Borough of Walthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1937. 67977 Borough of Wlaltbamstow REPORT OF THE MEDICAL OFFICER OF HEALTH' For the Year 1937. 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 19 ,, D.—Housing 27 ,, E.—Inspection and Supervision of Food 37 ,, F.—Prevalence of and Control over Infectious Disease 44 ,, G.—Infectious Disease Hospital 66 ,, H.—Maternity and Child Welfare 76 ,, I.—Thorpe Coombe Maternity Hospital 11l PAGE Abortion 106 Acreage 8 Adulteration 41 Albuminuria 115 Ambulance 13 Anaesthetics and Analgesia 97, 111 Ante-Natal Clinic 83, 86, 111 Antitoxin 56 Bacteriological Analyses 26, 38, 41 Bakehouses 24 Bed Bugs 27, 36 Births 10 ,, Notification of 79 ,, Registration of 79 Birth-Rate 1l Breech Delivery 119 Breast Feeding 84 Brookfield Hospital 90 Caesarean Section 124 Cancer . . 12 Cerebro-Spinal Meningitis 61 Child Guidance 92 Child Welfare 83 Clearance Areas 35 Clinics 14, 46, 83, 86, 131 Closet Accommodation 20 Committees 4, 76 Comparability Factor 10 Compensation (Midwives) 100 Connaught Hospital 17 Consultants 77, 98 Cowsheds 25 Cremation 72 Dampness 23 Deaths 10, 12 ,, Infant 82 ,, Infectious Diseases 11 Death Rate 11 Dental Treatment 91 Diarrhoea and Enteritis 9, 83 page Dick Tests 62 Diphtheria 56, 69 ,, Immunisation 48 Diseases of Animals Acts 41 Disinfection 23 Disinfestation . . 27, 36 District Midwife 101 Drainage 19 Dysentery 57 Eclampsia 115 Emergency Unit 110 Encephalitis Lethargica 62 Enteric Fever 56 Erysipelas 60 Essex Public Medical Service 18 ,, County Council Act 19,39 Factories and Workshops 42 Fishmongers 24 Food and Drugs 41 ,, Poisoning 62 Foot Clinic 14 Forceps Delivery 122 Haemorrhage— Ante-Partum 116 Post-Partum 125 Health Education 72 ,, Visitors 77 Home Helps 95 Hospital Accommodation 16, 53, 95 ,, Infectious Disease 68 ,, Smallpox 53 House-to-House Inspection 31 Housing 27 Act, 1936 31 ,, Conditions 34 ,, Inspection 28 ,, Register 34 ,, Shortage 34 ,, Statistics 27 ,, Tuberculous Cases 65 PAGE PAGE Ice Cream 39 Immunisation 48 Industrial Activity 9 Infant Life Protection 87 ,, Mortality 9, 81, 82, 128 Infectious Diseases 11, 44 ,, ,, Clinic 46 Institutional Treatment 95 Inquests 72 Invalid Children's Aid Asscn. 92 Isolation Hospital 66 Laboratory Work 13, 52, 70 Massage 87, 88 Maternal Mortality 11, 106, 131 Maternity and Child Welfare 75 ,, Homes 95 ,, Outfits 95 Measles 62 Meat Inspection 39 Medical Aid 99, 114 ,, Examinations 71 Midwives 98 Milk, Assisted Scheme 87, 93 ,, and Dairies Order 39 ,, Shops 25 ,, Special Designation Order 39 ,, Supply 37 Miscellaneous 72 Mortuary 72 Neo-Natal Mortality 81 Notices, Sanitary 21 Notification Rates 11 Notification of Births 79 Nursery School 90 Nursing 14,60,63 ,, Homes 19 Nutrition 41 Obstetric Consultants 77, 98 Ophthalmia Neonatorum 60, 106 Ophthalmic Treatment 92 Orthopaedic Treatment 90 Outworkers 43 Overcrowding 30, 32, 33 Parks 9 Perineal Lacerations 127 Physical Training 73 Pneumonia 59 Poliomyelitis 62 Population 8 Post-Mortems 72 Post-Natal Clinic 86, 111 Propaganda 72 Public Assistance 17 ,, Cleansing 20 Puerperal Fever and Pyrexia 60, 103, 127 ,, Sepsis 9 Rainfall 74 Rateable Value . . 8 Rats and Mice Destruction Act, 1919 42 Recreation Grounds 9 Refuse Disposal 20 Rent Restriction Acts 41 Rheumatism Clinic 46 Rivers and Streams 19 Sanitary Inspection 21 Scarlet Fever 53, 69 ,, ,, Immunisation 52 Schick Tests 48 Schools 27 Sewerage 19 Shellfish 41 Shops Act 25 Slaughterhouses 24 Smallpox 53 Smoke Abatement 25 Social Conditions 8 Special Premises 23 Staff 6, 77 Statistics 8, 9 Stillbirths 9, 81, 128 Sunlight Treatment 92 Swimming Baths 25 Thorpe Coombe Maternity Hospital 108 Tonsils and Adenoids 92 Tuberculosis 10.63,71 ,, Order, 1925 42 Tuberculous Meat 40 Twin Delivery 123 Unemployment 8 Vaccination 53 Venereal Diseases 18 Vital Statistics 9, 11 Walthamstow Child Welfare Society 88 Walthamstow District Nursing Association 96 Water 19 Whooping Cough 11 Women's Clinic 14 Zymotic Diseases 10 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Councillor R. E. Smith. His Worship the Mayor—Alderman G. Gibbons, J.P. The Deputy Mayor—Alderman Mrs. C. McEntee. J.P. Chairman of Finance Committee—Councillor E. C. Redhead (to September, 1937). Alderman Ross Wyld, J.P. (from September, 1937). Alderman P. Friedberg. Alderman W. J. Sharp ,, J. C. Hammond. (Chairman, Sanatorium ,, Mrs. M. Norrish. Visiting Committee), ,, Ross Wyld, J.P. Councillor Mrs. L. P. Bailey. Councillor V. S. King. ,, W. B. Fitt. ,, Mrs. E. M. Miller. ,, Mrs. B. M. Friedberg. ,, Mrs. E. M. Richards, ,, W. Gillett. ,, J. H. Thomason. ,, Mrs . E. M. Hammond . ,, Mrs . E. B. Toynbee Town Clerk: F. G. Garner, Esq. TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, I beg to present herewith a report on the work of the Public Health Department during 1937. The Registrar-General's estimate of population shows a decrease of 1,700, but in spite of this the vital statistics were satisfactory and on the whole below the corresponding rates for England and Wales and other areas comparable with Walthamstow. The incidence rates of diphtheria and scarlet fever were the lowest recorded. The routine work of the Department continues to increase as a result of new legislation—e.g., Housing and Midwives Acts, 1936; new regulations and memoranda—e.g., Air Raid Precautions, new rules of training for pupil midwives, etc.; and, at times, there is a heavy burden on the staff. The Engineer and Surveyor, Housing Manager, Cleansing Superintendent and the Superintendent of the Ambulance Service have again kindly contributed those sections of the report 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, particularly the Chief Clerk. I have to acknowledge the continued 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 Hospital: A. T. W. Powell, M.C., M.B., B.S. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. Assistant Medical Officers: D. Broderick, M.B., B.Ch., B.A.O., D.P.H., Barrister-at-Law. Miss Mary C. Sheppard, B.A., M.B., B.Ch., B.A.O., D.P.H., 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. Baknes (b), (c) S. E. Muggeridge, A.It .S.I. (to 10.8.37). (b), (d). (from 19.4.37). R. C. Bland, A.R.S.I. (b), (d) F. Northcote, A.R.S.I, (b), (c). N. F. Cripps, A.R.S.I, (b) ,(d). H. D. Perrin (b), (d). (from 23.8.37). T. Vaughan (&), (c), (e) F. W. Kemp, A.R.S.I, (a), (b), (c) (to 30.4.37). H. A. Whipp (b), (c). Miss 0. J. Panther (a) (half-time). (а) Cert. S.I.E.B. (London). (b) Cert. Inspector Meat and other Foods. (e) 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 (to 17.6.37),, Miss B. E. Parford (from 31.5.37), 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, (to 27.4.37) H. F. Thompson (from 19.4.37). 8 The following data refer to the whole Exchange area. Date. No. on Men remaining Register. Women. Total 1937. Total 1936. Amount of benefit paid during month. £ 25.1.37 4,422 1,064 5,486 7,446 19,465 22.2.37 4,310 912 5,222 6,844 19,959 22.3.37 3,918 727 4,645 6,394 14,237 19.4.37 3,508 608 4,116 5,875 17,151 24.5.37 3,250 644 3,894 4,961 12,847 28.6.37 3,232 617 3,849 4,700 11,836 26.7.37 3,164 577 3,741 4,377 14,051 23.8.37 2,976 574 3,550 4,263 10,869 27.9.37 3,569 528 4,097 4,272 12,832 25.10.37 3,759 637 4,396 4,449 14,528 22.11.37 4,294 903 5,197 4,872 15,345 20.12.37 4,591 1,201 5,792 4,556 23,521 A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1937) 131,900 Number of Assessments, 1st April, 1937 35,273 Rateable value £840,433 Sum represented by penny rate £3,312 Population.—The Registrar-General's estimate of the population at mid-year, 1937, is 131,900, a decrease of 1,700 on the previous figure. Social Conditions.—No appreciable change from 1931 Report. Unemployment.—The degree of unemployment in the area during 1937 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 36,000, and roughly two-thirds of the figures given below related to persons residing in Walthamstow (excluding Juveniles). 9 Mr. Dempsey states that the following were the registrations at the Juvenile Employment Bureau:— Live Register at beginning of year Boys. Girls. Total. 44 17 61 Fresh Registrations during year 1,281 1,045 2,326 Registrations during year 695 528 1,223 Live register at end of year 14 11 25 Industrial Activity.—Considerable industrial activity has been apparent in the erection of new factories and in the extension of existing works. Parks and Recreation Grounds.—Low Hall Sports Ground.— The construction of a Sports Pavilion, Groundsman's House and 12 Tennis Courts have been completed. Extracts from Vital Statistics.—The Registrar-General's mid-year, 1937, estimate of population (viz., 131,900) has been used for the calculation of all vital statistics:— Total. Males. Females. Legitimate 1,634 827 807 Birth rate per Live Births Illegitimate 41 25 16 1,000 of the estiTotal 1,675 852 823 mated resident population 12.7 Stillbirths 60 Rate per 1,000 total (live and still) births 34.5 Deaths 1,443 Death rate per 1,000 of the estimated resident population 10.9 Deaths from puerperal causes:— Rate per 1,000 (live and still) births. Puerperal Sepsis Deaths 4 2.30 Other Puerperal Causes 2 1.15 Total 6 3.45 Death rate of infants under one year of age:— All infants per 1,000 live births 51 Legitimate infants per 1,000 legitimate live births 53 Illegitimate infants per 1,000 illegitimate live births — Deaths from Measles (all ages) — ,, ,, Whooping Cough (all ages) 2 ,, ,, Diarrhoea (under 2 years of age) 15 10 (All rates are per 1,000 of estimated residential population.) Comparability factor 1.11 Adjusted death rate 12.0 Ratio of local to national crude death rate 0.87 Percentage reduction of adjusted death rate below that for England and Wales 3.2 Zymotic disease death rate 0.16 Pulmonary Tuberculosis death rate 0.60 Non-pulmonary Tuberculosis death rate 0.09 The natural increase of population, i.e., excess of births over deaths, was 232. The usual comparison of vital statistics 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 1937 (1,443) compares with 1,321 during 1936, the respective death-rates per 1,000 population being 10.9 and 9.8. 11 England and Wales, London, 125 Great Towns and 148 Smaller Towns (Provisional figures based on Weekly and Quarterly Returns). England and Wales. 125 County Boroughs and Great Towns (including London). 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Walthamstow. Ratesper 1,000 population. Births:— Live 14.9 14.9 15.3 13.3 12.7 Still 0.60 0.67 0.64 0.54 0.45 Deaths:— All Causes 12.4 12.5 11.9 12.3 10.9 Typhoid and Para-typhoid Fevers 0.00 0.01 0.00 0.00 — Smallpox — — — — — Measles 0.02 0.03 0.02 0.01 — Scarlet Fever 0.01 0.01 0.01 0.01 0.01 Whooping Cough 0.04 0.04 0.03 0.06 0.01 Diphtheria 0.07 0.08 0.05 0.05 0.03 Influenza 0.45 0.39 0.42 0.38 0.41 Violence 0.54 0.45 0.42 0.51 0.44 Notifications:— Smallpox 0.00 — 0.00 — — Scarlet Fever 2 33 2.56 2.42 2.09 1.53 Diphtheria 1.49 1.81 1.38 1.93 0.76 Enteric Fever 0.05 0.06 0.04 0.05 0.08 Erysipelas 0.37 0.43 0.34 0.44 0.46 Pneumonia 1.36 1.58 1.20 1.18 1.15 Rates per 1,000 LiveBirths. Deaths under 1 year of age 58 62 55 60 51 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 7.9 3.2 12.0 8.9 Maternal Mortality.— Puerperal Sepsis 0.97 Not av ailable 2.38 Others 2.26 1.19 Total 3.23 3.58 Rates per 1,0 00 Total Births (i .e. Live and Still) Maternal Mortality:— Puerperal Sepsis 0.94 2.30 Others 2.17 Not av ailable 1.15 Total 3.11 3.45 Notifications:— Puerperal Fever 1 4.15 2.30 Puerperal Pyrexia 13.93 17.59 11.52 14.34 19.59 Birth-rates, Death-rates, Analysis of Mortality, Maternal Death -rates and Case -rates for certain Infectious Diseases in the year 1937. 12 Causes of Death as given by the Registrar -General for the year 1937. Whole District. Causes of death. Males. Females. Total Total. 1936. l. Typhoid and Para-typhoid Fevers - - - - 2. Measles - - - 8 3. Scarlet Fever 1 - 1 1 4. Whooping Cough.. - 2 2 4 5. Diphtheria 2 2 4 2 6. Influenza 32 23 55 2 26 7. Encephalitis Lethargica - 2 2 8. Cerebro-spinal Fever - 1 1 2 9. T. B. of respiratory system 42 38 80 73 10. Other Tuberculous diseases 5 7 12 14 11. Syphilis 9 - 2 4 12. 13. General paralysis of the insane, (tabes dorsalis) 3 - 3 8 Cancer, malignant disease 96 124 220 192 14. Diabetes 6 11 17 16 15. Cerebral Haemorrhage, etc. 43 48 91 85 16. Heart disease 141 197 338 374 17. Aneurysm 4 6 10 7 18. Other circulatory diseases 24 23 47 43 19. Bronchitis.. 40 30 70 58 20. Pneumonia (all forms) 57 46 103 73 21. Other respiratory diseases 8 8 16 18 22. Peptic Ulcer 15 4 19 21 23. Diarrhoea, etc. (under 2 years) 9 6 15 11 24. Appendicitis 8 2 10 15 25. Cirrhosis of Liver 4 2 6 1 26. Other diseases of liver, etc. 1 5 6 5 27. Other digestive diseases.. 18 20 38 23 28. Acute and Chronic Nephritis 17 18 35 46 29. Puerperal Sepsis 4 4 1 30. Other Puerperal causes - 2 2 2 31. Congenital Debility and Malformation, Premature Birth, etc. 23 15 38 37 32. Senility 10 11 21 17 33. Suicide 8 6 14 15 34. Other violence 26 19 45 33 35. Other defined causes 65 51 116 82 36. Causes ill-defined or unknown .. — 2 Totals 710 733 1443 1321 The age distribution of Cancer deaths was as follows: - Under 1 yr. 1-2 yrs. 2-5 yrs. 5-15 vrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. & over — — — — — 12 99 109 13 The main classification of deaths—those for 1936 being given in parenthesis—was as follows: — Whooping Cough, 2 (4); Diphtheria, 4 (2); Pulmonary Tuberculosis, 80 (73); Non-Pulmonary Tuberculosis, 12 (14); Cancer, 220 (192); Cerebral Haemorrhage, 91 (85); Heart, 338 (374); Bronchitis, 70 (58); Nephritis, 35 (46); Congenital Debility, etc., 38 (37); Suicide, 14 (15); Violence, 45 (33). 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 ai'e 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. 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 a See below. (c) Maternity Patients. The ambulance services in the area appear to be quite adequate and sufficiently co-ordinated. 1. Municipal Service. Superintendent Camp, A.M.I. Fire E., reports as follows on the work done during 1937 :— Removals Accidents Maternity Total Mileage 1,999 687 174 2,860 14,336 97 maternity oases 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 17 times for cases of gas poisoning and collapse. It was successfully used on 6 occasions. An additional ambulance will be brought into use in 1938. 14 2. Whipps Cross Hospital. Removal of patients is carried out by ambulances attached to the Hospital. 3. St. John Ambulance Corps. Mr. W. H. Hussey, R.N.A.S.B.R., reports as follows: — First Aid cases attended 951 Number of patients removed 826 Mileage 17,146 Number of road accidents 41 Local duties at cinemas, sports meetings, cricket, football, outings and functions of all kinds, have been covered by request as usual. Our members are now trained in air raid protection work. Classes in First Aid, Home Nursing, Hygiene, Gas Protection and Decontamination have been well attended by the public of Walthamstow and the surrounding districts. 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 10,992, and of these 1,483 were by new patients and 9,509 were re-attendances by old patients. The receipts were £428 4s. 0d. 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 with Miss Helen Rodway, M.C.O.G., in charge of the weekly sessions. Dr. Rodway submits the following: report: — The attendances have been as follows: — 1937 1936 New Cases Old Cases New Cases Old Cases Monthly consultation clinic 14 124 17 108 Weekly clinic 251 853 259 589 Total 265 977 276 697 Thirty cases were referred to the clinic by general practitioners. 15 SUMMARY OF NEW CASES 1. Diseases of External Generative Organs:— Pruritis of vulva 5 Leukoplakia 1 Vulvo-vaginitis 3 2. Diseases of Vagina:— Senile vaginitis 3 Dyspareunia 3 Bartholin's cyst 2 Rectovaginal fistula 1 Traumatic vaginal atresia 1 3. Diseases of Cervix of the Uterus:— Erosion 12 Mucous polypus 8 Pre-carcinomatous polypus 1 4. Diseases of the Body of the Uterus:— Fibroids 3 Endometritis and metritis 2 5. Diseases of Ovary:— Endometrioma 2 6. Disorders of Menstruation:— Dysmenorrhoea 4 Irregular menstruation 6 Menorrhagia 3 Menopausal haemorrhage 2 7. Sterility 16 8. Displacements:— Retroversion 21 Prolapse 35 9. Congenital Malformations:— Absence of uterus and vagina 1 10. Diseases of Breast:— Chronic mastitis 1 Carcinoma 2 11. Examination during Pregnancy:— For diagnosis 41 Retroversion of uterus 2 Medical conditions associated with pregnancy 6 12. Miscarriage 8 13. For Contraceptive advice 9 14. Medical 17 15. Surgical 10 16. Miscellaneous:— Urinary dysfunction 8 Not classified 26 Total 265 The following operations were performed by Miss Basden, F.R.C.S., on patients referred from the clinic to the South London Hospital for Women. 16 The two genito-urinary operations were performed by Miss Lewis, F.R.C.S. Diagnosis No. Operation Uterine prolapse 6 2 Posterior colpoperineor- rhaphy. 1 Anterior and posterior colpoperineorrhaphy. 1 Removal of chocolate cyst of right ovary. Gilliam's suspension for retroversion . 1 Dilatation and Curettage. Amputation of cervix. Anterior and posterior colpoperineorrhaphy. 1 Trachelorrhaphy. Posterior colpoperineorrhaphy. Carcinoma breast and uterine prolapse 1 Radical amputation left breast. Dilatation and Curettage. Amputation cervix. Posterior colpoperineorrhaphy . Anal fissure 1 Excision of anal fissure. Urethrocele 1 Repair of urethrocele. Chronic mastitis 1 Local amputation right breast. Rectocele and incisional hernia 1 Repair of rectocele and incisional hernia. Chronic metritis 1 Panhysterectomy. Sterility 1 Dilatation and inflation. Chronic endometritis 1 Dilatation and Curettage. Bilateral renal tuberculosis 1 Cystoscopy. Congenital absence of uterus and vagina 1 Examination under anaesthetic . Traumatic vaginal atresia 1 Dilatation of vagina. Chronic appendicitis 1 Appendicectomy. Papilloma of bladder 1 Cystoscopy and diathermy. Endometrioma of left ovary 1 Sub-total hysterectomy and removal of left ovarian endometrioma. Senile vaginitis 1 Dilatation and Curettage. Rectocele 1 Posterior colpoperineorrhaphy. The 22 in-patients spent a total of 345 days in hospital. In addition, 33 out-patients made 42 attendances. The Council made a grant of £30 to the Hospital. Hospitals.—There were no changes during 1937 in the Hospital services used by the inhabitants of the Borough. 17 Public Assistance in Walthamstow is provided by the Southwestern Area Guardian 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, 1937: — Institutions Men Women Children Total Central Home 127 162 52* 341 Whipps Cross Hospital 743 796 361 1,900 Forest Gate Hospital 4 58 2 64 Harold Wood Hospital 3 1 — 4 Forest House 16 9 — 25 Aldersbrooke Children's Homes — — 49 49 Oldchurch County Hospital, Romford 9 14 12 35 *49 of these children were ultimately transferred to Aldersbrooke. 34 infants were born to Walthamstow mothers in Forest Gate Hospital during the year. The number of patients from Walthamstow in Mental Hospitals was 392 on the 31st December, 1937. 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, 972 were residents of the Borough. "The following figures show the progress of the Hospital during 1937 as compared with the previous year: — In-Patients Daily Average Out.Patients No. Admitted Average Stay New Cases Attendances 1937 1,865 21.35 109.93 14,798 77,437 1936 2,039 20.09 111.55 14,987 79,595 "The reason for the drop in the number of in-patients admitted was owing to the closing of certain wards for renovations and repairs, etc. "Particulars as to Staff, Beds and Departmental activities were the same as those for 1936. 18 "Operations and, Treatments.—During 1937, 968 major operations and 3,017 minor operations were performed, making a total of 3,985. 18,607 radiographs were taken. There were 12,853 massage treatments, also 22,878 electrical treatments, 31 special treatments and 3,513 artificial sunlight treatments at the Comely Bank Clinio; a total of 39,275 treatments at this Clinic." Venereal Disease Treatment. Treatment is provided by the Essex County Council, and all the facilities of the London County Council are available. 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 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 vears ended 31st December. 1937. was as follows: — 1936. 1937. £ s. d. £ s d. Total amount of out-relief granted to Walthamstow residents during year ended 31st December 54,034 19 4 49,288 2 6 Average weekly number of Walthamstow residents in receipt of relief during year ended 31st December Men 821 705 Women 1,232 1,134 Children 882 683 Total 2,935 2,522 "The reduction in the cost and numbers during 1937, as compared with previous years, is accounted for by the transfer of the cases of unemployed persons and their dependents to the Unemployment Assistance Board in April, 1937." 19 Public Health Act, 1936—Nursing Homes.—The following table gives information required by the Ministry of Health: — 1. Number of applications for registration (for additional beds) Nil 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 oases in which such Orders have been made:— (a) Confirmed on appeal Nil (b) Disallowed Nil 6. Number of applications for exemption from tration Nil 7. Number of cases in which exemption has been: — (a) Granted Nil (b) Withdrawn Nil (c) Refused Nil One application for transfer of registration was received and approved but the transfer was not proceeded with. Quarterly inspections are made by a member of the medical staff to each Home, in addition to any visits necessary for special inquiries. 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:—Forest Mount Road, Forest Road by St. Johns Road, Forest Road by Hempstead Road, Nightingale Hall Estate, Butterfields (The "Limes" Estate, Shernhall Street). 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. (ii) Drainage and Sewerage.—No works of this character have been carried out. 2. Rivers and Streams.—Periodical cleaning of the Dagenham Brook was carried out to the requirements of the Lea Conservancy Catchment Board. 20 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 during 1938, which will reduce the number of cesspools. (ii) Public Cleansing.— The Cleansing Superintendent. Mr. Eric Bell, M.I.P.C., A.R.S.I., reports as follows:— "House Refuse Collection.— There has been no material increase in the total weight of domestic refuse collected during the year, although the increase in bulk which was so noticeable last year has continued. "No new vehicles have been purchased during the year. "The usual weekly collection of house refuse has taken place, except on Bank Holidays, etc., when the collection has been made on the first working day afterwards. In every case householders affected have been notified by handbills, or through the Press, of the altered day of collection. "Few requests have been received for the removal of special articles of a bulky nature, but an increased number of requests have been made for the clearance of accumulations of refuse left by tenants vacating premises. "The total weight of refuse collected during the twelve months ended 31st December, 1937, was 27,617 tons, a slight increase over the corresponding period last year, whilst there was a further increase in the number of premises from which collections were made. "The average weight of refuse collected per day per 1,000 population has shown a slight increase over the previous year, although it is still considerably below the average throughout the country. "Trade Refuse.—The contract system with traders has been further extended during the year, and is proving very satisfactory both to the traders concerned and to the Council. "Refuse delivered by traders in their own vehicles amounted to 500 tons, a considerable reduction on the previous year. "Refuse Disposal.—During the year the whole of the refuse disposal works were altered and extended. "The Receiving Hopper, Elevator and Screen were duplicated. Two new units were erected, and the buildings extended. 21 "The furnaces themselves were closed down for approximately five months, and during this period the whole of the refuse was tipped. "Consequent upon the alterations, it is now possible to deal with the whole of the refuse received in one shift per day on the handling plant and two shifts per day on the burning plant, whilst Sunday work has been entirely eliminated. "The sale of salvage remained fairly consistent throughout the year. At one period hopes were entertained of a very big improvement in the metal market, but this did not materialise. It will be remembered that a nation-wide appeal was made through the Press lor scrap, and some rather extravagant forecasts were made. The trade fortunately took steps to control prices, so that attempts to trade upon what was presumed to be a national need were frustrated at the commencement, and the prices remained fairly steady, although the movement of scrap became easier. "Street Cleansing.—Every endeavour has been made to ensure that each road in the Borough should receive adequate attention. The two mechanical brooms employed on this work were entirely reconditioned and re-pn.inted during the year. "Gully Cleansing.—The total number of gullies cleansed was 10,438, every one of which was completely emptied and sealed with clean water, the total weight of sludge removed being 1,117 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 Statutory of Notices. Total Visits. Served. Complied with. Served. Complied with. 12,298 9,213 1 ,860 2,299 2,239 82 78 24,924 Although only 2,299) informal Notices were served during the year, 2,342 premises were rendered fit by informal action. 22 In several instances co-operation of certain owners has been sought and their assurance of rendering fit their properties has been accepted with the above gratifying result. Further, one company owning considerable small properties in this town has been providing drinking water direct from the main in many of its houses. In the course of time there will be, it is hoped, a "mains" supply in each house. The cost of provision of such a direct supply to about BOO houses in a short period would undoubtedly cause hardship, but spread over a period of years the cost is more easily borne and such an arrangement has been entered into and has loyally teen observed through the good will of the secretary of the company concerned, thus minimising the risk of contamination of the water supply to these houses. Failing compliance with Statutory Notices by the owners, the Council carried out these requirements to four houses involving an expenditure of £163 9s. l0d. The nature and variety of the work done during 1937 is shown in the following tables:— Drains tested 405 ,, reconstructed or repaired 385 ,, obstructions removed 208 ,, means of access provided 50 ,, ventilation provided or improved 80 ,, ventilation repaired 92 Soil pipes repaired 54 ,, ,, new, provided 43 Rain water pipes renewed 239 ,, ,, ,, disconnected from drains 33 Roofs repaired or renewed 902 Gutterings repaired or renewed 404 W.C. pans or traps provided 411 Gully traps provided 120 W.C. flush cisterns provided 102 ,, ,, ,, repaired 178 W.C. floors concreted 102 W.C.'s repaired and cleansed 515 W.C.'s light and ventilation improved 14 Waste pipes renewed or trapped 303 ,, ,, repaired 134 New sinks provided 226 Water supply reinstated 7 ,, ,, taken off main 23 Cisterns cleansed and covered 36 Conveniences cleansed or repaired 25 23 Sculleries paved 85 Yards and forecourts paved and repaired 490 Dirty houses cleansed 33 ,, rooms cleansed 2,918 Floors repaired 338 Ventilations under floors provided 205 New damp-proof courses provided 260 Sites concreted 6 Offensive accumulations removed 70 Animals improperly kept, removed 6 Manure receptacles provided 7 Stables cleansed, paved and drained 48 Manholes repaired or re-sealed 99 Other cases of dampness remedied 492 Separate Sanitary Conveniences provided to shops where both sexes are employed 2 Miscellaneous repairs 2,391 Infectious Disease. Visits to premises 863 Re-visits to premises 157 Premises disinfected 614 Articles disinfected at Low Hall 4,037 Articles destroyed at Low Hall 193 Dampness in Houses. Sites concreted 6 Damp-proof courses provided 260 Yards and forecourts paved and drained 490 Roofs made watertight 902 Rain-water pipes made good239 Guttering repaired or renewed 404 Other cases of dampness remedied 492 Ventilation under floors provided 205 House-to-house inspections 756 Special Premises. Visits Number. paid. Factories 256 366 Workshops 167 184 Outworkers 523 662 Slaughterhouses 10 494 Butchers' Shops 96 610 Bakehouses 45 200 Fishmongers, fish fryers and curers, etc. 52 288 24 Visits Number. paid. Eating-houses and Coffee Stalls 90 219 Ice Cream Vendors 154 236 Cowsheds 1 12 Dairies and Milkshops 243 237 Laundries 8 23 Rag and Bone Dealers 8 23 Elementary Schools 31) 7 Private Schools7) Piggeries 4 98 Street Stalls Numerous 91 Greengrocers ,, 123 Stables ,, 237 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers' Shops and Slaughterhouses. Special cleansings, 40: Paving repaired, 6; Accumulations removed, 8; New Galvanised Bins provided, 8; Drains repaired, 6: W.C.s repaired and cleansed, 14; Yard paving repaired, 6: Floors repaired and ventilated, 2; Roofs repaired, 5; Drains cleared, 5: Light and ventilation improved 1 . Bakehouses. Special cleansings, 73; Drains repaired, 3; W.C.s cleansed and doors repaired, 17; Yards repaved, 4; W.C. cisterns repaired, 4; Floors repaired, 2; Roofs repaired, 3; Premises general repairs, 5; Obstruction from drains removed, 2; New ceiling fixed, 1. Fishmongers. Special cleansings, 37; Yards repaved, 9; Accumulations removed, 6; Roofs repaired, 4; Other improvements, 14; Drains cleared, 2 ; Gutters renewed, 2. Coffee and Eating Houses. Special cleansings, 27; Yard pavings repaired, 5; W.C. cisterns repaired, 2; Drain repaired, 1. Ice Cream Vendors. Special cleansings, 14; Special cleansing of utensils, 9; Yard pavings repaired, 2 ; W.C. flush improved, 2. 25 Cowsheds and Milkshops Special cleansings, 12; Pavings relaid, 3; Fittings and other improvements, 3; Roof repaired, 1 ; W.C.s repaired, 2. Stable Premises. Cleansings, 55; Accumulations removed, 16; Roofs repaired, 11; Pavings repaired, 7; W.C. repaired, 1; Manure receptacles provided, 4; Drain reconstructed, 1. Laundries. Special cleansings, 8; Roofs repaired, 2; Other improvements, 4. Rag and Rone Dealers. Cleansings, 11; Paving repaired, 3; Accumulations removed, 4. Piggeries. Cleansings, 8; Paving repaired, I. (iv) Shops Act, 1934.—During the year there were no breaches of the Act calling for action. (v) Smoke Abatement.—During the year, 13 complaints of smoke emission were received and investigated. These were in the main justified and a consultation with those responsible for these nuisances had the desired effect of abatement. Observations on factory chimneys resulting in 8 instances of smoke emission were detected. The above procedure was followed with like results. (vi) Swimming Baths and Pools. (a) Public. (i) Municipal Baths, High Street.— This is a covered swimming bath. The Baths Superintendent kindly gives the following particulars: — "The Public Bath is situated in High Street and contains one covered swimming pool 129 feet long, 35 feet wide 3 ft. 6 ins. at the shallow end, and 6 ft. 7 ins. at the deep end. The capacity is 150,000 gallons (approx.). 26 "It has been installed with a modern system of filtration, aeration and chlorination plant by Messrs. Bell Bros., Ltd., and 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 operating for an average of 12.5 hours per day, the baths being open 149 days. "The approximate number of swimmers in 1937 was 53,966. The estimated maximum load was 889. "The Bath has been improved recently by a new set of teakwood dressing boxes, a new non-slip surround and the walls being tiled, with all angles and corners eliminated in order that no deposit or dirt can accumulate'. "Bacteriological and chemical analyses were carried out on four occasions, with excellent results." "There are 70 slipper baths in the building, with an ample supply of hot and cold water. All towels and other requisites are sterilised and freed from contamination." (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 two Boroughs. 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. on 10th August (unsatisfactory) and on 18th August (satisfactory). A chlorination and filtration plant has now been installed. (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 153 days. 27 "The approximate number of swimmers in 1937 was 38,450 and the estimated maximum load was 560. "Bacteriological and chemical analyses were carried out on five occasions, with results which were excellent." (vii) Eradication of Bed Bugs.— The number of houses found to be infested is as follows:— Council Houses. Other Houses. Infested 19 Infested 199 Successfully Successfully Disinfested 19 Disinfested 40 The methods employed for freeing infested houses from bed bugs are those described in the Annual Report for 1936. The work of disinfestation of houses other than those owned by the Local Authority is carried out by builders on behalf of owners, and by the tenants. Insecticide is given gratis to tenants with proper advice . The free use of a spray is at tenants' disposal. 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 Officer 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 1937. D.—HOUSING. (a) Statistics. The particulars of new houses erected during 1937 are given in the form used in previous years. The following are the figures supplied by the Engineer and Surveyor:— Number of new houses erected during the year:— («) Total, including number given separately under (b):— (1) By Local Authority 130 houses By other authorities Nil By other bodies or persons 86 houses 143 flats 359 28 (6) With State Assistance under the Housing Acts:— (1) By the Local Authority:— (a) For the purposes of the Act of 1930 130 The 359 houses are situated as follows:— Hale End Ward 196 (a) High Street Ward 9 Higham Hill Ward 38 (b) Hoe Street Ward 25 (c) St. James Street Ward 2 Wood Street Ward 89 (d) (a) Includes 21 fiats; (b) includes 36 flats; (c) Includes 24 flats; (d) includes 62 flats. The erection of 130 houses at Chestnut Farm is now completed and schemes for the erection of 74 houses at Millfield Avenue (No. 2), 14 houses at Essex Hall (No. 2), 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) 3,536 (b) Number of inspections made for the purpose 12,410 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 764 (b) Number of inspections made for the purpose 2,666 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 10 (N.B.—These comprise individual unfit houses and those situated in Clearance Areas.) 29 (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 2,412 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 2,342 III.—Action under Statutory Powers during the Year:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 64 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 55 (b) By local authority in default of owners (at a cost of £163 9s. l0d.) 5 B. Proceedings under the Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 18 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners18 (b) By local authority in default of owners Nil 30 C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil IV.—Housing Act, 1936, Part IV—Overcrowding:— A. (1) Number of dwellings overcrowded at the end of the year 273 (2) Number of families dwelling therein 273 (3) Number of persons dwelling therein 2,197 B. Number of new cases of overcrowding reported during the year 131 C. (1) Number of cases of overcrowding relieved during the year 443 (2) Number of persons concerned in such cases2,584 D. One case of overcrowding occurred during the year after the Council had rehoused an overcrowded family. This was subsequently abated. E. Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it advisable to report Nil 31 House-to-House Inspections. During the year, house-to-house inspections were carried out in the following streets:— Frederick Street. Brandon Road. Wellington Road. Eldon Road. Longfield Avenue. Luton Road. St. James Path, Victoria Road. Railway Cottages. Parts of:— Parts of:— Clacton Road. Pembar Avenue. Grange Road. Barclay Road. Acacia Road. Waverley Road. Queens Road. Chingford Road. Ickworth Park Road. Storey Road. Oatland Rise. Cazenove Road. Lancaster Road. Bedford Road. Goldsmith Road . Brettenham Road. Blenheim Road. Truro Road. Fairfield Road. Dudley Road. Shakespeare Road. Erskine Road. Higham Hill Road . Hawthorne Road . Century Road. Gainsford Road. Mayfield Road. Mansfield Road. Oakfield Road. Albert Road. Clarence Road. St. John's Road. Carlton Road. Hale End Road. St. Andrew's Road. Fulbourne Road. Tavistock Avenue. Macdonald Road. Blackhorse Lane. Oak Hill Cottages. (c) Housing Act, 1936—Clearance. During the year representations were made to and adopted by your Council with regard to the following properties:— Nos. 800, 802, 802a, 804, 806, 808, 810, 812, 814, Forest Road—8 houses and 1 shop. Demolition Orders were made in respect of the following individual unfit houses :— No. 31a, Higham Street. 32 (d) Housing Act, 1936—Overcrowding. The appointed day for Walthamstow with regard to Section 62 of the Act (i.e., the insertion of permitted numbers in rent books) was January 1st, 1937. Up to the end of December, 1937, a total of 25,276 dwellings had been surveyed and permitted numbers to the extent of 12,000 had been issued to applicants. Overcrowding.—507 enquiry forms were sent out during 1937. 387 cases of overcrowding were investigated by the District Sanitary Inspectors and/or measurers during the year 1937. These investigations showed that 237 of these 387 oases were still over-crowded and that the remaining 150 cases had been abated either by removal of tenants, death or marriage. During 1937, 165 new cases of overcrowding were discovered and these 131 were added to the schedule of overcrowded oases for re-housing. Of the remainder, 22 cases were abated by correspondence by the Chief Sanitary Inspector and 12 cases were reported to the Town Clerk for legal action, following failure by the responsible persons to abate the overcrowding. The 131 additional cases of overcrowding referred to in the foregoing may be subdivided as followsi:— 104 tenants overcrowded, 26 sub-tenants overcrowded, and 1 owner-occupier overcrowded. 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 these cases are then deleted from the schedule of overcrowded cases. Where an offence under the Act has been committed the appropriate action has been taken. 33 311 follow-up visits were paid by the District Sanitary Inspectors in all cases where the overcrowding has become abated by re-housing. A total of 1,147 visits have been paid by the District Sanitary Inspectors in connection with the Housing Act, 1936, during the year. (e) General. Mr. J. E. West, your Council's Housing Manager, kindly contributes the following statement:— (Period January 1st to December 31st, 1937.) Number of additional properties available for letting130 Number of other vacancies arising 110 Total number of lettings 240 These lettings are analysed as follows :— Rehoused from Housing Register 33 ,, on medical grounds 3 ,, from scheduled areas (1930 Act) 16 ,, by redistribution 34 86 ,, Council tenants, redistribution 20 ,, direct (1936 Act) 134 154 240 Abatement of Overcrowding. Number of scheduled cases as at 1st January, 1937 (a) 622 Additional cases reported during the year (b) 131 Total 753 (a) 54 relate to residents in Council properties. (b) 8 relate to residents in Council properties. Rehoused (includes 20 Council tenants) 154 Abated by redistribution, etc. 169 Removals 120 Deferred cases (c) 37 326 480 273 34 (c) These cases have been deferred rehousing for various reasons. For example, a certain number are not prepared to accept alternative accommodation, preferring to remain in their existing circumstances pending obtaining their own accommodation; alternatively, natural abatement of overcrowding which is anticipated due to marriage, etc. In other cases it had been felt that the overcrowding had been caused unreasonably and the bona fides of the cases were not altogether satisfactory. "A number of cases remain on the schedule who require acoommodation under the re-housing standards, as laid down in the Act, and are scheduled herewith: — 1 requiring 1 bedroom type house. 6 ,, 2 ,, ,, ,, 5 ,, 3 ,, ,, ,, 90 ,, 4 ,, ,, ,, 123 ,, 5 ,, ,, ,, 43 ,, 6 ,, ,, ,, 4 7 ,, ,, ,, ,, 1,, 8 ,, ,, ,, "Abatement of overcrowding has been greatly facilitated during the year by rigidly adhering to the policy of the Council, which is to allocate every possible vacancy, primarily to re-house persons living in scheduled areas under the 1936 Act, alternatively where such accommodation has not been appropriate to the family concerned, it has been offered to a case appearing on the overcrowding schedule. Consideration has next been given to cases recommended by the Medical Officer of Health on medical grounds, and finally where accommodation is not appropriate to any cases aforesaid, to any applicant who registered prior to December, 1933. "It will be observed from the foregoing table that the requirements are in the nature of multi-bedroom type houses rather than the normal three-bedroom type. "Proposals are already before the Ministry for the erection of a further 74 houses on the remaining portion of the Millfield Avenue site, and 14 on the remaining portion of the Essex Hall site. "I think it could rightly be claimed, having regard to the progress made in the abatement of overcrowding during the past year that the position could be considered reasonably satisfactory, as it will be seen that of the 753 scheduled oases, only 273 remain to be dealt with. 35 "It hardly seems feasible to anticipate the same rate of progress during the ensuing year, having regard to the very small possibilities of acquiring more land for the erection of further houses within the Borough boundaries. "The number of houses already erected by the Council are referred to in detail in the report for 1936. The houses on the Chestnuts Farm Estate reported therein, are all completed and occupied. "It has been abundantly brought to the notice of the Department when rehousing for the abatement of overcrowding, that the persons re-housed were those most in need of re-housing from almost every point of view, that is, they were amongst the very poorest wage earners and in a very great many cases, unemployment for a very considerable period was disclosed. Rent relief is almost inevitable in such cases. "Re-housing in this scheme has also brought to light many problems not hitherto met with, at all events in such magnitude. "Removals have to be arranged, furniture supplied, persuasive conversation with the principal tenant, and/or his wife, before they can be persuaded to leave their old surroundings and take up the much superior accommodation available for theim. "Considerable guidance has had to be given to the tenant before the tenancy is commenced, and it is pleasurable to report that a very large measure of success has been achieved in this direction, tenants having responded, probably not 100 per cent., but very little short. Slum Clearance. "There is only one remaining case on the list for rehousing under the above scheme, and accommodation required is of the multi-bedroom type referred to elsewhere. Accommodation for Cases not Overcrowded. "No additional accommodation has been provided during the year for rehousing the aged or elderly couples. Vacancies arising have been extremely few and such vacancies are invariably offered to similar types of persons. "During the year the Council decided to reserve a percentage of the accommodation available for young married couples. Having regard to other commitments, however, it was not found possible to reserve more than one two-bedroom type house for this section of the community. 36 Eradication of Bed Bugs. ''During the year under review, it has been necessary to deal with nineteen eases where vermin infestation has been found. "The methods at present being utilised, by the Department are:— (a) Cymex Candle Treatment. (Three cases have been dealt with under this heading.) (b) Bono Spray. (Sixteen cases have been dealt with by this method, as the extent of infestation was not so extensive as the three cases referred to above). Welfare Work. "Previous reports have suggested the need tor instituting an extension of social service, and in July, 1937, the Council appointed a woman Welfare and Social Worker, primarily for the benefit of the Council's Housing Estates. "The need for such service has been obvious for many years, and there is no doubt- whatever, that the engagement has proved a real service, not only to the tenants in particular but the Town in general. "Innumerable requests are received from tenants for the Social Worker to call, and many and varied are the subjects discussed. I have reason to consider that the Welfare Worker has been welcomed in almost every house at which she has called and certainly this is the case after the second call . "It is part of the duties of the Social Worker to visit all prospective tenants and to inspect their houses and effects. In instances where vermin is found, advice is given on the best methods for the housewife to adopt in order to rid herself of these pests, and at the same time careful notes are made of all rooms or articles infested. "When a Council House is allotted to a family, the Social Worker again visits—even if in the first instance the present house has been accounted clean and free from vermin—and reinspects the furniture. All articles noted as vermin infested at the first visit, and any others which have also become infested, or are merely suspect, must be disinfested. Articles unlikely to benefit by this treatment are recommended for incineration. The Social Worker draws up a list, agreed upon by the tenant, to have the selected articles disinfested, or where necessary destroyed. The latter precaution is taken in order to prevent a further spreading of the vermin to other houses by disposal of the infested furniture in the open market. 37 ''The disinfestation and/or the destruction is carried out by the appropriate department of the Council, who receives a duplicate list of the articles to be treated. "Early on the day of removal, the articles listed, are collected from the old address of the prospective tenant and destroyed or disinfested as the case may be. The articles disinfested are delivered later in the day to the new Council House and are available for use of the tenant. "When the family has been rehoused and, by the above means, is in possession of clean furniture, the Social Worker visits constantly, first to point out the facilities available to prevent reinfestation, some of which are quite a novelty to families accustomed to rooms devoid of all sanitary conditions and later to inspect and to ensure that the housewife is making use of her new conveniences and maintaining a clean house. "In cases where Council Houses have been disinfested, the Social Worker again calls regularly and advises on hygienic methods and on the prevention of a recurrence of the pests. In this way tenants are encouraged and persuaded to maintain and take a pride in possessing clean comfortable houses:." E.—INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Routine phosphatase tests are being carried out on samples of pasteurised milk more particularly to control the efficiency of the three plants licenced in the Borough. During 1937 your Council decided to inform the Ministry of Health that it supported the promotion of legislation to secure the compulsory pasteurisation of milk. The number of notifications or non-pulmonary tuberculosis (which it is reasonable to assume should show some relation to the extent of tuberculous infection of milk) during 1937, amounted to 25. The following table shows the position during the last 16 years. Year. Non-pulmonary Notifications Tuberculosis Deaths. Year. Non-pulmonary Notifications. Tuberculosis Deaths. 1937 25 12 1929 52 17 1936 27 14 1928 36 15 1935 41 6 1927 42 14 1934 34 15 1926 55 18 1933 45 11 1925 58 26 1932 34 14 1924 56 18 1931 40 13 1923 57 26 1930 34 9 1922 38 14 Average for Average for 8 year 35 11.75 8 years 49 18 38 The following extracts are taken from the Bulletin of the Health Organisation, League of Nations, June 1937. The Milk Problem. "It is our considered and emphatic opinion that all liquid milk for human consumption should be adequately pasteurised or boiled." "We believe that the future of the dairy industry lies in the gradual elimination of the small and often inefficient distributor, and its concentration into the hands of large, well-organised firms which are making use of every aid that science can offer them to improve the technical efficiency of their business and the high quality of their products. Just as, during the past century, the water supply of our large towns has passed out of the hands of multiple small producer-retailers into the hands of large concerns, controlled by the municipality, a public utility company, or some similar body, so, in the future, we believe that milk for human consumption in the liquid state will come to be regarded more and more as an article of food over which such care has to be exercised that none but large and efficient organisations will be allowed to handle it." The following is contributed by Chief Sanitary Inspector. The average number of cows kept in the district is seven. There is only one cowshed, and 12 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 243, most of whom carry on a general shop and sell milk in bottles as they receive it. Two hundred and thirty-seven visits were paid to registered premises of purveyors of milk during the year, and the general standard of cleanliness was maintained. During the year 36 samples of milk were taken for bacteriological examination, with satisfactory results. Of these 7 were from milk supplied to schools in the town. The samples taken are summarised below. Grade of Milk. No. of Samples. Pasteurised 24 Tuberculin Tested 12 Total 36 39 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 adulteration of the milk supply of the town. The Milk (Special Designations) Order, 1936 The number of licences granted for the Sale of Milk under Special Designations classified in the above Order was as follows :— Dealers' Licences. In respect of:— Pasteurised Milk 24 Tuberculin Tested Milk 11 Bottling Licences. In respect of Tuberculin Tested Milk, 2; Pasteurised Milk, 3. (6) Ice Cream. Under the requirements of the Essex County Council Act, 1933, all Ice Cream Vendors or Manufacturers in the Town must be registered. In this connection, of the 48 applicants for such registration, the Council refused to register 7. There have been no appeals. (c) Meat and other Food. During the year 3,853 animals intended for human consumption were slaughtered in the town. Every animal was inspected at time of slaughter and for this purpose 494 visits were paid to the slaughterhouses. It has not always been possible to make ante-mortem inspections but in those instances where such were carried out no untoward symptoms were discerned. There are 96 butchers' premises in the town and 610 inspections of these were made. At one such establishment a pig's pluck affected with tuberculosis was discovered, seized, and condemned. Despite the plea of not guilty the butcher was fined £5 and costs at Stratford Police Court for this offence. No application for meat marking under Part III of the Public Health Meat Regulations has been received from traders. 40 The following table indicates the number of each type of animal slaughtered, the percentage of such affected with tuberculosis and other diseases. CARCASES INSPECTED AND CONDEMNED. Cattle excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 151 115 246 2,171 1,170 Number inspected 151 115 246 2,171 1,170 All diseases except Tuberculosis:— Whole carcases condemned — — 1 1 6 Carcases of which some part or organ was condemned 14 10 25 45 Percentage of the number inspected affected with disease other than tuberculosis 9.26 8.69 .406 1.19 4.35 Tuberculosis only.— Whole carcases condemned 1 1 1 — 2 Carcases of which some part or organ was condemned 14 28 1 48 Percentage of the number inspected affected with tuberculosis 9.93 25.21 .813 - 4.27 In addition to the above the following miscellaneous articles were condemned and destroyed as unfit for food. 1 Rabbit. 22 stone Haddocks. 5 stone Salt Brisket. ,, Cattish. 3 61b. tins Corned Beef. 2 boxes Cod. 4 lbs. Green Bacon. 1 box Kippers. 11 boxes Pears. 1 ,, Rock Salmon. 5 boxes Cod fillets. 5 boxes Herring roes. 41 (d) Adulteration, etc. (Food and Drugs Adulteration Act, 1928). Eighty-one samples were submitted for analysis during the year. Of the 81 samples, 78 were in respect of milk of which 5 were taken in course of delivery. One sample of milk showed that 2½ per cent. of water had been added and this was in connection with one of the cases reported in 1936. One sample of butter and 2 samples of groats were submitted for analysis. No legal procedure was necessary in respect of any sample. Although the Council is not a Food and Drugs Authority, such good work has fceen carried out in the past by continuous sampling under this Act and the Milk and Dairies (Amendment) Act that no relaxation in this matter is contemplated. The Chief Inspector of the Essex County Council Weights and Measures Department reports that 56 samples of milk, 81 of butter and 256 of other articles were taken by his Department during 1937. (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. (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. RENT AND MORTGAGE RESTRICTIONS ACTS, 1920-1923. During the year six certificates were granted to tenants and nine 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. Swine Fever Order, 1908.—During the year, two premises were declared as Swine Fever infected places—one declared on 12th March was withdrawn on 5th April; the other was declared on 24th Mav and was withdrawn on 28th Mar. 42 Regulation of Movement of Swine Order, 1922.—Ten Isolation Notices affecting 96 swine were received. The Licences were in all cases duly observed. 53 movement Licences were received under the Order. The total number of animals affected by such Licences was 831. Tuberculosis Order, 1925.—Routine quarterly inspections were carried out by your Veterinary Surgeon and Chief Sanitary Inspector. No instance has arisen calling for mention. RATS AND MICE DESTRUCTION ACT, 1919. During the year 179 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 outbuildings 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 Sanitakt Inspectors or Inspectors of Nuisances. Premises. Inspections. Number of Written Notioes. Ocoupiar* Prosecuted . (1) (2) (3) (4) Factories 510 20 Nil. (Inoluding Factory Laundries.) Workshops .. 218 5 Nil. (Including Workshop Laundries.) Workplaces 145 6 Nil. (Other than Outworkers' premises.) Total 873 31 Nil. 43 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars Number of Defects. Number of offences in respect to which Prosecutions were instituted Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts: — Want of cleanliness 73 73 — — Want of ventilation 4 4 — — Overcrowding — — — — Want of drainage of floors 3 3 — — Other nuisances 54 54 — — insufficient 6 4 — — Sanitary unsuitable or defecaocommodation tive 90 90 - not separates for sexes 3 3 — — Offences under the Factory and Workshop Acts— Illegal occupation of underground bakehouse(s. 101) — - — — Other offences — - — — Total 233 231 Nil Nil NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1937. Wearing Apparel, making of 409 Fur 3 Brush Making 32 Artificial Flowers 10 Boxes 13 Toys 43 Christmas Crackers anil Handbag 7 Carnival Hat 6 Total523 44 Outworkers were notified from the following areas'— City of London 149 St. Marylebone 7 Bethnal Green 3 Stepney 9 Finsbury 61 Shoreditch 12 Hackney 46 Tottenham 12 Islington 8 Walthamstow 104 Leyton 101 Westminster 11 Poplar 12 Other Areas 15 Total 550 A total of 724 visits was paid in connection with outworkers as follows:—To Homes, 660; Factories, 51; Workshops, 13. 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 A over. 1937 1936 Soarlet Fever 207 315 1 51 116 24 12 3 Diphtheria 101 106 4 24 64 6 3 — Enteric Fever 11 8 — 1 3 3 4 - - Pneumonia 154 151 3 26 14 17 43 34 17 Puerperal Fever 4 5 — — — — 4 — - Puerperal Pyrexia 34 30 — — — 11 23 - - Ophthalmia Neonatorum 8 2 8 — — — — - - Erysipelas 61 52 3 1 6 8 18 18 7 Encephalitis Lethargica — — - — — — — - - Polio-encephalitis 1 1 - — — — 1 - - Cerebro-spinal Meningitis 1 1 - — — 1 — - - Anterior Poliomyelitis 9 5 1 2 6 — - - - Measles (under 5 years) 13 671 2 11 — - - - - Dysentery 84 5 — 30 37 7 9 1 — Tuberculosis 154 141 4 4 9 47 60 24 6 1937 Totals 1930 842 - 26 150 255 124 177 80 30 — 1493 49 745 330 118 156 66 29 45 Disease St James Street High Street Hoe Street Wood Street Hale End Higham Hill Totals Scarlet Fever 32 17 23 25 62 48 207 Diphtheria 42 11 20 8 6 14 101 Enteric Fever — 4 1 — 5 1 11 Pneumonia 22 21 15 15 22 59 154 Puerperal Fever — — — 2 1 1 4 Puerperal Pyrexia 4 4 4 10 6 6 34 Ophthalmia Neonatorum 3 2 o — — 1 8 Erysipelas 7 10 13 4 8 19 61 Encephalitis Lethargica — — — — — — — Polio-encephalitis — — — — — — 1 Cerebro-spinalMeningitis — — — — — 1 1 Anterior Poliomyelitis 2 — — 1 2 4 9 Measles (under 5 years) 3 1 o 1 2 4 13 Dysentery 33 25 10 6 g 8 84 Tuberculosis 23 33 19 16 33 30 154 Totals 1937 171 128 109 88 149 197 842 1936 277 186 233 149 246 402 1,493 From the foregoing tallies it will be seen that the outstanding feature of 1937 was an exceptional decrease in the incidence of Scarlet Fever, constituting the lowest recorded' figure for this disease The statistics given in the foregoing table are those for the calendar year 1937 The rates for Puerperal Fever and Puerperal Pyrexia are better expressed in relation to the number of births (ie live and stillbirths) registered than to population When calculated on this basis the rates are:— Puerperal Fever Puerperal Pyrexia Walthamstow 230 1959 England and Wales 1393 The Registrar-General gives the statistics for the 53 weeks ended 1st January, 1938, 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 P3'rexia Erysipelas Number 203 101 11 152 4 34 61 Case Rate— Walthamstow 153 076 008 115 003 025 046 England and Wales 233 149 005 136 (Not available) 037 46 Disease Total notified Removed to Hospital Per cent, removed to Hospital Deaths Deaths per cent, of cases notified Scarlet Fever 207 165 797 Nil Nil Diphtheria 101 98 9909 4 36 Enteric Fever 11 11 1000 Nil Nil Pneumonia 154 71 461 103 668 Puerperal Fever 4 3 750 1 250 Puerperal Pyrexia 34 13 382 5 147 Ophthalmia Neonatorum 8 5 625 Nil Nil Erysipelas 61 16 262 Not a classified cause of death Polio-encephalitis 1 1 1000 1 1000 Cerebro-spinalMeningitis 1 1 1000 Nil Nil Anterior Poliomyelitis 9 8 888 2 222 Measles (under 5 years) 13 Nil Nil Nil Nil Dysentery 84 20 238 Nil Nil Tuberculosis 154 184* 92 597 *This figure also includes cases notified during previous years Infectious Diseases Clinic—The weekly clinic at 2 pm on Tuesdays was continued, and all children of school age who had been in contact 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 Fifteen children were referred, 11 following diphtheria and 4 following scarlet fever One was already attending the rheumatism clinic before contracting infectious disease, and another failed to attend Of the remaining1 13 new patients referred, three had post-diphtheritic carditis and one had carditis following scarlet fever The following extract is from Dr Sheldon's report on the rheumatism Clinic :— ' 'Prevention—The practice of following up children who have been discharged from the Sanatorium after scarlet fever and diphtheria has been continued Twelve children were referred to the clinic in this way and 4 of these were found to have early cardiac damage "This method of prevention has now been employed for the last six years and the results have been analysed and embodied in 47 the opening paper of a discussion at the sixth Congress on Rheumatism held at Oxford in March, 1938 The following is taken from that communication:— " 'During the last six years a scheme of prevention has been introduced at Walthamstow, where the Medical Officer of Health has examined all patients under 15 years of age who have been discharged from the local fever hospital after scarlet fever and diphtheria Those who showed any abnormal cardiac signs were referred to the Walthamstow Rheumatism clinic, firstly for a more precise diagnosis, and then for treatment and supervision The results have been as follows:—3,050 children have been examined after leaving the fever hospital; 153 children with abnormal cardiac signs were referred to the Rheumatism clinic and of these, 33 (1 per cent, of those originally examinedl) were accepted as showing signs of rheumatic carditis Those in whom this diagnosis was not accepted were found to be suffering from a variety of cardiao abnormalities, such as congenital heart disease, nervous tachycardia, and functional bruits These were kept under observation for a period varying from 3 months to 4 years, but evidence of rheumatic carditis did not materialise in any of them' "Turning to the 38 children with early involvement of the heart, in 22 there was evidence of dilatation, and in 26 there was a systolic murmur at the apex conducted to the axilla A short, sharp first sound but no murmur was present in 5, and 5 had a mitral diastolic as well as a systolic murmur Treatment at home or in hospital, or in the special country heart homes, was arranged for these, followed by supervision at the rheumatism clinic on their return to school "The after-history of these children is as follows : a follow-up could not be maintained in 7, either because the parents had left the district, or from difficulty in obtaining oo-operation Of the remaining 26 no fewer than 15 are regarded as having recovered completely, that is to say, there is now no clinical evidence of any abnormality in the heart Even if we assume that carditis has persisted in the 7 cases not followed up, we are left with a recovery rate of 45 per cent, which, I submit, supports the contention that the early diagnosis of rheumatic heart disease combined with prompt treatment and prolonged supervision makes for a much improved prognosis "As would be expected, the prognosis was least satisfactory in those cases showing a diastolic as well as a systolic murmur The after-history of these children has been as follows : one child after 4 years is developing signs oif mitral stenosis; another was under observation for 2 years and then left school, at which time it was noted that there was a long mitral systolic murmur and shortness 48 of breath on exertion The third and fourth children had organic mitral systolic bruits after 3 and 5 years respectively, but were able to take part in full games and exercises at school, while in the fifth child the heart appeared perfectly normal after 18 months and has remained so for a further two years "The points in this investigation which 1 would like to emphasise are that a follow-up of children who have had an acute sore throat can be organised by public health authorities; that the diagnosis of early heart disease is to be expected in only about 1 per cent, of the children examined, and that this method of tackling the disease offers a means of limiting its ravages" Sore Throat Follow-up Scheme—At Dr Sheldon's request at the close of the year, a follow-up scheme was begun The parents of all children reported to the School Medical Service to have had a sore throat are to be invited in writing to bring the child to the infectious disease clinic approximately four weeks after the onset of sore throat The primary purpose is to make sure that no cardiac complications have followed the sore throat Only two cases were seen in 1937, but experience during 1938 suggests that the scheme will have definite value The parents have proved willing and anxious to co-operate 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 68 Number of attendances made 2,909 Average attendance per session 428 Number of scarlet fever cases discovered 1 Number of diphtheria cases discovered 10 Number of virulence tests taken in diphtheria carriers 49 Number of children recommended to rheumatism clinic 15 Number of children recommended to ear clinic 8 Number of children recommended to orthopaedic clinic 2 Diphtheria Immunisation—Immunisation was carried out at the weekly clinic on Tuesdays at 3 pm and at Infants' Departments, along the lines detailed in the previous reports The following summarises the work done :— Schick tested for the first time 161 Negative (including pseudo and negative) 65 Positive (including pseudo and positive) 96 49 Total number of immunisations completed during 1937:— (a) School age 1,250 (b) Pre-school age 154 (c) Over school age 6 Total 1,410 Number not completing immunisation or left district 38 Number of Schick & re-Schick tests following immunisation 777 Number of attendances made at Infectious Disease clinic for immunisation 1,916 Immunisation at schools (included above):— Number completely immunised 490 Number partly immunised 10 Number having second dose, immunised with single dose APT 1936 108 Diphtheria Immunisation at Schools—The first term of 1937 was occupied in completing the posterior Schick testing at eight Infants' departments which remained out of the 21 departments with children under 8 years of age and at which immunisation had been commenced with single dose Alum Precipitated Toxoid at the end of 1935 Summarising the whole of the work done since that time, a total of 1,502 posterior Schick tests: were done in children given one dose of 05 cc APT, and of these 1,141 (or 760 per cent) were negative at an average period of 238 weeks following the single dose The maximum and minimum percentages were respectively 98 and 28, at different schools The Schick test results at the various age levels are given below:— Age Group Total Schick Tested Total Positive % Positive % Negative 1-2 19 — 00 1000 2-3 36 2 55 945 3-4 65 8 123 877 4-5 151 26 172 828 5-6 378 89 235 765 6-7 463 137 296 704 7-8 389 98 252 748 8- 1 1 1000 00 Totals 1,502 361 240 760 The results suggest that the unreliability of the single dose method increases with age 50 The parents of those children incompletely protected were advised that a further dose was necessary, and in those responding no failure to obtain a negative Schick test was experienced Two dose method : 326 children, mostly under 8 years of age, were given two doses of APT, ie, 01 cc—14 days—05 cc All were Schick negative approximately one month after the second dose except for 9 Of these, 6 were negative approximately two months later and the other 3 were not re-tested, ie, by the two dose APT method only 3 were still possibly Schick positive at two months, ie, a Schick negative rate of 994 per cent Relapsed Immunity (1) One school which gave only 2 per cent Schick positive in November, 1935, after one dose APT was re-Sohicked on April 14th, 1937 Of 93 children previously Schick negative, 344 per •cent, had relapsed (2) Another school which had yielded 29 per cent Schick positive in April, 1936, after one dose APT showed on May 5th, 1937, 5 Schick positive amongst 40 previously negative, ie, a relapse rate of 125 per cent, but none amongst 15 who had Ijeen given a second dose 025 cc APT following their first positive posterior Schick In the light of this experience it was decided in the new school year, ie, September, 1937 to revisit all Infant and Mixed Departments and to offer a further dose to those children only previously immunised with the single dose method, and to use the two dose method (025 cc—14 days—05 cc) in all cases, but omitting the posterior Schick tests Up to the end of the year seven schools had been visited and 450 new cases were done and 50 new cases of pre-school age who were brought by the parents by invitation By this method it is hoped to secure as many acceptances as with the old method and at the same time to obtain a better and more lasting immunity The weekly immunisation clinic was continued on Tuesday afternoons, and as far as possible all children over five years are Schick tested after immunisation in order to control the efficiency of the prophylactics used Pre-school children who have been protected are advised to return for a Schick test shortly before being admitted to school By this means, in future years, it is hoped to gain valuable information as to the permanency of immunity following the use of APT 51 The following table gives a comparison of the attack rates of Diphtheria on the immunised and the non-immunised sections of the population under 15 years of age Year Immunised Not Immunised Population immunised under 15 years of age No of eases of Diphtheria under 15 years of age Attack rate per 1,000 population under 15 years immunised Deaths under 15 years Estimated population not immunised under 15 years of age No of cases of Diphtheria under 15 years of age Attack rate per 1,00P populat;on under 15 years Deaths under 15 years 1926 34,813 232 66 5 1927 33,899 229 67 11 1928 32,864 231 702 8 1929 31,888 273 85 16* 1930 30,100 439 104 22 1931 30,790 (census) 275 89 9 1932 36 — 30,754 321 104 5 1933 157 — - — 30,633 282 92 7 1934 320 — — — 30,470 235 77 8 1935 996 1 10 — 29,794 148 49 4 1936 2,182 1 045 — 28,608 88 307 2 1937 3,613 3 083 27,177 92 33 5 * All Ages 52 If the 609 persons who had given Schick negative results are added to the total of 3,613 immunised, the attack rate in this group is lowered to 071 per 1,000 and it is raised in the non-immunised group to 346 per 1,000, ie, nearly five times more than the immunised group Only one of the three cases of diphtheria in the immunised group was of any real severity, and considering the amount of membrane present there was a gratifying absence of toxnemia and there were no complications There was little doubt that although immunisation in this case had not prevented an attack of diphtheria, it had unquestionably helped to save the child's life All these cases had been protected by the single dose method which has now been discarded in favour of the two dose method Scarlet Fever Immunisation Dick Tests for Scarlet Fever— Positive, 31 ; Negative, 38 Total, 69 One child at Brookfleld Hospital was immunised Immunisation by General Practitioners—Diphtheria prophylactic is available to general practitioners During 1937, 16 ccs of alum precipitated toxoid were issued MUNICIPAL LABORATORY The following numbers of diphtheria swabs were examined during 1937:— Swabs Negative Positive Totals Private Practitioners 873 57 930 Health Department 244 34 278 School Medical Department 360 10 370 Totals 1,477 101 1,578 The total number of diphtheria specimens examined in 1936 was 1,735 Direct examinations: were done on 147 diphtheria specimens, and 17 were positive; 12 were positive on culture, although negative on direct examination In addition, 213 specimens of urine were examined, as compared with 159 in 1936 A total of 3,038 tubes of culture media were made by Mr West, and of these, 1,440 were sent to the Sanatorium 53 ESSEX COUNTY COUNCIL SCHEME The Essex County Council also provides facilities for examination of pathological specimens, and the County Medical Officer states that 2,730 specimens were examined for local practitioners during 1037 as follows :— Diphtheria Swabs, 137; Sputa, 1,059 ; Typhoid Specimens, 127; Ringworm Specimens, 15; Miscellaneous, 1,389; Diphtheria Virulence Tests, 1; Biological Examination for Tubercle Bacilli, 2 A total of 682 specimens were examined for the Connaught Hospital (included above) The total examinations carried out by the Essex County Council for the previous year was 1,465 VACCINATION Mr E Sharp, Vaccination Officer for the Area, has furnished the following return for 1937 :— Births Registered, Successfully Vaccinated Percentage Vaccinated, Insusceptible Exemptions Death before Vaccinated Postponed 1671 272 162 3 1258 53 51 In addition to the above, 18 primary vaccinations were recorded, and 21 re-vaccinations During 1937 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 256 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 1937 SCARLET FEVER A total of 207 cases of Scarlet Fever was notified in 1937, as compared with 315 in 1936 54 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 18 2 9 4 3 - - February 19 1 3 8 6 1 - - March 30 5 25 - - April 17 — 4 7 4 2 - - May 15 3 9 1 2 - - June 15 — 4 7 3 1 - - July 21 6 11 2 2 - - August 11 4 5 1 1 - September 9 5 3 1 - October 23 4 18 1 - - November 19 5 11 3 - - December 10 — 6 3 — 1 - Totals 1937 207 1 51 116 24 12 3 - 1936 315 3 65 188 36 23 - - Month St James Street High Street Hoe Street Wood Street Hale End Higham Hill January 3 2 2 2 3 6 February 2 1 2 2 6 6 March 4 — 2 2 18 4 April 5 2 1 3 5 1 May 3 2 4 1 4 1 June — 2 2 , 8 3 July — 3 2 2 7 7 August 3 — 3 2 3 September 2 3 1 1 - 2 October 4 1 3 4 6 November 6 1 1 3 8 December — — — 3 2 5 Totals 1937 32 17 23 25 62 48 1936 37 50 66 19 41 102 The percentage of oases removed to Hospital during 1937 was 797 against 911 in 1936 No case was refused admission The continued fall in the incidence of Scarlet Fever will be noted (ie, 1937, 207; 1936, 315; 1935, 569; 1934, 605), and a decrease 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 are: adequate isolation facilities (ie, a- 56 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 The following table with respect to the incidence of Return Cases during the last five years will bear out this statement. Year. Following Hospital Treatment. Following Home Isolation. Primary Cases. Return Cases. Primary Cases. Return Cases. No. No. Percentage. No. No. Percentage. 1934 465 16 3.4 140 1 0.7 1935 454 28 6.1 115 1 0.8 1936 287 2 0.6 62 1 1.6 Total 1,206 46 3.8 317 3 0.9 1937 205 2 0.9 45 Nil Nil The high return case rate for 1934/5 will be noted—the obvious explanation being the high incidence causing relative overcrowding of Wards with consequent increased complications, cross-infection and return cases DIPHTHERIA A total of 101 cases of Diphtheria was notified during 1937, as compared with 106 in 1936 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 6 — — — — February 12 1 2 7 1 1 — — March 10 1 3 6 — — — — April 7 — 2 5 — — — — May 5 — 1 4 — — — June 7 — 5 — — — July 6 — 1 3 2 — — — August 7 — n 3 1 1 — — September 11 — 3 7 1 — — October 13 — 3 10 — — — — November 9 2 4 — — — — December 7 — 1 4 2 — — — Totals 1937 101 4 24 64 6 3 — — 1936 106 — 21 67 8 9 1 — 56 Month St James' Street High Street Hoe Street Wood Street Hale End Higham Hill January 2 2 1 1 - 1 February 6 3 2 — 1 2 March 5 — 1 2 — 1 April 4 1 — 1 — 2 May 2 — — — 1 I June 2 1 1 1 — 2 July 1 1 2 — — 2 August 6 1 1 1 — — September 1 1 4 — 2 — October 7 1 3 — — 1 November 4 — 2 1 2 1 December 2 — 3 1 — 1 Totals 1937 42 11 20 8 6 14 1 1936 29 14 10 6 11 36 The percent age of cases removed to Hospital in 1937 was 990 against 952 in 1936 No case was refused admission as home treatment of Diphtheria can rarely he 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 1937, a total of 90 phials, containing 652,000 units of Diphtheria antitoxin, and 21 phials, containing 210 ocs of Scarlet Fever Antitoxin, was issued Diphtheria notifications have again remained low 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 ENTERIC FEVER Eleven cases of enteric fever were notified in 1937 All the cases were para-typhoid B, and were notified between 23rd January and 17th July In spite of the most careful inquiries no connection could be established between the cases'and no source of infection could be found 57 The following table gives particulars :— No Ward Age Date of Onset Diagnosis 1 Hale End 4 23137 Para-typhoid B 2 Higham Hill 19 ? 7137 , , 3 High Street 33 14237 , , 4 Hoe Street 13 14237 , , 5 Hale End 16 ? 3437 , , 6 Hale End 31 ? 13437 , , 7 Hale End 13 ? 10437 , , 8 Hale End 6 ? 13437 , , 9 High Street 30 22537 , , 10 High Street 19 17737 , , 11 High Street 35 17737 " All the cases were treated in Hospital BACILLARY DYSENTERY (a) First Series—Outbreak at Nursery School On June 23rd attention was called to the fact that the whole of one family with children attending the Nursery School had suffered from diarrhoea and vomiting When visited, the parents and five children were found to l>e more or less convalescent The first case was stated to be J W, aged 2 years, who with her sister, K W, attended the Nursery School A tentative diagnosis of bacillary dysentery was made Rectal swabs were taken and despatched for examination The following morning a message was received from the Head Teacher of the Nursery School reporting that there had been many cases of diarrhoea amongst the children On visiting, it was found that some 1 4 children were stated to have, or to have had, diarrhoea Rectal swabs were taken from these children, and after an enquiry into the whole circumstances at the school it appeared that the outbreak was probably due to bacillary dysentery The outbreak did not appear to be due in any way to food eaten at the school, but rather to a case-to-case infection, probablv originating with J W After consultation with the Director of Education it was decided to close the school forthwith in order to try to limit the spread of infection Closure was effected under Viticles 22 and 23 of the Code of Regulations for Public Elementary Schools, 1926 58 Later in the day visits were paid to seven absentees, also reported to be suffering from diarrhoea All except one were under the care of the family doctor and all appeared to have dysentery In some cases the illness had already spread to other children (later enquiries emphasized the highly infectious nature of the disease; eg, mam^ parents contracted the illness, and even members of other families sharing the same house) A circular letter was sent the same day to the parents of each child attending the Nursery School The letter advised the calling of medical aid in the event of diarrhoea and sickness, and the strictest precautions in order to avoid the spread of the illness Concurrently, a circular letter was sent to each medical practitioner in the town notifying the occurrence of the outbreak, and suggesting that it was due to bacillary dysentery The letter stated that patients could be admitted to the Sanatorium on request being made in the usual way On Saturday morning the 5 swabs from the " W" family and 7 of the 14 taken at the Nursery School were reported to have yielded B Dysenteric Sonne A further circular, letter was sent to all medical practitioners informing them that the outbreak was definitely dysenteric, drawing attention to the secondary cases, to the comparative mildness of the illness in most cases, and requesting co-operation in advising patients and contacts as to its extreme infectivity, and in particular requesting the name and address of any person trading in connection with food supplies The Director of Education was asked to instruct the caretakers of all schools in the St James Street area to disinfect all lavatory seats daily until further notice A total of 49 cases (all ages) were notified in connection with the outbreak, but the total number of persons affected in more or less degree is estimated at approximately 90 The very mildness of the illness in most cases has rendered it insidious and difficult to deal with The Nursery School was re-opened on July 12th with certain additional safeguards put into operation to limit the danger of further cases In view of the possibility of " carriers," further cases were expected, especially when it is remembered how difficult children between the ages of 2 and 5 years are to deal with when there is any tendency to diarrhoea In addition, there is at any Nursery School every conceivable factor favourable to the spread of such an outbreak Fortunately, no further cases were reported Two cases were reported amongst children attending a neighbouring school, but no direct connection could be traced 15 of the 59 total of 49 cases were scholars at the Nursery School and 25 were direct home contacts of these cases The remaining 9 were sporadic cases in homes in this portion of the Borough (6) Second Ser es Following the apparent termination of the Nursery School outbreak, three cases were notified between 8th and 23rd November A circular letter was again sent to all medical practitioners in the Borough stating the Wards in which the cases had occurred and giving all available information Twenty-five of the cases attended some 19 different schools, all of which, with one exception, were situated in that part of the Borough to the south of Forest Road As with the first series of cases, no common cause could be discovered and the infection appeared to be spread from case to case The age grouping of the cases is as follows:— First Series Second Series Total 0-5 years 26 4 30 5-10 years 9 15 24 10-15 years 7 6 13 15-25 years 5 2 7 25-45 years 2 7 9 Over 45 years — 1 1 Total 49 35 84 PNEUMONIA The tables show the incidence by months, ages and wards Most of the cases removed to Hospital received treatment at Whipps Crow Hospital :— Month All ages Under 1 yr 1-5 yrs 5-15 yrs 15-25 yrs 25-45 yrs 45-65 yrs 65& over January 60 1 13 3 7 17 13 6 February 14 1 6 1 — 1 4 1 March 7 1 — 2 — 3 1 — April 13 2 — 1 6 2 2 May 7 — — — 1 1 4 1 June 4 — — — 1 2 — 1 July 4 — — 1 1 1 1 — August 7 — 1 1 2 1 1 1 September 4 — — 1 — 1 2 — Ootober 5 — 1 1 — 3 — — November 11 — X 1 3 2 4 December 18 — 3 3 3 4 4 1 Totals 1937 154 3 26 14 17 43 34 17 1936 151 4 19 37 16 38 20 17 60 Month St James' Street High Street Hoe Street Wood Street Hale End Higham Hill January 3 9 6 9 7 26 February 3 2 2 — 2 5 March — 1 — 1 2 3 April 2 1 2 — 5 3 May 2 2 1 — 1 1 June — - 1 — — 2 July 1 - 1 — 2 1 August — 1 — 3 — 3 September 2 - 1 — - I October 1 1 1 — 1 I November 2 2 2 - 5 December 6 2 — 2 8 Totals 1937 22 21 15 15 22 59 1936 24 13 18 26 26 44 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 PUERPERAL FEVER AND PYREXIA See Maternity and Child Welfare Section OPHTHALMIA NEONATORUM See Maternity and Child Welfare Section ERYSIPELAS 61 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 2 1 — — — 1 — — February 5 1 — 1 — 1 — 2 March 5 — — — — 3 2 — April 3 — — — — 1 1 1 May 4 — — — 1 1 2 — June 7 — — — 2 — 5 — July 11 — — 1 1 5 3 1 August 3 — — — 2 1 — — September 7 — — 1 2 1 1 2 October 6 1 1 — — 2 2 — November 3 — — 2 — — 1 December 5 1 2 Totals 1937 61 3 1 6 8 18 18 7 1936 52 1 2 5 11 25 8 Month St James Street High Street Hoe Street Wood Street Hale End Higham Hill January — 1 — 1 — — February 1 1 — — 3 March — 2 1 1 — 1 April 1 — 2 — — — May — — 2 — 1 1 June 1 — 1 1 2 2 July 1 1 3 — 1 5 August — — 1 — — 2 September 1 2 2 — 1 1 October 1 1 1 3 — November — — — — 3 December 1 2 1 — — 1 Totals 1937 7 10 13 4 8 19 1936 9 13 10 4 7 9 CEREBRO-SPINAL MENINGITIS Three cases were notified, two being later withdrawn Date of By No Ward Age Notifi- whom Remarks cation Notified' *1 High Street 57 15237 Hospital Died in hospital *2 Higham Hill 6 31537 ,, Died in hospital, meningitis following mastoidectomy 3 Higham Hill 16 161237 ,, Recovered *Notification withdrawn 62 ANTERIOR POLIOMYELITIS Nine cases were notified:— No Ward Age Date of Notification By whom Notified Remarks 1 Hale End 6 19537 Private Practitioner Died 2 Higham Hill 8 16737 „ Recovered 3 St James Street 3 ?15737 „ 4 Higham Hill 6 1937 „ 5 Higham Hill 3 16837 Hospital Attending hospital as an out-patient 6 St James Street 9 mths 23737 „ Attended hospital as an out-patient 7 Hale End 10 ?21137 Private Practitioner Died 8 Higham Hill 9 ?31137 „ 9 Wood Street 8 ?91137 „ ENCEPHALITIS LETHARGICA No case was notified during the year FOOD POISONING On© case brought to notice was that of a family consisting of the parents and four children, all of whom partook of some duck for dinner, following which the parents and two of the children were taken ill All were again well on the following day and the bacteriological investigation proved to be negative to microorganisms of the Salmonella group Another case reported from a Metropolitan Borough was that of a person notified as suffering from food poisoning The food suspected was purchased from a store in Walthamstow Immediate inquiries were made and as no other cases had been reported in this area it was considered that 110 further action was necessary MEASLES Under the Walthamstow (Measles) Regulations, 1932, all cases of measles in children under 5 years of age are notifiable, except secondary cases in the same household or institution within two months of the primary case 63 There were no deaths from measles during 1937 Home nursing is provided, where necessary, by the Walthamstow Distriot Nursing Association PREVENTION OF BLINDNESS No action was necessary under Section 66 of the Public Health (Amendment) Act, 19"25, or Section 176 of the Public Health Act, 1936, for the prevention of blindness or the treatment of persons suffering from any disease of, or injury to, the eyes TUBERCULOSIS The year 1937 was a non-epidemic year, the number of notifications being shown below In addition, there were 13 cases of measles reported by Head Teachers, and mainly in school children of 5-14 years Month Total U nder 1 yr 1-5 yrs St James' Street High Street Hoe Street Wood Street Hale End Higham Hill January - - - - - - - - - Ferbruary - - - - - - - - - March - - - - - - - - - April 3 - 3 - 1 - - - 2 May 1 - 1 1 - - - - - June 1 - 1 1 - - - - - July 3 2 1 1 - 1 1 — August — — — — - — — — — October 1 — 1 — - 1 — — — November — — — — - — — — — December — — — — - — — — — 4 — 4 — - — — 2 2 Total 1937 13 2 11 3 1 2 1 2 4 1936 671 39 632 143 1 75 95 74 119 165 The following table shows particulars of new cases of Tuberculosis and of all deaths from the disease in the Borough during 1937 :— Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary m f m f m f m f Under 1 year — - 2 2 - — 2 2 1— 5 years 1 - 2 1 - — — 1 5—10 years 1 1 - - - - - - 10—15 years — 2 2 3 1 — - - 15—20 years 7 10 1 1 1 5 — — 20—25 years 6 16 3 3 3 11 — 1 25—35 years 17 18 — 2 11 8 2 1 35—45 years 9 13 I — 10 4 2 — 45—55 years 12 2 1 — 5 4 — — 55—65 years 3 5 1 — 8 3 — 1 65 years and - - - - - - - - upwards 3 3 — — 1 5 — — Totals 59 70 13 12 40 40 6 6 129 25 80 12 154 92 64 The 92 deaths represent a death-rate of 069 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 1937 59 70 13 12 154 4D 40 6 6 92 1936 58 56 15 12 141 43 30 12 2 87 The ratio of deaths in non-notified cases (ie, columns to the right of the double line) to total deaths from tuberculosis was 22 to 92 or 1 to 42 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 1937 :— Pulmonary Total NonPulmonary Total Gbaku Total No on Register m f m f 1st January 812 704 1,516 446 365 811 2,327 Notified during 1937 59 70 129 13 12 25 154 Total 871 774 1,645 459 377 836 2,481 Removed from Register, 1937 55 62 117 11 8 19 136 No on Register 31st December 816 712 1,528 448 369 817 2,345 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 — 4 — 2 — 5 1 43 3 10 2 4 6 65 One hundred and thirty-six removals from the Register were made up as follows :— Deaths Removals Pulmonary NonPulmonary Pulmon ary NonPulmonary m F m F m F m F 35 35 6 4 20 27 5 4 70 10 47 9 80 66 136 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 op Tuberculosis Treatment is given under the Essex County Council's Scheme The admissions to Hospital during 1937 were as follows :— Pulmonary Non-Pulmonary Total M F M F Adults 72 77 2 4 155 Children 5 7 5 4 21 No action was necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, Section 62 of the Public Health Act, 1925, or Section 172 of the Public Health Act, 1936 The arrangements detailed in the report for 1935 were continued during 1937 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 mdlk supply, and in any case of doubt the milk is biologically tested for the tubercle bacillus 66 Infectious Diseases notified by the Medical Staff Scarlet Fever, 10; Diphtheria 34; Dysentery, 28; Total, 72 Disinfection—At the beginning of the year, two 119 Morris Vans were brought into use to replace the two existing vans G—INFECTIOUS DISEASES HOSPITAL Renovations, etc—The following works of renovation and maintenance were carried out during 1937 :— A Block—Interior renovation of scullery, provision of new barless fires, hearths and curbs to Nurses' Sitting Room Replacement of defective concrete paving with red flag paving Extensive repairs and repointing of chimney stacks and repointing of ridge and hip tiles B Block—Provision of new concrete floor to two Dressing Rooms and portion of corridor Provision of new doors and concrete platforms D Block—Interior and exterior renovations E Block—Replacement of defective concrete paving with red flag paving F Block—Interior and exterior renovations Replacement of defective portions of concrete paving with red flag paving G Block—Interior renovations T Block—Cleansing throughout Shelters adjoining T Block—Interior and exterior renovations I^aundry Block—Cleansing throughout Mortuary—Exterior renovation Lodge-—R«decoration of various rooms General—Renovation of entrance gates, provision of new flagstaff, new mess room and repairs to garden frames, lights and fences Renewal of defective gas main from road adjoining A Block to D Block Staff—The staff at the end of the year remained the same as that detailed in the Report for 1935 67 Five probationers were successful in the first part of their Fever Certificate examination, and two obtained the Certificate on completion of training General The death rate per 100 admissions of infectious disease patients was 129 and per 100 total admissions 212 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 (ie, 81 beds) 405 (2) £10 per ambulance 20 Total £425 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 The following table shows the admissions, discharges and deaths during 1937 :— Scarlet Fever Diphtheria Other Diseases Tuberculosis Totals Remaining in Hospital 1st January 11 13 4 19 47 Admitted during vear 172 158 56 37 423 Discharged during vear 171 150 56 32 409 Died during year — 4 1 4 9 Remaining in Hospital 31st December 12 17 3 20 52 DAILY AVERAGE NUMBER OF PATIENTS IX HOSPITAL, (including Tuberculosis cases) January 498 February 691 March 693 April 730 May 577 June 469 July 483 August 419 September 485 October 549 November 614 December 520 Average whole year 560 68 Epping Urban District Council—The agreement with this Authority was terminated on 31st March, 1937 CLINICAL REPORT Dr Hamilton, Resident Medical Officer, reports as follows : — AGE AND SEX OF PATIENTS ADMITTED DURING 1937 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 20 24 40 34 5 10 4 21 69 89 158 Scarlet Fever 26 21 26 46 10 6 15 22 77 95 172 Bacillary Dysentery 1 2 ' 2 2 1 2 — 3 4 9 13 Para-Typhoid Fever — — 1 — — 2 1 3 2 5 7 Whooping Cough 2 1 2 4 1 5 Pulmonary Tuberculosis 37 37 37 Staff- 20 20 20 Other diseases 4 1 1 2 1 — — 2 6 5 11 Totals 53 49 72 84 17 20 20 108 162 261 423 Other Diseases include Ophthalmia (1), Broncho-Pneumonia (1), Otitis Media (1), Observation (3), Non-specific Tonsillitis (3) Erysipelas (1) and Quinsy (1) AGE AND SEX AT DEATH Nine deaths occurred, details of which are given below : 4 Pulmonary Tuberculosis 1 Broncho-Pneumonia 1 Haemorrhagic Diphtheria 1 Diphtheria (Suppurative dicitis) 2 Diphtheria (Laryngeal) 4 Females aged 57, 26, 22 and 33 years Male aged 1 year 10 months Female aged 10 years Male aged 8 years 1 Male aged 2 years 1 Female aged 11 months 69 MONTHLY ADMISSIONS OF DIPHTHERIA CASES Month Under 6 yeara 5 to 10 years lOto 15 years Over 15 years Total Total H r m F m f m f m w January 3 2 6 1 - — — 11 3 14 February 3 O 6 6 1 3 - 4 10 15 25 Maroh 1 2 3 2 — 1 - 1 4 6 10 April 2 2 6 2 — 1 - 2 8 7 15 May 1 — 3 3 — — - 3 4 0 10 June 2 2 2 3 — 1 1 2 5 8 13 July 1 — 1 2 — — - 4 2 6 8 August 2 3 1 1 — 1 - 2 3 7 10 September 2 I 1 6 1 1 - 1 4 9 13 Oetober 1 3 6 6 1 1 1 — 9 9 18 November 2 6 3 1 — 1 1 1 6 9 15 December — 1 2 2 — — 1 1 3 4 7 Totals 20 24 40 34 5 10 4 21 69 89 158 The cases of diphtheria were classified as follows :— Twelve patients were regarded as dangerously ill Nine of these were given 30,000 units of ADS intravenously in addition to the appropriate intramuscular dose This group included one case of hemorrhagic diphtheria In all these cases some degree of nasal infection accompanied the faucial lesion Laryngeal diphtheria (3), severe fauoial (11), mild faucial (72), mild nasal (10), bacteriological diphtheria (50) Complications—Complete paralysis of the lower limbs, 2 In all oases classified as dangerously ill and as severe a considerable amount of paresis of the lower limbs followed :— Palatal paresis, 8; paralysis of rectus externus oculi, 1; and paralysis of ciliary muscle, 5 MONTHLY ADMISSIONS OF SCARLET FEVER CASES Month Under 5 to 10 to Over 5 yeai a 10 years 15 years 15 years ■ Total Total M F M F M F M * M V January 1 2 2 3 1 — 1 4 5 9 14 February 2 2 1 6 1 1 3 3 7 12 19 March 1 1 5 8 1 1 — I 7 11 18 April 2 2 2 3 1 1 3 4 8 10 18 May 2 1 5 4 — — 2 1 9 6 15 June 3 1 2 2 — — 1 5 6 8 14 July 1 5 4 4 — — 2 1 7 10 17 August 3 1 1 1 — 1 — 2 4 5 9 September 1 3 — 2 1 1 1 - 3 6 9 October 1 2 2 7 3 1 1 — 7 10 17 November 3 — 1 4 2 — 1 — 7 4 11 December 6 1 1 2 — — — 1 7 4 11 Totals 26 21 26 46 10 6 15 22 77 95 172 70 Scarlet Fever Cases transferred to Cubicle Block.— The following patients were transferred to the cubicle block for the reasons stated —Otorrhoea (2); chicken-pox and nephritis (1); contact chicken-pox (2); secondary tonsillitis (2); unconfirmed cases of scarlet fever (3); virulent diphtheria carriers (2) (1 throat, 1 nose); generalised urticaria which later developed to acute appendicitis and was transferred to Whipps Cross Hospital (1); suspected mumps (1); and acute mastoiditis (1). Staff.—Members of the staff were admitte 1 to hospital beds suffering from the following complaints:—Influenza (4); "Colds" (1); Tonsillitis (4); Septic finger (1); Chicken-pox (1); Laryngitis (1); Scarlet Fever (1); Injured foot (2); Gastritis (1); Ulcerated leg (1); Aural furunculosis (1); Vincent's Angina (1); Nervous debility (1). (Note by Medical Officer of Health)—By arrangement with the County Medical Officer all new nursing and domestic staff at the Tuberculosis Block are now tuberculin tested and have a chest X-ray taken before taking up duty in the Block. Negative tuberculin reactors are excluded from duty in this Ward. Operations at Hospital. Six operations were performed. Tracheotomy, 2; Mastoid operations, 2; Abscess of thigh incised, 2 (both operations were on the same patient). Specialist Consultations.—Six Consultants attended on 20 occasions to see eight patients for the following reasons:—Ear complications, 3; Heart complications, 2; observation for cerebral complications, 2; cervical adenitis, 1. Swabs.-748 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 9 2 11 From Epping U.D.C. - 4 4 From Wanstead and Woodford B.C. 1 1 1 Totals 9 7 16 The following cases were transferred to Whipps Cross Hospital:— 1. Admitted from Whipps Cross Hospital where the patient had been undergoing treatment for paralysis following anterior poliomyelitis, re-admitted after recovery from diphtheria for 71 further treatment. 2. Cerebral symptoms supervening on acute otitis media. 3. Acute appendicitis. 4. Pustular acne of scalp. 5. Schonlein's Disease. 6. Acute phlebitis and for investigation of pelvic symptoms. Duration of Treatment.- The average duration of treatment in Hospital was as follows:— Diphtheria 44.2 days. Scarlet Fever 27.2 days. Other diseases 28.6 days. The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1937 Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.). In Hospital on 1st January, 1937. Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1937. Observation — 1 - - 1 T.B. Minus 2 11 7 1 5 T.B. Plus Group I 1 3 3 1 — T.B. Plus Group II 14 22 21 2 13 T.B. Plus Group III 2 - 1 — 1 Totals 19 37 32 4 20 Fourteen of the 37 admissions were Walthamstow cases. MEDICAL EXAMINATIONS. During the year, 117 examinations were carried out by the Medical Staff in respect of the Superannuation and Sick Pay Schemes. 72 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 108 Post-Mortem 80 Post-Mortems and Inquests (not included in above) 26 Total 214 CREMATION. Facilities for cremation are Available at the Crematorium provided by the Corporation of the City of London, at Manor Park, 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. The National Milk Publicity Council arranged lectures and demonstrations at nine different meetings in the Borough of Walthamstow during the year:— 73 1. Feb. 2. -Girls' Club, St. James Street "Food Value of Milk." 2. Feb. 9. -Women's Meeting, Wood Street Milk Cooking Demonstration. 3. Apr. 19. -Women's Fellowship, Christ Church, Cedars Avenue "Foods for Health." 4. Apr. 20. —B.W.T.A.U., St. James Street Brotherhood "Milk for Health." 5. May 5. —Mothers' Meeting, St. Saviour's, Markhouse Road "Food Value of Milk." 6. June 9. —Women's Meeting, St. James Street ' 'Food Value of Milk.'' 7. Sept. 21. —Women's Meeting, Wood Street Milk Cooking Demonstration. 8. Oct. 4. —Women's Fellowship, St. Oswald's, York Road ' 'Food Value of Milk. 9. Dec. 6. —Women's Fellowship, Christ Church, Cedars Avenue "Health Rules." Your Council subscribes one guinea per annum to the Industrial Health Education Society. Lectures were arranged by the Society in Walthamstow during 1937 on various subjects. The Borough Librarian states that the works recommended in the list issued by the British Social Hygiene Council are, in the main, in stock at the Central Library. The Mutual Property, Life & General Insurance Co., Ltd., held a Health Exhibition for seven days in November which waa attended by 735 persona. Physical Training for Adults.—A report on the matter by the Education Committee Physical Training Organisers appears on page 45 of the report of the School Medical Officer for 1937. 74 The organisers give the following additional information with regard to the classes:— Approx. No Attending. Mondays Winns Avenue Keep Fit 20—30 Club Leaders' Course, Wood Street 20 Tuesdays Chapel End Keep Fit, 8-9 p.m. 60—80 ,, 9-10p.m. 20—30 Wednesdays Folk Dancing-Sword Class, 7.308 p.m. 21—20 Folk Dancing, 8-9 p.m. 40—50 Mission Grove Keep Fit 40—45 Thursdays Winns Avenue Keep Fit, 8-9 p.m. 30—40 ,, ,, ,, 9-10 p. m. 30 Selwyn Avenue Keep Fit, 8-9 p.m. 40—45 Saturdays Games, Salisbury Hall 20—30 The Women's League of Health and Beauty commenced a weekly class at Blackhorse Road School in October, 1937. 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 ,, Average rainfall, 1920-1929 28.23 ,, which represents a yearly average of 25.2 inches over the 30 years. The rainfall during 1937 was as follows:— January 3.33 inches July 1.50 inches February 3.97 ,, August 2.95 ,, March 2.57 ,, September 1.51 ,, April 2.75 ,, October 2.14 ,, May 3.11 ,, November 1.39 ,, June 2.31 ,, December 3.33 ,, Total 30.86 inches. MATERNITY AND CHILD WELFARE. 76 SECTION H. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs. E. M. Miller. Ex- Officio: His Worship the Mayor—Alderman G. Gibbons, J.P. The Deputy Mayor—Alderman Mrs. C. McEntee, J.P. Chairman of Finance Committee—Councillor E. C. Redhead (to September, 1937). Alderman Ross Wyld, J.P. (from September, 1937). Alderman Mrs. M. Norrish. ,, W. J. Sharp. ,, Ross Wyld, J.P. Councillor Mrs. L. P. Bailet. ,, Mrs. B. M. Friedberg. ,, Mrs. E. M. Hammond. ,, P. Hammond. Councillor T. G. Kennard. ,, Mrs. A. L. Meadows. „ G. M. Page. ,, Mrs. E. M. Richards. „ Mrs. E. A. Smith. ,, R. E. Smith. A. W. Stannard. Councillor Mrs. E. B. Toynbee. Co-opted Members: Dr. J. L. Mackenzie Brown. Mr. W. H. Kindell. Mrs. V. Cosset. Mrs. W. H. Kindell. Mrs. M. A. Cross. Mrs. W. J. Sharp. Mrs. Hatton. Mrs. J. De Vries. 77 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 Mart C. Sheppard, B.A., M.B., B.Ch., B.A.O., D.P.H., Barrister-at-Law. Obstetric and Puerperal Fever and, Pyrexia Consultants (part-time): Miss M. M. Basden, M.D., F.R.C.S., F.C.O.G. Alan Brews, Esq., M.D., F.R.C.S., M.C.O.G. Bardlet 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.S., 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 Rodwat, 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). Ansesthetists (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. C'assidy, 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) (to 15/4/37). Miss D. E. Laidler, S.R.Nr» S.C.M., H.V. Cert. (Half-time). Miss D. G. Legg, S.R.N., S.C'.M., H.V. Cert. (Half-time). Mrs. J. Morris, S.R.N., S.C.M., H.V. Cert. (Half-time) (from 24/5/37). Miss O. M. North, S.R.N., S.C.M., H.V. Cert. (Half-time) (from 24/5/37). Miss J. M. Palmeb, S.R.N., S.C.M., H.V. Cert. (Half-time) (from 9/8/37). 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. Ctert., A.R.S.I. (Half-time). 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). (Eight 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. 78 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 done by the Maternity and Child Welfare Service during 1937. The year is notable for the operation of the Midwives Act, 1936, the organisation of an emergency obstetric unit, and the approval given to the scheme of training in gas and air analgesia at the Maternity Hospital. The total number of attendances at. the Council's Clinics was just under fifty thousand. I wish to take this opportunity of acknowledging your continued consideration and the good work of the staff. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 79 NOTIFICATION OF BIRTHS. 1,826 births (189 of which belonged to other areas) were notified during the year under the Notification of Births Acts, 1907 and 1915, and the Public Health Act, 1936. Notifications were received as follows:—doctors and parents, 428: midwives, 1,398. Included in the above are 205 births which were notified as having occurred outside the Borough. Also included are 55 stillbirths, 6 of which did not belong to the area- 15 were notified by doctors and 40 by midwives. Of the total, eleven occurred outside the area. The stillbirth rate per 1,000 population was 0.45. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Wales. Females. Totals. Legitimate 827 807 1.634 Illegitimate 25 16 41 852 823 1,675 (b) Stillbirths. Males. Females. Totals. Legitimate 31 26 57 Illegitimate 3 — 3 34 26 60 Of the 1,691 birth registrations received in the Department between 2nd January, 1937, and 1st January, 1938, a total of 156 were not notified in this area, but some may possibly have been notified elsewhere, especially in view of the fact that of the 1,691 registrations, 242 referred to births which belonged to other areas. Of the 1,691 local registrations, 242 are excluded, leaving a net total of 1,449, which are allocated to the wards as follows:— 80 The local registrations for 1937 were 47 more than in 1936 Births Registered Locally, 1937. 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 3 7 9 9 11 6 4 6 15 7 13 15 55 50 105 February 7 6 10 10 9 10 6 7 9 14 15 11 56 58 114 March 8 9 7 4 18 11 5 16 15 15 18 21 71 76 147 April 8 7 5 6 9 13 12 7 9 7 16 20 59 60 119 May 10 11 12 9 1 9 10 6 16 12 12 11 61 58 119 June 8 7 7 10 12 14 12 17 19 18 14 21 72 87 159 July 11 11 7 5 12 8 10 10 13 13 12 12 65 59 124 August 11 7 8 8 9 13 9 7 20 16 17 10 74 61 135 September 9 4 11 8 8 9 6 6 9 12 21 7 64 46 110 October 12 11 5 9 8 9 4 5 17 11 12 9 58 54 112 November 7 12 5 10 9 3 5 4 7 12 11 15 44 56 100 December 4 7 9 6 7 7 14 11 10 7 8 15 52 53 105 Totals 98 99 95 94 113 112 97 102 159 144 169 167 731 718 1,449 Grand Totals 197 189 225 199 303 336 1,449 81 INFANT MORTALITY. The deaths of infants under one year of age were:— Males. Females. Total Legitimate 51 36 87 Illegitimate — — — Total 51 36 87 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, 53; Illegitimate, nil; Total 51. The Infant Mortality Rate for other areas during 1937 was as follows:— England and Wales 58 125 County Boroughs and Great Towns (including London) 62 148 Smaller Towns (25,000 to 50.000) 55 London 60 Neo-Natal Mortality. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1937, 35 infants died in the first four weeks of life, yielding a rate of 20.8. 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. The following rates refer to Walthamstow:— Infant Deaths, Neo-Natal Mortality and Stillbirths. Year. Live Births. Birth Rate. 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. 1937 1,675 12.7 60 35.8 0.45 35 20.8 87 51 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 1930 1,959 15.7 69 34.0 0. 55 41 20.9 78 39 The neo-natal mortality for England and Wales for the decennium 1921-30 was 33. The following table shows the causes of death of children under one year of age during 1937:— 82 SUMMARY, 1937. Causes of Death of Children under 1 year of age. Cause of Death Under Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3 Months and under 6 Months 6 Months and under 9 Months 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 - - - - - - - - - - - - - - - - Small Pox - - - - - - - - - - - - - - - - Chicken pox - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - 1 1 - - 1 - - - Erysipelas - - - - - 1 1 1 - 3 — 1 - 1 1 - Tuberculous Meningitis - - - - - - 1 1 2 4 2 1 - - 1 - Abdominal Tuberculosis - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - Convulsions - 1 - - 1 - - - - 1 - 1 - - - - Laryngitis - - - - - - - - - - - - - - - - Bronchitis - - - - - 1 1 - 1 3 1 - 1 1 - - Pneumonia (all forms) 2 - 1 - 3 3 5 6 2 19 4 3 4 1 3 4 Diarrhoea — - - 1 1 3 3 3 1 11 4 1 — 2 3 1 Enteritis — - - - - 1 - - 1 2 - - - - - 2 Gastritis - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - Inattention at Birth, wilful neglect .. - - - - - - - - - - - - - - - - Suffocation, overlaying - - - - - - - - - - - - - - - - Injury at Birth - - - - - - - - - - - - - - - - Atelectasis - - - - - - - - - - - - - - - - Congenital Malformations 2 - 1 - 3 1 1 - - 5 - 1 - 2 1 1 Premature Birth 12 1 - - 13 - — - — 13 2 1 3 3 3 1 Atrophy, Debility and Marasmus 2 - - - 2 4 1 - — 7 1 — 2 2 2 — Inanition 2 - - - 2 - - - - 2 2 - - - - - Heart Failure 3 - - - 3 1 - 1 - 5 - - 2 - 3 - Other Causes 5 2 - - 7 3 — - l 11 2 4 l - 1 3 83 The death-rate from Diarrhœa and Enteritis in children under one year of age per 1,000 live births was 7.88. CHILD WELFARE. The equivalent of whole-time Municipal Health Visitors is 7.5, equal to one whole-time Health Visitor per 243 notified births, and one whole-time Health Visitor per 231 registered births during 1937. 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. Ante & Post-Natal 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, Markhouse Road. Thursday 10 to 12 noon „ „ „ The Memorial Hall, Winchester Road, E.4. Thursday 2 to 4 p.m. „ „ „ Low Hall Lane, Markhouse Road. Thursday 2 to 4 p. m. „ „ „ Estate Office, 1, Guildsway, Billet Road. Thursday 1.30 to 4.30 p. m „ „ „ "Brookscroft,'' Forest Road, E.17. Friday 2 to 4 p. m. „ „ „ Low Hall Lane, Markhouse Road. In addition, the Walthamstow Child Welfare Society at "Brookscroft" holds "special" clinics, e.g., massage and light sessions. A. MUNICIPAL SCHEME. 84 The detailed findings at first visits paid during 1937 are given in the following table:— 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. Room. St. James Street 229 35 24 15 273 220 64 4 88 58 87 28 26 1 High Street 151 33 21 3 202 176 25 4 40 124 23 9 8 1 Hoe Street 199 20 25 3 241 217 26 1 55 93 35 50 10 1 Wood Street 182 16 36 5 229 218 14 2 76 37 107 3 8 3 Hale End 275 27 39 11 330 317 24 — 199 40 92 8 2 Higham Hill 299 32 27 21 337 323 33 2 158 137 42 1 18 2 Total 1,335 163 172 58 1,612 1,471 186 13 616 489 386 91 1 00 1 t- 10 From the above table it will be seen that of 1,670 children, 1,335, or 79.9 per cent., were breast-fed on first being visited, but 58, or 3.4 per cent., had no separate sleeping accommodation. The particulars in respect of housing accommodation show the following comparison:— 85 House or Half 1-3 Flat Hou9e. Rooms. Total. 1937 1.105 386 179 1,670 1936 1,094 374 210 1,678 The findings appear to show that the proportion of families adequately housed in a separate house or flat increased. The following table shows the number and nature of visits paid in Wards during 1937 :— 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 288 579 867 893 1,760 552 86 205 69 36 105 106 2,814 High Street 205 458 663 496 1,159 278 79 67 20 3 23 17 1,623 Hoe Street 244 708 952 866 1,818 507 64 223 40 8 48 57 2,717 Wood Street 234 576 810 839 1,649 444 33 197 18 1 19 33 2,375 Hale End 341 1,065 1,406 1,446 2,852 285 185 266 49 14 63 38 3,689 Higham Hill 358 1,095 1,453 1,900 3,353 287 140 177 48 17 65 102 4,124 Total, 1937 1,670 4,481 6,151 6,440 12,591 2,353 587 1,135 244 79 323 353 17,342 Total, 1936 1,678 3,483 5,161 7,081 12,242 1,294 542 1,096 177 71 248 1,178 16,600 86 CLINICS. Early in the year an additional session was commenced at the Hale End Centre owing to the increased attendances. Draft plans have been prepared for new clinics in both the Hale End and Higham Hill areas. Dr. Sheppard reports as follows:— "There are seven welfare sessions held each week, five doctor's and two weighing sessions. The average attendance is 96 per session for babies and 19 for toddlers. "There are no separate toddlers clinics in Walthamstow as it has been found that the mothers prefer to attend the ordinary welfares with their older ohildren. They have contracted the excellent habit of devoting one afternoon at regular intervals to the welfare, and they continue this practice until their child is five years old. From the number of toddlers on our register it can be seen that this is a very successful arrangement. "The voluntary workers have continued to give faithful service during the year. "The Ante-Natal Clinic during >1937 continued as usual. "The number of Ante-Natal cases who attended during the year was 264, making 830 attendances, and the number of PostNatal cases was 21, making 36 attendances." Ante-Natal and Post-Natal Services. The following table summarises the attendances at the Clinics held:— New Patients:— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital 753 380 Low Hall Lane Clinic 264 21 Total 1,017 401 Total Attendances:— Thorpe Coombe Maternity Hospital 6,254 525 Low Hall Lane Clinic 830 36 Total 7,084 561 The total number of new patients attending the clinics represent the following percentages of total notified births (live and still):— Ante-Natal, 55.7; Poet-Natal, 21.9. 87 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. Clinic. 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 563 167 730 11718 10451 22169 22899 Higham Hill 293 81 374 4822 3334 8156 8530 Hale End 245 64 309 4009 3798 7807 8116 Total 1937 1101 312 1413 20549 17583 38132 39545 1936 1087 306 1393 19146 19292 38438 39831 Nurse Children.—At the end of 1937 there were 116 nurse children on the register, compared with 122 at the end of 1936. During the year 98 removed, 6 were adopted, and 14 reached the age of nine years. 107 new children were registered and 5 reregistered. There were no deaths among nurse children during 1937. 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. 249 cases attended for massage, and these made 2,340 attendances. Sale of Milk, etc., at Clinics.—The quantity and value of milk and food sold and issued free during 1937 was as follows:— Sales. Value. Free Issue, lbs. ozs. £ s. d. lbs. ozs. Cow and Gate 7,205 0 570 10 4 1532 0 Hemolac 257 0 21 8 4 123 0 Ostermilk .2,191 0 182 13 8 292 0 Ambrosia 701 0 58 8 4 105 0 Almata 124 0 9 6 0 Nil. Trufood 487 0 51 18 8 23 0 Lactogen .2,660 0 199 10 0 291 0 Prune and Banana Syrup 148 10 14 17 3 Nil. Parrish's Food 457 12 15 5 2 2 12 Cod Liver Oil 589 10 19 13 1 Nil. Cod Liver Oil Emulsion 1,504 8 88 13 9 0 12 Cream of Magnesia 361 12 24 2 4 Nil. Cod Liver Oil and Malt 1,414 0 41 4 10 6 0 Maltoline 40 tins 1 6 8 Nil. Roboleine 487 0 36 10 6 3 0 Virol 2,456 8 206 8 7 25 8 Virol Containers 2,965 12 7 1 2 0 £1,554 4 7 88 WALTHAMSTOW CHILD WELFARE SOCIETY. The organisation, staffing, and accommodation provided by the Society was fully dealt with in the 1935 Report. The Staff remained unchanged throughout the year. 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 4.30 p.m.—Infant Consultations. The work done during the calendar year is shown in the following table compiled from information kindly supplied bv Miss Coulston:— Clinics. First Attendances of New Cases. Re -attendances. Grand Total. Under 1 yr. 1-5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1937 469 94 563 7524 3737 11261 11824 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. Massage Treatments. Sunlight Treatments Total cases admitted to Observation Ward Local Authority's cases admitted to Observation Ward 1937 2468 1847 24 2 1936 2107 1461 28 10 1935 2197 1727 27 — 1934 1919 2292 32 1 89 Home Visits. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1937 464 1751 2215 1289 3504 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 gr&nt period 1937-42, make an annual grant of £700 to the Society, i.e., £500 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 1101 312 1413 20549 17583 38132 39545 Brookscroft 469 94 563 7524 3737 11261 11824 Total 1937 1570 406 1976 28073 21320 49393 51369 1936 1514 387 1901 24629 22694 47323 49224 Home Visits To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Municipal Scheme 1670 4481 6151 6440 12591* Brookscroft 464 1751 2215 1289 3504 Total 1937 2134 6232 8366 7729 16095 1936 2058 4734 6792 9720 16512 *4,751 other visits were paid for special reasons. 90 Percentage of notified live births represented , by number of children under 1 year of 1937 88.6 age who attended the Centres for the first time (i.e., new cases) Percentage of total notified births represented by number of expectant mothers at- 1937 55.7 tending Ante-Natal Clinics Nursery School and Classes.—Apart from the children at the Nursery School, 507 children born in 1933-34 (i.e., under 5 years of age) were on the school registers on 31st December, 1937. TREATMENT. (a) Orthopaedic.—The facilities provided by the Education Authority's Orthopaedic Scheme are available for all children attending the Welfare Centres. Miss Garratt has kindly furnished the following information with respect to children under five years of age: — Defects Seen at Orthopedic Clinic in Children under Five Years of Age. Anterior Poliomyelitis 5 Congenital Defects 7 Scoliosis 4 Spina Bifida 1 Rickets— Erbs Paralysis 1 (a) Genu Varum 81 Tibial and Flexion Deformity Toes 1 (b) Genu Valgum 46 Pes Piano Valgus 38 Sprengels Shoulder 1 Spastic Paralysis 9 Miscellaneous 15 Talipes 18 Tatal 246 Torticollis 19 Admissions to Brookfield Orthopaedic Hospital (under Five Years of Age). Anterior Poliomyelitis 2 Talipes Equinus (Accident) 1 Torticollis 2 Congenital Dislocation Hip 3 Spastic Paralysis 1 Genu Valgum 1 Total 10 Ten 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:— 1935 1936 1937 Mothers. Children under 5. Mothers. Children under 5. Mother Children under 5  Cases Treated 174 187 283 142 339 138 Attendances 276 263 654 270 536 207 Fillings 73 132 149 117 150 114 Extractions 485 278 661 169 618 146 General Anaesthetics 190 148 237 98 227 76 Scalings 10 3 61 — 67 — Dressings 13 78 32 361 8 235 Dentures 12 — 13 — 10 — Mr. L. W. Elmer, L.D.S., Senior Dental Surgeon, submits the following report from Mrs. W. R. Thorne, L.D.S., with regard to dental treatment under the Maternity and Child Welfare Scheme:— "The year 1937 has shown an increase in the number of Maternity and Child Welfare cases requiring treatment at the Dental Clinic. This increase is doubtless due to general propaganda about health matters, and the stressing of the need for a better standard of health in the expectant mother. People cannot fail to be affected by this trend of thought, even though, in their general habits of life they are indifferent to dental fitness, and do not visit the dentist until pain compels them to seek relief at his hands. "Formerly the expectant mother postponed all possible dental treatment during her pregnancy lest the treatment might have an adverse effect upon the child. That idea is being replaced by the desire of the mother to enjoy the best possible health at that period for her child's sake and also for her own. There was and still is, to some extent, a fear of dental treatment during pregnancy. In most cases mothers are easily assured. "The figures for the past year are worth a little consideration. 436 patients were referred for treatment from Thorpe Coombe Maternity Hospital and Welfare Centres and 339 oases have received treatment, some completely and some partially, the latter usually for extractions. "805 appointments for treatment were made : 536 attendances are recorded. "At the first visit all cases are examined and the treatment required is charted. If possible the treatment is commenced at that visit. On the morning allotted for new cases there is an anaesthetic session; this arrangement works very well because the patient not infrequently has suffered and is glad to have speedy relief. If the patient applies late in gestation and there is not 92 sufficient time for all the treatment, she is instructed to return afterwards for completion. "Among the number who receive treatment, very few are nursing mothers. Since treatment is available for nine months after childbirth, it is to be regretted that so few avail themselves of treatment. "Since the extension of the period during which dentures are available together with the reduced scale of fees for prosthetic work, there is a very greatly added inducement to accept treatment at the clinic. The extraction of teeth still holds the chief place in the mind of the average patient, to whom the tooth drawer and denture fitter sums the whole profession, resulting in the loss of so many natural dentitions. "The anxiety of the patient with an early caries with the "I'd rather it out" plea, shows how necessary it is to educate people to value their own organs. They do not realise the difference in value to themselves, between natural teeth and artificial, until the loss of the former brings them to accept the latter. "The ideal of providing a healthy oral condition for every mother is still a long way off.'' (c) Tonsils and Adenoids.—Six cases were operated on under the arrangement made by the Education Committee with the Connaught Hospital. (d) Ophthalmic Defects and Minor Ailments.—Children are given treatment either at the School Clinics or by special appointment. (e) Sunlight.—One infant and one mother were referred for sunlight treatment during 1937. There was definite improvement recorded in both of the cases. (f) Child Guidance.—Arrangements have now been made for children under five years of age to be referred to the London Child Guidance Clinic. (g) Invalid Children's Aid Association.—Miss Lewis, Secretary to the local branch of the Invalid Children's Aid Association, kindly reports that the following cases of children under five years of age were dealt with by her Association: — Referred by:— Medical men, Hospitals and Dispensaries 34 Orthopaedic Clinics 115 Others 8 157 93 Suffering from:— Anaemia and Debility 7 Marasmus and Malnutrition 4 Pneumonia, Bronchitis, Asthma, etc. 5 Bone Disease (non-T.B.) 76 Congenital Deformities 34 Paralysis 5 Hernia 2 After Infection 2 After acute Illness 2 Diseases of:— Glands (non-T.B.) 3 Ear 1 Nose and Throat 1 Rheumatism 1 Congenital Heart 1 Various 13 157 Help Given to Old and New Cases, 1937. Sent to Special Hospitals and Convalescent Homes *26 Provided with Surgical Boots and Appliances 55 Referred for Visiting and Advice 44 125 * Includes 8 admissions to Brookfield Hospital. ASSISTED MILK SCHEME. Up to two pints of milk per day can now be granted to expectant mothers at any time during pregnancy. A medica1 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. Dried milk is supplied if the infant is not breast-fed. Children between .3 and 5 years of age are granted milk on medical certificate only. Pasteurised milk sold under licence is insisted upon. 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. 94 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 either be granted free or at reduced cost, and the following shows the amount and approximate cost of milk granted by the Committee during 1937:— Number of applications during 1937 6,454 Number of families assisted 1,146 Of the 6,454 applications, approximately 37 per cent, were from families where the father was unemployed. The weekly average of the income of 2,104 employed cases granted milk between September and the end of the year varied fiom a maximum of £2 lis. 9d. to a minimum of £1 6s. 4¼d. Scale Amount Approximate cost to Authority £ s. d. Free 245 pints 3 6 4 ¼d. per pint 66,187 ,, 758 7 10 1d. per pint 108,781 ,, 1,019 16 5 l¼d. per pint 28 ,, 0 4 1 Half Cost 27,737 ,, 187 16 0 2d. per pint 336 ,, 1 15 0 203,314 ,, £1,971 5 8 The following is a summary of the applications for milk for the past four years:— Milk. Dried Milk. Unemployed. % Unemployed. Average per week. Milk. Dried Milk. 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 1937 5,882 572 2414 37.4 113.1 11.0 95 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 78 Home Helps approved during 1937 many mothers attending the Clinic made their own arrangements to obtain the help of suitable women whose names were supplied by the Health Visitors. Seven applications were rejected by the Rota Committee. The demand for Home Help.s has been as follows during the past seven years: 1931 (3), 1932 (12), 1933 (18), 1934 (21), 1935 (60), 1936 (87), 1937 (78). STERILISED MATERNITY OUTFITS. 13 outfits were issued below cost price. INSTITUTIONAL TREATMENT, ETC. Ten children were sent t.o Institutions under arrangements approved by your Committee. Three mothers were sent away for post-natal convalescent home treatment. HOSPITAL ACCOMMODATION FOR CONFINEMENTS. The following numbers of confinements occurred at the Institutions specified (Walthamstow residents only):— Thorpe Coombe Maternity Hospital 639 Nursing Homes in Walthamstow 194 Mothers' Hospital, Clapton 69 Forest Gate Hospital 44 Queen Mary's Hospital, Stratford 16 City of London Maternity Hospital 14 976 There are five nursing homes in the Borough with a total maximum accommodation of 29 beds for maternity crises. In addition, the Municipal Maternity Hospital has 35 lying-in beds and 4 isolation beds, making a total for the Borough of 64 lying-in beds and 4 isolation beds. 96 WALTHAMSTOW DISTRICT NURSING ASSOCIATION. Mrs. Drury, the Honorary Secretary, kindly reports as follows:— "The work of the Association continues to make progress in all its branches. "The staff has again increased considerably, and still further accommodation has had to be found. 36, Carisbrooke Road, is now full, in addition to 8, Castle Avenue, Highams Park, and 17/19, Carisbrooke Road. "The Provident Scheme continues to grow. Subscriptions are taken at all the Churches, Chapels, Social and Political Activities in the Borough by voluntary collectors. "The staff at the present time is as follows:— "One Superintendent; "One Assistant Superintendent; "Eight Queen's Nurses; "Two Queen's Candidates; "Four Nurse-Midwives; "Four Non-Queen's Nurses; "One Pupil Midwife; "One Post-Graduate Student. "General cases attended during the year, January 1st to December 31st, 1937 896 "Visits for general cases 19,530 "Midwifery and Maternity cases attended in the Maternity Home 150 "Midwifery and Maternity cases attended on the district 169 "Cases outside the Borough in and out of the Home 81 "Old age pensioners and necessitous cases are nursed free by the Association, so we must still depend on the generosity of subscriptions and donations to help in this important branch of our work. "The Council give a grant of £100 towards the cost of various cases attended at the request of the Medical Officer of Health. The Association is grateful to the Council for their help. "Another series of Post-Graduate Lectures for the Midwives of the Borough and surrounding districts has been arranged, and these are being well attended. Here again the Council shows sympathy by giving a grant of 2s. 6d. for every Midwife in the Borough who attends a lecture." 97 Your Council make a grant of £100 to the Association. The Superintendent reports that during 1937 the visits specified below were paid by the nursing staff: — Nature of Disease Cases Visits. Measles 3 11 Ophthalmia Neonatorum 12 118 Parotitis 2 8 Scarlet Fever 2 10 Threadworms 64 288 Whooping Cough 7 29 Puerperal Pyrexia 4 72 Pneumonia 77 1,446 Chicken Pox 1 16 Totals 172 1,998 The revised scheme made under the Local Government Act, 1929, for the grant period 1937-42 allocates £55 5s. Od. per annum to the Association in respect of Maternity and Child Welfare work. This grant will, in 1938, be merged into the grant m,ade under the Midwives Act, 1936. 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:— 1937. January 14th "Drugs; reagents and Dr Helen Rodway, analgesia in labour" M.C.O,G March 17th . "Breech Delivery" Miss Doubleday, S.C.M SK.N. Matron, General Lying-in Hospital, York Road. April 1st . "The Puerperium" Mr. W. McKim H. McCullagh, D.S.O., M.C., M.B. B.Ch., F.R.C.S., M.C.O.G. May 13th "Some Common Diseases Prof. L. Findlay, D.Sc. of the Newly Born" M.D., F.R.C.P. ANAESTHETIST'S FEES. Towards the end of the year your Council approved the payment of a fee of one guinea for the services of ,an anæsthetist when required by a medical practitioner engaged to attend a confinement provided the case was abnormal or difficult and the doctor had previously been engaged for the confinement. Recovery on the scale for assisted Maternity and Child Welfare services was made in the one case in which this service was approved. 98 CONSULTANT OBSTETRICIANS. The services of a Consultant Obstetrician were requested by General Practitioners on nine occasions (i.e., apart from the Maternity Home). The table below gives particulars in respect of each case:— No. Diagnosis. Where Treated. Result 1. Obstructed Labour Hospital Recovery 2. Ectopic Gestation Hospital Recovery 3 Salpingitis Remained at home Recovery 4. Albuminuria Admitted to Nursing Home Recovery 5. Impacted Breech Remained at home Recovery 6, Saprophytic infection and Heart Disease Remained at home Recovery 7. Puerperal infection Remained at home Recovery 8. Retained Placenta, post partum haemorrhage In Nursing home Recovery (There were two consultations with regard to the sixth case.) MID WIVES ACTS, 1902-1936. No. of Notices of Intention to Practice, January, 1937 35 ,, ,, during 1937 11 Total 46 No. of Midwives ceasing to practice during 1937 13 ,, ,, practising at the end of 1937 33 There was no change in the arrangements for the employment or subsidy of midwives by the Council. 99 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 1937, an average of 14 were employed at the Maternity Hospital and 7 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:—96, 65, 46, 41, 22, 7, 6, 2, 2, 2, 1, nil and nil within the Borough. The following table shows the work done by midwives (including those employed at Thorpe Coombe Maternity Hospital) during 1937:— No. of confinements attended as a Midwife 997 ,, ,, ,, Maternity Nurse ,. 220 ,, medical aid notices sent 467 ,, notifications of deaths 7 ,, twin births notified 20 ,, stillbirths notified 15 ,, notifications of liability to be a source of infection 17 ,, ,, ,, laying out of a dead body 7 ,, ,, ,, artificial feeding 6 ,, ,, ,, disinfection 17 The table includes the following numbers with regard to work done at Thorpe Coombe:— Midwifery cases, 535 in Hospital and 48 on District. Maternity cases, 107 in Hospital and 9 on District. Medical Aid Notices, 304. The percentages of medical aid notices were:— Total, 46.9. Maternity Hospital, 52.1. Domiciliary midwives, 39.3. The conditions for which medical aid was summoned by midwives in domiciliary practice have been summarised and were as follows:— 100 For complications during pregnancy:— Albuminuria 9 Threatened abortion 1 Varicose veins 2 Miscarriage 3 Oedema 2 Threatened miscarriage 1 Haemorrhage 2 Other conditions 9 Total 29 For complications during labour:— Delayed 1st and 2nd Post-partum haemor- stage 26 rhage 6 Perineal laceration 53 Ante-partum haemor- Malpresentation 5 rhage 5 Twins 3 Retained placenta 5 Pyrexia 8 Abdominal pain 1 Other conditions 9 Total 121 For complications in regard to the infant:— Prematurity and feeble- Asphyxia 2 ness 11 Other conditions 13 Discharging eyes 16 Total 42 Details of medical aid notices issued by midwives employed at Thorpe Coombe are given in the Maternity Hospital report. Midwives resident in Walthamstow also attended 134 midwifery patients and 62 maternity patients who were resident outside the Borough. Compensation for Loss of Cases.—Compensation is made to 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. One claim for compensation was made during 1937. Hospital treatment was required owing to mal-present at ion. Assistance re Midwives' Fees.—In order to endeavour to eliminate the handywoman by the provision of a certified midwife acting as maternity nurse the Council adopted a scale of fees for 101 the assessment of any application so received. The scale adopted was similar to the one in use for the assessment of medical aid fees under the Midwives Acts. Four applications were received during 1937. No difficulty was experienced in regard to the amendment by the Central Midwives Board of Rule E 17 (a), extending supervision by the midwife up to the 14th day after confinement. Midwives Act, 1936.—Operation of the scheme formulated under the Act was not. possible until January 1st., 1938, owing to the prolonged negotiations with the Walthamstow District Nursing Association. Before a final solution was found, the matter was referred to the Minister of Health, who decided that two of the eight midwives considered neoessary under the Council's Scheme be appointed by the District Nursing Association. The Scheme provided eight whole-time midwives to attend approximately 600 domiciliary confinements per annum. The Council adopted the following conditions of service:— (A) That eight whole-time midwives be appointed for the area of the Borough at the following salary scales:— (a) Certified Midwife, Trained Nurse, with Midwife Teachers' Diploma—£250, rising by £10 to £300 p.a. (b) Certified Midwife and Trained Nurse—£225, rising by £10 p.a. to £275 p.a. (c) Certified Midwife—£200, rising by £10 p.a. to £250 p.a. The midwives to be subject to the following conditions of service.. Uniform to be provided and the midwife required to wear uniform when on duty. All equipment, drugs and dressings to be provided by the Council; a telephone to be provided at the midwife's residence and actual travelling allowances to be paid, or a bicycle allowance of £5 per annum. An allowance of 5s. per week to be made in respect of a room in the midwife's house. The midwife (if resident in her own home) to be required to provide her own domestic help so that her whole time would be available for duty. Off-duty time to be one day per week; a 48 hours' week-end each three weeks and four weeks' annual leave. Each midwife to be 102 required to work on a rota for relief work in respect of her colleagues' off-duty, holidays, sickness, suspension and attendance at post-graduate courses. Free choice of midwife to be allowed to each patient (as far as practicable), and bookings and examinations to bo done at the midwife's home if the patient so desires. The midwife must, if required, be prepared to assist in the training of pupil midwives— in which case a board allowance of 30s. per week will be payable. All practice to be confined to the area of the Borough. (B) That midwives appointed be required (if necessary at a later date) to undertake any reasonable nursing duties other than midwifery or maternity nursing. (C) That the standard fee for a domiciliary confinement be 40s. <to include booking fee 2s. 6d. before 24th week, 5s. after). (D) That the recovery of fees from necessitous patients in respect of (1) midwife's fee, (2) home help, (3) accouchement outfit, (4) G.P. ante-natal examination, (5) medical aid recoveries, (6) consultant obstetrician, and (7) artificial dentures, be on the existing "Thorpe Coombe" scale adjusted on a fractional basis. (E) That this scale be applicable for all cases attended by whole-time salaried midwives. (F) That each midwife (if required) should attend an annual Refresher Course. (G) That the existing home help scheme be made available during any incapacity of an expectant mother during pregnancy on medical advice. (H) That accouchement outfits be supplied at 6s. 0d. each (sub ject to recovery on the scale adopted). (I) That the general practitioner ante-natal scheme formerly operative at "Thorpe Coombe" be extended to cover cases attended by whole-time salaried midwives under the new service, and that patients have free choice of ante-natal supervision under the scheme or at Municipal clinics. (J) That a rota be compiled of doctors with surgeries in the Borough and willing to serve on the general practitioner ante-natal and medical aid schemes. (K) That midwives over 65 years of age be offered compulsory retirement. Public Health Act, 1936 (Nursing Homes).—See Public Health Section of the Report. 103 PUERPERAL FEVER AND PYREXIA. Thirty-eight cases of Puerperal Fever and Pyrexia were notified during 1937. The notifications were received from the following sources:— Maternity Home, 18; Hospitals outside the area, 10 (in 6 of these the confinements occurred in Walthamstow); and General Practitioners, 10. Since 1st October, 1937, under the provision of the Public Health Act, 1936, the term Puerperal Fever has been dispensed with in regard to notification. The puerperal fever and pyrexia rate for 1937, was 21.89 per 1,000 births, and the mortality due to puerperal sepsis was 10.5 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. Per 1,000 live and still births Puerperal Puerperal Area Fever Pyrexia Total England and Wales 13.93 13.93 125 County Boroughs and Great Towns, including London 17.59 17.59 148 Smaller Towns (25-50,000 population) 11.52 11.52 London Administrative County 4.15 14.34 18.49 Walthamstow 2.30 19.59 21.89 Of the 38 notifications (Puerperal Fever, 4, and Puerperal Pyrexia, 34) received during 1937, 18 (all Puerperal Pyrexia) were from the Maternity Home. The notifications and rates for Walthaimstow for the past four years have been as follows:— Per 1,000 Total Births (live and still) Puerperal Fever Puerperal Pyrexia Total Year No. Rate No. Rate No. Rate 1937 4 2.30 34 19.59 38 21.89 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 23.09 104 PUERPERAL FEVER AND PYREXIA INCIDENCE, 1937 (Excluding Maternity Hospital). No. of Case. Fever or Pyrexia. Date of Notification. Date Notification Received. Age. Ward. Facilities requested on notification. Date of Birth or Miscarriage. Onset of Pyrexia. Date removed to Hospital. Remarks. 1 Pyrexia 8.1.37 11.1.37 26 Hale End All facilities available 7.1.37 7.1.37 Not removed Influenza. 2 „ 26.1.37 27.1.37 21 High Street „ „ 19.1.37 ? Already in Hospital Died in Hospital. Septic pneumonia. Had sore throat at time of confinement. 3 „ 4.2.37 5.2.37 28 Hoe Street „ „ 25.1.37 26.1.37 Not removed Pneumonia. 4 „ 15.3.37 20.3.37 32 Hoe Street „ „ 13.3.37 14.3.37 Already in Hospital Local uterine sepsis. 5 Fever 6.4.37 7.4.37 39 Higham Hill „ „ 31.3.37 2.4.37 31.3.37 Died in Hospital. Adherent placenta. 6 Pyrexia 30.6.37 1.7.37 20 Higham Hill „ „ 20.6.37 25.6.37 30.6.37 Premature birth. 8 months. 7 „ 29.6.37 2.7.37 29 St. James Street Bacteriological examination of lochia and blood 22.6.37 24.6.37 Already in Hospital Instrumental delivery, transverse lie, macerated foetus. 8 Fever 20.7.37 20.7.37 39 Wood Street Consultant required and trained nurse 9.7.37 15.7.37 Not removed Salpingitis. 9 „ 24.7.37 26.7.37 34 Hale End All facilities available 18.7.37 20.7.37 18.7.37 Abortion. Notified from Hospital. 105 PUERPERAL FEVER AND PYREXIA INCIDENCE, 1937 (Excluding Maternity Hospital). No. of Case. Fever or Pyrexia. Date of Notification. Date Notification Received. Age. Ward. Facilities requested on notification. Date of Birth or Miscarriage. Onset of Pyrexia. Date removed to Hospital. Remarks. 10 Pyrexia 27.7.37 27.7.37 24 Higham Hill All facilities available 20.7.37 26.7.37 28.7.37 11 „ 24.7.37 27.7.37 30 Wood Street " " 22.7.37 23.7.37 21.7.37 Vincent's angina. Died in Hospital. Pulmonary embolism and local uterine sepsis. 12 „ 28.7.37 29.7.37 26 High Street Removal to Hospital 25.7.37 27.7.37 28.7.37 Prolonged labour. Retained placenta. 13 Fever 19.8.37 20.8.37 36 Wood Street All facilities available 15.8.37 ? 18.8.37 Two months' abortion. Haemorrhage. 14 Pyrexia 6.10.37 7.10.37 24 Wood Street Removal to Hospital 4.10.37 5.10.37 5.10.37 15 " 1.11.37 1.11.37 30 Hale End Consultant required 9.10.37 25.10.37 Not removed Psychological causes. 16 „ 2.11.37 3.11.37 19 High Street Removal to Hospital 21.10.37 30.10.37 1.11.37 Scarlet fever. 17 „ 16.11.37 17.11.37 30 Wood Street „ „ 9.11.37 „ 13.11.37 Local uterine infection. 18 „ 13.11.37 15.11.37 24 Hoe Street All facilities available 29.10.37 ? ? 19 „ 23.11.37 24.11.37 31 Wood Street „ „ ? ? Abortion. 20 „ 20.12.37 5.1.38 Hale End Removal to Hospital 7.12.37 17.12.37 Died in Hospital. Puerperal endometritis and general peritonitis. 106 ABORTION. Circular 1661.—The number of cases in which medical aid notices were issued during 1937 by midwives in accordance with Rule E of the Central Midwives Board was:— Threatened abortion and miscarriage 3 Abortion and miscarriage 2 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 En d. Higham Hill. 1937 8 3 2 2 — — 1 1936 2 — — 1 1 — 1 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home In Hospital 1937 3 5 8 — — — 1936 1 1 1 — — 1 enteritis MATERNAL MORTALITY. During 1937, nine deaths associated with pregnancy and childbearing were investigated for the completion of enquiry forms ; one belonged to another area and is therefore excluded and two others are assigned by the Registrar-General to other associated causes. Particulars relating to the nine deaths are given in the accompanying table. The following table shows the maternal mortality rates for 1937 (calculated on six deaths):— Births Registered. Deaths of Women due to Pregnancy and Child-Bearing. WALTHAMSTOW. England and Wales. Puerperal Sepsis, (Heading 29 R.G. ) Other Puerperal Causes. (Haading 30 R.G.) 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, 1,675 4 2 6 2.38 1.1.9 3.57 0.97 2.26 3.23 Live and Stillbirths, 1,735 4 2 6 2.30 1.15 3.45 0.94 2.17 3.11 107 DEATHS DUE TO PREGENCY AND CHILD ??? Case No. , Date of Death. Certified Cause of Death, and Classification. Age. Ward. Circumstances. Pregnancy. Ante-Natal Care. Physical Condition. Date of Confine ment or Abort ion. Doctor called. Admission to Hospital. Prev. Duration of Doctor. Midwife. 1 7.1.37 1. Auricular Fibrillation 26 H.E. Poor Nil 36 weeks ( ?) Yes Yes Pre-existing heart disease Caesarean Section 7.1.37 7.1.37 7.1.37 2. Mitral Stenosis 2 26. 1.37 1. Septic Bronchopneumonia 21 Hi. Poor 1 36 weeks ( ?) Yes Yes Septic condition of mouth 19.1.37 12.1.37 24.1.37 2. Puerperal Septicaemia 3 18.4.37 1. Puerperal Septicaemia 39 H.H. Poor 2 40 weeks No Yes Fair 31.3.37 31.3.37 31.3.37 2. Retained placenta 4 2.7.37 1. Obstetric shock due to prolonged labour 30 J. Comfortable Nil 40 weeks No Yes Good 1.7.37 30.6.37 30.6.37 2. Acute pyelonephritis 5 28.7.37 1. Pulmonary Embolism due to 42 H.H. Comfortable 2 40 weeks Yes Yes Fair 14.7.37 - 11.7.37 2. Thrombo-phlebitis of femoral and saphenous veins of left lower extremity 6 10.8.37 1. Pulmonary Embolus 30 W. Comfortable 2 40 weeks Yes Yes Pre-existing disease. Contracted pelvis 22.7.37 - 21.7.37 2. Local uterine sepsis 7 20.9.37 1. Acute intestinal obstruction due to 23 Ex. Comfortable Nil 39 weeks Yes Yes Good 16.9.37 - 14.9.37 2. Paralytic Ileus and acute dilatation of stomach 3. Caesarean Section 8 31.10.37 1. Toxaemia and cardiac failure 38 W. Poor 5 38 weeks Yes Yes Pre-existing disease 16.10.37 15.10.37 16.10.37 2. Broncho-pneumonia due to acute bronchitis one week before confinement 9 26.12.37 1. General Peritonitis. 39 H.E. Comfortable 2 40 weeks Yes Yes Good 8.12.37 20.12.37 24.12.37 2. Puerperal endometritis Remarks:—Cases 2, 3, 5 and 9 are ascribed by the Registrar-General to Heading 29—Puerperal Sepsis. Cases 4 and 6 to Heading 30— Other Puerperal Causes. Case 1 to Heart Disease, and Case 8 to Pneumonia. Case 7 is excluded as a non-resident. 108 The following table sets out the maternal mortality, stillbirth and neo-natal death rates for the past five years:— Rate (per 1,000 live births) 1937. 1936. 1935. 1934. 1933. Maternal Mortality 3.57 1.74 3.00 6.40 5.39 Stillbirths 35.8 31.4 34.1 33.8 37.4 Neo-Natal Deaths 20.8 16.9 21.5 20.4 29.3 The maternal mortality rates for the past five years have been as follows:— Year. Total Births Register Deaths. Rates per 1,000 Births. Puerperal Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal Causes. Total. 1937 1,735 4 2 6 2.30 1.15 3.45 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 THORPE COOMBE MATERNITY HOSPITAL. Alterations and Extensions.—No alterations of major character were carried out. The extensions specified below have been approved by the Minister of Health and building should commence in 1938:— Two 4-bed wards attached to existing block. Two nurseries, each for four 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 Hospital when these extensions are completed will be:— Lying-in beds, 47. Isolation beds, 6. Total, 53. General.—(a) Form M.C.W. 96A (Ministry of Health). 1. Name and Address of Institution—Thorpe Coombe Maternity Hospital, 714, Forest Road, Walthamstow, E.17. 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds)—35. 2a. Number of beds, if any, under item 2 which have been allocated to, and reserved for, expectant mothers in need of hospital treatment—Variable according to requirements. No definite reservation. 3. Number of maternity oases admitted during the year—729 (including ante- and post-natal cases). 3a. Number of women treated during the year in the beds shown against item 2a. (Included in item 3).—109. 4. Average duration of stay of cases included against item 3— 13.7. 5. Number of cases delivered by— (a) Midwives—535. (b) Doctors—107. 6. Number of cases in which medical assistance was sought by a midwife in emergency—275. 7. Number of cases notified as— (a) Puerperal fever—Nil. (b) Puerperal pyrexia—18. 8. Number of cases of pemphigus neonatorum—Nil. 9. Number of infants not entirely breastfed while in the tion—73. 10. Number of cases notified as ophthalmia neonatorum—Nil. 11. (cr) Number of maternal deaths—3. (6) Cause of death in each case: — (1) (a) Pulmonary embolism due to (b) Thrombo-Phlebitis and saphenous veins of left lower extremity. (2) (a) Acute intestinal obstruction due to (b) Paralytic Ileus—acute dilatation of the stomach. (3) (a) Toxaemia and cardiac failure due to (b) Broncho Pneumonia due to (r) Acute Bronchitis (onset one week before confinement). 110 12. (a) Number of infant deaths— (i) Stillborn—16. (ii) Within 10 days of birth—9. (b) Cause of death in each case, and results of post-mortem examination (if obtainable)—See Clinical Report. The stillbirth rate was 25.0 per 1,000 live births, and the neonatal mortality within 10 days of birth was 14.0 per 1,000 live births. (h) Occupation of Beds. The average daily occupation of beds was as follows:— January 23.8 July 33.0 February 30.2 August 26.1 March 27.2 September 29.3 April 23.0 October 28.1 May 31.4 November 18.8 June 32.2 December 25.4 The average for the whole year was equal to 70.2 per cent. beds occupied (based on 39 beds). (c) Research.—Dr. Helen Rodway is co-operating with the investigation initiated by the People's League of Health into deficiency in diet in cases of maternal mortality and morbidity. (d) Emergency Unit.—During the course of the year the emergency obstetric services previously available to General Practitioners from the Maternity Hospital for the domiciliary treatment of patients whose condition precluded their immediate removal to hospital were re-organised in conformity with the suggestions of the Ministry of Health Circular 1622. General practitioners were informed that ,&ny request for the services of the emergency unit should be made by telephone to the Maternity Hospital stating whether or not the assistance of the Resident Obstetrician was required. Certain members of the trained midwifery staff are earmarked for this duty and special equipment is retained ready for dealing with emergencies such as hcemorrhage. Opportunity was taken of reminding general practitioners as to the other obstetric facilities available, i.e., Panel of Consultants for complications during pregnancy, confinement and puerperium, and the arrangements for the admission of emergency (unbooked) maternity cases to hospital. 111 The services of the emergency unit were utilised on four occasions:— 14/5/37. Mrs. G.—Post-partum haemorrhage. 10/8/37. Mrs. A.— ,, ,, ,, following miscarriage. 16/10/37. Mrs. J.—Post-partum haemorrhage following miscarriage. 28/12/37. Mrs. P.—Post-partum haemorrhage following miscarriage. In the third case the messenger telephoned for the "flying squad" with the result that police assistance was rendered in the first place. In spite of this delay the general practitioner in charge of the case considered that the services of the emergency unit contributed largely to the saving of the patient's life. The use of the term "flying squfid" should be strictly prohibited in connection with maternity services. (e) Gas and Air Analgesia.—The Maternity Hospital was approved by the Central Midwives Board for the purpose of giving special instruction in gas and air analgesia. (/) Teaching Apparatus.—A 16 m.m. cinema projector was provided for the instruction of pupil midwives. The following very full clinical report has been oompiled by Dr. Helen Rod way, M.C.O.G., Resident Obstetrician. THORPE COOMBE MATERNITY HOSPITAL. CLINICAL REPORT. During the year 729 patients were admitted to the Hospital; of these, 109 admissions were during the ante-natal period. All patients booked for confinement in the Hospital attended the Ante-Natal Clinics; the attendances were regular with very few exceptions. The administration of gas and air analgesia during the second stage of labour continued to be available for every healthy patient. There were 525 attendances at the Post-Natal Clinic. Ante-Natal Department. 1937. 1936. 1935. Number of Ante-Natal Clinics held:— Consultants' Clinics 12 12 21 Resident Obstetrician's Clinics 129 117 125 Midwives' Clinics 349 352 225 Total 490 481 371 112 Number of expectant mothers who attended the Ante-Natal Clinics 753 691 762 Total attendances made by patients:— (a) New patients 753 691 762 (b) Old patients 5,501 5,354 4,543 Total 6,254 6,045 5,305 Total number of attendances at:— (a) Obstetrician's Clinics 2,382 2,648 2,868 (b) Midwives' Clinics 3,872 3,397 2,437 Total 6,254 6,045 5,305 Average attendance per session:— (a) Obstetrician's Clinics 16.9 (b) Midwives' Clinics 11.0 Total Average 12.7 12.6 14.3 Number of patients admitted to the Maternity Hospital during the ante-natal period 109 137 97 TOTAL NUMBER OF PATIENTS ADMITTED. No. of Patients (a) Ante-Natal 109 (b) Miscarriage 3 (c) For confinement 616 (d) Post-Natal 1 729 ANTE-NATAL ADMISSIONS. 59 patients were admitted to the hospital for treatment during the ante-natal period. 2'6 of these patients were delivered before discharge fromj the hospital. There were in addition 3 patients admitted for miscarriage and 50 for " False alarms" of labour. A marked decrease in the number of patients needing treatment for pregnancy toxaemia was apparent this year. 113 Cause of Ante-Natal Admissions. No of Cases Pre-eclamptic toxaemia 15 Chronic nephritis 1 Essential hypertension 8 Antepartum haemorrhage 5 Hyperemesis 3 Threatened miscarriage 3 Cardiac disease 5 Glycosuria and pyelitis 1 Marked oedema 3 Bronchitis 1 Haemorrhage per rectum 1 Severe backache 4 Haematoma of vulva 1 Epileptic fit 1 Debility 1 Anaemia 1 For observation (i) Following a fall 2 (ii) ? Mental state 1 Premature rupture of membranes 2 Patients admitted for observation and discharged because not in labour 50 Total 109 Number of Confinements. (a) Primigravida 367 (b) Multigravida 272 Total 639 Number of patients delivered by:— (a) A doctor 107 (b) A midwife 532 Total 639 Miscarriages 3 114 Presentation and Position during Labour. Primigravida Multigravida Total Vertex left occipito-anterior 212 154 366 Vertex right occipito-anterior 102 99 201 Vertex right occipito-posterior 18 6 24 Vertex left occipito-posterior 14 2 16 Breech 23 13 36 Face 1 1 2 Brow — 1 1 Transverse 1 — 1 Unknown 1 1 2 Total 372 277 649 This includes 10 sets of twins: see separate table. Medical Aid Notices.—In 275 cases medical aid was sought by midwives in the Hospital. Treatment was given by the Resident Medical Officer or her deputy. For complications during pregnancy:— Abortion 1 For complications during labour:— Breech presentation 17 Twin pregnancy com- Brow presentation 1 plicated 2 Obstructed labour 2 Cardiac condition 4 Delay in 1st and 2nd Prolapsed cord 1 stage 44 Pre-eclampsia 3 Delay in 3rd stage 5 Perineal and vaginal Post-partum haemor- lacerations 174 rhage 2 Premature labour 1 Twin pregnancy 1 Foetal distress 5 262 Complications in regard to the infant:— Asphyxia 4 Stillbirths 2 Feeble condition 5 Infant deaths 1 12 Grand Total, 275. CASES OF ALBUMINURIA ADMITTED FOR TREATMENT. Reg- No. Case No. Gravida. Age of Patient. Onset of Symptoms. Maturity on Admission. Headaches. Eye Symptoms. Oedema. Albuminuria. Highest Blood Pressure. Blood Urea. JN o. of days in Hospital before delivery or discharge. Onset of Labour. Maturity of Child. Type of Delivery. Result. Condition of Patient on discharge. M. C. Albumin. Blood Pressure. Weeks. Weeks. % 1888 1 1 36 38 40 No No Yes Trace 180/120 29 mgms. 2 Spontaneous F.T. Spontaneous L. L. 0.1 158/108 1921 2 1 24 36 + 38 No No Yes Trace 150/90 21 8 „ 38 „ L. L. Nil 150/82 2305 3 P 19 36 + 36 + Nil Nil Nil Cloud 180/110 28.5 „ 9 „ 38 „ L. L. Nil 152/100 2373 4 P 24 38 + 38 + Nil Nil Yes Trace 140/100 21 2 „ 38 „ L. L. Nil 134/92 1901 5 P 29 38 38 Nil Nil Nil Trace 148/94 21 „ 10 „ F.T. „ L. L. Nil 120/84 1950 6 5 34 36 + 36 + Yes Nil Yes Cloud 178/90 37 16 „ 38 „ L. L. Nil 145/100 1991 7 1 43 38 + 38 + Yes Nil Yes Cloud 164/100 18 7 „ F.T. „ L. L. Nil 130/88 2021 8 P 27 38 + 38 + Nil Nil Nil Trace 170/106 27 „ 4 „ F.T. „ L. L. Trace 156/100 2071 9 P 38 32 36 Yes Yes Yes Cloud 180/100 17 14 „ 38 „ L. L. Trace 168/118 28 2266 10 P 29 30 30 Nil Nil Yes Trace 182/120 23 14 „ F.T. „ L. L. Nil 162/100 2393 11 6 36 36 + 36 + Yes Nil Yes Cloud 156/88 12 22 „ F.T. „ L. L. Nil 136/80 2584 12 P 24 34 36 Yes Nil Nil Cloud 142/86 20 9 „ F.T. „ L. L. Trace 138/84 Emergency 2467 13 P 22 30 32 Yes Yes Yes Heavy cloud 162/110 17 7 „ 32 „ L. S.B. Trace 138/90 Remarks—Case No. 9. Admitted twice. Case No. 10. Re-admitted for delivery. Case No. 12. Re-admitted for delivery. 115 ANALYSIS OF GASES WITH RENAL COMPLICATIONS. It is or significance that since all patients have had additional iron and calcium' administered at intervals during the year the number of cases of albuminuria has decreased. On the other hand it is disquieting to note that two cases of eclampsia have occurred, notwithstanding in-patient treatment. Booked Emergency 1. Number of patients admitted for albuminuria 12 1 Number of stillbirths or infant deaths — 1 2. Number of patients admitted on account of albuminuria who developed eclampsia 2 — Number of stillbirths or infant deaths 1 — 3. Number of patients admitted on account of chronic nephritis 1 — Number of stillbirths or infant deaths — — 4. Number of patients admitted on account of pyelitis 1 — Number of cases of albuminuria admitted for treatment (excluding chronic nephritis). Percentage 1937 15 2.4 1936 30 4.5 1935 26 4.0 116 ANTE-PARTUM HAEMORRHAGE. Number of cases:— Lateral placenta praevia 1 Fibroid of the uterus 1 Premature separation of placenta 1 Unknown cause 2 Total 5 Maternal mortality Nil Foetal mortality 1 Stillbirth. 1 Infant death. CASES OF ECLAMPSIA. Reg. No. Case No. Gravida. Age of Patient. Onset of Symptoms. Maturity on Admission. Headaches. Eye Symptoms. Oedema. Albuminuria. Highest Blood Pressure. Blood Fits No. of days in Hospital before delivery or discharge. Onset of Labour. Maturity of Child. Type of Delivery. Result. Condition of Patient on discharge. % Onset. No. M. C. Albumin. Blood Pressure. Weeks. Weeks. Weeks. 1923 I P 32 30 + 30 + Yes Yes Yes Cloud. Solid during Eclampsia 196/114 18 After induction by rupture of membranes 5 21 before delivery Following induction 34 Spontaneous L. Died day of birth Slight Cloud 134/82 2055 2 P 28 38 38 Nil Nil Yes Trace 190/120 15 First stage of labour 1 12 before delivery Following medical induction F.T. Forceps L. L. Trace 160/100 Remarks—Post-Natal Clinic:—Case No. 1. Albumin Nil. Blood pressure 120/84. Case No. 2. Albumin Nil. Blood pressure 124/88. CASES OF CHRONIC NEPHRITIS. Reg. No. Case No. Gravida. Age of Patient. Onset of Symptoms. Maturity on Admission. Headaches. Eye Symptoms. Oedema. Albuminuria. Highest Blood Pressure. Blood Urea. No. of days in Hospital before delivery or discharge. Onset of Labour. Maturity of Child. Type of Delivery. Result Condition of Patient on discharge. 0/ /o M. C. Albumin. Blood Pressure. Weeks. Weeks. 2509 1 P 30 Before pregnancy 24 No No No Cloud 164/100 45 9 Following induction by rupture of membranes 36 Spontaneous L. L. 4 pts. per 1,000 184/100 34 Yes No No Cloud 220/120 14 Remarks—Admitted twice. 117 ANTE-PARTUM HAEMORRHAGE. Reg. No. Case No. Age of Patient. Gravida. Maturity. Condition on Admission. Albumin. Blood Pressure. Treatment. No. of days in Hospital before labour or discharge. Result. Cause of Haemorrhage. M. C. 1949 1 24 P Weeks. 38 Good Nil 124/80 (a) Sedatives (b) Caesarean Section 4 L. L. Lateral placenta praevia. 2476 2 38 3 32 Good Nil 120/70 Sedatives 6 L. L. Cause unknown. 1853 3 27 P 34 Good Nil 120/80 Nil 1 L. Died Premature separation of placenta. Retroplacental clot. 2303 4 32 P 38 Good Nil 120/80 Sedatives 7 L. L. Cause unknown. 2309 5 36 1 28 + Good Nil 120/74 Sedatives 26 L. S.B. Fibroid of uterus. 118 TREATMENT AND RESULTS OF POSTERIOR POSITION. Method of delivery Number of Cases All Cases Primigravidae Multigr&vidae 1. Spontaneous delivery:— (a) Following spontaneous rotation 5 - 5 (b) Face to pubes 3 3 6 2. Manual rotation followed by forceps delivery 23 4 27 3. Caesarean section 1 - 1 32 7 39 Results to:— (a) Mother. Maternal mortality Nil (b) Child. Living 35 Stillborn 3 Died 1 Foetal mortality—10.3 per cent. TREATMENT AND RESULTS OF POSTERIOR POSITION. Reg. No. Case No. Gravida. Age of Patient. Method of Treatment. Duration of Labour. 1 Weight of Child. Result. ( 1st stage. 2nd stage. 3rd stage. M. C. h. m. h. m. h. m. lb. oz. 2453 1 2 28 Manual rotation. Forceps delivery 9 0 2 50 0 25 8 8 L. L. 1996 2 P 25 „ „ „ „ 19 0 4 5 0 15 7 12 L. L. 1876 3 P 23 „ „ „ „ 5 0 3 0 0 30 8 3 L. L. 2468 4 P 27 „ „ „ „ 25 30 1 40 0 20 7 6 L. L. 2411 5 P 28 „ „ „ „ 18 45 3 10 0 30 7 4 L. L. 2305 6 P 30 „ „ „ „ 62 0 4 5 0 25 7 10 L. L. 2336 7 P 29 „ „ „ „ 52 0 3 35 0 20 6 12 L. L. 2288 8 P 30 „ „ „ „ 29 0 5 50 0 20 6 15 L. L. 1938 9 P 34 „ „ „ „ 24 0 4 25 0 50 6 13 L. L. 2443 10 P 29 „ „ „ „ 24 15 2 40 0 30 6 14 L. L. 2406 11 P 29 „ „ „ „ 31 30 ?5 0 0 20 6 0 L. L. 2325 12 P 26 „ „ „ „ 49 30 1 10 0 40 5 10 L. L. 2412 13 P 25 „ „ „ „ 45 15 3 15 0 25 8 1 L. S.B. 1898 14 P 22 „ „ „ „ 24 0 — 0 20 8 2 L. S.B. 1837 15 P 34 „ „ „ „ 46 0 1 30 0 30 7 9 L. L. 1951 16 P 18 „ „ „ „ 20 55 1 20 0 15 7 2 L. L. 2218 17 P 30 „ „ „ „ 27 0 3 40 0 20 7 2 L. L. 1998 18 P 34 „ „ „ „ 36 15 4 0 0 45 9 14 L. L. 2132 19 P 29 „ „ „ „ 12 30 2 0 0 15 7 12 L. L. 2055 20 P 28 „ „ „ „ 23 15 2 15 0 35 8 5 L. L. 2047 21 P 32 „ „ „ „ 30 30 1 50 0 15 7 15 L. L. 1978 22 P 29 „ „ „ „ 22 15 2 25 0 35 7 8 L. L. 2416 23 3 44 „ „ „ „ 5 40 ? 0 10 9 15 L. S.B. 2032 24 2 32 „ „ „ „ 16 30 3 25 0 15 4 0 L. L. 2061 25 6 30 „ „ „ „ 5 20 2 25 0 15 7 7 L. L. 1882 26 P 34 „ „ „ „ 52 15 4 0 0 15 8 0 L. L. 1904 27 P 29 Spontaneous rotation and delivery 18 45 3 5 0 20 6 15 L. L. 2010 28 P 26 „ „ „ „ 2 45 1 5 0 15 5 10 L. L. 2129 29 2 24 Spontaneous delivery. Face to pubes 4 50 2 5 0 10 7 0 L. Li. 2240 30 P 33 „ „ „ „ 15 0 15 0 0 15 7 5 L. L. 2230 31 P 25 „ „ „ „ 14 20 1 0 0 15 7 15 L. Li. 1808 32 P 36 „ „ „ „ 4 15 0 20 0 15 6 4 L. L. 2024 33 3 22 „ „ „ „ 1 45 0 50 0 10 7 12 L. L. 2248 34 2 30 „ „ „ „ 3 45 1 10 0 20 8 6 L. L. 2434 35 P 28 Spontaneous rotation and delivery 70 45 1 35 0 20 6 8 L. L. 2220 36 P 17 „ „ „ 5 20 0 35 0 15 3 5 L. D. 2267 37 P 22 „ „ „ 18 20 0 55 0 10 8 6 L. L. 2440 38 P 39 Caesarean section. Failed forceps 27 0 4 15 — — L. D. 1817 39 P 26 Manual rotation. Forceps delivery 13 0 0 20 8 11 L. L. Remarks:—Case No. 12.—Ante-partum haemorrhage. „ 14.—Impaction of shoulders. „ 24.—First twin. 119 BREECH DELIVERIES. Version was not attempted in any case where the breech was found to be presenting. Uncomplicated:— Primigravidae Multigravidae Total Number of cases .... 17 9 26 Number of stillbirths or infant deaths 1 1 2 Complicated:— In these cases there was a maternal or foetal complication. Primigravidae Multigravidae Total Number of cases 4 2 6 Number of stillbirths 2 0 2 (I, Ante-partum haemorrhage; 2. Anencephalic foetus). 120 BREECH DELIVERIES. Reg. No. Case No. Gravida. Age of Patient. Maturity. Attitude of Breech. Method of Delivery. Weight of Infant. Result. M. C. UNCOMPLICATED. Weeks. lb. oz. 1997 1 P 27 38 Extended legs Spontaneous 6 3 L. L. 2423 2 P 23 40 „ „ „ 6 14 L. L. 2410 3 P 30 40 „ „ „ 7 14 L. L. 2312 4 P 23 40 „ „ Arms lifted out 6 6 L. L. 2265 5 P 24 40 „ „ Spontaneous 8 8 L. L. 2239 6 P 26 40 „ „ „ 7 0 L. L. 2144 7 P 30 40 „ „ „ 7 11 L. L. 2137 8 P 24 40 „ „ „ 7 4 L. L. 2103 9 P 26 40 „ „ „ 6 7 L. L. 1985 10 P 29 40 „ „ „ 7 10 L. L. 1979 11 P 27 40 Flexed legs „ 7 4 L. L. 1965 12 P 31 40 Extended legs. Dorsal displacement of anus Arms brought down 7 0 L. S.B. 1852 13 P 26 40 Flexed legs Spontaneous 6 10 L. L. 2401 14 P 22 40 Extended legs „ 6 6 L. L. 1809 15 P 30 38 Flexed legs „ 5 5 L. L. 2083 16 P 22 38 Extended legs „ 5 12 L. L. 2219 17 P 37 40 „ „ „ 5 6 L. L. 2505 18 2 22 40 „ 6 4 L. L. 2254 19 2 29 40 „ 7 1 L. L. 2121 20 6 30 40 „ 6 12 L. L. 2039 21 2 36 40 Extended legs „ 7 0 L. L. 2029 22 6 35 40 „ 9 4 L. L. 1983 23 2 27 40 Extended legs .. „ 8 2 L. L. 1939 24 8 36 40 „ „ „ 8 10 L. L. 1846 25 2 36 40 „ „ „ 6 9 L. L. 2118 26 2 29 40 Flexed legs „ 7 11 L. S.B. Remarks:—Case No. 26.—Morbidly adherent placenta showing multiple areas of haemorrhage. Oedematous. 121 BREECH DELIVERIES. Reg. No. Case No. Gravida. Age of Patient. Maturity. Attitude of Breech. Method of Delivery. Weight of Infant. Result. M. C. COMPLICATED. Weeks. lb. oz. 1880 1 3 36 40 Flexed legs Assisted 4 12 L. L. 2442 2 P 26 28 „ „ Spontaneous 2 8 L. S.B. 1953 3 P 26 32 „ „ „ — L. S.B. 2496 4 P 26 40 „ „ „ 5 2 L. L. 2445 5 P 28 38 Extended legs „ 5 8 L. L. 2343 6 3 34 38 „ 4 4 L. L. Remarks:—Case No. 1.—First of locked twins. „ 2.—Ante-partum haemorrhage. „ 3.—Macerated. Anencephalic. „ 4.—First twin. „ 5.—Second twin. „ 6.—Second twin. Multiple malformations. 122 FORCEPS DELIVERY. Indication for forceps Number of Cases All Primigravidae Multigravidae Cases Persistent occipito posterior position 23 4 27 Disproportion and delay in second stage 15 1 16 Foetal distress 2 — 2 Prolapsed cord — 1 1 Total 40 6 46 Results to:— (a) Mother. Maternal mortality Nil (b) Child. Living 42 Stillborn 4 Infant death Nil Foetal mortality—8.7 per cent. FORCEPS DELIVERIES. Reg. No. Case No. Gravida. Age of Patient. Maturity. Indication. Duration of Labour. Weight of Child. Result. 1st stage. 2nd stage. 3rd stage. M. C. Weeks. h. m. h. m. h. m. lb. oz. 1824 1 P 25 40 Delay in second stage 30 0 — 3 0 7 1 L. L. 2347 2 P 39 40 „ „ „ 12 45 1 50 0 35 8 0 L. L. 2453 3 2 28 40 Persistent occipito posterior position . . 9 0 2 50 0 25 8 8 L. L. 1990 4 P 25 40 „ „ „ „ 19 0 4 5 0 15 7 12 L. L. 1876 5 P 23 40 „ „ „ „ 5 0 3 0 0 30 8 3 L. L. 2468 6 P 27 40 „ „ „ „ 25 30 1 40 0 20 7 6 L. L. 2411 7 P 28 40 „ „ „ „ 18 45 3 10 0 30 7 4 L. L. 2305 8 P 30 40 „ „ „ „ 62 0 4 5 0 25 7 10 L. L. 2336 9 P 29 40 „ „ „ „ 52 0 3 35 0 20 6 12 L. L. 2288 10 P 30 40 „ „ „ „ 29 0 5 50 0 20 6 15 L. L. 1938 11 P 34 40 „ „ „ „ 24 0 4 25 0 50 6 13 L. L. 2443 12 P 29 40 „ „ „ „ 24 15 2 40 0 30 6 14 L. L. 2406 13 P 29 40 „ „ „ „ 31 30 5 0 0 20 6 0 L. L. 2325 14 P 26 38 „ „ „ „ 49 30 1 10 0 40 5 10 L. L. 2412 15 P 25 40 „ „ „ „ 45 15 3 15 0 25 8 1 L. S.B. 1898 16 p 22 40 „ „ „ „ 24 0 — 0 20 8 2 L. S.B. 1837 17 p 34 40 „ „ „ „ 46 0 1 30 0 30 7 9 L. L. 2293 18 P 28 40 Delay in second stage 39 30 2 55 0 25 6 7 L. L. 2078 19 p 28 40 „ „ „ „ 22 45 3 5 0 20 8 12 L. L. 2085 20 P 28 40 „ „ „ „ 42 5 3 0 0 35 8 4 L. L. 2175 21 p 25 40 „ „ „ „ 24 15 3 45 0 30 7 12 L. L. 2052 22 P 29 40 „ „ „ „ 20 15 3 25 0 25 6 7 L. L. 2114 23 P 33 40 „ „ „ „ 27 0 4 0 4 15 6 11 L. L. 2516 24 p 27 40 Disproportion 51 15 4 0 0 30 7 13 L. L. 2429 25 P 29 40 Foetal distress 12 30 6 30 0 20 7 1 L. L. 2333 26 P 23 40 Delay in second stage 27 0 3 45 0 20 6 14 L. L. 2155 27 P 30 40 „ „ „ „ 31 0 4 5 0 25 7 12 L. L. 2150 28 P 33 40 „ „ „ „ — — 0 10 8 0 L. L. 1951 29 P 18 40 Persistent occipito posterior position .. 20 55 1 20 0 15 7 2 L. L. 2218 30 P 30 40 „ „ „ „ 27 0 3 40 0 20 7 3 L. L. 1998 31 p 34 40 + „ „ „ „ 36 15 4 0 0 45 9 14 L. L. 2132 32 p 29 40 „ „ „ „ 12 30 2 0 0 15 7 12 L. L. 2055 33 P 28 40 „ „ „ „ 23 15 2 15 0 35 8 5 L. L. 2047 34 p 32 40 „ „ „ „ 30 30 1 50 0 15 7 15 L. L. 1978 35 p 29 40 „ „ „ „ 22 15 2 25 0 35 7 8 L. L. 2416 36 13 44 40 „ „ „ „ 5 40 — 0 10 9 15 L. S.B, 2032 37 2 32 36 „ „ „ „ 16 30 3 25 0 15 4 0 L. L. 2061 38 6 30 40 „ „ „ „ 5 20 2 25 0 15 7 7 L. L. 1954 39 2 34 40 Delay in second stage 28 30 1 0 0 15 6 12 L. L. 1830 40 2 30 40 Prolapsed cord 25 15 1 0 0 25 6 0 L. L. 2096 41 p 29 40 Delay in second stage 52 45 2 25 0 15 8 4 L. L. 1817 42 p 26 40 Persistent occipito posterior position .. 130 0 — 0 20 8 11 L. L. 1882 43 p 34 40 „ „ „ „ 52 15 4 0 0 15 8 0 L. L. 1872 44 p 25 40 Foetal distress 49 0 5 45 0 20 — L. S.B. 2450 45 P 28 40 Delay in second stage 81 0 17 20 0 10 7 7 L. L 2079 46 P 25 40 „ „ „ „ 20 30 2 55 0 20 6 8 L. L. Remarks:—Case No. 1.—Retained placenta. Manual removal. „ 14.—Ante-partum haemorrhage. „ 16.—Impaction of shoulders. „ 23.—Retained placenta. Manual removal. „ 37.—First twin. „ 44.—Second twin. 123 TWINS. Number of cases, 10—Primigravidae, 5; Multigravidae, 5. Of the 20 infants, four were stillborn, and one died. Reg. No. Case No. Age of Patient. Gravida. Maturity. Presentation and Position. : Sex. Weight. Type. Result. 1st. 2nd. 1 St. 2nd. 1st. 2nd. Mother. Infants. Weeks. lb. oz. lb. oz. 1st, 2nd. 1872 1 25 P 38+ V. V.R.O.A. F. F. 6 4½ — Binovular L. L. S.B. 1880 2 36 2 40 B. R.S.A. V.R.O.A. F. F. 4 12 — Uniovular L. L. S. B. 1821 3 23 2 40 V.L.O.A. V.L.O.A. F. F. 5 12 5 4 Binovular L. L. L. 2027 4 26 P 40 V.R.O.A. V.L.O.A. F. F. 5 12 5 8 Binovular L. L. L. 2191 5 29 P 36+ V.L.O.A. V.R.O.A. F. F. 3 15 3 3 Uniovular L. I D. S.B. 2343 6 34 2 36 V.L.O.A. B. R.S.A. M. M. 4 14 4 4 Uniovular L. L. L. 2445 7 28 P 40 V.L.O.A. B. R.S.A. F. F. 3 0 4 8 Binovular L. L. L. 2496 8 26 P 40 B.L.S.A. V.R.O.A. F. M. 5 2 5 12 Binovular L. L. L. 2470 9 34 2 38 V.L.O.A. — F. F. 6 0 3 11 Uniovular L. L. S.B. 2032 10 35 2 36 V.R.O. P. V.L.O.A. F. F. 4 0 3 6 Uniovular L. L. L. Remarks:—Case No. 9.—Macerated. 124 Remarks:—Case No. 2.—Puerperal pyrexia. „ 3.—Paralytic Ileus. „ 5.—Congenital heart. CAESAREAN SECTION. Number of cases, 5—Maternal Mortality, 1; Foetal Mortality, 1. Reg. No. Case No. Age of Patient. Gravida. Indication. Duration of Labour. Type of Operation. Weight of Child. Result. 1st stage. 2nd stage. 3rd stage. M. C. h. m. h. m. h. m. lb. oz. 2070 1 31 P (а) Delay in progress of labour (b) High presenting part. (c) Rigid cervix. 72 0 — — Lower segment 8 3 L. L. 2223 2 25 P Disproportion ; impaction of breech .. ?59 0 ?6 10 — „ „ 8 2 L. L. 2328 3 23 P Disproportion 24 0 — — Classical 7 12 D. L. 2354 4 32 P Malformed uterus — — — „ 6 15½ L. L. 2440 5 39 P Disproportion. Failed forceps 27 30 4 15 — „ — L. I.D. 125 POST-PARTUM HAEMORRHAGE. There were 9 cases of post-partum haemorrhage. Manual removal of placenta 5 Maternal mortality 1 (Death due to pulmonary embolus on 14th day. Maternal morbidity; notifiable pyrexia.) Foetal mortality 3 Stillbirths 3 126 POST-PARTUM HAEMORRHAGE. Reg. No. Case No. Age of Patient. Gravida. Maturity. Character of Labour. Delivery. Predisposing Cause. Treatment. Result. Pyrexia. M. C. Weeks. 1982 1 21 P 40 Normal Spontaneous Fragment of chorion retained Ergometrine. Pituitrin. Rectal salines. Coramine L. L. Temperature 100° once on 10th day. 2027 2 26 P 40 „ „ (Twins) Inertia of uterus after delivery Ergometrine. Pituitrin L. L.L. Nil. 2309 3 36 1 28 + „ Spontaneous Fibroid of uterus Pitocin. Intravenous saline. Intra-uterine glycerine. Uterine gauze pack L. S.B. Onset 4th day. 2337 4 34 P 40 „ „ — Ergometrine. Pituitrin L. L. 2445 5 28 P 40 „ (Twins) Inertia of uterus after delivery Ergometrine. Intravenous saline. Manual removal of placenta L. L.L. Temperature 100° once on 3rd day. 1824 6 25 P 40 Prolonged Forceps Inertia of uterus Manual removal of placenta L. L. Nil. 2114 7 33 P 40 Prolonged 2nd stage Spontaneous Inertia of uterus Manual removal of placenta L. L. Nil. 2118 8 29 P 40 Normal „ Morbidly adherent placenta Manual removal of placenta L. S.B. Onset 6th day. 2192 9 42 2 40 Prolonged Spontaneous Morbidly adherent placenta Manual removal of placenta D. Macerated foetus. Ante-natal pyrexia continued during puerperium PUERPERAL PYREXIA. Reg. No. Case No. Age. Gravida. Maturity. Ante-Natal Condition. Type of Labour. Method of Delivery. Onset of Pyrexia after Delivery. Duration of Pyrexia. Cause of Temperature. Result, M. C. Weeks. Davs. 1872 1 25 P 38 + Marked oedema Prolonged Twins 1 Spontaneous 2 Forceps 2nd day 6 Local infection L. L S.B, 1882 2 34 1 40 Satisfactory „ Forceps 3rd „ 3 Influenzal cold L. L. 1906 3 28 P 40 Albuminuria. Hyperpiesis Normal Spontaneous 2nd „ 3 „ „ L. L, 1966 4 24 P 40 Satisfactory „ „ 4th „ 2 Local infection L. L. 2083 5 24 P 40 „ „ „ 4th „ 2 Congested breasts L. L. 2096 6 29 1 40 Uraemic Prolonged Forceps 2nd „ 9 1. Urinary infection 2. Local infection L. L, 2110 7 21 P 40 Satisfactory Normal Spontaneous 8th „ 4 Non-suppurative mastitis L. L. 2127 8 27 P 40 „ „ „ „ 10th „ 6 + Suppurative mastitis L. L, 2118 9 29 2 29 „ „ „ 6th „ 5 Local infection L. S.B. 2192 10 42 2 40 Phlebitis Prolonged „ 1st „ 6 Local infection D. S.B. 2232 11 28 P 40 Satisfactory Delay in 2nd stage „ 6th „ 2 Non-suppurative mastitis L. L. 2298 12 23 P 40 Normal „ 8th „ 1 „ „ L. L, 2309 13 36 1 28 + Ante-partum haemorrhage „ „ 1st „ 27 Uterine infection L. S.B. 2397 14 18 1 40 Satisfactory „ „ 4th „ 2 Congested breasts L. L. 2401 15 22 P 40 Anaemic „ „ 3rd ,, 1 Unknown L. L, 2403 16 38 5 40 Bronchitis „ „ During ante-natal period 13 Bronchopneumonia D. L. 2440 17 39 P 40 Hyperpiesis Prolonged Unsuccessful forceps delivery Caesarean Section 4th day 4 Local infection L. D. 2470 18 34 1 40 Satisfactory Normal Spontaneous 9th „ 7 + Suppurative mastitis L. L. Remarks:—Case No. 8.—Transferred. „ 9.—Manual removal of placenta. „ 10.—Thrombo-phlebitis. Pulmonary embolus. 18. —Transferred. 127 PERINEAL SUTURE. Perineal suture was performed in 221 cases. Primigravidae. Multigravidae. All cases 1. Doctors' Cases:— (a) Vertex presentation; spontaneous delivery 4 12 16 (b) Breech presentation . . 9 1 10 (c) Vertex presentation; forceps delivery 32 5 37 (d) Face 1 — 1 Totals 46 18 64 2. Midwives' Cases:— (a) Vertex presentation; spontaneous delivery 122 34 156 (b) Breech — 1 1 Totals 122 35 157 PUERPERAL PYREXIA. Temperatures are usually taken twice daily. When there is a rise of temperature, a record is made four-hourly. The standard adopted for the classification of Puerperal Pyrexia is that of the Ministry of Health, namely a temperature of 100.4° or more sustained for twenty-four hours, or recurring within that period. Date of onset. Duration. Cause. No. of Cases. Days. Second day 6 Local infection 1 Third day 3 Influenzal cold 1 Second day 3 „ „ 1 Fourth day 2 Local infection 1 „ 2 Congested breasts 1 Second day 9 (1) Urinary infection; (2) Local infection 1 Eighth day 4 Non-suppurative mastitis 1 Tenth day 6 + Suppurative mastitis 1 First day 6 Local infection 1 Sixth day 2 Non-suppurative mastitis 1 Eighth day 1 „ „ 1 First day 27 Uterine infection 1 Fourth day 2 Congested breasts 1 Third day 1 Unknown 1 Before labour 13 Broncho-pneumonia 1 Fourth day 4 Local infection 1 Ninth day 7 + Suppurative mastitis 1 Sixth day 5 Local infection 1 18 Sepsis rate in all cases—2.8 per cent. 128 INFANTS. Primigravidae. Multigravidae. Total. Number of infants born 372 277 649 Total per cent. Total per cent Total Der cent. Number of stillbirths:— (a) Full term 5 1.34 5 1.8 10 1.5 (b) Premature 2 0.54 4 1.4 6 0.88 7 1.88 9 3.2 16 2.38 Number of infant deaths:— (a) Full term 3 0.8 1 0.36 4 0.62 (b) Premature 5 1.34 — — 5 0.84 8 2.14 1 0.36 9 1.46 STILLBIRTHS. Cause of Death. Premature. Prematurity 3 Maternal toxaemia; placental degeneration 1 Anencephaly 1 Unknown 1 Total 6 Full Term. Placental insufficiency 1 Asphyxia ; tight cord round neck 1 Difficult labour 3 Prolapsed cord 1 Impacted shoulders 1 Unknown 3 Total 10 INFANT DEATHS. Cause of Death. Premature. Prematurity 1 Respiratory failure and prematurity 3 Maternal eclampsia and prematurity 1 Total 5 Full Term. Malformation of intestine 1 Congenital malformation of heart 2 Atelectasis; bilateral suprarenal haemorrhage 1 Total 4 129 INFANTS—STILLBIRTHS Case No. Reg. No. First or later Pregnancy. Maternal Complication. Method of Delivery. Sex. Birth Weight. Recent. Macerated. Cause of Death. Post-Mortem Examination. lb. oz. 1 1872 First Obstructed labour Forceps F. — Yes — Difficult labour Not held. 2 1880 Third Locked twins F. — „ — „ „ „ 3 1890 8ccond Nil Spontaneous M. 3 0 „ — Prematurity „ 4 1898 First Persistent occipito posterior position Forceps F. 8 2 „ — Impacted shoulders „ 5 1953 Second Hydramnios Spontaneous F. - Yes Anencephaly „ 6 1965 First Nil Assisted breech F. 7 0 Yes — Difficult labour „ 7 2118 Second Nil Spontaneous breech M. 7 11 „ - Placental insufficiency Nil found to account for death. 8 2191 First Uterine inertia Spontaneous F. 3 3 „ — Prematurity Not held. 9 2192 Third „ „ „ F. 7 14 — — Unknown „ 10 2309 Second Fibroid of uterus „ M. 2 14 Yes — Prematurity „ 11 2407 First Nil „ M. 9 6 — Unknown „ 12 2412 „ Persistent occipito posterior position Manual rotation. Forceps M. — „ — Prolapsed cord. Difficult labour- „ 13 2416 Fifteenth Persistent occipito posterior position Manual rotation. Forceps M. 9 15½ „ — Unknown 14 2467 First Pre eclampsia Spontaneous F. 3 4 - Yes Maternal toxaemia. Placental degeneration Not held. 15 2477 Second Nil „ F. 3 11 - Yes Unknown „ 16 2488 „ Nil „ M. 7 14 Yes - Asphyxia. Cord round neck very tight „ Remarks:—Case No. 1. —Second twin. ,, 2.—Second twin. ,, 3.—28 weeks. ,, 5.—Previous miscarriage, 32 weeks. ,, 13.—Foetal heart sounds absent before delivery. 130 INFANT DEATHS Case No. Reg. No. First or later Pregnancy. Maternal Complication. Method of Delivery. Sex. Birth Weight. Cause of Death. Post-mortem Examination. lb. oz. 1 2220 First Nil Spontaneous M. 3 5 Prematurity Not held. 2 1923 „ Eclampsia „ F. 3 11 „ „ 3 2191 „ Uterine inertia Forceps F. 3 15 Respiratory failure. Prematurity „ 4 1853 „ Nil Spontaneous F. 4 0 „ „ „ „ 5 2507 „ „ „ F. 3 9½ „ „ „ „ 6 2310 Third „ „ M. 0 12 Malformation of intestine Held. 7 2437 First „ „ M. 7 12 Congenital malformation of heart „ 8 2440 „ „ Persistent occipito posterior position. Caesarean Section F. - „ „ „ „ 9 2495 „ „ - M. 8 12 Atelectasis. Bilateral suprarenal haemorrhage „ 131 MATERNAL MORTALITY. There were two deaths of patients who were delivered in the Hospital and one death of a patient admitted after delivery. 2192. Multigravida 2. Aged 42. Attended the Ante-Natal Clinic. Had phlebitis of both legs. Labour :—Uterine inertia. Post-partum hæmorrhage. Manual removal of placenta. Puerperium :—Pyrexia, due to thrombo-phlebitis both lower extremities. Death from pulmonary embolism occurred on the 14th day. 2328. Primigravida. Aged 23. Trial labour:—Classical Cæsarean Section. Puerperium:—Intestinal obstruction due to paralytic ileus. Death occurred on the fourth day of the puerperium. 2403. Multigravida 5. Aged 38. Bronchitis in the latter part of the ante-natal period. Labour :—Normal. Admitted following delivery at home. Bronchitis. Later Broncho-pneumonia developed. Died on the 13th day of the puerperium. POST-NATAL CLINIC. On discharge from the Hospital every patient is given an appointment for the Post-Natal Clinic six weeks from the date of confinement. One clinic is held weekly. Number of sessions held 51 Number of patients who attended :— (a) New cases 380 (b) Old cases 145 Total attendances 525 Percentage of new patients relative to the number confined in the Hospital 59.3 Average attendance per session 10.3