Some Phases of Nursery School Life, WHAM 12 County Borough of West Ham ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer 1933. including his Report as Administrative Officer under the Mental Deficiency Acts. F. GARLAND COLLINS, M.R.C.S. (Eng.). L.R.C.P. (Lond.), D.P.H. A CONTENTS. Page Preface 5-6 Members of the Council 7 Members of Staff 10-17 Statistics and Social Conditions of the Area 18-31 General Provision of Health Services 32-80 a. Hospitals 40-42 b. Maternity and Child Welfare 50-67 c. Reports by M.O.H. 67-74 d. Mental Deficiency 75-80 Sanitary Circumstances of the Area 80-90 Housing 91-95 Inspection and Supervision of Food 96-105 Infectious Diseases 106-122 Tuberculosis 123-130 Venereal Diseases 131-137 School Medical Officer's Report 139-198 4 Municipal Health Offices, Romford Road, West Ham, E.15. To the Mayor, Aldermen and Councillors of the County Borough of West Ham. Mr. Mayor, Aldermen and Councillors, I have the honour to present to you my Annual Report for the year 1933, which is set out in accordance with a circular from the Ministry of Health dated October '2nd, 1933. Your health services continue to extend, and now embrace within their ambit matters at one time unthought of in connection with public health. It is necessary to emphasize the fact that though the primary aim of the Department is to maintain health, adequate provision must be made for the treatment of illness. The vital statistics for the year are most satisfactory. The details are set out on page 19. The extremely low maternal death rate (,1.8 per 1,000) is particularly gratifying, and tends to show that if a big industrial area such as this can produce so low a rate, a similar rate should not be impracticable for the country as a whole. The infant mortality rate is also lower than that of the aggregate of the 118 Great Towns. I feel doubtful, however, whether this low infantile mortality rate can continue if the number of children born of needy and of improvident parents continues to preponderate. Great strides have been made in regard to housing and slum clearance, and this highly important phase of public health is still being rigorously carricd on. (See pages 91-95). An extensive outbreak of scarlet fever was epidemic during the year, and the numbers suffering from this disease were so great as to necessitate the acquisition of many extra beds at the London Fever Hospital. Your Fever Hospital was unable to cope with patients needing admission there, due to the fact that Harold Wood Hospital, with accommodation for one hundred and twenty scarlet fever cases, had been transferred in the early part of the year to the Public Assistance Committee to house chronic sick adults. The very difficult and, in this particular area, somewhat abstruse problem of providing sufficient and suitable accommodation for the sick is still claiming the attention of the appropriate Committees. A scheme for the erection of a hospital with five hundred beds is at present before the Ministry of Health for their consideration. Permission to extend the Mental Deficiency Colony at South Ockendon is awaiting the decision of the Board of Control. B 5 There is a constant interchange of patients where and when necessary between the various institutions and clinics of the Council, and the co-operation between the different sections is such that there is a real linking up of all the health services. The farms attached to the Mental Deficiency Colony and to the Sanatorium at Dagenham provide milk, eggs and other commodities not only for these institutions but also for the patients treated in the other institutions owned by the Council. A very considerable amount of health propaganda has been carried on throughout the year, especially with regard to measles and diphtheria. The advertisement frames previously used by the Empire Marketing Board have been acquired for the promulgation of health matters. Two additional part-time District Medical Officers were appointed as a temporary measure in December last. The Department has suffered a big loss by the retirement of my Chief Clerk, Mr. J. A. Cheatle, who had given over forty years of loyal and meritorious service to the Council. Mr. F. W. Bromley was promoted to fill the post vacated by Mr. Cheatle. I have to thank the members of the Council for their sustained interest in, and suggestions for, the advancement of the health of the populace, and also to put on record my appreciation of the invaluable help of my staff during the past year. Your obedient Servant, May, 1934. 6 List of Members of the Council. The Town Council of the County Borough of West Ham consists of 64 members, viz. : The Worshipful the Mayor (Alderman Herbert Joseph Rumsey, D.C.M., M.M.). The Deputy Mayor (Councillor A. J. Walker). Aldermen :— W. T. Bell; G. Croot; W. Devenay, J.P.; B. W. Gardner, J.P.; W. Godbold; J. H. Hollins, J.P.; J. T. Husband, J.P. ; J. J. Jones, J.P., M.P. ; Edith Kerrison, J.P.; E. J. Reed, J.P. ; W. J. Reed ; J. T. Scoulding, J.P. ; M. Streimer ; W. J. Thome, C.B.E., J.P., M.P. ; T. Wooder. Councillors :— H. D. Clark; T. E. Groves, J.P., M.P. ; P. Hearn; A. E. Cressvvell; E. W. Wordley, J.P. ; Mrs. E. Wybrew; J. Foster; O. O. Motsfield ; F. A. Warner; E. H. J. Adams; W. A. Gillman; F. E. Mansford ; S. Bulling, J.P. ; A. G. Gay, J.P. ; E. W. White, J.P. ; W. H. Luscombe ; W. C. Ridgwell, J.P. ; C. H. W. Ward, J.P. ; E. C. Cannon; D. H. A. Hanley, B.Sc. ; L. F. W. White, B.Sc. (Econ.j ; A. B. Macgregor , J. N. Osbourn ; A. G. Schirn ; G. R. Blaker; Mrs. Agnes Elizabeth Harnwell; C. St. Clair Collins; I). W. Hall; A. W. Wells; Mrs. E. C. Cook; A. E. Killip ; H. J. Manners; Mrs. A. A. Barnes; C. A. Bennett; G. J. Stokes; G. Dohertv, A. C. Gentry; D. H. Smith; S. M. Edwards; Mrs. F. Harris; Mrs. D. Parsons, J.P. ; Mrs. E. Bock; E. F. Bradley; Mrs. E. J. Gregory; J. Dohertv; Mrs. J. A. Hollins; Mrs. F. A. Wood. List of Committees. Dealing with Health Matters. His Worship the Mayor (Alderman Herbert Joseph Rumsey, D.C.M., M.M.) Ex-officio member of Committees. 7 Public Health Committee. Chairman : Councillor Clark. Aldermen : Husband, Edith Kerrison, E. J. Reed, Scoulding and Streimer. Councillors : Mrs. Barnes, Bradley, Collins, Gay, Mrs. Gregory, Hearn, Killip, S'chirn and Mrs. Wybrew. Maternity and Child Welfare Committee. Chairman : Councillor Hearn. Aldermen: Husband, Edith Kerrison, E. J. Reed, Scoulding and Streimer. Councillors: Mrs. Barnes, Bradley, Collins, Gay, Mrs. Gregory, Hearn, Killip, Schirn, Mrs. Wybrew and Clark. Mrs. E. Jones, Mrs. F. E. Quinn, Mrs. D. E. Samuels, Miss A. Davies, Miss N. G. Baily, and Dr. P. I. Watkin. Housing Committee. Chairman : Councillor Mrs. Parsons. The Deputy Mayor (Councillor A. J. Walker). Aldermen: Devenay and E. J. Reed. Councillors: Mrs. Bock, Bradley, Mrs. Cook, Gentry, Mrs. Harris, Macgregor, Schirn, Stokes, E. W. White, Mrs. Wood, and Wordley. Education Committee. Chairman : Councillor Blaker. The Mayor (Alderman Rumsey). The Deputy Mayor (Councillor Walker). Aldermen: Bell, Devenay, Gardner, Godbold, J. H. Hollins, Edith Kerrison, E. J. Reed, and W. J. Reed. Councillors: Bennett, Mrs. Bock, Bulling, Collins, G. Doherty, Gay, Mrs. Gregory, Mrs. Hollins, Luscombe, Mrs. Parsons, Ward, Warner and L. F. W. White. Mrs. E. V. Parker, Miss R. H. Cheetham, and Miss A. R. Harbott. The Revs. C. Carless, R. Rowntree Clifford and A. W. W. Wallace. Dr. R. J. McClean, H. Madden and F. G. Reynolds, Esquires. Special Schools and Welfare Sub-Committee. Chairman : Councillor Collins. Aldermen : Godbold, Edith Kerrison and E. J. Reed. Councillors: Bennett, Mrs. Bock, Bulling, Mrs. Gregory, Mrs. Hollins, Luscombc and Mrs. Parsons. Miss R. H. Cheetham. H. Madden, Esq. 8 The Hospitals Committee. Chairman : Alderman Croot The Deputy Mayor (Councillor Walker). Aldermen : Edith Kerrison and Streimer. Councillors : Adams, Mrs. Barnes, Mrs. Bock, Hall, Mrs. Harris, Mrs. Hollins, Killip, Mrs. Parsons, Ward, Mrs. Wood and Wordley. The Public Assistance Committee. Chairman : Councillor G. Doherty. Alderman Wooder. Councillors : Mrs. Barnes, Mrs. Bock, Bulling, Mrs. Cook, Mrs. Gregory, Mrs. Harris, Mrs. Hollins, Killip, Manners, Mansford, Mrs. Parsons, Ridgwell, and Mrs. Wybrew; together with Councillors Bradley, Edwards, Gay, Hanley, Mrs. Harnwell, Hearn, Osbourn, Wells, E. W. White and Mrs. Wood for facilitating the performance of the duties conferred or imposed on the Council by the Unemployment Insurance (National Economy) (No. 2) Order, 1931. The Committee tor the Care of the Mentally Detective. Chairman : The Mayor. The whole Council, Mrs. A. M. Bulling and Mrs. F. Cornelius. The Executive Committee for the Care of the Mentally Defective. Chairman : The Mayor. Aldermen: Bell, Croot, Devenay, Godbold, J. H. Hollins, Husband, Scoulding and Streimer. Councillors: Mrs. Bock, Mrs. Hollins, Mrs. Parsons, Ridgwell, Ward, Mrs. Wood and Wordley. Mrs. Bulling and Mrs. Cornelius. Institutions Management Sub-Committee. Chairman : Alderman Wooder. Plus Rota of Members of Public Assistance Committee. Children's and Margate Convalescent Home Sub-Committee. Chairman : Councillor Mrs. Bock. Plus Rota of members of Public Assistance Committee. 9 Staff of Medical Officer of Health's Department†. 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. T. W. Hill M.D., (Glasgow), D.P.H. (Cantab.) Deputy Medical Officer of Health. Dr. D. Maclntyre M.D. (Glasgow), D.P.H. Medical Superintendent Plaistow Fever Hospital Dr. G. M. Mayberry L.A.H. (Dublin), L.R.C.P. (Ireland) Medical Superintendent Dagenham Sanatorium 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 Tuberculosis Officer Dr. Helen Campbell M.B., Ch.B. (Edin.), D.P.H. Senior Assistant Medical Officer Maternity and Child Welfare Dr. Charlotte E. Forsyth M.B., Ch.B. Assistant Medical Officer Maternity and Child Welfare Dr. Muriel Frances Prout M.B., B.S., M.D. (Lond.) Part time Medical Officer Maternity and Child Welfare Dr. Dorothv L. M. Keats M.R.C.S. (Eng.), L.R.C.P (Lond.). D.P.H. Asistant Resident Medical Officer Dagenham Sanatoriu m Dr. G. McKinnon M.B., Ch.B. Resident Medical Officer Plaistow Fever Hospital Dr. R. B. Douglas M.B., Ch.B. Assistant Resident Medical Officer, Plaistow Fever Hospital; annual appointment Mr. O. R. M. Kelly F.R.C.S. (Eng.) Med. Supt., Whipps Cross Hospital Dr. D. G. Sharp M.R.C.S., L.R.C.P. Deputy Med. Supt. and First Assistant Whipps Cross Hospital 10 NAME QUALIFICATIONS OFFICES HELD (Wholetime appointments except where otherwise stated) Dr. W. E. Joseph M.R.C.S., L.R.C.P. Second Asst. Med. Officer Whipps Cross Hospital Dr. N. H. Skelton-Browne M.R.C.S., L.R.C.P. Asst. Med. Officer, Whipps Cross Hospital Dr. S. C. S. Cooke M.R.C.S., L.R.C.P. Do. Dr. Ian Mansfield L.M.S.S.A. Do. Dr. W. J. O'Donovan M.D. M.B. B.S. M.R.C.P. M.R.C.S., L.R.C.P. Part time Consultant Whipps Cross Hospital Mr. A. Gellatly F.R.C.S., M.B., Ch.B. Do. Mr. Alan Todd F.R.C.S. (Eng.), M.R.C.S. Do. Mr. Clifford Morson F.R.C.S., M.R.C.S. Do. Mr. Archer-Ryland F.R.C.S., M.R.C.S. Do. Dr. J. P. Martin F.R.C.P., M.D. Do. Dr. Lewis Savin M.R.C.S., L.R.C.P. Do. Dr. J. Barton L.M.S.S.A. Do. Dr. de Lacy Walker L.M.S.S.A. Do. Dr. J. S. Greig M.B., C.M. Medical Supt. Forest Gate Hospital and Central Home, Union Road Dr. H. R. England M.B., B.Ch. Deputy Medical Superintendent, Forest Gate Hospital. Dr. I. B. McCann M.R.C.S., L.R.C.P. Senior Resident Medical Officer, Central Home Dr. R. Leader M.R.C.S., L.R.C.P. Resident Medical Officer, Central Home Dr. J. S. Coleman M.B., B.S. (Lond.), M.R.C.S., L.R.C.P. Asst. Med. Officer, Forest Gate Hospital & Central Home Dr. T. L. Dolan L., L.M. 1918, R.C.P. Ireland; L., L.M. 1918 R.C.S. Ireland. District Med. Officer and Public Vaccinator Dr. C. E. Conran L.R.C.P., L.R.C.S., L.F. P.S. Do. Dr. P. G. S. Kennedy M.R.C.S., L.R.C.P. District Med. Officer (part time temporary) and Dr. J. F. Begley M.B., B.S. Public Vaccinator District Med. Officer (part Dr. E. T. Renbom M.R.C.S. (Eng.), L.R.C.P. (Lond.), M. R. C. P. (Lond.), M.B. (Lond.). time) Res. Med. Officer, Harold Wood Hospital (temporary) 11 NAME QUALIFICATIONS OFFICES HELD (Wholetime appointments except where otherwise stated) Dr. R. V. Brews, L., L.M., R.C.P. (Ireland) L., L.M., R.C.S. (Ireland) District Medical Officer (part time) Dr. J. J. McSharrv, L.R.C.P.I., L.R.C.S.I. Part time temporary District Med. Officer Dr. M. J. Murphy, M.B., B.Ch., B.A.O. Do. Dr. W. E. Passmore L.S.A. Lond.) L.M.S.S.A. (Lond.) Public Vaccinator Dr. A. S. Paterson M.B., Ch.B. Medical Officer (part time) Margate Convalescent Home Mr. H. H. King Vaccination Officer Mr. A. E. Parkes F.I.C., F.C.S. Public Analyst (part time Mr. H. E. Bywater M.R.C.V.S. Veterinary Officer Miss Evelyn Richardson L.D.S., R.C.S. Dental Surgeon Maternity and Child Welfare Miss R. Alefs General Nursing, C.M.B., Fever Nursing Certificate Health Visitor Miss C. H. Banks General Nursing, C.M.B., Queen's Nurse, Health Visitors' Cert., Royal San. Inst. 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., Health Visitor Miss B. de Rochfort San. Insprs. Cert. Royal San. Inst., Health Visitor's Cert. Royal San. Inst., C.M.B., Apothecary Hall Dispensing Cert. Do. Miss E. A. Edwards General Nursing, C.M.B., Health Visitors' Cert., Royal San. Inst. Do. Mrs. N. C. Gibbins General Nursing, C.M.B.. Health Visitor's and Fever Nursing Certificates Do. Miss M. Grierson General Nursing, C.M.B. Health Visitor. 12 NAME QUALIFICATIONS OFFICES HELD (Wholetime appointments except where otherwise stated) Miss F. B. E. Groub-Tong Genera] Nursing, C.M.B., Children's Nursing Health Visitor's Cert. Royal San. Inst., San. Inspector's Examn. Board Do. Miss R. Harrington General Nursing, C.M.B., Health Visitors' Cert., Royal San. Inst. Health Visitor Miss A. E. Lunn General Nursing, C.M.B. Do. Miss L. Martin General Nursing, C.M.B., Board of Education Diploma, Mat. and Child Welfare Cert. Do. Miss M. McKenzie General Nursing, C.M.B., Health Visitor's Cert. Royal San. Inst. Do. Miss E. Norrie General Nursing Cert. and Children's Cert., C.M.B., Board of Education Diploma, Liverpool University School of Hygiene Cert. 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 D. M. White General Nursing, C.M.B., Health Visitor's Certificate Royal San. Inst. Do. Miss H. Welham General Nursing, Fever Cert., C.M.B. Dental Nurse (left Council's Service, May, 1933) Miss F. M. Davies Gen. Nursing, R.M.P.A. Cert. Dental Nurse Mr. H. G. Clinch M.I.F.E.E. San. Inspr. Cert. R. San. Inst. Chief San. Inspr., Inspr. under Rag Flock Acts F.S.I.A. Meat and Food Inspr. R. San. Inst. Smoke Inspr. R. San. Inst. San. Inspr. Joint San. Insprs. Exam. Board, Exam, in advanced knowledge of practical and administrative duties of Inspr. 13 NAME QUALIFICATIONS OFFICES HELD (Wholetime appointments except where otherwise stated) Mr. B. G. Bannington M.S.I.A. San. Insprs. Cert. Royal San. Inst., Cert of London School of Economics (Lond. University) for Social Science and Administration; Honoursman and Gilchrist Medallist (Lond. University Extension) for Public Administration. Sanitary Inspector, Inspr. under Rag Flock Acts Mr. E. G. Simmons M.S.I.A. San. Insprs. Cert. Royal San. Inst. Sanitary Inspector, Inspr, under Rag Flock Acts Mr. John F. Mules M.S.I.A., F.F.A.S., A.M.I.S.E. San. Insprs. Cert., Meat and Food Inspr. Royal San. Inst. Sanitary Inspector Mr. B. J. Driscoll M.S.I.A. Cert. San. Inspectors' Examn. Board London Sanitary Inspector, Inspr. under Rag Flock Acts Mr. C. F. Riley San. Insprs. Cert., Meal and Food Inspr. Royal San. Inst. Sanitary Inspector. Mr. J. A. Dawson, M.S.I.A. San. Inspr. R.S.I., Meat and Food Inspr. R.S.I. Do. Mr. H. G. Avril, M.S.I.A., A.R.San.I. San. Inspr. Examn. Joint Board. Do. Mr. E. J. Cromwell, M.S.I.A. San. Inspr. Examn. Joint Board, Meat and Food Inspector Royal San. Inst. Sanitary Inspr., Inspr. under Rag Flock Acts Mr. H. Ault, M.S.I.A. San. Inspr., Royal San. Inst. Meat Inspr., Royal San. Inst. Smoke Inspr., Royal San. Inst. Meat Inspr., Liverpool Univ. School of Hygiene Port Sanitation Cert., Liverpool Univ. School of Hygiene Sanitary Inspector Mr. C. E. Jeffries San. Inspr. Examn. Joint Board, Meat and Food Inspector Royal San. Inst. Do. (temporary) 14 NAME QUALIFICATION'S OFFICES HELD (Wholetime appointments except where otherwise stated) Mr. R. Dicker, M.S.I.A. San. Inspr. Royal San. Inst. Meat and Food Inspr. Royal San Inst. Sanitary Inspector Mr. J. B. H. Jones, M.S.I.A., A.R.San.I. San. Inspr. Examn. Joint Board, Meat and Food Inspectors' Cert., Royal San. Inst. Do. Miss V. M. Busbv M.S. I. A. San. Insprs. Cert. Roval San. Inst., Royal San. Inst. and San. Insprs. Examn. Board Sanitary Inspector Miss B. M. Keogh San. Insprs. Cert. London Exam. Board, Health Visitor's Cert. Sanitary Inst. Sanitary Inspector Miss G. Briggs, M.S.I.A. San. Insprs. Examn Joint Board Sanitary Inspector Miss A. Maughan, M.S.I.A. San. Insprs. Cert. Royal San. Inst. Do. Mr. T. R. Harris M.S.I.A., A.R.San.I. San. Insprs. Cert., Meat and Food Insprs. Cert., Royal San. Inst. Sanitary Inspector & Meat Inspector San. Insprs. Cert., Meat and Food Insprs. Cert., San. Inspectors' Examn. Board, London San. Science Cert. 1st Class of the Battersea Polytechnic Diploma in Bacteriology of the Battersea Polytechnic. I Mr. E. F. Hughes M.S.I.A., A.R.San.I. Cert. San. Inspr. Royal San. Inst. Sanitary Inspector, Inspector under Food and Drugs Acts, and Official Sampler and Inspector under the Fertilisers and Feeding Stuffs Act, 1926 |Mr. E. J. Ferrier Inspr. under Shops Acts Miss C. Aitken General Nursing, Fever Nursing Cert. Supervising Nurse under Mental Deficiency Art (Died November, 1933) 15 Medical Officer of Health's Office Administrative Staff Mr. J. A. Cheatle Chief Clerk Superannuated Sept., 1933 ,, F. W. Bromley Chief Clerk ,, H. R. Cole Senior Clerk ,, F. H. Barker Clerk ,, J. Sabin do. A. Clarke do. Mr. D. Thompson Clerk ,, S. A. Lemmon do. Miss M. Sparrow do. Miss A. E. Durand Clerk ,, H. O. Williams do. ,, M. Doherty do. Mr. J. W. McCarthy Investigator TUBERCULOSIS DISPENSARY. Nurses. Mrs. E. Siggins, Sister-in-Charge. Miss E. J. Egerton Miss A. Williams Miss E. K. Pottinger Clerks. Mr. W. Pike Miss M. F. Bush Miss G. Williams PLAISTOW HOSPITAL. Mation. Miss I. Tulloeh Steward. Mr. W. Liddall Clerks. Mr. S. Strachan Mr. C. Poyser 74 Nursing Staff. 46 Domestic Staff. THE CHILDREN'S HOSPITAL, HAROLD WOOD. Matron. Miss L. M. Mackie 41 Nursing: Staff. Steward. Mr. W. Liddall 28 Domestic Staff. Used during the year by Public Assistance Committee. DAGENHAM SANATORIUM. Matron. Miss M. Duguid 27 Nursing Staff. Steward. Mr. H. Bromley 30 Domestic Staff. LANGDON HILL SANATORIUM. Matron. Miss F. M. Noble 10 Nursing Staff. Steward. Mr. H. Bromley 8 Domestic Staff. 16 WHIPPS CROSS HOSPITAL. Matron: Miss E. Downs Chief Steward: Mr. B. S. Lawrence. Assistant Steward: Mr. C. Samuel Clerks : Mr. R. F. Sizer. Mr. J. Lis. Mr. J. Jenkins. Mr. V. J. Stebbings. Mr. D. Jones. Mr. R. Adams. 200 Nursing Staff. 160 Domestic Staff. Medical Superintendent's Office. Clerks. Mr. H. R. Ramsey Mr. C. R. Sandell Miss B. M. Nicholson Forest House—see page 41. CENTRAL HOME. Matron : Mrs. M. E. Lambert. Master : Mr. S. P. Lambert. Clerks : Mr. H. Wiggins. (Superannuated Dec.. 1933) Asst. Master: Mr. R. L. Rutherford Mr. H. W. Latter. Mr. P. J. W. Martin Mr. H. W. Hagger. Mr. H. W. Quicke. Mr. E. C. Steggel. 215 Nursing Staff. 147 Domestic Staff. FOREST GATE HOSPITAL Matron : Mrs. E. M. Usherwood. Steward : Mr. E. J. Miles. Assistant Steward : Mr. A. J. Fillmore. Clerks : Mr. C. P. Chapman. Mr. J. W. Burr. Mr. A. W. Sawyer. Mr. J. Cassidv. 143 Nursing Staff. 67 Domestic Staff. MARGATE CONVALESCENT HOME. Matron : Miss G. B. Oddy. Clerk & Store Keeper : Mr. J. W. Rowe. 11 Nursing Staff. 15 Domestic Staff. D1SINFECTORS. Mr. B. Lyons. ,, H. T. Murty. Mr. C. Cornish. „ W. Hubbard. MORTUARY KEEPERS. Mr. E. Heisterman. Mr. A. Kelly For Staff of School Medical Officer see page 143. † A detailed list of the Staff is included in this Report by the request of the Minister of Health in Circular No. 1346. Statistics and Social Conditions of the Area. HE COUNTY BOROUGH OF WEST HAM is classified the tenth largest of the 118 Great Towns of England and Wales. Situated geographically within the County of Essex, it comprises an area of seven and a half square miles. In elevation it is almost flat, varying from less than 5ft. to 45ft. above ordnance datum. The Charter of Incorporation was granted to West Ham in 1886. It is bounded on the West by the Administrative County of London, on the East by the County Borough of East Ham, on the North by the Borough of Leyton, and on the South by the River Thames. The River Lee forms a natural boundary between West Ham and the Metropolis. There are over 128 miles of dedicated roads in the Borough, and 123 acres of waterways. In the Silvertown district of the Borough the New Dock Road, a wonderful feat of engineering, which is now nearing completion, has absolutely transformed this section of West Ham, and facilitated the approaches to the Victoria Dock. Along a comparatively short line, some 600 houses have been pulled down to make way for the new viaduct. Families displaced by this necessity have been rehoused in new dwellings adjoining Prince Regent Lane. The first section of the High Street, Stratford, Improvement Scheme, the Bridge which spans the new river at the City Mills, was officially opened in November of 1933. The widening of this highway it is hoped will greatly ease the passage of traffic in and out of London. In the carrying out of this work ninety per cent. of the labour engaged on the construction of the bridge was comprised of West Ham men. The County Borough is an important industrial centre. In addition to a number of factories in the North, there are in the South of the Borough some of the largest and most important factories in or near London. These factories manufacture various articles such as rubber, soap, sugar, and glass. By rail the Borough is only 5 miles from the City of London, hence a large number of the populace work in London and district. The whole of the Royal Victoria Dock, and part of the Royal Albert, and the new King George the Fifth Docks, as well as the locomotive and other works of the London and North Eastern Railway Company, and the carriage works of the Midland 18 way Company (London, Tilbury, and Southend section) are within the district. There are extensive docks, consequently one finds a large number of casual labourers. West Ham is a densely populated town, having 61 persons to the acre. The growth of the district can be observed by the fact that in 1762 the number of houses in the Borough was 700, whereas in 1931 the number was 49,280. Overcrowding is still very prevalent, and this position is somewhat aggravated bv reason of the fact that large building sites are no. longer available. Summary of General Statistics. Area (acres) 4,706. Population— Census 1931, 294,278. Estimated population to the middle of 1933, 282,900. Number of inhabited houses (1931), 49,280. Number of families or separate occupiers (1931), 72,994. Average Rateable Value— General Rate, £1,400,840. Sum represented by a Penny Rate—General District Rate, £5,837, Vital Statistics. Live Births Total Male Female Birth Rate 15.5. Legitimate 4289 2178 2,111 Illegitimate 117 65 52 Still Births, 165 . Rate per 1,000 total births 37. Deaths, 3337 Death Rate, 11.7 Deaths from diseases and accidents of pregnancy and child birth from sepsis 5 from other causes 3 = Maternity Mortality Rate 1.8 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 47 Deaths from Diarrhoea, etc. (under 2 years of age) 44 Death Rate of Infants under one year of age— All infants per 1,000 live births 64.4 Legitimate infants per 1,000 legitimate births 63.8 Illegitimate infants per 1000 illegitimate births 85.4 In the case of the Great Towns the Birth Rate was 14.4, the Death Rate 12.2, and the Infant Mortality Rate 67.0, whereas the Maternal Mortality Rate for England and Wales was 4.42. 19 Vital Statistics of the Wards of the Borough, 1933. Wards. Births Birth Bate Deaths Death Rate Infant Deaths Infant Mortality per 1,000 births Natural increase Births over Deaths Estimated resident population middle of 1933 New Town 270 16-07 216 12.86 18 66 54 16,795 Forest Gate 259 14.38 196 10.88 9 34 63 18,006 Hi gh Street 224 13.27 208 12.32 16 71 16 16,880 Broadway 208 15.05 186 13.45 14 67 22 13,820 Park 229 15.38 220 14.78 8 34 9 14,883 Upton 223 14.39 227 14.02 12 51 6 16,184 Plashet Road 261 18.03 176 12.64 15 59 75 13,921 West Ham 222 14.45 172 11.20 14 63 50 15,355 Plaistow 284 14.85 207 10.82 18 63 77 19,120 Bemersyde 160 12.50 158 12.34 6 37 2 12,794 Canning Town and Grange 429 16.37 244 9.31 26 60 185 26,200 Hudsons 316 16.03 240 12.17 18 56 76 19,705 Ordnance 280 15.15 209 11.31 27 96 71 18,479 Beckton Road 340 17.90 230 12.11 25 73 110 18,984 Tidal Basin 415 18.80 239 10.83 36 86 176 22,067 Custom House and Silvertown 286 14.51 209 10.60 22 76 77 19,707 County Borough 4,406 15.5 3,337 11.7 284 64.4 1,069 282,900 Births. The number of births registered in the Borough during the year was 5.740 (2,920 Males and 2,820 Females); but of this total 1,568 were children of non-residents, who came to be confined in one or other of the Maternity Hospitals, or were confined while visiting relatives or friends; while 234 West Ham women were confined outside the Borough. Suitable adjustment makes the net West Ham Births 4,406 (2,243 Males and 2,163 Females) ; 117 of these (65 Males and 52 Females) were illegitimate. Calculated on the Registrar General's estimate of the population of the Borough at the middle of 1933, viz. 282,900, the Rate for the year was 15.5, the lowest ever recorded for West Ham. The Birth Rate for the Great Towns was 14.4. Deaths. The number of deaths registered during the year was 1,987, but of these 202 occurred in persons not belonging to the Borough, while the deaths of 1,528 residents of West Ham occurred in various institutions and districts elsewhere, making the total net deaths attributable to the Borough number 3,337, of which 1,843 were Males and 1,494 Females. The allocation of these deaths to their different causes will be found later in this report, but the grand total from all causes gives an annual Death Rate of 11.7 per 1,000 of the estimated population. The Death Rate for the Great Towns was 12.2. BIRTH RATE. 23 Deaths in Public Institutions. The great use made of the facilities for Institutional treatment is shown by the subjoined table, viz. : Deaths in Council's Institutions. Under 1 year 1 year & upwards Whipps Cross Hospital 37 576 Central Home – 405 Harold Wood Hospital – 26 Dagenham Sanatorium – 66 West Ham Mental Hospital – 65 Plaistow Fever Hospital 13 92 Forest Gate Hospital 21 69 Deaths in other Institutions. Under 1 year 1 year & upwards Queen Mary's Hospital for the East End 45 152 St. Mary's Hospital, Plaistow 24 37 Plaistow Maternity Hospital 26 – Royal Albert Dock Hospital – 27 Children's Hospital, Balaam S'treet 13 2 Other places, e.g. Docks, etc. – 9 Residents dying in outside Institutions 60 293 239 1819 Non-residents dying in West Ham Institutions 51 151 188 1668 Net West Ham Deaths occurring in Institutions 1856 The above figures show that over 55.0 per cent. of the deaths occurring in West Ham took place in public institutions. 25 27 Causes of Death at Different Periods of Life in the County Borough of West Ham (Civilians only) during 1933. Causes of Death. Sex All Ages 0— 1— 2— 5— 15— 25– 35— 45— 55— 65— 75— ALL CAUSES M. 1843 164 30 33 57 94 97 120 197 371 358 322 F. 1494 120 30 51 48 76 76 85 132 203 301 372 1. Typhoid and Paratyphoid Fevers M. – – – – – – – – – – – – F. – – – – – – – – – – – – 2. Measles M – – – – – – – – – – – –– F. 1 – – – 1 – – – – – – – 3. Scarlet Fever M. 2 – 1 – – 1 – – – – – – F. 4 – – 1 1 – – 1 – – 1 – 4. Whooping Cough M. 21 10 6 4 1 – – – – – – – F. 26 10 7 9 – – – – – – – – 5. Diphtheria M. 28 2 1 9 16 – – – – – – – F. 26 – 3 11 11 – – – 1 – – – 6. Influenza M. 91 1 1 – 1 7 5 10 20 21 11 14 F. 56 1 – 2 1 1 2 3 8 7 8 23 7. Encephalitis Lethargica M. 3 – – – – – 2 – – 1 – – F. 6 – – – – – 2 1 – – 2 1 8. Cerebro-spinal Fever M. 6 2 2 1 1 – – – – – – – F. 4 – 1 1 – – 1 – 1 – – – 9. Tuberculosis of Respiratory System M. 175 1 – – 3 33 44 30 31 21 10 2 F. 107 1 – 1 3 38 25 11 16 9 – 3 10. Other Tuberculous Diseases M. 17 4 2 1 3 2 1 – 3 – 1 – F. 14 4 – 4 2 2 – 1 – 1 – – 11. Syphilis M. 5 1 – – – 1 – 1 – 2 – – F. – – – – – – – – – – – – 12. General Paralysis of the Insane, Tabes Dorsalis M. 12 – – – – – 1 – 6 4 1 – F. 3 – – – – – 1 – – 2 – – 13. Cancer, Malignant Disease M. 245 – – – 1 2 – 13 28 86 76 39 F. 161 – – – 1 – 5 13 23 43 42 34 14. Diabetes M. 14 – – – – – – – 1 3 8 2 F. 23 – – – – 1 – 1 1 9 7 4 15. Cerebral Haemorrhage, etc. M. 87 – – – – – – 1 5 21 29 31 F. 77 – – – – 2 – 3 6 12 24 30 16. Heart Disease M. 311 – – – 2 9 5 16 37 64 79 99 F. 347 1 – – 6 10 11 13 26 57 109 114 17. Aneurysm M. 12 – – – – – – – 2 5 5 – F. 5 – – – – – – – 1 1 1 2 18. Other Circulatory Diseases M. 48 – – – – – – 1 2 10 14 21 F. . 49 – – – – – 1 1 5 6 11 25 19. Bronchitis M. 98 6 – 1 – – 1 4 8 16 32 30 F. 68 3 – – – 1 2 1 2 4 20 35 20. Pneumonia (all forms) M. 129 18 11 13 1 4 7 9 16 25 16 9 F. 111 15 15 8 2 2 2 11 3 16 16 21 21. Other Respiratory Diseases M. 19 – – – – – 2 2 3 4 4 4 F. 23 – – – 1 – 1 1 3 4 4 9 22. Peptic Ulcer M. 29 – – – – 2 2 5 6 8 5 1 F. 6 – – – – – – – 1 2 2 1 23. Diarrhoea, etc. M. 33 26 3 – – 1 – – – – 2 1 F. 17 14 1 – – – – – 1 – – 1 24. Appendicitis M. 9 – – 1 – 1 1 1 3 2 – – F. 5 – – 2 – 1 – – 1 1 – – 25. Cirrhosis of Liver M. 4 – – – – – – 2 – 1 – 1 F. 2 – – – – – – – 1 – – 1 26. Other Diseases of Liver, etc. M. 3 – – – –— – – – 2 1 – – F. rr 7 – – – – – – – 1 2 3 1 27. Other Digestive Diseases M. 30 7 – 1 2 2 9 4 5 F. 39 7 – 3 2 4 1 7 5 7 3 28. Acute and Chronic Nephritis M. 52 – – – 1 2 2 2 7 9 19 10 F. 41 – – – 1 2 6 2 8 8 9 5 29. Puerperal Sepsis F. 5 – – – – 2 1 2 – – – – 30. Other Puerperal Causes F. 3 – – – – 1 1 1 – – – – 31. Congenital Debility, Premature Birth, Malformations, etc. M. 73 73 – – – – – – – – – – F. 57 55 – 1 – – – – 1 – – – 32. Senility M. 27 – – – – – – – – 1 4 22 F. 60 – – – – – – – – 4 16 40 33. Suicide M. 28 – – – – 3 6 1 4 9 i3 2 F. 7 – – – – – 2 3 1 – – 1 34. Other Violence M. 78 4 2 2 9 19 7 8 6 10 15 6 F. 23 1 1 1 – – 2 1 1 – 7 9 35. Other Defined Diseases M. 153 9 1 – 16 7 11 12 7 38 30 22 F. 111 8 2 7 16 9 10 15 13 10 12 9 36. Causes Ill-defined, or Unknown M. 1 – – – – – – – – – – 1 F. – – – – – – – – – – – – INFANTILE MORTALITY RATE. Chief Vital Statistics since 1887. Year. Population. Births. Birth Rate. Deaths. Death Rate. Infant Deaths. lntant Mortality Rate. 1887 174,523 6,865 39.1 Average for 10 yrs. 37.0 3,286 18.7 Average for 10yrs. 19.2 723 105 Average for 10 yrs. 147.8 1888 182,118 6,867 38.5 2,8???8 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 Average, for 10 yrs. 34.2 4,486 18 .3 1,535 175 Average for 10 yrs. 163.6 1898 250,145 8,750 34.9 4,594 18.3 Average for 10 yrs. 17.9 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 Average for 10 yrs. 30.1 4,412 15.7 1,078 123 Average for 10 yrs. 114.6 1908 283,121 9,214 32.5 4,364 15.4 Average for 10 yrs. 14.9 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 Average for 10 yrs. 24.8 4,203 15.4 Average for 10 yrs. 13.2 707 105 Average for 10 yrs. 79.8 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 1926 315,900 6,710 21.2 3,405 10.7 418 62 1927 315,400 5,991 18.9 Aver., 7 yrs. 17.9 3,481 11.0 Aver., 7 yrs. 11.3 404 67 Average for 7 yrs. 66.2 1928 306,900 5,913 19.2 3,340 10.8 380 64 1929 307,600 5,766 18.7 3,926 12.7 427 74 1930 296,900 5,606 18.2 3,263 10. 353 62 1931 296,700 5,266 17.7 3,384 11 .4 330 62 1932 289,300 4,980 17.2 3,313 11.4 358 71 1933 282,900 4,406 15.5 3,337 11.7 284 64 31 General Provision of Health Services. Co-ordination. Since the taking over by the Council of the health services provided under the old Board of Guardians, gradual changes have taken place, particularly with regard to the more efficient utilization of the hospital accommodation. Arrangements have been made whereby any suitable cases seen by the District Medical Officers may be drafted to a Maternity and Child Welfare Clinic, or to the Tuberculosis Dispensary. In the case of the former a post card as under is sent direct to the Medical Officer of Health, who then makes the necessary arrangements for their attendance. With regard to suspected cases of tuberculosis, or cases requiring treatment, the District Medical Officers send a card (specimen below) direct to the Tuberculosis Officer, who upon receipt of this, arranges for an appointment for examination. A similar arrangement is made whereby patients attending any of the Maternity and Child Welfare Clinics or Tuberculosis Dispensary may be drafted to see the District Medical Officers, when circumstances make it desirable, or are referred to the Public Assistance Officer. With regard to Foster Children, see page 60 of the Maternity and Child Welfare section of this report. On various occasions cases are sent to me by the Public Assistance Officer where mental defect is suggested. Arrangements are made for all these cases to be examined to discover whether or not they are suitable to be dealt with under the Mental Deficiency Acts. Some form of treatment is arranged in cases which can be dealt with under the above Acts. The Tuberculosis Officer visits the Whipps Cross Hospital at intervals and confers with the Medical Superintendent on various cases, and if necessary arranges their transfer to sanatorium or elsewhere. With regard to persons employed as Home Helps, a list of persons so employed is sent to the Public Assistance Officer, so do the names of all persons receiving extra nourishments under the tuberculosis scheme. This is done because a Central Register is kept of all people receiving money or other assistance from the Council to prevent overlapping in this direction. In the case of persons applying to be registered as Foster Mothers, the Public Assistance Officer is asked as to whether or not applicant is known to the Public Assistance Committee. 32 COUNTY BOROUGH OF WEST HAM. Medical Officer of Health's Department. Name Age Address I am of opinion that the above-named, who has to-day been examined by me, should attend the Maternity and Child Welfare Clinic at Date District Medical Officer. Date COUNTY BOROUCH OF WEST HAM. Medical Officer of Health's Department. Name Age Address The above-mentioned person has to-day been examined by me and I am of opinion that ...he is a suitable case for observation or treatment at the Tuberculosis Dispensary. Clinically i find Signed District Medical Officer. Date This card is for use only in cases of old or suspected Tuberculosis, definite cases must be notified to the Medical Officer of Health in the usual way, and will automatically be examined by the Tuberculosis Officer. 33 DIAGRAM ILLUSTRATING THE ACTIVITIES OF THE HEALTH SERVICES. 35 ' Psychological Clinic. The Clinic was started in June, 1932, and is held in the outpatient department of the Hospital for Invalid and Crippled Children in Balaam Street, Plaistow. There are two sessions weekly on Wednesdays and Saturdays from 11 a.m. to 12 noon, at which the Medical Superintendent of the Council's Mental Hospital, or one of his Assistant Medical Officers, attends. At first, as was to be expected, there were not many cases, but during the last year the numbers have increased as the Clinic has become better known. Early psychotic and psycho-neurotic cases are treated and also 4'difficult children." The Clinic is in touch with the Child Guidance Clinic and Whipps Cross Hospital, should their advice be required. The site is an ideal one, and the Clinic will be of great service in some cases before the admission to the Mental Hospital of Voluntary Cases, now that it has been decided to start receiving that type of patient. The Clinic has also been valuable for keeping in touch with discharged cases from the West Ham Mental Hospital. A letter has been sent by the Medical Officer of Health to all general practitioners, hospitals, voluntary societies, Assistant School Medical Officers, and District Medical Officers, drawing attention to the facilities for treatment of early cases of mental aberration. Laboratory Work. Bacteriological Work is carried out at the various Municipal Institutions. At Plaistow Fever Hospital, in addition to the routine bacteriological work of the Hospital, any medical practitioner may have a bacteriological report upon any case of suspected diphtheria, typhoid or cerebro-spinal fever. Queen Mary's Hospital, Stratford, carry out bacteriological examinations of samples of graded milk, ordinary milk, and various other articles. I he Tuberculosis Officer at the Tuberculosis Dispensary in Balaam Street examines all specimens of sputum submitted to him as suspected to contain the tubercle bacillus. Samples of water, milk, and food stuffs are analysed by a Public Analyst, who is a part-time Officer of the Council. He is also the Analyst under the Fertilisers and Feeding Stuffs Act, 1926. 37 AMBULANCE SERVICE. In connection with the Health Services of the Borough Ambulances are provided by the Council as follows Whipps Cross Hospital (Public Assistance Committee) Five Plaistow Hospital (for infectious cases only) Two Public Health Committee and Highways Committee Three There are three specially constructed motor vehicles in use for removing bedding, clothing, or other infected material to the Disinfecting Station at the Plaistow Fever Hospital. These vehicles arc stationed at the hospital. The Borough Ambulances, two in number, are used for the transference of non-infectious and accident cases to or from institutions. They made 2,179 journeys during the year. One thousand and seventy-seven persons were conveyed from one address to another within the Borough, and 1,102 persons from an address within the Borough to an institution outside, or vice versa. The Silvertown ambulance is available daily between the hours of 7 a.m. and 11 p.m. The other two vehicles are available night and day. This ambulance is used only for cases occurring at factories in the Silvertown district, and is partly maintained by certain factory owners. The number of journeys made during 1933 was 134. Facilities for obtaining the use of the ambulances through tram conductors and the police have been created, and notices are displayed in tramcars giving the necessary directions. Notices to the same effect are exhibited at all the Council's Conveniences, Fire Stations, Schools, and other public buildings. In November this year the Ministry of Health issued Circular 1356 with regard to delay in some instances of obtaining the use of the ambulance, on account of the non-existence of reciprocal arrangements. In this connection it is interesting to record that this Council has had reciprocal agreements with neighbouring authorities for a number of years. Thirty-nine journeys were made during the vear under these agreements. 38 Professional Nursing in the Home. Apart from the nurses attached to the District Medical Officers there is no municipal staff for professional nursing in the homes; there are, however, several voluntary Associations employing a large number of efficient nurses who carry out invaluable work in nursing necessitous cases. 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 Hospital, which serves all local areas. No arrangements are in force for the nursing of Infectious Diseases in the home. Cases requiring hospital treatment are removed to the Council's Isolation Hospitals. Maternity and Nursing Homes. There are three registered homes in the Borough. (See page 60. For Maternal Mortality (see pages 61-62). School Clinics† and Treatment Centres. School Clinics. Stratford Clinic, 84 West Ham Lane, E. Balaam Street Clinic, Plaistow, E. Rosetta Road Clinic, Custom House, E. S'wanscombe Street Clinic, Canning Town, E.16. 2 Dental Clinics 1 Minor Ailment Clinic 1 Ophthalmic Clinic l Minor Ailment Clinic 1 Dental Clinic 1 Minor Ailment Clinic 1 Dental Clinic 1 Minor Ailment Clinic 1 Dental Clinic Treatment Centres. Children's Hospital, Orthopaedic and Sunlight Clinics, Balaam Street, E.13. and Psychological Clinic 39 Tuberculosis Dispensary. Balaam Street, Plaistow. (See pages 124-125). Maternity and Child Welfare Clinics. See page 53, Maternity and Child Welfare Section, † See Ministry of Health Circular 1346. HOSPITALS. Infectious Diseases. (1) The Plaistow Fever Hospital contains 200 beds which were originally allocated for the reception of scarlet fever, diphtheria and enteric fever cases with isolation beds for mixed or staff cases. Other infectious cases are admitted, including severe Measles and Whooping Cough, Pneumonia, Tubercular Peritonitis and Encephalitis Lethargica. Cases of Puerperal Pyrexia and Puerperal Fever are also treated at this hospital. (2) The Children's Hospital, Harold Wood, until recently was used as a home for scarlet fever and diphtheria convalescents. It has accommodation for ,116 patients. During the year under review the Public Assistance Committee have used this institution for accommodating 160 chronic sick persons, men and women, from the grossly overcrowded Central Home. Smallpox. (3) Dagenham Smallpox Hospital is now used as a sanatorium for adult cases of Tuberculosis. It is situated in the County of Essex, and comprises a site of 6½ acres. The hospital is composed of permanent and temporary buildings sufficient to accommodate 300 patients. By arrangement with the London County Council, all cases of smallpox which occur are removed for treatment by that Authority in their institutions. Tuberculosis. □ agenham Sanatorium. (4) With the sanction of the Ministry of Health, Dagenham Smallpox Hospital is permitted to be used as a Temporary Sanatorium for adults with Pulmonary Tuberculosis. The total number of beds available for cases of tuberculosis at Dagenham is 128. Langdon Hills Sanatorium for Children. (5) This institution accommodates 40 children suffering from Pulmonary Tuberculosis, and is situated in one of the highest parts of Essex, overlooking the mouth of the Thames. 40 Cases suffering from Surgical Tuberculosis are treated at the Alexandra Hospital, Swanley, Kent; Sir William Treloar's Hospital, Alton; and at various London Voluntary Hospitals. Whipps Cross Hospital. (6) This hospital is situated within the Borough of Leyton, and is owned by the Council. Very severe overcrowding still prevails, and often the original accommodation for 741 cases is exceeded to the extent of some 300. In connection with the very acute shortage of hospital accommodation, a scheme is now on foot to provide additional accommodation for 500 hospital beds, and in addition a Nurses' Home for the requisite number of Nursing Staff. These buildings are to be erected on the Forest House site. Forest House. Forest House is in the same curtilage as Whipps Cross Hospital, with 396 beds for aged men and mental cases, also Forest House Cottages with 90 beds for aged married couples, but at present occupied by aged women. Forest Cate Hospital. (7) This institution is situated in the County Borough of West Ham, and is owned by the Council. The hospital has 774 beds to accommodate maternity patients, mental cases, and chronic sick. The Institution is approved by the Board of Control for 75 mental defectives, as under :— Adult Males 20 Adult Females 30 Males under 16 years 10 Females under 16 years 15 Central Home Institution. (8) This home is situated within the Borough of Leyton, and is owned by the Council. It is registered for 1,807 chronic sick and able-bodied persons. During the year 160 cases were removed from this institution to the temporary Public Assistance Institution at Harold Wood. Other Hospital Facilities. (9) The Council have an arrangement with Queen's Mary's Hospital and Plaistow Maternity Hospital for the institutional treatment of maternity cases (see pages 58). Orthopaedic treatment is carried out at the Children's Hospital, Balaam St reet, and at the Brookfield Hospital, Walthamstow (see pages 58-59). Cases of Ophthalmia Neonatorum are treated at the Royal London Ophthalmic Hospital and at St. Margaret's Hospital. 41 Open Air Schools. (10) There are two Open Air Schools, one at Fyfield (Residential) , near Ongar, to accommodate 80 boys and (30 girls, and one within the Borough at Crosby Road (Day), to accommodate 60 girls and 80 boys. No case of infectious disease has occurred at these schools during the year. Additional District Medical Officers. Owing to the exceptional amount of work which devolved upon the whole-time District Medical Officers, it was found necessary to appoint two part-time temporary District Medical Officers for one year. At the expiration of this period the whole question of this service is to be again considered in view of the re-organisation that may be necessitated owing to the retirement of certain of the permanent staff, and also the proposed legislation of the Government with regard to outdoor assistance. Vaccination Acts, 1867 to 1898. The following is a summary of the work carried out under the above mentioned Acts during the year 1933. No. of Cases in Birth Lists received during the year 5753 No. of Certificates of Vaccination received 1631 No. of Certificates of Postponement owing to— Health of Child 353 Condition of House – Prevalence of Infectious Disease 1 No. of Certificates under Section 2 of Vaccination Act, 1898, and No. of Statutory Declarations under Section 1 of the Vaccination Act, 1907 3157 No. of Certificates of Insusceptibility or of having had Smallpox 10 No of Cases— Parents removed out of District 958 Otherwise not found 258 No. of Entries in Lists sent to Public Vaccinator 1657 42 Shops Acts. The provisions of the Shops Acts are carried out by Mr. E. J. Ferrier, the Stoops Inspector, and the following Table shows the work performed in connection therewith :— List of Shops Visited during the Year 1933. Class of Shop. J Visited. No halfholiday form exhibited. Warned verbally. Warning Notice sent. Refused to serve. Summonses attended. Bakers 208 7 16 1 26 1 Boot repairers, etc. 38 1 1 ... ... ... Butchers 604 17 80 14 109 ... Caterers 79 2 6 ... ... 1 Carpets and rugs 21 ... ... ... ... ... Chemists and druggists 102 5 7 4 15 ... China and glassware 147 6 14 3 19 ... Clothiers 204 5 10 3 20 ... Confectionery and tobacco 625 15 79 39 190 39 Corn merchants 38 ... ... ... 1 ... Cycle Dealers 44 ... 1 ... 2 ... Drapers, Milliners and Mantle Dealers 472 25 72 22 70 3 Fishmongers 379 10 42 9 63 ... Fruiterers and Greengrocers 575 22 143 46 153 5 Furniture Dealers 86 2 2 ... 6 ... Furriers 10 ... ... ... ... ... Grocers and General 696 34 166 106 260 32 Hairdressers and Barbers 333 7 40 5 38 1 Hosiers and Hatters 122 2 7 3 12 ... Ironmongers 38 1 ... ... 2 ... Leather and Grindery 33 ... 2 ... 4 ... Mixed 496 22 122 82 176 2 Music 63 1 2 ... 7 ... Picture Frames 50 ... 1 ... 4 ... Public Houses 25 ... ... ... 1 ... Tailors 153 4 18 2 14 ... Toy and Fancy Goods 112 3 7 1 11 ... Watchmakers, Jewellers and Pawnbrokers 27 ... ... ... 1 ... Wireless 117 2 14 3 21 1 Totals 6,797 193 852 343 1,225 85 For results of Police Court Proceedings, see pages 84-85. 43 44 Particulars of Bodies Received into the Mortuaries during 1933. Month. Stratford Mortuary. Canning Town Mortuary. Number received. No. of bodies remaining in and viewed at Queen Mary's Hospital. Males Females Over 5 yrs. Under 5 yrs. Sent in by Coroner. Sent in by Police. Sent in on Sanitary grounds. Number of Postmortems. Number of Inquests. Number received. Males Females Over 5 yrs. Under 5 yrs. Sent in by Coroner. Sent in by Police. Sent in on Sanitary grounds. Number of Postmortems No. of Inquests January 14 2 9 7 13 3 12 4 ... 9 8 3 ... 3 3 ... 3 ... ... 3 ... February 10 4 12 2 11 3 8 6 ... 6 10 2 1 1 1 1 1 1 ... 2 ... March 11 3 9 5 14 ... 9 5 ... 9 8 3 1 2 2 1 1 2 ... 3 ... April 19 2 10 11 17 4 16 4 1 14 7 1 ... 1 ... 1 ... 1 ... 1 1 May 8 1 9 ... 9 ... 3 6 ... 4 4 2 2 ... 2 2 ... ... 2 ... June 12 2 13 1 11 3 6 5 3 4 9 6 4 2 5 1 4 2 ... 5 2 July 10 2 4 8 9 3 6 6 ... 5 6 1 1 ... 1 ... 1 ... ... ... ... August 13 1 12 2 14 ... 9 5 ... 9 7 2 ... 2 2 ... ... ... 2 ... ... September 8 4 7 5 10 2 8 4 ... 4 9 1 1 ... 1 ... 1 ... ... 1 ... October 11 5 12 4 14 2 8 8 ... 5 12 2 2 ... 2 ... 1 1 ... 2 ... November 11 ... 8 3 11 ... 7 4 ... 6 5 2 1 1 2 ... 2 ... ... 2 ... December 18 2 12 8 18 2 13 7 ... 16 7 4 3 1 4 ... 3 1 ... 3 1 Total 145 28 117 56 151 22 105 64 4 90 92 29 16 13 25 4 19 8 2 24 4 Grand Total 173 173 173 173 29 29 29 WORK CARRIED OUT UNDER PUBLIC ASSISTANCE. The following statistics are in respect of the Forest Gate Hospital, whipps Cross Hospital, Central Home, and Forest House, also of the District Medical Officers :— District Medical Officers. Number of Men. Number of Women. Number of Children. New cases seen 1428 3785 4927 Total No. of cases seen 5951 20561 16286 No. referred by Relief Sub- Committee 655 693 1016 Attendances at Surgery 5479 17700 11772 Sent to Institutions:— Voluntary Hospitals 3 5 16 Whipps Cross Hospital 266 294 267 Mental 5 6 – Otherwise 2 10 127 Central Homes 125 115 8 Forest House – 2 – Forest (late Hospital 5 14 1 Aldersbrook Home – – – Discharged as 110 longer in need of treatment 1092 3008 3682 New cases seen at Domiciliary visit 367 1224 1846 New cases transferred from (a) Institutions 4 – 2 (b) General Practitioner 1 4 4 Total No. of Domiciliary visits paid 841 4532 5088 Visits paid by District Nurse 162 3263 3026 Deaths 12 33 6 Total No. on register as receiving treatment from D.M.O. on 30/12/33 121 762 430 Prescriptions made up 7156 25484 14579 Total No. of vaccinations or re-vaccinations 232 788 45 C 46 FOREST GATE HOSPITAL. MEN WOMEN CHILDREN Total Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Admitted and Born 3 21 28 730 20 20 515 27 7 1371 Discharged and Dead 2 24 19 742 21 19 518 25 5 1375 Refused admission – – – – – – – – – – Admitted by means of:— MEN WOMEN CHILDREN Relieving Officer and District Med. Officer 2 124 8 134 Gen. Practitioner and Relieving Officer 2 78 4 84 Gen. Practitioner and Dis. .Med. Officer 2 149 5 156 M.O.H – 36 3 39 Otherwise 2 157 27 186 Transferred from other Institutions 38 166 43 247 Med. Superintendent – 45 3 48 No. of infectious cases – – 15 15 Transferred to other Institutions 31 119 57 197 Deaths 1 63 25 89 Total No. of sick cases receiving treatment on 80/12/33 135 464 84 683 Total No. of maternity patients in the Home – 39 – 39 No. of vacant beds, if any on 30/12/33 – 30 – 30 47 WHIPPS CROSS HOSPITAL. Acute MEN Sub-acute Chronic Acute WOMEN Sub-acutc Chronic Acute CHILDREN Sub-acute Chronic Total Admitted 3782 – 14 3804 – 19 2050 – 1 9670 Discharged 2990 – 129 3170 – 105 1840 – 6 8240 Seen as out-patients 428 – 147 126 – – 107 – 1 809 Not admitted 415 – 32 150 – 14 184 – 2 797 Admitted by means of :— MEN WOMEN CHILDREN Relieving Officer and District Med. Officer 229 336 378 943 Gen. Practitioner and Relieving; Officer 3146 3125 1467 7738 M.O.H – – 2 2 Otherwise 9 4 4 17 Transferred from other Institutions 195 161 124 380 Police (not accidents) 83 54 4 141 Accidents 160 75 49 284 Med. Superintendent 74 68 22 164 No. of infectious cases 319 209 166 694 Transferred to other Institutions 255 252 185 692 Deaths 742 525 187 1454 Total No. being treated in hospital on 30/12/33 365 320 270 955 No. of vacant beds, if any – – – – No. of cases seen by Consultants 3435 Ophthalmic 329 Aural 550 Light 1475 Gynaecologist 75 Surgeon 259 Neurologist 231 Dentist 326 Urologist 190 No. of cases allocated to : West Ham 1599 Essex 1127 East Ham 709 X-ray: West Ham 1376 Essex 1393 East Ham 710 48 CENTRAL HOME. MEN WOMEN CHILDREN Total Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Admitted 848 – 15 835 5 5 1 3 4 1716 Discharged 891 – 15 897 4 5 2 2 4 1820 Refused admission – – – – – – – – – – Admitted by means of:— MEN WOMEN CHILDREN Relieving Officer and District Med. Officer 118 184 – 302 Gen. Practitioner and Relieving Officer 470 438 1 909 Gen. Practitioner & D.M.O – – – – M.O.H 1 – – 1 Otherwise 39 16 3 58 Transferred from other Institutions 238 207 – 445 Med. Superintendent – – – – No. of infectious cases 5 3 10 18 Transferred to other Institutions 232 313 8 553 Deaths 492 390 – 882 Total No. of sick cases in the Home on 30/12/33 404 420 3 827 Total No. of able-bodied in the Home on 30 12/33 411 312 – 723 No. of vacant beds, if any, on 30/12/33 76 57 – 133 49 FOREST HOUSE. MEN WOMEN CHILDREN Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Total Admitted — — 3 — — — — — — 3 Discharged — 1 4 — — — — — 5 Refused admission — — — — — — — — — — Admitted by means of:— MEN WOMEN CHILDREN — Relieving Officer and District Med. Officer — — — — Gen. Practitioner and Relieving Officer — — — — Gen. Practitioner and Dis. Med. Officer — — — — M.O.H. — — — — Otherwise — — — — Transferred from other Institutions 18 — — 18 Med. Superintendent — — — — No. of infectious cases — — — — Transferred to other Institutions 11 — — l1 Deaths — — — — Total No. of sick cases in the Home on 30/12/33 66 — — 66 No. of vacant beds, if any. on 30/12/33 — — — — MATERNITY AND CHILD WELFARE. The Senior Medical Officer (Dr. Helen Campbell) reports:— Notification of Births. The birth rate for 1933 was 15.5, being a decrease of 1.7 compared with that rate for 1932. Total number of notified births, 5,835, of which number there were 5,662 live births and 173 stillbirths. Births notified by doctors and parents 967 Births notified by midwives 4868 Number of Births in the Borough in the last five years (net number of births of West Ham Residents): 1929 1930 1931 1932 1933 5766 5606 5266 4980 4406 Health Visiting. The Council employs eighteen full-time Health Visitors who undertake the routine home visiting of mothers and young children: by arrangement between the Medical Officer of Health's Department and the Committee of the Plaistow Maternity Hospital the majority of those children, born in that hospital or attended at birth by nurses from that Association, arc visited until 4 years of age by the nurses from that Association: at present there are thirty-four such nurses employed in health visiting. In addition home visiting is carried out in special cases attending the Clinics by the Superintendent Nurses of the various voluntary centres in the Borough. There has been no alteration in the routine visiting of infants and children up to school age: from birth until 2 years the child is visited at least once a quarter, thereafter until it goes to school, at intervals of six months. Premature and weakly infants are visited monthly or oftener according to the condition of the child. In addition, the Municipal Health Visitors undertake all the duties of Infant life Protection Visitors under the Children and Young Persons' Act, 1932 and 1933; and in addition investigate all deaths of infants and young children, stillbirths, and cases of puerperal pyrexia or fever, ophthalmia and pemphigus neonatorum. Many visits are paid to the homes of expectant mothers, who arc thereby brought into touch with the several sources by which they can obtain help, viz. antenatal supervision at Clinics, including Dental treatment, Home Help Scheme, the provision of dried milk at and after six months of pregnancy, hospital facilities for confinement A summary card of each child is passed over to the School Medical Officer immediately the child attends school (including attendance at the Council's two Nursery Schools). This card 50 contains brief notes regarding physical and mental development from birth, and any illnesses from which the child may have suffered prior to school age, and is thereafter included in the appropriate dossier of the school child concerned. Visits paid by all Health Visitors during 1933. First Visits Total Visits (a) To expectant mothers 5535 2026,1 (b) To children under one year of age 5780 42824 (c) To children from 1—5 years of age 1751 68785 †(d) Infant Life Protection visits 531 †(e) Special Visits (Home Helps, etc.) 12734 Total Visits 145,135 †Special visits are made only by the Municipal Health Visitors; visits under (a), (b) and (c) include all those paid to the homes not only by Municipal Health Visitors, but also by Nurses from the Plaistow Maternity Hospital and the other various voluntary Clinics in the Borough. Maternity and Child Welfare Clinics. The Borough is now well provided with Clinics under the Maternity and Child Welfare Scheme: that these Clinic Services are appreciated by the mothers is evidenced by the regular attendances at all Centres for antenatal supervision, for post-natal advice and for the supervision of the infants and young children. There are five Municipal Clinics and in addition seven Centres under voluntary Associations, all subsidized by the Council. Antenatal Clinics are held at the five Municipal and at four of the Voluntary Centres: the midwives avail themselves of the opportunities offered to their patients by urging attendance at the Clinics, and, as a written report on her patient is sent after each examination by the Clinic Medical Officer to the midwife, she is kept in close touch with her cases throughout pregnancy. The majority of mothers present themselves willingly for antenatal care and examination, and attend regularly as required. The need for dental treatment is not so well received and understood by the expectant mothers; this is partly due to the "fear of being hurt," and also results from wrong advice given by friends that such treatment "might do harm." Intensive propaganda and personal talks between doctor and patient and by Health Visitors and Midwives to the mothers individually will ultimately break down the prejudice that at present prevails. There has been no change in the Clinic Service, but owing to the increased attendances at Maybury Road Clinic it will soon be necessary to establish a third infant welfare session. 51 Through attendance at the Centres, mothers (expectant and nursing mothers; may receive dental treatment; provision is also made for dental treatment for children under five years of age; also, the mother is put in touch with the many other facilities available under the Council's Maternity and Child Welfare Scheme viz. convalescent treatment for the children, and for nursing mothers, sunlight and orthopaedic treatment in cases where such is necessary. It is gratifying to note that at all Centres there are a large number of women who attend regularly, realising that the Centres are not for treatment of her sick child but are definitely for the prevention of illness. Dental Treatment. The Dental Scheme has not been modified since 1932; treatment is given to expectant mothers, to nursing mothers (up to six months after confinement) and to all children until school age. As has been stated previously, there is still difficulty in inducing expectant mothers to receive this treatment, and much education of the public is required to remove the considerable prejudice that undoubtedly exists: dental treatment is an urgent necessity in many cases, and it is deplorable to note the pronounced degree of dental caries among the women, even in young mothers. In regard to the young children, this treatment is more acceptable, and it is rare now to have a child brought to the Dental Clinic requiring multiple extraction. The mothers realise the necessity of conservative treatment in its effect upon the health of the toddler and in its later effect upon the permanent dentition. Once a child has attended the Dental Clinic, it is kept under regular supervision by the Dental Surgeon until it goes to school. This system of reinspection impresses on the parent the necessity and importance of preserving the primary teeth. Attendances for Dental Treatment in 1933. Expectant and Nursing Mothers. Number of new cases treated 404 Total attendances 1258 Total attendances (a) for extraction 630 (b) for fillings 214 (c) for special treatment 414 Children under five years of age. Number of new cases treated 840 Total attendances 3134 Total attendances (a) for extraction 621 (b) for fillings 1611 (c) for special treatment, inspection, re-examination, etc. 902 52 Centres and Clinics (Municipal and Subsidized by the Council): Address Where held. Number of Sessions held weekly (excluding Dental Sessions) Day and Time of Meeting. Average per Session. Arrangements for Medical Supervision. Centre Attendances. Medical Consultations. Expectant Mothers. Children. Expectant Mothers. Children. West Ham Lane Municipal Clinic *Forest Gate Municipal 4 Mon., Tues., Thurs., 2 p.m. Tuesday, 9.30 a.m. Friday, 9.30 a.m. 18.7 48.3 18.7 40.0 Dr. Helen Campbell. Clinic, Forest Street 4 Tuesday, 9.30 a.m. Tues., Wed., Thurs., 2 p.m. 11.7 35.6 11.6 27.0 Dr. Helen Campbell. Dr. Charlotte Forsyth *Grange Road Municipal Clinic 3 Wednesday, Friday, 2 p.m. Wednesday, 9.30 a.m. 11.7 30.5 11.7 26.0 Dr. Charlotte Forsyth Dr. Muriel Prout *Maybury Road Municipal Clinic 3 Monday, 9.30 a.m., 2 p.m. Friday, 9.30 a.m. 16.2 42.2 16.2 31.6 Dr. Charlotte Forsyth Silvertown Municipal Clinic 2 Wed., 10 a.m. and 2 p.m. 5.0 31.5 5.0 25.7 Dr. Charlotte Forsyth *Chesterton House Centre 6 Wed.,Thur., 11 a.m. & 2.30 p.m. Mon., Fri., 1.30 p.m. 178. 78.3 70.8 26.3 Dr. Flora Hogg & Docks Centre, Hoy Street 5 Daily, 2 p.m. 48. 70.1 18.0 23.4 Dr. Peter Kennedy. Martin Street Clinic 1 Thursday, 3.30 p.m. 24.6 32.4 9.7 7.6 South West Ham Health Society Clinic, Lees Hall 3 Tues., Wed., and Thurs., 1.30 p.m. 23.4 fortnightly 47.7 11.0 fortnightly 21.4 Dr. J. Lorimer Hawthorne. Trinity Mission Centre, Oxford Road 2 Wed. and Thurs., 1.30 p.m. — 52.7 — 29.3 Dr. Jean Smith. Stratford Day Nursery Centre, Welfare Road 2 Mon. & Friday, 1.30 p.m. — 41.3 — 22.4 Dr. Dorothea Brooks Given Wilson Institute, Pelly Bridge 1 Mondays, 2 p.m. — 41.5 — 31.0 Dr. Eva Morton. Dental treatment for mothers, and for children under 5 years, is given at these Clinics. 53 Home Helps. The Home Help Scheme continues to function satisfactorily and has been appreciated by the many mothers who have received help from the Council in this way. The Home Help—a woman usually chosen by the patient subject to approval as a suitable person by the Health Visitor—attends at the home from the date of confinement and for fourteen days thereafter. As the duties of such a woman are purely domestic, she may be employed whether the patient is confined in hospital or at her own home. It is an infringement of the Home Help rules if the woman in any way undertakes the nursing of the mother or baby or undertakes any of the duties, at the confinement, of a trained nurse. An expectant mother, indeed, is not eligible for such help unless she has engaged a trained nurse to attend her at her confinement cither as a midwife or in conjunction with a doctor. The supervision of these Home Helps is carried out by the Municipal Health Visitors: each suggested Home Help is visited in her own home before being approved by the Health Visitor, and if approved, is handed a printed list of her duties. She is required to notify the Medical Officer of Health not later than the day following the confinement, in order that the Health Visitor may get in touch with the case at an early date. The Health Visitor visits the home of the lying-in woman several times during the 14 days to supervise the work of the Home Help. The assistance which this scheme gives to the poorer working class mothers produces immense benefit: it affords the patient herself an opportunity of longer convalescence: it ensures her peace of mind, for she realises that her children are not neglected and that the household duties are carried on as if she herself were not for the time being laid aside. During 1933:— Total number of applications for Home Helps, 1116. Of this number 922 were eligible, 154 were ineligible (i.e., did not fall within the Council's scheme as regards income). In 40 cases the applications were cancelled by the applicants. Suspension of Midwives practising in the Borough. The Supervisor of Midwives in the Borough is the Senior Assistant Medical Officer for Maternity and Child Welfare (Dr. Helen Campbell). Most of the Midwives practice under the aegis of one of several training schools or Midwives' Associations in the neighbourhood, and therefore are also under constant supervision by those authorities. There is no doubt that a factor largely contri- 55 buting to the excellent record of the Borough in respect of the low maternal mortality and morbidity rates is the sound training and method of these Associations from which the district Midwives work. The methods of the private Midwives are quite equal to those of the nurses practising from the Maternity Hospitals. The Council does not employ or subsidise any district Midwives. *Total Number of Midwives who notified their intention to practise in the Borough in 1933, 86. Number in practise at the end of 1933, 59. (*This figure appears unduly large owing to the fact that many pupil Midwives who receive their Midwifery training from large Midwifery Centres in West Ham, continue to practise from their school for varying periods after passing the required Central Midwives' Board Examination). It will be obvious that the women of West Ham are fortunate in being able to obtain skilled nursing at the confinement and in the puerperium, and it is therefore all the more regrettable that there are still a few general practitioners in the Borough who encourage their patients to engage untrained women as maternity nurses, and who allow these women to conduct the major part of the labour. Where such facts have come to the knowledge of the Medical Officer of Health, the "maternity nurse" has been interviewed, but it has been impossible to take proceedings against these women who have always been able to cover themselves by the fact that they were working with a doctor. The general effect of such interviews, however, has been to ensure that a doctor is summoned at an earlier stage of any subsequent confinement the women may attend. Number of cases attended by Midwives in 1933 3487 Number of cases in which medical aid was summoned 517 Number of cases in which the midwife acted as a maternity nurse 198 Stratford Day Nursery. The Stratford Day Nursery is the only institution of its kind in the Borough, and it has continued to carry out its excellent work in helping the mothers, who are obliged to leave their young children daily in order to go out to work. It is provided by a Voluntary Association, but receives a grant from the Council. Fifty children under five years of age can be accommodated here. During 1933 there were 7,566 total attendances at the Nursery, making an average daily attendance of 33 children. The daily charge per child is 8d. 56 Sunlight Treatment for Children under 5 years of age. This specialised treatment can be obtained at the Stratford Day Nursery Sunlight Clinic, under the supervision of Dr. Eva Morton. The arrangement made in 1928 between the Maternity and Child Welfare Committee and the Committee of the DayNursery is still in force, whereby young children may be drafted for treatment from any of the Welfare Centres in the Borough, through the Medical Officer of Health. These children attend twice weekly, a Municipal Health Visitor being in attendance at these two sessions. In addition the Sunlight Clinic is open on three sessions per week for the treatment of those children not subsidised by the Council's Maternity and Child Welfare Scheme. Many of the children are referred on account of anaemia and general debility with flabby musculature: a marked improvement is evident in those cases who attend regularly over a period of several weeks. It has been observed by the Clinic Medical Officers that possiblv the greatest improvement seems to be in those children referred for "nervous debility"—the then irritable, restless child becomes quieter, happier and more amenable, the appetite improves, the child sleeps better, and there is a very definite physical as well as mental improvement in these cases. Attendances at the Sunlight Clinic in 1933. (1) Municipal Clinic. (2 sessions per week) Total number of new cases 128 Total attendances for treatment 24,12 (2) Day Nursery Clinic. (3 sessions per week) Total number of new cases 142 Total attendances for treatment 4685 Distributions of Dried Milk to Expectant and Nursing Mothers and to Children under 3 years of age. During 1933 the arrangements hitherto in force have continued unaltered in regard to the distribution of Dried Milk from the four Centres in the Borough, viz.:— 84 West Ham Lane, Stratford. Public Hall, Barking Road, Canning Town. Nurses' Home, Howards Road, Plaistow. Maternity and Child Welfare Centre, Barnwood Road, Silvertown. In March, 1934, a Distributing Centre was commenced on one day per week at the Forest Gate Maternity and Child Welfare Centre for the benefit of those mothers in the outlying parts of the district on that side of the Borough. It is now possible for all mothers to obtain this milk from Centres accessible to their homes. 57 During the year 1933 full advantage has been taken of the Scheme, as is shewn by the fact that 102 tons, 9 cwt. and 19 lbs. of full-cream dried milk were distributed in 1 lb. greaseproof bags enclosed in carton packets, with printed directions clearly set out as to use. The milk powder is received in bulk in hermetically sealed canisters, is packed by the Council's own staff, and only the estimated required quantity is weighed up daily, so that the milk is supplied fresh to each applicant. Samples from each consignment of milk have been submitted for chemical analysis and bacteriological examination with satisfactory results in every instance. Expectant Mothers. Hospital Accommodation. Provision is made, as in previous years, for the admission of women for confinement to Queen Mary's Hospital, Stratford, and to the Plaistow Maternity Hospital, both of which are subsidized by the Council. The Forest Gate Hospital, under the Public Assistance Committee also admits a large number of women to its maternity wards. No. of beds West Ham Residents No. of cases admitted No. Confined No. of weeks spent. Queen Mary's Hospital 45 501 440 860 Plaistow Maternity Hospital 56 865 787 1854 Forest Gate Hospital 40 275 243 486 Hospitals for Children under 5 years of age. Children under 5 years of age can be admitted to St. Mary's Hospital, Plaistow, and to the Invalid and Crippled Children's Hospital, Plaistow. At the latter hospital the Council retain a ward of 16 cots, to which all cases for admission are referred through the Senior Assistant Medical Officer for Maternity and Child Welfare. This Ward is reserved chiefly for chronic medical cases from the various Infant Welfare Centres, such as Rickets, Malnutrition and diatetic disorders of infancy. The beds at St. Mary's Hospital are occupied chiefly by acute medical and surgical cases. Young children requiring orthopaedic treatment are referred to the Orthopaedic Department of the Invalid and Crippled Children's Hospital, Plaistow, where there are full facilities for the treatment of such cases: four beds in hospital are reserved by the Council if in-patient treatment is required. 58 No. of beds West Ham No. of cases admitted Residents No. of weeks spent St. Mary's Hospital, E.13 10 222 681 Children's Hospital, Balaam Street, E.13 (a) Babies' Ward 16 200 773 (b) Orthopaedic Ward 4 22 75 Arrangements are in force with the Committees of Queen Mary's Hospital, Stratford, and St. Mary's Hospital, Plaistow, for the treatment by Specialists of ear, nose and throat defects in young children. Convalescent Homes for Children under 5 years of age. The majority of young children referred for convalescence are sent to homes through the aid of the Invalid and Crippled Children's Society and the Invalid Children's Aid Association. Recently it has been possible to admit children of 4 years and over to the West Ham Convalescent Home, Margate. The children are all examined prior to being sent away by one of the Medical Officers for Maternity and Child Welfare. A large proportion of these young children are referred for convalescence from the various Infant Welfare Clinics in the Borough. Some are debilitated as a result of recent illness, others are found to be suffering from malnutrition and anaemia attributable in many cases to faulty routine and wrong feeding in the homes. A period of regular training and supervision, with a well-balanced suitable diet usually restores these children to normal health, and produces permanent benefit. That the Medical Officers of the Clinics make full use of the valuable treatment for the children is evident in that, during 1933, 262 children were sent to Convalescent Homes for periods varying from one to three months, being an increase of 43 as compared with the number sent away in 1932, and no less than 239 over the number sent in 1925. Convalescence for Nursing Mothers and Infants. As in ,1932, the Council retained two beds for nursing mothers and infants, who must be under three months of age. One mother with her infant is sent each fortnight of the year to "Child Haven, Brentwood, the Convalescent Home of the West Ham Central Mission; similarly, one mother with infant is sent every fortnight to the London Mothers' Convalescent Home, Sunningdale. The mothers are recommended for convalescence through the Medical Officers of the Maternity and Child Welfare Centres, and are examined in every case prior to admission by the Senior Assistant Medical Officer for Maternity and Child Welfare. The mothers appreciate very greatly the kind attention and help they 59 receive at both Homes from the Nursing Staffs. The great improvement in mothers and babies after their holiday, with its entire freedom from worry and work, is remarkable. During 1933, under this Scheme, 44 mothers with their infants were sent to these Homes, which are excellent in every way. Maternity and Nursing Homes in the Borough. There are three Nursing Homes in the Borough registered under the Nursing Homes' Registration Act, 1927, one of these being the Plaistow Maternity Hospital. Of the two remaining Homes, one receives only chronic medical and senile cases, the other having accommodation for medical, surgical and maternity cases in addition to senile patients. There have been no orders cancelling or refusing registration, and no application for exemption from registration or for registration. The Homes are inspected by the Senior Assistant Medical Officer for Maternity and Child Welfare. Children and Young Persons' Act, 1932, Foster Children. Under Part 1 of this Act the supervision of the foster children and of the homes of the foster mothers is carried out by the Municipal Health Visitors in their respective districts. Application for registration as a foster mother under the Act is sanctioned by the Council on the recommendation of the Maternity and Child Welfare Committee. Before the foster mother's application is approved, a detailed enquiry is made by the Infant Life Protection Visitor of the district, and in all those cases that are known to the Public Assistance Officer a report is received in regard to home and economic conditions. The register of cases notified as suffering from Tuberculosis is consulted in order to eliminate any possibility of introducing a child into an infected family. The foster mother must comply, if registered, with all rules under this Act and of the Council, which include provision of a fire-guard, separate suitable sleeping accommodation for the child, and attendance at an Infant Welfare Centre in the Borough until such time as the child goes to school. Registered foster mothers are visited as a routine by the Health Visitor at least once every two months. In no case was legal proceedings taken in 1933. 60 During the year 1933. Number of applications for registration as foster mothers 35 Number of applications passed by the Council 32 Number of applications refused by the Council 2 Number of applications withdrawn 1 Number of visits paid to the homes by the Health Visitors: (a) First visits 40 (b) Total visits 567 Number of Foster Mothers on the Register. (a) At the beginning of 1933 65 (b) At the end of 1933 60 Number of foster children who died during 1933 None OPHTHALMIA NEONATORUM. Seventeen cases of ophthalmia neonatorum were notified to the Medical Officer of Health during 1933, of whom one was born in an institution in the Borough, but was non-resident in West Ham. Of this total number, only three were treated in hospital, the remaining fourteen being attended at home by a private doctor or being taken daily to a hospital out patient department. A Health Visitor visits the home weekly—or oftener if necessary— until the condition of the eyes is satisfactory. Number Notified 17* Cases Treated At Home 14 in hospital 3 Vision Unimpaired 17 Vision Impaired 0 Total Blindness 0 Deaths 0 *Of whom one was non-resident in the Borough. Maternal Mortality. Total number of births notified in West Ham in 1933 was 5,835, of whom 4,406 occurred amongst residents in the Borough. The number of women who died from complications of pregnancy or childbirth, was eight, giving a maternal mortality rate of 1.8 per 1,000, compared with 4.4 per 1,000 for England and Wales. I he cause of death was puerperal sepsis in five cases, the remaining three being due to other complications of pregnancy. A detailed report is furnished to the Ministry of Health in regard to every maternal death. I he average age of death amongst these mothers was 28.9 years. 61 Puerperal Sepsis. Notified Cause of Death Age of Mother Pregnancy Remarks Legitimate illegitimate (1) Peritonitis following septic absorption after abortion. 42 Yes — No antenatal care. Patient did not realise she was pregnant. (2) Septicaemia following abortion 18 — Yes No antenatal care. Concealed pregnancy. (3) Puerperal Sepsis 28 Yes — Normal full-time confinement. Regular antenatal supervision. (4) Septicaemia and miscarriage 39 Yes — No antenatal care. Did not know she was pregnant. (5) Septicemia and miscarriage 21 — Yes Concealed pregnancy. No antenatal supervision. The above table is striking in that four out of the five deaths from puerperal sepsis occurred after miscarriage in the early weeks of pregnancy. This complication of pregnancy is far too lightly regarded by the women themselves, who frequently continue their daily duties and do not consider that medical aid or nursing is necessary. This should also serve to illustrate the folly of attempting to induce abortion, a practice that is all too prevalent in every area of the Borough, and a practice of whose dangers it is very difficult to convince the mothers. Maternal Deaths from causes other than Sepsis. Notified Cause of Death Age of Mother Pregnancy Remarks Legitimate illegitimate (1) Haemorhage due to ruptured extra uterine pregnancy 35 Yes — Did not know she was pregnant: (pregnancy only 3 weeks). (2) Eclampsia 20 — Yes Concealed pregnancy: no antenatal care. (3) Pulmonary Embolism in puerperium: premature labour 30 weeks. Albuminuria of pregnancy with high blood pressure 27 Yes — Regular antenatal supervision. 62 DEATHS OF INFANTS UNDER ONE YEAR SINCE 1900. 63 The low maternal mortality rate in the Borough is very gratifying when the economic and home conditions of the population are considered. There is very considerable overcrowding, more especially in the districts on the South side: there is, too, a large amount of unemployment, in many cases of long duration. The fact that this rate is so much lower than the rate for the country as a whole may be attributed to the following amongst other factors:— (1) Antenatal Supervision. The Borough is well served with Antenatal Clinics, and the women avail themselves readily of this supervision, and of the additional facilities available through attendance at a clinic. (2) There is no shortage of trained midwives in the district, so that all women can ensure the presence at confinement of skilled help. The majority of women do not engage a doctor for confinement, but seek the services of a trained nurse, as is shewn by the fact that 83 per cent. of the notified births were notified by midwives. Further, the standard of midwifery is high in the Borough —except for fourteen private midwives (of whom only six are in actual and regular practice) all the other nurses work under the aegis of large Maternity Hospitals or Nursing Associations approved by the Ministry of Health as training centres for pupil midwives. (3) The third factor conducing to the satisfactory result is the adequate and regular visiting of the homes of expectant mothers by the Health Visitors, particularly in regard to following up those expectant mothers who fail to keep the appointments for reexamination at the Antenatal Clinics. By this means the women are urged to re-attend to prevent the development of complications of pregnancy; or if such have developed, the patient is put in touch with the necessary help and supervision to prevent serious consequences. Puerperal Fever and Puerperal Pyrexia. During the year there were 15 cases of Puerperal Fever and 26 cases of Puerperal Pyrexia notified to the Medical Officer of Health: this represents 3.5 per 1,000 notified births in regard to Puerperal fever, and 9.6 cases of Pyrexia per 1,000 births. Arrangements are in force whereby a patient with her baby can be admitted immediately to hospital if such is considered necessary. Three Consultant Obstetric Specialists have been appointed, so that the patient may have the benefit of consultant services in her own home. Home Nursing of puerperal cases is carried out by the nurses from the various District Nursing Associations in the Borough. Further, if necessary expectant mothers are admitted to hospital to await their confinement or to receive appropriate treatment beforehand. 65 Infantile Mortality. The infantile mortality rate is 64.4 per 1,000 births, shewing a decrease of 6.6 compared with 1932. For the 118 great towns the rate was 67.0. The total number of deaths under one year was 284, of which 164 were males and 120 females. Ten of these deaths occurred amongst illegitimate infants. The following table of the causes of death illustrates again the fact that many of these infants would appear to be "born to die." They are congenitally weak or deformed, with insufficient vitality to maintain life even when all care and attention are given to them. Many die within the first four weeks after birth: the neonatal death rate remains high, and to this may be attributed the fact that, both in West Ham and the country as a whole, the infantile mortality rate is as high as 60—70 deaths per 1,000 births. Notified Causes of Deaths under One Year. Congenital debility, prematurity malformation 128 Diarrhoea, digestive diseases, etc. 54 Pneumonia and Bronchitis 42 Tuberculosis (all forms) 10 Syphilis 1 Heart Disease 1 Infectious Diseases 26 Deaths from other defined diseases 22 Total 284 Total number of deaths from 1—5 years of age during 1933 was 144. During this age period there are more deaths from the commoner infectious diseases, and less from digestive disorders. Table showing Causes of Death (1—5 years). Infections diseases (a) Whooping Cough 26 (b) Diphtheria 24 (c) Influenza 3 (d) Scarlet Fever 2 (e) Cerebro Spinal Meningitis 5 Pneumonia and Bronchitis 48 Tuberculosis (all forms) 8 Diarrhoea, digestive disorders 8 Appendicitis 3 Other defined diseases 17 Total 144 66 Of the above number, 15.6 per cent. of the deaths at this age period were due to Diphtheria. Recently there has been renewed propaganda in this Borough for immunization against Diphtheria, and the result of this simple form of treatment should lower materially the death rate from one of the most virulent diseases of childhood. SPECIAL REPORTS ISSUED BY THE MEDICAL OFFICER OF HEALTH DURINC THE YEAR. (1) District Medical Officers. In accordance with the instructions of the Public Assistance Committee, 1 submit herewith a report upon this service. At the present time the work is carried out by two whole-time District Medical Officers and three part-time District Medical Officers (one of whom, Dr. Brews, is an officer of the East Ham Council working jointly with the West Ham Council). Each whole-time officer is assisted by a full-time nurse, and the dispensing of their prescriptions is done in each case by a full-time dispenser. The dispensing of the part-time District Medical Officer is done by different chemists at contract prices. Further, each whole-time District Medical Officer has a deputy who attends to the work when he is off duty. The work of the whole-time Medical Officers is carried out at and from North West Ham and South West Ham Public Assistance Sub-Offices, that of the part-time District Medical Officers being carried out at and from their respective surgeries. The wards allocated to the respective Medical Officers are as follows, namely:— Dr. Dolan High Street, Broadway, New Town, Forest Gate, Park, Upton, Plashet Road and West Ham, comprising a total estimated population of 131,363. Dr. Conran Canning Town and Grange, Hudsons, part of Bemersyde and Tidal Basin, Ordnance, Beckton Road and Custom House, comprising a total estimated population of 111,822. Dr. P. Kennedy Plaistow part of Bemersyde, comprising a total estimated population of 23,153. 67 Dr. Begley Part of Tidal Basin, comprising a total estimated population of 19,684. Dr. Brews Silvertown, comprising a total estimated population of 8,256. The following figures will show to some extent how the work of the District Medical Officers has increased:— Number of cases seen. 1931 1932 Dr. Dolan 14556 17262 Dr. Conran 14219 18157 Dr. Kennedy 1073 1322 Dr. Begley 622 1065 Dr. Brews 820 900 After reviewing the position very carefully and interviewing both Dr. Dolan and Dr. Conran, I am of opinion that to cope efficiently with the work of their respective districts, additional help should be provided (this should incidentally, lead to more persons being able to be treated in their own homes, thus relieving to some extent the pressure on the institutional beds). I put forward for your consideration three alternative methods for relieving the pressure of work, namely:— 1. The appointment of one or more additional part-time District Medical Officers. 2. The appointment of another whole-time District Medical Officer. 3. The appointment of Assistants to Dr. Conran and Dr. Dolan. After very careful consideration of the whole of the factors, I suggest the first alternative to be the best method of approach to this problem at the present time. Both Dr. Conran's and Dr. Dolan's districts could be reduced by this method. Either the second or the third scheme would mean additional surgery accommodation, and also additional dispensers and possibly nurses. The work of the full-time dispensers has become greater owing to the increased number of cases dealt with, and it may be necessary for this Committee to provide additional help in this direction, unless the work is diminished. Under Scheme 1 the dispensing could be carried out by the different chemists on the prescription of the part-time District Medical Officer; this scheme would obviate additional surgery accommodation or the appointment of an additional dispenser. 68 Prescriptions dispensed by Mr. Love (North West Ham). March Qrt. 1931 6008 March Qrt. 1932 6744 March Qrt. 1933 9681 Prescriptions dispensed March Qrt. 1931 3664 by Mr. Arnold March Qrt. 1932 4476 (South West Ham). March Qrt. 1933 5009 A scheme whereby a person needing public assistance medical attention may call in any doctor of his choice has been propounded by the British Medical Association, and though not yet fully formulated, might be usefully discussed. 1 consider Scheme 3 the least desirable, particularly as it would, I believe, cause some confusion to the Relieving Officers in regard to "Orders" and other relevant duties. Dr. Peter Kennedy has, since the death of his father, been acting as temporary District Medical Officer for the Plaistow Ward and part of Bemersyde Ward, no permanent appointment having yet been made. Do the Public Assistance Committee desire this post to be advertised or will they wait until the report 1 have just outlined is further considered? F. GARLAND COLLINS. July, 1933. (2) ADDENDUM ON INSTITUTIONAL ACCOMMODATION. In accordance with the instructions of the Council I herewith re-issue the attached report. Since this report was first compiled in 1930, a number of factors have arisen and events occurred which have modified, to a certain extent, some of the subject matter therein, though, in the main, the broad principles involved have not changed. The following sets out in brief the more important points:— 1. Of the additional two hundred beds provided at Forest Gate Hospital, no less than one hundred and fifty were taken up to make room for one hundred and fifty cases which had been boarded out previously with the London County Council. 2. East Ham have built additional accommodation which will enable them to deal with most of their cases of tuberculosis now being treated at Whipps Cross Hospital (about twenty-eight). 3. Essex County Council are now considering the provision of additional beds for chronic sick cases: but all the evidence goes to show that, even if this materializes within the next two years, it will not relieve West Ham to any appreciable extent from having to provide for the Essex County Council's cases now being treated in West Ham institutions. (According to agreement.) 69 4. Only a fraction of the full scheme for a colony at Ockendon for mental defectives has been sanctioned and completed (namely, one hundred and thirty-four beds instead of seven hundred and fifty). This has not relieved the overcrowding at Forest Gate Hospital, from which institution only a negligible number of patients have been able to be transferred. 5. The recent decision of the Council to send adult cases of chronic sick to Harold Wood will relieve the immediate shortage of beds for such people, which is the most urgent problem at the moment; but this is only a temporary measure and must obviously involve a reduction of the number of beds available for acute illness in children, which will create, in turn, a demand upon the already overcrowded accommodation at Whipps Cross Hospital. 6. The restricting of admission to the Margate Convalescent Home of children between the ages of five to fourteen years, and moreover, only to those children whose parents are in receipt of poor law relief, has rendered it particularly difficult to use this institution to its full capacity. 7. A Psychological Clinic has been opened recently by the Council at the Children's Hospital, Balaam Street, staffed from the Mental Hospital at Goodmaves. 8. The agreements primarily existing with outlying authorities for sending cases of smallpox to an institution belonging to West Ham have not been renewed. West Ham cases of smallpox are now being treated by arrangement with the London County Council in their smallpox hospital. The question of the shortage of institutional accommodation for the sick of this borough is by no means a new one. As long ago as 19,10 the wards at the Whipps Cross Hospital (then called West Ham Infirmary) were grossly overcrowded and many patients were sleeping on the floor, and the day rooms were then (as they are now) used as wards. With comparatively recent years a considerable amount of accommodation has been secured in various ways: arrangements have been made and in some instances agreements drawn up between this Authority and other Authorities for the use of beds, e.g., 10 Beds for maternitv cases at the Plaistow Maternity Hospital. 10 Beds for maternity cases at Queen Mary's Hospital. 10 Beds for children under 5 years at St. Mary's Hospital, Plaistow. 16 Beds for sick babies at the Invalid and Crippled Children's Society, Balaam Street Hospital, Plaistow. 4 Beds for orthopaedic cases at I.C.C.S. Balaam Street Hospital. 6 Beds for cases of tonsils and adenoids operations at Balaam Street Hospital. 70 Beds (according to demand) for babies suffering from ophthalmia with their mothers at St. Margaret's Hospital (L.C.C.). Beds (varying according to demand) for treatment of venereal diseases under the L.C.C. Scheme. 2 Beds for convalescent nursing mothers and their babies (Sunningdale and "Child Haven," Brentwood). Beds (up to 16) at Sir William Treloar's Hospital for Cripples, Alton, for surgical tuberculosis. Beds at King George's Sanatorium, Liphook, for Seamen with pulmonary tuberculosis (according to demand). Beds at Alexandra Hospital for tuberculous hip cases. Beds at various convalescent homes for children sent through the medium of the I.C.C.S. and I.C.A.A. (average of 50). Beds for M.D. cases at various institutions (excluding cases now at South Ockendon Colony). (Average 130.) Beds for all smallpox cases per agreement with L.C.C. (variable). It will thus be seen that there has been a big development in the provision of beds for those cases needing urgent institutional treatment. The London County Council, a few weeks ago, wrote giving notice cancelling their agreement regarding the admission of cases of ophthalmia neonatorum at St. Margaret's Hospital from 31st, March, 1933. If West Ham was not contiguous with the great Metropolis and was a town apart, long ago it would have been necessary to have provided a great many more beds; as it is, a large number of sick cases from this area are admitted daily and treated in the big London hospitals, particularly Great Ormond Street Hospital, East London Hospital for Children, Poplar Hospital, London Hospital, St. Bartholomew's Hospital, Guy's Hospital and the Royal Free Hospital for Women, and of course, the local hospitals. With the stricter rules now applying as to admission to the wards of all voluntary hospitals, the number of cases referred back to be provided for by their own Local Authority increases. Additional institutional accommodation has been provided by this Authority within recent years at Dagenham Sanatorium, at Langdon Hills Sanatorium, at Harold Wood Hospital, at Forest gate Hospital, at Ockendon Colony, and at Fyfield Open-air school in the aggregate a matter of 700 beds—a big achievement; yet there is still a lack of sufficient suitable accommodation. 71 There should be, in my opinion, no definite separation of the various institutions in regard to the exact number and type of case suitable for admission. All beds should be pooled and as far as is practicable used to the best possible purpose. Naturally, infectious diseases should receive proper consideration in the light of recent research. I have issued several memoranda during the past few years on various matters concerning institutional accommodation, viz., I. In 1928 a statement showing the need for hospital accommodation for cases of pneumonia, whooping cough and measles, and also for babies suffering from wasting and allied diseases. II. and III. In 1929 and 1930 two separate memoranda concerning the taking over of the Poor Law Institutions by the Public Assistance Committee. IV. In May, 1930, a report pointing out emphatically the unsuitability of certain wards at the Central Home for the proper treatment of the sick. A similar statement has been made by me on several occasions to the Public Assistance Committee in regard to the Forest Gate Hospital. V. In 1931 I circulated a comprehensive report upon the whole of the institutional accommodation of the borough to every member of the Council. (Reprint herewith as directed by the Council.) VI. In March, 1932, a further report was issued to the Public Assistance Committee in regard to institutional accommodation with special reference to overcrowding. VII. In June, 1932, a memorandum on accommodation at Plaistow Hospital and Harold Wood Hospital for Children was circulated to members of the Hospitals Committee setting out various alternative methods for using Harold Wood and Plaistow Hospitals, as owing to the very big drop in the number of notified cases of infectious diseases these institutions had not been used to their full capacity for some time. VIII. In November, 1932, a report upon the Margate Convalescent Home was issued. In conclusion, I am of opinion that it is essential at once to provide many extra beds to meet adequately the demands and needs of the sick population of this borough. F. GARLAND COLLINS, Medical officer ot Health and Chief School Medical Officer. Municipal Health Offices, Romford Road, E.15. February, 1933. 72 (3) INSTITUTIONAL AND OTHER ACCOMMODATION FOR THE SICK. I have the honour to submit a further report (the tenth of a series) upon the above-named matter, though there is very little that can be added to my previous reports upon the same problem. The urgency of providing further hospital accommodation has again been emphasised by the Minister of Health in a letter to the Town Clerk dated December 20th, 1933. In a letter to the Council dated June 29th, 1931, the Ministry of Health stressed the fact that in the interests of West Ham their position as regards Essex and East Ham should be put on a clearer footing before they embark on a building programme based on the needs of the old Union. The full scheme set out in my report of January, 1931, assumed that the agreement with East Ham and Essex would extend over a period of twenty-five years. It is manifestly impossible to estimate the amount of future accommodation needed if at any time anything up to fifty per cent. of the cases may be withdrawn, though I am confident that if the scheme referred to is carried out there need be no wastage of accommodation at any reasonable future time. Though there is still need for the full scheme there are obviously some sections of it more urgent than others. The most urgent is the provision of extra accommodation for chronic sick cases (as a reference to my report of March, 1932, will clearly show). Almost as urgent is the need of suitable accommodation for children : a visit to the adult wards at Whipps Cross Hospital will demonstrate this, where it will be seen that children's cots abound between the beds for adult patients, in the centre of the wards and in the day rooms. Extension of premises for the staff at Whipps Cross Hospital is also necessary. If and when the above is completed, there is the remainder of the full scheme to be considered. Additional beds for pulmonary tuberculosis cases are needed, and Dagenham Sanatorium could be made to accommodate fifty more patients, though preferably new buildings should be erected at Langdon Hills. The number of convalescent beds needed might be arranged tor at the Margate Convalescent Home, but I am of opinion that this institution should be disposed of and more suitable premises obtained. A new Tuberculosis Dispensary is very desirable, and should form part of a general municipal out-patient department (with special clinics) situated in the borough as outlined in my report 73 An adequate scheme complying with my definition of such as set out in my report of March, 1930, would then be completed. I now suggest a new institution with a maximum of five hundred beds to supply the most urgent need. Harold Wood Hospital could then be relieved of poor law cases and suitably used; further, many of the chronic and sub-acute cases now taking up beds at Whipps Cross Hospital could be treated at this new institution, thus creating more space for the acute sick, and enabling the children to be treated in wards apart from adults. Many cases now at Forest Gate Hospital could be transferred to this new institution, thus allowing more space for the mentally deficient patients treated there. Some of the overcrowding at the Central Home would also be alleviated. If an institution with this number of beds were built adjoining Whipps Cross Hospital or Forest House, there would be many advantages over other sites, e.g., the staff could be accommodated more conveniently and be more easily administered, the special departments (X-ray, Sunray, etc.), and the visiting specialists to Whipps Cross would be immediately available; then, too, necessary transference of patients could be more easily effected. If the Mental Deficiency Colony at South Ockendon is proceeded with, on its completion some hundred beds will be freed at: Forest Gate Hospital; alternatively, if the lowest grade villas are not built at Ockendon, then Forest Gate Hospital will not be materially relieved. In any case the five hundred beds mentioned are needed. The voluntary hospitals are being used to their fullest extent, and have waiting lists. At a meeting convened on June 17th, 1931, under Section 13 of the Local Government Act, 1929, representatives of all the local voluntary hospitals attended at the Town Hall, and in regard to each hospital schemes were eventually promulgated for increased accommodation but without exception to be carried out at the expense of the Council. In conclusion, it is now over three years that this vital question has been under consideration. It is essential in the interests of the health of the borough that more accommodation should be provided: the non-vital though important questions of "designation" of classification, of "central committees," etc., might be considered in the light of a going concern. F. GARLAND COLLINS, Medical Officer of Health and Chief School Medical Officer. Medical Officer of Health's Department, Municipal Health Offices, Romford Road. E.15. January 5th, 1934. 74 MENTAL DEFICIENCY. The detailed work connected with this section, and in the running of the South Ockendon Colony is under the direct supervision of Dr. T. W. Hill, Deputy Medical Officer of Health. On the 31st December, 1933, there were 648 Mental Defectives on the register: Males, 316; Females, 332. In 1925 there were 223 on the register. Number in Institutions— Males 113. Females 95. Total 208. Number under Statutory Supervision— Males 200. Females 234. Total 434. Number under Guardianship under Order— Males —. Females 2. Total 2. Number on Licence from Institutions— Males 3. Females 1. Total 4. Eighty-seven new cases were dealt with during the year:— Recommended Institutional Care— Males 15. Females 18. Total 33. Recommended Supervision at Home— Males 11. Females 13. Total 24. Recommended for (Guardianship)— Males —. Females 1. Total 1. Referred for Reconsideration— Males 15. Females 14. Total 29. Number of cases notified by the Local Education Authority under Sec. 2 (2) — Males 17. Females 21. Total 38. Number of Cases admitted to Institutions— Males 9. Females 10. Total 19. During the year 51 Continuation Orders were received— For 5 years. Males 9. Females 5. Total 14. For ,1 year. Males 24. Females 13. Total 37. Thirteen cases were removed from the register for reasons as follows:— Removed to other Areas— Males 2. Females —. Total 2. Died— Males 4. Females 6. Total 10. Dea't with under Lunacy Acts— Males 1. Females —. Total 1. 75 Ascertainment. The system of co-operation with the various Local Organisations, Officers of the Council, local Police Courts, etc., as is practised in West Ham in the carrying out of the duties of discovering the mental defectives residing in the borough is, I think, efficient. This is evidenced by the fact that no fewer than 87 persons were brought to my notice for action under the Acts during the year. It will be seen from the figures shown above that 58 of these have been dealt with definitely, while the remainder will be paid friendly visits, and assistance and advice given as far as practicable. By far the larger number of these cases have been notified by the Local Education Authority, which together with the Public Assistance Officer form the main channels of information. Supervision. There are 434 defectives under supervision. Supervision is a very satisfactory form of care where the home and surroundings are suitable, and of course is considerably cheaper than maintaining them in institutions. Unfortunately, however, a number of patients are placed under supervision when they obviously should be dealt with by being sent to an institution. This is largely due to the lack of suitable institutional accommodation, and in a few cases to the fact that some parents are averse to allowing their children to be sent away. All of the cases under supervision are visited at varying intervals, and all possible assistance and sympathetic advice regarding the management and training (especially of the children) is given. These visits are fully appreciated by the majority of the parents. Cuardianship. This method of care is practised to a very limited extent in West Ham. In addition to two Females placed under guardianship under Order, there are two other women who have been placed with guardians, one on licence from an institution, the other, an elderly woman. The latter case was placed in this care following the death of her mother. She has settled down fairly well. The other cases have been with their guardians for some years and are doing quite well. It is hoped to make further use of guardianship for certain types of patients at South Ockendon Colony in the near future, as a means of testing their abilitv to live away from institutional care or to earn their own living. Colony Accommodation. The need for further colony accommodation for certain types of defectives is still very pressing. A large number of those defectives coming to my notice by means of the Public Assistance 71 Officer are already inmates of the Public Assistance Institutions, and while it would be preferable to place them in a certified institution it is impossible to do so at present. A scheme to extend the present colony at South Ockendon to 500 beds is before the Board of Control, and it is hoped that the scheme will very soon receive their approval. This extension will include a school for the younger patients and workshops for boot repairing, mat and rug-making, basket-work and brush-making, and suitable accommodation for the necessary staff. The extension will allow for all those cases who are at present boarded out to be brought to the one institution, and also for those defectives who are awaiting beds to be admitted. South Ockendon Colony. The Matron Superintendent (Miss W. S. Butler) reports:— The number of patients on the books is 130, of which 51 are males over 16 years 35 are females over 16 years 26 are males under 16 years 18 are females under 16 years Villa 1 houses 52 males (one under 16 years), but owing to lack of space eight of this number sleep in Villa 2. These patients are classified into two groups, viz., 28 high grade, 24 low grade. Villa 2 houses 23 males under 16 years, two boys being home on licence. Villa 3 houses 34 females over 16 years and 18 under 16 years. One female adult is on licence. The patients in Villas 2 and 3 are graded into six groups according to their mental age, irrespective of sex. Movements. These were as follows:— Admissions, 7 males, 5 females. Discharges to Forest Gate Hospital, 2 females, 1 male. Discharges to Rampton State Institution, 1 male. Leave. Licence was granted as follows:— Summer holidays, ; Christmas holidays, 37 ; 48 hours, 5 ; 3 months with parents, 2; 3 months in domestic service, 1. Health. The health of the Colony has been excellent. There has not been a single case of illness. Employment. I am pleased to be able to state that the gress made in this direction has been considerable, and the addition of the Workshops in January of this year has enabled us to enlarge the scope of our activities. A list of the total work done in the various departments during the past year is appended: work for the male adults is allocated as follows:— 77 GROUP 1. Farm Work 0 Gardening 2 Assisting handyman 2 Boot-mending 5 Carpentry 6 Cane-work 5 Ward and Kitchen work 2 Eggs, vegetables and fresh fruit are obtained from the Council's Farm, which is adjacent to the Institution. GROUP 2. Clean all the Institution's boots and shoes, pare potatoes, clean cutlery and kitchen utensils. Ten make wool rugs. All Patients do an allotted task in the ward before commencing work at a.m. They help with gardening when necessary, and are employed out of doors as much as possible when the weather is fine. Both Groups do physical drill three times a week and Group 1 are really excellent. They wear a special outfit for gymnasium and look very smart. To create interest the men are divided into four "houses," each with a self-elected Captain. They compete for marks for conduct, work, etc., which arc posted on a Notice Hoard in their dining room. The winning "house" wins a prize at the end of each month. The competition is very keen. Of the total of 52 males in B.l only one has been found incapable of being usefully employed. In Blocks '2'and 3, Groups 1 to 5 work to a time-table. Occupation is varied from hour to hour and ranges from brick-building, paper-folding, etc., to weaving, embroidery and rug-making. The working day begins at 9 a.m. with prayers, hymns, marching and action songs. Each Group does half-an-hour's physical exercises daily, according to their capacity, whilst the bigger boys drill with a male instructor. GROUP 6 consists of 28 fairly high-grade female adults. These do all the ward work in Blocks 2 and 3 and help in the main kitchen. At 11 a.m. they go to the needlcroom for the rest of the day with the exception of a break of one hour for games, physical drill or folk dancing. Very few of these girls had any knowledge of sewing on admission ; they have shewn remarkable progress and are now able to do all repairs and help in the making of new articles under instruction from the seamstress. Each girl has a piece of fancy work to do at her leisure, and this is much appreciated. The girls in Block 3 arc divided into two "houses." each with a self-electcd Captain. A "ladder" displayed on the Notice Board in their dining room denotes the rise or fall of marks of each "house." 78 Amusements. The men run football and cricket teams, which are almost invariably victorious in competition with visiting teams. Matches are held every Wednesday and Saturday afternoons, and there is a great demand for fixtures from teams in the vicinity. The girls play netball, the "houses" competing against each other. They are becoming very proficient at country dances, and will soon be good enough to give a display. There is a sand pit in course of construction for the smaller children. Dances are held every alternate Monday evening, out of doors during the summer. Music is obtained from the Radiograms, which are a constant source of pleasure. Several entertainments were given by visiting concert parties during the winter, notably one by members of the Public Health Dept. which was most enjoyable. The Patients and Staff also gave a concert and drill display, which was attended by members of the Committee and the patients' relatives. The usual Christmas and Guy Fawkes festivities were held and much enjoyed. The annual Sports were held in June and, though marred by inclement weather, were a great success. The patients go for long country walks every week, and during the summer months they have frequent picnics. Religion. An average of sixty patients attend the Village Church on Sunday. The Churches of other denominations are too far away to permit attendance at them. A Roman Catholic priest from Grays visits the Catholic patients periodically. Staff. An additional Charge Nurse, a General Assistant and a Seamstress were appointed this year ; also additional male and female nurses to allow a 48-hour week to be established. Summary of Work done 1st April, 1933, to 31st March, 1934. Needlework Department— 167 Dresses 359 Knickers (girls') 180 Chemises (girls') 538 Face Flannels 202 Bibs 120 Aprons (girls') 76 Aprons (men's) 150 Brush and Comb Bags 50 Bath Sheets 39 Baby's Knickers (boys') 24 Strong Rompers 673 Hand Towels 250 Tea Towels 14 Laundry Bags 79 84 Dish and Floor Cloths (knitted) 60 Curtains (short) 14 Curtains (long) 10 Gym. Slips 10 Knickers 12 Pierrots' Costumes 10 Nightdress Cases (embroidered) 8 Children's Jerseys (knitted) Handicraft Section— 27 Large Rugs 110 Small Rugs 17 Seagrass and Cane Stools 26 Shopping Baskets 9 Waste Paper Baskets 12 Trays 45 Pouchettes, Kettle-holders, Woollen Balls, etc. 11 Shopping Bags and Tea Cosies. Carpentry Section— 1 Tool Cupboard for Workshop 1 Set Drawers for Shoemakers' Bench 90 Wooden Posts for Fencing Flower Beds 1 First Aid Cabinet Boot-mending Section— 269 Pairs Children's Shoes mended 324 Pairs Men's Boots mended Sanitary Circumstances of the Area. WATER. 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 large factories have private wells for drawing water from the chalk. On complaint, one sample of water was taken from a private house, but upon analysis was found to be of a satisfactory nature. RIVERS AND STREAMS. The Thames and the Lee are both tidal rivers. Part of the Lee and the whole of the Thames abutting on the Borough are under the control of the Port of London Authority. The remainder of the River Lee and the Back Rivers connecting therewith which pass through the Borough come under the control of the Lee Conservancy and the newly created River Lee Catchment Board. 80 The Council have hitherto been responsible for the maintenance of the river banks under powers which have devolved upon them as successors to the Dagenham Commissioners, but the Land Drainage Act, 1930, has transferred certain of these powers to the River Lee and River Roding Catchment Boards. The Council are carrying out, in conjunction with the Lee Conservancy Board a large scheme for the improvement of the Back Rivers of the Borough under the provisions of the River Lee (Flood Relief, etc.) Act, 1930. DRAINAGE AND SEWERAGE. The water carriage system of sewage removal is almost universal throughout the whole Borough. With very few exceptions, houses are provided with properly flushed modern water closets, discharging by modern drainage into the Public Sewers which also convey the surface water. The part of the Borough lying South of the Victoria and Albert Docks drains into a main sewer which passes through portions of East Ham and North Woolwich, and discharges into the London County Council's sewer at North Woolwich. With the exception of a few isolated cottages on the North side of the Borough, the whole of the sewage is waterborne. Excepting this comparatively small area, the whole district North of the Victoria and Albert Docks is drained by gravitating sewers to the Corporation Pumping Stations at Abbey Mills, where the dry weather flow is pumped into the Northern outfall sewer, which crosses the Borough obliquely to the London outfall at Barking. There are certain other storm sewers provided which discharge into the rivers. SCAVENGING. This work is carried out by the Borough Surveyor's Department. The main roads are cleansed nightly, and the remainder of the thoroughfares either daily or two or three times a week, according to circumstances. 1 wo "Karrier" motor sweepers arc utilised to assist in this work. REFUSE DISPOSAL. The system of refuse disposal as a whole is one of far-reaching public health importance. The amount of refuse necessitating Collection in West Ham averages about 250 tons daily, and is at Present dealt with by the method of controlled tipping. The bulk the refuse is collected by means of the Pagefield system of containers. The refuse collected is shot on controlled tipping dumps at Beckton Road and Temple Mills, and the East Ham Tip at Barking Road. E 81 Schools. The Public Elementary Schools consist of 51 Council Schools, and 13 Non-Provided Schools. In addition, there are two Schools for Mentally and Physically Defective Children, two Centres for the Deaf, one Open-Air Day School, one Residential Open-Air School, and two Nursery Schools, each to accommodate 120 children. 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 a Chief Assistant School Medical Officer, 6 Assistant Medical Officers, 5 Dental Surgeons, 28 Nurses, and 9 Clerks. The Schools are, with several notable exceptions, fairly modern, substantially built building's adequately supplied with water, and provided with sufficient surrounding air space; moreover their general cleanliness is satisfactory. Cloak-room accommodation is very limited in some Schools, and more efficient heating is desirable. In connection with the foregoing paragraph it is interesting to note that the following works have been carried out during the year:— Increasing and remodelling latrine accommodation at one school. Provision of Teachers' Room by alteration of cloakrooms at another school, and replacement of external iron staircase. Additional cloak rooms at a special school, and also at an open-air school. Replacement of boilers, re-planing of floors, and removal of class room galleries at several schools. With a view to checking the spread of epidemic disease the Medical Officer of Health, on receiving information of the occurrence of infectious disease in the family of a scholar, sends a red-coloured 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 familv 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. 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. One school, however, was affected with constantly recurring cases of Diphtheria (see page 107). The scholars were inspected by an Assistant School Medical Officer, and swabs were taken of suspicious cases. No carrier was found. 82 No complaints were received as to unsatisfactory water supply. Officers of the Superintendent of Visitors' Department send me lists giving names and addresses of children absent from school, with the illness from which they are suffering. Cases of notifiable infectious diseases contained on these forms (specimen below) are checked with the Infectious Diseases Register, and if it is found that any case has not been officially notified a Sanitary Inspector calls at the address and makes full inquiries into the matter. All non-notifiable cases, e.g., measles, chicken pox, whooping cough, are followed up and advice given. CASES OF DISEASE IN CHILDREN ABSENT FROM SCHOOL. Department Name Address School B. G. I. Disease Date Signed Attendance Officer. Printed Matter Rate. To the MEDICAL OFFICER OF HEALTH, MUNICIPAL HEALTH OFFICES, ROMFORD ROAD, STRATFORD, E.15. F 83 Cases of Sickness extracted from the Superintendent of Visitors' School Attendance Returns Measles (including German Measles) 452 Chicken Pox 1057 Whooping Cough 662 Mumps 594 Tonsillitis 369 Other Diseases 637 PROSECUTIONS, 1933. Nuisances (Public Health Act) — 628 Summonses. 389 Summonses withdrawn. 1 Summons was adjourned sine die. 238 Magistrate's Orders were issued to do the uncompleted work specified on the sanitary notice, in a given time. Failure to comply with Magistrate's Orders- 82 Summonses. 46 Summonses withdrawn, including one in Bankruptcy. In 36 cases penalties were imposed. West Ham Corporation Acts, ,1893 and 1898— 6 Summonses. 4 Summonses withdrawn. In one case a penalty was imposed, and in another case no penalty was imposed. Rag Flock Acts, 1911 and 1928— 3 Summonses. 1 Summons withdrawn. 2 Summonses dismissed. In one case defendant prosecuted wholesaler, and case was dismissed on payment .of costs. Housing Act, 1930—Section 18— 1 Summons for obstruction. Fined. Shops (Hours of Closing) Act, 1928. 54 Summonses. 32 Summonses fines imposed. 20 Summonses dismissed on payment of costs. 2 Summons dismissed with a warning—costs incurred by Council. Shops Act, 1912. Section 1 (Sub-section 3) — 1 Summons. Fined. West Ham Grocers', etc., Closing Order, 1919— 26 Summonses. 9 Summonses dismissed on payment of costs. 16 fined. One Summons dismissed and costs incurred by the Council. 84 West Ham Grocers' Hall-Holiday Order, 1912— 3 Summonses. Two Summonses dismissed on payment of costs. 1 fined. West Ham Bakers' Half-Holiday Order, 1913— 1 Summons, which was dismissed on payment of costs. Council's Bye-laws. Failure to provide dung pit— 1 Summons, which was withdrawn on payment of casts. Bottling Milk in Street— 4 Summonses. 2 Summonses dismissed on payment of costs. 2 fined. Selling Self-Raising Flour in which added mineral matter for aerating purposes was absent— 1 Summons, which was dismissed on payment of costs. Adulterated Milk— 3 Summonses. 2 Summonses dismissed on payment of costs. 1 fined. Selling Sausages adulterated with Sulphur dioxide— 1 Summons. Fined. Selling Sausages containing preservatives which were not labelled in accordance with the Regulations— 1 Summons. Fined. For failing to store milk churns in a clean place when not in use— 1 Summons. Fined. For failing to store a lid of a churn in a clean place when not in use— 1 Summons. 1 Summons withdrawn on account of conviction on another charge; costs incurred by Council. Selling Milk from vehicle which had not name and address on— 1 Summons. Fined. For failing properly to cover milk churn when in use— 1 Summons, which was dismissed on payment of costs. 85 Summary of Work of Sanitary Inspectors. Houses visited in connection with Infectious Diseases 2955 Houses, Factories, and any other premises visited in connection with smallpox 502 Visits to Factories 178 „ Workshops 202 „ Outworkers 255 „ Bakehouses 206 „ Dairies 377 „ Common Lodging Houses 24 „ Houses Let in Lodgings 114 „ Cellar Dwellings, Underground Rooms, etc 9 „ Slaughterhouses 7 „ Fish Friers 76 „ Knackers' Yards 3 „ Cafe and Restaurant Kitchens, etc., P.H.A. 1925 139 „ Ice Cream Makers or Dealers, W.H.C.A. 57 „ Other Food Purveyors 5518 Visits re Burial Act 1857, Section 25, Exhumation of Human Remains 3 „ Private Houses to investigate complaints 5476 „ Offensive Trades 500 „ Other Noxious Trades 43 „ Canal Boats — „ Imported Food (Labelling) Order, 1921 176 „ Drainage Inspections 7959 „ Rats and Mice Destruction Act 317 „ Increase of Rent Restriction, etc., Acts 6 „ Bye-Laws—Tents, Vans, Sheds 58 Houses Inspected under the Housing Act, 1930 1955 Other Houses Inspected 2162 Smoke Observations—half-hour 17 Visits to Factories re Smoke 31 „ „ Steam Whistles Act, 1872 2 Visits to Places of Public Amusement, Theatres, Music Halls, Cinemas, etc. 91 Other Visits 1729 Re-inspections 37086 Total Visits 68155 86 Samples taken under Rag- Flocks Acts 45 Samples of Domestic Water supplies taken for analysis or bacteriological examination 1 Total Notices served 7084 Warning Letters sent re matters not dealt with by notice 51 Defective Houses dealt with 7109 Other Defective or Insanitary Conditions dealt with 54 Drain Tests carried out 334 Certificates granted under the Rent Restriction, etc. Act 7 No. of notices complied with—(1) By owner 0972 (2) By occupier 14 Summonses issued 779 *Apparent discrepancies caused by a number of notices not being complied with at the end of previous year. There would normally be a number of notices not fully complied with at any date during the year. Abatement of Nuisances. The following table shows the number of Inspections and Sanitary Notices served in respect of, in sixteen Wards of the Borough during the year 1933:— Notices served Ward 1 nspections in respect of New Town 751 566 Forest Gate 442 374 High Street 522 429 Broadway 513 351 Park 423 229 Upton 219 107 West Ham 407 361 Plashet Road 268 213 Plaistow 683 520 Canning Town and Grange 566 520 Ordnance 534 484 Hudsons 481 31,1 Bemersyde 309 222 Tidal Basin 749 670 Beckton Road 700 654 Custom House and Silvertown 544 476 8111 6487 In this connection 716 summonses have been issued during the year. 87 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories (Including Factory Laundries) 178 4 ... Workshops (Including Workshop Laundries) 202 20 ... Workplaces (Other than Outworkers' premises) Total 255 6 ... 635 30 ... 2.—Defects found in Factories, Workshops and Workplaces. 1 articulars. Number of Detects. Number of offences in respect to which Prosreotions were instituted. Found. Remedied. Referred to H.M. I nspector. (i) (2) (3) (4) (6) Nuisances under the Public Health Acts*:— Want of cleanliness 20 20 1 ... Want of ventilation 6 6 ... ... Overcrowding ... ... ... ... Want of drainage of floors ...... ... ... ... Other Nuisances 7 7 ... ... Sanitary Accommodation— Insufficient 1 1 1 Unsuitable or defective... 1 1 ... ... Not separate for sexes Offonces under the Factory and Workshop Acts: Illegal occupation of underground bakehouse (s. 101) Other Offences ... ... ... ... (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 35 35 2 ... * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Act*. 88 Common Lodging Houses. There arc nine Common Lodging Houses in the Borough, three in the North and six in the South. Most of these were originally constructed and used for ordinary dwelling houses, but have been altered so as to conform with the requirements of the Council's Bye-Laws dealing with Common Lodging Houses. The total number of beds at these premises is 525. Supervision is kept by the Sanitary Inspectors on these houses, and the number of visits made during the year was 24. No application was received for registration of new premises. Houses Let in Lodgings. Bye-Laws are now being reviewed in respect of this question. Rag Flock Acts 1911 and 1928. There are three makers of Rag Flock in the Borough. The premises are visited regularly by the Sanitary Inspectors. There are also a number of premises where flock is used in the making of furniture and bedding. Forty-five samples were taken during the year. Of this number six, upon analysis, were found not to conform to the requirements of the above-mentioned Acts. In three cases prosecutions were instituted against the offenders, and in the three other cases letters of warning were sent. In one case the firm prosecuted took proceedings against the wholesaler. Investigation has been made into the raw material used in the manufacture of Rag Flock, and it is learned that it may originate from such undesirable sources as refuse dumps. Rags from such places (and they have been known to include even used surgical bandages) are certainly not suitable for bedding material. None of the processes in Rag Flock manufacture attempt either the cleansing or sterilizing of such rags. The Rag Flock Acts require that only the chlorine content shall be limited. As chlorine is readily soluble in water, to achieve this the manufacturer merely dumps the rags in tanks filled with cold water. Here they are left for a time, which appears to be governed only by the demand for the finished product, and certainly not with any regard to the sterile condition. After removal from the tanks the fags are rough dried and ready for flocking. The drying process is governed by relatively the same conditions as the washing, i.e. the greater the demand the less the drying. I he greater proportion of Rag Flock is made up into cheap bedding, which has a quick sale in the retail markets, and there is little doubt that manv mattresses are sold and used in a decidedly damp condition. 89 Estimation by the chlorine method is not necessarily indicative that Rag Flock is free from organic pollution. Samples of Flock made from perfectly clean new cloth have proved on analysis to contain soluble chlorine far in excess of the permitted amount. This may be accounted for in the bleaching or dyeing at the weaving mills, the chemicals used probably being of the hypochlorite class. In the circumstances it would be advisable when considering future legislation that a more definite standard of cleanliness be made, and a limit be imposed on the aqueous condition of Rag Flock. Ash Pails. The Council has a scheme in force whereby householders can be supplied with a standard dustbin or dustbins as required, at a very reasonable rate. The charge made is 2s. per bin per year, and in each subsequent year a further 2s. in respect of supply and maintenance. During the year over 5000 dustbins were supplied. Offensive Trades. During the year 1933 there were 27 premises in the Borough where statutory offensive trades were being carried on. In the table below is set out the nature of the trades:— No. of Premises Nature of Offensive Trade. licenced Fat Melters and Bone Boilers 17 Chemical Manure Manufacturers 1 Soap Boilers 2 Gut Scrapers 2 Fish Meal Manufacturers 1 Tripe Dressers 1 Animal Charcoal Manufacturers 1 Glue Makers 1 Fellmonger 1 In addition to these, there are two premises where soap is made by a cold process which does not involve boiling. An application was received from a person to carry on the making of vegetable oil soaps in the Stratford district. The applicant, after having heard the conditions to be imposed in connection with the establishment of this trade, did not pursue the application. All the above-mentioned trades are carried on with very little annoyance, if any, to the people in the near vicinity of the factories. Five hundred inspections of premises were made by the Sanitary Inspectors. 90 HOUSING. In common with a large number of other Authorities great activity has been displayed in regard to Housing. The difficulties and problems of this vital question have occupied the deliberations of this Council for some years, and much has been done. Recently, however, additional facilities have been provided as regards dealing with slums. Contrary to what might be expected there are few bad slums in West Ham, for as I have mentioned in previous annual reports the growth of this Borough has been very rapid, and most of the property, and highways and byways are of comparatively recent development. The definition of a slum is so elastic that it is usually translated so as to indicate an indefinite statement. Courts and alleys are, with one or two exceptions, practically non-existent here. There are nevertheless, areas containing blocks of dwellings which by the nature of their construction, and disrepair, constitute highly undesirable domiciles of the character of a slum. One such area has been dealt with during 1933, under the nomenclature of the "West Ham Old Canning Town Clearance Area." The buildings in this area, which comprised 93 houses, were the subject of a public enquiry by the Ministry of Health, and in nearly every instance appeals were made by the owners against the demolition of their property. I set out below the outline of the general features submitted. It was satisfactory that, after an exhaustive (not to say tedious) enquiry, only five houses were omitted from the order. West Ham Old Canning Town Clearance Order. The ninety-three houses designated under the Clearance Order are comprised within the Canning Town Ward of the County Borough of West Ham, and within the old Canning Town district. This district is bounded on the east by the London and North Eastern Railway, and on the west by the River Lee, on the south by the Barking Road, and on the north by factories and marsh land as far as the District Railway. The area is low lying, being only six feet above ordnance datum (three feet below high water mark), is liable to flooding, and has indeed been flooded. The houses, which are occupied in the main by people of the lower working classes, are mostly old. The houses have deteriorated greatly within the last fifteen years : they are too badly constructed to be properly repaired, and have indeed for many years needed constant supervision by the Sanitary Inspectors. The area as a whole is undesirable for a housing site, and I have advised my Council under Section 2 (5) of the Housing Act, not to permit dwelling houses to be erected on this site in the event of this Clearance Order becoming operative. I have, with my Sanitary Inspectors, inspected each house in this area, and come to a definite conclusion "that the dwelling houses in the 91 area are, by reason of disrepair or sanitary defects, unfit for human habitation, or are by reason of their bad arrangement, or the narrowness or bad arrangement of the streets, dangerous or injurious to the health of the inhabitants of the area, and that the other buildings, if any, in the area are for a like reason dangerous or injurious to the health of the said inhabitants; and that the most satisfactory method of dealing with the conditions in the area is the demolition of all the buildings in the area." I formed this opinion upon my knowledge and experience based as a common factor upon the definition of what a fit house should be as set out in " The Manual on Unfit Houses and Unhealthy Areas" issued by the Ministry of Health in 1919, and upon Section 62 of the Housing Act, 1930. The houses do not comply with the bye-laws which are generally applicable to the houses of the working classes in this borough, and in my view constitute a nest of slum property which harbours dirt and disease. I will quote now a few relevant statistics viz.:— Clearance Area. Area comprises 8500 sq. yds. = 1.77*2 acres or 1J acres Density of houses 52.9 houses per acre Persons per acre 315.46 Number of houses in area 93 Number of families 117 Adults 355 Children 204 Total 559 Density, West Ham County Borough 49,521 houses 4,700 acres = 10.522 Persons per acre 63 Number of Sanitary notices served during last four years 306' I made an official representation on the 26th day of July, 1932, to the Housing Committee of West Ham to this effect, and the Committee, after visiting the area and satisfying themselves on the matter, took the necessary steps which have led up to this enquiry. The details of how each of the individual properties included in this Order falls within the necessary standard of unfitness as quoted above from Section 1 (i) of the Housing Act, 1930, are here available, and my Chief Sanitary Inspector is in a position to give evidence on any relevant point connected therewith. F. GARLAND COLLIN'S. Municipal Health Offices, Romford Road, E.15. May, 1933. 92 A far more extensive scheme for the demolition of small areas of slum dwellings has been submitted to the Ministry of Health covering the next five years. The first batch of these clearance areas involving 78 houses is, at the time of writing, the subject of public enquiry by the Ministry of Health. As will be seen by the table on page 95, a very large number of houses have been dealt with under Scction 17 of the Housing Act, 1930. In some instances the Council have had to avail themselves of the powers relegated to them under Section 18 of the Act of 1930, and have (the owner defaulting) carried out the necessary work stipulated in the notices, or that part of the work not completed to the satisfaction of the Medical Officer of Health. This work has been done at the instance of the Council by private building contractors. The Council are at present involved in legal proceedings of some importance in respect to this procedure, but it would appear that extreme care must be exercised before taking action under Section 18 of the Housing Act, 1930, if legal differences of opinion are not to arise. Considering, however, the volume and nature of the work accomplished it must be expected that some difficulties will arise. There is a very considerable number of houses in the Borough which should be dealt with under Section 19 (demolition) of the Housing Act, 1030, but until there is some alternative accommodation for the tenants who would be displaced, it is not practicable to make demolition orders. The problem of alternative accommodation is particularly difficult in these cases, as the type of house involved is usually in an overcrowded state, occupied by very poor tenants, who frequently neither attempt nor desire to obtain other accommodation. Overcrowding. Although the state of overcrowding pertaining in the Borough is common knowledge, I have continually and persistently, year after year, drawn attention to this evil which is undoubtedly an extraordinarily difficult problem to solve. I am of opinion that the abatement of overcrowding is quite as important as the clearance of slums, for a dwelling, however well built and hygienic, in itself is obviously insanitary and a menace to health when grossly overcrowded. A number of large houses, particularly in the northern area of the Borough, though by no means slum property are unhealthy and insanitary because of their grossly overcrowded condition. Some of these dwellings, which until recent vears domiciled a single family of some 0—8 people, are now let, sublet, and re-sub-let until they habitate in some cases as manv as 30 people. Bve-laws relating to houses let in lodgings are being reviewed to meet these cases. In this connection I am entirely at a loss to account for the drop of 6,400 in the population of west Ham as assigned bv the Registrar General. 93 Re-housing. With a density of 61 people to the acre it must be borne well in mind that spaces must be preserved in various areas of the Borough for recreation and to act as lungs for the town. More particularly is this needed, now that the district is being built round so extensively on those borders which were until a few years ago within a short distance of open country. In connection with the slum clearance scheme, the following table will shew the Council's programme for re-housing the persons displaced:— Number of houses and type Houses Site 2 bedrooms 3 bedrooms 4 bedrooms completed Churchill Road 12 60 8 Argyle Road 8 1,1 2 21 Gainsborough Road 8 28 4 28 99 14 21 Of the 141 houses shewn in the above table it will be noted that only 21 have been completed, and these are about to be occupied, at the time of writing. The remainder arc in various stages of erection. The Council also has two other sites at Samson Street and Greengate Street. These are at present undeveloped, but it is proposed to erect 86 houses as shewn in the table hereunder:— Number of houses and type Site 2 bedrooms 3 bedrooms 4 bedrooms Samson Street 18 10 14 Greengate Street 18 18 8 36 28 22 Section D. Housing. 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7084 (b) Number of inspections made for the purpose 37086 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1255 (b) Number of inspections made for the purpose 7080 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 13 (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 7084 94 2. Remedy of Defects during the year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers A considerable number of defective Dwelling Houses are rendered fit as a result of interviews between Officials and Owners. 3. Action under Statutory Powers during the year:— (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1255 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By Owners 866 (b) By Local Authority in default of Owners 29 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied *5829 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By Owners *6106 (b) By Local Authority in default of Owners 25 (c) Proceedings under Sections 19' and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 6 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 6 (d) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Apparent discrepancies caused by a number of notices not being complied with at the end of previous year. 95 INSPECTION AND SUPERVISION OF FOOD. Milk Shops and Dairies. Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies (Amendment) Act, 1922. Milk and Dairies Order, 1926. There were 377 inspections of dairies and milk purveyors' premises made during the year. Twelve persons were registered as purveyors of bottled milk only, and two as dairymen and their premises as dairies, and there were transfers in respect of 2 dairies and 18 purveyors of bottled milk. Three dairymen occupying premises without the Borough were registered as purveyors within the Borough. There are now 107 premises registered as dairies and their occupiers as dairymen, and 612 persons registered as purveyors of bottled milk only, their premises not being registered as dairies. Examination of Milk. Animal Inoculation. Sixty-five samples of milk were procured from producers and purveyors. This number includes eleven bottles of milk taken from Council's Schools. Nine samples were reported upon as shewing signs of a T.B. infection. Of this number one sample obtained from a School was adversely reported upon, and the source of supply was immediately discontinued. The matter was further investigated, and samples were taken on delivery to the purveyor. The source of infection was traced and the Medical Officer of Health of the producing area was immediately informed, and three animals were subsequently slaughtered. Of thirty samples taken from Council's Institutions, five shewed signs of a T.B. infection, and the supply was discontinued. Three samples taken from a purveyor which proved positive were investigated, the Medical Officer of Health of the producing area communicated with and, as a result, four animals were subsequcntlv slaughtered. Condensed Milk Regulations. Twenty-nine samples of condensed milk were taken, including thirteen for the purpose of testing the equivalent, which proved satisfactory. In every instance the particulars as to labelling were in accordance with the regulations. Cream. Four samples of cream were submitted for animal inoculation, as to the presence of a T.B. infection, and were satisfactorily reported upon 96 Microscopical and Bacteriological Examinations. Forty-seven samples of milk were taken for bacteriological and microscopical examinations. Twenty-seven of these were obtained from Council's Schools for the purpose of bacteriological examination, all of which proved satisfactory. Twenty samples were taken from purveyors (churns, hand-cans, and bottles for microscopical examination. Of this number five were unsatisfactorily reported upon, owing to the presence of Coliform Bacillus. Letters of caution were sent in each case, and the premises visited. Public Health (Preservatives, etc., in Food) Regulations. Eight samples of various foods were reported upon as being adulterated with preservatives, as under:— Meat: Containing sulphur di-oxide. Unofficial. Meat: do. Official. Letter of caution sent. Same Retailer. Subsequent official sample proved satisfactory. Meat: Containing sulphur di-oxide. Unofficial. Subsequent official samples proved satisfactory. Meat: Containing sulphur di-oxide. Unofficial. Subsequent official samples proved satisfactory. Meat: Containing sulphur di-oxide. Unofficial. Subsequent official samples proved satisfactory. Meat: Containing sulphur di-oxide. Unofficial. Subsequent sample proved satisfactory. Pepper: Containing sulphur di-oxide. Official. Letter of caution sent. Subsequent sample proved satisfactory. Confectionery: Containing sulphur di-oxide. Official. Letter of caution sent. Stock withdrawn from sale. MILK (SPECIAL DESIGNATIONS) ORDER, 1923. The following licences were granted during the year:— Eleven to sell Grade "A" (Tuberculin Tested) Milk including six supplementary licences; three to sell Certified; one to produce, bottle and sell, and eight to sell Grade "A" Milk, including four supplementary licences; one to pasteurize and sell, and fourteen to sell Pasteurized Milk, including twelve supplementary licences. One hundred and eighteen samples were submitted for bacteriological examination, the results being as follows:— Pasteurised Milk— Satisfactory 53 Unsatisfactory Nil Grade "A" Milik— Satisfactory 32 Unsatisfactory 12 (contained Coliform Bacillus in 100th c.c. Eight of the unsatisfactory samples were taken on delivery at one of the Council's Institutions, and the source of supply was stopped. 97 Grade "A" (Tuberculin Tested) Milk— Satisfactory 11 Unsatisfactory G (contained Coliform Bacillus in Certified Milk— 100th c.c. Satisfactory 3 Unsatisfactory 1 (contained Coliform Bacillus in 1/10th c.c. Letters of caution were sent in all cases of designated milks failing to meet the requirements of the Order, asking for investigation to be made with a view of tracing the defect, and preventing a recurrence. Other Foods. All factories dealing with food of various kinds, also retail shops and other premises, are constantly inspected by the Sanitary Inspectors, who during the year made 6,373 visits. Fertilisers and Feeding Stuffs' Act, 1926. (Inspector and Official Sampler: Mr. E. F. Hughes) FEEDING STUFFS. The following table sets out samples taken under the above Act during the year:— Sampled Officially— No. of Samples taken Analysis agrees Analysis disagrees Article Poultry Biscuit Meal 1 — 1 Meat and Bone Meal 5 1 4 Meat Meal 1 — 1 Feeding Meat and Bone Meal 2 2 — White Feeding Fish Meal 1 1 - Clover Cob Meal 2 — 2 Bran 1 1 - Sussex Ground Oats 1 1 - Ground Oats 1 1 Chicken Biscuit Meal 1 1 - Laving Meal 1 1 - G 1 1 - O 1 1 - Fattening Meal 1 — 1 Growing Mash 1 — 1 Sampled Unofficially— Green Bone Meal 2 2 - Feeding Meat and Bone Meal 1 1 - Laying Meal 1 — 1 Linseed 1 1 - Meat and Bone Meal 3 1 2 Barley Meal Grade 2 1 1 — 98 FERTILISERS. Sampled Officially— Article No. of Samples taken Analysis agrees Analysis disagrees Garden Bone Meal 4 3 1 Guano Compound 1 1 — C — Fertiliser (1) 1 — 1 C — Fertiliser (2) 1 1 — Potato Manure 1 — 1 1 Canary Guano 1 — C - '(1) 1 — 1 C — (2) 1 — 1 S — 2 — 2 Hoof and Horn 2 1 1 Blood Meal 2 1 1 Sweet Pea Fertiliser 1 — 1 R — 1 — 1 P — 1 — 1 C — 1 — 1 U — Fertiliser 1 — 1 Sampled Unofficially— Kainit 2 2 — Muriate of Potash 1 1 — Nitrate of Soda 1 1 — c — (1) 1 1 — C - (2)1 — 1 Garden Bone Meal 2 1 1 M — Fertiliser 1 — I Superphosphate of Lime 1 1 — Raw Guano 1 — 1 Basic Slag 1 1 — Unsound Food Condemned, 1933. 168 lbs. of Corned Beef 5 Boxes of Smoked Haddock 45 lbs. of Jellied Veal 4 st. of Catfish 6 lbs. of Pork Tongue 1 Box and 5 st. of Plaice 216 lbs. of Tinned Meat 21 Boxes Herrings 30 lbs. of Luncheon Meat 5 Tins of Tomatoes 72 lbs. of Tinned Ham 9 cwt. of Potatoes 21½ lbs. of Beef 42 Barrels of Horse-radish 38 lbs. of Skate Wings 36 Bags of Sprouts 14 st. of Cod 2 Doz. Rolls of Celery 8 st. of Dog Fish 6 Tins of Prunes 18 st. of Haddock 15 Tins of Condensed Milk 3 st. of Mackerel 2 cwt. of Sugar 99 Samples Analysed by Borough Analyst, 1933. Articles Analysed Genuine Adulterated Official Unofficial Official Unofficial Official Unofficial Milk 529 — 495 — 34 — Milk, Condensed 18 11 18 11 — — Milk, Dried 27 — 27 — — — Cream 7 1 7 1 — — Butter 51 29 51 29 — — Margarine 9 1 9 1 — — Lard 11 5 11 5 — — Dripping 8 5 8 5 — — Cream Cheese 3 — 3 — — — Cooking- Fat & Oil 5 1 5 1 — — Shredded Suet 1 2 1 2 — — Mustard 2 — 2 — — — Pepper 13 10 12 10 1 — Ground Ginger 3 1 3 1 — — Vinegars 40 — 35 — 5 — Pickles & Sauce 4 7 4 7 — — Cocoa 5 — 5 — — — Coffee 2 — 2 — — — Tea 14 — 14 — — — Jams 7 5 7 5 — — Cake 9 — 9 — — — Confectionery 32 16 31 16 1 — Dried Fruits 9 3 9 3 — — Pearl Barley 2 2 2 2 — — Flour & S.R. Flour 20 1 20 1 — — Rice 1 — 1 — — — Tapioca 3 — 3 — — — Peas, dried and cooked 2 2 2 2 — — Meat, fresh 26 40 25 35 1 5 Sausages &- Meat products 29 1 29 1 — — Meats, cooked & preserved 14 2 14 2 — — Fish & Meat Paste 3 — 3 — — — Beer 11 — 11 — — — Drugs 2 2 2 2 — — Ground & Desiccated Nuts — 4 — 4 — — Split Peas & Lentils 3 — 3 — — — Golden Syrup 1 — 1 — — — Whisky 1 3 1 3 — — Continued at top of next page. 100 Samples Analysed by Borough Analyst, 1932. Articles Analysed Genuine Adulterated Official Unofficial Official Unofficial Official Unofficial Cordials 12 2 11 2 * 1 – Boracic Ointment — 1 — 1 – — Camphorated Oil — 3 — 3 – — Epsom Salts — 1 — 1 – — Extract of Malt & Cod Liver Oil 1 – 1 – – – Olive Oil 2 — 2 – – — Seidlitz Powder — 2 — 2 – — Coffee and Chicory Essence 1 – 1 – – – Coffee & Coffee Mixture 3 – 3 – – – Rum — 1 — 1 – — Custard Powder 5 — 5 — – — Lemon Curd 2 — 2 — – — Sugar 5 — 5 — – — Orangeade and Lemonade Powder 8 1 8 1 – – Grape Fruit Crystals 1 — 1 – – — Salicylic Ointment — 2 — 2 – — Sulphur Ointment — 2 — 2 – — Bacon 3 — 3 – – — Sardines — 1 — 1 – — Liver Salts — 1 — 1 – — Wine 1 2 1 2 – — Cinnamon — 1 – 1 – – Dried Herbs 2 — 2 – – — Croats 1 — 1 – – — Corn Flour 2 – 2 – – – Bread 6 – 6 – – – Semolina 1 – 1 – – – Fish – 5 – 5 – Desiccated Soup – 1 – 1 – – Mincemeat 1 2 1 2 – – 984 182 941 177 43 5 For list of Prosecutions taken in connection with adulterated articles, see page 85. 101 The Public Health (Meat) Regulations, 1924. The Slaughter-House Bye-Laws and The Knackers'-Yard Bye-Laws. The Slaughter of Animals Act, 1933. (This work is carried out by the Veterinary Officer, Mr. H. E. Bywater, M.R.C.V.S., and the Meat Inspector, Mr. T. R. Harris) who report as follows:— Ante-Mortem Examinations. Ante-mortem examinations were made by the VeterinaryOfficer, involving 6,054 animals. Post-Mortem Examinations. The number of animals inspected after slaughter was 19,582, and of these 1,977 or 10.09 per cent. were found to be diseased. Among the 1,632 bovines inspected, 631 or 38.66 per cent. were affected with tuberculosis, while 185, or 11.33 per cent. were otherwise diseased. Swine numbered 4,116 and 374 or 9.08 per cent. were tubercular, and 285, or 6.92 per cent. were suffering with other diseases. Of the 13,834 sheep examined 502 or 3.62 per cent. were diseased. Detailed information is given in Table I. as to the numbers and percentages of animals diseased, while in Table II. the total quantity of meat found to be unfit for human food is enumerated. Tuberculosis. The incidence of tuberculosis observed among swine is higher than that recorded in any previous year. In the case of bovines the figure is lower than it has been since 1929. The examination of carcases affected with tuberculosis occupied a considerable amount of time, as the presence of any degree of tuberculosis necessitates a special examination (vide Memo. 62 Foods) to determine the extent and character of the infection prior to releasing any part of even a slightly affected carcase. Detention of Carcases. In order to prevent any misunderstanding arising as to the particular carcases detained for further examinations, labels bearing the words "Detained for further Examination" were usually attached to them. In some cases "Condemned" label was used. Disposal of Diseased Meat. Diseased meat and offal were released, under supervision, for industrial purposes. Prior to release a powerful dye or strong disinfectant was usually sprinkled over it to render it useless for the food of man. In other cases the placing of the diseased material in a digester at the premises where it was being destroyed was witnessed. All meat and offal found to be diseased was voluntarily surrendered. 102 Times of Slaughtering. Slaughtering occurred in the borough on all days of the week, including Sunday, and took place at all times of the day ; as a result, the work of inspection frequently had to be continued until a late hour of the day, and also had to be performed on Public Holidays and on Sundays. Sanitation of Slaughter-houses and Knackers'-Yards. With occasional exceptions the slaughter-houses and knackers'-yards in use in the borough conformed to a reasonable standard of cleanliness. Application for Licences. Ten applications were received for the renewal of slaughterhouse licences, all of which were granted. Two applications for the renewal of knackers'-yard licences were also received and considered by the Public Health Committee. One of these was granted. The other was refused on the ground that the premises were not now suitable for use as a knackers'-yard. Prosecutions. Such infringements of the regulations and bye-laws as were observed were remedied following verbal warnings or warning letters, and thus no case was reported for the institution of legal proceeding's. TABLE I. Table showing Animals examined Post-Mortem and those found to be Diseased. Class of Animals. Number Inspected Affected with T.B. Affected with other Diseases. No. Percentage. No. Percentage Bovines— Bulls 8 ... ... 2 25.00 Bullocks 487 37 7.59 48 9.85 Cows 1.015 587 57.83 132 13.00 Heifers 40 6 12.50 2 5.00 Calves 82 2 2.43 1 1.21 Porcines— Boars 15 3 20.00 ... ... Sows 70 17 24.28 7 10.00 Porkers 4.031 354 8.78 278 689 Ovines— Sheep 6,833 463 6.77 Lambs 7,001 39 0.55 Caprines— Goats ... ... ... ... ... Kids ... ... ... ... ... Totals 19,582 1,005 5.13 972 4.96 103 TABLE II. BOVINES. PORCINES. Entire carcases and Viscera 14 Entire Carcases and Viscera 18 Heads 168 Forequarters 3 Tongues 164 Heads and Collars 140 Forequarters 4 Hands and Springs 2 Bottom Pieces 2 Legs 3 Shins 2 Hearts 19 Clods 2 Lungs 256 Stickings 2 Stomachs 16 Briskets 5 Intestines 9 Flanks 2 Mesenteries 289 Ribs 3 Livers 93 Eegs ½ Spleens 2 Hearts 10 Kidneys 11 Lungs 577 Diaphragms 5 Stomachs 28 Omenta 20 OVINES. Intestines 14 Mesenteries 137 Entire Carcases and Viscera 31 Livers 250 Pancreas 37 Loins 4 Spleens 19 Lungs 68 Kidneys 18 Livers 380 Mammary Glands 192 Kidneys 2 Slaughter of Animals Act, 1933. This Act received the Royal Assent on the 28th July, 1933, and came into operation on the 1st January, 1934. It requires the use of a mechanically operated instrument for the slaughtering or stunning in a slaughter-house or knackers'yard of:— (a) any horse, mare, gelding, pony, foal, colt, filly, stallion, ass, donkey, mule, bull, cow, bullock, heifer, calf, steer, ox, goat, or kid ; and (b) any pig, boar, hog or sow where there is available a supply of electrical energy or where such a supply could reasonably have been made available ; and (c) any sheep, ewe, wether, ram or lamb where a resolution is passed by the local authority requiring such animals to be slaughtered or stunned with a mechanically operated instrument. In connection with (c) above a resolution was passed by the Council on the '28th November, 1933, requiring that, as from the 1st January, 1934, a mechanically operated instrument must be used for slaughtering or stunning all sheep, ewes, wethers, rams or lambs slaughtered in the slaughter-houses and knackers'—yard within the borough. 104 The expression "mechanically operated instrument" includes an instrument for stunning by means of electricity. The Council, on the 19th December, 1933, granted slaughtermen's licences, to be in force for a period of one year from the 1st January, 1934, to fifty-nine persons. A fee of two shillings was charged for each licence. Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies Order, 1926. Milk (Special Designations) Order, 1923. Tuberculosis Order of 1925. THE REPORT OF THE VETERINARY OFFICER. The cowsheds and dairy cattle within the borough boundaries are inspected monthly, under the provisions of the Acts and Orders relating to the milk supply, and also as occasion demands under the Tuberculosis Order; at the same time the hygienic conditions governing the production of milk are also supervised. During the year nine hundred and forty-eight (948) inspections of cattle were made, and where it appeared desirable, samples of milk or sputum were taken for microscopical examination for the presence of tubercle bacilli. These measures resulted in the detection of three cows which came within the scope of the Tuberculosis Order, and in consequence these animals were slaughtered. One case was tuberculosis of the udder, one, although not so affected, was found to be giving tubercular infected milk, while one was an active case of pulmonary tuberculosis. Post-mortem examinations (at which the owner, accompanied by his Veterinary Surgeon, is entitled to be present) were conducted to ascertain the correctness of the diagnosis and also to certify the extent of the infection. Should the animal not be affected with tuberculosis the owner is entitled to the full value of his animal plus one pound, but if affected the compensation is assessed at 75% of the valuation in non-advanced cases, and 25% in advanced cases as defined bv the Order, with a minimum of thirty (30) shilli Compensation amounting to £42 was thus paid during the year, 75% of which was borne by the Ministry of Agriculture and Fisheries. The carcases of these animals were used, under supervision, for the manufacture of manures, etc. I he Tuherculosis Order was introduced to permit the destruction of any bovine animal suffering from tuberculosis in such a degree as to be a danger to other animals or a source of contamination to the milk supply. The percentage of milk cattle affected with tuberculosis is very high, but the majority do not come within the scope of the Order, although thev must be regarded as potential sources of infection. 105 INFECTIOUS DISEASES. NOTIFIABLE DISEASES (Other than Tuberculosis). The following table shows the number of cases of notifiable diseases during the year 1933, together with the number removed to hospitals and the total number of deaths from each disease. Diseases. Cases Notified. Removed to Hospital Total Deaths. Smallpox 20 20 ... Diphtheria 515 498 54 Scarlet Fever 1356 1034 6 Enteric Fever (including Paratyphoid) ... ... ... Puerperal Fever 15 13 5 Pneumonia 521 240 240* (Acute Primary and Acute Influenzal only notifiable) Cerebro Spinal Fever 13 11 10 Acute Polio Myelitis 1 1 ... Acute Polio Encephalitis ... ... ... Encephalitis Lethargica 2 2 ... Erysipelas 198 78 3 Ophthalmia Neonatorum 17 6 ... Malaria ... ... ... Continued Fever ... ... ... Dysentery ... ... ... Puerperal Pyrexia 26 20 ... * Includes all forms. Table indicating deaths during the past eight years from:— Year Scarlet Fever Whooping Cough Measles 1926 7 20 78 1927 7 73 6 1928 5 26 69 1929 6 114 22 1930 4 19 78 1931 5 35 3 1932 3 29 77 1933 6 47 1 Scarlet Fever (Return Cases). Cases occurring within the margin of one month from the discharge of a case from Hospital to the same house were regarded as "Return Cases." Of 1,034 admitted to Hospital, 38, or 3.6, were associated with recurrent infections in this way (see also report of Medical Superintendent of Plaistow Fever Hospital, pages 110—122). 106 Diphtheria Prevention. On account of the prevalence of Diphtheria towards the end of the vear, large posters were exhibited on all the available hoardings in the Borough, and leaflets were distributed pointing out the facilities offered for any child living in West Ham to be immunized against this disease, free of charge. Over three hundred children have been treated as a result of these posters. A specimen of the leaflet and various forms considered advisable to be used in connection with this scheme are shewn below,viz:— (1) Leaflet. County Borough of West Ham. DIPHTHERIA PREVENTION. Diphtheria is a dangerous disease. In England and Wales 80 out of every 100 deaths from this infection occur in children under 10 years of age, most are under 5 years. The Council have arranged that any child living in West Ham can be protected against Diphtheria Free of Charge. The protection is not complete until three months after the treatment, but this protection lasts for many years, if not for life. Many children have already been safeguarded by this treatment. All enquiries can be made at the Municipal Health Offices, Romford Road, Stratford, E.15. F. GARLAND COLLINS, Medical Officer of Health and School Medical Officer. (2) Application form. COUNTY BOROUCH OF WEST HAM. Medical Officer of Health's Department. Dear Sir (or Madam), PROTECTION ACAINST DIPHTHERIA. Diphtheria is one of the most dangerous diseases of childhood. Many children die from its effects each year, while many others arc permanently weakened as a result of this disease. 107 It must, therefore, be of great interest to you as a parent to realize that your child can be protected from Diphtheria by a very simple form of treatment, which consists in giving- three injections under the skin of the arm at weekly intervals. The treatment is harmless : there is no pain or discomfort: it causes no sore, leaves no scar, and, in practically every case, affords complete protection. Full protection against diphtheria is not developed immediately following the treatment, but becomes established within about three months, remaining, thereafter, effective for a number of years. This treatment is provided free of charge for any child living in West Ham. If you desire your child to be protected in this way will you please complete the attached form and return it to me at:— THE MUNICIPAL HEALTH OFFICES, ROMFORD ROAD, STRATFORD, E.15. You will then be notified when and where to take your child for treatment. Yours faithfully, F. GARLAND COLLINS, Medical Officer of Health, and School Medical Officer. February, 1934. I desire that my child/children should be protected against Diphtheria. Infant Welfare Centre or Name of Child. Age. School attended (if any). Signed Parent or Guardian. Address Date 108 Clinic Card 1. County Borough of West Ham. Medical Officer of Health's Department. PROTECTION ACAINST DIPHTHERIA. I hereby consent to my child born being innoculated against Diphtheria. School attended (if any) Dept Infant Welfare Centre attended (if any) Signed (Parent or Guardian) Address Date Clinic Card 2. (Front). County Borough of West Ham. Medical Officer of Health's Department. DIPHTHERIA IMMUNISATION at CLINIC Name Date of Birth (Surname first) Address Date of Parents Consent School (if any) Dept Infant Welfare Centre (if any) Previous illnesses Immunisation Treatment. Date Treatment and Remarks Signature of Medical Officer (Back) Shick Test after Treatment. Date of Injection Date of Examination after Injection Result Remarks Signed for F. GARLAND COLLINS, Medical Officer of Health and School Medical Officer. 109 PLAISTOW HOSPITAL. The Medical Superintendent (Dr. D. Maclntyre) reports as follows:— The number of patients under treatment during 1933 was 2,080. This is a slight increase over the number treated in the previous year. The total deaths numbered 105, as compared with 128 in the previous year. In the early part of the year the Children's Hospital at Harold Wood was transferred to the Public Assistance Committee to relieve the overcrowding of the chronic sick in their institutions. This Hospital, which had 116 beds for fever cases, had been used for the convalescence of scarlet fever and diphtheria patients from Plaistow Hospital, and by its transference to the Public Assistance Committee the accommodation available for infectious diseases was reduced by one-third. Also the convalescence, particularly of diphtheria patients, was not so satisfactory at Plaistow Hospital as it had been previously in the healthier environment of the Harold Wood Hospital. On account of the reduced accommodation, the practice of admitting severe cases of whooping cough, measles and pneumonia had to be discontinued. The accommodation was reserved almost entirely for scarlet fever and diphtheria, the preference being given to diphtheria cases. Unfortunately, these two diseases increased in prevalence during the year, and it was found impossible to admit many of the scarlet fever cases that were notified. The first signs of a rising epidemic of scarlet fever occurred in June, and thereafter the number of admissions rapidly increased until the beginning of October, when the accommodation proved insufficient for the admission of all the cases notified. The type of disease remained mild. An unsually virulent type of diphtheria appeared in the district during the month of February, and cases of this type continued to be admitted throughout the rest of the year. The fatality from the disease steadily increased in spite of the administration of large doses of antitoxin, and by the end of the year the deaths numbered 49 as compared with 9 in the previous year. No case of typhoid fever was under treatment during the year. Two cases had been admitted as such, but they did not prove to be suffering from the disease. Measles was not prevalent during the year, and only a few cases were under treatment. 110 111 TABLE I. 1933 Admissions. Deaths. Scarlet Fever. Diphtheria. Typhoid Fever. Measles. Pneumonia Erysipelas. Chickenpox. Puerperal exia Whooping Cough. Other Diseases. Total. Scarlet Fever. Diphtheria. Typhoid Fever. Measles. Pneumonia Erysipelas. Chickenpox. Puerperal Pyrexia Whooping Cough. Other Diseases. Total. January 46 28 ... ... 31 9 3 ... 38 22 177 1 1 ... ... 6 ... ... ... 5 5 17 February 44 44 ... ... 13 9 4 2 6 19 141 ... 5 ... ... 9 2 ... ... 5 5 26 March 49 39 ... 2 3 6 1 1 ... 20 121 ... 7 ... ... 2 ... ... ... 1 ... 10 April 68 25 ... ... 4 6 ... ... ... 19 122 1 1 ... ... ... 1 ... ... ... ... 3 May 66 36 ... 1 ... 7 3 1 ... 19 133 1 4 ... ... ... ... ... ... ... ... 5 June 90 24 ... 1 ... 1 1 ... ... 16 133 ... 1 ... ... ... ... ... ... ... 2 3 July 88 36 ... 3 1 1 ... ... ... 21 150 ... 4 ... ... ... ... ... ... ... 3 7 August 100 33 ... ... ... 1 ... ... ... 14 148 ... 1 ... ... ... ... ... ... ... 2 3 September 110 46 ... ... ... 5 1 ... ... 10 172 1 2 ... ... ... ... ... ... ... 1 4 October 84 85 ... 1 ... 2 ... ... ... 10 182 1 8 ... ... ... ... ... ... ... ... 9 November 83 33 ... ... 1 3 ... ... ... 9 129 1 4 ... ... 1 ... ... ... ... ... 6 December 85 106 ... 1 1 2 1 ... ... 10 206 ... 11 ... ... ... ... ... ... ... 1 12 Totals 913 535 ... 9 54 52 14 4 44 189 1,814 6 49 ... ... 17 3 ... ... 11 19 105 TABLE 11. Scarlet Fever. Diphtheria. Typhoid Fever. Measles. Pneumonia. Whooping Cough. Erysipelas. Other Diseases. Total Year. Ad. D. Ad. D. Ad. D Ad. D. Ad. D. Ad. D. Ad. D. Ad. D. Ad. D. 1896 170 8 114 23 ... ... ... ... ... ... ... ... ... ... ... ... 284 31 1897 188 6 163 21 ... ... ... ... ... ... ... ... ... ... ... ... 351 27 1898 206 4 249 42 ... ... ... ... ... ... ... ... ... ... ... ... 455 46 1899 192 2 309 49 ... ... ... ... ... ... ... ... ... ... ... ... 501 51 1900 177 4 269 36 ... ... ... ... ... ... ... ... ... ... ... ... 446 40 1901 203 16 310 66 47 4 ... ... ... ... ... ... ... ... ... ... 560 86 1902 257 12 431 72 138 30 ... ... ... ... ... ... ... ... ... ... 826 114 1903 370 10 334 48 84 17 ... ... ... ... ... ... ... ... ... ... 788 75 1904 679 29 351 31 95 15 ... ... ... ... ... ... ... ... ... ... 1125 75 1905 747 18 438 53 62 14 ... ... ... ... ... ... ... ... ... ... 1247 85 1906 806 18 421 70 127 18 ... ... ... ... ... ... ... ... ... ... 1354 106 1907 667 29 422 82 68 12 ... ... ... ... ... ... ... ... ... ... 1157 123 1908 665 26 373 47 73 12 ... ... ... ... ... ... ... ... ... ... 1111 85 1909 990 32 337 35 34 5 ... ... ... ... ... ... ... ... ... ... 1361 72 1910 655 17 260 45 71 14 ... ... ... ... ... ... ... ... ... ... 986 76 1911 491 13 295 52 70 15 ... ... ... ... ... ... ... ... ... ... 856 80 1912 562 17 291 35 49 10 ... ... ... ... ... ... ... ... ... ... 902 62 1913 782 13 333 24 42 6 ... ... ... ... ... ... ... ... ... 1157 43 1914 699 10 380 43 36 7 ... ... ... ... ... ... ... ... ... ... 1115 60 1915 575 8 403 60 40 11 ... ... ... ... ... ... ... ... ... ... 1018 79 1916 310 7 533 64 23 2 ... ... ... ... ... ... ... ... ... ... 866 73 1917 304 8 559 67 27 4 ... ... ... ... ... ... ... ... ... ... 890 79 1918 213 4 464 70 25 ... ... ... ... ... ... ... ... ... ... ... 702 74 1919 373 3 601 57 15 2 18 2 5 2 ... ... ... ... 24 3 1036 69 1920 748 6 769 62 14 3 11 ... 2 2 ... ... 1 ... 25 5 1570 78 1921 1,119 10 560 32 7 ... 1 ... 2 2 ... ... ... ... 21 11 1710 55 1922 592 8 611 40 3 1 15 ... 5 1 21 4 1 ... 23 9 1271 63 19236 412 7 671 23 10 ... 33 ... 12 6 ... 10 ... 34 7 1182 43 1924 317 4 713 27 2 1 100 19 24 7 44 15 8 ... 137 7 1345 80 1925 412 4 719 18 5 1 81 6 24 2 22 8 14 1 150 9 1427 49 1926 899 6 647 13 7 ... 85 17 25 5 5 2 15 2 189 11 1872 56 1927 1250 3 816 34 12 2 19 1 17 5 13 5 5 ... 96 7 2228 57 1928 916 3 901 29 7 ... 60 9 16 3 13 4 17 1 122 9 2052 58 1929 983 5 741 33 4 ... 20 2 19 5 17 9 15 1 150 4 1949 59 1930 670 1 719 24 5 ... 86 15 11 1 12 1 14 1 133 9 1650 52 1931 540 4 327 10 ... ... 33 2 62 12 108 13 51 8 222 14 1343 63 1932 590 2 293 9 ... ... 282 3:1 214 37 118 14 42 4 326 20 1865 128 1933 913 6 535 49 ... ... 9 ... 64 17 44 11 52 3 207 19 1814 105 113 Cases of whooping cough and pneumonia were admitted only during the first two months of the year. After the transference of the Harold Wood Hospital to the Public Assistance Committee all the accommodation at Plaistow Hospital was taken up by scarlet fever and diphtheria cases. Erysipelas continued fairly prevalent throughout the year, and accommodation was provided for some of the more severe cases. At the beginning of 1933 there were 266 patients in residence, and 1,814 were admitted during the year, making a total of 2,080 under treatment. Of these, 1,741 were discharged as recovered, 105 died, and 234 remained under treatment at the end of the year. The chief causes of death during the year are briefly summarised as follows:— Scarlet Fever caused 6 deaths Diphtheria 49 ,, Pneumonia and Bronchitis 21 ,, Whooping Cough 11 ,, Meningitis 4 ,, Erysipelas 3 ,, Enteritis 3 ,, Other diseases 8 ,, The fatality rate, calculated on all the cases admitted during the year, was 5.78 per cent. Table I. shows the admissions and deaths for each month of the year, and in Table 11. there is shown the annual admissions and deaths from the principal infectious diseases since the Hospital was opened. Scarlet Fever. The total number of cases under treatment was 1,027. Of these, 927 were discharged, 6 died and 94 remained under treatment at the end of the year. Scarlet fever antitoxin was administered to 95 of the more severe cases which were admitted within the first three days of illness. The dosage varied from 10 to 50 c.c.s, the average being 20 c.c.s. The average duration of illness of all cases on admission was 3.89 days. In 114 cases, or 12 per cent. of the admissions, there was no rash present on the day of admission, and 121 cases showed no evidence of desquamation during their period of residence. In 64 cases, owing to the absence of rash and desquamation, the diagnosis remained doubtful. Of these, 8 developed the disease in the wards. A relapse occurred during the third week in four cases in which the diagnosis had been confirmed by the presence of rash and desquamation. The average duration of residence of all the cases was 37 days. c 115 Corrected diagnosis:—68 cases, notified as scarlet fever were wrongly diagnosed and proved after admission to be suffering from the following complaints:—Rubella 16, toxic rash 14, broncho pneumonia 5, measles 6, tonsillitis 4, gastro-enteritis 3, whooping cough 3, mumps 1, diphtheria 4, cervical adenitis 1, no disease 5, erysipelas 1, chickenpox 2, dermatitis 1, appendicitis 1, erythema 1. Fatality rate:—Of the 913 cases admitted during the year, 6 proved fatal; 3 of these were adults. A man, aged 20 years, and a woman, aged 36 years, were extremely toxic and died within 24 hours of admission. The other adult was a woman aged 67 years who was suffering from senile debilitv. One child, aged 9 years, died from endocarditis, and the other two children died from septic scarlet fever. The fatality rate was .65 per cent. In 28 cases the patient was found after admission to be suffering- from a second infection as follows :— Scarlet Fever with faucial diphtheria 3 cases ,, ,, ,, nasal diphtheria 11 ,, ,, ,, ,, chickenpox 8 ,, ,, ,, ,, rubella 3 ,, ,, ,, ,, whooping cough 2 ,, ,, ,, ,, nasal diphtheria and whooping-cough 1 ,, Of the 927 cases discharged, 299, or 32 per cent. suffered from complications as follows:— Adenitis 83 cases or 8.95 per cent. Albuminuria 49 ,, ,, 5.28 ,, ,, Arthritis 10 ,, ,, 1.07 ,, ,, Endocarditis 2 ,, ,, 0.21 ,, ,, Jaundice 3 ,, ,, 0.32 ,, ,, Nephritis 21 ,, ,, 2.26 ,, ,, Rhinitis 56 ,, ,, 6.04 ,, ,, Otorrhoea 71 ,, ,, 7.65 ,, ,, Vaginitis 4 ,, ,, 0.42 ,, ,, Diphtheria. The total number of cases under treatment was 588. Of these, 408 were discharged, 49 died, and 131 remained under treatment at the end of the year. Corrected diagnosis:—113 cases which had been notified as diphtheria were wrongly diagnosed and proved after admission to be suffering from the following complaints:—Tonsillitis 57 Laryngitis 16, Quinsy 9, Pharyngitis 4, Adenitis 2, Appendicitis 1, Rhinitis 2, Enteritis 1, No disease 2, Asthma 1, Bronchitis 6, Broncho Pneumonia 5, Measles 2, Lead Poisoning 1, Mumps 1, Scarlet Fever 3. 116 Of the 457 cases which were discharged or died, 381 suffered from faucial diphtheria, 38 had nasal diphtheria only, 21 had laryngeal diphtheria, 4 were cases of otorrhoea with positive swabs, and 13 were bacteriological cases showing no clinical signs of the disease. Among 381 faucial cases, 75 had severe clinical attacks and 306 were mild or of moderate severity. The amount of antitoxin administered to the severe cases varied from 48,000 units to 224,000 units given partly by intravenous and partly intramuscular injection. The average amount was 98,000 units. The amount of antitoxin given to the other cases averaged 19,000 units. Post diphtheritic paralysis occurred in 37 cases. It was severe in 18 cases and mild in 19 cases. Laryngeal diphtheria:—48 cases were admitted as laryngeal diphtheria, but 27 of these proved to be wrongly diagnosed. Of the 21 true cases, 9 required tracheotomy and 4 of these proved fatal. Three of the fatal cases suffered also from severe faucial diphtheria. The amount of antitoxin administered to the laryngeal cases averaged 24,000 units. Fatal cases:—All the fatal cases were children under 12 years of age. One died in the ambulance and 10 others were so toxic that they died within 24 hours of admission. The other cases died at varying periods during the first two weeks of illness, with the exception of 3 cases which died of post-diphtheritic paralysis late in the disease. One child of 11 months who died from nasal diphtheria was suffering also from marasmus. The fatality rate among the faucial cases was 11.54 per cent. The average duration of illness of the fatal cases prior to admission was 3.76 days, and the amount of antitoxin administered to them averaged 90,000 units. The average duration of residence of all the cases was 40.37 davs. Measles. Only 10 cases were under treatment during the vear. Of these, 6 had been admitted under a diagnosis of scarlet fever and 2 as laryngeal diphtheria; 8 were of a mild type, and 2 had a severe attack. All made a satisfactory recovery. Whooping Cough. Sixty-five cases were under treatment during the first 3 months of the year. Of these, 54 were discharged and 11 died, giving a fatality rate of 16 per cent. All the fatal cases were children under 4 years of age, and were complicated by broncho pneumonia. The disease was associated with scarlet fever in 5 cases and with diphtheria in 4 cases. Two diphtheria patients contracted whooping cough in the wards. 117 Pneumonia. Cases of bronchitis and broncho pneumonia are included under this group. A total of ,124 cases were under treatment. Of these, 23 suffered from lobar pneumonia, 85 from broncho pneumonia, and 18 from bronchitis. Twenty-one cases proved fatal, and of these, 4 were from lobar pneumonia, 15 from broncho pneumonia, and 2 from bronchitis. The deaths from broncho pneumonia were all in children under 2 years of age. Erysipelas. A total of 55 cases were under treatment. Of these, 51 were discharged, 3 died, and 1 remained under treatment at the end of the year. All the cases were fairly severe. The face and scalp were the parts affected in 41 cases, the arms in 3 cases, and the legs in 4 cases, and in 7 cases the disease had spread over the greater part of the body. Of the 3 cases which proved fatal, a man aged 33 years and a child aged 14 months were complicated by broncho pneumonia; the third case was a man aged 62 years suffering from senile debility. The fatality rate was 5.76 per cent. All the cases received erysipelas antitoxin and polyvalent antistreptocoecal serum in dosage varying from 35 to 100 c.cs. Of 5 other cases which had been admitted as erysipelas, 3 proved to be suffering from cellulitis and 2 from dermatitis. Meningitis. Four cases of meningitis were under treatment. Two of these proved to be suffering from cerebro-spinal meningitis. Both were children under 5 years of age. They were both moribund on admission, and died within 24 hours. A girl of 16 years died from tubercular meningitis, and a boy of 8 years died from pneumococcal meningitis. Four other cases which had been admitted as cerebro-spinal meningitis proved to be suffering from the following complaints:—Broncho pneumonia 1; Meningism 1; Anaemia 1, Mastoiditis with subdural abscess 1. The latter proved fatal. Other Diseases. In addition to the cases of revised diagnosis which have already been mentioned, the following are included under this group:—Puerperal pyrexia 5, Chickenpox 15, Rubella 4, Mumps 6, Rheumatic fever 2, Endocarditis 1, Peritonitis 2, Mastoiditis 2, Keratitis 1, Scalds 1, Septic Pharyngitis and Septicaemia 1, Poliomyelitis 1, Renal Colic 1. Of these, the following proved fatal:—Rheumatic fever 1, Endocarditis 1, Scalds 1, Septic Pharyngitis 1. Cross Infection. Six scarlet fever patients were admitted at various periods during the year in the incubation stage of chickenpox, and 25 other patients contracted the disease from them. One other patient developed herpes zoster in her second week of illness, and within a fortnight an outbreak of chickenpox occurred in that ward 118 which involved 5 patients. One scarlet fever patient contracted faucial diphtheria and 7 contracted nasal diphtheria. Two other scarlet fever patients contracted rubella, 6 diphtheria patients contracted chickenpox, and 4 contracted scarlet fever. One other diphtheria patient contracted measles. Active Immunisation Against Diphtheria and Scarlet Fever. Schick Test. Number of patients tested 641 Number which proved positive 396 Rate per cent. of positives 61.78 Number immunised 355 Number of cases in which permission for immunisation was refused 12 Rate per cent, of cases tested for whom permission for immunisation was refused 1.87 Dick Test. Number of patients tested 355 Number which proved positive 218 Rate per cent, of positives 61.41 Number immunised (4 weekly doses of Dick Toxin) 185 Number of cases in which permission for immunisation was refused 7 Rate per cent, of cases tested for whom permission for immunisation was refused 1.97 Cate 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 189 Number of these admitted 103 (Diphtheria 52, Scarlet Fever 27, Other diseases 24) Number brought by relatives 318 Number of these admitted 70 (Diphtheria 28, Scarlet fever 26, Other diseases 16) 119 Number from other hospitals 19 Number of these admitted 7 (Diphtheria 3, Scarlet fever 2, Other diseases 2) Total number of cases examined 824 (An increase of 295 over the previous year) Total number of cases admitted:— Diphtheria 83 Scarlet Fever 55 Other diseases 42 Total 180 Staff Illness. One probationer who gave a Dick negative reaction a few days after arrival for duty, developed scarlet fever nine months later. Three other probationers who were Dick positive contracted scarlet fever before they were immunised. All made a satisfactory recovery. Two "Schick positive" probationers contracted diphtheria before they were immunised—the attacks were not severe. Two probationers contracted whooping cough, one contracted rubella, and one contracted mild facial erysipelas. Twenty-three nurses and maids were warded with influenza, and 22 with tonsillitis. Fifty-eight others were off duty for short periods with minor ailments. All recovered. Schick Test, 1933. Number of probationers tested 60 Number which proved positive 28 Rate per cent. of positives 46 Number immunised 26 Dick Test, 1933. Number of probationers tested 60 Number which proved positive 12 Rate per cent. of positives 20 Number immunised 11 120 Bacteriological Work. Swabs examined for diphtheria bacilli:— Number sent by Medical Practitioners :— Positive results Per cent positive Faucial 1946 150 7.8 Nasal 163 26 16.0 Aural 22 3 13.6 Ophthalmic 1 — — Total 2132 179 8.4 Increase over 1932 655 56 Number sent by other Institutions:— Positive results Per cent positive Faucial 79 5 6.3 Nasal 17 5 29.4 Aural 2 1 50.0 Total 98 11 1,1.2 Number of gate cases swabbed:— Faucial 182 15 8.2 Nasal 52 7 13.5 Aural 7 2 28.6 Total 241 24 10.0 Increase over 1932 109 – Number of swabs examined for the Invalid Children's Aid Association:— Faucial 177 2 1.1 Nasal 179 11 6.1 Total 356 13 Increase over 1932 103 3 121 Number of swabs examined for the Invalid and Crippled Children's Society:— Positive results Per cent. positive Faucial 76 4 5.3 Nasal 70 5 7.1 Aural 2 – – Total 148 9 6.0 Increase over 1932 100 7 Widal reactions 2 – – Total number of examinations 2977 236 7.9 Increase over 1932 1063 76 Disinfecting Station. Number of articles removed from infected homes for disinfection 16423 Number of hospital articles disinfected 11071 Total 27494 Tuberculosis. The following table sets out the number of cases of Tuberculosis and the number of deaths during the year at certain age periods. Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. M. F. M. F. M. F. M. F. 0-1 1 4 4 1 1 4 4 1-4 5 3 8 8 ... 1 3 4 8-9 14 12 9 7 3 3 3 2 10-14 11 3 10 5 33 38 2 2 15-19 24 24 6 6 24 12 1 1 20-24 38 43 4 3 20 13 ... ... 25-34 65 40 4 6 30 11 ... 1 35-44 42 23 3 3 31 16 3 ... 45-54 40 15 3 6 21 9 ... 1 55-64 28 15 1 1 10 ... 1 ... 65 and upwards 12 4 ... ... 2 3 ... ... Totals 280 182 52 49 175 107 17 14 122 Included in the above new cases are 16 pulmonary males, 21 pulmonary females, and 7 non-pulmonary males and 4 nonpulmonary females, which were unnotified, but were discovered from the returns of the Registrar of Births and Deaths, showing that 16 per cent. of the deaths registered as due to Tuberculosis had not been notified during life. The following table sets out the percentage of deaths from tuberculosis (not notified during life) for the years 1924—1933, inclusive:— 1924 10.5 1929 8.0 1925 11.2 1930 13.0 1926 12.8 1931 18.0 1927 12.03 1932 15.0 1928 7.1 1933 16.0 In this connection many deaths notified as having been due to Tuberculosis are frequently so notified because the case had at some time or other suffered from this complaint, the actual cause of death often being due to some inter-current disease. The total number of fresh cases of Tuberculosis coming to my knowledge was 563, of which 462 were pulmonary cases. The deaths from all forms of Tuberculosis numbered 313, giving a death rate of 1.10 per 1,000 of the population. The death rate from respiratory Phthisis being 0.99, and from other forms 0.11, per 1,000 of the population. The reports of the Tuberculosis Officer and of the Medical Superintendent of Dagenham Sanatorium will be found on pages 124—128. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action taken. PUBLIC HEALTH ACT, 1925. SECTION 62. No action taken. Central Register. As a result of the coming into force of the Local Government Act, 1929, a Central Register was commenced, and is kept by the Public Assistance Officer. This register contains a record of all forms of assistance given to residents of West Ham. In this connection a specially designed form, setting out extra nourishment granted by the Tuberculosis Officer, is sent by me to the Public Assistance Officer. The information contained in the Central Register is available for all departments of the Council. 123 Tuberculosis Dispensary. The Tuberculosis Officer (Dr. P. A. Galpin) reports as follows:— The routine work of the Dispensary has been continued throughout the year. Comparison with work done in previous Years. Year 1928 1929 1930 1931 1932 1933 Request Cases 670 683 567 592 564 553 Notified Cases 198 142 176 130 128 98 Definite Cases 473 467 495 400 451 419 Contacts 633 532 561 448 585 507 Positive 22 19 20 .12 15 20 Percentage 3.5 3.7 3.7 2.6 2.5 3.9 Tuberculosis of Lungs. Diagnosis. The usual means of establishing a physical diagnosis have been adopted, viz.: study of the history of illness, clinical examination, sputum test and X-Rav examination. An increasing use of X-Rays is noted. Ninety-five X-Ray examinations were made. Appropriate treatment is arranged for definite cases; other cases are not discharged immediately, but are further examined with a view to determining the presence of a diathesis or predisposition to Tuberculosis. A faulty food habit such as leaving out, habitually, Green Vegetables or Fat is regarded as evidence of this. Such cases are kept under observation at the Dispensary until a normal food habit is established. Treatment. Dagenham Hospital and Sanatorium. Both febrile and afebrile or advanced and early cases have been sent to Dagenham. Grosvenor Sanatorium has been used for early cases either as an overflow or on special grounds, and the Brompton Hospital for special cases requiring some form of Collapse Treatment. Seamen have been treated at Bramshott. No. under Treatment Colony. at 1st Jan. or Disch. Died Remaining Settled admitted. Burrow Hill 7 5 — 2 — Preston Hall 3 1 — 1 1 Papworth Hall 4 Men 2 Men 1 Man 1 Man — 2 Women 2 Women 124 I have to report, with satisfaction, that one of the patients who was treated at the Burrow Hill Colony received also training' in Gardening and that since his discharge home, in July, 1933, he has been accepted for trial as a worker in the Parks Department of the Borough. Children. The Children's Sanatorium at Langdon Hill has been in full use. Domiciliary Treatment. Insured persons, awaiting admission to Institutions, or after discharge, have been placed on Domiciliary Treatment. Periodic reports are furnished by Panel Practitioners. Six hundred and thirty-five reports have been received during the year ; 372 patients were under treatment at the end of the year. Dispensary Treatment. Children and non-insured persons have been treated at the Dispensary. At the end of the year 580 cases were receiving Dispensary Treatment. Artificial Pneumothorax. Seventeen cases have been under regular treatment. One hundred and twenty refills have been given at the Dispensary. Non-Pulmonary Tuberculosis. Adult cases have been sent to the Royal Sea-Bathing Hospital, Margate. Children have been treated in different Orthopaedic Hospitals; the majority at the Lord Mayor Treloar Cripples' Hospital, Alton. Tuberculosis of Skin. Twenty-one cases have been under treatment by Finsen Light or Artificial Sunlight at the London Hospital. After Care. All cases on return from Institution are examined at the Dispensary or in their own homes, if necessary, and appropriate treatment arranged. Orthopaedic cases are referred either to the original Surgeon or to the Orthopaedic Surgeon at the Balaam Street Children's Hospital. Extra Nourishments. The number of cases has been gradually increasing. At the end of the year 260 cases were receiving grants; this number includes children. Aetiology of Tuberculosis. Investigations into the causation of Tuberculosis have been continued. Particular attention has been directed to the relation of the onset of the disease to some discouragement or worry. In some 200 cases investigated, approximately, 50% have given a story of some associated discouragement—shock, disappointment or bereavement. The presence of such an association is regarded as important in the subsequent treatment and progress of the disease. In consequence of these observations, Tuberculosis Nurses are visiting families some six months after the decease of a patient to enquire as to the health of the rest of the family. 125 DAGENHAM SANATORIUM AND LANCDON HILLS SANATORIUM FOR CHILDREN. Dagenham Sanatorium. The Medical Superintendent (Dr. G. M. Mayberry) reports as follows:— At the end of 1932 the number of patients remaining under treatment were:— Males 74 Females 43 117 The total admissions during 1933 were:— Males 155 Females 79 234 The number of deaths was:— Males 38 Females 28 66 Discharges during the year totalled:— Males 119 Females 47 166 Leaving under treatment at the 31st December, 1933:— Males 72 Females 47 119* *Including 16 Non-Insured persons. Insured persons admitted during the year totalled 198, the remaining 36 being Non-Insured. Forty-one Ex-Service men were admitted to the Sanatorium during the same period. The Death Rate (calculated on admissions) was 28.20%. In the case of males the percentage was 24.51, and in the case of females 35.44. The Average Duration of Residence (both sexes) was 17,1.88 days. The average for males was 157.14 days, and for females 209.21 davs. I he grades ot cages discharged and the results ot treatment were as follows:— T.B. Minus T.B. plus Grade I. T.B. plus Grade II. T.B. plus Grade III. Total Males 45 17 29 28 119 Females 23 2 17 5 47 MALES. Quiescent 21 13 8 — Improved 23 4 21 15 No material improvement 1 — — 13 45 17 29 28 126 FEMALES. Quiescent 10 2 4 — Improved 11 — 9 — No material improvement 2 — 4 5 23 2 17 5 During the past year 234 cases were admitted for treatment, compared with 287 in the previous period. The Death Rate, calculated on admissions, was 28.20%, compared with ,19.51% last year. These figures are very unsatisfactory, and until a larger percentage of cases reach the Institution in an earlier stage the result will continue disappointing. A considerable number of patients are admitted to the Institution in an advanced state of disease after previous treatment in other Institutions. It can be said with confidence that no treatment yet found can compare with Sanatorium, and when every avenue is explored to see that cases reach the Sanatorium early then, and then only, can satisfactory results be expected. While the death rate has been exceptionally high, one finds satisfaction in knowing that an Institution is the suitable place for a moribund and highly infectious patient, but with the admission of an increased number of moribund cases, more suitable accommodation for such cases is highly essential. The following table shews the comparison of rainfall for the past three years :— Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. 1931 1.31 1.41 .24 3.06 2.17 1.19 2.18 3.20 1.13 .48 1.99 .44 1932 .98 .16 1.31 1.38 2.57 .51 1.83 1.73 1.50 3.81 .45 .27 1933 .77 .90 1.04 .51 1.53 2,16 1.30 .28 1.87 .96 .72 .33 Entertainment. The entertainment that has been provided for the patients and Staff during the past year, consisting of monthly concerts, whist drives, and billiard handicaps, have been very highly appreciated, giving as it undoubtedly does something for the patients to look forward to, especially during the winter months. Nursing Staff. As in past years, Nurses have been tutored for the Tuberculsis Association's Examination. Four Nurses have been successful in passing the Final and gaining their Certificate, while two others have passed Part 1. 127 Staff Medical. Medical Superintendent. Assistant Medical Officer. Administration. Steward. Nursing. Matron. Assistant Matron and Sister Tutor. 3 Sisters (One Night). 1 Nurse-Housekeeper. 2 Staff Nurses. 4 Assistant Nurses. 15 Probationers. Domestic. 31 (including 6 laundry-maids, sewing maid, and Lodge Attendant). Male. 1 Caretaker. 1 Fitter. 1 Handyman. 1 Stoker. 1 Gardener. 4 Porters. 1 Night Watchman. WEST HAM SANATORIUM FOR CHILDREN, LANGDON HILLS. At the end of 1932 the number of patients remaining under treatment were:— Males 18 Females 22 40 The total admissions during 1933 were:— Males 21 Females 12 33 The number of deaths were:— Males Nil Females Nil Nil Discharges during the year totalled:— Males 18 Females 15 33 Leaving under treatment at the 31st December, 1933:— Males 21 Females 19 40 The Average Duration of Residence (both sexes) was 376.91 days. The average for males was 382.61 days, and for females 370.06 days. 128 The results of treatment for those discharged are as follows: T.B. Minus T.B. plus Grade I. T.B. plus Grade II. T.B. plus Grade III. Total Males 18 - - - 18 Females 11 - 3 1 15 MALES. Quiescent 16 - - - Improved 2 - - - No material improvement - - - - 18 - - - FEMALES. - - - - - Quiescent 10 - 2 - Improved 1 - 1 - No material improvement - — — 1 11 - 3 1 I he duration of residence has been somewhat higher than in the previous year. The period of treatment depends not only on the condition of the child, but it is essential that the home conditions should be considered before discharge. To send a child home to unsuitable surroundings not only does away with any benefit gained, but it is bound to bring about a very detrimental re-action. As the years go by since the opening of the Institution one becomes more and more impressed with the highly satisfactory results that can be obtained. The treatment in children is as encouraging as it is discouraging in adults. There are a large number of factors which contribute to this, and not the least the amenability of the children to treatment; even in a few cases should the child be home-sick for a few days, it is all forgotten soon, and they settle down to a really happy and contented existence. The adult often has many home cares and worries to think about, while the youth and younger girl have already reached a period in their life where their ideas and habits are difficult to change, and to plan a different outlook for them is often impossible. One can scarcely imagine anything more disappointing or sad than to see a child who has responded magnificently to treatment, looking well, with its life before it, discharged to an unsuitable home, sooner or later to break down and enter an adult Sanatorium, when it is certain that with prolonged treatment or observation in suitable surroundings they can eventually be fully restored to health and live useful and successful lives. How is this to be overcome ? I am convinced that it can be to a very large extent. It is recognised that very useful work is done in Colonies for adults, and with the material to hand in cases among children a still more hopeful plan is available. 129 At Langdon Hill there is a unique opportunity with the land surrounding the Institution to organize a scheme. I do not propose to outline a scheme here in detail, but rather to place roughly the lines that could be taken. 1 suggest that two small hostels could be built to accommodate eight to ten of either sex. These hostels to be occupied by cases suitably selected after a suitable period of treatment, where they can be trained in work to develop the existing site. The boys can be occupied in gardening, where fruit and vegetables of all kinds can be produced for the entire requirements not only of the Institution but also for Dagenham Sanatorium. In addition to this there is also room for poultry, and the question of providing milk for the Sanatorium is worthy of consideration. The girls can be trained in domestic work with the eventual idea of taking their place on the Staff of the Institution as vacancies occur. They can also be employed in sewing and repairing clothing, etc. In the elaboration of most schemes the expense involved is often underrated. Here the capital expenditure can be extremely moderate, and with suitable selection of cases should make the running of the Institution more economical. As regards Staff, we have already an experienced gardener capable of teaching and supervising the boys, though no doubt it would be necessary to have some help to organize poultry farming. I consider with the present staff we have sufficient to supervise the girls. The fruits of the scheme cannot be felt for some years, until the children arc old enough to take their full share in work, but the time will come when they can be proud to leave the Institution to make way for others, to compete in the outerworld, or get employment in another Institution, instead of having the misfortune to eke out their existence on public funds. With a scheme such as this under every public authority I believe it would be eventually possible to provide almost the entire staff for their adult Sanatoria. The following was the rainfall for the past three years in inches:— Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. 1931 .99 1.37 — 4.08 2.57 . 88'3.33 4.48 .91 — 1.87 .38 1932 1.15 — 1.03,1.52 3.51 .26 2.98 1.35 1.48 3.90 .52 .26 1933 1.07 .69 .69 .45 .72 1.84 .63 —2.10 .94 .47 .42 Staff. Nursing. Matron 2 Sisters. 7 Probationers. Domestic. 8 Male. 1 Head Gardener and Caretaker. 1 Motor Driver. 1 Handyman and Porter. 2 Assistant Gardeners. 130 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 22 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 to the British Social Hygiene Council to further propaganda work throughout the whole area. 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 including all public sanitary conveniences. 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 twelve 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 last year, setting out for comparison the particulars relating solely to West Ham and those relating to the whole of the participating authorities as regards the use made of the hostels. 13' Venereal Diseases (L.C.C. Scheme). Summary of work done by the Hospitals during the Year 1933. London. Middlesex. Essex. Surrey. Kent. Herts. Bucks East Ham. West Ham. Croydon. Total. Other Places. Grand Total. New Patients Syphilis 3,276 356 205 140 88 80 23 45 60 16 4,269 441 4,710 Soft Chancre 130 7 10 ... 6 4 2 2 2 1 163 32 195 Gonorrhoea 8,546 1,060 63 326 190 134 54 128 256 46 11,370 734 12,104 Not venereal 8,464 1,083 504 485 177 130 51 86 185 71 11,236 469 11,705 Total 20,416 2,506 1,349 951 460 328 130 261 503 134 27,038 1,676 28,714 Total attendances 856,592 81,165 55,244 25,584 11,021 8,502 2,900 11,228 26,025 2,407 1,080,668 16.546 1097214 No. of in-patient days 30,807 3,271 3,352 2,032 1.953 711 181 166 323 94 42,890 9,691 52,581 Salvarsan Subs, doses 46,084 6,710 3,615 2,220 1,001 844 351 634 1,255 179 62,893 3,110 66,01 3 132 PATHOLOGICAL EXAMINATIONS. For or at Centres:- Spirochaetes 2,297 109 102 63 22 30 11 17 17 8 2,676 116 2,792 Gonococci 86,701 8,161 7,854 4,551 1,964 1,102 657 1,306 3,140 505 115,941 2,376 118,317 Wassermann 33,137 3,128 2.022 1,628 647 524 217 405 755 213 42,676 1,549 44,225 Others 35,782 2,124 7,819 1,093 713 338 115 1,654 3,108 129 52,875 1,643 54,518 Total 157,917 13,522 17,797 7,335 3,346 1,994 1,000 3,382 7,020 855 214,168 5,684 219,852 For Practitioners:— Spirochaetes 29 1 2 2 ... ... 1 ... ... ... 35 ... 35 Gonococci 5,903 221 424 411 196 79 42 3 17 987 8,283 111 8,394 Wassermann 16,311 1,117 1,026 918 155 104 133 28 4 397 20,193 496 20,689 Others 8,532 208 764 377 33 25 3 25 3 391 10,361 170 10,531 Total 30,775 1,547 2.218 1,708 384 208 179 56 24 1.775 38,872 777 39,649 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. Gonorrhoea. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Clinic Practition ers. 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 24.4 03 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 1926 3,725 2,013 301 2 8,825 2,858 12,851 4,873 5,830 3,158 490,578 196,497 31,258 70,477 100,543 27,565 1927 3.886 2,209 203 7 9,637 2,859 13,726 5,075 6,799 3,365 554,171 213,107 21,268 91,145 107,512 27,046 1928 3,433 1,837 229 6 8,249 2,647 11,911 4,490 6,369 3,226 544,969 218,566 23,821 41,285 107,410 29,785 1929 3 303 1,628 276 4 8,271 2,503 11,850 4,135 5,656 3,145 557,747 211,125 23,121 28,399 114,840 32 605 1930 3,389 1,836 347 12 8,620 2,503 12,356 4,351 6,305 3,857 623,820 212,399 21.033 30,183 125,177 33,309 1931 3,009 1,521 326 12 7,713 2,260 11,048 3,793 6,853 4,253 699,752 230,596 23,408 33,133 161,092 35,468 1932 3,270 1,671 172 15 8,566 2,656 12,008 4,342 7,286 4,316 737,558 246,363 22,774 31.249 196,357 40,026 1933 3,072 1,638 185 10 8,791 3.313 12,048 4.961 7,325 4,380 804,042 293,172 23 504 29,077 219,852 39,649 133 Venereal Diseases (L.C.C. Scheme). Return showing the extent to which the facilities have been utilised during the year ended 31st December, 1938. Hospital. New Cases. No. of Persons. Total attendances. No. of Inpatient days. Sal. Subs, doses given. Pathological Examinations. Total. Syp. S.C. Gon. Not V.D. Total. Ceased to attend. Discharged Spiro. Gon. Wass. Others. M (b) M (b) (a) (b) (a) (b) Albert Dock 161 25 339 250 765 31 496 11,062 2,024 1,291 14 ... 308 18 826 153 826 153 2,298 Gt. Ormond Street 53 ... 11 567 621 15 610 3,465 2,180 1,181 ... ... 470 26 1.106 246 740 150 2.738 Guy's 366 15 637 933 1,951 214 1,731 62,469 1,898 7,144 215 1 12,658 1.033 3,466 2,580 4,652 743 25,348 King's College 128 4 89 246 467 141 343 13,405 724 966 16 6 1,202 156 1,443 2,545 6 1 5,375 L.C.C. Clinic (Whitechapel) 668 47 2,391 1,359 4,465 1,581 1,768 301,398 2.949 10,996 660 ... 30,601 1,428 6,905 3.557 34,093 5,083 82.327 Metropolitan 67 12 158 132 369 108 251 24,786 265 1,332 18 1 612 108 517 275 115 60 1,706 Middlesex 143 5 500 61 709 233 251 38,650 1,333 1,196 9 3 4,434 179 895 1 248 35 591 7,386 Miller General 86 2 206 73 366 194 228 13,944 175 1,063 24 ... 1,081 14 328 716 ... ... 2,163 Royal Free 184 ... 591 610 1,385 183 1,200 35,591 2,685 3,054 19 ... 7,409 144 2,618 883 3,997 926 15,996 Royal London Oph. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Northern 202 2 647 303 1,154 247 634 43,018 222 3,035 66 1 1,699 28 937 1,588 6 ... 4,325 St. George's 221 15 613 382 1,231 320 851 40,030 1 001 2,743 7 485 39 2,042 141 10 ... 2,724 St. John's (Lewisham) 56 1 144 229 430 38 433 9,397 530 670 9 ... 281 61 648 325 504 77 1 905 St. Mary's 263 ... 559 236 1,058 104 221 24,049 357 2 680 70 4 3,348 243 1.205 1,748 184 17 6.819 St. Paul's 260 7 1,071 1,135 2,473 116 2,206 130.970 2,321 5.830 229 1 11,118 1,54 3,774 559 122 54 17.511 St.Thomas' 804 45 1,850 3,267 5,966 1,332 4,594 174,763 4,755 8,321 1,098 2 27,208 2,574 11,180 2,186 4,035 395 48,678 Seamen's 389 11 613 247 1,260 627 545 13,258 9,718 2,545 106 ... 1,395 71 847 111 1,528 24 4 .082 South London for Women 24 ... 147 122 293 23 111 8,682 529 53 ... ... 1,151 114 221 142 ... ... 1,628 University College 186 ... 363 93 642 267 583 34,299 559 2,185 4 ... 1,727 241 1,089 7 ... ... 3,068 West London 333 2 724 1,175 2,234 397 1,848 84,190 2,225 8 237 205 9 6,851 238 3,144 754 3,225 817 15 243 Westminster 109 o 213 47 371 83 282 21,750 145 1,436 19 ... 1,225 25 629 933 440 1,440 4,711 S.A. Mothers' 14 ... 187 248 449 25 604 8 ,038 5,275 55 11 ... 3,054 ... 405 ... ... ... 3,470 Children's, Waddon 4 ... 51 ... 55 ... 54 ... 10,711 ... ... ... ... ... ... ... ... ... Totals 4,710 195 12,104 11,705 28,714 6,279 19, 845 1,097,214 52,581 66,003 2,792 35 118.317 8,394 44,225 20,689 54,518 10,531 259,601 Pathology—(a) For Centre, 219,852. (b) For Practitioners, 39,649. 135 Venereal Diseases. Utilisation of facilities at Hostels, 1933. Particulars of the work done on behalf of the participating authorities by the hostels in the scheme for the year ended 31st December, 1933. These institutions are as follows:— Royal Free—20-22 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—122-4 Lower Clapton Road, E. Salvation Army—126-8 Lower Clapton Road, E. West London Mission—35 Parkhurst Road, N.7. 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 144 14,574 56.3 Middlesex 13 2,256 8.7 Essex 13 1,307 5.0 Surrey 20 2,460 9.5 Kent 16 2,356 9.1 Herts 17 2,297 8.9 Bucks 3 317 1.2 East Ham - - - West Ham 2 245 1.0 Croydon 2 80 .3 Totals 230 26,891 100.0 137 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE YEAR 1933 F. GARLAND COLLINS, M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. 139 TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I have the honour to present to you the Annual Report of the School Medical Service for the year 1933. No new development has taken place of sufficient importance to merit special mention. The health of the school children contiues to be, on the whole, of a high order. Extensive outbreaks, both of Scarlet Fever and of Diphtheria, caused a correspondingly big drop in the percentage of school attendance, particularly in the Infants' Departments. In regard to Scarlet Fever the mortality rate among the scholars was very slight, only two deaths having occurred, but in respect of Diphtheria the disease was more virulent than usual, and caused the death of no fewer than 27 school children. (See page 27). The staff have lost with regret several members, namely Dr. Borland, who was superannuated, Miss Parsons, who resigned in December, and Nurse Robson. By direction of the Board of Education the general outline of this Report is somewhat modified from previous Reports. Your obedient Servant, School Medical Officer. Municipal Health Offices, Romford Road, Stratford, E.15. May, 1934. 141 (1) Staff. The Staff consists of the following Officers:— Chief School Medical Officer . F. Garland Collins, M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (also Medical Officer of Health). Chief Assistant School Medical Officer. Robert J. Reid, M.B., Ch.B. (Edin.), D.P.H. (Edin. Univ.). Assistant School Medical Officers (full time) . A. C. Lupton, M.B., C.M. ' H. McD. Borland, M.B., Ch.B. (retired June, 1933). A. Furniss, L.R.C.P., L.R.C.S., L.R.F.P.S. (Glas.), D.P.H., L.D.S. A. Muriel Ison, M.D., D.P.H. Jessie H. Fitchet, M.B., Ch.B., D.P.H. B. M. R. West, M.R.C.S. (Eng.), L.R.C.P. (Lond.) (Since August, 1933.) Dental Officers (full time). L. K. Percy, L.D.S. (Eng.). J S. Dick, L.D.S. (Eng.). Helene M. Gubb, L.D.S. (Eng.). O. B. Heywood, L.D.S. (Eng.). Dorothy Marsden, L.D.S. (Eng.). (Temporary) School Oculist (full time) . W. J. Thomas, M.R.C.S., L.R.C.P., D.P.H. Consultant Aural Surgeon (part time) . F. Stoker, F.R.C.S. Clerical Staff. Mr. F. W. England (Chief Clerk). Mr. R. H. Thomas (Senior Clerk) Mr. T. P. Swatts Miss P. I. Geaussent Miss M. I. Parsons Miss G. A. Blackler (resigned Dec., 1933) Miss M. G. England Mr. R. Huxtable Miss E. W. Wood 143 School Nursing Staff. Miss E. Alford Miss C. E. Hutton Miss D. S. Ayton Miss E. K. Jack Miss A. Burrows Miss C. H. Jones Miss E. M. Bussell Miss E. Large Miss A. J. Costain Miss A. K. McCormack Miss M. A. Costain Mrs. M. Mace Miss M. M. Empson Miss I. B. B. Mann Mrs. E. G. Eyton Miss L. F. Manning Miss E. Fraser (Knox Road & Miss M. H. Rose Crosby Road Special Schools) Miss A. Sheehan Miss L. C. Glover Miss E. R. Tanner Mrs. C. B. Halls Miss M. E. Tanner Miss E. D. Harris Miss M. A. Van Ryssen Miss F. G. Hobbs Mrs. S. Wilderspin (Grange (Special Enquiry Nurse) Road Special School) Miss D. Wright. Nursing Staff, Fyfield Residential Open-air School: Miss W. M. Barnes, Matron. Miss M. James, Nurse. (2) Co-ordination of Departments. Arrangements for co-ordination of the work of the School Medical Service with that of other Health Services continue to be carried out in the manner set out in my previous Reports. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. (3) School Hygiene. All structural defects relating to heating, lighting and ventilation are referred to the Committee's Architect (J. H. Jacques, Esq., F.R.I.B.A.). As stated in my last Report, box desks are still being gradually substituted for the old dual type of desk. The cleansing of classrooms and cloakrooms and the drying of children's clothes, as required, continue on the lines already set out previously. At various schools, alterations or improvements were made in the heating and lighting, and at one school the latrines were modernized. 144 At the Grange Road and Regents Lane Schools alterations were made by removing partitions, etc., which will put these schools into a higher category on the Board's Black List, as by these partitions passing through classrooms has been largely obviated, and the conditions improved generally. A new Junior Mixed School at Tollgate was opened during the year. This school as regards sanitation, etc. is of the very latest type, and is provided with special accommodation for medical inspection purposes. Spray baths are provided at five Elementary Schools, viz. : Gainsborough Road, Rosetta Road, South Hallsville, Pretoria Road and Tollgate, also at the Special School at Knox Road and the Fyfield Open-air School. Selected children, with the consent of the parents, are conducted during school hours, in rota, to the Corporation Slipper Baths at Balaam Street, Plaistow Road, Silvertown, Jupp Road and Fen Street. The number of school children who attended the Corporation Washing Baths under the Committee's Scheme during the year was as follows:— Boys Girls Total 20,180 15,682 35,862 Facilities are afforded for swimming instruction in school hours at the following baths:—Balaam Street, Jupp Road, Silvertown, Dockland Settlement and Plaistow Red Triangle Club. Professional instructors arc appointed for this work, and Teachers who accompany the scholars to the Baths also take part in the instruction. (4) Medical Inspection. The scheme of Inspection as previously set out still appertains. The following three groups of children were inspected during the year. (1) Entrants. (Children admitted to school for the first time during the year). (2) Intermediates. (Children of 8 years of age.) (3) Leavers. (Children expected to leave school, and who have not been previously inspected since reaching the age of 12 years.) Besides the above statutory routine examinations, a considerable number of other children have also been medically inspected, particulars of which have been fully set out in past reports. (S'ee Appendix Table I.) 145 There has been no important departure made in the Board's Schedule of Medical Inspection. For information I again append a list of schools where Medical Inspection is not held on the premises, but, with the Board's sanction, at the places indicated. Hallsville Clarkson Street The Public Hall, Canning Town. St. Margaret s Holy Trinity St. Luke's The Boyd Institute. Carpenters Road The Old Vicarage, Christ Church. St. Francis' The Wesleyan Hall, The Grove, Stratford St. Paul's. The Mechanics' Institute (L.N.E.R.) Colegrave Road The Rosetta Junr. The Bancroft Hall. St. James'. Hanford Memorial Hall, Forest Lane. West Ham Church Boys. Stratford School Clinic. Frederick Road. South Hallsville School, Medical Room (temporary). St. Antony's. St. Antony's Hall. St. Andrew's. St. Andrew's Vestry. SCOPE OF THE SCHOOL MEDICAL SERVICE. The scope of the School Medical Service in this area was fully detailed on page 151 of my last Report. (5) The Findings of Medical Inspection. (a) MALNUTRITION. During the course of Routine Medical Inspection 281 children were found to require treatment, and 63 cases were considered to be in need of observation. Among the "Specials" 11 cases required treatment and 15 to be kept under observation. 146 AVERAGE HEIGHT AND WEIGHT, 1932-1933. HEIGHT. Age 1932. 1933 Number Examined Average Height in inches. Number Examined Average Height in inches. Boys 5 1153 41.7 1140 42.2 8 2313 47.5 1971 48. 12 2425 55.6 2223 55.8 Girls 5 1081 41.5 1008 42.4 8 2200 48.8 1959 47.4 12 2519 56.1 2051 56.1 WEIGHT. Age Number Examined Average Weight in lbs. Number Examined Average Weight in Ibs. Boys 5 1153 39.6 1,140 40.6 8 2313 52.5 1971 55.6 12 2425 76.9 2223 77.9 Girls 5 1081 39.2 1008 40. 8 2200 53.4 1959 54. 12 2519 78.9 2051 80.2 (b) UNCLEANLINESS. The following- figures give a brief resume of the work done and the findings. These figures refer to examinations of children bv School Nurses. Number Ova and Body Head and Body Examined Ova Pediculi Pediculi Pediculi Sores Dirty 66038 5884 805 66 4 315 273 The percentages for head and body vermin are respectively 1.35 and .106. Number of Home Visits 3504 Number of Children visited at School 13345 (c) MINOR AILMENTS AND DISEASES OF THE SKIN. Minor ailments of the Skin, Eyes, Ears., etc., are included under the appropriate headings. I here were 176 cases of Skin disease among the Routine Inspections, 154 being referred for treatment. In addition, 3,316 “Specials” were referred for treatment. Included in the above are 28 cases of Tinea Tonsurans and 117 Tinea Body, which were referred for treatment. 147 (d) VISUAL DEFECTS AND EXTERNAL EYE DISEASE. External Eye Disease includes Blepharitis, Conjunctivitis, Corneal Ulcers, etc. These conditions frequently connote eyestrain and debility (i.e. Blepharitis or unhygienic surroundings). There were 99 cases referred for treatment at Routine Inspection, and 1,251 among the "Specials." With regard to Defective Vision, 1,387 cases were referred for refraction, and 15,1 for Squint. In addition there were 994 specially referred for defective vision and 219 for Squint. (e) NOSE AND THROAT DEFECTS. At Routine inspection 906 cases were found to require treatment of the nose and throat, and 676 among the Specials. In addition there were 470 cases requiring to be kept under observation among the routines and 9 among the "Specials." (f) EAR DISEASE AND DEFECTIVE HEARING. The findings under this heading at Routine Medical Inspection amounted to 218 requiring treatment. In addition 1,231 Special cases were referred for treatment. (g) DENTAL DEFECTS. The teeth are examined by the School Doctors as a matter of routine, and all defects referred for treatment. (h) ORTHOPAEDIC AND POSTURAL DEFECTS. The Authority have an arrangement with a local Children's Hospital for the treatment of children found at Routine and Special examination to require treatment. (Sec page 155 of this report),. (i) HEART DISEASE AND RHEUMATISM. During the year 33 Organic Heart Disease cases were found in the course of Routine Inspection, and 58 cases were found among the "Specials." In addition there were 261 children requiring to be kept under observation for their heart condition. (j) TUBERCULOSIS. During the year one definite and 22 suspected cases of Pulmonary Tuberculosis, together with five non-Pulmonary cases, were found in the course of Routine examination. There were six definite and 27 suspected Pulmonary, together with 15 non-Pulmonary complaints found in the "Specials." Forty-two Pulmonary and 11 non-Pulmonary cases were required to be kept under observation. 148 (k) OTHER DEFECTS AND DISEASES. During Routine Medical Inspection 375 cases of other defects and diseases were found and referred for treatment, and ,156 required keeping under observation. There were in addition 6,439 defects needing treatment and 188 needing observation among the "Specials." All cases recommended for treatment, and those recommended for observation only, form the basis of the Doctor's Reinspection, which takes place by a subsequent visit to the school. The number of Re-inspections by the School Doctors of Elementary School children amounted to 7,451. (6) Following-Up. At the time of Medical Inspection a following-up card is made out for all children requiring treatment for any defects found. If the case is one requiring Clinic or Hospital treatment the child is followed up by home visits made by one of the School Nurses. If the treatment required is beyond the scope of domestic measures the family Doctor or Hospital is advised. Both home and school visits are made in the course of following-up and the case is not relinquished until adequate improvement is obtained. Children requiring new glasses are followed up by one of the School Nurses attached to the area, until glasses are obtained, and these children and their glasses are re-inspected by the Doctor within three months. The following table gives a summary of work of the Nurses in the process of following-up during the year:— Total number of children visited at home 10848 Total number of children visited at school 4833 Total number of hours spent by Nurses in visiting 3140 (7) Arrangements for Treatment. (a) MALNUTRITION. Tables II. in the Appendix set out the number of Malnutrition cases found at Routine and Special inspections. These children are dealt with in various ways, such as admission to a Day or Residential Open-air School, periods of convalescence (which is arranged through the Medical Officer of Health's Department), and the provision of free meals in necessitous cases. In a number of schools arrangements are made for the supply of a morning drink of milk, which has been found to be very advantageous and beneficial to the children. 1 149 (b) UNCLEAN LI NESS. Dirty and verminous children found at Routine Inspection, Special Inspections and Cleanliness Surveys are followed up at their homes until clean. A certain number, with the parents' consent, are cleansed at the School Clinics. Conditions remedied during the year under the Cleanliness scheme were as follows:— Defective Clothing 28 Unclean Heads 1967 Unclean Bodies 135 Skin Diseases 38 No children were cleansed under Section 122 of the Children Act, but 253 heads were cleansed at the School Clinics by Nurses. (c) MINOR AILMENTS AND DISEASES' OF THE SKIN. There are many minor ailments and skin diseases amongst school children, for which parents will not seek medical aid through a private Practitioner or Hospital. For such cases the School Clinics arc available. Head Teachers are empowered to send all children to the School Clinics who fall into this category. Certain defects found at Routine or Special examinations are also referred to the Clinics for treatment, or for further examintion or observation. The following figures give an indication of the attendances at the Medical Clinics, of which there are four in the Borough, one of them (Balaam Street) being served by two Doctors:— Stratford Clinic 15161 Balaam Street Clinic (a) 7172 Balaam Street Clinic (b) 3060 Swanscombe St. Clinic 15027 Rosetta Road Clinic 21693 Total 62113 With regard to Ringworm of the Scalp arrangements have been made by this Authority with the London Hospital for X-ray treatment of this condition. All such cases before being referred for treatment are first seen by an Assistant School Medical Officer, who also re-inspects the cases before they are re-admitted to school. During the year there were 13 cases of Ringworm of the Scalp treated at the London Hospital. 150 (d) VISUAL DEFECTS AND EXTERNAL EVE DISEASES. All cases of Visual defects, which arc examined by the Committee's Oculist, are, in the first instance, inspected by an Assistant School Medical Officer. The Oculist devotes ten Sessions per week to these refractions, which are re-inspected by the respective Assistant School Medical Officer within the following three months. In necessitous cases assistance is rendered in the purchase of the glasses. Following is a resume of the results of the examinations by the School Oculist:— Cases referred to Oculist 4292 Number attended 3625 Percentage attendance 84.46 Glasses ordered 2930 Number of Clinic Sessions 403 Those cases which did not keep the first appointment were followed up by the Area Nurse, and in the majority of cases further appointments were made. The following is a report by Dr. W. J. Thomas on the work at the Ophthalmic Clinic during the year:— The Authority have made arrangements for these defects to be dealt with at the Stratford Ophthalmic Clinic. It is clear that the needs of the children in both Elementary and Secondary Schools in the County Borough of West Ham are being met with a considerable degree of success. There is usually a short waiting list for this treatment, which is made up from the recommendations of the Assistant School Medical Officers at their Routine and Special Examinations in school. Apart from this, the teachers, parents and the Clinics notify the School Medical Officer direct at any time of children who appear to have defective sight. Prescriptions are made up at contract prices, and every case prescribed for is followed up, and warning letters are sent to parents who persistently neglect their children's requirements in this direction. All children with Defective sight, Eye strain, Strabismus, etc. are referred to the Oculist. The cases of Myopia are re-examined frequently according to the degree of Myopia. The co-operation of the teachers is of the greatest possible value in referring early backwardness and disability that indicate bad sight" to the School Medical Officer; they also see that the children with glasses wear them as ordered. 1 151 The total number of children found to be suffering from External Eye disease, and requiring treatment, amounted to 1,396. Of these, 1,262 received treatment under the Authority's scheme, and 4,1 were treated by private endeavour. The remainder were kept under observation by home visits, with a view to treatment being obtained either at the School Clinic or Hospital. (e) NOSE AND THROAT DEFECTS. All children recommended for operative treatment of the nose and throat are referred to one of the following Hospitals:—Queen Mary's Hospital, Stratford; St. Mary's Hospital, Plaistow; The Children's Hospital, Balaam Street, Plaistow. A total of 793 children were operated on for these conditions under the Authority's scheme, and 34 received treatment byPrivate Practitioners, or otherwise; 134 cases received other forms of treatment. The following are copies of Vouchers used in cases recommended for operative treatment at the above hospitals. WEST HAM EDUCATION COMMITTEE. School Medical Service. Name Age Address School The above child has been recommended to attend for treatment under current agreement at the Nose and Throat Department of one of the following Institutions:— Queen Mary's Hospital for the East End, Stratford (Tuesday or Friday at 8.45 a.m.). St. Mary's Hospital, Upper Road, Plaistow (Thursday at 1 p.m.). Assistant School Medical Officer, for F. GARLAND COLLINS, Chief School Medical Officer, Municipal Health Offices, Date Romford Road, Stratford, E. 15. 152 WEST HAM EDUCATION COMMITTEE. School Medical Service. Name Age Address School Dept The above named child has been recommended to attend for operative treatment under agreement at the Nose and Throat Department of the Children's Hospital, Balaam Street, Plaistow (No child over 12 years of age is treated at this Hospital.) The parent or responsible guardian is requested to call in the first place at the Hospital on any Wednesday morning between 10 and 12 o'clock to make arrangements for the operation. It is not necessary on such occasions to take the child. Assistant School Medical Officer, for F. GARLAND COLLINS, Chief School Medical Officer, Municipal Health Offices, Date Romford Road, Stratford, E.15. (f) EAR DISEASE AND DEFECTIVE HEARING. During the year, 1,186 children with minor Ear Defects were treated at the Clinics. Fifty-seven cases received treatment privately. There are two Deaf Centres in the Borough, one in the north and one in the south, with places for 40 and 44 deaf mutes respectively. In accordance with the Board of Education's requirements all West Ham pupils attending these schools are examined by an expert Aural Surgeon (Mr. Stoker, F.R.C..S.) once a year. (g) DENTAL DEFECTS. Reference to my previous Report will show the scheme of Dental treatment in this area. There has been no departure from these arrangements. Particulars of the work done during the year will be found in Table IV, Group V. 153 I submit herewith remarks and comments from individual reports of the five Dental Surgeons:— Mr. Percy reports— There is very little to add to what I have already stated in previous years, but I can confidently say that throughout the routine inspection I have found the condition of the children's teeth to have greatly improved—not nearly so many requiring treatment, and in the matter of specials sent from the Schools, these have also decreased greatly. I can only attribute this to the improved all-round conditions. I again express my gratitude to the teaching staff for their valuable help in our work. Mr. Dick reports— Dental conditions are found to be much the same on inspection, consequently treatment is continued on the same lines. As the numbers in the schools are now decreasing it is hoped that a gradual improvement may be made in the amount of conservative work it is possible to do. The number of special cases continues to interfere with routine work, but there is some consolation in the fact that the treatment and advice given, especially to the older children, is in practically all cases very much appreciated by the parents. The continued co-operation of the Head Teachers is much appreciated and contributes in a large measure to the ultimate success of the service. Miss Gubb reports— The School inspections have been carried out on the same lines as previous years and followed up by treatment at the Clinic for the children found to require it. There has been no outstanding feature during the year which calls for any special remarks. The numbers inspected, although smaller in accordance with the drop in the school numbers, do not seem to allow of conservative work being increased to any great extent. The "Specials" each year remain at very much the same figure, which perhaps can be partly explained by the fact that in view of the numerous epidemics affecting school attendance during the year, there are a certain number of absentees during: Routine Inspection or ill at the time appointed for attendance at the Clinic, so these children inevitably swell the large number of "Specials." The Head Teachers show a keen interest in the welfare of the children and once more I should like to thank them for their valuable help and co-operation in trying to instil the "Dental Habit" into the parents and children. 154 Mr. Heywood reports— The most outstanding feature of the work carried out at Balaam Street during 1933 was the introduction into the routine of school examinations of a short preliminary talk on the subject of dead teeth, Oral Sepsis and their sequelae. The effects were varied and surprising. Not naturally, in the junior schools the response showed so little improvement that the experiment was not continued. In the senior schools however, the percentage of refusals, while they varied as ever according to areas, showed without exception a heavy decrease, many of the children actually persuading distrustful parents to consent to their treatment. The consequent introduction of no small number of previously untreated cases, mostly in an advanced stage of Oral Sepsis, has caused the high number of extractions and the low number of fillings for the year, and on reflection it will be seen that this is, at present, a most desirable state of affairs. Miss Marsden reports— Annual Routine Inspections were made during the year 1933, of all the Schools allotted to this Clinic and appointments given to the children requiring treatment. The attendance was fairly uniform, but owing to lack of parental control or inertia, still does not increase as rapidly as we would wish. The unfortunate tendency of children to put off visiting the Clinic, until they have severe toothache, leads to a great number of Specials. This would not occur so much it the children attended more regularly, when given appointments at the time their School was inspected. The objection to conservative treatment still continues. There does, however, seem some hope of overcoming this eventually, as in the Schools where hygiene lessons are given, the number of children attending for fillings has greatly increased, owing to the enthusiasm of the teachers. This is most encouraging. I should like to thank all Head Teachers, who have helped me greatly during inspection and in encouraging the children to keep their appointments at the Clinic. (h) ORTHOPAEDIC AND POSTURAL DEFECTS. All cases found to require treatment are advised to go to Hospital. The Authority have an arrangement with a local Children's Hospital for Orthopaedic In-Patient and Out-Patient treatment, and undertake financial responsibility for all such cases sent there. The Committee also from time to time maintain special cases at Orthopaedic Hospital Schools approved by the Board. Any children found with minor Postural defect are noted on the Special Confidential list left with Head Teachers. Recommendations regarding any definite exercises and forms of drill are given according to the nature of the defect. 155 (i) HEART DISEASE AND RHEUMATISM. There is no special Clinic for the treatment of Heart Disease and Rheumatism. Children found at Routine Inspections and special examinations, and cases referred through private practitioners and Hospitals are examined by the Chief Assistant School Medical Officer, and those cases found to require periods of stay at Heart Hospital Schools, etc., are recommended accordingly, the Committee accepting responsibility for maintenance. (j) TUBERCULOSIS. All definite cases of Tuberculosis found by Assistant School Medical Officers are notified to the Medical Officer of Health. Suspicious cases are always referred to the Tuberculosis Officer for examination and report. The number of cases so referred amounted to 96. The Council have a special Children's Sanatorium at Langdon Hills, Essex, with accommodation for 40 children. The Tuberculosis Officer is responsible for all children who are admitted to and discharged from this Institution. Following is a complete list of Tuberculous children (out-ofschool) having Institutional treatment:— Langdon Hills Children's Sanatorium 40 Whipps Cross Hospital 1 Heritage Craft Schools, Chailey 5 Sir William Treloar's Home, Alton 4 Seven Oaks Hospital for Hip Diseases 1 S't. Vincent's Cripple Home, Pinner 4 Ascot Cripple Home 1 Hayling Island Convalescent Home 3 Princess Mary Hospital, Margate 1 Hastings Home and Residential School 1 Black Notley Sanatorium, Braintree 1 In addition there were 23 out-of-school cases of Tuberculosis at the end of December, 1933. (k) OTHER DEFECTS AND DISEASES. The figures relating to other defects and diseases will be found in the Appendix, Tables II (Return of Defects found). These conditions mainly consist of minor injuries, sores, chilblains, etc., and receive various forms of treatment, either at the Clinics or by referring them to a Private Practitioner or local Hospital. 156 (1) ARTIFICIAL SUNLIGHT TREATMENT. During the past few years arrangements have been in force whereby all children so recommended receive Artificial Light treatment at the Children's Hospital, Plaistow, on behalf of the Education Committee. Dr. Eva Morton, who is responsible for the administration of this treatment at the Hospital, sends me the following report, showing the results of the treatment of West Ham school children in this connection:— The number of children of school age referred for treatment in the Light Department of Balaam Street Hospital during 1933 was 117, in addition to a large number carried over from the previous year who were still under treatment on January 1st. Of children who completed their term of treatment during the first half of the year, practically all those showing an attendance of 30 visits or more usually over a period of 10 weeks—were discharged as "greatly improved," in regard to the particular condition for which thev were being treated. These conditions were usually debility, malnutrition, anaemia, rheumatism, and enlargement of the glands of the neck (tuberculous or otherwise); but other less common complaints, including asthma, enuresis and torticollis, also responded remarkably well, as did one case each of emphysema, muscular dystrophv and acne. Fewer children as compared with previous years were referred for bronchitis and other catarrhal conditions, but most of such cases did well. Nearly all the cases of debility, frequently following scarlet fever, whooping cough or measles, improved very much in weight and appetite. A disappointingly large number of mothers only came once, or twice, to the Clinic, non-attendance in such cases appearing usually to have been due to financial difficulties. (8) Infectious Diseases. The methods employed in the detection, and preventing the spread, of Infectious diseases are as follows:— (1) Exclusion from school of all children found to be suffering from any disease or complaint which is considered to be infectious or contagious. (2) Exclusion from school of all children who have been in contact with infectious disease. (3) There is complete co-ordination between the Health Services and the School Attendance Department. Daily returns of children out of school on medical grounds are brought to notice by the School Attendance Officers and cases of Infectious Disease are visited by Sanitary Inspectors. During the year the School Attendance Officers reported the following cases:- During the year the School Attendance Officers reported the following cases):- 157 Measles (including German Measles) 452 Whooping Cough 662 Chicken Pox 1057 Tonsillitis 369 Other Diseases 637 Mumps 594 There were no school closures during the year through Infectious Disease. The following Table gives an analysis of the defects for which children were excluded from school during the year, by the Assistant School Medical Officers:— Exclusions during 1933. Impetigo 24 Otorrhoea 9 Scabies 150 Verminous 5 Other Skin Diseases 27 Tuberculosis 145 Conjunctivitis 18 Tinea Tonsurans. Blepharitis 5 Treated by X-Rays 13 Keratitis 2 Treated at Clinic 4 Mumps 30 Tinea Body 3 Chorea 7 Other Defects and Diseases 27 Enlarged Glands 9 Chicken Pox 24 542 Tonsillitis 12 Diphtheria 2 Anaemia and Debility 8 Total number of children involved 523 Bronchitis 11 Heart 7 (9) Open Air Education. (a) Playground Classes. Opportunity is taken, weather permitting, of holding classes in the playgrounds, and physical exercises are taken in the openair whenever possible. Four schools hold classes during the warmer months in the open-air on the flat roofs available, and certain schools hold classes in the neighbouring parks and recreation grounds. (b) Open-Air Classrooms. In the recently opened Elementary schools in West Ham, viz. Pretoria Road and Tollgate, and the new South Hallsville School, which has been reconstructed, provision has been made for open-air classrooms. 158 (c) School Journeys and Camps. During; the year several Departments undertook School Journeys to different places for varying periods. The children were accommodated in Boarding-houses or hostels, while some went under canvas. All children before going on a School Journey are examined by an Assistant School Medical Officer, as to their fitness to undertake the journey. Holiday Camps were held during the Summer Vacation for boys and girls, at Shoeburyness and Dymchurch respectively. Here again all selected children were previously medically inspected and dentally examined, special regard being paid to cleanliness and freedom from contagion. This branch of the Education Committee's activities is not only greatly appreciated by the children who are fortunate enough to go, but show results, from the medical point of view, which make one regret that this scheme could not be still further extended. The following extracts from the reports of the respective Camp Superintendents are of interest:— Mr. Taylorson reports— "The ninth annual report on the West Ham Schoolboys' Hospital Camp presents some difficulties, inasmuch as in the main it will be but a repetition of those of previous years. Once again the seaward meadow of South Shoebury Hall Farm was our temporary home. Through the courtesy in placing a barn at our disposal throughout the year many of our transport difficulties have been solved. Indeed, were it not for these facilities many of the amenities which so distinguish our camp would have to lapse, as the cost of transporting heavy and bulky fittings of the bath house, washing sheds, latrines and kitchen would be prohibitive. This year 862 boys enjoyed your hospitality, being divided into two nearly equal parties. On Thursday, July 26th, the boys from the Northern half of the Borough entrained, giving way to their Southern friends on August 10th. Throughout, the weather was glorious, and all revelled in the sunshine which was our practically constant companion. The general health was the best we have as yet experienced, although our first serious case of illness developed towards the end of our stay, a boy having to be operated upon for appendicitis. He received every care and attention at the Southend General Hospital, and made a good recovery. The equipment is in general good order. Only minor replacements will be necessary, except that a new mess marquee is fast becoming essential. 159 The general routine work of the camp followed on the same lines as in previous years. There were no formal parades, except for tent inspection every morning. The menu was varied and ample, and to it both boys and staff did full justice. To my colleagues I must express my deepest thanks. For twenty-four hours everv day they were ready to perform any duty the exigencies of camp might require, and to their untiring and unswerving lovaltv may the success of the camp be largely attributed." Miss Wise reports— "It is with great pleasure that I submit my eighth annual report on the Girls' Camp held at Dvmchurch from 11th August to 25th August, 1933. The party numbered 222 girls, of whom 157 were assisted cases and the remainder paid the full cost of the holiday. Ten Teachers accompanied the party. As last year, we travelled by coaches, and the journey both there and back proved most comfortable and enjoyable. It was rather disappointing to arrive at Camp in pouring rain after experiencing a glorious heat wave, but we forgot this disappointment in the interest of arranging dormitories, camp groups and meal tables, to say nothing of getting into camp kit and generallv making camp into a home for the fortnight. As usual a good tea was ready for us as soon as we had settled in, and having done justice to this we were ready to start at once on the fortnight's round of pleasure. Fine weather favoured us, and we were able to spend a great deal of time on the beach and in the water. It says much for the swimming teaching in our Borough that each vear we find the number of non-swimmers steadily lessens. Most of the staff being enthusiastic and expert swimmers, the bathing was at all times most carefully supervised, and it would be very difficult to find a place where bathing could be safer or more enjoyable. The large stretches of sand and the smooth running of the tide enable even the smallest and most timid to enjov dailv dips, and the warm weather this year made it possible for the girls to live in bathing costumes, and to get from dormitory to beach without fear of chill. Games on the sands and in the camp fields played an important part in the camp life. The net-ball courts were in constant use ; stool ball had many adherents; even the warm weather failed to deter the Rugbv touch enthusiasts; and our old favourite, sand hockey, never failed to attract. It speaks well for our increased skill at the latter game that our only casualty was one black eye acquired by a member of the staff. Excursions were arranged for those who wished to go. A large party went to Folkestone by char-a-banc, and spent the day and their money there. Several parties visited Hythe, and 160 plored the canal and various places of interest. Practically the whole party went by the light railway to visit the lighthouse at Dungeness, and spent a most instructive and enjoyable afternoon, finishing up with a picnic on the shingle. As West Ham must be in the fashion, hiking parties were more popular than ever. It was a matter of real interest to me to see how eagerlv the girls packed their rucksacks, had their shoes inspected, and set off with the ordnance maps. Those who know this district will realise the difficulties of making these walks interesting, yet keeping within the walking capacity of the girls, owing to the marshy character of the country and the dykes with which it is intersected. The longest of these walks was made particularly interesting by the fact that the party was met at Ivychurch by the Rector, who conducted a tour over the ancient and historic Church of the village, and pointed out the landmarks from the tower of the Church. While these outside interests take up much of the time, the inside camp life is not neglected. Impromptu concerts, community singing. entertainment competitions, etc., all add zest to the holiday; and the climax of these revels came when the Staff gave their eagerly awaited entertainment. Judging from the applause of the audience it was as much appreciated as ever. The health of the children was good and we had no accidents. This, together with the fine weather, made this as enjoyable a fortnight as we have spent there." In this connection the local branch of the Children's Country Holiday Fund sent away a large number of children (both boys and girls) during the Summer holidays. All these children are inspected by the Nursing staff, as to their cleanliness and freedom from infectious or contagious conditions. (10) Physical Training. There is no organiser for physical training in the Elementary schools, but drill, games and physical exercises are supervised by individual teachers in the various schools. There is a well organised School Sports Association composed of members of the West Ham Education Committee and teachers. All available sites in the Borough are utilised to the fullest extent in carrying through a vast athletic programme. Scholars for whom an opinion is required as to fitness for participation in various sections of games are referred for examination by an Assistant School Medical Officer. During the year 229 bovs were examined. Only 2 were found unfit. 161 (11) Provision of Meals. Under this paragraph in my previous reports I have set out the scheme which exists for the provision of meals. This particular scheme has been in operation for several years. I give below the number of meals provided during the year at the School Dining Centres:— Breakfasts, 507,082. Dinners, 901,009. There are a number of voluntary agencies which also help in this direction. (12) Co-operation of Parents, Teachers, School Attendance Officers and Public Bodies. (a) Parents are always notified when their children are due to be medically inspected, and the fact that last year the percentage of parents who were actually present at the Elementary School examinations amounted to 82.6, indicates the interest taken in the work of the School Medical Service. The number of parents who refuse to have their children medically examined is extremely low. In 1933 the number of children who were affected by this parental objection amounted to 53. Parents are always encouraged to accompany their children both when they are being inspected at school, or treated at the Clinics. (b) The assistance rendered by Teachers has always been greatly appreciated by the staff of the School Medical Service. The facilities, which are invariably afforded Doctors, Dentists and Nurses whenever they have occasion to go to a school, help considerably in the smooth running of the department. In selecting special cases for examination, urging attendance at Clinics and impressing upon parents the need for carrying out advice given, or recommendations made, the teachers play an invaluable part. Children who show some defect and are considered by the Doctor to need individual supervision by the teacher are reported to the Head Teacher on a special confidential form. All cases such as bad vision, defective hearing, heart trouble, etc., are so reported. To the members of the School Inspectorate I also tender my best thanks for their enthusiastic co-operation. (c) There is complete co-ordination between the School Medical Service and the Bye-Laws Department. The work done by the School Attendance Officers in connection with the Health Services of the Borough is of great value, particularly in regard to cases of non-notifiable infectious diseases, which are brought bv them daily to the notice of the Medical Officer of Health. 162 (d) The School Medical Service is in close touch with certain voluntary associations and societies on behalf of the welfare of individual children. The Invalid Children's Aid Association and the Invalid and Crippled Children's Society notify the School Medical Officer of children coming under their notice who require new or altered Surgical Appliances. The Education Committee assists in the purchase of instruments or alterations to same. These Societies also reported cases requiring Convalescent treatment. During the year, 463 school children were sent away for periods of convalescence. Assistance in the purchase or repair of Surgical Appliances was rendered to 26 children. I am also indebted to the National Society for the Prevention of Crueltv to Children and the Central Association for Mental Welfare, as well as to the Almoners of a number of voluntary Hospitals for their valuable help. (e) In addition to the voluntary hospitals (not only of West Ham, but of London) there arc a number of other voluntary bodies who do very valuable work in regard to the health of the children. (13) Blind, Deaf, Defective and Epileptic Children. (a) The returns of children falling under this heading are obtained from two sources, viz,., by Head Teachers and the School Attendance Department. These cases are notified as they arise and are followed up by a Nurse specially detailed for this work. The children are also examined by the Chief Assistant School Medical Officer to ascertain their fitness for school, or otherwise. Some are returned to the Elementary school, many are recommended for admission to the Special Schools, but the majority are found to be unfit for school attendance. The permanent out-of-school cases are visited from time to time by the Nurse detailed for the purpose'and any changes in the condition justifying re-examination are then brought to light. There is also an annual census taken at the end of the year of all exceptional children submitted by Head Teachers. These are examined bv the medical staff, and cases considered unfit for an ordinary school are referred for further examination to the Chief Assistant School Medical Officer. A number of children have been placed in various Institutions, and the Local Authority are responsible for their maintenance. (b) A Special Nurse is employed in following up all mentally defective children not in school. All out-of-school cases are periodically medically examined to ascertain their fitness for admission to Special Schools. 163 Mentally defectivc children who are not in Special Schools are those who are too young for certification. These are reviewed from time to time bv the Chief Assistant School Medical Officer. (c) Ceneral Review of the work of the Authority's Special Schools. Knox Road and Grange Road Special Schools for Mentally and Physically Defective Children. The Special Schools at Knox Road and Grange Road have provision for Mentally and Physically Defective children, as follows:— Knox Road 95 Mental Defectives 80 Physical Defectives Orange Road 95 Mental Defectives 72 Physical Defectives All the children attending these Special Schools have annual routine inspection, and any cases found to require treatment for minor ailments are referred to the Clinics in the same way as appertains with the ordinary elementary schools. Cases also found to be in need of dental treatment are sent to a Dental Clinic and treated, where possible, under the Authority's scheme. A certain number of cases arc referred for treatment at the Dental Department of a local Hospital. Children found with defective vision are seen by the Committee's Oculist, and assistance given in the purchase of glasses, if necessary, as in the case of elementary children. Age Distribution of Examinees. M.D. and P.D. Children. Age Number Examined 7 16 8 20 9 30 10 35 11 38 12 42 13 36 14 16 15 13 Total 246 Attendance of Parents, 67%. 164 Chief delects referred for Treatment or Observation. Treatment Unclean Head 19 Other Ear Diseases 4 Unclean Body 5 Enlarged Tonsils and Adenoids 2 Scabies 1 Other Skin Diseases 10 Other Conditions Nose and Throat 1 Blepharitis 2 Defective Vision 15 Teeth—Oral Sepsis 24 Squint 8 Other Defects and Diseases 1 Otitis Media 3 The following Table shows the number of defects treated at the Clinics during the year:— Scabies 1 Other Eye Conditions 5 Other Skin Diseases 165 Defective Hearing 2 Blepharitis 1 Otitis Media 32 Conjunctivitis 1 Other Ear Diseases 2 Referred to Oculist 57 Other Defects and Diseases 215 Two voluntary After-Care Committees sit to consider the welfare of children who have recently left these schools. 165 Observation Malnutrition 90 Heart Disease— Organic 15 Other Skin Diseases 1 Defective Vision 30 Functional 4 Squint 12 Anaemia 7 Other Eye Conditions 1 Other Disease of Lungs 1 Defective Hearing 18 T.B. Spine 15 Otitis Media 3 T.B. Hip 6 Enlarged Tonsils only 20 T.B. other Bones and Joints 9 Adenoids only 6 Enlarged Tonsils and Adenoids 13 Epilepsy 3 Other Conditions (Nerves) 37 Other Conditions Nose and Throat 17 Rickets 3 Enlarged Cervical Glands 20 Spinal Curvature 5 Other Forms Deformities 14 Defective Speech 24 Teeth—Oral Sepsis 50 Other Defects and Diseases 165 The following reports have been received regarding "leavers" during the past year:— Knox Road Special School. M.D. P.D. Returned to Elementary School 1 4 Left at Age Limit 2 4 Permission granted at 14+ to take up work 3 6 Excluded by Medical Officer 2 1 Removed from the area 7 5 Transferred to M.D. School - 1 Of the P.D. children who have left during the year, seven have obtained employment as follows:— One is working in a wholesale stationers. One is working at dressmaking. One is working at shoemaking. One is working at upholstery. One has domestic work. One is in a factory. One is working for the L.N.E.R. Of the M.D. children who left during the year Two are working in shops. One is a machinist. One is working in the L.N.E.R. Grange Road Special School. P.D. M.D. Returned to Elementary Schools 9 5 Removed from District 3 3 Left at Age Limit 2 6 Left having obtained suitable employment 3 8 Transferred to Residential Schools 5 - Excluded 4 7 Deceased 1 - Transferred to Knox Road M.D. School - 1 Of the P.D. children who obtained employment One boy is working with the Shaftesbury Society One boy is apprenticed to a hairdresser. One boy is working as an electrician's mate. One girl is working in a sweet factory, and One girl is working as a shop assistant. Of the M.D. children who obtained employment One boy is helping father as a hawker, One girl is working in a sweet factory, and One girl is working at a mackintosh makers. 166 Frederick Road and Water Lane Deaf Centres. These Centres have accommodation for 40 and 44 Deaf mutes respectively. All the children are examined annually by an Assistant School Medical Officer, and arrangements are also made for an annual examination by a Specialist Aural Surgeon. During 1033 the number of children examined at these schools in the course of Routine Medical Inspection was as follows:— Frederick Road Deaf Centre, 35. Water Lane Deaf Centre, 30. Very few minor defects were found, and these were referred to the Clinic for appropriate treatment. A number of children from outside areas are admitted to these schools by arrangement with the Local Education Authority, when vacant places permit. The following After-Care Committee's reports on West Ham "leavers" have been received during the year:— Frederick Road Deaf Centre. Three girls and one boy have left this school during the year. One girl is employed in a rubber factory. One girl is employed in a box-making factorv. One girl is working in a cigarette factory. One boy is helping to load and unload at a furniture factory. Water Lane Deaf Centre. Two boys learning basket making at basket works One boy obtained employment at sign writing One girl staying at home at present One girl staying at home and doing household duties. Blind. There are no local arrangements made for the education of blind and partially blind children. Where possible, arrangements are made for these children to be admitted to Residential Schools for the Blind or Partially Blind. Epilepsy. Only severe cases of Epilepsy arc excluded from attendance at the Elementary schools. As far as possible arrangements are made for cases of major epilepsy to be boarded out at suitable Institutions. Stammerers. Special classes of from eight to ten weeks' duration have been carried out at North Street School during the year. They are under the supervision of a qualified teacher, and 167 the results have been very promising. In the case of children where sufficient improvement was not made during the first course, a repeat course was recommended. The children are examined by an Assistant School Medical Officer before and at the end of each Course. During the year 14 boys and 6 girls attended the first class, 13 boys and 5 girls took a second Course, and 5 boys a third Course. Three boys were considered to be in need of still further Courses. Four classes were held during the year. Children from outside areas are accepted when vacancies are available. Fyfield Residential Open-Air School. The Residential Open-air School at Fyfield, Ongar, Essex, maintained by the Authority for 80 boys and 60 girls provides all the essentials of outdoor education. The function of the School is to afford an opportunity of improving the resisting power of the debilitated child of the noninfectious type. The children are selected and recommended by the School Medical Staff and are examined before admission. The cases selected for admission are children who are below average in health or physique or who are debilitated after illness. Children suffering from active disease are not considered suitable cases for admission. All candidates for Fyfield have their teeth put in order and any neccssary operation upon the throat performed prior to admission. Fortnightly visits are paid to the School by the Chief Assistant School Medical Officer, when all the children are medically reexamined and the height and weight noted. In case of emergency or sudden illness a local practitioner is called in. During the year 193 boys and 173 girls were admitted and 198 boys and 174 girls discharged. The discharged cases are medically re-examined a few months after leaving the School to ascertain if the improvement is maintained. Of the 392 cases sent for re-inspection, 22 did not attend for various reasons. Out of the 370 examined 311 showed continued improvement, whereas 59 had had intercurrent ailments, and their then present condition was not considered so satisfactory. My annual report for ,1932 sets out the daily routine at the school. The dietary has proved quite satisfactory. A specimen week is given below:— 168 WEEKLY MENU FOR SUMMER MONTHS. Breakfast. Lunch. Dinner. Tea. Supper. Sunday Cocoa, Bread and Butter, Jam, Fruit or Marmalade. — Roast Beef, Cabbage and Potatoes, Stewed Fruit or Fruit Salad and Custard. Tea, Bread and Butter, Cake. Milk, Bread and Dripping. Monday Tea, Porridge, Bread and Butter, or Dripping. Milk. Cold Meat, Beetroot, or Green Salad Potatoes, Suet Pudding with Syrup, Jam or Fruit. Tea, Bread and Butter, Jam or Fruit. Sardines. Milk, Bread and Dripping. Tuesday Tea, Grape Nuts, Bread and Butter. Lemonade or Milk. Stewed Steak, Carrots and Onions, Potatoes, Milk Pudding, Fruit in Season. Tea, Bread and Butter, Jam or Fruit. Cocoa, Bread and Butter. Wednesday Tea, Fish, Bread and Butter. Milk. Meat Pudding Cabbage and Potatoes, Raw Fruit or Fruit and Custard. Tea, Bread and Butter, Buns. Milk, Bread and Butter. Thursday Tea, Grape Nuts, or Fruit, Bread and Butter. Milk. Stew, Carrots and Onions, Potatoes, Milk Pudding, Lemonade. Tea, Currant Bread. and Fruit or Jam. Milk, Bread and Dripping. Friday Tea, Boiled or Scrambled Egg's, Bread and Butter. Milk. Fish, White Sauce and Potatoes, Fresh or Dried Fruit, Suet Puddings. Tea, Bread and Butter, Jam or Fruit. Cocoa. Saturday Tea or Cocoa, Porridge or Fruit, Bread and Butter. Milk or Lemonade. Hot or cold Ham, Hot or cold Mutton, Two Vegetables or Potatoes and Salad, Jam Tarts or Blancmange and Stewed Fruit. Tea, Bread and Butter, Jam or Fruit. Milk. Lettuce, Tomatoes, Radishes, for dinners and teas, when in season. Fresh Fruit for breakfasts and teas, when in season. All Milk used is Grade "A." The Menu for the Winter months is very similar, except that there is less fresh fruit and lettuce, etc. 169 Crosby Road Open-Air School. The Authority maintains a Day Open-air School at Crosby Road, Forest Gate, for 90 children, from the age of 7 years upwards. The cases are recommended by the School Medical Staff from their findings at Routine and Special examinations. Long periods of attendance at the Day Open-air School are usually required, as in many instances home influences very often detract from the benefit that would otherwise accrue. The children have the benefit of spray baths, breathing exercises and handkerchief and tooth brush drill; also plenty of rest as well as lessons in an open-air environment. Good meals with morning milk are also provided. Periodical medical examinations are carried out at the school by the Chief Assistant School Medical Officer. During the year 20 boys and 26 girls were admitted, and 7 boys and 35 girls discharged. I am indebted to Miss Davies (the Head Mistress) for the following report on the School:— "The year 1933 has been encouraging. Real improvement, physical and mental, is noticed in all children shortly after admission, and this improvement on the whole continues. 'Health first' is necessarily the slogan of the School, and the curriculum is adapted towards that end. Personal hygiene occupies a large part of the timetable, and particular stress is laid on individual cleanliness. As a result of well-balanced menus, quiet, orderly meal-times, and definite rest periods, real physical improvement takes place, and with it a corresponding mental improvement. The adjoining garden, and the privilege of working in their own individual gardens, are much prized by the children. Gardening as a means of self-expression is very valuable to the School, for the moral and mental stimulus it bestows. The usual school subjects are not neglected, and dancing, singing, and dramatic work are much enjoyed. The parents seem to appreciate the work of the School, and co-operate as far as possible. A Parents' Day was held in April, and a re-union of old scholars in July." Ogilvie School of Recovery, Clacton-on-Sea. The Authority also retains 10 beds for girls at the Ogilvie School of Recovery, Clacton-on-Sea. The selected cases are delicate children found at Routine and Special examinations. The children selected for admission are further medically examined before going to Clacton, and the discharged cases are examined soon after their return home. During the year 12 cases were admitted and 11 discharged. 171 (14) Full-time Courses of Higher Education for Blind, Deaf, Defective and Epileptic Students. Following are the Institutions at which West Ham cases were undergoing a specialised course of training, having regard to their particular defect, during 1933:— Swiss Cottage for the Blind 3 men, 2 women Barclay School for the Blind, Brighton 1 woman National Institute for the Blind 1 man Royal School for the Blind, Leatherhead 2 men Royal Normal College 1 man London Association for the Blind 1 woman Lingfield Epileptic Colony 1 woman Heritage Craft School 1 man In addition, 14 adult blind persons are in receipt of training at the West Ham Municipal Workshops for the Blind. This Institution is administered by the West Ham Council, as the Statutory authority under the Blind Persons' Act. During the year three men were examined and reported on as to suitability for training under this Act. No particulars are available regarding the after-careers of students who have left the above Institutions. (15) Nursery Schools. The Authority has two Nursery Schools, one in the north and one in the south of the Borough, on sites adjoining Abbey and Rosetta Road Schools respectively. The particulars regarding the structure and details of organisation of these schools were given in my last report. The following reports have been received from the Assistant School Medical Officers responsible for the Medical Inspection and treatment of the children attending these two Nursery Schools:— Rebecca Cheetham Nursery School. During the year 1933 the usual eight visits were made to the Rebecca Cheetham Nursery School, four being concerned with the routine examination of the infants and four for the purpose of re-inspection of children found to have had some physical defect at the previous routine inspection. Total number of children inspected 399 Number of defects found 101 (25.5%) Total number re-inspected 101 Special Cases 11 172 The following interesting differences in the final results of the examinations made during the years 1932 and 1933 indicate the increasing benefit which the Nursery School system is conferring on the younger child. (a) Forty-nine more children underwent routine examination in ,1933 than 1932, indicating a larger annual attendance at the School, and consequently a better state of the child's health. (b) A great diminution in the actual number and in the percentage figure of defects found, and this in spite of the fact that more children were examined in 1933. This is attributable to several factors. (c) The high standard of personal hygiene was found to have been maintained, only 15 children requiring some attention in respect of cleansing, and therefore making a lower percentage figure than in 1932. I should like to thank Miss Whittingham and the Nursery School Staff for their kindly assistance in securing co-operation between the Medical Staff and parents, and thus ensuring a smooth working. Miss Gubb reports on the Dental Examination and Treatment as follows:— "The Rebecca Cheetham Nursery School was inspected twice during the year, and all children found to require treatment were referred to the Clinic and subsequently treated. The dental condition of the children as a whole was very good, the jaw formations with few exceptions also good, and in nearly all the children the normal eruption of teeth for their respective ages was present. The parents tend to show a greater interest in the preservation of the teeth, even though they are 'only the baby teeth,' and attend more willingly for conservative treatment. The parents also seem to have a better understanding and appreciation of the advice given to them with regard to the many factors influencing the dental condition of their children. I should like to thank Mfss Whittingham for her valuable help and co-operation at all times with the parents and babies." The Edith Kerrison Nursery School. I his School has now completed its third year. During the year 1933 four medical inspections—quarterly—were carried out. I he following report relates to the findings at these inspections. Examinations Boys examined Girls examined Total Parents present Number Defective Percentage of Defects March 54 56 110 91 34 30.9 June 53 60 113 99 21 18.5 September 49 51 100 80 18 18.0 December 51 66 117 95 18 15.3 173 At the March examination respiratory catarrh was very prevalent. There were 10 cases of rather severe bronchitis and a larger number with varying degrees of bronchial catarrh. In June the condition of the children was very good. The School was free from infectious disease. In September the general health of the children was very good. Of the 20 children absent, only two were very ill, the others being on holiday or hopping. The December examination provided the best report of all. The number examined (117) was the highest recorded since the School was opened. Of the three absent children, one had Diphtheria, one had Tonsillitis, and the third was absent for no apparent reason. There is complete co-ordination between the Headmistress, Miss J. E. Cass, and the School Medical Staff. Any child requiring attention is sent to the Clinic at Rosetta Road, where any condition found to require treatment is promptly dealt with. Miss Marsden, the Dental Surgeon, reports:— "During the year 1933 the School was inspected twice, and treatment followed almost immediately afterwards. Any children absent through illness or anv other cause are able to attend later (owing to the nearness of the School to the Clinic). Thus all the children were treated regularly during the year. On the whole the dental condition of the children is pretty satisfactory, and if continued should auger well for the future of these children. I should like to thank Miss Cass for help during inspections, and for the efforts made to see that the children do attend at the Clinic for the necessary treatment." There are also several voluntary Nursery Schools doing excellent work. (16) Secondary Schools and Other Institutions of Higher Education. The Institutions referred to here comprise— (1) The Municipal College (Provided by the Authority). (2) The West Ham Secondary School (Provided by the Authority). (3) St. Angela's High School for Girls (Ursuline Convent) (Aided by the Authority). (4) The Plaistow Secondary School (Provided by the Authority). (5) The West Ham High School for Girls (Aided by the Authority). 174 MUNICIPAL COLLEGE. The Local Authority undertakes the Medical Inspection of certain students in attendance at this College, provided by them. The students examined are those attending (1) Junior Courses Engineering, first and second year (2) Trade School for Girls (a) Preparatory (b) Dressmaking, first and second years (c) Cookery, first and second year (3) Junior Art Trade School for Boys and Girls. Three visits are made during the year, and re-inspections are made of examinees from each previous medical inspection. The examinations are fuller in detail than obtain in the Elementary Schools, colour vision, head and chest measurements, and other enquiries incidental to the age period being noted. The procedure of following-up by Nurses' visits and reinspection by the Assistant School Medical Officer is the same as in the Elementary Schools. The School Clinic and Hospital arrangements for the operative treatment of Tonsils and Adenoids, the School Oculist and the X-Ray Specialist are available if required. Arrangements have now been made for the female students to be examined by a lady Doctor. Total number inspected (122 boys, 100 girls) 222. Total number of defects found 43. The majority of the above defects were due to defective vision, necessitating change of glasses. On the whole, the majority of the students appeared to be healthy and of good physique; well grown and well nourished. Thanks are due to the Principal and Staff of the College for their courteous co-operation and assistance during the medical inspections. SECONDARY SCHOOLS. All the Scholars in the West Ham Secondarv and Plaistow -Secondary Schools are medically examined annually, in addition to which the Assistant School Medical Officers make one visit a year for the purpose of re-inspecting those pupils found with defects at the previous examination. 175 The procedure of following-up by Nurses' visits is the same as in the Elementary Schools. The girl students in these Schools are medically examined by a Lady Doctor. Every facility provided by the Authority for the treatment of children is available for these pupils. Many of the pupils, however, have their defects remedied privately. Treatment is obtainable by all the scholars, i.e. scholarship holders and feepayers. WEST HAM SECONDARY SCHOOL. All the pupils were medically examined during 1933 and those requiring treatment were seen three months later in order to determine whether this had been satisfactorily obtained. Number Examined Number Defective Boys Girls Boys Girls 364 224 77 32 Faulty vision accounted for the major portion of defects found to require treatment. One must emphasize the great interest taken in the work by the Principal, Dr. Churchill. He and his staff render valuable assistance to the School Medical Department. PLAISTOW SECONDARY SCHOOL. All the pupils were medically examined during 1933 and those requiring treatment were seen three months later in order to determine whether this had been satisfactorily obtained. Number Examined Number Defective Boys Girls Boys Girls 340 224 74 46 The greatest number of defects was due to faulty vision. The Principal, Mr. J. W. Hand, takes a great interest in the medical inspection of the pupils. He is, at all times, most willing to co-operate with the School Medical Department. 176 WEST HAM HIGH SCHOOL FOR GIRLS AND ST.ANCELA'S HIGH SCHOOL. On the request of the respective Governors, the Authority provides for the Medical Inspection of West Ham scholars in these Schools, with the exception of the Preparatory Schools. These Schools are visited each year by a Lady Doctor, and the same Medical Services are available for the scholars as for those children in the Elementary Schools. Vision is mainly treated by the School Oculist, but a few parents prefer to obtain treatment privately. All other defects are treated almost entirely privately. WEST HAM HIGH SCHOOL FOR GIRLS. An inspection took place of the West Ham pupils attending this school, excepting those in the Preparatory Department. The keenness and enthusiasm of the Principal, Dr. Florence Barnett, have helped to maintain the high standard of health found amongst the scholars. Age Distribution of Examinees. Age Number Examined 9 1 10 5 11 39 12 44 13 52 14 31 15 19 16 16 17 3 Total 210 Attendance of parents, 83%. Number of children found defective, 15%. Chief Defects referred for Treatment. Skin Disease 1 Dental Caries 18 Defective Vision 19 Anaemia ... 2 Defective Hearing 1 Nervous Debility 1 Other Ear Conditions 1 Spinal Curvature 2 Enlarged Tonsils and Adenoids 2 Other Conditions 3 177 Recommendations were left with the Principal re the following, amongst other conditions:— Defective Vision 19 Physical Exercises Dental Caries 18 (Flat Foot, etc.) 25 Defective Hearing 1 The remedial exercises for slight deformities are carried out by the Drill Mistress. ST. ANGELA'S HIGH SCHOOL FOR GIRLS. This school is medically inspected annually, the inspection being confined to West Ham scholars, excluding those in the Preparatory School. The co-operation and active interest of the Principal is much appreciated. Age Distribution of Examinees. Age No. Examined 11 24 12 31 13 36 14 23 15 10 16 11 17 8 18 2 Total 151 Attendance of parents, 80%. Number of children defective, 10%. Chief Defects referred for Treatment. Malnutrition 1 Dental Caries 9 Skin Disease 1 Anaemia 1 Defective Vision 7 Other Conditions Nose and Throat 2 Defective Hearing 1 Otitis Media 1 Other Conditions 1 Recommendations were left with the Principal re the following, amongst other conditions:— Defective Vision 7 Physical Exercises (Flat Foot, etc.) 21 Defective Hearing 2 Dental Caries 9 The Drill Mistress undertakes the special exercises for slight deformities. 178 Continuation Schools. There are now two Continuation Schools in the Borough, viz., the Shakespeare Institute and the Lister Institute. No scheme of Routine Medical Inspection has been carried out in the past, but an annual Inspection is now being arranged for the pupils in attendance at these Schools. Hitherto the Head Teachers of these Institutes have been empowered to refer cases to the School Medical Officer for advice, and treatment if necessary. Scholarship Children. All scholarship children are medically examined soon after taking up their scholarships. The schools at which such scholarships are held are:— Provided by the Authority: (1) The Grove Central School. (2) The Russell Central School. (3) The West Ham Secondary School. (4) The Plaistow Secondary School. Aided by the Authority: (5) St. Angela's High School for Girls. (6) West Ham High School for Girls. (7) A few boys hold their scholarships at St. Bonaventure's. Xos. 3, 4, 5, and (5 above have been dealt with as separate reports. SCHEME OF MEDICAL INSPECTION AT THE CENTRAL SCHOOLS PROVIDED BY THE AUTHORITY. There are two Central Schools, namely, The Grove School, Forest Gate, and The Russell School, Plaistow. At the present time there are two examinations in the year, one in September at which all newly entered scholarship children are inspected, whilst the second examination takes place during the second quarter of the year, and comprises all scholars who are in their third year and due to leave at midsummer. At either of these examinations it is open for the Headmasters to submit as "specials" any scholars not due for examination where retarded progress or some definite ailment or condition makes it appear advisable. The Head may also consult with the School Medical Officer between school visits on any case where it is not deemed advisable to await the next medical inspection. 179 The same routine procedure of following up by Nurse's visits and re-inspection by the Assistant School Medical Officer, obtain as in the case of the Elementary Schools. The Committee's Oculist, X-Ray Specialist, School Clinic and Hospital arrangements for the operative treatment of Tonsils and Adenoids are available for cases needing it. The Crowe Central School. During the year 1933, two medical inspections were carried out at The Grove Central School and a total of 191 routine examinations were made. In the summer, 86 children were inspected prior to their leaving school and in October, 105 "entrants" were examined medically. Treatment Observation Skin Diseases (not T.B.) 1 — Blepharitis 1 — Defective Vision 17 25 Squint 1 1 Defective Hearing — 1 Enlarged Tonsils only 4 7 Enlarged Cervical Glands (not T.B.) — 4 Other Diseases and Defects 1 5 As a result of the examinations in 1932, 36 children were found to need treatment, while in 1933 the lowered figure of 25 is shown. As has been observed previously, faulty vision claimed the major portion of defects requiring treatment. It is noteworthy that the personal hygiene of the children was found to be exceedingly good. Mr. Madden's kindly interest in and co-operation with, the Medical Service, has done much to produce this highly satisfactory standard of hygiene and health in the scholars during 1933, and I should like to thank him. The Russell Central School. Leavers were examined in June, 1933. These pupils commenced their studies at the school in August, 1930, and during this period they have done remarkably well, the average gains for this period being, height 7 inches, weight 33 lbs, and chest measurement 4 inches. Pupils examined. Age Boys Girls 15 52 35 Parents present 26 29 Combined percentage of parents present, 63. 180 Chief Defects referred for Treatment and Observation. Defect BOYS GIRLS Treatment Observation Treatment Observation Defective Vision 4 — 4 1 Skin Disease — — 1 — Defective Hearing 1 — — — Otitis Media 1 — — — Enlarged Tonsils — — 1 — Oral Sepsis 1 — — — Heart Disease — — 1 — Other Disease — — 1 — Two Special cases were also examined, one girl with defective vision and one boy with asthma and bronchitis. The girl was referred to the eye specialist and the boy was given advice. Re-Inspection. Vision: Four boys and four girls were prescribed glasses and all obtained them. In addition the girl "Special" was prescribed glasses and she obtained them. Psoriasis: There was no improvement in this girl's skin condition. She was sent to a skin specialist. Otitis Media: Boy receiving hospital treatment, some improvement noticed. Defective Hearing: Boy receiving hospital treatment, slight improvement. Enlarged Tonsils : Some improvement following the use of gargles. Oral Sepsis: Treatment not carried out. Heart Disease : In statu quo. Other Defect (Cyst) : Girl has had operation performed with a successful result. The Entrants were examined in November, 1933. The following constitutes a resume of the examination. Boys. Girls. No. Examined. No. Defective. No. Examined. No. Defective. 50 10 55 16 Parents present: Boys, 49. Girls, 53. Combined percentage, 97%. Percentage defective: Boys, 20%. Girls, 29%. 181 Chief Defects referred for Treatment or Observation. Treatment Observation Defective Vision 18 3 Otitis Media 1 — Enlarged Tonsils 4 1 Organic Heart Disease 1 — Bronchitis 1 — Other Defects and Diseases 2 1 Following Up and Treatment. Defective Vision: Eighteen pupils prescribed glasses and all obtained them ; two not prescribed glasses. Otitis Media: Ear now quite clear. Enlarged Tonsils: Some improvement in all the four cases. Organic Heart Disease: Heart condition has got worse. Girl now temporarily out of school. Bronchitis : Chest clear. Other Defects (3): (.1) Nsevus: For operation during the Christmas holiday. (2) Slight Umbillical Condition same, no need for operation. Weakness : (3) Migraine (girl) : Definite improvement. Mr. C. W. Truelove, the Principal, takes a special interest in Medical Inspection at the School, with the result that a large percentage (average 80) of the parents attend the two inspections each year. (17) Parents' Payments. The arrangements made for recovering the cost of treatment from parents of children attending Public Elementary Schools and pupils attending Secondary Schools and other Institutions of Higher Education are as follows :— Medical and Dental Treatment. Lists of cases treated are periodically sent to the Superintendent of Visitors. The School Attendance Officers visit each case and ascertain the income of the parents. The cases are then assessed in accordance with the Committee's scale and the amount is then collected by weekly instalments. Spectacles. Parents claiming assistance in respect of the supply of spectacles to children attend the School Attendance Department and state particulars of their income. Upon this information, an order is given to the Optician to the Education Committee, to supply the spectacles at contract price at a cost to the parents according to their means. 182 (18) Health Education. The staff of the School Medical Service have not given any Health talks in the Elementary or Secondary Schools during the year. Copies of the Board's Handbook of Suggestions on Health Education have been supplied to Head Teachers. (19) Special Inquiries. There have been no special inquiries conducted during the year by members of the School Medical staff in regard to Special Services. (20) Miscellaneous. Employment of Children and Young Persons. The employment of school children out of school hours is subject to certain restrictions governed by Bye-Laws under Section 9 of the Education Act, 1921. These restrictions limit the age at which a child can commence such work, and the hours of employment. The child must also be medically examined and a certificate given that the work will not injure the child's health or prejudice its education. The greater part of the work undertaken by children in this Borough consists of newspaper delivery and other errand rounds connected with provision stores. The Bye-Laws under the Education Act, 1921, relating to the employment of children have been recently revised and adopted by the Council. In the main they give greater elasticity to child employment without essentially altering the hours of employment or encroaching on the conditions. Moreover they bring these conditions more into line with those of the London County Council and neighbouring Boroughs. During 1933, 165 children were examined; one certificate was not granted on account of unfitness. During the same period certificates of fitness under the Employment of Children in Entertainments Rules (Sec. 101, Education Act, 1921), were granted in respect of 34 girls and 5 boys. Pathological Work. The microscopical examination of sputum for the presence of the tubercle bacillus is undertaken by the Tuberculosis Officer. Throat swabs are taken bv the School Medical staff as required, and sent to the Superintendent of the Plaistow Fever Hospital for cultivation and report. The microscopic diagnosis of ringworm of the head is undertaken by the School Medical staff in the Laboratory provided for that purpose. K 183 APPENDIX II. STATISTICAL TABLES, SCHOOL MEDICAL OFFICER'S ANNUAL REPORT, 1933. 185 TABLE I. RETURN OF MEDICAL INSPECTIONS. Year ending- 31st December, 1933. ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. Number of Inspections in the Prescribed Groups. Entrants 5652 Second Age Group 4698 Third Age Group 5191 Total 15541 Number of other Routine Inspections 1623 B.—Other Inspections. Number of Special Inspections 18593 Number of Re-Inspections 7451 Total 26044 186 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1933. ELEMENTARY SCHOOLS. Defect or Disease. Routine Inspections. Special Inspections No. of Defects No. of Defects Requiring treatment Requiring to be kept under observation, but not requiring treatment Requiring treatment Requiring to be kept ? observation, but not requiring treatment (1) (2) (3) (4) (5) Malnutrition 275 60 9 15 SKIN— Ringworm—Scalp 1 — 27 — ,, Body 2 - 115 1 Scabies 13 204 — Impetigo 30 - 1,043 — Other Diseases (Non-Tuberculous) 89 20 1,926 - Eye— Blepharitis 55 3 316 1 Conjunctivitis 33 1 665 — Keratitis 1 13 1 Corneal Opacities 4 1 42 2 Defective Vision (Excluding Squint) 992 232 987 20 Squint 145 10 219 1 Other Conditions 10 7 267 2 Ear— Defective Hearing 51 14 104 8 Otitis Media 110 25 714 3 Other Ear Diseases 39 6 413 1 Nose and Throat— Chronic Tonsillitis only 464 341 241 2 Adenoids only 21 10 26 1 ChronicTonsillitis&Adenoids 297 63 248 4 Other Conditions 75 25 159 2 Enlarged Cervical Glands (Non-Tuberculous) 23 33 228 6 Defective Speech 10 22 89 11 Heart and Circulation— Heart Disease—Organic 25 112 58 27 ,, Functional 92 2 16 Anaemia 168 91 130 58 Lungs— Bonchitis Other Non -Tuberculous 178 87 66 17 Diseases 10 19 16 1 187 TABLE II.— (Continued) Defect or Disease. Routine inspections Special Inspections No. of Defects No. of Defects Requiring treatment Requiring to be kept under observation, but not requiring treatment Requiring treatment Requiring to be kept under observation, but not requiring treatment ' (1) (2) (3) (4) (5) Tuberculosis— Pulmonary: Definite 1 4 6 — Suspected 22 28 27 7 Non-Pulmonary: Glands 4 4 13 1 Bones and Joints — 3 — 1 Skin 1 1 — — Other Forms — 1 2 — Nervous System— Epilepsy 3 11 14 1 Chorea 25 9 36 6 Other Conditions 50 40 59 12 Deformities— Rickets 2 7 1 7 Spinal Curvature 18 3 7 — Other Forms 18 14 8 13 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 340 125 6,439 188 B.—Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases):- Group Number of Children Percentage of Children found to require treatment Inspected Found to require treatment (1) (2) (3) (4) Prescribed Groups— Entrants 5,652 1,129 19 9 Second Age Group 4,698 1,038 22 0 Third Age Group 5,191 982 18 9 Total (Prescribed Groups) 15,541 3,149 20 2 Other routine Inspections 1,623 97 5.9 188 TABLE III. Return of all Exceptional Children in the County Borough. Children Suffering from Multiple Defects. Children suffering from any combination of the following types of defect:— Blindness (NOT Partial Blindness). Deafness (NOT Partial Deafness). Mental Defect. Epilepsy Active Tuberculosis. Crippling. Heart Disease. Number of children suffering from any combination of the above defects 5 Blind Children. At Certified Schools for the Blind. At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 3 — — — 3 Partially Blind Children. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 13 - 3 - 3 19 Deaf Children. At Certified Schools for the Deaf. At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 28 — — — 28 189 Partially Deaf Children. At Certified Schools for the Deaf. At Certified Schools for t he Partially Deaf. At Public Elementary Schools At Other Institutions. At no School 0r Institution. Total. 11 - 7 - — 18 Mentally Defective Children. Feeble-minded Children. At Certified Schools for Mentally Defective-Children. At Public Ele m§ntary Schools At Other Institutions. At no School or Institution. Total. 184 84 - 8 226 Children Notified by the Local Education Authority to the Local Mental Deficiency Authority. Diagnosis. Boys Girls 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots 1 1 (b) Imbeciles 6 6 (c) Others 4 8 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives — — (b) Others — 1 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 8 2 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases - 4. Children who in addition to being mentally defective were blind or deaf 1 1 Number of children notified 20 19 190 Epileptic Children. Children Suffering from Severe Epilepsy. At Certified Special Schools At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 7 2 3 7 19 Physically Defective Children. A. Tuberculous Children. 1.—Children Suffering from Pulmonary Tuberculosis. (including pleura and intra-thoracic glands) At Certified Special Schools At Elementary Public Schools At Other Institutions. At no School or Institution. . Total. 40 4 1 18 63 II.—Children Suffering from Non-Pulmonary Tuberculosis. At Certified Special Schools At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 82 5 1 5 93 B. Delicate Children. Children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open-Air School. At Certified Special Schools At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 214 248 4 12 478 191 C. Crippled Children. Children (other than those diagnosed as tuberculous and in need of treatment for that disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life, i.e., children who generally speaking are unable to take part, in any complete sense, in physical exercises or games or such activities of the School curriculum. At Certified Special Schools At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 48 16 3 18 85 D . Children with Heart Disease. Children whose defect is so severe as to necessitate the provision of educational facilities other than those of the Public Elementary School. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 28 10 3 14 55 192 TABLE IV. Return of Defects Treated during- the Year ended 31st Dec., 1933. ELEMENTARY SCHOOLS. Treatment Table. Croup 1.— Minor Ailments (excluding Uncleanliness, for which sec Group VI) Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm, Scalp 27(13*) — 27 Body 115 1 116 Scabies 208 5 213 Impetigo 1,044 8 1,052 Other Skin Disease 1,916 43 1,959 Minor Eye Defects— (External and other, but excluding cases falling: in Group II.) 1,262 41 1,303 Minor Ear Defects 1,186 57 1,243 Miscellaneous (e.g.. minor injuries, bruises, sores, chilblains, etc.) 5,956 303 6,259 Totals 11,714 458 12,172 * Number treated by X-Rays Croup II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group 1). Defect or Disease. Number of Defects dealt with. Under the Authority's Scheme. By private practitioner or at Hospital, apart from the Authority's Scheme Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) 3,625 21 7 3,653 Other Defect or Disease of the eyes (excluding those recorded in Group 1) 30 1 - 31 Total 3,655 22 7 3,684 193 TABLE IV.—Continued. Number of Children for whom spectacles were prescribed:— (a) Under the Authority's Scheme 2930 (b) Otherwise 31 Number of Children who obtained spectacles:— (a) Under the Authority's Scheme 2792 (b) Otherwise 21 Group III.— Treatment of Delects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 352 19 422 28 15 3 14 2 367 22 436 30 134 989 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. Croup IV.—Orthopaedic and Postural Delects. Number of children treated. Under the Authority's Scheme (1) Otherwise. (2) Total number treated. Residential treatment with education. Residential treatment without education. Non-Residential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Non-Residential treatment at an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) — — — - — — — 194 Group V.—Dental Defects. (.1) Number of Children who were:— (1) Inspected by the Dentist: Routine Age Groups Aged: Total 20102 4 521 5 1064 6 5452 7 4728 8 2997 9 964 10 964 11 1151 12 993 13 1189 14 79 Specials 4736 Grand Total 24838 (ii) Found to require treatment 13857 (iii) Actually treated 10628 (2) Half-days devoted to— Inspection 233 Treatment Total 1958 219,1 (3) Attendances made by children for treatment. 16892 (4) Fillings— Permanent teeth 1876 Temporary teeth 648 Total 2524 (5) Extractions— Permanent teeth 1672 Temporary teeth 16941 Total 18613 (6) Administrations of general anaesthetics for extractions Nil (7) Other Operations— Permanent teeth 1805 Temporary teeth Total 445 2250 195 Croup VI.— Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 9.8 (ii) Total number of examinations of children in the Schools by School Nurses G6038 (iii) Number of individual children found unclean 965 (iv) Number of children cleansed under arrangements made by the Local Education Authority Nil (v) Number of cases in which Legal proceedings were taken:— (a) Under the Education Act, 1921 Nil (b) Under School Attendance Bye-laws Nil SECONDARY SCHOOLS AND OTHER INSTITUTIONS OF HIGHER EDUCATION. TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1933. DEFECT OR DISEASE. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment Requiring to be kept under observation. but not requiring Treatment. Requiring Treatment. Requiring to be kept under obser vation, but not requirin Treatment (1) (2) (3) (4) (5) Malnutrition 6 3 2 — Skin— Ringworm Scalp — — — — Body — — — — Scabies — — — 1 Impetigo 2 — — — Other Diseases (Non-Tuberculous) 17 2 1 — Eye— Blepharitis — — — — Conjunctivitis — — — — Keratitis — — — — Corneal Opacities — 7 — — Defective Vision (excluding Squint) 395 186 7 1 Squint 6 6 — — Other Conditions — — — — Ear— Defective Hearing 5 6 — — Otitis Media 12 ' — Other Ear Diseases 1 • — — 196 defect or disease. (1) Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment (2) Requiring to be kept under observation, but not requiring Treatment. (3) Requiring Treatment. (4) Requiring to be kept under observation, but not requiring Treatment. (5) Nose and Throat— Chronic Tonsillitis only 37 31 — — Adenoids only 1 — — — Chronic Tonsillitis & Adenoids 8 — — — Other Conditions 3 — 2 — Enlarged Cervical Glands (NonTuberculous) - 5 — — Defective Speech — 3 — — Heart and Circulation— Heart Disease: Organic 8 9 — 1 Functional — 4 — — Anaemia 4 1 — — Lungs— Bronchitis 3 4 1 - Other Non-Tuberculous Diseases — — — — Tuberculosis— Pulmonary: Definite — 2 — — Suspected — 1 — — Non-Pulmonary: Glands — — — — Bones and Joints — — — — Skin — — — — Other Forms — — — — Nervous System— Epilepsy — — — — Chorea — — — — Other Conditions 7 5 — — Deformities— Rickets - - — - Spinal Curvature 2 — — — Other Forms 3 47 — — Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 26 31 — B. Number of Individual Children Found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Number of Children Inspected 2118 Number of Children found to require Treatment 524 Percentage of Children found to require Treatment 24.7 197 INDEX (Public Health). PAGE Ambulance Services 38 Ashpails 90 Births 20 50 Central Home41 48 Cerebro Spinal Fever 118 Charts 21 23 29 35 53 Children and Young Persons' Act, 1933 60-01 Clinics, School, etc. 39 40 51 53 Committees, list of 7-9 Common Lodging Houses 89 Contents 4 Convalescence 59 60 Co-ordination 32-33 Council, list of Members 7 Dagenham Sanatorium and Langdon Hills Sanatorium, Medical Superintendent's Report, etc. 40 126-128 Deaths 20 Deaths, causes of 27 Deaths, in Institutions 25 Dental Treatment 52 Diarrhoea, etc. (deaths from—under 2 years of age) 19 Diphtheria 107-109 116 Disinfection 122 District Medical Officers 42 45 67-69 Drainage and Sewerage Dried Milk, distribution of 57-58 Erysipelas 118 Extracts from Vital Statistics 19 Factories, Workshops and Workplaces 88 Fertilisers' and Feeding Stuffs' Act, 1926 98-99 Food, Inspection and Supervision of Unsound, etc 85 96-105 Forest Gate Hospital 41 46 99 Forest House Foster Children 60-61 General Provision of Health Services 32-30 Harold Wood Hospital 110 Health Visiting 50-51 Home Helps 55 Hospitals 40-42 58 Housing 91-95 Houses let in lodgings Immunization against Diphtheria 107-109 119-120 Infantile Mortality Infectious Diseases, Prevalence of, and Control over, etc. 40 106-122 Institutional Accommodation 69-74 Laboratory Work 198 PAGE Langdon Hills Sanatorium 40 128-130 Maternal Deaths 65 Maternity and Child Welfare, Report of Senior Medical Officer for, etc. 50-67 Maternity and Nursing Homes 39 60 Measles 106 117 Meat, disposal of condemned 102 Meat, Public Health Regulations, 1924 102-105 Meningitis (Cerebro Spinal) 118 Mental Deficiency 75-80 Midwives 55-56 Milk, Condensed, Regulations 95 Milk, Examination of (animal inoculation) 95 Milk, Bacteriological examination 97 Milk Supply 95 Milk (Special Designations) Order, 1923 97-98 Milk and Dairies (Amendment) Act, 1922 96 Milk and Dairies (Consolidation) Act, 1915 96 Milk and Dairies Order, 1926 96 Mortality, Maternal, Infant and General 19 61 62 66 Moltuaries 44 Notifiable Diseases 106-107 Nuisances, Abatement of 87 Nursing Homes 39-60 Nursing, Professional, in the Home 39 Offensive Trades 90 Open-Air Schools 42 Ophthalmia Neonatorum 61 Orthopaedic Treatment, etc. 58-59 Overcrowding 93 Plaistow Hospital, Medical Superintendent's Report 110-122 Plaistow Hospital, Bacteriological 121-122 Pneumonia 118 Preface 5-6 Public Health Regulations Preservatives, etc., in Food 97 Puerperal Fever and Puerperal Pyrexia 65 Prosecutions 84-85 Psychological Clinic 37 Rag Flock Acts 69-90 Rates— Birth 19 Death 19 Infantile Mortality 19 Maternal Mortality 19 Still Birth 19 Refuse Disposal 81 Reports of Medical Officer of Health 67-74 91-92 Rivers and Streams 80 199 PAGE Samples taken, Food and Drugs Acts 100-101 Sanitary Circumstances of Area 80-90 Scarlet Fever, Return Cases, etc. 106-115 Scavenging 81 Schick and Dick Test 107-109 119-120 Schools 82-84 Shops Acts 43 84-85 Slaughter Houses 102-105 Slaughter of Animals Act, 1933 104-105 Smallpox 40 Staff, List of 10-17 Statistics and Social Conditions of the Area 18-31 Statistics, Vital 19 South Ockendon Colony for Mental Defectives 77-80 Stratford Day Nursery 56-57 Summary of General Statistics 19 Do. Work of Sanitary Inspectors 86-87 Sunlight Clinic 57 Treatment Centres 39 Tuberculosis 40 Do. Table of Notified Cases, etc. 122-123 Do. Report of Tuberculosis Officer 124-125 Tuberculosis Order, 1925 105 Vaccination Acts, 1867-1898, summary of work 42 Veneral Diseases 131-137 Veterinary Officers' Report 102-105 Vital Statistics, Extracts from Do. of Wards 20 Do. Chief since 1887 31 Water 80 West Ham, Old Canning Town Clearance Order 91-92 Whipps Cross Hospital 41-47 Whooping Cough 106-117 200 INDEX (School Medical). SUBJECT. PAGE After-Care Committees 165, 167 Artificial Light 157 Baths 145 Blind Children 163, 167 Blind, Deaf, Defective and Epileptic Children 163 Students 172 Blind Persons' Act Central Association for Mental Welfare Central Schools 179 Children's Country Holiday Fund 161 Clinics—Summary of Work 150 Co-ordination 144 Continuation Schools 179 Convalescent Treatment 163 Crosby Road Open Air School 171 Deaf Children 153, 163 Defective Children 163 Dental Defects 148, 153 Ear Diseases 148, 153 Edith Kerrison Nursery School 173 Employment of Children and Young Persons 183 Epileptic Children 163, 167 Exclusions 158 Eye Diseases (External) 148, 151 Findings of Medical Inspection 146 Following-up 149 Frederick Road Deaf Centre 167 Fyfield Open Air School 168 Grange Road Special School 164 Health Education 183 Hearing (Defective) 148, 153 Heart Disease 148, 156 Height (Comparative Tables) 147 Higher Education 172, 174 Holiday Camps 159 Hygiene 144 Infectious Diseases 157 Invalid and Crippled Children's Society 163 Invalid Children's Aid Association 163 Knox Road Special School 164 Malnutrition 146, 149 Meals, Provision of 162 Medical Inspection 145 Menu (Fyfield) 169 Milk in Schools 149 201 SUBJECT. PAGE Minor Ailments 147, 150 Municipal College '75 National Society for the Prevention of Cruelty to Children 163 Nose and Throat Defects 148, 152 Nursery Schools 172 Ogilvie School of Recovery 171 Orthopaedic and Postural Defects 148, 155 Open Air Education 158 ,, Schools 168 Out-of-School Cases 163 Parents, Co-operation of Parents' Payments Pathological Work 183 Physical Training Plaistow Secondary School 176 Playground Classes Rebecca Cheetham Nursery School Ringworm 150 St. Angela's High School 177, 178 Scholarship Children 179 School Attendance Officers, Co-operation of 157, 162 School Journeys 159 Scope of School Medical Service 146 Secondary Schools 174, 175 Skin Diseases 147, 150 Special Schools 164 Spray Baths 145 Staff 143 Stammerers Statistical Tables 185 Surgical Instruments Teachers, Co-operation of The Grove Central School The Russell Central School Tonsils and Adenoids 148, 152 Treatment, Arrangements for Tuberculosis 148, 156 Uncleanliness 147, 150 Visual Defects 148, 151 Voluntary Bodies, Co-operation of 163 Water Lane Deaf Centre 167 Weight (Comparative Tables) West Ham High School for Girls 177 West Ham Secondary School 176 202