Ack. w.1 Ac 44444 WHAM 17 Countsy Borough of West Ham ANNUAL REPORT ON THE HEALTH SERVICES FOR THE YEAR 1945 BY F. ROY DENNISON, M.D., D.P.H. Medical Officer of Health County Borough of West Ham ANNUAL REPORT ON THE HEALTH SERVICES FOR THE YEAR 1945 BY F. ROY DENNISON, M.D., D.P.H. Medical Officer of Health Madam Mayor, Ladies and Gentlemen, I have the honour to submit this Annual Report on the Health Services of the Borough for the year 1945. Comment is rendered difficult by the fact that the work of which the report gives an account was carried out entirely during the term of office of my predecessor, and I can claim neither personal knowledge nor any credit for it. The period under review saw the end of hostilities and the beginning of a return to more normal conditions. The last rocket fell in the Borough on 18th March, 1945, and shortly afterwards those evacuees who could find some accommodation in which to live began to return. By midsummer the Registrar-General estimates that the population had crept up from 128,620 of the previous year to 135,260; by the end of the year it is thought to have reached 150,300. Concurrently with this rise went small increases in the numbers of births and deaths; and a very substantial increase in the number of confinements which took place in the various hospitals, brought about by the serious condition of so many of the houses in the Borough. The various rates shewed little change from those of the previous year. The birth rate was 21.6, as against 21.7; the stillbirth rate shewed a small increase from 21 to 24; the death rate a small increase from 14.5 to 15.2, to which several of the causes of death contributed; and the maternal mortality increased from 1.43 to 2.05; against this, the infant mortality dropped from 43 to 38. Turning now to infectious diseases, there were a number of increases from the very low figures of the previous year. The year 1945 was an "epidemic year" for measles, and there was a substantial rise in the rates both of scarlet fever and diphtheria, with a small mortality in each disease. On 3 the other hand, there was a very substantial drop in the number of cases of whooping cough. No other infectious diseases were of any consequence during the year and there were no epidemics apart from that of measles mentioned above. Despite the increases which have been recorded, the amount of serious infection remained very small, and it is a matter of congratulation that the Borough should have such a favourable experience at the end of nearly six years of war. Later sections of the report tell of a successful first year's working of the V.D. Clinic at Queen Mary's Hospital; of solid achievements at the various Municipal Hospitals, despite serious staffing difficulties; and a substantial increase in the work of the Maternity and Child Welfare Section. The work of the Sanitary Section was maintained in the face of a deviation of a considerable portion of the staff for work in connection with war damage; and the Sampling Officer continued his close surveillance on the standards of food and drugs sold in the Borough, appreciably increasing the number of samples of milk. In conclusion, I feel sure that my predecessor, had he remained to write this report, would have wished to acknowedge his debt to the members of the staff of the department for their part in contributing to the efficiency of the service, and I wish to add my own thanks for their generous help in the preparation of this report. I am. Madam Mayor, Ladies and Gentlemen, Your obedient servant, F. ROY DENNISON, Medical Officer of Health. Municipal Health Offices, 223/5, Romford Road, West Ham, E.7. 4 SUMMARY OF VITAL STATISTICS, 1945 Area of Borough 4,689 acres 1945 1944 Population (R.G.'s mid-year estimate) 135,260 128,620 Live births—legitimate 2,696 2,609 Live births—illegitimate 229 185 —2,925 — 2,794 Birth rate (per 1,000 population) 21.6 21.7 Stillbirths—legitimate 66 53 Stillbirths—illegitimate 6 7 -72 — 60 Stillbirth rate (per 1,000 total live and stillbirths) 24 21 Number of deaths 2,052 1,869 Death rate (per 1,000 population) 15.2 14.5 Deaths of infants under one year 112 120 Infantile mortality rate (deaths per 1,000 live births) 38 43 Maternal deaths: Puerperal sepsis 1 1 Other causes 5 3 Total maternal deaths 6 4 Maternal death rate (per 1,000 live births) 2.05 1.43 Maternal death rate (per 1,000 live and stillbirths) 2.00 1.40 VARIOUS DISEASES: Cases and deaths. Cases Case rate per 1,000 pop. Deaths Death rate per 1,000 pop. Smallpox — - - - Scarlet fever 382 2.83 l 0.007 Diphtheria 133 0.98 2 0.01 Enteric fever 1 0.007 - - Measles 2,403 17.77 4 0.03 Whooping cough 131 0.97 1 0.007 Diarrhoea and enteritis under 2 years (rate per 1,000 live births) - - 21 7.18 Pneumonia: Acute primary and influenzal 179 1.32 - - All forms — - 80 0.59 Bronchitis — - 167 1.23 Pulmonary tuberculosis 178 1.32 107 0.79 Other forms of tuberculosis 34 0.25 15 0.11 Cancer - 284 2.11 5 Causes of Death in Age Groups—1945 (as supplied by Registrar-General) Cause of Death All Ages Deaths at different periods of life of residents (civilians), whether occurring within or without the district Under 1 Year 1-5 Years 5-15 Years 15-45 Years 45-65 Years 65 and Upwards M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1. Typhoid & para-typhoid fevers — — — — — — — — — — — — — — 2. Cerebro-spinal fever 2 1 1 1 — — — — — — 1 — — — 3. Scarlet fever — 1 — — — — — 1 — — — — — — 4. Whooping Cough 1 — 1 — — — — — — — — — — — 5. Diphtheria 1 1 — — — — 1 1 — — — — — — 6. Tuberculosis of respiratory system 60 47 — — — 2 — 2 25 32 30 8 5 3 7. Other forms of tuberculosis 11 4 — 1 5 — 1 — 2 2 1 1 2 — 8. Syphilitic diseases 7 4 — — — — — — — 1 6 1 1 2 9. Influenza 6 6 •— — 1 — — — — — 2 1 3 5 10. Measles 2 2 1 1 — — 1 1 — — — — — — 11. Acute polio-myelitis and polio-encephalitis — — — — — — — — — — — — — — 12. Acute infective encephalitis 3 2 — — — — — — 3 2 — — — — 13. Cancer of buccal cavity & oesophagus (M) uterus (F) 12 15 — — — — — — — 3 5 7 7 5 14. Cancer of stomach and duodenum 36 27 — — — — — — 1 2 12 13 23 12 15. Cancer of breast — 24 — — — — — — — 4 — 11 — 9 16. Cancer of all other sites 99 71 — — — — — — 4 3 45 29 50 39 17. Diabetes 4 12 — — — —- — 1 — 1 2 4 2 6 18. Intracranial vascular lesions 73 84 — — 1 —- — — — 1 19 22 53 61 19. Heart disease 222 218 — — — — — — 9 14 57 47 156 157 20. Other diseases of circulatory system 30 27 — — — — — — 2 — 10 10 18 17 21. Bronchitis 102 65 2 3 1 2 — — 2 1 34 14 63 45 22. Pneumonia 42 38 11 11 4 2 1 1 1 2 7 4 18 18 23. Other respiratory diseases 13 5 — — 1 — — — . — 1 5 1 7 3 24. Ulcer of stomach and duodenum 23 4 — — — — — — 7 1 9 2 7 1 25. Diarrhoea under two years 12 9 12 9 — — — — — — — — — — 26. Appendicitis 4 2 1 — — — 1 — 1 1 — — 1 1 27. Other digestive diseases 14 20 — — 1 —- 1 — — 2 6 3 6 15 28. Nephritis 16 11 — — 1 1 — — 1 4 8 4 6 2 29. Puerperal and post abortive sepsis — 1 — — — — — — — 1 — — — — 30. Other maternal causes — 5 — — — — — — — 5 — — . — — 31. Premature birth 14 7 14 7 — — — — — — — — — — 32. Congenital malformations, birth injury, infant dis. 16 15 13 14 — — 1 — 1 — 1 1 — — 33. Suicide 9 2 — — — — — — 4 1 4 1 1 — 34. Road Traffic accidents 11 5 — — 1 1 2 — 1 1 4 2 3 1 35. Other violent causes 118 137 1 3 13 6 18 18 42 55 31 32 13 23 36. All other causes 111 106 2 3 — — 3 — 12 7 7 13 87 83 Total 1074 978 59 53 29 14 30 25 118 147 306 231 532 508 6 POPULATION The Registrar-General's estimate of the resident population for the middle of the year was 135,260. The estimated population for the middle of the year 1944 was 128,620. These figures show an increase in the population of 6,640. LIVE BIRTHS. The actual live births allocated to the Borough consisted of 1,535 male and 1,390 females, making a total of 2,925. Of these 229 (115 males and 114 females) were illegitimate. The birth rate for 1945 was 21.6 per 1,000 of the population, as compared with a rate of 21.7 for the year 1944. STILLBIRTHS. The number of stillbirths allocated to the Borough was 72 (40 males and 32 females). Of these 5 males and 1 female were illegitimate. The stillbirth rate per 1,000 (live and still) births was 24.0. DEATHS.—The nett number of deaths allocated to the Borough was 2,052, which gives a death rate of 15.2 per 1,000 of the population, as compared with 14.5 for the year 1944. Of these 2,052 deaths, 1,074 were of males and 978 of females. Causes of death. The causes of death at all ages and at different periods of life are given in Table 1. The chief causes of death were: heart diseases, 440; cancer, 284; bronchitis, 167; tuberculosis, 122; pneumonia, 80. INFANT DEATHS. Deaths of infants under one year totalled 112, of which 59 were males and 53 females. Of these, 5 males and 4 females were illegitimate. The infantile, mortality rate was therefore 38, as compared with 43 for the year 1944. MATERNAL DEATHS. During the year 6 women died in childbirth. One of these deaths was due to sepsis and five to other conditions associated with childbirth. The maternal mortality rate for all causes was 2.00 per 1,000 live and still births, as compared with 1.40 for the year 1944. INFECTIOUS DISEASES TUBERCULOSIS. The number new cases of tuberculosis notified during the year was 212, as compared with 228 in 1944. Of these cases 178 (103 males and 75 females) suffered from the pulmonary form of the disease and 34 (14 males and 20 females) from the non-pulmonary forms. The case rate for all forms of tuberculosis was 1.57 per 1,000 of the population, as compared with 1.77 for the year 1944. Deaths from this disease numbered 122, of which 71 were males and 51 females. 7 SMALLPOX. No case of this disease was notified during the year. SCARLET FEVER. During the year 382 cases of scarlet fever were notified (176 males and 206 females), giving a case rate of 2.83 per 1,000 of the population. The corresponding figure for 1944 was 246. The number of patients removed to hospital was 284. There was one death from this disease, giving a death rate of 0.007 per 1,000 population. DIPHTHERIA. (a) There were 133 cases of this disease during the year, of which 52 were males and 81 females. The case rate was 0.98 per 1,000 of the poulation. There were two deaths from this disease, giving a death rate of 0.01 per 1,000 of the population. One of the deaths occurred in a West Ham child who was temporarily residing outside the Borough. All the notified cases were removed to hospital. (b) DIPHTHERIA PROPHYLAXIS. The number of children immunised during the year was 1,765. Of this number 1,625 were under 5 years and 140 were between the ages of 5 and 15 years. ENTERIC FEVERS. One case of para-typhoid fever occurred during the year, giving a case rate of 0.007 per 1,000 of the population. This patient was removed to hospital and recovered. MEASLES. The number of cases of measles which were notified during the year was 2,403, as compared with 269 cases in 1944. Of the 2,403 cases 1,195 were males and 1,208 females. The case rate was 17.77 per 1,000 of the population. There were four deaths from this disease, giving a death rate of 0.03 per 1,000 population. The number of patients removed to hospital was 198. WHOOPING COUGH. During 1945 the number of cases of whooping cough notified was 131. Of these 64 were males and 67 females. The case rate was 0.97 per 1,000 of the population. There was one death from the disease, giving a death rate of 0.007 per 1,000 of the population. The number of cases removed to hospital was 21. CEREBRO-SPINAL FEVER. During the year 7 cases were notified, of which 5 were males and 2 females. The number of deaths from this disease was 3 (2 males and 1 female), giving a death rate of 0.02 per 1,000 of the population. Six of the cases were removed to hospital. ERYSIPELAS. The number of cases of erysipelas notified during the year was 32, of which 14 were males and 18 females. This gives a case rate of 0.24 per 1,000 living. The corresponding number of cases for 1944 was 53. There were no 8 deaths from this disease. The number of patients removed to hospital was 12. DYSENTERY. There were 36 cases of this disease during the year: 25 males and 11 females, as compared with 43 in 1944. The number of patients removed to hospital was 34. MALARIA. Twenty-one cases of this disease were notified during the year—all were males. All cases were believed to have been contracted abroad. DIARRHOEA AND ENTERITIS. During 1945 the number of deaths of children under 2 years of age from diarrhoea and enteritis was 21. Of the 21 children who died, 12 were males and 9 females. The corresponding figure for 1944 was 18. The death rate per 1,000 of the population was 0.15. PNEUMONIA. The number of notifications of pneumonia —primary and influenzal—received during the year was 179, as compared with 161 in 1944. Of this number 107 were males and 72 females. The case rate was 1.32 per 1,000 of the population. PUERPERAL PYREXIA. The number of cases during the year was 29, as compared with 43 in 1944. Of these, 26 were removed to hospital. OPHTHALMIA NEONATORUM. The number of cases during the year was 7, as compared with 3 in 1944. Four cases were removed to hospital. ACUTE POLIOMYELITIS. One case of this disease was notified during the year. 9 PLAISTOW FEVER HOSPITAL Report by Dr. Donald MacIntyre, M.C., M.D., D.P.H., Medical Superintendent During 1945 there was a slight rise in the prevalence of scarlet fever, diphtheria and measles, but the type of infection remained generally mild. The total number of admissions during the year was 991, as compared with 740 in 1944. The number of cases in the Hospital on December 31st, 1944, was 54, bringing the total under treatment to 1,045. Of these 927 were discharged recovered, 10 were transferred to other hospitals, 22 died, and 86 remained under treatment at the end of the year. SCARLET FEVER. The number of admissions was 288, as compared with 176 in the previous year, but the type of disease continued to be mainly mild. One fatality, however, occurred. This was a girl of 7 years who succumbed to an anaphylactic shock following an intramuscular injection of 9,000 units of scarlet fever antitoxin. As usually happens in such case, there was no indication prior to the administration of the serum that the injection might cause a fatal result. Complications occurred in 54 cases (18.75 per cent.). The complications were: cervical adenitis, 26; otitis media, 11; rhinitis, 7; nephritis, 5; septic sores, 4; arthritis, 1. The diagnosis was changed in 10 cases notified as scarlet fever. The corrected diagnoses were: measles, 3; tonsillitis, 2;, erythema, 2; dermatitis, 1; urticaria, 1; bronchitis, 1. DIPHTHERIA. The number of cases under treatment was 140, as compared with 63 in the previous year. Of these, 99 were discharged recovered, one died, and 40 remained under treatment at the end of the year. The disease was classified as mild in 44 cases, moderate in 36 cases, and severe in 19 cases. The fauces were involved in all except 8 cases, in which the infection was confined to the nose. The fatal case was a boy, aged 8 years, who had been ill for 5 days before admission. He had a severe faucial attack and was comatose on admission. Paralysis occurred in 11 cases, being of a mild type in 8 cases and severe in 3 cases. In one of the latter the paralysis involved the diaphragm and the intercostal muscles, and the patient had to be nursed in the iron lung for 3 weeks; he ultimately made a satisfactory recovery. Twenty-seven patients gave a history of having been previously immunised against diphtheria. The attack was mild in 23 of these cases and moderately severe in 4 cases. The diagnosis was revised in 99 of the cases notified as 10 diphtheria. The corrected diagnoses were as follows: tonsillitis, 81; laryngitis, 8; bronchitis, 3; Vincent's angina, 4; quinsy, 3. MEASLES. This disease was prevalent during the first half of the year and 189 cases came under treatment. Of these, 181 were discharged recovered, 5 died, and 3 remained in residence at the end of the year. Broncho-pneumonia was the complication present in 4 of the fatal cases, who were all children under 2 years of age. The fifth case was complicated by acute encephalitis. WHOOPING COUGH. Only 22 cases of this disease were under treatment during the year. Of these, 19 were discharged recovered, one died, and 2 were in hospital at the end of the year. The fatal case was an infant, aged 4 weeks, who was suffering from broncho-pneumonia. MENINGITIS. Seventeen cases, notified as meningitis, were admitted. Of these, 4 were suffering from meningococcal meningitis, 2 had tubercular meningitis, and in 2 cases the causal organism was not isolated. One death occurred in the meningeal group, and the tubercular cases were both fatal. The remaining cases proved after admission to be suffering from the following complaints: broncho-pneumonia, 3; pharyngitis, 2; mastoiditis, 1; quinsy, 1; chorea, 1; no disease, 1. DYSENTERY. During the year. 45 cases were under treatment suffering from gastro-enteritis. In 7 of these the Sonne type of organism was isolated; they all recovered. Among the remaining 38 cases, 6 proved fatal. These were all infants under the age of nine months. OTHER DISEASES. The main diseases in this group were as follows: Erysipelas, 11; pneumonia, 77; chickenpox, 17; dermatitis, 14; scabies, 13; erythema, 10; coryza, 5; stomatitis, 2; rheumatism, 1; cellulitis, 3; rubella, 3; puerperal fever, 2; chorea, 2; impetigo, 7; jaundice, 2; intussusception, 1; cerebral tumour, 1; intestinal, obstruction, 1; ophthalmia neonatorum, 1; poliomyelitis, 1; no disease, 18. In the above group 5 of the cases suffering from pneumonia proved fatal. GATE CASES. The number of patients suspected to be suffering from an infectious disease who were brought to the Hospital for diagnosis was 1,061. Of these, 511 were referred by medical practitioners and 550 were brought direct by relatives. The number of these admitted To the Hospital was 147. A total of 1990 swabs from nose and throat were examined for medical practitioners and other institutions for the presence of diphtheria bacilli. Of these, 173 were found to be positive. During the year, 108 patients under five years of age were immunised against diphtheria. 11 Return of Admissions, Discharges and Deaths for 1945 In Hosp. 31.12.44 Admitted since Discharged Died In Hosp. 31.12.45 Scarlet Fever 18 288 274 1 31 Diphtheria 4 136 99 1 40 Measles 3 186 181 5 3 Whooping Cough 4 18 19 1 2 Meningitis 1 8 6 3 — Gastro Enteritis 1 44 35 6 4 Pneumonia 8 69 71 5 1 Erysipelas 1 10 10 — 1 Chickenpox — 17 15 — 2 Puerperal Fever — 2 2 — — Tonsillitis 2 88 89 — 1 Laryngitis 2 8 10 — — Bronchitis 1 10 11 — — Rubella — 3 3 — — Dermatitis 3 11 14 — — Encephalitis 1 — 1 — — Mumps 1 8 9 — — Mastoiditis 1 — 1 — — Scabies 2 11 13 — — Urticaria 1 5 6 — — Vincent's Angina — 4 4 — — Syphilis — 1 1 — — Erythema — 10 10 — — Coryza — 5 5 — — Rheumatism — 1 1 — — Stomatitis — 2 2 — — Quinsy — 4 4 — — Cellulitis — 3 3 — — Otitis Media — 1 1 — — Chorea — 2 1 — 1 Impetigo. — 7 7 — — Influenza — 1 1 — — Pemphigus — 1 1 — — Jaundice — 2 2 — — Meningism — 2 2 — — Intussusception — 1 1 — — Cerebral Tumour — 1 1 — — Intestinal Obstruction — 1 1 — — Ophthalmia Neonatorum — 1 1 — — Poliomyelitis — 1 1 — — No Disease — 18 18 — — TOTALS 54 991 937 22 86 SCABIES. This disease, which affected both children and adults, was not quite so prevalent in 1945 as it was in 1944. It is, however, pleasing to record a slight drop in the number of persons who received treatment at the Centres, namely: 2,761, as against 2,970 in 1944. It would not be reasonable to expect 12 a complete eradication of scabies at the moment, owing to the general overcrowding in the homes of the people, and also to the lack of soap and washing facilities. At the beginning of the year there were two Centres functioning, but from June onwards there was only one Centre in operation at the Council's Balaam Street Baths. Children discovered at school to be suffering from the infection were sent for treatment by the school medical officers. The general practitioners also sent their patients for treatment, and many cases were received from out-patient departments of the hospitals in the area. The treatment, which consisted mainly of thorough bathing and painting with Benzyl Benzoate, proved very successful. The general public appreciated the facilities available, as is evidenced by their continued attendance until a cure was made. Many patients suffering from skin diseases, other than scabies attended for treatment. These were examined by the Medical Superintendent of the Council's Infectious Diseases Hospital, who paid daily visits to the Centres, and cases requiring hospital treatment were admitted to Plaistow Hospital. DISINFECTION AND DISINFESTATION The number of dwellings disinfected after removal to hospital, recovery or death of a patient was 738, involving the disinfection of 898 rooms. Disinfestation for vermin was carried out in 305 premises. VENEREAL DISEASES. The Council participates in a Joint Scheme with the London County Council and adjoining Counties and County Boroughs. The following particulars, supplied by the London County Council regarding West Ham cases attending the various treatment centres, have been abstracted: New Patients— Syphilis 41 Soft Chancre — Gonorrhoea 99 Not Venereal 211 Total 351 Total attendances of all patients 5,230 Total number of in-patient days 15 Pathological Examinations— For or at the Centres: Spirochaetes — Gonococci 1,326 Wasserman 718 Others 2,063 For Practitioners— Total 4,107 Wasserman — Others — 13 QUEEN MARY'S HOSPITALSPECIAL TREATMENT CENTRE Report by Director, Dr. F. G. MacDonald, for the year 1945 The centre was opened on September 18th, 1944, the staff consisting of the Director, a whole-time sister and a whole-time orderly. The Director attends for 12 hours each week. This is divided into six sessions of 2 hours each—3 male and 3 female. The centre is also open at certain times every day, except Sunday, for patients requiring intermediate treatment. Pathological specimens are dealt with according to their nature. Those requiring dark ground examinations are examined at the centre. Smears and cultures are identified in the Pathological Department of the hospital. Blood specimens are at present sent to one of the E.M.S. Laboratories. The following statistics are sent to the Medical Officer of Health: Monthly attendances. Copy of the quarterly return to the Ministry showing the cases of early infective syphillis and gonorrhoea. Copy of the Annual Return to the Ministry, which embodies complete statistics of attendances, by diagnosis and by area, and all work done. Owing to the increased attendances of female patients and the longer time it takes to examine and give treatment to a woman compared with a man, it was found advisable a few months ago to engage a staff nurse to work with the sister. There is evidence that, if the Director were available at more sessions, the number of new patients would increase still more. Not infrequently it happens that intending patients apply for advice or treatment outside the advertised sessions. They do not always attend again when invited to do so at an appropriate time. The Year 1945- Director Intermediate Totals 3,272 (411) 1,263 4,535 Director—patients seen by the Director. Intermediate—patients attending for intermediate treatment only. New patients are shown in brackets. Total Attendances by Areas for 1945— West Ham East Ham Essex L.C.C. Other Areas 2,654 173 1,296 405 7 Total 4,535. 14 As a matter of public health importance it may be of interest to include the numbers of patients who were found to be suffering from Early Infective Syphilis and Gonorrhoea. The Year 1945— Early Syphilis 18 (6 men, 12 women) Gonorrhoea 54 (20 men, 34 women) The balance of these figures was made up of venereal cases in the later or non-infective phases, and of those in whom no venereal disease was found. VENEREAL DISEASES—REGULATION 33b Contacts notified to the Medical Officer of Health during the period January 1st, 1945, to December 31st, 1945: M. F. (1) (a) Total number of contacts in respect of whom Form 1 was received 2 18 (b) Number in (a) transferred from other areas — — (2) Number of cases in (1) in which attempts were made during the current period outside the scope of the Regulation to persuade the contact to be examined before the latter had been named on a second Form 1: Contacts found — 12 Contacts examined or already under treatment — 12 (3) (a) Number of those in (1) in respect of whom two or more Forms 1 were received — 3 (b) Number included in (3) (a) in respect of whom the first Form 1 was previously reported under (1) — 2 (c) Number included in (3) (a) transferred from other areas — — (4) Number of those in (3) (a) who were: (a) found — 2 (b) examined after persuasion or already under treatment — 1 (c) served with Form 2 — 1 (d) examined after service of Form 2 — 1 (e) prosecuted for failure: (i) to attend for, and submit to, medical examination — — (ii) to submit to and continue treatment — — (f) transferred to other areas — — 15 GENERAL AMBULANCE FACILITIES. Two of the three ambulances provided for accidents, maternity patients and cases of serious illness are owned by the Health Committee. These vehicles made 3,841 journeys during the year. Reciprocal arrangements are in force between the County Borough of East Ham and this County Borough for the use of their respective ambulances, on call, in cases of emergency. Arrangements were also made with the London County Coun'cil for West Ham ambulances to remove all emergency cases from the part of the Borough of Woolwich north of the Thames. In addition to the Health Committee's two ambulances, the Highways Committee of the Council has an ambulance stationed at Silvertown. This vehicle is used mainly for accidents occurring in factories in the Silvertown district, and certain factory owners contribute towards the cost of this service. During the year the number of journeys made by this ambulance was 133. In November, the Council provided a sitting case car, which was stationed at the Transport Department. This is used for cases who, in the opinion of the doctor in attendance, require removal to hospital, but do not need an ambulance. MORTUARIES. BODIES RECEIVED INTO THE MORTUARY DURING 1945 STRATFORD MORTUARY Month Bodies in Queen Mary s Hospital on which inquests were held Number received Total Males Females Under 5 years Over 5 years Sent in by Coroner Sent in by Police Sent in on sanitary grounds Number of PostMortem Examinations Number of Inquests January — 22 22 15 7 2 20 21 1 - 22 3 February 2 16 18 13 5 — 18 8 8 2 14 3 March 2 11 13 11 2 1 12 8 5 — 11 3 April — 12 12 7 5 — 12 7 5 — 11 7 May 1 9 10 6 4 2 8 6 4 — 9 5 June 1 7 8 5 3 1 7 4 4 — 7 4 July 1 10 11 7 4 — 11 8 2 1 9 1 August — 11 11 6 5 — 11 9 2 — 11 2 September 2 11 13 9 4 3 10 8 5 — 11 5 October 3 14 17 10 7 2 15 12 5 — 14 8 November 2 13 15 13 2 1 14 10 5 — 13 6 December — 16 16 9 7 4 12 14 2 — 16 4 Total 14 152 166 111 55 16 150 115 48 3 148 51 16 SHOPS ACTS, 1912-1936. Owing to the limited amount of goods for sale in shops, and the restrictions on lighting, the infringements of the Shops (Hours of Closing) Act, 1928, were of a minor character, and it was not found necessary to take legal proceedings in any case. The Inspectors' time was chiefly taken up in revising the register, ascertaining that the prescribed forms, as required by the Shops Acts, 1912/1936, were exhibited in the shops, and a proper record of the hours of employment of young persons was duly kept; also assisting generally with other duties of the department owing to the shortage of staff at various times. SUPPLY OF INSULIN. During the year one new application was received for a free supply of insulin. In addition, 27 other persons continued to receive assistance in this connection. VACCINATION ACTS. The following is a summary of the work carried out during the year 1945: Number of cases in birth lists received during 1945 3,477 Number of certificates of vaccination received 927 Number of certificates of postponement owing to: Health of child 98 Condition of house — Prevalence of infection disease — Number of certificates under section 2 of the Vaccination Act, 1898, and number of statutory declarations under section 1 of the Vaccination Act, 1907 1,333 Number of certificates of insusceptibility or of having had smallpox 3 Number of cases: Parents removed out of district 665 Otherwise not found 267 Number of entries in lists sent to public vaccinators 976 FOOD INSPECTION MILK (SPECIAL DESIGNATIONS) ORDER, 1936 Particulars are given below regarding the various types of milk graded under this Order, which were sampled during the year and submitted to the appropriate tests. The methylene blue test and the phosphatase test were applied to all samples of heat-treated milk. 17 All samples satisfied the phosphatase test. Grade Number sampled Results of Examination Number satisfactory Unsatisfactory Contained excessive bacteria Failed methylene blue test Failed Methylene blue test and contained excessive bacteria Pasteurised 98 90 1 1 6 Pasteurised (from schools) 70 57 5 1 7 Tuberculin Tested (Pasteurised) 30 27 1 1 1 Contained coliform bacillus Failed methylene blue test and contained coliform bacillus Tuberculin Tested (Certified) 43 40 2 1 — Accredited 22 19 2 — 1 Totals 263 233 11 4 15 HEAT-TREATED MILK. In addition to designated milk, the following samples of heat-treated milk were submitted to the appropriate tests. All samples satisfied the phosphatase test. Type Number sampled Results of Examination Number satisfactory Failed methylene blue test Sterilised 110 110 — Heat Treated 109 98 11 Homogenised 12 12 — Totals 231 220 *11 *Letters of caution were sent. EXAMINATION OF MILK FOR TUBERCULE (GUINEA PIG TEST) During the year 24 samples of milk, as shewn below, were examined for the presence of the tubercule bacillus. All samples proved negative. 18 BIOLOGICAL TESTS Type of Milk Number Examined Result Positive Negative "Tuberculin Tested (Certified)" (From Purveyor) 16 - 16 Accredited (From Producer) 3 — 3 Pasteurised (Delivered at Institutions) 5 — 5 TOTALS 24 — 24 ICE CREAM. Twelve samples of ice cream were taken from shopkeepers and itinerent vendors and submitted for bacteriological examination. Of 7 samples obtained from shopkeepers, 5 proved satisfactory and 2 contained excessive bacteria and coliform bacilli. Of 5 samples taken from itinerent vendors, 2 proved satisfactory, one sample contained excessive bacteria and coliform bacilli, and 2 samples contained coliform bacilli. In all cases of unsatisfactory results, letters of warning were sent and the premises, the utensils, and the methods generally employed were examined. CONDENSED MILK REGULATIONS. During the year 8 samples of condensed milk were submitted. Of this number, 6 samples of condensed machine-skimmed milk sweetened were also examined for the purpose of testing the equivalent, and proved satisfactory. Two samples of condensed full cream milk sweetened were submitted, one of which was also tested for the equivalent. Both proved satisfactory. The labelling satisfied the requirements of the Regulations. • REPORT OF THE PUBLIC ANALYST By Albert E. Parkes, F.I.C., F.C.S. During the year 1945, 1,056 samples were examined under the Food and Drugs Act. These were all submitted by the Medical Officer of Health, and no samples were submitted by the public. Of the samples submitted 16 were found to be adulterated. The adulteration was at the rate of 1.52 per cent, of the samples examined. The samples purchased informally numbered 370. The adulteration of samples submitted during the past ten years is shown in Table I. 19 TABLE I Adulteration of samples submitted Year No. of samples examined Per cent. adulterated 1936 1,175 1.3 1937 1,176 2.5 1938 1,203 2.1 1939 1,177 1.5 1940 1,176 1.8 1941 1,125 2.3 1942 1,065 1.5 1943 1,055 1.7 1944 1,054 0.6 1945 1,056 1.5 Average per year 1,126 1.7 The number of samples of milk which were examined during the year was 260. Four of these were adulterated. The milk adulteration in the Borough for the past ten years is shown in Table II. TABLE I Adulteration of samples submitted Year No. of samples examined Per cent adulterated 1936 414 1.9 1937 407 2.4 1938 376 3.1 1939 375 2.1 1940 399 3.8 1941 284 1.4 1942 190 0.05 1943 250 1.2 1944 269 — 1945 260 1.5 Average per year 322 1.7 CONDENSED MILK. Ten samples of condensed milk were examined, all of which were satisfactory. DRIED MILK. Two samples of dried milk examined proved satisfactory. 20 PRESERVATIVES. There was no contravention of the Preservatives Regulations. DRUGS. Seventy samples of drugs were examined during the year. Two of these were adulterated. In addition to the above, the following were analysed during 1945: 3 samples of rag flock, one of which was unsatisfactory, 17 samples of fertilisers, 14 samples of feeding stuffs, 5 samples under the Pharmacy and Poisons Act. ACTION TAKEN ON ADULTERATED SAMPLES Butter (informal). 0.4% excessive water; subsequent sample proved satisfactory. Butter. 0.5% excessive water. Letter of caution; subsequent sample proved satisfactory. Margarine. 0.8% excessive water. Letter of caution, subsequent sample proved satisfactory. Zinc ointment (informal). 26.6% deficient in zinc oxide. Zinc ointment (official). 24.5% deficient in zinc oxide. Seller was summoned, who summoned his supplier as the actual offender, who in turn, relied on a warranty given him by the manufacturer. The manufacturer accepted full responsibility, and the case was dismissed under the Probation of Offenders Act, on payment of £11 lls. costs, which was allocated as follows: £5 5s. to first purchaser. £1 1s. to seller. £5 5s. to the Corporation. Whisky. 13.2% water. Dismissed under the Probation of Offenders Act on payment of £7 7s. costs. Milk. 8.2% water. Fined £20 (third offence). Milk (sterilised). 16.6% deficient in fat. Seller was summoned, who summoned his supplier as the actual offender. Dismissed under the Probation of Offenders Act on payment of £5 5s. costs. Milk. 16.6% deficient in fat. Letter of caution, subsequent sample proved satisfactory. Milk. 6.6% deficient in fat. Letter of caution, subsequent samples proved satisfactory. Non-brewed vinegars. Letters of caution, subsequent samples proved satisfactory. DAIRIES. During the year there were 278 visits to dairies and all were found to be in a satisfactorv condition. 21 PHARMACY AND POISONS ACT, 1933 The number of persons entitled to sell Part (ii) poisons entered in the local authority's list at the end of the year was 96. Five samples were examined during the year and proved satisfactory. FERTILISERS AND FEEDING STUFFS ACT, 1926 Particulars are given below of 30 official and unofficial samples which were taken during the year. Type of sample No. of samples taken Analysis agreed Analysis disagreed Fertilisers: (a) Official (b) Unofficial 3 14 1 11 2 3 Feeding Stuffs: (a) Official (b) Unofficial 2 11 3 2 8 TOTALS 30 15 15 SANITARY CIRCUMSTANCES WATER SUPPLY. There is no change regarding the water supply in the Borough, every house is supplied direct from the mains by the Metropolitan Water Board, which has proved in every way to be satisfactory. No samples of water from dwelling houses were taken. 22 During the year 56 samples of water taken from other premises were submitted for examination as follows: Source of sampling Number of samples Bacteriological Chemical Council's wells 32 1 Taps of ward kitchens and other points at institutions 9 3 Storage tanks at institutions 3 1 Well at business premises Taps at business premises 2 2 Sec. 41 Factories Act, 1937 ) 2 1 48 8 Two samples taken from taps of ward kitchens revealed a slight bacterial impurity. The source of contamination was immediately traced, the defect was remedied, and subsequent samples proved satisfactory. With these two exceptions, all samples were found to be satisfactory and were reported upon as being consistent with a pure and wholesome water suitable for drinking and domestic purposes. WORK OF THE DISTRICT SANITARY INSPECTORS. During the year 1945, several of the District Sanitary Inspectors were engaged, practically full-time, with war damaged houses which included permits for building materials, classification of war damaged houses, etc., the remainder of the staff devoted as much time as possible to normal Public Health work. Their duties, however, were rendered difficult by the enormous amount of damage caused by enemy action, but during the year under review 2,919 Notices were served resulting in the issue of 96 summonses, which gives an indication that the Public Health Acts were receiving attention as circumstances permitted. It is hoped that from early in 1946, all the normal routine duties under the Public Health and allied Acts, will be resumed, so far as the building labour and materials allow. During the concluding stages of the war, huge quantities of food were condemned as unfit for human consumption. Eight Closing Orders were granted by the Stipendiary Magistrate in respect of dwelling houses which were agreed to be unfit for human habitation. The occupiers were provided with other accommodation by the Local Authority. The following statement sets out the work carried out by the Sanitary Inspectors' Section, and in this connection it should be noted that considerable time was spent on war damage work. Houses inspected following infectious disease 8 Visits to factories (mechanically operated) 809 Visits to factories (without mechanical power) 226 Visits to workshops 63 Visits to workplaces 120 Visits to bakehouses 264 Visits to dairies 278 Visits to offices (as workplaces), P.H.A., 1936 103 Visits to outworkers 45 Visits to cellar dwellings, underground rooms, etc 3 Visits to slaughter-houses 142 Visits to scheduled offensive trades 176 Visits to fish fryers 327 23 Visits to other noxious trades 122 Visits to knackers' yards 1 Visits to registered hairdressers and barbers, W.H.C.A., Section 49 95 Visits to registered premises wherein food is manu- tured, W.H.C.A., Section 67 479 Visits to registered premises occupied by vendors of food, W.H.C.A., Section 66 1,812 Visits to caf6 and restaurant kitchens, etc., P.H.A., 1925 735 Visits to ice-cream makers or dealers, W.H.C.A., Sec. 66, and P.H.A. 151 Visits to other food purveyors 796 Burial Act, 1857, Sec. 25, Exhumation of human remains 1 Visits to shops (Shops Act, 1934) 1,396 Visits re overcrowding provisions of Housing Acts 57 Drainage inspections 1,984 House-to-house inspections under Public Health or Housing Acts 17 Visits under Rats and Mice Destruction Act 1,431 Visits under Increase of Rent Restriction, etc., Acts 19 Visits under Bye-laws—tents, vans, sheds 1 Visits to private houses to investigate complaints 6,104 Houses inspected under the Housing Act, 1936, re Closing and Demolition Orders or Reconstructions or re Schedules of Evidence 32 Smoke observations 36 Visits to factories re smoke 18 Visits to places of public amusement, theatres, music halls, cinemas, etc. (Ministry of Health Circular 120 of 1920) 70 Visits to licensed premises 87 Other visits 548 Re-inspections 8,124 Total Visits 26,716 Samples taken under Rag Flock Act 2 No. of Notices served 2,919 Warning Letters sent re matters not dealt with by Notice 47 Other defective or insanitary conditions dealt with 26 Drain tests carried out 151 Certificates granted under Rent Restriction, etc., Acts and Landlord and Tenant (War Damage Acts) 69 No. of Notices complied with—(1) by owner 1,853 No. of Notices complied with—(2) by occupier 21 Summonses issued 96 24 TUBERCULOSIS The total number of cases of tuberculosis on the Register at 31st December, 1945, was 961. There were added to the Register during the year on account of fresh notifications and inward transfers 274 cases. As a result of death, removal from the area, or change of diagnosis 335 names were removed from the Register. NOTIFICATIONS. During the year 178 cases of pulmonary and 34 cases of non-pulmonary tuberculosis were formally notified, making a total of 212 cases (117 males and 95 females). DEATHS. The total deaths from tuberculosis of all types during the year was 122 of which 107 (60 males and 47 females) were of the pulmonary form of the disease, and 15 (11 males and 4 females) were of the non-pulmonary form. WORK OF THE CHEST CLINIC. The following is a summary of the work done at the Chest Clinic during the year:— (1) Patients in receipt of allowances under Government Scheme at 31.12.45 67 (2) Examinations at Clinic 5,735 (3) Patients receiving domiciliary treatment at 31.12.45 111 (4) Patients receiving treatment at Clinic 410 (5) Patients in receipt of Home Nourishment at 31.12.45 48 (6) Sputum examinations 808 (7) X-ray examinations 969 (8) Total number on register, 31.12.45:— Definite cases 961 Observation cases 201 DAGENHAM AND LANGDON HILL SANATORIA. The following brief report has been supplied by Dr. G. M. Mayberry, the Medical Superintendent: — (a) DAGENHAM SANATORIUM. No. of admissions Males 101. Females 101. Total 202 No. of discharges Males 56. Females 71. Total 127 No. of deaths Males 15. Females 28. Total 43 No. of patients in institution:— Dec., 1945 Males 60. Females 43. Total 103 Extra-district patients admitted during the year 5 25 Five cases remained in for less than one month-two had no active disease FEMALES Quiescent 14 6 4 1 Improved 3 2 20 4 No material improvement - 3 8 Six cases remained in for less than one month. The cases admitted during the year were mostly of the chronic and advanced type. This was only to be expected after so many years of war. The absence of accommodation for carrying out minor surgery in connection with the expansion of modern treatment was a continued handicap. The difficulty was increased by the admission of a number of ex-Servicemen where collapse therapy had already been started but not completed in other institutions. I trust that it will be possible to provide this accommodation so urgently necessary to carry out modern treatment in a satisfactory manner, at an early date. A number of cases were admitted to the London Chest Hospital during the year for both major and minor chest surgery, but the beds available there are far too few to meet the many calls on them. Great difficulty was experienced throughout the year in obtaining a satisfactory number of nursing and domestic staff to carry on the work of the institution although the number of beds occupied were less than normal owing to damage to buildings by enemy action Dr. Nelson took up duties as Assistant Medical Officer on January 1st and resigned at the end of March to take up an appointment abroad. Dr. R. Posner was appointed to fill the position, and took up duties in April. Occupational Therapy was started and carried out to a limited extent. Concert parties were arranged during the winter months and were highly appreciated by patients and staff. The grads of cases discharged and the result of treatment were as follow:- T.B. T.B. plus T.B. plus T.B. plus Minus Grade I. Grade II. Grade III. Males 13 7 20 11 Females 17 8 31 15 MALES Quiescent 10 6 5 1 Improved 3 1 15 7 No material ment — — — 3 26 It was quite impossible to keep the beds fully occupied during the year owing to the extreme shortage of both nursing and domestic staff. Many applications for the admission of extra-district cases had to be refused. The results of treatment were, as in the past, satisfactory and encouraging. I regret that more beds were not available. A number of old patients now grown up and fully occupied have visited the institution, some on leave from the Forces. 27 (b) LANGDON HILL SANATORIUM. No. of admissions Males 14. Females 9. Total 23 No. of discharges Males 17. Females 8. Total 25 No. of deaths Males —. Females—. Total — No. of patients in institution:— Dec., 1945 Males 14. Females 17. Total 31 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. Males 17 — — — Females 6 — — 2 One case was under treatment for both pulmonary and surgical tuberculosis. MALES Quiescent 16 — — - Improved 1 — — - No material improvement - - - - FEMALES Quiescent 6 - - 2 Improved — — - — No material improvement - - - — Extra-District cases admitted during the year were: — Males 3. (2 East Ham, 1 Surrey). Females 1. (Surrey). Total: 4 MATERNITY AND CHILD WELFARE Report by Dr. Helen Campbell, M.B., Ch.B., D.P.H., Senior Medical Officer for Maternity and Child Welfare In the early months of the year West Ham was still being subjected to enemy air activity, so that the routine work was interrupted frequently, especially in regard to health visiting. With the cessation of hostilities, it became easier to re-organise the work, but the problem of rehousing the people bombed out or returning from evacuation, made it difficult for individual health visitors to contact all mothers with young children in their districts. New temporary colonies were established in some areas with a large child population. Other areas previously built up are scheduled for use for other purposes, so that a re-allocation of the area became necessary to ensure that each health visitor had approximately an equal number of children on her books for whom she was responsible. In 1945 there were 19 health visitors employed by the Council, of whom 18 gave full-time service to maternity and child welfare work, the remaining health visitor giving approximately one-third of her time to work in connection with the Venereal Diseases Scheme. Seven health visitors were employed by voluntary organisations working in this area, whose duties were concerned chiefly with clinic work. The total number of visits paid during 1945 by all health visitors was:— (1) To expectant mothers 5,937 (2) To children under one year 11,283 (3) To children between 1 and 5 years 19,216 In addition to these visits the health visitors investigated cases of puerperal pyrexia, ophthalmia neonatorum, stillbirths, maternal deaths, and deaths of children under five years. They also visited the homes of all cases of notified infectious diseases to advise regarding care of the patient, if at home, and supervision of the contacts. The home-help scheme was administered by this department, the circumstances being investigated and all arrangements being approved by the health visitor in respect of cases on their own districts. These several schemes involved considerable additional visits, so that in 1945 the health visitors paid 10,484 special visits in addition to the routine maternity and child welfare visits. Health visiting in West Ham, as in many areas, especially in London, is difficult and up-hill work at present, chiefly due to the bad housing conditions with gross overcrowding. Problems have arisen during and since the war completely different from those of the pre-war period, but the health visitors have tackled their work with energy and enthusiasm, and again I wish to record my appreciation of their constant help. 28 Clinic Work The numbers attending the various clinics rose steadily throughout the year, so that additional ante-natal sessions and child welfare sessions have been established at all municipal clinics, in particular the ante-natal clinic attendances increased and continue, to date, to remain at a high level. Total number of children who attended at the clinics during 1945: Under one year 2,512 One to five years 3,533 Total attendances of children during 1945: Under one year 21,347 One to five years 7,720 Ante-Natal Clinics Total number of women who attended the clinics during 1945: 4,577, with a total attendance of 15,887. Post-Natal Clinics Separate sessions have not been established at the Council's clinics for post-natal work, but it is hoped to organise this scheme in the near future, so that all the nursing mothers will be encouraged to regard post-natal supervision as necessary, as is supervision during pregnancy. Additional staff will be required for such work. In 1945, however, 254 mothers attended for such post-natal examination. Staff There were no changes during 1945 in the medical staff, but several resignations occurred amongst health visitors for various reasons, e.g., retired on superannuation, leaving the district, etc. It has been difficult to replace the health visitors, especially with experienced staff who are so urgently required to deal with the many varied problems of the mothers in this area. Dental Clinics Concurrently with the increased attendances at the antenatal and child welfare clinics, there was a greater demand made on the dental services. Mrs. Rogers, L.D.S., continued as dental surgeon, attending 7-8 sessions per week. The improvement in the teeth of children under five years has been a noticeable feature during and since the war, so that her work is more concentrated now on expectant and nursing mothers. 29 Dental Treatment during 1945: — Number of children who attended 276 Total attendances 876 Number of expectant and nursing mothers 625 Total attendances 2,059 This section of the population is more "teeth conscious." Many of the young expectant mothers and their husbands served in the Forces, where they received regular dental supervision, and intensive education in health matters. Therefore, for themselves and their children, dental treatment has become an essential part of personal hygiene. Diphtheria Immunisation Steady work was carried on in respect of immunisation against diphtheria and whooping cough throughout the year at all the maternity and child welfare clinics. The health visitors continued their invaluable propaganda regarding this scheme at all home visits. Similarly at the clinics the mothers were constantly reminded about the necessity of giving young children this protection. The diphtheria inoculation was combined with whooping cough vaccine as for several years past, and therefore given to infants as soon as possible after the child reached the age of six months. During 1945 the number of children immunised at the maternity and child welfare clinics was :— Diphtheria only: Under five years 137 Over five years 42 Diphtheria and whooping cough: Under five years 1,376 Under five years 26 Eye Clinic According to the arrangements between the Education Committee and the Maternity and Child Welfare Committee, children under five years suffering from eye disease or defect were referred as follows to the Council's School Ophthalmic Medical Officer :— Number of new cases 77 Total attendances 223 Number of children for whom glasses were prescribed 56 Number of children referred to hospital for special treatment 9 30 Orthopcsdic and Sunlight Treatment The majority of children under five years of age for whom such treatment was required during 1945 were referred to the Children's Hospital, Balaam Street, Plaistow, as follows:— For Sunlight treatment 78 For Orthopædic treatment 93 Where in-patient orthopædic treatment was considered necessary, the children were admitted to various hospitals in London, the Children's Hospital, Balaam Street, not having re-organised its in-patient work. Convalescence (a) Children under five years. Children were recommended by the medical officers of hospitals, clinics, day nurseries or by private practitioners for a period of convalescence following an acute illness or for debility following a more chronic condition. During 1945, 155 children were placed in suitable homes through the Invalid and Crippled Children's Society and the Invalid Children's Aid Association, the average duration of stay per child being 8-10 weeks. (b) Nursing Mothers. Fifty-five mothers with their young infants were sent to "Child Haven," Hutton, Essex, the Home of the West Ham Central Mission. The mothers were selected from those attending the Child Welfare Centres or were recommended by health visitors; frequently the mother was debilitated following her recenc confinement, or nervous and over-anxious in regard to the care of her young baby. The complete rest, with the understanding help and personal interest of the nursing staff at "Child Haven" soon restored these mothers to better physical health and to a happier, less worried approach to their own particular problems. "Child Haven" has achieved a reputation amongst the mothers and the maternity and child welfare staff, so that there is always a keen demand for vacancies there. Midwifery The rise in the birth rate has produced one of the most difficult problems in the area. Owing to the unsatisfactory housing conditions, many more women were obliged to be confined in hospital in 1945 than in pre-war years. In the early months women were evacuated to Emergency Maternity Homes because of the prevalence of local rocket incidents. The three maternity hospitals in West Ham continued to function fully throughout, although Plaistow Maternity Hospital carried on the bulk of its work at the annexe at Loughton. All the hospitals received blast damage, Forest Gate Hospital Maternity Unit being particularly affected. Fortunately, there were no casualties 31 amongst either patients or staff. Even after cessation of war, West Ham mothers continued to take advantage of the evacuation scheme, and in a more limited way, mothers from this area are still sent to emergency homes at about the 38th week of pregnancy. The problem of inadequate midwifery staff was persistent and acute, but with the closure of two emergency homes staffed by midwives from Plaistow Maternity Hospital the position in respect of domiciliary midwifery has become easier. The Council's four domiciliary midwives continued their work; one, however, resigned at the end of 1945, but has been replaced. Maternity Hospitals Normally there are approximately 183 maternity beds available in West Ham. These serve mothers from West Ham and certain neighbouring areas. At the end of 1945, 170 of these beds were in use. The total number of women admitted to these beds during 1945 was 3,506, of whom 1,899 were West Ham residents. There were 3/207 confinements Tn hospital. The number of mothers admitted for ante-natal treatment during 1945 was 551; although the health of the expectant mothers has been remarkably good in spite of nervous strain, domestic difficulties, etc., there was noticed at the clinics an increase in cases of toxaemia of pregnancy of varying degrees. The majority of mothers availed themselves of the additional milk and other rationed food allocated to them as a priority class. Much propaganda was, and still is, required in respect of the equal need of expectant mothers to take the vitamin supplements. Emergency Maternity Homes During 1945, 106 West Ham mothers were evacuated under the Government Scheme, and these arrangements were continued after the war-time evacuation scheme ended on August 30th, 1945, when the Council agreed to accept financial responsibility for West Ham cases evacuated henceforth. Domiciliary Midwifery Pre-war there were 24 domiciliary midwives working in West Ham. At the end of 1945, this number had fallen to 16. In addition, however, the senior pupil midwives from Plaistow Maternity Hospital conducted a number of home confinements under the supervision of a qualified midwife. Six midwives were in private practice, having attended only 34 confinements during the year. Total domiciliary confinements during 1945 were 976, of which 928 were delivered by midwives only, the remaining 48 being maternity cases with a doctor in attendance. 32 Under Section 14 (i) of the Midwives' Act, 1918, Medical Aid was summoned by district midwives in 373 cases. Analgesia was not administered to any district case, but it is hoped that this may soon become a recognised feature of the district work. Transport of the necessary apparatus, especially in " black-out " days of early 1945, made such a scheme impracticable. Care of the Unmarried Mother and her Child The Council's arrangement with the Essex Diocesan Moral Welfare Worker proved satisfactory. The unmarried expectant mothers attended the ante-natal clinic and where thorough investigation by the clinic medical officer and health visitor proved that additional help was required, either during pregnancy or after the baby was born, the co-operation of the Moral Welfare Worker was sought with satisfactory results. The majority of these unmarried mothers lived at home with their parents or other relatives and, therefore, arrangements were made in the usual way. Where necessary a girl could be admitted to a special home during pregnancy. Again, the larger number of these unmarried mothers returned home from hospital with their babies and with the subsequent help of the day nurseries for the care of the baby while the mother goes to work, it has been possible to keep mother and baby together. During 1945, no girls were admitted to the Post-natal Home at Buckhurst Hill, Essex, where an agreement exists between the Essex County Council and the West Ham Council for the admission of suitable cases, but two unmarried expectant mothers were admitted to a special ante-natal hostel in Essex. Home-Help Scheme This scheme continued on the part-time basis, but owing to lack of suitable women it has been difficult to administer. Forty-four applications were granted in respect of maternity cases, and 3 in respect of general sickness cases. Care of Premature Infants The total number of premature births in West Ham during 1945 was 192, of whom 148 were born in hospital. Of those born at home, namely 44, 10 died during the first month. Of the 148 born in hospital, 115 survived at the end of the first four weeks of life, 26 died and 7 were still-born. Where required, a mother with her premature infant may be admitted from the district to one of the maternity hospitals in the area for more adequate supervision and nursing. In six cases only was this help sought by those in attendance on the premature infant. 33 Maternal Deaths During 1945 there were 6 maternal deaths of West Ham residents. One death was caused by puerperal sepsis and five from other maternal causes. Child Life Protection and Adoption of Children Full investigation and supervision in all such cases was carried out by the Maternity and Child Welfare medical officer and health visitors. At the end of 1945, 12 foster-children were under supervision, and 4 children under Section 7 of the Adoption of Children (Regulation) Act, 1939. Increasingly, the services of the maternity and child welfare staff have been used to place suitable children with West Ham residents with a view to legal adoption. The registered Adoption Societies requested reports from the health visitors before and after a child was placed with prospective adopters; or in certain cases the child was handed over to a prospective adopter by an official of this department. In every case a complete investigation was carried out prior to this action to ensure that the child would be happy and well looked after. Day Nurseries During 1945, the six war-time day nurseries continued to function fully. Plans were made to transfer the Howards Road Nursery, these premises being required for use by the Plaistow Maternity Hospital. Accordingly, early in January, 1946, the Howards Road Day Nursery was transferred to the Children's Hospital, Balaam Street, Plaistow. Up to date, the nurseries are fully used by women still employed in factories, domestic work, shops and canteens, and there still remains a long waiting list and a big demand for the services of nurseries. The health of the child at the nurseries during 1945 was good, except for minor epidemics of certain infectious diseases such as chicken-pox and measles. Every child who had not already been inoculated was immunised soon after admission against diphtheria and whooping cough. The chief difficulty in regard to staff was to obtain sufficient probationer nursery nurses. Training was given to all suitable probationers for the Certificate of the National Society of Children's Nurseries. In spite of the close proximity to certain rocket incidents, the nurseries sustained only slight blast damage and there were no casualties amongst the staff or children. The nurseries were visited by officials from the National Society of Children's Nurseries, to which organisation each nursery is affiliated, and the reports received were gratifying in regard to general management of the nursery and appearance of the children. 34 In conclusion, although there is nothing dramatic to report in respect of maternity and child welfare work during 1945, the various schemes of the Council have been pursued steadily and with satisfactory results. HOSPITALS GENERAL STATEMENT The Institutions owned and controlled by the County Borough Council are the following: — (1) Whipps Cross Hospital; (2) Forest Gate Hospital; (3) Harold Wood Hospital; (4) Isolation Hospital, Plaistow; (5) Dagenham Sanatorium; (6) Langdon Hill Sanatorium; (7) South Ockendon Colony; (8) Central Home;, (9) Forest House. Of these, Central Home and Forest House are controlled by the Social Services Committee. Beds in all the Institutions, except the two Sanatoria, the Isolation Hospital and South Ockendon Colony, are allocated to the Essex County Council and the East Ham Borough Council under a User Agreement. The proportions are 34 per cent, for Essex and 16 per cent. for East Ham. This section of the report deals with all these Institutions except the Isolation Hospital, the two Sanatoria and South Ockendon Colony, which are more completely dealt with in the sections devoted to infectious diseases, tuberculosis and mental deficiency. WHIPPS CROSS HOSPITAL Report by Dr. A. Norman Jones, F.R.C.S., Medical Superititendent This is a large general hospital under the control of the Health Committee. The conclusion of the war divided the year's work into two parts: during the first period it was not dissimilar to that of previous years; in the second half there were many differences, e.g., there was a cessation of air-raid casualties except for those who attended for treatment in respect of some previous injury. During the latter part of the year the work began to resemble that of 1938, which was the last year of normal working. Moreover, it was possible to consider plans for the future development of the hospital; naturally little could be accomplished at the time, and in the first case measures were directed to winding up the various air-raid organisations, and to removing certain protective works, black-out windows, etc. In connection with A.R.P. work, there were a number of incidents during the early part of 1945, the most notable being the fall of a rocket within the grounds of the hosnital on 35 January 26th. This occurred at about 9.15 a.m. and, fortunately, it fell in some land used for agricultural purposes which was, however, not further than one hundred yards from one of the hospital wards. No person was killed or injured and no serious damage was done, although many windows were blown out. As was found at previous incidents, there was no panic among the staff or patients. It is convenient at this point to refer to the devoted and willing service given by all members of the hospital staff to the various air-raid precaution schemes, and to acknowledge our indebtedness to all those who helped the hospital through the difficult war years. The number of patients admitted during the year was 7,316, a figure less than in 1938. Some statistics are included in a brief appendix, but it must be pointed out that, owing to abnormal circumstances, they cannot really be considered as giving a reliable picture of the work done at the hospital. During the year it was found possible to inaugurate an Almoner's service. Miss L. M. Gilbert was appointed Head Almoner to the Council's Hospitals and was stationed at Whipps Cross Hospital in order that a commencement might be made. An immediate problem was the provision of suitable office accommodation, and as a temporary measure the old Female Receiving Ward was utilised for this purpose and is still being used at the time of writing; it must be emphasised that this arrangement is qute unsuitable for the Almoner's Department, and it is hoped that a better office can be provided at an early date. Another activity directly affecting the patients was the reorganisation of the Hospital Library Service. The Borough Librarian was asked to report on the whole question and, following his advice, a room was set aside as a library and arrangements made for the preparation of record catalogues, the changing of books and the necessary work of binding and repair. It was further agreed that the Library Service should eventually be provided for the patients and for the medical and nursing staff. A considerable amount of attention was given to the question of the food service at the hospital and many visits were paid and Committees held when this subject was discussed. A special visit was made by an expert dietitian from the Ministry of Health and a comprehensive report received on the changes which would seem to be desirable. It was evident that considerable difficulty would be found in bringing about some of these changes, owing to the lack of experienced staff, the difficulty in obtaining certain equipment and the impracticability of providing the accommodation which was considered essential for a proper service of meals. Nevertheless, the Committee decided to introduce as many of the recommendations as seemed possible, and to this end approved the appointment of a Catering Organiser to be responsible for the catering in the hospital, under the direction of the Medical Superintendent. 36 A further innovation was the establishment of a Food Committee, comprising representatives of the various grades of the hospital staff to act in an advisory capacity, and it was possible to hold the first meeting of this Committee in the autumn. There were a number of staff changes during the year, the most important of which was the resignation of Mr. O. R. M. Kelly, F.R.C.S., Medical Superintendent, who intimated his desire to retire from the Council's service on medical grounds to the Health Committee Meeting of June 14th, 1945. Mr. Kelly had twenty-three years' service at Whipps Cross Hospital, and for some time acted as Deputy Medical Superintendent to Dr. Muir, whom he succeeded as Medical Superintendent in November, 1932. He was well-known to many people in the Borough and enjoyed a wide reputation as a surgeon. The strain of the war years had undoubtedly levied a toll on his health, and it was with regret that his decision to retire was received, as by his simplicity of manner and honesty of purpose he had endeared himself to a wide circle. He was succeeded by Mr. A. Norman Jones, F.R.C.S., Medical Superintendent of the West Park (County) General Hospital, Macclesfield, who was appointed on October 30th, 1945. It was hoped that Dr. Jones would be able to take up his duties at an early date, but it soon became evident that he would not be likely to join the staff until some time in 1946. The Medical Staff Committee continued to meet at monthly intervals throughout the year, and there is no doubt it has served a useful purpose in helping the Medical Superintendent with practical advice on various points. The meetings have been well attended by the resident staff, but it has not been practicable for the Consultants to come as often as might be desired, and it was evident that it might be necessary to change the time and place of the meetings. The Whipps Cross Hospital Medical Society continued its meetings for the purposes of hearing lectures and addresses and demonstrations of clinical work by the staff of the hospital. The attendances were uniformly good; there is no doubt that this Society is much appreciated by the doctors in the neighbourhood, who feel that the meetings give them an opportunity of keeping in touch with the latest developments in medicine and surgery and also of making personal contact with members of the hospital staff. In common with other hospitals, the shortage of nurses and domestics was acute and from time to time Matron had considerable difficulty in providing an adequate staff for the wards. A number of wards had to remain closed because of this shortage and this in turn brought about overcrowding in those wards which were open. In order to facilitate the recruitment of nurses, a brochure with illustrations of the hospital and containing details of a nurse's training were printed for circulation. 37 The shortage of domestic help was even more acute, but was relieved to some extent by the introduction of Belgian maids, the hospital receiving 15 in the first place. As would be expected, no considerable alteration was made in the buildings, but recommendations concerning some departments were drawn up. For some time there had been an increase in the number of casual cases seen at the hospital and there had been an increased demand for the establishment of consultative clinics where a patient could be referred by a general practitioner for a second opinion. It was evident that this work could not be properly undertaken without an increase in staff and the provision of appropriate rooms. Eventually it was decided that C.l ward, which was empty, should be divided up for the purpose of an out-patient deparment and clinic and this plan was put into action during the year. Nevertheless, the clinic, when erected, did not appear to be suitable, and was in fact, not utilised during the year. For some time the Massage staff had been inadequate to deal with all the treatments recommended and it was obvious that the existing department was too small. It was agreed that A.7 ward, formerly used as a mental observation ward, should be taken over for the purposes of a Massage Department. This ward was considered to be very suitable for the purpose, as it lies between the Occupational Therapy and the Light Departments, and it was hoped that when it had been suitably adapted, and the staff vacancies filled, the Physiotherapeutic and Remedial arrangements of the hospital would provide a service of which the hospital might well be proud. Statistics 1. Admissions West Ham East Ham Essex Total Public Health 2,139 1,474 3,703 7,316 E.M.S. 443 Grand total:— 7,759 Average number of in-patient days (Public Health) 36 Average number of in-patient days (E.M.S.) 25 2. Discharges. West Ham East Ham Essex Total 2,140 1,422 3,613 7,175 (This figure includes deaths as stated in para. 5 below E.M.S. 457 Total: — 7,632 3. Number of Out-Patients 3,688 38 4. Patients Seen by Consultants 3,312 5. Deaths. Public Health 1,277 ,, E.M.S. 23 Total:— 1,310 6. Number of Operations Performed 1,929 7. Number of X-Rays 5,859 8. Number of Fractures Treated 2,433 9. Number of Post-Mortem Examinations By Coroner's Pathologist 355 By own Medical Officers 35 Total:— 390 10. Number of Specimens dealth with in Pathological Laboratory 11,327 FOREST GATE HOSPITAL Report of the Medical Superintendent, Dr. H. R. England, M.B., Ch.B., M.A.O., M.M.S.A. The work at Forest Gate Hospital during the year 1945 continued in ever increasing volume, and there was a constant pressure throughout the year on the available beds in the Maternity Department, both as regards the lying-in beds and the increased number of Ante-natal cases requiring in-patient treatment by reason of a complication of pregnancy or of a disease complicating pregnancy. The year 1945 saw the end of hostilities, and the war years had been a very trying time, and I feel that the fact that during the period September 3rd, 1939, to the end of the war in Europe, 6,795 babies were born at Forest Gate Hospital deserves a mention in this final war year report. I think this a very considerable war effort and one of which the staff at Forest Gate Hospital,' and the County Borough of West Ham might well be proud when taking into account the difficulties and harassing conditions under which so much of the work was 39 conducted, and it can be marked down as a remarkable achievement. No mother or infant was lost as a result of enemy action. As I have stated in my previous reports, the hospital buildings suffered considerable damage from enemy action, and during the year the work of repairing the extensive damage has been going on. The following table shows the admissions and confinements at Forest Gate Hospital for a ten-year period—1935-1945. Except for one of the war years—1941—it will be seen that the work in the Maternity Unit has progressively increased. When one realises that this has been done with much of the same ward accommodation originally provided at Forest Gate Hospital for the reception and treatment of maternity cases in the early 1920's, the present-day difficulties experienced in the adequate treatment of the patients can be readily understood. 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 Total number of Admissions 728 861 1007 1205 1177 1011 740 1754 1659 1521 1843 Number of Confinements 640 779 907 1077 1051 917 647 1510 1500 1429 1659 I submit the following details of the work at Forest Gate Hospital for the year 1945 as supplied to the Ministry of Health on Form M.C.W.96A. (1) Total number of admissions (including infants born in Hospital) 3,456 (2) Number of women confined in the Hospital 1,659 (3) Number of live births 1,613 (41 Number of still births 46 (5) Number of deaths of babies under four weeks born in the Hospital 20 (6) Number of deaths of women confined in the Hospital 2 (7) Average number of days' residence of women confined in the Hospital 10.81 (8) Number of premature births (those weighing 5½ lbs. at birth or less) 128 (9) Number of Puerperal Pyrexia cases 8 (10) Number of cases of Ophthalmia Neonatorum Nil MATERNAL DEATHS. 2. Case No. 1. "Toxaemia of Pregnancy" "Pulmonary Oedema" "Cardiac Failure after Childbirth." Case No. 2. "Eclampsia." The cause of death was confirmed in each case by P.M. examination. 40 STILLBIRTHS (a) Premature (weighing 5½ lbs. or less) 23 (b) Full term 23 Attributed causes Anencephalic foetus 5 Intra-uteria death 5 Pre-eclampsia 3 Macerated foetus 3 Toxic accidental A.P.H. 3 Intra-natal death 3 Concealed accidental haemorrhage 3 Severe pre-eclampsia 2 Extended breech 2 Eclampsia 2 Toxaemia of pregnancy 2 Hydrocephalus (spina bifida) 1 Obstructed labour—disproportion 1 Breech—premature labour 1 Placenta praevia—marginal 1 Chronic nephritis 1 Hydramnios—intra-uterine death 1 Specific, W.R. doubtful, Kahn positive 1 Uterine inertia (severe) 1 A.P.H. 1 Cause unknown 4 46 NUMBER OF INFANT DEATHS WITHIN 10 DAYS OF BIRTH. (a) Premature (weighing 5½ lbs. or less) 10 (b) Full term 10 Certified Cause of Death Prematurity 7 Atelectasis ) Pulmonary atelectasis) 7 Spina-bifida 2 Haemorrhagic disease of the new born 1 Pericarditis 1 Icterus gravis 1 Haemorrhagic diathesis 1 Total: 20 CONFINEMENTS Of the 1,661 confinements: — 726 were Primigravidae. 935 were Multipara. 41 INFANT FEEDING (a) Number of infants wholly breastfed on discharge from Hospital 1,429 (b) Number of infants receiving a supplementary or complementary feed on discharge 184 ANTE-NATAL CLINICS There were over 5,000 attendances at Forest Gate Hospital Ante-Natal Clinic during the year 1945. POST-NATAL CLINICS There were approximately 800 attendances of patients at the Post-Natal Clinic. Only special cases needing supervision are seen at present. PATHOLOGICAL LABORATORY A laboratory service was instituted towards the end of 1945 and we were fortunate in obtaining the services of Mr. S. J. Butt, Technician, who commenced duty on the 26th November, 1945. The laboratory has not been fully equipped at present, but by the end of the year 110 examinations had been carried out. Dr. W. W. Walther, Pathologist, Whipps Cross Hospital, has been most helpful with regard to special investigations which have been necessary from time to time. BLOOD TRANSFUSIONS Many blood transfusions (Ante, Intra and Post-Natal) have been carried out. We are indebted to Dr. J. Shone, Director of the North London Blood Supply Depot, Barnet, Herts, for arranging for the provision of a regular supply of blood, particularly Rhesus Negative blood, and also the authorities at Whipps Cross Hospital, who supplied blood at very short notice. X-RAY OF PATIENTS During the year, 238 maternity cases were sent for X-ray at Whipps Cross Hospital, and I would like to thank the Radiographer (Mr. Morley) for his help and co-operation in the conducting of these X-rays. I am of the opinion that an X-ray apparatus should be provided at Forest Gate Hospital at the earliest practicable date. NURSING STAFF I have to draw attention to the acute shortage of Nursing Staff during the year affecting all sections of the hospital, particularly the Maternity Unit. 42 I also recommend the provision of increased accommodation for resident nursing and domestic staffs. DOMESTIC STAFF A shortage of domestic staff also exists. KITCHEN The equipment in the main kitchen should be brought up-to-date as soon as practicable. HOSPITAL LAUNDRY The hospital laundry is inadequate and cannot deal with the complete requirements for the hospital. The present method of sending articles for laundering to an outside laundry is unsatisfactory. OTHER SECTIONS OF THE HOSPITAL Much of the accommodation for patients at Forest Gate Hospital other than maternity was destroyed as a result of enemy action during the war period. At the end of 1945 the number of patients in residence was 128 (59 adult males and 69 adult females). Of this number, 16 (9 males and 7 females) were detained under the Mental Deficiency Acts, 1913-38. One adult male has been on licence for a considerable period and according to reports received on his progress appears to be leading a normal home life in the care of his married sister. LUNACY ACT, 1890 (Section 24). 23 patients (17 Males and 6 Females) were subject to the provisions of this Act. ADMISSIONS There were 67 admissions (6 males and 61 females) during the year. The majority of these were re-admitted after evacuation to the South Ockendon Colony as an emergency war measure. DISCHARGES There were 9 discharges (6 males, 3 females). 43 DEATHS There were 4 deaths during the year as follows:— 1. Coronary thrombosis. 2. Status epilepticus. 3. Cardiac, failure, hypostatic pneumonia. 4. Encephalitis lethargica. EMPLOYMENT All the ambulant patients, who are physically able, do various jobs and make themselves generally useful in and around the hospital wards, departments and grounds. The Handicrafts Department Tor the female patients was busily employed during the year and much useful work was done. The patients engaged in this department are under the supervision of Mrs. Cattaneo, Acting Handicrafts Instructress. The Brush-making shop and Boot-repairing shop also usefully occupy several of the male mental defective and epileptic patients. Mr. Connor, Male Handicrafts Instructor, and Mr. Harman, Bootmaker Instructor, are responsible for the work done and the supervision of the patients engaged therein. RECREATION As much recreation is allowed the patients at Forest Gate Hospital as the facilities permit. Many of the patients are given periodical and seasonal leave at the request of responsible relatives and they undoubtedly benefit by the change. The showing of talking pictures was resumed, at the end of the year, after a break during the war period, and this treat is much appreciated by the patients. As a conclusion to this report I would like to thank all members of the Staff at Forest Gate Hospital, who by their co-operation and close working, have contributed to the wellbeing of the patients during the year 1945. I must in this connection specially mention the Nursing Staff of the Maternity Unit, upon whom the major portion of the work fell. My thanks are also due to the Matron, Acting Steward, and Engineer, for their help and co-operation, and to my medical colleagues, Dr. Helen Mayer and Dr. R. Murphy. Due acknowledgement must be made of the invaluable services of Mr. J. V. O'Sullivan, Consultant Obstretician, and also to Mr. C. Berry Pitts, visiting Dental Surgeon, and Dr. G. Somerville, visiting Psychiatrist. I wish also to pay tribute to the Chaplains for their ministrations to the patients. I have also to acknowledge the assistance I received from the Medical Officer of Health, the ready 'help and co-operation at all times of the staff of his Department, and to the Chairman 44 and Members of the Health Committee for their kindness and consideration during the year when dealing with the management and welfare of Forest Gate Hospital. CENTRAL HOME This Institution, which is owned and controlled by the Social Services Committee, is used as administrative buildings and for housing chronic sick, mental and able-bodied persons. The number of persons admitted to the chronic sick section during the year was 1,132 (males 628; females 504). There were 326 discharges (males 162; females 164), and 810 deaths (males 459; females 351). FOREST HOUSE Forest House is situated in the same grounds as Whipps Cross Hospital, but is controlled by the Social Services Committee. The accommodation provides mainly for aged men and women, epileptics and mental patients. During the year there were 145 admissions (males 88; females 57), and 151 discharges (males 87; females 64). The deaths numbered 2 (1 male and 1 female). HAROLD WOOD HOSPITAL This hospital is used chiefly for the accommodation of chronic sick patients and for children convalescing from infectious diseases. It is controlled by the Health Committee. During the year there were 44 admissions (6 males and 38 females). The number of discharges was 13 females; deaths numbered 35 (8 males and 27 females). The children's wards were not used during the year owing to evacuation of patients. MENTAL DEFICIENCY On the 31st Decemeber, 1945, the number of defectives on the register ascertained to be "subject to be dealt with" was 682 (337 males and 345 females). DISTRIBUTION OF DEFECTIVES. The manner in which the defectives who were on the register at the end of the year had been dealt with is shewn in the following table:— 45 DISTRIBUTION OF DEFECTIVES Males Females Total Number in institutions under Order 168 149 317 Number on licence from institutions 18 16 34 Number under Guardianship Orders 4 4 8 Number in " places of safety " 12 46 *58 Number under Statutory Supervision 119 121 240 Number in which action not yet taken under any one of the above headings 16 9 25 337 345 682 * The large number of "places of safety" cases is due chiefly to evacuation from Forest Gate Hospital owing to war-time emergencies. NEW CASES. During the year, 27 defectives were added to the register. Of these, 14 were notified by the local education authority, 11 reported from various sources, and 2 former West Ham cases who had returned to the area. DEATHS. Eight defectives died during the year—5 in institutions, 1 on licence to a sanatorium, 1 at home, and . 1 in a poor law institution. ASCERTAINMENT. The number of mental defectives dealt with for the first time during the year was 25 (.14 males and 11 females). Included in this number are 14 cases (8 males and 6 females) notified by the local education authority. Of these new cases 7 (2 males and 5 females) were admitted to institutions. The remainder were placed under statutory supervision. In addition 5 cases (2 males and 3 females) were investigated, but proved not to be certifiable. INSTITUTIONAL ACCOMMODATION. The number of "West Ham mental defectives detained under Order is 351 (186 males and 165 females), of whom, 34 (18 males and 16 females) are absent from the institutions on licence. In addition, 58 cases, the majority of whom are considered to be mental defectives, are in South Ockendon Colony as in a " place of safety." Of these, 47 are patients evacuated from Forest Gate Hospital, and 10 evacuated from their homes owing to war-time emergencies. These patients will be dealt with under the Mental Deficiency Acts when circumstances permit. During the year 14 defectives (5 males and 9 females) were admitted to institutions, 13 under Order and 1 as in a "place of safety." Two of these cases (males) were dealt with under Section 8 of the Mental Deficiency Act, and 2 (1 male and 1 female) were dealt with under Section 9 of the Act. In 46 addition, 4 Orders were obtained in respect of defectives who were in institutions as " place of safety " cases. SUPERVISION. At the end of the year there were 240 defectives (119 males and 121 females) under statutory supervision and 25 cases (15 males and 10 females) under friendly supervision. In addition, there were 27 patients—13 males and 14 females—on licence from institutions and residing in the borough. These cases are visited at varying intervals by the visiting nurse according to the circumstances of the individual case. The parents are advised as to the best methods of training and caring for the defective, and endeavours are made to assist them in every possible way. A large number of the defectives are in fairly regular employment. In the majority of the cases visits are welcomed, but in a few instances some resentment is felt against this supervision. This is generally in the case where the parents consider their children to be normal, and feel that supervision casts a stigma upon them. LICENCE. During the year 11 patients (4 males and 7 females) were granted licence and 6 patients (3 males and 3 females) were recalled from licence. One defective on licence died in a sanatorium and in the case of another his Order was discharged. At the end of the year 34 defectives (18 males and 16 females) remained on licence. SOUTH OCKENDON COLONY Report by Medical Superintendent— Dr. Bernard Mathieson, M.B., Ch.B., D.P.M. On the 1st January, 1945, there were 407 patients subject to the provisions of the Mental Deficiency Acts on the register, namely 197 men, 152 women, 34 boys and 24 girls. During the year 12 men, 11 women, 2 boys and 5 girls were admitted, while 2 women died, and 3 men, 5 women and 2 girls were discharged, leaving a total of 425—206 men, 156 women, 36 boys, 27 girls—remaining on 31st December, 1945. In addition to these patients there were 240 evacuees— 30 men and boys and 210 women—being cared for in the Colony. During the year no evacuee patient was admitted, while 3—2 men and 1 woman—died, and 10 men and boys and 101 women were discharged, leaving a total of 126—18 men and boys and 108 women—remaining on 31st December, 1945. There was a total of 551 patients—260 men and boys and 291 women and girls—remaining in the Colony on 31st December, 1945. 47 ACCOMMODATION The available accommodation in the Colony has been stretched to its farthest limits, and the lack of more suitable accommodation for low grade patients and cripples has proved a considerable handicap. Overcrowding existed throughout the year and the absence of school buildings has caused me to continue using for this purpose rooms originally intended for staff. The need for .special accommodation for low grade patients, for school patients, and for sick patients remains urgent. GENERAL HEALTH The health of the patients has been good. There has been no serious outbreak of any infectious fever during the year. There were 5 cases of influenza, 2 epidemic jaundice, 2 lobar pneumonia, 1 pulmonary tuberculosis. Five patients died during the year—causes of deaths are set out below:— Empyema enteritis and T.B. 1 Broncho-pneumonia 1 Status epilepticus 1 Lobar pneumonia 2 So far as war-time conditions have allowed, as varied a diet as possible has been maintained and the general health of the patients does not appear to have suffered. All patients are weighed at least once a quarter and comparisons are made, not only with the preceding quarters, but with the corresponding weight period of the previous year. CONDUCT AND BEHAVIOUR OF PATIENTS This has on the whole been satisfactory. Good behaviour in mental defectives is found to be in direct proportion to activities and outlets provided for them, e.g., satisfactory occupations, recreations, preparations for concerts, outings, etc. The relative freedom, too, has a beneficial effect. There are not in the daytime, with the exception of one villa, any locked doors; escorting of patients from place to place is at a minimum. "Parole" is permitted outside the grounds and in Ockendon for selected male patients and, although there is no definite line of demarcation between the women's and men's sides, undesirable mixing has not occurred. The relative freedom and the ease of access to outside the Colony, together with the reduction of supervision due to shortage of staff, renders it a very easy thing for patients to run away. Nevertheless, over the year only eight patients (5 men and 3 women) absconded—all of whom were eventually traced and returned. The periods of absence varied from six days to nearly three months. It is, 48 perhap9, unfortunate that special accommodation is not available for the treatment and confinement ' of the high grade feebleminded person with delinquent tendencies. It is my view that such patients are best dealt with away from other defectives, in institutions, such as in Rampton State Institution. These patients, who usually arrive directly or indirectly from the Police Courts, have a detrimental effect on the behaviour of other patients and on the morale of staff and are frequently at the root of instability in a ward or villa. LICENCE Twenty-one patients—8 men, .1 boy, 10 women and 2 girls— were granted licence during the year, of whom 5—2 men, 1 boy, 1 woman and 1 girl—were returned. There were also 2 men and 1 woman previously granted licence who returned during the year. I set out below the reasons for their return: — Man returned after one week—beyond control. Girl returned after 16 days—parents were dissatisfied with care provided. Woman returned after six weeks—unsatisfactory conduct. Man returned after two months—charged by Police with larceny. Boy returned after three months—unmanageable at home. Man returned after nearly seven months—guardian left her home on account of rockets. Woman returned after over three years—pregnancy. Man returned after 1 years—following a complaint by Police of indecent exposure. EMPLOYMENT Patients are employed in and around the Colony in ordinary routine tasks. I give below a list showing the average number so employed daily and the occupations in which they are engaged: — Male Patients— Farmers 13 Gardens 13 Engineers 11 Main stores 2 Main kitchen 2 Lodge 1 Workshops 66 Porters' helps 2 Laundry 4 Villa workers 42 Total 156 49 The following shows the work carried out by the patients during1 the year:— Boot repairs: 7,121 soled, 2,457 heeled, 323 patched. Repairs: 4 Fibre Mats, 4 Woollen Rugs, 6 Baskets. Made: 14 Fibre Mats, 14 Wooden Toys. Female Patients- Laundry 16 Kitchen 11 Sewing room 47 Handicrafts 78 Wardwork 37 Helping with children 7 196 The following shows the work carried out by the patients during the year:— 178 Hand-knitted jumpers 1,048 Prs. men's, boys', ankle, small socks 46 Curtains 42 Sisters' caps 20 Prs. Nurses' sleeves 1,416 Hand towels 493 Tea towels 225 Sheets 27 Bath mats 303 Draw sheets 210 Bath sheets 460 Face flannels 130 Bibs 210 Men's and women's aprons 542 Pillow slips 222 Food covers 93 Tablecloths 112 Tray cloths 139 Napkins 202 Nightgowns. 248 Women's knickers 86 Boys' knickers 342 Pinafores 178 Staff aprons 72 Laundry bags 29 Special suits 112 Brassieres 20 Smocks (boys) 248 Dresses 126 Skirts 50 46 Cot draw sheets 24 Pants (boys) 20 Oven cloths 10 Blouses 56 Hair capes, pillow cases, towels (Jaconet) 19,439 Articles repaired, plus darning socks and jumpers. In addition to these, a few of the men patients go to seasonal daily work on the neighbouring- farms, for which they are paid at the rate of 1/- per hour, part of which goes to help towards their maintenance, part is saved and part given for pocket-money. RECREATION Occupational hours are between 9 and 12.15 in the mornings and from 2 to 4.30 in the afternoons. On Tuesday afternoons the patients attend the cinema in the main hall, and on Saturday afternoons there is dancing in the main hall and/or football and cricket, netball, according to season. Indoor games played are table-tennis, darts, card games, board games (draughts, ludo, etc.).- It was hoped to introduce small-sized billiards and bagatelle tables, but these are still in short supply and difficult to obtain. Small parties of "parole" patients are permitted to go unescorted to the neighbourhoods of Grays and Upminster to attend the cinema and the privilege is seldom abused. The Annual Sports Day was held on 14th July. It was on a bigger scale than usual, as combined with it were the V.E. day celebrations. In addition to the straight events there were many side-shows, including "Aunt Sally" and a giant slide. The arrangements made for tea and dancing on the lawn in the evening were upset by a heavy rainstorm. The usual full programme was arranged over the Christmas season including the popular Concert given by the patients themselves. The programmes for Sports Day and Christmastime are set out below:— SPORTS DAY, 14th July, 1945 1. Boundary race—men. 2. 220 yds race—girls 3. 50 yds race—schoolgirls. 4. 50 yds race—schoolboys. 5. Egg and spoon race—men. 6. Sack race—schoolgirls and boys. 7. 440 yds race—men. 51 8. Skipping race—girls. 9. 100 yds race—men. 10. 100 yds race—girls. 11. Obstacle race—men. 12. Fashion race—men. 13. Slow cycle race—staff. 14. Chairs in the park—guests and staff. 15. Musical chairs—women. 16. Tug of war—men. 17. Egg and spoon race—girls. CHRISTMAS FESTIVITIES, 1945 Christmas Day 10 a.m. Carol Service conducted by Revd. Pace in Recreation Hall. 11-12 noon. Xmas Tree (Limes, Laurels and School). 2.30 p.m. Concert by patients in Recreation Hall. 5 p.m. High tea. Boxing Day 10 a.m. Treasure Hunt—staff. 2.30 p.m. Patients' Dance. 8 p.m. Informal Dance for staff. 27.12.45— 2 p.m. Cinema for patients (first party). 5 p.m. Cinema for patients (second party). 28.12.45— 3 p.m. Schoolchildren's Tea Party. 8 p.m. Nursing Staff Dinner and Party. 29.12.45 3 p.m.—Tea Party and Cabaret for women patients. 30.12.45—11 a.m. Church Service. 1. 1.46—Concert for patients given by Naivette School of Dancing. 4. 1.46—8.30 p.m. Staff Dance. RELIGIOUS SERVICES The higher grade Church of England patients attend the local churches in the village. The Roman Catholic Priests hold Mass in the Colony once a month and occasional special services are held in the Colony by the Revd. Pace. VISITS BY OFFICERS OF BOARD OF CONTROL On the 10th September, 1945, a visit was paid to the Colony by Mr. Cyril F. Penton (Senior Commissioner) and Mr. R. G. Anderson (Commissioner) of the Board of Control. Their report, which was considered a satisfactory one, has been duly submitted to the Council. 52 STAFF In common with most Institutions the Colony has suffered from shortage of staff of both sexes. The recruitment of parttime workers, temporary staff, and, on the men's side, of middle-aged and even elderly men, has helped to meet a very difficult situation. During the year the one candidate who sat for the Preliminary Examination of the Royal Medico-Psychological Association was successful, and, out of nine candidates who sat, six passed the Final Examination and obtained the Certificate in the Nursing of Mental Defectives. In conclusion I should like to express my appreciation to all members of the staff for their loyal assistance. FOREST GATE HOSPITAL Report by Medical Superintendent— Dr. H. R. England, M.B., Ch.B., M.A.O., M.M.S.A. Forest Gate Hospital is approved by the Board of Control under Section 37 of the Mental Deficiency Act, 1913, for the reception of 23 mental defectives, of whom not more than 10 shall be adult males, and not more than 13 shall be adult females. The class of defectives authorised to be received are the lowest grade, including cot and chair cases. On the 31st December, 1945, the number of patients on the register, subject to the provisions of the Mental Deficiency Acts, was 16 (9 males and 7 females): one of these, a male, was on licence from the hospital. Further information on this subject will be found in the section dealing with hospitals, see page ' WEST HAM NERVE CLINIC Report by Dr. George Somerville, M.D., D.P.M. During the year ended 31st December, 1945, 65 new cases were treated at the O.P. Clinic. There has been a very noticeable increase in the numbers and attendances of patients during the latter half of the year, this being associated with the cessation of hostilities and the return of citizens to the Borough. At present, two sessions of about three hours are held weekly on Monday and Wednesday afternoons. Dr. E. P. Dodds is responsible for the Monday session, and since Dr. J. E. Glancy left the hospital service in September, 1945, his place has been taken by Dr. M. Lidgate. We 53 hope to increase our Out-Patients' Sessions to three per week early in 1946. As the numbers have increased during the latter months, an appointment system has been instituted. This has been found to work exceptionally well, as the majority of patients, realising that the system is for their benefit, do endeavour to keep their appointments. In these difficult days, however, it is inevitable that some patients do not keep strictly to their appointments, the usual apology and explanation being that of queueing for food, soap, and even coal. The services of our Psychiatric Social Worker, Miss Batkin, have been invaluable to the clinic. She is in attendance at each session to take full social histories of the new cases, and as this saves the doctor's time, he can give more attention to treatment of the patients. The Psychiatric Social Worker arranges appointments for new patients—seeing relatives when necessary, while some of her most useful work is co-operating with the Employment Exchange in finding new or suitable jobs for patients. We have found the Employment Exchange most helpful in this part of our work. Of the 65 cases treated—27 were patients who had been in-patients of the West Ham Mental Hospital and wished to avail themselves of the clinic's help after discharge. These expatients are very regular in their attendance, and we find that they are more able to carry on their everyday activities and meet responsibilities knowing that they have the clinic team to lean on. Of these discharged cases, five have since relapsed and been re-admitted to hospital as Voluntary Patients, on the advice of the doctor. Of the remaining 38 new cases—14 were admitted to hospital for more intensive psychiatric treatment, such as insulin shock, or electrical convulsant treatment. In these cases the benefits of early hospital treatment are noticeable. For example, several Schizophrenics in the early stages of the disease have been admitted for insulin shock therapy and have been discharged recovered at the end of three months. Only two patients refused to consider hospital treatment as advised, and discontinued attending the clinic. Most of these cases were referred to the clinic by the local general practitioners and by. the welfare doctors, while a few were referred by the Citizens' Advice Bureau. It is interesting to note that all cases admitted to hospital were voluntary patients, although in the first instance, two were admitted on "urgency order." Two cases, both children, suffering from congenital mental defect, were referred to the Child Guidance Clinic for mental testing, and disposal. A limited number of children are treated at the clinic, but wherever the doctor considers that the child- will derive benefit 54 from more intensive treatment, he refers it to the Child Guidance Clinic. A certain number of patients suffering from the neuroses have been treated psychologically and have derived much benefit from continued weekly psychological interviews. Five patients have discontinued attendance due to their removal to other parts of the country. At the end of the present year, the clinic is in a healthy condition and we anticipate an increase in numbers and attendances in the coming year. Below is a summary of the cases dealt with. TYPES OF MENTAL ILLNESS (a) Adults— Psychoses Schizophrenia 16 Paranoia 2 Cyclothymia 16 Cerebral Arteriopathy 7 Epilepsy 3 Confusional States 1 Psychoneuroses Anxiety States 10 Compulsive Obsessional 2 Hysteria 2 (b) Children— Anxiety States 2 Congenital mental defect 4 55 INDEX Subject page Adulteration of food—action taken 21 Ambulance facilities 16 Births, live 7 Births, stillbirths 7 Central Home 45 Chest Clinic 25 Child Life Protection 34 Dagenham Sanatorium 25-26 Day Nurseries 34-35 Deaths—age groups 6 do. infant 7 do. maternal 7 Diphtheria immunisation 8, 10, 30 Disinfection and disinfestation 13 Domiciliary midwifery 32-33 Emergency maternity homes 32 Fertilisers and Feeding Stuffs Act, 1926 22 Food inspection 17-21 Forest Gate Hospital 39-45, 53 Forest House 45 Harold Wood Hospita l45 Home Helps 33 Hospitals: — Central Home 45 Forest Gate 39-45 Forest House -45 Harold Wood -45 Maternity 33 Plaistow Fever 10-13 South Ockendon Colony 47-53 Whipps Cross 35-39 Ice cream 19 Infectious diseases 7.15 Insulin—supply of -17 Langdon Hill Sanatorium 27 56 SUBJECT (contd.) PAGE Maternity and Child Welfare 28-35 Clinic work 29 Dental clinics 29-30 Eye clinic 30 Midwifery 31-32 Orthopaedic and sunlight treatment 31 Premature infants 33 Unmarried mothers with children 33 Maternity Hospitals 32 Mental Deficiency 45-53 Midwifery—domiciliary, etc. 31-33 Milk—samples taken 17-20 Mortuaries 16 Nerve Clinic 53-55 Pharmacy and Poisons Act, 1933 22 Plaistow Fever Hospital Report 10-13 Population 7 Public Analyst—report of 19-21 Queen Mary's Hospital—Special Treatment Centre 14-15 Sanatoria 25-27 Sanitary circumstances 22-24 Sanitary Inspectors—work of 23-24 Shops Acts 17 South Ockendon Colony 47-53 Statistics, vital 5-7 Tuberculosis 25-27 Chest Clinic 25 Dagenham Sanatorium 25-26 Deaths 25 Langdon Hill 27 Notifications 25 Vaccination 17 Venereal Diseases 13-15 Vital statistics 5-7 Water supply 2-23 Whipps Cross Hospital 35-39 The Plainstow Press PLAISTOW, LONDON, E. 15