With the Compliments Medical Officer of Health and School Medical Officer, Borough of Walthmstone. WAL 24 AC 4411(1) WALTHMSTOW BOROUGH OF WALTHAMSTOW R E P O R T OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1941. A.T.W.POWELL, M.C., M.B. , B.S., D.P.H. MEDICAL OFFICER OF HEALTH & SCHOOL MEDICAL OFFICER. CONTENTS. Abortion 32 Acreage 4 Adulteration 13 Albuminuria 31 Ante-Natal Clinic 26, 36 Bacteriological Analyses 12 Births 4, 23 Breech Delivery 37 Caesarean Section 37 Cancer 5 Cerebro-Spinal Meningitis 15 Child Welfare 24 Child Life Protection 26 Clinics 5, 6, 26, 27 Clothing Coupons for Expectant Mothers. 23 Committees 2, 21 Consultants 31 Dampness 9 Deaths 4, 5, 19 Death Rate 4 Dental Treatment 28 Diphtheric 15 " Immunisation 16 Diseases of Animals Acts 13 Disinfestation 10 District Midwifery 30 Drainage 6 Dysentery 15 Eclampsia 37 Emergency Unit 35 Enteric Fever 15 Erysipelas 15 Factories and Workshops 9, 14 Food Inspection 12 Foot Clinic 5 Forceps Delivery 37 Haemorrhage - Ante-Partum 37 Health Services 5, 6 " Visiting 25 Home Helps 29 Hospital Accommodation 30, 36 " Infectious Disease 16, 18 Housing 10, 11 " Act, 1936 11 " Inspection 10 Ice Cream 9, 12 Immunisation 16 Infant Mortality 4 , 23 , 24 , 35 Infectious Diseases 9, 15, 16 Institutional Treatment 30 Invalid Children's Aid Assn. 29 Isolation Hospital 18, 19 Laboratory Work 17 Layettes 30 Massage 26 Maternal Mortality 32, 33, 34 Maternity and Child Welfare 21 Measles 15 Meat Inspection 12 Medical Aid 37 Medical Examinations 20 Midwives 30, 31, 32, 35 Milk, Assisted Scheme 29 Milk Supply, etc 12 Miscellaneous 20 Neo-Natal Mortality 24, 34 Notices, Sanitary 8 Obstetric Consultants 31 Ophthalmia Neonatorum 32 Orthopaedic Treatment 28 Outworkers 15 Petroleum 14 Pneumonia 15 Post-Natal Clinic 26, 36 Public Cleansing 6, 7 Puerperal Pyrexia 32, 38 Rateable Value 4 Rats and Mice Destruction Act, 1919 13 Refuse Disposal 7 Rent Restriction Acts 13 Rheumatism Clinic 16 Rivers and Streams 6 Sanitary Inspection 8, 9 Scarlet Fever 15 Shick Tests 16 Sewerage 6 Social Conditions 4 Special Premises 9 Staff 4 Statistics 4 Sterilised Maternity Outfits 29 Stillbirths 4, 24, 34 Thorpe Ceomabe Maternity Hospital 34 Trade Refuse 7 Tuberculosis 19, 20 Vaccination 17 Vital Statistics 4 Vitamins 23 Walthamstow Child Welfare Society 27 Walthamstow District Nursing Association 30 Waste Food 7 Water 6 Women's Clinic 6 Zymotic Diseases 4 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Alderman Mrs.E.M.Miller The Worshipful the Mayer - Councillor J.H.Williams, J.P. The Deputy Mayor - Councillor R.W.A.Russell, J,P. Chairman of Finance Committee - Alderman Ross Wyld, J.P. Alderman Mrs.L.P.Bailey, J.P. Alderman Miss E.M.Pracy, B.Sc. " A.G.Bottomley, O.B.E. " Mrs.E.M.Richards Alderman Mrs.C.McEntee, J.P.,E.C.C. Councillor W,E.Barnes Mrs.B.M.Friedberg " F.W.Gentle " W. Gillett " T.C.W.Green " G.J.R.Holt " J.W.Lis Councillor G.S.Mace A. E. Manning " Mrs .A. L .Meadows " Mrs .E.A.Smith " G.H. Spackman " Mrs .E .B. Toynbee " A.H.Williams Town Clerk: F.G.GARNER, ESQ,. TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, The Report for 1941 has again been curtailed as far as possible and has been duplicated as a measure of economy. On the instruction rf the Ministry of Health no information is given as to population etc. for reasons of security. The comparative rates in regard to England and Wales, London Administrative County and Walthamstow are favourable to the latter in respect of the following:- Deaths from all causes; from Typhoid and Paratyphoid Fevers, Whooping Cough, Diphtheria and Influenza Notifications in regard to Typhoid and Paratyphoid, Cerebrospinal Fever, Scarlet Fever, Diphtheria and Erysipelas were fewer. The incidence of Diphtheria was again particularly low. The Public Health services have been maintained as near to the normal as possible, and I have again to acknowledge your 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. STAFF . The following left for the reasons stated Dr.D.Broderick (Deputy M.C.H.) - Resigned on superannuation. Mr.D.R.King (Clerical Assistant) - To H.M.Forces. Mr.G.J.Bradley( " " )- " " " Mr.E.E.Harber (Ambulance Driver) - Resigned on superannuation. The following were appointed:- Dr. Melville Watkins - Deputy M.O.H, Miss I.Burr - Clerical Assistant. Mr. R.D.Wilshire - Clerical Assistant. Mr. D.Clements - Ambulance Driver. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343 Number of Assessments, 1st.April, 1941 35,770 Rateable value £864,973 Sum represented by penny rate £3,100 Extracts from Vital Statistics,- The Registrar-General's mid-year, 1941, estimate of population has been used for the calculation of all vital statisties:- Total Males Females. Live Births Legitimate 1254 646 606 Illegitimate 50 28 22 Total 1304 676 623 Stillbirths 35 rate per 1,000 total (live & still) births Deaths 1253 26.1 Deaths from puerperal causes:- Rate per 1,000 (live ana still) births. Puerperal Sepsis 3 2.51 Other Puerperal Causes 5 4.19 Total 8 6.70 Death rate of infants under one year of age:- All infants per 1,000 live births 44,8 Legitimate infants per 1,000 legitimate live births 45.0 Illegitimate infants per 1,000 illegitimate- live births 40.0 Deaths from Measles (all ages) 4 ” Whooping Cough (all ages) 1 " Diarrhœa (under 2 years of age) 2 Zymotic disease death rate 0.12 Pulmonary Tuberculosis death rate 0.55 Non-pulmonary Tuberculosis death rate 0.09 The natural increase of population, i.e., excess of births Over deaths, was 51. Births.- Births are dealt with under -the Maternity and Child welfare section the Report. Deaths . - The Registration -generals classification of causes of death by sex totals is given. The total number of deaths in 1941 (1255} compares with. 1,607during 1940. 4. CAUSES OF DEATH AS GIVEN BY THE REGISTRAR-GENERAL FOR THE YEAR 1941. WHOLE DISTRICT Causes of Death Males Females Total 1. Typhoid & Paratyphoid Fevers - - - 2. Cerebro-spinal Fever 2 3 5 3. Scarlet Fever - - - 4. Whooping Cough - 1 1 5. Diphtheria 5 - 5 6. T.B. of respiratory system 32 19 51 7. Other Foms of Tuberculosis 9 3 12 8. Syphilitic disease 6 5 9 9. Influenza 11 4 15 10. Measles 2 2 4 11. Acute poliomyelitis & polioencephalitis - 1 1 12. Acute infectious encephalitis - 2 2 13M. Cancer of buccal cavity & oesophagus (Males only) 11 - 11 13F. Cancer of Uterus - 8 3 14. Cancer of stomach and duodenum 19 12 31 15. Cancer of breast - 20 20 16. Cancer of all other sites 79 47 126 17. Diabetes 1 7 8 18. Intra-cranial vascular lesions 41 51 92 19. Heart disease 142 137 273 20. Other diseases of the circulatory system 22 21 43 21. Bronchitis 52 48 100 22. Pneumonia 44 39 83 23. Other respiratory diseases 13 5 21 24. Ulceration of the stomach or duodenum 15 1 15 25. Diarrhoea (under 2 years) - 2 2 26. Appendicitis - 3 3 27. Other digestive diseases - 8 17 28. Nephritis 14 11 25 29. Puerperal and post-abortive sepsis - 3 3 30. Other maternal cases - 5 5 31. Premature birth 1 4 14 32. Congenita malform,birth injury, infantile disease 13 3 15 33. Suicide 8 2 10 34. Road traffic accidents 7 4 11 35. Other violent causes 44 46 90 36. All other causes 5 7 57 114 Totals 167 582 1253 Totals for 1940 790 817 1607 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. 15-65 yrs. 65 yrs. and over. - - - 1 1 14 65 95 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Clinics and Treatmens Centre: Foot Clinic.- Total attendances were 8,472 end of these 587 were by ne.v patients and 7,785 were re-attendances by old patients. The receipts were £400.12.7. 5. 0 Women's Clinic.- Sessions were held weekly, with one consultant session monthly. Miss Heler Redway, M.R.C.O.G submits the following report:- WOMEN'S CLINIC REPORT, 1941. The total attendances this year were 1,322; this includes attendances made by 299 new patients. Since May the Consultants Clinic has not been held as so few patients have required the services of a Consultant. Sixteen patients were referred to the south london Hospital for investigations which could not be carried out at the Women's Clinic; in five cases patients were admitted for operation. Twelve patients were referred to the Connaught or other hospitals for treatment. During the war only urgent cases are generally admitted for operation. At the present time there is great reluctance en the part of women t' enter hospital for treatment as they do not wish to leave their homes and families or rive up their employment if they are working. Number of sessions held - 74. Total attendances made by patients:New - 299; Old - 1023. Previous years attendances were:- 1940 1939 1938 1937 New Old New Old New Old New Old (a) Consultant's Clinic 1 124 7 115 21 135 14 124 (b) Assistant Medical Officer's Clinic 259 1031 329 1077 298 1043 251 853 (c) Senior Sister's Clinic - 28 - 42 - 6 - - Totals 260 1183 336 1234 319 1179 265 957 Summary of New Cases this year. Ante-Natal 69, Post-Natal 12, Gynaecological 123, Sterility 15, Surgical 31, Medical 28, Contraceptive 13, Not classified 8, Total: 299. Twenty-five patients were referred to the Clinic from Private Doctors; eleven were referred to private Doctors. SANITARY CIRCUMSTANCES OF THE AREA. 1.(i) WATER.- No new mains have been installed during the year 1941 (ii) DRAINAGE AND SEWAGE- No work of this character has been carried put during the year 1941. 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.- No change since 1940. (ii) PUBLIC CLEANSING. - Mr . Eric Bell, M.I.P.C., A.R San.I. , Cleansing Superintendent, reports as follows:- HOUSE REFUSE COLLECTION.- Although difficult conditions still prevail the total weight of refuse collected during the past year was 21807 tons. This is a slight reduction in weight compare with 1940. 6. The analysis of the refuse still shows that large quantities of tinned fords are being consumed; a drop in the ash and cinder content; and still a large amount of waste paper, cardboard, rags etc. being mixed with the refuse, despite the many appeals made for this to be kept separate, and the Compulsory Orders issued by the government, so that it may be used to the full advantage in tne war effort. Housewives have been appointed as Street Salvage Officers in almost every stroet, and have been advised as to materials most urgently neodod and the point has been stressed very clearly that certain articles 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. These ladies have done and arc still doing excellent work. WASTE FOOD- A scheme has been inaugurated whereby some 1025 tons of this valuable waste food have been collected during the year, and sold direct to farmers for the feeding of pigs and poultry. Approxirately 1,200 bins have been distributed throughout the Borough to Salvage Officers, Works Canteens and Restaurants. These are collected daily during the summer months, and three to four times weekly during the winter. The bins are cleansed and sterilised periodically at the Works TRADE REFUSE.- The contract system for the 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, metel tins, etc. The amount of trade refuse delivered by traders to the Works for disposal for the year 1941 has shown a reduction on previous years. REFUSE DISPOSAL.- During the past year the total tonnage of refuse handled at these Works has been 23298 tons. After the subtraction of all salvageable material the actual tonnage that goes to the furnaces is naturally low. It has been found possible to dispose of this by working a reduced number of shifts The national appeal for every ounce of salvageable material to be extracted for the war effort and the extension of the various markets has anabled us to sell various grades of scrap for which, in the past, it has been very difficult to find markets. STREET CLEANSING.- The present standard of street cleansing has been maintained despite the black-out conditions, reduction in sweepers, and the majority of the regular employees now serving with H.M.Forces. GULLET CLEANSING.- The periodical cleansing, disinfecting and sealing of the gullies has been carried, out mechanically, and the machine has now been adapted so that it can be used for Decontamination and fire-fighting. CIVIL DEFENCE.- Nearly the whole of the employees who are eligible have been trained for Decontamination work; squads have been on continued standby day and night and have been of great assistance i:i clearing debris from main roads during raids. A new Decontamination Laundry holding eight boilers, capacity 350 glns, each, has been completed during this year to deal with the decontamination of clothing in the event of gas being used. 7 . Several tests have been carried out at the laundry and it has proved very officient. GENERAL.- The Department is responsible for the clearance of bombed sites and debris from the roads. This entailed an enormous task swing to the difficulty in obtaining suitable labour. The average number of men engaged on this work was 350 per day and 20 lorries. All classes of building material that could be salvaged for re-use was recovered, and a large portion of the ground at the Works allocated for storage. During the year approximately 9,588 loads of debris were removed, 1,500,000 bricks cleaned and re-used for the building of shelters, blast walls, N.F.S. Sub-stations, etc., and many other miscellaneous articles such as slates, tiles, timber, dorrs, baths etc., used for the repairing of bomb damaged properties. (III) SANITARY INFECTION' 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 wi t h Served Complied with 8,639 3,304 1,382 732 909 47 61 13,148 The work under review for 1941 has been rather difficult in that only three District Inspectors were available for three quarters of the year and five for the last quarter - the usual number being seven Inspectors. The average number of complaints received in 1937 and 1938 was 1740, in 1941 the number of complaints was 1332 and with the very depleted inspectorial staff no House to House Inspections were possible. The number of houses found with defects was 899 necessitating the serving of written notices in respect of 732 premises and during the year 909 premises were put into habitable condition. A fair amount of difficulty is being experienced in getting compliance with notices. Shortage of labour and material and sometimes financial embarrassment to the owners are the main causes of this and it would appear that this position will not be eased for some time. The nature and variety of the work done during 1941 is shown in • the following tables:- Drains tested, 335; Drains reconstructed or repaired, 221; Drains, obstructions removed, 142; Drains, means of acoess provided 14; Drains, ventilations provided or improved, 19; Drains, ventilation repaired, 33; Soil pipes repaired, 35; Soil pipes new, provided, 16; Rain water pipes renewed, 39; Rain water pipes disconnected from drains, 3; Roofs repaired or renewed,208; Gutterings repaired or renewed, 207; W.C. pans or traps provided, 160; Gully traps provided, 29; W.C.flush cisterns provided, 50; W.C.flush cisterns repaired, 85; W.C.floors concreted, 32; W.C's.repaired and cleansed, 131; W.C's. light and ventilation improved, 4: Waste pipes renewed or trapped,70; Waste pipes repaired, 81; Few sinks provided, 14 Water supply reinstated, 5; Cisterns cleansed and covered, 16; Conveniences cleansed or repaired, 11; Sculleries paved, 17; Yards and forecourts paved and repaired, 72; Dirty houses cleansed, 2; Dirty rooms cleansed, 849; Floor repaired, 63; Ventilations under floors provided or improved, 27; New damp-proof courses provided, 17; Sites concreted, 2; Offensive accumulations removed, 40; Animals improperly kept, removed, 3;Manure receptacles provided, 1; Stables cleansed, paved and. drained,45; Manholes repaired or re-sealed, 113; Other cases of dampness remedied, 144; Miseellaneous repairs, 859. 8 Infectious Diseases. Visits to premises, 546; Re-visits to premises, 130; Premises disinfected, 218; Articles disinfected at Low Hall, 2471; Articles destroyed at Low Hall, 65; Bedding dried from 7 bombed houses. Dampness in Houses. Site's concreted, 2; Damp-proof courses provided, 17; Yards and forecourts paved and drained, 72; Roofs made watertight, 203; Rain-water pipes made good, 99; Guttering repaired or renewed,207; Other oases of dampness remedied, 144; Ventilation under floors provided or improved, 27 Special Premises. Number. paid. Factories 366 484 Outworkers 293 1037 Butchers' Shops 80 336 Balee houses 42 196 Fishmongers, fish fryers & curers, etc. 25 140 Eating-houses and Coffee Stalls 84 197 Ice Cream. Vendors 127 76 Cowsheds 1 6 Dairies and Milkshops 109 157 Laundries 8 6 Rag and Bore Dealers 6 15 Piggeries 3 48 Street Stalls Numerous 41 Greengrocers " 117 Stables, Mews, Yards, etc. " 200 As a result of the regular periodical visiting of the Special Premises the following works were carried out:- Butchers' Shops and Slaughter houses . Special cleansings, 25; Pavitig repaired, 1; Accumulations removed, 10; New Galvanised Bins provided, 6; Drains repaired,2; W.C.S repaired and cleansed, 9; Yard paving repaired, 1; Floors repaired and ventilated, 1; Roofs repaired, 1; Drains cleared, 4. Bakehouses. 'Special" cleansings, 71; Drains repaired, 1; W.C.S. cleansed and doors repaired, 36; W.C. cisterns repaired, 3; Roofs repaired, 5; Premises general repairs, 2; Obstruction from drains removed,4; Ceilings repaired, 2; Floors repaired, 3. Fishmongers. Special cleansings, 15; Yards repaved, 2; Accumulations removed, 5; Roofs repaired, 2; Other improvements, 4; Drains cleared, 6; Gutters renewed, 3. Coffee and. Eating Houses. Special Cleahsings,46; W.C. cisterns repaired, 1; Drains repaired, 3. Ice Cream Vendors . Special cleansings, 14; Special cleansing of utensils, 4; Cowsheds and Milkshops. Speecial cleansings, 17; Fittings and other improvements, 1; Roofs repaired, 4; Light improved, 1. Stable Premises . Clean sings,46; Accumulations removed, 10; Roofs repaired, 5; Pavings repaired, 3; W.C.S repaired, 1; Manure receptacles provided, 1; Drains/reconstrueted, 4. Laundries. Special cleansings, 3; Roofs repaired, 2; Other improvements, 1. 9. Rag and Bone Dealers. Cleansings, 9; Accumulations removed, 1, Figgeries. Cleansings. 10; Paving rolaid, 1: Retrained, 1. (iv.) Eradication of Bed Bugs.- Work in connection with this matter was carried out as heretofore. HOUSING. (a) Statistics. The particulars of new houses erected during 1941 are given in the form of previous years. The following are the figures supplied by the Borough Engineer and Surveyor;- Number of new houses erected during the year:- By Local Authority Nil By Other Authorities Nil By Other Bodies or persons 24 The 24 houses are situated as follows:- Halo End Ward 24 High Street Ward Nil Higham Hill Ward Nil Hoe Street Ward Nil St. James' Street Ward Nil Wood. Street Ward Nil (b) Inspection. The following information is given in the form required by the Ministry of Health, and is supplied by the Chief Sanitary Inspector: - I..- Inspection of Dwelling-Houses During the Year:- (1)(a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 1,983 (b) Number of inspections made for the purpose 4,707 (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 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (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 frr human habitation 899 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 909 10. III.- Lotion Under Statutory Powers During the Year:- A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:- (1) Number of dwelling-houses in respect of which notices were served requiring repairs 45 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners 52 (b) By local authority in default of owners (at a cost of £98.0.10.) 7 B. Proceedings under the Public Health Acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By owners 2 (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 (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 Unfit Houses. 17 - 20, Courtenay Place. These four houses were in December, reported and confirmed as unfit for human habitation. (c) General. The Council's Housing Manager, Mr.J.E.West, in a full report draws attention to the difficulties of rehousing under war-time conditions, to the increase in overcrowding, to the full use of requisitioning powers for the rehousing of the homeless, to the shortage of accommodation for families of one to three persons and to the promising experiment in adapting a large house for hostel accommodation. 74 vacancies arose in Council Houses, there were 10 transfers rehousing 41 persons, 40 cases of rehousing involving 193 persons, 12 lettings involving 64 persons and 4 oases rehoused on medical grounds and involving 22 persons. Disinfestation has been carried out where possible with hydrogen cyanide. 11. INSPECTION AND SUPERVISION OF FOOD. The following is contributed by the Chief Sanitary' Inspector;- (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 average number of cows kept in the district is eight. There is only one a cowshed and 6 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 109, most of whom carry on a general shop and sell milk in battles as they receive it. Visits were paid to maintain the general standard of cleanliness. During the year 19 samples of milk were taken for bactericlogica1 examination. Two gave unsatisfactory results. The samples are summarised as follows:- No . Of Samples Satisfactory. Unsatisfactory. Tuberculin Tested 5 - Pasteurised 12 2 Totals 17 2 THE MILE AND DAIRIES ORDER, 1926. Attention was again directed to this Order with a view to minimising the risk of contamination, infection and adulteration -of milk. 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's Licences. In respect of:- Pasteurised Milk 30 Tuberculin Tested Milk 16 Supplementary Licences . Pasteurised Milk 3 Tuberculin Tested Milk 3 Bottling Licences. In respect of Tuberculin Tested Milk, 2; Pasteurised Milk, 2. Council Under the requirements of the Essex County Act, 1933, all Ice Cream Vendors or Manufacturers in the Town must be registered. During the year registration was granted in two cases, and a total of 127 Vendors were trading. Most sold a proprietary article and those manufacturing the commodity were kept under special supervision. (b) Meat and Other Food. No slaughtering has been carried out during the year under review. As mentioned in the Report for the year 1940, slaughtering in this Borough ceased owing to the operation of the Live Stock (Restriction of Slaughter ins-) Order 1940. The following is a list of food condemned as unfit for human consumption:- 6 tins Luncheon Meat 3 " Chopped Pork 2 " Beef Briskot 8 " Chicken & Ham Roll 3 lbs. Corned Beef 7 " Ox Liver 11 " Lamb 5 " Beef 7½ " Mutton 40 " Beef & Mutton Trimmings 154 " Bacon 20 lbs. Cocoa & Coffee 374 " Tea 140 '' Cones (type of Rice Flour) 6½ " Rice 3½ " Tapioca 41" Oats 6 boxes Marmite Cheese Spread 28 jars Beetox 10 '' Pickles 15 " Beef & Vegetable Extract 2 " Salmon & Anchovy Paste 12. 82 lbs. Pig Brawn 42 " Sausages 1 lb. Liver Sausage 24 Sausage Roils 50 Meat Pies 42 tins Plums 53 " Pears 2 " Raspberries 1 tin Damsons 1 " Peaches 155 lbs. Tinned Fruit (various) 10 tins Beans 13 " Carrots 46 " Peas 304 lbs. Apples 40 " Apple Rings 104 " Sultanas 109 " Dried Fruits 65 " Onions 4 doz. Cauliflowers 9 tins Salmon 4 " Mackerel 1 " Pilchards 1 " Cray Fish 346 " Sardines 5 " Herrings in Tomato 2933 " Milk (1280 returned 1280 " for reconditioning) 1 jar Turkey & Tongue Paste 809 Eggs 12 jars Meat Paste 218½ lbs.Flour 150 " Pastries 22 leaves Bread 29 lbs. Biscuits 44 pkts. Cereals 115 Savoury Rolls 2 tins Savoury Rolls ) 2 lbs. Matz-o-Meal 20 " Cheese 286 " Sugar 34 Bate Cake 565 " veal Loaves 210 Butter,Margarine & Cooking 18 " Dripping (Fat. 1 Turkey (approx. 14 lbs.) 2 Chickens (cooked) 20 Pkts.Pudding Mixture 3 tins Morton's Emergency Meal 4½ doz. (¾ lb.) Plum Puddings 14 Table Jellies 102 lbs. Jam (various) 5 stone Coal Fish 27 " Witch. 15 lbs. Fillets 140 " Cod Fish (c) Adulteration, - Food & Drugs Act ,1938. During the year 172 samples of a variety of food and drugs have been taken for analyses. Of these 3 samples were not satisfactory the particulars being as fellows:- Description of Article Shredded Beef Suet Veal Loaf Egg Substitute Result of Analysis. Adulterated by 7% excess of Rice Flour. Impregnated with mould growths. Only about 1/4 strength usually regarded as proper for egg substitute powders. Decision Taken. No action - adulteration insignificant. 565 lbs. of these loaves condemned . A No action. At the time of this sample the Ministry of Food had the matter of legislation for substitutes (in hand .Therefore it was (not advisable to institute proceedings. RENT AMD MORTGAGE RESTRICTIONS ACTS, 1920-1928. During the year seven certificates were granted to tenants and one certificate has been issued upon application and completion the scheduled works. DISEASES OF ANIMALS ACTS, 1894-1928. Regulation of Movement of Swine Order, 1922.- Isolation Notices affecting 19 swine were received. The Licences were duly observed. RATS AND MICE DESTRUCTION ACT, 1919. Much attention has been given to destruction of rats during the year, particularly to areas affected by enemy action. Such work necessitates many revisits. In certain cases prebaiting was carried out, and Cyanide Gassing of rats has been executed wherever practicable . In connection with this work, two labourers have been available from the Cleansing Department. 13. Under the Food Control Committees (Destruction of Eats & Mice) Order, 1940, a report is furnished monthly to the Ministry of Food (Rodent Officer) setting out information as to inspections and action taken in combating the rodent nuisance on all descriptions of premises and land. The following is a summarised version of the work carried nut for the year:- No. of premises & Sites Inspected. Premises & Sites found to be Infested. Methods used at Infected Premises & Sites Food. Other. Food. Other. Baiting Trapping .Gassing Other 334 751 53 491 207 31 29 324 Complaints received 249 Premises rat-proofed . 42 Advice only given 39 Re-inspections 560 PETROL (MIXTURES) ORDER, 1929. Legal proceedings were instituted regarding this Order made under the Petroleum Act 1928. Convictions were obtained against a firm for the second time - the first conviction occurring in 1940 - for identical offences. For (1) storing petrol mixture without a licence and (2) storing the mixture not properly labelled, the Defendants were fined £25 and £5 respectively, plus 10 guineas costs. FACTORIES ACT, 1957. The following tables show the work done under these Acts:— 1,:- INSPECTION 0E FACTORIES,. ETC. Including Inspections made by Sanitary Inspectors. Premises (1) Number of Inspections (2) Written Notices (3) Occupiers Prosecuted (4) Factories (power); 371 15 Nil. " (non-power) 128 11 Nil. Other premises under the Act 88 6 Nil. Total 587 32 Nil. 2.- DEFECTS FOUND IN FACTORIES, ETC. Particulars (1) No. of Defects No . of Offences in respect of which prosecutions were instituted, (5) Found (2) Remedled. (3) Referred to H.M. Inspector (4) Want of cleanliness 37 37 - - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation - - - - Ineffective drainage of floors - - - - Sanitary Conveniences insufficient 15 15 - - unsuitable or defective 69 69 - - not separate (for seres 1 1 - - Other offences 21 21 - . r Total 143 143 Nil Nil. 14. NU1DER AND TRADES OF OUTWORKERS NOTIFIED DURING 1941 Wearing Apparel, making of 197 Toys 1 Brush Making 52 Belts 6 Boxes 24 Feathers 1 Furs 1 Shoes and Bents 10 Artificial Flowers 1. Total 293. Cutworkers were notified from the following areas:- City of London 28 Shoreditch 4 3ethnsl Green 9 Southwark 2 Finsbury 22 Stepney 2 Hackney 49 Tottenham 3 Islington 12 Wandsworth 2 Kensington 3 Walthamstow 8 Leyton 127 Westminster 8 St.Pancras 2 Woodford 12 Total 293 A total of 1037 visits were paid in connection with outworkers. PREVALENCE OF, & CONTROL OVER, INFECTIOUS & OTHER DISEASES. GENERAL.- The accompanying tables show the age and ward incidence of the various infectious diseases which are discussed separately in later stages 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 years. 1941 1940 Scarlet Fever 117 89 - 35 62 8 11 - - Diphtheria 26 17 - 5 17 3 1 - - Enteric Fever 2 3 - - - 1 - 1 - Pneumonia 138 90 4 8 16 13 40 40 17 Puerperal Pyrexia 33 35 - - - 14 23 1 - Opthalmia Neonaterum 3 4 3 - - - - - - Erysinclas 31 27 - 1 1 2 10 12 5 Encepnalitis Lethargiea - 5 - - - - - - - Polio-encephalitis - - - - - - - - - Cerebro Spinal Meningitis 20 6 3 2 3 5 5 2 - Anterior Poliomyelitis 1 1 - - - 1 - - - Measles 1,087 73 32 432 611 9 3 - - Whooping Cough 451 14 39 237 171 1 2 1 - Dysentery - 1 - - - - - - - Tuberculosis 116 156 - 3 5 31 59 15 3 Totals 1941 2,030 - 81 724 886 88 154 72 25 1940 - 526 18 91 91 82 141 69 22 Diseases St.James Street High St. Hoe Street Wood Street Hale End Higham Hill Totals Scarlet Fever 24 11 25 4 33 20 117 Diphtheria 5 6 2 6 4 3 26 Enteric Fever - 1 - - 1 - 2 Pneumonia 25 13 18 15 37 30 138 Puerperal Pyrexia 4 6 6 6 9 7 33 Ophthalmia Neonatorum - - - 1 1 1 3 Erysipelas 7 5 4 1 7 7 31 Encephalitis Lethargica - - - - - - - Polio-encephalitis - - - - - - - Cerebro-Spinal Meningitis 2 5 3 1 2 7 20 Anterier Poliomyelitis 1 - - - - - 1 Measles 268 193 122 36 163 300 1,087 Whooping Cough 80 73 30 19 74 120 451 Dysentery - - - - - - - Tuberculosis 17 18 25 13 20 23 116 Totals 1941 433 336 285 102 356 518 2,030 1940 75 56 33 44 120 148 526 The statistics given in the foregoing table are those for the calendar year 1941. 15 . The rate for Puerperal Pyrexia is better expressed in relating to the number of births (i.e. live and still-births) registered than to population. When calculated on this basis the rate is:- Walthamstow 29.1 England and Wales. 11.91 1. All cases not notified. * 2. Not a registrable cause of death. 3. Not notified, or notified in previous years. The following, table shows the work done at the infectious disease clinic, the large majority of patients being of school age:- Number of clinics held in connection with Infectious Diseases and Immunisation 51 Number of attendances made 2,646 Average attendance per session 46,2 Number of virulence tests taken Number of children recommended to rheumatism clinic Number of children recommended to ear clinic 4 DIPHTHERIA IMMUNISATION. Immunisation was carried out at the weekly clinic on Tuesdays at 2 p.m. and at all departments at schools, along the lines detailed in the previous reports. The following summarises the work done:- Schick tested for the first time Negative (including pseude and negative) positive (" " positive) Total number of immunisations completed during 1941:- (a) School age 1,200 (b) Pre-school age (including 236 of 1 yr. of age)755 (c) Over school age 16 Total 1,971 Number not completing immunisation or left district 126 Number of Schick tests following immunisation Number of attendances made at clinic for immunisation 2,046 Immunisation at schools (included above) Number- comp1etely immunised Number partly immunised Number having second dose, immunised with single dose in previous years 16. Disease Total Notified Removed to Hospital Percent. removed to Hospital Deaths Deaths per cent. of cases notified. Scarlet Eever 117 81 69.2% Nil Nil Diphtheria 26 25 96.l% 5* 19,2% Enteric Fever 1 1 100% Nil Nil Pneumonia 138 53 38.4 % 33 60.1% (1) Puerperal pyrexia 38 5 13.1% Nil Nil Ophthalmia Neonatorum 3 1 33% Nil Nil (2) Erysipelas 31 9 29.0% Nil Nil (2) Cerebre Spinal Meningitis 20 19 95.0% 5 25.0% Encephalitis Lethargica - - - 2 - (3) Measles 1,087 24 2.2% 4 .30% Whooping Cough 451 42 9.3% 1 .22% Anterior Poliomyelitis 1 1 100% Nil Nil Tuberculosis 116 147 (3) - 61 52.6 % Birthday Letters.- Letters were sent to the parents of all infants following their first birthday and stressing the need for protection against diphtheria. 834 letters were issued and 206 infants were brought and protected. 408 infants had left the district. 8 infants were immunised by private practitioners. Immunisation by General Practitioners.- Diphtheria prophylactic is available to general practitioners. During 1941, 29 c. c's. of alum precipitated toxrid were issued; this quantity is sufficient to protect 29 children. Scarlet Fever Immunisatifon.- There were no Dick tests for Scarlet Fever during 1941.:- MUNICIPAL LABORATORY. The following numbers Of diphtheria swabs were examined during 1941:- Swabs. Negative. Positive. Totals. Private Practitioners 228 15 243 Health Department 11 3 14 School Medical Department 79 3 . 31 Totals 3JLG 26 344 The ttal number rf diphtheria specimens examined in 1941 was 324. Direct examinations T/ere done rn 22 diphtheria specimens nf which 4 were positive. In addition, 57 specimens of urine were examined, as compared vri tli 158 in 194C. A trtal of 682 tubes rf culture media were made and of these, 300 were sent t~ the Sanatorium. ESSEX COUTY COUNCIL SCHEME. The Essex County Council also provides facilities for examination of pathological specimens, and the County Medical Officer states that 1155 specimens were examined for local practitioners during 1941 as fallows:- Diphtheria swabs, 15; Sputa, 532; Typhoid specimens, 11; Miscellaneous, 508; VACCINATION. Mr.E.Sharp, Vaccination Officer for the Area, has furnished the following return for 1941:- Births Successfully Percentage Insus- Exemptions Death before PostRegistered Vaccinated Vaccinated ceptible Vaccinated poned 1,031 183 17.07 2 471 37 16 In addition to the above, 21 primary vaccinations were recorded, and 13 re-vaccinations. During 1941 the vaccinal condition of all schorl children examined at Routine Medical Inspection was recorded, and a summary of the findings for the year showed that 18.0 per cent. were vaccinated. HOSPITAL TREATMENT OF SMALLPOX. As for previous reports. PREVENTION OF BLINDNESS. No action was necessary under Section 175 of the public Health Act, 1935, for the prevention of blindness or the treatment of persons suffering from any disease of, of injury to, the eyes. 17. INFECTIOUS DISEASES HOSPITAL. Renovations, etc. - The following; works of maintenance were carried out during 1941:- (1) Renewal of Heating and Domestic Hot Water Boiler in chamber adjoining Laundry Block. (2) Rebuilding of chimney stack at the N. end of F. Block. (3) Renewal of overhead cable to internal bell and fire alarm system. No other work of major importance was carried out in 1941. General.- (1) The death rate per 100 admissions of infectious disease patients was 1.35 and per 100 total admissions 3.64. (ii) During the year the County Council continued the grant payable by them in respect of infectious disease beds, and amounting to £425. (in) The following table shows the admissions, discharges and deaths during 1941:- Scarlet Fever Diphtheria Other Diseases Tuberculosis Totals. Remaining in Hospital 1st.January 10 3 10 12 35 Admitted during year 117 90 155 22 384 Discharged during year 117 72 155 13 360 Died during year - 3 3 3 14 Remaining in hospital 31st.December 10 18 7 10 45 SCABIES. Twelve cases of Scabies were observed in patients admitted for infectious diseases and gave opportunity for prolonged observation. An "apparent" cure can be obtained by any of the new classical treatments. But the disease can be dormant for months and is very difficult to eradicate, fully. Early and easy cures arc deceptive. Children cannot tolerate strong sulphurointment. Benzyl benzrete was disappointing. Each case must be treated its merits. One or two applications is sufficient for some patients and some cases seem to defy all treatment. Three oases were complicated by impetigo, and were very obstinate. DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL, (including Tuberculosis cases.) January 33.9 April 38.9 July 33.2 October 40.5 February 37.8 May 43.3 August 33.2 November 40.2 March 38.6 June 37.0 September 39.6 December 49.0 Average whole year 38.8, 18. CLINICAL REPORT. Dr.Hamilton, Resident Medical Officer, reports as follows AGE AND SEX OF PATIENTS ADMITTED DURING 1941. 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 24 18 26 19 7 7 8 8 65 52 117 Diphtheria 12 15 21 15 4 6 7 11 45 45 90 Whooping Cough & 24 22 3 7 - - -- - 27 29 56 Bron. Pneumonia Measles 9 18 6 5 - - 1 2 16 25 41 Pulmonary Tuberculosis - - - - - - - 22 - 22 22 Staff - - - - - - - 13 - 13 13 Other diseases 5 5 5 5 5 7 8 22 23 45 Totals 74 78 61 51 16 18 23 64 175 209 384 ''Other Diseases" included rubella, simple tonsillitis, colds, erysipelas and oases sent in for observation in whom no specific symptoms developed. AGE AND SEX AT DEATH. Fourteen deaths occurred, details of which are given below:- 8 Pulmonary Tuberculosis 8 Females aged 36, 39, 21, 29, 32, 49, 18 and 25. 1 Broncho-pneumonia 1 Male aged 4 years. 1 " " & Whooping Cough. l Female aged 5 weeks. 3 Diphtheria 1 Female aged 4f years, 2 Males aged 6 and 7 years. 1 Facial Erysipelas 1 Female aged 51 years. NUMBER OF OUTSIDE AUTHORITIES' CASES AND NATURE. Diphtheria Scarlet Fever Other Diseases Totals. From Ley ton B.C. 40 38 45 123 " Chingford B.C. - 1 3 4 " Whipps Cross Hospital 1 - 1 2 " Essex County Council - - 3 3 Totals 41 39 52 132 "Other diseases" covers a wide range of cases viz: measles, rubella, whooping cough, cerebre-spinal meningitis. Seventeen cases of Cerebro-Spinal Meningitis were admitted on notification to us. Twelve cases were confirmed bacteriologicelly. Four were severe and eight of moderate intensity. All made good recoveries. Swabs.- 204 swabs were taken and examined during the year in the laboratory at the hospital. Duration of Treatment.- The average duration of treatment in Hospital was as fallows:- Diphtheria 43 days. Scarlet Fever 22.1 " Other diseases 23.1 " 19. The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1941:- Classification in accordance with Ministry of Health Memorandum 37 T.(Rev.) In Hospital on 1st. Jan.1941 Admitted during year Discharged during year Died during year In Hospital on 31st. Dec.1941. Observation - 1 - - T.B.Minus 1 5 2 — 3 T.B.Pius Group I. - 1 1 - - T.B.Plus Group II. 10 13 5 2 6 T.P.Plus Group III. - - - - - Totals 11 20 8 2 10 Ten of the 11 admissions were whlthamstow cases. MEDICAL EXAMINATIONS. During the year, 13 examinations were carried out by the M. dical Staff in respect of the Superannuation and Sick Pay Scheme. MISCELLANEOUS. 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 Inquests only 147 Post-Morterns 100 Post-Mortems and Inquests (not included in above) 26 Total 273 CREMATION. Facilities for cremation are available at the Crematorium provided by the Corporation of the City of London, at Manor Park, Little Ilford. PREVENTION OP TUBERCULOSIS. In order to limit the spread of infection and following the issue of the Public Shelter Rules made by the Regional Commissioners under the Defence Regulations, a letter was addressed to each known "open" case of pulmonary tuberculosis in the Borough prohibiting the use of a Public Air Raid Shelter. Any such patient not possessing a habitable domestic air raid shelter for the sole use of the patient's own family was invited to communicate with the Borough Engineer who had kindly agreed to give priority to all such cases. 20. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs.E.A.Smith. Ex-Officic: The Worshipful the Mayor - Councillor J.K.Williams, J.P. The Deputy Mayor - Councillor R.F.A.Russell, J.P. Chairman of Finance Committee - Alderman Ross 7yld, J.P. Alderman Mrs.L.P.Bailey, J.P. Alderman Mrs .E.M.Miller " A.G.Bottomley, G.B.E. " Miss E.M.Pracy,B.Sc. " Mrs.C.McSntee, J.P., E.C.C. " Mrs.E.M.Richards Alderman W.H.Shaw. Councillor Mrs.B.M.Eriedberg Councillor G.S.Mace " F.W.Gentle " Mrs. A.L.Meadows " W.Gillett " R.E.Smith " G.J.R.Holt " G.H.Spackman " J.W.Lis " Mrs.E.B.Toynbee " G.R.Lowton A.H.Williams Co-opted Members: Dr .Helen Watson Mr.W.H.Kindell Mrs.S.Cand y Mrs.W.H.Kindell Mrs.M.Jarman Mrs. G.N.Riley. Tom Clerk: F.G.GARNER, ESQ. 21. TO TIE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen, This report records another low infant mortality rate (44), although slightly higher than that of 194C. The birth rate was below that of 1940, hut was the second highest of the ten years to 1932. The maternal mortality was, unfortunately, the highest for many years and no fewer than five deaths were due to abortion, illegal or natural. During the year extra clothing coupons were distributed to expectant mothers, and fruit juices to infants and young children. This additional work was cheerfully borne by the Staff. I again have to record your 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. 22. NOTIFICATION OF BIRTHS. 1122 births (33 of which belonged to other areas) were notified during the year under the Public Health Act, 19-36. Notifications were received as follows:- doctors and parents, 113, midwives,1009. Included in the above are 71 births which were notified as having occurred outside the Borough. Also included are 35 stillbirths, 1 of which did not belong to the area. 5 were notified by doctors and 30 by midwives. Of the total, one occurred outside the area. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:- (a) LIVE BIRTHS. Males Females Totals. Legitimate 648 606 1254 Illegitimate 28 22 50 Totals 676 628 1304 (b) STILLBIRTHS. Legitimate 23 10 33 Illegitimate - 2 2 Totals 23 12 35 Of the 1045 birth registrations received in the Department between 29th.December, 1940, and 27th.December, 1941, a total of 7 were not notified in this area, but some may possibly have been notified elsewhere. Appropriate action as taken when necessary. Of the 1045 local registrations, 63 belonging to other areas are excluded, leaving a nett total of 982, ISSUE OF CLOTHING COITIONS TO EXPECTANT MOTHERS. A special issue of clothing coupons became available to expectant mothers from August 9th. 1941. These were issued by the Public Health Department on production of a certificate of pregnancy. Up to the end of the year issues had been made to 731 expectant mothers whose arrangements in regard to confinements were as follows:- Dootors, 71; Midlives, 225; Nursing Homes, 49; Thorpe Coombe Maternity Hosnital. 371: Evacuating, 15. This scheme has had the effect of notifying all pregnancies and full advantage of this has been taken in follow-up visits by Health Visitors. ISSUE OF VITAMINS. Bottles Cod Liver Oil Bottles Blackcurrant Syrup Tins Blackcurrant Puree Welfare Centres, Thorpe Coombe and Town Hell 1123 519 1934 Issued by Milk Office 334 91 838 Total issued in Walthamsto. 1457 610 2772 INFANT MORTALITY. The deaths of infants under one year of age were:- Males Females Total. Legitimate 33 17 50 Illegitimate 2 - 2 Totals 35 17 52 23. The death-rates of infants under one year of age per 1,000 live births when calculated on the totals given by the RegistrarGeneral are therefore:- Legitimate, 45.0; Illegitimate,-40.0; Total, 44.8. The Infant Mortality Rate for other areas during 1941 was as follows:- England and Wales 59 126 County Boroughs & Great Towns (including London) 71 148 Smaller Toms (25,000 to 50,000) 56 London 68 Neo-Natal Mortality. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1941, 31 infants died in the first four weeks of life, yielding a rate of 23.7. For the lest ten years in England and Wales the neo-natal deaths have been approximately one-half of the total deaths under one year of age. The following rates refer to Walthamstow:- INFANT DEATHS, NEO-NATAL MORTALITY AND STILLBIRTHS. Year Live Births Stillbirths Nro-Natal Deaths Infant Deaths. No. Per 1,000 live births No. Per 1,000 live births No. Per 1,000 live births 1941 1304 35 26.8 31 23.7 52 44 1940 1575 42 26.6 39 24.7 60 40 The neo-natal mortality for England and "ales for the decennium 1521-30 was 33. The death-rate from Diarrhoea in children under one year of age per 1,000 live births was 1.53. 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 152 notified births, and one whole-time Health Visit per 178 registered births during 1941. MATERNITY AND CHILD WELFARE CLINICS. As set out in previous reports. A. MUNICIPAL SCHEME. The detailed findings at first visits paid during 1941 are giver, in the fallowing table:- 24. 25. The following table shows the number and nature of visits paid during 1941:- 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. Total Visits First Re-visits Total First Visit Subsequent Visits Total Visits Other Visits 1 2 3 4 5 6 7 8 - - 9 10 Cols.5-10 St.James Street 209 523 732 884 1616 652 15 0 102 23 125 274 2,690 High Street 124 369 493 544 1037 371 21 1 43 26 69 139 1,638 Hoe Street 171 580 751 921 1672 567 77 7 47 26 73 186 2,582 Wood Street 99 183 282 298 580 321 8 - 30 11 41 86 1,036 Hale End 238 966 1204 1574 2778 645 29 - 48 22 70 341 3,863 Higham Hill 247 783 1030 1966 2996 687 112 4 67 28 95 300 4,194 Total, 1941 1088 3404 4492 6187 10679 13243 262 20 337 136 473 1326 16,003 Total, 1940 1372 3038 4410 4682 9092 2821 147 604 250 48 298 592 13,554 CLINICS. Dr. Sheppard reports as follows:- Facilities for massage, dental, orthopaedic, ophthalmio and aural treatment were, taken full advantage of. A Representative from the South-Eest Essex Technical College attended the Welfares regularly and gave the mothers great assistance in wartime cookery. Thanks are again due to the voluntary workers who have been very faithful and helpful The attendances at the Ante-Natal Clinics increased towards the end of 1941 and several extra sessions had to be arranged. The Evacuation Scheme for Expectant Mothers has worked smoothly. During 1941, 52 mothers were evacuated. Every effort is made to see each mother during the week previous to her departure. 99 .ante-Natal Sessions were held in 1941 and 897 attendances made. 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 824 340 Low Hall Lane Clinic 281 8 Totals 1105 348 Total Attendances:- Thorpe Coombe Maternity Hospital 6475 464 Low Hall Lane Clinic 897 8 Totals 7372 472 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 430 236 666 7509 7832 15341 16007 Higham Hill 219 99 318 3520 4040 7560 7878 Hale End 197 48 245 3375 4598 7973 8218 Total 1941 846 383 1229 14404 16470 30874 32103 Total 1940 1029 365 1394 16803 17241 34044 35438 Nurse Children.- At the end of 1941 there were 40 nurse children on the register, compared with 48 at the end of 1940. During the year 14 removed, 4 were adopted, and 4 reached the age of nine years. 11 new children were registered. There were no deaths among nurse children during 1941. 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, Wednssday. 134 cases attended for massage, and these made 1,930 attendances. 26. Sale of Milk, etc. at Clinics,- The value of milk and food sold and issued free during 1941 was £2,397. 2,10. WALTHAMST0W 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 D. Carter:- CLINICS. First Attendances of New Cases Re-attendances Grand Total Under 1 Yr. 1-5 yrs. Total Under 1 Yr. 1-5 yrs. Total 1941 340 91 431 3953 2554 6507 6938 Special Treatment, etc.- Massage Treatments, 921. Sunlight " 955 HOME VISITS. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total First Subsequent Total 1941 308 519 827 1504 2331 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 846 383 1229 14404 16470 30874 32103 Brookscroft 340 91 431 3953 2554 6507 6938 Total 1941 1186 474 1660 18357 19024 37381 39041 Total 1940 1473 439 1912 23998 20902 44900 46812 HOME VISITS. To Children under 1 year Visits to Children 1-5 years. Grand Total First Subsequent Total Municipal Scheme 1088 3404 4492 7889 12381 Brookscroft 308 519 827 1504 2331 Total 1941 1396 3923 5319 9393 14712 Total 1940 1810 4164 5974 7808 13782 Percentage of notified live births represented by number of children under 1 year of age who attended the Centres for the first time, (i.e. new cases) 1941. 106.1x x Some first attendances were duplicated at Voluntary Centres. 27. Percentage of total notified births represented) by number of expectant mothers attending Ante-Natal Clinics 1941. 98.4 TREATMENT. (a) Orthopaedic. Defects seen at Orthopaedic Clinic in Children under Five Years of Age. Anterior Poliomyelitis 2 Congenital Dislocation of Hip 1 Ollier's Disease 2 Congenital Defects 10 Rickets - Talipes 14 (a) Genu Varum 43 Miscellaneous 10 (b) Genu Valgum 43 Total 167 Pes Plano Valgus 31 Spastic Paralysis 3 Torticollis 7 Arthritis 1 (b) Dental. The following work was done by the Education Committee's Dental Surgeons in respect of Maternity and Child Welfare patients:- 1939 1940 1941 Mothers Children under 5. Mothers Children under 5. Mothers Children under 5. Cases Treated 184 92 87 105 137 104 Attendances 657 160 277 278 539 169 Fillings 221 84 214 116 185 142 Extractions 446 139 288 92 274 44 General Anaesthetics 171 73 107 62 106 21 Scalings 92 - 57 - 67 - Dressings 34 30 17 14 41 56 Dentures 26 - 11 - 30 - Mrs. W.R.Thorne, L.D.S., reports as follows:- The number of new cases during 1941 was 353, a considerable decrease on the previous year. 43% of these attended the clinic, a slight increase in attendance on the previous year. 902 appointments were given. 28% received complete treatment, 60% received partial treatment, the rest no treatment. A very fee refused to be treated. On request a number of failures were sent for again. The response was disappointing as very few of these attended, and there are always the cases who ask to have some part of their treatment postponed until after the birth of the child. These rarely return unless for prosthetic work. Though fewer cases were referred to the clinic a larger percentage received treatment. The failures to complete are too numerous and very discouraging: when the patient has not been in the habit of receiving regular dental attention, it is hardly to be expected that during pregnancy she would wish to have it. Some failures are directly due to the mother being out at work and, with her home duties she does not find time to have treatment. 30 dentures have been supplied, which is a good increase on the previous year. Dental sepsis is lessening, although there is no evidence that greater attention is given to oral hygiene. (c) Tonsils and Adenoids.- One case was operated on under the arrangement made with the Connaught Hospital. (d) Ophthalmic Defects and Minor Ailments.- Children are given treatment either at the School Clinics or by special appointment. 28. (e) Sunlight.- No infants were referred for sunlight tre&tnent during 1941. (f) Child Guidance.- Arrangements have now been made for children under five years of age to be referred to the London Child Guidance Clinic. No cases were referred in 1941. (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 24 Orthopaedic Care 11 Others 3 38 Suffering from:- Anaemia and Debility 1 Marasmus and Malnutrition 2 Pneumonia, Bronchitis, Asthma, etc. 8 Bone Disease (non-T.B.) 14 Congenital Deformities 3 Paralysis 1 After Infection 3 Diseases of Ear 2 Air Roids 1 Various 3 38 Help Given to 0ld and New Cases, 1941. Sent to Special Hospitals and Convalescent Homes 9 Provided with Surgical Boots and Appliances 24 33 ASSISTED MILK SCHEME. Number of applications during 1941 338 Number of families assisted 98 The National Milk Scheme operated from July, 1940 and the above represent applications for special brands of milk not supplied under that scheme. HOME HELPS. Applications for the provision of Home Helps ere considered by the Milk Rota Committee and. if approved, a payment of 12s.6d. per week for,two weeks is made. In addition to the 105 Home Helps approved during 1941 many mothers attending the Clinic made their own arrangements to obtain the help of suitable women whose names were supplied by the Health Visitors. 8 applications were rejected by the Rota Committee. The demand for Home Helps has been as follows during the past seven years: 1935 (50), 1936 (87), 1937 (78), 1938 (178), 1939 (125), 1940 (128), 1941 (105). STERILISED MATERNITY OUTFITS. A total of 247 sets were used in the Borough and 175 outfits were issued below cost price. A sterility test was carried out with satisfactory results on a sample set. 29. LAYETTES. 400 (apprex. ) Layettes were distributed free to necessitous expectant mothers from February, 1941. These Layettes were the generous gift of the American Red Cross. INSTITUTIONAL TREATMENT ETC. 7 children were sent to Institutions under arrangements approved by your Committee. HOSPITAL ACCOMODATION FOR CONFINEMENTS. The following numbers of confinements occurred at the Institutions specified (Walthamstow residents only):- Thorpe Coombe paternity Hospital 619 Maternity Homes in "althamstow 19 Mothers' Hospital, Clapton 30 Forest Gate Hospital 27 City of London Maternity Hospital 2 Other Maternity Homes 26 723 ALTHAMSTOW DISTRICT NURSING- ASSOCIATION (In affiliation with the Queen's Institute of District Nursing.) 17 & 19, Carisbrooke Road, E.17. Miss C.A.Lee, Superintendent, reports as follows:- "This year the Association has suffered a severe loss in the resignation of Mrs. Drury, Honorary Secretary. She has been a valiant worker for the Association since its inception nearly 36 years age - first as a member of the Committee and for the past 18 years as Honorary Secretary. The Provident scheme of payment, which should be a sound basis of our finance, has shown a tendency upward for the first time since the beginning of the War when it suddenly collapsed. The depleted staff of nurses and midlives have more than justified their existence. They make up in quality what is lacking in quantity. Twelve pupil midlives sent by Thorpe Coombe received their district midwifery training - each for three months. The number of midwifery cases is the lowest we have ever had not because our bookings were less but owing to cases being transferred by doctors for various reasons to Thorpe Coombe or other maternity hospitals. The Staff at the end of December was as follows:Superintendent 3 Pupil Midlives 4 Queen's Nurses (All midlives) 1 Permanent Voluntas Nurse 2 Municipal Midlives A rota of voluntary nurses (whose help is greatly appreciated). The use of gas and air has practically ceased since the war started. All nurses are qualified to give it. Midwifery and maternity eases attended for the year were as follows:- Municipal Other cases Midwives 129 13 Doctors 13 7 142 20 30. CONSULTANT OBSTETRICIANS. The services of a Consultant Obstetrician was requested by a General Practitioner on one occasion (i.e. apart from the Maternity Home). MIDVIVES ACTS, 1902 - 1936 No. of Notices of Intention to Practice, January, 1941 22 " " " " " " " during 1941 11 Total 33 No. of Midwives ceasing to practice during 1941 10 " " " practising at the end of 1941 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 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 1941:- No. of confinements attended as a Midwife 914 " " " " " "Maternity Nurse 117 " " Medical aid notices sent 381 " " notifications of deaths 8 " " twin births notified 6 " " stillbirths notified 6 " " notifications of liability to be a source of infection 1 " " " " laying out of a dead body - " " " " artificial feeding 3 " " " " disinfection 2 The above table includes the following numbers with regard to work done at Thorpe Coombe:- Midwifery cases 571 Maternity cases 73 Medical Aid Notices 279 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 Miscarriage 2 Abortion 1 Other conditions 9 16 For complications during labour:- Delayed 1st.and 2nd.stage 11 Ante-partum haemorrhage 1 Perineal laceration 20 Retained placenta 2 Malpresentation 2 Abdominal pain 1 Post-partum haemorrhage 3 Other conditions 19 Total 59 For complications in regard to the infant:- Prematurity and feebleness 3 Cyanosis 2 Discharging eyes 10 Other conditions 12 27 Details of medical aid notices issued by midwives employed at Thorpe Coombe are given in the Maternity Hospital report. 31. MUNICIPAL MID??? 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. 1126 1415 109 278 19 5381 3328 PUBLIC HEALTH ACT, 1936 (Nursing Homes). See Public Health Section of the Report. PUERPERAL PYREXIA. 56 crises of Puerperal Pyrexia were notified during 1941. The puerperal pyrexia rate for 1941 was 29.1 per 1,000 births, as compared with 21.6 in 1940. ABORTION. CIRCULAR 1661..- The number of cases in which medical aid notices were issued during 1941 by midwives in accordance with Rule E. of the Centra] Midwives Board was:- Threatened abortion and miscarriage 1 Abortion and miscarriage 1 C??? NEOMATCRUM. 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 1941 3 - — — 1 1 1 1940 4 — - - — — 3 Treated Year At Home In Hospital Vision inimpaired Vision impaired Total Blindness Deaths. 1941 2 1 3 — — — 1940 2 2 4 - - - MATERNAL MORTALITY. During 1.941, eight deaths associated however slightly with pregnancy and child-bearing were investigated for the completion of enquiry forms. Particulars relating to the eight deaths are given in the accompanying table. The following table shows the maternal mortality rates for 1941 (calculated on the three deaths assigned by the RegistrarGeneral to Headings 29 and 30. Births Registered Deaths of Women due to Pregnancy and Child-Bearirg. ??? England and ales Puerperal Sepsis (Heading 29 R.G) Other Puerperal Cause (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 1160 3 5 8 2.58 4.31 6.89 Not available. Live & Stillbirths, 1193 3 5 8 2.5 4.19 6.70 0.48 1.75 2.23 32 33 Eight deaths were reported due to pregnancy, childbirth or associated therewith. Of these,five were abortionsthree illegal and two natural. Of the other three cases two refused advice as to hospital treatment The certified causes of death are given below:- DEATHS DUE TO PREGNANCY AND CHILD-BEARING AND/OR ASSOCIATED THEREWITH. Case No. Date of Death Certified Cause of Death and Classification Age Case No. Date of Death Certified Cause of Death and Classification Age 1. 28. 1.41 Shock from concealed accidental haemorrhage and natural abortion. 30 5. 16. 5.41 Eclampsia, Pregnancy Toxaemia, Stillbirth 30 2. 13. 3.41 Shock from instrumental interference with a pregnancy resulting in a commencing abortion. P.M. 44 6. 7. 6.41 Pyaemia due to septic abortion. Conviction of using instrument to procure abortion. P.M. 19 3. 24. 4.41 Shook and haemorrhage from retained placenta 31 7. 15. 8.41 Toxaemia due to septic abortion. (Natural) 29 4. 5. 5.41 Peritonitis following septic abortion illegally performed by herself at Kettering between 24th.& 29th.April, P.M. 30 8 8.12.41 Internal haemorrhage due to rupture of ectopic pregnancy. 18 The Registrar General allocates Nos.4,6,7 to classification 29 - Puerperal & Post abortive sepsis. Nos.1,2, 5,5,8 " " 30 - Other maternal causes. 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). 1941 1940 1939 1938 1937 Maternal Mortality 6.89 0.63 1.29 1.85 3.57 Stillbirths 26.8 26.6 38.6 43.2 35.8 Neo-Natal Deaths 23.7 24.7 17.4 17.3 20.8 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 1941 1193 3 5 8 2.51 4.19 6.70 1940 1617 - 1 1 - 0.61 0.61 1939 1668 2 - 2 1.19 - 1.19 1938 1687 1 2 3 0.59 1.18 1.78 1937 1735 4 2 6 2.30 1.15 3.45 THORPE COOMBE MATERNITY HOSPITAL. ALTERATIONS AND EXTENSIONS.- The Hospital now provides 48 beds for confinements and six in a separate block for Post-Natal conditions. GENERAL.- (a) Form M.C.W. 96A (Ministry of Health). 1. Name and Address of Institution - Thorpe Coombe Maternity- Hospital, 714, Forest Road, Walthamstow, E.17. 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds) - 48. 2a. Number of beds, if any, under item 2 which have been allocated to, and reserved for, expectant mothers in need of hospital treatment.- Variable according to requirements. No definite reservation. 3. Number of maternity oases admitted during the year - 717 (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). - 101. 3b. Average duration of treatment of expectant mothers in the beds shown against item 2a.- 2.8 days, (ante-natal) 4. Average duration of stay of cases included against item 3 - 13.2 days (confinement). 34. 5. Number of oases delivered by - (a) Midwives, 572; (b) Doctors, 73; Total 645. 6. Number of oases in v.hich medical assistance was sought by a midwife in emergency - 27S. 7. Number of cases notified as - (a) Puerperal Fever - Nil; (b) Puerperal Fyrexia - 32. 8. Number of cases of pemphigus neonatorum - Nil. 9. Number of infants not entirely breast fed while in the institution - 62 complemented, 16 (artificially fed). 10. Number of oases 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 - 9. (b) Cause of death in each case, and results of post-mortem examination (if obtainable) - See Clinical Report. The stillbirth rate was 36.5 per 1,000 live births, and the neo-natal mortality within 10 days of birth was 14.2 per 1,000 live births. (c) Occupation of Beds.- The average daily occupation of beds was as follows:- January 24.5 July 23.7 February 19.8 August 30.0 March 20.0 September 28.0 April 29.0 October 30.0 May 20.5 November 27 6 June 20.0 December 32.4 The average for the whole year was equal to 80 per cent. beds occupied (based on the 32 beds which were fully in use). (d) Emergency Unit.- The services of the emergency unit were not required during the year. (e) Gas and Air Analgesia.- The Maternity Hospital is approved by the Central Midwives Board for the purpose of giving special instruction in gas and air analgesia. (f) 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 1941, 31 pupils from Thorpe Coombe obtained the Certificate of the Central Midwives Board, and 12 obtained the Part II Certificate. The following clinical report has been compiled by Dr.Helen Rodway, M.R.C.O.G., Resident Obstetrician. 35 THORPE COOMBE MATERNITY HOSPITAL. CLINICAL REPORT FOR 1941. Following the evacuation of many expectant mothers in the late months of 1940, bookings for confinement in the Hospital, for the first four months of this year, were reduced to about 66 per cent, of the usual figure. In the second half of the year they were again at pre-war level. It has since been found necessary to restrict bookings, in order that the upper Block shall be occupied only by ambulant patients, who could - in the event of an air raid - walk to the Shelter Room in the Nurses Home. DETAILS OF THE .YORK OF THE HOSPITAL. * Ante-Natal Clinics. Number of Clinics held:- 1941 1940 1939 1938 1937. (a) Consultant's Clinics 12 8 8 12 12 x (b) Resident Obstetrician's Clinics 154 301 176 155 129 (c) Midlives' Clinics 285 1 33 2 3 4 2 9 4 549 Totals 449 442 418 461 490 x In 1940 and part of 1939 the Assistant Medical Officer was also responsible for a number of the Clinics. Number of Expectant Mothers who attended Ante-Natal Clinics 824 750 733 702 753 Total attendances at Ante-Natal Clinics:- (a) New patients 824 750 733 702 753 (b) Old patients 5661 6679 5750 6032 5501 Totals 6485 7429 6483 6734 6254 A number of patients who attended the Ante-Natal Clinics this year, were evacuated in late pregnancy. Total number of attendances at:- (a) Consultant's Clinics 110 85 117 186 (b) Resident Obstetrician's Clinics 2507 5547 2904 2229 2382 (c) Midwives Clinics 3868 1797 3462 4319 3872 Totals 6485 7429 6483 6734 6254 Average attendance per session:- (a) Consultant's Clinics 9.16 8.62 14.62 15.5 (b) Resident Obstetrician's Clinics16.27 18.42 16.5 14.38 16.9 (c) Midwives' Clinics 13.66 13.51 14.79 14.69 11.0 Post-Natal Clinics. Number of Clinics 52 Number of attendances:-. (a) New patients - 315; (b) Old patients - 149; Total - 464. Average attendance per session was:- 8.92. The percentage of new patients relative to the number of confinements in the Hospital was 48.83. Admissions to the Hospital - 1941 14940 1939 1938 1937. 717 817 675 775 729 (a) Ante-natal admissions were 101 (30 patients delivered before discharge). (b) For confinement 615 (c) Post-natal 1 Total 717 (these include 10 unbooked cases) 36. REASONS FOR THE ADMISSION OF ANTE-NATAL CASES. Number of Admissions. Ante-partum haemorrhage 6 Pre-eclamptic toxaemia (two re-admissions) 17 Chronic nephritis 4 (two re-admissions) Hyperemesis 2; Hyperpiesis 3. 5 Hydramnios 2 Heart disease 8 Secondary anaemia 2 Pyelitis 1; Phlebitis 2. 3 Sciatica 1 Observation following fall 2 Rest 3 Version 2 Observation and discharged because not in labour 46 Total 101 REASONS FOR THE AMISSION 0F UNBOOKED CASES. Ante-partum haemorrhage 1 Pre-eclamptic toxaemia 1 Malpresentation 1 Prolonged labour. Uterine inertia 3 Prolapsed cord 1 No arrangements made for confinement 3 Total 10 NUMBER OF CONFINEMENTS. 1941 1940 1939 1938 1937. Primigravida 383 427 352 399 367 Multigravida 262 293 243 292 272 Total 645 720 595 691 639 In 14 cases the patients were delivered by a Private Practitioner; in 59 by the Resident Obstetrician or the Doctor acting for her. OPERATIONS PERFORMED. Caesarean section:- Number of oases. (a) For contracted pelvis and disproportion 2 4 (b) Disproportion only 1 (c) Elderly primipara. breech 1 Forceps delivery 51 Version 3 Surgical induction of labour:- (a) For pyelitis 1 8 (b) Placenta praevia 2 (c) Pre-eclamptic toxaemia 3 (d) Eclampsia 1 (e) Chronic Nephritis 1 Manual removal of the placenta 8 Total 74 MEDICAL AID REQUESTS. In 279 cases medical aid was sought by midwives working in the Hospital. Treatment was given by the Resident Obstetrician or the Doctor acting for her. 37. INFANTS "■ The number born in the Hospital was 655; including six coses of twins and one of triplets. There were 25 stillbirths and P infant deaths. On discharge:- Per cent. Infants entirely breast fed 545 87.4 " partly breast fed 62 10.0 " not breast fed at all 16 2.6 Total 621 100.0 FOETAL AND INFANT MORTALITY. Stillbirths:- Number of Cases Premature, i.e. 5½ lbs. or less 11 Full term, i.e. over 5½ lbs. 12 Total 25 Infant Deaths:- Premature 5 Full term 4 Total 9 Mortality rate per 100 births. (a) Stillbirths 3.52 (b) Infant Deaths 1.37 Total percentage 4.89 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. sustained for twenty-four hours, or recurring within that period. Percentage Causes of Pyrexia. Number of cases. of cases. Bronchitis 2 Influenzal cold 3 Gastro-intestinal disturbance 1 1.1 Laryngeal tuberculosis 1 Congested or flushed breast 9 Mastitis; developed breast abscess 1 Local genital infection 9 3.6 Streptococcal infection 1 Urinary infection 2 Undiagnosed 3 0.5 32 MATERNAL MORTALITY. There was one maternal death due to eclampsia. Further details of the medical work of the Hospital are contained in the statistical report, typewritten copies of which are available for reference. 38. / DAY NURSERIES. 1. VOLUNTARY. a. Walthamstow Child Welfare Society , A Day Nursery was opened at "Brookscroft" on 19th.May, 1941. Children of all ages up to 5 years are admitted and there is accommodation for 25 children. b. Friends' Ha11, Greenleaf Road. A Day Nursery was opened on 20th.October, 1941, and admits up to 25 children between 2 and 5 years of age. 2. MUNICIPAL. Preparations were in hand at the close of the year for the provision of a War Time Day Nursery at Wyatts Lane. Accommodation for 60 children of all ages was to be provided. 39. 1941