??? With the Compliments of the Medical Officer of Health and School Medical Officer, Borough of Walthamstow. WAL 25 BROUGH OF WALTHAMSTOW REPORT OF TIES MEDICAL OFFICER OF 'HEALTH FOR THE YEAR 1942. A.T.POWELL, M.C., M.B., B.S., D.P.H. MEDICAL OFFICER OF HEALTH, SCHOOL MEDICAL OFFICER. CONTENTS. Abortion 33 Acreage 4 Adulteration 13 Albuminuria 33 Ante-Natal Clinic 28, 38 Bacteriological Analyses 12 Births 4, 24 Breeoh Delivery 38 Caesarean Section 40 Cancer 5 Cerebro-Spinal Meningitis 15 Child Welfare 26 Child Life Protection 28 Clinics 5, 6, 26, 27, 28, 29 Clothing Coupons for Expectant Mothers . 24 Committees 2, 22 Dampness 9 Day Nurseries 24 Deaths 4, 5, 19 Death Rate 4 Dental Treatment 30 Diphtheria 15 Diphtheria Immunisation 16 Diseases of Animals Acts. 13 Disinfestation 10 District Midwifery 32 Drainage 6 Dysentery 15 Eclampsia 38 Enteric Fever 15 Erysipelas 15 Expectant Mothers, Investigation on the Nutrition of 41 Factories and Workshops 9, 14 Pood Inspection 12 Foot Clinic 5 Forceps Delivery 40 Haemorrhage - Ante-Parturn 38 Health Services 5, 6 Health Visiting 27 Home Helps 31 Hospital Accommodation 31 Hospital, Infectious Disease 16, 19 Housing 10, 21 Housing Act, 1936 11 Housing Inspection 10 Ice Cream 9, 12 Immunisation 16 Infant Mortality 4, 24, 25, 37 Infectious Diseases 9, 15, 16 Infestation by Head Lice . 17 Institutional Treatment 31 Invalid Children's Aid Assn 30 Isolation Hospital 19 Laboratory Work 18 Layettes 31 Massage 28 Maternal Mortality 34, 35, 36 Maternity and Child Welfare 22 Measles 15 Meat Inspection 12, 13 Medioal Aid 40 Medical Examinations 21 Midwives 32, 33, 37 Milk, Assisted Scheme 31 Milk Supply, etc. 12 Miscellaneous 21 Mortuary 21 Neo-Natal Mortality 26, 34 Notices, Sanitary 8 Ophthalmia Neonatorum 34 Orthopaedic Treatment 29 Outworkers 15 Pneumonia 15 Tost-Natal Clinic 28, 38 Public Cleansing 6, 7 Puerperal Pyrexia 33, 40 Rateable Value 4 Rats and Mice Destruction Act, 1919. 14 Refuse Disposal 7 Rent Restriction Acts 13 Rheumatism Clinic 16 Rivers and Streams 6 Sanitary Inspection 8, 9, 10 Scabies 18 Soarlet Fever 15 Schick Tests 16 Sewerage 6 Social Conditions 4 Special Premises 9 Staff 4 Statistics 4 Sterilised Maternity Outfits. 31 Stillbirths 4, 24,34 Thorpe Coombs Maternity Hospital,, . 36, 37 Trade Refuse 7 Tuberculosis 19,20 Vaccination 18 Vital Statistics 4 Vitamins 24 Walthamstow Child Welfare Society 28,29 Walthamstow District Nursing Association 32 Waste Food 7 Water 6 Women's Clinic 6 Zymotic Diseases 4 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: . Alderman Mrs.E.M.Miller Vice-Cho irmam: Councillor Mrs.B.M.Friedberg. The Worshipful the Mayor - Alderman Mrs.E.M.Richards, J.P The Deputy Mayor - Councillor J.H.Williams. Chairman of Finance Committee - Alderman Ross Wyld, J.P. Alderman Mrs-L.P.Bailey, 7.P. Alderman Miss E.M.Pracy, B.Sc. Alderman Mrs.C.McEntee, J.P. Councillor W.E.Barnes Councillor G.S.Mace „ A.Crosier „ A. ,E. Manning „ Mrs. S.Candy „ Mrs .A.L.Meadows „ F.Vv. Gentle „ A.E.Simmons „ V Gillett „ Mrs. E.A.Smith „ J.F.Green „ R.E.Smith „ T.C.W.Green „ G.H.Spackman „ H.E.Hammond „ Mrs.E.B.Toynbee Councillor G.J.R.Holt. Town Clerk: F.G.Garner, Esq. 2. TO THE CHAIRMAN A ND NUMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, The report for 1942 is again curtailed and duplicated as a measure of economy. The estimated population is not published but shows an increase of some 4,500. Vital statistics are again favourable when compared with England and ales. Good progress was continued in immunising against diphtheria, the death rate for which was only one fifth of that for England and ales, and the notification rate only one twentieth. I have again to thank you for your consideration and the staff of the Department for their good work. I have the honour to be, Your obedient servant, A. T. .W. POWELL. Medical Officer of Health. 3. STAFF. The following new; appointments were made during the year:- Dr.W.H.Brodie - Deputy M.O.H Dr.J.P.Crichton - Deputy M.O.H. Mrs.F.Harrison - Dental Surgeon. Mrs.F.V .Atkinson - Clerioal Assistant. Mr.D.W.Flatman - Junior Clerk. The following left for the reasons stated:- Dr.Melville Watkins - (Deputy M.O.H. ) - To H.M.Forces. Dr. W.H. Brodie (Deputy M.O.H.) - Resigned. Dr.J.F.Crichton (Deputy M.O.H.) - Resigned. Mr.L.Kemp (Clerical Assistant) - To H.M.Forces. Miss P.Parsons (Dental Attendant) - Resigned. Mr.R.D VViishire (Junior Clerk) - To Merchant Navy. STATISTICS _--ND SOCIAL CONDITIONS OF THE AREA. Area (in acres) ... ... ... 4,343. Number of Assessments. 1st.April, 1942 . . 35,807 Rateable value ... ... ... £859,134 Sum represented by penny rate ... ... £3,163. Stillbirths ..52 Rate per 1,000 total (live and still) births.. 29.5 Deaths ...1140 Death rate per 1,000 of the estimated resident population Deaths from puerperal causes:- Rate per 1,000 (live and still) births. Puerperal Sepsis .... 1 0.56 Other Puerperal Causes .... 1 0.56 Total... 2 1.13 Death rate of infants under one year of age:- All infants per 1,000 live births 40 Legitimate infants per 1,000 legitimate live births .... 40 Illegitimate infants per 1,000 illegitimate live births.. 53 Deaths from Measles (all ages) 0 " " Whooping Cough (all ages) 4 " " Diarrhoea (under 2 years of age) 7 Zymotic disease death rate 0.12 Pulmonary Tuberculosis death rate 0.43 Non-pulmonary " " " 0.11 The natural increase of population, i.e., excess of births over deaths, was 578. 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 1942 (1140) compares with 1,253 during 1941. 4. Extracts from Vital Statistics.- The Registrar-General's mid-year, 1942, estimate of opulation has been used for the calculation of all vital statistics: - Total Ma le s Females. Live Births (Legitime te.... 1662 835 827 Birth rate per 1,000 of the estimated resident population -17.4 (Illegitimate.. 56 30 26 (Total 1718 865 853 CAUSES OF DEATH AS GIVEN BY THE REGISTRAR-GENERAL FOR THE YEAR 1942. WHOLE DISTRICT Causes of Death Males Females Total 1 Typhoid and Paratyphoid Fevers _ — — 2. Cerebro-spinal Fever 1 1 2 3. Scarlet Fever — — — 4. Whooping Cough 3 1 4 5. Diphtheria 1 — 1 6. T.B. of respiratory system 20 23 43 7. Other forms of Tuberculosis 5 5 10 8. Syphilitic disease 7 7 14 9. Influenza 2 3 5 10. Measles - - - 11. Acute poliomyelitis & polioencephalitis - - - 12. Acute infectious encephalitis 2 — 2 13M. Cancer of buccal cavity &, oesophagus (Males only) 6 - 6 13F. Cancer of Uterus - 10 10 l4 , Cancer of stomach and duodenum 20 17 37 15. Cancer of breast — 25 25 16. Cancer of all other sites 65 49 114 17. Diabetes 3 6 9 18. Intra-cranial vascular lesions 47 57 104 19. Heart disease 137 133 270 20. Other diseases of the circulatory system 14 23 37 121. Bronchitis 60 26 86 22. Pneumonia 46 28 74 23. Other respiratory diseases 10 4 14 24. Ulceration of the stomach or duodenum 9 5 14 125. Diarrhoea (under 2 years) 3 4 7 26. Appendicitis 8 3 11 27. Other digestive diseases 11 12 23 28. Nephritis 12 7 19 29. Puerperal and post-abortive sepsis - 1 1 30. Other maternal causes - 1 1 31. Premature birth 12 12 24 32. Congenital malform. birth in jury,infantile disease 10 8 18 33. Suicide 5 3 8 34. Road traffic accidents 5 1 6 35. Other violent oauses 13 3 16 36. All other causes 76 49 125 Totals 613 527 1140 Totals for 194 671 582 1253 . . j The age distribution of Cancer deaths was as follows:- Under I yr. 1-2 yrs. 2-5 ' 5-15 1 15-25 yrs.j yrs, '[ yrs. 25-45 yrs. 45-65 yrs. 65 yrs. and over. 1 - - - ! - i i i i 16 73 102 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Clinic3 and Treatment Centres. Foot Clinio.- Total attendances were 7,794, and of these 569 '•vers by nsw "patients and 7.225 were re-attendances by old patients. The receipts were £405.7.4d, 5. Summary of New Cases, 1942. For diagnosis of Pregnancy, 13C , Gynaecological 210 , Sterility 29, Surgical 10, Medical 25, Contraceptive 18, Not classified 2.Total 424 Sixty-seven patients were referred to the Clinic from private doctors. Thirty-three patients were referred to hospitals for treatment. SANITARY CIRCUMSTANCES OF THE ARM. 1.(i) WATER,- No new mains have been installed during the year 1942. (ii ) DRAINAGE AND SE???.GE.- No ork of this character has been carried out during the year 1942. 2. RIVERS -ND STRE/MS.- Periodical cleaning of the Dagenhara Brook was carried out to the requirements of the Lea Conservancy Catchment Board. 3.(i) CLOSET ACCOMMODATION.- Ho change since 1940. (ii) PUBLIC CLEANSING.- Mr.Eric Bell, M.I.P.C., A.R.San.I., Cleansing Superintendent, contributes the following report:- In preparing this report on the activities of the Public Cleansing Department I am very pleased tc state that all essential services were maintained during the year 1942, in spite of the increased difficulties mainly due to the manpower situation. HOUSE REFUSE COLLECTION. The total weight of refuse collected during the past year was 22,706 tons. This shows an increase compared with 1941 - due most probably to the return of residents who had been evacuated. From this tonnage 5663 tons of salvage were returned to industry - thus saving valuable shipping space and probably lives of some of the Merchant Navy. 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 despite the many appeals to keep separate waste paper, cardboard, rags etc., a large amount is still being mixed in with 6. Women's Clinic.- Sessions were held weekly, with one consultant session monthly. Kiss Helen Rodway, K.R.C.O.G., submits the following report:- WOMEN'S CLINIC REPORT, 1942. The total attendances this year were 1,727; this includes attendances made by 424 new patients. At Thorpe Coombe the relief session was continued on Saturday mornings for diagnosis of pregnancy and gynaecological coses. This additional clinic made it possible for a certain number of patients to attend who could not do so during the week. No. of sessions held. No, of attendances. Average attendance per session. New cases. Old coses. Total. Hoe Street 53 250 886 1136 21.4 Thorpe Coomb? 3 51 174 417 591 11.6 104 424 1303 1727 Comparison of attendances with previous years: 1942. 1941. 1940 . New Cases Old Cases Total .New Cases Old Cases. Total. New Cases Old Cases Total. 424 1303 1727 299 1023 1322 260 1183 1443 1939. 1938 1937. 329 1234 1563 319 1179 1498 265 957 1222 the salvage, although the Compulsory Order issued by the Government now makes this an offence. STREET SALVAGE OFFICERS. These ladies continue to do excellent work - we now have some 400. Periodically these are advised as to materials most urgently needed, and the point has been stressed very clearly that certain articles must not be put into the dustbin, but placed either by the side of the bin or in the sack provided at the Salvage Officer's residence. WASTE FOOD. This scheme continues to provide valuable feeding material for pigs and poultry, and 1,596 tons have been collected during the past year. This shows a substantial increase on 1941. Approximately 1,200 bins are 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 has again been extended this year. 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, metal, tins, etc. REFUSE DISPOSAL. During the past year the total tonnage of refuse handled at these Works has been 22,790 tons. After the subtraction of all salvageable material the actual tonnage that goes to the furnaces is naturally low. The great drive for salvage enables us to dispose of various grades of scrap for which in the past, it has been very difficult to find markets. Ashes, cinders etc., have been sold for use in the construction of roadways to camps and on aerodromes. STREET & MARKET CLEANSING. Despite the blaokout conditions, and the reduction in the number of sweepers owing to the fact that the majority of regular employees are now serving with H.M.F., every endeavour has been made to maintain the pre-war standard of cleansing. Here again the public could greatly assist if they would refrain from littering the streets with bus tickets, etc. GULLET CLEANSING. The gulley machine still continues to give excellent service, and during the past year approximately 12,000 gulleys have been cleansed, disinfected and sealed. CIVIL DEFEITGE. The Department is responsible for the maintenance and painting of some 420 Gas Detector Points throughout the Borough. These are periodically inspected and repainted during the year. Owing to the calling to H.M.Forces of the majority of our permanent employees it has been necessary to train new entrants into the Department in Decontamination work. Squads have been continually on standby duty, thus being available to deal with any emergency. 7. A new Cleansing Station has been erected during the past year and is completely equipped for treating contaminated personnel. It is capable of passing 90 persons per hour. Several tests have been carried out, and it has proved very efficient. GENERAL. The Department is still responsible for the clearance of bombed sites and debris from roads. During the past year this work has proceeded in accordance with recent Government circulars. All classes of building materials which could be salvaged for re-use have been recovered, and have been used for carrying out repairs to bomb damaged properties, building of shelters, blast walls, N.F.S. Sub-stations, static water tanks, eto. All timber has now been transferred to the Timber Control and the majority sent to reconditioning plants, only a very small auantitv boine retained for urgent first aid repairs. SANITARY INSPECTION OF THE AREA. Mr.M.E.Duncan, Chief Sanitary Inspector, reports as follows:- No. of inspections made. No. of nuisances detected. No. of complaints received. No. of Informal Served Notices Complied with No. of Statutory Served Notioes Complied with Total Visits 8,512 3,492 2,239 1,468 1,213 118 97 15,352 During the year under review the inspectoral staff has been the equivalent of two below full strength. The Chief Sanitary Inspector was granted sick leave in October and was unable to return to duties for the remainder of the year. Mr.F. W.Kemp was appointed as Acting Chief Inspector. The number of complaints received was 2,239, a marked increase as compared with 1,382 in the previous year and 1,271 in 1940. This increase is no doubt due to the great difficulty experienced by owners and agents in procuring the necessary skilled labour to carry out ordinary house repairs and maintenance, and also to the greatly increased cost. No House to House Inspections could be carried out. The number of houses found with defects was 1,679, and written notices were served in respect of 1,468 premises. The number of notices complied with during the year was 1,213 informal and 97 statutory. The nature and variety of the work carried out during 1942 is shown in the following tables:- Drains tested, 433; Drains reconstructed or repaired, 375; Drains, obstructions removed, 330; Drains, means of access provided, 27; Drains, ventilation provided or improved, 38; Drains, ventilation repaired, 71; Soil pipes repaired, 15; Soil pipes new, provided, 40; Rain water pipes renewed, 104; Rain water pipes disconnected from drains, 9; Roofs repaired or renewed, 395; Gutterings repaired or renewed, 208; W.C.pans or traps provided, 226; Gully traps provided, 63; W.C.Flush cisterns provided, 44; W.C. Flush cisterns repaired, 181, W.C.floors concreted, 35; W.C.'s repaired and cleansed, 167; W.C.'s light and ventilation improved, 11; Waste pipes renewed or trapped, 96; Waste pipes repaired, 67; New sinks provided, 35; Water supply reinstated, 6; Water supply taken off main, 1; Cisterns cleansed and covered, 14; Conveniences cleansed or repaired, 9; Sculleries paved, 27; Yards and forecourts paved and repaired, 86; Dirty houses cleansed, 1; Dirty rooms cleansed, 412; Floors repaired, 136; Ventilations under floors provided, 66; New damp-proof courses provided, 23; Sites concreted, 5; Offensive accumulations removed, 40; Animals improperly kept, removed, 2; Manure receptacles provided,-; Stables cleansed, paved and drained, 37; Manholes repaired or re-sealed, 93; Other cases of dampness remedied, 169; Miscellaneous repairs, 1006. 8. INFECTIOUS DISEASE. Visits to premises, 713; Re-visits to premises, 132; Fremises disinfected, 504; Articles disinfected at Low Hall, 7,199; Articles destroyed at Low Hall, 30; Bedding dried, 9. DAMPNESS IN HOUSES. Sites concreted, 5; Damp-proof courses provided, 23; Yards and forecourts paved and drained, 86; Roofs made watertight, 395; Rainwater pipes made good, 104; Guttering repaired or renewed,208; Other coses of dampness remedied, 169; Ventilation under floors provided, 66. SPECIAL HREMISES. Number. Visits Paid. Factories (a) Fower 226 234 (b) Won Power 132 110 (c) Other Premises 67 66 Outworkers 362 839 Slaughterhouses Butchers' Shops Not in use. 84 275 Bakehouses 45 164 Fishmongers, fish fryers and curers, etc. Eating-houses and Coffee Stalls 34 111 86 139 Ice Cream Vendors 119 33 Cowsheds 1 12 Dairies and Hilkshops 90 201 Laundries 8 8 Rag and Bone Dealers 6 12 Elementary Schools 31) 5 Private Schools 5) Figgerles 6 50 Street Stalls Numerous 26 Greengrocers „ 117 Stable s „ 168 As a result of the regular periodical visiting of the Special Premises the following works were carried out:- BUTCHERS' SHOPS Special cleansing, 13; Paving repaired, 4; Accumulations removed, 3; New Galvanised Bins provided, 4; Drains repaired, 2; W.C's repaired and cleansed, 5; Yard paving repaired, 4; Floors repaired and ventilated, 3; Roofs repaired, 5; Drains cleared, 5. BAKEHOUSES. Special cleansings, 82; Drains repaired, 6; .C's cleansed and doors repaired, 7; Yards repaved, 1; W.C. cisterns repaired, 2; Roofs repaired, 3; Premises general repairs, 2; Obstruction from drains removed, 5; Other improvements, 6. FISHMONGERS. Special cleansings, 34; Yards repaved, 2; Accumulations removed, 4; Roofs repaired, 1; Other improvements, 5: Drains cleared, 1; Gutters renewed, 2. COFFEE ATP EATING HOUSES. Special cleansings, 45; Yard pavings repaired, 3; .C.cisterns repaired, 5; Kitchen light and ventilation improved, 1. ICE CREAM VTTDORS. Special cleansings, 12; Special cleansing of utensils, 2; 9. COWSHEDS AND MILKSHOPS. Special cleansings, 14; Fittings and other improvements, 2; Roofs repaired, 1; W.C's repaired, 4. STABLE PREMISES. Cleansings, 63; Accumulations removed, 8; Roofs repaired, 7; Pavings repaired, 1; E.C's repaired, 2; Manure receptacles provided, 1; Drain reconstructed, 4. LAUNDRIES. Special cleansings, 8; Roofs repaired, 1; Other improvements,1. RAG AND BONE DEALERS. Cleansings, 12; Accumulations removed, 2. PIGGERIES. Cleansings, 7. (iv) ERADICATION OF BED BUGS. The free issue of insecticides and the loan of small pneumatic sprayers has continued. HOUSING. (a) Inspection. The following information is given in the form required by the Ministry of Health, and is supplied by the Chief Sanitary Inspector:- 1. - Inspection of Dwelling-House s during the Year:- (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 2,862 (b) Number of inspections made for the purpose 7,143 (2) (a) Number of dwelling-houses (included under sub-head (l) 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 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 1,599 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 1,123 III. - Action under Statutory Powers during the Year. A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:(l) Number of dwelling-houses in/respect of which notices were served requiring repairs 10 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners 90 (b) By local authority in default of owners, Nil. (c) Withdrawn - premises vacated and undertaking not to allow future occupation Nil. 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 notices:- (a) By owners 4 (b) By local authority in default of owners 5 C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:- (1) Number of dwelling-houses in respect of which Demolition Orders were madeNil. (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. (b). General Mr. J.E.//est, Housing Department, contributes the following:This report and statistics are based on the year 1942/3 During the year there was a further deterioration of the housing position generally in the Borough, due to the increased demands for accommodation from families returning from evacuation and other causes including normal growth of families and the large number of war-time marriages. That housing problems were in the fore-front is demonstrated by the many frequent parliamentary and press notices on the subject. Much valuable work was done by the reinstatement of premises damaged by enemy action, but the number of premises resulting from these activities, fell far short of the demand. So far as the Council Estates are concerned, the following statistical information is given:- Number of vacancies arising on the Council Estates, including properties repaired and brought back to use 40. There were 28 transfers, involving 113 persons. The premises let during the year totalled 32, comprising six lettings to families, whose original home had been rendered uninhabitable by ememy action, involving 24 persons. 24 normal lettings involving 105 persons, and two cases of rehousing upon your recommendation, involving 9 persons. As I indicated in my annual report, dated 8th.April, 1943, there would appear to be reason to believe that there is much overcrowding in the Borough and a number of cases on the Council Estates. There is also considerable subletting in Council houses. During the year 1942/3, 142 requisitioned properties were let accommodating 401 persons. 11. Welfare. Despite the very difficult conditions this work; has continued and has become an important integral part of the work of my department. A further number of cases of infestation by vermin were reported and were appropriately dealt with. The Housing Department as such, has acquired during the last year or two on entirely new horizon and outlook, and today its interests cover the whole field of housing within the Borough. INSPECTION AND SUPERVISION OF FOOD. (Contributed by the Chief Sanitary Inspector) (a) Milk Supply. The average number of cows kept in the borough is seven. There is only one cowshed and twelve 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 at the beginning of the year was 90, but at the close of the year the number had been somewhat reduced owing to the fact that the sale of small quantities of bottled milk from General Shops had mainly ceased. Routine visits were paid to maintain the general standard of cleanliness. During the year 7 samples of milk were token for bacteriological examination. Two gave unsatisfactory results. The samples are summarised as follows:- No. of Samples. Satisfactory. Unsatisfactory. Tuberculin Tested. - 2. " " Pasteurised. 1 Pasteurised. 4 5 2 The Milk (Special Designations) Order 1936. The number of licences granted for the Sale of Milk under Special Designations classified in the above Order was as follows:- Dealers' Licences: In respect of:- Pasteurised Milk 22 Tuberculin Tested Milk 9 Supplementary Licences. Pasteurised Milk 3 Tuberculin Tested Milk 3 Bottling Licences. Pasteurised Milk 2 Tuberculin Tested Milk 2 Ice Cream. Owing to the war-time restrictions in the use of milk in the manufacture of ice cream and the limited supplies of proprietary commodities, a comparatively small number of traders continued to sell this commodity. Special supervision of the manufacturing plants was carried out. Six samples of Ice Cream were taken and submitted for bacteriological examination and were found to be of a satisfactory standard. (b) Meat and Other Foods. Owing to the continued operation of the Live Stock (Restriction of Slaughtering) Order 1940, no slaughtering has been carried out at Slaughter Houses during the year. There were, however, 2 pigs killed belonging to a local Pig Club. The pigs were in good condition and disease free. The following is a list of food condemned as unfit for human consumption. Wherever possible the food was salvaged for animal feeding either through the Salvage Division of the Ministry of Food, or the local Pig Food Scheme:- 20 lbs. (Tins) Meat 4 Cases Herrings 44 lbs. „ Veal & Ham 2 „ Whiting 18 lbs. „ Pork Tongue 4 „ Skate 12. 73 lbs. (Tins) 0x Tongue 1 box Haddock 577 lbs „ Luncheon Meat 20 boxes Mackerel 107 lbs. „ Sausage Meat 2 " Cod 284½ lbs „ Chopped Ham 91 Fish Cakes 42 tins Salmon 391 lbs. Cheese 17 „ Sardine s 3¾lbs. Lard 95 „ Filchards ½ lb Margarine 14 „ Herrings ¾lb. Cooking Fat 212 „ Beans 955 Eggs 223 „ Beans in brine 77½ doz. Crumpet s 43 „ Meat and vegetables 5½ " Meat Pies 12 „ Picnic Roll 14 Sausage Roils 14 „ Prepared Meat 815 Jellied Tarts 83 „ Stewed Steak 2½ lbs . Cake 11 „ Rabbit 40 lbs. Swee ts 20 „ Go up 352 slabs Toffee 80 „ Condensed Milk 101 bars Chocolate 2 „ Dried Milk 144 lbs Jam 3508 „ Evaporated Milk 14 lbs. Syrup 19 „ Various Foods 12 lbs. Ma rma la d e 73 „ Plums 71 lbs . Sugar 159 „ Pineapple 25 lbs. Dried Apricots 20 „ Apples 70 lbs. Date s 15 „ Peache s 5 lbs. Mixed Cereals 58 „ Pears 8 cwt. Beans 149 „ Tomatoe s 43 packets Beans 13 „ Mixed Vegetables 188 packets Egg Substitute 14 „ Carrots 31 packets Custard Powder 295 „ Peas 5 jars Betox 23 „ Various Fruits 6 jars Paste 73 lbs. Beef 2 jars Fickle s 9 „ Mutton 3 bottles Various Essenc 40l „ Bacon 8½ sacks Potato es 61 „ Rabbit 7 sacks Cabbage 78 „ Fish Fillets 5½ sa cks Cones (Ground Rise) 1 case Dogfish 1 case Orange s (c) Adulteration 4 cwt. Onions - Food and Drugs Act, 1938 During the year 114 samples of food and drugs were submitted to and examined by the Public Analyst. Three samples were unsatisfactory, the particulars being as follows:- Description of Article Rum (Informal) Vinegar „ Result of Analysis. 41.4° under Proof of full strength but artificial vinegar decision Taken. Formal sample satisfactory. Vendor cautioned. Farsley Lemon & Thyme Forcemeat. No apparent Lemon constituent Manufacturer alleged evaporation No legal procedure was necessary in respect of any sample. Chemical and Bacteriological Examination of Food. Chemical examination is carried out by the Public Analyst, Dr.Bernard Dyer, and bacteriological examination by the Counties Public Health Laboratories, Gidea Park College. Rent and Mortgage Restrictions Acts. During the year 17 certificates were granted to tenants and six certificates issued to owners upon their application and completion of the scheduled works. Diseases of Animals Acts, 1894-1928. Sheep Scab Order, 1920 - No case of this disease occurred in the Borough during the year. 13. The Sheep Scab Order, 1928.- During the year, no sheep were admitted into the area under Licence for Slaughter. Swine Fever Order, 1908.- No action was necessary under this Order during the year. Regulation of Movement of Swine Order. 1922.- Four Isolation Notices affecting 49 swine were received. The Licences were in all cases duly observed. 2 Movement Licences were issued under the Order. Rats and Mice Destruction Act, 1919. Work under this heading still demands much time and careful attention. A thorough investigation is made of all complaints regarding rat infestations and appropriate action taken. Under the Food Control Committee's (Destruction of Rats and Mice) Order 1940, a report is furnished monthly to the Ministry of Food Rodent Officer setting out information as to inspections made and action taken in combating rodent nuisances. The following is a summarised statement of the vear's work:- No.of Premises & Sites Inspected. Premises & Sites found to be infested. Methods used at Infected Premises & Sites Food Other Food Other Baiting. Trapping. Gas sing .Other 209 688 65 445 235 45 10 318 Complaints received 352 Premises rat-proofed 42 Advice only given 29 Re-inspections 899 Pre-baiting used 35 FACTORIES ACT. 1957. The following tables show the work done under these Acts:1. - INSPECTION OF FACTORIES, ETC. Including inspections made by Sanitary Inspectors. Premises Inspection Number of Written Notices Occupiers Prosecuted. (1) (2) (3) (4) Factories with mechanical power 234 13 Nil. Workshops without mechanical power 110 6 Nil. Other premises under the Act. 66 1 Nil. Totals 410 20 Nil. 2.- DEFECTS FOUND IN FACTORIES. ETC. Particulars. No.of Defects. No.of Offences Found Remedied . Referred to H.M. Inspector. in respect of which prosecutions were instituted. (1) (2) (3) (4) (5) Want of cleanliness 36 36 - _ Overcrowding - - - - Unreasonable temperature - - - Inadequate ventilation 5 5 - - Ineffective drainage of floors 1 1 - - (insufficient 5 Sanitary (unsuitable 1 5 - - conveniences (or defective 26 26 - - (not separate 1 1 - - for sexes Other offences 18 18 1 - Total0 92 92 1 Nil. NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1942. Wearing Apparel, making of 246 Cotton Spinners 2 Brush Making 76 Artificial Flowers ... 4 Boxes 14 Belts 5 Spectacle Frames 1 Cellophone bags 1 Upholstering 1 Feathers 1 Shoes 11 Total 362 Outworkers were notified from the following areas:- Bethnal Green 3 Poplar 3 City of London 13 St .Marylebone 18 Edmonton 4 Shored itch 12 Finsbury 49 Tottenham 7 Hackney 71 Walthamstow 49 Islington 21 Westminster 12 Leyton 85 Other Areas 15 Total 362 A total of 839 visits was paid in connection with outworkers. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. GENERAL.- The accompanying tables show the age and ward incidence of the various infectious diseases which are discussed separately in later pages of the Report:- Disease All 1942 Ages 1941 Under 1 yr. ! 1-5 yrs, 5-15 yrs. 15-25 yrs. | 2,5-45 yrs. 45-65 yrs. 65 & over. Scarlet Fever 421 117 3 110 281 14 11 2 _ Diphtheria 6 26 1 — 4 I - - Enteric Fever 4 2 - - - 2 — 2 Pneumonia 91 138 2 12 12 11 18 26 10 Puerperal Pyrexia 29 38 - - - 9 20 — r- Opthalmic Neonatorum 1 3 1 - - - - - Erysipelas 35 31 - 1 4 2 5 17 6 Encephalitis Lethargioa - - - - - - - - - Polio-encephaliti s - - - - - - - - - Cerebro-Spinal Meningitis 15 20 1 3 8 1 1 1 Anterior Poliomyelitis 2 1 1 1 - - - - - Measles 769 1087 23 322 418 3 3 - - Whooping Cough 151 51 9 92 46 1 2 1 - Dysentery 3 - — 2 - - - 1 - Tuberculosis 148 116 - 4 13 61 43 22 5 , 1948 1675 - 41 547 778 112 103 72 22 Totals 1941 2030 81 724 886 88 154 72 25 Disease St.James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Scarlet Fever 66 43 46 39 86 141 421 Diphtheria 2 — 2 1 1 — 5 Enteric Fever _ — — 1 3 4 Pneumonia 25 6 8 8 27 17 91 Puerperal Pyrexia 1 3 6 3 8 8 29 Opthalmia Neonatorum — — — - - 1 1 Erysipelas 9 5. 2 1 7 11 35 Encephalitis Lethargica - - - - - - - Polio-encephalitis - - - - - - — Cerebro-Spinal Meningitis 6 - 1 - 4 4 15 Anterior Poliomyelitis 1 - - - - 1 2 Measles 128 144 128 52 141 176 769 pooping Cough 47 17 17 7 26 37 151 Dysentery - 1 • - - 2 3 Tuberculosis 32 16 25 12 37 26 148 1942 317 235 235 123 338 427 1675 Totals 1941 433 336 285 102 356 518 20 30 15. The statistics given in the foregoing table are those for the calendar year 1942 The rate for Puerperal Pyrexia is better expressed in relation to the number of births (i.,e. live and stillbirths)registered than to population. When calculated on this basis the rate is:- Malthamstow 16.38 England & Wales. 12.61 Disease Total Notified Removed to Ho spital Per cent, removed to Hos pi tal' Deaths Deaths per cent. of cases notified. Scarlet Fever 421 253 60.1 Nil. Nil. Diphtheria 6 6 1CC.0 1 16.6 enteric Fever 4 4 100.0 Nil. Nil. Pneumonia 91 39 42.8 74 81.3 (1) Fuerperal Pyrexia 29 6 20.6 Ml. Nil. Ophthalmia Neonatorum 1 1 100.0 Nil. Nil.(2) Erysipe las 35 4 11.4 Nil. Nil.(2) Cerebro-Spinal Meningitis 15 15 100.0 2 13.3 Encephalitis Lethargica - - 2 Nil.(3) Measles 769 23 3.0 Nil. Nil. Whooping Cough 151 20 13.2 4 2.6 Anterior Poliomyelitis 2 1 50.0 Nil. Nil. Tuberculosi s 148 183(3) 56 37 .8 Dysentery 3 Nil. Nil. Nil. Nil. 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.. 52 Number of attendances made 770 Average attendance per session 15.6 Number of children recommended to rheumatism clinic 14 " " " " " ear clinic 15 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 67 Negative (including pseudo and negative) 32 Positive (including pseudo and positive) 35 Total number of immunisations completed during 1942:- (a) School age (b) Pre-school age 1555 (c) Over school age 31 3898 Number not completing immunisation 360 Number of Schick tests following immunisation 124 Number of attendances made at clinic for immunisation 3642 Average attendance per session 70.4 Immunisation at schools (included above):- Number completely immunised 2016 Number partly immunised 93 Number having extra dose, immunised in previous years 998 16. Birthday Letters.- Letters were sent to the parents of all infants following their first birthday and stressing the need for protection against diphtheria. 904 letters were issued and 348 infants were brought and protected. 172 infants had left the district. Immunisation by General Practitioners.- Diphtheria prophylactic is available to general practitioners. During 1942, 120 c.c's. of alum precipitated toxoid were issued: this quantity is sufficient to protect 120 children. Scarlet Fever Immunisation.- Dick tests for scarlet fever:Positive, 15; Negative, 20; Total 35. DIPHTHERIA IMMUNISATION. Immunisation was begun in Walthamstow in 1932, but the response at first was slow. The means of publioity were by leaflets distributed at school inspections, at houses where a case of infectious disease occurred, at Welfare Centres, by advertising in the local press and by personal contact when the opportunity occurred. Visits to the infants' schools in the town were commenced in October 1935. Speoial letters were prepared for the parents and a consent form enclosed which they were asked to sign and to return to the Head Teacher. Since the soheme began 7,183 have been immunised, 6,661 of school age and 527 of pre-school age. In addition 1,880 children previously immunised have received an extra dose. The immunisation campaign was further intensified in 1937 when it was realised that many ohildren under 5 years of age were not being reached. It was accordingly decided to send a birthday letter to parents soon after the child's first birthday stressing the need for immunisation and advising them to visit the next immunisation clinic at the Town Hall. During the five years the soheme has been in force 5,691 births have been notified in the district, Of these, 1,213 had moved out of the district or died before reaching their first birthday, so only 4,478 letters have been sent out. Of these 1,430 have been immunised. The Health Visitors do their best to influence the mothers when they visit the homes, and are notified when ohildren under 5 years of age are protected. Immunisation has recently been given at the Welfare Centres. During the last quarter of 1942, the average weekly attendance for immunisation sessions was 11,1 at the rate of 577 per annum. There are'also facilities at school immunisation sessions for mothers to take their children of pre-school age, This is often more convenient for the busy mother because the school is nearer the home than the Town Hall or Welfare Centre, The Head Teachers have kindly co-operated in this scheme and thus facilitated its working. Immunisation is also carried out at the War-time Day Nurseries in the town. INFESTATION BY HEAD LICE. During the year the new Lethane treatment was tried out extensively with very successful results. Advioe and treatment is now available at all Clinics and Welfare Centres. The unsatisfactory homes have been classified with regard to cleanliness as suggested in Circulars issued by the Ministry of Health and special supervision given where necessary. Great difficulty occurs in some homes on account of mothers being at work and in consequence the work of the Health Visitors and School Nurses has increased considerably. 17. MUNICIPAL LABORATORY. The following numbers of diphtheria swabs were examined during 1942:- Swabs. Negative. Positive. Totals. Private Practitioners 283 3 286 Health Department 15 1 16 School Medical Department 181 - 181 Totals 479 4 483 The total number of diphtheria specimens examined in 1942 was 344. Direct examinations were done on 31 diphtheria speaimens, and all were negative. In addition, 63 specimens of urine were examined, as compared with 57 in 1941. A total of 594 tubes of culture media were made by Mr. West, and of these 96 were sent to the Sanatorium. In addition to the above, 61 primary vaccinations were recorded, and 43 re-vaccinations During 1942 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 16.8 per cent, were vaccinated. No. of children vaccinated who were resident in Walthamstow, but born elsewhere - 90. PREVENTION OF BLINDNESS. No action was necessary under Section 176 of the Public Health Act, 1936, for the prevention of blindness or the treatment of persons suffering from any disease of, or injury to, the eyes. SGABIES. In view of the increased incidence of scabies a special session was allotted to this work at the Town Hall Clinic.on 2.7th.March 1942 and in October 1942 a special treatment centre was opened in the Public Gas Cleansing Centre which had been erected at the rear of the Public Baths. Two slipper baths were installed, hot water was available from the Public Baths and the entire staffing has been carried out by the personnel of the Civil Defence Casualty Service under the supervision of the trained nurses. All the personnel have given excellent service. Up to the end of 1942, 98 patients made a total of 165 attendances. This arrangement was made possible with the co-operation of tne Public Health, Public Baths, Emergency Committees and their Officers. GENERAL.- (1) The death rate per 100 admissions of infectious disease patients was 1.59 and per 100 total admissions 1.94. (ii) During the year the County Council continued the grant payable by them in respect of infectious disease beds, amounting to £425. 18. VACCINATION. Mr.E.Sharp, Vaccination Officer for the Area, has furnished the following return for 1942:- Births Regi stered Successfully Vaccinated Percentage Vaccinated Insusceptible Exemptions Heath before Vaccinated Postponed. 1461 327 22.5 2 623 35 37 (iii) The following table shows the admissions, discharges and deaths during 1942:- Scarlet Fever Diphtheria Other Diseases Tuberculosis Totals. Remaining in Hospital 1st .January 10 18 7 10 45 Admitted during year 420 74 9 22 618 Discharged " " 380 74 1 16 564 Died during year - 1 7 4 12 Remaining in hospital 31st.December 50 17 8 12 87 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL, (including Tuberculosis cases). January 50.12 April. 40.8 July 47.16 October. 66.17 February 43.12 May 39.12 Augu st . 56.7 November 86.16 March 37 .15 June, 31.1 September 60.7 December 88.15 Average whole year 54.7. CLINICAL REPORT. Dr.Hamilton, Resident Medical Officer, reports as follows:- AGE AND SEX OF PATIENTS ADMITTED DURING 1942. 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 55 60 118 113 26 18 9 21 208 212 420 Diphtheria 18 20 7 7 3 5 7 7 35 39 74 Measles 9 9 4 8 ~ - 2 - 15 17 32 Rubella — - — _ _ - 5 3 5 3 8 Whooping Cough 8 9 2 3 - 1 - - 10 13 23 Cerebro-spinal Meningitis 3 2 - - - - 2 2 6 4 10 Mumps 1 - 1 1 - - 1 1 3 2 5 Tuberculosis — _ - - - - - 22 - 22 22 Other Diseases — 2 2 - - 4 1 4 5 9 Staff - - - _ - - 15 - 15 15 Totals 94 102 133 134 29 24 30 72 286 332 618 AGE AND SEX AT DEATH. Twelve deaths occurred, details of which are given below:- 4 Pulmonary Tuberculosis . 4 Females aged 48, 453 28 and 21 years 1 Broncho- pneumonia 1 Female aged 3 months. 4 Broncho-pneumonia and Whooping Cough . (2 Males aged 4 years & 14 weeks (2 Females aged 2 years 3 months, and 14 months. 1 Diphtheria. 1 Male aged 10 years. 1 Cerebro-spinal Meningitis 1 Female aged 67 years. 1 Medullary embolism and Myocarditis 1 Male aged 20 years. 19. NUMBER OF OUTSIDE AUTHORITIES' CASES AND NATURE. Diphtheria Scarlet Fever Other Diseases Totals From Barking 3 17 1 21 " Whipps X.Hospital 1 1 1 3 " wanstead _ 1 _ 1 " Chingford - 2 — 2 " Leyton 33 168 24 225 Totals 37 189 26 252 "Other Diseases" covers a wide range of cases viz: Measles, whooping cough, cerebro-spinal meningitis. Miscellaneous. Meningo-encephalitis arose in two cases of measles. Both children were females aged 4½ years In one all four limbs developed a spastic type of paralysis. In the other a flaccid type developed. These two patients were transferred to an E.M.S. Hospital. One died after about two months. and post mortem sections of the brain were under examination at the time when the last report was received. The second patient, who was completely flaccid when transferred, gradually improved and eventually recovered almost completely. One patient, a girl of four, developed acute suppurative ethmoiditis and was given a blood transfusion as part of a general treatment. She made an excellent recovery. A drug eruption, due to "M.& B.693" was notified as a case of scarlet fever. Of the sixteen cases of rubella admitted only seven were notified as such. The other nine cases were notified as scarlet fever. During the year there has been a marked and increasing inaccuracy in the notifications. This causes great difficulty in a small hospital with severely limited cubiole accommodation. Swabs.- 120 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 follows:- Diphtheria 34.7 days Scarlet Fever 26.3 " Measles 13.4 " Whooping Cough 20.7 " Other diseases 14.4 " The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1942:- Classification in accordance with Ministry of Health Memorandum 37T.(Rev.) In Hospital on 1st, Jan.1942 Admitted during year Discharged during year. Died during year In Hospital on 31st. Dec. 1942. Observation 1 — 1 _ - T ,B.Minus 3 4 5 - 2 T.B. Plus Group I. - 1 - 1 - T.B. plus Group II. 6 16 9 3 10 T.B. Plus Group III. - - - - — Totals 10 21 15 4 12 12 of the 21 admissions were Walthamstow cases. 20. MEDICAL EXAMINATIONS. During the year, 52 examinations were carried out by the Medical Staff in respect of the Superannuation and Sick Pay Scheme. MISCELLANEOUS. Your Council made the following grants during the year to voluntary orgsnisations:- Invalid Children's Aid Association £100 Y/althamstow Association of Tuberculosis Care Helpers £25. MORTUARY.- A Coroner's Court, mortuary (with special provision for Infectious Disease cases) and a post-mortem room is provided by your Council at Queen's Road Cemetery. The Cemetery Superintendent reports that the number of inquests and post-mortems were as follows:- Inquests only 86 - Post-Mortems 106 Post-Mortems and Inquests (not included above) 55 Total 245 CREMATION. Facilities for cremation are available at the Crematorium provided by the Corporation of the City of London, at Manor Park, Little Ilford. Mr.T.S.Cunningham, B.Sc., M.Inst.M.& Cy.E., Borough Engineer and Surveyor, kindly contributes the following information:- Housing. Statistics. Number of new houses erected during the year: - By private enterprise 1 (Hale End Ward). No major alterations were carried out at the Sanatorium or at Thorpe Coombe Maternity Hospital. 21. maternity and chile welfare committee. Chairman: Councillor Mrs,E.A.Smith. Ex-Officio: The Worshipful the Mayor - Alderman Mrs.E.M.Richards, j.p, The Deputy Mayor - Councillor J,H.Williams. Chairman of Finance Committee - Alderman Ross Wyld, j.p. Alderman Mrs.l.F,Bailey, J.P. Mrs.C.McEntee, J.F. Councillor V.E.Barnes " Mrs.S.Candy " Mrs.B.M.Friedberg " F.W.Gentle " W.Gillett G.J.R.Holt " G.R.Lowton " A,E.Manning Alderman Mrs.E.M:Miller, j.p " W.H.Shaw. Councillor G.S.Mace " Ilrs. A. l. Meadows " E.G.Richards " W.F,Savill " a .E. Simmons " R.E.Smith " G.H.Spackman, j.p Mrs.E.B.Toynbee Councillor a-h Williams. Co-opted Members: Dr.Helen Sfetson Mrs.G.N.Riley Mrs.W.H.Xindell Mrs,E.Clarke Mr. W. H. Kind el 1 Mr s. M. Jarman. Town Clerk: f,g.garner, esq,. 22. TC THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen, I beg to present, herewith, a report of the work done in 1942, The birth rote at 17.4 was the highest since 1925, and the infant mortality rate at 40 was again low as was the maternal mortality rate The distribution of clothing, coupons in effect secured the notification of pregnancy and full use of this information was made by the Health Visitors. The distribution of vitamins and fruit ,1uices was a measure of first rate importance. A wer time day nursery was opened, and additional ante-natal clinics were necessary. The recorded institutional confinements totalled 900 Once more I have to record your consideration and the good work of the Staff. I have the honour to be, Your obedient servant, L.T.W.PO E.L. Medical Officer of Health. 23. NOTIFICATION OF BIRTHS. 1,659 births (70 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, 248; Midwives, 1,411. Included in the above are 167 births which were notified as having occurred outside the Borough. Also included are 50 stillbirths, 3 of which did not belong to the area. 19 were notified by doctors and 31 by midwives. Of the total, 12 occurred outside the area. ' REGISTRATION OF BIRTHS. The Reistrar-General's returns show the following registrations during the calendar year:- (a) LIVE BIRTHS. Males Females Totals. Legitimate 835 827 1662 Illegitimate 30 26 56 865 853 1718 (b) SILLBIRTHS. Legitimate 31 20 51 Illegitimate - 1 1 31 21 52 Of the 1515 registrations received in the Department between 28th.December 1941 and 2nd. January 1943, a total of 10 were not notified in this area, but some may possibly have been notified elsewhere. Appropriate action was taken when necessary. Of the 1515 local registrations, 105 belonging to other areas are excluded, leaving a nett total of 141C. ISSUE OF PRE-NATAL- CLOTHING COUPONS During the year 1,922 expectant mothers were issued with coupons. The information available by virtue of the applications was fully utilised by the Health Visitors VITAMINS. With effect from February 2nd. 1942, in addition to the facilities previously existing for the issue of Cod Liver Oil and Fruit Juices,to infants under 2 years of age, the Ministry of Food made those preparations available to all children aged up to 6 years. Vitamins were distributed at all the Welfare Centres, at the Town Hall, and at the Food Office. DAY NURSERIES. A nursery accommodating 60 children of all ages up to 5 years was opened on April 1st. 1942 in leased premises adjoining the St.Mary's Convent. Two further nurseries, each of 50 children, in prefabricated huts were projected at the end of the year. The nursery for 25 children attached to the welfare Centre at Brookscroft was continued during the year and was recognised by the Ministry of Health for grant. A Nursery School for 25 children provided at The Friends' Hall was also available. 24 WYATTS LANE WAR-TIME DAY NURSERY. MEDICAL REPORT FOR 1942. Dr.Helen Rodway reports as follows:- The Nursery was opened for the care of children under five, whose mothers were employed on war work or in other occupations. Twenty-eight children were admitted on the first day; on December 31st., there was a total of seventy-four children on the Nursery Register, with an average attendance from Monday to Friday, during that month, of 52.7 children. All children were given a medical examination as early as possible after admission to the Nursery and subsequent examinations were arranged at three-monthly intervals. Every child was immunised against diphtheria and in 56 cases against whooping cough. No child who was immunised against whooping cough had contracted the disease up to the end of January 1943. The majority of children at their first examination were found to be adequately nourished and healthy, although a surprisingly large number suffered from a catarrhal condition of the upper air passages, in some cases associated with enlarged spongy tonsils and in others with bronchial catarrh. There were few cases of dental caries. Minor degrees of rickets and anaemia required treatment and in most cases response to treatment was good. There were not more than three early cases of scabies and three of a staphylococcal eruption. The infectious diseases were as follows:Measles, 39; Scarlet Fever, 6; Whooping Cough, 6 (not confirmed by cough plate); Rubella, 2; Chickenpox, 2. INFANT MORTALITY. The deaths of infants under one year of age were:- Males Females Total. Legitimate 36 31 67 Illegitimate 2 1 3 Totals 38 32 70 The death rates of infants under one year of age per 1,000 lire births when calculated on the totals given by the RegistrarGeneral are, therefore;- Legitimate, 40; Illegitimate, 53; Total, 40. The Infant Mortality Rate for other areas during 1942 was as follows:- England and Wales 49 126 County Boroughs & Great Towns (including London) 59 148 Smaller Towns (25,000 to 50,000) 46 London 60 NE0-NATAL MORTALITY. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1942, 35 infants died in the first four weeks of life, yielding a rnte of 20.3 For the last ten years in England and ales the neo-natal deaths have been approximately one-half of the total deaths under one year of age. The following rates refer to Walthamstow:- 25. INFANT DEATHS, NEO-NATAL MORTALITY AND STILLBIRTHS. Year Live Births Stillbirths Neo-Natal Deaths Infant Deaths. No. Per 1,000 live births No. Per 1.000 live births No. Per 1,000 live births 1942 1718 52 30.2 35 20.3 70 40 1941 1304 35 26.8 31 23.7 52 44 The neo-natal mortality for England and Wales for the decennium 1921-30 was 33. The death rate from Diarrhoea and Enteritis in children under 1 year of age per 1,000 live births was 4.0. 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 211 notified births, and one whole-time Health Visitor per 188 registered births during 1942, CLINICS. During the year 1942 nothing outstanding occurred at the Welfare Centres. The attendance continued at practically prewar level. The Welfare Centres are distributing fruit juices and cod liver oil under the Government Scheme, the distribution being done by members' of the Women's Voluntary Service and Civil Defence Workers. At each Welfare Centre there is a "Make and Mend" and Cookery Stall rum by the South-West Essex Technical College, and the mothers show a good interest in the exhibits. The health of the children maintained a satisfactory level during the year and owing to constant supervision there was no increase in rickets or scurvy. Thanks are again due to the voluntary workers who so ably assisted the staff. The Ante-Natal sessions were held twice weekly, with an occasional extra session when necessary. Towards the end of the year it was found necessary to hold four weekly sessions, the increase in the number of attendances being due to the scarcity of hospital accommodation and consequent home confinements and to the number of mothers "evacuating", As these have no midwife in attendance they have to be given considerable extra attention at the Clinics. The necessity to have forms for permits for milk and eggs and certificates for the Labour exchange etc. also induoed more mothers to attend during the early months of pregnancy and greatly increasedthe work of the Clinics. Every effort is being made to induce mothers to attend for Post-Natal examination. MUNICIPAL SCHEME. The following table shows the number and nature of visits paid during 1942:- 26. 27 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 Sub sequent Visits Total Visits 1 2 3 4 5 6 7 8 9 10 Cols.5-10. St.James Street 249 426 675 696 1371 485 30 1 75 35 110 268 2265 High Street 187 486 673 603 1276 299 16 - 35 18 53 67 1711 Hoe Street 237 820 1057 1130 2187 356 26 1 70 30 100 137 2807 Wood Street 167 339 506 516 1022 380 13 - 42 21 63 120 1598 Hale End 370 1093 1463 1292 2755 408 37 3 92 29 121 323 3647 Higham Hill 381 924 1305 2096 3401 385 41 11 113 43 156 266 4263 Total, 1942 1591 4088 5679 6333 12012 2313 166 16 427 176 603 1181 16291 Total, 1941 1088 3404 4492 6187 10679 3243 262 20 337 136 473 1326 16003 ANTE-NATAL AND POST-NATAL SERVICES. The following table summarises the attendances at the Clinics held:- Ante-Natal Post-Natal New Patients:- Thorpe Coombe Maternity Hospital 769 506 Low Hall Lane Clinic 676 30 Totals 1445 536 Total Attendance:- Thorpe Coombe Maternity Hospital 7315 621 Low Hall Lane Clinic 1957 38 Totals 9272 659 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 Rd. 604 163 767 10122 8788 18910 19677 Higham Hill 326 72 398 5412 5086 10498 10896 Hale End 305 29 334 5134 5895 11029 11363 Total 1942 1235 264 1499 20668 19769 40437 41936 Total 1941 846 383 1229 14404 16470 30874 32103 NURSE CHILDREN.- At the end of 1942 there were 39 nurse children on the register, compared with 40 at the end of 1941. During the year 15 removed, 1 was adopted, and 4 reached the age of nine years. 19 new children were registered. There were no deaths among nurse children during 1942. MASSAGE.- Five massage sessions per week were held at the Welfare Centres, i.e., Low Hall Lane, Monday, Thursday and Friday; Highams Park, Tuesday; and Higham Hill, Wednesday. 135 cases attended for massage, and these made 2,511 attendances. SALE OF MILK ETC. AT CLINICS.- The value of milk and food sold and issued free during 1942 was £3,120.16.0. 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 D.Carter:- CLINICS. Year First Attendances of New Cases Re-attendances Grand Total Under 1 Yr. 1-5 yrs. Total Under 1 Yr. 1-5 yrs. Total 1942 442 74 516 6229 2557 8786 9302 Special Treatment, etc.- Massage Treatments, 952. Sunlight Treatments,1742. 28. HOME VISITS. Year Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total First Subsequent Total 1942 403 1143 1546 1312 2858 SUMMARY OF MUNICIPAL AND VOLUNTARY SCHEMES. 4 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 1235 264 1499 20668 19769 40437 41936 Brookscroft 442 74 516 6229 2557 8786 9302 Total, 1942 1677 338 2015 26897 22326 49223 51238 Total, 1941 1186 474 1660 18357 19024 37381 39041 HOME VISITS. To Children under 1 year of age To Children 1-5 years of age Total First Subsequent Total Municipal Scheme 1591 4088 5679 6333 12012 Brookscroft 403 1143 1546 1312 2858 Total, 1942 1994 5231 7225 7645 14870 Total, 1941 1396 3923 5319 9393 14712 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) 1942 104.2 Percentage of total notified births represented by number of expectant mothers attending Ante-Natal Clinics 1942 87.1 (a) TREATMENT. Orthopaedic. Defects seen at Orthopaedic Clinic in Children under Five Years of Age. Rickets:- (a) Genu Varum 22 Congenital Defects 9 (b) Genu Valgum 14 Torticollis 4 Pes Piano Valgus 17 Miscellaneous 4 Spastic Paralysis 2 Total 75 Talipes:- (a) Equino Varus 2 (b) Equino Valgus - (c) Calcaneo Valgus 1 29. (b) Dental. ✓ The following work was done by the Education Committee's Dental Surgeons in respect of Maternity and Child Welfare patients:- Mothers 1940. 1941. 1942. Children under 5. Mothers Children under 5. Mothers Children under 5 Cases Treated 87 105 137 104 139 76 Attendances 277 278 539 169 647 205 Fillings 214 116 185 142 272 214 Extractions 288 92 274 44 263 93 General Anaesthetics 107 62 106 21 121 51 Scalings 57 - 67 - 72 - Dressings 17 14 41 56 101 49 Dentures 11 - 30 — 22 - Mr.L.W.Elmer, L.D.S., Senior Dental Surgeon, Submits the following report from Mrs. W.R.Thome, L.D.S., with regard to dental treatment under the Maternity and Child welfare Scheme:- During 1942 two sessions weekly have been devoted to this work. Large numbers of mothers have been referred, but the response is still not good; many women only wish to visit the dental surgeon when compelled by pain. The minority who complete their treatment are the only ones who really benefit and are likely to interest themselves permanently in dental health. An increase in the charge for artificial dentures with a reduction in necessitous cases, might well be considered. The present small charge is not appreciated and is liable to be considered as indicating inferior service. (c) Tonsils and Adenoids. Seven cases were operated on under the arrangement made by the Education Committee with the Connaught Hospital. (d) Ophthalmic Defects and Minor Ailments. Children are given treatment either at the School Clinics or by special appointment. (e) Sunlight. No infants were referred for sunlight treatment during 1942. (f) Child Guidance. Arrangements have now been made for children under five years of age to be referred to the London Child Guidance Clinic. There were no cases in 1942. (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 12 Orthopaedic Clinics 61 Others 9 82 Suffering from:- Anaemia and Debility 1 Marasmus and Malnutrition 2 Pneumonia, Bronchitis. Asthma, etv. 2 Bone Disease (non-T.B.) 46 30 Congenital Deformities 19 Paralysis 2 Hernia 1 After Infection 6 Rheumatism 1 Various 2 82 Help Given to Old and New Cases. 1942. Sent to Special Hospitals and Convalescent HomesX 10 Provided with Surgical Boots and Appliances 13 Referred for Visiting and Advice 14 x Includes 2 admissions to Runwell. 37 ASSISTED MILK SCHEME. Number of applications during 1942 489 Number of families assisted 121 The National Milk Scheme operated from July 1940 and the above represents applications for special brands of milk not supplied under that scheme. HOME HELPS. Applications for the provision of Home Helps are considered by the Committee, and, if approved, a payment of 25/- per week for two weeks is made. In addition to the 140 Home Helps approved during 1942, 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 and 1 cancelled by the patient. The demand for Home Helps has been as follows during the past seven years:- 1936 (87), 1937 (78) 1938 (178), 1939 (125), 1940 (128), 1941 (105), and 1942 (140). STERILISED MATERNITY OUTFITS. A total of 436 sets were used in the Borough and 282 outfits were issued below; cost price. LAYETTES. 228 (approx.) layettes were distributed free to necessitous expectant mothers in 1942, These layettes were the generous gift of the American Red Cross. INSTITUTIONAL TREATMENT. 7 children were sent to Institutions under arrangements approved by your Committee. HOSPITAL ACCOMMODATION FOR COTFINEMENTS. The following numbers of confinements occurred at the Institutions specified ( walthamstow residents only):- Thorpe Coombe Maternity Hospital 658 Maternity Homes in walthamstow 83 Mothers' Hospital, Clapton 46 Forest Gate Hospital 57 Queen Mary's Hospital, Stratford - City of London Maternity Hospital 7 Other Maternity Homes 49 900 31. Walthamstow district nursing association. (In affiliation with the Queen's Institute of District Nursing) Homes:- Central Home 17 & 19, Carisbrooke Road, E.17. Branch Home .... 18, Lyndhurst Road, Highams Park, E.4. The Superintendent, Miss C.A.Lee, S.R.N., S.C.M., reports as follows:- The year 1942 was satisfactory in spite of difficulties due to a depleted staff. The Inspector of the Queen's Institute reported on the efficient work of the nurses and the high standard of the midwifery technique Salaries of the nurses were increased by 10% in accordance with ' the wishes of the Queen's Institute. Fifteen pupil midwives received training in District Midwifery under the Council's training scheme. The number of midwifery cases attended was as follows:- Municipal Voluntary Total. Without doctor 205 13 218 With doctor 17 36 53 Totals 222 49 271 Thanks are due for the assistance given by the Civil Defence Nurses and Red Cross Nurses from the Technical College. CONSULTANT OBSTETRICIANS. The services of a Consultant Obstetrician were not required during the year (i.e. apart from the Maternity Home). MID IVES ACTS, 1902-1936. No.of Notices of Intention to Practise, January, 1942 22 " " " " " during 1942 10 Total 32 No. of Midwives ceasing to practise during 1942 6 " practising at the end of 1942 26 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 1942. No. of confinements attended as a Midwife 1215 " " " " Maternity Nurse 193 " medical aid notices sent 540 " notifications of deaths 6 " twin births notified 24 " stillbirths notified 5 " notifications of liability to be a source of infection 7 " " " laying out of a dead body 1 " " " artificial feeding 7 " " " disinfection 7 The above table includes the following numbers with regard to work done at Thorpe Coombe:- Midwifery cases 606 Maternity cases 89 Medical Aid Notices 365 32. The percentages of medical aid notices were:Total, 38,4. Maternity Hospital, 52.5. Domiciliary midwives,24.5. The conditions for which medical aid was summoned by midwives in domiciliary practice have been summarised and were as follows:- For complications during pregnancy:- Albuminuria 3 Threatened abortion - Varicose veins 3 Miscarriage 4 Abortion 1 Other conditions 4 Abdominal pain 2 Total 17 For complications during labour:- Delayed 1st. and 2nd. stage 30 Ante-partum haemorrhage 4 Perineal laceration 69 Retained placenta 2 Malpresentation 2 Abdominal pain 2 Pyrexia 3 Other conditions 23 Post-partum haemorrhage 4 Total 139 For complications in regard to the infant:- Prematurity and feebleness 4 Cyanosis 1 Discharging eyes 7 Other conditions 7 Total 19 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 Clinic Deliveries Lying-in Visits Total Visits Patients' Homes Midwife's House Mid. Mat. 1626 3585 169 486 20 9445 15331 PUBLIC HEALTH ACT, 1936 (Nursing Homes).- See Public Health Section of the Report. PUERPERAL PYREXIA. 29 cases of Puerperal Pyrexia were notified during 1942. The puerperal pyrexia rate for 1942 was 18.2 per 1,000 births, as compared with 29.1 in 1941, and the mortality due to puerperal sepsis was 3.4 per cent. of the cases of puerperal pyrexia notified. ABORTION. CIRCULAR 1661.- The number of cases in which medical aid notices were issued during 1942 by midwives in accordance with Rule E of the Central Midwives Board was:- Threatened abortion and miscarriage 2 Abortion and miscarriage 3 33. OPHTHALMIA NEONATORUM. The number of cases notified during the last two years were:- Year Totals St.James Street High Street Hoe Street Wood Street Hale End Higham Hill 1942 1 - - - - - 1 1941 3 - - - 1 1 1 Year Treated Vision unimpaired Vision impaired Total Blindness Deaths At Home In Hospital 1942 - 1 1 - - - 1941 2 1 3 — — - MATERNAL MORTALITY. During 1942, three deaths associated with pregnancy and child-bearing were investigated for the completion of enquiry forms. Particulars relating to the three deaths are given in the accompanying table. The following table shows the maternal mortality rates for 1942 (calculated on the two deaths assigned by the RegistrarGeneral to Headings 29 and 30). Births Registered Deaths of Women due to Pregnancy and Child-Bearing. WALTHAMSTOW England and Wales Puerperal Sepsis (Heading 29 R.G.) Other Puerperal Causes (Heading 30 R.G.) Total Rates per 1,000 Births registered Rates per 1,000 Births registered Puerperal Sepsis Other Puerperal Causes Total Puerperal Sepsis Other Puerperal Causes Total Live, 1718 1 1 2 0.58 0.58 1.16 Not available Live & Still births,1770 1 1 2 0.56 0.56 1.13 0.42 1.59 2.01 The following table sets out the stillbirth and neo-natal death rates for the past five years:- Rate (per 1,000 live births). 1942 1941 1940 1939 1938 Stillbirths 30.2 26.8 26.6 38.6 43.2 Neo-Natal Deaths 20.3 23.7 24.7 17.4 17.3 34. 35 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. 27.9.42 Pulmonary Embolism due to femoral thrombo-phlebitis following childbirth. 30 3. 18.10.42 Obstetric shock. Ante-partum haemorrhage and placenta praevia. 28 2. 8.10.42 la. .Acute ante-partum haemorrhage. lb. Toxaemia of pregnancy. 2. Premature labour induced. 31 The Registrar General allocates No.l to Classification 29 - Puerperal & Post abortive sepsis. No.2 " " 30 - Other maternal causes. 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 Fuerperal Causes Total Puerperal Sepsis Other Puerperal Causes Total 1942 1770 1 1 2 0.56 0.56 1.13 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 - 2 - 0.59 1.18 1.78 THORPE COOMBE MATERNITY HOSPITAL. GENERAL.- (a) Form M.C.7. 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 cases admitted during the year - 801 (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). - 137. 3b. Average duration of treatment of expectant mothers in the beds shown against item 2a. - 4.19 days, (ante-natal). 4. Average duration of stay of cases included against item 3.- 14.66 days (confinement). 5. Number of cases delivered by:- (a) Midwives - 606, (b) Doctors - 89, Total 695. 6. Number of cases in which medical assistance was sought by a midwife in emergency - 365. 7. Number of cases notified as:- (a) Puerperal fever - Nil, (b) Puerperal pyrexia - 21. 8. Number of cases of pemphigus neonatorum - Nil. 36. 9. Number of infants not entirely breast fed while in the institution - 81 complemented, 28 (artificially fed). 10. Number of cases notified as ophthalmia neonatorum - Nil. 11. (a) Number of maternal deaths - 1. (b) Cause of death - Pre-eclamptic toxaemia and ante-partum haemorrhage. 12. (a) Number of infant deaths - (i) Stillborn - 22. (ii) Within 10 days of birth - 11. (b) Cause of death in each case, and results of post-mortem examination (if obtainable) - See Clinical Report. The stillbirth rate was 32.6 per 1,000 live births, and the neo-natal mortality within 10 days of birth was 16.3 per 1,000 live births. (b) Occupation of Beds.- The average daily occupation of beds was as follows:- January 28.8 February 34.8 March 24.3 April 27.2 May 30.8 June 31.3 July 31.8 August 28.8 September 28.1 October 31.9 November 31.6 December 32.4 The average for the whole year was equal to 62.5 per cent. cent. beds occupied (based on 48 beds). (c) Emergency Unit.- The services of the emergency unit were not required during the year. (d) 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. (e) 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 Fart II of the training under the new rules. During 1942, 19 pupils from Thorpe Coombe obtained the Certificate of the Central Midwives Board. The following clinical report has been compiled by Dr.Helen Rodway, M.R.C.O.G., Resident Obstetrician 37. THORPE COOMBE MATERNITY HOSPITAL CLINICAL REPORT FOR 1942. During the year there were 801 admissions, the number of confinements was 695, attendances at the Ante-natal Clinics were 7,315 and at the Post-natal Clinics 625. Admissions. 1942 1941 1940 1939 1938 (a) Ante-natal 137 101 126 119 96 (b) For confinement 658 615 684 552 675 (c) On account of miscarriage 2 - 3 — 3 (d) Post-natal 4 1 4 4 1 801 717 817 675 775 Confinements. 1942 1941 1940 1939 1938 695 645 720 595 691 A number of patients admitted during the ante-natal period were delivered before discharge. Of the confinements this year 80 per cent were normal, the remaining 20 per cent. required the services of the Doctor at the delivery. Ante-natal Admissions. Reasons for admissions. Ante-partum haemorrhage 8 Pre-eclamptic toxaemia 20 Chronic nephritis 1 Hyperemesis 4; Hyperpiesis, 1. 5 Heart disease 8 Secondary anaemia 1 Pyelitis 2; Cystitis 2. 4 Chorea 2 Phlebitis 1 Breech for version 6 For observation and rest 14 For observation and discharged because not in labour. 68 Total 137 Number of Emergency Admissions - 28. Reasons for admissions. Ante-partum haemorrhage 4 Pre-eclamptic toxaemia 4 Disproportion 1 Breech for version 2 Prolonged labour; uterine inertia 9 Premature labour 2 No arrangement made for confinement 5 Chronic nephritis 1 Ante-natal Clinics. Number of Clinics held:- 1942 1941 1940 1939 1938 (a) Consultant's Clinics 12 12 8 8 12 x (b) Resident Obstetrician's Clinics 146 154 301 176 155 (c) Midwives' Clinics 284 283 133 234 294 Totals 442 449 442 418 461 x In 1940 and part of 1939 the Assistant Medical Officer was also responsible for a number of Clinics. 38. Number of Expectant Mothers who attended Ante-natal Clinics:- 1942 1941 1940 1939 1938 764 824 750 733 702 Total attendances at Ante-natal Clinics:- (a) New Patients 764 824 750 733 702 (b) Old Patients 6551 5661 6679 5750 6032 Totals 7315 6485 7429 6483 6734 Total number of attendances at:- (a) Consultant's Clinics 124 110 85 117 186 (b) Resident Obstetrician's Clinics 2845 2507 5547 2904 2229 (c) Midwives' Clinics 4346 3868 1797 3462 4319 Totals 7315 6485 7429 6483 6734 Average attendance per session:- (a) Consultant's Clinics 10.3 9.16 8.62 14.62 15.5 (b) Resident Ohstetrician's Clinics 19.48 16.27 18.42 16.5 14.38 (c) Midlives' Clinics 15.3 13.66 13.51 14 79 14.69 lost-natal Clinics:- Number of Clinics 52 Number of Attendances:- (a) New Patients 504 (b) Old Patients 117 Total 621 Average attendance per session was:- 11.93. The percentage of new patients relative to the number of confinements in the Hospital was 62.9 INFANTS. The number born in the Hospital was 711; this number includes 16 cases of twins, that is 2.3 per cent. of all confinements this year. (An average figure for twins is 1 per cent.) The smallest infant - not a twin - weighed 2 lbs. at birth and was discharged at 3 months weighing 6 lbs. 5 ozs. BREAST FEEDING. There has been no definite decline in breast feeding this year among patients in the Hospital. With the exception of last year. which was our most successful year for breast feeding, our figures are as good, indeed even better, than the several preceding years. 1942 1941 1940 1939 1938. (a) Infants completely breast fed. 83.9 87.6 77.4 75.9 77.0 (b) Infants partly breast fed. 12.0 9.9 18.7 18.7 17.5 (c) Infants not breast fed at all. 4.1 2.5 3.9 5.4 5.5 100.0 100.0 100.0 100.0 100.0 HOETAL AND INFANT MORTALITY. (a) Stillbirths. Number of cases Premature, i.e. 5½ lbs. or less 6 Full term, i.e. over 5½ lbs. 16 Total 22 (b) Infant Deaths. Premature 8 Full term 3 Total 11 39. Mortality rate per 1,000 births. (a) Stillbirths 30.9 (b) Infant deaths. 15.5 OPERATIONS PERFORMED. Number of cases. (a) Caesarean section 1 (b) Forceps delivery 65 (c) Surgical induction of labour 5 (d) Version 5 (e) Manual removal of placenta 7 83 MEDICAL AID REQUESTS. In a total of 365 cases, medical aid was required by a Midwife. Treatment was given by the Resident Obstetrician or the Doctor acting for her. CASES OF PUERPERAL PYREXIA. No. of cases notified 21 Percentage of cases relative to number of deliveries. 3.02. Causes of Pyrexia. Number of cases. (a) localised uterine infection 7 (b) Urinary infection 5 (c) Abdominal infection, following Caesarean section. 1 (d) Flushed breast 4 (e) Excoriated nipples 1 (f) Breast abscess 1 (g) Tonsillitis 1 (h) Undiagnosed 1 21 MATERNAL DEATH. There was one maternal death from pre-eclamptic toxaemia and ante-partum haemorrhage. One patient, who had had a normal confinement, died at home six weeks after her delivery. Between May 1st., 1934, when the Hospital was opened, and April 2nd., 1943, there were 5,000 confinements, 5054 infants were born - 52 cases of twins and one of triplets. 533 patients (10.7 per cent.) were admitted for treatment during the ante-natal period. At the ante-natal clinic, 5,767 patients made a total attendance of 48,532. Since the Post-Natal Clinic (which patients attend for a final examination and any necessary treatment after confinement) was inaugurated in April 1935, 2,746 mothers, (i.e. 61 per cent. of the total eligible) have attended; 1164 extra attendances were made for treatment. Maternal mortality Stillbirth rate Infant Death rate rate per 1,000 per 1,000 total per 1,000 live births. births. England & Wales 1942 (Lowest 28.6 ever recorded) 2.47 33.3 first month. (last known figures 1937.) Thorpe Coombe First 5,000 cases. 2.2 33.8 13.6 (first 14 days) Thorpe Coombe 1942. 1.4 30.9 15.6 (first 14 days) 40. THORPE COOMBE MATERNITY HOSPITAL. A Report on an Investigation on the nutrition of expectant and nursing mothers, in which 500 patients from Thorpe Coombe were included (with the approval of the Maternity and Child Welfare Committee) was published by the People's League of Health this year. A Committee of obstetric specialists was appointed in 1938 to arrange the details of the Investigation and later to assess the results. The Investigation was carried out on 5,000 expectant and nursing mothers from a number of hospitals between March 1938 until December 1939. The purpose of the Investigation was to see whether or not the additions of vitamins and minerals to the daily diet would benefit the course of pregnancy and labour and favourably influence the condition of the new-born child. Calcium and other minerals together with vitamins A,B,C and D were given to the experimental group of patients for the last four months of pregnancy. A control group was included in the investigation; they were not given the additions to their diet. The results of the Investigation showed that women receiving the special diet were protected against the risks of pregnancy toxaemia (raised blood pressure and, or, albumen in the urine) to a degree of almost 30 per cent. The chances of a woman carrying her child to term were improved by the diet. There was, however, no evidence to show that the additions to the diet appreciably effected the risks of puerperal pyrexia end sepsis. Nor did the investigators find any appreciable influence on the character and duration of labour. 41.