wham 3 County Borough of West Ham. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1924. ^ ,V. . INDEX. PAGE Acts, Bve-Laws and Local Regulations (list of adoptive) 28 Ambulance Service 27 Births 10 Cerebro-Spinal Fever14 Clinics, School Dagenham Sanatorium, Medical Superintendent's Report 59, 60 Dairies, Cowsheds and Milkshops Order Deaths 10 Deaths, Causes of 44 Deaths in Public Institutions 10,11 Disinfection, and Disinfestation 38 Dried Milk, Distribution of 46, 47 Eucephalitis Lethargica 14,15 Extracts from V'tal Statistics of the year 13 Factory and Workshop Act, 1 901 43 Food, Unsound, Condemned 32 Hospital Accommodation 26,27 House Refuse, Collection of 49 Housing 38, 39 Increase of Rent and Mortgage Interest Restriction Act, 1920 38 Infectious Diseases 13, 14 Laboratory Work 27 Maternity and Child Welfare 18, 19, 20, 21 Milk and Cream Regulations, 1912 and 1917 35, 36, 37 Mortuaries 48, 49 Notifications, Summary of 45 Nuisances, Abatement of 29, 40 Out-workers 41, 42 Physical Features and General Character of the District 9 Plaistow Hospital, Medical Superintendent's Report 51,52,53,54,55,56,57,58 Poliomyelitis 14 Propaganda Work 17 Prosecutions 31, 32 Research Committee 16 Samples taken, Food and Drugs Act 33 Slaughter Houses 40 Smoke Abatement 38 Staff, List of 5, 6, 7, 8 Summary of General Statistics 12 Summary of Work of Sanitary Inspectors 30 Tuberculosis Officer, Report of 61, 62, 63, 64, 65, 66 Venereal Diseases 22, 23, 24, 25 Veterinary Surgeon's Report 33, 34 Vital Statistics of Wards, 1924, etc 12, 50 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE COUNTY BOROUGH OF WEST HAM. Mr. Mayor. Ladies and Gentlemen, I have the honour to present to you the Annual Report of the Public Health Department for the year 1924. Having been appointed your Medical ()fficer of Health so recently as September last, this, my first Annual Report, is chiefly confined to statistical tables and the record of actual facts, as it would be premature for me to attempt to enlarge on certain subjects or to give considered opinions on various matters. I hope, however, in my next Annual Report to publish a full and detailed account of Public Health work as carried out in this Borough, and also to be in a position to be able to record some definite improvements and advances towards the safeguarding and amelioration of the health of the inhabitants. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, F. GARLAND COLLINS. M.R.C.S. (Eng.). L.R.C.P. (Loud.). D.P.H.. Medical Officcr of Health. April, 1925. 5 Public Health Staff.* NAME. QUALIFICATIONS. OFFICES HELD. (Wholetime appointments except where otherwise stated.) Dr. F. Garland Collins Dr. F. B. Skerrett M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. M.B., B.Sc. (Lond.), M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health, Chief Administrative Tuberculosis Officer and School Medical Officer. Assistant Medical Officer of Health and Chief Assistant School Medical Officer. Dr. D. Maclntyre M.D. (Glasgow), D.P.H. Medical Superintendent Plaistow Fever Hospital. Dr. E. James M.B., Ch.B. (Aberdeen) Resident Medical Officer Plaistow Fever Hospital. Dr. YV. R. Kilgour M.R.C.S. (Eng.), L.R.C.P. (Lond.) Assistant Tuberculosis Officer. Dr. G. M. Mayberry L.A.H. (Dublin), L.R.C.P. (Ireland). Medical Superintendent Dagenham Sanatoriam. Dr. Constance M. Willis M.R.C.S. (Eng.), L.R.C.P. (Lond.), B.S. Assist. Resident Medical Officer Dagenham Sanatorium. Mr. A. McCunn M.R.C.V.S. Veterinary Surgeon (part. time officer). Miss A. E. Bradley General Nursing, C.M.B., Royal Sanitary Institute Health Visitor. Miss B. H. Clipstone General Nursing, C.M.B. Do. Miss A. Connolly General Nursing, Health Visitor's Certificate Do. Miss M. Cross General Nursing, C.M.B., Fever Nursing Certificate Do Miss M. Day General Nursing, C.M.B., Board of Education Diploma Do. Mrs. N. C. Gibbins General Nursing, C.M.B., Health Vis. and Fever Nursing Certificate Do. Miss M. Grierson General Nursing, C.M.B. Do. 6 NAME. QUALIFICATIONS. OFFICES HELD. (Wholetime appointments except where otherwise stated.) Miss M. E. Hop wood General Nursing, C.M.B., San. Inst. Examn. Board Health Visitor. Miss A. E. Lunn General Nursing, C.M.B. Do. Miss L. Martin Miss M. B. Wallace General Nursing, C.M.B., Board of Education Diploma General Nursing, C.M.B. Do. Do. Miss E. B. Welch General Nursing, C.M.B., Board of Education Diploma Do. Miss A. S. Billing Diploma Sanitary Inst., Advanced Physiology and Hygiene, Science & Art, Kensington Sanitary Inspector. Miss C. M. Heaviside San. Inspr. Cert. Royal San. Institute. Do. Miss B. M. Keogh San. Inspr. Cert. London Examn. Board, Health Visitor's Cert. Sanitary Inst., L.C.C. Teachers' Certificates in First Aid, Infant Care, Home Nursing, Health Do. Miss M. Monkhouse Certificate General Nursing and Certificate of O. V. J. I. as Nurse and as Superintendent of Queen's Nurses, San. Inspr. Royal San. Institute, San. Inspr. San. Inspectors' Association Do. Mr. B. G. Bannington San. Inspr. Cert. R. San. Inst., Cert, of London Sch. of Economics (Lond. University) for Social Service and Administration, Honoursman and Gilchrist Medallist (Lond. University Extension) for Public Administration Do. Inspr. under Rag Flocks Act. Mr. J. Dyke Cert. San. Inspr. Royal San. Inst., Cert. Building Constn.West Ham Tech. Institute Sanitary Inspector. Inspr. under Rag Flocks Act. 7 NAME. QUALIFICATIONS. OFFICES HELD. (Wholetime appointments except where otherwise stated.) Mr. T. R. Harris, A.R.San.I., M.S.I.A. Cert. San. Inspr., Meat Inspr. Royal San. Inst. Cert. San. Insgr., Meat Inspr. San. Inspectors' Board. Cert. San. Science, 1st Class, Battersea Polytechnic Sanitary Inspector. Mr. John F. Mules, M.S.I.A. Cert. San. Inspr., Meal Inspr. Royal San. Inst. Dip. San. Science, Lond. Do. Mr. H. E. Parker, M.S.I.A. Mr. A. T. Plackett Cert. San. Inspr. Royal San. Inst. Cert. San. Inspr. Royal San. Inst. Sanitary Inspector. Inspr. under Rag Flocks Act. Do. Mr. W. H. Roberts, M.S.I.A. Cert. San. Inspr. (1892) Royal San. Inst. Prizeman Building Const (Honours) Prizeman Civil Engineering (Survey Sec.) West Ham Tech. Inst. Do. Mr. Chas. Smith, M.S.I.A. Cert. San. Inspr. (1894) Royal San. Inst. Cert. Building Const. (Adv.) Science & Art Dept, S Kensington Do. Mr. H. A. Smith Cert. San. Inspr. Royal San. Inst. Sanitary Inspector. Mr. E. J. Simmons, M.S.I.A. Mr. G. H. Wilson Cert. San. Inspr. (1912) Royal San. Inst. Cert. San. Inspr. Royal San. Inst. Cert. Problems of Life and Health (Merit) London University Do. Inspr. under Rag Flocks Act. Do. Mr. E. F. Hughes Mr. E. J. Ferrier Cert. San. Inspr. Royal San. Institute. Inspector of Food. Shops Inspector. Mr. W. S. Taylor Dust Inspector. Miss E. D. Rayment General Nursing Mental Deficiency Nurse. 8 Public Health Administrative Staff. Mr. J. A. Cheatle Chief Clerk. ,, F. W. Bromley Senior Clerk. „ H. R. Cole Clerk. ,, C. A. Haigh (Mental Deficiency) do. ,, F. H. Barker do. ,, A. Clark do. ,, B. J. Driscoll do. Miss V. M. Busby do. ,, W. I. Compton do. TUBERCULOSIS DISPENSARY. Nurses. Clerks. Mrs. E. Siggins, Sister.in.Charge. Mr. W. Pike. Miss E. J. Egerton, Nurse. Miss M. F. Bush. Mrs. Z. Griffin, do. Miss K. E. Pottinger, do. PLAISTOW HOSPITAL. Steward. Matron. Clerks. Mr. F. Milsted. Miss M. Drakard. Mr. J. Regan. ,, W. Liddall. DISINFECT ORS. Mr. G. Palmer. Mr. G. J. Howes. ,, H. J. Murty. ,, W. Hubbard. MORTUARY KEEPERS. Mr. J. Gould. Mr. H. B. West. * A detailed list of the Staff is included in this Report by the special request of the Minister of Health in accordance with Circular 540, dated 18th December, 1924. County Borough of mest Gam ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1924. 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 3?, 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 4,70(> 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^ 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 Thanet 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 Iee 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 in 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. 10 Births. The number of births registered in the Borough during the year was 7,975 (4,014 males and 3,901 females), but of this total 888 were children of non.residents who came to be confined in one or other of the maternity hospitals or were visiting friends, while 115 West Ham mothers were confined outside the Borough. Suitable adjustment makes the net West Ham births 7,202 (3,642 males and 3,560 females); 201 of these (102 males and 99 females) were illegitimate. Calculated on the Registrar General's estimate of the population of the Borough at the middle of 1924, viz., 317,400, the birth.rate for the year was 22.69. 7,548 live births and 201 still births were notified within 36 hours of birth in accordance with the Notification of Births Act, 1907. Deaths. The number of deaths registered during the year was 2,650, but of these 198 occurred in persons not belonging to the Borough, while the deaths of 1,200 residents of West Ham occurred in various institutions and districts elsewhere, making the total net deaths attributable to the Borough number 3,652, of which 1,913 were males and 1,739 females. The distribution of these deaths to their various causes will be found later in this report, but the grand total of 3,652 from all causes gives an annual death.rate of 11.5 per 1,000 of the estimated population. It may be of interest to compare the annual death rate for England and Wales, which was 12.2 per 1,000 of the total population, and that for the 105 County Boroughs and Great Towns, including London, which was 12.3. 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 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 (Queen Mary's Hospital for the East End, St. Mary's Hospital, Plaistow Maternity Charity, I.C.C.S. Children's Hospital, II 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) 86 infants and 1,114 persons over the age of 1 year died during the year, and in the latter group (inside Institutions) 140 infants and 410 elders died, of which numbers 38 infants and 160 elders' deaths were of non.residents of the Borough. The net deaths of West Ham residents in Public Institutions were 188 infants and 1,364 persons of one year and upwards, making a total of 1,552 institutional deaths as compared with 2,100 deaths in private residences. Over 57 per cent, of the deaths during the year occurred in Public Institutions. Deaths in Outside Institutions :— Under l year and 1 year. upwards. Whipps Cross Hospital 52 509 Central Home 3 319 Dagenham Sanatorium — 35 Goodmayes Mental Hospital 51 Residents dying in London Institutions, &c. 31 200 Deaths in Inside Institutions: — Plaistow Hospital 14 66 Queen Mary's Hospital for East End 50 132 St. Mary's Hospital 42 53 Plaistow Maternity Charity 12 5 Royal Albert Dock Hospital 1 55 I.C.C.S. Children's Hospital 5 2 Forest Gate Sick Home 16 62 Other Places, e.g., Docks — 35 226 1524 Non.residents dying in Inside Institutions 38 160 188 1364 Net West Ham Deaths in Institutions 1552 12 Vital Statistics of the Wards of the Borough during: 1924 Wards. Births. Birth Kate. Deaths. Death Rate. | Infant Deaths. Infant Mortality per 1,000 births Natural increase Births over Deaths. ated population middle of 1934. New Town 409 20.83 211 10.74 37 90 198 19,629 Forest Gate 372 18.37 229 11.31 19 50 143 20,243 High Street 515 26.67 180 9.32 28 54 335 19,303 Broadway 310 21.30 172 10.77 22 64 168 15,960 Park 288 17.73 156 9.00 15 52 132 16,246 Upton 255 13.91 187 10.20 12 47 68 18 332 Plashet Road 319 19.31 186 11.26 24 75 133 16,513 West H am 380 20.58 217 11.75 32 84 163 18,464 Plaistow 530 23.69 240 10.72 37 69 290 22,369 Bemeersyde 228 14.85 133 8.66 13 57 95 15,353 CanningTown & Grange 639 25.20 326 12.85 60 93 313 25,357 Hudsons 458 21.45 253 11.87 30 65 205 21,350 Ordenance 564 26.43 280 13.12 48 85 284 21,334 Beckton Road 587 27.68 238 11.22 63 107 349 21,205 Tidal Basin 748 32.26 354 15.26 69 92 394 23,183 CustomHo.&Silvertn 570 25.26 290 12.85 55 96 280 22,559 County Borough 7,202 22.69 3,652 11.5 564 78.31 3,550 317.400 Summary of General Statistics IN THE FORM ASKED FOR BY THE MINISTRY OF HEALTH. Area (acres), 4,706. Population (1924), 317,400. Number of inhabited houses (1921), 47.995. Number of families or separate occupiers (1921). 68,569. Rateable value—Poor Rate. £1,404,039. General District Rate. £1,314,533. Sum represented by a penny rate—General District Rate, £5,400. 13 Extracts from Vital Statistics of the Year. . Eng& Births Total. Male. Female. Wales. Legitimate 7,001 3,540 3,461 Birth.rate22.09 18.8 Illegitimate 201 102 99 Deaths 3,652 1,913 1,739 Death.rate 11.5 12.2 Number of women dying in, or in consequence of, child.birth— From Sepsis 5 From other causes 7 Deaths of infants under one year of age per 1.000 births— Legitimate, 74.84. Illegitimate, 3.47. Total 78.31 Deaths from measles (all ages) 114 Deaths from whooping cough (all ages) 84 Deaths from diarrhoea (under 2 years of age) 75 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 .. .. .. Diphtheria 801 751 33 Scarlet Fever 388 320 4 Enteric Fever and Paratyphoid 19 16 4 Puerpural Fever 15 13 5 Pneumonia 419 158 494 Cerebro Spinal Fever 2 1 3 Acute Poliomyelitis 2 2 .. Acute Polio. Encephalitis 2 .. .... Encephalitis Lethargies 26 19 1 Erysipelas 177 32 8 Ophthalmia Neonatorum 24 4 .. Malaria 26 16 •• M Cases of sickness visited and investigated by Women Sanitary Inspectors during 1924: — Number Disease Visited. Chicken Pox 671 Measles 2,304 Whooping Cough 839 Influenza 655 Other infections 787 Catarrh Colds 206 Bronchitis 431 Tonsillitis, sore throat 719 Ringworm 96 Scabies 35 Other skin diseases 562 Tuberculosis 68 Injuries 139 Other causes 475 Special Diseases. Cerebrospinal Fever (Spotted Fever). During the year only two cases of Cerebro. Spinal Fever were notified, both infants under a year old (a boy and a girl), and both died. In addition one doubtful case (an adult male) was not notified, but actually died from this disease. Poliomyelitis. Two cases of Poliomyelitis (a boy 2 years and a girl 1 year). Both recovered, each with the loss of power in a limb. Encephalitis Lethargica. Thirty.one cases of Encephalitis Lethargica were notified, but in three cases the diagnosis was not confirmed. Two (a 15 boy and a girl under 4 years of age) were afterwards diagnosed as Tubercular Meningitis, and one (a young man) as Tonsillitis. Of the other 28 notifications, one (a girl of 13) appeared to make a good recovery, but 8 months later was re.notified. One death occurred, a girl baby under a year old. There are eight cases that appear to have completely recovered, viz., a girl of 14, and males aged 26, 17, 14, 6, and 3 boys aged 4. The remaining cases are under treatment suffering from various nervous symptoms or from debility. Of the entire notifications, 20 were male cases and 7 female cases (one having been notified twice). Tuberculosis. The following table sets out the number of notified cases of Tuberculosis and the number of deaths during the year at certain age periods, distinguishing: separately the certain age periods, distinguishing separately the pulmonary and non.pulmonary forms, males and females: — Age Periods. New Casks. Deaths. Pulmonary. Non.pulmonary Pulmonary. Non.pulmonary. M. F. M. F. M, F. M. F. 0 1 .. 4 2 .. .. 5 3 1 9 12 26 25 1 3 18 21 5 56 52 20 11 3 3 3 2 10 44 36 16 8 4 7 3 2 15 25 39 6 5 15 16 .. 1 20 55 59 7 8 20 28 3 1 25 72 73 7 6 44 17 .. 3 36 60 43 6 2 44 24 1 .. 45 47 34 1 2 22 13 3 .. 85 29 16 1 1 22 11 .. .. 65 and upwards 7 3 2 1 9 2 .. 1 Totals 405 367 95 71 184 124 36 34 Included in the above new cases are 18 pulmonary males, 8 pulmonary females, 8 non.pulmonary males, and 6 non. pulmonary females, which were not notified but were discovered 16 from the returns of the Registrars of Births and Deaths, showing that 10.5 per cent, of the deaths registered as due to Tuberculosis had not been notified during life. The total number of cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year was 938, of which 772 were pulmonary cases and 166 tuberculosis of the other organs. The deaths due to this disease numbered 378, giving a death.rate for the year of 1.19 per 1,000. The death.rate from respiratory phthisis being 0.97, and from other forms 0.22 per 1,000. The Reports of the Assistant Tuberculosis Officer and of the Medical Superintendent of Dagenham Sanatorium will be found on pages 59 and 61. Research Committee. This Committee has been formed during the year and is composed of all the Medical Staff of the Council and of the Education Committee, certain of the Staff of the Hospitals in the Borough, and several local Medical Practitioners. The work of this Committee is not, perhaps, so much in the nature of research itself as to attempt by discussion and other methods, to lead up to a definite line along which research work. might be undertaken in certain diseases with a good prospect of success. The Committee has met on six occasions, and so far confined its attentions chiefly to the Cancer problem and to Tuberculosis. Any findings of the Committee which are considered relevant are placed before the Council's Public Health Committee for their consideration. A great drawback to the work of this Committee is the fact that each individual member, being already in the active practice of his profession, has only a limited amount of time at his disposal for research. A fully equipped pathological laboratory attached to one of the local hospitals would be of great service to the Borough. 17 Propaganda Work. During the year the question of Propaganda in connection with the Public Health of the Borough has been under consideration. To inaugurate a campaign of this type in December a Christmas card was printed and (with the cordial co.operation of the School Teachers) distributed to each of the scholars in the Boys' and Girls' Departments of the Elementary Schools. The text of this card is reproduced here. It is the intention of the Medical Officer of Health to write a brief article on each of the nine points mentioned and to elicit the help of the School Teachers in bringing these articles to the notice of the children and their parents. (Outside Cover). HEALTH IS BETTER THAN WEALTH. The Public Health Committee of the West Ham Council send Greetings for a Happy Xmas and Good Health during the Coming Year. {Inside). health is better than wealth. How to be Healthy. 1. Eat plain wholesome food at regular intervals, and drink plenty of water. 2. Keep the teeth sound and clean and the feet warm and dry. 3. Breathe through the nose, not through the mouth. 4. Remember an open window lets out more disease than it could ever let in. 5. Take daily open.air exercise, in the sunshine when possible. 0. Go to bed early to get sufficient sleep, and be regular in your habits. 7. Wash the whole body at least once a week. 8. Strive to be healthy if you wish to be happy. 9. Never forget that the most powerful of all disinfectants is LIGHT. 18 Maternity and Child Welfare. Visits paid by Health Visitors during the year 1024:— To Expectant Mothers: First Visits, 1,048; Total Visits. 2,067 To Infants Under I year: First Visits. 4,229; Total Visits, 19,332 To Children 1—5 years: Total Visits, 31,462. Number of Midwives practising in District: Trained 93; Untrained 1. (Bona fide, 1904.) The Public Health Authority does not emply or subsidize practising midwives. Maternity Homes Subsidized by Council: — Number of Beds: Queen Mary's Hospital 10 Plaistow Maternity Charity 10 Number of Cases received during the year: Queer. Mary's Hospital 444 Plaistow Maternity Charity 453 Number of Weeks spent in Hospital by such Cases: Queen Mary's Hospital 8154/7 Plaistow Maternity Charity 993 Hospitals for Children under 5 years (subsidized by Council:— St. Mary's Hospital—Number of Beds 10 I.C.C.S. Hosp. (late Settlement Hosp.)—Number of Beds 10 Number of Children admitted to St. Mary's Hospital 429 Number of Children admitted to I.C.C.S. Hospital 79 Number of Weeks spent by Children in St. Mary's Hosp. 9575/7 Number of Weeks spent in I.C.C.S. Hospital 5602/7Number of Children under 5 years in Homes and Hospitals outside Borough 28 Number of Weeks spent in such Homes 243 Day Nursery (subsidized by Council) No ½ days. Whole days, 6,292. Daily average 26 19 No Institutional provision exists for unmarried mothers, illegitimate infants, and homeless children in the district. Municipal Centres and Clinics (subsidized by Council except Silvertown Municipal Centre):— Centres. No. of Sessions held weekly. Day and time of meeting. Average per Session . Present arrangements for Medical Supervision. Expectant Mothers. Children. Chesterton House 4 Tues., Wed., Thurs., Fri., 1.30 p.m. 65.98 87.88 Dr. Kennedy. St. Luke's Squire 4 Mon.,Tues ,Wed.,Thurs., 2 p.m. 59.13 71.45 „ Hirst. Martin Street 1 Thurs., 3.30 p.m. 21.65 53. ,, Kennedy. S.W.Ham Health Society 3 Wed. & Friday, 1.30 p.m. Tues:, 1 p.m. 9 43.93 ., Lilian Hawthorne. Trinity Mission 2 Wed. & Thuis., 2.30 p m. 1.84 34.81 ,, Margaret Alden. Women's League of Service 3 Mon., Wed. & Fri., 2.30 p.m. 1.84 30.16 ,, Dorothea Brooks. S. Town (Municipal 1 Wed., 2.30 p.m. . 23. „ Tivy. Domiciliary Confinements in West Ham carried out by the Midwives attached to the Plaistow Maternity Charity during the past three years:— 19)2 1923 1924 From the Central Homes, Howards Road 3,109 1,831 2,192 From the Docks Branch 1,276 1,223 1,078 From Stratford Branch 477 428 363 Totals 3,862 3,482 3,633 20 Ophthalmia Neonatorum. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 24 22 2 21 3 — — Midwives' Acts, 1902 & 1918. Number ot Midwives practising for an Association or privately. Number giving notice of intention to practise. Number of Hirths attended. Number of Records of sending for Medical Aid. Plai«tow Maternity Charity 42 2,974 538 Beechcroft Nurses' Home 23 89 22 Salvation Army Nurses 3 434 36 Tate Nurses' Institution 6 211 33 Queen Mary's Hospital Extern. 9 162 27 Private Practice: a. 1 43 3 b I 78 8 c 1 37 1 d 1 290 16 e 1 7 0 /f 1 41 11 g 1 131 19 h 1 173 26 Resident outside Borough but practising i 1 3 1 j 1 38 1 k 1 6 0 94 4,717 742 21 Analysis of " Records of sending for Medical Aid." Year 1924. Pregnancy— Lying.in— Abort, or Threatened 22 Fits — Ante. Part. Haemorrhage 38 Unsatisfactory condition 44 Dangerous varicose veins — Temp, raised 71 Albuminuria — Breasts swollen 0 Excessive sickness 2 Sec. P.P.H. 2 Labour— Child— Placenta prsevia 6 Injury at birth — Pres. or prolapse of cord 7 Deformity 10 Mal.presentation 37 Dangerous feebleness 52 Pres. not made out 3 Inflam. or disch. of eyes 21 Excessive Haemorrhage 28 Skin eruptions 2 Retd. plac. or membranes 32 Haemorrhage of navel — Prolonged labour 92 Unsatisfactory condition 01 Ruptured perineum 159 Prematurity 39 Unsatisfactory condition 24 Asphyxia 9 773 School Clinics.* Stratford Clinic, 2 Dental Clinics 84. West Ham Lane, E. 1 Minor Ailment Clinic. Balaam Street Clinic, I Dental Clinic. Plaistow, E. 1 Eye Clinic. 1 Minor Ailment Clinic. Rosetta Road Clinic, 1 Minor Ailment Clinic. Custom House, E. Public Hall, 1 Minor Ailment Clinic. Canning Town, E.16. All Clinics are used also as Inspection Clinics, and are provided by the Local Education Authority. * See Min. of Health Circular 540, dated 18/12/24. 22 Venereal Diseases—Utilization of facilities at Hostels, 1924. Particulars of the work done on behalf of the participating authorities, by the Hostels in the Scheme for the year ended 81st December, 1924. 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.I. Royal Free, 02, Regents Park Road, N.W. Salvation Army, 17 Highbury Terrace, N. Salvation Army, 4 Clapton Common, E. West London Mission, 35 Parkhurst Road, N. 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 1 n residence. Percentage (days). London 177 16,994 65.4 Middlesex 24 2,436 9.4 Essex 22 1,990 7..7 Surrey 16 1,790 6.9 Herts 9 1,143 4.4 Kent 12 945 3.6 Bucks 4 549 2.1 Croydon 2 140 .5 East Ham .. • • .. West Ham .. .. .. Totals 266 25,987 100.0 23 LONDON COUNTY COUNCIL. Venereal Diseases. Return showing the extent to which the facilities have been utilized during the year ended 31 st December, 1924. Hospital. New Cases. No. of Persons. Total attendances. No. ot Inpatient days. Sal. Subs, doses given. Spiro. Pathological Examinations. Others. Total. Syp. S.C. Gon. Not V.D. Total. Ceased to attend Discharged. Gon. Wass. (a) (b) (a) (b) (a) (b) (a) (b) Albert Dock 198 38 284 271 791 3,364 850 9,882 2,031 1,245 68 3 318 5 579 309 .. .. 1,282 Charing Cross 205 2 242 124 573 327 246 7,038 300 1.129 19 1 207 1,685 636 945 12 233 3,738 Diseases of Skin 74 .. 113 30 217 102 57 6,067 .. 1,321 11 .. 891 91 464 180 4 1.641 E.G.Anderson 50 .. 56 96 202 10 38 2.633 548 531 .. 1 491 28 236 337 218 .. 1.311 Gt. Ormoncl Street 79 .. 24 495 598 19 546 3,145 1,981 1.438 1 .. 490 . 1,313 46 232 2 2.084 Guy's 450 2 400 255 1 107 334 181 21,706 2,664 3.450 51 .. 2,572 84 1,539 1,838 231 .. 6.315 King's College 209 10 152 201 572 123 174 18,351 909 706 20 9 3,716 77 1,569 2,073 18 .. 7,482 Lock (Male) 672 75 2,546 1,095 4,388 1,311 2,522 81,502 11,256 3,278 193 .. 3,216 510 4 011 350 719 7 9,006 Lock (Female) 327 .. 760 158 1.245 37 145 9.713 39,352 1,149 .. .. .. .. .. .. .. .. .. London 508 5 708 569 1.790 859 204 34,257 4,500 3,362 15 7 4,545 602 2,099 3,014 .. .. 10,282 Metropolitan 155 33 205 168 561 176 125 6,371 103 1,076 41 .. 617 15 697 198 .. .. 1,568 Middlesex 190 1 212 120 523 224 203 13,616 618 1,646 24 .. 1,520 134 1 321 473 326 .. 3,798 Miller General 143 1 180 141 465 156 91 13,340 588 770 .. .. .. .. .. .. .. .. .. Royal Free 222 4 360 325 911 142 512 25.152 2,168 73 .. .. 3,655 18 1,420 718 50 5,861 Royal London Ophthalmic 157 .. 49 .. 206 .. .. 3,821 2,574 996 3 .. 68 .. 533 .. 14 .. 618 Royal Northern 292 .. 314 242 848 357 196 14,697 258 1,988 42 .. 1,177 61 1,002 1,512 8 .. 3,802 St. George's 173 2 194 120 489 110 266 7,619 33 1,905 21 1 519 105 964 609 14 .. 2,233 St. John's, Skin 75 1 53 6 135 64 26 7,118 675 10 5 128 16 287 300 .. .. 746 St. John's. Lewisham 86 7 175 30 298 118 116 9,382 728 570 .. .. 237 26 757 352 414 142 1,928 St. Mary's 227 1 274 127 629 176 177 10,086 492 1,209 10 .. 584 106 513 894 .. .. 2,107 St. Paul's 205 11 750 526 1,492 368 440 57,611 .. 1.379 189 .. 2,484 121 1,206 74 602 68 4,744 St. Thomas' 914 47 1,563 1,558 4,082 696 1,181 126,476 3,815 12,868 •• 5 4,021 410 6,774 919 9,292 377 21,798 Seamen's 463 60 644 22 1.189 674 325 26,203 8,036 1,329 22 3 1,067 1,359 779 631 133 9 4,003 South London for Women 40 .. 62 147 249 67 212 3,805 636 351 4 .. 471 89 242 132 2 940 University 185 4 197 103 489 158 65 15.373 731 1,776 37 .. 381 10 846 62 1,336 West London 226 .. 528 284 1,038 352 260 35,237 52 2,642 120 2 890 154 889 1,567 13 136 3,771 Westminster 75 1 98 58 232 36 76 12,340 158 788 12 1 496 8 321 453 32 85 1,408 S.A., Mothers' 20 .. 189 21 230 .. .. 6,461 8,823 68 .. .. .. .. .. .. .. .. .. Children's, Waddon 6 •• 18 .. 24 •• 29 •• 9,102 •• .. .. .. .. .. . .. .. .. Totals 6.626 305 11 350 7,292 25,573 10,360 9,263 589,002 102,456 49,718 913 38 34.761 5,714 30,997 17,986 12,334 1,059 103,802 (a) For Centre: 79,005. (b) For Practitioners: 24,797. 24 Venereal Diseases. Summary of the work done at the London Clinics for all areas from 1917. Year. New Cases. Total Y'enereal Cases. Total Non.Venereal Cases. Total Attendances. In.patient days. Pathological Examinations for Syphilis. Soft Chancre. Gonorrhoea. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Clinic. Practitioners. 1917 4,427 3,351 199 11 3,830 1,207 8,456 4,569 1,192 1,168 120,659 63,923 13,988 3,649 1918 3,764 3,002 116 13 4,844 1,940 8,724 4,955 1,345 1,348 169,485 66,095 25,973 6,380 1919 6,394 3,391 463 18 10,441 2.440 17,298 5,849 3,418 1,700 201,626 106,096 24,025 49,186 51,554 10,464 1920 6,988 3,579 706 25 10,669 2,427 18,423 6,031 4,403 2,189 329,940 134,093 29,430 52,182 58,920 14,027 1921 5,088 3,100 458 13 8,573 2,136 14,119 5,249 3,696 2,354 357,503 138,706 30,272 49,420 66,134 18,472 1922 4,207 2,600 309 12 8,233 2,402 12,749 5,014 3,759 2,191 387,631 141,372 28,809 83,755 74,022 19,836 1923 4,497 2,631 311 4 9,043 2.520 13,851 5,155 4,167 2,477 412,915 142,594 29,661 77,001 69,784 24,403 1924 4,174 2.452 301 4 8.565 2,785 13,040 5,244 4,869 2,423 424,850 164,152 31,620 70,836 79,005 24,797 25 LONDON COUNTY COUNCIL. Venereal Diseases. Summary of work done by the Hospitals during the year 1924. London. Middle sex. Essex. Surrey. Kent. Herts. Bucks. East Ham. West Ham. Croydon Total. Other places. Grand Total. New Patients:— Syphilis 4,763 445 260 170 133 81 23 49 166 37 6,127 499 6,626 Soft Chancre 202 7 9 3 4 3 ... 1 7 1 237 68 305 Gonorrhœa 8,571 724 424 203 196 87 32 78 241 76 10,632 718 11,350 Not Venereal 5.879 590 332 199 125 65 30 68 286 49 7,087 205 7,292 Total 18,879 1,766 1,025 575 458 236 85 187 700 163 24,083 1,490 25,573 Total attendances 478,484 33,604 14,616 12,836 7,867 3,455 1,410 3,879 9,971 2,899 569,021 19,981 589,002 No. of In-patient days 63,948 3,342 3,054 2,763 2,784 1,774 1,001 548 838 541 80,593 21,863 102,456 Salvarsan Sals, doses 38,284 3,484 1,520 1,354 631 515 206 342 1,240 444 48,020 1,698 49,718 Pathological Examinations. For or at Centre: Spirocbaetes 760 42 14 15 1 3 2 ... 12 1 850 63 913 Gonococci 28,087 1,832 1,147 671 562 174 69 368 725 193 33,828 933 34,761 Wasserman 24,426 1,738 933 807 522 294 129 222 690 241 30,002 995 30,997 Others 10,463 417 199 598 227 42 55 28 9 116 12,154 180 12,334 Total 63,736 4,029 2,293 2,091 1,312 513 255 618 436 551 76,834 2,171 79,005 For Practitioners: Spirochaetes 27 5 1 2 1 ... ... 1 1 ... 38 ... 38 Gonococci 3,898 165 119 371 143 23 17 26 121 510 5,393 321 5,714 Wasserman 14,802 550 827 458 71 46 111 133 426 370 17,794 192 17,986 Others 829 28 9 109 5 14 12 ... ... 2 1,008 51 1,059 Total 19,556 748 956 940 220 83 140 160 548 882 24,233 564 24,797 26 Hospital Accommodation. (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 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 smallpox 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, Ongar Rural. 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. Fortunately 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. Accommodation for 24 extra beds (making a total of 128) is now being proceeded with, and these beds should be available for tuberculosis cases in the early part of 1925. 27 (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 institution has during the last 2 years been used for the reception of diphtheria convalescents. 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 861 journeys during the year. In 280 eases persons were removed from one address to another within the Borough. In 581 cases from an address within the Borough to an institution outside or vice versa. Mutual arrangements are in existence 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. Laboratory Work. In addition to the Bacteriological work carried out at the Plaistow Hospital and at the Tuberculosis Dispensary, 540 swabs for suspected cases of diphtheria, 172 specimens of sputum and 5 specimens of blood from suspected cases of typhoid fever were examined at Seamen's Hospital, Greenwich, on behalf of the Public Health Department, most of the specimens having been submitted by private practitioners in the Borough. Diphtheria antitoxin can be obtained free from the Isolation Hospital or from the Public Health Department, Town Hall. Arrangements have recently been made whereby all swabs from cases of suspected diphtheria are to be sent by private practitioners direct to the Plaistow Fever Hospital for bacteriological examination and report instead of to the Seamen s Hospital, Greenwich, as formerly. This method (besides being more economical) will enable the result of the examination of the swab to be communicated to the doctor concerned with a minimum of delay. 28 List of adoptive Acts. Bye laws and local regulations relating: to public health in force in West Ham. The Public Health Acts Amendment Act, 1907. Sections 10, 20, 22, 29, 33. Part II. 38, 50. ,, III. 53, 02, 03, 04. ,, IV. ,, 81 (Part of) ,, VII. ,, 95 ,, X. Adopted 10th April, 1909. Bye-Laws. Removal of House Refuse Adopted 28th December, 1892. Common Lodging Houses ,, 20th July, 1892. Knackers' Yards ,, 28th December, 1892. Offensive Trades ,, 1st November, 1892. Nuisances do. Houses Let in Lodgings do. Slaughter Houses ,, 1st April, 1921. Nuisances in connection with the removal of offensive or noxious matter ,, 22nd August, 1907. Local Regulations. Dairies, Cowsheds and Milkshops Orders 1885 and 1886. Adopted 1st August, 1888. 29 Defects for the abatement of which Notices were served during the year 1924. Drains and Soil Pipes— Flushing Apparatus— Cleansed 457 Repaired 338 Repaired 537 New provided 386 W.C. Pans or Traps— Water Supply provided 18 Cleansed 55 Repaired 79 Yard Paving— New provided 100 Repaired 691 Surface Gullies- New provided 288 Cleansed 3 Defects remedied in— Repaired 12 Roofs 3387 New provided 4 Floors 1233 Sinks and Sink Pipes— Staircases 961 Cleansed 132 Windows 1944 Repaired 195 Doors 1629 New provided 14 Fireplaces 1679 Walls and Ceilings 5100 Stack Pipes and Rain- Water Gutters— Ditches, urinals, etc.— Cleansed 986 1 1285 Repaired Repaired 1285 15 Animals improperly kept New provided 6 Offensive Accumulations 75 Water Fittings and Overcrowding 42 Cisterns— Smoke Nuisance 44 Cleansed 102 Dust Receptacles 073 Repaired 214 Rooms Disinfected 2388 New provided 1 It frequently happens that a single sanitary notice specifies many defects needing abatement. 30 Summary of Work of Sanitary Inspectors during 1924. Number of Complaints Received and Investigated 4,687 Dwelling Houses Inspected 9,554 Newly-infected Houses 8,356 Common Lodging Houses 58 Slaughter Houses 532 Bakehouses 165 Dairies 95 Cow Sheds 23 Milk Shops 128 Retail Shops (e.g., Eel Pie Shops, Jam Factories, Ice Cream Shops, etc.) 2,292 Schools 3 Offensive Trades 185 Factories (including Food Factories) 292 Workshops 240 Laundries 12 Miscellaneous (e.g.. Smoke Abatement, Offensive Accumulations, Stables, etc.) 3,437 Re-inspections 39,619 Number of Notices served— On Offender 16 On Owner *8,298 On Occupier 186 Number of Notices complied with by— Offender 9 Owner *8,794 Occupier 51 Total Nuisances found (separate items) 48,806 ,, ,, abated do. 49,130 * Apparent discrepancy caused by large number of notices not complied with at end of previous year. There would normally be About 1,000 notices not fully complied with at any date during the year, rather more in winter than in summer. 31 Prosecutions, 1924. Nuisances (Public Health Act)— 341 Summonses. 1(38 Summonses withdrawn. Failure to comply with Magistrates' Orders— 44 Summonses. 11 Summonses withdrawn. Adulterated Milk (Food and Drugs Acts)— 6 Summonses. 3 Summonses dismissed. Margarine (without wrapper)— 2 Summonses. 1 Summons dismissed. * Butter— 1 Summons. West Ham Corporation Acts 1893 and 1898— 7 Summonses. 6 Summonses withdrawn. Rats and Mice Destruction Act, 1919— 1 Summons. 1 Summons dismissed. Establishing an Offensive Trade of a Fat Melter without written consent of the Urban Sanitary Authority— 1 Summons. For selling Potatoes to which a false trade description was applied— 1 Summons. Shops' Act.— Early Closing Act, 1920— 28 Summonses. 10 Summonses dismissed. Shops Early Closing Act, 1920.— Amendment Act, 1921 — 2 Summonses. West Ham Grocers', etc.. Closing Order, 1919— 15 Summonses. West Ham Grocers', etc., Half Holiday Order, 1912— 3 Summonses. 32 West Ham Butchers' Half Holiday Order, 1913— 3 Summonses. West Ham Bakers' Half Holiday Order, 1913— 1 Summons. Sec. 9, Shops Act.—West Ham Grocers', etc., Closing Order. 1919— 1 Summons. Having Carcase of Pig unsound at John Jansen's Slaughter House, As'nton Street— 2 Summonses. 2 Summonses dismissed. Discharge of faecal matter into ditch adjoining Temple Mill Lane— 1 Summons. 1 Summons withdrawn. Summonses Attended. Sale of Food and Drugs Acts 9 Public Health Acts, etc. 391 Shops Acts 53 West Ham Corporation Acts 7 Unsound Food Condemned. Pork, l0lbs. Cows' Lungs, 4 prs. Pigs' Heads, 9. Pigs' Plucks, 9. Cauliflowers, 120. Skate, 8 st. + 3 boxes. Dabs, 12 st. Tomatoes, 12 boxes+ 7 cwts. 40 lbs. Pigs, 8. Celery, 5doz. bundles, Mutton, 17 lbs. Pigs' Livers, 2. Apples, 350 lbs.+ 10 boxes. Log Fish, 1 box. Sheep's Lungs, 2 prs. Condensed Milk, 131 tins. Plaice, 4 cwt. 1 qr. Mussels, 1 bag. Eels, 10½st. Cherries, 2,120 lbs. Rabbits, 4 and 114 lbs. Pears, 20 boxes. Skate Wings, 6st. + 2 boxes. Kippers, 20 boxes. Haddocks, 15st., 76 boxes. Beef, 8st. Cows' Livers, 4. Whiting, 20 st. 3 lbs. Cat Fish, 6 st. Winkles, 3¾ bags. 33 Samples Taken (Sale of Food & Drug's Acts). Milk 626 Ground Ginger 16 Condensed Milk 71 Baking Powder 49 Dried Milk 28 S.R Flour 28 Cream 18 Caraway Seeds 1 Preserved Cream 6 Coffee and Chicory 1 Butter 204 Mustard Compound 1 Margarine 21 Salad Cream 1 Lard 65 Semolina 1 Dripping 7 Lemon Powder 2 Coffee 27 Dessicated Cocoanut 1 Cocoa 44 Total 1,363 Mustard 30 Pepper 77 Vinegar and Malt Vinegar 38 Various Adulterated Articles- Milk— Deficient Solids not Fat 2 Deficient Fat and Solids not Fat 4 Deficient in Fat 1 Butter 1 Veterinary Surgeon's Report. During the year 1924 only seven Cowsheds 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. There was no evidence of contagious or infectious disease in any of the animals. 34 Situation of Cowsheds. No. of Cows examined each quarter. Clegg Street 16 17 14 16 Balaam Street 9 10 9 8 Edward Street 1 2 4 1 Vicarage Lane 53 55 53 56 Beale Street 9 10 9 7 Idmiston Road 13 14 13 12 Blanche Street 25 27 28 25 Totals 126 135 130 125 Dairies, Cowsheds and Milkshops Order. Cowsheds. On January 1st, 1924, there were 219 Milkshops and Dairies on books, and during the year 44 new premises were registered for sale of milk and 5 premises have ceased to sell. Of the 44 new premises, 27 were for the sale of bottled milk only, and two for use only in restaurants. On December 31st, 1924, milk was being sold from 258 premises, of which 96 were dairies. Of these 38 sell only sterilised bottled milk. Three of these are restaurants which do not retail milk. On 26 premises defects were found, and fifteen Sanitary Notices were served by the District Inspectors. In all, 58 defects were remedied, including 9 roofs, 3 gutterings or stackpipes, 6 water fittings, 2 flooring, 7 plaster, 6 cleansing, 2 bad ventilation, etc., and 9 ash-pails were supplied. Under the Milk (Special Designations) Order, 1923, the following Licences were granted:—1 to bottle and sell, and 4 to sell Grade "A" (Tuberculin Tested) Milk obtained from Lord Rayleigh's Farm, Hatfield Peveral; 4 to sell "Certified" Milk bottled at Lord Rayleigh's Farm, Platfield Peveral; 2 to bottle and sell, and 3 to sell. Grade "A" Milk purchased from Carter & Sons, of Lewes, and Lord Rayleigh's Farm, Hatfield Peveral; 1 to Pasteurise and sell at 104 Windmill Lane, E.15, and 4 to sell Pasteurised Milk. One Licence was temporarily withheld to enable applicant to carry out certain works required by the Local Authority. These licences, expired automatically at the end of the year. 35 Report of the Medical Officer of Health under the Milk and Cream Regulations 1912 and 1917 for the year 1924 A.—Report of the Borough Analyst for the fourth quarter of 10-24 351 Samples were analysed as follows — Milk 109 Pepper 27 Dried Milk 4 Ground Ginger 7 Butter 91 Baking Powder 4 Margarine 1 Self-raising Flour 7 Dripping 1 Vinegar and Malt Vinegar 25 Lard 29 351 Coffee 8 Cocoa 15 .Mustard 23 Of the Milks, 107 were genuine, 1 (No. 71) was deficient in Solids not Fat, and 1 (No. 146) in Fat to the extent of, respectively, 5 and 7.3 per cent. All the samples of Milk were free from preservative and foreign colouring. The Dried Milks were genuine. The Butters were all genuine, and 27 contained Boric preservative in the proportions (calculated as Boric acid) stated in the table below:— 4 contained 0.3 per cent. 9 ,, 0.2 „ „ 14 ,, 0.1 „ „ The Margarine was genuine and free from preservative. The Dripping. Lards. Coffees and Cocoas were all genuine and free from adulteration. Of the Mustards, 22 were genuine and 1 (No. 20) adulterated with 22 per cent. of Wheat Flour. 36 The Peppers and Ground Gingers were all genuine. Of the Baking Powders, 3 were genuine and 1 (No. 309) produced only a trace of carbon di-oxide gas, therefore was practically useless as a Baking Powder. The Self-Raising Flours were all genuine. Of the Vinegars, 24 were unadulterated and 1 (No. 162) diluted with 10 per cent, of water. 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. in which Preservative was reported to be present, and percentage of( Preservative found in each sample. No. of Samples examined for the pretence of a Preservative. Milk 626 Nil. Cream 18 1 Sample No. 841 contained 0.2 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 6 (ii.) Statements incorrect - 6 37 (iii) Percentage of Preservative Percentage stated on found in each sample. statutory label. No. 216 0.37% Boric Acid 0.4% Boric Acid No. 317 0.27% do do. No. 392 0.21% do do. No. 503 0.25% do do. No. 731 0.35% do do. No. 831 0.25% do do. (b) Determinations made of Milk Fat in Cream sold as Preserved Cream— (i.) Above 35 per cent 6 (ii.) Below 35 ,, ,, — 6 (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. Thickening substances:—Nil. 4. Other observations, if any:—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, 38 Smoke Abatement. Chimneys are at all times under general observation, special detailed observations being made at intervals or when complaints are received. Responsible persons are interviewed, and letters of warning sent, or notices served when occasions for such action arise. Number of warnings and notices issued during the year—44. Arrangements for Disinfection and Disinfestation, and the extent of their use All infected material is collected by special vans and taken to the Isolation Hospital for disinfection by high pressure steam. Disinfectants for domestic use are supplied free from various centres in the Borough. After having been inspected by a Sanitary Inspector, infected or infested premises are dealt with by special disinfectors who have been appointed for that purpose. During the year 2,388 premises were disinfected. 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 50. Housing particulars during 1924 in the form desired by the Ministry of Health. Number of New Houses erected during the year— (a) Total 37 (b) As part of a Municipal Housing Scheme Nil 39 1. Unfit Dwelling Houses: inspection— (1) Total number of Dwelling Houses inspected for housing defects (under Public Health and Housing Acts) 9,554 (2) Number of Dwelling Houses which were spected and recorded under the Housing (Inspection of District) Regulations 1910 Included in No. (1) (3) Number of Dwelling Houses certified 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 8,500 2. Remedy of Defects without service of formal notice Nil 3. Action under Statutory powers— A. Proceeding under Sec. 28 of Housing and Town Planning, etc., Act, 1919: Several warning notices to take action under this Section were issued, the result being the carrying out of the necessary work. B. Proceedings under Public Health Acts: (1) Number of Dwelling Houses in respect of which notices were served requiring defects to be remedied 8,500 (2) Number of Dwelling Houses in which fects were remedied— (a) By Owners 8,854 (b) By Local Authorityin default of Owners Nil C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909 Nil 4° Slaughter Houses. There are 29 Slaughter Houses in the Borough, of which 11 are registered and lb are annually licensed. During the year 674 visits were paid by Sanitary Inspectors, but it was not found necessary to serve any Sanitary Notices. Abatement of Nuisances. In regard to the number of notices served in connection with the abatement of nuisances it should be borne in mind that a big percentage of the notices are served in respect to a certain class of house, and that there is in this Borough a very considerable amount of property of such a nature as to be in constant need of repair, and where it frequently happens that no sooner is one Sanitary Notice complied with than it becomes necessary to serve a further notice on the same premises concerning a recently arisen nuisance. There is little doubt that nothing short of the actual abolition of property of this type will prove of lasting avail. Overcrowding continues to be acute, and while there is the present shortage of accommodation little can be done to alleviate this very deplorable condition. In my next Report I propose to show the number of Sanitary Notices served, allocated to the 26 wards of the Borough. 41 Table showing the different Trades in which the Outworkers were engaged during 1924 Tailoring 232 Making of Shirts 164 ,, ,, Underclothing 65 ,, ,, Dresses 40 ,, ,, Ties 37 ,, ,, Blouses 36 ,, ,, Brushes 27 ,, ,, Millinery 21 ,, ,, Shoes 15 ,, ,, Umbrellas 15 „ ,, Jumpers 15 ,, ,, Baby Clothes 15 ,, ,, Boxes 10 ,, ,, Feathers 8 ,, „ Furs 8 ,, ,, Waterproofs 8 ,, ,, Tennis Balls 8 ,, ,, Flowers 7 ,, ,, Belts 6 ,, Bags 5 ,, ,, Upholstery 5 ,, ,, Mantles 4 ,, ,, Lampshades 2 ,, Flags 4 757 Numbers of Outworkers noti- Numbers of Outworkers for fied to West Ham from the West Ham Firms notified to undermentioned Districts. the undermentioned Districts. City of London 259 Stepney 167 Poplar 76 East Ham 102 Finsbury 76 Leyton 78 East Ham 57 Poplar 11 Stepney 43 Bethnal Green 10 Bethnal Green 38 Hackney 6 Leyton 29 Walthamstow 5 Hackney 18 Ilford 3 Shoreditch 17 Barking 2 Westminster 13 Marylebone 6 Southwark 2 Kensington 2 Hertford 2 Islington 1 Tottenham 1 Lambeth 1 Hornsey 1 642 384 42 Nature of Work. 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 Outworkers' Addresses forwarded to other Councils. Twice in year. Once in year. Outworkers. Outworkers. Lists. Contractors. Workmen. Lists. Contractors. Workmen. Wearing Apparel— (I) Making, etc. 68 35 413 11 15 29 .. .. .. (2) Cleansing & 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 .. .. .. .. .. .. .. .. .. Tile Making .. .. .. .. .. .. .. .. .. Electro Plate .. .. .. .. .. .. .. .. .. Cables and Chains .. ... .. .. .. .. .. .. .. Locks, Latches and Keys .. .. ... .. .. .. .. .. .. Totals 70 35 417 12 15 32 642 384 108 43 1. —Inspection of Factories, Workshops and Workplaces. Including Inspections made. by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices Piosecutions. (1) (2) (3) (4) Factories 476 28 • • (Including Factory Laundries) Workshops 319 28 1 (Including Workshop Laundries) Workplaces 80 19 .. (Other than Out workers'premises) Total 875 75 1 2 —Defects found in Factories, Workshops and Workplaces Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 155 155 .. .. Want of ventilation 5 5 .. • • Overcrowding 2 2 .. • • Want of drainage of floors 3 3 .. • • Other nuisances 179 178 .. • • Sanitary accommodation— Insufficient .. .. .. * * Unsuitable or defective 28 28 .. 1 Not separate for sexes .. .. .. • • Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) .. .. .. .. Other offences .. .. .. .. (Excluding oftrnces relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) Total 372 371 .. 1 *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 44 Causes of Death at Different Periods of Life in the County Borough of West Ham during 1924. Causes or Death. Sex. All Ages 0— 1— 2— 5— 15— 25— 45— 65— 75— ALL CAUSES M 1,913 319 108 96 50 90 241 492 304 213 F 1,739 245 116 102 70 84 163 390 250 319 1 Enteric Fever M 3 .. .. .. .. 2 1 F 1 .. .. .. .. .. 1 2 Small-pox M F 3 Measles M 51 20 13 17 1 F 63 10 23 25 5 4 Scarlet Fever M 1 .. .. 1 F 3 .. .. 2 1 5 Whooping Cough M 37 13 15 9 F 47 19 17 9 1 1 6 Diphtheria M 17 1 1 11 3 1 F 16 1 2 5 8 7 Influenza M 60 6 1 4 2 4 14 18 7 4 F 67 4 2 2 1 3 11 17 16 11 8 Encephalitis Lethargica M F 1 1 9 Meningococcal Meningitis M 2 1 .. . .. 1 F 1 1 10 Tuberculosis of Respiratory System M 184 .. .. 1 7 35 88 44 9 F 124 .. 2 1 10 44 41 24 1 1 11 Other Tuberculous Diseases M 36 5 8 10 6 3 1 3 F 34 3 6 15 4 2 3 .. .. 1 12 Cancer, Malignant Disease M 197 .. 1 .. .. 4 8 103 67 14 F 209 .. .. .. 1 3 32 116 32 25 13 Rheumatic Fever M 8 .. .. 1 1 2 4 F 9 .. 1 .. 4 3 1 14 Diabetes M 8 .. .. .. .. 1 1 2 4 F 9 .. .. .. .. 2 3 2 2 15 Cerebral Haemorrhage, etc. M 70 .. .. .. .. 1 27 24 18 F 94 .. .. .. .. 3 31 29 31 16 Heart Disease M 166 .. .. .. 1 *8 16 64 47 30 F. 164 .. .. .. 7 8 11 52 42 44 17 Arterio-sclerosis M 40 .. .. .. .. 2 10 16 12 F 21 .. .. .. .. 1 7 13 18 Bronchitis M 170 13 4 4 .. i *8 46 44 50 F 178 12 3 1 .. 22 51 89 19 Pneumonia, all forms M 260 90 46 28 5 4 21 39 17 10 F 234 69 52 30 10 5 7 25 18 18 20 Other Respiratory Diseases M 28 2 3 1 1 4 9 6 2 F 17 .. .. 2 1 1 2 4 7 21 Ulcer of Stomach, or Duodenum M 23 .. .. .. .. 7 11 5 F 3 .. .. .. .. 3 22 Diarrhoea, &c. M 50 40 8 .. .. 1 1 F 35 25 2 1 1 2 1 3 23 Appendicitis and Typhilitis M 9 .. .. .. 4 2 3 F 11 .. .. 1 3 3 1 2 1 24 Cirrhosis of Liver M 7 .. .. .. .. 4 1 2 F 3 .. .. .. .. 3 25 Acute and Chronic Nephritis M 52 1 .. 1 1 1 12 19 11 6 F 56 .. 1 .. 3 1 2 27 14 8 26 Puerperal Sepsis M .. .. F 5 .. .. .. .. 5 27 Other Accidents and Diseases of Pregnancy and Parturition M .. .. F 7 .. ... .. .. 7 28 Congenital Debility, Malformation and Premature Birth M 93 92 .. .. 1 , , F 80 77 1 .. .. # # 2 29 Suicide M 17 .. .. .. .. 3 9 4 1 F 8 .. ... .. .. 3 5 30 Other Deaths from Violence M 78 5 1 2 7 11 19 20 8 5 F 20 3 .. 2 2 3 3 3 1 3 31 Other defined Diseases M 246 30 7 6 10 10 29 64 36 54 F 219 20 4 6 8 8 29 50 31 63 32 Causes ill-defined or unknown M F 45 Summary of Notifications. Week Ending. 1924 Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. J Small Pox. j Typhus Fever. Cerebro Spinal Fever. Acute Poliomyelitis. Acute Polio Encephalitis Encephalitis j Lethargica. j Erysipelas. Ophthalmia Neonatorum. Tuberculosis. Pneumonia. Malaria. Dysentery. Trench Fever. Relapsing Fever Continued Fever. Respiratory. Other. Jan. 5 9 18 - - - - - - - - 2 - 10 1 7 1 - - - - ,, 12 6 24 - - - - - - - - 5 - 13 5 12 - - - - - ,,19 9 16 - - - - - - - - 1 - 23 3 13 - - - -- - ,, 2 7 18 - - - - - - - - 2 4 18 4 12 - - - - - Feb. 2 4 24 - 1 -- - - - - - 4 - 22 4 20 2 - - - - ,, 9 6 15 1 - - -- - - - - 3 - 18 6 21 - - - - - ,, 16 4 17 - - - - - - - - 3 1 19 6 23 - - - - - „ 23 5 12 - - - - 1 - - - 1 - 19 3 18 1 - - - - Mar. 1 2 12 1 2 - - - - - - 4 1 12 - 21 - - - - - ,, 8 5 13 - 1 - - - - - 1 1 2 18 6 18 - - - - - ,, 15 8 13 - 2 - - - - - - 4 - 16 2 13 - - - - - „ 22 4 18 - - - - - - - 2 4 2 15 4 5 - - - - - „ 29 11 12 - 1 - - - - - 1 1 - 13 2 7 - - - - - April 5 11 10 - - - - - - - - 3 - 11 3 12 - - - - - ,, 12 5 10 - - - - - - - 3 - - 15 8 2 - - - - - ,, 19 8 7 - - - - - - - 3 2 - 10 4 9 - - - - - „ 26 3 13 - - - - - - - 1 2 2 21 3 4 - - - - - May 3 7 15 - - - - - - - - 2 5 18 2 3 - - - - - ,, 10 5 13 - - - - - - - 1 3 - 15 4 9 - - - - - ,, 17 13 9 - - - - - - - 2 3 - 26 2 4 - - - - - „ 24 9 11 - - - - - - - 1 4 - 17 3 9 - - - - - ,, 31 5 12 - - - - - - - 2 1 - 17 3 2 - - - - - June 7 2 11 - - - - - - - - - - 22 4 6 - - - - - ,, 14 3 7 1 - - - - - - 1 3 - 10 5 3 1 - - - - „ 21 5 16 - - - - - - - - - - 17 3 5 - - - - - ,, 28 4 12 - - - - - - - - 4 - 12 4 5 - - - - - July 5 5 12 1 - - - - - - - 3 - 16 2 5 1 - - - - ,, 12 6 10 2 - - - - - - - 2 - 9 4 9 1 - - - - ,, 19 5 13 - - - - - - - - 9 - 17 7 3 - - - - - 26 6 18 - - - - - - 2 1 - 4 2 2 - - - - - Aug. 2 8 11 - - - - - - - 1 3 - 9 2 2 - - - - - ,, 9 2 11 - 1 - - - - - - 2 - 12 5 - - - - - - ,, 16 2 12 1 - - - 1 - 1 1 3 - 6 - 2 - - - - - ,, 23 3 13 - - - - - - - - - 1 11 - 6 1 - - - - ,, 30 6 11 - - - - - - - - 5 - 6 5 2 - - - - - Sept. 6 6 8 - 1 - - - - - - 2 1 9 - 8 - - - - - ,, 13 3 10 - - - - - - - 1 3 1 9 2 2 - - - - - ,, 20 17 22 2 - - - - - - - 6 - 15 3 5 - - - - - ,, 27 10 14 - - - - - - 1 - 4 1 10 3 4 - - - - - Oct. 4 12 21 2 - - - - - - - 8 - 20 - 5 - - - - - 11 13 16 3 1 - - - - - - 5 - 19 4 12 - - - - - „ 18 13 20 - 1 - - - - - - 7 2 13 3 7 5 - - - - „ 25 15 21 - 1 - - - - - - 7 -- 22 8 8 6 - - - - Nov. 1 15 26 - - - - - - - - 5 - 12 - 10 3 - - - - ,, 8 7 20 1 - - - - - - - 4 - 19 4 5 2 - - - - ,, 15 11 15 - - - - - - - - 8 - 22 3 10 1 - - - - ,, 22 8 21 - - - - - - - - 5 - 18 3 13 - - - - - ,, 29 5 21 - 1 - - - - - - 4 1 16 - 12 1 - - - - Dec. 6 5 21 4 1 - - - - - 1 7 - 11 7 8 - - - - - „ 13 15 20 - - - - - - - 1 4 - 14 2 3 - - - - - ,, 20 6 19 - - - - - - - - 2 - 10 2 3 - - - - - „ 27 11 14 - - - - - - - - 1 - 5 2 5 - - - - - 1925 13 23 - 1 - - - - - 1 5 - 11 4 4 - - - - - Jan. 3 Totals 388 801 19 15 - - 2 1 2 26 177 24 772 171 419 26 - - - - 46 Distribution of Dried Milk to Nursing: and Expectant Mothers and Children under 3 years of age During the year, 106 tons of Dried Milk were distributed in carton packets with printed directions in accordance with the Council's scheme to persons residing in the Borough from the following Centres:— 84. West Ham Lane, Stratford. Public Hall, Barking Road, Canning Town. Nurses' Home, Howards Road, Plaistow. Barnwood Road, Silvertown. Since August, 1920, Dried Milk has been distributed under the Maternity and Child Welfare Scheme, and, as will be seen from the following table, the amount has steadily and rapidly increased:— Year 1920.— 18,247 packets or 8 tons 3 cwt. 1921.— 73,872 do. 33 tons. 1922.—127,934 do. 57 tons 2 cwt. 1923.-221,114 do. 98 tons 14 cwt. 1924.—237,9(33 do. 100 tons 4½cwt. Owing to the need for accommodation at the Town Hall the Maternity and Child Welfare Committee approached the Education Committee with a view to obtaining the unused portion of a hut situate at 81 West Ham Lane for the purpose of packing and distribution. This was eventually acquired, fitted up, and opened on the 8th September, 1924; it has proved a great convenience both from the public and administrative points of view. The average weekly number of packets supplied = 5,050 ,, persons who apply = 3,500 ,, ,, ,, ,, ,, supplied free, 1930 = ,, ,, ,, ,, at half cost, 70= 3,500 ,, ,, ,, ,, ,, at cost price, 1500 = ) In consequence of the beneficial results obtained by the use of Dried Milk by Expectant Mothers and Children the Council have issued the following circular with a view to making the scheme more generally known, and judging by the eager and regular manner in which the Milk is applied for by the public it is proof positive that the Council's efforts in this connection are appreciated. 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. 47 Dried Milk is a valuable food (not a patent manufactured food), being good cows' milk 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 unobtainable in most towns, and in view of the liability to bacterial changes in fresh milkwhen 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. 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, Public Hall, Barking Road; Nurses' Home, Howards Road, Plaistow: and the Maternity Centre, Barnwood Road, Silvertown, 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 above places 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. 48 Particulars of Bodies received into the Mortuaries during 1924. Month. Stratford Mortuary. Canning Town Mortuary. Number received. Over 5 yrs. Under5yrs. 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 16 14 2 14 2 .. 8 16 6 5 1 .. 5 1 4 5 February 19 13 6 19 .. .. 14 19 6 6 .. .. 5 4 5 March 16 12 4 14 2 .. 11 16 4 4 .. .. 4 .. 4 4 April 16 11 5 12 4 .. 13 16 2 2 .. .. 2 .. 2 2 May 8 8 6 2 .. 4 8 1 ' 1 .. .. 1 .. 1 1 June 9 6 3 9 .. .. 4 9 6 6 .. .. 6 .. 3 6 July 17 12 5 15 2 .. 12 17 2 2 .. .. 1 1 .. 1 August 16 10 6 16 .. .. 11 16 2 2 .. .. 2 .. 2 2 September 11 10 1 9 2 .. 9 11 3 3 .. .. 3 .. 1 3 October 15 12 3 15 .. .. 10 15 2 2 .. .. 1 1 1 1 November 14 13 1 13 1 .. 10 14 4 4 .. .. 4 .. 2 4 December 18 15 3 17 1 .. 13 18 2 2 .. .. 2 .. 2 2 Total 175 136 39 159 16 .. 119 175 40 39 1 .. 36 4 26 36 West Ham Mortuary was not in use during 1924. The above Inquests were dealt with at Strattoid. 49 Number of days bodies remained in Mortuaries during 1924: — 33 were 1 day in Stratford Mortuary. 120 ,, 2 days ,, ,, ,, 12,, 3,, ,, ,, ,, 7 ,, 4 ,, ,, ,, 3 3 ,, ,, ,, ,, ,, 4 were 1 day in Canning Town Mortuary. 9 „ 2 days ,, 24 ,, 3 ,, ,, „ ,, ,, 3 ,, 4 ,, ,, ,, ,, ,, 1 Doctor performed 11 post-mortem examinations. 2 Doctors ,, 8 ,, ,, each. 2 „ „ 6 3 ,,,,5,, ,, ,, 4 ,, ,, ,, ,, 6 ,,3 13 ,, ,, 2 ,, ,, ,, 31 ,, ,, 1 ,, ,, ,, Collecting House Refuse. 38,677 loads of House Refuse were collected in the Borough during 1924, approximately 58,015 tons. This refuse was disposed of as follows:— Mr. G. W. Abbott's shoot at Temple Mills 20,605 loads. Quadrant Street Wharf 18,072 ,, 50 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 1S90 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 86 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 1924 317,400 7,202 22.6 3,652 11.5 564 78 51 Plaistow Hospital. Annual Report for 1924. The total number of cases treated in the Hospital during 1924 showed an increase of 214 over the number treated in 1923. The type of disease was also, on the average, much more severe. This is shown by the number of deaths, which totalled 80 in 1924 as compared with 43 in the previous year. This increase is due mainly to the fact that a severe epidemic of Measles was raging in the district at the beginning of the year, and was followed closely by an epidemic of Whooping Cough. Severe and complicated cases of these two diseases were admitted as accommodation became available, and together they accounted for 34 of the deaths, whereas there were no deaths from these diseases in the previous year. Diphtheria cases showed a slight increase over the number treated in the previous year, but the type of disease, on the average, continued mild. There was a marked decline in the admissions from both Scarlet Fever and Typhoid Fever. The chief causes of death during the year are briefly summarised as follows: — Scarlet Fever caused 4 deaths. Diphtheria ,, 27 Typhoid Fever ,, 1 Measles ,, 19 Whooping Cough ,, 15 Pneumonia ,, 7 Other diseases ,, 7 Total 80 The mortality rate, calculated on all the cases admitted, was 5.94 per cent. At the beginning of the year 215 cases were in residence, and 1345 were admitted, making a total of 1560 cases under treatment during the year. Of these, 1252 were discharged recovered, 80 died, and 228 remained under treatment at the end of the year. The following table shows the admissions and deaths for each month of the year; — 52 TABLE "A." Adm1ss1ons. Deaths. 1924. Scarlet Fever. D1phther1a. Typho1d Fever. Measles. Whoop1ng Cough. Ch1ckenpox. Pneumon1a Other D1seases. Total. Scarlet Fever. D1phther1a. Typho1d Fever. Measles. Whoop1ng Cough. Pneumon1a Other D1seases Total. January 22 63 .. 11 3 .. 3 4 106 1 3 .. 3 1 1 .. 9 February 18 66 .. 28 6 .. 5 7 130 .. 6 .. 3 1 2 .. 12 March 23 51 .. 25 7 2 4 8 120 .. 7 .. 4 1 .. .. 12 Apr1l 27 51 .. 22 2 2 1 4 109 1 2 .. 7 4 .. 3 17 May 20 41 .. 7 6 1 4 11 90 .. .. .. 1 2 1 1 5 June 13 42 .. 4 3 1 .. 9 72 .. 1 .. 1 .. .. 1 3 July 18 50 .. 3 2 2 .. 23 98 .. 2 .. .. 1 .. .. 3 August 15 44 .. 1 .. 1 6 67 .. 1 .. .. .. .. .. 1 September 39 67 2 .. 6 .. 2 17 133 .. 4 1 .. 3 1 1 10 October 49 84 .. 2 1 1 18 155 1 .. .. .. 1 .. .. 2 November 25 49 .. 1 .. 3 12 90 1 1 .. .. .. 1 .. 3 December 48 105 .. 5 2 .. 15 175 .. .. .. .. 1 1 1 3 Totals 317 713 2 100 44 11 24 134 1,345 4 27 1 19 15 7 7 80 53 Scarlet Fever.— There has been a steady decline in the prevalence of Scarlet Fever during the past three years. The number of admissions remained low throughout 1924, and tintype of disease also continued mild. The total number of cases under treatment was 409. which is 53 less than in the previous year. Four cases, which were of the "septic type," proved fatal, giving a fatality rate of 1.26 per cent. of the admissions. In 27 cases the disease was complicated by the presence of other infections as follows: — Scarlet Fever with Diphtheria 10 cases ,, ,, ,, Measles 8 ,, ,, ,, ,, Whooping Cough 5 ,, ,, ,, ,, Pneumonia 4 ,, 22 cases admitted as Scarlet Fever were wrongly diagnosed, and proved to be suffering from the following diseases: — Measles 7 cases Septic Rash 3 ,, Erythema 5 ,, Lobar Pneumonia 2 ,, Otitis Media 2 ,, Gastritis 1 case Cellulitis 1 ,, Constipation 1 ,, Three cases, admitted as Diphtheria, were found to be suffering from Scarlet Fever. The average duration of residence of all cases was 42.95 days. Diphtheria.— This disease continues to be very prevalent in the Borough. The admissions in 1924 were the highest for the past three years. The type of disease, however, remained mild, and the proportion of "late cases" has fortunately been low. The grave danger which results from delay in the treatment of Diphtheria appears to have been more fully realised in recent years by the populace, and medical advice is usually sought as soon as the disease is suspected. A significant fact in this connection is the increasing number of parents who bring their children direct to the Hospital when suffering from 54 throat affections, especially if there is any difficulty in obtaining the immediate attendance of a general practitioner. The following Table shows the number of admissions and the deaths from Diphtheria during the past 15 years:— TABLE " B." Year. Admissions. Deaths. Fatality Rate. 1910 260 45 17.3 per cent 1911 295 52 17.62 „ „ 1912 291 35 12.02 „ „ 1913 333 24 7.2 „ „ 1914 380 43 11.31 „ „ 1915 403 60 14.88 „ „ 1916 533 64 12 „ „ 1917 559 67 11.9 „ „ 1918 464 70 15.08 „ „ 1919 601 57 9.4 „ „ 1920 769 62 8.06 „ „ 1921 560 32 5.7 „ „ 1922 611 40 6.5 „ „ 1923 671 23 3.4 „ „ 1924 713 27 3.7 „ „ The total number of cases under treatment during 1924 was 820. Of these, 632 were discharged recovered, 27 died, and 161 remained under treatment at the end of the year. In 81 cases the larynx and trachea were involved. Of these, 34 recovered without operation. Tracheotomy was performed in 47 cases; 7 of these were patients recovering from Measles, and in 4 cases Whooping Cough was present as a complication. Nine deaths occurred among the tracheotomy cases, giving a fatality of 19.14 per cent. of those operated on. The fatality rate of all the cases admitted was 3.7 per cent. 113 cases notified as Diphtheria were wrongly diagnosed, and proved after admission to be suffering from the following complaints: — Tonsillitis, 81; Measles, 6; Bronchitis, 7; Laryngitis, 8; Quinsy, 7; Syphilis, 1; Miliary Tuberculosis, 1; jaundice, 1; Enteritis, 1, 55 According to the history obtained of the 27 fatal cases, the duration of illness before admission to the Hospital was as follows:— 3 cases had been ill 2 days before admission. 6 ,, ,, ,, 3 ,, ,, ,, 8 ,, ,, ,, 4 ,, ,, ,, 4 ,, ,, ,, 5 ,, ,, ,, 2 ,, ,, ,, 6 ,, ,, ,, 3 ,, ,, ,, 7 ,, ,, ,, 1 case ,, ,, ,, 8 ,, ,, ,, The ages of the fatal cases were as follows: — 3 cases were under 1 year of age. 16 ,, ,, between 1 and 5 years. 7 ,, ,, 5 ,, 10 ,, 1 case was ,, 10 ,, 12 ,, None of these received antitoxin before admission. The average amount given to them in the Hospital was 49,000 units. The average amount of antitoxin given to all the cases was 18,000 units. The average duration of residence of all the diphtheria cases was 58.73 days. Typhoid Fever.—Six cases, notified as Typhoid Fever, were admitted during the year. Of these, only two proved to be suffering from the disease. Both patients were married women; their ages were 30 years and 36 years respectively. The disease was very severe in the case of the elder patient, and proved fatal four days after admission. The other four cases were found after admission to be suffering from the following diseases:—Influenza, 1; Enteritis, 1; Rheumatic Pericarditis, 1; Tubercular Meningitis, 1. These cases are shown in Table "A" under the column of "Other Diseases.'' Measles.—An epidemic of Measles appeared in the district in the winter of 1923, and was at first of a mild type, but assumed a virulent character by the beginning of 1924. Five patients were in residence on 1st January, and 100 cases were admitted during the first six months of the year, when the disease continued prevalent, making a total of 105 cases under 56 treatment. Of these, 86 were discharged, recovered, and 19 died, giving a fatality rate of 18.09 per cent. The fatal cases were all children under 5 years of age, and as only severe cases with complications were admitted, the fatality rate was high, Tracheotomy was performed in three of the fatal cases for ulceration of the larynx. Seven cases notified as Scarlet Fever, and six as Diphtheria, proved after admission to be suffering from Measles, and 15 patients in the Hospital were infected by these cases. Whooping Cough.—This disease was very prevalent throughout the year, and severe cases were admitted as accommodation became available. The total number of cases under treatment was 44. Of these '26 were discharged recovered, 15 died, and 3 remained in residence at the end of the year. Thirteen of the fatal cases were children under three years of age, and two were between four and five years. The fatality rate was 34.09 per cent. In 21 cases the disease was present as a complication with other infections as follows: — Whooping Cough with Scarlet Fever 5 cases. ,, ,, ,, Diphtheria 4 ,, ,, ,, ,, Measles 12 ,, Chickenpox.—Eleven cases were under treatment during the year. Two of these were of a severe type, but no complications occurred, and there were no deaths. The disease was present in combination with Diphtheria in two cases, and with one case of Scarlet Fever. Pneumonia.—Twenty-four cases of Pneumonia were under treatment during the year. Of these 17 were discharged recovered, and 7 died, giving a fatality rate of 29.16 per cent. The fatal cases were all children under 5 years of age. Other Diseases.—Under this group are classed diseases which are not regularly admitted, and cases in which the diagnosis was changed after admission. The following are the diseases included in the group: — Tonsillitis, 81; Enteritis, 5; Biliary Catarrh, 1; Bronchitis, 6; Cerebral Abscess, 1; Cerebro-spinal Meningitis, 1; Debility, 1; Encephalitis Lethargica, 4; Erysipelas, 8; Constipation, 1; Gastritis, 2; Influenza, 1; Laryng'itis, 8; Quinsy, 6; Nephritis, 57 1; Otitis Media. 2; Septic Rash, 3; Puerperal Fever, 2; Miliary Tuberculosis, 1; Tubercular Meningitis, 3; Pericarditis, 1; Tetanus, 1. Of these, 7 cases proved fatal, as follows: — Tubercular Meningitis 3 cases. Miliary Tuberculosis 1 case. Enteritis 1 ,, Cerebral Abscess 1 ,, Cerebro-spinal Meningitis 1 ,, The Grange Convalescent Home.—Owing to the diminished prevalence of Scarlet Fever the accommodation at the Convalescent Home had not been fully occupied during the past year, and as Diphtheria cases had increased, the Council decided last Spring to use the Home for patients convalescent from Diphtheria instead of Scarlet Fever. On March '26th, 25 Scarlet Fever Convalescents which were in residence were removed to Plaistow Hospital, and the Home was thoroughly disinfected. It was re-opened on April 10th, and was used during the rest of the year for Convalescent Diphtheria cases. The total number of cases under treatment during the year was 363. Of these, 313 were discharged, and 50 were in resilience at the end of the year. The patients remained at the Home for periods varying from 3 to 8 weeks, the average duration of residence being 36.63 days. Staff Illness.—79 nurses and maids had been warded during the year for various complaints. Two nurses and 1 maid contracted Scarlet Fever, and 9 nurses contracted Diphtheria: all recovered. Twenty-one nurses and maids had been warded with sore throat, and 13 with Influenza. Twenty-three had been off duty for short periods through minor ailments; all recovered. Gate Cases.—During the past few years an increasing number of cases have been brought up to the Hospital for diagnosis. Some of these are sent by medical practitioners, and others are brought along direct by relatives. These cases used to be examined in the waiting room at the main entrance, but this arrangement was not satisfactory, as they often came in contact with visitors who called to enquire for patients. This difficulty was overcome last summer by turning into a "receiving room" a small "flat" which had formerly been the sleeping quarters for the Junior Medical Officer. 58 The following is a record of the cases examined during the last six months of 1924: — Total number of cases examined 297 Number sent up by a Medical Practitioner 158 ,, of these admitted 82 ,, brought up by relatives 139 ,, of these admitted 42 Bacteriological Work.— In addition to the routine bacteriological work of the Hospital the following examinations were made for medical practitioners and for "gate cases": — Throat swabs for Diphtheria 470 Number which proved positive 84 Nasal swabs for Diphtheria 10 Number which proved positive 0 Sputum examination 1 Eye swab 1 Widal Tests 2 Total number of examinations 490 Towards the end of the year all the medical practitioners in the Borough were notified by the Medical Officer of Health that facilities were available at the Hospital for the examination of swabs in suspicious cases of Diphtheria. Swab out-fits have been supplied to each medical practitioner and arrangements made to notify him within 24 hours of the result of the examination. Schick Test.— This test was performed in 140 cases, mostly Scarlet Fever patients. Sixty-eight cases were positive and 72 negative. Fifty of the positive cases received three prophylactic injections of toxin-and-antitoxin mixture. Ambulances and Disinfecting Vans.— The number of journeys made by the two motor ambulances during the year was 1,100. The mileage run was 5,500. In the collection and delivery of infected clothing the two motor vans made 3,194 journeys. The number of articles disinfected for the public was 12,479. The mileage run by the vans was 9,786. All minor repairs to the motor vehicles are carried out by the Engineer's staff. D. MacINTYRE, Medical Superintendent. 59 Dagenham Sanatorium. Annual Report for the year 1924. At the end of 1923 the number of patients remaining under treatment was: — Males 65 Females 33 98 The total admissions during 1924 was: — Males 195 Females 99 258 The number of deaths was: — Males 24 Females 11 35 Discharges during the year totalled: — Males 137 Females 87 224 Leaving under treatment at 31st December, 1924: — Males 63 Females 34 97* * Includes 14 non-insured persons. The Classes of cases discharged and the results were as follows: — Early. Intermediate. Advanced. Males 21.8 23.4 54.6 Females 31.8 16.6 52.2 Arrested. Improved. Unimproved, Stationary or Worse. Males 39.8 46.01 14.06 Females 36.6 44.4 18.8 The number of patients admitted during the year totalled 258, 50 of these being non-insured. 72 Ex-service Men were admitted to the Sanatorium during the same period. 6o The Death Rate (calculated on admissions) was 13.56 %. In the case of males the percentage was 15.09. ,, females ,, 11.11. Average Duration of Residence (both sexes), 140.8 days. The average for males was 144.88 days. ,, females ,, 134.05 ,, A number of patients of both sexes left for domestic reasons before completing the period of treatment, recommended. Present Accommodation:— Beds. Male Hospital 14 ,, Sanatorium 52 Female Hospital 14 ,, Sanatorium 24 Total 104 Alterations are now being carried out to accommodate 24 more patients. The beds will be ready at an early date. This extra accommodation will enable all the female patients to be treated in one building, and the male hospital cases now treated in wards in different blocks can, in future, be treated in adjacent wards. These changes will be very satisfactory from an Administrative point of view. The new accommodation will be as follows:— Beds. Male Hospital 28 ,, Sanatorium 2 Female Hospital 24 ,, Sanatorium24 Total 28 Dr. Muriel Willis, late Assistant Medical Officer, Maltings Farm Sanatorium, Nayland, has been appointed Assistant Medical Officer. G. M. MAYBERRY, Medical Superintendent. 61 Annual Report of the Tuberculosis Officer for the year 1924. The work at the Dispensary during the year is shown by the following figures and tables:— TABLE "A." Number of persons seen for the first time 1,969 Adults 1,022 Children 947 1,969 Males 952 Females 1,017 1,969 Notified Cases 342 "Contact" Cases 984 "Request" Cases 643 1,969 Total attendances at Dispensary during the year 13,502 At end of year: Number under Dispensary treatment 1,034 Number under Dispensary observation 310 Number under Domiciliary treatment 301 Number of Domiciliary Reports received in 1924 695 Domiciliary Visits paid to the patients' homes by the Staff at the Dispensary 3,896 62 TABLE " B." Positive. Negative. Pre T.B. or Indef. Adults. Under 16 years. Adults. Under 16 years. Adults. Under 16 years. M. F. M. F. M. F. M. F. M. F. M. F. Total. Notified Cases 100 85 59 31 1 8 J 4 9 5 11 11 18 342 "Contact" Cases — 10 12 18 83 234 248 213 4 28 73 61 984 "Request" Cases 128 102 43 34 97 67 31 15 23 36 30 37 64S 228 197 114 83 181 309 283 237 32 75 114 116 1.969 425 197 490 520 107 230 622 1,010 337 63 The following Summary of the Figures for the last 5 years —1920-1924 inclusive—will show the increasing work carried out at the Dispensary:— Total Number of Persons seen for the first time. Year. Adults. Under 16 Years. Total. M. f. m. f. 1920 441 408 333 286 1,468 1921 413 426 376 328 1,543 1922 383 467 423 391 1,664 1923 433 528 433 417 1,811 1924 441 581 511 436 1,969 Notified Cases. Year. Adults. Under 16 Years. Total. M. f. m. f. 1920 250 158 81 68 557 1921 79 68 41 48 236 1922 67 59 57 45 228 1923 95 71 78 80 324 1924 106 104 74 58 342 "Contact" Cases. Year. Adults. Under 16 Years. Total. M. f. m. f. 1920 61 129 195 167 552 1921 75 187 268 228 758 1922 81 216 302 273 872 1923 79 265 269 274 887 1924 87 272 333 292 984 64 "Request" Cases. Year. Adults. Under 16 Years. Total. m. F. m. F. 1920 130 121 57 51 359 1921 259 171 67 52 549 1922 233 191 64 76 564 1923 259 192 86 63 600 1924 248 205 104 86 643 Positive. Year. Adults. Under 16 Years. Total. m. F. m. F. 1920 ... 307 234 100 90 731 1921 202 158 98 82 540 1922 ... 198 152 106 91 547 1923 216 162 116 99 593 1924 228 197 114 83 622 Negative. Year. Adults. Under 16 Years. Total. M. F. M. F. 1920 ... 87 118 119 126 450 1921 176 202 163 162 703 1922 134 239 183 195 751 1923 193 324 239 242 998 1924 ... 181 309 283 237 1,010 Pre T.B. or Indef. Year. Adults. Under 16 Years. Total. M. F. M. F. 1920 ... 47 56 114 70 287 1921 35 66 115 84 300 1922 49 75 134 108 366 1923 ... 24 42 78 76 220 1924 ... 32 75 114 116 337 65 Received Institutional Treatment. Year Adults. Under 16 Years. Total San. Hosp. San. Hosp. 1920 178 49 20 7 254 1921 185 27 26 17 255 1922 176 38 27 22 263 1923 174 27 17 10 228 1924 188 28 17 6 239 These figures speak for themselves, and require no special comment. Sanatorium Treatment.— An increasing number of the patients seen for the first time have been found to be in a sufficiently early stage to justify expectation of permanent arrest of the disease by Sanatorium treatment. Unfortunately, there are not sufficient beds available to make the early admission of these patients to Sanatorium possible. They have, therefore, to wait several weeks before commencing treatment. The scarcity of beds also prevents patients remaining in Sanatorium for a sufficient length of time. The opening of a new ward at Dagenham will, it is hoped, bring this very unsatisfactory state of affairs to an end. A certain number of cases too ill for Sanatorium treatment to hold out any hope of improvement are seen every year. A Home for Advanced cases, in West Ham, would be a suitable way of dealing with them. At present they remain at home, where they fail to obtain the careful nursing they require, and are a constant source of danger to all in contact with them, or end in Whipps Gross Poor Law Hospital, or are transferred to Dagenham Hospital, where they have a depressing effect on the other patients. After-Care.— A more extensive After-Care Scheme is needed if permanent good results are to be expected from Sanatorium treatment. Provision of Extra Nourishments cannot be said to have helped very much in the treatment of patients. I should like to draw attention to the late Tuberculosis Officer's suggestion in last year's report that the 66 Nourishment granted should be provided at one or more central dining centres which, for a small sum, could have attached thereto a reading and rest room for the patients. Open Air Schools for Tuberculous Children on the lines of these which have proved so successful in some Boroughs would be of great assistance in dealing with the large number of such children attending the Dispensary. Moreover, the provision of such schools would prevent children, on completing Sanatorium treatment, returning to ordinary schools, which are often not suitable for them. Artificial Sunlight treatment, which has given excellent results in a neighbouring Borough, might, with advantage, be provided for West Ham patients. W. R. KILGOUR. Asst. Tuberculosis Officer. 20th April, 1925.