WAL 21 I AC44111(1) WALTHAMSTOW Borough of Walthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1939. A. T. W. POWELL, M.C., M.B., B.S., D.P.H., Medical Officer of Health, School Medical Officer Medical Superintendent— Thorpe Coombe Maternity Home and Isolation Hospital Borough of Malthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1939. INDEX. PAGE Acreage 5 Adulteration 22 Albuminuria 49 Anaesthesia and Analgesia 60 Ante-Natal Clinic 39,58 Bacteriological Analyses 20 Bakehouses 13 Births 5, 7, 35 Breech Delivery 60,61 Caesarean Section 62 Cancer 8 Caravans 14 Cerebro-Spinal Meningitis 25, 26 Child Welfare 37 Child Life Protection 40 Clinics 9, 39, 40 Committees 3,33 Comparability Factor 6 Connaught Hospital 10 Consultants 47 Dampness 13 Deaths 6,8,31 Death Rate 6,7 Dental Treatment 43 Diphtheria 25,26 ,, Immunisation 27, 28 Diseases of Animals Acts 23 Disinfestation 19 District Midwifery 47 Drainage 11 Dysentery 25,26 Eclampsia 59 Emergency Unit 57 Enteric Fever 25,26 Erysipelas 25,26 Essex County Council Act 11 Factories and Workshops 13, 24 Fishmongers 14 Food Inspection 19 Foot Clinic 9 Forceps Delivery 62 Haemorrhage— Ante- Partum 59,61 Post- Partum 62 Health Services 9 ,, Visitors 35,37 Home Helps 45 Hospital Accommodation 10,46,55 ,, Infectious Disease 29, 30, 31 House-to-House Inspection 17 Housing 15 Act, 1936 17, 18 ,, Inspection 15, 16 Ice Cream 14,20 Immunisation 27,28 Infant Mortality 6,36,56 Infectious Diseases 13,25,27 Institutional Treatment 10, 45 Invalid Children's Aid Asscn. 44 Isolation Hospital 29, 30, 31 Laboratory Work 28,29 Massage 40 Maternal Mortality 7,52,53 Maternity and Child Welfare 33 ,, Homes 11 page Measles 25,26 Meat Inspection 21,22 Medical Aid 61 ,, Examinations 32 Mid wives 47,48,57 Milk, Assisted Scheme 45 ,, Supply, etc. 19 Miscellaneous 32 Mothercraft Instruction 63 Neo-Natal Mortality 36 Notices, Sanitary 12 Notifications and Rates 7 Nursing Homes 11 Nutrition 63 Obstetric Consultants 47 Ophthalmia Neonatorum 52 Ophthalmic Treatment 44 Orthopaedic Treatment 42 Outworkers 25 Overcrowding 18,19 Pneumonia 25,26 Population 5 Post-Natal Clinic 39,58 Public Assistance 10 ,, Cleansing 11 Puerperal Pyrexia 7,50,51 ,, Sepsis 7 Rateable Value 5 Rats and M ice Destruction Act, 1919 23 Refuse Disposal 11 Rent Restriction Acts 23 Research 63 Rheumatism Clinic 27 Rivers and Streams 11 Sanitary Inspection 12 Scarlet Fever 25,26 Schick Tests 27,28 Sewerage 11 Smoke Abatement 14 Social Conditions 5 Special Premises 13 Staff 35 Statistics 5,6 Stillbirths 6,7,56 Sunlight Treatment 44 Swimming Baths 15 Thorpe Coombe Maternity Hospital 54 Tonsils and Adenoids 44 Tuberculosis 31,32 Tuberculous Meat 22 Twin Delivery 60, 61 Unemployment 10 Vaccination 29 Vertex, Posterior 60 Vital Statistics 5,6 Walthamstow Child Welfare Society 40 Walthamstow District Nursing Association 46 Water 11 Whooping Cough 1 Women's Clinic 9 Zymotic Diseases 6 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Councillor Mrs. E. M. Miller. The Worshipful the Mayor—Alderman H. Frost, J.P. The Deputy Mayor—Alderman Mrs. C. McEntee, J.P. Chairman of Finance Committed—Alderman Ross Wyld, J.P. Alderman A. G. Bottomley. Alderman Miss E. M. Pracy, B.Sc. ,, W. B. Fitt. ,, Mrs. E. M. Richards. ,, J. C. Hammond. Councillor Mrs. L. P. Bailey. Councillor Mrs. E. A. Smith. ,, Mrs. B. M. Friedberc;. ,, R. E. Smith. „ W. Gillett. ,, Mrs. E. B. Toynbee. ,, J. W. Lis. Town Clerk : F. G. Garner, Esq. TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, I beg to submit, herewith, my report as Medical Officer of Health for the year 1939. On the instructions of the Ministry of Health the report has been curtailed as far as possible. The large amount of time and energy which has been given to the organisation of the Casualty Service in connection with Civil Defence was amply repaid by its smooth operation at the outbreak of War. As far as possible the Public Health Services were continued unaltered after the declaration of War. Mercifully, the incidence of serious infectious disease during the first months of War remained low. I gratefully acknowledge your help and consideration and the good work of the Staff of the Department. I have the honour to be, Your obedient servant. A. T. W. POWELL, Medical Officer of Health. 5 Staff.— No change from previous report except that the following members of the Staff were called up for service with the Armed Forces :— Miss M. McCallum, S.R.N. (Senior Chiropodist), R.A.F. Nursing Service. Mr. F. Northcote, A.R.S.I. (Sanitary Inspector). (Later released.) Mr. W. H. Dunn (Ambulance Staff), R.A.F. A.— STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1939) 130,000 Number of Assessments, 1st April, 1939 35,874 Rateable value £871,442 Sum represented by a penny rate £3,475 Population.— The Registrar-General's estimate of the population at mid-year, 1939, is 130,000, a decrease of 800 on the previous figure. Extracts from Vital Statistics.— The Registrar-General's mid-year 1939 population (viz., 130,000) has been supplied for the purpose of calculating Birth rates only, but for the purpose of calculating Death rates and the incidence of notifiable diseases a separate figure of 123,900 has been provided. Similarly, two sets of figures with respect to live births have been supplied, (a) 1,606 for the calculation of the Birth rate per 1,000 estimated population (130,000) and, (b) 1,540 for the purpose of calculating Infant and Maternal Mortality rates. The explanation of the separate figures is due to temporary movement of residents owing to war conditions. Total Males Females Live Births Legitimate 1,566 801 765 Birth rate per 1,000 of the estimated resident population 12.3 Illegitimate 40 23 17 Total 1,606 824 782 6 Stillbirths 62 Rate per 1,000 total (live and still) births 37.0 Deaths 1,312 Death rate per 1,000 of the estimated resident population 10.5 Deaths from puerperal causes :— Rate per 1,000 (live and still) births. Puerperal Sepsis Deaths 2 1.19 Other Puerperal Causes - - Total 2 1.19 Death rate of infants under one year of age :— All infants per 1,000 live births 29.2 Legitimate infants per 1,000 legitimate live births 30.0 Illegitimate infants per 1,000 illegitimate live births - Deaths from Measles (all ages) - ,, ,, Whooping Cough (all ages) 3 ,, ,, Diarrhoea (under two years of age) 4 (All rates are per 1,000 of estimated residential population.) Comparability factor 1.11 Adjusted death rate 11.6 Ratio of local to national crude death rate 0.86 Percentage reduction of adjusted death rate below that for England and Wales 4.1 Zymotic disease death rate 0.07 Pulmonary Tuberculosis death rate 0.61 Non-pulmonary Tuberculosis death rate 0.04 The natural increase of population, i.e., excess of births over deaths was 294. 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 1939 (1,312) compares with 1,340 during 1938, the respective death rates per 1,000 population being 10.5 and 10.2. 7 Birth-rates, Death-rates, Analysis of Mortality, Maternal Death-rates and Case-rates for certain Infectious Diseases in the year 1939. 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 Population 25,000 to 50,000 at 1931 Census). London Administrative County. Walthamstow. Rates per 1,000 population. Births:— Live 15.0 14.8 15.6 12.3 12.03 Still 0.59 0.59 0.57 0.44 0.47 Deaths:— All Causes 12.1 12.0 11.2 11.9 10.5 Typhoid and Para-typhoid Fevers 0.00 0.00 0.00 0.00 0.00 Smallpox 0.00 - 0.00 - - Measles 0.01 0.01 0.01 0.00 0.00 Scarlet Fever 0.01 0.00 0.00 0.00 - Whooping Cough 0.03 0.03 0.02 0.03 0.02 Diphtheria 0.05 0.05 0.04 0.02 0.01 Influenza 0.21 0.19 0.20 0.18 0.02 Notifications:— Smallpox 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 1.89 1.96 1.78 1.53 1.4 Diphtheria 1.14 1.21 1.16 0.98 0.26 Enteric Fever 0.4 0.03 0.04 0.03 0.02 Erysipelas 0.34 0.40 0.31 0.37 0.35 Pneumonia 1.02 1.21 0.89 0.99 1.13 Rates per 1,000 Live Births . Deaths under 1 year of age 50 53 40 48 29 Deaths from Diarrhoea and Enteritis under 2 years of age 4.6 6.3 3.0 8.2 2.4 Maternal Mortality:— Puerperal Sepsis 0.77 Not available 1.29 Others 2.16 - Total 2.93 1.29 Rates per 1,000 Total Births (i.e. Live and Still) Maternal Mortality:- Puerperal Sepsis 0.74 Not available 1.24 Others 2.08 - Total 2.82 1.24 Notifications:— Puerperal Fever 14.35 17.26 12.99 3.31 22.78 Puerperal Pyrexia 14.22 8 Causes of Death as given by the Registrar -General for the year 1939. Whole District. Causes of death. Males. Females. Total. Total 1938. 1. Typhoid and Para-typhoid Fevers - - - - 2. Measles - - - 5 3. Scarlet Fever - - - - 4. Whooping Cough 1 2 3 2 5. Diphtheria 1 1 2 2 6. Influenza 18 8 26 7 7. Encephalitis Lethargica 4 - 4 4 8. Cerebro-spinal Fever - - - 3 9. T. B. of respiratory system 46 30 76 72 10. Other Tuberculous diseases 3 3 6 13 11. Syphilis 1 1 2 5 12. General paralysis of the insane, (tabes dorsalis) 1 2 3 5 13. Cancer, malignant disease 102 126 228 210 14. Diabetes 8 15 23 21 15. Cerebral Haemorrhage, etc. 38 43 81 88 16. Heart disease 162 159 321 346 17. Aneurysm 4 4 8 7 18. Other circulatory diseases 23 18 41 52 19. Bronchitis 31 27 58 49 20. Pneumonia (all forms) 36 38 74 88 21. Other respiratory diseases 9 2 11 14 22. Peptic Ulcer 8 1 9 20 23. Diarrhoea, etc. (under 2 years) 2 2 4 7 24. Appendicitis 3 4 7 11 25. Cirrhosis of Liver 3 - 3 6 26. Other diseases of liver, etc. 3 3 6 5 27. Other digestive diseases 7 9 16 32 28. Acute and Chronic Nephritis 11 12 23 26 29. Puerperal Sepsis - 2 2 1 30. Other Puerperal causes - - - 2 31. Congenital Debility, Malformation, Premature Birth, etc. 19 11 30 34 32. Senility 36 31 67 50 33. Suicide 7 5 12 15 34. Other violence 25 16 41 33 35. Other defined causes 66 59 125 104 36. Causes ill-defined or unknown - - - 1 Totals 678 634 1312 1340 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. 46-65 yrs. 65 yrs. & over 1 - - 1 1 11 101 113 9 B— Clinics and Treatment Centres:— Foot Clinic.— Total attendances were 13,509, and of these 1,452 were by new cases and 12,057 were re-attendances by old cases. The receipts were £509 4s. 0d. 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. In September a subsidiary clinic was opened on Saturday morning only at the Markhouse Road Centre. This clinic ceased on the outbreak of war. Women's Clinic.— Sessions were held weekly, with one consultant session monthly. Miss Basden continued as Consultant-in-Charge 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 Consultant Clinic 11 (b) Assistant Medical Officer's Clinic 51 (c) Senior Sister's Clinic 7 Total 69 Total of attendances made by patients:— New. Old. (a) Consultant's Clinic 7 115 (b) Assistant Medical Officer's Clinic 329 1,077 (c) Senior Sister's Clinic - 42 Total 336 1,234 Average attendance per session :— (a) Consultant's Clinic 0.63 10.45 (6) Assistant Medical Officer's Clinic 6.45 21.11 (c) Senior Sister's Clinic - 6.00 Referred to private doctors 6 Referred from private doctors 43 Referred to the South London Hospital for Women 23 Referred to other Hospitals 12 Operations at the South London Hospital on patients referred from the Clinic 18 The 18 in-patients spent a total of 314 days in hospital. In addition, 23 out-patients made 41 attendances. 10 The Council made a grant of £30 to the Hospital. Institutions Men Women Children Total Central Homes 148 164 53* 365 Whipps Cross Hospital 677 714 199 1,590 Forest Gate Hospital 12 82 5 99 Harold Wood Hospital - - - - Forest House 15 16 - 31 Aldersbrooke Children's Homes - - 45 45 *The majority of these children were ultimately transferred to Aldersbrooke. 48 infants (7 stillborn) were born to Walthamstow mothers in Forest Gate Hospital during the year. The number of patients from Walthamstow in Mental Hospitals was 430 on the 31st December. 1939. The Connaught Hospital. No. Admitted In- Patients Average Stay Daily Average Out- Patients New Cases Attendances 1939 1,390 20.96 83.10 8,448 56,632 1938 1,937 20.5 108.05 14,470 78.104 The decrease in figures is, of course, due to the fact that a number of beds have been allocated for casualties under the Emergency Hospital Scheme, and also certain Out-patient Departments were temporarily closed owing to the outbreak of war, but they are now in full swing again. Particulars as to Departmental activities were the same as those for 1938. 1. Public Assistance:— 1938. 1939. £ s. d. £ s. d. Total amount of out-relief granted to Walthamstow residents during year ended 31st December 51,598 52,360 1 10 17 11 Average weekly number of Walthamstow residents in receipt of relief during year ended 31st December Men 707 733 Women 1,154 1,171 Children 597 536 Total 2,458 2,440 2. Maternity and Child Welfare.— See Section H of the Report. 11 3. 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 beds were registered in 1938, but have never been brought into use. No applications were refused, cancelled or appealed against. 19 quarterly inspections were made by the medical staff. Routine enquiries are made with regard to unregistered homes. No difficulties in regard to supervision arose. Essex County Council Act.— Four licences to practise chiropody were granted by your Council. C.— SANITARY CIRCUMSTANCES OF THE AREA. 1. (i) Water. —A new main has been installed in Lowther Road. (ii) Drainage and Sewage. —No new major works of this character have been carried out during the present year. 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.— The number of cesspools in use is seven. (ii) Public Cleansing.— Mr. Eric Bell, M.I.P.C., A.R.San.I., Cleansing Superintendent, reports as follows:— "During the past year there have been no outstanding alterations in the methods employed for the collection and disposal of domestic and trade refuse, nor in street) cleansing operations. "Naturally, the evacuation of a large number of school children on the outbreak of war resulted in a very large decrease in the weight of refuse collected, but the gradual drift back again increase the weights so that by the end of the year the department was once again almost back to normal. "The work of decontamination in connection with A.R.P. has been readily undertaken by the staff of the Department without additional pay, and squads of seven men have been on duty 24 hours a day ever since the outbreak of war, almost 100 per cent. of the 12 employees sharing the duty. In the event of a gas attack, arrangements have been made for 10 fully trained and equipped Decontamination Squads to be available for voluntary service from employees of the Department." (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. 9,892 9,836 1,599 2,207 2,175 98 88 26,085 Failing compliance with Statutory Notices by the owners, the Council carried out these requirements to 9 houses involving an expenditure of £288 13s. 3d. The nature and variety of the work done during 1939 is shown in the following tables :— Drains tested, 443; Drains reconstructed or repaired, 474; Drains, obstructions removed, 226; Drains, means of access provided, 52; Drains, ventilation provided or improved, 77; Drains, ventilation repaired, 99; Soil pipes repaired, 51; Soil pipes, new, provided, 75; Rain-water pipes renewed, 2'73; Rain-water pipes disconnected from drains, 22; Roofs repaired or renewed, 877; Gutterings repaired or renewed, 495; W.C. pans or traps provided, 440; Gully traps provided, 104; W.C. flush cisterns provided, 86; W.C. flush cisterns repaired, 163; W.C. floors concreted, 6-8; W.C's repaired and cleansed, 581; W.C's light and ventilation improved, 22; Waste pipes renewed and trapped, 293; Waste pipes repaired, 148; New sinks provided, 172; Water supply re-instated, 6; Water supply taken off main, 2; Cisterns cleansed and covered, 64; Conveniences cleansed or repaired, 7; Sculleries paved, 83; Yards and forecourts paved and repaired, 531; Dirty houses cleansed, 16; Dirty rooms cleansed, 2,922; Floors repaired, 307; Ventilation under floors provided, 225 ; New damp-proof courses provided, 233; Sites concreted, 5; Offensive accumulations removed, 48; Animals improperly kept, removed, 3; Manure receptacles provided, 2; Stables cleansed, paved and drained, 54; Manholes repaired or re-sealed, 96; Other cases of dampness remedied, 494; Miscellaneous repairs, 2,712. 13 Infectious Diseases. Visits to premises, 674; Re-visits to premises, 90; Premises disinfected, 56-6; Articles disinfected at Low Hall, 6,041; Articles destroyed at Low Hall, 167. Dampness in Houses. Sites concreted, 5; Damp-proof courses provided, 233; Yards and forecourts paved and drained, 531; Roofs made water-tight, 877; Rain-water pipes made good, 273; Guttering repaired or renewed, 495; Other cases of dampness remedied, 494; Ventilation under floors provided, 225; House-to-house inspections, 737. Special Premises. Number. Visits paid. Factories 485 723 Outworkers 477 157 Slaughterhouses 9 426 Butchers' Shops 94 543 Bakehouses 41 173 Fishmongers, Fish Fryers and Curers, etc. 50 192 Eating-houses and Coffee Stalls 98 100 Ice Cream Vendors 196 230 Cowsheds, Dairies and Milkshops 228 128 Laundries 9 7 Rag and Bone Dealers 7 23 Elementary Schools - 2 Private Schools 7 Piggeries 4 22 Street Stalls Numerous 62 Greengrocers „ 111 Stables „ 183 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers' Shops and Slaughterhouses. Special cleansings, 40; Paving repaired, 4; Accumulations removed, 7; New galvanised bins provided, 211; Drains repaired, 11; W.C's repaired and cleansed, 13; Yard paving repaired, 3; Floors repaired and ventilated, 2; Roofs repaired, 7; Drains cleared, 5; New drinking water cisterns, 1; Light and ventilation improved, 1 ; Other improvements, 2. Bakehouses. Special cleansings, 65; W.C's cleansed and doors repaired, 8; Yards re-paved, 3; W.C. cisterns repaired, 5; Roofs repaired, 5; Premises, general repairs, 6; Obstruction from drains removed, 3 ; New ceilings fixed, 1; Floors repaired, 1. 14 Fishmongers. Special cleansings, 47; Yards re-paved, 5; Accumulations removed, 4; Roofs repaired, 5; Drains cleared, 5; Gutters renewed, 5; Other improvements, 14; Defective bins, 1. Coffee and eating houses. Special cleansings, 33; Yard pavings repaired, 4; W.C. cisterns repaired, 3; Drains repaired, 2; Defective dustbins, 3. Ice Cream Vendors. Special cleansings, 13; Special cleansing of utensils, 6; Yard pavings repaired, 4; W.C. flush improved, 3; Other improvements, 1. Cowsheds and Milkshops. Special cleansings, 17; Pavings re-laid, 2; Fittings and other improvements, 3; Roofs repaired, 3; W.C's repaired, 1. Stable Premises. Cleansings, 62; Accumulations removed, 22; Roofs repaired, 5; Pavings repaired, 3; W.C's repaired, 8; Manure receptacles provided, 2. Laundries. Special cleansings, 14; Paving repaired, 2; Accumulations removed, 2; Other improvements, 2. Rag and Bone Dealers. Cleansings, 14; Paving repaired, 2; Accumulations removed, 2; Other improvements, 21. Piggeries. Cleansings, 11. (iv) Shops and Offices.—107 inspections have been made in reference to infringements under the Shops Act, as reported by the Shops Act Inspector, and the necessary action taken for the abatement of such infringements. (v) Camping Sites.— There are 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.—18 complaints of nuisances caused by smoke were investigated—only 11 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. 15 (vii) Swimming Baths and Pools.— The model bye-laws of the Ministry of Health were adopted during the year. Twelve samples were taken from four baths and all were satisfactory. (viii) Eradication of Bed Bugs.—As for 1938. 4. Schools.—As for 1938. D.—HOUSING. (a) Statistics. The particulars of new houses erected during 1939 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 211 houses. 77 flats. 288 The 288 houses and flats are situated as follows:— Hale End Ward 204 (a) High Street Ward Nil Higham Hill Ward 16 (b) Hoe Street Ward Nil St. James Street Ward Nil Wood Street Ward 68 (c) (a) Includes 6 flats; (b) Includes 14 flats; (c) Includes 57 flats. (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 or Dwelling-Houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 3,006 (b) Number of inspections made for the purpose 14,744 (2) (a) Number of dwelling-houses (included under sub-head (I) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 737 (b) Number of inspections made for the purpose 3,729 16 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 2,301 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 2,175 III.— Action under Statutory Powers during the Year:— A. Proceedings under Section 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 94 (2) Number of dwelling-houses which were rendered fit after service of formal notice :— (a) By owners 75 (b) By local authority in default of owners (at a cost of £288 13s. 3d.) 9 B. Proceedings under 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 notice:— (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 3 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 2 17 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room haying been rendered fit Nil IV.— Housing Act, 1936, Part IV— Overcrowding:— A. (1) Number of dwellings overcrowded at the end of the year 138 (2) Number of families dwelling therein 138 (3) Number of persons dwelling therein 1,094 B. Number of new cases of overcrowding reported during the year 18 C. (1) Number of cases of overcrowding relieved during the year 95 (2) Number of persons concerned in such cases 609 D. Cases of overcrowding occurring during the year after the Council had re-housed an overcrowded family Nil E. Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it advisable to report See later pages House- to- House Inspection. During the year, house-to-house inspections were carried out in the following streets:— Ritchings Avenue. Green Pond Road. Orchard Street. Cross Street. Stoneydown Avenue. Sylvester Road. The Links. Wyatts Lane. Fairfield Road. Lime Street. Farnborough Avenue. Parkhurst Road. Parts of :— Parts of:— Pretoria Avenue. Alexandra Road. Clacton Road. Herbert Road. Grange Road. Longfellow Road. Ringwood Road. Milton Road. Somers Road. Carlton Road. Chingford Road. Blackhorse Lane. Marten Road. Gloucester Road. Springfield Road. Stirling Road. Fulbourne Road. Selbourne Road. St. John's Road. Hatherly Road. Turner Road. Beaconsfield Road. 18 (c) Housing Act, 1936. Unfit Houses. During the year one house was dealt with under this Act as follows:— 37, Higham Street—Demolition Order. (d) Housing Act, 1936—Overcrowding. Total number of houses in the Borough scheduled as overcrowded on 1st January, 1939 215 Additional cases added during the year 18 Cases abated during the year:— Rehoused by the Council 58 Removals, altered accommodation, decrease of family units, etc. 37 95 This leaves a total of 138 cases of overcrowding remaining on the schedule at the end of the year. The 18 cases added to the schedule are classified as follows :— Increasing age of existing children 4 Family increased 2 Combined age advance and family increase 9 Adjustment of "permitted number" allowed 2 Restored to schedule 1 Total 18 Permitted Numbers.— A total of 412 visits were paid by the District Sanitary Inspectors in connection with the Housing Act, 1936, as it relates to overcrowding. (e) General. Mr. J. E. West, your Council's Housing Manager, kindly contributed the following statement:— Overcrowding cases brought forward 1st January, 1939 215 Additional cases reported 18 233 Rehoused 58 Abated 37 95 138 The number of vacancies arising 75 (a) Rehoused from insanitary areas 8 (b) Rehoused from overcrowding schedule 58 (c) Rehoused by redistribution 13 (d) Rehoused from Housing Register 7 86 19 (b) Includes one case of overcrowding in Council Houses. Analysis of Cases on the Overcrowding Schedule. (а) Number of cases on Schedule at 1st January, 1939, in 215 dwellings and involving 1,616 persons 215 (b) New cases reported during the year ending 31st December, 1939, involving 87 persons 18 (c) Number of cases relieved :— 58 involving 356 persons rehoused. 37 involving 253 persons by redistribution, abatement, removals, etc. 95 cases 609 persons relieved. Analysis of Requirements. 1 case requiring 1 bedroom type house. 1 cases ,, 2 „ ,, „ 6 cases „ „ 2 „ „ „ 21 „ „3 „ „ „ 57 „ „4 „ „ „ 43 „ „5 „ „ „ 9 „ „6 „ „ „ 1 cases „ „7 „ „ „ Eradication of the Bed Bug. The number of cases treated during the year was 20. 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 two plants licensed in the Borough. The following is contributed by the Chief Sanitary Inspector :— The average number of cows kept in the district is eight. There is only one cowshed, and 12 visits were paid by the Sanitary Inspectors, in addition to special visits paid by your Chief Sanitary Inspector, The number of retail purveyors of milk is 227, most of whom carry on a general shop and sell milk in bottles as they receive it. Visits were paid to maintain the general standard of cleanliness. During the year, 26 samples of milk were taken for bacteriological examination. Of these, 9 were from pasteurised milk supplied to schools in the Town, and these samples gave satisfactory results. Of the remaining 17 samples, all were satisfactory excepting one, where a positive coliform result was obtained. 20 The samples are summarised as follows:— No. of Samples. Satisfactory. Unsatisfactory Tuberculin tested 2 1 Pasteurised 19 - Raw 4 - Totals 25 1 The Milk and Dairies Order, 1936. 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 to the Town. The Milk (Special Designations) Order, 1936. The number of licenses granted for the sale of Milk under Special Designations classified in the above Order was as follows :— Dealers' Licences. In respect of :— Supplementary Licences. Pasteurised Milk 30 Pasteurised Milk 2 Tuberculin Tested Milk 15 Tuberculin Tested Milk 2 Bottling Licences. In respect of Tuberculin Tested Milk, 2; Pasteurised Milk, 2. Ice Cream. Under the requirements of the Essex County Council Act, 1933, all Ice Cream Vendors or Manufacturers in the Town must be registered. There are 196 Vendors of Ice Cream in this Town, the majority of whom sell a proprietary article. During the year registration was granted in 60 cases, and refused in two instances. In May and June 45 samples of this commodity were taken and submitted for analysis on fat content, and 41 samples were also submitted to bacteriological examination. The results of the above analyses—ranging from 1.1 to 13.1 per cent. fat content showed, on the whole, a very poor standard. The bacterial counts ranged from 300 to 370,000 per millilitre, and of these only seven were above 100,000 per millilitre. The following table indicates the low fat contents of the samples submitted :— Below 2 per cent. 3 per cent. 5 per cent. 8 per cent. 4 18 34 38 Following these analyses, I interviewed all Vendors of Ice 'Cream whose commodity showed a very poor fat content and/or where cleanliness was apparently lacking—in all, 36 Vendors were interviewed and subsequently samples were obtained of their commodity. 21 The following showing fat contents, if compared with the above table, will show the improvement in the fat content of Ice Cream sold in this Town as a result of these interviews, and although still not satisfactory, is a great advance on the former standard of this commodity, and appears fully to justify the energy and expense incurred :— Below 2 per cent. 3 per cent. 5 per cent. 8 per cent. — 4 16 28 It may be interesting to know that there was a period of two months between the two sets of samples being obtained.. One Vendor, whose commodity gave a bacterial count of 1,800,000, refrained from dealing with this commodity under my advice. In two instances where fat contents were low, the Vendors concerned discontinued making the commodity and commenced to sell a proprietary article. The total number of samples taken was 154—71 for fat content, 83 for bacteriological examination. Several Vendors use a proprietary brand of ice cream powder, adding water thereto as prescribed by the makers of the powder, and make a cold mix. I have found, as a consequence of analyses, that in several instances considerably more water has been added to the mix than that specified by the makers of the powder, with a consequent reduction in the percentage of fat content of the commodity. Vendors have laid blame to the powder for the low fat content, and in such cases I have ascertained, by analysis, this to be incorrect. Some Vendors, in taking the matter up with the makers of the powder, have omitted to state the fact that more water than specified has been added to the powder, which is unfortunate and likely to bring about a. strained position between such makers of proprietary brands of powder and the local authority concerned. Except for the Isle of Man—where recently a standard of at least 8 per cent, of fat, and a bacterial count of not more than 100,000 per millilitre has been fixed by legislation (to come into force in two years' time)—there appears to be no standard for Ice Cream throughout the British Isles. (b) Meat and other Food. During the year 2,611 animals intended for human consumption were slaughtered in the Town. Every animal was inspected at time of slaughter, and for this purpose 426 visits were paid to the slaughterhouses. The following table indicates the number of each type of animal slaughtered, the percentage of such affected with tuberculosis and other diseases. 22 CARCASES INSPECTED AND CONDEMNED. Cattle excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 235 12 143 1,565 656 Number inspected 235 12 143 1,565 656 All diseases except Tuberculosis :— Whole carcases condemned - - - - - Carcases of which some part or organ was condemned 46 2 2 20 35 Percentage of the number inspected affected with disease other than tuberculosis 19.57 16.66 1.39 1.28 5.34 Tuberculosis only:— Whole carcases condemned 2 - - - 1 Carcases of which some part or organ was condemned 27 9 1 - 37 Percentage of the number inspected affected with tuberculosis 12.34 75.0 0.69 — 5.79 In addition to the meat involved in the above table, the following miscellaneous articles were condemned and destroyed as unlit for food :— 2¾ barrels Apples 22 Fillets Cod. 56 lbs. Tomatoes. 4½ stone Skate. 48 lbs. Pears. 5 stone Pollock. 2 Hams and 2 portions. 2 stone Dogfish. 6 stone Beef and Mutton. 12 stone Dabs. 2 portions Gammon. 4½ stone Cod. 2,379 tins Smoked Brisling. (c) Adulteration, etc.— Food and Drugs (Adulteration) Act, 1928, and Food and Drugs Act, 1938. The latter Act replaced the former one on 1st October and the Corporation then became the Food and Drugs Authority. Prior to this date, and as in the past, samples—chiefly of milk—have been procured as "such good work has been carried out" to quote from the Annual Report for 1938. 23 Since then the operation of the new Act has, of course, been greatly accelerated. This now includes a large variety of food and drugs. During the year 100 samples have been taken and submitted for analyses. Seven of these were informal samples. Two samples were unsatisfactory and the particulars are as follows :— Description of Article. Result of Analysis. Decision taken. Tinned Brisling (Smoked) Tins in bad condition Inspection of retailer's stock; 2,397 tins of this particular consignment confiscated without recompense. Lard Not lard fat—actual Government Cooking Fat (purchased 29th December) Retailer warned. RENT AND MORTGAGE RESTRICTIONS ACTS, 1894-1928. During the year 13 Certificates were granted to tenants and five Certificates have been issued to owners upon their application and completion of the scheduled works. DISEASES OF ANIMALS ACTS, 1894-1928. Regulation of Movement of Swine Order, 1922.—Four Isolation Notices affecting 43 swine were received. The Licenses were in all cases duly observed. Foot and Mouth Disease (Infected Areas Restrictions) Order, 1938.— This standstill Order was made because of danger of widespread infection. It was in operation from 5th—20th November, 1939. Under the Order, Movement Licences were issued affecting 216 animals. RATS AND MICE DESTRUCTION ACT, 1919. Much has been done in combating the rat nuisance, and where necessary poison—barium carbonate in biscuit form—has been issued gratis. As a result of investigation carried out upon complaints being received, action has been taken as follows:— Notices served 43 Cyanogas pump used 4 Drains tested 118 Accumulations removed 2 Drains and manholes repaired 82 Sheds lifted or removed 6 Pavings lifted and runs traced 16 Drains relaid 8 Poison issued 124 Premises rat-proofed 7 24 FACTORIES ACT, 1937. The following table shows the work done under this Act:— 1 .—INSPECTION OF FACTORIES, ETC. Including Inspections made by the Sanitary Inspectors. Premises. Number of Inspections Written Notices. Occupiers Prosecuted (1) (2) (3) (4) Factories with mechanical power 540 26 Nil. Workshops without mechanical power 150 6 Nil. Other premises under the Act. 33 1 Nil. Total 723 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) (5) Want of cleanliness 54 54 - - Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation 2 2 — — Ineffective drainage of floors 3 3 — — Sanitary Conveniences insufficient 2 2 — — unsuitable or defective 102 103 - - not separate for sexes — — — - Other offences 52 50 6 — Total 215 214 6 Ni 25 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1939. Wearing Apparel, making of 344 Pencils 1 Brush Making 38 Artificial Flowers 7 Boxes 22 Toys 29 Carnival Hats 2 Handbags 3 Envelopes 2 Novelties 1 Furniture 1 Feathers 2 Furs 5 Shoes 20 Total 477 Outworkers were notified from the following areas:— City of London 103 Leyton 123 Tottenham 20 Bethnal Green 3 Poplar 3 Walthamstow 50 Finsbury 45 Woodford 5 Westminster 11 Hackney 71 Stepney 11 Other Areas 13 Islington 8 Shoreditch 11 Total 477 F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. General.—The accompanying tables show the age and ward incidence of the various infectious diseases which are discussed separately in later pages of the Report:— Disease. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. 1939 1938 Scarlet Fever 192 281 — 37 122 20 12 1 — Diphtheria 35 65 — 6 23 4 2 — — Enteric Fever 3 2 — 1 — 1 1 — - Pneumonia 147 147 4 14 14 2 38 33 22 Puerperal Pyrexia 38 35 — — — 15 23 — — Ophthalmia Neonatorum 5 4 5 — — — — — — Erysipelas 54 76 — - 1 4 8 33 7 Encephalitis Lethargica — — — — — — — — — Polio-encephalitis - - - - - - - - - Cerebro-spinal Meningitis 3 3 — 1 — — 2 — — Anterior Poliomyelitis — - - — — — — — — Measles (under 5 years) 10 772 4 6 - - - - - Dysentery 3 23 - 1 2 — — — — Tuberculosis 141 164 — 7 14 35 60 20 5 Totals 1939 631 - 13 74 176 101 146 87 34 1938 — 1575 53 843 268 108 184 86 33 26 Disease. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals Scarlet Fever 28 25 31 27 40 41 192 Diphtheria 3 6 4 3 10 9 35 Enteric Ferer - 1 1 - 1 - 3 Pneumonia 6 11 6 8 4 3 38 Puerperal Pyrexia 28 17 24 21 23 34 147 Ophthalmia Neonatorum 2 — 1 1 1 — 5 Erysipelas 8 7 12 1 9 17 54 Encephalitis Lethargica — — - - — — - Polio-encephalitis — - - - — — - Cerebro-spinalMeningitis — 1 1 — — 1 3 Anterior Poliomyelitis — - - - — - - Measles (under 5 years) 2 2 2 - 1 3 10 Dysentery 1 1 1 — — — 3 Tubsrculosis 19 18 23 18 34 29 141 Totals 1939 97 89 106 79 123 137 - 1938 262 203 210 225 335 340 1575 The statistics given in the foregoing table are those for the calendar year 1939. The Registrar-General gives the statistics for the 52 weeks ended 30th December, 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 192 35 3 147 38 54 Case Rate— Walthamstow England and 1.4 0.26 0.02 1.13 0.24 0.35 Wales 1.89 1.14 0.04 1.02 14.35 0.34 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 23.7 England and Wales 14.35 27 Disease. Total notified. Removed to Hospital. Per cent. removed to Hospital. Deaths. Deaths per cent. of cases notified. Scarlet Fever 192 177 91.7 Nil Nil Diphtheria 35 35 100 2 5.6 Enteric Fever 3 3 100 Nil Nil Pneumonia 147 67 46 74 50.3 Puerperal Pyrexia 38 5 13.1 2 5.2 Ophthalmia Neonatorum 5 2 40 — — Erysipelas 54 8 14.8 Not a classified cause of death Cerebro-spinal Meningitis 3 3 100 — — Encephalitis Lethargica — — 100 — — Measles (under 5 years) 10 — — — — Dysentery 3 1 33.3 Nil Nil Tuberculosis 141 185* — 82 58.1 *This figure also includes cases notified during previous years. Infectious Diseases Clinic:— Number of clinics held in connection with Infectious Diseases and Immunisation 51 Number of attendances made 2.233 Average attendance per session 43.7 Number of Scarlet Fever cases discovered 2 Number of Diphtheria cases discovered Nil Number of virulence tests taken in Diphtheria carriers 4 Number of children recommended to Rheumatism Clinic 18 Number of children recommended to Ear Clinic 16 DIPHTHERIA IMMUNISATION. The following summarises the work done:— Schick tested for the first time 67 Negative (including pseudo and negative) 27 Positive (including pseudo and positive) 40 Total number of immunisations completed during 1939:— (a) School age 499 (b) Pre-school age 318 (c) Over school age 1 Total 818 Number not completing immunisation or left district 164 Number of Schick tests following immunisation 54 28 Number of re-Schick rests following immunisation in previous years 384 Number of attendances made at clinic for immunisation 1,901 Immunisation at schools (included above):— Number completely immunised 474 Number partly immunised 39 Number having second dose, immunised in previous years 107 Follow-up of Double Dose A.P.T. Immunisation for Schick Test.—531 children were sent for and 271 responded. Of these 18 gave a positive result or 6.6 per cent. had lost some of their immunity and were given another dose. Diphtheria in, Immunised Children.—One case occurred, the patient, a boy of 6 years, was admitted to the Isolation Hospital with a bad throat which, though clinically resembled diphtheria, was thought to be mainly due to Vincent's Angina. The bacteriological result of the swab taken was "K.L.B. virulent and of the intermediate type, also organisms of Vincent's Angina were found." The boy made a good recovery, which would probably not have been so had he not been immunised and therefore had a certain amount of protection. First Birthday Letters.—1,564 letters were sent to the parents of all children following their first birthday, advising them to have their infants protected against diphtheria. 156 children were brought and protected and 20 others were immunised by private practitioners. Immunisation by General Practitioners.—Diphtheria prophylactic is available to general practitioners. During 1939, 22'c.c's of alum precipitated toxoid were issued. This quantity is sufficient to protect 22 children. Scarlet Fever Immunisation.—There were no Dick tests for scarlet fever during 1939. MUNICIPAL LABORATORY. The following numbers of Diphtheria swabs were examined during 1939:— Swabs. Negative. Positive. Totals. Private Practitioners 537 30 567 Health Department 107 14 121 School Medical Department 202 1 203 Totals 846 45 891 29 The total number of Diphtheria specimens examined in 1938 was 1,771. Direct examinations were done on 54 Diphtheria specimens, and 7 were positive; 3 were positive on culture, although negative on direct examination. In addition, 156 specimens of urine were examined, as compared with 163 in 1938. A total of 1,565 tubes of culture media were made by Mr. West and of these, 636 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 1,997 specimens were examined for local practitioners during 1939, as follows:— Diphtheria swabs, 146; Sputa, 759; Typhoid specimens, 28; Ringworm specimens, 7; Miscellaneous, 1,055; Diphtheria. Virulence Tests, 2. VACCINATION. Mr. E. Sharp, Vaccination Officer for the Area, has furnished the following return for 1939:— Births Registered Successfully Vaccinated Percentage Vaccinated Insusceptible Exemptions Death before Vaccinated Postponed 1,457 204 14.10 l 867 27 47 In addition to the above, 11 primary vaccinations were recorded, and 18 re-vaccinations. During! 1939 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 22.4 per cent. were vaccinated. Infectious Diseases notified by the Medical Staff.—Scarlet Fever, 10; Diphtheria, 7; Dysentery, 6; Total, 23. G.—INFECTIOUS DISEASES HOSPITAL. Renovations, etc.—Various works of renovation and maintenance were carried out during 1939. 30 The following table shows the admissions, discharges and deaths during 1939:— Scarlet Fever. Diphtheria. Other Diseases. Tuberculosis . Totals. Remaining in Hospital 1st January 15 20 3 20 58 Admitted during year 216 98 5 26 345 Discharged during year 228 108 7 28 371 Died during year — 1 — 7 8 Remaining in Hospital 31st December 3 9 1 11 24 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL (including Tuberculosis cases). January 59.3 February 61.3 March 64.0 April 47.2 May 48.7 June 49.9 July 50.3 August 39.9 September 34.0 October 28.4 November 25.2 December 24.8 Average whole year 44.3 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 26 23 27 63 18 24 15 20 86 130 216 Diphtheria 15 11 21 13 8 9 7 14 51 47 98 Whooping Cough 3 3 — — — — — — 3 3 6 Rubella 3 2 3 6 — 2 2 1 8 11 19 Pulmonary Tuberculosis - - - - - - - 26 - 26 26 Staff — — - — — - - 25 - 25 25 Other diseases — 2 — — — — 2 3 2 5 7 Totals 47 41 51 82 26 35 26 89 150 247 397 Other diseases include C.S.M., 1; P.T.F., 1; Diarrhoea, 3; for observation, 2. 31 AGE AND SEX AT DEATH. Eight deaths occurred, details of which are given below:— 7 Pulmonary Tuberculosis Females, aged 49, 30, 22, 36, 21, 39 and 43 years. 1 Diphtheria (Heart Block) Male, aged 19 years. Staff. —Members of the staff were admitted to hospital beds suffering from the following complaints:-Purpura (1); Facial Dermatitis (1); Tonsillitis (3); Intestinal Adhesions; (1); Varicose Dermatitis (1); Abscess of Breast (1); Epistaxis (1); Injured Ankle (1); Endocarditis (1); Jaundice (1); Common Cold (2); Dental Abscess (1); Rubella (1). Operations at Hospital.—One operation (Tracheotomy) was performed. Specialist Consultations.—Twelve consultant visits were paid by six consultants, viz.:—C.S.M., 3; Heart Disease, 2; Meningitis, 2; Mastoid, 2; Sinusitis, 2; Skin Trouble, 1. Swabs.—345 swabs were taken and examined during the year in the laboratory at the Hospital. Number of Outside Authorities' Cases and Nature.— Diphtheria. Scarlet Fever. Dysentery. Total From Whipps Cross Hospital 5 1 — 6 From Leyton B.C. 16 16 — 32 From Army Authorities 2 — 3 5 Total 23 17 3 43 The following cases were transferred to Whipps Cross Hospital:— 1 Cleft palate. 1 Drug eruption. 1 possible case of T.B. 1 Diabetes. Meningitis. 1 to continue treatment of anterior poliomyelitis. Duration of Treatment.—The average duration of treatment in Hospital was as follows:— Diphtheria 40.6 days. Scarlet Fever 23.1 days. Other diseases 16.5 days. 32 The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1939:— Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.). In Hospital on 1st January, 1939. Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1939. Observation — — — — — T.B. Minus 2 6 7 — 1 T.B. Plus Group I 1 — 1 — — T.B. Plus Group II 15 20 17 8 10 T.B. Plus Group III 1 2 3 - - Totals 19 28 28 8 11 Ten of the 28 admissions were Walthamstow cases. MEDICAL EXAMINATIONS. During the year, 53 examinations were carried out by the Medical Staff in respect of the Superannuation and Sick Pay Schemes. MISCELLANEOUS. Your Council made the following grants during the year to voluntary organisations:— Invalid Children's Aid Association £100 Walthamstow Association of Tuberculosis Care Helpers £25 Mortuary.—A Coroner's Court, mortuary (with special provision for Infectious Disease cases) and a post-mortem room is provided by your Council at Queen's Road Cemetery. The Cemetery Superintendent reports that the number of inquests and post-mortems were as follows:— Inquests only 146 Post-mortems 86 Post-mortems and Inquests (not included in above) 29 Total *261 *Included in the above are 149 non-residents. 33 SECTION H. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs. E. A. Smith. Ex-Officio: The Worshipful the Mayor—Alderman H. Frost, J.P. The Deputy Mayor—Alderman Mrs. C. McEntee, J.P.. Chairman of the Finance Committee—Alderman Ross Wyld, J.P. Alderman W. B. Fitt. Councillor Mrs. E. M. Miller. „ Mrs. E. M. Richards. „ G. M. Page. „ W. J. Sharp. „ R. W. A. Russell. Councillor Mrs. L. P. Bailey. „ R. E. Smith. „ Mrs. B. M. Friedberg. „ J. H. Thomason. „ Mrs. A. L. Meadows. Mrs. E. B. Toynbee. Co-opted Members : Dr. J. L. Mackenzie Brown. Mrs. W. H. Kindell. Mrs. S. Candy. Mrs. A. R. Robbins. Mrs. Hatton. Mrs. W. J. Sharp. Mr. W. H. Kindell. Mr. J. Dei Vries. 34 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen, I beg to present herewith a report on the Maternity and Child Welfare Services in your Borough for the year 1939. The year is notable for the lowest Infantile Mortality rate ever recorded in Walthamstow, viz., 29, the previous lowest being 37 in 1935, and a new low record in the Maternal Mortality rate, viz., 1.29. The Services were maintained as fully as possible during the year and in spite of four months of war, the work done at Thorpe Coombe and at clinics was almost up to that of previous years. Again I have to acknowledge the help of your Chairman and the good work of the Staff. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 35 STAFF. As for 1938, with the addition of Miss F. Donovan, S.R.N., S.C.M., H.V. Cert., appointed 14th June, 1939, for Health Visiting and supervision of Out Workers. NOTIFICATION OF BIRTHS. 1,678 births (158 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, 323; midwives, 1,365. Included in the above are 244 births which were notified as having occurred outside the Borough. Also included are 52 stillbirths, 4 of which did not belong to the area. 17 were notified by doctors and 35 by midwives. Of the total, seven occurred outside the area. The stillbirth rate per 1,000 population was 0.40. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Males. Females. Totals. Legitimate 801 765 1,566 Illegitimate 23 17 40 824 782 1,606 (b) Stillbirths. Males. Females. Totals. Legitimate 43 17 60 Illegitimate 1 1 2 44 18 62 Of the 1,455 birth registrations received in the Department between 7th January, 1939, and 30th December, 1939, a total of 22 were not notified in this area, but some may possibly have been notified elsewhere. Appropriate action was taken when necessary. Of the 1,455 local registrations, 204 belonging to other areas are excluded, leaving a nett total of 1,251. The local registrations for 1939 were 104 less than in 1938. 36 INFANT MORTALITY. The deaths of infants under one year of age were:— Males. Females. Total Legitimate 24 21 45 Illegitimate — — — Total 24 21 45 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, 29; Illegitimate, —; Total 29. The Infant Mortality Rate for other areas during 1939 was as follows:— England and Wales 50 126 County Boroughs and Great Towns (including London) 53 148 Smaller Towns (25,000 to 50,000) 40 London 48 Neo-Natal Mortality. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1939, 28 infants died in the first four weeks of life, yielding a rate of 17.4. 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 lire births. Per 1,000 population. No. Per 1,000 live births. No. Per 1,000 live births. 1939 1,806 12.3 62 38.6 0.47 28 17.4 45 29 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 60 34.0 0.55 41 20.9 78 39 The neo-natal mortality for England and Wales for the decennium 1921-30 was 33. 37 The death-rate from Diarrhoea and Enteritis in children under one year of age per 1,000 live births was 2.49. CHILD WELFARE. The equivalent of whole-time Municipal Health Visitors at the end of the year was 7i, equal to one whole-time Health Visitor per 284 notified births, and one whole-time Health Visitor per 194 registered births during 1939. MATERNITY AND CHILD WELFARE CLINICS. As for 1938. A. MUNICIPAL SCHEME. The detailed findings at first visits paid during 1939 are given in the following table:— The particulars in respect of housing accommodation show the following comparison:— House or Flat. Half House. 1-3 Rooms. Total. 1939 1.049 291 143 1,483 1938 1,128 293 199 1.620 38 The following table shows the number and nature of visits paid in Wards during 1939:— 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 251 418 669 1,092 1,761 486 41 166 59 23 82 144 2,680 High Street 215 407 622 780 1,402 231 63 93 43 — 43 47 1,879 Hoe Street 185 405 590 627 1,217 290 33 158 32 14 46 85 1,829 Wood Street 212 366 578 496 1,074 336 32 139 59 1 60 118 1,759 Hale End 328 1,058 1,386 1,676 3,062 462 130 210 56 12 68 63 3,995 Higham Hill 292 807 1,099 2,032 3,131 468 87 296 45 21 66 123 4,171 Total, 1939 1,483 3,461 4,944 6,703 11,647 2,273 386 1,062 294 71 365 580 16,313 Total, 1938 1,620 3,882 5,502 7,752 13,254 2,151 494 1,321 351 146 497 1,250 18,967 39 CLINICS. Dr. Sheppard reports as follows:— "During the first eight months of 1939, the progress of Maternity and Child Welfare in the Borough was very favourable. "Serious depletion of the Staff was caused in the early days of the war through evacuation and A.R.P. duties. The Welfare work was, nevertheless, not permitted to suser. "The drift back of mothers and babies began in a week or two and in a very short time the numbers attending the Centres were almost normal. "The mothers of Walthamstow are to be congratulated that all through the very anxious period at the end of 1939 the Maternity and Child Welfare Committee kept their Services running as usual, although hampered by the need for giving help to the Reception Areas. "The black-out was another difficulty, but that was overcome by the Staff shortening their dinner hour and opening all the Centres by 1.30 p.m. so that the mothers could have every attention and yet be able to leave in time to reach home before dark. "Thanks are due to the voluntary workers who so ably assisted the Staff during the year and especially during those difficult months at the commencement of the war." 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 733 401 Low Hall Lane Clinic 401 17 Total 1,134 418 Total Attendances:— Thorpe Coombe Maternity Hospital 6,483 556 Low Hall Lane Clinic 642 34 Total 7,125 590 The total number of new patients attending the Clinics represent the following percentages of total notified births (live and still):— Ante-Natal, 67.5; Post-Natal, 24.9. 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. 40 Summary of Attendances at Welfare Clinics. Clinic. First Attendances of New Cases. Re-attendances. Grand Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Markhouse Road 540 159 699 10088 10319 20407 21106 Higham Hill 260 59 319 3952 4020 7972 8291 Hale End 223 41 264 4458 4804 9262 9526 Total 1939 1023 259 1282 18498 19143 37641 38923 1938 1035 285 1320 19890 19316 39206 40526 Nurse Children.—At the end of 1939 there were 58 nurse children on the register, compared with 108 at the end of 1938. During the year 94 removed, 1 was adopted, and 25 reached the age of nine years. 70 new children were registered. There were no deaths among nurse children during 1939. 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. 197 cases attended for massage, and these made 1,932 attendances. Sale of Milk, etc., at Clinics.—The quantity and value of milk and food sold and issued free during 1939 was £1,784 7s. 4d. WALTHAMSTOW CHILD WELFARE SOCIETY. The organisation, staffing, and accommodation provided by the Society was fully dealt with in the 1935 Report. The work done during the calendar year is shown in the following table compiled from information kindly supplied by Miss O. M. Francis. Clinics. First Attendances of New Cases. Re-attendances. Grand Total. Under 1 yr. 1-5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1939 521 87 608 8368 4484 12852 13460 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 41 Special Treatment, etc. Massage Treatments. Sunlight Treatments Total cases admitted to Observation Ward Local Authority's cases admitted to Observation Ward. 1939 1489 1224 10 4 1938 2314 1949 35 1 1937 2468 1847 24 2 1936 2107 1461 28 10 1935 2197 1727 27 — Home Visits. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1939 495 1398 1893 1058 2951 1938 508 1691 2199 1097 3296 1937 464 1751 2215 1289 3504 1936 380 1251 1631 2639 4270 1935 338 1441 1779 2672 4451 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 1023 259 1282 18498 19143 37641 38923 Brookscroft 521 87 608 8368 4484 12852 13460 Total 1939 1544 346 1890 26866 23627 50493 52383 1938 1531 400 1931 29277 24382 53659 55590 42 Home Visits To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Municipal Scheme 1483 3461 4944 6703 11647 Brookscroft 495 1398 1893 1058 2951 Total 1939 1978 4859 6837 7761 14598 1938 2128 5573 7701 8849 16550 Percentage of notified births represented by number of children under 1 year of age who attended the Centres for the first time (i.e., new cases) 1939 94.9 Percentage of total notified births represented by number of expectant mothers attending Ante-Natal Clinics 1939 67.5 TREATMENT. (a) Orthopaedic.— Defects Seen at Orthopaedic Clinic in Children under Five Years of Age. Anterior Poliomyelitis 5 Talipes 7 Bowed Tibiae 25 Torticollis 4 Rickets— Congenital Defects 7 (a) Genu Varum 8 Amyotonia 1 (b) Genu Valgum 26 Miscellaneous 14 Pes Piano Valgus 24 Spastic Paralysis 5 Total 126 Admissions to Brookfield Orthopaedic Hospital (under Five Years of Age). Hemiplegia 2 Two operations were performed. The hospital was closed at the outbreak of War. 43 (b) Dental.—The following work was done by the Education Committee's Dental Surgeons in respect of Maternity and Child Welfare patients:— 1937 1938 1939 Mothers. Children under 5. Mothers. Children under 5. Mothers. Children under 5. Cases Treated 339 138 210 130 184 92 Attendances 536 207 521 183 657 160 Fillings 150 114 176 56 221 84 Extractions 618 146 431 279 446 139 General Anaesthetics 227 76 180 96 171 73 Scalings 67 — 63 — 92 — Dressings 8 235 10 26 34 30 Dentures 10 — 27 — 26 — 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 :— "During the year 1939, 401 maternity and nursing cases, mostly pre-natal, have been referred for dental treatment. Number of appointments kept:— (a) Expectant mothers from Thorpe Coombe 170 (b) Expectant mothers from Welfare Centres 43 (c) Nursing mothers 13 Total 226 Number receiving complete treatment 33 Number receiving partial treatment, but not attending for completion 193 216 Number failing to keep appointments 28 Number deciding to postpone treatment indefinitely 3 "For the last quarter of the year a much greater time has been devoted to maternity cases, owing to the evacuation of the school children. The acceptance rate for that period was exceptionally high. There has been a slight decrease in the incidence and severity of diseases of the gums. "Conservative work has increased. Fifteen patients were supplied with dentures. 27 dentures were fitted. "The provision of dental treatment for mothers of childbearing age is not wide enough in its scope, and should not be restricted to the ante-natal and nursing periods." 44 (c) Tonsils and Adenoids.—Seven cases were operated on under the arrangement made by the Education Committee with the Connaught Hospital. (d) Ophthalmic Defects and Minor Ailments.—Children are given treatment either at the School Clinics or by special appointment. (e) Sunlight.—No infants were referred for sunlight treatment during 1939. (f) Child Guidance.—No case was referred in 1939. (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 30 Orthopaedic Clinics 70 Rheumatism 1 101 Suffering from:— Anaemia and Debility 1 Marasmus and Malnutrition 1 Pneumonia, Bronchitis, Asthma, etc. 6 Bone Disease (non-T.B.) 57 Congenital Deformities 16 Paralysis 1 After Infection 6 Diseases of:— Glands (non-T.B.) 1 Ear 4 Nose and Throat 1 Various 7 101 Help Given to Old and New Cases, 1939. Sent to Special Hospitals and Convalescent Homes *20 Provided with Surgical Boots and Appliances 21 Referred for Visiting and Advice 92 133 * Includes 3 admissions to Brookfield Hospital. 45 ASSISTED MILK SCHEME. Number of applications during 1939 6,339 Number of families assisted 1,281 Of the 6,339 applications, approximately 37 per cent. were from families; where the father was unemployed. Scale. Amount. Approximate cost to Authority. £ s. d. Free 595 pints 7 11 0 ½d. per pint 53,512 „ 589 4 10 1d. per pint 132,255 „ 1,515 8 6 Half Cost 22,544 „ 187 17 0 208,906 „ £2,300 1 4 The following is a summary of the applications for milk for the past five years:— Milk. Dried Milk. Unemployed. 0/ /o Unemployed . Average per week. Milk. Dried Milk. 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 1939 5,766 573 2,324 37.0 110.8 11.0 HOME HELPS. In addition to the 125 Home Helps approved during 1939, 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. STERILISED MATERNITY OUTFITS. A total of 273 sets were used in the Borough and 212 outfits were issued below cost price. INSTITUTIONAL TREATMENT, ETC. Eleven children were sent to Institutions under arrangements approved by your Committee. 46 HOSPITAL ACCOMMODATION FOR CONFINEMENTS. The following numbers of confinements occurred at the Institutions specified (Walthamstow residents only):— Thorpe Coombe Maternity Hospital 595 Maternity Homes in Walthamstow 107 Mothers' Hospital, Clapton 62 Forest Gate Hospital 46 Queen Mary's Hospital, Stratford 3 City of London Maternity Hospital 20 Other Maternity Homes 84 917 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 43 lying-in beds and 4 isolation beds, making a total for the Borough of 74 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 year has been a disastrous one for the Association owing to the fact that, at the beginning of hostilities, it was not possible properly to protect No. 19, Carisbrooke Road as a Maternity Home, and, therefore, it was decided to close it down temporarily. The Staff of the Home were employed until they obtained posts, which they did very soon. Where possible, cases already booked for the Home were attended to in their own homes, but many, of course, evacuated and were lost to the Association. "In consequence of No. 19, Carisbrooke Road being unused, 36, Carisbrooke Road was given up and the nurses all moved over to the houses Nos. 17 and 19, Carisbrooke Road. "The District Nursing Work has been fully maintained and was increased considerably by the fact that Hospitals evacuated their cases at an early stage. All calls have been met. "The Staff at December 31st, 1939, was as follows:— "One Superintendent. "One Assistant Superintendent. "Four Queen's Nurses (all Midwives). "Two Municipal Midwives. "One Voluntary Midwife. "One Emergency Midwife. "One Non-Queen's Nurse 47 and two Queen's Candidates who were given their training, passed their examination and were approved on the Queen's Roll by H.M. Queen Mary. They are now on the Staff. "General cases attended during the year, January 1st to December 31st, 1939 918 "Visits for general cases 22,129 '"Midwifery and Maternity cases attended on the District 218 "Midwifery and Maternity cases attended in the Maternity Home 77 "Cases outside the Borough in and out of the Home (included above) 68 "Gas and Air—Cases to which this was administered on Home and District 59 "Twelve Pupil Midwives were trained during the year, comprising eight from Thorpe Coombe and four from L.C.C. Hospitals. "The Nurses of the Association have been allocated by the M.O.H. to Dressing Stations in the event of Air Raids. "Sixty-one Lectures were given by the Superintendent to men and women to enable the majority of the members to enter for the St. John Ambulance examination. "Anti-Gas Lectures were given to the Staff of Messrs. Marks & Spencer by Miss Duff. "The Provident Scheme was badly affected by evacuation, but counteracted by the fact that many new members were made, and also, we were working in conjunction with the Greater London Provident Scheme. "The Association sustained a great loss in the retirement of the Chairman, Dr. A. P. Eldred. His successor is Dr. Myer Cohen." ANAESTHETIST'S FEES. During 1939 recovery on the scale for assisted Maternity and Child Welfare services was made in the two cases in which this service was approved. CONSULTANT OBSTETRICIANS. The services of a, Consultant Obstetrician were requested by a General Practitioner on one occasion (i.e., apart from the Maternity Hospital). 48 The table below gives particulars:— Diagnosis. Where Treated. Result. Prolonged labour Hospital Recovery. MIDWIVES ACTS, 1902-1936. No. of Notices of Intention to Practice, January, 1939 32 „ „ „ „ during 1939 15 Total 47 No. of Midwives ceasing to practice during 1939 20 „ „ practising at the end of 1939 27 There was no change in the arrangements for the employment or subsidy of midwives by the Council. 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 1939:— No. of confinements attended as a Midwife 1,096 „ „ „ Maternity Nurse 247 „ medical aid notices sent 450 „ notifications of deaths 4 „ twin births notified 5 „ stillbirths notified 6 „ notifications of liability to be a source of infection 9 „ „ „ laying out of a dead body 1 „ „ „ artificial feeding 6 „ „ „ disinfection 9 The above table includes the following numbers with regard to work done at Thorpe Coombe:— Midwifery cases, 500. Maternity cases, 95. Medical Aid Notices, 264. The percentages of medical aid notices were:— Total, 41.0; Maternity Hospital, 52.8; Domiciliary midwives, 31.2 49 The conditions for which medical aid was summoned by midwives in domiciliary practice have been summarised and were as follows:— For complications during pregnancy:— Albuminuria 3 Threatened abortion 1 Miscarriage 1 Other conditions 11 Total 16 For complications during labour:— Delayed 1st and 2nd stage 27 Ante-partum haemorrhage 7 Perineal laceration 55 Retained placenta 8 Malpresentation 10 Phlebitis 5 Pyrexia 7 Other conditions 20 Post-partum rhage 2 141 For complications in regard to the infant:— Prematurity and feeble- Cyanosis 1 ness 4 Other conditions 14 Discharging eyes 7 Jaundice 3 Total 29 Details of medical aid notices issued by midwives employed at Thorpe Coombe are given in the Maternity Hospital report. Municipal Midwifery and Maternity Service.— 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. 1746 2007 439 353 108 10235 14888 Public Health Act, 1936 (Nursing Homes).—See Public Health Section of the Report. 50 PUERPERAL PYREXIA. Thirty-eight cases of Puerperal Pyrexia were notified during 1939. The notifications were received from the following sources:— Maternity Hospital, 26; Hospitals outside the area, 3; and General Practitioners, 9, The Puerperal Pyrexia rate for 1939 was 22.1 per 1,000 births, and the mortality due to Puerperal Sepsis was 5.2 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. Per 1,000 live and still births. Area. Puerperal Fever. Puerperal Pyrexia. England and Wales 14.35 126 County Boroughs and Great Towns, including London 77.26 148 Smaller Towns (25-50,000 population) 12.99 London Administrative County Walthamstow 3.31 14.22 22.1 The notifications and rates for Walthamstow for the past five 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. 1939 Not notifiable 38 22.78 38 22.78 1938 Not notifiable 35 20.80 35 20.80 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 51 PUERPERAL PYREXIA INCIDENCE, 1939 (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 11.2.39 13.2.39 29 Wood Street Removal to Hospital 8.2.39 10.2.39 11.2.39 Abortion. 2 25.2.39 2.3.39 20 Hale End Already in Hospital 16.2.39 22.2.39 15.2.39 Influenza. Occurred outside district. 3 11.3.39 13.3.39 18 High Street All facilities available 19.2.39 10.3.39 Not removed Influenza. 4 16.3.39 18.3.39 25 High Street All facilities available 20.2.39 4.3.39 Not removed Influenza. 5 19.4.39 20.4.39 — Ex. Removal to Hospital 14.4.39 17.4.39 17.4.39 Abortion. 6 25.4.39 27.4.39 26 High Street Removal to Hospital 6.4.39 14.4.39 26.4.39 7 2.7.39 3.7.39 38 High Street Removal to Hospital 24.6.39 30.6.39 2.7.39 8 24.7.39 25.7.39 25 High Street Already in Hospital 16.7.39 24.7.39 24.7.39 9 20.8.39 21.8.39 22 Hoe Street All facilities available 16.8.39 19.8.39 Not removed Cerebral thrombosis. Extended breech. 10 31.8.39 8.9.39 35 Hoe Street Already in Hospital 23.7.39 25.7.39 22.7.39 Caesarean section. Urinary infection. Occurred outside district. 11 19.9.39 22.9.39 40 Higham Hill Already in Hospital 16.9.39 17.9.39 11.9.39 Bronchitis. Occurred outside district. Died. Caesarean Section. 12 24.11.39 25.11.39 32 St. James Street All facilities available 9.11.39 22.11.39 Not removed 52 52 ABORTION. Circular 1661.—The number of cases in which medical aid notices were issued during 1939 by midwives in accordance with Rule E of the Central Midwives Board was:— Threatened abortion and miscarriage 1 Abortion and miscarriag 1 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. 1939 5 2 — 1 — 1 1 1938 4 — — 2 1 — 1 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1939 1 4 5 — — — 1938 2 2 4 — — 1 The cause of death was prematurity. MATERNAL MORTALITY. During 1939, six deaths associated however slightly with pregnancy and child-bearing were investigated for the completion of enquiry forms. Particulars relating to the six deaths are given in the accompanying table. The following table shows the maternal mortality rates for 1939 (calculated on the two 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, 1,606 2 — 2 1.29 — 1.29 0.77 2.16 2.93 Live and Stillbirths, 1,668 2 — 2 1.24 — 1.24 0.74 2.08 2.82 53 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. Weeks. 1 26.1 .39 General peritonitis due to perforation of uterus by an instrument 23 Ho. Moderately comfortable 1 ? 8 No No Good 26.1.39 26.1.39 26.1.39 2 10.3.39 Multiple pulmonary infarction associated with thrombo-phlebitis of iliac veins (Bilateral) associated with childbirth 24 Ho. Fairly comfortable 1 40 Yes Yes Satisfactory 5.2.39 - - 3 2.4.39 Puerperal septicaemia— miscarriage 37 W. Poor 4 ? 16 No No ? 2.3.39 3.3.39 20.3.39 4 21.8.39 Valvular disease of the heart 38 He. Comfortable 16 32 Yes Yes Poor 19.8.39 - 16.8.39 5 24.8.39 Heart failure, myocardial degeneration. Acute yellow atrophy of liver 30 Ho. Comfortable 1 - Yes Yes Good 23.8.39 3.8.39 12.8.39 6 19.9.39 Paralytic ileus following Caesarean section 39 H.H. Poor 2 39 Yes Yes Pre-existing disease 16.9.39 - 11.10.39 54 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). 1939. 1938. 1937. 1936. 1935. Maternal Mortality 1.29 1.85 3.57 1.74 3.00 Stillbirths 38.6 43.2 35.8 31.4 34.1 Neo-Natal Deaths 17.4 17.3 20.8 16.9 21.5 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. 1939 1,668 2 — 2 1.19 — 1.19 1938 1,687 1 2 3 0.59 1.18 1.78 1937 1,735 4 2 6 2.30 1.16 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 THORPE COOMBE MATERNITY HOSPITAL. Alterations and Extensions.— The extensions approved by the Minister of Health were commenced in 1938. The total accommodation of the Hospital when these extensions are completed will be:— Lying-in beds, 47; Isolation beds, 6; Total, 53. General.—(a) Form M.C.W. 96A (Ministry of Health). 1. Name and address of Institution—Thorpe Coombe Maternity Hospital, 714. Forest Road, Walthamstow, E.17. 55 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds)—43. 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—675 (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).—119. 4. Average duration of stay of cases included against item 3— 14.12. 5. Number of cases delivered by— (a) Midwives—500. (b) Doctors—95. 6. Number of cases in which medical assistance was sought by a midwife in emergency—264. 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 tion—107 complemented, 31 (artificially fed). 10®. Number of cases notified as ophthalmia neonatorum—1. 10b. Result of treatment. Satisfactory after-treatment at St. Margaret's Hospital. 11. (a.) Number of maternal deaths—2. (b) Cause of death in each case:— (1) Pulmonary infarction associated with phlebitis of iliac veins. (2) Auricular fibrillation; Mitral incompetence; Death occurred following Caesarean Section. 12. (a) Number of infant deaths— (1) Stillborn—19. (2) Within 10 days of birth—12. (6) Cause of death in each case, and results of post-mortem examination (if obtainable). 56 1. Stillbirths:— (a) Premature— Recent ated Hydrops foetalis 1 — Maternal Haemorrhage 1 2 Maternal toxaemia and placental in sufficiency - 2 Undetermined — 2 2 6 (b) Full Term— Maternal toxaemia, placental insufficiency 2 — Hydrocephaly 1 1 Intra-cranial trauma 2 — Pressure upon cord 2 — Atelectasis 1 — Undetermined 2 — 10 1 2. (a) Infant Deaths:— Premature— Respiratory failure due to prematurity 5 Intestinal obstruction due to congenital volvulus 1 Haemorrhagic discharge of the new-born 1 7 (b) Full Term— Intra-cranial trauma 2 Atelectasis, suprarenal haemorrhage 2 Hydrocephaly and spina bifida 1 5 The stillbirth rate was 33.0 per 1,000 live births, and the neonatal mortality within 10 days of birth was 20.8 per 1,000 live births. (b) Occupation of Beds.—The average daily occupation of beds was as follows:— January 27.0 July 33.06 February 33.9 August 37.32 March 27.9 September 11.74 April 33.7 October 12.8 May 30.1 November 13.7 June 33.7 December 19.7 57 The average for the whole year was equal to 74.8 per cent. beds occupied (based on 39 beds). (c) Emergency Unit.—The services: of the emergency unit were required on three occasions during the year. (d) Training of Pupil Midwives.—The Hospital is approved by the Central Midwives Board, 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 1939, 13 pupils from Thorpe Coombe obtained the Part I Certificate of the Central Midwives Board. The following clinical report has been compiled by Dr. Helen Rodway, M.R.C.O.G., Resident Obstetrician. THORPE COOMBE MATERNITY HOSPITAL. CLINICAL REPORT. During the year there were 675 admissions to the Hospital, 595 confinements, 6,483 attendances at the Ante-Natal Clinic and 556 at the Post-Natal Clinic. In September, at the outbreak of war, the Hospital was partly cleared temporarily in preparation for any special war-time function for which it might be required. Owing to t'he evacuation of expectant mothers, there was, for several months, a considerable decrease in admissions and future bookings, but by the end of the year, the bookings were only ten less than in December, 1938. An unabridged statistical and clinical report had, as usual, been compiled, but will not be printed in detail this year. Typewritten copies will be filed and made available for reference. A general outline of the work of the Hospital is given below:— Admissions:— (а) for confinement 552 (b) ante-natal *119 (c) miscarriage — (d) post-natal 4 Total 675 *43 of these patients were delivered before discharge from the Hospital. 58 Ante-Natal Clinics. Number of Clinics held:— 1939. 1938. 1937. 1936. 1935. (a) Consultant's Clinic 8 12 12 12 21 (b) Resident Obstetrician's Clinics 176 155 129 117 125 (c) Midwives' Clinics 234 294 349 352 225 Totals 418 461 490 481 371 Number of Expectant Mothers who attended Ante-Natal Clinics 733 702 753 691 762 Total attendances at AnteNatal Clinics:— (a) New patients 733 702 753 691 762 (b) Old patients 5,750 6,032 5,501 5,354 4,543 Totals 6,483 6,734 6,254 6,045 5,305 Total number of attendances at:— (a) Consultant's Clinics 117 186 — — — (b) Resident Obstetrician's Clinics 2,904 2,229 2,382 2,648 2,868 (c) Midwives' Clinics 3,462 4,319 3,872 3,397 2,437 Totals 6,483 6,734 6,254 6,045 5,305 Average attendances per session :— (a) Consultant's Clinics 14.62 15.5 — — — (b) Resident Obstetrician's Clinics 16.5 14.38 16.9 (c) Midwives' Clinics 14.79 14.69 11.0 — — Post-Natal Clinics. Number of Clinics held 47 Number of attendances:— (a) New patients 401 (b) Old patients 155 Total 556 The percentage of new patients relative to the number of confinements in the Hospital was 67.3. Average attendance per session, 11.8. 59 ANTE-NATAL ADMISSIONS. There were 119 admissions during the ante-natal period this year; 43 patients were delivered before discharge from the Hospital. Reasons for Admission:— Albuminuria and hyperpiesis 33 (Seven of these were re-admissions) Pre-eclamptic condition 3 Eclampsia 1 Hyperpiesis 4 Hyperpiesis and hyperemesis 2 Hyperemesis 2 Oedema 1 Glycosuria 1 Cardiac condition 10 Ante-partum haemorrhage 8 Phlebitis 1 Pyelitis 3 For observation following a fall 4 For rest 12 85 For observation and discharged because not in labour 34 Total 119 EMERGENCY ADMISSIONS. Reasons for Admission:— Ante-partum haemorrhage 4 Pre-eclamptic state 2 Obstructed labour 1 Delay in progress of labour 2 Face presentation 1 Breech presentation 1 Maternal distress 1 Prolapsed cord 1 Post-maturity 1 Disproportion 1 Transferred from other Hospitals 3 Total 18 In addition, two infants were admitted with their mothers; in one case the mother was confined at home, but was admitted because she was booked for admission here, in the other case the patient was re-admitted after discharge for observation prior to transfer to a Mental Hospital. 60 Number of Confinements:— (а) Primigravidae 352 (b) Multigravidae 243 Total 595 Number of Patients delivered by:— (a) A doctor 95 (b) A midwife 500 Total 595 ANALGESIA IN LABOUR. In every suitable case sedative drugs and gas-air analgesia were administered to patients. In no case was there any ill effect on the mother or infant. Presentation and Position during Labour:— Primigravida. Multi gravida. Total. Vertex left occipito-anterior 218 154 372 Vertex right occipito-anterior 89 67 156 Vertex right occipito-lateral 2 — 2 Vertex left occipito-lateral 8 — 8 Vertex right occipito-posterior 10 3 13 Vertex left occipito-posterior 13 4 17 Breech 19 10 29 Face 2 — 2 Brow 1 — 1 Not stated 3 — 3 Totals 365 238 603 This includes 8 cases of twin confinement. INFANTS. The number born in the Hospital was 603. Number completely breast fed 434 Number complemented with other milk 107 Number not breast fed 31 Stillbirths:— Per- Number. centage Premature, i.e., under 5½lbs. 8 1.3 Full Term, i.e., over 5½lbs. 11 1.8 Total 19 3.1 61 Infant Deaths:— Per- Number. centage. Under 5½lbs. 7 1.1 Over 5½lbs. 5 0.8 Total 12 1.9 MEDICAL AID NOTICES. In 264 cases medical aid was sought by midwives working in the Hospital. Treatment was given by the Resident Medical Officer. (a) For Complications during Pregnancy:— Pre-eclamptic condition 1 Eclampsia 1 Collapse of patient 1 Cardiac condition 1 4 (b) For Complications during Labour:— Ante-partum haemorrhage 7 Pre-eclampsia 1 Eclampsia 3 Epileptic Fit 1 Collapse in first stage (on admission) 1 Cardiac: second stage 10 Toxaemia: second stage 6 Delay in first and second stages 35 Delay in third stage 2 Obstructed labour 1 Breech presentation in a primipara 15 Brow presentation 1 Twins 3 Face presentation 1 Obstructed labour 1 Maternal distress 3 Foetal distress 7 Ruptured perineum 146 Post-partum haemorrhage 2 246 (c) For Complications during Puerperium:— (Post-Natal admission) Ruptured perineum 1 62 (d) For Complications in regard to the Infant:— Asphyxia 10 Feeble condition 3 13 SUMMARY OF ABNORMAL CASES. Pregnancy toxaemia including eclampsia 29 Chronic nephritis 1 Ante-partum haemorrhage— (a) Placenta praevia 6 (b) Toxaemia 1 (c) Undetermined 2 Organic heart disease 10 Post-partum haemorrhage (over 20 ounces) 30 Manual removal of placenta 3 Puerperal pyrexia— (a) Local infection 2 (b) Uterine and peritoneal infection 1 (c) Urinary infection 1 (d) Pyelitis 1 (e) Non-suppurative mastitis 14 (f) Suppurative mastitis 1 (g) Influenzal cold 4 (h) Undiagnosed 2 Total 108 Operations performed:— Caesarean section, on account of— (a) Cardiac disease 2 (b) Disproportion and contracted pelvis 8 (c) Previous still-births 1 (d) Placenta praevia 2 Induction of labour 8 Forceps delivery 53 MATERNAL MORTALITY. There were two maternal deaths in the Hospital during the year. In the first case this was due to pulmonary infarction associated with thrombo-phlebitis of the iliac veins; in the second case the patient's death was due to auricular fibrillation and occurred after Cæsarean Section. 63 RESEARCH. (a) Nutrition of Expectant and Nursing Mothers in relation to Maternal Mortality and Morbidity:— The results of this investigation, in which the Hospital, with nine mothers, took part, have not yet been reported. The research was carried out under the guidance of the People's League of Health, who supplied accessory food factors to fifty per cent. of our mothers from March, 1938, until July of this year. (b) Investigation into Daily Diets of Patients: Since March, 1938, this investigation has also been carried out by us in co-operation with the People's League of Health. Each patient, when first attending the Hospital, is given a sheet in which to give details of her diet day by day for a week. In addition, questions are asked with a view to finding out what amount of protective foods patients include in their diets. This investigation has made it possible for us to give greater help to patients in the correction of faulty diets, and, where diet is inadequate, to make arrangements for the supply of necessary food. (c) Investigation into the Cause of Mastitis in Nursing Mothers:— This investigation was begun this year, with the help of Dr. Camps, who is having the bacteriological part of the work carried out at Chelmsford. MOTHERCRAFT INSTRUCTION. The keenness of our young mothers attending the ante-natal clinics made us aware that they were looking to us for help, advice, and instruction in preparing for their babies, which was not possible to give, much as we wished, at the ante-natal clinics. On this account, we began in December to have fortnightly classes in which to teach our mothers the simple principles of mothercraft.