BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report on the health and Sanitary Condition of the Borough including Reports on the Isolation Hospital and Bacteriological Laboratory, and THE REPORT TO THE EDUCATION COMMITTEE, by G. SOWDEN, M.D., D.P.H., Medical Officer of Health, Medical Superintendent of the Borough Hospital, Medical Officer to the Education Committee, together with the report of the CHIEF SANITARY INSPECTOR, For the Year ended 31st December, 1909. South Essex Printing and Publishing Co., Ltd. High Street South, East Ham, E. 1910. To His Worship the Mayor, the Aldermen and Councillors of the Borough of East Ham. Gentlemen, I beg to present my fifth Annual Report on the health and sanitary condition of the Borough, together with the reports on the work of the Isolation Hospital and Bacteriological Laboratory. For convenience of reference, the Report to the Education Committee is also included. This contains an account of the first year's work in connection with the Medical Inspection of School Children, in addition to a record of the other duties performed for the Education Committee. I am pleased to report that East Ham continues to maintain its position as one of the healthiest towns in the country. Of the 76 large towns in England and Wales only one had a lower death rate during the past year than East Ham. Both the General Death Rate and the rate of Infantile Mortality was the lowest hitherto recorded in the Borough. In addition to this the Infectious Diseases Attack Rate was the lowest recorded since the Notification Act came into force 20 years ago. I am, Gentlemen, Yours faithfully, G. SOW DEN, M.D., D.P.H. Town Hall, East Ham, March, 1910. EAST HAM CORPORATION PUBLIC HEALTH COMMITTEE. Councillor A. J. Jones (Chairman). The Mayor (Councillor G. Pratt, J.P., C.C.). The Deputy-Mayor (Councillor W. C. Ford, J.P.). Alderman J. Brooks, J.P., C.C. Councillor T. Hassan Cowper. Alderman J. H. Carte, J.P. Councillor G. P. Dean. Alderman C. Northfield, J.P. Councillor E. Edwards, J.P. Alderman J. Savage, J.P. Councillor W. T. Howlett, L.T.C. Councillor O. R. Anstead, J.P., C.C. Councillor H.Evan Jones, J.P., C.C. Councillor H. Barfield. Councillor Murrell, Oakes, J.P. Councillor F. Bradley. Councillor J. Prince, J.P. Councillor F. G. Cosburn, C.C. Councillor H.F. Witherspoon, C.C STAFF OF THE PUBLIC HEALTH DEPARTMENT. W. J. Worley, Junior Clerk. W. L. Garrett, Junior Clerk. F. J. Kendall, Chief Clerk. Sanitary Inspectors : M. J. J. Hillyard, J. G. Anderson, G. D. Lill. School Nurse and Health Visitor: Miss A. G. Mayman. Matron of Isolation Hospital: Miss Wilson. Veterinary Inspector : H. J. Parkin, M.R.C.V.S. Chief Sanitary Inspector and Inspector Contagions Diseases (Animals)' Act: Joseph G. Banks, A.R. San. I. Deputy Medical Officer of Health: W. Benton, M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health, School Medical Officer, and the Medical Superintendent Isolation Hospital : G. Sowden, M.D., D.P.H. Fellow of the Royal Society of Medicine. Fellow of the Society of Medical Officers of Health. Fellow of the Royal Institute of Public Health. 4 SUMMARY OF REPORT FOR 1909. Population, Census, 1901, 96,018. Persons per acre, 33. Estimated Population, 1909, 149,575. Persons par acre, 45. Inhabited Houses, Census 1901, 16,681. Estimated Inhabited Houses 1909, 23,547. Births, 3,518. Birth-rate per 1,000, 23.5. Deaths, 1,412. Death-rate per 1,000, 9.4. Excess of Births over Deaths, 2,106. Zymotic Death-rate, 1.25. Infantile Mortality per 1,000 Births, 95. Total Rainfall, 24.1. Borough Isolation Hospital, Roman Road, East Ham. Hospital for Small Pox, Dagenham (Joint Hospital). COMPARATIVE STATISTICS. Rates per 1,000 of Population. Rate per 1,000 Registered Births. Births. Deaths. Zymotic Deaths. Infant. Mortality. England and Wales 25.6 14.5 1.12 IO9 76 Great Towns 257 14.7 1.42 118 London 24.4 14.0 1.30 IO7 EAST HAM 23.5 9.4 1.25 95 5 STATISTICAL DATA. Year. Population. Rateable Value. General District Rate. Poor Rate and Education Rate. *I878 7,500 £33,661 3/- 2/6 1881 10,706 £49,401 3/- 2/6 1891 32,712 £127,721 2/- 3/2 1901 96,018 £341,088 3/6 4/9 1909 H9.575 £464,070 3/9 5/6 * East Ham Local Government District was constituted on 6th December, 1878. ACTS OF PARLIAMENT, BYE-LAWS, AND REGULATIONS IN FORCE IN THE BOROUGH. SPECIAL ACTS. East Ham Improvement Act, 1898. East Ham Improvement Act, 1903. ADOPTED ACTS. Infectious Diseases (Notification) Act, 1889. do. (Prevention) Act, 1890. Public Health Acts Amendment Act, 1890. Public Baths and Wash-houses Acts, Housing of the Working Classes Act, 1890. Public Libraries Act, 1892. BYE-LAWS, REGULATIONS, ETC. Tents, Vans, and similar structures for human habitation. Removal of House Refuse. New Streets and Buildings and alterations to Buildings. Common Lodging Houses. Dairies, Cowsheds and Milkshops. Slaughter Houses, Bakehouses and Nuisances. Public Pleasure Grounds. Houses let in lodgings or occupied by members of more than one family. 6 PHYSICAL FEATURES. The Borough of East Ham has an area of 3,355 acres, including inland water. It extends from the River Thames on the South to the Urban District of Wanstead on the North. On the East the River Roding separates it from the Urban Districts of Barking and Ilford, while on the West it adjoins the County Borough of West Ham. The sub-soil is sand and gravel, with the exception of a portion of the South of the Borough where it consists of alluvium overlying the London clay. The altitude is not great, the highest point above ordnance datum being about 50 feet. For administrative purposes the Borough is divided into six Wards, it forms part of the Parliamentary Division of Romford, and for purposes of the Poor Law is included in the West Ham Union. The population is chiefly working class, the majority being employed in London. There are few factories in the Borough, the most important local industry being the Beckton Gas Works. Water is supplied by the Metropolitan Water Board, the quality is good and the supply constant. The streets are well kept, and nearly all are planted with trees. These number at present about 17,000, and form quite a feature of the district. The Borough is well supplied with Gas and Electric Light, the latter works being owned by the Corporation. Electric Trams, also a Corporation undertaking, not only traverse the Borough, but run to Ilford, Barking, Canning Town, Poplar, Stratford, and also to Bow, where they join the London County Council system. 6a Extract from Local Government Board's Memorandum as to Annual Reports of Medical Officers of Health, October, igog. As subjects concerning which the Board desire to obtain, through Annual Reports of the Medical Officer of Health, not only definite general information, but record also of particular changes of condition that may have occurred incidentally or by action of the local authority, the following dese ve to be specially borne in mind :— Physical features and general character of the district and general conditions of its population. The chief occupations of the inhabitants, and the influence of any particular occupation on public health. House accommodation, especially for the working classes: its adequacy and fitness fot habitation. Sufficiency of open space about houses, and cleanliness of surroundings. Supervision over erection of new houses. Action under Parts I., II. and HI. respectively of the Housing of the Working Classes Act, taken or needed. Water supply of the district or of its several parts: its source (from public service or otherwise), nature (river water, well water, upland water, etc.), sufficiency, wholesomeness, and freedom (by special treatment or otherwise) from risks of pollution. In the case of waters liable to have plumbo-solvent action, any facts either clinical or chemical, whether negative or positive, as to contamination of the water by lead should be stated, and whether administrative action has been taken during the year in respect of such contamination. Milk supply: character and wholesomeness of milk produced within the district or imported ; condition of dairies, cowsheds, and milkshops; administration in regard to miik. Tuberculous milk. Other foods: unsound food and food inspection; sanitary condition of premises where foods are prepared, stored, or exposed for sale. Meat inspection, disease in meat, and condition cf slaughterhouses. Action under Sale of Food and Drugs Acts, taken or needed. Action under section 117 of the Public Health Act, 1875. Number of carcases and parts of carcases condemned for tuberculosis. Sewerage and drainage : its sufficiency in all parts of the district. Condition of sewers and house rains. Method or methods of disposal of sewage. Localities where improvements are needed. 6b Pollution of rivers and streams in the district: the sources and nature of such pollution, and any action taken to check it. Excrement disposal : system in vogue ; defects, if any. Removal and disposal of house refuse—whether by public scavenger or occupiers ; frequency and method. Nuisances : proceedings for their abatement—any remaining unabated. Byelaws as to hous s let in lodgings, offensive trades, etc. Details as to number of premises coming under each set of byelaws and action taken. Any need of amendment or further byelaws, Schools, especially public elementary schools ; sanitary condition of, including water supply; action taken in relation to the health of the scholars and for preventing the spread of infectious disease. Methods of dealing with infectious diseases; notification; isolation hospital accommodation, its sufficiency and efficiency ; disinfection. Methods of control of tuberculosis; whether any system of notification of cases pulmonary tuberculosis, compulsory or voluntary, is in operation. Number of cases notified; what action ir> taken in respect of known cases and of deaths. Amount of hospital accommodation for cases of pulmonary tuberculosis in infirmaries and elsewhere, for advanced and for earlier cases of the disease. "With regard to such points it should be remembered that these reports are for the information of the Board and of the County Council, as well as of the Council of the District, and that a statement of the local circumstances and a history of local sanitary questions which may seem superfluous for the latter may often be needed by the former bodies. " It is expected that each of the preceding points will be mentioned in the Annual Report, and the extent of action or absence of action on each of them definitely stated " Under Section 132 of the Factory and Workshop Act, 1901, the Medical Officer of Health is also required to report specifically on the administration of the Act in Workshops and Workplaces; and to send a copy of his Annual Report, or so much of it as deals with this subject, tc the Secretary of State. 7 BOROUGH OF EAST HAM. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1909. VITAL STATISTICS. POPULATION. As it is now nine years since the last Official Census was made, it is difficult to obtain a very accurate estimate of the present population, and consequently the Vital Statistics based on this have become less reliable. According to the estimate of the Registrar General, the population of the Borough at the middle of 1909 was 149,575. It is practically certain that this figure is too high, the growth of the Borough during recent years has not been so rapid as formerly, while the percentage of empty houses is probably larger now than at the time of the Census. For the purpose of calculating the various rates in this report the estimate of population given by the Registrar General has been used in order that our figures may be compared with other districts, the populations of which have been similarly estimated by him. 6 ward populations. The following Table gives the population of the Borough and of each Ward, both according to the Estimate of the Registrar General and also based on an enumeration of the number of occupied houses made at the middle of the year :— Population based on Number of Occupied Houses. Population according to Estimate of Registrar General. Difference. Beckton and North Woolwich Ward 13,008 12,553 - 455 Central Ward—East 25,686 27,659 +1,973 Central Ward—West. 24,615 28,115 +3,500 Manor Park Ward 29,913 30,962 +1,049 Plashet Ward—East 20,062 22,776 +2,714 Plashet Ward—West 25,496 27.510 +2,014 BOROUGH 138,780 149,575 + 10,795 BIRTHS. The births during the year numbered 3,518, of which 1,806 were boys and 1,712 were girls. The birth-rate was 23.5 per 1,000 as compared with 25.6 for England and Wales. The birth-rate for each of the four quarters of the year was as follows :— 9 1909. Rate Per 1,000. 1st Quarter 24.3 2nd „ 24.1 3rd „ 23.2 4th „ , 227 The following Table gives ihe number of births a:id the birth-rate for the Borough and for each of the Wards : — Births. Rate per 1,000 Population. Beckton and North Woolwich Ward 324 25.8 Central Ward—East 685 24.8 Central Ward—West 702 24.9 Manor Park Ward 731 23.6 Plashet Ward—East. 476 20.9 Plashet Ward—West 600 21.8 BOROUGH 3,518 23.5 The steady fall in the birth-rate, which has been such a marked feature during recent years, not only in this Borough but in the whole country, still continues. The birth-rate during the past year is again the lowest on record, and despite the increase in population, the actual number of births is also lower than in any year since 1901. The following table giving the Population, the number of births, and the birth-rate for the past nine years clearly shows this continuous fall 10 Year. Population. No. of Births registered. Birth-rate. 1901 96,000 3,503 36.4 1902 104,023 3,805 36.5 1903 110,451 3,805 34.4 1904 116,902 3,7!7 31.7 1905 123,381 3,687 29.8 1906 129,886 3,656 28.1 1907 136,421 3,690 27.0 1908 142,976 3,534 24.7 1909 149,575 3,518 23.5 On the opposite page the variations in the birth-rate during the past 20 years are graphically shown. Illegitimate Births. Of the total births, 49, or 1.4 per cent., were illegitimate. In the previous year the percentage of these births was 1.6 per cent. Nine of these births occurred in the Workhouse. The death-rate of these illegitimate infants, under 1 year of age, was equal to 449 per 1,000, the rate for legitimate infants for the same age being 90 per 1,000. 12 DEATHS. For the fourth year in succession I have the pleasure of reporting the lowest death-rate hitherto recorded in the Borough. During the past year the number of deaths which were registered in the district was 1.160. Of these, 26 were those of strangers or visitors and have to be excluded, the particulars relating to them were sent to the districts to which the persons belonged. 278 deaths were reported to me of persons belonging to the Borough, who had died in various institutions situated outside the district (41 occurred in the Workhouse, 125 in the Infirmary, and 112 in various Asylums, Hospitals, &c.) Including these we have a nett total of 1,412 deaths, (705 males and 707 females), which is equal to a rate of 9.4 per 1,000. The death-rate in each of the four quarters of the year was as follows. The rates for the corresponding quarters of the previous year are also given for comparison :— RATE PER 1,000. 1909. 1908. 1st Quarter 12.6 11.8 2nd do. 9.5 10.0 3rd do. 8.1 10.5 4th do. 9.2 9.1 Table I on page 61 gives the deaths and death-rates for the past 10 years. As slated above it will be seen that the rate for the past year is the lowest yet recorded. The chart on the opposite page gives a graphic representation of the death-rate of' the district for the past 20 years. 14 The following table, which gives the nett death rates for England and Wales, and for each of the 76 Great Towns for the year 1909, has been taken from the quarterly returns of the Registrar General. It will be seen that only one other town in the country had a lower death-rate than East Ham:— Death Rate per 1,000. England and Wales 14.5 76 Great Towns 14.7 Hornsey 8.3 Plymouth 14.5 East Ham 9.4 Walsall 14.5 Walthamstow 9.6 Newcastle-on-Tyne 14.8 King's Norton 9.7 Hull 14.9 Handsworth 9.8 Bolton 15.1 Leyton 10.3 Sheffield 15.1 Willesden 10.4 South Shields 15.1 York 11.4 Brighton 15.3 Reading 11.5 Newport (Mon.) 15.3 Tottenham 11.5 West Bromwich 15.3 Devonport 11.6 Birmingham 15.4 Croydon 11.7 Preston 15.8 W. Hartlepool 11.8 Binkenhead 15.9 Burton-on-Trent 12.0 Coventry 16.0 Barrow-in-Furness 12.2 Wolverhampton 16.0 Hastings 12.5 Burnley 16.1 Gateshead 12.6 Blackburn 16.2 Bournemouth 12.7 Bury 16.2 Bristol 12.7 Rochdale 16.2 Smethwick 12.8 Huddersfield , 16.3 15 Wallasey 12.8 Nottingham 16.3 Leicester 12.9 Rhondda 16.3 Aston Manor13.0 Stockport16.5 Cardiff 13.1 Bootle 16.9 Ipswich 132 Sunderland 16.9 Rotherham 13.2 Warrington 17.0 Derby 13.3 Tynemouth 17.3 Grimsby 13.3 Great Yarmouth 17.5 Northampton 13.3 Merthyr Tydfil 17.7 Southampton13.3 Manchester 17.9 Halifax 13.8 Salford 17.9 Norwich 13.9 Hanley 18.1 Stockton-on-Tees 13.9 St. Helen's 18.6 London 14.0 Liverpool 19.0 West Ham 14.0 Wigan 19.0 Leeds 14.1 Middlesbrough. 19.1 Portsmouth 142 Oldham 19.1 Bradford 14.5 Swansea 19.4 17 CORRECTED DEATH-RATE. In common with most new and rapidly growing districts East Ham contains an excess of young people, and therefore should have a lower death-rate than towns where this condition does not obtain. The death-rate for females is also lower than that of males, and therefore districts where women preponderate have lower death-rates. It is p ssible to make a fairly accurate correction for this varying age and sex distribution, and on the basis of the Census of 1901, the "factor for correction," as it is termed, for East Ham is 1.067. If the nett death-rate is multiplied by this, the result gives the rate which would probably have occurred had the age and sex distribution been the same as that of England and Wales as a whole. Corrected in this way the death-rate of East Ham for 1909 becomes 10.0 per 1,000 of population. WARD DEATH-RATES. The number of deaths and the death-rates in each of the Wards are given in the following table. For comparison the rates for the previous year are also given :— Ward. Deaths. Death-rate. (1909). Death-rate. (1908). Beckton and North Woolwich 140 11.1 10.4 Central—East 246 8.9 9.9 Central—West 290 10.3 IO.5 Manor Park 327 10.5 11.3 Plashet—East 177 77 8.4 Plashet—West 232 8.4 9.1 BOROUGH 1,412 9.4 99 UNCERTIFIED DEATHS. Two were recorded during the year as compared with nil for 1908. The following causes of death were stated by the Registrars:— Heart failure and goitre ... Female 51 years. Pulmonary Tuberculosis Male 33 ,, 18 INQUESTS. 93 Inquests were held during the year. The following were the causes certified by the Coroner :— Under 1 year. 1 5 15 25 65 and over. Total 5 15 25 65 Heart Disease 1 — — — 5 5 11 Burns and Scalds 2 5 — 1 1 — 9 Pneumonia 4 1 1 — 1 — 7 Suffocation (overlaid in bed) 7 - - - - - 7 Syncope 1 — — — 3 2 6 Suicides — — — — 5 — 5 Diarrhoea 3 — 1 1 — — 5 Want of proper attention at Birth 5 - - - - - 5 Convulsions 4 — — — — — 4 Bronchitis — 1 — - 1 1 3 Drowning - — 1 1 1 — 3 Falls — 1 — 1 — 1 3 Alcoholism — — — — 1 1 2 Apoplexy — — — — 2 — 2 Improper Feeding .. 2 — — — — — 2 Street Accidents — 1 — 1 — — 2 Measles 1 — — — — — 1 Phthisis — — — — 1 — 1 Cancer — — — 1 — 1 Diphtheria 1 — — — 1 Other Causes 3 1 1 — 5 3 13 19 INFANTILE MORTALITY. This is measured by the ratio of deaths under 1 year of age to 1,000 registered births. It amounted to 95 during the past year as compared with 104 in 1908. The rate for England and Wales during 1909 was 109, and for the 76 Great Towns 118, per 1,000 births registered. The following Table gives the number of infant deaths anc the rate per 1,000 births during the past five years. Year. Number of Infant Deaths. per 1,000 Births. I905 478 129 1906 473 129 1907 386 105 1908 368 104 1909 334 95 Although the Notification of Births Act (1907), which was framed to combat the high rate of Infant Mortality, by providing for earlier notification of all births to the Medical Officer of Health, has not been adopted in this Borough, arrangements have been made with most of the midwives and nurses practising in the District by which this information is obtained. The Matron of Sister Katherine's Branch of Maternity Nurses also sends me prompt information of the large number of cases attended by the Staff under her charge. Printed instructions on the care and feeding of Infants are sent to all the cases notified, and, as far as time permits, the School Nurse, who also acts as Health Visitor, calls at the houses where it is considered that her help and influence are likely to be most useful. 20 Table V., on page 68, gives a complete list of the causes of death of all children under 1 year of age. For many years Public Health work in connection with Infantile Mortality has been chiefly concerned with combating the death-rate from Diarrhceal diseases, these being usually due to unsuitable or polluted food, together with insanitary surroundings in association with hot, dry weather. At the present time this group of diseases is not the chief cause of Infant Mortality. What are termed "Wasting Diseases"which includes Premature Birth, Debility, Congenital Defects, etc., are responsible for nearly 50 per cent, of Infant deaths. On Table V., page 68, it will be seen that during the past year the total number of Infant Deaths was 334, to this, Diarrhceal diseases contributed 47, and Wasting diseases 147, and of this latter number no less than 66 died within seven days of birth, while 103 died within one month. It is impracticable to remedy this mortality through the children, these feeble puny infants are practically doomed from birth. Conditions in the parents must be chiefly responsible tor this weakly condition and high death-rate in Infants so young, and to remedy this, Public Health work must be chiefly directed to the causal conditions in the parents and not to the children. The following Table gives the rate of Infant Mortality and other allied statistics, for each Ward in the Borough for 1909 21 Borough. Beckton & North W'lwich. Central East. Central West Manor Park. Plashet East. Plashet West. Population 149,575 12,553 27,659 28,115 30,962 22,776 27,510 Births 3,518 324 685 702 731 476 600 Birth-rate 23.5 25.8 24.8 24.9 23.6 20.9 21.8 Deaths 1,412 140 246 290 327 177 232 Deaths under 1 year 334 37 68 71 81 32 46 Infant Mortality Rate 95 111 96 104 115 65 73 Death-rate per 1,0001 births from Diarrhoeal diseases 13 15 17 18 13 11 3 Death-rate per 1,000 births from ''Wasting diseases" 42 43 47 41 49 36 32 ZYMOTIC MORTALITY. The seven chief Epidemic diseases caused 187 deaths, giving a Zymotic death-rate of 1.25 per 1,000 of population. The corresponding rate for England and Wales was 1.12, and for the 76 Great Towns it was 1.42. The following Table gives the number of deaths and the death-rate per 1,000 of population from each of the seven principal Epidemic diseases during the last five years;— 22 Zymotic Diseases. 1905 1906 1907 1908 i9«9 Deaths Deathrate. Deaths Deathrate. Deaths Deathrate. Deaths Deathrate. Deaths Deathrate. Small Pox - - - - - - - - - - Scarlet Fever 22 0.17 18 0.13 22 0.16 24 0.16 15 0.10 Diphtheria 38 0.30 27 0.20 42 0.31 65 0.45 24 0.16 Enteric Fever 16 0.13 8 0.06 2 0.01 3 002 5 0.03 Measles 48 0.39 32 0.24 70 0.49 29 0.20 57 0.38 WhoopingCough 57 0.46 24 0.18 62 0.44 7 0.05 32 0.21 Diarrhoea 97 0.78 150 1.15 44 0.32 81 0.56 54 0.37 Totals 278 2.25 259 1.99 242 1.77 209 1.46 187 1.25 Deathsand Deathrate from all causes 1555 12.3 1491 11.4 1504 11.0 1419 9.9 1412 9.4 The number of deaths fiom each Zymotic disease and the death rate per 1,000 of population from all these diseases in each Ward during 1909 is shown in the following Table :— Zymotic Diseases. Beckton and North Woolwich. Central East. Central West. Manor Park. Plashet East. Plashet West. Scarlet Fever 1 6 3 2 1 2 Diphtheria 1 4 6 7 2 4 Enteric Fever 1 2 - 1 1 — Measles 8 11 6 25 2 5 WhoopingCough 6 5 8 4 6 3 Diarrhoea 6 14 14 11 6 3 Totals 23 42 37 50 18 17 Rate per 1,000 of population 1.8 1.5 1.3 1.6 0.8 0.6 TABLE SHEWING NOTIFICATIONS OF EACH INFECTIOUS DISEASE FOR THE PAST FIVE YEARS—1905-1909: Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Totals. 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 1905 1906 1907 1908 1909 January 60 83 76 82 82 34 34 21 41 27 5 2 5 2 1 17 13 14 13 5 1 2 1 1 .. 117 131 117 139 115 February 51 63 47 80 65 26 36 20 51 34 .. .. .. 2 1 6 20 12 9 8 .. 1 1 .. .. 83 125 80 142 108 March 43 53 44 68 53 21 19 17 32 47 6 1 .. 2 .. 9 11 7 1' 11 2 1 .. 1 .. 81 85 68 114 111 April 26 54 49 90 57 23 10 16 37 27 3 .. 6 .. .. 14 6 8 14 9 .. .. 1 .. .. 66 70 80 141 93 May 54 63 78 69 42 14 12 16 41 17 5 1 4 .. .. 6 10 11 12 4 .. .. .. 2 .. 79 89 109 125 63 June 58 35 55 58 55 15 11 10 43 13 7 5 3 1 .. 9 9 6 14 12 .. .. .. 1 .. 89 60 74 117 80 July 75 60 86 96 56 21 19 24 39 19 3 3 4 1 .. 4 7 5 14 5 .. .. .. .. .. 103 89 119 150 80 August 72 50 73 87 26 29 17 18 32 8 17 4 5 3 1 10 9 7 7 9 .. .. .. .. .. 128 80 103 129 44 September 13S 49 117 115 35 31 25 55 33 17 10 9 2 2 3 19 10 12 13 7 1 .. 1 .. .. 199 93 187 163 62 October 186 108 157 97 35 29 30 71 46 22 15 8 2 2 .. 7 15 8 8 10 1 1 1 .. 1 238 162 239 153 68 November 138 94 184 83 25 21 20 51 33 25 5 2 3 2 2 15 22 14 23 10 1 .. .. .. .. 180 138 252 144 62 December 67 73 114 69 45 26 16 57 31 15 2 4 3 1 2 13 14 14 16 18 2 1 1 .. .. 110 108 189 117 80 Totals 968 790 1080 1030 576 293 249 376 456 271 73 39 37 13 10 129 146 118 154 108 8 6 6 5 1 1473 1230 1617 1634 966 23 NOTIFIABLE INFECTIOUS DISEASES. The total number of cases of Infectious Disease notified during the past year was 966, this is equal to an attack rate of 6.4 per i,oooof population. The Infectious Diseases Notification Act was passed in 1889 and I find on searching through the statistics of the Borough that the rate during the past year is the lowest recorded in this district since notification first came into force 20 years ago. This decrease was not brought about through any marked diminution in the prevalence of any particular disease, but was due to a material and very gratifying decrease in the number of cases of all the notifiable infectious diseases. During the past 5 years the total number of cases notified and the attack rates per 1,000 of population have been as follows:— 1905 1906 1907 1908 1909 No. of cases 1,437 1,230 1,617 1,634 966 Rate per 1,000 of population 11.9 9.4 11.8 11.4 6.4 24 The following table shows the distribution of the cases notified during the past year together with the death-rates and attack rates for each disease:— Notifiable Diseases. Cases notified. Deaths. Attack rate per 1,000. Death-rate per 1,000. Small Pox — — — — Scarlet Fever 576 15 3.8 0.10 Diphtheria 271 24 1.8 0.16 Enteric Fever 10 5 0.07 0-03 Puerperal Fever 1 — — — Erysipelas 108 4 0.7 0.02 Total 966 48 6.4 0.32 The number of cases of each disease notified during the past year, the percentage removed to Hospital and the attack rates per 1,000 of Population for each of the Wards are given in the Table opposite:— NOTIFIABLE DISEASES. CASES NOTIFIED IN EACH WARD. BOROUGH. ATTACK RATE PER 1,000 OF POPULATION. BOROUGH. PERCENTAGE OF CASES REMOVED TO HOSPITAL. BOROUGH. Beckton & North Woolwich. Central East. Central West. Manor Park. Plashet East. Plashet West. Beckton & North Woolwich. Central East. Central West. Manor Park. Plashet East. Plashet West. Beckton & North Woolwich. Central East. Central West. Manor Park. Plashet East. Plashet West. Small Pox — — - - - - - - - - - - - - - - - - - - - Scarlet Fever 51 114 96 121 109 85 576 4.1 4.1 3.4 3.9 4.8 3.1 3.9 76 73 73 64 71 54 68 Diphtheria 20 50 92 56 19 34 271 1.6 1.8 3.2 1.8 0.8 1.2 1.8 75 100 89 73 68 68 82 Enteric Fever 2 2 2 1 2 1 10 0.16 0.07 0.07 0.03 0.09 0.03 0.7 100 100 100 100 50 — 80 Puerperal Fever — — 1 - - - - - - 0.03 - - - - - - - - - - - Erysipelas 8 20 31 29 9 11 108 0.6 0.7 1.1 0.9 0.4 0.4 0.7 — — — 14 — — 3 Phthisis:— Poor Law 8 7 11 11 6 2 45 0.6 0.3 0.5 0.4 0.2 0.2 0.4 50 44 21 50 30 40 38 Voluntary — 2 3 1 4 3 13 26 The following Table gives the total notification rate per 1,000 of population for each Ward during the past five years:— 1905. 1906. 1907. 1908. 1909. Beckton & N. Woolwich Ward 9.2 7.2 9.9 12.2 6.4 Central Ward—East 11.2 8.2 10.5 11.5 6.7 Central Ward—West. 16.1 10.8 13.3 14.7 7.9 Manor Park Ward 12.7 8.5 16.1 11.6 6.7 Plashet Ward—East 10.1 8.2 9.5 11.1 6.1 Plashet Ward—West 10.1 11.8 9.0 7.8 4.7 SMALL POX. No case has been notified since 1904. Provision for the isolation of cases of this disease is secured at the Small Pox Hospital of the West Ham Corporation, which is situated at Dagenham. SCARLET FEVER. 576 cases were notified as compared with 1,000 cases during the previous year. Scarlet Fever was rather prevalent during January and February, but during the remaining months of the year a marked diminution took place in the prevalence of this disease. A number of cases were of a very mild type, so much so that in many instances the nature of the illness was not recognised until desquamation commenced. It is these mild and unrecognised cases of the disease, which are chiefly responsible for the continued Endemic prevalence of Scarlet Fever in all large centres of population. The deaths resulting from Scarlet Fever numbered 15, this gives a death-rate of 2.6 per cent, as compared with a death-rate of 2.4 per cent during the previous year. The following Table gives the number of cases of Scarlet Fever notified, the attack rate per 1,000 of population and the Case Mortality of the disease during the past five years :— 27 Year. Population. Cases Notified Attack rate per 1,000 of Population. Mortality per 1,000 Cases. 1905 123,381 968 7.84 2.2 1906 129,886 790 6.08 2.2 1907 136,421 1,080 7.91 2.0 1908 142,976 1,000 6.99 2.4 1909 149,575 576 3.85 2.6 DIPHTHERIA. The number of cases of this disease notified during the year was 271 as compared with 456 cases during the previous year. Although there was this very material decrease in prevalence, the type of the disease was in many cases of a very severe character. The number of deaths was 24, which gives a deathrate of 8.8 per cent, as compared with 65 deaths and a djathrate of 14.25 per cent, in the previous year. The Wards in which the disease was most prevalent were Central West, Central East and Manor Park. In the first named Ward a number of the cases were in connection with children attending Hartley Avenue School. Many visits were paid to this school and a large number of children were examined before all the sources of infection were discovered. The difficulty of dealing with outbreaks of this disease in a school, is due to the fact, that children, especially those with adenoids or large tonsils, may harbour the Diphtheria germs in the throat or nose for long periods without having any symptoms of illness. Yet these apparently healthy children can,aud often do infect others with a severe form of the disease. The cases can only be recognized by a Bacteriological examination and the Borough Bacteriological Laboratory was of course invaluab'e in connection with the discovery of these cases, in fact without its assistance it would probably have been necessary to close the school, and when this is done, it is impracticable to maintain that close supervision over the children which is necessary at such a time. 28 The death-rate from Diphtheria was equal to 0.16 per 1,000 of Population, compared with 0.45 during the previous year. The rate for England and Wales was 0.14, and the average rate for the 76 Great Towns was 0.15 per 1,000 of Population. The following Table gives the number of cases notified, the attack rate per 1,000 of population, and the mortality per cent, during the past five years:— Year. Population. Cases Notified. Attack rate per 1,000 of Population. Mortality per 100 Cases notified. 1905 123,381 290 2.35 13.10 1906 129,886 249 1.90 10.88 1907 136,421 376 2.75 11.17 1908 142,976 456 3.19 14.25 1909 149,576 271 1.18 8.86 During the past year, at the request of the Local Government Board, a special report was prepared on the prevalance of Diphtheria in the Borough, together with an account of the preventive measures taken in connection with this disease. For purpose of reference a copy of this report is here given:— REPORT ON THE PREVALENCE OF DIPHTHERIA IN THE BOROUGH. In accordance with the request of the Local Government Board as expressed in their letter of the 18th June, I beg to present the following report on the prevalence of Diphtheria in the Borough during the past few years, together with an account of the various measures undertaken to control the spread of this disease. Diphtheria in England and Wales. Before discussing the probable cause or causes influencing the prevalence of this disease, it must be stated that Diphtheria, like Measles and many other infectious diseases, has a cyclical 29 nature, that is, years in which the disease is very prevalent are followed by years of greatly diminished prevalence and fatality and these cycles are of irregular and uncertain duration. The following figures giving the registered death-rates from Diphtheria per million persons in England and Wales and in London during the years 1861 to 1905, well illustrate this irregular variation :— TABLE I. Deaths per Million of Population. Years. England and Wales. London. 1861 to 1870 187 179 1871 to 1880 121 122 1881 to 1890 163 259 1891 to 1900 263 500 1901 to 1907 194 187 Diphtheria in Certain Counties. Apart from this irregular periodic variation, there is also a geographical variation, that is, certain parts of the Country, for reasons at present unknown, always suffer from Diphtheria more than others. This is shown in the following Table which gives the average death-rates from Diphtheria per million of population in England and Wales and in certain counties during the ten years, 1897 to 1906:— TABLE II. Areas. Deaths per million of Population. Northamptonshire 118 Suffolk 144 Surrey 173 Bedfordshire 211 ENGLAND & WALES 227 Kent 257 Middlesex 264 London 280 ESSEX 322 Leicestershire 324 30 It is obvious from the above Table that Essex is one of the counties where Diphtheria tends to be rather prevalent. The average rate during the above ten years being much greater that the average for England and Wales as a whole. Local Prevalence of Diphtheria. In dealing with smaller areas and populations great care is needed if fallacious conclusions are to be avoided, for in addition to the periodical and geographical variation above mentioned, there are other factors instrumental in the spread of this disease which must be considered, and which vary materially in extent in different localities. The most important of these are:—The percentage of young children in a district, school attendance and accommodation, and social conditions favouring close personal concact, such as overcrowding, poverty and density of population. All these points must be taken into consideration in connection with the prevalence of Diphtheria (and other infectious diseases) as well as the degree of thoroughness and efficiency which Local Public Health Authorities attain in their efforts to control this disease. I have purposely omitted any reference to defective drains and other insanitary conditions as these are not direct causes of Diphtheria. The ill-health these conditions produce diminishes the resisting power of the body and so predisposes to attack when anyone is exposed to infection, but in the absence of the Diphtheria germs, such conditions alone cannot produce Diphtheria. In the following Table (III.) I give the average attack-rates and death-rates from Diphtheria per 1,000 of population for East Ham, for all the adjoining Districts, and also for the whole of the Urban Districts of Essex for the ten years 1898 to 1907. For comparison the figures for England and Wales for the same period are also given. The density of population both per acre and per house, as these existed at the last Census (1901), is also shown, 31 TABLE III. For the ten years 1898 to 1907. Attack-rates per 1,000 of Population. Death-rates per 1,000 of Population. Persons per Acre. Persons per House. West Ham 3.29 . 0-44 56 6.40 Barking 3.7 0.35 5 5.60 EAST HAM 3.1 0.32 33 5.75 Walthamstow 2.7 0.43 21 5.90 Leyton 2.12 0.28 38 5.50 Ilford 2.1 0.16 5 4.90 Essex (Urban Districts) 2.35 0.29 6 — England and Wales 2.18 0.21 1 — The above Table shows that the Diphtheria attack-rates and death-rates for the Urban Districts of Essex during the past ten years have been higher than those of England and Wales. It also shows that the larger and more densely populated districts suffer more than the Urban Districts of the County as a whole, doubtless because included in the latter are many small areas of really rural character. No doubt density of population per house is of even greater importance than density per acre, and in this respect Table III. is most interesting. It will be noticed that the highest deathrate is in the district where the number of persons per house is greatest (West Ham), and the lowest death-rate is where the number of persons per house is least (Ilford), and with one exception this rule holds good in all the districts mentioned, the exception being in favour of East Ham, although the number of persons per house is greater here than in Barking, the deathrate in East Ham is lower than that of Barking. To make this point quite clear I have arranged all the districts mentioned in two columns, the first column referring to death-rates, the highest being first in order, the next column dealing with the number of persons per house, the highest being first:— 32 TABLE IV. In order of death-rates (Highest first). Population per house (Highest first). West Ham. West Ham. Walthamstow. Walthamstow. Barking. EAST HAM. EAST HAM. Barking. Leyton. Leyton. Ilford. Ilford. Having regard to all the points mentioned above, I think it must be granted that during the past ten years East Ham does not compare unfavourably with other large districts in the County, either as regards attack-rate or death-rate from Diphtheria, for of the five surrounding districts mentioned, three had higher death-rates and two higher attack-rates from this disease. Preventive Methods in force in the Borough. On the receipt of a notification of a case of Diphtheria, the patient is at once removed to hospital if this is desired or necessary, and the room previously occupied and its contents are disinfected. Library books, if present are also removed for disinfection. Whether removed to Hospital or not, the Sanitary Inspector at once calls and obtains all particulars of the case and endeavours to trace the source of infection. He also leaves a printed form giving full instructions as to isolation, etc., and the precautions which should be adopted to prevent the spread of infection. Information is obtained as to the day and Sunday schools attended either by the patient or by children in the house, the School Authorities are notified, and all children living in the house are, for a time, excluded. The source of the milk supply, the occupation of the inmates, home work, sanitary condition of the premises, water supply, presence of animals, etc., are all investigated, and a report made to me on the same day. The name of the laundry used is also ascertained, the proprietor is notified, and the sending of clothes there is prohibited until the premises are free from infection. 33 Disinfectants are supplied free of charge in every case. The Council also supply Antitoxine to all Medical Practitioners, for the treatment of cases in the Borough. The above measures have been in force for some years, at the present time the following additional precautions are taken:— Bacteriological Laboratory. This was established in 1906, and free diagnosis is given to Medical Practitioners in connection with all suspicious cases of sore throat, and there is no doubt by this means many cases of Diphtheria, which otherwise would not have been discovered, have been detected and isolated. Since the establishment of the Laboratory, no case of Diphtheria treated in Hospital is discharged until examination has proved it to be free from Diphtheria bacilli. Recently, the Medical Practitioners in the Borough were asked to adopt this method in connection with cases of this disease which they treat at home. It was pointed out that Diphtheria bacilli occasionally persist in the throat long after all symptoms have subsided, and as such cases can only be recognised by bacteriological examination, it is important that this should be done before isolation is discontinued. Their co-operation in this matter was particularly asked in all cases where the tonsils were enlarged, where the patients attended school, or where young children were present in the house. During the present year, in all cases where the Sanitary Inspectors' reports showed the presence of many children in the house, I have personally visited the premises and taken "swabs" from the throats of all contacts. In this way many persons apparently well, but who were really harbouring Diphtheria germs in their throats, have been discovered and isolated. Nine of these so-called "carrier cases" have been admitted to the Hospital during the past few months. If the investigation of a case points, as it frequently does, to a school being the source of infection, this is visited, the C 34 children are examined and "swabs" taken from the nose and throat of all suspicious cases. Disinfection of slates, pencils, class rooms, etc., being done where thought necessary. In addition to the above, a weekly list of infected premises is sent to the Schools, Public Libraries, Pawnbrokers, etc. Free bacteriological diagnosis of all doubtful or suspected cases is also given by the Council to all Medical Practitioners. The use of Antitoxine as a prophylactic has not been recommended, I doubt its value in mere "carrier cases," where there are no symptoms, for the serum is simply Antitoxic, it is not anti-bactericidal. Summary and Conclusions. 1. Table I. shows the great variation which occurs in the prevalence of Diphtheria in the course of a number of years, and suggests that considerable caution should be exercised before either assuming that Diphtheria is excessively prevalent in a district, or conversely, before attributing undue value to our efforts of prevention. 2. Tables II. and III. indicate that Diphtheria is more prevalent in the Urban Districts of Essex than in England and Walt s as a whole, also, although Diphtheria has for some years been rather prevalent in East Ham, the notification rate and death rate from the disease compares not unfavourably with other similar populous districts in the County. 3. The various preventive measures now in force in the Borough comprise all that the most advanced Public Health Authorities can well undertake, in fact, I doubt if any other Authority does more to check the spread of this disease than is now being done in your Borough. ENTERIC FEVER. The steady decrease in the prevalence of this disease, which has been mentioned in the Annual Reports for the last four years, still continues. During the past year only 10 cases were notified, this is the lowest number reported in any year since notification was established 20 years ago. 35 The following Table gives the number of cases notified, the attack-rate, and the death-rate from this disease during the past 5 years:— Year Population. Cases notified. Attack rate per 1,000 of Population. Mortality per 100 Cases Notified. 1905 123,381 77 0.62 20.7 1906 129,886 39 0.32 22.8 1907 136421 37 0.27 5.4 1908 142,976 19 0.13 15.8 1909 149,576 10 0.07 50.0 Of the 10 cases notified last year 8 were admitted either to Hospitals in London or to the Infirmary. The number of deaths from this disease was 5, which equals a rate of 0.03 per 1,000 of population. The rate for England and Wales was 0.06, and the average rate for the 76 Great Towns 0.06 per 1,000 of population. ERYSIPELAS. 108 cases were notified with 4 deaths, as compared with 154 cases and 3 deaths during the previous year. As this disease is only very slightly infectious, unless there is a wound or abrasion of the skin, removal of these cases to Hospital is rarely either desired or necessary, and they can quite well be treated at home. In four instances only were cases admitted to Hospital, and these either had an exceptionally severe attack of the disease, or the home conditions were unsuitable for nursing the case. PUERPERAL FEVER. One case only was notified. As the number of births registered during the past year was 3,418, and in addition to this there must have been a considerable number of abortions, miscarriages, still births, etc., which are not reported, it is remarkable that only one case of Puerperal Fever should have occuried in this large number of confinements. Either modern 36 antiseptic methods, as applied to Midwifery practice, are singularly successful, or, what is more probable, a number of mild cases of Puerperal infection which do occur are not notified. TUBEROULOSIS. 149 deaths were registered as being due to variou: forms of Tuberculosis; the parts of the body affected are given in Table IV, page 64. The number of deaths and the death-rate from all forms of this disease during the past five years are as follows :— Year. No. of Deaths. Death-rate per 1,000 of Population, 1905 158 1.28 1906 169 1.30 1907 175 1.28 1908 171 1.18 1909 149 0.99 PULMONA'RY TUBERCULOSIS. The age and sex distribution of the deaths which took place during the year from Pulmonary Tuberculosis are as follows:— Males. No. of cases. Females. No. of cases. Total. Under 5 years 4 I 5 5—15 ,, — 3 3 15—25 ,, 13 3 16 25—50 ,, 35 18 53 Over 50 „ 9 12 21 Voluntary notification has been in fo: ce in the Borough since 1906, but as regards giving information concerning the prevalence of this disease, it has proved quite a failure. The number of cases notified in each year being as follows;— 37 1906, 9 cases. 1907, 18 cases. 1908, Nil. 1909, 13 cases. On 1st January, rgog, the Tuberculosis Regulations of the Local Government Board came into force, these provide for the compulsory notification of all cases of Pulmonary Tuberculosis coming under the care of the Poor Law Authorities. Since that date 45 notifications of such cases have been received, and 20 of these cases were admitted to the West Ham Infirmary. The Regulations provide not only for thff notification of these cases when they are first discovered, but also require Relieving Officers to notify any change of residence of these patients. All cases notified are at once visited and enquiries are made as to the source of infection. Printed instructions are left at each house giving information relating to the disease and stating the precautions which should be taken in connection with it. Disinfection of the room, etc., is done after removal to Hospital or Infirmary and after the death of a case. Occasional disinfection of the room occupied by a consumptive is also obtained when possible. Pocket sputum bottles are supplied where these are considered to be necessary and the patient is unable to purchase one. Inquiries are also made with a view of discovering if other cases, especially in an early stage are present in the house or are suspected to exist, and if so the necessity for immediate medical advice is urged. Free bacteriological examination of Sputum is provided in the Borough Laboratory for all Medical Practitioners to assist in making an early diagnosis of cases of this disease. There can be no doubt but that Tuberculosis in the past has not received from Public Health Authorities the amount of attention that its importance, as a cause of death, demands. In the majority of districts, Isolation Hospital accommodation is provided for cases of Small Pox, Scarlet Fever, Diphtheria, and Typhoid Fever, yet the number of deaths from these four diseases combined is far below the number caused by Tuberculosis In East Ham during the past year the number of 38 deaths from the above four diseases was 49, while the number from Tuberculosis was 149. This proportion is typical of the country generally, in fact, on an average, the deaths from Tuberculosis about equal, if they do not exceed, those caused by all other infectious diseases combined. Another factor which adds importance to Tuberculosis, and this refers particularly to the most common and infectious form, Tuberculosis of the Lungs (Consumption), is that the majority of those attacked are persons in the prime of life, young adult men and women, at the time when their lives and services are most valuable to the community. Two years ago it was found possible to use for a time a vacant Ward at the Isolation Hospital for the treatment of selected cases of this disease; since then the accommodation has not permitted a repetition of this. During the coming year, in the absence of any epidemic, there is little doubt but that we shall be able to use a Ward of 20 beds for these cases, owing to the increased accommodation we now have at the Hospital. The distribution of Tuberculosis in the various Wards is shown in the following table, which gives the number of deaths and the death-rate per 1,000 of population in each :— Ward. No. of deaths registered. Deathrate. Beckton and North Woolwich Ward 22 1.8 Central Ward—East 28 1.0 Central Ward—West 25 0.9 Manor Park Ward 35 1.1 Plashet Ward—East 15 0.7 Plashet Ward —West 24 0.9 PREVALENCE OF TUBERCULOSIS DURING THE PAST 10 YEARS. In comparison with other large towns, the death rates in East Ham from the various forms of Tuberculosis are remarkably low. 39 During the past year the Medical Officers of Health of all towns having populations exceeding 100,000 prepared from their death returns the number of deaths from all forms of Tuberculosis, bcth male and female, which had occurred during the past 10 years. The various returns were summarised by the Medical Officer of Health of Sheffield, who had suggested the preparation of these figures, and the results were published in the "Journal of Public Health, together with the comments and explanations of each Medical Officer on the statistics of his own District. The main features were reported to the Public Health Committee in a report made on 4th October, igoq. The Report, as follows, is reproduced here for purpose of reference:— I beg to present the following statistics dealing with the local incidence of Tuberculosis. The tables give the death-rates from Tuberculosis of the Lungs per million of population both for males and females, and also the death-rates from other forms of Tuberculosis for males and females, and also for children under five years of age. The figures have been prepared by the Medical Officers of Health of the respective districts, and should prove of value in indicating in what direction efforts are chiefly required to combat this disease. Any very marked departure from the standard of England and Wales as a whole, calling for local explanation and consideration of the factors probably concerned, whether due to housing, industrial conditions, age and sex distribution of population, or soil, etc. 40 It will be noticed that for the Country generally, the male death-rate from Tuberculosis of the lungs is about half as much again as the female. That the male death-rate from "other forms of Tuberculosis" is very little greater than the female. The death-rate among children under five from "other forms of Tuberculosis" is exceedingly heavy. The following Tables give the average mortality rates per annum per million persons living during ten years, 1898 to.1907, from Tuberculosis of the Lung and other forms of Tuberculosis in England and Wales, and the large towns with over 100,000 population, also in four largest Scotch towns, and in the County of London and the Metropolitan Boroughs. Towns. Estimated Population (1907) Tuberculosis of Lung. Other forms of Tuberculosis. Males all ages. Females all ages. Males all ages. Females all ages. Children under five. England and Wales 34,945,600 1,445 1,033 582 487 2,839 Birkenhead 118,441 1,611 1,240 336 234 1,820 Birmingham 553,155 1,818 886 494 394 2,354 Blackburn 134,438 1,330 883 737 572 3,956 Bolton 182,917 1,748 1,094 471 344 2,549 Bradford 290,323 1,616 920 561 420 2,550 Brighton 129,023 1,889 1,021 657 437 3,062 Bristol 367,979 1,233 981 — — 1,681 Burnley 103,947 1,568 1.145 446 336 2,627 Cardiff 187,620 1,341 1,162 660 585 2,976 Croydon 154,342 1,293 781 528 432 2,605 East Ham 136,421 827 718 419 437 2,070 41 Towns. Estimated Population (1907) Tuberculosis of Lung. Other forms of Tuberculosis. Males all ages. Females all ages. Males all ages. Females all ages. Children under five. Gateshead 125,783 1,623 1,199 588 488 2,567 Hull 266,762 1,287 997 560 446 1,990 Leeds 470,268 1,675 1,028 801 671 4,337 Leicester 236,124 1.523 990 571 402 3,015 Leyton 120,000 1,161 745 478 367 2,191 London 4,758,218 2,075 1,168 668 515 3,681 Manchester 643,158 2,433 1,425 800 655 4,265 Norwich 119,191 1.474 994 863 640 4,661 Nottingham 257.492 1,581 1,025 581 398 2,907 Oldham 141,730 1,987 1,202 605 465 2,813 Liverpool 746,144 2,055 1,361 662 524 3,239 Plymouth 120,063 1,443 1,201 681 522 2,980 Portsmouth 208,291 1,696 1,289 373 249 2.235 Salford 236,670 2,189 1,333 860 648 4,526 Sheffield 455,553 1,523 990 571 402 3,015 Southampton 119,745 1,944 1,004 522 455 3,028 South Shields 113,460 1,756 1.365 792 697 3,246 Stockport 100,986 1,665 1,170 699 652 3,961 Sunderland 155,359 1,664 1,337 834 711 3,887 West Ham 392,484 1,523 1,007 664 571 3,160 Willesden 144,376 1,087 856 422 326 2,063 42 District. Estimated Population (1907) Tuberculosis of Lung. Other forms of Tuberculosis. Males all ages. Females all ages. Males all ages. Females all ages. Children under five. Wolverhampton, E. 40,597 1,371 790 700 559 — Wolverhampton, W. 60,903 1,008 544 430 354 — Aberdeen 174,579 1,452 1,405 782 617 3,328 Dundee 165,748 1,785 1,834 1,099 764 4,647 Edinburgh 345,967 1,753 1,239 824 637 4,360 Glasgow 847,584 1,856 1,665 944 793 4,377 County of London and Metropolitan Boroughs. Administrative County of London 758,218 2,075 1,168 668 515 3,681 Battersea 181,736 1,638 1,108 605 440 2,657 Bermondsey 527,856 2,417 1,364 789 728 4,561 Chelsea 74,857 2,231 1,062 467 412 3,082 Hampstead 91,137 1,081 572 401 248 2,278 Islington 347,017 1,901 1,134 494 378 3,010 Kensington 180,500 1,703 883 689 413 4,081 Lewisham 152,532 1,118 685 459 331 2,181 Paddington 149,542 1,485 791 530 377 3,084 Shoreditch 114,700 2,588 1,512 1,005 799 5,191 Southwark 209,781 2,891 1,723 756 683 4,092 Stoke Newington 51,247 1,666 938 612 318 3 ,117 Wandsworth 325,850 1,197 820 477 324 2,503 Woolwich 129,336 1,632 1,134 458 406 2,058 43 East Ham. Dealing with our district, I am pleased to say that all the rates are remarkably low. The male death-rate from Tuberculosis of the Lungs is by far the lowest in the Kingdom, being the only one of three figures (see Tables). The female deathrate is with one exception the lowest, and the exception mentioned is only for part of a town. From "other forms of Tuberculosis" only two towns have a lower male death-rate, while ihe rates for females and children under five are also very favourable. It will also be noticed that in East Ham the death-rates for the two sexes are practically equal. It is impossible to be dogmatic as to the cause or causes concerned in producing the above conditions. I am of opinion, however, that the following are probably the most important factors :— SITUATION.—This is very favourable. On three sides of the Borough there is a belt of open country. On the north are Wanstead Park and Flats (1,700 acres), on the south is the River Thames, and on the east the River Roding, with much undeveloped land in the valley of this stream. It is only in the west that it is closed in by the adjoining Borough of West Ham. The presence of this open country on three sides, together with the many parks and open spaces in the Borough, no doubt exercises a favourable influence in connection with this disease. HOUSING.—The district is practically all of recent develjpment; the housing is therefore above the average, being all of modern construction. There are no back-to-back houses, and there is an entire absence of the narrow courts, alleys, and slums, which are more or less present in all older towns. This is, without doubt, a very important factor. 44 SOIL .—With the exception of a portion of the south of the Borough, the entire district is situated on excellent gravel soil, which is everywhere found within a few inches of the surface. It is significant to note that in the south portion of the Borough, which is not on gravel soil, the death rate from tuberculosis and diseases of the respiratory system is nearly double the rate for the rest of the Borough. It is, however, probable that other factors are also present which are partly responsible for the increased rate in this particular area. EMPLOYMENT.—There are practically no factories here, and though from a pecuniary point of view their absence may be deplored, it follows that there are no unhealthy trades and also no smoke or other fumes to pollute the air. The Borough is practically a dormitory for London, a large portion of the population of both sexes being employed there in warehouses, offices, shops, etc. This probably explains why the death-rates for the two sexes are about equal; both aie largely engaged in sedentary indoor occupations, doubtless under very similar conditions, and therefore tending to produce approximately equivalent results. MEASLES. This disease was somewhat prevalent, especially duiing February and March. 262 cases were reported by teachers in the Elementary Schools, but this by no means represents the total number of cases which probably occurred in the Borough. 57 deaths were registered as being due to Measles, and of this number no less than 51 were children under five years of age. The death-rate was equal to 0.38 per 1,000 of Population as compared with 0.20 during the previous year. Tire death rate from this disease in England and Wales was 0.32 and the average rate for the 76 Great Towns was 0.47 per 1,000 of Population. 45 WHOOPING COUGH. This affection was far more prevalent than during the previous year, and was the cause of 32 deaths, as compared with 7 during 1908. The whole of the 32 deaths occurred in children under the age of five years. In connection with both this disease and Measles, a printed form is sent to the address of every known case, pointing out the serious nature of these affections, and urging the necessity for isolation and careful nursing. The majority of mothers appear to consider these diseases to be of quite a trivial nature, and children suffering from them are rarely confined to bed or even to the room, but are allowed to run about the house, exposed to cold, with the result that some Respiratory complication generally d ivelopes, such as Pneumonia or Bronchitis, which in young children often proves fatal. A glance at the diagram on page 16 shows how much more frequently Measles and Whooping Cough figure as causes of death than diseases such as Scarlet Fever and Diphtheria, which are always treated as serious affections and receive much more care and attention. MUMPS. This affection was exceedingly prevalent, especially during the latter part of the year, and practically all parts of the Borough were affected. 316 cases were reported from the Council's Schools, although this by no means represents the total number of cases which must have occurred. Although very infectious and difficult to control, the disease is practically never fatal and during the past year no deaths were reported from this cause. 46 CANCER. 102 deaths were recorded (including five from Sarcoma) as being due to various forms of Malignant disease, as compared with 89 during the previous year. The parts of the body attacked and the sex distribution of the cases were as follows:— Parts affected. Males. Females. Total. Stomach and Alimentary Canal 24 12 36 Uterus — 12 12 Liver 4 10 14 Breast — 10 10 Ovaries — 5 5 Tongue and Throat 4 — 4 Bladder 3 1 4 Neck 3 1 4 Various parts 6 7 13 44 58 102 The number of deaths and the death-rate per 1,000 of population from Cancer during the past five years are as follows:— Year. Deaths. Death-rate per 1,000 of Population. 1905 84 0.61 1906 74 0.68 1907 77 0.57 1908 89 0.62 1909 102 0.68 47 BACTERIOLOGICAL LABORATORY. The use made of this increases yearly. Free bacteriological diagnosis is afforded to all Medical Practitioners in the Borough, the bulk of the work done being in connection with Diphtheria, Tuberculosis, and Typhoid Fever. The Laboratory was opened in 1906, and the number of specimens examined each year since that date is shown in the following Table:— BACTERIOLOGICAL EXAMINATIONS. DISEASES SUSPECTED. Year. Tuberculosis. Diphtheria. Typhoid Fever. Ringworm, Meningitis, etc. Total. 1906 13 345 4 2 364 1907 51 418 — 14 483 1908 26 752 — 6 784 1909 31 936 — 2 969 Total 121 2451 4 24 2600 The results of examination, if positive, are sent to the Medical Practitioners either by telephone or messenger. Negative results are usually forwarded by post. For the proper transmission of the material necessary for examination, suitable apparatus is supplied to all medical men. This apparatus is prepared and sterilised at the Laboratory. BAKEHOUSES. There are 49 Bakehouses in the Borough, including four factory and ten underground bakehouses. Frequent visits are paid by the Inspectors, and usually they are also visited annually by myself. The regulations as to limewashing, painting, etc., are well carried out, and the general condition of them is, on the whole, satisfactory. Want of cleanliness is the defect most frequently discovered. CHILDREN ACT (1908). This Act came into force on 1st April, 1909. 48 The only part with which we are concerned, from a Public Health point of view, is Section 122, dealing with Verminous Children. This states that "where any Sanitary Authority within the district of a local Education Authority have provided premises or appliances for cleansing the person or clothing of persons infested with vermin, the Sanitary Authority shall allow the local Education Authority to use such premises and appliances for the purpose of this section upon such payment, if any, as may be agreed between them." The building lately used as a Dogs' Home has been altered and fitted up with bath, hot water, etc., for the purpose of this Act, and the apparatus formerly used as a lethal chamber, now answers admirably as a disinfector for clothing infested with vermin. Sulphur di-oxide gas is used for this purpose and the process can be easily and efficiently carried out without any discomfort to the operator. The apparatus has another advantage, the disinfection is so rapidly performed that the clothes are ready for use again, by the time the person has been bathed, with steam apparatus the process takes much longer owing to the necessary drying. COWSHEDS, DAIRIES, MILKSHOPS, AND MILK SUPPLY. There are 6 Cowsheds and 157 Registered Dairies and Milkshops in the Borough, these are all inspected regularly. With regard to milk, very little is produced in the Borough, nearly the whole of the supply comes in by rail, in many instances coming a considerable distance. In connection with quality and adulteration, action is taken by the County Council Authorities, who are responsible for the working of the Food and Drugs Act, particulars of the samples taken and results of analyses are given on page 53. Special attention is given to the storage of milk in Dairies and Milkshops, in order to prevent pollution gaining access to it. A proper counter pan with well fitting and ventilated metal cover, and provided with a hinged lid, is in all cases insisted upon. 49 CUSTOMS AND INLAND REVENUE ACT. By the authority of Section 26, 53 & 54, Vic. c. 8 and Section 11. 3 Ed. VII c 46, exemption from Inhabited House Duty is granted to Owners of tenements of an annual value of less than £10 if the Medical Officer of Health is satisfied that they afford suitable accommodation for each of the families or persons dwelling therein and that due provision is made for their sanitary requirements. During the past year 103 tenements have been visited and examined. Certificates were granted to 27, the remainder were considered to be unsatisfactory. DISINFECTION. House disinfection is carried out by spraying with a solution of a coal tar disinfectant of guaranteed bactericidal efficiency. During the past year, 1,175 premises or rooms were disinfected by this method For articles needing steam disinfection, a Thresh's Current Steam Disinfector is used. D 50 FACTORY AND WORKSHOP ACT. Annual Report of the Medical Officer of Health for the year 1909 for the Borough of East Ham on the administration of the Factory & Workshop Act, 1901, in connection with Factories, Workshops, Laundries, Workplaces & Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 57 1 — Workshops (Including Workshop Laundries) •205 5 - Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) - - - Total 262 6 - 2—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of cleanliness 6 6 — — Want of ventilation 14 14 — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 32 32 — — Sanitary accommodation insufficient — - — - unsuitable or defective 1 1 — — not separate for sexes — — — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse(s.101) — — — — Breach of Special sanitary requirements for bakehouses (ss. 97 to 100). 8 8 — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) - - - - Total 61 61 — — 3.—HOME WORK. nature of work. outworkers' lists, section 107. Inspections of Outworkers' Premises OUTWORK IN UNWHOLE SOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109 & 110. Lists received from Employers. Addresses of Outworkers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances Notices Served. Prosecutions. Instances. Orders made (S. no). Prosecutions (Sections 109, no.) S ending twice in the Year. Sending once in the Year. Received from other Councils Forwarded to other Councils. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. Wearing Apparel— 16 19 123 11 3 67 158† 158‡ - - - 48* - - - 3 - - (1) making, etc. 665 85 192 (2) cleaning & washing Lace, lace curtains and nets 2 6 - - - - - 2 - - - - - - - - - - Artificial Flowers Nets, other than wire nets Tents Sacks Furniture& Upholstery Fur pulling Feather Sorting Umbrellas, &c. - - - - - - - - - - - 1 — - - - - - Carding buttons, &c Paper Bags and Boxes 2 - 9 - - - - 4 - - - 5 - - - - - - Basket Making Brush making - - - - - - - - — — — 1 - - - - - - Racquet & tennis ball Stuffed Toys File making Electro Plate Cables and Chains Anchors and Grapnels Cart Gear Locks Latches & Key Pea Picking Total 20 25 132 11 3 67 823 249 — — — 247 - — — 3 — — *Incorrect addresses, work given up, or removals. †Received in error. 4.—REGISTERED WORKSHOPS. 5.—OTHER MATTERS. Workshops on the Register (s. 131) at the end of the year. Number. Class Number. Wearing apparel Manufacturers 109 Matters notified to H.M. Inspector of Factories:— Bakehouses 49 Failure to affix Abstract of the Factory and Workshop Act (s. 133) 17 Laundries 44 Action taken in matters Notified by H.M. Printers 10 referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). spector 5 Other workshops t 48 Reports (of action taken) sent to H.M. v Inspector. 5 Total number of workshops on Register 260 Other — Underground Bakehouses (s. 101):— Certificates granted during the year Nil In use at the end of the year 10 53 In connection with the sufficiency and suitability of the Sanitary accommodation in workshops, etc., the standard required in the Borough is one w.c. to 25 persons. During the year in one workshop employing about 50 hands and engaged in the manufacture of delicate wearing apparel, ornamented with fancy bead-work, etc., a case of Scarlet Fever occurred. Disinfection of the work handled by this employee was carried out, but in a few days another case of the disease occurred. Both attacks were very severe in nature, and one proved fatal. With the ready consent and co-operation of the owner, and without any legal formality, the place was closed for four days, the whole of the stock and the premises were, at the owners risk, disinfected, and the walls distempered. This procedure proved quite effective, and no more cases occurred. FOOD AND DRUGS ACT. The Inspector for this District, Mr. MacKirdy, has furnished the following particulars as to the number of samples taken and results of analyses during the past year:— Article. Number Submitted. Genuine. Adulterated. Milk 74 67 7 Butter 53 48 5 Margarine 1 1 - Totals 128 116 12 Proceedings were instituted in 11 cases; 1 dealer was cautioned. The results of the cases heard were as over:— 54 MILK. 1 dealer was fined £12 and 15s. 6d. costs. 2 dealers were fined £1 and 15s. 6d. „ 1 dealer was fined 5s. and 10s. respectively on two summonses, with costs £2. 2s. 1 summons was withdrawn. BUTTER. I dealer was fined £5 and costs 15s. 6d. 1 „ „ £4 „ 15s. 6d. 2 dealers were each fined £2 and costs 15s. 6d. 1 dealer was fined £1 and costs 15s. 6d. For exposing margarine for sale unlabelled, 1 dealer was fined 10s. and costs 15s. 6d. FOOD AND MEAT INSPECTION. There is no specially qualified or separate official for food inspection, but each Sanitary Inspector performs this duty in the portion of the district under his charge. A quantity of unsound food was condemned during the year, particulars of which are given below. In the majority of cases this was voluntarily surrendered therefore no legal proceedings took place. 4 trunks Haddock 4 „ Mackerel 1 „ Cod 1 ,, Skate 1 bushel Winkles 1 box Kippers 22 rabbits With respect to meat inspection for the purpose of detecting disease, this can only be efficiently done at the time of slaughtering, when the whole of the Viscera and offal can be examined. As there are 15 slaughter-houses in the Borough with no 55 nised days or hours for killing, proper supervision is impossible. The establishment of a Public Abattoir in the Borough would be practically useless, as animals would be killed in adjoining districts and the meat then brought in for sale. Perfect supervision will only be attained when private slaughter-houses are entirely abolished and slaughtering throughout the country is only permitted in Public Abattoirs. During the past year a cow was condemned and killed on account of Tuberculosis, but under conditions which did not admit of legal proceedings being taken. The animal was grazing with others in an open space, when in passing I noticed its condition and strongly suspected it to be suffering from Tuberculosis. Although the Veterinary Surgeon was of the same opinion, he did not care to definitely certify this. However the owner agreed to have the animal killed on the understanding that no compensation be paid if it proved to be healthy, and no proceedings taken if found to be diseased. On being slaughtered it was found to have very extensive Tuberculous disease and the whole carcase was destroyed in the Corporation's destructor. It was fortunate that at the time the animal was not giving milk, for from the condition found this would undoubtedly have also been Tuberculous. HOUSE ACCOMMODATION. This is adequate, reasonable in price, and on the whole satisfactory in character. In addition to the accommodation provided by private enterprise, the Council own 220 double tenements. Each contains 2 bedrooms, sitting-room, scullery, with bath, etc., and let at 7s. per week upstairs, and 6s. 6d. on the ground floor. During the past year plans have been passed for the erection of the following buildings:— 792 Single tenements. 10 Double tenements. 29 Shops. 56 A total of 831. for the year, compared with 568 during 1908. In addition to the above, permission was given, subject to certain conditions, for the erection of 24 temporary buildings. MORTUARIES. The necessity for a new central Mortuary was mentioned in the report for last year and also in that for 1907, but the building has not yet been commenced. Plans and estimates have been prepared and an enquiry held by the Local Government Board, so that the work of erection should commence at an early date. There has been some delay in obtaining the sanction of the Local Government Board apparently owing to the fact that in the plans a Post-Mortem room is included as well as a Mortuary. It is of course essential to have a Post-Mortem room and naturally the most useful and convenient place for this room is to have it attached to the Mortuary, where the bodies needing Post-Mortem examination are kept. Curiously enough however, this most convenient and suitable arrangement is contrary to Law. The Public Health Act siates:— Sec. 143 "Any local authority may provide and maintain "a proper place (otherwise than at a workhouse or at a "mortuary) for the reception of dead bodies during the time "required to conduct any post-mortem examination ordered "by a coroner or other constitued authority, and may make "regulations with respect to the management of such place." When the Act was passed in 1875, I understand this Clause was inserted at the last moment owing to an objection raised by a member who suggested that "body snatching" would take place from the Mortuaries for unnecessary Post-Mortem examination and without any sanction. Such fears are of course absurd, but as the Act is in force, the two buildings cannot legally be combined. To overcome the difficulty it is proposed to erect a fence to separate the approach to the Post-Mortem 57 room from the rest of the building, a door being provided to take the bodies through as required. This will satisfy the legal requirements and so enable an eminently satisfactory and suitable arrangement to be carried out. PARKS AND OPEN SPACES. The following list gives the situation and acreage of th public parks and open spaces in the Borough:— Beckton and N. Woolwich Beckton Park 12 acres. Do. Victoria Gardens 8 „ Central Ward—East Barking Road Recreation Ground 8 „ Do. Vicarage Lane Ground 2 „ Central Ward—West Central Park 30 „ Manor Park Ward Wanstead Flats 92 „ Do. Recreation Ground 8 „ Plashet Ward—East Plashet Park 15 „ SEWAGE DISPOSAL. The Borough is sewered generally on the separate system, that is, surface water, etc., is kept out of the foul system. The rain water, however, from the back slope of the roofs, and from the back yards, etc., is admitted into the sewers so that there is a considerable increase in flow during wet weather. The dry weather flow is about 3½ million gallons daily, or about 20 gallons per head of population per day. The sewage is domestic in character, that is, it contains practically no trade effluents. The method of purification adopted is chemical precipitation by lime and alumina, followed by filtration through a "clinker" bacteria bed. The area of the filter beds in use is 1¼ acres, additional beds measuring ¾ of an acre are in course of preparation. 58 The final effluent is discharged into Barking Creek, a tidal tributary of the Thames. The amount of sludge from the precipitation tanks averages 1,300 tons per week. Owing to the district being very flat, the main sewer on reaching the works is situated at a very low level. This necessitates pumping the whole of the sewage into the precipitation tanks, and from these it has again to be pumped on to the filter beds. Power for this purpose is obtained by steam from the refuse destructor, and also from an electric generator and motors. REFUSE DESTRUCTOR. This apparatus is by Meldrum & Co., and is of the underfeed type. It was installed in 1904, and consists of two threechambered cells with flues, bye-pass, etc., to chimney. During the year 20,147 tons of refuse were burned in the destructor. The heat of combustion, as stated above, is applied to the generation of steam for pumping sewage, There are two boilers, each capable of evaporating 7,000 pounds of water per hour, together with feed water pumps, economisers, etc. The above figures have been kindly furnished by the Borough Engineer. WATER SUPPLY. The Borough is supplied by the Metropolitan Water Board; the supply is of course abundant and constant, and the quality very satisfactory. 59 SUMMARY OF IMPROVEMENTS EFFECTED DURING THE YEAR. 20 bed ward for Scarlet Fever patients. 12 bed Observation Ward (separate cubicles). See Report on Hospital. Accommodation for Scarlet Fever Nursing Staff, comprising bedrooms to accommodate 24 persons, sitting room for Nurses, bath rooms, etc., and kitchen. New Mortuary at Isolation Hospital. Residence for Medical Officer at Hospital. Premises and appliances adapted for cleansing verminous persons. 60 METEOROLOGICAL RECORD—YEAR 1909. Rain Gauge 5-in. in diameter, placed 1-foot above ground, 12.5-feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Rainfall. Highest. Lowest. Mean of Mean Temperature of Air. No. of Days on which Rain fell, 001 inches and over. Total fall in inches. Mean rate of fall for Rainy Days. Greatest fall in 24 hours Date of greatest fall. All Highest. All Lowest January 51° 21° 42°.9 32°.9 37°.9 11 0.76 0.07 0.16 10th February 55° 21° 43°.7 29°.6 36°.6 6 0.32 0.05 0.20 9th March 59° 9° 44°.0 32°.1 38°.0 23 2.97 0.13 0.59 5th April 70° 29° 58°.0 38°.5 48°.2 11 1.74 0.16 0.49 19th May 82° 33° 62°.8 41°.7 52°.2 8 1.03 0.15 0.44 24th June 71° 39° 61°.8 47°.3 54°.5 17 3.50 0.21 0.61 12th July 76° 44° 68°.2 52°.2 60°.2 18 3.16 0.17 0.82 26th August 86° 45° 71°.4 52°.3 61°.9 8 1.52 0.19 0.46 19th September 70° 39° 62°.1 48°.1 55°.l 19 2.16 0.11 0.43 23rd October 66° 30° 58°.8 46°.8 52°.8 19 3.82 0.20 0.78 26th November 59° 28° 47°.6 35°.7 41°.6 9 0.77 0.08 0.40 29th December 54° 24° 45°.5 34°.3 39°.9 22 2.37 0.11 0.38 3rd Means and Totals for the Year. 86° 9° 55°.6 40°.9 48°.3 171 24.1 0.14 0.82 July 26th The Rainfall for the Year was 4 inches, above and the number of days on which rain fell 44 above the year 1908, at East Ham. 61 TABLE 1. Vital Statistics of Whole District during 1909 and ten previous Years — Year Population estimated to Middle of each Year. BIRTHS. Total Deaths Registered in the Borough. Total Deaths in Public Institutions in the Borough. Deaths of Non-residents registered in Public Institutions in the Borough Deaths of Residents registered in Public Institutions beyond the Borough. Nett Deaths at all Ages belonging to the Borough. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1899 88,000 3,028 34.4 529 174 1,201 13.6 .. .. 44 1,245 14.1 1900 92,000 3,297 35.8 549 166 1,255 13.6 35 .. 48 1,303 14.1 1901 96,000 3,503 36.4 549 156 1,279 13.3 34 .. 178 1,457 15.1 1902 104,023 3,805 36.5 446 117 1,120 10.7 44 .. 122 1,242 11.9 1903 110,451 3,805 34.4 430 113 1,133 10.2 37 .. 132 1,265 11.4 1904 116,902 3,717 31.7 375 154 1,406 120 54 2 208 1,612 13.7 1905 123,381 3,687 29.8 478 129 1,308 10.5 53 3 220 1,525 12.3 1906 129,886 3,656 28.1 473 129 1,224 9.4 44 15 271 1,491 11.4 1907 136,421 3,690 27.0 386 105 1,280 9.4 67 12 236 1,504 11.0 1908 142,976 3,534 24.7 368 104 1,181 8.2 101 27 265 1,419 9.9 ages for years 1899- 1908. 114,004 3,572 31.8 478 134 38 11.0 52 6 172 1,406 12.6 1909 149,575 3,518 23.5 334 95 1,160 7.8 55 26 278 1,412 9.4 *Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the Borough. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the Borough on account of sickness or infirmity, and dying in public institutions here; and by the term "Residents" is meant persons who have been taken out of the Borough on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public institutions" taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity such as hospitals, workhouses, and lunatic asylums. TABLE II. Vital Statistics of separate Wards in 1909 and previous years : Year. Whole District. Beckton & North Woolwich Ward. Central Ward* East. Central Ward West. Manor Park Ward Plashet Ward East. Plashet Ward West. Population estimated to middle of each year Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. | Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. i Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. 1899 88,000 3028 1245 529 1900 92,000 3297 1303 549 1901 96,000 3503 1457 549 1902 104,023 3805 1242 446 1903 110,451 3805 1265 430 1904 116,902 3717 1612 575 1905 123,381 3687 1525 478 7469 279 149 49 20,245 656 285 98 22,931 793 298 84 27,242 801 337 115 20,147 514 194 54 25,347 644 262 78 1906 129,886 3656 1491 473 7593 254 125 36 22,895 737 247 99 24,873 772 309 107 28,540 826 338 116 20,581 483 208 56 25,404 584 264 59 1907 136,421 3690 1504 386 8523 296 143 40 24,895 722 252 82 25,873 746 295 72 28,940 810 342 86 21,581 494 211 48 26,609 622 261 58 1908 142,976 3534 1419 368 11.442 296 119 28 25,558 715 255 64 26,053 721 274 83 30,181 765 333 86 22,315 480 189 52 27,427 557 249 55 Averages of Years 1899 to 1908. 114,004 3572 1406 478 1909 149,575 3518 1412 334 12,553 324 140 37 27,659 685 \246 68 28,115 702 290' 71 30,962 731 327 81 22,776 476 177 32 27,510 600 232 46 TABLE III. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1909. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in Each Ward. No. of Cases removed to Hospital from each Ward. At all Ages. Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Beckton and North Wool wich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total. Beckton and North Woolwich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plasliet Ward East. Plashet Ward West. Total. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 271 2 75 169 11 13 1 20 50 92 56 19 34 271 15 50 82 41 13 23 224 Erysipelas 108 1 9 7 11 67 13 8 20 31 29 9 11 108 .. .. .. 4 .. .. 4 Scarlet Fever 576 3 143 361 50 19 .. 51 114 96 121 109 85 576 39 83 70 78 77 46 393 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 10 .. .. 3 3 4 .. 2 2 2 1 2 1 10 2 2 2 1 1 •• 8 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 1 .. .. .. .. 1 .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 966 6 227 540 75 104 14 81 186 222 207 139 131 966 56 135 154 124 91 69 629 Phthisis Poor Law 45 .. .. .. 9 35 1 8 7 11 11 6 2 45 4 4 3 6 2 1 20 Voluntary 13 .. .. .. 4 9 .. .. 2 3 1 4 3 13 .. .. .. .. 1 1 2 64 TABLE IV. Schedule Number. Causes of Death in East Ham during year ending 31st December, 1909. Deaths at the subjoined Ages of " Residents " whether occurring in or beyond the Borough, Deaths of all Ages of "Residents" belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Public Institutions in the Borough. All ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Beckton N. W'wich. Central East. Central West. Manor Park. Plashet East. Plashet West. Residents. NonResidents. 1 Small Pox (a) Vaccinated - - - - - - - - - - - - - - - (b) Unvaccinated - - - - - - - - — — - — — — — (c) No Statement - - - - - - - - — — — — — — — 2 Measles 57 9 42 6 - - - 8 11 6 25 2 5 — — 3 Scarlet Fever 15 1 7 3 2 2 — 1 6 3 2 1 2 10 — 4 Typhus Fever - - - - - - - - - - — — — — — 5 Epidemic Influenza 27 5 7 1 1 6 7 - 4 15 4 2 2 — — 6 Whooping Cough 32 18 14 - - - - 6 5 8 4 6 3 — — 7 Diphtheria and Memb Croup 24 1 8 14 — 1 — 1 4 6 7 2 4 15 — 8 Enteric Fever 5 - - - - 5 - 1 2 - 1 1 — — — 9 Asiatic Cholera - - - - - - - - - - - - - - — 10 Diarrhœa, Dysentery 54 47 6 - - 1 - 6 14 14 11 6 3 - 3 11 Epidemic Enteritis - - - - - - - - - - - - - — - 12 Other Allied Diseases - -- - - - - - - — — — — — — 13 Hydrophobia - - - - - - - - - - - - - - — 14 Glanders - - - - - - - - — — — — — — — 15 Tetanus - - - - - - - - - - - - - - - 16 Anthrax - - - - - - - - - - - - - - — 18 Syphilis - - — - — — - - - - - - - - — 19 Gonorrhœa 1 - - - - 1 - - — — — — 1 — — 21 Erysipelas 4 - - - - 1 3 - 1 — 1 1 1 — — 22 Puerperal Fever - — — — — — — — — - - - - - — 23 Pyæmia 3 - — - 1 2 — 1 — 2 - - - - - 24 Infective Endocarditis - - — — — — — — — — — — — — — 25 Other Allied Diseases 1 1 - - - - - - - - - - 1 - - 26 Malarial Fever - - - - - - - - - - - - - - - 27 Rheumatic Fever 10 - — 7 1 2 — 1 2 1 2 2 2 — — 28 Rheumatism of Heart — — — — - — - - - - - - - - - 29 Tuberculosis of Brain 21 6 11 4 - - - 4 6 1 4 3 3 - 1 30 Tuberculosis of Larynx 3 - — - 1 2 — — 2 — — — 1 — — 31 Tuberculosis of Lungs 98 4 1 3 16 73 1 12 18 16 24 9 29 — 1 32 Abdominal Tuberculosis 8 6 1 — 1 — — 1 — 3 4 — — — — 33 General Tuberculosis 7 2 1 — 2 2 — 2 1 1 1 2 — — 5 34 Other forms Tuberculosis 12 1 2 3 1 4 1 3 1 4 2 1 1 - - 36 Thrush - - - - - - - - - - - - — — — 37 Actinomycosis — — — — — — — — — — — — — — — 38 Hydatid Disease — — — — — — — — — — - — - — - 39 Scurvy - - - - - - - - - - - - - - 2 40 Ptomaine Poisoning — — — — — — — — — — — — — — — 41 Acute Alcoholism - - - - - — — — — — — — — — — 42 Chronic Alcoholism 2 - - — — 1 1 — — 1 1 — — — - 43 Chronic Industrial Poisonings 44 Other Chronic Poisonings - — — — — — — — — — - - - - - 45 Osteo-arthritis 6 - - 1 - 2 3 - 1 1 1 1 2 — — 46 Gout 1 - - - - - 1 — — — - 1 — — — 47 Cancer 102 - - 2 - 69 31 8 12 21 20 16 25 — — 48 Diabetes Mellitus 6 - - - — 6 - - - 1 1 1 3 - - Carried forward 499 101 100 44 26 180 48 55 90 104 115 57 78 25 12 65 Schedule Number. Causes of Death in East Ham During year ending December 31st, 1909. Deaths at the subjoined Ages of "Residents" whether occurring in or beyond the Borough. Deaths at all Ages of "Residents" belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Public Institutions in the Borough. All Ages, Under 1. 1 and under 5. 5 and under 15. | 15 and under 25. 25 and under 65. 65 and upwards. Beckton & N. W'wich. Central East. Central West. Manor Park. Plashet East. Plashet West. Residents. Non- Residents. Brought forward 499 101 100 44 26 180 48 55 90 104 115 57 78 25 12 49 Purpura Hæmorrhagica 1 - - - - 1 - - - 1 - - - - - 50 Hæmophilia - - - - - - - - - - - - - - - 51 Anæmia 1 - - - 1 - - - - - 1 - - - - 52 Lymphadenoma 1 - - - 1 - - - - - 1 - - - - 53 Premature Birth 62 62 - - - - - - 17 12 11 8 7 - 1 54 Injuary at Birth - - - - - - - - - - - - - - - 55 Debility at Birth 6 6 - - - - - - 1 1 1 2 1 - - 56 Atelectasis 6 6 - - - - - 2 - 2 1 - 1 - - 57 Congenital Defects 8 8 - - - - - - 2 3 1 1 1 - - 58 Want of Breast Milk 9 8 12 - - - - - 1 1 5 1 1 - - 59 Atrophy, Debility, Marasmus 65 63 2 - - - - 5 12 12 19 7 10 - 7 60 Dentition 6 4 1 - - - - 1 - 1 2 - 2 - - 61 Rickets 2 1 - - - - - - 1 1 - - — — 62 Old Age, Senile Decay 27 - - - - - 27 2 2 9 3 6 5 - - 63 Convulsions 11 10 2 - - - - 2 2 1 1 1 4 - - 64 Meningitis 7 1 3 3 - - - 1 3 1 1 - 1 - - 65 Encephalitis 2 - - 1 1 - - - - 1 - 1 - - - 66 Apoplexy 5 - - - - 2 3 - - 1 1 1 2 - - 67 Softening of Brain 3 - - - — 1 2 - — - 3 - - — — 68 Hemiplegia 14 - — 1 — 7 6 2 3 1 4 2 2 — — 69 General Paralysis of Insane - - - - - - - - - - - - - - - 70 Other forms of Insanity - - - - - - - - - - - - - - - 71 Chorea 1 - - 1 - - - 1 - - - - - - - 72 Cerebral Tumour 7 - - 1 - 6 — 1 2 1 1 - 2 - - 73 Epilepsy 5 - 1 1 1 2 - - 1 1 2 - 1 - - 74 Laryngismus Stridulus 3 2 1 - - - - - - 3 - - - - - 75 Locomotor Ataxia - - - - - - - - - - - - - - - 70 Paraplegia 3 — — — — 2 1 — — 1 1 1 — — — 77 Other forms Drain Disease 5 — 1 - - 3 1 — 1 - 1 - 3 — — 78 Otitis Otorrhœa 4 1 - 2 1 - - - 1 1 - 2 - - - 79 Diseases of Nose - - - - - - - - - - - - - - - 80 Diseases of Eye - - - - - - - - - - - - - - - 81 Pericarditis - - - - - - - - - - - - - - - 82 Endocarditis, Valvular Dis. of Heart.. 41 — 1 4 3 20 13 7 6 5 9 6 8 — — 83 Hypertrophy of Heart - - - - - - - - - - - - - - - 84 Angina Pectoris 3 — — — — 2 1 - — — 1 1 I — — 85 Aneurism 3 — — — — 2 1 - — 2 — 1 — — — 86 Senile Gangrene - - - - - - - - - - - - - - - 87 Embolism, Thrombosis 12 — — — — 9 3 — 4 — 3 4 1 — — 88 Phlebitis - - - - - - - - - - - - - - - 89 Varicose Veins - - - - - - - - - - - - - - - 90 Other Diseases Heart and Vessels 153 4 3 3 4 52 87 11 23 29 37 23 30 - - Carried forward 975 277 117 61 38 289 193 97 171 195 226 125 161 25 20 E 66 Schedule Number. Causes of Death in East Ham during year ending December 31st, 1909. Deaths at the subjoined Ages of "Residents" whether occurring in or beyond the Borough. Deaths at all Ages of " Residents " belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Public Institutions in the Borough. All Ages. Under 1. 1 and under 5. 5 and under 15, 15 and j under 25, 25 and under 65. 65 and umvards. Beckton & N. W'wich. Central East. Central West. Manor Park. Plashet East. Plashet West. Residents. Non- Residents. Brought forward 975 277 117 61 38 289 193 97 171 195 226 125 161 25 20 91 Laryngitis 1 - - - - 1 - - - 1 - - - - - 92 Croup 1 - 1 - - - - - 1 - - - - - - 94 Acute Bronchitis 68 23 9 1 1 9 25 5 5 15 23 9 11 - - 95 Chronic Bronchitis 70 — 2 — — 22 46 4 16 14 14 13 9 — - 96 Lobar Pneumonia 14 - 1 - 1 9 3 4 3 1 2 1 3 - - 97 Lobular Pneumonia 46 6 22 2 - 9 7 6 8 5 13 5 9 — 1 98 Pneumonia 63 7 7 4 3 26 16 2 12 16 15 6 12 — 1 99 Emphysema, Asthma 5 - - - — 4 1 1 - 1 2 - 1 - - 100 Pleurisy 3 — — — — 3 - - — 2 — — 1 — — 101 Other Diseases Respiratory System 2 _ — 1 1 _ 1 _ 1 - 102 Diseases of Mouth and Annexa - - - - - - - - - - - - - - - 103 Diseases of Pharynx - - - - - - - - - - - - - - - 104 Diseases of (Esophagus - - - - - - - - - - - - - - - 105 Ulcer of Stomach and Duodenum 4 - - - - 3 1 1 1 1 1 - - - - 106 Other Diseases of Stomach 8 1 - - - 4 3 1 3 1 2 - 1 - - 107 Enteritis 9 - 3 2 - 3 1 1 1 - 3 4 - - - 108 Appendicitis - - - 4 2 2 - - 2 3 1 1 1 - - 109 Obstruction of Intestine 11 2 2 1 — 3 3 2 2 2 2 1 2 - - 110 Other Diseases of Intestine - - - - - - - - - - - - - - 111 Cirrhosis of Liver 7 - - - - 4 3 1 1 3 - 1 1 - - 112 Other Diseases of Liver 8 3 - - - 4 1 - 1 4 - 2 1 - - 113 Peritonitis 1 - - - - - 1 - - - 1 — - - - 114 Other Diseases, Digestive System - - - - - - - - - - - - - - - 115 Diseases of Lymphatic System and Glands 5 — 1 — - 3 1 — — 3 — 2 — - - 116 Acute Nephritis 12 - 1 1 - 8 2 1 2 4 4 - 1 - - 117 Bright's Disease 26 - - - 1 18 7 4 2 5 9 5 1 - 1 118 Calculus - - - - - - - - - - - - - - - 119 Diseases of Bladder and Prostate 3 - — — — 1 2 — - 3 - - - - - 120 Other Diseases Urinary System 2 - - — - 2 - 1 - - — - 1 - - 121 Diseases of Testis and Penis - - - - - - - - - - - - - - - 122 Diseases of Ovaries - - - - - - - - - - - - - - - 123 Diseases of Uterus and Appendages 1 - - - - 1 — - - 1 - - - - - 124 Diseases of Vagina and External Genitals - - - - - - - - - - - - - - - 125 Diseases of Breast - - - - - - - - - - - - - - - 126 Abortion, Miscarriage - - - - - - - - - - - - - - - 127 Puerperal Mania - - - - - - - - - - - - - - - 128 Puerperal Convulsions 1 - - - 1 - - - - - - - 1 - - 129 Placenta Prævia, Flooding 1 — — — - 1 — — 1 - - - - - - 130 Puerperal Thrombosis - — — — — - — — — — — — — — — 131 Other Diseases Pregnancy and Childbirth 2 - - - 1 1 - 1 - - - 1 — — — Carried forward 1357 319 166 76 48 431 317 132 233 280 319 173 217 25 23 67 Schedule Number. Causes of Death in East Ham during Year ending December 31st 1908. Deaths at the subjoined Ages of "Residents" whether occurring in or beyond the Borough. Deaths at all Ages of "Residents" belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Public tions in the Borough. All ages. Under 1. 1 and under 5 5 and under 15. 15 and under 25. 25 and under 65. 66 and upwards. Beck ton & N.W'wich. Central East. Central West. Manor Park. Plashet East. Plashet West. Residents. Non. Residents. Brought forward 1357 319 166 76 48 431 317 132 233 280 319 176 217 25 23 132 Arthritis, Ostitis, Periostitis 1 — — — - 1 - - - - - - 1 - - 133 Other Diseases Osseous System 1 - - - - 1 - - - - - - 1 - - 134 Ulcer, Bedsore 1 — — — — 1 — - — — — — 1 — — 135 Eczema — - — — — — — — — — — — — — — 136 Pemphigus 1 - - - 1 - - - - - 1 - - - - 137 Other Diseases Integumentary System - - - - - - - - - - - - - - - Accidents and Negligence. 138 In Mines and Quarries - - - - - - - - - - - - - - - 139 In Vehicular Traffic 2 — 1 — 1 — — 1 — 1 — — — - - 140 On Railways - - - - - - - - - - - - - - - 141 On Ships, Boats, &c. (not drowning) — - — — — — — — — — — — — — — 142 In Building Operations - - - - - - - - - - - - - - - 143 By Machinery - - - - - - - - - - - - - - - 144 By Weapons and Implements 6 1 — 1 — 2 3 — 3 1 1 — 1 — — 145 Burns and Scalds 9 2 5 — 1 1 — 2 1 2 1 — 3 4 — 146 Poisons, Poisonous Vapours — — — — — — — — — — - - - - - 147 Surgical Narcosis — — - - - - - - - - - - - - - 148 Effects of Electric Shock — — — — — — - - - - - - - - - 149 Corrosions by Chemicals - - - - - - - - - - - - - - - 150 Drowning 4 — — 2 1 1 - - 3 - - 1 - - - 151 Suffocation, Overlaid in Bed 6 6 - - — — — — 1 — — — 5 —- — 152 „ Otherwise - - - - — — — — — -• — — — — — 153 Falls, not specified 8 — 1 — 1 2 4 2 3 1 1 — 1 — — 154 Weather Agencies - - - - - - - - - - -- - - - 155 Otherwise, not stated 5 4 1 - — — — 1 — 1 2 — 1 — — 156 Homicide 1 1 - — — — — - 1 — — — — ~ 1 Suicides, 157 By Poison 2 — — — - 2 - — — 2 - - - - - 158 By Asphyxia 1 - - - - 1 - 1 - - - - - - - 159 By Hanging and Strangulation - - - - - - - - - - - - - - - 160 By Drowning 2 - - - - 2 - 1 - - 1 - - - - 161 By Shooting - - - - - - - - - - - - - - - 162 By Cut or Stab — — — — — — — — — — — — — - — 163 By Precipitation from Elevated Places - - - - - - - - - - - - - - - 164 By Crushing - - - - - - - - - - - - - - - 165 By other and unspecified methods - - - - - - - - - - - - - - - 166 Execution - - - - - - - - - - - - - - - 167 Sudden Death, cause not ascertained - - - - - - - - - - - - - - - 168 IIlldefined and unspecified causes 5 1 1 - - 3 - - 1 2 1 - 1 - - Total 1412 334 175 79 53 448 323 140 246 290 327 177 232 29 26 TABLE V. INFANTILE MORTALITY DURING THE YEAR 1909. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under l Week 1-2 Weeks 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. | 5-6 | Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under 1 Year. All Causes— Certified 75 18 21 15 129 43 33 19 16 17 15 16 11 13 10 12 334 Uncertified - - - - - - - - - - - - - - - - — Common Infectious Diseases. Small Pox — — — — — — — — — — — — - — - - - Chicken Pox - - - - - - - - - - - - - - - - — Measles - - - - - - - - - - - 1 1 2 3 2 9 Scarlet Fever - - - - - - - - - - - - - - - 1 1 Diphtheria (including Membranous Croup) - - - - - - - - - - - - - - - - 1 ii. Diarrhœal Diseases. Whooping Cough — — 1 2 3 1 2 — 1 1 3 2 1 3 — 1 18 1 1 4 2 5 2 9 — 2 — 2 27 Enteritis, Muco-enteritis, Gastro enteritis — — — — — 4 4 3 1 — 1 1 1 1 — 1 17 Gastritis, Gastro-intestinal Catarrh — — — — — 1 — — — — — 1 — 1 — — 3 iii. Wasting Diseases. Premature Birth 42 5 5 6 58 3 1 - - - - - - - - - 62 Congenital Defects 9 2 — 1 12 1 — — — — 1 — - — — - 14 Injury at Birth — — — — — — — — — — — — - — — - - Want of Breast Milk, Starvation — — — 1 1 2 1 — — 1 1 — 1 — 1 - 8 Atrophy, Debility, Marasmus 15 7 7 3 32 12 9 2 1 1 1 — 2 2 1 — 63 iv. Tuberculous Diseases. Tuberculous Meningitis — — — — — — — 1 2 1 1 — — — — 1 6 Tuberculous Peritonitis: Tabes Mesenterica — — — — — 1 2 — 1 — 1 1 — — — - 6 Other Tuberculous Diseases — — — — — — — 2 2 1 — 1 - — - 1 7 v. Other Causes. Erysipelas - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - — — - - Rickets - - - - - - - - - - - - - - 1 - 1 Meningitis - - - - - - - - - - - - - - - - 1 Convulsions 1 1 1 — 3 2 — 3 — 1 — — 1 — — — 10 Bronchitis — 1 — 1 2 3 8 1 1 1 2 2 1 1 — 1 23 Laryngitis 1 1 2 - 4 2 - - 1 - 1 1 - - - 2 — Pneumonia 1 1 2 — 4 2 — — 1 — 1 1 1 1 — 2 13 Suffocation (overlying) — — 1 — 1 2 — — 2 — — 1 — — - - 6 Other Causes 7 1 4 — 12 5 4 2 2 1 2 3 2 1 2 2 38 75 18 21 15 129 43 33 19 16 17 15 16 11 13 10 12 334 Births in the year—Legitimate, 3,469; Illegitimate, 49. Males 1,806; Females 1,712. Deaths from all Causes at all Ages, 1,412. Deaths in the year of Legitimate Infants, 312; Illegitimate Infants, 22. 69 APPENDIX I. Report on the Borough Isolation Hospital. HOSPITAL SUB-COMMITTEE. The Mayor (Councillor G. PRATT, J.P., C.C.). The Deputy-Mayor (Councillor W. C. FORD, J.P.). Alderman J. BROOKS, J.P.. C.C. Alderman J. SAVAGE, J.P. Councillor F. BRADLEY. Councillor F. G. COSBURN, C.C. Councillor W. T. HOWLETT, L.T.C. Councillor A. J. JONES. Councillor H. F. WITHERSPOON, C.C. 70 Report on the Borough Isolation Hospital. Owing to the diminished prevalence of Infectious disease during the past year, the number of cases treated in the Hospital was considerably lower than during the previous year. This is undoubtedly a matter for congratulation, for the prevention of disease is far more to be desired than its cure. In connection with the Enteric Fever Wards, I have to report the remarkable fact that throughout the entire year they were not required for this disease. They were, however, used for Diphtheria cases, as on several occasions the accommodation for this latter disease was insufficient. The Enteric Wards also served another useful purpose, prior to the building of the Cubicles they were used as an Observation Ward for doubtful cases and also occasionally for patients suffering from infectious complications. The following table shows the number of patients admitted and under treatment during the year, and also the mortality per cent. of completed cases:— 71  In Hospital Dec. 31st, 1908. Admitted Total under treatment. Discharged. Died. Death-rate per cent. of completed cases. Remaining in Hospital Dec. 31st, 1909. Scarlet Fever Wards 72 500 572 520 10 1.88 42 Diphtheria Wards 25 236 261 226 16 7.27 19 Cubicles (Opened Oct., 1909) — 7 7 3 — — 4 97 743 840 749 26 — 65 V 72 In calculating the Mortality rate, cases incorrectly diagnosed have been excluded. Also in connection with Diphtheria the death-rate is calculated on actual cases of clinical Diphtheria, "carrier cases" and cases incorrectly diagnosed being both excluded. SCARLET FEVER. 572 cases of this disease were under treatment during the year. In only five instances was the diagnosis incorrect, the patients being subsequently found to be suffering from some other disease. Excluding the 42 patients remaining in Hospital at the end of the year (1909) there were 530 completed cases of this disease treated, of these 10 died, giving a death-rate of 1.88 per cent. as compared with a rate of 3.6 for the previous year. Three of the fatal cases died within twenty-four hours of admission. Another admitted with both Measles and Scarlet Fever, developed Pneumonia, which proved fatal. The remainder either had some other infection in addition to Scarlet Fever, or developed various serious complications. All the fatal cases occurred in the last six months of the year. During the first six months, 254 cases were treated without a single death. The chief complications which occurred in the 572 cases under treatment during the year were as follows:— Complication. Number of Cases. Complication. Number of Cases. Glandular Abscess 13 Mastoid Disease 2 Nephritis 10 Scarlatinal Rheumatism 11 Otorrhœa 59 Rhinorrhœa 73 In many instances patients were admitted who were either suffering from or were in the incubation stage of some other Infectious disease in addition to Scarlet Fever, others had various conditions present, not necessarily infectious, but which needed treatment. 73 In addition to these unavoidable conditions there was another, which is quite preventable, and yet which was present to such an extent as to be a perfect disgrace to those concerned. I refer to the verminous condition of the childrens' heads. Out of the 500 cases of Scarlet Fever admitted last year, not less than 205 had actual living vermin in the head. A great many more had " nits," but these are not included in the above figures. With soap and water so cheap and plentiful such a large percentage of verminous children is absolutely inexcusable. The following table gives particulars of the chief diseases and conditions associated with Scarlet Fever which were present in the patients admitted during the year:— Diseases, etc. Number of Cases. Diseases, etc. Number of Cases. Burns 1 Pleurisy 1 Cellulitis 2 Ringworm 2 Chicken Pox 6 Septic wounds 6 Diphtheria 39 Tapeworm I Eczema 2 Whooping Cough 4 Epilepsy 1 Verminous heads 205 Measles 9 DIPHTHERIA 261 patients suffering from this disease were under treatment during the year. This number includes 14 so called "carrier" or contact cases; these patients usually present no symptoms of disease except occasionally a little discharge from the nose, and yet they ate a most fertile source of infection to other people. The above 14 cases were discovered either at school, in class rooms where several cases of Diphtheria had occurred, or in homes in which a case of this disease had been notified. As there are no symptons of illness, these cases can only be recognised by bacteriological examination, but when discovered they need isolation and treatment until proved to be free from infection, and therefore the above 14 persons were admitted to Hospital. 74 In calculating the death-rate from this disease, the above 14 "carrier cases" and also 8 cases in which the diagnosis was incorrect, have been excluded, and the death-rate is based on cases of actual clinical Diphtheria only. Excluding the above and also the 19 cases remaining in Hospital at the end of the year, 220 completed cases of Diphtheria were treated during the year, and of this number 16 died. This equals a case mortality of 7.27 per cent. The case mortality in Hospital from this disease during the preceding five years was as follows:— 1904 14.6 1907 9.4 1905 11.9 1908 12.7 1905 10.9 1909 7.27 During the past year, four of the deaths occurred within 48 hours of admission to Hospital, 8 took place within a week, the remainder at a later period from various complications. Included in the total number of patients admitted, are 18 cases in which the disease was of the Laryngeal form. The operation of Tracheotomy was required and performed in Hospital on eight of these, all of which recovered. In two other instances, the symptoms being very urgent this operation had been performed before sending the patient to Hospital, they were admitted for the necessary after treatment but both of these cases proved fatal. In the treatment of the 261 cases which were in Hospital during the year, nearly 2½ million units of Antitoxine were used, or an average of about 9,000 units for each patient. The chief complications which occurred in the 261 cases under treatment during the year were as follows:— 15 Complications. No. of Cases. Complications. No. of Cases. Laryngeal obstruction 18 Paralysis 22 Antitoxine rashes 66 Abscesses 4 Otorrhœa 10 Phlebitis I In many instances patients were admitted who were either suffering from or were in the incubation stage of some other disease in addition to Diphtheria. The following table gives particulars of these:— Disease. No. of Cases. Broncho Pneumonia 1 Mumps 5 Scarlet Fever 7 Whooping Cough 1 CUBICLES. These were only brought into use for a few weeks in the latter part of the year. Seven patients were admitted suffering from the following diseases and combinations of them:— Disease. No. of Cases. Erysipelas 2 Scarlet Fever with Diphtheria 2 Scarlet Fever with Mumps 2 Measles with Pneumonia 1 It is very obvious how useful these rooms must prove, as the diseases or combinations of them for which they were used cannot safely be admitted into an ordinary ward. HOSPITAL BUILDINGS. The new buildings erected during the year were opened in October, they consist of: 1. Two wards for Scarlet Fever patients, each containing ten beds. 2. Above these, but reached by a separate staircase, accommodation for the Scarlet Fever staff is provided, comprising dining room, kitchen, bathrooms, box room, linen store, and bedrooms for 16 22 nurses and maids. 3. A single storey block containing 12 separate cubicles. These are intended for patients in whom the diagnosis is doubtful, and also for those suffering from two or more infectious diseases, and whose presence in a general ward would therefore be attended with danger to others. As buildings of this kind are rather an innovation in Hospital construction, illustrations of the ground floor plan and also of the elevation of the building are given on page 80. It will be seen that in the centre is the Nurses' duty room; on each side of this are six cubicles arranged three on each side of a central corridor. There is through ventilation at each end of the corridor, and additional ventilation in the roof by means of louvred openings. A separate overall is provided for each cubicle, which is put on by the nurse before entering to attend to the patient. On leaving, it is taken off, and the hands are washed before attending to any other patient. For this purpose four hand basins, each supplied with hot and cold water are placed in the corridor. This routine is necessary to avoid any danger of cross infection. The inner walls of the cubicles are of glass. This enables patients to see into the adjoining cubicle, and also into the cubicle on the opposite side cf the corridor, and prevents the loneliness and fear a young child might otherwise have at being alone in a room. The other new buildings are:—4. A small mortuary. 5. Residence for Medical Officer. In addition to the erection of the above new buildings, the Scarlet Fever convalescent ward, built in 1907, the walls of which had temporarily been distempered, was thoroughly 77 renovated and painted with Paripan. Lavatory accommodation was also provided for the playroom which is over the centre of this ward. Alterations and improvements were also made to the Matron's quarters, and the Diphtheria and Typhoid Wards and Administration block (temporary buildings) were painted outside. HOSPITAL ACCOMMODATION. The following table gives the total bed accommodation now available for patients :— Beds. ^ubic feet per bed. Diphtheria Wards ... 20 1,000 Enteric Wards 20 1,000 Observation Wards ... 12 1,500 Scarlet Fever (acute) 20 2,000 Scarlet Fever (convalescent) 52 1,000 The Diphtheria and Enteric Wards and the accommodation for the staff of these wards are temporary buildings of wood and iron. The Observation and Scarlet Fever Wards, and the quarters for the staff of these are permanent brick buildings. The following list gives the number of the Staff at present engaged:— 1 Matron 1 Cook 5 Laundresses 2 Sisters 5 Ward Maids 1 Laundry Attendant 7 Staff Nurses 4 Maids 2 Ambulance Drivers 13 Probationer Nurses 1 Gardener 3 Porters 78 HEALTH OF STAFF. During the year 3 Nurses suffered from Diphtheria, and 1 Maid from Scarlet Fever. These illnesses were obviously contracted in the performance of their duty, but all recovered. HOSPITAL ACCOUNTS. For the Year ended 31st March, 1909.* ESTABLISHMENT CHARGES. £ Provisions 1338 1/11¼ average per person per day. Linen, Bedding and Furniture 224 Chandlery and Sundries 312 Lighting, Heating and Water 789 Repairs to Hospital and Maintenance of Grounds 222 Rates, Taxes and Insurance 120 Telephone Rental 30 Office Expenses 14 Salaries 1491 £4540 *The financial year ended at this date, to comply with the requirements of the county Council, it therefore does not coincide with the remainder of this report, the year for which ended on 31st December. 79 PATIENTS' EXPENSES. £ Medicines (including Antitoxine and Disinfectants) 287 3d. average per person per day. Stimulants 10 Horsing Ambulance 292 £589 Total cost of upkeep 2/2¼ per person per day. Days Average days each in Hospital. Scarlet Fever. Balance of cases in Hospital, 1/4/08 1,278 - 569 recovered Scarlet Fever cases 22,371 39 16 fatal Scarlet Fever cases 139 9 23,788 Diphtheria. Balance of cases in Hospital, 1/4/08 435 - 289 recovered Diphtheria cases 8,268 28 42 fatal Diphtheria cases 360 9 9,063 Typhoid Fever. Balance of cases in Hospital, 1/4/08 6 - 2 recovered Typhoid Fever cases 74 37 1 fatal Typhoid Fever case 2 2 - 82 Staff. 38 Hospital Staff 366 - 13.908 Tola 46,841 BOROUGH OF EAST HAM. Report OF the Medical Officer TO THE Education Committee FOR THE YEAR 1909 EAST HAM EDUCATION COMMITTEE. Councillor J. Prince, J.P. (Chairman). Councillor H. Barfield (Vice-Chairman). Councillor G. Pratt, J.P. (Mayor). Councillor W. C. Ford, J.P. (Deputy-Mayor). Mrs. Ford. Alderman R. Banks-Martin, J.P. Councillor T. Hassan Cowper. Alderman J. Brooks, J.P. Councillor G. P. Dean. Alderman J. H. Carte, J.P. Councillor E. Edwards, J.P. Alderman C. Northfield, J.P. Councillor W. T. Howlett, L.T.C. Alderman H. Osborn, J.P. Councillor M. Hutchins. Alderman J. Savage, J.P. Councillor A. J. Jones. Councillor O.R. Anstead, C.C., J.P. Councillor H. Evan Jones, J.P. Councillor F. Bradley. Councillor J. Lawrence, J.P. Councillor T. W. Cashman, J.P. Councillor Murrell Oakes, J.P. Councillor F. G. Cosburn, C.C. Councillor H. F. Witherspoon, C.C. Cleric: Miss P. Perry. School Nurse: Miss A. G. Mayman. Secretary: H. C. Padgett. Assistant Medical Officer (part time): W. Benton, M.R.C.S., L.R.C.P., Medical Officer: G. Sowden, M.D., D.P.H. STATISTICAL DATA. School Places:— Provided Schools 24,713 Non-provided Schools 1,160 Total 25,873 Number on Registers:— Provided Schools 24,081 Non-provided Schools 1,000 Total 25,081 Cost per Child (excluding Administration and Capital Charges) 1908-9. 14s. 3d. per annum. Teaching Staff. Head. Assistant Certificated. Assistant Uncertificated. Supplementary. Student. 607 58 412 102 5 30 Education Rate. 1908-9, 1/10 1909-10, 2/2 Grants Received 1908-9 £60,554 4 10 (Including Special grant for necessitous districts £16,076). Since 1874. 16 New Schools have been erected 1 2 Temporary Schools opened and alterations made to two Schools Total cost £35,081 BOROUGH OF EAST HAM EDUCATION COMMITTEE. Mr. Chairman, Mrs. Ford, and Gentlemen, In accordance with the requirements of the Education (Administrative Provisions) Act 1907, I beg to present my Report on the Public Elementary Schools, the Medical Inspection of School Children, and other duties performed for the Committee during the year 1909. This is the first report dealing with the Medical Inspection of School Children, and in connection with this work I desire to acknowledge the co-operation and assistance given by the Teachers. I also wish to record the very able manner in which Miss Mayman discharged the duties of School Nurse; her ability, tact, and unfailing courtesy were invaluable in removing the difficulties invariably associated with the initiation of new work. I regret that her resignation was received at the end of last year, and am sure that all acquainted with her work will share that regret. For much information concerning Education Statistics, School accommodation, average attendance of scholars, etc., I am indebted to Mr. Padgett, Secretary to the Education Committee. Yours faithfully, G. SOW DEN, M.D., D.P.H. March, 1910, LIST OF SCHOOLS, WITH ACCOMMODATION AND OTHER DETAILS. SCHOOL. Date opened. Accommodation. Artificial Lighting Heating Cleanliness. REMARKS. Infants. Boys. Girls. Central Park Rd. 1899 600 524 524 Fairly good. By incandescent gas mantles Radiators and open grates. The latter not of good design Good Tobin's tubes inaccessible for cleaning. Urinal flush inadequate. Essex Rd. 1898 582 500 500 Inadequate. Ordinary gas burners Radiators and open grates Fair Drinking water supplied from cistern; practically inaccessible for cleaning. Fourth Avenue 1890 330 408 408 do. Stoves and open grates Fair Drinking water from cistern. Tobin's tubes inaccessible for cleaning. Infants' School is a separate single storey building. Hartley Avenue 1903 521 560 560 do. Radiators and open grates Good Tobin's tubes inaccessible for cleaning. Flushing arrangements of urinals unsatisfactory. High St. 1874 357 358 405 do. Open grates Fair Old buildings of obsolete type. Kensington Ave. 1901 541 516 516 do. New light being tried Radiators and open grates Moderate Urinal flush inadequate. Class rooms have north aspect. Cloak roams have south aspect. Lathom Road 1808 571 480 480 Inadequate. Ordigas burners Slow combustion stoves in Main Hall. Open grates in Class Room. Former unsatisfactory Fair Tobin's tubes inaccessible for cleaning. Drinking water from cisterns. Urinal flush inadequate, w.c. seats unsatisfactory. Manor Park 1893 400 400 400 do. Open grates Moderate No flush to boys' urinal, insufficient to infants'. Cloak room accommodation unsatisfactory. Monega Road 1905 552 520 520 do. Radiators and open grates Good Urinal flush inadequate. Tobin's tubes inaccessible for cleaning. Napier Road 1902 530 568 568 do. Radiators and open grates Good Outside drinking fountain from uncovered cistern. Tobin's tubes inaccessible for cleaning. LIST OF SCHOOLS, WITH ACCOMMODATION AND OTHER DETAILS.—Continued. SCHOOL. Date opened. Accommodation. Artificial Lighting. Heating. Cleanliness. REMARKS. Infants. Boys. Girls. New Beckton 1887 420 372 300 Inadequate. Ordinary gas burners Radiators, not well distributed Moderate Insufficient fall to urinals. No flushing arrangements. Latrines not well kept. North Woolwich 1893 472 — — Inadequate Stoves and open grates Very moderate Latrines and urinals obsolete and unsatisfactory; not well kept. Plashet Lane 1890 535 596 520 Inadequate. Ordinary gas burners Radiators, hot water pipes, and open grates Fair No flush to urinals. Latrines not satisfactory. Sandringham Rd. 1896 780 620 620 do. Radiators and open grates Good Insufficient flush to urinals, Tobin's tubes inaccessible for cleaning. Drinking-water from uncovered cistern. bury Rd. 1894 698 600 600 Bray's burners and incandescent mantles Radiators and open grates Fair Ditto. bury Rd. 1887 254 410 348 Inadequate. Ordinary gas burners Open grates Moderate Insufficient flush to urinals. Latrines unsatisfactory. Tobin's tubes inaccessible for cleaning. Vicarage Lane — 204 — — — — An old building, soon to be closed Walton Road 1900 629 540 540 Inadequate. Ordinary gas burners Open grates of obsolete type. Good Drinking water cistern practically inaccessiblefor cleaning. Urinal flush inadequate. Class rooms have north aspect. Castle St. R.C. 1903 60 240 do. Radiators and open grates. Fair Playground unpaved. Drinking water from uncovered cistern. No flush to urinals. Silvertown R.C. — 212 348 do. 1 gas stove, slow combustion stoves and open grates Very moderate Gas stove objectionable. No flush to Infants' urinals. Premises not well kept. St. Wine fride's R.C. 1909 300 do. Open grates Good New School. *Non-provided Schools. 87 SCHOOL ACCOMMODATION. There are 24 Schools, including 3 Non-Provided Schools, representing 55 departments. The total accommodation is 25,873 and the total number of children on the registers at the end of last year was 25,081. Out of a total of 54 departments, 29 have an average attendance in excess of their accommodation. A new School is now being built at Vicarage Lane and the commencement of another at North Woolwich is expected at an early date. SCHOOL BUILDINGS. It is difficult to give any summary of these as they vary much in design. The majority are buildings of three storeys and of the central hall type. With the exception of St. Winefride's R.C. School, there are none of very recent construction. As to their hygienic conditions, some of them, especially the older schools, are not entirely satisfactory. The table on pages 85 & 86 gives a list of the schools, the date of opening, accommodation, and a few other details. Furniture.—The School desks are practically all of one type, that is continuous seats and desks, chiefly of two sizes to accommodate five and eight children respectively. Much better designs are either single desks and seats or continuous desks with separate seats. In the new Schools I hope these will be provided. Ventilation.—All the Schools have natural ventilation, the inlets for fresh air being the windows, supplemented in nearly all the Schools by Tobin's Tubes. The latter are not satisfactory as no method of cleaning them has been provided. In consequence they contain a quantity of dust, derived both from the class-rooms and from the streets, which has accumulated since the School was built and which cannot be removed. Over this accumulation fresh air has to pass to enter the building. With respect to class-room ventilation however, the important point is not so much the means of ventilation provided, as the extent to which the teachers make use of them. It is possible to enter two adjoining rooms and in one case to find the atmosphere quite satisfactory and the children alert, bright, and attentive, and in the other to find the air foul and stuffy, the children sleepy and inattentive and the teacher irritable, simply because no use is being made of the means of ventilation provided. LIGHTING. A. Natural.—The majority of the schools are fairly well lighted, the windows being well situated and adequate in area. In several of the older schools the lighting is bad. B. Artificial.—In many of the schools this is not altogether satisfactory. The illuminant is gas by means of ordinary fishtail burners. These not only give a poor light, but the distribution of them in the class-rooms in many cases is faulty. Experiments are at present being made to discover a suitable form of incandescent mantle. Hitherto it has proved impracticable to use mantles, owing to the expense caused by their constant breakage. In future schools Electric Light should be installed. Heating.—The method varies in different schools, some have open fire-places only, some stoves only, others hot water pipes and radiators either alone or in conjunction with open fires. Small class-rooms can be fairly well heated by means of an ordinary fire, but for large rooms hot pipes or radiators are required in addition. If only a fire is used the children nearest are too hot, while those furthest away suffer from cold. A number of the fireplaces are not of good design, they consume a large quantity of coal, and much of the heat produced 89 is lost. To replace these with fireplaces of more modern type would not only give warmer rooms, but would be an economy owing to decreased consumption of coal. Cleaning.—Dust in schools, as elsewhere, consists of: 1. Inorganic or Mineral matter derived from the roads outside, brought in on children's boots, and from the chalk and wear of the materials inside the school. This is comparatively unimportant. 2. Organic dust, derived from the children's bodies, scales from the skin, hair, bacteria, etc. This dust is important; it is decomposable, and so becomes foul if not removed ; it may also contain germs of disease. The close, stuffy odour, so obvious in a class-room, especially if the windows are closed, is due to this organic dust. Hence the more free the school from dust, the healthier it is. For this reason it is important to limit the number of maps, pictures, paper, etc., hanging on the walls, and to see that the furniture and fittings are as far as possible so designed as not to harbour dust. An enormous improvement would be made in our schools if the floors, instead of being of wood, were made of one of the compositions now so largely used in hospitals. The amount of dust would be infinitely less, while the labour of cleaning would be materially reduced. The spread of infection would also be lessened; children are frequently sick in school; this material falls into the crevices between the boards, and cannot be removed; later, when dry, in the form of dust, it is distributed about the room. With a jointless composition floor this risk would be entirely obviated. Method of Cleaning.—It is obvious from the preceding, that in cleaning a school, or any other place, it is essential to remove the dust without dispersing it into the air of the room. For this reason, dry sweeping and dusting should be absolutely prohibited. The instructions to caretakers are to use damp sawdust on the floors when sweeping, and afterwards 90 to sprinkle them with a weak disinfectant solution. This method is fairly satisfactory, although if expense did not prohibit it, a better plan would be to wash the floors every week, instead of the quite inadequate three times a year, and dispense with the daily sprinkling with disinfectants. All dusting is ordered to be done with a cloth made damp with paraffin. Cloakrooms.—The amount of space between the pegs is in all cases the minimum allowed by the Regulations of the Board of Education. This is barely adequate, the hats and coats are in such close contact that the free circulation of air between them, which is so necessary, especially when the clothes are wet, is not obtained. The improvements required in cloakrooms are more space between the pegs, hot water pipes to be carried round the rooms in order to dry the clothes, and constant ventilation in the form of a grating, which cannot be closed, should be provided in addition to the windows. The latter are with few exceptions nearly always closed and the cloak-rooms consequently often have an objectionable odour. Hand Basins.—These are placed at the ends of the cloak rooms and practically all the schools are well supplied. In fact in some schools the number is in excess of the requirements of the children and could well be reduced. Water Supply.—All the schools are supplied by the Metropolitan Water Board. Drinking water is provided both in the main halls of the schools and also in the playgrounds, in some cases from a cistern, in others from the main. The latter arrangement is the better and should always be provided. Cisterns are liable to pollution from being uncovered, and in some cases the situation of them being inaccessible for cleaning. Sanitary Conveniences.—All schools are provided with trough closets, automatically flushed. These are objectionable 91 both from educational and hygienic aspects. Separate closets with independent flushing arrangements are the only kind really satisfactory. The question of providing these in the new school now being built was considered, but chiefly owing to the reported expense of maintenance, it was decided to adhere to the old type. The existing trough closets are in most instances capable of being improved, in many the seats are faulty in design, in all there is too much woodwork and as the latter is in all cases fixed, it is difficult to satisfactorily clean the trough underneath. Urinal accommodation is adequate in practically all the Schools, but the flushing arrangements are not so satisfactory. In a few cases there is no flushing apparatus, while in others it is rendered inadequate owing to the unsuitable sizes of the sparge pipes. The provision of stalls also appears to be unnecessary and undesirable, these are not flushed and have to be washed by the caretakers, and while increasing their work they serve no useful purpose. Playgrounds.—These are asphalted with the exception of Castle Street Roman Catholic School and Vicarage Lane. The latter is a temporary School and will soon be replaced by a new building. The former should be asphalted, as in wet weather the water stands in pools, and in that condition it is not suitable for the children's use. MEDICAL INSPECTION OF SCHOOL CHILDREN. This work commenced in January, 1909, and was carried on throughout the School year. Staff.—This consists of myself, Dr. Benton, the Deputy Medical Officer of Health (who devotes four half-days per week to the work) the School Nurse, and a girl clerk. 92 Method of Inspection.—In last year's report, the method to be adopted was fully described, there is therefore no occasion to repeat all the details. Briefly the procedure is as follows:— 1. The parents are notified and invited to be present at the inspection. 2. The Teachers record the child's attendance and their opinion concerning its mental capacity, an 1 also test the vision of the older boys and girls with test types. 3. The Nurse weighs and measures the children, and notes the condition of the head. 4. To save time the above details are entered on the Inspection cards by the clerk, so as to be ready for the doctor when he attends to conduct the inspection. The schedule of Inspection is practically that suggested by the Board of Education, although the order and arrangement have been varied somewhat. Cards of two colours are used, buff for boys and green for girls. A copy of the cards is reproduced here:— CONFIDENTIAL EAST HAM EDUCATION COMMITTEE. i. ii. iii. iv. i. ii iii iv (pp) (pp) (pp) (pp) Date Boots 8 Age Nutrition Standard Clothing Cleanliness Sufficiency *vision Teeth: 10 Decayed Cleanliness a 11 Mental Capacity Tonsils 1 Adenoids External Eye Dis. Glands 2 13 Ear Disease Nose 3 13 Hearing Tubercle 4 Deformities14 Speech 5 Congenital Acquired Heart and Infectious or Contagious Circulation Disease 15 Other Diseases or 16 Lungs Detects 6 Nervous System 7 Condition of Head Medical Officer's Initials Age 412 512 612 712 812 912 1012 1112 1212 1312 1412 Height, b centimeters. Weight, b kilograms. *Omit on Admission a G—Good. A—Average D —Dull. Def—Detective. b With clothes, without boots. Name Date of Birth (Surname first). Address Removed to Removed to Do Date of leaving School School Date of admission ... Scarlet Fever. Diphtheria. Measles. i Whooping Cough. Chicken Pox. Mumps. Rheumatic Fever. Date of Illnesses Year 19 19 19 19 19 19 19 19 19 19 Actual attendances... Possible attendances Family History (if exceptional) Directions to Parents or Teachers General Observations. F. Occupation: I M Total Rooms Families Adults Children Number of Consumption on Father's side ? Do. on Mother's side ? III Work before or after Nature School. Duration IV 95 Scope of Inspection.— The children examined were those entering school for the first time and those expected to leave by the end of the year. It was also found possible to commence the inspection of children of an intermediate age, and in three schools the children eight years of age were also examined. In addition to the above, the Head Teachers were invited to include for inspection any children whom they suspected to have either physical or mental defect or concerning whom they desired advice or information. 336 of these specially selected children were examined during the year. NUMBER OF CHILDREN EXAMINED. The following table gives the total number of children examined in the Boys', Girls', and Infants' Departments of each school:— 96 School. Infants. Boys. Girls. Total. Central Park 68 49 24 141 Essex Road 119 19 46 184 Fourth Avenue 142 52 31 225 Hartley Avenue 200 113 133 446 High Street 105 27 23 155 Kensington Avenue 175 137 116 428 Lathom Road 179 23 20 222 Manor Park 91 33 23 147 Monega Road 132 34 8 174 Napier Road 93 32 23 148 New Beckton 30 20 7 57 North Woolwich 40 — — 40 Plashet Lane 99 83 20 202 Sandringham Road 112 27 10 149 Shaftesbury Road 196 182 107 485 Shrewsbury Road 76 25 24 125 Vicarage Lane 66 — — 66 Walton Road 108 19 6 133 Castle Street R C. 9 3 6 18 Silvertown R.C. 40 9 4 53 St. Winefrides R.C. 24 1 — 25 Total 2104 888 631 3623 97 OBJECTIONS TO INSPECTION. These have been comparatively few. In 3,623 examinations 162 objections were received. The objectors consist practically of three classes, first, those whose objection is due to ignorance or misconception of the reason or necessity for examination. The number of these varies in different schools, due very largely to the influence of the head teacher, a few words of explanation to the parents generally at once removing the objection. The second class object because they know the condition of their children is open to criticism. The third consists of those peculiarly constituted people who object to anything and everything, they might be termed professional objectors, and apparently the gratification of their peculiar prejudice is more important to them than the condition of their children. Why any sane parent should object to the free examination of his child, properly conducted in the parent's presence it is difficult to conceive. During the year scores of cases of defective vision, hypertrophied tonsils, adenoids, many cases of slight heart or lung disease, etc. were found and of which the parents were quite ignorant. Although the number of objections was not great, no doubt a similar percentage of defects exists in these children as in the others, and it is a matter for regret that they should have to suffer for the foolish views of their parents. ATTENDANCE OF PARENTS. This is always to be desired, they can often give information as to the previous health of the child and in return direct advice can be given concerning any defect found on examination. Unfortunately the parents who attend are chiefly those who take the greatest care of their children and therefore the G 98 majority of these are usually in good health and condition. One would infinitely prefer an interview with the parents of the weakly or neglected child. The following table gives the number and percentage ol parents present at the examinations :— Number examined. Number of parents present. Percentage of parents present. Boys 665 50 0.7 Girls 888 82 9.2 Infants 2070 355 17.1 Totals 3623 487 13.4 HEIGHT AND WEIGHT. The importance of these is very great, in fact their value cannot be over estimated. Growth depends on nutrition, and children insufficiently nourished do not attain the height or weight they normally should. It is therefore of interest to compare the height and weight of children of certain ages in this Borough with the standards of the Anthropological Society, and also to compare the children in different parts of the Borough with each other. The record of weight is the most valuable to the teacher, and in connection with this a weighing machine is provided for each school; any child suspected either of chronic disease or defective nutrition should for a time be regularly weighed. If the weight is found to be stationary or decreasing it shows the necessity for immediate inquiry into the case. Height is recorded in both English and Metric systems, and is taken with the boots off. Weight is also recorded in both systems, and is taken with the boots off, but the child's ordinary indoor clothing on. 99 The following Table gives the average height and weight of all the children examined, classified both for age and sex. For comparison, the standards of the Anthropological Society are also given :— HEIGHT TABLE. East Ham Children. Standards of Anthropological Society. AGE. Years. BOYS GIRLS. BOYS. Inches. GIRLS. Inches. No. Exam'd. Inches. Cms. No. Exam'd. Inches. Cms. 5 699 40.8 103.6 679 40.9 103.9 41.0 40.5 6 233 42.5 108.0 267 42.5 108.0 44.0 42.8 7 95 45.5 115.6 97 44.3 112.5 45.9 44.4 8 237 47.0 119.4 215 45.5 115.5 47.0 46.6 13 332 57.3 145.6 201 57.8 146.8 56.9 57.7 14 228 58.7 149.1 136 584 148.4 59.3 59.8 WEIGHT. East Ham Children. Standards of Anthropological Society. AGE. Years. BOYS. GIRLS. BOYS, lbs. GIRLS, lbs. No. Exam'd. lbs. Kilos. No. Exam'd. lbs. Kilos. 5 699 38.4 17.4 679 37.7 17.1 39.9 39.2 6 233 40.7 18.4 267 40.4 18.3 44.4 41.7 7 95 47.0 21.3 97 43.8 19.8 49.7 47.5 8 237 49.6 22.5 215 45.5 20.6 549 52.1 13 332 80.9 36.8 201 83.4 37.9 82.6 87.2 14 228 85.5 38.9 136 86.7 39.4 92.0 96.7 100 It will be noticed in connection with the height ot East Ham children that the boys of 13 and the girls ot 5 and 13 years of age slightly exceed the standard of the Anthropological Society, at all other ages they are either about the standard or below it. With respect to the weight of the children in the Borough it will be seen that this is less satisfactory; at every age period, and in both sexes, the average weights are below those of the standard, in some cases being very much below. The average height and weight of the children examined in each school at each age period are shown in the following tables. For comparison the averages for the total number examined in the Borough are also given. To facilitate reference type of rather larger size has been used where the averages of each School are under the averages of the Borough. 101 HEIGHT IN INCHES. SCHOOLS. 5 YEARS. 6 YEARS. 7 YEARS. 8 YEARS 13 YEARS. 14 YEARS. Boys Girls. Boys. Girls, Boys. Girls. Boys. Girls. Boys Girls. Boys. Girls. Central Park Road 41.5 41.0 425 43.2 45.5 ... 47.3 ... 60.2 58.3 61.0 58.4 Essex Road 40.9 40.3 42.4 43.1 46.7 43.6 ... ... 56.7 58.1 56.3 7.9 Fourth Avenue 41.3 40.3 42.2 42.7 40.2 45.2 48.5 45.6 57.6 58.1 58.7 56.7 Hartley Avenue 40.4 40.5 41.5 42.1 45.4 45.0 46.7 47.0 56.6 57.7 59.3 59.5 High Street 41.0 40.6 41.4 43.2 44.5 44.7 45.6 47.1 56.7 573 58.3 58.9 Kensington Avenue 42.1 41.8 43.2 43.11 50.9 45.8 47.7 48.3 57.7 59.1 60.5 60.9 Lathom Road 41.5 41.4 42.8 43.3 48.3 45.1 48.4 45.7 58.9 58.4 59.7 58.5 Manor Park 41.4 41.5 43.0 42.5 44.9 44.6 45.1 48.4 57.3 57.3 58.9 58.2 Monega Road 41.7 41.5 43.4 43.2 45.5 44.6 ... ... 57.8 55.8 59.1 60.8 Napier Road 40.6 40.1 41.2 40.2 44.9 ... ... ... 56.1 57.2 56.7 57.9 New Beckton 40.0 40.2 44.5 42.1 ... 40.6 ... ... 56.9 58.9 57.1 57.2 North Woolwich 39.7 41.7 40.9 42.8 ... ... ... 44.3 ... ... ... ... Plashet Lane 41.1 40.2 42.5 41.9 46.0 42.6 42.3 45.2 56.7 58.8 59.5 58.1 Sandringhain Road 40.4 41.1 42.8 41.8 40.3 42.7 ... 39.8 55.6 ... 59.5 58.6 Shaftesbury Road 41.1 41.5 43.2 43.8 46.3 45.1 47.9 46.7 57.2 58.7 59.6 57.8 Shrewsbury Road 40.5 40.2 42.7 43.9 46.0 ... 50.8 ... 57.1 58.3 58.3 58.8 Vicarage Lane 40.1 41.1 42.8 43.2 ... ... ... ... ... ... ... ... Walton Road 40.9 40.3 42.6 41.8 43.8 43.5 ... 42.0 57.2 56.3 57.1 55.7 Castle Street R.C. 40.2 41.8 ... 42.8 ... ... ... ... 56.0 57.3 ... 59.5 Silvertown R.C. 40.3 41.4 42.2 ... ... 44.5 ... ... 58.7 57.1 ... ... St. Winefride's R.C. 39.9 39.7 41.1 41.7 42.7 47.0 ... ... ... ... ... ... Average for whole Borough 40.8 40.9 42.5 42.5 45.5 44.3 47.0 45.5 57.3 57.8 58.7 58.4 102 WEIGHT IN POUNDS. SCHOOLS. 5 YEARS. 6 YEARS. 7 YEARS. 8 YEARS. 13 YEARS. 14 YEARS. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Central Park Road 40.6 38.2 41.5 42.3 47.0 ... 51.9 ... 91.7 86.4 91.7 89.5 Essex Road 38.3 37.4 40.5 41.1 48.1 43.1 ... ... 77.0 81.6 76.2 88.7 Fourth Avenue 38.0 38.0 40.4 40.6 47.0 47.3 48.9 48.7 81.1 89.2 87.9 81.2 Hartley Avenue 38.4 37.9 40.0 40.1 47.3 40.0 49.3 49.2 87.4 82.5 88.3 91.6 High Street 39.0 37.2 36.9 41.0 45.9 45.0 47.3 40.4 78.4 85.1 84.9 83.4 Kensington Avenue 40.8 38.8 42.2 39.3 61.0 47.5 50.1 52.0 84.4 87.6 91.3 95.7 Lathom Road 38.3 36.6 40.3 40.9 42.3 43.7 54.3 40.0 81.1 80.0 87.7 84.7 Manor Park 38.9 37.3 40.6 40.7 45.1 42.5 44.3 48.8 77.4 76.6 84.5 89.5 Monega Road 39.6 38.1 42.4 40.0 48.8 43.2 ... 81.7 74.6 85.2 93.9 Napier Road 38.9 38.6 40.2 37.8 49.4 ... ... ... 78.6 79.6 81.6 90.3 New Beckton 38.0 37.6 43.5 37.8 ... 41.2 ... ... 78.8 89.9 78.6 77.8 North Woolwich 37.5 38.0 39.9 43.1 ... ... ... 41.2 ... ... ... ... Plashet Lane 39.9 37.6 41.1 40.0 50.0 42.8 40.2 45.7 78.2 85.4 88.0 85.5 Sandringham Road 37.4 37.3 41.3 39.2 37.5 39.1 ... 37.7 76.6 ... 84.3 85.9 Shaftesbury Road 37.5 36.8 39.3 43.2 47.5 44.4 51.0 49.0 77.7 87.7 89.5 83.2 Shrewsbury Road 37.6 36.8 41. 4 44.0 44.7 ... 529 ... 78.9 85.3 85.5 80.2 Vicarage Lane 37.6 36.5 42.0 40.1 ... ... ... ... ... ... ... ... Walton Road 38.1 38.3 41.3 39.9 44.3 42.1 ... 34.8 82.5 78.3 81.7 75.0 Castle Street R.C. 36.0 38.4 ... 38.9 ... ... ... ... 76.0 85.3 ... 98.5 Silvertown R.C. 38.3 38.7 42.4 ... ... 44.3 ... ... 88.8 82.1 ... ... St. Winefride.sR.C.. 37.2 37.5 36.9 38.6 46.0 45.3 ... ... ... ... ... ... Average for whole Borough 38.4 37.7 40.7 40.4 47.0 43.8 49.6 45.5 80.9 80.4 85.5 86.7 103 In connection with children 7 years of age the total number examined was small, therefore too much reliance must not be placed on the above averages. Children 8 years of age were only systematically examined in three schools, viz. :— Hartley Avenue, Kensington Avenue, and Shaftesbury Road. These averages are therefore based on a fair number of children. In other schools, as the numbers at this age were few, the statistics are therefore less trustworthy. DISEASES AND DEFECTS. The total number of diseases and defects found in the whole of the children examined, and also the diseases and detects found in the children of each school are given in the following tables :— 1. Total Diseases and Defects in all Children examined. 2. Diseases and Defects in Children of each School. TOTAL DEFECTS AT ALL AGES. DEFECTS. 5 years. 6 years. 7 years. 8 years. 13years. 4 years. All Ages. Total Percentage Defective. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys Girls. Hoys. Girls. Boys. Girls. Boys and Girls. Number Examined 699 679 233 267 95 97 201 215 227 221 197 156 1692 1931 3623 Defective Vision ... ... ... ... ... ... 18 24 27 21 19 12 74 63 137 8.8 Squint and External Eye Disease 30 22 12 10 10 5 9 4 8 15 3 3 78 69 147 4.1 Hearing and Ear Discharge 11 23 9 5 7 2 8 6 17 16 6 13 65 66 131 3.6 Speech Defects 17 11 10 5 3 1 1 1 3 7 3 7 42 33 75 2.0 Heart Affections 27 13 7 5 7 1 6 8 12 15 5 8 67 52 119 3.2 Tuberculosis (all forms) 4 3 4 1 3 4 1 2 3 ... ... 1 16 11 27 0.7 Disease of Nervous System ... ... 3 2 1 1 ... ... ... 2 ... ... 5 5 10 0.2 Vermin of— Head 14 53 6 30 5 8 1 13 2 11 1 2 32 124 156 4.3 Body 11 14 6 1 1 3 2 2 6 6 5 1 ... 35 44 79 2.2 Clothing— Deficient 4 3 2 4 5 4 2 1 3 8 ... 1 17 23 40 11 Very Dirty 19 16 5 5 2 3 4 2 1 3 3 2 37 37 74 2.0 Boots Defective 41 38 4 7 5 2 4 1 38 17 2 ... 99 65 164 4.5 Nutrition Defective 7 4 5 4 5 2 3 2 5 1 4 ... 31 15 46 1.3 Decayed Teeth— 3 or less 192 164 75 80 34 30 103 9! 123 Hi 141 71 711 602 1313 362 4 or more 162 170 51 67 31 40 127 65 43 34 43 33 493 434 927 256 Tonsils— Enlarged 123 105 36 48 20 14 11 28 54 42 44 19 297 272 569 15.7 Much Enlarged 44 29 17 20 90 7 21 8 10 12 13 12 120 103 223 6.1 Adenoids 38 36 15 18 10 1 9 7 13 11 3 3 95 80 175 14.8 Mentally— Dull ... ... 1 1 2 2 31 21 28 20 28 25 113 69 182 8.1 Defective ... ... 2 2 2 2 2 1 4 2 ... ... 14 7 21 0.9 Rickets 16 8 7 5 7 2 9 9 5 4 8 2 52 33 85 23 Deformities 7 8 5 4 5 2 11 4 17 10 10 5 60 39 99 2.7 Infectious Diseases 11 15 5 1 2 2 6 1 1 3 ... ... 25 22 47 1.3 Ringworm and Other Skin Diseases 19 13 5 4 2 2 13 2 6 1 7 2 56 38 94 2.6 Parents Notified of Defects 152 151 64 89 35 19 62 X) 48 66 45 55 41 458 417 875 24.1 * This total does not represent only the preceding columns. A few children of ages 9 to 12 years who were also examined are included. DEFECTS CLASSIFIED ACCORDING TO SCHOOLS. Schools. Department. Number Examined. Vision defective. Squint and External Eye Disease. Hearing Defective. Ear Discharge. Speech Defective. Heart Affections. Tuberculosis (all forms.) Disease of Nervous System. Vermin of nead. Vermin of Body. Clothing Insufficient. Clolhing very Dirty. Boots Defective." Nutrition Defective. Teeth Decayed 3 or less. Teeth Dccayed 4 or more. Tonsils Enlarged. Tonsils much enlarged. Adenoids. Mentally Dull. Mentally Defective. Rickets. Deformities. Infectious Di-eases. Ringworm and other Skin disea-cs. Notice- sent to parents. Central Park Infants 68 ... 4 2 5 2 3 ... 2 3 ... 1 ... 5 1 24 8 3 1 5 ... ... 2 ... 5 1 9 Boys 49 3 ... 1 2 ... ... ... ... ... ... ... ... 3 1 18 10 4 ... 3 4 ... 1 1 ... 2 3 Girls 24 3 ... 3 3 ... 2 ... ... 1 ... ... ... ... 1 14 4 6 2 5 3 ... ... 1 ... 2 9 Essex Road Infants 121 ... 3 1 2 ... 4 2 ... 8 4 2 4 8 4 29 38 26 12 7 ... ... 1 1 1 1 30 Boys 19 1 ... ... ... 2 ... ... ... ... 1 ... ... 1 ... 9 2 5 2 2 2 ... ... 1 1 1 1 Girls 46 2 ... 1 1 ... ... ... ... 2 ... ... ... ... ... 11 13 10 3 3 ... ... ... ... 1 ... 1 Fourth Avenue Infants 14 ... 4 2 2 7 2 ... 1 9 6 ... 2 8 ... 53 33 11 14 4 ... ... 5 2 1 3 45 Boys 52 8 5 2 6 1 ... ... ... 1 ... ... 1 1 28 17 13 1 5 19 1 2 7 2 3 28 Girls 31 1 3 1 1 ... 2 ... ... 2 1 ... 2 ... ... 12 11 7 1 4 17 ... 2 3 ... 2 10 Hartley Avenue Infants 200 ... 9 5 7 3 10 3 1 7 1 2 3 5 3 60 46 26 27 17 ... ... 2 1 5 4 33 Boys 113 7 4 ... 1 1 4 ... ... ... ... 1 ... 3 3 51 20 15 4 4 4 ... 2 4 1 5 12 Girls 133 19 4 2 2 2 5 ... ... 3 ... ... ... 1 1 57 46 19 9 5 ... ... ... 1 ... 1 17 High Street Infants l05 ... 4 1 ... 2 5 ... ... 9 2 5 4 7 ... 49 22 21 7 3 ... ... 3 ... 2 5 26 Boys 27 2 3 ... ... ... ... ... ... ... ... ... 2 3 ... 11 9 3 1 3 4 ... ... 2 ... ... 5 Girls 23 ... 3 2 2 ... 1 ... ... 1 ... 2 4 ... ... 11 5 1 ... 1 3 ... ... 1 ... 1 12 Kensington Avenue. Infants 171 ... 2 2 1 7 7 2 ... 2 1 ... 3 3 ... 58 54 44 9 10 ... ... 9 1 3 7 21 Boys 137 9 1 3 3 2 3 1 ... ... 2 1 2 1 1 75 34 41 10 4 14 ... 4 6 ... 6 44 Girls 116 15 ... ... 1 I 3 1 ... 1 ... ... ... 1 ... 55 38 14 3 1 4 ... ... 3 1 1 30 Lathom Road Infants 179 ... 8 1 2 5 5 2 ... 6 1 ... 1 6 3 59 32 30 11 6 ... ... 4 4 1 2 32 Boys 23 4 ... ... ... ... 3 ... ... ... ... ... ... 2 ... 12 3 6 1 ... 1 2 1 1 ... ... 2 Girls 20 ... 3 3 1 4 ... ... ... ... ... ... ... 1 ... 14 2 5 ... 2 7 ... 2 ... ... 4 7 Manor Park Infants 91 ... 5 1 2 5 1 1 ... 3 4 ... ... 7 ... 28 21 10 10 6 ... ... 1 5 ... ... 26 Boys 33 3 1 ... ... 1 ... ... ... ... ... ... ... 1 ... 18 3 3 8 1 3 2 1 2 1 ... 12 Girls 23 3 ... ... ... 1 2 ... 1 1 1 ... ... ... ... 11 4 7 3 ... 2 1 1 1 ... ... 8 Monega Road Infants 132 3 1 4 2 4 8 2 1 7 2 44 39 17 11 11 1 4 6 1 35 Boys 34 3 1 ... ... ... 1 ... ... 1 ... ... ... 2 ... 20 3 7 4 ... 4 ... 1 1 ... 3 5 Girls 8 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 5 3 5 ... ... 3 ... ... ... ... ... 1 Napier Road Infants 93 ... 3 ... 3 ... 1 1 ... 4 4 ... 6 10 ... 20 18 15 9 5 ... ... 1 ... 2 ... 35 Boys 32 3 2 ... ... ... 1 ... ... ... ... 1 ... 5 ... 14 9 10 1 1 8 1 1 ... ... 1 8 Girls 23 4 ... ... ... ... ... ... ... ... 2 4 ... ... 1 11 1 10 1 ... ... ... ... 1 ... ... 4 New Beckton Infants 30 ... 1 ... ... 1 ... ... 1 2 2 ... 1 7 ... 7 4 8 1 1 ... 1 ... 1 1 2 6 Boys 20 2 1 1 ... 1 ... ... ... 1 3 ... ... 7 1 8 3 3 1 2 2 2 ... 1 ... ... 7 Girls 7 2 ... ... ... ... 2 ... ... 1 ... ... ... ... ... 4 ... ... 2 ... ... ... ... 1 ... ... 4 North WooLwich Infants 40 ... 3 ... ... ... 1 1 ... 5 3 1 2 12 ... 12 5 6 ... ... ... ... ... 1 2 1 10 Plashet Lane Infants 99 ... 1 ... 1 1 3 ... ... 12 ... 3 4 7 2 29 20 18 2 10 ... ... ... 1 1 3 36 Boys 83 3 ... ... ... ... 1 ... ... 1 ... ... 2 2 1 16 6 9 ... ... 1 ... ... ... ... ... 7 Girls 20 2 1 ... 1 ... 1 ... ... ... ... ... ... ... ... 4 2 ... 1 ... ... ... ... i ... ... 2 Sandringiiam Road Infants 112 ... 4 ... 2 4 3 1 ... 3 3 1 1 3 2 26 31 15 6 5 ... 3 4 6 1 1 23 Boys 27 4 ... ... ... ... ... 1 ... ... ... ... ... 2 ... 13 9 4 ... 1 ... ... 2 1 1 1 10 Girls 10 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... 4 4 ... 2 ... 7 ... ... 1 ... 1 4 Shaftesbury Road Infants 196 ... 10 5 8 7 10 3 ... 12 4 4 2 7 5 55 73 26 10 9 1 ... 10 4 4 8 31 Boys 182 18 15 4 9 ... 6 2 ... 1 2 1 ... 5 5 72 56 25 7 3 1 1 12 9 1 10 43 Girls 107 5 5 3 5 2 10 ... 1 10 4 1 ... 1 1 51 36 17 8 5 25 ... 1 3 2 ... 37 Shrewsbury Road Infants 76 ... 3 ... ... ... 4 1 ... 3 5 ... ... 2 ... 16 29 8 2 1 15 ... 1 ... ... 1 11 Boys 26 3 1 1 1 ... ... ... 3 2 3 ... 1 1 1 8 7 ... 2 ... ... ... ... 4 ... Girls 24 2 1 ... ... ... 2 ... ... 2 2 ... 1 1 ... 16 5 1 1 ... 9 1 ... ... ... 1 3 Vicarage Lane Infants 66 ... 4 1 1 2 ... ... ... 2 4 ... 5 1 ... 20 19 10 2 2 9 ... 1 1 ... 1 10 Walton Road Infants 108 ... 7 ... 4 2 3 ... ... 21 2 4 11 8 4 30 40 10 8 5 ... 2 2 1 1 2 65 Boys 19 2 1 ... ... ... 1 ... ... ... 1 ... ... ... 1 11 5 4 2 ... 2 ... ... ... ... 1 7 Girls 6 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... 4 1 ... 1 1 2 ... ... ... ... ... 2 Casti.e Street R.C. Infants 9 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 3 3 2 3 ... 1 2 ... ... ... ... 3 Boys 3 1 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... 1 Girls 6 ... 3 ... ... ... ... ... ... ... ... 1 ... ... ... 1 2 ... ... ... 1 ... ... ... ... ... ... sllvertown R.C. Infants 40 ... 3 ... 1 ... 1 ... ... 4 3 1 3 1 1 15 6 3 ... 3 ... ... 4 1 ... 1 7 Boys 9 1 1 ... ... ... ... 1 ... ... ... ... ... 2 ... 5 1 2 ... 2 ... ... ... 2 ... ... 1 Girls 4 ... 1 ... ... ... ... ... ... 1 2 ... ... ... ... 2 ... ... ... 1 5 ... ... 1 ... ... 1 St. Winefride's R.C Infants 24 ... 4 ... 1 ... 2 ... ... 4 3 3 6 1 ... 7 7 1 ... 3 1 ... 1 1 ... 3 9 Boy s 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... Girls ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 3623 137 147 52 79 75 119 27 10 156 79 40 74 164 46 1313 927 569 223 175 182 21 85 99 47 94 875 105 GENERAL REVIEW OF THE PRINCIPAL DEFECTS DISCLOSED BY EXAMINATION. Vision.— In Infants' schools this is not tested. Boys and girls are examined by means of Snellen's test types, those able to read 6/12 being passed as satisfactory, those with less acute vision being termed defective. Of the 665 boys examined, 74, equal to 11.4 per cent., had defective sight. Of 888 girls who were examined, 63 required glasses, equal to 7.1 per cent. These cases were all advised to obtain treatment. In 13 cases the vision was only 6/60, such children when in class would not be able to read anything on a blackboard, they would sufter from constant eye strain and the teachers would be handicapped in their efforts. The parents of most of these children were entirely unaware of the presence of such a serious defect. Adenoids and Enlarged Tonsils.— Children suffering from there are usually dull and backward, the hearing is often defective, the mouth is constantly open giving a vacant expression, and such children are more liable to colds and various infectious diseases. A slight operation for the removal of these growths leads to enormous improvement in both the physical and mental condition. The slight cases were ignored and only the severe ones where obstruction was marked were advised to obtain treatment. This was considered advisable in no less than 271 cases. Teeth.— Of the 3623 children examined only 1383 had perfect teeth, 1313 children had three or less decayed, 927 had four or more decayed teeth. A considerable amount of ill health is caused by decayed and dirty teeth, this is due not only to defective mastication of food, but also to the continual swallowing of foul, septic, decayed matter. 106 Of the 3,623 children examined, only 493 cleaned their teeth regularly, 790 cleaned them occasionally, 2,339 did not clean them at all. The School Nurse has persuaded many to use a tooth brush, but the parents cannot be made to see that decay in the temporary teeth of their children is important, neither can they, in many case=, afford to have the permanent teeth stopped when these decay. Ear Discharge and Defective Hearing.—131 children were found to be suffering from these defects. A running from the ears is often considered to be a matter of no importance ; as a matter of fact it may lead to deafness, and at times even proves fatal by causing abscess of the brain or other serious complication. Defective hearing is very important from an educational point of view. Dull and backward children are often found to have defective hearing, which is the real cause of the unsatisfactory mental condition. Frequent causes of defective hearing are Adenoids and enlarged tonsils, ear discharge, wax or other matters in the ear. Clothing and Boots.— In connection with clothing the following classification was adopted. Children sufficiently clad and with woollen undergarments were termed good. Those sufficiently clad, but with cotton under-garments were called medium. Those whose clothing was insufficient to maintain the heat of the body were termed deficient. Many cases were found where the clothing was very excessive, such children being in a constant state of perspiration, and even hampered in their movements owing to the enormous number of garments they were wearing. The following table summarises the conditions found in connection with Clothing and Boots:— 107 Clothing. Boots. Good. Medium. Deficienct Good. Defective. Infants 1762 239 22 1923 97 Boys 539 no 7 578 49 Girls 791 77 11 846 18 Total 3092 426 40 3347 164 Mental Capacity.— This was only recorded in the Boys' and Girls' Departments, not in the Infants. The teachers were asked to state their opinion of the child's ability according to the following scales: Good, Average, Dull, Defective. The results indicate that 39.6 per cent, were Good, 41 per cent. Average, 8.1 per cent. Dull, 0.9 per cent. Defective. The figures for the different schools showed considerable variation, due, no doubt, to the personal interpretation of the teacher; what one might term average, another would call dull, and so on. Verminous Conditions.— Of the 3,623 children examined, 235 had vermin either on the head or body. So many of the girls had nits in the head that these had to be ignored, and only cases with vermin present were dealt with. Both teachers and attendance officers have commented on the improvement in the cleanliness of the children which has taken place since Medical Inspection began. It should soon be possible to raise the standard of cleanliness required so that the presence even of nits can be objected to. The following list gives the number and percentage of Verminous children:— 108 Number Examined. Vermin of Body. Vermin of Head. Number. Poreontagi'. Number. Percentage. Boys 1692 35 2.1 32 1.9 Girls 1931 44 2.3 124 6.4 In connection with verminous heads, comparison of the figures for hoys and girls gives strong evidence for the advisability of girls' hair being kept short. Nutrition.— This is an important item and one difficult to classify. 46 children were recorded as suffering from defective nutiition. It must not be assumed that this number were therefore insufficiently fed. Some cases may be due to unsuitable food or defective assimilation. More accurate classification cannot be adopted unless the homes are visited and further information obtained, but with only one School Nurse it is impossible at present to do this. The head teachers' attention was called to all cases where deficient feeding was suspected in order that the child might benefit by the arrangements made for feeding necessitous children. Heart Disease.— Most of these cases were of a mild degree and did not require exclusion from school. Instructions were given to the teachers not to allow any long continued cr violent exercise during playtime, etc. One case was probab'y caused by the strain of carrying heavy weights, the boy being engaged out of school hours in delivering milk. Tuberculosis.— One of the most satisfactory items in this report is the few cases of Tuberculosis that were found in the children inspected. It is quite possible that a few very early cases may have been overlooked. It is also probable that some children had tuberculous glands or disease in internal parts not accessible to examination, but these cases will not be numerous. 109 The highly infectious cases are those with Pulmonary Tuberculosis. These can usually be detected by ordinary examination, and are excluded from school. Deformities.— These were present in 99 children, or 27 per cent. They include curvature of the spine, deformity of chest, etc.; the former was most commonly seen in girls, the latter in boys. Infectious Diseases.— 47 cases were found, equal to 1-3 per cent, of the children inspected. They included the following diseases:— Scarlet Fever, Mumps, Diphtheria, etc. A number of children were also found suffering from various skin a'ffections such as Ringworm, Impetigo, Itch, etc. Work out of School Hours.— Of the 424. older boys examined, 85, or 20 per cent., were engaged in various employments, such as shop work, selling papers, delivering milk, etc., either before morning school, in the evening, or both. Of these 21 under the age of 13 years were found to be working in excess of the hours permitted by the local Bye-laws, and steps were taken in all cases to prohibit this. The Work of the School Nurse.— The work performed by the School Nurse is exceedingly valuable, and may be described under two heads :— 1st. In the School. 2nd. In the homes. 1. In the school, the nurse prepares the children for inspection and also takes note of the height, weight, condition of head, etc., thus saving the time of the doctor. At other visits to the schools she gives advice and help to the teachers in connection with verminous children or those suspected to be suffering from infectious or other illnesses. 2. It is in the home however, that the most valuable part of the Nurse's work is performed. Defects and diseases which have been discovered at the inspection are here explained to the parents and the necessity for obtaining treatment is pointed out. 110 A personal interview in this way is far more successful than any number of written notice-, and a very considerable proportion of the cases which have been remedied can be attributed to the visits of the Nurse, although in many cases two or even more visits may be required before the necessary steps are taken to have the defects remedied. In addition to this, the Nurse gives instruction to the mothers in connection with the treatment of minor defects, and shows how remedies, obtained either from the hospital or doctor should be applied. During the past year the Nurse paid over 600 visits to the homes of children suffering from various ailments. With the large number of children in our schools, three or four times this number of visits are necessary, but such work takes time, and one Nurse cannot possibly do more. I would strongly urge the appointment of a second Nurse to cope with this, for it is one of the most valuable parts of medical inspection. This appointment need not be objected to on the ground of expense, because the increased grant, owing to better attendance of scholars would probably pay for this. At present in many instances, children are excluded for long periods without receiving any treatment at all. A visit by the Nurse in many cases ensures that advice is obtained, and therefore the child sooner returns to School. In addition to this a number of visits were made in connection with minor affections such as can usually be treated by the mothers if the Nurse calls and gives them the necessary instructions. Many cases of slight inflammation of the eyes or eyelids, various skin affections in an early stage and other slight ailments are often found at the inspection by the doctors and directions are given to the Nurse who then visits and instructs the mothers as to the treatment required. A cons derable number of visits were made in connection with such cases. Diseases and Defects found on Examination which have been Remedied.— In all cases a printed Form is first sent to the parents, calling their attention to the defects or diseases 111 found at inspection. After a few weeks, the Nurse visits a school, and ascertains if the necessary treatment has been obtained. (A record of the children needing treatment is kept at each school). If not, she visits the home, and endeavours to get this done. As stated on a previous page, the visits of the Nurse accomplish more in this direction than printed notices. The following Table gives the number of cases which had received treatment up to the end of the year:— Diseases, etc. No. Remedied. Diseases, etc. No. Remedied. Adenoids 23 Eczema 3 Enlarged Tonsils 50 Impetigo 11 Teeth (stopped) 2 Bronchitis 10 ,, (extracted) 29 Blepharitis 14 Defective Vision 39 Nasal Polypus 1 (glasses) Squint 5 Ear do. 1 Otorrhœa 7 Ringworm 5 Corneal Ulcer 3 Anaemia 4 Various 15 Total 222 That a total of 222 suffering children have been relieved is no doubt satisfactory, but this only represents a very small percentage of those needing treatment. For instance, the Table shows that 73 children had Tonsils and Adenoids removed. Notices were sent to 271 cases where this was badly needed. The remainder have not received the treatment they urgently need. 2240 children had decayed teeth ; 31 have been attended to. 112 In connection with defective sight, 39 children have obtained glasses, but Notices were sent to 172 cases where these were required. It is obvious therefore that at present only a small percentage of children are receiving the treatment they require. TREATMENT REQUIRED AND METHODS AVAILABLE. This part of the subject is extremely important, and deserves the most careful consideration. The primary object of Medical Inspection was to discover to what extent school children suffered from diseases or defects, which either rendered them unfit to attend school, or unable to fully benefit by the instruction given. The necessity for this examination has everywhere been abundantly proved. From the preceding pages it is obvious that the most important conditions needing treatment are:—Adenoids, Enlarged Tonsils, Defective Vision, Dental Diseases, Ear Disease and Deafness. Then there are a number of minor conditions such as Skin Diseases, External Eye Disease, Pediculosis, Diseases of Heart and Lungs, etc, The treatment of these latter conditions is not expensive, operations, etc., are not required, and in the majority of cases the parents can obtain the necessary treatment from their own medical attendant. But a totally different state of things exists in connection with the first-named diseases and defects, and it is these which are not only the most common, but also the most detrimental to the child. Adenoids and Enlarged Tonsils.—These require an operation for their removal. How many parents in this district can afford to pay even a guinea or two for this to be done ? And if, as frequently happens, two or three children in the same family are affected, the difficulty becomes greater. Defective Vision.— This needs skilled examination, followed by the provision of suitable spectacles. Many medical 113 men do not undertake the treatment of visual defects, but even if they did and the necessary glasses were prescribed, the parents in scores of cases cannot afford to purchase them. Dental Affections.— Here again, skilled treatment with special appliances is wanted, and this is necessarily expensive. In a working class district like this few can afford the services of a dentist to the extent that is necessary. Ear Disease and Deafness.— The treatment of these conditions is often prolonged, and in many chronic cases an operation is practically the only remedy. In London and in many large towns general hospitals are available, in the out-patients' departments of which these cases are being treated. But the hospitals of London have almost more than they can do to 'treat the London children, and therefore they are not available for outside districts, even if the children could get there. Our local hospital is apparently for accidents and minor surgical cases, and does not undertake the treatment of the conditions named. How is the difficulty to be overcome ? There are several methods available:— ist. Treatment by the Poor Law Authorities. This would not be popular, and therefore would not be successful. 2nd. By establishing a School Clinic. The objection to this is the expense of providing the necessary buildings, in addition to the equipment, and also the difficulty of supervising cases after operation. It occasionally happens that a case needs keeping in bed for a day after operation, and for these the conveniences of a hospital are necessary. 3rd. The most economical and satisfactory arrangement would be to extend the usefulness of our local hospital by adding to it an out-patient department properly equipped for the treatment of the cases mentioned. This is not the place to discuss the details of any such scheme, but I should like H 114 to point out some of the advantages of this suggestion. At present our schools and also various clubs and societies, collect subscriptions, etc. in order to obtain letters for the treatment of cases in the West Ham and other Hospitals which do undertake the treatment of the diseases mentioned above. All these agencies could then work for own hospital. Again, there are numbers of people in the Borough apart from school children suffering from various affections needing hospital treatment, these people at present have to attend hospitals at either West Ham, Plaistow, or London. These might all be attended to here. It may be urged that the local hospital cannot afford the expense which would be necessary. With reference to this the Council has power to make contributions to local institutions for the treatment of" suitable cases occurring in school children. In addition to this, not only would the hospital receive many contributions which now go to other better equipped institutions, but there are many pirents well able to give a contribution towards the cost of the treatment they need, but who cannot afford to pay the whole. Many of these parents have no desire to accept charity, and should not be permitted to do so; they should be expected to contribute according to their means for the work dons for them. This scheme would be less expensive than a School Clinic and would also be more satisfactory, in addition to this the value of the local hospital to the Borough would be enormously increased. Instead of chiefly confining its energies to minor surgical work, much of which local medical men can well undertake, it could treat the many special conditions which local practitioners do not undertake and which, for want of a suitable institution, at present go unattended, to the detriment of the sufferers, both as regards their health and value to the community. INFECTIOUS DISEASES. Information concerning notifiable Infectious Diseases occurring in school children is sent by the Medical Officer of Health to all head teachers. 115 Information concerning the existence of cases of nonnotifiable disease is chiefly obtained from the teachers and Attendance Officers. Printed Instructions stating the precautions necessary to be taken are sent to all cases. During the past year the following cases occurred amongst children attending the different Elementary Schools in the Borough:— SCHOOL CASES, 1909 SCHOOLS. Dept. Scarlet Fever. Diphtheria Mea sles. C'gh. Chicken Pox. Mumps Ringworm Total. Central Park Road Infants 10 4 32 .. .. 36 .. 107 Boys 17 1 .. .. .. .. .. Girls 3 4 .. .. .. .. .. Castle Street R.C. Infants 1 .. .. .. .. .. .. 5 Boys 2 .. .. .. .. .. .. Girls 2 .. .. .. .. .. .. Essex Road Infants 20 .. .. .. .. .. .. 40 Boys 13 .. .. .. .. .. .. Girls 4 3 .. .. .. .. .. Fourth Avenue Infants 9 1 4 16 21 45 .. 120 Boys 5 .. .. .. .. .. .. Girls 11 1 .. .. .. 7 .. Hartley Avenue Infants 12 29 .. .. .. .. .. 60 Boys 4 4 .. .. .. 1 2 Girls 3 5 .. .. .. .. .. High Street Infants 2 2 1 .. .. 6 .. 27 Boys 4 .. .. .. .. .. .. Girls 9 3 .. .. .. .. .. Kensington Avenue Infants 3 10 .. 23 .. 61 .. 114 Boys 4 .. .. 2 .. 3 .. Girls 6 1 .. .. .. 1 .. Lathom Road Infants 10 8 .. .. .. 37 77 Boys 8 3 .. Girls. 6 2 .. .. .. 3 .. Monega Road Infants 17 4 .. .. .. 2 .. 104 Boys 4 .. .. .. .. .. .. Girls 5 2 .. .. .. .. .. Manor Park Infants 3 14 .. 1 26 .. .. 60 Boys 5 1 .. .. .. .. .. Girls 7 3 .. .. .. .. .. Napier Road Infants 8 2 43 .. .. 76 .. 144 Boys 5 .. .. .. .. .. .. Girls 9 1 .. .. .. .. .. New Beckton Infants 4 l 1 .. 1 .. .. 21 Boys 3 2 .. .. 1 .. .. Girls 1 5 .. .. .. .. .. North Woolwich Mixed 1 .. .. .. .. .. .. 44 Infants 5 .. 38 .. .. .. .. Plashet Lane Infants 2 2 .. .. .. 26 .. Boys .. .. .. .. .. 4 2 39 Girls 3 .. .. .. .. .. .. Shrewsbury Road Infants 4 4 .. .. .. .. .. 20 Boys 6 .. .. .. .. .. .. Girls 5 1 .. .. .. .. .. Sandringham Road Infants 5 1 34 14 .. .. .. 62 Boys 4 1 .. .. .. .. .. Girls 3 .. .. .. .. .. .. Silvertown R.C. Mixed .. 1 .. .. 6 8 .. 15 Infants .. .. .. .. .. .. .. Infants 7 2 14 .. .. .. .. Shaftesbury Road Boys 3 2 .. .. .. .. .. 34 Girls 3 3 .. .. .. .. .. St.Winefride'SR.C. Mixed . .. .. 1 .. .. .. .. 3 Infants 2 .. .. .. .. .. .. Vicarage Lane Infants 8 .. 43 .. .. .. .. 51 Infants 2 5 47 .. .. .. .. Walton Road Boys 3 .. 1 .. .. .. 2 69 Girls 3 3 3 .. .. .. .. Totals 308 141 262 104 76 316 9 1216 117 Mumps was very prevalent during the greater part of the year and practically affected the entire district. It is many years since such a number of cases of this disease occurred. SPECIAL EXAMINATIONS. The following examinations were made at the office of the Medical Officer at the Town Hall and reports submitted to the Committee on each case :— Boys for Truant and Industrial Schools 37 Mentally Defective Children 7 Teachers examined on appointment 63 Teachers examined for illness 11 Special examinations of children 97 Total 215 Report of the Chief Sanitary Inspector. 121 Annual Report of the Chief Sanitary Inspector. To his Worship the Mayor, the Aldermen, and Councillors of the Borough of East Ham. Mr. Mayor and Gentlemen, I have the honour to present to you my fourteenth Annual Report of the work done by the Sanitary Inspectors during the year ended 31st December, 1909. Inspection of the Borough and Abatement of Nuisances.—I am pleased to record that during the year under review much activity was displayed in the discharge of the duties incumbent upon the Inspectorial Staff to improve the sanitation of the Borough and Health of the Burgesses. The character and usefulness of the work done with its effect, are best judged by the healthy condition of the inhabitants and the high standard the Borough has attained in the position of healthy Towns. It is only necessary to call your attention to the table on page 16 to confirm the practical character of the work. In investigating complaints lodged, notification of infectious diseases received, house to house inspections, etc., 4,874 inspections were made as under :— Beckton and N. Woolwich Ward. Central East Ward. Central West Ward. Manor Park Ward. Plashet East Ward. Plashet West Ward. Tota January 78 97 109 131 35 38 488 February 28 120 148 115 58 44 513 March 34 120 125 113 44 50 486 April 25 107 112 113 31 22 410 May 60 90 114 112 34 40 450 June 65 92 94 90 22 67 430 July 49 66 84 74 34 31 338 August 33 61 40 66 30 24 254 September 72 83 89 73 18 57 392 October 30 92 100 104 40 50 416 November 57 96 92 95 12 15 367 December 27 88 82 91 19 23 330 Totals 558 1112 1189 1177 377 461 4874 As a result of the inspections made 6,705 nuisances have been discovered as set forth in the following table, 2,676 by House to House Inspection, and 4,209 by Routine work necessitating the service of 1,429 Preliminary, 96 Statutory, 23 Water and 135 Dust Bin Notices. The following is a record in detail of the inspections made during the Year, 1909. Beckton and North Woolwich Ward. Central East Ward. Central West Ward. Manor Park Ward, Plashet East Ward. Plashet West Ward. Total. Gen. H to H Gen. H to H Gen. H to H Gen. H to H Gen. H to H Gen. H to H Geo. H to H Inspections 465 93 736 376 655 534 824 353 320 43 435 40 3435 1439 Premises found in fair condition 248 18 326 85 342 183 358 29 146 10 209 9 1629 334 Factories, workshops, and outworkers' premises inspected 18 — 117 — 104 — 159 — 83 — 92 — 573 — Bakehouses, slaughter-houses and dairies inspected. 38 — 73 — 62 — 151 — 36 — 47 — 407 — Urinals inspected 22 — 21 — 14 — 12 — 4 — 10 — 83 — Walls and ceilings dirty and dilapidated 15 20 47 70 45 96 68 83 32 — 46 — 253 269 Yards improperly paved and dilapidated 9 7 22 93 19 60 42 143 12 8 19 11 123 322 No forecourt paving 1 — 15 65 13 82 9 47 2 11 30 18 70 223 Drains unstopped and cleansed 419 — 34 — 259 — 365 — 140 — 188 — 1605 — Defective drains 8 18 5 20 35 98 15 3 7 1 42 2 112 142 Defective w.c. connections 3 — 6 3 3 — 9 2 2 — 5 — 28 5 Defective w.c. traps 3 — 2 2 1 — 5 6 3 — 2 — 16 8 Soil pipes and drains insufficiently ventilated — — 2 — 5 — — — 1 — — — 8 — Defective flushing apparatus 2 2 22 27 21 28 33 53 13 — 13 — 104 110 Soil pans foul and broken 4 3 21 41 43 101 29 32 16 2 63 2 176 181 Defective vent pipes 8 — 16 26 6 26 14 38 6 1 14 — 64 91 R.w pipes and eaves gutters defective 8 8 19 37 . 6 29 20 112 5 3 8 — 61 189 Do. corn ected to drain — — — 4 3 24 6 2 2 — 3 — 14 30 Roofs leaky 2 4 10 18 9 39 12 53 5 — 17 — 55 114 Defective sink waste pipes 6 7 4 11 7 18 9 30 6 1 11 — 43 67 Houses without water (M.W.Bd.) — — 5 — 5 — 14 — 8 — 9 — 41 — Cisterns without covers 11 — 15 41 18 38 45 101 9 — 18 6 116 186 Drinking water improperly stored — — 10 25 7 8 14 8 11 — 9 — 51 41 Dilapidated floors 2 8 6 10 1 12 6 31 — — 4 — 19 61 Insufficient underfloor ventilation 25 15 9 107 21 160 34 78 8 14 20 17 117 391 Dampness — 4 8 10 5 9 17 62 7 — 6 — 43 85 Accumulations 29 1 40 — 38 7 64 29 20 — 29 — 220 37 Inundations — — 2 — 2 — 8 — — — 2 — 14 — Overcrowding — — 5 — 6 — 8 5 1 1 4 — 24 6 Unsound food — — 2 — 5 — 4 — — — 2 — 13 — No dust bins 9 7 1 4 3 22 33 6 — 6 54 37 No manure bins 2 — — 1 — 1 2 2 — — — — 4 14 Animals improperly kept 1 — 3 — 6 3 11 I 4 — 2 — 27 4 Temporary buildings found 3 — 4 1 3 2 10 — 4 — 2 — 26 3 Smoke nuisances 1 1 44 — 1 1 1 1 1 1 2 — 50 4 Rear passages unpaved or undrained 9 — — — — — — — — — — — 9 — Gipsies 81 — 97 — 9 — 59 — — — — — 246 — Breaches of Bye-Laws — — 2 — 2 — 2 2 — — — — 6 2 Other nuisances 24 — 84 17 44 16 51 28 17 2 28 1 212 64 Drains tested 51 22 11 22 138 86 145 2 97 3 121 2 666 137 HOUSE TO HOUSE INSPECTION. Name of Road. Number of Houses Inspected Number of Houses where defects existed. Number of Mouses in fair condition. Aintree Avenue 3 3 ... Albert Road 14 14 ... Boleyn Road 83 59 24 Bonny Downs Road 49 35 14 Burges Road 16 ... 16 Castle Street 46 38 8 Caulfield Road 5 5 ... Church Road 7 7 ... Claremont Street 20 20 ... Cleves Road 99 68 31 Dore Road 29 27 2 Dorset Road 7 7 ... Eighth Avenue 2 2 ... Elizabeth Street 22 ... 22 Ernald Avenue 4 4 ... Florence Road 7 7 ... Folkestone Road 5 3 2 Fourth Avenue 9 9 ... Francis Street 15 15 ... Gainsborough Avenue 8 7 1 Glenister Street 2 2 ... Gordon Road 9 6 3 Grantham Road 125 108 17 Green Street 27 ... 27 Halley Road 2 2 ... Herbert Road 4 4 ... High Street, North Woolwich 2 2 ... High Street North 15 12 3 High Street South 9 9 ... Jephson Road 2 ... 2 Keppel Road 2 2 ... Landseer Avenue 11 11 ... Lansdowne Road 12 12 ... Lathom Road 1 1 ... Lawrence Avenue 50 43 7 Macaulay Road 6 3 3 Mountfield Road 78 56 2 Muir Street 18 7 11 Parkhurst Road 14 14 ... Parr Road 52 35 17 Priory Road 46 33 13 Redclyffe Road 42 27 15 Robert Street 12 12 ... Romford Road 2 2 ... Rosebery Avenue 12 12 ... Saxon Road 5 1 4 Selborne Avenue 20 20 ... Seymour Road 63 38 25 Sheridan Road 2 2 ... Sheringham Avenue 2 2 ... Sherrard Road 12 12 ... Shrewsbury Road 4 4 ... St. Stephen's Road 2 2 ... Telham Road 108 89 19 Temple Road 2 2 ... Tennyson Avenue 4 4 ... Tudor Road 45 37 8 Wakefield Street 2 2 ... Walton Road 76 76 ... Warwick Road 1 1 ... Wellstead Road 84 66 18 Woodstock Road 2 2 ... 1,439 1,105 334 124 House to House Inspection.—One of the most important duties devolving upon the Sanitary Inspectors is systematic house inspection, with a view of ascertaining what nuisances exist calling for abatement. Of the 4,874 primary inspections made for all purposes, 1,439 were house to house visitations. The number of premises upon which there was no nuisance detected was 1,629 or 49 per cent. routine work, as compared with 334 or 23 per cent. House to House work. In reviewing the House to House inspection work we find that at 77 houses in every 100 visited, nuisances were detected, as compared with 51 houses in every 100 for general work. This is explained by the fact that House to House Inspection has been done in selected districts where Sanitary Inspection is most needed, but which nevertheless proves its necessity, for by it there are revealed not only Sanitary defects but conditions under which people are content to live without complaining to the Local Authority or informing the landlord. It is surprising the little interest some owners take in their property or their tenants' comfort, while on the other hand it is disappointing to find the little regard some tenants have for the landlord's house, or their own health. It frequently happens that houses are put in good condition as a result of Notices having been served but are speedily rendered unfit for habitation by unfair treatment. Choked Drains.—In reviewing the character of the nuisances in the foregoing table, it will be observed that stopped drains occupy the foremost position. The number of houses reported and attended to under this heading being 1,605. This number appears at first consideration to be large in proportion to the number of houses in the Borough (26,000) but upon second thought we find that the Council have for many years adopted the policy of clearing drains and unstopping water closets without charge, so that very few stoppages occur without being reported. Then the system of drainage is by combined drains and the average number of houses running into one main drain would be 125 six, and as the main drain is intercepted from the sewer by a syphon (where the block usually occurs) it affects the whole of the hpuses. I have in previous years commended the Council's policy of attending to this important work of unstopping and cleansing drains, and one might claim that this is one of the factors that helps to raise the Borough to the high position it holds among the healthiest towns of England. It must be obvious to the lay mind that there is a great difference between unstopping a drain and sweeping a chimney, a man may be an excellent sweep but a disastrous drain clearer. There was a time before interceptors formed part of a drain that the sweep could manage the work, but that day is past in East Ham. The Council have two very able men who are acquainted by many years experience with the position of the manholes, and know the run of almost every drain in the Borough. This knowledge prevents a great deal of delay and waste of time which is a danger to health, in addition, frequently the breaking of pipes and causing serious damage. The small cost of doing this important work is a profitable investment for the general ratepayer, for it is better to spend a small amount in prevention than large amounts in curatives. Drainage Work.—A great deal of excellent work has been done under the heading of drainage re-construction. The number of drains that have been tested either by water, smoke or chemicals was 803—of this number, in 254 instances defects were discovered in the connection or the trap. On every occasion of drainage re-construction the work is subjected to the strictest supervision and no pipes are permitted to be covered until they have been tested and passed by the Inspector. The principal work for the year under consideration has been done at the following premises:— 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, Francis Street. 55. 57. 59. 61, 63, 65, Elizabeth Street. 24, 26, 28, Robert Street. 126 2 to 28, Telham Road. 46, St. Albans Avenue. 3, Langdon Crescent. 57, Roman Road. 27, Wellstead Road. 6, Walton Road. 122, Alverstone Road. 112, Seventh Avenue. 27, Gloucester Road. 765, 767, Romford Road. 33, Stanley Road. 37, Coleridge Avenue. 14, Durham Road. 68, Kensington Avenue. Eighth Avenue Works. 27, Caledon Road. 15, Greenhill Grove. 11, Manor Park Road. 75, Third Avenue. 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70 72 and 74, Cleves Road. 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38 and 40, Boleyn Road. 2, 4, 6, 8, 10, 12, Florence Road. 71, 73, 75, 77, 79, Cleves Road. 91, 93, 95, 97. 101 and 103, Cleves Road. 58, Plashet Lane. 14, 16 Ratcliffe Road. 36, 38, 40, Halley Road. 71, 73 and 75 Boleyn Road. 55, 57 Lawrence Avenue. 38, Castle Street. 145, South Esk Road. 39, York Road. 34, Whitfield Road. 37, 39, Seymour Road. 2, Edith Road. 31, Plashet Lane. 127 28, Seymour Road. 27, Chester Road. 75, Oakfield Road. 15, Cleves Road. 23, Wordsworth Avenue. 53, Parr Road. 17, St. Stephens Road. 21, Stafford Road. 54, Rothsay Road. 5, Lawrence Road. 46, Colvin Road. 18, St. Stephen's Road. 80, Sheridan Road. 33, 35, 37, 39. and 41, Redclyffe Road. 52, St. Bernard's Road. In addition to drains proper there are the appurtenances thereto—soil pans, traps, ventilating pipes, etc. It is most important they should be efficiently attended to, and in this connection it is with pleasure one recognises the advantage derived from the Council's new Bye-laws, although it is to be regretted that the Bye-laws do not give greater powers to deal with the materials used in such things as eaves-gutters, rainwater pipes, etc., in the construction of new property. Dirty Premises.—It will be seen from the table of sanitary defects that nuisances arising from internal dirty walls and ceilings have been dealt with in 522 instances as compared with 479 for the previous year. These figures reflect some credit upon the property owners and occupiers, for if we consider that about 5,000 premises have been inspected, the figures represent that at about 10 per cent. of such premises internal walls and ceilings were found to be dirty. It should also be considered that the greater number of inspections have been made in the districts comprising the smallest property. The introduction of Gas into small properties by means of penny-in-the-slot meters largely accelerates the blackening of walls and ceilings; especially is this so where the rooms are small and ceilings low. 128 Overcrowding.—The number of cases of overcrowding that have been dealt with by Notice and abated during the year was 30, a reduction of two from the previous year. I have in former reports referred to the difficulty experienced in remedying this serious nuisance. Overcrowding is more or less inevitable in districts where rent is high. The number of rooms occupied by a workman is largely determined by what he can afford, instead of what is required to comfortably and hygienically house his family. It is patent to all that if a man's income is small and his work precarious, to provide the standard number of cubic feet of space, some sacrifice must be made in another direction, which few people are prepared to make. In the Beckton and North Woolwich Ward the number of persons per house is slightly higher than in other parts of the Borough, but no case of overcrowding has been reported that would justify action being taken. I have previously pointed out that the only true remedies for overcrowding are cheap rents and regular work, and to instil into the rising generation the vital importance of fresh air and cubic space, and that it is as essential to provide sufficient wholesome bedrooms as it is to provide wholesome food, and that one is as necessary as the other. It is to be regretted that a lack of appreciation of fresh air (among people who should know better) should exist, and in this particular direction it is not uncommon to find that although there is an abundant cubic capacity, there is a dearth of fresh air, and it is frequently considered that both are unimportant. I have stated that poor people have to submit to their circumstances, and make the best of the number of rooms at their disposal, but every one, irrespective of position, can obtain an unlimited supply of fresh air, which is more essential than cubic capacity, and is freely available to all. 129 Unsound Food.—The market places have been regularly inspected and on 4 occasions unsound food has been discovered by an Inspector exposed for sale and destroyed. They comprised various kinds of fish, vegetables, and meat. In no instance was legal proceedings instituted as the cases were not flagrant, but merely accidental. The owners were cautioned. One important factor in conrection with the food supply of the Borough is that the shops are situated in the main thoroughfares, which are well lighted and it is to the tradesmen's own interest to stock and expose for sale only sound food. In nearly every instance where attention has been called to some doubtful article, the tradesman has without hesitation had the doubtful article destroyed. The practice of giving certificates of condemnation for unsound food which has been surrendered by the owners (having been purchased or consigned in an unsound condition) prevents a large quantity of food being exposed and sold to the public. During the year, nine consignments comprising Haddock, Mat kerel, Cod, Skate, Winkles, Kippers and Rabbits, have been submitted and destroyed. Although it is admitted that the practice has many advantages, it has been alleged that unscrupulous retailers have substituted stale and unsound stock for the fresh consignment, surrendering the former for condemnation, obtaining a certificate, and then using same for the purpose of obtaining compensation from the wholesale merchant. This is perhaps done in a few cases, but I believe the percentage is very small, and in any event it is a form of fraud which should be dealt with rather by the wholesale merchant than by the Sanitary Authority, as has been done in another trade. Every care is taken so far as it is possible by us to 130 prevent fraud of this kind. The person who actually bought the submitted article is questioned as to time of purchase, name of vendor, whether he personally saw the consignment prior to purchase; the marks on boxes or cases and weight are carefully noted, as well as the time of submission and the condition, which latter is also invariably further witnessed by one of the District Inspectors. It will therefore be seen that a person submitting for condemnation an article which he has substituted for that actually bought can be quickly brought to book, if the wholesale merchant has any doubt of fraudulent practices. In connection with this important matter of food supply, I believe that the time is not far distant when, with the exception of meat and milk, it will be a rare thing to find any unsound food exposed for sale. The three chief factors in the improvement of the food markets are: First, the gradual education of the purchasing public as to quality; secondly, the keen competition between the various tradesmen; and thirdly, and perhaps the most important, the growth of branch shops of great limited companies whose leading trade principle is to supply the public with a thoroughly sound and fresh article at the lowest price, and other shopkeepers have been compelled to fall into line with great advantage to the public in general. With regard to Meat and Milk, the case is somewhat different, and will never be quite satisfactory until there is some settled national standard for dealing with tuberculous cows and new legislation in regard to slaughtering. The aim of most reformers in the latter direction is compulsory use of municipal abattoirs. While having the very greatest admiration for this scheme in the abstract, it presents too many difficulties in the concrete to recommend itself to my undivided support. It is a well known principle in English law that legislation shall never, or rarely, be retrospective and 131 although it would be apparently a perfectly simple matter to pass an enactment that no further private slaughter houses should be licensed in any place in England, and empowering every Sanitary Authority to erect at the public charge a Municipal Abattoir, it is not probable that Parliament will break away from its long established usage of non-interference with what has been sanctioned in the past. We should then still have for very many years to come the old slaughter-houses to deal with. A far simpler plan, and very effective, as it appears to me, would be to pass an enactment compelling every slaughterman to obtain a permit from the local inspector. This would inflict no hardship on the dealer in sound animals and would give the Inspector the opportunity of examining the carcase at the moment of evisceration. This is of the very greatest importance for after a beast has been dressed for shop it is often quite impossible to detect disease without cutting into the meat, which of course no butcher would allow unless compensation was paid for damage. Complaints.—996 Complaints were received for the year under review 581 written and 415 verbal. The greater number of complaints referred to stopped drains, for occupiers and owners are encouraged to send on the information when anything is wrong or suspected of being out of order with the drains. Many of the matters referred to by complainants were outside the jurisdiction of a Sanitary Inspector, while some were frivolous, others vindictive, but the majority were bona-fide complaints of nuisances which required attention. A large number of anonymous letters was received, which had the fullest attention, as there are frequently good reasons for withholding the name. Complaints were received in the various Wards as follows ;— 132 Beckton and North Woolwich Ward 45 Central Ward—East 137 Central Ward—West 184 Manor Park Ward 319 Plashet Ward—East 155 Plashet Ward—West 156 Total 996 Gipsies.—Some 246 visits to Gipsy Caravans and Squatters' Tents have been made. This is a decrease of 26 as compared with the previous year. On no occasion has it been necessary to use physical persuasion as the Council's Bye-laws give power to proceed against the offenders to enforce the provision of water, etc. No summary proceedings have yet been taken under the Bye-lavvs. The Gipsies' visits are very short; they do not feel at all tempted to stay long enough to avail themselves of the provisions of the Bye-laws. Dairies and Cowsheds.—There are six registered Cowsheds and 15 Dairies in the Borough. There is a slight decrease in the number of Cowsheds and an inerease in the Dairies. It is evident that it is more convenient and probably more profitable to have the milk sent in from the country than to keep cows in the Borough. 225 Inspections have been made and the obligations of the Dairies, Cowsheds, and Milkshops Order incumbent upon the vendors insisted upon, which includes good drainage, ventilation, light, water supply, cubic space, and although the cowsheds in the Borough might be called clean they require constant attention. Trade Refuse.—The collection and disposal of Trade Refuse under the new system has been in operation since May, 1106 loads were collected. Very few complaints being received. 133 The refuse is collected twice in every week from tradesmen's premises (provided it is deposited in a receptacle and placed in a convenient position ready for collection) free of charge. This is certainly a great concession to the Tradesmen, considering that formerly they had to remove it at their own cost; but it is surprising what some folks expect, and complaints have been made because the Council's men have declined to enter the premises and shovel up the refuse and carry it out. I am pleased to report that these unreas anable persons are exceptional, and speaking generally the Tradesmen appreciate the present policy of the Council and co-operate in the work by facilitating the work of collection. The cost of the collection to the general ratepayer does not exceed £200 per annum. It will be noticed in the Nuisance Table on page 121, that nuisances arising from offensive accumulations number 257, as compared with 303 for the previous year. Offal and Bone Refuse Collection.—Special attention has been given, particularly in the summer months, to the collection of Fish Offal, Meal bones, etc. During the hot weather the collecting vans become very offensive, unless frequently cleansed. This very disagreeable work is done late at night, and the nuisance thus reduced to a minimum. The public are ever ready to complain if they see or smell a collecting van, but the nature of the business should be considered and what would result if the offalwas left uncollected. Factories and Workshops.—There are 26c Factories and Workshops on the Register, comprising Laundries, Factory Bakehouses, Blouse-makers, Tailors, Bootmakers, Shirt-makers, etc. During the year 262 inspections have been made. Six Notices have been served calling attention to breaches of the Public Health Act. On 17 occasions the attention of the Chief Factory Inspector was called to failures to exhibit the Home Office Abstract. 134 We have been notified 5 times, by the Chief Inspector of Factories of nuisances existing in Workshops calling for abatement. Slaughter-houses.—There are 15 Registered or Licensed Slaughter Houses in the Borough, and during the year 86 inspections have been made. On no occasion was unsound or diseased meat discovered by the Council's Inspectors. The Slaughter Houses generally throughout the Borough may be said to be in a satisfactory condition. Attention has been given to cleansing of the premises and utensils. The annual licenses have been renewed and no complaints have been lodged in respect of the Slaughter Houses. The following is a list of the slaughter houses in the Borough :— 10, Greenhill Grove. 363, Green Street. 319, Green Street. 14, High Street North. 170, High Street South. 330, Katherine Road. 86, Plashet Grove. 32a, Plashet Lane. 638, Romford Road. 28, Station Road. 6, Station Road. Shaftesbury Road. 24, Wakefield Street. 65, Whitta Road. Forest View Farm. Collection of House Refuse.—During the year 1909, 13,409 loads of House Refuse were collected from the houses in the Borough, as compared with 13,595 for the year 1908. 135 The existing contract with Mr. Mark Gibbard to provide a sufficient number of horses and drivers to collect from every house in the Borough at least once in every week works most satisfactorily, very few complaints have been received in respect of non-collection. It will be noticed that there is a decrease of 189 loads for the year. I think this is largely attributable to the increasing use of Gas Stoves for domestic purposes. The whole of the refuse has been deposited at the Council's Destructor, where it is used for generating steam for pumping purposes in connection with the Sewage Works. 135 Notices have been served upon responsible persons to furnish houses with suitable galvanised iron dustbins, and have been complied with, but it is to be regretted that the bins are manufactured of such poor material that their life is very short, necessitating going through the work again. Landlords frequently complain that the bins are damaged by the Dustmen while collecting, but if a trifle more was paid for the bins in the first instance it would be more economical. The following Table gives the number of loads of House Refuse collected during the year :— DUST COLLECTION. NUMBER OP LOADS COLLECTED DURING 1909 FROM:— Beckton and North Woolw'h Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total Loads Collected per Month. JANUARY 63 208 200 260 248 246 1225 FEBRUARY 71 218 186 241 174 189 1079 MARCH 65 243 180 295 204 204 1191 APRIL 69 244 234 248 188 226 1209 MAY 98 230 188 257 185 195 1153 JUNE 66 224 169 296 206 197 1158 JULY 84 235 209 231 187 179 1125 AUGUST 66 202 156 257 175 159 1015 SEPTEMBER 66 190 177 227 167 206 1033 OCTOBER 80 222 181 221 157 166 1027 NOVEMBER 68 222 173 273 185 170 1091 DECEMBER 50 220 215 226 175 217 11O3 846 2658 2268 3032 2251 2354 13,409 137 Temporary Buildings.—There are many nuisances for which occupiers of houses are responsible, such as keeping fowls, ducks rabbits and goats penned in small structures in back yards and in some instances fowls and rabbits have been discovered housed inside the dwelling house. Fowls and ducks are permitted to roam all over the yard, being partially fed with waste food from the table. Immediately around the dwelling-house (and sometimes inside) it is not uncommon to find the yards in a filthy condition and excremental deposits on the kitchen and scullery floors. The practice of erecting temporary buildings such as wooden out-houses of various shapes and sizes is common. These are put to numerous uses, including stables, smoke boles, pigeon lofts, cycle houses, etc. The question of Council's Byelaws or the ventilation of the dwelling house is not considered by the occupier, who is most anxious to erect wooden buildings against the permanent structure to keep his animal pets warm. It frequer???ly happens that a temporary building will be erected encasing the back ground floor bedroom window, back door and ground floor water closet, while the innocent occupier is studying the comfort of the animals, he is disregarding the ventilation of his home and the health of his family. When the importance of fresh air and ventilation are pointed out to him, he regards them as sanitary fads, and if called upon to remove the building he invariably regards himself as an aggrieved person. During the year 29 Temporary buildings have been dealt with under the Budding Bye-laws and Public Health Act. Schools.—The Public and Private Schools have received the Inspectors' attention, and generally have been found in a satisfactory condition. The Urinals, Latrines and Sanitary Appliances, for the cleanliness of which the Caretakers are responsible, in most 138 schools may be stated to be satisfactory, but in a few schools this cannot be said of them, for occasionally they are permitted to get into a dirty state. The refuse from the schools is removed by the Council's Contractor, and the large gullies, drains and manholes are kept clean by the Council's drain men. It is the duty of the Caretakers to keep the small gullies clean. The chief failings in private schools are the tendency to overcrowd and in disregard of fresh air, but in no case during the year has it been necessary to serve notice for the abatement of any nuisance. Passages at rear of Premises.—The business premises and some of the private residences are provided with secondary means of access at rear. These passages are often found to be in a dirty condition; they are generally unlighted and at night lend themselves to the deposit of filth. The joint occupation increases the difficulty of keeping them clean, for what is many person's work is usually nobody's, with the result that much time has to be given in serving Notices on persons legally responsible to carry out their obligations in the abatement of nuisances. I am afraid these passages will always be an annoyance, for where we have served Notices and had them paved, drained, and gates erected, they are permitted to get into a disgraceful condition with garbage and filth, and the gate either left open or broken off. Gross thoughtlessness prevails where there is joint responsibility. Disinfectants.—There are three distributing stations in the Borough for issuing disinfectants—Central Station, Nelson Street; Northern Station, Church Road Depot; and the Southern Station, at New Beckton. These issuing depots are a great convenience to the inhabitants who unfortunately have infectious disease in their houses and need disinfectants. This 139 convenience is much appreciated, especially by those living in the extreme North and South of the Borough. Disinfectants are obtainable free of charge from 9 till 11 a.m., and from 2 to 3 p.m., and in cases of emergency at any time during Office hours. During the year 30 tons of powder and 1,200 gallons of liquid disinfectants have been given away. The greater quantity of the powder has been utilized for the purpose of disinfecting the dustbins at the time of emptying by the Dustmen. Mortuaries.—The Council's Mortuaries have been regularly inspected, and have always been found in a clean condition. The Wakefield Street Mortuary, which has served the District many years (very inadequately) is shortly to give place to a modern building to be erected on the Town Hall site. Petroleum Licenses.—There are some 20 premises in the Borough licensed for the storage of Petroleum. Two new Garages opened, for which Petrol Licenses have been granted. The premises have been systematically inspected, and the requirements incumbent upon Licensees under the provisions of the Petroleum Acts duly observed. Urinals.—There are eight Public Conveniences in the Borough, two of which are underground. Special men are engaged by the Council to keep them clean. They have been regularly inspected, together with the Public House Urinals. The general condition of the whole may be considered fairly satisfactory, although it has been necessary to call attention to little irregularities. Contagious Diseases of Animals Act.—The prevalence of swine fever in the County of Essex has necessitated the Swine Fever (Regulation of Movement) Order, which came into operation in June, 1908, to remain in force during the year. Under the provisions of the Order it is necessary to obtain 140 Movement Licenses when removing pigs from any district outside the scheduled area and for the purpose of the said Order East Ham has been included as a part of the London Area. It is now possible for pigs to be taken from East Ham (excepting Langdon Crescent) to any part of the Metropolis without a License, or vice versa. During the year a large number of pigs that have been fed in the Borough have been sent to the Midlands for bacon, while many that have been bred in the district have been sold to the London Market. There have been two cases of reported Swine Fever. In consequence of pigs dying, Notices (Form "A") were served on each occasion, but in neither case was the report confirmed by the Veterinary Inspector of the Board of Agriculture. During the year 84 declarations have been made and Licenses issued authorising the removal of nearly 2,000 pigs. Glanders.—There have been five outbreaks of Glanders for the year, affecting nine horses, as compared with three outbreaks, affecting four horses, for the previous year. Of the nine horses killed, five were clinical cases and four contact animals that were Mallein tested and re-acted. Post Mortem examinations were held by the Veterinary Inspector, and the diagnosis in each instance confirmed. Eight of the animals destroyed were poor specimens, while one was a valuable horse. The carcases were cremated in the Council's Destructor, the stables and mews thoroughly disinfected, and the utensils and fodder destroyed. The origin of the disease was the subject of searching enquiry. Compensation was paid in accordance with the provisions of Glanders or Farcy Order, 1907. 141 Sanitary Inspectors' Conference.—The Chairman of the Public Health Committee with myself attended the Annual Conference of the Sanitary Inspectors' Association held in Glasgow from June 28th to July 3rd. The occasion offered many opportunities for obtaining information valuable in the discharge of one's duties. A special report was presented to the Public Health Committee, containing a summary of the papers read together with an account of the visits made to various works of Sanitary interest. The subjects that came before the conference were comprehensive in character and included every aspect of practical sanitary administration. At the close of the conference all those who had devoted several days to its work felt that the time had been profitably spent. Great praise is due to the Glasgow Corporation (whose guests we were) for their most hospitable reception and to the (joint) Conference Committee who organised the proceedings. Summary Proceedings were instituted, and convictions obtained as under :— Date. Address. Offence. Result of Proceedings. Jan. Alverstone Road Non - compliance with Sanitary Notice. Fined 15s. 6d. and 10s. costs. August Pulleyns Avenue Breach of Glanders and Farcy Order (1894) Imprisonment for One Month. August Pulleyns Avenue Breach of Glanders and Farcy Order (1894) 142 Table showing the Localities in which certain Diseases of a Zymotic character occurred during the year 1909. LOCALITY. No. of Occupied Houses. June, 1909. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Phthisis. Albert Road 116 4 2 •• 1 •• 1 Alexandra Road 70 4 1 •• •• •• •• Arthur Road 11 •• •• •• •• •• •• Altmore Avenue 185 5 2 •• 1 •• •• Ashford Road 54 5 1 •• •• •• •• Aintree Avenue 63 1 •• •• •• •• •• Arragon Road 108 3 •• •• 2 •• •• Abbotts Road 64 •• 1 •• 1 •• •• Aldersbrook Lane 1 •• •• •• .. •• •• Aldersbrook Road 26 1 •• •• •• •• •• Albany Road 45 1 1 •• •• •• •• Alverstone Road 155 •• l •• 1 •• •• Ashley Road 26 •• •• •• •• •• •• Ann's Cottages 9 •• •• •• •• •• •• Burnaby Street •• •• •• •• •• •• •• Blenheim Road 53 1 1 •• •• •• •• Brooks Avenue 72 1 •• •• •• •• •• Beaconsfield Street 21 1 •• •• •• •• •• Beckton Road 105 •• 4 •• •• •• 1 Bridge Road 37 •• •• •• •• •• •• Bedford Road 6 •• •• •• •• •• •• Becket Avenue 58 6 •• •• •• •• •• Brighton Road 61 1 •• •• 1 •• •• Bonny Downs Road 59 •• •• 1 1 •• •• Burges Road North 218 10 1 •• 1 •• •• Burges Road South 12 1 2 •• •• •• •• Bartle Avenue 61 2 1 •• •• •• 1 Bendish Road 46 1 .. •• •• •• 1 Boleyn Road 94 2 •• •• 3 •• 1 Barking Road 271 4 2 •• 1 •• 1 Boundary Road 91 1 1 •• •• •• •• Brancaster Road 6 •• •• •• •• •• •• Barrington Road 34 •• •• •• •• •• •• Browning Road 224 •• 2 •• •• •• •• Benson Avenue 72 8 1 •• •• •• •• Bath Road 6 •• •• •• •• •• •• Byron Avenue 227 1 1 •• •• •• •• Berkeley Road 35 •• •• •• •• •• •• Bristol Road 137 4 •• •• •• •• •• Balmoral Road 1 •• •• •• •• •• •• Birchdale Road 72 1 •• •• •• •• •• Clacton Road 3 1 •• •• •• •• •• Cotswold Gardens •• •• •• •• •• •• •• Central Avenue •• •• •• •• •• •• •• Creek Terrace 33 •• •• •• •• •• •• Cyprus Place 37 2 •• •• •• •• •• 143 LOCALITY. No. of Occupied Houses, June, 1909 Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Phthisis. Cameron Street 19 • • • • • • • • • • 1 Church Street 26 1 • • • • 1 • • • • Claremont Street 52 1 • • • • • • • • 1 Calverton Road 62 1 • • • • • • • • • • Charlemont Road 123 5 2 • • 2 • • • • Caulfield Road 175 4 2 • • 1 • • 1 Caledon Road 154 4 2 • • • • • • • • Clements Road 163 3 1 • • • • • • • • Compton Avenue 75 2 1 • • • • • • • • Campbell Road 34 1 • • • • • • • • • • Castle Street 35 4 • • • • • • • • 1 Cleves Road 94 • • • • • • 1 • • 3 Colvin Road 61 2 • • • • 1 • • • • Creighton Avenue 73 • • 1 • • •• • • • • Central Park Road 251 9 4 • • 2 • • • • Charlotte Terrace 3 • • • • • • • • • • • • Chesterford Road 94 1 1 • • 1 • • 1 Carlton Road 48 1 • • • • • • • • • • Clarence Road 25 • • • • • • • • • • • • Cumberland Road 15 • • • • • • • • • • • • Capel Road 66 1 • • • • • • • • • • Carlyle Road 118 2 1 • • 1 • • • • Colchester Avenue 65 3 3 • • • • • • • • Church Road 153 3 • • • • • • • • • • Colston Road 36 6 • • • • • • • • 1 Clifton Road 34 • • 1 • • • • • • • • Coleridge Avenue 67 2 2 • • 1 • • • • Crescent Road 47 • • • • • • • • • • • • Cowper Avenue 25 • • • • • • • • • • • • Cromwell Road 63 2 • • • • • • • • • • Chester Road 68 5 1 • • • • • • • • Claremont Road 58 1 • • • • • • • • • • Denbigh Road 51 2 3 • • • • • • • • Drew Road 5 • • • • • • • • • • 1 Dukes Avenue 3 • • • • • • • • • • • • Dickens Road 51 • • • • • • • • • • 2 Dore Road 29 1 • • • • • • • • • • Dersingham Avenue 166 4 1 • • 1 • • • • Durham Road 93 • • • • • • • • • • • • Dorset Road 71 • • 2 • • 1 • • • • Elizabeth Street 130 2 l • • • • • • • • Eastbourne Road 52 • • • • • • • • • • • • Eversleigh Road 66 • • • • • • • • • • • • Ernald Avenue 62 1 6 • • • • • • • • Empress Avenue 33 • • 2 • • 1 • • • • Eighth Avenue 41 • • • • • • • • • • • • 144 LOCALITY. No. of Occupied Houses, June, 1909. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Phthisis. Elsenham Road 29 3 • • • • 1 • • • • East Avenue 61 5 • • • • 1 • • • • Essex Road 110 3 • • • • • • • • 1 Elizabeth Road 113 .. • • • • 1 • • • • Edith Road 31 • • • • • • • • • • • • Frinton Road 49 • • • • • • • • • • • • Factory Road 1 • • • • • • • • • • • • Francis Street 15 • • • • 1 • • • • 1 Ferndale Street 10 4 • • • • • • • • • • Fabian Street 28 • • • • • • • • • • • • Folkestone Road 22 • • • • • • • • • • • • Friars Road 96 • • • • • • 1 • • • • Florence Road 35 • • • • • • • • • • • • Fifth Avenue 39 3 • • • • • • • • • • Fourth Avenue 120 6 • • • • • • • • 1 First Avenue 143 3 • • • • • • • • • • Forest View Road 26 • • 1 • • • • • • • • Forest Drive 40 4 1 • • 1 • • • • Fry Road 15 • • • • • • • • • • • • Finden Road 19 1 • • • • • • • • • • Grosvenor Gardens 27 • • • • • • • • • • • • Glenister Street 30 3 • • • • • • • • • • Gresham Road • • • • • • • • • • • • • • Gooseley Lane 35 3 1 • • • • • • • • Gillett Avenue 56 • • 3 • • 1 • • • • Grosvenor Road 28 • • • • • • 1 • • • • Greenleaf Road 15 • • • • • • • • • • • • Gainsborough Avenue 44 • • • • • • • • • • • • Grantham Road 140 • • 3 • • 5 • • 2 Gordon Road 10 • • • • • • • • • • • • Gladding Road 12 • • • • • • • • • • • • Gloucester Road 49 • • i • • • • • • • • Greenhill Grove 95 • • • • • • • • • • • • Goldsmith Avenue 111 10 • • • • • • • • • • Gladstone Avenue 92 2 1 • • • • • • • • Green Street 208 13 2 • • 1 • • i Hubert Road • • • • • • • • • • • • • • Hollington Road 60 • • • • • • • • • • • • Haldane Road 19 • • • • i • • • • Henniker Gardens 83 • • • • • • • • • • • • Hatherley Gardens 92 3 • • • • • • • • • • High Street, N. Woolwich 44 1 • • • • • • • • 12 Hall Road 94 5 1 • • • • • • • • Hertford Road 3 • • 1 • • • • • • • • Holloway Road 7 • • • • • • • • • • • • 145 LOCALITY. No. of Occupied Houses, June, 1909. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Pueperal Fever. Phthisis. Holland Road 7 • • • • • • • • • • • • Howard Road 11 • • • • • • • • • • 2 Henry Road 13 • • 1 • • • • • • • • Holme Road 61 • • • • • • • • • • • • Harrow Road 39 • • 1 • • 1 • • • • Heigham Road 130 3 1 • • 1 • • 1 Hartley Avenue 43 1 3 • • • • • • • • Hockley Avenue 69 6 3 • • 1 • • • • High Street South 124 • • 2 • • 1 • • • • Herbert Road 137 6 2 • • 2 • • • • Harcourt Avenue 107 2 2 1 2 • • • • High Street North 408 2 5 • • 1 • • 3 Halley Road 360 11 3 • • 2 • • • • Henderson Road 90 • • 3 • • • • • • • • Hilda Road 28 • • • • • • • • • • • • Hampton Road 29 • • • • • • • • • • • • Johnstone Road 20 • • • • • • • • • • • • Jephson Road 56 1 • • • • • • • • • • Johnson's Place 7 • • • • • • • • • • • • Kennard Street 2 • • • • • • • • • • • • Keppel Road 101 6 • • • • 2 • • • • Kempton Road 150 6 4 • • 1 • • • • Kimberley Avenue 2 • • • • • • • • • • • • Kings Road 36 1 • • • • • • • • • • Katherine Road 383 5 9 1 1 • • • • Kensington Avenue 149 • • 1 • • • • • • • • Lonsdale Avenue 59 • • • • • • • • • • • • Livingstone Street 18 1 • • • • • • • • • • Lichfleld Road 45 1 • • • • • • • • • • Leigh Road 90 1 6 • • • • • • • • Lydeard Road 20 • • • • • • • • • • • • Latimer Avenue 70 1 • • • • • • • • 1 Langdon Road 15 • • • • • • • • • • • • Lloyd Road 40 • • 1 • • 1 • • 1 Lathom Road 166 3 1 • • • • • • • • Langton Avenue 43 1 • • • • 1 • • 1 Ladysmith Avenue 35 3 1 • • • • • • • • Loxford Avenue 52 • • • • • • • • • • 1 Lawrence Road 71 3 4 • • • • • • • • Leader Avenue • • • • • • • • • • • • • • Landseer Avenue 95 1 • • • • 1 • • 1 Little Ilford Lane 136 4 6 1 • • • • 1 Little Ilford Avenue 26 • • • • • • 1 • • • • Lawrence Avenue 204 4 3 • • • • 1 1 Lancaster Road 82 3 1 • • • • • • • • 146 LOCALITY. No. of Occupied Houses. June, 1909. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Phthisis. Lansdowne Road 65 1 1 • • • • • • • • Masterman Road 74 2 • • • • • • • • • • Mitcham Road 51 • • • • 1 • • • • • • Marlow Road 12 1 • • • • 1 • • • • Milk Street 8 • • • • • • • • • • • • Muir Street 13 1 • • • • 1 • • • • Manor Way 13 • • • • • • • • • • • • Montpelier Gardens 56 i • • • • • • • • • • Mountfield Road 75 4 2 • • • • • • • • Market Street 88 10 1 • • 1 • • • • Melbourne Road 106 • • • • • • • • • • 1 Mafeking Avenue 10 • • • • • • • • • • • • Myrtle Road 7 • • i • • • • • • • • Malvern Road 56 • • 2 • • • • • • 1 Macaulay Road 69 i 1 1 • • • • • • Meanley Road 131 8 4 • • • • • • • • Morris Avenue 58 3 3 • • 1 • • • • Michigan Avenue 18 • • • • • • • • • • • • Manor Park Road 52 i 5 • • • • • • • • Merlin Road 27 1 • • • • • • • • • • Monega Road 365 16 2 • • • • • • • • Marlborough Road 54 1 1 • • • • • • • • Milton Avenue 160 • • 1 • • • • • • • • Newland Street 6 • • • • • • • • • • • • Norfolk Road 40 • • • • • • • • • • • • Northfield Road 48 • • 2 • • • • • • • • Nelson Street 37 • • 1 • • • • • • • • Norman Road 22 • • • • • • • • • • • • Napier Road 83 • • 2 • • • • • • • • Navarre Road 25 i • • • • • • • • • • Nigel Road 72 2 2 • • • • • • • • Outram Road 71 • • 1 • • • • • • • • Oakfleld Road 109 4 10 • • 1 • • • • Oregon Avenue 19 • • • • • • • • • • i Osborne Road 39 2 • • • • • • • • • • Pulleyns Avenue 54 1 • • • • • • • • 1 Plevna Street 13 • • • • • • • • • • • • Poulet Road 49 3 • • • • • • • • • • Park Avenue 30 2 • • • • • • • • • • Parr Road 85 1 • • • • 1 • • • • Priory Road 66 3 i • • • • • • • • Parkhurst Road 227 7 3 • • 3 • • • • Plashet Lane 138 7 3 • • 2 • • • • Prestbury Road 71 • • • • • • • • • • • • 147 LOCALITY. No. of Occupied Houses. June, 1909. Scarlet Fever. Diphtheria. Typhoid Fever Ery. sipelas Puerperal Fever Phthisis. Park Road 63 1 • • • • • • • • • • Plashet Grove 158 2 1 • • 1 • • • • Robert Street 31 • • • • • • • • • • • • Roman Road 178 5 5 • • • • • • • • Rancliffe Road 39 • • • • • • • • • • • • Ranelagh Road 79 4 1 • • 1 • • • • Redclyffe Road 43 • • • • • • • • • • 1 Romford Road 464 7 4 • • 1 • • 1 Rabbits Road 11 • • • • • • • • • • • • Rectory Road 44 1 • • • • • • • • • • Reynolds Avenue • • • • • • • • • • • • • • Rosebery Avenue 165 19 1 • • • • • • • • Ruskin Avenue 148 4 • • • • • • • • • • Rixsen Road 30 3 • • • • 1 • • • • Rosedale Road 70 2 1 • • • • • • • • Rothsay Road 49 • • 1 • • • • • • • • Ratcliffe Road 48 5 • • • • • • • • • • Rutland Road 90 • • • • • • 1 • • 1 Station Street 11 • • • • • • • • • • • • Shepstone Street • • • • • • • • • • • • • • Savage Gardens 112 4 • • • • • ••• • • • • Stanley Street 15 2 • • • • • • • • • • Staveley Street 6 • • • • • • • • • • • • Storey Street 51 1 • • • • 1 • • • • Saxon Road 10 • • 4 • • • • • • • • Southchurch Road 25 • • • • • • 1 • • • • Stevenage Road 40 • • • • • • • • • • • • Springfield Road 27 1 • • • • • • • • • • St. Olaves Road 46 • • • • • • • • • • • • St. Albans Avenue 78 • • • • • • • • • • • • Southend Road 80 • • 1 • • • • • • • • Skeffington Road 99 • • 1 • • • • • • • • Shoebury Road 23 • • • • • • • • • • • • Streatfield Avenue 69 7 4 • • • • • • • • Sussex Road 5 • • • • • • • • • • • • St. Bartholomew's Road 38 • • • • • • • • • • 1 Stamford Road 105 • • 7 1 • • • • • • St. John's Road 79 • • 3 • • • • • • • • Spencer Road 41 1 1 • • • • • • • • St. Bernard's Road 91 2 3 • • • • • • • • Seymour Road 86 • • 1 • • 3 • • • • St. Martin's Avenue 51 2 • • • • • • • • • • Station Road 42 • • 1 • • • • • • • • St. Margaret's Road 46 • • • • • • • • • • • • Salisbury Road 65 3 1 • • • • • • • • Second Avenue 147 5 1 • • 1 • • • • 148 LOCALITY. No. of Occupied Houses, June, 1909. Scarlet Fever. Diphtheria. Typhoid rever. Ery sipelas. Puerperal Fever. Phthisis. Selborne Avenue 27 • • • • • • • • • • • • Sixth Avenue 169 7 1 • • • • • • • • Seventh Avenue 115 1 1 • • 1 • • • • Sheringham Avenue 202 3 2 • • 1 • • • • School Road 21 • • • • • • • • • • • • Sebert Road 1 • • • • • • • • • • • • Sheridan Road 81 4 • • • • • • • • • • Sibley Grove 103 1 • • • • • • • • • • Shelley Avenue 143 1 2 • • • • • • • • Stanley Road 51 • • • • • • • • • • • • Swinburne Avenue 21 • • • • • • • • • • • • Shakespeare Crescent 223 • • • • • • • • • • 1 Strone Road 400 11 • • • • • • • • 2 Sherrard Road 395 9 2 • • 1 • • 3 Shrewsbury Road 289 11 2 1 1 • • • • St. Stephen's Road 135 4 3 • • • • • • 1 Shaftesbury Road 47 1 • • • • • • • • • • South Esk Road 197 5 1 • • 1 • • • • St. Dunstan's Road 23 • • • • • • • • • • • • Sandringham Road 31 • • • • • • • • • • • • Stafford Road 108 10 2 • • • • • • • • Tilbury Road 6 • • • • • • 1 • • • • Telham Road 95 • • • • • • • • • • 1 Talbot Road 110 2 • • 1 • • • • • • Thorpe Road 46 • • 4 • • • • • • • • Thackeray Road 62 1 2 • • 4 • • • • Tudor Road 75 2 1 • • 2 • • • • Temple Road 16 3 • • • • • • • • • • The Chase 3 • • • • • • • • • • • • The Warren 26 3 • • • • • • • • • • Toronto Avenue 12 • • • • • • • • • • • • Third Avenue 147 12 1 • • 2 • • 1 Trevelyan Avenue • • • • • • • • • • • • • • Tennyson Avenue 44 • • 3 • • • • • • • • Vicarage Lane 33 • • 1 • • • • • • • • Victoria Avenue 78 6 2 • • • • • • • • Vernon Avenue 7 • • • • • • • • • • • • Welbeck Road • • • • • • • • • • • • • • White Horse Road 23 • • • • • • • • • • • • Wolsey Avenue 89 1 • • • • • • • • • • Wall End Road 23 • • • • • • • • • • Wellstead Road 91 3 • • • • 1 • • 1 Wellington Road 74 • • • • • • • • • • • • Winter Avenue 36 1 4 • • • • • • • • Wakefield Street 150 • • 1 • • • • • • • • 149 LOCALITY. No. of Occupied Houses, June, 1909. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Phthisis. Wilson Road 39 3 • • • • 1 • • • • Worcester Road 50 2 • • • • • • • • • • Wanstead Park Avenue 95 • • • • • • • • • • • • Walton Road 129 4 • • • • • • • • 3 Washington Avenue 46 1 1 • • • • • • • • Whitta Road 46 1 1 • • • • • • • • Wentworth Road 32 • • • • • • • • • • • • Wolferton Road 6 • • • • • • • • • • • • Warwick Road 26 1 • • • • • • • • • • Woodhouse Grove 42 • • .. • • • • • • • • Wordsworth Avenue 54 2 • • 1 • • • • • • Washington Road 9 • • • • • • • • • • • • Waterloo Road 24 • • • • • • • • • • • • Walpole Road 37 • • • • • • • • • • 1 Whitfield Road 45 • • • • • • • • • • • • Whittaker Road 40 1 • • • • • • • • • • Wyndham Road 39 1 • • • • • • • • • • Wortley Road 35 • • • • • • • • • • • • Woodstock Road 59 • • • • • • • • • • • • Windsor Road 63 • • • • • • • • • • • • York Road 98 • • • • • • • • • • • • 150 INDEX. A PAGE Abatement of Nuisances 120 Acts, Bye-laws, and Regulations in force 5 Adenoids 105, 112 Air Temperature 60 Alleys 138 Artizan's Dwellings 55 B Back Passages 138 Bacteriological Laboratory 33, 47 Bakehouses 47 Births 4, 8, 9 Birth-rate 4, 8, 9 Births, Illegitimate 10 Boots of School Children 106 Building Operations 55 Bye-Laws, Employment of Children 109 ,, Streets and Buildings 5 C Cancer 46 Chart, Birth-rate, 20 years 11 „ Death-rate, 20 years 13 „ Relative Fatality 16 Children Act 47 Children, Physically and Mentally Defective 117 Children, Medical Inspection of 91 Clothing of School children 106 151 INDEX—continued. PAGE Complaints 131 Contagious Diseases (Animals) Act 139 Cost of Upkeep of Isolation Hospital 78, 79 Cowsheds 48, 132 Customs and Inland Revenue Act 49 D Dairies 48, 132 Deafness of School Children 113 Deaths 4, 12 Death-rate, Illegitimate Children 10 Death-rate, Corrected 17 Death-rate, General 4 Death-rate, Zymotic 4, 22, 24 Death-rate, Infantile 4 Deaths of Non-Residents 64 et. seq. Deaths, Uncertified 17 Deformities of School Children 109 Diarrhœa 20 Diphtheria 27, 73 „ Special Report 28 Dirty Premises 127 Disinfectant Stations 139 Disinfection 49 Diseases and Defects Remedied no Drainage Work 124,125 E Ear Discharge 106,113 Education Statistics 83 Enteric Fever 34 Erysipelas 35 Employment 44 Employment of Children 109 Employment of Children Bye-laws 109 152 INDEX— continued. F PAGE Factory and Workshop Act 50, 133 Filter Bed 57 Fish Offal Collection 133 Food and Drugs Act 53 Food Inspection 54, 129 Food, Unsound and Diseased 54 G Gipsies 132 Glanders Outbreaks 140 H Hearing of School Children 106, 113 Heart Disease of School Children 108 Hospital Accommodation 77 Hospital Additions 75, 76 Hospital Buildings 75 Hospital Cubicles 75 Hospital Establishment Charges 78 Hospital Patients Expenses 79 Hospital Staff 77 Hospital Staff, Health of 78 House Refuse Removal 135 House to House Inspection 124 Housing 43, 55 I Improvements 59 Infantile Mortality 19 Infectious Diseases 115 Infectious Diseases of School Children 109 Infectious Disease, Attack Rate 24, 26 Inhabited Houses, Number of 4 163 INDEX—continued. PAGE Inhabited House Duty Exemption 49 Inquests 18 Inspection of Borough 120 Isolation Hospital 70 L Laboratory Work 33, 47 Legal Proceedings 141 M Market Places 129 Measles 44 Meat, Diseased 55 Medical Inspection of School Children 91 „ „ Attendance of Parents 97 „ „ Defects 104 „ „ Height and Weight 98 „ „ Method of 92 ,, „ Number Examined 95 „ „ Objections to 97 ,, ,, Scope 95 Mental Capacity of School Children 107 Membranous Croup 74 Milkshops 48 Mortuaries 56, 139 Mumps 45, 117 N Notices Served 121 Notification of Infectious Diseases 23 Notification Rate 23 Nutrition of School Children 108 154 INDEX—continued. O PAGE Open Spaces 57 Outworkers 50 Overcrowding 128 P Parks and Open Spaces 57 Passages 133 Petroleum Licenses 139 Phthisis 36 Population 4, 5, 7, Population, Natural increase of 4 Puerperal Fever 35 Pulmonary Tuberculosis 36 R Rainfall 4 Rateable Value and Rates 5 Refuse Destructor 58 S Sanitary Inspectors' Conference 141 Scarlet Fever 26, 72 Schools, Elementary 85, 137 School Accommodation 87 „ Buildings 87 ,, Cleaning and Method 89 „ Cloakrooms 90 „ Furniture 87 „ Hand Basins 90 „ Heating 88 „ Lighting 88 ,, Playgrounds 91 ,, Sanitary Conveniences 90 155 INDE X—continued. PAGE School Ventilation 87 „ Water Supply 90 Sewerage and Sewage Disposal 52 Slaughter Houses 134 Small Pox 26 Soil and Situation 44 Swine Fever Outbreaks 140 T Table—Average Stay of Hospital Patients 79 „ Bacteriological Examinations 47 „ Births 9, 10 „ Birth-rate 9, 10 „ Boots of School Children 107 ,, Cancer Mortality 46 ,, Clothing of School Children 107 „ Comparative Statistics 4 „ Complaints Received 132 „ Cost of Up-keep of Isolation Hospital 78, 79 „ Deaths 64, 65, 66, 67 „ Death-rates 76 Great Towns 14, 15 ,, Diseases and Defects remedied 111 „ Diphtheria, Attack rate 28 ,, „ Hospital Patients 25 „ „ Mortality 28 ,, „ Notifications 28 „ Drainage Work 125, 126, 127 „ Dust Collection 136 „ Enteric Fever, Attack rate 35 „ „ „ Hospital Patients 25 „ „ „ Mortality 35 „ „ „ Notifications 35 „ Erysipelas Mortality 24 ,, „ Notifications 24 ,, Factories and Workshops 50, 51, 52 „ Food and Drugs Act, Legal Proceedings 53 156 IN DEX—continued. PAGE Table—Height of Children 99, 101 ,, Hospital Staff 77 „ Hospital Patients, Scarlet Fever 71 „ Hospital Patients, Diphtheria 71 „ Hospital Patients, Pulmonary Tuberculosis 63 ,, House to House Inspection 123 „ Infantile Mortality 19, 21, 68 „ Infectious cases removed to Hospital 63 „ „ „ schools 116 Inquests 18 „ Inspections made 120 „ Isolation Hospital 71 „ Legal Proceedings 141 „ Medical Inspection, number of children examined 96 „ Medical Inspection, defects 104 ,, Meteorological Record 60 ,, Notifications 23,24,63 ,, Notification Rate 23, 26 „ Nuisances Discovered 122 „ Other Diseases Treated in Hospital 72, 73, 75 „ Outworkers 50 „ Population 8 ,, Population, Ward 8 „ Pulmonary Tuberculosis, Hospital Patients 25 „ „ „ Notifications 25 ,, „ „ Attack rate 25 „ Rainfall 60 „ Scarlet Fever, Attack rate 24, 25, 26, 27 „ Scarlet Fever Mortality 24 ,, Scarlet Fever Notifications 24, 25 „ Scarlet Fever, Hospital Patients 25 ,, Slaughter Houses 134 „ Statistical Data 5 „ Tuberculous Disease Mortality 36, 38, 40 „ Tuberculosis of Lungs 36,40 „ Typhoid Fever 35 157 IN DEX—continued. PAGE Table—Verminous Condition of School Children 108 ,, Vital Statistics (10 years) 61, 62 ,, Ward Death Rates 17 „ Ward Population 8 „ Weight of Children 99, 102 ,, Zymotic Case Rate 25 ,, Zymotic Mortality 22, 24 Teachers, Medical Examination of 117 Teeth of School Children 105,113 Temperature 60 Temporary Buildings 137 Tonsils, Enlarged 105, 112 Trade Refuse, Removal of 133 Truants 117 Tuberculous Diseases 36 „ ., of School Children 108 Typhoid Fever 34 U Unsound Food 54, 129 Urinals 139 V Verminous condition of School Children 107 Vision of School Children 105, 112 W Ward Death Rates 17 Ward Population 8 Water Supply 58 Whooping Cough 45 Workshops 50, 133 Work of Children out of School hours 109 Work of School Nurse " 109 Z Zymotic Death Rate 4, 21, 22 Zymotic Diseases 23