AC 4411(1) WALTHAMSTOW WAL 23 BOROUGH OF WALTHAMSTOW REPORT of the MEDICAL OFFICER OF HEALTH for the year 1940. 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. CONTENTS Acreage 4 Adulteration 17 Albuminuria 35 Ante-Natal Clinic 30, 40 Bacteriological Analyses 16 Bakehouses 12 Births 4, 5, 27 Breech Delivery 41,42, 43 Caesarean Section 42 Canoer 6 Caravans 12 Cerebro-Spinal Meningitis 30 Child Welfare 28 Child Life Protection 30 Clinics 6, 7, 30, 31 Committees 2, 35 Comparability Factor 4 Connaught Hospital 8 Consultants 34 Dampness 11 Deaths 4, 5, 6, 23 Death Rate 4, 5 Dental Treatment 32 Diphtheria 20 " Innumisation 21 Diseases or Animals Acts 18 Disinfestation 15 District Midwifery 34 Drainage 9 Dysentery 20 Eclampsia 41 Emergency Unit 39 Enteric Fever 20 Erysipelas 20 Essex County Council Act 3 Factories and Workshops 11,19 Fishmongers 12 Food Inspection 15 Food Poisoning 22 Foot Clinic 6 Forceps Delivery 42 Haemorrhage - Ante-Partum 41, 43 Post-Partum 43 Health Services 6, 7 " Visitors 28 Home Helps 33 Hospital Accommodation.S,34, 38 " Infectious Diseases. 21. 23 House—to-House Inspection 24 Housing 12, 13 " Act, 1956 14 " Inspection 13, 14 Ice Cream 12, 16 Immunisation 21 Infant Mortality 4, 27, 28, 39 Infectious Diseases 11, 20, 21 Institutional Treatment 8, 34 Invalid Children's Aid Assn. 33 Isolation Hospital 23, 24 Laboratory York 22 Massage 30 Maternal Mortality 5, 37, 38 Maternity and Child Welfare 25 Maternity Homes 8 Measlse 20 Meat Inspection 16 Medical Aid 43 Medical Examinations 24 Midwives 34, 35, 36, 39 Milk, Assisted Scheme 33 Milk Supply, etc. 15, 16 Miscellaneous 24 Mothercraft Instruction 40 For—natal Mortality 28 Notices, Sanitary 10 notifications and Rates 5 Nursing Homes 8 Obstetric Consultants 34 0phthalmia neonatorum 37 Orthopaedic Treatment 32 Outworkers 19 Overcrowding 14, 15 Petroleum 18 Pneumonia 20 Population 4 Post-natal Clinic 30, 40 Public Assistance 8 Public Cleansing 9, 10 Puerperal Pyrexia 5, 36, 43 Puerperal Sepsis 5 Rateable Value 4 Rats and Mice Destruction Act, 1919 18 Refuse Disposal 9 Rent Restriction Acts 18 Rheumatism Clinic 21 Rivers and Streams 9 Sanitary Inspection 10,11 Scarlet Fever 20 Schick Tests 21 Sewerage 2 Smoke Abatement 12 Social Conditions 4 Special Premises 11 Statistics 4, 5 Stillbirths 4, 5, 39 Swimming Baths 12 Thorpe Coombe Maternity Hospital 38 Tuberculosis 24 Tuberculous Meat 16 Twin Delivery 42, 43 Unemployment 8 Vaccination 22 Vertex, Posterior 42 Vital Statistics 4, 5 Walthamstow Child Welfare Society 31 Walthamstow District Nursing Association 34 Water 9 Whooping Cough 5 women's Clinic 7 Zymotic Diseases 4 I PUBLIC HEALTH AND SANATORIUM VISITING COMMITEES. Chairman: Mrs. E.N.Miller The Worshipful the Mayor - Councillor R.W.A.Russell, J.P. The Deputy Mayor - Alderman H.Frost, J.P. Chairman of Finance Committee - Alderman Ross Wyld, J.P. Alderman A.G. Bottermlry, O.B.E. Aiderman Miss E.M .Pracy, B " G.Gibbons, J.P.(Decd.) Mrs.B.M.Richards " Mrs .C.McEntee , J.P., E.C.C. " W.H. Shaw Alderman Mrs.L.P.Bailey , J.P. Councillor G.S.Mace Councillor Mrs.B.M.Friedberg " A.E.Manning " F.W.Gentle " Mrs.A.L.Meadows " E.Gillett " R.I.Smith " G.J.R.Holt " Mrs. E.L.,Smith " J.E.Lis " Mrs.E.B.Toynbee " G.R.Lowton " A.H.Williams. Town Clerk: F.G.GARNER, ESQ,. 2. TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE Ladies and Gentlemen, The Report for 1940 has been curtailed as far as possible and has been duplicated as a measure of economy. The year is notable for the maintenance of a high standard of health in spite of the abnormal conditions of night shelter life during the last three months. Thus a comparison of the vital statistics with those of the whole country and with any portion thereof is very favourable to Walthamstow. Diphtheria immunisation was resumed in the schools and a new low record of Diphtheria incidence is to be noted. Public Health Services have been maintained as near the normal as possible in spite of the large amount of time and energy given by many members of the Staff to Civil Defence duties. It is again my pleasure to record your kindly consideration and the good work of the Staff. I have the honour to be, Your obedient servant, A.T.W.POWELL, Medical Officer of Health. 3. STAFF.- The following members were on active service:- Miss M.McCallum, S.R.N. (Senior Chiropodist). Mr.R.A.C.Green - Clerk " A.T.Wade - " " F.J.Aylward - " " W.H.Dunn - Ambulance Staff, and the following temporary appointments were made:- Miss E.H.Page - Clerk " V.K.Prime - " Mrs.M.W.Grimwood - " Mr.M.Hellman - " A.- STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343. Population (Registrar-General's Estimate, mid-year 1940)109,400. Number of Assessments, 1st,April, 1940. 36,205. Rateable value £381,962. Sum represented by penny rate £3,423. POPULATION.- The Registrar-General's estimate of the population at mid-year, 1940, is 109,400, a decrease of 20,600 on the previous figure. EXTRACTS FROM VITAL STATISTICS.- The Registrar-General's mid-year, 1940, estimate of population (viz., 109,400) has been used for the calculation of all vital statistics. Total Males Females Birth rate per 1000 of the estimated resident population 14.3 ( Live ( Births ( Legitimate 1535 800 735 Illegitimate 40 2.0 20 Total 1575 820 755 Stillbirths 42. Rate per 1,000 total (live & still)births 25.3 Deaths 1607. Death rate per.1,000 of the estimated resident population 14.6 Deaths from puerperal causes:- Rate per 1,000 (live and still) births. Puerperal Sepsis Deaths 0 Other Puerperal Causes 1 0.61 Total 1 0.61 Death rate of infants under one year of age:- All infants per 1,000 live births 40.0 Legitimate infants per 1,000 legitimate live births 41.0 Illegitimate infants per 1,000 illegitimate births 25.0 Deaths from Measles (all ages) - " " whopping Cough (all ages) - " " Diarrhoea (under 2 years of age) 8 (All rates are per 1,000 of estimated residential population.) Comparability factor 1.07 Adjusted death rate 15.6 Ratio of local to national crude death rate 0.91 Zymotic disease death rate 0.10 Pulmonary Tuberculosis death rate 0.53 Non-pulmonary Tuberculosis death rate 0.12 4. The natural decrease of population, i.e., excess of deaths over births, was 32. 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 1940 (1,607) compares with 1,312 during 1939, the respective death-rates per 1,000 population being 10.5 and 14.6. BIRTH-RATES, CIVILIAN DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL MORTALITY, AND CASE RATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1940. PROVISIONAL FIGURES BASED ON WEEKLY AND QUARTERLY RETURNS. England and Wales, London, 126 Great Towns and 143 Smaller Towns. England &c Wales 126 County Boroughs & Great Towns (including London) 148 Smaller Towns (Resident Population 25,000 - 50,000 at 1931 Census. London Administrative County Walthamstow. Rates per 1,000 Civilian Population:- Births: - Live Births 14.6 16.0 15 .7 13.7 14.3 Still 0.55 0.64 0.55 0.44 0.38 Deaths: - * All Causes 14.3 15.8 12.8 17.8 14.6 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.00 0.00 Diphtheria 0.06 0.07 0.05 0.01 0.01 Influenza 0.32 0.29 0.30 0.18 0.15 Smallpox - - - - - Measles 0.02 0.02 0.02 0.01 0.00 Notifications. Enteric 0.0 7 0.06 0.10 0.06 0.02 Cerebro Spinal Fever 0.32 0.33 0.29 - 0.28 0 .05 Scarlet Fever 1.63 1.53 1.57 0.82 0.76 Whooping Cough 1.34 1.29 1.35 0.22 0.11 Diphtheria 1.16 1.29 1.21 0.61 0.14 Erysipelas 0.33 0.36 0.30 0.35 0.24 Smallpox 0.00 - - - - Measles 10.24 9.23 9.99 1.78 0.71 Pneumonia 1.20 1.37 1.00 0.87 0.82 Rates per 1,000 Live Births:- Deaths under 1Year of Age 55 61 54 50 40 Deaths from Diarrhoea and Enteritis under 2 years of Age. 4.6 i I 5.9 4.4 5.8 5.07 Maternal Rates per 1,000 Total Births (Live and Still):- Mortality: - (Excluding Abortion) Puerperal Infection (No.147) 0.52) Others 1.64) Not available Total 2.16) Notoficatons:- Puerperal Fever 11.96 13.90 9.73 Including 3.34 13.30 Puerperal Fever. " Pyrexia * - » CAUSES CP DEATH AS GIVEN BY THE REGISTRAR-GENERAL FOR THE YEAR 1940. WHOLE DISTRICT. Causes of Death. Males Females Total 1. Typhoid & Paratyphoid Fevers 1 - 1 2. Cerebro-spinal Fever 1 2 5 3. Scarlet Fever - - - 4. Whooping Cough - - - 3. Diphtheria 1 1 2 6. T.B. of respiratory system 34 24 53 7. Other Forms of Tuberculosis 7 7 14 8. Syphilitic disease 5 2 7 9. Influenza 9 3 17 10. Measles - - - 11. Acute poliomyelitis and polioencephalitis 1 - 1 12. Acute infectious encephalitis 3 2 5 13M. Cancer of buccal cavity & oesophagus (Males only) 9 - 9 13F. Cancer of Uterus - 17 17 14. Cancer of stomach and and duodenum 25 20 45 15 . Cancer of breast - 17 17 15. Cancer of all other sites 66 45 112 17. Diabetes 5 14 19 18. Intra-cranial vascular lesions 58 80 158 19. Heart disease 187 206 393 20. Other diseases of the circulatory system 15 29 44 21. Bronchitis 99 63 167 22. Pneumonia 35 37 72 23. Other respiratory diseases 9 11 20 24. Ulceration of the stomach or duodenum 18 5 23 25. Diarrhoea (under 2 years) 4 4 8 25. Appendicitis 3 1 4 27. Other digestive diseases 13 25 43 28. Nephritis 11 13 29 29. Puerperal and post-abortive sepsis - - - 30. Other maternal causes - 1 1 31. Premature birth 9 7 16 32. Congenital malform. birth injury,infantile disease 3 16 19 33. Suicide 11 6 17 34. Road traffic accidents 9 5 14 35. Other violent causes 56 68 134 36. All other causes 78 70 148 Totals. 790 817 1607 Totals for 1939 673 634 1312 The age distribution of Cancer Deaths was as follows:- Under 1 yr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-55 yrs. 65 yrs. and over. 1 - - - - 18 83 98. 3. CLINICS AND TREATMENT CENTRES. FC CT CLINIC.- Total attendances were 11859, and of these 997 were '03? new patients and 10862 were re-attendances by old patients. The receipts were 5422.10.6. Two part-time chiropodists were employed when necessary in addition tr the two full-time chiropodists, and fr r certain perils all four were fully employed. 6. WOMEN'S CLINIC.- Sessions were held weekly, with one consultant session monthly. Miss Helen Rodway, M„R.C.C,G., submits the following report:- The number of patients attending the Clinic was well maintained until the end of August, from which time there was a definite decrease. The total number of attendances during the year was 1,443; this includes attendances by 260 new patients, 230 of whom attended during the first seven months of 1940. Number of sessions held:- (a) Consultant's Clinics 11 (b) Assistant Medical Officer's Clinics 53 (c) Senior Sister's Clinics 12 Total 76 Comparison with previous years. (a) Consultant's Clinics, (b) Assistant Medical Officer's Clinics, (c) Senior Sister's Clinics. 1940 1939 1938 1937 1936 New Cases Old Cases Now Cases Old Cases New Cases Old Cases Now Cases Old Cases New Cases Old Cases (a) 1 124 7 115 21 125 14 124 17 108 (b) 259 1031 329 1077 298 1048 251 833 259 589 (c) - 28 - 42 - 6 - - - 260 1183 336 1234 319 1179 265 957 276 697 Average attendance Per session Net," 'Cases Cld•Cases (a) Consultant's Clinics . 090 11.27 (b) Assistant Medical Officer's Clinics 4.88 19.45 (c) Senior Sister's Clinics - 2.33 Summary of New Cases. 193 Ante-natal 43 Surgical 19 Post-natal 5 Medical 26 Gynaecological 137 Contraceptive 12 Sterility 8 Not classified 10 193 Total 260 Referred to Clinic from Private Doctors 25 Referred to Private Doctors 10 Referred to the south London Hospital for Women 6 Referred to the South London Hospital (Operations performed) 2 Diagnosis and Operation Admitted Discharged No. of days. Papilloma of Bladder 20.4.40 24.4.40 4 Diathermy to Papilloma of Bladder Ditto 6.9.40 11.9.40 5 Uterine Fibroid-Hysterectomy 18.6.40 2.7.40 14 Total 23 Referred to other hospitals 8. The 3 in-patients spent a total of 23 days in hospital. In addition, 4 out-patients made 10 attendances. The Council made a grant of £30 to the Hospital. 7. HOSPITALS. - Mr. Pegram, the Clerk to the Public Assistance Committee (South-western Area) , has Kindly supplied the following particulars of Walthamstow residents admitted to the various institutions during the year ended 31st December, 1940:- Institutions Men Women Children Total Central Home 114 102 — 216 Whipps Cross Hospital 682 714 145 1541 Forest Gate Hospital 3 66 2 71 Harold Road Hospital - 8 — 8 Forest House 17 4 - 21 Aldersbrook Children's House - - 73 73 43 infants were born to Walthamstow mothers in Forest Gate Hospital during the year. The number of patients from Walthamstow in Mental Hospitals was 425 on the 31st.December, 1940. THE CONNAUGHT HOSPITAL. - No. admitted In-Patients Average Stay Daily Average New Cases Out-patients Attendances 1940 1,406 16.07 60.64 9,378 57,841 1939 1,390 20.96 83.10 8,448 56,632 PUBLIC ASSISTANCE.- 1940 1939 £. s. d. £. s. d. Total amount of out-relief granted to Walthamstow residents during year ended 31st.December 49,562. 0. 7. 52,360 1. 10. Average weekly number of Walthamstow Men 604 733 residents in receipt of relief Women 1007 1171 during year ended 31st.December Children 329 536 Total 1940 2440 MATERNITY AND CHILD WELFARE.- See Section H. of the Report. PUBLIC HEALTH ACT, 1936 - NURSING HOLES. 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 4 25x .10 35 x14 of these are not in use during the period of the War. In addition, three further beds have been registered, but have never been brought into use. No applications were refused, cancelled or appealed against. 13 quarterly inspections were made by the Medical Staff. Routine enquiries are made with regard to unregistered Homes. Wo difficulties in regard to supervision arose. ESSEX COUNTY COUNCIL ACT.- One licence to practise chiropody was granted by your Council. 8. C.- SANITARY CIRCUMSTANCES OF THE AREA. 1. (i) WATER.- No new mains have been installed during the year 1940. (ii) DRAINAGE & SEWAGE.- No works of this character have been carried out during 1940. 2. RIVERS & STREAMS.- Periodical cleaning of the Dagenham Brook was carried out to the requirements of the Lea Conservancy Catchment Board. 3.(i)COLOSET ACCOMMODATION.- There has been no change in the number of cosspools which exist within the area. (ii) PUBLIC CLEANSING. - Mr. Eric Bell, M.I.P.C., A.R.San.I. Cleansing Superintendent, reports as follows:- HOUSE REFUSE COLLECTION. In spite of air-raids and the evacuation of many people, the total weight of refuse collected during the past year was 25012 tons, 5 cwts; this is a slight reduction in weight compared with 1939. The analysis of the refuse still shows that large quantities of tinned foods are being consumed; a drop in the ash and cinder content; and still a large amount of waste paper being mixed with the refuse, despite the many appeals made for this to be kept separate, so that it may be used to the full advantage in the production of articles for the war effort. Separation and incineration has always been maintained in this Borough, and since the war tremendous efforts have been made to extend the salvage activities of the Department, to ensure that even the smallest scrap of any value be returned to industry. Special salvage films have been shown throughout the Borough, lectures have been given to the various Women's organisations, and women have been appointed as Street Salvage Officers in almost every street; they have been advised on the subject of materials most urgently needed and the point has been stressed very clearly that paper, cardboard and rags must not be put into the bins, but bundled and placed either by the side of the bin or in the sacks provided at the Street Salvage Officer's house. All other refuse may bo placed in the bins as the contents are mechanically sorted at these Works. TRADE REFUSE. The contract system for the charges re collection of Trade Refuse from business premises within the Borough continues to operate most satisfactorily, and despite the war, has been further extended. Every trader who comes under this scheme, from the smallest shop to the largest factory, has had an allowance made in his contract rate for any salvageable materials collected by the Council, i.e. cardboard, paper, tins, etc. The amount of Trade Refuse delivered by traders to the Works for disposal for the year 1940 has shown a reduction on previous years. REFUSE DISPOSAL. During the past year it has been found possible to dispose of the refuse, working only 1½ shifts per day instead of 2 - this has been brought about by the reduction in weight of refuse collected, and the extensive salvage system now in operation. 9. The plant as a whole has proved very efficient, and has effected a considerable financial saving. The national appeal for every ounce of salvageable material to be extracted for the war effort and the opening up of the various markets has enabled us to move the accumulation of various grades of scrap that have been stored at these Works while the markets were dead. STREET CLEANSING. Despite the black-out conditions and the reduction in sweepers, every endeavour has been made to maintain the present standard of street cleansing. The frequency of sweepings has naturally had to be reduced, and various pre-war schemes such as building sub-depots, have had to be cancelled. The interchanging of street orderly bins has proved a great success. The sweepers' trucks have been converted so that in the event of an emergency they could be used as stretcher carriers. They are now distributed to the various First Aid and Cleansing Centres throughout the Borough. GULLEY CLEANSING. The periodical cleansing, disinfecting and scaling of the gulleys has been carried out mechanically, and the machine has now been adapted so that it can be used for Decontamination work and fire-fighting. GENERAL. Despite the war and the damage sustained at these works through enemy action, the normal work of the Department has been carried out regularly. Considerable loss was caused on one occasion when a fire, resulting from a number of Incendiary Bombs gutted the garage and stores, but, fortunately, owing to the scattered policy which operated, all the vehicles were saved. Various plots of land previously laid out as gardens have nov.: been cultivated as allotments, and good crops of vegetables have been obtained during the past year. A new and up-to-date salvage building has been erected, also a garage whereby the whole of the Department's vehicles will be under cover, and practically every type of repair executed under decent working conditions. The installation of an electrically controlled road and rail weighbridge, capable of weighing the heaviest loads we are ever likely to handle, was completed during this year, and has proved to be a great asset to the Department ( iii) SANITARY INSPECTION OF THE AREA. Mr.M.S.Duncan, Chief Sanitary Inspector, reports as follows No. of inspections made. No. of nuisances detected Number of complaints received. No. of Informal Notices No. of Statutory Notices Total Visits Served Complied with Served Complied with 7306 1817 1271 1195 1178 82 80 16117 Failing compliance with Statutory Notices by the owners, the Council carried out these requirements to 13 houses involving an expenditure of £234.,8.1. 10. The nature and variety of the work done during 1940 is shown in the following tables:- Drains tested, 220; Drains reconstructed or repaired, 297; Drains, obstructions removed, 141; Drains, means of access provided, 27; Drains, ventilation provided or improved, 14; brains, ventilation repaired, 97; Soil pipes repaired, 40; Soil pipes, new, provided, 36; Rain-water pipes renewed, 194; Rain-water pipes disconnected from drains, 5; Roofs repaired or renewed, 633; Gutterings repaired or renewed, 294; W.C. pans or traps provided, 359; Gully traps provided, 35; W.C. flush cisterns provided, 111; W.C. flush cisterns repaired, 151; W.C. floors concreted, 34; W.C's repaired and cleansed, 295; W.C's light and ventilation improved, 10; Waste pipes renewed and trapped, 142; Waste pipes repaired,162; New sinks provided, 33; Water supply re-instated, 1; Cisterns cleansed and covered, 105; Conveniences cleansed or repaired, 11; Sculleries paved, 31; Yards and forecourts paved and repaired, 158; Dirty houses cleansed, 7; Dirty rooms cleansed, 1568, Floors repaired, 131; Ventilation under floors provided, 132; New damp-proof courses provided, 66; Sites concreted, 3; Offensive accumulations removed, 39; Animals improperly kept, removed, 1; Manure receptacles provided, 4; Stables cleansed, paved and drained, 82; Manholes repaired or re-sealed, 89; Other"cases of dampness remedied, 262; Miscellaneous repairs, 1504. INFECTIOUS DISEASES. Visits to premises, 430; Re-visits to premises, 234; Premises disinfected, 175; Articles disinfected at Low Hall, 3005; Articles destroyed at Low Hall, 105. Bedding dried from 17 bombed houses. DAMPNESS IN HOUSES. Sites concreted, 3; Damp-proof courses provided, 66;. Yards and forecourts paved and drained, 158; Roofs made water-tight, 633; Rain-water pipes made good, 194; Guttering repaired or renewed, 294; other cases of dampness remedied, 262; Ventilation under floors provided, 132. SPECIAL PREMISES. Number. Visits Paid. Factories (a) Power 284 450 (b) Non-Power 140 109 (c) Other premises 23 31 Outworkers 448 438 Slaughterhouses 9 13 Butchers' Shops 92 340 Bakehouses 47 115 Fishmongers, Fish Fryers and Curers, etc. 51 124 Eating-houses and Coffee Stalls 94 96 Ice Cream Vendors 178 53 Cowsheds, Dairies and Milkshops 232 122 Laundries 9 6 Rag and Bone Dealers 4 23 Piggeries 4 20 Stables 76 101 Street Stalls Numerous 38 Greengrocers 65 As a result of the regular periodical visiting of the Special Promises the following works were carried out:- BUTCHERS SHOPS AND SLAUGHTERHOUSES: Special cleansings, 10; Paving repaired, 1; Accumulations removed, 5; New galvanised bins provided, 12; Drains repaired, 1; W.C's repaired and cleansed, 5; Yard paving repaired, 2; Floors repaired and ventilated, 1; Roofs repaired, 16; Drains cleared, 7; 11. BAKEHOUSES. Special cleansings, 62; W.C's cleansed and doors repaired, 22; W.C.cisterns repaired, 5; Roofs repaired, 6; Premises, general repairs, 7; Obstructions from drains removed, 1; New ceilings fixed, 5; Floors repaired, 3; Drains repaired,2. FISHMONGERS. Special cleansings, 22; Yards re-paved, 3; Accumulations removed, 3; Roofs repaired, 11; Drains cleared, 7; Gutters renewed, 7; Other improvements, 3. COFFEE AND EATING HOUSES. Special cleansings, 30; Yard pavings repaired, 2; W.C. cisterns repaired, 3; Drains repaired, 1; W.C.pan and trap renewed, l ICE CREAM VENDORS. Special cleansings, 14; Special cleansing of utensils, 10; w. c.flush improved, 3. COWSHEDS AND MILKSHOPS. Special cleansings, 13; Fittings and other improvements, 2; Roofs repaired, 18; w.c's repaired, 3; Drains reconstructed,1, STABLES PREMISES. Cleansings, 55; Accumulations removed, 17; Roofs repaired,8; Pavings repaired, 1; W.C's repaired, 1. LAUNDRIES, Special cleansings, 3; Other improvements, 1. RAG AND BONE DEALERS . Cleansings, 10; Paving repaired, 1. PIGGERIES. Cleansings, 4; Paving relaid, 1; Redrained, 1. (iv). SHOPS AND OFFICES.- 64 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.- 4 complaints of nuisances caused by smoke were investigated, and were found justified. 11 observations wore carried cut and the cause of complaints were remedied. Unsuitable coal and/or bad stoking were the causes of smoke emission, and consultations with those responsible brought about the cessation of the nuisance. (vii) SWIMMING BATHS AND POOLS.- 8 samples wore taken from four baths and all were satisfactory, (viii).ERADICATION OF BED BUGS.- As for 1938. D.- HOUSING. (a) Statistics. The particulars of new houses erected during 1940 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 29 houses 2 flats 12. 31 The 31 houses and flats are situated as follows:- Hale End Ward 29(a) High Street Ward Nil Higham Hill Ward Nil Hoe Street Ward 2 St. James Street Ward Nil Wood Street Ward Nil (a) Includes 2 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 OF DWELLING-HOUSES DURING TEC YEAR: - (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 1870 (b) Number of inspections made for the purpose 7881 (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 191 (b) Number of inspections made for the purpose 1098 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 1272 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 1326 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 75 (2) Number of dwelling-houses which were rendered fit after service of formal notice:- (a) By owners 60 (b) By local authority in default of owners (at a cost of £234,8.1.) 13 B. Proceedings under the Public Health Acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 7 (2) Number of dwelling-houses in which defects were remedied after service of formal notice:- (a) By owners 7 (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 Nil 13. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders nil D. Proceedings under Section 12 of the Housing Act, 1936:- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil IV.- HOUSING ACT, 1936, PART IV. - OVERCROWDING: - A.(l) Number of dwellings overcrowded at the end of the year 127 (2) Number of families dwelling therein 127 (3) Number of persons dwelling therein 997 B. Number of new cases of overcrowding reported during the year 15 C.(l) Number of cases of overcrowding relieved during the year 26 (2) Number of persons concerned in such cases 165 D. Cases of overcrowding occurring during the year after the Council had re-housed an overcrowded' family Nil HOUSE-TO-HOUSE INSPECTION. During the year 191 house-to-house inspections were carried out, (c) Housing Act, 1936. Unfit Houses, No action was taken under this heading. (d) Housing Act, 1936 - Overcrowding. Total number of houses in the Borough scheduled as overcrowded on 1st.January, 1939 138 Additional cases added during the year 15 Cases abated during the year:- Rehoused by the Council 18 Removals, altered accommodation, decrease of family units, etc. 8 26 This leaves a total of 138 cases of overcrowding remaining on the schedule at the end of the year. The 15 cases added to the schedule are classified as follows:- Increasing age of existing children 7 Family increased 3 Combined age advance and family increase - Adjustment of "permitted number" allowed 1 Reatored to schedule 1 Total 15 Pera.itted Numbers. - A total of 222 visits were paid by the District Sanitary Inspectors in o^nneution with the Housing Act, 1936, as it rfilatpp to Pver'Mvwiiintr, (e) General. Mr.J.E.West, your Council's Housing Manager, kindly contributed the following statement 14, Overcrowding cases "brought forward 1st.Januery,1940 138 Additional cases reported from Jan.tr Dec.1940 14 153 Overcrowding cases rehoused from Jan. to Dec.1940 23 Abated 26 _49 Overcrowding cases as at Dec. 31st. 1940 1015 Number of Council Property vacancies created 99 Analysis. (a) Cases rehoused from o/Crowding schedule 23 (b) " " by re-distribution 10 (c) " " from housing register 22 (d) " " " insanitary areas 6 (e) » " " future O/C. M.O.H.list 2 (f) " !l under Rehousing of the Civil Population Scheme 48 111 (a) This figure includes 3 cases of ~ Council House overcrowding. (f) This figure is in no way connected with the overcrowding schedule, and is quoted solely for the purpose of showing how the vacant Council properties were re-let. ANALYSIS OF CASES ON THE OVERCROWDING- SCHEDULE. (a) Number of cases on schedule at Jan.1st.1940 in 138 dwellings involving 1040 persons 138 (b) New cases reported during year ending Dec,31st.1940 involving 54 persons _ 14 (c) Number of cases relieved. 23 cases involving 143 persons rehoused 26 " " 157 '' by abatement, removals etc. 49 " " 300 " relieved. Analysis of Requirements. 1 case requiring 1 bedroom type house 3 " " 2 " " " 12 " " 3 " " " 36 » 4 " " " 41 » 5 " " " 9 " n 6 " " " 1 " « 7 " " " Eradication _of__the_Bed__Bug. Number of cases treated during January to Dec.1940 14 D.- INSPECTION AND SUPERVISION OF FOOD. (a) MILK SUPPLY. The following is contributed by the Chief Sanitary Inspector:- Routine phosphatase tests were carried out on samples of pasteurised milk, more particularly to control the efficiency of the two plants licenced in the Borough. The average number of cows kept in the district is seven. There is only one cowshed, and 9 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 231 most of whom •carry on a general shop and sell mill: in bottles as they receive it. Visits were paid to maintain the general standard of cleanliness. During the year, 24 samples of milk were taken for bacteriological examination. Four gave unsatisfactory results. The samples are summarised as follows:- 15.  No. of Satisfactory. Samples. Unsatisfactory Tuberculin tested 4 1 Pasteurised 16 3 20 4 THE MILK AMD DAIRIES ORDER, 1936. 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:- Supplementary Licences. Pasteurised Milk 30 Pasteurised Milk Tuberculin Tested Milk 11 Tuberculin Tested Milk 2 Br tiling Licences. In respect of Tuberculin Tested Milk, 2; Pasteurised Milk, 2. ICE CREAM. Under the requirements of the Essex County Council Act, 1935, all Ice Cream Vendors or Manufacturers in the Town must be registered. . There are 178 Vendors of Ice Cream in this Town, the majority of Whom sell a proprietary article. During the year registration was granted in 3 cases. All productive plants were kept under constant supervision. (b) MEAT AND OTHER FOOD. During January 43 animals intended for human consumption were althoughtared in the Town. All were inspected at time of slaughter, and for this purpose 13 visits were paid to the slaughterhouses. No further slaughtering was carried out during the year due to the operation of the Live Stock (Restriction of Slaughtering) Order, 1940. 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 18 2 6 5 12 Number inspected 18 2 6 5 12 All diseases except Tuberculosis: - Whole carcases condemned - - --- - - Caroases of which some part or organ was condemned 1 1 - 2 - Percentage of the number inspected affected with diseases other than tuberculosis 5.55 50.00 - 40.00 - Tuberculosis only:- Whole carcases condemned — - - - - Carcases of which some part or organ was condemned 2 1 - - - Percentage of the number inspected affected with tuberculosis 11.11 16. In addition to the meat involved in the above table, the following articles were condemned as unfit for food:- 18¾ lbs. Pork 704½ lbs. Bacon 14 " Beef 9 " Green Bacon 1 lb. Mutton trimmings 4¼ " Ham 1 hindquarter Beef 19½ " Tinned Ham 9 Ox livers 7 Pork pies. 2 " lungs 1 Steak & Kidney pie 1 " heart 5 lbs. Butter 1 " fats 330 Eggs 1 " head & tongue 11 tins Food (various) 4 Sheep's kidneys 12 doz. Fish Cakes 4 Lambs' livers 4 jars Fish & Meat Paste 1 box Mixed Fish 3 tins Salmon 3 boxes Kippers 2 jars Mixed Pickle 1 box Dabs 10 Rabbits 2½ stone Catfish 4 Ducks 4 " Plaice 10 lbs. Cabbages 6 Dog Fish 4 boxes Tomatoes 3 stone Whiting 2 tins Peas. 3 " Skate 2 " Plums 9 fresh Haddocks (c) ADULTERATION, etc.- FOOD AND DRUGS ACT, 1938. During the year 373 samples of a "variety of food and drugs have been taken and submitted for analyses. One sample was abortive by reason that it was destroyed by fire due to enemy action. Eighteen samples were unsatisfactory and the particulars are as follows:- Description of Article. Result of Analysis, Decision taken. Carbonate of Soda (informal) Not Garb, but Bi-carb. of B.P.standard No action -believed genuine mistake by vendor. Chocolate Roll (informal) No evidence of appreciable quantity of cocoa. Further sample obtained 16th.Feb.satisfactory. Beef Sausages Genuine, but contained preservatives (sulphur dioxide.) Warned re vendor's non-declaration re preservative. Sausages (long) do. do. Beef Sausages do. . Legal proceedings taken re non-declaration. Result dismissed, but manager fined 20/on summons by defendants. Haricot Beans Objectionably large quantity cyanogenetic glucoside generating 0.05% hydrocyanic acid. Enquiries made Lon. Port Area Grain Com. Result - Actually Rangoons & supplied to trade as such. No further action by Council. Malt Vinegar Of full strength but artificial vinegar. Believed to be mistake by vendor letter of explanation received. Vendor cautioned. Ammon.Tinct .of Quinine (Informal) Deficient in ammonia by 0.3)6 Further sample (formal) taken from vendor see next item. do. do . Warned. Glauber Salts.(Informal) Dry sodium sulphate 95.3% Strong - due to evaporation. No action. 17. Description of Article Result of Analysis Decision taken. Atora Suet Adulterated by 7% excess of flour. No legal proceedings - due to delayed action. Rangoon Beans Objectionably large quantity cyanegenetic glucoside generating 0.057% hydrocyanic acid. No action - see Haricot Beans mentioned above. Milk Added water at least 1%. See two samples of milk recorded below. Suet Adulterated by 4% excess of flour. No action. Do. Adulterated by 2% excess of flour do. Milk Added water at least ½% These, together with the one referred to above, were from same vendor. Two other samples taken in course of delivery were genuine. Legal proceedings. Result vendor fined £4 plus £1.1.0 costs. (8.1.41) Do. „ „ „ „ 1% Butter Genuine, but so seriously impregnated with mould growths that considered unfit for food. Voluntarily submitted by retailer as specimen of small quantity he had for sale. On analyst's report considered advisable to condemn the stock (approx. 6 lbs.) RENT AND MORTGAGE RESTRICTIONS ACTS, 1894-1928. During the j^ear S Certificates were granted tr tenants and 3 Certificates have been issued tr nmers upon their application and completion of the scheduled works. Two completion certificates were refused. DISEASES OF ANIMALS ACTS, 1394-1928. Regulation of Movement of Swine Jj.rder, 1922.- Two Isolation Notices affecting 21 swine were received. The" Licences were in all cases duly observed. E-:ot and Mouth Disease (Infected Areas Restrictions) Order, 1958.- Walthamstow was included as an Infected Area" in April, but no applications were made for Movement Licences. RATS JAiD MICE DESTRUCTION ACT, 1919. Much has been done in combating the rodent 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 fellows Notices Served 14 Cyanogas pump used 4 Drains tested 152 Accumulations removed 8 Drains & manholes Sheds lifted or removed 3 repaired 171 Pavings lifted & runs traced 24 Poison issued 136 Premises rat-proofed 13 PETROLEUM (MIXTURES) ORDER, 1929. Legal proceedings were instituted regarding this Order made under the Petroleum Act, 1928. Convictions were obtained against a firm on two counts, (1) storing petroleum mixture without a licence, (2) storing petroleum mixture in unlabelled receptacles. Defendants were fined a total of £25 plus 10/Sd. costs. 18. l.- INSPECTION OF FACTORIES, ETC. 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 450 16 Nil Workshops without mechanical power 109 5 Nil Other premises under the Act 31 3 Nil Total 590 24 Nil. 2.- DEFECTS FOUND IN FACTORIES, ETC. Particulars Number of Defects No. of Offences in respect of which prosecutions were instituted. Found Remedied Referred to H.M. Inspector Want of cleanliness 53 53 - - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation 2 2 - - Ineffective drainage of floors - _ - - Sanitary Conveniences insufficient unsuitable or defective 72 74 - - not separate for sexes - - - - Other offences 30 30 6 — Total 159 161 6 Nil. NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1940. Wearing Apparel, making of 300 Pencils 1 Brush Making 78 Artificial Flowers 5 Boxes 25 Toys 2 Carnival Hats 1 Handbags 2 Envelopes 2 Novelties 6 Furniture 1 Feathers 2 Furs 4 Shoes 19 Total 448 Outworkers were notified from the following areas City of London 107 Stepney 8 Bethnal Green 4 Shoreditch 8 Finsbury 69 Tottenham 17 Hackney 75 Walthamstow 24 Holborn 6 Wanstead and Woodford 6 Islington 4 Westminster 5 Leyton 103 Other Areas 12 Total 448 A total of 708 visits were paid in connection with outworkers. 19. E.- PREVALENCE OF, AND CONTROL OVER, INFECTIOUS & OTHER DISEASES. GENERAL.- The accompanying tables show the ago and ward incidence of the various infectious diseases which are discussed separately in later pages of the Report:- Disease All Ages under lYr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over 1940 1939 Scarlet Fever 89 192 2 24 47 7 8 1 - Diphtheria 17 35 1 8 6 2 — - - Enteric Fever 3 3 - 2 - 1 - - - Pneumonia 90 147 2 6 4 13 26 27 12 Puerperal Pyrexia 35 38 - - - 5 30 , - Ophthalmia Neonatorum 4 5 4 - - - - - - Erysipelas 27 54 - - - 1 7 15 4 Encephalitis Lethargic 5 - - - — - 1 3 1 Polio- encephalitis - - - - - - - - - Cerebro-spinal Meningitis 6 3 - - 2 2 1 1 - Anterior Poliomyelitis 1 - - 1 — - - - - Measles 78 10 6 36 28 8 - - - Whooping Cough 14 - 2 7 4 - 1 - - Dysentery 1 3 - 1 - - - - - Tuberculosis 156 141 1 6 12 43 67 22 5 Totals 1940 526 - 13 91 103 32 141 39 22 1939 - 531 13 74 176 101 145 87 34 Disease St.James Street High Street Hoe Street Wood Street Hale End Higham Hill Totals Scarlet Fever 8 7 12 5 35 22 89 Diphtheria 2 3 3 3 5 1 17 Enteric Fever - 1 1 1 - - 3 Pneumonia 23 9 10 10 23 15 90 Puerneral Pyrexia 5 4 7 4 11 4 55 Ophthalmia Neonatorum - 1 - - - 3 4 Erysipelas 2 3 5 2 5 12 27 Encephalitis Lethargica 1 2 1 - 1 - 5 Polio-encephalitis - - - - - - - Cerebro-Spinal Meningitis - 1 1 - 1 3 6 Anterior Poliomyelitis - - - - 1 - 1 Measles 5 6 10 4 10 42 78 Whooping Cough 2 4 - 1 - 7 14 Dysentery 1 - - - - - 1 Tuberculosis 25 15 33 14 30 39 156 Totals 1940 75 56 83 44 120 148 523 1939 97 89 106 79 123 137 631 The statistics given in the foregoing table are those for the calendar year 1940. The Registrar-General gives the statistics for the 52 weeks ended 23th. December 1940, 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 84 16 3 90 34 27 Case Rate - Walthamstow 0.76 0.14 0.02 0.82 0.31 0.35 England and Wales 1.63 1.16 0.07 1.20 (Not available) 0.33 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. Then calculated on this basis the rate is:- Walthamstow 21.0 England and Hales 11.95 20. Disease Total Notified Removed to Hospital Per cent removed to Hospital Deaths Deaths per cent of cases notified Scarlet Fever 91 70 76.9 Nil Nil Diphtheria 17 17 100 2 11.7 Enteric Fever 3 3 100 1 33.3 Pneumonia 92 28 30.4 72 78.2 (1) puerperal Pyrexia 35 1 2.8 Nil Nil Ophthalmia Neonatorum 4 2 50 Nil Nil (2) Erysipelas 27 7 25.9 Nil Nil (2) Cerebro-spinal Meningitis 6 3 50 3 50 Anterio Poliomyelitis 1 1 100 1 100 Encephalitis Lethargica - - - 5 - (3) Measles 88 7 7.9 Nil Nil Whooping Cough 14 2 14.3 Nil Nil Dysentery 1 1 100 Nil Nil Tuberculosis 156 47 31.2 72 46.1 (4) 1. All cases not notified. 2. a registrable cause of death. 5. Not notified. 4. Includes those notified in previous years. INFECTIOUS DISEASES CLINIC:- Number of clinics held in connection with Infectious Diseases and Immunisation 53 Number of attendances made 696 Average attendance per session 13,1 Number of children recommended to Rheumatism Clinic 8 Number of children recommended to Ear Clinic 12 DIPHTHERIA IMMUNISATION. Immunisation was carried out at the weekly clinic on Tuesdays, but was discontinued at the infant schools owing to the uncertainty of events. It was, however, re-commenced towards the end of the year. Total number of immunisations completed during 1940:- (a) School age 129 (b) pre-school age 220 (c) Over school age - Total 349. Number not completing immunisation or left district - Number of Schick Tests following immunisation 5 Number of attendances made at Clinic for immunisation.540 Immunisation at schools (included above) Number completely immunised 31 Number partly immunised - Number having extra dose,immunised in previous years 12. First Birthday Letters.- 1038 letters were sent to the parents of all children following their first birthday, advising them to have their infants protected against diphtheria. 165 children were brought and protected and 25 others were immunised by their private practitioners. Immunisation by General Practitioners.- Diphtheria prophylacticis available to general practitioners. During 1940, 45 c.cs. of alum, precipitated toxoid were issued; this quantity is sufficient tr protect 45 children. Scarlet Fever Immunisation.- There were no Dick Tests for Scarlet Fever during 1940. 21. MUNICIPAL LABORATORY. The following numbers of diphtheria swabs were examined during 1940:- Swabs Negative Positive Totals. Private Practitioners 178 8 136 Health Department 92 - 92 School Medical Department 43 - 46 Totals 313 8 324 The total number of diphtheria specimens examined in 1959 was 691. Direct examinations were done on 12 diphtheria specimens, and one was positive. In addition, 158 specimens of urine were examined, as compared with 156 in 1959. A total of 550 tubes of culture media were made and of these, 312 were sent to the Sanatorium. ESSEX COUNTY COUNCIL SCHEME. The Ass ex County Council also provides facilities for examination of pathological specimens, and the County Medical Officer states that 1965 specimens were examined for local practitioners during 1940 as follows: - Diphtheria swabs, 81; Sputa 778; Typhoid specimens, 36; Ringworm specimens, 3; Miscellaneous, 1028, Milk and Ice Cream, 30; later, 5. VACCINATION. Mr.A.Sharp, Vaccination o fficer for the Area, has furnished the frilling return for 1946: - Births Registered. Successfully Vaccinated Percentare Vaccinated Insusceptible Exemptions Death before Vaccinated Postponed 1,391 195 14.01 1 687 37 35 In addition to the. above, 21 primary vaccinations were recorded and 13 re-vaccinations. During 1940 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 21.2 per cent. were vaccinated. FOOD POISONING. Note on Cases of Cadmium Poisoning. In May, 1940, three adults and five children were found to have become acutely ill some 15 minutes after consuming 'lemonade ices' prepared by freezing lemonade' in the metal trays of a recondition refrigerator. All were sick, four had diarrhoea, but recovery was generally complete within 24 hours. The remains of the unconsumed 'lemonade ices' were not available but the method of preparation was repeated. This consisted of dissolving a popular brand of lemonade crystals, (consisting of citric acid and sugar) in boiling water and freezing overnight in the refrigerator. Analysis showed that the traps had been plated with cadmium on occuper and that there was up to 279 p.p.m., of cadmium in solution. This roughly represented one-twentieth grain of cadmium per 'ice' block. It therefore appears that amounts of about one-twentieth grain of cadmium may cause somewhat severe poisoning. The refrigerator was of a well known make but had been supplied on a second-hand basis by another firm. It had then acquired cadmium plated copper trays not supplied originally when new. 22. The supplying firm was instructed to warn all its customers as to the danger of making 'lemonade ice' in similar trays. The original manufacturers were naturally most anxious to investigate the matter, but the supplying firm, unfortunately., proved non-co-operative in regard to tracing back the persons responsible for the re-plating of the trays with cadmium. The quantitative toxicity of cadmium has apparently not yet been clearly established but it is sufficiently dangerous for its use to be prohibited in colouring matters for foodstuffs. F.- INFECTIOUS DISEASES HOSPITAL. RENOVATIONS, ETC.- Various works of renovation and maintenance were carried out during 1940. Scarlet Fever Diphtheria Other Diseases Tuberculosis Totals. Remaining in Hospital 1st. January 3 9 1 11 24 Admitted during year 128 90 43 23 284 Discharged during year 121 93 31 12 257 Died during year Nil 3 3 10 16 Remaining in hospital 31st.December. 10 3 10 12 35 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL. (Including Tuberculosis cases). January 28.2 April 22.0 July 35.8 October 39.3 February 31.9 May 32.4 August 36.2 November 33.3 March 28.2 June 33.1 September 33.5 December 29.5 Average whole year 31.9. CLINICAL REPORT. Dr.Hamilton, Resident Medical Officer, reports as follows:AGS AMD SEX OF PATIENTS ADMITTED DURING 1940. Disease Under 5 yrs. 5-10 yrs. 10-15 yrs. Over 15 yrs. Total Total. M. F. M. F. M. F. M. F. M. F. Scarlet Fever 17 16 35 24 9 7 9 11 70 58 128 Diphtheria 20 15 11 10 3 5 4 22 38 52 90 Measles 7 7 - 1 - - - - 7 8 15 Pulmonary Tuberculosis . - - 23 - 23 23 Staff — — - - - - - 17 - 17 17 Other diseases 9 8 5 5 6 5 6 5 26 23 49 Totals 53 46 51 40 18 17 19 78 141 181 322 AGS AND SEX AT DEATH. Sixteen deaths occurred, details of which are given below:- 10 Pulmunary Tuberculosis 10 Females aged 53,40,19,22,37,20, 43,25,37,44. 2 Laryngeal Diphtheria 1 Male - 2½-years, and 1 Male - 8 months. 1 Faucial Diphtheria 1 Female aged 17 years. 1 Heart Disease 1 Female aged 61 years (Staff) . 1 Broncho-pneumonia 1 Female aged,3 years. 1 Anterior poliomyelitis 1 Male aged 2½ years. 23 . NUMBER OF OUTSIDE AUTHORITIES' CASES AND NATURE.- Diphtheria Scarlet Fever Other Diseases Totals. From Leyton B.C. 46 56 26 128 "Chingford B.C. - - 1 1 "Uhipps Cross Hospital - - 2 3 Total 46 57 29 132 "Other diseases covers a wide range of cases viz: Whopping cough, rubella, measles, adenitis, typhoid fever (5) diarrhoea, observation cases, i.e. croup, sore throat, "colds" and opthalmia. Two cases were transferred to Whipps Cross Hospital:- 1 Cerebral abscess; 1 old standing case of anterior poliomyelitis returned for continuation of treatment. SWABS.- 273 swabs were taken and examined during the year in the laboratory at the hospital. DURATION OF TREATMENT.- The average duration of treatment in Hospita1 was as follow:- Diphtheria 37.6 days. Scarlet Fever 24.6 days . Other diseases 17.1 days. The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1940:- Classification in accordance with Ministry of Health Memorandum 37.T.(Rev.) In Hospital on 1st. Jan.1940. Admites during year. Discharged during year. Died during year. In Hospital on 31st. Dec. 1940 Observation - - - - - T.B. Minus 1 3 2 - 2 T.B. Plus Group I. - 5 2 - 5 T.B,. Plus Group II. 10 14 8 10 6 T.B. Plus Group III - 1 - - 1 Totals 11 23 12 10 12 11 of the 23 admissions were Walthamstow cases. MEDICAL EXAMINATIONS. During the year, 30 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 ???id Association £100 Walthamstow Association of Tuberculosis Helpers £25 MORTUARY.- A Coroner's Court, mortuary (with special. provision for Infectious Disease cases) and a post-morton room is proovided by your Council at Queen's Road Gemetery. The Cemetery Superintenriant reports that the number of inguesta and post-mortens were as follows:- Inquests only 206 Post Moertems 157 Post Mortems and Inquests (not included in above) 26 389 24. HATERNITY AND CHILD WELFARE COMMITTEE. Chairman: COUNCILER MRS. E.A SMITH. Ex-Officio: The Worshipful the Mayor - Councillor J.H.Williams, J.P. The Deputy Mayor - Councillor R.W.A.Russell, J.P. Chairman of. the Fir.ance Committee - Alderman Ross Wyld, J.P. Alderman A.G.Bottomley, O.B.E. Councillor W.Gillett " Mrs.C.McEntee, J.P .E.C. " G.R.J.Holt " MiSQ E.M.Pracy, 3.3c. " G.R.Lowton " Mrs .E.M.Richards " G.S.Mace " W.H.Shaw " Mrs.A.L.Meadows ALDERMAN Mrs .L.P .Bailey, Jp. " G.H.Spademan Councillor. Mrs .S. Candy " Mrs .E .A.Smith " Mrs.3.M.Friedberg " R.E.Smith 11 F .W. Gentle " Mrs.E .3. Tcynbee Councillor A.H.Williams Co-opted Members: Dr.Helen Watson Mr.W.H.Kindell Mrs.S.Candy Mrs.W.H.Kindell Mrs.Riley Mr.J.DeVries Mrs.Jarmon. 25. TO THE CHAIRMAN AND M2MBE.RS 07 THE MATERNITY AND CHILD WELFARE. COMMIITEE. Ladies and Gentlemen, The Report for 1940 records another low infant mortality rate (40), as compared with 55 for England and Wales and 50 for London Administrative County. The maternal mortality rate is the lowest sn far recorded and Welfare attendances were well maintained. The total number of admissions to Thorpe Coom.be - in suite of the evacuation of expectant mothers in the latter part of the year - was the highest recorded. I have pleasure in a grain recording your continued help and the goodwill of the Staff. I have the honour to be , Your obedient Servant, A.T.To POWELL, Medical. Officer of "Health. 26. STAFF. As for 1939. NOTIFICATION OF BIRTHS. 1,543 births (82 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,243; midwives, 1300. Included in the above are 170 births which were notified as having occurred outside the Borough. Also included are 45 stillbirths, 3 of which did not belong to the area. 14 were notified by doctors and 31 by midwives. Of the total, nine occurred outside the area. The stillbirth rate per 1,000 population was 0.37. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:- (a) LIVE BIRTHS. Males Females Totals. Legitimate 800 735 1535 Illegitimate 20 20 40 820 755 1575 (b) STILLBIRTHS. Males Females Totals. Legitimate 21 20 41 Illegitimate - 1 1 21 21 42 Of the 1504 birth registrations received in the Department between 31st. December, 193 9 and 28th.December, 1940, a total of 15 were not notified in this area, but some may possibly have been notified elsewhere. Appropriate action was taken When necessary. Of the 1504 local registrations, 120 belonging to other areas are excluded, leaving a nett total of 1384, The local registrations for 1940 were 22 more than in 1939. INFANT MORTALITY. The deaths of Infants under one year of age were:- Males Females Totals. Legitimate 24 32 56 Illegitimate 2 2 4 26 34 60 The death-rates of infants under one year of age per 1,000 live births when calculated on the totals given by the Registrar-General are therefore:- Legitimate, 41; Illegitimate, 25; Total 40. The Infant Mortality Rate for other areas during 1940 was as follows:- England and Wales 55 126 County Boroughs and Great Towns (including London) 61 148 Smaller Towns (25,000 to 50,000) 54 London 50 27. NEO-NATAL MC TALITY. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1940 , 3 9 infants died in the first four weeks of life, yielding a rate of 24.7. The following rates refer to Wothamstow:- INFANT DEATHS, ISO-NATAL MORTALITY AND STILLBIRTHS. . Year Live Births Birth Rate Stillbirths Neo-Natal Deaths Per 1,000 live births Infant Deaths No . Per 1,000 live births Per 1,000 popuiation No. No. Per 1,000 live births 1940 1575 14.5 42 26.6 0.30 39 24.7 30 40 1939 1606 12.3 62 30.6 0.47 23 17.4 45 29 1958 1617 12.5 70 45.2 0 .55 28 17.5 66 40 1937 1675 12.7 60 35.0 0.45 35 20.8 87 51 1936 1715 12.0 54 31.4 0.40 29 13.9 72 42 1935 1670 12.4 57 34.1 0.42 33 21.5 62 37 1934 1715 12.3 60 35.8 0.44 35 20.4 77 44 1933 1670 12.5 55 37.4 0.47 49 29.3 89 53 1932 1739 15.2 82 45.8 0.30 55 30.8 103 57 1931 1947 14.5 59 29.4 0.43 51 23.2 110 56 The neo-natal mortality for England and Wales for the decennium 1921-30 rras 33. The death-rate from Diarrhoea and Enteritis in children under one year of age per 1,000 live births was 3.17. CHILD WELFARE. The equivalent of whole-time Municipal Health Visitors at the end of the year was 7.5, equal to one whole-time Health Visitor per 205 notified births, and one whole-time Health Visitor per 210 registered births during 3 940. MATERNITY AND CHILD WELFARE CLINICS. As for 1938. 28. 29. The following table shows: the number and nature of visits paid during 1940:- 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 223 443 666 884 1550 521 8 110 69 18 87 172 2,448 High Street 143 345 488 498 986 338 29 37 24 - 24 41 1,455 Hoe Street 207 460 667 667 1334 491 23 148 31 10 41 73 2,110 Word Street 165 205 370 274 6644 241 16 77 46 3 49 53 1,080 Hale End 315 869 1184 947 2131 440 21 97 33 14 47 57 2,793 Higham Hill 319 716 1035 1412 2447 790 50 135 47 3 50 196 3,668 Totals 1940 1372 3038 4410 4682 9092 2821 147 604 250 48 298 592 13,554 Totals 1939 1483 3461 4944 6703 11647 2273 385 1062 294 71 365 580 16,313 CLINICS• Dr.Dheppard reoorts as fallows:- "The Welfare Centres continued their good work as usual during 1940. In September the numbers temporarily went down but even then many of the mothers attended regularly. Up to the end of 1940 war conditions had not noticeably affected the health of the under fives', and it is hoped that this happy state of affairs will continue. The national Mill: Scheme is especially good for the toddlers, but does not adequately meet the requirements of those babies whoso mothers ore unable to feed them naturally. Your Committee, therefore, continues to supply those babies with the appropriate baby foods. The Committee's thanks are again due to the Voluntary Workers who, in spite of difficulties, continue to give their valuable services. The .Ante-Natal Clinics continue to be well attended and in fact at the close of the year showed a tendency to increase. The health of the mothers, in spite of air-raids etc. showed no deterioration. ANTE-NATAL AND POST-NATAL SERVICES. The fallowing table summarises the attendances at the Clinics held:- New Patients Ante-Natal post-Natal. Thorpe Coombe Maternity Hospital 750 330 Low Hall Lane Clinic 353 3 1106 333 Total Attendances:- Thorpe Coombe Maternity Hospital 7429 470 Low Hall Lane Clinic 932 5 8361 473 SUMMARY OF ATTANDENCES 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 496 936 752 8712 8552 17264 17996 Higham Hill 287 95 382 3370 4209 8079 3461 Hale End 246 34 280 4321 4480 8701 8931 Total 1940 1029 365 13 4 16803 17241 34044 35438 Total 1939 1023 259 1282 38493 19143 37641 38923 NURSE CHILDREn.- At the end of 1940 there were 48 nurse children on the register, compared with 58 at the end of 1939. During the year 18 removed, 3 were adopted, and 4 reached the age of nine years. 15 new children were registered and re-registered. There were no deaths among nurse children during 1940 . MASSAGE.- Five massage sessions per week were held at the Welfare Centres, i.e., Low Hall Lane, Monday, Thursday and Friday; Highans Park, Tuesday; and Higham Hill, Wednesday. 168 cases attended for massage, and these made 1,806 attendances. SALE OF MILK., ETC. AT CLINICS.- The value of milk and food sold and issued free during 194.0. was £2245.13.4d. 30. 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 1yr. 1-5 yrs. Total 1940 444 74 513 7195 3661 10856 11374 1939 521 37 60S 3363 4484 12352 13460 1938 496 115 611 9337 5066 14453 15064 1937 469 94 563 7524 3737 11261 11324 1935 427 31 508 5433 3402 8835 9393 SPECIAL TREATMENT, ETC. Massage Treatments Sunlight Treatments Total cases admitted to Observation Ward Local Authority's cases admitted to Observation Ward. 1940 935 719 - — 1939 1489 1224 10 4 1938 2314 1949 35 1 1937 2468 1847 24 2 1936 2107 1461 28 10 HOME VISITS. Visits to Children under 1 year. Visits to Children 1-5 Years. Grand Total First Subsequent Total 1940 438 1126 1564 1361 3425 1939 495 1398 1393 1058 2951 1938 508 1691 2199 10 97 3296 1937 464 1751 2215 1289 3504 1936 380 1251 1631 2639 4270 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 1029 365 1394 16803 17241 34044 35438 Brrokscroft 444 74 518 7195 3661 10856 11374 Total 1940 1473 439 1912 23993 20902 44900 46312 Total 1939 1544 346 1890 26866 23627 50493 52383 31. HOME VISITS To Children under 1 year of age To Children 1-5 years of age Total First Subsequent Total Municipnl Scheme 1372 3038 4410 5947 10357 Brockscroft . 438 1126 1564 1861 3425 Totals 1940 1810 4164 5974 7808 13782 Totals 1939 1973 4859 ..... 3837 7731 14598 Percentage of notified live births represented by number of children under 1 year of age who attended the Centres for the 1940 98.3 first time (i.e., new cases). Percentage of total notified births represented by number of expectant mothers attending 1940 71.6 Ante-Natal Clinics TREATMENT. (a) ORTHOPAEDIC. DEFECTS SEEM AT ORTHOPAEDIC CLINIC IN CHILDREN UNDER FIVE YEARS OF AGE. Anterior Poliomyelitis 1 Terticrllis 41 Rickets - Congenital Dislocation of Hip 21 (a) Genu Varum 22 Congenital Defects 51 (b) Genu Valgum 18 Miscellaneous 2 Pes Piano Valgus 14 Total 801 Spastic Paralysis 3 ... I Talipes 11 (b) DENTAL. The following work was done by the Education Commttee's Dental Surgeons in respect of Maternity and Child Welfare patients:- 1938 1939 1940 Mothers Children under 5. Mothers Children under 5. Mothers Children under 5 Cases Treated 210 130 184 92 87 105 Attendances 521 183 657 160 277 273 Fillings 175 55 221 84 214 116 Extractions 431 279 446 139 288 92 General Anaesthetics 180 96 171 73 107 62 Scalings 63 - 92 - 57 - Dressings 10 26 34 30 17 14 Dentures 27 — 26 - 11 - 1940 has been a very disappointing Year for dental treatment of maternity cases. The unfortunate interruption of sessions by air raids has had a serious effect upon the attendanc: also many mothers who were transferred to maternity homes in reception areas, missed their dental treatment and failed to re-apply for treatment on returning home. Appointments were sent to 437 new cases and only 41% attended the Clinic: not all of those received treatment. Some refused to have treatment other than extractions, some preferred to wait until after the birth and then did not return for treatment. 20% had partial treatment, 7% completed their treatment, 1C dentures were fitted. The failure problem is a difficult one to remedy, the more so because every expectant or nursing mother in need of treatment is asked whether she is willing to be treated at the Clinic and it is at her own express wish that the form is filled in. It is evident that there is a great deal of apathy about dental conditions. Sepsis was less marked in the majority of cases. 32. (c) INVALID CHILDREN's AID ASSOCIATION. The 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:- 1. Medical men, Hospitals and Dispensaries 10 2. (a) Medical Officers of Health and Infant Welfare Centres 6 (b) Education Committees and School Medical Officers 1 3. Orthopaedic Care 44 4. Rheumatism Clinic 1 5. Others 1 63 Suffering from:- Anaemia and Debility 6 Marasmus and Malnutrition 1 Pneumonia, Bronchitis, Asthma, etc 3 Bene Disease (Non-T.B.) 29 Congenital Deformities 18 Hernia 1 After Infection 1 Various 1 Diseases of Digestive Organs 1 Air Raids 1 62 HELP GIVEN TO OLD AMD NEW CASES, 1940. Sent to Special Hospitals and Convalescent Hemes 11 Provided with Surgical Boots and Appliances 28 Referred for Visiting and Advice 17 56 ASSISTED MILK SCHEME. Number of applications during 1940 3,669. Number of families assisted 1,013. Of the 3,669 applications, approximately 28 per cent, were from families where the father was unemployed. Scale Amount Approx. cost to Authority. £ s. d. Free 224 pints 3. 14. 8. ½d. per Dint. 23, 8C0 " 347 . 1. 8. 1d. " " 77,551 " 969. 7. 9. Half Cost 11,592 " __96. 12. 0. 113", 167" pints 1,416 . 16. 1. The following is a summary of the applications for milk for the past five years:- Year Milk Dried Milk . . Unemployed . % Unemployed . Average per week Milk Dried Milk 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 1940 3,154 515 1,046 28.0 101.7 9.9 HOME HELPS In addition to the 128 Home Helps approved during 1940, many aethers attending the Clinics made their own arrangements to Obtain the help of suitable women whose names were supplied by the Health Visitors. Four applications were rejected and eleven were cancelled by the Rota Committee. 33. STERILISED MATERNITY CUTFITS. A total of 268 sets were used in the Borough and 210 outfits were issued below cost price. INSTITUTIONAL TREATMENT, ETC. Six children were sent to Institutions under arrangements approved by your Committee. HOSPITAL ACCOMODATION FOR CONFINEMENTS. The fallowing numbers of cenfineraents occurred at the Institutions specified (walthaastOW residents only):- Thorpe Coombe Maternity Hospital 684 Maternity Hemes in Nalthamstow 32 Mothers' Hospital, Clapton 65 Forest Gate IN HOspital 43 Queen Mary's Hospital, Stratford City of London Maternity Hospital 10 Other Maternit Homes 53 887 WALTHAMSTOW DISTRICT NUNSING ASSOCIATION. (In affiliation with the Queen's Institute of District Nursing). Mrs.Drury, the Honorary Secretary, kindly reports as fOllows:- "In spite of financial difficulties, a further reduction in staff and the wartime conditions, no call was neglected throughout the year. At the beginning of April we undertook the whole of the nursing of Public Assistance cases fOr the E.C.C. We alse,during the early part Of the year, assisted in external training for Medical Students. District Midwifery training was given to 5 Pupil Midwives each for 3 months. lectures en emergency midwifery and first-aid were given by the Superintendent to A.R.P. workers and housewives etc. The staff en December the 31st. was as follows:- Superintendent 1 Voluntary Midwife ("Queen's) 4 "ueen's" Nurses (all Midwives) 2 Pupil Midwives 2 Municipal Midwives 2 Voluntary District Nurses, Cases nursed:- General 1,200. Municipal Midwifery 154 Non-municipal " 80. Visits:- Genera], 27,266. Midwifery (including ante—natal) 2,150. ANASSTEETIST'S FEES . During 1940 recovery on the scale For assinged Maternity and Child Welfare services was made in one case in which this Service was approved. CONSULTANT -OBSTETRICIANS. The services of a Consultant Obstetrician were not-required during the year. 34. MIDLIVES ACTS, 1902-1935. No. of Notices of Intention to Practise, January, 1940 27 " " " " " during 1940 8 Total 35 No. of Midwives ceasing to practise during 1940 1 34 " " " who have left the district 11 " " " practising at the end of 1940 23 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 oarried 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 1940:- No. of confinements attended as a Midwife 846 " " '' " " Maternity Nurse 156 medical aid notices sent 513 " " notifications of deaths 2 " " twin births notified 11 " " stillbirths notified 4 " " notifications of liability to be a source of infection 8 " " " " laying out of a dead body - " " " " artificial feeding 2 " " " " disinfection 9 The' above table includes the following numbers with regard to work done at Thorpe Coombe:- Midwifery-cases, 600. Maternity cases, 111. Medical Aid Notices, 377, The percentages of Medical Aid Notices were:Maternity Hospital, 62.8; Domiciliary Midwives 55.2; Total 60.6. 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 4 Threatened abortion - Varicose veins - Miscarriage 2 Abortion 1 Other conditions 14 Total 21 For complications during labour:- Delayed 1st. and 2nd. stage 9 "Ante-partum haemorrhage. 1 Perineal laceration 10 Retained placenta 4 Malpresentat ion . 4 Abdominal pain 61 Pyrexia - Total 94 Post-partum haemorrhage 5 Total 94 35. For complications in regard to the infant:- Prematurity and feebleness 5 Cyanosis - Discharging eyes 6 Other conditions 9 Melaena - Total 20 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. 1694 1367 207 454 74 10256 14051 PUELIC HEALTH ACT, 1936. (Nursing Homes).- See Public Health Section of the Report. PUERPERAL PYREXIA. Thirty-five cases of Puerperal Pyrexia were notified during 1940. The puerperal pyrexia rate for 1940 was 21.6 per 1,000 births, and there were no deaths from puerperal sepsis. The notifications and rates for Walthamstow for the past four Years have been as follows:- Per 1,000 Total Births (Live and Still) Year Puerperal Fever Puerperal Pyrexia Total No. Rate No. Rate No. Rate 1940 Not notifiable 35 21.6 35 21.6 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 36. ABORTION. CIRCULAR 1661.- The number of cases in which Medical aid notices were issued during 1940 by midwives in accordance with Rule E of the Central Midwives Beard was:- Threatened abortion and miscarriage Nil. Abortion and miscarriage Nil. 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 Higam Hill 1940 4 - 1 - - - 3 1939 5 2 - 1 - 1 1 Year Treated Vision unimpaired . Vision impaired Total Blindness Deaths. At Home In Hospital 1940 2 2 4 - - - 1939 1 4 5 - - -- MATERNAL MORTALITY. During 1940, one death associated however slightly with pregnanoy and child-bearing was investigated for the completion of enquiry forms. The following table shows the maternal mortality rates for 1940 (calculated on the one death assigned by the RegistrarGeneral to Headings 29 and 30). Births Registered Deaths of Women due to Pregnancy and Child-Bearing. WALTHAMSTOW England and Wales Rates per 1,000 Births registered Rates per 1,000 Births registered Puerperal Sepsis (Heading '29 R.G.) Other Puerperal Causes (Heading 30 R.G.) Total Puerperal .Sepsis Othor Puerperal Causes Total Puerperal Sepsis Other Puerperal Causes Total Live, 1575 - 1 1 - 0.63 0.63 Not available live &. Still -births, 1617 - 1 1 - 0.61 0.61 0.52 1.64 2.16 37. 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) 1940 1939 1938 1937 1936 Maternal Mortality 0.65 1.29 1.85 3.57 1.74 Stillbirths 26.6 38.6 43.2 35.8 31.4 Nee-Natal Deaths 24.7 17.4 17.3 20.3 16.9 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 1 Puerperal Sepsis Other Puerperal Causes Total 1940 1617 - 1 1 1 * 0.61 0.61 1939 1668 2 - 2 1.19 - 1.19 1933 1687 1 2 3 0.59 1.18 1.78 1937 1735 4 2 6 2.50 1.15 3.45 1938 1769 1 2 3 0.56 1.13 1.69 THORPE COOMBS MATERNITY HOSPITAL. ALTERATIONS AND EXTENTIONS.- No alterations of major character were carried out GENRAL.- (a) Form M.C.W. 96A. (Ministry of Health). 1. Name and Address of Institution - Thorpe Coombe Matornity Hospital, 714, Forest Road, Nalthamstow, U.17. 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds) - 46. 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 aneordins to reonirements. No definite reservation. 3. Number of maternity cases admitted during the year - 817. (including ante- and post-natal cases). 3a. Number of women treated during the year in the beds shewn against item 2a. (Included in item 3) /33. 4. Average duration of stay of cases included against Item 5.- 14.24. 38. 5. Number of cases delivered "by - (a) Midwives - 609 plus 3 miscarriages. (b) Doctors - 111. 6. Number of oases in which medical assistance was sought by a midwife in emergency - 377. 7. Number of cases notified as - (a) Puerperal fever - Nil. (b) Puerperal pyrexia - 31. 8. Number of cases of pemphigus neonatorum - Nil. 9. Number of infants not entirely breast fed while in the institution - 130 complemented, 27 (artificially fed). 10. Number of cases notified as ophthalmia neonatorum - Nil, 11. (a) Number of maternal deaths - 1. (b) Cause of death - Eclampsia. 12. (a) Number of infant deaths (i) Stillborn - 23. (ii) Within 10 days of birth - 6. (b) Cause of death in each case, and results of post-mortem examination (if obtainable).- See Clinical Report. The stillbirth rate was 32.8 per 1,000 live births, and the neo-natal mortality within 10 days of birth was 8.5 per 1,000 live births. (a) Occupation of Beds.- The average daily occupation of beds was as follows:- January 27.0 July 26.0 February 29.3 August 36.3 March 35.2 September 33.1 April 35.4 October 26.9 May 38.4 November 16.5 June 25.7 December 16.6 The average for the whole year was equal to 62.9 per cent. beds occupied (based on 46 beds). (b) Emergency Unit.- The services of the emergency unit were required on one occasion during the year. (c) 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. No examination was held 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 1940, 32 pupils from Thorpe Coombe obtained the Part I.Certificate of the Central Midwives Board, and 11 obtained the Part II. Certificate. The following Clinical Report has been compiled by Dr.Helen Rodway, M.R.C.O.G., Resident Obstetrician. 39 . THORPS COOMBS MATERNITY HOSPITAL. CLINICAL REPORT FOR 1940. This year a greater number of patients have availed themselves of the Hospital Services than in previous years. Owing, however, I to the evacuation of expectant mothers following air-raids in September, there was a gradual decrease in the number of patients I booking for their confinements at that time with, consequently, fewer admissions in the latter part of the year. The attendances at the Ante-natal Clinic were splendidly maintained during the year., oven at the time when day air-raids were of frequent occurrence. The Post-natal Clinic attendances were not so good, because many mothers left Waltharmstow shortly after their confinements. A aeries of Mothercraft Instruction Classes was held during the I year; these were attended with great enthusiasm by many of our expe otant mo thers. Ante-natal and Post-natal Exercise Classes were also held and a I teaching film was made of the exorcises done by our patients. DETAILS OF THE WORK OF THE HOSPITAL. Ante-natal Clinics. Number of Clinics held:- 1940 1939 1938 1937 1936 1935 (a) Consultant's Clinics 8 8 12 12 12 21 (b) Resident Obstetrician's• Clinics 301 176 155 129 117 125 (c) Midwives' Clinics 135 254 294 549 552 225 Totals. 442 418 461 490 481 371 Number of Expectant Mothers who attended Ante-natal Clinics 750 733 702 755 691 752 Total attendances at Ante-natal Clinics:- (a) New patients 750 733 702 755 691 762 (b) Old patients 6679 5750 6032 5501 5554 4545 Totals. 7429 6483 6734 62,54 6045 5305 Total number of attendances at:- (a) Consultant's Clinics 85 117 186 - - - (b) Resident Obstetrician's Clinics 5547 2904 2228 2382 2648 2863 (c) Mid-wives ' Clinics 1797 3462 4319 3872 3397 2437 Totals. 7429 6483 6734 6254 6045 5305 Average attendance per session:- (a) Consultant's Clinics 8.62 14.62 15.5 — — - (b) Resident Obstetrician's Clinics ... 18.42 16.5 14.38 16.9 - - (a) Midwives' Clinics 13.51 14.79 14.69 11.0 - — Post-natal Clinics. Number of Clinics 53 Number of Attendances:- (a) New patients 350 (b) Old patients 140 Total 470 The percentage of new patients relative to the number of confinements in the Hospital was 45.33. Average attendance per session was 8.86. ] 40. ADMISSIONS TO THE HOSPITAL. The total number of admissions was 817, which includes 20 unbooked cases. Number of Admissions. 1937 1938 1939 1940. (a) Ante-natal (33 were delivered before discharge) 109 96 119 126 (b) For confinement 716 675 552 684 (c) Miscarriage 3 3 - 3 (d) Post-natal 1 1 4 4 Totals 729 775 675 817 REASONS FOR THE ADMISSION OF ANTE-NATAL CASES. Pregnancy toxaemia 23 (two re-admissions) 2 Eclampsia 1 Chronic nephritis 1 Hyperpiesis 2 Hyperemesis gravidarium 4 Oedema 2 Ante-partum haemorrhage 11 Heart disease 15 Haemorrhoids 1 Urinary infection 2 Phlebitis 1 Anaemia 2 For rest 3 Homeless after air-raids 2 For observation and discharged because not in labour 54 Total 126 REASONS FOR THE ADMISSION OF UNBOOKED CASES. Delay in progress of labour 4 Obstructed labour 1 Extended breech 1 Hyperemesis 1 Cardiac disease 1 Ante-partum haemorrhage 4 Home conditions unsuitable following air-raids 3 (admitted with infants after confinement) Homeless following air-raids 2 Difficulty of transport to hospital where bed was booked for confinement 1 Arrangements for confinement not made 2 Total 20 CONFINEMENTS. (a) Primigravida 427 (b) Multigravida 293 Total 720 In 22 cases the patients were delivered by a Private Practitioner; in 82 by the Resident Medical Officer In seven cases the operation of Caesarear. Section was performed. 41. PRESENTATION AND POSITION DURING LABOUR. Prinigravida Multigravida Total Vertex left occipitoanterior 227 165 392 Vertex left occinito-latoral 3 - 3 Vertex left occipito-posterior 15 9 24 Vertex right occipitoanterior 131 92 223 Vertex right occipite- lateral 4 2 6 Vertex right occipito-postericr 14 9 23 Vertex (no details given) 7 - 7 Breech 23 16 39 Face - 1 1 Not stated 5 - 5 Totals 429 294 723 (This includes 3 eases of twin confinement) INFANTS. The number born in the Hospital was:- 725. (This includes 5 cases of twins) Infants completely breast fed 506. " complemented with other milk 130. " not breast fed 27. FOETAL AND INFANT MORTALITY. Stillbirths: Number of cases. Premature, i.e., under 5-½ lbs 8 Full term, i.e., over 5-½ lbs 15 Total 23 Infant Deaths: Premature 4 Full term 2 Total 6 Mortality rate per 100 births: ( a) Stilbirths 3.2 (b) Infant Deaths 0.83 Total percentage 4 OPERATIONS ???. Number of cases Cacsaroan section:- 7 (a)for pelvic disprecption 5) (b)for mitral, stenosis and ) pelvic disproportion 1) (c)for pelvic asymmetry 1) Forceps delivery 70 Manual removal of Placenta 5 Induction of labour 7 Total 87 42. MEDICAL AID NOTICES. In 377 cases medical aid was sought by midwives working in the Hospital. Treatment was given by the Resident Medical Officer (a) For Gomplications during Labour. Ante-parturn haemorrhage 7 Breech presentation 18 Abnormal presentation 1 Cardiac condition 5 Chorea with slow second stage 1 Collapse after second stage 1 Delay in second stage 54 Episiotomy Eclamptic fit in second stage 1 Foetal distress 13 Foetal heart not heard 1 Post-partum haemorrhage 8 Post-parturn collapse 1 Premature labour 1 Ruptured perineum 230 Toxaemia - patient in labour 12 Twin pregnancy 2 Unsatisfactory condition 3 Total 362 In addition one medical aid for the DistrictPremature Labour. (b) For Compilcations in regard to the Infant. Asphyxia 6 Cyanosis 2 Phimosis 1 Premature 4 Poor Colour 1 Unsatisfactory condition 1 Total 15 PUERPERAL PYREXIA. 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. In 31 cases, notification of pyrexia was made. Causes of Pyrexia. Number of Cases (a) Flushed or congested breast 9 (b) Mastitis 1 (c.) Suppurative mastitis 2 (d) Urinary infection 2 (e) Local genital infection 7 (f) Wound sepsis 3 (g) Influenzal cold 2 (h) Infective arthritis 1 (k) Gastro-enteritis 1 (l) Undiagnosed 2 (m) Thrombo-phlebitis Cerebral and pulmonary embolism 1 Total 31 Sepsis rate m all cases - 4.3%. MATERIIAL MORTALITY. There was one maternity death in the Hospital this year. This was due to eclampsia. One ante-natal patient died at home of heart failure. 43 .