WAL 28 Borough of Walthastow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1945 A. T. W. POWELL. M.C., M.B.. B.S., D.P.H., Medical Officer of Health. Crusha & Son. Ltd. (T.U.). Tottenham, Wood Green, Southgate & Enfield. Borough of walthamstow REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1945 INDEX page Section A.— Statistics and Social Conditions of the Area 7 Section B.— General Provision of Health Services in the Area 11 Section C.— Sanitary Circumstances of the Area 16 Section D.— Housing 21 Section E.— Inspection and Supervision of Food 24 Section F.— Prevalence and Control over Infectious Diseases 30 Section G.— Infectious Diseases Hospital 45 Section H.— Maternity and Child Welfare 50 Section I.— Thorpe Coombe Maternity Hospital 77 page Abortion 74 Adoption 64 Acreage 7 Adulteration 27 Ambulance Facilities 11,48 Ante-Natal Clinics 59, 63, 67, 79 Assessments 7 Bacteriological Analyses 27 Births 7, 52 ,, Notification of 51 ,, Registration of 52 Birth Rate 7,9 Breast Feeding 60, 82 Cancer 10 Caravans 20 Care of Illegitimate Children 55 Cerebro-Spinal Meningitis 9, 10, 30, 40 Child Guidance 68 Child Life Protection 63 Child Welfare 59 ,, ,, Clinics 59, 62, 66, 79, 85 Clinics 12, 31 Committees 4, 50 Compensation (Midwives) 73 Connaught Hospital 14 Consultants 71 Cremation 48 Daily Guardians 54 Day Nurseries 37, 53 Deaths 7, 10, 75 ,, Infants 55, 58, 82, 83 ,, Infectious Diseases 10 Death Rate 7, 8, 9 Dental Treatment 13, 67 Dietetics 78, 84 Diphtheria 9, 10, 30, 35 ,, Immunisation 32 Diseases of Animals Acts 28 Disinfestation 20, 62 District Midwifery 73 Domestic Help 48 Dysentery 30, 36 page Emergency Unit • 78 Encephalitis Lethargica 30, 38 Enteric Fever 9, 10, 30, 36 Erysipelas 9, 30, 39 Evacuation of Expectant Mothers 70 Factories Act, 1937 28 Food & Drugs Act, 1938 27 Food Inspection 24 Foot Clinic 12 Gas and Air Analgesia 78 Health Visitors 59, 85 Home Helps 69 ,, Visits 61, 67 Hospital Accommodation 14, 70, 77 ,, Infectious Disease 45 Housing ,.21 Act, 1936 23 ,, Conditions 60 ,, Inspection 21 Ice Cream 20, 25 Immunisation 32 Infant Mortality 54, 55, 58 Infectious Diseases 30 ,, ,, Ambulance Service 48 ,, ,, Clinic 31 ,, ,, Hospital 45 Infestation 20, 62 Institutional Treatment 14, 70 Inquests 48 Invalid Children's Aid Asscn. 69 Insulin 49 Laboratory Service 33 Lectures to Midwives 71 Malaria 30, 40 Massage 65 Maternal Mortality 9, 75 Maternity & Child Welfare 50 ,, Homes 70 page Measles 9, 10, 30, 41 Meat Inspection 25 Medical Aid 72 ,, Examinations 48 Midwives 72, 73 ,, Lectures to 71 Milk, Assisted Scheme 65, 69 ,, Special Designations Order 25 ,, Supply 24 Miscellaneous 48 Mortuary 48 Municipal Dental Service 13 ,, Laboratory 33 ,, Ambulance Service 11 „ Midwifery & Maternity Service 73 Neo-Natal Mortality 55 Notices, Sanitary 18, 22 Notification of Births 51 Nursing 12 ,, Homes 16 Obstetric Consultants 71 Ophthalmia Neonatorum 30, 38, 74 Ophthalmic Treatment 68 Orthopaedic Treatment 67 Outworkers 29 Overcrowding 23 Parenthood and Mothercraft Lectures 76 Pneumonia 9, 10, 30, 38 Poliomyelitis 30, 38 Population 7 Post-Mortems 48 Post-Natal Clinic 63, 79 Premature Infants 57 Prevention of Blindness 34 Public Assistance 15 ,, Cleansing 16 Puerperal Pyrexia 7, 9, 30, 73, 83 page Rateable Value 7 Rats and Mice Destruction Act 28 Refuse Disposal 16 Rent Restriction Acts 27 Sanitary'Inspection 17 Scabies Clinic 14 Scarlet Fever 9, 10, 30, 34 Schick Tests 32 Smallpox 9,34 Social Conditions 7 St. John Ambulance Brigade 12 Staff 6, 51 Statistics 7 Sterilised Maternity Outfits 70 Stillbirths 7, 52, 55, 82 Sunlight Treatment 68 Swimming Baths 20 Thorpe Coombe Maternity Hospital 77 Tonsils & Adenoids 68 Tuberculosis 8, 10, 30, 43, 47 Training of Pupil Midwives 78 ,, ,, Probationers 45 Unemployment 7 Vaccination 33 Venereal Disease 15 Vital Statistics 7 Vitamins 53 Walthamstow Child Welfare Society 65 Walthamstow District Nursing Association 71 Water 16 Whooping Cough 9, 30, 42 Women's Clinio 12 Zymotic Diseases 8 PUBLIC HEALTH AND SANATORIUM VISITING COMMITTEES. Chairman: Alderman Mrs. C. McEntee, J. P. Vice-Chairman: Councillor Mrs. S. Candy. The Worshipful the Mayor—Councillor Mrs. E. A. Smith, J.P. The Deputy Mayor—Alderman A. E. Manning, J. P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman Mrs. L. P. Bailey, J.P. ,, A. G. Bottomley, O.B.E., M.P., J.P. Alderman W. B. Fitt Alderman Mrs. E. Miller. Alderman T. Smith. Councillor S. N. Chaplin. ,, R. W. Davis. ,, MRS. B.. M. RIEDBERG ,, F. W. Gentle. Councillor A. J. Llewellyn. ,, A. E. Mallett. ,, D. R. Perry. ,, R. E. Smith. Councillor Mrs. E. B. Toynbee. Town Clerk: G. A. Blakeley, Esq. TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Ladies and Gentlemen, I beg to present herewith a report on the work of the Public Health Department for 1945. Vital Statistics and Infectious Disease incidence and rates were again good, particularly in regard to Diphtheria, with only 16 confirmed cases and again no death. 2,281 children were protected against Diphtheria during the year. The various clinic services were fully used, with nearly 10,000 treatments at the Foot Clinic, over 2,000 at the Women's Clinic and over 4,000 at the Skin Clinic. The Municipal Dental Clinic made good progress. A domestic help scheme was commenced during the year. Schemes were approved for improvement to the Infectious Diseases Hospital Kitchen and Laundry. Staff shortage caused considerable anxiety. Many changes of Staff occurred, notably the retirement due to ill health of Mr. M. E. Duncan, your Chief Sanitary Inspector for 24 years after serving as a District Inspector for 10 years. Your Council decided to award Mr. Duncan a testimonial under seal. Again I have to record your consideration and the good work of the Staff. I am, Your obedient servant, A, T. W. POWELL, Medical Officer of Health. 6 STAFF. The following changes occurred in the Staff:— Resignations. Mr. M. E. Duncan (Chief San. Inspector) 5. 7. 45 Mrs. F. Green (Clerical Staff) 8. 11. 45 Mr. F. Hellman (Clerical Staff) 31. 12. 45 Mr. M. Marks, L.D.S. (Dental Staff) 1. 3. 45 Mrs. N. Moger (Clerk/Receptionist) 6. 6. 45 Mrs. H. Nathan (Clerical Staff) 14. 4. 45 Mr. H. D. Perrin (Sanitary Inspector) 31 10 45 Mrs. D. Richards (Chiropodist) 30. 11. 45 Miss N. Waterman (Clerical Staff) 8. 7. 45 (2 years Leave of absence) Mrs. J. Wolpert (Clerical Staff) 9. 6. 45 Miss E. Woods (Dental Staff) 6. 3. 45 Appointments. Miss G. Baker (Clerical Staff) 8. 10. 45 Mr. G. J. Bradley (Clerical Staff) 5. 11. 45 (Resumed after War Service) Dr. C. F. Chadwick (Medical Staff) 1. 1. 45 Mrs. P. Crisp, S. R. N. (Skin Clinic) 1. 7. 45 Miss J. Foster (Clerical Staff) 2. 7. 45 Mrs. F. Gerdes (Skin Clinic Staff) 1. 7. 45 Miss G. Hutchins (Dental Staff) 9. 4. 45 Mr. S. Jordan (Ambulance Staff) 1. 1. 45 Mr. M. Marks, L.D.S. (Dental Staff) .. 29. 5. 45 Mr. W. Richards (Dep. Chief San. Insp.) 1( ).9. 45 Mr. G. Rowe (Skin Clinic) 1. 7. 45 Miss S. Snowden (Dental Staff) 12. 2. 45 Mr. D. L. Stokes (Chiropody Staff) 10. 12. 45 Mr. R. V. Tait, L.D.S. (Dental Staff) 3. 9. 45 Miss M. Warren (Clerk/Receptionist) 4. 6. 45 Miss E. F. Weatherill (Clerical Staff) 17. 9. 45 Mrs. M. E. West (Clerical Staff) 2. 7. 45 Mrs. J. Wolpert (Clerical Staff) 23. 4. 45 7 A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1945) 103,320 Number of Assessments, 1st April, 1945 35,617 Rateable value £867,336 Sum represented by penny rate £3,400 Population.—The Registrar-General's estimate of the population at mid-year, 1945, is 103,320, an increase of 2,180 on the previous figure. Unemployment.—According to information kindly supplied by Mr. Percy C. Graham, Manager of the local EmploymentExchange, the number of insured persons employed in the whole of the area covered by the Leyton Employment Exchange in July, 1945, was approximately 45,000. Of these, it is estimated that about 25,000 were employed in Walthamstow. During 1945 the number of unemployed persons was small, and at no time exceeded 450 for the whole of the area covered by the Employment Exchange. The majority of the unemployed persons were placed in employment within a few days of their registering at the Exchange and there was a steady demand for both male and female workers throughout the year. Extracts from Vital Statistics.—The Registrar-General's mid-year, 1945, estimate of population (viz., 103,320) has been used for the calculation of all vital statistics:— Total Male* Females Birth rate per 1,000 of the estimated resident population 16.5 Live Births Legitimate 1,614 830 784 Illegitimate 99 53 46 Total 1,713 883 830 Stillbirths 56 Rate per 1,000 total (live and still) births 31.6 Deaths . 1,271 Death rate per 1,000 of the estimated resident population 12.3 Deaths from puerperal causes :— Rate per 1,000 (live and still) births. Puerperal Sepsis Deaths 2 1.13 Other Puerperal Causes 1 0.56 Total 3 1.69* Death rate of infants under one year of age : — All infants per 1,000 live births 38 Legitimate infants per 1,000 legitimate live births 37 Illegitimate infants per 1,000 illegitimate live births 50 Deaths from Measles (all ages) — ,, ,, Whooping Cough (all ages)- — ,, ,, Diarrhoea (under two years of age) 6 (All rates are per 1,000 of estimated residential population.) Zymotio disease death rate 0.04 Pulmonary Tuberculosis death rate 0.59 Non-pulmonary Tuberculosis death rate 0.05 The natural increase of population, i.e., excess of births over deaths was 442. 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 1945 (1271) compares with 1,343 in 1944, the respective death rates per 1,000 population being 12.3 and 13.2. 9 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and case Rates for certain Infectious Diseases in the year 1945. Provisional figures based on weekly and quarterly returns. England and Wales. 126 County Boroughs and Great Towns (including London). 148 Smaller Towns (Resident Population 25,000 to 50,000 at 1931 Census). London Administrative County. Walthamstow. Rates per 1,000 civilian population. Births:— Live 16.1* 19.1 19.2 15.7 16.5 Still 0.46* 0.58 0.53 0.40 0.54 Deaths:— All Causes 11.4* 13.5 12.3 13.8 12.3 Typhoid and Para-typhoid 0.00 0.00 0.00 0.00 — Scarlet Fever 0.00 0.00 0.00 0.00 — Whooping Cough 0.02 0.02 0.01 0.02 — Diphtheria 0.02 0.02 0.02 0.01 — Influenza 0.08 0.07 0.07 0.07 0.07 Smallpox Measles 0.02 0.02 0.02 0.01 — Notifications:— Typhoid Fever 0.01 0.01 0.01 0.01 — Para-typhoid Fever 0.01 0.00 0.01 0.00 0.01 Cerebro-Spinal Fever 0.05 0.05 0.05 0.06 0.06 Scarlet Fever 1.89 2.02 2.03 1.57 2.61 Whooping Cough 1.64 1.65 1.47 1.25 1.27 Diphtheria 0.46 0.52 0.56 0.31- 0.15 Erysipelas 0.25 0.28 0.24 0.31 0.25 Smallpox 0.00 0.00 — 0.00 — Measles 11.67 10.89 11.19 9.03 6.69 Pneumonia 0.87 1.03 0.72 0.78 0.69 Rates per 1,000 Live Births. Deaths under 1 year of age 46| 54 43 53 38 Deaths from Diarrhoea and Enteritis under 2 years of age 5.6 7.8 4.5 7.6 3.5 Rates per 1,000 Total Births (Live & Still) (a) Notifications:— Puerperal Fever 9.93 12.65 8.81 3.601 18.08 Puerperal Pyrexia ‡ 15.87 (b) Maternal Mortality No. 140 No. 141. Abortion without Sepsis. No. 147. Puerpera Infections Nos. 142-6, 148-50. Other. Abortion with Sepsis England and Wales 0.25 0.08 0.24 1.22 Walthamstow 0.56 — — 1.13 * Rates per 1,000 Total Population, † Per 1,000 related births. ‡ Including Puerperal Fever. A dash (—) signifies that there were no deaths. 10 Causes of Death as given by the Registrar -General for the year 1945. Whole District. Causes of death. Males. Females. Total. 1. Typhoid and Para-typhoid Fevers — — — 2. Cerebral-spinal Fever 2 2 4 3. Scarlet Fever — — — 4. Whooping Cough — — — 5. Diphtheria — — — 6. T.B. of respiratory system 36 25 61 7. Other forms of Tuberculosis 5 1 6 8. Syphilitic Disease 7 2 9 9. Influenza 3 4 7 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis — — — 12. Acute infectious encephalitis 1 — 1 13. Cancer of buccal cavity and oesophagus (Males) 12 — 12 Cancer of uterus (Females) — 12 12 14. Cancer of stomach and duodenum 26 16 42 15. Cancer of breast — 14 14 16. Cancer of other sites 70 57 127 17. Diabetes 2 8 10 18. Intra-cranial vascular lesions 43 85 128 19. Heart Disease 135 144 279 20. Other diseases of the circulatory system 16 19 35 21. Bronchitis 56 36 92 22. Pneumonia 34 26 60 23. Other Respiratory Diseases 10 4 14 24. Ulceration of the stomach or duodenum 13 4 17 25. Diarrhoea (under 2 years) 2 4 6 26. Appendicitis 1 3 4 27. Other digestive diseases 11 11 22 28. Nephritis 7 8 15 29. Puerperal and post-abortive sepsis —, 2 2 30. Other maternal causes — 1 1 31. Premature birth 5 3 8 32. Congenital malformation, birth injury, infantile disease 20 14 34 33. Suicide 4 4 8 34. Road traffic accidents 7 5 12 35. Other violent causes 40 32 72 36. All other causes 83 74 157 Totals, 1945 651 620 1,271 Totals, 1944 706 637 1,343 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. & over — — — — 1 17 87 102 11 B—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. I:—(i) Public Health Officers of the Authority:— Resignations and appointments during the year are given at the beginning of the Raport and also in the Maternity and Child Welfare Section of the Report. (ii) (a) Laboratory Facilities:—(See I. D. Section.) (b) Ambulance Facilities: Municipal Service. Removals. Accidents. Treatment. Maternity. Others. Total Mileage. 1,547 541 3,446 501 23 6,058 34,189 The ambulance fleet comprises three pre-war ambulances, two stand-by converted ex-Civil Defence ambulances and a motor car for sitting cases. There are 13 Driver/Attendants. During the War and up to 21st January, 1945, staffing had been by Civil Defence personnel, who during these three weeks of 1945 were responsible for a total of 406 journeys. The following is a record of the good work carried out by Civil Defence for the Municipal Ambulance Service during the period 1942 to January, 1945:— Removals and Treatments Accidents Maternity Total No. of journeys Mileage 1942 2,935 Fire Service Fire Service 2,935 15,000 (approx.) 1943 3,613 451 526 4,590 28,230 1944 5,136 427 799 6,362 35,064 1945 335 34 37 406 1,980 Totals 12,019 912 1,362 14,293 80,274 After the transfer, the vehicles were centralised first at Roger Ascham School and then at Fulbourne Road Depot. In August, 1945, the St. John Ambulance Brigade generously provided volunteer attendants to assist the night shift of paid drivers. A total of 66 "duties" were given up to the end of the year. A conference was held with neighbouring authorities in regard to the provision of a joint ambulance service. Whipps Cross Hospital. Removal of patients is carried out by ambulances attached to the Hospital. 32 St. John Ambulance Brigade. Mr. V. G. Turner, Divisional Superintendent, kindly contributes the following report:— "Now that the War is over we are gradually getting back to our pre-war standard. Although we have more than 50 members not yet returned from H.M. Forces (only 4 demobilised so far), we have been able to cover the usual duties, such as:— Cinemas, the local Theatre, Football Matches, the Roadside Hut (during the Summer) and a few Victory Teas for the children. "No First-aid Classes for the public have been held, as there was no demand, but we hope to run one in the near future. "The number of cases treated has dropped to below 500. "We have not commenced our Motor Ambulance Service again, for various reasons, although some members who can spare the time are assisting as Orderlies on the Municipal Ambulances, for the purpose of assisting at Street Accidents, etc." (c) Nursing in the Home. (i) General.—No change. (ii) Infectious Diseases.—No change. (d) Clinics and Treatment Centres. Foot Clinic.—Total attendances were 9,865, and of these 710 were by new patients, 8,971 were re-attendances by old patients, and 184 were by "casuals". The receipts were £595 13s. 3d. Women's Clinic.—Miss Helen Rodway, M.R.C.O.G., submits the following report:— "The Gynaecological Clinics were held on Tuesday afternoons and Saturday mornings up to the end of September. From this date the Saturday morning Clinic was held once a fortnight instead of weekly. "In addition a session of the Contraceptive Clinic was held once a month for advising women who, on medical grounds, were unfit for pregnancy.'' No. of sessions held No. of attendances Total Attendances Average Attendance per session New Cases Old Cases (a) Tuesday Afternoon 50 356 1,228 1,584 31.7 (b) Saturday Morning 43 260 437 697 16 Totals 616 1,665 2,281 13 Summary of New Cases:— Tuesday Saturday Total. For diagnosis or complications of Afternoon. Morning. pregnancy 80 100 180 Sterility 25 31 56 Gynaecological 186 103 289 Surgical 18 10 28 Medical 6 6 12 Contraceptive 35 3 38 Not classified 8 5 13 Total 358 258 616 (24 cases were transferred from the Saturday to the Tuesday Clinic.) Comparison of attendances with previous years:— 1945. 1944. 1943. 1942. 1941. 1940. 1939. 1938. New Cases 616 444 524 424 299 260 329 319 Old Cases 1,665 1,630 1,618 1,303 1,023 1,183 1,234 1,179 Totals 2,281 2,074 2,142 1,727 1,322 1,443 1,563 1,498 136 patients were referred to the Clinics by private doctors. 42 patients were referred to hospitals for treatment. Municipal Dental Service. Mr. L. W. Elmer, L.D.S., Senior Dental Surgeon, reports as follows:— "This service, commenced in April, 1944, has, I believe, justified the hopes expressed at the end of 1944 that, with the return of normal conditions, its scope and usefulness would greatly expand. "Treatment is available to inhabitants of the Borough. The scale of fees is based on the National Health Insurance Dental Scale. Actual fees charged to patients are reduced by assessment to persons unable to pay the full fee, while adolescents under the age of 18 years are charged at a reduced fee. ' 'In the following report the figures for 1944 are inserted in brackets. "379 (143) patients were treated during the year. 2,234 (633) appointments were made and 2,143 (558) were kept. The approximate nett cost to the Council was only £57. "1,005 (135) fillings were inserted and 147 (67) scalings, 228 (71) dressings and 1,068 (266) extractions were carried out. "General anaesthetics were administered on 238 (58) occasions, local anaesthetics on 112 (54) occasions. "223 (33) impressions were taken, 97 (24) bites and 106 (23) 'try-ins'. 14 "134 (26) dentures were fitted and 9 (5) repaired. "The mechanical work is now distributed amongst three dental technicians and this work has been done, on the whole, very satisfactorily, but it will be of great advantage, both in efficiency and speed, if this section of the work can be carried out on the premises. "In spite of the increase of work it has, up to the present, been possible to obtain sufficient dental surgeons to operate the service and it is to be hoped that this happy state of affairs will continue. "The appointment of a dental clerk in September has been of great assistance in the administration of the service." Note by M.O.H.—The weekly sessions were increased to 10. A Dental Workshop was commenced in 1946. Scabies Clinic.—The arrangements at the special treatment Centre detailed in previous reports were continued. One State Registered Nurse, who had helped while in the C.D. Service, was appointed to take charge, with the help of two ex-Civil Defence Auxiliaries. The equipment and lay-out were improved. 1,258 cases were treated during the year, receiving 4,348 treatments. (e) Hospitals.—There were no changes during 1945 in the hospital services used by the inhabitants of the Borough. Public Assistance in Walthamstow is provided by the Southwestern Area Guardians' Committee of the Essex County Council which retains a certain proportion of beds in each of the local institutions provided bv the County Boroughs of East Ham and West Ham. Mr. Fegram, the Clerk to the Committee, has kindly supplied the following particulars of Walthamstow residents admitted to the various institutions during the year ended 31st December, 1945:— Institutions Men Women Children Total Central Homes 107 90 7* 204 Whipps Cross Hospital 614 760 279 1.653 Forest Gate Hospital — 54 — 54 Harold Wood Hospital — 6 — 6 Forest House 9 9 — 18 Aldersbrooke Children's Homes — — 71 71 *These children were ultimately transferred to Aldersbrooke. 28 infants were born to Walthamstow mothers in Forest Gate Hospital during the year. The number of patients from Walthamstow in Mental Hospitals was 375 on the 31st December, 1945. The Connaught Hospital. The Secretary to the Hospital has kindly supplied the following information :— 15 "Of the total number of in-patients admitted during the year, 869 were residents of the Borough. The following figures show the progress of the Hospital during 1945 as compared with the previous year:— No. Admitted In-patients Out-patients Average Stay Daily Average New Cases Attendances 1945 1,769 16.95 81.19 20,487 91,499 1944 1,665 15.12 70.11 9,485 71,106 "Particulars as to Staff, Beds and Departmental activities.—There are 128 beds, including 10 Private Wards and 10 'A' beds reserved for E.M.S. "Operations and Treatments.—During 1945, 762 major operations and 2,648 minor operations were performed, making a total of 3,401. 14,532 radiographs were taken. There were 13,676 massage treatments, also 27,916 electrical treatments and 1,501 artificial sunlight treatments at the Comely Bank Clinic; a total of 43,093 treatments at this Clinic." Facilities at Comely Bank.—The following facilities for electro-medical Treatment are provided at Comely Bank:—Massage, Radiant Heat, Electrical Treatment and Sun Ray Treatment. Venereal Disease Treatment. Treatment is the responsibility of the Essex County Council and all the facilities of the London County Council are available. No special clinic facilities have yet been provided in Walthamstow. Outfits for taking specimens from patients are provided for practitioners, on request, by the Whitechapel (London County Council) Clinic, Turner Street, Whitechapel^ E. 1. 2. Public Assistance. Out-relief and institutional treatment is provided by the Essex County Council. Essex County Council. Mr. Pegram, 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, 1945, was as follows:— 1945. 1944. £ s. d. £ s. d. Total amount of out-relief granted to Walthamstow residents during year ended 31st December 39,295 12 9 36,655 8 2 Average weekly number of Walthamstow residents in receipt of relief during year ended 31st December Men 220 220 Women 467 444 Childrer 234 238 Total 921 902 16 3. Maternity and Child Welfare.— See Section H of the Report. 4. Public Health Act, 1936.—Nursing Homes:— No. of Homes. No. of Patients provided for Maternity Patients. Others. Totals. Homes first registered during the year — — — — Homes on Register at the end of the year 4 24* 18 42 *14 of these were not in use during the period of the War. There were no refusals, cancellations or appeals. 10 Inspections were made by the medical staff. Routine enquiries are made with regard to unregistered homes. No difficulties in regard to supervision arose. 5. Essex County Council Act.—No new licence to practice chiropody was granted by your Council. Four licences were renewed following inspection of premises. C.—SANITARY CIRCUMSTANCES OF THE AREA. Water.—The authority responsible is the Metropolitan Water Board. The supply has been satisfactory in quality and quantity. Routine tests are carried out by the Board and the usual practice was continued of notifying the Board in all cases of actual or suspected enteric fever. The Board then arranges special tests at the addresses concerned. All were negative in 1945. No action was necessary in respect of contamination. All dwelling houses in the area are supplied direct with water. Public Cleansing.—Mr. Eric Bell, M.I.P.C., A.R.San.I., Cleansing Superintendent, reports as follows:— ' 'In reporting on the work of the Public Cleansing Department for the year 1945, I would ask Members to note that although hostilities fortunately ceased this year, very little, if any, effect has been felt on our most urgent problem, the labour question. A small number of our employees who served in H.M. Forces have returned to duty in the latter part of the year, but in the main we have had, as in the war years, to contend with an acute shortage of suitable labour. I have no doubt that the position will improve considerably during 1946, but for the present I have had to be content with formulating the schemes for improving our essential services as and when labour becomes available. "In so far as the normal service statistics are concerned I would report as follows:— "House Refuse Collection.—The normal standard of a once 17 weekly collection of refuse from all parts of the Borough has been consistently maintained, resulting in the total collection of 29,676 tons of refuse, an increase of 3,103 tons over the previous year. This increase is no doubt accounted for by the continued return of residents to the Borough, and also by the fact that the poorer quality coal at present being issued has greatly increased the ash content of the resulting residue. "Included in the above figure, of course, is the total tonnage of salvage collected, amounting to some 3,956 tons, this figure shows a decrease of 579 tons over the year 1944 and, I am afraid, represents the general trend of public opinion in-so-far as salvage is concerned. This downward trend is national and despite many appeals from the Ministry of Supply the reduction continues. "Waste Food.—As I have already stated, the general salvage collection has decreased by an appreciable figure, but it should be noted that the decrease in waste food collection is much less marked, namely, 1,526 tons collected in 1945 as against 1,589 tons in 1944. These figures lead me to believe that the salvage is there, could we provide a more satisfactory system of collection; this could be obtained by the provision of a separate kitchen waste container for each household in the Borough. "Trade Refuse.—The contract system for the collection of trade refuse from business premises within the Borough is continuing satisfactorily and further improvements in this direction can hardly be expected inasmuch as we have practically every trader covered by this scheme. "Refuse Disposal.—The increase in the total of refuse collected in the year has naturally affected the tonnage incinefated, this latter figure having increased by 2,060 tons to 23,413 tons. This I consider to be a very satisfactory tonnage for a plant of this type. "Street and Market Cleansing and Gully Cleansing.—As with other services, our general standard of cleanliness in respect of Streets, Markets and Gullies will improve with the improving labour position, and I hope during 1946 to increase the number of Street Sweepers. The number of gullies cleansed during 1945 increased by 1,976 over the 1944 figure, and amounted to 11,353 cleansings in the twelve months; this I consider to be the maximum that can be expected of our Gully Cleansing Machine and the only way that the desired frequency of emptying can be attained is by the provision of another machine. "In conclusion I wish to place on record my appreciation of the services rendered to the Department by all employees and every member of my staff. We have surmounted another difficult year, and once again can claim unbroken record of normal services being maintained, and I sincerely hope that the coming year will see the end of some of the difficulties that beset us during the past years." SANITARY INSPECTION OF THE AREA. Owing to Mr. Duncan's continued illness he was unable to resume duties as Chief Sanitary Inspector during the year, and he 18 tendered his resignation to take effect on the 5th July. Mr. Duncan had held his position for 24 years. In addition, the inspectorate was two below strength for four months and one for the remainder of the year. Mr. F. W. Kemp, who assumed duties as Chief Sanitary Inspector as from 6th July, reports as follows:— No. of inspections made. No. of nuisances detected. No. of complaints received. No. of Informal Notices. No. of Statutor}' Notices. Total Visits. Served. Complied with. Served. Complied with. 8,885 4,307 2,946 1,425 1,135 | 28 56 15,106 "Of the 1,425 intimation notices which were served during the year, 13 were in respect of factory premises, and of the 1,412 relating to defects in houses 1,102 were complied with without resort to statutory procedure. "Owing to the failure of owners to carry out certain Statutory Notices, served under Section 9 of the Housing Act, 1936, the Council executed the necessary work to two houses at a cost of £137 10s. 3d. "The nature and variety of the work done in 1945 is shown in the following tables:— Drains tested, 499; Drains reconstructed or repaired, 328; Drains, obstructions removed, 403; Drains, means of access provided, 37; Drains, ventilation provided or improved, 38; Drains, ventilation repaired, 79; Soil pipes repaired, 86; Soil pipes, new, provided, 34; Rain-water pipes renewed, 115 ; Rain water pipes disconnected from drains, 7 ; Roofs repaired or renewed, 320; Gutterings repaired or renewed, 181; W.C. pans or traps provided, 234; Gully traps provided, 99; W.C. flush cisterns provided, 72; W.C. flush cisterns repaired, 211; W.C. floors concreted, 42; W.C.'s repaired and cleansed, 143; W.C's., light and ventilation improved, 17; Waste pipes renewed and trapped, 95; Waste pipes repaired, 126; New sinks provided, 38; Water supply reinstated, 15; Water supply taken off main, 2; Cisterns cleansed and covered, 29; Conveniences cleansed or repaired, 8; Sculleries paved, 26; Yards and forecourts paved and repaired, 33; Dirty houses cleansed, 1; Dirty rooms cleansed, 97; Floors repaired, 182; Ventilations under floors provided, 75; New damp-proof courses provided, 15; Sites concreted, 2; Offensive accumulations removed, 36 ; Animals improperly kept, removed, 9; Manure receptacles provided, 1; Stables cleansed, paved and drained, 31; Manholes repaired or re-sealed, 160; Other cases of dampness remedied, 64; Miscellaneous repairs, 1902. 19 Infectious Diseases. Visits to premises, 541; Re-visits to premises, 42; Rooms disinfected, 270; Articles disinfected at Low Hall, 3,110; Articles destroyed at Low Hall, 8; Articles dried at Low Hall, 173. Dampness in Houses. Sites concreted, 2; Damp-proof courses provided, 15; Yards and fore-courts paved and drained, 33; Roofs made watertight, 320; Rain-water pipes made good, 115; Guttering repaired or renewed, 181; Other cases of dampness remedied, 164; Ventilation under floors provided, 75. Special Premises . Number. Visits paid. Factories (a) Power 280 221 (b) Non-Power.. 203 54 (c) Other premises 76 27 Outworkers — 260 Slaughterhouses — — Butchers' Shops 77 146 Bakehouses 31 111 Fishmongers, Fish Fryers and Curers, etc. 29 93 Eating-houses and Coffee Stalls 95 91 Ice Cream Vendors 52 97 Cowsheds 1 4 Dairies and Milkshops 74 83 Laundries 3 5 Rag and Bone Dealers 4 8 Piggeries 4 37 Street Stalls Numerous 27 Greengrocers „ 100 Stables „ 56 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers' Shops. Special Cleansings, 20; Paving repaired, 3; Accumulations removed, 5; New Galvanised Bins provided, 5; Drains repaired, 3; W.Cs. repaired and cleansed, 6; Yard paving repaired, 1; Roofs repaired, 5; Drains cleared, 5. Bakehouses. Special cleansings, 31; W.C. cisterns repaired, 1; W.Cs. cleansed and repaired, 2; Premises general repairs, 6; Obstructions from drains removed, 1; New ceilings fixed, 1; New W.C. pans and traps, 2. Fishmongers. Special cleansings, 19; Yards repaved, 4; Accumulations removed, 2; Roofs repaired, 2; Other improvements, 9. 20 Eating Houses, Special cleansings, 26; Yard payings repaired, 1; W.C. cisterns repaired, 7; Drains repaired, 4. Ice Cream Vendors. Special cleansings, 11; Special cleansing of utensils, 4; Yard pavings repaired, 1; Other improvements, 10. Cowsheds and Milkshops. Special cleansings, 13; Pavings relaid, 1; Drains reconstructed, 1; Other improvements, 2. Stable Premises. Cleansings, 24; Accumulations removed, 10; Roofs repaired, 5; Pavings repaired, 1; Manure receptacles provided, 2. Laundries. Special cleansings, 2; Roofs repaired, 3; 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 a number of premises were dealt with at the request of the War Damage Officer. Swimming Baths and Pools.—The model bye-laws of the Ministry of Health were adopted during 1938. (a) Municipal Baths, High Street.—This is a covered swimming bath. Mr. W. Cantes kindly contributes the following report "As you are no doubt aware the Swimming Bath is now open all the year round. "From April 1st to December 31st, 1945, the Swimming Bath was open on 247 days, during which period 69,103 bathers used the Bath. 21 "Maximum load in 1945 was on June 18th, when we had 792 bathers." Three water samples were taken during the year, with satisfactory results. (6) Whipps Cross Bathing Pool.—This is a large open-air pool situated in Epping Forest, in the area of the Borough of Leyton and a few hundred yards from the Walthamstow boundary. It is administered by a joint committee representing the two Boroughs. The pool is supervised by the Medical Officer of Health for Leyton, who kindly sends a copy of the analytical findings when samples are taken. (c) South-West Essex Technical College.—Sampling was carried out on four occasions, with satisfactory results. (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.—Closed during the war. (/) Woodford High School for Girls.—This is a covered bath with continuous chlorination and filtration. D.—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) 3,288 (b) Number of inspections made for the purpose 8,791 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (N.B.—These comprise individual unfit houses.) (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,533 22 II.—Remedy or 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 1,102 III.—Action under Statutory Powers during the Year:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 28 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 54 (b) By local authority in default of owners (at a cost of £137 10s. 3d.) 2 (c) Withdrawn—premises vacated and undertaking not to allow future occupation Nil B. Proceedings under the Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 13 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a)By owners 10 (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 Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D. Proceedinqs under Section 12 of the Housing Act, 1936:— (1) Number of separate 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 23 (b) Housing Act, 1936. Unfit Houses. During the year one dwelling was dealt with under this Act as follows:— Wooden structure, rear of 66, Higham Street—Closing Order. General. The following is supplied by Mr. J. E. West, your Council's Housing Manager:— "It will be appreciated that the year ending in March, 1945, was, from the housing point of view, the most difficult of the war years. The renewal of enemy activity by flying bombs and rockets from June onwards, resulted in the total loss of 458 dwellings and a further 784 were so badly damaged as to be uninhabitable. Nearly three thousand other houses in the Borough were very seriously damaged indeed, but by attention to essential repairs, the occupiers were able to remain. ''The loss of so many properties during a short period and at a time when the demand had been steadily increasing for some years, resulted in a serious deterioration of the housing position in the Borough, and it will obviously be a considerable time before replacement dwellings are available for the number of families involved. ''A significant figure showing the strain upon housing accommodation due to enemy activity is reflected in the billeting returns for the period which showed that no fewer than 5,481 persons were billeted during the year. "So far as the Council Housing Estates are concerned, 32 properties were destroyed and a further 57 so seriously damaged as to be uninhabitable for lengthy periods. "The Lettings Section dealt with 47 vacancies on the Council Estates during the year, and these are analysed as follows:— By normal lettings 5 cases involving 19 persons. Rehousing Council tenants rendered homeless 11 cases involving 80 persons. Rehousing homeless 9 cases involving 43 persons. Resumption of tenancies by Council tenants 13 cases involving 64 persons. By recommendation of the Medical Officer of Health 2 cases involving 8 persons. Redistribution of accommodation 7 cases involving 26 persons. "By the end of March, 1945, it had become obvious that the housing problem with which we had been faced hitherto, was assuming proportions which no efforts either by the Central Government or the Local Authority could mitigate within a period of some years, and if a sound long-term policy was to be adopted and due regard 24 given to the proper planning of our residential areas, there would be a very considerable 'over-spill' which could not be accommodated within the present boundaries of the Borough. Side by side with the demand for more dwellings, there has been a growth in the public consciousness that well-balanced estates, and well designed and attractive premises, should take the place of the present inferior and ill-planned houses and streets. To make the people conscious that they are not enjoying the amenities which could be within their reach, is probably the first step towards the creation of the 'better world' of tomorrow to which we must all look. Failure to give proper attention to the housing requirements during the past two hundred years has, in my opinion, been the direct cause of the impoverishment of the people in both a cultural and material sense. This low standard of housing low-income groups, may take several generations to eradicate, and only by large-scale planning and a more adventurous spirit in the tackling of the problem facing us, can we hope to set our footsteps on the way towards a reasonable standard of housing accommodation for all".' E.—INSPECTION AND SUPERVISION OF FOOD, (a) Milk Supply. The following is contributed by the Chief Sanitary Inspector:— The number of samples of milk submitted to the Counties Laboratories for bacteriological examination, including Phosphatase and Methylene Blue tests, was 116. To comply with new Regulations which became operative in March, samples were taken regularly twice monthly from the two firms holding Producers' Licences within the Borough. In addition, samples were procured from other dealers in the district, thus making the record number of 116. The following table gives details of samples taken Grade No. of Samples RESULTS Satisfactory Unsatisfactory in one or more tests Pasteurised 67 62 5 Tuberculin Tested Pasteurised 16 15 1 Tuberculin Tested 16 14 2 Sterilised 8 8 — Heat Treated 9 7 2* Totals 116 106 10 * These two were retailed as " Ordinary" and as such are of satisfactory standard. The attention of dealers was brought to the unsatisfactory samples, and remedial action followed. 25 There is one cowshed in the district and the average number of cows kept is four. The number of Retail Purveyors of Milk is 74. The majority of these are of the ''general'' shop type, and sell ''milk as received'' in bottles. Eighty-three visits were paid to registered dealers during the year and a fair standard of cleanliness was maintained. The Milk (Special Designations) Order, 1936. The number of Licences granted for the sale of Milk under Special Designations classified in the above Order was as follows:— Dealers' Licences. In respect of:— Supplementary Licences. Pasteurised Milk 15 Pasteurised Milk 2 Tuberculin Tested Milk 10 Tuberculin Tested Milk 2 Bottling Licences. Pasteurised Milk 2 Tuberculin Tested Milk 2 (6) Ice Cream. The embargo on the sale of ice cream having been removed, 59 applications to manufacture or for the sale of this commodity were received. Licences were granted as follows:— Manufacturers and Vendors 23 Vendors only 35 Refused 1 As soon as conditions permit it is hoped that the Minister of Health will formulate Regulations governing the chemical composition and bacteriological standard for this much sought-after food. (c) Meat and Other Foods. The Live Stock (Restriction of Slaughtering) Order, 1940, continued in force and no slaughtering was carried out during the year. The following is a list of the food condemned as unfit for human consumption. As in previous years, wherever possible, the food was salvaged either through the Ministry of Food Salvage Division or the local scheme. In addition to the following list a quantity of war damaged food was also dealt with. 155 tins Pork Luncheon Meat 165 ,, Chopped Ham 61 ,, Meat Loaf 4 ,, Corned Beef 7 ,, Tongue 5½ lbs. Fudge 3½ ,, Gums 29½ ,, Chocolate 24½ ,, Boiled Sweets 1 lb. Honey 26 14 tins Sausage Meat 7 ,, Ready Meal 184 ,, Casserole Steak 2 ,, Kipper Snacks 148 ,, Salmon 14 ,, Shrimps 30 ,, Mackerel 624 ,, Pilchards 45 ,, Herrings 240 ,, Sardines 16 ,, Crayfish 346 ,, Beans 39 ,, Mixed Vegetables 90 ,, Peas 20 ,, Beetroot 3 ,, Carrots 71 ,, Soup 747 ,, Evaporated Milk 545 ,, Condensed Milk 2 ,, Apples 43 ,, Plums 2 jars Calves Foot Jelly 56 ,, Paste 57 ,, Pickles 7 ,, Salad Dressing 6 ,, Mustard 29 ,, Horseradish Cream 3 bots. Coffee 361 ,, Fish 3 ,, Vinegar 2 gals. Synthetic Cream 2 Hospital Packs Ovaltine 49 Cakes 4 Trifles 1 pkt. Ryvita 1 ,, Coffee 1 ,, Lemon Flavouring 1 ,, Custard Powder 1 ,, Salt 1 ,, Suet 115 pkts. Hundreds & Thousand! 4 ,, Quaker Oats 36 ,, Shredded Wheat 1159 ,, Dessert Mould 18 ,, Meat Cubes 5 ,, Soup 31 ,, Sponge Mixture 248 ,, Pudding Mixture 335 ,, Cake Mixture 6 lbs. Lemon Curd 7 ,, Golden Syrup 2 ,, Mincemeat 127 ,, Jam 87½ ,, Marmalade 36½ ,, Biscuits 9 ,, Cake 482 ,, Flour 13 ,, Pancake Mixture 6 ,, Cereals 1248 ,, Sugar 102 ,, Cheese 7 ,, Dripping 7 ,, Prunes 116½ ,, Bacon 227 ,, Sausage Meat 5 ,, Stewing Steak 15 ,, Loin of Pork 56 ,, Liver 31 ,, Sausages 13 ,, Black Pudding 30 ,, Meat Roll 25 ,, Fried Fish 1 lb. Galantine 66 lbs. Spaghetti 398 ,, Macaroni 317 ,, Semolina 244 ,, Rice 17 ,, Tea 6 ,, Cocoa 2 cwt. 94 lbs. Rolled Oats 2½ ,, 64 ,, Pearl Barley 4 ,, 82 ,, Figs 80 ,, 23 ,, Oranges 14 ,, Potatoes 630 lbs. Dates 31 ,, Sultanas 37 ,, Raisins 25 ,, Dried Apples 584 ,, Apples 280 ,, Grapefruit 25 ,, Apricots 175 ,, Peaches 1 lb. Margarine 3 lbs. Butter 4½ ,, Lard 33 ,, Eels 5 stone Hake 21 ,, Roe 27 4 pkts. Frutella Sauce 6 ,, Dried Egg 110 sacks (100 lbs. each) Soya Grits 485 Eggs 143 Fish Cakes 60 Chocolate Bars 1 lb. Jellies 1 ,, Nougat 3 lbs. Caramels 49 stone Skate 5 ,, Witch 48½ ,, Cod 10 ,, Haddock 73 ,, Herring Mackerel 54 ,, Herrings 9 ,, Rock Salmon 20½ ,, Plaice 12½ ,, Whiting 1 ,, Kippers (d) Adulteration, etc.—Food and Drugs Act, 1938. During the year 100 samples of foods and drugs were submitted to the Public Analyst. Ten samples were found to be, in some respect, unsatisfactory—details are as follows:— Description of Article Result of Analysis Action taken  Cake Mixture (Informal) No appreciable amount of raising agent. Remaining packet surrendered. Milk (Formal) 2½ % added water Slight defect in machinery—remedied. Warning sent. Veal Loaf (Formal) Low meat content Referred to Food Executive Officer. Gravy Cubes (Informal) Hard and containing mites. Remainder of small stock surrendered. Orangeade (Informal & Formal—2 samples.) Deficient in Acid and Sugar. Referred to Food Executive Officer. Pork Sausages (Formal) Containing Soya product Referred to Food Executive Officer. Throat Tablets (Informal) Not in accordance with formula. No further supplies obtainable. Spirit Vinegar (Formal) Non-brewed Vinegar 25% deficient in Acetic Acid. Wholesaler unknown. Dealer warned. Tomato Ketchup (Informal) Incipient fermentation No further supplies obtainable. No legal proceedings were necessary in respect of the ten samples dealt with, as detailed above. In addition to those procured by your Officers, nine samples of milk were taken by the Food Sampling Officer of a London Borough, in course of delivery, at a local dairy. (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 eight certificates were granted to tenants and 28 one application was received from an owner for a certificate upon completion of works, which was granted. DISEASES OF ANIMALS ACTS, 1894-1938. The Sheep Scab Order, 1938. —No action necessary. Swine Fever Order, 1938.—No action necessary. Regulation of Movement of Swine Order, 1922.—No action necessary. Parasitic Mange Order, 1938.—No action necessary. Foot and Mouth Disease (Infected Areas) Special Order No. 1 of 1945.—One licence was issued for the movement of a pig for slaughter. 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 work of the Sanitary Inspectors during the year:— No. of premises and Sites Inspected. Premises and Sites Found to be Infested. Methods used at Infect ed Premises and Site* Food. Other. Food. Other. Bailing. Trapping. Glssing Other 55 580 51 445 360 8 4 212 Complaints received 472 Premises rat-proofed 9 Advice only given 16 Re-inspections 873 FACTORIES ACT, 1937. The following tables show the work carried out under this Act:— 1.—INSPECTION OF FACTORIES, Etc. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupion Prosecuted. (1) (2) (3) (4) Factories with Machine 221 10 Nil. Factories without power 54 3 Nil. Other premises under the Act 27 — Nil. Totals 302 13 Nil. 29 2.—DEFECTS FOUND IN FACTORIES, ETC. Particulars Number of Defects. Number of offences in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Want of cleanliness 39 39 Overcrowding — — — — Unreasonable temperature 2 2 — — Inadequate ventilation 7 7 — — Ineffective drainage of floors 4 4 — — Sanitary Conveniences insufficient — — — — unsuitable or defective 48 47 not separate for sexes — — — Other offences 35 35 — — Totals 135 134 — — NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1945. Wearing Apparel, making of 156 Rubber goods 1 Brush making 7 Boots and Shoes 3 Boxes 14 Total 181 Outworkers were notified from the following areas:— Bethnal Green 2 Leyton 44 Chingford 12 St. Marylebone 2 City of London 13 Shoreditch 4 Finsbury 27 Walthamstow 16 Hackney 46 Westminster 3 Islington 3 Other Areas 9 Total 181 A total of 260 visits were paid in connection with outworkers. 30 F—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 ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. 1945 1944 - Scarlet Fever 270 176 1 46 188 23 11 1 — Diphtheria 16 13 — 5 8 1 2 — — Enteric Fever 1 1 — — — — 1 — — Pneumonia 72 80 2 8 10 7 22 14 9 Puerperal Pyrexia 32 28 — — — 13 19 — — Ophthalmia Neonatorum 2 1 2 — — — — — — Erysipelas 26 20 — — 1 2 8 12 3 Encephalitis Lethargica — — — — — — — — — Polio-encephalitis — — — — — — — — — Cerebro-spinal Meningitis 7 4 3 2 — 1 1 — — Anterior Poliomyelitis 1 — — — 1 — — — — Measles 692 406 46 398 242 4 2 — — Whooping Cough 131 195 15 74 41 — — 1 — Dysentery 84 83 2 36 26 9 4 5 2 Malaria 2 5 — — — 1 1 — — Tuberculosis 160 158 — 10 17 44 57 23 9 Totals 1945 1496 71 579 534 105 128 56 — 23 1944 — 1170 48 380 447 117 108 25 15 Disease. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals Scarlet Fever 65 30 57 25 3 8 55 270 Diphtheria 8 1 3 — 1 3 16 Enteric Fever — — 1 — — 1 Pneumonia 16 11 9 7 1 8 11 72 Puerperal Pyrexia 8 1 4 9 7 3 32 Ophthalmia Neonatorum — * — 2 2 Erysipelas 3 10 3 1 5 4 26 Encephalitis Lethargica — — — — — — — Polio-encephalitis — — — — — — — Cerebro-spinal Meningiti's 1 2 — 1 1 2 7 Anterior Poliomyelitis — 1 — — — 1 Measles 102 88 87 122 158 15 692 Whooping Cough 27 26 20 10 18 30 131 Dysentery 7 10 8 3 18 38 84 Malaria — 1 1 2 Tuberculosis 24 12 26 16 36 46 160 Totals 1945 261 192 219 194 300 30 1496 1944 170 202 154 110 172 62 1170 The statistics given in the foregoing tables are those for the calendar year 1945. 31 The Registrar-General gives the statistics for the 52 weeks ended 31st December, 1945, and these are given in the following table together with the case rates per 1,000 population both for England and Wales and for Walthamstow:— Disease. Scarlet Fever. Diphtheria. Enteric Fever. Pneumonia. Puerperal Pyrexia. Erysipelas Number 270 16 1 72 32 26 Case Rate— Walthamstow 2.61 0.15 0.009 0.69 0.309 0.25 England and Wales 1.89 0.46 0.01 0.87 Not Available 0.25 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. When calculated on this basis the rate is:— Walthamstow 18.08 England and Wales 9.93 Disease. Total notified. Removed to Hospital. Per cent, removed to Hospital. Deaths. Deaths per cent, of cases notified. Scarlet Fever 270 151 55.9 Nil Nil Diphtheria 16 15 93.7 Nil Nil Enteric Fever 1 1 100.0 Nil Nil Pneumonia 72 18 25.0 60 83.3 Puerperal Pyrexia 32 6 18.7 Nil Nil Ophthalmia Neonatorum 2 2 100.0 Nil Nil Erysipelas 26 4 15.3 1 3.8 Encephalitis Lethargica — — — 1† — Polio-encephalitis — — — Nil Nil Cerebro-spinalMeningitis 7 6 85.7 4 57.1 Anterior Poliomyelitis 1 1 100.0 Nil Nil Measles 692 30 4.3 Nil Nil Whooping Cough 131 10 7.6 Nil Nil Dysentery 84 14 16.6 Nil Nil Tuberculosis (all forms) 160 *170 — 67 81.4 *This figure also includes cases notified during previous years. †This case was not notified. Infectious Diseases Clinic.—The weekly clinic at 3.30 p.m. on Wednesdays, was continued, and all children of school age who had been in contact 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 of cardiac defect to the next Rheumatism Clinic. 32 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 50 Number of attendances made 472 Average attendance per session 9.4 Number of children recommended to Rheumatism Clinic - Number of children recommended to Aural Clinic 1 DIPHTHERIA IMMUNISATION. Immunisation was carried out at the weekly clinic on Tuesdays at 2 p.m., at Schools, and at all Welfare Centres along the lines detailed in previous Reports. The following summarises the work done:— Schick tested for the first time 29 Negative (including pseudo and negative) 14 Positive (including pseudo and positive)15 Total number of immunisations completed during 1945:— (a) School age 938 (b) Pre-school age 1336 (c) Over school age 7 Total 2281 The above total includes 115 children who were immunised at Brookscroft, and 144 by private practitioners. Number of Schick tests following immunisation 47 Number Positive 3 Number Negative 44 Number of clinics held for immunisation 50 Number of attendances made at clinic for immunisation 1,161 Average attendance per session 23.2 Immunisation at schools (included in above):— Number completely immunised 370 Number partly immunised 8 Number having extra dose, immunised in previous years 209 Since the commencement of immunisation in 1932 a total of 18,279 persons have been protected. Of these, at the end of 1945 14,502 were in the age group of 0-14 years. On the basis of the estimated population at mid-June, 1945 (supplied by the Registrar-General), the percentages protected in the various age groups were as follows:— 33 Under 5 years 5-14 years Total (0-14 years) Protected 3,222 11,280 14,502 Estimated population 8,040 14,030 22,070 Percentage protected 40.1 80.4 65.7 The Chief Medical Officer of the Ministry of Health has stated it is a sad reflection that in this country during the war far more children under 15 were killed by this preventable disease than by enemy bombs.'' Birthday Letters.—The arrangements as detailed in the 1944 Report were continued. Immunisation by General Practitioners.—Diphtheria prophylactic is available to general practitioners. During 1945, 144 c.cs. of alum precipitated toxoid were issued; this quantity is sufficient to protect 144 children. MUNICIPAL LABORATORY. The following numbers of Diphtheria swabs were examined during 1945:— Swabs. Negative. Positive. Totals. Private Practitioners 166 9 175 Health Department 38 14 52 School Medical Department 202 2 204 Totals 406 25 431 The total number of diphtheria specimens examined in 1944 was 38,1. In addition, 50 specimens of urine were examined, as compared with 6 in 1944. Ministry of Health Emergency Laboratory Service. This service provides facilities for examination of pathological specimens. 925 specimens were examined for local practitioners during 1945, as follows:— Diphtheria Swabs, 431*; Dysentery Specimens, 448; Ringworm Specimens, 9; Miscellaneous, 37. *These were re-examinations of swabs sent on from Walthamstow. VACCINATION. Mr. E. Sharp, Vaccination Officer for the area, has furnished the following return for 1945:— 34 Births Registered Successfully Vaccinated Percentage Vaccinated Insusceptible Exemptions Death before Vaccinated Postponed 1,524 416 27.1 3 556 46 51 In addition to the above, 23 primary vaccinations were recorded, and 13 re-vaccinations. During 1945, 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 vacpinated. PREVENTION OF BLINDNESS. No action was necessary under Section 176 of the Public Health Act, 1936, for the prevention of blindness or the treatment of persons suffering from any disease of, or injury to, the eyes. SMALLPOX. No notifications were received, and the usual steps were taken in the supervision of contacts from abroad. SCARLET FEVER. A total of 270 cases of Scarlet Fever was notified in 1945 as compared with 176 in 1944. 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 9 - 3 5 1 - - - February 5 - 3 2 - - - March 6 - 1 3 1 1 - - - April 14 - 3 9 2 - - May 26 - 5 19 - 2 - - June 22 - 4 14 2 2 - - July 29 - 1 24 4 - - - August 17 - 3 10 1 3 - - September 29 1 9 17 1 1 - - October 48 - 4 40 4 - - - November 32 - 5 22 3 1 1 - December 33 - 8 22 2 1 - Totals 1945 270 1 46 188 23 11 1 1944 176 1 32 121 15 7 — — 35 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January — — 3 — — 6 February — 1 1 1 1 1 March 3 3 — — — — April 5 3 1 1 1 3 May 6 5 1 5 6 3 June 3 2 10 1 2 4 July 7 2 11 4 3 2 August 4 — 5 — 2 6 September 8 3 7 2 4 5 October 11 3 9 6 8 11 November 8 6 2 3 7 6 December 10 2 7 2 4 8 Totals 1945 65 30 57 25 38 55 1944 38 19 27 10 29 53 DIPHTHERIA. A total of 16 cases of Diphtheria was notified during 1945 as compared with 13 in 1944. 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 — — — — — — — — February — — — — — — — — — — March 1 — — — — 1 — — — April — — — — — — — May — — — — — — — — June — — — — — — — July 3 — 1 1 1 — — — August 3 — — 2 — 1 — — September — — — — — — — October 1 — — 1 — — — — November 2 — 1 1 — — — — December 6 — 3 3 — — — — Totals 1945 16 — 5 8 1 2 — — 1944 13 1 1 9 1 1 — — 36 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January — — — — — — February — — — — — — March 1 — — — April — — — — — — May — — — — — — June — — — — — — July 2 — — — — 1 August — — — — 1 2 September — — — — — — October — — 1 — — — November 2 — — — — December 4 1 1 — — — Totals 1945 8 1 3 — 1 3 1944 2 — 3 — 3 5 The percentage of cases removed to hospital in 1945 was 93.7 against 92.3 in 1944. No case was refused admission as home treatment of 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 Park. During 1945, a total of 31 phials, each containing 8,000 units of Diphtheria antitoxin were issued. There were 64 cases notified as Diphtheria or for Diphtheria observation, and of these 16 were confirmed. Only one of the 16 had been protected and this was a case of bacteriological (i.e., swab positive) diphtheria without any clinical signs. ENTERIC FEVER. One case occurred in the Hoe Street Ward—a female, aged 28 years. She was admitted to hospital and recovered. DYSENTERY. A total of 84 cases of Dysentery was notified during 1945, as compared with 83 in 1944. The following tables show the incidence by months, ages and wards:— 37 Month. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 21 13 3 1 2 1 1 February 19 — 11 4 3 — 1 — March 11 — 2 7 — — 1 1 April 4 1 2 1 — — — — May 8 1 2 4 1 — — — June 7 — 1 2 3 — 1 — July 3 — 1 1 — 1 — — August 2 — — — 1 — 1 — September 1 — — 1 — — — — October 6 — 2 3 — 1 — — November — — — — — — — December 2 — 2 — — — — — Totals 1945 84 2 36 26 9 4 5 2 1944 83 4 49 25 3 2 — — Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January — 1 4 — 4 12 February 1 1 1 1 10 5 March — 1 — — 2 8 April — — — — — 4 May 1 1 1 — 2 3 June 2 3 1 — — 1 July — 1 — — — 2 August 1 — 1 — — — September — — — — — 1 October — 2 — 2 — 2 November — — — — — — December 2 — — — — — Totals 1945 7 10 8 3 18 38 1944 2 10 17 19 7 28 BACILLARY DYSENTERY. A total of 84 cases was notified (Higham Hill Day Nursery—9, Handsworth Avenue Day Nursery—6, Schools—26, others—43). The previous highest totals were 84 in 1937 (which included an outbreak at the Nursery School) and 83 in 1944. Details of the cases at the Day Nurseries during 1945 are given below:— Higham Hill Day Nursery. The first case occurred on January 22nd, 1945. The usual precautions were taken, including swabbing of all staff and children. Five swabs were positive and later three others who were absentees gave positive swabs, making a total of 9 positive swabs. The nursery was cleared by March 13th, 1945. 38 Handsworth Avenue Day Nursery. The first case occurred on February 6th, 1945. The usual precautions were taken, including swabbing of all staff and children. Two swabs were positive and later two others gave positive swabs who were originally negative. Twelve days later a staff nurse gave a positive swab, she also being negative at the original swabbing. There were six cases and the Nursery was cleared by March 26th, 1945. \ Public Health (Infectious Diseases) Regs., 1927. Compensation was again continued to a chronic enteric carrier. A baker was compensated for the short period during which he was a Dysentery carrier. ANTERIOR POLIOMYELITIS. Two cases were notified, one being later withdrawn. Details of the confirmed case are as follows:— A female, age 5 years (High St. Ward)—removed to hospital. There were no cases of Encephalitis Lethargica, nor of PolioEncephalitis. OPHTHALMIA NEONATORUM. Two cases were notified in the Higham Hill Ward. Both were removed to hospital and both recovered with no impairment of vision. PUERPERAL PYREXIA. See Maternity and Child Welfare Section. PNEUMONIA. The 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 14 — — 2 2 5 3 2 February 20 2 3 2 1 3 4 5 March 2 — 1 — — — 1 — April 10 — 2 — 2 4 1 1 May 7 — — 1 1 4 1 — June 1 — — 1 — — — — July 2 — — 1 — 1 — — August 6 — 1 1 — 3 1 — September 4 — — 1 1 1 — 1 October November 4 — 1 — — 1 2 — December 2 — — 1 — — 1 — Totals 1945 72 2 8 10 7 22 14 9 1944 80 2 8 15 7 15 23 10 39 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 1 1 5 1 3 3 February 5 4 1 — 5 5 March — — 1 — 1 — April 2 1 2 — 3 2 May 3 1 — 2 1 — June — — — 1 — — July — 1 — 1 — — August 2 2 — 1 1 — September — — — — 3 1 October — — — — — — November 2 1 — 1 — — December 1 — — — 1 — Totals 1945 16 11 9 7 18 11 1944 14 9 9 6 18 24 Your Council decided to continue the grant to the Walthamstow District Nursing Association, in return for which the Association was, amongst other services, required to provide home nursing facilities for cases of Pneumonia. The local practice 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 sanitation which may be found. Otherwise there is little gained by notification. 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 3 — — — — 2 — 1 March 1 1 — April 1 1 — May 3 3 — June 1 — — — 1 — — — July 5 — — — — 2 2 1 August 2 2 — September October 3 — — — 1 1 — 1 November.. 5 — — 1 2 2 — December 1 — — — — 1 — — Totals 1945.. 26 — — 1 2 8 12 3 1944.. 20 — — — — 11 7 2 40 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January — - —' — 1 — February — 2 1 — — — March 1 — — — — — April — 1 — — — — May — 1 — — — 2 June — 1 — — — — July 1 — 1 1 1 1 August — 1 — — 1 — September — — — — — — October 1 1 1 — — — November — 2 — — 2 1 December — 1 — — — — Totals 1945 3 10 3 1 5 4 1944 5 3 1 — 5 6 CEREBRO-SPINAL MENINGITIS. Nine cases were notified during the year. In two of these the diagnosis was not confirmed. No. Ward. Age. Date notified. Hospital. Remarks. 1 H.E. 6 mths. 29.1.45 Yes. Recovered. 2 Hi. St. 3 yrs. 3.2.45 „ Died few hours after admission. 3 Hi. St. 10 mths. 23.2.45 „ Recovered. 4 W.St. 10 mths. 25.4.45 No Died—P.M. 5 H.E. 37 yrs. 14.5 45 Yes Diagnosis not confirmed. 6 J. 18 yrs. 1.6.45 „ Recovered. 7 H.H. 30 yrs. 9.6.45 „ Recovered. 8 H H 1½ yrs 1.9.45 „ Recovered. 9 Ho. 5 yrs. 24.12.45 „ Diagnosis not confirmed. Died of T.B. Meningitis. The Registrar-General classifies four deaths to Cerebro-Spinal Meningitis. MALARIA. Two cases were notified. Both were members of the Forces home on leave and contracted the disease abroad. No. Ward. Age. Date Notified. Hospital. 1 H.H. 29 years 14.2.45 Yes 2 Ho. 32 years 2.7.45 Yes 41 MEASLES. 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 7 1 5 1 — — February 153 11 78 64 — — — — March 174 9 78 84 3 — — — April 133 10 94 28 — 1 — — May 55 4 41 9 1 — — — June 30 2 23 5 — — — — July 34 2 20 12 — — — — August 33 1 20 12 — — — — September 12 3 4 4 — 1 — — October 22 — 16 6 — — — — November 18 1 11 6 — — December 21 2 8 11 — — — — Totals 1945. 692 46 398 242 4 2 — — 1944 406 12 168 208 15 3 — — Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 1 2 4 February 19 29 24 28 28 25 March 34 14 17 15 69 25 April 32 17 6 25 34 19 May 4 7 10 9 11 14 June 4 4 5 6 2 9 July 3 — 4 15 2 10 August 2 6 4 14 — 7 September 1 1 1 1 5 3 October — 4 6 3 6 3 November 2 3 3 4 6 December — 3 5 2 1 10 Totals 1945 102 88 87 122 158 135 1944 47 96 41 25 30 167 42 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 yrs. 45-65 yrs. 65 & over. January 3 3 — — — — — February 5 — 3 1 — — 1 — March 7 2 3 2 — — — — April 2 — 1 1 — — — — May — — — — — — — — June 2 — — 2 — — — — July 20 1 13 6 — — — — August 21 3 10 8 — — — — September 12 3 6 3 — — — — October 17 1 11 5 — — — — November 19 2 9 8 — — — December 23 3 15 5 — — — — Totals 1945 131 15 74 41 — — 1 — 1944 195 25 112 56 2 — — — Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 1 1 1 February 2 — — — — 3 March 1 2 — — 4 — April — 1 — — 1 — May — — — — — — June — — 1 — 1 — July 5 6 4 1 3 1 August 5 6 7 1 1 1 September 3 — 4 — 2 3 October 5 2 — 1 3 6 November 3 2 1 4 1 8 December 3 6 2 3 2 7 Totals 1945 27 26 20 10 18 30 1944 41 45 21 26 32 30 43 TUBERCULOSIS. The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1945 :— Age Periods. New Cases. Deaths. Non- Non- Pulmonary. Pulmonary. Pulmonary. Pulmonary. M. F. M. F. M. F. M. F. Under 1 year — - - — — — — — 1—5 years 1 — 6 3 1 — 2 — 5-10 ,, 2 — — 2 — 1 — — 10-15 ,, 1 7 3 2 1 2 — — 15-20 ,, 7 8 5 1 1 1 — — 20-25 ,, 13 6 1 3 2 1 — — 25-35 ,, 11 14 1 1 4 9 — 1 35-45 ,, 18 10 1 1 7 5 — 1 45-55„ 8 4 — — 9 1 — — 55-65 ,, 6 4 — 1 5 2 1 — 65 yrs. & over 8 1 — — 6 3 — 1 75 54 17 14 36 25 3 3 Totals 129 31 61 6 160 67 The 67 deaths represent a death-rate of 0.6 per 1,000 population. New cases in 1944 were 158 with 74 deaths—i.e., a rate of 0.73. The returns for the past two years are compared below:— Year New Cases Deaths Non- Non- Total Pulmonary Pulmonary Total Pulmonary Pulmonary M. F. M. F. M. F. M. F. 1945 75 54 17 14 160 36 25 3 3 67 1944 74 57 14 13 158 44 16 8 6 74 The period 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 to 12 months. Over 12 months. Not notified. Notified after death. Non- Non- Non- Non- Non- Non- Non- Pul. Pul. Pul. Pul. Pul. Pul. Pul. Pul. Pul. Pul. Pul. Pul. Pul. Pul. 3 4 2 - 5 — 1 — 29 2 14 3 4 — 44 The ratio of deaths in non-notified cases (i.e., columns to the right of the double line) to total deaths from tuberculosis was 21 to 67 or 1 to 3.2. Appropriate action was taken when necessary with regard to non-notification. The table given below shows the number of cases on the Register at the beginning and end of 1945:— Pulmonary. Total. NonPulmonary. Total Grand Total. No. on Register 1st January M. F. M. F. 909 803 1,712 462 382 844 2,556 Notified during 1945 75 54 129 17 14 31 160 Totals 984 857 1,841 479 396 875 2,716 Removed from Register, 1945 37 37 74 4 6 10 84 No. on Register 31st December 947 820 1,767 475 390 865 2.632 Removals from the Register were made up as follows:— Deaths. Removals. Pulmonary. Non-Pul monary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 26 20 2 2 11 17 2 4 46 4 28 6 50 34 84 The discrepancy between the number of deaths recorded here and the number of registered deaths during the calendar year is accounted for by transferable deaths and by cases not notified prior to death. Treatment of Tuberculosis.—Treatment is given under the Essex County Council's Scheme. The admissions to Hospital during 1945 were as follows:— Pulmonary Non-Pulmonary Total 1945 Total 1944 M. F. M. F. Adults 56 93 — — 149 131 Children 4 12 3 2 21 23 45 G.—INFECTIOUS DISEASES HOSPITAL. The following renovations were carried out at the Sanatorium during the year:— Administration Block, 'C' Block and 'E' Block.—Whitening of ceilings and washing down walls. 'G' Block, 'T' Block and Mortuary.—Washing down ceilings and walls. 'D' Block.—Rebuilding of kitchen. Lodge.—Whitening of ceilings and distempering of walls in two bedrooms, ground floor front and lavatory. General.—Removal of black-out, replacement of glazing, etc. Schemes were approved for new kitchen equipment at an estimated cost of £1,330 and for new laundry equipment at an estimated cost of £510. General.—(i) The death-rate per 100 admissions of infectious disease patients was 1.31. (ii) The following table shows the admissions, discharges and deaths during 1945:— Scarlet Fever. Diphtheria. Other Diseases. Tuberculosis. Totals. Remaining in Hospital 1st January 6 4 4 16 30 Admitted during year 288 67 294 34 683 Discharged during year 276 56 283 28 643 Died during year — 2 4 4 10 Remaining in Hospital 31st December 18 13 11 18 60 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL (including Tuberculosis cases). January 36.1 May 41.5 September 51.2 February 30.1 June 47.8 October 54.8 March 35.8 July 51.3 November 60.0 April 43.2 August 53.6 December 63.2 Average whole year 47.0 Training.—During 1945, 8 probationers passed the preliminary and 2 the final examination for the Fever Nursing Certificate of the General Nursing Council. The examination fees of probationers are now paid by the Council. Staff.—The staffing position both nursing and domestic became progressively worse as the year advanced. 46 CLINICAL REPORT. Dr. M. Hamilton, Resident Medical Officer, reports as follows:— AGE AND SEX OF PATIENTS ADMITTED DURING 1945. Disease. Under 5 years. 5-10 years. 10-15 years. Over 15 years. Total. Grand Total. M. F. M. F. M. F. M. F. M. F. Scarlet Fever 31 36 71 61 25 28 17 19 144 144 288 Diphtheria 9 16 10 11 4 3 4 10 27 40 67 Measles 21 16 7 9 - - 1 3 29 28 57 Cerebro-Spinal Meningitis 4 4 - - - - - 1 4 5 9 Whooping Cough 6 7 — 4 - — - — 6 11 17 Sonne Dysentery 3 4 1 1 2 — 2 4 8 9 17 Phthisis — — — — — — - 34 — 34 34 Other Diseases 22 39 33 21 12 12 22 28 89 100 189 Staff — — — — - — — 5 — 5 5 Totals 96 122 122 107 43 43 46 104 307 376 683 The 189 cases listed under "other diseases" include mainly observation cases in which no specific disease was diagnosed— tonsillitis, Vincent's angina, mumps, rubella, chicken pox, otorrhoea, "common cold", pneumonia and impetigo. Five cases were transferred to Whipps Cross Hospital:— One case of non-infective diarrhoea. One case of intractable cervical adenitis. One case of intractable scabies and impetigo. One case of retro-pharyngeal abscess. One case of nephritis not due to infective disease. Three cases were received from Whipps Cross Hospital, one of scarlet fever, one of measles and one of rubella. One member of the nursing staff was transferred to a hospital for mental diseases. There were three cases of "sore throat" among the staff. Two other members of the staff suffered from minor injuries. One patient notified as a case of cerebro-spinal meningitis proved to be a case of sub-arachnoid haemorrhage. SEX AND AGE AT DEATH. Ten deaths occurred, details of which are given below. 4 Pulmonary Tuberculosis .. Females aged 26, 26, 28 and 32 years. 2 Cerebro-Spinal Meningitis .. Male aged 5 years. *Female, aged years. 47 1 Laryngeal Diphtheria Male, aged 3 years. 1 Laryngeal and Faucial Diph- Female, aged 5| years, theria. 1 Cerebral Haemorrhage, com- Female, aged 5 years. plicating Whooping Cough. 1 Broncho-pneumonia, compli- Female, aged 11 months, eating Whooping Cough. All were Leyton cases except the one marked thus (*). Duration of Treatment.—The average duration of treatment in hospital was as follows:— Diphtheria 18.2 days. Scarlet Fever 21.6 days. Other diseases 17.2 days. The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1945:— Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.). In Hospital on 1st January, 1945. Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1945. Observation — 1 — — 1 T.B. Minus 7 14 15 — 6 T.B. Plus Group I — 4 4 — — T.B. Plus Group II 9 14 9 4 10 T.B. PIus Group III - 1 — - 1 Totals 16 34 28 4 18 NUMBER OF OUTSIDE AUTHORITIES' CASES AND NATURE. Measles. Diphtheria Scarlet Fever. Other Diseases. Total. Leyton 25 47 134 18 224 H.M. Forces - 1 2 15 18 Others 9 — — 7 16 Totals 34 48 136 40 258 48 18 of the 34 admissions were Walthamstow cases. Infectious Disease Ambulance Service.—With the termination of the Civil Defence Organisation it became necessary to provide telephones at the residences of the drivers. Arrangements were made with ex-Civil Defence Nursing Auxiliaries for part-time service as ambulance attendants. MISCELLANEOUS. Your Council made the following grants during the year to voluntary organisations :— Invalid Children's Aid Association £100 Walthamstow Association of Tuberculosis Care Helpers £25 Mortuary.—A Coroner's Court, mortuary (with special provision for Infectious Disease cases) and a, post-mortem room is provided by your Council at Queen's Road Cemetery. The Cemeter^ Superintendent reports that the number of inquests and post-mortems were as follows :— Inquests only 89 Post-mortems 127 Post-mortems and Inquests (not included in above) .. 36 Total 252 Medical Examinations. During the year, 127 examinations were carried out by the Medical Staff in respect of the Superannuation and Sick Pay Schemes. Cremation. Facilities for cremation are available at the Crematorium provided by the Corporation of the City of London at Manor Park, Little Ilford. A conference was held with neighbouring authorities in regard to the provision of a joint crematorium. Domestic Help. Your Council commenced a scheme in accordance with Circular 179/44 on Domestic Help. Full publicity could not be given to the scheme on account of the difficulty of recruiting helpers, probably owing to the low rate of pay (i.e., the Hetherington rate of £2 12s. 6d. per week or Is. 2d. 49 per hour). A total of 17 applications for help were received and these were dealt with as follows:— Number of cases given financial assistance 8 ,, ,, financial assistance declined 2 ,, ,, overscale 3 ,, ,, otherwise not eligible .. .. 2 ,, ,, unable to find domestic help 2 Assistance at E.M.S. Hospitals (i.e., Connaught Hospital, Whipps Cross Hospital and Hermon Hill Hospital.) and District Nursing. Personnel of the Civil Defence Casualty Service helped during a total of 5,375 hours. Supply of Insulin. Three patients were supplied with Insulin in accordance with Circular 2734/1943 at a total cost to the Council of £10 18s. 8d. Delegation of Powers by the County Council. During 1945 there was no further delegation of any Health function. 50 SECTION H. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Councillor Mrs. B. M. Friedberg. Ex-Officio : The Worshipful the Mayor—Councillor Mrs. E. A. Smith, J. P. The Deputy Mayor—Alderman A. E. Manning, J. P. Chairman op Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman Mrs. L. P. Bailey, J.P. Alderman W. B. Fitt. Alderman Mrs. C. McEntee, J.P. Alderman Mrs. E. M. Miller. Councillor E. G. Baily Councillor D. Evans. ,, Mrs. R. Baily ,, Mrs. A. L. Meadows. ,, W. E. Barnes ,, M. Sharland. ,, Mrs. S. Candy ,, A. E. Simmons. ,, H. J. Cole ,, R. E. Smith. Councillor Mrs. E. B. Toynbee. Co-opted Members: Mrs. Cooper Mrs. G. E. Nicholls Mrs. Riley Mrs. E. Clarke Mrs. M. H. Jarman Mrs. Holsworth Mrs. Dyde Dr. H. Watson 31 TO THE CHAIRMAN AND MEMBERS OP THE MATERNITY AND CHILD WELFARE COMMITTEE. Ladies and Gentlemen, I beg to present herewith a report on the Maternity and Child Welfare Service during 1945. The Maternal Mortality rate was low at 1.74, while the Infant Mortality rate at 38 was much lower than that of 46 for England and Wales and 53 for London. The first attendances of infants at Child Welfare Clinics exceeded the total of all live births in the area and the number of ante-natal patients seen at Ante-Natal Clinics represented over 91 per cent. of notified live births. The total attendances at Welfare Clinics exceeded 46,000. Special attention was paid to the care of premature and illegitimate children and to child life protection, including adopted children. The work at Thorpe Coombe reached a new high level—nearly 1,000 confinements. It is my pleasure again to record your consideration and the good work of the Staff. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. STAFF. Resignations. Dr. E. M. Sawdon, Thorpe Coombe Medical Staff—17.9.45. Appointments. Dr. E. M. Sawdon, Thorpe Coombe Medical Staff—-16.5.45. Dr. M. G. King, Thorpe Coombe Medical Staff—1.11.45. NOTIFICATION OF BIRTHS. 1,727 births (38 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows:—Doctors and parents, 228; Midwives, 1,499. Included in the above are 159 births which were notified as having occurred outside the Borough. 52 Also included are 50 stillbirths. 6 were notified by Doctors and 44 by Midwives. Of the total, 5 occurred 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 Births. Males. Females. Totals. Legitimate 830 784 1,614 Illegitimate 53 46 99 883 830 1,713 (b) Stillbirths. Males. Females. Totals. Legitimate 28 25 53 Illegitimate 3 — 3 31 25 56 Of the 1,560 birth registrations received in the Department between 6th January, 1945 and 29th December, 1945, a total of 9 were not notified in this area, but some may possibly have been notified elsewhere. Appropriate action was taken when necessary. Of the 1,560 local registrations, 85 belonging to other areas are excluded, leaving a nett total of 1,475. Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. January 14 9 6 7 10 10 8 8 22 11 17 13 77 58 February 8 6 10 6 12 14 11 11 13 12 19 16 73 65 March 8 15 10 8 11 4 6 4 7 3 8 10 50 44 April 7 4 6 4 10 11 9 7 11 11 9 11 52 48 May 6 5 8 12 9 10 15 3 14 8 12 17 64 55 June 4 4 6 5 13 13 10 5 14 8 14 9 61 44 July 6 10 5 5 19 12 9 9 21 9 16 17 76 62 August 9 8 11 4 14 11 9 9 18 16 20 18 81 66 September 3 6 14 10 7 5 13 14 7 8 8 9 52 52 October 7 6 4 12 8 14 13 8 16 16 13 14 61 70 November 12 11 9 10 6 18 8 13 9 21 19 19 63 92 December 4 11 2 7 7 9 17 5 16 14 10 7 56 53 Totals 88 95 91 90 126 131 128 96 168 137 165 160 766 709 Grand Totals 183 181 257 224 305 325 1,475 53 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 given during offduty hours. DAY NURSERIES. A grant-aided Day Nursery at Brookscroft provided by the Walthamstow Child Welfare Society has accommodation for 25 children, but this was closed on 1st June, 1945. Attendances.—The following table shows the average attendances at the various Nurseries during 1945 (Mondays to Fridays only). Month. Nurseries. Over 2 yrs. Under 2 yrs. Total. January Wyatts Lane 22.8 11.4 34.2 Higham Hill 29.0 7.0 36.0 Handsworth Ave. 18.6 8.8 27.4 Brookscroft 9.1 — 9.1 February Wyatts Lane 27.6 11.9 39.5 Higham Hill 24.7 5.2 29.9 Handsworth Ave. 15.1 6.2 21.3 Brookscroft 13.4 — 13.4 March Wyatts Lane 15.0 9.1 24.1 Higham Hill 34.6 6.2 40.8 Handsworth Ave. 18.5 8.4 26.9 Brookscroft 13.9 — 13.9 April Wyatts Lane 28.4 8.2 36.6 Higham Hill 27.9 5.2 33.1 Handsworth Ave. 14.2 10.9 25.1 Brookscroft 17.1 — 17.1 May Wyatts Lane 32.2 11.0 43.2 Higham Hill 38.0 9.1 37.1 Handsworth Ave. 25.0 13.8 28.8 Brookscroft 14.1 — 14.1 June Wyatts Lane 43.8 9.6 53.4 Higham Hill 37.4 5.3 42.7 Handsworth Ave. 35.2 12.9 48.1 July Wyatts Lane 38.6 11.9 50.5 Higham Hill 37.8 7.6 45.4 Handsworth Ave. 35.2 12.9 48.1 August Wyatts Lane 36.8 13.8 50.6 Higham Hill 31.5 8.4 39.9 Handsworth Ave. 32.2 11.7 43.9 September Wyatts Lane 37.3 15.8 53.1 Higham Hill 38.8 9.9 48.7 Handsworth Ave. 37.3 13.5 50.8 October Wyatts Lane 34.0 16.5 50.5 Higham Hill 35.3 9.6 44.9 Handsworth Ave. 33.4 14.7 48.1 November Wyatts Lane 27.9 15.9 43.8 Higham Hill 32.2 11.1 43.3 Handsworth Ave. 38.3 14.3 52.6 December Wyatts Lane 29.0 6.5 35.5 Higham Hill 31.9 9.3 41.2 Handsworth Ave. 36.7 10.2 46.9 54 Staffing.—This has, at times, proved difficult, and much help was received from Civil Defence personnel—in total amounting to some 1,006 hours work. Training.—Thirteen probationers obtained the Nursery Nurses Certificate, including one distinction. The Council agreed to pay the examination fees of probationers. Hours of Opening.—From October the Nurseries were open Monday to Friday from 8 a.m. to 5 p.m. Infectious and Contagious Diseases.—Comparatively limited outbreaks of Bacillary Dysentery (Sonne) occurred at Handsworth Avenue and Higham Hill Day Nurseries. These are referred to in the Public Health section of this report. DAILY GUARDIANS. This scheme has operated since 1942 in conjunction with the Ministry of Labour, but terminated in its original form on 31st March, 1946, when the payments to Guardians by that Ministry ended. The scheme attained a limited success in Walthamstow in the earlier years of the war, but fell into disuse by the end of 1945, as will be seen from the following table: - Registered Daily Guardians. Mothers requiring Daily Guardians. 1942 56 40 1943 26 26 1944 9 9 1945 4 Nil The scheme operated in the following manner:— The intending Daily Guardian filled in a form of application. If the Sanitary Inspector's report was satisfactory details were handed to the Health Visitor, a registration form was sent to the Labour Exchange and the Daily Guardian notified. The "mothers" form was sent to the Labour Exchange, from which the Guardian of the child obtained payment weekly. INFANT MORTALITY. The deaths of infants under one year were:— Males. Females. Total. Legitimate 37 24 61 Illegitimate 1 4 5 Total 38 28 66 55 The death-rate of infants under one year of age per 1,000 live births when calculated on the totals given by the Registrar-General are therefore:— Legitimate, 37; Illegitimate, 50; Total, 38. The Infant Mortality rate for other areas during 1945 was as follows:— England and Wales 46 126 County Boroughs and Great Towns (including London) 54 148 Smaller Towns (25,000-50,000) 43 London 53 Neo-Natal Mortality. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1945, 36 infants died in the first four weeks of life, yielding a rate of 21.0. For the last ten years in England and Wales the neo-natal deaths have been approximately half the total deaths under one year of age. The following rates refer to Walthamstow:— Infant Deaths, Neo-Natal Mortality and Stillbirths. Year. Live Births. Birth Bate. Stillbirths. Neo-Natal Deaths. Infant Deaths. No. Per 1,000 live births. Per 1,000 population. No. Per 1,000 live births. No. Per 1,000 live births. W'stow. births. England & Wales 1945 1,713 16.5 56 32.6 0.54 36 21.0 24.8 66 38 1944 1,915 18.9 52 27.1 0.51 40 20.8 24.3 71 37 1943 1,828 18.2 58 30.7 0.57 48 26.2 25.2 73 40 1942 1,718 17.4 52 30.2 0.52 35 20.3 27.2 70 40 1941 1,304 13.3 35 26.8 0.37 31 23.7 29.0 52 44 The neo-natal mortality for England and Wales is shown for comparison and was higher than the Walthamstow rates with the exception of 1943. The death rate from Diarrhoea and Enteritis in children under one year of age per 1,000 live births was 6. CARE OF ILLEGITIMATE CHILDREN. , The action taken under Circular 2866/1944 is fully set out in the report for that year. The Council has an agreement with the Wal- 56 thamstow Girls' Aid Association, which provides a Hostel of 19 beds staffed by three whole-time workers. The Superintendent of the Association reported that the chief difficulties during 1945 were to secure accommodation for confinements and suitable foster mothers. Although the local Day Nurseries helped very considerably there was a 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. The figures quoted below give a comparison between illegitimate and legitimate rates. Illegitimate Births and Mortality. Year. Live Births. Infantile Deaths. Death Rates. Legitimate. Illegitimate. Legitimate. Illegitimate. Legitimate. Illegitimate. 1935 1,626 44 60 2 37.0 45.0 1936 1,684 31 69 3 41.0 97.0 1937 1,634 41 87 — 53.0 — 1938 1,572 45 63 3 40.0 66.0 1939 1,566 40 45 - 29.0 — 1940 1,535 40 56 4 41.0 100.0 1941 1,254 50 50 2 40.0 40.0 1942 1,662 56 67 3 40.0 53.0 1943 1,767 61 71 2 40.0 32.0 1944 1,825 90 68 3 37.0 33.0 Average 1935-1944 1,612 49.8 63.6 2.2 39.8 46.6 1945 1,614 99 61 5 37.0 50.0 Only too often the illegitimate infant mortality is two or three times that of the legitimate rate. In Walthamstow during the past 11 years the illegitimate rate has been nil in 2 years and the same or below the legitimate rate in three other years, in spite of the considerable increase in the total number of illegitimate births since 1940 and the very large increase in 1944 and 1945. Miss Williams, Superintendent of the Home provided by the Walthamstow Branch of the Chelmsford Diocesan Moral Welfare Association reports as follows:— "The numbers given below include cases dealt with outside:— 1. Total number of cases dealt with 114 2. Number of those living in Walthamstow 38 3. Number of cases referred from Stratford 4 Expectant mothers are taken in at any time during pregnancy and employment is obtained for them until about six weeks before 57 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 closest co-operation exists between Miss Williams and your Council's Health Visitors. CARE OF PREMATURE INFANTS. The action suggested in Circular 20/44 has been carried out as far as possible and the steps taken were detailed in the report for 1944. During 1945, 13 premature babies were born at home and 88 in Hospital. Of the 13 premature babies born at home, 10 were entirely nursed at home, 4 died during the first 24 hours (i.e., 31%) and 7 survived at the end of one month (i.e., 54 %). Of the 88 premature babies born in Hospital, 6 died during the first 24 hours (i.e., 7%) and 64 survived at the end of one month (i.e., 73%). A course of lectures on premature infants was arranged at the Maternity Hospital for midwives. Details are given on a later page. The table of "Causes of Death" which follows includes 8 deaths from premature birth as compared with 13 in 1944. CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE, 1945. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total deaths under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year St. James St. High Street Hoe Street Wood Street Hale End Higham Hill Total Influenza - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - T.B. Meningitis — - - - - - - - - - - - - - - - - Other T.B. diseases - - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - - Meningitis Tubercular) - - - 1 1 - - - 1 2 - - - 1 1 - 2 Convulsions 1 - - - 1 - - - - 1 - - 1 - - - 1 Bronchitis — - - 1 1 1 1 1 1 5 1 1 - 1 1 1 5 Pneumonia (all forms) — 2 1 - 3 2 5 2 2 14 2 3 2 1 5 1 14 Diarrhoea - - - - - 3 - - - 3 - - - 3 - - 3 Enteritis - - - - - - 1 - - 1 - - - - - - 1 Gastritis - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (overlaying) - - - - - - - - - - - - - - - - - Injury at birth 2 — - - 2 - - - - 2 - 1 1 - - - 2 Atelectasis 14 — - - 14 - - - - 14 3 2 1 1 4 3 14 Congenital malformation 1 1 - - 2 2 2 1 - 7 2 - - 1 1 3 7 Premature birth 8 - - - 8 - - - - 8 1 3 2 - - 2 8 Atrophy, debility, marasmus - - - - - 1 - - - 1 - - - 1 - - 1 Inanition - - - - - 1 - - - 1 - - - - 1 - 1 Heart failure - - - - - - - - - - - - - - - - - Other causes 4 - - - 4 — 1 1 1 7 1 1 — 2 2 1 7 Totals 30 3 1 2 36 10 10 5 5 66 10 11 7 11 16 11 66 58 59 CHILD WELFARE. The equivalent of whole-time Municipal Health Visitors at the end of the year was 8, equal to one whole-time Health Visitor per 216 notified births, and one whole-time Health Visitor per 195 registered births during 1945. 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- and Post-Natal Low Hall Lane, Markhouse Road, E. 17. *Tuesday 9 a.m. „ „ „ „ Wednesday „ „ „ „ „ Friday „ „ „ „ „ * New cases only. Tuesday 2 to 4 p.m. Child Welfare Estate Office, 1, Guildsway, Billet Rd., E. 17. Tuesday „ „ „ „ The Memorial Hall, Winchester Rd., E.4. Wednesday „ „ „ „ Low Hall Lane, Markhouse Road, E. 17. Wednesday 1.30 to 4.30 p.m . ,, ,, "Brookscroft," Forest 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. Thursday 1.30 to 4.30 p.m "Brookscroft," Forest Road, E.17. 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. MUNICIPAL SCHEME. The detailed findings at first visits paid during 1945 are given in the following table:— How Fed. Sleeping Arrangements. Condition of baby. Accommodation. Breast Breast & Hand Hand With Mother Cot or Cradle Good Fair Bad Whole house Flat Half house Three rooms Two rooms One room St. James Street 156 31 28 3 212 145 69 1 62 18 78 31 16 10 High Street 150 26 12 — 188 178 10 — 48 125 3 4 8 — Hoe Street 177 22 17 — 216 207 9 — 107 84 1 11 13 — Wood Street 175 22 38 2 233 212 22 1 73 76 62 — 2 22 Hale End 285 28 38 — 351 340 11 — 203 75 52 10 5 6 Higham Hill 327 29 21 2 375 352 18 7 280 76 18 1 2 — Total 1,270 158 154 7 1,575 1,434 139 9 773 454 214 57 46 38 60 From the above table it will be seen that of 1,582 children, 1,270, or 80.3 per cent., were breast fed on first being visited, and 7, or 0.4 per cent., had no separate sleeping provision. 141 Ward. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. Unsuccessful Visits. Visits to Nurse Children. Visits re Milk Scheme. Ante-Natal Visits. Other Visits. Total Visits. First. Re-visits. Total. First Visit. Subsequent Visits. Total Visits. 1 2 3 4 5 6 7 8 — — 9 10 Cols. 5-10. St. James Street 215 388 603 1,053 1,656 456 6 — 66 24 90 249 2,457 High Street 188 562 750 1,189 1,939 406 5 — 38 13 51 129 2,530 Hoe Street 216 719 935 1,156 2,091 624 5 — 16 9 16 191 2,936 Wood Street 235 297 532 567 1,099 357 7 3 30 10 40 126 1,632 Hale End 351 1,322 1,673 2,762 4,435 327 30 2 67 43 110 246 5,150 Higham Hill 377 991 1,368 2,593 3,961 223 42 15 57 19 76 240 4,557 Total, 1945 1,582 4,279 5,861 9,320 15,181 2,393 95 20 274 118 383 1,181 19,262 Total, 1944 1,649 4,088 5,737 6,261 11,998 2,067 104 15 261 128 389 984 15,557 infants lived in accommodation of 3 rooms or less, as compared with 119 in 1944. The following table shows the number and nature of visits paid during 1945:— 61 62 INFESTATION. The steps taken to combat infestation include cleanliness inspections by School Nurses 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 Walthamstow Schools, Clinics, Day Nurseries, and Welfare Centres. As a result of a special enquiry it was found that at the end of October last, out of some 38 infectious disease patients admitted to the Sanatorium during the month, 13 were infested on admission (i.e., 34.2%). An analysis of the case papers of patients admitted during 1945 showed the following position:— Disease. Number admitted. Number with live vermin. Number with nits only. Scarlet Fever 288 41 36 Diphtheria 67 16 10 Tuberculosis 34 — — Other Diseases 294 12 10 On the other hand infestation amongst the mothers admitted to Thorpe Coombe is, fortunately, very unusual. CLINICS. Dr. M. Sheppard reports as follows:— "The Welfare and Ante-Natal Clinics continued to function well during 1945. There were 35,946 attendances at the Welfares; 384 new cases were seen at the Ante-Natal Clinics, the total attendances being 1,257. There were also 49 new Post-Natal cases, and a total of 77 attendances. ' 'The number of Post-Natal cases is disappointing, and I would urge the midwives to impress on their patients the advisability of a Post-Natal examination even for those mothers who appear to be progressing satisfactorily after their confinement. "I am also concerned at the number of babies who on their first visit to the Welfare are already wholly or partly bottle fed, the usual reason given being 'my milk went when I got up', and I would like to see an intensive breast-feeding campaign started in the Borough. "The auxiliary services, i.e., orthopaedic, dental and ophthalmic have been much appreciated. 63 "Immunisation against Diphtheria is done at all the Welfare Centres. The number of children aged 1-5 years immunised in the Borough was 1,336, and of these approximately 524 were done at the Welfares. "Thanks are again due to the voluntary workers who have continued to give good and faithful service during the past year.'' 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 1,190 667 Low Hall Lane Clinic 384 49 Totals 1,574 716 Total Attendances:— Thorpe Coombe Maternity Hospital 9,882 894 Low Hall Lane Clinic 1,257 77 Totals 11,139 971 Summary of Attendances at Welfare Clinics. Clinic. First Attendances of New Cases. Re -attendances. Grand Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Markhouse Road 529 121 650 8342 6307 14649 15299 Higham Hill 331 68 399 4722 4479 9201 9600 Highams Park 330 29 359 5070 5618 10688 11047 Total 1945 1190 218 1408 18134 16404 34538 35946 1944 1086 143 1229 17861 15048 32909 34138 Child Life Protection.—At the end of 1945 there were 25 nurse-children on the Register, compared with 27 at the end of 1944. There were no deaths among nurse-children during 1945. Number on Register on 31.12.44 27 New Registrations 13 Re-registrations 2 42 64 Deduct: Removals from District 9 No. reaching the age of 9 years 3 Number adopted 5 17 Number on Register 31.12.4525 In addition there were 88 children under 9 years in homes and institutions exempted from visiting. The following is the information required by Circular 2790 of the Ministry of Health with regard to the Adoption of Children (Regulation) Act, 1939:— (а) Number of persons who gave notice under Section 7 (3) during the year 13 (б) Total number of children in respect of whom notice was given under Section 7 (3) during the year 13 (c) Number of children notified under Section 7(3):- (i) Under supervision at the end of year 13 (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 The arrangements in force in regard to Child Life Protection were reviewed by an officer of the Ministry of Health and certain suggestions were made. The procedure in regard to this matter has not been stated for some time and is as follows :— 1. The foster mother notifies the Department in regard to the reception of an infant. 2. The Sanitary Inspector visits and reports on home conditions and any sanitary defects. 3. The reports are passed to the Superintendent Health Visitor and if approved registration is recommended and regular routine visits are paid by the Health Visitor. Removal from the area is notified to the new area concerned. In previous years the number of children on the Register exceeded 100, but for the last five years it has been 40 or less. Adoption.—Close co-operation exists with the Education Department's Attendance Officers, and a Health Visitor's report is given in regard to each application. Similar action is taken in regard to cases referred from adoption societies and Public Assistance Officers. 65 13 persons gave notice under Section 7 of the Adoption of Children (Regulation) Act, 1939. All these children were under supervision at the end of the year and no proceedings were necessary. Massage.—Five massage sessions 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. 184 cases attended for massage and these made 2,516 attendances. Sale of Milk, etc., at Clinics.—The quantity and value of milk and food sold and issued free during 1945 was as follows:— Sales. Free Issue. lbs. ozs. lbs. ozs. Cow and Gate 11,949 — 812 — Ostermilk 3,612 — 379 — Ambrosia 492 — 5 — Trufood 1,243 — 53 — Lactogen 3,127 — 152 — Prune and Banana 90 4 — — Parrish's Food 245 — 1 — Cod Liver Oil 41 — — — Malt and Oil 401 — 2 — Emulsion 250 8 — 8 Magnesia 703 — 2 — Virol 1,861 8 — — Virolax 92 4 — — Roboleine 454 — — — Farex 1,734 — — — Ovaltine 1,583 8 — — Marmite 988 12 — 4 Glucose 96 8 — — Maltoline 692 — 1 — Adexolin 744 — — — Allergilac 10 — — — Sprulac 9 — — — Value £2,727 17s. 5d. WALTHAMSTOW 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:— Tuesday & Friday, Massage and Sunlight Treatment. 1.30 to 4 p.m. Wednesday, Weighing Clinic and Dispensary Treatment. 1.30 to 4.30 p.m. Thursday, Infant Consultations. 1.30 to 4.30 p.m. 66 The work done during the calendar year is shown in the following table compiled from information kindly supplied by Miss D. Carter:— Clinics. First Attendances of New Cases. Re -attendances. Grand Total. Under 1 yr. 1-5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1945 545 55 600 7211 2348 9559 10159 1944 421 39 460 6140 1903 8043 8503 1943 489 51 540 8513 2627 11140 11680 1942 442 74 516 6229 2557 8786 9302 1941 340 91 431 3953 2554 6507 6938 Home Visits. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1945 319 632 951 686 1637 1944 271 578 849 719 1568 1943 443 824 1267 909 2176 1942 403 1143 1546 1312 2858 1941 308 519 827 1504 2331 A total of 115 children were immunised against Diphtheria during the year. Your Council, under the Scheme approved by the Ministry of Health, makes an annual grant of £700 to the Society. SUMMARY OF MUNICIPAL AND VOLUNTARY SCHEMES. The following tables give the total number of attendances at clinics and home visits :— Attendances at Clinics. First Attendances. Re-attendances. Grand Total. Under 1 year of age. 1-5 years of age. Total. Under 1 year of age. 1-5 years of age. Total. Municipal Scheme 1190 218 1408 18134 16404 34538 35946 Brookscroft 545 55 600 7211 2348 9559 10159 Total 1945 1735 273 2008 25345 18752 44097 46105 1944 1507 182 1689 24001 16951 40952 42641 67 The number of first attendances of children under one year of age at Child Welfare Centres exceeded the number of notified live births. Home Visits To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Municipal Scheme 1582 4279 5861 9320 15181 Brookscroft 319 632 951 686 1637 Total 1945 1901 4911 6812 10006 16818 1944 1920 4666 6586 12717 19303 Ante-Natal Care.—The number of expectant mothers who attended the Ante-Natal Clinics represented 91.1% of notified births. TREATMENT. (a) Orthopaedic.—The facilities provided by the Education 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 Years of Age. Scoliosis 3 Torticollis 12 Rickets:—(a) Genu Varum 44 Congenital dislocation of Hip 1 (6) Genu Valgum 60 Pes Piano Valgus 26 Congenital Defects 15 Spastic Paralysis 5 Digitus Varus 1 Talipes:-(a) Equino Varus 11 Miscellaneous 6 (b) Calcaneo Valgus 8 Total 192 (b) Dental.—The following work was done by the Education Committee's Dental Surgeons in respect of Maternity and Child Welfare patients:— 68 1945. 1944. Mothers. Children under 5. Mothers. Children under 5. Cases treated 196 80 109 27 Attendances 553 169 629 76 Fillings 224 97 299 43 Extractions 166 8 212 6 General anaesthetics 66 3 99 4 Scalings 56 — 66 — Dressings 74 66 79 42 Dentures 13 — 20 — Mr. L. W. Elmer, L.D.S., Senior Dental Surgeon, submits the following report from Mrs. W. R. Thome, L.D.S., with regard to dental treatment under the Maternity and Child Welfare Scheme:— "The year 1945 has been a successful year for the Clinic. An increasing number of cases have been referred for treatment. 356 acceptance papers were sent in, 283 from Thorpe Coombe and 73 from Welfare and Nursing Centres. Of these 232 attended for examination and advice. 36 did not return for any treatment. Of the remaining 196, 44 completed their attendances and treatment. "13 patients were supplied with dentures, 22 dentures being fitted. Among the completed cases were all the patients supplied with dentures, which is significant of the trend of values re dental treatment. "Too large a number still prefer extractions and artificial replacements to preserving their natural dentitions. "To be of real value the provision of dental treatment should be available earlier, so that the future mother can start married life with a healthy mouth, and not be obliged to undergo treatment at a difficult period; if referred later there would not be extensive treatment to be carried out. Cases of gross neglect are much fewer. "Women who have been in the Services almost invariablv wish to have conservative treatment. This work has increased, giving much hope for the future.'' (c) Tonsils and Adenoids.—38 cases were operated on under the arrangements 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.—125 infants were referred for sunlight treatment during 1945. (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. 69 (g) Invalid Children's Aid Association.—Miss D. E. Taylor, Secretary to the local branch of the Invalid Children's Aid Association, kindly reports that the following cases of children under five years of age were dealt with by her Association:— Referred by:— Medical men, Hospitals and Dispensaries.. 25 Orthopaedic Clinic 13 Others 8 46 Classification of cases:— Anaemia and debility 6 Marasmus and malnutrition 1 Diseases of lungs (non-T.B.) i.e., Bronchitis, Pneumonia and Asthma, etc. 3 Bone disease (Non-T.B.) 13 After-infection 2 Congenital deformities 11 Diseases of Nose and Throat 1 Diseases of Skin 4 Various 5 46 Help Given to Old and New Cases, 1945. Sent to Hospitals, Nursing and Convalescent Homes 5 Provided with Surgical Instruments and Carriages 22 Referred for Visiting and Advice 19 46 ASSISTED MILK SCHEME. Number of applications during 1945 213 Number of families assisted 102 The National Milk Scheme operated from July, 1910, and the above represents applications for special brands of milk not supplied under that Scheme. HOME HELPS. Applications for the provision of Home Helps are considered by the Committee, and, if approved, financial assistance up to 25s. Od. per week for two weeks is made. In addition to the 130 Home Helps approved during 1945, many mothers attending the Clinic made their own arrangements to obtain the help of suitable women whose names were supplied by the Health Visitors. 32 applications were rejected by the Committee. 70 The demand for Home Helps has been as follows during the past eight years:—1938 (178). 1939 (125), 1940 (128), 1941 (105), 1942 (140), 1943 (175), 1944 (133), 1945 (130). The appointment of one whole-time home help was sanctioned, but not proceeded with because no suitable applicant could be found, probably owing to the low rate of pay (Hetherington Scale)—this has been remedied during 1946. STERILIZED MATERNITY OUTFITS. A total of 350 sets wore supplied and 145 outfits were issued below cost price. INSTITUTIONAL TREATMENT, ETC. One child was sent to an institution under arrangements approved by your Committee. HOSPITAL ACCOMMODATION FOR CONFINEMENTS. The following numbers of confinements occurred at the Institutions specified (Walthamstow residents only):— Thorpe Coombe Maternity Hospital 995 Maternity Homes in Walthamstow 67 Mothers' Hospital, Clapton 58 Forest Gate Hospital 28 Queen Mary's Hospital, Stratford 6 City of London Maternity Hospital 7 Other Maternity Homes 60 Total 1,221 The total for 1944 was 1,164. EVACUATION OF EXPECTANT MOTHERS. The number of evacuations carried out under the Government/ L.C.C. Scheme has been:— 1940 49 1943 100 1941 49 1944 76 1942 94 1945 44 Since August 1st, 1945, cases have been charged to the Council at 14s. Od. per day, the total cost per case amounting to nearly £25. Patients have been required to meet this charge subject to reduction in accordance with the Council's scale of assessment. These recoveries have reduced evacuation to a minimum even though registrations were only from where home conditions were not suitable for home confinement. 71 WALTHAMSTOW DISTRICT NURSING ASSOCIATION. (In affiliation with the Queen's Institute of District Nursing.) Homes:— Central Home .. 17 & 19, Carisbrooke Road, E.17. Branch Home 18, Lyndhurst Road, Highams Park, E.4 The Superintendent, Miss C. A. Lee, S.R.N., S.C.M., reports as follows "In presenting the report, I would like first of all to express my very sincere thanks to the Medical Officer of Health and his staff, which includes the Health Visitors, for the many kindnesses received and which makes our work so much easier. ' 'The Association has suffered from the general shortage of staff but as usual the staff we had have most loyally co-operated and no call has been neglected. "The midwifery bookings for the coming year are already very heavy. "The number of cases for the year ending December, 31st 1945, are:— Municipal. Voluntary. Total. Without Doctor 145 — 145 With Doctor 33 12 45 178 12 190 ' 'The year has been an expensive one owing to the many replacements both in household and nursing equipment. "It is felt, however, by all that the cessation of hostilities will give us heart to make an extra effort in every way." CONSULTANT OBSTETRICIANS. The services of a Consultant were not required in 1945. POST-GRADUATE LECTURES TO MIDWIVES. Three lectures to midwives were given in October by Dr. V. Mary Crosse. The subjects were as follows:— 1. Review of foetal and neo-natal mortality due to prematurity and means of reduction. Management of the premature infant during delivery. 2. Management of the premature infant immediately after delivery and subsequently. 3. Feeding of the premature infant. A total of 117 attended, including some medical practitioners. 72 MIDWIVES ACTS, 1902-1936. No. of Notices of Intention to Practise, January, 1945 29 ,, ,, ,, ,, during 1945 13 Total 42 No. of Midwives ceasing to practise during 1945 9 ,, ,, practising at the end of 1945 33 There was no change in the arrangements for the employment or subsidy of midwives by the Council. Non-medical supervision of Municipal Midwives has been carried out by the Assistant Matron at the Maternity Hospital. The following table shows the work done by midwives (including those employed at Thorpe Coombe- Maternity Hospital) during 1945:— No. of confinements attended as a Midwife 1,246 ,, ,, ,, Maternity Nurse 233 ,, medical aid notices sent 356 ,, notifications of deaths (all children) 7 ,, twin births notified 21 ,, stillbirths notified 45 ,, notifications of liability to be a source of infection 2 ,, ,, ,, laying out of a dead body 1 ,, ,, ,, artificial feeding 5 ,, ,, ,, disinfection 2 The above table includes the following numbers with regard to work done at Thorpe Coombe :— Midwifery cases . 877 Maternity cases . 118 Medical aid notices . 271 The percentages of Medical Aid Notices were:— All cases 28.5 Maternity Hospital Midwives 30.9 Domiciliary Midwives 23.0 The conditions for which Medical Aid was summoned by Midwives in domiciliary practice have been summarised and were as follows:— 73 For complications during pregnancy:— Albuminuria 2 Miscarriage 1 Other conditions 3 6 For complications during labour:— Delayed 1st and 2nd stage 12 Malpresentation 5 Retained placenta 1 Ruptured Perineum 33 Other conditions 11 Post-partum — haemorrhage 1 63 For complications in regard to the infant:— Prematurity and Other conditions 11 feebleness 3 Cyanosis 2 Total 16 Compensation for Loss of Cases.—Compensation is made to Midwives by the payment of 10s. 0d. 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 1945. Municipal Midwifery and Maternity Service.—The table below shows the number of visits done:— Ante-Natal Visits. Deliveries. Lying-in Visits. Total Visits. Patients' Homes. Midwife's House. Clinic. Mid. Mat. 1838 2037 42 275 60 6616 10868 Public Health Act, 1936 (Nursing Homes).—See Public Health Section of the Report. PUERPERAL PYREXIA. Thirty-two cases of Puerperal Pyrexia were notified during 1945. The notifications were received from the following sources:— Maternity Hospital 26 Hospitals outside the area 4* General Practitioners 2* *All were in Hospital or admitted. 74 The Puerperal Pyrexia rate for 1945 was 18.08 per 1,000 births as compared with 14.23 in 1944 and the mortality due to Puerperal Sepsis was nil. The Registrar-General has issued the following rates with regard to the notification of Puerperal Pyrexia. The Walthamstow rates are set out in comparison. Area. Per 1,000 live and still births. Puerperal Fever. Puerperal Pyrexia. England and Wales 9.93 126 County Boroughs and Great Towns, including London 12.65 148 Smaller Towns (25-50,000 population) 8.81 London Administrative County 3.60 15.87* Walthamstow 18.08 * Including Puerperal Fever. 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. 1945 32 18.08 1944 28 14.23 1943 44 23.33 1942 29 16.38 These rates have been high because of the strictness of notifications at the Maternity Hospital, i.e., cases are notified which in other areas would not be notified, especially in domiciliary practice. ABORTION. Circular 1661.—The number of cases in which medical aid notices were issued during 1945 by Midwives in accordance with Rule E of the Central Midwives Board was:— Threatened abortion and miscarriage 1 Abortion and miscarriage Nil OPHTHALMIA NEONATORUM. The number of cases notified during the last two years were :— Year. Totals. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. 1945 .. 2 — — — — — 2 1944 .. 1 — — — — 1 — 75 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1945 — 2 2 — — — 1944 1 1 - — — MATERNAL MORTALITY. During 1945, there were 3 deaths due to sepsis or other puerperal causes. Particulars relating to these deaths are given in the accompanying table, from which it will be seen that one was due to self-induced abortion. DEATHS DUE TO PREGNANCY AND CHILD BEARING AND/OR ASSOCIATED THEREWITH DURING 1945. Case No. Date of Death Certified Cause of Death and Classification. Age Ward 1 8.12.44 Shock and acute gas forming infection from septic abortion, self-induced 34 W 2 25. 3.45 Heart failure. Shock. Pulmonary embolism 25 Ho. 3 1. 7.45 Sub-acute nephritis following pregnancy three months ago 31 W N.B.—Case No. 1 was reported as Case No. 9 in the 1944 Report. The following table shows the maternal mortalitv rates for 1945:— Births Registered. Deaths of Women due to Pregnancy and Child-Bearing. WALTHAMSTOW. England and Wales. Puerperal Sepsis. (Heading 29 R.G.) Other Puerperal Causes. (Heading 30 R.G.) Total. Rates per 1,000 Births registered. Rates per 1,000 Births registered. Puerperal Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal Causes, Total. Lire, 1,713 2 1 3 1.16 0.58 1.74 no t avail able Live and Stillbirths, 1,769 2 1 3 1.13 0.56 1.69 / ,, ,, ,, 76 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). 1945. 1944. 1943. 1942. 1941. Maternal Mortality 1.74 5.21 4.92 1.16 6.89 Stillbirths 32.6 27.1 30.7 30.2 26.8 Neo-Natal Deaths 21.0 20.8 26.2 20.3 23.7 The maternal mortality rates (per 1,000 total births) for the past five years have been as follows:— Year. Total Births Registered. Deaths. Rates per 1,000 Births. (Live and Still). Puerperal Sepsis. Other Puerperal Causes, Total. Puerperal Sepsis. Other Puerperal Causes. Total. 1945 1,769 2 1 3 1.13 0.56 1.69 1944 1,967 2 8 10 1.01 4.06 5.07 1943 1,886 6 3 9 3.18 1.59 4.77 1942 1,770 1 1 2 0.56 0.56 1.13 1941 1,193 3 5 8 2.51 4.19 6.70 COURSE OF LECTURES ON PARENTHOOD AND MOTHERCRAFT. A course of lectures was held at the Walthamstow Educational Settlement (Friends' Hall), Greenleaf Road, Walthamstow, on Thursdays at 3 p.m., between October and December, 1945. The Course extended to 12 lectures arranged for the Settlement in association with the National Association of Maternity and Child Welfare Centres by the Walthamstow Public Health Department. The lectures were given by:— 1. Dr. Leslie Housden. 2. Miss E. M. Howson, Midwife Teachers' Diploma, S.R.N., S.C.M., Sister Tutor at Thorpe Coombe Maternity Hospital. 3. Mrs. D. Androvenda, S.R.N., Matron—Handsworth Avenue Day Nursery. 4. Miss A. C. Keenan, Health Visitor's Certificate, S.R.N., S.C.M., Superintendent Health Visitor. 77 I. THORPE COOMBE MATERNITY HOSPITAL. Alterations and Extensions.— The following renovations were carried out at the Maternity Hospital during the year:— Resident Medical Officer''s and Matron's Quarters.—Wash down throughout. Basement.—Lime washing throughout. Ground Floor (Maternity Ward).—Whitening ceilings and painting walls, etc., throughout. Ground Floor (Premature Baby Ward).—Provision of humidifier. General.—Removal of blackout, replacement of glazing, etc. A scheme was approved for the improvement of the Kitchen, amounting to £655 for the first portion and £495 for the second. General.—(a) Form M .C.W. 96A (Ministry of Health). 1. Name and address of Institution—Thorpe Coombe Maternity Hospital, 714, Forest Road, Walthamstow, E.17. 2. Number of maternity beds in the Institution (exclusive of isolation and labour beds)—48. 2a. Number of beds, if any, included under item 2 which have been reserved for expectant mothers in need of hospital treatment.—Variable according to requirements. No special reservation. 3. Number of maternity cases admitted during the year—1,131 plus four miscarriages (including ante-natal and postnatal admissions). 3a. Number of women treated during the year in the ante-natal beds shown against item 2a. (These women should be included also against item 3)—156. 3b. Average duration of stay of expectant mothers in the antenatal beds shown against item 2a—4.5. 4. Average duration of stav of cases in the lying-in wards— 13.7. 5. Number of cases delivered by— (a) Midwives—877; (b) Doctors—118; Total—995. 6. Number of cases in which medical assistance was sought by a midwife in emergency—271. 7. Number of cases admitted after delivery—7. 8. Number of cases notified as— (a) Puerperal fever—Nil; (b) Puerperal pyrexia—26. 9. Number of cases of pemphigus neonatorum—Nil. 10. (a) Number of infants on a supplementary feed on discharge— 91 complemented, 24 artificially fed. (b) Number of infants wholly breast fed on leaving the Institution—851. 11. (a) Number of cases notified as ophthalmia neonatorum—1. (b) Result of treatment in each case—Satisfactory. 78 12. (a) Number of maternal deaths—Nil. 13. (a) Number of stillbirths—38. (b) Cause in each case, and results of post-mortem examination (if obtainable)—See Clinical Report. 14. (a) Number of infant deaths within 10 days of birth—-11. (6) Cause of death in each case, and results of post-mortem examination (if obtainable)—See Clinical Report. The stillbirth rate was 37.3 per 1,000 live and still births, and the neo-natal mortality within 10 days of birth was 13.2 per 1,000 live births. (b) Occupation of Beds.—The average daily ocoupation of beds was as follows :— January 34.9 February 46.6 March 30.6 April 39.2 May31.2 June 37.7 July 41.2 August 42.0 September 43.6 October 42.3 November 45.4 December 42.1 The average for the whole year was equal to 82.5 per cent, beds occupied (based on 48 beds). (c) Emergency Unit.—The services of the emergency unit were not required during the year. (d) Gas and Air Analgesia.—The Maternity Hospital is approved by the Central Midwives Board for the purpose of giving special instruction in gas and air analgesia. (e) Training of Pupil Midwives.—The Hospital is approved by the Central Midwives Board, jointly with the Middlesex Hospital, for the training of pupil midwives in both Part I and Part II of the training under the new rules. During 1945, 36 pupils from Thorpe Coombe obtained the Part I and 15 the Part II Certificate of the Central Midwives Board. The Council agreed to pay examination fees. (/) Conditions of Service.—The Council agreed to adopt all the recommendations of the Midwives' Salaries Committee. (g) Dietetics.—A part-time dietitian was appointed. Personnel of the Civil Defence Casualty Service gave considerable nursing assistance. The following Clinical Report has been compiled by Miss Helen Rodway, M.R.C.O.G., Resident Obstetrician. THORPE COOMBE MATERNITY HOSPITAL. CLINICAL REPORT FOR 1945. During this year there were 995 confinements; 534, that is 53.7 per cent., of these being first births. The total number of 79 finements since the hospital was opened in May, 1934, to the end of December, 1945 is now 8,314. The number of infants born this year was 1,017. This includes 20 cases of twins, a percentage of 1.98 relative to the total number of confinements, and one case of triplets. There were 156 ante-natal admissions; 76 of these were patients admitted for observation and discharged because not in labour. The other 80 cases, representing 8 per cent, of the total number of confinements, were admitted for treatment or rest. In addition there were 7 post-natal admissions; 4 cases of miscarriage and 7 babies admitted from the district. The attendances at the ante-natal clinic were well maintained, 1,190 cases, making 9,882 attendances. The attendance of 667 patients at the post-natal clinic was a percentage of 67 as compared with 68 last year. There were 25 unbooked cases admitted this year. A summary of the work of the hospital is given below. A full statistical clinical report has been prepared as usual and is available for reference. SUMMARY OF THE WORK OF THE HOSPITAL. Clinic Attendances— No. of Clinics held. No. of attendances. Average attendance per session. (A) Ante-Natal Clinics: (a) Consultant's clinics 7 53 7.6 (6) Resident Obstetrician's Clinics 192 4,584 23.8 (c) Midwives' Clinics 246 5,245 21.3 Totals 445 9,882 (B) Post-Natal Clinics: 50 First Visit 667 Subsequent Visits 227 894 17.9 08 COMPARATIVE FIGURES. From January, 1936, to the end of December, 1945. 1945. 1944. 1943. 1942. 1941. 1940. 1939. 1938. 1937. 1936. Totals. No. of confinements 995 907 891 695 645 720 595 691 640 660 7,439 Total number of admissions 1,135 1,018 1,037 801 717 817 675 775 729 769 8,473 Clinic Attendances: Ante-Natal Clinics— (a) New Patients 1,190 1,016 944 764 824 750 733 702 753 691 8,367 (6) Old Patients 8,692 7,666 7,775 6,551 5,661 6,679 5,750 6,032 5,501 5,354 65,661 Totals 9,882 8,682 8,719 7,315 6,485 7,429 6,483 6,734 6,254 6,045 74,028 Post-Natal Clinics— (a) First attendances 667 617 769 504 315 330 401 479 380 453 4,915 (6) Subsequent attendances 227 219 114 117 149 140 155 151 145 177 1,594 Totals 894 836 883 621 464 470 556 630 525 630 6,509 81 ADMISSIONS TO THE HOSPITAL. (a) Ante-Natal 156 (27 patients were delivered (b) For Confinement 968 before discharge.) (c) Post-Natal 7 (d) On account of miscarriage 4 (e) Infants 7 Total 1135 Indications for the admission of Ante-Natal patients. Number of Cases. Ante-partum haemorrhage 6 Pregnancy toxaemia (two patients admitted twice) 10 Acute nephritis (one patient admitted twice) 2 Chronic nephritis — Acute rheumatism 1 Hyperemesis 4 Hyperpiesis 6 Hydramnios 2 For rest and treatment on account of anaemia, debility, multiple pregnancy 14 Heart disease 12 For version 9 For induction of labour 7 On account of patient being apparently overdue 4 Threatened miscarriage 3 For observation and discharged because not in labour 76 Total 156 Emergency admissions: Ante-partum haemorrhage 3 Pre-eclamptic toxaemia 4 Eclampsia 1 Hyperpiesis 2 Abdominal pain 2 Twin pregnancy, for rest 2 Complications of labour 8 Unsuitable home conditions 3 Total 25 Operations performed: External version 7 Internal version 9 Surgical induction of labour 11 Forceps delivery 64 82 Manual removal of placenta 12 Exploration of the uterus 2 Total 105 Medical Aid requests from the Hospital Midwives for the services of the Resident Obstetrician or her deputy, numbered 261 (that is 26.4 per cent.) for patients in labour and 10 (that is 0.98 per cent.) for infants. INFANTS. The number bom in the Hospital this year was 1,017; this included 20 cases of twins and one case of triplets. There were 82 premature infants (those weighing 5J lbs. or less): this represents 8 per cent, of the total number of infants. Breast Feeding.—88.1 per cent, of mothers discharged from the Hospital were completely breast feeding their infants; a further 9.42 per cent, were partly breast feeding, while in 2.48 per cent, of cases, bottle feeding had, for one reason or another, to be substituted. 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 (a) Infants completely breast fed 88.1 85.63 82.5 83.9 87.6 77.4 75.9 86.0 85.0 85.7 (b) Infants partly breast fed 9.42 11.45 12.2 12.0 9.9 18.7 18.7 - - - (c) Infants not breast fed 2.48 2.92 5.3 4.1 2.5 3.9 5.4 — — — 100.0 100.0 100.0 100.0 100.0 100.0 100.0 — — — FOETAL AND INFANT MORTALITY. (a) Stillbirths. Number of cases. (i) Premature (weight 5J lbs. or less).. 15 (ii) Full term 23 Total 38 The stillbirth rate was 37.3 per 1,000 live and stillbirths. (b) Infant Deaths. Number of Cases. (i) Premature 9 (ii) Full term 4 Total 13 83 The neo-natal mortality rate within 10 days of birth was 13.2 per 1,000 live births. The rate for England and Wales for 1945 was 24.8. Three infants admitted from the District died subsequently in the Hospital. PUERPERAL PYREXIA. Number of cases notified 26 Percentage of cases relative to the number of patients delivered 2.6 Percentage of cases. Causes of Pyrexia. No. of cases. Local uterine infection 7 26.9 Urinary infection 5 19.2 Non-suppurative mastitis and flushed breast 5 19.2 Streptococcal tonsillitis 2 7.5 Pneumonia, pleurisy, respiratory catarrh 3 11.5 Phlebitis 1 3.8 Otitis media 1 3.8 Not diagnosed 2 7.5 26 Maternal Mortality.-—There were no maternal deaths during the year. Infant Deaths and Stillbirths.—The following is an analysis of causes of stillbirths and infant deaths during 1945. The total number of stillbirths was 38. (a) Premature, i.e., weighing 5½ lbs. or less (b) Full term Total 1. Congenital malformation: Anencephalus 2 — 2 Hydrocephalus 2 2 4 Spina bifida 2 — 2 Foetal ascites 1 1 2 Congenital malformation of the heart — 2 2 2. Haemorrhagic disease — 1 1 3. Maternal conditions: Toxaemia 1 — 1 Ante-partum haemorrhage 1 — 1 4. Labour complications 2 7 9 5. Cord complications 1 4 5 6. Unknown 3 6 9 Totals 15 23 38 84 A post-mortem examination was made in 10 cases. The number of deaths within 10 days of Infants born in the Hospital was 11, details being as follows:— (a) Premature. (b) Full Term. Total. Atelectasis 8 1 9 Haemorrhagic disease 1 - 1 Erythroblastosis - 1 1 Totals 9 2 11 A post-mortem examination was made in five cases. Three infants admitted from the District died subsequently in Hospital, the causes of death being as follows:— Atelectasis and Prematurity 2 Congenital malformation of the heart 1 REPORT ON THE DIET OF PATIENTS AND STAFF. Since the Council agreed to the proposal to allow the occasional services of an advisory dietitian, Miss Simmonds, Senior Dietitian in the London County Council Service has visited the Hospital at intervals. In August Miss Simmonds made an analysis of the food served in the Hospital to patients and staff for a period of one week. She has agreed to do this every two months and to report her opinion and advice. The main points of the first report are as follows:— 1. The diet of both patients and staff in spite of the limitations in variety of food is well balanced and conforms to accepted pre-war standards for healthy adults. It does, however, fall a little below the new standards accepted at the Hot Springs conference. 2. The mineral and vitamin contents are above the pre-war standards except in the case of vitamin D where it falls below the allowance advised for nursing mothers. In making a comparison with the new standard which has been accepted by the Ministry of Food, the mineral and vitamin content of the diet is less than it should be for nursing mothers and very slightly less than it should be for active adults. On comparison with the Medical Research Standard, U.S.A.—There is a shortage of Vitamin A and D in the diet of the patient. This can be made up with cod liver oil or vitamin capsules. An addition to the diet of a little more fish would also increase the amount of vitamin D. Herrings, salmon and sardines are the best sources of this vitamin. 85 A little more calcium is needed in the diet, and this is being supplied with additional dried milk. Vitamin C, of which there is shortage in the diet, is contained in fresh fruit, green vegetables and salads. A great amount of this vitamin disappears on storage of food containing it and also in cooking. To increase the amount of vitamin C patients are being asked to bring in their concentrated orange juice, for which they have priority. Nutritional surveys are now being carried out all over the country and it appears likely that we shall be unable to maintain the very high standard of diet that is regarded as an optimum for nursing mothers. I think Matron is to be congratulated that the standard of the Hospital diet has been so well maintained throughout the difficult years of the war. FORM M.C.W.96 (Revised). The following information is extracted from this report to the Ministry of Health. No. of Health Visitors employed:— (i) by Council, 13. (ii) by Voluntary Associations, 1. Equivalent of whole-time staff employed on Health Visiting:— (i) employed by Council, 8. (ii) employed by Voluntary Associations, 1. Infant Welfare Centres:—Council, 3; Voluntary, 1. Ante-Natal Clinics:—Council, 2;. Post-Natal Clinics:—Council, 2. Mothers attending Ante-Natal Clinic, 1,645; Post-Natal Clinic, 707. Infectious Diseases:— Ophthalmia Neonatorum. Puerperal Pyrexia. Domiciliary Confinements — 5 Institutional Confinements 2 27