparae. All cases. Prolonged second stage 10 2 12 Delay in second stage 7 — 7 Persistent occipito-posterior position 10 3 13 Prolapse of cord — 1 1 Maternal distress 1 — 1 Cardiac disease — 1 1 Inertia 1 — 1 Totals 29 7 36 124 TWINS. Number of cases, 5—Primiparae, 4; Multiparae, 1. Of the 10 infants, one was stillborn and two died within a few hours of birth. Two of the cases were complicated by albuminuria and hyperpiesis during pregnancy. Reg. No. Case No. Age of Patient. Gravida. Maturity. Presentation and Position. Sex. Weight. Type. Result. 1st. 2nd. 1st. 2nd. 1st. 2nd. Mother. Infants. weeks. lbs. ozs. lbs. ozs. 1st. 2nd. 1228 1 25 1 38 V.R.O.P. V.L.O.A. F. F. Not weighed 4 11 Uniovular L. S.B. L. 1426 2 26 1 40 B.R.S.A. B.R.S.A. F. M. 4 8 5 2 Binovular L. L. L. 1478 3 35 2 40 V.L.O.A. B.R.S.P. M. M. 4 8 5 10 Uniovular L. L. L. 1539 4 29 1 30 V.R.O.A. V.L.O.A. F. F. 2 10 2 8 Uniovular L. I. D. I. D. 1605 5 28 1 28 V.L.O.A. V.L.O.P. M. F. 4 15½ 4 8½ Binovular L. L. L. Remarks—Case 1. Puerperal pyrexia. Case 2. Puerperal pyrexia. Case 5. (a) Manual removal of placenta. (b) Puerperal pyrexia. CAESAREAN SECTION. Reg. No. Age of Patient. Gravida. Indication. Duration of Labour. Weight of Infant. Result. Remarks. 1st stage. 2nd stage. 3rd stage. Mother. Child. 1134 24 1 Disproportion hours. — — lbs. ozs. L. S.B. Failed forceps. Puerperal pyrexia. 48 + 8 14¼ FORCEPS DELIVERY. Reg. No. Case No. Gravida. Age of Patient. Indication. Duration of Labour Weight of Infant. Result. 1st stage. 2nd stage. 3rd stage. M. C. h m h m h m lb. oz. 1005 1 1 38 Inertia 94 0 2 10 0 20 Not weighed L. S.B. 1021 2 2 32 Prolapse of cord 4 15 0 15 0 10 6 10½ L. L. 1015 3 3 27 Prolonged second stage 68 0 3 30 0 10 9 13 L. L. 1124 4 1 34 Persistent occipito posterior position 72 12 2 10 0 35 6 11 L. L. 1149 5 1 19 „ „ „ „ 77 15 3 5 + 0 15 6 3 L. L. 1143 6 1 35 „ „ „ „ — — 0 20 7 12 L. L. 1168 7 1 29 Prolonged second stage 15 5 4 0 0 5 6 14 L. L. 1169 8 1 34 „ „ „ 14 0 4 5 0 15 6 7 L. L. 1176 9 1 30 Maternal distress 5 55 0 0 0 15 8 6 L. L. 1191 10 1 23 Persistent occipito posterior position 31 0 3 45 0 20 8 2 L. L. 1209 11 1 33 Delay in progress 44 25 2 17 0 7 7 9 L. L. 1220 12 1 21 Prolonged second stage 24 30 3 20 0 5 7 15 L. L. 1234 13 1 28 „ „ „ 10 20 3 5 0 15 5 11 L. L. 1257 14 1 30 Delay in second stage — — 0 30 7 12 L. S.B. 1258 15 2 37 Cardiac disease 33 0 1 30 0 15 9 0 L. L. 1283 16 1 23 Persistent occipito posterior position 39 0 3 15 0 15 7 13 L. L. 1205 17 2 33 „ „ „ „ 33 0 1 45 0 45 6 15 L. L. 1342 18 1 28 Delay in second stage — — 0 25 6 14 L. L. 1330 19 1 29 Prolonged second stage 12 45 3 15 0 15 8 2 L. L. 1337 20 1 30 Delay in second stage 9 0 2 20 0 20 6 4 L. L. 1404 21 1 28 Prolonged second stage 24 0 3 40 0 15 7 10 L. L. 1563 22 1 28 Persistent occipito posterior position 21 30 0 25 0 10 7 9 L. L. 1569 23 1 22 Prolonged second stage 16 45 3 40 + 0 30 7 4 L. L. 1613 24 1 28 Persistent occipito posterior position 29 0 3 20 0 20 10 1 L. L. 1721 25 1 28 Delay in second stage — — 0 10 7 8 L. L. 1754 26 2 29 Persistent occipito posterior position — — 0 20 10 9 L. S.B. 1760 27 1 31 Prolonged second stage 12 0 ?4 30 0 25 7 7 L. L. 1771 28 2 30 „ „ „ 10 30 ?3 45 0 20 9 2 L. L. 1795 29 1 22 „ „ „ — 3 0 + 0 20 7 12 L. L. 1746 30 1 33 Persistent occipito posterior position — — 0 20 10 4 L. S.B. 1228 31 1 25 Delay in second stage — 3 0 0 30 4 11 L. L. 1134 32 1 24 „ „ „ 48 0 + — 8 14 L. S.B. 1353 33 1 28 Persistent occipito posterior position 30 15 1 35 0 13 6 8 L. L. 1568 34 1 28 „ „ „ „ 16 0 + — 0 25 7 15 L. L. 1585 35 2 22 „ „ „ „ 11 30 3 20 0 30 8 2 L. L. 1456 36 1 23 „ „ „ „ — — 0 15 8 14 L. L. *CAESAREAN SECTION.—1 Case. 1134 1 1 24 Disproportion 48 0 + — — 8 14 L. S.B. Remarks. Case 7.—Child: Long moulded head. Disproportion. „ 11.—Marked moulding of child's head. „ 13.—Weighed on third day after birth. Disproportion. „ 17.—Infant very moulded head. Weighed on sixth day. Disproportion. „ 19.—Disproportion. „ 20.—Infant very moulded head. *Case 1.—Unsuccessful attempt at delivery with forceps. Puerperal Pyrexia. Remarks. Case 21.—Disproportion. „ 23.—Excessive moulding of infant's head. Disproportion. „ 31.—Second infant of twins. „ 32.—Disproportion. Failed forceps. Caesarean section. Puerperal Pyrexia. „ 34.—Disproportion. „ 36.—Disproportion. 125 CONTRACTED PELVIS. (Including relative disproportion between the pelvis and the foetal head.) Number of Cases 12 Number of Stillbirths and Infant Deaths 1 Foetal Mortality 8.3% Maternal Mortality Nil Reg. No. Case No. Gravida. Age of Patient. Method of Delivery. Duration of Labour. Weight of Infant. Result. 1st stage. 2nd stage. 3rd stage. M. C. h m h m h m lb. oz. 1134 1 1 24 Caesarean Section 48 + — — 8 14½ L. S.B. 1168 2 1 29 Forceps 15 50 ?4 0 0 5 6 14 L. L. 1288 3 2 33 Manual rotation. Forceps 33 0 1 45 4 5 6 15 L. L. 1209 4 1 33 Forceps 44 25 2 17 0 7 7 9 L. L. 1234 5 1 28 Forceps 10 20 3 5 0 15 5 11 L. L. 1337 6 1 30 Forceps 9 0 2 20 0 20 6 4 L. L. 1568 7 1 28 Manual rotation. Forceps — — 0 15 7 15 L. L. 1404 8 1 28 Forceps 23 0 3 40 0 15 7 10 L. L. 1456 9 1 23 Manual rotation. Forceps — 3 50 + 0 15 8 14 L. L. 1487 10 1 30 Spontaneous 61 55 1 20 0 35 8 0 L. L. 1567 11 1 27 Spontaneous 12 30 4 15 0 15 6 12 L. L. 1569 12 1 22 Forceps 18 45 4 30 0 30 7 4 L. L. Remarks. Case 1.—Failed forceps. Puerperal Pyrexia. „ 2.—Infant: long moulded head. „ 3.—Infant: very moulded head. Weighed on sixth day. Persistent occipito posterior. „ 4.—Infant very moulded head. „ 5.—Weighed on third day. Remarks. Case 6.—Infant: very moulded head. „ 7.—Persistent occipito posterior position. „ 9.—Persistent occipito posterior position. „ 10.—Emergency admission. „ 11.—Infant: very moulded head. 126 POST-PARTUM HAEMORRHAGE. There were 12 cases of post-partum haemorrhage. Primiparae. No. of Cases. Multiparae. All Cases. Vertex presentation 7 3 10 Spontaneous delivery Forceps 1 — 1 Twins 1 — 1 Total 9 3 12 Percentage of cases—1.8%. Manual removal of the placenta was performed 6 times for post-partum haemorrhage. There was one case of pyrexia following this operation. There was one maternal death from shock following manual Removal of the placenta. 127 POST -PARTUM HAEMORRHAGE. Reg. No. Case No. Age of Patient. Gravida. Method of Delivery. Length of 3rd stage. Predisposing Cause. Treatment. Result. Pyrexia. M. C. h. m. 1221 1 29 1 Spontaneous 1 35 Unknown Manual removal of placenta. Intra-uterine glycerine. Intravenous glucose saline. Pituitrin. Ergometrine. Femergin. Coramine D. L. Nil. 1257 2 30 1 Forceps 0 45 Uterine exhaustion Manual removal of placenta. Femergin. Pituitrin. Intrauterine glycerine L. L. - 1327 3 26 1 Spontaneous 0 45 Large placental site Intravenous saline. Pituitrin. Ergometrine. Coramine L. L. Nil. 1440 4 32 2 Spontaneous 0 10 Unknown Ergometrine. Pitocin. Coramine L. L. Onset 4th day. 1424 5 29 1 Spontaneous 0 40 ?Retained cotyledon of placenta. Degenerate placental tissue Pituitrin. Femergin. Ergometrine. Intravenous saline L. L. Nil. 1580 6 28 1 Spontaneous 0 15 Rapid 2nd stage. Uterine inertia Pituitrin. Femergin. Ergometrine. Rectal coffee glucose saline L. L. Nil. 1587 7 25 1 Spontaneous 0 20 Premature partial separation of placenta Pituitrin. Femergin. Rectal coffee glucose saline L. L. Nil. 1605 8 28 1 Twins Spontaneous 3 5 Uterine inertia Pituitrin. Femergin. Ergometrine. Morphine. Manual removal of placenta. Rectal coffee glucose saline L. L. L. Onset 5th day. 1679 9 40 6 Spontaneous 3 45 Adherent placenta Manual removal of placenta. Ergometrine. Femergin. Morphine L. L. Nil. 1725 10 21 1 Spontaneous 2 10 Uterine inertia Manual removal of placenta. Ergometrine. Pituitrin. Rectal coffee glucose saline L. L. Nil. 1728 11 31 1 Spontaneous 2 20 Uterine inertia Manual removal of placenta. Ergometrine. Coramine. Pituitrin. Morphine. Rectal L. L. Nil. 1733 12 26 2 Spontaneous 0 45 Uterine inertia coffee glucose saline Pituitrin. Ergometrine. Rectal coffee glucose saline L. L. Nil. Maturity:-All were 40 weeks. 128 PUERPERAL PYREXIA. The standard adopted for the estimation of Puerperal Pyrexia is that of the Ministry of Health, namely, a temperature of 100.4°, or more sustained for 24 hours, or recurring within that period. Analysis of cases:— Number of cases notified, Primiparae. Multiparae All Cases, %of Cases 646 Booked Confinements . 16 7 23 3.5 14 Unbooked Confinements 1 1 2 14.3 660 Total number of Confinements 17 8 25 3.7 Day of onset of Pyrexia. Duration. Cause. No. of Cases. First day 11 days Urinary infection 1 Second day Patient transferred Pelvic abscess 1 „ „ „ „ Uterine infection 1 „ „ „ „ „ „ 1 „ „ „ „ Tonsillitis on admission 1 ?BIood stream infection Third day „ „ Very mild uterine infection 1 „ „ „ „ Pulmonary Tuberculosis 1 Fourth day Under care of own doctor, 15 days Urinary infection 1 „ „ Patient transferred Uterine infection 1 Fifth day 1 day Very mild uterine infection 1 „ „ Patient transferred Anaerobic streptococcal blood stream infection 1 Sixth day 3 days Urinary infection 1 „ „ 3 days Non-suppurative mastitis 1 Seventh day 1½ days Non-suppurative mastitis 1 Eighth day 4 days Influenzal cold 1 „ „ 5 days Undiagnosed 1 „ „ 3 days Perineum infection 1 Ninth day 3 days Non-suppurative mastitis 1 \„ „ 4 days Non-suppurative mastitis 1 Tenth day 1 day Acute cold 1 „ „ 3 days Undiagnosed 1 Eleventh day 8 hours Gastro-intestinal disturbance 1 Twelfth day 2 days Non-suppurative mastitis 1 Fourteenth day 9 days Suppurative mastitis 1 Sixteenth day 1½ days Undiagnosed 1 25 129 PUERPERAL PYREXIA. Reg. No. Case No. Gravida. Age. Ante-Natal Conditions. Type of Labour. Method of Delivery. Onset of Pyrexia. Duration of Pyrexia. Cause. 1025 1 1 22 Satisfactory Normal Spontaneous 6th day 3 days Urinary infection. 1030 2 3 33 „ — Spontaneous (B.B.A.) 16th „ 36 hours No clinical signs 1047 3 1 30 „ Normal Spontaneous 8th „ 4 days Influenzal cold. 1117 4 1 26 „ „ „ 11th „ 8 hours Gastro-intestinal disturbance. 1134 5 1 24 „ Prolonged Failed forceps Caesarean Section. 2nd „ - Pelvic abscess. 1136 6 3 31 „ Normal Spontaneous 9th „ 3 days Non-suppurative mastitis. 1157 7 1 27 „ „ „ 14th „ 9 „ Bilateral suppurative mastitis 1185 8 2 26 Healing varicose ulcer „ „ 8th „ 5 „ Undiagnosed. 1211 9 1 23 Satisfactory „ „ 9th „ 4 „ Non-suppurative mastitis. 1222 10 1 17 Marked anaemia „ „ 8th „ 3 „ Perineal infection. 1259 11 1 23 Satisfactory „ „ 12th „ 2 „ Non-suppurative mastitis. 1228 12 1 25 Hydramnios Prolonged.. (1) „ 2nd „ — Uterine infection. Oedema (2) Forceps 1307 13 3 35 Satisfactory Normal Spontaneous 6th „ 3 days Non-suppurative mastitis. 1313 14 2 34 „ „ „ 10th „ 12 hours Acute cold. 1427 15 1 28 „ „ „ 4th „ 15 days - 1426 16 1 26 Albuminuria Hyperpiesis Oedema „ Twins Spontaneous 2nd „ - Haemolytic streptococcal infection. 130 PUERPERAL PYREXIA. Reg. No. Case No. Gravida. Age. Ante-Natal Conditions. Type of Labour. Method of Delivery. Onset of Pyrexia. Duration of Pyrexia. Cause. 1442 17 1 27 Tonsillitis in late pregnancy. Normal Spontaneous 2nd day — - 1440 18 2 32 Albuminuria „ „ 4th „ — (a) Uterine infection. (b) Urinary infection. 1460 19 2 20 Satisfactory „ „ 3rd „ 5 days Very mild uterine infection. 1549 20 1 23 „ „ „ 5th „ 24 hours 1547 21 1 25 „ „ „ 7th „ 36 „ Non-suppurative mastitis. 1605 22 1 28 Albuminuria Hyperpiesis Oedema. Prolonged.. „ 5th „ - Anaerobic streptococcal infection of blood and urine. 1626 23 1 22 Pulmonary tuberculosis. Normal „ 3rd „ — Pulmonary tuberculosis. 1663 24 1 31 Satisfactory „ „ 10th „ 3 days Undiagnosed. 1680 25 5 29 Pre-eclamptic toxaemia Ante-Partum haemorrhage. „ 1st „ 11 „ Urinary infection. Remarks. Case 2.—Infant born at home. Admitted on sixth day because booked for Maternity Home. Manual removal of placenta. „ 5.—Transferred. „ 12.—Transferred. Emergency admission. „ 16. —Transferred. „ 17.—Transferred. Patient died one week later. Remarks. Case 18.—Transferred. „ 19. —Transferred. „ 22.—Transferred. Twins. Manual removal of placenta. „ 23.—Sent home under care of own doctor. Later transferred to sanatorium where she subsequently died. „ 25.—Emergency admission. 131 PERINEAL SUTURE. Perineal suture was performed 284 times. (i) Doctors' Cases:— Primiparae. Multiparae. All cases. (a) Vertex presentation Spontaneous delivery 15 3 18 (b) Breech presentation 11 1 12 (c) Vertex presentation Forceps delivery 22 2 24 Total 43 6 54 (ii) Midwives' Cases:— (a) Vertex presentation Spontaneous delivery 178 46 224 (b) Breech presentation — 6 6 Total 178 52 230 INFANTS. Primiparae. Multiparae. All cases. Total per cent. Total per cent. Total per cent. Number of infants born 421 244 665 Number of stillbirths:- (a) Full term 12 2.9 3 1.23 15 2.25 (b) Premature 4 0.95 3 1.23 7 1.05 Total 16 3.85 6 2.46 22 3.3 Number of infant deaths:- (a) Full term 1 0.24 — — 1 0.5 (b) Premature 5 1.2 2 0.8 7 1.05 Total 6 1.44 2 0.8 8 1.55 132 Causes of Stillbirths. Recent. Macerated. Placental separation 4 Ante-partum haemorrhage 1 Prolonged labour 2 Multiple malformations 1 Shock after internal version 1 Unknown 1 Cerebral haemorrhage 1 Congenital morbus cordis 1 Tumour of thymus gland 1 Anencephaly 1 Multiple malformations 1 Unknown 1 13 3 With associated complications of pregnancy. Albuminuria. Hyperpiesis Prolonged labour 1 Hydramnios Maternal toxaemia 1 Albuminuria. Hyperpiesis Unknown 1 Albuminuria Unknown 1 Albuminuria. Hydramnios Shock. First infant of twins. Delay in labour 1 Pre-eclamptic toxaemia Concealed haemorrhage 1 3 3 Post-mortem examinations were held in four of the above cases:— 1. Tumour of thymus gland. 2. Anencephaly. 3. Congenital morbus cordis. 4. No apparent abnormality. Infant deaths (under 10 days)—8 cases. Atelectasis. Cerebral haemorrhage 1 Cerebral haemorrhage 1 Prematurity and inanition 3 Congenital morbus cordis 1 Exomphalos 1 Acute pyelitis 1 8 All infants were premature. Post-mortem examinations were held in three of the above cases:— 1. Atelectasis. Cerebral haemorrhage. 2. Congenital morbus cordis. 3. Cerebral haemorrhage. 133 Full term (15 Cases). INFANTS—STILLBIRTHS. Case No. Reg. No. First or later Pregnancy. Maternal Complications. Method of Delivery. Sex. Infant Birth Weight. Recent or Macerated. Cause of Death. Post-mortem Examination. lbs. ozs. 1 1134 First - Caesarean Section following failure in delivery by forceps F. 8 14 Recent .. Premature separation of part of placenta Not held. 2 1296 „ — Spontaneous M. 8 1 „ „ 3 1690 „ — „ M. 7 12½ „ „ „ 4 1005 „ — Forceps F. Not weighed „ prologed labour „ 5 1012 Second — Spontaneous M. „ Macerated Unknown „ 6 1257 First — Forceps M. 7 12 Recent Prolonged labour „ 7 1745 Fourth — Spontaneous after version M. Not weighed „ Shock after version „ 8 1754 Second — Forceps M. 10 9 „ ? Cerebral haemorrhage „ 9 1352 First — Spontaneous F. Not weighed „ Congenital morbus cordis Large patent foramen ovale. 10 1642 „ — „ M. „ „ Tumour of thymus gland Held. 11 1599 „ — „ F. „ „ Anencephaly „ 12 1447 „ — Assisted breech M. „ „ Multiple malformations „ 13 1061 „ — Spontaneous M. v „ Unknown Not held. 14 1414 „ — „ M. 7 0 Macerated Ante-partum haemorrhage „ 15 1746 „ Albuminuria. Hyperpiesis Forceps M. 10 4 Recent Prolonged labour „ Remarks—Case 4. Foetal death during first stage. Case 6. Foetal death during first stage. Case 7. Labour: Prolapsed arm. Impacted shoulder. Case 12. Delay in birth of head. 134 INFANTS—STILLBIRTHS. Premature (7 Cases). Case No. Reg. No. First or later Pregnancy. Maturity. Maternal Complications. Method of Delivery. Sex. Infant Birth Weight. Recent or Macerated. Cause of Death. PostMortem Examination. weeks lb. OZ. 1 1130 Second 38 — Spontaneous M. 5 0 Recent Placental separation Not held 2 1004 „ 36 Albuminuria „ M. Not weighed Macerated Unknown „ 3 1013 First 36 Hydramnios Maternal toxaemia. „ F. „ „ „ „ 4 1235 „ 32 — „ M. „ „ Multiple malformations „ 5 1228 „ 38 Albuminuria Hydramnios „ F. „ Recent Shock—first infant of twins „ 6 1178 „ 38 Albuminuria Hyperpiesis Spontaneous following surgical induction. F. „ „ Unknown „ 7 1680 Fifth 32 (a) Pre-eclamptic toxaemia. (b) Concealed haemorrhage. Spontaneous following rupture of membranes. M. „ Macerated Maternal condition „ 135 INFANT DEATHS. Case No. Reg. No. First or later Pregnancy. Maturity. Maternal Complications. Method of Delivery. Sex. Infant Birth Weight. Duration of Life. Cause of Death. PostMortem Examination. weeks lb. oz. d h m 1 1028 Second 38 Nil. Spontaneous F. 5 8 0 4 50 (a) Atelectasis (b) Cerebral haemorrhage Held 2 1119 First 38 Hyperpiesis „ M. 4 13 3 0 0 Congenital morbus cordis „ 3 1214 „ 28 Nil. „ M. 1 15 0 2 55 Exomphalos Not held 4 1308 Sixth„ 32 Ante-partum haemorrhage „ F. 3 6 6 0 0 (а) Inanition (b) Prematurity „ Marginal placenta praevia 5 1349 First„ 36-38 Nil. „ M. Not weighed 0 16 15 Cerebral haemorrhage Acute pyelitis Held 6 1395 „ F.T. Slight „ M. 7 8 16 0 0 - „ 7 1539 „ 30 Nil. „ F. 2 10 0 6 40 Prematurity Not held 8 1539 „ 30 Nii. „ F. 2 8 0 3 40 136 MATERNAL MORTALITY. There was one maternal death in the Maternity Home. Details of maternal death:— Primipara, aet 29 years. During pregnancy the patient was well, apart from hyperpiesis. After delivery the placenta failed to separate. Manual removal was performed under chloroform anaesthesia. Haemorrhage was moderate. The placenta was adherent in the right upper part of the fundus of the uterus. Two and a quarter hours after the operation the patient collapsed and died. Another patient died one week after transfer from the Home with puerperal pyrexia. POST-NATAL CLINIC. On discharge from the Maternity Home every patient is given an appointment for an examination at the Post-Natal Clinic six weeks from the date of confinement. The majority of patients were discharged with health unimpaired. Where there is disability suitable treatment is given. An attempt is made to follow up any case where health is impaired as a result of confinement, gynaecological conditions, e.gpregnancy toxaemia, or chronic nephritis, etc. One Post-Natal Clinic is held weekly. Number of sessions held 50 Number of patients who attended:— (a) New cases 453 (b) Old cases 177 Total attendances 630 Percentage of new patients relative to the number confined in the Home was 68.6 Average attendance 12.6 137 ANALGESIA IN LABOUR. The administration of sedative drugs forms part of the routine for patients in labour; the administration of gas and air with the Minnitt apparatus has continued to be available for every healthy patient. Nevertheless, the measure of relief from pain for all patients has not been as good as many patients had hoped. There are several reasons for this: (i) a few patients are too timid to try the apparatus as they are afraid of becoming unconscious; (ii) others use the gas very ineffectively because they are unable to maintain the necessary self-control in keeping the mask close to the face; (iii) a further group show a lessening of self-control with deep inhalation of the mixture of gas and air; (iv) the inhalations should precede the onset of pains, as a short interval elapses before the analgesic effects become apparent. Most patients do not apply the mask and inhale until they are suffering acute pain, consequently the relief of pain is not so good as it might be. Although the gas and air apparatus has been designed for selfadministration by the patient, it is found in practice that all patients require very close supervision and help in order to derive the maximum benefit from its use. There is now an improved type of apparatus on the market, which, it is claimed, will afford greater relief from pain for women in labour than other designs. ' JRI/68