EAS 049 BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report ON THE Health and Sanitary Condition of the Borough, The Isolation Hospital, Bacteriological Laboratory, AND THE REPORT TO THE EDUCATION COMMITTEE, BY W. BENTON, M.R.C.S., L.R.C P., 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, 1913. South Essex Recorders, Ltd., High Road, Ilford. 1914. To His Worship the Mayor, the Aldermen, and Councillors of the Borough of East Ham. Gentlemen, I beg to present the Annual Report on the state of the Public Health and the record of sanitary work carried out during the year 1913, with reports on the Isolation Hospital and Bacteriological Laboratory. The Report to the Education Committee is also included, together with an account of the work done in connection with the Medical Inspection of School Children and School Clinic. It is gratifying to report that the death-rate is still on the decline, being as low as 10.1, the lowest ever recorded. The Infantile Mortality was also the lowest recorded, viz., G3 per 1,000 births registered. I regret to report during the last few months of the year a considerable increase in the number of Infectious Diseases notified. This was chiefly due, in my opinion, to two causes, viz., the long spell of dry, dusty weather and the increase in number of children who attend Cinematograph Theatres in the convalescent stage of Infectious Diseases or who have had a mild unrecognised attack. In a Borough such as East Ham, with so many Picture Houses, we should have the power to make Bye-Laws and Regulations to control such. The Zymotic death-rate was 0'77. I am, Gentlemen, Your obedient Servant, W. BENTON, Medical Officer of Health. Town Hall, East Ham. March, 1914. EAST HAM CORPORATION. PUBLIC HEALTH COMMITTEE. Alderman J. Brooks, J.P. (Chairman). The Mayor (Alderman 0. R. Anstead, J.P.). The Deputy-Mayor (Councillor AV. T. Howlett, L.T.C.). Alderman E. Edwards, J.P. Councillor G. P. Dean. Alderman C. Northfield, J.P. Councillor J. Evans. Alderman M. Oakes, J.P. Councillor W. C. Ford, J.P. Alderman H. Osborn, J.P. Councillor J. J. Francis. Councillor H. Barfield. Councillor V. R. Oliver. Councillor F. Bradley. Councillor AV. H. Pilgram. Councillor G. Brown, Councillor A. Stokes. CouncillorT. W. Cashman, J.P., C.C. Councillor A. Taylor. Councillor A. Coles. Councillor J. A. Williams. Councillor T. H. Cowper. Councillor A. H. Wiseman, C.C. Councillor H. F. AVitherspoon. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Clerks: G. W. Friend, AV. J. AVorley, R. A. Baskett, F. J. Kendall, A.R.San.I., Chief Clerk. Sanitary Inspectors: M. J. J. Hillyard, M.S.I.A., J. G. Anderson, M.S.I.A., G. D. Lill, M.S.I.A. Shops Act Inspector: W. S. C. Tooby. Health 1 'isitor: Miss B. Kerr, A.R.San.I. School Nurses: Miss H. Forbes and Miss F. Howe. Matron of Isolation Hospital: Miss AA7ilson. Veterinary Inspector: H. J. Parkin, M.R.C.V.S. Chief Sanitary Inspector and Inspector Contagious Diseases (Animals) Act: Joseph G. Banks, A.R.San.I., M.S.I.A. Deputy Medical Officer of Health and Assistant School Medical Officer: AV. A. Berry, M.B., B.S. (Lond.), D.P.H. Medical Officer of Health, School Medical Officer, and Medical Superintendent Isolation Hospital: AV. Benton, M.R.C.S.., L.R.C.P., D.P.H. 5 Summary of Report for 1913. Population, Census 1911, 133,487. Estimated Population to middle of year 1913, 142,467. Persons per acre, 43. Inhabited Houses, Census 1911, 29,289. Births, 3,596. Birth.rate per 1,000 of the estimated population, 25*2. Deaths, 1,437. Death.rate per 1,000 of the estimated population, 10'1. Excess of Births over Deaths, 2,159. Natural increase per 1,000 living, 15" 1. Zymotic Death.rate, 0'77. Infantile Mortality per 1,000 Births, 63. Total Rainfall, 21'35 inches. Borough Isolation Hospital, Roman Road, East Ham. Hospital for Small Pox, Dagenham (Joint Hospital). Water Supply—Metropolitan Water Board. comparative statistics. Annual Rate per 1,000 living. Rate per 1,000 Reg:stered Births. Births. Deaths. Deaths. Zymotic Infant Mortality. Diarrhoea & Enteritis (under 2 years). England and Wales 23.9 13.7 1.20 109 23.4 96 Great Towns ... 25.1 14.3 1 51 117 29.3 London ... 24.5 14.2 1.37 105 27.5 Essex 23.4 11.0 0.83 79 16.8 EAST HAM 25.2 10.1 0.77 63 14.4 6 statistical data. Year. Population. Rateable Value. General District Rate. Poor Rale and Education Rate. *1878 7,500 £33,661 3/- 2/6 1881 10,706 £49,401 3/- 2/6 1891 32,712 £127,721 21- 3/2 1901 96,018 £365,887 3/6 4/9 1911 133,504 £521,698 3/8 6/5 1913 142,467 £552,706 3/9 6/9 * Eist I Iain Local Government District w is constituted on 6th Deceml-er, 187S. ACTS OF PARLIAMENT, BYE-LAWS. AND REGULATIONS IN FORCE IN THE BOROUGH Special Acts. East Ham Improvement Act, 1898. East Ham Improvement Act, 1903. East Ham Improvement Act, 1914. Adopted Acts. Infectious Diseases (Notification) Aot, 1889. do. (Prevention) Act, 1890. Public Health Acts Amendment Act, 1890. Public Baths and Wash-houses Acts. Housing of the Working Classes Act, 1890, Part III. Public Libraries Act, 1892. Notification of Births Act, 1907. Bye-Laws, Regulations, Etc. Public Health (Tuberculosis) Regulations, 1912. Essex (Parasitic Mange) Order, 1909. Cleansing Regulations. Tent, Vans, and similar structures for human habitation. 7 Removal of House Refuse. Regulations under Glanders or Farcy Order, 1894. New Streets and Buildings and alterations to Buildings. East Ham Allotments (Swine Fever) Order, 1906. Common Lodging Houses. Tramways. Public Pleasure Grounds. Employment of Children. Cleansing of Footways and Pavements. Cleansing of Waterclosets, Privies, etc. Nuisances. Good Rule and Government. Dairies, Cowsheds and Milkshops. Slaughter Houses and Bakehouses. Houses let in lodgings or occupied by members of more than one family. Hairdressers' and Barbers' Half Holiday and Early Closing Order. Bootmakers' Half Holiday Order. Butchers' Half Holiday and Early Closing Order. Chemists' and Druggists' Half Holiday Order. Drapers' Half Holiday and Early Closing Order. Fishmongers' Half Holiday Order. Grocers' Half Holiday Order. Milliners' Half Holiday and Closing Order. East Ham is classified as one of the 96 great towns of England and Wales and included within the Greater London area. It is bounded on the north by Wanstead, south by the River Thames, adjoins West Ham on the west, Ilford and Barking on the east. It is well served by railways, viz. : District, Midland, (London, Tilbury and Southend section), and Great Eastern ; also 8 a through service of trams and motor omnibuses, which convey a large number of the population, chiefly consisting of clerks, warehousemen, mechanics, postal and telephone officials to and from the City of London. The industries of the district are the Beckton Works of the Gas Light and Coke Company, Royal Albert Docks, a firm of wholesale druggists, several manufacturers of ladies' wearing apparel, a butter substitute factory, a food factory, monumental masons, artificial flower workshop and office paste works. The district has grown from a population of 96,018 in 1901, to 133,487 at 1911 Census, and is still growing. The building of the new docks (now under construction bv the Port of London Authority) will increase the demand for houses in that part of the Borough. The houses now being erected in the immediate neighbourhood of the Greatfield Estate are very satisfactory, each with a small piece of garden at the rear. The subsoil is sand and gravel with the exception of a portion in the south of the Borough, where it consists of alluvium overlying London clay. The altitude is low, the highest point being about 50 feet above ordnance datum. 9 BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. REPORT of the MEDICAL OFFICER OF HEALTH For the year 1913. VITAL STATISTICS. For administrative purposes the Borough is divided into six Wards, it forms part of the Parliamentary Division of Romford, for Poor Law Purposes is included in the West Ham Union, and is a portion of the Metropolitan Police area. Water is supplied by the Metropolitan Water Board with a constant supply of good quality. The streets are well kept, and a large number of trees planted. The Borough is supplied with gas and electric light, the latter works being owned by the Corporation. POPULATION. The population of the Borough at the Census of 1911 was 133,487. The estimated population, according to the Registrar General, at the middle of 1913, was 142,467. Ward Density of Population. The area of the Borough (including 55 acres of inland water) is 3,326 acres. There are in addition 20 acres of tidal water and 9 of foreshore. The average density is 43 persons per acre, as against 29 per acre in 1901. 10 The density of the population in the different Wards is giver ielow:— Area in acres. Density. Bcckton and North Woolwich Ward 901 17.8 Central Ward—East 622 40.5 Central Ward—West 513 52.3 Manor Park Ward 784 37.7 Plashet Ward—East 283 69.0 Plashet Ward—West 223 112.8 BOROUGH 3326 428 BIRTHS. During the year 3,596 births were registered as against 3,573 in 1912, giving a birth.rate of 25*2 per 1,000 of population. Of these 1,857 were males and 1,739 females, the male births were therefore to the female births in the proportion of 1,067 to 1,000. The birth.rate for England and Wales for the year was 23'9 per thousand, whilst the average rate for the 96 large towns was 25" 1. The rate is still on the decline although the number of children born is in excess of last year. The following table gives the number of births and the birth.rate in the Borough as a whole and in each of the Wards:— Birth! Rale per 1,000 Population. Beckton and North Woolwich Ward 530 33.0 Central Ward—East 637 25.2 Central Ward—West 709 26.4 Manor Park Ward 744 25.1 Plashet Ward—East 441 22.5 Plashet Ward—West 535 21.2 BOROUGH 3596 252 11 The following tables give the population, the number of births and birth.rate for the Borough for the past 10 years, and that of England and Wales for the past 53 years :— Year Population. Nn. of Births Registered. Birth.rate. 1904 107,544 3,717 34.6 1905 111,386 3,687 33.1 1906 115,228 3,656 31.7 1907 119,070 3,690 30.9 1908 122,912 3,534 28.7 1909 126,754 3,518 27.7 1910 130,596 3,455 26.4 1911 134,441 3,466 25.8 1912 138,450 3,573 25.8 1913 142,467 3,596 25.2 England and Wales. 1860—1870 35.2 1871—1880 35'4 1881—1890 32.5 1891—1900 29'9 1901—1910 27'2 1911—1913 24.0 Illegitimate Births. Eighty.three of these were registered, and of these 43 were males and 40 females, which represents 2'3 per cent, of the total births. There were 15 deaths. The death.rate of these illegitimate infants under one year was equal to 181 per 1,000 births registered, whilst the rate for legitimate was GO per 1,000. 12 13 DEATHS. The number of deaths which took place in the Borough during the year was 1,044. Of these, 32 were non.residents of the Borough and can therefore be excluded. Particulars concerning them were sent to the districts to which they belonged. 425 deaths were reported of persons belonging to the Borough which had taken place in various institutions outside the district, viz., 30 in the West Ham Workhouse, 142 in the Union Infirmary, 18 in the London Hospital, 43 in the Essex County Asylum, and 162 in various Hospitals, etc. Including these we have a nett total of 1,437 (756 males and 681 females), which gives a rate of 10'1. The death.rate for England and Wales was 13.7, and for the 96 great towns 14'3. The following table, taken from the annual summary of the Registrar.General, shows the relative death.rate and infant mortality for a few large towns of England and Wales:— Annual Rate per 1,000 Persons Living. Infant Moriality per 1,000 Births Registered. Ilford ... 8.4 69 Ealing 9.0 75 Hornsey 9.5 60 Gillingham 9.6 71 Enfield 9.8 89 East Ham 10.1 63 Eastbourne 10.1 66 Walthamstow 10.1 79 Bournemouth 10.2 63 Southend.on.Sea 10.2 84 Willesden 10.2 83 Ley ton 10.3 83 Wimbledon 10.6 105 Tottenham 11.2 89 Acton 11.4 91 Croydon 11.7 94 Edmonton 11.7 ... 105 14 ] Annual Rate per 1,000 Persons Living. Infant Mortality per 1,000 Births Registered. Hastings 12.9 80 Brighton 138 117 London 14.2 105 Nottingham 14.3 129 Great Yarmouth 14.6 108 West Ham 14.7 106 Birmingham . 14.9 129 Bradford 15.2 127 Leeds . 15.6 133 Correction of Death.Rate for differences of Sex and Age Constitution of Population. The standardizing factor for correction fixed by the Registrar. General at 1911 Census is 1'0536. This rate therefore is 10'62. Ward Death Rates. The number of deaths and the death.rate in each of the Wards are given in the following table:— Ward. No. of Deaths registered. Death.rate. Beckton and North Woolwich. 185 11.5 Central—East . 212 8.4 Central—West 275 10.2 Manor Park 317 10.7 Plashet—East . 167 8.5 Plashet—West . 281 11.1 BOROUGH 1,437 101 Uncertified Deaths. None was recorded in 1912 or 1913. 15 16 17 INQUESTS. 136 INQUESTS WERE HELD. POST-MORTEM EXAMINATION WAS HELD ON 65 CASES The following were the causes certified by Coroners:— Accident 52 Heart Disease 17 Pneumonia 7 Suicide 12 Bronchitis 3 Pulmonary Tuberculosis 1 Want of proper attention at birth 4 Convulsions 2 Cerebral Haemorrhage 14 Found Drowned 4 Status Lymphaticus 4 Murder 1 Snake Bite 1 Other Causes 14 INFANTILE MORTALITY. 226 deaths of Infants under one year of age occurred in the Borough, giving a rate of 63 per 1,000 births registered as against 71 in 1912 and 119 per 1,000 in 1911. The number of infant deaths and the rate per 1,000 births for the past five years were as follows :— Year. Number of Infant Deaths. Rale per 1,000 Births Registered. 1909 334 95 1910 312 90 1911 412 119 1912 256 71 1913 226 63 18 The following table gives the rate of infantile mortality and other allied statistics for each Ward in the Borough for 1913:— Borough. Beckton & North W'lwich. Central East. Central West. Manor Park. Plashet East. Plashet West. Population 142,467 16,048 25,238 26,807 29,602 19,545 25,167 Births 3,596 530 637 709 744 441 535 Birth-rale 252 330 252 264 251 225 21 2 Deaths 1,437 185 212 275 317 167 281 Death-rate 101 115 8-4 102 10-7 8-5 111 Deaths under 1 year 220 39 35 37 58 29 28 Infant Mortality Rate 63 73 55 52 78 66 52 Death - rate per 1,000 births from Diarrheal diseases 14 19 28 15 16 2 Death - rate per 1,000 births from "Wasting diseases " 31 34 20 20 43 45 28 It is pleasing to record a still further decline in the rate ol Infantile Mortality. The rate is the lowest yet recorded, and is one of the lowest in the United Kingdom. The rate has been gradually reduced during the past few years, and as the summer of 1913 was dry (but not unusually hot' we might take some credit in connection with the work carried on by means of the Infant Consultation in this reduction of Infantile Mortality. The Infant Consultations, which are conducted at the old Public Offices, Wakefield Street, continue to attract mothers with their infants. Many of the babies brought to the Clinic were wasting and badly nourished, owing to insufficient knowledge of the mother on the care and feeding of her baby. A large number uld probably have died had not the advice and instruction obtaine at the Clinic 19 been carried out. In most cases the improvement was most marked. Of the total number of infants on the register, viz., 472, only 13 have died, as shown in the Table. The attendance of the mothers at the Clinic proves the need for such, and shows that the mothers are anxious to do their best for their offspring to render them healthy and resistive to disease. Nothing will hurt a mother's feeling so much as to suggest that what she is doing is not the best for her child, but a young mother properly directed in the feeding of her infant will confess what little trouble that child gives. It is pleasing to note the interest taken in the improvement of the general condition of the children by their mothers when brought to be weighed. The Infant Consultations have been carried on up to the present out of voluntary funds obtained by dances, whist drives, etc. The Council have applied to the Local Government Board for permission to make a grant of £25 to the fund, and I have no doubt that this v. ill be forthcoming. In those cases where I thought the infants would benefit by " Virol," this was supplied. £30 were spent on this alone during the year. " Glaxc," £ preparation of dried milk, was also supplied to mothers who Here unable to suckle their babies, either from poverty or ill-health. We give short addresses to the mothers on the care and judicious feeding of infants, emphasising the importance of suckling where possible. No two cases are alike in their ability or disability to digest an artificial food, hence the necessity of a clinic to inspect and advise each case on its merits. The work will thus be seen to be a good one, as it not only preserves but perpetuates valuable life, the necessity for which is the most urgent demand of the country, owing to the everdecreasing birth-rate. It would therefore be unfortunate if the good advice at present given to these mothers, who with praiseworthy zeal bring their children to the Clinic, should be thrown away if funds are not forthcoming to carry out the measures advised. 20 It will thus be seen that the adoption of the Notification of Births Act and the appointment of a Health Visitor has been attended with good results. Miss Kerr visits most of the cases notified, and in those where it is not thought advisable or necessary to call, an instruction card on the care and feeding of infants is sent by post. During the year the Clinic has grown so considerably that we have enlisted some voluntary helpers, and I should like to express my gratitude to Mrs. Athelstan Coles, Mrs. Howe, Mrs. Thomas and Mrs. Roberts for their kind help in weighing the babies and registering their weights. The following is an analysis of the work done at the " Infants' Clinic " :— Number at present on Register ... ... ... 472 Number of 1st year completed since March, 1912 220 FEEDING OF INFANTS UNDER 1 YEAR. Food. IT) CS QJ V-< st* S i-< a ^ p"| r* X o o _• x 73 c rt c £ rt IT O C/3 ^ ~Q <L» 03 Z ^ y> V, < JA ~o) — —* *1= 2 13 5-K > m o S-o1" £ U jg Number .. 367 21 11 12 17 I 1 42 DEFECTS. Umbilical Hernia Inguinal Hernia. Inflamed Hernia. Rickets. Nsevus. 8) 1 1 12 12 DEATHS. Marasmus. Diarrhoea. Bronchitis. Result of Scalds. Inquest. 7 2 3 1 21 ZYMOTIC MOHTALITY. 110 deaths were attributed to the principal Zymotic diseases, as against 129 in 1912. This equals a mortality rate of 0.77 per 1,000 of population. It should be noted that this figure includes 62 deaths from "Diarrhoeal Diseases," such as Infective Enteritis, Diarrhoea not infective, Enteritis, Gastro-Enteritis, Dyspepsia in children under two years of age, Colic, Ulceration of intestines, and Duodenal Ulcer. The following table gives the number of deaths and death-rate from each of the seven chief Zymotic diseases during the past five years:— Zymotic Diseases. 1909 1910 1911 1912 1913 Deaths. Deathrate. Deaths. Deathrate. Deaths. Death rate. Deaths. Deachrate. Deaths. Deathrate. Small Pox Scarlet Fever 15 0.12 3 0.02 2 001 7 0.05 4 0.03 Diphtheria 24 0.19 13 0.09 11 008 9 0.07 16 0.11 Enteric Fever. 5 0.04 5 0.04 8 006 3 0.02 2 0.01 Measles 57 0.45 12 0.09 68 0-50 39 0.28 11 0.08 Whooping Cough 32 0.25 24 0.18 12 009 39 0.28 15 0.10 Diarrhoea 54 0.42 48 0.36 205 1.52 32 0.23 62 0.43 Totals 187 1.47 105 0.80 306 2.28 129 0.93 110 0.77 Deaths and Deathrate from all causes 1412 11.1 1330 10.2 1623 1.21 1474 10.6 1437 1.01 22 The number of deaths from each Zymotic disease and the death-rate per 1,000 of population from all these diseases in each Ward during 1913 is shown in the following Table: — Zymotic Diseases Beck ton and North Woolwich Central East. Central West. Manor Park. Plashet East. Plashet West. Scarlet Fever ... ... 3 1 ... ... Diphtheria 6 2 1 6 l ... Enteric Fever ... 1 ... ... l ... Measles 1 2 3 1 l 3 Whooping Cough 3 5 ... 2 l 4 Diarrhcea 13 20 12 13 3 1 Totals 23 30 19 23 7 8 Rate per 1,000 of population 1.43 1.18 0.73 0.77 0.35 0.32 23 NOTIFIABLE INFECTIOUS DISEASES. 1909 1910 1911 1912 1913 No. of cases notified 966 600 694 684 945 Attack rate per 1,000 of population 7.6 4.6 5.1 4.9 6.6 Notifiable Diseases. Cases notified. Deaths. Attack rate per 1,000 Population, Death-rate per 1,000 Population. Small Pox ... ... ... ... Scarlet Fever 526 4 3.7 0.03 Diphtheria 258 16 1.8 0.11 Enteric Fever 19 2 0.1 0.01 Puerperal Fever 8 1 ... ... Erysipelas 119 ... 0.8 ... Typhus Fever 1 ... ... ... Cerebro-Spinal Meningitis 6 4 ... 0.04 Acute PolioMyelitis 8 4 ... 0.05 Total 945 32 6.6 0.22 NOTIFIABLE DISEASES. CASES NOTIFIED IN EACH WARD BOROUGH. ATTACK RATE PER 1.ooo 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 43 92 79 113 42 157 526 2.6 36 2 9 3.8 21 62 3.7 81 80 85 86 62 75 79 Diphtheria 32 95 57 43 19 12 258 1.9 37 21 1.4 10 05 1.8 59 92 89 86 84 67 85 Enteric Fever 1 13 2 1 2 ... 19 ... 05 ... ... 01 ... 0.1 100 100 100 100 100 ... 100 Puerperal Fever ... 2 ... 4 1 1 8 ... ... ... ... ... ... ... ... 50 ... 50 100 ... 50 Erysipelas 17 19 23 29 12 19 119 1.0 07 0.9 10 06 08 0.8 12 16 13 14 8 10 12 Typhus Fever ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 100 ... ... 100 Cerebro-Spinal Meningitis 1 1 ... 2 1 1 6 ... ... ... ... ... ... ... 100 100 ... 100 ... 50 Polio-Myelitis ... 1 3 1 1 2 8 ... ... ... ... ... ... ... ... 100 33 100 100 50 62 Pulmonary Tuberculosis 49 91 138 102 45 67 492 3.0 3.6 5.1 3.4 2.3 2.6 3.4 43 47 30 47 58 48 43 Other forms of Tuberculosis 26 38 33 51 19 29 196 1.6 1.5 1.2 1.7 1.0 1.1 1.3 8 11 15 16 21 24 15 TABLE SHEWING NOTIFICATIONS OF EACH INFECTIOUS DISEASE FOR THE PAST FIVE YEARS—1909-1913. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Cerebrospinal Fever. Acute Poliomyelitis. Typhus Fever. Totals. Pulmonary Tuberculosis. Other forms of Tuberculosis. 190;* 1910 1911 1912 1913 1909 1910 1911 1912 1913 1909 1910 1911 1912 1913 1909 1910 1911 1912 1913 1909 1910 1911 1912 1913 1912 1913 1912 1913 1913 1909 1910 1911 1912 1913 1909 1910 1911 1912 1913 1913 January 82 21 13 39 39 27 11 12 19 4 I ... ... ... 1 5 7 8 24 15 ... 1 1 2 ... ... ... ... ... 115 40 34 84 59 11 5 11 56 21 February 65 54 29 28 20 34 16 11 13 9 1 ... ... 1 ... 8 7 11 14 5 ... ... 1 1 ... ... ... ... ... 108 77 52 56 35 2 10 6 36 29 59 March 53 35 25 31 30 47 7 10 18 7 ... ... ... ... 1 11 15 12 9 5 ... ... ... ... ... ... 1 ... 111 57 47 58 44 3 3 11 27 38 32 April 57 16 14 35 26 27 10 7 2 1 ... ... 3 1 ... 9 6 7 8 9 ... ... ... 1 ... 1 ... ... ... 93 32 31 46 38 4 4 10 41 45 23 May 42 24 22 30 15 17 14 7 3 6 ... ... ... 1 ... 4 5 7 11 7 ... 1 1 1 1 ... ... ... ... ... 63 44 37 46 29 6 8 40 33 73 15 June 55 26 15 23 27 13 16 10 1 22 ... ... 1 ... 1 12 6 6 9 5 ... ... ... ... ... 1 ... ... ... ... 80 48 32 33 55 3 8 27 26 31 13 July 56 28 25 24 67 19 4 32 2 15 ... 1 ... 1 1 5 6 5 6 15 ... ... ... 1 ... ... ... ... ... ... 80 39 62 34 98 3 11 19 25 41 17 August 26 20 29 16 41 8 8 4 3 15 1 1 4 7 4 9 9 8 15 9 ... 1 ... 1 1 ... 1 ... 1 ... 44 39 45 42 72 6 8 10 18 30 4 September... 35 24 44 48 53 17 11 5 5 28 3 3 12 1 2 7 8 15 9 9 ... ... 2 ... ... ... ... ... 3 ... 62 46 78 63 95 3 4 23 32 41 5 October ... 35 18 58 68 74 •22 20 10 3 50 ... 7 21 1 4 10 9 22 19 14 ... 1 1 1 ... 4 2 3 ... 68 55 111 92 150 7 5 22 17 53 7 November... 25 41 56 55 69 25 11 10 2 61 2 3 12 ... 3 10 16 18 19 15 ... ... 1 1 3 1 ... ... ... ... 62 71 97 77 151 5 6 26 26 36 7 December... 45 22 47 38 65 15 14 3 1 40 2 4 3 ... 2 18 10 15 9 11 ... 2 1 ... ... ... ... ... 1 80 52 68 49 119 5 14 16 28 54 14 Totals 576 829 377 435 526 271 142 121 72 258 10 19 56 13 19 108 104 134 152 119 1 6 6 8 8 2 6 2 8 1 966 600 694 680 945 58 86 •221 365 492 196 25 NOTIFIABLE INFECTIOUS DISEASES. 945 cases of Infectious Disease were notified during the year, as against 684 in the previous year. This number is the largest since 1909, 966 cases being notified in that year and 1,634 in 1908. Of the cases notified, 420 occurred during the last three months of the year. This, in my opinion, was largely due to the long spell of dry, dusty weather in the autumn. It will be seen how Infectious Diseases may be spread when one notices the amount of dust, which may be loaded with micro-organisms, is disturbed by the traffic along the main streets, especially by the motor bus. This dust settles on uncovered fruit, vegetables, meat and other articles of diet which are exposed for sale outside shops. It has also occurred to me, when walking down the streets, that infection may be spread by what is a very common occurrence, viz., food-stuffs, such as rashers of bacon, meat, etc., being freely handled by would-be purchasers who may be carriers of disease. The following Table gives the total Notification Rate per 1,000 of population for each Ward during the past year:— Notification Rate, excluding Tuberculos's. Tuberculesis Notification Rate. Pulmonary. Other forms. Beckton and N. Woolwich Ward .. 5.8 3.0 1.6 Central Ward—East 8.8 3.6 1.5 Central Ward—West 6.1 5.1 1.2 Manor Park Ward 6.5 3.4 1.8 Plashet Ward—East 4.0 2.3 1.0 Plashet Ward—West 7.6 2.6 1.2 Borough 6.6 3.4 1.4 26 In the following table a comparison is given of the Attack Rates per 1,000 of population for the chief diseases in certain large aggregations of population:— Smallpox. Typhus Fever. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Erysipelas. England and Wales ... ... 357 1.89 0.22 0.05 0.63 England ... ... 3.51 1.39 0.22 0.05 0.64 Wales (including Monmouth). ... ... 4.52 1.40 0.23 0.05 0.46 London ... ... 3.89 1.70 0.17 0.08 0.92 County Borough of West Ham. ... ... 4.10 1.48 0.25 0.04 0.85 Administrative County of Essex. ... ... 2.50 1.41 0.17 0.06 0.58 East Ham ... ... 3.69 1.81 0.13 0.06 0.83 Small Pox. No cases of Small Pox were notified during the year. I again feel it my duty to call attention to the increasing proportion of unvaccinated infants in the Borough. Although we have not had cases of the disease for some years, when I hear of a ship having arrived in the Docks in close proximity to the Borough which has had a case of Small Pox on board, I dread to think of the consequences should the disease get a footing. Several ships arrived in the Docks during the year that had had cases of Small Pox on board, and the names and addresses of members of the crew and passengers who reside in the Borough were notified to me by the Port of London Medical Officer, but in no instance, fortunately, did any contact develop the disease. An agreement still exists with West Ham Corporation whereby, by an annual payment calculated on the estimated population of the Borough, we are able, should any cases occur, to send them to their Small Pox Hospital at Dagenham. 27 Scarlet Fever. 526 cases of this disease were notified during the year, as against 435 in 1912. The disease is still of a very mild type, as shown by the small number of four deaths. In a large number of cases the symptoms were so slight that no medical man was called in to see the patient, and the children wen afterwards sent to school, where they were found to be in the desquamating stage. During one month I was notified of several cases in married adults who had children that had no symptoms of the disease and who, in my opinion, contracted the disease by travelling on crowded trains on the District Railway. It will thus be seen how difficult it is to control the spread of the disease. The greatest number of cases was notified in July and the last three months of the year. The death-rate from Scarlet Fever for East Ham was 0'03 per 1,000, for England and Wales 0'06, and for the 96 Great Towns 0.07. The following table gives the number of cases of Scarlet Fever notified, the attack-rate per 1,000 of population, and the case mortality during the past five years:— Year. Population. Cases Notified. Attack rate per 1,000 of Population. Mortality per 100 cases notified. 1909 126,754 576 4.5 2.6 1910 130,590 329 2.5 0.9 1911 134,441 377 2.8 0.5 1912 138,450 435 3.1 1.6 1913 142,467 526 3.6 0.8 28 Diphtheria. 258 cases of this disease were notified during the year, with 16 deaths. 72 cases were notified in 1912, with 9 deaths. The large number of cases occurred as shown in the report printed on the next page, as presented to the Council on 17th November at the request of the Local Government Board. It is interesting to note that the fatality-rate was low. This was owing to early diagnosis on account of the practitioners of the Borough being given free bacteriological examination of all " swabs " from suspected throats, and the early use of Anti-toxin. There is no doubt that a perfectly healthy person may be a " carrier " of the Diphtheria bacillus. This I discovered by visiting three of the schools from which cases were notified, and taking " swabs " from the remainder of the children of a class. I found quite a number of children who apparently were not ill but had evidently been infected by the Diphtheria bacillus. Children who were suffering from Adenoids or Nasal Catarrh appeared more susceptible as " carriers " of the disease. Of the 258 cases notified, 172 were school children, thus showing it was a school infection. All the children who were discovered to be harbouring the Diphtheria bacillus were removed to the Isolation Hospital until bacteriological examination proved them free. This shows the good work done in the Bacteriological Laboratory. I would also point out the danger of the common drinking cup in the schools from a carrier of Diphtheria, and would advise spray jets to be provided instead. 29 The following table gives the number of cases notified, attackrate 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. 1909 126,754 271 2.1 8.86 1910 130,596 142 1.9 9.15 1911 134,441 121 0.9 9.09 1912 138,450 72 0.5 12.5 1913 142,467 258 1.8 6.2 In accordance with the request of the Local Government Board, as expressed in their letter of November 11th, 1913, I presented a report containing information concerning the recent epidemic of Diphtheria in the Borough, together with an account of the measures undertaken to control the spread of the disease, and the number of patients admitted to the Isolation Hospital. " The Borough has been remarkably free from Diphtheria for the last few years, only 72 cases being notified in 1912, as compared with 456 in 1908 and 271 in 1909. " During the quarter ending December 31st, 1912, the number of cases notified in East Ham was 6, as compared with:— Ilford 30 cases. Leyton 31 „ Walthamstow 46 „ " From December 31st, 1912, to June 1st, 1913, 27 cases were notified. In June 22 cases were notified. „ July 15 „ „ „ August 15 „ „ „ September 28 „ „ „ October 50 „ „ " It will thus be seen that the increasing number of cases notified was seasonal, viz., during the dry, dusty weather. 30 The cases occurred in the Wards as below:— Beckton and N. Woolwich. Central East. Central West. Manor Park. Plashet East. Plashet West. July — 8 3 2 2 — August 1 2 5 5 1 1 September 4 7 11 4 1 1 October 7 9 13 11 6 4 "The large number of cases notified and admitted to Hospital during October was due to my visiting the Infants' Department of Hartley Avenue, Fourth Avenue, and Napier Road Schools, and discovering a number of infected contacts by bacteriological examination of " swabs " from throats of these children. " In one case a family of seven children was infected by one of the children having a mild attack of Nasal Diphtheria, who I found still in attendance at school, and had not been medically attended. " It has been impossible to trace the source of the outbreak. The milk supply has been ascertained, and in most cases the families affected have been supplied with milk by different dairymen. " The disease is in most cases of a severe type, and in five cases it was necessary to perform tracheotomy, all of whom recovered. Preventive Methods Undertaken to Control the Spread of the Disease. " On 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 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 31 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 is also ascertained, the proprietor is notified, and the sending of clothes there is prohibited until the premises are free from infection. " Disinfectants in every case are supplied free of charge. " The Council also supply Anti-toxin to all medical practitioners for the treatment of cases in the Borough. Bacteriological Laboratory. " 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. " No case of Diphtheria treated in the Hospital is discharged until examination has proved it to be free from bacilli. The medical practitioners in the Borough adopt this method in connection with cases of this disease which they treat at home. 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. "During the 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. " If the investigation of a case points, as it frequently does, to a school being the source of infection, this is visited, the children are examined, and " swabs " taken from the nose and throat of all suspicious cases. Disinfection of slates, pencils, class-room, 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. 32 Number of Patients Admitted to the Isolation Hospital. " In every case where it was desired or necessary, the patient was removed to the Isolation Hospital. During June 20 out of 22 cases notified were admitted. „ July 13 „ 15 „ „ „ „ August 15 „ 15 „ „ „ „ September 28 „ 28 „ „ „ „ October 44 „ 50 „ „ „ " We have now reached the limit of accommodation, amd should the epidemic continue it will be necessary to discharge the Tuberculosis patients." Enteric Fever. 19 cases of Enteric (Typhoid) Fever were notified during the year. In none of the cases could any probable cause be traced to the Borough. There is no doubt that the chief infection is caused by eating shell-fish, especially mussels. There were only two deaths from this disease, which is exceptionally low. Of the cases notified, 15 were admitted to the Isolation Hospital, six of them from one family. The following table gives the number of cases notified, the attack-rate, and the case mortality from the disease during the past five years:— Year. Population. Cases Notified. Attack rate per 1,000 of Population. Mortality per 100 cases notified. 1909 126,754 10 0.08 50.0 1910 130,596 19 0.14 26.3 1911 134,441 56 0.41 14.3 1912 138,450 13 0.09 23.1 1913 142,467 19 0.13 10.5 33 Erysipelas. 119 cases of Erysipelas were notified, as compared with 152 cases in 1912. One death occurred. I am still of opinion that a large number of cases notified as Erysipelas should not be, such as Alveolar Abscess, Inflamed Eczema, etc. Puerperal Fever. Eight cases of this disease were notified, with one death. This disease is becoming much less common, with the increasing knowledge of hygienic conditions and greater care exercised during the lying-in period and supervision of midwives under the Midwives Act. Cerebro-Spinal Fever and Acute Polio-Myelitis. The Local Government Board desire full particulars of every case of these diseases which has occurred in the Borough during 1913. Six cases of Cerebro-Spinal Fever (Cerebro-Spinal Meningitis) were notified, with four deaths. This disease is very fatal, and there is no doubt that the two recovered cases were not genuine cases of the disease. A child 11 months of age had Infantile Convulsions, which was thought to be Cerebro-Spinal Meningitis at the time notified, and the other recovered case was of the same family as another child notified as Poliomyelitis. Two cases were admitted into the cubicles at the Isolation Hospital, but death occurred a short time after admission. Two other cases were not notified until after death. In no case was it possible to verify the diagnosis by post-mortem examination or bacteriologically by lumbar-puncture, owing to objection by the parents. 34 The following table gives particulars of the cases:— Name. Age. S X. Ward. Notification received. Result. A.M.A. 11 mths. F. Plashet West April 14th Recovered—Diagnosis doubtful. W.D.C. 11 „ F. Manor Park Aug. 26th Died Aug. 22nd. E.H. 3 years F. Manor Park Oct. 2nd Died Oct. 2nd. L.B. 9 „ M. Central East Oct. 13th Died Oct. 14th in Isolation Hospital. E.F. 5 „ F. Central West Oct. 20th Died Oct. 20th, in Isolation Hospital. G.M. 1 yr. 8 mths. M. Manor Park Oct. 27 th Recovered — no Paralysis. Acute Polio-Myelitis. This disease is more commonly known as Infantile Paralysis. Eight cases were notified during the year. Four cases were not notified until after death had taken place. One case notified was a chronic case of two years' standing. The particulars are given in the following table:— Name. Age. Sex. Ward. Notification received. Result. A.M. 5 years M. Manor Park Mar. 19th Recovered with Paralysis of lower extremities. H.J. 1½ M. Plashet West Aug. 29th Recovered — right leg paralysed. *A.B.H. 6 „ F. Central West Sept. 22nd. Died Sept. 20th. *A.J.H. 1 yr. 10mths. M. Central West Sept. 22nd Died Sept. 20th. F.B. 3 years M. Central West Sept. 24th Chronic case of 2 years' standing. A.F. 2½ years. M. Central East Oct. 9th Left arm and right leg paralysed. D.W. 10 „ F. Plashet West Oct. 14th Died Oct. 14th. J.M. 3„ M. Plashet East Oct. 20th Died in London Hospital Oct. 24th. * Same family. Typhus Fever. One case was notified during the year. The patient recovered. I visited the case and all precautions were taken, but the diagnosis was doubtful. Tuberculosis. It is gratifying to note a diminution in the number of deaths from this disease during the year. 168 deaths occurred, as compared with 190 in 1912. 35 The following table shows the number of deaths from Pulmonary Tuberculosis and other forms of the disease:— Pulmonary Tuberculosis (including Phthisis) 124 deaths. (61 males, 63 females) Tuberculosis of the Brain 16 deaths. Acute Miliary Tuberculosis 3 „ Abdominal Tuberculosis 17 „ Other forms of Tuberculosis 8 „ Notification Rales per 1,000 of Population. Pulmonary Tuberculosis Other Tuberculosis. London 5.01 1.55 England, excluding London. 2.32 1.11 Wales and Monmouth 2.19 0.75 East Ham 3.45 1.37 Under the Public Health (Tuberculosis) Regulations, 1912, the total number of notifications received was:— Tuberculosis (Pulmonary) 245 males. 247 females. 492 do. (Other Forms) 196 688 The same measures have been taken to control the disease as in previous years. Every case notified has been visited and advice given as to the precautions necessary to prevent the spread of infection. A card of rules, etc., for consumptives has been given to each patient. Any insanitary conditions discovered are remedied, and the public now realise that every improvement in ventilation, and cleanliness, tends to diminish the risk of infection. 36 On the removal or death of a patient from Tuberculosis the premises and bedding are disinfected, and the landlord advised to re-decorate the rooms. Pocket spittoons are supplied to those patients who are unable to purchase them. Free examination of sputum is undertaken at the Borough Bacteriological Laboratory. The County Council are at present responsible for carrying out the sanatorium provisions of the National Insurance Act. A Tuberculosis Dispensary has been established in the Borough, and the Assistant Tuberculosis Officer attends on three half days per week, but it is found that the work is growing so much that sufficient could be found for an officer to devote the whole of his time to cases of Tuberculosis in the Borough. 24 beds at the Isolation Hospital have been in use during the year for treatment of Pulmonary Tuberculosis. These beds were allotted to the County Council for treatment of cases recommended by the Insurance Committee. In my opinion this is not a satisfactory arrangement, as an Isolation Hospital should be used for the isolation of advanced cases. If it is the duty of a Sanitary Authority to provide beds for the isolation of acute infectious diseases, such as Scarlet Fever, Diphtheria, etc., it is quite as important from a Public Health point of view to provide beds for advanced cases of Tuberculosis, as the patient removed to such an Institution diminishes the great risk of infecting other members of the family. Beds used as such do not materially increase the cost of administration. During the latter months of the year, being pressed for room for Infectious Diseases, we had to curtail the number of cases of Pulmonary Tuberculosis admitted, but plans have been prepared for the erection of a Tuberculosis pavilion. Under the present arrangement, both early and late cases have been treated together, which is most unsatisfactory, as it is most distressing for early cases to see patients who are in the later stage of the disease. The movement for eradication is now 37 national, and much may be expected in the future from the crusade against this disease, but I still express the opinion I have held for a number of years—that the only way to stamp out the disease is by the isolation of advanced cases in Hospitals, where they should be kept, if possible, until death takes place. Much has been done in the past by Poor Law Authorities, but so many patients now object to be sent into the Infirmaries. One of the constant difficulties in dealing with patients after discharge from the sanatoriums is to find them suitable work and sufficient food. In a large number of cases the employers refuse to take them back to their usual work, and the benefit derived from the treatment is soon lost and the disease breaks out afresh. The number of deaths and death-rate from all forms of this disease for the past five years are given in the following table:— Year. Estimated Population. No. of Deaths. Death-rate per 1,000 of Population. 1909 126,754 149 1.18 1910 130,196 163 1.25 1911 134,441 164 1.22 1912 138,450 190 1.37 1913 142,467 168* 1.18 Under the Public Health (Tuberculosis) Regulations, 1912, every form of Tuberculosis has now to be notified. Extract from Local Government Board Circular. December 30th, 1912. Non-Pulmonary Tuberculosis and Child Mortality. " The new Regulations apply to non-pulmonary as well as to pulmonary tuberculosis. More than half the deaths from nonpulmonary tuberculosis are of children under five years of age, and it is probable that a much higher percentage of the total number of persons suffering from non-pulmonary tuberculosis are children of this age. It is hoped that notification of these cases will facilitate the investigation of sources of infection and assist in securing improvement in the conditions under which the children live. 38 Duties of Medical Officers of Health. " Article XI. relates to the duties of a Medical Officer of Health in connection with notification. He is required:— (1) To send to the approximate District all notifications erroneously addressed to him and to inform the notifying practitioner that he has done so ; (2) to keep a register containing the full particulars set out in each notification received by him ; and (3) to send to the Medical Officer of Health for the County after the end of each week a statement of all notifications received during the week. " Article XII. relates to the action to be taken by a Medical Officer of Health upon the receipt of a notification. " Either the Medical Officer of Health himself or an Officer acting under his instructions is required to make such inquiries and take such steps as may be necessary or desirable for investigating the source of infection, for preventing the spread of infection, and for removing conditions favourable to infection. It is contemplated that for the purpose of carrying out the requirements of this Article a visit to the home of the patient will generally be necessary, and the Medical Officer of Health will doubtless avail himself of the co-operation of the notifying practitioner. When a case is notified, inquiry should be made to ascertain the state of health of all other members of the household. " A record should be kept of the enquiries or investigations made in each case into the causes and antecedents of this disease, and of the conclusions reached by the Medical Officer of Health as to the factors which combined to produce it." Paragraph 35 of the Departmental Committee's report states : " Sanitary Authorities are the bodies primarily concerned in the administration of the Public Health Laws of this country, and they must occupy an important position in any general scheme dealing with Tuberculosis. It is they who receive notification of cases of Pulmonary Tuberculosis, and it is the duty of their Medical Officers of Health on receiving notification to take such steps as may appear to them to be necessary or desirable for 39 venting the spread of infection and for removing conditions favourable to infection." Pulmonary Tuberculosis (Tuberculosis of the Lungs). 124 deaths were registered as due to this cause, as compared with 147 in 1912. The number of notifications has increased, owing to its being made compulsory. 492 cases were notified, giving a rate of 3.45, as against 365 in the previous year. The notification-rate for England and Wales was 2.64 per 1,000 of population. The following table gives the number of deaths and death-rate per 1,000 of population from Tuberculosis in the various wards:— Ward. No. of deaths registered. Death-rate. Beckton and North Woolwich 24 1.49 Central Ward—East 19 0.75 Central Ward—West 36 1.34 Manor Park Ward 38 1.28 Plashet Ward—East 13 0.66 Plashet Ward—West 38 1.51 Measles. This disease was not so prevalent as in 1912. 155 cases were reported from the schools. A Measles Register is kept at all the schools, but owing to delay in notification it becomes difficult to check the disease. In several schools it has been done by visiting the class affected, excluding the contacts for a period and disinfection of the class-room. The disease is very infectious during the incubation period, when the child is thought to have a cold. Printed forms giving the symptoms of Measles and directions for isolation and nursing are supplied to Infants' Departments of the schools to be given to parents. 40 11 deaths occurred, as compared with 39 in 1912. The deaths usually in this disease are from such complications as Bronchitis and Pneumonia, and the danger is chiefly to children under the age of 5 years. 10 out of the 11 deaths took place between the ages of 1 and 5 years. Measles is considered by parents a disease that children must have, but this proves the less danger if the disease is postponed later. Whooping Cough. 100 cases were reported by Head Teachers of Schools and Attendance Officers. 15 deaths occurred from the disease, as against 39 in 1912. Of these deaths 12 occurred in children under the age of 2 years. As in Measles, the complications of Bronchitis and Pneumonia are the chief causes of death, often brought about by children being out during the evening in bad weather. A very common sight in the Borough is to see a number of women standing outside public-houses with young infants either in their arms or in a perambulator exposed to the cold night atmosphere. A few prosecutions under the Children Act would have a beneficial effect in preventing this waste of infant life. Mumps. 249 cases were reported. No deaths occurred. Varicella (Chicken Pox). 171 cases were reported. One death was notified as due to this disease in an infant under the age of one year. I visited the case, and from the report given by the medical man an3 mother there was no doubt that the child also had the complication of Broncho-Pneumonia. 41 Anthrax. One case of this disease was notified during the year. I was asked to see the case in consultation with a Medical Practitioner who thought it might be Erysipelas. There was no doubt in my mind of the condition, and the patient, a man who was employed at a brush factory in London, was sent into the London Hospital, where death took place. Cancer. 122 deaths were registered as due to Cancer, as compared with 107 in the previous year. 89 of these deaths were in persons of 45 years of age and upwards. The organs most frequently affected in women were the breast and genital organs, viz. : 14 from the former and 15 from the latter. The number of deaths from Cancer during the past five years is as follows:— Year. Deaths. Death-rate per 1,000 of Population. 1909 102 0.80 1910 93 0.71 1911 105 0.78 1912 107 0.77 1913 122 0.86 42 REPORT ON THE BOROUGH LABORATORY. There has been a considerable increase in the work of the Laboratory during the year 1913. This has been largely owing to the epidemic of Diphtheria that has visited the Borough in common with other areas in and around the London district. Clinical Bacteriology. The following is a summary of the number of specimens examined during the year ending December 31st, 1913:— Table I. Specimens. Positive. Negative. Suspected Diphtheria 980 348 632 Suspected Ringworm 97 74 23 Sputum for suspected Tuberculosis 252 58 194 Suspected Typhoid (Widal) 17 6 11 Examinations were also made of specimens of water from the swimming bath; of urine; and of blood for Anthrax (one specimen which proved to be positive). Amongst the Ringworm cases there was one of Favus, and one of Tricophyton; the remainder consisted of the small " spore " form. There is shown in Table II. the monthly numbers of " Swabs " sent by Doctors, by the School Clinic, and by the Borough Hospital. Under the heading " Clinic " are included 80 swabs taken from the throats of " contact " cases, and 30 from suspicious cases met with during routine medical inspection in the schools, the remaining swabs having been taken from "Clinic" cases proper. 43 Table II. Doctors' Swabs. Clinic Swabs. Hospital Swabs. + - + - + - January 1 10 — 1 — 12 February 5 8 4 3 — 1 March 2 13 1 4 1 6 April — 9 — 1 — 1 May 3 15 1 14 — 4 June 4 11 12 16 4 5 July 7 10 4 23 12 30 August 3 9 7 20 23 23 September 8 32 3 14 22 22 October 19 27 11 20 32 27 November 17 31 29 55 51 51 December 24 36 3 15 35 53 Totals 93 211 75 186 180 235 304 261 415 Results, if positive, arc sent either by telephone or special messenger. Negative results are sent by post. BAKEHOUSES. The bakehouses are visited frequently by the Sanitary Inspectors during their ordinary inspections. The Chief Sanitary Inspector and myself also pay visits of inspection periodically. The number of underground bakehouses in the Borough is ten, and it is chiefly these which require supervision, as it is so difficult to keep them in such a satisfactory condition as those above ground. A number of bakers have installed machinery into their bakehouses, and these are also visited by H.M. Inspector of Factories. 44 COWSHEDS, DAIRIES AND MILKSHOPS. The decrease in the number of cows and cowsheds in the Borough is satisfactory, as it is unnatural for cows to be confined in an ill-ventilated shed in a populous district. It cannot be expected that the same quality of milk can be extracted from such cows as those which are turned out to grass in the open country. Frequent and careful examination of all the premises connected with the supply of milk to the Borough is made, and marked improvement during the past few years has taken place on the insistence of the need for proper ventilation and absolute cleanliness in utensils, etc., used for milk storage. The largest quantity of milk consumed in the Borough is brought in by rail from country districts. The Essex County Council are responsible for superintending the quality and purity under the Food and Drugs Act. For particulars of samples taken and prosecutions see page 48. CUSTOMS AND INLAND REVENUE ACT. 18 certificates were granted to owners of tenements for exemption from Inhabited House Duty where the tenements afforded suitable accommodation for more than one family, and of an annual value of less than £20. DISINFECTION. 1,307 premises were disinfected during the year. The steam disinfector at the Isolation Hospital is used for bedding and other articles requiring disinfection. 45 FACTORY AND WORKSHOP ACT. Annual Report of the Medical Officer of Health for the year 1913, for the Borough of East Ham, on the administration of the Factory & Workshop Act, 1901, in connection with Factories, Workshops, Workplaces & Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors. PREMISES Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 137 — — Workshops (Including Workshop Laundries) 342 6 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) — — — Total 479 6 — 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS. AND WORKPLACES PARTICULARS. Number of Defects. N umber of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of cleanliness 12 12 — — Want of ventilation 8 8 — — Overcrowding 3 3 — — Want of drainage of floors 1 1 — — Other Nuisances 74 74 — — Sanitary accommodation (I W.C. required for 25 persons) insufficient 2 1 — — unsuitable or defective — — — — not separate for sexes 1 — — — 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). 9 9 — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) 4 4 — — Total 114 112 — — 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the Year. Number. Wearing Apparel Manufacturers 129 Bakehouses. 50 Laundries 50 Printers 11 Other Workshops 66 Total number of Workshops on Register 306 5. OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 5 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspector. 4 Other — Underground Bakehouses (s. 101):— Certificates granted during the year Nil In use at the end of the year 10 47 3.—HOME WORK. NATURE OF WORK. Wearing Apparel— OUTWORKERS LIST, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109 & 110 Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions Sending twice in the Year. Sending once in the Year. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices Served. Prosecutions. In- stances. Orders made (S. no). Prosecutions (Sections 109, 110.) Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Work- men. (1) making, etc. 26 13 93 13 7 78 — — — — — — 2 — — (2) cleaning & washing — — — 1 1 1 — — — — — — — — — Household Linen Lace, Lace Curtains and Nets Curtains and Furniture Hangings Furniture & Upholstery Electro plate File making Brass & Brass Articles Fur pulling Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches & Keys Umbrellas, &c. Artificial Flowers Nets, other than wire nets (sieves) Tents & Sacks Racquet & Tennis Balls Paper, &c., Boxes, Paper Bags 2 — 4 — — — — — — — — — — — — Brush Making Pea Picking Feather Sorting Carding &c. of Buttons,&c. Stuffed Toys Basket Making Chocolates & Sweets Cosaques, Xmas Crackers & Xmas Stockings Textile weaving 28 13 97 14 8 79 — — — — — — 2 — — 48 FOOD AND DRUGS ACT. The Essex County Council is the Authority responsible for the administration of this Act in the Borough. The Inspector for the District, Mr. Card, has supplied the following particulars of the work done during the year:— Summary of samples taken in East Ham during the year 1913:— Articles. Number Submitted. Genuine. Adulterated. Milk 191 180 11 Butter 136 130 6 Other Samples 16 15 1 Totals 343 325 18 Thirteen prosecutions were undertaken, one case was withdrawn, the costs, 11s. and 13s. 6d., were ordered to be paid in two cases, and the following fines were inflicted:— In respect of Margarine £2 and costs 5s. Butter £2 „ 12s. Butter £2 „ 10s. Butter £2 „ 10s. Butter £1 „ 10s. Chocolate £1 ,, 17s. Milk £2 „ 10s. Milk £2 „ 10s. Milk £2 „ 12s. Milk £3 „ 10s. Three cautions were given in respect to milk, and three adulterations were of samples taken informally. 49 FOOD INSPECTION. The inspection of food is carried out regularly by the Inspectors and myself. Very little trouble has been experienced, the food sold in the Borough being on the whole very satisfactory. Fishmongers frequently surrender fish, which they consider unfit for sale, for examination at the Public Health Department, and if on examination it is found to be in such condition it is sent to the Destructor at the Sewage Works and a certificate given. The slaughter houses have been frequently visited and advice given for improving conditions. HOUSING ACCOMMODATION. The Borough is well supplied with houses and tenements, and being chiefly of modern construction are in a satisfactory condition. The Council own 220 artisans' dwellings in the Beckton and North Woolwich Ward, which were erected a few years ago. They are double tenements containing two bedrooms, sitting room, scullery with bath, etc., and let at 7s. per week first floor, and 6s. 6d. per week on the ground floor. All newly constructed houses when completed are inspected by the Borough Engineer and the Chief Sanitary Inspector, and if they are constructed in accordance with the building Bye-Laws a certificate is granted by the Borough Engineer certifying their fitness for habitation. The following table gives the building plans approved during the past 17 years:— 50 BUILDING PLANS APPROVED. YEAR. Houses. Alterations and Additions Houses and Shops. Churches and Chapels. Stables and Coach Houses. Schools. Hotels. Banks. Places of Entertainment. Bakehouses. Miscellaneous. totals. 1897 1303 29 61 4 26 2 — — — 2 11 1438 1898 2794 62 125 1 23 1 — — — 3 9 3018 1899 1823 29 128 1 26 1 - — — 2 14 2024 1900 1104 31 62 2 32 2 — l — 3 15 1252 1901 1216 57 141 4 18 2 l l — 4 16 1460 1902 1008 37 58 2 22 2 — l — 2 34 1166 1903 1081 40 36 2 11 1 2 — — 5 24 1202 1904 875 66 45 1 16 1 1 — — 3 14 1022 1905 613 26 30 5 13 1 — — l — 9 698 1906 513 38 58 3 9 — 1 — — — 8 630 1907 631 38 17 1 8 1 2 — — 4 29 731 1908 571 53 10 1 7 3 1 — — 1 7 654 1909 812 38 29 — 8 3 — — 2 — 15 907 1910 653 59 13 2 4 2 l 7 1 16 758 1911 533 34 15 — — 1 1 — 2 — 8 594 1912 453 31 11 — 2 2 — — — — 15 514 1913 266 33 3 — 3 — — — — 2 13 320 Total 16249 701 842 29 228 25 9 4 12 32 257 18388 51 HOUSING, TOWN PLANNING, Etc., ACT, 1909. Systematic inspection of dwelling houses under the above Act has been carried out in the Borough as requested by the Order of the Local Government Board. Article 5 requires the Medical Officer of Health to include in his Annual Report information and particulars as to the inspections made and results. The following is a statement of the work carried out:— (1) Number of houses inspected, 1,703. (2) Number of houses found unfit for habitation, nil. (3) Number of representations to the Local Authority, nil. (4) Number of closing orders made, nil. (5) Number of houses remedied without closing order, 1,199. (6) Number of closing orders determined, nil. (7) Number of houses dealt with under Section 15, nil. (8) Number of houses dealt with under Public Health Act, 1,970. General character of defects:— Dirty walls and ceilings. Drinking-water improperly stored. Defective flushing apparatuses. Soil pans foul and broken. Yards and forecourts improperly paved. OFFENSIVE TRADES. No Licence has been granted for any of these trades to be carried on in the Borough. SMOKE NUISANCE. Fortunately for the health of the Borough we have very few factories, so that few complaints are made of this nuisance. In no instance was it found necessary to take legal proceedings to enforce abatement of the nuisance. PARKS AND OPEN SPACES. The Borough is well supplied with Parks and playing fields. Bowling greens consisting of six rinks have been laid out in Plashet and Central Parks. Cricket and tennis is permitted in certain parts of the Parks during the summer, and football in the winter. During the summer months band music and entertainments are given. 52 The following list gives the situation and acreage of the Public Parks and Open Spaces in the Borough:— Beckton and N. Woolwich Beckton Park About 13 acres. Do. Victoria Gardens 8 Do. Brampton Park 8 „ Central Ward—East Barking Road Recreation Ground 8 „ Do. Vicar age Lane Ground 2 Central Ward—West Central Park 25 „ Manor Park Ward Portion of Wanstead Flats 96 „ Do. Two Recreation Grounds 18 „ Plashet Ward—East Plashet Park 18 „ PUBLIC HOUSES. There are 87 licensed houses, consisting of 25 ale houses, 9 beer houses, and 53 off-licenses. There have been no proceedings against any proprietor during the year. PUBLIC URINALS. There are 12 public conveniences in the Borough for men, but the accommodation for women is still unsatisfactory, and is under consideration by a Special Committee of the Council. The urinals were inspected periodically, and found to be kept in a most satisfactory manner. REFUSE REMOVAL. The collection of house refuse is still carried out by contract once weekly. Where a dust bin is not provided a Notice is served upon the Owner to provide. During the year a number of complaints were received about men causing a nuisance by turning the refuse over in the dust bins on to the forecourt, the police were notified, and the nuisance thus caused has diminished. The refuse is carted to the Destructor which adjoins the Sewage Disposal Works. The Destructor contains 2 units of 3 cells each, Meldrum's "Simplex" front-feed. The heat of combustion is applied to the generation of steam required for the Works. The units are worked alternately, one working whilst the other is being cleared. The weight of refuse destroyed daily is from 50 to 60 tons. 53 RELIEF—POOR LAW. The Clerk of the West Ham Board of Guardians has kindly given the following information:— Amount of Poor Law outdoor relief granted to paupers resident in the Borough of East Ham during the year ended 30th September, 1913, was £9,638. RELIEF WORK. Extract from Report of the Secretary to the Distress Committee:— 1,208 applications for employment were received from October 7th, 1912, to April 30th, 1913, as compared with 1,253 during the Sessions 1910 to 1911. Registration Statistics. From 7th October, 1912, to 30th April, 1913. Number of applications received 1208 (66 under 12 months' residence.) „ persons affected (including 2443 children) 4501 „ cases investigated 1208 „ cases eligible (225 single men) 1141 „ men offered work 765 „ men employed 607 „ men who found work elsewhere 116 „ men who did not respond to notices for work 35 „ men suspended by Committee 7 Stated Causes of Unemployment. Slackness 840 Dispute with employer 8 Pensioned 2 To better position 41 Works stopped 12 Dock Strike 39 Failure of firm 5 Work put out to contract 33 Reduction of staff 10 No work 40 Accidents 10 Not stated 66 Illness 28 Women 55 Discharge 16 1208 Wages expended, £2,227 5s. 5d. 54 SEWAGE DISPOSAL. The drainage of the Borough is on the separate system, the surface water flowing to the water course and the sewage to the Council's own Works and Pumping Station. The sewage at first passes through a screening chamber into a pump-well beneath the engine-house, from which it is pumped into precipitation tanks, where it is treated with lime (9 grains to each gallon of sewage). There are two continuous-flow precipitation tanks. Only one tank is in use at a time during dry weather. The effluent from these tanks is treated with Ferric sulphate in liquid form (4.7 grains per gallon of sewage). It then flows into one of the three quiescent tanks and allowed to rest for two or three hours, and afterwards pumped on to the bacteria beds. The effluent from the bacteria beds flows through a humus basin to allow suspended matter to settle, and is finally discharged into the River Roding, a tidal tributary of the Thames. The effluent is frequently analysed, and no complaints have been made during the year as to its character. It contains very little trade effluent. SWIMMING BATHS. The new covered-in Public Swimming Bath has been much appreciated. The swimming pond is 120 ft. by 40 ft. For a distance of 30 ft. from the shallow end it has a uniform depth of 3 ft., the remainder ranging from 3 ft. to 6 ft. 9 in. at the deep end, the deepest portion being 8 ft. 6 in. over the outlet. There are three shower baths and two foot baths, with urinal and w.c. accommodation. The slipper baths and vapour baths extension are now completed. There is no doubt that besides serving the purpose of instruction in swimming, the bath will promote cleanliness and good health. The open air swimming bath in Central Park is well patronised during the warm weather by those who prefer to swim in the open. WATER SUPPLY. Water is supplied by the Metropolitan Water Board, and is of excellent purity. Most houses in the Borough which had previously storage cisterns now have a supply direct from the main. 55 METEOROLOGICAL RECORD—YEAR 1913. Rain Gauge 5-in. in. diameter, placed 1-foot above ground, 15 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. Mean Temperature of Air. Rainfall. Highest Maximum. Lowest Minimum. Mean of No. of Days on which Rain fell, 0.01 inches and over. Amount collected in inches. Mean rate of fall for Rainy Days. Greatest fall in 24 hours. Date of greatest fall. All Highest. All Lowest. January 53° 24° 46°.4 34°.9 40°.6 17 2.65 0.15 0.45 11th February 55° 26° 46°.3 34°.6 40°.4 10 0.78 0.08 0.25 1st March 58° 28° 51°.6 37°.6 44°.6 21 2.13 0.10 0.31 15th April 64° 30° 54°.5 39°.4 46°.9 18 2.32 0.13 0.44 11th May 83° 37° 64°.8 45°.9 55°.3 9 1.31 0.14 0.46 3rd June 84° 42° 69°.2 49°.3 59°.2 6 0.32 0.05 0.09 6th & 8th July 74° 46° 66°.7 51°.4 59°.0 11 1.80 0.16 0.38 10th August 78° 45° 69°.6 52°.4 61°.0 11 2.01 0.18 0.67 31st September 78° 41° 66°.9 50°.2 58°.5 11 1.37 0.12 0.40 16th October 67° 34° 59°.1 45°.2 52°.3 16 3.60 0.22 0.77 26th November 60° 25° 54°.1 40°.2 47°.1 13 2.30 0.18 0.59 21st December 55° 28° 46°.3 37°.4 41°.8 7 0.76 0.11 0.30 23rd Means and Totals for the Year. 84° 24° 57°.9 43°.2 50°.6 150 21.3 0.13 0.77 Oct. 26th The Rainfall for the Year was 3 inches below, and the number of days on which rain fell 16 below the year 1912, at East Ham. 56 Table Showing Vital Statistics of Whole District during 1913 and Ten Previous Years. Year Population estimated to Middle of each Year. BIRTHS. DEATHS. Number. *Rate. Under 1 Year of age. At all Ages. Total Deaths in Public Institutions in the Borough. Deaths of Non-residents registered in Public Institutions in the Rerough. Deaths of Residents registered in Public Institutions beyond the Borough. Nett Deaths at all Ages belonging to the Borough. Nett Number. Rate per 1,000 Births registered. Total No. registered in the Borough. *Rate. Number. *Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1903 103,702 3,805 36.6 430 113 1,133 10.9 37 ... 132 1,265 12.2 1904 107,544 3,717 34.6 575 154 1,406 13.0 54 2 208 1,612 14.9 1905 111,386 3,687 33.1 478 129 1,308 11.7 53 3 220 1,525 13.7 1906 115,228 3,656 31.7 473 129 1,224 10.6 44 15 271 1,491 12.9 1907 119,070 3,690 30.9 386 105 1,280 10.8 67 12 236 1,504 12.6 1908 122,912 3,534 28.7 368 104 1,181 9.6 101 27 265 1,419 11.5 1909 126,754 3,518 27.7 334 95 1,160 9.1 55 26 278 1,412 11.1 1910 130,596 3,455 26. 4 312 90 1,069 8.2 55 36 297 1,330 10.2 1911 134,441 3,466 25.8 412 119 1,230 9.1 57 17 410 1,623 12.1 1912 138,450 3,573 25.8 256 71 1,048 7.5 53 14 426 1,474 10 .6 Averages for years 1903. 1912. 121,008 3,610 30.1 402 110 1,204 10.0 57 15 274 1,465 12.1 1913 142,467 3,596 25.2 226 63 1,044 7.3 55 18 425 1,437 10.1 * 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 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 1. Vital Statistics of Whole Borough during 1913 and previous Years. YEAR. Population estimated to Middle of each Year. BIRTHS. TOTAL DEATHS REGISTERED IN THE BOROUGH. TRANSFERABLE DEATHS• NETT DEATHS BELONGING TO THE BOROUGH. Uncorrected Number. Nett. of Nonresidents Registered in the Borough. of Residents not Registered in the Borough. Under 1 Year of Age. At all Ages. Number. Hate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1908 122,912 3,512 3,534 28.7 1,181 9.6 27 265 368 104 1,419 11.5 1909 126,754 3,496 3,518 27.7 1,160 9.1 26 278 334 95 1,412 l1.1 1910 130,596 3,411 3,455 26.4 1,069 8.2 36 297 312 90 1,330 10.2 1911 134,441 3,417 3,466 25.8 1,230 9.1 17 410 412 119 1,623 12.1 1912 138,450 3,518 3,573 25.8 1,048 7.5 21 426 256 71 1,474 10.6 1913 142,467 3,536 3,596 25.2 1,044 7.3 32 425 226 63 1,437 10.1 This Table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. * "Transferable Deaths" are deaths of persons having a fixed or usual residence in East Ham, who died in another district. TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1913. Notifiable Disease. Number of Cases Notified. Total Cases Notified in Each Ward. No. of Cases removed to Hospital from each Ward. At all Ages. Under 1 year. 1 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 15 and under 65 years. 65 and upwards. Beckton and North Woolwich 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. Plashet Ward Fast. Plashet Ward West. Total. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous 258 2 67 172 11 6 ... ... 32 95 57 43 19 12 258 19 88 51 37 16 8 219 Erysipelas 119 3 4 8 16 38 35 15 17 19 •23 29 12 19 119 2 3 3 4 1 2 15 Scarlet Fever 526 3 104 354 52 12 1 ... 43 92 79 113 42 157 526 35 74 67 97 26 118 417 Typhus Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... 1 Enteric Fever 19 ... 2 6 4 3 3 1 13 a 1 2 ... 19 1 13 2 1 2 ... 19 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 8 ... ... ... 2 6 ... ... ... 2 ... 4 1 1 8 ... 1, ... 2 1 ... 4 Cerebro-Spinal Meningitis 6 2 2 2 ... ... ... ... 1 1 ... 2 1 1 6 1 1 ... ... 1 ... 3 Poliomyelitis 8 ... 5 3 ... ... ... ... ... 1 3 1 1 2 8 ... 1 1 1 1 1 5 Totals 945 10 184 545 85 66 39 16 94 223 164 194 78 192 945 58 181 124 143 48 129 683 Pulmonary Tuberculosis 492 ... 19 123 88 192 64 6 49 91 138 102 45 67 492 21 43 41 48 26 32 211 Other forms of Tuberculosis 196 2 38 105 32 11 8 ... 26 38 33 51 19 29 196 2 4 5 8 4 7 30 59 TABLE III. Causes of, and Ages at Death during the Year 1913. Excluding deaths of strangers at the Passmore Edwards Hospital and St. Elizabeth's Home, and adding deaths of East Ham residents known to have occurred outside the Borough. Schedule Number. Causes of Death In East Ham during year ending 31st December, 1913. Nett Deaths at the subjoined Ages of " Residents" whether occurring within or without the Borough. Nett Deaths at all Ages of "Residents" belonging to Wards, whether occurring in or beyond the Borough. To»nl Deaths in Public Institutions in the Borough. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and unwards Beckton & N. W'wich. Central East. Central West Manor Park. Plashet East. Plashet West. Residents. Non- Residents. I.—General Diseases. 1 Enteric Fever 2 — — — 1 — 1 — — — 1 — — 1 — 1 — 2 Typhus — — — — — — — — — — — — — — — — — 3 (A B) Relapsing Fever a. Relapsing Fever — — — — — — — — — — — — — — — — — 6. Meliterranean Fever — — — — — — — — — — — — — — — — — 4 Malaria 1 — — — — — 1 — — — 1 — — — — — — 5 Small Pox a Vaccinated — — — — — — — — — — — — — — — — — b. Not vaccinated — — — — — — — — — — — — — — — — — c. Doubtful — — — — — — — — — — — — — — — — — 6 Measles 11 3 3 4 1 — — — — 1 2 3 1 1 3 1 3 7 Scarlet Fever 4 — — 4 — — — — — — — 3 1 — — 3 — 8 Whooping Cough 15 3 9 2 1 — — — — 3 5 — 2 1 4 — — 9 (A) Diphtheria 16 1 3 6 6 — — — — 6 2 1 6 1 — 10 — (B C.) Croup 6. Membranous Laryngitis — — — — — — — — — — — — — — — — — c. Croup — — — — — — — — — — — — — — — — — 10 Influenza 15 — 1 1 1 5 1 4 2 2 2 4 5 1 1 — — 11 Miliary Fever — — — — — — — — — — — — — — — — — 12 Asiatic Cholera — — — — — — — — — — — — — — — — — 13 Cholera Nostras — — — — — — — — — — — — — — — — — 14 Dysentery — — — — — — — — — — — — — — — — — 15 Plague — — — — — — — — — — — — — — — — — 16 Yellow Fever — — — — — — — — — — — — — — — — — 17 Leprosy — — — — — — — — — — — — — — — — — 18 Erysipelas 1 — — — — — 1 — — — — — 1 — — — — 19 (A. R. C. D.) Other Epidemic Diseases a. Mumps — — — — — — — — — — — — — — — — — b. German Measles — — — — — — — — — — — — — — — — — c. Varicella 1 1 — — — — — — — — — 1 — — — — — d. Other Diseases included under 19 — — — — — — — — — — — — — — — — — 20 (A. B. C.) Pyæmia Septicæmia a. Pytemia 1 — — — — — 1 — — — — — — — 1 — — b. Septicæmia — — — — — — — — — — — — — — — — — c. Vaccinia — — — — — — — — — — — — — — — — — 2l Glanders — — — — — — — — — — — — — — — — — 22 Anthrax (Splenic Fever) 1 — — — — — 1 — — — — 1 — — — — — 23 Rabies — — — — — — — — — — — — — — — — — 24 Tetanus — — — — — — — — — — — — — — — — — 25 (A. B.) Mycoses a. Actinomycosis — — — — — — — — — — — — — — — — — b. Other Mycoses — — — — — — — — — — — — — — — — — 26 Pellagra — — — — — — — — — — — — — — — — — 27 Beri-beri — — — — — — — — — — — — — — — — — 28 (A. B.) Pulmonary Tuberculosis (not acute) a. Pulmonary Tuberculosis 88 — 2 1 3 26 40 15 1 15 10 21 13 5 24 11 4 b. Phthisis (not defined as tuberculous) 34 — — — 2 5 14 10 3 2 4 6 12 5 5 — — 29 (A.) Acute Phthisis 2 — — — — — 1 1 — 1 — 1 — — — — — (B.) Acute Miliary Tuberculosis 3 — — — 3 — — — — — — — 3 — — — — 30 Tuberculous Meuinsrit's — — 4 5 4 — — — — 3 — 4 2 1 6 — — 31 (A. B.) Tuberculosis of Peritoneum and Intestin's a. Tabes Mesenterica 2 — — 2 — — — — — 1 1 — — — — — — b. Other Peritoneal and Iutestinal Tubercle 15 3 3 3 1 — 2 3 — — 4 2 5 2 2 — — 32 Tuberculosis of Spinal Column 2 — — — — 2 — — — — — 2 — — — — — 33 Tuberculosis of Joints 1 — — — 1 — — — — — — — 1 — — — — Carried forward 231 13 25 29 24 38 63 33 6 31 32 49 52 18 46 26 7 60 Schedule Number. Causes of Death in East Ham during year ending 31st December, 1913. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the Borough. Nett Deaths at all Apes of "Residents" belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Public Institu tions in the Borough. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. l5 and under 25. 25 and under 45. 45 and under 65. 6b and upward. BecKton & N.W'wirh. Central East Central West. Manor Park. Plashet East. Plashet West. Residents. Non- Residenta. Brought forward 231 13 25 29 24 38 63 33 6 34 32 49 52 18 46 26 7 31 (A.B.C.) Tuberculosis of other Organs a. Lupus — — — — — — — — — — — — — — — — — b. Scrofula — — — — — — — — — — — — — — — — — c. Other Tuberculosis included under 34 4 — — 1 — 1 1 1 — 1 — — 2 — 1 1 — 35 Disseminated Tuberculosis 1 — 1 — — — — — — 1 — — — — — — 1 36 (A.B.) Rickets, Softening of Bones a. Rickets 1 1 — — — — — — — — 1 — — — — — — b. Other forms of Bone Softening — — — — — — — — — — — — — — — — — 37 Syphilis 6 4 — 1 — — 1 — — 1 1 4 — — — — 2 38 (A.B.C.) Other Venereal Diseases a. Soft Chancre — — — — — — — — — — — — — — — — — b. Gonococcus Infection — — — — — — — — — — — — — — — — — c. Purulent Ophthalmia — — — — — — — — — — — — — — — — — 39 Cancer of the Buccal Cavity 5 — — — — — 2 2 1 — 1 — ] 1 2 — — 40 Cancer of the Stomach, Liver, &c. 43 — 1 — — — 3 20 19 4 1 10 5 10 10 — — 41 Cancer of the Peritoneum, Intestines and Rectum 27 — — — — — 1 18 8 2 6 8 4 — 7 1 — 42 Cancer of the Female Genital Organs 15 — — — — — 1 11 3 2 2 3 3 2 3 — — 43 Cancer of the Breast 11 — — — — — 2 7 5 1 2 4 2 1 4 — — 44 Cancer of the Skin 1 — — — — — — — — — — — — — — — — 45 Cancer of other or unspecified Organs 17 — — — 1 — 3 7 6 2 5 6 3 — 1 — — 46 (A. B. C.) Other Tumours (situation undefined) a. Angloma — — — — — — — — — — — — — — — — — b. Adenoma — — — — — — — — — — — — — — — — — c. Other tumours included under 46 1 — — — — — 1 — — — — — — — 1 — — 47 Rheumatic Fever 9 — — — 4 — 3 — — — 9 5 1 1 — — 48 (A. B.) Chronic Rheumatism, Osteo arthritis a. Chronic Rheumatism 3 — — — — — — — 3 1 1 — 1 — — — — b. Osteo-arthritis 3 — — — — — — 1 2 — 1 — 1 — 1 — — 48 (C) Gout 1 — — — — — — — 1 1 — — — — — — — 49 Scurvy — — — — — — — — — — — — — — — — — 50 Diabetes 14 — — — 1 2 2 6 3 3 — 4 3 4 — — — 5l Exophthalmic Goitre — — — — — — — — — — — — — — — — — 52 Add son's Disease 1 — — — — — — 1 — — — — — — 1 — — 53 (A. B.) Leucocythæmia, Lymphadenoma a. Leucocythæmia (Leuchæmia) 1 — — — 1 — — — — — — — — — 1 — — 6. Lymphadenoma — — — — — — — — — — — — — — — — — 54 Anæmia, Chlorosis 6 — — — — 1 3 2 — — — — 2 2 2 — — 55 (A. B. C. D.) Other General Diseases a. Diabetes Insipidus 1 — — — — — — 1 — — 1 — — — — — — 6. Purpura 1 — — — — 1 — — — — — — — — 1 — — c. Haemophilia — — — — — — — — — — — — — — — — — d. Other diseases included under 55 — — — — — — — — — — — — — — — — — 56 Alcoholism (acute or chronic) — — — — — — 1 — — — — — — 1 — — — 57 (A. B.) Chronic lead poisoning a. Occupational lead poisoning — — — — — — — — — — — — — — — — — b. Non-occupational lead poisoning — — — — — — — — — — — — — — — — — 58 Other chronic occupational poisonings — — — — — — — — — — — — — — — — — 59 Other chronic poisonings — — — — — — — — — — — — — — — — — II— Diseases of the Nervous System and of the Organs of Special Sense. 60 Encephalitis 1 — — — — 1 — — — — — — 1 — — — — 61 (A) Cerebro-spinal fever — — — — — — — — — — — — — — — — — 61 (B. C.) Meningitis, other forms or undefined 5. Posterior basal meningitis 2 2 — — — — — — — — — 1 1 — — — — c. Meningitis, other forms 11 1 2 4 3 1 — — — — 4 2 3 — — 2 — Carried forward 422 21 29 35 34 45 87 112 59 55 62 93 89 40 83 30 10 61 Schedule Number. Causes of Death In East Ham during year ending 31st December, 1913. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the Borough. Nett 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 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and unwards. Backton & N. W'wich Central East. Central Went. Manor Park Plashet East. Plashet West. Residents. NonResidents. Brought forward 422 21 29 35 34 15 87 112 59 55 62 93 89 40 83 30 10 62 Locomotor Ataxy 1 — — — — — — 1 — — — 1 — — — — — 63 (a. B.) Other diseases of the spinal cord a. Diseases formerly classed to "Other nervous affections" 6 — — — — — — 3 3 1 — 1 1 1 2 — — b. Other diseases included under 63 7 — 1 1 2 1 1 — 1 — — 4 1 1 1 — — 64 (A. B. C. D. E.) Cerebral haemorrhage, Apoplexy a. Apoplexy 7 — — — — — 1 1 5 — 1 1 — 1 4 — — b. Serous apoplexy and œdema of brain — — — — — — — — — — — — — — — — — c. Cerebral congestion 1 1 — — — — — — — — — — 1 — — — — d. Cerebral atheroma — — — — — — — — — — — — — — — — — e. Cerebral hæmorrhage 53 — — — — 1 3 22 27 9 5 10 11 9 9 — 1 65 Softening of brain 2 — — — — — — 1 1 — — — 9 — — — — 66 (A. B. C.) Paralysis without specified cause a. Hemiplegia 7 — — — — — 1 3 3 1 1 — 1 3 1 — — b. Paraplegia 1 — — — — — 1 — — — 1 — — — — — — c. Other forms of paralysis 2 — — — — — — 1 1 — — — — — 2 — — 67 General paralysis of the insane 9 — — — — — 7 2 — 1 2 1 1 — 1 — — 68 Other forms of mental alienation — — — — — — — — — — — — — — — — — 69 Epilepsy 4 — — — — — 3 — 1 — 1 — 1 2 — — — 70 (A. B.) Convulsions, non-puerperal, 5 years and over a. Epileptiform Convulsions — — — — — — — — — — — — — — — — — b. Others included under 70 — — — — — — — — — — — — — — — — — 71 (A. B.) Infantile convulsions under 5 years a. Convulsions with teething 3 9 — 1 — — — — — — 1 — — 2 — — — b. Other infantile convulsions 4 9 2 — — — — — — 1 — — 1 — 2 — — 72 Chorea — — — — — — — — — — — — — — — — — 73 (A. B.) Hysteria, Neuralgia, Neuritis a. Hysteria, Neuralgia, Sciatica — — — — — — — — — — — — — — — — — b. Neuritis — — — — — — — — — — — — — — — — — 74 (A. B. C. D.) Other diseases of the nervous system a. Idiocy, Imbecility 1 1 — — — — — — — — 1 — — — — — — b. Cretinism — — — — — — — — — — — — — — — — — c. Cerebral tumour — — — — — — — — — — — — — — — — — d. Other diseases included under 74 1 — — — — — 1 — — — 1 — — — — — — 75 Diseases of the eyes and annexa — — — — — — — — — — — — — — — — — 76 (A) Mastoid disease — — — — — — — — — — — — — — — — — 76 (B) Other diseases of the ears 2 — — — — 1 1 — — — — — 1 — 1 — — III—Diseases op the Circulatory System. 77 Pericarditis 1 — — — 1 — — — — — — — 1 — — — — 78 (A.. B. C.) Acute endocarditis a. Acute myocarditis 1 — — — — — 1 — — — — — 1 — — — — b. Infective Endocarditis 2 — — — 1 — — — — 1 — 1 — — — — — c. Other acute endocarditis 8 — — — — 4 9 2 — 1 3 9 1 — 1 — — 79 A. Valvular disease 73 — — — 9 1 18 26 — 11 10 11 20 10 11 — — 79 B. Fatty degeneration of the heart 11 — — — — — 1 4 6 2 1 2 — 1 5 — — 79 C. Other organic disease of the heart 56 1 — — — 4 1 22 28 7 7 12 12 2 16 — — 80 Angina pectoris — — — — — — — — — — — — — — — — — 81 A. Aneurysm 3 — — — — — 2 1 — — 2 — — — 1 — — 81 B. Arterial scleosis 13 — — — — — 1 4 8 1 3 1 1 1 6 — — 81 C. Other diseases of arteries — — — — — — — — — — — — — — — — — 82 A. Cerebral embolism & thrombosis 7 — — — — — — 4 3 1 2 1 3 — — — — 82 B. Other embolism and thrombosis 3 — — — — — 1 2 — — — 1 1 — 1 1 — Carried forward 711 28 32 37 40 57 134 211 172 92 101 142 153 73 147 31 11 62 Schedule Number. Causes of Death in East Ham during year ending 31st December, 1913. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the Borough. Nett Deaths at all Ages of "Residents" belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Pnblic Institutions in the Borough. All A gee. 1 Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Beckton & N. W'wich. Central East. Central Wrst. Manor Park. Plashet East. Plashet West. Residents. Non- Residents. Brought forward 711 28 3? 37 40 57 134 211 172 92 104 142 153 73 147 31 11 83 (A. B. C. D.) Diseases of the veins— (Various, Haemorrhoids, Phlebitis, &c.) a. Phlebitis — — — — — — — — — — — — — — — — — b. Varix — — — — — — — — — — — — — — — — — c. Pylephlebitis — — — — — — — — — — — — — — — — — d. Varicocele — — — — — — — — — — — — — — — — — 84 A . Status Fymphaticus 3 1 — — 2 — — — — — — — 3 — — — — 84 B. Other diseases of the lymphatic system 2 1 — 1 — — — — — — — I 1 — — — — 85 (A. B. C.) Hsemorrhage; other diseases of the circulatory system a. Functional disease of the heart — — — — — — — — — — — — — — — — — b. Epistaxis — — — — — — — — — — — — — — — — — c. Other diseases included under 85 — — — — — — — — — — — — — — — — — IV.—Diseases op the Respiratory System. 8f. Diseases of the nasal fossæ — — — — — — — — — — — — — — — — — 87 (A. B. C.) D.seases of the Larynx a. Laryngi smus stridulus 1 — — 1 — — — — — — — — — — — — — b. Laryngitis 2 — 1 — — — 1 — — — 1 — 1 — — 1 — c. Other diseases of larynx — — — — — — — — — — — — — — — — — 88 D.seases of the thyroid body 1 — — — — — — — — — — — — — — — — 89 (A. B.) Bronchitis & a. Bronchiectasis, Bronchial Catarrh, &c. 2 — — — — — — — 2 1 — 1 — — — — — 90 b. Other bronchitis 112 15 4 — 1 — 4 14 74 12 12 29 18 16 25 — — 91 Broncho-pneumonia 49 17 7 4 3 — 4 4 10 8 7 2 12 4 16 — — 92 A. Lobar pneumonia 22 9 — — 1 3 7 6 3 2 4 7 3 1 5 — — 92 B. Pneumonia—type not stated ?7 1 1 1 1 10 8 5 ? 4 4 9 5 3 — — 93 (A. B.) Pleurisy a. Empyema 1 — — — — 1 — — — 1 — — — — — — — b. Other pleurisy 2 — 2 1 1 — — 94 (A. B. C. D.) Pulmonary congestion, Pulmonary apoplexy a. Pulmonary apoplexy and infarction — — — — — — — — — — — — — — — — — 6. Pulmonary oedema and congestion 5 — — — — — — 2 3 — 1 — 1 — 3 — — c. Hypostatic pneumonia — — — — — — — — — — — — — — — — — d. Collapse of lung, 3 months & over — — — — — — — — — — — — — — — — — 95 Gangrene of the lung — — — — — — — — — — — — — — — — — 96 Asthma 6 — — — — — 2 3 1 — 2 1 — 1 2 — — 97 Pulmonary emphysema 1 — — — — — — — 1 — — — 1 — — — — 98 A. Fibroid disease of lung 1 — — — — — — 1 — — — — — 1 — — — 98 B. Other diseases of the respiratory system 1 — — — — — — — 1 — — — 1 — — — V.—Diseases of the Digestive System. 99 A. Diseases of the teeth and gums — — — — — — — — — — — — — — — — — 99 (B. C. D.) Other diseases of the mouth and annexa b. Thrush, Aphthous Stomatitis — — — — — — — — — — — — — — — — — c. Parotitis — — — — — — — — — — — — — — — — — d. Other diseases included under 99 — — — — — — — — — — — — — — — — — 100 (A. B. C.) Diseases of pharynx, ton si1litis a. Tonsillitis 2 — — 1 — — — 1 — — — — — 1 1 — — b. Ludwige's Angine — — — — — — — — — — — — — — — — — c. Other diseases of the pharynx 1 — — — 1 — — — — — 1 — — — — — — Carried forward 958 64 15 45 49 62 161 251 272 118 136 187 203 104 201 32 11 63 Schedule Number. Causes of Death in East 11am during year ending 31st December, 1913. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the Borough. Nett Deaths at all Ages of " Residents " belonging to Wards, whether occurring in or beyond the Boruugh. Total Deaths in Public Institutions in the Borough. All Ages. 1 Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and unwards. N W'wich. Central East. Central West. Manor Park. Plashet East. Plashet West. Residents, NonResi dents Brought forward 952 61 45 45 19 62 161 251 272 118 136 187 203 101 201 32 11 101 Diseases of oesophagus — — — — — — — — — — — — — — — — — 102 Perforating ulcer of stomach 10 — — — — — 2 4 4 1 1 2 9 1 3 — — 103 A. Inflammation of stomach 6 5 — — — — 1 — — 1 — 1 9 1 1 — — 103 B. Other diseases of the stomach 2 — — — — 1 — 1 — — — — 1 — 1 — — 104 & (A. B. C. D. E. F. G. H. Diarrhœa and enteritis 105 a. Infective enteritis 23 15 7 1 — — — — — 6 7 4 6 — — — — b. Diarrhoea, not returned as infective 8 6 1 — — — — 1 — 2 3 1 2 — — — — c. Enteritis, not returned as infective 9 5 3 — — — — 1 — — 2 4 2 1 — — 2 d. Gastro-enteritis, not returned as infective 16 11 4 — — — 1 — — 3 7 3 3 — — — — e. Dyspepsia, under 2 years f. Colic 1 — — — — — — 1 — — — — — — 1 — — g. Ulceration of intestines 1 — — — — — — — 1 1— — — — — — — — h. Duodenal ulcer 4 — — — — — 3 1 — 1 1 — — 2 — — — 106 Ankylostomiasis — — — — — — — — — — — — — — — — — 107 Other intestinal parasites 1 — — 1 — — — — — 1 — — — — — — — 108 Appendicitis 11 — — 1 3 9 — 1 1 1 2 1 4 — 3 — — 109 A. Hernia 3 — — — — — — 2 1 — — — 1 1 1 — — 109 B. Intestinal obstruction 5 I — — — 1 — 1 9 1 — — — 3 1 — — 110 Other diseases of the intestines 2 — — — — — — 1 1 — — 1 — — 1 — — 111 Acute yellow atrophy of Liver — — — — — — — — — — — — — — — — — 112 Hydatid of liver — — — — — — — — — — — — — — — — — 113 (A. B. C.) Cirrhosis of the liver a. Cirrhosis of the liver, not re turned as alcoholic 16 — — — — — 1 14 1 — 3 2 6 1 4 — — b. Cirrhosis of the liver, returned as alcoholic — — — — — — — — — — — — — — — — — c. Diseases formerly classed to "Other diseases of Liver and gall bladder " — — — — — — — — — — — — — — — — — 114 Biliary calculi 2 — — — — — — — 2 — — — 1 — 1 — — 115 Other diseases of the liver 3 — — — — — — 2 1 1 1 1 — — — — — 116 (A. B.) Diseases of the spleen a. Infarction of spleen — — — — — — — — — — — — — — — — — b. Other diseases of the spleen — — — — — — — — — — — — — — — — — 117 Peritonitis, cause unstated 3 — — — 2 1 — — — 1 — — 2 — — — 118 (A. B.) Other diseases of the a. Abdominal abscess, Sub-phrenic — — — — — — — — — — — — — — — — — 6. Other diseases included under 118 — — — — — — — — — — — — — — — — — VI.—Non-vrnereal Diseases of the Genito-Urinary System and Annexa. 119 Acute nephritis 5 — — — — 1 2 2 — — 1 9 — — 2 — — 120 (A. B.) Bright's disease a. Bright's disease as in 1901 list 41 — — — 1 1 8 20 11 3 7 7 5 7 12 — — b. Nephritis (unqualified), 10 years and over, and Uraemia 4 — — — — 1 2 1 — — 1 1 — 1 1 — — 121 Chyluria — — — — — — — — — — — — — — — — — 122 (A. B. C. D.) Other diseases of the kidney and annexa a. Abscess of kidney 1 — — — — — — 1 — — 1 — — — — — — b. Cystic disease — — — — — — — — — — — — — — — — — c. Suppression of urine — — — — — — — — — — — — — — — — — d. Other diseases included under 122 1 — — — — — 1 — — 1 — — — — — — — Carried forward 1130 107 60 48 55 70 185 308 297 112 173 217 240 122 236 32 13 64 Schedule Number. Causes of Death In East Ham during year ending 31st December, 1913. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the Borough. Nett Deaths at al1 Ages of " Residents " belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Public Institutions in the Borouch. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Berkton & N. W'wich. Central East. Central West. Manor Park. P'ashet East. Plashet West. Residents. Non- Residents. Brought forward 1130 107 60 48 55 70 185 208 207 142 173 917 240 199 236 39 13 123 Calcum of the urinary passages 2 — — — — — — 2 — — — 1 — — 1 — — 124 Diseases of the bladder 3 — — — — — — — 3 — — 1 2 — — — — 125 (A. B.) Diseases of the urethra, Urinary abscess, &c. a. Penineal abscess — — — — — — — — — — — — — — — — — b. Other diseases of urethra, &c. 1 — — — — — — — 1 — — 1 — — — — — 126 Diseases of the prostate 5 — — — — — — — 5 1 1 — — 3 — — — 127 Non-veuerea diseases of male genital organs — — — — — — — — — — — — — — — — — 128 (A. B.) Uterine haemorrhage (non puerperal) a. Menorrhagia — — — — — — — — — — — — — — — — — b. Other uterine haemorrhage — — — — — — — — — — — — — — — — — 129 Uterine tumour (non-cancerous) 1 — — — — — — l — — — — 1 — — — — 130 (A. B.) Other diseases of the uterus a. Disorders of menstruation, except menorrhagia 1 — — — — — 1 — — — — 1 — — — — — b. Other diseases included under 130 — — — — — — — — — — — — — — — — — 131 — — — — — — — — — — — — — — — — — 132 (A. B.) Other diseases of the female genital organs a. Diseases of ovary, excluding ovarian tumour — — — — — — — — — — — — — — — — — 6. Other diseases included under 132 — — — — — — — — — — — — — — — — — 133 Non-puerperal diseases of the breast (non-cancerous) — — — — — — — — — — — — — — — — — VII.—The Puerperal State. 131 (A.B.C.D.E.) Accidents of pregnancy a. Abortion — — — — — — — — — — — — — — — — — b. Haemorrhage of pregnancy — — — — — — — — — — — — — — — — — c. Uncontrollable vomiting — — — — — — — — — — — — — — — — — d. Ectopic gestation — — — — — — — — — — — — — — — — — e. Other accidents of pregnancy — — — — — — — — — — — — — — — — — 135 Puerperal haemorrhage 2 — — — — — 2 — — — 1 — 1 — — — — 136 Other accidents of childbirth 4 — — — — — 4 — — 1 — — 1 — 2 — — 137 Puerperal fever 1 — — — — — 1 — — — — — — — 1 — — 138 (A. B. C.) Puerperal albuminuria and convulsions a. Puerperal nephritis and uræmia — — — — — — — — — — — — — — — — — b. Puerperal albuminuria and Bright's disease — — — — — — — — — — — — — — — — — c. Puerperal convulsions 1 — — — — — 1 — — 1 — — — — — — — 139 (A. B.) Puerperal phlegmasia alba dolens, embolism, and sudden death o. Puerperal phlegmasia, alba dolens and phlebitis — — — — — — — — — — — — — — — — — 6. Puerperal embolism and sudden death — — — — — — — — — — — — — — — — — 140 Puerperal insanity — — — — — — — — — — — — — — — — — 141 Puerperal diseases of the breast — — — — — — — — — — — — — — — — — VIII.—Diseases of the Skin and of the Cellular Tissue. 142 A. Senile Gangrene 5 — — — — — — — 5 1 — — 2 1 1 — — 142 (B. C.D.) Gangrene, other types b. Noma Gangrene of mouth — — — — — — — — — — — — — — — — — c. Noma pudendi — — — — — — — — — — — — — — — — — d. Other gangrene — — — — — — — — — — — — — — — — — Carried forward 1156 107 60 48 55 70 194 311 311 116 175 221 247 126 241 32 13 65 Schedule Number. Causes of Death in East Ham during year ending 31st December, 1913. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the Borough. Nett Deaths at all Ages of " Residents " belonging to W ards, whether occurring in or beyond the Borough. Total Deaths in Public Institu- tions in the Borough All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45 45 and under 65. 65 and upwards. Beckton & N. W'wich. Central East Central West. Manor Park Hiasnet Hast. Plashet West. Residents. Non- Residents. Brought forward 1156 107 60 18 55 70 194 311 311 146 175 221 217 126 241 32 13 143 Carbuncle, Boil — — — — — — — — — — — — — — — — — 144 (A. B.) Phlegmon, acute abscess a. Phlegmon 1 — — — — — — — 1 — — 1 — — — — — b. Acute abscess — — — — — — — — — — — — — — — — — 145 (A. B. C. D.) Diseases of the integumentary system a. Ulcer, Bedsore — — — — — — — — — — — — — — — — — 6. Eczema 2 2 — — — — — — — — — — 1 1 — — — c. Pemphigus 2 2 — — — — — — — — — — 1 1 — — — d. Other diseases of integumentary system 1 1 — — — — — — — — — 1 — — — — — IX.-Diseases of the Bones and of the Organs of Locomotion. 146 Diseases of the bones 2 1 — — — — — — 1 — — — 2 — — — — 147 Diseases of the joints — — — — — — — — — — — — — — — — — 148 Amputations — — — — — — — — — — — — — — — — — 149 Other diseases of locomotor system — — — — — — — — — — — — — — — — — X.—Malformations. 150 (A. B. C. D.) Congenital malformations a. Congenital hydrocephalus 1 1 — — — — — — — — 1 — — — — — — b. Phimosis — — — — — — — — — — — — — — — — — c. Congenital malformation of heart 5 5 — — — — — — — 1 — — — 1 3 — — d. Other congenital malformations 6 6 — — — — — — — — — 1 2 2 1 — — XI.—Diseases of Early Infancy. 151 A. Premature birth 46 46 — — — — — — — 12 8 5 10 8 3 — 1 151 (B.C.D.E.) Infantile debility, Icterus and Sclerema b. Infantile atrophy, debility and marasmus 41 11 3 — — — — — — 2 3 7 19 7 6 — 4 c. Icterus neonatorum 3 3 — — — — — — — 1 1 1 — — — d. Sclerema and œdema neona torum — — — — — — — — — — — — — — — — — e. Want of breast milk 1 1 — — — — — — — — — — 1 — — — — 152 (A.B.C.D.) Other diseases peculiar to early infancy a. Diseases of umbilicus, &c. 1 1 — — — — — — — 1 — — — — — — — b. Atelectasis 1 1 — — — — — — — — — — — — 1 — — c. Injuries at birth 1 1 — — — — — — — — 1 — — — — — — d. Cyanosis neonatorum — — — — — — — — — — — — — — — — — 153 Lack of care 3 3 — — — — — — — 1 — — — 1 1 — — XII.—Old Age. 154 (A. B.) Old age a. Senile dementia 11 — — — — — _ — 11 — 2 4 9 3 — — — b. Senile decay 74 — — — — — — 3 71 6 12 17 15 5 19 — — XIII.— Affections produced by External Causes. 155 Suicide by poison 3 — — — — 1 2 — — — 1 — 2 — — — — 156 Suicide by asphyxia — — — — — — — — — — — — — — — — — 157 Suicide by hanging or strangulation 2 — — — — — 1 — 1 — — — 1 — — — _ 158 Suicide by drowning 2 — — — — — 1 — 1 — — 9 — — — — 159 Suicide by firearms 1 — — — — 1 — — — — — 1 — — — — — Carried forward 1369 222 63 18 55 72 198 314 397 170 203 262 303 156 275 32 18 66 Schedule Number. Cairses of Death in East Ham during year ending 3lst December, 1913. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the Borough. Nett Deaths at all Ages of " Residents" belonging to Wards, whether occurring in or beyond the Borough. Total Deaths in Public Institutions in the Borouah. All Ages. Under 1. 1 arid under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 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 1369 222 63 48 55 72 198 314 397 170 203 262 303 156 275 32 18 160 Suicide by cutting and piercing instruments 3 — — — — — 2 1 — — 2 — — 1 — — — 161 Suicide from jumping from high place — — — — — — — — — — — — — — — — — 162 Suicide by crushing — — — — — — — — — — — — — — — — — 163 Other suicides — — — — — — — — — — — — — — — — — 161 Poisoning by food — — — — — — — — — — — — — — — — — 165 Other acute poisonings 1 — — — — — — 1 — — — — 1 — — — — 166 Conflagration — — — — — — — — — — — — — — — — — 167 Burns, conflagration excepted 6 — — 2 1 1 1 — 1 2 1 2 1 — — 1 _ 168 Absorption of deleterious gases, (con flagration excepted) 2 1 — — — — — 1 — 1 — — — 1 — — — 169 Accidental drowning 7 — — — — — 4 3 — 2 — 1 3 — 1 — — 170 Injury by firearms 1 — — — — 1 — — — — — — — — l 1 — 171 Injury by cutting or piercing instruments — — — — — — — — — — — — — — — — — 172 Injury by fall 19 — 1 — 1 — 6 5 6 4 3 7 9 3 — 2 — 173 Injury in mines and quarries — — — — — — — — — — — — — — — — — 174 Injury by Machines 1 — — — — — — — 1 — — — — — 1 — — 175 Injury by other crushing (vehicles railways, Landslides, &c.) 16 — — — 2 5 5 2 2 2 1 2 — 5 1 1 — 176 Injury by animals — — — — — — — — — — — — — — — — — 177 Starvation — — — — — — — — — — — — — — — — — 178 Excessive cold 1 — — — — — — 1 — 1 — — — — — — — 179 Effects of heat — — — — — — — — — — — — — — — — — 180 Lightning — — — — — — — — — — — — — — — — — 181 Electricity (lightning excepted) — — — — — — — — — — — — — — — — — 182 Homicide by firearms — — — — — — — — — — — — — — — — — 183 Homicide by cutting and piercing instruments — — — — — — — — — — — — — — — — — 184 Homicide by other means 1 1 — — — — — — — — — — 1 — — — — 185 186 Fractures, cause not specified Other violence 1 2 — 1 — — — — — — — — — — — 1 1 — — — — 1 — — — — 1 — — 1 — — — — XIV.—Ill-defined Causes. 187 Dropsy — — — — — — — — — — — — — — — — — 188 A. Syncope, aged 1 year and under 70 1 — — — — — — 1 — 1 — — — — — — — 188 B. Sudden death, not otherwise defined — — — — — — — — — — — — — — — — — 189 A. Heart failure, aged 1 year and 2 — — — — — — — — — — 1 — — 1 — — 189 (B. C. D. E.) Other ill-defined causes b. Atrophy, dehility, marasmus (aged 1 year and under 70) — — — — — — — — — — — — — — — — — c. Teething 2 1 1 — — — — — — 1 1 — — — — — — d. Pyrexia — — — — — — — — — — — — — — — — — e. OtheT ill-defined deaths 1 — — — — — 1 — — 1 — — — — — — — 189 F. Cause not specified 1 — — — — — 1 — — — — — 1 — — — — Total 1137 226 65 50 59 79 218 332 408 185 212 275 317 167 281 37 18 153/4 % 4½ % 3½ % 4 % 5½ % 15¼ % 23 % 28½ % The total Institution Deaths include those of strangers occurring within the Borough Deaths of such strangers occurring at the Passmore Edwards hospital or Sr. Elizabeth's Home are excluded from all other columns of the table. 67 TABLE IV. INFANT MORTALITY. Nett Deaths from stated Causes at various Ages under 1 Year of Age. Cause of Death. Under 1 week. 1-2 weeks. weeks. 3-4 weeks. Total undrr 4 weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. All Causes— Certified 63 11 14 6 94 43 38 23 28 226 Uncertified ... ... ... ... ... ... ... ... ... ... Small Pox . ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... 1 ... 1 Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 2 1 ... 3 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 2 ... 2 Abdominal Tuberculosis. ... ... ... ... ... ... 2 ... ... 2 Other Tuberculous Diseases ... ... ... ... ... 1 ... ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 1 1 3 Convulsions ... 1 1 ... 2 1 ... l ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 ... 1 4 7 l 2 15 Pneumonia (all forms) ... ... ... ... ... 5 3 3 8 19 Diarrhœa ... ... ... ... ... 4 5 2 4 15 Enteritis 2 ... ... ... 2 2 7 7 4 22 Gastritis ... ... 1 ... 1 ... 2 ... 2 5 Syphilis 1 ... ... 2 3 1 ... ... ... 4 Rickets ... ... ... ... ... 1 ... ... ... 1 Suffocation (overlying) ... ... ... ... ... ... 1 ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 9 3 ... 1 13 1 2 1 ... 17 Premature Birth 36 2 2 1 41 3 2 ... ... 46 Atrophy, Debility and Marasmus 9 4 6 2 21 15 1 1 ... 41 Other Causes 5 1 3 ... 9 5 3 2 ... 21 63 11 14 6 94 43 38 23 28 226 Nett Births in the year legitimate illegitimate 3513 83 Nett Deaths in the year of legitimate infants illegitimate infants 212 14 68 APPENDIX I. Report on the Borough Isolation Hospital. HOSPITAL SUB-COMMITTEE. Alderman J. Brooks, J.P. (Chairman). The Mayor (Alderman O. R. Anstead, J.P.). Deputy Mayor (Councillor W. T. Howlett, L T.C.). Councillor F. Bradley. „ G. Brown. ,, T. H. Cowper. ,, A. Taylor. ,, A. H. Wiseman. 69 Isolation Hospital, Roman Road. The total admissions for the year were 884, as compared with 564 in the previous year. The results have been very satisfactory, as shown below :— Patients admitted. Cases. Deaths. Scarlet Fever 448 3 Diphtheria 237 9 Enteric (Typhoid) Fever 15 1 Pulmonary Tuberculosis 126 9 Various Cases in Cubicles 58 4 During the early part of the year the accommodation at the Hospital was ample, but during the latter part, owing to the epidemic of Diphtheria, the number of beds was insufficient to supply the demand for admission. In October, on visiting three schools I discovered a number of "contacts "or " carriers," and I felt it my duty to admit them to prevent the spread of infection. To accommodate so large a number I could not give them the amount of air space required by the Local Government Board regulations, viz., 2,000 cubic feet per patient, and was accused of overcrowding, but had these cases been kept out it would have been impossible to have kept the epidemic within bounds. In a great number of cases the patients could not afford to have a medical man in attendance, and had they been kept at home we should have had a much larger outbreak and a greater number of deaths. 24 beds have been used for the treatment of Tuberculosis patients under the National Insurance Act. 70 Cases have been sent into the Hospital having double infection such as Scarlet Fever and Whooping Cough, Mumps, or Chicken Pox, but in every case the diagnosis has been made before admission into the Ward, and these cases have been isolated in the cubicles without any cross infection taking place. It is still gratifying to note the improved condition of the children admitted as regards cleanliness due to medical inspection of school children. The work at the Hospital takes up a considerable amount of my time, which might be spent in out-door Public Health work, especially since the Tuberculosis Patients have been under treatment. I visit the Hospital at least once a day, and at other times when necessary or telephoned for, but the fact that there is no Resident Medical Officer involves a large amount of responsibility on the Matron and Nursing Staff. The following report, dated 5th January, 1914, was issued to the Committee on the further provision of accommodation at the Hospital, and a sub-committee has been appointed to consider the same :— "Until the recent outbreak of Diphtheria in the Borough the accommodation at the Borough Isolation Hospital has been sufficient and for the past 18 months the Local Government Board have been pleased to sanction the use of 24 beds for treatment oi Tuberculosis under the National Insurance Act. "As the Local Government Board point out in their letter of December 4th, 1913, the number of beds available at the Hospital on the basis of their standard of 2,000 cubic feet of air space per bed is only 76, whereas taken on the estimated population of 142,000 we should have at the rate of 1 per 1,000, viz. : 142 beds for Infectious Disease. "The Board in their letter suggest provision should be made for :— "(1) A new Tuberculosis pavilion to be placed outside the existing Hospital upon some of the adjoining land belonging to the Council, and which is at present let off in allotments. 71 "(2) Two new pavilions to contain at least 22 beds each for cases of Infectious Disease other than Tuberculosis, to be placed within the present Hospital site. " (3) A Discharging Block. "I would draw the Committee's attention to the demand for admittance to Hospital in a Borough of this kind. The population is rapidly increasing, the housing conditions and habits of the people are not improving—so many houses that were at one time occupied by one family are now occupied by two. "There is also an increasing danger from being in close contact, with other places from which Infectious Disease may be introduced. Recently London and West Ham have had epidemics of Scarlet Fever and Diphtheria. It will therefore be seen how a serious epidemic may be established in this Borough by the amount of intercourse. It is only necessary to travel on the District Railway in the early morning or evening to find out the danger owing to the serious overcrowding of the trains of an epidemic of Infectious Diseases occurring. I recently had in the Hospital a youth who had been travelling up to business in town for a month desquamating from a mild attack of Scarlet Fever. " My suggestions therefore are "(1) That one new pavilion similar to 'A' Block should be provided with accommodation for staff above (otherwise it would be necessary to build a new Administration Block). " (2) A second pavilion similar to ' B ' Block (Bothwell's). " (3) A Discharging Block to be erected near the Porter's Lodge containing 4 each male and female beds, with bath and dressing rooms at each end. "In connection with the suggestions of the Local Government Board to erect a Tuberculosis patients' pavilion, I would suggest that a pavilion of 24 beds should be provided for the treatment of Pulmonary Tuberculosis on condition that the Treasury make a grant of three- fifths of the total cost of such under the provision of the National Insurance Act. "It may be thought by some members of the Committee that such a site is unsuitable for the erection of a pavilion for the treatment of Pulmonary Tuberculosis, but I would point out that V 72 the Local Government Board suggest that Hospital beds to the number of 1 per 5,000 of population, in addition to the Poor Law Beds, should be provided for the purpose of observation, treatment, education and isolation, besides the same number in another sanatorium. "In my opinion the isolation of advanced cases is absolutely essential in attempting to stamp out Consumption. In most cases of Pulmonary Tuberculosis the disease is not recognised until the disease is far advanced, and it is these cases that should be isolated to prevent spread of infection to other persons. "I frequently have application for admission to Hospital from persons in an advanced stage of the disease who are unable to work, and the poverty and suffering caused becomes most distressing. In most cases they absolutely refuse to go into the Poor Law Infirmary, and become a danger to the community. Some of these cases have been sent away to a distant sanatorium, and at the end of their allotted time at the Institution it has been difficult to get them home again. Last week I had an application for the use of the Motor Ambulance to fetch a patient from a sanatorium about 40 miles away who was too ill to travel otherwise. It is for such cases that local beds should be provided, where they are close to their friends for visitations." SCARLET FEVER. 494 cases were treated during the year. 448 cases were admitted, and these, with 46 remaining in the Hospital from the previous year, made a total of 494 treated. There were only three deaths, which gives the low death-rate from this disease as 0.6. Those cases which proved fatal had complications of BronchoPneumonia. Other complications were chiefly those of Enlarged Glands, Otorrhæa, and one child required operation for Mastoid disease. The patients are detained in the Hospital for a minimum period of six weeks. All patients having nose or ear discharge are kept until some days have elapsed after the last signs of discharge, as there is no doubt it is to these cases that the few return cases we have 73 are due, as desquamation of the skin is no longer considered to be infectious. In one case that was recently brought to my notice a girl who during her stay in the Hospital had no symptoms of ear trouble, two days after being discharged developed a discharging ear and infected other members of the family, and was re-admitted. There is no doubt this was due to having no Discharging Block. The patients are bathed on the morning of discharge from the Hospital, and if the weather is bad the possibility of catching cold and living in less hygienic surroundings is likely to cause catarrh of the nose and ear, especially in those patients having Adenoidand enlarged Tonsils. DIPHTHERIA. 237 cases of Diphtheria were admitted during the year, as compared with 90 in 1912. These, together with one remaining from the previous year, made a total of 238 cases treated. Nine deaths occurred, giving a case mortality of 3.7 per cent. The case mortality in the Hospital from this disease during five years was as follows : — 1909 7.2 1910 5.5 1911 6.7 1912 5.5 1913 3.7 It was found necessary to perform tracheotomy in ten cases, only three of which ended fatally, and in one fatal case the parents refused until the patient was moribund to sanction operation. 1 he usual stay in the Hospital was about four or five weeks, but no case was discharged until a negative "Swab" was obtained by bacteriological examination. The excellent results obtained were by the free use of antitoxin, as except in rare cases, such as haemorrhage and purulent discharge from the nose no local treatment was given. 74 ENTERIC FEVER. 15 cases of this disease (Typhoid Fever) were treated in the Hospital during the year. Six of these were of one family. Only one death occurred, this being in the later stage of the disease, from heart failure. PULMONARY TUBERCULOSIS. 126 cases of Pulmonary Tuberculosis were admitted during the year, and with 16 cases remaining from the previous year made a total of 142 cases treated. Nine deaths occurred. All the cases admitted were either insured persons or their dependants. Most of them stayed for a period of three months, and expressed their gratitude for the treatment received. Some who had been previously to other sanatoria informed me that our dietary was the best experienced. CUBICLE BLOCK. 58 cases were treated in the Cubicles. Four deaths occurred. 2 cases of Cerebro-spinal Meningitis were in a critical condition when admitted, and died within a few hours. Another death occurred from Croup and one from Broncho-Pneumonia. The Cubicles are most valuable for cases of doubtful diagnosis, as well as for those of double infection. HOSPITAL ACCOMMODATION. The following- table gives the total bed accommodation at the Hospital :— Beds. Cubic fect per bed. Scarlet Fever ("A" Block) 20 2,000 Scarlet Fever ("B" Block) 26 2,000 Diphtheria Wards 20 1,000 Enteric Wards ... 20 1,000 Cubicles 12 1,500 "Open Air Shelter" and under Canvas 15 — 75 The Diphtheria, Enteric Wards and Open Air Shelter, together with the Administrative Block are temporary buildings of wood and iron. It will soon be necessary to build a permanent Administration Block, as the present kitchen and sleeping accommodation is not sufficient for the demands of the Hospital. STAFF. The health of the staff has caused some anxiety. A number of nurses having finished their probationary period of three years left to take up general Hospital Nursing, and being replaced by young probationers who were more susceptible to infection, three of them developed Scarlet Fever and two Diphtheria. It was therefore necessary to obtain extra assistance. I beg to record my thanks to the Matron and Nursing Staff for the interest taken at all times in the welfare of the patients, and to whom I give the credit for the excellent results obtained. The figures given will compare most favourably with any Isolation Hospital. The Staff consists of Matron, 3 sisters, 7 staff nurses, 3 junior staff nurses, 14 probationer nurses, 1 cook, 12 maids, 5 laundresses, 1 laundry attendant, 1 boiler attendant, 2 gardeners, 2 ambulance drivers, and 2 porters. 1 he ambulances consist of 1 horse ambulance and a new .notor ambulance, which is giving complete satisfaction. 76 HOSPITAL ACCOUNTS. For the Year ended 31st March, 1913. ESTABLISHMENT CHARGES. £ 2s. 9¾d. average per person per day. Provisions 1845 Linen, Bedding and Furniture 256 Chandlery and Sundries 241 Lighting, Heating and Water 813 Repairs to Hospital and Maintenance of Grounds 476 Rates, Taxes, and Insurance 125 Office Expenses 88 Salaries 1928 £5772 PATIENTS' EXPENSES. £ 3½d. average per person per day. Medicines, Medical Appliances, Antitoxin, and Disinfectants 238 Stimulants 10 Horsing Ambulance 370 £618 Total cost of upkeep, 3/1¼ per person per day. * The financial year ended at this date. It therefore does not coincide with the remainder of this report, the year for which ended on 31st December, 77 Days. Average No. of days in Hospital. Scarlet Fever. Balance of cases (34) in Hospital 1st April, 1912 1,101 32 332 recovered Scarlet Fever cases 13,350 40 7 fatal Scarlet Fever cases 96 14 14,547 Diphtheria. Balance of cases (13) in Hospital 1st April, 1912 219 17 50 recovered Diphtheria cases 1,418 28 6 fatal Diphtheria cases 58 10 1,695 Typhoid Fever. 12 recovered Typhoid Fever cases 480 40 2 fatal do. do. 7 4 487 3 recovered Erysipelas cases 89 30 Measles. 6 recovered Measles cases 149 25 1 fatal Measles case 2 2 151 Pulmonary Tuberculosis. Balance of cases (18) in Hospital 1st April, 1912 1,862 103 87 Pulmonary Tuberculosis cases 7,086 81 19 fatal do. do. 1,262 67 10,210 Staff. 38 Hospital Staff 13,870 365 Total 41,049 BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report of the School Medical Officer FOR THE YEAR 1013. 80 EAST HAM EDUCATION COMMITTEE Alderman H. Osborn, J.P. (Chairman). Councillor A. Coles (Vice-Chairman). Alderman 0. R. Anstead, J.P. (Mayor). Councillor W. T. Howlett, L.T.C. (Deputy-Mayor). Mrs. Ford. Alderman J. Brooks, J.P. Alderman E. Edwards, J.P. Alderman C. Northfield, J.P. Alderman M. Oakes, J.P. Councillor H. Barfield. Councillor F. Bradley. Councillor G. Brown. Councillor T. W. Cashman, J.P., C.C. Councillor T. H. Cowper. Councillor G. P. Dean. Councillor J. Evans. Councillor W. C. Ford, J.P. Councillor V. R. Oliver. Councillor A. Stokes. Councillor A. Taylor. Councillor J. A. Williams. Councillor A. H. Wiseman. John Prince, Esq.. J.P. Clerk: Miss P. G. Perry. School Nurses: Miss Forbes and Miss Howe. Dentist: C. H. Taylor, L.D.S. Ophthalmic Sxirgeon: A. Henry Thompson, M.D. Assistant Medical Officer: W. A. Berry, M.B., B.S. (Lond.), D.P.H. Medical Officer: W. Benton, M.R.C.S., L.R.C.P., D.P.H. 81 STATISTICAL DATA. School Places:— Provided Schools 25,808 Non-Provided Schools 1,129 Total 26,937 Number on Registers Provided Schools 24,830 Non-Provided Schools 1,032 Total 25,862 Teaching Staff: Head Assistant Certificated Assistant Uncertificated Supplementary Student Cookery 634 58 481 66 5 19 5 Education Rate. 1909-10 2/2 1910-11 2/2½ 1911-12 2/3 1912-13 2/4 1913-14. 2/4 Cost of Medical Inspection and Treatment, 1912-13, £753. Grants Received, 1912-13 £66,666. (Including Special Grant for necessitous districts, £19,215.) Estimated Product of a Penny Rate, 1912-13, £2,012. 82 Borough of East Ham Education Committee. Mr. Chairman, Mrs. Ford, and Gentlemen,— I beg to submit my Annual Report as School Medical Officer for the year ending 31st December, 1913. The staff was added to this year by the appointment of Mr. C. H. Taylor, L.D.S., as part-time School Dentist. He commenced his duties on 22nd January. Later in the year a change in the Medical Staff occurred through Dr. Stalker resigning his position as Assistant School Medical Officer. His place was taken by Dr. Berry, who began his duties on 1st May. During the year 1913, there were Medically Inspected 5,432 children, of which 4,905 were routine cases, and 527 special cases. This number represents about as many as can be properly ininspected with the present staff, especially as the work of the Inspection and Treatment Clinics has so enormously increased. In my report for 1912 I forecasted a further increase in the routine Medical Inspection. The Board of Education in Circular 823, issued 18th August, 1913, have made it clear that more will be required of Local Education Authorities in the near future. I quote the following paragraphs from the Circular to which 1 refer:— " Paragraph 6 : "It has also been found that the existing definition of the last age-group as 'all children who are expected to leave school in the year' has led to some difficulties in practice. It has, therefore, been decided to substitute for this definition one founded on an age basis, and to require the inspection of all children between 12 and 13 years of age, together with all children over 13 years who have not already been examined after reaching the age of 12. This change should be brought into operation for the year beginning on 1st April, 1914, in order that any temporary additional burden due to the change 83 may have ceased by the time that the requirements of the inspection of a third age-group referred to in the following paragraph comes into force." "Paragraph 7: "In conclusion, I am to say that the Board consider that the time has now come when the work of Medical Inspection should be consolidated by provision for the routine inspection of an intermediate age-group. They are aware that in a large number of areas provision is already made for the inspection of one or more age-groups other than those specified in Article 58 (b) of the Code. They desire, therefore, to give ample notice of this extension of the work of Medical Inspection in order that as little inconvenience as possible may be caused to authorities whose provision for Medical Inspection is at present limited to the two age-groups hitherto prescribed by the Code. Accordingly, they have decided to make no change as regards the year ending on the 31st March, 1915, but for the year beginning on April 1st, 1915, and subsequent years it will be required that provision shall be made for the Medical Inspection of all children between 8 and 9 years of age, as well as for the group of ' Entrants,' and the group of children between 12 and 13 years of age." It will thus be seen that in East Ham there will require to be Medically Inspected during the year 1914 :— A erouo of children "Entrants." Do. (a) Aged 12-13 years. (b) ,, 13 years and over. And in subsequent years :— A group of children "Entrants." Do. Aged 8-9 years. Do. ,, 12-13 years. Further, by the passage of the Mental Deficiency Act, 1913, it becomes the duty of every Local Education Authority:— (1) To ascertain the existence of mental defect of such kind or degree as to justify the diagnosis of feeble-mindedness, imbecility, or idiocy: 84 (2) To determine whether a child diagnosed as feebleminded is or is not capable of benefiting from education in a special school; and (3) To notify to the Local Authority, under the Mental Deficiency Act, all defective children over the age of seven (a) who are incapable of education in special schools; (b) who, though educable, are detrimental to other children ; (c) who require supervision or guardianship under the Mental Deficiency Act; or (d) who, after leaving a special school, need institutional treatment or guardianship. Obviously there will be a considerable increase in the duties of the medical, nursing, and clerical staff. The latter, as at present constituted, will not be able to deal efficiently with all the work. I therefore recommend that a second Assistant School Medical Officer and an additional Nurse be appointed. I have to point out that in connection with the new Medical Inspection and Treatment Grants, the Board of Education have stated that "it will be necessary not only that no appreciable number of children should escape inspection, but also that actual examination should be accurate and comprehensive and in dealing with the same subject the Board make it clear that they will give attention to the adequacy of the salaries paid by authorities to their School Medical Officers and Assistant Medical Officers. During the year 1913 two groups of children again furnished the cases for routine examination, namely, "Entrants" and "Leavers." In practice it has been found that a considerable number of children leave school before their final Medical Inspection is effected; but this leakage should cease with the adoption of the age basis 12 years as recommended by the Board of Education. 85 Comparative Statement of Work. 1912. 1913. Routine Inspections 4,657 4,905 Special Cases 631 527 Re-Inspections 973 1,189 Visits for Medical Inspection 282 260 Consultations at Inspection Clinic 3,493 5,626 Number of Treatments at Clinic 2,914 *2,851 Nurses' Special Visits to Departments 277 64 Nurses' Visits to Homes 1,254 943 Children Examined for Cleanliness 23,386 22,983 Number of Cleansings 171 16 * Ophthalmic and Dental cases are not included in the number for the year 1913. ARRANGEMENTS FOR MEDICAL INSPECTION AND DISTURBANCE OF SCHOOL ROUTINE. The arrangements for Medical Inspection are briefly as follows:— Teachers are given several days' notice of the intended visit of the Doctor and Nurse. In the interval between the notice and the Doctor's visit, cards are sent by the teachers to the parents of children whose ages come within the scope of routine inspection. By means of these cards to parents— (1) Particulars are obtained of the Infectious Diseases from which the children have suffered. (2) Parents are notified of the date and hour of the Medical Inspection, and are given permission to attend. (3) Opportunity is given to those parents who may wish to object to their children being examined. Medical Inspection cards, bearing the name and address of each child and certain other data, are prepared by the teachers. At the Doctor's visit a complete physical examination is made of each child, and the results of the examination, together with the information obtained from the teachers and parents, are noted on the card. On the completion of each day's inspection, the Medical Inspection cards are taken to the School Medical Officer's Department, where the information on each is summarised and notice of defects is sent to the parents. 86 1 he cards are subsequently returned to the schools and kept in special filing cases supplied to each department. The disturbance of school routine is minimised by using teachers' rooms in the majority of cases for the inspections, and by having the children from their class in small batches of six at a time. The arrangements for accommodating the Officers concerned in the work are adequate in the majority of the schools in the Borough. PARENTS PRESENT AT MEDICAL INSPECTION. During the year 1913, the percentage of parents present at the inspections was 34.9, as compared with 27.5 in 1912. The number of parents sufficiently interested to be present at the Medical Examination varies considerably in different schools, and sometimes in the several departments of a particular school. Where the Head Teacher manifests active sympathy in the work of School Medical Inspection the percentage of parents who attend is high; where, on the contrary, Medical Inspection is regarded merely as a necessary evil, parents are not urged to be present, and, parallel with this lack of sympathy, one finds the number of objections to inspection is increased. EXTENT AND SCOPE OF MEDICAL INSPECTION DURING 1913. Inspection has taken place in all the Borough Schools. Certain departments were re-visited in order to secure the examination of children who, through absence, had escaped Medical Inspection at former visits. The grouping of children for inspection was the same as last year, namely:— (1) Entrants. (2) Leavers. (3) Special Cases. Under "Special Cases" were included children who, owing to their ages did not come within the scope of routine inspection, were believed to exhibit defects; such cases were usually put forward by their teachers. 87 The scope of the work also embraced the re-examination of all defective cases found at Medical Inspection in whom the defects were of such a nature as to deem it advisable that parents should be notified thereof; the "following up" of the same; the inspection for general cleanliness of all children attending the elementary schools of the Borough; the cleansing of children under the statutory powers conferred by the Children Act; and the work accomplished at the Inspection and Treatment Clinics. The following table shows the number of children examined during 1913, classified according to age and sex :— Routine Inspection. Special Inspection. Ages examined Boys Girls Hoys Girls 5 years 944 935 — — 6 „ 443 494 — — 7 „ 75 79 7 11 8 ,, — — 52 55 9 „ — — 37 55 10 ,, — — 60 55 11 „ — — 33 46 12 „ — — 50 66 13 „ 917 748 — — 14 „ 153 93 — — 15 ,, 18 6 — — 2,550 2,355 239 288 CO-ORDINATION OF THE SCHOOL MEDICAL AND PUBLIC HEALTH SERVICES. In the Borough of East Ham the School Medical Officer is also Medical Officer of Health; direct unity of action is thus at once obtained. A comprehensive scheme is in force that secures active cooperation between the Medical Officers and the School Teachers, School Nurses and Attendance Officers, in order to prevent the spread of infection. In this scheme are included the notifiable and non-notifiable infectious diseases, together with the contagious skin and eye affections. 88 Each case of notified disease is regarded as possibly connected with other cases of the same disease, which, owing to their mildness or the absence of some of the characteristic symptoms, have been overlooked by the parent or the teacher, or both. Inquiries therefore are made at the patient's home and into the condition of the children who have been in contact at school with the scholar who has fallen ill. Teachers are instructed in the symptoms of onset of the chief infectious diseases, and are directed temporarily to exclude children showing any symptoms suggestive of any of these diseases until medical assurance can be had that they may attend school without harm to themselves or danger to other scholars. The Head Teachers are at once informed of cases of notifiable diseases occurring in children attending their departments, and "contacts " can therefore be forthwith excluded. The Attendance Officers inform the School Medical Officer of any children who have recently been kept at home with illness of a suspicious character, or concerning whom circumstances suggest the possibility of infection. A register of the non-notifiable diseases, Measles, Chickenpox, Whooping Cough and Mumps is kept in the School Medical Officer's Department. The entries in this register are made from notification forms sent by school teachers. The accuracy of these notifications is verified by the Attendance Officers, who consult the Medical Officer in all cases of doubt. The return of these diseases for the year 1913 appears in the table, page 90. It has been stated that the greater control exercised over the spread of infectious and contagious diseases in schools has caused a decreased average attendance; but, whereas during 1912 there were issued 817 exclusion forms under Article 53 (b) of the Code, and the average attendance expressed as a percentage was 84, yet during the year 1913 the exclusions under this heading reached the number of 955, and the average attendance similarly expressed rose to 88. Particulars of the exclusions are given in a table on the next page. These exclusions were independent of suspensions from attendance which took place in connection with the notifiable and other diseases that are carried out by the School Teachers in accordance with printed regulations. 89 During the year 1913 the epidemic of Diphtheria that visited East Ham, in common with surrounding districts, gave rise to a considerable increase in work on the part of all concerned with the health of the school children. I have to express my great appreciation of the alertness shown by many teachers in promptly reporting cases of sore throat. Many of these cases were seen at the nine o'clock Clinics, and in the course of the year over 150 throat and nose " swabs " were taken from such patients. By this procedure cases of Diphtheria were discovered that might otherwise have passed unnoticed. During the year 1913 exclusion forms were issued by the School Medical Officer as follows:— For Ringworm of Scalp 149 ,, Ringworm of Body 16 ,, Impetigo Contagiosa ... 214 ,, Infective Eye Inflammations 99 ,, Eczema 17 ,, Acute Throat Conditions 96 ,, Scabies 31 ,, Miscellaneous Affections 333 Total 955 The annexed table gives the complete notification of infectious diseases in school children received for the year 1913 : — SCHOOL CASES, 1913. SCHOOLS. 'Dept. Scarlet Fever. Diphtheria. Typh. Fever. Measles Wh. Cough. Chicken Pox. Mumps. Ringworm. Total. Head Body Central Park Road Infants 5 11 ... 42 ... ... ... 4 ... 80 Boys 6 l ... ... ... ... ... 2 ... Girls 4 3 ... ... ... ... ... 2 ... Castle Street R.C. Infants ... ... ... ... 1 4 1 1 ... 16 Boys ... 1 ... ... ... 2 ... ... ... Girls ... ... ... ... ... 3 2 1 ... Essex Road Infants 6 1 ... 35 ... 17 ... 7 ... 75 Boys 3 ... ... ... ... ... ... 3 1 Girls 1 ... ... ... ... ... ... 1 ... Fourth Avenue Infants 13 4 ... 1 ... 18 6 1 1 81 Boys 10 1 ... 1 ... 3 1 5 ... Girls 5 1 ... 1 1 5 2 ... 1 Hartley Avenue Infants 8 5 ... ... ... ... 1 15 2 46 Boys 1 ... ... ... ... ... ... 4 2 Girls ... 4 ... ... ... ... ... 4 ... High Street Infants 6 9 ... 1 17 10 38 2 ... 112 Boys 9 4 ... 1 ... 1 6 1 ... Girls 3 1 1 ... ... ... ... 1 1 Kensington Avenue Infants 11 8 ... ... ... 16 34 7 ... 110 Boys 2 1 ... ... ... 1 6 6 ... Girls 12 2 ... ... ... 3 ... 1 ... Lathom Road Infants 10 1 l 1 15 3 10 7 ... 64 Boys 3 1 l ... ... 1 ... 2 ... Girls 8 ... ... ... ... ... ... ... ... Manor Park Infants 6 1 ... 29 1 15 9 4 ... 79 Boys 2 ... ... ... ... ... ... 1 ... Gills 7 2 ... ... ... ... ... 1 1 Monega Road Infants 9 1 ... 7 6 8 39 ... ... 85 Boys 4 ... ... ... ... ... ... ... ... Girls 3 ... 1 ... ... ... ... 2 ... Napier Road Infants 8 9 ... ... ... 8 6 7 1 66 Boys 3 2 ... ... ... ... ... 2 1 Girls 9 5 ... ... ... ... ... 5 ... New Beckton Infants ... 1 ... 9 ... 3 ... 2 1 20 Boys ... 1 ... ... ... ... ... ... ... Girls 2 ... ... ... 1 ... ... ... ... North Woolwich Infants 1 ... ... ... ... ... ... 1 ... 5 Mixed 2 ... ... ... ... ... ... 1 ... Plashet Lane Infants 10 6 ... 1 22 9 46 2 1 119 Boys 6 1 ... ... 1 ... 1 2 ... Girls 9 ... ... ... ... 1 ... 1 ... St. Winefride's R.C. Infants 1 3 ... ... ... ... 2 2 ... 13 Mixed ... ... ... ... ... 2 1 ... ... Sandringham Road Infants 14 ... ... 6 ... ... ... 1 ... 37 Boys 7 1 ... ... ... ... ... ... ... Girls 7 1 ... ... ... ... ... ... ... Shaftesbury Road Infants 11 1 ... ... 14 ... 1 8 ... 86 Boys 21 ... ... ... ... ... ... 4 1 Girls 17 ... ... ... ... ... ... 8 ... ShrewsburyRoad Infants 4 1 ... ... 13 3 5 6 ... 42 Boys 5 1 ... 1 ... ... ... ... ... Girls 1 ... ... 1 ... ... ... ... 1 Silvertown R.C Infants ... ... ... ... ... 15 ... ... 1 21 Mixed ... ... ... 2 ... 1 2 ... ... Vicarage Lane Infants 6 14 ... 16 ... 9 28 7 1 100 Mixed 7 8 ... ... ... ... 1 3 ... Walton Road Infants 7 4 ... ... 8 10 1 ... ... 46 Boys 5 2 ... ... ... ... ... 1 ... Girls 1 1 ... ... ... ... ... ... 1 Totals 321 125 4 155 100 171 249 160 18 1303 DEFECTS CLASSIFIED ACCORDING TO AGES. 5 years. 6 years. 7 years. 13 years. 14 years. 15 years. Totals. Percentage. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. 1 Boys. Girls. Boys. Girls. Number examined 944 935 443 494 75 79 917 748 153 93 18 6 2550 2355 ... ... DEFECTS. Squint 10 18 4 9 2 2 9 12 ... ... ... ... 25 41 0.98 1.7 External Eve Disease 15 22 7 12 3 3 17 12 2 3 ... ... 44 52 1.7 2.2 Defective Vision— Number examined ... ... ... ... ... ... 899 722 147 91 18 6 1064 819 ... ... Slightly defective ... ... ... ... ... ... 54 33 15 8 1 ... 70 41 6.5 5.0 Greatly defective ... ... ... ... ... ... 156 94 25 12 3 ... 184 106 17.3 12.9 Ear Disease— Discharge 10 11 4 8 4 ... 39 27 6 2 1 ... 64 48 2.5 2.03 Deafness 7 13 9 10 1 ... 62 45 11 5 1 ... 91 73 3.5 3.1 Defective Speech 23 14 7 3 1 1 17 6 6 2 ... ... 54 26 2.1 1.1 Disease of Heart 9 14 4 8 ... ... 13 17 4 4 3 ... 33 43 1.3 1.8 Disease of I.ungs 42 17 12 16 3 1 26 16 3 2 ... 1 86 53 3.3 2.2 Disease of Nervous System 1 ... 3 2 ... ... ... 1 ... 1 ... ... 4 4 0.15 0.17 Verminous Head 8 14 2 7 2 5 5 9 ... ... ... ... 17 35 0.66 1.5 Verminous Body 7 1 7 5 3 4 5 2 ... ... ... ... 22 12 0.86 0.51 Defective Clothing 2 1 4 4 1 ... 2 ... ... ... ... ... 9 5 0.85 0.21 Defective Boots. 30 24 13 17 8 2 34 20 ... ... ... ... 85 63 3.3 2.6 Defective Nutrition— Under Normal 88 35 33 25 9 5 71 61 13 4 3 ... 167 130 6.5 5'5 Bad 10 4 2 2 1 1 1 1 1 ... ... ... 15 8 0.59 0.34 Decayed Teeth 1 to 2 164 188 99 99 9 16 328 266 53 51 4 2 657 622 25.7 26.4 3 to 4 •221 178 102 104 13 19 156 146 30 8 4 4 526 459 20.7 19.5 More than 4. 104 104 58 69 18 15 36 30 11 1 ... ... 227 219 8.9 9.3 Tonsils— Slightly enlarged 93 102 42 61 11 10 51 55 6 4 1 ... 204 232 8.0 9.8 Greatly enlarged 13 21 16 9 3 5 10 12 1 ... ... ... 43 47 1.7 1.9 Adenoids 67 67 38 42 9 8 22 20 5 1 1 1 142 139 5.5 5.9 Enlarged Glands 80 79 31 32 4 3 29 28 4 6 ... ... 148 148 5.8 6.2 Nose Defects 83 58 34 27 5 2 31 12 4 ... ... ... 157 99 6.1 4.2 Mental Defects— Number examined 282 283 128 144 5 4 903 740 150 93 ... ... 1468 1264 ... ... Dull 12 1.0 15 7... ... ... 95 133 25 14 ... ... 147 164 10.0 12.9 Deficient 2 ... ... ... ... 1 7 2 1 1 ... ... 10 4 0.69 0.32 Deformities 14 4 9 "7 3 ... 27 28 8 3 1 ... 62 42 2.4 1.7 RiDgworm 2 3 2 3 1 ... 3 ... 1 ... ... ... 9 6 0.35 0.25 Scabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Impetigo 1 4 1 i 1 ... 2 ... ... ... ... ... 5 5 0.19 0.21 Tuberculosis— Glandular 5 7 4 1 ... ... 2 1 ... 1 ... ... 11 10 0.43 0.42 Osseous 2 1 3 ... ... 3 ... ... 1 ... ... 8 2 0.31 0.09 Pulmonary 1 1 2 4 ... ... 5 9 2 ... ... ... 10 14 0.39 0.59 Anaemia 12 12 9 4 ... 4 5 2 2 ... 1 26 25 1.02 1.06 Mouth Breathers 56 37 22 23 5 6 13 13 3 1 ... 2 98 82 3. 9 3.4 Other Diseases 17 9 7 3 4 15 12 6 2 ... ... 4o 30 1.7 1.3 DEFECTS ARRANGED ACCORDING TO SCHOOLS. SCHOOLS. Sex. Total Number Examined. Squint. External Eye Disease. Vision. Disease of Ears. Speech defects. Disease of Heart. Disease of Lungs. Diseases of Nervous System. Verminous Head. Verminous Body. Defective Clothing. Defective Boots. Nutrition. Teeth. Tonsils. Adenoids. Glands. Nose. Mental Defects. Deformities. Infectious Skin Diseases. Anaemia. Mouth-breathers. Tubercle. Other Diseases. Number Examined. Slight Defect. Great Defect. Discharge. Deafness. Under Normal. Bad. Decayed. 1—2. Decayed 3—4. More than 4. Decayed. Slightly Enlarged. Much Enlarged. Number Examined. Dull. Deficient. Ringworm. Scabies. Impetigo. Glandular. Osseous. Pulmonary. Castle Street, R.C Boys 20 1 ... 11 2 1 ... 1 ... 1 ... ... ... ... ... ... 1 ... 5 4 2 3 ... 2 ... 2 20 1 ... 4 1 ... ... 1 1 ... ... ... ... Girls 23 ... 1 14 3 4 ... ... ... ... 2 ... 2 1 ... 1 2 ... 8 2 ... 2 1 1 1 1 23 2 ... ... ... ... ... ... 1 ... ... ... 1 Central Park Road Boys 122 1 2 02 4 0 2 10 ... ... 3 1 ... ... ... 1 11 ... 28 22 11 5 2 6 5 2 117 22 ... 3 ... ... 1 ... 2 1 ... 1 1 Girls 106 3 1 42 3 7 3 7 ... 3 ... 1 1 ... ... 1 7 1 32 23 10 0 1 2 2 1 104 18 ... 3 ... ... ... ... 2 ... ... ... ... Essex Road Boys 168 2 1 55 2 11 2 2 7 3 6 ... 3 1 ... 1 11 ... 37 36 18 9 5 11 9 12 168 8 ... 2 1 ... ... ... 11 1 1 ... 1 Girls 139 2 ... 50 ... 13 4 4 4 2 2 ... 1 1 ... 3 5 ... 33 33 11 10 1 7 9 8 139 10 ... 6 ... ... 1 ... 0 1 1 ... 1 Fourth Avenue Boys 152 ... 3 83 4 13 5 8 ... 2 1 ... ... ... ... ... 8 ... 47 22 16 14 2 4 6 6 85 15 6 1 ... ... ... 1 2 1 ... ... 3 Girls 118 1 2 59 3 6 3 0 ... ... 4 1 ... ... ... 3 13 ... 28 20 13 14 3 6 6 3 59 17 1 3 ... ... ... ... 3 1 ... 3 4 Hartley Avenue Boys 154 ... 2 58 4 7 1 1 9 ... 4 ... 1 ... ... 2 8 ... 44 39 13 13 5 7 20 15 154 5 ... 3 1 ... ... ... 6 ... ... 1 4 Girls 150 3 4 49 ... 6 2 3 2 3 1 ... ... ... ... 2 9 ... 39 45 17 13 1 12 14 11 148 8 1 3 ... ... ... 3 7 ... ... ... 2 High Street Boys 70 3 34 1 3 1 4 4 ... 1 ... ... 2 8 ... 16 12 8 5 1 5 2 5 35 6 1 2 ... ... ... 1 4 ... ... ... ... Girls 80 2 1 29 2 4 ... 1 ... 1 1 ... ... ... 2 1 3 1 23 16 8 3 5 3 4 6 30 4 ... 1 ... ... ... 2 1 ... ... 1 1 Higher Elementary Boys 33 ... ... 33 2 7 1 1 ... 4 ... ... ... ... ... ... 3 ... 7 6 2 1 ... 1 1 ... 33 ... ... 2 ... ... ... ... 1 ... ... ... ... Girls 12 ... 2 12 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 7 5 ... ... ... 1 ... ... 12 ... ... ... ... ... ... 1 2 ... ... ... ... Lathom Road Boys 171 1 3 58 6 11 2 4 5 2 3 ... 1 1 ... ... 9 ... 35 56 12 11 2 6 11 2 58 4 ... 4 ... ... ... ... 1 ... 1 ... 3 Girls 147 3 2 57 2 10 4 3 ... 5 2 ... 8 ... ... 2 7 ... 44 36 18 18 1 4 10 3 61 7 ... 1 1 ... ... 2 3 ... ... 1 1 Manor Park Boys 181 3 5 60 1 8 2 3 2 1 8 ... 3 3 ... 5 8 2 52 46 19 22 5 15 14 13 60 ... ... 5 3 ... 1 ... 15 2 ... 3 2 Girls 171 5 4 46 6 5 2 1 4 2 2 1 3 1 ... 5 7 46 40 23 23 5 10 13 5 46 10 ... 2 ... ... 1 ... 9 1 ... 1 1 Monega Road Boys 100 1 1 109 6 19 4 8 2 2 4 ... ... ... ... 1 13 9 64 46 90 9 5 11 14 7 109 19 ... 9 ... ... ... 4 4 ... ... ... 3 Girls 173 2 3 65 2 4 1 5 1 3 7 ... 1 1 ... 1 5 2 54 33 22 21 6 12 15 4 67 10 1 1 ... ... ... ... 3 ... 1 ... 3 Napier Road Boys 102 1 5 09 18 8 7 3 3 3 ... ... ... l 3 8 5 27 19 3 9 1 2 1 6 70 4 ... 2 1 ... ... 1 1 1 ... ... 1 Girls 84 ... 2 48 6 8 3 5 ... ... ... ... 1 1 1 4 7 20 5 ... 5 1 4 1 4 48 8 ... 2 ... ... ... ... ... ... ... ... 1 New Beckton Boys 74 1 2 50 3 17 5 7 ... 1 3 1 ... ... 1 2 7 ... 16 7 1 5 ... 2 2 6 51 7 ... ... ... ... ... 1 3 1 ... 1 7 Girls 60 ... 2 36 7 5 ... 3 ... 2 ... ... 1 ... ... 5 4 ... 10 9 1 3 1 ... 2 3 33 ... ... 1 ... ... 1 ... 3 ... ... ... 2 North Woolwich Boys 40 ... 1 ... ... ... 1 ... ... ... 2 ... 1 1 ... 4 ... 3 8 9 5 4 1 4 3 5 22 4 1 1 ... ... ... 1 ... ... ... ... ... Girls 40 2 4 ... ... ... 1 ... ... ... 2 ... 1 ... ... ... ... 2 5 9 4 11 2 7 3 5 24 2 ... 1 ... ... 1 2 ... ... ... ... ... Kensington Avenue Boys 164 1 ... 54 1 9 1 5 2 2 10 ... ... ... ... ... 10 ... 55 42 15 8 3 3 12 7 55 2 ... 1 ... ... ... 1 4 2 1 ... ... Girls 130 6 2 29 2 2 2 2 1 3 6 ... ... ... ... 1 14 ... 35 40 13 11 1 5 7 3 29 1 ... 3 ... ... ... 3 8 1 ... 1 1 Plashet Lane Boys 140 2 2 78 8 13 5 6 2 ... 3 ... ... ... ... 9 17 ... 33 18 5 9 2 2 3 9 120 15 1 5 1 ... ... 2 1 ... 2 2 2 Girls 118 1 3 46 ... 5 4 10 2 6 ... ... ... ... 1 1 9 1 31 13 2 7 ... 6 4 4 107 14 ... 3 ... ... ... 3 3 ... ... 2 4 Silvertown, R.C. Boys 40 1 ... 17 ... 2 1 2 7 ... 2 ... ... ... ... 5 2 1 10 7 5 10 ... 5 6 3 40 5 1 3 ... ... ... ... 2 ... ... ... ... Girls 40 2 ... 10 1 1 ... ... 2 1 ... ... 1 l 1 4 3 ... 14 8 6 6 ... 3 4 1 49 3 ... ... ... ... 1 ... ... ... ... ... ... St. Winefride's, R.C Boys 24 ... 1 6 ... 1 ... ... ... ... 1 ... ... ... ... 2 ... ... 9 5 2 1 ... 3 6 1 24 1 ... ... ... ... ... ... 4 ... ... ... 3 Girls 20 ... 1 5 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 5 1 1 1 ... 1 ... 1 20 1 ... ... ... ... ... 1 ... ... ... ... ... Shrewsbury Road Boys 111 1 1 43 3 17 5 2 1 2 4 ... 1 1 1 6 9 ... 24 21 15 12 1 16 7 12 54 2 ... 3 ... ... ... 2 2 ... 1 ... 4 Girls 128 3 . 54 2 7 2 2 1 1 4 ... 2 ... ... 2 6 ... 37 21 23 14 5 9 22 3 88 2 1 2 3 ... ... 1 ... 2 ... ... 1 Sandringham Road Boys 84 ... 1 32 1 5 ... 2 1 ... 4 ... ... 3 ... 2 7 ... 17 13 12 1 3 1 1 3 37 7 ... 1 ... ... 1 ... 1 1 ... 1 1 Girls 63 ... 3 18 ... ... ... 2 ... 1 ... ... 2 1 ... 1 2 ... 11 10 10 1 1 2 1 1 19 1 ... ... ... ... ... ... 2 1 ... ... ... Shaftesbury Road Boys 163 1 3 69 2 13 7 9 4 6 4 ... 1 ... ... 3 7 ... 55 34 23 17 ... 11 11 5 72 9 ... 5 1 ... 1 4 7 ... ... 1 2 Girls 159 2 6 60 ... 7 7 7 ... 3 4 ... 7 ... ... ... 10 ... 34 34 10 17 5 13 11 7 62 26 ... 4 1 ... ... 2 7 ... ... 1 3 Vicarage Lane Boys 192 6 6 24 1 5 5 2 3 ... 9 1 1 8 ... 13 13 ... 28 45 16 25 2 19 11 24 24 5 ... 3 ... ... ... 1 20 1 1 ... 6 Girls 202 2 3 25 2 2 2 2 5 4 8 ... 2 1 ... 9 4 1 69 21 20 30 5 18 17 11 29 ... ... 2 1 ... ... ... 13 3 ... ... 3 Walton Road Boys 149 2 2 58 1 8 7 11 2 4 7 ... 5 3 4 19 10 ... 40 17 15 12 3 6 3 12 60 6 ... 5 ... ... ... 2 7 ... 1 ... 2 Girls 107 2 6 65 ... 10 8 10 4 3 6 ... 7 4 ... 17 12 ... 37 35 7 16 2 10 2 14 67 20 ... ... ... ... ... ... 9 ... ... 4 1 Totals Boys 1550 25 44 1064 70 184 64 91 54 33 80 4 17 22 9 85 168 15 657 526 227 204 43 142 148 157 1468 147 10 62 9 ... 4 20 99 11 8 10 45 Girls 2355 41 52 819 41 106 48 73 26 43 53 4 35 12 5 63 130 8 622 459 219 232 47 139 148 99 1264 164 4 42 6 ... 5 25 82 10 2 14 30 Percentage defective Boys ... 0.98 1.7 ... 6.5 17.3 2.5 3.5 2.1 1.3 3.3 0.15 0.66 0.86 0.35 3.3 0.5 0.59 25.7 20.7 8.9 8.0 1.7 5.5 5.8 6.1 ... 10.0 0.69 2.4 0.35 ... 0.15 1.02 3.9 0.43 0.31 0.39 1.7 Girls ... 1.7 2.2 ... 5.0 12.9 2.03 3.1 1.1 1.8 2.2 0.17 1.5 0.51 0.21 2.6 5.5 0.34 26.4 19.5 9.3 9.8 1.9 5.9 6.2 4.2 ... 12.9 0.32 1.7 0.25 ... 0.21 1.06 3.4 0.42 0.09 0.59 1.3 91 HYGIENIC CONDITIONS OF THE SCHOOLS. In my Annual Reports for the years 1911 and 1912 I gave a review of the hygienic condition of all Public Elementary Schools in the Borough. Attention was drawn to the sanitary conveniences, lighting, heating, ventilation, desks, seats and playgrounds. In all these matters improvements are being effected. The following alterations have been made at the schools named since the last Annual Report :— General Repairs and Re-Decoration. External painting at Napier Road and Sandringham Road Schools. Internal repairs and re-decoration at Walton Road, Manor Park, High Street, and Kensington Avenue Schools. Removal of Galleries. Essex Road Infants' School. Alteration to Windows. Walton Road Girls' School. Erection of Glazed Partitions. Moveable glazed partitions have been erected in the Boys' Departments of Central Park, Plashet Lane, and Shrewsbury Road Schools. Alterations of Scholars' Desks. The desks in Shrewsbury Road Girls' School have been altered by providing a modern pattern of desk standard and reducing the size of the desks. Lighting of Schools. Electric light was installed at Central Park Road Schools during the summer vacation of 1913. It is proposed to instal electric light at Shaftesbury Road School during the next summer vacation, and the Education Committee have at present under consideration the question of improving the artificial lighting at all schools where flat flame burners are at present in use. 92 SPECIAL CASES WITH DEFECTS. Ages. Dept. Number examined. Squint. Vision defective. Deafness and discharging ears. Adenoids and enlarged tonsils. Other defects. No defects found. Total number of defects. Slight defect. Great defect 7 years Boys 7 — — — — 2 3 2 5 Girls 11 — 1 3 1 3 3 2 11 8 years Boys 52 3 — 11 4 6 22 8 46 Girls 55 — 2 9 5 6 28 5 50 9 years Boys 37 1 1 15 4 1 10 5 32 Girls 55 1 — 12 5 8 13 17 39 10 years Boys 60 2 — 24 10 6 14 6 56 Girls 55 1 3 19 4 5 9 16 41 11 years Boys 33 2 1 7 5 1 6 13 22 Girls 46 — 5 12 3 8 11 11 39 12 years Boys 50 1 1 10 6 4 7 22 29 Girls 66 — 2 22 5 6 15 19 50 Totals Boys 239 9 3 67 29 20 62 56 190 Girls 288 2 13 77 23 36 79 70 230 Total — 527 11 16 144 52 56 141 126 420 93 DEFECTS DISCLOSED BY MEDICAL INSPECTION. Squint. 25 boys and 41 girls were found to have this defect; these numbers give percentages of 0.98 and 1.7 respectively. The offer of treatment was readily accepted in the majority of cases. External Eye Inflammation. The various inflammations and their sequelae under this heading were found in 44 boys and 52 girls, giving percentages 1.7 and 2.2 respectively. Blepharitis was the commonest defect, and in many cases the general cleanliness of the children was neglected. A considerable number of corneal opacities was also discovered. Defective Vision. The total number examined for visual defects was 1,883. The results are tabulated as to numbers and percentage under slight and great defect:— Slight Defect. Defect. Boys 70 Boys 184 Percentage 6.5. Percentage 17.3. Girls 41 Girls 106 Percentage 5.0. Percentage 12.9. Fuller details are given of the cases of defective vision in the Ophthalmic Surgeon's report on page 114. Deafness and Discharging Ears. The percentages of boys and girls found to have subsnormal hearing or to be actually deaf were 3.5 and 3.1 respectively. Discharging ears, so frequently associated with impaired hearing, were noted in 61 boys and 48 girls, yielding percentages of 2.5 and 2.03 respectively. By reference to the table inset facing page 112, it will be seen that a great many treatments were given for discharging ears; by these means a considerable number of children were permitted to remain in attendance at school. 94 Diseases of the Heart. Occurred in 33 boys and 43 girls, the percentage of boys affected being 1.3 and of girls 1.8. Several of the cases were forbidden to drill, and in nearly all the parents when present were invited to bring the children to the Friday Clinic for subsequent examination. Diseases of the Lungs. In 86 boys and 53 girls, that is, in percentages of 3'3 boys and 2.2 girls, evidence of disease of the lungs was found. Pulmonary tuberculosis was present in 10 boys and 14 girls, i.e., percentages of 0.39 and 0'59 respectively. As in the case of those found to have heart disease, those with lung and bronchial affections were urged to attend the Clinic at stated intervals, in order that they might be kept under observation. In quite a number of instances weekly and fortnightly weighings were registered. On reference to the table inset facing page 90, it will be seen that the majority of lung diseases (bronchitis is included) occurred in the "entrants" group of children. It will also be observed that it is in the same group that the great majority of mouthbreathers is found. The rectification of this defect is of great importance, and in cases where it was present cards giving suitable instructions for its correction were handed or sent to the parents. Verminous Conditions. (a) Conditions found at routine Medical Inspection.—These 1 regret to say show little improvement on those found during the preceding year. The results for purposes of comparison are best expressed as percentages Verminous Heads. 1912. 1913. Boys 0.54 0.66 Girls 1.4 1.5 Verminous Bodies. Boys 0.39 0.86 Girls 1.08 0.51 95 (b) Inspections for general cleanliness made by the nurses under Section 122 of the Children Act, 1908. In this connection the results have been less satisfactory. The number of children examined for cleanliness during 1913 was 403 less than in 1912, and the number of cleansings effected was only 16, as compared with 171 during the same period. The explanation of the general falling off in respect of this important aspect of the work is due simply to lack of staff. In order to make comparison the following table is submitted:— 1912. 1913. Children Examined for Cleanliness 23,386 22,983 Number of Statutory Notices Served 373 425 Number of Cleansings 171 16 Number Cleansed Statutorily 161 16 96 TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. Body and Clothing Verminous. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. Body and Clothing Verminous. Castle Street R.C. Infants 112 8 20 2 Napier Road Girls 438 50 54 6 Mixed. 155 18 18 5 Boys 460 10 12 10 Central Park Road Girls 482 40 43 ... Infants 435 40 53 17 New Beckton Girls 234 28 22 4 Boys 525 4 6 5 Infants 602 20 24 2 Boys 249 8 6 10 Essex Road Girls 338 19 24 ... Infants 260 20 29 2 North Woolwich Mixed 336 33 46 12 Boys 382 1 3 Infants 244 12 4 1 Plashet Lane Girls 492 40 78 9 Fourth Avenue Girls 471 46 21 5 Boys 500 8 18 12 Boys 534 7 2 ... Infants 466 20 35 6 Infants 441 35 17 2 St. Winefride's R.C. Mixed 262 15 6 8 Hartley Avenue Girls 530 20 68 ... Sandringham Road Girls 327 19 24 ... Boys 545 8 6 2 Infants 542 35 23 2 Boys 389 1 ... 3 High Street Girls 315 20 28 2 Infants 244 12 4 1 Shaftesbury Road Girls 525 6 19 6 Boys 329 5 9 8 Infants 276 18 30 2 Boys 470 12 ... 1 Kensington Avenue Girls 479 24 52 6 Infants 436 26 2 ... Shrewsbury Road Girls 387 35 52 ... Boys 530 25 12 4 Infants 523 30 12 3 Boys 383 ... ... 5 Lathom Road Girls 467 36 42 ... Infants 299 3 20 5 Silvertown R.C. Infants 260 20 20 9 Boys 488 10 4 2 Infants 528 24 14 1 Mixed 162 14 14 3 Manor Park Girls 224 17 26 2 Vicarage Lane Girls 313 15 34 1 Boys 318 4 ... 1 Boys 404 12 8 8 Infants 204 ... 17 ... Infants 416 24 18 7 Monega Road Girls 470 9 13 Walton Road Girls 495 35 65 27 Boys 543 2 ... 2 Boys 520 ... ... 20 Infants 513 5 9 ... Infants 508 5 52 17 97 Defective Clothing and Boots. The percentage of children with defective clothing was considerably less than during the year 1912, but it must be borne in mind that the observations were not all made by the same individual. Of the children with defective boots the percentage was much the same as in 1912. Boys. Girls. Percentages with Defective Clothing 0.35 0.21 Percentages with Defective Boots 3.3 2.6 Nutrition. 168 boys and 130 girls (percentages of 6.5 and 5.5 respectively) were under normal nutrition, whilst 15 boys and 8 girls (percentages of 0.59 and 0.34 respectively) were badly nourished. These figures are lower than the corresponding ones for 1912. Again, the figures are not strictly comparable, as many of the estimations were made by a different observer in 1913, and, as is well known, each Medical Officer is guided by his own individual experience of children. 98 AVERAGE WEIGHTS AND HEIGHTS COMPARED WITH ANTHROPOLOGICAL STANDARD. HEIGHT. East Ham Children. Anthropological Standard. BOYS. GIRLS. BOYS. GIRLS. No. Exam'd. Centim. No. Exam'd. Centim. Centim. Centim. 5 years 944 104.9 935 104.4 104.2 102.8 6 years 443 109.6 494 109.6 111.8 108.6 13 years 917 145.1 748 141.6 144.4 146.6 WEIGHT. East Ham Children. Anthropological Standard. BOYS. GIRLS. BOYS. GIRLS. No.. Exam'd. Kilog. No. Exam'd. Kilog. Kilog. Kilog. 5 years 944 17.5 935 17.4 17.9 17.7 6 years 443 18.7 494 18.8 20.1 18.9 13 years 917 36.3 748 37.9 37.5 38.7 99 AVERAGE HEIGHTS (IN CENTIMETRES) ACCORDING TO SCHOOLS. SCHOOLS. 5 YEARS. 6 YEARS. 13 YEARS. Boys. Girls. Boys. Girls. Boys. Girls. Castle Street, R.C. 106.0 104.4 113.0 109.7 143.0 146.5 Central Park Road 107.5 106.8 110.7 109.7 144.7 147.5 Essex Road 100.8 104.4 110.4 109.1 143.6 145.9 Fourth Avenue 105.7 103.4 107.3 107.5 146.3 142.5 Hartley Avenue 106.3 104.7 107.5 109.9 145.0 148.0 High Street 101.9 101.0 112.3 108.8 144.6 147.2 Kensington Avenue 107.8 106.7 112.2 111.2 147.4 150.4 Lathom Road 107.8 105.1 115.6 108.0 147.9 149.3 Manor Park 106.0 105.5 110.5 110.8 146.3 145.9 Monega Road 106.2 104.4 109.2 108.8 147.7 148.3 Napier Road 105.6 105.0 108.9 110.1 144.2 135.6 New Beckton 105.2 106.8 113.0 109 3 144.5 147.4 North Woolwich 105.9 103.0 113.5 115.4 - - Plashet Lane 100.0 104.0 107.1 108.6 143.4 153.2 St. Winefride's, R.C. 106.8 106.6 106.2 105.9 140.6 146.0 Sandringham Road 106.9 102.6 110.1 105.7 148.4 150 6 Shaftesbury Road 104.2 105.7 110.0 108.2 144 6 137.7 Shrewsbury Road 103.7 103.7 105.1 108.5 150.7 147.9 Silvertown, R.C. 100.7 100.6 103.0 107.9 146.1 150.8 Vicarage Lane 104.6 104.8 108.5 108.6 141.7 145.9 Walton Road 104.4 103.3 106.4 104.1 142.7 144.3 100 AVERAGE WEIGHTS (IN KILOGRAMMES) ACCORDING TO SCHOOLS. SCHOOLS. 5 YEARS. 6 YEARS. 13 YEARS. Boys. Girls. Boys. Girls. Boys. Girls. Castle Street, R.C. 17.7 17.7 20.8 19.4 33.9 37.5 Central Park Road 18.7 18.7 19.4 18.7 35.8 37.3 Essex Road 17.4 19.0 19.5 19.2 35.4 38.3 Fourth Avenue 18.2 17.5 18.9 18.7 37.6 36.5 Hartley Avenue 17.5 16.9 17.5 19.1 35.1 39.2 High Street 17.6 16.9 19.9 18.3 35.0 38.1 Kensington Avenue 18.6 17.5 19.3 19.1 37.9 40.6 Lathom Road 17.7 16.8 19.3 17.6 37.7 38.9 Manor Park 17.0 16.5 18.5 18.3 37.7 37.9 Monega Road 16.2 17.2 18.3 17.5 36.9 39.4 Napier Road 17.4 17.3 18.4 18.2 35.6 37.8 New Beckton 17.6 18.5 19.7 18.3 35.4 36.8 North Woolwich 17.5 16.5 20.4 21.1 — — Plashet Lane 16.5 17.2 18.1 17.6 35.1 40.6 St. Winefrides, R.C. 18.0 17.6 16.5 16.6 34.4 34.9 Sandringham Road 18.1 17.0 19.5 18.3 37.9 39.8 Shaftesbury Road 17.4 17.2 18.5 17.6 36.0 38.2 Shrewsbury Road 17.4 16.8 18.2 18.9 39.8 36.9 Silvertown, R.C. 17.0 17.1 17.3 23.5 37.2 38.4 Vicarage Lane 17.4 17.5 18.6 20.4 36.5 37.8 Walton Road 17.3 18.1 20.1 17.9 35.4 34.7 101 Teeth. The percentages of decayed teeth found at routine inspection were as follows:— 1 to 2. 3 to 4. More than 4. Boys 25.7 20.7 8.9 Girls 26.4 19.5 9.3 These figures are in the majority of cases higher than the corresponding ones for 1912. The scheme for dental treatment outlined in my report for 1912 has been in operation since the end of January, 1913. It makes provision for the routine examination and treatment of children aged 6 to 8 years. The report of the School Dentist for the year will be found on page 115. 102 Enlarged Tonsils and Adenoids. 8'9 per cent, of the boys and 9.3 per cent, of the girls had slightly enlarged tonsils, and 1.7 per cent, boys and 1.9 per cent, girls had tonsils that were much enlarged. The percentages of children affected with post-nasal adenoids were 5.5 and 5.9 for boys and girls respectively. Many of the cases were advised to have operative treatment. Not infrequently parents have asked if their childrens' throats needed attention, thus showing that the people generally are becoming educated as to the importance of post-nasal obstruction and enlarged tonsils. Mental Defects. Of the boys and girls examined at Routine Medical Inspection, 10 per cent, of the boys and 12.9 per cent of the girls were considered dull. 14 children were found to be mentally deficient. The coming into force of the Mental Deficiency Act, 1913, will in future require greater attention being paid to this subject. The duties laid upon local Education Authorities have already been mentioned on page 83. It is hoped that by the adoption of the scheme of examination recommended by the Board and the employment of the tests of Binet and Simon, the result will become more uniform throughout the country. 103 Ringworm. During the year 1913 there were discovered at routine inspection 15 cases of Ringworm as compared with 22 cases during 1912. Parallel with this reduction the total number of children excluded for this affection was also lower, there being 165 for 1913, against 217 in 1912. Hence it may be concluded that the incidence for the year 1913 was lower than in the preceding year. An attempt was made to treat some of the cases with Liquor Ferri Perchlor Fort B.P. after the method recommended by Dr. Garrett, of Cheltenham. It was found that early cases responded well to this treatment, but those of long standing were not benefited. As in several instances the children failed to attend regularly and the work of the nursing staff in other directions began to suffer, the method was discontinued. Ringworm was discussed at some length in last year's Report. It is hoped that X-ray treatment will soon be made available at the East Ham Hospital. The following table gives the incidence of Ringworm of the Scalp in 1913, in each of the Borough Schools:— 104 TABLE SHOWING SCHOOL INCIDENCE OF RINGWORM OF SCALP DURING 1913. Schools. Ringworm of Scalp. Percentage of Average Attendance. Castle Street, R.C. 2 0.75 Central Park Road 8 0.49 Essex Road 11 0.76 Fourth Avenue 6 0.56 Hartley Avenue 23 1.5 High Street 4 0.42 Kensington Avenue. 14 0.97 Lathom Road 9 0.63 Manor Park 6 0.59 Monega Road 7 0.54 Napier Road 14 1.01 New Beckton 2 0.25 North Woolwich 2 0.58 Plashet Lane 5 0.35 St. Winefride's, R.C. 4 1.6 Sandringham Road 1 0.10 Shaftesbury Road 20 1.3 Shrewsbury Road 6 0.78 Vicarage Lane 10 0.85 Walton Road 6 0.4 160 0.7 105 Tuberculosis. At routine inspection the incidence of Tuberculosis was found as follows:— Glandular. Osseous. Pulmonary. Boys 11 8 10 Girls 10 2 14 Percentages— Boys 0.43 0.31 0.39 Girls 0.42 0.09 0.59 In addition to the above found at routine inspection, other cases came under the notice of the school medical department. Altogether 65 cases of Tuberculosis in its various forms were excluded for longer or shorter periods during 1913, and at the end of the year there were still excluded 43 cases of the Pulmonary form. Several of the latter were considered bad enough to advise permanent exclusion. Others were probably in the pre-tubercular stage, and at the moment of writing some have returned to school and exhibit no signs of the disease. FOLLOWING UP. No change was made in the method employed in former years. The homes of defective children were visited 943 times in 1913, as compared with 1,254 visits in 1912. Here again there is evidence that the extra time spent by the nurses at the General and Dental Clinics has encroached upon their other duties. With the prospect of an immediate extension of routine inspections, and presumably an increase in the number of defects discovered, the appointment of an additional nurse becomes imperative. The table of results will be found on the next page. During the year a large number of cases of carious teeth was notified. It will be seen by reference to the table that 457 of these received no treatment. Most School Medical Officers must be familiar with this statement by parents, "Oh ! I thought they 106 TABLE OF RESULTS AFTER FOLLOWING UP. Clinic. Hospital. Private Practitioner. Home Treatment. No Treatment. Per centnge in whom treatment was unnecessary through spontaneous cure or relief. Left. Refused. Totals. Glasses. Treatment. Opera, tion. Glasses. Treatment. Operation. Glasses. Treatment. Defective Vision including Squint 149 27 1 64 6 ... 15 7 ... 113 62 28 42 514 Enlarged Tonsils and Adenoids ... ... 116 ... 11 7 ... 11 ... 111 53 6 33 348 Discharging Ears and Deafness ... 27 9 ... 19 ... ... 16 13 36 6 4 2 132 Inflamed Eyes ... 16 ... ... 3 ... ... 2 6 1 ... ... ... 30 Malnutrition, Anaemia and Debility ... ... ... ... 4 ... ... 6 2 ... 1 ... ... 13 Ringworm, Impetigo and other skin affections ... 2 ... ... 2 ... ... 2 2 2 ... ... ... 10 Decayed Teeth ... 121 ... ... 31 ... ... 62 ... 457 5 71 40 787 Other conditions ... 5 2 ... 43 ... ... 49 9 38 10 4 1 158 149 198 128 64 123 7 15 155 32 753 137 118 118 1992 107 were only the first teeth "when it is pointed out to them that the six-year-old molars (the first of the permanent set) have become decayed. Obviously a considerable number of parents either do not think their childrens' teeth require attention or they cannot afford dental fees. There is undoubtedly a certain number of parents whose resources are taxed to provide sustenance for their children, let alone the cost of dental treatment. It is true that when the scheme of dental treatment launched by the Education Committee has been in work for a few years, the majority of the bad cases of dental caries will disappear, as they will have been caught at an earlier and savable period. EDUCATION OF BLIND, EPILEPTIC AND MENTALLY DEFICIENT CHILDREN The following cases of the above defects are at present boarded out in the Institutions named:— Royal Normal College for the Blind 1 boy. Swiss Cottage Institution for the Blind 1 boy. St. Elizabeth's Home for Epileptics, Much Hadham 1 girl and 1 boy. PROVISION OF MEALS. The Education (Provision of Meals) Act as administered in the Borough is placed outside the scope of the School Medical Department. The School Medical Officer and his Assistant visit the centres occasionally but take no part in the selection of children to be fed. This is contrary to the recommendations made by the Board of Education in their Annual Report for 1912. The Board point out that an effective co-ordination should exist between the work of the provision of meals and that of the 108 school medical service; and they consider no scheme as wholly satisfactory unless the School Medical Officer (a) has the right to nominate for school feeding any children found at the routine medical inspection or on special examination to be suffering from mal-nutrition due to insufficiency or unsuitability of food; (b) is consulted as to the dietary provided; (c) has the right and duty of inspecting the actual ments made in regard to the preparation, distribution, and service of the meals; (d) is consulted in all cases of doubt as to the necessity for retaining a child on the feeding list owing to its physical condition. THE TEACHING OF HYGIENE. Mothercraft and Schools for Mothers. Six cookery centres in the Borough provide instruction for 1,600 children annually. The teaching of temperance and hygiene—with the exception of cookery—does not form part of the syllabus. Optional instruction is given to the senior pupils by reading lessons in such subjects as Baby Care, Health, Temperance, Elementary Anatomy, and Physiology, etc. Instruction in the care of infants and young children is becoming increasingly frequent throughout the country as part of the school curriculum. From my experience gained in general practice and more recently in connection with the Infants' Clinic, I am convinced of the urgent need of systematically instructing the elder girls in the Care and Management of Infants. I therefore suggest that a class be started at one of the more central schools. Thus far East Ham cannot boast of a School for Mothers. The Infants' Clinic at the Council Offices in Wakefield Street will, however, form an excellent nucleus. Indeed, at the present time the work carried on there, as far as its scope extends, compares favourably with that of schools for which grant is payable. 109 In order that the East Ham Infants' Clinic should qualify for grant as a School for Mothers it would be necessary to establish systematic classes in various subjects, such as Hygiene, Infant Care, Home Nursing, Garment Making, and so forth, and to obtain for these classes the official recognition of the Board of Education. INSTRUCTION IN SWIMMING. Bathing accommodation is now available for 1,000 boys and 500 girls each week. The baths are open to boys on Monday, Tuesday, and Thursday forenoons, and the boys attend from the separate schools, 60 in number, each half-hour. For girls the baths are available on Monday afternoon and on Wednesday forenoon and afternoon. One teacher accompanies every 30 scholars. THE INSPECTION CLINIC. The Inspection Clinic was conducted on each school day as follows:—Monday, Tuesday, Wednesday, and Thursday from 9 to 10 a.m., and on Friday from 9 a.m. until noon or later as the work demanded. In addition a few special cases were seen on Saturday mornings. As in the previous year, cases which required detailed and lengthy examination were frequently met with between 9 and 10 o'clock, and if the nature of such allowed of their being referred to Friday forenoon, when more time was available, this was done. The supply of cases to the Inspection Clinic was from the following sources:— 1. Cases referred from Routine Medical Inspection for further examination. 2. Cases sent by School Teachers. 3. Cases sent by Attendance Officers. 4. Cases sent by Divisional Committees, and 5. Cases brought by parents. 110 The number of consultations at the Inspection Clinic during 1913 was 5,626; this was 2,136 in excess of the number in 1912. This number includes cases that were subsequently referred to the Ophthalmic Surgeon for more detailed examination, but does not include cases seen by the Dentist. It is thus seen that judged merely by the number of consultations the Inspection Clinic is not losing in popularity. Probably no part of the work of medical inspection of school children has been more useful. It is, however, impossible to show in statistics all that has been done in the way of advice. On the next page will be found a detailed list of the various affections for which children were sent to the Clinic. The total number, 5,626, does not represent that many cases. It has happened that the same case has been seen at intervals of a fewdays for a week or more. The number of throat cases shows a great increase on the previous year's experience. The same statement applies to cases of Impetigo Contagiosa and cases sent forward by the Divisional Committees. I should like to draw attention to the number of cases met with of infectious diseases. During 1913 there were 171 seen at the Clinic, as compared with 130 in 1912. This aspect of the Clinic is of prime importance, for apart from the value accruing to the individual of an early diagnosis, especially in the case of Diphtheria, there is the effect of lessening the danger of spread of infection in the school and in the community at large. TREATMENT CLINIC. On table inset facing page 112 and on table on page 112, will be found records showing the common affections for which treatment was provided and the number of treatments afforded. During 1913 the Clinic was open for treatment each week-day except Saturday and throughout the holidays. The total number of treatments given for the year was 183 in excess of 1912. The increase was mainly in respect of Ringworm and Discharging Ears. 1ll CLASSIFICATION OF CONSULTATIONS AT INSPECTION CLINIC, 1913. Ringworm of Scalp 897 Ringworm of Body 126 Throat Affections 828 Vision Cases 802 Impetigo Contagiosa 478 Chest Examinations 279 Corneal Ulcer and other External Eye Inflammations 271 Attendance Cases 202 Infectious Diseases 171 Teeth 142 Unclassified 139 Ear Affections 123 Scabies 109 Eczema 108 Tuberculosis (all forms) 100 Non-Specific Rashes 77 Glandular Affections 71 Verminous Conditions 64 Catarrh of Respiratory Organs 63 Stomach Affections 60 Chorea 69 Nervous Disorders 58 Injuries 54 Nose Affections 47 Anaemia and Debility 46 Heart Affections 24 Alopœcia Areata 23 Abscesses, various 22 Pityriasis Alba 20 Rheumatism 17 Seborrhœa 16 Mental Affections 15 Herpes 10 Spinal Affections 10 Urinary Affections 9 Epilepsy 8 Hernia 7 Psoriasis 7 Deformities 7 Bright's Disease 6 Shingles 6 Tumours 6 Urticaria 5 Affections of Speech 3 Menorrhagia 3 Jaundice 3 Acne Vulgaris 3 Paralysis 3 Cellulitis 3 Mastoiditis 3 Appendicitis 3 Œdema 2 Nævus 2 Torticollis 1 Diarrhœa 1 Erythema Nodosum 1 Goitre 1 Hysteria 1 X-ray Dermatitis 1 Total 5,626 112 TABLE OF RESULTS OF CLINIC TREATMENT (Dental and Vision Cases Excluded). Cured. Relieved. Unchanged. Left the Borough. Totals. Impetigo 4 ... ... ... 4 Blepharitis 19 ... ... ... 19 Corneal Ulceration and other external eye inflammation. 54 3 2 ... 59 Discharging Ears and Deafness 47 21 13 5 86 Ringworm—Body 23 ... ... ... 23 Head 31 ... 19 ... 50 Septic Wounds, Abscesses, &c. 44 ... 6 ... 50 Eczema 2 ... ... ... 2 Scabies 1 ... ... ... 1 Totals 225 24 40 5 294 It remains for me to express my indebtedness to the Committee for the sympathetic attitude they have always shown towards Medical Inspection. My thanks are also due to the Secretary to the Committee for many courtesies and helpful acts; to the school nurses and teachers, and to Miss Perry for preparing neat and careful records. I am, Mrs. Ford and Gentlemen, Your obedient Servant, WILLIAM BENTON, Medical Officer to Education Committee. TREATMENT CLINIC. SHEWING THE NUMBER OF TREATMENTS CARRIED OUT AT THE CLINIC (DENTAL AND OPHTHALMIC CASES ARE NOT INCLUDED). Number of Times Treated 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 20 21 22 23 24 26 27 29 33 39 45 48 55 59 60 68 84 93 97 Totals. Impetigo ... 1 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Blepharitis 4 8 2 1 1 ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61 External Inflammation of Eyes other than Blepharitis. 3 17 7 7 4 2 ... 3 6 1 ... ... 1 2 ... ... ... ... 1 ... ... ... ... ... 1 2 1 1 ... ... ... ... ... ... ... ... ... 424 Discharging Ears and Deafness 10 21 12 6 4 1 2 ... 4 ... ... 1 1 ... ... 2 1 ... 2 ... ... ... 1 1 1 1 1 2 2 1 2 1 1 1 2 1 1 1312 Ringworm Body 4 8 4 3 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 67 Head 2 5 3 3 4 1 3 1 3 ... 2 ... 2 1 ... 2 1 1 1 1 3 2 ... ... 3 2 2 1 1 ... ... ... ... ... ... ... ... 686 Septic Sores and Abscess Formation. 2 12 8 8 2 3 1 3 5 3 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 254 Eczema ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Scabies ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Totals 25 144 114 116 85 48 63 64 162 40 44 36 52 42 15 80 34 18 80 21 66 46 24 26 135 145 132 156 135 48 110 59 60 68 168 93 97 2851 113 APPENDIX I. Report of Ophthalmic Surgeon. The selection of cases for Ophthalmic examination is made partly on the results of the preliminary test of vision at the schools and partly from special cases complaining of difficulty with distant vision or persistent headache, etc., and referred by the teachers to the Inspection Clinic. Children with eye symptoms or visual defects are requested to attend the Inspection Clinic held on Friday forenoons. A further examination is made under more perfect conditions of light. Where there is found a defect sufficient to suggest the necessity for glasses, atropine ointment is put into the eyes and a small box of ointment, with simple instructions as to its application, is given to the parent, who is told to bring the child again on the Monday following. On Mondays the new cases are seen. Towards the end of the session the Optician attends and takes measurements of the children requiring glasses and also distributes glasses ordered to those children who were seen the previous week. By this means the Surgeon is enabled to make a final inspection and the suitability of such spectacles is ensured. Further, the dual attendance of the Surgeon and Optician is a distinct advantage in cases where questions arise as to special points in spectacles. Provision of Spectacles. At the present time the spectacles cost 3s. 6d. or 2s. per pair according to the lenses. For these prices a good solid nickel or nickel steel frame and best quality lenses are provided. The question is now under consideration as to whether a flat rate of 2s. 6d. should be charged for every pair. In necessitous cases the spectacles are paid for out of a fund supported by voluntary contributions and controlled by the School Medical Officer. The shades used in the treatment of squint cases are supplied at cost price by the Optician. 114 During the year 1913 there were 355 cases examined as follows:— Myopia 46 Simple Myopic Astigmatism 8 Compound Myopic Astigmatism 42 Hypermetropia 68 Simple Hypermetropic Astigmatism 33 Compound Hypermetropic Astigmatism 64 Mixed Astigmatism 28 Odd Eyes 17 Prisms only 2 Squint without refractive error 47 Corneal Opacities Ciliary Spasm No defect Total 355 Each of the above received appropriate treatment. 115 APPENDIX II. First Annual Report of the Dental Treatment at the East Ham School Clinic. Accommodation. The same rooms are at the disposal of the Dental Officer as for the School Medical Officers and the eye specialist, and are in use three mornings per week for dental work, viz., Tuesday, Wednesday, and Thursday. The surgery is equipped with an up-to-date operating chair, spittoon, and all necessary instruments, etc. Equipment and Outfit. Chair.—An hydraulic pump chair specially designed and adapted for children is in use. The back, arms, head-rest, etc., are adjustable, so that the chair will accommodate children of the youngest or oldest school age. All the metal parts are white enamel or oxidised copper, the seat, back, and footboard of wood, and the head-rest of leather, so that the various parts can easily be kept clean and sterilised. The Cabinet.—An antiseptic table with hospital cupboard enamelled white, glass sides and shelves to keep all the instruments, drugs, materials, etc., used in the dental department. Spittoon.—The most necessary part of the outfit is of crystal glass with japanned base with hot and cold water supply. Dental Engine.—The engine is of the electrical type, all cord, motor japanned black and plated arm. Bracket Table is mounted on tripod stand enamelled white, provided for holding the instruments, etc., in use during each operation, and is easily kept clean. Artificial Light is provided by means of an adjustable electric pendant above the chair. 116 Sterilizer.—This is an electric type and is used for boiling all instruments after each operation. A modified form of Bale's School Dental Clinic Card Index System is used for keeping the records of examinations and operations performed. The object of dental treatment in a school clinic is to promote the health of the children and thus increase their comfort and well-being', that they may be able to take advantage of the instruction given them. Another obvious benefit which necessarily follows will be better attendance, as no child receiving proper and regular dental attention need suffer from toothache so severely as to warrant non-attendance at school. In this way much time and trouble, and therefore money, will be saved; and better, healthier individuals sent out to the lasting benefit of the community. Having briefly considered this subject from the point of view of health, we must not lose sight of the fact that it is an educational scheme and that good health is necessary to enable the scholars to acquire the knowledge that is imparted to them. We should also bear in mind the importance of children being educated to appreciate the value of keeping their teeth and mouths in a healthy condition for health's sake. The practical value of learning to a person is greatly diminished if the individual is not in good health, so that to educate children to care for their teeth is of the first importance. We will perhaps better realise the extreme importance of keeping the mouth and teeth in a clean and healthy condition when we consider the fact that the mouth is the "gateway" of the body. Everything that enters the alimentary tract passes through it, and of necessity becomes contaminated unless the mouth and teeth are kept thoroughly clean. Of what use is it that such great care is taken (and very rightly, too) to ensure that our food, milk, meat, bread, etc., should be pure, wholesome, and unadulterated, if all kinds of filth and disease germs, by the million, are swallowed with each mouthful at every meal, from a dirty mouth and diseased teeth? 117 Is it not obvious that such constant poisoning of the system, even if it does not lead to actual ill-health (as is frequently the case), will prove a very serious tax and extra strain upon the vital forces of the body? Examination of the mouths of the children in the schools confirms the very serious conclusion that this condition tends to progress rapidly, and the unhealthy state of the mouths and teeth goes from bad to worse. It will, therefore, next be instructive to enquire what are the causes of this condition. It is primarily due to dental caries (decay of the teeth). This by far the most common, yet at the same time most easily cured and preventable disease, is due to various causes, the chief of which are heredity, constitutional weakness, lack of oral hygiene, improper diet, &c. These various factors may work separately, but more commonly in combination, by far the most important undoubtedly being improper feeding, more especially during infancy and adolescence, but also during the whole of life. Foodstuffs are commonly taken containing substances that readily ferment in the mouth, with the formation of lactic acid, in small quantities, but in the nascent (most active) state. The acid so produced dissolves the tooth substance, and with the germs normally present in the mouth, is the most important factor in the causation of decay of the teeth. The method that has so far been found useful for investigating and recording the condition of the childrens' mouths and treating such cases as are suitable is as follows:—Having no school nurse, the kindly assistance of the teachers is obtained to write names, age, &c., on the cards (Appendix A, page 121), one card being used for each scholar. A convenient time is then arranged for examination. Suitable instruments are taken to the school. A careful note of such children as require treatment at the Clinic is made, and printed notices stating the object and aims of such attention are then sent by the Clerk to the parent or guardian of such child (Appendix B, page 121). A form, to be signed, if the parent desires the necessary treatment to be carried out, accompanies the above. On the return of these forms duly signed an appointment is sent fixing a time for attendance at the Clinic. In most cases parents accompany their children on the visits to the Clinic. 118 During the year 3,215 children have been examined. Of these 1,160 did not require any treatment, i.e., 67 per cent, required treatment. Among- these were scholars over the age of 8, who only received attention when the condition of the teeth and mouths were such as to interfere with their attendance at school and education. The 934 children who were examined and treated had 18,116 teeth, of which 10,165 belong- to the milk or temporary set. Of these temporary set 7,224 were sound, 2,926 were so hopelessly decayed as to be unsavable, and in many instances doing serious damage to the health of the child and to the teeth of the permanent set forming beneath them in the jaw. Of the 7,951 permanent teeth, 7,280 were sound, 295 were hopelessly decayed and 376 required filling. A few words here will not be out of place as to what has been done to alleviate these existing conditions. 934 children have been treated at the Clinic during the past year, and these made in the aggregate 1,313 attendances. 2,664 teeth were extracted, those of 50 children under the anaesthetic influence of ethyl chloride; the remaining teeth were removed (mostly temporary) by local anaesthetic. In addition to this, 171 fillings were inserted. All dirty mouths and teeth needing attention were scaled and cleaned. The time occupied was 117 attendances at the Clinic for surgical work, the remainder for examinations at the school. The sum received from parents in fees amounted to £11 3s. lOd. The following is a summary of treatment:— Of children treated 934 Of attendances made by such children 1,313 Of extractions 2,664 Of fillings 171 Amounts received from parents towards cost of treatment £11 3s. lOd. Cases for gas 50 Cases for local anaesthetics 342 119 CASES EXAMINED BY SCHOOL DENTIST. Numbers not requiring treatment. Numbers still requiring treatment. Numbers treated. Total number examined. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Castle Street R.C. 2 3 2 3 Central Park Road 8 6 8 6 Essex Road 14 7 14 7 Fourth Avenue 7 3 7 3 Hartley Avenue 24 18 24 18 High Street 52 48 61 59 38 58 151 160 Higher Elementary 2 2 Kensington Avenue 8 10 8 10 Lathom Road 54 52 98 104 84 66 226 218 Manor Park 10 13 10 13 Monega Road 90 94 90 101 29 42 209 230 Napier Road 103 103 71 55 61 58 228 217 New Beckton 8 3 8 3 Plashet Lane 96 88 79 72 37 30 204 186 St. Winefride's R.C. 1 1 1 1 Sandringham Road 1 2 1 2 Shaftesbury Road 86 84 118 114 35 21 222 220 Shrewsbury Road 43 31 44 52 27 20 112 100 Silvertown R.C. 2 1 2 1 Vicarage Lane 76 60 40 43 90 80 194 180 Walton Road 3 1 3 1 600 560 601 600 490 444 1636 1579 Shaftesbury Road School wa» inspected in 1913, but not treated until 1914. 120 CASES TREATED AT DENTAL CLINIC. Ages. Number Exam'd. Temporary Teeth. Permanent Teeth. Extractions. Anaesthetics. Scalings. Dressings. Fillings. Saveable. Unsaveable. Saveable. Unsaveable. Temp. Teeth. Perm. Teeth. Local. N2O. 5 years B. 30 4 115 ... ... 70 ... 17 ... ... ... 2 G. 37 ... 152 2 ... 108 ... 31 1 ... ... 1 6 years B. 100 3 372 22 ... 311 ... 38 7 ... 3 9 G. 103 3 397 21 1 326 ... 29 6 ... ... 8 7 years B. 124 2 453 36 3 403 2 31 8 1 2 18 G. 101 1 364 36 10 292 7 34 7 ... 3 18 8 years B. 94 ... 273 49 8 251 6 17 3 ... 2 31 G. 72 2 265 45 12 226 7 19 4 ... 5 22 9 years B. 48 ... 98 14 9 82 7 14 ... ... 1 7 G. 42 ... 145 30 11 127 19 12 3 ... 3 15 10 years B. 30 ... 68 13 23 49 15 10 1 1 4 8 G. 26 ... 58 17 21 50 14 14 ... ... ... 1 11 years B. 14 ... 28 8 13 30 5 5 ... ... ... 1 G. 16 ... 44 8 22 30 19 11 ... 2 ... 7 12 years B. 18 ... 29 10 22 19 17 7 1 2 ... 3 G. 24 ... 29 16 33 24 35 15 4 ... ... 4 13 years B. 26 ... 21 28 43 20 33 15 2 1 8 12 G. 18 ... 6 9 39 7 24 14 1 1 ... 2 14 years B. 6 ... 2 8 18 1 12 6 2 ... ... ... G. 5 ... 7 4 7 6 10 3 ... ... ... 2 Totals B. 490 9 1459 188 139 1236 97 160 24 5 20 91 G. 444 6 1467 188 156 1196 135 182 26 3 11 80 934 13 2926 376 295 2432 232 342 50 8 31 171 117 attendances for treatment. 121 Age. APPENDIX A. Treatment Card. Date. Name. Sch. Date. Temp. Teeth. Sound Save Unsa. Perm. Teeth. Sound Save Unsa. Extractions Anaesthetics. Sealing. Dres. Ag. No, Fillings. Notes Temp Teeth Perm Teeth Local. n2o. (Green Card for Boys and Pink for Girls). On the back is a diagram of the upper and lower jaws, showing both temporary and permanent teeth, and this is marked by the Dentist .x) show the teeth extracted or filled. APPENDIX B. Borough of East Ham Education Committee. Dental Treatment of School Children. Town Kail, East Ham, School Dentist: C. H. Taylor, L.D.S. 191 To the Parents and Guardians of The Teeth of the above-named child have been reported by the School Dentist to be in need of attention. It is strongly urged that your child should have the necessary treatment. This can be obtained by taking your child to your own Dentist, or by filling* in the attached form, and returning it to me, you cvin have treatment tor your child done by the School Dentist at the Town Hall. Parents will be notified of the hours children are required to attend the Dental Clinic. W. Benton, School Medical Officer. N.B.—A small charge to those who can afford will be made for treatment by the School Dentist. (Please detach this portion and return signed to the School Medical Officer, Town Hall.) I wish my child (Name of Child.) attending (Name of School.) to have dental treatment at the School Clinic. (Name of Parent or Guardian). (Residence). Report OF THE Cbtef Sanitary Jnspectov FOR THE YEAR 1913. 124 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 submit to you my eighteenth Annual Report of the work done by the Sanitary Inspectors during the year ended 31st December, 1913. INSPECTION OF THE BOROUGH AND ABATEMENT OF NUISANCES. The total number of primary inspections made during the year under consideration was 5,627, as compared with 6,568 for the previous year 1912. It will be observed there is a decrease of 941 in the number of inspections made. This is accounted for by the fact that during the year 1912 there was a low notification rate, and reference to the Medical Officer of Health's report will reveal that there has been a considerable increase in the number of infectious cases, which occupies a large portion of the Inspectors' time in investigating, and leaving less time to be devoted to house to house inspection. It will be noticed that the decrease in the number of inspections is greater than the increase of infectious cases, but it is obvious that to inspect infected houses scattered over a large area occupies a greater time than inspecting a row of houses adjoining each other. The inspections include house to house inspections, visits to premises upon complaint of nuisance, inspection of markets, workshops, slaughterhouses, bakehouses, cowsheds, dairies, etc. The health of the Borough is the first consideration of the inspectorial staff, who perform this work with one object in view —that the Borough may maintain its good record of being a healthy district. 125 PRIMARY INSPECTIONS. Beckton and N. Woolwich Ward. Centt a' Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total. 1912 1913 1912 1913 1912 1913 1912 1913 1912 1913 1912 1913 1912 1913 Tanuary 66 61 241 107 86 194 94 92 35 22 93 146 615 622 February 83 24 244 242 80 61 101 99 25 14 89 145 572 585 March 28 77 241 84 68 50 127 65 35 10 100 117 599 403 April 70 77 162 172 77 34 95 126 31 20 77 95 512 524 May 235 48 80 105 27 105 83 96 32 39 50 120 507 513 June 196 37 83 152 63 32 97 49 39 6b 91 75 569 411 fuly 65 47 117 172 185 66 58 40 33 49 122 54 580 428 August 32 34 149 49 71 35 84 72 47 18 98 70 481 278 September 18 49 29 76 48 89 99 86 24 26 57 78 275 404 October 62 70 84 97 267 81 121 114 34 38 101 86 669 486 November 35 35 80 141 225 65 149 122 33 30 133 77 655 470 December 54 50 75 91 110 128 145 133 34 30 116 71 534 503 Totals 894 609 1,585 1,488 1,307 940 1,253 1,094 402 362 1,127 1,134 6,568 5,627 As the result of the 5,627 inspections made of premises in the Borough, some 5,212 nuisances were discovered. These nuisances comprised choked and defective drains, dirty and dilapidated walls and ceilings, defective yard pavings, leaky roofs, drinking water improperly stored in cisterns, unsound food, offensive accumulations, defective sanitary appliances, animals (particularly poultry) kept near dwelling houses in dirty condition, etc. To obtain the abatement of the nuisances referred to in the table necessitated the serving of 1,725 preliminary notices, 81 statutory notices, 8 water notices, 193 dust bin notices, a large number of intimation letters, together with numerous interviews, and in 11 instances legal proceedings were instituted. Following is a tabulated statement showing sanitary defects discovered and remedied under the Public Health Acts, East Ham Improvement Acts, and the Council's Bye-Laws and Regulations :— 126 COMPLAINTS RECEIVED. During the year, 1,028 complaints were received, 605 written and 423 verbal, the figures for the previous year being 984 complaints, 625 written and 359 verbal. The majority of the written complaints were anonymous. COMPLAINTS RECEIVED. Beckton and N. Woolwich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total. January 4 24 14 25 14 28 109 February 3 16 8 18 8 16 69 March 2 14 12 12 10 9 59 April 4 23 22 48 14 18 129 May 6 14 13 27 12 16 88 June 10 14 20 17 7 13 81 July 5 25 14 30 5 18 97 August 4" 18 11 19 5 17 74 September 6 25 17 20 10 9 87 October 10 26 14 33 11 10 104 November 4 12 17 22 12 9 76 December 9 13 9 12 7 5 55 Totals 67 224 171 283 115 168 1028 And referred to the following nuisances:— COMPLAINTS—NUISANCES. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total. Drains Choked 55 41 27 53 40 46 45 35 51 38 50 30 511 Accumulations 14 6 7 19 17 7 8 8 2 13 5 6 112 (Refuse, etc.) Water cut off 6 2 — 1 3 1 — — 1 — — 1 15 Offensive smells 4 — 3 3 2 2 6 8 4 8 3 — 43 Dilapidations — 1 — 2 — — — — — 4 — — 7 Insanitary condition 5 2 7 3 2 2 6 7 3 14 3 5 59 Overcrowding 2 5 — 2 1 4 8 2 1 3 1 2 31 No dust bins — — 3 7 1 2 2 2 1 7 3 1 29 Dampness 8 — 2 23 — — — — 2 — 1 — 36 Others (various) 15 12 10 16 22 17 22 12 22 17 10 10 185 Total 109 69 59 129 88 81 97 74 87 104 76 55 1028 The following is a Record in Detail of the Inspections made during the Years 1912—1933:— Beckton anil North Woolwich Ward. Central East Ward. Central West Ward. Manor Park Ward. Plashet East Ward. Plashet West Ward. Total. General. H. to H. General. H. to H. General. H. to H. General. H. to H. General. H. to H. General. H. to H. General. H. to H. 1912 1913 1912 1913 1912 1913 1912 1913 1912 1913 1912 1913 1912 1913 1912 1913 1912 1913 1912 1913 1912 1913 1912 11913 1012 1913 1912 1913 Premises found in fair condition 250 203 200 99 358 424 169 220 428 444 142 61 560 463 20 8 199 120 3 3 422 341 54 US 2221 2055 594 504 House to house inspections ... ... 459 ... ... ... 870 ... ... ... 519 ... ... ... 137 ... ... ... 39 ... ... ... 413 ... ... ... 2437 ... Outworkers 30 47 ... ... 68 75 ... ... 178 144 ... ... 07 23 ... ... 71 39 ... ... 199 95 ... ... 618 423 ... ... Factories and Workshops 28 5.5 ... ... 48 80 ... ... 56 48 ... ... 118 102 ... ... 35 21 ... ... 80 41 ... ... 305 347 ... ... Bakehouses 7 9 ... ... 19 15 ... ... 29 36 ... ... 24 18 ... ... 25 23 ... ... 38 31 ... ... 142 132 ... ... Slaughterhouses 2 1 ... ... 22 13 ... ... 3 4 ... ... 99 98 ... ... ... ... ... ... 18 18 ... ... 144 134 ... ... Dairies ... 54 44 ... ... 86 01 ... ... 70 78 ... ... 109 100 ... ... 30 29 ... ... 60 56 ... ... 409 308 ... ... Urinals inspected 15 31 ... ... 23 47 ... ... 14 36 ... ... 33 21 ... ... 6 4 ... ... 19 20 ... ... 110 159 ... ... Complaints received and attended to 89 07 ... ... 154 224 ... ... 182 171 ... ... 277 283 ... ... 113 115 ... ... 109 168 ... ... 984 1028 ... ... Walls and ceilings dirty and dilapidated 23 17 114 48 36 48 174 147 51 74 52 31 100 90 34 95 28 23 3 26 34 66 91 93 278 324 468 444 Yards improperly paved and dilapidated 7 4 82 21 21 85 309 85 40 29 110 13 45 50 39 02 15 11 6 22 29 24 120 107 157 159 678 310 No forecourt paving 6 2 15 ... 22 4 198 115 21 19 158 33 8 8 25 28 6 3 12 20 21 29 154 111 84 05 562 307 Drains unstopped and cleansed 362 251 ... ... 300 402 ... ... 410 437 ... ... 489 402 ... ... 172 235 ... ... 295 225 ... ... 2124 1952 ... ... Defective drains 8 o 10 7 16 23 10 9 23 6 ... ... 26 18 1 ... 4 3 ... 1 28 24 114 41 105 70 141 58 Defective w.c. connections 3 7 4 2 6 5 9 1 6 4 2 ... 0 9 1 ... ... ... ... ... 3 5 ... 3 24 30 16 9 Defective w.c. traps ... 1 ... 1 5 7 2 3 2 2 ... ... 6 21 7 5 1 5 ... 5 2 6 ... 1 10 42 9 15 Soil pipes and drains insufficiently ventilated ... ... ... ... ... ... 8 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 1 7 ... 3 1 15 Defective flushing apparatus 9 9 17 13 15 25 53 25 23 30 8 1 34 32 18 16 12 13 ... 12 14 25 11 21 107 134 107 88 Soil pans foul and broken 5 1 32 4 11 21 97 19 31 20 10 1 30 51 23 41 15 22 ... 26 43 44 172 117 135 1..9 340 208 Defective vent pipes 2 ... ... 7 14 22 10 12 6 8 ... 25 2(1 18 8 7 3 ... 5 13 12 9 29 66 55 57 52 R W. pipes and eaves gutters defective 4 4 10 8 10 32 131 28 14 10 16 5 37 43 35 32 7 3 6 28 10 20 19 28 82 112 217 129 Do. connected to drain ... ... ... ... ... ... ... ... ... ... 4 9 2 3 ... ... ... 9 9 3 5 28 0 5 7 40 Roofs leaky 5 3 12 7 14 13 43 19 9 11 7 1 18 19 15 0 6 2 1 0 7 16 35 20 59 04 113 71 Defective sink waste pipes 2 40 10 6 9 117 14 12 9 35 8 23 25 10 7 14 3 1 10 14 10 13 88 71 50 222 82 Houses without water (M.W.Bd.) ... ... ... 4 2 ... ... 4 1 ... ... 5 4 ... ... 6 4 ... ... 3 4 ... ... 22 15 ... ... Cisterns without covers ... ... ... 3 4 5 12 14 2 1 2 5 3 4 ... 4 3 ... ... »> 3 10 24 10 29 22 34 33 Drinking water improperly stored 3 1 31 ... 20 30 275 138 15 33 107 28 40 44 10 6 14 18 15 28 14 22 70 60 112 148 520 205 Dilapidated floors 1 13 11 1 2 37 18 5 14 8 2 13 8 12 29 1 ... 6 3 11 5 41 23 36 !u7 Insufficient underfloor ventilation 3 80 11 6 8 131 24 7 13 56 6 14 14 28 34 5 3 5 25 9 8 104 112 44 40 410 212 Dampness 5 3 5 6 8 7 13 15 9 6 2 ... 28 39 17 25 4 7 ... 9 8 9 17 26 02 85 54 81 Accumulations 18 13 ... ... 20 24 1 ... 23 26 ... ... 50 29 11 8 17 17 ... ... 23 24 2 1 151 133 14 9 Inundations 2 ... ... 1 ... ... ... 2 5 4 ... 0 1 ... ... ... 3 ... ... 4 1 lo 9 4 1 Overcrowding 3 3 ... ... 9 4 1 1 3 4 ... ... 7 10 1 1 1 1 ... ... 3 3 19 31 2 9 Unsound food ... ... ... 2 ... ... ... 6 8 ... ... 7 10 ... ... 3 ... ... ... 3 ... 21 18 No dust bins 3 1 ... 3 4 7 8 5 13 4 3 ... 18 14 15 29 2 2 4 4 11 0 29 t 40 . 34 59 48 No manure bins 1 ... ... ... 1 ... ... ... ... ... 2 1 ... 1 1 3 ... ... 1 A 5 Animals improperly kept 3 2 ... ... 4 4 3 2 5 4 ... ... I 11 2 4 2 ... ... ... 4 2 2 8 2-i 23 7 14 Temporary buildings found ... 2 ... ... 5 5 ... ... 5 7 ... ... a 9 ... 2 3 ... ... 2 1 7 19 30 * Smoke nuisances 12 45 ... ... 44 93 ... ... ... 8 ... ... 3 1 ... 9 2 1 ... ... 1 5 ... l 02 lb3 ... 3 Hear passages unpaved or undrained ... ... ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 3 1 1 ... ( ,i r-vci pc 4 ... ... 79 187 2 ... ... 11 ... ... 73 45 ... ... ... ... ... ... ... ... ... 150 243 2 ... VJ1 UolCD Breaches of Bye-Laws and Regulations 11 0 ... ... 13 8 ... 6 6 ... ... 14 3 ... ... 7 1 ... ... "l8 6 ... ... 67 30 ... ... Other nuisances 21 21 10 8 28 37 45 32 48 40 14 10 00 51 25 19 13 13 1 16 33 45 20 50 203 207 115 144 rirainc tpctpfl 65 83 35 9 95 107 37 6 123 142 2 ... 125 155 10 13 45 65 ... 6 84 150 142 42 537 768 226 70 Inspections 435 422 459 187 715 870 870 618 788 777 519 103 1116 911 137 183 363 266 39 96 714 078 413 450 4131 3924 2437 1703 127 HOUSE TO HOUSE INSPECTION. In previous reports special reference has been made to the importance of this branch of Public Health service, and as much time as is at the disposal of the inspectorial staff is given to this work, but the visitation to infectious cases receive the first claim upon the Inspectors' time. The number of premises visited were 1,703, as compared with 2,437 for the previous year. Of the 1,703 premises visited, 504 were found in such a condition as to warrant no action being taken by the Inspector for the abatement of any nuisance. This figure is equal to 29'59 premises in fair condition, and 70"40 premises at which nuisances existed. The latter figures may appear high, but house to house inspections are made in selected areas where the Inspector's experience tells him he is required. It will be observed that there is a decrease in the number of inspections made. There are one or two causes for this, the principal being the increased number of infectious cases that occurred during the year 1913, another reason being that during the latter part of 1912 a large number of inspections were made, necessitating much of the work being carried forward into the year 1913. 128 HOUSE TO HOUSE INSPECTION. NAME OF ROAD. Number of Premises Inspected. Number of Premises where Defects Existed. Number of Premises found in Fair Condition. Beckton and North Woolwich Ward. Albert Road 82 24 58 Claremont Street 48 33 15 Elizabeth Street 11 6 5 Fabian Street 19 13 6 Francis Street 19 4 15 Glenister Street High Street, N. Woolwich 1 7 1 7 187 88 99 Central Ward Central Ward East. West. Becket Avenue 35 20 15 Bonny Downs Road 85 49 36 Brighton Road 38 25 13 Eastbourne Road 66 23 43 Folkestone Road 23 14 9 Langton Avenue 41 19 22 Latimer Avenue 4 4 — Market Street 2 2 — Mountfield Road 58 28 30 North field Road 3 3 — Streatrfield Avenue 65 65 — St. Albans Avenue 13 13 — Talbot Road 31 20 11 Telham Road 62 30 32 Wellington Road 6 5 1 Molsey Avenue 86 78 8 618 398 220 Bartle Avenue 22 19 8 Central Park Road 16 10 6 Ernald Avenue 56 25 31 Gillett Avenue 2 2 — Maoaulay Road 59 41 18 Plashet Lane 3 3 — Wakefield Street 5 2 3 Manor Park Ward. 163 102 61 Church Road 8 7 1 Gloucester Road 1 1 — Grantham Road 88 85 3 Selborne Avenue 34 34 — Walton Road 52 48 4 Plashet Ward East. 183 175 8 Berkeley Road 24 23 1 Halley Road 5 5 — Monega Road 8 8 — Stanley Road 59 57 2 96 93 3 129 HOUSE TO HOUSE. INSPECTION—continued. NAME OF ROAD. Number of Premises Inspected. Number of Premises where Defects existed. Number of Premises found in Fair Condition. Plashet Ward West. Cromwell Road 04 51 13 Jephson Road 20 20 Lansdowne Road 23 13 10 Marlborough Road 09 52 7 Rothsay Road 3 3 — Rutland Road 100 62 38 Stafford Road 4 3 1 Walpole Road 40 31 9 Whitfield Road 40 32 8 Whittaker Road 44 30 14 Woodstock Road 59 40 13 456 343 113 1,703 1,199 504 DRAINS UNSTOPPED AND CLEANSED. The work of unstopping and cleansing drains has received the usual attention. The policy of the Council to send their own men free of charge to do this important work, essential to the good health of the Borough, is still in operation. The men engaged for this work are capable and well trained, having a thorough practical knowledge of the sewers, manholes, etc. Serious and permanent damage is frequently done to drains by men (engaged by owners to remove a stoppage) not being acquainted with the run of the drain, and who generally commence their work by breaking a pipe to insert the rods. There are 27,000 houses in the Borough, and at 1,952 the drains have b2en unstopped and cleansed, being 7"23 per cent. This may appear large, but when it is considered that the district is drained by combined system, and a careless act, such as allowing a scrubbing brush to be thrown down the water-closet, will cause the drains of six and sometimes more houses to be choked, the high figure is more easily understood. 130 DRAINAGE WORK. At 844 houses the drains have been tested, and in 134 instances defects in the drains have been discovered. 58 of these were the result of house to house inspections, and 76 by routine work, such as visits caused by the occurrence of a case of infectious disease, or complaint of offensive smells. In addition to the 134 defective drains there were 39 defective water closet connections and 57 defective water closet traps. In 367 instances soil pans were renewed and cleansed, and 125 new ventilating pipes were erected. For the carrying out of these sanitary amendments the District Inspectors supervised and passed the work. No pipes were permitted to be covered until they were tested. The following are premises where the principal works of reconstruction of drains were carried out during the past vear :— Royal Victoria Gardens, North Woolwich. 44, Chester Road. 69-79, Market Street. 53-57, Marlborough Road. 88-104, Parkhurst Road. 610-614, Romford Road. 1-21, Skeffington Road. 18-24, Whitfield Road. SANITARY APPLIANCES. This term includes the appurtenances to the drains proper, and during the year there have been 222 flushing apparatuses to the water closets renewed or repaired, as compared with 214 for the previous year. 138 waste pipes from scullery sinks and baths were dealt with, as compared with 293 for the year 1912. DIRTY PREMISES. Under this form of nuisance are included dirty walls and ceilings, and at 768 premises the internal cleansing of walls and ceilings has been performed, the figures for the previous year being 746. By reference to the nuisance table inset facing page 126, it will be seen that there has been 1,703 house to house inspections made, and at 444 of the houses internal dirty walls and ceilings were discovered. This is equal to 26'0 per cent, of 131 the inspections made, while as a result of ordinary routine work, which include the inspections made upon complaint and at dairies, slaughterhouses, bakehouses, etc., the inspections were 3,924, and nuisances arising from dirty walls and ceilings were 324, being equal to 8'25 per cent., the figures for 1912 being 6'7. ROOFS, EAVES GUTTERS, AND RAIN-WATER PIPES. In 421 instances Notices have been served upon owners to abate nuisances caused by defective roofs, eaves gutters, and rain water pipes. Serious damage is often done to property by neglecting to keep in thorough repair Ihe roof, eaves gutterings, and rain-water pipes of the houses. A defective rain-water pipe or eaves gutter will cause extensive damage to the property as well as much discomfort to the occupiers, and yet it frequently occurs that an owner regards a Notice respecting this form of nuisance as unnecessary. STORAGE OF DRINKING WATER. The Inspectors in discharging their duties have given special attention to this important branch of sanitary work, viz., seeing that the dwelling houses inspected have at their command a wholesome supply of water for drinking and domestic purposes. In 468 houses improvement has been effected, in 413 instances a branch pipe from the Water Board's rising main has been fixed, and in .">5 cases cisterns cleansed and fitted with proper coverings ; the figures for the previous year being 695 branches from rising main fixed and 63 cisterns cleansed and covered. There is a slight decrease in figures for 1913 as compared with 1912, but this is explained by the fact that at all houses built in recent years a branch pipe from the rising main has been insisted upon as well as a properly covered cistern erected in a suitable position affording facilities for cleansing. In the future these figures must get smaller and smaller until they entirely disappear. HOUSES WITHOUT WATER. The Metropolitan Water Board found it necessary to cut the water off from premises within the Borough on 15 occasions, as compared with 22 for the previous year, and 20 for the year 1911. In every case the wat^r was cut off for waste, and with few 132 ceptions only after notice had been given to the person responsible to perform the necessary work to prevent such waste. Considering the large number of houses in the Borough (27,000), the number that were deprived of water (15) is exceedingly small. In each of the 15 instances the Council's 24 hours' Notice under the provisions of the East Ham Improvement Act was served upon the owners, and in every case complied with by the water being re-instated. INTERNAL DAMPNESS. This form of nuisance includes damp and dilapidated walls, defective and insufficient underfloor ventilation, defective damp courses. On 424 occasions, as compared with 570 for the previous year, it has been necessary by the service of Notice to call attention to the existence of these defects. Work has been done by providing better under-floor ventilation, and new damp courses have had to be inserted to some property, which is a difficult and expensive work to perform. YARD AND FORECOURT PAVING. During the year the provisions of the East Ham Improvement Act, 1898, Section 34, with reference to the paving of open spaces in connection with dwelling houses have been put in operation in 841 instances, the number for the previous year being 1,481. It is found as a matter of experience that if the ground immediately adjacent to the brickwork of the house is paved with an impervious pavement it adds materially to the dryness of the house, as well as helping to keep the interior floors clean. In all new houses erected since the confirmation of the Council's Bye-Laws, 1908, the provision of paving back and front is insisted upon, and in the near future it will be an accomplished fact throughout the whole Borough. OVERCROWDING. Thirty-three cases of overcrowding have been investigated and dealt with by the service of Notice, as compared with 21 for the previous year. In each instance the Notice was complied with by either the occupants moving or the re-arranging of the sleeping 133 accommodation. I can only repeat what I have frequently stated in my previous reports—that overcrowding is a form of nuisance which requires matured experience to deal with. The service of a Notice and clearing a family out of a house may comply with the Notice but it does not abate the nuisance, for if the overcrowding is the result of poverty (which is only too often the case), the family who have had to vacate the overcrowded house will be forced to seek a shelter, frequently under worse conditions than those they have left. My experience urges me to suggest where it is at all practicable to re-arrange the sleeping accommodation. URINALS. There are twelve public conveniences in the Borough (excluding those in public parks); four are underground and seven on the ground level. Special attendants are engaged, whose duty it is to keep them clean. During the past year the Council have constructed two new underground conveniences in the Barking Road, and made additional accommodation in the public parks for ladies. There are also 28 urinals attached to licensed premises to which the public have access. Many inspections of these conveniences have been made by the Inspectors. Notices have been served for the abatement of nuisances in connection therewith, the principal cause of complaint being insufficient water supply for cleansing, and light. The want of light is frequently a primary cause of the abuse to which the urinals are often subjected. PASSAGES AT REAR OF PREMISES. Secondary means of access are provided for most of the business premises in the Borough, and undoubtedly are found to be of great importance, but unfortunately they are a serious menace to Public Health. These passages are used in common by the many whose premises abut; they are invariably dark and in a dirty condition; where there are gates they are usually left open, affording facilities to any person who desires to dispose of any objectionable matter. It is to be regretted that occupiers of premises who have the right to use these passages do not display a more intelligent 134 interest in their sanitary condition, and put into practice preventable means whereby the nuisance arising from the filthy condition of these passages would be averted. If the entrances were barred by gates much of the trouble would be prevented, but if the gates are left open and a van or cart left in the carriage way, these are conditions which lend themselves for the place to become a public convenience. Much time has been given and many Notices served for the abatement of nuisances, but it is with difficulty that the work of abatement is carried out. SMOKE NUISANCES. Observations have been taken on 156 occasions of the emission of smoke from chimneys, as compared with 62 for the previous year. This form of nuisance is seldom seen in a serious form in the Borough, there being few manufacturers who have chimney shafts to emit smoke. On no occasion was the nuisance bad enough to warrant any action beyond an ordinary letter being sent to the offenders. MORTUARIES. The mortuaries have been regularly inspected and always found in a most excellent condition. The Central Mortuary on Town Hall site is fully equipped with all necessary appliances. There have been 98 bodies received and 65 post-mortems during the year. VAN DWELLERS AND SQUATTERS. The geographical position of East Ham to London affords facilities for gipsy trading, and 1 am afraid 'that while there is unfenced vacant land in the Borough these nomads will continue to pest the inhabitants who live near the sites they select for squatting. During the year under consideration, on 243 occasions visits were made by the Inspectors to their encampments, which were principally on the Eastern Boundary of the Borough. The figures for the previous year were 158. The Council's Bye-Laws, which enforce the provision of a water supply, have been put into operation on two occasions, legal proceedings being instituted, 135 and fines imposed of twenty shillings including costs in both cases, which amounts were forthwith paid. It is hoped that these proceedings will act as a deterrent to squatters coming into the Borough. TEMPORARY BUILDINGS. The erection of 34 temporary buildings contrary to the Council's Bye-Laws have been detected by the Inspectors. The figures for the previous year were 19. These structures are usually found at the rear of premises, and are used for various purposes, generally for the keeping of animals. They are frequently erected adjacent to the house with a total disregard to the ventilation of the dwelling. All breaches of the Council's Regulations in this respect have been reported to the Borough Engineer with a view to their removal, and in many instances the Works Committee have insisted upon the demolition of these structures. SCHOOLS. The public elementary and private schools have been systematically inspected, special attention being given to the drains, gullies, latrines, urinals, etc. In the public schools the gullies and drains are flushed regularly by the Council's drain flushers. The caretakers are responsible for the cleansing of the latrines and urinals. In most of the schools the work is done satisfactorily. In the private schools, which number 10, the tendency is to overcrowd, and once during the year the attention of a proprietor had to be called to the fact. PETROLEUM LICENCES. The premises licensed by the Council for storage of petroleum have been inspected before the annual renewal of Licences. In every case of either renewal, or application for a new Licence the provisions of the Act of Parliament have been insisted upon. DISINFECTANTS Have been supplied to Ratepayers requiring them from the four depots situated in the north, south and centre of the Borough. These four stations are a great convenience to the public. They are open daily, and from them during the year 4G tons of Carbolic Powder and 1,360 gallons of Disinfectant Fluid have been distributed. 136 UNSOUND FOOD. The markets have been regularly inspected, and on 31 occasions the Inspectors have discovered food exposed for sale, which, in their opinion, was unfit for human food, but not in such a condition as to warrant seizure. The food chiefly comprised fruit, which was destroyed by the owner at the suggestion of the Inspector. There have been 10 consignments of unsound food surrendered for condemnation as follows:—1 sack mussels, 16 large codfish, carcase of pig, 8½ stone dogfish, 2 boxes small haddock, 2 stone skate, 2 boxes dogfish, 1 rabbit. Ten certificates indicating the condition of the food when it was submitted were given. Great care is exercised to do justice to the wholesale dealer, as well as the retail purchaser, though it is an exceedingly difficult problem. It is alleged that dishonest retailers, having purchased by sample, will substitute bad articles for the good and submit them for condemnation, while on the other hand the wholesale merchant submits a sound sample and at times supplies an unsound article. It is the practice of the office to take minute details such as time, marks, weights, etc., and furnish them on certificate. DAIRIES AND COWSHEDS. There are six registered cowsheds and 158 registered dairies in the Borough. During the year 22 were added to the regis'ter. 368 inspections have been made, as compared with 409 for the previous year for the purpose of seeing that the provisions of the Dairies and Cowsheds Regulations have been fulfilled, viz., cleansing, limewashing, etc. These premises require constant supervision to keep them up to a standard of efficiency. In the cowsheds the greatest nuisance is caused by the nonremoval of the manure from the sheds. In the dairies it is the cleanliness of the utensils, etc., that requires attention. In comparing the general condition of cowsheds of to-day and of a few \ears back there is a decided improvement, but there yet remains much to be done before wholesome milk is obtainable. 137 SLAUGHTER HOUSES. There are 15 registered and licensed slaughter-houses in the Borough, and during the year 131 inspections have been made, as compared with 141 for the previous year. The provisions of the Council's Bye-Laws, viz., limewashing and cleansing, have been carried out. The inspections were made in most cases at time of slaughtering, which necessitated visits being made at extraordinary hours, including Sundays. The private slaughter-house is a menace to the suppression of diseased meat being imposed upon the public, for it is obvious if an unscrupulous person has a questionable animal he refrains from sending it to a public abattoir, where it would be subjected to inspection, but he sends it to the private slaughter-house to be killed at the time when the local Inspector is in bed. There seems little difficulty in disposing of questionable carcases without sending them to a public market. The establishment of public abattoirs and the abolition of private slaughter-houses is the only means of checking the trade of dealing with diseased animals. The following are the slaughter-houses in the Borough :— Beckton Road. Forest View Road. 10, Greenhill Grove. 319, Green Street. 363, Green Street. 14, High Street North. 170, High Street North. 89, Plashet Grove. 32a, Plashet Lane. 638, Romford Road. 6, Station Road. 28, Station Road. Shaftesbury Road. 24, Wakefield Street. 65, Whitta Road. Three of the slaughter-houses are subject to annual Licences, which have been renewed. 138 INFECTIOUS DISEASES. In all cases of Infectious Diseases notified the premises are forthwith visited by the District Inspector, the sanitary arrangements of the house with its surrounding conditions are examined, the drains tested, and where any sanitary defects are discovered, or stripping and cleansing required, Notices are served upon the person responsible and the work done under the Inspector's supervision. Directions are given as to isolation and a printed list of precautions handed to the responsible person setting forth the rules to be observed to prevent the spread of infection. A report of each case containing full details required for the Medical Officer of Health is prepared by the Inspector. The Librarian is notified of the existence of any infected premises to which books from the Public Libraries have been supplied, and the proprietors of Laundries are informed when any of their customers have an infectious case in their house. Books from an infected house are returnable direct to the Public Health Department, and disinfected by being placed in an airtight chamber and subjected to S.0.2 fumigation under pressure. The Head Teachers of day schools, and the responsible officials of Sunday schools are advised of all cases of infectious disease occurring at houses where scholars attending their respective schools reside. BAKEHOUSES, FACTORIES AND WORKSHOPS. There are, excluding outworkers, 479 Factories and Workshops in the Borough, which include Bakehouses, Laundries, Blousemakers, Tailors, Boot-repairers, Shirt-makers, Embroiderers, Artificial Flower-makers, etc. During the year 902 Inspections have been made, which include 132 made to the Bakehouses and 423 made to outworkers' premises, the figures for the previous year being 507 Inspections. The Chief Inspector of Factories has informed us on 8 occasions of the existence of nuisances in workshops, which have been discovered by the Home Office Inspectors when performing their inspectorial duties, and in 17 instances the Chief Inspector of Factories has been informed of irregularities which have been noticed by our Inspectors, and come within his province to deal with. 139 During the year 8 Notices have been served for the abatement of nuisances, which comprise principally defective ventilation and repairs to defective sanitary appliances. OFFENSIVE TRADES. There are two gut-trimming businesses situated in Langdon Crescent, Wall End. The work is confined to trimming fat from the runners and cleansing ox-gut. Renewed application has been made for a licence to scrape pig and sheep gut, but the Council, after full and careful consideration, declined the application. Reference has been made in previous Reports to the disagreeable odours given off from the pans of fish frying establishments, but up to the present no cheap effectual remedy has been generally adopted. The ordinary hood in itself is a failure in cold weather, and of little use at any time. The collection of fish offal and butchers' bones is carried c ut by private contractors. Occasional complaints are made in the summer months of the offensive odours which are emitted from ihc collecting vans. The fish offal is collected late at night, or very early in the morning. The principal offenders are the bone and fat collectors; the vans used for the work are open and unsuitable. If hermetically sealed vans were used in this business and kept clean the nuisance would be mitigated. COMMON LODGING HOUSE. The common lodging house situated in Albert Road, North Woolwich, has been frequently visited. It has not been found necessary to serve any Notices during the year for the abatement of nuisances. There is accommodation for 42 beds at this lodging house. TRADE REFUSE. The policy to collect refuse from tradesmen's premises twice in every week, free of charge, continues to work satisfactorily, the only conditions being that the refuse is contained in a suitable receptacle and placed in a convenient position ready for the collector, who calls regularly at the same day and hour. The refuse is taken to the destructor works and destroyed. 140 During the year 1,904 loads have been collected and deposited at the Council's Destructor, as compared with 1,872 loads for the year 1912. By reference to the Nuisance Table inset facing page 12G, it will be seen that 133 offensive accumulations were discovered as ocpmared with 165 for the previous year. These offensive accumulations consist principally of garbage, which is deposited on vacant land and back passages. DUST BINS. Under the provisions of the East Ham Improvement Act, 1903, the Council have power to call upon owners to provide every dwelling house with a galvanised iron dust bin, and to determine its size and construction. During the past year 193 premises have been reported to the Public Health Committee for not being furnished with a suitable dust bin. In each instance the Committee authorised the service of a Statutory Notice upon the responsible person to supply the premises with an efficient portable galvanised iron dust bin, 18 inches deep and 16 inches in diameter. These sizes may appear small in comparison with the old ashpit, but we learn from experience that large dust bins encourage many people to deposit in the dust bin matter which should be immediately burnt. In cases where the Notices were not complied with, the Council exercised its powers by providing bins, and recovering I he costs The bins supplied by the Council are excellent in design and construction ; they are made to a carefully prepared specification, purchased in large quantities by contract, and supplied at a low figure. COLLECTION OF HOUSE REFUSE. 11,243 loads of house refuse have been collected during the year. There are 27,000 houses in the Borough, from which the refuse is collected every week, and to perform this work there are employed 8 fillers, 16 carmen (who also assist to load) with 16 horses and vans, with a responsible foreman in charge. The refuse is conveyed to the Destructor, where it is used as fuel for generating steam for sewage pumping. The horses and drivers are supplied under contract, while the fillers are employed and the rolling stock owned by the Council. The lump sum contract 141 has now been working for several years most successfully, the system being that the contractor undertakes for a fixed sum to supply as many horses and drivers as are necessary to keep every house in the Borough clear of refuse by a weekly collection, work to commence and finish at fixed times. This method has proved an economical one to the Council. The total cost for collection for 1913 amounted to £4,000, which is equal to 2s. 11½d. per house per annum. Few complaints have been received during the year. The Council's fillers are experienced and trustworthy men, having been in the Council's service many years; each filler has two carmen under him and a specified number of houses, for which he is responsible, to collect from. The occupiers knowing the day and hour when the dust will be collected, place the dust bin outside, which considerably facilitates the work of collection. The Council's Bye-laws compelling occupiers to place the dust bin out ready for collection, under a penalty for failure to do so, have never had to be brought into operation, which speaks well for the co-operation received from the inhabitants of the Borough in this very important branch of Public Health work. 142 DUST COLLECTION. NUMBER OF LOADS COLLECTED DURING 1913 FROM Beckton and North Wo lw'h Ward. Central Ward East. Central Ward West. Manor Park Ward. Pashet Ward East. Pashet Ward West. Total Loads Collected per Month. JANUARY 126 191 176 214 155 206 1068 FEBRUARY 121 162 130 200 135 145 893 MARCH 140 156 144 232 134 158 964 APRIL 121 182 133 217 170 167 990 MAY 141 189 161 203 165 159 1018 JUNE 113 155 122 239 134 140 903 JULY 114 167 134 210 164 176 965 AUGUST 134 160 126 178 122 127 847 SEPTEMBER 108 161 116 226 142 131 884 OCTOBER 123 178 137 194 122 182 936 NOVEMBER 133 159 122 195 125 138 872 DECEMBER 105 156 94 253 156 139 903 1,479 2,016 1,595 2,561 1,724 1,868 11,243 143 CONTAGIOUS DISEASES OF ANIMALS ACT. To comply with the provisions of the Swine Fever (Regulation of Movement) Order, 1908, 109 Declarations have been signed and presented, and licences issued authorising the bringing into the Borough of 2,033 store pigs, while 229 licences have been issued for the removal of 1,941 fat pigs out of the Borough for slaughter. Under the East Ham Allotments (Swine Fever) Order, 190G, 10 licences were granted for the removal of 100 pigs from Langdon Crescent to local slaughter-houses. In addition to the 2,033 imported pigs there is a large number bred in the Borough. Licences are not required to remove pigs within the Metropolitan area, which includes East Ham, with the exception of Langdon Crescent, which is specially dealt with by an Order. There have been five reported cases of Swine Fever during the year. The usual Notice, Form "A," was served in each gase, and in only one instance did the Board of Agriculture confirm the report. One case of Parasitic Mange was notified which recovered. A case of Anthrax occurred in the north of the Borough, the animal, a horse, which was working in a coal van up to within a few hours of its death, appeared in good health. It was bedded in for the night and found dead in the stable next morning. In each case of Contagious disease the premises were thoroughly disinfected and precautions taken to prevent the spread of the disease. SHOPS ACT. From the passing of the Shops Act until the early part of 1913 the inspectorial duties under the Act were entrusted to the Sanita'v Inspectors, but as several Closing Orders became operative, necessitating more time being given to the enforcing of the provisions of these several Orders, the Council decided to appoint an Inspector to devote his whole time to the Shops Act and the duties arising therefrom. 144 There are about 2,000 shops in the Borough, comprising 65 trades, and during the past year 1,019 inspections have been made as follows: — Grocers, Provision and General 628 Drapers 117 Bakers 56 Butchers 41 Greengrocers 41 Milliners 23 Oil Stores 16 Tobacco 15 Hosiers 14 Boot 12 Barbers 10 Tailors 9 Corn dealers 8 Confectioners 6 Ham and Beef 4 Fancy 3 Fishmongers 3 On Licences 3 Fruiterers 2 Coffee and Dining Rooms 2 Music 2 Dairy 1 Chemist 1 Florist 1 Off Licence 1 As a result of the Inspections made, 385 contraventions were discovered, resulting in legal proceedings being instituted in 40 instances, as follows:— Contravening the Grocers', Provision Dealers' and General Shop-keepers' Half-holiday Order 18 Do. Butchers' Closing Order 6 Employing children during prohibited hours 17 Failure to exhibit Notice 1 Two cases that were dismissed related to proceedings under the Butchers' Closing Order, and referred in the first instance to a provision dealer selling salt pork after the butchers' 145 shops were closed, and in the second to keeping his shop open for the purpose of selling cooked meat after the closing time. The Court held that neither salt pork nor cooked meat came within the purview of the Butchers' Closing Order. In the four instances where convictions were obtained under the Butchers' Closing Order they referred to butchers and a provision dealer keeping their shops open after the closing hour for the sale of fresh meat. Grocers', Provision Dealers', and General Shopkeepers' Half-holiday Order. Eighteen cases have been brought before the Court and fines imposed in each instance. They referred to butchers selling eggs, cooked meat, and dripping; greengrocers selling eggs, tinned fruit, and vinegar; ham and beef dealers selling eggs and sauce; general shops keeping open for the sale of goods after the closing time; and dairymen selling cheese and cocoa. It will be observed how one trade takes advantage of the closing of another trade to sell articles that do not come within the limit of their own business. The most important proceedings instituted under the Act referred to the case of a butcher selling dripping in contravention of the Provision Dealers' Half-holiday Order. It was argued before the magistrate that dripping was meat and a perishable article, but the Court decided against the defendant on these points, and imposed a small fine. It was considered by the butchers' trade to be of great importance, as the decision decided the question whether a butcher could sell cooked meat when the provision shops were compulsorily closed. The magistrate was asked to state a case for the Superior Court, which he did. The appeal was heard by three learned Judges, when the appellant dropped the two points that had been strongly contested before the magistrate, and contended that selling dripping was part of the butchers' business, and on this point the appeal succeeded. The presiding Judge stated that "articles which are sold in the ordinary course of two businesses, our view is that the selling by a man of such an article (dripping), an ambiguous article, an article which is sold by him in the ordinary course of his own business is no evidence ol his carrying on the other business, although in that other business it is also sold. This judgment 146 does not in the least apply to articles that are not of an ambiguous character. The conviction ought to be quashed. I think this decision has a very limited application." On taking a cursory view of the case and the Judge's summing up, it does not appear to be of great importance, but when applied to every-day administration of the Act we are confronted with profound difficulties. The term "ambiguous" as applied to articles implies doubt and requires some deciding. Consider the exempted trades that are not called upon to close because they sell either perishable articles or commodities of urgent necessity, but who sell articles in the ordinary course of business which are not perishable or of urgent necessity, and are sold by other tradesmen in the ordinary course of their businesses; the latter are compelled to close in conformity with the Act, viz.:— The fishmonger who sells cod liver oil and salad oil. The baker who sells packet tea and biscuits. The butcher who sells meat pies and dripping. The dairyman who sells eggs and bacon. The tobacconist who sells walking sticks and playing cards. The greengrocer who sells preserved fruit and vinegar. The ham and beef dealer who sells pickles and preserves. The chemist who sells scents and toilet soaps. The newsagent who sells stationery and periodicals. The florist who sells garden utensils and bulbs. The off-licence keeper who sells biscuits and cheese (consumed off the premises). All these articles appear to be of an ambiguous character and are sold by these particular trades in the course of ordinary business. They also form an important factor in other businesses that are compelled to close. How far the decision of the Superior Court will establish the right of these exempted trades selling these doubtful articles the Court alone can determine, and also what articles are strictly within the meaning of the term ambiguous. The Shops Act contains too many exemptions and options, and there is little doubt will at some future date be subject to amendment. 147 Employment of Children Act. Under the Employment of Children Act the Council have made Bye-laws, and it is provided that no child under 14 years of age shall work in or in connection with any shop after 8 p.m. During the year 15 cases were brought before the Court by the Public Health Department, and fines imposed in each case. They referred to 13 boys and 2 girls—6 boys and one girl working in barbers' shops. The case of the girl was that she was only ten years of age, and employed by her father to lather men as late as 10 p.m. The second girl was 12 years of age, and employed by her father to serve fish from a stall after 11 p.m. The remaining boys were employed to discharge miscellaneous work in connection with shops. 148 Report of the Chairman of the Public Health Committee and the Chief Sanitary Inspector re Sanitary Inspectors' Conference held at Llandudno, September 6th to the 13th, 1913. To the Members of the Public Health Committee. Gentlemen, We beg to report, in compliance with the request of the Council, that we attended the Conference held under the auspices of the Sanitary Inspectors' Association from September 6th to 13th inclusive, by the kind invitation of the Chairman and Members of the Llandudno District Council. The meetings were held at the Town Hall. MONDAY, SEPTEMBER 8th. The Conference commenced at 9 a.m. with a special meeting of the Provident Association and Defence League, and other auxiliary work of the Inspectors' Association. TUESDAY, SEPTEMBER 9th. The Conference resumed at 10 a.m. at the Prince's Theatre, the chair being occupied by William Williams, Esq., Chairman of the Llandudno District Council, who welcomed the delegates in a few well chosen words. He was followed by Sir James Crichton-Browne, M.D., LL.D., F.R.S., President of the Sanitary Inspectors' Association, delivering his Presidential address. Sir James referred to the need of highly trained Inspectors, urging the Association to make their examination a thorough test of competency. Pundits are not required for Sanitary Inspectors, nor men crammed with theoretical science, but a certain amount of scientific knowledge is necessary as a basis for practical sanitation. Sir James devoted himself very largely in his address to the dust problem and its effects upon the human race, and how the hedge-rows had lost their refreshing greenery and had become a seared, withered belt bounding the roads. The dust problem assumed of lat^ years a wide and significant sanitary question— modern civilisation is one vast grind of attrition, and in the process 149 many noxious kinds of dust are generated; special attention has been devoted to industrial dust with beneficial results, and although there has been of recent years an improvement in the mortality rate in dust generating trades when compared with the mortality rate of agriculturalists who live and work in practically a dustless atmosphere that the difference is excessive to a startling degree. Industrial dust is largely dealt with by the Factory Inspector, but the municipal and domestic dust falls to the Sanitary Inspector to supervise. Sir James went fully into the question of road making to combat the great dust trouble caused by the 220,000 motor vehicles in Great Britain, and referred to the dangers of the road by motor traffic. The President closed a very lengthy address with an appeal to the Inspectors to discharge their duties with earnestness of spirit and technical skill to fight gallantly against ignorance and disease, display a kind heart and redress human wrongs. The Town Clerk of Llandudno (A. Connolly, Esq.), followed Sir James Crichton-Browne by reading a paper entitled "Holiday Months." The purport of the paper was to urge the necessity of spreading the summer holidays over a longer season, by which overcrowding of boarding houses, hotels, and trains would be considerably obviated. It was agreed by the delegates that it would be better in the interest of Public Health if this could be done, and with this in view it was suggested that Education Authorities should not all close their schools at one period, and that railway companies should commence running excursion trains earlier in the season. At the close of this paper the delegates were entertained to lunch by William Williams, Esq. Subsequent to the luncheon the Isolation Hospital, Destructor, Public Abattoir, and Workmens' Dwellings, were visited. WEDNESDAY, SEPTEMBER 10th. The Conference was resumed at 9.30 a.m. Papers were read by G. Lewis Travis, Esq., D.P.H., Medical Officer of Health, Northern Division of Carnarvonshire, entitled "Health Resorts." The reader dealt largely in his paper with the essentials a health 150 resort should contain, such as good drainage and sewerage system, pure water supply, and a low death-rate. The next paper was read by Mr. J. H. Mole, of Chester-leStreet, on the subject of the "Laws of Health." This paper was of a deeply interesting character, embracing a long period in the world's history, and showing that to perfect the laws of health there must be a practical knowledge in the provision of the essential elements tnat make for health, such as fresh air, pure water, wholesome food, personal cleanliness, etc. It was urged by the writer that hygiene should be a compulsory subject to be taught in our public elementary schools. Mr. Rodgers, of Todmorden, then read an interesting paper on the " Sanitary Inspector's Modern Outlook." After a discussion on these papers the Conference adjourned. THURSDAY, SEPTEMBER 11th. The Conference resumed at 9.30 a.m. The first paper was read by Councillor E. R. Woodhousej entitled "The Milk Supply of Health Resorts." The principal feature of this paper was the contamination of milk in transit and the best means to be adopted to prevent it. The next paper was entitled the "Shops Act, 1912-1913." This paper was a very exhaustive one, dealing with every aspect of the Shop Hours problem. The next paper was read by Mr. Abdy, of Sheffield, on the subject of "Pulmonary Tuberculosis," which proved most interesting and instructive. FRIDAY, SEPTEMBER 12th. Papers were read by Mr. Sarson, Chairman of the Public Health Committee, on " The Housing of the Working Classes Mr. Arthur Kent, of Stourbridge, on " The Housing Question "; and by Miss H. A. Gorniot, of Willesden, on " The Sanitary Lady." 151 SATURDAY, SEPTEMBER 13th. This day was devoted to visiting places of interest. The Conference closed by votes of thanks being accordcd to those who had worked assiduously to make the Conference a success. We are, Gentlemen, Your obedient servants, (Signed) F. Bradley, Chairman. Joseph G. Banks, Chief Sanitary Inspector. Town Hall, East Ham. 29/9/T3. 152 SUMMARY OF LEGAL PROCEEDINGS. Date. Address. Offence. Result. February Fabian Street Failing to comply with Sanitary Notice served under Public Health Act. Fined £2; 10/6 costs. April Barking Road Contravening Butchers' Closing Order Fined 15/-; 5/- costs. ,, Ditto Ditto Dismissed. ,, Vicarage Lane Ditto Ditto. ,, High Street North Ditto Fined 15/-; 7/6 costs. ,, Ditto Contravening Shops Act Fined 2/6 ; 5/- costs. ,, Katherine Road Contravening Grocers', Provision Dealers' and General Shopkeepers' Half Holiday Order. Fined 15/-; 7/- costs. ,, Ditto Ditto Fined 10/-; 8/- costs. May Vicarage Lane Contravening Bye-law under Employment of Children Fined 10/-; 5/- costs. June Albert Road Contravening Butchers'Closing Order Fined 10/-; 5/- costs. ,, Hertford Road Contravening Bye-law respecting Tents, Vans, &c., used for human habitation. Fined £1 and costs or 14 days. ,, Ditto Ditto Ditto. ,, Ditto Ditto Ditto. ,, Ditto Ditto Ditto. 153 June Hertford Road Contravening Bye-law respecting Tents, Vans, &c., used for human habitation. Fined £1 and costs or 14 days. ,, Ditto Ditto Ditto. ,, Ditto Ditto Ditto. ,, Ditto Ditto Not served. ,, Ditto Ditto Ditto. ,, Albert Road Contravening Butchers'Closing Order Fined 10/-; 5/- costs. ,, Plashet Grove Contravening Bye-law Employment of Children Ditto. ,, High Street North Contravening Grocers', Provision Dealers', and General Shopkeepers' Half Holiday Order. Fined 5/-; 5/- costs. ,, Ditto Ditto Ditto. ,, Green Street Contravening Bye-law Employment of Children Payment of 5/- costs. ,, Ditto Ditto Fined 10/-; 5/- costs. ,, Ditto Ditto Fined 10/-; 7/- costs. ,, Barking Road Ditto Fined 10/-; 6/- costs. ,, Ditto Ditto Fined 10/-; 5/- costs. ,, Ditto Ditto Ditto. ,, Church Ditto Ditto. ,, Plashet Lane Ditto Ditto. ,, Ditto Ditto Ditto. 154 Date. Address. Offence. Result. June Greenhill Grove Contravening Bye-law Employment of Children Fined 10/-; 5/- costs. July Romford Road Contravening Grocers', Provision Dealers', &c., Half Holiday Order. Ditto. ,, Ditto Ditto Ditto. ,, Ditto Ditto Fined 10/- ; 7/- costs. ,, Ditto Ditto Ditto. ,, Ditto Contravening Bye-law Employment of Children Ditto. ,, Katherine Road Ditto Fined 10/-; 7/- costs. ,, Green Street Ditto Not served (removed). ,, Ditto Ditto Fined 10/-; 5/- costs. ,, Ditto Contravening Grocers', Provision Dealers', &c., Half Holiday Order. Fined 5/-; 8/- costs. ,, Barking Road Ditto Fined 10/-; 7/- costs. ,, Vicarage Lane Contravening Bye-law, Employment of Children Fined 10/-; 5/- costs. ,, High Street North Contravening Grocers', Provision Dealers', &c., Half Holiday Order. Fined 5/-; 7/- costs. ,, Romford Road Ditto Fined 10/-; 7/- costs. ,, Ditto Ditto Fined 10/-; 5,/- costs. August High Street North Ditto Fined 1/-; 5/- costs. 155 October Wakefield Street Exposing unsound Food for sale Fined £\; 18/6 costs. November Manor Way Contravening Grocers', Provision Dealers', &c., Half Holiday Order. Fined 10/-; 8/- costs. ,, Oakfield Road Ditto Fined 1/-; 6/- costs. ,, Shrewsbury Road Ditto Fined 10/-; 7/- costs. ,, Ditto Ditto Ditto. JOSEPH G. BANKS, Chief Sanitary Inspector. 156 Table showing the Localities in which certain Diseases of a Zymotic character occurred during the year 1913. LOCALITY. No. of Houses. March, 1914. Scarlet Fever. Diphtheria. Typhoid Fever. Ervsipelas. Puerperal Fever. Tuberculosis. Pulmonary. Other Forms. Ascot Road ... ... ... ... ... ... ... ... Albert Road 122 2 1 ... 1 ... 2 ... Alexandra Road 82 1 ... ... ... ... ... 2 Altmore Avenue 192 8 1 ... ... ... 2 2 Arthur Road 11 ... ... ... ... ... ... ... Ashford Road 55 ... ... ... ... ... 1 1 Abbotts Road 64 ... 1 ... 2 ... ... ... Aintree Avenue 65 ... 2 ... ... ... 2 ... Arragon Road 110 7 4 ... 1 ... 7 2 Albany Road 45 ... 1 ... ... ... ... ... Aldersbrook Lane 2 ... ... ... ... ... ... ... Aldersbrook Road 28 1 ... ... ... ... 1 ... Alverstone Road 197 4 3 ... 1 4 1 Ann's Cottages 9 ... ... ... ... ... ... ... Ashley Road 29 ... ... ... 1 ... ... ... Burford Road 14 ... ... ... ... ... ... ... Boston Road 16 ... ... ... ... ... ... ... Beverley Road 42 ... ... ... ... ... ... ... Brampton Road 81 1 ... ... ... ... 2 1 Beaconsfield Street 30 ... 1 ... ... ... ... 2 Beckton Road 109 ... 1 ... ... ... ... ... Buxton Road 6 ... ... ... ... ... ... ... Blenheim Road 68 ... 1 ... 1 ... ... 1 Brooks Avenue 80 ... ... ... ... ... 1 2 Burnaby Street ... ... ... ... ... ... ... ... Becket Avenue 111 1 1 ... ... ... 2 1 Bedford Road 36 1 ... ... ... ... ... ... Bridge Road 39 ... ... ... ... ... ... 1 Brighton Road 63 6 1 ... ... ... 3 1 Brookwood Road ... ... ... ... ... ... ... ... Bonny Downs Road 66 2 6 ... 1 ... 3 1 Burges Road North 228 4 ... ... 1 ... 2 1 Burges Road South 12 ... ... ... ... ... ... ... Bartle Avenue 63 2 ... ... 2 ... 8 1 Bendish Road 48 ... ... ... 1 ... ... ... Benson Avenue 76 4 3 ... ... ... 2 ... Bole.vn Road 98 1 1 ... 2 ... 2 ... Barking Road 367 6 4 ... 1 ... 5 ... Boundary Road 108 ... ... 1 ... ... 2 ... Brancaster Road 6 ... ... ... ... ... ... ... Barrington Road 36 ... ... ... ... ... 1 Browning Road 244 2 1 ... 1 ... 4 1 Bath Road 6 ... ... ... ... ... ... ... Byron Avenue 235 3 ... ... ... ... 2 ... Berkeley Road 43 1 ... ... ... ... ... ... Bristol Road 144 1 ... ... ... ... 1 2 Balmoral Road 1 ... ... ... ... ... ... ... Birchdale Road 73 5 ... ... ... 1 ... ... Chesley Gardens 30 ... ... ... ... ... ... ... Central Avenue ... ... ... ... ... ... ... ... Clacton Road 64 1 1 ... ... ... ... 1 Cotswold Gardens 51 ... ... ... ... ... ... ... 157 lOCALITY. No. of Houses. March, 1914. Scarlet Fever. Diph- Typhoid theria. Fever. Erysipelas. Puerperal Fever. Tuberculosis. Pulmonary. Other Forms. Creek Terrace 34 ... ... ... ... ... ... ... Cyprus Place 41 ... ... ... 1 ... ... ... Cameron Street 20 1 ... ... ... ... 1 ... Church Street 30 ... 4 ... 3 ... 3 ... Claremont Street 66 2 ... ... ... ... ... ... Calverton Road 64 1 2 ... ... ... ... ... Charlemont Road 126 4 9 ... ... 1 4 ... Caulfield Road 225 3 ... ... ... ... 2 3 Caledon Road 161 2 2 ... 1 ... 2 ... Clements Road 178 3 ... 1 1 ... 2 2 Compton Avenue 81 2 ... ... ... ... 4 1 Campbell Road 36 1 ... ... ... 1 4 ... Castle Street 40 ... 1 ... ... ... ... ... Cleves Road 100 ... ... ... ... ... 7 1 Colvin Road 61 1 ... ... ... ... ... 1 Creighton Avenue 76 4 ... ... ... ... 2 1 Central Park Road 312 1 2 ... 1 ... 9 2 Charlotte Terrace 5 ... ... ... ... ... ... ... Capel Road 70 ... ... ... 1 ... ... 1 *Carlyle Road 120 3 ... ... ... ... ... 2 Chesterford Koad 100 ... 1 ... ... ... ... 1 Carlton Road 48 ... ... ... ... ... ... ... Clarence Road 29 ... ... ... ... ... 1 ... Cumberland Road 16 1 ... ... ... ... ... ... Colchester Avenue 69 ... ... ... ... ... 2 ... Church Road 107 ... ... ... ... ... ... ... Colston Road 43 ... 1 1 ... ... 2 ... Clifton Road 34 3 ... ... ... ... ... ... Coleridge Avenue 73 1 ... 1 2 ... 1 ... Crescent Road 47 1 ... ... ... ... 6 1 Covvper Avenue 25 1 ... ... ... ... ... ... Cromwell Road... 63 3 1 ... ... ... 2 ... Chester Road 72 2 ... ... 1 ... 1 l Claremont Road 62 1 ... ... ... ... ... ... Denbigh Road 100 ... ... ... 1 ... 6 1 Drew Road ... ... ... ... ... ... ... ... Dukes Avenue 3 ... ... ... ... ... ... ... Dickens Road 61 2 2 ... ... ... 2 3 Dore Avenue 39 1 ... ... ... ... ... 2 Dersingham Avenue 256 6 1 ... 3 1 4 2 Durham Road 99 7 ... ... ... ... ... ... Dorset Road 72 2 ... ... 1 ... 2 2 Elizabeth Street 169 ... ... 1 ... ... 3 1 Eastbourne Koad 58 ... 1 ... ... ... 2 ... Eversleigh Road 69 1 ... ... ... ... 1 1 Ernald Avenue 70 2 4 2 1 ... 8 1 Empress Avenue 36 1 ... ... ... ... ... ... Eighth Avenue 54 ... ... ... 1 ... ... ... Elsenham Road 33 ... ... ... ... ... ... ... East Avenue 64 ... ... ... ... ... 1 ... Essex Road 113 ... ... ... ... ... 4 2 Elizabeth Road 115 1 1 ... ... ... ... 1 Edith Road 31 1 ... ... 1 ... 1 ... East Road 14 ... ... ... ... ... ... ... *And one case Typhus Fever. 158 LOCALITY. No. of Houses. March, x9*4 Scarlet Fever. Diphtheria. T yphoid Fever. Ervsipelas. Puerperal Fever. Tuberculosis. Pulmonary. Other Forms. Frinton Road 110 ... 2 ... 2 ... 1 ... Factory Road 2 ... ... ... ... ... ... ... Francis Street 22 ... ... ... ... ... ... 1 Ferndale Street 10 ... ... ... ... ... ... 1 Fabian Street ao ... 1 ... ... ... 1 ... Folkestone Road 23 ... ... ... ... ... ... ... Friars Road 96 2 l ... 1 ... 1 1 Florence Road 30 ... ... ... ... ... ... ... Fifth Avenue 42 ... 1 ... ... ... 1 ... Fourth Avenue 124 6 ... ... ... ... s ... First Avenue 144 4 ... ... ... ... 1 1 Forest View Road 26 ... ... ... ... ... ... ... Forest Drive 40 ... ... ... 1 ... 1 1 Fry Road 15 1 ... ... ... ... 1 ... Finden Road 19 ... ... ... ... ... 1 1 Geoffrey Gardens 17 ... ... ... ... ... ... ... Grosvenor Gardens 37 1 ... ... ... ... 1 ... Glenister Street 32 ... ... ... ... ... 1 1 Gresham Road 38 ... ... ... ... ... ... ... Gosseley Lane 54 ... 1 ... ... ... 1 ... Gillett Avenue 58 ... ... ... 1 ... 3 1 Grosvenor Road 29 1 ... ... ... ... ... ... Greenleaf Road 15 ... ... ... ... ... 1 ... Gainsborough Avenue 48 l ... ... ... ... 2 ... Grantham Road 159 4 2 ... 1 ... 4 3 Gordon Road 10 ... 2 ... ... ... ... ... Gladding Road 13 9 ... ... ... ... ... 10 Gloucester Road 49 5 ... ... ... ... ... ... Greenhill Grove 97 ... ... ... 1 ... 4 ... Goldsmith Avenue 116 ... ... ... 1 ... ... 1 Gladstone Avenue 93 1 ... ... 1 ... 2 ... Green Street 222 2 1 ... 2 ... 1 2 Hubert Road 74 1 4 ... ... ... 1 ... Hollington Road 84 1 ... ... ... ... 3 2 Haldane Road 142 4 1 ... 1 ... 1 ... Henniker Gardens 161 3 1 ... ... ... 1 1 Hatherley Gardens 173 3 ... ... 1 ... 2 ... High Street, North Woolwich 49 ... 1 ... 2 ... 2 1 Hall Road 97 ... ... ... 1 ... ... ... Hertford Road 5 ... ... ... ... ... ... ... Holloway Road 7 ... ... ... ... ... ... ... Holland Road 56 ... ... ... ... ... ... ... Howard Road 11 ... ... ... ... ... ... ... Henry Road 15 1 ... ... ... ... ... 1 Holme Road 64 ... ... ... 1 ... 4 ... Harrow Road 39 3 ... ... 1 ... 1 ... Heighair, Road 139 3 ... ... ... ... 1 ... Hartley Avenue 44 ... ... ... ... ... ... ... Hockley Avenue 69 4 3 ... ... ... 4 ... High Street South 173 5 ... ... 1 ... 3 3 Herbert Road 142 4 ... ... ... ... 4 1 Harcourt Avenue 118 4 1 ... ... 1 1 3 High Street North 440 2 3 ... 1 ... 4 2 Halley Road 388 13 1 ... 3 ... 2 2 159 ALOCALITY. No. of Houses. March, 1914. Scarlet Fever. Diphthei ia. Typhoid Fever. Ervsipelas. Puerperal Fever. T uberculosis Pulmonary. Other Forms Henderson Road 93 1 ... ... 1 ... 1 ... Hilda Road 28 2 ... ... ... ... ... ... Hampton Road 30 ... ... ... 1 ... ... ... Johnstone Road ?9 ... 1 1 ... ... 2 ... Jephson Road 57 2 1 ... ... ... ... ... Johnson's Place 8 ... ... ... ... ... ... ... Konnard Street 2 ... ... ... ... ... ... ... Koppel Road 104 ... ... ... ... ... 1 ... Kempton Road 167 7 ... 5 2 ... 4 ... Kimberley Avenue 73 ... 1 ... 1 ... ... ... King's Road 36 ... ... ... ... ... 2 ... Katnerine Road 446 6 9 1 ... ... 5 ... Kensington Avenue 153 ... 3 ... ... ... 1 ... Lonsdale Avenue 84 1 1 ... ... ... 1 ... Livingstone Street 19 ... ... ... ... ... ... ... Lichfield Road 105 1 1 ... 1 ... ... ... Leigh Road 94 1 ... ... ... ... 1 ... Lydeard Road 20 ... ... ... ... ... ... ... Latimer Avenue 72 ... 3 ... ... ... 2 ... Langdon Road 16 ... 1 ... ... ... ... ... Lloyd Road 41 1 1 ... ... ... ... ... Lathom Road 172 3 ... ... ... ... ... 3 Langton Avenue 44 1 ... ... ... ... 3 1 Ladvsmith Avenue 75 1 ... ... ... ... ... ... Loxford Avenue 70 ... 2 ... 2 ... 2 2 Lawrence Road 75 ... 1 ... ... ... 1 1 Leader Avenue ... ... ... ... ... ... ... ... Landseer Avenue 97 5 1 ... ... ... 1 ... Little Ilford Lane 144 2 ... ... 1 ... 5 1 Little Ilford Avenue 45 ... ... ... 1 ... 1 1 Lawrence Avenue 233 3 1 ... 1 ... 7 1 Lancaster Road 110 3 1 ... ... ... 3 2 Lansdowne Road 68 1 ... ... ... ... 1 1 Monmouth Road 48 ... ... ... 1 ... ... ... Mortimer Road 84 1 2 ... ... ... ... ... Masterman Road 188 3 2 ... ... ... 3 ... Mitcham Road 185 ... 5 ... ... ... ... ... Marlow Road 81 3 ... ... 1 ... 3 ... Milk Street 10 2 ... ... ... ... ... ... Muir Street 18 3 ... ... ... ... 1 ... Manor Way 12 2 ... ... ... ... ... ... Montpelier Gardens 109 ... 3 ... ... ... ... ... Mountfield Road 78 ... 1 ... 1 ... 4 ... Market Street 98 3 4 3 ... ... 11 ... Melbourne Road 108 2 6 1 1 ... 4 1 Mafeking Avenue 77 1 ... ... ... ... ... ... Myrtle Road 7 ... ... ... ... ... 1 ... Malvern Road 58 ... ... ... ... ... ... ... Macaulay Road 77 ... 1 ... ... ... 4 1 Meanley Road 143 3 ... ... ... 1 2 1 Morris Avenue 59 2 3 ... 1 ... 1 ... Michigan Avenue 20 ... ... ... ... ... 1 ... 160 LOCALITY. No. of Houses. March, 1914. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. T uberculosis. Pulmonary. Other Forms. Manor Park Road 63 1 ... ... 1 ... ... ... Merlin Road 27 ... ... ... ... ... ... ... Monega Road 376 11 ... ... 2 ... 2 ... Marlborough Road 60 4 ... ... 1 ... ... ... Milton Avenue 162 3 1 ... ... ... 5 ... Newland Street 6 ... ... ... 1 ... 1 ... Norfolk Road 75 ... 1 ... ... ... ... ... Northfield Road 55 ... 1 ... ... ... ... ... Nelson Street 46 ... ... ... ... ... 4 ... Norman Road 23 ... ... ... ... ... ... ... Napier Road 83 2 5 ... 2 ... 5 ... Navarre Road 29 ... 1 ... ... ... ... ... Nigel Road 74 3 ... ... ... ... 1 1 Outram Road 74 1 ... ... ... ... 5 2 Oakfield Road 112 1 1 ... ... ... 8 ... Oregon Avenue 23 ... ... ... ... ... ... ... Osborne Road 39 2 ... ... ... ... ... ... Pulleyns Avenue 89 ... 2 ... ... ... 1 ... Plevna Street 13 ... ... ... ... ... ... ... Poulet Road 54 2 1 ... ... ... 1 ... Park Avenue 31 1 1 ... ... ... ... ... Parr Road 90 4 3 ... ... ... 1 2 Priory Road 66 ... ... ... 1 ... 2 ... Parkhurst Road 270 1 4 ... 3 ... 4 3 Plashet Lane 177 ... 1 ... ... ... 2 1 Prestbury Road 73 5 ... ... ... ... 1 1 Park Road 63 3 ... ... 1 ... 3 ... Plashet Grove 169 8 ... ... ... ... 1 ... Robert Street 32 ... ... ... ... ... 2 ... Roman Road 183 1 1 ... ... ... 4 ... Rancliffe Road 42 ... ... ... ... ... ... ... Ranelagh Road 85 2 2 1 2 ... 1 4 Redelyffe Road 46 ... 1 ... ... ... ... 1 Romford Road 546 13 2 ... ... ... 1 2 Rabbits Road 12 ... ... ... ... ... 1 ... Rectory Road 49 ... ... ... ... ... ... 2 Reynolds Avenue — ... ... ... ... ... ... ... Rosebery Avenue 172 1 ... ... 1 ... 2 ... Ruskin Avenue 152 2 4 ... ... ... 3 ... Rixsen Road 35 ... ... ... ... ... 2 ... Rosedale Road 74 3 2 ... ... ... ... ... Rothsay Road 53 3 ... ... ... ... 1 1 Rateliffe Road 50 5 ... ... ... ... 1 ... Rutland Road 93 5 ... ... ... ... 3 ... Sandford Road 11 ... ... ... ... ... ... ... Station Street 21 ... ... ... ... ... ... ... Shepstcne Street — ... ... ... ... ... ... ... Savage Gardens 132 ... ... ... ... ... ... ... Stanley Street 21 ... ... ... ... ... ... 1 Stavele.v Street - ... ... ... ... ... ... ... Storey Street ... 46 3 ... ... ... ... 2 1 161 LOCALITY. No. of Houses. Match, 1914. Scarlet Fever. Diphtheria. Typhoid Fever. sipelas. Puerperal Fever. Tuberculosis. Pulmonary. Other Forms. Saxon Road 10 ... ... ... ... ... ... 1 Southchurch Road 32 1 ... ... ... ... ... ... Stevenage Road 40 1 1 ... ... ... ... ... Springfield Road 55 1 ... ... ... ... ... ... St. Olaves Road 59 2 6 ... ... ... ... ... St. Albans Avenue 84 ... 1 ... ... ... 5 1 Southend Road 86 6 2 ... ... ... 2 ... Skeffington Road 104 ... 1 ... 1 ... 3 ... Shoeburv Road 48 3 1 ... ... ... 1 ... Streatfield Avenue 70 2 ... ... ... ... ... ... Sussex Road 5 ... ... ... ... ... ... ... St. Bartholomew's Road 41 ... ... ... 1 ... ... ... Stamford Road 108 ... ... ... 1 ... ... ... St. John's Road 81 3 ... ... ... ... 1 ... Spencer Road 43 2 2 ... ... ... 4 ... St. Bernard's Road 96 2 ... ... ... ... 2 1 Seymour Road 88 5 ... ... ... ... 6 2 St. Martin's Avenue 58 ... 1 ... ... ... 1 ... Station Road 46 ... ... ... ... ... 1 ... St. Margaret's Road 59 ... ... ... 1 ... ... ... Salisbury Road 71 3 1 ... ... ... 2 1 Second Avenue 152 1 ... ... ... ... 5 1 Selborne Avenue 30 ... ... ... 1 ... 1 1 Sixth Avenue 179 4 1 ... 1 ... 2 1 Seventh Avenue 126 5 1 ... ... ... 1 1 Sheringham Avenue 227 3 1 ... 1 ... 8 4 School Road 26 ... 7 ... ... ... 1 ... Sebert Road 1 ... ... ... ... ... ... ••• Sheridan Road 95 1 ... ... ... ... 4 3 Sibley Grove 110 1 ... ... ... ... 1 1 Shelley Avenue 146 ... ... ... ... ... ... ... Stanley Road 54 1 ... ... ... ... ... ... Swinburne Avenue 22 ... ... ... ... ... ... ... Shakespeare Crescent 224 3 4 ... ... 1 1 ... Strone Road 416 7 ... ... 1 ... 6 3 Sherrard Road 420 11 1 ... ... ... 11 2 Shrewsbury Road 304 8 3 ... 4 ... 2 ... St. Stephen's Road 137 8 ... ... ... ... 4 ... Shaftesbury Road 72 1 ... ... ... ... ... ... South Esk Road 210 2 ... ... ... ... 4 2 St. Dunstan's Road 24 ... ... ... ... ... ... ... Sandringham Road 34 1 ... ... ... ... ... ... Stafford Road 108 6 1 ... 2 ... 1 3 Tilbury Road 12 1 ... ... ... ... 1 ... Telham Road 97 ... 1 ... ... ... 2 4 Talbot Road 112 1 7 ... 1 ... 4 1 Thorpe Road 46 1 ... ... ... ... 2 ... Thackeray Road 67 2 1 ... ... ... 1 Tudor Road 81 1 1 ... ... ... 2 ... Temple Road 16 ... 1 ... ... ... 1 ... The Chase 3 ... ... ... ... ... ... ... The Warren 27 ... ... ... ... ... 1 ... Toronto Avenue 12 ... ... ... ... ... ... ... Third Avenue 118 5 1 ... ... ... 2 1 Trevelyan Avenue - ... ... ... ... ... ... ... 162 LOCALITY. No. of Houses. March, 1914. Scarlet Fever. Diphtheria. Typhoid F ever. Erysipelas. Puerperal Fever. Tuberculosis. Pulmonary. Other Forms. Tennyson Avenue 46 ... ... ... ... ... ... ... Vicarage Lane 38 1 ... ... ... ... ... 1 Victoria Avenue 80 1 ... ... 1 ... 1 ... Vernon Avenue 7 ... ... ... ... ... 1 1 Welbeck Road 70 1 ... ... l ... 1 3 White Horse Road 25 1 3 ... ... ... ... 1 Wolsey Avenue 91 1 7 ... ... ... ... 1 Wall End Road 37 ... ... ... ... ... ... 1 Welstead Road 95 1 13 ... 1 ... 3 1 Wellington Road 75 2 l ... ... ... 1 ... Winter Avenue 36 ... ... ... ... ... ... 1 Wakefield Street 167 7 l ... ... ... 5 ... Wilson Road 41 ... ... ... l ... 1 ... Worcester Road 50 3 ... ... ... ... ... 1 Wanstead Park Avenue 103 ... 2 ... ... 1 1 ... Walton Road 200 1 3 ... 2 ... 4 1 Washington Avenue 50 4 ... ... 1 ... 1 ... Whitta Road 48 ... ... ... ... ... 2 ... Wentworth Road 33 ... ... ... ... ... ... ... Wolferton Road 6 ... ... ... ... ... ... ... Warwick Road 27 1 ... ... ... ... ... ... Woodhouse Grove 43 ... 1 ... ... ... ... ... Wordsworth Avenue 54 ... ... ... ... ... ... ... Washington Road 10 ... ... ... ... ... 1 ... Waterloo Road 25 1 1 ... ... ... ... ... Walpole Road 39 2 ... ... ... ... 2 ... Whitfield Road 47 5 ... ... 2 ... 6 ... Whittaker Road 42 3 ... ... ... ... ... 1 Wyndham Road 40 1 ... ... ... ... 1 ... Wortley Road 36 ... ... ... ... ... 1 ... Woodstock Road 58 1 ... ... ... ... 1 ... Windsor Road 68 ... 2 ... ... ... ... 1 York Road 100 10 ... ... ... ... 2 1 163 INDEX. A Abatement of Nuisances 124 Acreage 9, 10 Acts adopted 6 Acts, Bye-Laws, and Regulations in force 6 Adenoids 91, 102, 106 Air Temperature 55 Alleys 133 Altitude 8 Anterior polio-myelitis 23, 34 Antitoxin 28, 31 Anthrax 41, 143 Area 9 Artizan's Dwellings 8, 49 B Back Passages 133 Bacteriological Laboratory 28, 31, 36, 42 Bakehouses 43, 46, 138 do. Underground 46 Birth Notification 20 Births 5, 10 Birth-rate 5, 10 Births, Illegitimate 11, 67 Blind Children 107 Blepharitis 93 Boots of School Children 97 Boundaries 7 Building Operations 8, 49, 50 Butchers' Offal Collection 139 Bye-Laws, Streets and Buildings 7 164 IN DEX—con tinned. c Cancer 41, 60 Cerebro-Spinal Meningitis 23,33,74 Chart, Birth-rate, 20 years 12 ,, Death-rate, 20 years 15 ,, Relative Fatality 16 Chicken Pox 40 Children Act 40, 87, 95 Children, Medical Inspection of 93 Cleanliness of School Children 94,95,96 Cleansing Station 95 Cleansing of School Children 95 Clinic 82, 85, 87, 89, 103, 109, 110 et seq. Clothing of School Children 97 Common Lodging-house 139 Comparative Statistics 5 Complaints of Nuisances 126 Contagious Diseases (Animals) Act 143 Cost of House Refuse Collection 141 Cost of Upkeep of Isolation Hospital 76 Cowsheds 44, 136 Customs and Inland Revenue Act 44 D Dairies 44, 136 Dampness 132 Deafness 93 Deaths, No. of 5, 13 Death-rate, Corrected 14 Death-rate, General 3, 5 Death-rate, Illegitimate Children 11,67 Death-rate, Infantile 3,5 Deaths, Institutional 13 Deaths of Non-Residents 13 ,, in Large Towns 5, 13, 14 Deaths, Uncertified 14 Death-rate, Zymotic 3,5 165 INDEX—continued. Density of Population 5, 10 Dentistry 101,107,11 b et seq. Diagram showing Relative Fatality 16 Diarrhceal Diseases, Death-rate 5, 18, 21 Diphtheria 28, 73 ,, Carriers 28, 69 ,, Epidemic 29,70,89 ,, Preventive Methods 30 Dirty Premises 129 Discharging Ears 93, 110 Disinfectant Stations 135 Disinfection 44, 138 Disinfection of Library Books 138 Diseases and Defects Remedied in School Children 106, 112 Drainage Work 129, 130 Dust Bins, supply of 140 E Ear Diseases of School Children 93, 111, 112 Education Statistics 81 Employment of Children Act 147 Enteric Fever 32, 74 Epileptic Children 107 Erysipelas 33 Eye Diseases of School Children 113 Eye, External Inflammation of 9 Eye Testing 113 F Factory and Workshop Act 45, 138 Filter Bed 54 Fish Frying 139 Fish Offal Collection 139 "Following up" cases 105Food and Drugs Act 44, 48 Food Inspection 49 Food, Unsound and Diseased 136 Forecourt Paving 130 Foreshore, amount of 9 166 INDEX—continued. G Gipsies 134 H Hairdressers' and Barbers' Closing Order 7 Half Holiday Orders 7, 145 Health Visitor 20 Hearing of School Children 93 Heart Diseases of School Children 94 Home Work, outworkers 47 Hospital Accommodation 69, 70 Hospital, Admissions to 69 Hospital Buildings 70, 71, 74, 75 Hospital Cubicles 74 Hospital Establishment Charges 76 Hospital Patients' Expenses 76 Hospital Staff 75 Hospital Staff, Health of 75 House Refuse, Cost of Collection 141 ,, Removal 140 House to House Inspection 127 Housing 8,49 Housing, Town Planning, etc., Act 51 Hygiene, teaching of 108 Hygienic Conditions of Schools, etc. 91 I Impetigo 110, 111, 112 Improvements in School Buildings 91 Industries 8 Infant Consultation 18, 19, 108 Infantile Mortality 3,5,17 Infectious Diseases 25, 110, 138 Infectious Diseases non-notifiable 88,90 Infectious Diseases of School Children 88, 90 Infectious Diseases, Attack Rate 25, 26, 27, 29 Infectious Diseases, Prevention 30, 87, 138 167 INDEX—continued. Inhabited Houses, Number of 5 Inhabited House Duty Exemption 44 Inquests 17 Inspection of Borough 124 Isolation Hospital 69 L Laboratory Work 30, 31, 36, 42 Legal Proceedings 48, 144, 145 Licenses, Animals 143 ,, Petroleum 135 Lighting 9, 91 Lung Diseases of School Children 94 M Malignant Disease 41, 60 Mange, Parasitic 143 Market Places 136 Meals for School Children 107 Means of Communication 7 Measles 39 Meat, Diseased 136 Medical Inspection of School Children 86 ,, ,, Arrangements for 85 „ ,, Attendance of Parents 86 ,, ,, Defects 93, 105 Eyes 91, 92, 93, 112, 113, 114 ,, ,, Height and Weight 98, 99, 100 ,, ,, Method of 85 ,, ,, Number Examined 85 ,, ,, Objections to 86 ,, ,, Scope of 86 Mental Defects of School Children 102, 107 Mental Deficiency Act 83,84,102 Meteorology 55 Milkshops 44 Mortuaries 133 Mother-craft 108 168 INDEX—continued. Mothers, Schools for 108 Mouth Breathers 94 Mumps 40 N National Insurance Act, Beds 69 Notices Served 125 Notification of Births 20 Notification of Infectious Diseases 22,23,24 Notification Rate 23,24,25, 26,27,29 Nuisances Abatement 124 Nuisances Discovered 125 Nutrition of School Children 97 O Observation Wards (Hospital) 74 Offal Collection 139 Offensive Accumulations 140 Offensive Trades 51, 139 Open-air Treatment 36, 74 Open Spaces 51 Ophthalmic Report 113 Orders 7 Outworkers 47 Overcrowding 132 P Parks and Open Spaces 51 Passages 133 Petroleum Licenses 135 Playing Fields 51 Poor Law Relief 53 Population 5, 6, 8, 9 ,, Density of 5, 9 ,, Growth of 8 ,, Natural Increase of 5 Public Houses 52 Puerperal Fever 33 169 INDEX—continued. R Rainfall 5 Rateable Value and Rates 6 Refuse Destructor 52 Refuse Removal 52 Regulations 6, 7 Relief Works 53 Ringworm 103, 104, 110, 111, 112 Roofs Leaky 131 S Sanitary Inspectors' Conference 148 et seq. Scabies 111,112 Scarlet Fever 27,72 ,, ,, Return Cases 73 Schools, Elementary 134 School Accommodation 81 ,, Alterations made 91 ,, Building Improvements 91 ,, Children, Boots of 97 ,, Children, Defective Clothing 97 ,, Children Excluded 89 ,, Children, Heart Diseases of 94 ,, Children, Lung Diseases of 94 ,, Children, Nutrition of 97 ,, Children, Skin Diseases of 87 ,, Children, Spectacles supplied to 113 ,, Children, Teeth 101, 107 ,, Children, Verminous Conditions 94 ,, Clinic 82, 85, 87, 89, 103, 109 et seq. ,, Dentistry 101, 115 ,, Hygienic, condition of 91 ,, Lighting 91 ,, Nurses 84, 105 ,, Places 81 ,, Register, No. of Children 81 Sewerage and Sewage Disposal 54 Shops Act 142 170 INDEX—continued. Shopkeepers 144 Skin Diseases of School Children 87 Slaughter Houses 49, 137 Small Pox 26 ,, Hospital 5, 26 Smoke Nuisances 51, 134 Spectacles Supplied to School Children 113 Sputum Examination 36, 42 Squint 93 Staff 4, 75, 80, 81 Statistics (Comparative) 5,56,57 Statistical Data 6 Subsoil 8 Summary of Report 5 Swimming Baths 54 Swimming Instruction 109 Swine Fever 142 T Table—Acreage 10 ,, Air Temperature 55 ,, Area 9, 10 ,, Attack Rate, Infectious Diseases 23, 26 ,, Average Stay of Hospital Patients 77 ,, Bacteriological Examinations 42, 43 ,, Births Registered 10,11,18,56,57 ,, Birth-rate 10,11,18 ,, Birth Visitations 20 ,, Cancer ,.. 41 ,, Cleansing of School Children 85, 95 ,, Clinic, Treatment at 112 and inset ,, Comparative Statistics 5 ,, Complaints—Nuisances 126 ,, Complaints Received 126 ,, Cost of Up-keep of Isolation Hospital 76 ,, Deaths in Public Institutions 56 ,, Death-rate 13,18,21 ,, Death-rate Tuberculosis 37, 39 ,, Death-rate Diarrhoeal Diseases 5, 18, 21 171 INDEX—continued. Table—Death-rate—Great Towns 13, 14 ,, Death-rate Wasting Diseases 18 „ Deaths Registered 18, 56, 57, 59 et seq. ,, Density of Population 10 ,, Dental Treatment 118, 119, 120 ,, Diphtheria, Attack Rate 23,24,29 ,, ,, Hospital Patients 24,58,69 ,, ,, Mortality 23,29,73 ,, ,, Notifications 29 ,, Diseases and Defects Remedied 106, 112 ,, Dust Collection 142 ,, Education Rate 81 ,, Enteric Fever, Attack Rate 23,24,32 ,, ,, ,, Hospital Patients 24, 69 ,, Enteric Fever Mortality 23, 32 ,, ,, ,, Notifications 32 ,, Erysipelas Mortality 23 ,, ,, Notifications 23 ,, Eye Examinations 114 ,, Factories and Workshops 45, 46 ,, " Following-up " 106 ,, Food and Drugs Act, Legal Proceedings 48 ,, Grants Received 81 ,, Height of Children 98, 99 ,, Hospital Accommodation 74 ,, Hospital Establishment Charges 76 ,, Hospital Patients' Expenses 76 ,, Hospital Patients, Scarlet Fever 24, 58 ,, Hospital Patients, Diphtheria 24,58 ,, House to House Inspection 128,129 ,, House Refuse Collection 142 ,, Infants' Clinic 20 ,, Infant Feeding 20 ,, Infantile Mortality 13,17,18,56,57,67 ,, Infectious Cases Removed to Hospital 58 ,, ,, ,, Notified 23,58,156 et seq. ,, ,, ,, Schools 90 ,, Inquests 17 172 INDEX—continued. Table—Inspections made 125 „ Isolation Hospital 76, 77 ,, Legal Proceedings 48, 152et seq. ,, Medical Inspection, Number of Children Examined 85 ,, ,, ,, Defects 91, 92 ,, ,, ,, Special Cases Examined 87 ,, Meteorological Record 55 ,, Notifications 58 ,, Notification Rate 25 ,, Nuisances Discovered 125, inset 126 ,, Outworkers 47 ,, Parks and Open Spaces 52 ,, Plans Passed 50 ,, Population 11,56,57 ,, Population, Density of 10 ,, Population, Ward 18 ,, Rainfall 55 ,, Rateable Value 6 ,, Relief Works 53 ,, Ringworm 104 ,, Scarlet Fever, Attack Rate 23,24,27 ,, ,, Mortality 23, 27 ,, ,, Hospital Patients 24, 69 ,, ,, Notifications 27 ,, School Children Excluded 89 ,, ,, ,, Defects insets 90 ,, School Clinic Consultations 111, 120 ,, ,, ,, Results of Treatment 112 ,, ,, ,, Treatment 111 ,, School Places 81 ,, Shopkeepers 144 ,, Statistical Data 6 ,, ,, ,, (Education) 81 ,, Streets and Houses, Number of 156 et seq. ,, Transferable Deaths 57 ,, Tuberculosis, Attack Rate 24 ,, ,, Death-rate 37 ,, ,, Deaths Registered 37 173 Table—Tuberculosis, Hospital Patients 24,69 ,, ,, Notifications 24 ,, ,, Notification Rate 25,35 „ Typhoid Fever 32 ,, ,, ,, Hospital Patients 24,58,69 ,, ,, ,, Notifications 32 ,, ,, ,, Mortality 32 ,, Unemployment 53 ,, Verminous Condition of School Children 94,95,96 ,, Vision of School Children 93 ,, Vital Statistics (10 years) 56 ,, ,, ,, (6 years) 57 ,, Ward Death Rates 14 ,, Ward Population 18 ,, Ward Zymotic Death-rate 22, 23 ,, Weight of School Children 98, 100 ,, Zymotic Case Rate 23 ,, Zymotic Deaths 21 ,, Zymotic Mortality 21, 22, 23 Teaching Staff 81 Teeth Decayed 101 Teeth of School Children 101, 107 Temperature 55 Temporary Buildings 135 Throat Affections 89, 102 Tonsils, Enlarged 102 Trade Refuse, Removal of 139 Tuberculosis 39,74,94,105 ,, Attack Rate 24,35 ,, Treatment of 36, 74 ,, Visits 35 Tuberculous Diseases 34, 35 Tuberculous Diseases of School Children 105 Tuberculosis Dispensary 36 Tuberculosis Officer 36 Typhoid Fever 32, 74 Typhus Fever 34 174 INDEX—continued. u Unemployment 53 Unsound Food 136 Urinals 52, 133 V Van Dwellers 134 Vaccination 26 Varicella 40 Verminous Condition of School Children 94 Vision of School Children 91, 92, 93, 110, 113, 114 W Ward Births 10 ,, Birth-rate 10 ,, Death-rates 14 ,, Deaths 14 „ Population 18 ,, Infant Mortality 18 Wasting Diseases Death-rate 18 Water, Inland 9 Water Storage 131 Water Supply 5, 9, 54, 131 Water, Tidal 9 Whooping Cough 40 Widal Test 42 Workshops 138 Work of School Nurses 84, 102 Y Yard Paving 132 Z Zymotic Death-rate 3,5,21 Zymotic Diseases 35 et seq., 156 et seq.