Ac 4411 (1) WALTHAMESTOW JrO h [*2.(9 With the Compliments of the Medical Officer of Health and School Medical Officer, Borough of Walthmestow. BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1943. A.T.SV.POWELL, M.C., M.B., B.S., D.P.H. mLDICAL OFFICER OF HEALTH. CONTENTS. Abortion 42 Acrcage 4 Adulteration 18 Ambulance Facilities 7 Ante-Natal Clinic 36, 48 Bacteriological Analyses 18 Births 30 Cancer 6 Cerebro-Spinal Meningitis,30.21 Child Welfare 32 Child Life Protection36 Clinics 7, 8, 33, 34, 35, 36 37 and 38. Clothing Coupons for Expectant Mothers 30 Committees 2, 28 Cremation 27 Dampness 12 Day Nurseries 30, 31 Deaths 4, 5, 6, 26 Death Rate 4 Dental Treatment 38 Diphtheria 20, 21 Diphtheria Immunisation 22 Diseases of Animals Acts 18 Disinfestation 14 District Midwifery 41, 42 Dysentery 20, 21 Enteric Fever 20, 21 Erysipelas 20, 21 Factories & Workshops,13 ,19, 20 Food Inspection 16 Foot Clinic 7 Forceps Delivery 48 Haemorrhage - Ante-Partum 48 Health Services 7 Health Visiting 33, 34 Home Helps 39 Hospital Accommodation 8, 40 Hospital, Infectious Disease 20, 25 Housing 15, 16 Housing Act, 1936 15 Housing Inspection 15 Ice Cream 17 Immunisation 22 Infant Mortality 5, 32, 45 Infectious Diseases 12, 20, 21 and 25 Infestation by Head Lice 35 Institutional Treatment 40 Invalid Children's Aid Assn.39 Isolation Hospital 25 Laboratory Work 22 Massage 36 Maternal Mortality. 42, 43, 44 Maternity & Child Welfare 28 Measles 20, 21 Meat Inspection 17, 18 Medical Aid 48 Medical Examinations 27 Midwives 41, 42, 46 Milk, Assisted Scheme 39 Milk Supply, Etc. 16 Miscellaneous 27 Mortuary 27 Neo-Natal Mortality 32, 44 Notices, Sanitary 12 Nursing Homes 9 Ophthalmia Neonatorum,20,21, 42 Orthopaedic Treatment 38 Outworkers 20 Pneumonia 20, 21 Post-Natal Clinic 36 Public Assistance 9 Public Cleansing 10 Puerperal Pyrexia,20, 21,42, 48 Rateable Value 4 Rats & Mice Destruction Act, 1919 19 Refuse Disposal 10 Rent Restriction Acts 18 Rheumatism Clinic 21 Sanitary Inspection .10, 11, 12 13 & 14. Scabies 8 Scarlet Fever 21, 20 Schick Tests 22 Sewage 10 Social Conditions 4 Special Premises 13 Staff 4 Statistics 4 Sterilised Maternity Outfits.39 Stillbirths 4, 30, 44 Sunlight Treatment 39 Swimming Baths 14 Thorpe Coombe Maternity Hospital 44, 45, 46, 47, 48 and 49. Trade Refuse 11 Tuberculosis 21, 23, 24, 25, 26 Unemployment 4 Vaccination 23 Venereal Disease 9 Vital Statistics 4 Vitamins 30 Walthamstow Child Welfare Society 37 Walthamstow District Nursing Association 40 Waste Food 10 Water 10 Whooping Cough 20, 21 Women's Clinic 7 Zymotic Diseases 5 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Councillor Mrs.E.A.Smith. Vice-Chairman: Councillor Mrs.S.Candy The Worshipful the Mayor - Alderman Mrs.E.M.Miller, J.P. The Deputy Mayor - Alderman Mrs.E.M.Richards, J.P. Chairman of Finance Committee - Alderman Ross Wyld, J.P. Alderman Mrs.L.P.Bailey, J.P. Alderman Mrs.C.McEntee, J.P. " W.Gillett " Miss E.M.Pracy, B.Sc. Alderman W.H.Shaw. Councillor H.S.Baker " S.N.Chaplin H.J.Cole " A.Crosier " Mrs.B.M.Friedberg " F.W.Gentle " J.F.Green Councillor W.E.Hammond G.J.R.Holt " A.E.Manning " Mrs.A.L.Meadows " V.L.McEntee, M.P. " R.E.Smith " G.H.Spackman, J.P. Councillor Mrs.E.B.Toynbee. Town Clerk: F.G.Garner, Esq. till 31.3.43. G.A.Blakeley,Esq. from 1.4.43. 2. TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, In accordance with v»ar-time custom the report is again curtailed and duplicated. Generally speaking the report again shows a satisfactory position in the fifth year of vzar. The estimated population is not published but shows a natural increase of 534. The birth rate is 2.4 per cent, higher than that for the Administrative County of London, and the death rate is 2.2 per cent. less. With the permission of the Controller the perconnelof the Civil Defence Casualty Service assisted very materially in the maintenance of the various health services. I have the honour to be, Your obedient servant, A.T.W.POWELL. Medical Officer of Health. 3. STAFF. The following changes occurred in the Staff:P.esignations and Appointments:- Dr.Utting Temporary Assistant Assumed duty 25.1.43 Medical Officer. Resigned 30.6.43 Dr.Cardwell Temporary Assistant Assumed duty 1.7.43 Medical Officer Resigned 15.10.43 Dr.Highet Temporary Assistant Medical Officer Assumed duty 6.12.43 Mrs.F.L.Green appointed 26.7.43 Mrs.D.A.Jacobs ft 16.8.43 Miss R.Kaufman resigned 5.5.43. STATISTICS «ND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343 Number of Assessments, 1st.April 1943 35,856 Rateable value £861,526 Sum represented by penny rate £3,294 POPULATION.- The Registrar-General's estimate of the population at mid-year, 1943, showed an increase of 1,750 on the previous figure. UNEMPLOYMENT.- The degree of unemployment in the area during 1943 may be estimated from the following data kindly supplied by Mr.H.A.Jones, Manager of the Local Employment Exchange. The following data refer to the whole Exchange area. Date No.remaining on Register. Total. Date No.remaining on Register. Total. Men. Women. Men. Women. 18.1.43. 306 65 371 19.7.43. 162 11 173 12.4.43. 292 33 325 18.10.43 180 27 207 Approximately 60% of the persons registered as unemployed reside in Walthamstow. EXTRACTS FROM VITAL STATISTICS.- The Registrar-General's mid-year, 1943, estimate of population has been used for the calculation of all vital statistics:- Total Males Females. Live Legitimate 1767 883 884 Births Illegitimate 61 29 32 Totals 1828 912 916 Stillbirths 58. Rate per 1,000 total (live & still )births. .30. Deaths 1294. Deaths from puerperal causes:- Rate per 1,000 (live & still! births. Puerperal Sepsis Deaths 6 3.18 Other Puerperal Causes 3 1.59 Totals 9 4.77 4. 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 " " "illegitimate " " 32 Deaths from Measles (all ages) 1 " " Whooping Cough (all ages) 1 " " Diarrhoea (under 2 years of age) 3 Zymotic disease death rate 0.08 Pulmonary Tuberculosis death rate 0.58 Non-pulmonary " " " 0.04 The natural increase of population, i.e., excess of births over deaths, was 534. The usual comparison of vital statistics rates with those for the whole country, is shown in the table on the following page. BIRTHS.- Births are dealt with under the Maternity and Child Welfare Section of the Report. DEATHS.- The Registrar-General's classification of causes of death by sex totals is given. The total number of deaths in 1943 (1,294) compares with 1,140 during 1942. 5. CAUSES OF DEATH AS GIVEN BY THE REGISTRAR-GENERAL FOR THE YEAR 1943. WHOLE DISTRICT Causes of death. Males Females Total. 1. Typhoid & Paratyphoid Fevers – – – 2. Cerebro-spinal Fever 2 – 2 3. Scarlet Fever – – – 4. Whooping Cough 1 – 1 5. Diphtheria 2 1 3 6. T.B. of respiratory system 37 22 59 7. Other forms of Tuberculosis 1 3 4 8. Syphilitic disease 6 3 9 9. Influenza 15 15 30 10. Measles 1 – 1 11. Acute poliomyelitis & polioencephalitis – – – 12. Acute infectious encephalitis 2 – 2 13M.Cancer of buccal cavity & oesophagus (Males only) 10 – 10 13F.Cancer of Uterus – 16 16 14. Cancer of stomach and duodenum 21 18 39 15. Cancer of breast – 24 24 16. Cancer of all other sites 90 56 146 17. Diabetes 2 6 8 18. Intra-cranial vascular lesions 47 56 103 19. Heart disease 141 139 280 20. Other diseases of the circulatory system 18 24 42 21. Bronchitis 61 43 104 22. Pneumonia 47 42 89 23. Other respiratory diseases 19 1 20 24. Ulceration of the stomach or duodenum 22 2 24 25. Diarrhoea (under 2 years) – 3 3 26. Appendicitis 1 3 4 27. Other digestive diseases 10 17 27 28. Nephritis 10 9 19 29. Puerperal and post-abortive sepsis – 6 6 30. Other maternal causes – 3 3 31. Premature birth 10 10 20 32. Congenital malform. birth injury, infantile disease 19 6 25 33. Suicide 3 1 4 34. Road traffic accidents 4 3 7 35. Other violent causes 20 10 30 36. All other causes 70 60 130 Totals 692 602 1294 Totals for 1942 613 527 1140 The age distribution of Cancer deaths was as follows:- Under 1 yr. 1-2 yrs. 2-5 yrs. 5-15 yrs . 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. and over. – – – – – 21 85 129 GENERAL. PROVISION OF HEALTH SERVICES IN THE AREA. (a) LABORATORY FACILITIES.- (See I.D.Section). (b) AMBULANCE FACILITIES.- No change. MUNICIPAL SERVICE. Removals Accidents Maternity Total Mileage 3593 484 549 4626 28756 346 maternity cases have been removed to Thorpe Coombe Maternity Hospital. An ambulance car for the conveyance of sitting cases was in use from September onwards in addition to the three ambulances. The four vehicles of the Municipal Ambulance Service were entirely staffed by Civil Defence Personnel who gave excellent service. WHIPPS CROSS HOSPITAL. Removal of patients is carried out by ambulances attached to the Hospital. ST.JOHN AMBULANCE CORPS. Mr .V.G.Turner, Divisional Superintendent, kindly contributes the following report:- First Aid cases attended 1,152 Number of patients removed 87x x Up till May. Mileage 697x 1 Owing to the petrol restrictions, etc., our motor ambulance transport was suspended in May until the end of the War. (c) CLINICS AND TREATMENT CENTRES. FOOT CLINIC.- Total attendances were 9,078, and of these 672 were by new patients, 8,406 were re-attendances by old patients, The receipts were £443.18.6d. WOMEN'S CLINIC.- Sessions were held weekly, with one consultant session monthly. Miss Helen Rodway, M.R.C.O.G., submits the following report:- No .of sessions held. No.of attendances Total Attendances Average attendance per session. New Cases Old Cases (a) Hoe Street Clinic 53 283 1,215 1,498 28.26 lb) Thorpe Coombe Clinic 49 241 403 644 15.14 524 1,618 2,142 Summary of New Cases.- For diagnosis or complications of pregnancy 123 Sterility 50 Gynaecological 262 Surgical 25 Medical 24 Contraceptive 22 Not classified 18 524 7. Comparison of attendances with previous years:- 1943 1942 1941 1940 1939 1938 New cases 524 424 299 260 329 319 Old cases 1,618 1.303 1,023 1,183 1,234 1,179 Totals: 2,142 1,727 1,322 1,443 1,563 1,498 Sixty patients were referred to the Clinics by private doctors. Forty-eight patients were referred to Hospital. SCABIES' CLINIC The weekly diagnostic session was continued at the Town Hall and treatment facilities at the Public Gas Cleansing Centre adjoining the Public Baths. The arrangements detailed in the 1942 Report were continued and the entire staffing was carried out by personnel of the Civil Defence Casualty Service under the supervision of Civil Defence trained nurses. All the personnel gave excellent service. 1,045 cases were treated during the year receiving 3,415 treatments. (d) HOSPITALS.- There were no changes during 1943 in the Hospital services used by the inhabitants of the Borough. Public Assistance in Walthamstow is provided by the Southwestern Area Guardian Committee of the Essex County Council which retains a certain proportion of beds in each of the local institutions provided by the County Boroughs of East Ham and West Ham. Mr.Pegram, the Clerk to the Committee, has kindly supplied the following particulars of Walthamstow residents admitted to the various institutions during the year ended 31st.December 1943:- Institutions Men Women Children Total. Central Home 122 136 46x 304 Whipps Cross Hospital 552 745 339 1636 Forest Gate Hospital 2 59 1 62 Harold Wood Hospital 4 5 - 9 Forest House 5 4 - 9 Aldersbrooke Children's Homes - - 56 56 xThese children were ultimately transferred to Aldersbrooke. 43 infants were born to Walthamstow mothers in Forest Gate Hospital during the year. The number of patients from Wal thamstow in Mental Hospitals was 385 on the 31st.December, 1943. THE CONNAUGHT HOSPITAL. The Secretary to the Hospital has kindly supplied the following information:- "Of the total number of in-patients admitted during the year, 869 were residents of the Borough. "The following figures show the progress of the Hospital during 1943 as compared with the previous year:- No. Admitted In-Patients Out-Pat ients Average Stay Daily Average New Cases Attendances 1943 2018 16.04 88.19 12,592 75,466 1942 1961 16.26 86.79 13,335 79,028 "Particulars as to Staff, Beds and Departmental activities:- 8. 128 beds, including 10 Frivate -Yards and 10 A for E.M.S. Operations and treatments.- During 1943, 885 major operations and 161 minor operations were performed, making a total of 1,046. 6,351 Radiographs were taken. There were 13,766 massage treatments, also 30,479 electrical treatments and 2,266 artificial sunlight treatments at the Comely Bank Clinic; a total of 46,511 treatments at this Clinic. FACILITIES AT COMELY BANK.- The following facilities for electro-medical treatment are provided at Comely Bank:- Massage, Radiant Heat, Electrical Treatment, and Sun-ray Treatment. VENEREAL DISEASE TREATMENT. Treatment is provided by the Essex County Council, and all the facilities of the London County Council are available. Outfits for taking specimens from patients are provided for practitioners, on request, by the Whitechapel (London County Council) Clinic, Turner Street, Whitechapel, E.l. PUBLIC ASSISTANCE.- Out-relief and institutional treatment is provided by the Essex County Council. Mr.Pegram, Clerk to the Essex County Council South-Western Area Guardian's Committee, kindlv states that the amount of relief provided in Walthamstow during the two years ended 31st.December, 1943, was as follows:- 1943. 1942. £. s. d. £. .s. d. Total amount of out-relief granted to Walthamstow residents during year ended 31st.December 35,152. 4. 1. 33, 024.7. 11. Average weekly number of Walthamstow) Men 225 230 residents in receipt of relief ) Women 456 472 during the year ended 31st.December) Children 251 263 Totals 932 965 MATERNITY AND CHILD WELFARE.- See Section H of the Report. PUBLIC HEALTH ACT, 1936. - NURSING HOMES. No. of Homes. No. of patients provided for Maternity Patients Others. Totals. Homes first registered during the year Nil. – – – Homes on register at the end of the year 4 28x 10 38 There were no refusals, cancellations nor appeals. 12 inspections were made by the medical staff. Routine enquiries are made with regard to unregistered Homes. No difficulties in regard to supervision arose. xl4 of these are not in use during the period of the War. 9. SANITARY CIRCUMSTANCES OF THE AREA. WATER.- Water is supplied by the Metropolitan Water Board and is quite satisfactory as regards sufficiency and quality. Mr.T.S.Cunningham, B.Sc., M.Inst. M.& Cy.E., Borough Engineer and Surveyor, kindly contributes the following report:- SEWERS.- New pumps of greater capacity have been installed by the Borough Engineer & Surveyor's Department to deal with the additional soil sewage discharge from a factory area. RODENT CONTROL.- A direction has been given under The Infestation Order, 1943, Rodent Repression in Sewers, for the destruction of rats in the soil sewers within the Borough. The work, which is being carried out by the Borough Engineer & Surveyor's Department, was commenced early in December, 1943, is now in progress,and in the first three of the four weeks of the first of the two treatments at present proposed, the estimated number of rats destroyed is 9,800. PUBLIC CLEANSING.- Mr.Eric Bell, M.I.P.C., A.R.San.I., Cleansing Superintendent, kindly contributes the following report:- In preparing this report on the activities of the Public Cleansing Department, I am very pleased to state that all essential services were maintained during the year 1943 despite the many difficulties mainly due to the manpower situation. HOUSE REFUSE COLLECTION. The total weight of refuse collected during the past year was 23,014 tons. This shows an increase of approximately 300 tons, compared with 1942, due most probably to the return of further residents from reception areas From this tonnage 5,625 tons of salvage were returned to industry, thus saving valuable shipping space and probably lives of seamen. The analysis of the refuse still shows that large quantities of tinned foods are being consumed, a drop in the cinder content, and a slight increase in dust. Despite the many appeals made to the public, and the Compulsory Order issued by the Government making this an offence, large quantities of waste paper, cardboard, rags, etc., are still mixed with refuse. STREET SALVAGE OFFICERS. These ladies continue to do excellent work - we now have some 400. During the past year valuable assistance was given by these ladies, the W.V.S., Boy Scouts, Girl Guides, Girls Training Corps, Young Communist League, etc., in the Book Recovery Drive. Walthamstovs' s target, set by the Ministry, was 250, 000; this was easily achieved. Naturally this entailed a tremendous amount of work for these volunteers, also for every section of the Cleansing Department. The Borough Librarian, with the assistance of the Teachers' Association, kindly arranged to supervise the scrutiny of each book collected. WASTE FOOD. This scheme continues to provide valuable feeding material for pigs and poultry, and 1,618 tons have been collected during the past year. 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 or four times during the winter. The bins are cleansed and sterilised periodically at these Works. During the past year about 75% of the bins have been painted broken white with suitable wording in red. This was done mainly to attract public attention to the correct uses of these bins, in the hope of eliminating the practice 10. very prevalent during the past year of depositing articles other than waste food and bones in these bins, and also to obviate the danger to pedestrians during blackout hours. 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 from his premises, i.e. cardboard, paper, metal, tins, etc. From reports received all traders participating in the scheme are quite satisfied with the services rendered by the Department. REFUSE DISPOSAL. During the past year the total tonnage of refuse handled at these Works has been 23,099 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 it has previously been very difficult to find markets. Ashes, cinders, etc., have been sold for use in the construction of roadways to camps and aerodromes, and screened dust to farmers. STREET AMD MARKET CLEANSING. Despite the blackout 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. Forces, 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., and would use the litter baskets which have recently been reconditioned and refixed to the trolley-bus poles throughout the Borough. GULLY CLEANSING. The Gully machine still continues to give excellent serviceduring the year 1943, 13,000 gullys have been cleansed, disinfected and sealed. CIVIL DEFENCE. The Department is responsible for the maintenance and painting of the Gas Detector points throughout the Borough. These were all repainted during the past year. Decontamination Squads have been continuously on standby duties in conjunction with the Fire Guard Business and Government Premises Order 1943. These men are available not only to deal with fires, but for any emergency outside the Works, such as removing debris from main roads. 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 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 bombdamaged properties, building of shelters, blast walls, N.F.S. sub-stations, static water tanks, etc. 11. During the year, hundreds of tons of sludge have been removed from the sewer beds and sold to farmers and allotment holders as a fertiliser. From reports received, excellent crops have been produced v.h'ere this material has been used. After nearly completing a very strenuous year's v:ork, the Department was further hampered by the fact that two high explosive bombs were dropped during December, thus disorganising the normal routine working of the Department. Despite this, no services operating in the Borough suffered in any way - refuse collections, salvage and waste food collections, street cleansing, were still carried on in the usual way - thanks to the loyal co-operation of all employees and every member of my staff. 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 No. of Notices No. of Statutory No. of Notices Total' Visits Served Complied with Served Complied with 12,265 5,496 2,613 1,809 1,625 93 75 19,993 The number of complaints received was 2,613 an increase compared with last year, partly due to difficulty of getting repairs carried out and to extensive work of Rat Repression. No House to House Inspections were carried out. The nature and variety of the work done during 1943 is shown in the following tables:- Drains tested, 766; Drains reconstructed or repaired, 442; Drains obstructions removed, 261; Drains means of access provided, 47; Drains, ventilation provided or improved, 55; Drains, ventilation repaired, 76; Soil pipes repaired, 40; Soil pipes new, provided, 21; Rain water pipes renewed, 116; Rain water pipes disconnected from drains, 6; Roofs repaired or renewed, 659; Gutterings repaired or renewed, 237; W.C.psns or traps provided, 224; Gully traps provided, 71; W.C.flush cisterns provided, 50; W.C.flush cisterns repaired, 262; W.C.floors concreted, 36; W.C's. repaired and cleansed, 183; W.C's. light and ventilation improved, 3; Waste pipes renewed or trapped, 82; Waste pipes repaired, 83; Mew sinks provided, 36; Water supply reinstated, 8; Water supply taken off main, 5; Cisterns cleansed and covered, 16; conveniences cleansed or repaired, 11; Sculleries paved, 30; Yards and forecourts paved and repaired, 99; Dirty houses cleansed, 9; Dirty rooms cleansed 574; Floors repaired, 180; Ventilations under floors provided, 81; New damp-proof courses provided, 46; Sites concreted, 6; Offensive accumulations removed, 34; Animals improperly kept, removed, 6; Manure receptacles provided, Nil; Stables cleansed, paved and drained, 35; Manholes repaired or re-sealed, 122; Other cases of dampness remedied, 281; Miscellaneous repairs, 1,433. INFECTIOUS DISEASE. Visits to premises, 998; Re-visits to premises, 140; Premises disinfected, 552; Articles disinfected at Low Hail, 5,232; Articles destroyed at Low Hall, 44; Articles Dried, 126. DAMPNESS IN HOUSES. Sites concreted, 6; Damp-proof courses provided, 46;Yards and forecourts paved and drained, 99; Roofs made water hight 652 Rain-water pipes made good, 116; Guttering repaired or renewed, 237; Other cases of dampness remedied, 281; Ventilation under floors provided. 81. 12. Special Premises. Number Visits paid. , Factories (a) Power 215 298 (b) Non-Power 135 116 (c) Other premises 33 40 Outworkers 393 400 Slaughterhouses Not in use. Butchers' Shops 74 301 Bakehouses 31 195 Fishmongers, fish fryers and curers, etc. 35 124 Eating-houses and Coffee Stalls 92 129 Ice Cream Vendors Ml. Nil. Cowsheds 1 8 Dairies and Milkshops 48 144 Laundries 5 10 Hag and Bone Dealers 4 8 Elementary Schools 31 4 Private Schools 1 Piggeries 7 51 Street Stalls Numerous 16 Greengrocers " 135 Stables " 165 As a result of the regular periodical visiting of the Special Premises the following works were carried out:- BUTCHERS' SHOPS AND SLAUGHTERHOUSES. Special cleansings, 34; Paving repaired, 2; Accumulations removed, 4; New Galvanised Bins provided, 6; Drains repaired, 8; 7v'.C's. repaired and cleansed, 8; Yard paving repaired, 1; Floors repaired and ventilated, 6; Roofs repaired, 1; Drains cleared, 3. BAKEHOUSES. Special cleansings, 46; Drains repaired, W.C ' s.cleansed and doors repaired, 17; Yards repaved, 4; W.C.cisterns repaired,3; Roofs repaired, 1; Premises general repairs, 4; Other improvements, 3. FISHMONGERS. Special cleansings, 27; Yards repaved, 2; Accumulations removed, 5; Roofs repaired, 1; Other improvements, 8; Drains cleared, 4. COFFEE AND EATING HOUSES. Special cleansings, 22; Yard pavings repaired, 3; W.C.cisterns repaired, 5; Drains repaired, 2; New W.C.Pan trap, 1. COWSHEDS AND MILKSHOPS. Special cleansings, 11; Pavings relaid, 1; Fittings and other improvements, 2; Roofs repaired, 1; W.C's. repaired, 1. STABLE PREMISES. Cleansings, 44; Accumulations removed, 6; Roofs repaired, 1; Pavings repaired, 4; W.C's. repaired, 2; Drains reconstructed, 2. LAUNDRIES. Special cleansings, 6; Roofs repaired, 1; Other improvements, 2. RAG AND BONE DEALERS. Cleansings, 6; Accumulations removed, 1. 13. PIGGERIES. Cleansings, 10. CAMPING SITES. There were no sites in the area used as camping sites. There are, however, several van dwellers in the Higham Hill area, and the Council have authorised these to be dealt with under the' Essex County Council Act. SMOKE ABATEMENT. A few complaints of nuisance caused by smoke were investigated and remedial measures adopted as far a s practicable with the type of fuel supplied. ERADICATION 0? BED BUGS. The free issue of insecticides and the loan of small pneumatic sprayers has continued. SWIMMING BATHS AND POOLS. The model bye-laws of the Ministry of Health were adopted during the year. (a) MUNICIPAL BATHS, HIGH STREIT. This is a covered swimming both. Mr.W.Cantes kindly contributes the following report:- The plant was kept operating for an average of 1? hours per day, the baths being open 150 days in 1943. The approximate number of swimmers in 1943 was 74,547. The estimated maximum load was 988. Bacteriological and chemical analyses were carried out on two occasions, and the water was considered suitable for swimming bath purposes. There are 70 slipper baths in the building, with an ample supply of hot and cold water. All towels and other requisites are sterilised snd freed from contamination. (b) WHIPPS CROSS BATHING POOL.- This is a large open-air pool situated in Epping Forest, in the area of the Borough of Leyton and a few hundred yards from the Walthamstow boundary. It is administered by a joint committee representing the two Boroughs. The pool is supervised by the Medical Officer of Health for Leyton, who sends a copy of the analytical findings when samples are taken. (c) SOUTH-Yi EST ESSEX TECHNICAL COLLEGE.- Sampling was carried out on three occasions, and the water was considered suitable for swimming bath purposes, (d) FOREST SCHOOL.- This is a small swimming bath with a capacity of approximately 47,000 gallons, treated with "Voxsan" with frequent changes of water. (e) THE KINGFISHER POOL.- This is an open-air pool in Epping Forest. Details were given in the 1935 report. The Managing Director kindly gives the following particulars: The plant was kept in operation all day and night over the week-ends, if found necessary. The approximate number of swimmers in 1943 was 31,229. Bacteriological and chemical analyses were carried out on one occasion, and the water was considered suitable for swimming bath purposes. 14. HOUSING. 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-HOUSES DURING THE YEAR;- (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts 2,711 (b) Number of inspections made for the purpose 6,723 (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 2 (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 1,608 II. - REMEDY OF DEFECTS DURING THE YEAR VJTHOUT SERVICE OF FORMAL NOTICES: - Number of defective dwelling-houses rendered fit in in consequence of informal action by the Local Authority or their Officers 1,271 III. - ACTION UNDER STATUTORY POWERS DURING THE YEAR:- A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:- (1) Number of dwelling-houses in respect of which notices were served requiring repairs ... 91 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a ) By owners 69 (b) By local authority in default of owners (at a cost of £33.8.2d.) 5 (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 2 (2) Number of dwelling-houses in which defects were remedied after service of formal notices 15. (a) By owners 1 (b) By local authority in default of owners.. Nil. 0. 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 madeNil. (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. INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLY. The average number of cows kept in the Borough is seven. There is only one cowshed and eight 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 48, many of whom carry on a general shop and sell milk in bottles as they receive it. Routine visits were paid to maintain the general standard of cleanliness. During the year 33 samples of milk were taken for bacteriological examination. Four gave unsatisfactory results. The samples are summarised as follows:- No. of Samples. Satisfactory. Unsati sfactory Tuberculin Tested 3 - " " Pasteurised 4 - Pasteurised 10 - Pasteurised (not sold as such) 12 4 Totals 29 4 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 23 Tuberculin Tested Milk 12 Supplementary Licences. Pasteurised Milk 2 Tuberculin Tested Milk 2 Bottling Licences. Pasteurised Milk 2 Tuberculin Tested Milk 2 16 ICE CREAM. Owing to the war-time restrictions ice cream is not made. Two samples of "Iced Blanc Mange" were taken and submitted for analysis under the sale of Food & "rugs Act. This commodity was sold in a frozen condition similar to ice cream and subsequently proceedings were taken by the Food Executive Officer. 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. 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 Fig Food Scheme 197 tins Luncheon Meat 1 gall. jar Salad Dressing 82 " Chopped Ham 1 jar Peanut Butter 135 " Sausage Meat 7 jars Bovril 11 " Lambs Tongue 3 " Betox 11 " Ox Tongue 12 " Paste 99 " Stewed Steak 27 " Pickles 6 " Rabbit 3 " Piccallili 4 " Corned Beef 1 bottle Vinegar 3 " Beef Loaf 1 " Red Cabbage 13 " Prepared Meal 16 " Sauce 5 " Picnic Roll 5 " Coffee 16 " Soya Links 2 " Lenon Squash 59 " Meat & Vegetables 2 " Custard Flavouring 20 " Braised Pork & Beans 6 pkts.Pancake Mixture 310 " Beans 8 " Junket Tablets 42 " Carrots 4 " Corn Flekes 7 " Beetroot 23 " Sponge Mixture 17 " Mixed Vegetables 23 " Semolina Pudding Mixture 373 " Peas 2 lbs. Lemon Curd 7 " Spaghetti 58 " Marmalade 41 " Diced Parsnips 161 " Jam 5 " Scotch Broth 4 " Golden Syrup 121 " Soup 372 " Sugar 3 " Spinach Puree .53 " Dried Prunes 6 " Tomato " 65 " Apple Rings 4 " Brislings 90 lbs. Egg Substitute Powder 323 " Pilchards 484 " Flour 201 " Sardines 83 " Cake Flour 136 " Salmon 623 " Biscuits 71 " Herrings 52 " Cake 10 " Mackerel 9 " Tea 5 " Crayfish 6 " Cocoa 10 " Fish Cake Roll 112 " Spaghetti 1,151 " Condensed Milk 74½ " Rice 3,709 " Evaporated Milk 190 " Oats 13 " Dried Milk 31 " Semolina 34 " Peaches 344 " Cheese 20 " Rhubarb 306 " Bacon 395 " Plums 17 " Margarine 25 " Prunes 2 " Butter 32 '' Pears 8 " Cooking Fat 40 " Pineapple 5½ " Chocolate 7 " Damsons ¾ " Toffee 2 " Apricots 68 Bars Butterscotch Toffee 11 " Blackberries 48 " Plain York Chocolate 11 " Apples 5 cwt. Figs 8 " Cherries 8 " Potatoes 4 " Grapefruit 37 stone Cod Fillets 7 " Gooseberries 28 " Herrings 4 " Fruit Salad 27 " Skate 2 " Oranges 9½ " Coley 17. 3 tins Various Fruits 6 stone Hake 1466 " Egg Substitute Powder 5 " Dog Fish 108 " Custard Powder 5 " Haddocks 1 tin Salad Cream 77 lbs. Beef 1 "Dried Egg 35 " Lamb 3 " Bourn Vita 30 " Meat (various) 4 " Barlova 14 " Sausages 11 " Ovaltine 14 " Liver 2 jars Malted Milk 10 " Mutton 5 " Horseradish Cream 5 " Ttorlk 7 " Mustard Cream 3 Ox Tongues 1 jar Calves Tongue 3 Hearts 19 Rabbits 24 Sausage Pies 3 Chickens 6 Savoury Pies 61 Fish Cakes 5 Steak Pies 377 Eggs. ADULTERATION - FOOD AND DRUGS ACT, 19 38. During the year 85 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 Result of Analysis Decision Taken. Cooked Pease Pudding (Informal) Offensive & Objectionable smell as to render it unsuitable for human consumption. Withdrawn from Factory Canteen. Rice (Informal) Dirty condition, but not harmful. Suggested bulk of rice be mixed with at least twice its weight of clean rice. Mustard Cream (Informal) Stale quality and unfit for sale. Balanoe of stock surrendered by retailer. No legal procedure was necessary in respect of any sample, (d) CHEMICAL AM) BACTERIOLOGICAL EXAMINATION OF FOOD. Chemical examination is carried out by the Public Analyst, Dr.Bernard Dyer, 20, Eastcheap, E.C.3., and bacteriological examination by the Counties Public Health Laboratories, Gidea Park College. RENT AND MORTGAGE RESTRICTIONS ACTS, 1920-1923. During the year 17 certificates were granted to tenants and four certificates have been issued to owners upon their application and completion of the scheduled works. DISEASES OF ANIMALS ACTS, 1894-1928. Sheep Scab Order, 1920 - No case of this disease occurred in the Borough during the year. The Sheep Scab Order, 1928.- During the year, no sheep were admitted into the area underLicence for Slaughter. Swine Fever Order. 1908.- No action was necessary under this Order during the year. Regulation of Movement of Swine Order, 1922.- Three Isolation Notices affecting 53 swine were received. The Licences were in all cases duly observed. One Movement Licence was issued under the Order. 18. IMPORTATION OF DOGS ORDERS. Notification was received in respect of the importation of a dog into this Borough without the animal first being subjected to quarantine. The necessary action was taken. RATS AND MICE DESTRUCTION ACT, 1919 AND INFESTATION ORDER, 1943. In conformity with this Order a large amount of work was involved. Practically the whole Town has received attention in this direction whilst Factories, sewers and drains at the rear of houses, together with open water-ways, have received special consideration. In addition to the two regular men employed by the Council two other men were seconded from Civil Defence duties on their duty days (but carried out Civil Defence duties at night). They also gave service on a paid basis during their off duty days. The total number of men employed on Rat Repression was therefore the equivalent of four whole time men. Pre-baiting and Poison baiting with, in many instances a repetition of this baiting, has been carried out with very satisfactory results. It is contemplated that the Council will be reimbursed for rat repression work carried out by the Public Health Department in certain factory premises. The following is a summarised statement of the year's work:- No. of Premises & Sites Inspected Premises & Sites found to be Infested. Methods used at Infested Premises and Sites. Food Other Food Other Baiting. Trapping. Gassing. Other. 127 825 70 599 340 60 4 338 Complaints received 584 Premises rat-proofed 66 Advice only given 53 Re-inspections 1,400 FACTORIES ACT, 1937. The following tables show the work done under these Acts. 1.-INSPECTION OF FACTORIES, ETC. Including Inspections made by Sanitary Inspectors. Premises (1) Number of Inspections (2) Written Notices (3) Occupiers Prosecuted (4) Factories with machine power 298 16 Nil Factories without power 116 2 Nil Other premises under the Act. 40 – Nil Totals 454 18 Mil. 19. 2. - DEFECTS FOUND IM FACTORIES, ETC. Particulars. No. of Defects. No. of Offences in respect of which prosecutions were instituted. Found j Reme|died. ; Referred to H.M. Inspector. (1) (2) (3) (4) (5) i j '.'/ant of cleanliness 50 50 — — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation 1 1 — — Ineffective drainage of floors 2 2 — — Sanitary Conveniences insufficient 3 3 — — unsuitable or defective 40 40 — — not separate for sexes 2 2 — — Other offences 43 43 1 — Totals 141 141 1 Nil. NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1943. Steering Apparel, making of 359 Belts 2 Brush Making 13 Paper Bags 5 Boxes 7 Feathers 1 Boots and Shoes 6 Total 393. Outworkers were notified from the following areas: - Bethnal Green 6 Poplar 3 City of London 18 St.Marylebone 15 Finsburv 36 Shoreditch 6 Hackney 72 Walthamstow 88 Islington 12 Westminster 13 Leyton 86 Other Areas 38 Total 393 A total of 400 visits was paid in connection with outworkers. PREVALENCE OF, AND CONTROL OYER, INFECTIOUS & 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 1943 Ages 1942 Under 1 Yr. 1-5 yrs 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs & over Scarlet Fever 7 67 421 1 171 553 21 17 4 — Diphtheria 23 6 — 4 15 3 1 — — Enteric Fever — 4 — — — — — — — Pneumonia 122 91 1 10 19 9 35 35 13 Puerperal Pyrexia 43 29 — — — 12 31 — — Ophthalmia Neonatorum 2 1 2 — — — — — — Erysipelas 26 35 1 1 8 13 3 Encephalitis Lethargica — — — — — — — — — Polio-encephalitis — — — — — — — — — Cerebro-Spinal Meningitis 5 15 2 1 1 1 — — Anterior Poliomyelitis 1 2 — — 1 — — — — Measles 618 769 37 327 245 9 — — — Whooping Cough 93 151 8 57 27 — 1 — — Dysentery 71 3 1 13 37 4 9 5 2 Tuberculosis 159 148 1 2 13 52 53 20 Totals 1943 1,930 — 54 586 913 111 161 86 19 1942 — 1,675 41 547 778 112 103 72 22 20. St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Scarlet Fever 101 82 118 86 217 163 767 Diphtheria 2 3 4 5 2 7 23 Enteric Fever — — — — — — — Pneumonia 26 18 14 9 30 25 122 Puerperal Pyrexia 4 1 12 8 9 9 43 Dphthalmia Neonatorum 1 — — — — 1 2 Erysipelas 4 2 4 — 5 11 26 Encephalitis Lethargica — — — — — — — Polio-encephalitis — _ — — — — — Cerebro-Spinal Meningitis 1 1 1 — 2 — 5 Interior Poliomyelitis 1 — — — — — 1 Measles 84 124 84 88 76 162 618 Whooping Cough 10 28 14 4 16 21 93 Dysentery 31 25 7 2 — 6 71 Tuberculosis 20 20 20 21 38 40 159 Totals 1945 285 304 278 223 395 445 1,930 1942 317 235 235 123 338 427 1,675 The statistics given in the foregoing table are those for the calendar 'ear 1943. The Registrar-General gives the statistics for the 51 weeks ended 1st.January, 1944, and these are given in the following table. Disease Scarlet Fever Diphtheria Enteric Fever PneuPu monia erperal Pyrexia Erysipelas Number Cases Rate - 759 25 – 120 44 26 Disease Total Notified Removed to Hospital Per cent. removed to Deaths Hospital Deaths per cent. of cases notified Scarlet Fever 767 421 54.8 Nil. Nil. Diphtheria 23 21 91.3 3 0 13.04 Enteric Fever – – – – – Pneumonia 122 56 45.9 89 72.95x Puerperal Pyrexia 4-3 4 9.3 2 4.6 Ophthalmia Neonatorum 2 – – – – Erysipelas 26 6 23.07 Not a registrable cause of death. Encephalitis Lethargica – – – – – Polio-encephaliti s – – – – – Cerebro-Spinal Meningitis 5 5 100.0 1 20.0 Anterior Poliomyelitis 1 1 100.0 Nil. Nil. Measles 618 36 5.8 1 0.16 Whooping Cough 93 7 7.5 1 1.07 Dysentery 71 2 2.8 Nil. Nil. Tuberculosis (All Forms) 159 149 – 63 40.0 XA11 cases not notified.Ø No death occurred from Diphtheria of an immunised person. INFECTIOUS DISEASES CLINIC.- 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 made1,276 Average attendance per session 24.5 Number of children recommended to Rheumatism Clinic " " " " " Aural Clinic 15 21. DIPHTHERIA IMMUNISATION. Immunisation was carried out at the weekly clinic on Tuesdays at 2 p.m. an! 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 46 Negative (including pseudo and negative) 15 Positive (including pseudo and positive) 31 Total number of immunisations completed during 1943:- (a) School age 790 (b) Pre-school age 36 (c) Over school age 15 811 Number of Schick tests following immunisation 93 Number of attendances made at clinic for immunisation 2088 Average attendance per session 40.1 Immunisation at schools (included above):- Number completely immunised 826 Number having extra dose, immunised in previous year 320 BIRTHDAY LITTERS.- Letters were sent to the parents of all infants following their first, birthday and stressing the need for protection against diphtheria. 1,235 letters were issued and 045 infants were brought and protected. 183 infants had left the district. IMMUNISATION BY GENERAL PRACTITIONERS.- Diphtheria prophylactic is available to general practitioners. During 1943 80 c.c's. of alum precipitated toxoid were issued; this quantity is sufficient to protect 80 children. In February 1944 a special report was submitted to your Committee reviewing the incidence of Diphtheria in Walthamstow between 1890 and 1943. The report showed that between 1890 and 1919 the number of cases of Diphtheria varied between 130 and 516 averaging 242 each year, and the number of deaths between 12 and 78, averaging 31 yearly. Protection against Diphtheria was commenced in 1932, and in the twelve years before protection the average number of cases per year was 309 and the number of deaths 12. In the 12 years since Immunisation the average number of cases each year has been 125 and the number of deaths only 3. This favourable result largely follows from over 15,000 persons in Walthamstow having now been protected against Diphtheria, the large majority being under 20 years of age. At the end of 1943 nearly half the children under 5 years of age were protected and just over three-quarters of the children between 5 and 15 years. The urgent need now, is to protect babies as soon as possible after they reach the age of one year, and the necessary facilities are available either from the family Doctor, at any of the Welfare Centres, or at the special Clinic at the Town Hall at 2 p.m. on Tuesdays. MUNICIPAL LABORATORY. The following number of diphtheria swabs were examined during 1943: - Swabs Negative Positive Totals. Private Practitioners 359 13 372 Health Department 7 1 3 School Medical Department 219 – 219 Totals 565 14 599 22 VACCINATION. Mr.E.Sharp, Vaccination Officer for the Area, has furnished the following returns for 1943:- Births Registered Successfully Vaccinated Percentage Vaccinated Insusceptible Exemptions Death before Vaccinated Postponed 1,724 392 22.7 4 698 28 39 In addition to the above, 39 primary vaccinations were recorded and 53 re-vaccinations. During 1943 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 20.7 per cent, were vaccinated. PREYEOTION OF BLINDNESS. No action was necessary under Section 176 of the Public Health Act, 1936, for the prevention of blindness or the treatment of persons suffering from any disease of, or injury to the eyes. TUBERCULOSIS. The following table shows particulars of new cases of Tuberculosis and of all deaths from the disease in the Borough during 1943:- Age Periods New Cases Deaths. Pulmonary Non-Pulmonary Pulmonary Hon-Pulmonary M. F. M. F. M. F. M. F Under 1 year 1 – – – – – – – 1-5 years – 1 1 – – – – 1 5-10 " 1 4 – 3 – – – – 10-15 " 1 4 2 1 – – – 1 15-20 " 9 12 1 1 1 4 – – 20-25 " 9 15 1 4 1 4 1 – 25-35 " 13 22 2 – 5 5 – – 35-45 " 13 6 1 1 9 3 – – 45-55 " 16 6 – – 8 5 1 – 55-D5 " 7 – – – 11 1 – – 65 years and upwards – 1 – – 2 – – Totals 70 71 8 10 35 24 2 2 143 159 18 59 4 63 The returns for the past two years are compared below:- Year New Cases Total. Deaths. Total. Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. 1943 70 71 8 10 169 35 24 2 2 63 1942 67 52 17 12 148 19 25 9 3 56 The periods elapsing between notification and death, and the number of cases not notified were as follows:- S3. Under 3 months. 3 to 6 months 6 to 9 mont hs. 9 to 12 months. Over 12 months. Mot notified, Notified after death Pul . NonPul. Ful. NonPul. Pul. MonPul. Ful. NonPul. Ful. NonPul. Pul. NonPul. Pul. NonPul. 6 – 4 – . 3 – 1 – 35 – 8 3 2 1 The ratio of deaths in non-notified cases (i.e., coluransto the right of the double line) to total deaths from tuberculosis was 11 to 49 or 1 to 4.45. Appropriate action was taken when necessary vi th regard to the non-notification. The table given below shows the number of cases on the Register at the beginning and end of 1943: - Fulmonary. Total. Non- Pulmonary. Total. Grand Total. Mo. on Register 1st Jan.1943 M. F. 1583 M. F. 812 2395 649 734 450 362 Notified during 1943. 70 71 141 8 10 18 158 Totals. 9l0 805 1724 458 372 830 2554 Removed from Register,194 3. 44 32 76 5 2 7 83 No. on Register 31st Dec.1943. 875 . 773 1648 453 370 823 247l Eighty-three removals from the Register were made up as follows: - Deaths. Removals. Pulmonary. Non-Pulmonary, Pulmonary. Non-Pulmonary, M. F. M. F. . M. F. M. F. 35 24 2 2 9 8 3 - 59 4 17 3 63 20 83 Treatment of Tuberculosis. Treatment is given under the Essex County Council's Scheme. The admissions to Hospital during 19i3 were as follows: - Pulmonary. Non-Pulmonary. Total. Adults. M. F. M. F. 138 58 78 1 1 Children. 6 5 – – 11 24. INFECTIOUS DISEASES HOSPITAL. RENOVATIONS, etc.- There were no major alterations at the Sanatorium nor at Thorpe Coombe Maternity Hospital. GENERAL.- (l) The death rate per 100 admissions of infectious disease patients was 0.65, and per 100 total admissions 0.89. (ii) During the year the County Council continued the grant payable by them in respect of infectious disease beds, amounting to £425. (iii) The following table shows the admissions, discharges and deaths during 1943:- Scarlet Fever Diphtheria Other Diseases Tuber- culosis Totals Remaining in Hospital 1st.January 50 17 8 12 87 Admitted during year 567 94 101 21 783 Discharged during year 602 96 98 15 811 Died during year - 3 2 2 7 Remaining in Hospital 31st.December 15 12 9 16 52 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL. (Excluding Tuberculosis cases). January 57.7 July 47.4 February69.1 August 38.0 March 70.0 September 45.8 April 61.5 October 60.4 May 51.5 November 51.5 June 57.4 December 41.6 Average whole year 54.2. CLINICAL REPORT. Dr.Hamilton, Resident Medical Officer, reports as follows:- AGE AND SEX OF PATIENTS ADMITTED DURING 1943. Disease Under 5 years 5-10 yrs. 10-15 yrs. Over 15 yrs. Total Total M. F M. F. M. F. M. F. M. F. Scarlet Fever 84 94 142 161 18 26 20 22 264 303 567 Diphtheria 12 13 16 16 10 9 8 10 46 48 94 Measles 15 7 7 4 2 - - 2 24 13 37 Wooping Cough 5 6 - - - - - - 5 6 11 Vincent's Angina - - - - - - 3 3 3 3 6 Other Diseases 2 2 2 7 2 2 - - 6 11 17 Phthisis - — - - - - - 21 - 21 21 Staff - - - - - - - 30 - 30 30 Totals 118 122 167 188 32 37 31 88 435 435 783 25 AGE AND SEX AT DEATH. Seven deaths occurred, details of which are given below:2. Phthisis 2 Females aged 46 and 24. 3 Diphtheria 1 Male aged 16 years; 1 Female aged 2½ years' 1 Male aged 6 years. 1 Broncho-pneumonia, complicating Wooping Cough 1 Male aged 2 years 1 Pneumococcal Meningitis 1 Female aged 37 years. SWABS.- 100 swabs were examined at the hospital laboratory. All the cases admitted during the year were, with the exception of the 5 fatal cases, very mild in degree and no single case developed any unusual complication. One case of scarlet fever had followed burns. One child was transferred to a children's hospital with a rheumatic heart. The notifications on the diphtheria side are becoming very inaccurate. The Sanatorium report dated 23rd.March stated for the first time for many years (and probably for the first time since the opening of the Sanatorium) that there was no single case of diphtheria under treatment. On the same date no case was being home nursed. This satisfactory position is yet another result from the progress of diphtheria protection. NUMBER OF OUTSIDE AUTHORITIES CASES AND NATURE. Measles Diphtheria Scarlet Fever Other Diseases Totals. Leyton 5 29 165 6 205 Chingford - - 1 - 1 Waltham Joint Hospital Board 1 - - - 1 Army - 3 4 1 8 Navy - - 1 - 1 Royal Air Force - 1 5 - 6 Totals 6 33 176 7 222 DURATION OF TREATMENT.- The average duration of treatment in Hospital was as follows:- Diphtheria 31.6 days. Scarlet Fever 23.6 " Other Diseases 16.7 " The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1943:- Classification in accordance with Ministry of Health Memorandum 37T. (Rev.) In Hospital on 1st. Jan.1943 Admitted during year Discharged during year Died during year In Hospital on 31st. December, 43. Observation - - - - - T.B.Minus 2 6 4 - 4 T.B.Plus Group 1. - - - - - T.B.Plus Group 11. 10 15 11 2 12 T.B.Plus Group 111. - - - - - Totals 12 21 15 2 16 14 of the 21 admissions were Walthamstow cases. Personnel of the Civil Defence Casualty Service gave considersoi' nursing assistance. 26. MEDICAL EXAMINATIONS. During the year, 33 examinations were carried out by the Medical Staff in respect of the Superannuation and Sick Pay Schemes. MISCELLANEOUS. Your Council made the following grants during the year to voluntary organisations:- Invalid Children's Aid Association £100. Walthamstow Association of Tuberculosis Care Helpers £25. MORTUARY.- A Coroner's Court, mortuary (with special provision for infectious disease cases) and a post-mortem room is provided by your Council at Queen's Road Cemetery. ' The Cemetery Superintendent reports that the number of inquests and post-mortems were as follows:- Inquests only 109 Post-Mortems 127 Post-Morteins and Inquests (not included in above) 25 261 CREMATION. Facilities for cremation are available at the Crematorium provided by the Corporation of the City of London, at Manor Park, Little Ilford. ASSISTANCE AT E.M.S. HOSPITALS (i.e.Connaught Hospital, Whipps Cross Hospital and Hermon Hill Hospital) and DISTRICT NURSING. Personnel of the Civil Defence Casualty Service helped during a total of just over 3,000 hours. 27. 28. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs.B.M.Friedberg. Ex-Officio: The Worshipful the Mayor - Alderman Mrs.E.M.Miller, J.P. The Deputy Mayor - Alderman Mrs.E.M.Richards, J.F. Chairman of Finance Committee - Alderman Ross Wyld, J.P. Alderman Mrs.L.F.Bailey, J.P. Alderman Mrs.C.McEntee, J.P. „ W.B.Fitt „W.H.Shaw Councillor E.G.Baily Councillor A.E.Manning „ W. E.Barnes „ Mrs. A. L. Meadows „ Mrs.S.Candy „ E.G.Richards „ H.J.Cole „W.F. Savill „ F.71.Gentle „ A.E.Simmons „ T.C.W Green „ Mrs.E.A.Smith „ W.E.Hammond „ R.E Smith „ G.J.R.Holt „ G.H.Spackman, J.P. Councillor Mrs.E.B.Toynbee. Co-opted Members: Mrs.Cooper Mrs.G.E.Nicholls Mrs.G.N.Riley. Dr.Helen Watson Mrs.E.Clarke Mrs.M. Jarman Mr.J.Marston. TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY » AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen, I beg to present, herewith, a report on the work done during 1943. The birth rate was higher than that for 1942, which in turn was the highest since 1925. The infant death rate was 40 per 1,000 live births, a rate 18 per 1,000 less than that for London Administrative County. Home visits were nearly 4,000 more and clinic attendances over 2,000 more than in 1942. Unfortunately, the maternal mortality rate was again high due largely to the occurrence of five abortions, three of which were instrumental and two of which were natural. The admissions to Thorpe Coombe were the highest ever recorded. A second war-time day nursery was opened. I have again to thank you for your consideration and to record the good work of the staff. I have the honour to be, Your obedient servant, A.T. W. POWELL. Medical Officer of Health. 29. Of the 1674 birth registrations received in the Department between 3rd.January, 1943 and 1st.January, 1944, a total of 5 were not notified in this area, but some may possibly have been notified elsewhere. Appropriate action was taken when necessary. Of the 1674 local registrations, 155 belonging to other areas are excluded, leaving a nett total of 1519. ISSUE OF PRE-NATAL CLOTHING COUPONS. The issue of coupons was continued up to 24th.July when, according to instructions received, distribution was transferred to the Food Office. VITAMINS. The facilities for the distribution of Vitamins outlined in the report for 1942 were continued. Personnel of the Civil Defence Casualty Service helped and a considerable proportion of the assistance was during off duty hours. DAY NURSERIES. A second War-time Day Nursery was opened in April. This was a prefabricated nursery with accommodation for 50 children erected on a portion of the Higham Hill Recreation Ground. Both nurseries were in due course recognised by the National Society of Children's Nurseries for purposes of training for the Nursery Nurses' Certificate. The accommodation at the end of the year was: - Municipal (0-5 years) Voluntary (2-5 years) Wyatts Lane 60 Brookscroft 25 Higham Hill 50 Friends Hall 25 30. NOTIFICATION OF BIRTHS. 1,883 births (101 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, 253; midwives, 1,630. Included in the above are 134 births which were notified as having occurred outside the Borough. Also included are 55 stillbirths, 2 of which did not belong to the area. 8 were notified by doctors and 47 by midwives. Of the total, 4 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 883 881 1767 Illegitimate 29 32 61 912 916 1823 (b) STILLBIRTHS. Males Females Totals. Legitimate 36 21 57 Illegitimate 1 - 1 37 21 58 31. Personnel of the Civil Defence Casualty Service gave considerable assistance. War-time day nurseries - average daily attendance, 1943. The table below gives the attendances at the Municipal Nurseries:- WYATTS LANE NURSERY. HIGHAM HILL NURSERY. 1943 MON.-FRI. SATURDAY AVERAGE TOTAL ATTENDANCES. MON.-FRI. Saturday AVERAGE TOTAL ATTENDANCES Under 2. Over 2. Under 2. Over 2. Mon.- Fri. Sat. Under 2. Over 2. Under 2. Over 2. Mon. - Fri. Sat. Jan. 15.0 29.58 10.40 10.60 44.62 21.00 - - - - - - Feb. 15.70 28.95 10.75 7.77 44.65 18.52 - - - - - — ; Mar. 15.69 30.96 9.75 10.00 46.50 19 . 75 ~ " - - - - April 15.95 31.45 11.00 14.00 47.31 25.00 9.38 13.46 4.0 1 2.0 22.85 6.00 may 18.19 35.90 13.00 14.40 54.10 27.40 11.95 18.95 5.60 4.60 30.90 10.20 June 19.14 37.62 14.33 14.66 56.76 29.00 14.86 20.19 6.00 3.00 35.05 1 9.00 July 17.23 38.27 10.75 18.50 55.56 29.25 20.18 25.73 6.75 5.25 45.91 12.00 Aug. 16.90 32.05 9.25 16.00 48.95 25.25 22.86 23.33 7.78 6.50 46.19 14.25 Sept. 20.32 34.18 111.25 16.25 54.50 27 .50 17.91 28.64 7.75 6.75 46.55 14.50 Oct. 18.67 37.24 11.40 19.80 55.90 31.20 16.67 30.43 6.80 9.20 47.09 16.00 Nov. 10.77 34.77 5.25 14.25 45.56 19.50 13.73 29.55 5.00 7.00 43.25 12.00 Dec. 13.77 31.23 7.67 ll.00 45.00 18.67 8.59 29.73 3 . 67 7.33 38.32 111.00 Totals 16.43 33.54 10.44 14.04 49.96 24.47 15.37 25,01 6.18 6.16 40.38 12.36 INFANT MORTALITY. The death rates of infants under one year of age per 1,000 live births when calculated on the totals given by the Registrar General are, therefore;- Legitimate, 40; Illegitimate, 32; Total 40. The Infant Mortality rate for other areas during 1943 was as follows:- England and Wales 49 126 County Boroughs and Great Towns (including London) 58 148 Smaller Towns (25,000 to 53,000) 46 London 58 NE0-NATAL MORTALITY. The Neo-Natal Mortality is the number of deaths of infants under one month per 1,000 live births. During 1943, 48 infants died in the first four weeks of life, yielding a rate of 26.2. For the last ten years in England and Wales the neo-natal deaths have been approximately one-half of the total deaths under 1 year of age. 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 0.54. CHILD WELFARE. The equivalent of whole-time Municipal Health Visitors at the end of the year was 7.5, equal to 1 whole-time Health Visitor per 251 notified births, and one whole-time Health Visitor per 223 registered births during 1943. A. MUNICIPAL SCHEME. The detailed findings at first visits paid during 1943 are given in the following table, from which it will be seen that of 1721 children, 1400, or 81.3%, were breast-fed on first being visited, and 14, or .81%, had no separate sleeping accommodation:- 32. The deaths of infants under one year of age were:- Males Females Total. Legitimate 45 26 71 Illegitimate 112 Totals 46 27 73 33 Waard. How Fed Sleeping Accommodation Condition of Baby . Accommodation Breast Breast and Hand Hand With Mother Cot or Cradle Good Fair Bad Whole House Flat Half-House 3 Rooms 2 Rooms 1 Room St.James Street 167 29 16 -- 212 165 | 43 4 82 46 44 4 2 34 High Street 155 13 31 1 198 186 12 1 74 114 9 - - 2 Hoe Street 227 53 11 - 291 245 44 2 i121 96 61 3 10 - Wood Street 164 21 29 - 214 188 26 - 92 53 62 6 1 - Hale End 317 33 38 3 385 373 14 i 1 243 61 80 3 1 Higham Hill 370 33 14 10 407 383 28 6 276 102 30 1 8 - Totals 1400 182 139 14 1707 1540 167 14 888 472 286 14 24 37 34. 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 1 Visits j Other Visits i Total Visits The following table shows the number and "nature^onf""Tislfcs paid during 1943:- First Re-Visits Total First Visit Subsequent Visits Total Visits St.James 3 212 490 702 1172 1874 708 22 - 40 12 52 284 2940 High Street 199 536 735 955 1690 299 7 - 21 9 30 65 2091 Hoe Street 291 947 1238 1526 2764 301 25 - 66 23 89 149 3328 Wood Street 214 469 683 638 1321 401 13 6 29 22 51 117 1909 Hale End 388 1383 1771 2024 3795 257 38 3 93 25 118 184 4395 Higham Hill 417 1283 1700 2930 4630 362 45 16 78 31 109 269 5431 Totals 1943 1721 5108 6829 9245 16074 2328 150 25 327 122 449 1068 200 94 1942 1591 4088 5679 6333 112012 2313 166 16 427 176I 603 1181 16291 INFESTATION BY HEAD LICE. During the year the new Lethane treatment was tried out extensively with very successful results. Advice 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 The contents of the Ministry of Health Circular 283l, suggesting the steps to be taken to improve the general standard of cleanliness and to combat infestation by lice, were brought to the notice of all the Health Visiting and School Nursing staffs. CLINICS. Dr.M.Sheppard reports as follows:- welfare Centres. The Welfare Centres were well attended during 1943, the number of attendances being 44,164. No increase in any deficiency disease was noted although many mothers failed to take up their cod liver oil and orange juice. The toddlers did not show any appreciable effect of war conditions. The response to diphtheria immunisation has not been as good as one might wish, in spite of facilities being offered at each Welfare Centre. The Vvar-time Cookery Demonstrations at the Centres are much appreciated. The thanks of the Committee are again due to the voluntary workers who helped at the Centres. The Ante-Natal Clinic. The mothers at the Ante-Natal Clinic made 1,966 attendances during the year, or an average of 11.3 per session. Four sessions were held weekly most of the year to give extra attention to those mothers who are evacuating under the Governmerrt Scheme and, consequently, have no regular supervision from a midwife. Normally, patients are seen three times, about the 16th., 27th., and 37th. week. Post-Natal. The number of Post-Natal examinations made was 105, which is not at all a satisfactory proportion if maternal mobidity is to be countered and, as with war conditions the mobidity is likely to rise, it is a pity that more mothers do not take advantage of this clinic. Home Helps. The Home Help Scheme was continued but the difficulty in finding satisfactory people is great as so many suitable women prefer other and more remunerative types of war work. This difficulty is likely to continue until Home Helps are given a recognised place in the country's Maternity Scheme. 35. 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 944 769 Low Hall Lane Clinic 546 87 Totals 1490 856 Total Attendances:- Thorpe Coombe Maternity Hospital 8719 882 Low Hall Lane Clinic 1966 105 Totals 10685 987 SUMMARY OF ATTENDANCES AT WELFARE CLINICS. Clinic First Attendances of new Cases Re-Attendances Grand Total Under 1 yr. 1-5 yrs. Total Under 1 yr. 1-5 yrs. Total. Markhouse Rd. 590 129 719 11083 7787 18870 19589 Higham Hill 301 44 345 5958 5513 11471 11816 Highams Park 308 17 325 5966 6468 12434 12759 Total 1943 1199 190 1389 23007 19768 42775 44164 Total 1942 1235 264 ... 1499 20668 19769 40437 41936 CHILD LIFE PROTECTION, At the end of 1943 there were 30 nurse children on the register, compared with 39 at the end of 1942. During the year 15 removed, 3 were adopted, and 4 reached the age of nine years. 14 new children were registered. There was one death among nurse children during 1943. The following is the information required by Circular 2790 of the Ministry of Health:- (a) No. of persons who gave notice under Section 7 (3) during the year 2 (b) Total number of children "adopted" under the section during the year 2 (c) No. of such children:- (1) under supervision at the end of the year 2 (11) who died during the year (111) on whom inquests were held during the year (d) Particulars of any proceedings taken during the year... - 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. 122 cases attended for massage, and these made 2,816 attendances. SALE OF MILK, ETC. AT CLINICS.- The value of milk and food sold and issued free during 1943 was £3,527. 6. 5d. 36. WALTH AMSTOW 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 l yr. 1-5 yrs. Total 1943 489 51 540 8513 2627 11140 11680. SPECIAL TREATMENT, ETC. Massage Treatments 835. Sunlight Treatments 1441. HOME VISITS. Year Visits to children under 1 year. Visits to Children 1-5 years. Grand Total. First Subsequent Total. 1943 443 824 1267 909 2176 Your Council, under the. Scheme approved by the Ministry of Health, for the grant period, makes an annual grant of £700 to the Society. 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 yr. 1-5 yrs. Total Under 1 yr. 1-5 yrs. Total. Municipal Scheme Brookscrof t 1199 489 190 51 1389 540 23007 8513 19768 2627 42775 11140 44164 11680 Totals 1943 1688 241 1929 31520 22395 • 53910^ 55844 1942 1677 338 2015 26897 22326 49223 51238 HOME VISITS. To Children under 1 year of age To Children 1-5 years of age Total First Subsequent Total. Municipal Scheme 1721 5108 6829 7478 14307 Brookseroft 443 824 1267 909 2176 Totals 1943 2164 5932 8096 8387 16483 1942 1994 5231 7225 7645 14870 Percentage of notified live births represented) by number of children under 1 year of age ) 1943 92.3 who attended the Centres for the first time ) Percentage of total notified births represented) by number of expectant mothers attending 1943 81.8 Ante-Natal Clinics ) 37 TREATMENT. (a) ORTHOPAEDIC Defects Seen at Orthopaedic Clinic in Children Under Five Years of Age. Scoliosis 2 Torticollis 14 Rickets:- Congenital Dislocation (a) Genu Varum 45 of Hip 2 (b) Genu Valgum 44 Congenital Defects 18 Fes Piano Valgus 32 Miscellaneous 10 Spastic Faralysis 2 Talipes:- Total 179 (a) Equino Varus 4 (b) Calcaneo Valgus 6 Three children were admitted to hospital, and three operations were performed. (b) DENTAL.- The following work was done by the Education Committee's Dental Surgeons in respect of Maternity and Child welfare patients:- 1941. 1942. 1943. Children Children Children Mothers under 5 Mothers under 5. Mothers under 5 Cases Treated 137 104 139 76 202 82 Attendances 539 169 647 205 888 180 Fillings 185 142 272 214 347 114 Extractions 274 44 263 93 337 75 General Anaesthetics 106 21 121 51 142 41 Scalings 67 - 72 - 102 - Dressings 41 56 101 49 152 30 Dentures 30 - 22 - 26 - Mr.L.W.Elmer, L.D.S., Senior Dental Surgeon, submits the following report from Mrs.W.R.Thorne, L.D.S., with regard to dental treatment under the Maternity and Child Welfare scheme:- "A review of the work accomplished during the past year, 1943, may have some new points of interest. The average age of the mothers is younger; this may be due to a larger number of first pregnancies. There is less paradontal disease, a natural expectation in younger patients, who may also be showing the benefit of treatment given at the school clinics. There is still much too great a loss of the grinding teeth - some patients having no molars at all. For aesthetic reasons, patients value the anterior teeth more than the back ones, and do not greatly mind having a molar or two extracted. Too often, the result is that partial dentures are required to give efficient mastication. These partial dentures are a preliminary to complete loss of the remaining teeth; for, when wearing partial dentures, the strictest care of the natural teeth is required if further loss of these is to be avoided. Amongst a small section of patients, there is still a distaste for conservative treatment, particularly and almost solely amongst those patients who have managed to avoid treatment in childhood. Children who have received treatment at the School Clinic rarely object to it later. In this district where there has been the offer of treatment for so many years, there should be improved dental health. However, it is gratifying to note that there have been very few really septic mouths this past year. There has been an increase in the number of patients in 1943 over 1942, and a decrease in cases suffering from severe forms of gingival infections; more dentures have been supplied than in the previous year. 38. (c) TONSILS AND ADENOIDS.- No case was operated, on.-during the year. (d) OPHTHALMIC DEFECTS AND MINOR AILMENTS.- Children are given treatment either at the School Clinics or by special appointment. (e) SUNLIGHT.- 8 infants were referred for sunlight treatment during 1943. (f) CHILD GUIDANCE.- Arrangements have now been made for children under 5 years of age to be referred to the Child Guidance Clinic commenced by the Education Committee during this year. There was one case in 1943. (g) INVALID CHILDREN'S AID ASSOCIATION.- Miss Russell, Secretary to the local branch of the Invalid Children's Aid Association, kindly reports that the following cases of children under 5 years of age were dealt with by her Association:- Referred byt- Medical men, Hospitals and Dispensaries 22 Orthopaedic Clinics 16 Others 3 41 Suffering from:- Anaemia and Debility 3 Pneumonia, Bronchitis, Asthma, etc 10 Bone Disease (non-T.B.) 8 Congenital Deformities 12 Hernia 4 Various 4 41 HELP GIVEN TO OLD AND NEW CASES, 1943. Sent to Special Hospitals and Convalescent Homes..9 Provided with Surgical Eoots and Appliances 11 Referred for visiting and advice 21 41 ASSISTED MILK SCHEME. Number of applications during 1943 427 „ „ families assisted 136 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 175 Home Helps approved during 1943, many mothers attending the Clinic made their own arrangements to obtain the help of suitable women whose names were supplied by the Health Visitors. 28 applications were rejected by the Rota Committee. The demand for Home Helps has been as follows during the past seven years:- 1937 (78), 1938 (178), 1939 (125), 1940 (128), 1941 <105), 1942 (140), 1943 (175). STERILISED MATERNITY OUTFITS. A total of 420 sets were used in the Borough and 219 outfits were issued below cost price. 39. INSTITUTIONAL TREATMENT, ETC. One child was sent to an institution under an arrangement approved by your Committee. HOSPITAL ACCOMMODATION FOR CONFINEMENTS. The following numbers of confinements occurred at the Institutions speoified (Walthamstow residents only):- Thorpe Coombe Maternity Hospital 891 Maternity Homes in Walthamstow 112 Mothers' Hospital, Clapton 52 Forest Gate Hospital 47 Queen Mary's Hospital, Stratford City of London Maternity Hospital 3 Other Maternity Homes 42 1127 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:- "I have much pleasure in submitting the following report of the activities of the Association for the year ending 31st.December, 1943. In spite of a small (but excellent) staff the standard and efficiency of the work has been maintained in both the general nursing and midwifery as is shown by the satisfactory reports received from the Queen's Inspector (through the Queen's Institute) and Miss Greaves. During the year a post-certificate course of midwifery lectures was arranged by the W.D.N.A. Committee. Professor Dame Louise Mcllroy kindly undertook the lectures which,by the courtesy of the Borough Council, were given at Thorpe Coombe. Midwives in 'the surrounding areas were invited to attend. The Committee has adopted the Rushcliffe scale of salaries laid down in the report for District Nurses. We are happy to say that the overdraft which was crippling our efforts has been wiped out. To maintain this state and also to meet the increased salaries we look to receiving greater local support. The Provident Scheme is slowly growing but it is still not worthy of this large Borough. We appeal to all householders to join this scheme in their own interests as well as ours. From the 21st.December, 1942, to October 31st.1943, 17 pupils entered for their district midwifery training'.' The number of midwifery cases attended in Walthamstow throughout the year are as follows:- Municipal Voluntary Total. Without Doctor 187 21 208 With Doctor 18 9 27 Totals 205 30 255 We should like to place on record our appreciation and thanks to the many friends and especially to the voluntary collectors who by their efforts have helped our finances. Our thanks are also due to Dr.Powell, M.O.H., for his ready help and encouragement and, finally, to the splendid help given by the Civil Defence and Red Cross Nurses. (These latter are attached to the South-West Essex Technical College). 40. Post Graduate Lectures to Midwives. Five lectures were arranged by the Walthamstow District Nursing Association, acting in conjunction with the Council, and were given by Dame Louise Mcllroy during May 1943. A total of 52 midwives and pupil midwives, including midwives from contiguous areas, made 136 attendances. CONSULTANT OBSTETRICIANS. The services of a Consultant Obstetrician were not required during 1943. MIDLIVES ACTS, 1902-1936. No. of Notices of Intention to Practise, January, 1943 25 " " " " " during 1943 13 Total 38 No. of Midwives ceasing to practise during 1943 9 " practising at the end of 1943 29 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 1943:- No. of confinements attended as a Midwife 1429 „ „ „ „ „ „ „ Maternity Nurse 208 " " medical aid notices sent 535 " " notifications of deaths 6 " " twin births notified 28 " " stillbirths " 11 " " notifications of liability to be a source of infection 9 " " " " laying out of a dead body 1 " " " " artificial feeding 13 " " " " disinfection 9 The above table includes the following numbers with regard to work done at Thorpe Coombe:- Midwifery cases, 797 Maternity cases, 94 Medical Aid Notices, 339 The percentages of medical aid notices were:Total, 32.6. Maternity Hospital, 38.0. Domiciliary midwives,26.2 The conditions for which medical aid was summoned by midwives in domiciliary practice have been summarised and were as follows: For complications during pregnancy 9 " " " labour 165 " " in regard to the infant 22 Details of medical aid notices issued by midwives employed at Thorpe Coombe are given in the Maternity Hospital report. 41. 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. 2612 2654 474 452 46 9742 15,980. PUBLIC HEALTH ACT, 1936. (Nursing Homes).- See Public Health Section of the Report. 42. PUERPERAL PYREXIA. 44 cases of Puerperal Pyrexia were notified during 1943. The notifications were received from the following sources: - Maternity Hospital, 33; Hospitals outside the area, 4; and General Practitioners, 6. The puerperal pyrexia rate for 1943 was 23.3 per 1,000 births, as compared with 18.2 in 1942, and the mortality due to puerperal sepsis was 13.6 per cent. of the cases of puerperal pyrexia notified ABORTION. CIRCULAR 1661.- The number of cases in which medical aid notices were issued during 1943 by midwives in accordance with Rule E of the Central Midwives Board was:- Threatened abortion and miscarriage Nil. Abortion and miscarriage Nil. OPHTHALMIA NEONATORUM. The number of cases notified during the last two years were two in 1943, and one in 1942. MATERNAL MORTALITY. During 1943, nine deaths associated however slightly with pregnancy and child-bearing were investigated for the completion of enquiry forms. Particulars relating to the nine deaths are given in the accompanying table, from which it will be seen that five were due to abortion, three being instrumental, and two natural. The following table shows the maternal mortality rates for 1943 (calculated on the nine deaths assigned by the RegistrarGeneral to Headings 29 and 30). 43. DEATHS DUE TO PREGNANCY AND CHILD-BEARING AND/OR ASSOCIATED THEREWITH. Case No. Date of Death Certified Cause of Death Age Case No. Date of Death. Certified Cause of Death Age 1. 13. 2.43 Acute general peritonitis due to puerperal endometritis 39 6. 20.10.43 Internal haemorrhage due to ruptured ectopic gestation. 36 2. 18. 2.43 Pyaemia due to septic thrombophlebitis of the right leg following childbirth. 26 7. 2.11.43 Pyaemia following septic incomplete abortion (natural) 30 8. 14.11.43 Toxaemia due to septic instrumental abortion. 3 17. 3.43 Shock following instrumental abortion. 23 9. 29.12.42 Acute general peritonitis due to instrumental abortion. 33 I 4. 13. 5.43 Acute pulmonary oedema due to left ventricular failure associated with paralytic ileus. 24 5. 20. 7.43 Cardiac failure due to toxaemia due to pyaemia due to Right Tubo-ovarian abscess due to infective abortion. 35 The Registrar General allocates Nos.1,2,5,7,8 & 9 to Classification 29 - Puerperal & Post abortive sepsis Nos. 3,4 & 6 " " 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) 1943 1942 1941 194 1939 Maternal Mortality 4.92 1.16 6.89 0.63 ] Stillbirths 30.7 30.2 26.8 26.6 38.6 Neo-Natal Deaths 26.2 20.3 23.7 24.7 17.4 The maternal mortality rates, for the past five years have been as fellows:- Year Total Births Registered Deaths Rates per 1,000 Births (Live and Still) Puerperal Sepsi s Other Puerperal Causes Total Puerperal Sepsis Other Puerperal Causes Total 1943 1886 6 3 9 3.18 1.59 4.77 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 THORPE COOMBE MATERNITY HOSPITAL. ALTERATIONS AND EXTENSIONS.- No alterations of major character were carried out. 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, included under item 2 which have been reserved for expectant mothers in need of hospital treatment.Variable according to requirements. No special reservation. 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 Hates per 1,000 Births registered Puerperal Sepsis Other Puerperal Causes Total Puerperal Sepsis Other Puerperal Causes I Total. Live, 1828 6 3 9 3.28 1.64 4.92 Not available Live & Stillbirths,. 1886 6 3 9 • 3.18 1.59 4.77 Not available 44. 3. Number of maternity cases admitted during the year.- 1037 (including ante-natal and post-natal admissions) 3a. Number of women treated during the year in the ante-natal beds shown against item 2a. (These women should be included also against item 3).- 165. 3b. Average duration of stay of expectant mothers in the ante-natal beds shown against item 2a.- 3.5. 4. xAverage duration of stay of cases in the lying-in wards.- 14.95, 5. Number of cases delivered by - (a) Midwives - 797, (b) Doctors - 94, Total 891. 6. Number of cases in which medical assistance was sought by a midwife in emergency.- 339. 7. Number of cases admitted after delivery.- 6. 8. Number of cases notified as - (a) Puerperal fever - Nil, (b) Puerperal pyrexia - 33. 9. Number of cases of pemphigus neonatorum.- Nil. 10.(a)Number of infants on a supplementary feed on discharge.104 complemented, 45 artificially fed. (b) Number of infants wholly breastfed on leaving the Institution.- 705. 11.(a)Number of cases notified as ophthalmia neonatorum.- 1. (b)Result of treatment in each case.- Vision unimpaired. 12.(a)Number of maternal deaths.- 2. (b)Cause of death in each case.- (i) Acute pulmonary oedema due to left/Ventricular failure. Faralytic ilfcus. (ii) Acute cardiac failure due to mitral stenosis. 13.(a)Number of stillbirths.- 33. (b)Cause in each case, and results of post-mortem examination (if obtainable) See attached list. 14.(a)Number of infant deaths within 10 days of birth.- 19. (Two of these infants were admitted after birth). (b)Cause of death in each case, and results of post-mortem examination (if obtainable). - See Clinical Report. The stillbirth rate was 36.4 per 1,000 live and still births, and the neo-natal mortality within 10 days of birth was 20.6 per 1,000 live births. Occupation of Beds.- The average daily occupation of beds was as follows:- January 37.5 July 39.5 February 36.6 August 36.5 March 40.7 September 40.6 April 35.4 October 42.5 May 36.6 November 43.0 June 40.0 December 29.3 Based on the actual number of days each patient stayed. 45. The average for the whole year was equal to 70.7 per cent. beds occupied (based on 54 beds). 257 Walthamstow patients could not be booked nor 107 applicants from other areas. Emergency Unit.- The services of the emergency unit were not required during the year. 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. 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 1943, 21 pupils from Thorpe Coombe obtained the Certificate of the Central Midwives Board. Personnel of the Civil Defence Casualty Service gave considerable nursing assistance. The following Clinical Report has been compiled by Miss Helen Rodway, M.R.C.O.G., Resident Obstetrician, who draws attention to the following:- "i. The satisfactory attendances made by patients at the Clinics:. Patients have been booking early and making regular attendances in spite of domestic worries and shopping difficulties, Patients doing war work had no difficulty in getting time off for attending for examination. In one or two factories where Ante-natal clinics have been established our patients did not take advantage of these facilities but attended the Thorpe Coombe Clinics throughout their pregnancy. Very few patients continued in employment after the seventh month of pregnancy. ii. The attendances at the Post-natal clinic for an examination six weeks after confinement were unusually good. I doubt if in the future we shall at any time have a higher percentage of patients attending the Clinic. iii. Of the 33 stillbirths - 42 per cent. were due to a congenital abnormality. iv. Infant deaths: More than half of these were associated with marked prematurity. The smallest infant that survived this year weighed 2 lbs. 8 ozs. v. Maternal Mortality: Maternal mortality rate for England and Wales 2.29. " " " " Thorpe Coombe 2.07. THORFE COOMBE MATERNITY HOSPITAL. CLINICAL REPORT FOR 1943. During this year there were 891 confinements in the Hospital, bringing the total number of confinements - since the Hospital was opened in May 1934 - up to 6412. There 7vere 166 ante-natal admissions to the Hospital and 6 post-natal. Every patient attended the ante-natal clinic, in most cases regularly on the day of appointment; 8,719 attendances were made by the patients during pregnancy and 883 for examination, advice or treatment after confinement. In addition there were large attendances of ante-natal and nursing mothers at the monthly Mothercreft lectures and discussions, and many young mothers took advantage of the instruction given at the pre-natal and post-natal exercise classes. 46. The atmosphere of helpfulness and kindness created by the Matron, Nursing Staff and lecturers at the Mothercraft classes, has been appreciated by the patients and has had an influence of value in the work of the Hospital. M embers of the staff of the Domestic Science Department of the South-West Essex Teohnical College have contributed to our Mothercraft work and our appreciation and thanks are extended to them. A full statistical and clinical report has, as usual, been prepared, and is available for medical reference. A summary of the year's work is given below. SUMMARY OF THE WORK OF THE HOSPITAL. Clinic Attendances. (a) Ante-natal Clinics: 944 patients made 8,719 attendances at 440 Ante-natal clinics during the year. Number of Number of Average attendance clinics held.attendances. per session. i.Consultant's Clinics 12 144 12.0 ii.Resident Obstetrician's Clinics 184 3,287 17.85 iii.Midwives' Clinics 244 5,288 21.7 Totals 440 8,719 (b) Post-natal Clinic : 769 patients - a percentage of 86.3 of those due to attend for examination paid one visit for a Post-natal examination; 114 extra visits were paid for advice and treatment. COMPARATIVE FIGURES From May 1934 until the end of December 1943. 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 Totals Number of Confinements 891 695 645 720 595 691 640 660 646 229 6412 Total number of Admissions 1037 801 717 817 675 775 729 769 747 258 7325 Clinic Attendances Ante-natal Clinic: (a) New patients 944 764 824 750 733 702 753 691 762 371 7294 (b) Old patients 7775 6551 5661 6679 5750 6032 5501 5354 4543 1745 55591 Totals 8719 7315 6485 7429 6483 6734 6254 6045 5305 2116 62885 Post-Natal Clinic (a)First Attendances 769 504 315 330 401 479 380 453 256 3887 (b)subsequent Attendances 114 117 149 140 155 151 145 177 210 - 1358 Totals 883 621 464 470 556 630 525 630 466 5245 ADMISSIONS TO HOSPITAL. (a) Ante-natal 166X (b) For confinement 865 (c) Post-natal 6 Total 1037 x 26 patients were confined before discharge. 47. Ante-natal Admissions. Indications for Admission No. of cases, Ante-partum haemorrhage 8 Pre-eclamptic toxaemia 19 For rest on account of cardiac disease 6 Hyperpiesis 6 Hyperemesis 2 Pyelitis 5 Thrombophlebitis 3 Breech for version 15 For observation and rest 22 For observation, and discharged because not in labour 80 Total 166 Emergency Admissions. Reason for Admission No. of cases. Ante-partum haemorrhage 5 Pre-eclamptic toxaemia 3 Breech for version 3 Complications of labour and premature labour 5 Death of foetus 2 Post-partum haemorrhage 1 Unsatisfactory medical condition of patient 2 Total 21 Confinements. Of the 891 confinements, 556, that is 62.4 per cent, were first confinements. Operations performed. No. of cases. Surgical induction of labour 10 Version 15 Forceps delivery 63 Manual removal of placenta 19 Caesarean Section 7 Total H4 Medical Aid requests from the Hospital Midwives for the services of the Resident Obstetrician or her deputy, numbered 329, or 36.8 per cent. for patients in labour, and 10, or 1.2 per cent. for the infants. Cases of Puerperal Pyrexia. No. of cases notified 33. Percentage of cases relative to the number of deliveries 3.7 Cause of Pyrexia. No. of cases. Percentage of cases. Localised uterine infection 11 30.0 Urinary infection 5 15.1 Flushed breast 7 24.2 Breast abscess 5 15.1 Paratyphoid 1 3.0 Undiagnosed 4 12.0 Total 33 48 INFANTS. The number born in the Hospital this year was 905, this includes 14 cases of twins, a percentage of 1.54 relative to the number of confinements. There were 4.7 per cent. of infants classified as premature on clinical grounds. (The Paediatricians' standard of prematurity for statistical purposes is an infant weighing 5½ lbs. or less irrespective of other factors). Breast feeding. 82.5 per cent. of mothers were discharged from the Hospital completely breast feeding their infants; a further 12.2 per cent. were partly breast feeding, while in 5 per cent. of cases bottle feeding had, for one reason or another, to be substituted. 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934, (a)Infants completely breast fed. 82.5 83.9 87.6 77.4 75.9 86.0 85.0 85.7 93.0 98.7 (b)Infants partly breast fed. 12.2 12.0 9.9 18.7 18.7 - (c)Infants not breast fed. 5.3 4.1 2.5 3.9 5.4 - - - 100.0100.0100.0100.0100.0 FOETAL AND INFANT MORTALITY. (a) Stillbirths. No. of cases. 1. Premature (5½ lbs. or less) 13 ii. Full Term 20 Total 33x x3.6 per cent. of all births. (b) Infant Deaths. i. Premature 9 ii. Full Term _9 Total 18x 2.06 per cent. of live births. In addition two infants admitted as emergencies died. Maternal Mortality. There were two maternal deaths; a maternal mortality rate of 2.07 per 1,000. (Maternal mortality rate for England and Wales for 1943 was 2.29). One patient died of acute pulmonary oedema due to failure of the left ventricle of the heart. The other died during pregnancy of acute cardiac failure due to chronic valvular disease of the heart, (mitral stenosis). 49. I