WAL 29 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1946 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. MEDICAL OFFICER OF HEALTH E. G. Ellis & Sons, Willow Street, E.4. BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1946 INDEX page Section A.—Statistics and Social Condition® of the Area 7 Section B.—General Provision of Health Services in the Area 12 Section C.—Sanitary Circumstances of the Area 19 Section D.—Housing 25 Section E.-—Inspection and Supervision of Food 29 Section F.—Prevalence and Control over Infectious Diseases 37 Section G.-—Infectious Diseases Hospital 54 Section H.—Maternity and Child Welfare 60 Section I.—Thorpe Coombe Maternity Hospital 88 page Abortion 85 Adoption 74 Acreage 7 Adulteration 33 Ambulance Facilities 12 Ante-Natal Clinics 69, 72, 90 Assessments 7 Bacteriological Analyses 31, 34 Births 8. 61 „ Notification of 61 „ Registration of 62 Birth Rate 8 Breast Feeding 70, 94 Cancer 11 Capital Expenditure 59, 87 Caravans 23 Care of Illegitimate Children 66 Cerebro-Spinal Meningitis 37, 38, 49 Child Guidance 78 Child Life Protection 73 Child Welfare 69 „ „ Clinics 69, 73, 76 Clinics 13, 72 Committees 4, 60 Compensation (Midwives) 83 Confinements 80, 84, 91 Connaught Hospital 17 Cremation 59 Daily Guardians 64 Day Nurseries 63 Deaths 8, 9, 10, 11 „ Infants 68, 95 „ Infectious Diseases 38 Death Rate 8 Dental Treatment 15, 77 Diphtheria 37, 38, 43 „ Immunisation 39 Diseases of Animals Acts 34 Disinfestation 24, 72 District Midwifery 83 Domestic Help 59 Dysentery 37, 38, 46 page Emergency Unit 89 Encephalitis Lethargica 37, 38 Enteric Fever 37, 38, 44, 45 Erysipelas 37, 38, 48 Evacuation of Expectant Mothers 81 Essex County Council Act 18 Factories Act, 1937 . 35 Food & Drugs Act, 1938 33 Food Inspection 32 Foot Clinic 13 Gas and Air Analgesia 83, 89 Grants 58, 75 Health Visitors 69 Home Helps 79 „ Visits 70, 71 Hospital Accommodation 81 „ Infectious Disease 54 Housing 27 „ Act, 1936 26, 27 „ Conditions 70 „ Inspections 25 Ice Cream 30 Immunisation 39 Infant Mortality 64, 95 Infectious Diseases Clinic 38 „ „ Hospital 54 Infestation 72 Institutional Treatment 16, 79 Inquests 58 Invalid Children's Aid Asscn. 78 Insulin 59 Laboratory Services 41 Lectures to Midwives 82 Malaria 37. 38, 49 Massage 74 Maternal Mortality 10. 86. 96 Maternity 6? Child Welfare 60 „ Homes 81 page Measles 37, 38, 50 Meat Inspection 31 Medical Aid 82, 83, 93 „ Examinations 59 Midwives 82 Lectures to 82 Milk, Assisted Scheme 79 „ Special Designations Order 30 „ Supply 29 Miscellaneous 58, 86 Mortuary 58 Municipal Dental Service 15 „ Laboratory 41 „ Ambulance Service 12 „ Midwifery and Maternity Service 83 National Health Service Act, 1946 59 Neo-Natal Mortality 65 Notices, Sanitary 21 Notification of Births 61 Nurses Act, 1943 59 Nursing 13 „ Homes 18 Ophthalmia Neonatorum 37, 38, 47, 85 Ophthalmic Treatment 78 Orthopaedic Treatment 76 Outworkers 36 Pneumonia 37, 38, 47 Poliomyelitis 37, 38, 47 Population 7 Post-Mortems 58 Post-Natal Clinics 69, 72, 90 Premature Infants 67, 94 Prevention of Blindness 41 Priority Sheet Dockets 79 Public Assistance 18 „ Cleansing 19 Puerperal Pyrexia 37, 38, 84, 95 page Rateable Value 7 Rats and Mice Destruction Act 35 Refuse Disposal 19 Rent Restriction Acts 34 Sanitary Inspection 21 Scabies Clinic 16 Scarlet Fever 37, 38, 42 Schick Tests 39 Smallpox 41 Social Conditions 7 St. John Ambulance Brigade 13 Staff 6, 61 Statistics 7, 8, 9, 10, 11 Sterilised Maternity Outfits 79 Stillbirths 8 Sunlight Treatment 78 Swimming Baths 24 Thorpe Coombe Maternity Hospital 88 Total Infant Mortality 63 Tonsils and Adenoids 78 Tuberculosis 37, 38, 52, 53, 54, 58 Training of Pupil Midwives 89 „ „ Probationers 55, 64 Unemployment 7 Vaccination 41 Venereal Disease 17 Vital Statistics 8 Vitamins 62 Walthamstow Child Welfare Society 75 Walthamstow District Nursing Association 81 Water 19 Whooping Cough 8, 37, 38, 51 Women's Clinic 14 HEALTH COMMITTEE Chairman : Alderman Mrs. C. McEntee, J.P Vice-Chairman : Councillor E. G. Baily. Ex-officio : The Worshipful the Mayor—Alderman A. G. Bottomley, O.B.E., M P., J.P. The Deputy Mayor—Councillor Mrs. E. A. Smith, J.P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman T. Fitzpatrick. „ W. Gillett. „ A. E. Manning. Councillor C. J. Alford. „ W. E. Barnes „ Mrs. Candy. „ Mrs. Christy. „ Mrs. Frewin. „ J. F. Green. Councillor F. E. Nicoll. „ W. H. Shaw. „ R. E. Simmons „ R. E. Smith. „ Mrs. Tweed. Sanatorium (Hospital Management) Sub-Committee. Chairman : Councillor E. G. Baily. Alderman W. Gillett. Alderman Mrs. C. McEntee, J.P. Councillor Mrs. Candy. Councillor Mrs. Frewin. Mrs. Christie. „ Mrs. E. A. Smith, J.P. Town Clerk : G. A. Blakeley, Esq. TO THE CHAIRMAN AND MEMBERS OF THE HEALTH COMMITTEE Ladies and Gentlemen, I beg to present herewith a report on your Health Services during 1946. The vital statistics are good and of the infections diphtheria, whooping cough and enteritis were again low in incidence. Good progress continued with protection against diphtheria, but the great need now is to concentrate on the pre-school child. Two small series of cases of the enteric group stress the need for constant vigilance in regard to the standards of cleanliness of food production. This is especially so in view of the number of carriers in the community. More education is urgently necessary in regard to habits of personal deanliness. The fulfilment of your recommendation for free public lavatory facilities is to be hoped for. The grave housing shortage continued to produce some deplorable examples and gave rise to increased correspondence and visits in order to decide which cases should be the subject of priority on medical grounds. The shortage of staff at the Infectious Diseases Hospital continued to cause anxiety. The Municipal Dental Service made good progress. Your kindly consideration is again acknowledged together with the good work of the staff. It has been very pleasing to welcome back all the staff who have been in the services. I am, Your obedient servant, A. T. W. POWELL, Medical Officer of Health. 6 STAFF The following changes occurred in the Staff :— Resignations Mrs. V. Atkinson (Clerical Assistant) 25. 5.'46 Mrs. V. Aylward (Clerical Assistant) 9. 2.'46 Mrs. E. Chamberlain (Clerical Assistant) 28. 2.'46 Mrs. M. Grimwood (Clerical Assistant) 3. 1.'46 Mrs. D. Haines (Municipal Ambulance Clerk) 12. 4.'46 Mr. L. Joyce (Junior Clerk) 1. 8.'46 (To join H.M. Forces) Mrs. Sampson (Municipal Ambulance Clerk) 15. 2.'46 Mr. D. L. Stokes (Chiropodist) 6. 4.'46 Mrs. M. West (Clerical Assistant) 26.11.'46 Mr. H. W. Whipp (Sanitary Inspector) 31. 8.'46 Appointments Mr. E. A. Austerberry (Sanitary Inspector) 1. 8.'46 Mr. F. J. Aylward (Clerical Assistant) 18. 3.'46* Miss S. Branigan (Clerical Assistant) 19. 8.'46 Mr. S. E. Chandler (Municipal Ambulance Driver) 27. 5.'46 Mr. V. Croft (Sanitary Inspector) 30.11.'46 Mr. R. A. C. Green (Clerical Assistant) 1. 4.'46* Mr. J. W. Harris (Sanitary Inspector) 11. 3.'46 Miss S. Horsnell (Clerical Assistant) 1. 4.'46* Mrs. D. Jacobs (Clerical Assistant) (Part-time) 12. 2.'46 Mr. L. R. W. Kemp (Clerical Assistant) 29. 4.'46* Mr. D. R. King (Clerical Assistant) 6. 8.'46* Mr. R. J. King (Chiropodist) 8. 4.'46 Mrs. E. A. Lynch (Tempy. Female Auxiliary Nurse) 7. 1 .'46 Mr. L. R. Skinner (Chiropodist) 29. 4.'46 Mr. A. T. Wade (Clerical Assistant) 15. 4."46* * Resumed after War Service. 7 A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year, 1946) 118,050 Number of Assessments, 1st April, 1946 35,572 Rateable Value £866,208 Sum represented by penny rate £3,465 Population. — The Registrar - General's Estimate of the population at mid-year, 1946, is 118,050, an increase of 14,730 on the previous figure. The graph given below clearly shows the decline in the population during the war years. The evacuation of the population can be seen in the steep decline to 1941. This is followed by the small but steady drift back until 1945, after which there is a steep rise, which, if continued, will bring the population up to pre-war level by 1948. Unemployment.—According to information kindly supplied by Mr. Percy C. Graham, Manager of the Local Employment Exchange, approximately 1,000 men and 200 women were placed in employment every month during the year 1946, through the placing machinery of the Leyton Employment Exchange. The number of insured persons employed in the whole area covered by the Exchange, comprising the Boroughs of Walthamstow, Leyton, Chingford, Wanstead and Woodford, was 61,000 in July, 1946. Of these, it is estimated that about 31,000 were employed in Walthamstow. During 1946, the average number of persons unemployed in the whole of the exchange area was 630 men and 85 women; these included 150 disabled men and 10 disabled 8 women. Apart from certain older men and some badly disabled persons, the majority of unemployed men and women were placed in suitable employment within a short period, and there was a steady demand for both male and female workers throughout the year. Extracts from Vital Statistics.—The Registrar-General's midyear, 1946, estimate of the population (viz., 118,050) has been used for the calculation of all vital statistics :— Total Males Females Legitimate 2,453 1,277 1,176 Birth rate per 1,000 of the estimated resident population 21.5 Live Illegitimate 91 46 45 Births Total 2,544 1,323 1,221 Stillbirths 70 Rate per 1,000 total (live and still) births 26.7 Deaths 1,331 Death rate per 1,000 of the estimated resident population 11.2 Deaths from puerperal causes :- Rate per 1,000 (live and still) births. Puerperal Sepsis Deaths — — Other Puerperal Causes 2 0.76 Total 2 0.76 Death rate of infants under one year of age :— All infants per 1,000 live births 34 Legitimate infants per 1,000 legitimate live births 33 Illegitimate infants per 1,000 illegitimate live births 66 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under two years of age) 3 9 Pulmonary Tuberculosis death rate 0.39 Non-pulmonary Tuberculosis death rate 0.10 (All death rates are per 1,000 of the estimated residential population.) The natural increase of population, i.e., excess of births over deaths was 1,213. 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 1946 (1,331) compares with 1,271 in 1945, the respective death rates per 1,000 population being 11.2 and 12.3. 10 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and case Rates for certain Infectious Diseases in the year 1946. Provisional figures based on weekly and quarterly returns. England and Wales. 126 County Boroughs and Great Towns (including London) 148 Smaller Towns (Resident Population 25,000-50,000 at 1931 Census London Administrative County. Walthamstow. Rates per 1,0 00 Civilian Population. Births :— Live 19.1* 22.2 21.3 21.5 21.5 Still 0.53* 0.67 0.59 0.54 0.59 Deaths:— All Causes 11.5* 12.7 11.7 12.7 11.2 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 - Scarlet Fever 0.00 0.00 0.00 0.00 - Whooping Cough 0.02 0.02 0.02 0.02 0.02 Diphtheria 0.01 0.01 0.01 0.01 0.06 Influenza 0.15 0.13 0.l4 0.l2 0.l3 Smallpox 0.00 0.00 0.00 - Measles 0.00 0.01 0.00 0.01 — Notifications :— Typhoid Fever 0.01 0.01 0.01 0.01 0.92 Paratyphoid Fever 0.02 0.02 0.01 0.01 0.01 Cerebro-spinal Fever 0.05 0.05 0.04 0.06 0.05 Scarlet Fever 1.38 1.51 1.33 1.42 1.50 Whooping Cough 2.28 2.48 2.05 2.22 1.66 Diphtheria 0.28 0.32 0.31 0.24 0.19 Erysipelas 0.22 0.25 0.22 0.27 0.28 Smallpox 0.00 0.00 0.00 0.00 - Pneumonia 0.89 1.02 0.74 0.75 0.69 Rates per 1,000 Live Births. Deaths under 1 year of age 43† 46 37 41 34 Deaths from Diarrhoea and Enteritis under 2 years of age 4.4 6.1 2.8 4.2 1.1 Rates per 1,000 Total Births (Live & Still) a) Notifications :— Puerperal Fever 8.50 10.35 7.63 162 12.62 Puerperal Pyrexia ‡9.68 b) Maternal Mortality:— No. 140. Abortion with Sepsis. No. 141. Abortion without Sepsis. No. 147. Puerperal Infections. Nos. 142-6. 148-50. Other. England and Wales 0.13 0.06 0.18 1.06 Walthamstow — — — 0.76 * Rates per 1,000 Total Population. † Per 1,000 related births. ‡ Including Puerperal Fever. A dash (—) signifies that there were no deaths. 11 Causes of Death as given by the Registrar-General for the year 1946 Whole District Causes of Death. Males. Females. Total. 1. Typhoid and Paratyphoid Fevers - - - 2. Cerebro-spinal Fever 3 2 5 3. Scarlet Fever — — — 4. Whooping Cough 1 2 3 6. Diphtheria 3 3 6 6. T.B. of Respiratory System 30 16 46 7. Other Forms of Tuberculosis 10 2 12 8. Syphilitic Diseases 6 — 6 9. Influenza 9 7 16 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis - - - 12. Acute Infectious Encephalitis 1 1 2 C Cancer of buccal cavity and oeso13. phagus (Males) 6 - 6 Cancer of uterus (Females) — 11 11 14. Cancer of stomach and duodenum 27 19 46 15. Cancer of breast — 21 21 16. Cancer all other sites 78 61 139 17. Diabetes 1 12 13 18. Intra-cranial vascular lesions 64 85 149 19. Heart Disease 147 131 278 20. Other Diseases of the Circulatory System 22 22 44 21. Bronchitis 59 47 106 22. Pneumonia 39 32 71 23. Other Respiratory Diseases 9 8 17 24. Ulceration of the Stomach or Duodenum 16 3 19 25. Diarrhoea (under 2 years) 1 2 3 26. Appendicitis 2 3 5 27. Other Digestive Diseases 15 14 29 28. Nephritis 11 10 21 29. Puerperal and Post-abortive Sepsis — — — 30. Other Maternal Causes — 2 2 31. Premature Birth 11 11 22 32. Congenital Malformation, Birth Injury, Infantile Disease 19 14 33 33. Suicide 9 3 12 34. Road Traffic Accidents 8 1 9 35. Other Violent Causes 10 14 24 36. All Other Causes 76 79 155 Totals, 1946 693 638 1,331 Totals, 1945 651 620 1,271 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 4 12 88 118 12 B.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 1 :—(i) Public Health Officers of the Authority :—Resignations and appointments during the year are given at the beginning of the Report 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. When service is required it should be stated whether an ambulance or ambulance car is required, and application should be made as follows : — Accident and Emergency.—Dial " 999 " and ask for Ambulance. Removal, etc.—Dial LARkswood 4556 (A medical certificate is necessary). Removals. Accidents. Treatment. Maternity. Others. Total. Mileage. 1946 1,522 543 3,760 739 98 6,662 31,123 1945 1,547 541 3,446 501 23 6,058 34,189 The total number of calls is 604 more than for 1945, an increase of nearly 10 per cent. The considerable increase in maternity removals will be noted. This reflects the pressure caused by the increased birth rate of 1946. "Other calls" have increased on account of the transport facilities provided for District Midwives since 1st June, 1946. Transport is available at night when the public service is not available or is restricted and, of course, in emergencies. The ambulance fleet, staff and garage arrangements remain as detailed in the previous report. The voluntary assistance of members of the St. John Ambulance Brigade has continued and totalled 243 duties during the year. This assistance enabled extra vehicles to be available at night and at weekends. First Aid Examination.—The Council gratefully accepted the offer made by the St. John Ambulance Brigade through Dr. J. L. McKenzie Brown, O.B.E., and Mr. V. G. Turner to conduct a course of First Aid lectures and demonstrations for the ambulance staff free of charge. At the conclusion of the course two of the men obtained Vouchers, ten obtained First Aid Certificates and one failed. Provision has been made in the current financial year 1947/8 for the provision of two new ambulances, but it is doubtful if these will be supplied during the year. 13 Reciprocal Arrangements.—During 1946 the position was as follows : — Authority Incoming calls. Outgoing calls. Leyton 9 24 Chingford 33 8 Woodford and Wanstead 1 1 Tottenham - 1 Total 43 34 There were nine more calls done for other areas than the total of calls transferred out. Whipps Cross Hospital. Removal of patients is carried out by ambulances attached to the Hospital. St. John Ambulance Brigade. Mr. V. G. Turner, Divisional Superintendent, kindly contributes the following report: — "As more members have now returned from the Forces, we are getting back to normal. Duties have been covered, such as football, theatres, boxing, etc., and a good many cases have been treated. Some members are still assisting as orderlies on the Municipal Ambulances, and we hope to do better with these duties in the coming year. We held one first aid class for the general public, with very good results, and we shall carry on with these classes if there is any demand. The competition spirit is again coming forward, and there are two teams in training for an interdivisional competition which is being held in January, 1947." (c) Nursing in the Home. (i) General.—No change. (ii) Infectious Diseases.—No change. (d) Clinics and Treatment Centres. Foot Clinic.—Total attendances were 11,751 and of these 1,087 were by new patients, 10,657 were re-attendances by old patients and seven were by " casuals." The receipts were £727 14s. 2d. Sessions are held at the Town Hall, as follows: — Monday 9 a.m. to 12 noon 1.30 to 4 p.m. 4.30 to 7 p.m. Tuesday do. (Children only)— — Wednesday do. 1.30 to 4 p.m. Thursday do. do. 4.30 to 7 p.m. Friday do. do. do. Saturday do. — — 14 Toward the end of the year the Foot Clinic was transferred from Lloyd Park Mansion to a room at the Town Hall providing accommodation for four chiropodists. The resignation of Miss McCallum, S.R.N., C.S.M.M.G., Senior Chiropodist, who had inaugurated the Foot Clinic in 1931 was received with regret. Chiropody treatment only is given and treatment is by appointment which may be made by personal call, by letter (enclosing a stamped addressed envelope) or by telephone (LARkswood 4675). Women's Clinic.—This clinic is held in Thorpe Coombe AnteNatal Block. It deals mainly with gynaecological conditions. Contraceptive advice is given when indicated on medical grounds. An additional (nurse's) session was commenced during the year. Miss Helen Rodway, M.R.C.O.G., submits the following report: — No. of Sessions. No. of Attendances. Total. Average Attendance per Session. New Patients. Old Patients. (a) Tuesday Afternoon 52 479 1,478 1,957 37.6 (b) Saturday Morning 25 131 267 398 15.9 Totals 77 610 1,745 2,355 30.5 (c) Tuesday Morning 23 38* 345† 383 16.6 * These patients were transferred from the Post-natal or Gynaecological Clinics, † A number of gynaecological patients' attendances are included in this figure. Summary of New Cases : — Tuesday afternoon. Saturday morning. Total. For diagnosis or complications of pregnancy 113 57 170 Sterility 53 5 58 Gynaecological 230 52 282 Surgical 8 4 12 Medical 14 2 16 Contraceptive 40 3 43 Post-natal 6 3 9 Not classified 15 5 20 Totals 479 131 610 147 patients were referred by medical practitioners to the clinic. 63 patients were referred to hospital. 15 Comparison of attendances with previous years : — 1946. 1945. 1944. 1943. 1942. 1941. 1940 1939. 1938. New cases 610 616 444 524 424 299 26C 329 319 Old cases 1,745 1,665 1,630 1,618 1,303 1,023 1,183 1,234 1,179 Totals 2,355 2,281 2,074 2,142 1,727 1,322 1,443 1,563 1,498 Municipal Dental Service. Treatment is available for patients of all ages (except those attending grant-aided schools which are dealt with through the School Dental Service) living in Walthamstow. Treatment is only given by appointment—telephone LARkswood 2334, Extension 9. Mr. L. W. Elmer, L.D.S., Senior Dental Surgeon, reports as follows: — "This service has now been in operation for upwards of three years, and 1946 has been a year of steady if not spectacular progress both in the number of patients treated and in the operations performed. "Below is given a statistical report of the work undertaken during the year. The comparable figures for 1945 are also given. 1946 1945 Number of patients treated 585 379 Appointments made 3,719 2,234 Appointments kept 3,315 2,143 Fillings 786 1,005 Scalings 206 147 Dressings 207 228 Extractions 1,570 1,068 General anaesthetic 446 238 Local anaesthetic 182 112 Impressions 371 223 Bites 162 97 Try-ins 193 106 Dentures supplied 258 134 "It must be understood that, in addition to the items listed, an amount of other work, impossible to classify accurately, has been done during the year under review. This includes crowns and their preparation, gum treatments, adjustments of dentures, orthodontic appliances, etc. " The only disappointing feature is the disproportion in the number of fillings as compared with the number of extractions and the amount of denture or prosthetic work. This, it is to be hoped, will be remedied in the future by an increase in the attendance of adolescents and younger people generally, these being the classes who can derive most benefit from preventive dentistry." 16 Note by M.O.H.—A Dental Workshop was equipped by early 1947 and a dental mechanic commenced duty. A whole-time dental surgeon was appointed. Scabies Clinic. The arrangements at the special treatment Centre detailed in previous reports were continued. Alterations were carried out in order to facilitate and improve treatment at an estimated cost of £90. Sessions are held as set out below at the Scabies Clinic premises, which are situated behind the Public Baths in High Street. Treatment is by appointment only (i.e., through a doctor or through the Health Department). Morning 9.12 Afternoon 2.5 Evening 5.30-8.30 Monday — — M/F Tuesday — F — Wednesday F — — Thursday — — M/F Friday F - - Saturday M/F — — M Males. F = Females and Children 956 cases were treated during the year, receiving 3,541 treatments. A total of 92 cases was treated (on payment) for the Woodford and Wanstead Corporation. (e) Hospitals.—There were no changes during 1946 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 by the County Boroughs of East Ham and West Ham. Mr. Pegram, Clerk to the Committee, has kindly supplied the following particulars of Walthamstow residents admitted to the various institutions during the year ended 31st December, 1946 :— Institutions Men Women Children Total Central Home 97 84 3* 184 Whipps Cross Hospital 530 803 290 1,623 Forest Gate Hospital — 37 — 37 Harold Wood Hospital 8 9 — 17 Forest House 3 2 — 5 Aldersbrooke Children's Homes - - 53 53 * These children were ultimately transferred to Aldersbrooke. Thirty-one infants were born to Walthamstow mothers in Forest Gate Hospital during the year. 17 The number of patients from Walthamstow in Mental Hospitals was 367 on the 31st December, 1946. The Connaught Hospital. The Secretary to the Hospital has kindly supplied the following information: — "Of the total number of in-patients admitted during the year, 861 were residents of the Borough. " The following figures show the progress of the Hospital during 1946 as compared with the previous vear In-Patients Out-Patients No. Admitted Average Stay Daily Average New Cases Attendances 1946 1,940 18.77 99.13 17,139 90,274 1945 1,769 16.95 81.19 20,487 91,499 "Particulars as to Staff, Beds and Departmental activities : — There are 118 beds, including 10 private wards. "Operations and Treatments during 1946:—720 major operations and 3,154 minor operations were performed, making a total of 3,874. 16,762 radiographs were taken. There were 17,176 massage treatments, also 25,549 electrical treatments and 1,535 artificial sunlight treatments at the Comely Bank Clinic ; a total of 44,260 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. During 1946 a self-contained Nurses' Teaching Unit was erected in the grounds of Comely Bank comprising two large class rooms with ancillary accommodation. Extensions were also commenced to the administration block including an up-to-date enlarged kitchen with nurses' dining room above and maids' bedrooms and sitting room on the top floor. 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. It is understood that a treatment centre is to be erected in 1947 in the grounds of Comely Bank annexe to the Connaught Hospital. 18 2. Public Assistance. Out-relief and institutional treatment is provided by the Essex County Council. Mr. Pegram, Clerk to the Essex County Council, South-Western Area Guardians' Committee, kindly states that the amount of relief provided in Walthamstow during the two years ended 31st December, 1946, was as follows :— 1946 1945 £ s d. £ s d. Total amount of out-door relief granted to Walthamstow residents during the year ended 31st December 41,915 3 7 39,295 12 9 Average weekly number of Walthamstow residents in receipt of relief during the year ended 31st December Men 225 220 Women 497 467 Childrer 261 234 Total 983 921 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 1 - 8 8 Homes on register at the end of the year 0 .26* 26 62 * 14 of these have not been used since the beginning of the war. There were no cancellations, refusals or appeals. Eighteen inspections were made by the medical staff. One new registration was approved for one medical and seven chronic patients. In addition a registration in regard to an existing maternity home for seven beds was reduced to five, and a house adjoining was newly registered for four maternity beds, i.e., an increase of two. Routine enquiries are made with regard to unregistered homes. No difficulties in regard to supervision arose. 5. Essex County Council Act.—One new licence to practice chiropody was granted by your Council. Two licences were renewed following inspection of premises, 19 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 suspeoted enteric fever. The Board then arranges special tests at the addresses concerned. All were negative in 1946. 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 this brief report of the work of the Public Cleansing Department for the year 1946, I would point out that a great deal of the basic work undertaken has been of a re-organising nature, preparing the ground for the increased standard that was being aimed at before the war. "Our labour position has improved during the year inasmuch as quite a number of our ex-employees have returned from service in H.M. Forces. This has not materially increased the number of employees, but it has enabled us to bring a greater number of experienced men to bear in the sections most affected by the war-time "call-up." In general the current return to normal of industry has been shown by the increased tonnage of the principal cleansing services. "House Refuse Collection.—I am still maintaining the system of a once weekly collection of household refuse throughout the Borough, and our total tonnage collected has jumped to the figure of 54,549 tons, which shows an increase of 4,873 tons over the year 1945, and further, I can expect this figure to keep on increasing until the peak of the building programme in Walthamstow has been reached and passed. "The above figure, of course, includes the total tonnage of the various grades of salvage collected, and in contradition to the current national downward trend of salvage collections, Walthamstow has maintained its return to industry of these valuable and much needed commodities. This is proved by the fact that during the year 1946 a total of 3,956 tons of general salvage was dealt with against a figure of 3,960 tons in 1945. While I consider this state of affairs to be fairly satisfactory in view of my previous remarks regarding national figures, I would, of course, be extremely glad to see an increase during the forthcoming year, as our salvage effort all tends to alleviate the rate demand. 20 "Waste Food.—I am afraid that I cannot state the same facts with regard to Waste Food collection as applied to the general salvage collection, as the figures have actually dropped by some 56 tons to a total collection for the year 1946 of 1,470 tons. This fact in my opinion is quite alarming, as we are repeatedly being exhorted by the various Ministries concerned to increase our tonnage as much as ever possible, in order to alleviate the desperate need of feedingstuffs for pigs and poultry. This downward trend, I feel quite confident, can only be checked by the institution of further and far reaching methods of Waste Food collection. "I am prepared to believe that we are collecting as much waste food as possible from the communal bins throughout the Borough, and I would say that the only way to increase this collection to the needed figure is to provide more convenient receptacles, and that in turn points to the individual kitchen waste container for every household. "Trade Refuse.—The contract system for the collection of trade refuse from business premises within the Borough is continuing satisfactorily, and I can hardly expect improvements in this direction, as once again we have covered practically all traders, and certainly all the principal trades. "Refuse Disposal.—Once again I have to report an increase in the total refuse incinerated, the figure having increased by 2,637 tons to a total of 26,050 tons. This increased tonnage has, however, placed a very heavy strain on the incinerator, and breakdowns are becoming more and more frequent. We are, however, attempting to carry the additional load as well as possible. "Street and Market Cleansing and Gully Cleansing.—The return of many of our pre-war employees has enabled me to increase the frequency of sweeping in certain areas of the Borough, and I think I can claim that we are definitely making headway against the accumulation left by war debris. This problem of the disposal of debris from bombed sites is proving quite a serious one, inasmuch as it is not only the initial bomb clearance debris that has to be dealt with, but I have also to contend with the resulting filth which finds its way on to the footpaths and roads almost as soon as they have been cleansed, and further, I find that the various bombed sites in the town have had to be cleared time and time again owing to the fact that many unauthorised persons are using the bombed sites purely as tipping sites. I have made various representations to the Authorities concerned regarding the stopping of this practice, but it is very difficult to stop when all and sundry are implicated. 21 "I regret to have to report that the number of gullies cleansed during 1946 dropped to 10,183, a reduction of 1,170 on the previous year, but can only point out that this was solely due to the fact that the gully cleansing machine was out of commission for several months as we could not obtain the necessary spare parts to effect repairs. "Once again I have pleasure in reporting an unbroken record of normal service throughout the year, and I wish to extend my sincere thanks and appreciation to all concerned, as without their co-operation it would have been impossible to have maintained the smooth running of the various services during the past year." SANITARY INSPECTION OF THE AREA During the year the inspectorate was equivalent to one below full complement owing to resignations and sickness. Mr. F. W. Kemp, Chief Sanitary Inspector, reports as follows :— No. of inspections made. No. of nuisances detected. No. of complaints received. No. of Informal Notices No. of Statutory Notices. Total Visits. Served. Complied with. Served. Complied with. 11,376 7,319 3,979 2,616 2,288 266 218 22,448 Of the 2,616 intimation notices which were served during the year, 56 were in respect of business premises, and of the 2,560 relating to defects in houses, 2,046 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 eight houses at a cost of £155 8s. 7d. The nature and variety of the work done in 1946 is shown in the following tables :— Drains tested, 528; Drains reconstructed or repaired, 545; Drains obstructions removed, 395; Drains, means of access provided, 48; Drains, ventilation provided or improved, 45; Drains ventilation repaired, 97; Soil pipes repaired, 89; Soil pipes, new, provided, 60; Rain water pipes renewed, 211; Rain water pipes disconnected from drains, 8; Roofs repaired or renewed, 624; Gutterings repaired or renewed, 421; W.C. pans or traps provided, 335; Gully traps provided, 159; W.C. 22 flush cisterns provided, 118; W.C. flush cisterns repaired, 254; W.C. floors concreted, 48; W.C.s repaired and cleansed, 248; W.C.s, light and ventilation improved, 21; Waste pipes renewed and trapped, 156; Waste pipes repaired, 208; New sinks provided, 91; Water supply reinstated, 26; Water supply taken off main, 9; Cisterns cleansed and covered, 29; Conveniences cleansed and repaired, 11; Sculleries paved, 37; Yards and forecourts paved and repaired, 49; Dirty houses cleansed, 5; Dirty rooms cleansed, 328; Floors repaired, 418; Ventilations under floors provided, 122; New damp-proof courses provided, 68; Sites concreted, 1; Offensive accumulations removed, 40; Animals improperly kept, removed, 12; Manure receptacles provided, 1; Stables cleansed, paved and drained, 27; Manholes repaired or re-sealed, 118; Other cases of dampness remedied, 435 ; Miscellaneous repairs, 1,754. Infectious Diseases. Visits to premises, 529; Re-visits to premises, 23; Rooms disinfected, 220; Articles disinfected at Low Hall, 717; Articles destroyed at Low Hall, 40. Dampness in Houses. Sites concreted, 1; Damp-proof courses provided, 68; Yards and forecourts paved and drained, 49; Roofs made watertight, 624; Rain-water pipes made good, 211; Guttering repaired or renewed, 421; Other cases of dampness remedied, 435 : Ventilation under floors nrovided 122 Special Premises. Number Visits paid Factories (a) Power 368 284 (b) Non-power 81 238 (c) Other premises 70 96 Outworkers 122 220 Butchers' shops 79 330 Bakehouses 31 200 Fishmongers, Fish Fryers and Curers, etc. 36 193 Cafes and Caterers 84 306 Grocers, etc. 182 885 Ice Cream Manufacturers and Vendors 102 228 Cowsheds 1 4 Dairies and Milksellers 71 113 Laundries 3 6 Rag and Bone Dealers 3 11 Piggeries 3 25 Street Stalls Numerous 31 Greengrocers ,, 155 Stables ,, 96 23 As a result of the regular periodical visiting of the Special Premises the following works were carried out: — Butchers' Shops. Special Cleansings, 33; Paving repaired, 5; Accumulations removed, 5; New Galvanised Bins provided, 9; Drains repaired, 6; W.C.s repaired and cleansed, 12; Yard paving repaired, 3; Roofs repaired, 4; Drains cleared, 3. Bakehouses. Special cleansings, 29; W.C. cisterns repaired, 4; W.C.s deansed and repaired, 6; Premises general repairs, 8; Obstructions from drains removed, 2; New ceilings fixed, 3; New W.C. pans and traps, 2; Floors repaired, 4; Yards paved, 4. Fishmongers. Special cleansings, 29; Yards repaved, 4; Accumulations removed, 4; Roofs repaired, 4; Drains cleared, 6; Other improvements, 16. Cafes and Caterers. Special cleansings, 41; Yard pavings repaired, 2; W.C. cisterns repaired, 2; Drains repaired, 5; Light and ventilation improved, 4. Ice Cream Manufacturers and Vendors. Special cleansings, 14; Special cleansing of utensils, 2; Yard pavings repaired, 3; Other improvements, 8. Cowsheds and Milkshops. Special cleansings, 27; Pavings relaid, 1; New fittings and other improvements, 3. Stable Premises. Cleansings, 27; Accumulations removed, 9; Roofs repaired, 4; Pavings repaired, 4; Manure receptacles provided, 1; Drains repaired, 2. Laundries. Special cleansings, 5; Roofs repaired, 1; Other improvements, 2. Rag and Bone Dealers. Cleansings, 6 ; Accumulations removed, 1. Piggeries. Cleansings, 5. Camping Sites. There were no sites in the area used for camping. There are, however, several van dwellers in the Higham Hill area. 24 Smoke Abatement. The use of unsuitable fuel gave rise to several 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 in 1938. (a) Municipal Baths, High Street.—This is a covered swimming bath. Mr. W. Cantes kindly contributes the following report:— "From January 1st to December 31st, 1946, the swimming bath was open on 332 days, during which period 98,885 bathers used the bath. "Maximum load in 1946 was on June 24th, when we had 935 bathers." Three water samples were taken during the year. (b) Whipps cross Bathing Pool.—This is a large open-air pool situated in Epping Forest, in the area of the Borough of Leyton and a few hundred yards from the Walthamstow boundary. It is administered by a joint Committee representing the two Boroughs. The pool is supervised by the Medical Officer of Health for Leyton, who kindly sends a copy of the analytical findings when samples are taken. (c) South-West Essex Technical College.—Sampling was carried out on two 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. Sampling was carried out on one occasion, with satisfactory results. (e) The Kingfisher Pool.—The Managing Director kindly gives the following particulars: — "The chlorination and filtration plant has a turnover of eight hours, with a possible speeding up to six hours. 0.2 parts per million of free chlorine are aimed at for the deep end and 0.6 at the shallow end. 25 The plant was kept in operation all day and night over the week-ends, if found necessary. "The approximate number of swimmers in 1946 was 23,000. "Bacteriological and chemical analyses were carried out on three occasions, with satisfactory results. "The following Essex championships were held at the Pool during the year : — 1. Schoolboys' Team Swimming. 2. Ladies' Spring-board Diving. 3. Schoolgirls' Team Swimming. 4. Men's Spring-board Diving." (f) 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) 4,508 (b) Number of inspections made for the purpose 10,565 (2) (d) 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 Nil (N.B.—These comprise individual unfit houses) (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,560 26 II.—Remedy of Defects During the Year Without Service of Formal Notices: — Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 2,060 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 103 (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) By owners 128 (b) By Local Authority in default of owners (at a cost of £155 8s. 7d.) 8 (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 152 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 78 (b) By Local Authority in default of owners 4 C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil 27 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil (b) Housing Act, 1936 Unfit Houses No Demolition or Closing Orders were made during the year. General The following is supplied by Mr. J. E. West, your Council's Housing Manager:— "The year ending in March, 1946, saw the beginning of the great task of post-war reconstruction. "It may be well to review here the total number of dwellings lost during the war years, together with the numbers of families recorded as needing accommodation, in order that the immense task of rehousing can be fully appreciated. "In all, 1,392 houses had been destroyed or scheduled for demolition, whilst a further 2,720 houses were so badly damaged as to be uninhabitable. Bearing these figures in mind, together with the national and perhaps abnormal increase in the number of families and the fact that there had been no new house building for the whole of the war years, it is not surprising that 7,401 persons were recorded at the 31st March, 1946, on the Housing Register, which was set up on the 1st October, 1945. This figure provides an under-statement of the true position, as numbers of persons still away on war service and others had not, by the close of the year, registered for accommodation and the weekly number of persons registering is still far in excess of accommodation becoming available each week. "To meet this grave problem a number of schemes were projected, the situation being so urgent that 1,200 temporary houses were sited to provide a short term remedy, for at any rate, a number of cases. Unfortunately, this figure had to be reduced to the present figure of 530. Having in mind the need for permanent houses, the long term policy was at the same time put in hand resulting in work on the Countess Road and Millfield Avenue sites being formulated. Twenty blocks of flats providing 414 dwellings are already in course of construction at the former site and 74 houses are in an advanced stage on the latter site. A request has also been submitted 28 by the Council for the earmarking of 2,000 houses to be erected at Harlow for occupation by Walthamstow applicants. Conjointly with this general programme the repair or rebuilding of bombed premises has also proceeded throughout the Borough. "Of the lettings arranged during the year 252 were in respect of requisitioned properties and 73 on the Council estates and 56 in temporary houses, while nominations submitted to owners from our list of applicants for tenancies of private properties were agreed by the owners in 103 cases. "The Council house lettings are analysed as follows:— Resumption of tenancies by Council tenants 15 cases involving 60 persons Rehousing Council tenants rendered homeless 11 „ „ 57 „ By normal lettings 13 „ „ 79 „ Rehousing homeless 2 „ ,, 11 „ Transfer from requisitioned properties 7 „ „ 35 „ By recommendation of the Medical Officer of Health 2 „ „ 10 „ Redistribution of accommodation 23 „ „ 126 „ 73 378 "In August, 1945, in order that conditions existing on the Council estates might be ascertained, a house to house survey was carried out and it was established that 120 cases were overcrowded, 51 of them being by reason of sub-letting, and it was known that overcrowding would occur in 46 other cases by reason of returning members of the Forces and children reaching the age of 10. 306 houses (254 of them to members in the Forces) were recorded as being sub-let to married sons or daughters and a further 71 were sub-let to miscellaneous persons. "These figures occasion no surprises as it was already well known that housing conditions on the Council estates had considerably deteriorated during the war years. In prevailing circumstances little can be done to alleviate the position beyond the gradual rehousing of the subtenants by qualification within the "Points" scheme of the Council. A careful check is made, however, of all cases where sub-letting occurs and this type of infringement of the Council regulations is very much discouraged especially where overcrowding or other undesirable features are the direct result. By the maintenance of strict supervision of all subletting cases, it is hoped to avoid further deterioration of the conditions which almost inevitably occur as a result of sub-letting. 29 "Truly, the present housing situation is difficult to say the least, but with the energetic application to the task of rebuilding, I am sufficiently optimistic to look forward to an everbrightening future when at last the conditions of housing may be described as "reasonable"—at least its most important aspects. "The following is an extract of the report of Progress submitted to the Council in January, 1947, indicating the progress made up to 31st December, 1946:— Prefabricated bungalows occupied 234 Housing applications received 9,549 Housing applications in the "live register" 8,331 Personal interviews since 1/4/46 11,621 Total rehousing since 1/4/46 335 "The minimum amount of accommodation required to meet the housing needs as analysed from the list of Housing applications, is as follows:— % of Applications Single persons, etc. (Hostels) 2 235 Young married couples (2 rooms) 43 3,843 Families of 3 to 5 persons 42 3,729 Families of 6 to 7 persons 11 1,127 Families of 8 to 10 persons 1.5 190 Families of 12 to 14 persons 0.5 44 Families not stated 381 Number of properties requisitioned 1,046 Number of properties still held 636 Furniture cash sales amount to £1,587 7 6 Furniture on loan amounts to £12,003 10 7 £13,590 18 1 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 146—a record number. Samples were taken regularly twice monthly from the two firms holding Producers' Licences within the Borough and from other dealers in the district. 30 The following table gives details of samples taken:— Grade. No. of Samples. Results Satisfactory. Unsatisfactory in one or more tests. Pasteurised 84 79 5 Tuberculin Tested Pasteurised 18 18 Tuberculin Tested 14 12 2 Sterilised 4 4 Heat Treated 26 20 6 Totals 146 133 13 Investigation was made into the unsatisfactory samples, and remedial action followed. There is one cowshed in the District and the average number of cows kept is four. The number of Retail Purveyors of Milk is 71. The majority of these are the "general" shop type, and sell milk "as received" in bottles. One hundred and thirteen visits were paid to registered dealers during the year and a good 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 (b) Ice Cream. Forty-six applications to manufacture or for the sale of this commodity were received. Licences were granted as follows:— Manufacturers and Vendors 6 Vendors only 40 31 Representations were made to the Minister of Health, (a) seeking legislation for the compulsory medical examination of all persons engaged in the preparation and sale of ice cream, and (b) urging the formulation of compulsory standards both chemical and bacteriological. Your Committee's Public Analyst reported as follows:— "We are taking this opportunity of again repeating our view that the present position in respect to ice cream is unsatisfactory. Quite apart from the major question of a standard for fat content in ice cream there is the equally important question of cleanliness. While the argument against the fixing of a minimum standard of fat in ice cream, namely, that ice cream of any grade of nutritional value has a psychological value at the present time in adding variety to our diet, is sound, we venture to assert that it must run parallel with a proper condition of cleanliness. Bacteriological examination by itself is not complete or certain evidence of cleanliness, but a bad bacteriological condition is a safe indication of the necessity for a special examination of the premises in which the ice cream is prepared, and such inspection is vital when it is remembered that while the bacteriological examination indicates a contamination, it does not indicate at what stage the contamination occurred. It may have been in the manufacture or during storage, or even at the time of sale." Bacteriological Examination. Thirty-seven samples were submitted for bacteriological examination. The results are classified below:— Very satisfactory 7 Satisfactory 19 Passable 4 Unsatisfactory 7 The above results compare favourably with those taken in other districts. Several local manufacturers have samples taken at their own expense by a private bacteriologist, thus enabling them to maintain a proper standard of cleanliness. (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, 32 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. 1400 tins Evaporated Milk 8 pkts. Cremola Mix 226 „ Condensed Milk 9 „ Cake Mixture 21 „ Full Cream Milk 2 „ Batter Mix 15 „ Skimmed Milk 2 „ Bun Flour 8 „ Dried Milk 2 ,, Cake Flour 385 ,, Pilchards 8 „ Sponge Mixture 209 „ Salmon 3 „ Pickling Spice 39 „ Sardines 1 pkt. Mixed Spice 7 „ Crayfish 18 pkts. Dessert Mould 4 „ Herrings 4 „ Semolina 6 „ Shrimps 5 „ Soup 5 „ Mackerel 74 „ Gravy Salt 8 „ Norwegian Brislings 2 „ Butterkist 4 „ Norwegian Silds 1 pkt. Dried Egg 1 tin Crab and Lobster 1 „ Breakfast Oats 361 tins Soup 1 „ Cocoa 101 „ Stewed Steak 1 „ Chocolate Wafers 54 „ Meat Veg. Ration 2591 lbs. Flour 51 „ Casserole Steak 649 „ Cake 59 „ Veg. in Gravy 278 „ Swiss Roll 24 „ Luncheon Meat 170 „ Bread 8 „ Corned Beef 533/4 „ Biscuits 7 „ Chopped Ham 7 „ Cake Flour 7 „ Ham & Tongue Roll 351 „ Dates 2 „ Ox Tongue 2783/4 „ Sultanas 4 „ Ready Meal 178 „ Cherries 8 „ Sausage Meat 1750 „ Oranges 2 „ Irish Stew 100 „ Marmalade Oranges 4 ,, Steak & Kidney 62 „ Prunes 151 „ Plums 55 „ Lemons 32 „ Peaches 30 „ Raisins 18 „ Tomatoes 263½ „ Beef 28 „ Tomato Juice 713/4 „ Bacon 11 „ Pears 63½ „ Sausage Meat 31 „ Apples 17 „ Galantine of Meat 3 „ Pineapples 8¼ ,, Sausages 2 „ Fruit Cocktail 1½ „ Liver Sausage 3 „ Damsons 140 „ Noodles 1 „ Apricots 28 „ Macaroni 199 „ Beans 12 „ Lentils 525 „ Peas 3 „ Semolina 18 „ Mixed Veg. 2 „ Oats 4 „ Carrots 63 „ Cheese 8 „ Beetroot 55 „ Sugar 33 1 tin Turnip 21½ lbs. Tea 125 tins Fish Roll 16½ „ Butter 4 „ Fish Paste 114¼ ,, Margarine 85 „ Jam 1 lb. Lard 13 „ Orange Marmalade 70½ lbs. Jam 14 „ Grapefruit Marmalade 29 ,, Orange Marmalade 2 „ Treacle Pudding 28 „ Celery Soup Powder 2 „ Macaroni & Tomato 123/4 „ Black Pudding 1 tin Macaroni & Cheese 2½ „ Russian Salad 1 „ Anchovies 9 „ Ground Almonds 1 „ Dried Meat 9½„ Assorted Sweets 1 „ Dried Eggs 2½ „ Boiled Sweets 1 „ Pate de Foie Gras 2 „ Toffee 20 x 6 lb. tins Corned Beef ½ „ Chocolate 1 x 6 lb. tin Corned Mutton 12½ cwts. Figs 3 x 1 lb. tins Lambs Tongues 1 cwt. Ox Tail Soup Powder 1 x 6 lb. tin Tongue 1 „ Tomato Soup Powder 1 x 2½ lb. tin Luncheon Meat 1 „ Chocolate Semolina 1x4 lb. tin Brisket 6 boxes Camembert Cheese 3 x 2J lb. tins Chopped Ham 1 box Rabbits 2 x 1J lb. tins Pork Sausage Meat 12 doz. Crumpets 15 x 1 lb. tins Meat Roll 22 „ "Kit Kat" Chocolate 4 x lb. tins Peaches Wafers 1 x 6 lb. tin Apricots 14 bars Assorted Chocolate 6x2 lb. tins Jam 70½ stone Kippers 6 x 8 lb. tins Grapefruit 52½ „ Cod Marmalade 28 „ Herrings 2 x 8 lb. tins Orange 19 „ Skate Marmalade 10 ,, Assorted Fish 1 x 1 gallon tin Tomatoes 8 „ Smoked Fillets 21 jars Fish Paste 6 „ Whiting 5 „ Meat Paste 6 „ Ray 42 „ Honey 5 „ Roker Wings 8 „ Jam 5 „ Roe 25 „ Spiced Sprats 4 „ Dover Sole 5 „ Pickles 1 „ Plaice 1 jar Mayonnaise 20 Ice Cream Cornets 1 „ Calves Foot Jelly 470 Eggs 29 botts. Dill Cucumber 411 Fish Cakes 37 pkts. Baking Powder 18 Fowls 14 „ Marshalls Master 8 Ducks Mixture 14 „ Pudding Mixture (d) Adulteration, etc.—Food and Drugs Act, 1938. During the year 118 samples of food and drugs were submitted to the Public Analyst, three of these being examined on behalf of the Food Executive Officer, 34 Fourteen samples were found to be in some respect, unsatisfactory—details are given below:— Description of Article Result of Analysis Action Taken Cake Mixture (Informal) Packet incorrectly No similar packets. labelled. Warning sent. Milk (Formal) 2 samples 1½% added water Bottling discontinued. Warning sent. Cucumber, Pickled (In- Mould growth and Stock surrendered, formal). mould spores. Wholesaler warned. Sausages (Formal) Preservative not deRetailer warned. dared. Vinegar, Non - brewed Deficient in acetic acid Further sample (Formal). tory. Ice Cream (Formal) 5 Not of the standard of Manufacturers warned, samples. cleanliness desirable. Resampled satisfactory. No legal proceedings were necessary in respect of the eleven samples, as detailed above. Taken for Food Executive Officer : Dripping (3 samples) Suitable for fish frying Owner prosecuted and fined. (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, 66, Victoria Street, S.W.I. (f) A total of 813 circular letters were sent to persons in charge of premises where food was prepared, stored or sold, calling attention to the precautions to be observed against contamination of food. The formulation of model bye-laws in regard to the handling, wrapping and delivery of food and the sale or exposure for sale in the open-air of food for human consumption is urgent. Your Committee approved of the need for publicity in regard to the washing of hands after using the water closet and urinal, and recommended that as soon as supplies of soap and towels were available the Council should provide free washing facilities at public conveniences. RENT AND MORTGAGE RESTRICTION ACTS During the year forty-five certificates were granted to tenants and seven applications were received from owners for certificates upon completion of works, which, with the exception of one, were 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. 35 Parasitic Mange Order, 1938.—No action necessary. Foot and Mouth Disease (Infected Areas) Special Order No. 49 of 1946.—Three licences were dealt with under this Order. 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 is performed 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 undertaken during the year:— SANITARY INSPECTORS Types and No. of Premises Found Premises Inspected to be Infested. Methods used at Infested Premises. Food. Other. Food. Other. Baiting. Trapping. Gassing. Other. 62 546 52 449 371 15 1 161 Complaints received 479 Premises rat-proofed 22 Advice only given 7 Re-inspections 921 RODENT OPERATIVES. No. of Infestations No. of Infestations Number reduced Estimated Treated. Cleared. Major to Minor. Kill. Reservoir Major Minor — 10 318 319 5 5,202 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. Occupiers Prosecuted. (1) (2) (3) (4) Factories with Machine 284 12 Nil Factories without Power 238 4 Nil Other Premises under the Act 96 — Nil Totals 618 16 Nil 36 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 35 — Overcrowding 3 3 — — Unreasonable temperature — — — — Inadequate ventilation 12 12 — — Ineffective drainage of floors 7 7 — — Sanitary Conveniences - insufficient 16 16 — — unsuitable or defective 43 41 — — not separate for sexes — — — — Other offences. 66 52 5 — Totals 176 165 5 — NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1946 Wearing Apparel, making Boxes 6 of 102 Rubber Goods 4 Brush making 7 Boots and Shoes 3 Total 122 Outworkers were notified from the following areas:— Bethnal Green 3 St. Marylebone 1 City of London 9 Shoreditch 4 Finsbury 16 Walthamstow 19 Hackney 30 Westminster 2 Islington 3 Other areas 11 Leyton 24 Total 122 A total of 220 visits were paid in connection with outworkers. 37 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 :— All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. 1946 1945 Scarlet Fever 178 270 1 37 125 7 6 2 Diphtheria 23 16 — 4 18 — 1 — — Typhoid Fever. . 3 — — — 3 — — — — Paratyphoid Fever 2 1 — 1 1 — — — — Pneumonia 82 72 4 3 12 5 20 29 9 Puerperal Pyrexia 33 32 — — — 7 26 — — Ophthalmia Neonatorum 4 2 4 — — — — — — Erysipelas 34 26 — 1 — — 7 17 9 Encephalitis Lethargica Polio-encephalitis Cerebro-spinalMeningitis 7 7 3 1 2 1 — — — Anterior Poliomyelitis. . — 1 — — — — — — — Measles 503 692 25 300 171 5 — 2 — Whooping Cough 197 131 17 132 46 1 1 — — Dysentery 25 84 — 12 9 — 1 1 2 Malaria 1 2 — — — — 1 — — Tuberculosis 167 160 2 9 14 49 68 19 6 Totals, 1946 1,259 56 500 401 75 131 70 26 Totals, 1945 — 1,496 71 579 534 105 128 56 23 St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals. Scarlet Fever 27 13 30 34 45 29 178 Diphtheria 5 1 6 3 1 7 23 Typhoid Fever — — — — — 3 3 Paratyphoid Fever 1 — 1 — — — 2 Pneumonia 16 17 10 4 20 15 82 Puerperal Pyrexia 3 2 9 9 5 5 33 Ophthalmia Neonatorum 1 — — 1 1 1 4 Erysipelas 5 1 4 2 7 15 34 Encephalitis Lethargica . . Polio-encephalitis — — — — — — — Cerebro-spinal Meningitis — 2 1 1 2 1 7 Anterior Poliomyelitis — — — — — — — Measles 94 104 69 75 32 129 503 Whooping Cough 54 35 13 13 30 52 197 Dysentery 6 — 8 1 7 3 25 Malaria — — — — — 1 Tuberculosis 21 28 32 15 31 40 167 Totals, 1946 233 203 183 158 182 300 1,259 Totals, 1945 261 192 219 194 300 330 1,496 38 The statistics given in the foregoing tables are those for the calendar year 1946. The Registrar-General gives the statistics for the 52 weeks ended 31st December, 1946, 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 :— Scarlet Diph' Enteric Pneu- Puerperal Disease. Fever. theria. Fever. monia. Pyrexia. Erysipelas Number 178 23 5 82 33 34 Case rate :— Walthamstow 1.50 0.19 0.04 0.69 0.27 0.28 England and wales 1.38 0.28 0.03 0.89 Not available 0.22 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 12.62 England and Wales 8.50 Disease. Total notified. Removed to Hospital. Per cent, removed to Hospital. Deaths. Deaths per cent, of cases notified. Scarlet Fever 178 100 56.1 Nil Nil Diphtheria 22 22 100.0 6 27.2 Typhoid Fever 3 2 66.6 Nil Nil Paratyphoid Fever 2 * 100.0 Nil Nil Pneumonia 82 47 57.3 71 86.5 Puerperal Pyrexia 33 S 15.1 Nil Nil Ophthalmia Neonatorum 4 1 25.0 Nil Nil Erysipelas 34 3 8.8 Nil Nil Encephalitis Lethargica. . — — — 2* — Polio-encephalitis — — — Nil Nil Cerebro-spinalMeningitis 7 6 85.7 5 71.4 Anterior Poliomyelitis . . — — — Nil Nil Measles 503 24 4.7 Nil Nil Whooping Cough 197 22 11.1 3 1.6 Dysentery 25 16 64.0 Nil Nil Malaria 1 — — Nil Nil Tuberculosis (all Forms) 167 159f 58 34.7 * No cases were notified. t This figure also includes cases notified during previous years. 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. 39 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. The following table shows the work done at the infectious diseases Clinic, the large majority of patients being of school age :— Number of clinics held in connection with Infectious Diseases _. .... 50 Number of attendances made 373 Average attendance per session 7.4 Number of children recommended to Rheumatism Clinic — 1 Number of children recommended to Aural Clinic 3 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 4 Negative (including pseudo and negative) 1 Positive (including pseudo and positive) 3 Total number of immunisations completed during 1946: — (a) School age 882 (b) Pre-school age 1,730 (c) Over school age — 11 Total 2,623 (d) Number already immunised having a reinforcing dose 1,840 The above total includes 180 children immunised at Brookscroft and 225 by Private Practitioners. Number of Schick Tests following immunisation 79 Number Positive 3 Number Negative 73 Not seen — ...... 3 Number of clinics held for immunisation 52 Number of attendances made at clinic for immunisation 2,008 Average attendance per session 38.6 Immunisation ait schools (included above) Number completely immunised 792 Number partly immunised 71 Number having extra dose, immunised in previous years 1,655 40 At the end of 1946 a total of 16,206 persons aged 0 to 15 years had been protected against Diphtheria, i.e., 67.3% of the estimated " under-fifteen " population of 24,080. At the end of 1945 this total was 14,502, representing a net increase in 1946 of 1,704. The total of " under-fifteens " protected in 1946 was 2,940 which has to be reduced by 1,236, the total of those protected in previous years who reached the age of 15 years. The numbers and percentages of children protected in the various age-groups in 1945 and 1946 were as follows :— At 31st Dec.: 1946 1945 Total number of children under 5 immunised 4,551 3,222 Estimated mid-year population under 5 9,040 8,040 Percentage immunised 50.34 40.1 Total number of children 5-15 immunised 11,655 11,280 Estimated mid-year population 5-15 15,040 14,030 Percentage immunised 77.6 80.4 Total number of children 0-15 immunised 16,206 14,502 Estimated mid-year population 0-15 24,080 22,070 Percentage immunised 67.3 65.7 During 1946 there were six deaths from Diphtheria in Walthamstow—all in unprotected persons. By comparison there were no deaths in 1944 nor in 1945. In 1930 there were 22 deaths from Diphtheria. The present position is that although over three-quarters of all children of school age have been protected against Diphtheria only one-half of those under five years of age have been protected. The great need now is for every baby to be immunised at nine months or one year. During 1946 a boy aged 6£ years, not completely protected (inasmuch as no negative Schick test had been obtained) died from cardiac paralysis following faucial Diphtheria. The death certificate was given on clinical grounds but two throat swabs were negative. General Practitioner Scheme.—Thr was extended to cover all children up to the age of 15 years (previously 5 years) at a fee of 3s. per injection. During 1946, 224 c.cs. of alum precipitated toxoid were issued, a quantity sufficient to protect 224 children. Birthday Letters.—The arrangements as detailed in the 1944 Report were continued. 41 MUNICIPAL LABORATORY The following numbers of Diphtheria swabs were examined during 1946: — Swabs Negative Positive Totals Private practitioners 445 7 452 Health Department 97 9 106 School Medical Department 398 — 398 Totals 940 16 956 The total number of diphtheria specimens examined in 1945 was 431. In addition 41 specimens of urine were examined, as compared with 50 in 1945. Ministry of Health Emergency Laboratory Service. This service provides facilities for examination of pathological specimens. 945 specimens were examined for local practitioners during 1946, as follows :— Diphtheria Swabs, 558*; Dysentery Specimens, 298 ; Ring' worm Specimens, 23 ; Miscellaneous, 66. * These were reexaminations of swabs sent on from Walthamstow. VACCINATION Mr. E. Sharp, Vaccination Officer for the area, has furnished the following return for 1946 :— Births Successfully Percentage Insus' Exemp' Deaths before Post' Registered Vaccinated Vaccinated ceptible tions Vaccinated poned 2,343 578 24.6 2 652 57 49 In addition to the above, 116 primary vaccinations were recorded and 51 re-vaccinations. During 1946, the vaccinal condition of all school children examined at Routine Medical Examinations was recorded, and a summary of the findings for the year showed that 18.0 per cent, were vaccinated. 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 Between February and April a total of 134 persons who had been in contact with cases of smallpox were notified and required examination and supervision up to 21 days after contact. This supervision entailed much extra work for the medical, sanitary and clerical staff, and fortunately ended without the conveyance of infection into the Borough. The contacts were from some 16 troopships, mostly from India. 42 SCARLET FEVER A total of 178 cases of Scarlet Fever was notified during 1946 as compared with 270 in 1945. 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 2 6 1 February 12 — 1 10 — 1 — — March 9 — 1 7 1 — — April 13 — 1 10 1 1 — — May 20 1 8 11 — — — — June 16 — 2 11 2 July 15 — 5 8 — 2 — August 10 — 3 5 1 1 — — September 18 — 3 13 1 — 1 — October 11 — 5 6 — — November 17 — 3 13 1 _ December 29 — 3 25 1 — — ("1946. . 178 1 37 125 7 6 2 Totals ■< L1945. . 270 1 46 188 23 11 1 — Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 3 1 2 2 1 February 3 — 1 2 5 1 March 1 1 4 1 1 * 1 April 1 2 4 3 2 1 May 2 2 1 10 2 3 June 1 — 2 3 4 5 July — 2 1 1 6 5 August 3 1 2 — 2 2 September 1 1 5 1 4 6 October 2 — 5 — 3 1 November 3 1 2 2 8 1 December 7 2 1 9 7 3 f1946.. 27 13 30 34 45 29 Totals -< [1945.. 65 30 57 25 38 55 43 DIPHTHERIA A total of 22 cases of Diphtheria was notified during 1946 as compared with 16 in 1945. The following tables show the incidence by months, ages and wards:— Month. All ages. Under i yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 3 - - 2 - 1 - - February 1 — — 1 — — — — March 2 — — 2 — — — — April 2 — — 2 — — — — May 6 — 2 3 — — — — June 3 — 1 2 — — — — July 4 — 1 3 — — — — August - - - - - - - - September - - - 1 - - - - October 1 — — — — — — November 1 — — 1 — — — — December - - - - - - - - 1946 22 4 17 — 1 — — Totals 1946 16 - 5 8 1 2 - - Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 1 _ - 2 February 1 - — - — — March 2 - — - — — April 1 - 1 - — — May — - 2 3 — — June — - — — — 3 July — 1 3 — — — August — - — — — — September — - — — — - October — - — — — 1 November — - — — — 1 December — - — — — - 1946 6 1 6 3 — 7 Totals 1946 8 1 3 - 1 3 44 The percentage of cases removed to hospital in 1946 was 100.0 against 93.7 in 1945. No case is 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 1946, a total of 64 phials, each containing 8,000 units of Diphtheria antitoxin were issued. Eighty Walthamstow patients were admitted to hospital either as cases of diphtheria or for "diphtheria observation." Diagnosis was confirmed in 22 cases. Of these 6 were non-clinical (i.e., swab positive only), 11 were clinical cases and five were severe and fatal cases. Of the 22 cases five had received previous protection. Of these five cases two were non-clinical and three were severe to mild. One of the severe cases died and although the clinical appearance was of diphtheria, all swabs were negative. ENTERIC FEVER (a) Typhoid Fever A boy of eleven years was admitted to hospital in January for investigation and treatment. Shortly afterwards he was transferred to an Infectious Diseases Hospital as a possible case of Typhoid Fever. The usual enquiries were made. Later the same day a District Attendance Officer reported that another boy living in the same locality was at another hospital as a suspected case of Typhoid. Since the two children attended the same class at school, absentees were followed up with the result that a third child who had been ill at home for some three weeks was considered to be a further possible case of Typhoid. The position was complicated by the fact that a sister had suffered from paratyphoid in 1938. The first blood test result was not diagnostic but the rectal swab was later reported to be positive to Typhoid. Information as to the position was circulated to all Medical Practitioners pointing out that the only two common factors were attendance at the same Sunday school and the same day school class. The onsets in the three cases were 3rd, 6th and 13th January. 45 The most suggestive feature was a party at school just before Christmas to which food was largely contributed by the parents. A detailed list was prepared for each scholar as to food contributed to the party, and food consumed. In spite of the closest investigation no definite cause could be found. Consultation was made with the Medical staff of the Ministry of Health, one of whom carried out further enquiries and visits— again unfortunately with no definite results. (b) Paratyphoid Fever At the request of the family doctor a patient from Hoe Street Ward was admitted to the Infectious Diseases Hospital on the 13 th April for suspected Dysentery. By April 20th a rectal swab had proved positive to Paratyphoid B. On the 14th a request was received from another family doctor for a consultation in regard to a patient in the St. James' Street Ward previously thought to be suffering from Dysentery, but then showing a suspicious rash. A tentative diagnosis of Enteric Fever was made and admission to hospital was suggested but declined. The relatives were warned -to take all precautions pending the examination of a rectal swab. The result received on the 16th April confirmed that the disease was Paratyphoid Fever. Active enquiries were at once initiated to connect up these two cases (one not yet finally confirmed) from opposite ends of the town. The single common factor was the consumption of ice cream from a small producer-retailer whose family was immediately swabbed. The husband of the producer-retailer was reported to he suspiciously positive and by the 20th April the sale of ice cream was prohibited until further notice. All the swabs showed the presence of Bacillus Paratyphoid B Vi-phage Type I. One additional case from a neighbouring Borough was discovered. The occurrence of only three cases is surprising. The general conditions under which the ice cream (a cold mix) were made were excellent. Sales amounted to approximately six gallons on a busy day. A voluntary undertaking was readily obtained from the persons conccrned that no ice cream would be made, sold or distributed until released from the undertaking given. The fullest co-operation was obtained and, unfortunately, in spite of hospital treatment (including surgical treatment) the carrier condition still continues. 46 Public Health (Infectious Diseases) Regs., 1927. Typhoid Carriers.—Part compensation continues to be paid to a chronic carrier in order to prohibit her from following her normal occupation as a cook and to make up her wages as a convenience attendant. DYSENTERY A total of 25 cases was notified during 1946, as compared with 84 in 1945. 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 - 2 5 February 4 — 3 1 — — — — March 10 — 5 3 — 1 — 1 April 1 - - - - - - 1 May 3 — 2 — — — 1 — June - - - - - - - - July - - - - - - - - August - - - - - - - - September - - - - - - - - October - - - - - - - - November - - - - - - - - December - - - - - - - - 1946 25 - 12 9 — 1 1 2 Totals 1945 84 2 36 26 9 4 5 2 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 6 - - - 1 - February — — — — 4 — March — — 7 — 2 1 April — — — 1 — — May — — 1 2 July - - — — — — August - — — — — — September - — — — — — October - — — — — — November - — — — — — December - — — — — — 1946 6 - 8 1 7 3 Totals 1945 7 10 8 3 18 38 47 ANTERIOR POLIOMYELITIS One case, a boy aged one year, from Hale End Ward, was notified, but the diagnosis was not confirmed. The boy was removed to hospital. There were no cases of Encephalitis Lethargica, nor of PolioEncephalitis. OPHTHALMIA NEONATORUM Four cases were notified during the year, the details being as follows:— Sex Age Ward Removed to Hospital Remarks M 8 days Higham Hill No Recovered F 3 weeks St. James Street No „ M 3 weeks Wood Street No „ M 4 weeks Hale End Yes „ PUERPERAL PYREXIA See Maternity and Child Welfare Section. PNEUMONIA The tables show the incidence by months ages and wards:— ]Month. All ages. Under lyr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. January 7 - - 1 - 2 4 - February 5 — — — — — 4 1 March 10 1 — 1 — 3 4 1 April 9 — — 2 1 4 2 — May 2 — — 1 — — 1 — June 6 1 — 2 — 1 1 1 July 13 — 1 4 — 3 3 2 August 8 — — 1 1 3 2 1 September 6 — 1 — 1 — 2 2 October 3 — — — — 1 2 — November 5 — 1 — 1 2 1 — December 8 2 — — 1 1 3 1 1946 82 4 3 12 5 20 29 9 Totals 1945 72 2 8 10 7 22 14 9 48 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 2 1 1 1 2 February — 3 1 — 1 March 2 — 1 7 April 1 2 2 2 2 May 1 — — — — 1 June 2 1 1 — 1 1 July 1 2 2 2 2 4 August 2 3 1 2 September 2 — 1 1 1 1 October 2 1 November 1 1 1 1 1 December 2 2 — — 2 2 1946 16 17 10 4 20 16 Totals l945 16 11 9 7 18 11 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 1 — — — — — 1 — March 3 — — — — 1 1 1 April 5 — — — — 2 1 2 May 3 — — — — 1 2 — June 3 — — — — 1 2 — July 3 — — — — — 2 1 August — — — — — — — — September 2 — — — — — 1 1 October 3 — — — — — 1 2 November 6 — 1 — — 1 4 — December 4 — — — — 1 1 2 1946 34 — 1 — — 7 17 9 1945 26 — — 1 2 8 12 3 49 Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January - - - - 1 - February — — — — — 1 March — 1 — — — 2 April 1 — 1 — 1 2 May — — 2 1 — — June — — — — — 3 July 1 — — — 2 — August — — — — — — September — — — — 1 1 October 2 - - - - 1 November 1 - - - 1 4 December — - 1 1 1 1 Totals 1946 5 1 4 2 7 15 1945 3 10 3 1 5 4 CEREBRO SPINAL MENINGITIS Seven cases were notified during the year, the details being as follows:— No. Ward. Age. Date notified. Hospital. Remarks. 1 W. St. 5 months 6. 1.46 Yes Died 2 Ho. St. 9 years 16. 1.46 Yes Recovered 3 H.E. 11 months 31. 1.46 Yes Recovered 4 H.E. 5 years 3. 6.46 No Died—P.M. 5 Hi. St. 17 years 14. 9.46 Yes Died 6 Hi. St. 6 years 14.10.46 Yes Died 7 H.H. 6 months 14.12.46 Yes Died MALARIA One case was notified the details being as follows:— Ward. Age. Date notified. Hospital. Remarks. H.E. 36 years 27.6.46 No Contracted in Egypt— Recovered 50 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 62 3 44 15 - - - - February 86 2 49 35 — - — — March 70 3 48 18 1 - — — April 61 1 32 26 2 - — — May 54 4 32 15 1 - 2 — June 75 6 37 32 — - — — July 49 2 30 17 — - — — August 8 1 5 1 1 - — — September 6 1 4 1 — - — — October 12 1 7 4 — - — — November 13 1 9 3 — - — — December 7 — 3 4 — — — — Totals 1946 503 25 300 171 5 — 2 — 1946 692 46 398 242 4 2 - - Month. St. James Street. High Street. Hoe Street. Wood Stree Hale End. Hgham Hill. January 16 8 9 4 1 24 February 15 23 9 31 1 7 March 15 26 5 3 3 18 April 13 13 2 8 8 17 May 10 7 10 12 3 12 June 15 6 19 8 7 20 July 5 5 11 4 6 18 August 1 — — 2 — 5 September 1 2 — — — 3 October — 5 1 3 — 3 November — 9 1 — 1 2 December 3 — 2 — 2 — Total 1946 94 104 69 75 32 129 1945 102 88 87 122 158 135 51 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 42 4 28 10 - - - - February 21 1 14 6 — — — — March 27 2 19 6 — — — — April 33 5 21 7 — — — May 21 1 13 6 — 1 — — June 11 1 7 3 — — — — July 13 — 9 3 1 — — — August 9 1 5 3 — — — — September 7 — 6 1 — — — — October 3 1 1 1 — — — — November 7 1 6 - - - - - December 3 — 3 - - - - - Totals 1946 197 17 132 46 1 1 — — 1945 131 15 74 41 - - 1 - Month. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. January 10 5 2 1 3 21 February 6 2 — 4 3 6 March 9 6 1 — 9 2 April 2 7 4 2 4 14 May 6 3 — 3 5 4 June 2 4 2 2 - 1 July 2 2 4 1 3 1 August 5 4 — — - — September 6 — — — - 1 October 1 — — — - 2 November 3 1 — — 3 — December 2 1 — — - — Totals 946 54 35 13 13 3 30 52 1945 27 26 20 10 18 30 52 TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1946:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. m. f. m. f. m. f. m. f. Under 1 year - - 2 - - — 2 — 1- 5 years 1 4 3 1 - - 2 — 5-10 „ 1 — 3 1 - — — - 10-15 „ 1 3 1 4 - 1 - 1 15-20 „ 5 11 — — - 1 1 - 20-25 „ 13 15 3 2 2 1 — 1 25-35 „ 30 16 1 - 6 6 1 - 35-45 „ 13 6 — 2 5 4 3 - 45-55 „ 7 3 1 — 4 2 - - 55-65 „ 6 1 - 1 5 1 - - 65 and over 5 1 — — 8 — 1 — Totals 82 60 14 11 30 16 10 2 142 25 46 12 167 58 The 58 deaths represent a death rate of 0.5 per 1,000 population. New cases in 1945 were 160 with 67 deaths—i.e., a rate of 0.6. The returns for the past two years are compared below Year. New Cases. Deaths. Pulmonary. NonPulmonary. Total. Pulmonary. NonPulmonary. Total. m. f. m. f. m. f. m. f. 1946 82 60 14 11 167 30 16 10 2 58 1945 75 54 17 14 160 36 25 3 3 67 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. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 1 — 1 1 10 — 3 — 24 3 9 2 2 2 53 The ratio of deaths in non-notified cases (i.e., columns to the right of the double line) to total deaths from tuberculosis was 15 to 43 or 1 to 2.8. 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 1946:— Pulmonary. Total. NonPulmonary. Total. Grand Total. m. f. m. f. No. on Register 1st January 963 841 1,804 478 390 868 2,672 Notified during 1946 83 67 150 16 12 28 178 Totals 1,046 908 1,954 494 402 896 2,850 Removed from Register, 1946 37 21 58 4 5 9 67 No. on Register 31st December 1,009 887 1,896 490 397 887 2,783 Removals from the Register were made up as follows :— Deaths. Removals. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. m. f. m. f. m. f. m. f. 23 13 4 2 13 8 4 - 36 6 21 4 42 25 67 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. 54 Treatment of Tuberculosis.—Treatment is given under the Essex County Council's Scheme. The admissions to Hospital during 1946 were as follows:- Pulmonary. Non-Pulmonary. Total, 1946. Total, 1945. m. f. m. f. Adults 51 77 8 3 139 149 Children 6 5 5 4 20 21 G.—INFECTIOUS DISEASES HOSPITAL General.—(i) The death rate per 100 admissions was 4.6. (ii) The following table shows the admissions, discharges and deaths during 1946 :— Scarlet Fever. Diphtheria. Other Diseases. Tuberculosis. Totals. Remaining in Hospital 1st January, 1946 18 13 11 18 60 Admitted during year 181 44 233 34 492 Discharged during year 182 42 224 29 477 Died during year — 5 13 6 24 Remaining in Hospital 31st December, 1946 17 10 7 17 51 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL (including Tuberculosis cases) January 55.2 July 42.8 February 52.8 August 37.1 March 50.1 September 33.8 April 51.4 October 34.5 May 51.5 November 39.2 June 47.7 December 46.3 Average whole year 45.2 55 The question of staffing, both nursing and domestic, gave rise to continuing anxiety during the year and the position in 1947 continues to be very unsatisfactory, especially in regard to the recruitment of probationers. No real solution of the difficulty appears possible until conditions in regard to salary and hours are made comparable with those in industry and commerce. In an attempt to encourage the recruitment of probationers an attractive illustrated brochure entitled "The Story of a Nurse" was produced by the Public Relations Department in conjunction with the Matron. In addition and to improve amenities for both patients and staff a new wireless installation was provided at a cost of £300. Training.—During 1946, eight probationers passed the final examination for the Fever Nursing Certificate of the General Nursing Council. The examination fees of probationers are paid by the Council. CLINICAL REPORT Dr. M. Hamilton, Resident Medical Officer, reports as follows:— AGE AND SEX OF PATIENTS ADMITTED DURING 1946 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 28 25 43 42 10 16 11 6 92 89 181 Diphtheria 8 7 10 12 4 — — 3 22 22 44 Measles 24 8 4 3 2 — — — 30 10 40 Cerebro-Spinal Meningitis 1 1 1 - - - - 1 2 2 4 Whooping Cough 11 19 4 3 - — — — 15 22 37 Dysentery 10 1 1 — 3 — 2 3 16 4 20 Phthisis — — — — — — — 34 — 34 34 Other Diseases 26 20 12 If) 6 6 20 22 64 58 122 Staff — - - - - - - 10 — 10 10 Totals 108 81 75 70 25 22 33 79 241 251 492 56 The outstanding feature of the work in the hospital during the year has been the gradual decline, and towards the end of the year, the virtual elimination of diphtheria. Scarlet Fever is almost invariably mild on admission and the control which the sulpha drugs and penicillin can exert on the complications make them now-a-days of little importance. The need for cubicle accommodation becomes ever more pressing. Amongst the more interesting cases treated during the year were the following:— (a) A patient admitted for whooping cough with meningitis. The corrected diagnosis was whooping cough and cerebral haemorrhage due to the violence of the cough. Recovery was complete. (b) A female adult two days after admission coughed up a three inch long membrane of the trachea. Recovery was complete. SEX AND AGE AT DEATH Twenty-four deaths occurred, details of which are given below:— 5 Pulmonary Tuberculosis Females aged 19, 21, 23, 27 and 32 years. 5 Faucial Diphtheria 3 males aged 5, 4½ and 11 years. 2 females aged 5 and 28 years. 2 Cerebro-spinal Meningitis Female, aged 17 years. Male, aged 6 years. 1 Tuberculous Meningitis Male, aged 4 years. 1 Primary Bronchopneumonia Male, aged 4 months. 57 2 Broncho-pneumonia complicating Whooping Male, aged 15 months. Cough Female, aged 12 months. 1 Broncho-pneumonia complicating Measles Male, aged 8 months. 1 Broncho-pneumonia complicating Cerebrospinal Meningitis Male, aged 6 months. 1 Facial Erysipelas Female, aged 74 years. 1 Infective Enteritis Female, aged 13 months. 1 Rheumatic Fever Male, aged 11 years. 1 Cerebral Haemorrhage Female, aged 84 years. 1 Hypostatic Pneumonia complicating Enteritis Male, aged 9 months. 1 Septicaemia due to infected chilblain (P.M.) Male, aged 38 years. NUMBER OF OUTSIDE AUTHORITIES CASES AND NATURE Measles. Diphtheria. Scarlet Fever. Other Diseases. Total. Leyton 6 29 79 51 165 H.M. Forces — 2 2 5 9 Others — 1 3 6 10 Totals 6 32 84 62 184 Duration of Treatment.—The average duration of treatment in hospital was as follows:— Scarlet Fever 22.1 days Diphtheria 36.1 days Others 17.0 days 58 The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1946:— Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.) In Hospital on 1st January, 1946. Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1946. Observation 1 1 2 — T.B. Minus 6 11 9 2 6 T.B. Plus Group I — 3 1 — 2 T.B. Plus Group II 10 16 13 3 9 T.B. Plus Group III 1 — — — 1 Totals 18 30 26 5 18 MISCELLANEOUS 1. Grants.—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 2. Mortuary.—A Coroner's Court, mortuary (with special provision for infectious disease cases) and a post-mortem room is provided by your Council at Queens Road Cemetery. The Cemetery Superintendent reports that the number of inquests and post-mortems were as follows:— Inquests only 103 Post-mortems 167 Post-mortems and Inquests (not included in above) 33 Total 303 3. Post-mortem Room.—After discussion with the Coroner's Pathologist a scheme for the adaptation of a room adjoining the mortuary was prepared by the Borough Engineer and Surveyor, but approval was deferred owing to the cost. 59 4. Cremation.—Facilities for cremation are available at the Crematorium provided by the City of London at Manor Park, Little Ilford. The attempts of previous years to secure the co-operation of other areas in regard to the provision of a joint crematorium were revived and discussion is still proceeding. 5. Medical Examinations.—During the year, 163 examinations were carried out by the Medical Staff in respect of the Superannuation and Sick Pay Schemes. 6. Domestic Help.—Following the receipt of Ministry of Health Circular 110/46, your Committee recommended that the existing scheme be modified on the lines suggested and that an organiser and four full-time domestic helps be appointed together with any necessary clerical help. It was decided that the existing Home Help scheme for expectant mothers which has for many years worked well and smoothly should continue unaltered. The calls for domestic help were fortunately very few since it was not possible to recruit satisfactory domestic helpers. This position continues in 1947. 7. Nurses Act, 1943.—The County Council delegated to your Counoil functions under Part II of the Act. 8. Capital Expenditure.—The proposals under this heading included £10,000 for the modernisation and extension of the Infectious Diseases Hospital; the provision of new and additional Welfare Centres and extensions at the Maternity Hospital. 9. National Health Service Act, 1946.—Suggestions were made to the County Council as the Local Health Authority under the Act in regard to the "zoning" and reservation of some fourteen sites for future health centres. 10. Supply of Insulin.—Four patients were supplied with Insulin in accordance with Circular 2734/1943, at a total cost to the Council of £6 11s. Od. 60 SECTION H MATERNITY AND CHILD WELFARE COMMITTEE Chairman: Councillor Mrs. Candy. Ex-officio: The Worshipful the Mayor—Alderman A. G. Bottomley, O.B.E., M.P., J.P. The Deputy Mayor—Councillor Mrs. E. A. Smith, J.P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman W. B. Fitt. Alderman Mrs. C. McEntee, J.P. Alderman Mrs. E. M. Miller. Councillor E. G. Baily. Councillor M. Sharland. Mrs. R. Baily. „ R. E. Smith. W. E. Barnes. „ Mrs. Tillyer. „ Mrs. Bottomley. „ Mrs. Tweed. „ C. J. Crosbie. „ M. F. Watcham. Mrs. Frewin. Co-opted Members : Mrs. E. Clarke. Mrs. Cooper. Miss A. de Vries. Mrs. Holsworth. Mrs. M. H. Jarman. Mrs. G. E. Nicholls. Mrs. Riley. Dr. H. Watson. 61 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE Ladies and Gentlemen, A report on your Maternity and Child Welfare Services is presented in the following pages. Notified births reached a new peak for recent years, while the total infant mortality rate was the lowest ever recorded. The maternal mortality rate was again low, a result, at least in part, of some 86 per cent. of expectant mothers receiving ante-natal supervision under your Committee's arrangements. The work at Thorpe Coombe Maternity Hospital reached a new high level during the year, made possible by the discharge of patients at ten days after normal childbirth. A scheme of selective bookings had to be adopted which gave rise to much extra work and correspondence. District Midwifery cases reached a high level and great credit is due to the District Midwives. The strain on the Maternity Services generally was met with success, due to the good work of all the staff. The resignation of Miss F. Bambridge, Matron of Thorpe Coombe since its inception, was received with regret. In conclusion, I would record again your unfailing help and consideration. I am, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. STAFF Resignations Bambridge, Miss F Matron, Thorpe Coombe 4.2.46 Lambert, Mrs. D Health Visitor 12.8.46 Procopiou, Miss P Health Visitor 30.4.46 Puckle, Miss N. Matron, Thorpe Coombe 10.7.46 Appointments Evans, Miss J Clerical Assistant 28.1.46 Lambirth, Miss B Clerical Assistant 25.2.46 Manton, Mrs. M Clerical Assistant 28.1.46 Mitchell, Miss I. Health Visitor 28.1.46 Puckle, Miss N. Matron, Thorpe Coombe 1.3.46 Randall, Miss L. Matron, Thorpe Coombe 11.7.46 NOTIFICATION OF BIRTHS 2,659 births (95 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, 305 ; Midwives, 2,354. Included in the above are 282 births which were notified as having occurred outside the borough. 62 Also included are 68 stillbirths. Three were notified by Doctors and 65 by Midwives. Of the total, three occurred outside the area. REGISTRATION OF BIRTHS The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Males. Females. Totals. Legitimate 1,277 1,176 2,453 Illegitimate 46 45 91 1,323 1,221 2,544 (b) Stillbirths. Males. Females. Totals. Legitimate 42 27 69 Illegitimate 1 — 1 43 27 70 The stillbirth rate per 1,000 population was 0.59. Of the 2,333 birth registrations received in the Department between 5th January, 1946, and 28th December, 1946, a total of seven were not notified in this area, but some may possibly have been notified elsewhere. Appropriate action was taken when necessary. Of the 2,333 local registrations, 163 belonging to other areas are excluded, leaving a nett total of 2,170. 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 8 5 10 6 11 15 18 9 20 19 25 15 92 69 February 16 11 8 10 14 20 13 5 15 11 13 18 79 75 March 8 10 11 9 8 20 8 6 17 17 14 24 66 86 April 13 7 10 7 15 17 11 16 18 20 21 15 88 82 May 8 7 16 7 11 8 11 10 22 18 15 21 83 71 June 17 13 13 13 22 21 22 27 16 28 26 21 116 123 July 14 20 9 11 11 17 15 8 21 15 23 23 93 94 August 14 8 17 5 18 29 23 15 20 11 16 22 108 90 September 15 11 10 16 20 8 12 12 27 16 24 20 108 83 October 12 18 9 9 13 12 7 9 15 14 19 18 75 80 November 16 24 13 15 19 18 21 19 26 19 19 22 114 117 December 21 10 7 8 11 15 12 17 15 18 27 17 93 85 Totals 162 144 133 116 173 200 173 153 232 206 242 236 1,115 1,055 Grand Totals 306 249 373 326 438 478 2,170 VITAMINS The facilities for the distribution of vitamins outlined in the 1942 Report were continued at all Welfare Centres. 63 The position of Walthamstow out of a total of 95 Distributing Centres in the Greater London Area during the last five months of the year is shown below. Month ending Orange Juice Cod Liver Oil A. & D. Tablets Per cent. of Potential Per cent. of Potential Per cent. of Potential August 24, 1946 51.86 31.23 45.99 September 28, 1946 42.73 35.21 30.31 October 26, 1946 42.01 35.72 57.64 November 30, 1946 47.59 44.05 45.76 December 28, 1946 43.97 41.27 39.70 There is room for considerable improvement in these percentages and every effort is being made to increase the demand. DAY NURSERIES Wyatts Lane Day Nursery was closed on 31st March, 1946, on the return of the premises to the Convent Authorities for use as a residential nursery. The following table shows the average attendances at the various Nurseries during 1946 (Mondays to Fridays only). Month. Nurseries. Over 2 yrs. Under 2 yrs. Total. January Higham Hill 30.9 7.7 38.6 Handsworth Ave. 34.6 9.7 44.3 Wyatts Lane 28.2 9.9 38.1 February Higham Hill 32.4 7.7 40.1 Handsworth Ave. 33.4 8.6 42.0 Wyatts Lane 21.4 8.9 30.3 March Higham Hill 27.9 5.6 33.5 Handsworth Ave. 30.3 9.6 39.9 Wyatts Lane 19.9 4.2 24.1 April Higham Hill 35.8 10.5 46.3 Handsworth Ave. 36.4 11.7 48.1 May Higham Hill 35.1 13.2 48.3 Handsworth Ave. 40.1 11.5 51.6 June Higham Hill 34.7 14.4 49.1 Handsworth Ave. 34.8 10.4 45.3 July Higham Hill 40.2 14.1 54.3 Handsworth Ave. 33.5 9.8 43.3 August Higham Hill 37.6 11.9 49.5 Handsworth Ave. 38.4 9.1 47.5 September Higham Hill 39.1 15.7 54.8 Handsworth Ave. 38.1 12.3 50.4 October Higham Hill 40.5 14.0 54.5 Handsworth Ave. 42.6 7.5 50.1 November Higham Hill 37.0 11.6 48.6 Handsworth Ave. 40.4 5.3 45.7 December Higham Hill 34.0 12.6 46.6 Handsworth Ave. 41.1 6.2 47.3 64 Training.—One probationer obtained the Nursery Nurses Certificate. The Council agreed to pay the examination fees of probationers. Hours of Opening.—The Nurseries were open Monday to Friday from 8 a.m. to 5.30 p.m. throughout the year. 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 — There has been no demand during 1946. INFANT MORTALITY The deaths of infants under one year were:— Males. Females. Totals. Legitimate 45 36 81 Illegitimate 5 1 6 Totals 50 37 87 The death rate of infants under one year of age per 1,000 live births when calculated on the totals given by the RegistrarGeneral are therefore:— Legitimate, 33 ; Illegitimate, 66 ; Total, 34. 65 The Infant Mortality rate for other areas during 1946 was as follows:— England and Wales 43 126 County Boroughs and Great Towns (including London) 46 148 Smaller Towns (25,000 to 50,000) 37 London 41 Neo-Natal Mortality. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1946, 49 infants died in the first four weeks of life, yielding a rate of 19.2. For the last ten years in England and Wales the neo-natal deaths have been approximately half the deaths under one year of age. Infant Deaths, Neo-Natal Mortality and Stillbirths Year. Live Births. Birth Rate. 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. England & Wales. 1946 2,544 21.5 70 27.5 0.59 49 19.2 24.5 87 34 1946 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 Diarrhcea and Enteritis in children under one year of age per 1,000 live births was 1.1. TOTAL INFANT MORTALITY This is defined as the sum of the deaths that occur during child birth and during the first year of life. The attached graphs show the position siince 1930 and that the 1946 total Infant Mortality was the lowest ever recorded. 66 The general trend is steadily downwards and it will be seen . that the 1946 Infant Mortality rate was only bettered once, in 1939 ; the Stillbirth rate three times, in 1944, 1941 and 1940; and the Neo-Natal Death rate three times in 1936, 1938 and 1939. 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 Walthamstow Girls' Aid Association, which provides a hostel of 19 beds staffed by three whole-time workers. The chief difficulties during 1946 were again to secure accommodation for confinements and suitable foster mothers. The 'local Day Nurseries helped very considerably. 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, 67 Illegitimate Births and Mortality Year. Live Births. Infant Deaths. Death Rates. Legitimate. Illegitimate. Legitimate. Illegitimate. Legitimate. Illegitimate. 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 1945 1,614 2,453 99 61 6 37.0 50.0 1946 91 81 6 33.0 66.0 Miss Williams, Superintendent of the Home provided by the Walthamstow Branch of the Chelmsford Diocesan Moral Welfare Association, reports as follows:— "The total number of cases received into the Home during the year was as follows:— Total number of cases dealt with 162 Number of those living in Walthamstow 23 Number of cases referred from Stratford 3 "Expectant mothers are taken in at any time during pregnancy and employment is obtained for them until about six weeks before confinement. Mother and baby usually return to the Home 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 1946, 27 premature babies were born at home and 67 in Hospitals and Nursing Homes in the area. Of the 27 premature babies born at home, 16 were entirely nursed at home, seven died during the first 24 hours (i.e., 26%) and 19 survived at the end of one month (i.e., 70%). Of the 67 premature babies born in hospital, seven died during the first 24 hours (i.e., 10.5%) and 54 survived at the end of one month (i.e., 80.5%). The table "Causes of Death" which follows includes 22 deaths from premature birth as compared with eight in 1945. 68 CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE 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. - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - Whooping Cough — - - — — - 1 1 - 2 - 1 - — — 1 2 Diphtheria - - - - - - - - - - - - - - - - - T.B. Meningitis — - - — — - 1 - 1 2 - — - 1 — 1 2 Phthisis - - - - - - - - - - - - - - - - - Other forms of T.B. - - - - - - - - - - - - - - - - - Meningitis (Non-T.B.) — - - — — - 1 1 - 2 - — - 1 — 1 2 Convulsions 2 - - — 2 - — - - 2 2 — - — — — 2 Bronchitis - - 1 — 1 - 1 - - 2 — 1 - 1 — — 2 Pneumonia (all forms) 1 1 1 — 3 6 4 2 2 17 2 3 2 1 4 6 17 Diarrhoea, enteritis — - 1 — 1 1 2 — — 4 — — — 1 2 1 4 Syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (overlaying) - - - - - - - - - - - - - - - - - Injury at birth 3 - - — 3 1 — — — 4 — — — 1 2 1 4 Atelectasis 1 1 - - 2 - - - - 2 - - - 1 1 - 2 Congenital malformation 8 3 - — 11 3 2 1 — 17 2 2 2 3 4 4 17 Premature birth 22 — - — 22 — — — — 22 5 2 1 6 2 6 22 Atrophy, debility, marasmus 1 1 - — 2 — — — — 2 — 1 — — — 1 2 Inanition - - - - - - - - - - - - - - - - - Heart failure - - - - - - - - - - - - - - - - - Other causes 1 1 - — 2 1 3 — 2 8 1 — 1 3 1 2 8 Totals 39 7 3 — 49 12 16 5 5 87 12 10 6 20 16 23 87 69 CHILD WELFARE The equivalent of whole-time Municipal Health Visitors at the end of the year was eight, equal to one whole-time Health Visitor per 332 notified births, and one whole-time Health Visitor per 291 registered births during 1946. The following table gives a list of the current Ante-Natal and Welfare Clinics:— MATERNITY AND CHILD WELFARE CLINICS Monday 2 p.m. Ante & Post'Natal Markhouse Road, E.17. *Tuesday 9 a.m. „ „ „ „ „ „ Wednesday „ „ „ „ „ „ „ Friday „ „ „ „ „ „ „ * New cases only. Monday 2 to 4 p.m. Child Welfare St. John's Church Hall, Penrhyn Ave., E.17. Tuesday „ „ „ The Memorial Hall, Winchester Rd., E.4. Wednesday „ „ „ Low Hall Lane, Markhouse Road, E.17. Wednesday „ 55 55 "Brookscroft," Forest Road, E.17. Thursday 10 to 12 noon „ „ The Memorial Hall, Winchester Rd., E.4. Thursday 2 to 4 p.m. „ „ Low Hall Lane, Markhouse Road, E.17. Thursday „ „ „ St. John's Church Hall, Penrhyn Ave., E.17. Thursday „ „ „ “Brookscroft," Forest Road, E.17. Friday „ „ „ Low Hall Lane, Markhouse Road, E.17. The premises previously used at No. 1 Guildsway were vacated at the end of the year for larger premises at St. John's Church Hall in Penrhyn Avenue, E.17. In addition, Walthamstow Child Welfare Society holds massage and sunlight sessions. MUNICIPAL SCHEME The detailed findings at first visits paid during 1946 are given in the following table:— -J o From the above table it will be seen that of 2,314 children, 1,928 or 83.3 per cent. were breast fed on first being visited, and 26, or 1.1 per cent. had no separate sleeping accommodation. 334 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 248 46 33 19 307 249 75 2 106 45 82 53 28 12 High Street 231 25 20 — 276 252 22 2 64 170 13 6 22 Hoe Street 290 19 30 1 338 305 32 2 147 144 13 27 7 1 Wood Street 270 27 34 1 330 311 17 3 86 94 62 10 9 70 Hale End 407 44 39 1 489 475 16 — 270 103 55 43 17 22 Higham Hill 482 43 27 4 548 526 19 7 356 147 23 10 14 2 Total 1946 1,928 203 183 26 2,288 2,118 180 16 1,029 703 248 149 97 88 1945 1,270 158 154 7 1,575 1,434 139 9 773 454 214 57 46 38 71 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. infants lived in accommodation of three rooms or less, as compared with 141 in 1945. The following table shows the number and nature of visits paid during 1946:— First. Re-visits. Total. First Visits. Subsequent Visits. Total Visits. 1 2 3 4 5 6 7 8 — — 9 10 Cols. 5-10 St. James St 326 415 741 791 1,532 386 24 — 96 48 144 250 2,336 High Street 276 563 839 857 1,696 370 13 — 62 25 87 132 2,298 Hoe Street 339 674 1,013 920 1,933 408 7 — 24 3 27 230 2,605 Wood Street 331 354 685 333 1,018 179 6 — 71 4 75 98 1,376 Hale End 490 1,380 1,870 1,222 3,092 437 32 — 121 31 152 177 3,890 Higham Hill 552 1,031 1,583 2,343 3,926 241 30 4 62 23 85 239 4,525 Totals, 1946 2,314 4,417 6,731 6,466 13,197 2,021 112 4 436 134 570 1,126 17,030 Totals, 1945 1,582 4,279 5,861 9,320 15,181 2,393 95 20 274 118 383 1,181 19,262 72 INFESTATION The steps taken to combat infestation include cleanliness inspections by School Nurses at Schools once per term, treatment at School Clinics (which includes supply of Lethane and of steel combs) and inspection and treatment for scabies and pediculosis at the Skin Clinic. In addition educational work is caried out at all Walthamstow Schools, Clinics, Day Nurseries and Welfare Centres. CLINICS Dr. M. Sheppard, reports as follows:— "During 1946, the first full post-war year, the work at the Welfare Centres and Ante- and Post-Natal Clinics showed a very gratifying increase. The total Welfare Attendances were 43,525, an increase of 7,579 over the 1945 total. The Ante-Natal new cases were 1,030, making 2,769 attendances— over double the 1945 figures. The Post-Natal cases were almost double, nevertheless the number was only 80, or about eight per cent. of the ante-natal cases seen, which is far too low a percentage. "The ancillary services were much appreciated and are all doing excellent work. "Thanks are again due to the voluntary workers who have given such good service during 1946." Ante-Natal and Post-Natal Services The following table summarises the attendances at the Clinics held s— New Patients:— Ante-Natal. Post-Natal. Thorpe Coombe Maternity Hospital 1,253 920 Low Hall Lane Clinic 1,030 80 Totals 2,283 1,000 Total Attendances:— Ante-Natal. Post-Natal. Thorpe Coombe Maternity Hospital 11,955 1,503 Low Hall Lane Clinic 2,769 142 Totals 14,724 1,645 The percentage of Ante-Natal cases to notified births was 85.8. Welfare Clinics Attendances at the Municipal Welfare Clinics are summarised in the following table. Weekly attendances reached pre-war level during the year— on four occasions being over 1,000. 73 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 672 130 802 10,321 7,747 18,068 18,870 Higham Hill 395 54 449 6,098 5,080 11,178 11,627 Highams Park 404 52 456 6,395 6,177 12,572 13,028 Total 1946 1,471 236 1,707 22,814 19,004 41,818 43,525 1945 1,190 218 1,408 18,134 16,404 34,538 35,946 Child Life Protection.—At the end of 1946 there were 30 nurse-children on the Register, compared with 25 at the end of 1945. There were no deaths among nurse-children during 1946. Number on Register, 31.12.45 25 New Registrations 14 Re-registrations 1 40 Deduct : Removals from District 8 Number reaching the age of 9 years 1 Number adopted 1 — 10 Number on Register 31.12.46 30 In addition there were 71 children under nine 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:— (a) Number of persons who gave notice under Section 7 (3) during the year 19 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the year 19 (c) No. of children notified under Section 7 (3):— (i) Under Supervision at the end of the year 19 (ii) Who died during the year Nil (iii) On whom inquests were helding during the year Nil 74 (d) Particulars of any proceedings taken during the year Nil The arrangements in force in regard to Child Life Protection remain as detailed in the 1945 Report. 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 cases referred from adoption societies and Public Assistance Officers. Nineteen 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.—Six 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. 174 cases attended for massage and these made 2,237 attendances. Sale of Milk, etc., at Clinics.—The quantity and value of milk and food sold and issued free during 1946 was as follows:— Sales. Free Issue. lbs. ozs. lbs. Cow & Gate 17,239 — 208 Ostermilk 4,582 — 39 Ambrosia 1,095 — 2 Trufood 1,682 — 10 Lactogen 6,438 — 222 Prune and Banana Syrup 131 — — Parrish's Food 108 6 — Cod Liver Oil 23 — — Malt and Oil 756 — — Emulsion 358 12 — Cream of Magnesia 369 8 — Virol 1,736 — — Virolax 117 8 — Roboleine 833 — — Farex 1,075 — — Ovaltine 1,827 — — Marmite 1,542 8 — Glucose 85 — — Maltoline 700 10 — Adexolin 14 4 — Midlothian Oat Food 1,086 — — Allergilac 54 — — Sprulac 2 — — Bemax 23 — — Value £4,151 17s. 3d. 75 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. 2 to 4 p.m. Wednesday, Weighing Clinic and Dispensary 2 to 4 p.m. Treatment. Thursday, Infant Consultations. 2 to 4 p.m. 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. 1946 690 79 769 9,631 2,988 12,619 13,388 1945 545 55 600 7,211 2,348 9,559 10,159 1944 421 39 460 6,140 1,903 8,043 8,503 1943 489 51 540 8,513 2,627 11,140 11,680 1942 442 74 516 6,229 2,557 8,786 9,302 Home Visits Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1946 314 54 368 1,413 1,781 1945 319 632 951 686 1,637 1944 271 578 849 719 1,568 1943 443 824 1,267 909 2,176 1942 .. 403 1,143 1,546 1,312 2,858 A total of 180 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. 76 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 Brookscroft 1,471 236 1,707 22,814 19,004 41,818 43,525 690 79 769 9,631 2,988 12,619 13,388 Total 1946. 2,161 315 2,476 32,445 21,992 54,437 56,913 1945 1,736 273 2,008 25,345 18,752 44,097 46,105 The total of 56,913 represents the highest total ever recorded. The percentage of first attendances of children under 1 year of age at Child Welfare Centres to the number of notified live births was 97.3. Home Visits To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Municipal Scheme 2,314 4,417 6,731 6,466 13,197 Brookscroft 314 54 368 1,413 1,781 Total 1946 2,628 4,471 7,099 7,879 14,978 1945 1,901 4,911 6,812 10,006 16,818 TREATMENT (a) Orthopædic.—The facilities provided by the Education Authority's Orthopaedic Scheme are available for all children attending the Welfare Centres. 77 Mies 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 2 Torticollis 11 Rickets—(a) Genu Varum 42 Congenital dislocation of the hip 1 (b) Genu Valgum 73 Pes Piano Valgus 20 Congenital defects 15 Spastic Paralysis 5 Achondroplasia 1 Talipes—(a) Equino Varus 20 Miscellaneous 1 (b) Calcaneo Total 206 Valgus 15 (b) Dental.—The following work was done by the Education Authority's Dental Surgeons in respect of Maternity and Child Welfare patients:— Mothers. Children under 5. Cases treated 118 130 Attendances 447 259 Fillings 237 209 Extractions 97 79 General anaesthetics 43 54 Scalings 42 — Dressings 78 50 Dentures 21 — Mr. L. W. Elmer, L.D.S., Senior Dental Surgeon, submits the following report in regard to dental treatment under the Maternity and Child Welfare Scheme:— "During 1946 there was a considerable increase in the number of children under five attending the clinic, accompanied by a proportionate increase in the treatment given. This is very encouraging and shows a growing appreciation of the value of early treatment. On the other hand considerably fewer expectant and nursing mothers attended, but of this reduced number a larger proportion accepted conservative work and received it. This, of course, is all to the good, and it is hoped that in the course of time the number of mothers with gross dental sepsis, for whom extractions and dentures are the only possible treatment, will drop to zero. The earlier treat' ment which adolescents and other young people are receiving under the Municipal Dental Service should be of great assistance in helping this trend. Cases of gross neglect are, as noted in earlier reports, much fewer." 78 (c) Tonsils and Adenoids.— Twelve cases were operated on under the arrangements made by the Education Authority with the Connaught Hospital. (d) Ophthalmic Defects and Minor Ailments.— Children are given treatment either at the School Clinics or by special appointment. (e) Sunlight.— 97 infants were referred for sunlight treatment during 1946. (/) Child Guidance.—Arrangements exist for children under five years of age to be referred to the Education Authority's Child Guidance Clinic. (g) Invalid Children's Aid Association.—Miss O. M. Barnard, 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 30 Welfare Centres and School Medical Authorities 7 Orthopedic Clinic 18 Others 9 64 Classification of cases:— Anaemia and debility 12 Marasmus and malnutrition 1 Diseases of the lung (non-T.B.) i.e., bronchitis, pneumonia and asthma, etc. 11 Bone disease (non-T.B.) 11 After infectious illness or operation 6 Hilar Adenitis 2 Congenital deformities 14 Diseases of the nose and throat 1 Various 6 64 Help given to old and new cases:— Sent to Convalescent Homes and Nurseries 19 Provided with surgical appliances and boots 14 Referred for visiting and advice 12 Transferred to other agencies 5 50 79 ASSISTED MILK SCHEME Number of applications during 1946 75 Number of families assisted 61 The National Milk Scheme operated from July, 1940, and the above represents applications for special brands of dried milk not supplied under that scheme. HOME HELPS Financial assistance up to 25s. Od. per week for two weeks is granted on the assessment scale laid down by your Council. The appointment of a whole-time Home Help was sanctioned during 1945, but not proceeded with because no suitable applicant could be found, probably owing to the low rate of pay under the Hetherington Scale, although the offer of a more attractive wage during 1946 produced the same result. Applicants are therefore required to make their own arrangements. Failing this the Health Visitors are usually able to arrange a suitable Home Help. Home Helps are, however, almost as difficult to obtain as Domestic Helps, and in view of this the pre-war restriction in regard to relatives has been waived for the time being. During the year there were 191 applications for assistance, of which two were granted free, 116 were granted at part cost and 73 were rejected as they were over the scale laid down by the Council. The demand for Home Helps has been as follows during the past eight years 1939 (125); 1940 (128); 1941 (105); 1942 (140) ; 1943 (175); 1944 (133); 1945 (130); 1946 (118). PRIORITY SHEET DOCKETS Priority Dockets for sheets were supplied, on behalf of the Board of Trade, to expectant mothers who were being confined at home, on production of a certificate from the Midwife stating that home confinement was hampered by lack of sheets. During 1946, 760 mothers were supplied with 2,100 dockets. STERILISED MATERNITY OUTFITS A total of 801 sets were supplied and 165 outfits were issued below cost price. INSTITUTIONAL TREATMENT No children were sent to Institutions under your Committee's arrangements. 80 CONFINEMENTS The following table shows the location of confinements for 1946 and the previous eight years. CONFINEMENTS 1938 1939 1940 1941 1942 1943 1944 1945 1946 Thorpe Coombe Maternity Hospital 691 595 720 645 695 891 907 995 1,247 Other Hospitals and Maternity Homes . . 437 322 203 104 242 236 257 226 442 Total in Hospital 1,128 917 923 749 937 1,127 1,164 1,221 1,689 District Municipal 303 299 364 155 284 293 266 157 350 W.D.N.A 168 162 164 142 222 205 203 178 336 W.D.N.A. (Private) 56 56 80 20 49 30 43 12 31 W.D.N.A. Total 224 218 244 162 271 235 246 190 367 Total on District 527 517 608 317 555 528 512 347 717 Grand Totals 1,655 1,434 1,531 1,066 1,492 1,655 1,676 1,568 2,406 Births Registered 1,617 1,606 1,575 1,304 1,718 1,828 1,915 1,730 2,544 The discrepancy in the last two lines is due to births in the reception areas, and to births not falling into the above headings. 81 HOSPITAL ACCOMMODATION FOR CONFINEMENTS The following numbers of confinements occurred at the Institutions specified (Walthamstow residents only):— 1946 1945 Thorpe Coombe Maternity Hospital 1,247 995 Maternity Homes in Walthamstow 160 67 Mothers' Hospital, Clapton 108 58 Forest Gate Hospital 30 28 Other Maternity Hospitals and Homes 144 73 Totals 1,689 1,221 EVACUATION OF EXPECTANT MOTHERS Since August 1st, 1945, cases have been charged to the Council at 15s. 0d. per day, the total cost per case amounting to over £26. 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 three cases during 1946. WALTHAMSTOW DISTRICT NURSING ASSOCIATION (In affiliation with the Queen's Institute of District Nursing) Homes:— Central Home 17 and 19, Carisbrooke Road, E.17. Branch Home 18, Lyndhurst Rd., Highams Park, E.4. The Superintendent, Miss C. A. Lee, S.R.N., S.C.M., reports as follows:— "I have pleasure in submitting a short account of the activities of the Walthamstow District Nursing Association for the year 1946. "It has been a busy but entirely satisfying year—midwifery and general nursing cases were equally heavy and we fed we have really justified our existence. "We are all most grateful for the continued help we receive—in particular we are grateful to Dr. Sheppard and the Health Visitors for all their attention to the midwifery cases referred to Low Hall Lane Clinic and to Dr. Rodway at Thorpe Coombe who so willingly finds room for midwifery cases which for one reason or another cannot be nursed in their own homes. "We are fortunate in having more staff for the general nursing—four of these nurses are midwives and have been able to help the Municipal Midwives fulfil their heavy obligations. "The cases for the year ending December 31st, 1946, are as follows:— Municipal. Voluntary. Total. Without Doctor 290 20 310 With Doctor 46 11 57 336 31 367 82 "Our financial outlook at the moment is black, so regretfully the Committee of the W.D.N.A. have decided to increase the cost of Membership for the Provident Scheme and raise the cost of the nursing fees. "This, by the end of 1947, should have considerably relieved the situation." POST-GRADUATE LECTURES TO MIDWIVES Four lectures to midwives were given in May and June by Dr. Alan Brews, F.R.C.S., F.R.C.O.G. The subjects were as follows:— 1. Toxaemias of Late Pregnancy. 2. Antepartum and Postpartum Haemorrhage. 3. Delay in Labour. 4. Abnormalities of the Puerperium. A total of 126 attended, including medical practitioners. MIDWIVES ACTS, 1902-1936 No. of Notices of Intention to Practise, January, 1946 29 „ „ „ „ during 1946 16 Total 45 No. of Midwives ceasing to practise during 1946 10 „ „ practising at the end of 1946 35 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) durine 1946:— No. of confinements attended as a Midwife 1,910 „ „ „ „ „ Maternity Nurse 356 ,, medical aid notices sent 518 „ notifications of deaths (all children) 5 „ twin births notified 30 ,, stillbirths notified 12 „ notifications of liability to be a source of infection 3 „ notifications of laying out of a dead body — ,, notifications of artificial feeding 5 ,, notifications of disinfection 6 The above table includes the following numbers with regard to work done at Thorpe Coombe:— Midwifery cases 1,084 Maternity cases 163 Medical Aid Notices 299 The percentage of Medical Aid Notices were:— All cases 27.1 Maternity Hospital Midwives 27.6 Domiciliary Midwives 26.5 83 The conditions for which Medical Aid was summoned by Midwives in domiciliary practice have been summarised and were as follows:— For complications during pregnancy:— Miscarriage 6 Antepartum hæmorrhage 7 Hyperemesis — Albuminuria 1 Other conditions 4 18 For complications during labour:— Prolonged 1st and 2nd stage 22 Post-partum haemorrhage 2 Ruptured perineum 105 Retained placenta 6 Premature labour — Abnormal presentation 9 Rise of temperature 8 Other conditions 17 Total 169 For complications in regard to the infant:— Stillbirth 4 Prematurity and Feebleness 10 Jaundice 3 Convulsions 1 Cyanosis 3 Other conditions 11 Total 37 Medical Aid Fees.—Your Committee recommend that, as from beginning of the next financial year, no recovery was to be obtained from the patient in regard to medical aid fees. Compensation for Loss of Cases.—Compensation is made to Midwives by payment of 10s. Od. 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 1946. Gas and Air Analgesia.—Your Committee requested the Health Committee to appoint an additional Municipal Ambulance Service Driver in order to provide transport facilities for gas and air apparatus. 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. Municipal 1,250 2,171 34 310 40 5,209 8,664 W.D.N.A 1,207 2,338 — 290 46 5,893 9,438 Total 2,457 4,509 34 600 86 11,102 18,102 84 FACILITIES FOR CONFINEMENT The table below gives details of "future bookings" at the end of the month stated. The peak months for Thorpe Coombe bookings were June to October, for District bookings October to December, and for total bookings October and November. Since the end of the year bookings have declined sharply and at the time of writing (June, 1947) it has become possible to remove aill restrictions on bookings at Thorpe Coombe. Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. (a) Thorpe Coombe 592 589 609 609 612 624 624 639 625 623 604 579 (b) District Municipal 117 149 150 186 191 195 187 205 224 243 238 228 (c) District, W.D.N.A. 154 197 220 210 233 206 220 210 223 259 260 266 (d) Total (ft) and (c) 271 346 370 396 424 401 407 415 447 502 498 494 Grand Total (a) and (d) 863 935 979 1,005 1,036 1,025 1,031 1,054 1,072 1,125 1,102 1,073 Public Health Act, 1936 (Nursing Homes).—See Public Health Section of the Report. PUERPERAL PYREXIA Thirty-three cases of Puerperal Pyrexia were notified during 1946. The notifications were received from the following sources:— Maternity Hospital 19 Hospitals outside the area 9 General Practitioners 5* * All were in Hospital or admitted except one. The Puerperal Pyrexia rate for 1946 was 12.62 per 1,000 births as compared with 18.08 in 1945, 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 8.50 126 County Boroughs and Great Towns, including London 10.35 85 148 Smaller Towns (25,000 to 50,000 population) 7.63 London Administrative County 1.62 9.68* Walthamstow 12.24 * 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. 1946 33 12.62 1945 32 18.08 1944 28 14.23 1943 44 23.33 The rates have been high because of the strictness of notification 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 1946 by Midwives in accordance with Rule E of the Central Midwives Board was:— Threatened abortion and miscarriage Nil Abortion and miscarriage Nil OPHTHALMIA NEONATORUM The number of cases notified during the last two years were:— Year. Totals. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. 1946 4 1 — — 1 1 1 1946 2 — — — — — 2 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1946 .. 3 1 4 - - - 1946 .. — 2 2 — — — 86 MATERNAL MORTALITY During 1946, there were two deaths due to other puerperal causes. Particulars reflating to these deaths are given in the accompanying table. It must be stressed that in one of these maternal deaths, childbirth took place seven years ago (Case No. 1). DEATHS DUE TO PREGNANCY AND CHILD BEARING AND/OR ASSOCIATED THEREWITH DURING 1946 Case No. Date of Death. Certified Cause of Death and Classification. Age. Ward. 1 22.11.46 Uraemia. Renal Hypertension. Toxaemia of Pregnancy 24 H.H. 2 22.10.46 Obstetric Shock (Natural) due to antepartum and postpartum haemorrhage due to toxaemia of pregnancy 32 H.E. The following "table shows the maternal mortality rates for 1946:— Deaths of Women due to Pregnancy and Child-Bearing. Births. Registered. WALTHAMSTOW. England and Wales. Puerperal Sepsis. (Heading 29 R.G.) Other Puerperal Causes. (Heading 30 R.G.) Total Rates per 1,000 Births registered. Rates per 1,000 Births registered. Puerperal Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal Causes. Total. Live, 2,544 — 2 2 — 0.78 0.78 Not available Live and Stillbirths, 2,614 — 2 2 — 0.70 0.70 „ „ „ 87 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). 1946. 1945. 1944. 1943. 1942. Maternal Mortality 0.78 1.74 5.21 4.92 1.16 Stillbirths 27.5 32.6 27.1 30.7 30.2 Neo-Natal Deaths 19.2 21.0 20.8 26.2 20.3 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. 1946 2,614 — 2 2 — 0.70 0.70 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 MISCELLANEOUS. Maternity Survey.—Your Committee authorised participation in the survey organised by the Royal College of Obstetricians and Gynaecologists. Capital Expenditure.—The suggested programme of capital expenditure included the provision of new welfare centres at Higham Hill and Highams Park and the further extension of Thorpe Coombe Maternity Hospital. 88 I. THORPE COOMBE MATERNITY HOSPITAL. Bookings.—In February, in view of the pressure on the accommodation at Thorpe Coombe your Committee recommended a schemc of selective bookings on the following basis per month:— First confinements, 50; unsatisfactory conditions, 25; for medical/obstetric reasons, 15; plus late emergencies. With a maximum total of 105 per month. After receipt of Ministry of Health Circular 96/46 your Committee recommended that patients be discharged on the 10th day unless medical and home conditions contra-indicated—home nursing to be provided by the Domiciliary Midwifery Sisters. Bookings Refused. Residents. Non-residents. Total. 1943 257 107 364 1944 66 102 168 1945 121 130 251 1946 538 163 701 Research.—Dr. Helen Rodway contributed a paper on "The Effects of Exercises on Child Bearing" to the Journal of Obstetricians and Gynaecologists of the British Empire. 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 labour and isolation beds)—50. 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—1,443 plus three miscarriages (including ante-natal and post-natal admissions). 3a. Number of women treated during the year in the ante-natal beds shown against item 2 a. (These women should be included also against item 3)—203. 3b. Average duration of stay of expectant mothers in the antenatal beds shown against item 2a—4.54. 4. Average duration of stay of cases in lying-in wards—12.4. 5. Number of cases delivered by— (a) Midwives—1,084; (b) Doctors—163; Total—1,247. 6. Number of cases in which medical assistance was sought by a midwife in emergency—299. 7. Number of cases admitted after delivery—18. 8. Number of cases notified as— (a) Puerperal Fever—Nil; (b) Puerperal Pyrexia, 19. 89 9. Number of cases of pemphigus neonatorum—Nil. 10. (a) Number of infants on a supplementary or complementary feed on discharge—170. (b) Number of infants wholly breast fed on leaving the Institution—1,027. 11. (a) Number of cases notified as ophthalmia neonatorum—1. (b) Result of treatment in each case—Satisfactory. 12. (a) Number of maternal deaths—3 (1 admitted after delivery). 13. (a) Number of stillbirths—46. (b) Cause of death 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—19. (b) Cause of death in each case, and results of post-mortem examination (if obtainable)—See Clinical Report. The stillbirth rate was 36.8 per 1,000 live and still births, and the neo-natal mortality within 10 days of birth was 15.2 per 1,000 live births. (b) Occupation of Beds.— The average daily occupation of beds was as follows:— January 45.1 July 46.9 February 46.1 August 42.4 March 49.6 September 48.0 April 48.4 October 44.4 May 50.5 November 45.8 June 49.7 December 44.9 The average for the whole year was equal to 93.8 per cent, of beds occupied (based on 50 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 Part I) and Part II of the training. During 1946, 24 pupils from Thorpe Coombe obtained the Part I and 24 the Part II Certificate of the Central Midwives Board. The Council agreed to pay the examination fees. (f) Conditions of Service.—The Council have adopted all the recommendations of the Midwives' Salaries Committee. 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 1946 The Hospital, with 35 maternity beds, was opened in May, 1934, and in the eight months of that year there were 229 90 ments. In 1946, with 54 beds, there were 1,247 confinements in twelve months, bringing the total figure since the Hospital was opened to 9,561. Of these 1,247 confinements, 684, that is 54 per cent., were first births. The number of infants born in 1946 was 1,264. This includes 17 cases of twins, a percentage of 1.34 relative to the total number of confinements. There were 1,446 admissions including 69 unbooked cases and in addition 17 infant admissions. Attendances at the antenatal clinics during the year were as usual good, 1,253 expectant mothers making 11,955 attendances for examinations and in addition mothers expecting the first baby making over 750 attendances at the monthly mothercraft educational classes. At the post-natal clinic 920 mothers, a percentage of 73.7 of the related confinements, attended for examination and advice approximately six weeks from the date of confinement and made 583 subsequent attendances for treatment. 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— (A) Antenatal Clinics: No. of Clinics held. No. of attendances. Average attendance per session. (a) Consultant's Clinics 12 98 8.1 (b) Resident Obstetrician's Clinics 209 *1,253 6.0 do. — †4,411 21.0 (c) Midwives' Clinics 238 6,193 26.0 Totals 459 11,955 * New patients, † Old patients. The average number of attendances made by each patient was 9.5. (B) Post-Natal Clinics : No. of Clinics held. No. of attendances. Average attendance at each session. (a) First Visits 52 920 17.7 (b) Subsequent Visits 583 11.2 Total 1,503 28.9 Percentage of first visits relative to number of confinements was 73. 91 COMPARATIVE FIGURES FOR CONFINEMENTS AND CLINIC Attendances from May, 1934, until December 31st, 1946 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1. No. of confinements 1,247 995 907 891 695 645 720 595 691 640 660 646 229 2. Total number of admissions 1,446 1,135 1,018 1,037 801 717 817 676 775 729 769 747 258 3. Clinic Attendances: Ante-Natal Clinics— (a) New Patients 1,263 1,190 1,016 944 764 824 750 733 702 753 691 762 371 (b) Old Patients 10,702 8,692 7,666 7,775 6,551 5,661 6,679 5,750 6,032 5,501 5,354 4,543 1,745 Total Ante-Natal Attendances 11,955 9,882 8,682 8,719 7,315 6,485 7,429 6,483 6,734 6,254 6,045 5,305 2,116 Pott-Natal Clinics— (a) First attendances 920 667 617 769 504 315 330 401 479 380 463 256 - (b) Subsequent attendances 583 227 219 114 117 149 140 156 151 145 177 210 — Total Post-Natal Attendances 1,503 894 836 883 621 464 470 556 630 526 630 466 — 92 ADMISSIONS TO THE HOSPITAL (a) Ante-Natal 203 (25 patients were delivered before discharge.) (b) For Confinement 1,222 (c) Post-Natal 18 (d) On account of miscarriage 3 (e) Infants 17 Total 1,446 Indications for the Admission of Ante-Natal Patients. No. of Cases. Ante-partum haemorrhage 16 Pregnancy toxæmia 70 Hyperpiesis and oedema 7 Hyperemesis 3 Heart disease 16 Hydramnios 1 Urinary infection 7 Breech for version 18 For rest and treatment on account of anaemia, debility, and multiple pregnancy 10 For induction of labour 11 Total 104 This represents 8.3 per cent, relative to 1,247 confinements. For observation and discharged because not in labour 99 Total 203 Emergency Admissions: Ante-partum haemorrhage 9 Pregnancy toxaemia 3 Hvperemesis 2 Hyperpiesis 1 Hydramnios and death of foetus 2 Twin pregnancy 3 Breech for version 2 Breech for delivery 6 Complications of labour 13 Premature labour 5 Unsatisfactory home conditions 2 Arrangements for confinement failed 3 Total 51 93 Postnatal Admissions: Post-partum haemorrhage 8 With premature infant 3 Post-partum eclampsia 1 For minor operation and treatment 2 Unsatisfactory medical condition 2 Unsatisfactory home conditions 2 Total 18 Operations Performed: External version 18 Internal version 2 Surgical induction of labour 13 Forceps delivery 84 Exploration of uterus 4 Cæsarean section 3 Manual removal of the placenta 18 Total 142 Medical Aid Requests: Ante-partum haemorrhage 10 Premature labour 3 Previous stillbirths 2 Foetal death ; foetal abnormality 2 Unsatisfactory condition of patient 2 Fit during second stage 1 Prolapsed cord 3 Cardiac 3 Abnormal presentation 2 Breech delivery 25 Foetal distress 26 Maternal distress 8 Foetal and maternal distress 3 Delay in 2nd stage 62 Delay in 3rd stage and post-partum haemorrhage l5 Post-partum haemorrhage 17 Perineal lacerations 102 Total 286 Unsatisfactory condition of infant 13 Total 299 94 The percentage of medical aid requests relative to the number of confinements was 22.9 and for the infant 1.0. INFANTS The number of infants born in the hospital this year was 1,264; this figure includes 17 cases of twins and 81 premature infants, a premature birth rate of 6.4 relative to the total number of infants. In addition 17 infants, of which eight were premature, were admitted from the district. Premature Infants.—For statistical reports a premature infant is taken as one weighing 5½ lbs. or less. This is an international standard. Infants born in Thorpe Coombe. Infants born at home. (a) 5½ lbs. or more than 4½ lbs. 48 1 (b) 4½ lbs. „ „ „ 3½ lbs. 19 5 (c) 3½ lbs. „ „ „ 2½ lbs. 8 2 (d) 2½ lbs. or less 6 — Totals 81 8 Breast Feeding.—On discharge from Thorpe Coombe at 14 days, up to May, and later from 10 to 12 days, 85.8 per cent, of mothers were breast feeding their infants, 10.2 per cent, partly breast feeding, while 4 per cent, of infants were fed on dried cows' milk. 1946 1946 1944 1943 1942 1941 1940 1939 (a) Infants completely breast fed 85.8 88.1 85.6 82.5 83.9 87.6 77.4 75.9 (b) Infants partly breast fed 10.2 9.4 11.5 12.2 12.0 9.9 18.7 18.7 (c) Infants not breast fed 4.0 2.5 2.9 5.3 4.1 2.5 3.9 5.4 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 95 FOETAL AND INFANT MORTALITY Number of cases. Birth Weight. Total. 5½ lbs. or less. Over 5½ lbs. (a) Stillbirths. (i) Developmental defects 5 13 18 (ii) Maternal haemorrhage; Toxaemia and other illness 10 8 18 (iii) Erythroblastosis foetalis — 1 1 (iv) Complications of labour — 6 6 (v) Unknown 1 2 3 Totals 16 30 46 (b) Infant Deaths. (i) Prematurity and associated conditions 9 - 9 (ii) Pneumonia and prematurity 2 — 2 (iii) Developmental defects — 5 5 (iv) Hæmorrhagic disease 2 — 2 (v) Intracranial haemorrhage — 2 2 (vi) Circulatory failure — 1 1 Totals 13 8 21 Stillbirths. Infant Deaths. (a) Booked cases 32 17 (b) Unbooked cases 14 4 Totals 46 21 Two infants admitted from the district died in the Hospital; one baby 3 lbs. 13 ozs. died of atelectasis and the other congenital malformation of the heart. PUERPERAL PYREXIA The number of cases in which pyrexia occurred in the puerperium was for booked cases 16, a percentage of 1.33 relative to 1,196 booked confinements, and for unbooked cases 3, a percentage of 4.3 relative to 69 emergency admissions (18 of which took place at home). 96 Apparent Causes of Pyrexia. No. of cases. Percentage of cases relative to total of 19 (a) Local uterine infection—Booked cases 6 31.6 Unbooked „ 3 15.7 (b) Urinary infection 5 26.3 (c) Local uterine infection, also urinary infection 2 10.5 (d) Non-suppurative mastitis 1 5.3 (e) Pulmonary embolus 1 5.3 (f) Tonsillitis 1 5.3 19 Maternal Deaths. There were two maternal deaths of patients delivered in the Hospital. One was due to myocarditis associated with congenital malformation of the heart and the other to obstetric shock due to ante-partum and post-partum haemorrhage. Another patient admitted after delivery died of uraemia following post-partum haemorrhage.