Ac 4411(1) WALT HAMSTON WAL 27 With the Compliments of the Medical Officer of Health and School Medical Officer, Borough of Walthametew. BOROUGH OF WALTHAMSTO??? REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1944. A.T.W.POWELL, M.C., M.B., B.S., D.P.H. MEDICAL OFFICER OF HEALTH. CONTENTS. Portion 53 Acreage 4 Adulteration 18 Ambulance Facilities 8 Ante-Natal Clinic 46, 57 Bacteriological Analyses 18 Births 38 Cancer 7 Cerebro-Spinal Meningitis, ,20, 28 Child Welfare 43 Child Life Protection 47 Clinics.. 8, 9, 44, 45, 46, 47,48 and 49 Committees 2, 36 Contents 1 Cremation 34 Dampness 11 Day Nurseries 39 Deaths 5, 7, 33, 42 Death Rate 5 Dental Treatment 49 Diphtheria 20, 24 Diphtheria Immunisation 21, 22 Diseases of Animals Acts 18 Disinfestation 12 District Midwifery 51, 52 Domestic Help 34 Dysentery 20, 25 Enteric Fever 20, 25 Erysipelas 20, 28 Factories & Workshops 11, 19 Food Inspection 16, 17, 18 Foot Clinic 8 Forceps Delivery 58 Haemorrhage - Ante-Farturn 58 Health Services 8 Health Visiting 44, 45 Home Helps 50 Hospital Accommodation 9 , 10, 50 Hospital, Infectious Disease 20, 32, 25. Housing 13, 14, 15, Housing Act, 1936 15 Ice Cream 16 Illegitimate Children, Care of 40, 41 Immunisation 21, 22 Infant Mortality 5, 40, 59 Infectious Diseases 11, 20, 21, 32, 33 Infestation 46 Institutional Treatment 50 Invalid Children's Aid Assn 49 Isolation Hospital 32 Laboratory work 22 Malaria 20, 29 Massage 47 Maternal Mortality 53, 54, 55 Maternity & Child Welfare 36 Measles 20, 29 Meat Inspection 16, 17 Medical Aid 52 Medical Examinations 33a Midwives 51, 52 Milk, Assisted Scheme 50 Milk Supply etc 16 Miscellaneous 33a Mortuary 34 Municipal Dental Service 35 Neo-Natal Mortality 40, 59 Notices, Sanitary 11 Nursing Homes 10 Ophthalmia Neonatorum 20, 27, 53 Orthopaedic Treatment 49 Outworkers 19 Pneumonia 20, 27 Population 4 Post Natal Clinic 46 Premature Infants 41 Public Assistance 10 Puerperal Pyrexia 20, 53, 59 Rateable Value 4 Rats & Mice Destruction Act, 1919 18 Rent Restriction Acts 18 Sanitary Inspection 11, 12, 16, 17 Scabies 9 Scarlet Fever 20, 23 Schick Tests 21 Social Conditions 4 Special Premises 11 Staff 4, 38 Statistics 4 Sterilised Maternity Outfits 50 Stillbirths 5, 38, 55. Sunlight Treatment 49 Swimming Baths 13 Thorpe Coombe Maternity Hospital 55,56, 57, 58, 59 Tonsils & Adenoids 49 Tuberculosis 20,30, 31, 32,33a Unemployment 4 Vaccination 22 Venereal Disease 10 Vital Statistics 5 Vitamins 39 Walthamstow Child Welfare Society 47, 48 Walthamstow District Nursing Association 50 Water 11 Whooping Cough 20, 30 Women's Clinic 8, 9 Zymotic Diseases 5 1. PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Alderman Mrs.C.McEntee, J.P. Vice-Chairman: Councillor Mrs.S.Candy. The Worshipful the Mayor - Alderman A.E.Manning, J.P. The Deputy Mayor - Alderman Mrs.E.M.Miller, J.P. Chairman of Finance Committee - Alderman Ross Wyld, J.P. Alderman Mrs.L.P.Bailey, J.P. Alderman W.B.Fitt " T.W.Smith " Miss E.M.Pracy, B.Sc. Councillor H.S.Baker Councillor A.E.Mallett " R.W. Davis " D.R. Perry " Mrs. B.M.Friedberg " Mrs.E.A.Smith " F.W. Gentle " R.E.Smith Councillor Mrs.E.B.Toynbee. " A.J.D.Llewellyn. Town Clerk: G.A.Blakeley, Esq. 2. TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, I beg to submit this report for the year 1944. The estimated population was 101,140 and the various rates quoted on page 6 are very favourable to Walthamstow, especially in regard to the incidence of and mortality from Diphtheria. So also are the infant mortality rates both legitimate and illegitimate. Once more I have to thank you for your consideration and the staff for good work under very trying circumstances. 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:- Resignations:- Miss 1.12.Burr Clerical 4. 7.44 Dr.M.C.Clarke Medical 31.10.44 Mr.D.Clements Ambulance 10. 8.44 Mr.D.Flatraan Clerical 26. 4.44 Mrs.T.Harrison Dental 12. 2.64 Dr.A.Highet Medical 28. 8.44 Mr.R.E.Hyman Dental 30. 9.44 Mr. J.L.Taylor " 24. 6.44 Mrs. M. Whitaker Chiropody 29. 2.44 Appointments:- Dr.M.Edmond Medical 4. 9.44 Mr.R.E.Hyman Dental 20. 3.44 Mr.L.Joyce Clerical 14. 2.44 Miss F.Posner " 30. 5.44 Mrs.A.Sampson " 22. 5.44 Mr.C.Shamash Dental 13.12.44 Mr.J.L.Taylor " 11. 4.44 Miss S.Woods " 11. 4.44 Mrs.H.B.Nathan Clerical 27.11.44 Miss K.M.Nibbs Chiropody 3. 4.44 Deceased:- Mr.G.West Clerical & Laboratory 30. 5.44 Assistant STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (inacres) 4,343 Population (Registrar-General's Estimate, mid-year 1944) 101,140 Number of Assessments, 1st.April 1944 35 , 855 Rateable value £874,415 Sum represented by penny rate £ 3,410 POPULATION.- .The Registrar-General's estimate of the population at mid-year, 1944, is 101,140, an increase of 640 on the previous figure. UNEMPLOYMENT.- The degree of unemployment in the area during 1944 may be estimated from the following data kindly supplied by Mr .H.A.Jones, Manage'r of the Local Employment Exchange. The following data refer to the whole Exchange area. Date No. remaining on Register. Total 1944. Date No. remaining on Register. Total 1944. Men. Women. Men. Women. 17. 1.44 172 40 212 17. 7.44 96 15 111 17. 4.44 166 37 203 16,10.44 102 31 133 Approximately 331/3 of the persons registered as unemployed reside in Walthamstow. EXTRACTS FROM VITAL STATISTIC.- The Registrar-General's mid-year, 1944, estimate of population (viz., 101,140) has been used for the calculation of all vital statistics Live Births Legitimate Illegitimate Total Total Males males 1825 948 877 90 44 46 1915 992 925 Birth rate per 1,000 of the estimated resident population 18.9 Stillbirths 52. Rate per 1,000 total (live & Still) births 26.4 Deaths 1343. Death rate per 1,000 of the estimated resident population 13.2 Deaths from puerperal causes:- Rate per 1,000 (live & still births) Puerperal Sepsis Deaths 2 1.01 Other Puerperal Causes 8 4.06 Totals 10 5.08 Death rate of infants under one year of age:- All infants per 1,000 live births 37 Legitimate infants per 1,000 legitimate live births 37 Illegitimate infants per 1,000 illegitimate live births 33 Deaths from Measles (ell ages) 2 " " Whooping Cough (all agos) 3 " " Diarrhoea (under 2 years of age) 2 Zymotic disease death rate 0.06 Pulmonary Tuberculosis death rate 0.59 Non-pulmonary " " " 0.13 The natural increase of population, i.e., excess of births over deaths, was 543. 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 1944 (1,343) compares with 1,294 during 1943, the respective death-rates per 1,0(0 population being 13.2 and 12.8. * 5. BIRTH-RATES, CIVILIAN DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL MORTALITY, AND CASE RATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR, 1944. PROVISIONAL FIGURES BASED ON WEEKLY AND QUARTERLY RETURNS. England & Wales 126 County Boroughs & Great Towns (including London) 148 Smaller Towns (Resident Populations 25,000 - 50,000 at 1931 Census.) London Administrative County Walthamstow x Rates per 1,000 CLvilian PopulatLrn:- Births:- Live Births 17.6 † 20.3 20.9 15.0 18.9 Still " 0.50 † 0.64 0.61 0.42 051 Deaths:- All Causes 11.6 † 13.7 12.4 15.7 13.2 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.03 0.03 0.02 0.04 0.02 Diphtheria 0.02 0.03 0.03 0.01 0.00 Influenza 0.12 0.10 0.11 0.08 0.09 Smallpox 0.00 - - - 0.00 Measles 0.01 0.01 0.01 0.00 0.01 Notifications:- Typhoid fever 0.01 0.01 0.01 0.01 0.01 Paratyphoid fever 0.01 0.00 0.01 0.01 - Corebro-Spinal Fever 0.05 0.06 0.04 0.06 0.03 Scarlet Fever 2.40 2.41 2.67 1.57 1.64 Whooping Cough 2.49 2.49 2.29 2.90 1.92 Diphtheria 0.58 0.67 0.69 0.31 0.12 Erysipelas 0.29 0.32 0.28 0.37 0.19 Smallpox 0.00 0.00 0.00 0.00 - Measles 4.16 4.51 3.94 2.98 4.01 Pneumonia 0.97 1.13 0.82 0.93 0.79 Rates per 1,000 Live Births Deaths under 1 Year of Age Deaths from Diarrhoea & Enteritis 46 ø 52 44 61 37.0 under 2 years of age 4.8 7.3 4.4 10.1 1.0 Rates per 1,000 Total Births (Live and Still) (a) Notifications:- Puerperal Fever) 10.34 13.13 9.25 3.61 Puerperal ) Pyrexia ) † 14.14 14.6 (b) Maternal Mortality No. 140 Abortion with Sepsis. No.141 Abortion without Sepsis. No.147 Puerperal Infections No s.142, 148-??? Other England & Wales 0.31 0.09 0.28 1.35 W'stow. 1.01 2.03 1.5 0.5 x A dash (-) signifies that there were no deaths. ø Per 1,000 related births. † Rates per 1,000 Total population. ‡ Including Puerperal fever. 6. CAUSES OF DEATH AS GIVEN BY THE REGISTRAR-GENERAL FOR THE YEAR 1944. WHOLE DISTRICT Causes of death Males Females Total. 1. Typhoid & Paratyphoid Fevers — — — 2. Cerebro-spinal Fever 1 — 1 3. Scarlet Fever — — — 4. Whooping Cough 1 2 3 5. Diphtheria — — — 6. T.B. of respiratpry system 44 16 60 7. Other forms of Tuberculosis 8 6 14 8. Syphilitic disease 8 3 11 9. Influenza 7 3 10 10. Measles 1 1 2 11. Acute poliomyelitis & polioencephalitis — — — 12. Acute infectious encephalitis 2 — 2 13M Cancer of buccal cavity & oesophagus (Males only 3 8 — 8 13F Cancer of uterus — 7 7 14. Cancer of stomach and duodenum 23 15 38 15. Cancer of breast — 26 26 16. Cancer of other sites 79 62 141 17. Diabetes 1 13 14 18. Intra-cranial vascular lesions 47 79 126 19. Heart disease 134 120 254 20. Other diseases of the circulatory system 14 16 30 21. Bronchitis 52 26 78 22. Pneumonia 45 27 72 23. Other respiratory diseases 6 5 11 24.. Ulceration of the stomach or duodenum 16 4 20 25. Diarrhoea (under 2 years) 1 1 2 26. Appendicitis 3 3 6 27. Other digestive diseases 9 14 23 28. Nephritis 11 15 26 29. Puerperal and post-abortive sepsis — 2 2 30. Other maternal causes — 8 8 31. Premature birth 11 4 15 32. Congenital malform., birth injury, infantile disease 26 7 33 33. Suicide 4 3 7 34. Road Traffic Accidents 4 — 4 35. Other violent causes 53 73 126 36. All other causes 87 76 163 Totals 1944 706 637 1343 Totals 1943 692 602 1294 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. — — — — — 12 98 110 7. GENERAL PROVISION OP HEALTH SERVICE IN THIS AREA. I.- (i) public Health Officers of the Authority.- The names and qualifications of officers employed by your Authority are siren at the beginning of the Report and also in the Maternity and Child Welfare Section of the Report. All aro whole-time Officers unless otherwise stated. (ii) (a) LABORATORY FACILITIES.- (See I.D.Seotion.) (b) AMBULANCE FACILITIES.- No ohange. MUNICIPAL SERVICE. Removals. Accidents. Maternity. Total. Mileage. 5,136 427 995 6,362 33,064. The above totals include 1,113 journeys covering 4,899 miles done by Civil Defence vehicles replacing Municipal Ambulances when out of commission and 224 of the journeys under Maternity were calls for conveying municipal midwives. WHIPPS CROSS HOSPITAL. Removal of patients is carried out by ambulances attached to the Hospital. ST.JOHN AMBULANCE BRIGADE. Mr.V.G.Turner, Divisional Superintendent, kindly contributes the following report:- First Aid Cases attended 1,193. Our Motor Ambulance Servico is in abeyance until after the War. (C) NURSING IN THE HOME. (i) General.- No change. (ii) Infectious Diseases.- No change. (d) CLINICS AND TREATMENT CENTRES. FOOT CLINIC.- Total attendances were 10,002, and of these 547 were by new patientB and 9,455 were re-attendances by old patients. The recoipts were £557.0.4. WOMEN'S CLINIC.- Miss Helen Rodway, M.R.C.C.G., submits the following report:- No. of sessions held. No. of attendances New Cases Old Cases Total Attendances Average attendance per session. (a) Hoe Street Clinic 52 170 1010 1180 22.60 (b) Thorpe Coombo Clinic 51 274 620 894 17.52 Totals 444 1630 2074 8. Summary of New Cases.- For diagnosis or complications of pregnancy 134 Sterility 37 Gynaecological 228 Surgical 18 Medical 11 Contraceptive 11 Not classified 5 Total 444 Comparison of attendances with previous years:- 1944 1943 1942 1941 1940 1939 1938 New Cases 444 524 424 299 260 329 319 Old Cases 1630 1618 1303 1023 1183 1234 1179 Totals 2074 2142 1727 1322 1443 1563 1498 Fifty-four patients were referred to the Clinics by private doctors. Thirty patients were referred to hospitals for treatment. 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 personnal of the Civil Defence Casualty Service under the supervision of Civil Defence trained nurses. All the personal gave excellent service. 999 cases were treated during the year, receiving 3,881 treatments. no (e) HOSPITALS.- There were changes during 1944 in the hospital services used by the inhabitants of the Borough. Public Assistance in Walthamstow is provided by the South-Western 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 tho following particulars of Walthamstow residents admitted to the various institutions during the year ended 31st.December 1944:- Institutions. Men Women Children Total. Central Home 98 112 22 x 232 Whipps Cross Hospital 602 689 240 1531 Forest Gate Hospital - 47 - 47 Harold Wood Hospital 1 9 - 10 Forest House 10 13 - 23 Aldersbrooke Children's Homes - - 41 41 1 These children were ultimately transferred to Aldersbrooke. 41 infants were born to Waltharastow mothers in Forest Gate Hospital during the year. The number of patients from Walthamstow in Mental Hospitals was 383 on the 31st. December 1944. THE CONNAUGHT HOSPITAL. The Secretary to the Hospital has kindly supplied the following information "Of the total number of in-patiants admitted during the year, 788 were residents of the Borough. 9. The following figures showed the progress of the Hospital during 1944 as compared with the previous year:- In-patients Out-Patients No. Admitted. Average Stay Daily Average New Cases Attendances. 1944 1665 15.12 70.11 94-85 71106 1943 2018 16.04 83.19 12592 75466 Particulars as to staff, Beds and Departmental activities 128 beds, including 10 Private Wards and 10 "A" beds reserved for E.M Operations and Treatments:- During 1944, 726 major operations and 2,140 minor operations were performed, making a total of 2866. 12678 radiographs were taken. There were 12480 massage treatments, also 24184 electrical treatments and 1624 artificial sunlight treatments at the Comely Bank Clinic; a total of 38288 treatments at this Clinic". FACILITIES AT COMELY BANK. - The following facilities for electromedical treatment are provided at Comely Bank:- Massage, Radiant Heat, Electrical Treatment and Sun Ray Treatment. VENEREAL DISEAS E 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.Pegrara, Clerk to the Essex County Council South-Western Area Guardian's Committee, kindly states that the amount of relief provided in Walthamstow during the two years ended 31st.December 1944, was as follows:- 1944. 1943. Total amount of out-relief granted to Walthamstow residents during the year ended 31st. December £36,655. 8. 2. £35,152. 4. 1. Average weekly number of ) Walthamstow residents in receipt) Men 220 225 of relief during the year ended ) Women 444 456 31st. December ) Children 238 251 Totals 902 932 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 24x 17 41 There were no refusals, cancellations nor appeals. 20 inspections were made by the medical staff. Routine enquiries are made with regard to unregistered Homes. No difficulties in regard to supervision arose. x14 of these are not in use during the period of the War. ESSEX COUNTY COUNCIL ACT".- No new licence to practice chiropody was granted by your Council, 10. SANITARY CIRCUMSTANCES OF THE AREA. WATER. - The water supply is from the Metropolitan Water Board and has been satisfactory in quality and quantity. SANITARY INSPECTION OF THE AREA. Owing to the illness of Mr.Duncan, the following has been compiled by Mr. F.W.Kemp, who deputised as from the 1st December. No. of inspections made. No. of nuisances detected. No. of complaints received. No. of Informal Notices No. of Statutory Notices Total Visits. Served Complied with. Served Complied with. 8,952 3,776 2,065 1,202 1,153 87 109 16,238 In addition the inspectorate was one short for the whole of the year and one Inspector was seconded to War Damage work as from the 6th July. Of the 1,202 informal notices served during the year 15 were in . respect of factory premises, and although 1,187 notices were in respect of houses, 1,139 premises were rendered fit by informal action. Failing compliance with Statutory Notices by the owners, the Council carried out these requirements to 14 houses involving an expenditure of £324,19.9. The nature and variety of the work done in 1944 is shown in the following tables:- Drains tested, 486; Drains reconstructed or repaired, 355; Drains obstructions removed, 276; Drains - means of access provided 19; Drains - ventilation provided or improved 28; Drains - ventilation repaired 55; Coil pipes repaired 34; Soil pipes new, provided 15; Rain water pipes renewed 152; Rain water pipes disconnected from drains 5; Roofs repaired or renewed 433; Gutterings repaired or renewed 220; W.C. pans or traps provided 188; Gully traps provided 60; W.C. flush cisterns provided 37; W.C. flush cisterns repaired 213; W.C. floors concreted 19; W.C's. repaired and cleansed 138; W.C's. light and ventilation improvod 4; Waste pipes renewed arid trapped 61; Waste pipes repaired 81; New sinks provided 11; Water supply reinstated Water supply taken off main 2; Cisterns cleansed and covered 5; Conveniences cleansed or repaired 10; Sculleries paved 7; Yards and forecourts paved and repaired 70; Dirty houses cleansed 9; Dirty rooms cleansed 353; Floors repaired 127; Ventilations under floors provided 43; Now damp-proof courses provided 15; Sites concreted 1; Offensive accumulations removed 20; Animals improperly kept, removed 2: Manure receptacles provided 1; Stables cleansed, paved and drained 23: Manholes repaired or re-sealed 106; Other cases of dampness remedied 139; Miscellaneous repairs 892.. Infectious Disease. Visits to premises 561; Re-visits to premises 68; Rooms disinfected 134; Articles disinfected at Low Hall 6,425; Articles destroyed at Low Hall 22: Articles dried at Low Hall 632. Dampness in HOuses. Sites concreted 1; Damp-proof courses provided 15; Yards and forecourts paved and drained 70; Roofs made watertight 433; Rain-water Pipes made good 152; Guttering repaired or renewed 220; Other cases of dampness remedied 139; Ventilation under floors provided 43. Special Premises. Number Visi ts paid Factories (a) power 239 348 (b) Non-Power 134 130 (c) Other premises 39 74 Cutworkers 207 293 Slaughterhouses 1 Butchers' sShops 73 263 Bakehouses 31 176 11.  Number Visits paid. Fishmongers, fish fryers and curers, etc. 31 143 Eating-houses and Coffee Stalls 90 176 Ice Cream Vendors 1 2 Cowsheds 1 4 Dairies and Milkshops 76 122 Laundries 5 8 Rag and Bone Dealers 4 14 Piggeries 5 49 Street Stalls Numerous 14 Greengrocers " 146 Stables " 156 As a result of the regular periodical visiting of the Special Premises the following works were carried out: - Butchers' Shops. Special cleansings, 24; Paving repaired, 1; Accumulations removed, 5; New Galvanised Bins provided, 2; Drains repaired, 1; VV.C's. repaired and cleansed, 6; Yard paving repaired, 3; Roofs repaired, 3; Drains cleared, 1. Bakehouses. Special cleansings, 49; Drains repaired, 2; V.C's cleansed and doors repaired, 4; Yards repaved, 1; W.C.cisterns repaired, 1; Premises general repairs, 1; Obstruction from drains removed, 3; New ceilings fixed, 1. Fishmongers. Special cleansings, 23; Yards repaved, 2; Accumulations removed, 6; Roofs repaired, 1; Other improvements, 4. Coffee and Fating Houses. Special cleansings, 25; Yard pavings repaired, 1; W.C.cisterns repaired, 4; Drains repaired, 2. Ice Cream Vendors. Special cleansings, 1; Special cleansing of utensils, 1; Yard pavings repaired, 1; Other improvements, 1. Cowsheds and Milkshops. Special cleansings, 8; Pavings relaid, 1; Drains reconstructed, Stable Premises. Cleansings, 23; Accumulations removed, 2; Roofs repaired, 2; Pavings repaired, 1; Manure receptacles provided, 1. Laundries. Special cleansings, 4; Roofs repaired, 2; Other improvements,3. Rag and Bone Dealers. Cleansings", 6; Accumulations removed, 1. Piggeries. Cleansings, 7. Camping Sites. There were no sites in the area used as camping sites. There are, however, several van dwellers in the Higham Hill area. Smoke Abatement. The use of war-time fuel gave rise to a few complaints which were investigated. Remedial measures were carried out as far as practicable. Eradication of Bed Bugs, etc. The free issue of insecticides was continued, and the number of applications for assistance was lower than usual, due no doubt to war-time habits of sleeping away from the usual bedrooms. 12. SWIMMING BATHS AND FOOLS.- The model bye-lows of the Ministry of Health were adopted during the year. (a) MUNICIPAL BATHS, HIGH STREET.- This is a covered swimming bath. Mr. 57.Cantes kindly contributes the following report:- "The plant was kept operating for an average of 12 hours per day, the baths being open 208 days in 1944. The approximate number of swimmers in 1944 was 47,961. The estimated maximum load was 922. Four water samples were taken during the year. The examinations showed that three of the samples were satisfactory and one was unsatisfactory due to the chlorination not being up to standard. There are 70 slipper baths in the building, with an ample supply of hot and cold water. All towels and other requisites are sterilised and freed from contamination. (b) SHIFT'S 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 kindly sends a copy of the analytical findings when samples are taken. (c) SOUTH-WEST ESSEX TECHNICAL COLLEGE,- Sampling was carried out on three occasions, and 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. The Managing Director kindly gives the following particulars: - The chlorination and filtration plant has a turnover of eight hours, with a possible speeding-up to six hours. 0.2 parts per million of free chlorine are aimed at for the deep end and 0.6 at the shallow end. The plant was kept in operation all day and night over the week-ends, if found necessary. The approximate number of swimmers in 1944 was 35,262. (f) WOODFCRD HIGH SCHOOL FOR GIRLS.- This is a covered bath with continuous chlorination and filtration. Sampling gave satisfactory results. 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:- I. - INSPECTION OF DWELLING-HOUSES DURING THE YEAR:- (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 2,646 (b) Number of inspections made for the purpose 7,589 (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. 13. (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (N.B.) These comprise individual unfit houses 7 (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 1,344 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 1,153 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 whioh nbtices were served requiring repairs 81 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners 97 (b) By local authority in default of owners (at a cost of £324.19. 9.) 12 (c) Withdrawn - premises vacated and undertaking not to allow future occupation Nil. B. Proceedings under the Public Health Aots:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 6 (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. 2 C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:- (1) Number of dwelling-houses in respect of which Demolition Orders were made 7 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. D. Proceedings under Section 12 of the Housing Act, 1836:- (1) Number of peparate tenements or underground rooms in respect of which Closing Orders were made 1 (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. 14. HOUSING ACT, 1936. UNFIT HOUSES. During the year 8 premises were dealt with under this Act as follows:- 18, Willow Walk 17, Courtenay Place 18, 11 " 19, " " Demolition Orders. 20, Courtenay Place 1, Gould's Cottages 2, " " Demolition Orders 21, Collingwood Road (2 rooms First Floor) Closing Order. GENERAL. The following is supplied by Mr.J.E.West, your Council's Housing Manager:- "Housing conditions in the Borough during the year 1943/4 continued to deteriorate due to enemy action and lack of facilities for adequate maintenance and repair. Although comparatively light compared with other years the number of properties damaged during the year amounted to 3,900 comprising 2 demolished, 1 condemned, 21 seriously damaged and uninhabitable, 61 seriously damaged but still habitable, and the remainder slightly damaged or windows only. Probably the most important development in housing during the year was the issue of Ministry of Health Circular 2845 relating to the housing of persons "inadequately housed" where requisitioned premises in excess of the "approved" quota were held for "homeless persons", i.e. homeless by enemy action, a number of properties could be transferred under the powers delegated by the Circular referred tc for the accommodation of persons inadequately housed. For this purpose 10 flats were reserved and following a very careful scrutiny of those cases which appeared to be most in need, these premises were allocated and 28 persons in all rehoused. During the year 124 families comprising 420 persons were rehoused from the "homeless" group and 59 transfers affecting 191 persons were arranged. Much useful work was also done by "indirect lettings" as the result of co-operation with local Estate Agents and some exchanges of tenancies were also negotiated which all assisted in the improvement of living conditions for the families concerned. The vacancies arising during the year numbered 36 and in addition 11 properties were repaired following extensive damage by enemy action. A total of 51 properties was dealt with in the following way. By transfers of tenants to smaller or larger accommodation as required - 10. These lettings involved 52 persons. 2 lettings involving 7 persons on the recommendation of the Medical Officer of Health. 18 normal lettings from the waiting list affeoting 65 persons. 17 lettings due to enemy aotion involving 65 persons. It cannot be denied that the decline in housing standards during the war years will have very serious repercussions in the years following the war and already it is possible to see the rough outline of the problem with whioh we shall be faced. Only the most determined effort by the Government, the Local Authorities and the people can succeed in remedying the ravages of the war, and the lowering of the standards due to cessation of building, damage by enemy aotion and steady growth in the number of families, together with the influx of families from other parts of the greater London area which have also suffered severely from enemy aotion. 15. INSPECTION AND SUPERVISION OF FOOD. (a) MILK SUPPLY. The following is contributed by the Chief Sanitary Inspector: - Routine phosphatase tests were carried out on samples of pasteurised milk, more particularly to control the efficiency of the two plants licensed in the Borough. 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 speoial visits made by your Chief Sanitary Inspector. The number of retail purveyors of milk is 76, most of whom carry on a "General" shop and sell milk in bottles as received. One hundred and twenty-two visits were paid to Registered premises of purveyors of milk during the year and a good standard of cleanliness was maintained. During the year 15 samples were taken for bacteriological examination. One was reported on as unsatisfactory. The samples are summarised as follows:- No. of Samples. Satisfactory. Unsatisfactory. Tuberculin Tested 2 Pasteurised 3 " not sold as such 1 Bottled milk 8 1 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' Liceriees. In respect of:- Pasteurised Milk 19 Tuberculin Tested Milk. 13 Supplementary Licences. Pasteurised Milk 2 Tuberculin Tested Milk 2 Bottling Licences. Pasteurised Milk 2 Tuberculin Tested Milk 2 (b) ICE CREAM. The restriction on the sale of ice cream continued until the last month of the year and one application for Registration for the Manufacture and Sale of this commodity was received and granted. Two samples of "Iced Blanc Mange" were submitted for analysis under the Food and Drugs Act. Subsequently legal proceedings were taken against two firms by the Food Executive Officer for the illegal sale of Ice Cream. (c) MEAT AND OTHER FOODS. The Live Stock (Restriction of Slaughtering) Order, 1940, continued to operate and with the exception of three pigs slaughtered at Christnae under the Ministry of Food licence, no slaughtering was carried out during the year. The following is a list of food condemned as unfit for human consumption. Wherever possible the food was salvaged either through the Ministry of Food Salvage Division or the local scheme. In addition to the foodstuffs enumerated below, there was a large quantity damaged by enemy action. This was dealt on the same lines and the Ministry of Food informed of all salvageable goods. 16. 189 tins Chopped Ham 211 " Lunchcon Meat 37 " Meat Loaf 12 " Pork Sausage Meat 2 " Rabbit 12 " Torgue 91 " Stewed Steak 154 " Sardines 91 " Salmon 555 " Pilchards 3 " Shrimps 59 " Earrings 40 " Mackerel 5 " Crawfish 3 " Fish Paste 1 tin Fish Roe 1 " Bisto 90 tins Peas 215 " Beans 16 " Carrots 5 " Beetroot 2 " Spinach 20 " Mixed Vegetables 32 " Tomatoes 77 " Vegetables in Gravy 2 " Apples 2 " Dam sons 3 " Blackberries 68 " Plums 2 " Pears 2 " Prunes 2 " Grapefruit 1 tin Peaches 96 tins Soup 3451 " Evaporated Milk 255 " Condonsed Milk 5 " Dried Milk 2 " Golden Syrup 3 " Oraltine 5 " Cocoa 1 tin Barlova 1 bottle Vinegar 8 bottles Sauce 2 " Piccalilli 1 Jar Chutney 1 " Marmite 241 jars Pickles (Mixed) 11 " Paste 4 " Pickled Herring 1 pkt. Vita Wheat 96 pkt3.Breakfast Food 3 ". Dried Egg Powder 3 " Ryvita Biscuits 38 " Pudding Mixture 6 " Cake Mixture 362 lbs. Cake 45¼ " Sugar 62 " Butter 3 " Margarine 10 " Cooking Fat ll0½ " Cheese 9½ " Ham 8 Qtrs. 5$ lbs. Bacon 422 lbs. Jam 254 " Marmalade 5 " Lemon Curd 1 lb. Honey 10 lca7es of Bread 65½ lbs. Sultanas 25 " Prunes 159 " Dates 51¼ " Figs 7½ " Biscuits 91 " Oatmeal 2 " Pearl Barley 204½ " Oats 3 " Barley Flakes 14 " Sausage Rusk 10 " Tea 7 " Coffee 142 " Flour 2 " Cake Flour 1½ " Soya Flour 133 " Pea Flour 12 " Semolina 285 " Rice 11½ " Split Peas 18 " Tomatoes 4½ " Beetroots 5 " Leeks 84 " Lettuces 462 " Fresh Peas 261 " Lemons 4270 " Oranges 2½ Bushels Cherries 4 tons 18 cwts. 2 Qtrs. Potatoes 1 ton 10 cwts.2 Q,trs.3 lbs.Cabbages 5 cwt. Pea Pickings 244 Fish Cakes 11 Picnic Hams 1 Whole Cheese 90 Meat Pies 99 Pork Pies 98 Sausage Rolls 17 Swiss Rolls 16 Cakes 33 Trifles 36 x 2d. Chocolate Cocktails 19 lbs. Sweets 7 " Chocolate Toffee 5 stone Dog-fish 40 " Skate 17 " Whiting 3 " Haddocks 11½ " Kippers 3 " 10½ lbs. Cod Fillet 2 " 3 " Plaioe 15 " 3 " Dabs 11 cwts. Dried Salt Fish 19¼ lbs. Black Pudding 30 " Minced Beef 5 " Loin of Pork 289 " Sausages 48$ " Sausage Meat 15 " Ox Tongue 28 " Liver 24¼ " " Sausage 4 " Roast Beef 1 Leg of Mutton 149 Rabbits 78 Chickens 1 Goose 33 Lettuces 9 Baskets of Cress 1689 Eggs 17. (d) ADULTERATION ETC. - FOOD AND DRUGS ACT, 1938. During the year 102 samples of food and drugs were submitted to and examined by the Public Analyst. Sixteen samples were unsatisfactory - 12 of milk being from one source - the particulars are as follows:- Description of article Result of Analysis Action Taken. Dried Pees (Informal) Discoloured and many badly weevilled Bulk surrendered. Gin (Formal) 40% Under Proof Vendors fined £12.10.6. Milk 12. (Formal) Added Water varying from 2% to 10% and 3 also deficient in fat from 7% to 18%. Producer fined £30.10.0. Frozen Blanc Mange 2. (Ice Cream) Formal Infringement of Ministry of Food. Ice Cream Order. Subsequently prosecuted by Food Executive Officer. (e) CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOODS. 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. During the year 13 certificates were granted to tenants and 10 applications were received from owners for certificates upon completion of works, six were granted. DISEASES OF ANIMALS ACT, 1894-1938. The Sheep Scab Order 1938. - No action necessary. Swine Fever Order 1938. " " " Regulation of Movement of Swine Order 192_2 - No action necessary. Foot and Mouth Disease Order 1928 - " " " Parasitic Mange Order 1938 - One notice was received during the year regarding a pony. The requirements of the notice were carried out. RATS AND MICE DESTRUCTION ACT, 1919 AND INFESTATION ORDER,1943. Much work is still carried out under these headings. Preliminary investigations are made by the Sanitary Inspectors and operative treatment carried out by the Council's trained Rat Catchers under supervision. Pre-baiting and Poison baiting has been carried out with much success. The following is a summary of the Vanitary Inspectors' 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. 64 527 42 399 304 16 6 165 Complaints received 371 Premises rat-proofed 15 Advice only given 14 Re-inspections 1,068 FACTORIES ACT, 1937. The following tables show the work done under this Act. 18. 1. - INSPECTION OF FACTORIES, ETC. Including Inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) Factories with Machine 348 8 Nil. Factories without power 130 1 Mil. Other premises under the Act. 74 - Nil. Totals 552 9 Nil. 2. - DEFECTS FOUND IN FACTORIES, ETC. Particulars. (1) No. of Defects No. of Offences in respect of which prosecutions were instituted. (5) Found (2) Remedied (3) Referred to H.M. Inspector. (4) ant of cleanliness 31 31 - - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation 1 1 - - Ineffective drainage of floors - - - - Sanitary Conveniences insufficient - - - - unsuitable or defective 50 48 not separate for sexes - - - - Other offences 9 9 - - Totals 91 89 Nil. Nil. NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1944. Wearing Apparel, making of 155 Belts 3 Brush Making 10 Rubber goods 5 Boxes 10 Dolls 3 Boots and Shoes 3. Total 189. Outworkers were notified from the following areas:- Bethnal Green 2 Leyton 29 Chingford 5 St. Marylo bone 2 City of London 18 Shoreditch 6 Finsbury 25 Walthamstow 29 Hackney 46 Westminster 5 Islington 8 Other Areas 14 Total 189. A total of 293 visits was paid in connection with Outworkers. 19. 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 1944 Ages 1943 Under 1 yr. 1-5| yrs 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 &over yrs Scarlet Fever 176 767 1 32 121 15 7 - - Diphtheria 13 23 1 1 9 1 1 - - Enteric Fever 1 - - - - - 1 - - Pneumonia 80 122 2 8 15 7 15 23 10 Puerperal Pyrexia 28 43 - - - 10 18 - - Ophthalmia Neonatorum 1 2 1 - - - - - - Erysipelas 20 26 - — - - 11 7 2 Encephalitis Lethargica - - - - — - - - - Polio-encephalitis - - - - - - _ - - Cerebro-Spinal Meningitis 4 5 1 2 1 - - — _ Anterior Poliomyelitis - 1 - - -. - - — - Measles 406 618 12 168 208 15 3 - _ yhooping Cough 195 93 25 112 56 2 — - - Dysentery 83 71 4 49 25 3 2 - - Malaria 5 - - — - 2 3 - 1 Tuberculosis 158 159 1 8 12 62 47 25 3 Totals 1944 117 0 - 48 380 447 117 108 55 15 Totals 1943 - 1930 54 586 913 111 161 86 19 Disease St.James Street High street Hoe Street wood Street Hale End Higham Hill Total Scarlet Fever 38 19 27 10 29 53 176 Diphtheria 2 - 3 - 3 5 [???] Enteric Fever - - - - - 1 [???] Pneumonia 14 9 9 6 18 24 [???] Puerperal Pyrexia 2 4 4 4 8 6 [???] 0, 'halmia Neonatorum - - - 1 — [???] Erysipelas 5 3 1 - 5 6 [???] Encephalitis Lethargica - - - - [???] Polio-encephalitis - - - - - [???] Cerebro-Spinal Meningitis - 1 - - 1 2 [???] Anterior Poliomyelitis - - - " - - [???] Measles 47 96 41 25 30 167 whooping Cough 41 45 21 26 32 30 [???] Dysentery 2 10 17 19 7 28 [???] Malaria 1 - 2 - 1 1 [???] Tuberculosi s 18 15 29 20 37 39 Totals 1944 170 202 154 110 172 36? [???] Totals , 1943 285 304 278 223 395 445 [???] The statistics given in the foregoing table are those for the calendar vear 1944. The Registrar-General gives the statistics for the 52 weeks ended 31st. December 1944, and these are given in the following table, together with the case rates per 1,000 population both for England and ales and for ''althamstow: - Disease Scarlet Fever Diphtheria Enteric Fever Fneumonia Puerperal Fvrexia Ervsinelas. Number 176 13 1 80 28 20 Case Rate walthamstow 1.64 0.12 0.01 0.79 0.27 0.19 England & wales 2.40 0.58 0.01 0.97 Not available C.29 20. The rate for Puerperal Pyrexia is better expressed in relation to the number of births (i.e. live and still-births) registered than to population. Then calculated on this basis the rate is:- Walthamstow 14.23, England & Wales 10.34. Disease Total Notified Removed to Hospital Per cent. removed to Hospital Deaths Deaths per cent.of oases notified. Scarlct Fever 176 101 57.3 Nil Nil Diphtheria 13 12 92.3 Nil Nil Enteric Fever 1 1 100.0 Nil Nil Pneumonia 80 25 31.25 72 90.0 puerperal Pyrexia 28 6 21.4 2 7.1 Ophthalmia Neonatorum 1 Nil Nil Nil Nil Erysipelas - - - Nil Nil Encephalitis Lethargica - - - Nil Nil Polio-encephalitis - - - Nil Nil Cerebro-Spinal Meningitis 4 4 100.0 1 25.0 Anterior Poliomyelitis - - - - - Measles 405 13 3,2 2 0.49 Whooping Cough 195 22 11.2 3 1.5 Dysentery 83 15 19.2 Nil Nil Tuberculosis (All forms 158 77 43.7 74 46.8 Infectious Diseases Clinic.- The weekly clinic at 2 p.m. on Tuesdays was continued, and all children cf school ege who had been in contaot with cases of infectious diseases were seen prior to their return to school. As in previous years all children discharged from the Isolation Hospital or after home isolation for infectious diseases were seen, and particular care was taken to refer all cases with any suspicion of rheumatism or cf cardiac defect to the next rheumatism 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 cf attendances mode 404 Average attendance per cession 7.7 Number of children recommended to Rheumatism Clinic 1 " " " " Aural Clinic 3 DIPHTHERIA IMMUNISATION. Immunisation was carried out at the weekly clinic on Tuesdays at 2 p.m. at Infants' schools, end at all the Welfare Centres along the lines detailed in the previous reports. The following summarises the work done:- Schiok tested for the first time 9 Negative (including pssudo end negative) 4 Positive ( " " and positivo) 5 Total number of immunisations completed during 1944:- (a) School age 191 (b) Pre-school age 852 (c) Over school age 4 1057 Number of Schick tests following immunisation 54 Number Positive 3 Number Negative 51 Number of clinics held for immunisation 51 Number of attendances made at clinic for immunisation 911 Average attendence per session 17.8 21. Immunisation at schools (included above):- Number completely immunised 111 " partly " 20 Number having extra dose, immunised in previous years 38 The following sets out the reduction in Diphtheria incidence and mortality before and since the commencement of Diphtheria Immunisation - Before Immunisation Since Immunisation i .e.1922/1932. 1932/1942. 1944. No. of cases of Diphtheria in 10 years. 2,588 966 13 No. of deaths from Diphtheria in 10 years. 85 35 Nil. It has been estimated that in Great Britain, of 100 children born and not protected against Diphtheria, 10 will contract the disease and one will die of it; of every 100 children protected against Diphtheria only one will contract a mild form of Diphtheria and none will die of the disease. Owing to movement of population (especially evacuation) no percentage figures can oe given for the end of 1944, but at 30th.June 1945 50% of the under fives and 80$ of the 5/15 year age group or 70% of all children in the Borough, aged 0-15 years, had been protected against Diphtheria. BIRTHDAY LETTERS.- In consequence of the number of removals, it was decided to send a letter to the parents on the birth of their child stressing the need of immunisation after it reaches the age of nin6 months. IMMUNISATION BY GENERAL PRACTITIONERS.- Diphtheria prophylactic is available to general practitioners. During 1944, 135 c.cs. of alum precipitated toxoid were issued; this quantity is sufficient to protect 135 children. MUNICIPAL LABORATORY. The following numbers of diphtheria swabs were examined during 1944:- Swabs. Negative. Positive. Totals. Private Practitioners 247 15 262 Health Department 37 4 41 School Medical Department 78 - 78 Totals 362 19 381 The total number of diphtheria specimens examined in 1943 was 599. In addition, 6 specimens of urine were examined. ESSEX COUr.TY COUNCIL SCHEME. The Assex County Council also provides facilities for examination of pathological specimens, and the County Medical Officer states that 956 specimens were examined for local practitioners during 1944, as follows:- Diphtheria Swabs, 381; Dysentery Specimens, 562; Ringworm Specimens, 3; Miscellaneous, 10. xThese were re-examinations of swobs sent on from .althamstow. VACCINATION. Mr.E.Sharp, Vaccination Officer for the Area, has furnished the following return for 1944:- Births Registered Successfully Vaocinated Percentage Vaccinated Insusceptible Exemptions Death before Vaccinated Postponed 1,614 336 21.0 3 601 41 37 In addition to the above, 97 primary vaccinations were recorded, and 63 re-vaccinations. 22. During 1944 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 20.8 per cent. were vaocinated. PREVENTION OF BLINDNESS. No action was neoessary under Seotion 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. No cases of smallpox occurred in 1944. SCARLET FEVER. A total of 176 oases of Scarlet Fever was notified in 1944 as compared with 767 in 1943. The following tables show the incidenoe by months, ages and wards:- Month All ages Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 41 - 11 26 3 1 - - February 42 - 4 31 6 1 - - March 20 - 4 15 1 - - - April 9 - 1 7 - 1 - - May 12 - 1 11 - - - - June 12 - 1 6 2 1 - - July 8 - 2 8 - 1 - - August 2 - - 2 - - - - September 6 - 3 3 - - - - October 9 1 1 5 2 - - - November 8 3 3 1 1 - - Deoember 7 - 1 5 - 1 - - Totals 1943 176 1 32 12l 15 7 - - 767 1 171 553 21 17 4 - Month St . Jame s Street High Street Hoe Street Wood Street Hale End Higham Hill January 10 5 5 2 10 9 February 3 6 7 1 6 19 Mar oh 4 2 3 1 3 7 April 1 2 1 2 - 3 May 4 1 - 1 2 4 June 3 1 2 2 2 2 July 4 - 1 - 1 2 August - 1 1 - - - September 1 - 3 - 1 1 October 3 1 1 1 1 2 November 2 - 3 - 1 2 Deoember 3 - - - 2 2 Totals 1944 38 19 27 10 29 53 1943 101 82 118 86 217 163 23. DIPHTHERIA. A total of 15 cases of Diphtheria was notified during 1944 as compared with 23 in 1943. The following tables show the incidence by months, ages and wards:- Month All Ages Under 1-5 5-15 1 yr. | yrs. yrs. 15-25 yrs. 25-45 45-65 yrs. yrs. 65 & over January 2 - - 1 - 1 - - February 5 - 1 4 - - - - March - - — - - - — — April 3 - - 2 1 - - _ May 1 1 - _ - _ - - June - — — - - - - - July * — - • - - - - August - - - _ - - - - September 1 - "" 1 - - • - October - - - - _ - > - November 1 - - 1 - - _ _ December - - " " - - ~ - Totals 1944 13 1 1 9 1 1 - 1943 23 - 4 15 3 1 - Month St.James Street High Street Hoe Street Wood Street Hale End Higham Hill January — - - _ — 2 February - _ 3 ~ 1 1 March - - - - - - April 1 - - - • 2 May - - - - 1 June - - - - - - July - - - - - - August - - - - - - September - _ - • 1 - October _ - - November 1 - _ - - - December - - ~ - - Totals 1944 2 _ 3 3 5 1943 2 3 4 5 2 7 The percentage of cases removed to Hospital in 1944 was 92.3 against 91.3 in 1943. No case was refused admission as home treatment cf Diphtheria can rarely be adequate unless the disease is extremely mild. Antitoxin continued to be available for free issue to medical practitioners at the Public Health Department during office hours, and at all times at the Fire Station, Forest Road, and at Mr.Gaze's, 10, The Avenue, Highams Fark. During 1944, a total of 20 phials, containing 8,000 units of Diphtheria antitoxin were issued. 24. ENTERIC FEVER. One case occurred in the Higham Hill Ward - a male, aged 32 years, on leave from the Merohant Navy. Contracted disease abroad - Recovered. DYSENTERY. A total of 83 cases of Dysentery was notified during 1944, as compared with 71 in 1943. The following tables show the incidence by months, ages and cards: - Month All Ages Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. Janua ry _ - - - - - - - February - — - - - - - - Maroh 1 - - 1 - - - - April - - - - - - - - May 23 - 22 1 - - - - June 3 - 1 - 1 1 - - July 10 1 6 2 1 - - - August - - - - - - - - September 16 1 12 3 - _ - - October 9 — 3 5 - 1 - November 12 2 2 8 - - - - December 9 - 3 5 1 - - - Totals 1944 83 4 49 25 3 2 - — 1943 71 1 13 37 4 9 5 2 Month St.James Street High Street Hoe Street food Street Hale End Higham Hill January - — - - - - February - - - - - - March - ' - - - 1 - April - - - - - - May - 1 6 10 3 3 June - 1 1 - - 1 July - - 2 5 1 2 August - - - - - - September 2 4 1 - - 9 October - 3 1 1 1 3 November _ - 1 2 1 8 December - 1 5 1 - 2 Totals 1944 2 10 17 19 7 28 1943 31 25 7 2 - 6 BACILLARY DYSENTERY. A total of 83 cases was notified (yatts Lane Day Nursery - 31, Higham Hill Day Nursery-13, schools - 26, others - 13). The previous highest totals were in 1937 (84 - which included an outbreak at the Nursery School), and 71 in 1943. Details of the cases at the Day Nurseries during 1945 are given below:- WYATTS LANE VAR-TIME DAY NURSERY. On May 8th.1944 a message was received that three children had Diarrhoea. Rectal swabs were taken and the children were excluded. A positive result for Sonne Dysentery was received on May 10th and an immediate visit to the Nursery revealed three more children and two members of the Staff to have Diarrhoea. 25. All absentee children were visited by the Health Visitors and those found to have diarrhoea were swabbed. On May 11th. all members of the staff and all ohildren in attendance at the Nursery were swabbed, and the usual Dysenteric precautions were put into operation. Leaflets of advice were given to all parents and rigorous cleaning and disinfection of the Nursery was carried out. After consultation with the Ministry of Health the question of closing the Nursery was deferred. On the 13th.May a report was received from the Sector Laboratory that three of the fifty-two swabs taken on the 11th. wore positive and as the next day was a Saturday the Nursery was closed in order to afford the opportunity for more thorough and complete disinfection. On May 15th two probationer nurses were reported off duty with Diarrhoea and on request,visits were paid by a medical and a nursing officer from the Ministry who advised that absentee children should not be admitted until giving a negative rectal swab and that absentees on account of Diarrhoea should be required to give three consecutive negative rectal swabs at intervals of three days. During the outbreak twenty-three children gave positive swabs and of these two had no clinical symptoms. In addition, six children and two staff had symptoms but gave negative swabs. In six of the cases other members of the same household were affected. Five children were admitted to hospital for domestic reasons and the outbreak was apparently cleared by June 20th.1944. On July 8th. a further case from this Nursery was notified by a private practitioner. All staff and children were again swabbed and seven of the children and one probationer gave positive swabs. No further case occurred until twelve days later when another Probationer had Diarrhoea with a positive swab. All cases were cleared by August 8th. and no further cases were reported after that day for the remainder of the year. HIGHAM HILL WAR-TIME DAY NURSERY. The first case of Diarrhoea was reported on September 8th. and a rectal swab proved Positive to Sonne Dysentery. On the 11th.September the child was admitted to Hospital and the precautions previously adopted at the Wyatts Lane war-Time Day Nursery in connection with the outbreak there early in the year were repeated at Higham Hill Nursery. In particular, all staff, nursing and domestic, and children were swabbed and absentees were visited by the Health Visitors. Of 25 swabs taken, six from ohildren were positive and all from the staff were negative. On the 15th.September six farther swabs were taken from children suffering from Diarrhoea and previously negative three of these proved positive. One child on re-admission following three negative swabs suffered from Diarrhoea and to deal with such children Matron was instructed to bed isolate or to oot isolate eaah re-admission for at least one day. During the whole outbreak 13 positive reotal swabs were obtained and in six of these other members of the same household were affected. There were no cases of Anterior Poliomyelitis, Encephalitis Lethargica nor of polio Encephalitis. 26. OPHTHALMIA NEONATORUM. One case was notified in the Hale End ward. PUERPERAL PYREXIA. See Maternity and Child Welfare Section. PNEUMONIA. The tables show the inoidence by months, ages and wards. Month All Ages Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 12 1 2 3 1 3 2 • February 14 - 2 2 1 1 6 2 March 5 - - 1 - 2 1 1 April 18 1 2 5 2 2 3 3 May 7 - 1 2 - 1 2 1 June 5 - - - 1 3 - 1 July 7 - 1 - - 2 3 1 August • - - - - - - September 2 - - - 1 - 1 - October - - - - - — - November 7 - - 2 1 1 2 1 Deoember 3 - - - - 3 - Totals 1944 80 2 8 15 7 15 23 10 1943 122 1 10 19 9 35 35 13 Month St.James Street High Street Hoe Street Wood Street Hale End Higham Hill January 2 1 3 — 5 1 February 1 3 3 1 1 5 March 1 1 - 1 1 1 April 5 1 1 1 4 6 May - 1 - 1 1 4 June 1 1 - - 2 1 July 1 - 2 _ 2 2 August - - - - - - September - - - - - 2 October - - - - - - November 1 1 - 2 2 1 December 2 - - - 1 Totals 1944 14 9 9 6 18 24 1943 26 18 14 9 30 25 Your Council decided to continue the grant to the Walthamston District Nursing Association, in return for which the Association was, amongst other services, required to provide home nursing facilities for oases of pneumonia. Bacteriological examination of sputum and typing is available through the medium of the exoellent laboratory service provided by the Essex County Council. The local praotice is for the District Sanitary Inspector to visit on receipt of a notification and to make the necessary enquiries and opportunity is taken to'deal with any obvious defects In [???]n which may bo found. 27, ERYSIPELAS. The following tables show the incidence by months, ages and wards:- Month All Ages Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 1 • • . - 1 - - February 2 - - - - 1 1 - March 1 - - - — 1 • - April 2 - - - - 1 1 • May 5 - - - - - 3 2 June 1 — — - — 1 - - July 2 - - - - 2 - — August 1 - - - - 1 - - September 2 - - - - 1 1 - October 1 - • - • 1 - _ November 1 - • - * 1 - - December 1 - - • - 1 - Totals 1944.20 - - - - 11 7 2 1943.26 1 1 - - 8 13 3 Month St.James Street High Street Hoe Street wood Street Hale End Higham Hill January - - -J-- — 1 February 1 - - • 1 March - - - - 1 - April 1 - - - - 1 May 1 1 1 - 1 1 June - 1 - - July - 1 - - - 1 August 1 - - - - - Septamber - - - - 2 - October - - - - - 1 November 1 - - _ - - December - - - - 1 - Totals 1944 5 3 1 — 5 6 1943 4 2 4 5 11 CEREBRO-SPINAL MENINGITIS. Four cases were notified, the details being as follows:- No. Ward Age Date Notified Hnspital Remarks 1. H.H., 8 months 18. 4.44 Yes Recovered. 2. H.E. 15 months 23. 5.44 Yes Recovered. 3. Hi. 7 years 9.10.44 Yes Recovered. 4. H.H. , 16 months 23. 9.44 Yes Recovered. 28. MALARIA. Five cases were notified. All were members of His Najesty' s Forces and contracted the disease abroad. No. ward Age Date Notified Hospital 1. H.H. 36 years 24. 2.44 Yes 2. H.E. 19 years 26. 4.44 Yes 3. H.H. 27 years 3. 5.44 i Yes 4. Ho. 22 years 3. 5.44 Yes > 5. J. 29 years 9. 6.44 Yes MEASLES. The following tables show the incidence by months, e.ges and wards:- Month All Ages Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 3 - 2 1 - - - - February i 26 1 9 11 6 1 - ~ March 60 1 14 40 4 1 - - April 50 2 18 26 3 1 - - May 118 2 40 75 1 - _ - June 104 1 60 42 1 - _ _ July 32 2 17 13 - - - - August 2 - 2 - - - - - September - - - - - - - - October 4 1 3 - - - • - November 1 - 1 - • - - - December 4 2 2 - - - - - Totals 1944 .406 12 168 208 15 3 - - 1943 .618 37 327 245 9 _ - - Month St.James Street High Street Hoe Street Wo od Street Hale End Higham Hill January - 1 - - 1 1 February 4 3 3 9 3 6 March 7 8 16 11 5 13 April 15 15 3 3 7 7 May 4 31 6 1 5 71 June 10 35 7 - 5 47 July 5 3 1 1 2 20 August - — 1 - 1 - September • 1 - - - - October 1 - - 1 2 November 1 - — — - • December - _ 4 - - — Totals 1944 47 96 41 25 30 167 1943 84 124 84 88 76 162 29. WHOOPING COUGH. The following tables show the incidence by months, ages and wards:- Month All Ages Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 j 45-65 yrs. yrs. 65 & over. January 17 3 10 4 - - - - February 16 2 9 5 - - - March 30 6 11 12 1 - - - April 14 3 7 4 - - - — May 33 4 18 11 _ _ - - June 25 1 18 6 - — — - July 39 4 26 9 - - - - August 10 - 4 5 1 - - - Sept ember 6 _ 6 - - - - October 1 - 1 - - - - - November 3 1 2 - - - - - December 1 1 — - - _ _ — Totals 1944.195 25 112 56 2 - - - 1943. 93 0 57 27 - 1 - - Month St.james Street High Street Hoe Street Wood Street Hale End Higham Hill January 2 4 - 2 3 6 February 1 6 1 1 4 3 March 4 4 1 7 9 5 April 4 3 1 2 2 2 May 14 5 8 2 1 3 June 3 11 3 3 1 4 July 9 8 4 5 10 3 August - 3 1 1 2 3 September 2 1 2 - - 1 October 1 - - - - - November - - - 3 - - December 1 - ~~ - • - Totals 1944 41 45 21 26 32 30 1943 10 28 14 . . 4 16 21 TUBERCULOSIS. The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1944:- Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary - NonPulmonary M. F. M. F. M. F. M. F. Under 1 year - - - 1 - - - 2 1-5years 3 3 1 1 - 1 - 1 5-10 " 2 - 1 1 - - 1 - 10 - 15 " 1 2 4 1 1 2 2 1 15 - 20 " 9 14 2 2 1 2 - - 20 - 25 " 10 20 1 4 6 4 - 1 25 - 35 " 13 9 3 - 8 2 - - 35 - 45 " 10 8 2 2 8 2 1 - 45 - 55 12 - 1 - 15 1 1 - 55 - 65 " 11 1 - - 4 2 1 1 65 yrs.& over 3 - - - 1 - 2 " Totals 74 57 14 13 44 16 8 6 131 27 60 14 158 74 The 74 deaths represent a death-rate of 0.73 per 1,000 population 30. The returns for the past two years are compared below:- Year New Cases Deaths Pulmonary NonPulmonary Total Pulmonary NonFulmonary Total M. F. M. F. M. F. M. F. 1944 74 57 14 13 158 44 16 8 6 74 1943 71 71 8 16 166 31 20 1 52 The periods elapsing between notification and death, and the number of cases not notified were as follows: - Under 3 months 3 to 6 months 6 to 9 months 9-12 months Over 12 months Not notified Notified after death Pul. NonPul. Pul. Non pul. Pul. Non Pul. Pul. Non pul. Pul. Non Pul. Pul .Nonpul Pul. Non- Pul. 6 1 2 - 3 2 - 27 1 19 8 1 4 The ratio of deaths in non-notified cases (i.e. columns to the right of the double line) to total deaths from tuberculosis was 32 to 74 or 1 to 2.3. Appropriate action was taken when necessary with regard to non-notificetion. The table given below shows the number of cases on the Register at the beginning and end of 1944:- Pulmonary Total NonPulmonary Total Orand Total M. F. M. F. No. on Register 1ast.January 882 783 1,665 455 372 827 2,492 Notified during 1944 74 57 131 14 13 27 158 Totals 956 840 1,796 469 385 854 2,650 Removed from Register, 1944 47 37 . 84 7 3 10 94 No.on Register 31st.December 909 803 1.712 462 382 844 2,556 Ninety-four removals from the Register were made up as follotjs:- Deaths Removals Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 30 10 1 1 17 27 6 2 40 2 44 8 42 52 94 The discrepancy between the number of deaths recorded here and the number of registered deeths during the calendar year is accounted for by transferable deaths and by cases not notified prior to death. 31. Treatment of Tuberculosis. Treatment is given under the Essex County Council's Scheme. The admissions to Hospital during 1944 were as follows:- Fulmonary Non-Fulmonary Total M. F. M. F. Adults 52 70 4 5 131 Ohildren 7 11 3 2 23 INFECTIOUS DISEASES HOSPITAL. RENOVATIONS, etc.- There were no major alterations at the Sanatorium nor at Thorpe Coombe Maternity Hospital. GENERAL.- (i) The death/rate per 100 admissions of infeotious disease patients was 1.87 and per 100 total admissions 3.20. (ii) During the year the County Council continued the grant payable by them in respect of infeotious disease beds, amounting to £425. (iii) The following table shows the admissions, discharges and deaths during 1944:- Scarlet Fever Diphtheria Other Diseases Tuberculosis Totals. Remaining in Hospital 1st .January 15 12 9 16 52 Admitted during year 143 72 158 33 406 Discharged during year 152 79 157 27 415 Died during year - 1 6 6 13 Remaining in Hospital 31st. December 6 4 4 16 30 DAILY AVERAGE NUMBER OF PATIENTS IK HOSPITAL. (Including Tuberculosis cases). January 49.6 February 51.3 March 51.4 April 44.9 May 33.6 June 36.2 July 35.7 August 32.5 September 25.5 October 34.4 November 36.8 December 34.1 Average whole year 39.8. 32. Under 5 years. 5-10 yrs. 10-15 yrs. Over 15 yrs. Total . Grand Total. M F M F M F M F M F Scarlet Fever 30 33 20 | 23 9 15 6 7 65 78 143 Diphtheria 15 11 5 10 7 6 6 12 33 39 72 Measles 3 3 1 3 — - 1 2 5 8 13 Cerebro-Spinal Meningitis. - 1 - 1 - - - - 2 2 Whooping Cough 14 20 2 i - - - - 16 20 36 Rubella — — - — - - 30 , 30 — 30 Sonne Dysentery 12 3 - - - - 1 - 13 3 16 Phthisi s — - - - - - 33 - 33 33 Other Diseases 10 20 6 8 3 5 3 3 22 36 58 Staff 1 - - - - 1 - r 3 3 3 Totals 84 91 34 45 19 26 47 60 184 222 406 175 79 45 107 406 SEX AND AGE AT DEATH. Thirteen.deaths occurred, details of which are given below*. - 6 Phthisis 6 Females aged 17, 24, 22, 47, 51 & 20 years. 1 Diphtheria 1 Male aged 4 years. 1 Whooping Cough 1 Male aged 5 weeks. 4 Broncho-pneumonia 1 Male 3mths., 3 females aged 2 yrs., 11 months, complicating 17.Cough and 3 months. 1 Broncho-pneumonia 1 . male aged 10 months. complicating S.Fever The year's work was entirely uneventful. One little girl aged 4 years was transferred to the L.C.C. Hospital for Diseases of the Nervous System, at Chase Farm, suffering from encephalitis complicating measles - the measles rash was still present - She died twenty-four hours after admission there. Other diseases cover a wide field including nursing mothers and babies at breast, colds, tonsillitis, Vincents Angina, ringworm and impetigo. NUMBER OF OUTSIDE AUTHORITIES' CASES & NATURE. Measles. Diphthoria. Scarte Fever. Other Diseases. Totals. Leyton 9 23 46 20 98 Epping - - - 8 8 Middlesex C.C. - - 1 — 1 H.M.Forces. - 7 3 37 47 Totals. 9 30 50 65 154 33 DURATION OF TREATMENT. - The average duration of treatment in Hospital was as follows:- Diptheria 24.4 days. Scarlet Fever 21.7 days. Other diseases 17.3 days. The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1944:- Classification in accordance with Ministry of Health Memo randum 37T.(Rev.) In Hospital on 1st Jan. 1944. Admitted during year. Discharged during year. Died du ring year. In Hospital on 31st Dec. 1944 Observation - - - - - T.B.Minus 4 11 6 2 7 T.B.Plus Group I - 1 1 _ - T.B.Plus Group II 12 22 21 4 9 T.B.Plus Group III - — - — - Totals 16 34 20 6 16 16 of the 50 admissions were Walthamstow cases. Personnel of the Civil Defence Casualty Service gave considerable nursing assistance. MEDICAL EXAMINATIONS. During the year, 44 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. 33 MQRTUARY.- A (Coroner's Court, Mortuary (with special provision for Infeotious 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 vere as follows: - Inquests only 94 Post-Mortems 114 Post-Mortems end Inquests (Not included in above) 23 231 CREMATION. Facilities for cremation are available at the Crematorium provided by the Corporation of the City of London at Manor Park, Little Ilford. DOMESTIC HELP. Following the receipt of Circular 179/44 in December 1944 the Council decided to operate a scheme on the lines suggested by the Ministry of Health and subject to the following conditions:- (a) That the scheme suggested by the Ministry be administered by the Public Health Committee. (b) That assessment be on the scale now operative in regard to Maternity and 3hild Welfare Home Helps (i.e. varying from full cost +o one-eighth recovery). (c) That domestic helps only be supplied on confirmation of the need by a certificate from a registered medical practitioner. (d) That the rate of pay be that laid down in the Hetherington Scale (i.e. Is. 2d. per hour for part-time workers, subject to the total not exceeding £2.12.6d. per week and £2.12.6d. per week for whole-time workers doing 48 hours per week). (e) That the Medioal Officer of Health be authorised to operate the scheme as soon as domestic helps are obtained, and to advertise for domestic helps, etc., as may be necessary. The demand during 1945 has fortunately been comparatively light because extreme difficulty has been experienced in finding helpers in spite of every means cf publicity (e.g. in the Press, at Cinemas and by posters). The main reasons appear to be the labour shortage generally and the inadequate rates of pay of the Hetherington Scale. 34. MUNICIPAL DENTAL SERVICE. Mr.L.W.Elmer, L.D.S . senior Dental Surgeon reports: - This service was commenced in April and during the period from that date to the end of 1944, 143 patients received treatment. Treatment is available to residents of the Borough. The scale of fees is based cn the National Health Insurance Dental Scale. Actual fees charged to patients are reduced by assessment to persons unable to pay the full fee. 633 appointments were made, and in spite of fairly continuous enemy action, 558 of them were kept. During the above period 135 fillings were inserted and 67 sealings, 71 dressings and 266 extractions were carried out. General anaesthetics were administered on 58 occasions, local anaesthetics on 54. 33 impressions were taken, 24 bites and 23 "try-ins'. 26 dentures were fitted and 5 repaired. All Dental Surgeons in the Borough were invited to participate in the scheme and during the period under review, sufficient volunteers were forthcoming to carry out all the treatment required. The period during which the scheme has beem in operation has been so abnormal and short, that it may be unwise to prophesy concerning its future, but I believe it is justifiable to envisage, with the return of more normal conditions, a considerable expansion of its scope and usefulness. 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 cf just over 3,000 hours. 35 MATERNITY AND CHILD WELFARE COMMITTEE. CHAIRMAN: Councillor Mrs.B.M.Friedberg. Ex-Officio: The Vorshipful the Mayor - Alderman A.E.banning, J.F. The Deputy Mayor - Alderman Mrs.E.M.Miller, J.P. Chairman of Finance Committee - Alderman Ross yld, J.P. Alderman Mrs.L.P.Bailey, J.P. Alderman Mrs.C.McEntee, J.P. Alderman W.B.Fitt. Councillor E.G.Baily " W.E.Barnes " Mrs.S.Candy " D.Evans " T.C.W.Green " W.E.Hammond Councillor Mrs.A.L.Meadows " A.E Simmons " Mrs.E.A.Smith " R.E.Smith " G.H.Spackman, J.P. " Mrs.E.B.Toynbee. Co-opted Members: Mrs.E.Clarke Mrs. Cooper Mrs. Holsworth Mrs.M. Jorman Mr.J.Marston Mrs.G.E.Nicholls Mrs.G.N.Riley. Dr.Helen Watson. 36. TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTE. Ladies and Gentlemen, The following report on the work done in 1944 shows that the total births were 87 higher at 1915 than in 1943. Illegitimate births were much higher at 90 as against 58. The infant mortality rate at 37 was the best of the five war years 1940/44 as was the illegitimate mortality rate at 33. The year saw the opening of a third day nursery at Higham Hill and increased diphtheria protection at velfare Centres.aThere was a new high record of ccnfinements at Thorpe Coombe Maternity Hospital. The only real black spot was the high rate of Maternal mortality - a total of 10 deaths of which 3 were due to abortion. Once more I have to acknowledge your consideration and the good work of the staff. I have the honour to be, Your obedient servant, A.T.W.FOWELL Medical Officer of Health. 37. STAFF. The following changes occurred in the Staff:- Resignations: - Miss E.Donovan Health Visiting 6.3.44. Appointments:- Miss R.Boyd Health Visiting 27.11.44. Miss E.C.Manning " " 11. 4.44. Deceased: Mrs.Morris " " 30. 6.44. NOTIFICATION OF BIRTHS. 1,886 births (85 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows:- dootors and parents, 275; midwives, 1,611. Included in the above are 193 births which were notified as having oocurred outside the Borough. Also included cre 55 stillbirths. 15 were notified by dootors and 40 by midwives. Of the total, 8 oocurred outside the area. The stillbirth rate per 1,000 population was 0.54. REGISTRATION OF BIRTHS. The Registrar-General's returns show the following registrations during the calendar year:- (a) LIVE BIBTHS. Males Females Totals. Legitimate 948 877 1825 Illegitimate 44 46 90 992 923 1915 (b) STILLBIRTHS. Legitinate 25 21 46 Illegitimate 3 3 6 28 24 52 Of the 1,658 birth registrations received in the Department between 2nd.January 1944 end 30th.December 1944, a total of 4 were not notified in this area, but some may possibly have been notified elsewhere. Appropriate action was taken when necessary. Of the 1,658 local registrations, 130 belonging to other areas are excluded, leaving a nett total of 1,528. Births Registered Locally 1944. St.James Street High Street Hoe Street Wood Street Hale End Higham Hill Totals. M. F. M. F. M. F. M. F. M. F. M. F. M. F. January 12 8 7 6 11 7 8 5 9 19 14 18 61 63 February 6 9 8 4 12 14 13 '•4 9 13 12 23 60 67 March 10 11 13 7 5 14 9 10 18 17 20 29 74 89 April 13 11 7 16 10 10 9 11 15 9 11 8 65 65 May 8 9 10 11 13 18 19 9 22 24 22 16 94 87 June 10 6 8 8 10 17 9 6 16 14 20 3 73 44 July 12 10 7 13 16 15 6 7 13 12 17 17 71 74 August 7 7 7 8 12 9 10 5 10 13 12 13 58 55 Septamber 11 8 4 5 6 5 6 5 11 6 10 11 48 40 October November 4 8 10 4 9 12 7 6 15 9 19 10 64 49 9 10 12 9 13 11 7 10 10 12 14 17 65 69 December 6 4 8 4 11 11 1 6 12 11 12 7 50 43 Totals 108 101 101 95 128 143 104 60 159 183 172 783 745 Grand Totals 209 196 271 188 319 355 1528 38. 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 third day nursery was opened at Handsworth Avenue in January 1945. This is a prefabricated nursery with accommodation for 50 children and is recognised for the purposes of training for the Nursery Nurses' Certificate. A grant aided Day Nursery at Brookscroft provided by the Walthamstow Child welfare Society has accommodation for 25 children. ATTENDANCES.- The following tables show the average attendances at the various Nurseries during 1944 (Mondays to Fridays only). MONTH NURSERIES Over 2 yrs. Under 2 yrs. TOTAL. January Wyatts Lane 29.4 13.0 42.4 Higham Hill 33.1 15.3 48.4 Handsworth Ave. 6.1 5.8 11.9 Brookscroft 18.0 7.0 25.0 February Wyatts Lane 35.7 15.6 51.3 Higham Hill 31.7 15.4 47.1 Handsworth Ave. 11.6 8.1 19.7 Brookscroft 18.0 7.0 25.0 March Wyatts Lane 37.8 15.6 53.4 Higham Hill 28.2 12.7 40.9 Handsworth Ave. 15.4 8.4 23.8 Brookscroft 15.6 5.0 20.6 April Fyatts Lane 39.3 15.8 55.1 Higham Hill 40.25 9.25 49.5 Handsworth Ave. 21.0 8.4 29.4 Brookscroft 18.2 1.0 19.2 May Wyatts Lane 21.2 10.9 32.1 Higham Hill 44.3 10.5 54.8 Handsworth Ave. 28.5 7.9 36.4 Brookscroft 15.0 2.0 17.0 June Wyatts Lane 24.8 11.4 36.2 Higham Hill 32.0 10.6 32.6 Handsworth Ave. 24.8 6.6 31.4 Brookscroft 17.5 1.0 18.5 July Wyatts Lane 17.3 6.3 23.6 Higham Hill 21.3 6.2 27.5 Handsworth Ave. 12.0 4.6 16.6 Brooksoroft 14.1 - 14.1 August Wyatts Lane 18.1 2.9 21.0 Higham Hill 20 .0 11.0 31.0 Handsworth Ave. 10.4 4.0 14.4 Brookscroft 7.6 - 7.6 September Wyatts Lane 21.0 10.4 31.4 Higham Hill 19.9 7.5 27.4 Handsworth Ave. 14.0 7.0 21.0 Brookscroft 9.2 - 9.2 October Wyatts Lane 22.4 1 2. 6 35.0 Higham Hill 33.7 11.3 45.0 Handsworth Ave. 16.5 7.4 23.9 Brookscroft 11.8 - 11.8 November Wyatts Lane 31.8 15.5 47.3 Higham Hill 36.6 11.3 47.9 Handsworth Ave. 18.1 9.2 27.3 Brookscroft 13.6 - 13.6 December Wyatts Lane 31.4 9.9 41.3 Higham Hill 34.6 6.9 41.5 Handsworth Ave. 19.7 8.7 28.4 Brookscroft 15.6 - 15.6 39. STAFFING.- This matter has, at times, proved difficult and much help vias received from Civil Defence personnel - in total amounting to some 1,469 hours work. INFECTIOUS AND CONTAGIOUS DISEASES.- Comparatively limited, outbreaks of Baoillary Dysentery (Sonne) occurred at wyatts Lane and Higham Hill Day Nurseries. These are referred to in the Fublic Health section of this report. 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 RegistrarGeneral are therefore:- Legitimate, 37; Illegitimate 33; Total 37. The Infant Mortality Rate for other areas during 1944 was as follows: - England and Eales 46 126 County Boroughs & Great Towns (including London 52 148 Smaller Towns (25,000 to 50,000) 44 London 61 NEO-NATAL MORTALITY. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1944, 40 infants died in the first four weeks of life, yielding a rate of 20.8. For the last ten years in England and Wales the neo-natal deaths have been approximately one-half of the total deaths under one year of age. The following rates refer to Waltharastow: - INFANT DEATHS, NEO-NATAL MORTALITY AND STILLBIRTHS. Year Live Births Birth Rate No. Stillbirths Neo-Natal Deaths per No. Infant Deaths per 1,000 live births Per 1,000 live births Per 1,000 population No. 1,000 live births 1944 1915 18.9 52 27.1 0.51 40 20.8 71 37 1943 1828 18.2 58 30.7 0.57 48 26.2 73 40 1942 1718 17.4 52 30.2 0.52 35 20.3 70 40 1941 1304 13.3 35 26.8 0.37 31 23.7 52 44 1940 1575 14.3 42 26.6 0.38 39 24.7 60 40 The neo-natal mortality for England and T7ales for the decennium 1921-30 Was 33. The death-rate from Diarrhoea and Enteritis in children under one year of age per 1,000 live births 1.04. CARE OF ILLEGITIMATE CHILDREN. Your Council gave careful consideration to Ministry of Health Oircular 2866 issued in October 1943 and your representatives attended a conference of the separate Welfare Authorities in the County which was held in December. The report of the representatives was later considered by the Council and the Ministry of Health was informed that in conjunction with the Walthamstow Girls Aid Association the suggestions contained in para.5 of the Ciroular were being carried out. 40. The Girls' Aid Association deals with the Southern portion of Chingford, the whole of Walthamstow and the Northern portion of Leyton. The Council pays an annual grant of £25 towards the work of the Association. The Association provides a hostel in Walthamstow with a total of 19 beds. Staff comprises, 3 whole-time workers. Expectant mothers are taken in at any time during pregnancy and employment is obtained for them until about 6 weeks before confinement. Mother and baby usually return to the Hostel unless arrangements have been made for the baby to be adopted or placed with a suitable foster mother The Superintendent of the Association reported that the chief difficulties during 1944 were to secure accommodation for confinements and suitable foster mothers. Although the local Day Nurseries helped very- considerably there was need for a residential nursery in the County area. Every possible step has, as in previous years, been taken to ensure that the care of illegitimate children does not fall below that given to children who are legitimate and the figures quoted below reveal a very satisfactory position: - ILLEGITIMATE BIRTHS AND MORTALITY. Year Live Births Infantile Deaths Death Rates Legitimate Illegitimate Legitimate Illegitimate Legitimate Illegitimate 1934 1678 37 75 2 44.0 54.0 1935 1626 44 60 2 37 .0 45.C 1936 1684 31 69 3 41.0 97.0 1937 1634 41 87 - 53.0 - 1938 1572 45 63 3 40.0 66.0 1939 1566 40 45 - 29.0 - 1940 1535 40 56 4 41.0 100.0 1941 1254 50 50 2 40.0 40.0 1942 1662 56 67 3 40.0 53.0 1943 1767 61 71 2 40.0 32.0 Average 1934/43 1597.8 44.5 64.3 2.1 41.0 48.7 1944 1825 90 68 3 37 33 Only too often the illegitimate infant mortality is two or three times that of the legitimate rate. In Waltharastow during the past 11 years the illegitimate rate has been nil in 2 years and the same or below the legitimate rate in 3 other years, in spite of the considerable increase in the total number of illegitimate births since 1940 and the very large increase in 1944. CARE OF PREMATURE INFANTS. The recommendations made in Ministry of Health Circular 20/44 issued in March 1944 have been carried out as far as possible having regard to war-time conditions, and the various steps taken are detailed below. On receipt of the Circular a letter was sent to all Medical Practitioners in the area requesting that where the birth weight was 5½ lbs. or less this information be inserted On the notification of birth card which has been provided with an appropriate space. Attention was drawn to the availability of accommodation at the Council's Maternity Hospitayor(if the baby was to remain at home) to the conditions to be provided and the special equipment which would be available as required from the Council's Maternity Hospital. All private maternity homes in the Borough and midwives in domiciliary practice were similarly advised. A rota of specialist paediatricians was arranged and a course of lectures by a opecialist has been arranged during the current year. 41. 42. CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE, 1944. Cause of Death Under 1 week 102 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks & under 3 months 3 months & under 6 months 6 months & under 9 months 9 months & under 12 months Total Deaths under one Year St.James Street High Street Hoe Street Wood Street Hale End Higham Hill s Influenza Measles 1 1 1 1 Whooping Cough 1 1 1 3 . 1 1 1 3 Diphtheria T.B.Ueningitis 1 1 2 1 1 2 Abdominal Meningitis Other T.B.Diseases Phthisis Meningitis (Non-tuberoular) 1 1 1 1 Convulsions 1 1 1 1 Bronchitis 3 3 2 1 3 Pneumonia (All forms) 2 1 3 6 4 2 2 14 3 1 1 2 3 4 14 Diarrhoea 1 1 2 1 1 2 Enteritis Gastritis Syphilis Ri cket s Inattention at birth, w.n. Suffocation - (Overlaying) Injury at birth 3 1 4 4 1 2 1 4 Atelectasis 7 1 8 8 3 3 2 8 Congenital Malformations 5 1 6 2 1 9 2 1 2 3 1 9 Premature Birth 10 1 1 12 1 13 2 1 1 3 3 3 13 Atrophy,Debility,Marasmus 1 1 1 1 1 Inanition Heart failure 1 1 1 1 1 Other causes 2 2 1 5 8 2 1 1 1 2 1 8 Totals 31 3 3 3 40 13 12 3 3 71 14 6 9 10 18 14 71 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 257 notified births, and one whole-time Health Visitor per 218 registered births during 1944. The following table gives a list of the current Ante-Natal and Welfare Clinics:- MATERNITY AND CHILD WELFARE CLINICS. Monday 2 to 4 p.m. Ante & Fost-Natal Low Hall Lane, Markhouse Road. xTuesday 9 a.m. " " " " " " " " Wednesday " " " " " " " " " Friday " " " " " " " " " x New cases only. Tuesday 2 to 4 p.m. Child r/elfare Estate Office, 1, Guildsway,Billet Rd.5.17, Tuesday " " " The Memorial Hall, Winchester Road, E.4. Wednesday " " " Low Hall Lane, Markhouse Road, E.17. Thursday 10 to 12 noon " " The Memorial Hall, Winchester Road, E.4. Thursday 2 to 4 p.m. " " Low Hall Lane, Markhouse Road, E.17. Thursday " " " Estate Office, 1, Guildsway,Billet Rd.E.17. SPednesday 1.30 to 4.30 p.m. " "Brookscro", Forest Road, E.17. Thursday " " " " " Friday 2 to 4 p.m. " " Low Hall Lane, Markhouse Road, E.17. In addition, the Walthamstow Child welfare Society at "Brookscroft" holds massage and sunlight sessions. A. MUNICIPAL SCHEME. The detailed findirgs at first visits paid during 1944 are given in the following table:- 43. 44. Frm the above table it will be seen that of 1,649 children, 1,354, or 82.1 per cent., were breast-fed on first being vistted, and 18, or .82 per cent., had no seoparate sleeping accommodation. Ward How Fed Sleeping Accommodation. Condition of Baby Accommodation- Breaat Breast and Hand Hand mth Mother Cot or Cradle Good Fair Bad Whole House Flat Half-House 3 Rooms 2 Rooms 1 Room St.Jomes St. 174 34 28 9 227 177 58 1 105 22 63 7 12 27 High Street 205 16 14 1 234 216 14 5 70 162 l 1 1 - Hoe Street 166 15 9 - 190 173 16 1 81 71 20 - 3 15 Wood. Street 164 16 24 - 204 187 17 _ 74 79 32 11 3 5 Hale End 301 31 40 2 370 361 10 210 67 66 - 6 23 Higham Hill 344 45 23 6 406 383 18 11 289 91 27 - 3 2 Totals 1,354 157 138 18 1,631 1,497 133 19 829 492 209 19 28 72 45. The follwing table shows the number and nature of visits paid during 1944:- , Ward Visits to Children under 1 year. Ante-Natal Visits Total Vi sits First Re-Visits Total Visits to Children 1-5 years Grand Total Unsuccessful Visits Visits to Nurse Children Yisits re Milk Scheme First Visit Subsequent Visits Total Visits Other Visits 1 2 , 3 4 5 6 7 8 - 9 10 Cols.5-10. St .J a .lies St. 236 347 583 609 1192 490 17 2 47 39 86 235 2022 High Street 235 435 670 580 1250 268 11 - 30 10 40 95 1664 Hoe Street 190 692 882 1049 1931 351 11 - 25 9 34 154 2481 Wood Street 204 352 556 431 987 441 2 - 38 11 49 60 1539 Hale End 372 1267 1639 1419 3058 234 26 3 63 36 99 169 3589 Higham Hill 412 995 1407 2173 3580 283 37 10 58 23 81 271 4262 Totals 1944 1649 4088 5737 6261 ll998 2067 104 15 261 128 389 984 15557 1943 1721 5108 6829 9245 16074 2328 150 25 327 122 449 1068 20094 INFESTATION. The steps taken to combat infestation include cleanliness inspection by School Nurse at schools once per term, treatment at School Clinic (which includes the supply of Lethane and of steel combs) and inspection and. treatment for Scabies at the Skin Clinic. In addition educational work is carried out at all 7althamstow schools and Day Nurseries. An experienced worker who has recently returned to Walthamstow after evacuation recalls a very marked improvement in the care and cleanliness of Pre-school children as compared with their condition in 1939. CLINICS. Dr.Sheppard reports as follows: Welfare Centres. The Welfare Centres were well attended during 1944, the number of attendances being 34,138. 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 been better. 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 1,984 attendances during the year, or an average of 9.9 per session Three sessions were held weekly and extra attention was given to those mothers who evacuated under the Government 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 86, which is not at all a satisfactory proportion if maternal morbidity is to be countered and, as with war conditions the morbidity 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. 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 1016 617 Low Hall Lane Clinic 404 62 Totals 1,420 679 Total attendances:- Thorpe Coombe Maternity Hospital 8,682 836 Low Hall Lane Clinic 1,984 86 Totals 10.666 922 46. SUMMARY OF ATTENDANCES AT V.ELFARE CLINICS. Clinio 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. 515 107 622 8562 5859 14421 15,043 Higham Hill 304 23 327 4654 4003 8657 8,984 Highams Park 267 13 280 4645 5186 9831 10,111 Total 1944 1086 143 1229 17861 15048 32909 34,138 Total 1943 1199 190 1389 23007 19768 42775 44,164 CHILD LIFE PROTECTION. - At the end of 1944 there were 27 nurse children on the register, compared with 30 at the end of 1943. During the year 1,0 removed. 7 new children were registered. There were no deaths among nurse children during 1944. The following is the information required by Circular 2790 of the Ministry of Health:- (a) Number of persons who gave notice under Section 7 (3) 3 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the year 3 (c) Number of children notified under Section 7 (3):- (i) Under supervision at the end of the year 3 (ii) who died during the year Nil. (iii) on whom inquests were held during the year Nil. (d) Particulars of any proceedings taken during the year . Nil. MASSAGE.- Five massage seeoiono per week were held at the Welfare Centres, i.e. Low Hall Lane, Monday, Tuesday, Thursday and Friday; Highams Park, Tuesday; and Higham Hill, Wednesday. 143 oases attended for massage and these imde 2,284 attendances. SALE OF MILK, ETC. AT CLINICS.- The quantity and value of milk and food sold and issued free during 1944 was as follows:- lbs. Sales Free.. Issue. ozs. lbs. OZS. Cow and Gate 10,538 - 1,200 - 0 s termilk 4,481 - 443 - Ambrosia 273 - 9 - Trufood 1,080 - 75 - Lactogen 2,969 - 340 - Prune and Banana 87 6 - - Parrish's Food 127 - - - Cod Liv3r Oil 40 - - - Malt and Oil 432 - 1 - Emulsion 23C 8 - — Magnesia 369 - - - Virol and Milk 21 - - - Virol 1,308 4 1 - Virolax - - - — Roboleine 387 - 1 - Farex 1,334 - - - Ovaltine 3,147 8 - - Marmite 1,065 4 - - Glucose 70 4 - - Ma ltoleine 250 - - - Adexolin 492 - - - Allergilac 54 - - - Celin Tablets 13 -- - Value:- £2,703. 2. 0. WALTHnMSTOY; CHILD WELFARE SOCIETY. The organisation, staffing and accommodation provided by the Society was fully dealt with in the 1935 report. Clinics are held as follows:- 47. Tuesday and Friday, 1,30 to 4 p.m. - Massage & Sunlight Treatment. Wednesday, 1.30 to 4.30 p.m. - Weighing Clinic & Dispensary Treatment. Thursday, 1.30 to 4.30 p.m. - Infant Consultations. 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 1944 421 39 460 6,140 1,903 8,043 8,503 1943 489 51 540 8,513 2,627 11,140 11,680 1942 442 74 516 6,229 2,557 8,786 9,302 1941 340 91 431 3,953 2,554 6,507 6,938 1940 444 74 518 7,195 3,661 10,856 11,374 HOME VISITS Year Visits to First Children under Subsequent 1 year. Total. Visits to ohildren 1-5 years. Grand Total. 1944 271 578 849 719 1.568 1943 443 824 1,267 909 2,176 1942 403 1,143 1,546 1,312 2,858 1941 308 519 827 1,504 2,331 1940 438 1,126 1,564 1,861 3,425 Your Counoil, under the Soheme approved by the Ministry of Health, for the grant period 1937-42, makes an annual grant of £700 to the Society. SUMMARY OF MONICIPAL AND VOLUNTARY SCHEMES. The following tables give the total number of attendances at cllnios and home visits:- ATTENDANCES AT CLINICS. First attendances Re-attendances Grand Total Under 1 yr. of age. 1-5 years of age Total Under 1 yr. of age l-5 years, of age Total Municipal Soheme 1,086 143 1,229 17,861 15,048 32.909 34,138 Brookaoroft 421 39 460 6,140 1,903 8,043 8,503 Total 1944 1,507 182 1,689 24,001 16,951 40,952 42,641 Total 1943 1,688 241 1,929 31,520 22,395 53,910 55,844 HOME VISITS. To ohildren under 1 year of age. Total To children 1-5 years of age. Total First Subsequent Municipal Scheme 1,649 4,088 5,737 11,998 17,735 Brookscroft 271 578 849 719 1,568 Total 1944 1,920 4,666 6,586 12,717 19,303 Total 1943 2,164 5,932 8,096 8,387 16,483 Percentage of notified live births represented by number of children under 1 year of age who attended the Centres for the first time 1944 82.3 Percentage of total notified births represented by number of expeotant mothers attending Ante-Natal Clinics 1944 80.2 48. TREATMENT. (a) orthopaedic.- The faeilites provided by the Edusation Authority's Orthopaedic Scheme are available for all children attending the Welfare Centres. Miss Garratt has kindly furnished the following information with respect to children under five years of age:- DEFECTS SEEN at orthopaedic clinic in CHILDREN UNDER FIVE YEiRS OF AGE. Scoliosis 3 Rickets:- (a) Genu Varum 37 (b) Genu Valgum 32 Pes Piano Valgus 31 Spastic Paralysis 4 Talipes: - (a) Equino Varus 10 (b) Calcaneo Valgus 7 Torticollis 13 Congenital Dislocation of Hip 2 Congenital Defects 17 Digitus Varus 1 Miscellaneous 5 162 (b) DENTAL.- The following work was done by the Education Committee's Dental Surgeons in respect of Maternity and Child TV'elfare patients:- 1943 1944 Mothers. Children under 5. Mother s. Children under 5. Cases treated 202 82 109 27 Attendancez 888 180 629 76 Fillings 347 114 299 43 Extradtions 337 75 212 6 General Anaesthetics 142 41 99 4 Scalings 102 - 66 - Dressings 152 30 79 42 Dentures 26 - 20 - (c) TONSILS AND ADENOIDS.- 27 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. - 97 infants were referred for sunlight treatment during 1944. (f) CHILD GUIDANCE.- Arrangements have now been made for children under five years of age to be referred to the Education Committee's Child Guidance Clinic. (g) INVALID CHILDREN'S AID ASSOCIATION.- Miss D.E.Taylor, Secreta: 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 21 Others 12 33 Classification of cases: - After effects of infectous illness 1 Marasmus and malnutrition 2 Diseases of Lungs (non T.B.) (a) Bronchitis,pneumonia etc. 4 (b) Asthma 1 Diseases of digestive organs 1 Nervous conditinos 5 Congenital deformities 8 Hernia 1 Diseases of ears I " " eyes 2 Child Guidance 5 Various 2 33 HELP GIVEN TO OLD AND NEW CASES, 1944. Sent tc hospitals, nursing and convalescent homes 11 Provided with surgical instruments and carriages 8 Referred for visiting and advice 6 Referred by I.C.A.A. to other agencies 8 33 ASSISTED MILK SCHEME. Number of applications during 1944 300 " " families assisted 140 The Eational Milk Soheme operated from July 1940 and ttoe 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 133 Home Helps approved during 1944, many mothers attending the Clinic made their own arrangements to obtain the help of suitable women whose names were supplied by the Health Visitors. 30 applications were rejected by the Rota Committee, and one was cancelled by the patient. The demand for Home Helps has been as follows during the past seven years:- 1938 (178), 1939 (125), 1940 (128), 1941 (105), 1942 (140), 1943 (175), 1944 (133). STERILIZED MATERNITY OUTFITS. A total of 497 sets were supplied and 178 outfits were issued below cost price. INSTITUTIONAL TREATMENT, ETC. Five children were sent to an institution under arrangements approved by your Committee. HOSPITAL ACCOMMODATION FOR CONFINEMENTS. The following numbers of confineaents occurred at the Institutions specified (Ufeltiamstow residonts cnly):- Thorpe Coombe Maternity Hospital 907 Maternity Homes in 7/althamstop 64 Mother' Hospital, Ckapton 50 Forest Gate Hospital 47 Queen Mary's Hospital, Stratford 8 City of London Maternity Hospital 5 Other Maternity Homes 83 6 1164 WALT HAMSTOW DISTRICT NURSING ASSOCIATION. (In affiliation with the Queen's Institute of District Nursing). Homes: - Central Home 17 Sc 19, Carisbrooke Road, E.17. Branch Home 8 Lyndhurst Road, Highams Park., E.4. The Superintendent, Miss C.A.Lee, S.R.N., S.C.M., reports as follows:- It gives me great pleasure again to submit a report on the activities of this Association for the year ending December, 1944. I have reason to be justly proud of the services undertaken by a wartime depleted staff of nurses. A very generous contribution to this excellent work was made again by the Civil Defence nurses and British Red Cross personnel attached to the South-West Essex Technical College. Ve are very grateful to all these nurses who give of their own time in many instances. The standard of 50. the work is still maintained as evidenced by letters from patients and their friends and by official bodies. In spite of increased salaries (Rushcliffe Scale) the finances of the Association are sound. The Provident Scheme fluctuates as it is badly effected by waf damage. The employees of a good number of firms are now paying regularly so on the whole the Scheme shows an upward trend. Nineteen pupil midwives entered for their district midwifery training during the year. Four trained nurses were approved for the "Queen's" Roll by H.M. Queen Mary following their training and examination. I should like to place on record mine and the Committee's thanke for the facilities granted and given by the Public Health, Electricity and Cleansing Departments and their Officers, Dr.Ramsay (by permission of Dr .Bullough), the Matron (Connaught Hospital), Mr.D.C.Cross (Lea Bridge District Gas Company), Mr.J.Davis (Messrs. Hitcfcman's Dairies), The Queen's training is very comprehensive and without the cooperation and help of all those mentioned this training could not be undertaken by this Association. The number of midwifery oases attended were:- • Municipal Voluntary Total Without Doctor 180 20 200 With Doctor 23 23 46 203 43 246 CONSULTANT OBSTETRICIANS. The services of a Consultant Obstetrician were not required during 1944. POST GRADUATE LECTURES TO MIDV/IVES. A series of 4 post graduate lectures for midwives was arranged by the Council during the summer, the subjects and Lecturers being as follows: - "The Toxaemias of Late Pregnancy" "Haemorrhage in Pregnaney" •- "Puerperal Pyrexia" "Disproportion and OccipitoPosterior Positions" Mr.John Blaikley, F.R.C.S. , F.R.C.O.G. Mr.Alan Brews, M.D.M.S., F.R.C.S., F.R.C.O.G. Mr.Aleck Bourne, M.A., F.R.C.S. F R C 0 • G • Mr.Christie Brown, M.S., F.R.C.: F.R.C.O.G. Although the lectures were primarily intended for practising midwives, medical praotitioners were invited and the total attendances were - Doctors 23 Midwives and pupil midvives. .167 MIDWIVES ACTS, 1902-1936. No.of notices of Intention to Practice, January 1944 31 " " " " " " " " during 1944 4, 35 No. of Midwives ceasing to practice during 1944 8 " " " practising at the end of 1944 27 There was no change in the arrangements for the employment or subsidy of midwives by the Council. Non-medical supervision of Municipal Midwives has been carried out by the Assistant Matron at the Maternity Hospital. 51. The following table shows the work done by Midwives (including those employed at Thorpe Coombe fraternity Hospital) during 1944:- No.of confinements attended as a Midwife 1343 " " " Maternity Nurse 226 " " Medical Aid notices sent 400 " " notifications of deaths 4 " " twin births notified 29 " " stillbirths notified 10 " " notifications of liability to be a source of infection 5 " laying out of a dead body 1 " artificial feeding 5 " " " " disinfection 5 The above table includes the following numbers with regard to work done at Thorpe Coombe: •• Midwifery cases 795 Maternity cases 112 Medical Aid Notices 261 The percentages of Medical Aid Notices vtere:- Total, 25.4. Maternity Hospital, 28.8. Domiciliary Midwives, 21.1, 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 1 Threatened abortion 1 Other conditions 5 • , • • ■ ■ * 7 For complications during labour:- Delayed 1st and 2nd stage 18 Perineal laceration 65 Pyrexia 5 Post-partum haemorrhage 1 Ante-par turn haemorrhage 1 Malpresentation 5 Retained placenta 4 Other conditions10 Tota 1 109 For complications in regard to the infant: - Prematurity & feebleness 6 Discharging eyes 1 Other conditions16, Total 23 COMPENSATION FOR LOSS OF CASES.- Compensation is made to Midwives by the payment of 10/- per confinement lost by reason of the reference of the patient from the Council's Ante-Natal Clinic to hospital on account of any abnormality. No claim for compensation was made during 1944. MUNICIPAL MIDWIFERY AND MATERNITY SERVICE.- The table below shows the number of visits done:- Ante-Natal Visits Clinic Delive ries Lying-in Visits Total visits Patients' Homes Midwife's House Mid. Mat. 2,167 2,826 340 422 47 9,282 15,084 PUBLIC HEALTH ACT, 1936 (Nursing Homes).- See Public Health Section of the report. 52. Puerperal Pyrexia. 28 cases of Puerperal Pyrexia were notified during 1944, The notifications were received from the following souroes:Maternity Hospital, 17; Hospitals outside the area 9; and General Practitioners, 2. The Puerperal Pyrexia rate for 1944 was 14.23 per 1,000 births as compared with 23.3 in 1943 and the mortality due to Puerperal Sepsis was 2.1 per cent of the cases of Puerperal Pyrexia notified. The Registrar-General has issued the following rates with regard to the notification of Puerperal Pyrexia. The '.'a It hams tow rates are set out in comparison. Per 1,000 live Puerperal Fever and still births Puerperal Pyrexia England and n&les 10. 34 126 County Boroughs and Great Towns, including London 13.13 148 Smaller Towns (25-50,000 population) 9.25 London Administrative County 3.61 14.14 Walthamstow 14.23 The Notifications and rates for Walthamstow for the past four years have been as follows:- Per 1.000 Total Births (live and still) Puerperal . Pyrexia Year No. Rate. 1944 28 14.23 1943 44 23.33 1942 29 16.38 1941 39 29.1 ABORTION. CIRCULAR 1661.- The number of cases in which medical aid notices w issued during 1944 by midwives in accordance with Rule E of the Central Midwives Board was:- Threatened abortion and misoarriage 1. Abortion and miscarriage Nil. 0PHTHAL'TA 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 1944 1 - - - - 1 - 1943 2 1 - - - - 1 Year Treated Vision unimpaired Vision impaired Total blindness Deaths At home In hospi tal 1944 1 - 1 - - - 1943 1 1 2 — - - MATERNAL MORTALITY. During 1944, ten deaths associated however slightly with pregnancy and child-bearing were investigated for the eompletion of enquiry forms Particulars relating to the ten deaths are given in the accompanying table, from which it will be seen that three were due to instrumental aborti on. 53. 54 DEATHS DUE TO PREGNANCY AND CHILD-BEARING AND/OR ASSOCIATED THEREWITH, 1944. > Case No. Date of death. Certified cause of death and classification. . Age Ward Circumstances No.of Pregnancy and Duration. Ante-Natal Care Physical Cond it ion Date of confinement or Abortion. Doctor called Admission to Hospital. Dr. Midwife . 1. 21. 1.44 Puerperal cellulitis of periP.eum due to bursting of tears of vagina; 31 Hi. Comfb rtable 1st. 44 weeks Yes Yes Good 18.1.44 Yes 19. 1.44 8. 15. 5.44 Placenta Praevia 29 W. 11 1st 28 weeks Yes No Good 14.5.44 Yes 5. 5.44 3. 30. 4.44 Shock due to Post-Partum haemorrhage due to retained placenta. 38 Ho. " 7th 40 weeks Yes Yes Good 29.4.44 Yes Died at home. 4. 23. 5.44 Air embolism due to instrumental abortion. 22 H.H. " 1st 18 weeks Yes No Good 23.5.44 Yes Died at home. 5. 23. 9,44 Shock and haemorrhage from instrumental abortio 39 n. H.E. Poor ? 20 weeks Nil Nil Good 24.9.44 No Died at home. 6. 16. 8,44 Acute cystitis, pyelitis & Pyelo-nephritis secondary to pregnancy 32 weeks 30 J. Comfortable 1st 31 weeks Yes Yes ? 15.8.44 Already in Hospit al. 7. L3.12,44 Ante-Partun haemorrhage due to rupture of uterus due to pregnancy toxaemia 32 Ho. Comfor tab1e 3rd 40 weeks Yes Yes Good 13.12.44 Yes 13.12.44 8. 22.11.44 Acute eclampsia 23 W. ? 1st 36 weeks Yes No Good : 21.11.44 Yes 20.11.44 9. 8.12.44 Shock and acute infection from septic abortion self induced. 34 W. Poor ? 12 weeks No No ? 8.12,44 No Died at home. 10. 26. 7.44 Cerebral haemorrhage. Eclampsia. Pregnancy 28 weeks. 32 H.E. Comfortable 1st 30 weeks Yes Yes ? Undelivered . Yes 26. 7.44 Deaths of Women due to Pregnancy and Child-bearing. Births Registered V/alt hamstow England and Vfelee 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. To tal Puerperal Sepsis Other Puerperal causes. To tal. Live, 1915 2 8 10 1.04 4.17 5.21 Not availalble Live & Stillbirths, 1967 2 8 10 1.01 4.06 5.07 " " 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) 1944 1943 1942 1941 1940 Maternal Mortality 5,21 4.92 1.16 6,89 0.63 Stillbirths 27.1 30.7 30.2 26.8 26.6 Neo-Natal Deaths 37.0 26.2 20.3 23.7 24.7 The maternal mortality rates for the past five years have been as follows:- Year Total Births Registered Deaths Rates per 1,000 Births (Live and still) Puerperal Sepsis Other Puerperal causes. To tal Puerperal Sepsis Other Puerperal causes Total 1944 1967 2 8 10 1.01 4.06 5.07 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 THORPE COOMBE MATERNITY HOSPITAL ALTERATIONS AND EXTENSIONS. - No alterations of major character were carried cut. GENERAL. - (a) Form M.C.W. 96A. (Ministry of Health). 1. Nafiie and address of Institution - Thorpe Coombe Maternity Hospital) 714 Forest Road, V.'althamstow, 3.17. 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 speoial reservation. 3. Number of maternity cases admitted during the year - 1015 plus three miscarriages (including ante-natal and post-natal admissions.) 55. 3a. Number of wcmen treated during the year in the ante-natal beds shown against item 2a. (These women should be included also against item 3) 141. 3b. x Average duration of stay of expectant mothers in the ante-natal beds shown against item 2a. - 4.85. 4. x Average duration of stay of cases in the lying-in wards. - 14.41. 5. Number of cases delivered by - (a) Midwives - 795, (b) Doctors - 112, Total 907. 6. Number of cases in which medical assistance was sought by a midwife in emergency - 261. 7. Number of cases admitted after delivery - 6. 8. Number of cases notified as - (a) Puerperal fever - Nil, (b) Puerperal pyrexia - 17. 9. Number of cases of pemphigus neonatorum - Nil. 10. (a) Number of infants on a supplementary feed on disoharge. - 102 complemented, 26 artificially fed. (b) Number of infants wholly breastfed on leaving the Institution - 763. 11. (a) Number of cases notified as ophthalmia neonatorum - Nil. (b) Result of treatment in each case. - 2. (a) Number of maternal deaths - 1. (b) Cause of death in each case.- Ante-partum haemorrhage due to rupture of the uterus. Toxaemia of pregnancy. 3. (a) Number of stillbirths - 24. (b) Cause in each case, and results of post-mortem examination (if obtainable) - See Clinical report. 4. .(a) Number of infant deaths within 10 days of birth - 9. (b) Cause ofddeath in each case, and results of post-mortem examination (if obtainable). - See Clinical report. The stillbirth rate was 25.9 per 1,000 live and still births, and the neo-natal mortality within 10 days of birth was 10.0 per 1,000 live births. Occupation of beds. - The average daily occupation of beds was as follows: - January 42.16 February 40.89 March 39.06 April 38.73 May39.6 June37.9 July 35.2 August 29.5 September 28.7 October 33.1 November 29.8 December 31.2 The average for the whole year was equal to 64.8 per cent.beds occupied (based on 54 beds.) Emergency Unit. - The services of the emergency unit were not required during the year. Gas and Air Analgesia. - The Msternity Hospital is approved by the Central Midwives Board for the purpose of giving special instruction in gas and sir analgesia. training of Pupil Midwives. - The Hospital is approved by the Central Midwives Board, jointly with the Middlesex Hospital, for the training of 56. pupil midwives in both Part I and Part II of the training under the new rules. During 1944, 15 pupils from Thorpe Coombe obtained the certificate of the Central Midwives Board. Personnel of the Civil Defence Easualty Service gave considerable nursing assistance. The following Clinical Report has been compiled by Miss Helen Rodway M.R.C.O.G., Resident Obstetrician. THORPE COOMBE MATERNITY HOSPITAL. CLINICAL REPORT FOR 1944. During this year there were 907 confinements in the Hospital, bringling the total to 7,319 since the Hospital was opened in May 1934. There were 141 ante-natal admissions and 6 post-natal; in addition 3 patients were admitted on account of miscarriage. The attendances at the Ante-Natal Clinics were well maintained, 1,016 a-tr-natal patients making 8,682 attendances. The Post-Natal Clinics were not so well attended this year, only 617 patients, that is 68 per cent, attending for examination six weeks after their confinement; last year 86 per cent of patients attended. There were 31 uhbooked cases admitted to the Hospital. A summary of the work of the Hospital is given below. A full statistical clinical report has as usual been prepared and is available for medical reference. SUMMARY OF THE WORK OF THE HOSPITAL. Clinic Attendances. A, Ante-Natal Clinics: No. of Olinics held. No. of attendances Average attendance per session. (a) Consultant's Olinics 12 106 8.83 (b) Resident Obstetrician's Clinics. 191 3,757 19.67 (c) Midwives Clinics 227 4.819 21.22 Totals 430 8.682 B, Post-Natal Clinics: 5£ First visit 617 Subsequent visits 219 16.07 836 COMPARATIVE FIGURES. From January 1935 until the end of December 1944. 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 Totals ITo.of confinements 907 891 695 645 720 595 691 640 660 646 7090 Total number of admissions 1018 1037 801 717 817 675 775 739 769 747 8086 Clinic attendances. Ante-Natal Clinics. (a) New patients 1016 944 764 824 750 733 702 753 691 76S. 7939 (b) Old patients 7666 7775 6551 5661 6679 5750 6032 5501 5354 4543 61512 Totals: 8682 8719 7315 6485 7429 6483 6734 6254 6045 5305 69451 Post-Natal Clinics, la) First attendances 617 769 504 315 330 401 479 380 453 256 4504 (b) Subsequent attendances 219 114 117 149 140 155 151 145 177 2] 0 1577 Totals: 836 883 621 464 470 556 630 525 630 466 6081 57. ADMISSIONS TO THE HCSPITAL. (a) Ante-Natal 141 (39 patients were delivered before discharge) (b) For confinement 868 (c) Post-Natal 6 (d) On account of m.i scarriage 3 Total 1018 Indications for the admission of Ante-Natal patients. Number of cases. Ante-partum haemorrhage 7 Pre-eclamptic toxaemia 10 Hyperpiesis 12 Hyperemfcsis 1 Creech for version 13 For rest on account cf cardiac disease 10 For observation and rest 12 For observation and discharged because not in labour 76 Total 141 Emergency admissions. Indications for admission. Number of cases. Ante-partum haemorrhage 1 Pre-eclamptic toxaemia; hyperpiesis 3 Complications cf labour 8 Threatened miscarriage 1 Unsuitable home conditions 4 Transferred from Nursing Home 14 To tal 31 or Confinements. °f the 907 confinements, 474 / 52 per cent were first births. Operations performed. Number of cases. Surgical induction of labour 16 Version 10 Forceps delivery 52 Manual removal of placenta 11 Caesarean section 6 Total 95 Medical Aid requests from the Hospital Midwives for the services of the Resident Obstetrician or her deputy, numbered 251, that is 27.7 per cer for patients in labour and 10, that is 1.1 per cent for infants. INFANTS. The number born in the hospital this year was 925; this included 18 cases of twins, a percentage of 1.9 relative to the total number of confinements. . There were 65 premature infants (those weighing 5^ lbs. or less): this represents 7 per cent of the total number of infants. Breast Feeding. 85.63 per cent of mothers were discharged from the Hospital completely breast feeding their infants; a further 11.45 per cent were partly breastfeeding, while in 2.92 per cent of cases, bottle feeding had, for one reason or another, to be substituted. 58.  1944 1943 1942 1941 1940 1939 19 38 1937 1936 (a) Infants completely breast fed. 85.63 82.5 83.9 87.6 77.4 75.9 86.0 85.0 85.7 (b) Infants partly breast fed. 11.45 12.2 12.0 9.9 18.7 18.7 - - - (c) Infants not breast fed. 2,92 5.3 4.1 2.5 3.9 5.4 - - - 100.0 100.0 100.0 100.0 100.0 ,100.0 FOETAL AND INFANT MORTALITY. (a) Stillbirths. Number of cases. 1, Premature (weight 5-g- lbs.or less) 8 ii. Full term 16 Total . 24 Thfe stillbirth rate was 25.9 per 1,000 live and stillbirths. (b) Infant Deaths. Number of cases, i. Prema ture 6 ii. Full term 3 Total V The Neo-Natal mortality rate within 10 days of birth was 10-.0 per cent per 1,00C live births. At the present time there are no oomparable figure for England and "ales. ' 11 One infant re-admitted died at 8 weeks. Three infants admitted from the District died subsequently in the Hospital PUERPERAL PYREXIA. Number of cases notified - 17. Percentage of cases relative to the number of patients delivered - 1.9 Causes of Pyrexia. No. of cases. Percentage of cases. Local u erine infection 6 35.29 Pelvic and uterine infection 3 17.64 Mastitis 3 17.64 Flushed breast 2 11.76 Urinary infection 2 11.76 Undetermined 1 5.88 17 Maternal Mortality. There was one maternal death due to ante-partum haemorrhage with rupture of the uterus in a case of pregnancy toxaemia. 59.