WAL 19 AC 4411 (1) WALTHAMATOW Borough of Walthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1938. Borough of Walthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1938. 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 28 ,, E.—Inspection and Supervision of Food 38 ,, F.—Prevalence of and Control over Infectious Disease 44 ,, G.—Infectious Disease Hospital 63 ,, H.—Maternity and Child Welfare 72 ,, I.—Thorpe Coombe Maternity Hospital 102 PAGE Abortion 100 Acreage 8 Adulteration 41 Air Raid Precautions 71 Albuminuria 108 Ambulance 13 Anaesthesia and Analgesia 117 Ante-Natal Clinic 84, 105 Antitoxin 55 Bacteriological Analyses 41 Bakehouses 24 Births 9 ,, Notification of 77 ,, Registration of 77 Birth-Rate 9 Breech Delivery 112 Breast Feeding 82 Brookfield Hospital 88 Caesarean Section 116 Cancer 12 Caravans 25 Oerebro-Spinal Meningitis 59 Child Guidance 90 Child Welfare 81 Child Life Protection 85 Clearance Area 32 Clinics 14, 81, 84, 86, 105, 124 Closet Accommodation 20 Committees 4, 73 Comparability Factor 10 Compensation (Midwives) 97 Connaught Hospital 17 Consultants 75, 95 Cowsheds 25 Cremation 69 Dampness 23 Deaths 9,12 ,, Infant 80, 119 ,, Infectious Diseases 11 page Death Rate 9 Dental Treatment 89 Diarrhœa 9 Dick Tests 51 Diphtheria 54, 66 ,, Immunisation 48 Diseases of Animals Acts 41 Disinfection 23 Disinfestation 27, 37 District Midwifery 97 Drainage 20 Dysentery 56 Eclampsia 108 Emergency Unit 104 Encephalitis Lethargica 59 Enteric Fever 55 Erysipelas 58 Essex Public Medical Service 18 ,, County Council Act 19 Factories and Workshops 42 Fishmongers 24 Food and Drugs 41 Foot Clinic 14 Forceps Delivery 110 Hæmorrhage— Ante-Partum 109 Post-Partum 109, 117 Health Education 69 ,, Visitors 75 Home Helps 92 Hospital Accommodation 17,93 ,, Infectious Disease 63 ,, Smallpox 53 House-to-House Inspection 31 Housing 28 Act, 1936 30 ,, Conditions 35 ,, Inspection 29 ,, Tuberculous Cases 35 page Ice Cream 25,39 Immunisation 48 Industrial Activity 9 Infant Mortality 9, 79 Infectious Diseases 44 ,, ,, Clinic 47 Institutional Treatment 17, 92 Inquests 69 Invalid Children's Aid Assen. 90 Isolation Hospital 63 Laboratory Work 13, 52, 67 Massage 85 Maternal Mortality 9, 100, 123 Maternity and Child Welfare 72 ,, Homes 19 Measles 9, 60, 68 Meat Inspection 39 Medical Aid 96, 107 ,, Examinations 68 Midwives 76, 95 Milk, Assisted Scheme 85, 91 ,, and Dairies Order 39 ,, Shops 25 ,, Special Designation Order 39 ,, Supply 38 Miscellaneous 68 Mortuary 69 Neo-Natal Mortality 79 Notices, Sanitary 22 Notifications and Rates 11 Notification of Births 77 Nursery School 14, 88 Nursing 14 ,, Homes 19 Nutrition 41, 123 Obstetric Consultants 75,95 Ophthalmia Neonatorum 100 Ophthalmic Treatment 89 Orthopaedic Treatment 88 Outworkers 44 Overcrowding 31, 35 Parks 9 Perineal Lacerations 117 Pneumonia 57 Poliomyelitis 59 Population 8 Posters 69 Post-Mortems 69 Post-Natal Clinic 84,124 Propaganda 69 Public Assistance 18 ,, Cleansing 20 page Puerperal Pyrexia 98, 122 ,, Sepsis 9 Rainfall 71 Rateable Value 8 Rats and Mice Destruction Act, 1919 42 Recreation Grounds 9 Refuse Disposal 20 Rent Restriction Acts 41 Rheumatism Clinic 48 Rivers and Streams 20 Sanitary Inspection 22 Scarlet Fever 53,66 ,, ,, Immunisation., 51 Schick Tests 48 Schools 28 Sewerage 20 Shellfish 41 Shops Act 25 Slaughterhouses 24 Smallpox 53 Smoke Abatement 25 Social Conditions 8 Special Premises 24 Staff 8,7,64,75 Statistics 8, 11, 28, 47 Stillbirths 9, 79, 118 Sunlight Treatment 90 Swimming Baths 26 Thorpe Coombe Maternity Hospital 102 Tonsils and Adenoids 89 Tuberculosis 10,60 Tuberculous Meat 40 Twin Delivery 115 Unemployment 8 Unhealthy Areas 32 Vaccination 52 Venereal Diseases 18 Vertex, Posterior 111 Vital Statistics 8, 9, 11 Walthamstow Child Welfare Society 86 Walthamstow District Nursing Association 93 Water 19 Whooping Cough 9 Women's Clinio 14 Zymotic Diseases 10 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Councillor R. E. Smith. The Worshipful the Mayor—Alderman Mrs. C. McEntee, J.P. The Deputy Mayor—Alderman H. Frost, J.P. Chairman of Finance Committee—Alderman Ross Wyld, J.P. Alderman G. Gibbons, J.P. Alderman W. J. Sharp ,, J. C. Hammond (Chairman, Sanatorium ,, Mrs. M. Norrish. Visiting Committee). Councillor Mrs . L. P. Bailey . Councillor J. L. Marston . ,, W. B.Fitt. ,, Mrs. E. M. Miller. Mrs. B. M. Friedberg. ,, Mrs. E. M. Richards. ,, W. Gillett. ,, J. H. Thomason. ,, J.W.Lis. ,, Mrs. E. B. Toynbee. A. E. Mallett. Town Clerk: F. G. Garner, Esq. TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, I beg to submit herewith a report on the work of the Public Health Department during 1938. The statistics are again favourable—a low death rate, a low maternal mortality rate, an infantile mortality rate of only 40, a diphtheria incidence rate of only one-third, and a diphtheria death rate only one-seventh of those relating to England and Wales. Legislation requiring the compulsory pasteurisation of milk— at least in urban areas—and specifying chemical and bacteriological standards for ice cream is still awaited. The routine work of the Department again increased, and acknowledgment must be made of the good work of the staff. I am again indebted to my colleagues in other Departments for those sections of the report on matters with which they have dealt. I also wish to acknowledge the consideration received from your Committee and 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.O., 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 -La w. Miss Mary C. Clarke, M.B., B.Ch., B.A.O. Consultants, Puerperal 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.R.C.O.G. Medical Officer—Miss Helen Rodway, M.R.C.S., L.R.C.P., M.R.C.O.G. Sisters (part-time)—Miss A.M. Duncan, S.R.N. Mrs. R. D. D. Farley. S.R.N., S.C.M. (from 5.7.38.) 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. Miss D. M. Pickles, M.C.Ch.A. (Temporary.) Clerk—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: R. C. Bland, A.R.S.I. (6), (d). S. E. Muggeridge, A.R.S.I. N. F. Cripps, A .R .8.1. (6), (d). (b), (d). F. W. Kemp, A.R.S.I. F. Northcote, A.R.S.I. (b), (c). (a), (6), (c). H. D. Perrin (b), (d). H. A. Whipp (6),'(c). Miss 0. J. Panther (a) (half-time) (to 5.5.38). (a) Cert. S.I.E.B. (London). (b) Cert. Inspector Meat and other Foods. (c) S.I. Cert, of R.S.I. (d) S.I. Cert, of R.S.I, and S.I.E.J.B. (e) Cert, of Sanitary Science, R.S.I. In addition some of the Inspectors hold special Certificates. 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 R. Kaufman (from 12.9.38), Miss B. E. Parford (to 26.8.38), R. A. C. Green, L. Rushton, F. J. Aylward, A. T. Wade, A. R. Kiggins, G. J. S. Bradley (from 11.4.38). Ambulance Drivers and Disinfecting Staff: W. H. Dunn, E. E. Harber, R. High, H. F. Thompson. 8 A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1938) 130,800 Number of Assessments, 1st April, 1938 35,505 Rateable value £850,353 Sum represented by penny rate £3,390 Population.—The Registrar-General's estimate of the population at mid-year, 1938, is 130,800, a decrease of 1,100 on the previous figure. Social Conditions.—South-West Essex Technical College.— An outstanding event of the year in the social and cultural conditions of the area was the opening of the new Technical College erected by the Essex County Council. Unemployment.—The degree of unemployment in the area during 1938 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). The following data refer to the whole Exchange area. Date. No. remaining on Register. Total Total Amount of benefit paid during month. Men. Women. 1938. 1937. £ 31.1.38 5,338 1,350 6,688 6,586 24,523 28.2.38 5,090 1,393 6,483 5,222 23,704 23.3.38 4,546 1,331 5,877 4,645 21,589 25.4.38 4,567 1,270 5,837 4,116 21,376 23.5.38 4,600 1,348 5,948 3,894 21,634 27.6.38 4,330 1,319 5,649 3,849 20,143 25.7.38 4,064 1,412 5,476 3,741 19,993 29.8.38 4,058 943 5,001 3,550 19,639 26.9.38 4,828 944 5,772 4,097 20,543 31.10.38 4,815 932 5,747 4,396 21,284 28.11.38 5,309 1,156 6,465 5,197 23,670 28.12.38 6,151 1,524 7,675 5,792 26,792 Mr. Dempsey states that the following were the registrations at the Juvenile Employment Bureau:— 9  Boys. Girls. Total. Live Register at beginning of year 14 11 25 Fresh Registrations during year 1,541 1,708 3,249 Registrations during year 867 418 1,285 Live register at end of year 55 66 121 Industrial Activity.—Considerable industrial activity has been apparent in the erection of new factories and in the extension of existing works. I Parks and Recreation Grounds.—No change since 1937. Extracts from Vital Statistics.—The Registrar-General's mid-year, 1938, estimate of population (viz., 130,800) has been used for the calculation of all vital statistics:— Total. Males. Females. Live Births "Legitimate 1,572 771 801 Birth rate per Illegitimate 45 28 17 Total l,617 799 818 1,000 of the estimated resident population 12.3 Stillbirths 70 Rate per 1,000 total (live and still) births 41.7 Deaths 1,340 Death rate per 1,000 of the estimated resident population 10.2 Deaths from puerperal causes:— Rate per 1,000 (live and still) births. Puerperal Sepsis Deaths 1 0.59 Other Puerperal Causes 2 1.18 Total 3 1.78 Death rate of infants under one year of age:— All infants per 1,000 live births 40 Legitimate infants per 1,000 legitimate live births 40 Illegitimate infants per 1,000 illegitimate live births 66 Deaths from Measles (all ages) 5 ,, ,, Whooping Cough (all ages) 2 ,, ,, Diarrhœa (under 2 years of age) 7 10 (All rates are per 1,000 of estimated residential population.) Comparability factor 1.11 Adjusted death rate 11.3 Ratio of local to national crude death rate 0.87 Percentage reduction of adjusted death rate below that for England and Wales 2.5 Zymotic disease death rate 0.12 Pulmonary Tuberculosis death rate 0.55 Non-pulmonary Tuberculosis death rate 0.09 The natural increase of population, i.e., excess of births over deaths, was 277. 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 1938 (1,340) compares with 1,443 during 1937, the respective death-rates per 1,000 population being 10.2 and 11.3. 11 Birth-rates, Death-rates, Analysis of Mortality, Maternal Death -rates and Case-rates for certain Infectious Diseases in the year 1938. England and Wales, London, 126 Great Towns and 148 Smaller Towns (Provisional figures based on Weekly and Quarterly Returns). England and Wales. 126 County Boroughs and Great Towns (including London). 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Walthamstow. Rates per 1,000 population. Births:— Live 15.1 15.0 15.4 13.4 12.3 Still 0.60 0.65 0.60 0.48 0.53 Deaths:— All Causes 11.6 11.7 11.0 11.4 10.2 Typhoid and Para-typhoid Fevers 0.00 0.00 0.00 0.00 Smallpox 0.00 — 0.00 — - Measles 0.04 0.05 0.03 0.06 0.03 Scarlet Fever 0.01 0.01 0.01 0.01 — Whooping Cough 0.03 0.03 0.02 0.03 0.01 Diphtheria 0.07 0.07 0.06 0.05 0.01 Influenza 0.11 0.10 0.11 0.06 0.05 Notifications:— Smallpox 0.00 0.00 0.00 - - Scarlet Fever 2.41 2.60 2.58 2.05 2.13 Diphtheria 1.58 1.85 1.53 1.90 0.49 Enteric Fever 0.03 0.03 0.04 0.05 0.01 Erysipelas 0.40 0.46 0.39 0.46 0.58 Pneumonia 1.10 1.28 0.98 0.98 1.11 Rates per 1,000 Live Births Deaths under 1 year of age 53 57 51 57 40 Deaths from Diarrhœa and Enteritis under 2 years of age 5.5 7.8 3.6 13.1 4.3 Maternal Mortality:— Puerperal Sepsis 0.89 Not available 0.61 Others 2.19 1.23 Total 3.08 1.85 Rates per 1,000 Total Births (i. e. Live and Still) Maternal Mortality:— Puerperal Sepsis 0.86 Not available 0.59 Others 2.11 1.18 Total 2.97 1.78 Notif ications:— Puerperal Fever 14.42 18.08 12.51 3.53 20.80 Puerperal Pyrexia 15.46 12 Causes of Death as given by the Registrar -General for the year 1938. Whole District. Causes of death. Males. Females. Total. Total 1937. 1. Typhoid and Para-typhoid Fevers 2. Measles 3 2 5 3. Scarlet Fever - - - 1 4. Whooping Cough.. 1 1 2 2 5. Diphtheria — 2 2 4 6. Influenza 2 5 7 55 7. Encephalitis Lethargica 1 3 4 2 8. Cerebro-spinal Fever 3 — 3 1 9. T. B. of respiratory system 45 27 72 80 10. Other Tuberculous diseases 7 6 13 12 11. Syphilis 4 1 5 2 12. General paralysis of the insane, (tabes dorsalis) 5 - 5 3 13. Cancer, malignant disease 103 107 210 220 14. Diabetes 6 15 21 17 15. Cerebral Haemorrhage, etc. 42 46 88 91 16. Heart disease 178 168 346 338 17. Aneurysm 4 3 7 10 18. Other circulatory diseases 15 37 52 47 19. Bronchitis.. 27 22 49 70 20. Pneumonia (all forms) 42 46 88 103 21. Other respiratory diseases 6 8 14 16 22. Peptic Ulcer 14 6 20 19 23. Diarrhoea, etc. (under 2 years) 3 4 7 15 24. Appendicitis 9 2 11 10 25. Cirrhosis of Liver 5 1 6 6 26. Other diseases of liver, etc. 2 3 5 6 27. Other digestive diseases 18 14 32 38 28. Acute and Chronic Nephritis 12 14 26 35 29. Puerperal Sepsis — 1 1 4 30. Other Puerperal causes — 2 2 2 31. Congenital Debility and Malformation, Premature Birth, etc. 19 15 34 38 32. Senility 20 30 50 21 33. Suicide 9 6 15 14 34. Other violence 19 14 33 45 35. Other defined causes 63 41 104 116 36. Causes ill-defined or unknown 1 — 1 — Totals 688 652 1340 1443 The age distribution of Cancer deaths was as follows:- Under lyr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. & over — — — 1 — 11 92 106 13 The main classification of deaths—those for 1937 being given in parenthesis—was as follows:— Whooping Cough, 2 (2); Diphtheria, 2 (4); Pulmonary Tuberculosis, 72 (80); Non-Pulmonary Tuberculosis, 13 (12); Cancer, 210 (220); Cerebral Hæmorrhage, 88 (91); Heart, 346 (338); Bronchitis, 49 (70); Nephritis, 26 (35); Congenital Debility, etc., 34 (38); Suicide, 15 (14); Violence, 33 (45). 1.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. I.—(i) Public Health Officers of the Authority.—The names and qualifications of officers employed by your Authority are given at the beginning of the report and also in the Maternity and Child Welfare Section of the Report. All are whole-time officers unless otherwise stated. (ii) (a) 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. (b) Ambulance Facilities.— Infectious Cases.—No change since last report. Non-Infectious and Accident Cases, and Maternity Patients. See below The ambulance services in the area appear to be quite adequate and sufficiently co-ordinated. Municipal Service. Superintendent Camp, A.M.I. Fire E., reports as follows on the work done during 1938:— Removals Accidents Maternity Total Mileage 2,619 722 186 3,527 19,044 122 maternity cases have been removed to Thorpe Coombe Maternity Hospital. The oxygen-carbon dioxide breathing apparatus, giving a mixture of 7 per cent, carbon dioxide, has been in use 8 times for cases of gas poisoning and shock. It was successfully used on 4 occasions, the remaining 4 patients being beyond help before the ambulance was called. An additional ambulance was brought into use in 1938. Whipps Cross Hospital. Removal of patients is carried out by ambulances attached to the Hospital. 14 St. John Ambulance Corps. Mr. V. 6. Turner, Divisional Superintendent, reports as follows:— First Aid cases attended 1,215 Number of patients removed 722 Mileage 16,940 Local duties at cinemas, sports meetings, cricket, football, outings and functions of all kinds, have been covered by request as usual. During the summer months the Roadside Huts at the Waterworks and the Robin Hood have been staffed and many casualties treated—including forest fires at the Robin Hood. Several classes in First Aid have been held and a large percentage of candidates have attained Certificates, which has meant an increase in the personnel of the Division. Members of the Division are still active in A.R.P., and the majority are now in possession of Anti-Gas Certificates. (c) Nursing in the Home. (i) General.—No change since 1931. (ii) Infectious Diseases.—No change since 1931. (d) Clinics and Treatment Centres. Foot Clinic.—Total attendances were 14,692, and of these 1,879 were by ew patients and 12,813 were re-attendances by old patients. The receipts were £563 3s. 0. Two part-time chiropodists were employed when necessary in addition to the three full-time chiropodists, and for certain periods all five were fully employed. Tn September a subsidiary clinic was opened on Saturday mornings only, at the Markhouse Road Centre. Women's Clinic.—Sessions were held weekly, with one consultant session monthly. Miss Basden continued as Consultant-in-oharge with Miss Helen Rodway, M.R.C.O.G., in charge of the weekly sessions. Dr. Rodway submits the following report:— Number of sessions held:— (a) Monthly Consultation Clinic 2 (b) ssistant Medical Officer's Clinic 1 (c) Senior Sister's Clinic Total 6 15 Total attendances made by patients:— New. Old. (a) Consultant's Clinic 21 125 (b) Assistant Medical Officer's Clinic 298 1,048 (c) Senior Sister's Clinic — 6 Total 319 1,179 Average attendance per session:— (a) Consultant'8 Clinic 1.75 10.4 (b) Assistant Medical Officer's Clinic 5.8 20.5 (c) Senior Sister's Clinic — 2.0 SUMMARY OF NEW CASES 1. Diseases of the Vulva:— Eczema vulvae 2 Leukoplakia vulvae 2 Pruritus vulvae 6 2. Diseases of Bartholin's Gland:— Bartholinian abscess 1 Bartholinian cyst 1 3. Diseases of the Vagina Senile vaginitis 2 Vaginal cyst 2 Dyspareunia 2 4. Diseases of the Uterus:— Cervical polypi 3 Cervical erosion 30 Uterine fibroid 3 Metropathia haemorrhagica 2 5. Disorders of Menstruation :— Menorrhagia 11 Epineurorrhœa 5 Irregular menstruation 14 Dysmenorrhoea 5 Amenorrhoea 9 6. Prolapse of the Pelvic Organs and Displacements:— Prolapse of the uterus 3 Cystocele and rectocele 36 Retroversion 17 7. Diseases of the Fallopian Tubes and Ovaries:— Ovarian cyst 2 Salpingo-oophoritis 4 8. Examination during Pregnancy:— For diagnosis of pregnancy 43 Complications and abnormalities 9 9. Miscarriage 5 10. Sterility 18 11. For Contraceptive ad vice 14 12. Medical 26 13. Surgical:— Chronic mastitis 2 Carcinoma of breast 1 Appendicitis 3 Inguinal hernia 2 Haemorrhoids 7 14. Miscellaneous 17 Total 319 16 Referred to private doctors 34 Referred from private doctors 41 Referred to the South London Hospital for Women 26 Referred to other hospitals 16 Operations at the South London Hospital on patients referred from the Clinic (see below) 17 Diagnosis. No. Operation. Haemorrhoids 2 Haemorrhoidectomy. Metrorrhagia 2 Dilatation and curettage. Chronic mastitis 1 Local amputation left breast. Retroverted uterus 1 Gilliam's suspension. Chronic appendicitis 1 Appendicectomy. Prolapse 1 Anterior and posterior porrhaphy. Amputation of cervix. Gastric ulcer and prolapse 1 Anterior and posterior porrhaphy. Ovarian cyst impacted 1 Removal right ovarian cyst. Rectal haemorrhage 1 Sigmoidoscopy. Menorrhagia 1 Dilatation and curettage. Papilloma of bladder 1 Diathermy to papilloma of bladder. Uterine prolapse 1 Repair of urethrocele and colpoperineorrhaphy. Retroverted uterus, pro- 1 Amputation of cervix. Poslapse terior colporrhaphy. Gilliam's suspension. Partial resection left ovary. Ovarian cysts 1 Removal of ovarian cysts and both tubes. Sterility 1 Dilatation, insufflation and curettage. The 17 in-patients spent a total of 320 days in hospital. In addition, 26 out-patients made 34 attendances. The Council made a grant of £30 to the Hospital. (e) Hospitals.—There were no changes during 1938 in the Hospital services used by the inhabitants of the Borough. 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 17 institutions provided by the County Boroughs 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, 1938:— Institutions Men Women Children Total Central Home 157 203 43* 403 Whipps Cross Hospital 839 822 352 2,013 Forest Gate Hospital 5 100 4 109 Harold Wood Hospital — — — — Forest House 18 8 — 26 Aldersbrooke Children's Homes — — 49 49 *These children were ultimately transferred to Aldersbrooke. 52 infants were born to Walthamstow mothers in Forest Gate Hospital during the year. The number of patients from Walthamstow in Mental Hospitals was 434 on the 31st December, 1938. The Connaught Hospital. The Secretary to the Hospital has kindly supplied the following information:— ''Of the total number of in-patients admitted during the year, 1,000 were residents of the Borough. "The following figures show the progress of the Hospital during 1938 as compared with the previous year:— No. Admitted In-Patients Average Stay Daily Average Out.Patients New Cases Attendances 1938 1,937 20.5 108.05 14,470 78,104 1937 1,865 21.35 109.93 14,798 77,437 "Particulars as to Staff, Beds and Departmental activities were the same as those for 1936. "Operations and Treatments.—During 1938, 1,071 major operations and 2,978 minor operations were performed, making a total of 4,049. 18,703 radiographs were taken. There were 13,954 18 massage treatments, also 24,727 electrical treatments, 4 special treatments and 2,981 artificial sunlight treatments at the Comely Bank Clinic; a total of 39,893 treatments at this Clinic." Facilities at Comely Bank.—The following facilities for electro-medical treatment are provided at Comely Bank:—Galvanism; Faradism; Radiant Heat—Infra-Red Ray; DiathermyHigh Frequency; Massage and Remedial Exercises; Special treatment for Warts and Nevi. 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, Turner Street, Whitechapel, E.l. By arrangement with the Licencees. 67 new metal plaques, supplied by the County Council, were fixed in public-house urinals, etc. The plaques draw attention to facilities for treatment. Essex Public Medical Service. The above service brings to dependants of panel patients and to others benefits roughly analogous to those of the National Health Insurance Act. Twenty-two of the medical praotitioners of the Borough accept patients under the scheme. 2. Public Assistance.—Out-relief and institutional treatment is provided by the Essex County Council. Mr. Pegram, Clerk to the Essex County Council South-Western Area Guardian's Committee, kindly states that the amount of relief provided in Walthamstow during the two years ended 31st December, 1938, was as follows:— 1938. 1937. £ s. d. £ s. d. Total amount of out-relief granted to Walthamstow residents during year ended 31st December 51,598 17 11 49,288 2 6 Average weekly number of thamstow residents in receipt of relief during year ended 31st December Men 707 705 Women 1,154 1,134 Children 597 683 Total 2,458 2,522 3. Maternity and Child Welfare.—See Section H of the Report. 19 4. Public Health Act, 1936—Nursing Homes.— No. of Homes. No. of Patients provided for Maternity Patients. Others. Totals. Homes first registered during the year Nil - - - Homes on Register at the end of the year 5 31 17 48 In addition, three further beds have been registered, but have never been brought into use. No applications were refused, cancelled or appealed against. 22 quarterly inspections were made by the medical staff. Routine enquiries are made with regard to unregistered Homes. No difficulties in regard to supervision arose. Particulars as to the registered homes at the end of the year are given below:— Name of Home. Person Registered. Number of Beds Registered. Total. Midwifery and Maternity. General. The Gables Nursing Home, 20, Falmouth Avenue, E.4 Mrs. M. A. Conyers, S.R.N. 5 7 12 The Forest Hydro, Forest Road, E.17 Dr. F. C. Shone 4 13 17 Kingswood Maternity Home, Forest Rise, E.17 Mrs. A. M. Putnam, S.C.M. 5 — 5 St. Margaret's Maternity Home, 3, East Avenue, E.17 Miss A.M. Sitch, S.C.M. 3 - 3 Walthamstow District Nursing Association, 19, Carisbrooke Road, E.17 Miss C. A. Lee, S.R.N., S.C.M. 14 - 14 Total 31 20 51 Essex County Council Act.—Two licences to practice chiropody were granted by your Council. Bye-laws with regard to Hairdressers and Barbers were adopted during the year. C.—SANITARY CIRCUMSTANCES OF THE AREA. 1. (i) Water.—New mains have been installed in the following roads:—Longacre Road, Trevose Road, Grantock Road, Carnanton Road and Sutherland Road. 20 Following the issue of Circular 1684 re water supplies, notification is made to the Director of Water Examination, Metropolitan Water Board, as to the name and address of any person notified to be suffering from any disease capable of transmission by drinking water. (ii) Drainage and Sewage.—A new 9in. soil sewer has been laid in Forest Glade from an existing manhole at its junction with Sheredan Road to The Avenue, where it changes direction and proceeds in a north-easterly direction along The Avenue over the Ching Brook and terminates approximately at the Forest strip of land adjacent to Chingford Lane. A new surface water Relief Sewer laid in 24in., 21in., 18in. and 15th. concrete pipes has been constructed of 212 yards length from the junction of Henry's Avenue with Charter Road and discharging into the Highams Park Lake for the prevention of flooding in this particular area. 2. Rivers and Streams.—Periodical cleaning of the Dagenham Brook was carried out to the requirements of the Lea Conservancy Catchment Board. 3. (i) Closet Accommodation.—Following the construction of the new sewer in Forest Glade and a portion of the Avenue the number of cesspools within the Borough has now been reduced by eight. (ii) Public Cleansing.—Mr. Eric Bell, M.I.P.C., A.R.San.I., Cleansing Superintendent, reports as follows:— "House, Refuse Collection.—During the past year, in spite of the increased number of premises, there has been a reduction in the weight of refuse collected. This has, however, been accompanied by a slight increase in bulk, and once again we find that the general public are tending more and more to the consumption of tinned and prepared foods, the amount, judging by the tins and containers received at the works, being almost double the consumption of about six years ago. This is a common experience all over the country except in the country districts, where the increase has not been so noticeable. "As usual, where it has been necessary to suspend the usual collection owing to Bank Holidays, etc., the public have been notified by handbills and through the press of the altered day of collection. The few requests that have been received for the removal of bulky articles have been promptly attended to, and the fact that this service is operated seems to be becoming more widely known to the public. 21 ''Trade Refuse.—The Contract System with, traders continues in operation most satisfactorily, and has been extended as opportunity arose during the year. So far no trader has withdrawn from the scheme except where they have left the town. The amount of refuse delivered by traders to the works for disposal has shown a reduction on the previous year. "Refuse Disposal.—It is now possible to form an estimate of the efficiency of the extended plant, and in spite of certain setbacks which were experienced in the beginning, the alterations have proved economical, and after meeting the increased loan charges have effected a considerable financial saving. "The salvage markets have been anything but good during the year. During the early part the markets were extremely dull and resulted in difficulties in moving stocks. When the crisis occurred in September movements became easier, but prices were, fortunately for the country, strictly controlled, so that although movement became easier, prices remained very much on their previous level, and this state continued until the end of the year. The national call for scrap which was issued resulted in numerous Authorities throughout the country putting a salvage scheme into operation, and should result in an appreciable increase in the amount of home produced scrap. "Street Cleansinq.—Every endeavour has been made during the year to improve this service. New roads have been taken over and plans formulated for the erection throughout the Borough of SubDepots for use by sweepers. Facilities are being provided for the storage and cleansing of trucks, whilst spare bins at each Depot will obviate the emptying of sweepings into heaps and effect economies in the removal of sweepings. So far the only Sub-Depot in use is in the Stores Depot of the Housing Department in Billet Road, but the results have been most encouraging. "Gully Cleansing.—The periodic cleansing, disinfecting and sealing of the gullies has been carried out mechanically. During the year only one complaint was received regarding offensive smells from gullies, and this was dealt with the same day. '"General.—During the year steady progress has been made, and it is evident that the public are becoming more Cleansingminded, and appreciative of the work done. Vehicles have been reconditioned and repainted, litter baskets fixed at Bus Stops, summer uniforms supplied to all street cleansing staff and motor drivers, and the public in their turn have responded by a reduction in the amount of litter thoughtlessly thrown down. 22 "A fall of snow occurred during the Christmas week which seriously tried the patience of everyone. It was dealt with expeditiously, and although it was economically impossible to deal with the whole town, all main roads and shopping centres were kept clear." Note by Medical Officer of Health.—The evidence produced with regard to the increased use of tinned and prepared foods is most regrettable but not unexpected. (iii) SANITARY INSPECTION OF THE AREA. Mr. M. E. Duncan, Chief Sanitary Inspector, reports as follows:— No. of inspections made. No. of nuisances detected. No. of complaints received. No. of Informal Notices. No. of Statutory Notices. Total Visits. Served. Complied with. Served. Complied with. 12,665 10,629 1,629 2,396 2,357 90 88 28,638 Of the 2,396 informal notices served during the year 33 were in respect of factory premises, and although 2,363 notices were in respect of houses, 2,388 premises were rendered fit by informal action. Failing compliance with Statutory Notices by the owners, the Council carried out these requirements to 12 houses involving an expenditure of £376 11s. 9d. The nature and variety of the work done during 1938 is shown in the following tables:— Drains tested 478 ,, reconstructed or repaired 487 ,, obstructions removed 167 ,, means of access provided 58 ,, ventilation provided or improved 94 ,, ventilation repaired 96 Soil pipes repaired 55 ,, ,, new, provided 46 Rain water pipes renewed 269 ,, ,, ,, disconnected from drains 35 23 Roofs repaired or renewed 902 Gutterings repaired or renewed 451 W.C. pans or traps provided 516 Gully traps provided 92 W.C. flush cisterns provided 112 repaired 194 W.C. floors concreted 69 W.C.'s repaired and cleansed 679 W.C.'s light and ventilation improved 28 Waste pipes renewed or trapped 336 ,, ,, repaired , 164 New sinks provided 45 Water supply reinstated 10 ,, ,, taken off main 24 Cisterns cleansed and covered 50 Conveniences cleansed or repaired 19 Sculleries paved 118 Yards and forecourts paved and repaired 566 Dirty houses cleansed 37 ,, rooms cleansed 3,170 Floors repaired 338 Ventilations under floors provided 288 New damp-proof courses provided 285 Sites concreted 11 Oflensive accumulations removed 56 Animals improperly kept, removed 7 Manure receptacles provided 6 Stables cleansed, paved and drained 66 Manholes repaired or re-sealed 118 Other cases of dampness remedied 580 Miscellaneous repairs 3,185 Infectious Disease. Visits to premises 786 Re-visits to premises 169 Premises disinfected 649 Articles disinfected at Low Hall 6,691 Articles destroyed at Low Hall 172 Dampness in Houses. Sites concreted 11 Damp-proof courses provided 285 Yards and forecourts paved and drained 566 Roofs made watertight 902 Rain-water pipes made good 269 Guttering repaired or renewed 451 Other cases of dampness remedied 580 Ventilation under floors provided 288 House-to-house inspections 881 24 Special Premises. Number. Visits paid. Factories 499 992 Outworkers 436 522 Slaughterhouses 8 307 Butchers' Shops 94 555 Bakehouses 41 206 Fishmongers, fish fryers and curers, etc. 55 248 Eating-houses and Coffee Stalls 93 159 Ice Cream Vendors 187 186 Cowsheds 1 14 Dairies and Milkshops 230 369 Laundries 7 24 Rag and Bone Dealers 7 22 Elementary Schools 31 8 Private Schools 9 Piggeries 4 89 Street Stalls Numerous 73 Greengrocers „ 156 Stables „ 369 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers' Shops and Slaughterhouses. Special cleansings, 43; Paving repaired, 7; Accumulations removed, 4; New Galvanised Bins provided, 12; Drains repaired, 7; W.C.s repaired and cleansed, 18; Yard paving repaired, 6; Floors repaired and ventilated, 5; Roofs repaired, 4; Drains cleared, 1; Other Improvements. 1. Bakehouses. Special cleansings, 63; Drains repaired, 1; W.C.s cleansed and doors repaired, 11; Yards repaved, 3; W.C. cisterns repaired, 2; Roofs repaired, 3; Premises general repairs, 3; Obstruction from drains removed, 2; New ceilings fixed, 2. Fishmongers. Special cleansings, 42; Yards repaved, 10; Accumulations removed, 7; Roofs repaired, 3; Other improvements, 14; Drains cleared, 2; Gutters renewed, 3; W.C.s cleansed, 2. Coffee and Eating Houses. Special cleansings, 38; Yard pavings repaired, 8; W.C. cisterns repaired, 8; Drains repaired. 5; Kitchen light and ventilation improved, 2; Floors renewed, 1. 25 Ice Cream Vendors. Special cleansings, 14; Special cleansing of utensils, 6; Yard pavings repaired, 4; W.C. flush improved, 6; Drain repaired, 1. Cowsheds and Milkshops. Special cleansings, 16; Pavings relaid, 1; Fittings and other improvements, 2; Roofs repaired, 5; W.C.s repaired, 2; Light improved, 1. Stable Premises. Cleansings, 42; Accumulations removed, 10; Roofs repaired, 7; Pavings repaired, 13; W.C.s repaired, 2; Manure receptacles provided, 5; Drain reconstructed, 1. Laundries. Special cleansings, 9; Roofs repaired, 2; Other improvements, 2. Rag and Bone Dealers. Cleansings, 12; Paving repaired, 1; Accumulations removed, 1. Piggeries. Cleansings, 10. (iv) Shops and Offices.—Towards the latter part of the year attention was drawn to 32 breaches under the Shops Act 1934, and as a result the following conditions have been met:— In 20 instances the conditions of the Act have been complied with; 5 matters are pending for carrying into effect the plans sanctioned by the Council; the remaining 7 are in hand. (v) Camping Sites.—There were no sites in the area used as camping sites. There are, however, several van dwellers in the Higham Hill area, and the Council have authorised these to be dealt with under the Essex County Council Act. (vi) Smoke Abatement.—14 complaints of nuisance caused by smoke were investigated—only 9 of which were justifiable—and remedial measures adopted. Unsuitable coal and/or bad stoking were the causes of smoke emission, and consultations with those responsible brought about the cessation of the nuisance. 26 (vii) Swimming Baths and Pools.—The model bye-laws of the Ministry of Health were adopted during the year. (a) Municipal Baths, High Street.—This is a covered swimming bath. The Baths Superintendent kindly gives the following particulars : — "The Publio 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.). "It has 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 hours per day, the baths being open 153 days in 1938. "The approximate number of swimmers in 1938 was 54,379. The estimated maximum load was 964. "Bacteriological and chemical analyses were carried out on two 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." (b) 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 26th July with a satisfactory result. A chlorination and filtration plant has now been installed. (c) South-West Essex Technical College.—This is a covered swimming bath with a capacity of 160,000 gallons. It has a modern system of filtration and chlorination plant by The Paterson Engineering Co., Ltd., and a turnover period for filtration of four hours. 27 The bath will be used all the year round and was brought into use on 22nd November. 1938. Sampling was carried out on the 9th December, 1938, with a satisfactory result. (d) Forest School.—This is a small swimming bath with a capacity of approximately 47,000 gallons, treated with "Voxsan" with frequent changes of water. Sampling was carried out on the 4th July, 1938, with an unsatisfactory result. (e) 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 6ix 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 approximate number of swimmers in 1938 was 21,928. "Bacteriological and chemical analyses were carried out on three occasions, twice with satisfactory results, and once with unsatisfactory result." (viii) Eradication of Bed Bugs.—The methods employed for freeing infested houses from bed bugs are as follows:— (1) By the use of Solution "D" Insecticide. (2) ,, ,, "Zaldecide" Insecticide. (3) ,, ,, "Fuminol" Insecticide. (4) ,, ,, "Pyagra" Insecticide. (5) ,, ,, Hydrocyanic Acid Gas. (6) ,, ,, Sulphur Candles. (7) ,, ,, Cymex Tablets. The work of disinfestation is mainly carried out by builders on behalf of owners. Those premises dealt with by hydrocyanic acid gas were carried out on behalf of owners by a specialist firm. Insecticide in the form of Solution "D" and "Zaldecide" has been given gratis to tenants, and the free use of a sprayer is at their disposal. In the older parts of the town it is, to some extent, expected that repeated action by builders and tenants is necessary, and it is difficult to say definitely that disinfestation has been satisfactorily carried out owing to the nature and structure of some of the older houses, and in connection with this aspect I dealt with the matter more fully in the 1936 Annual Report. 28 The stripping of walls and ceilings, the removal of skirtings and architraves, and the proper repair of plaster work, is usuallycarried out in the work of disinfestation. 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 1938. Action in respect of infectious diseases among school children is, in general, along the lines of the Memorandum on Closure of and Exclusion from School, 1927, although it is felt that some revision of this Memorandum is now necessary. The work of the Infectious Diseases Clinic is referred to in Section F. D.—HOUSING. (a) Statistics. The particulars of new houses erected during 1938 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:— (1) By Local Authority Nil By other authorities Nil By other bodies or persons 121 houses. 179 flats. 300 The 300 houses and flats are situated as follows :— Hale End Ward 103 (a) High Street Ward Nil Higham Hill Ward 22 (b) Hoe Street Ward 2 (c) St. James Street Ward Nil Wood Street Ward 173 (d) (a) Includes 16 flats; (b) includes 18 flats; (c) Includes 2 flats; (d) includes 143 flats. 29 Tenders for the erection of 74 houses at Millfield Avenue (No. 2), 14 houses at Essex Hall (No. 2), 4 flats at Carlton Road will be invited at an early date. (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) 3,411 (b) Number of inspections made for the purpose15,487 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 881 (b) Number of inspections made for the purpose.. 4,464 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (N.B.—These comprise individual unfit houses.) (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 2,479 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 2,388 30 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 86 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 71 (b) By local authority in default of owners (at a cost of £376 l1s. 9d.) 12 (c) Withdrawn—premises vacated and undertaking not to allow future occupation 1 B. Proceedings lender the Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 4 (b) By local authority in default of owners Nil 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 3 (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 3 (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 31 IV.—Housing Act, 1936, Part IV—Overcrowding:— A. (1) Number of dwellings overcrowded at the end of the year 215 (2) Number of families dwelling therein 215 (3) Number of persons dwelling therein 1,616 B. Number of new cases of overcrowding reported during the year 70 C. (1) Number of cases of overcrowding relieved during the year 165 (2) Number of persons concerned in such cases 1,196 D. Cases of overcrowding occurring during the year after the Council had rehoused an overcrowded familyNil E. Any other particulars with respect to overcrowding See conditions upon which the Medical Officer of later Health may consider it advisable to report pages House-to-House Inspections. During the year, house-to-house inspections were carried out in the following streets:— Gainsford Road. Bristol Park Road. Chaucer Road. Hervey Park Road. Ickworth Park Road. Parts of:— Parts of:— Jewel Road. Macdonald Road. Luton Road. Carlton Road. Mansfield Road. St. Andrew's Road. Rosebank Grove. Fairfield Road. Chingford Road. Blenheim Road. Westbury Road. Oatland Rise. Brookdale Road. Higham Street. Acacia Road. Gloucester Road. Myrtle Road. Blackhorse Lane. Springfield Road. Century Road. Grange Road. Tenby Road. Clacton Road. Buxton Road. Fulbourne Road. Ritchings Avenue. Kitchener Road. Waverley Road. 32 Repair Costs. In 1934. I endeavoured to show that through the activities of your Sanitary Department the huge sum of £100.000 was necessarily expended by owners of property in repairs to premises in this Town during that year. 1934 was no exception, for this sum is a yearly figure and remains about constant. During the year the Council had before them, for statutory purposes, estimates of the cost of carrying out repairs to 241 houses. These estimates—prepared by your Engineer and Surveyor— totalled the sum of £8 877 10s. 0d., which is an average of a little less than £37 per house. The cost of repairs to these 241 houses ranged from £4 to £242 per house. During the year 2,388 houses were put in repair without formal action, and 84 premises were dealt with by formal action. The total of 2,472 houses repaired at an average cost of £37 per house represents a sum of £91,464, from which a 10 per cent. deduction for overhead charges leaves a nett figure of £82,318. In addition 487 house drains were repaired through informal action, and at an average cost of £5 per house represents a sum of £2,435, which, added to £82,318, gives a round figure of £84,753. If reference be made to the section of the Report dealing with Factories on page 43 under the heading "2. Defects Found," it will be seen that six new W.C.s were provided, 102 sanitary conveniences were rendered fit, 37 cleansings were carried out, and 57 other defects were remedied. The cleansing, etc., of 66 stable premises, provision of six manure receptacles, the removal of 56 accumulations, together with all those items of work carried out to special premises—other than houses—detailed on page 24, together with other incidental works to be found in the Report, is estimated to account for a round figure of £20,000, thus accounting for the expenditure by owners of a sum not less than £100,000 through your sanitary staff during the year. (c) Housing Act, 1936. Action re Clearance Orders. Walthamstow (Forest Road) Compulsory Purchase Order: Order confirmed. 33 (Nos. 800-810 and 802a, Forest Road, comprising six houses and one shop.) Walthamstow (Chingford Road (No. 1)) Compulsory Purchase Order: Not confirmed as all four houses had been demolished at the time of the Inspector's visit. Walthamstow (Chingford Road (No. 2)) Compulsory Purchase Order: Confirmed with the exception of two properties already demolished. Walthamstow Compulsory Purchase (Blackhorse Road) Order: Nos. 219, 221, Blackhorse Road. Order confirmed. Unfit Houses. During the year six premises were dealt with under this Act as follows:— 1 and 2, Cambridge Cottages, Chingford Road.—Demolition Order. The Bungalow, at rear of 19a and 21, Prospect Road.— Demolition Order. The Bungalow in King's Yard, Grange Road.—Closed for human habitation. 88 and 90, Wood Street.—Closed for human habitation. (d) Housing Act, 1936—Overcrowding. Total number of cases in the Borough scheduled as overcrowded on January 1st, 1938 310 Additional cases added during the year 70 Cases abated during the year:— Rehoused by the Council 55 Removals, altered accommodation, decrease of family units, etc. 110 165 This leaves a total of 215 cases of overcrowding remaining on the schedule at the end of the year. 34 The 70 cases added to the schedule are classified as follows:— Increasing age of existing children 36 Family increased 13 "Related" cases restored to list 14 Check on survey records, when actual measuring for permit showed very small rooms 5 Owner-occupier (age increase) 1 Overcrowded after Council's rehousing caused by increased age in new tenant's family 1 Total 70 Regarding the 110 cases abated during the year, as shown above, a complete review of all cases on the overcrowded schedule was carried out during the year for the first time since the "A" Survey in 1935-1936. This served a most useful purpose in that it disclosed the movement of families, or alteration to family details, which led to the removal from the schedule of such a large number of cases under this heading during the year. There have been many cases of failure on the part of the landlord to inscribe in tenant's rent books the permitted number for the premises. The District Sanitary Inspectors reported 59 such cases and as a result of correspondence by your Chief Sanitary Inspector applications were duly made by the owners concerned and permitted numbers supplied and duly entered in the rent books. In addition 201 applications were received from owners for permitted numbers, and the number of houses for which permitted numbers were dealt with was 2,634. Three hundred and fifty copies of Form D, giving details of the family concerned, together with their accommodation, were received by me during the year. Each Form was acknowledged by circular or special letter of explanation as the case required. Arising out of these forms 17 cases of illegal overcrowding were discovered, in connection with which 47 special letters were sent out by your Chief Sanitary Inspector which brought about the abatement of these cases of overcrowding. In 10 instances of overcrowding 27 special letters were sent and finally were reported to the Town Clerk for his attention. 35 Eleven further cases of overcrowding necessitated the sending of 35 special letters requiring further information from landlords or tenants. One hundred and forty-five follow-up visits were paid by the District Sanitary Inspectors in all cases where the overcrowding became abated by the Council re-housing. A total of 468 visits have been paid by the District Sanitary Inspectors in connection with the Housing Act, 1936. (e) General. Mr. J. E. West, your Council's Housing Manager, kindly contributed the following statement:— Abatement of Overcrowding. "The rehousing policy laid down by the Council some two years ago has been consistently followed. All new houses or vacancies arising have been allocated for the purpose of— (а) Slum Clearance Scheme rehousing; (b) Abatement of Overcrowding; (c) Ten per cent, reservation for rehousing cases recommended by the Medical Officer of Health on Medical Grounds. "With regard to (c) it should be noted that these recommendations are still limited to cases where pulmonary tuberculosis has been certified by the County Tuberculosis Officer. "There are now no authentic cases awaiting rehousing from Slum Clearance Orders which have been confirmed by the Ministry. "Despite the fact that there have been no new houses erected during the period, there has been progress made in the abatement of overcrowding. "It will be seen on reference to the Report for 1937 that there were still 273 cases of overcrowding on the register, and 37 additional cases deferred for further enquiries. During the year 70 more cases were reported, making a total of 380 for the year. "Owing to the lack of additional properties being available the utmost possible use has had to be made of accommodation available, and by methods of redistribution. This, it will readily be visualised, necessitates the complete co-operation of tenants, 36 other landlords, and the Estate Office staff. As a consequence the number of overcrowding cases has been reduced from 380 to 215 still requiring suitable accommodation. Overcrowding cases brought forward 1st January, 1938 273 Add deferred cases 37 310 Additional cases reported 70 380 Rehoused 55 Abated 110 165 215 The number of vacancies arising 72 (а) Rehoused from insanitary areas 3 (б) Rehoused from overcrowding schedule 55 (c) Rehoused by redistribution 13 (d) Rehoused from Housing Register 1 72 (b) Includes four cases of overcrowding in Council houses. (c) Relates to tenants who, by agreement, have been transferred from large houses to houses more appropriate to their needs, thus leaving available houses that could be let to large families on the overcrowding schedule. Without this system the number of real vacancies arising would be 59, and the number of overcrowding cases relieved would also be reduced accordingly, as it is frequently found that a real vacancy arising, i.e., the tenancy terminated by a tenant, is not suitable for any case on our schedule, but by redistribution a new case can be accommodated. (d) This letting is included to agree with the number of actual lettings shown in our register, and was entirely unsuitable for the purpose of relieving overcrowding, etc. Analysis of Cases on the Overcrowding Schedule. (a) Number of cases on schedule at 1st January, 1938, in 310 dwellings and involving 2,373 persons 310 (b) New cases reported during the year ending 31st December, 1938, involving 439 persons 70 37 (c) Number of cases relieved. 55 involving 391 persons rehoused. 110 involving 805 persons by redistribution, abatement, removals, etc. 165 cases 1.196 persons relieved. Analysis of Requirements. 2 cases requiring 1 bedroom type house. 14 „ „2 „ „ „ 23 ,, „3 „ „ „ 68 „ „ 4 „ „ „ 66 „„5 „ „ „ 37 „ „6 „ „ „ 4 „ „ 7 „ „ „ 1 „ „ 8 „ „ „ 215 Eradication of the Bed Bug. "This problem is still with us, unfortunately, but the tenants are responding reasonably to the efforts of the staff called upon to deal with this pest, when found to be prevalent. "The number of cases treated during the year amounted to 9, all of which we were able to treat without recourse to such drastic methods as hydro-cyanic acid gas, now considered by the Government to be inadvisable for use in Council houses. Welfare Work. "Very satisfactory progress has been made in this section of the work, and a chapter in itself could well be written and found of great benefit, not only to our housing estates, but to the Town generally. "The demands on the time and services of the Welfare Worker are extensive to a degree, and the variety of problems submitted is very significant. 38 "Valuable help has been given to and also received from voluntary organisations in the Town, and also assistance has been given to our less fortunate citizens by generous individual citizens interested in this work. "It is noteworthy that not one single complaint has been brought to my notice in connection with this section of the work, and an extension of the service is worthy of consideration, if one is to judge by the results obtained." E.—INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Routine phosphatase tests were carried out on samples of pasteurised milk, more particularly to control the efficiency of the three plants licensed in the Borough. The following is contributed by the Chief Sanitary Inspector. The average number of cows kept in the district is seven. There is only one cowshed, and 14 visits were paid by the Sanitary Inspectors, in addition to special visits paid by your Chief Sanitary Inspector. The number of retail purveyors of milk is 230, most of whom carry on a general shop and sell milk in bottles as they receive it. Three hundred and sixty-nine visits were paid to registered premises of purveyors of milk during the year, and the general standard of cleanliness was maintained. During the year 54 samples of milk were taken for bacteriological examination. Of these, 17 were from pasteurised milk supplied to schools in the Town, and these samples gave satisfactory results. Of the remaining 37 samples, all were satisfactory excepting four where a positive coliform result was obtained. The samples are summarised as follows:— No. of Samples. Satisfactory. Unsatisfactory. Tuberculin tested 3 — Pasteurised 36 — ,, (not sold as such) 1 1 Raw 10 3 Totals 50 4 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 37 Tuberculin Tested Milk 17 Supplementary Licences. Pasteurised Milk 3 Bottling Licences. In respect of Tuberculin Tested Milk, 2; Pasteurised Milk, 3. 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 53 applicants for such registration, the Council refused to register 5. There have been no appeals. Two vendors were convicted for selling ice cream after the Council had refused to register them. Twelve samples of ice cream were taken and submitted for bacteriological examination. In addition four samples were sent for chemical analyses. The chemical analyses of two showed the material to be of poor quality. The bacterial contents were mostly satisfactory. (6) Meat and other Food. During the year 1,771 animals intended for human consumption were slaughtered in the town. Every animal was inspected at time of slaughter and for this purpose 307 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. 40 There are 94 butchers' premises in the town and 555 inspections of these were made. 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 112 4 128 1,131 396 Number inspected 112 4 128 1,131 396 All diseases except Tuberculosis:— Whole carcases condemned — — Carcases of which some part or organ was condemned 26 1 - 4 20 Percentage of the number inspected affected with disease other than tuberculosis 23.21 25.00 - 0.35 5.05 Tuberculosis only:— Whole carcases condemned — — — — 4 Carcases of which some part or organ was condemned 16 - - - 21 Percentage of the number inspected affected with tuberculosis 14.29 — — — 6.31 In addition to the above the following miscellaneous articles were condemned and destroyed as unfit for food. 41 bundles Tangerines (approx. 5,950). 1 Chicken. 28 cases Mandarines (approx. 12,160). 86 Rabbits. 4J lbs. Semolina. 2 boxes Kippers. 5 lbs. Oatmeal. 5½ stone Codfish. 1 bottle Sweets (approx. 7 lbs.). 9 Codfish. 1 71b. tin Corned Beef. 3 61b. tins Corned Beef. 1 ton, 7 cwt. 1 qtr. 6 lbs. Butchers' Meat (various)—including 24 lbs. Sausages. 41 (c) Adulteration, etc. (Food and Drugs Adulteration Act, 1928). Fifty-eight samples of milk were submitted for analysis during the year. Of the 58 samples of milk 1 was taken in course of delivery. No legal procedure was necessary in respect of any sample. Although the Council is not a Food and Drugs Authority, such good work has been carried out in the past by continuous sampling under this Act and the Milk and Dairies (Amendment) Act that no relaxation in this matter is contemplated. (d) 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, and bacteriological examination by the Counties Public Health Laboratories, 91, Queen Victoria Street, E.C.4. (e) 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 Beport of the School Medical Officer. (/) Shell Fish. There are no shell-fish beds or layings in the Borough. RENT AND MORTGAGE RESTRICTIONS ACTS, 1920-1923. During the year ten certificates were granted to tenants and seven 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.—No action was necessary under this Order during the year. Regulation of Movement of Swine Order, 1922.—Seven Isolation Notices affecting 63 swine were received. The Licences were in all cases duly observed. Six movement Licences were received under the Order, affecting 36 animals. 42 Importation of Dogs and Cats Order, 1928.—Ten performing dogs were admitted under licence, the conditions of which were duly observed. Foot and Mouth Disease (Regulation of Movement) Order, 1928.—This standstill Order was made because of danger of widespread infection. It came into operation on 4th April and was withdrawn on 18th April. Under the Order this Borough was a "controlled area," and the necessary Movement Licences were issued. Tuberculosis Order, 1938, etc.—Section 19 (i) of the Agriculture Act, 1937, transferred, with effect from 1st April, 1938, the functions of Veterinary Inspection by the Local Authority to the inspectors appointed by the Ministry of Agriculture and Fisheries. The Tuberculosis Order of 1925 has now been replaced by the Order of 1938, under which routine inspections are now carried out by the Ministry's Veterinary Inspectors. RATS AND MICE DESTRUCTION ACT, 1919. During the year 20 Notices were served under this Act. In 93 instances poison was issued gratis to occupiers of premises upon complaint after investigation. In 63 instances drains were repaired where found defective. In 32 instances drains were tested giving negative results. In 17 instances rat proofing of out-buildings was carried out. It is difficult to estimate the number of rats destroyed, but judging by the amount of rat bait apparently consumed, the number must be quite considerable. The poisons used were Liquid Extract of Red Squill, and Barium Carbonate in Biscuit form. In all 182 complaints were received and dealt with. FACTORY AND WORKSHOP ACT, 1901. AND FACTORIES ACT, 1937. The following tables show the work done under these Acts. 43 1 .—inspection of factories, etc. Including Inspections made by Sanitary Inspectors. Promises. (i) Number of Inspections. (2) Written Notices. (3) Occupier* Prosecuted . (4) Factories with mechanical power 695 19 Nil. Workshops without mechanical power 227 14 Nil. Other premises under the Act. 70 — Nil. Total 992 33 Nil. 2.—defects found in factories, etc. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (6) Want of cleanliness 37 37 — — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation 1 1 — — Ineffective drainage of floors 4 4 — — Sanitary Conveniences insufficient 5 6 — — unsuitable or defective 107 102 not separate for sexes 2 2 — — Other offences 54 52 — — Total 210 204 Nil Nil 44 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1938. Wearing Apparel, making of 304 Furs 3 Brush Making .. .. 33 Artificial Flowers 9 Boxes 22 Toys 32 Carnival Hats 1 Handbags 4 Pattern Cards 3 Fancy Goods 9 Shoes 16 Total 436 Outworkers were notified from the following areas:— City of London 96 St. Marylebone 4 Bethnal Green 1 Stepney 12 Finsbury 28 Shoreditch 10 Hackney 38 Tottenham 25 Islington 9 Walthamstow 108 Leyton 74 Westminster 10 Poplar 8 Other Areas 13 Total 436 A total of 522 visits was paid in connection with outworkers. F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. A table is given showing the incidence of notifiable disease in the Towns of the London Outer Ring during 1938. 45 NOTIFICATION OF INFECTIOUS DISEASES IN LONDON OUTER RING TOWNS FOR THE 52 WEEKS ENDED 31ST DECEMBER, 1938. Towns in Outer Ring. Estimated Population Mid-year, 1938. Scarlet Fever. Rate per 1,000 Population. Diphtheria. Rate per 1,000 Population. Enteric (Typhoid and Paratyphoid) Fever. Rate per 1,000 Population. Acute Pneumonia (Primary & Influenzal) Rate per 1,000 Population. Dysentery. Rate per 1,000 Population. Puerperal Pyrexia.* Rate per 1,000 Population. Ophthalmia Neonatorum. Rate per 1,000 Population. Acton M.B. 68,670 158 2.3 19 0.27 43 0.62 3 0.04 2 0.02 4 0.05 Barking M.B. 76,790 263 3.4 164 2.13 8 0.10 119 1.54 3 0.03 24 0.31 5 0.06 Beckenham M.B. 70,590 171 2.4 21 0.29 3 0.04 31 0.43 3 0.04 13 0.18 1 0.01 Brentford and Chiswick M.B. 61,470 81 1.3 85 1.38 1 0.01 23 0.37 1 0.01 3 0.04 1 0.01 Croydon C.B. 243,400 522 2.1 284 1.16 9 0.03 40 0.16 6 0.02 60 0.24 21 0.08 Dagenham M.B. 107,400 275 2.5 130 1.21 — — 98 0.91 1 0.00 28 0.26 8 0.74 Ealing M.B. 161,000 386 2.4 149 0.92 2 0.01 103 0.64 12 0.07 45 0.27 15 0.09 East Ham C.B. 129,500 287 2.2 141 1.08 15 0.11 85 0.65 18 0.13 18 0.13 9 0.07 Edmonton M.B. 103,200 293 2.8 111 1.07 6 0.05 79 0.76 14 0.13 84 0.81 12 0.11 Enfield U.D. 91,940 190 2.0 59 0.64 1 0.01 96 1.04 113 1.22 10 0.10 1 0.01 Finchley M.B. 65,140 115 1.8 22 0.33 3 0.04 21 0.32 — — 2 0.03 1 0.01 Harrow U.D. 183,500 500 2.7 63 0.34 2 0.01 98 0.53 13 0.07 34 0.18 8 0.04 Hendon M.B. 145,100 288 2.0 195 1.34 5 0.03 103 0.71 66 0.45 72 0.49 18 0.12 Heston and Isleworth M.B. 101,500 315 3.1 40 0.39 4 0.03 161 1.58 2 0.02 65 0.64 10 0.09 Hornsey M.B. 96,680 144 1.4 112 1.15 3 0.03 46 0.04 3 0.03 17 0.17 4 0.04 Ilford M.B. 166,900 303 1.8 144 0.86 4 0.02 152 0.91 54 0.32 84 0.50 9 0.05 Leyton M.B. 117,200 291 2.4 191 1.62 — — 107 0.91 26 0.22 22 0.18 2 0.01 Mitcham M.B. 66,020 150 2.2 64 0.97 1 0.01 43 0.65 — — 4 0.06 3 0.04 Southgate M.B. 67,860 96 1.4 26 0.38 2 0.02 37 0.54 5 0.07 9 0.13 2 0.02 Tottenham M.B. 144,400 186 1.2 220 1.52 — — 121 0.83 11 0.07 23 0.15 6 0.04 Twickenham M.B. 96,550 274 2.8 70 0.72 — — 68 0.70 6 0.06 15 0.15 12 0.12 Walthamstow M.B. 130,800 279 2.1 65 0.49 2 0.01 146 1.11 23 0.17 35 0.26 4 0.03 Wembley M.B. 118,800 416 3.5 82 0.69 4 0.03 74 0.62 15 0.12 26 0.21 7 0.05 West Ham C.B. 254,900 828 3.2 467 1.83 32 0.12 297 1.16 11 0.04 67 0.26 17 0.06 Willesden M.B. 187,600 371 1.9 415 2.21 11 0.05 284 1.51 37 0.19 47 0.25 26 0.13 Wimbledon M.B. 58,680 55 0.9 37 0.63 1 0.01 21 0.35 1 0.01 11 0.18 8 0.13 Wood Green M.B. 53,190 90 1.6 61 1.14 1 0.01 23 0.43 — — 8 0.15 3 0.05 Average 117,362 271 2.3 129 1.09 4 0.03 93 0.79 16 0.13 31 0.26 8 0.06 * Includes Puerperal Fever. 46 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. 5 45-65 yrs. 65 & over 1938 1937 Scarlet Fever 281 207 1 72 163 31 12 2 - Diphtheria 65 101 1 7 42 12 3 — - Enteric Fever 2 11 — — 1 — 1 — - Pneumonia 147 154 3 23 24 12 44 25 1 Puerperal Pyrexia 35 38 — — — 7 28 — - Ophthalmia Neonatorum 4 8 4 — — — - — - Erysipelas 76 61 — 1 1 4 25 31 1 Encephalitis Lethargica 3 — — — 2 — 1 — - Polio-encephalitis - 1 - - - - - - - Cerebro-spinal Meningitis 3 1 2 — — 1 — — - Anterior Poliomyelitis — 9 — — — — — — - Measles (under 5 years) 772 13 41 731 - - - - - Dysentery 23 84 — 5 13 1 2 2 - Tuberculosis 164 154 1 4 22 40 68 26 - Totals 1938 1575 53 843 268 108 184 86 33 1937 842 1 26 150 255 124 177 80 36 Disease. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total Scarlet Fever 26 25 51 76 51 52 281 Diphtheria 22 10 7 11 10 5 65 Enteric Fever — — — — — 2 2 Pneumonia 19 16 18 19 29 46 147 Puerperal Pyrexia 4 2 8 8 7 6 35 Ophthalmia Neonatorum - - 2 1 - 1 4 Erysipelas 18 14 5 4 19 16 76 Encephalitis Lethargica — 1 — — — 2 3 Polio-encephalitis - - - - - - — Cerebro-spinal Meningitis 1 - - - - 2 3 Anterior Poliomyelitis - - - - - - - Measles (under 5 years) 137 111 85 89 175 175 772 Dysentery 3 6 1 2 3 8 23 Tuberculosis 32 18 33 15 41 25 164 Totals 1938 262 203 210 225 335 340 1575 1937 171 128 109 88 149 197 842 The statistics given in the foregoing table are those for the calendar year 1938. 47 The Registrar-General gives the statistics for the 53 weeks ended 1st January, 1939, 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 Pyrexia. Erysipelas. Number 279 65 2 146 35 76 Case Kate— Walthamstow 2.13 0.49 0.01 1.11 0.26 0.58 England and Wales 2.41 1.58 0.03 1.10 (Not available) 0.40 The rate for Puerperal Pyrexia is better expressed in relation to the number of births (i.e. live and still-births) registered than to population. When calculated on this basis the rate is:— Walthamstow 20.8 England and Wales 14.42 Per cent. | Deaths Total Removed removed per cent. Disease. notified. to to Deaths. | of cases Hospital. Hospital. notified. Scarlet Fever 281 247 87.9 Nil Nil Diphtheria 65 63 96.9 2 3.0 Enteric Fever 2 2 100 Nil Nil Pneumonia 147 73 49.6 88 59.8 Puerperal Pyrexia 35 7 20 1 2.8 Ophthalmia Neonatorum 4 2 50 1 25.0 (enteritis) Erysipelas 76 27 35.5 Not a classified cause of death Cerebro-spinalMeningitis 3 3 100 2 66.6 Encephalitis Lethargica 3 3 100 2 66.6 Measles (under 5 years) 772 95 12.3 5 0.6 Dysentery .. ..23 10 43.4 Nil Nil Tuberculosis 164 206* — 85 51.7 *This figure also includes cases notified during previous years. Infectious Diseases Clinic.—The weekly clinic at 2 p.m. 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 diseases 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. 48 Thirty-one children were referred, 13 following diphtheria, 10 following scarlet fever and 8 in connection with the scheme detailed below. Sore Throat Follow-up Scheme.—The parents of all children reported to the School Medical Service to have had a sore throat are 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. 150 cases were seen in 1938, and eight cases were referred to Dr. Sheldon. 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 52 Number of attendances made 3,571 Average attendance per session 68.6 Number of scarlet fever cases discovered 3 Number of diphtheria cases discovered 2 Number of virulence tests taken in diphtheria carriers 11 Number of children recommended to rheumatism clinic 31 Number of children recommended to ear clinic 8 Number of children recommended to orthopaedic clinic 3 DIPHTHERIA IMMUNISATION. Immunisation was carried out at the weekly clinic on Tuesdays at 3 p.m. and at Infants' Departments, along the lines detailed in the previous reports. The following summarises the work done:— Schick tested for the first time 120 Negative (including pseudo and negative) 48 Positive (including pseudo and positive) 72 Total number of immunisations completed during 1938:— (а) School age 1,140 (б) Pre-school age 288 (c) Over school age 4 Total 1,432 49 Number not completing immunisation or left district 46 Number of Schick tests following immunisation 107 Number of re-Schick tests following immunisation in previous years 546 Number of attendances made at clinic for immunisation 2,398 Immunisation at schools (included above):— Number completely immunised 1,034 Number partly immunised 46 Number having second dose, immunised with single dose in previous years 248 Follow-up of Single Dose A .P.T. Immunisation Cases.—In view of the unreliability of the single dose method, invitations were sent to the parents of all children immunised with one dose A.P.T. to have them Schick tested. 1.240 invitations were sent, 546 responded and 42 were found to have relapsed, i.e. 7.6 per cent. All these cases were given a further dose. Follow-up of Double Dose A.P.T. Immunisation.—During the current year (1939) Schick testing is being done in cases given two doses A.P.T. eighteen to twenty-four months previously. There appears to be a considerable loss of immunity, as shown by the number of positive results obtained. Diphtheria and Vincents Angina.—From one institution during the year nine cases notified as diphtheria were removed, but four proved to be Vincent's Angina. In addition there were at least 10 cases of oral angina, mostly amongst children in the nursery school section. A special dental inspection at the time showed 12 cases of gingivitis which is probably a precursor of the angina. Diphtheria in Immunised Children.—No definite case occurred. Birthday Letters.—Beginning on 21st October, 1938, letters were sent to the parents of all infants following their first birthday and stressing the need for protection against diphtheria. 278 letters were issued and 35 infants were brought and protected. 23 infants had left the district. 50 The following- table gives a comparison of the attack rates of Diphtheria on the immunised and the non-immunised sections oi the population under 15 years of age. Year. Immunised. Not Immunised. Population immunised under 15 years of age. No. of cases 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 1,000 population under 15 years. Deaths under 15 years. 1926 34,813 232 6.6 5 1927 33,899 229 6.7 11 1928 32,864 231 7.02 8 1929 31,888 273 8.5 16* 1930 30,100 439 14.5 22 1931 30,790 (census) 275 8.9 9 1932 36 — — — 30,754 321 10.4 5 1933 157 — — — 30,633 282 9.2 7 1934 320 — — — 30,470 235 7.7 8 1935 996 1 1.0 — 29,794 148 4.9 4 1936 2,182 1 0.45 — 28,608 88 3.07 2 1937 3,592 3 0.83 — 27,198 92 3.3 5 1938 5,024 — 0.0 — 25,766 52 2.0 2 * All Ages. 51 Year. Number pre-Schick Negative. Total carried forward. Number Immunised. Total carried forward. Number Immunised pre-Schick Negative. Total carried forward. 1932 17 17 36 36 53 53 1933 157 174 121 157 278 331 1934 119 293 163 320 282 613 1935 164 457 676 996 840 1,453 1936 87 544 1.186 2,182 1,273 2,726 1937 65 609 1,410 3,592 1,475 4,201 1938 48 657 1,432 5,024 1,480 5,681 Year. Running total of Immunised and Schick Negative. Number of Cases of Diphtheria. Attack Rate per 1,000 Population. Deaths. Percentage of Deaths to Notifications. 1930 - 509 4.08 22 4.3 1931 — 324 2.44 11 3.4 1932 53 356 2.64 5 1.4 1933 331 334 2.47 7 2.1 1934 613 274 2.03 8 2.9 1935 1,453 163 1.21 4 2.4 1936 2,726 106 0.79 2 1 .8 1937 4,201 101 0.76 4 4.0 1938 5,681 65 0.49 2 3.0 At the end of 1938 a total of 4,875 immunised persons then under 15 years of age, for whom information was available, showed the following age analysis :— Under 1 yr. 1-2 years 2-3 years 3-4 years 4-5 years 5- 6 years 6-7 years 7-8 years 1 72 146 227 385 662 782 882 8-9 years 9-10 years 10-11 years 11-12 years 12-13 years 13-14 years 14-15 years Total 725 513 203 120 70 46 41 4875 Up to the end of 1938, approximately 18.4 per cent. of the estimated number of children under 15 years had been protected, and 1,496 children under 5 years of age had been immunised out of an approximate total of 8,445 registered live births during the previous 5 years, i.e., 17.7 per cent. Immunisation by General Practitioners.—Diphtheria prophylactic is available to general practitioners. During 1938, 29 c.cs. of alum precipitated toxoid were issued: this quantity is sufficient to protect 29 children. Scarlet Fever Immunisation.—Dick tests for scarlet fever:— Positive, 26; Negative, 156; Doubtful, 18. Total 200. The above were done at a children's residential institution, 73 children were given a prophylactic dose of scarlet fever antitoxin. During the year 30 resident children were removed to Hospital for scarlet fever and 18 further cases from the attached day school. The prevalent type of streptococcus pyogenes was Type 27. 52 MUNICIPAL LABORATORY. The following numbers of diphtheria swabs were examined durins 1938:— Swabs. Negative. Positive. Totals. Private Practitioners 938 38 976 Health Department 347 29 376 School Medical Department 416 3 419 Totals 1,701 70 1,771 The total number of diphtheria specimens examined in 1937 was 1,578. Direct examinations were done on 87 diphtheria specimens, and 9 were positive; 5 were positive on culture, although negative on direct examination. In addition, 163 specimens of urine were examined, as compared with 213 in 1937. A total of 2,845 tubes of culture media were made by Mr. West, and of these, 1,038 were sent to the Sanatorium. ESSEX COUNTY COUNCIL SCHEME. The Essex County Council also provides facilities for examination of pathological specimens, and the County Medical Officer states that 2,612 specimens were examined for local practitioners during 1938 as follows:— Diphtheria Swabs, 137; Sputa, 1,041; Typhoid Specimens. 25; Ringworm Specimens, 17; Miscellaneous, 1,391; Diphtheria Virulence Tests, 1. A total of 534 specimens were examined for the Connaught Hospital (included above). The total examinations carried out by the Essex County Council for the previous year was 2,730. VACCINATION. Mr. E. Sharp, Vaccination Officer for the Area, has furnished the folio wins return for 1938:— Births Registered, Successfully Vaccinated. Percentage Vaccinattd, Insusceptible. Exemptions. Death before Vaccinatec Postponed.  1,626 290 17.8 2 1,008 38 43 In addition to the above, 18 primary vaccinations were recorded, and 17 re-vaccinations. During 1938 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 23.0 per cent. were vaccinated. 53 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. 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 1938. SCARLET FEVER. A total of 281 cases of Scarlet Fever was notified in 1938, as compared with 207 in 1937. 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 17 — 5 6 6 — — — February 19 — 3 9 4 2 1 — March 17 — 4 10 3 — — —- April 20 — 5 12 3 — — — May 39 — 10 25 2 2 — — June 27 — 5 19 3 — -— — July 15 — 2 7 4 2 — — August 13 — 7 3 1 2 — — September 29 — 6 21 —- 2 — — October 40 1 7 25 4 2 1 — November 24 — 9 15 — — — — December 21 — 9 11 1 — — — Totals 1938 281 1 72 163 31 12 2 — 1937 207 1 51 110 24 12 3 — Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 2 2 3 1 5 4 February 3 1 4 1 6 4 March 4 — 1 4 4 4 April 3 1 2 7 2 5 May 2 2 1 24 7 3 June 2 1 1 10 10 3 July 2 1 3 2 3 4 August 1 1 5 3 3 — September 1 3 10 7 4 4 October 5 7 14 8 1 5 November — 2 3 5 3 11 December 1 4 4 4 3 5 Totals 1938 26 25 51 76 51 52 1937 32 17 23 25 62 48 54 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 (i.e., a separate room), no other inmate of the house to be employed in the preparation or distribution of food to the public and adequate medical supervision to be available. 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 1937 205 2 0.9 45 Nil Nil Total 1,411 48 3.4 362 3 0.9 1938 236 11 4.2 34 Nil Nil The last recorded death from Scarlet Fever in the Sanatorium occurred during 1936, and the last recorded death of a Walthamstow resident was in 1937, and this occurred in a hospital outside the Borough. DIPHTHERIA. A total of 65 cases of Diphtheria was notified during 1938, as compared with 101 in 1937. 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 5 - - 4 1 - - - February 8 — 1 4 3 — - — March 5 — 1 4 — — - — April 5 — — 4 1 — - — May 6 — 1 4 - 1 - — June 2 — — 1 1 — - — July 1 — — 1 — — - — August 3 — — 1 2 — - — September 9 1 — 6 1 1 - — October 8 — 1 6 — 1 - — November 10 - 3 5 2 - - - December 3 — — 2 1 — — — Totals 1938 65 1 7 42 12 3 — — 1937 101 4 24 64 6 3 - — 56 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 2 1 1 1 — — February 2 2 2 2 — — March 2 1 — 1 1 — April 2 1 — 1 — 1 May 3 — — 2 1 — June 1 — — — 1 — July — — — 1 — — August 1 1 1 — — — September — 2 2 1 2 2 October 1 — 1 1 4 1 November 6 1 — 1 1 1 December 2 1 — — — — Totals 1938 22 10 7 11 10 5 1937 42 11 20 8 6 14 The percentage of cases removed to Hospital in 1938 was 94.0 against 99.0 in 1937. No case was refused admission as home treatment of Diphtheria can rarely be adequate unless the disease is extremely mild. Antitoxin continued to be available for free issue to medical practitioners at the Public Health Department during office hours, and at all times at the Fire Station, Forest Road, and at Mr. Gaze's, 10, The Avenue. Highams Park. During 1938, a total of 85 phials, containing 564,000 units of Diphtheria antitoxin, and 11 phials, containing 110 c.c's 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. At the end of 1938 a total of 5,681 persons were either protected or Schick negative out of an estimated total of 30,790 under 15 years of age, i.e., 18.4 per cent. ENTERIC FEVER. Four cases of enteric fever were notified. All were removed to Hospital. Two were later withdrawn as diagnosis was not confirmed. The following table gives particulars :— No. Ward. Age. Date of Onset. Diagnosis. 1 Higham Hill 7 4.9.38 Recovered. 2 Higham Hill 4 13.9.38 Diagnosis not 3 Higham Hill 42 12.9.38 confirmed. 4 Higham Hill 29 12.12.38 Recovered. 56 The provision of free washing facilities in connection with public lavatories appears to be long overdue. DYSENTERY. Twenty-three cases of Dysentery were notified, 10 being removed to Hospital. The following tables give particulars:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 8 - 3 4 - - 1 - February 11 — 1 6 1 2 1 — March 1 — -— 1 - — — — April - - - - - - - - May - - - - - - - - June 2 — 1 1 - — — — July - - - - - - - - August - - - - - - - - September - - - - - - - - October - - - - - - - November 1 — — 1 - — — — December - - - - - - - — Totals 23 - 5 13 1 2 2 — Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 2 4 — — 1 1 February — 1 1 2 2 5 March 1 — — — — — April — — — — — — May — — — — — — June — 1 — — — 1 July — — — — — — August — — — — — — September — — — — — — October — — — — — — November — — — — — 1 December — — — — — — Totals 3 6 1 2 3 8 57 PNEUMONIA. The tables show the incidence by months, ages and wards. Most of the cases removed to Hospital received treatment at Whipps Cross Hospital:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 26 2 7 1 — 7 4 5 February 20 1 4 5 2 4 2 2 March 19 — 3 3 1 5 5 2 April 14 — 2 5 — 3 1 3 May 16 — — 4 1 7 3 1 June 14 — 1 1 1 5 5 1 July 5 — 1 — 1 1 2 — August 6 — 1 - 2 2 — 1 September 4 — — 1 - 3 - — October 4 — — 1 1 1 1 - November 7 — 2 — 1 1 2 1 December 12 — 2 3 2 5 — — Totals 1938 147 3 23 24 12 44 25 16 1937 154 3 26 14 17 43 34 17 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 1 2 3 3 8 9 February 2 2 2 3 4 7 March 5 — 1 1 7 5 April 1 — — 3 3 7 May 2 3 2 3 2 4 June 1 1 3 1 2 6 July 1 1 1 1 1 — August 1 2 1 1 — 1 September — — 1 — 1 2 October 1 — 3 — — — November 2 1 — 2 — 2 December 2 4 1 1 1 3 Totals 1938 19 16 18 19 29 46 1937 22 21 15 15 22 59 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. 58 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 PYREXIA. See Maternity and Child Welfare Section. OPHTHALMIA NEONATORUM. See Maternity and Child Welfare Section. ERYSIPELAS. The following tables show the incidence by months, ages and wards:— Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 9 — — 1 1 — 4 3 February 8 — — — 1 1 3 3 March 3 — 1 — — — 1 1 April 9 — — — — 3 4 2 May 9 — — — — 3 2 4 June 5 — — — — 2 3 — July 7 — — — — 4 3 — August 2 - - - - - 1 1 September 3 — — — 1 1 1 — October 11 — — — 1 6 4 — November 4 — — — - 1 3 — December 6 — — — — 4 2 — Totals 1938 76 — 1 1 4 25 31 14 1937 61 3 1 6 8 18 18 7 59 Month. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 3 1 — — 3 2 February 3 3 — — 2 — March — — — — — 3 April 2 2 1 — 2 2 May 2 1 1 1 3 1 June — 1 1 — 3 — July 3 1 1 — 1 1 August — 1 — — — 1 September 1 — 1 — — 1 October 3 1 — 2 1 4 November 1 1 — — 1 1 December — 2 — 1 3 — Totals 1938 18 14 5 4 19 16 1937 7 10 13 4 8 19 CEREBRO-SPINAL MENINGITIS. Three cases were notified, the details being as follows:— No. Ward. Age. Date Notified. Hospital. Remarks. 1. St. James Street 20 15.1.38 Yes Died in hospital 2. Higham Hill 6 mos. 4.2.38 Yes Died in hospital 3. Higham Hill 5 mos. 5.5.38 Yes Recovered. ANTERIOR POLIOMYELITIS. There were no definite cases notified during 1938. Two children, a girl aged 9 years (St. James Street Ward) and a boy aged 6 years (Hale End Ward) were removed to hospital for observation, but diagnosis was not confirmed. ENCEPHALITIS LETHARGIC A. Three cases were notified during the year. No. Ward. Age. Date Notified. Hospital. Remarks. 1. High Street 25 22.11.38 Yes Died in hospital. 2. Higham Hill 8 25.11.38 Yes Recovered. 3. Higham Hill 5 1.12.38 Yes Died in hospital. 60 MEASLES. Under the Walthamstow (Measles) Regulations, 1932, all cases of measles in children under 5 years of age are notifiable, except secondary cases in the same household or institution within two months of the primary case. The year 1938 was an epidemic year, the number of notifications being shown below. Month. Total. Under 1 yr. 1-5 yrs. St. James' Street. High Street. Hoe Street. Wood Street. Hale End. High Hill January 31 2 29 3 4 3 9 8 4 February 191 9 182 26 29 22 36 40 38 March 292 16 276 49 32 40 31 54 86 April 147 8 139 43 25 11 9 29 30 May 60 4 56 13 14 5 2 13 13 June 24 2 22 2 5 3 1 12 1 July 19 — 19 - 1 - 1 14 3 August 4 — 4 1 — 1 — 2 - September 1 — 1 — 1 — — — - October 1 - 1 - - - - 1 - November 2 - 2 - - - - 2 - December — — — — — — — — - Totals 1938 772 41 731 137 111 85 89 175 175 1937 13 2 11 3 1 2 1 2 4 94 cases of measles were admitted to the Sanatorium. There were five deaths from Measles during 1938. Home nursing is provided, where necessary, by the Walthamstow District Nursing Association. PREVENTION OF BLINDNESS. No action was necessary under 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 following table shows particulars of new cases of Tuberculosis and of all deaths from the disease in the Borough during 1938 61 The 85 deaths represent a death-rate of 0.65 per 1,000 population. The returns for the past two years are compared below :— Year. New Cases. Total. Deaths. Total. Pulmonary. NoilPulmonary. Pulmonary. NonPulmonary. M. p. M. p. M. F. M. p. 1938 75 60 14 15 164 43 29 6 7 85 1937 59 70 13 12 154 40 40 6 6 92 The ratio of deaths in non-notified cases (i.e., columns to the right of the double line) to total deaths from tuberculosis was 24 to 85 or 1 to 3.5. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. p. M. p. M. F. M. F. Under 1 year - 1 - — - - — 1 1— 5 years - — 3 1 - - 1 2 5—10 years 1 4 2 4 -— - - 2 10—15 years 3 2 2 4 — — - — 15—20 years 5 13 1 — 5 7 2 — 20—25 years 8 12 1 — 5 3 — — 25—35 years 23 14 3 5 13 6 3 1 35—45 years 13 10 — — 6 3 — — 45—55 years 12 2 — — 9 4 — — 55—65 years 8 2 1 1 4 1 1 — 65 years and upwards 2 — 1 — 3 3 — — 75 60 14 15 45 27 7 6 Totals 135 29 72 13 164 85 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. Pol. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 11 1 7 — 3 — 7 — 23 3 8 6 7 3 62 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 1938:— Pulmonary. Total. NonPulmonary. Total. Grand Total. No. on Register 1st January Notified during 1938 M. F. M. F. 816 712 1,528 448 369 817 2,345 75 60 135 14 15 29 164 Total 891 772 1,663 462 384 846 2,509 Removed from Register, 1938 No. on Register 31st December 64 43 107 13 15 28 135 827 729 1,556 449 369 818 2,374 One hundred and thirty-five removals from the Register were made up as follows :— Deaths. Removals. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M . F. M. F. M. F. M. F. 39 28 1 3 25 15 12 12 67 4 40 24 71 64 135 The discrepancy between the number of deaths recorded here and the number of registered deaths during the calendar year is accounted for by transferable deaths and by cases not notified prior to death. Treatment of Tuberculosis. Treatment is given under the Essex County Council's Scheme. The admissions to Hospital during 1938 were as follows:— Pulmonary. Non-Pulmonary. Total. M . F . M. F. Adults 91 70 11 4 176 Children 13 5 5 7 30 63 No action was necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or Section 172 of the Public Health Act, 1936. The arrangements detailed in the report for 1935 were continued during 1938. Amongst other measures taken to prevent tuberculosis are the following :— (a) Re-housing of patients with infectious pulmonary tuberculosis. The re-housing is subject to the patient occupying, as far as possible, a separate bed and bedroom, and attending the Tuberculosis Dispensary regularly. (b) When a patient is notified to be suffering from nonpulmonary tuberculosis an inquiry is made as to the milk supply, and in any case of doubt the milk is biologically tested for the tubercle bacillus. Infectious Diseases notified by the Medical Staff.—Scarlet Fever, 10; Diphtheria, 7; Dysentery, 6; Total, 23. G.—INFECTIOUS DISEASES HOSPITAL. Renovations, etc.—The following works of renovation and maintenance were carried out during 1938:— A Block.—Interior renovation of Scullery, Kitchen Vegetable Store and Refrigerator Room. Cleansing and whitening of corridors and No. 42 Bedrooms, No. 11 Bathrooms, No. 10 Lavatories. B Block.—Interior renovations. Provision of glazed curbs and hearths to ventilating grates. Replacement of defective concrete paving with red flag paving. C Block.—Interior renovations. Provision of glazed curbs and hearths to ventilating grates. Replacement of defective concrete paving with red flag paving. E Block.—Interior renovations. G Block.—Interior renovations throughout. T Block.—Interior and exterior renovations. General.—Reinforced concrete floor over pit in Laundry Boiler House. Provision of No. 2 Refrigerators. Provision of electric bell system of communication. 64 Staff.—The staff remained the same as detailed in previous Reports. The following examination results were obtained by probationers * Final Examination 6 passed at first attempt. „ „ 2 passed at second attempt. Preliminary Examination 4 passed; 2 failed. Educational Test 3 passed; 2 failed. General.—(i) The death rate per 100 admissions of infectious disease patients was 0.62 and per 100 total admissions 0.97. (ii) During the year the County Council continued the amount of the grant payable by them in respect of infectious disease beds. The grant was made up as follows:— £ (1) £5 per bed on a basis of 2,000 cubic feet per bed (i.e., 81 beds) 405 (2) £10 per ambulance 20 Total £425 (iii) 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. An agreement has been drawn up and a Joint Hospital Committee is now dealing with the necessary extensions. (iv) Your Committee instructed that a 48-hour week was to be operated in regard to all Staff. (v) Reciprocal arrangements were entered into with the Waltham Joint Hospital Board for the treatment of infectious disease cases. (vi) The following table shows the admissions, discharges and deaths during 1938:— Scarlet Fever. Diphtheria. Other Diseases. Tuberculosis. Totals. Remaining in Hospital 1 st January Admitted during year Discharged during year 12 17 3 20 52 248 113 124 30 515 245 109 122 28 504 Died during year Remaining in Hospital 31st December — 1 2 2 5 15 20 3 20 58 65 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL, (including Tuberculosis cases.) January 48.7 July 51.3 February 61.3 August 40.2 March 83.0 September 47.9 April 78.7 October 61.9 May 69.2 November 54.1 June 71.2 December 57.6 Average whole year 60.4 CLINICAL REPORT. Dr. Hamilton, Resident Medical Officer, reports as follows:— AGE AND SEX OF PATIENTS ADMITTED DURING 1938. 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. Scarlet Fever 43 49 33 40 16 20 15 32 107 141 248 Diphtheria 11 20 17 22 6 7 5 19 39 74 113 Bacillary Dysentery — — — 1 1 — — 1 1 2 3 Measles Pulmonary 35 41 8 9 1 — — — 44 50 94 Tuberculosis - - - - - - - 30 — 30 30 Staff - - - - - - - 12 - 12 12 Other diseases 2 6 5 — — — 2 — 9 6 15 Totals 91 122 63 72 24 27 22 94 200 315 515 Other diseases include Rubella (8), Vincent's Angina (4), Whooping Cough (1), Cerebro-spinal Meningitis (2). AGE AND SEX AT DEATH. Five deaths occurred, details of which are given below:— 2 Pulmonary Tuberculosis 2 Females aged 28 and 35 years. 2 Measles and Broncho-pneumonia 1 Female aged 5 months. 1 Male aged 1 year. 1 Diphtheria (cardiac failure) 1 Female aged 3½ years. 66 MONTHLY ADMISSIONS OF DIPHTHERIA CASES. Month. Under 6 years. 5 to 10 years. 10 to 16 years. Over 15 years. Total. Total. M F M F M F M F M F January - 3 — 4 — - — 2 — 9 9 February 1 4 2 — — — — 3 3 7 10 March 1 3 — 3 2 1 1 1 4 8 12 April 1 1 1 2 — - — 1 2 4 6 May 1 3 1 3 — 1 1 2 3 9 12 June - - 1 1 — — 2 2 3 3 6 July 2 4 — — — - — 1 2 5 7 August — 1 — 1 — 1 — 2 — 5 5 September 1 — 2 3 4 1 1 2 8 6 14 October 1 1 — 4 — 1 — — 1 6 7 November 1 4 2 1 — 2 — 1 3 8 11 December 2 2 8 — — — — 2 10 4 14 Totals 11 26 17 22 6 7 5 19 39 74 113 The cases of diphtheria were classified as follows:— Those receiving up to 24,000 units are included under the heading "mild." Those receiving over 24,000 as severe. Mild, 36; Severe, 40; Bacteriological, 37. All the cases in the class "severe" suffered from paresis of the lower limbs. Other complications were palatal paresis 8, and paralysis of the ciliary muscle, 3. Three patients were regarded as dangerously ill. Two survived with permanent heart weakness. Three children were regarded as seriously ill, and this included the only case of laryngeal diphtheria admitted during the year. They all made good recoveries. MONTHLY ADMISSIONS OF SCARLET FEVER CASES. Month. Under 5 years. 5 to 10 years. 10 to 16 years. Over 15 years. Total. Total. M F M E M F M F M F January 3 4 1 - 3 — 3 3 10 7 17 February 1 3 1 5 — 2 2 2 4 12 16 March 3 5 2 2 1 2 1 2 7 11 18 April 4 2 2 1 2 2 — 2 8 7 15 May 5 8 5 3 1 3 1 4 12 18 30 June 5 5 2 7 — 2 1 2 8 16 24 July — 3 3 2 1 1 4 4 8 10 18 August 3 4 1 1 — — 2 3 6 8 14 September 5 2 5 8 2 2 — 3 12 15 27 October 5 3 7 7 1 1 — 6 13 17 30 November 4 5 3 2 4 3 - — 11 10 21 December 5 5 1 2 1 2 1 1 8 10 18 Totals 43 49 33 40 16 20 15 32 107 141 248 67 Scarlet Fever Cases transferred to Cubicle Block.—The following patients were transferred to the cubicle block for the reasons stated :—Erysipelas (1); Chicken-pox (3); Nasal diphtheria (1); contact chicken-pox (6); Measles (4); Measles contact (1); suspected whooping cough (1); haemolytic streptococcal carriers (3); rheumatism (1); otorrhoea (1). Staff.—Members of the staff were admitted to hospital beds suffering from the following complaints :—Burnt foot (1); tonsillitis (2); lumbago and enteritis (1); boils in aural meatus (1); scarlet fever (1); uterine haemorrhage (1) ; rubella (]); cold(l); sciatica (1); fractured astragalus (1); septic foot (1). Operations at Hospital.—One operation (Wilde's incision) was performed. Specialist Consultations.—Four consultant visits were paid, viz.: C.S.M., 2; heart disease, 1; torticollis, 1. Swabs.—580 swabs were taken and examined during the year in the laboratory at the hospital. Number of Outside Authorities' Cases and Nature.— Diphtheria. Scarlet Fever. Measles. Total. From Whipps Cross Hospital 10 6 — 16 From Leyton B.C. — 3 22 25 From Tottenham B.C. — — 2 2 Total 10 9 24 43 The following cases were transferred to Whipps Cross Hospital :— 1 Diabetes. 2 Mastoiditis. 1 Nephritis. 1 Uterine haemorrhage (staff). 2 Heart cases. 1 returned for continuation of treatment. Measles.—The cases of measles admitted were of a much milder type than in 1936. Of the 94 admitted, 20 were placed on '"danger notice" as they were complicated with broncho-pneumonia, and five more had otorrhoea. Thirteen children in all had otorrhoea, eight of the cases occurring in children who also had broncho-pneumonia. Of the remaining 69 cases, their claim to hospital treatment could only be justified by very poor home conditions. 68 Duration of Treatment.—The average duration of treatment in Hospital was as follows:— Diphtheria 45.2 days. Scarlet Fever 27.8 days. Measles 23.4 days. Other diseases 9.0 days. The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1938:— Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.). In Hospital on 1st January, 1938. Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1938. Observation 1 — 1 — — T.B. Minus 5 5 7 — 2 T.B. Plus Group I — 3 2 — 1 T.B. Plus Group II 13 22 19 1 15 T.B. Plus Group III 1 1 — 1 1 Totals 20 31 29 2 19 Six of the 31 admissions were Walthamstow cases. MEDICAL EXAMINATIONS. During the year, 99 examinations were carried out by the Medical Staff in respect of the Superannuation and Sick Pay Schemes. MISCELLANEOUS. Your Council made the following grants during the year to voluntary organisations:— Invalid Children's Aid Association £100 Walthamstow Association of Tuberculosis Care Helpers £25 69 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 114 Post-Mortems 105 Post-Mortems and Inquests (not included in above) 19 Total 238 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 53 lectures at various schools in the Borough during the year. Milk Cookery demonstrations were held at Electric House, the total attendances being 221. Your Council subscribes one guinea per annum to the Industrial Health Education Society. Leaflets issued by the Dental Board were fully utilized. PHYSICAL TRAINING FOR ADULTS. A report on the matter by the Education Committee's Physical Training Organisers appears on page 39 of the report of the School Medical Officer for 1938. The following is extracted from their report:— 70 "The Keep Fit classes for women and girls started in Walthamstow last year have continued to run and additional classes have been formed. Ten of these classes are now held at the following Centres:— Mondays Chapel End. Tuesdays Blackhorse Road and Coppermill Road. Wednesdays Forest Road, Mission Grove and Selwyn Avenue. Thursdays Markhouse Road, Mission Grove, Winns Avenue (2 classes). "In connection with this work for the adolescent, a Games Club has been started. This club meets on Saturday afternoons at the Salisbury Hall Playing Field, most generously lent by the Education Committee, and it is possible for any girl or woman in Walthamstow to play hockey, netball, tennis or cricket for a fee of 2d. for the afternoon. For this very modest sum members get the services of a games coach and are supplied with the necessary games equipment. The club has approximately 50 members. Several matches with local clubs have been played, and it is hoped that, as girls become more skilful during school life, the desire to continue their games and the membership of this club will greatly increase. The provision of such cheap facilities in a built-up area such as Walthamstow must be indeed rare. "The men's Keep Fit class started at Selwyn Avenue lastMarch continues to hold regular weekly meetings and is now under the control of the Essex Education Authority, which has also extended its provision of teachers of physical training to the recently formed Old Boys' Club at the Joseph Barrett and Chapel End Senior Boys' Schools." The following Keep Fit Classes were held during 1938 :— Mondays Winns Avenue Senior Girls' School 8-9 p.m. Club Leaders' Course at Forest Road Boys'School 7.30-9 p.m. Tuesdays Chapel End Senior Girls' School 8-9 p.m. 9-10 p.m. Wednesdays Mission Grove Infants' School 8-9 p.m. Forest Road Junior Girls' School— Sword Dancing 7.30-8 p.m. Forest Road Junior Girls' School— Folk Dancing 8-9 p.m. Thursdays Selwyn Avenue Infants' School 8-9 p.m. Winns Avenue Senior Girls' School 7-8 p.m. Also on 8-9 p.m. Saturdays Salisbury Hall Playing Fields 2.30p.m. until dusk. 71 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 1938 was as follows:— January 2.72 inches July 1.19 inches February 0.51 „ August 1.32 „ March 0.36 „ September 3.09 „ April 0.05 „ October 2.54 „ May 1.71 „ November 3.11 „ June 0.39 „ December 3.17 „ Total 20.16 inches. Air Raid Precautions.—A great deal of work has been necessary in regard to this matter, and the original scheme providing fixed first aid posts for the whole population within half a mile has been developed. Up to the time of the September crisis ten schools had been allocated as fixed posts, but it was then realised how unsatisfactory these would be. Contracts were then entered into by your Council for the erection of 10 "ad hoc" posts, each post consisting of three Nissen huts each 16 feet wide and 48 feet long with air locks at each end and joined by a corridor. The central hut is divided along its long axis for the decontamination and cleansing of both sexes. One of the laterally placed huts is allocated to each sex for first aid. The huts are provided with air filters and hot and cold water. They are rendered splinter proof with earth covering. Drugs and dressings were also ordered in September, and these have now been distributed to the posts. In order to supplement the ambulances and cars for stretcher parties and sitting cases eleven trailer ambulances, each taking six stretchers, have been provided. No reference to the subject would be complete without full acknowledgment of the generous and unstinted assistance which has been given by the St. John Ambulance Brigade, and in particular by Dr. J. L. McKenzie Brown, who has accepted the appointment of Honorary First Aid Commandant. His enthusiasm, industry and tact have rendered bearable a necessary but distasteful task. MATERNITY AND CHILD WELFARE. 73 SECTION H. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor MRS. E. M. Miller. Ex-Officio: The Worshipful the Mayor—Alderman Mrs. C. McEntee, J.P. The Deputy Mayor—Alderman H. Frost, J.P. Chairman of Finance Committee—Alderman Ross Wyld, J.P. Alderman G. Gibbons, J.P. ,, Mrs. M. Norrish. ,, W. J. Sharp. Councillor Mrs. L. P. Bailey. ,, Mrs. V. A. Cossey. ,, W. B. Fitt. ,, Mrs. B. M. Friedberg Councillor F. W. Gentle. ,, 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. Mrs. S. Candy. Mrs. Hatton. Mr. W. H. Kindell. Mrs. W. H. Kindell. Mrs. A. R. Robbins. Mrs. W.J. Sharp. Mr. J. De Vries. 74 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen, I beg to submit herewith a report on the Maternity and Child Welfare services during 1938. The year is notable for an increased volume of work and for very favourable statistics. The total attendances in connection with all welfare services, Municipal and Voluntary, were over 66,000. Greater use was made of the assisted milk scheme and more home helps were provided. The Infant Mortality rate was 40 (England and Wales, 53); the Maternal Mortality rate was 1.78 (England and Wales, 2.97); and the neo-natal mortality was only 17.3. I am again indebted to your Committee for every help and consideration and to the staff for good work and loyalty. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 7* 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. Shbppard, B.A., M.B., B.Ch., B.A.O., D.P.H., Barrister-at-Law. Obstetric and Puerperal Pyrexia Consultants (part-time): Miss M. M. Basden, M.D., F.R.C.S., F.R.C.O.G. Alan Brews, Esq., M.D., F.R.C.S., M.R.C.O.G. Eaudley Holland, Esq., M.D., F.R.C.S., F.R.C.P. V. Lack, Esq., F.R.C.S., F.R.C.P., F.R.C.O.G. W. McAllister, Esq., F.R.C.S., F.R.C.O.G. W. McKim H. McCui.lagh, Esq., d.s.o., m.c., F.R.C.S., F.R.C.O.G. Dame Louise McIlroy, D.B.E., M.D., D.Sc., F.R.C.O.G. H. G. Everard Williams, Esq., M.D., M.R.C.P., F.R.C.O.G. Maternity Home. Resident Obstetrician and Assistant Medical Officer of Health: Miss Helen Rodway, M.R.C.S., L.R.C.P., M.R.C.O.G. Miss Helen Jardine, M.B., Ch.B., M.M.S.A. (part-time relief). Anesthetists (part-time): D. R. Blunn, Esq., M.R.C.S., L.R.C.P. J. H. T. Challis, Esq., M.R.C.S., L.R.C.P. A. D. Woolf, Esq., M.D., L.R.C.P., L.R.C.S., L.R.F.P.S., D.A. (Eng.). Matron: Miss F. Bambridge, S.R.N., S.C.M. Health Visitors: Miss A. C. Keenan, S.R.N., S.C.M., H.V. Cert. (Superintendent). Miss M. B. Cassidy, S.R.N., S.C.M., H.V. Cert. Miss C. R. Douglas, S.R.N., S.C.M., H.V. Cert. Miss D. E. Laidler, S.R.N., S.C.M., H.V. Cert. (Half-time). Miss D. G. Legg, S.R.N., S.C.M., H.V. Cert. (Half-time). Mrs. J. Morris, S.R.N., S.C.M., H.V. Cert. (Half-time). Miss O. M. North, S.R.N., S.C.M.. H.V. Cert. (Half-time). Miss J. M. Palmer, S.R.N., S.C.M., H.V. Cert. (Half-time). Miss O. J. Panther, Cert. S.I.E.B. (Lond.), (Half-time) (to 5.5.38). Miss A. Stuart, S.R.N., S.C.M., H.V. Cert., T.B. Cert., 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). 76 District Midwives: Appointed by Borough Council:— Mrs. S. E. V. Allen, Mrs. P. Rayner, S.C.M. S.R.N., S.C.M. Miss I. W. R. Bodfish, Miss O. Roberts, S.C.M. S.R.N., S.C.M. Miss A. Evans, Mrs. A. E. Townsend, S.R.N., S.C.M. S.C.M. Appointed by Walthamstow District Nursing Association:— Miss M. Bannock. S.C.M. Miss R. Rees. S.C.M. Masseuse (Half-time): Miss Kathleen M. Hill, C.S.M.M.G. Record Clerk : Miss V. LeComber. Retirement of Staff. Your Council during the year decided that those Health Visitors. Nurses and Midwives who desire to retire at the age of 60 years under the 1937 Act and who will not have completed 40 years' service be granted additional annual compensatory allowances representing the difference between the pension due at the age of 60 years and the pension that would be payable if the officer remained in the service until the age of 65 years, such additional allowance to be paid out of the fund to which the salary is normally charged, subject to such superannuation allowance not exceeding two-thirds of the employee's average annual remuneration. 77 NOTIFICATION OF BIRTHS. 1,898 births (205 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows:— doctors and parents, 358; midwives, 1,540. Included in the above are 227 births which were notified as having occurred outside the Borough. Also included are 72 stillbirths 6 of which did not belong to the area. 11 were notified by doctors and 61 by midwives. Of the total, seven occurred outside the area. The stillbirth rate per 1,000 population was 0.53. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Males. Females. Totals. Legitimate 771 801 1,572 Illegitimate 28 17 45 799 818 1,617 (b) Stillbirths. Males. Females. Totals. Legitimate 36 34 70 Illegitimate - - - 36 34 70 Of the 1,617 birth registrations received in the Department between 2nd January, 1938, and 1st January, 1939, a total of 79 were not notified in this area, but some may possibly have been notified elsewhere. Appropriate action was taken when necessary. Of the 1,617 local registrations, 262 belonging to other areas are excluded, leaving a nett total of 1,355, which are allocated to the wards as follows:— 78 The local registrations for 1938 were 94 less than in 1937. Births Registered Locally, 1938. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals. Grand Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. January 5 4 10 2 9 7 9 10 12 7 12 4 57 34 91 February 9 11 6 7 8 12 8 7 13 7 6 8 50 52 102 March 6 10 8 8 11 10 10 15 15 18 15 12 65 73 138 April 4 13 7 8 10 3 6 9 12 9 15 10 54 52 106 May 10 6 8 10 8 15 9 4 20 14 10 11 65 60 125 June 8 5 12 13 13 14 14 9 19 16 14 17 80 74 154 July 6 7 2 7 7 12 3 6 12 15 14 10 44 57 101 August 7 8 8 11 8 17 10 12 6 23 8 13 47 84 131 September 10 7 11 8 8 6 11 10 7 7 14 11 61 49 110 October 7 7 6 5 7 6 4 10 7 8 17 13 48 49 97 November 13 4 6 6 7 13 3 12 15 11 14 7 58 53 111 December 8 6 5 2 8 11 5 7 6 9 13 9 45 44 89 Totals 93 88 89 87 104 126 92 111 144 144 152 125 674 681 1,355 Grand Totals 181 176 230 203 288 277 1,355 79 INFANT MORTALITY. The deaths of infants under one year of age were:— Males. Females. Total Legitimate 42 21 63 Illegitimate 1 2 3 Total 43 23 66 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, 40; Illegitimate, 66; Total 40. The Infant Mortality Rate for other areas during 1938 was as follows:— England and Wales 53 126 County Boroughs and Great Towns (including London) 57 148 Smaller Towns (25,000 to 50,000) 51 London 57 Neo-Natal Mortality. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1938, 28 infants died in the first four weeks of life, yielding a rate of 17.3. 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. 1938 1,617 12.3 70 43.2 0.53 28 17.3 66 40 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 1938:— 80 SUMMARY. 1938. Causes of Death of Children under 1 year of age. Cause of Death. Under 1 Week 12 Weeks 2 3 Weeks 3 4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3 Months and under 6 Months i 6 Months and under 9 Months 9 Months and under 12 Months Total Deaths under One Year. Wards. St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Influenza - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - Chickenpox - - - -- - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - 1 - 1 - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - Phthisis .. - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - 1 1 - - 1 - 2 - - - - - - Convulsions - - - - - - - - - 3 - 1 1 - - - Laryngitis - - - - - - - - - - - - - - - - Bronchitis - - - - - 2 1 - - 3 - - - - - - Pneumonia (all forms) - - - 2 2 4 4 2 1 13 3 1 3 2 - 4 Diarrhœa - - - - - 2 6 1 - 9 5 1 1 1 1 - Enteritis - - - - - - - - - - - - - - - - Gastritis - - - - - - - - - - - - - - - - Syphilis - - - - - 1 - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - Inattention at Birth, wilful neglect - - - - - - - - - - - - - - - - Suffocation, overlaying - - - - - - - - - - - - - - - - Injury at Birth 4 - - - 4 - - - - 4 - 1 - - - - Atelectasis - - - - - - - - - - - - - - - - Congenital Malformations 5 - - - 5 2 - 1 - 8 1 2 2 - 1 2 Premature Birth 12 - 1 - 13 1 1 - - 15 1 1 4 3 - - Atrophy, Debility and Marasmus - - 1 - 1 - 1 - - 2 1 1 - - - - Inanition - - - - - - - - - - - - - - - - Heart Failure l - - - - - - - - - - - - - - - Other Causes - - - - 1 - - - - - - - - - - - 81 The death-rate from Diarrhœa and Enteritis in children under one year of age per 1,000 live births was 6.18. CHILD WELFARE. The equivalent of whole-time Municipal Health Visitors at the end of the year was 7.0, equal to one whole-time Health Visitor per 271 notified births, and one whole-time Health Visitor per 231 registered births during 1938. 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, Wincheater 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. 82 The detailed findings at first visits paid during 1938 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. 1 Room. St. James Street 215 35 21 17 254 195 72 4 65 36 95 42 23 10 High Street 172 9 20 10 191 176 24 1 45 138 3 5 9 1 Hoe Street 186 21 28 2 233 197 37 1 50 82 64 32 7 - Wood Street.. 190 15 27 - 232 225 7 - 64 81 36 37 13 1 Hale End 266 37 46 2 347 335 13 1 212 64 71 - 2 - Higham Hill 276 29 27 17 315 301 30 1 175 116 24 6 6 5 Total 1,305 146 169 48 1,572 1,429 183 8 611 517 293 122 60 17 From the above table it will be seen that of 1,620 children, 1,305, or 80.5 per cent., were breast-fed on first being visited, and 48, or 2.9 per cent., had no separate sleeping accommodation. The particulars in respect of housing accommodation show the following comparison:— 83 House or Half 1-3 Flat. House. Rooms. Total. 1938 1,128 293 199 1,620. 1937 1.105 386 179 1.670 The findings appear to show that the proportion of families adequately housed in a separate house or flat increased slightly. The following table shows the number and nature of visits paid in Wards during 1938:— 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 271 478 749 1,181 1,930 534 74 209 97 41 138 322 3,207 High Street 201 406 607 773 1,380 178 164 58 32 6 38 123 1,881 Hoe Street 235 573 808 939 1,747 348 48 301 59 30 89 166 2,699 Wood Street 232 411 643 793 1,436 394 41 232 52 15 67 164 2,334 Hale End 349 1,075 1,424 1,718 3,142 349 116 260 54 23 77 223 4,167 Higham Hill 332 939 1,271 2,348 3,619 348 111 261 57 31 88 252 4,679 Total, 1938 1,620 3,882 5,502 7,752 13,254 2,151 494 1,321 351 146 497 1,250 18,967 Total, 1937 1,670 4,481 6,151 6,440 12,591 2,353 587 1,135 244 79 323 353 17,342 84 CLINICS. Plans have been approved for new clinics in both the Hale End and Higham Hill areas. Dr. Sheppard reports as follows:— "There were no alterations in the routine work of the Welfare Centres during the past year. Seven sessions are held each week; five of these are 'doctor's sessions, and two are for weighing only. "All the centres are well attended. 1,320 new cases were booked last year, 20,925 attendances were made by babies under one year of age. and 19,601 by toddlers. "Thanks are again due to the voluntary workers who have been so helpful at all the Welfare Clinics. "The ante-natal examinations in connection with the Municipal Midwifery Scheme are now in good working order. Each midwife has a day allocated at regular intervals on which her cases are seen—urgent cases being seen at any clinic. This arrangement works smoothly as each midwife can attend the medical examination of her own patients if she so desires. "It is satisfying to report that there have been no maternal deaths among the mothers who attend the Ante-Natal Clinics." 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 695 481 Low Hall Lane Clinic 437 23 Total 1,132 504 Total Attendances:— Thorpe Coombe Maternity Hospital 6,734 632 Low Hall Lane Clinic 1,074 27 Total 7,808 659 The total number of new patients attending the clinics represent the following percentages of total notified births (live and still):— Ante-Natal, 59.6; Post-Natal, 26.5. 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. 85 Summary op 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. Markhouse Road 537 162 699 10707 11231 21938 22637 Higham Hill 262 75 337 4356 4206 8562 8899 Hale End 236 48 284 4827 3879 8706 8990 Total 1938 1035 285 1320 19890 19316 39206 40526 1937 1101 312 1413 20549 17583 38132 39545 Nurse Children.—At the end of 1938 there were 108 nurse children on the register, compared with 118 at the end of 1937. During the year 93 removed, 2 were adopted, and 6 reached the age of nine years. 88 new children were registered and 3 reregistered. There were no deaths among nurse children during 1938. 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. 236 cases attended for massage, and these made 2,282' attendances. Sale of Milk, etc., at Clinics.—The quantity and value of milk and food sold and issued free during 1938 was as follows:— Sales. Value. Free Issue. lbs. ozs. £ s. d. lbs. ozs. Cow and Gate 7,646 0 605 8 5 1,209 0 Hemolac 189 0 15 15 0 16 0 Ostermilk 2,466 0 205 10 0 348 0 Ambrosia 544 0 45 6 8 81 0 Almata 9 0 0 13 6 Nil. Trufood 537 0 57 4 0 Nil. Lactogen 4,042 0 303 3 0 404 0 Farex 147 8 13 8 5 2 0 Prune and Banana Syrup 192 10 19 5 3 Nil. Parrish's Chemical Food 476 8 15 17 8 0 2 Cod Liver Oil 561 8 18 14 4 0 10 Cream of Magnesia 546 6 36 8 6 Nil. Malt and Oil 1,785 0 52 1 3 7 0 Emulsion 1,715 4 102 17 7 2 12 Glucose 95 4 6 7 0 Nil. Virol and Milk 50 0 5 12 6 12 0 Virol 2,221 0 185 1 8 20 0 Roboleine 603 0 45 4 6 10 0 Maltoline 20 0 1 6 8 Nil. Marmite 342 2 41 2 7 Nil. Ovaltine 329 8 41 3 9 0 8 Virol containers 3,340 0 13 18 4 0 1 £1,831 10 7 86 WALTHAMSTOW CHILD WELFARE SOCIETY. The organisation, staffing, and accommodation provided by the Society was fully dealt with in the 1935 Report. The Matron, Miss C. C. Morley, resigned her position at the end of the year and a new appointment has been made, otherwise the Staff remains unchanged. 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 by Mr. J. C. Higham:— Clinics. First Attendances of New Cases. Re-attendances. Grand Total. Under 1 yr. 1-5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1938 496 115 611 9387 5066 14453 15064 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 1938 2314 1949 35 1 1937 2468 1847 24 2 1936 2107 1461 28 10 1935 2197 1727 27 - 1934 1919 2292 32 1 87 Home Visits. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1938 508 1691 2199 1097 3296 1937 404 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 grant period 1937-42. makes an annual grant of £700 to the Society, i.e., £550 per annum as to child welfare work and £150 per annum as to the infants' " observation " ward. SUMMARY OF MUNICIPAL AND VOLUNTARY SCHEMES. The following tables give the total number of attendances at clinics and home visits:— Attendances at Clinics. First Attendances. Re-attendances. Grand Total. Under 1 year of age. 1-5 years of age. Total. Under 1 year of age. 1-5 years of age. Total. Municipal Scheme 1035 285 1320 19890 19316 39206 40526 Brookscroft 496 115 611 9387 5066 14453 15064 Total 1938 1531 400 1931 29277 24382 53659 55590 1937 1570 406 1976 28073 21320 49393 51369 Home Visits To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Municipal Scheme 1620 3882 5502 7752 13254 Brookscroft 508 1691 2199 1097 3296 Total 1938 2128 5573 7701 8849 16550 1937 2134 6232 8366 7729 16095 *5,713 other visits were paid for special reasons. 88 Percentage of notified live births represented by number of children under 1 year of age who attended the Centres for the first time (i.e., new cases) 1938 83.8 Percentage of total notified births represented by number of expectant mothers attending Ante-Natal Clinics 1938 59.6 Nursery School and Classes.— Apart from the children at the Nursery School, 566 children born in 1934-35 (i.e., under 5 years of age) were on the school registers on 31st December. 1938. 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 12 Scoliosis 1 Spina Bifida 1 Rickets— (a) Genu Varum 61 Tibial and Flexion Deformity Toes 2 (b) Genu Valgum 49 Amyotonia 1 Pes Piano Valgu 36 Miscellaneous 12 Spastic Paralysis 4 Talipes 12 Total 207 Torticollis 11 Admissions to Brookfield Orthopedic Hospital (under Five Years of Age). Anterior Poliomyeliti 3 Congenital Talipes Calcaneo Valgus 1 Rickets 1 Congenital Talipes Equino Varus 1 Congenital Dislocation Hip 2 Total 8 Five operations were performed. 89 (b) Dental.—The following work was done by the Education Committee's Dental Surgeons in respect of Maternity and Child Welfare patients:— 1936 1937 1938 Mothers. Children under 5. Mothers. Children under 5. Mothers. Children under 5. Cases Treated 283 142 339 138 210 130 Attendances 654 270 536 207 521 183 Fillings 149 117 150 114 176 56 Extractions 661 169 618 146 431 279 General Anaesthetics 237 98 227 76 180 96 Scalings 61 — 67 — 63 — Dressings 32 361 8 235 10 26 Dentures 13 — 10 — 27 — 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:— "For the year 1938 the number of patients referred for treatment has been good, and the attendance fairly constant. 257 cases were referred from various centres—210 attended. Of these 144 were from Thorpe Coombe, 58 from the welfare centres and district midwives: 13 were nursing mothers. 47 failed to attend for examination, 43 kept all their appointments and received complete treatment; the remainder did not attend well for re-appointments. This partial treatment consisted mainly of extractions. 17 patients had prosthetic work done. 27 dentures were fitted. "The treatment given has shown an increasing amount of conservative work and the attendances for this are improving. Since the patients rarely come for treatment before the fourth month onwards, the fitting of dentures usually takes place in the post-natal period. "Few of the patients are free from peridontal disease. Good results follow treatment for the time the patient is under the supervision of the clinic. "The number of sessions, two per week, is the same as in the previous year. "This amount of time seems to be sufficient for those who accept and complete their treatment. The two sessions devoted to this work have, been well spent." (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. 90 (e) Sunlight.—Four infants were referred for sunlight treatment during 1938. There was definite improvement recorded in all 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. Two cases were referred in 1938. (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 40 Orthopaedic Clinics 92 Others 2 134 Suffering from:— Anaemia and Debility 14 Marasmus and Malnutrition 3 Pneumonia, Bronchitis, Asthma, etc 8 Bone Disease (non-T.B.) 63 Congenital Deformities 18 Paralysis 6 Hernia 3 After Infection 2 Diseases of:— Glands (non-T.B.) 2 Ear 4 Nose and Throat 2 Various 9 134 Help Given to Old and New Cases, 1938. Sent to Special Hospitals and Convalescent Homes 26 Provided with Surgical Boots and Appliances 46 Referred for Visiting and Advice 99 171 * Includes 5 admissions to Brookfield Hospital. 91 ASSISTED MILK SCHEME. Up to two pints of milk per day can now be granted to expectant mothers at any time during pregnancy. A medical or midwife's certificate as to pregnancy is required. Milk is granted free to nursing mothers for the first 14 days following confinement. One pint of milk per day is granted to ohildren 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. 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. During 1938 Marmite, Glucose and Ovaltine were also made available for expectant mothers. 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 1938:— Number of applications during 1938 6,960 Number of families assisted 1,305 Of the 6,960 applications, approximately 42 per cent, were from families where the father was unemployed. Scale Amount Approximate cost to Authority £ s. d. Free 721 pints 10 10 3 ½d. per pint 73,708 ,, 921 7 0 1 d. per pint 126,225 ,, 1,314 1 11 Half Cost 30,329 ,, 221 3 0 230,983 ,, £2,467 2 2 92 The following is a summary of the applications for milk for the past five 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 2,414 37.4 113.1 11.0 1938 6.452 508 2,962 42-5 124.1 9.9 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 178 Home Helps approved during 1938 many mothers attending the Clinic made their own arrangements to obtain the help of suitable women whose names were supplied by the Health Visitors. Four applications were rejected and one was cancelled by the Rota Committee. The demand for Home Helps has been as follows during the past seven years: 1931 (3), 1932 (12), 1933 (18), 1934 (21), 1935 (60), 1936 (87), 1937 (78), 1938 (178). The large increase in 1938 is chiefly due to the operation of the new whole-time midwifery service. STERILISED MATERNITY OUTFITS. A total of 314 sets were used in the Borough and 213 outfits were issued below cost price. A sterility test was carried out with satisfactory results on a sample set. INSTITUTIONAL TREATMENT, ETC. Nineteen children were sent to Institutions under arrangements approved by your Committee. 93 HOSPITAL ACCOMMODATION FOR CONFINEMENTS. The following numbers of confinements occurred at the Institutions specified (Walthamstow residents only):— Thorpe Coombe Maternity Hospital 625 Maternity Homes in Walthamstow 215 Mothers' Hospital. Clapton 85 Forest Gate Hospital 52 Queen Mary's Hospital, Stratford 11 City of London Maternity Hospital 15 Other Maternity Homes 59 1062 There are five nursing homes in the Borough with a total maximum accommodation of 31 beds for maternity cases. In addition, the Municipal Maternity Hospital has 35 lying-in beds and 4 isolation beds, making a total for the Borough of 66 lying-in beds and 4 isolation beds. WALTHAMSTOW DISTRICT NURSING ASSOCIATION. Homes:— Central Home 19, Carisbrooke Road, E.17. Branch Home 36, Carisbrooke Road, E.17. Branch Home 384, Hale End Road, E.4. Mrs. Drury, the Honorary Secretary, kindly reports as follows:— ' 'The past year has been a momentous one in that we have definitely been included in the local Municipal Midwifery Scheme and two of our Midwives appointed to undertake our portion of this work. "The staff at the end of the year was as follows:— "One Superintendent. "One Assistant Superintendent. "Six Queen's Nurses (five also Midwives). "Two Queen's Candidates (also Midwives). "Two Municipal Midwives. "One Emergency Queen's Nurse Midwife. "One Maternity Nurse. "Four Non-Queen's Nurses. "Four Pupil Midwives. 94 "Three Queen's Candidates successfully passed the examination for the Queen's Roll and were placed on the staff of the W.D.N.A. "During the year the Superintendent (Miss Lee) and four Queen's Nurses took the course in Gas and Air Analgesia (Bursaries for these being kindly given by the Central Council for District Nursing in Greater London at Queen Charlotte's Hospital and York Road Lying-in) and received their Certificates. Ten of the staff are now qualified to administer Gas and Air. "A second Minnitt Gas and Air Machine (Queen Charlotte's Model) has been purchased for the District Midwifery cases. This cost only £5 owing to the generosity of the Birthday Trust Fund. "Nurses Welbrock and Duff took the A.R.P. Instructor's Course and were awarded Certificates. "Twenty-nine Pupil Midwives were trained during the year. Of these, 12 were from Thorpe Coombe and 17 from L .C.C. Hospitals. "General cases attended during the year, January 1st to December 31st, 1938 1,111 "Visits for general cases 20,052 "Midwifery and Maternity cases attended in the Maternity Home 232 ' 'Midwifery and Maternity cases attended on the District 224 "Cases outside the Borough in and out of the Home (included above) 68 "The Provident Scheme remains stationary. Old Age Pensioners and othei necessitous cases are nursed free in spite of our serious financial difficulties. "We are grateful to the Council for their continued support." Your Council make a grant of £100 to the Association. Dr. Cecilia Cohen, acting for the Association, kindly arranged the following post-graduate lecture for midwives in the Borough, an invitation to attend also being extended to the midwives in adjoining areas:— 1938. January 27th "Normal Labour" Dame Louise Mellroy, D.B.E., M.D., D.Sc., F.R.C.O.G. 95 ANAESTHETIST'S FEES. Towards the end of the year 1937 your Council approved the payment of a fee of one guinea for the services of an anaesthetist 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. During 1938 recovery on the scale for assisted Maternity and Child Welfare services was made in the one case in which this service was approved. CONSULTANT OBSTETRICIANS. The services of a Consultant Obstetrician were requested by General Practitioners on five occasions (i.e., apart from the Maternity Home). The table below gives particulars in respect of each case:— No. Diagnosis. Where Treated. Result. 1. Puerperal pyrexia and tachycardia Hospital Recovery. 2. Cerebral Embolus Hospital Patient died. 3. Post partum haemorrhage Remained at home Recovery. 4. Streptococcal Urticaria Hospital Recovery. 5. Post-Matural Disproportion Remained at home .. Recovery. MIDWIVES ACTS, 1902-1936. No. of Notices of Intention to Practice, January, 1938 30 ,, ,, during 1938 11 Total 41 No. of Midwives ceasing to practice during 1938 9 ,, ,, practising at the end of 1938 32 There was no change in the arrangements for the employment or subsidy of midwives by the Council. 96 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. Non-medical supervision of Municipal Midwives has been carried out by the Assistant Matron at the Maternity Hospital. The following table shows the work done by midwives (including those employed at Thorpe Coombe Maternity Hospital) during 1938: — No. of confinements attended as a Midwife 1292 ,, ,, ,, Maternity Nurse 302 ,, medical aid notices sent 519 ,, notifications of deaths 7 ,, twin births notified 16 ,, stillbirths notified 25 ,, notifications of liability to be a source of infection 17 ,, ,, ,, laying out of a dead body 1 ,, ,, ,, artificial feeding 7 ,, ,, ,, disinfection 17 The above table includes the following numbers with regard to work done at Thorpe Coombe:— Midwifery cases, 571. Maternity cases, 121. Medical Aid Notices, 322 The percentages of medical aid notices were:— Total, 39.0. Maternity Hospital, 56.4. Domiciliary midwives, 27.3. The conditions for which medical aid was summoned by midwives in domiciliary practice have been summarised and were as follows:— For complications during pregnancy:— Albuminuria 12 Threatened abortion.. 1 Varicose veins 7 Miscarriage 1 Abortion 1 Other conditions 10 Total 32 97 For complications during labour:— Delayed 1st and 2nd Ante-partum stage 33 rhage 8 Perineal laceration 43 Retained placenta 2 Malpresentation 8 Abdominal pain 2 Pyrexia 12 Other conditions 20 Post-partum rhage 1 Total 129 Details of medical aid notices issued by midwives employed at Thorpe Coombe are given in the Maternity Hospital report. 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. Four claims for compensation were made during 1938. Hospital treatment was required for all four cases owing to malpresentation. Municipal Midwifery and Maternity Service.—The scheme drawn up under the Midwives Act, 1936, and detailed in the Report for 1937, became operative on January 1st, 1938. Six whole-time midwives had previously been appointed by your Council and two by the Walthamstow District Nursing Association acting on your behalf. The service has worked well and only a few minor complications have arisen. The table below shows the number of visits done:— Ante-Natal Visits. Deliveries. Lying-in Visits. Total Visits. Patients' Homes. Midwife's House. Clinic. Mid. Mat. 1985 833 1377 361 110 9108 13774 For complications in regard to the infant:— Prematurity and feeble- Cyanosis 2 ness 5 Other conditions 14 Discharging eyes 14 Melaena 1 Total 36 98 The Walthamstow (Prohibition of Unqualified Persons) Order became operative from December 1st, 1938, and prohibited the employment of the "handy woman." Public Health Act, 1936 (Nursing Homes).—See Public Health Section of the Report. PUERPERAL PYREXIA. Thirty-five cases of Puerperal Pyrexia were notified during 1938. The notifications were received from the following sources:— Maternity Hospital. 26; Hospitals outside the area, 2; and General Practitioners, 7. The puerperal pyrexia rate for 1938 was 20.8 per 1,000 births, and the mortality due to puerperal sepsis was 2.8 per cent. of the cases of puerperal pyrexia notified. The Registrar-General has issued the following rates with regard to the notification of Puerperal Pyrexia. The Walthamstow rates are set out in comparison. Area Per 1,000 live and still births Puerperal Fever Puerperal Pyrexia England and Wales 14.42 126 County Boroughs and Great Towns, including London 18.08 148 Smaller Towns (25-50.000 population) 12.51 London Administrative County 3.53 15.46 Walthamstow 20.8 The notifications and rates for Walthamstow 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 1938 Not notifiable 35 20.80 35 20.08 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 99 PUERPERAL PYREXIA INCIDENCE, 1938 (Excluding Maternity Hospital). No. of Case. 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 6.1.38 10.1.38 30 Wood Street All facilities available 29.12.37 3.1.38 4.1.38 Twins. Post-partum haemorrhage. Endometritis. 2 21.3.38 22.3.38 40 St. James Street ,, ,, 13.3.38 13.3.38 17.3.38 Abortion due to fall. Endometritis . 3 30.7.38 2.8.38 38 Hale End ,, ,, 27.7.38 29.7.38 Not removed Perineal tear. Natural labour. 4 9.8.38 10.8.38 27 Hoe Street Removal to Hospital 6.8.38 8.8.38 9.8.38 Prolonged labour. 5 13.8.38 13.8.38 37 Higham Hill Nil 1.8.38 12.8.38 12.8.38 6 21.9.38 23.9.38 30 Hale End Consultant and removal to Hospital 12.9.38 21.9.38 21.9.38 7 17.10.38 19.10.38 21 Hale End Removal to Hospital 12.10.38 16.10.38 Not removed Septic abortion. Died before removal to Hospital. 8 9.12.38 12.12.38 — Hale End Already in Hospital 4.12.38 7.12.38 12.12.38 Pyrexia due to reaction. 9 13.12.38 16.12.38 36 St. James Street 9.11.38 10.11 .38 8.11.38 100 ABORTION. Circular 1661.—The number of cases in which medical aid notices were issued during 1938 by midwives in accordance with Rule E of the Central Midwives Board was:— Threatened abortion and miscarriage 1 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 End. Higham Hill. 1938 4 — — 2 1 — 1 1937 8 3 2 2 — — 1 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1938 2 2 3 — — 1 1937 3 5 8 — — — The cause of death was prematurity. MATERNAL MORTALITY. During 1938, seven deaths associated however slightly with pregnancy and child-bearing were investigated for the completion of enquiry forms. Particulars relating to the seven deaths are given in the accompanying table. The following table shows the maternal mortality rates for 1938 (calculated on the three deaths assigned by the RegistrarGeneral to Headings 29 and 30). Births Registered. Deaths of Women due to Pregnancy and Child-Bearing. WALTHAMSTOW. England and Wales. Puerperal Sepsis, (Heading 29 R.G.) Other Puerperal Causes. (Heading 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, 1,617 1 2 3 0.61 1.23 1.85 0.89 2.19 3.08 Live and Stillbirths, 1,687 1 2 3 0.59 1.18 1.78 0.86 2.11 2.97 101 DEATHS DUE TO PREGNANCY AND CHILD-BEARING AND/OR ASSOCIATED THEREWITH. Case No. Date of Death. Certified Cause of Death and Classification. Age. Ward. Circumstances. No. of Pregnancy and Duration. Ante-Natal Care. Doctor. Midwife. Physical Condition. Date of Confinement or Abortion. Doctor called. Admission to Hospital. 1 8.3.38 Pulmonary embolism consequent upon pelvic and femoral thrombophlebitis after childbirth 29 Hi. Comfortable 2 weeks. 40 — Yes Good 11.2.38 15.2.38 — 2 18.7.38 1. Chronic heart failure 2. Chronic rheumatic endocarditis with aortic stenosis. 3. Pregnancy. 4. In second stage of labour. 23 W. Comfortable 1 40 Yes - Pre-existing disease 18.7.38 Attending Hospital 11.7.38 3 15.8.38 Septicaemia from septic endometritis following spontaneous abortion. 21 H.E. Comfortable 1 16/20 - - Good 8.8.38 8.8.38 Attending Hospital 9.8.38 4 8.9.38 1. Paralytic Ileus. 2. Eclampsia due to Pregnancy toxaemia 29 H.H. Comfortable 1 16 - Yes Pre-existing disease (eclampsia) 7.9.38 1.9.38 5 28.9.38 Cerebral Embolus 43 H.H. Comfortable 7 40 — — Good 13.6.38 4.7.38 4.7.38 6 16.10.38 General peritonitis due to instrumental perforation of uterus. Septic incomplete abortion. Self-induced. 21 H.E. Poor 1 12/16 - - Good 12.10.38 16.10.38 - 7 21.10.38 Ante-partum haemorrhage due to premature separation of the placenta due to pregnancy toxaemia. 38 H.H. Poor 10 36 Yes - Pre-existing disease (Toxaemia and Haemorrhage) Attend - ing Hospital 19.10.38 Remarks:—Registrar-General's classification—Cases 1 and 7, heading 30 (other puerperal causes); Case 3, heading 29 (Puerperal sepsis). 102 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). 1938. 1937. 1936. 1935. 1934. Maternal Mortality 1.85 3.57 1.74 3.00 6.40 Stillbirths 43.2 35.8 31.4 34.1 33.8 Neo-Natal Deaths 17.3 20.8 16.9 21.5 20.4 During 1938 a preparation containing yeast was made available for expectant mothers. Work done in other areas appears to show that such a supplementary foodstuff is extremely valuable in pregnancy. 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 commenced 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. The maternal mortality rates for the past five years have been as follows: — Year. Total Births Registered. Deaths. Rates per 1,000 Births. (Live and Still). Puerperal Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal Causes. Total. 1938 1,687 1 2 3 0.59 1.18 1.78 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 6.18 103 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. 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. 96 A (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 cases admitted during the year—775 (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).—100. 1. Average duration of stay of cases included against item 3— 13.9. 5. Number of cases delivered by— (a) Midwives—570. (b) Doctors—-121. 6. Number of oases in which medical assistance was sought by a midwife in emergency—322. 7. Number of cases notified as— (a) Puerperal fever—Nil. (b) Puerperal pyrexia—26. 8. Number of cases of pemphigus neonatorum—Nil. 9. Number of infants not entirely breast fed while in the institu tion—115 complemented, 36 (artificially fed). 10. Number of cases notified as ophthalmia neonatorum—-Nil. 11. (a) Number of maternal deaths—2. (b) Cause of death in each case :— (1) (a) Paralytic Ileus. (b) Eclampsia due to Pregnancy Toxaemia. (2) (a) Ante-partum Haemorrhage due to (b) Separation of placenta, due to Pregnancy Toxaemia. 104 11. (a) Number of infant deaths— (i) Stillborn—32. (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 51.2 per 1.000 live births, and the neo-natal mortality within 10 days of birth was 14.4 per 1,000 live births. (b) Occupation of Beds.—The average daily occupation of beds was as follows:— January 28.4 July 30.5 February 23.9 August 26.5 March 29.8 September 24.5 April 29.8 October 27.4 May 34.5 November 24.0 June 28.2 December 32.8 The average for the whole year was equal to 72.8 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.—The services of the emergency unit were not required during the year. (e) Gas and Air Analgesia.—The Maternity Hospital is approved by the Central Midwives Board for the purpose of giving special instruction in gas and air analgesia, and 9 candidates were examined and 8 passed. (/) Staff.—Your Committee instructed that a 48-hour week was to be operated in regard to all staff. (g) Training of Pupil Midwives.—The Hospital was approved by the Central Midwives Board during the year, jointly with the Middlesex Hospital, for the training of pupil midwives in both Part I and Part II of the training under the new rules. During 1938, 15 pupils from Thorpe Coombe obtained the Certificate of the Central Midwives Board. The following very full clinical report has been compiled by Dr. Helen Rodway, M.R.C.O.G., Resident Obstetrician. 105 THORPE COOMBE MATERNITY HOSPITAL. CLINICAL REPORT. During the year there were 775 admissions to the Hospital:— (a) for confinement 675 (b) ante-natal 96 (c) miscarriage 3 (d) post-natal 1 Total 775 The total number of attendances at the Ante-natal Clinic was 6,734 and at the Post-natal Clinic 630. The Saturday morning clinic was discontinued this year, as it was an inconvenient time for patients to attend. Statistical details are set out in the following tables:— Ante-Natal Clinics. Number of Clinics held:— 1938. 1937. 1936. 1935. (a) Consultant's Clinics 12 12 12 21 (b) Resident Obstetrician's Clinics 155 129 117 125 (c) Midwives' Clinics 294 349 352 225 Totals 461 490 481 371 Number of Expectant Mothers who attended Ante-Natal Clinics 702 753 691 762 Total attendances at Ante-Natal Clinics:— (a) New patients 702 753 691 762 (b) Old patients 6,032 5,501 5,354 4,543 Totals 6,734 6,254 6,045 5,305 Total number of attendances at:— (a) Consultant's Clinics 186 - - - (b) Resident Obstetrician's Clinics 2,229 2,382 2,648 2,868 (c) Midwives' Clinics 4,319 3,872 3,397 2,437 Totals 6,734 6,254 6,045 5,305 Average attendance per session:— (a) Consultant's Clinics 15.5 - - - (b) Resident Obstetrician's Clinics 14.38 16.9 - - (c) Midwives' Clinics 14.69 11.0 - - Totals 14.63 12.7 12.6 14.3 106 ANTE-NATAL ADMISSIONS. 55 patients were admitted for treatment and rest during the ante-natal period; 16 of these were delivered before discharge from hospital. In addition. 41 patients were admitted for observation and three on account of miscarriage. Reason for Ante-Natal Admissions. No. of Cases. Ante-partum haemorrhage 12 Albuminuria and hyperpiesis 20 Hyperpiesis 3 Hyperemesis 3 Hyperpiesis and hyperemesis 1 Hysteria 1 Chronic nephritis 3 Abdominal pain 1 Sciatica 1 For rest 9 For induction of labour on account of post-maturity 1 Patients admitted for observation and discharged because not in labour 41 Total 96 Reason for Emergency Admissions. Ante-partum haemorrhage 6 Obstructed labour—failed forceps 1 Pregnancy Toxaemia 1 Hydramnios 1 Premature labour 1 Breech presentation 3 Delayed progress in labour 4 Retained placenta; post-partum haemorrhage 1 For observation 1 No arrangements for confinement 2 Total 21 107 Presentation and Position during Labour. Primigravida. Multigravida. Total Vertex left occipito-anterior . 217 172 389 Vertex right occipito-anterior . 123 96 219 Vertex right occipito-posterior. 14 6 20 Vertex left occipito-posterior . 14 10 24 Breech 35 6 41 Transverse — 1 1 Face 2 1 3 Brow 1 — 1 Totals 406 292 698 This includes 7 cases of twins: see separate table. Medical Aid Notices.-—In 322 cases medical aid was sought by Midwives in the Hospital. Treatment was given by the Resident Obstetrician or her deputy. For complications during pregnancy:— Threatened miscarriage 1 Ante-partum haemorrhage 2 Eclampsia 1 4 In addition, three infants were admitted—two on account of prematurity and one with the mother. Number of Confinements. (a) PrimigTavidae 399 (6) Multigravidae 292 Total 691 Number of Patients delivered by— (a) A doctor 121 (b) A midwife 570 Total 691 Miscarriages 3 108 For complications during labour:— Premature labour 1 Cardiac condition 1 Obstructed labour 3 Breech presentation 18 Face presentation 2 Twin labour 5 Hydramnios 1 Delay in 1st and 2nd stage 55 Delay in 3rd stage 6 Haemorrhage in 1st stage 4 Foetal distress 7 Post-partum haemorrhage 4 Perineal and vaginal lacerations 191 298 For complications in regard to the infant:— Asphyxia 3 Feeble condition 7 Hyperpyrexia 1 Stillbirths 9 20 Grand Total, 322. — ANALYSIS OF CASES WITH RENAL COMPLICATIONS. 1. Number of patients admitted on account of albuminuria 20 (This includes the patient who developed eclampsia.) 2. Number of maternal deaths 1 ,, stillbirths or infant deaths 1 3. Number of patients admitted on account of chronic nephritis 3 Number of stillbirths or infant deaths 2 The following is a summary of the number of cases during the last four years:— Patients admitted with eclampsia (excluding chronic nephritis) Per centage 1935 15 4.0 1936 30 4.5 1937 15 2.4 1938 20 2.9 CASES OF ALBUMINURIA ADMITTED FOR TREATMENT. Case No. Reg. No. Age. Previous Pregnancies. Detection of Onset of Symptoms. First Sign or Symptom. Other Signs. Oedema. %°f Albumen. %of Blood Urea. Highest Blood Pressure. No. of days in Hospital before labour or discharge. Onset of Labour. Type of Delivery. Maturity of Infant. Result. Condition of Patient on discharge. ( Full Term. Premature . Miscarriages. Headache. Eye Symptoms. M. C. %of Albumen. Blood Pressure. 1 2584 24 — — — Weeks. 24 Increase in weight Yes No No 0.3 20 132/88 9 Spontaneous Spontaneous Weeks. 38 L. L. + 138/84 2 2686 26 — — — 30 Albuminuria Nil No Yes 0.65 12 182/110 21 ,, ,, 36 L. L. 0.05 150/88 3 2626 30 — — — 38 Increase in weight Yes Yes Yes 0.1 17 170/80 9 ,, ,, 40 L. L. Nil 128/88 4 2664 26 — — — 38 ,, ,, Yes No Yes 0.8 27 170/100 6 ,, ,, 40 L. L. Nil 120/80 5 2806 25 — — — 34 Hyperpiesis Yes No Yes 0.3 27 152/102 3 ,, ,, 38 L. L. Nil 138/98 6 2899 25 1 — — . 36 Albuminuria No Yes Yes 0.25 — 150/70 12 ,, ,, 40 L. L. Nil 144/90 7 2928 31 1 1 — 34 Increase in weight No No No 0.4 30 158/92 9 ,, ,, 40 L. L. Nil 154/94 8 3003 18 — — — 32 ,, ,, No No Yes 0.5 — 168/110 3 ,, ,, 40 L. L. — — 9 3035 37 2 — — 36 Oedema No No Yes 0.5 — 180/110 19 ,, ,, 40 L. L. Nil 138/96 10 3056 33 — — — 32 Hyperpiesis Yes No Yes 0.18 18 180/130 6 Caesarean Section 40 L. L. Nil 146/84 11 3092 23 1 — — 24 Albuminuria No No No 0.5 19 128/70 12 Spontaneous Spontaneous 40 L. L. Nil 122/74 12 3105 18 — — — 36 ,, ,, No No Yes 0.1 — 130/90 8 ,, ,, 38 L. L. Trace 126/88 13 3166 31 — — — 36 Increase in weight No No Yes 0.5 18 170/120 22 After induction ,, 38 L. L. Nil 124/98 14 3200 30 — — — 38 ' ,, ,, No No Yes 0.1 26 148/110 12 ,, ,, ,, 38 + L. L. Faint race 160/88 15 3191 34 1 — — 30 ,, ,, No No Yes 0.33 — 184/120 14 ,, ,, ,, 40 L. L. 174/124: 16 3229 28 — — — 36 ,, ,, No No Yes 0.5 — 150/110 6 Spontaneous ,, 38 L. L. Nil 118/90 17 3255 26 — — — 36 ,, ,, No No Yes 0.1 — 150/110 6 ,, Forceps 40 L. L. Nil 120/68 18 3129 25 — — — 25 ,, ,, No No No 0.05 14 160/110 8 ,, Spontaneous 36 L. L. Nil 160/110 19 2932 24 1 — — 24 Albuminuria No No Yes 0.4 — 148/88 3 ,, ,, ,, 40 L. L. — 130/92 CASES OF ECLAMPSIA. Case No. Reg. No. Age. Previous Pregnancies. Detection of Onset of Symptoms. First Sign or Symptom. Other Signs. Oedema. %°f Albumen. %of Blood Urea. Highest Blood Pressure. No. of days in Hospital before labour or discharge. Onset of Labour. Type of Delivery. Maturity of Infant. Condition of Patient after admission. Full Term. Premature . Miscarriages. Headache. Eye Symptoms. M. C. 1 3060 29 — — Weeks. 32 Cramp Insomnia Yes No Yes 0.4 25 152/108 12 Followed rupture of membranes Forceps Weeks. 38 D. S.B. One fit before onset of labour. Paralytic ileus in first stage. CASES OF CFRONIC NEPHRITIS ADMITTED FOR TREATMENT. Case No. Reg. No. Age. Previous Pregnancies. Detection of Onset of Symptoms. First Sign or Symptom. Other Signs. Oedema. %°f Albumen. %of Blood Urea. Highest Blood Pressure. No. of days in Hospital before labour or discharge. Onset of Labour. Type of Delivery. Maturity of Infant. Result. Condition of Patient on discharge. Full Term. Premature. Miscarriages. Headache. Eye Symptoms. M. C. %of Albumen. Blood Pressure. Weeks. Weeks. 1 2691 31 — — — 14 Albuminuria Yes No Yes 0.6 45 210/116 24 After induction Spontaneous 36 L. L. 0.4 184/100 2 3146 26 — S.B. — 14 ,, Yes No No Heavy trace 15 130/90 9 Spontaneous ,, 30 L. S.B. 0.01 134/82 3 3261 40 5 S.B. — 28 Albuminuria and Hyperpiesis Yes No Yes 0.05 23 160/110 8 ,, ,, 36 L. S.B. Trace 100/90 ANTE-PARTUM HAEMORRHAGE. Case No. Reg. No. Age. Previous Pregnancies. Weight of Infant. Condition on Admission. Treatment. Delivery. Result. Cause of Hæmorrhage. Full Term. Premature. Miscarriage . General Condition. Haemorrhage. Albumen. M. C. 1 2950 36 1 — 1 lb. oz. 4 15 Good Moderate Nil Morphine Spontaneous L. S.B. Unknown. 2 2967 39 1 — — 7 0 Good Moderate Nil Morphine ,, L. L. — 3 3135 38 7 — 2 — Poor Severe Trace Morphine Blood transfusions — D. — Toxaemia. 4 2625 32 4 — — 8 0 Poor Severe Nil Morphine Blood transfusions Forceps L. S.B. Central placenta praevia 5 2845 33 — 1 — 5 10 Poor Severe Nil Morphine Blood transfusions ,, L. S.B. Partial placenta praeria 6 2955 36 — — 1 6 0 Good Slight Nil Nil ,, L. L. ,, ,, 7 2888 27 — — — 5 13 Good Slight Nil Nil Spontaneous L. L. ,, ,, 8 3261 40 5 — — 4 9 Good Slight Nil Nil ,, L. S.B. ,, ,, EMERGENCY ADMISSIONS 1 2607 29 — — — 5 0 Poor Severe Cloud Morphine ,, L. S.B. Toxaemia. Degeneration of placenta 2 2638 26 — — — 5 0 Poor Severe Trace Morphine ,, L. S.B. vlVyll \J 1 UiCivvli vCf 9 9 9 9 3 2654 30 — — — 6 0 Good Slight Nil — ,, L. L. — 4 2807 34 3 — — 6 12 Fair Severe Nil Morphine. Willetts Clamp. Intravenous saline ,, L. L. Partial placenta praevia 5 2822 39 6 — 2 5 0 Poor Severe Trace Morphine Blood transfusion ,, L. S.B. Toxaemia. Five-sixths of placenta showed 6 2998 34 2 — — 10 2 Good Moderate Nil — ,, L. L. premature separation. Remarks:—Case No. 3.—Patient undelivered. 109 ANTE-PARTUM HAEMORRHAGE. Number of cases:— Partial placenta praevia 5 Central placenta praevia 1 Toxaemic haemorrhage 5 Unknown 3 Total 14 Maternal death 1 Stillbirths 7 110 FORCEPS DELIVERY. Number of Cases All Cases Indication for forceps Primiravidae Multigravidae Persistent occipito-posterior position (see separate table) 24 6 30 Delay in progress and disproportion 26 1 27 Unsatisfactory condition of patient 2 1 3 Ineffective contractions 1 — 1 Cardiac disease 1 — 1 Foetal distress 5 1 6 Mento-posterior presentation 1 — 1 Total 60 9 69 Maternal deaths Nil. Stillbirths 5 Infant deaths 1 Foetal and infant mortality–8.7 per cent. FORCEPS DELIVERIES. Case No. Reg. No. Age of Patient. Previous Pregnancies. Indication for Use of Forceps. Duration of Labour. Weight of Infant. Result. Full Term. Premature. Miscarriage. 1st Stage. 2nd Stage. 3rd Stage. M. C. h. m. h. m. h. m. lb. oz. 1 2580 34 – – - Delay in progress. Disproportion 13 30 4 5 0 20 7 4 L. L. 2 2558 29 – - - ,, ,, Mento-posterior presentation ? ? 0 30 5 8 L. L. 3 2619 29 - - - ,, ,, Disproportion 25 45 4 10 0 25 7 10 L. L. 4 2624 27 - - - ,, ,, Ineffective contractions 35 0 3 25 0 25 9 0 L. L. 5 2625 32 4 - - Unsatisfactory condition of patient 12 30 0 40 0 20 8 0 L. S.B. 6 2646 28 - - - Slow advance 4 40 2 55 0 15 6 12 L. L. 7 2656 26 - - - Foetal distress 34 40 6 0 0 15 8 8 L. S.B. 8 2724 28 - - - Delay in progress 12 30 3 20 0 10 7 4 L. L. 9 2750 26 - - - Cardiac condition 13 45 1 50 0 20 6 12 L. L. 10 2759 26 - - - Delay in progress 47 30 3 50 0 25 8 6 L. L. 11 2763 22 - - - Foetal distress 7 45 0 45 0 20 4 3 L. L. 12 2768 35 - - - Delay in progress 15 0 4 45 0 35 8 0 L. L. 13 2781 35 - - - Delay in progress. Rigid perineum 21 0 2 15 0 10 5 4 L. L. 14 2786 29 - - - Delay in progress 15 45 4 30 0 25 6 4 L. L. 15 2792 27 - - - Foetal distress 22 45 3 25 0 20 7 0 L. L. 16 2804 28 - - - Delay in progress. Lateral position of head 22 0 4 15 0 25 9 12 L. L. 17 2805 33 - - - Foetal distress 15 0 3 5 0 10 7 12 L. L. 18 2846 37 - - - Delay in progress. Rigid perineum 22 30 3 15 0 10 7 0 L. L. 19 2904 27 - - - Foetal distress 11 20 3 20 0 20 8 0 L. L. 20 2911 32 - - - Delay in progress. Disproportion 6 30 3 45 0 25 7 11 L. L. 21 2914 22 - - - Delay in progress. Lateral position 14 45 3 30 0 10 6 9 L. L. 22 2955 36 - - 1 Foetal distress 16 0 1 40 0 15 6 0 L. L. 23 2954 28 - - - Delay in progress 29 0 3 55 0 15 7 8 L. L. 24 2966 24 - - - Delay in progress. Lateral position of head in both twins 22 30 2 50 0 20 6 6 3 4 L. L. L. L. 25 2968 25 - - - Delay in progress 29 25 3 15 0 20 7 6 L. L. 26 2985 30 - - - Delay in progress. Rigid perineum 23 30 6 0 0 30 6 12 L. L. 27 2990 30 - - - Delay in progress 15 15 2 20 0 25 8 0 L. S.B. 28 3007 29 - - - „ „ 16 15 3 55 0 40 7 0 L. L. 29 3022 37 - - - „ „ ? 0 15 6 8 L. L. 30 3060 29 - - - Unsatisfactory condition of patient 26 0 1 15 1 5 6 3 D. S.B. 31 3034 28 - - - Delay in progress. Rigid perineum.. ? 0 15 7 5 L. L. 32 3117 35 - - 1 Delay in progress 19 50 4 50 0 10 7 4 L. L. 33 3196 30 - - - „ „ 18 45 3 25 0 10 6 12 L. L. 34 3226 33 - - - „ „ 24 45 2 5 0 10 8 5 L. S.B. 35 3241 22 - - - „ „ 19 0 4 5 0 35 6 8 L. L. 36 3246 24 - - - „ „ V 0 20 7 10 L. L. 37 3276 25 - - - Delay in progress. Disproportion 26 0 2 40 0 40 6 14 L. L. EMERGENCY ADMISSIONS. 1 2654 30 - - - Maternal distress ? 1 40 0 30 6 0 L. L. 2 3024 43 3 - - Delay in progress. Second degree prolapse ? 0 20 7 0 L. L. Remarks:-Case No. 5.-Placenta praevia. Case No. 30.-Macerated. Eclampsia. Paralytic ileus. ,, 9.-Mitral stenosis. ,, 34.-Degenerate placenta. Retroplacental clot. ,, 24.-Twins. Emergency Case No. 1.-Ante-partum haemorrhage. ,, 27.-Hydrocephalic infant. Albuminuria. TREATMENT AND RESULTS OF POSTERIOR POSITION. Case No. Reg. No. Age of Patient. Previous Pregnancies. Position of Foetus. Method of Treatment. Delivery. Duration of Labour. Weight of Infant. Result. Full Term. Premature. Miscarriage . 1st Stage. 2nd Stage. 3rd Stage. M. C. h. m. h. m. h. m. lb oz. 1 2556 28 - - - V.R.O.P. Manual rotation Forceps 26 15 3 25 0 25 8 7 L. L. 2 2583 35 1 1 1 V.L.O.P. „ „ „ 16 0 ? 0 25 7 6 L. L. 3 2593 35 - - 2 V.R.O.P. „ „ „ 45 30 1 50 0 25 8 12 L. L. 4 2613 31 - - - V.R.O.P. „ „ „ 0 25 7 2 L. L. 5 2640 29 - - - V.L.O.P. „ „ „ 30 0 1 40 0 40 8 0 L. L. 6 2695 34 - - - V.R.O.P. „ „ „ 30 30 1 45 - 9 0 L. L. 7 2723 30 1 - - V.L.O.P. „ „ „ 15 0 3 30 0 10 8 4 L. L, 8 2774 20 - 1 - V.R.O.P. „ „ „ 6 0 3 10 0 15 8 0 L. L 9 2776 31 - - - V.R.O.P. „ „ „ 39 30 4 20 0 10 8 10 L. L. 10 2856 27 - - - V.L.O.P. „ „ „ 30 0 2 30 0 15 6 11 L. L 11 2948 24 - - - V.L.O.P. „ „ „ 20 0 3 30 0 20 8 1 L. L 12 3004 25 - - - V.R.O.P. „ „ „ -- - 0 30 6 10 L. L. 13 3043 29 - - - V.R.O.P. „ „ „ 41 0 3 10 0 20 6 12 L. L 14 3064 28 - - - V.L.O.P. „ „ „ 24 10 4 5 0 30 6 8 L. L 15 3074 33 - - - V.L.O.P. „ „ „ 28 15 2 15 0 15 9 8J L. L 16 3085 34 - - - V.L.O.P. „ „ „ 54 0 1 15 0 30 6 12 L. L. 17 3089 28 - - - V.L.O.P. „ „ „ 37 30 3 40 0 20 6 4 L. L 18 3114 26 - - - V.R.O.P. „ „ „ 32 45 3 20 0 15 7 0 L. L. 19 3126 36 1 - - V.R.O.P. „ „ „ 25 15 2 50 1 20 3 15½ L. L. 20 3151 29 - - - V.R.O.P. „ „ „ 30 0 1 35 0 15 7 10 L. L. 21 3164 33 - - - V.R.O.P. „ „ „ 103 15 2 15 0 15 5 14 L. L. 22 3209 30 - - 1 V.L.O.P. „ „ „ 9 45 3 5 0 20 8 10 L. L. 23 3238 28 1 - - V.L.O.P. „ „ „ 2 45 2 25 0 20 7 8 L. L. 24 2541 32 - - - V.L.O.P. Nil Spontaneous 22 15 5 45 0 25 8 5 L. L. 25 3152 34 1 - - V.R.O.P. „ 15 0 0 20 0 20 8 9 L. L. 26 3180 28 1 - - V.R.O.P. „ „ 9 0 1 5 0 20 7 15 L. L. 27 3077 21 - - 1 V.R.O.P. „ „ 24 30 1 5 0 15 7 5 L. L. 28 3041 20 - - - V.L.O.P. „ „ 10 0 0 45 0 15 6 0 L. L. 29 3018 27 2 - - V.R.O.P. „ „ 7 45 0 50 0 10 7 8 L. L. 30 2922 31 2 - - V.L.O.P. „ „ 5 45 0 45 0 15 9 0 L. L. 31 2902 26 1 - - V.R.O.P. „ „ 5 0 1 35 0 20 8 5 L. L. 32 2900 24 - - - V.R.O.P. „ „ 4 30 2 55 0 40 6 8 L. L. 33 2895 28 2 - - V.L.O.P. „ „ 10 0 0 35 0 5 6 13 L. L. 34 2863 24 1 - - V.R.O.P. „ „ 9 10 0 20 0 20 6 0 L. L. 35 2737 27 - - - V.R.O.P. „ „ 22 50 2 55 0 15 7 2 L. L. 36 2643 23 - - - V.L.O.P. Manual rotation Forceps 6 0 2 5 0 25 9 0 L. L. 37 3255 26 - - - V.L.O.P. Rotation unsuccessful 2 10 4 30 0 25 7 8 L. S.B. 38 3268 39 - - - V.L.O.P. Manual rotation „ 14 30 4 0 0 15 6 13 L. L. 39 3017 33 - - - V.R.O.P. „ „ „ 22 30 3 30 0 15 7 8 L. L. 40 3040 32 - - - V.L.O.P. „ „ „ ? ? 0 40 8 7 L. L. 41 3200 30 - - - V.R.O.P. „ „ „ 11 0 2 15 0 20 4 0 L. L. EMERGENCY ADMISSIONS. 1 2610 24 - - - V.R.O.P. Manual rotation Forceps ? ? 0 30 7 0 L. S.B, L. 2 2807 34 3 - - V.R.O.P. „ „ Spontaneous 55 30 1 15 0 55 6 10 L. 3 2607 29 - - - V.L.O.P. Nil „ 5 15 0 45 0 20 NOt weighed L. S.B. Remarks:-Case No. 6.-Placenta expelled with infant during third stage. ,, 9.-Infant died. ,, 18.-Post-partum haemorrhage. ,, 19.-Marked prolapse of vaginal wall. ,, 36.-Macerated. Cases 24-35, and 38.-Pace to pubes. Case No. 41.-Second Twin. Emergency Case No. 1.-Admitted on account of failed forceps. ,, 2.–Placenta Praevia. Willetts forceps applied. 111 TREATMENT AND RESULTS OF POSTERIOR POSITION Method of delivery Number of Cases All Cases Primigravidae Multigravidae 1. Spontaneous— (a) Following spontaneous rotation 5 8 13 (b) Face to pubes 1 – 1 2. (a) Manual rotation followed by forceps delivery 23 6 29 (b) Delivered by forceps, face to pubes 1 — 1 30 14 44 Results to:– (a) Mother. Maternal mortality Nil. (b) Child. Stillbirths 3 Infant deaths Nil. Foetal mortality–6.8 per cent. 112 primary breech presentation. Version was not attempted in any case where the breech was found to be presenting. Uncomplicated:- Primigravidae Multigravidae Total Number of cases 17 5 22 Number of stillbirths or infant deaths - - - Complicated:- Number of cases 9 3 12 Number of stillbirths 2 1 3 Number of infant deaths 2 - 2 Total 34 cases. Foetal and infant mortality:- Uncomplicated Nil. Complicated 42.0 per cent. 113 PRIMARY BREECH PRESENTATION. UNCOMPLICATED. Case No. Reg. No. Age of Patient. Previous Pregnancies. Maturity. Attitude of Foetus. Method of Delivery. Weight of Infant. Result. Full Term. Premature. Miscarriage . M. C. Weeks. lb. oz. 1 2565 20 - - - 38 Extended legs Spontaneous 5 0 L. L. 2 2586 23 - - - 40 „ „ „ „ 6 10 L. L. 3 2647 28 - - - 40 „ „ Assisted 7 0 L. L. 4 2701 20 - - - 40 „ „ Spontaneous 7 15 L. L. 5 2780 39 2 - 1 40 „ „ „ „ 6 8 L. L. 6 2848 26 - - - 38 „ „ „ „ 5 12 L. L. 7 2920 25 - - - 38 „ „ „ „ 5 2 L. L. 8 3092 23 1 - - 40 „ „ „ „ 9 8 L. L. 9 3109 23 - - - 40 Flexed legs „ „ 7 2 L. L. 10 3134 30 - - - 40 Extended legs „ „ 8 4 L. L. 11 3116 25 - - - 40 „ „ „ „ 7 2 L. L. 12 3129 25 - - - 38 „ „ „ „ 4 11 L. L. 13 3178 20 - - - 38 „ „ Assisted 5 10 L. L. 14 3242 27 1 - - 40 „ „ Spontaneous 7 2 L. L. 15 3228 33 - - 40 „ „ Assisted 7 13 L. L. 16 3257 23 - - - 38 „ „ Spontaneous 5 1 L. L. 17 3273 26 - - - 40 „ „ „ „ 7 4 L. L. 18 3297 27 - - - 40 „ „ „ „ 6 12 L. L. 19 2876 29 1 - 1 40 „ „ „ „ 7 8 L. L. 20 2894 24 - - - 40 „ „ Assisted 7 4 L. L. EMERGENCY ADMISSIONS. 1 2578 39 2 - - 40 Flexed legs Spontaneous 6 8 L. L. 2 3121 23 - - - 40 „ „ „ „ 7 0 L. L. Remarks:-Emergency Case No. 1.-Puerperal Pyrexia. 114 PRIMARY BREECH PRESENTATION. COMPLICATED. Case No. Reg. No. Age of Patient. Previous Pregnancies. Maturity. Complication. Method of Delivery. Weight of Child. Result. Full Term. Premature. Miscarriage. M. C. Weeks. lb. oz. 1 2533 25 - - - 40 First of twins Spontaneous 5 12 L. L. 2 2747 24 - - 40 „ „ Assisted Forceps for head 5 14 L. L. 3 2747 24 - - - 40 Second of twins Assisted 6 12 L. L. 4 2806 25 - - - 38 † ,, „ Spontaneous 3 11 L. L. 5 2868 28 - - - 40 First of twins „ „ 5 6 L. L. 6 2868 28 - - - 40 Second of twins „ „ 6 8 L. L. 7 3056 38 - - - 40 Albuminuria. Hyperpiesis. Oedema Caesarean Section 7 9 L. L. 8 3181 19 - - - 40 Anencephalic malformation of spine Assisted 7 11 L. S.B. 9 2950 36 1 - 1 36 Ante-partum haemorrhage Assisted 4 15 L. S.B. EMERGENCY ADMISSIONS. 1 2794 29 - - - 32 Albuminuria. Hyperpiesis. Oedema Assisted 3 2 L. L. 2 2794 29 - - - 32 Twins 2 2 L. L. 3 2924 29 ■ - Albuminuria Assisted Forceps for head 6 12 L. S.B. Remarks:-Emergency Case No. 1 .-Infant died first day. ,, ,, 2.-Infant died seventh day. 115 TWINS. Primigravidae. Multigravidae. Total. Number of cases 7 - 7 Number of stillbirths - - - Number of infant deaths 2 - 2 Case. No Reg. No. Age of Patient. Previous Pregnancies. Maturity. Presentation and Position. Sex. Weight. Result. Full Term. Premature . Miscarriage . 1st. 2nd. 1st. 2nd. Mother. Infants. 1st. 2nd. - - - - Weeks. lb. oz. lb. oz. 1st. 2nd. 1 2533 25 - - - 40- B.R.S.A. V.L.O.A. F. M. 5 0 5 12 L. L. L. 2 2806 25 - - - 40- V.R.O.A. B.L.S.A. F. F. 6 8 3 12 L. L. L. 3 2747 24 - - - 40- B.R.S.A. B.L.S.A. M. F. 5 14 6 12 L. L. L. 4 2966 24 - - - 40 V.L.O.L. V.R.O.L. M. M. 6 3 6 2 L. L. L. 5 3200 30 - - - 40 V.L.O.A. V.R.O.P. F. F. 4 4 4 0 L. L. L. 6 2868 28 - - - 40- B.R.S.A. B.R.S.A. F. F. 5 6 6 8 L. L. L. EMERGENCY ADMISSION. *1 2794 29 - - - 32 B.R.S.A. B.R.S.A. M. F. 3 2 2 2 L. L. L. (Both died) Remarks:-*Albuminuria, hyperpiesis and oedema. Induction of labour. 116 caesarean section. Primigravidae. Multigravidae. Total. Number of cases 2 1 3 Maternal mortality - - - Foetal mortality - - - Case No. Reg. No. Age of Patient. Previous Pregnancies. Type of Operation Weight of Infant. Result. Full Term. Premature. Miscarriage . Indication for Operation. Duration of Labour. M. C. 1bs. oz. 1 3056 33 - - - Pregnancy toxaemia. Breech presentation. Operation performed before onset of labour. Classical 7 9 L. L. 2 3094 28 - - - Pregnancy toxaemia. Disproportion. Operation performed before onset of labour. Lower segment 9 0 L. L. 3 2212 24 2 - - Ante-partum haemorrhage Partial placenta praevia. Operation performed before onset of labour. Classical 7 3 L. L. 117 analgesia and anaesthesia. Gas and air analgesia continued to be available for patients during the second stage of labour. The machines used were the Walton-Minnitt apparatus, and since September also the Queen Charlotte's apparatus which was very generously presented to us by the National Birthday Trust Fund. Number of Details of cases. Patients. 1. Gas and air analgesia during the second stage of labour 516 2. Gas and air analgesia followed by gas and oxygen plus ether 35 3. Other analgesia or anaesthesia (a) Gas and oxygen only 8 (b) Gas and oxygen plus chloroform 8 (c) Chloroform only 6 (d) Gas and oxygen plus ether 40 — 62 Total 613 This number represents 88.7 per cent. of the patients delivered in the Hospital. Two patients only refused to try the gas and air analgesia. In the majority of cases where it was not administered there was an adequate reason. Results of gas and air administration:— Relief from pain Good. Moderate. Nil. Walton-Minnitt Apparatus 83.4 12.5 4.1 Queen Charlotte's Apparatus 85.0 9.9 5.1 In no case was there any ill effect on the mother or infant. perineal lacerations. There was a total of 271 cases. 1. Doctors' Cases:— Primigravidae Multigravidae Total (a) Vertex presentation, spontaneous delivery 13 2 15 (b) Breech presentation 12 1 13 (c) Vertex presentation, forceps delivery 45 6 51 (d) Face presentation 1 - 1 Total 71 9 80 POST-PARTUM HAEMORRHAGE. Priinigravidae. Mllltigravidae. Total. Number of cases 8 3 11 Maternal deaths - - - Stillbirths or infant deaths 2 - 2 Case No. Reg. No. Age of Patient. Previous Pregnancies. Delivery. Duration of Labour. Cause. Treatment. Result. Morbidity. Full Term. Premature. Miscarriages. 1st stage. 2nd stage. 3r staj d ?e. M. C. h. m. h. m. h. m. 1 2671 20 - - - Spontaneous 14 15 1 5 2 20 Inertia of uterus Retained placenta Manual removal. Intravenous saline. Ergometrine. L. L. - 2 2708 25 - - - „ 7 1 15 2 45 Inertia of uterus. Retained placenta Manual removal. Intravenous and rectal salines. Ergometrine. L. L. L. L. Notifiable pyrexia. 3 2740 25 - - - „ 30 0 3 0 0 20 Inertia of uterus Ergometrine. Coramine. Rectal saline. - 4 2913 29 - - - „ 8 30 0 45 2 30 Inertia of uterus. Retained placenta Manual removal. Drip saline. Ergometrine. L. L. Notifiable pyrexia. 5 2938 31 1 1 - „ 11 30 0 40 0 25 Toxaemic condition. Inertia of uterus Rectal saline. Ergometrine. L. L. - 6 3000 27 - - - „ 13 0 0 35 0 55 Fibromyoma of uterus. Ergometrine L. L. - 7 3035 37 2 - - „ 5 15 0 15 3 15 Morbidly adherent placenta. Manual removal. Ergometrine. Intravenous and rectal saline. L. L. - 8 3029 35 1 - 1 „ 5 30 0 30 1 45 Inertia of uterus Retained placenta Manual removal. Ergometrine. Rectal saline. L. S.B. Notifiable pyrexia. 9 3125 26 - - - „ 12 15 1 55 1 55 Inertia of uterus Retained placenta Manual removal. Ergometrine. Rectal saline. Morphine. L. S.B. - 10 3281 26 - - - „ 17 50 2 10 1 45 Placenta caught in cervix. Manual removal. Intravenous saline. Ergometrine. L. L. - emergency admission. 1 2941 30 - - - Spontaneous Infant born at home. Uterine inertia Retained placenta Post-partum Haemorrhage. Manual removal. Ergometrine. Rectal saline. Morphine. L. L. - 118 PERINEAL LACERATIONS (continued). 2. Midwives' Cases:- Primigravidae. Multigravidae. Total. (a) Vertex presentation, spontaneous delivery 127 61 188 (b) Breech presentation - 3 3 Total 127 64 191 INFANTS. Primigravidae. Multigravidae. Total. Number of children born in Hospital 406 292 698 Total per cent. Total per cent. Total per cent. Number of stillbirths:- (a) Premature 5 1.2 6 2.05 11 1.57 (b) Full term 15 3.7 6 2.05 21 3.0 20 4.9 12 4.1 32 4.57 Number of infant deaths:- (a) Premature 2 0.5 2 0.67 4 0.57 (b) Full term 3 0.74 2 0.67 5 0.71 5 1.24 4 1.34 9 1.28 STILLBIRTHS. Booked Cases. Premature- Macerated. Recent. No. of cases Asphyxia due to maternal haemorrhage 1 1 2 Maternal nephritis - 1 1 Anencephaly - 1 1 Maternal toxaemia 1 - 1 Undetermined 1 1 2 Totals 3 4 7 Full Term- Maternal toxaemia 1 - 1 Congenital malformation of heart 1 - 1 Hydrocephaly 5 - 5 Abdominal cyst - 1 1 Anencephaly - 1 1 119 STILLBIRTHS (continued). Booked Cases (continued). Full Term- Macerated. Recent. No. of cases. Asphyxia due to- (a) Maternal haemorrhage - 2 2 (b) Difficult labour and forceps delivery - 2 2 (c) Difficult labour, shoulder presentation - 1 1 (d) Placental insufficiency - 1 1 Undetermined - 4 4 7 12 19 Emergency Cases. Premature- Macaerated. Recent. No. of cases. Maternal haemorrhage and toxaemia 3 - 3 Undetermined 1 - 1 4 - 4 Full Term- Asphyxia dtie to prolonged and difficult labour; forceps delivery - 1 1 Difficult delivery; breech delivery - 1 1 - 2 2 INFANT DEATHS. No. of Cases Premature Infants- Respiratory failure due to prematurity 3 Congenital malformation of the heart 1 4. Full Term Infants- - Hydrocephalic 1 *Congenital heart 1 *Cerebral haemorrhage 2 *Atelectasis due to displacement of lungs by abdominal viscera. Imperfect formation of left half of diaphragm 1 Total 9 * Post-mortem held. INFANTS-STILLBIRTHS Case No. Reg. No. Previous Pregnancies. Maternal Complication. Method of Delivery. Sex. Birth Weight. Recent or Macerated. Cause of Death. Full Term. Premature . Miscarriage . BOOKED CASES - Premature. 1 2950 1 - 1 Ante-partum haemorrhage Spontaneous F. 1b. oz. 4 15 Macerated Maternal haemorrhage 2 2709 2 1 - Nil „ F. 3 15 „ Undetermined. 3 3201 3 - 1 Toxaemia „ F. 3 0 „ Maternal toxaemia. 4 3146 1 - - Chronic nephritis „ F. * Recent Maternal nephritis. 5 3247 - - - Nil „ M. 4 10 „ Undetermined. 6 2864 1 - - „ M. 2 1 „ Anencephaly. Spina bifida. 7 3261 5 - - Maternal toxaemia. Antepartum haemorrhage due to placenta praevia „ M. 4 9 „ Maternal haemorrhage BOOKED CASES - Full Term. 1 3060 - - - Maternal toxaemia. Eclampsia. Paralytic ileus Forceps F. 6 3 Macerated Maternal toxaemia. 2 3011 1 - - Nil Spontaneous M. _* „ Congenital malformation of the heart.† 3 2539 1 - - Accident, last week of pregnancy. „ M. 8 0 „ Hydrocephaly. 4 2990 - - - Nil „ M. 8 0 „ „ 5 2956 - - - Nil „ M. 7 8 „ „ 6 3187 - - - Nil „ M. 7 12 „ „ 7 3161 1 - - Albuminuria and oedema „ F. * „ „ 8 3029 1 - 1 Uterine inertia in third „ F. 8 9 Recent Abdominal eyst.f stage 9 - - - Nil Assisted F. 7 11 „ Anencephaly. 10 2625 4 - - Ante-partum haemorrhage due to placenta praevia Forceps F. 8 0 „ Maternal haemorrhage 11 2845 - 1 - „ „ „ F. 5 10 „ „ „ 12 3266 1 - - Assisted F. 8 0 „ Difficult Labour. 13 3255 - - - Albumen, hyperpiesis and oedema Forceps M. 7 0 „ „ „ 14 3226 - - - Nil „ M. 8 5 „ Degenerate placenta.f Placental insufficiency Retro-placental clot. 15 3175 - - - Uterine inertia. Retained placenta Spontaneous F. _♦ „ Undetermined. 16 3124 - - - Post-partum haemorrhage „ F. 9 10 „ „ 17 3115 - - - Influenza last week of pregnancy „ _♦ „ „ 18 2656 - - - Nil Forceps M. 8 8 „ Difficult Labour. 19 3123 - - - Nil Spontaneous F. _* „ Undetermined. * Infant not weighed. † Post-mortem held. 12U INFANTS-STILLBIRTHS. Case No. Reg. No. Previous Pregnancies. Maternal Complication. Method of Delivery. Sex. Birth Weight. Recent or Macerated. Cause of Death. Full Term. Premature . Miscarriage . EMERGENCY CASES.— Premature. 1 2607 - - - Maternal toxaemia. Antepartum haemorrhage Spontaneous M. lb. oz. Macerated Maternal haemorrhage 5 0 2 2638 - - - Ante-partum haemorrhage 9 9 M. 5 0 „ „ „ 3 3098 - - -' Nil 9 9 F. _* „ Undetermined. 4 2822 - - 2 Maternal toxaemia. Antepartum haemorrhage 9 9 F. 5 0 „ Maternal haemorrhage Full Term. 1 2610 - - - Nil Forceps M. 7 0 Recent Prolonged and difficult labour. Forceps delivery. 2 2924 - - - Maternal toxaemia Assisted F. 6 12 „ Difficult breech delivery. * Infant not weighed-under 3 lb. INFANT DEATHS Case No. Reg. No. Age of Patient. Previous Pregnancies. Method of Delivery. Sex. Birth Weight. Cause of Death. Full Term. Premature . Miscarriages . Premature. 1 2794 29 - - - Spontaneous M. lb. oz. Respiratory failure due to prematurity. 3 2 2 2794 29 - - - „ F. 2 2 „ „ „ „ 3 3126 36 1 - - Forceps F. 3 15 „ „ „ „ 4 2767 39 1 - 3 Spontaneous M. 5 2 Congenital malformation of heart.* full Term . 5 2660 21 - - - Spontaneous M. 8 0 Hydrocephaly. 6 2776 31 - - - Forceps F. 8 10 Cerebral haemorrhage.* 7 2967 39 1 - - Spontaneous M. 7 0 * „ „ „ „ 8 3095 24 - - - „ F. 5 10 Congenital malformation of heart.* 9 3136 31 5 1 - „ F. Not weighed Atelectasis due to displacement of lungs by abdominal viscera. Imperfect formation of left half of diaphragm. * Post-mortem held. Remarks:-Cases Nos. 1 and 2.-Maternal toxaemia. Emergency admissions. 121 puerperal pyrexia. Case No. Reg. No. Age of Patient. Previous Pregnancies. Maturity. Ante-Natal Condition. Type of Labour. Method of Delivery. Onset of Pyrexia after Delivery. Duration of Pyrexia. Apparent Cause of Pyrexia. Result, Full Term. Premature. Miscarriages. M. C. Weeks. Days. 1 2529 25 - - - 40 Satisfactory Normal Spontaneous 9th day 1 Non-suppurative mastitis L. L. 2 2558 29 - - - 38 „ „ Assisted 2nd ,, 1 Retention of urine L. L. 3 2549 30 1 - - 38 „ „ Spontaneous 7th ,, 11/2 Non-suppurative mastitis L. L. 4 2619 29 - - - 40 „ Prolonged Forceps 12th „ 28 Suppurative mastitis L. L. 5 2708 25 - - - 38 Anaemic Delay in 3rd stage Spontaneous 3rd ,, 10 Uterine infection L. L. 6 2690 24 - - - 40 Satisfactory Normal „ 12th ,, 2 † Suppurative mastitis L. L. 7 2845 33 - 1 - 38 Ante-partum haemorrhage Post-partum haemorrhage „ 3rd ,, 6 Local infection L. S.B, 8 2903 25 - - - 40 Satisfactory Normal „ 13th ,, 1 Non-suppurative mastitis L. L. 9 2913 29 - - - 40 „ Delay in 3rd stage „ 12th ,, - Cellulitis of breast L. L. 10 2953 27 - - 1 40 „ Normal „ 9th ,, 1 Non-suppurative mastitis L. L. 11 2947 30 - - - 40 Ante-partum haemorrhage „ „ 11th „ 6 † Suppurative mastitis L. L. 12 2965 28 1 - - 38 Satisfactory „ „ 8th ,, 4 Non-suppurative mastitis L. L. 13 2966 24 - - - 40 " Post-partum haemorrhage Twins Forceps 3rd ,, 8 Local infection L. L. 14 3043 28 - - - 40 - Prolonged 2nd stage Forceps 3rd ,, 9 „ L. L. 15 3008 36 - - - 40 Satisfactory Normal Spontaneous 5th „ - Non-suppurative mastitis L. L. 16 3039 22 - - 40 „ „ „ 9th ,, 11/2 „ L. L. 17 3038 27 1 - - 40 „ „ „ 11th „ 11/2 „ L. L. 18 3037 28 - - - 40 „ „ „ 12th „ 11/2 Lymphangitis of breast L. 19 3052 27 - 1 - 40 „ „ „ 14th ,, 1 1/2 Cellulitis of breast L. L. 20 3102 22 - - - 40 „ „ „ 8th ,, l Throat infection L. L. 21 3216 32 - - 1 40 „ „ „ 14th „ 2 Non-suppurative mastitis L. L. 22 3193 24 - - - 40 „ „ „ 11th ,, - „ L. L. 23 3125 26 - - 1 40 „ Delay in 3rd stage „ 2nd ,, 12 Local infection L. S.B. EMERGENCY ADMISSIONS. 1 2578 39 2 1 40 Long 1st stage Spontaneous 3rd day 2 Undiagnosed L. L. 2 2610 24 - - - 40 - Prolonged .. Forceps 3rd „ 1* Local infection L. S.B. 3 3075 40 5 1 2 40 - Normal Spontaneous 1st ,, 3 Undiagnosed L. L. Remarks:-Case No. 5.-Manual removal of placenta. „ 9.- „ „ „ „ 23 „ „ „ Emergency Case No. 1.-Admitted on account of long first stage. ,, ,, 2.-Failed forceps. 122 PUERPERAL PYREXIA. Temperatures are usually taken twice daily, but 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 deg. or more sustained for twenty-four hours, or recurring within that period. Day of onset. Duration Cause. No. of Cases. Days. First 3 Undiagnosed 1 Second H Retention of urine 1 „ 12 Local infection 1 Third 10 Uterine infection 1 „ 6 Local infection 1 „ 8 „ „ 1 „ 9 „ „ 1 „ 2 Undiagnosed 1 „ l1/2 Local infection 1 Fifth - Non-suppurative mastitis 1 Seventh 1 1/2 „ „ „ „ 1 Eighth 4 „ „ 1 „ 1 Throat infection 1 Ninth 1 Non-suppurative mastitis 1 „ 3/4 „ „ 1 „ 1 1/2 „ „ 1 Eleventh 6 † 11/2 Suppurative mastitis Non-suppurative mastitis 1 1 Twelfth 28 Suppurative mastitis 1 „ 2 † „ „ 1 „ — Cellulitis of breast 1 „ l 1/2 Lymphangitis of breast 1 Thirteenth 1 Non-suppurative mastitis 1 Fourteenth 1 Cellulitis of breast 1 „ 2 Non-suppurative mastitis 1 26 Sepsis rate in all cases—3.7 per cent. 123 MATERNAL MORTALITY. There were two deaths in the Hospital during the year:— 3060. Primigravida. Aged 29. Ante-natal condition : Albuminuria, hyperpiesis and oedema. Admitted twice for treatment. On the second occasion the patient had an eclamptic fit. Following induction of labour by rupture of the membranes, she was delivered of a macerated foetus, weight 61b. 3oz. During the first stage of labour the patient developed a paralytic ileus. She died 10 hours after delivery. 3157. Multigravida 9. Aged 37. Ante-natal condition: Slight ante-partum haemorrhage following a fall at the 36th week. Admitted for observation. No further loss until nine days later, when patient was again admitted. On admission: Colour good. Blood pressure 154/80. Oedema of ankles. Urine clear. Haemorrhage slight but increased during labour two days after admission, when patient collapsed and died undelivered. RESEARCH. Nutrition of Expectant and Nursing Mothers.—Since March this year the Hospital has taken part in the People's League of Health research on the nutrition of expectant and nursing mothers in relation to maternal mortality and morbidity. Each alternate patient attending the Ante-Natal Clinic has been provided with a supply of accessory food factors throughout pregnancy; these being given free of cost by the People's League of Health. I am unable to make any report on the results of this treatment until the investigation is completed. 124 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 the confinement. Number of Clinics held 51 Primi- Multigravidae. gravidae. Total. Number of patients who attended:— New cases 284 195 479 Old eases 94 57 151 630 Percentage of new patients relative to the number of confinements in the Hospital 69.3 Average attendance per session 12