WHAM 14 Country Borough of West ham 1935 ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer 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. CONTENTS Page Preface 5-6 Members of the Council and Committees 7-9 Members of Staff 10-17 Statistics and Social Conditions of the Area 18-30 General Provision of Health Services : 31-71 (a) Hospitals 39-41 (b) Maternity and Child Welfare 51-70 (c) Mental Deficiency 70-74 Sanitary Circumstances of the Area 74-82 Housing 83-89 Report of the Medical Officer of Health on Housing Act, 1935 86-89 Inspection and Supervision of Food 89-102 Infectious Diseases 102-115 Tuberculosis 115-123 Venereal Diseases 124-129 School Medical Officer's Report 131-208 4 Municipal Health Offices, Romford Road, West Ham, E.15. To the Mayor, Aldermen and Councillors. Mr. Mayor, Ladies and Gentlemen, Legislation continues to place increased responsibilities upon yourselves and your officials. Notwithstanding the enormous strides made in the progress and extension of your Public Medical Services during the past decade, many further important phases have been instituted during the past year. The chief of these are:— (1) The inclusion in the Maternity and Child Welfare Scheme of the following : (a) The provision of dentures for nursing and expectant mothers ; (b) the provision of free meals for necessitous nursing and expectant mothers ; (c) the granting of a subsidy (under certain conditions) to midwives ; (d) the extension of the convalescent scheme for mothers and babies. (2) The extension of hospital accommodation at Whipps Cross Hospital by 500 beds, together with another operating theatre and new receiving wards, and the building of a new Nurses' Home and Maids' Home. (3) The confirmation of several further large Clearance Areas under the Housing Acts. The demolition of certain Clearance Areas, together with the re-housing of the displaced tenants. It is very unfortunate that owing to the lack of suitable sites the clearance of certain Clearance Areas is being delayed. Every reasonable effort should be made to bring this vital matter to a successful issue while still retaining sufficient open spaces. A large strip of land unsuitable for houses, but in every respect suitable for factories, will be available between the Silvertown Way and River Lee when Tidal Basin Nos. I to IV Clearance Areas are dealt with. (4) The negotiations for the extension of your Colony for Mental Defectives at South Ockendon to 500 beds, mentioned in so many of my previous reports, have now reached the final stage and work should be commenced during the ensuing year. (5) In order to comply with the provisions of the Housing Act, 1935 (see pages 86-89), extra temporary staff had to be appointed and, in addition, extra work has been thrown upon the permanent staff. A comprehensive report upon this matter will be issued by me as soon as practicable. 5 (6) The Pharmacy and Poisons Act, 1933, also the Shops Act, 1935, have come into force this year. The provisions of the latter Act have been so extended that it became necessary to appoint an additional Shops Inspector (see page 42-43). The Vital Statistics for the year are again very satisfactory. The most striking figure is that of the Infantile Mortality Rate, which has gone down to the figure of 45 in comparison with 62 for the other Great Towns, the lowest previous figure for West Ham being 59. Nearly half the total deaths are accounted for by only three diseases. Over 25 per cent. of deaths are due to heart disease, while cancer claims 14.2 per cent. of deaths, the toll from respiratory diseases being 10 per cent. Owing to inherent difficulties connected chiefly with the unsuitable and quite inappropriate nature of the building, the Margate Convalescent Home was closed last August. This has not meant any loss of necessary convalescent treatment for children, who are at present sent to Homes elsewhere. The proposition as to whether or not to purchase a new convalescent home is receiving the consideration of the Council. As is inevitable where a big staff is concerned, there have been a number of changes in the personnel during the year. The places of those leaving have been filled, but the only additional appointment made was that of another Shops Inspector. As in previous years, propaganda on health matters has been carried on as routine work, special attention having been given to proper food values and diet (see pages 9(3-97). Towards the end of the year a booklet was printed containing a synopsis and information concerning all the health services of the Borough. This booklet was sent to all Medical Practitioners, Teachers and Clergy, as well as to the Public Libraries, various Voluntary Societies and others. The acknowledgements received from various sources proved the usefulness of the information given. This is the Twelfth Annual Report I have had the privilege of submitting to you, and once again I wish to express my gratitude to you for the help afforded to me and my staff, and for the unflagging interest you take in all matters pertaining to the health of your constituents; help and interest reflected in the satisfactory statistics, and the progression of your Health Services. Your obedient Servant, I Garham Cholham May, 1936. 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 (Councillor Cuthbert St. Clair Collins, J.P.). The Deputy Mayor (Alderman Mrs. Esther Bock). Aldermen W. T. Bell; G. R. Blaker, J.P. ; G. Croot, J.P. ; B. W. Gardner, J.P., M.P. ; T. E. Groves, J.P., M.P.; J. H. Hollins, J.P. ; J. T. Husband, J.P. ; J. J. Jones, J.P., M.P. ; Mrs. D. Parsons, J.P. ; E. J. Reed, J.P.; W. J. Reed; H. J. Rumsey, D.C.M., M.M. ; J. T. Scoulding, J.P. ; W. J. Thome, C.B.E., J.P., M.P. ; T. Wooder. Councillors E. H. J. Adams; Mrs. A. A. Barnes; C. A. Bennett; E. F. Bradley; S. Bulling, J.P. (deceased) ; E. C. Cannon; Mrs. A. M. Clark; C. K. Collins; Mrs. E. C. Cook; A. E. Cresswell; G. Doherty; J. Doherty; S. M. Edwards; W. P. Foley; E. J. Fox; A. G. Gay, J.P. ; A. C. Gentry; W. A. Gillman; Mrs. E. J. Gregory; D. W. Hall; Mrs. A. E. Harnwell; Mrs. F. Harris; P. Hearn ; Mrs. J. A. Hollins; Dr. Sidney Lee; W. H. Luscombe; A. B. Macgregor; H. J. Marners; F. E. Mansford; A. C. Moorey; W. C. Ridgwell, J.P. ; A. G. Schirn; D. H. Smith; G. J. Smith; G. J. Stokes; M. J. Sullivan; G. A. Taylor; D. Thorogood ; Mrs. Ethel Venton; A. J. Walker; C. H. Ward, J.P. ; F. A. Warner; A. W. Wells; E. W. White, J.P. ; Mrs. F. A. Wood; E. W. Wordley, J.P. ; Mrs. E. E. Wybrew. List of Committees. Dealing with Health Matters. His Worship the Mayor (Councillor Cuthbert St. Clair Collins, J.P.) Ex-officio member of every Committee. 7 Public Health Committee. Chairman : Councillor P. Hearn. Vice-Chairman: Councillor Mrs. Barnes. Aldermen: Husband, E. J. Reed and Rumsey. Councillors: Bradley, Cannon, Mrs. Clark, Fox, Gay, Gentry, Mrs. Gregory, Lee, Schirn, and Mrs. Wybrew. Maternity and Child Welfare Committee. Chairman : Councillor Mrs. Barnes. Vice-Chairman : Councillor Schirn. Aldermen: Husband, E. J. Reed, and Rumsey. Councillors: Bradley, Cannon, Mrs. Clark, Fox, Gay, Gentry, Mrs. Gregory, Lee, Schirn, and Mrs. Wybrew. Co-opted Members : 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 Walker. Vice-Chairman : Councillor Bradley. Aldermen : E. J. Reed and Rumsey. Councillors: Mrs. Clark, Mrs. Cook, J. Doherty, Foley, Gentry, Gillman, Macgregor, Schirn, G. J. Smith, White, and Wordley. Education Committee. Chairman : Councillor Mrs. Gregory. Vice-Chairman : Alderman Blaker. The Mayor (Councillor Cuthbert St. Clair Collins). The Deputy Mayor (Alderman Mrs. Bock). Aldermen: Bell, Croot, Gardner, J. H. Hollins, Mrs. Parsons, E. J. Reed, and W. J. Reed. Councillors : Bennett, Bulling (deceased), G. Doherty, Edwards, Foley, Gay, Mrs. Hollins, Luscombe, Moorey, Mrs. Venton, Walker, Ward, and Warner. Co-opted Members: 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. W. Godbold and F. G. Reynolds, Esquires, and Dr. M. S. Jevons. Special Schools and Welfare Sub-Committee. Chairman : Councillor Mrs. Hollins. The Deputy Mayor (Alderman Mrs. Bock). Aldermen : Croot, Mrs. Parsons, and E. J. Reed. Councillors: Bennett, Bulling (deceased), Edwards, Luscombe, and Mrs. Venton. Co-opted Members: The Misses R. H. Cheetham and A. RHarbott, W. Godbold, Esquire. 8 The Hospitals Committee. Chairman : The Deputy Mayor (Alderman Mrs. Bock). Vice-Chairman: Alderman Croot. Aldermen : Mrs. Parsons and Rumsey. Councillors: Adams, Mrs. Barnes, Hall, Mrs. Harris, Mrs. Hollins, Lee, Macgregor, Walker, Ward, Mrs. Wood, and VVordley. The Public Assistance Committee. Chairman : Alderman Mrs. Parsons. Vice-Chairman : Alderman Wooder. The Deputy Mayor (Alderman Mrs. Bock). Councillors: Mrs. Barnes, Bulling (deceased), Mrs. Cook, G. Doherty, Mrs. Harnwell, Mrs. Harris, Mrs. Hollins, Manners, Mansford, Ridgwell, Mrs. Venton, and Mrs. Wybrew. The Committee for the Care of the Mentally Defective. 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. The Deputy Mayor (Alderman Mrs. Bock). Aldermen: Bell, Blaker, Croot, J. H. Hollins, Husband, Mrs. Parsons, and Scoulding. Councillors : Bradley, Hall, Mrs. Hollins, Ridgwell, Ward, Mrs. Wood and Wordley. Mrs. Bulling and Mrs. Cornelius. Institutions Management Sub-Committee. Chairman : Councillor G. Doherty. Plus Rota of Members of Public Assistance Committee. Maintenance Sub-Committee. Chairman : Councillor Mansford. Plus Rota of Members of Public Assistance Committee. Joint Committee re Hospital Accommodation. The Deputy Mayor (Alderman Mrs. Bock). Aldermen: Mrs. Parsons and Wooder. Councillors: G. Doherty, Mrs. Gregory, Hearn, Mrs. Hollins, Ridgwell, Walker, and Wordley. 9 Staff of Medical Officer of Health's Departments 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. Mayberrv 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. (Edin.), D.P.H. Assistant Medical Officer Maternity and Child Welfare Dr. Muriel Frances Prout M.D., B.S. (Lond.) Part time Medical Officer Maternity and Child Welfare Dr. Angel V. B. Crawford B.A., M.B., B.Ch. (Dublin), D.P.H. (Eng.) Do. Dr. Dorothy L. M. Keats M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. Assistant Resident Medical Officer Dagenham Sanatorium Dr. H. L. W. Beach M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. Senior Resident Medical Officer Plaistow Fever Hospital Dr. T. Standring M.R.C.S., L.R.C.P., M.B., B.S. Junior Assistant Resident Medical Officer, Plaistow Hospital; annual appointment Mr. O. R. M. Kelly M.B., B.S. (London), F.R.C.S. (Eng.) Med. Supt., Whipps Cross Hospital Dr. D. G. Sharp M.R.C.S. (Eng.), L.R.C.P. (Lond.) Deputy Med. Supt. and First Assistant, Whipps Cross Hospital Dr. W. E. Joseph M.R.C.S. (Eng.), L.R.C.P. (Lond.) Second Asst. Med. Officer Whipps Cross Hospital 10 NAME QUALIFICATIONS OFFICES HELD (Wholetime appointments except where otherwise stated) Dr. N. H. Skelton-Browne M.R.C.S. (Eng.), L.R.C.P. (Lond.) Asst. Med. Officer, Whipps Cross Hospital Dr. Ian Mansfield L.M.S.S.A. (London) Do. Dr. G. McKinnon M.B., B.Ch. (Glasgow) Do. Dr. C. E. D. H. Goodhart M.R.C.S. (Eng.), L.R.C.P. (Lond.) Do. Dr. W. J. O'Donovan M.D., B.S., M.R.C.P. (Lond.), M.R.C.S. 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.), Do. Mr. Clifford Morson M.B., B.S. (London) F.R.C.S. (Eng.), Do. Mr. Archer-Ryland L.R.C.P. (Lond.) F.R.C.S. (Eng.), Do. Dr. J. P. Martin L.R.C.P. (Lond.) F.R.C.P. (Lond.), Do. Dr. Lewis Savin M.D., B.Ch. (Belfast) F.R.C.S. (Eng.), Do. Dr. J. Barton L.R.C.P. (Lond.) L.M.S.S.A. Do Dr. de Lacy Walker L.M.S.S.A. Do. Dr. J. S. Greig M.B., C.M. (Aberdeen) Medical Supt. Forest Gate Hospital and Central Home, Union Road (Superannuated December, 1935) Dr. H. R. England M.B., B.Ch. (N.U. Ireland) Medical Superintendent, Forest Gate Hospital Dr. I. B. McCann M.R.C.S. (Eng.), L.R.C.P. (Lond.) Senior Resident Medical Officer, Central Home Dr. R. Leader M.R.C.S. (Eng.), L.R.C.P. (Lond.) Resident 1st Assistant Medical Officer, Central Home Df- J. S. Coleman M.B., B.S. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.) As?t. Med. Officer, Forest Gate Hospital & Central Home (Left Council's service) Df. T. L. Dolan Dr. C. E. Conran L., L.M., R.C.P. Ireland, L., L.M., R.C.S. Ireland L.R.C.P. (Edin.), L.R.C.S. (Edin.) District Med. Officer and Public Vaccinator Do. (Superannuated) J- P. Robinson M.B., B.Ch., B.A.O. (N.U. Ireland) District Medical Officer Dr- P. G. S. Kennedy M.A., M.B., Ch.B. (Lond.) District Med. Officer and Public Vaccinator (parttime temporary) Dr.J. F. Begley M.B., B.S. R.U. Ireland) District Med. Officer (part time) Dr. W. E. Willis M.B., Ch.B. (Edin.). Part time Medical Officer, Harold Wood Hospital 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. (N.U. Ireland) Do. and Public Vaccinator Dr. A. S. Paterson F.R.C.P. (Edin.) M.B., Ch.B. (Edin.) Medical Officer (part time) Margate Convalescent Home (Closed 31/8/35) Mr. H. H. King — Vaccination Officer Mr. A. E. Parkes F.I.C., F.C.S. Public Analyst (part time VI r. H. E. By water M.R.C.V.S. Veterinary Officer Mr. T. J. Maguire M.R.C.V.S. Veterinary Officer Miss Evelyn Richardson L.D.S., R.C.S. (part time) Dental Surgeon Maternity and Child Welfare Miss R. Alefs General Nursing, S.C.M., Fever Nursing Certificate Health Visitor Miss M. H. Banks General Nursing, S.C.M., Queen's Nurse, Health Visitors' Cert., Royal San. Inst. Do. Miss Phyllis Bennett General Nursing, S.C.M., Queen's Nurse, Health Visitors' Cert., Royal San. Inst. Do. Miss B. H. Clipstone General Nursing, S.C.M., Do. Miss A. Connolly General Nursing, Health Visitor's Certificate Do. Miss M. Cross General Nursing, S.C.M., Do. Miss B. de Rochfort San. Insprs. Cert. Royal San. Inst., Health Visitor's Cert. Royal San. Inst., S.C.M., Apothecary Hall Dispensing Cert. Do. Miss E. A. Edwards General Nursing, S.C.M., Queen's Nurse, Health Visitors' Cert., Royal San. Inst. Do. Mrs. N. C. Gibbins General Nursing, S.C.M., Health Visitor's and Fever Nursing Certificates Do. 12 NAME QUALIFICATIONS OFFICES HELD (Wholetime appointments except where otherwise stated) Miss F. B. E. Groub-Tong General Nursing, S.C.M., Children's Nursing Health Visitor's Cert. Royal San. Inst., San. Inspector's Examn. Board Health Visitor Miss R. Harrington General Nursing, S.C.M., Health Visitors' Cert., Royal San. Inst. Do. Miss A. E. Lunn General Nursing, S.C.M., Do. Miss L. Martin General Nursing, S.C.M., Board of Education Diploma, Mat. and Child Welfare Cert. Do. Miss M. McKenzie General Nursing, S.C.M., Health Visitor's Cert. Royal San. Inst. Do. Miss E. Norrie General Nursing Cert. and Children's Cert., S.C.M., Board of Education Diploma, Liverpool University School of Hygiene Cert Do. Miss M. B. Wallace General Nursing, S.C.M., Do. Miss E. B. Welch General Nursing, S.C.M., Board of Education Diploma Do. Miss D. M. White Miss F. M. Davies General Nursing, S.C.M., Health Visitor's Certificate Royal San. Inst. Gen. Nursing, R.M.P.A. Cert. Do. Dental Nurse Mr. H. G. Clinch F.S.I.A., M.R.S.T. San. Inspr. Cert. R. San. Inst. Meat and Food Inspr. R. San. Inst. Smoke Inspr. R. San. Inst. San. Inspr. Joint San. Insprs. Exam. Board, Cert, of Exam, in advanced knowledge of practical and administrative duties of Inspr. Ollett Silver Medallist in Housing Administration Chief San. Inspr., Inspr. under Rag Flock Acts 13 NAME QUALIFICATIONS OFFICES HELD (Wholetime appointments except where otherwise stated) Mr. B. G. Bannington 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. Senior Sanitary Inspector, Inspr. under Rag Flocl Acts Mr. E. G. Simmons M.S.I.A. San. Insprs. Cert. Royal San. Inst. Sanitary Inspector, fnsp under Rag Flock Acts Mr. John F. Mules M.S.I.A., F.F.A.S.. A.M.T.S.E. San. Insprs. Cert., Meal and Food Inspr. Royal San. Inst. Sanitary Inspector Mr. B. J. Driscoll M.S.I.A. Cert. San. Inspectors' Examn. Board London Sanitary Inspector, Insp under Rag Flock Acts Mr. C. F. Riley San. Insprs. Cert., Meat 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.L 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. ui der 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 •, 3,1 Mr. C. E. Jeffries, M.S.I.A. San. Inspr. Examn. Joint Board, Meat and Food Inspector Royal San. Inst. Do. 14 NAME QUALIFICATIONS 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., Smoke Inspr. Royal San. Inst. Do. Miss V. M. Busby M.S.I.A. San. Insprs. Cert. Royal 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 lns[>ector Miss G. Briggs, M.S.I.A. San. Insprs. Examn Joint Board sanitary Inspector (now resigned) 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. 1. 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. 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 Mr. C. J. Genery — Inspector under Shops Acts Supervising Nurse under Mental Deficiency Act Miss H. Swift S.R.N., S.C.M. 15 Medical Officer of Health's Office Administrative Staff Mr. F. W. Bromley Chief Clerk ,, H. R. Cole Senior Clerk ,, F. H. Barker Clerk ,, J. Sabin do. ,, A. Clarke do. Mr. D. Thompson ... Clerk Miss A. E. Durand Clerk ,, S. A. Lemmon do ,, H. O. Williams do. , M. Doherty do. Mr. J. P. Quinn do. Mr. J. W. McCarthy Investigator Mr. F. Johnson Asst. Sampler TUBERCULOSIS DISPENSARY. Nurses. Clerks. Mrs. E. Siggins, Sister-in-Charge. Mr. W. Pike Miss E. J. Egerton Miss M. F. Bush Miss M. Schwer Miss G. Williams Miss E. K. Pottinger PLAISTOW HOSPITAL. Matron. Steward. Clerk. Miss I. Tulloch Mr. W. Liddall Mr. C. Poyser 74 Nursing Staff. 46 Domestic S'taff. THE CHILDREN'S HOSPITAL, HAROLD WOOD. Matron. Steward. Miss L. M. Mackie Mr. W. Liddall 41 Nursing Staff. 28 Domestic Staff. Used during the year by Public Assistance Committee. DAGENHAM SANATORIUM. Matron. Steward. Miss M. Duguid Mr. H. Bromley 27 Nursing Staff. 31 Domestic Staff. Clerk. Mr. C. Woodward LANGDON HILL SANATORIUM. Matron. Steward. Miss F. M. Noble Mr. H. Bromley 10 Nursing Staff. 8 Domestic Staff. 16 WHIPPS CROSS HOSPITAL. Matron : Steward : Clerks : Miss E. Downs. Mr. B. S. Lawrence. Mr. R. F. Sizer. Mr. J. Lis. Assistant Steward : Mr. V. J. Stebbings. Mr. C. Samuel 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 40. CENTRAL HOME. Matron : Master : Clerks : Mrs. M. E. Lambert. Mr. S. P. Lambert. Mr. H. W. Latter. Asst. Master: Mr. H. W. Hagger. Mr. R. L. Rutherford Mr. H. W. Quicke. Mr. E. C. Steggel. Mr. J. Hollington. Mr. E. Barnett. 215 Nursing Staff. 147 Domestic Staff. FOREST GATE HOSPITAL. Matron: Steward: Clerks: Mrs. E. M. UsherwoodMr. E. J. Miles. Mr. J. W. Burr. Assistant Steward : Mr. A. W. Sawyer. Mr. A. J. Fillmore. Mr. J. Cassidy. Mr. E. E. West Medical Superintendent's Office. Clerk : Mr. C. P. Chapman 143 Nursing Staff. 67 Domestic Staff. MARGATE CONVALESCENT HOME. Matron : Clerk & Store Keeper : Miss G. B. Oddy. Mr. J. W. Rowe. 11 Nursing Staff. 15 Domestic Staff. (Closed down 31/8/35) DISINFECTORS. Mr. B. Lyons. Mr. C. Cornish. ,, H. J. Murty. ,, W. Hubbard. MORTUARY KEEPERS. Mr. E. Heisterman. Mr. A. Kelly For Staff of School Medical Officer see page 135. †A detailed list of the Staff is included in this Report by the request of the Minister of Health in Circular 1492. 17 Statistics and Social Conditions of the Area. West Ham is the eleventh largest of the 121 Great Towns of England and Wales. It is situated geographically within the County of Essex, and 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 1686. (The jubilee is being celebrated this year, 1936). 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. It is an industrial borough, but like similar boroughs, has a large number of unemployed inhabitants. The insurable population of the district is approximately 97,000 of which 12.6 were unemployed (Men 16.2, Women 5.7, Juveniles 4.7) at the end of December, 1935. The figure of 12.6 for West Ham is the second highest for the Metropolitan and extra-Metropolitan districts. Factories abound on the river frontages, West and South. In the North there are extensive railway works, which give employment to a large number of regular hands. The Borough is only a short distance from the City of London, and consequently a large proportion of the populace follow their daily toil in London and district. This year there has been no outstanding illness or sickness calculated materially to affect the health of the people. Summary of General Statistics. Area (in acres), 4,706. Population— Census, 1931 — 294,278. Estimated population to middle of 1935, 270,700. Number of inhabited house, 49,588. Number of families or separate occupiers (1931), 72,994. Average Rateable Value— General Rate, £1,503,284. Sum represented by a Penny Rate— General District Rate, £6,263. 18 GENERAL DEATH RATE. 19 BIRTH RATE. 21 Vital Statistics. Total Male Female Live Birth Legitimate 4088 2045 2043 Birth Rate 15.5 Illegitimate 112 51 61 Still Births, 125 Rate per 1,000 total (live and still births), 28.9 Deaths, 2,914 Death Rate, 10.7 Deaths from diseases and from Sepsis 6 accidents of pregnancy from other causes 8 and child birth = Maternal Mortality Rate 3.23 Deaths from Measles (all ages) 5 Deaths from Whooping Cough (all ages) 12 Deaths from Diarrhoea (under 2 years of age) 19 Dfcath Rate of Infants under one year of age— All infants per 1,000 births 45.4 Legitimate infants per 1,000 legitimate births 44.2 Illegitimate infants per 1,000 illegitimate births 89.2 In the case of the Great Towns the Birth Rate was 14.8, the Death Rate 11.8, and the Infant Mortality Rate 62, whereas the Maternal Mortality Rate for England and Wales was 3.93. Vital Statistics of the Wards of the Borough, 1935. WARDS. Births Birth Rate Deaths Death Rate Infant Deaths Infant Mortality per 1,000 births Natural increase Births over Deaths Estimated resident population middle of 1934 New Town 289 18.04 165 10.30 16 55 124 16,015 Forest Gate 272 15.79 206 11.95 10 36 66 17,226 High Street 226 14.03 161 10.00 10 44 65 16,099 Broadway 186 14.20 154 11.75 9 48 32 13,098 Park 230 16.24 172 12.14 8 34 58 14,101 Upton 223 14.47 179 11.62 8 35 44 15,405 Plashet Road 243 18.40 156 11.81 13 53 87 13,199 West Ham 190 12.96 181 12.36 9 47 9 14,633 Plaistow 300 16,35 196 10.68 18 60 104 18,339 Bemersyde 164 13.58 155 12,83 9 54 9 12,072 Canning Town & Grange 369 14.51 229 9.00 19 51 140 25,418 Hudsons 293 15.48 230 12.15 8 27 63 18,924 Ordnance. 263 14.86 155 8.75 8 30 108 17,689 Beckton Road 286 15.71 164 9.00 15 52 122 18,203 Tidal Basin 353 16.58 214 10.05 16 45 139 21,286 Custom House & Silvertown 313 16.53 197 10.40 15 47 116 18,926 County Borough 4200 15.5 2914 10.7 191 45.4 1286 270,700 B 23 Scarlet Fever. There was a considerable decrease in the number of cases of Scarlet Fever as compared with 1934, there being a drop of nearly 500 cases. In the earlier and latter part of the year the disease was more prevalent, but seemed to diminish somewhat about the middle of the year. Of the 1,057 cases notified, it was not possible to provide hospital accommodation for all cases requiring" hospital treatment at Plaistow Hospital. In view of this position it was considered expedient to make other arrangements, and as in 1934, the London Fever Hospital was able to admit cases from West Ham, thus relieving the pressure on the Council's Isolation Hospital. Ninetysix cases were admitted during the year. The deaths from Scarlet Fever were six. Diphtheria. This disease shewed a very slight increase over the figures for the previous year. On account of the demand for accommodation at the Plaistow Hospital it was found necessary to send 27 cases of Diphtheria to the London Fever Hospital. Nearly 300 posters offering facilities for immunization against this disease were posted on various public buildings, in hospitals, clinics, nursery schools, and other appropriate places. (See also pages 104 and 113). Births. The number of births registered in the Borough during the year was 5,400 (2,718 males and 2,682 females) ; but of this total 1,540 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 340 West Ham women were confined outside the Borough. Suitable adjustment makes the net West Ham Births 4,200 (2,096 males and 2,104 females) ; 112 of these (51 males and 61 females) were illegitimate. Calculated on the Registrar General's estimate of the population of the Borough at the middle of 1935, viz. : 270,700, the rate for the year was 15.5. The Birth Rate for the Great Towns was 14.8. Deaths. The number of deaths registered in the Borough during the year was .1,696, but of these 218 occurred in persons not belonging to the Borough, while the deaths of 1,436 residents of West Ham occurred in various institutions and districts elsewhere, making the total net deaths attributable to the Borough number 2,914, of which 1,551 were males and 1,363 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 10.7 per 1,000 of the estimated population. The Death Rate for the Great Towns was 11.8. 24 Causes of Death at Different Periods of Life in the County Borough of West Ham (Civilians only) during 1935 Causes of Death. Sex All Ages 0— 1— 2— 5— 15— 25—35 — 45— 55— 65— 75— ALL CAUSES M. 1551 100 24 26 34 78 76 89 163 295 376 290 1. Typhoid and Paratyphoid Fevers F. 1363 91 22 25 34 58 77 76 123 195 282 380 M. 1 - - - - - - - - 1 - - F. - - - - - - - - - - - - 2. Measles M. 2 — 1 - 1 - - - - - - - F. 3 - 1 2 - - - - - - - - 3. Scarlet Fever M. 4 - - 1 3 - - - - - - - F. 2 — 1 1 - - - - - - - - 4. Whooping Cough M. 5 — 4 — 1 — — — — — — — F. 7 4 2 1 - - - - - - - - 5. Diphtheria M. 16 1 — 9 5 1 - - - - - - F. 23 1 2 8 11 — — — 1 — — — 0. Influenza M. 6 1 - - - - - - 1 1 3 — F. 13 — — 1 — — — 1 2 3 2 4 7. Encephalitis Lethargica M. 3 — — — — — 1 1 1 — — — F. 1 — - - - 1 - — — — — — 8. Cerebro-spinal Fever M. 4 — 1 — 1 1 — 1 — — — — F. 2 — 1 — 1 — — — ' — — — — 9. Tuberculosis of Respiratory System M. 128 — — — 1 21 25 22 24 27 8 — F. 96 — 1 — 3 26 32 13 7 9 4 1 10. Other Tuberculous Diseases M. 21 1 1 4 1 4 4 1 2 3 — — F. 5 — 1 — 1 3 — — — — — — 11. Syphilis a M. 9 1 — — — — 1 1 3 3 — — F. 3 1 — — — — — 1 1 — — — 12. General Paralysis of the Insane, Tabes Doisalis M. 13 - - - - - - 3 5 3 2 - F. 6 - - - - - 1 1 3 1 - — 13. Cancer, Malignant Disease M. 219 — — — 2 — 4 11 26 72 76 28 F. 196 1 — 1 — — 6 10 34 51 55 38 14. Diabetes M. 14 — — 1 — — — — 1 6 5 1 F. 27 - - - - - - - 2 6 17 2 15. Cerebral Haemorrhage, etc. M. 93 - - - - - 2 — 8 17 41 25 F. 84 - - - - - - - 4 22 22 36 16. Heart Disease M. 374 — — — 2 7 5 13 28 65 119 135 F. 378 — — — 1 8 10 14 27 45 103 170 17. Aneurysm M. 11 - - - - - - 1 3 5 1 1 F. 1 - - - - - - 1 - - - - 18. Other Circulatory Diseases M. 42 - - - - - - 1 2 7 15 17 F. 48 - - - - - - 1 3 7 17 20 19. Bronchitis M. 57 1 — — — 2 2 2 5 9 14 22 F. 39 2 — — — 2 1 1 1 2 8 22 20. Pneumonia (all forms) M. 90 21 8 2 1 3 — 3 10 16 15 11 F. 82 16 9 4 1 — 4 4 8 8 12 16 21. Other Respiratory Diseases M. 22 1 1 1 1 2 3 4 1 2 5 1 F. 9 — — 1 — — 2 1 — — 3 2 22. Peptic Ulcer M. 31 — — — — 1 4 4 7 11 4 — F. 7 - - - - - - 2 2 2 1 — 23. Diarrhoea, etc. M. 8 8 - - - - - - - - - - F. 13 11 - - - - - - - - 2 — 24. Appendicitis M. 15 — — 1 2 2 4 1 1 3 1 — F. 9 — — — 1 2 1 — 2 2 — 1 25. Cirrhosis of Liver M. 6 - - - - - - - - 1 5 — F. 3 - - - - - - - - 2 — 1 26. Other Diseases of Liver, etc. M. 2 — — — — — — — 1 — 1 — F. 8 - - - - - - 1 3 2 — 2 27. Other Digestive Diseases . M. 28 1 2 1 1 2 3 3 3 2 7 3 F. 24 2 1 1 2 2 1 2 3 2 4 4 28. Acute and Chronic Nephritis M. 52 — — 1 — 7 2 — 4 12 18 8 F. 42 1 — — 1 — 2 1 3 9 12 13 29. Puerperal Sepsis F. 6 — — — — 2 3 1 — — — — 30. Other Puerperal Causes F. 8 — — — — 1 5 2 — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. M. 51 51 - - - - - - - - - - F. 49 48 — 1 - - - - - - - - 82. Senility M. 13 - - - - - - - - - 2 11 F. 32 - - - - - - - - - 3 29 33. Suicide M. 23 - - - - - 2 4 8 5 3 1 F. 8 - - - - - 1 5 1 1 — — 34. Other Violence M. 64 2 3 1 4 15 5 5 13 7 4 5 F. 20 — 1 2 2 2 — — 3 1 2 7 35. Other Defined Diseases M. 122 11 3 4 8 9 9 8 6 16 27 21 F. 108 4 1 2 10 9 8 14 13 20 15 12 36. Causes Ill-defined, or Unknown M. 2 — — — — 1 — — — 1 — — F. 1 — 1 - - - - - - - - - 25 INFANTILE MORTALITY RATE. 27 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 20 523 Central Home 386 Harold Wood Hospital 32 Dagenham Sanatorium and Hospital 58 West Ham Mental Hospital 63 Plaistow Fever Hospital 1 55 Forest Gate Hospital 12 25 Deaths in other Institutions Under 1 year 1 year & upwards Queen Mary's Hospital for the East End 15 82 St Mary's Hospital, Plaistow 17 22 Plaistow Maternity Hospital 11 12 Royal Albert Dock Hospital — 9 Children's Hospital, Balaam Street 16 5 Other places, eg Docks, etc — 4 Residents dying in outside Institutions 54 300 TOTAL 146 1576 Nonresidents dying in West Ham Institutions 55 163 91 1413 Net West Ham Deaths occurring in Institutions 504 The above figures show that over 51 per cent, of the deaths occurring in West Ham took place in public institutions 29 Chief Vital Statistics since 1887 Year Population Births Birth Rate Deaths Death Rate Infant Deaths Infant Mortality Rate 1887 174,523 6,865 391 Average for 10yrs 370 3,286 18 7 Average for 10 yrs192 | 723 106 Average for 10yrs 1478 | 1888 182,118 6,867 385 2,848 180 905 131 1889 189,713 6,947 385 2,883 180 907 130 1890 197,308 7,063 385 3,977 217 1,142 161 1891 206,463 7,911 382 3,952 191 1,191 150 1892 212,703 8,013 369 4,019 186 1,225 158 1893 218,942 8,026 353 4,565 200 1,387 172 1894 225,184 8,089 339 4,026 182 1,123 139 1895 231,420 8,591 359 4,656 209 1,452 109 1896 237,665 8,519 354 4,395 189 1,395 163 1897 243,908 8,761 358 Average for 10 yrs 342 4,486 183 Average for 10 yrs 179 1,535 175 1898 250,145 8,750 349 4,594 183 1,525 174 Average for 10 yrs 1636 1899 256,386 8,779 342 5,213 203 1,770 201 1900 262,627 8,885 338 5,156 196 1,671 188 1901 268,868 9,434 350 4,910 182 1,589 168 1902 270,076 9,553 353 4,858 179 1,382 144 1903 272,250 9,478 348 4,394 161 1,344 142 1904 274,424 9,276 333 4,836 176 1,467 158 1905 276,598 9,018 325 4,574 165 1,341 148 1906 278,772 9,193 329 4,610 165 1,270 138 1907 280,946 8,759 311 Average for 10 yrs 301 4,412 157 Average for 10 yrs 149 1,078 123 1908 283,121 9,214 325 4,364 154 1,089 118 Average for 10 yrs 1146 1909 285,471 8,730 306 4,435 151 1,087 123 1910 287,471 8,646 300 3,773 131 866 100 1911 289,646 8,642 298 4,561 157 1,223 141 1912 291,900 8,642 296 4,146 142 889 102 1913 294,223 9,125 305 4,312 144 984 107 1914 296,570 8,848 298 4,425 149 957 108 1915 294,396 8,380 284 4,744 161 940 112 1916 287,960 8,377 29 1 4,233 147 828 112 1917 271,934 6,701 246 Average for 10 yrs 248 4,203 154 Average for 10 yrs 132 707 105 1918 262,858 6,021 229 5,492 208 700 116 J Average for 10 yrs798 1919 287,966 7,132 247 3,946 137 619 86 1926 299,440 9,723 324 3,888 129 716 73 1921 300,903 8,242 273 3,712 123 615 74 1922 304,738 7,959 261 4,124 135 641 80 1923 314,400 7,803 248 3,331 105 466 59 1924 317,400 7,202 226 3,652 115 564 78 1925 318,500 7,017 220 3,428 107 463 65 1926 315,900 6,710 212 3,405 107 418 62 1927 315,400 5,991 189 Average, 9 yrs 173 3,481 110 Average, 9 yrs 113 404 67 1928 306 900 5,913 19 2 3,340 10 8 380 84 Average, 9 yrs 63 1929 307,600 5,766 18 7 3,926 127 427 74 1930 296,900 5,606 18 2 3,263 106 353 62 1931 296,700 5,266 177 3,384 11 4 330 62 1932 289,300 4,980 17 2 3,313 114 358 71 1933 282,900 4,406 156 3,337 117 284 04 ] 934 276,150 4,333 156 3,219 116 284 65 1935 270,700 4,200 155 2914 107 191 45 30 GENERAL PROVISION OF HEALTH SERVICES Convalescence Consequent upon the closing of Margate Home at the end of August, it was necessary to extend the arrangements in regard to cases needing convalescence already in force with the Invalid Children's Aid Association and the Invalid and Crippled Aid Society, to place all the children I should like here to record my appreciation of the help given by these two voluntary bodies, over a long period of years Psychological Clinic I am indebted to Dr J Harvey Cuthbert for the following report:— The Nerve Clinic, which has now been in existence for three and a half years, continues to expand its activities in a satisfactory way Since its inception, there hasbeen a steady increase in the annual number of patients who have been referred for diagnosis and treatment During the year 1935, some sixtyseven cases have been dealt with, an increase of 15 as compared with the previous year Study of the statistics which follow, provide definite evidence that the Clinic is proving its worth in the prevention and treatment of nervous and mental disease Attention is again directed to the primary object of the Clinic The organisation provides for the diagnosis, treatment and disposal of all forms of mental illness in adults, and in children For general practitioners in West Ham, the Clinic also offers a consultant service It is especially the purpose of the Clinic to make provision for the detection and investigation of EARLY cases of mental disorder There are large numbers of men and women who suffer from "nerves," and who are relatively incapacitated socially and occupationally This type of illness is amenable to psychological treatment in its early stages, but, if allowed to become chronic, is most resistant to all forms of therapy For such "nerve" sufferers, the Clinic offers facilities for relief and cure by means of modern psychothe&peutic methods This aspect of the Clinic work has already achieved a considerable measure of success It is to be noted that some 250 therapeutic interviews were given during the year An important feature of the Clinic activity has been the facilitating of the operation of the Mental Treatment Acts One of the chief purposes of the Act was to empower Public Mental Hospitals to receive voluntary patients with the object of encouraging sufferers from mental disease to seek and obtain treatment in the eatly stages of their disease Actually, twentytwo cases of serious mental disorder were investigated at the Clinic, and of these twelve were recommended and admitted to the Mental Hospital as Voluntary Patients It is already apparent that this 31 practice is helping to break down popular prejudice against Mental Hospitals, which unfortunately still exists to some extent When it is more generally appreciated that patients can go to the Mental Hospital of their own free will and leave when they so desire, and that they will receive treatment according to the best scientific methods of today, the Mental Hospital will come to be regarded as a Hospital in the true sense of the word, a place where patients are treated, healed, and cured As will be noticed from the statistics, a considerable proportion of the cases investigated at the Clinic were children This is one of the most promising of the Clinic's activities, especially from the standpoint of mental hygiene These problem and maladjusted children are the future neurotics, delinquents, and general social misfits, and their treatment and management constitute an urgent and vital need in any community It was noticeable that the economic factor played an important part in the genesis of the nervous illnesses of many of the children examined at the Clinic This was revealed in their malnutrition, and general debility It requires little imagination to appreciate that bad or inadequate nutrition must inevitably adversely affect the mental constitution, and so foster those psychological difficulties which repercuss gravely in adult life We have had the cooperation of the London Child Guidance Clinic in dealing with the treatment of stammering, the estimation of intelligence, and in treating cases which were beyond the resources of the Clinic Referrals to the Clinic as in past years have come chiefly from the general practitioners in West Ham, the Public Health Medical Staff, Court Probation Officers, Whipps Cross Hospital, and the Invalid and Crippled Children's Hospital A certain number of patients discharged from the Mental Hospital have kept in contact with the medical staff through the Clinic, and this has constituted a valuable form of "aftercare" treatment To the various doctors in private practice and in the Public Health Service, who have cooperated with the Clinic, we offer our thanks and grateful appreciation Total number of new cases examined in 1935 67 Total number of consultations, therapeutic and diagnostic 302 Types of Mental Illness Psychoses— Schizophrenia 6 Melancholia 12 Paraphrenia 2 Epilepsy 2 22 32 Psycho-Neurotic States- Anxiety States 5 Neurasthenia 1 Depression 4 Acute Insomnia 1 11 Behaviour Problem and Maladjusted Children— Anxiety ("Nerves," Morbid Fears, "Tantrums") 13 Enuresis (bedwetting) 2 Stealing 2 Other behaviour Disorders (Abnormal conduct at home and school) 3 Hysteria 1 Educational Retardation 2 Stammering 2 Chorea 2 27 Congenital Mental Defect 7 Results in Cases considered suitable for Treatment Recovered Relieved Subsequent failure to attend Still under treatment No improvement Psychoses — 2 3 — — Psychoneuroses 2 5 2 4 2 Behaviour Problems 2 8 3 3 1 Psychotic Patients admitted to Mental Hospital— As voluntary patients 12 Recommended to be certified 1 Of these patients 9 have since been discharged "recovered" or " relieved" Disposal of Children not considered suitable for prolonged Nerve Clinic Treatment— Recommended to— West End Hospital for Nervous Diseases 2 London Child Guidance Clinic 2 Residential School 1 Open-air School 3 School Clinic 1 Invalid and Crippled Children's Hospital 2 Special Mental Defective School 1 33 Insulin, Supply of A number of applications have been received from persons residing in the Borough, asking the Council on account of lack of means, to meet the cost of supplying the Insulin necessary for their treatment This matter has been carefully considered by the appropriate Committee, and it is now possible for certain necessitous cases approved by the Medical Officer of Health to obtain the necessary Insulin free of charge Laboratory Work The question of the establishment of a Pathological and Bacteriological Laboratory at Whipps Cross Hospital, as a part of the extension being carried out, is now receiving the attention of the Council At present there is no central Municipal Laboratory, though Bacteriological work is carried out at several of the Municipal Institutions At Plaistow Fever Hospital routine Bacteriological work is carried out, but in addition to this, medical practitioners may have a report upon any case of suspected diphtheria, typhoid, or cerebrospinal fever Specimens of sputum submitted for examination as to the presence of the tubercle bacillus, are dealt with by the Tuberculosis Officer at the Tuberculosis Dispensary in Balaam Street Samples of graded milk, ordinary milk, and various other articles are sent for Bacteriological examination to Queen Mary's Hospital, Stratford, E15 A parttime Analyst is employed by the Council, and he carries out the analysis of samples of water, milk, and various foodstuffs He is also the Analyst under the Fertilisers and Feeding Stuffs Act, 1926 An arrangement is in force between the West Ham Insurance Committee and Queen Mary's Hospital, by which facilities are granted to any general practitioner on the Panel to have a pathological report upon any case, or material, if considered necessary 34 AMBULANCE SERVICE Ambulances are available for use by the Burgesses, under certain qualifying conditions, viz:— Whipps Cross Hospital (Public Assistance Committee) 5 Plaistow Fever Hospital (Hospitals Committee) 2 Public Health Committee and Highways Committee 3 (For street and other accidents, maternity cases, etc) The two ambulances under the control of the Public Health Committee made 2,171 journeys during the year The number of persons conveyed from one address to another in the district was 1,223, and 948 persons were taken from one address within the Borough to an address outside, or vice versa These ambulances are only used for noninfectious and accident cases, or for cases requiring immediate removal to hospital for treatment or operation, and in the latter cases a medical certificate is required Notices giving particulars regarding the use of the ambulances are exhibited in Fire Stations, Schools, and other buildings; also, the police are fully conversant with the arrangements in force, and often themselves get in touch with ambulance stations There are reciprocal arrangements in force with the County Borough of East Ham, and with the Borough of Barking, for the use of their respective ambulances, on call, in cases of emergency, should the ambulance of one or other authority be in commission The journeys made under these arrangements are as under:— In thirteen cases the East Ham Ambulance was used for the removal of West Ham cases, and in 32 instances the West Ham Ambulance was used to remove East Ham cases An interworking arrangement is also in force between West Ham Council and the London County Council The present service seems to be quite sufficient to cope with the work Of course, now and again both of the Council's Ambulances are out when a call is made, but this difficulty is easily overcome owing to the existence of reciprocal arrangements, as mentioned, being in operation The Plaistow Fever Hospital has motor vans specially designed for dealing with removal of bedding, clothing, or anv infected material to the disinfecting station, which is attached to the hospital 37 There is an additional ambulance stationed at the Fire Station in the Silvertown area, which is available daily between the hours of 7 am and 11 pm This ambulance is used mainly for cases occurring in factories in the Silvertown district, and a number of factory owners contribute funds towards the upkeep of this amenity There were 127 journeys made by this vehicle during the year Professional Nursing in the Home The Council has no staff for carrying out professional nursing in the homes, except the two nurses who are wholly employed by the two wholetime District Medical Officers From the voluntary associations an adequate supply of competent nurses is available at any time, and they consistently carry out a tremendous amount of good work in nursing necessitous cases The fullest cooperation is maintained between these Societies and the Council, both as regards home nursing and health visiting The Essex County Nursing Association, from their branch in Beech croft Road, Leytonstone, supplies the Forest Gate section of the Borough with homenurses, and the Silvertown area is similarly supplied through the Tate Nurses (Queen's Nurses) Nurses' Home, Saville Road, Silvertown The greater part of nursing in the homes is conducted through the Plaistow Maternity Charity, which provides a training school for District Nurses and a maternity hospital There are no Municipal arrangements for the nursing of infectious diseases in the home All cases requiring hospital treatment are if practicable removed to the Council's Isolation Hospital Maternity and Nursing Homes There are three registered homes in the Borough (see page 59) School Clinics and Treatment Centres School Clinics Stratford Clinic, 2 Dental Clinics 84 West Ham Lane, J Minor Ailment Clinic Stratford, E15 1 Ophthalmic Clinic Balaam Street Clinic, il Minor Ailment Clinic Plaistow, E13 1 Dental Clinic Rosetta Road Clinic, il Minor Ailment Clinic Custom House, E16 1 Dental Clinic S'wanscombe Street Clinic, 1 Minor Ailment Clinic Canning Town, E16 1 Dental Clinic Treatment Centres Children's Hospital, Orthopaedic and Sunlight Clinics, Balaam Street, E13 and Psychological Clinic 38 Tuberculosis Dispensary Balaam Street, Plaistow, E13 (see pages 115118) Maternity and Child Welfare Clinics See page 55, Maternity and Child Welfare Section Hospitals Infectious Diseases (1) Plaistow Fever Hospital has available 210 beds for the treatment of cases of scarlet fever, diphtheria, enteric fever, severe cases of measles, or whooping cough, pneumonia, tubercular peritonitis and encephalitis lethargica; also cases of puerperal pyrexia and puerperal fever, are treated at this hospital There are in addition isolation beds for mixed cases The number of beds allocated to any particular complaint is varied from time to time in accordance with the demand owing to any specific epidemic (2) The Children's Hospital, Harold Wood, has accommodation for 200 cases This accommodation is still being used by the Public Assistance Committee for the treatment of chronic sick adult cases, with the exception of 20 beds reserved for children convalescing from diphtheria Smallpox (3) Dagenham Smallpox Hospital, which was originally built for 300 cases of smallpox, is still being used for the treatment of 128 adult cases of pulmonary tuberculosis Arrangements are still in force with the London County Council for the removal, in the event of an outbreak, of all cases of smallpox occurring within this area Tuberculosis Dagenham Hospital and Sanatorium (4) This institution is being used for the treatment of 128 adult cases of pulmonary tuberculosis (See also pages 119121) Langdon Hills Sanatorium for Children (5) This institution has accommodation for 40 children suffering from pulmonary tuberculosis (See pages 122123) Surgical Tuberculosis Cases of surgical tuberculosis are treated at the Alexandra Hospital, Swanley, Kent; Sir William Treloar's Hospital, Alton; and at various voluntary hospitals 39 Whipps Cross Hospital (6) This institution is the property of the West Ham Council, but is situated in Leyton The complete plans in connection with the scheme for the provision of an additional 500 beds have been finally approved by the Ministry of Health The preparation of specifications and quantities is now being carried out, and it is hoped that tenders for the carrying out of the work will be considered about July next The scheme when completed will actually provide for 504 beds as follows:— 16 Wards with 24 beds each 32 Wards with 2 beds each 32 Wards with 1 bed each Isolation Block with 24 beds There will also be a new Operating Theatre, new Receiving Block, additions to Kitchen, extension of Laundry, extension of Mortuary; also a new residence for five Medical Officers The building of a Nurses' Home and Maids' Quarters, mentioned in my report of 1934, is proceeding satisfactorily Forest House (7) Forest House is in the same ground as Whipps Cross Hospital, although in a separate curtilage There are 396 beds for aged men and for cases of epilepsy and those certified under Section 24 of the Lunacy Act, 1890; in addition, Forest House Cottages, with 90 beds occupied by aged women, is an annexe to Forest House Forest Cate Hospital (8) 'Ihis institution is owned by the West Ham Council, and is situated within the Borough The Hospital provides for cases of chronic sick, and in addition has 40 maternity beds, and also has provision for 75 mental defectives classified as under Adult Males 20 Adult Females 30 Males under 16 years 10 Females under 16 years 15 The institution is approved by the Board of Control for the reception of mental defectives 40 Central Home Institution (9) This home is situated within the Borough of Leyton, and is owned by the Council It is registered for 1,807 people, composed of chronic sick patients and ablebodied adults Margate Convalescent Home (10) The abovementioned home, which had been in use for a great number of years, and belonged to the old West Ham Board of Guardians, was closed on 31st August this year, owing to the premises having proved to be quite unsuitable for an uptodate convalescent home Consequent upon this closure, arrangements were made to send cases of convalescence away through two voluntary associations in the Borough Other Hospital Facilities (11) The Council have an arrangement with Queen Mary's Hospital and Plaistow Maternity Hospital for the institutional treatment of maternity cases (See page 58) Orthopaedic treatment is carried out at the Children's Hospital, Balaam Street, and at the Brookfield Hospital, Wal thamstow (See pages 6061) Cases of Ophthalmia Neonatorum are treated at St Margaret's Hospital, an Institution belonging to the London County Council Surgical Tuberculosis is treated at various institutions in London and elsewhere Voluntary Hospitals Queen Mary's Hospital, West Ham Lane, E15 St Mary's Hospital, London Road, E13 Albert Dock Hospital, Connaught Road, E16 Children's Hospital, Balaam Street, E13 Plaistow Maternity Hospital, Howards Road, E13 OpenAir Schools (12) There are two OpenAir Schools, one at Fyfield (Residential), near Ongar, to accommodate 80 boys and 60 girls; and one within the County Borough of West Ham, at Crosby Road (Day), for 60 children (See pages 165169) 41 Vaccination Acts, 1867 to 1898 The following is a summary of the work carried out under the above mentioned Acts during the year 1935:— No of Cases in Birth Lists received during the year 5401 No of Certificates of Vaccination received 1272 No of Certificates of Postponement owing to— Health of Child 329 Condition of House — Prevalence of Infectious Disease — No of Certificates under Section 2 of Vaccination Act, 1898, and No of Statutory Declarations under Section 1 of the Vaccination Act, 1907 2950 No of Certificates of Insusceptibility or of having had Smallpox 12 No of Cases— Parents removed out of District 841 Otherwise not found 270 No of Entries in Lists sent to Public Vaccinators 1320 Shops Acts, 19121934 The Shops Act, 1934, which gives effect to certain of the recommendations made by the Select Committee on Shop Assistants constituted in November, 1930, came into operation on 30th December, 1934 A summary of the principle provisions of the Act was given in my Report for 1934 It will be appreciated that the Act places new and heavy responsibilities on the Council In carrying out their duties, the Shops Inspectors have found that a considerable number of shopkeepers need instruction and supervision in the keeping of the prescribed records Theatres and other places of entertainment have to be visited to ensure that the Act is complied with as regards the employment of young persons in the retail trade 'The enforcement of the provisions of the Act with regard to lighting and facilities for washing, which apply to all shops where assistants are employed, and in certain circumstances facilities for taking meals, are duties which add considerably to the work of inspection In addition, there are a number of minor matters needing attention, which necessitate much time being spent in making the provisions of the Act known The total number of visits made by the Shops Inspectors during the year was 7,744, and 3,626 infringements were detected The majority of these were minor irregularities, in respect of which 2,240 verbal cautions were given In cases of a more persistent nature, 299 written warnings were issued, and in 38 cases it was found necessary to institute legal proceedings (see page 78) 42 43 SHOPS ACTS The provisions of the Shops Acts are carried out by Messrs E j Ferrier and C J Genery, the Shops Inspectors, and the following Table shows the work performed in connection therewith:— Summary of Shops Visited during the Year 1935 Principle Trade No of Visits INFRINGEMENTS WARNINGS Refused to serve after hours Summonses Notices NOT exhibited Open after Hours YPs working after hourf Verbal Letters H-H K E or F H or J Bakers 366 51 22 26 28 24 6 100 17 40 — Boots and Shoes 157 58 1 14 13 9 7 92 4 8 — Builders' Merchants 49 8 — 2 4 2 2 14 1 2 — Butchers 416 27 22 30 32 48 7 153 11 103 — Caterers 202 14 15 18 19 — 8 24 7 — — Carpets, Rugs and Linos 24 1 2 4 4 4 — 7 — 2 — Chemists and Druggists 203 18 13 13 14 12 3 35 5 33 — China and Glass 83 5 1 3 4 2 — 10 4 11 — Clothiers 141 21 — 18 17 34 5 35 6 10 — Confectionery and Tobacco 873 28 18 30 32 152 29 242 49 259 23 Corn Merchants 83 9 4 20 23 2 4 36 10 11 — Cycle Dealers 84 10 — 5 6 6 1 10 1 4 — Domestic Stores 151 19 8 10 10 29 5 39 2 17 — Drapers, Milliners, etc 669 60 48 42 42 81 14 193 20 81 — Fishmongers 288 33 10 25 30 43 6 102 3 31 — Florists 62 9 9 7 10 4 — 15 2 3 — Fruiterers and Greengrocers 621 65 4 24 30 111 2 140 23 68 — Furniture Dealers 132 30 7 22 24 21 4 53 5 11 — Furriers 13 1 2 — — — — 2 — — — Grocers, General, etc 903 90 40 85 92 196 37 335 66 308 9 Hairdressers and Barbers 433 80 19 60 54 39 2 179 10 21 1 Hosiers and Hatters 125 10 5 8 7 22 1 18 3 19 1 Ironmongers 33 2 — 1 2 3 — 3 — 2 — Leather and Harness Makers 58 2 — 3 5 4 — 6 1 5 — Live Stock 24 2 — — — 1 — 2 — — — Mixed 525 41 39 18 21 95 7 91 19 275 1 Music 50 4 2 4 4 6 2 9 1 5 — Newsagents and Stationers 105 10 5 7 7 18 1 22 3 10 — Opticians 33 4 2 6 5 1 — 12 1 — — Photographers and Pictures 48 3 2 1 1 2 — 4 — 6 — Public Houses 162 19 18 — — — — 19 5 — — Tailors 233 21 — 31 27 30 8 65 9 25 — Toys and Fancy Goods 129 6 5 11 7 33 2 48 5 25 — Undertakers 20 Watchmakers, Jewellers and Pawnbrokers 93 11 3 28 28 4 2 41 1 4 Wireless and Electrical 153 16 8 36 34 44 9 84 5 45 3 Totals:— 7744 788 334 612 636 1082 174 2240 299 1 [444 38 H-H (Half-Holiday) K (Seats for females) E or F (Hours worked by Young Persons) II or J (Abstract of Act 1934) For results of Police Court Proceedings see pages 42, 78 45 Particulars of Bodies Received into the Mortuaries during 1935 MONTHS Stratford Mortuary Camming Town Mortuary Number received No of Inquests held on Bodies remaining in 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 18 4 15 7 21 1 17 5 ... 14 10 1 1 ... ... 1 ... 1 ... 1 ... February 6 4 8 1 7 2 5 4 ... 3 6 ... ... ... ... ... ... ... ... ... ... March 11 2 6 7 12 1 8 5 ... 10 5 2 1 1 2 ... 1 ... 1 1 ... April 16 3 15 4 15 4 16 3 ... 14 6 1 1 ... 1 ... 1 ... ... 1 ... May 9 2 8 3 9 2 4 7 ... 4 8 1 1 ... 1 ... 1 ... ... 1 ... June 10 5 12 3 14 1 9 6 ... 8 10 ... ... ... ... ... ... ... ... ... ... July 7 2 7 2 9 ... 5 3 1 6 4 1 1 ... 1 ... 1 ... ... ... 1 August 9 1 8 2 8 2 6 4 ... 5 6 1 1 ... 1 ... 1 ... ... 1 ... September 14 3 14 3 2 15 2 ... 9 10 ... ... ... ... ... ... ... ... ... ... October 11 1 6 6 12 ... 11 1 ... 8 4 4 4 ... 3 1 3 1 ... 4 ... November 14 2 9 7 13 3 15 1 ... 9 7 3 2 1 3 2 1 ... 2 ... December 23 3 13 13 26 ... 23 3 ... 22 5 3 2 1 2 1 3 ... ... 3 ... Total 147 32 121 58 161 18 134 44 1 112 81 17 14 3 14 3 13 3 1 14 1 Grand Total 179 179 179 179 17 17 17 WORK CARRIED OUT UNDER PUBLIC ASSISTANCE The following statistics are in respect of the District Medical Officers, also Forest Gate Hospital, Whipps Cross Hospital, Central Home, and Forest House:— 46 District Medical Officers Number of Men Number of Women Number of Children New cases seen 1395 3107 3626 Total No of cases seen 6166 17595 9393 No referred by Relief Sub- Committees 380 408 416 Attendances at Surgery 6402 17011 7318 Sent to Institutions Voluntary Hospitals 4 10 8 Whipps Cross Hospital 176 271 186 Mental 3 7 0 Otherwise 3 1 0 Central Home 76 93 4 Forest House 2 3 0 Forest Gate Hospital 2 6 2 Aldersbrook Homes — — — Plaistow Hospital 2 5 80 Discharged as no longer in need of treatment 781 1324 2045 New cases seen at Domiciliary visit Fresh cases transferred from 388 1027 1431 (a) Institutions 2 16 14 (b) General Practitioners 1 2 0 Total No of Domiciliary visits 1357 4740 3691 Visits paid by District Nurse 201 3198 2052 Deaths 10 44 5 Total No on register as receiving treatment from DMO on 28/12/35 234 648 283 Prescriptions made up 7622 22908 7878 47 FOREST GATE HOSPITAL MEN WOMEN CHILDREN Total Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Admitted 1 17 37 828 21 25 635 28 7 1599 Discharged 1 19 30 826 30 22 638 17 11 1594 Admitted by means of :— MEN WOMEN CHILDREN relieving Officer and District Med Officer 3 46 1 50 Gen Practitioner and Relieving Officer 3 39 7 49 Relieving Officers - 328 7 335 MOH and Relieving Officers - 137 137 Otherwise 1 9 8 18 Transferred from other Institutions 43 147 30 220 Med Superintendent 4 177 5 186 No of infectious cases - - - Transferred to other Institutions 38 57 23 118 Deaths - 73 20 93 Total No of sick cases in the Home on 28/12/35 14,1 473 110 732 Total No of maternity patients in the Home 42 28 70 No of vacant beds or 28/12/35 1 28 Cots in Maternity Wards and Mothers' Nursery 29 + Cots 48 WHIPPS CROSS HOSPITAL MEN WOMEN CHILDREN Total Acute Subacute Chronic Acute Subacute Chronic Acute Sub-acute Chronic Admitted 3540 - 52 3759 — 54 1659 - - 9064 Discharged 2941 — 61 3280 — 75 1572 - — 7919 Seen as outpatients 469 — 215 117 - 2 151 — - 954 Not admitted 418 — 28 148 — 14 142 - - 750 Admitted by means of :— MEN WOMEN CHILDREN Relieving Officer and District Med Officer 265 360 273 898 Gen Practitioner and Relieving Officer 2837 3060 1224 7121 MOH 3 5 12 20 Otherwise 9 6 2 17 Transferred from other Institutions 170 203 98 471 Police (not accidents) 104 65 3 172 Accidents 100 58 50 208 Med Superintendent 110 51 26 187 No of infectious cases 299 213 110 622 Transferred to other Institutions 235 272 143 650 Deaths 616 450 ,118 1184 Total No being treated in hospital on 28/12/35 298 304 228 830 No of vacant beds — — — No of cases seen Gynaecologist 114 No of cases allocated to :— XRay: by Consultants 3784 Surgeon 269 West Ham 1459 Ophthalmic 40; Neurologist 178 West Ham 1997 Essex 1424 Aural 419 Dentist 288 Essex 1283 East Ham 552 Light 1780 Urologist 244 East Ham 504 49 CENTRAL HOME MEN WOMEN CHILDREN Total Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Admitted 856 5 10 981 9 5 7 - - 1873 Discharged 849 6 11 944 7 5 7 — - 1829 Refused admission — — — — — — — — - - Admitted by means of :— MEN WOM EN CHILDREN Relieving Officer and District Med Officer 75 123 1 199 Gen Practitioner and Relieving Officer 549 603 1 1153 Gen Practitioner & DMO - - — MOH - 1 1 Otherwise 36 24 2 62 Transferred from other Institutions 207 239 2 448 Med Superintendent — — — — No of infectious cases 2 6 14 22 Transferred to other Institutions 146 244 5 395 Deaths 538 415 - 953 Total No of sick cases in the Home on 28/12/35 389 453 - 842 Total No of ablebodied in the Home on 28/12/35 360 319 - 679 No of vacant beds on 28/12/35 134 46 - 180 50 FOREST HOUSE MEN WOMEN CHILDREN Total Cbronic Sick Mental Epileptic Chronic Sick Mental Epileptic Chronic Sick Mental Epileptic Admitted - - - - - - - - - - Discharged - 5 2 - - - - - - 7 Refused admission - — - - - - - - - - Admitted by means of :— MEN WOMEN CHILDREN Relieving Officer and District Med Officer - - - Gen Practitioner and Relieving Officer — - - Gen Practitioner and DisMed Officer — - MOH — — - - Otherwise — — — - Transferred from other Institutions 28 — - 28 Med Superintendent — — — — No of infectious cases — — — — Transferred to other Institutions 19 - 19 Deaths — — — — Total No of sick cases in the Home on 28/12/35 68 68 No of vacant beds on 28/12/35 5 — — 5 MATERNITY AND CHILD WELFARE The Senior Assistant Medical Officer (Dr Helen Campbell) reports :— Notification of Births The birth rate for 1935 was 155, being a decrease of 1 compared with the rate for 1934 The total number of notified births was 5,3,14, of which number there were 5,158 live births and 156 still births Births notified by doctors and parents 1069 Births notified by midwives 4245 Number of births in the Borough in the last five years (net number of births of West Ham Residents) : 1931 1932 1933 1934 1935 5266 4980 4406 4470 4200 Health Visiting The Council employs eighteen fulltime 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, are visited until 4 years of age by the nurses from that Association : at present there are thirtyone 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 more often 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 They also 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 are 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, provision of free meals (since January, 1936), and hospital facilities for confinement in cases where such help is indicated 51 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 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 First Visits Total Visits (a) To expectant mothers 5115 19610 (b) To children under one year of age 5599 38067 (c) To children 15 years of age 1293 48277 *(d) Infant Life Protection visits 50 389 *(e) S'pecial visits (Home Helps, etc) — 11108 Total Visits 117451 * Visits under (a), (b) and (c) include all visits to the homes by Municipal Health Visitors and by those Nurses attached to the Plaistow Maternity Hospital and to the various Voluntary Clinics in the Borough Visits under (d) and (e) are made only by the Municipal Health Visitors Maternity and Child Welfare Clinics There are twelve Maternity and Child Welfare Clinics in the Borough, so situated that every district is within a reasonable distance of a Clinic Of this number five are Municipal Clinics staffed entirely bv the Council's medical and nursing staff; the remaining seven are attached to various voluntary organisations which are subsidised by the Council Antenatal sessions are held weekly at each of the Municipal Clinics, and at four of the Voluntary Clinics ; the majority of patients are referred by local mid wives for antenatal examination and supervision, or are sent by the Health Visitors : a number also report on the advice of friends and other mothers who have attended the Clinic In the case of the Municipal Clinics a written report is sent by the Medical Officer of the Clinic to the midwife after each examination of the patient, so that there is close and satisfactory cooperation in antenatal work In addition, the midwife is notified immediately to visit any patient who fails to keep her appointment for subsequent examination Antenatal supervision is definitely regarded as the normal procedure by expectant mothers in this Borough, and it is rare for either Midwife or Health Visitor to encounter opposition to this supervision Dental treatment has been provided at the Council's Maternity and Child Welfare Clinics for the last six years for expectant and nursing mothers and for the preschool child The decision of the Council in February, 1935, to assist the women in the provision of dentures after extractions has Droved invaluable in augmenting' 62 this very important service for the improvement of the health of the mothers Many women previously refused multiple extractions where there was no prospect of subsequently being able to provide dentures Attendances of mothers and children at all the Clinics have been maintained satisfactorily and regularly It was found that 855% of the infants born in 1935 attended a Welfare Centre during the year Through attendance at the Clinics the mother is put in touch with the many facilities for the benefit of herself or her child, such as convalescent treatment, sunlight, dental and orthopaedic treatment, or admission to hospital Treatment of a sick child is definitely debarred at the Council's Clinics, whose work is purely preventive and educative, but, in all cases where necessary, the means are available for a sick child to have treatment under the Maternity and Child Welfare Services of the Council Dental Treatment Dental treatment is provided for expectant and nursing mothers and for the pre-school child through attendance at the various clinics in the Borough The dental scheme for mothers provides for dentures to be supplied in cases selected by the Dental Surgeon For this purpose a dental mechanic was appointed in May, 1935, to undertake the work in conjunction with and under the supervision of the Council's Dental Surgeon Payment is claimed from the patient for dentures according to a scale approved by the Council The improvement in recent years of the teeth of the toddler may be accounted for partly by the better feeding of the infant and young child, and partly by the better understanding of the parent in regard to the need for care of the primary teeth It is a rule at the Council's Dental C'inics that a child who is referred for this treatment shall be reexamined thereafter at regular intervals until he goes to school Attendances for Dental Treatment (1) Expectant and Nursing Mothers Number of new cases treated 468 Total attendances 1679 Total attendances (a) for extraction 1097 (b) for fillings 133 (c) for special treatment 341 Number of dentures supplied (since May, 1935) 73 (2) Children under School Age Number of new cases treated 708 Total attendances 2531 Total attendances (a) for extraction 839 (b) for fillings 1176 (c) for special treatment, inspection, etc 763 53 Home Helps There has been no alteration in the Home Help Scheme, which is of great value to the 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 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 either 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 lyingin woman several times during the 14 davs to supervise the work of the Home Help The assistance which this scheme gives to the poorer working class mothers is of 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 neelected and that the household duties are carried on as if she herself were not for the time being laid aside The total number of applications for Home Helps was 975, of this number 761 were eligible, 149 were ineligible (ie did not fall within the Council's scheme as regards income) In 65 cases the applications were cancelled by the applicants Supervision 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) During 1935, 89 midwives notified their intention to practise midwifery ; at the end of the year it was found that 57 midwives only were actually practising in the Borough This apparent discrepancy is accounted for by the fact that a certain number of pupil midwives practise for a short period from their training schools in the Borough after passing the Central Midwives' Board examination A large number of these midwives practise under the aegis of one of the several training schools or nursing associations in the neighbourhood The standard of midwifery is high ; there is no difficulty for any patient in obtaining the services of a qualified midwife, nor for any doctor obtaining a trained maternity nurse to assist him in his midwifery cases 34 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 5 Mon., Tues., Thurs., 2 p.m. Tuesday, 9.30 a.m. Friday, 9.30 a.m. 26.0 43.6 26.0 37.7 Dr. Helen Campbell. *Forest Gate Municipal Clinic, Forest Street 4 Tuesday, 9.30 a.m. Tues., Wed., Thurs., 2 p.m. 15.0 41.5 14.4 27.5 Dr. Charlotte Forsyth Dr. Muriel Prout *Grange Road Municipal Clinic 3 Wednesday, Friday, 2 p.m. Wednesday, 9.30 a.m. 13.0 36.5 12.9 29.9 Dr. Helen Campbell. Dr. Charlotte Forsyth Dr. Muriel Prout *Maybury Road Municipal Clinic 4 Monday, 9.30 a.m., 2 p.m. Friday, 9.30 a.m. Thursday, 2 p.m. 21.1 35.2 21.1 26.1 Dr. Charlotte Forsyth Dr. Angel Crawford Silvertown Municipal Clinic 2 Wed., 10 a.m. and 2 p.m. 5.2 37.4 5.2 35.6 Dr. Charlotte Forsyth *Chesterton House Centre 6 Wed., Thur., 11 a.m. & 2.30 p.m. Mon.. Fri., 1.30 p.m. 132.0 83.7 79.7 16.3 Dr. Flora Hogg & Dr. Peter Kennedy. Docks Centre, Hoy Street 5 Daily, 2 p.m. 4U.0 78.3 18.2 20.2 Martin Street Clinic 1 Thursday, 3.30 p.m. 20.4 40.9 9.0 10.5 South West Ham Health Society Clinic, Lees Hall 3 Tues., Wed., and Thurs., 1.30 p.m. 31.0 fortnightly 50.2 16.4 fortnightly 24.7 Dr. J. Lorimer Hawthorne. Trinity Mission Centre, Oxford Road 2 Wed. and Thurs., 1.30 p.m. — 51.5 — 27.1 Dr. Jean Edwards Stratford Day Nursery Centre, Welfare Road 2 Mon. & Friday, 1.30 p.m. — 35.4 — 20.8 Dr. Dorothea Brooks Given Wilson Institute, Pelly Bridge 1 Mondays, 2 p.m. — 47.1 — 29.5 Dr. Eva Morton. * Dental treatment for mothers, and for children under 5 years, is given at these Clinics. 55 The number of cases attended by midwives during the year was:— (a) As midwives 2012 (b) As maternity nurses 2.14 Medical aid was summoned under Section 14 (1) of the Midwives' Act, 1918, in 489 cases. The number of births notified by midwives (i.e. by midwives practising in local maternity hospitals and in the district) = 4,245, which is equivalent to 79.8% of the total notified births. In September, 1935, the. Council agreed to subsidise the district midwives in respect of patients attending the Antenatal Clinics, and who were transferred subsequently for confinement to hospital for medical reasons on the recommendation of the Medical Officer of the Clinic. This scheme was brought into operation in October, 1935; one claim was submitted during 1985. Distributions of Dried Milk to Expectant and Nursing Mothers and to Children under 3 years of age. This important service has continued to function satisfactorily: the milk is distributed from five Centres in the Borough, viz.: 84 West Ham Lane, Stratford. Public Hall, Barking Road, Canning Town. Maternity and Child Welfare Centre, Forest Gate. Maternity and Child Welfare Centre, Westwood Road, Silvertown. Nurses' Home, Howards Road, Plaistow. The dried milk powder is obtained in bulk and packed in l1b. packets at the Centre in West Ham Lane; it is distributed to the mothers in special cartons, each bearing directions for mixing and quantities for use in infant feeding. Samples from each consignment of milk have been submitted for bacteriological and chemical examination, with satisfactory results. During 1935 approximately 108 tons have been distributed under the Council's Scheme. Free Meals for Expectant and Nursing Mothers. This additional scheme to provide help for necessitous mothers was approved by the Council in October, 1935, but actually came into operation in January, 1936. The scheme provides for a free dinner daily (including Sundays and all public holidays) to necessitous expectant mothers from the commencement of the fifth month of pregnancy, and to all mothers who are breast-feeding their infants. 57 By agreement with the Education Committee, it has been possible to arrange for the mothers to attend the various School Dining Centres, of which there are eleven, so situated as to be accessible to all areas of the Borough. The mothers attend at a time separate from the school children. The menus are varied and well balanced. Special diet is arranged where such is indicated by the report of the Clinic Medical Officer. Application for this help is made to the Medical Officer of Health, and must be accompanied by a medical certificate from the Clinic Medical Officer. A patient cannot receive this help unless she attends a Clinic in the Borough, and she is required to present herself to the Clinic Medical Officer at least once every four weeks in order that her circumstances may be reviewed before sanctioning a continuance of this help. This scheme has already established itself as a popular and necessary adjunct to the Council's work for mothers; the benefits to the health of the mothers and their infants are indisputable, as, in the majority of homes where the income is small, it is the mother who deprives herself for the sake of the other members of her family. Hospital Accommodation. There are two large Voluntary Maternity Hospitals in the Borough which are subsidised by the Council for the provision of maternity beds for women resident in West Ham, viz.: Plaistow Maternity Hospital, Plaistow, E.13, and Queen Mary's Hospital, Stratford, E.15. In addition there are 46 beds available in the Maternity Wards of Forest Gate Hospital, Forest Lane, E.7, an Institution administered by the Public Assistance Committee of the Council. There is a very close co-operation between the staff of this hospital and the staff of the Municipal Antenatal Clinics: the majority of patients who wish to enter Forest Gate Hosnital for confinement now attend one or other of the Council's Clinics for antenatal care: indeed, arrangements for admission are usually made through attendance at a Clinic. A report of each patient is sent to the Medical Superintendent of Forest Gate Hospital before the patient enters for confinement, with details of her condition throughout pregnancy. Pupil midwives from Forest Gate Hospital attend weekly at two of the Municipal Antenatal Clinics. Convalescence tor Nursing Mothers and their Infants. For several years this scheme has been in operation, but with the development of the Maternity Services in the Borough it was felt that the number of beds available, viz. two beds, was inadequate. Accordingly in February, 1935, the Council agreed to augment this scheme, whereby it is now possible to send away each fortnight throughout the year four mothers with their young 58 infants, three to "Child Haven," Brentwood, the convalescent home of the West Ham Central Mission, and one to the London Mothers' Convalescent Home, Sunningdale. The mothers are recommended from the various Clinics in the Borough and by the Health Visitors; each mother is examined prior to being sent away by the Senior Assistant Medical Officer for Maternity and Child Welfare. A report is received from the Matron-in-charge of each home on the discharge of the patients, with details as to progress of mother and baby while away. To the women who are fortunate enough to receive this help, the holiday comes in the early weeks after confinement at a time when it is most needed. The complete relaxation and opportunity for rest, the freedom from worry, good diet, and the change of surroundings, not only restore the physical health of the mothers, but awaken their interests to new ideas and ideals. This scheme may appear small in comparison with other activities, but it is, nevertheless, a highly important service in promoting the welfare of the mothers; it is appreciated not only by the mothers themselves but equally by those who are engaged in work at the Clinics and in visiting the homes. During 1935 it was possible to send away under the scheme 85 mothers with their infants, of whom 68 went to "Child Haven," and 17 to Sunningdale. Provision of facilities for Birth Control. In December, 1934, an arrangement was made between the National Association for the Provision of Birth Control Clinics and the Council wherebv patients recommended by any of the Clinic Medical Officers as suitable cases, could be referred to the East London Women's Welfare Centre, Burdett Road, E. This agreement took effect on 1st January, 1935, and is proving satisfactory. During 1935, 35 women were referred by Medical Officers of the various Clinics for advice regarding Birth Control. 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, one receives 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 applications for exemption from registration. The nursing home for senile patients was removed in January, 1935, to larger and more suitable premises. The homes are inspected by the Senior Assistant Medical Officer for Maternity and Child Welfare. 59 Stratford Day Nursery. The Stratford Day Nursery is provided by a Voluntary Association, but receives a grant from the Council. It is the only institution of its kind in the Borough, and serves a useful purpose in helping the mothers who are obliged to leave their young children daily while they go out to work. There is accommodation at the Nursery for fifty children from early infancy to school age. During 1935 there were 7,146 total attendances, making an average daily attendance of 31 children. The Association makes a daily charge of 8d. per child, which includes three meals. 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 Day Nursery 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 bv the Council's Maternity and Child Welfare Scheme. Many of the children are referred on account of anaemia and general debility with flabby musculature, or for debility after an acute illness: a marked improvement is evident in certain cases who attend regularly over a period of several weeks. Attendances at the Sunlight Clinic. (1) Municipal Clinic. (2 sessions per week) Total number of new cases 118 Total attendances for treatment 2190 (2) Day Nursery Clinic. (3 sessions per week) Total number of new cases 117 Total attendances for treatment 3793 Hospitals for Children under 5 years of age. Children under 5 years of age requiring hospital treatment can be admitted to St. Mary's Hospital, Plaistow, and to the Invalid and Crippled Children's Hospital, Balaam Street, Plaistow. The beds at St. Mary's Hospital are occupied mainly bv acute medical and surgical cases. At the Invalid and Crippled Children's 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. Such cases are usually recommended from the various Welfare Centres for treatment for marasmus, rickets, malnutrition, and dietetic disorders of infancy and early childhood. 60 In addition, at the Invalid and Crippled Children's Hospital, four beds are reserved for young children requiring in-patient orthopaedic treatment; there are complete facilities at the hospital for out-patient treatment of the common deformities of this age period, e.g. bowlegs and knock-knees, slight talipes, torticollis in infancy due to birth injury, etc. Most of these patients are referred to the Orthopædic Surgeon from the Child Welfare Centres in the Borough. Arrangements are in force with the Committees of Queen Mary's Hospital, Stratford, and St. Mary's Hospital, Plaistow, for the treatment of ear, nose and throat defects in young children. Number of Children admitted to Hospitals. No. of Beds No. of cases admitted St. Mary's Hospital, E.1 10 269 Children's Hospital, Balaam Street: (a) Babies' Ward 16 178 (b) Orthopaedic Ward 4 21 Convalescent Homes for Children under 5 years of age. Young children referred for convalescence are sent to Homes through the aid of the Invalid Children's Aid Association and the Invalid and Crippled Children's Society. The children are all examined prior to convalescence by one of the Council's Medical Officers. During 1935, 336 children were sent to various Homes for periods from one to three months: the number is an increase of 108 over that number for 1934. This service has grown tremendously in recent years with the establishment of more Infant Welfare Centres, whereby many more children now receive medical supervision and examination. It is found that convalescence in the case of young children is more frequently required for such chronic ailments as malnutrition, anaemia, rickets, general debility, than for debility following an acute illness. The children are more often recommended from Infant Welfare Centres than from private doctors or Medical Officers of Hospitals. In some cases the cause of malnutrition, failure to gain weight, anorexia may be definitely attributed to an acute infection, but in the large majority the history is simply that the child has not been well for some weeks, is fretful, and refusing food. The mother becomes worried, which in turn affects the child, hence a vicious circle is set up. The only remedy is to remove this child from the care of its mother for a period of several weeks, not to a hospital, but to a convalescent home with its regular, 61 orderly routine. The staff at the Homes for toddlers should be not only adequate in number but competent by training to deal with the child's needs, physically, mentally and psychologically. The regular life, discipline and companionship ot other children of the same age exert a wonderful effect, so that there is a steady return to good health. Fresh air, a good, well-balanced diet, and long periods of rest play no small part in this improvement. In their own homes many of these small children do not have sufficient rest at night, and the daily rest is generally foregone after the first two years of life. In the treatment of early Rickets with complicating deformities such as bowlegs, good surroundings and suitable diet with additional rest will cure the condition effectively. Money spent by any authority in sending a case of Rickets to a Convalescent Home for a prolonged period will be repaid in saving the cost of orthopaedic treatment later; in this way, too, the child leads a healthy, normal life, free from the physical and mental distress occasioned by the necessity perhaps for operative treatment or the wearing of unsightly surgical splints. In a poor district with overcrowded home conditions and considerable unemployment, there will always be a need for convalescent treatment as an important adjunct in the Maternity and Child Welfare Services of the area. The resulting benefits are permanent in many cases, particularly where the mother is willing to co-operate and to continue as far as possible the regular ways developed in the child while at a Convalescent Home. For the after-treatment in young children of pneumonia, acute bronchitis, bronchiectasis after whooping cough, or pulmonary congestion after measles, there is no remedy so effective in completely clearing up the pulmonary condition as prolonged convalescence, whereby the general resistance of the child to subsequent infection, such as tuberculosis, is also greatly increased. Children and Young Persons' Act, 1932. Foster Children. Under Part 1 ot 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 62 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 with the regulations of the Council, which include provision of a fire-guard, separate and 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 Visitors at least once every two months. In no case was legal proceedings taken in 1935. At the end of 1935 there were 42 foster-mothers on the Register, and 42 children registered as foster children. Registration was refused to two applicants on the grounds of unsatisfactory home conditions. OPHTHALMIA NEONATORUM. During 1935 there were 17 cases of Ophthalmia Neonatorum notified to the Medical Officer of Health. The Health Visitors investigate and report upon all such cases occurring in West Ham residents. Weekly or more frequent visits are paid until the case is completed in order to ensure that the mother carries out the treatment recommended. The Council have an agreement with the London County Council whereby an infected infant and its mother can be admitted immediately to St. Margaret's Hospital, Kentish Town, for specialist treatment. Analysis of Notified Cases. Total Cases = 17. Total West Ham residents = 15. Number of cases treated at home = 11. Number of cases treated in hospital = 6. Vision unimpaired = 17. Number of deaths = 1. (Cause of death = Marasmus. Age at death = 3 months.) Pemphigus Neonatorum. There was no case of this disease notified to the Medical Officer of Health during 1935. 63 Puerperal Fever and Puerperal Pyrexia. Nine cases of Puerperal Fever and 49 cases of Puerperal Pyrexia were notified to the Medical Officer of Health; this represents 1.5 per 1,000 notified births in regard to Puerperal Fever, and 9.0 cases of Pyrexia per 1,000 births. Arrangements are in force whereby the mother and baby can be admitted immediately to hospital it such is considered necessary. Three Consultant Obstetric Surgeons have been appointed by the Council 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 several District Nursing Associations in the Borough. Where Nursed Result West Ham Residents. Home Hospital Recovered Died Puerperal Fever 0 9 7 2 Puerperal Pyrexia 19 30 29 4 Infantile Mortality. The Infantile Mortality Rate for 1935 is 45.4 per 1,000 births, being a decrease of 20.,1 per 1,000 compared with 1934. This rate is the lowest on record in West Ham, and compares very favourably with the rate of 62.0 per 1,000 for the 121 Great Towns. The total number of deaths under one year was 191 (100 males, 91 females), of which number ten deaths occurred in illegimate infants. Table shewing Notified Causes of Deaths under one year of age. Congenital debility, prematurity, malformation, etc. 99 Pneumonia and Bronchitis 41 Diarrhoea, digestive disturbances 22 Synhilis 2 Malignant disease 1 Nephritis 1 Whooping Cough 4 Diphtheria 2 Influenza 1 Tuberculosis (non-pulmonary) 1 Violence 2 Other defined diseases 15 Total 191 64 There is a considerable reduction in the number of deaths from Pneumonia as compared with 1934, when there was a severe Measles epidemic with deaths from secondary Broncho-Pneumonia. In the absence, however, of an epidemic of measles and whooping cough, tne percentage of deaths in young infants from acute respiratory infections is unduly high, being 21.4%. Broncho Pneumonia always exacts a heavy toll in causing deaths of children below one year of age. At the ordinary infant welfare sessions it is very common to find infants suffering from bronchitis and bronchial catarrh, especially associated with the eruption of the first teeth. Probably more infants are referred to hospitals or to private doctors from the Centre for treatment for this condition than for any other disease. There is a tendency on the part of the mothers to accept this sub-acute or chronic bronchial infection as an inevitable accompaniment of dentition, and, indeed, of infancy. The condition is either not treated, or the infant is unwisely overtreated with many and varied remedies recommended by friends and neighbours, so that there results not only a chronically inflamed respiratory tract, but a general lowering of resistance of the patient to subsequent acute infections. No fewer than 51.7% of the infantile deaths in 1935 were due to causes such as congenital debility, prematurity, marasmus, malformation; neonatal deaths remain high in spite of improved care of the mothers during pregnancy and labour, and of the infants in the early days and weeks atter confinement. Of the 191 deaths under one year of age, no fewer than 88, or 46.1 per cent., occurred in infants within the first four weeks of life. The following Tables indicate clearly that there is much research required into the causes and prevention of premature labour, before it will become possible to reduce very considerably and permanently the infantile mortality rate. In the absence of epidemic diseases this rate would be very low were it not for the continued large number of deaths in the neo-natal period. Age period at death. Under one week 67 From 1 to 2 weeks 9 From 2 to 3 weeks 5 From 3 to 4 weeks 7 88 D 65 Total deaths within 24 hours of birth 39 Causes of death within 24 hours of birth:— Prematurity 27 Congenital defect or deformity 7 Fits 1 Injury at birth 4 39 Deaths amongst children from 1—5 years of age. There were 97 deaths amongst children in the age period, 1—5 years, as compared with 196 for the corresponding ages in 1934; again the decrease must be mainly attributed to the comparatively few cases of Measles in 1935. Nineteen children died from Diphtheria, 17 between the ages of 2—5 years. Of the total deaths from Diphtheria in the Borough in 1935, viz. 39, it is thus shown that 48.6% occur in these young children who are known to be particularly susceptible to this infection. The demand for immunisation against Diphtheria is still unfortunately too small, in spite of propaganda at the various Infant Welfare Centres and in the homes by the Health Visitors. Table showing causes of death 1—5 years of age. Infectious diseases— (a) Measles 4 (b) Scarlet Fever 3 (c) Whooping Cough 7 (d) Diphtheria 19 (e) Influenza 1 (f) Cerebro Spinal Fever 2 36 Tuberculosis (all forms) 7 Pneumonia and Respiratory Diseases 26 Appendicitis, digestive disorders 6 Violence 7 Other diseases 15 Total 97 66 67 Maternal Mortality. There were fifteen deaths in 1935 due to pregnancy or associated with child-birth in this Borough. Of this number seven were due to sepsis, all of whom died in hospital, and eight to causes other than sepsis, of whom three died at home and five in hospital. The Maternal Mortality rate for 1935 was 3.23 per 1,000. The average age of the mothers at death was 29.25 years. Eight of the fifteen deaths occurred among primiparae. Of the seven cases where death was due to sepsis, three deaths occurred after abortion at varying periods from 8 to 20 weeks; in no case was there any suggestion of illegal interference: there had been no ante-natal care in these cases, but this is not surprising in view of the comparative early stage of pregnancy. The majority of patients still tend to wait until about the fifth month before presenting themselves for ante-natal examination, hence abortions may, and do, frequently occur before the patient has availed herself of help in any way. Many cases of complete abortion remain unknown to workers amongst the mothers, and medical treatment is frequently only obtained in those cases where the abortion is incomplete or accompanied by other symptoms. It would appear evident, however, that there is a better knowledge and realisation of the dangers of abortion, and there is assuredly now less attempt at any serious interference with the eourse of pregnancy. This better state of affairs is partly a result of the constant teaching of health matters by Health Visitors, by Doctors at Maternity and Child Welfare Clinics and in practice, by popular lectures and by articles in the press. While this widespread advertisement of the dangers of pregnancy and childbirth has perhaps inculcated into the minds of women an abnormal fear of a normal process, yet it has served a useful purpose in helping to produce the right attitude to the dangerous practice of inducing abortion, once so universal throughout this country. Maternal Deaths (as given by the Registrar General) from causes other than sepsis, number eight. In two cases, however, there was pre-existing cardiac disease undoubtedly aggravated by the strain of pregnancy and confinement. To include these cases as true maternal deaths—i.e. deaths attributable to conditions directly associated with pregnancy or childbirth—produces a higher mortality rate which is misleading : without the pre-existing heart lesion in both these cases it is doubtful if death would have occurred : excluding these two cases the Maternal Mortality rate for 1935 becomes 3.09 per 1,000. Two other deaths might be classed as unavoidable—viz. Cerebral embolism during normal labour, and sudden rupture of an early tubal pregnancy. Such tragedies will unfortunately always occur, however well-organised is the Maternity Service. 69 In two cases it was noted when the deaths were investigated that the patients failed to avail themselves of advice given, or to co-operate in any way so as to assist those in attendance on them. This failure to co-operate is not common in this Borough: the Social Services for the mothers, both expectant and nursing, are extensive: nutrition is maintained by the provision of free meals and milk; there are readily available facilities for ante-natal supervision, for dental treatment, hospital treatment during pregnancy and for confinement, and later, convalescent treatment for nursing mothers. The mothers are kept under close supervision in their homes by the Health Visitors and midwives. These services are more and more appreciated by the mothers, and there can truly be said to exist a mutual spirit of friendly co-operation which is all to the good of the Maternity Services of the Borough. MENTAL DEFICIENCY. On the 31st December, 1935, there were 718 Mental Defectives on the register—Males 354, Females 364. Number in Institution under Order (excluding cases on licence)— Males 130. Females 109. Total 239. Number on Licence from Institutions— Males 15. Females 5. Total 20. Number under Guardianship under Order— Males —. Females 3. Total 3. Number on Licence from Guardianship— Males —. Females 1. Total 1. Number in "Places of Safety"— Males 2. Females —. Total 2. Number under Statutory Supervision— Males 207. Females 246. Total 453. Eighty-eight new cases were dealt with during the year as follows:— Recommended Institutional Care— Males 16. Females 17. Total 33. Recommended Supervision at Home— Males 13. Females 9. Total 22. Referred for Reconsideration— Males 25. Females 8. Total 33. Number of Cases notified by Local Education Authority under Sec. 2 (12) — Males 11. Females 12. Total 23. Number of Cases admitted under Order to Institutions Males 20. Females 17. Total 37. 70 During the year 69 Continuation Orders were received. For 5 yrs. Males 27. Females 23. Total 50. For 1 yr. Males 10. Females 9. Total 19. Twenty-four cases were removed from the register for reasons as follows:— Removed to other Areas— Males 11. Females 5. Total 16. Died— Males 1. Females 4. Total 5. Dealt with under the Lunacy Acts— Males 1. Females 2. Total 3. Number of cases who were granted Licence— Males 8. Females 5. Total 13. Ascertainment. A Local Authority is, to a great extent, dependent upon various agencies in carrying out its duty of obtaining knowledge of the mental defectives living within its area, and it is only by close co-operation with the Officers of the Education, Public Assistance and Maternity and Child Welfare Committees, Local Police Courts and Voluntary Associations that complete information regarding them can be obtained. As will no doubt be realised, the Education and Public Assistance Committees are the chief sources of information. During the year 55 new cases were certified under the Acts, and of these 23 were reported by the Education Committee and 16 by the Public Assistance Committee. Cuardianship. This type of care is found to be the most suitable for certain cases, and is obviously more economical than institutional care. There are three women under Guardianship under Order. Two of these are in the care of their parents. It was found that the parents in these cases were averse to parting with them, but were obliged to consider the question of applying for admission to an institution as their means were so small that they could not afford to keep them. Orders for Guardianship were accordingly obtained and a small weekly allowance made to the parents. Institutional Accommodation. Although 37 cases were admitted to institutions during the year, great difficulty is still experienced in obtaining vacancies in suitable homes, especially for the lower grade defectives. The question of the provision of 340 additional beds at South Ockendon Colony has received much attention, and it is hoped that the buildings will be commenced in a few months. The extension scheme includes facilities for training and caring for the various grades of patients, and will comprise three Villa Blocks for 60 adult males each, one Villa Block for 60 adult females, two Villa Blocks for 50 children each, Recreation Hall, selfcontained Administrative Block, Male and Female Workshops, Nurses' Home, Medical Superintendent's House and Staff Cottages. It is to be regretted, however, that there is to be no special accommodation for the lowest grade of patients. 71 Licence. The system of granting leave of absence on trial from institutions provides a means of judging a defective's capability of living away from institutional routine and discipline. It is a fairly safe way of giving him an opportunity of showing whether he is able to fit in with the outside world. There are 20 West Ham defectives on licence from institutions, some in the care of guardians and the others with their parents. Of these, five have obtained regular employment and are doing extremely well. One has been employed at a local hospital as a maid since September, 1931, and another regularly employed since October, 1934. The others, while not in regular work, are quite happy, giving no cause for anxiety. Of the 13 cases who were granted licence during the year only two (1 male and 1 female) had to be recalled; the male after five months and the female after four months. Both of them became unsettled at home, and it was deemed advisable for them to return to the institution. South Ockendon Colony. The Matron Superintendent (Miss W. S. Butler) reports:— The number of patients on the books is 142, of which 59 are males over 16 years. 36 are females over 16 years. 30 are males under 16 years. 17 are females under 16 years. Rowans (Male Block, 44 beds) has a total of 59 patients, all over 16 years. Seven of this total are on licence, and, owing to lack of space, eight sleep in Limes at night. These patients are classified into two groups, viz. 31 high grade, 28 low grade. Limes (Boys' Block, 50 beds) has a total of thirty patients, all under 16 years. Three of this total are on licence. Elms (Girls' Block, 50 beds) has a total of 53 patients, 36 over 16 years and 17 under 16 years. Two of this total are on licence. The patients in Limes and Elms are graded into three groups irrespective of age. Movements. These were as follows:— Admissions: 6 males 1 Female Discharges: 1 Female Deaths: 1 male at Whipps Cross Hospital One male is at present on licence at the West Ham Sanatorium, Dagenham, suffering from pulmonary tuberculosis. One male patient is on licence at Forest Gate Hospital owing to physical deterioration. Leave was granted as follows:— Summer holidays 31 Christmas holidays 39 Forty-eight hours 6 72 Health. The following were sent for treatment during the course of the year to Whipps Cross Hospital:— 2 girls over 16 years, with Rheumatism. 1 boy under 16 years with Broncho-Pneumonia. 1 boy under 16 years with acute Nephritis. To Orsett Isolation Hospital: 1 girl over 16 years with Chicken Pox. These patients all made good recovery, with the exception of the case of acute Nephritis, which proved fatal. There was an epidemic of Tonsillitis among the girls in February of this year, otherwise the health of the Colony has been very good. Employment. The higher grade patients are now able to help, to a large extent, with the maintenance of the Institution. All boot mending is done by male patients, and the making and mending of clothes by female patients, with staff supervision. A great many articles, such as rugs, baskets, etc., in use in the Colony are of our own production. We receive constant orders for handicrafts, and articles to the value of £50 have been sold this year. The sewing room produced 2,122 new articles. Twelve male patients work regularly at the Farm. Scouts and Cuides. These have now been in existence for a year. The Scouts number 20, including 4 Cubs. The Guides number 16. Officers are members of the Staff. I cannot speak too highly of the benefit which the Colony has obtained from these movements, as, apart from the constant pleasure and interest which the members derive from it, the improvement in the general conduct and deportment has been most marked. The Scouts held a camp in the grounds of the Harold Wood Hospital last July. The Guides gave an Anniversary Party on the 26th of March, 1936, to which Guides from the surrounding district and County Officers were invited. The Troops take part in all local functions, and receive numerous invitations to all gatherings in the district. Amusements. The Football and Cricket teams for the boys continue to flourish, also the girls at Netball. Fixtures with visiting teams are much appreciated. The Jubilee was celebrated with sports, a dance, and a visit to London in two motor coaches to view the decorations. The Annual Sports were held in July in lovely weather, and we were honoured with the presence of many members of the Council. Christmas was celebrated in the traditional manner, and the Staff gave a concert for the patients on Boxing Day. Visits to Institution. Visits were paid by members of the Hoard of Control as follows: 3rd May, 1935; 25th October, 1935; 3lst January, 1936. 73 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. No complaints have been received from private houses, or any other source, with regard to unsatisfactory water supply. 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 River Lee Catchment Board. 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 scheme for the improvement of the Back Rivers of the Borough under the provisions of the River Lee (Flood Relief, etc.) Act, 1930, mentioned in my report of last year, is now practically complete. 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 bv 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. 74 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 Engineer'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. Two "Karrier" motor sweepers are utilised to assist in this work. REFUSE DISPOSAL. The amount of refuse required to be collected in West Ham is over 260 tons daily, and is dealt with by the method of controlled tipping. Most of the refuse is collected by means of the Pagefield system of containers. The refuse is shot on controlled tipping dumps at Beckton Road and Temple Mills, and by arrangement at one of the East Ham Corporation's Tips. Common Lodging Houses. There are nine Common Lodging Houses in the Borough, three in the North and six in the South. Practically all of these were originally used as ordinary dwelling-houses, but have been converted so as to come in line with the Bye-Laws of the Council. The aggregate number of beds is 525. The Sanitary Inspectors make periodical visits to these houses, and thirty-seven such visits were made during the year. It was not found necessary, as the outcome of these visits, to serve any statutory notices, or communicate in any way with the 75 various owners in regard to the conduct of these premises, and no complaints were received from the occupants or general public in this connection. No application was received for registration of new premises or for any alteration to the existing buildings. SMOKE ABATEMENT. No great difficulties have been experienced during the year in this connection. Excessive smoke emission from a biscuit wafer factory was found to be due to inefficient firing, and was remedied. No trouble was experienced in connection with railway engines. A chimney at a chocolate factory caused some trouble, and on investigation it was found that one section of the firm's power plant was totally inadequate to cope with a constantly increasing load. At the year end the firm were proposing to provide a high pressure boiler plant and to dispense with the section referred to. In two cases firms of varnish makers, upon request, ceased to discharge into the atmosphere undesirable fumes. Proceedings were instituted against a firm of refuse disposal contractors for permitting an offensive accumulation consisting of burning refuse in old worked-out gravel pits. The Court made an Order prohibiting the nuisance, and the firm now cover the refuse with earthy material instead of burning it. Houses Let in Lodgings. For various reasons the Bye-Laws mentioned in my last Annual Report have not yet been adopted, but the whole question is under consideration. Rag Flock Acts, 1911 to 1928. There are three premises in the Borough wherein Rag Flock is manufactured. These are visited regularly by the Sanitary Inspectors. In addition to these, there are a number of premises where flock is used in the making of furniture and bedding. Ten samples were taken during the year for analysis; of these one did not conform to the standard of permissible soluble chlorine content. A letter of warning was sent to the offender. 76 Offensive Trades. There are 27 premises in the area where statutory offensive trades are being carried on. These trades are as follows:- Nature of Offensive Trade. No. of Premises 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 Fellmongers 1 All these places are visited very frequently by the Sanitary Inspectors, and during the year 498 inspections were made. Proceedings were instituted for establishing the trade of fat melter against a pig-keeper who had installed a fat digester, steam actuated, and was found to be melting fat even though there were no pigs on the premises. He entered a plea that the oil extracted was sold to linoleum manufacturers, and the residue was used for the feeding of pigs at another piggery outside the Borough. The Court held that he had not established the trade of Fat Melter, and dismissed the case with Costs. MOSQUITOES. No complaints were received during the year of infestation by mosquitoes from the Northern Outfall Sewer, which was badly affected in 1934. An urgent appeal for assistance was received from the Manager of a Telephone Exchange, when it was found that serious infestation was occurring due to semi-stagnant water near by. This and all surrounding vegetation was sprayed with a thin oil, which proved effective. No more trouble was experienced throughout the year. PROSECUTIONS, 1935. Nuisances (Public Health Acts)— 702 Summonses. 369 Summonses withdrawn: 1 Summons was dismissed, Costs incurred: 1 Summons was adjourned sine-die: 331 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— 85 Summonses. 41 Summonses withdrawn: In 44 cases penalties were imposed. West Ham Corporation Acts, 1893 and 1898. 22 Summonses. 17 Summonses withdrawn: Penalties were imposed in 5 cases. 77 Shops (Hours of Closing) Act, 1928— 28 Summonses. 11 Summonses dismissed on payment of Costs. In 17 cases fines were imposed. West Ham Grocers', General Shopkeepers' and Provision Dealers' Half-Holiday Order, 1912— 2 Summonses. 1 Summons dismissed on payment of Costs. 1 fined. Hairdressers' and Barbers' Shops (Sunday Closing-) Act, 1930— 1 Summons. 1 Summons dismissed on payment of Costs. West Ham Grocers', General Shopkeepers' and Provision Dealers' Closing Order, 1919— 9 Summonses. 5 Summonses dismissed on payment of Costs : 1 Summons dismissed, Costs incurred. Fines were imposed in 3 cases. Shops Act, 1912— 1 Summons. 1 Summons dismissed on payment of Costs. Offensive Accumulation— 1 Summons. 1 Order made by Magistrate to abate nuisance. Establishment of an Offensive Trade without Consent of Council— 1 Summons. 1 Summons dismissed, Costs incurred. SUMMARY OF WORK OF SANITARY INSPECTORS. Houses Visited in connection with Infectious Diseases 2353 Houses, Factories, and any other premises visited in connection with Small-Pox 35 Visits to Factories 176 „ Workshops 90 „ Outworkers 125 „ Bakehouses 210 „ Dairies 270 „ Common Lodging Houses 37 „ Houses Let in Lodgings 53 „ Cellar Dwellings, Underground Rooms, Etc. 85 „ Slaughterhouses 1 „ Fish Fryers 107 „ Knackers' Yards — „ and Restaurant Kitchens, Etc., P.H.A. 1925Café 138 „ Ice Cream Makers or Dealers, W.H.C.A. 63 „ Other Food Purveyors 4605 Visits re Burial Act, 1857, Section 25, Exhumation of Human Remains 4 „ Private Houses to Investigate Complaints 6696 „ Offensive Trades 498 „ Other Noxious Trades 45 „ Canal Boats — „ Imported Food (Labelling) Order, 1921 5 „ Drainage Inspections 6695 „ Rats and Mice Destruction Act 95 „ Increase of Rent Restriction, Etc., Acts 7 „ Bye-laws—Tents, Vans, Sheds 19 78 Houses Inspected under the Housing Acts, 1930 and 1935 2054 Other Houses inspected 2270 Visits to Places of Public Amusement, Music Halls, Cinemas, Etc. 99 Visits to Factories re Smoke 42 Other Visits 1128 Re-Inspections to supervise works 32258 Samples purchased under Rag Flock Acts 10 Samples of Domestic Water Supplies taken for Analysis or Bacteriological Examination Nil Total Notices served (P.H. 7531) (H.A. 265) 7796 Warning Letters sent re matters not dealt with by Notice 30 Defective Houses dealt with 8161 Other Defective or Insanitary Conditions dealt with 5 Drain Tests carried out 369 Certificates granted under the Kent, &c., Restrictions, Acts 14 No. of Notices complied with—(1) By Owner 7289 —(2) By Occupier 141 Summonses issued 809 Inspection of Dwelling Houses. The following table shows the number of inspections and Sanitary Notices served in respect of, in sixteen Wards of the Borough during the year 1935 Ward Inspections Notices served in respect of New Town 818 640 Forest Gate 439 410 High Street 629 519 Broadway 562 422 Park 298 219 Upton 274 175 West Ham 515 493 Plashet Road 284 300 Plaistow 743 656 Canning Town and Grange 696 689 Ordnance 595 522 Hudsons 542 379 Bemersyde 258 173 Tidal Basin 905 807 Beckton Road 820 813 Custom House and Silvertown 680 579 9058 7796 In this connection 809 summonses have been issued during the year. 79 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories (Including Factory Laundries) 176 10 ... Workshops (Including Workshop Laundries) 90 7 ... Workplaces (Other than Outworkers' premises) 89 6 ... Total 355 23 ... 2.—Defects found in Factories, Workshops and Workplaces. Particulars. (1) Number of Defects. Number of offences in respect of which Prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts* :— Want of cleanliness 17 17 ... ... Want of ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors 2 2 ... ... Other Nuisances 11 9 1 ... Sanitary Accommodation— Insufficient 2 1 ... ... Unsuitable or defective 1 1 ... ... Not separate for sexes ... ... ... ... Offences 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 33 29 1 ... * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 80 Schools. There are 49 Council Schools, and 12 Non-Provided Schools, comprising: 166 Departments. The accommodation available is 58,352. In addition there are two Schools for Mentally and Physically Defective Children, two Centres for the Deaf, one Open-Air Day School, and 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. During the year the following improvements were carried out:— Provision of new Handicraft Room and Domestic Science Room. Domestic Science Rooms modernised and two new Science Rooms provided. Erection of a Domestic Centre, Practical Room and Handicraft Centre. Provision of a new room for reading or marginal purposes, by conversion of a cloak-room. Hot water supply to lavatory basins. Remodelling of latrines at two schools, and provision of additional lavatory accommodation at two special schools. Provision of shelters at two Dining Centres. Nine Schools re-decorated externally; eight Schools and a Clinic re-decorated internally. Re-dressing and tar-paving of playgrounds of ninteen Schools. Removal of galleries, and floor planing at several Schools. At two non-provided Schools substantial alterations and improvements have been carried out. With regard to the prevention of the spread of infectious disease, the Medical Officer of Health on receiving information of 61 a Case of infection in a house, instructs the Sanitary Inspector to call and make full investigations as to the number of children in the house; also whether they are in attendance at any School, and any other relevant details. In addition he informs the parents that their children must not return to School until the house has been officially certified as free from infection. Upon receipt of the report of the Inspector, the Head Teacher of all Schools involved (Day and Sunday) are notified immediately by the issue of a red coloured notice, requesting exclusion of the children from the infected house. This notice is followed up by a white notice freeing the family from quarantine at the completion of the necessary isolation, and the official disinfection of the premises. A supply of disinfectants for general or special use in Schools is supplied by the Education Authority. No School or Department was closed during the year on account of the prevalence of any infectious disease. No complaints were received with regard to unsatisfactory water supply. SWIMMING BATHS AND POOLS. Mr. J. D. Sutton, Superintendent Engineer, reports as follows:— In connection with the management of Swimming Pools under the control of the West Ham Council, every care is taken to ensure the water being continually in a safe and satisfactory condition. During the periods when the Pools are available to the public the water in every establishment is continually Filtered, Aerated and Sterilised. The latter result is attained by means of Liquid Chlorine. Filtration is rendered more efficient by the use of Sulphate of Alumina as a means to effect a coagulation on the surface of the filtering media. Daily tests are taken to ascertain the presence of free Chlorine, and every endeavour is made to allow only .3 parts per million of water. I am very particular about the results of these tests for two obvious reasons:— (a) To ensure the water being perfectly sterilised. (b) To endeavour to cause no discomfort to the bathers by excess of free Chlorine in the water. 62 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) 9058 (b) Number of inspections made for the purpose 40908 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 365 (b) Number of inspections made for the purpose 1827 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 47 Parts of buildings let as separate tenements found to be unfit for human habitation 23 (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 7726 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 265 (2) Number of dwelling-houses which were rendered fit after service of formal notices (a) By Owners 378 (b) By Local Authority in default of Owners — (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied *7531 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By Owners *7834 (b) By Local Authority in default of Owners — E 63 (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 28 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 8 (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 22 (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. Ten Clearance Orders were confirmed by the Ministry dur the year. 1 hese were as follows:— Houses Persons to be displaced Major Road and Beddingfield Street Area 15 93 Major Road Area 11 66 Bidder Street Area 6 38 Quadrant Street (Swiss Terrace) Area 5 27 Forty Acre Lane, etc., Area 6 84 Quadrant Street Area 3 31 Star Lane Area 3 17 Smith Street, etc., Area 22 158 Swanscombe Street Area 7 33 Scott Street Area 3 30 81 577 At the year end, houses to accommodate the people from these and other outstanding Clearance Areas were approaching completion. An Official Representation was submitted to the Council in May, 1935, respecting a Clearance Area, Tidal Basin No. 1. This comprised the following houses :— 84  Houses Persons to be displaced Nelson Street Area 19 154 Fen Street Area 32 351 Huntingdon Street Area 20 189 Victoria Dock Road Area 1 6 Alice Street Area 28 249 Catherine Street Area 2 21 102 970 It was proposed to deal with this by Compulsory Purchase Order, but difficulties in connection with sites for re-housing occupiers caused delay, and the Order had not been made by the end of the year. A preliminary report was made in November respecting five more proposed Clearing Areas as follows :— Houses ns to be displaced North Street Area 3 16 Castle Buildings Area 11 149 Abbey Road Area 12 43 Cam Road Area 30 122 White Hart Cottages Area 6 19 62 349 Several further Clearance Areas under the five years' programme are scheduled and awaiting the necessary action. Under Part 2 of the Housing Act, 1930, appeals were entered against Closing Orders in respect of three basement dwellings dealt with under Section 20 as "Parts of a building let separately for human habitation and which were unfit." The owner had submitted undertakings to execute works, but in view of the lack of light and ventilation inherent in the dwellings, the Committee declined to accept the undertakings. The Judge himself inspected the properties, by which time the owner had carried out considerable works in one of the dwellings. The Closing Orders were confirmed with Costs. Appeals were entered against a block of eight Notices under Section 17 of the Housing Act, 1930, but in these cases it was found the owner was embarrassed financially and had appealed to gain time additional to the three months allowed by the Notices. In these circumstances he was promised that provided the works were completed within an additional three months no further action 85 would be taken. He withdrew his appeals and did, in fact, complete the works within the time agreed. In addition to the foregoing, 9,058 houses were inspected under the Public Health Acts; 7,531 Statutory Notices were served and were followed by the issue of 702 summonses. Of these 369 were withdrawn on payment of Costs, the work having been completed before the date of hearing. In 331 oases Magistrate's Orders to execute works were made. Of these, 85 were not complied with, and summonses were issued in all these cases for failing to comply with Magistrate's Orders, 41 being withdrawn on payment of Costs where the works were completed before the date of hearing, and in 44 cases penalties were imposed by the Court. Under the West Ham Corporation Acts, 1893 to 1898, 22 summonses were issued, mostly in connection with combined drains. Penalties were imposed by the Magistrate in 5 cases and 17 summonses were withdrawn, the works having been carried out before the date of hearing. It is usually difficult to induce the owners of a group of properties served by a combined drain to act in co-operation and instruct one common contractor, and it is not the practise of the Council to carry out such works in default, but it has been found that owners usually co-operate following the issue of summonses on all parties. SPECIAL REPORT ISSUED BY THE MEDICAL OFFICER OF HEALTH. Housing Act, 1935. Preliminary Memorandum by the Medical Officer of Health. The above-named Act, which came into force on August 2nd, 1935, is one which must have far-reaching effects upon the mental and physical health of the populace, and may be considered one of the most important health measures since the great Public Health Act of 1875. It legislates, among other matters, to make further and better provision for the abatement and prevention of overcrowding, the re-development of Urban Areas in connection with the provision of housing accommodation therein, the reconditioning of buildings, and to amend the enactments relating to clearance areas and housing generally. Several Circulars, Provisional Regulations and Memoranda have been issued by the Minister of Health (copies of these have been circulated to you by the Town Clerk) concerning the working of the Act and elucidating certain clauses and sections. The object of this Memorandum is to set out as briefly as possible (a) the immediate duties which have to be carried out through my Department; (b) to put forward suggestions to the Housing Committee as to the manner in which these duties may be performed. 86 The Act (amongst a wealth of detail) states: Section 1. (1) It shall be the duty of every local authority before such dates as may be fixed by the Minister as respects their district, to cause an inspection thereof to be made with a view to ascertaining what dwelling-houses therein are overcrowded, and to prepare and submit to the Minister a report upon the result of the inspection and the number of new houses required in order to abate overcrowding in their district, and, unless they are satisfied that the required number of houses will be otherwise provided, to prepare and submit to the Minister proposals for the provision thereof. (2) If at any time or times after effect has been given by a local authority to the provisions of the foregoing sub-section it appears to them that occasion has arisen therefor, or the Minister so directs, it shall be the duty of the authority to cause a further inspection to be made and to prepare and submit a report and proposals as aforesaid as respects their district or any part thereof, and, where the Minister gives a direction under this sub-section, he may, after consultation with the local authority, fix dates before which the performance of the said duties is to be completed. Section 2 gives the definition of overcrowding. Section 3 specifies the offences in relation to overcrowding. Sections 4 and 5 deal with exceptions where the local authority may, under certain safeguards, permit temporary overcrowding. Section 6 relates to entries in rent books, etc., regarding the permitted number of people who may inhabit a particular house. Section 7 gives power to the local authority in regard to publication of information concerning overcrowding. Section 8 imposes upon a landlord or his agent the duty to inform the local authority of any overcrowding that may occur after the appointed date. Section 9 gives certain rights to landlords to obtain possession of an overcrowded house. Section 10 deals with the enforcement of the foregoing provisions of the Act by the local authority. Section 11 imposes upon Medical Officers of Health definite duties, including the furnishing annually to the Minister of Health particulars concerning overcrowding. Section 12 defines "Dwelling-house," "Landlord," "Room," "Suitable alternative accommodation." 87 The sections mentioned above are those which need immediate attention. Other sections in the Act directly affecting my Department, particularly Section 13 and those following—dealing with re-development areas—and also Section 20, will be doubtless the subject of consideration at a later and more appropriate time. The amendments relating to clearance areas (contained in Sections 62 to 67 of the Act) will come up for consideration automatically when any particular clearance area becomes the subject of an enquiry by the Minister of Health. Properly to carry out the above-mentioned work additional staff is essential. At present the number of Sanitary Inspectors employed is sixteen, excluding the Chief Sanitary Inspector. These members of my staff are allocated to the different Wards of the Borough. Their time is fully occupied in dealing with the routine work of inspection and reporting upon defective and infected houses and in preparing schedules under the various Housing Acts. Some of the work entailed by the Housing Act, 1935, will dovetail into their daily routine, but much additional work is inevitable until the whole of the houses of the Borough (some 50,000) have been inspected. The inspection must reveal two main results :— (1) The number of people occupying every dwelling-house. ("Dwelling-house means any premises used as a separate dwelling by members of the working classes or of a type suitable for such use." Section 12.) (2) The description and sizes of rooms in each dwelling-house. I append to this Memorandum a specimen form (Form B.), setting out the enquiries that are necessary to be made, and which indicates in no uncertain manner the amount of detail necessary to be obtained before any major action can be taken under this Act. I suggest that:— (1) Enumerators be appointed to visit every house and to obtain all the information needed to fill Columns 1 to 8 of Form B. The number to be appointed will of course vary in relation to the length of time proposed to be spent on the survey. I am of opinion that if the survey is to be completed expeditiously, each Ward should have an enumerator working under the surveillance of the district inspector for that Ward. Those attached to the Wards where the survey would be completed quickly could be transferred on completion of the survey of that Ward to the more densely populated districts. 88 (2) The Sanitary Inspectors carry out the work connected with the description and sizes of the rooms as set out in Columns 9 and 10 on Form B. This would by no means entail a visit to each house, as in many streets all the houses are exactly similar in regard to the number and size of the rooms; the report of the enumerator would reveal those houses which did not conform to type. (3) That Columns 11 to 16 on Form B. be filled in at my Office. It is essential that the enumerators appointed be persons of integrity and sufficient experience. Alternately to the above suggestions, but much more expensive to put into practice, additional Sanitary Inspectors could be appointed to survey all the dwellings. The sending of forms to the occupiers of dwelling-houses to be filled in and returned would, in my view, prove very unsatisfactory, and in any case measurements of the premises should only be carried out by trusted and responsible persons. I need hardly stress the fact that this Memorandum only purports to outline the Act as it affects my Department at this juncture; considerable elasticity must be allowed for developments which will arise during the inauguration and working of such a big and far-reaching survey. F. GARLAND COLLINS, Medical Officer of Health. Medical Officer of Health's Department, Municipal Health Offices, Romford Road, Stratford, E.15. November, 1935. ADDENDUM. Since compiling the above Memorandum, Circular 1507 has been issued from the Ministry of Health fixing the following dates in respect of Section 1 of the Housing Act, 1935. (l) For the completion of inspection—1st April, 1936. (2) For the submission of Report thereon—1st June, 1936. (3) For the submission of proposals therewith—1st August, 1936. F.G.C. 89 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 270 inspections of dairies and milk purveyors' premises made by the sanitary inspectors during the year. Twenty persons were registered as purveyors of bottled milk only, and three as dairymen and their premises as dairies; also there were transfers in respect of three dairies and 36 purveyors of bottled milk. There are now 110 premises registered as dairies and their occupiers as dairymen, and 643 persons registered as purveyors of bottled milk only. The bulk of the milk sold in the Borough is Pasteurised, some is bottled and sold as sterilised, but there is a certain quantity of raw milk being bottled by retailers. In these cases steam sterilisers for the treatment of the bottles are insisted upon in compliance with Article 21 of the Milk and Dairies Order, 1926, which provides: (1) "Every such vessel, lid and appliance, shall be thoroughly washed as soon as may be after use, and shall be cleansed and scalded with boiling water or steam before it is used again." As it is impracticable to scald glass bottles with boiling water, steam is the only alternative, though some retailers appear to have been informed bv their Associations that it is sufficient merely to wash the bottles. Having secured the installation of steam sterilisers, the difficulty remains in the case of the small retailers referred to of ensuring that they do in fact use them, whereas the large firms pasteurise their milk and cleanse and sterilise their bottles as a commercial proposition in order to ensure the good-keeping quality of their product. Examination of Milk. Animal Inoculation (Cuinea Pig Test). Sixty samples of milk were secured from producers and purveyors. This number included fourteen third-pint bottles of milk supplied to children at the Council's Schools, all of which proved satisfactorv. Ten samples were obtained on delivery at Council's Institutions, and these also proved satisfactory. Of the remaining thirty-six, one sample obtained on delivery from a producer revealed a positive tuberculous infection. The facts were immediately reported to the Medical Officer of Health of the area in which the milk was produced, who took appropriate action in the matter. Condensed Milk Pegulations. Fifty-one samples of condensed milk obtained were examined as follows :— 90 Condensed Machine Skimmed Milk Sweetened 40 Of this number thirty-four were examined for the purpose of testing the equivalent, three of which proved to be lower than the declared amount. In one case a subsequent sample was obtained and proved satisfactory, but in the other case a subsequent sample giving a similar result, the matter was thoroughly investigated, the source of origin traced, and the full facts communicated to the Ministry of Health. Condensed Full Cream Milk Sweetened 8 Of this number three were examined for the purpose of testing the equivalent, all of which proved correct. Condensed Full Cream Milk Unsweetened 3 Of this number two were examined for the purpose of testing the equivalent, all of which proved correct. Microscopical and Bacteriological Examinations. Ninety-three samples of milk were obtained from producers, purveyors and schools. Of this number, forty-nine were taken from Council's Schools (Pasteurised in ½rd pint bottles), two of which proved unsatisfactory on account of excessive bacteria; thirty-one from producers, sixteen of which were reported adversely upon, owing to the presence of pus cells, streptococci, coliform bacillus, and excessive bacteria respectively; thirteen were obtained from purveyors, eight of which proved unsatisfactory on account of the presence of coliform bacillus, pus cells and streptococci respectively. With regard to the unsatisfactory samples, in every case appropriate action was taken. Public Health (Preservatives, etc., in Food) Regulations. Twelve samples of various foods were reported upon as being adulterated with preservatives, as under:— No. 68. Malt Vinegar. Containing sulphur di-oxide. Official. No. 110. Malt Vinegar. Containing sulphur di-oxide. Official. Sample No. 110 taken in course of delivery in connection with No. 68 Official. Letter of caution sent in each instance, and explanation received. No. 456. Strawberry Jam. Containing sulphur di-oxide. Official. No. 541. Strawberry Jam. Containing sulphur di-oxide. Official. Letter of caution sent and explanation received. No. 515. Meat. Containing sulphur di-oxide. Unofficial. No. 566. Minced Meat. Containing sulphur di-oxide. Official. No. 567. Meat. Containing sulphur di-oxide. Official. Nos. 566 and 567, Proceedings instituted and fine of £2 2s. imposed. No. 618. Beer. Containing sulphur di-oxide. Official. Letter of caution sent, and explanation received. No. 706. Junket Powder. Containing sulphur di-oxide. Unofficial. 91 No. 707. Junket Powder. Containing sulphur di-oxide. Official. Proceeding's instituted against previous seller and case dismissed on payment of £10 costs. No. 909 Sausages. Containing sulphur di-oxide. Official. Declaration obscured. Letter of caution sent. No.921. Preserved Sausages, containing sulphur di-oxide. Official. Proceedings against previous seller, who was fined £2. MILK (SPECIAL DESIGNATIONS) ORDER, 1923. Licences were granted under the above Order during 1935, for the sale of Graded Milk, as under:— One to pasteurise and sell, and 23 to sell including two supplementary licences for the sale of Pasteurised Milk; four to sell Certified Milk; thirteen to sell including two supplementary licenses for the sale of Grade "A" (Tuberculin Tested) Milk; three to sell, including one supplementary licence to sell Grade "A" Pasteurised Milk; nine to sell, including one to produce, bottle and sell Grade "A" Milk. One hundred and five samples were submitted for bacteriological examination, the results being as follows:— Pasteurised Milk— Satisfactory 56 Unsatisfactory 1 (Excessive Bacteria) Grade "A" Milk- Satisfactory 21 Unsatisfactory 1 (Excessive Bacteria, and Conform Bacillus present in 1/100 th c.c.) Certified Milk— Satisfactory 3 Unsatisfactory 1 (Excessive Bacteria) Grade "A" (Tuberculin Tested) Satisfactory 17 Unsatisfactory 4 (Coliform Bacillus was present in 1/100 c.c., and in addition one contained excessive bacteria) Grade "A" Pasteurised Milk— Satisfactory 1 Unsatisfactory Nil With regard to the samples which failed to meet the requirements of the above mentioned Order, letters of caution were sent Pointing out that a thorough investigation into the matter must be made with a view to tracing the source of contamination and preventing a recurrence. Other Foods. All factories dealing with foods of various kinds, also retail shops and other premises, are frequently inspected by the Sanitary Inspectors, who made 5,394 visits during the year. 92 Fertilisers and Feeding Stuffs' Act, 1926. The Food and Drugs Inspector, Mr. E. F. Hughes, is also the Inspector and official sampler under the above mentioned Act. Of 25 samples, 13 official and 12 unofficial, obtained of various Feeding Stuffs, for the purpose of analysis under the above Act, five official and eight unofficial samples disagreed with the declared analysis. With regard to the 27 samples, 18 official and nine unofficial, taken of various Fertilisers, for analysis, six official and five unofficial samples disagreed with the declared analysis. UNSOUND FOOD CONDEMNED, 1935. 501bs. Apples. 4st. Catfish. 7 doz. rolls Celery. 146 tins Cherries. 13 bags Chestnuts. 3 Chickens. 23st. & 2 boxes Cod. 1 tin Cooked Ham. 98lbs. Corned Beef. 13½ cases Dates. 20lbs. Eels. 2525 tins Fruit. 22 barrels Grapes. 3st. Haddock. 12lbs. Jellied Veal. 55 boxes Kippers. 20lbs. Lambs' Livers. 3531bs. Tinned Meat. 1 box Megrims. 1 sack Mussels. 4 tins Peaches. 7 tins Pears. 15 boxes & 461b. Pears. 17 tins Plums. 30 baskets Plums. 1 Leg Pork. 601bs. Rabbits. 38 Molloys Radishes. 5st. Roker. 20st. Skate Wings. 20001bs. Tomatoes. 27 Pockets Walnuts. Samples Analysed by Borough Analyst, 1935. Articles Analysed Genuine Adulterated Official Unofficial Official Unofficial Official Unofficial Milk 435 - 426 - 9 — Milk, Condensed 11 40 11 40 — — Milk, Dried 28 - 28 - — — Semolina 1 - 1 - — — Preserved Ginger 1 1 1 1 — — Ground Ginger 2 2 2 2 — — Cinnamon - 1 - 1 — — Cream 7 6 7 6 — — Butter 63 43 63 43 — — Margarine 12 - 12 — — — Lard 18 7 18 7 — — Dripping 11 1 10 — 1 1 Cooking Fats 7 1 7 1 — — Pepper 29 8 29 8 — — —Continued at top of next page. 93 Samples Analysed by Borough Analyst, 1935.—Cont. Articles Analysed Genuine Adulterated Official Unofficial Official Unofficial Official Unofficial Mustard 3 — 3 — — — Vinegar 30 - 27 — 3 — Vinegar, Malt 18 - 16 — 2 — Pickles 7 1 7 1 — — Cocoa 10 - 10 — — — Coffee 10 - 10 — — — Tea 17 - 17 — — — Bread 5 - 5 — — — Cake 11 - 11 — — — Flour & S.R. Flour 38 - 38 — — — Pearl Barley 2 1 2 1 — — Tapioca 3 - 3 — — — Rice 5 - 5 — — — Peas 9 - 9 — — — Arrowroot 1 1 1 1 — — Custard Powder 2 - 2 — — — Tripe 1 — 1 — — — Jam 8 3 5 1 3 2 Honey 2 — 2 — — — Table Jelly — 1 — 1 — — Sugar 9 — 9 — — — Sweets 10 11 10 11 — — Meat 32 32 30 31 2 1 Cooked Meats 21 — 21 — — — Curry Powder 1 — 1 — — — Mixed Spices 1 — 1 — — — Mixed Peel 2 — 2 — — — Mincemeat 5 — 5 — — — Marmalade 1 — 1 — — — Pudding Mixture — 1 — 1 — — Bacon 3 — 3 — — — Sausages 24 — 22 — 2 — Sausage Meat 1 — 1 — — — Beef Cubes 3 4 — 3 3 1 Sardines — 11 — 11 — — Whisky 1 7 1 6 — 1 Olive Oil 1 2 1 2 — — Boracic Ointment — 1 — 1 — — Steak Pie 1 — 1 — — — Compound Syrup of Figs - 1 - 1 - - Epsom Salts — 3 — 3 — — Aspirin Tablets 1 3 — 2 1 1 Cheese 3 1 3 1 — — —Continued at top of next page. 94 Samples Analysed by Borough Analyst, 1935.—Cont. Articles Analysed Genuine Adulterated Official Unofficial Official Unofficial Official Unofficial Coffee & Chicory 1 — 1 — — — Coffee & Milk 1 — 1 — — — Tea Siftings 1 — 1 — — — Baking Powder — 1 — 1 — — Lemon Curd 2 — 2 - — — Dried Fruit 12 — 12 - — — Tinned Vegetables 1 4 1 4 — — Meat & Fish Pastes 2 1 2 1 — — Lemon Barley Water 1 — 1 — — — Lemonade Powder 1 — 1 — — — Camphorated Oil — 2 — 2 — — Welsh Rarebit — 1 — 1 — — Chillies — 1 — 1 — — Junket Powder 1 3 — 2 1 1 Caraways — 1 — 1 — — Ground Almonds 6 1 6 1 — — Dressed Lobster — 1 — 1 — — Cordials 2 1 2 1 — - Lemonade Crystals 1 — 1 — — - Beer 4 — 3 — 1 - Suet 1 1 1 1 — — Totals 964 212 936 204 28 8 During the year 1935, 1,176 samples were examined under the Food and Drugs (Adulteration) Act. Three of these samples were submitted by a neighbouring Authority, the remainder by the Inspector. No sample under the Act was submitted by the Public. rhirty-six samples were found to be adulterated, and fortytwo samples were reported as of inferior quality or doubtful purity. I he adulteration was at the rate of 3.1 per cent, as compared with 3.19 per cent. for the whole of the London area and 5.3 per cent. for the whole of England and Wales in 1934. The adulteration in the Borough for the past six years was as follows:— Year. No. of Samples Examined. % of Adulteration. 1935 1,176 3.1 1934 1,173 2.4 1933 1,166 4.3 1932 1,153 3.8 1931 1,296 2.2 1930 1,226 4.8 Average 1,198 Average 3.4 95 The number of samples examined was at the rate of 4.26 per 1,000 of the population ,as compared with 9.75 per 1,000 of the population for the whole of London and 3.52 per 1,000 for the whole of England and Wales in 1934. Four hundred and thirty-five samples of milk were examined during the year, of which nine samples, or 2.1 per cent., were found to be adulterated, and twenty-four samples were reported as of inferior quality. The milk adulteration in the Borough for the past six year was as follows :— Year. No. of Samples Examined. % of Adulteration. 1935 435 2.1 1934 491 2.0 1933 529 6.6 1932 463 3.9 1931 449 1.3 1930 357 3.9 Average 456 Average 3.3 Condensed Milks. Fifty-one samples of condensed milk were examined during the year, four of which were unsatisfactory, all being low in the equivalent of fresh milk. Preservatives. There were 12 contraventions of the Preservatives' Regulations. These were :— 2 Jams containing excess of sulphur dioxide. 2 Sausages containing excess of sulphur dioxide. 1 Beer containing excess of sulphur dioxide. 3 Meats containing sulphur dioxide. 2 Junket Powders containing sulphur dioxide. 2 Malt Vinegars containing sulphur dioxide. Other samples examined during the year were :— 11 Rag Flock, one of which was unsatisfactory. 1 Turpentine 4 Dried Milks all for the Medical Officer of Health's Department. Fifty-two samples were examined under the Fertilisers and Feeding Stuffs Act. Nutrition. The definitions of nutrition and malnutrition are vague and many factors enter into the conditions resultant upon them; further, the opinions of different medical practitioners vary greatly 96 as to what constitutes malnutrition in a person. Lack of sufficient food is a potent and definite factor, but so too is lack of the right kind of food; further, inability to absorb food even of the correct kind is another factor bearing upon malnutrition, and the circumstances which might bring about this inability are numerous. In this Borough there is no evidence of any widespread lack of nutrition; amongst the many that come under the direct aegis of my Department I have reason to think that the persons who fall farthest below the normal as regards nutrition are the married women (usually with several children)—this does not so much apply to those receiving Public Assistance allowances as to the wives of men at work but receiving low wages, a large percentage of which is frequently taken up in rent and fares. It is hoped that the recently inaugurated scheme for the feeding of nursing and expectant mothers may help to some extent in this direction. I have been privileged to collaborate to some small extent with Professors Marrack and Harris, who have been carrying out research work at the Nutritional Laboratory of the Cambridge University and the Hale Laboratory of the London Hospital in regard to the nutrition of certain young children as to the amount of Vitamins present in their systems. This paper (a highly technical one) was published in the "Lancet" of December 21st, 1935. Further work is being carried out along these lines. Dried Milk Scheme, as part of Nutrition, see page 57. Free Meals. See pages 158-159 of this Report, School Medical Service (weights, etc. of scholars—meals and milk). The Public Health (Meat) Regulations, 1924. (This work is carried out by the Veterinary Officer, Mr. H. E. Bywater, M.R.C.V.S., Assistant Veterinary Officer, Mr. T. J. Maquire, M.R.C.V.S., and the Meat Inspector, Mr. T. R. Harris) who report as follows :— Scope of Report. In this report we review the work carried out under the Regulations during the year, with the exception of that relating to Stalls, Shops, Stores, etc. Ante-Mortem Examinations. Ante-Mortem examinations involving 4,871 animals were made by the Veterinary Officer. Post-Mortem Examinations. 19,388 animals were inspected after slaughter, and of these 2,446, or 12.61 per cent., were diseased. 97 Bovines numbered 2,088, of which 663, or 31.75 per cent., were affected with tuberculosis, while 194, or 9.29 per cent., were otherwise diseased. Porcines accounted for 5,673, and of this number 546, or 9.62 per cent., were tubercular, and 540, or 9.51 per cent., were affected with other diseases. Of the 11,627 Ovines which were examined, 503, or 4.32 per cent., were found to be diseased. Detailed information is given in Table I as to the numbers and percentages of animals diseased, while the total quantity of meat found to be unfit for human food is enumerated in Table II. Tuberculosis. The percentage of tuberculosis amongst bovines is the lowest observed since 1926. In porcines the percentage is higher than in any previous year. The presence of any degree of tuberculosis in an animal necessitated a special examination in accordance with Memo. 62 Foods, to determine the extent and character of the infection prior to releasing any part of even a slightly affected carcase, and such examinations occupied a considerable amount of time. Disposal of Diseased Meat. Diseased meat and offal was released under supervision for industrial purposes. Prior to release a powerful dye or strong disinfectant was usually sprinked 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. We were successful in effecting the voluntary surrender of all meat and offal found to be diseased. 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, and also had to be performed on Sundays and on Public Holidays. Prosecutions. It was not deemed necessary to report any cases for legal proceedings, as such infringements of the regulations as were observed were remedied following verbal or written warnings. 68 TABLE I Showing Animals examined Post-Mortem and those found to be Diseased. Class of Animals. Number Inspected Affected with T.B. Affected with Other Diseases. Number Percentage Number Percentage Bovines :— Bulls 1 1 100.00 - — Bullocks 792 94 11.86 51 6.43 Cows 1,036 542 52.31 125 12.06 Heifers 187 25 13.36 18 9.62 Calves 72 1 1.38 — — Porcines:— Boars 19 2 10.52 1 5.26 Sows 65 14 21.53 2 3.07 Porkers 5,589 530 9.48 537 9.60 Ovines:— Sheep 5,002 — — 442 8.83 Lambs 6,625 — — 61 .92 Caprines :— Goats — — — — — Kids - — — — — Totals 19,388 1,209 6.23 1,237 6.38 TABLE 11. Showing Unsound Meat Condemned as a Result of Post-Mortem Examination. BOVINES. Stomachs 9 Omenta 6 Entire Carcases and Viscera 12 Intestines 9 Mesenteries 180 Heads 171 Livers 291 Tongues 172 Pancreas 28 Forequarters 11 Spleens 9 Hindquarters 4 Kidneys 27 Shins 2 Kidney Knobs 3 Clods 2 Mammary Glands 228 Stickings 2 Briskets 2½ PORCINES. Flanks 3 Entire Carcases and Viscera 14 Loins 2 Rumps 2 Forequarters 1 Aitch Bones 2 Heads and Collars 140 Hearts 5 Hands and Springs 1 Lungs 575 Spare Ribs and Blade Bones 1 Diaphragms 4 F 99 Bellies 1 OVINES. Legs 1 Entire Carcases & Viscera 18 Hearts 61 Forequarters 2 Lungs 454 Heads 2 Stomachs 15 Necks 4 intestines 14 Breasts 3 Mesenteries 519 Loins 2 Livers 195 Legs 2 Spleens 22 Lungs 107 Kidneys 2 Livers 387 Kidneys 3 Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies Order, 1926. Milk (Special Designations) Order, 1923. THE REPORT OF THE VETERINARY OFFICER. The dairy cattle and cowsheds, within the Borough boundaries, are inspected every month, and as other occasion may demand, under the Acts and Orders relating to the milk supply; and at the same time the hygienic conditions governing the production of milk are supervised. Also, when a sample of milk offered for sale within the Borough, but produced at premises outside the Borough is found, upon examination, to be infected with the germs of Tuberculosis, a visit is usually made to the producer's premises in consultation with the veterinary staff of the appropriate Local Authority, with the object of tracing the source of infection. The Milk and Dairies Order contains a schedule of diseases and conditions of milch cows, in addition to Tuberculosis, which are liable to contaminate the milk supply, and power is given to prohibit, by means of a notice, the sale of milk from any cow which may be found to be affected by any of these diseases. Action is frequently taken under this provision. In addition, visits are made and examinations carried out by the veterinary staff, acting under the provisions of the Diseases of Animals Acts and Orders, and where it is considered necessary, samples of milk are taken and examined microscopically for Mycobacterium tuberculosis. These measures resulted in the detection of two cows affected with Tuberculosis of the udder, and as a result these animals were slaughtered under the provisions of the Tuberculosis Order made under the Diseases of Animals Acts. The Slaughter of Animals Act, 1933. The Slaughter-House Bye-Laws. The Knackers'-Yard Bye-Laws. This work is carried out by the Meat Inspector, Mr. T. R. Harris, who reports as follows :— Slaughter of Animals Act. Sections 1 and 2, as they apply to West Ham, require that no animal killed in a slaughter-house or knackers'-yard in the 100 Borough shall be slaughtered or stunned except by means of a mechanically operated instrument. Infringements observed have been dealt with verbally or by warning letters. Generally, however, this requirement has been carried out satisfactorily. Section 3 provides that "no animal shall be slaughtered or stunned in a slaughter-house or knackers'-yard by any person who is not the holder of a licence granted by a local authority and in force under this section." The Council, in December, 1934, renewed fifty-six licences under this section, to be in force for one year from the 1st January, 1935. A further two licences were renewed during the year, and seven new applicants were also granted licences in 1935. It was not found necessary to recommend the suspension or revocation of any of these licences. Slaughter-House Byelaws. Ten applications for the renewal of slaughter-house licences were received and granted by the Council in respect of the year 1935/36. There are also nine "Registered" slaughter-houses in the Borough. These premises have been kept in a reasonably clean condition, although on many occasions it was necessary to insist upon the more frequent removal of garbage material. Knackers'-Yard Bye-Laws. The Council received and granted, in respect of the year 1935/36, one application for the renewal of a knackers'-yard licence. The condition of this knackers'-yard has been satisfactory. There are two "Registered" knackers'-yards in the Borough, one of which was not used, while the other was in use frequently and was kept in a cleanly state. PROSECUTIONS (Food & Drugs Acts). Adulterated Milk— 2 Summonses. 2 Summonses dismissed, costs incurred. Adulterated Meat— 3 Summonses. 1 Fined. 1 Summons dismissed, costs curred. 1 Summons dismissed on payment of costs. Adulterated Junket Powder— 1 Summons. 1 Summons dismissed on payment of costs. Adulterated Sausages— 2 Summonses. 1 dismissed on conviction of Wholesaler. 1 Fined. False Warranty— 1 Summons. 1 Summons dismissed, costs incurred. Bottling Milk in Street— 2 Summonses. 1 Fined. 1 dismissed on payment of costs. 101 INFECTIOUS DISEASES. NOTIFIABLE DISEASES (Other than Tuberculosis). The following table shows the number of cases of notifiable diseases during the year 1935, 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 - - - Diphtheria 771 735 39 Scarlet Fever 1057 795 6 Enteric Fever (including Paratyphoid 3 1 1 Puerperal Fever 8 8 6 Puerperal Pyrexia 48 27 — Pneumonia (Acute Primary and Acute Influenzal only notifiable) 290 90 172* Cerebro Spinal Fever 11 11 6 Acute Polio-Myelitis 12 8 — Acute Polio-Encephalitis — — — Encephalitis Lethargica 4 3 4 Erysipelas 126 45 — Ophthalmia Neonatorum 17 7 - * Includes all forms. The figures set out below show the number of deaths from Scarlet Fever, Diphtheria, Whooping Cough and Measles during the past nine years:— Year Scarlet Fever. Diphtheria Whooping Cough. Measles. 1927 7 40 73 6 1928 5 34 26 69 1929 6 39 114 22 1930 4 34 19 78 1931 5 11 35 3 1932 3 12 29 77 1933 6 54 47 1 1934 16 49 15 94 1935 6 39 12 5 Totals 58 312 370 355 102 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 796 admitted to hospital, 41 or 5.1 per cent. were associated with recurrent infections in this way. (See also report of Medical Superintendent of Plaistow Fever Hospital, pages 104-115). Cases of sickness extracted from the Superintendent of Visitors' School Attendance Returns. Measles (including German Measles) 348 Chicken Pox 1199 Tonsillitis 476 Whooping Cough 994 Mumps 1089 Other Diseases 497 As compared with 1934, the above figures show an increase in the cases of Chicken Pox, Whooping Cough, Mumps and other diseases, whereas in the case of Measles there was a big drop in numbers. The number of cases of Tonsillitis showed little variation. IMMUNISATION ACAINST DIPHTHERIA. Immunisation against Diphtheria has been carried on regularly throughout the year at the various Infant Welfare Clinics in the Borough and at Plistow Hospital. There is still much apathy in regard to this preventive treatment on the part of the general public, although it is noticed at the Clinics that more requests are made than formerly on the advice of friends whose children have themselves been treated. 103 Three months after the injections are completed, each child receives an appointment for the Schick Test to be done, and if satisfactory a certificate is given to the parents to this effect. Number of Children immunised during 1935 at the Council's Clinics 1323 Number of Children who attended for the Schick Test 1030 PLAISTOW HOSPITAL. (Dr. D. Maclntyre, Medical Superintendent, reports as follows:— The number of patients under treatment during 1935 was 1,946. This is 152 less than the figure for the previous year. The total deaths numbered 56, as compared with 75 in the previous year, and 105 in 1933. Scarlet fever continued prevalent during the greater part of the year and, except during the summer months, all the cases notified could not be admitted owing to lack of accommodation. The total admissions were slightly less than in the previous year and probably this indicates that the epidemic wave, which had set in during the summer of 1933, has passed its peak. The cases were mostly of the prevalent mild type. The prevalence of diphtheria showed no appreciable decrease. The admissions were 722 as compared with 777 in the previous year. The deaths numbered 35, as compared with 37 in 1934 and 49 in 1933. A feature of the year was a marked increase in the number of streptococcal throats admitted as diphtheria and also in cases of mixed infection. These resulted in cases of scarlet fever and septic throat cropping up at frequent intervals in the diphtheria wards. During the year 21 diphtheria patients contracted scarlet fever and 35 others developed secondary tonsillitis during convalescence. Among these 23 developed otorrhoea. Every facility is afforded to the medical practitioners of the Borough for the examination of swabs from suspected cases of diphtheria, but though this procedure has been extensively practised by them during the post-war years it has not materially affected either the prevalence or the fatality of the disease. 104 Parents, however, are now taking an active interest in immunisation, and as the proportion of immunised children increases it is hoped the severity and prevalence of the disease will diminish. One case only of paratyphoid fever was under treatment during the year. During the latter half of the year sporadic cases of measles were admitted in increasing numbers. These probably herald the biennial epidemic which is due to appear in the early months of 1936. The disease was not of a severe type, and the requests for admission had not reached epidemic proportions by the end of the year. Whooping Cough appeared to be fairly prevalent throughout the year, and severe cases were admitted as accommodation became available. Four cases of cerebro-spinal meningitis and one of tubercular meningitis were under treatment during the year, and of these 2 proved fatal. The number of erysipelas and pneumonia cases under treatment was small because, as in the previous year, many requests for admission had to be refused owing to lack of accommodation. At the beginning of the year 226 patients were in residence and 1,720 were admitted during the year, making a total of 1,946 cases under treatment. Of these, 1,670 were discharged, 56 died, and 220 remained under treatment at the end of the year. The chief causes of death during the year are briefly summarised as follows:— Scarlet Fever 4 deaths Diphtheria 35 ,, Measles 3 „ Whooping Cough 2 ,, Pneumonia 2 ,, Meningitis 2 ,, Septic Pharyngitis 2 ,, Other diseases 6 ,, T he fatality rate, calculated on all the cases admitted during the year, was 3.25 per cent. Table I. shows the admissions and deaths for each month of the year, and in Table II. there is shown the annual admissions and deaths from the principal infectious diseases since the Hospital was opened. 105 106 TABLE I. 1935 Admissions. Deaths. Scarlet Fever. Diphtheria. Paratyphoid. Measles. Pneumonia. Erysipelas. Chicken-pox. Puerperal Pyrexia. Whooping Cough. Other Diseases. Total. Scarlet Fever. Diphtheria. Paratyphoid. Measles. Pneumonia. Erysipelas. Chicken-pox. Puerperal Pyn xia. Whooping Cough. Other Diseases. Total. January 43 58 ... ... ... ... 1 ... 1 6 109 ... 5 ... ... ... ... ... ... ... 1 6 February 66 81 ... ... ... 1 ... ... 1 11 160 1 6 ... ... 2 ... ... ... ... ... 9 March 53 97 1 ... 3 1 ... ... 1 16 172 1 4 ... ... ... ... ... ... ... 1 6 April 48 70 ... ... 1 ... 1 ... 1 14 135 ... 6 ... ... ... ... ... ... ... 1 7 May 55 75 ... 3 ... 3 1 ... ... 17 154 ... ... ... 1 ... ... ... ... ... 1 2 June 50 36 ... 8 ... ... 1 ... 2 11 108 ... 1 ... ... ... ... ... ... 1 ... 2 July 49 28 ... 6 ... 1 ... ... 7 27 117 ... ... ... ... ... ... ... ... ... 2 2 August 58 58 ... 7 ... ... ... ... 5 26 154 ... 2 ... ... ... ... ... ... ... 1 3 September 56 30 ... 2 ... 1 2 ... 5 20 116 ... 4 ... 1 ... ... ... ... ... 1 6 October 103 81 ... 3 ... 2 1 ... 1 27 218 1 2 ... 1 ... ... ... ... ... ... 4 November 52 43 ... 3 ... 1 ... ... 3 11 113 1 3 ... ... ... ... ... ... 1 1 8 December 69 65 ... 3 ... ... ... ... 3 23 164 ... 2 ... ... ... ... ... ... ... 1 3 Totals 702 722 1 34 5 10 7 ... 30 209 1,720 4 35 ... 3 2 ... ... ... 2 10 66 \ TABLE II. Scarlet Fever. Diphtheria. Typhoid Fever. Measles. Pneumonia. Whoop- i ing 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 20 373 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 ... ... ... ... ... ... ... ... ... ... 101 8 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 ... 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 1923 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 6 047 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 68 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 33 214 37 118 14 42 4 326 29 1865 128 1933 913 6 535 49 ... ... 9 ... 54 17 44 11 52 3 207 19 1814 105 1934 798 9 777 37 ... ... 76 8 21 9 4 1 14 1 174 10 1864 75 1935 702 4 722 35 ... ... 34 3 5 2 30 2 ... ... 217 10 1720 56 107 Scarlet Fever. The number of cases notified as scarlet fever, which were admitted during the year, was 738. In 36 of these, or 4.87 per cent., the diagnosis was changed after admission. In 13 other cases the diagnosis remained uncertain ; they showed no definite signs of the disease on admission or afterwards, and suffered no complications. One of these developed scarlet fever in the wards. A relapse occurred during the 3rd and 4th weeks of illness in 9 cases in which the original diagnosis had been confirmed. Sixty-six cases were in residence at the beginning of the year, making a total of 768 cases under treatment. Of these, 693 were discharged, 4 died, and 71 remained under treatment at the end of the year. The day of illness on which the patients were admitted is shown in the following Table:— Bay of Illness 1st 2nd 3rd 4th 5th 6th 7th Later No. of cases 12 139 165 124 83 51 37 79 Per cent. of total 1.74 20.14 23.91 17.97 12.03 7.39 5.36 11.45 The average duration of illness on admission was 4.19 days. In 50 per cent. of the cases a scarlatiniform rash was present on the day of admission, but 23 per cent. of these did not show any definite desquamation afterwards. In 10 per cent. of the admissions no rash or desquamation was detected. Corrected diagnosis:—The 36 cases. in which the diagnosis was amended after admission, were found to be suffering from the following complaints:—Rubella 3. toxic rash 8, cervical adenitis 1, alveolar abscess, 1, paratyphoid B. 1, chickenpox 2, measles 2, tonsillitis 10, gastro-enteritis 1, dentition rash 1, broncho pneumonia 1, impetigo 1, whooping cough 1, diphtheria 3. Four cases admitted as diphtheria proved to be suffering from scarlet fever. Fatality rate:—Of the four cases which proved fatal, a boy aged five years suffered from toxic scarlet fever and did not respond to antitoxin treatment. A girl aged two years developed broncho pneumonia and empyema. A boy aged four years developed endocaritis and pericarditis. A boy aged 11 years died from acute nephritis and uraemia. The fatalitv rate was 0.57. Mixed infections:—In 38 cases the disease was complicated by a second infection, as follows:— Scarlet fever with faucial diphtheria 9 cases ,, ,, ,, nasal diphtheria 17 ,, ,, ,, ,, chicken-pox 7 ,, ,, ,, ,, whooping cough 3 ,, ,, ,, ,, measles 2 ,, 109 Of the 693 cases discharged, 287, or 41.4 per cent, suffered from one or more complications, as follows:— Adenitis 48 cases or 6.93 per cent. Albuminuria 44 ,, ,, 6.35 ,, ,, Nephritis 5 ,, ,, 0.72 ,, ,, Otorrhoea 57 ,, ,, 8.22 ,, ,, Arthritis 19 ,, ,, 2.74 ,, ,, Rhinitis 65 ,, ,, 9.38 ,, ,, S'eptic fingers 22 ,, ,, 3.17 ,, ,, Secondary tonsillitis 21 ,, ,, 3.03 ,, ,, Endocarditis 3 ,, ,, 0.43 ,, ,, Vaginitis 3 ,, ,, 0.43 ,, ,, The average durations of residence of all the cases was 35.01 days. Diphtheria. The number of cases admitted during the year, notified as diphtheria, was 856. The diagnosis was amended after admissions in 134 of these cases, or 15.65 per cent. of the admissions. At the beginning of the year 153 patients were in residence and the total number under treatment was 875. Of these, 712 were discharged, 35 died, and ,128 remained under treatment at the end of the year. The average duration of residence was 53.66 days. Corrected diagnosis:—The 134 cases which proved to be wronely diagnosed were found after admission to be suffering from the following complaints:—Tonsillitis 84, lary ngitis 10, bronchopneumonia 4, lobar pneumonia 1, Vincent's angina 12, ulcerative pharyngitis 3, retro-pharvngeal abscess 4, bronchitis 3, thrush 2, polio-myelitis 1, congenital stridor 2, measles 1, mumps 1. malnutrition 1, pulmonary tuberculosis 1. scarlet fever 4. Of these, the following proved fatal:—Ulcerative pharyngitis 2, poliomyelitis 1, pulmonary tuberculosis 1. The cases which were discharged or died during the year are classified as follows:— Type of Disease. Number of Cases. % of Total Cases. Deaths. Fatality Rate Faucial 592 79.25 30 5.07 Laryngeal 26 3.48 5 19.23 Nasal only 91 12.18 — — Aural 4 0.54 — — Bacteriological 34 4.55 — — The faucial cases are again classified according to severity, as follows:— Mild 198 cases, or 33.45 per cent. Moderate 21.1 ,, ,, 35.64 ,, Severe 183 ,, „ 30.91 ,, 110 Paralysis:—Post diphtheritic paralysis occurred in 76 of the above cases. It was mild in 49 cases and severe in 27 cases. Laryngeal diphtheria:—49 cases were admitted as laryngeal diphtheria, but 23 of these proved to be wrongly diagnosed. Of the 26 true cases, 12 required tracheotomy, and 5 of these died. Broncho-pneumonia was a complication in 3 of the fatal cases; the other 2 had extensive faucial involvement and died from toxaemia. The fatality rate was 41.6 per cent, of the cases operated on. Fatal cases:—30 deaths occurred among the faucial cases; all were children under 11 years of age. The average duration of illness on admission was 4.3 days. Three cases were moribund on admission and died within 24 hours. Of the others, 22 died at varying periods during the first three weeks of illness and 5 died from paralysis between the fifth and eighth weeks. The amount of antitoxin administered to them averaged 163,000 units. The fatality rate among the faucial cases was 5.07 per cent. Treatment:—The amount of antitoxin administered to the nasal and mild faucial cases averaged 14,000 units. The moderate faucial cases received an average of 34,000 units. To the severe faucial cases, the antitoxin was given partly by intravenous and partly by intramuscular injection, and averaged 133,000 units. Typhoid Fever. One case, a girl aged 5 years, who was admitted as scarlet fever, proved to be suffering from Paratyphoid B. She had a mild attack and made an uneventful recovery. Of two other cases which had been notified as scarlet fever, one suffered from acute rheumatism, and the other from gastro-enteritis. Measles. The number of cases under treatment was 34. Of these, 27 were discharged, 3 died, and 4 remained under treatment at the end of the year. The fatal cases were children under 2 years of age, and were complicated by broncho-pneumonia. Though moderately severe the majority of the cases escaped complications. Whooping Cough. During the year, 30 cases were admitted. Of these, 22 were discharged, 2 died, and 6 remained under treatment at the end of the year. The two fatal cases were children aged 13 months and 14 months respectively. The disease was also present as a complication in 5 cases of diphtheria, one case of scarlet fever, and 2 cases of measles. Pneumonia and Bronchitis. The number of cases under treatment was 13. Of these, 3 suffered from lobar pneumonia, 3 from broncho-pneumonia, and 7 from bronchitis. Two cases proved fatal; both were children under two years suffering from broncho-pneumonia. 111 Erysipelas. This disease was not so prevalent as in previous years, and only 10 cases were under treatment. They were not so severe, and none proved fatal. The face was the part affected in 5 cases, the leg in 3 cases, and the arm in 2 cases. The ages of the patients ranged from 2 years to 72 years. Cerebro-Spinal Meningitis. Of 10 cases which had been notified as cerebro-spinal meningitis 4 proved to be suffering from the disease; 3 of these made a satisfactory recovery, and one died. In 3 of these cases the meningo-coccus was typed and proved to be of type I., type II., and type III. It was not typed in the fourth case. The patients were all children under 12 years. The amount of serum administered to them averaged 250 c.c.s per patient, and the cisterna, lumbar, intravenous, and intramuscular routes were employed for the injections. The fatal case was a boy aged ,11 years, from whom type I. meningo-coccus was isolated; he died on the 18th day of illness. Anterior Poliomyelitis. Six cases of this disease were under treatment; all were children under 6 years of age. Two of them died within 24 hours of admission. The 4 which recovered were left with varying degrees of disablement. In 2 of these there was marked paralysis and wasting of both legs, and they were transferred to a general hospital for massage and electrical treatment. The other 2 were discharged. one with slight dragging of the right leg and the other with slight weakness of the right deltoid muscle. Other Diseases. Included in this group are the following:—Acute rheumatism 3, rubella 4, chickenpox 7, mumps 9, otorrhoea 3, diabetic coma 1, general pyaemia 1, tubercular meningitis 1, transient pyrexia 1, babies admitted with mothers 3, no disease 1, re-admitted 3. Of these, the cases of diabetic coma, general pyaemia and tubercular meningitis proved fatal. Cross Infection. During the year 21 diphtheria patients contracted scarlet fever during convalescence. Six patients were admitted in the incubation stage of chickenpox, and from these, 18 cases of diphtheria and 7 cases of scarlet fever contracted the disease. From 3 cases which were admitted incubating measles, 10 patients were infected. Six patients contracted whooping cough, and 4 contracted mumps. 112 Active Immunisation Against Diphtheria and Scarlet Fever. Schick Test. Number of patients tested 465 Number which proved positive 316 Rate per cent, of positives 67.95 Number immunised 298 Number of cases in which permission for immunisation was not obtained 34 Rate per cent. of cases tested in which permission for immunisation was not obtained 10.78 Dick Test. Number of patients tested 378 Number which proved positive 176 Rate per cent. of positives 46.56 Number of cases in which permission for immunisation was not obtained 17 Rate per cent. of cases tested in which permission for immunisation was not obtained 9.65 Gate Cases. The following is a record of cases suspected to be suffering from infectious diseases which were brought direct to the Hospital for diagnosis:— Number sent by medical practitioners 176 Number ot these admitted (Diphtheria 57, Scarlet Fever 14, Other diseases 11) 82 Number brought by relatives 298 Number of these admitted (Diphtheria 45, Scarlet Fever 15, Other diseases 8) 68 Number sent from other hospitals 28 Number of these admitted (Diphtheria 9, Scarlet Fever 2) 11 Total number of cases examined 626 Total number of cases admitted:— 161 Diphtheria 111 Scarlet Fever 31 Other diseases 19 113 Bacteriological Work. Swabs examined for diphtheria:— Number sent by Medical Practitioners:— Positive results Per cent. positive Faucial 2317 313 13.0 Nasal 332 71 21.0 Aural 12 5 42.0 Total 2661 389 15.0 Numbers sent by other institutions:— Faucial 183 11 6.0 Nasal 137 5 4.0 Total 320 16 5.0 Number of gate cases swabbed:— Faucial 166 28 17.0 Nasal 101 16 16.0 Aural 3 3 100.0 Total 270 47 17.0 Number of swabs examined for the Invalid Children's Aid Association:— Faucial 232 17 7.0 Nasal 230 12 5.0 Total 462 29 6.0 Number of swabs examined for the Invalid and Crippled Children's Society:— Faucial 62 3 5.0 Nasal 56 6 11.0 Total 118 9 8.0 Total number of examinations 3831 490 13.0 Staff Illness. One nurse who was Dick positive contracted scarlet fever before immunisation was commenced. Another nurse contracted mumps. During the year 21 nurses and maids were warded with tonsillitis, and 9 with influenza; 35 others were off duty for short periods with minor ailments. All recovered. 114 Schick Test, 1935. Number of nurses tested 52 Number which proved positive 27 Rate per cent, of positives 52 Number immunised 24 Dick Test. Number of nurses tested 52 Number which proved positive 10 Rate per cent. of positives 19 Number immunised 7 Tuberculosis. The reports of the Tuberculosis Officer and of the Medical Superintendent of Dagenham Sanatorium and Langdon Hills Sanatorium will be found on pages 115-123. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action taken PUBLIC HEALTH ACT, 1925. SECTION 62. (Compulsory Removal to hospital of infectious persons suffering from pulmonary tuberculosis.) No action taken. Tuberculosis Dispensary. The Tuberculosis Officer (Dr. P. A. Galpin) reports as follows:— 1 he following figures show the number of cases examined in comparison with other years:— Year 1930 1931 1932 1933 1934 1935 Request Cases 567 592 564 553 516 537 Notified Cases 176 130 128 98 104 74 Definite Cases 495 400 451 419 328 276 Contact Cases 561 448 585 507 351 401 Contact Cases (Tuberculous) 20 12 15 20 10 11 Percentage 3.7 2.6 2.5 3.9 2.8 2.7 115 Tuberculosis of Lungs. Diagnosis. The usual methods have been employed. One hundred and forty-one cases were examined by X-Ray at the Whipps Cross Hospital. Treatment. Residential Treatment has been arranged at our Hospital and Sanatorium at Dagenham. There is a marked decline in the number treated at outside Sanatoria, e.g., Grosvenor and King George Sanatoria. Certain cases have been sent to the Brompton Chest Hospital for Surgical Treatment. Five cases were admitted; in four the operation of Thoraco-plasty was performed, and one case simple collapse of the lung by Artificial Pneumothorax. Children. The Sanatorium at Langdon Hills has been in full use. Domiciliary Treatment. At the end of the year 282 patients were receiving treatment from their Panel Doctors who submitted 435 Domiciliary Reports. Dispensary Treatment. At the end of the year 433 children and non-insured persons were receiving this form of treatment. Artificial Pneumothorax Treatment. Every Friday afternoon a Session is held. Twelve patients have been under treatment, and 65 refills have been given. One patient has had Gold Treatment. Non-Pulmonary Tuberculosis. Adult cases have been treated at the Royal Sea-Bathing Hospital, Margate. At the end of the year nine cases were under treatment. Children have been sent chiefly to the Lord Mayor Treloar Cripples' Hospital, Alton. In all, 24 cases were under treatment at the end of the year. Tuberculosis of Skin. Fourteen cases have been under treatment at the London Hospital. Extra Nourishment. At the end of the year 242 cases were in receipt of grants. Home Visiting. Four thousand nine hundred visits were made by the Tuberculosis Nurses to the homes of the patients. 116 An analysis of Primary Notifications and Transfers into the West Ham Area of cases suffering from Tuberculosis of the Lungs has been made:— Men Women Children Total Total 170 134 28 332 Admitted to Dagenham or Langdon Hills 88 47 14 149 Admitted to other Institutions Declines Treatment at 11 13 1 25 Dagenham or Langdon Hills 11 21 2 34 Dispensary Treatment recommended 2 6 3 11 Dispensary Supervision recommended 5 – – 5 Domiciliary Treatment recommended 10 5 – 15 Diagnosis of T.B. not confirmed 5 3 3 11 Removed from Area 3 2 – 5 Not examined 35 37 5 77 The 77 cases who have not been examined have been been further analysed:— Notified Deaths 34 In Institutions 23 Declined to attend Dispensary 9 Left Area 3 Prevented from attending, by work, etc. 8 77 Dispensary Treatment. A small number of cases of Tuberculosis of the Lung have been treated at the Dispensary as they were unsuitable for Sanatorium Treatment for one reason or another. Case No. 1 (03731) Housewife, aged 60 years, suffering from chronic Tuberculosis, sputum negative. Has attended regularly for three years and received a grant of Milk, Eggs, Butter, Green Salads and Green Vegetables. 7/ 2/33 weight 95 lbs. 25/10/33 weight 113 lbs. 3/ 3/33 ,, 101½lbs. 24/10/34 ,, 111 lbs. 12/ 4/33 ,, 106 lbs. 25/ 9/35 ,, 114½lbs. 5/ 7/33 ,, 108 lbs. 12/ 2/36 „ 111½lbs. It is seen that the patient has gained 181bs. in the first eight months; for two years she maintained this gain, and she has been able to do light housework. G 117 Case No. 2 (03632) Housewife, age 28 years. Notified in November, 1932, sputum positive. Has been under treatment for three and a half years. No grant of Nourishment. * Had given birth to a healthy boy and was feeding him. During more than 2½ years this patient had gained 161bs. in weight. On her last visit she had lost considerably—she had had great worry. Her Mother has Cancer, and the patient has been nursing her for a period of three months until she had to give up and allow her Mother to go to Hospital. Her younger boy has acute Rheumatism, and has been confined to bed. Case No. 3. Housewife, aged 29 years. Notified in October, 1933, as a case of Tuberculosis of Lung. X-Ray evidence, sputum test negative, work—Street Trader. The patient has since been an absentee, but the Visiting Nurse reported in January, 1936, that she was keeping well and working. Case No. 4 (13345) Female, aged 36 years, single. Notified in July, 1934, haemoptysis + 27/7/34 examined, physical signs right, Stage 2, weight 101lbs. Sanatorium Treatment not essential. This patient has gained 211bs. in 18 months, and is now doing light work—one half-day per week, daily domestic. 118 Sanatorium Treatment not recommended—nervous type. 31/10/32 weight 116 lbs. 5/ 2/34 weight 131 lbs. 6/ 2/33 „ 122½lbs. reported * 14/ 8/33 ,, 130 lbs. 19/12/34 „ 132 lbs. 4/12/33 „ 142 lbs. 26/ 6/35 ,, 132 lbs. 26/ 2/36 „ 120 lbs. Sanatorium Treatment not advisable as the patient is of the nervous type. 10/10/33 weight 111 lbs. /10/34 weight 122 lbs. 8/11/33 ,, 107 lbs. / 3/35 „ 120 lbs. 6/12/33 ,, 116 lbs. / 7/35 „ 115 lbs. 26/ 3/34 „ 122¾ lbs. Extra Nourishment granted. / 1/35 weight 119 lbs. / 1/36 weight 131 lbs. / 7/35 „ 126 lbs. DACENHAM SANATORIUM AND LANGDON HILL SANATORIUM FOR CHILDREN. Dagenham Sanatorium. The Medical Superintendent (Dr. G. M. Mayberry) reports as follows:— At the end of 1934 the number of patients remaining under treatment were:— Males 59 Females 40— 99 The total admissions during 1935 were:— Males 148 Females 85—233 The total number of deaths was:— Males 30 Females 28—58 Discharges during the year totalled:— Males 108 Females 69—177 Leaving under treatment at the 31st December, 1935:— Males 69 Females28— 97 Including 13 Non-Insured persons. Insured persons admitted during the year totalled 186, the remaining 47 being Non-Insured. Thirty-five ex-Service men were admitted to the Sanatorium during the same period. The Death Rate (calculated on admissions) was 24.89%. In the case of Males the percentage was 20.27%, and in the case of Females 32.94%. The Average Duration of Residence (both sexes) was 158.80 days. The Average for Males was 148.29 days, and for Females 173.66 days. 119 The grades of cases discharged and the results of treatment were as follows:— T.B. Minus T.B. plus Grade I. T.B. plus Grade II. T.B. plus Grade III. Total Males 19 16 46 18 99 Females 21 7 17 18 63 MALES. Quiescent 11 13 18 1 Improved 7 3 26 9 No material improvement 1 0 2 8 19 16 46 18 Nine cases were under treatment for less than 4 weeks and not classified. FEMALES. Quiescent 13 4 6 — Improved 8 3 11 12 No material improvement — — — 6 21 7 17 18 Six cases were under treatment for less than 4 weeks and not classified. The average number of beds occupied during the year has been appreciably less than in previous years, as also was the period of residence. After making allowances for the usual number of patients who take their discharge owing to home affairs, there are a large number of patients who arrive at the Institution with the erroneous idea that three months' treatment is quite sufficient; many of these are suffering from advanced disease. This is a regrettable factor, as had they remained on they would have received a great deal more benefit. This has been confirmed in many cases by their relapse and re-admission, often in a hopeless condition. Improvements of enormous value have been carried out for the benefit and comfort of patients during the last year. Cubicles have been erected on the hospital side with individual lighting for each bed, which has proved to be an undoubted success and has been highly appreciated. The advent of an X-Ray plant will no doubt be a useful adjunct in diagnosis and treatment. Considerable improvements have been carried out in the grounds, where pleasant surroundings play a helpful part in treatment. 120 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. 1933 .77 .90 1.04 .51 1.53 2.16 1.30 .28 1.87 .96 .72 .33 1934 .97 .05 1.76 1.34 .44 1.14 1.03 1.79 .91 1.05 1.53 3.18 1935 .65 1.44 33 2.20 1.07 1.81 .61 1.85 2.11 1.63 2.50 1.60 Staff. Medical. Medical Superintendent. Assistant Medical Officer. Administration. Steward. Steward's Clerk. 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 Engineer. 1 Handyman. 1 Stoker. 1 Gardener. 4 Porters. 1 Night Watchman. 121 Entertainment. The usual practice of having Whist Drives and Concerts during the year was continued. These events are looked forward to, and proved to be a striking success, both from the point of view of patients and Staff. Nursing Staff. Two Nurses passed the final examination for the Certificate of the Tuberculosis Association during the past twelve months, and one was successful in passing Part 1. WEST HAM SANATORIUM FOR CHILDREN, LANGDON HILL. At the end of 1934 the number of patients remaining under treatment were:— Males 25 Females 15—40 The total admissions during 1935 were:— Males 12 Females 12—24 The number of deaths were:— Males Nil Females Nil—Nil Discharges during the year totalled:— Males 14 Females 11—25 Leaving under treatment at the 31st December, 1935:— Males 23 Females l6—39 The Average Duration of Residence (both Sexes) was 390.80 days. The average for Males was 338.43 days, and for Females 457.45 days. The results of treatment for those discharged are as follows T.B. Minus T.B. plus Grade I. T. R. plus Grade II. T.B. plus Grade III. Total Males 13 — — — 13 Females 8 — — 3 11 One observation case w,as found to have no active disease. MALES. Quiescent 13 — — — Improved — — — — No material improvement — — — — 13 — — — FEMALES. Quiescent 7 — — — Improved 1 — — — No material improvement — — — 3 8 — — 3 122 The class of case admitted during the year has been similar to those in past years. Three advanced cases were discharged to Dagenhain Sanatorium compared with two in the previous year. The results of treatment as usual have been highly satisfactory. It has been pleasant to hear of many old patients now at work, some of whom were very ill at one time. It is, however, a matter of regret to find some who responded well to treatment, after keeping well for a time, have later come to Dagenham, and still more regrettable to feel that had it been possible to keep them under suitable surroundings they would have remained well. With confidence, I can only again refer to my remarks in the report of 1933, where many suitable cases can be saved on economical lines from serious relapse. Staff. Nursing. 1 Matron. 2 Sisters. 7 Probationers. Domestic. 8 Male. 1 Head Gardener. 1 Motor Driver. 1 Handyman and Porter 2 Assistant Gardeners. 1 Night Watchman. 123 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 21 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 13 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; they also 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. 124 125 Venereal Diseases (L.C.C. Scheme) Summary of work done by the Hospitals during the Year 1935. London. Middlesex. Essex. Surrey Kent. Herts Bucks East Ham. West Ham. Croydon. Total. Other Places. Grand Total. New Patients:— Syphilis 2.734 340 121 115 77 32 20 25 52 9 3,525 405 3,930 Soft Chancre 235 7 16 7 4 ... ... 2 9 ... 280 70 350 Gonorrhoea 7,645 1,062 458 341 149 154 52 106 193 36 10,186 766 10,952 Not venereal 9,213 1,341 616 588 279 155 67 96 199 87 12,641 630 13,171 Total 19,827 2,740 1,211 1,061 609 341 139 229 453 132 26,632 1,771 28,403 Total attendances 863,948 94,266 64'635 28,320 12,155 9.206 3,008 15,231 29,498 2,006 1,122,273 16,219 1,138,492 No. of in-patient days 32,868 4,546 2 692 1,261 2,209 683 562 117 736 102 45,676 9,890 55,566 Salvarsan Subs, doses 42,567 6,725 2,904 2,420 1,186 706 290 605 1,266 93 58,762 2,051 60,813 PATHOLOGICAL EXAMINATIONS. For or at Centres:— Spirochaetes 2,734 84 94 35 12 5 5 21 25 6 3,021 124 3,145 Gonococci 106,701 13,225 11,221 5,212 2 215 1,589 825 2,651 4,105 518 148,295 1.824 150,119 Wassermann 33,840 3,738 1.940 2,042 783 521 234 375 696 222 44,391 1,378 45,769 Others 39,986 4,030 4,(74 2,233 909 484 246 841 1,548 253 54,704 1,666 56,370 Total 183,261 21,077 17,429 9,522 3,919 2,699 1,310 3,891 6,374 1,029 250,411 4,992 255,403 For Practitioners:— Spirochaetes 8 3 1 6 ... ... ... ... ... ... 18 ... 18 Gonococci 5,072 195 888 333 52 65 74 4 6 853 7,541 104 7,645 Wassermann 14,793 1,006 1,393 1,291 197 65 96 38 19 589 19,467 594 20,061 Others 7,186 236 1,282 675 15 21 10 26 16 799 16,266 364 10,630 Total 27,059 1,440 3,564 2,305 264 150 180 63 41 2.221 37,292 1,092 38,354 128 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 1018 3,764 3,002 116 13 4,844 1,940 8,724 4,955 1,345 1,348 169,485 66,095 25,973 6,380 1919 6,394 3,391 463 18 10,441 2,440 17,298 5,849 3,418 1,700 201,626 106,096 24,025 49,186 51,554 10,464 1920 6,988 3,579 766 25 10,669 2,427 18,423 6,031 4,403 2,189 329,940 134,093 29,430 52,182 58,920 14,027 1921 5,088 3,100 458 13 8,573 2,136 14,119 5,249 3,696 2,354 357,503 138,706 30,272 49,420 66,134 18,472 1922 4,207 2,600 309 12 8,233 2,402 12,749 5,014 3,759 2,191 387,631 141,372 28,809 83,755 74,022 19,836 1923 4,497 2,631 311 4 9,043 2,520 13,851 5,155 4,167 2,477 412,915 142,594 29,661 77,001 69,784 24,403 1924 4,174 2,452 301 4 8,565 2,785 13,040 5,241 4,869 2,423 424,850 164,152 31,620 70,836 79,005 24,797 1925 3,556 2,346 268 11 8,464 2,857 12,288 5,214 5,726 2,954 459,011 187,120 29,313 73,141 106,064 26,346 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 35,498 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 1934 2,673 1,506 159 6 8,689 3,031 11,521 4.543 7,520 4,539 820,469 321,818 22,928 31,161 261,116 37,286 1935 2,578 1,352 336 14 8.184 2,768 11,098 4,134 8,575 4,596 826,122 312,370 21,654 33,912 255.403 38,3 54 Venereal Diseases (L.C.C. Scheme). Return showing the extent to which the facilities have been utilised during the year ended 31st December, 1935. Hospital New cases No. of persons Total attendance; No. of inpatients s days A.B.C. doses given Pathological examinations Syp. sc. Gon. Not V.D. Total Ceased to attend Discharged Spiro Gon. Wass. Others Total (a) (b) (a) (b) (a) (b) (a) (b) Albert Dock 123 35 319 244 721 41 423 11,759 2,382 1,425 12 1 284 30 713 285 713 285 2,323 Gt. Ormond Street 33 — 17 572 622 10 598 3,218 2,127 1,014 1 — 1,116 19 1,041 690 582 71 3,520 Guy's 288 72 570 1,033 1,963 384 1,548 55,223 2,667 4,391 301 — 14,468 866 3,392 2,665 4,935 1,149 27,776 King's College 132 2 107 269 510 145 312 13,075 892 1,203 12 2 666 91 1,438 2,379 340 55 4,983 L.C.C. Clinic (Whitechapel) 484 48 1,629 1,537 3,698 1,459 2,513 339,555 3,407 9,868 737 — 44,040 1,394 6,119 3,039 16,541 4,921 76,791 Metropolitan 55 15 136 107 313 122 185 26,824 246 914 28 — 606 54 477 240 490 253 2,148 Miller General 99 4 171 107 381 212 200 13,705 182 1,120 13 1 1,020 6 354 863 263 61 2,581 Royal Free 155 — 565 684 1,404 198 1,387 34,703 2,642 2,113 20 — 17,938 141 2,596 993 3,964 1,034 26,686 Royal Northern 147 4 524 346 1,021 332 694 54,197 369 2,180 47 — 3,274 46 1,099 1,229 130 22 5,847 St. George's 153 8 567 349 1,077 279 806 40,071 728 1,975 90 — 1,472 35 1,576 100 547 2 3,822 St. John's (Lewisham) 77 2 140 279 498 49 447 9,181 748 797 7 — 250 66 623 350 602 132 2,030 St. Mary's 362 1 1,072 644 2,079 418 976 85,674 2,196 6,209 201 — 12,735 288 3,284 1,510 2,461 26 20,505 St. Paul's 221 11 984 2,039 3,255 660 2,488 112,095 1,589 4,636 211 — 9,148 758 4,101 321 2,348 49 16,936 St. Thomas' 623 96 1,862 2,948 5,529 1,380 4,017 163,761 4,496 8,774 1,079 8 18,632 2,850 12,092 2,957 13,510 1,320 52,448 Seamen's 325 50 654 304 1,333 834 311 14,211 9,433 1,731 146 2 3,021 73 838 145 1,768 18 6,011 S.London for Women 39 1 131 179 350 87 216 9,802 622 158 3 — 3,765 379 478 314 454 9 5,402 University College 154 1 331 138 624 312 291 34,368 549 3,102 84 — 1,821 272 1,037 23 345 — 3,582 West London 340 — 771 1,198 2,309 593 1,546 86,748 2,134 6,445 111 4 12,052 255 3,680 441 5,414 425 22,382 Westminster 107 — 244 35 386 124 233 25,462 195 2,745 30 — 1,513 22 534 1,517 687 798 5,101 S.A. Mothers' 8 — 101 159 268 83 157 4,860 5,243 13 12 — 2,298 — 297 — 276 — 2,883 Children's, Waddon. 5 — 57 — 62 — 63 — 12,719 — — — — — — — — — — TOTALS 3,930 350 10,952 13,171 28,403 7,722 19,411 1,138,492 55,566 60,813 3,145 18 150,119 7,645 45,769 20,061 56,370 10,630 293,757 Pathology—(a) For centre 255,403 Pathology (b) For practitioners 38,854 127 Venereal Diseases. Utilisation of Facilities at Hostels, 1935. Particulars of the work done on behalf of the participating authorities by the hostels in the scheme for the year ended 31st December, 1935. 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.6. 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 192 19,774 68.84 Middlesex 15 1,779 6.2 Essex 13 1,466 5.1 Surrey 20 2,543 8.85 Kent 17 2,250 7.83 Herts 6 555 1.93 Bucks — — — East Ham — — — West Ham 2 236 .82 Croydon 1 124 .43 266 28,727 100.0 * Closed 31st October, 1935. 129 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE YEAR 1935 F. GARLAND COLLINS, M.R.C.S. (Eng.), L.R.C.P. (Land.), D.P.H. 131 TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE. Madam Chairman, Ladies and Gentlemen, I herewith present the Annual Report upon the School Medical Service for the year 1935. During the year special consideration has been given to the Open Air Schools. There has been some re-organization of the Day Open Air School at Crosby Road (see page 185) and it has been decided to extend the Residential Open Air School at Fyfield by 60 beds for the reception of 40 Girls and 20 Boys. The sanction of the Board of Education has recently been obtained to this project and building operations will be begun at a very early date. When completed this will bring the accommodation of Fyfield Open Air School up to 200 beds. In regard to Circular 1444 issued by the Board of Education in January last, Appendix II. sets out a report concerning certain matters which is receiving special consideration. As a whole the health of the children has remained good. I am, Your obedient Servant, School Medical Officer. Municipal Health Offices, Romford Road, Stratford, E.15. June, 1936. 133 (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. A. Furniss, L.R.C.P., L.R.C.S., L.R.F.P.S. (Glas.), D.P.H., L.D.S. Jessie H. Fitchet, M.B., Ch.B., D.P.H. B. M. R. West, M.R.C.S. (Eng.), L.R.C.P. (Lond.) Jessie Griffin, M.B., Ch.B., D.P.H. Dental Officers (full time) . J S. Dick, L.D.S. (Eng.). He1ene M. Gubb, L.D.S. (Eng.). O. B. Heywood, L.D.S. (Eng.). Dorothy Marsden, L.D.S. (Eng.). G. C. Baird, L.D.S. (Eng.) (appointed January, 1935). 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) Miss E. W. Wood Miss P. I. Geaussent Mr. T. P. Swatts Miss G. A. Blackler Mr. R. Huxtable Miss M. G. England (resigned Miss E. Laker April, 1935) Mr. W. Phillips (appointed June, 1935) Messenger. Mr. R. Denney (appointed June, 1935) 135 School Nursing S'taff. Miss D. S. Ayton Miss C. E. Hutton Miss H. Bredin Miss E. K. Jack Miss H. E. Bredin Miss E. Large (appointed Nov., 1935) Miss A. K. McCormack Miss A. Burrows Mrs. M. Mace Miss E. M. Bussell Miss I. B. B. Mann Miss A. J. Costain Miss L. F. Manning Miss M. A. Costain Miss M. H. Rose Miss M. M. Empson Miss A. Sheehan Mrs. E. G. Eyton Miss E. R. Tanner (Resigned Nov., 1935) Miss M. E. Tanner Miss L. C. Glover Miss E. Taylor Mrs. C. B. Halls Miss M. A. Van Ryssen Miss E. D. Harris Miss D. Wright. Miss E. Fraser (Knox Road & Mrs. S. Wilderspin (Grange Crosby Road Special Schools) Road Special School) Miss F. G. Hobbs (Special Enquiry Nurse) Nursing Staff, Fyfield Residential Open-air School: Miss W. M. Barnes, Matron. Miss M. James, Nurse. Miss R. Aylott, Matron's Help (appointed March, 1935) (2) Co-ordination of Departments. The arrangements for securing the close correlation of the School Medical Service with that of other Health Services in West Ham are in complete accordance with the suggestions made by the Board of Education. The advantages of the unification of the Services are manifest in the way of promoting economy and efficiency. The School Medical Officer is also Medical Officer of Health, and directs and supervises the work of a large School Medical Staff. The Bye-Laws Department daily notifies the Medical Officer of Health of absentees from school on medical grounds. The Tuberculosis Officer is constantly in touch with the School Medical Department, reporting on children referred to him by the Assistant School Medical Officers who have been sent away for Institutional treatment. 136 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.). During the year 1935 the children's latrines at Colegrave Road, Gainsborough Road, and Grange Road Schools were remodelled and brought up-to-date, with separate flushing to each pan, etc. The obsolete lavatory basins were removed from Canning Town, Beckton Road, and Bridge Road Schools, and lavatory troughs with spray taps were installed. At Hermit Road School a low pressure hot water heating system was installed. The Domestic Centre at Burke Senior Girls' School was remodelled and fitted with modern apparatus, and at New City Road School new Domestic Science and Handicraft rooms were erected. At Carpenters Road School a new Hall was erected. The obsolete electric light installation at West Ham Municipal Secondary School was removed and a new electric light installation provided, also at various Schools improvements to electric lighting have been effected. A domestic hot water supply to the lavatory basins at three Schools was provided. The hot water heating boilers at Shipman Road, Holborn Road, and Colegrave Road Schools were replaced. The interiors of the two Nursery Schools were redecorated. The interior of the Boys' School at Fyfield Residential Open Air School was also redecorated. The cleansing of classrooms and cloakrooms and the drying of children's clothes, as required, continue on the lines set out previously. Spray baths are provided at five Elementary Schools, viz. : fiainsborough Road, Rosetta Road, South Hallsville, Pretoria Road and Tollgate, also at the S'pecial School at Knox Road and at 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 Romford Road, Balaam Street, Plaistow Road, Silvertown and Fen Street. The number of attendances of school children at the Corporation Washing Baths during the year was as follows:— Boys Girls Total 19,760 13,747 33,507 137 With regard to the Baths at Romford Road, 135 Slipper Baths have been provided for the use of the general public, and for school children who attend during school hours in charge of a teacher. The swimming bath water is continually filtered, aerated and sterilised, the Filtration Plant being capable of dealing with 120,000 gallons of water per hour. Facilities are afforded for swimming instruction in school hours at the following baths:—Romford Road, Balaam Street, Silvertown, Dockland Settlement and Plaistow Red Triangle Club. Professional instructors are appointed for this work, and teachers who accompany the scholars to the Baths also take part in the instruction. (4) Medical Inspection. The Borough is divided into five Sub-Areas, each served by a School Clinic, an Assistant School Medical Officer and Nurses. The Schools in each area are visited in rotation. The Head Teachers send out notices to parents informing them of the times to attend the medical inspection, according to an arranged programme. Arrangements are made whereby those children who were absent from the Inspection are examined at a later visit to the School by the Assistant School Medical Officer. The "age groups" inspected throughout the Schools are as follows:— (1) Children admitted to School for the first time during the year (Entrants). (2) Children of 8 years of age (Intermediates). (3) Children expected to leave School and who have not been previously inspected since reaching the age of 12 years (Leavers). Besides the above statutory Routine examinations, a considerable number of other children have also been medically examined, classified as follows:— (1) "Specials" selected by Head Teachers and examined at School at the time of the Doctor's visit. (2) "Specials" sent by Head Teachers to the Clinics for treatment of minor ailments. (3) A number of non-ailing children are examined as to fitness for (1) Sport (2) Employment (3) Camp life (4) Employment in entertainments. All these comprise "Other Routines. (4) All other children referred in any way to the School Medical Officer for examination, advice or treatment (5) A census and medical examination of all exceptional children at the schools for the purpose of Table III. of the report. The Board's schedule of inspection has been strictly adhered to. 138 1 again append a list of Schools where, owing to exceptional circumstances, medical inspection is not held on the premises, but, with the Board's sanction, at the places indicated:— Clarkson Street St. Margaret's r The Public Hall, Canning Town. Holy Trinity St. Luke's. The Boyd Institute. St. Francis'. The Wesleyan Hall, The Grove, Stratford. St Paul's The Mechanics' institute (L.N.E.R.). Colegrave Road Rosetta Junr. The Bancroft Hall. St. James'. Hanford Memorial Hall, Forest Lane. 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 following activities are included in the Scope of the School Medical Service:— (1) Medical Inspection in Elementary Schools (Routine 3nd Specials). (2) Following up, by home visit, of children found to require treatment. (3) Following up of children Out- of-School on Medical grounds. (4) Cleanliness Surveys. (5) Treatment of Minor Ailments. (6) Dental Inspection and Treatment. (7) Treatment of Visual Defects (Provision of glasses at Contract prices). (8) Examination of children re Physical Fitness for participating in Sports. (9) Operative Treatment of Tonsils and Adenoids, by arrangement with three local Hospitals. (10) X-Ray Treatment of Ringworm. (11) Provision of Meals to necessitous children. (12) Provision of Surgical Instruments and Appliances for crippled children. (13) Orthopaedic Treatment. Remedial Clinic In-Patient and Out-Patient treatment at Orthopaedic Hospitals. 139 (14) Examinations re Convalescent treatment for debilitated School children. (15) Examinations re Employment of School children. (16) Open-Air Education. (1) Residential Open-Air School for 80 Boys and 60 Girls at Fyfield. (2) Day Open-Air School, Crosby Road, for 60 children (Girls and Junior Boys). (3) Ten allocated beds for Girls at the Ogilvie School of Recovery, Clacton-on-Sea. (4) Two Holiday Camps (Boys and Girls) during the Summer Vacation at the seaside. (17) Medical Inspection of all children undertaking School Journeys. (18) Artificial Sunlight Treatment. (19) Class for Stammering children. (20) Routine Medical Examination and Treatment at the two schools for Mentally and Physically Defective children; also special examinations of children for admission to these schools as well as examinations in connection with cases recommended for Residential Institutions. (21) Examination and Treatment of children attending the two Deaf Centres (including annual examination of all children by Specialist Aural Surgeon). (22) Medical Inspection of pupils at the two Central Schools. (23) Medical Inspection of pupils (including Bursars) at the two Secondary Schools. (24) Medical Inspection of Junior Technical and Art Classes at the Municipal College. (25) Medical Inspection of St. Angela's High School for Girls. (26) Medical Inspection of pupils at the West Ham High School for Girls. (27) Medical Examination and Treatment of pupils attending the two Day Continuation Schools. (28) Medical Examination of students referred from Junior Instruction Centre. (29) Examination and treatment of children attending Nursery Schools. (30) Work in conjunction with the N.S'.P.C.C. as occasion arises. (5) The Findings of Medical Inspection. (a) NUTRITION. The Board of Education, on the 31st December, 1934, issued fresh instructions (Administrative Memorandum No. 124) as to the classification of nutrition. The result of these findings will be seen in the Statistical Tables IIB for Elementary and School:; of Higher Education. 140 AVERAGE HEIGHT AND WEIGHT, 1934-1935. HEIGHT. Age Number Examined 1934 1935 Average Height in inches. Number Examined Average Height in inches. Boys 5 800 41.8 935 41.8 8 1765 47.4 1815 48.7 12 1910 55.8 2146 56.0 Girls 5 797 41.6 921 41.8 8 1862 48.3 1769 48.5 12 1918 56.5 2085 56.6 WEIGHT. Age Number Examined Average Weight in lbs. Number Examined Average Weight in lbs. Boys 5 800 40.2 935 40.4 8 1765 57.4 1815 57.6 12 1910 78.1 2146 79.8 Girls 5 797 39.2 921 39.8 8 1862 53.2 1769 54.1 12 1918 82.1 2085 83.0 (b) UNCLEANLINESS. The following figures give a brief resume of the work done and the findings. These figures refer to examinations of children by School Nurses. Number Examined Ova Ova and Pediculi Body Pediculi Head and Body i Pediculi Sores Dirty 89149 7377 1418 22 12 708 241 (c) MINOR AILMENTS AND DISEASES OF THE SKIN. Minor affections common in school children, such as minor ailments of the Skin, Eyes, Ears, etc., are included under the appropriate headings. 141 The percentages for head and body vermin are respectively 1.64 and .13. Number of Home Visits 5225 Number of Children visited at School 8519 During the year there were 192 cases of Skin diseases found among Routine examinations at the Elementary Schools, 144 being referred for Treatment; 4,411 "Specials" were also referred for treatment. Thirteen cases of Tinea Tonsurans and 148 Tinea Body, are included in the above cases referred for Treatment. With regard to Higher Educational Institutions the figures were as follows:—Routines referred for Treatment 26, "Specials" requiring Treatment, 13 (including one Tinea Body). (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 92 cases referred for treatment at Routine Inspection (17 being in respect of Higher Education) and 1,094 among the "Specials" (six Higher Education). With regard to Defective Vision, 591 Routine cases were referred for refraction, and ,123 for Squint. In addition there were 619 specially referred for defective vision and 162 for Squint. These figures apply to Elementary School children only. Following are the figures relating to Higher Education :— Defective Vision requiring Treatment—276 (including 15 "Specials"). Squint requiring Treatment—3. (e) NOSE AND THROAT DEFECTS. At Routine inspection 678 cases (including 40 Higher Education) were found to require treatment of the nose and throat, and 699 (6 Higher Education) among the Specials. In addition there were 376 cases requiring to be kept under observation among the routines and 12 among the "Specials." (f) EAR DISEASE AND DEFECTIVE HEARING. The findings under this heading at Routine Medical Inspection (Elementary Schools) amounted to 185 requiring treatment. In addition, 920 Special cases were referred for treatment. Twenty-three students attending Higher Educational Institutions were found to be in need of treatment. (g) DENTAL DEFECTS. The teeth are examined by the School Doctors as a matter of routine, and all defects referred for treatment. 142 (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. (i) HEART DISEASE AND RHEUMATISM. During the year, 33 Organic Heart Disease cases were found in the course of Routine Inspection at Elementary Schools and two at the Secondary and other Schools of Higher Education; 39 cases were found among the "Specials," all of whom were Elementary School children. In addition there was a total of 252 children requiring to be kept under observation for their heart condition. (j) TUBERCULOSIS. During the year one definite and 20 suspected cases of Pulmonary Tuberculosis, together with seven non-Pulmonary cases, were found in the course of Routine examination. There was one definite and five suspected Pulmonary, together with six nonPulmonary complaints found in the "Specials." Fifty-four Pulmonary and 14 non-Pulmonary cases were required to be kept under observation. Of the above figures the following relate to Higher Education:— Suspected Pulmonary Tuberculosis—4 (one requiring treatment). Non-Pulmonary Cases for observation—2. (k) OTHER DEFECTS AND DISEASES. rollowing are particulars of children found to require Treatment or Observation under this heading:— Elementary Schools : Routine Cases in need of Treatment 464 Routine Cases in need of Observation 404 "Specials" in need of Treatment 6638 "Specials" in need of Observation 65 Higher Education: Cases requiring Treatment 69 Cases in need of Observation 22 All cases recommended for treatment, and those recommended for observation, form the basis of the Doctor's Reinspection, which takes place by a subsequent visit to the school. The total number of Re-inspections by the School Doctor's amounted to 7,645. 143 (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 10237 Total number of children visited at school 5138 Total number of hours spent by Nurses in visiting 3446 (7) Arrangements for Treatment. (a) NUTRITION. Table 11B in the Appendix sets out the classification of the Nutrition of children inspected during the year in the routine age groups at elementary and schools ot Higher Education. Children suffering from malnutrition are dealt with in various ways, such as admission to a Day or Residential Open-air School, periods of Convalescence and the provision of free meals in necessitous cases. There is a Voluntary Milk Scheme in operation in the schools. (b) UNCLEANLINESS. 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 39 Unclean Heads 2343 Unclean Bodies 2 Skin Diseases 9 144 No children were cleansed under Section 122 of the Children Act, but 109 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 are available. Head Teachers are empowered to send all children to the School Clinics who come under 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 (Stratford Clinic) being served by two Doctors:— Stratford Clinic (a) 13589 Stratford Clinic (b) 6898 Balaam Street Clinic 11905 Swanscombe St. Clinic 16983 Rosetta Road Clinic 17171 Total 66546 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 six cases of Ringworm of the Scalp treated at the London Hospital. (d) VISUAL DEFECTS AND EXTERNAL EYE DISEASES. Cases of Visual defects are examined by the Committee's Oculist. The Oculist devotes ten Sessions per week to these refractions, which are re-inspected by the respective Assistant School Medical Officers 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:— Elementary Schools Higher Education Special Schools Cases referred to Oculist 4198 483 56 Number attended 3419 440 46 Percentage attendance 81.4 91.1 82.1 Glasses ordered 2635 403 38 145 The total number of Clinic Sessions devoted to Refraction work was 364. 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, the Committee's Oculist:— The Authority have made arrangements for visual defects to be dealt with at tne Mratiord Ophthalmic Clinic. It is clear that the needs ot the children in all schools in the borough are being met with a considerable degree of success. it is quite possible tor a child to have defective vision in one or botn eyes, and yet make no complaint either at school or at home. Children wno have never experienced full clarity of detail cannot realise that they see objects indistinctly. Barents should watch their children closely, and if they have any reason to think that a child's sight is less than perfect, expert medical advice should be obtained without delay. Many children are accused unjustly of being dull at school when in ract they are handicapped by the inability to see properly, and by the consequent "nervous strain" which is thrown upon them in straining to overcome the defect. Many minor ailments may be traced to the want ot proper correction with spectacles. It is of the first importance that children's sight should be entrusted only to specially qualified medical officers. In many cases defective sight is due to "bodily, ill-health." A doctor also has the medical knowledge and training necessary to detect and treat such conditions. With the co-operation of the School Medical Service children can obtain expert medical eye examination, which is so necessary, and spectacles made accurately according to prescription, by the dispensing optician appointed by the local authority. Prescriptions for glasses are made up at contract prices, and every case 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 and heterophoria or squint, are referred to the Oculist. All cases of myopia are reexamined frequently according to the degree of myopia. The co-operation of Head Teachers is of the greatest possible value in referring early backwardness and disability that indicates "bad sight" to the School Medical Officer; they also see that the children with glasses wear them as ordered. There is usually a waiting list, which is made up from the recommendations of the area School Medical Officers at their routine and special examinations in the schools. Head Teachers can notify the School Medical Officer direct of children who appear to have any ocular defect. 146 The total number of children suffering from External Eye disease who received treatment under the Authority's scheme amounted to 1,109, 62 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 684 children were operated on for these conditions under the Authority's scheme, and 52 received treatment by Private Practitioners, or otherwise; 172 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. 147 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, 986 children with minor Ear Defects were treated at the Clinics. S'eventy-one cases received treatment privately. Nine of whom were scholars attending the Higher Educational Institutions. 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 once a year by an expert Aural Surgeon (Mr. Stoker, F.R.C.S.). (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. 148 I submit herewith remarks and comments from individual reports of the five Dental Surgeons:— Mr. Dick reports:— Treatment has been continued on the same lines as in previous years, but owing to a smaller number of children in the schools, a little more time has been available for conservative work. This condition is highly satisfactory, as much conservative work has in the past of necessity been impossible to do owing to the number of extractions required. The number of special cases is still high and interferes with routine work. Many of these are not really urgent, and I would ask the Head Teachers to send up, as specials, only cases which obviously require immediate treatment. I am pleased to note that several more teachers have introduced the "Ivory Castles' League" to their classes. This league does splendid propaganda work. I am indebted to Head Teachers and Teachers for their help, and wish to thank them for their co-operation at all times. Miss Gubb reports:— The Routine School Inspections were carried out during the year 1935 All children found to require dental treatment were referred, and those accepting treatment in due course attended the Clinic, the appointments being all sent out as far as possible within two or thre"e weeks of the School Inspection. Persistent refusals are still a constant source of worry, as they almost always attend the Clinic at some future date as one of the many Specials. A large nurriber of Specials is inevitable cm/ account of the various epidemic illnesses and other unavoidable causes, and these children must of course be treated when they are able to attend. The six-year old molar (1st Permanent Molar) is still a source of mystery to the Parents, a fact which leads to the early loss of many of these most valuable teeth. All Parents who show any signs of interest or a desire for knowledge on the subject are given a very brief account of the Permanent and Temporary Dentitions as it is impossible to do more in the limited amount of time available. It is also pointed out to the Parents that though the deciduous dentition (1st Dentition) is only a temporary one, it has a very definite function to perform and a very important role to play in the Dental Scheme. It is gratifying to see in many of the schools evidence of the interest taken by the Teachers by the presence of the paint books issued by the Ivory Castle League, and many of the children are wearing the Ivory Castle League badges which give them an added interest in themselves. 149 All children recommended for Fyfield Open-Air School are Dentally inspected and treated if necessary so that they are able to derive the maximum amount of benefit from their stay at the School. The same applies to all children prior to their admission to he Langdon Hills' Sanatorium. Each year a few children are referred to the various London Dental Hospitals for Orthodontic treatment with very satisfactory results. The parents perhaps at present only appreciate the aesthetic result in the improved personal appearance of the child. It is pointed out to them, however, that the benefit reaches far beyond the mere personal appearance of the child. I would once again like to express my thanks to all the Head Teachers for their valuable help and co-operation. Mr. Baird reports:— During the year, all the Schools in the area of Swanscombe Street Clinic have been inspected, and the necessary treatment given to those accepting it. Conservative treatment has been accepted by the parents in a fair percentage of cases, but until this figure increases, the number of special cases will remain large. The number of Special Cases is also increased by reason of the Routine Inspections being confined to those children between the ages of six and eight, many requiring emergency treatment for the relief of pain from teeth in the deciduous dentition. I might stress the fact that parents do not realise that the six-year old molars are permanent teeth, and require careful attention. I wish to express my thanks to the Head Teachers for their valued help and co-operation in the attendance of children at the Clinic, and during the Routine Inspections. Mr. Heywood reports:— There have been few noteworthy features in connection with the work carried out at Balaam Street during 1935. The proportion of refusals shows, in general, little abatement, and it is unfortunately to be observed that nearly all these cases are equally unwilling to accept treatment or advice. At Grange Road Special School, which was included in the area for the first time, the percentage found to require treatment was naturally large, but the proportion of acceptances was here encouragingly high and practically all serious cases, both physically and mentally defective, were dealt with, excepting those few children for whom, owing to the dangerous condition of their hearts, treatment could not be undertaken. Miss Marsden reports:— In 1935, Routine Dental Inspection followed by treatment that is, to those who took advantage of the scheme for dental treatment—continued as in previous years. 150 The percentage of children requiring some dental treatment is still very large. There is undoubtedly though, an improvement in the condition of the children's teeth, not very many requiring really extensive treatment. It is uphill work persuading the parents and children to accept treatment, especially conservative treatment, one mother stating that she did not believe in the children being forced to have treatment, while another stated that she knew what was best for the child's health (when it was pointed out that carious teeth had a bad effect on health). It is, of course, really the children who rule the home, and who decide whether they will have treatment or not. So it is the Head Teachers and Class Teachers who have the greatest influence in persuading the children to accept treatment. I should like to take the opportunity of thanking all the Head Teachers and Class Teachers for their very great help and courtesy. (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. (See Table IV., Group IV., of the Appendix.) Any children found with minor Postural defects 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. (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 101. 151 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 having Institutional treatment. Langdon Hills Children's Sanatorium 39 Heritage Craft Schools, Chailey 3 Sir William Treloar's Home, Alton 13 Hastings Home and Residential School 1 In addition there were 3 out-of-school cases of Tuberculosis at the end of December, 1935. (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. (1) ARTIFICIAL SUNLIGHT TREATMENT. This treatment is carried out at the Children's Hospital, Plaistow, under the administration of Dr. Eva Morton. The Education Committee have made special arrangements with the Hospital whereby they accept responsibility for all children recommended this form of treatment. Dr. Morton sends the following particulars, which relate to the West Ham children who have been treated there during the past year:— During the year 1935, the number of School children treated at the Sunlight Clinic was 163, as compared with 110 in the previous year. Of these, 65 were discharged "greatly improved," 40 "improved," 25 "unchanged," and 33 were still under treatment. Of the "unchanged" group, all but three made only seven attendances or less, several only coming once. The three remaining cases in this group, who attended 11, 12 and 14 times respectively, were referred, one for anaemia and debility, one for tuberculous adenitis (inguinal glands) and one for malnutrition and debility. The great majority of the children who attended for the full three months' course, and who were regular in their attendance, an important point, gained weight and improved remarkably in other ways, such as sleep, appetite, temper and spirits. 152 Debility and catarrh were two of the commonest conditions for which the children were referred to the clinic. Nineteen cases of anaemia and 17 cases of enlarged glands, usually of the neck, were treated during the year, most of these, as is usual with such cases, doing well. (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:— Measles (including German Measles) 348 Whooping Cough Chicken Pox 994 1199 Tonsillitis 476 Other Diseases 497 Mumps 1089 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. Exclusions during 1935. Impetigo 49 Verminous 2 Scabies 142 Tinea Tonsurans: Other Skin Diseases 18 Treated by X-Rays 6 Conjunctivitis 9 Treated at Clinic 5 Blepharitis 3 Tinea Body 6 Mumps 38 Other Defects and Diseases 7,1 Chorea 3 Enlarged Glands 8 Chicken Pox 8 397 Tonsillitis 5 Diphtheria 11 Total number of children involved 377 Anaemia and Debility 1 Bronchitis 8 Heart 4 153 (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. Some 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 three of the most modern schools in the Borough, viz. Tollgate, Pretoria Road and the re-constructed South Hallsville School, special provision has been made for open-air classrooms. (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 Isle of Wight 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. Pannell reports—- The 11th Boys' Holiday Camp was held at the South Shoebury Hall Farm during the Summer Vacation, this being the 10th Camp in the same field, and it would be difficult to find another position possessing the same essential and desirable facilities. Here we have ample supplies of fresh water close at hand, sea bathing within easy reach, space in plenty for the playing of games, and a soil with good natural drainage. 154 The evening of Friday, July 19th, saw some two dozen enthusiastic teachers and other helpers erecting canvas in intermittent storms of wind and rain. By 11 p.m. they were sitting down to a well-earned supper by candle light in the small marquee. Sufficient canvas had, by this time, been put up to cover the weary sleepers and to put blankets and other stores under shelter. On Saturday morning a necessary but very unpopular reveille at 6 o'clock enabled an early start to be made on the large marquee, the erection of which in half a gale of wind needs considerable care. During the day, however, the weather improved, and the remainder of the work proceeded satisfactorily until the late afternoon, when a heavy downpour of rain and general weariness called a halt for the day. On the following morning another early start was necessary to complete the essential work of establishing the Camp. The early evening saw these willing helpers departing in various conveyances, the less fortunate ones proceeding to the local station and from there completing the journey in a crowded excursion train. The first party of boys numbering 161, mostly from schools in the north of the Borough, entered the Camp on July 25th in glorious sunshine, and during the whole of their fortnight's holiday the same glorious weather prevailed. Great care had to be taken during the first few days to prevent the serious effect of a too sudden exposure of tender skins to the rays of the sun, but the precautions taken happily avoided any severe cases of sunburn. The change over took place on August 8th, and the difference between the "brown-skins" who left the Camp in the morning and the "pale faces" who arrived in the afternoon was very noticeable. Unfortunately, the day of brilliant sunshine was followed by a night of torrential rain. This would be most unwelcome at any time, but coming on the first night of any party of boys is an experience the Staff has no wish to have repeated. However, these boys had only another evening of rain during their fortnight, and although the sun was not quite so consistent, the weather generally was almost as good as for the previous party. During the whole month the health of the boys remained excellent, and the almost complete absence of tooth-ache does credit to the inspection by the Medical Department of the children before proceeding to Camp. The usual amount of home sickness was experienced—this being mostlv among the junior boys. The usual outdoor activities were indulged in and proved as popular as ever—cricket, camp golf, football and rounders—each game having its particular devotees. The increasing popularity of the last-named amongst boys of all ages is specially noticeable. Sea bathing and mud walks were organised according to the state of the tide, and the usual competitions arranged towards t c close of each period, these being selected to give the athletic and non-athletic boys equal chances. In the hour between supper 155 and bed-time community singing alternated with story reading, and the change retained the popularity of both. Indoor games were noticeable during the whole month only by their absence. Morning by morning throughout the month would see the keenest rivalry to prove which tent, in cleanliness and tidiness, should be the best of the day. Were any added incentive necessary, it was certainly provided by the special prizes given for the best tent in each period. Every effort was made to introduce as much variety as possible in the menu, but in this matter very careful experiment is needed, for due consideration must be given on the one hand to the cooking facilities available and on the other to the tastes of the boys. Among other changes, both cooked and uncooked green food were introduced as opportunity offered. One prominent feature of this year's Camp was the new bathhouse, a great improvement both as regards beauty and utility on any previous structure. Miss Wise reports— It is with great pleasure that I present this Tenth Annual Report of the Girls' Camp, held this year at East Cowes, Isle of Wight. The party consisted of 259 girls and 11 staff, and we travelled on Saturday, 10th August. The journey was most enjoyable, and the facilities afforded us by the railway company made it very easy and pleasant. Although an early start from Plaistow had to be made, no one was late, and all were checked in and ready for the train at 6.23 a.m. To save the awkward journey from Plaistow to Waterloo, and the difficulty of dealing with a big crowd of children at such a terminus, the railway company arranged for the party to travel direct from Plaistow to Southfields, and to change there into a special non-stop train to Portsmouth. The children enjoyed the novelty of the boat trip from Portsmouth to Ryde, and the last train journey from Ryde to Whippingham, the nearest station for camp, was impatiently borne as the excitement of nearing East Cowes grew greater. The East Cowes Camp is situated in a beautiful spot about a mile and a half from the sea ; the River Medina is seen from the playing fields, which cover about sixteen acres. The buildings consist of four well-built dormitories, with staff quarters, bathroom, etc., attached, and communicating with one another by a covered way. A large marquee served as dining room. There is also a house with staff dining room, kitchens, and additional accommodation. As it is a much smaller camp than Dymchurch, we had the advantage of being the only party there, and had our numbers been fewer, one of the buildings would have been kept as a recreation room or dining room for wet weather. 156 Although the Camp is rather far from the sea, this proved no drawback to enjoyment; in fact, rather the reverse, as the children thoroughly enjoyed the beautiful, shady, tree-lined walk to the sea. The liners, ships of all kinds, yachts, seaplanes, etc., added interest to the seashore, and the short trip to West Cowes by motor launch for a penny or by the floating bridge for a halfpenny return, was a source of much pleasure. The esplanade with its paddling pool, grassy slopes, playground and the trees shading it make it an ideal spot. The bathing is good and safe, and the sea is warmer than at Dymchurch. The district abounds in so many places of interest and beauty that it was difficult to choose which to visit, and the fortnight proved all too short to do more than visit a very few. Excursions were arranged for every dav. These included visits to Carisbrooke Castle and Osborne House, for which permits had been previously obtained by the Education Committee. These visits were thoroughly enioyed bv all; the donkeys and the well at Carisbrooke, and Swiss Cottage and the grounds at Osborne House were great attractions. The coach trip to Alum Bay was very popular, as also was a trip to Shanklin and Sandown by train ; while some of the most affluent managed a trip to view the liner "Majestic" in Southampton Dock. Walks to such places as West Cowes, Gunard Bay, Newport, along the river bank, Woodside, Whippingham, were common to every day. It would be impossible in a short reoort like this to give an account of all the places seen by the children, but I really was amazed at the amount of walking cheerfully done and thoroughly enioved in order to see as much as possible of the island in the fortnight. On account of the many facilities for enioyment outside, the time actually spent in Camp was very little. In the evenings after the day's outing's, games were organised and were as popular as ever—stoolball this year being' first favourite-—while the little swimming pool in the camn grounds was full at every opportunity. Jhe usual dormitorv frolics were indulged in—community singing, concerts, etc., finishing with the usual staff entertainment. The food supplied at camp was good, well cooked, and adeouate. Meals were well served and alwavs punctual. Packed lunches or teas were provided to order, and hot meals provided on the return of those who had been out for the day. The weather was excellent, glorious sunshine prevailing until the last dav, when unfortunately we had a verv wet journey home. The health of the girls was exceptionallv good—no sickness of any kind needed attention. In this reoort I should like to sav that though I have enioyed camp manv times. I think this the most eniovable one I have experienced, and from the visits I have had from parents and the 157 letters I have received since we returned, I know that the children too thoroughly enjoyed every minute of it. In conclusion, I must thank all those who help to make the camp such a success, the Committee who grant the facilities to make the holiday possible, the staff at the offices who attend so well to the details of arrangement, and the Medical Staff who see that all start fit. I know that the members of the teaching staff enjoy this work and need no thanks ; the knowledge that they have been able to help for a while to lighten the more or less drab lives of the children is sufficient. But at the same time, I appreciate their services to the full. Children's Country Holiday Fund. A further activity which should be mentioned under this heading is the work of the Children's Country Holiday Fund. All children sent away by the local branches of this Fund are examined by the Nursing Staff as to their cleanliness and freedom from infectious or contagious conditions. The number of children so inspected during 1935 amounted to 1,938. (10) Physical Training. An Inspector of Physical Training has now been appointed for the organization and supervision of physical training in all schools and other Educational Institutions under the Education Committee. 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 185 boys were examined. Only two were found unfit. (11) Provision of Meals. The same scheme which has pertained for several years, and which I have on previous occasions set out in detail, still exists for the purpose of providing meals for children. The Education Committee, on behalf of the Maternity and Child Welfare Committee, now make provision for supplying meals to expectant and nursing mothers at the above Centres, at special times. 158 During the year the number of meals served at the various School Dining Centres was as follows:— Breakfasts, 418,756. Dinners, 849,9,11. The average number of children fed each week was 3,467. (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 83.4, indicates the interest taken in the work of the School Medical Service. The number of parents who refuse to have their children medical examined is extremely low. In 1935 the number of children who were affected by this parental objection amounted to 75. 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 by them daily to the notice of the Medical Officer of Health. (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 notifv the School Medical Officer of children coming under their notice who require new or altered 159 Surgical Appliances. The Education Committee assists in the purchase of instruments or alterations to same. These Societies also report cases requiring Convalescent treatment. During the year a large number of school children were reported to the Medical Officer of Health, and sent away for periods of convalescence. Assistance in the purchase or repair of Surgical Appliances was rendered to 30 children. I am also indebted to the National Society for the Prevention of Cruelty 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 are a number of other voluntarv 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 various sources, viz., by Head Teachers, the School Attendance Department, Hospitals and Voluntary Associations. These cases are dealt with as they arise and are followed up bv 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 schools, many are recommended for admission to the Special Schools, whilst the remainder are considered unfit for school attendance. The permanent out-of-school cases are visited from time to time bv the Nurse, and should there be any changes in the condition which justify re-examination, arrangements are made accordingly. There is also an annual return at the end of the year, submitted by Head Teachers, of all children who in their opinion are exceptional. These are examined by the medical staff, and cases considered unfit for attendance at an ordinary school are referred for further examination by the Chief Assistant School Medical Officer. A number of children are placed in various Institutions, and the Local Authority is responsible for their maintenance. (b) All mentallv defective children not in school are followed up. These out-of-school cases are periodically medicallv examined to ascertain their fitness for admission to Special Schools. Mentally defective children who are not in Special Schools are those who are too young- for certification. These are reviewed from time to time by the Chief Assistant School Medical Officer. 160 (c) Ceneral Review of the work of the Authority's Special Schools. Knox Road and Orange 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 Crange Road 95 Mental Defectives 95 Mental Defectives 80 Physical 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 School Dental Clinic and treated, where possible, under the Authority's scheme. A certain number of cases are 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 school children. Age Distribution of Examinees. M.D. and P.D. Children. Age Number Examined 6 5 7 17 8 18 9 26 10 32 11 41 12 38 13 45 14 22 15 11 Total 255 Attendance of Parents, 66.6% Chief defects referred for Treatment or Observation. Treatment Unclean Head 10 Other Eye Conditions 1 Unclean Body 4 Otitis Media 6 Scabies 1 Other Ear Diseases 1 Other Skin Diseases 5' Teeth—Oral Sepsis 7 Blepharitis 3 Anaemia 4 Defective Vision 14 Other Defects and Diseases 2 Squint 161 Observation Other Skin Diseases 4 Heart Disease— Defective Vision 34 Organic 18 Squint 8 Functional 1 Other Eye Conditions 1 Anaemia 9 Defective Hearing 12 Other Disease of Lungs 1 Otitis Media 5 T.B. Spine 14 Enlarged Tonsils only 16 T.B. Hip 10 Adenoids only 3 T.B. other Bones and Joints 7 Enlarged Tonsils and Adenoids 6 Other Conditions (Nerves) 22 Other Conditions Nose and Throat 4 Rickets 1 Enlarged Cervical Glands Spinal Curvature 7 11 Deformities (Other Forms') 32 Defective Speech 19 Teeth—Oral Sepsis 46 Other Defects and Diseases 7 The following Table shows the number of defects treated at the Clinics during the year:— Scabies 1 Minor Ear Defects 38 Impetigo 2 Other Defects and Minor Eye Defects 8 Diseases 303 Two voluntary After-Care Committees sit to consider the welfare of children who have recently left these schools. The following reports have been received regarding "leavers" during the past year. Knox Road Special School. M.D. CHILDREN. During the year 1935 one boy and one girl left, having attained the age limit of sixteen years. The girl is now employed on domestic work at Forest Gate Hospital. Twelve children obtained permission to leave at the age of fourteen years, having obtained suitable work; of these One boy obtained work in a Rubber Factory. One boy obtained work in a Shop. Two boys obtained work as Van Boys. One boy obtained work as a Plumber's Mate. One boy obtained work as apprentice to a Mirror Maker. One boy obtained work as a Tin Maker. One girl obtained work at Dressmaking. One girl obtained work as an Ironer. One girl obtained work at a Tape Factory. One girl obtained work as a Machinist. One girl obtained work at a Button Factory. 162 All these children are still in employment. Of the remaining children who lett during the year 1935, three boys removed from the district and two children are in a Convalescent Home. P.D. CHILDREN. No Physically Defective child remained at school until the age limit of sixteen years was reached. The leavers at the age of fourteen years included: One boy who obtained work in a Chemist's Shop. One boy who assists in the upkeep of a car. One boy who acts as lather boy to a Hairdresser. One boy who is apprenticed to a Dental Surgeon. One boy who obtained employment in a Shop. One girl who obtained work as a Box Maker. One girl who obtained work as a Cigarette Packer. One girl who is apprenticed to a Florist. All these, too, are still in employment. In addition: Two children were transferred to other schools. Two children removed from the district. One boy was transferred to the M.D. School. Crange Road Special School. P.D. M.D. Number on Roll December, 1934 63 98 Number on Roll December, 1935 64 86 Number admitted during 1935 24 12 Number left during 1935 23 24 There has been a considerable amount of change with the children during the year, especially in the P.D. Department; but there are less M.D. admittances this year. Concerning the Leavers, the causes of leaving are varied. The following table shows the numbers at a glance:— P.D. M.D. Age limit of 16 years 3 5 Permission granted by S'.M.O. to take up work 8 10 Residential Homes, Hospitals and Institutions 5 2 Fit to return to Ordinary School 2 — Excluded as either Physically or Mentally Unfit for any School 2 6 Removed from district 3 — The numbers on the rolls of both Departments in December, 1935, are decidedly lower than they have been for many years now, and certainly the Defect is diagnosed earlier with the P.D. child, for out of the 24 admittances to this Department 16 of these were children young enough to start in the "Infant" Stage Room. This gives the P.D. child a fairer chance of education, and in the end 163 gives him a secured position in after life to grapple with and make the best ot his tew physical abilities. Of the 18 children (both Departments together) given permission to take up suitable jobs found for them, ,14 actually kept their work; the others have changed since; one M.D. only is not working regularly. Ot the eight of the "Age Limit" Class (both Departments), four have procured work and 4 are unplaced. In all cases this year the jobs obtained are of the "Factory" type. We still keep in touch with many of the old pupils. One 1922 badly crippled lad is earning on an average £2 weekly by travelling about in a wheeled chair with a confectionery counter in front. His sale sites are School and Park gates. It is rather wonderful, for he greets every customer, despite the sale is ¼d. perhaps, with a cheerful word and smile. Another, a P.D. girl, who is unable to move about alone, keeps herself as "Needlewoman "for her neighbours, and her connection is now spreading farther afield. We feel far more hopeful this year. Industry is improving, and of our 26 Leavers who are 14 years plus we have 18 in all at work, that is approximately 69.2%. We are nearing our erstwhile pre-war estimates ot 75%. Therefore we are convinced that these Schools do benefit these Defective Children and give the "higher grade pupil" a chance ot becoming self-supporting citizens. 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 the Specialist Aural Surgeon. The Education Committee have decided to instal a Multitone Deaf Aid Wireless Apparatus at each of the Deaf Centres. By its aid deaf mute children with partial hearing can be taught and their speech should more rapidly improve. During 1935 the number of children examined at these schools in the course of Routine Medical Inspection was as follows:— Frederick Road Deaf Centre, 24. Water Lane Deaf Centre, 38. 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 reports have been received from the Head Teachers of the Deaf Centres regarding "Leavers":— Frederick Road Deaf Centre. One boy working for a Builder. One boy working in a Basket-making Factory. One boy unemployed. One girl unemployed. 164 Water Lane Deaf Centre. Two boys working at a local Basket Works. 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 are 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 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 9 boys attended the first class, 8 boys and 3 girls took a second Course, and 3 boys and 4 girls a third Course. One boy and one girl were considered to be in need of a further Course. Three classes were held during the year. Children from outside areas are accepted when vacancies are available. A special examination was made by Dr. West of children who attended the Stammering Class during 1934; of these, 4 boys and 4 girls were recommended for a further Course. The following Table sets out the general daily routine at the Stammering Class:— 9.30 to 10.30 a.m.—Breathing, Voice and Articulation Exercises, followed by individual difficulties. 10.30 to 10.45 a.m.—Break. 10.45 to 11.30 a.m.—Reading, Poetry or Conversation. 11.30 to 12 —Arithmetic or written answers to tions upon English, Geography, History or General Knowledge. 2. 0 to 3. 0 p.m.—Voice and Articulation Exercises, Reading, Poetry or Conversation. 3. 0 to 3.15 p.m.—Break. 3.15 to 4. 0 p.m.—Handwork, composed of Bookbinding, Paper Modelling or Drawing. Girls encouraged to bring Needlework or Knitting. Solving of Children's Crossword Puzzles. 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. 165 The approval of the Board of Education has now been obtained for additional accommodation of 20 boys and 40 girls. 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 suifering from active disease are not considered suitable cases for admission. All candidates for Fyfield have their teeth put in order and any necessary 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 174 boys and 139 girls were admitted and 175 boys and 134 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 322 cases sent for re-inspection, 23 did not attend for various reasons. Out of the 299 examined 266 showed continued improvement, whereas 33 had had intercurrent ailments, and their then present condition was not considered so satisfactory. The daily routine at this School commences at 7 a.m., when the children rise, clean their boots and shoes and wash. Breakfast is served at 8. This is followed by inspection and any necessary attention by the nursing staff. From 9.10 a.m. to 11.50 a.m. and from 2.40 p.m. to 4.35 p.m., classes are conducted by fully-qualified teachers in class-rooms specially constructed for open-air work. These rooms are open to the air on three sides and are fitted with a hot water heating system for use in cold weather. When conditions are suitable, classes are carried on in an enclosure where trees have been planted. Dinner is served at 12 and then comes the "Rest" of hours. During this time the children lie in a large open-sided rest-room on chairs made for the purpose and under the supervision of one of the nurses. At 4.45 the children have tea, and the remainder of the day is devoted to recreation. For this purpose there is a large playing field for football, cricket, netball, etc., and large rooms for indoor games. Evening entertainments are given and there is a children s library. Bathing takes place twice each week, and careful attention is given to teeth and personal hygiene generally. The dietary has proved quite satisfactory. A specimen week is given on the following page:— 166 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 l ea 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, etg. 167 Crosby Road Open-Air School. The Authority maintains a Day Open-air School at Crosby Road, Forest Gate, tor 60 Girls ana Junior Boys, from the age of 7 years upwards (see report by School Medical Officer, Appendix 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 7 boys and 11 girls were admitted, and 12 boys and 20 girls discharged. I am indebted to Miss Davies (the Head Mistress) for the following report on the School:— The year 1,935 opened with 75 children on the roll and ended with 67. Of the 32 children who left during the year, 25 returned to ordinary school, six were allowed to leave at the age of 14 years to take up suitable employment, and one girl was transferred to Fyfield Open-air Residential School. During the year, due attention has been paid to the usual school subjects, and additional time this year has been spent on physical training, to the decided benefit of the children mentally and physically, showing chiefly in an improvement in posture and in an increased readiness of response. The great stress laid on hygiene and personal cleanliness is rewarded by the improvement in the general bearing and appearance of the children, and in a marked gain in self-confidence and poise. The garden and the activities connected therewith are a great blessing to the School, and here again the benefits are moral, mental and physical. Great enthusiasm and really good material results were shown at the Vegetable and Flower Show held by the children in September. We endeavour to keep in touch and to co-operate with the parents in every way, and a Parents' Day, held in April, was a great success. The old girls and boys of the School enjoyed a Reunion in the form of a Garden Party 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. 169 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 9 cases were admitted and 13 discharged. (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 1935:— Swiss Cottage for the Blind 1 man Royal School for the Blind, Leatherhead 2 men Heritage Craft School 1 man In addition three adult blind persons received 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. 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 following reports have been received from the Assistant School Medical Officers and Dental Surgeons responsible for the Inspection and treatment of the children attending these two Nursery Schools :— Rebecca Cheetham Nursery School. Dr. West reports:—During the 1935 four quarterly routine medical tion were. The following particulars indicate the results. of same. Examination Boys examined Girls examined Total Parents present Number of Defects Percentage of Defects March 55 42 97 91 19 19.5 June 61 53 114 107 25 21.9 September 56 45 101 84 13 12.8 December 60 53 113 89 17 15.4 170 At the March examination a considerably larger number of children were in attendance than at the corresponding period in the previous year, and the percentage of defects was also much lower. The condition of the children was satisfactory. In June the attendance was particularly good, and most of the children examined showed dehnite increase in weight. Nose and throat, chest and minor skin complaints accounted for the majority of the defects found. In September a few of the children showed slight decrease in weight, due in part to previous illness, and perhaps in certain instances to some alteration in their diet and rest periods during the intervening holiday. There were no cases of infectious disease; absent children were either in convalescent homes or with their parents hopping. In December the general condition of the children was satisfactory, and with one exception all had gained weight. There were only two cases of infectious disease amongst the absentees— one being diphtheria and the other chicken pox. During the year 39 children were given Cod Liver Oil or Malt and Oil—these being cases of subnormal nutrition, bronchial catarrh and slight rickets. The Headmistress, Miss Bowen, continues to give valuable assistance both at the examinations and in ensuring the attendance of children requiring treatment at the Clinic. Miss Gubb reports on the Dental Examination and Treatment as follows:— The Routine School Inspection of all children attending the Nursery School was carried out during the year 1935. The Inspection was followed up by the Routine Treatment of all children requiring treatment whose parents accepted the treatment for their children. The parents on the whole accept treatment better now, not only merely to relieve acute toothache but for conservative work, and are more appreciative of the treatment. The children themselves benefit much from early treatment and from the good habits inculcated in them by regular and correct nose blowing, which I think is one of the important factors in preventing the chronic mouth breathing in a largje number of school children of all ages. I should like once more to tender my thanks to the Head Teacher for her kind co-operation and help and her great interest in the welfare of all her small charges. I am indebted to Miss Bowen for an account on the daily routine of the above School:— T he Nursery School opens at 8.30 a.m. so that elder brothers and sisters may leave the little ones on their way to school. Children continue to arrive until 9.30, and the daily contact with parents at this time affords a means of co-operation between home and school. 171 If a child is found, upon arrival, to be suffering from some minor ailment, the parent is urged to seek advice at the School Treatment Clinic. Meantime the children, after removing their outdoor clothing and putting on the coloured overalls provided for them, clean their teeth, and wash themselves if necessary. While some play with dolls and toys, others busy themselves over household duties. Boys and girls alike don rubber aprons and scrub tables and chairs with a zest which never ceases to thrill their astonished parents. Plants are watered, flowers arranged and the tables prepared for the morning milk and rusks. The children who have Cod Liver Oil at this time, upon the recommendation of the School Medical Officer, are regarded with envy by the rest. Morning songs of greeting, occupation with sense-training and creative materials, music, stories, toys and liberty to wander in the garden till the morning until the children come in to prepare for dinner. Faces and hands are very grubby by this time, but washing is no hardship when even the youngest child is encouraged to take his own flannel from the hook (identified by its picture], turn on the tap, and wash himself. This above all things, the child likes to do unaided, and any offer ot help is met by the injured assurance, "1 can wash myself." Dinner is awaited with eager impatience, but even hunger is forgotten in the desire to "serve." Great control is shown, not merely of appetite, but of eye and hand in carrying dishes on tiny trays made to fit the children's grasp. After second and third helpings, dinner becomes less absorbing, and voices are raised again, until they are hushed once more as the children fall asleep upon their beds. A romp in the garden, followed by a story or music, and the afternoon fruit, bring the day to a close, and parents are greeted with much excited chatter about the day's adventures. The Edith Kerrison Nursery School. Dr. Furniss reports:— The Edith Kerrison Nursery School has now completed its fifth year. During the year 1985 four quarterly medical inspections were carried out. The following report relates to the find- tions were carried out. The following report relates to the findings at these inspections:— Examination Boys examined Girls examined Total Parents present Number Defective Percentage of Defects March 51 64 115 104 25 21.0 June 56 59 115 96 22 20.0 September 47 42 89 73 11 12.3 December 52 53 105 75 18 17.1 The following are extracts from the four quarterly reports. March: "The condition of the children is very good, lour children are away with diphtheria." 172 June: "The general condition of the children remains good. There are, however, a number of children with bronchitis, due in great part to the inclement weather of the past few weeks. Five children were absent—one with scarlet fever, one with tonsillitis, one with a 'cold,' one away at a convalescent home, and one away for no apparent reason." September: "The condition of the children examined remains good. Apart from two cases of scarlet fever and one of whooping-cough, the school is free from infection. The large number of absentees is due to the fact that the children are either with their parents hop-picking or are away at convalescent homes." December: "The condition of the children is not so good as in the case of the three previous inspections. Many children were found to have bronchitis of rather a severe degree, whilst more were found with lesser degrees of bronchial catarrh. These conditions were caused in great part by the longer period of unusually wet and cold weather. The fifteen absent children are away in consequence of bronchitis or heavy colds. Details of defects and other information can be obtained from the quarterly reports." During the course of the year fifty-three children were given doses of a standardised brand of cod liver oil. These children were suffering from subnormal nutrition, debility, bronchitis and slight rickets. The Headmistress, Miss J.E. Cass, attends at every medical inspection. There is also complete co-ordination between Miss Cass and the School Medical Staff. Miss Marsden, the Dental Surgeon, reports:— The Edith Kerrison Nursery School was inspected twice during 1935, treatment following inspection. Owing to the nearness of the School to the Clinic, the attendance for treatment was very good. Only a small percentage of children needed treatment, which is very encouraging. This is very largely due to Miss Cass, the Headmistress, and I should like to thank her for her great helpfulness in encouraging the children to come to the Clinic. I also have to thank Miss Cass for the following account on the daily routine of the School:— Every morning at 8.30, sometimes before, the 2-to-5's begin arriving. Everyone begins by washing, a certain amount of grime having accumulated on the way to School. Teeth are then vigorously cleaned, mostly because it's such fun, although it has other merits. At 10 o'clock a mug of milk and a rusk help to stave off the first pangs of hunger. The shelters and garden offer almost unlimited possibilities— grass to roll on, bikes to ride, the jungle gym to climb, while the sand pit is even better than Southend. Very soon their mothers won't recognise these bonnie pink cheeked children. 173 Then there are times of quiet play, music, singing and dancing, with perhaps a story afterwards, while out of the cupboards come tea sets, dolls, puzzles, bricks, and all sorts of other jolly things. By this time of course everyone is really starving, but fortunately something is being done about it. By the time everyone has washed the sand off their hands, put their toys away, and settled themselves tidily at the table, the dinner wagons appear. Their arrival is joyfully proclaimed, and some of the 2-year-olds mount their chairs, unobserved, to get a better view of what is on the plates. Very soon these same plates are empty. A certain amount of dinner has now to be removed from hands and faces, and teeth are given a last scrub. By this time beds are down, and soon everyone is wrapt in a blanket, "To sleep—perchance to dream," but only of pleasant things. After nearly two hours of peace, everyone feels lively again, ready for a little more play and some fruit before "Mums" and "Dads" arrive, and the Nursery School day is over. There are two Voluntary Day Nursery Schools in the Borough. No statutory medical examinations have taken place in the schools, but children under 5 years for whom operative treatment of Tonsils and Adenoids is required are referred for treatment by the Maternity and Child Welfare Department. The following are the details of the Dockland Settlement Nursery School:— Our aim in the Nursery School during the past year has been to give the children a deep feeling of security—a peaceful atmosphere—and the help, opportunity and materials necessary for their physical and mental development. To do this we have tried to have no hurried times; to keep the school a united family while allowing each age of child to do things at their own rate; and also to have restful periods besides the sleeping time. The children's day is 8.30 a.m.—4.30 p.m. During the day the children have a mid-morning drink of milk—a two course dinner and a tea. They have these together—also the afternoon sleep, indoors in winter, and in the garden in summer. They also play together in the playroom when they first come (after they have cleaned their teeth—combed their hair and put on their pinafores). At this time the room has in it flowers, growing plants in a movable box garden, fishes, newts, growing seeds and other seasonable nature objects. It has wheeled toys, big bricks, a slide, climbing ladder, dolls .and doll's beds. The afternoon play, which is in the open air whenever possible, is similar to this. In the mid-morning they play in the Settlement garden, finding all sorts of interesting insects, birds, flowers and pants. 174 In the middle of the morning the two-year-olds have the bathroom to themselves for a long time, so that while most are playing with quiet toys a few at a time are learning to wash themselves and enjoying it. Meanwhile the big ones in the playroom have music, stories, and occupations involving sensetraining materials and toys requiring careful manipulation, such as fretsaw puzzles, interlocking toys, hammering, etc. The big ones have another quiet time at 10 o'clock in the morning; a time most useful for language training and for developing a true family feeling. They tell of interesting things which have happened at home or in the streets, are shown new objects in the school, or pictures illustrating what thev have seen. A simple hymn is then sung. The past year has been an exceedingly healthy and happy one for us. Our attendance has also been good. (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). 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 visions, chest measurements, and other enquiries incidental to the age period being noted. 175 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 treatment of Tonsils and Adenoids, Defective Vision, and Tinea of the Scalp (X-Ray Treatment) are available if required. Arrangements have been made for the female students to be examined by a lady Doctor Total number inspected 234 Total number of defects found 37 As on previous occasions, defective vision was responsible for the majority of the defects. The students appeared to be healthy, well nourished, and of good physique. Thanks are due to the Principal and Staff of the College for their kind co-operation and assistance during the inspections. SECONDARY SCHOOLS. All the Scholars in the West Ham Secondary 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. 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. Dr. West has submitted the following report on the examination of the boys at the above School:— The customary Routine Medical Inspection of the pupils attending the above School was made during the year 1935, and those requiring treatment were seen three months later to ascertain if this had been obtained. Total number examined 359 Found defective 14.7% 176 The principle defects noted were:— Skin Disease 2 Defective Vision 34 Other Eye Conditions 1 Defective Hearing 1 Enlarged Tonsils and Adenoids 1 Other Throat' Conditions 1 Catarrhal Chest Conditions 1 Other Conditions 15 Re-inspection. Skin conditions—both improved under treatment. Vision—Of the 34 cases referred for refraction, 27 were prescribed glasses and obtained them. Other Eye conditions—Blepharitis much improved. Defective Hearing-—Some improvement noted; still receiving hospital treatment. Enlarged Tonsils—Awaiting operation at later date. Nasal obstruction—Improved following treatment by nasal douches. Chest conditions—Improved. Other conditions—Two cases of hernia had received surgical treatment and were cured; the other defects, mainly of a minor orthopaedic nature, had all improved as a result of remedial exercises. Dr. Fitchet reports as follows regarding: the girls:— All the girls were examined during 1935, and those found to require treatment were re-examined later in the year. Two hundred and sixty-two girls were examined, and of these 40 were found to require treatment. The Drill Mistress undertook to carry out the necessary remedial exercises for slight deformities. Our best thanks are due to the Principal, Dr. Churchill, and his staff for the valuable assistance rendered to the School Medical Department. PLAISTOW SECONDARY SCHOOL. I have received from Dr. Furniss the undermentioned report on the examination of the boys at this School:— All the boys were examined during the year 1935, and those requiring treatment or observation were seen at the School two or three months later. No. examined 346 No. defective 81 Percentage defective 23.4 The greatest number of defects (77%) was due to faulty vision. 177 The Nutritional state of the boys was very good, the analysis being as follows:— Excellent 110 31.8% Normal 234 67.7% Slightly subnormal 2 .5% 346 100.0% Chief defects referred for Treatment and Observation:— Defect Treatment Observation Skin diseases 3 - Blepharitis 2 - Conjunctivitis ,1 - Defective vision 63 9 Other Eye conditions - 1 Otitis media 1 - Enlarged Tonsils 6 - Other Throat condition 1 - Defective speech - 1 Oral Sepsis 2 Heart Disease 1 1 Lung Disease (not T.B.) - 1 Spinal Curvature 2 - Other deformities 1 1 Other defects 5 1 The two slightly subnormal nutrition cases were recommended suitable treatment. Re-inspection. Skin diseases—Two recovered, one much better. Blepharitis—Both recovered. Conjunctivitis—Recovered. Defective vision—Fifty-six boys were prescribed glasses and all obtained them. There were also two East Ham cases, one of whom obtained the glasses, the other had not by the end of the year. Five boys were not prescribed glasses. Six of the nine observation cases were at reinspection put through to see the Eye Specialist. Otitis Media—Recovered as a result of Clinic treatment. Enlarged Tonsils—All six cases showed some improvement as a result of medical treatment (gargles, etc.). Other Throat condition (catarrh)—Recovered. Oral Sepsis—Both had dental treatment. Heart Disease—One boy improving, the other boy almost well. 178 Spinal Curvature—Both boys improving as a result of special exercises. Other Deformity—Boy attending Orthopaedic Clinic. Other Defects (five)—The three boys with boils, one with whitlow, and one debilitated, all recovered. Dr. Fitchet also reports regarding the girls:— All the girls were medically examined during 1935. Total number examined 243 Defects found 57 Those girls found to require treatment were re-examined later in the year to determine if this had been satisfactorily obtained. The Principal, Mr. J. W. Hand, takes a keen interest in the medical inspection of the pupils. He is ready at all times to cooperate with the School Medical Department. WEST HAM HIGH SCHOOL FOR CIRLS AND ST. ANCELA'S HICH 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 mainlv treated by the School Oculist, but a few parents prefer to obtain treatment privately. All other defects are treated almost entirely privately. WEST HAM HICH SCHOOL FOR CIRLS. All the West Ham pupils, excluding those in the Preparatory School, were examined during 1935. The number examined was 199, and of these 27 were found to require treatment. A list of 45 names of girls requiring remedial exercises for flight deformities was left with the Drill Mistress, who shows great enthusiasm in carrying out this treatment. A re-inspection of those girls found defective took place later in the year. Thanks are due to the Principal and her Staff for their efficient co-operation during the inspections. 179 ST. ANGELA'S HIGH SCHOOL FOR GIRLS. An inspection of all West Ham pupils, excluding those in the Preparatory School, was made during 1935. A total of 159 pupils were examined, of whom 20 were found to require treatment. A re-inspection of those found defective was carried out later. In addition, 20 girls required remedial exercises for slight deformities, and this was willingly undertaken by the Drill Mistress. The Principal continues her active interest and co-operation in the Medical Inspection. Continuation Schools. There are two Continuation Schools in the Borough, viz., the Shakespeare Institute and the Lister Institute. Routine Medical Inspection of the pupils attending the Continuation Schools is now undertaken by the Authority. Arrangements have been made for the examination of the Girl students by a Lady Doctor at each school. All the pupils attending the two Continuation Schools in the Borough were examined during- the vear 1935. The following particulars relate to the examination of the boys:— No. examined No. defective Shakespeare Institute 46 8 Lister Institute 56 10 The principle defects noted were:— Shakespeare Institute: Defective Vision 7 Other Eye conditions 1 Nose and Throat conditions 1 Lister Institute: Defective Vision 6 Adenoids 1 Other Throat and Nose conditions 2 Flat Foot 1 Arrangements were made for the following up of all cases where defects were found, and for the treatment of any minor ailments at the School Clinics if desired. The results of the Inspection of the Girls in October, 1935, were as follows:— 180  Examined Defective Lister Institute 83 19 Shakespeare Institute 59 5 Total 142 24 Parents present, 77; i.e. 54%. The following were the defects found Treatment. Skin Disease 5 Defective Vision 16 Squint 1 Miscellaneous 6 Five cases were referred for observation. Early dental treatment was advised in 20 cases. There were a few cases of early flat feet and faulty posture. In these cases simple exercises were taught and special instructions given to teachers. The physical condition was good, and classified as follows :— Above average 25.3% Average 66.2% Below average 8.5% The cleanliness was satisfactory. Since the Routine Inspection those children requiring treatment have been "followed up" and in most cases treatment was obtained either at a Hospital or the School Clinic. During the year 1935 all those children who were found to have defects at the Routine Medical Inspection in October, 1934, were "followed up" .and in the majority of cases treatment was found to have been obtained through the School Medical Service or privately. During the year the following "received attention" at the Minor Ailments Clinic:— Special Cases 20 Re-inspections 10 The standard of health and physique of the majority of the pupils was satisfactory and personal hygiene good. Both the Principals take a keen interest in the examinations, and afford every facility for the smooth conduct of same. 181 Scholarship Children. All scholarship children are medically examined soon alter 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. Nos. 3, 4, 5, and 6 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 ol 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. 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 Clinics and Hospital arrangements for the operative treatment of Tonsils and Adenoids are available for cases needing it. 182 The Grove Central School. During the year Medical Inspection was carried out at the above School, and a total of 190 scholars was examined. The number of defects found amounted to 55. The Principal, Mr. Madden, continues to take a great interest in the work of the School Medical Service, and his assistance is much appreciated. The Russell Central School. All leavers were examined in June, 1935, and the entrants in October. Total Number Examined 180 Defects found 28 All students found defective at the examinations were followed up and re-inspected. Improvement or cures were obtained in all cases. As on previous occasions, defective vision was responsible for the majority of defects. The Principal, Mr. C. W. Truelove, takes the greatest interest in the School Medical Inspection, with the result that a large percentage of the parents attend the examinations. The standard of health and hygiene among the scholars at both the above schools was very satisfactory. (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 t>ommittee, to supply the spectacles at contract price at a cost to the parents according to their means. 183 (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. (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 1935, 244 children were examined; two certificates were 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 52 girls. Pathological Work. The microscopical examination of sputum for the piesence of the tubercle bacillus is undertaken by the Tuberculosis Officer. Throat swabs are taken by 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. 184 APPENDIX I. REPORT BY THE SCHOOL MEDICAL OFFICER UPON CROSBY ROAD OPEN-AIR DAY SCHOOL. In accordance with the instructions of the Education Committee 1 beg to submit a report upon the above-named School. This School was opened on, April 27th, 1925, and was named the Knox Road Open-air Day School. It was erected on the same site as that of the Knox Road Special School, and consisted of temporary structures, comprising two class-rooms, each accommodating thirty children, a cloakroom, and a dining-room which was also used as a rest-room. The children attending the School were girls who were, in the opinion of the School Medical Officer, too delicate properly to derive the full benefit from the ordinary Elementary School and who needed special attention. The School was placed under a separate headship from that of the adjoining Special School for mentally defective and physically defective children. In February, 1926, the name of the School was changed to Crosby Road Open-air Day School, in order to meet certain objections received in regard to its being possibly confused with the M.D. School. In July, 1931, after due consideration of a report from your Chief Inspector at that time, the Education Committee decided to increase the accommodation of the School from sixty to ninety pupils. Only girls had been previously admitted; it was now agreed also that boys up to the age of eleven years be admitted to the two lower classes. An additional class-room was provided by the rest-room being used as a class-room. Additional cloak-rooms, and a medical inspection room (since disused for this purpose) were installed, and certain minor improvements were also carried out. The School is open on five ordinary school days each week, and the hours of attendance are from 9 a.m. to 5.30 p.m. during the Summer months, gradually shortening to 4 p.m. during the Winter months. The scholars use the spray baths provided at the Knox Road Special School. Hot running water is provided for washing purposes. Heating of the School in the Winter is by slow combustion stoves in two class-rooms, and by an electric radiator in the room used as a dining-hall and class-room. 185 The Staff consists of:— 1 Head Teacher (part time). 3 Assistant Teachers. 1 School Nurse (part time). 1 General Helper. Kitchen staff are those employed at Knox Road Special School. 1 ram tickets are provided for the children where necessary, free or at part cost, according to the parents' income. Meals are provided as follows:— Breakfast at 8.45 a.m. during the Summer, and 9 a.m. during the Winter months. Dinner at 12 noon. Full tea at 5 p.m. during the Summer months. Milk and a biscuit at 4 p.m. during the Winter months. Mid-morning milk at 10.45 a.m. All the children have a rest period from 1.30 p.m. to about 3 p.m. This School has in my opinion served a very valuable purpose in the interests of the weakly school children of the Borough (a review of the reports of the Headmistresses issued yearly in my report bears out this view). With the opening of the girls' section of the Fyfield Residential Open-air School the number of parents willing to send their children to the Day Open-air School fell off somewhat, as was perhaps only natural. The School has from the first had to face a number of drawbacks, particularly in respect to the type and "limitation of the structure provided ^which was only temporary), and in regard to its being within the same curtilage as a school for mentally defective children. The site not being a central one is also detrimental. The fact also that there is one room used continually as a class-room, as a rest-room, and as a dining-room, appears to be a highly undesirable arrangement. Bearing this in mind, I suggest that the Committee consider returning to the original number of sixty pupils of both girls and junior boys, when the School should continue to be of the utmost value. F. GARLAND COLLINS, School Medical Officer. Municipal Health Offices, Romford Road, Stratford, E.15. October, 1935. 186 APPENDIX II. A REPORT BY THE SCHOOL MEDICAL OFFICER UPON A PROPOSED NEW SCHOOL FOR CERTAIN SPECIAL DISABILITIES. As far back as November, 1929, 1 issued a report proposing certain additional services for the betterment of the health of your school children, and setting- out certain suggestions in regard to them. Since that date very little has been done in this matter. Two months ago another report was issued on the same theme, including in addition to my original scheme new accommodation for deaf children, at present provided for in your two Deaf Centres, which have been established for many years. It is, of course, common knowledge that there exist wide differences of opinion as to the advisability, or otherwise, of treating certain disabilities in special schools, and as to the wisdom of segregation or non-segregation of various types of scholars. These differences of opinion, however, should in no way be allowed to mask the fact that there are a very considerable number of children who should be dealt with, without further undue delay, in some way, either through the School Medical Service, educationally, or by the co-operation of the appropriate social services. A school of the type such as I have already mooted in my last report to you would, in my opinion, be a valuable asset to the medical and educational services of the Borough. Whether this view be accepted or not, it is manifest that there are a very considerable number of children attending the elementary schools in West Ham who are a deterrent to other children, and who need some, specialised or individualised form of treatment. I am setting out in further detail and under the various headings the types mentioned in the report issued to you in February, 1936. (1) Myopia (Partially Sighted Children). The report of the Committee appointed by the Board of Education to inquire into this condition was issued in 1934, and deals exhaustively with the whole question. In the return made to the Board of Education for the year 1935, there were sixteen children classified as partially sighted children, i.e., those who, "though they cannot read ordinary school books or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a special school for the partially sighted." Most of these are sent to a Myopic School under the London County Council, but it would be far more advantageous if this Authority had a school or class of its own, as it is open to parents to object to their children going to extraneous schools. The average number of such children is stated to be one in a thousand of the school population, which would give in this Borough at least forty cases. 187 (2) Speech Defects. In 1930 classes for stammerers were established, one in the north and one in the south of the Borough, and were moved from school to school according to the convenience of the pupils and the availability of rooms in the schools. During the last two or three years it has been found that only one such class was practicable. There are, however, still many stammerers who remain uncured, and in addition, there are a number of children suffering from speech defects other than stammering. My return for 1935 to the Board of Education gave sixty-nine such children requiring treatment for speech defect, and one hundred and five children requiring observation, some of whose defects are probably the result of enlarged tonsils and adenoids. 1 suggest that accommodation for at least twenty-five such children should be provided. On page 1'27 of the report above referred to on "partially sighted children," it is stated that "speech training is an especially important subject for partially sighted children." Assuming this to be correct, the great advantage of a special class for speech defects in the same curtilage as a class for myopic children is obvious. (3) Certain Rheumatic Conditions. At present this Authority has no special facilities for dealing with cases of rheumatism. Some are sent to different clinics in London; some attend ordinary schools, and, in addition, there are those cases which have progressed to a state of definite and serious heart disease (i.e., are incapable by reason of such physical defect of receiving proper benefit from instruction in the ordinary public elementary schools); of these latter thirty-four are attending one or the other of your schools for physically defective children, and according to the return already mentioned for 1935, twenty-two such heart cases are attending public elementary schools. There are, however, in addition to these definite cases, children who are predisposed to rheumatism and heart disabilities, and on the border-line of becoming permanently affected (cases definitely unsuitable for open-air schools or ordinary convalescence); these should be at school under special attention for a somewhat lengthy period. Such children obviously need specialised forms of physical exercises—so do partially sighted children; one more reason for collective co-operation of specialised procedure. Accommodation for some fifty cases under heading (3) is desirable. (4) Deaf Children (see previous report). 188 (5) Very Retarded Children. In my report of February, 1936, I referred to the findings of the Joint Committee set up by the Board of Education and the Board of Control to investigate this complex problem. In order to get first-hand knowledge of the present position in West Ham Schools I solicited the ever-willing help and valuable co-operation of your Head Teachers in a letter couched as follows :— Municipal Health Offices, Romford Road, Stratford, E.15. 31st March, J936. Dear Sir (or Madam), Very Retarded Children. 1 shall be very grateful if you will kindly send me names and addresses, together with any other relevant particulars of such children, if any, in your school, who in your judgment may be classed as "very retarded." This term implies those children who are so mentally dull and retarded as to be incapable of keeping up with even an ordinary dull and backward pupil, or who are outstandingly a deterrent to the progress or comfort of other children, though not necessarily able to be classified as mental defectives. Your co-operation in this involved matter will be deeply appreciated. Yours faithfully, F. GARLAND COLLINS, lo the Head Teacher. School Medical Officer. P.S.—For your convenience 1 enclose a form and stamped addressed envelope for reply. Replies which I have received and tabulated reveal information of a disquieting nature. No fewer than six hundred names have been submitted as falling more or less into the category defined in my letter; only eight Head Tcachcrs failed to send in a report, (a) 29 Head Teachers sent "nil" returns, (b) 8 Head Teachers sent returns of from 1 to 5 cases, (c) 33 sent returns of 0 to 10 cases, and (d) 7 sent returns of 11 cases or over. 189 (e) Age Groups. Age Boys Girls Total 4 1 0 1 5 14 10 24 6 38 24 62 7 50 29 79 8 49 39 88 9 38 36 74 10 42 45 87 11 32 42 74 12 30 42 72 13 22 17 39 14 0 0 0 Total 316 284 600 (f) Accompanying special defects are noted in these very retarded children, as follows :— Epilepsy 1 Special Defects 27 Eye Defects 10 Asthma 2 Chorea 5 Weak Heart 4 Defect in Walking 1 In two cases it is specially noted that the child is due to go to a Senior School at an early date; moreover, the age group total shows that 84 boys and 101 girls are over eleven years of age and, therefore, presumably in Senior Schools. I will quote a few of the remarks made by the Head Teachers on certain cases. (a) Peggy B—, 11 years. "Abnormally backward for her age; healthy, well kept and fed, and no abnormal illnesses. Can write and sew well, but has great difficulty with the simplest reading; bad memory; poor at numbers; is doing seven-year-old work, and goes to a Senior School in August." (b) Florence D—, 10 years. "Very backward; finds it impossible to keep up with the rest of 'C' Division; very bad memory; no concentration; very difficult to make her improve herself at all." 190 (c) Gladys W—, 9½ years. "Has impediment in her speech; seems very simple. Although 9 years of age, does not know two lettered words, and cannot put together simple numbers, e.g., 2 + 1." (d) Margaret C—, 9 years. "Working in lowest class, but cannot keep up with even the slow ones. Is up to the level of a very medium 7 year old." (e) Vera G—, 13 years. "Mentally unstable. Has periods when she can do nothing at all." (f) Three boys, aged 8 years. "These boys are definitely very retarded, and are a serious drawback in a class of forty children. They are able to copy from a blackboard, but the work is obviously of a parrotlike nature, and they have little conception of its meaning. They can write their names, but cannot tell me the names of the letters comprising them. On the other hand, they are capable of assimilating knowledge, but the progress would be very slow and needing a lot of special individual teaching." (g) Ivy M—, 12 years. "Although we are able to classify the A, B, C and D classes, and though girls in the 'D' group are generally speaking, dull and backward, Ivy is unable to follow the work of the class, and has to be treated separately. She presents no behaviour problem, and is most persevering and patient." (h) Leonard W—, 13 years. "This boy was submitted as M.D. when 7 years of age, but was not regarded as suitable for admission to a M.D. School. During' the last eighteen months, when he has been working in a 'C' group, he has made some slight progress. He is decidedly unable to keep up with the ordinary dull and backward pupils." After they have left the ordinary elementary schools many such cases as the above come to my notice as Medical Officer of Health, often through the Police Court, the illegitimate birth register, or because of abnormal behaviour of some sort. These cases reveal evidence of a sub-normal mind usuallv of prolonged standing, and of abnormal impulses which, in many instances, had they been dealt with in childhood, would have been subjugated. There is no scientific way of gauging- exactlv the degree of intelligence or lack of intelligence in a person. The intelligence tests usually applied, are admittedly only a guide; moreover, the activity of a subnormal mind is prone to even greater degrees of changes of latitude than a normal mind. 191 It is thus evidently impossible at one examination of a pupil to gauge accurately his mental ratio. I do not suggest that the whole of the six hundred children whose names have been submitted as being very retarded should be treated at a special school. I do submit, however, that the matter cannot any longer be disregarded, and that the disabilities should be individually and properly analysed and, if necessary, classified into different groups, in order that these unfortunate children may receive the proper attention to improve their condition and prospects, and so prevent them hindering their fellow pupils or becoming a perpetual menace to the law and order of domestic life and to the State, if not eventually a charge upon the public in institutions, or otherwise. In my judgment no fewer than two hundred vacancies in the first instance should be allotted to cases of this character specially selected by Head Teachers and Doctors as suitable for training apart from the ordinary elementary school. The objection to children with a subnormal mind being educated within the same curtilage as other tvpes of physically subnormal children is not a serious one, and should be faced in the interest of the children themselves, the parents being made thoroughly to realise that this only means the same site being used and not actual contact of the different types with each other. The dearth of available sites, in this area at least, renders a multiplicity of special schools impracticable, even if it were necessary. Generally, it is nearly thirty years since the School Medical Service was inaugurated, over which period an enormous amount of statistical and clinical evidence has been accumulated. The time appears ripe to discard much of what has been proved to be of little, or no, comparative value, and to concentrate more upon those aspects of the Service which enhance the general well-being of the school population, and render the school child of to-day a healthy, useful and contented citizen of to-morrow. The foregoing report purports to indicate the need of this. Further, the treatment of thousands of cases of trivial minor ailments at school clinics aids very little in the broader scheme ; these clinics might function more as consultative centres. Finally, arrangements should be made for the examination of more children otherwise than by routine age groups, and an extension of the dental scheme to include all ages is necessary. F. GARLAND COLLINS, School Medical Officer. Municipal Health Offices, Romford Road, West Ham, E.15. May, 1936. 192 APPENDIX III. STATISTICAL TABLES, SCHOOL MEDICAL OFFICER'S ANNUAL REPORT, 1935. 193 MEDICAL INSPECTION RETURNS. Year ended 31st December, 1935. ELEMENTARY SCHOOLS. TABLE 1. A.—Routine Medical Inspection. Number of Inspections in the Prescribed Groups. Entrants 4871 Second Age Group 3984 Third Age Group 4907 Total 13762 Number of other Routine Inspections 1678 Grand Total 15440 B.—Other Inspections. Number of Special Inspections 15609 Number of Re-Inspections 7243 Total 22852 C.—Children found to require Treatment. Number of Individual Children Found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Prescribed Groups: Entrants 884 Seconds Age Group 735 Third Age Group 927 Total (Prescribed Group) 2546 Other Routine Inspections 117 Grand Total 2663 194 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1935. Defect or Dlaesae. (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) Skin— (1) Ringworm—Scalp — — 13 — (2) Ringworm—Body 9 — 139 — (3) Scabies 11 — 164 — (4) Impetigo 8 5 672 — (5) Other Diseases (Non-Tuberculous) 116 43 3423 1 TOTAL (Heads 1 to 5) 144 48 4411 1 Eye— (6) Blepharitis 47 10 312 1 (7) Conjunctivitis 16 2 507 2 (8) Keratitis — — 12 — (9) Corneal Opacities — 1 2 1 (10) Other Conditions (excluding Defective Vision & Squint) 12 13 255 6 TOTAL (Heads 6 to 10) 75 26 1088 10 (11) Defective Vision (excluding Squint) 591 126 619 4 (12) Squint 123 21 162 2 Ear— (13) Defective Hearing 45 14 38 2 (14) Otitis Media 83 28 544 4 (15) Other F.ar Diseases 57 4 338 2 Nose and Throat— 16) Chronic Tonsillitis only 197 225 119 3 (17) Adenoids only 40 43 25 1 (18) Chronic Tonsillitis and Adenoids 287 64 357 6 (19) Other Conditions 114 36 192 2 (20) Enlarged Cervical Glands (Non-T uberculous) 19 56 251 5 (21) Defective Speech 8 51 61 54 Heart and Circulation— Heart Disease: (22) Organic 33 156 39 37 (23) Functional 1 78 - 9 (24) Anaemia 186 123 156 18 195 TABLE II.— (Continued) Defect or Disease. Routine Inspection Special Inspection No. of Defects No. of Defect Requiring treatment Requiring to be kept under observation, but not requiring treatment Requiring treatment Requiting to be kept uudsf observation, but not requiring treatment (1) (2) (3) (4) (5) Lungs— (25) Bronchitis 124 179 113 13 (26) Other Non-Tuberculous Diseases 22 64 15 6 Tuberculosis— Pulmonary: (27) Definite 1 1 I 1 (28) Suspected 19 24 5 25 Non-Pulmonary: (29) Glands 7 6 6 2 (30) Bones and Joints — 1 — 1 (31) Skin — 2 — — (32) Other Forms — — — — TOTAL (Heads 29 to 32) 7 9 6 3 Nervous System (33) Epilepsy 3 12 9 11 (34) Chorea 21 21 27 16 (35) Other Conditions 27 40 56 25 Deformities— (36) Rickets 3 6 — 1 (37) Spinal Curvature 27 4 6 — (38) Other Forms 53 61 51 6 (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 464 404 6638 65 Total 2774 1924 15327 332 B.—Classification of the Nutrition of Children Inspected during the Year in the Routine Age Croups. Age-groups Number of Children Inspected A (Excellent) T? (Normal) (Slightly subnormal) D (Bad) No. % No. % No. or /o No. % Entrants 4871 666 13.67 3609 74.09 |560 11.5 36 .74 Second Age-group 3984 523 13.12 2963 74.37 457 11.47 41 1.03 Third Age-group 4907 876 17.85 3525 71.84 464 9.45 42 .85 Other Routine Inspections 1678 366 21.81 1186 70.68 114 6.79 12 .71 TOTAL 15440 2431 15.74 11282 73.08 1595 10.33 1311 .84 196 TABLE III. Return of all Exceptional Children in the Area. Blind Children. At Certified Schools for the Blind. At Public Elementary Schools At , Other Institutions. At no School or Institution. Total 2 — — — 2 Partially Sighted Children. At Certified Schools for the Blind. At Certified Schools for the Partially Sighted. At Public Elementary Schools At Other Institutions. At no School or Institution. Total. — 12 3 - 1 16 Deaf Children. At Certified Schools for the Deaf. At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 27 — — — 27 Partially Deaf Children. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 6 — 6 — — 12 Mentally Defective Children. Feeble-minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 170 20 2 18 210 197 Epileptic Children. Children Suffering from Severe Epilepsy. At Certified Special Schools At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 5 2 2 6 15 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 — — (b) Imbeciles 2 — (c) Others 4 9 (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 2 Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 3 1 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 — — Number of children notified 10 12 Physically Defective Children. A. Tuberculous Children. 1.—Children Suffering from Pulmonary Tuberculosis. At Certified Special Schools At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 39 3 2 3 47 198 II.— Children Suffering from Non-Pulmonary Tuberculosis. Certified At Special Schools At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 57 12 2 - 71 B. Delicate Children. At Certified Special Schools At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 221 263 — 10 494 C. Crippled Children. At Certified Special Schools At Public Elementary Schools At Other Institutions. At no School or Institution. Total. 71 9 1 9 90 D. Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 34 22 — 10 66 Children Suffering from Multiple Defects. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Deaf and Dumb and Mental Defect. 1 - - - I Epilepsy and Crippling 1 - - - I Epilepsy and Mental Defect - - - 2 2 Mental Defect and Crippling - - 1 - 1 Mental Defect and Heart 1 - — - 1 199 TABLE IV. Treatment Tables. Croup 1.—Minor Ailments (excluding Uncleanliness, for which see Table VI.) Disease or Detect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm-Scalp— (i) X-Ray Treatment 6 — 6 (ii) Other ,, 7 — 7 Ringworm-Body 142 4 146 Scabies 165 3 168 Impetigo 674 5 679 Other skin disease 3387 89 3476 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 1101 52 1153 Minor Ear Defects 978 62 1040 Miscellaneous (e.g., minor injuries, bruises, sores chilblains, etc.) 5485 477 5962 Total 11945 692 12637 Croup II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group 1). No. of Defects dealt with. Under the Authority's Scheme. Otherwise. Total. Errors of Refraction (including squint) 3419 64 3483 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) Total 3419 64 3483 200 TABLE IV.— Continued. No. of Defects dealt with. Under the Authority's Scheme Otherwise Total No. of Children for whom spectacles were (a) Prescribed 2635 58 2693 (b) Obtained 2502 58 2560 Croup 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) 157 883 122 32 522 5 7 3 32 3 129 35 554 8 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. Croup IV.— Orthopaedic and Postural Defects. 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 of an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) Number of children treated. 1 19 73 — 1 27 121 201 TABLE V.—Dental Inspection and Treatment. (1) Number of Children who were Inspected by the Dentist: Aged: (a) Routine Age Groups. 4 378 Total 16674 5 688 6 4049 7 3899 8 3820 9 673 10 672 11 697 12 854 13 900 14 44 (b) Specials 3890 (c) Total (Routine and Specials 20564 (2) Number found to require treatment 13518 (3) Actually treated 10684 (4) Attendances made by children for treatment 16883 (5) Half-days devoted to— Inspection 191 Treatment 2001 Total 2192 (6) Fillings— Permanent teeth 1825 Temporary teeth 538 Total 2363 (7) Extractions— Permanent teeth 1566 Temporary teeth 16356 Total 17922 (8) Administrations of general anaesthetics for extractions Nil (9) Other Operations— Permanent teeth 2125 Temporary teeth 585 Total 2710 TABLE VI.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 12.7 (ii) Total number of examinations of children in the Schools by School Nurses 89149 (iii) Number of individual children found unclean 1452 (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 202 MEDICAL INSPECTION RETURNS. Year ended 31st December, 1935. SECONDARY SCHOOLS AND OTHER INSTITUTIONS OF HIGHER EDUCATION. TABLE I. A.—Routine Medical Inspections. Number of Inspections 2608 B.— Other Inspections. Number of Special Inspections 81 Number of Re-Inspections 402 Total 483 C.—Children Found to Require Treatment. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding uncleanliness and Dental Disease) 438 203 TABLE 11. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1935. 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) Skin— (1) Ringworm — Scalp — — — — (2) Ringworm — Body — — 1 — (3) Scabies — — — — (4) impetigo — — — — (5) Other Diseases (Non-Tuberculous) 26 2 12 - TOTAL (Heads 1 to 5) 26 2 13 — Eye— (6) Blepharitis 11 1 — — (7) Conjunctivitis 6 — 5 — (8) Keratitis — — — — (9) Corneal Opacities — — — — (10) Other Conditions (excluding Defective Vision & Squint) - - 1 - TOTAL (Heads 6 to 10) 17 1 6 — (11) Defective Vision (excluding Squint) 261 39 15 - (12) Squint 3 1 — — Ear— (13) Defective Hearing 3 — - — (14) Otitis Media 11 — 3 — (15) Other Ear Diseases 6 3 - 1 Nose and Throat— (16) Chronic Tonsillitis only 17 4 1 — (17) Adenoids only 1 - - — (18) Chronic Tonsillitis & Adenoids 1 1 3 — (19) Other Conditions 21 3 2 — (20) Enlarged Cervical Glands (Non-Tuberculous) 1 - - - (21) Defective Speech — 5 — 1 Heart and Circulation— Heart Disease: (22) Organic 2 13 - 1 (23) Functional — 5 1 — (24) Anaemia 20 8 — 1 Lungs— (25) Bronchitis 1 — — — (26) Other Non-Tuberculous Diseases - 3 - - 204 TABLE II.—Cont. 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: (27) Definite — — — — (28) Suspected 1 3 — — Non-Pulmonary : (29) Glands — 1 — — (30) Bones and Joints — 1 — (31) Skin — - — — (32) Other Forms — - — — TOTAL (Heads 29 to 32) — 2 — — Nervous System— (33) Epilepsy — 1 — — (34) Chorea — 2 — — (35) Other Conditions 2 1 — — Deformities— (36) Rickets — — — — (37) Spinal Curvature 9 1 - — (38) Other Forms 15 12 1 — (39) Other Defects and Diseases excluding Uncleanliness and Dental Diseases) 43 22 26 Total 461 132 71 4 B. Classification of the Nutrition of Children Inspected During the Year in the Routine Age Groups. Age-groups Number of Children Inspected A (Excellent) B (Normal) c (Slightly subnormal) D (Bad) No. % No. % No. % No. % Routine Inspections 2608 488 18.71 19991 76.65 121 4.64 - - 205 TABLE IV. Treatment Tables. Croup 1.—Minor Ailments (excluding Uncleanliness, for which see Table VI.) Disease or Defcct Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm-Scalp— (i) X-Ray Treatment — — — (ii) Other ,, — — — Ringworm-Body 1 — 1 Scabies — — — Impetigo — — — Other skin disease 13 15 28 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 8 10 18 17 Minor Ear Defects 8 9 Miscellaneous (e.g., minor injuries, bruises, sores chilblains, etc.) 10 27 37 Total 40 61 101 Croup II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). (1) No. of Defects dealt with. Under the Authority's Scheme. (2) Otherwise (3) Total. ] Errors of Refraction (including squint) 440 11 451 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) - - - Total 440 11 J 451 206 TABLE IV—cont. Under the Authority's Scheme Otherwise. Total. No. of Children for whom spectacles were (a) Prescribed 403 11 414 (b) Obtained 365 11 376 Croup III.—Treatment of Defects 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) 15 33 3 — 5 — — — 10 — 3 — 15 — (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids. (iv) Other defects of the nose and throat. Croup IV.—Orthopaedic and Postural Defects. 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) Number of children treated. - - - - - 7 7 207 TABLE V.—Dental Inspection and Treatment. (1) Number of Children Inspected by the Dentist 127 (2) Number Found to require treatment 98 (3) Number Actually treated 95 (4) Attendances made by children for treatment 207 (5) Half-days devoted to:— Inspection - Treatment - Total - (6) Fillings— Permanent teeth 90 Temporary teeth — Total 90 (?) Extractions— Permanent teeth 65 Temporary teeth 35 Total 100 (8) Administration of general anaesthetics for extractions — (9) Other operations— Permanet teeth 59 Temporary teech — Total 59 208 INDEX (Public Health). Ambulance Services 37-38 Births 24 51 Birth Control 59 Central Home 41 49 Cerebro Spinal Fever 112 Charts 19 21 27 35 67 Children and Young Persons' Act, 1933 62-63 Clearance Areas, Housing Act 84-85 Clinics, School, etc 38-39 52-53 55 Committees, list of 7-9 Common Lodging Houses 75-76 Contents Convalescence 31 58-59 61-62 Council, list of Members 7 Dagenham Hospital and Sanatorium and Langdon Hills Sanatorium, Medical Superintendent's Report, etc. 39 119-121 Deaths 24 Deaths, causes of 25 66 Deaths, in Institutions 29 Dental Treatment 53 Diarrhoea, etc. (deaths from—under 2 years of age) 23 Diphtheria 24 103 110-111 District Medical Officers 4 Drainage and Sewerage 74 75 Dried Milk, distribution of 57 Dwelling Houses, Inspection of 79 Erysipelas 112 Extracts from Vital Statistics 23 Factories, Workshops and Workplaces 80 Fertilisers' and Feeding Stuffs' Act, 1926 93 Food, Inspection and Supervision of Unsound, etc. 90-101 Forest Gate Hospital 40 47 Forest House 40 50 Foster Children 62-63 General Provision of Health Services 31-74 Harold Wood Hospital 39 ITiaUli Rewipfv AetiMitfey of 35 Health Visiting 51 52 Home Helps 54 Hospitals 39-41 58 60-6 Hospitals, Voluntary 83 -89 Houses let in lodgings 24104 Immunization against Diphtheria Infantile Mortality 64-66 Infectious Diseases, Prevalence of. and Control over, etc. 39 102 Insulin, Suoplv of 34 Knackers' Yards 101 210 PAGE Laboratory Work 34 Langdon Hills Sanatorium 39 122-123 Margate Convalescent Home 41 Maternal Deaths 69-70 Maternity and Child Welfare, Report of Senior Medical Officer for, etc. 51-70 Maternity and Nursing Homes 38 59 Meals, free, for Expectant and Nursing Mothers 57-58 Measles 103 111 Meat, disposal of condemned 98 Meat, Public Health Regulations, 1924 97-100 Meningitis (Cerebro-Spinal) 112 Mental Deficiency 70-73 Midwives 54 57 Milk, Condensed, Regulations 90 91 96 Milk, Examination of (animal inoculation). 90 Milk, Bacteriological examination 91 99-100 Milk Supply 100 Milk (Special Designations) Order, 1923 90 92 Milk and Dairies (Amendment) Act, 1922 90 Milk and Dairies (Consolidation) Act, 1915 90 100 Milk and Dairies Order, 1926 89-90 100 Mosquitoes 77 Mortality Rates, Maternal, Infant and General 23 Mortuaries 45 Notifiable Diseases 102 Nursing Homes 38 59 Nursing, Professional, in the Home 38 Nutrition 96-97 Offensive Trades 77 Open-Air Schools 41 Ophthalmia Neonatorum 63 Orthopaedic Treatment, etc 38 60-61 Plaistow Hospital, Medical Superintendent's Report ... 104-115 Plaistow Hospital, Bacteriological Work 114 Pneumonia Ill Preface 5-6 Public Health (Preservatives, etc., in Food) Regulations 91 92 96 Puerperal Fever and Puerperal Pyrexia 64 Prosecutions 77-78 101 Psychological Clinic 31-33 Rag Flock Acts. 76 Rates— Birth 21 23 Death 19 23 Infantile Mortality 19 23 27 64 Maternal Mortality 23 69 70 Still Birth 23 211 PAGE Refuse Disposal 75 Report of Medical Officer of Health (Special) 86-89 Rivers and Streams 74 Samples taken, Food and Drugs Act, 1928 93-96 Sanitary Circumstances of Area 74-82 Scarlet Fever, Return Cases, etc. ... 24 103 109-110 Scavenging 75 Schick and Dick Test 113 115 Schools 81-82 Shops Acts 42-44 78 Sickness in Schools 103 Slaughter Houses 101 Slaughter of Animals Act, 1933 100 101 Smallpox 39 Smoke Abatement 76 Staff, List of 10-17 Statistics and Social Conditions of the Area 18-30 Statistics, Vital 23 South Ockendon Colony for Mental Defectives 72-73 Stratford Day Nursery 60 Summary of General Statistics 18 Do. Work of Sanitary Inspectors 78-79 Sunlight Clinic 60 Swimming Baths and Pools Treatment Centres 38 Tuberculosis 39 116 Do. Report of Tuberculosis Officer 115 123 Tuberculosis Order, 1925 '00 Typhoid Fever "' Vaccination Acts, 1867-1898, summary of work Venereal Diseases 124-129 Veterinary Officers' Report 100 Vital Statistics, Extracts from 23 Do. of Wards 23 Do. Chief since 1887 30 Water 74 Whipps Cross Hospital 40 48 Whooping Cough 103 111 212 INDEX (School Medical). SUBJECT. PAGE Artificial Light Baths 137 Blind Children Blind, Deaf, Defective and Epileptic Children 160 ,, ,, ,, ,, ,, Students Blind Persons' Act 17 Central Association for Mental Welfare 160 Central Schools Children's Country Holiday Fund '58 Co-ordination 136 Continuation Schools Convalescent Treatment 160 Crosby Road Open Air School 169, 185 Deaf Children 148, 160, 164 Defective Children '60 Dental Defects '42, 148 Ear Diseases '42, 148 Edith Kerrison Nursery School 172 Employment of Children and Young Persons 184 Epileptic Children 160 Exceptional Children 160 Exclusions '53 Eye Diseases (External) 142, 145 Findings of Medical Inspection 140 Following-up 144 Frederick Road Deaf Centre 164 Fyfield Open Air School 165 Grange Road Special School 161 Health Education 184 Hearing (Defective) 142, 148 Heart Disease 143, 151 Height (Comparative Tables) 141 Higher Education 175 Holiday Camps 154 Hygiene 137 Infectious Diseases 153 Invalid and Crippled Children's Society 159 Invalid Children's Aid Association 159 Knox Road Special School 161 Meals, Provision of 158 Medical Inspection 138 Menu (Fyfield) 167 Milk in Schools 144 Minor Ailments 141, 145 Municipal College 175 213 SUBJECT. PAGE Myopia 187 National Society for the Prevention of Cruelty to Children 160 Nose and Throat Defects 142, 147 Nursery Schools 170 Nutrition 140, 144 Ogilvie School of Recovery 169 Orthopasdic and Postural Defects 143, 151 Open Air Education 154 ,, Schools 133 Other Defects and Diseases 143, 152 Out-of-School Cases 160 Parents, Co-operation of 159 Parents' Payments 183 Pathological Work 184 Physical Training 158 Plaistow Secondary School 177 Playground Classes 154 Rebecca Cheetham Nurseiy School 170 Retarded Children 189 Rheumatism 143, 151 Ringworm 145, 188 St. Angela's High School 179 Scholarship Children 182 School Attendance Officers, Co-operation of 159 School Journeys 154 Scope of School Medical Service Secondary Schools 175 Skin Diseases 141, '45 Special Schools 161, 187 Speech Defects 188 Spray Baths 137 Staff 135 Stammerers 165 Statistical Tables 193 Surgical Instruments 160 Teachers, Co-operation of 159 The Grove Central School 182 The Russell Central School 182 Treatment, Arrangements for 144 Tuberculosis 143. '51 Uncleanliness 141, '44 Visual Defects 142, 145 Voluntary Bodies, Co-operation of 16 Water Lane Deaf Centre Weight (Comparative Tables) 1 West Ham High School for Girls 179 West Ham Secondary School 176 214