WHAM 2 County Borough of West Ham. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1923. 66 206 INDEX. PAGE Ambulance 13 Bacteriological Investigations 5 Births 2 Cancer 9, 11 Chief Vital Statistics since 1877 40 Cowsheds 28, 29 Dagenham Sanatorium, Medical Officer's Report 55, 56 Dairies, Cowsheds and Milkshops Order 30 Deaths 2, 38 Deaths in Public Institutions 2, 3 Documents, Official, relating to Public Health 42, 43, 44 Extracts from Vital Statistics of the year 5 Factory and Workshop Act, 1901 25, 26 Food, Unsound, Condemned 32 Fur Dermatosis 11 Home Workers 27 Hospital Accommodation 11. 12 Housing 22, 23, 24 House Refuse, Collection of 42 Infectious Diseases 5, 6, 7, 39 Measles 6 Midwives' Acts, 1908 and 1918 15 Milk and Cream Regulations, 1912 and 1917 33, 34, 35, 36 Milk, Distribution of 16, 17, 18 Mortuaries 41, 42 Nuisances, Abatement of 28 Physical Features and General Character of the District 1 Plaistow Hospital 44, 45, 46, 47, 48, 49 Prosecutions 32, 36, 37 Samples taken (Sale of Food and Drugs Acts) during 1923 32, 33 Slaughter Houses 29, 30 Summary of General Statistics 4 Summary of Work of Sanitary Inspectors 30, 31 Tuberculosis 8 Tuberculosis Officer, Report of 49, 50, 51, 52, 53, 54 Venereal Disease 21 Vital Statistics of Wards, 1923 4 Welfare Centre and Clinics 15 County Borough of West Ham ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1923. Physical Features and General Character of the District. West Ham is situated in latitude 51° 30' to 51° 33' N. and longitude 0° 1' to 0° 3' E., in the extreme south-west of the County of Essex and on the eastern side of the administrative County of London, from which it is separated by the windings of the River Lee and Bow Creek for 3½ miles. In shape it is an irregular rhomboid, some 2 miles from east to west, and 4 miles from north to south, comprising within its boundaries 4,706 acres. The northern and eastern sides of the Borough are contiguous to the populated district of Leyton and the County Borough of East Ham respectively. The southern boundary is formed by the river Thames for 2 1/8 miles. In elevation it is almost flat, varying from less than 5 feet to 45 feet above ordnance datum, about half the area being not more than 10 feet above that level, and consequently protected only from serious flooding by the river banks. Chalk may be reached at depths varying from 100 to 150 feet, overlaid by green Thariet sands and Woolwich beds, on which rests 5 to 50 feet of London clay. In the north-eastern half of the Borough 16 feet to 20 feet of river drift gravel overlays the London clay, sloping down towards the river Lee and river Thames in the marshy clay and alluvium, a large part of the surface being made ground. Considerable excavations of the gravel have been removed m patches in connection with the erection of buildings and cellars, not approved by the Local Board, constructed which in times of storm are liable to temporary flooding. 2 Births. The number of births registered in the Borough during the year was 8,173 (4,229 males and 3,944 females), but of this total 523 were children of non-residents who came to be confined in one or other of the maternity hospitals or were visiting friends, while 153 West Ham mothers were confined outside the Borough. Suitable adjustment makes the net West Ham births 7,803 (4,018 males and 3,785 females); 225 of these (120 male and 105 female) were illegitimate. Calculated on the Registrar General's estimate of the population of the Borough at the middle of 1923, viz., 314,400, the birth-rate for the year was 24.81. This was the lowest birth-rate yet published except during the War years 1917 and 1918. 7,609 live births and 235 still births were notified within 36 hours in accordance with the Notification of Births Act. Deaths. The numbar of deaths registered during the year was 2,409, but of these 208 occurred in persons not belonging to the Borough, while the deaths of 1,130 residents of West Ham occurred in various institutions and districts elsewhere, making the total net deaths attributable to the Borough number 3,331, of which 1,803 were males and 1,528 females. The distribution of these deaths to their various causes will be found later in this Report and in the Appendix; but the grand total of 3,331 from all causes gives an annual death-rate of 10.59 per 1,000 of the estimated population, which is the lowest death-rate recorded during the past 47 years. Deaths in Public Institutions. The increasing use made of the facilities for Institutional treatment is shown by the subjoined table, which also serves to some extent as an index of prevailing distress. The larger Institutions serving the Borough, such as the Whipps Cross Hospital and Central Home of the Board of Guardians, and the Borough Mental Hospital, are situate outside the Borough boundary, while in addition many West Ham residents are received into the London Hospitals and Institutions elsewhere. Similarly the Public Institutions within the Borough (Plaistow Hospital, Queen Mary's Hospital for the East End, St. Mary's 3 Hospital, Plaistow Maternity Charity, I.C.C.S. Children's Hospital, Royal Albert Dock Hospital and Forest Gate Sick Home) receive patients from the surrounding districts whose deaths are registered in the district, but have to be excluded from tabulation as transferable to West Ham. It will be noted that in the former group (outside Institutions) 59 infants and 1,071 persons over the age of 1 year died during the year, and in the latter group (inside Institutions) 134 infants and 372 elders died, of which numbers 38 infants' and 170 elders' deaths were of non-residents of the Borough. The net deaths of West Ham residents in Public Institutions were 155 infants and 1,273 persons of one year and upwards, making a total of 1,428 institutional deaths as compared with 1,903 deaths in private residences. That is to say, over 42 per cent. of the deaths during the year occurred in Public Institutions. Twenty years ago the percentage was, so far as could be ascertained, not more than 25. Deaths in Outside Institutions:— Under 1 year. 1 year and upwards. Whipps Cross Hospital 18 399 Central Home — 296 Dagenham Sanatorium — 38 Goodmayes Mental Hospital — 58 Residents dying in London Institutions &c. 41 280 Deaths in Inside Institutions: — Plaistow Hospital 3 40 Queen Mary's Hospital for East End 54 144 St. Mary's Hospital 34 41 Plaistow Maternity Charity 13 5 Royal Albert Dock Hospital — 53 I.C.C.S. Children's Hospital 7 2 Forest Gate Sick Home 20 63 Other Places, e.g., Docks 3 24 193 1443 Non-residents dying in Inside Institutions 38 170 155 1273 Net West Ham Deaths in Institutions = 1428 4 Vital Statistics of the Wards of the Borough during 1923. Wards. Census Population adjusted to middle of 1921 by RegistrarGenl. Births. Birth Rate. Deaths. Death Rate. Infant Deaths. Infant Mortality per 1,000 births Natural increase Births over Deaths. Estimated population middle of 1933. New Town 18,963 449 23.18 220 11.35 33 73 229 19,369 Forest Gate 19,842 382 19.11 167 10.75 13 34 167 19,983 High Street 18 511 518 27.13 329 9.90 35 67 329 19,088 Broadway 15,568 359 22.80 163 12.44 27 75 163 15,745 Park 15,854 319 19.81 145 10.85 13 40 145 16,031 Upton 18,020 342 18.87 156 10.26 17 49 156 18,117 Plashet Road 16,034 355 21 77 182 10.61 18 50 182 16,298 West Ham 17,855 392 21.47 217 9.58 16 40 217 18,254 Plaistow 21,665 518 23.37 291 10.24 29 56 291 22,159 Bemersyde 14,981 296 19.35 154 9.34 17 57 154 15,193 Canning Tn.& Grange 24,450 686 27.22 426 10.31 46 67 426 25,197 Hudsons 20,607 458 21.61 263 9.20 22 48 263 21,190 Ordnance 20,403 636 30.03 398 11.24 41 64 398 21,174 Beckton Road 20,322 648 30.72 443 9.72 43 66 443 21,090 Tidal Basin 22,122 861 37.32 574 12.44 62 72 574 23,068 CustomHo.& Silvertn 21,803 584 26.32 335 11.09 34 58 335 22,444 County Borough 307,000 7,803 24.81 3,331 10.59 466 59 4,472 314,400 Summary of General Statistics, IN THE FORM ASKED FOR BY THE MINISTRY OF HEALTH. Area (acres), 4,706. Population (1923), 314,400. Number of inhabited houses (1921), 47,995. Number of families or separate occupiers (1921), 68,569. Rateable value—Poor Rate, £1,410,738. General District Rate, £1,324,685. Sum represented by a penny rate—General District Rate, £5,340. 5 Extracts from Vital Statistics of the Year. Births— Total. Male. Female. Birth-rate, 24.81 Legitimate 7,578 3,898 3,680 Illegitimate 225 120 105 Deaths 3,331 1,803 1,528 Death-rate, 10.59 Number of women dying in or consequence of child-birth— From Sepsis 11 From other causes 13 Deaths of infants under one year of age per 1,000 births— Legitimate, 439; illegitimate, 27. Total 466 Deaths from measles (all ages) 12 Deaths from whooping cough (all ages) 23 Deaths from diarrhoea (under 2 years of age) 70 Bacteriological Investigations. In addition to the Bacteriological routine work carried out at the Plaistow Hospital and the Tuberculosis Dispensary (recorded in the Appendix), 280 diphtheria specimens and 148 tubercular sputa were examined on behalf of the Public Health Department and private practitioners. In connection with a diphtheria outbreak at one school in the Borough, prompt inspection by two Assistant School Medical Officers, accompanied by bacteriological investigation, discovered an unsuspected " carrier." whose exclusion checked further spread of the disease. Infectious Diseases Below is appended a table showing the number of cases of the notifiable diseases occurring during the year, together with the number removed to hospitals and the total number of deaths in each disease. Disease. Cases Notified. Removed to Hospital. Total Deaths. Smallpox 2 2 .. Diphtheria 701 671 27 Scarlet Fever 530 412 7 Enteric F ever and Paratyphoid 25 10 1 Puerpural Fever 16 14 11 Pneumonia 198 .. 119 Cerebro Spinal Fever 1 1 3 Acute Poliomyelitis, etc. 5 4 .. Encephalitis Lethargica 6 2 2 Erysipelas 138 .. 4 Ophthalmia Neonatorum 31 .. .. Malaria .. .. .. 6 It may be of interest to compare the incidence of some of these diseases with the figures for England and Wales supplied by the Registrar General, as set out below:— Disease. Case rate per 1,000 population West Ham. England and Wales. Smallpox 0.00 0.06 Scarlet Fever 1.68 2.23 Diphtheria 2.22 1.04 Enteric Fever 0.07 0.08 Puerperal Fever 0.05 0.06 Erysipelas 0.43 0.32 In addition to the above, some other diseases need comment. Measles. At the time of writing a proposal has been made by the West Ham Branch of the National Council of Women Teachers that this disease should be made compulsorily notifiable. One can sympathise with the teachers, whose salaries, owing to the grading of the schools per attendance, may be affected adversely by a scant attendance due to measles which the Education Committee does not consider grave enough to justify special exemption from lower grading; but it is more than doubtful whether the proposal will either secure the object sought or materially benefit the public health. Not only have towns which secured special powers in this respect subsequently found them of little value, but from the year 1915 to 1919, by general order of the Local Government Board, primary cases of measles and German measles were made notifiable throughout the country, and the experience gained led to the rescinding order of the latter year. Owing to the fact that the majority of cases of the disease are not seen by a doctor unless some complication arises, notification gives a very imperfect estimate of the incidence of the complaint, whereas by the arrangement authorized by the Education Committee whereby the School Attendance Officers report to the Medical Officer of Health absentee school children suffering from illness, a more liberal knowledge of juvenile sickness is gained by him than through the medium of notification. During the year under review by the method referred to above, 1,066 cases of measles and 854 cases of whooping cough were brought to the notice of the Medical Officer of Health, of 7 which 519 cases of measles and 204 cases of whooping cough occurred in children under 5 years of age. The correctness of the diagnosis is, of course, liable to error in many cases, but such liability would still remain under a system of notification for the reason already stated. The number of deaths certified as due to these causes were 12 and 23 respectively, astonishingly small numbers when compared with those of a severer epidemic year, such as 1909, when in a much smaller population the deaths from measles and whooping cough were 217 and 184 respectively. Change of type in disease may account partly for a diminished death-rate, but education also is a potent factor not to be forgotten and that the Public Health Department is an educational force which never sleeps may be exemplified in the case of these juvenile complaints. It is impossible to visit every case of illness that is not under the care of a medical practitioner, but the majority of measles, whooping cough, chicken pox and other diseases coming to the knowledge of the Department have for years been visited by the Women Sanitary Inspectors, who, by distributing special leaflets accompanied by friendly advice to those who often are woefully in need of it, must be materially aiding the conquest of disease, while of recent years the visitation of infants and children under 5 years by the Health Visitors under the Maternity and Child Welfare Scheme by the same means affords justification for the statement that disease is being prevented. The visits in case of sickness which the Women Sanitary Inspectors dovetailed into their other work during the year may be seen from the accompanying table:— Disease. Number reported. Number Visited. Disease. Number reported. Number visited. Chicken Pox 1,222 825 Tonsillitis, sore throat 1,335 825 Measles 1,066 1,037 Ringworm 219 145 Whooping Cough 318 318 Scabies 53 37 Influenza 559 364 Other Skin 871 553 Other Infections 687 260 Tuberculosis 108 73 Catarrh Colds 730 288 Injuries 216 124 Bronchitis 631 397 Other causes 1,073 737 Several of these cases were admitted to the Plaistow Hospital for Infectious Disease, as will be seen in Dr. MacIntyre's report on the work of the Hospitals. 8 Tuberculosis. The following table, in the form desired by the Ministry of Health, sets out the number of notified cases of Tuberculosis and the number of deaths during the year at certain age periods, distinguishing separately the pulmonary and non-pulmonary forms, males and females:— Age Periods. New Cases. Deaths. Pulmonary. No n-pulmonary Pulmonary. Non-pulmonary. M. F. M. F. M. F. M. F. 0 1 .. 4 2 .. 1 3 2 1 5 3 22 19 3 .. 15 9 5 63 60 30 24 .. 2 4 5 10 39 55 17 19 .. 7 4 4 15 41 47 13 10 12 20 3 3 20 45 57 4 8 21 32 4 3 25 70 58 5 5 33 22 4 2 35 70 38 2 1 48 21 1 3 45 49 25 1 1 22 20 .. 2 55 19 13 1 .. 20 6 .. .. 65 and upwards 7 2 .. 1 5 4 .. .. Total 409 358 99 90 164 135 38 33 Included in the above new cases are 17 pulmonary males, 1(3 pulmonary females, 15 non-pulmonary males and 17 nonpulmonary females, which were not notified but were discovered from the returns of the Registrars of Births and Deaths, showing that 17 per cent. of the deaths registered as due to Tuberculosis were not notified. Early in the year the Ministry of Health by a special circular letter called the attention of medical practitioners to the statutory duty of notification under the Regulations of 1912. Enquiries made into cases of nonnotification elicited information either that the certifying doctor had reason to believe the case had been notified before the patient entered the Institution in which he died, or that he had only been called in to attend the patient a short time before death occurred. The total number of cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year was 956, of which 767 were pulmonary cases and 189 tuberculosis of other organs. The deaths due to this disease numbered 370, which is the same number as the deaths of last year. The tubercular death-rate for the year, however, was less, being 1.17 per 1,000. 9 The death-rate from respiratory phthisis was 0.95. and from other forms 0.22 per 1,000. Although still one of the diseases responsible for the greatest number of deaths, some satisfaction may be drawn from its steady, if slow, decline. 370 deaths and a tubercular death-rate of 1.17 per 1,000 during 1923 compares favourably with the mortality during the ten years 1903 to 1912, during which period the average yearly number of deaths from the disease was 496 and the average annual tubercular death-rate was 1.75 per 1,000. There is no doubt that advent of notification and the formulation of Tuberculosis schemes on the passing of the National Health Insurance Act has led to more accurate diagnosis and certification of deaths in the case of tubercle, but when every allowance for error in the earlier years is made, the fact that Tuberculosis is being slowly vanquished remains. The detailed work carried out at the Tuberculosis Dispensary and Dagenham Sanatorium will be found in the appended reports of Dr. Garland Collins and Dr. Mayberry respectively. Cancer. This disease, which has caused much concern for many years past by reason of its increasing prevalence (both apparent and real), was responsible for 349 deaths (184 males and 165 females) in West Ham during the year, making a death rate of 1.11 per 1,000. This discovers a slight improvement on the previous year, when 350 deaths (175 male and 175 female) occurred, the death rate being 1.14 per 1,000. In England and Wales during that year (1922), 46,903 deaths from Cancer occurred, equivalent to the higher death rate of 1.23 per 1,000 of the population, but although West Ham's figures appear to be favourable as compared with the whole country they support, the belief generally held as to a real increase in the incidence of the disease. Twenty years ago (1903) the death-rate from malignant disease was 0.73 per 1,000, and the average death-rate from the disease during the ten years 1903 to 1912 was 0.79 per 1,000. Among the numerous proposals made with a view to checking the incidence and mortality from Cancer, notification of the disease was suggested several years ago, but its varied forms, insidious development and multiple modes of attack are such that the Local Government Board decided notification was impracticable in view of the many administrative difficulties connected with its adoption—a view which, in my opinion, 10 pertains with equal force to-day. There can be little doubt, however, as to the benefit to be derived from active propaganda with a view to informing the public of the danger of delay in applying for advice in the early stages of the disease. The Central Midwives Board some years ago drafted a leaflet for distribution by midwives and others with special reference to cancer of the womb. The most recent leaflet is that prepared by the Royal Society of Medicine, a copy of which I append below:— What ought to be known about Cancer. 1. In England and Wales 45,000 people died in the year 1921 from cancer. 2. There is every reason to believe that many of the patients could have been cured if the disease had been discovered early and the right treatment adopted. 3. Treatment by drugs, taken by the mouth, or applied externally, at present offers no prospect of cure. 4. In its earliest stages cancer is confined to one spot and rarely gives rise to pain, or a feeling of ill-health; nevertheless, there is usually evidence that there is something amiss, for example:— (a) A lump in an unusual situation. (b) Bleeding or discharge from unwonted parts of the body. This early stage is the favourable one for the immediate treatment of cancer. 5. If a lump is found in the breast of a woman, medical opinon should at once be sought. Many such lumps are cancer. 6. Cancer of the womb may occur at any age over 25, but most frequently between the ages of 40 and 60. It causes bleeding and discharge, and is rarely painful in its early stages. 7. Any bleeding from the womb, however slight, after the change of life, almost always means cancer. 8. When any irregular bleeding or blood-stained discharge occurs at the change of life, a doctor should be consulted. Often it means that cancer is present. 9. For any abnormal enlargement within the abdomen, a doctor should be consulted, because such enlargement, apart from pregnancy, may be due to tumours which, though usually simple, are sometimes cancerous. 11 10. Any sore or wart occurring on the lip, especially in men over 40, is likely to be cancerous. Early removal means cure; neglect spells death. 11. An unhealed sore or lump on the tongue, especially in men, should be regarded with suspicion. Many of these are cancer. 12. Irritation of the tongue or inside the cheek, by broken or jagged teeth or tooth plates, must be avoided. The lower lip is often irritated by smoking a pipe with a rough or hot stem. This irritation may end in cancer. 13. Sores, cracks, ulcers or lacerations which refuse to heal, and moles which tend to spread, all demand careful medical investigation. Such troubles are often the starting points of cancerous growths, and their treatment by salves or ointment only waste of time. 14. Persistent indigestion, obstinate constipation or bleeding from the bowel commencing in middle life always demand investigation. Frequently the patient thinks bleeding from the bowel is due to piles, but too often the real cause is cancer of the rectum. Fur Dermatosis. During the year attention was directed to a number of cases of skin eruptions in London caused by dye used in the preparation of cheap furs, used for finishing fur-trimmed coats. The risk attending the workers using white arsenic and quinone in curing and mordanting furs is recognized, but the recent offender appears to have been a chemical (p-methyl-amidophenol sulphate) called by the manufacturers (The Berlin Aniline Company) ursol. Four cases were brought to my notice; two were employees of the Council and two members of the public, all being ladies, three of whom had recently purchased fur-trimmed coats. The sufferers were chiefly affected on the sides of the face, neck and forearms, where the furs impinged, the eruption commencing as small red papules and passing on to ulceration and crusting. Considerable irritation and temporary disfigurement was noticed, but the rash subsided in a short time under treatment after the objectionable garment had been discarded. Hospital Aceommodation. (1) The Plaistow Fever Hospital (opened as two wards in 1896 and as to the computed Hospital designed by the late Edwin T. Hall in 1901) now contains 210 beds, originally allocated for the reception only of scarlet fever, diphtheria and 12 enteric fever cases, with 15 isolation beds for mixed or staff cases. The variable incidence of these diseases in recent years has enabled the Medical Superintendent to receive and treat many other infectious cases as well as to admit special cases for teaching purposes. (2) Dagenham Smallpox Hospital, situate about 9 miles from the Borough, occupies a site of 6½ acres, enclosed within the Rookery farm of 119 acres, owned and cultivated by the Council. It consists of permanent buildings, capable of accommodating 50 patients with the administrative staff required for their care, together with temporary iron buildings sufficient to treat 300 cases. The permanent buildings were opened in 1899, and the Hospital is a safeguard in epidemic periods of smallpox to the greater part of London-over-the-Border, as by agreement eleven other authorities contribute to the maintenance of the Hospital in consideration of West Ham undertaking to receive and treat all the small pox patients sent to the Hospital by those authorities, viz., Barking, East Ham, Romford Joint Hospital Board, Ilford, Wanstead, Waltham Joint Hospital Board, Brentwood, Billericay, Loughton, Epping Rural, Epping Urban. Under the Tuberculosis Scheme formulated after the passing of the National Health Insurance Act, the Council were permitted to use Dagenham Hospital as a Temporary Sanatorium, but owing to an outbreak of smallpox at Easter, 1920, the Hospital had to be promptly cleared of consumptive patients and revert to its primary use, a costly and very inconvenient undertaking, as only 30 smallpox cases were admitted. For tunately in 1922 the Council was enabled to enter into agreement with the Orsett Joint Hospital Board whereby the latter authority will admit sporadic cases of smallpox sent to their Hospital by West Ham, thus enabling the Council to continue using Dagenham Hospital for the reception of phthisical sufferers until, owing to the increasing pressure on the accommodation of the Orsett Hospital, the Ministry of Health called upon the Council to re-open Dagenham Hospital for smallpox cases. (3) The Grange Convalescent Home consists of a residential mansion and 7 acres of grounds, together with 61 acres of land, situate at Harold Wood, being about 9 miles from the Borough. It was opened on 22nd February, 1909, for the reception of scarlet fever convalescents, and is capable of accommodating 60 patients. Owing to the fall in the number of scarlet fever cases the Council has recently approved of the institution being cleared of scarlet fever cases and used for the reception of diphtheria. 13 Ambulance Service. The Council has two Motor Ambulances for the removal of infectious patients to hospital, and two ambulances for removing infected bedding, clothing, etc., to the disinfecting station. There are also two motor ambulances for transference of non-infectious and accident cases to or from institutions. The latter ambulances made 607 journeys during the year. In 159 cases persons were removed from one address to another within the Borough. In 448 cases from an address within the Borough to an institution outside or vice versa. During the year under review a mutual arrangement was agreed to between West Ham, the County Borough of East Ham and the District of Barking for reciprocal use of ambulances on call in case of emergency should the ambulance of one or other authority be unavailable. Midwives' Acts, 1902 & 1918. Number ot Midwives practising for an Association or privately. Number giving notice of intention to practise. Number of Births attended. Number of Records of sending for Medical Aid. Plaistow Maternity Charity 57 3,567 591 Beechctoft Nuises' Home 31 164 33 Salvation Army Nurses 2 433 32 Tate Nurses' Institution 3 235 46 Queen Mary's Hospital Extern. 5 152 18 Private Practice: a. Hughes, F. 1 105 15 b. Masterson, Jane 1 50 2 c. Palmer, Eliza 1 39 0 d. Southwell, Sarah 1 2 0 e. Stephens, Alice 1 324 24 f. Price, Flora 1 45 1 g. Storey, Lilian 1 121 32 h. Ruedi, Bertha 1 180 29 i. Speake, Alice 1 69 5 j. Richards, Elizh 1 0 0 k. Hall, Catherine 1 54 12 l. Jarvis, Cecilia 1 5 1 110 5,545 841 Totals of cases treated by Doctors on "Records of sending for Medical Aid ":— Pregnancy— Abortion or Threatened 20 Ante Partum Haemorrhage 24 Rash 1 Dangerous Veins 1 Albuminuria 2 Excessive Sickness 3 Labour— Fits 1 Purulent Discharge or Sores on Genitals 2 Mal-presentation 28 Presentation not made out 2 Excessive Haemorrhage 19 Retained Placenta & Membranes 46 Prolonged labour 111 Ruptured Perineum 182 Unsatisfactory Condition 35 Lying-in— Fits 0 Unsatisfactory Condition 51 Temperature raised 43 Breasts swollen 5 Secondary P.P. Haemorrhage 3 Child— Injury at Birth 0 Deformity 19 Dangerous Feebleness 02 Inflammation of Eyes 34 Skin Eruptions 6 Haemorrhage of Navel 3 Unsatisfactory Condition 78 Prematurity 40 Asphyxia 10 Visits paid by Health Visitors during the year 1923:— To Expectant Mothers: First Visits, 2,020; Total Visits, 2,474 To Infants under 1 year: First Visits, 4,649; Total Visits, 19,151 To Children 1—5 years: Total Visits. 38,723. Maternity Homes subsidized by Council:— Number of Patients: Queen Mary's Hospital for East End 302 Plaistow Maternity Charity 354 Number of Weeks spent in such Homes by Patients: Queen Mary's Hospital 515 Plaistow Maternity Charity 708 Hospitals for Children under 5 years in Borough subsidized by Council:— St. Mary's Hospital—Number of Patients 321 Number of Weeks spent in Hospital 1058 Settlement Hospital—Number of Patients 68 Number of Weeks spent in Hospital 467 15 Hospitals and Homes for Children under 5 years outside Borough:— Number of Children 24 Number of Weeks spent in Homes 287 Number of Whole-day Attendances at Stratford Day Nursery, 6,309. No Half-days. Daily Average, 29. Domiciliary Confinements in West Ham carried out by the Midwives attached to the Plaistow Maternity Charity during the past three years:— 1921 1922 1923 Total. From the Central Homes, Howards Road 1,998 2,109 1,831 5,938 From the Docks Branch 1,315 1,276 1,223 3,814 From Stratford Branch 478 477 428 1,383 Totals 3,791 3,862 3,482 11,135 Welfare Centres and Clinics. Centres. Sessions held. Average Attendance. Medical Supervision. Expectant Mothers. Children. Chesterton House 4 weekly 42.72 82.12 Dr. Kennedy. St. Luke's Square 4 „ 58.44 69.09 „ Sinclair. Martin Street 1 „ 24.90 61.44 „ Kennedy. Lees Hall 3 „ 10.59 45.74 „ Lilian Hawthorne. Trinity Mission 2 „ .96 64.23 „ Mary Alden. Union Road 3 „ 4.42 28.21 „ Dorothea Brooks. Silvertown 1 „ — 18.80 „ Tivy. 16 Distribution of Milk to Nursing and Expectant Mothers and Children under 3 years of age. Since August, 1920, Dried Milk only has been distributed under the Maternity and Child Welfare Scheme. Eight tons of Dried Milk were used during the last five months of that year, but the amount has steadily and rapidly increased, until 104 tons were disposed of during the year 1923. The milk is handed to the applicant (after the requisite information is duly supplied on the application form approved by the Council) in cardboard packets with printed directions, and the present rate of disposal is approximately given as under:— Average weekly number of packets supplied 5,000 „ „ „ „ persons who apply 3,500 „ „ „ „ „ supplied free, 1930 „ „ „ „ „ at half cost, 70 3,500 „ „ „ „ „ at cost price, 1500 The quasi-relief character of the undertaking under existing economic conditions occupies an immense amount of time and labour on the part of Mr. Cheatle and the staff working under him, not only in carrying out the routine work of distribution, but also in detecting as far as possible fraudulent receipt of milk with a view to their submission to the Rota Committees chargeable with the duty of deciding upon the appropriate action in each case. Although applicants for free supply are constantly warned of their duty to notify improved changes in their financial condition, they frequently fail to do so, and merely refunding the cost of supplies wrongly obtained does not appear to check the evil. 17 The following leaflet was drawn up and distributed with a view to popularize its use:— Dried Milk. What every Nursing Mother ought to know. The Council are selling Full Cream Milk in a dried form suitable for infants and nursing mothers. Dried Milk is a valuable food (not a patent manufactured food), being good cows' milk from from which the moisture has been evaporated and possesses certain special advantages. Liquid milk cannot be kept for any lengthened period without undergoing changes which render it unfit for food, but Dried Milk can undoubtedly be preserved for a considerable time with practically unimpaired food value. Dried Milk is an excellent substitute—not for breast milk and not for really good cows' milk—but for much of the milk upon which infants are now fed. Under present conditions pure fresh cows' milk is practically unattainable in most towns, and in view of the liability to bacterial changes in fresh milk when kept in the ordinary dwelling-house, especially in hot weather, it is often desirable to use dried milk in preference. By its use waste is preventable; the exact quantity can be made up as and when occasion requires. The processes used in drying milk largely reduce the number of bacteria present and materially decrease the risk of conveyance of disease from tuberculous milk, a very common cause of tuberculosis in children. Mortality figures showing comparison of death rate between children fed on Dried Milk and other hand-fed children are strikingly in favour of the use of Dried Milk. Scurvy and Rickets are rare in infants fed on Dried Milk, and their occurrence is probably not attributable to this form of food. 18 Full Cream Dried Milk requires to be mixed with about seven parts by weight of water to give a mixture corresponding to ordinary milk. Therefore, 5 ozs. of Dried Milk should reconstitute to correspond to one quart of milk. Dried Milk is cheaper than liquid milk, and it is sold by the Council at cost price for the safeguarding of the health of young children and nursing mothers. Dried Milk can be obtained from the Town Hall, Stratford, by Nursing and Expectant Mothers for their own consumption or for the use of children under three years of age in accordance with a Scale adopted by the Council. Dried Milk can also be obtained from the Town Hall for the use of children between three and five years of age, but in such case a medical certificate must be supplied in respect of each child. Any Nursing Mother experiencing difficulty in preparing the milk should send a post-card to the Medical Officer of Health at the Town Hall, Stratford, when a Health Visitor will call and give all the information necessary. Venereal Diseases—Utilization of facilities at Hostels 1923. Particulars of the work done on behalf of the participating authorities, by the Hostels in the Scheme for the year ended 31st December, 1923. These institutions are as follows:- Women's After Care, 22 Highbury Quadrant, N. Southwark Diocesan, 80 Stockwell Park Road, S.W. St. Thomas', 148 Lambeth Road, S.E.1. Royal Free, 24 Gloucester Road, N.W. Salvation Army, 17 Highbury Terrace, N. Salvation Army, 4 Clapton Common, E. West London Mission, 35 Parkhurst Road, N. 19 The following table shows the allocation of the patients received at these institutions to the areas in the Scheme:— Area. No. of Patients. Aggregate No. of days in residence. Percentage (days). London 148 13,550 63.0 Middlesex 19 2,204 10.3 Essex 11 1,676 7.8 Surrey 11 1,332 6.2 Kent 8 1,415 6.6 Herts 5 355 1.6 Bucks 3 447 2.1 East Ham 1 41 .2 West Ham .. .. .. Croydon 3 475 2.2 Totals 209 21,495 100.0 20 LONDON COUNTY COUNCIL. Venereal Diseases. Summary of work done by the Hospitals during the year 1923. London. Middlesex. Essex. Surrey. Kent. Herts. Bucks. East Ham. West Ham. Croydon Total. Other places. Grand Total. New Patients:— Syphilis 5,198 429 232 153 135 73 38 46 208 53 6,565 563 7,128 Soft Chancre 223 15 11 33 4 4 .. 4 18 .. 312 3 315 Gonorrhœa 8,633 732 356 246 184 82 49 135 281 64 10,762 801 11,563 Not Venereal 4,904 458 226 191 109 54 23 75 348 58 6,446 198 6,644 Total 18,958 1,634 825 623 432 213 110 260 855 175 24,085 1,565 25,650 Total attendances 453,856 33,534 12,228 12,133 7,556 2,443 1,336 3,727 9,744 2.816 539,373 16,136 555,509 No. of In-patient days 67,680 3,662 2,890 4,531 2,360 866 1,247 469 1,396 280 85,381 21,281 106,662 Salvarsan Sals, doses 40,732 3,534 1,545 1,425 1,011 463 190 367 1,179 406 50,852 1,140 51,992 Pathological Examinations. For or at Centre: Spirochaetes 616 61 10 10 3 5 .. 5 17 2 729 33 762 Gonococci 22,795 1,627 857 600 329 128 56 369 727 119 27,607 420 28,027 Wasserman 24,673 1,711 837 873 470 239 131 202 729 264 30,129 808 30,937 Others 8,490 281 211 601 151 38 49 23 20 47 9,911 147 10,058 Total 56,574 3,680 1,915 2,084 953 410 236 599 1,493 432 68,376 1,408 69,784 For Practitioners: Spirochaetes 54 4 .. 11 1 .. .. .. .. .. 70 .. 70 Gonococci 3,300 160 100 512 184 24 4 58 203 341 4,886 98 4,984 Wasserman 15,810 466 716 541 166 58 71 133 228 270 18,459 210 18,669 Others 531 28 22 17 15 7 2 1 1 1 625 55 680 Total 19,695 658 838 1,081 366 89 77 192 432 612 24,040 363 24,403 21 LONDON COUNTY COUNCIL. Venereal Diseases. Return showing the extent to which the facilities have been utilized during the year ended 31st December, 1923. Hospital. New Cases. No. of Persons. Total attendances. No. of Inpatient days. Sal. Subs. doses given. Pathological Examinations. Total. Syp. S.C. Gon. Not V.D. Total. Ceased to attend Discharged. Spiro. Gon. Wass. Others. (a) (b) (a) (b) (a) (b) (a) (b) Albert Dock 213 24 303 301 841 15 195 8,792 2,618 1,193 31 .. 266 1 588 136 .. .. 1,022 Charing Cross 175 1 169 148 493 117 207 5,576 380 961 13 1 86 1,165 692 895 271 275 3,398 Diseases of Skin 108 1 135 43 287 58 69 8,234 .. 1,408 24 .. 1,227 129 485 125 4 .. 1,994 E. G. Anderson 59 .. 34 81 174 16 40 3,142 734 703 1 .. 689 22 280 353 .. .. 1,345 Gt. Ormond Street 113 .. 17 505 635 23 85 2,930 1,161 1,481 .. 1 347 103 840 704 153 38 2,186 Guy's 388 9 313 262 972 282 173 16,488 2,345 3,580 33 .. 1,811 79 1,299 1,749 9 .. 4,980 King's College 206 8 205 159 578 171 268 17,397 923 667 17 4 2,620 69 2,150 1,869 21 .. 6,750 Lock (Male) 969 139 2,930 610 4,648 1,430 2,838 90,483 10,993 3,064 200 .. 2,929 325 4,240 569 717 33 9,013 Lock (Female) 312 .. 585 85 982 132 57 7,697 31,765 1,152 .. .. .. .. .. .. .. .. 10,793 London 557 7 754 707 2,025 830 261 28,538 4,604 3,317 26 4 4,759 590 2,245 3,169 .. .. 2,066 Metropolitan 177 13 216 189 595 167 123 6,735 52 1,239 28 1 585 22 777 583 70 .. 3,641 Middlesex 210 2 262 101 575 217 126 13,689 427 1,640 3 .. 1,859 231 832 697 19 .. .. Miller General 123 4 248 100 475 141 83 14,443 575 880 .. .. .. .. .. .. .. .. .. Royal Free 227 11 427 313 978 396 1,464 20,941 2,151 1,757 .. .. 3,014 13 1,540 804 12 .. 5,383 Royal London Ophthalmic 199 .. 48 .. 227 70 .. 4,343 2,015 1,298 .. .. 38 .. 517 .. 45 .. 600 Royal Northern 285 .. 400 230 915 558 177 15,948 289 1,667 37 5 1,097 48 1,055 1,595 5 .. 3,842 St. George's 215 8 166 122 511 190 293 7,876 88 2,349 20 4 504 172 982 353 15 .. 2,050 St. John's, Skin 89 4 81 7 181 79 24 8,461 .. 908 9 21 151 17 359 412 .. .. 969 St. John's, Lewisham 80 1 84 11 176 155 97 6,034 1,159 403 2 .. 121 40 432 463 3 .. 1,061 St. Mary's 263 3 248 140 654 181 165 9,616 121 1,111 5 3 414 107 428 937 .. .. 1,894 St. Paul's 166 3 683 457 1,309 355 120 42,906 .. 942 103 6 1,258 1 721 1 6l 27 2,178 St. Thomas' 999 38 1,432 1,541 4,010 691 1,059 124,646 2,856 13,671 .. 11 1,319 587 7,137 384 8,426 35 17,899 Seamen's 465 35 741 24 1,265 323 433 23,136 7,495 1,058 37 3 1,009 1,141 851 697 140 3 3,881 South London for Women 57 .. 64 65 186 26 138 3,001 736 443 4 .. 161 2 343 6 6 .. 522 University 195 2 190 46 433 301 47 12,720 705 1,782 33 .. 508 4 900 90 .. .. 1,535 West London 214 .. 529 313 1,056 400 321 34,175 174 2,421 128 5 825 114 941 1,513 5 143 3,674 Westminster 70 2 100 57 229 53 118 12,021 459 811 8 1 430 2 303 565 76 126 1,511 S.A., Mothers' 13 .. 174 27 214 132 10 5,541 23,171 86 .. .. .. .. .. .. .. .. .. Children's, Waddon 1 .. 25 .. 26 .. 25 .. 8,666 .. .. .. .. .. .. .. .. .. .. Totals 7,128 315 11,563 6,644 25,650 7,509 9,014 555,509 106,662 51,992 762 70 28,027 4,984 30,937 18,669 10,058 680 94,187 (o) For Centre: 69,784. (b) For Practitioners: 24,403. 22 Housing. The total number of houses in the Borough is 48,842, and the number unoccupied 167. The effect of the War on Building is clearly shown by comparing the number of plans for dwelling houses sanctioned before the War and after its commencement, supplied to me by the Borough Engineer:— Year. North. South. Total. Year. North. South. Total. 1909 21 19 40 1915 6 9 15 1910 6 61 67 1916 .. 10 10 1911 21 112 133 1917 .. 9 9 1912 17 20 37 1918 .. .. .. 1913 3 104 107 1919 .. 2 2 1914 18 267 285 1920 2 15 17 1921 .. .. .. 1922 2 .. 2 1923 1 41 42 86 583 669 11 86 97 The following houses have been erected by the Council in 1923: Manor Road, 120; Ladvsmith Road, 18; Cumberland Road, 28. In addition to the depletion of housing accommodation, the War involved much restriction in the service of the usual sanitary notices, which, coupled with the increase of overcrowding, left the Borough in 1918 with an accumulation of structural delects and impairment of domestic amenities which the Sanitary Inspectors have not even yet been able to overtake, but an estimate of their difficulties may be gauged by comparing the number of summonses issued for magistrates' orders to execute 23 repairs in normal times with the number issued since the War ended:— Housing Summonses issued. Before. During. After. Year. No. Year. No. Year. No. 1910 92 1915 51 1919 221 1911 100 1916 57 1920 380 1912 97 1917 72 1921 438 1913 75 1918 40 1922 442 1914 67 1923 374 431 220 1,855 Increase of Rent and Mortgage Interest Restriction Act, 1920. The total number of certificates granted by the Authority under the above Act during the year was 27. Housing particulars during 1923 in the form desired by the Ministry of Health. Number of New Houses erected during the year— (a) Total 42 (b) As part of a Municipal Housing Scheme 28 1. Unfit Dwelling Houses: Inspection— (1) Total number of Dwelling Houses inspected for housing defects (under Public Health and Housing Acts) 11,207 (2) Number of Dwelling Houses which were spected and recorded under the Housing (Inspection of District) Regulations 1910 3,735 (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 (4) Number of Dwelling Houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 8,380 24 2. Remedy of Defects without service of formal notice— Number of defective Dwelling Houses rendered fit in consequence of informal action by the local authority or their officers Nil 3. Action under Statutory powers— A. Proceeding under Sec. 28 of Housing and Town Planning, etc.. Act. 1919: (1) Number of Dwelling Houses in respect of which notices were served requiring repairs (2) Number of Dwelling Houses which were rendered fit— (a) By Owners (b) By Local Authority in default of Owners (3) Number of Dwelling Houses in respect of which closing orders became operative in pursuance of declarations by Owners of intention to close Nil B. Proceedings under Public Health Acts: (1) Number of Dwelling Houses in respect of which notices were served requiring defects to be remedied 8,380 (2) Number of Dwelling Houses in which fects were remedied— (a) By Owners 9,069 (b) By Local Authorityin default of Owners Nil C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909: (1) Number of Representations made with a view to the making of closing orders (2) Number of Dwelling Houses in respect of which closing orders were made (3) Number of Dwelling Houses in respect of which closing orders were determined, the dwelling houses having been rendered fit (4) Number of Dwelling Houses in respect of which demolition orders were made (5) Number of Dwelling Houses demolished in pursuance of demolition orders Nil 25 Action taken under the Factory and Workshop Act, 1901. 1.- Inspections. Inspections. Notices. Factories, including Factory Laundries 61 10 Workshops, including Workshop Laundries 107 11 Workplaces 4 — 172 21 2. Defects found and remedied in Factories, Workshops, and Workplaces under the Public Health Act. Want of Cleanliness 57 Want of Ventilation 1 Want of Drainage of Floors 2 Other Nuisances 82 Sanitary Accommodation insufficient — Sanitary accommodation unsuitable or defective 10 Overcrowding 1 3. Workshops on Register 615 4. Other Matters. Failure to affix Abstract notified to H.M. Inspector 5 Action taken in matters notified by H.M. Inspector— Notified 11 Report sent to H.M. Inspector 11 Number of Homeworkers' premises inspected 250 26 Nature of World. Outworkers' List. Section 107. Notices served on Occupiers as to keeping or sending Lists. Lists received from Employers. Number of Outworkers' Addresses received from other Councils. Number of Outworkrs' Addresses forwarded to other Councils. Twice in year. Once in year. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (i) Making, etc. 80 109 467 9 7 24 .. .. .. (2) Cleaning and Washing Lace, Lace Curtains and Nets 2 .. 4 .. .. .. .. .. .. Furniture and Upholstery .. .. .. .. .. .. .. .. .. Fur Pulling .. .. .. .. .. .. .. .. .. Umbrellas, etc. .. .. .. .. .. .. .. .. .. Paper Bags and Boxes .. .. .. .. .. .. .. .. .. Brush Making .. .. .. .. .. .. .. .. .. Stuffed Toys .. .. .. .. .. .. .. .. .. Tennis Balls 2 .. 19 .. .. .. .. .. .. Tile Making .. .. .. .. .. .. .. .. .. Electro Plate .. .. .. .. .. .. .. .. .. Cables and Chains .. .. .. .. .. .. .. .. .. Anchors &Grapnels .. .. .. .. .. .. .. .. .. Cast Gear .. .. .. .. .. .. .. .. .. Locks, Latches and Keys .. .. .. .. .. .. .. .. .. Totals 84 109 490 9 7 24 710 409 104 27 Names of Home-workers notified to West Ham from the undermentioned Districts. From City of London 277 Finsbury 97 Poplar 85 East Ham 61 Bethnal Green 42 Stepney 40 Hackney 32 Leyton 30 Shoreditch 19 Westminster 10 Marylebone 7 Southwark 5 Woolwich 2 Holborn 1 Croydon 1 Islington 1 Names of Home workers for West Ham Firms notified to the undermentioned Districts. To Stepney 155 Leyton 105 East Ham 101 Poplar 24 Bethnal Green 8 Walthamstow 7 Ilford 3 Hackney 3 Barking 2 Bermondsey 1 Table showing the different Trades in which the Home workers were engaged during 1923. Tailoring 247 Making of Shirts 230 „ „ Blouses 96 „ „ Underclothing 74 „ „ Brushes 36 „ „ Ties 35 „ „ Christmas Crackers 33 „ „ Millinery 32 „ „ Umbrellas 32 „ „ Boxes 29 „ „ Tennis Balls 20 „ „ Shoes 15 „ „ Dressing Gowns 10 „ „ Mantles 10 „ „ Flags 10 „ „ Furs 8 „ „ Belts 4 „ „ Artificial Flowers 4 „ „ Feathers 2 Washing 4 931 28 Abatement of Nuisances. In the Appendix will be found a table of details showing the work of the Sanitary Inspectors, chiefly under the Public Health Act, 1875. Many of the defects found cannot be said to be injurious to health, though they are sufficiently inimical to comfort to be considered nuisances, and it is our interesting administrative paradox that the graver nuisances give the Sanitary officials less trouble than those of a slighter degree, more fuss being frequently made over trivial matters than in respect of really harmful conditions. 51,120 errors of one kind or another needing action occurred during the year, 49,320 of which were satisfactorily dealt with before the year closed. These included the service of 8,343 notices to remedy 22,360 defects in connection with dwelling houses. 53 notices were served on factory owners to abate nuisance from excessive discharge of black smoke—a nuisance which has been lessened of recent years, but which still exists to a far greater extent than is either good for the public or necessary for commerce. Supervision of Special Trades.—These include bakehouses, slaughter houses, common lodging houses, and the factories dealing with animal matter specifically cited as offensive trades in the Public Health Act. Of the last mentioned West Ham contains probably a larger and more varied number than any other town in the South, and all have been kept under regular inspection. They carry out work of great advantage to the community with generally a minimum degree of offence, and except during spells of sultry weather are not a source of inconvenience to residents, a fact largely due to modern machinery. During the year new buildings were constructed with the approval of the Council in Stratford, for the preparation and manufacture of Sterilized Surgical Ligatures, by the authorities of the London Hospital technically an offensive trade, but practically a most beneficent one. Cowsheds. In 1901, when the Council first arranged for a quarterly examination of all cows in the Borough by the Veterinary Surgeon for the purpose of ascertaining whether any suffered from tubercular disease of the udder, tnere were 23 cowsheds 29 in use. During last year only nine were occupied, and I append below the four quarterly returns made to me by Mr. McCunn, your Veterinary Surgeon, with the number of cows examined. It is pleasing to note that no tubercular disease of the udder was found in any of the animals, although some of the cowsheds were found both by Mr. McCunn and by the Sanitary Inspectors to require the service of notice to remedy defects. Situation of Cowshed. No. of Cows examined each quarter. 1 2 3 4 Balaam Street 9 10 10 10 Vicarage Lane 47 58 48 52 Beale Street 9 9 8 9 Idmiston Road 18 18 15 16 Edwin Street 2 2 — — Neville Road 14 14 — — Blanche Street 5 5 14 18 Edward Street 8 8 8 8 Clegg Street 12 12 15 12 119 131 118 115 In this connection the Council supported Resolutions passed by other Sanitary authorities recommending the Government to bring into force the Tuberculosis Order, 1914, made by the Board of Agriculture and Fisheries, the operation of which was suspended by an amending order before the date of its commencement. Due to the extending use of modern plant during the year, considerable alteration has been made in the arrangement for dealing with offensive fumes at one large works, the efficacy of which has not yet been fully tested. The 90 bakehouses in the northern part of the Borough and 83 in the south have been found kept in a cleanly condition and without nuisance. 44 of these are underground bakehouses which were duly inspected by the Public Health Committee and licensed under Section 101 of the Factory and Workshops Act, 1901. The slaughter houses of the Borough number 29, of which 11 are registered and IB are annually licensed. Only slight use is made of several of these owing to the convenient proximity of Smithfield, and the licences are probably retained more on account of the commercial value they add to the premises than for the actual requirement of the business. Constant supervision of scattered private slaughter houses without an impossible number of Inspectors is impossible, but I feel justified in saying that both in the case of registered houses and certainly in the annually licensed houses the Inspectors pay a reasonable 30 number of visits and are frequently communicated with by the licensee when organs exhibiting doubtful characters are found by the slaughterman. During the year 1922 a very helpful memorandum in connection with the inspection of meat, etc., was issued by the Ministry of Health. Two applications for the use and occupation of premises for the purpose of slaughtering were made to the Council, but were refused on the recommendation of the Public Health Committee. Dairies, Cowsheds and Milkshops Order. On 1st January, 1923, 196 milk shops (including dairies) were on the Register. Four of these have ceased to be used for the sale of milk, and all the others were re-registered under the Milk and Dairies Amendment Act, 1922. 27 new premises were registered during the year, some of the applicants asking to be registered for the sale of sterilized milk only, an unnecessary application. 219 premises were on the Register at December, 1923, of which 86 were dairies where milk is the only or chief article sold. Defects found on inspection and remedied under notice included:—Drains, 3; W.C. pan, 1; Roofs, 4; Flooring, 3; Water Fittings, 3; Guttering, 2; Yard Paving, 2; Coppers, 2; Plastering, 4; Damp Walls, 2; No Ash Pail, 2; Cleansing, 5. Under the Milk (Special Designation) Order, 1923, four licenses were granted by the Local Authority to sell Grade A Tuberculin Tested Milk, bottled at Lord Rayleigh's Farm at Hatfield Peverel, Essex. Three licences expired automatically at the end of the year. Summary of Work of Sanitary Inspectors during 1923. Number of Complaints received and investigated 5,265 Dwelling Houses (house to house) inspected 12,000 Newly-infected Houses 8,848 Common Lodging Houses 58 Slaughter Houses 674 Bakehouses 320 Dairies 124 Cow Sheds 22 Milk Shops 170 Retail Shops 2,954 Offensive Trades 244 31 Factories 1,246 Workshops 731 Miscellaneous 3,948 Laundries 10 Schools 5 Re-inspections 47,493 Number of Notices served— On Offenders 26 „ Owners 9,069 „ Occupiers 208 Number of Notices complied with— By Offenders 17 „ Owners 8,861 „ Occupiers 93 Total Nuisances found 51,120 „ „ abated 49,326 Defects for the abatement of which 8,343 Notices were served during the year 1923. Drains and Soil Pipes— Flushing Apparatus— Cleansed 501 Repaired 511 Repaired 551 Newly Provided294 New Provided 4 Water Supply Provided 19 W.C. Pans or Traps— Yard Paving— Cleansed 44 Repaired 655 Repaired 56 New Provided 73 New Provided 83 Defects remedied in— Surface Gullies— Roofs 3010 Cleansed 14 Floors 1340 Repaired 20 Staircases 997 New Provided 1 Windows 2311 Sinks and Sink Pipes— Doors 891 Cleansed 133 Fireplaces 1203 Repaired 137 Walls and Ceilings 4420 New Provided 1 Ditches, Urinals, etc., Stack Pipes and Rain- Cleansed 3 Water Gutters— Animals improperly kept 9 Cleansed 678 Offensive Accumulations 105 Repaired 1049 Overcrowding 36 New Provided 2 Smoke Nuisances 53 Water Fittings and Dust Receptacles Provided 695 Cisterns— Rooms Disinfected 2064 Cleansed 106 Other Nuisances 186 Repaired 205 Total 22,360 32 Summonses Attended. Sale of Food and Drug Acts 21 Public Health Acts 488 Unsound Food Condemned. 7| st. Whiting. 2 Cows' Lungs. 2 bushels Winkles. 7 Cows' Plucks. 80 lbs. Beef. 3 boxes, 16 st. 6 lbs. Skate. 2 baskets, 8 st. Haddocks. 6 tins Prawns. 2 bags Greens. ll½ sieves Plums. 2 cases Herrings. 1 Cow's Liver. 1½ boxes Plaice. 24 Rabbits. 7 lbs. Pork. 10 boxes Grapes. 15 Pigs' Heads. 9 boxes Onions. 34 boxes Oranges. 10 lbs. Lamb. 31 boxes, 1½ barrels, 15 bushels 2 Pigs. apples. 80 boxes, 24 lbs. Tomatoes. 19 boxes Pears. 1 box White Grapes. 20 st. Catfish. 9 Pigs' Plucks. 5 boxes Kippers. 120 Cauliflowers. 200 boxes Black Currants. Samples taken (Sale of Food and Drug Acts). Milk 668 Preserved Cream 3 Milk, Condensed 20 Clotted Cream 1 Milk, Dried 31 Butter 245 Corn Flour 1 Oatmeal 1 Blanc Mange Powder 1 Bisto 1 Margarine 51 Coffee and Chicory 4 Dripping 15 Tea 1 Lard 149 Carraway Seed 3 Suet 1 Ground Ginger 7 Coffee 26 Cocoa 51 Bun Flour 1 S.R. Flour 11 Pepper 47 Curry Powder 1 Vinegar 15 Mustard 16 Egg Substitute 3 Jam 1 Baking Powder 45 Glauber Salts 1 Lemonade Powder 6 Arrowroot 1 Total 1,431 Cream 3 33 Various Adulterated Articles. Milk- Deficient Solids not Fat 6 Deficient Fat and Solids not Fat 7 Deficient in Fat 3 Skimmed Condensed Milk (unfit for human food on account of the dirt it contained) 1 Vinegar 2 Baking Powder 5 Butter 1 Margarine 1 Report of the Medical Officer of Health under the Milk and Cream Regulations 1912 and 1917 for the year 1923. A.— Report of the Borough Analyst for the 4th quarter of 1923. 342 Samples were analysed as follows:— Milk 183 Lemonade Powder 1 Dried Milk 8 Mustard 5 Butter 60 Pepper 7 Margarine 12 Vinegar 3 Lard 28 Ground Ginger 3 Dripping 1 Arrowroot 1 Jam 1 Cocoa 8 Coffee 9 Baking Powder 10 Total 342 Self Raising Flour 2 34 Of the Milks 176 were genuine and unadulterated, 1 deficient in Solids not Fat (No. 371) to the extent of 7.8 per cent., and 6 deficient in both Fat and Solids not Fat in the proportion stated below:— Deficient in Fats and Solids not Mark on Sample. Fat per cent. 194 23.5 and 27.3 215 16.0 and 32.3 302 12.2 and 15.0 303 11.1 and 14.6 329 9.1 and 3.6 353 4.7 and 13.3 All the Milks were free from preservative and foreign colouring. The Dried Milk were all perfectly genuine. The Butters were unadulterated, and 26 contained boric preservative in the proportions (calculated as Boric acid) stated below:— 1 contained 0.4 per cent. 8 contained 0.2 per cent. 5 „ 0.3 „ 12 „ 0.1 „ The Margarines were all genuine, and 11 contained Boric Acid, in the form of a preservative, in the proportion of: in 6 cases 0.2 and in 5 of 0.1 per cent. With the exception of 1 sample of Baking Powder (No. 193), which was very weak in the property essential to Baking Powder, all the remaining samples were genuine and unadulterated. 35 B.— Summary of action taken under the Milk and Cream Regulations on the lines indicated in the Departments Circular, Letter No. 162, dated 7.1.1921. 1. Milk: and Cream not sold as Preserved Cream:— (a) (b) No. of Samples examined for the presence of a Preservative. No. in which Preservative was reputed to be present, and percentage of Preservative found in each sample. Milk 668 Nil. Cream 4 1 Sample No. 73 (Clotted Cream). Genuine. Contained 0.15 per cent. Boric Acid. No disclosure made. Letter of caution sent. 2. Cream sold as Preserved Cream:— (a) Instances in which samples have been submitted for Analysis to ascertain if the statements on the label as to preservatives were correct— (i.) Correct statements made 3 (ii.) Statements incorrect — 3 (iii.) Percentage of Preservative found in each sample. Percentage stated on statutory label. No. 72 0.28% B. Acid 0.4 B. Acid 874 0.25% „ „ „ 881 0.16% „ „ „ (b) Determinations made of Milk Fat in Cream sold as Preserved Cream— (i.) Above 35 per cent. 3 (ii.) Below 35 per cent. - 3 36 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed— Nil. (d) Particulars of each case, in which the Regulations have not been complied with, and action taken— Nil. 3. Nil. 4. Nil. 5. Action in connection with Paragraph 4 of the said Circular Letter 162 : — No cases occurred in which an "appeal to the cow" was made. 6. Action taken under Section 4 of the Milk and Dairies (Amendment) Act, 1922 : — No cases occurred in which it was necessary to take action under this section. Prosecutions. 1923. £ s. d. Nuisances (Public Health Act)— 274 Summonses—Total Fines 27 10 0 Total Costs 34 11 0 169 Summonses withdrawn. Failure to comply with Magistrates' Orders— 29 Summonses—Total Fines 96 2 6 Total Costs 1 1 0 6 Summonses withdrawn. Adulterated Milk (Food and Drugs Act)— 9 Summonses—Total Fines 13 0 0 Total Costs 10 7 0 4 Summonses dismissed. Baking Powder (useless as such)— 3 Summonses—Total Fines 2 0 0 Total Costs 3 17 6 37 Shops Act— Early Closing Act, 1920: 97 Summonses—Total Fines 33 7 0 Total Costs 6 16 0 West Ham Grocers', etc., Closing Order, 1919— 38 Summonses—Total Fines 14 2 6 Total Costs 3 0 0 1 Summons dismissed. West Ham Bakers' Half Holiday Order, 1913: 1 Summons—Total Fine 0 10 0 Total Costs — - - Shoos Early Closing Act. 1920— Amendment Act, 1921: 7 Summonses—Total Fines 2 10 0 Total Costs 0 12 0 West Ham Butchers' Closing Order, 1922— 1 Summons—Total Fine - - - Total Costs 0 4 0 West Ham Grocers', etc., Half Holiday Order, 1912— 6 Summonses—Total Fines 1 15 0 Total Costs 0 12 0 Shops Act, Sec. 2, 1912— 1 Summons;—Total Fine 1 0 0 Total Costs - - - West Ham Corporation Acts, 1893 & 1898— 4 Summonses—Total Fines - - - Total Costs 0 10 0 3 Summonses withdrawn. Vinegar, adulterated— 2 Summonses—Total Fines 1 0 0 Total Costs 1 9 0 1 Summons dismissed. Margarine (without Wrapper)— 5 Summonses—Total Fines 1 7 6 Total Costs 3 4 6 Margarine, exposed (not labelled)— 1 Summons—Total Fine — — — Total Costs 0 14 6 38 Causes of Death at Different Periods of Life in the County Borough of West Ham during 1923. Causes of Death. Sex. All Ages 0- 1- 2- 5 - 15- 25- 45- 65- 75- ALL CAUSES M 1.803 272 55 44 62 97 252 513 293 215 F 1,528 194 55 48 52 92 185 347 282 273 1 Enteric Fever M 1 .. .. .. .. 1 F 2 Small-pox M F 3 Measles M 7 .. 6 1 F 5 2 1 2 4 Scarlet Fever M 5 .. 3 2 F 2 .. 1 1 5 Whooping Cough M 13 6 4 3 F 10 1 3 6 6 Diphtheria M 13 .. 5 4 4 F 14 .. 2 5 7 7 Influenza M 25 1 .. 2 .. 1 8 11 1 1 F 22 .. 1 .. 1 2 5 7 5 1 8 Encephalitis Lethargica M 2 .. .. .. 1 1 F 9 Meningococcal Meningitis M 1 1 F 2 1 .. .. 1 10 Tuberculosis of Respiratory System M 164 .. 3 .. .. 33 81 42 4 1 F 135 1 .. .. 9 52 43 26 2 2 11 Other Tuberculous Diseases M 38 3 10 5 8 7 5 F 33 2 7 2 9 6 5 2 12 Cancer, Malignant Disease M 184 .. .. 1 2 .. 14 96 54 17 F 165 .. 1 .. .. 1 23 75 43 22 13 Rheumatic Fever M 7 .. .. .. 2 1 2 2 F 6 .. .. .. 2 1 3 14 Diabetes M 9 .. .. .. .. .. 2 3 3 1 F 11 .. .. .. .. .. 2 7 1 1 15 Cerebral Haemorrhage, etc. M 76 .. .. .. .. .. 4 24 22 26 F 108 .. .. .. .. 1 8 34 33 32 16 Heart Disease M 182 .. .. .. 6 11 24 58 52 31 F 202 .. .. 1 8 8 12 68 57 48 17 Arterio-sclerosis M 47 .. .. .. .. .. .. 15 17 15 F 21 .. .. .. .. .. .. 2 9 10 18 Bronchitis M 140 14 1 .. .. .. 5 48 38 34 F 144 10 2 1 .. .. 7 24 46 54 19 Pneumonia, all forms M 210 49 13 15 7 13 31 55 18 9 F 129 29 25 11 5 3 7 24 16 9 20 Other Respiratory Diseases M 21 .. 1 1 .. .. 1 11 5 2 F 20 .. .. 1 1 .. 4 3 5 6 21 Ulcer of Stomach, or Duodenum M 19 .. .. .. .. .. 5 13 .. 1 F 7 .. .. .. .. .. 1 4 2 22 Diarrhæa, &c. M 49 36 4 3 .. .. 1 2 2 1 F 43 26 4 3 .. .. 2 2 2 4 23 Appendicitis and Typhlitis M 13 .. .. 1 4 4 2 1 1 F 17 .. .. .. 2 4 3 7 1 24 Cirrhosis of Liver M 6 .. .. .. .. .. 1 4 1 F 4 .. .. .. .. .. .. 3 1 25 Acute and Chronic Nephritis M 54 2 .. 1 1 .. 7 23 13 7 F 25 .. .. .. 3 1 6 7 7 1 26 Puerperal Sepsis M F 11 .. .. .. .. 1 10 27 Other Accidents and Diseases of Pregnancy and Parturition M F 13 .. .. .. .. 1 12 28 Congenital Debility, Malformation and Premature Birth M 114 111 .. 1 .. 1 .. 1 F 85 84 .. 1 .. 29 Suicide M 26 .. .. .. .. 4 1 17 3 1 F 2 .. .. .. .. 2 30 Other Deaths from Violence M 82 13 .. 2 11 7 14 26 4 5 F 31 6 2 8 .. 2 4 1 4 4 31 Other defined Diseases M 293 36 4 3 15 13 43 61 55 63 F 260 32 6 6 4 7 28 51 47 79 32 Causes ill-defined or unknown M 2 .. 1 .. .. .. 1 F 1 .. .. .. .. .. .. .. 1 39 Summary of Notifications. Week Ending. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Small Pox. Typhus Fever. Cerebro Spinal Fever. Acute Poliomyelitis. Acute Polio Encephalitis. Encephalitis Letbargica. Erysipelas. Ophthalmia Neonatorum. Tuberculosis. Pneumonia. Malaria. |Dysentery. Trench Fever. Relapsing Fever Continued Fever. Retpiratory. Other. Jan. 6 11 15 1 - - - - - - - 1 2 15 1 1 1 — — — — ,, 18 7 25 1 - - - - - - - 2 — 12 4 7 1 — — — — ,, 20 15 18 — - - - - - - - - 1 5 5 1 - - - - - ,, 27 6 19 - - - - - - - - 3 — 19 2 5 - - - - - Feb. 3 6 11 - - - - - - - - 4 — 21 5 5 - - - - - ,, 10 13 10 1 — - - - - - - 3 — 13 1 4 1 — — — — ,, 17 4 16 - - - - - - - - 3 — 15 5 2 - - - - - ,, 24 8 15 - - - - - - - - - - 20 6 2 - — — — — Mar. 3 8 23 - - - - - - - - 3 1 13 4 - - - - - - ,, 10 18 18 2 — — — 1 — — — 3 — 11 2 6 — — — — — ,, 17 5 14 — I — — — — — — 1 — 14 3 5 — — — - — ,, 24 8 13 - - - - - - - - 4 2 18 2 8 - - - - - ,, 31 13 8 - - - - - - - - 3 — 14 4 8 1 — — — — April 7 8 10 — — — — — — — — 2 1 8 8 3 — - — — — ,, 14 4 7 - - - - - - - 1 2 — 14 9 6 - - - - - ,, 21 9 9 - - - - - - - - 3 — 27 3 2 - - - - - ,, 28 5 15 1 1 - - - - - - 2 1 11 7 4 - - - - - May 5 6 9 2 - - - - - - — 3 1 16 13 3 - - - - - ,, 12 3 11 — 1 — — — - — — 1 — 15 1 1 - - - - - ,, 19 4 9 - - - - - - - - 3 — 21 6 3 - - - - - ,, 26 5 4 1 — — — — — - - 4 1 8 7 2 - - - - - June 2 10 7 — 1 — — — — 1 — 1 — 11 2 6 - - - - ,, 9 2 9 - - - - - - - — 2 — 22 6 - - - - - - ,, 16 7 15 1 I 2 — — — — - 2 2 9 3 4 1 — — — — ,, 23 13 11 1 — — — — — — — — — 11 3 1 - - - - - ,, 30 10 5 — 1 — — — — — — 2 — 15 3 1 1 — — — — July 7 15 7 - - - - - - - — 2 — 25 1 6 - - - - - ,, 14 9 10 — 1 — — — - — — 1 4 15 4 9 - - - - - ,, 21 11 7 1 2 — — — 2 — — 1 — 22 2 11 1 — — — — ,, 28 16 13 — — — — — 1 — - 2 1 19 1 3 1 - - - - Aug. 4 5 7 1 I — — — — — — 1 1 11 2 2 - - - - - ,, 11 4 9 1 - - - - - - — 1 1 10 3 1 - - - - - ,, 18 4 12 — - - - - - - - 2 2 13 8 1 1 - - - - ,, 25 8 13 — — — — — — — - 4 1 24 2 5 — - - - - Sept. 1 10 7 1 - - - - - - - 1 2 13 3 2 - - - - - ,, 8 10 12 — - - - - - - - 3 - 15 10 1 - - - - - ,, 15 15 10 — - - - - - - 1 1 - 7 2 2 - - - - - ,, 22 8 8 1 - - - — — — - 1 — 21 5 - — - - - - ,, 29 21 14 - - - - - - — 4 — 1 14 2 3 - - - - - Oct. 6 18 11 2 1 — - — — — - 5 — 19 3 3 - - - - - ,, 13 12 16 3 1 - - — — — - 2 — 17 — 3 - - - - - ,, 20 17 16 1 —- — - - - — - 6 — 15 7 4 2 - - - - ,, 27 12 26 — I - - - - -— - 9 - 8 5 4 - - - - - Nov. 3 21 27 2 - — - - - — - 3 - 22 4 5 - - - - - ,, 10 11 17 - 1 - — — — 1 - 8 1 24 — 1 - - - - - ,, 17 16 21 - - - - - - — - 6 2 8 1 10 —- - - - - ,, 24 16 20 1 1 —- - — — — — 2 - 9 1 6 — - - - - Dec. 1 11 18 — - - - - - - - 3 1 12 4 5 1 - - - - ,, 8 10 19 - — — - — _ - - 3 — 15 - 7 - - - - ,, 15 21 12 — — — — — — — - 2 1 9 2 4 1 - - - - ,, 22 10 19 — 1 - - - - - - 5 — 21 2 7 — - - - - ,, 29 11 24 - - - - - - - - 3 1 1 — 3 - - - - - Total. 530 701 25 16 2 - 1 3 2 6 138 31 767 189 198 13 - - - - 40 Chief Vital Statistics since 1877. Year. Population. Births. Birth Rate. Deaths. Death Rate. Infant Deaths. Infant Mortality Rate. 1877 112,541 4,149 36.8 1,817 16.1 530 128 1878 115,144 4,491 39.0 2,147 18.6 733 163 1879 120,747 4,862 40.2 2,113 17.5 688 141 1880 124,350 5,164 41.5 2,371 19.0 793 153 1881 128,953 5,488 42.5 2,409 19.4 745 136 1882 136,548 5.907 43.2 2,586 18.9 874 148 1883 144,143 6,014 41.7 2,693 18.6 897 149 1884 151,737 6,563 43.2 3,057 20.1 1,035 157 1885 159,334 6,547 41.0 3,503 21.9 1,070 163 1886 166,936 7,075 41.7 3,151 18.8 1,060 149 1887 174,523 6,865 39.1 3,286 18.7 723 105 1888 182.118 6,867 38.5 2.848 18.0 905 131 1889 189,713 6,947 38.5 2,883 18.0 907 130 1890 197,308 7,063 38.5 3,977 21.7 1,142 161 1891 206,463 7,911 38.2 3,952 19.1 1,191 150 1892 212.703 8,013 36.9 4,019 18.6 1,225 158 1893 218,942 8,026 35.3 4,565 20.0 1,387 172 1894 225,184 8,089 33.9 4,026 18.2 1,123 139 1895 231,426 8,591 35.9 4,656 20.9 1,452 169 1896 237,665 8,519 35.4 4,395 18.9 1,395 163 1897 243,908 8,761 35.8 4,486 18.3 1,535 175 1898 250,145 8,750 34.9 4,594 18.3 1,525 174 1899 256,386 8,779 34.2 5,213 20.3 1,770 201 1900 262,627 8,885 33.8 5,156 19.6 1,671 188 1901 268,868 9,434 35 0 4.910 18.2 1,589 168 1902 270,076 9,553 35.3 4,858 17.9 1,382 144 1903 272,250 9,478 34.8 4,394 16.1 1,344 142 1904 274,424 9,276 33.3 4,836 17.6 1,467 158 1905 276,598 9,018 32.5 4,574 16.5 1,341 148 1906 278,772 9,193 32.9 4,610 16.5 1,270 138 1907 280,946 8,759 31.1 4,412 15.7 1,078 123 1908 283,121 9,214 32.5 4,364 15.4 1,089 118 1909 285,471 8,730 30.6 4,435 15.1 1.087 123 1910 287,471 8,646 30.0 3,773 13.1 866 100 1911 289,646 8,642 29.8 4,561 15.7 1.223 141 1912 291.900 8,642 29.6 4,146 14.2 889 102 1913 294,223 9,125 30.5 4,312 14.4 984 107 1914 296,570 8,848 29.8 4,425 14.9 957 108 1915 294,396 8,380 28.4 4,744 16.1 940 112 1916 287,969 8,377 29.1 4,233 14.7 828 112 1917 271,934 6,701 24.6 4,203 15.4 707 105 1918 262,858 6,021 22.9 5,492 20.8 700 116 1919 287,966 7,132 24.7 3,946 13.7 619 80 1920 299,440 9,723 32 4 3.888 12.9 716 73 1921 300,903 8,242 27.3 3,712 12.3 615 74 1922 304,738 7,959 26.1 4,124 13.5 641 80 1923 314,400 7,803 24.8 3,331 10.5 466 59 41 Particulars of Bodies received into the Mortuaries during 1923. Month. Stratford Mortuary. Canning Town Mortuary. Number received. Over 5 yrs. Under 5yrs. Sent in by Coroner. Sent in by Police. Sent in on Sanitary grounds. Number of Postmortems. Number of Inquests. Number received. Over 5 yrs. Under 5yrs. Sent in by Coroner. Sent in by Police. Sent in on Sanitary grounds. Number of Postmortems. Number of Inquests. January 29 23 6 29 .. .. 21 29 2 1 1 .. 1 1 1 1 February 18 9 9 18 .. .. 15 18 3 2 1 .. 3 .. 2 3 March 18 12 6 17 1 .. 12 18 7 7 .. .. 6 1 4 6 April 23 15 8 19 4 .. 16 23 2 2 .. .. 1 1 1 1 May 12 6 6 12 •• •• 8 12 1 1 •• .. 1 .. 1 1 June 16 10 6 14 2 .. 12 16 5 4 1 .. 5 .. 3 5 July 20 16 4 19 .. 1 12 19 5 5 .. .. 5 .. 3 5 August 16 14 2 14 2 •• 9 16 4 4 .. .. 2 2 2 2 September 14 10 4 12 2 •• 12 14 5 5 • • 4 1 1 4 October 15 10 5 13 1 1 11 14 3 3 .. .. 3 .. 1 3 November 21 14 7 20 1 .. 14 21 2 2 .. .. 2 .. 2 2 December 18 14 4 18 .. .. 14 18 5 5 .. .. 5 .. 4 5 Total 220 153 67 205 13 2 156 218 44 41 3 .. 38 6 25 38 West Ham Mortuary was not in use during 1923. 42 Number of days bodies remained in Mortuaries: — 44 were 1 day in Stratford Mortuary. 138 ,, 2 days ,, ,, ,, 30 ,, 3 ,, ,, ,, ,, 6 ,, 4 ,, ,, ,, ,, 2 ,, 5 ,, ,, ,, ,, 2 were 1 day in Canning Town Mortuary. 11 ,, 2 days ,, ,, ,, ,, 27 ,, 3 ,, ,, ,, ,, 4 ,, 4 ,, ,, ,, ,, 1 Doctor performed 12 post-mortem examinations. 2 Doctors ,, 8 ,, ,, each. 3,, ,,5 ,, ,, ,, 17,, ,, 3 ,, ,, ,, '28 „ „ 2 11 ,, ,, 1 ,, examination Collection of House Refuse. 37,192 loads of House Refuse were collected in the Borough during 1923, approximately equal to 55,781 tons. This refuse was disposed of as follows: — Mr. G. W. Abbott's shoot at Temple Mills 19,951 loads Quadrant Street Wharf 17,241 ,, Official Documents relating to Public Health. The undermentioned Circulars and Memoranda were issued by the Ministry of Health during the year 1923: — Circular 353—Explains provisions of the Local Government and other Officers' Superannuation Act, 1922. Circular 359—Setting out the lines on which the Annual Reports of Medical Officers of Health should be drafted. Circular 363—Forms for the prescribed returns from Venereal Diseases Treatment Centres. Circular 368—Guidance to Local Authorities in connection with the administration of the Town Planning (General Interim Development) Order, 1922. 43 Circular 369—Syllabus and Regulations of examination which home teachers of the Blind appointed after 1st April, 1923, will be required to pass within two years of their appointment. Circular 371—Re vocational training of ex-service men suffering from Tuberculosis at Preston Hall and Aylesford Training Colony. Circular 373a—Form T88 for Returns of Notifications made under Public Health (Tuberculosis) Regulations, 1912. Circular 374—Further information with regard to the Rats and Mice (Destruction) Act, 1919. Memorandum 76 V.—Forwarding Form V.R.5 for Returns of Pathological examinations made at V.U. Laboratories. Memorandum 78T.—Explaining procedure in filling up Form T52 relating to vocational training of ex-service men. Memorandum on taking of Samples under the Milk (Special Designations) Order, 1922. Circular 415—Calling attention to the case of Davis v. Morris, with regard to the practice of an unqualified midwife under the direction of a medical practitioner. Report by Dr. J. R. Hutchinson on the incidence of Scarlet Fever and Diphtheria in Ramsbury, Wilts. Report by Dr. Hamill on the Pasteurization of Milk. Circular 422—Calling attention to possible danger from Smallpox in connection with Training Camps of Territorial Army and O.T.C. Circular 424—To Boards of Guardians Forwarding Order, No. 68631, prescribing a new form of Notice of Requirement of Vaccination. Circular 388a—Explaining the Provisions of the Housing Act, 1923. Circular 425—Drawing the attention of Medical Practitioners to their statutory duty in regard to the Notification of Cases of Tuberculosis. Circular 426—Containing a Memorandum describing the chief characteristic features of Cancer, the present methods of 44 treatment, and offering suggestions to Local Authorities on the stimulation of public opinion as to the necessity of early application for medical advice. Circular 437—Importance of early reporting cases of suspected Plague or Cholera, with instructions as to bacteriological investigations. Circular 446—Postponing till 1st November the operation of the Public Health (Condensed Milk) Regulations. The Annual Report of the Chief Medical Officer of the Ministry of Health for the year 1922. Report by Dr. Janet Campbell on the Training of Midwives. Report on the use of Hydrocyanic Acid for fumigation purposes. Report on outbreak of Dysentery at Lynton spread through the agency of Milk traced to an active carrier of the disease. Circulars 356 and 356a—Explaining procedure in respect of the granting of Licences to sell Milk under special designations. Circular 358—New Scale of Fees payable to Doctors called in by Midwives, as from 1st January, 1923. In addition to the above, several lists of Institutions, with rates of charges for maintenance approved under the Tuberculosis Scheme and Lists of approved Salvarsan substitutes for treatment of venereal diseases were circulated by the Ministry, as well as Statutory Rules and Orders under the National Health Insurance Acts. Plaistow Hospital. Annual Report for 1923. The year 1923 proved a mild one as regards the number and average severity of the cases admitted to the Hospital. The total admissions were 89 less than in the previous year, and the total deaths were 43 as compared with 63 in 1922. The fatality rate, calculated on all the cases admitted, was 3.6 per cent. The decrease in the number of admissions was due to the diminished prevalence of Scarlet Fever, the admissions from this disease being 273 less than in the previous year. Cases of 45 Diphtheria, on the other hand, showed a slight increase, but the type of disease was milder; the fatal cases were 17 less than in 1922. At the beginning of the year 164 cases were in residence in the Hospital; 1,182 were admitted, making a total of 1,346 cases under treatment during the year. Of these, 1,088 were discharged, recovered, 43 died, and 215 remained under treatment at the end of the year. The following table shows the admissions and deaths for each month of the year : — 1923. Admissions. Deaths. Scarlet Fever. Diphtheria. Fyphoid Fever. Measles. Chickenpox. Other Diseases. Total. Scarlet Fever. Diphtheria. Typhoid Measles. Chickenpox. Other Diseases. Total. January 30 52 .. 1 1 3 87 .. 3 .. .. .. 1 4 February 18 52 .. 2 1 3 76 .. 1 .. .. .. 1 2 March 39 80 .. 6 .. 5 130 .. 1 .. .. .. 3 4 April 23 32 .. 3 .. 1 59 2 2 .. .. .. 1 5 May 16 44 2 1 1 1 65 .. 2 .. .. .. 1 3 June 29 42 2 1 3 6 83 .. 1 .. .. .. .. 1 July 30 23 1 1 1 1 57 .. .. .. .. .. .. .. August 27 53 1 .. .. 2 83 .. 3 .. .. .. .. 3 September 39 34 .. 3 .. 1 77 1 3 .. .. .. 1 5 October 58 79 3 3 .. 8 151 4 2 .. .. .. .. 6 November 61 97 1 3 1 11 174 .. 4 .. .. .. 4 8 December 42 83 .. 9 .. 6 140 .. 1 .. .. .. 1 2 Totals 412 671 10 33 8 48 1.182 7 23 .. .. .. 13 43 Scarlet Fever.— During 1922 there had been a steady decline in the prevalence of Scarlet Fever, and the admissions in 1923 remained exceptionally low throughout the year. The total number of cases under treatment was 462, which is 273 less than for the previous year. The type of disease was mild 46 for the first nine months of the year, but a slight rise in prevalence occurred during October and November, and the cases became more severe. Seven cases proved fatal. Six of these were suffering from the "septic type" of the disease; the seventh died from nephritis. The fatality rate was 1.6 per cent. of the admissions. In 24 cases the disease was complicated by the presence of other infections as follows:— Scarlet Fever with Diphtheria 15 cases ,, ,, ,, Measles 4 ,, ,, ,, Whooping Cough 2 ,, ,, ,, ,, Pneumonia 2 ,, ,, „ ,, Chicken-pox 1 case Diphtheria.—Cases of Diphtheria showed a slight increase over the number treated during the previous year. The type of the disease, however, was on the average much milder. The total number under treatment was 783, which is 71 more than in the previous year, but the total deaths were 23 as compared with 40 in the previous year. According to the history obtained of the 23 fatal cases, the duration of illness before admission to the Hospital was as follows: — 1 case had been ill 2 days before admission. 10 cases ,, ,, ,, 3 ,, ,, ,, 5,, ,, ,, ,, 4 ,, ,, ,, 4 ,, ,, ,, ,, 5 ,, ,, ,, 2 ,, ,, ,, ,, 6 ,, ,, ,, In one case the duration of illness was not known. The ages of these cases were as follows : — 14 were under 5 years of age. 7 ,, between 5 and 10 years. 2 „ „ 10 „ 13 „ None of the cases received antitoxin before admission. The average amount of antitoxin given to them in the Hospital was 42,000 units. The average amount given to all the cases was 19,000 units. 47 In 73 cases the larynx and trachea were involved. 38 of these recovered without operation. Tracheotomy was performed on 35 cases, and of these three were intubated later owing to difficulty in getting them to go without their tracheotomy tube. Eight deaths occurred among the tracheotomy cases, giving a fatality rate of 22.8 per cent. of the cases operated on. The fatality rate of all the cases admitted was 3.4 per cent. Typhoid Fever.—18 cases, notified as Typhoid Fever, were admitted during the year. Eight of these proved not to be suffering from the disease. Of the ten true cases, five occurrcd in one family. The type of disease was, on the average, not very severe, and all the cases recovered. The eight cases which were wrongly diagnosed are shown in the Table under the column of " Other Diseases They were found to be suffering from the following diseases: — Enteritis 5 cases *Ulcerative Colitis 1 case. *Miliary Tuberculosis 1 ,, *Ulcerative Endocarditis 1 ,, * These cases proved fatal. Measles.—33 cases were under treatment during the year. The type of disease was mild in the majority of cases and all recovered. Towards the end of the year an epidemic of the disease set in, and the number of admissions began to rise rapidly; also the type was becoming more severe. During this period three cases admitted as scarlet fever and two as diphtheria proved to be Measles. Whooping Cough.—This disease was not prevalent during the year, and no case, notified as Whooping Cough, was admitted. The disease, however, was present in eight cases in combination with other infections, as follows: — With Scarlet Fever 2 cases ,, Diphtheria 3 ,, ,, Pneumonia 3 ,, Whooping cough was a contributory cause of death in one case. 48 Chicken-pox.—Eight cases were under treatment during the year. All were of a mild type; there were no deaths. The disease was present in combination with diphtheria in two cases. Other Diseases.—Under this group are classed diseases which are not regularly admitted, and also cases which were found on admission to be wrongly diagnosed. The following are the diseases included in the group: — Pneumonia, 12; Erysipelas, 10 ; Tonsillitis, 5; Laryngitis, 2; Mumps, 1; Urticaria, 1; Tubercular Meningitis, 1; Cerebral Haemorrhage, 1; Puerperal Fever, 1; Hematuria, 1; Infantile Paralysis, 1; Nephritis, 1; Bronchitis, 1; Quinsy, 1; Vincent's Angina, 1. Of these, nine cases proved fatal, as follows: — Pneumonia 6 cases Vincent's Angina 1 case Cerebral Haemorrhage 1 ,, Tubercular Meningitis 1 ,, Vacant Accommodation.—In view of the diminished prevalence of Scarlet Fever during the year, the Council decided in the autumn to use vacant accommodation in the Hospital for cases of other diseases than Scarlet Fever and Diphtheria which might benefit by Hospital treatment. This decision was taken advantage of by medical practitioners, who sent in severe cases of Pneumonia, Measles, Whooping Cough and Erysipelas. Towards the end of the year, when an epidemic of Measles was prevalent in the district, two wards were opened for complicated cases of this disease. The Grange Convalescent Home.—During the year 218 patients convalescent from Scarlet Fever were transferred to the Convalescent Home at Harold Wood. They remained under treatment at the Home for periods varying from three to seven weeks, the average duration of residence being 35 days. These patients derived much benefit from their stay at the Convalescent Home. Staff Illness.—79 members of the nursing and domestic staffs had been warded during the year for various ailments. Two Nurses contracted Scarlet Fever, and seven contracted Diphtheria; all recovered. Sixteen nurses and maids had been warded for Influenza and nine for Tonsillitis. Forty-five had 49 been off duty for short periods through minor ailments; all recovered. Bacteriological Work.— Besides the routine bacteriological work done in connection with Hospital patients, the following examinations were made for medical practitioners in the Borough: — Throat Swabs 307 Nasal Swabs 22 329 Ambulances and Disinfecting Vans.— The number of journeys made by the two motor ambulances during the year was 877; the mileage run was 4,385. In the collection and delivery of infected clothing the two motor vans made 3,005 journeys. The number of articles disinfected for the public was 12,990. The mileage run by the vans was 9,345. All minor repairs to the motor vehicles are carried out by the Engineer's staff. D. MACINTYRE. Annual Report of the Tuberculosis Officer for the year 1923. As year succeeds year the number of people examined at the Tuberculosis Dispensary increases. This is due not to an increased incidence in the number of cases of Tuberculosis, but to other causes, the chief of which are: — (a) The marked increase in the number of contacts examined. (The number of contacts examined in 1920 was 552, and the number examined in 1923, 887.) (b) The large number of patients who previously sought treatment at one or other of the big London Chest Hospitals now prefer to be treated at their own Tuberculosis Dispensary: at the present time there is only a very small percentage of cases being treated elsewhere. 50 (c) The number of doubtful cases sent to the Tuberculosis Officer for diagnosis or advice by General Practitioners continues to rapidly increase. (The number of " Request" Cases examined in 1920 was 359, and the number examined in 1923, 600. ) It is a pleasing feature of the work and a significant fact that the Dispensary is now well recognised by the populace as a centre for obtaining any information or advice concerning Tuberculosis, and numerous interviews are given, and letters written, on questions appertaining to Tuberculosis in its various phases. Though bad housing conditions continue to be prevalent, I cannot refrain from testifying to the very marked improvement in the general cleanliness of the interior of the dwellings of most Tuberculous patients as compared with ten years ago, and to the valiant efforts put forth by them to make the best of existing conditions and to prevent, as far as practicable, the spread of their complaint. Notified Cases (i.e., cases notified by Medical Practitioners).—See Table A. (Note.—Cases notified as Tuberculosis to the Medical Officer of Health by the Tuberculosis Officer are found under Tables C and D as Positive Cases.) The number of these cases is slightly in excess of the number for 1922, though the percentage of cases which proved not to have been actually Tuberculosis is larger. The probable reason for this is that a circular letter was sent to all General Practitioners by the Ministry of Health asking them to pay particular attention to the notification of all cases of Tuberculosis, or cases reasonably suspected to be suffering from 1 uberculosis which came under their notice. This circular letter was promulgated owing to the fact that in many districts it became evident that a considerable number of deaths from Tuberculosis had never been notified in life as suffering from that disease. Although the number of notified cases do not decrease, what is very encouraging is the much higher percentage of positive cases examined in the first stage of the disease—see Table B. (In 1920, 50% in Stage I.; in i923 70% in Stage I.) 51 Table "A"—Notified Cases. Positive. Negative. Observation. Total. Adults— Males 79 11 5 95 Females 54 15 2 71 Children— Males 62 13 3 78 Females 63 13 4 80 258 52 14 324 Table " B "—This includes Positive Cases in Tables A, C & D Type I. Type II . Type III. Surgical and Combined. Total. Turban Gerhadt Classification 418 89 26 60 593 Contact Cases are such cases has have been in contact with, or exposed to infection by a case of Tuberculosis. As mentioned in Paragraph 1, the number of contacts examined is large, and is an indication of the good sense of the adults, and of the parents of the children, examined under this heading. The percentage of contacts found to be suffering from Tuberculosis is very low and shows a big drop from previous years. This is a natural sequence of the earlier stage in which the disease is notified (the infectivity of Tuberculosis in its very early stage being slight in comparison to the advanced stage) and from the greater precautions against infection taken in the house than formerly. Table " C "—Contact Cases. Positive. Pre-T. B. or Indef. Negative. Total Adults— Males 3 4 72 79 Females 11 22 232 265 Children— Males 21 48 200 269 Females 16 47 211 274 51 121 715 887 52 Request Cases are those cases which have been sent by a Medical Practitioner, a General Hospital, or other Authority to the Tuberculosis Dispensary for diagnosis or advice. In this connection the co-operation between the Tuberculosis Officer, the Doctors, and the various Hospitals and Institutions, both within and Without the Borough, is complete and cordial. Table " D "—Request Cases. Adults— Positive. Observation. Negative. Total. Males 134 15 110 259 Females 97 18 77 192 Children— Males 33 27 26 86 Females 20 25 18 63 284 85 231 600 Observation Cases consist of several classes of cases, e.g., those cases in whom the diagnosis is for a time uncertain, and who are examined at frequent short intervals pending a definite diagnosis (expectant cases), as also those in whom the disease has become quiescent or arrested and who are examined at more or less long intervals (supervision cases). Pre-Tubercular cases, so classified, are those (mostly the offspring of Tuberculous parents) in whom, though no actual sign of Tuberculosis is present, tne general condition of health is one bordering on Tuberculosis. Treatment.—Treatment given consists of either Dispensary, Sanatorium, Hospital or Domiciliary, according to the state of the disease and other guiding factors. Though the number of cases treated at outside Institutions is decreasing, the retention of a small number of beds at these extraneous Institutions is advantageous, as there are a few patients whom it would, for exceptional reasons, be unwise to send to the Dagenham Sanatorium. 53 At the end of the year 278 people were receiving Domiciliary Treatment, and during the year 719 Domiciliary Reports were received from Practitioners concerning Tuberculous patients. These reports are of great value to the Tuberculosis Officer in his work, and he fully appreciates the help given him by the General Practitioners in this connection. In addition to the above, 3,949 visits were paid to the patients' homes by the Staff of the Dispensary. Table " E." Dispensary— Number of persons seen for the first time 1,811 Adults 961 Children 850 1,811 Males 866 Females 945 1,811 Notified Cases 324 Contact Cases 887 Request Cases 600 1,811 Number under Dispensary Treatment at 31st Dec. 1,066 Number under Dispensary Observation at 31st Dec 351 Total Attendances at Dispensary 13,396 Sanatorium. Hospital. Total Number of Adult Patients who received Institutional treatment during the year 319 76 395 Number of Adult Patients receiving Institutional treatment at 31st December 99* 25 124 Children.— The Council have formulated a different method than the one at present in existence for the Residential Institutional Treatment of children, and if this method should be adopted a very real advance will be made in this vitally important matter. * Nine of these patients were receiving Treatment combined with Vocational Training at special Institutions under the Ministry of Pensions. 54 A very big percentage of the children treated at the Dispensary are not actually suffering from Tuberculosis, but in that condition described above as Pre-Tuberculous, and it is imperative that these children should be adequately treated or supervised if they are to be prevented from becoming definitely Tuberculous. After-Care. (Extra Nourishments, Visiting by Nurses, Dispensary Treatment, Periodical consultations between the Panel Doctors and the Tuberculosis Officer.) The Extra Nourishment granted, though of advantage in a few individual cases, has not proved to be the definite asset in maintaining the patient's strength that was anticipated. Failing a more extensive "After-Care " Scheme, it would doubtless be advantageous if the Nourishment granted could be provided at one or more central dining centres which, for a small sum, could have attached a reading and rest room for the patients. A very essential part in the treatment of Tuberculosis is efficient "After-Care ", and it is in this essential that the scheme is weakest. Except in the very earliest cases, Tuberculosis is not cured in the comparatively short period of time that a patient remains in a Sanatorium, which only really builds up the resistance for further prolonged treatment, to be carried out, generally, in the patient's home. It is abundantly evident that any scheme for dealing with the treatment or eradication of Tuberculosis should, like most other public health measures, be broad based upon healthy homes. F. GARLAND COLLINS, Tuberculosis Officer. 55 Dagenham Sanatorium. Annual Report for the year 1923 At the end of 1922 the number of Patients remaining under Treatment was— Males 52 Females 13 — 65 The Total Admissions during 1923 were— Males 177 Females 72 249 The following classes of cases were treated : — Early. Intermediate. Advanced. Males 36.5 30.4 32.9 Females 26.3 22.2 51.3 The Number of Deaths was— Males 26 Females 12 — 38 Discharges during the year totalled— Males 138 Females 40 178 The disease was arrested in 40 per cent. of the cases, improved in 44, and unimproved, stationary, or worse in 16. The following remained under Treatment at 31st December, 1923: — Males 65 Females 33 — 98* * Includes 19 non-insured persons (males 8. females 11). 56 The average gain in weight was 10.01, exclusive of the unimproved cases. Insured Persons admitted during the year totalled 199, the remaining 50 being non-insured. Sixty-five Ex-service Men were admitted to the Sanatorium during the same period. The Death Rate (calculated on admissions) was 15.2%. In the case of males the percentage was 14.7. ,, ,, ,, females .. ,, ,, 16.6. Average Duration of Residence (both sexes): 136.6 days. The average for males was 141.7 days. „ females ,, 121.3 ,, Accommodation.—On August 31st a ward containing 24 beds was declared open by the Mayor for the treatment of female patients, bringing the number of beds up to 104, as follows: — Male, Hospital 14 ,, Sanatorium 52 Female, Hospital 14 ,, Sanatorium 24 The accommodation is to be further increased to provide 14 Hospital beds for male cases and 10 Sanatorium beds for female cases, making a total of 128 beds. Recreation.—Whist Drives and Concerts were frequently arranged during the year, and keen interest was taken in the billiard handicaps. Wireless was installed during the year, and has been much appreciated by the bed patients. G. M. MAYBERRY, Medical Superintendent.