WHAM 4 County Borough of West Ham. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1925. INDEX. page Acts, Bye-Laws and Local Regulations (list of adoptive) 24 Ambulance Service 16, 17 Births 9 Cerebro-spinal Fever 67 Chicken Pox, Outbreak of 14 Clinics, School, etc 18 Common Lodging Houses 41 Dagenham Sanatorium, Medical Superintendent's Report 92-94 Deaths 9 Deaths, Causes of 11 Deaths in Public Institutions 9, 10 Disinfection 73 Dried Milk, Distribution of 106-109 Encephalitis Lethargica 68 Extracts from Vital Statistics of the year 7, 8 Factories, Workshops and Workplaces 50, 51 Food, Inspection and Supervision of, Unsound, etc 52-59, 62 General Provision of Health Services 14-35 Health Week 26 Hospitals 14-16 House Refuse, Disposal of 37, 38 Housing 44-47 Increase of Rent and Mortgage Interest Restrictions Act, 1920 45 Infant Mortality, Hot weather and 25 Infectious Diseases, Prevalence of, and control over 65-69 Laboratory Work 68, 69 Legislation, 1921-1925 inclusive 23 Maternity and Child Welfare 101-115 Measles, Outbreak of 14 Meat 55-58 Meat, Public Health Regulations, 1924 55-58 Milk and Cream Regulations, 1912 and 1917 63-65 The state of the Public Health being so intimately connected with the health of the school children, this Report would be amplified if read in conjunction with the Report of the work of the School Medical Service for 1925. 3 page Milk and Dairies Amendment Act, 1922 58, 54 Milk and Dairies (Consolidation) Act, 1915 53 Milk (Special Designations) Order, 1923 54, 55 Milk, Supply of 52 Mortuaries 34, 35 Natural and Social Conditions 6 Notifications, Summary of 71 Nuisances, Abatement of 38 Nursing, Professional, in the Home 33 Offensive Trades 41, 42 Outworkers 48, 49 Plaistow Hospital, Medical Superintendent's Report 73-82 Poliomyelitis 68 Propaganda 24-33 Prosecutions 47, 48 Research Committee 69, 70 Samples taken, Food and Drugs Acts 63 Sanitary Circumstances of Area 35-43 Scarlet Fever 67, 73-82 Schools 42, 43 Slaughter Houses 58 Small Pox, Provision for 14-16 Smoke Abatement 40 Staff, List of 19-22 Street Trading 59-61 Summary of General Statistics 7 ,, ,, Work of Sanitary Inspectors 39, 40 Tuberculosis, Table of Notified Cases, etc 83, 84 ,, Report of Tuberculosis Officer 84-91 Tuberculous Milk and Cattle 54 Venereal Diseases 95-100 Veterinary Surgeon's Report 61 Vital Statistics of Wards, 1925, etc 8 ,, ,, Chief, since 1877 13 4 TO HIS WORSHIP 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 my Annual Report on the work of the Public Health Department for the year 1925. In accordance with the desire of the Ministry of Health, as contained in Circular 648, this Report is a survey one, dealing with the past five years. The principal changes which have taken place during that time are set out under their respective headings. During the year, the following important and far-reaching Public Health measures have come into force:— A. The Public Health Act, 1925: B. The Public Health (Meat) Regulations: C. The Milk and Dairies (Consolidation) Act: D. The Tuberculosis Order, 1925: E. The Public Health (Prevention of Tuberculosis) Regulations and F. The Housing Act, 1925. In order to carry out the extra legislation laid upon this Department in connection with the above-named Acts and Regulations, it was found necessary to appoint two additional officers (a Meat Inspector and a Veterinary Surgeon—who also acts as a Meat Inspector). During the period under review a very comprehensive coordination has been established between this Department and the ancillary health services in the district and in the contiguous areas, also a further linking up of the work between the various sub-departments, especially in respect to Maternity and Child Welfare, Tuberculosis, and the School Medical Service. In June, 1925, the Public Health Committee considered it advisable to replace the present obsolete and unhygienic method of collection of House Refuse by establishing a system of combined motor and horse traction (Pagefield System). In order, however, to co-ordinate this in the closest possible way with the cleansing of the Highways and Streets, it was agreed at a joint meeting of the Public Health Committee and the Highways and Parks Committee to transfer the responsibility for the collection of house refuse to the Borough Engineer's Department, In the 5 near future, therefore, a modern and vastly improved means of dealing with this highly important matter will be instituted. The first Health Week to take place in West Ham was held (in conjunction with the Insurance Committee) from October 4th to 10th, details of the arrangements made are to be found in the body of this report. That the event proved very successful, was due in large measure to the whole-hearted co-operation of all those who were approached to help make it so. A new Municipal Ante-Natal and Child Welfare Clinic will soon be opened in the Stratford District. It has also been decided to appoint a Lady Doctor to assist in Maternity and Child Welfare work. A Sanatorium for children suffering from pulmonary tuberculosis has been a long-felt need, arrangements are now completed (and await the sanction of the Ministry of Health) for the erection on your Langdon Hills site, of an Institution to accommodate 40 tuberculous children. A proposal to build an open-air swimming bath in West Ham Park is now under consideration, and it is to be hoped that this much desired measure will be achieved in due course. A scheme has been prepared for the establishment of a colony at Ockenden to accommodate 500 mental defectives, and it seems probable that this scheme will soon receive official sanction. In my last Annual Report I expressed the hope that this year would see some definite improvements in respect to the amelioration and safeguarding of the health of the populace. A study of the contents of this Report will prove that my hope was not ill-founded. I am hopeful of still further improvements, though it must be borne well in mind that the in auguration of health measures of various kinds will not, of itself, produce healthy citizens; this can only be achieved in the course of time by studious and painstaking attention to all matters, both great and small, which tend to raise or lower the general health of the community, either individually or collectively. It is essential also that the inhabitants should make the best possible use of the health facilities afforded to them. I am indebted to the Council and to all the members of my staff for their loyal help in enabling me to carry out the manifold duties of this Department. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, F. GARLAND COLLINS, M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H., Medical Officer of Health. 6 County Borough of West Ham. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1925. Natural and Social Conditions. 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 21/8 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 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 Lee and river Thames in the marshy clay and alluvium, a large part of the surface being made ground. 7 Summary of General Statistics. Area (acres), 4,706. Population- Census, 1921, 300,860. Estimated, 1925, 318,500. Number of inhabited houses (1921), 47,995. Number of families or separate occupiers (1921), 68,569. Rateable value— Poor Rate, £1,447,680. General District Rate, £1,350,003. Sum represented by a penny rate—General District Rate, £5,600. Amount of Poor Law Relief, £797,249 8s. 8½d. Chief Occupations of Inhabitants. West Ham is a typical industrial Borough. Large factories abound on the river frontages west and south; railway works employing thousands of regular hands are located in the north, and large docks—the staple support of casual labour—intersect the south. The rest of the area may be said to form the dormitory of artizans, clerks and others whose daily work is carried on in London and district, together with the local shops and retail businesses necessary for the welfare of their families. There is no particular industry calculated to specially affect the public health. Extracts from Vital Statistics of the Year 1 he Births during 1925 numbered 7,017, classified as follows:— Total. Male. Female. Legitimate 6,848 3,505 3,343 Illegitimate 169 94 75 giving a Birth Rate of 22.03 (Eng. and Wales 18.3.) 8 The Deaths numbered 3.428, viz., 1799 Males, 1,629 Females, giving a Death Rate of 10.7 (Eng. and Wales 12,2). Number of women dying in, or in consequence of, child birth:— From Sepsis 8 From other causes 12 Maternal Mortality 2.85 Infant Mortality (Deaths of Infants under one year of age per 1,000 births) 65.98 (Eng. and Wales) 75. 0 Deaths from Measles (all ages) 32 Deaths from Whooping Cough (all ages) 81 Deaths from Diarrhoea (under two years of age) 93 Vital Statistics of the Wards of the Borough during 1925. Wards. Births. Birth Kate. Deaths. Death Kate. Infant Deaths. Infant Mortality per 1,000 births Natural increase Births over Deaths. Estimated population middle of 1925. New Town 401 20.35 266 13.50 22 54 135 19,702 Forest Gate 314 15.45 248 12.20 22 70 66 20,316 High Street 486 25.08 180 9.28 31 63 306 19,376 Broadway 318 19.87 192 12.00 31 97 126 16,000 Park 255 15.62 167 10.23 11 43 88 16,318 Upton 273 14.83 192 10.43 14 51 81 18,405 Plashet Road 306 18.45 166 10.00 16 52 110 16,585 West Ham 361 19.42 201 10.84 25 69 160 18,537 Plaistow 475 21.16 216 9.62 30 63 259 22,442 Bemersyde 233 15.13 141 9.16 14 60 92 15,393 Canning Town & Grange 650 25.56 283 11.12 51 78 367 25,430 Hudsons 483 22.54 236 11.01 25 51 247 21,423 Ordnance 581 27.14 218 10.18 34 58 363 21,407 Beckton 566 26.60 215 10.10 42 74 351 21,278 Tidal Basin 779 33.49 279 11.99 68 87 500 23,256 CustomHouse & Silvertown 536 23.68 228 10.07 27 50 308 22,632 County Borough 7,017 22.03 3.428 10.7 463 65 98 3,589 318,500 9 Births The number of births registered in the Borough during the year was 7,834 (4,021 males and 3,813 females) but of this total 902 were children of non-residents who came to be confined in one or other of the maternity hospitals or were visiting friends, while 145 West Ham women were confined outside the Borough. Suitable adjustment makes the net West Ham Births 7,017 (3,599 males and 3,418 females); 109 of these (94 males and 75 females) were illegitimate. Calculated on the Registrar General's estimate of the population of the Borough at the middle of 1925, viz., 318,500, the birth rate for the year was 22.03, being the lowest ever recorded for the Borough. 7,520 live births and 196 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 2,334, but of these 174 occurred in persons not belonging to the Borough, while the deaths of 1,268 residents of West Ham occurred in various institutions and districts elsewhere, making the total net deaths attributable to the Borough number 3,428. of which 1,799 were males and 1,629 females. The distribution of these deaths to their various causes will be found later in this report, but the grand total of 3,428 from all causes gives an annual death-rate of 10.7 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 12.2. 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 the 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, Children's Hospital (Balaam Street), Royal Albert Dock Hospital and Forest Gate Sick 10 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) 85 infants and 1,194 persons over the age of one year died during the year, and in the latter group (inside Institutions) 135 infants and 301 elders died, of which numbers 38 infants and 118 elders were non-residents of the Borough. The net deaths of West Ham residents in Public Institutions were 182 infants and 1,377 persons of one year and upwards, making a total of 1, 559 institutional deaths as compared with 1,809 deaths in private residences, i.e., over 45 per cent. of the deaths during the year occurred in Public Institutions. Deaths in Outside Institutions:— Under 1 year 1 year and upwards. Whipps Cross Hospital 43 494 Central Home 7 386 Dagenham Sanatorium — 51 Goodmayes Mental Hospital — 46 Residents dying in London Institutions, etc 35 218 Deaths in Inside Institutions:— Plaistow Hospital 6 43 Queen Mary's Hospital for East End 56 111 St. Mary's Hospital 55 60 Plaistow Maternity Charity 10 3 Royal Albert Dock Hospital — 39 Children's Hospital, Balaam Street 1 3 Forest Gate Sick Home 6 28 Other Places, e.g., Docks 1 13 220 1495 Non-residents dying in Inside Institutions 38 118 182 1377 Net West Ham Deaths in Instititions 1559 11 Causes of Death at Different Periods of Life in the County Borough of West Ham during 1925. Causes of Death. Sex. All Ages 0— 1— 2- 5— 15— 25- 45— 65- 75— ALL CAUSES M 1,799 266 74 58 61 90 247 452 329 222 F 1,629 197 55 60 50 91 182 389 262 343 1 Enteric Fever M 2 .. .. .. .. .. 2 F 2 .. .. .. 1 .. 1 2 Small-pox M F 3 Measles M 20 3 9 7 1 F 12 1 5 5 1 4 Scarlet Fever M 4 .. 1 1 2 F 2 1 1 .. .. 5 Whooping Cough M 36 20 8 6 2 F 45 19 12 13 1 .. 6 Diphtheria M 7 .. 2 2 3 .. F 11 .. 3 6 2 7 Influenza M 27 1 .. 1 1 .. 5 13 5 1 F 35 1 1 1 1 3 14 9 5 8 Encephalitis Lethargica M 4 .. .. .. 1 .. 2 1 F 1 .. .. .. .. 1 9 Meningococcal Meningitis M 2 .. 1 .. 1 .. F 2 .. .. .. .. 2 10 Tuberculosis of Respiratory System.. M 191 .. .. 1 5 37 84 57 6 1 F 118 .. .. .. 4 48 39 24 2 1 11 Other Tuberculous Diseases M 39 5 10 8 4 3 6 3 F 26 2 2 9 5 2 3 3 12 Cancer, Malignant Disease M 172 .. .. .. .. 2 8 79 63 20 F 186 .. .. .. .. 1 28 89 44 24 13 Rheumatic Fever M 9 .. .. .. 4 2 1 1 1 F. 17 .. .. .. 8 5 3 .. 1 14 Diabetes M 10 .. .. .. .. .. 2 3 4 1 F 7 .. .. .. .. 1 .. 3 3 15 Cerebral Haemorrhage, etc M 72 .. .. .. .. .. 3 22 28 19 F 77 .. .. .. .. .. 2 23 24 28 16 Heart Disease M 174 .. .. 1 5 4 21 63 53 27 F 237 .. .. .. 5 9 22 77 63 61 17 Arterio-sclerosis M 50 .. .. .. .. .. 1 8 22 19 F 36 .. .. .. .. .. .. 6 13 17 18 Bronchitis M 158 13 1 2 .. 1 7 29 49 56 F 167 9 3 1 1 .. 2 25 43 83 19 Pneumonia, all forms M 189 44 24 14 2 5 25 43 17 15 F 166 37 15 16 7 3 15 36 16 21 20 Other Respiratory Diseases M 14 1 .. 1 .. .. 2 5 2 3 F 16 1 .. .. 1 .. .. 6 1 7 21 Ulcer of Stomach, or Duodenum M 29 .. .. .. .. .. 13 9 7 F 5 .. .. .. .. .. 3 2 22 Diarrhœa, &c. M 56 45 6 .. 1 .. 1 3 F 48 36 6 1 .. 1 .. 2 1 1 23 Appendicitis and Typhlitis M 11 .. .. .. 6 1 2 1 1 F 6 .. .. 1 1 .. 1 3 24 Cirrhosis of Liver M 9 .. .. .. .. .. 2 6 1 F 5 .. .. .. .. .. 1 3 1 25 Acute and Chronic Nephritis M 64 .. 1 .. 3 3 10 22 17 8 F 51 .. .. .. 1 2 10 23 11 4 26 Puerperal Sepsis M F 8 .. .. .. .. .. 8 27 Other Accidents and Diseases of Pregnancy and Parturition M F 12 .. .. .. .. 2 10 28 Congenital Debility and Malformation, Premature Birth M 80 78 .. 1 .. .. .. .. 1 F 65 63 .. .. .. .. 1 1 29 Suicide M 17 .. .. .. .. .. 7 6 3 1 F 9 .. .. .. .. 1 3 5 30 Other Deaths from Violence M 98 12 4 7 9 14 14 28 6 4 F 29 7 .. 2 1 1 2 3 5 8 31 Other defined Diseases M 254 44 7 6 11 18 29 49 43 47 F 227 20 6 6 10 11 25 41 25 83 32 Causes ill-defined or unknown M 1 .. .. .. .. .. .. 1 F 1 .. 1 18 Chief Vital Statistics since 1877. Year. Population. Births Birth Rate. Deaths. Death Rate. Infant Deaths. Infant Mortality Hate. 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 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 1925 318,500 7,017 22.0 3,428 10.7 463 65 14 During the Spring and early Summer, 1925, an outbreak of Chickenpox occurred in which many of the cases were of a severe type. The Medical Officer of Health was called into consultation by several different private Practitioners in regard to cases suspected to be Smallpox. In one case the diagnosis was so very doubtful that I deemed it advisable to seek the opinion of Dr. Wanklyn, the consulting specialist for Smallpox of the London County Council. Dr. Wanklyn very kindly at once came to see the child. Fortunately this case, as also all the others, proved not to be Smallpox. In November, 1925, a severe outbreak of Measles occurred. The cases were fairly evenly distributed throughout the Borough. Though Measles is not notifiable in West Ham, the great majority of cases come to the knowledge of the Medical Officer of Health by means of the Health Visitors, the School Attendance Officers, and other sources. The homes were visited, advice given, special leaflets distributed and, in addition, posters published on all the hoardings throughout the Borough. (See page 32.) At the time of writing (March, 1926) the epidemic is greatly on the wane, but it has, nevertheless, caused the death of a number of children and impaired the general health of many others. Isolation of the cases, except in very severe or complicated cases which are able to be admitted to hospital is, in the main, impracticable, owing to the grossly over-crowded condition of so many of the dwellings. General Provision of Health Services. HOSPITALS, (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 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, including severe Measles, Tubercular Peritonitis, Encephalitis Lethargica, etc. (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 15 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 for a further 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 for Adults with Pulmonary Tuberculosis, 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, up to 20 in number, sent to their Hospital by West Ham, thus enabling the Council to continue using Dagenham Hospital for the reception of Tuberculosis until the increasing pressure on the accommodation of the Orsett Hospital compels the Council to re-open Dagenham Hospital for smallpox cases. During the year 1924-25, 24 additional beds for tuberculous cases were added, bring the total accommodation up to 128. A very large number of houses are being built in the Dagenham Area, and the site occupied by the Smallpox Hospital (Temp. Tuberculosis Sanatorium), though getting more valuable from a financial point of view, is becoming increasingly unsuitable for the purpose of isolating smallpox, nor is it altogether desirable as a Sanatorium for Tuberculosis. The population of Dagenham has, during the past five years, increased from 9,127 to 38,000, and building is still proceeding. A part of the site in the S.W. corner has been cut off by the Romford Rural Council in connection with their new roadmaking scheme, and the Dagenham Spur of the new road to Southend, runs along the border of the site only a quarter of a mile from the Hospital itself. It should become a matter of very serious consideration for the Council as to whether or not 16 Dagenham Hospital as at present situated would be a suitable Institution for dealing with a serious epidemic of smallpox, taking into full account the very large area which it would have to serve, and also the danger to the metropolis of any breakdown in the efficiency of dealing with an Epidemic, seeing that many thousands of people from the area in question carry out their daily work in the City and travel to and from their workunder over-crowded and insanitary conditions. (3) The Grange Convalescent Home consists of a residential Institution with 7 acres of grounds, together with 61 acres of land situated 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 3 years, been used for the reception of diphtheria convalescents. HOSPITALS SUBSIDIZED BY COUNCIL. (4) Plaistow Maternity Hospital (see page 110). (5) Queen Mary's Hospital—Maternity and Out-Patients for Tonsils and Adenoids (see page 110). (6) St. Mary's Hospital—Children and Infants under 5 (sec page 110). (7) Children's Hospital, Balaam Street (see page 110). AMBULANCE SERVICE. The Council has two Motor Ambulances for the removal of infectious patients to hospital, and two ambulances for removing bedding, clothing, or other infected material 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 959 journeys during the year. In 356 cases persons were removed from one address to another within the Borough. In 603 cases from an address within the Borough to an institution outside, or vice versa. Provision is made for a Nurse to accompany the patient, and hot bottles are supplied during the cold weather. 17 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, and 16 journeys were made in this connection. Facilities for obtaining ambulances through Tram Conductors and the Police have been made, and transparencies are displayed on all West Ham cars giving full information. Notices to the same effect are exhibited at all the Council's Conveniences and Fire Stations. The following table sets out the nature of the cases removed:— Abscess 5 Internal Trouble 66 Appendicitis 75 Jaundice 1 Arthritis 1 Kidney Trouble 9 Attempted Suicide 18 Lockjaw 1 Brights Disease 1 Loss of Memory 4 Broken Ribs 10 Lunatic 2 Bronchitis 5 Massage 1 Bruises 1 Mastoid 2 Burns 5 Maternity Cases 80 Cancer 1 Measles 1 Cerebral disease 1 Nephritis 2 Collapse 46 Neuritis 1 Dislocated Shoulder 5 Obstruction 2 Dog Bite 1 Operation 11 Eclampsia 1 Peritonitis 1 Erysipelas 1 Pneumonia & Pleurisy 21 Fall 3 Poisoning, Blood 5 Fit 62 Removal home from Hospital 4 Fractured Femur 2 Fractured Pelvis 1 Rheumatic Fever 1 Fractured Tibia 2 Rheumatism 2 Gallstones 4 Rupture 5 Gastric Ulcers 6 Shock 8 Gastritis 1 Sleepy Sickness 2 Haemorrhage 25 Strangulated Hernia 7 Heart Trouble 11 Sunstroke 2 Influenza 1 Suffocation 1 Injured Head, Back (Concussion, etc ) 195 T.B. Meningitis 2 Throat Trouble 4 Injured Hands and Arms 13 Tumour 1 Iniured Legs and Feet 188 Ulcerated Stomach 2 Injured Thigh 13 X-Ray 4 18 School Clinics.* Stratford Clinic, 84, West Ham Lane, E. Balaam Street Clinic, Plaistow, E. Rosetta Road Clinic, Custom House, E. Swanscombe St. Clinic, Canning Town, E.16. 2 Dental Clinics 1 Minor Ailment Clinic. 1 Minor Ailment Clinic. 1 Eye Clinic. 1 Minor Ailment Clinic. 1 Minor Ailment Clinic. 1 Dental Clinic. All Clinics are used as Inspection Clinics, and are provided by the Local Education Authority. Tuberculosis Dispensary: Balaam Street, Plaistow. 1 here are 8 Maternity and Child Welfare Centres subsidised by the Council (see page 110) in addition to one Municipal Infant Welfare Clinic. For table of Hospitals treating Venereal Disease under the L.C.C. Scheme (see page 96). * See Ministry of Health Circular 648, dated 10th December, 1925. 19 Public Health Staff.* NAME. QUALIFICATIONS. OFFICES HELD. (Wholetime appointments except where otherwise stated.) Dr. F. Garland Collins M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. Medical Officer of Health, Chief Administrative Tuberculosis Officer and School Medical Officer. Dr. F. B. Skerrett M.B., B.Sc. (Lond.), M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officer of Health and Senior Assistant School Medical Officer. Dr. D. MacIntyre 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. P. A. Galpin M.D., D.P.H. Tuberculosis Officer. Dr. W. R. Kilgour M.R.C.S. (Eng.), L.R.C.P. (Lond.) Assistant Tubercutosis Officer. Dr. G. M. Mayberry L.A.H. (Dublin), L.R.C.P. (Ireland). Medical Superintendent Dagenham Sanatorium. 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 (parttime officer). Miss R. Alefs General Nursing, C.M.B., Fever Nursing Certificate. Health Visitor. Miss A. E. Bradley General Nursing, C.M.B., Royal Sanitary Institute Do. 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 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. B 20 NAME. QUALIFICATIONS. OFFICES HELD. (Wholetime appointments except where otherwise stated.) Miss M. E. Hopwood General Nursing, C.M.B., San. Inst. Examn. Board Health Visitor. Miss A. E.Lunn General Nursing, C.M.B. Do. Miss L. Martin General Nursing, C.M.B., Board of Education Diploma Do. Miss M. B. Wallace General Nursing, C.M.B. 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. Inst., Advanced Physiology & Hygiene (Kensington), St. John's Ambulance Nursing and First Aid, London City and Guilds Cookery Certificate. 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 A.R.S.I. Certificate General Nursing and Certificate of Q. V. J. I. as Nurse and as Superintendent of Queen's Nurses,*San. Inspr. Royal San. Institute, San. Inspr. San. Inspectors' Association Registered Nurse and Member of the College of Nursing. Do. Mr. B. G. Bnnnington M.S.I.A. 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. B. J. Driscoll Cert. San. Insp.'s Examn. Board, London. Sanitary Inspector. 21 NAME. QUALIFICATIONS. OFFICES HELD. (Wholetime appointments except where otherwise stated.) Mr. J. Dyke Cert. San. Inspr. Royal San. Inst., Cert. Building Constn.West Ham Tech. Institute Sanitary Inspector. Inspr. under Rag Flocks Act. Mr. T. R. Harris, A.R.San.I., M.S.I.A. Cert. San. Inspr., Meat Inspr. Royal San. Inst. Cert. San. Inspr., Meat Inspr. San. Inspectors' Board. Cert. San. Science, 1st Class, Battersea Polytechnic Sanitary Inspector. (Appointed Meat Inspr.). Mr. John F. Mules, M.S.I A. Cert. San. Inspr., Meat Inspr. Royal San. Inst. Dip. San. Science, Lond. Do. Mr. H. E. Parker, M.S.I.A. Cert. San. Inspr. Royal San. Inst. Sanitary Inspector. Inspr. under Rag Flocks Act. Mr. A. T. Plackett Cert. San. Inspr. Royal San. Inst. 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. G. Simmons, Cert. San. Inspr. (1912) Royal San. Inst. Do. Inspr. under Rag Flocks Act. Mr. G. H. Wilson Cert. San. Inspr. Royal San. Inst. Cert. Problems of Life and Health (Merit) London University Do. Mr. E. F. Hughes, M.S.I.A., A.R.S.I. Cert. San. Inspr. Royal San. Institute. Inspector of Food. Mr. E. J. Ferrier Shops Inspector. Miss E. D. Rayment General Nursing Supervising Nurse under Mental Deficiency Act. 22 Public Health Administrative Staff.* Mr. J. A. Cheatle Chief Clerk. ,, F. W. BromleySenior Clerk „ H. R Cole Clerk. ,, C. A. Haigh do. ,, F. H. Barker do. ,, J. Sabin do. „ A. Clark do. Miss V. M. Busby do. ,, W. I. Compton do. TUBERCULOSIS DISPENSARY. Nurses. Clerks. Ars. 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. DAGENHAM. Steward. Matron. Mr. F. Milsted. Miss E. Jones. DISINFECTORS. Mr. G. Palmer. Mr. G. J. Howes. ,, H. J. Murty. ,, W. Hubbard. MORTUARY KEEPERS. Mr. J. Gould. Mr. H. B. West. In addition, the West Ham Education Authority have a staff of 6 Medical Officers, 3 Dental Surgeons, 23 Nurses, 9 Clerks, and also 2 Consulting Oculists, who work in the closest possible co-operation with the above staff. * A detailed list of the Staff is included in this Report by the special request of the Minister of Health in accordance with Circular 548, dated 10th December, 1925. 23 Legislation Introduced 1921-1925, inclusive. Shops Early Closing Act, 1920. Transferred from Police to Local Authority. Sale of Food Order, 1921 (Parts 3, 4, 5, Imported Meat Jam and Fats). Slaughter House Bye-Laws, 1921. Butchers' Closing Order, 1922. Milk and Dairies Amendment Act, 1922. Milk (Special Designations) Order, 1923. Public Health (Meat) Regulations, 1924. Tuberculosis Order, 1925. West Ham Corporation Bill, 1925. Shops Acts. The Shops Acts are carried out under the supervision of the Medical Officer of Health, and the following table shows the work performed in connection therewith:— List of Shops Visited during the year 1925. Visited. No halfholiday form exhibited. Warned Verbally Warning Notice sent. Refused to serve. Summonses attended. Bakers 99 11 17 2 21 .. Boot-repairers, etc. 98 7 10 11 15 .. Butchers 167 28 20 4 36 .. Caterers 103 11 5 .. .. .. Carpets and Rugs 33 .. .. .. .. .. Chemists and Druggists 72 6 5 .. .. .. China and Glassware 61 1 5 4 7 .. Clothiers 79 5 3 .. 7 .. Confectionery and Tobacco 892 36 201 113 168 78 Corn Merchants 48 3 2 .. .. .. Cycle Dealers 47 3 2 2 2 .. Drapers, Milliners and Mantle Dealers 289 38 26 20 39 1 Fishmongers 62 10 5 .. .. .. Fruiterers and Greengrocers 263 12 40 19 30 7 Furniture Dealers 50 2 1 2 .. .. Furriers 22 .. .. .. Grocers and General 710 61 103 65 135 10 Hairdressers and Barbers 106 11 8 1 2 .. Hosiers and Hatters 102 1 4 3 4 1 Ironmongers 53 1 1 .. .. .. Leather and Grindery 57 2 1 3 .. .. Mixed 238 12 27 6 64 .. Music 49 1 1 5 1 1 Picture Frames 30 .. .. .. .. .. Public Houses 189 62 41 7 53 .. Tailors 67 5 1 3 2 .. Toy and Fancy Goods 80 5 7 3 14 .. Watchmakers, Jewellers, & Pawnbrokers 48 2 .. 2 1 .. Wireless 33 2 .. 3 4 .. Totals 4,147 338 545 278 605 98 24 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 16, 20, 22, 29, 33. Part II. Sections 38, 50. Part III. Sections 53, 62, 63, 64. Part IV. Section 81 (part of). Part VII. Section 95. Part X. Adopted 10th April, 1909. BYE-LAWS. Good Rule and Government (Tent Dwellers, Squatters, etc.). Adopted 22nd October, 1889. *Removal of House Refuse. Adopted 28th December, 1892. Common Lodging Houses. Adopted 26th July, 1892. Knackers' Yards. Adopted 28th December, 1892. Offensive Trades. Adopted 1st November, 1892. Nuisances. Adopted 1st November, 1892. Houses Let in Lodgings. Adopted 1st November, 1892. Slaughter Houses. Adopted 1st April, 1921. Nuisances in connection with the removal of offensive or noxious matter. Adopted 22nd August, 1907. * Transferred to Borough Engineers' Department, 1st June, 1925. LOCAL REGULATIONS. Dairies, Cowsheds and Milkshops Orders, 1885 and 1886. Adopted 1st August, 1888. These Bye-Laws and Regulations are enforced, where necessary, by the Public Health Committee, acting through their Medical Officer of Health. Propaganda. Propaganda work has been very actively carried on during 1925. Following a Public Health Christmas Card issued in 1924, at Easter all the schools were sent a placard entitled " Holiday Hints," on which were printed some hints in respect to the best way to spend the time during a holiday (e.g., spend your holiday in the open air, do not play in the streets, but go to one of the Parks or open spaces, etc., etc.). 25 In the early summer, when a spell of very hot weather occurred, the following leaflet was distributed from all Infant Welfare Centres, and it was exhibited on large posters on all the hoardings:— HOT WEATHER AND INFANT MORTALITY. Hot dry weather has a very marked influence upon the prevalence of diarrhoea in infants and young children. Infant Diarrhoea is a serious complaint which often ends fatally unless treated early. The cause is due to contamination of food (chiefly milk), feeding bottles, dummies, etc., by dust and germs. This disease can be prevented by cleanliness and fresh air. Use only dried milk or clean pure liquid milk and cover the top of the milk jug and sugar basin with muslin. Feeding bottles, bottle brushes, etc., must be boiled each day and kept in a clean place. Protect All Food from contamination and buy only from Vendors who endeavour to do the same. House Flies carry the Germs of diarrhoea, so protect all food from them and kill as many as you can. The child should have plenty of fresh air and be fed regularly. At the first onset of diarrhoea or sickness, take the child to your doctor or the nearest Infant Welfare Clinic. F. Garland Collins, Medical Officer of Health. Addresses of Infant Welfare Centres in West Ham : Plaistow Maternity Charity, Howards Road, Plaistow. South West Ham Health Society, 81 Barking Road. Women's League of Service, Welfare Road, Stratford. Trinity Mission, Oxford Road, Stratford. Given-Wilson's Institute, Pelly Road, Plaistow. Maternity Centre, St. Luke's Square, Tidal Basin. Plaistow Maternity Centre, 66 Martin Street, Stratford. Silvertown Municipal Centre, Westwood Road, Silvertown. Town Hall, West Ham, E. 15. 26 A Health Week was observed from October 4th to 10th, and was organized in co-operation with the West Ham Insurance Committee. A series of lectures on Health matters were delivered at various halls in different parts of the Borough. Illuminated signs were posted in different places, and Health Hints were displayed on the screen at the Cinemas (by the kind co-operation of the Proprietors). In most of the Churches and Chapels the Clergy gave a sermon upon "Health." The Local Hospitals and Medical Practitioners also co-operated. Many thousand copies of the following pamphlet, entitled "How to be Healthy" were distributed: — {Title Page). County Borough of West Ham. Health Week, October 4th to 10th. HOW TO BE HEALTHY, by F. GARLAND COLLINS, M.R.C.S. (Eng.), L.R.C.P. (Lon.), D.P.H Medical Officer of Health AND Chief School Medical Officer. town hall, west ham. October. 1925. 27 {Inside). FOREWORD. In presenting this pamphlet to the Public, it seems desirable to explain that though the information contained therein is necessarily of a very fragmentary nature, it is issued in the hope that it will help to strengthen the general health of the populace so as better to resist the effects of those conditions which militate against the Public Health. These conditions are being dealt with by the Town Council: but whatever the circumstances, it is essential that every citizen shall maintain as far as possible a high standard of personal health. F.G.C. HOW TO BE HEALTHY. FOOD. (1) Eat plain wholesome food at regular intervals and drink plenty of water. By plain wholesome food is meant that food which is not made up, re-cooked, highly flavoured, or spiced; but which is pure and unadulterated. There is no hard-and-fast rule as to exactly what each person should eat. That "one man's food is another man's poison" is, to some extent true. Unfortunately at the present time there is a large quantity of food exposed for sale which is "everyone's poison." Milk is the only food that should be taken by infants up to nine months old. Such milk should, if possible, be the milk of a healthy mother. If, for various reasons, the child has to be fed artificially, it should be given either fresh, pure liquid milk or good dried milk (diluted). It is extremely difficult to procure pure cow's milk in any large town. Purchasers should, however, refuse to buy, for any purpose, milk which has been produced or which is being sold under unhygienic conditions. The diet of a child from the age of nine months should be gradually altered so as to include food of a semi-solid and then solid nature. Very young children should not be given too much starchy matter (e.g., potatoes) or sweets. These need not be withheld altogether, but should be given in moderation. Fruit juice, fish, boiled or stewed (not fried), eggs and meat in moderate quantities are all very desirable, whilst some form of green vegetable is essential. 28 Water should be drunk between, not with, meals, and school children particularly should drink at least three glasses of water each day. Food should not be taken within one hour of going to bed, particularly by children of school age. It is of the utmost importance that meals be taken at regular intervals, and at the same time each day. It is wrong to eat between meals. All foods should be fresh, free from preservatives or dirt, and if cooked, properly cooked. keep all food protected from flies, which convey germs and infection. (2) Keep the teeth sound, and clean and the feet warm and dry. Teeth must be cleaned every night and every morning. If decay begins the dentist should be visited without delay. Bad teeth contaminate good food, and contaminated food contaminates the whole body. The feet should always be kept dry and warm in order to avoid catarrh, chills and other ailments. air and light. (3) Breathe through the nose, not through the mouth. The nose acts as a filter for all air entering the lungs; it also warms the air to the correct temperature. Therefore always breathe through the nose. Air which has once been breathed into the lungs is no longer pure, and the oftener the same air is breathed in and out of the lungs the more poisonous it becomes. That is why anyone dies of suffocation if confined in a sufficiently small space. If one is in a room with the door and window shut one must breathe impure air into the lungs: this air, although perhaps not poisonous enough to cause suffocation, is harmful enough to cause disease and ill-health. Therefore, always keep the windows open. An open window lets out more disease than it could ever let in. 29 (4) Take daily open-air exercise, in the sunshine when possible. Exercise is essential to health and growth, and should be regular, but adjusted according to the physical condition. Out-door exercise is, of course, the best. The greatest of all germ killers is sunlight. A very large number of illnesses are caused by germs which are really extremely minute living organisms. They thrive and multiply in waste, rubbish, dust and dirt and in dark and gloomy places. On the otherhand germs are killed by certain disinfectants and by light. One of the most difficult of germs to kill is the germ of tuberculosis, but even that is destroyed if exposed to direct sunlight for 15 minutes. Therefore every effort should be made to secure all the light and sunshine possible both in houses and elsewhere. sleep and regular habits. (5) Go to bed early to get sufficient sleep, and be regular in your habits. Sleep is nature's medicine for all ailments. Sleep, however, can be of various degrees, e.g., restless, fitful, deep, etc., dependent upon the mental and physical condition of the sleeper, and also upon the circumstances under which he is sleeping. Children from 5 to 14 years of age need to sleep about 10 hours out of every 24 hours. Children under 5 years of age need at least 12 hours sleep per day. The best rest is obtained during the early hours of the night. Retire to rest at the same hour each night. Regularity in all habits, personal and otherwise, is of vital importance in the maintenance of good health. cleanliness. (6) Wash the whole body at least once a week. The human skin is covered with thousands of tiny openings called pores, which help the lungs and the kidneys to keep the body healthy. If the pores become choked up, as they do if the skin is not regularly washed, the whole system suffers in some way. Therefore be sure to wash the whole body weekly and the face and hands several times a day. The pores of the face and hands being generally entirely exposed, are constantly being shut up with dust and dirt. The hands, moreover, are often the means by which germs are conveyed into the mouth. 30 Burn all the rubbish and waste you can and place the rest into a covered receptacle. clothing. (7) To over-clothe the body is as prejudicial to health as to under-clothe it. Children, especially, should throughout all the year wear a wool or flannel garment next to the skin. The garments worn next to the skin require washing at least weekly, and any garment in use during the day should not be worn at night. conclusion. (8) Finally, it must be borne in mind that good health cannot be purchased, neither can it be obtained or retained simply by making use of the exceptionally well-equipped medical facilities provided by the State and Local Authority. It is only by careful attention to the ordinary laws of nature, and by in all respects so modelling the mode of life and thought, as to place health as a matter of prime importance, that one of the greatest assets vouchsafed to humanity, viz.: Good Health, can be secured for the individual and for the community. Every person should strive to be healthy, remembering that " Health is better than Wealth." During Rat week—November 2nd to 9th—Posters were exhibited and Leaflets distributed to all factories and business premises pointing out the damage done by rats, their danger and the various means of rat destruction. It was also made plain that it is the duty of each individual citizen to keep their premises free from rats and mice. At Christmas, 1925, the following Christmas Card was issued through the School Teachers to every school child: — (Title Page). THE PURLIC HEALTH COMMITTEE of the West Ham Council send Greetings for a Happy Xmas and Good Health during the Coming Year. 31 (Inside). HEALTH IS BETTER THAN WEALTH This Child Eats:— Wholemeal Bread. Butter and Dripping. Fresh Fish. Good Meat. Green Vegetables. Suet Pudding. Eggs. Fruit. He Drinks:— Pure Milk. Cocoa. Water. He Wears:— Woollen Undergarments. He Exercises:— In the open-air. This Child Eats:— White Bread. Margarine and Jam. Dried Fish. Tinned Food. Dried Peas and Beans. Pastry. Sweets. He Drinks:— Infected Milk. Tea. Coffee He Wears:— Cotton Undergarments. He Exercises:— Very little or not at all. 32 An Epidemic of Measles, which was general all over the Country, became most severe during the month of December. With the consent of the Public Health Committee leaflets were issued and widely distributed, pointing out the dangers and premonitory signs of measles, and the following poster was printed in large type and exhibited on all hoardings:— MEASLES. Measles is dangerous and very infectious: immediate treatment is most essential. There is at present a severe epidemic of this disease, causing the death of a number of west ham children each week. The first sign of Measles is a Feverish Cold, with sneezing and running from the eyes and nose. The Rash first appears on the fourth day. The Dangerous Stage of Measles is during convalescence. It is then that complications develop which are liable to prove fatal. Take the utmost care during the second week of illness, and do not allow the child out of doors under at least ten days from the onset of the rash. Don't forget the younger the child the greater the danger. F. Garland Collins, Medical Officer of Health." Town Hall, West Ham, E. 15. I am convinced that much good is done by such methods of propaganda as set out above, and have proof from the reports of Health Visitors, Sanitary Inspectors, School Nurses and others, that much of the information given is being acted upon by an increasing number of people. In this connection my sincere thanks are due to the local press for the invaluable co-operation which they have extended to this Department in giving prominence in the Press to health matters. 33 With the increasing amount of propaganda being pursued, there is, in my opinion, urgent need for closer co-operation between the various Societies and Authorities concerned in order to prevent overlapping and undue prominence being given to one or other particular phase. Professional Nursing in the Home. There is no municipal arrangement for professional nursing in the homes. There are, however, several voluntary Associations employing a large staff of efficient nurses who carry out invaluable work in nursing the necessitous in their homes. As mentioned elsewhere, the co-operation between these Societies and the Local Authority is of the closest possible nature, both in respect to home nursing and health visiting. The Forest Gate section of this Borough is supplied with home-nurses by the Essex County Nursing Association from their branch in Beechcroft Road, Leytonstone.. The Silvertown area is similarly supplied through the Tate Nurses (Queen's Nurses), Nurses Home, Saville Road, Silvertown. By far the largest amount of nursing in the homes, however, is carried out by the Plaistow Maternity Charity, who serve all local areas. Co-Operation. The matter set out in the various sections of this report is sufficient to indicate that there is close and friendly co-operation between this department and the ancillary Health Services (both private and public) in the Borough, and this remark applies also to many Hospitals and other medical organizations outside the Borough; nor is this co-operation confined to direct Health organizations. There is, however, one weak link in the chain, viz., that though the co-operation between H.M. Inspector of Factories and the Medical Officer of Health is complete, there is a regrettable lack of any co-operation between this department and the Factory Medical Service (which is supervised by the Home Office and not by the Ministry of Health). This lack of co-operation on the part of the Factory Medical Service extends likewise to the School Medical Service, and is all the more regrettable seeing that there are so many Factories in the Borough which cmploy a very large number younc: persons (particularly girls) almost as soon as they leave school. Particulars of Bodies received into the Mortuaries during 1925. Month. Number received. Stratford Mortuary. Number received. Canning Town Mortuary. | Over 5 yrs. Under 5yrs. Sent in by Coron r. Sent in by Police. Sent in on Sanitary grounds. Number of Postmortems. Number of Inquests. 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 24 17 7 24 .. .. 18 24 2 i 1 .. i i i i February 19 13 6 18 i .. 15 19 3 2 1 .. 3 .. 2 3 March 12 9 3 12 .. .. 8 12 3 3 .. .. 3 .. 3 3 April 18 15 3 18 • • .. 14 18 5 5 .. .. 5 .. 4 5 May 14 10 4 14 .. .. 9 14 2 2 .. .. 1 i 1 1 June 18 13 5 18 .. .. 11 18 2 2 .. .. 2 .. 1 2 July 16 13 3 14 2 .. 11 16 4 3 1 .. 3 i 2 3 August 15 12 3 15 •• .. 13 15 2 2 •• .. 2 .. 1 2 September 21 17 4 19 2 .. 17 21 2 2 .. .. 2 .. 1 2 October 14 12 2 11 3 .. 10 14 4 4 .. .. 4 .. 4 4 November 16 8 8 14 2 .. 12 16 4 4 .. .. 4 .. 4 4 December 18 13 5 18 .. .. 7 18 2 2 .. .. 2 .. 2 2 Total 205 152 53 195 10 .. 145 205 35 32 3 .. 32 3 26 32 West Ham Mortuary was not in Use during 1925. The above Inquests were dealt with at Strattord. 34 35 Number of days bodies remained in Mortuaries during 1925):— 47 were l day in Stratford Mortuary. 131 „ 2 days „ „ „ 15 „ 3 „ „ „ „ 9 „ 4 „ „ „ „ 3 „ 5 „ „ „ „ 5 were 1 day in Canning Town Mortuary. 10 „ 2 days „ „ „ 17 „ 3 „ „ „ „ 3 „ 4 „ „ „ „ 1 Doctor performed 13 post-mortem Examinations. 1 „ „ 12 „ „ 1 „ „ 11 „ „ 1 „ „ 9 „ „ 3 Doctors „ 0 „ „ each. 3 „ „ 5 „ „ 4 „ „ 4 „ „ 6 „ „ 3 „ „ 16 „ „ 2 „ „ 27 „ „ 1 „ „ Sanitary Circumstances of the Area. WATER. Several large factories have private wells for drawing water from the chalk, but practically the whole of the Borough is supplied with water by the Metropolitan Water Board. The supply is constant, and in every case it is conveyed directly to the house. A few houses have storage tanks in the roof which need periodical cleansing. RIVERS AND STREAMS. The ditches are under the control of the Town Council as successors to the Dagenham Commissioners, as also are the river banks for the prevention of floods. The Lea and the c 30 Thames, both tidal rivers, are under the control of the Port of London Authority as regards the Thames and part of the River Lea. The rest of the Lea and its backwaters are under the Lea Conservancy. There are two main sources of pollution into the river before it enters West Ham at Temple Mills, viz., from the sewage effluents of two neighbouring Authorities. These enter this area at Temple Mills Railway Sidings and discharge into the Water Works River (a tributary of the Lea). Under the London County Council (General Powers) Act, 1925, both these Authorities now have powers to discharge into the L.C.C. Sewer at Hackney. In respect to one of these Authorities plans have been prepared, and the work should be in hand shortly. If and when both the above-mentioned effluents cease to enter the Lea, the river will be improved as regards pollution, but will still be subject to storm waters which are, so far, inevitable. A further contingency may develop should the two effluents previously mentioned be cut off, for during the summer months, with extreme heat and little tide running, the river beds may run dry owing to the whole of the Lea water being taken up by the Metropolitan Water Board with the exception of just sufficient to allow for the navigation of the Lea Cut from Lea Bridge to Old Ford. DRAINAGE AND SEWERAGE. The water carriage system of sewage removal is almost universal throughout the whole area. With few exceptions all houses are provided with properly flushed modern water-closets, discharging through appropriate drains into Public Sewers, which also convey the surface water and most of the rainfall. A certain portion of the Borough, being isolated by the Victoria and Albert Docks, is drained into a main sewer running from west to east through a narrow strip of the southern portion of the Borough of East Ham, whence it discharges into the London County Council Sewer at North Woolwich. The North-Western corner of the Borough—an area of, roughly, 120 acres containing two terraces of houses and some isolated buildings remains unsewered, but is drained into a 37 series of cesspools. A scheme is now in hand whereby the sewage of this area will be dealt with by the installation of suitable filter beds. The Sewers draining the main portion of the district (fivesixths of the whole area) converge by means of specially constructed intercepting Sewers to the Corporation Pumping Station, situated near the middle of the Western border of the Borough. Here the sewerage is pumped into the London Northern Outfall Sewer which crosses the Borough obliquely, whence it gravitates to the London Outfall at Barking. Disposal of House Refuse. During the years 1021 to 1924, inclusive, house refuse to the number of loads as indicated below, was collected and disposed of by this Department:— 1921 34,157 loads. 1922 35,716 „ 1923 37,192 „ 1924 38,677 „ The house refuse is at present collected by horse-drawn vehicles, and is disposed of in two different ways. The refuse from the Northern section of the Borough is carted to a big refuse dump at Temple Mills, which is well isolated and suited for the purpose. This site is rented from Messrs. Abbotts. Some other method of refuse disposal should occupy the attention of the Council in due course, as the site in question will not be available for a much longer period. The refuse from the Southern part of the Borough is carted to a wharf at Quadrant Street and, under contract, taken by barges down the river Thames to be disposed of. In the early part of the year the Public Health Committee had under consideration a more modern method of dust collection, and came to the conclusion that the system known as the Pagefield System " (collection by combined horse traction and motor lorry) was a suitable one to adopt. In order, however, that the collection of house refuse might be more closely correlated with the cleansing of the streets and highways, the 38 responsibility for dust collection was transferred from the Public Health Department to the Borough Engineer's Department. It is probable that this combined system will soon be in actual working. By the West Ham Corporation Act, 1888, the Corporation is empowered to require owners of houses to provide movable receptacles for house refuse instead of ashpits, and by special Bye-Law the occupiers of houses are required to place them outside their houses on such days as the Council fix. Under these provisions the house refuse is collected twice each week by the Council's own vehicles. Abatement of Nuisances. The following table shows the number of Inspections and Sanitary Notices served in respect of, in the sixteen Wards of the Borough during the year 1925:— Ward. Inspections. Notices served in respect of New Town 775 606 Forest Gate 504 353 High Street 1055 836 Broadway 716 423 Park 333 221 Upton 440 306 West Ham 603 411 Plashet Road 313 201 Plaistow 790 644 Canning Town and Grange 1105 893 Ordnance 711 550 Hudsons 590 372 Bemersyde 306 205 Tidal Basin 972 775 Beckton Road 946 760 Custom House & Silvertown 979 634 Totals 11,138 8,190 39 Summary of Work of Sanitary Inspectors during 1925. No. of Complaints Received and Investigated 5,340 No. of Inspections- Dwelling Houses 11,358 9,930 82 Newly-infected Houses Common Lodging Houses Slaughter-houses 3,282 292 Bakehouses Dairies 124 Cowsheds 43 Milkshops 118 Retail Shops (e.g., Eel-pie Shops, Ice Cream Shops, etc.) 3,514 1 Schools Canal Boats Offensive Trades 238 Factories (including Food Factories) Workshops 692 283 Laundries 14 Miscellaneous (e.g., Smoke Abatement, Offensive Accumulations, Stables, etc.) 3,749 Re-inspections 42,349 Number of Notices served— On Offender 10 On Owner *8,314 237 2 On Occupier Number of Notices complied with— By Offender By Owner *8,338 184 By Occupier Total Nuisances found 46,508 45,787 Total Nuisances abated *Apparent discrepancies caused by a large number of notices not being complied with at the 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. 40 Defects for the abatement of which Notices were served during the year 1925. Drains and Soil Pipes— Cleansed 139 Repaired 84(5 New Provided 3 W.C. Pans or Traps— Cleansed 42 Repaired 127 New provided 318 Surface Gullies- Repaired 19 New provided 1 Sinks and Sink-Pipes— Cleansed 8 Repaired 447 New provided 41 Stack-Pipes and RainWater Gutters— Repaired 1994 New provided 20 Water Fittings & Cisterns— Cleansed 4 Repaired 338 New provided 1 Flushing Apparatus— Repaired 628 New provided f'4 Water Supply provided 1'2 Yard Paving— Repaired 1300 New provided 1 Defects remedied in— Roofs 4210 Floors 1373 Staircases 586 Windows £030 Doors 077 Fireplaces 1552 Walls and Ceilings 145:31 Animals improperly kept 27 Offensive Accumulations 12(3 Over-crowding 28 Smoke Nuisance 175 Gipsies removed 0 Dust receptacles provided 1291 Rooms disinfected 2711 Premises infested with Rats 2 It frequently happens that a single sanitary notice specifies many defects needing abatement. 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. The smoke rising from Railway Engines at a large Railway Centre in the Borough is very appreciable. The same may be said in respect to ships in the Docks when stoking is in progress. The number of warnings and notices issued during the year was 175. Readings of atmospheric impurity are not taken. 41 Common Lodging Houses. There are 11 Common Lodging Houses in the Borough, four in the North of the Borough and seven in the Southern portion, all of which, with one exception, were originally constructed and used for other purposes such as private dwellings or warehouses, and have been adapted more or less successfully to meet the requirements of the Common Lodging House Bye-Laws. The accommodation in these houses amounts to 666 beds. These Lodging Houses receive frequent visits from the Sanitary Inspectors. There are some houses let as tenements which are often a source of anxiety, as they are not subject to Bye-Laws similar to a Common Lodging, and it is manifestly impracticable at present to put into force in this area Section 6 of the Housing Act, 1925. Offensive Trades. There are '29 premises where statutory offensive businesses are carried on in the Borough. They include : Fat Melters and Bone Boilers 21; Soap Boilers, 2; Fish Skin Dressers, 1; Gut Scrapers, 1; Chemical Manure Manufacturers, 1; Fish Waste Collectors and Fish Meal Manufacturers, 1; Degreasing Bones and Glue Making Contractors, 1; Tripe Dressers, 1. These are subject to constant inspection, and may be said to be carried on with as little nuisance or inconvenience to the general public as practicable. As a result of notices served and letters sent the following improvements have been carried out at offensive trades factories:—Messrs. Edward Cook and Co., Ltd., Soap Makers, Cook's Road, have installed an entirely new process for dealing with the fumes emanating from the fat melting appliances, consisting of a separate 6in. iron pipe from each pan carried to a sprinkler condenser; after leaving the condenser the fumes are conveyed by means of a large pipe to the main boiler flue, the temperature of which is usually about 350 degrees Far. Thos. Harris and Sons, Ltd., Soap Makers, Marshgate Lane, have installed Meldrum furnaces to each boiler (automatically stoked). At the entrance to the main flue there is also 42 a large forced draught fan. From many observations taken since this installation 1 am convinced that there is a marked diminution of emissions of smoke. The Smithfield Animal Products Co., Ltd., Marshgate Lane, have recently installed Johnson's Patent Smoke Consumer to their boiler furnace, and claim that it has been working satisfactorily. During the year 1925, application was received from Messrs. Turner and Sampson, to establish Fat Melting at premises in Beckton Road, Canning Town. This license was granted subject to the satisfaction of the Medical Officer of Health as to suitable storage, apparatus, and machinery to be used, and the approval of the Borough Engineer as to plans for a proposed extension of building. An application was also received from Messrs. Geo. Johnson and Son to establish Fat Melting and Bone Boiling at the works of the Anglo-Continental Guano Works, and Gibbs' Fertilizers, North Woolwich Road. This license was granted subject to the storage apparatus and machinery being to the satisfaction of the Medical Officer of Health, and also that the license held by them in respect of 101 Carpenters Road, E.15, be surrendered, and the license held by 'Messrs. Gibbs' Fertilizers in respect of North Woolwich Road, also be surrendered. Bye-Laws are in force in respect to the time and manner of conveyance of offensive material through the streets, and several summonses have been issued upon offenders and heavy penalties imposed in this connection. With the modern facilities for transport and power it is difficult to find any laudable reason why offensive trades should be established and carried on in the very midst of thickly populated districts. Schools. The Public Elementary Schools consist of 4(5 Council Schools and 14 Non-Provided Schools, together with five Council Special Schools, and two Higher Elementary Schools, affording in the aggregate accommodation for 70,090 scholars. The School Medical Service is administered by the Chief School Medical Officer (who is also the Medical Officer of Health) with a whole-time staff of 9 Medical Officers, 3 Dental Surgeons, 23 Nurses and 9 Clerks. 43 The Schools are for the most part modern, substantially built buildings adequately supplied with water and provided with sufficient surrounding air space, while their general cleanliness appears to be well looked after. Cloak-room accommodation is very limited in some Schools, and more efficient heating is desirable. With a view to checking the spread of epidemic disease it has been the practice for many years past for the Medical Officer of Health on receiving information of the occurrence of infectious disease in the family of a scholar to send a redcoloured Notice to the Head Teacher of the School attended (Day School and Sunday School) recommending the exclusion of children coming from the infected home. The Red Notice is subsequently followed by a White Notice freeing the family from quarantine on the completion of the necessary isolation and the official disinfection of the premises. Each school is provided with a supply of disinfectants for general or special use by the Education Authority. Chiefly for its moral effect fifty-eight Schools (Infants' Departments) were disinfected during the Christmas Vacation, 1925, in consequence of the increase in the number of cases of Measles. It was not found necessary to order the closure of any School, or part of a School, on account of infectious disease, or for any other reason. During 1925 a residential Open Air School to accommodate 80 boys was opened at Fyfield, near Ongar, Essex. The benefit derived by the children who have been fortunate enough to be sent to this School has been really remarkable. The School, which has now been open for over a year, and not a single case of infectious disease or serious illness of any kind has occurred. I am of opinion that such a School is one of the most valuable assets in the Institutional treatment of children. A Day Open Air School, to accommodate 60 girls, has been opened within the Borough at Crosby Road. Only one case of infectious disease (Diphtheria) has occurred during the year. The Head Mistress of the School writes in her Report: • • •. "Almost without exception the children are happier, more alert and at the same time more composed and under better self-control. Their appetites are steadier and less fussy. Work, play, meals and rest are all enjoyed." .... The girls who have attended this School have all gained in weight, and their general health has improved. It is a great example of the efficacv of open air in dealing with delicate children. 44 Housing. A large shortage of houses still exists. The reason for this would seem to be cessation, or curtailing, of building since the War. No houses have been erected by the West Ham Council during the year 1925, but 42 were erected by private enterprise. A housing scheme for the proposed erection of 152 (fourstorey) tenement flats is now before the Ministry of Health for consideration. The great lack of building space seriously hampers the Council in their proposals as to the extent and nature of their housing scheme. From 1021 to 1925, inclusive, 249 houses have been erected either by Municipal Housing Scheme, or by private enterprise, and the population during that time has increased to the extent of approximately 16.140, this showing one house erected for about every 65 persons. In 1921 there were 6.26 persons per inhabited house, and in 1925 6.55 persons per inhabited house. The standard of housing of the area varies considerably. A certain amount of property is in such a bad state of disrepair that normally a closing order would be issued in respect to it. There are no houses to let, and the few empty ones are only obtainable by purchase. Requests for accommodation are received almost daily. In many cases people are in a position, and willing to pay for extra accommodation, but it is practically impossible to procure the same within the Borough. Twenty-eight exceptionally bad cases of over-crowding were dealt with by Notice under the Public Health Act during the year 1925. Over-crowding is very prevalent, and is one of the most urgent problems needing attention, causing, as it does, chronic ill-health and a grave menace in respect to the spread of infectious diseases. Further, its effect upon the morals of the populace is degrading. Its causes are only too well known and are not peculiar to West Ham, but to more or less all large industrial areas throughout the country. Apart from the type of property, referred to above, which is in a perpetual state of disrepair, and where no sooner is one Sanitary Notice complied with than it becomes necessary to issue a further Notice, most of the defects are due to wear and tear, which is often of an excessive nature because of the large number of occupants, including sub-tenants. Some of the poorest class of property changes ownership at comparatively 45 frequent intervals. With a certain class of landlord, not until a Magistrates' Order has been obtained is the work specified on a Sanitary Notice carried out. This involves frequent reinspections and a great amount of clerical work. '260 Summonses were issued during 1925 (see page 47). Blocks of houses in two roads in the Southern area are subject to flooding during storm periods owing to the fact that the ground floor of these dwellings is below the level of the sewer. Several devices have been employed to obviate this, but with only partial success. No representations have been made to the Council with regard to unhealthy areas; all action has been taken with regard to separate houses. Van-dwellers congregate with their various shows (Hobbyhorses, Cocoa-nut pitches, etc.) on several vacant plots in the Borough. Notices have, in two instances, been served upon the owners of the plots concerned to rid them of these people, but considerable difficulty has been experienced in getting the Notices complied with. In a few cases the Public Health Committee has given instructions for the vacant plot concerned to be fenced. 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 35. Housing particulars during 1925 in the form desired by the Ministry of Health. Number of New Houses erected during the year— (a) Total—including numbers given separately under (b) 42 (b) With State assistance under the Housing Acts— (i.) By Local Authority Nil (ii.) By other bodies or persons Nil 1. Unfit Dwelling Houses: Inspection— (1) Total number of Dwelling Houses inspected for housing defects (under Public Health or Housing Acts 11,358 46 (2) Number of Dwelling Houses which were spected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 8,688 (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-head) found not to be in all respects reasonably fit for human habitation 8,561 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. A certain number of defective Dwelling Houses are rendered fit as a result of interviews between Officials and Builders. 3. Action under Statutory Powers— A. Proceedings under Section 3 of the Housing Act, 1925— (1) Number of Dwelling Houses in respect of which notices were served requiring repairs. All notices dealt with under Public Health Acts and West Ham Corporation Acts. (2) Number of Dwelling Houses which were rendered fit after service of formal notices— (a) By Owners ... ... ... Nil (b) By Local Authority in default of Owners Nil (3) Number of Dwelling Houses in respect of which closing Orders became operative in pursuance of declarations by Owners of intention to close Nil 47 B. Proceedings under Public Health Acts— (1) Number of Dwelling Houses in respect of which notices were served requiring defects to be remedied 8,561 (2) Number of Dwelling Houses in which fects were remedied after service of formal notices— (a) By Owners 8,524 (b) By Local Authorityin default of Owners Nil C. Proceedings under Sections 11, 14, 15 or the Housing Act, 1925— (1) (2) (3) (5) Nil. Prosecutions, 1925. Nuisances (Public Health Act) — 260 Summonses. 174 Summonses withdrawn. Failure to comply with Magistrate's Orders— 14 Summonses. 8 Summonses withdrawn. Adulterated Milk— 2 Summonses. Refusal to sell Milk to Officer— 1 Summons. Carrying on Trade as Dairyman or Purveyor of Milk without consent— 1 Summons. Selling Baking Powder useless as such— 1 Summons. 1 Summons dismissed on payment of £1 1s. Od. costs. West Ham Corporation Acts, 1893 and 1898— 8 Summonses. 8 Summonses withdrawn. Removal of offensive matter during prohibited hours— 2 Summonses. 48 Removal of offensive matter in a vehicle not properly covered or constructed for the purpose— 2 Summonses. West Ham Grocers, etc., Half Holiday Order, 1921— 2 Summonses. West Ham Grocers, etc., Closing Order, 1919— 6 Summonses. Shops Early Closing Act, 1920— 90 Summonses. 2 Summonses dismissed. The above number of Summonses issued total 389 The total number for the 5 years 1921-1925 2310 The total number for the previous 5 years, 1916-20 819 The total number for the 5 years previous to the Great War, 1911-1915 498 Table showing the different Trades in which the Outworkers were engaged during 1925. Tailoring 214 Making of Shirts 187 „ „ Underclothing 33 „ „ Blouses 32 „ „ Ties 28 „ „ Boxes 27 „ „ Umbrellas 26 „ „ Millinery 24 „ „ Dresses 17 „ „ Brushes 1« „ „ Dressing Gowns 12 „ „ Knitted Goods 13 „ „ Upholstery 11 „ „ Bon-bons 11 „ „ Artificial Flowers 10 „ „ Lamp Shades 6 „ „ Shoes 6 „ „ Tennis Balls 6 „ „ Furs 5 „ „ Waterproofs 5 „ „ Flags 5 „ „ Hand-bags 4 698 49 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. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing A pparel— (I) Making, etc. 78 86 366 4 13 653 347 104 (2) Cleansing & Washing Lace, Lace Curtains and Nets 2 .. 4 .. .. .. .. .. .. Furniture and Upholstery .. .. .. .. .. .. .. .. .. Fur Pulling .. .. .. .. .. .. .. .. .. Umbrellas, etc. .. .. .. .. .. .. .. .. .. Paper Bags & Boxes .. .. .. .. .. .. .. .. .. Brush Making .. .. .. .. .. .. .. .. .. Stuffed Toys .. .. .. .. .. .. .. .. .. Tennis Balls .. .. .. 1 .. 4 .. .. .. Tile Making .. .. .. .. .. .. .. .. .. ElectroPlate Cables and Chains .. .. .. .. .. .. .. .. .. Locks, Latches and Keys .. .. .. .. .. .. .. .. .. Totals 80 86 370 6 17 653 347 104 Number of Outworkers notified to West Ham from the tinder mentioned Districts. City of London 234 Poplar 105 East Ham 63 Stepney 53 Lejrton 49 Finsbury 54 Shoreditch 21 Westminster 15 Hackney 13 Marylebone 5 Islington 3 Hertford 2 Tottenham 2 Woolwich 1 Walthamstow 1 Kensington 1 Hendon 1 Number of Outworkers working for West Ham firms not ified to the undermentioned Districts. Stepney 168 Leyton 80 East Ham 58 Poplar 20 Betlinal Green 8 Walthamstow 4 Hackney 3 Westminster 2 Ilfora 2 Barking 2 653 347 50 1,—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisance. Premises. Number of Inspections. Written Notices Uccupiers Piosecuted. (1) (2) (3) (4) Factories (Including Factory Laundries) 528 16 •• Workshops (Including Woikshop Laundries) .. 7 •• Workplaces (Other than Outworkers'premises] 148 10 .. Total 787 33 .. 2 —Defects found in Factories, Workshops and Workplaces Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :— Want of cleanliness 112 109 .. .. Want of ventilation 6 5 .. .. Overcrowding 2 2 .. .. Want of drainage of floors 1 1 .. .. Other nuisances 96 109 .. .. Sanitary accommodation— .. .. Insufficient .. .. Unsuitable or defective . 17 16 .. .. Not sepaiate for sexes .. .. Offences under the Factory and Woikshop Acts:— .. .. Illegal occupation of underground bakehouse (s. 101) .. .. Other offences 9 8 7 .. (Excluding- offences 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 243 250 7 •• * Including those specified in sections 2, 3, 7 and 8 of the Factory and Woikshop Act, 1901, as remediable under the Public Health Acts. 51 Outwork in Unwholesome Premises Section 108. Nature of Work. Instances. Notices, served. Prosecutions. (1) (2) (3) (4) Wearing Apparel— Making, etc Cleaning and Washing Household linen Lace, lace curtains and nets Curtains and furniture hangings Furniture and upholstery Electro-plate File making Brass and brass articles Fur pulling Cables and chains Anchors and grapnels Nil. Cart gear Locks, latches and keys Premises satisfaetorv. Umbrellas, etc Artificial flowers Nets, other than wire nets Tents Sacks Racquet and tennis balls Paper, etc., boxes, paper bags Brush making Pea picking Feather sorting Carding, etc., of buttons, etc Stuffed toys Basket making Chocolates and sweetmeats Cosaques, Christmas crackers, mas stockings, etc Textile weaving Total — — — 52 Inspection and Supervision of Food. MILK SUPPLY. On January 1st, 1925, there were 258 Milkshops and Dairies on the register, and during the year 13 new premises were registered for the sale of ordinary cows' milk, and seven premises ceased to sell it, leaving 264 premises on the books on December 31st, 1925, of which 226 sell ordinary milk and five sell milk only on the premises (restaurants), the remaining 33 sell bottled milk only. Of the 226 milk premises 101 are Dairies, or premises where milk is the chief—or one of the chief—articles for sale. Thirty-five persons applied to be registered for the Sale of Milk, the majority of whom had taken over businesses where milk had already been sold. Five were refused registration, as the premises were unsuitable, but in one case the applicant eventually obtained accommodation which he was able to alter to the satisfaction of the Sanitary Authority, and registration was granted. Two other applicants who wished to share premises with another Dairyman, but were refused registration, eventually got other accommodation in another Borough. In one case where registration was refused, the applicant defied the decision of the Council and was prosecuted and heavily fined. One Dairyman, by the advice of the Medical Officer of Health, has removed to much better premises, which he has altered so as to bring it up to modern standards, and in another case old and undesirable premises were greatly altered and improved. One Dairy has been closed as the premises were unsuitable, the occupant, on the advice of the Sanitary Authority, selling his round to a Dairyman. In two cases application to be registered as a Milk Seller was made, but subsequently withdrawn. 53 Six Statutory Notices were served by the Inspector of the district, and the following defects remedied: — 1 Defective Drain. 1 Drain Vent Pipe. 2 Roofs. 1 Defective Stackpipe. 2 Defective Walls. 1 Defective Guttering. 1 Defective Water Fittings. In six cases the dairy and yard floorings were repaired and a roof repaired and ashpail supplied and a drain vent pipe repaired and cleansing done on four premises without a legal Notice being served; and in one case more satisfactory arrangements for the cleansing of the milk vessels have been made. MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. Five requests were made by Purveyors to procure samples of milk in the course of transit or delivery from the seller. In three cases it was found unnecessary to comply with such requests, but in the other two cases samples were duly taken, and the milk passed the standard. In addition, two requests were made by the Medical Officers of adjoining Boroughs, and samples were taken from churns on each occasion. MILK AND DAIRIES (AMENDMENT) ACT, 1922. It was not deemed necessary to take any action under the above Act. The practice of retailing " loose " milk from general shops should cease. The milk is frequently kept on the same counter with brushes, soap, firewood, oil, etc. The present method of purveying milk in churns, and often dirty " prams," and of running the quantity of milk into the jug on the dirty street or doorstep, is absolutely opposed to 54 cleanliness. No milk should be sold except in properly cleansed sealed bottles of varying capacity. In this connection it is a matter of considerable satisfaction to write that an increasing demand among the populace for bottled milk is very noticeable. TUBERCULOUS MILK AND CATTLE. During the year 90 samples of milk were taken, and submitted to the Bacteriologist for microscopical examination for the presence of Tubercle Bacilli, special sterile bottles being procured for this purpose. Of these samples 83 proved negative. The remaining 13 shewed the presence of Acid Fast Bacilli indistinguishable microscopically from the Tubercle Bacillus, and appropriate action was taken in each case. No case of Tuberculous Cattle came to the notice of the Local Authority during the year. MILK (SPECIAL DESIGNATIONS) ORDER, 1923. The following Licences were granted: — One to bottle and sell and four to sell Grade "A" (Tuberculin Tested) milk obtained from Lord Rayleigh's Farms, Hatfield Peverel, and J. H. Robinson, Iford, Lewes, Sussex; five to sell Certified Milk bottled at Lord Rayleigh's Farm, Hatfield Peverel; two to bottle and sell, and three to sell Grade "A" milk purchased from Carter and Sons, of Lewes, and Lord Rayleigh's Farm, Hatfield Peverel; one to Pasteurize and sell at 106 Windmill Lane, E.15; and three to sell Pasteurized Milk. Thirty-eitrht samples of milk were submitted for Bacteriological Examination, the results beiryg as follows:— Grade "A." Grade "A" (Tuberculin Tested). Pasteurized. Up to Below Up to Below Up to Below Standard. Standard. Standard. Standard Standard. Standard. 1 5 6 5 13 8 55 With reference to the 5 samples of Grade "A" Milk which failed to pass the required standard, the serious attention of the Dealer was called to the unsuitability of his premises. In the case of the 5 samples of Grade "A" (Tuberculin Tested) and 8 samples of Pasteurized Milk which failed to pass the required standard, these having been supplied by the same Dealer, letters of warning were sent drawing his serious attention to the offence, and threatening drastic action by the Local Authority. At an interview between another Dealer and the Medical Officer of Health certain suggestions, particularly in respect of the method of cleansing the milk bottles, were made by the latter. These methods were put into operation with satisfactory results. GRADED DESIGNATED MILKS. Applications for licences to sell designated milk have been refused in several instances, chiefly owing to the fact that the premises were unsuitable, and that previous samples of milk taken from the premises proved, from bacteriological examination to be contaminated—sometimes to a marked degree. All grades of milk have proved from time to time, on bacteriological examination, not only not to reach the standard required, but in some instances to be more contaminated than ordinary milk. It is only by the constant visiting of the premises, and by letters of warning to the dealers that ' designated" milks do not fall far below the degree of impurity officially allowed. Hie apparatus used for Pasteurizing is the " Tarbet Positive Holder," made by the Aluminium Plant Vessels Co. Meat. PUBLIC HEALTH MEAT REGULATIONS, 1924. brom the date of operation of the above Regulations the Sanitary Inspectors on their respective districts carried out all inspections during the day, but a weekly rota was formed for the night work for two Inspectors to work the whole of the 56 Borough. This procedure continued until the appointment of a Meat Inspector, who commenced his duties on the 23rd November, 1925, and from this date forward the Sanitary Inspectors have taken duty singly to enable the inspection to be fully carried out. No steps have been taken in connection with the marking of meat. In the early part of 1926 a fully qualified Veterinary Surgeon was appointed to work these regulations in conjunction with the Meat Inspector. Of the 9,148 animals inspected from the inauguration of the above regulations 487, or 5.3°/ were diseased. In connection with the disposal of condemned meat, all condemned meat is dealt with at Local Factories. In the event of any meat being condemned a Certificate from the factory receiving the same is required by the Local Authority before an official Condemnation Certificate is issued. The following forms are used in connection with the above regulations: — Public Health (Meat) Regulations. 1924. NOTICE OF INTENTION TO SLAUGHTER. At Slaughter-house. Section 10 provides that NO carcase or internal organ* of any animal shall be removed from the slaughterhouse until three hours have elapsed from slaughter or six hours from the giving of notice to the Local Authority. No of Cattle Date. Time of Slaughter. Calves Lambs If the six hours expire before 7 a m. the carcase must remain until that time. Sheep Pigs Signed . This notice must be delivered at the Public Health Department, Town Hall, West Ham (Telephone No. Maryland 2660) in accordance with the Regulations. Date and time of Posting 57 Form for Voluntary Surrender of Meat, Fish or other Articles of Food. COUNTY BOROUGH OF WEST HAM. particulars of foods, etc., surrendered. Date 182 Time Article Examined Where Examined Result of Examination Name and Address of Owner Surrendered by Destroyed at Remarks San'tary Inspector's Initials Form for Voluntary Surrender of Meat, Fish or other Articles of Food. COUNTY BOROUGH OF WEST HAM. (public health department). Public Health Act, 1875. Meat Regulations, 1924. THIS IS TO CERTIFY that Mr has this day Voluntarily surrendered to me, the undersigned which upon Examination (was) (were) lound to be and unfit for the food of man. Signed, Sanitary Inspector. Date 192 Form for Voluntary Surrender of Meat, Fish or other Articles of Food. COUNTY BOROUOH OF WESI HAM. (public health department). Public Health Act, 1875, and Sect. 28. Public Health Acts Amentment Act, 1890. Meat Regulations, 1924. THIS IS TO CERTIFY that I, the undersigned, being THE OWNER of which upon Examination by Mr Sanitary Inspector to the Sanitary Authority (are) (is) declared by him to be and unfit for the food of man, do hereby Voluntarily Surrender the said for the purpose of having the same destroyed or so disposed of as to prevent (it) (them) being used for the food of man. Signed Date 192 58 All butchers, slaughterers and stall-holders were circularized and acquainted with the new regulations, and a Sanitary Inspector visited each and personally explained the regulations. A summons was issued in one case for an infringement, but 011 account of the death of the offender, prior to the hearing, was not pursued. A number of warning letters have been sent to offenders. On the whole the butchers and stall-holders have carried out the regulations in a fairly satisfactory manner, though there is yet room for much improvement. It is by educating the public to refuse to buy food which has been exposed to contamination that butchers and others will sooner or later be compelled in their own interests to screen their goods. Slaughter Houses. The following is a list of private Slaughter Houses in use in West Ham, as desired by the Ministry of Health:— In 1920. In Jan 1925. In Dec., 1925. Registered 9 9 9 Licensed (Annually) *18 *18 *lfi 27 27 25 * Includes two Slaughter Houses for slaughtering horses for Export. During the year 3,282 visits were paid by Sanitary Inspectors, but it was not found necessary to serve any Sanitary Notices. It was found, however, that several slaughterers were not using a mechanical instrument in contravention to the West Ham Corporation Bve-Laws with respect to Slaughter Houses dated 25th January. 1921. These offenders were duly warned, and this Bye-Law is now being properly adhered to. 59 Other Foods. There are a number of Factories dealing with food of various kinds in the Borough, and these,together with the Retail Shops, Bakehouses and other such premises are continually under the observation of the District Sanitary Inspectors. 4,200 visits were paid during the year 1925. There are 45 underground bakehouses. The Food Inspector, who devotes the greater part of his time to the administration of the Sale of Food and Drugs Acts, is charged equally with the other Inspectors with the duty of safeguarding the sale of food in market streets and other premises where dietary articles are exposed for sale. Street Trading. Part VI. of the West Ham Corporation Act, 1925 (which received the Royal Assent on August 7th, 1925) deals with street trading, and confers upon the Corporation powers which are of very far-reaching Public Health importance. Section 52 states:—"From and after tfre first day of January one thousand nine hundred and twenty-six it shall not be lawful for any person to sell or expose or offer for sale any article or thing from or upon any barrow, cart, stall or other receptacle occupying a stationary position at a place in the carriageway or footway of any street in the Borough without a License from the Corporation authorising him so to do. Provided that this Section shall not apply to any person selling or exposing or offering for sale any article or thing from or upon any barrow, cart, stall or other receptacle which he ordinarily moves from place to place in pursuit of his trade." Section 57 states:—" (1) The Corporation may make ByeLaws prescribing the days on which and the times during which articles or things may be sold or exposed or offered for sale under the authority of a licence granted or renewed under this part of this Act, and making provisions and requirements with respect to the removal of refuse the allocation, dimensions, and arrangement of barrows, carts, stalls or other receptacles, the storage and sanitary supervision (while at the place of intended sale or exposure or offering for sale) of 'tr icles of food intended to be sold or exposed or offered for sale under the authority of the license and generally as to the conditions under which articles or things may be sold or exposed or offered for sale under such authority. 60 " (2) The provisions of Sections 182 to 185 of the Public Health Act, 1875, so far as they relate to Bye-Laws made by an Urban Sanitary Authority shall apply to all Bye-Laws made under this Section with the substitution of the Secretary of State for the Minister of Health as the confirming authority. Provided that before confirming any Bye-Law relating to the storage and sanitary supervision of articles of food the Secretary of State shall consult the Minister of Health." Section 60 deals with the penalties for not complying with the Bye-Laws, etc., etc. The Bye-Laws drawn up are as appended: — 16. A licensed street trader selling or exposing or offering for sale articles of food from any stall for human consumption: — (a) Shall cause such stall to be suitably covered over and to be screened in such a manner as to prevent mud, filth, or other contaminating substance being splashed or blown from the ground upon any food on the stall. (b) Shall cause the stall and every counter, slab, vessel or other article on or in which food is placed for sale, and all knives and other implements used in connection with the food to be thoroughly cleansed after use and to be kept at all times in a cleanly condition. (c) Shall take all steps as may be reasonably necessary to guard against the contamination of the food by flies. (d) Shall not place or cause to be placed any such article of food on, or within 18 inches of, the ground, floor, or street level, unless it is placed in a closed cupboard or other adequately protected space not less than nine inches from the ground, floor or street level. (e) Shall not sell or expose or offer for sale for human consumption any article of food which is contaminated by mud, filth or other contaminating substance. (/) Shall cause all refuse, scraps, waste material or rubbish arising from the nature of the business carried on, to be placed in properly covered receptacles kept exclusively for that purpose, and shall cause all such receptacles to be kept in a reasonably clean state, regard being had to the purpose for which they are provided. 61 Provided that this Bye-Law shall not apply:— (i.) to any articles of food in respect of which the conditions of sale or exposure or offer for sale are prescribed in any order or regulation made by the Minister of Health, and for the time being in force in the Borough; or (ii.) to any articles of food contained in receptacles so closed as to exclude all risk of contamination. As these Bye-Laws have only very recently received the sanction of the Home Office it is too soon to say anything in respect to their working, but certainly these cannot but be a valuable asset in the carrying out of the supervision of food. Veterinary Surgeon's Report. During the year 1925 eleven 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, and the animals were found to be generally in good condition. Situation of Cowsheds. No. of Cows examined each quarter. March Quarter June Quarter. September Quarter. December Quarter. Clegg Street 15 14 14 12 Balaam Street 11 9 9 9 Edward Street 3 2 2 - Vicarage Laue 54 58 54 53 Beale Street 8 10 10 10 Idmiston Road 15 17 17 17 Blanche Street 20 20 24 23 Edwin Street 1 — — — Beckton Road — — 16 14 Leyes Road (2 sheds) — — 5 5 Totals 133 130 151 143 * The use of this Cowshed was discontinued at the instance of the Medical Officer of Health owing to its total unsuitability. 62 Unsound Food Condemned. Apples: 6561bs. Apricots: 30 crates. Beasts— Crow Fats: 3. Forequarters : 2. Gut Fats: 3. Heads: 14. Heads, Collar & Mesentery : 1. Kidneys: 1. Livers: 92 and 76^1bs. Lungs: 104 pairs. Mesenteries: 1. Offal: 1. Spleens: 5. Tongues: 4. Beef: 40st., 2 bodies & viscera, 1 body and offal, 2 carcases and offal, 4 heads, collars and tongues. Brussel Sprouts: 20 bags. Cherries: 501bs. Grapes: 23 barrels. Haddocks: 2 boxes and 1 trunk. Herrings: 1 box. Kippers : 1 box. Lobster: 1 tin. Mutton : 1 leg, 3 loins, 2 targets, 1 fore-end, 1 shoulder. Mutton Trimmings : 301bs. Ox Skirt: 1. Pears: 41 boxes, 1 bushel. Pigs : Bellies 7, codgut 1, crow fats, omentum & spleens 3, crow fats 13, carcase and viscera 1, livers 56, loins 2, lungs 60 pairs, mesenteries 24, plucks 54, spleens 12. Plaice : 1st. and 1 box. Pork: 4st. 1 hand. PorkFat: 61bs. Pickled: 21bs. Roker Wings: 1 box. Sheep— Cauls : 4. Livers : 35. Lungs: 31 pairs. Mesenteries: 1. Plucks: 1. Skate : 1 box. Skate Wings: 8st. & 1 barrel. Tomatoes: 64 boxes and 40 bundles. Veal: 81bs. Whelks: 1 bag. Whiting: 5 boxes. Winkles : 2 bags & 5 gallons. 63 Samples Analysed by Borough Analyst, 1925 Articles. Analysed. Genuine. Adulterated. Official. Unofficial. Official. Unofficial Official. Unofficial. Milk 531 6 520 5 11 1 Dried Milk 20 .. 20 .. .. .. Butter 150 124 149 121 1 .. Margarine 29 10 29 10 .. .. Dripping 22 10 20 9 2 1 Lard 38 59 38 59 I.ard Compound 1 .. 1 .. .. .. Coffee 25 15 24 14 1 1 Cocoa 30 33 30 33 .. Vinegar 55 .. 50 .. 5 .. Mustard 20 17 20 17 .. .. Pepper 104 26 104 26 .. Ground Ginger 2 8 2 8 .. Baking Powder 21 5 16 4 5 1 Self-raising Flour 17 1 17 1 .. .. Condensed Milk 4 .. 4 .. .. .. Cream 2 .. 2 .. .. .. Preserved Cream 5 .. 5 .. .. .. Coffee and Chicory 2 .. 2 .. .. .. Bread 1 .. 1 .. .. .. Puff Paste 1 1 .. .. A rrowroot 2 1 2 1 .. .. Cornflower 1 .. 1 .. .. .. Totals 1,082 316 1,057 309 25 7 Public Health (Milk and Cream' Regulations, 1912 and 1917. Summary of action taken under the above Regulations, on the lines indicated in the Department's Circular Letter No. 162, dated 7/1/1921, 64 1. Milk: and Cream not sold as Preserved Cream:— (a) No. of Samples examined for the presence of a Preservative. (b) No. in which Preservative was reported to be present, and percentage of Preservative found in cach sample. Milk 537 Nil. Cream 2 Nil. 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 5 (ii.) Statements incorrect — Total 5 (iii.) Percentage of Preservative Percentage stated 011 found in each sample. statutory label. No. 680 0.26% Boric Acid 0.4% Boric Acid. No. 681 0.24% do. do. No. 774 0.22% do. do. No. 790 0.32% do. do. No. 1397 0.21% do. do. (b) Determinations made of Milk Fat in Cream sold as Preserved Cream— (i.) Above 35 per cent 5 (ii.) Below 35 ,, ,, — 5 65 (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: — There were two cases in which colouring matter (Annatto) had been added, and letters of caution were sent. Prevalence of, and Control over, Infectious Diseases. NOTIFIABLE DISEASES (OTHER THAN T.B.). The following table shows the number of cases of notifiable diseases occurring during the years 1921-1925, inclusive, together with 66 the number removed to hospitals and the total number of deaths from each disease:— DISEASE. Cases Notified. Removed to Hospital. Total Deaths. 1921 1922 1923 1924 1925 1921 1922 1923 1924 1925 1921 1922 1923 1924 1925 Smallpox — 3 2 — _ 3 2 — — — 1 — — — Diphtheiia 649 673 701 801 766 560 611 671 751 719 32 44 27 33 18 Scarlet Fever 1695 746 530 388 478 1119 592 412 320 412 11 8 7 4 6 Enteric Fever (including Paratyphoid) 22 14 25 19 13 7 3 10 16 5 2 2 1 4 4 Puerpural Fever 8 12 16 15 10 5 3 14 13 6 4 6 11 5 8 Pneumonia* 209 293 198 419 433 75 72 66 158 130 398 659 119 494 355 Cerebro Spinal Fever 1 2 1 2 5 1 1 1 5 1 2 3 3 4 Acute Polio Myelitis 3 3 5 2 1 2 1 4 2 1 - - - - - Acute Polio Encephalitis 3 - - 2 - - - - - - - - - - - Encephalitis I.ethargicaf 10 2 6 26 14† 7 2 2 19 10 3 3 2 1 5† Erysipelas 165 153 138 177 215 19 32 17 32 58 13 — 4 8 6 Ophthalmia Neonatorum 61 34 31 24 34 5 5 2 4 1 - - - - - Malaria 3 13 — 26 8 - - — 16 2 — — — — — Continued Fever - - - - 2 - - - - - - - - - - Dysentery — — — — 1 - - — — — — - - — *Notification of this disease is confined to certain types of Pneumonia, and the figures given are liable to be very misleading, e.g., in 1922, though only 293 cases were notified, no fewer than 659 deaths from Pneumonia(all forms) were registered. † One of the 5 deaths during 1925 was one of the 26 cases notified in 1924, the remaining 4 cases were firstnotified in 1925. 67 An analysis of the above table will show that there has not been an undue prevalence of any particular infectious disease during the last five years. The number of cases of Malaria are more than would be expected were it not for the fact that most of these cases have been notified from the Royal Albert Dock branch of the Seamen's Hospital, which chiefly admits cases from ships in the Dock coming from countries where Malaria is pandemic. SCARLET FEVER (RETURN CASES). Cases occurring within the outside margin of one month of the discharge of a case from Hospital to tlie same house were regarded as " Return Cases." Of the 412 admitted to Hospital 16, or 3.88 per cent, were associated with recurrent infection in this way (see also report of Medical Superintendent of Plaistow Fever Hospital, pages 73 to 82. REPORT ON SPECIAL CASES NOTIFIED DURING 192'). Cerf.bro-Spinal Fever. During the year f> cases of Cerebro-Spinal Fever were notified (1 male and 4 females), but in two of these cases the diagnosis was not confirmed—one being a woman of 23 years, who died of Pneumonia, and the other a boy of 5 years, who recovered from Rheumatic Fever. Of the cases that were confirmed, two (a woman of 22 years and a girl baby of 2 months) died, and a little girl of 3 years old recovered. _ One other case, a boy of twelve, was not notified, he arrived from abroad sufferincr from Cerebro-Sninal Fever and died here. All six cases were treated in Hospital. B 68 Poliomyelitis. Only one case of Poliomyelitis, a boy of five, was notified, and he is still under treatment and reported to be improving. Encephalitis Lethargica (see preceding table). Fourteen cases of Encephalitis Lethargica were notified (7 males and 7 females), of whom four died, a boy aged 13 years, a woman of 47, a girl of 19, and a little girl under three years of age. The woman of 47 was found at Post-mortem examination to have died of a Sarcoma. A further case was notified, but the diagnosis was not confirmed, the patient, a girl of 20 years of age, dying in hospital of Pneumococcal Meningitis; one of the 14 cases, a girl of 18, was a relapse case. The ages of the males affected were: 43, 30, '24, 19. 17, 13 and 6 years; and of the females: 47, 42, '29, 19, 18, 10 and 2 years. Twelve of the cases were treated in Hospital, one in the out-patient department of a hospital, and one was treated at home. Four cases are still very ill, while one is reported to be slowly improving. Three men have been able to resume their work, and two children—though still under treatment—are well enough to return to School. LABORATORY WORK. In addition to the work carried out at the Plaistow Fever Hospital (see the report of the Medical Superintendent, Plaistow Hospital), and at the Tuberculosis Dispensary, other pathological specimens are examined at the Seamen's Hospital. 69 Greenwich, most of these specimens being submitted by private Practitioners in the Borough. Queen Mary's Hospital, Stratford, will shortly open a Pathological Department, fully equipped with the most up-todate apparatus. The Laboratory will be under the charge of a highly skilled Pathologist, and should prove a great asset to all concerned. CASES OF SICKNESS VISITED AND INVESTIGATED BY THE WOMEN SANITARY INSPECTORS DURING 1925. Measles 1,636 Chicken Pox 1,589 Whooping Cough 542 Mumps 566 Tonsillitis 472 Other cases 2,601 7,406 RESEARCH COMMITTEE. Phis Committee is composed of the whole of the Medical Staff of the Borough Council, Education Committee, Poor LawAuthority, and of certain of the staff of the Hospitals in the Borough", together with several local Medical Practitioners. Any findings of the Committee which are considered relevant are placed before the Council's Public Health Committee for their consideration. 70 The work of the Committee is not so much in the nature of research itself as generally understood, but has conformed more to the definition given to that word by Lieut.-General Sir William Leishman, Director-General of the Army Medical Service in his address on " Research in the Medical Service," to the Royal Society of Medicine, October 12th, 1925. The address begins thus : — "At the outset it is my purpose, if I can, to remove from your minds the impression that Research is of necessity an esoteric matter, confined to mysterious laboratories, and that it can be carried out only by professors and specialists who have given years of work to their subject, and who are ' peculiar folk ' and talk in a vongue 'not understanded of the people.' It is true that much experimental enquiry demands expert knowledge, special equipment, and comes within the opportunity of comparatively few of us: but I prefer to give to the word Research a much wider significance, and to take it to cover any means by which we, of set purpose, and of deliberate plan, strive to add to the existing knowledge of the cause, the prevention, and the treatment of disease." Working on these lines, much good has ensued from the meetings, and a number of helpful suggestions have been formulated for the betterment of the health of the community. For sources from which information concerning nonnotifiable diseases are obtained see page 14. 71 Summary of Notifications. Week Ending. 1925 Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Small Pox. Typhus Fever. Cerebro Spinal Fever. Acute Poliomyelitis. Acute Polio Encephalitis Encephalitis Lethargica. Erysipelas. Ophthalmia Neonatorum. Respiratory. OtherForms Pneumonia. Malaria. Dysentery. Trench Fever. j Relapsing Fever Continued Fever. Jan. 10 7 14 - - - - - - - - 4 1 18 1 10 - - - - - „ 17 8 19 - 1 - - - - - - 5 1 14 4 9 1 - - - 1 „ 24 11 17 - 2 - - - - - - 6 - 12 - 12 - - - - - „ 31 6 20 - - - - - - - - 2 - 23 11 16 - - - - - Feb. 7 8 14 - 1 - - - - - - 4 - 25 6 23 - - - - - „ 14 7 16 2 - - - - - - - 4 1 22 6 12 - - - - - „ 21 5 16 - - - - - - - 1 5 1 22 1 9 1 - - - - „ 28 6 26 - - - - - 1 - - 4 1 9 1 7 - - - - - Mar. 7 8 20 - - - - - - - 1 5 - 11 3 - - - - - - „ 1 1 5 18 - - - - - - - - - - 21 5 9 - - - - „ 21 8 23 - - - - - - - 1 4 1 25 3 9 - - - - - „ 28 6 31 - - - - - - - - 3 1 21 1 9 - - - - - April 4 5 9 - - - - - - - - 3 1 22 4 10 - - - - - „ 11 9 17 - - - - - - - 1 2 - 9 1 6 1 - - - - „ 18 10 11 - - - - - - - - 2 1 12 1 10 2 - - - - „ 25 11 10 - - - - - - - 1 1 2 22 4 1 - - - - - May 2 8 11 - - - - - - - - 2 - 16 3 10 - - - - - „ 9 5 18 - 1 - - - - - - 5 - 20 4 6 - - - - - „ 16 12 11 - - - - - - - - 3 1 18 5 2 - - - - - „ 23 4 22 - - - - - - - - 5 - 27 8 7 - - - - - „ 30 8 14 - - - - 1 - - - 3 - 14 4 5 - - - - - June 6 9 16 1 - - - - - - 1 5 2 14 2 5 - 1 - - „ 13 5 6 - - - - - - - - 3 1 18 3 4 - - - - - „ 20 4 11 - - - - - - - - 4 - 11 1 2 - - - - - „ 27 6 14 1 - - - - - - - 6 - 20 7 - - - - - - July 4 8 10 - - - - - - - - 5 - 5 2 7 - - - - - „ 11 7 8 - 1 - - 2 - - - 4 1 17 3 11 1 - - - - „ 18 17 7 - 1 - - - - - - 4 - 19 2 2 1 - - - - „ 25 11 9 - 1 - - - - - - 3 1 16 3 7 - - - - - Aug. 1 5 16 1 1 - - - - - - 2 1 18 6 4 - - - - 1 „ 8 8 13 - - - - - - - - 1 - 9 - 4 - - - - - „ 15 12 13 - - - - - - - - 8 - 16 2 2 - - - - - „ 22 11 8 - - - - - - - - 2 1 6 3 3 - - - - - „ 29 12 12 - - - - - - - - 3 2 5 2 3 - - - - - Sept 5 10 18 3 - - - - - - - 9 - 19 4 3 - - - - - „ 12 10 14 - - - - - - - - 5 - 14 3 3 - - - - - „ 19 12 7 1 - - - - - - - 4 2 12 2 5 - - - - - „ 26 14 5 - - - - - - - - 5 1 14 5 3 - - - - - Oct. 3 12 9 - - - - - - - 1 2 - 16 1 5 1 - - - - „ 10 11 13 - - - - - - - - 4 1 11 6 3 - - - - - „ 17 15 23 - - - - - - -- - 6 1 22 4 4 - - - - - „ 24 12 23 - - - - - - - - 6 - 13 2 12 - - - - - „ 31 13 18 - - - - - - - 1 8 - 9 1 5 - - - - - Nov. 7 16 12 1 - - - 1 - - 2 6 2 12 5 7 - - - - - „ 14 7 23 - - - - 1 - - 1 2 2 13 5 9 - - - - - „ 21 6 20 - - - - - - - 1 7 - 11 5 14 - - - - - „ 28 11 15 3 - - - - - - 1 3 - 12 2 20 - - - - - Dec. 5 6 12 - - - - - - - - 7 - 21 2 26 - - - - - „ 12 18 9 - - - - - - - - 9 1 14 5 22 - - - - - „ 19 9 15 - - - - - - - - - 1 13 2 14 - - - - - „ 26 9 12 -- 1 - - - - - - 2 - 6 1 11 - - - - - 1926 Jan. 2 15 18 - - - - - - - - 8 2 13 1 29 - - - - - Totals 478 766 13 10 - - 5 1 - 14 215 34 802 168 433 8 1 - - 2 73 Disinfection. The following return sets out the diseases for which disinfection took place during 1925: — Disease. North. South. Totals. Scarlet Fever 254 290 544 Diphtheria 356 547 903 Enteric Fever 7 8 15 Puerperal Fever 2 3 5 Phthisis 383 371 754 Encephalitis Lethargica 15 8 23 Cerebro-Spinal Fever 2 3 5 Erysipelas 6 5 11 Pneumonia and Measles 15 3 18 Cancer 19 12 31 Schools (Classrooms) 99 122 221 General Infection 43 30 73 Disinfestation 71 47 118 Total 2,721 Plaistow Hospital for Infectious Diseases. Annual Report for 1925 The total number of cases treated in the Hospital during 1925 showed an increase of 95 over the number treated in the previous year. The type of disease, however, was, on the average, milder. The total deaths during the year numbered 49 as compared with 80 in 1924. There was a slight increase in the number of admissions from Scarlet Fever and Diphtheria, but the type of disease in each case remained mild. Measles and Whooping Cough were not so prevalent or severe as in 1924; the deaths from these two diseases were 14 as compared with 34 in the previous year. The incidence of Typhoid Fever remained low. 74 The chief causes of death during the year are briefly summarised as follows:— Scarlet Fever caused 4 deaths Diphtheria 18 „ Typhoid Fever 1 „ Measles 6 „ Whooping Cough 8 ,, Pneumonia 2 „ Other diseases 10 ,, Total 49 The mortality rate, calculated on all the cases admitted, was 3.43 per cent. It may be of interest to review the prevalence of Scarlet Fever, Diphtheria and Typhoid Fever in the Borough as shown by the admissions to the Hospital since it was opened in 1896, and in Table 1. there is shown the annual admissions and deaths from these diseases during the past thirty years. The building of the Hospital was not completed until 1901 and Typhoid Fever cases were not admitted until that year. From this Table it will be seen that the prevalence of Typhoid Fever has greatly diminished in recent years and there are good reasons to hope that with the continued improvement in sanitation and the general standard of living this disease may shortly be stamped out. With regard to Scarlet Fever, marked fluctuations have occurred in its prevalence, but the general type of the disease has become milder as shown by the fall in the case mortality. Diphtheria, on the other hand, shows a steady increase in prevalence during recent years, and though the mortality has been low in the past three years it is impossible to say if this level can be maintained. Hospital treatment and isolation do not appear to have had any effect on the prevalence of either Scarlet Fever or Diphtheria though they may have contributed to the reduction in the mortality rate. There are good prospects, however, that these diseases may soon be prevented by the inoculation of susceptible individuals. This has already been carried out in the case of Diphtheria and appears to give excellent results. 75 TABLE I. Showing the annual admissions and deaths from Scarlet Fever, Diphtheria and. Typhoid Fever since the Hospital was opened in 1896. Year. Scarlet Fever. Diptheria. Typhoid Fever. Admissions. Deaths, Admissions. Deaths. Admissions. Deaths. 1896 170 8 114 23 .. .. 1897 188 6 163 21 .. .. 1898 206 4 249 42 .. .. 1899 192 2 309 49 .. .. 1900 177 4 269 36 .. .. 1901 203 16 310 66 47 4 1902 257 12 431 72 138 30 1903 370 10 334 48 84 17 1904 679 29 351 31 95 15 1905 747 18 438 53 62 14 1906 806 18 421 70 127 18 1907 667 29 422 82 68 12 1908 665 26 373 47 73 12 1909 990 32 337 35 34 5 1910 655 17 260 45 71 14 1911 491 13 295 52 79 15 1912 562 17 291 35 49 10 1913 782 13 333 24 42 6 1914 699 10 380 43 36 7 1915 575 8 403 60 40 11 1916 310 7 533 64 23 2 1917 304 8 559 67 27 4 1918 213 4 464 70 25 0 1919 373 3 601 57 15 2 1920 748 6 769 62 14 3 1921 1,119 10 560 32 7 0 1922 592 8 611 40 3 1 1923 412 7 671 23 10 0 1924 317 4 713 27 2 1 1925 412 4 719 18 5 1 On 1st January, 1925, 228 cases were resident in the Hospital, and 1,427 were admitted, making a total of 1,655 cases under treatment during the year. Of these 1,392 were discharged recovered, 49 died, and 214 remained under treatment at the end of the year. The following Table shows the admissions and deaths for each month of the year:— 76 TABLE II. 1925. Admissions. Deaths. Scarlet Fever. Diphtheria Typhoid Fever. Measles. Whooping Cough. Chickenpox. Erysipelas. Pneumonia Rubella. Other Diseases. Total. Scarlet Fever. Diphtheria. Typhoid Fever. Measles. Whooping Cough. ChickenPox. Erysipelas. Pneumonia Rubella. Other Diseases Total. January 30 74 .. .. 6 1 .. .. .. 8 119 1 3 .. .. .. .. .. .. 1 5 February 17 67 .. .. 5 2 1 2 .. 6 100 .. 1 .. .. 3 .. .. .. 1 5 March 33 90 .. .. 1 1 1 .. .. 13 139 .. 3 .. .. 2 .. .. .. 2 8 April 30 49 .. 2 4 .. .. .. .. 14 99 .. 2 .. .. 1 .. .. .. .. 3 May 30 55 .. 3 .. 2 .. 1 1 9 101 .. 1 .. 1 .. .. .. .. 1 3 June 24 54 1 8 .. 1 1 3 2 8 99 .. 2 .. .. 1 .. .. 1 .. .. 4 July 32 43 2 2 2 .. a 2 2 7 94 .. .. .. 1 .. .. .. 1 .. .. 2 August 40 48 .. 3 1 2 3 1 2 17 117 1 .. .. .. .. .. 1 .. .. 1 3 September 48 50 .. 4 2 1 2 1 1 14 123 .. .. .. .. 1 .. .. .. .. .. 1 October 42 67 .. 9 1 1 1 2 2 9 130 .. 2 .. 1 .. .. .. .. .. .. 4 November 24 51 1 23 .. .. 1 4 2 7 113 1 .. 1 1 .. .. .. .. .. .. 3 December 62 71 1 31 .. .. 3 8 1 17 193 .. 4 .. 2 .. .. .. .. .. 2 8 Totals 412 719 5 81 22 11 14 24 13 126 1,427 4 18 1 6 8 1 2 .. 9 49 77 scarlet Fever.-The total number of cases under treatment was 470, which is 61 more than in the previous year. Of these, 399 were discharged recovered, 4 died, and 67 remained under treatment at the end of the year. Of the 4 fatal cases, one suffered from shock due to burns; septic complications and broncho-pneumonia were contributory causes of death in the other 3 cases. The fatality rate was .97 per cent. of the admissions. In 52 cases the disease was complicated by the presence of other infections as follows :— Scarlet Fever with Diphtheria 10 cases ,, ,, ,, Measles 12 „ Whooping Cough 8 „ Mumps 9 „ ,, ,, ,, Chickenpox 13 „ Twenty-nine cases admitted as Scarlet Fever proved to be wrongly diagnosed and were found after admission to be suffering from the following diseases:— Measles, 8; Rubella, 7; Septic rash, 2; Urticaria, 2; Erythema, 3; Tonsillitis, 2; Jaundice, 2; Chickenpox, 1; Lobar Pneumonia, 2. Four cases admitted as Diphtheria were found to be suffering from Scarlet Fever. Complications:—Of the 399 cases discharged during the year 262 or 65.6 per cent. suffered from complications as follows: — Arthritis 13 cases or 3.2 per cent. Otorrhœa 30 ,, 7.5 ,, Nephritis 8 ,, 2.0 ,, Albuminuria 34 ,, 8.5 ,, Cardiac affections 4 „ 1.0 ,, Adenitis 122 ,, 30.5 ,, Rhinitis 51 „ 12.7 ,, The average duration of residence of all the cases was 46.88 days. 78 diphtheria.—The prevalence of Diphtheria in the Borough still remains high. The admissions in 1925 were 719, which is the largest number for the past five years. The majority of the cases, however, were of a mild type as shown by the total deaths which numbered 18, the lowest figure yet recorded. During the year a large number of swabs were examined for the practitioners in the Borough, but it is impossible to estimate to what extent, if at all, the practice of routine throat swabbing has affected the mortality from the disease. Unfortunately, bacteriological examination is not always reliable; a " negative swab " cannot be taken as a guarantee that any particular case is not suffering from Diphtheria. This fact was demonstrated by two of the fatal cases last year. In each of these the swab taken at the outset by the practitioner was found to be negative, but three to four days later the true nature of the condition became obvious from the clinical symptoms, but it was too late then for antitoxin to have much effect. Early treatment is of such vital importance in Diphtheria that the mortality would probably be much reduced of it became a wider practice among practitioners to give a small injection of antitoxin to all suspicious cases instead of waitng for the result of a swab. The total number of cases under treatment during the year was 880. Of these, 758 were discharged recovered, 18 died, and 104 remained under treatment at the end of the year. In 58 cases the larynx and trachea were involved. Of these, 33 recovered without operation. Tracheotomy was performed in 25 cases; 6 of these were patients recovering from Measles, and in 2 cases Whooping Cough was present as a complication. Seven deaths occurred among the tracheotomy cases, giving a fatality rate of 28 per cent, of those operated on. The fatality rate of all the cases admitted was 2.5 per cent. The average duration of illness of the fatal cases prior to admission was 4 days, and the average age was 3½ years. The amount of antitoxin given to the fatal cases averaged 62,000 units, while the average amount for all the cases was 15,000 units. The duration of residence of all the Diphtheria cases averaged 54.34 days. 79 One hundred and nine cases admitted as Diphtheria proved to be wrongly diagnosed and were found after admission to be suffering from the following complaints:— Tonsillitis, 76; Laryngitis, 6; Measles, 7; Vincent's Angina, 2; Broncho-Pneumonia, 5; Bronchitis, 3; Quinsy, 1; Mumps, 3; Adenitis, 1; Hydrocephalus, 1; Marasmus, 2; Chickenpox, 1; Retro-pharyngeal abscess, 1. Typhoid Fever.—11 cases, notified as Typhoid Fever, were admitted during the year. Of these, 5 proved to be suffering from the disease and one of them died. The other 6 cases were found after admission to be suffering from the following complaints: — Enteritis, 2; Pneumonia, 1; Cerebro-spinal Fever, 1; Ulcerative Colitis, 1; Pyelo-nephritis, 1. measles.—This disease became very prevalent in the Borough towards the end of the year. The total number of cases under treatment was 82. Of these 55 were discharged recovered, 6 died, and 21 remained under treatment at the end of the year. The fatality rate was 7.3 per cent. of the admissions. Eight cases admitted as Scarlet Fever and 7 as Diphtheria proved after admission to be suffering from Measles. These cases infected 9 patients in the Hospital. Six susceptible contacts were injected with 5 cubic centimetres of blood from convalescent measles patients and did not afterwards contract the disease. Of the 6 fatal cases 5 suffered from broncho-pneumonia, and one from ulcerative laryngitis. whooping Cough.—25 cases were under treatment during the year. Of these, 17 were discharged recovered, and 8 died. The fatal cases were children under 5 years and all of them suffered from complications as follows: Bronchopneumonia, 4; Tubercular Meningitis, 2; Miliary Tuberculosis, 1; Marasmus, 1. The fatality rate was 32 per cent. The disease was also present as a complication in 8 cases of Scarlet Fever and in 10 cases of Diphtheria. 80 chickenpox.—ll cases were admitted during the year. They were all of a mild type and there were no deaths. The disease was also present in combination with Scarlet Fever in 13 cases, with Diphtheria in 7 cases, and with Measles in 4 cases. Erysipelas.—15 cases were under treatment during the year. They were all moderately severe. Eight of the cases were adults, 3 male and five female; the others were children under 12 years: The face was the situation affected in 12 cases, the leg in 2 cases. One case proved fatal, a baby, aged 6 months, who had a very severe attack which involved the greater part of the body. rubella. —13 cases were under treatment, all of them mild. Seven cases had been notified as Scarlet Fever, and 3 as Measles. None proved fatal, and there were no complications. pneumonia.—24 cases were under treatment. Of these 17 were discharged recovered, 2 died, and 5 remained under treatment at the end of the year. The fatal cases were both children aged 3 years and 4 years respectively. other Diseases.- Under this group are classed diseases which are not regularly admitted and also cases in which the diagnosis was changed after admission. The following are the diseases included in the group: — Tonsillitis, 78; Laryngitis, 6; Bronchitis, 4; Enteritis, 5; Cerebro-spinal Meningitis, 2; Encephalitis Lethargica, 2; Abscess of scalp, 1 ; Bromide, rash, 1; Cervical Adenitis, 1; Congenital Hydrocephalus, 1 ; Endocarditis, 1 ; Erythema, 2; Marasmus, 2; Mosquito bites, 1; Mumps, 6; Nephritis, 1; Otitis Media, 1; Pneumococcal Meningitis, 1; Quinsy, 1; Retro-pharyngeal abscess, 1; Rheumatic fever, 1 ; Septic rash, 2; Tubercular Meningitis, 1; Thrush, 1; Ulcerative Colitis, 1; Vincent's Angina, 2. 81 Of these cases, 9 proved fatal as follows: — Cerebro-spinal Meningitis 2 cases Pneumococcal Meningitis 1 case Tubercular Meningitis 1 ,, Congenital Hydrocephalus 1 ,, Bronchitis 1 ,, Endocarditis 1 ,, Nephritis 1 ,, Ulcerative Colitis 1 ,, The Grange Convalescent Home.—The Convalescent Home was used during the year for patients convalescing from Diphtheria. The total number of cases transferred there from Plaistow Hospital was 474. Of these, 438 were discharged, and 36 remained in residence at the end of the year. Patients are kept at the Home for periods varying from 3 to 9 weeks; the average duration of residence during the year was 38.8 days. At the beginning of the year an additional acre of land adjacent to the kitchen garden was fenced in and planted with fruit trees. The gardens keep the Home supplied with vegetables and a good quantity of fruit. Over 5,000 eggs were supplied last year from the poultry kept at the Home. Staff Illness.—86 nurses and maids have been warded during the year with various complaints. Six nurses contracted Scarlet Fever, 6 had mild attacks of Diphtheria, and 3 contracted Mumps; all recovered. 19 nurses and maids have been warded with sore throat, 16 with influenza, and 36 others had been off duty for short periods through minor ailments; all recovered. Gate Cases.—The following is a record of cases suspected to be suffering from infectious disease which were brought direct to the Hospital for diagnosis: — Number sent by medical practitioners 229 ,, of these admitted 133 ,, brought by relatives 367 ,, of these admitted 124 ,, Trom other hospitals 25 ,, of these admitted 16 Total number of cases examined 621 ,, ,, these admitted 273 82 bacteriological Work.—In addition to the routine bacteriological work of the Hospital, the following examinations were made for medical practitioners:— Throat swabs for Diphtheria 1,585 Number which proved positive. 186 Nasal swabs for Diphtheria 85 Number which proved positive 37 Ear swabs for Diphtheria 14 Number which proved positive 7 Eye swabs (negative) 3 Widal Tests (negative) 2 Total number of examinations 1,689 Total number of positive swabs 230 DICK Test.—This test was performed during the year on 48 nurses and 62 convalescent diphtheria patients. Of the 48 nurses 11 gave positive reactions and 2 of these contracted Scarlet Fever later. Of the 62 patients, 27 gave positive reactions. SCHICK Test.—This test was performed on 38 Scarlet Fever convalescents, and of these 29 gave positive reactions and 9 were negative. It was also performed on 35 Diphtheria convalescents, and of these 30 were negative and 5 gave pseudo-negative reactions. Ambulances and Disinfecting Vans.—The number of journeys made by the two motor ambulances during the year was 1,144. The mileage run was 5,720. In the collection and delivery of infected clothing the two motor vans made 3,178 journeys, and mileage run was 10,230. All minor repairs to the motor vehicles are carried out by the Engineer's staff. D. MacIntyre, Medical Superintendent. 83 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 pulmonary and non-pulmonary forms, males and females:— AGE PERIODS. New Cases. Deaths. Pulmonary. Non-pulmonary Pulmonary. Non-pulmonary M. F. M. F. M. F. M. F. 0 2 1 3 2 3 1 4 1 1 15 14 26 17 8 6 13 14 5 50 39 18 9 3 2 4 7 10 37 36 16 18 4 3 2 3 15 57 51 6 11 17 21 2 2 20 51 54 2 6 25 22 1 .. 25 80 73 6 3 28 20 3 .. 35 62 52 3 8 47 19 2 2 45 47 31 4 2 35 13 2 1 55 23 13 .. 1 16 8 .. .. 65 and upwards 8 7 1 2 6 2 .. 2 Totals 432 371 85 79 192 117 33 32 Included in the above new cases are 19 pulmonary males, 10 pulmonary females, 9 non-pulmonary males, and 4 nonpulmonary females, which were not notified but were discovered from the returns of the Registrars of Births and Deaths, etc., showing that 11.2 per cent. of the deaths registered as due to Tuberculosis had not been notified during life. 1 he total number of cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year was 967, of which 803 were pulmonary cases. The deaths due to this disease numbered 374, giving a death rate of 1.18 per 1,000. The death rate from respiratory Phthisis being 0.97 and from other forms 0.21 per 1,000. 84 Table showing death rate from Tuberculosis per 1,000 deaths during last five years:— Pulmonary. Non-Pulmonary. 1921 1.01 0.26 1922 0.94 0.23 1923 0.95 0.22 1924 0.97 0.22 1925 0.97 0.21 The Reports of the Tuberculosis Officer and of the Medical Superintendent of Dagenham Sanatorium will be found on pages 84 to 94. Tuberculosis Dispensary—Annual Report of Tuberculosis Officer. (1) Co-operation with General and Special Hospitals, etc General and Special Hospitals. These Hospitals usually communicate with the Dispensary whenever they have cases of Tuberculosis requiring treatment. Appointments are made for such cases and they are seen without delay. Frequently, the cases are sent by ambulance to the Dispensary. These remarks apply chiefly to the London Hospital, Queen Mary's Hospital, City of London Hospital and Brompton Hospital. Cases in which an X-ray examination is desired are sent either to the London Hospital or Queen Mary's Hospital. Payment has been made for reports in one or two cases otherwise this is done gratuitously. School Clinics. Many cases are referred by the School Medical Officer. The result of examination and other information are communicated to the School Medical Officer. Contacts examined at the Dispensary, not tuberculous, are referred to the School Medical Officer as possible cases for Open Air School. 85 (2) Co-operation with Medical Practitioners and co ordination of work. Doubtful Cases. Cases are daily referred, usually by letter, to the Tuberculosis Officer for opinion. The findings at the Dispensary are communicated to the Practitioner at the earliest possible moment by letter. No formal letter has yet been adopted for the purpose. Form G.P. 35 is used in some cases. Notified Cases. Form G.P. 17 (revised) is used in a certain number of cases. The Practitioner is informed of the results of examination and of the treatment recommended in each case. The Practitioner concerned is notified of the admission of the case to Institution and also of the death of his patients in Institution. After discharge from Sanatorium, the patient is examined at the Dispensary or at home, if necessary, and the Practitioner is then informed of the treatment recommended, capacity for work, and other details of interest noted during the period of Residential Treatment. Practitioners furnish quarterly, or when requested, the domiciliary progress reports on cases under their care. The failure of a patient to attend at his Doctor's Surgery is a frequent cause of delay in completing such forms. (3) The arrangements for following up patients in cases in which the diagnosis is doubtful. The procedure is as follows:— After the first examination a card is given to the patient with the date of the next attendance. When a patient fails to attend, after the elapse of a week a letter is sent making another appointment. If the patient still fails to attend, the practitioner concerned is informed of the fact. F 86 (4) The arrangements for securing the examination and systematic supervision of home contacts. Visiting Nurses make arrangements for examination of contacts. Supervision of contacts is carried out at the Dispensary in special cases. In other cases, at their homes by Visiting Nurses. (5) Information as to special methods of diagnosis and treatment in use, and the number of persons to whom these special methods have been applied. Diagnosis. X-ray examinations have been required in a certain number of cases. Treatment. Nothing special in use. (6) The results of local experience as to the relative value of each form of treatment. My observations have, so far, been limited to a few months. My experience, so far, is not adequate to enable me to express an opinion on the relative value of the various forms of treatment. (7) The nature and extent of Dental Treatment provided, etc. Extractions and fillings required by patients while undergoing Sanatorium Treatment have been paid for by the Council. Fillings and Extractions—11. (8) Arrangements for the provision of Nursing. There are none. Extra Nourishments. A Fund is provided to supply Extra Nourishments to patients at home. Grants are made by the Tuberculosis 87 Officer after consideration of the financial and other circumstances of the case. There is constant supervision of the cases thus supplied to ensure that patients carry out general instructions re precautions, medical treatment, etc., to ascertain that they are really in need of and require the grant. (9) Treatment of Non-Pulmonary Tuberculosis. Tuberculosis of Skin. These cases are treated at the London Hospital as outpatients. In the event of Finsen or Artificial Sunlight being recommended, payment is made. Tuberculosis of Bones and Joints. adults.—There are no special institutions. Two or three cases have been sent to the Royal Sea-Bathing Hospital. Others are treated at the various London and Local Voluntary Hospitals. Children.—-These are sent to the Alexandra Hospital, Swanley. The authorities have arranged to let us have the use of ten beds. Provision of Surgical Apparatus. Surgical Apparatus have been provided in certain cases, recommended by the Surgeon-in-Charge, after examination of the case and careful consideration of all the circumstances by the Tuberculosis Officer. (10) Arrangements for Care and After-Care, etc. On return from Residential Treatment, the patient is examined at the Dispensary, if able to attend. In the case of insured persons, domiciliary treatment is usually recommended. The Panel Practitioner is informed of this fact and of other essential details of the case. Extra Nourishment is granted when the circumstances require it. The Tuberculosis Nurse visits periodically and reports to the Tuberculosis Officer. Form G.P. 36 is received periodically. 88 In this way the Tuberculosis Officer is informed of the progress of the case and of any changing circumstances, financial or otherwise. Whenever possible, the patient is advised to return to his or her former occupation. In the case of the non-insured, when fit, the patient attends at the Dispensary, otherwise the patient is advised to consult a General Practitioner. (11) Local Arrangements for finding employment for Patients. There are none. (12) Supply and supervision of shelters at the homes of Patients. None have been supplied in recent years. (13) The Incidence of Tuberculosis—Occupational. No data. (14) Prevention of Tuberculosis. Special methods adopted. Isolation of an Advanced Case. Hospital treatment is advised wherever possible. When treatment at home is carried out, the importance of isolation is urged and impressed upon relatives by Visiting Nurses. Search for Contacts. Constant search is made by Visiting Nurses for cases suspected or suspicious. Open-Air School. Cases in which infection is almost certain but show no definite signs of active disease are drafted to the School Medical Department with a view to admission to an OpenAir School. This is a valuable Institution, not only that the child is given a healthy environment but is removed from a dangerous one, 89 (15) Special difficulties encountered. Overcrowding, due to the shortage of houses and poverty, is undoubtedly, a great difficulty. It renders isolation impossible and increases the risk of infection and lowers resistance to attack. Unemployment.—The presence of thousands of unemployed creates in the employed person a fear of losing his employment, and compels him to continue at work or to return to work when he should remain at home. The fact that so many able-bodied are out of work renders the task of a tuberculous workman in search of a job almost hopeless. Advanced cases are met with from time to time. I have noticed more often that these are uninsured persons working on their own account in some small business and who postpone medical treatment until the last possible moment. During the last five years important changes have taken place at the Dispensary. In 1921 the administration of Sanatorium Benefit ceased to be a function of the Insurance Committee and the Council became responsible for the provision of Institutional Treatment and the Tuberculosis Officer became responsible for the administration of the treatment of domiciliary cases. The staff of the Dispensary was increased by the addition of two for the extra clerical work. These two clerks were transferred from the staff of the Insurance Committee. In 1922, owing to the increase in the number of cases, the premises were extended by addition of consulting room with waiting and dressing rooms. An assistant, Dr. Kilgour, was appointed. In 1925 the accommodation at the Dagenham Sanatorium was increased by the opening of new wards holding 24 beds. The administration of Institutional Treatment for children, formerly carried out by the Medical Officer of Health, was taken over by the Dispensary. In February, 1925, the present Tuberculosis Officer was appointed and took up his duties three months later. P. A. GALPIN, Tuberculosis Officer. 90 Return showing the work of the dispensary during the year 1925 Diagnosis. Pulmonary. Non-pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M F. M. f. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 212 174 39 40 14 26 52 34 226 200 91 74 (b) Doubtfully tuberculous – – – – – – – – 49 42 40 35 (c) Non-tuberculous – – – – – – – – 103 83 66 55 b.—Contacts examined during the year :— (a) Definitely tuberculous — 14 9 8 — 2 3 2 — 16 12 10 (b) Doubtfully tuberculous — — — — — — — — 2 21 38 54 (c) Non-tuberculous – – – – – – – – 74 190 184 247 These figures refer to persons examined for the first time during the year 1925. C.—Cases written off the Dispensary Register as (a) Cured — — 1 — — — — — — — 1 — (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 175 268 241 298 D. —Number of prsons of pensary Register on December 31st:- (a) Diagnosis completed 165 176 67 67 12 26 55 86 177 202 122 103 (b) Diagnosis not completed — — — — — — — — 40 53 63 70 Thisfigure has been obtained from the Nurse's lists. 1. Number of persons on Dispensary Register on January 1st 2.919 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 11 2. Number of patients transferred from other areas and of "lost sight of" cases returned— "1925" cases only 6 10 Number of consultations with medical practitioners :— 185 (a) At Homes of Applicants Not recorded (b) Otherwise 3. Number of patients transferred to other areas and cases "lost Right of"—"1925 " cases only 30 11. Number of other visits by Tuberculosis Officers to Homes 4. Died during the year 190 12. Number of visits by Nurses to Homes for Dispensary purposes 4,121 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 139 13. Number of (a) Specimens of sputum, etc., examined 574 (b) X-ray examinations made in connection with Dispensary work. 4 6. Number of attendances at the Dispensary (including Contacts) 13,024 14. Number of Insured persons on Dispensary Register on the 31st December—"1925" cases only 602 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision Nil. 15. Number of Insured Persons under Domiciliary Treatment 011 the 31st December 310 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for 1,287 Not recorded. 16. Number of reports received during the year in respect of Insured Persons:- (a) "Light" treatment (a) From G.P. 17 1 (b) Other special forms of treatment (b) Form G.P. 36. 786 91 92 Dagenham Sanatorium. Annual Report for the Year 1925 At the end of 1924 the number of patients remaining under treatment were:— Males 63 Females34—97 The total admissions during 1925 were:— Males 189 Females 123—312 The number of deaths were:— Males 37 Females 14—51 Discharges during the year totalled:— Males 139 Females 96—235 Leaving under treatment on 31st December, 1925:— Males 76 Females 47—123* * Includes 23 non-insured persons. The classes of cases discharged and the results were as follows:— Stage I. Stage II. Stage III. Males 54 36 49 Females 57 23 16 Quiescent. Improved. Unimproved, Stationery or Worse. Males 51 69 19 Females 34 48 14 The average gain in weight was 8 lbs. 93 lusted persons admitted during the year totalled 239, the remaining 73 being non-insured. 76 ex-service men were admitted to the Sanatorium during the same period. The Death Rate (calculated on admissions) was 16.34 per cent. In the case of Males the percentage was 19.57. In the case of Females the percentage was 11.38. Average duration of residence (both sexes) was 131.07 days. The average for Males was 132.3 days. The average for Females was 129.11 days. The Sanatorium closed down on the 1st April, 1920, owing to the outbreak of Smallpox, and re-opened in July, 1922. The number of beds available on re-opening were 68—40 beds for male Sanatorium cases, 14 beds for male Hospital cases and 14 beds for female cases. After re-opening, a further 12 beds were provided for Male Sanatorium cases in one of the temporary out-buildings, after the necessary alterations were carried out, bringing the total up to 80. Owing to the large number of cases awaiting admission, especially female cases, it was found necessary to provide further accommodation, and another temporary building was altered to take 24 female cases in 1923. Though this eased the situation considerably, it was necessary to provide still further beds, and the adjoining ward was opened in 1925 to accommodate 24 more female cases. The ward originally used in the permanent building for 14 female cases was then used for male Hospital cases, and enabled all the female cases to be placed in adjacent wards, which has proved highly satisfactory from every point of view. The extra accommodation provided has made it possible to have cases admitted, if not at once, shortly after they are recommended for treatment, and so enable cases to have early treatment, which is of paramount importance. Recent statistics show that the number of advanced cases coming under treatment are lower than formerly owing to this extra 94 tion. A considerable number of advanced cases will, however, always have to be admitted as, for various reasons, they do not reach the Dispensary until the disease is well advanced. The following is the present accommodation available:— Male Sanatorium Beds 52 Male Hospital Beds 28 Female Sanatorium Beds 24 Female Hospital Beds 24 Total 128 A most disappointing factor is the number of cases that take their discharge annually before receiving the maximum benefit, mostly due to financial and other domestic affairs. Several new forms of treatment, combined with Sanatorium, have been tried in recent years in Pulmonary cases, the results so far cannot yet be considered encouraging, except in the cases of artificial Pneumo-thorax, which in a limited number of cases has given satisfactory results. The question of adopting this form of treatment in the Sanatorium in the future is one for serious consideration. During the year a number of concert parties visited the Sanatorium, and the concerts were much appreciated by the patients. Whist Drives and billiard handicaps were also arranged. The wireless installation has been brought up to date, and headphones placed at the head of all the Hospital beds. The result has been most satisfactory and given great pleasure to the bed patients. G. M. MAYBERRY, Medical Superintendent. 95 Venereal Diseases. Under the Public Health (Venereal Diseases) Regulations, 1916, West Ham is included in the Joint Scheme approved for the Greater London Area, the participating authorities being the London County Council, the Counties of Middlesex, Essex, Hertford, Buckingham, Surrey and Kent, and the County Boroughs of West Ham, East Ham and Croydon. Under the Scheme free treatment can be obtained by anyone (who has acquired Venereal disease) at any of the 28 Hospitals approved under the joint agreements. There are also seven Hostels, assisted by financial grants, where women suffering from either of these diseases can be accommodated, with a view to facilitating continued treatment. Provision is made for enabling Medical Practitioners to obtain laboratory reports on suspected material or specimens, and for the free supply of Salvarsan substitutes to practitioners who have obtained the necessary qualification to be placed on the approved list. In addition to paying its proportionate share of the cost of carrying out the Scheme, approximately one-twenty-fifth of the total expenses incurred, the Council makes a grant of £100 per annum to the National Council for Combating Venereal Diseases to further propaganda work throughout the whole area. In this connection several lectures were delivered at various centres by Lecturers from the British Social Hygiene Council Incorporated. Posters and enamel plaques pointing out the dangers of Venereal Diseases, urging immediate treatment and giving a list of Hospitals where treatment may be obtained free of cost, are exhibited in many parts of the Borough and in all public sanitary conveniences. All local Medical Practitioners are fully conversant with the facilities for diagnosis and treatment of Venereal Disease, and have a printed circular setting out all relevant details in connection with the Scheme. There are six practitioners who are qualified to receive supplies of arseno-benzol compounds. The attached tables show the use made of the various centres by patients and practitioners. The following tables show the summary of work done under the Scheme during the past five years, setting out for comparison the particulars relating solely to West Ham and those relating to the whole of the participating authorities. 96 Table of Hospitals treating Venereal Diseases under the L.C.C. Scheme. albert dock. charing cross. diseases of skin. e. (J. anderson. gt. ormond street. guy's. king's college. lock (male). lock (female). london. metropolitan. middlesex. miller general. royal free. royal london ophthalmic. royal northern. st. george's. st. john's, skin. st. john's, lewisham. st. mary's. st. paul's. st. thomas'. seamen's. south london for women. university. west london. westminster. s.a., mothers'. children's, waddon. 97 Summary of work done by Hospitals. West Ham Cases. Total Casks of Ten Authorities. New Patients:— 1921 1922 1923 1924 1925 1921 1922 1923 1934 1925 Syphilis 240 157 208 166 120 8,188 6,401 6,565 6,127 5,454 Soft Chancre 17 20 18 7 5 471 264 312 237 212 Gonorrhoea 313 310 281 241 198 10,709 10,035 10,762 10,632 10,550 Not Venereal 349 278 348 286 238 6,050 5,943 6,446 7,087 8,387 Total 919 765 855 700 561 25,418 22,643 24 085 24,083 24,603 Total attendances 9,294 9,280 9,744 9,971 10,039 496,209 514,857 539,373 569,021 632,667 No. of In-patient days 1,038 1,558 1,396 838 1,227 79,692 92 037 85,381 80,593 81,335 Salvarsan Subs. doses 1,334 1,007 1,179 1,240 921 74,730 55,202 50,852 48,020 48,237 Pathological Specimens Examined. For or at a Centre : Spirochaetes 50 39 17 12 4 1,598 1,046 729 850 1,268 Gonococci 784 762 727 725 910 27,857 32,539 27,607 38,828 57,160 Wasserman 667 640 729 690 495 30,482 30,996 30,129 30,002 30,426 Others 8 12 20 9 39 6,197 9,319 9,911 12,154 14,110 Total 1,509 1,453 1,493 1.436 1,448 66,134 73,900 68,376 76,834 102,954 For Practitioners: Spirochaetes 1 .. .. 1 .. 32 49 70 38 30 Gonococci 51 180 203 121 15 2,648 3,657 4,886 5,393 3,923 Wasserman 276 306 228 426 480 15,670 14,389 18.459 17,794 30,540 Others 2 .. 1 .. 2 122 347 625 1,008 1,650 Total 330 486 432 548 497 18,472 18,442 24 040 24 333 26,142 98 LONDON COUNTY COUNCIL. Venereal Diseases Summary of work done by the Hospitals during the year 1925. London. Middlesex. Essex. Surrey. Kent, Herts Bucks. East Ham. West Ham. Croydon. Total. Other Places. Grand Total. New Patients :— Syphilis 4,284 375 216 152 143 56 31 44 120 33 5,454 448 5,902 Soft Chancre 169 9 8 11 3 2 .. 5 5 .. 212 67 279 Gonorrhœa 8,625 677 336 294 203 82 34 86 198 35 10,550 771 11,321 Not Venereal 6,508 638 339 245 152 65 35 97 238 70 8,387 293 8,680 Total 19,566 1,699 899 702 501 205 100 232 561 138 24,603 1,579 26,182 Total attendances 539,353 33,633 15,143 15,144 7,933 3,167 1,303 14,314 10,039 2,648 632,677 13,454 646,131 No. of In-patient days 65,902 3,342 2,819 1,471 3,349 1,589 1,155 385 1,227 96 81,335 21,119 102,454 Salvarsan Subs. doses 38,149 3,575 1,738 1,521 1,010 471 215 318 921 319 48,237 2,459 50,696 Pathological Examinations. For or at Centres:— Spirochaetes 1.153 50 6 34 1 8 5 5 4 2 1 268 62 1.330 Gonococci 48,923 2,034 1.670 1,297 1,037 347 178 437 910 317 57,150 1,652 58,802 Wasserman 25,014 1,597 930 960 585 304 125 207 495 209 30,426 1,177 31,603 Others 11,918 572 237 801 236 90 71 32 39 114 14,110 219 14,329 Total 87,008 4,253 2,843 3,092 1,859 749 379 681 1,448 642 102,954 3,110 106,064 For Practitioners:— Spirochaetes 20 2 .. 8 .. .. .. .. .. .. 30 .. 30 Goncocci 2,386 251 140 453 35 6 4 30 15 602 3,922 5 3,927 Wasserman 15,636 2,011 955 571 101 49 100 172 480 465 20,540 170 20,710 Others 1,416 47 22 132 18 7 3 1 2 2 1,650 29 1,679 Total 19,458 2,311 1,117 l,164 154 62 107 203 497 1,069 26 142 2C4 26 346 99 Venereal Diseases. Summary of the work done at the London Clinics for all areas from 1917. Year. New Cases. Total Venereal Cases. Total Non-Venereal Cases. Total Attendances. In-patient days. Pathological Examinations for Syphilis Soft Chancre. Gonorrhœa. 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 3 579 766 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 5,241 4 869 2,423 424.850 164,152 31,620 70,836 79,005 24,797 1925 3,556 2,346 268 11 8,464 2,857 12,288 5,214 5,726 2,954 459 011 187,120 29,313 73,141 106,064 26,346 100 Venereal Diseases. Utilization of Facilities at Hostels, 1925. Particulars of the work done on behalf of the participating authorities, by the Hostels in the Scheme for the year ended 31st December, 1925. These institutions are as follows:— Royal Free, 22 Highbury Quadrant, N. Royal Free, 62, Regents Park Road, N.W. St. Thomas', 148 Lambeth Road, S.E Southwark Diocesan, 80 Stockwell Park Road, S.W. Salvation Army, 4 Clapton Common, E. Salvation Army, 17 Highbury Terrace, N. 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 in residence. Percentage (days). London County 161 13,704 59.7 Middlesex 24 2,536 11.0 Kent 23 2,229 9 7 Essex 25 1,767 7.7 Surrey 15 1,364 5.9 Herts 10 886 3 9 Bucks 3 278 1 2 East Ham 1 143 .6 West Ham 1 61 3 Croydon .. .. .. Totals 263 22,968 100 0 101 Maternity and Child Welfare. The activity of the Council in respect of the condition of the health of expectant and nursing Mothers and of children under 5 years of age, is carried out in conjunction with several voluntary and other organisations, the chief of which is the Plaistow Maternity Charity, whose nurses attend nearly 50 per cent. of the total births occurring in the Borough—either in the Maternity Hospital at Howards Road, or in the patients' own homes. This organisation is subsidized by the Council and there is a definite working arrangement between them and the Medical Officer of Health in order to prevent any overlapping of visiting between the Council's Health Visitors and the Plaistow Maternity Charity workers. There is at present only one Municipal Infant Welfare Centre, viz., at Silvertown, which is visited by Dr. Tivy on every other Friday, and by the Health Visitors twice weekly. Several Infant Welfare Clinics are functioning in different parts (see attached table) all of which are subsidized by the Council and work in close co-operation with the Medical Officer of Health and Health Visitors. I should like to tender to the Doctors and Staff of these various Societies my sincere thanks for the great help given by them to this branch of my Department, and to congratulate them on the good work they are doing. A Maternity block was opened in 1923 at the Queen Mary's Hospital for the East End in 1923. The Council retain 10 beds in this block—which is one of the most up-to-date in the whole country. Ten beds are also retained at the Plaistow Maternity Charity Hospital, which, though not so modern a building as that iust mentioned, is none the less every bit as modern as regards the treatment placed at the disposal of the patients. Children under five years of age are, by agreement, treated at St. Mary's Hospital, Plaistow (see attached list of cases admitted during 1925). Orthopaedic treatment was instituted in March, 1924, and is carried out at the Invalid Crippled Children's Society Hospital, Balaam Street. Up to the end of 1925, 18 cases under 5 years of age had been treated. The Forest Gate Sick Home (an Institution belonging to the West Ham Guardians) has a Maternity block where a large number of confinements take place, including those taking place in respect to unmarried mothers. G 102 Sunlight Clinic.—The Women's League of Service for Motherhood in July, 1925, started a Sunlight Clinic in their Institution at Welfare Road. This Clinic is subsidized by the Council. I append some extracts from the report issued concerning the Clinic:— "The patients for the Sunlight Clinic come "from the rickety, backward and debilitated "children of poor homes and poor parents." "The majority of the children have certainly "improved, their weights have gone up, there is "more colour in their cheeks, their eyes are brighter, "they smile and laugh more; they are more alert "and observant, their muscles are firmer and they "stand and walk more steadily. The parents "report that they sleep better and their appetite " is improved." As stated in the first section of this report, the Maternal mortality is 2.85, which is distinctly low, considering the conditions pertaining in this area. Every case of death during child-birth and every case of death in an infant is fully enquired into by a Health Visitor, and the circumstances reported to me. Recently, Dame Janet Campbell, Senior Medical Officer of the Ministry of Health, has begun an investigation into the causes of premature birth; the Council's staff are lending all possible assistance in this highly important matter. "Home Helps," is the name given to women who are employed by the Council to assist in the homes during the lying-in period of certain necessitous women. These "helps" are specially selected and approved by the Health Visitors as being suitable for the work. A list of such available women is kept at the Town Hall, anv person concerned being entitled to see this list as an aid to the selection of a suitable Home Help. The work of these women is closelv supervised hv the Health Visitor, and onlv those people from homes clean and free from infectious disease are allowed to come to the lying-in patient. The Health Visitor also visits the house several times during the stay of the Home Help in the house, in order to see that she performs her duties and also to give any advice needed. The duties of these women are briefly set out in the following form, a copv of which is handed to each one on her accenting duty. The object of the quick return of the intimation of the commencement of duties is in order that the Health Visitor 103 may at once get into touch with the case, for obviously the expectant mother sends first for her doctor, midwife, or home help, and it might be many days before the Health Visitor got to know that the birth had occurred. County Borough of West Ham. DUTIES OF HOME HELPS. 1. To act under the direct supervision of the Health Visitor. 2. To be at hand at the time of labour and confinement: to see that the patient's room is clean and everything in readiness for the arrival of the Doctor or Midwife. The Home Help is not responsible for the confinement itself, nor must she interfere in any way with the instructions of the Doctor or Midwife. 3. After the confinement, to remove all soiled linen from the patient's room, and to care for her generally, especially as regards.cleanliness and food. 4. To see that the infant is properly fed and cared for, and, if possible, put to sleep in a separate cot. 5. To wash and dry the labour clothes as soon as possible and to keep the ordinary clothes washed in the usual way: to get meals and tidy the house as the patient would, were she not for the time laid aside. 6. To care for any other children there may be and see that school children attend punctually and are clean and tidy. 7. Should the Home Help in any way come into contact with a case of infectious disease, either in her own home, the home of the patient, or elsewhere, she must at once report the matter to the Medical Officer of Health. 8. On the day following the confinement, the Home Help must notify the Medical Officer of Health (Town Hall, Stratford, E.15), that she has commenced her duties. 9. Any conduct on the part of the Home Help which is contrary to the interests of the person she is helping, may lead to her name being removed from the list of Home Helps, and render her liable to forfeit the payment due to her. Town Hall, G. Garland Collins, West Ham. Medical Officer of Health. 104 To: The Medical Officer of Health, Town Hall, Stratford, E.15. In accordance with my agreement to act as Home Help to Mrs of I hereby inform you that I began my duties on the day of 192 Signed Home Help's Address Detach this slip and forward as directed above. During 1925 there were 1,592 applications for the grant of a Home Help. All these applications were investigated as to the eligibility of the applicant for the grant and a "Help" was granted to 1,367 of the applicants, 217 being ineligible and the application withdrawn in eight cases. I am firmly of opinion that this is an extremely useful measure, and saves many women from getting up too soon after their confinement, with often its consequent chronic ill-health due to "pelvic" trouble. A number of children under five years of age are sent to convalescent homes at the expense of the Council through the I.C.A.A. and I.C.C.S. These children are all examined by the Senior Assistant School Medical Officer who gives a certificate which states the length of convalescent treatment necessary. School Medical Service and Maternity and Child Welfare. In the early part of the year a very efficient linking-up of the Maternity and Child Welfare Scheme with the School Medical Service was effected. A weekly list of all children attending school for the first time is sent to the Medical Officer of Health by the Bye-Laws (School Attendance) Department of the Education Committee. From this list the Infant Welfare card of each child is. procured. This card, which contains full particulars of the infant's medical history from birth, is transferred to the School Medical Department 105 and then passed, with the School Inspection Medical Card, to the Head-Teacher of the particular school to which the child has been admitted and is produced at the next medical inspection of the scholars by the Assistant School Medical Officer. There were eight deaths during 1925 from Puerperal Fever amongst 7,017 births. Considering the condition of the homes in which many of the women are confined, I consider that this is a remarkably low percentage of deaths, and that it redounds to the credit as to the care taken by the General Practitioner and Midwife. The fact remains, though, that there should not be any deaths from Puerperal Fever which, under proper circumstances, is a preventable disease. Pemphigus Neonatorum.—During the year, a very considerable number of cases of Pemphigus Neonatorum has occurred: the first case was brought to my notice during August of last year, and up to January, 1926, 15 such cases have been notified, though there have occurred a number of other cases which were not notified, but which have come to my knowledge through the Health Visitors. Of the 15 notified cases, 6 were born in Queen Mary's Hospital, 7 were attended by the Plaistow Maternity Charity, and the remaining 2 occurred in the practice of a private midwife, in September last. (There has been no further case in the practice of this midwife since.) In the series of cases under review the complaint began between the 5th and 10th day after birth, with the occurrence of an inflamed lozengeshaped area, with no definite site: this inflamed area within the space of a few hours resolved itself into a raised blister containing clear watery serum. In some cases only one blister occurred, in others a large number occurred, but with no uniform distribution. Most of the infants were in fair general health during the attack and able to take their feeds well. In two of the 15 cases death occurred, the rash having spread rapidly over the whole body, becoming confluent and then postulate, death supervening within a few days. Every case has been, as far as practicable, carefully investigated, but in no instance has any definite source of infection been established. I am strongly of opinion that this complaint should be made compulsorily notifiable. No case occurred amongst either the mothers or any other adults. All the babies were breast fed. I am still further investigating this outbreak with a view to obtaining, if possible, some scientific data. 106 The South West Ham Health Society established an Ante-natal Clinic at their Infant Welfare Centre, Lees Hall, two years ago. The following is an extract from the last annual report of this Society:— "Our experience during these two years is that "the health of the mother is greatly improved "during pregnancy and that confinement is made "easier." This Society also holds Mother-craft classes. The percentage of West Ham mothers who breast-feed their babies is very big indeed and is steadily increasing (see table below). Table showing how babies are fed. Year. No of Infants Breast Fed. No. of Infants Breast Fed and Supplementary Feeds. Entirely Artificially Fed. 1923 3,173 1,047 510 1924 4,354 948 460 1925 4,754 855 597 Distribution of Milk to Nursing and Expectant Mothers and Children under 3 years of age. This branch of the Council's service has now been in operation for five years, and in order to give some idea of the steady growth of this Department during the period under review the following particulars will, I hope, prove interesting:— On the 1st January, 1920, as a result of a conference with Milk Retailers in the district an arrangement was agreed upon for the exchange of the Council's Vouchers for a supply of milk to expectant and nursing mothers, and children under five years, so that during the first part of the year liquid milk to the extent of 76,764 gallons was supplied to such cases as fell within the Council's scheme. During August of the same year the Council decided to substitute 107 full cream dried milk powder for liquid milk, and for the remainder of the year dried milk was supplied in one-pound packets. The milk powder is received in bulk in hermetically sealed cannisters and is packed into grease-proof bags enclosed in cartons on which printed directions are given, and only the estimated required quantity is packed daily m order to ensure, as far as possible, the milk being fresh when supplied to applicants from the following centres:— 84, West Ham Lane, Stratford. Public Hall, Barking Road, Canning Town. Nurses' Home, Howards Road, Plaistow. Barnwood Road, Silvertown. When the scheme was first put into operation the Town Hall, Stratford, was used as a distributing centre, but owing to the lack of accommodation at the Town Hall for dealing with the public the Maternity and Child Welfare Committee approached the Education Committee with a view to obtaining the unused portion of a hut situate at 84, 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. Since Dried Milk has been distributed under the Maternity and Child Welfare Scheme, viz., from August, 1920, the amount has steadily increased as the following table indicates:— Year 1920— 18,247 packets or 8 tons 3 cwts. „ 1921— 73,872 „ 33 tons. „ 1922—127,934 „ 57 tons 2 cwts. „ 1923—221,114 „ 98 tons 14 cwts. „ 1924—237,963 „ 106 tons 4½ cwts. „ 1925—222,410 „ 99 tons 5 cwts. 90lbs. Although the following extract of a circular "What every Nursing Mother ought to know," has appeared in previous 108 reports I think this brief summary of particulars covering five years would be incomplete without it. The circular is issued with a view to making the Council's Dried Milk scheme more generally known and there can be no doubt that the many advantages and beneficial results obtained by its use has been realised by hundreds of parents residing in the Borough. Circular 185 of the Ministry of Health, dated 31st March, 1921, has been followed and samples of Dried Milk from each consignment have been submitted to chemical analysis and bacteriological examination. Stock books, authorised vouchers, showing receipts and issues are kept and monthly stocktakings are carried out. 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) bring 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, 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. 109 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, 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. Maternity and Child Welfare. Midwives— Number practising in district: Trained, 118; Untrained, 1. Bona fide, 1904. Number of cases attended in 1925, 4581. Number of cases in which Medical Aid was summoned, 761. 110 Health Visitors— Visits paid during 1925: To Expectant Mothers. First visits, 1,792. Total visits, 2177. To Infants under 1 year. First Visits, 4,204. Total visits, 18,471. Children 1-5. Total visits, 21,987. Maternity Homes (Subsidised by Council)— (1) Queen Mary's Hospital. Number of beds, 10. (2) Plaistow Maternity Charity. Beds, 10. Number of cases received during 1925: (1) Queen Mary's Hospital, 375. (2) Plaistow Maternity Charity, 498. Number of weeks spent in Hospital by such cases: (1) Queen Mary's Hospital, 654. (2) Plaistow Maternity Charity, 996. Hospital for Children under 5 yrs. (Subsidised by Council)— (1) St. Mary's Hospital. Number of beds, 10. (2) Children's Hospital, Balaam Street. Number of beds, 10. Number of Children admitted to (1) St. Mary's Hospital, 308 (2) Children's Hospital. Balaam Street, 44. Number of weeks spent by Children in (1) St. Mary's Hospital, 710. (2) Children's Hospital, Balaam Street, 235 4/7. Number of Children under 5 years in Homes and Hospitals outside Borough, 23. Number of weeks spent in such Homes, 204. Welfare Road Day Nursery (Subsidised by Council)— Half-days, Nil. Whole days, 230. Average per day,30.56. 111 Centres and Clinics (Subsidised by Council except Silvertown Municipal Clinic)— Address. No. of Sessions held weekly. Day and time of meeting. Average per Session. Present arrangements for Medical Supervision. Expectant Mothers. Children. Chesterton House 4 Mon., Wed., Thurs., Fri., 1.30 p.m. 90 05 69 03 Dr. Kennedy. St. Luke's Square 2 Tuesdays & Fridays, 3 p.m. 70 90 141.17 „ Hogg. Martin Street 1 Thurs., 3.30 p.m. 28.61 48.75 „ Hogg. S.W.Ham Health Society 3 Tues., Wed. & Friday, 1.30 p.m. 15 01 65.79 „ Lorimer. Hawthorne Trinity Mission 2 Wed. & Thurs., 1.30p.m. 2.36 41 03 „ Margaret Alden. Women's League of Ser. (Welfare Road). 3 Mon., Wed. & Fri., 2 p.m. 5.96 34.20 „ Dorothea Brooks Silvertown Munpl. Centre 1 Wed., 2 p.m. - 15.15 „ Tivy. Given-Wilson Ins. 1 Mondays, 2 p.m. — 25.47 „ Eva Mortqn Number of West Ham Births. 1921. 1922. 1923. 1924. 1925. 8,242 7,959 7,803 7,202 7,017 Ophthalmia Neonatorum. Notified. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Treated. At Home. InHospital. 34 33 1 33 1 0 0 112 The following gives the number of cases of Ophthalmia Neonatorum notified in the previous four years:— 1921. 1922. 1923. 1924. 61 34 31 24 Year 1925. Midwives Act, 1902 and 1918. Midwives practising for Associations or privately. Number giving notice of intention to practise. Number of Births attended. Number of Records of sending for Medical Aid. Plaistow Maternity Charity 65 2,838 566 Essex County Nuising Association (Beechcroft Nurses) 29 115 9 Salvation Army Nurses 5 403 49 Tate Nurses' Institute 6 161 19 Queen Mary's Hospital (Extern.) 10 173 17 Private Practice: a. 1 47 4 b. 1 8 0 c. 1 302 23 d. 1 126 23 e. 1 180 30 f. 1 86 4 g. 1 109 13 Resident outside Borough but practising within: 1. 1 28 4 2. 1 0 0 3. 1 3 0 4. 1 0 0 5. 1 1 0 6. 1 1 0 118 4,581 761 113 Analysis of " Records of sending for Medical Aid," Year 1925:— Pregnancy— Abortion or Threatened Abortion 113 Ante-partum Hæm 30 Dangerous varicose veins 1 Albuminuria 5 Excessive sickness 2 Unsatisfactory condition 4 Labour— Plac. prœvia Pres. or prolapse of cord 2 Mal-presentation 27 Fits 3 Excessive haemorrhage 34 Retd. plac. or membranes 56 Prolonged labour 111 Ruptured perineum 156 Unsatisfactory condition 35 Erysipelas and sores on genitals 1 Lying-in— Fits — Unsatisfactory condition 35 Temp. raised 35 Breasts swollen 2 Secondary P.P. hæmorr — Swollen and painful veins 15 Child— Deformity 9 Dangerous feebleness 25 Inflam. or disch. from eyes 41 Skin eruptions 11 Unsatisfactory condition 71 Prematurity 35 Asphyxia 8 Fits 7 Total 779 List of Complaints of Children under 5 years of age treated at St. Mary's Hospital, and Children's Hospital (Ralaam St.):— St. Mary's Hospital. Abdominal Pain 1 Abscess of— Elbow 1 Empyema Scar 1 Groin 3 Leg 2 Neck 4 Acute Gastritis 1 Appendicitis 1 Axilliary Abscess 2 Bow Legs 1 Bronchial Pneumonia 10 Bronchitis 26 Bruised Face 1 Catarrh 1 Cellulitis 2 Ciliac Disease 1 Concussion 1 Congenital Heart 5 Conjunctivitis 2 Constipation 2 Convulsions 5 Corneal Ulcer 6 Cut Tendon, R. Hand 1 Dermoid Cyst 2 Discharging Eyes 1 Double Hip Disease 2 Empyema 3 Enteritis 55 Erbs. Paralysis 1 114 For observation Fractured Humerus Gland of Neck Hematuria of the New Born Harelip Henochs Purpura Hernia High Temperature Hydrocele Influenza Injury to— Palate Shoulder Impetigo Indigestion Intussusception Jaundice Lacerated Scrotum Laryngitis Lobar Pneumonia Marasmus Mastoid Measles Meningitis Neavus, R. Thigh Necrosis, Finger Nephritis Nystagmus Osteoclasis Osteomyelitis Otitis Media 1 Otorrhœa 1 1 Paralysis 1 1 Peritonitis 1 Periostitis 1 4 Persistent Screaming 1 1 „ Vomiting 1 1 Pleurisy 1 44 Pneumonia 11 1 Prolapse, Rectum 2 3 Pyloric Stenosis 1 1 Pyrexia 2 Quinsey 1 1 Rheumatism 2 1 Ricketts 1 1 Scald of— 1 Buttocks, etc. 4 7 Hand 1 1 Septic Forehead 1 1 „ Hand 1 1 „ Wound 1 1 Skin 1 14 Stomatitis 3 8 Strabismus 3 2 Sub-Ling. Abscess 1 2 Swelling over Fibula 1 1 Tenotomy 1 1 Tonsils and Adenoids 8 1 T.B. Hip 1 1 „ Meningitis 4 1 „ Peritonitis 1 1 Whooping Cough 2 2 Children's Hospital, Balaam Street. A.P.M. 1 Appendicitis 1 Bronchitis 2 Circumcision 1 C.T.E.V. 4 Dorsal Caries 1 D.V. 1 Fractured Skull 1 Malig. Endocarditis 1 Neavus 2 O.C.T 1 Otorrhœa 10 Ricketts 3 Spinal Caries 1 Tonsil and Adenoids 1 T.B. Hip 2 Peritonitis Vomiting 1 115 Deaths from the under-mentioned Diseases. 1921-1925 Inclusive, in Children, under 5 years Year. Measles. Bronchitis. Whooping Cough Epidemic Diarihœa. Prematurity. 1921 9 47 36 165 257 1922 109 86 171 48 184 1923 11 28 23 76 197 1924 108 37 82 76 170 1925 30 29 78 95 142 The above table is of interest, and is chiefly remarkable for the big fall in the number of deaths from Prematurity, though, as intimated earlier in this report, it is lamentable that so many deaths should still occur from this cause (see p. 11†). During the past five years the work of the Maternity and Child Welfare has been consolidated and co-ordinated with other Health Agencies to a remarkable degree. The combined toil of many workers on behalf of the mothers and babies is now beginning to bear fruit. The one-time resentment of the young mother to any sort of advice respecting her child has disappeared. Though hard things are still said in respect to the Health Visitors by some ill-informed persons, in most homes in this Borough they are welcome visitors, and daily at the Town Hall there are enquiries from people seeking their help. The need of more dental treatment is very essential. I am informed by my School Dentists that much of their time is spent in trying—often ineffectually—to remedy the ravages to the child's teeth caused by ill-attention before school age; further, much of the distress and ill-health caused by enlarged tonsils is attributable to non-attention to the teeth during infancy. A definite system for the supervision and treatment of infants' teeth is sadly needed, and also, though to a lesser degree, some scheme for the care of the mother's teeth. The Maternity and Child Welfare Committee have obtained the sanction of the Ministry of Health to appoint a new Lady doctor, and to establish a new Municipal Ante-natal and Infant Welfare Centre in West Ham Lane. In the very near future both these things will be accomplished, and a further important step taken towards safe-guarding the health of pregnant women, and of helping mothers to bring up into healthy and useful citizens those children whom they have gone through so much to bring into the world. 116 APPENDIX. Mental Deficiency Act, 1913. On the 31st December, 1925, the number of Mental Defectives on the Register numbered 223. Males 127, Females 96. Number actually in Institutions, 96. Males 58, Females 38. Number under supervision, 127. Males 69, Females 58. Thirty-four new cases were dealt with during 1925, as follows: Recommended Institutional Treatment, 16. Males 5, Females 11. Recommended supervision at home, 4 Males 1, Females 3. Recommended no action necessary, 14. Males 9, Females 5. Number awaiting Institutional treatment 31/12/25, 17. Males 5, Females 12. Number discharged during the year, 2. Males 2, Females 0. Number removed to other areas, 1. Males—, Females 1, 117 Number died during the year, 3. Males 2, Females 1. Number removed to other areas, 1. Males—, Females 1. Cases notified by the Local Education Authority under Sec. 2 (1) (b.) (v) during the year, 12. Males 4, Females 8. Nine cases were admitted to Institutions, of which number four were notified to the Local Authority prior to 1/1/25, and five notified during 1925, 9. Males 5, Females 4. During the year 20 Continuation Orders were received as follows:— For 5 years, 13. Males 7, Females 6. For 1 year, 7. Males 2, Females 5. Very great difficulty has been, and is still being experienced in obtaining suitable Institutions for Mental Defectives owing to lack of accommodation. The above lists do not include mentally defective children being dealt with under the Education Acts.