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, 1914. Recorders, Ltd., High Road, Ilford. 1915. 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 1914, 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 pleasing to note that the Borough occupies a very satisfactory position in regard to its Mortality Statistics, the death-rate being as low as 10.4 and Infantile Mortality 77. I wish to express my thanks to the members of the Council for the support they have extended to me, and especially in having taken over the cost of maintenance of the Infants' Clinic. This work is very necessary in a district such as this. The fact that so many children found at the Medical Inspection of School Children to be suffering from various diseases which might have been prevented by Medical advice in early life, makes it the duty of the Public Health Authority to take steps to prevent this, so that children arriving at school age will be better able to benefit by the education provided. The Local Government Board, I am pleased to note, have recognised the value of this work and are prepared to make grants to the Local Authorities who undertake the work. It is a matter of regret that delay has occurred in the scheme for extension at the Isolation Hospital. The increase in the number of Scarlet Fever cases is partly accounted for by the fact that I have not been able to give the necessary amount of cubic air space, thus causing overcrowding and further, having no discharge block, the patients must be bathed on the morning of discharge, and although the patient may have been free from discharges from the ear and nose (in 4 which the infection is carried), the fact of going out in all kinds of weather after the bath increases the danger, especially in those patients having Adenoids and Enlarged Tonsils. I have also to express my thanks to my colleagues and the Public Health Staff generally for the support extended to me. The Staff has been depleted by the call for "King and Country." Dr. Brough has been granted a commission in the Royal Army Medical Corps, Nurse Forbes (School Nurse), and Sisters Savery and Yorke (Isolation Hospital), all of the Territorial Nursing Force, were called up for service. Miss Kerr (Health Visitor) has gone to Serbia as Sanitary Inspector, and Messrs. Kendall, Worley and Baskett joined the City of London Sanitary Corps. I am, Gentlemen, Your obedient Servant, W. BENTON, Medical Officer of Health. Town Hall, East Ham. March, 1915. EAST HAM CORPORATION. PUBLIC HEALTH COMMITTEE. Councillor H. F. Witherspoon (Chairman). The Mayor (Alderman R. Banks-Martin, J.P.). The Deputy-Mayor (Councillor J. A. Williams). Alderman O. R. Anstead, J.P. Councillor W. C. Ford, J.P. Alderman J. Brooks, J.P. Councillor J. J. Francis. Alderman E. Edwards, J.P. Councillor W. T. Howlett. Alderman C. Northfield, J.P. Councillor G. Mitchell. Alderman M. Oakes, J.P. Councillor V. R. Oliver. Alderman H. Osborn, J.P. Councillor W. H. Pilgram. Councillor H. Barfield. Councillor F. Smith. Councillor A. Coles. Councillor A. Stokes. Councillor G. P. Dean. Councillor A. Taylor. Councillor J. Evans. Councillor A. H. Wiseman, C.C. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Clerks: G. W. Friend, W. J. Worley, R. A. Baskett, F. J. Kendall, A.R.San.I., Chief Clerk. W. L. Garrett, Acting 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 Visitor: Miss B. Kerr, A.R.San.I. School Nurses: M iss H. Forbes, Mies F. Howe and Miss L. Mali,on. School Medical Clerk: Miss P. Perry. Matron of Isolation Hospital: Miss Wilson. 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 Senior Assistant School Medical Officer: W. A. Berry, M.D., B.S. (Lond.), D.P.H. Assistant School Medical Officer: D. S. Brough, M.B., Ch.B., D.P.H. Medical Officer of Health, School Medical Officer, and Medical Superintendent Isolation Hospital: W. Benton, M.R.C.S., L.R.C.P., D.P.H. 6 Summary of Report for 1914. Population, Census 1911, 133,487. Estimated Population to middle of year 1914, 146,526. Persons per acre, 44. Inhabited Houses, Census 1911, 29,289. Births, 3,436. Birth-rate per 1,000 of the estimated population, 23'5. Deaths, 1,528. Death-rate per 1,000 of the estimated population, 10.4. Excess of Births over Deaths, 1,908. Natural increase per 1,000 living, 13'0. Zymotic Death-rate, 0.9. Infantile Mortality per 1,000 Births, 77. Total Rainfall, 22.4. 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. Deaths under one year to 1OOO births. Births. Deaths. Crude. Standardised. England and Wales 23.6 13.9 13.6 105 97 great towns, including London 24.9 14.6 14.9 113 145 smaller towns 23.6 12.8 12.9 104 England and Wales less the 242 towns 21.9 13.3 12.2 93 London 24.6 14.4 14.4 103 EAST HAM 23.5 10.9 10.4 77 7 STATISTICAL DATA. Year. Population. Rateable Value. General District Rate. Poor Rate and Education Rate. *1878 7,500 £33,661 s. d. 3/- s. d. 2/6 1881 10,706 £49,401 3/- 2/6 1891 32,712 £127,721 2/- 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 1914 146,526 £554,554 3/11 7/2 *East Ham Local Government District was constituted on 6th December, 1878. ACTS OF PARLIAMENT, BYE-LAWS, AND REGULATIONS IN FORCE IN THE BOROUGH Special Acts. East Ham Improvement Act, 1898. East Ham Improvement Act, 1903. East Ham Improvement Act, 1914. Adopted Acts. Infectious Diseases (Notification) Act, 1889. do. (Prevention) Act, 1890. Public Health Acts Amendment Act, 1890. Public Baths and Wash-houses Acts. Housing of the Working Classes Act, 1890, 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. 8 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 97 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 9 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 146,526 in 1914, and is still growing. The building of the new docks (now under construction by 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. 10 BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. REPORT OF THE MEDICAL OFFICER OF HEALTH For the year 1914. 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 1914, was 146,526. 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 44 persons per acre, as against 29 per acre in 1901. 11 The density of the population in the different Wards is given below:— Area in scree. Density. Beckton and North Woolwich Ward 901 18.5 Central Ward—East 622 41.6 Central Ward—West 513 53.7 Manor Park Ward 784 38.6 Plashet Ward—East 283 71.4 Plashet Ward—West 223 115.9 BOROUGH 3326 44.1 BIRTHS. During the year 3,436 births were registered as against 3,596 in 1913, giving a birth-rate of 23.5 per 1,000 of population. Of these 1,717 were males and 1,719 females. The birth-rate for England and Wales for the year was 23.6 per thousand, whilst the average rate for the 97 large towns was 27.9. The rate is still on the decline and is the lowest recorded. The following table gives the number of births and the birth-rate in the Borough as a whole and in each of the Wards:— Births. Rate per 1,000 Population. Beckton and North Woolwich Ward 494 29.6 Central Ward—East 623 24.1 Central Ward—West 627 22.7 Manor Park Ward 762 25.2 Plashet Ward—East 458 22.6 Plashet Ward—West 472 18.3 BOROUGH 3436 23.5 12 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. No. of Births Registered. Birth-rate. 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 1914 146,526 3,436 23.5 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. Seventy of these were registered, and of these 31 were males and 39 females, which represents 2.0 per cent. of the total births. There were 10 deaths. The death-rate of these illegitimate infants under one year was equal to 143 per 1,000 births registered, whilst the rate for legitimate was 76 per 1,000. 13 Rate. per 1000 Mart showing birth Rate of East Ham for the past 20 Years. 14 DEATHS. The number of deaths which took place in the Borough during the year was 1,031. Of these, 18 were non-residents of the Borough and can therefore be excluded. Particulars concerning them were sent to the districts to which they belonged. 515 deaths were reported of persons belonging to the Borough which had taken place in various institutions outside the district, viz., 27 in the West Ham Workhouse, 118 in the Union Infirmary, 57 in the London Hospital, 74 in Forest Gate Sick Home, and 176 in various Hospitals, etc. Including these we have a nett total of 1,528 (813 males and 715 females), which gives a rate of 10.4. The death-rate for England and Wales was 13"6, and for the 97 great towns 14.9. 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 Persuns Living. Infant Morlality per 1,000 Births Registered. Hornsey 8.8 57 Ilford 8.8 62 Eastbourne 9.4 58 Wimbledon 10.1 69 Southend-on-Sea 10.2 69 Enfield 10.3 81 East Ham 10.4 77 Leyton 10.4 78 Walthamstow 10.5 77 Willesden 10.5 82 Edmonton 10.7 85 Croydon 10.9 79 Acton 11.3 91 Tottenham 11.3 89 Gillingham 11.8 75 Brighton 13.6 84 15 Annual Rate per 1,000 Persons Living. Infant Mortality per 1,000 Births Registered. West Ham 14.9 108 Leeds 15.0 124 Birmingham 15.2 122 Nottingham 15.3 146 Bradford 15.7 123 Correction of Death-Bate for differences of Sex and Age Constitution of Population. The standardizing factor for correction fixed by the RegistrarGeneral at 1911 Census is 1.0536. This rate therefore is 10.98. 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 188 11.2 Central—East 238 9.2 Central—West 287 10.4 Manor Park 357 11.7 Plashet—East 202 9.9 Plashet—West 256 9.9 BOROUGH 1,528 10.4 Uncertified Deaths. No uncertified deaths were recorded in 1913 or 1914. 16 Rate per Chart showing Death Rate of East Ham for the past 2.0 Years 1000 17 Digram showing relative importance of various diseases as causes of death during 1914 Total Deaths in the Borough from all causes during 1914(Males 813 Females 715) 1,528 18 INQUESTS. 135 inquests were held. Post-mortem examinations were made on 105 cases. The following were the causes certified by Coroners:— Accident 18 Pulmonary Tuberculosis 11 Syncope 10 Suicide 9 General Paralysis 9 Heart Disease 8 Pneumonia 8 Cerebral Haemorrhage 8 Want of proper attention at birth 3 Convulsions 3 Found Drowned 3 Alcoholism 3 Senile Decay 2 Other Causes 40 INFANTILE MORTALITY. 267 deaths of Infants under one year of age occurred in the Borough, giving a rate of 77 per 1,000 births registered as against 63 in 1913 and 71 per 1,000 in 1912. 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. Rate per 1,000 Births Registered. 1910 312 90 1911 412 119 1912 256 71 1913 226 63 1914 267 77 19 The following table gives the rate of infantile mortality and other allied statistics for each Ward in the Borough for 1914:— Borough. Beckton & North Wlwich. Central Eat. Central West. Manor Park. Plashet East. Plashet West. Population 146,526 16,724 25,914 27,543 30,280 20,221 25,844 Births 3,436 494 623 627 762 458 472 Birthrate 23.5 29.6 24.1 22.7 25.2 22.6 18.3 Deaths 1,528 188 238 287 357 202 256 Death-rate 10.4 11.2 9.2 10.4 11.8 9.9 9.9 Deaths under 1 year 267 35 53 45 76 24 34 Infant Mortality Rate 77 71 85 72 99 52 72 Death - rate per 1,000 births from Diarrhœal diseases 18 12 22 10 33 15 8 Although the Infantile Mortality is slightly higher than in 1913 the rate is still low and is one of the lowest in the United Kingdom, being 77 per 1,000 as compared with 105 for England and Wales and 113 for the 97 great towns. Methods for Preventing Infantile Mortality in the Borough. The adoption of the Notification of Births Act has been justified by the results obtained, the Infantile Mortality rate having fallen from 119 per 1,000 in 1911 to 77 in 1914. Of the 3,436 registered Births 2,798 were notified as required by the Council. There is no doubt that the appointment of a Health Visitor has done much towards this reduction, but in a borough of this size, to carry out the work as it should be done, it is necessary to appoint several more Health Visitors, as one can only visit a small percentage of the cases notified. A large number attend the Infants' Clinic at the old Public Offices in Wakefield Street, but it is necessary for visits to be made to the homes of those who do not attend. 20 Of the notified cases it was only found possible for one Health Visitor to visit 369 cases. The commonest cause of Infantile Death is the want of knowledge of infant care. At the Infants' Clinic short addresses are given to the mothers on the care and feeding of infants. The interest shown by the attendance of the mothers at the Clinic proves the need for such and shows that they are anxious for the welfare of their babies. The advantage of Maternal Nursing as against artificial feeding is pointed out. Artificially fed children are much more susceptible to intestinal disorders and complications of other diseases caused thereby. Where from any cause such as insufficiency or poorness of the mother's milk, artificial feeding is resorted to, the advantage of the Clinic, where advice may be obtained as to the best foods to be given, will be understood. I attend myself at the Clinic and give advice to those mothers where the baby does not appear to be making satisfactory progress. It may be said that these mothers should seek advice from a private doctor, but 1 would point out the impossibility of most of the parents obtaining medical advice on account of the expense. Where treatment is necessary in the way of medicine the parent is advised to take the child either to her own doctor or a hospital. But this is not always possible, as even fares and loss of time in attending hospital is a serious consideration. A number of medical men in the borough now send mothers with their infants to the Clinic, where it is found that it is impossible for the parent to pay for private advice. The infants are weighed and weight recorded on a card supplied to the mother as well as in a register kept at the Clinic. It is interesting to note the interest taken by the mother in the improvement as shown by the increase in weight of the infant. 21 In some cases "Virol" is supplied to be given to the babies with very satisfactory results, especially those found to be suffering from Rickets and Malnutrition. To encourage the mothers to take more interest a "Baby Show" was held in the Town Hall during the year and a number of valuable prizes provided out of a voluntary fund were given to the most healthy babies. About 250 who attended the Clinic were entered. The judges, who comprised medical men and visitors, all remarked on the excellent condition of the infants. In those cases notified where it is impossible for Miss Kerr to visit, a card of instructions on the care and feeding of infants is sent by post, but with the appointment of more Health Visitors it would be much more satisfactory for the homes to be visited, to make inquiries into the condition of the health of mothers and infants, and home life, viz., the sanitary condition of the premises, overcrowding, lighting and ventilation. It would be interesting to know the number of deaths of infants caused indirectly by a very common and distressing sight only too frequently to be seen in this Borough, viz., that of children in charge of their mothers outside public-houses at all hours of the day, being exposed to varying conditions of weather, thus causing Bronchitis and other respiratory diseases. The prosecution under the Children Act in a few cases would be a protection to these children. I have in the Isolation Hospital at the present time a child only one year and ten months old who frequently asks the Nurse for beer to drink, thus showing the conditions with which this child is surrounded at home. I should again like to express my thanks to the voluntary helpers, Mrs. Athelstan Coles, Mrs. Clift, Mrs. Howe, Mrs. Roberts, Mrs. F. Thomas and Mrs. G. Thomas, for their kind assistance at the Clinic, also for the making of clothing, which was distributed at the Annual Christmas Tree in connection with the Clinic. 22 The following is a summary of the work carried out by the Health Visitor (Miss Kerr) for the year 1914:— Births 369 Re-visits 486 Phthisis 555 Re-visits 296 Special Visits 322 Ophthalmia Neonatorum 11 Re-visits 10 Cases reported N.S.P.C.C. 7 Total 2,056 Total attendances at Infants' Consultation, 4,664. An analysis of this follows:— Births. Re-visits. B'ckt'n and North W'lw'h Central East. Central West. Manor Park. Plashet East. Plashet West. B'ckt'n and North W'lw'h Central East. Central West. Manor Park. Plashet East. Plashet West. 54 122 97 47 29 20 53 164 155 54 28 32 Phthisis. Re-visits. B'ckt'n and North W'lw'h Central East. Central West. Manor Park. Plashet East. Flashet West. B'ckt'n and North W'lw'h Central East. Central West. Manor Pak. Plashet East. Plashet West. 58 96 199 105 37 60 19 55 128 56 26 12 Summary of work at Infants' Consultation for 1914:— Number on Register 990 Total Attendances 4 664 FOOD. Breast. Glaxo. Nestles. Allenbury's Breast and Bottle. Cow's Milk and Water. Virol. 546 66 100 5 46 99 200 23 DEFECTS. Umbilical Hernia Inguinal Hernia. Nævus. Infantile Paralysis. Rickets. P. T. 38 14 10 4 42 2 DEATHS. Marasmus. Whooping Cough. Suffocation. Broncho Pneumonia. Gastro Enteritis. Bronchitis. Laryngitis. 6 1 1 2 1 3 1 24 ZYMOTIC MORTALITY. 132 deaths were attributed to the principal Zymotic diseases, as against 110 in 1913. This equals a mortality rate of 0'90 per 1,000 of population. It should be noted that this figure includes 59 deaths from" Diarrhœal 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. 1910 1911 1912 1913 1914 Deaths. Deathrate. Deaths. Death rate. Deaths. Deathrate. Deaths. Deathrate. Deaths, Deathrate. Small Pox ... ... ... ... ... ... ... ... ... ... Scarlet Fever 3 0.02 2 0.01 7 0.05 4 0.03 7 0.05 Diphtheria 13 0.09 11 0.08 9 0.07 16 0.11 27 0.18 Enteric Fever 5 0.04 8 0.06 3 0.02 2 0.01 5 0.03 Measles 12 0.09 68 0.50 39 0.28 11 0.08 15 0.10 Whooping Cough 24 0.18 12 0.09 39 0.28 15 0.10 19 0.12 Diarrhœa 48 0.36 205 1.52 32 0.23 62 0.43 59 0.40 Totals 105 0.80 306 2.28 129 0.93 110 0.77 132 0.90 Deaths and Deathrate from all causes. 1330 10 2 1623 121 1474 10.6 1437 10.1 1528 10.4 25 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 1914 is shown in the following Table:— Zymotic Diseases. Beckton and North Woolwich Central East. Central West. Manor Park. Plashet East. Plashet West. Scarlet Fever ... ... 2 2 1 2 Diphtheria 6 6 3 4 5 3 Enteric Fever ... 2 1 1 ... 1 Measles 3 4 2 1 3 2 Whooping Cough 2 2 1 5 4 5 Diarrhoea 6 12 5 25 7 4 Totals 17 26 14 38 20 17 Rate per 1,000 of population 1.02 1.00 0.51 1.25 0.98 0.65 26 NOTIFIABLE INFECTIOUS DISEASES FOR PAST 10 YEARS. 1905 1900 1907 1908 1909 1910 1911 1912 1913 1914 No. of cases notified 1437 1230 1617 1634 966 600 694 684 945 1173 Attack rate per 1,000 of population 11.9 9.4 11.8 11.4 7.6 4.6 5.1 4.9 6.6 8.0 Notifiable Diseases. Cases notified. Deaths. Attack rate per 1,000 Population Death-rate per 1,000 Population. Small Pox ... ... ... ... Scarlet Fever 677 7 4.6 0.05 Diphtheria 319 27 2.1 0.18 Enteric Fever 21 5 0.1 0.03 Puerperal Fever . 4 2 0.01 Erysipelas 130 2 0.8 0.01 Ophthalmia Neonatorum . 17 0.1 ... Typhus Fever ... ... ... ... Cerebro-Spinal Meningitis 1 ... ... ... Acute PolioMyelitis 4 ... ... ... Total 1173 43 8.0 0.29 TABLE SHEWING NOTIFICATIONS OF EACH INFECTIOUS DISEASE FOR THE PAST FIVE YEARS—1910-1914. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Ophthalmia Neonatorum. Puerperal Fever. Cerebrospinal Fever. Acute Poliomyelitis. Typhus Fever. Totals. Pulmonary Tuberculosis. Other forms of Tuberculosis. 1910 1911 1912 1913 1914 1910 1911 1912 1913 1914 1910 1911 1912 1913 1914 1910 1911 1912 1913 1914 1914 1910 1911 1912 1913 1914 1913 1914 1913 1914 1914 1910 1911 1912 1913 1914 1910 1911 1912 1913 1911 1914 January 21 13 39 39 66 11 12 19 4 40 ... ... ... 1 4 7 8 24 15 10 ... 1 1 2 ... 1 ... ... ... ... ... 40 34 84 59 121 5 11 56 21 67 8 February ... 54 29 28 20 79 16 11 13 9 43 ... ... ... ... ... 7 11 14 5 9 ... ... 1 ... 1 ... ... ... ... 2 ... 77 52 56 35 133 10 6 36 29 68 14 March 35 25 31 30 62 7 10 18 7 27 ... ... ... 1 2 15 12 9 5 6 1 ... ... ... ... 1 ... ... 1 2 ... 57 47 58 44 101 3 11 27 38 58 13 April 16 14 35 26 38 10 7 2 1 19 ... 3 1 ... ... 6 7 8 9 12 5 ... ... ... 1 ... 1 ... ... ... ... 32 31 46 38 74 4 10 41 45 42 11 May 24 22 30 15 32 14 7 3 6 15 ... ... ... ... ... 5 7 11 7 6 ... 1 1 1 1 ... ... ... ... ... ... 44 37 46 29 53 8 40 33 73 53 15 June '26 15 23 27 39 16 10 1 22 18 ... 1 ... 1 3 6 6 9 5 6 3 ... ... ... ... ... ... ... ... ... ... 48 32 33 55 69 8 27 26 31 36 13 July 28 25 24 67 52 4 32 2 15 18 1 ... 1 1 4 6 5 6 15 8 3 ... ... 1 ... ... ... ... ... ... ... 39 62 34 98 85 11 19 25 41 56 8 August 20 29 16 41 33 8 4 3 15 10 1 4 ... 4 5 9 8 15 9 9 ... 1 ... ... ... ... 1 ... 1 ... ... 39 45 42 72 57 8 10 18 30 33 10 September 24 44 48 53 60 11 5 5 28 36 3 12 1 2 8 15 9 9 5 2 2 ... ... 2 ... ... 3 ... ... 46 78 63 95 105 4 23 32 41 32 6 October 18 58 68 74 87 20 10 3 50 36 7 21 1 4 1 9 22 19 14 22 ... 1 ... 1 ... ... 4 ... 3 ... ... 55 111 92 150 146 5 22 17 53 37 8 November 41 56 55 69 60 11 10 2 61 36 3 12 ... 3 2 16 18 19 15 21 2 ... 1 1 3 ... ... ... ... ... ... 71 97 77 151 121 6 26 26 36 35 7 December 22 47 38 65 69 14 3 1 40 21 4 3 ... 2 ... 10 15 9 11 16 1 2 1 1 52 68 49 119 108 14 16 28 54 33 2 Totals 329 377 435 526 677 142 121 72 258 319 19 56 13 19 21 104 134 152 119 130 17 6 6 8 8 4 6 1 8 4 600 694 680 945 1173 86 221 365 492 550 115 NOTIFIABLE DISEASES. CASES NOTIFIED IN EACH WARD BOROUGH. ATTACK RATE PER 1,000 OF POPULATION. BOROUGH. PERCENTAGE OF CASES REMOVED TO HOSPITAL. BOROUGH. Beckton & North Woolwich. Central East. Central West. Manor Park. Plashet East. Plashet West. Beckton & North Woolwich. Central East. Central West. Manor Park. Plnshet East. Plashet West. Beckton & North Woolwich. Central East. Central West. Manor Park. Plashet East. Plashet West. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 89 162 117 96 123 90 677 5.3 6.2 4.2 3.1 6.0 3.4 4.6 73 70 84 71 70 71 73 Diphtheria 69 70 44 61 39 36 319 4.1 2.7 1.5 2.0 1.9 1.3 2.1 85 91 100 79 62 64 82 Enteric Fever 1 1 3 10 4 2 21 ... ... 0.1 0.3 0.2 ... 0.1 100 100 100 70 75 50 76 Puerperal Fever ... 8 ... ... ... 1 4 ... 0.1 ... ... ... ... ... ... 67 ... ... ... ... 50 OphthalmiaNeonatorum 4 2 6 2 ... 3 17 ... ... ... ... ... ... ... ... ... ... 50 13 24 , Erysipelas... 14 18 36 26 15 21 130 0.8 0.6 1.3 0.8 0.8 0.8 0.8 7 6 14 23 13 24 16 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Meningitis ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Polio-Myelitis ... ... 1 3 ... ... 4 ... ... ... ... ... ... ... ... ... ... 33 ... ... 25 Pulmonary Tuberculosis 52 98 191 96 51 62 550 3.1 3.7 6.9 3.1 2.5 2.4 3.7 35 22 18 32 31 24 25 Other forms of Tuberculosis 27 13 30 23 7 15 115 1.6 0.5 1.0 0.7 0.3 0.5 0.7 4 15 10 26 29 13 14 28 NOTIFIABLE INFECTIOUS DISEASES. 1,173 cases of Infectious Disease were notified during the year as against 945 in the previous year. There was an increase in the number of Scarlet Fever cases notified, this being partly due to the prevalence of the disease in the Metropolitan Area. Quite a large number of adults were notified, who probably contracted the disease outside the Borough. There was no evidence of any connection with the increased number of cases to any milk supplied in the Borough. The following Table gives the total Notification Rate per 1,000 of population for each Ward during the past year :— Notification Rate, excluding Tuberculosis. Tuberculosis Notification Rate. Pulmonary. Other forms. Beckton and N. Woolwich Ward 10.6 8.1 1.6 Central Ward—East 9.8 3.7 0.5 Central Ward—West 7.5 6.9 1.0 Manor Park Ward 6.5 3.1 0.7 Plashet Ward—East 8.9 2.5 0.3 Plashet Ward—West 5.9 2.4 0.5 Borough 8.0 3.7 0.7 Small Pox. No case of Small Pox was notified during the year. One suspicious case was reported to me, which I visited and found to be a severe case of Chicken Pox. The agreement with West Ham Corporation has been renewed, 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. 29 Scarlet Fever. 677 cases of this disease were notified during the year as against 526 in the year 1913. During the early part of the year the disease still continued to be of a very mild type, and there is no doubt this mildness was a reason for the unusual spread of the disease. In some cases the symptoms were so slight that the disease was not discovered until desquamation had commenced, and in the meantime the child may have returned to School, or as I have mentioned in previous reports, attended Cinema Theatres, and thus spread infection. 7 deaths occurred from the disease giving a death-rate of 0'05, compared with 0.03 for the year 1913. The death-rate for England and Wales was 0'08 and for the 97 great towns 0.09. Of the 677 cases notified 503 were admitted to the Isolation Hospital. 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 too cases notified. 1910 130,596 329 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 1914 146,526 677 4.6 1.0 Diphtheria. 319 cases of this disease were notified during the year with 27 deaths. 258 cases were notified in 1913 with 16 deaths. 30 As in the case of Scarlet Fever, this disease has been more prevalent, being the largest number since the year 1908, when there were 456 cases notified. During the last few months of the year there was an epidemic in the Infants' Department at New Beckton School, and although I visited the School a number of times and took " swabs " from the throats of the children in the class-rooms affected, I found it impossible to arrest the spread of the disease until I advised the closure of the Department for 14 days. Since that time there have been no more cases from that district. I again point out the danger of the common drinking cup in the Schools, which may be infected by a " carrier " of Diphtheria, and advise spray drinking jets to be provided instead. 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. 1910 130,596 142 1.9 9.1 1911 134,441 121 0.9 9.0 1912 138,450 72 0.5 12.5 1913 142,467 258 1.8 6.2 1914 146,526 319 2.1 8.4 Preventive Methods Undertaken to Control the Spread of the Disease. On receipt of the 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 the patient be 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 CHART showing the number of cases of Diphtheria notified during each week of the year 1914. CHART showing the number of cases of Scarlet Fever notified during each week of the year 1914. 31 should be adopted to prevent the spread of infection. Information is obtained as to the Day and Sunday schools attended, either by the patient or by children in the house, the school authorities are notified, and all children living in the house are for a time excluded. The source of the milk supply, the occupation of the inmates, home work, sanitary condition of the premises, water supply, presence of animals, etc., are all investigated, and a report made to me on the same day. The name of the laundry 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 that 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 32 are examined, and "swabs" taken from the nose and throat of all suspicious cases. Disinfection of class-room, slates, pencils, 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. Enteric Fever. 21 cases of Enteric (Typhoid) Fever were notified during the year. There were five deaths from the disease. Of the 21 cases notified 18 were admitted to the Isolation Hospital for treatment. One case was diagnosed as Acute Tuberculosis and another as Acute Mania, these being sent to the Infirmary. Five other cases were members of one family. In all the cases notified the probable infection was contracted outside the Borough. One case admitted to the Isolation Hospital from the General Hospital, Shrewsbury Road, was that of a soldier who was wounded at the Battle of the Aisne and subsequently developed Typhoid. 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. Popu'ation. Cases Notified. Attack rate per 1,000 of Population. Mortality per 100 cases notified. 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 1914 146,526 21 0.14 23.8 Erysipelas. 130 cases of Erysipelas were notified as compared with 119 cases in 1913. Two deaths occurred. 33 Opthalmia Neonatorum. During the year 1914, 17 cases were notified, and visited to find out if they were having the necessary treatment, and in those cases where it was thought advisable the children were sent to Hospital. Puerperal Fever. Only four cases of this disease were notified, but unfortunately two deaths occurred, as against eight cases in 1913 and one death. On receipt of a notification the case is immediately investigated, and in order to prevent the spread of the disease the Nurse is suspended from attending further cases for a certain period and the necessary disinfection of her clothes and appliances carried out. Epidemic Cerebro-Spinal Meningitis. During the year one case of this disease (Cerebro-Spinal Fever) was notified to me. The case was sent into a London Hospital where the child died. The cause of death was given as Tubercular Meningitis. Acute Polio-Myelitis. Four cases of this disease, commonly known as Infantile Paralysis, were notified. I visited these and found that two were of the chronic variety and were under treatment at London Hospital. One other case recovered entirely and another had partial paralysis of one leg. Typhus Fever. No case was notified. Tuberculosis. The number of deaths from Tuberculosis during the year was 181, as compared with 168 in 1913 and 190 in 1912. 34 The following table shows the number of deaths from Pulmonary Tuberculosis and other forms of the disease:— Pulmonary Tuberculosis (including Phthisis), 82 mades and 53 females 135 deaths Tuberculosis of the Brain 14 „ Acute Miliary Tuberculosis 3 „ Abdominal Tuberculosis 14 „ Other forms of Tuberculosis 15 ,, Notification Rates per 1,000 of Population. Pulmonary Tuberculosis. Other Tuberculosis. 3.7 0.7 Under the Public Health (Tuberculosis) Regulations, 1912, the total number of notifications received was :— Tuberculosis (Pulmonary) 294 males. 256 females. 550 do. (Other Forms) 115 665 Males. Females. Total. 294 256 550 Analysis as follows :— AGE PERIODS—MALES. 1-5 5-10 10—15 15 20 20-25 25-35 35—45 45 55 55- 65 65 and over. Total. 14 31 28 33 31 61 52 24 17 3 294 35 AGE PERIODS—FEMALES. 1-5 5—10 10-15 15- 20 20—25 25—35 35—45 45—55 9 55 65 65 and over. Total. 4 51 28 38 36 47 38 4 1 256 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. 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 Essex County Council are until April 1st responsible for carrying out the Sanatorium provisions of the National Insurance Act. The Tuberculosis Dispensary in Wakefield Street, under the direction of the Medical Officer appointed by the County Council, has continued to carry on excellent work. The number of patients on the Treatment Register on December 31st, 1911, suffering from Tuberculosis of the Lungs, was 377, and other forms of Tuberculosis 5. Upon East Ham becoming a County Borough on April 1st, 1915, the Tuberculosis work will come under the Local Authority which should be more satisfactory, thus bringing closer contact between the Tuberculosis Officer and Nurses to the Public Health Department. 36 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. 1910 130,596 163 1.25 1911 134,441 164 1.22 1912 138,450 190 1.37 1913 142,467 168 1.18 1914 146,526 181 1.24 Under the Public Health (Tuberculosis) Regulations, 1912, every form of Tuberculosis has now to be notified. Pulmonary Tuberculosis (Tuberculosis of the Lungs). 135 deaths were registered as being due to this cause, as compared with 124 in 1913. 550 cases of Pulmonary Tuberculosis were notified, giving a rate of 3.7, as against 492 in the previous year. The number of cases notified shows an increase, but there is no doubt that a large number of contacts have been notified that should be classed not as suffering from the disease, but in the pretubercular stage. These cases are chiefly of children who probably are in delicate health, but show no physical signs of the disease. To indicate the wholesale manner of cases being notified, eight in one family, viz., husband, wife and six children, were notified to me as suffering from the disease. 1 examined three of the children and could find no evidence in the way of physical signs, but should classify them as being predisposed to the disease. 152 cases notified were under the age of 15 years. Table 2 gives the number of cases notified at different ages with the prevalence in the respective wards. 37 It is difficult to explain the fact that Beckton and North Woolwich Ward, which is one of the poorest and most crowded districts in the Borough, should, apart from Plashet Ward East, have the least number of cases notified. 137 cases have had treatment in different Sanatoria and Hospitals. The insured persons under the National Insurance Act have been provided for by the Essex County Insurance Committee. When a patient is discharged from the institution where he has undergone treatment he is advised to attend the Tuberculosis Dispensary. 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-rat. Beckton and North Woolwich 27 1.6 Central Ward—East 24 0.9 Central Ward—West 39 1.4 Manor Park Ward 46 1.5 Plashet Ward—East 20 0.9 Plashet Ward—West 25 0.9 COMMUNICABLE DISEASES NON-NOTIFIABLE. Measles. 549 cases of Measles were registered from the Schools. The majority of the cases occurred in the first half of the year. This disease is the most difficult to check in Schools as it is so very infectious during the period when the child is probably thought to be suffering from a severe cold. A Measles Register is kept at all the Schools, but owing to the delay in receiving notifications the disease has probably infected most of the class before contacts are excluded. 38 The number of deaths from Measles and complications was 15. All the deaths were of children under School age, viz., 11 between the ages of 1 and 2 years, three between the ages of 2 and 5 years, and one under the age of 1 year. Measles is considered by parents a disease that children must have, but these figures prove how much less is the danger if the disease is postponed until the child is older. The chief danger of Measles is the complications of the respiratory organs, such as Bronchitis and Broncho-Pneumonia. It was not considered necessary to close any of the Schools, but the different class-rooms were disinfected to check the spread of the disease. Special leaflets giving the symptoms of Measles and directions for isolation and nursing are supplied to the Schools to be given to parents. In the poorer and more congested areas of the Borough it is impossible to find adequate means of isolation, and unfortunately the Cubicle Block at the Isolation Hospital has been so fully occupied by other infectious diseases, that I was not able, as in previous years, to admit cases of Measles for treatment. This is unfortunate, as there is no doubt that in some cases, where from poverty it was impossible to place the patient under favourable circumstances for treatment, some of the deaths might have been prevented by removal of the patient to hospital. Whooping Cough. 151 cases were reported by Head Teachers of the Schools, but these are only a small minority of the cases in the Borough. There were 19 deaths from the disease as against 15 in 1913 and 39 in 1912. 16 deaths occurred in children under the age of two years and as in the case of Measles, the complications of Bronchitis and Pneumonia were the chief causes of death. Mumps. 37 cases were reported. No deaths occurred. 39 Varicella (Chicken Pox). 245 cases were reported from the Schools. No deaths occurred, although some of the cases I visited were severe. One case I saw in consultation with the Medical Attendant was thought to be a case of Small Pox, but the course of the disease proved otherwise. Other Diseases. Respiratory diseases, including Bronchitis, Pneumonia, Pleurisy and other diseases connected with the respiratory system accounted for 292 deaths, of which 97 were upwards of 65 years of age. Cancer. 108 deaths were registered as due to cancer, as compared with 122 in the previous year. 94 of these deaths were in persons of 45 years and upwards. The organs most frequently affected were the abdominal organs, viz., stomach, liver and intestines. The number of deaths from Cancer during the past five years is as follows :— Year. Deaths. Death-rate per 1,000 of Population. 1910 93 0.71 1911 105 0.78 1912 107 0.77 1913 122 0.86 1914 108 0.73 40 REPORT ON THE BOROUGH LABORATORY. The work of the Laboratory continues to show a steady increase. During the year 1914 there were 1,584 specimens examined, as compared with 1,226 for the year 1913. From Table I. it will be seen the more strenuous swabbing of suspected Diphtheria throats accounts for much of the increase. Clinical Bacteriology. The following is a summary of the number of specimens examined during the year ending December 31st, 1914:— Table I. Specimens. Positive. Negative. Suspected Diphtheria 1236 425 811 Suspected Ringworm 157 122 35 Sputum for suspected Tuberculosis 186 43 143 Suspected Typhoid (Widal) 19 5 14 Examinations were also made of specimens of water from the swimming bath, of urine, and of pus for gonococci. Amongst the Ringworm cases was one of Tricophyton. In Table 2 is shown the monthly number of " swabs " sent by doctors, by the Borough Hospital, and obtained from the schools, etc. Under the heading " Schools, etc.," are included 84 swabs taken from "contacts," 85 from suspicious cases met with during routine medical inspection in the schools, and 189 from similar cases that attended the School Clinic. 41 Results, if positive, are communicated per telephone, or sent by 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 as satisfactory condition as those above ground. A number of bakers have installed machinery in their bakehouses, and these are also visited by H.M. Inspector of Factories. Table 2. Doctors' Swabs. Hospital Swabs. School,&c., Swabs. + - + - + - January 14 44 34 28 14 36 February 20 22 25 38 16 40 March 7 25 31 48 9 31 April 13 19 10 11 8 23 May 12 13 6 11 3 25 June 9 17 12 9 1 4 July 6 32 16 22 3 9 August 3 11 9 23 — — September 11 14 12 19 12 25 October 16 22 13 14 5 40 November 17 20 6 25 7 31 December 15 25 13 24 5 11 149 264 193 272 83 275 413 465 358 42 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 46. CUSTOMS AND INLAND REVENUE ACT. 33 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 were of an annual value of less than £20. DISINFECTION. 1,535 premises were disinfected during the year. The steam disinfector at the Isolation Hospital is used for bedding and other articles requiring disinfection. 43 FACTORY AND WORKSHOP ACT. Annual Report of the Medical Officer of Health for the year 1914, 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) 58 — — Workshops (Including Workshop Laundries) 314 7 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) Total 372 7 — 2 DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES. PARTICULARS. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts :— Want of cleanliness 9 — — — Want of ventilation 2 — — — Overcrowding — — — — Want of drainage of floors 1 — — — Other Nuisances 3 — — — Sanitary accommodation(i w.c. required for 25 persons) 'insufficient — — — — unsuitable or defective — — — — not separate for sexes — — — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse(s. 101) — — — — Breach of Special sanitary requirements for bakehouses (ss. 97 to 100). — — — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) Total 15 — — 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LIST, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109 & no. 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. Instances. Orders made (S. no). Prosecutions (Sections 109, no.) Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) making, etc — — — 10 16 86 - - - - - - - - - (2) cleaning & washing - - - - - - - - - - - - - - - Household Linen — 1 1 1 - - - - - - - — — 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 Brush Making Pea Picking Feather Sorting Carding&c. of Buttons,&c. Stuffed Toys Basket Making Chocolates & Sweets Cosaques, Xmas Crackers & Xmas Stockings Textile weaving Total - - - 11 17 87 - - - - - - - - 45 4.—REGISTERED WORKSHOPS. 5.—OTHER MATTERS. Workshops on the Register (s. 131) at the end of the Year. Number. Class. Number. Wearing Apparel Manufacturers 90 Matters notified to H.M. Inspector of Factories:— Bakehouses 48 Failure to affix Abstract of the Factory and Workshop Act (s. 133) 6 Laundries 5 5 Printers 8 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 5 Other Workshops 108 Reports (of action taken) sent to H.M. Inspector... 5 Other Nil. Underground Bakehouses (s. 101) Certificates granted during the year Nil. Total number of Workshops on Register 309 In use at the end of the year 10 46 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:— Number of samples taken in East Ham during the year ended December 31st, 1914:— Milk 173 Butter 182 Other samples 7 Total 362 Ten prosecutions were undertaken and resulted in convictions and fines, as follows £ s. d. £ s. d. In respect of Butter 2 10 0 & costs 0 10 0 „ Butter 2 0 0 „ 0 10 0 „ Butter 3 0 0 „ 0 11 0 „ Milk 2 0 0 „ 0 12 0 „ Milk 2 0 0 „ 3 16 0 „ Milk 2 0 0 „ 6 6 0 „ Milk 2 0 0 „ 0 10 0 „ Milk 2 0 0 „ 0 10 0 „ Milk 1 0 0 „ 0 10 0 „ Milk 1 0 0 „ 0 11 0 Cautions have been given where proceedings were not advisable. FOOD INSPECTION. The inspection of food is carried out as far as possible by the Inspectors and myself, but in a Borough of this size there should be sufficient work for a special Inspector to devote most of his time to this work. During the latter part of the year since the outbreak of war there has been a great demand for meat to supply the troops and a considerable amount of slaughtering has taken place at the slaughter-houses in the Borough. 47 The slaughtering takes place at all hours of the day and night. It will thus be seen how difficult it is, owing to the limited time of the Inspectors, to supervise and inspect the meat. Surprise visits are paid and meat seized and condemned. Unfortunately we have no power to close existing slaughterhouses. Most of the present slaughter-houses are structurally unfitted for such use, and in most cases it is impossible to maintain them in a sanitary condition. To obtain a pure meat supply the provision of a Public Abattoir should be made. This would provide the best of opportunities for inspecting all meat at the time of or immediately after slaughtering. A stamped certificate from the Meat Inspector could then be given to the butcher. In a number of cases when the Inspector visits a slaughterhouse, carcases found to be Tubercular are voluntarily surrendered, but it will be seen how from ignorance or otherwise of the pathological condition the meat may be dressed and freed from all signs of disease for human consumption. In most of the present slaughter-houses the want of space renders it well-nigh impossible to slaughter under proper conditions. The following are a few of the many advantages of a Municipal Abattoir:—Methods of slaughtering. Official supervision of slaughtering. The manner in which animals are sometimes slaughtered in private slaughter-houses may amount to systematic cruelty which could not exist in a public slaughter-house. Under supervision and inspection the humane slaughtering of animals could be insisted upon. I have seen children at doors of private slaughter-houses watching animals being killed, which I consider is very objectionable. 48 The lairage in connection with most slaughter-houses is usually insufficient, and often creates a nuisance in the immediate neighbourhood. Private slaughter-houses are often situate near shops or dwelling houses, thus creating a dangerous nuisance. The offal and blood may find its way into sewer. The flooring and walls are often of such a character that it is impossible to keep them as clean as they should be. Another objectionable practice is found in the hanging of the meat close to where the animal has been slaughtered, with offal and manure lying on the floor. All these obvious defects would be remedied by the provision of a public Abattoir. To those improvements mentioned may also be added the interest to the general public in the guarantee of a pure meat supply. HOUSING ACCOMMODATION. The Borough is well supplied with houses and tenements, and these, 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 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 18 years:— 49 BUILDING PLANS APPROVED. YEAR. Houses. Alterations and Additions. Houses and Shops. Churches and Chapels. Stables and Coach Houses. Schools. Hotels. Hanks. 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 1914 226 25 4 — 1 1 Sunday 1 — 1 1 12 272 Total 16475 726 846 29 229 26 10 4 13 33 269 18660 50 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, 2,027. (2) Number of houses found unfit for habitation, 1. (3) Number of representations to the Local Authority, 1. (4) Number of closing orders made, 1. (5) Number of houses remedied without closing order, 1,216. (6) Number of closing orders determined, 1. (7) Number of houses dealt with under Section 15, Nil. (8) Number of houses dealt with under Public Health Act, 1,723. 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. 51 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 14 public conveniences in the Borough. 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 supply one. 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, 52 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 is 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 covered-in Public Swimming Bath is 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 are also well patronised. 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 previously had storage cisterns now have a supply direct from the main. 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, 1914, was:— £ s. d. No. 4 District—East Ham North 2,976 0 10 No. 16 District—East Ham South 3,006 13 1 No. 22 District—East Ham East 3,406 14 11 Total £9,389 8 10 u METEOROLOGICAL RECORD—YEAR 1914. Rain Gauge 5.in. in diameter, placed I.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. Rainfall. Highest Maximum. Lowest Minimum. Mean of Mean Temperature of Air. No. of Days on which Rain fell, 0.01 inches and over. Amount collected in inches. Mean rate of falf for Rainy Days. Greatest fall in 24 hours. Date of greatest fall. All Highest. All Lowest. January 56° 18° 42°6 33°.0 37°.8 8 0.33 0.15 0.13 9th February 58° 28° 51°.7 37°.9 44°.8 15 2.29 0.15 0.64 9th March 65° 25° 50°.4 37°.4 43°.9 24 3.93 0.16 0.72 8th April 72° 33° 59°.3 40°.2 49°.8 11 0 92 0.08 0.20 7th May 81° 36° 62°.1 44°.0 53°.0 8 2 09 0.26 0.88 7th June 86° 40° 70°.1 49°.3 59°.7 12 1.23 0.10 0.23 22nd July 85° 47° 72°.3 54°.7 63°.5 13 1.34 0.10 0.23 5th August 81° 47° 72°.6 54°.2 63° 3 10 0.9.3 0.09 0.36 5th September 82° 35° 60°.0 48°.8 57°.8 7 0.71 0.10 0.17 13th October 67° 35° 58°.7 45°.9 51°.9 11 1.05 0 09 0.29 29th November 61° 30° 51°.1 39°.6 45°.1 14 2.05 0.14 0.42 11th December 56° 27° 47°.2 36°.8 42°.2 23 5.53 2.40 1.06 28th Means and Totals for the Year. 86° 18° 58°.2 43°.5 51°.1 156 22.40 0.32 1.06 Dec. 28th The Rainfall for the Year was I inch above, and the number of days on which rain fell 6 above the year 1913, at East Ham. 55 Table Showing Vital Statistics of Whole District during 1914 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 reregistered in Public Institutions in the Berough. Deaths of Residents registered In Public Institutions beyond the Borough. Nett Deaths at all Ages belonging to the Borough. Nett Num. bjr. 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 1904 107,544 3,717 34.6 575 154 1,406 130 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 1,412 111 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 1,623 121 1912 138,450 3,573 25.8 256 71 1,048 7.5 53 14 426 1,474 10 6 1913 142,467 3,596 25.2 226 63 1,044 7.3 55 18 425 1,437 101 Averages for years 1904. 1913. 125,085 3,589 28.9 382 106 1,195 9.6 59 17 304 1,483 11.9 1914 146,526 3,436 23.5 267 77 1,031 7 0 53 18 515 1,528 104 *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. 56 TABLE 1. Vital Statistics of Whole Borough during 1914 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 Nod. residents Registered in the Borough. of Residents not Registered in the Borough. Under I Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1909 126,754 3,496 3,518 27.7 1,160 9.1 26 278 334 95 1,412 10.2 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 1,623 121 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 1914 146,526 3,373 3,436 235 1,031 70 18 515 267 77 1,528 104 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. 57 TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1914. Notifiable Disease. Number ok 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. 45 and under 65 years. 65 and upwards. Beckton and North Woolwich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Flasket Ward West. Total. Beckton and North Woolwich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous 319 2 91 203 11 8 4 ... 69 70 44 61 39 36 319 59 64 44 48 24 23 262 Erysipelas 130 3 5 7 10 39 49 17 14 18 36 26 15 21 130 1 1 5 6 2 5 20 Ophthalmia Neonatorum 17 17 ... ... ... ... ... ... 4 2 6 2 ... 3 17 ... ... ... 1 ... ... 1 Scarlet Fever 677 2 146 450 47 30 2 ... 89 162 117 96 123 90 677 65 114 99 68 86 64 496 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 21 ... 1 5 5 8 1 1 1 1 3 10 4 2 21 1 1 3 7 3 1 16 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... ... ... 1 3 ... ... ... 3 ... ... ... 1 4 ... 2 ... ... ... ... 2 Cerebro-Spinal Meningitis 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... Poliomyelitis 4 ... 3 1 ... ... ... ... ... ... 1 3 ... ... 4 ... ... ... 1 ... ... 1 Totals 1173 24 247 666 74 88 56 18 177 256 207 199 181 153 1173 126 182 151 131 115 93 798 Pulmonary Tuberculosis 550 ... 10 142 129 201 63 5 52 98 191 96 51 62 550 18 22 35 31 16 15 137 Other forms of Tuberculosis 115 2 21 60 14 15 3 ... 27 13 30 23 7 15 115 1 2 3 6 2 2 16 60 Schedule Number. Causes of Death in East Ham during year ending 31st December, 1914. 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 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. Plashet East. .Plashet West. Residents. Non- Residents. Brought forward 424 28 35 29 34 41 90 112 52 57 52 83 107 54 71 158 8 62 Locomotor Ataxy 3 - - - - - - 3 - - - 1 2 - - 3 - 63 (A. B.) Other diseases of the spinal cord a. Diseases formerly classed to 2 - - - - - - 2 - - 1 1 - - - 1 - Other nervous affections " b. Other diseases included under 63 5 - - 1 1 1 1 1 - - - 1 2 1 1 3 - 64 (A. B.C.D.E.) Cerebral hæmorrhage Apoplexy a. Apoplexy - - - - - - 2 5 3 - 6 — 1 1 2 2 — 6. Serous apoplexy and oedema of - - - - - - - - - - - - - - - - - brain c. Cerebral congestion - - - - - - - - - - - - - - - - - a. Cerebral atheroma — - - - - - - - - - - - - - - - - Cerebral haemorrhage 47 — — — - - 3 16 28 7 5 11 7 9 8 15 — 65 Softening of brain 2 — — — - — — 1 1 — 1 — 1 — — — — 66 (A. B. C.) Paralysis without specified cause a. Hemiplegia 4 - - - - - - - - - - 1 1 2 — 1 — b. Paraplegia 1 - - - - - - - 1 - - 1 - - - 1 — c. Other forms of paralysis 3 - - - - - - 1 2 1 — — — 2 — — — 67 General paralysis of the insane 27 — - — — — 13 10 4 5 3 7 2 6 4 24 — 68 Other forms of mental alienation 2 — — — — — 1 1 — — 1 — — 1 — 1 — 69 Epilepsy 4 — 1 — — — 2 1 — 2 — 1 — — 1 3 — 70 (A. B.) Convulsions, non-puerperal, 5 years and over a. Epileptiform Convulsions - - - - - - - - - - - - - - - - - b. Others included under 70 1 - - - 1 - - - - - - 1 - - - - - 71 (A. B.) Infantile convulsions under 5 years a. Convulsions with teething - - - - - - - - - - - - - - - - - b. Other infantile convulsions 20 18 2 - - — — — 3 3 4 5 4 1 1 — 72 Chorea - - - - - - - - - - - - - - - - - n (A. B.) Hysteria, Neuralgia, Neuritis a. Hysteria, Neuralgia, Sciatica .. 1 - - - - - - - 1 - - 1 - - - - - b. Neuritis - - - - - - - - - - - - - - - - - 74 (A. B. C. D.) Other diseases of the nervous system a. Idiocy, Imbecility - - - - - - - - - - - - - - - - - b. Cretinism — — — — — — — — — — — — — — — — — c. Cerebral tumour 5 — 1 1 1 — 1 1 — — — 1 2 1 1 l — d. Other diseases included under 74 - - - - - - - - - - - - - - - - - 75 Diseases of the eyes and annexa - - - - - - - - - - - - - - - - - 76 (A) Mastoid disease - - - - - - - - - - - - - - - - - 76 (B) Other diseases of the ears 2 — — — 2 - — — - 1 — 1 - — — 2 - III.—Diseases op the Circulatory System. 77 Pericarditis 5 - - - 1 2 2 - - - 1 1 - 3 - 5 - 78 (A. B. C.) Acute endocarditis 4 - - - 1 2 - 1 - 1 - 1 1 - 1 1 - a. Acute myocarditis 1 - - - - - - 1 - - - 1 - - - 1 b. Infective Endocarditis 5 - - - 1 1 2 1 - 1 1 1 1 - 1 5 - c. Other acute endocarditis 10 - - 1 - 2 2 2 1 2 5 1 1 - - 1 - 75) A. Valvular disease 70 1 1 - 4 4 15 22 23 7 11 6 20 11 - 25 79 B. Fatty degeneration of the heart 13 - - - - - — 5 6 — 4 2 - 2 5 1 - 79 C. Other organic disease of the heart 37 - - — 2 - 6 12 15 4 8 (5 9 4 6 12 - 80 Angina pectoris 2 - - - - - 1 1 - - - - 2 - - - 81 A. Aneurysm 2 - - - - - - 2 — — 1 — 1 — — 1 — 81 B. Arterial sclerosis 5 — — — — — — 4 1 — — 3 2 — — 5 — 8L C. Other diseases of arteries - - - - - - - - - - - - - - - - - 82 A. Cerebral embolism & thrombosis 7 — — — 1 — 1 1 4 1 — 2 2 1 1 1 - 82 B. Other embolism and thrombosis 1 - - - - - - 1 - - - - - - 1 - - Carried forward 725 47 40 32 51 60 142 207 146 92 103 139 169 102 120 277 8 61 Schedule Number. Causes of Death in East Ham during year ending 31st December, 1914. 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. Ail Ages. Under 1. 1 and under 2. 2 and under 5. 5 nd under 15. 15 and under 25. 25 and under 45. 15 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 725 17 40 32 51 60 207 116 92 103 139 16!) 102 120 277 8 83 (A. B. C. D.) Diseases of the veins— (Varices, Haemorrhoids, Phlebitis, &c.) a. Phlebitis - - - - - - - - - - - - - - - - - b. Varix - - - - - - - - - - - - — — — — — c. Pylephlebitis 1 - - - - 1 - - - - 1 - - - - 1 — d. Varicocele - - - - - - - - - - - - - - - - - 84 A Status lymphaticus - - - - - - - - - - - - - - - - - 84 B. Other diseases of the lymphatic system 1 1 — - - - - - - - - - - - - - - 85 (A. B. C.) Hæmorrhage; other diseases of the circulatory system a. Functional disease of the heart - - - - - - - - - - - - - - - - - b. Epistaxis - - - - - - - - - - - - - - - - - c. Other diseases included under 85 - - - - - - - - - - - - - - - - - IV. -Diseases of thb Respiratory System. 86 Diseases of the nasal fossæ - - - - - - - - - - - - - - - - - 87 (A. B. C.) Diseases of the Larynx a. Laryngismus stridulus - - - - - - - - - - - - - - - - - b. Laryngitis 2 2 — - — — — — — - — 2 — — — — — c. Other diseases of larynx - - - - - - - - - - - - - - - - — 88 Diseases of the thyroid body 1 - - - - - - - - - - - - - - 1 — 89 (A. B.) Bronchitis & a. Bronchiectasis, Bronchial Catarrh, &c. 3 1 — — - — — 1 1 — — — 1 — 2 1 — 90 b. Other bronchitis 124 18 2 2 — — 8 33 61 10 23 22 32 16 21 18 — 91 Broncho-pneumonia 65 21 16 1 1 — 4 9 13 9 12 16 12 9 7 12 — 92 A. Lobar pneumonia 25 9 1 2 2 1 6 9 2 5 7 1 3 2 7 6 - 92 B. Pneumonia—tvpe not stated 52 5 5 1 3 1 9 lb 13 7 15 5 8 8 9 6 1 93 (A. B.) Pleurisy 1 - - - - 1 - - - - - - 1 - - 1 - a. Empyema 1 - - - - - 1 - - - - - - - - - — b. Other pleurisy 4 - - - - - 1 — 3 — — 1 — 1 2 1 — 94 (A. B. C. D.) Pulmonary congestion, Pulmonary apoplexy a. Pulmonary apoplexy and infarction - - - - - - - - - - - - - - - - - b. Pulmonary oedema and congestion 6 1 — — - - 1 2 2 2 1 - 3 - - - - c. Hypostatic pneumonia 2 - - - - - - - 2 - - - - 2 - 1 - d. Collapse of lung, 3 months & over 1 1 — — — — — — — — — — 1 - — 1 - 95 Gangrene of the lung 2 — — — — 1 1 — — - — 1 1 - - 2 - 96 Asthma 3 — — — — — 1 2 - 1 — - - 1 1 - - 97 Pulmonary emphysema - - - - - - - - - - - - - - - - - 98 A. Fibroid disease of lung - - - - - - - - - - - - - - - - - 98 B. Other diseases of the respiratory system - - - - - - - - - - - - - - - - - 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, tonallitis a. Tonsillitis 2 - - - - 2 - - - - - - - - - - - b. Ludwig's Angina - - - - - - - - - - - - - - - - - c. Other diseases of the pharynx 1 — - - - - - - - - - - - - - - - Carried forward 1022 99 61 39 57 67 174 279 243 128 163 187 232 141 171 331 9 64 Schedule Number. Causes of Death In East Ham during year ending 31st December, 1914. 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 upwards. Beckton & N. W'wich. Central East. Central West Manor Park. Hasdet East. Plashet West. Residents. Non- Residents. Brought forward 1199 118 66 17 61 75 202 322 278 148 19.1 221 276 161 197 401 9 14.3 Carbuncle, Boil 1 - - - - - - - 1 - - - 1 - - - - 144 (A. B.) Phlegmon, acute abscess a. Phlegmon - — — — — — — — — — - — — —- — b. Acute abscess - - - - - - - - - - - - - - - - - 145 (A. B. C. D.) Diseases of the integumentary system a. Ulcer, Bedsore - - - - - - - - - - - - - - - - - b. Eczema — - - - - - - - - - - - - - - - - c. Pemphigus - - - - - - - - - - - - - - - - — d. Other diseases of integumentary system - - - - - - - - - - - - - - - - - IX.—Diseases of the Bones and of the Organs of Locomotion. 146 Diseases of the bones 3 1 - — 1 - - 1 - 1 1 - - 1 — 3 — 117 Diseases of the joints — — — — — — — — — — — — — — 118 Amputations - - - - - - - - - - - - - - - - - 149 Other diseases of Locomotor system - - - - - - - - - - - - - - - - - X.—Malformations. 150 (A. B. C. D.) Congenital malforma tions a. Congenital hydrocephalus - - - - - - - - - - - - - - - - - 6. Phimosis - - - - - - - - - - - - - - - - - c. Congenital malformation of heart 5 5 - - - - - - - - - - 5 - - - - d. Other congenital malformations 4 3 - - - - 1 — — — - 2 — — 1 XI.—Diseases op Early Infancy. 151 Premature birth 60 60 - - - - - - - 8 8 10 23 4 7 3 — 151 (B.C.D.E.) Infantile debility, Icterus and Sclerema b. Infantile atrophy, debility and marasmus 41 41 — - — — - — - 5 8 10 8 6 4 6 1 c. Icterus neonatorum 1 1 - - - - - - - - - - - - 1 - - d. Sclerema and oedema neona torum - - - - - - - - - - - - - - - - - e. Want of breast milk - - - - - - - - - - - - - - - - - 152 (A.B.C.D.) Other diseases peculiar to early infancy - - - - - - - - - - - - - - - - - b. Atelectasis 3 3 - - - - - - - 1 - - - - 2 - - c. Injuries at birth - - - - - - - - - - - - - - - - - d. Cyanosis neonatorum - - - - - - - - - - - - - - - - 153 Lack of care 2 2 — — — — — — — - — 1 1 - - - - XII. -Old Age. 154 a. Senile dementia 15 — - - - - - - 15 2 3 2 3 3 2 13 - b. Senile decay 132 - - - — — — 4 128 10 13 28 21 24 36 60 - XIII.—Affections produced by External Causes. 155 Suicide by poison 2 - - - - - 2 - - 1 - 1 - - - 1 - 156 Suicide by asphyxia 1 - - - - - - - - - - - - - - - - 157 Suicide by hanging or strangulation 3 - - - - - - 1 - - 1 1 - - - - - 158 Suicide by drowning - - - - - - - - - - - - - - - - - 159 Suicide by firearms 1 - - - - - 1 - - - - 1 - - - - - Carried forward 1473 264 66 47 62 75 208 329 422 177 229 278 341 199 249 488 10 65 Schedule Number. Causes of Death in East Ham during year ending 31st December, 1914. Nett Deaths at the subjoined Ages of "Residents" wheth- r 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 upwards. Beckton & N. W'wich. Central East. Central West. Maror Park. Plashet East. Plashet West. Residents. NonResidents. Brought forward 1473 261 66 47 62 75 208 329 422 177 229 278 341 199 249 488 10 160 Suicide by cutting and piercing instruments 1 - - - - - - 1 - - - — 1 — - 1 — 161 Suicide from jumping from high place - - - - - - - - - - - - - - - - - 162 Suicide by crushing 3 - - - - 1 1 1 - - 2 1 — - — — 163 Other suicides 1 - - - - - - 1 - — 1 — - — — — — 161 Poisoning by food - - - - - - - - - - - - - - - - - 165 Other acute poisonings 1 - - - - - - 1 - - - - 1 - - 1 — 166 Conflagration - - - - - - - - - - - - - - - - - 167 Burns, conflagration excepted 3 — — - l — I 1 1 — — 1 — 1 3 — 168 Absorption of deleterious gases, (con flagration excepted) 2 1 - - - - - 1 - - - - 1 - 1 - — 169 Accidental drowning 3 - - - - 1 - - 2 1 - - — — 2 — 1 170 Injury by flrearma - - - - - - - - - - - - - - - - - 171 Injury by cutting or piercing instruments - - - - - - - - - - - - - - - - - 172 Injury by fall 10 - - - l - 1 2 6 9 1 2 3 2 — 9 — 173 Injury in mines and quarries - - - - - - - - - - - - - - - - - 174 Injury by machines 1 — — - - — 3 1 — 4 — — — — — 3 — 175 Injury by other crushing (vehicles railways, landslides, &c.) 12 1 — 2 l 2 — 4 2 1 3 2 5 — 1 5 - 176 Injury by animals - - - - - - - - - - - - - - - - - 177 Starvation - - - - - - - - - - - - - - - - - 178 Excessive cold - - - - - - - - - - - - - - - - — 179 Effects of heat 2 — 1 1 - - - - - 1 - - 1 - - 2 — 180 Lightning - - - - - - - - - - - - - - - - - 181 Electricity (lightning excepted) - - - - - - - - - - - - - - - - - 182 Homicide by firearms - - - - - - - - - - - - - - - - - 183 Homicide by cutting and piercing in - - - - - - - - - - - - - - - - - 181 Homicide by other means 1 - - - - 1 - - - - - 1 - - - - - 186 Fractures, cause not specified — — — — — — — — — — — — — — — — — 186 Other violence - - - - - - - - - - - - - - - - - XIV.—Ill-defined Causes. 187 Dropsy - - - - - - - - - - - - - - - - — 188 A. Synocpe, aged 1 year and under 70 2 — — — — 1 — — 1 — — — 1 — 1 1 — 188 B. Sudden death, not otherwise de- - - - - - - - - - - - - - - - - - 189 A. Heart failure, aged 1 year and under 70 7 - - - - - 3 3 1 1 1 3 1 - 1 2 189 (B. C. D. E.) Other ill-defined causes b. Atrophy, debility, marasmus (aged 1 year and under 70) 1 - 1 - - - - - - - - - - - - - - c. Teething - - - - - - - - - - - - - - - - - d. Pyrexia — - - - - - - - - - - - - - - - - e. Other ill-defined deaths 2 1 — — — 1 — — — — - - — — - - - 189 F. Cause not specified — - - - - - - - - - - - - - - - - Total 1528 267 68 50 65 82 216 345 435 188 238 287 357 202 256 515 11 The total Institution Deaths include those of strangers occurring within the Borough. Deaths of such strangers occurring at the Passmore Edwards Hospital or St. Elizabeth's Home are excluded from all other columns of the table. 66 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 under 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 ... ... ... ... ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 3 2 2 3 10 'Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 2 ... ... 2 Abdominal Tuberculosis ... ... ... 1 1 1 ... 1 1 4 Other Tuberculous Diseases ... ... ... ... ... 1 1 1 ... 3 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 3 1 5 Convulsions 2 5 2 1 10 5 1 ... 2 18 Laryngitis ... ... ... ... ... ... ... ... 2 2 Bronchitis ... ... ... l 1 6 5 3 4 19 Pneumonia (all forms) ... ... ... 1 1 3 10 5 9 28 Diarrhœa ... ... ... 1 1 3 6 6 8 24 Enteritis ... 1 2 2 5 4 4 3 4 20 Gastritis ... ... ... ... ... ... 1 ... ... 1 Syphilis ... ... 1 ... 1 ... ... ... ... 1 Rickets ... ... ... ... ... 2 ... ... ... 2 Suffocation (overlying) ... ... ... ... ... ... 1 ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 2 ... ... ... 2 ... 1 ... ... 3 Congenital Malformations 4 2 ... ... 6 1 2 ... ... 9 Premature Birth 43 5 2 4 54 6 ... ... ... 60 Atrophy, Debility and Marasmus 16 5 2 4 27 7 3 4 ... 41 Other Causes 4 1 ... 1 6 2 2 ... 2 12 72 13 9 16 116 44 43 28 36 267 Nett Births in the year legitimate 3366 illegitimate 70 Nett Deaths in the year of legitimate infants 257 illegitimate infants 10 67 APPENDIX. Report on the Borough Isolation Hospital. HOSPITAL SUB-COMMITTEE. Councillor H. F. Witherspoon (Chairman). The Mayor (Councillor R. Banks-Martin, J. P.) The Deputy Mayor (Councillor J. A. Williams). Alderman J. Brooks, J.P. ,, H. Osborn, J.P. Councillor H. Barfield. ,, A. Taylor. ,, A. H. Wiseman. 68 Isolation Hospital, Roman Road. The total admissions for the year were 953, as compared with 889 for the previous year. The following table shows the results obtained:— Disease. Cases Admitted. Deaths. Scarlet Fever 503 3 Diphtheria 306 21 Enteric (Typhoid) Fever 18 2 Pulmonary Tuberculosis 62 3 Various Cases in Cubicles 64 2 Totals ... 953 31 The accommodation at the Hospital has been taxed to the utmost, and although I have admitted every case where this was asked for, it was not possible to give the patients the requisite amount of air space required for infectious diseases, and I had hoped that the proposed extension, for which plans have already been prepared, would have been proceeded with before this time. SCARLET FEVER. 503 cases of Scarlet Fever were admitted during the year, and there were 58 remaining in the Hospital from the previous year, making a total of 561 cases treated. Three deaths occurred, which gives the low death-rate for the disease of 0.5 per cent. Two cases died a short time after admission from Malignant Scarlet Fever. It was noticed that the cases admitted towards the last few months of the year were more severe, and developed more complications in the way of suppuration of glands and septic 69 broncho-pneumonia. One child had the complication of Empyema, on which I operated and removed about two pints of pus. I have already mentioned the disadvantage of not having a discharge block, as there is no doubt that the return cases we have are due to the patients catching cold after the bath on the morning of discharge, and the catarrh resulting therefrom causing an infectious discharge from the nose or ear, especially in those children having adenoids and enlarged tonsils. DIPHTHERIA. 306 cases of Diphtheria were admitted during the year, as compared with 237 in 1913. Seventy of these cases were sent in by the School Medical Officer, either having been discovered at the Medical Inspection at School or at the Inspection Clinic, the diagnosis having been made after a bacteriological examination of a swab from the throat or nose. Thirty-two cases remained from the previous year, making a total of 338 cases treated. Twentyone deaths occurred, giving a case mortality of 6.2 per cent. The case mortality in the Hospital from this disease during the past five years was as follows:— Year. Case Mortality. 1910 5.5 1911 6.7 1912 5.5 1913 3.7 1914 6.2 In seven cases it was found necessary to perform the operation of 1 racheotomy, two of which ended fatally. As in the case of Scarlet Fever, it was found that the cases admitted during the latter part of the year were much more severe than during the earlier months. No case is discharged until negative results are obtained by bacteriological examination of swabs from throat and nose. On this account it is most rare to have a return case of the disease. 70 ENTERIC (TYPHOID) FEVER. 18 cases notified as suffering from this disease were admitted for treatment, and two deaths occurred. Two of the cases were found to be suffering from other diseases, viz., Acute Tuberculosis and Meningitis. One of the fatal cases was that of a LanceCorporal, who was wounded at the battle of the Aisne, and eventually developed Enteric Fever. PULMONARY TUBERCULOSIS. Sixty-two cases of Pulmonary Tuberculosis were admitted during the year, and with 11 cases remaining from the previous year, there was a total of 72 cases treated in all. Three deaths occurred. All the cases admitted were either insured persons or dependants, sent in by the Essex Insurance Committee. Five of the patients occupied a shelter each, but both for the patients and the nursing staff this is most unsatisfactory. In bad weather it is impossible to keep the shelter dry, and during the severe storms of the last few months the wind was so violent as to blow off the roofs of two shelters while the patients were in bed. If patients suffering from this disease are to be treated at the Hospital it will be necessary to put up a permanent building. In my last year's report I suggested that a pavilion of 24 beds might be erected at small cost to the Authority, suitable for treatment of these cases. The Treasury would probably make a grant of three-fifths of the total cost, under the provisions of the National Insurance Act. A suitable block could be erected at a cost of £90 per bed. CUBICLE BLOCK. 64 cases were treated in the Cubicles. Two deaths occurred and in both cases the patients suffered from the double infection of Diphtheria and Scarlet Fever. The cases treated in this block are doubtful ones, or patients with double infection. It is most rare now to have cases of "cross infection" in the other wards, as in any case of doubt the patient is admitted to the Cubicles until the diagnosis is determined. 71 HOSPITAL ACCOMMODATION. The following table gives the total bed accommodation at the Hospital:— Beds. Cubic feet 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 Shelters 12 - The Diphtheria and Enteric Wards and Shelters, together with the Administrative Block, are temporary building's of wood and iron. The present Administrative Block is not large enough for the increasing demands of the Hospital. STAFF. The health of the Nursing Staff has again caused anxiety during the year, and this is, in my opinion, due to the bad arrangement of the sleeping accommodation. The Staff either sleep in the unhealthy room of the old temporary Administrative Block or in the rooms which are above the Scarlet Fever Block, so that even when they leave the wards at off-duty time, instead of being able to get away from the smell of an infectious ward to a properly arranged Nurses' Home, their sitting room and bedrooms are so situated that the foul air from the wards beneath rises and enters their windows.. I again wish to record my thanks to the Matron and Nursing Staff for the willing service given at all times, and the interest taken in the welfare of the patients during a year of heavy work. 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. The ambulances consist of one horse and one motor ambulance, the latter giving complete satisfaction. BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report OF THE School Medical Officer FOR THE YEAR 1914. 74 EAST HAM EDUCATION COMMITTEE Alderman H. Osborn, J.P. (Chairman). Councillor A.H. Wiseman (Vice-Chairman). Councillor R. Banks-Martin, J.P. (Mayor). Councillor J. A. Williams (Deputy-Mayor). Mrs. Ford. Alderman O.R. Anstead, J.P. Alderman J. Brooks, J.P. Alderman E. Edwards, J.P. Alderman C. Northfield, J.P. Alderman M. Oakes, J.P. Councillor H. Barfield. Councillor T. H. Cowper. Councillor A. Coles. Councillor G. P. Dean. Councillor J. Evans. Councillor W.C. Ford. Councillor J. J. Francis. Councillor W. T. Howlett. Councillor V. R. Oliver. Councillor W. H. Pilgram. Councillor F. Smith. Councillor A. Taylor. John Prince, Esq., J.P. Clerk: Miss P. G. Perry. School Nurses: Miss Forres, Miss Howe, and Miss Mallon. Dentist: C. H. Taylor, L.D.S. Ophthalmic Surgeon: A. Henry Thompson, M.D. Assistant Medical Officers: W. A. Berry, M.D., B.S. (Lond.). D.P.H. D. S. Brough, M.B., B.Ch. D.P.H. Medical Officer: W. Benton, M.R.C.S., L.R.C.P., D.P.H. 75 STATISTICAL DATA. School Places:— Provided Schools 25,803 Non-Provided Schools 1,129 Total 26,937 Number on Registers:— Provided Schools 21,273 Non-Provided Schools 1,032 Total 25,305 Teaching Staff: Head Assistant Certificated Assistant Uncertificated Supplementary Student Ccokcry 636 58 494 56 5 18 5 Education Rate. 1914-15 ... ... ... ... 276 76 County 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 December 31st, 1914. The staff was increased by the appointment of Dr. D. Brough as second Assistant Medical Officer and Nurse Mallon as third School Nurse. Dr. Brough, Nurses Forbes and Mallon have been granted leave of absence to take up duties in connection with the War, Dr. Brough being granted a temporary commission in the R.A.M.C. and the Nurses are connected with Military Hospitals. Details of the work accomplished during the year found in the following pages will show that increased work has been carried out as required by the Board of Education. During the year there were medically examined 8,339 children, of which number 7,881 were routine cases and 458 special cases. These were included in the following groups:— A group of children " Entrants." (a) Aged 12-13 years. Ditto (b) Aged 13 years and over (Leavers). For the year beginning on April 1st, 1915, the Board of Education in their Circular 823 issued on August 18th, 1913, gave notice that provision must be made for the medical inspection of another age group, viz., those of children between 8 and 9 years of age. The alteration to the children in the group between the age of 12 and 13 years has remedied the leakage which formerly occurred in " Leavers." 77 Comparative Statement of Work. 1913. 1914. Routine Inspections 4,905 7,881 Special Cases 527 458 Re-inspections 1,189 1,397 Visits for Medical Inspection 260 310 Consultations at Inspection Clinic 5,626 5,885 Number of Treatments at Clinic *2,851 1,737 Nurses' Special Visits to Departments 64 41 Nurses' Visits to Homes 943 878 Children Examined for Cleanliness 22,983 15,209 Number of Cleansings 16 59 * Ophthalmic and Dental cases are not included in the number for the years 1913 and 1914. 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. 78 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. The 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 1914 the percentage of parents present at Inspection was 30.5 as compared with 34.9 in 1913. It is unfortunate that more parents do not attend at Medical Inspections, as it is found that treatment is more likely to be secured in those cases where defects are found and can be demonstrated to the parent. The number of objections to Medical Inspection are on the decrease. The larger number are found to be in the Senior Girls Department, and this difficulty might probably be overcome by the appointment of a female Medical Inspector, who might undertake the examination of all girls. The objections being so numerous in some departments of certain schools led one to believe that it might be due to lack of sympathy in the work of Medical Inspection by the Head Teacher, but I am now convinced that this is not the reason. The teachers are largely responsible for the effectiveness of the 79 examination, and, with one or two exceptions, realise the importance of Medical Inspection and are entirely sympathetic with the work. The co-operation of the teachers is invaluable. It has been difficult in the past to arrange to visit the school at the most convenient time suitable to the Head Teacher, but to remedy this a circular has been sent round to each school asking the most convenient month of the year for the attendance of the School Medical Inspectors. EXTENT AND SCOPE OF MEDICAL INSPECTION DURING 1914. Inspection has taken place in all the Borough Schools. Certain departments have been re-visited in order to secure the examination of children who, through absence, escaped Medical Inspection at former visits. The grouping of children for inspection was as follows:— (1) Entrants. (2) Aged 12 to 13 years. (3) Leavers, 13 years and over. (4) Special cases. Special cases included children who were outside the scope of routine inspection but were usually put forward by teacher or at the request of parents when thought to be defective in some respect. 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 1914, classified according to age and sex:— 80 Routine Inspection. Special Inspection. Ages examined Boys Girls Boys Girls 5 years 1,281 1,175 — — 6 „ 662 685 — — 7 „ 186 194 — — 8 „ — — 56 49 9 „ — — 24 79 10 „ — — 49 43 11 „ — — 79 79 12 „ 836 846 — — 13 „ 1,049 831 — — 14 „ 51 58 — — 15 „ 15 12 — — 4,080 3,801 208 250 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. 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 81 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 1914 appears in the table, page 83. Swabs from the throats of children who had suggestive symptoms of Diphtheria were taken and examined in the Bacteriological Laboratory. 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 Inspection Clinic, and in the course of the year 358 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 1914 exclusion forms were issued by the School Medical Officer under Article 53 (b) of the Code. For Ringworm of Scalp 101 ,, Ringworm of Body 23 ,, Impetigo Contagiosa 318 ,, Infective Eye Inflammations 180 ,, Eczema 38 ,, Acute Throat Conditions 207 ,, Scabies 22 ,, Miscellaneous Affections 527 Total 1,416 82 EXCLUSION FORMS ISSUED, 1914. Impetigo 318 Infantile Paralysis 3 Tonsilitis 207 Hernia 3 Ringworm of Scalp 101 Corneal Ulcer 3 Conjunctivitis 99 Chicken Pox 3 Blepharitis 81 Purpura 2 Pulmonary Tuberculosis 63 Alopecia 2 Eczema 38 Skin Disease 2 Debility 34 Epistaxis 2 Bronchitis 34 Hemoptysis 2 Vermin 30 Cellulitis 2 Abscesses 29 Tubercular Hip 2 Septic Sores 28 Iritis 2 Chorea 26 Ictenis 2 Ringworm of Face 23 Pharyngitis. 2 Ear Discharge 22 Tubercular Peritonitis 2 Scabies 22 Cystitis 1 Rheumatism 21 Vertigo 1 Injuries 18 Mignaine Heart 18 Papilla Bursitis 1 Bronchial Catarrh 17 Pleurodynia 1 Nephritis 16 High Myopia 1 Abdominal Pains 15 Keratitis 1 Enlarged Glands 11 Asthma 1 Weak Chest 10 Dyspepsia 1 Epilepsy 8 Ozœma 1 Whitlow 6 Mastoid Abscess 1 Desquamation 6 Gastric Catarrh 1 Diarrhoea 6 Flat Foot 1 Tubercular Glands 6 Erythema Nodosum 1 Anaemia 6 Forunculosis 1 Incipient Pneumonia 5 Prolapsus Recti 1 Urticaria 5 Parotitis 1 Shingles 5 Tubercular Elbow 1 Whooping Cough 5 Arthritis 1 Adenitis 5 Tubercular Adenitis 1 Jaundice 4 Tubercular Lesions in Hands Gastro Enteritis 4 and Foot 1 Synovitis 3 Total 1,416 Nasal Obstructions 3 Incontinence of Urine 3 The annexed table gives the complete notification of infectious diseases in school children received for the year 1914:— DEFECTS ARRANGED ACCORDING TO SCHOOLS. SCHOOLS. Sex. Total Number Examined. External Eye Disease. Squint. Number Examined. Vision. Disease of Ears. Speech. Disease of Heart. Disease of Lungs. Disease of Nervous System Condition of Head. Condition of Body. Condition of Clothing Defective Boots. Nutrition. Teeth. Tonsils. Mouth-breathers. Adenoids Glands. Nasal Defects. Mental Capacity. Deformities. Infectious Skin Disease . Tubercle. Other Diseases. Blepharitis. Conjunctivitis. Corneal Capacity. Other Diseases. 6/12 6/18 6/24 6/36 6/60 6/0 Deafness. Discharge. Other Disease. Defective Articulation Stammering. Disease. Anæmia. Bronchitis. Tuberculosis Tuberculosis suspected. Other Disease. Epilepsy. C horea. Other Disease. Nits. Vermin. Dirty. Vermin. Bad. Dirty. Under Normal. Bad. Less than 4. More than 4. Sepsis. Slightly Enlarged. Greatly Enlarged. Slight Marked. Greatly Marked. Slightly Enlarged. Greatly Enlarged. Number Examined. Dull. Defective. Ringworm Scabies. Impetigo. Glandular. Osseous. 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Girls 158 1 ... 1 ... 2 83 2 3 3 2 1 3 ... ... 1 ... ... ... ... 1 ... ... ... 1 ... 1 ... 2 ... ... ... ... ... ... 29 ... ... ... ... 1 3 8 ... 136 22 ... 28 8 ... 1 1 ... ... 2 81 10 ... 4 ... ... ... ... ... 1 3 Fourth Avenue Boys 221 2 ... ... ... 3 83 14 15 5 3 ... 2 1 1 ... ... ... ... 3 3 2 2 ... 1 2 7 4 11 ... ... ... ... ... ... 6 1 5 4 ... 4 6 22 ... 181 40 ... 26 12 5 10 3 9 3 1 44 10 2 2 ... ... ... 1 ... ... 5 Girls 193 ... ... ... ... 3 55 11 11 2 2 ... 1 ... ... ... ... ... ... 1 3 ... 1 ... ... 4 3 1 4 ... ... ... ... ... ... 66 3 3 ... ... ... 8 15 ... 169 24 ... 31 14 2 3 2 7 2 3 56 16 ... 2 ... ... ... 1 2 ... 3 Hartley Avenue Boys 204 1 1 ... ... 2 94 4 ... 3 2 2 ... 2 ... ... ... ... ... 2 5 1 5 ... ... 2 5 1 6 ... ... ... ... ... ... 8 1 3 2 ... 2 7 22 ... 184 20 2 16 6 2 3 3 9 4 11 95 8 ... 4 ... ... ... ... 1 1 6 Girls 267 ... ... 1 ... 1 150 6 9 3 1 3 1 3 1 5 4 ... ... 2 2 3 3 ... 1 ... 4 ... 10 ... ... ... 1 ... ... 58 8 2 ... ... ... ... 28 ... 249 18 ... 16 12 1 2 ... 7 1 11 120 8 ... 3 ... ... ... 1 1 1 2 High Street Boys 203 3 ... l 1 2 75 3 4 3 2 2 1 1 ... ... ... ... ... ... 3 1 1 ... ... 3 11 ... 17 5 ... ... ... ... ... 13 3 6 ... 1 1 8 25 ... 182 21 ... 21 11 6 4 2 4 ... 3 74 1 1 5 ... ... ... 1 ... ... 1 Girls 197 ... 2 ... ... 2 74 4 3 2 2 4 3 ... ... 1 ... ... ... 2 ... 1 3 ... ... ... 6 2 9 2 ... ... ... ... ... 70 11 5 1 ... 2 6 20 ... 171 26 ... 18 11 2 3 1 7 1 2 81 10 1 6 ... ... ... 1 ... ... 1 Higher Elementary Boys 116 ... ... ... ... 2 115 3 3 8 8 ... ... 3 3 5 5 ... ... 2 2 2 1 ... 2 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 8 112 4 ... 7 ... ... 1 ... ... 1 2 43 ... ... 2 ... ... ... ... ... ... 4 Girls 111 ... 1 ... ... 2 111 5 4 2 2 3 4 2 ... 6 8 ... ... 1 1 1 1 ... ... ... 5 1 ... ... ... ... ... ... ... 3 ... ... ... ... ... ... 12 ... 106 5 ... 2 ... ... ... ... ... 2 ... 92 ... ... 3 ... ... ... ... ... ... 8 Lathom Road Boys 203 ... ... ... ... ... 89 3 6 2 2 2 2 ... ... 1 1 ... ... 3 3 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 17 ... 168 35 ... 33 13 ... ... ... ... ... ... 72 7 ... 1 ... ... ... ... ... ... 1 Girls 246 1 ... ... ... 1 124 9 10 9 9 ... ... ... ... ... ... ... ... 5 2 ... ... ... ... ... 1 4 4 ... ... ... ... l ... 56 ... 1 ... ... ... ... 9 ... 223 23 ... 33 13 1 ... ... ... ... ... 126 10 ... 9 ... ... ... ... ... ... 1 Manor Park Boys 204 ... ... ... 1 2 77 2 1 1 7 1 2 2 1 ... ... 2 2 3 3 2 7 ... 3 2 5 3 15 1 ... ... ... ... ... 7 ... 2 ... 1 2 4 24 ... ... ... ... 17 21 6 6 6 5 2 4 78 ... ... 6 ... ... ... ... ... ... ... Girls 181 5 1 ... ... 3 64 6 6 5 6 ... 1 ... ... ... ... 1 ... ... 2 1 1 ... 1 ... 6 2 7 ... ... ... ... ... ... 39 5 3 3 ... 4 5 11 ... 160 21 2 23 9 5 3 1 4 2 1 65 14 ... 4 ... ... ... ... 1 ... 5 Monega Road Boys 255 ... ... ... ... 4 68 7 4 2 2 ... ... 3 1 ... ... ... ... 1 1 ... ... ... ... 2 5 1 7 1 ... ... ... ... ... 3 ... 4 ... ... 1 2 19 ... 237 18 ... 32 14 4 2 2 7 2 1 110 5 ... ... ... ... ... 2 ... ... 4 Girls 244 2 1 ... ... 4 108 12 12 ... ... 6 6 ... 1 ... ... ... ... 2 1 2 ... ... ... ... 4 1 4 ... ... ... ... ... ... 21 3 2 ... ... 1 4 14 ... 227 17 ... 39 11 2 1 1 4 1 4 110 4 ... 2 ... ... ... 2 1 ... 1 Napier Road Boys 244 8 ... ... ... 3 109 4 8 3 5 3 5 3 2 1 2 ... ... 1 2 ... 1 ... 1 9 4 ... 10 2 ... ... ... ... ... 21 5 22 3 2 12 21 20 1 228 16 ... 15 8 7 5 2 14 ... 8 109 6 ... 4 1 ... ... ... ... ... 5 Girls 251 3 1 ... ... 1 111 5 5 2 2 7 5 5 1 ... 4 ... ... 5 5 5 1 ... ... 2 4 ... 2 ... ... ... ... l ... 108 9 13 3 3 4 15 18 1 229 22 ... 17 12 6 2 3 6 4 7 111 18 ... 4 1 ... ... 3 ... ... 3 New Beckton Boys 107 ... ... ... ... ... 70 4 3 1 4 2 1 1 1 ... ... ... ... 4 9 ... ... ... ... ... ... ... 3 ... ... ... ... ... ... 3 ... 4 ... ... ... 9 5 ... 103 4 ... 17 5 ... ... ... ... ... ... 66 2 ... ... ... ... ... ... ... ... 2 Girls 91 ... ... ... 1 ... 62 9 13 4 3 3 3 ... ... ... ... ... ... 2 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 21 2 ... 1 ... ... 4 13 ... 84 7 ... 12 7 ... ... ... 1 ... ... 62 7 ... 1 ... ... ... ... ... ... ... North Woolwich Boys 57 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... 2 ... 1 ... ... ... 1 3 ... 52 5 ... 9 4 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... Girls 49 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 33 2 ... 1 ... 7 ... 2 ... 38 11 ... 8 7 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Kensington Avenue Boys 159 ... ... ... ... ... 94 4 2 6 6 3 4 ... ... 1 1 ... ... 1 3 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 143 16 ... 18 9 ... ... ... ... ... ... 94 7 ... 2 1 ... ... ... ... ... ... Girls 140 ... ... ... ... ... 65 7 6 2 2 3 4 ... ... 1 1 ... ... 1 2 ... 1 ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 5 ... 123 17 ... 29 12 ... ... ... ... ... ... 65 1 ... 2 ... ... ... ... ... ... ... Plashet Lane Boys 280 6 1 ... ... 6 122 17 19 2 3 4 4 4 6 6 5 ... ... 3 1 2 1 ... ... 1 4 9 26 ... ... ... ... ... ... 16 3 8 2 ... 4 12 47 ... 251 29 ... 35 6 11 3 5 17 4 26 122 15 ... 11 2 ... ... 2 ... ... 6 Girls 219 3 2 ... 1 4 85 7 2 1 4 5 3 1 2 2 2 ... ... 2 3 1 2 ... 3 2 9 2 14 1 ... ... ... ... ... 86 9 5 1 ... 1 5 16 ... 200 19 ... 12 13 3 2 5 16 3 7 80 17 ... 2 ... ... ... 1 ... ... 3 Silvertown, R.C. Boys 59 2 1 ... ... ... 20 ... ... 1 ... 2 1 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 5 2 4 1 1 1 10 1 ... 47 12 ... 15 6 ... ... ... ... ... ... 44 6 ... 1 ... ... ... 1 ... ... ... Girls 72 ... ... ... ... 1 40 5 5 ... ... 1 1 ... ... ... ... ... ... 3 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 28 7 3 ... 1 ... 9 4 ... 67 5 ... 14 11 ... 2 ... ... ... 1 64 10 ... 3 ... ... ... ... ... ... ... St. Winefride's, R.C. Boys 38 ... ... ... ... ... 29 2 2 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... ... 3 1 ... 36 2 ... 3 2 ... ... ... ... ... 1 30 9 ... ... ... ... ... ... ... ... ... Girls 26 ... ... ... ... ... 18 2 ... 1 ... ... 2 1 ... ... ... ... ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... l ... 8 1 ... ... ... ... 1 1 ... 24 2 ... 2 3 ... 1 ... ... ... ... 18 3 ... ... ... ... ... ... ... ... ... Shrewsbury Road Boys 146 4 ... ... ... 8 68 9 6 ... 2 1 2 ... 1 ... ... ... ... 1 3 2 1 ... 3 2 2 ... 4 ... ... ... ... ... ... 2 ... 2 ... ... 1 5 12 ... 125 21 ... 13 1 3 1 1 6 ... 4 46 ... ... 2 ... ... ... 2 ... ... 1 Girls 127 ... ... ... 1 2 55 4 3 2 4 2 3 2 2 1 ... ... ... 2 2 3 2 ... 2 1 ... 1 5 ... ... 1 ... 1 ... 18 1 ... ... ... ... ... 12 ... 113 14 1 7 4 1 ... 3 3 2 1 55 2 ... ... ... ... ... ... 1 ... 3 Sandringham Road Boys 191 1 3 ... ... 4 92 10 7 3 5 1 1 2 1 ... 2 ... ... 1 1 3 3 ... ... ... 6 ... 5 ... ... ... ... ... ... 3 3 1 ... ... ... ... 23 ... 161 30 ... 29 4 2 9 ... 11 ... 3 92 21 ... 7 ... ... ... ... ... ... 1 Girls 161 1 1 ... ... 2 67 8 6 ... ... 8 4 ... ... ... 2 ... ... 1 3 1 ... ... 1 ... 3 1 2 ... ... ... ... ... ... 35 5 ... 2 ... 1 ... 13 ... 140 21 ... 21 7 1 1 2 1 3 2 67 12 ... ... ... ... ... ... ... ... 1 Shaftesbury Road Boys 279 2 ... ... l 9 123 6 5 8 13 6 2 1 1 1 ... ... ... 1 ... 1 1 ... 2 1 8 2 12 ... ... ... ... ... ... 8 1 3 ... ... 1 ... 31 ... 238 41 ... 13 14 4 6 1 16 1 8 52 3 ... 5 1 ... ... 2 ... 1 3 Girls 250 4 1 ... ... 2 101 5 4 5 2 3 2 ... 1 1 4 ... ... 4 1 2 ... ... ... 1 8 ... 8 1 ... ... ... ... ... 68 12 l 2 ... ... ... 18 ... 223 27 ... 23 10 3 5 1 4 1 12 78 18 ... 3 2 ... ... ... ... 1 6 Vicarage Lane Boys 234 ... ... ... 1 7 72 3 2 3 2 3 4 ... ... 1 ... ... ... 1 4 ... 2 ... 2 ... 5 ... 4 2 ... ... ... ... ... 20 2 7 2 ... 3 17 21 ... 209 25 ... 18 13 3 4 5 9 7 5 94 7 ... 4 ... ... ... 3 ... ... 3 Girls 268 ... ... ... 3 6 107 6 7 1 4 4 3 1 4 ... 1 ... ... 3 2 3 4 ... 5 ... 6 ... 9 2 ... ... ... ... 1 79 8 5 6 ... 2 8 21 ... 235 33 ... 14 6 4 2 1 8 1 2 122 15 1 2 ... 1 ... 1 ... ... 1 'Walton Road Boys 330 6 ... ... 1 10 180 15 14 13 16 2 3 1 2 2 2 ... ... 4 4 2 1 ... ... 3 3 ... 9 ... 1 ... ... ... ... 36 3 14 5 ... 6 34 34 ... 300 30 1 50 22 5 3 2 12 6 6 147 20 1 9 2 ... 1 4 1 2 5 Girls 252 1 2 ... 2 5 98 13 12 5 7 2 2 ... ... ... 1 ... ... 1 1 ... 1 ... 2 ... 3 ... 7 ... ... ... ... ... ... 136 15 7 2 1 1 20 27 3 229 23 1 40 16 2 ... 1 9 2 5 97 28 1 4 2 ... 1 4 1 ... 4 Totals Boys 1080 35 8 1 6 70 1855 125 111 76 102 42 40 27 22 20 21 3 2 35 56 24 33 ... 19 24 76 15 146 13 1 ... ... 2 ... 168 25 90 24 5 38 156 390 1 3641 439 3 541 193 64 36 36 132 33 94 1620 151 4 76 9 ... 1 19 2 5 50 Girls 3801 22 14 2 8 50 1704 137 130 55 61 59 55 18 15 22 30 1 ... 41 40 25 25 ... 18 10 72 21 100 9 ... 1 1 5 1 1030 105 51 24 6 25 89 295 3 3416 385 7 416 204 36 34 22 86 31 66 1676 212 4 60 4 1 1 7 6 2 49 Percentage defective Boys ... 0.85 0.19 0.02 0.14 1.7 ... 6.74 5.97 4.1 5.49 2.27 2.16 1.45 1.19 1.08 1.13 0.10 0.1 0.85 1.37 0.58 0.81 ... 0.46 0.59 1.86 0.36 8.58 0.32 0.02 ... ... 0.05 ... 4.12 0.61 2.2 0.59 0.1 0.93 3.82 9.56 0.02 89.24 10.76 0.07 11.05 4.73 1.57 1.62 0.88 2.1 0.81 2.3 ... 9.32 0.24 1.86 0.22 ... 0.02 0.46 0.05 0.1 1.0 Girls ... 0.58 0.36 0.05 0.21 1.31 ... 8.04 7.63 3.22 8.58 3.45 3.22 1.05 0.88 1.29 1.70 0.05 ... 1.08 1.06 0.66 0.66 ... 0.48 0.26 1.89 0.55 2.63 0.24 ... 0.03 0.03 0.13 0.03 27.18 2.76 1.34 0.63 0.16 0.66 2.34 7.76 0.08 89.87 10.13 0.18 10.94 5.37 0.94 0.89 0.58 3.47 0.81 1.73 ... 12.65 0.23 1.58 0.1 0.03 ... 0.18 0.16 0.05 1.29 DEFECTS CLASSIFIED ACCORDING TO AGES. 5 years. 6 years. 7 years. 12 years. 13 years. 14 years. 15 years. Totals. Percentage. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Number examined 1281 1175 662 685 186 194 836 846 1049 831 51 58 15 12 4080 3801 ... ... DEFECTS. External Eye Disease— Blepharitis 10 8 11 2 3 ... 5 8 6 4 ... ... ... 35 22 0.85 0.58 Conjunctivitis 3 3 1 6 ... 1 1 1 3 2 ... 1 ... ... 8 14 0.19 0.36 Corneal Opacity ... ... ... ... ... ... 1 ... ... 2 ... ... ... ... 1 2 0.02 0.05 Other Disease 1 2 1 2 1 1 1 2 1 1 1 ... ... ... 6 8 01.4 0.21 Squint 30 23 21 12 8 3 3 6 6 6 1 ... ... ... 70 50 1.71 1.31 Defective Vision— Number examined ... ... ... ... ... ... 809 819 980 816 51 57 15 12 1855 1704 ... ... 6/12 Right ... ... ... ... ... ... 61 72 61 62 1 3 2 ... 125 137 6.74 8.04 Left ... ... ... ... . . . ... 56 67 52 59 1 4 2 ... 111 130 5.97 7.63 6/18 Right ... ... ... ... ... ... 38 30 33 25 5 ... ... ... 76 55 4.1 3.22 Left ... ... ... ... ... ... 45 30 54 29 3 2 ... ... 102 61 5.49 3.58 6/24 Right ... ... ... ... ... ... 20 30 20 28 2 1 ... ... 42 59 2.27 3.45 Left ... ... ... ... ... ... 19 21 19 32 2 2 ... ... 40 55 2.16 3.22 6/36 Right ... ... ... ... ... ... 10 10 15 5 2 3 ... ... 27 18 1.45 1.05 Left ... ... ... ... ... ... 10 11 12 3 ... 1 ... ... 22 15 1.1 0.88 6/60 Right ... ... ... ... ... ... 12 9 4 10 4 3 20 22 108 1-29 Left ... ... ... ... ... ... 12 13 6 12 3 5 ... ... 21 30 11.3 1.76 6/0 Right ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... 3 1 0.16 0.05 Left ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 2 ... 0.1 ... Ear Disease— Deafness Right 1 1 1 ... 1 ... 11 17 20 22 1 1 ... ... 35 41 0.85 1.08 Left 3 4 2 4 ... ... 24 13 24 18 3 1 ... ... 56 40 1.37 10.6 Discharge Right 3 3 ... 2 2 1 9 9 8 10 1 ... ... ... 24 25 0.58 0.66 Left 7 4 4 4 1 1 9 8 11 8 1 ... ... ... 33 25 08.1 0.66 Other Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Defective Speech— Articulation 6 7 2 ... 1 ... 2 4 8 7 ... ... ... ... 19 18 0.46 0.48 Stammering 6 6 2 1 1 ... 6 ... 8 3 ... ... 1 ... 24 10 0.59 0.26 Disease of Heart— Disease 25 17 27 7 1 1 14 21 8 22 1 4 ... ... 76 72 1.86 1.89 Anæmia 7 8 5 6 ... ... 3 ... ... 6 ... 1 ... ... 15 21 0.36 0.55 Disease of Lungs— Bronchitis 89 51 So 27 5 9 7 2 10 11 ... ... ... ... 146 100 3.58 2.63 Tuberculosis 3 ... 3 1 1 1 2 4 4 3 ... ... ... ... 13 9 0.32 0.24 Tuberculosis Suspected ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 0.02 ... Other Disease ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 0.03 Disease of Nervous System— Epilepsy ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 0.03 Chorea 1 ... 1 1 ... ... ... 3 ... 1 ... ... ... ... 2 5 0.05 0.13 Other Disease ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 0.03 Condition of Head— Nits 61 268 38 195 16 54 16 261 31 250 1 4 ... 1 168 1033 4.12 27.18 Vermin 8 21 4 13 4 9 3 33 6 29 ... ... ... ... 25 105 0.61 2.76 Condition of Body— Dirty 27 9 14 10 8 5 13 13 28 13 ... 1 ... ... 90 51 2.2 1.34 Vermin 5 7 7 3 5 3 3 5 4 6 ... ... ... ... 24 24 0.59 0.63 Condition of Clothing— Bad 2 ... 2 ... ... 2 1 4 ... ... ... ... ... ... 5 6 0.01 0.16 Dirty 12 13 15 1 4 3 5 1 2 7 ... ... ... ... 38 25 09.3 0.66 Defective Boots. 40 16 21 17 14 6 35 20 45 29 1 1 ... ... 156 89 3.82 2.34 Defective Nutrition Under Normal 117 69 76 56 18 15 81 80 90 70 6 5 2 ... 390 295 9.56 7.76 Bad ... ... ... 2 ... 1 1 ... ... ... ... ... ... ... 1 3 0.02 0.08 Decayed Teeth Less than 4 . 1075 1005 558 570 162 165 791 811 990 800 50 54 15 11 3641 3416 89.24 89.87 More than 4 206 170 104 115 24 29 45 35 59 31 1 4 ... 1 139 385 10.76 10.13 Sepsis 1 ... ... 1 ... ... ... 1 2 5 ... ... ... ... 3 7 0.07 0.18 Tonsils— Slightly enlarged 151 134 72 81 19 30 94 92 114 77 1 1 ... 1 451 416 11.05 10.94 Greatly enlarged 64 65 38 45 15 15 37 41 37 38 2 ... ... ... 193 204 4.73 5.37 Adenoids Slightly marked 36 16 16 10 1 1 5 3 8 4 ... ... ... ... 66 34 1.62 0.89 Greatly marked 20 16 10 4 1 1 2 ... 3 ... ... 1 ... ... 36 22 0.88 0.58 Glands — Slightly enlarged 83 35 24 31 5 3 12 11 8 6 ... ... ... ... 86 132 2.1 3.47 Greatly enlarged 17 11 8 9 3 5 3 5 2 1 ... ... ... ... 33 31 0.81 0.81 Mouth Breathers 44 17 14 16 3 1 1 1 2 1 ... ... ... ... 64 36 1.57 0.94 Nasal Defects 49 32 15 11 5 5 14 12 11 6 ... ... ... ... 91 66 2.3 1.73 Mental Defects— Number examined 23 15 ... 9 5 8 711 789 823 789 43 54 15 12 1620 1676 ... ... Dull 3 1 ... ... 1 4 63 90 83 116 1 1 ... ... 151 212 9.32 12.65 Defective ... ... ... ... ... ... 3 2 1 2 ... ... ... ... 4 4 0.24 0.23 Deformities 18 8 12 9 6 3 14 13 22 23 3 4 1 ... 76 60 1.86 1.58 Ringworm Head 7 1 2 1 ... 2 ... ... ... ... ... ... ... ... 9 4 0.22 0.1 Body ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 0.03 Scabies ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 0.02 ... Impetigo 9 4 4 2 ... ... 1 1 5 ... ... ... ... ... 19 7 0.46 0.l8 Tubercle— Glandular ... 1 ... 2 ... 1 1 1 1 1 ... ... ... ... 2 6 0.05 0.16 Osseous ... ... ... 1 ... ... 2 1 3 ... ... ... ... ... 5 2 0.1 0.06 Other Diseases 20 15 9 6 3 1 3 10 14 16 1 ... ... 1 50 49 1. 1.29 83 SCHOOL CASES, 1914. SCHOOLS. Dept. Scarlet Fever. Diphtheria. Typh. Fever. Measles Wh. Cough. Chicken Pox. Mumps. Rirgworm. Total. Head Body Central Park Road Infants 10 12 ... 1 ... 6 ... 1 1 45 Boys 3 4 ... ... ... ... ... ... 1 Girls 4 1 ... ... ... ... ... 1 ... 27 Castle Street R.C. Infants 2 ... ... 18 ... 2 ... ... 1 Boys 1 ... ... ... ... ... ... ... ... Girls 1 ... ... 1 1 ... ... ... ... Essex Road Infants 9 5 ... 45 ... ... ... ... ... 17 Boys 4 2 ... ... ... ... ... ... ... Girls 4 ... ... ... ... ... ... 2 ... Fourth Avenue Infants 6 4 ... 1 24 31 3 1 ... Boys 3 ... ... ... 2 1 ... 2 1 97 Girls 5 1 ... ... 1 5 ... 3 3 Hartley Avenue Infants 4 4 ... ... ... ... ... 3 1 Boys ... 1 ... ... ... ... ... 1 1 23 Girls 5 2 ... ... ... ... ... 1 ... High Street Infants 6 3 ... 38 20 14 2 1 ... 100 Boys 3 ... ... ... ... ... 1 1 ... Girls 6 3 ... ... ... ... ... ... 2 Kensington Avenue Infants 19 3 ... 80 23 11 ... 1 1 189 Boys 5 4 ... 4 ... 1 ... 1 ... Girls 24 3 ... 5 1 1 ... 1 1 Lathom Road Infants 29 4 ... 70 1 2 1 ... 1 149 Boys 9 1 ... ... ... ... ... 2 ... Girls 21 1 ... 3 ... 3 ... ... ... Manor Park Infants 4 5 ... 18 5 4 14 1 3 64 Boys 1 1 ... ... ... ... ... 1 1 Gills 2 3 ... ... ... ... ... 1 ... Monega Road Infants 8 ... ... 79 41 73 2 3 ... 231 Boys 7 ... ... ... ... ... ... 3 ... Girls 9 6 ... ... ... ... ... ... ... 110 Napier Road Infants 1 13 ... 57 ... ... 1 8 2 Boys 3 7 ... ... ... ... ... ... 2 Girls 5 2 ... ... ... ... ... ... 2 New Beckton Infants 2 4 ... 1 14 ... ... 3 ... 30 Boys ... 2 ... ... ... ... ... 1 ... Girls 1 2 ... ... ... ... ... ... ... 9 North Woolwich Infants ... ... ... ... ... 8 ... ... ... Mixed ... 1 ... ... ... ... ... ... ... Plashet Lane Infants 10 1 ... 37 ... 4 ... 6 ... 78 Boys 3 2 ... ... ... 11 ... 2 ... Girls 6 2 ... ... ... ... ... 3 1 St. Winf.fride's R.C. Infants ... ... ... 2 2 3 ... 3 ... 13 Mixed ... ... ... ... ... ... 1 1 1 Sandringham Road Infants 4 ... ... 19 7 ... ... ... ... 37 Boys 4 ... ... ... ... ... ... ... ... Girls 3 ... ... ... ... ... ... ... 3 Infants 7 2 ... 10 6 45 ... 7 111 Shaftesbury Road Boys 9 ... ... ... ... ... ... 6 3 Girls 6 5 ... ... ... ... ... 2 ... Infants 2 2 ... 9 ... 6 1 ... ... 38 Shrewsbury Road Boys 4 ... ... 3 ... ... 1 3 ... Girls 2 ... ... 1 ... 4 ... ... ... Silvertown R.C. Infants 1 ... ... 9 1 ... 7 ... ... 23 Mixed ... ... ... 1 1 ... 3 ... ... Vicarage Lane Infants 7 6 ... ... 1 ... ... 4 3 Mixed 3 8 ... ... ... ... ... 1 ... 33 Walton Road Infants 1 3 39 4 Boys 1 3 1 1 ... ... ... 3 1 65 Girls 4 2 ... ... ... ... ... 2 ... Totals 303 140 2 552 151 225 37 97 36 1543 85 HYGIENIC CONDITIONS OF THE SCHOOLS. It is pleasing to record the fact that considerable improvements have been effected during the past few years in the sanitary conditions of the schools in the Borough, but there is still m??? to be done in a number of the older schools, but I am afraid that the effects of the war, together with the high education rate, with postpone further improvements that should be carried out. When we consider that an important part of a child's life in spent on school premises at the time of life (5 to 14 years) wnen it is most important for the future welfare that the child should be placed under most perfect surrounding as regards ventilation an-' good lighting, it should be our duty to render the school premises as hygienic as possible. The bad lighting of many of our schools is accountable in my opinion for the large number of cases of defective vision discovered. The sanitary conveniences are in most cases very satisfactory. I would again call attention to the danger of the common drinking cup in the schools. I should like to see a drinking spray installed. The common danger was particularly brought to my notice during an outbreak of Diphtheria at one of our schools. Although I visited the school and swabbed the children's throats in the various classes affected, the disease was not checked until the school was closed for a fortnight. It was quite possible that a "carrier" of the disease through the drinking cup infected those who contracted the disease. Disinfection of certain class-rooms of schools is frequently carried out when an outbreak of infectious disease occurs, and apart from the school above mentioned it was not found necessary to close any other school on account of infect'ous d'sease being prevalent. 86 SPECIAL CASES WITH DEFECTS. Ages. Dept. Number examined. Squint. Vision defective. Deafness and discharging ears. Adenoids and enlarged tonsils. Other defects. No defect found. Total number of defects. Slight defect. Great defect. 8 years Boys 56 1 - 7 1 14 15 25 38 Girls 49 3 — 2 1 8 9 31 23 9 years Boys 24 1 1 14 1 1 7 8 25 Girls 79 — 11 43 5 6 14 30 79 10 years Boys 49 2 — 32 2 3 8 17 47 Girls 43 1 3 16 2 4 8 19 34 11 years Boys 79 3 9 56 8 3 12 2 91 Girls 79 - 24 27 11 10 22 7 94 Totals Boys 208 7 10 109 12 21 42 52 201 Girls 250 4 38 88 19 28 53 87 230 Total - 458 11 48 197 31 49 95 139 431 87 GENERAL REVIEW OF FACTS DISCLOSED BY MEDICAL INSPECTION. Nutrition. 390 boys and 295 girls were noted as being below normal nutrition. This gives a percentage of 9.56 in boys and 7.76 in girls. One boy and three girls were given as badly nourished. This percentage is higher than the previous year, but the estimate of the nutrition of a child is a difficult matter and varies by different inspectors. The relation of the weight to the height is helpful, but other conditions have to be taken into consideration. This condition is often more frequently due to improper food than to insufficiency, combined with bad hygienic surroundings. The presence of bad teeth and enlarged tonsils with adenoids, together with other septic conditions of the mouth, are largely responsible for some cases of mal-nutrition. The relation of the weight to the height is a fair standard to take, but this is not sufficient alone to estimate the condition of the child's health. The following tables, giving the average weights and height, are interesting, but as the weight of clothing varies to a certain extent, at the time of weighing, allowance should be made to obtain the exact condition. 88 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 1281 104.6 1175 103.8 104.2 102.8 6 years 662 110.0 685 109.3 111.8 108.6 12 years 836 141.3 846 142.5 - - 13 years 1049 144.8 831 146.1 144.4 146.6 WEIGHT. East Ham Children. Anthropological Standard. BOYS. GIRLS. BOYS. GIRLS. No. Exam'd. Kilog. , No. Exam'd. Kilog. Kilog. Kilog. 5 years 1281 17.4 1175 17.1 17.9 17.7 6 years 662 19.1 685 18.6 20.1 18.9 12 years 836 33.3 846 34.3 - - 13 years 1049 35.4 831 36.5 37.5 38.7 89 AVERAGE HEIGHTS (IN CENTIMETRES) ACCORDING TO SCHOOLS. SCHOOLS. 5 YEARS. 6 YEARS. 12 YEARS. 13 YEARS. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Castle Street, R.C. 103.6 107.8 113.2 112.5 147.7 144.6 153.8 148.8 Central Park Road 108.4 103.4 111.9 111.2 139.7 143.4 145.2 148.4 Essex Road 104.5 105.1 107.2 109.4 140.9 139.0 144.6 147.6 Fourth Avenue 106.7 103.9 108.2 108.5 139.8 141.3 143.7 144.5 Hartley Avenue 102.8 104.7 110.7 109.4 146.4 142.2 147.5 144.1 High Street 105.4 104.9 109.1 109.0 140.2 145.5 143.1 148.9 Higher Elementary - - - - 142.5 149.4 148.0 154.6 Kensington Avenue 108.5 107.1 110.6 110.1 142.8 145.4 146.7 141.3 Lathom Road 110.8 107.7 111.6 112.5 140.2 144.1 147.2 147.1 Manor Park 105.0 106.0 112.5 110.2 140.8 143.5 143.1 145.0 Monega Road 107.1 105.1 112.2 110.5 141.1 144.6 144.3 148.0 Napier Road 104.7 104.3 106.5 105.5 140.1 137.4 143.0 139.6 New Beckton 101.9 95.1 107.2 111.0 137.5 136.0 142.5 148.6 North Woolwich 106.0 103.3 105.2 103.2 - - - - Plashet Lane 103.3 107.5 107.8 109.6 145.0 141.9 147.3 148.6 St. Winefride's, R.C. 103.6 104.3 112.2 108.0 144.2 146.1 140.2 142.2 Sandringham Road 105.0 107.3 111.0 109.8 141.0 141.8 145.8 145.6 Shaftesbury Road 105.6 106.1 110.2 109.7 140.2 143.0 143.8 148.5 Shrewsbury Road 104.3 104.1 109.1 110.5 147.0 143.6 144.2 145.2 Silvertown, R.C. 101.0 95.9 108.4 105.6 136.7 141.5 140.8 138.4 Vicarage Lane 104.0 101.6 109.4 112.8 140.6 144.6 143.5 147.2 Walton Road 105.5 105.3 106.2 107.0 133.6 144.3 141.9 141.5 90 AVERAGE WEIGHTS (IN KILOGRAMMES) ACCORDING TO SCHOOLS. SCHOOLS. 5 YEARS. 6 YEARS. 12 YEARS. 13 YEARS. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Castle Street, R.C. 17.0 17.6 20.1 19.8 37.0 32.9 37.4 36.1 Central Park Road 17.7 16.6 19.6 19.7 33.7 34.2 35.6 38.7 Essex Road 17.6 17.3 17.3 18.6 33.6 32.7 36.4 38.4 Fourth Avenue 18.5 17.7 19.3 19.2 31.2 33.5 33.4 34.7 Hartley Avenue 16.6 17.3 19.3 18.7 32.8 34.7 35.4 37.3 High Street 17.6 17.4 18.5 19.2 32.8 34.1 34.7 38.3 Higher Elementary - - - - 34.3 35.5 37.0 41.4 Kensington Avenue 18.6 17.7 19.1 18.5 33.7 34.3 36.1 35.2 Lathom Road 17.3 17.6 20.5 18.9 35.9 34.2 35.4 35.7 Manor Park 17.2 15.9 19.4 18.2 33.1 33.4 33.8 34.6 Monega Road 18.5 17.8 20.1 19.3 33.8 35.9 35.2 36.7 Napier Road 18.1 16.7 17.5 17.5 32.5 31.8 34.5 33.7 New Beckton 12.9 15.8 17.3 21.1 32.3 32.3 34.6 39.7 North Woolwich 17.1 16.3 17.3 16.4 - - - - Plashet Lane 17.7 15.8 18.2 19.6 35.0 34.1 36.1 34.8 St. Winefrides, R.C. 18.9 17.2 19.9 15.4 32.7 34.8 32.3 32.4 Sandringham Road 18.0 17.6 19.5 18.7 32.9 35.6 35.7 38.0 Shaftesbury Road 15.8 18.4 18.2 26.0 32.5 33.3 35.3 37.2 Shrewsbury Road 17.5 17.4 18.5 18.9 31.9 33.8 35.0 35.4 Silvertown, R.C. 17.8 16.0 20.0 18.4 33.4 36.2 40.1 37.4 Vicarage Lane 17.2 19.0 22.3 17.2 33.3 34.9 35.4 36.7 Walton Road 17.7 17.6 18.5 18.2 30.8 33.3 34.0 33.7 91 Defective Clothing and Boots. The percentage of children found with defective clothing was more satisfactory than in the previous year. The children with defective boots was about the same as in 1913. In a large number of cases there appeared to be a lack of knowledge of the hygienic value of clothing for children. Some children are found to be overloaded with clothing, whilst others are underclothed both in quantity and quality. 38 boys and 25 girls were found wearing dirty clothing. These are to be found in those children who either have no mother to look after them or where the parent spends the time that should be spent at home in visiting beer-houses or places of amusement. Squint. 70 boys and 50 girls were found to have this defect, giving a percentage of 1.7 in boys and 1.31 in girls. The majority of the parents will be advised to follow treatment prescribed by the Ophthalmic Surgeon, but there are still a few stupid parents who inform the doctor that " the child has had the squint since birth, and they do not see that it should be interfered with now." Shades are provided free of charge and advice given for treatment, but often it is found that the prescribed treatment has not been carried out. External Eye Inflammation. The following is a summary of external disease of the eye:— Boys. Girls. Blepharitis 35 22 Conjunctivitis 8 14 Corneal Opacity 1 2 Other diseases 6 8 It will be noted that Blepharitis is the most common external eye trouble. 92 This disease, which is commonly called "Blight," is not nearly so prevalent as in the days before Medical Inspection and clinic treatment. In those days this disease sometimes occurred in severe epidemics, especially in the schools of the poorer districts where the children were badly housed in overcrowded, dark, and illventilated rooms. Defective Vision. 3,559 children were examined for visual defects, as compared with 1,883 in the previous year. The results will be found in the table of defects, also in the report of the Ophthalmic Surgeon on page 109. Diseases of the Ear. The percentage of boys found to have defective hearing was 0.85 in the right ear and 1.37 in the left. In girls, 1.08 in the right and 1.06 in the left. This defective hearing is, in a large number of cases, found to be associated with Adenoids and Enlarged Tonsils. Discharging ears, which is so common after such diseases as Measles and Scarlet Fever and associated with impaired hearing, was discovered in boys with the right ear involved in the percentage of 0'58 and left ear 0'81. In girls the percentage was 0.66 right ear and 0.66 in left. Several children had to be excluded from school on account of the offensive smell connected with this trouble, but the majority were allowed to attend school during treatment at the morning clinic. Diseases of the Heart Heart disease was found in 76 boys and 72 girls, giving percentages of 1.86 and 1.89 respectively. In quite a large number of cases the parents were not aware of the existence of this disease in their children, and upon investigation the condition was frequently found to be associated with a history of Chorea or slight Rheumatism. in some cases this 93 attack may only be temporary, which fact is explained to the parents, when present, who are invited to bring the children up later to the Clinic for further examination. In the meantime directions are given as to the amount of physical exertion, such as drill, that should be allowed. Diseases of the Lungs. Under this heading is included Bronchitis. 146 boys and 100 girls were found to be suffering from some forms of Bronchitis. Pulmonary Tuberculosis was present in 13 boys and 9 girls, with percentages of 0.32 and 0.24. In these cases well-marked physical signs were present, but there is no doubt that some of the children classified as suffering from Bronchitis were probably in the pre-tubercular stage. These cases are recommended to attend the Tuberculosis Dispensary when thought necessary, or frequently re-examined at the Clinic. Cleanliness. Cleanliness of the body has improved of late years, but there is still much to be desired in the condition of the children in several schools. One child whose head or body is in a verminous condition may act as a focus to the remainder of the class. Since Nurse Forbes was called up in August the depleted staff has not been able to devote the usual time for inspection' of general cleanliness, but at the ordinary routine examinations the following results were noted:— 25 boys and 105 girls were found to have verminous condition of the head. 24 boys and 24 girls had vermin on the body. 168 boys and 1,030 girls showed nits in the hair. In the case of girls' schools it can be readily understood how one child with vermin may infect most of the class, and it is 94 often a matter of regret when one serves a Statutory Notice on a parent who, on further enquiry, is found to have done everything possible to prevent the condition. Girls are advised to put their hair up in plaits. For purposes of comparison the percentages are given for the past three years. Verminous Head. 1912. 1913. 1914. Boys 0.54 0.66 0.61 Girls 1.4 1.5 2.76 Verminous Bodies. Boys 0.39 0.86 0.59 Girls 1.08 0.51 0.63 Inspections for General Cleanliness under Section 122 of the Children Act, 1908. The number of children examined for general cleanliness during 1914 was 15,209, as against 22,983 in 1913, and the number of cleansings carried out was 59, as compared with 16 in 1913. The explanation of the falling off in the number of inspections is due to the depletion of the staff. In order to make comparison the following table is submitted:— 1913. 1914. Children examined for cleanliness 22,983 15,209 Number of Statutory Notices served 425 505 Number of cleansings 16 59 Number cleansed Statutorily 16 37 No prosecutions took place under the Act, but this certainly was not because they were not needed. The proceeding takes such a considerable time that it was found to be impracticable. 95 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 102 20 28 2 Napier Road Girls 471 98 85 10 Mixed 173 24 26 4 Boys ... ... ... ... Infants 458 30 60 19 Central Park Road Girls ... ... ... ... Boys ... ... ... ... New Beckton Girls 218 6 19 ... Infants 607 36 22 ... Boys 290 3 21 5 Infants 227 18 15 2 Essex Road Girls 445 30 26 ... Boys 453 10 8 4 North Woolwich Mixed 437 18 22 3 Infants 537 15 23 ... Plashet Lane Girls 455 57 45 8 Fourth Avenue Girls 362 51 29 1 Boys ... ... ... ... Boys ... ... ... ... Infants 524 52 66 20 Infants 320 20 16 2 St. Winefride's R.C. Mixed ... ... ... ... Hartley Avenue Girls 467 56 32 ... Boys ... ... ... ... Sandringham Road Girls ... ... ... ... Infants 512 20 47 6 Boys ... ... ... ... High Street Girls 316 30 66 6 Infants 227 23 ... ... Boys 311 7 28 8 Shaftesbury Road Girls 540 104 24 ... Infants 306 32 60 5 Boys ... ... ... ... Kensington Avenue Girls 472 10 11 ... Infants 519 37 19 ... Boys 468 4 1 ... Shrewsbury Road Girls ... ... ... ... Infants 402 4 10 ... Boys ... ... ... ... Lathom Road Girls 455 18 32 2 Infants 213 23 5 ... Boys 412 10 2 ... Silvertown R.C. Infants 172 20 18 6 Infants 534 9 14 3 Mixed 217 17 16 9 Manor Park Girls ... ... ... ... Vicarage Lane Girls 462 60 63 9 Boys ... ... ... ... Boys ... ... ... ... Infants 311 21 7 1 Infants 496 20 40 16 Monega Road Girls ... ... ... ... Walton Road Girls 408 73 43 11 Boys ... ... ... ... Boys 462 4 11 13 Infants 448 17 15 8 Infants ... ... ... ... Total 8413 444 503 52 Total 6796 663 572 131 96 Teeth. It is now being recognised the part defective teeth takes in the cause of various diseases of the alimentary canal. A large number of recruits examined since the commencement of the war have been rejected on account of the bad condition of their teeth. It now behoves us to look to the future. Much has been done since the appointment of a part-time Dentist, but this is only a fraction of what should be done. There is sufficient work for several full-time Dentists. 439 boys and 385 girls were found to have more than four decayed teeth, giving percentages of 10.76 and 10.13 respectively. 3,641 boys and 3,416 girls had less than four decayed teeth, with percentages of 89.24 and 89.87. Much might be done in the schools by the teaching of dental hygiene. The report of the School Dentist for the year 1914 will be found on pages 111, 112, 113. Enlarged Tonsils and Adenoids. 1105 per cent. of boys and 10.94 per cent. of girls had slightly enlarged tonsils, and 4.73 per cent. boys and 5.37 per cent. girls greatly enlarged. The percentage of children affected with post-nasal adenoids were 1.62 per cent. of boys and 0.89 per cent. girls with slightly marked adenoids, and 0.88 boys and 0.58 girls greatly marked. The presence of very large tonsils and adenoids are a grave menace to the health of the child. Their presence causes the child to become a mouth breather, which gives the vacant expression associated with the condition. Children affected are also much more susceptible to diseases of the lungs from insufficient expansion of the chest during respiration owing to the obstruction of breathing. These children are also found to be "carriers" of infectious micro-organisms. 97 There is found to be no difficulty in persuading parents to seek advice when their attention is called to the condition, and the London Hospital are always willing to carry out operative treatment where necessary. Mental Defects. At routine inspection 9.32 per cent. boys and 12.65 per cent. girls were classified as dull. Four girls and four boys were also found to be mentally defective whilst in attendance at school. In my Annual Report for 1912 I drew the attention of the Committee to the urgent need for provision of a special centre for these cases of mental deficiency, and I regret to note that nothing has been done in the way of providing a special school for such cases. Mental Deficiency Act, 1913, and Elementary Education Defective and Epileptic Act, 1914. The School Medical Officers have been appointed under this Act, which makes it compulsory for the Education Authority to ascertain the number of children in the area who are defective within the meaning of the Act, between the ages of 7 and 16 years. During last year 7 children were examined and certified as mentally defective. The following cases 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. Ringworm. This disease is much less common in our schools than a few years ago, owing to the measures adopted for the discovery of the disease and exclusion from school until entire absence of any trace of the diseased hair, as proved by microscopical examination. Only nine cases in boys and four in girls of Ringworm of the head were discovered at the routine examinations during the year. The number of children excluded for the affection was 101, as compared with 165 in 1913 and 217 in 1912. 98 TABLE SHOWING SCHOOL INCIDENCE OF RINGWORM OF SCALP DURING 1914. Schools. Ringworm of Scalp. Percentage of Average Attendance. Castle Street R.C. ... ... Central Park Road 2 0.12 Essex Road 2 0.14 Fourth Avenue 6 0.56 Hartley Avenue 5 0.34 High Street 2 0.21 Higher Elementary ... ... Kensington Avenue 3 0.22 Lathom Road 2 0.14 Manor Park 3 0.27 Monega Road 6 0.47 Napier Road 15 1.09 New Beckton 4 0.53 North Woolwich ... ... Plashet Lane 11 0.75 St. Winefride's, R.C. 4 1.6 Sandringham Road ... ... Silvertown R.C. ... ... Shaftesbury Road 15 1.0 Shrewsbury Road 3 0.39 Vicarage Lane 5 0.37 Walton Road 9 0.61 97 0.4 99 FOLLOWING UP. The same practice Has been adopted as in previous years. The homes of defective children have been visited. The results obtained may be considered satisfactory. This visiting by the Nurses occupies a considerable part of their time, but it is found much more satisfactory for the Nurse to call on the parents than to send a notice of defects by post. Some parents are quite indifferent as to the advice given, but the majority will take advantage of any facility given them for the treatment of defects at the Clinic. It is often found most difficult to persuade parents to seek advice re defective vision. The following letter is an example of many such letters received from ignorant parents :— " Sir, "I strongly object to your treatment of the eyes, there was only a slight defect in one of my child's eyes and you have used some acid ointment which has caused her to go almost blind. I consider it cruel and do not wish you to use any strong magnifying glasses on her eyes." It is gratifying to know that as. a result of Medical Inspection 356 of our school children have had their defective vision restored by the supply of spectacles. The applications for dental treatment are so numerous that the part-time Dentist has had no time to visit any of the schools for inspection during the last six months of the year. 100 TABLE OF RESULTS AFTER FOLLOWING UP. Clinic. Hospital. Private Practitioner. Home Treatment. No Treatment. Number in whom treatment was unnecessary through spontaneous cure or relief. Left. Refused. Totals. Glasses. Treatment. Operation. Glasses. Treatment. Operation. Glasses. Treatment. Defective Vision including Squint 241 18 1 73 10 ... 34 10 ... 202 136 108 29 862 Enlarged Tonsils and Adenoids ... ... 72 ... 14 3 ... 12 ... 197 17 17 13 345 Discharging Ears and Deafness ... 14 9 ... 20 ... ... 13 31 29 4 13 2 135 Inflamed Eyes ... 6 ... ... 2 ... ... 1 3 ... ... 1 ... 13 Malnutrition, Anæmia and Debility ... ... ... ... 2 ... ... 9 2 1 ... ... ... 14 Ringworm, Impetigo and other skin affections ... 2 ... ... ... ... ... 1 6 1 ... 1 ... 11 Heart and Lung affections ... ... ... ... 28 1 ... 91 29 37 2 9 ... 197 Decayed Teeth ... 104 ... ... 24 ... ... 24 6 145 4 19 24 350 Other conditions ... 1 3 ... 31 ... ... 7 3 20 1 9 ... 75 241 145 85 73 131 4 34 168 80 632 164 177 68 2002 101 PROVISION OF MEALS. Under the Education (Provision of Meals) Act, 1914, the Education Authority may now extend the feeding of necessitous school children. The effect of this Act is as follows :— (1) To equalise the feeding of school children during school holidays. (2) To abolish the ½d. rate limit. (3) To make the Act non-adoptive. The Board of Education will take into consideration the following points in making their grants:— (a) The extent to which the work is co-ordinated with that of the School Medical Service. (b) The care exercised in selection of the children for admission to the meals. (c) The sufficiency and suitability of the dietary. (d) The extent to which attention is given to the educational aspect of the work. (e) The suitability of the accommodation and equipment and the efficiency of the service and the supervision of the meals. (f) The completement of the arrangements made for ascertaining and recording the effect of the meals on the physical and mental condition of the children. (g) The economical administration of the work. Up to the present time there has been co-ordination of the feeding of children with the School Medical Service. There is no doubt that a large number of children are fed whose circumstances and physical condition do not warrant such, but on the other hand cases frequently come under the notice of the School Medical Officer where the parents either from carelessness, indifference or laziness will not apply for their children to be fed ; the physical condition on account of ill-health or poverty demanding such feeding. The Board suggest that two courses should be provided, instead of the one usually given. 102 If the menu is carefully arranged the cost of a two-course dinner would be a very small fraction more than one course. At one school I visited I found a leg of mutton cooked for dinner, and on suggesting to the Cook as to the giving of rice pudding I was informed that the children would not eat rice pudding. Those children who refused pudding could not have been hungry and would probably have benefited more by the rice pudding than by the meat. The number of children fed for the years 1912-1915 and number of meals per child fed are given in the following table:— No. of children fed. No. of meals per child fed. 1912-13 1,175 126 1913-14 1,073 106 1914-15 1,025 180 It will be noted that although the number of children fed were less from March, 1914-15, the number of meals increased. The number of meals provided and the total cost per meal for the same year are as follows:— Number of meals. Cost per meal. 1912-13 148,367 2.44d. 1913-14 113,487 2.72d. 1914-15 184,626 2.71d. THE TEACHING OF HYGIENE. Mothercraft and School for Mothers. Six cooking centres in the Borough provide instruction for 1,600 children annually. The teaching of hygiene is not part of the syllabus except at the Higher Elementary School. At this School instruction is given in First Aid, Elementary Anatomy, Physiology, Infant Management, Health and Temperance. I would like to see as part of the syllabus instruction to the elder girls in the Elementary Schools the management of infants and housewifery with general house sanitation. 103 In connection with the Infants' Clinics an Ante-Natal Class has been formed so that expectant mothers may attend and advice given for their future welfare. INSTRUCTION IN SWIMMING. The swimming baths provide bathing accommodation for 1,000 boys and 500 girls each week. The baths are available for boys on Mondays, Tuesdays, and Thursdays, forenoon, and boys to the number of 60 each halfhour attend from the different schools. For girls the baths are available on Monday afternoons and Wednesday mornings and afternoons. One teacher accompanies every 30 scholars. During the year a swimming competition is held, when some fine swimming contests between different schools for the challenge cups and shields may be seen. Each teacher takes great interest in instructing scholars, and keen competition is shown. 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 to 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. 104 The number of consultations at the Inspection Clinic during 1915 was 5,885. The Inspection Clinic forms the most important part of the work of the School Medical Officer. The clerical work in connection with this work is becoming considerable in extent. The table given shows the various affections for which children were sent to the Clinic. It will be seen that the attendance of Ringworm cases constituted a large proportion of the consultations. It was in connection with this malady and other contagious skin affections that co-operation between the School Medical Officer's Department and Attendance Officers was very effective. Certificates of exclusion from school attendance, issued by the School Medical Officer for contagious skin disorders, were effective until re-admission forms from the same official were granted. Meantime periodical examinations were conducted at the Inspection Clinic so that the children were under organised and careful observation. At each visit of infected children, subsequent visits were arranged and recorded in a special register. If children did not attend on the date arranged the attendance sub-department received information to this effect. Little difficulty was experienced in procuring the attendance of children and the arrangements made for their periodic visits worked harmoniously and effectively. The Inspection Clinic afforded means for amplifying co-operative measures between Attendance Officers and the School Medical Officer's department. Many of the 5,885 cases seen at the ordinary Inspection Clinic were cases sent by Attendance Officers, who, when visiting at the homes of children absent from school found it expedient to have the School Medical Officer's opinion as to the rectitude of absence. 105 199 cases were sent to the Inspection Clinic by the Divisional Committees for a similar purpose. A definite opinion on special forms regarding the latter was supplied to the Education Offices, and further procedure of the Committees and Officers was based on such opinions. 901 cases of throat affections were seen at the Inspection Clinic. These were in nearly every case sent by school teachers. When deemed advisable, "swabs" were taken and cultures made and examined. 90 examinations for suspected tubercular affections were made. These examinations in nearly every case consisted of physical examinations of the chest. Every case of phthisis pulmonalis which was discovered at the routine and special examinations at the schools was definitely diagnosed at the Inspection Clinic. A large number of children with non-specific and indefinite rashes were sent to the Clinic by teachers, who made it a rule to have the Medical Officer's opinion on any skin eruption. Many of these affections were seborrhœic, and their appearance had rendered the teachers apprehensive of ringworm. Cases of Contagious Impetigo were seen at the Clinic and a considerable amount of attendance was saved by the prompt isolation of such cases and the advice given to parents as to its infectivity and treatment. Under the treatment recommended lengthy exclusion is not needed. 106 CLASSIFICATION OF CONSULTATIONS AT INSPECTION CLINIC, 1914. Throat 901 Jaundice 5 Vision 698 Warts 5 Ringworm of Head 690 Cellulitis 4 Impetigo 638 Urinary Affections 4 External Eye Inflammation 400 Erythema Nodosum 4 Chest Examinations 265 Flat Foot 4 Teeth 255 Forunculosis 4 Attendance Cases 199 Iritis 4 Ear Affections 140 Dyspepsia 4 Ringworm of Body 135 Speech Affections 4 Infectious Diseases 134 Acne Vulgaris 3 Septic Sores 105 Chilblains 3 Eczema 104 Mignaine 1 Tuberculosis, Pulmonary 90 Arthritis 3 Verminous Condition 75 Sabaceous Cyst 3 Nettle Rash 73 Desquamation 3 Scabies 72 Cyst 3 Injuries 69 Mastoiditis 2 Stomach Affections 67 Nævus 9 Catarrh of Respiratory Organs 66 Spinal Affections 2 Seborrhœa 2 Debility and Anæmia 61 Psoriasis 2 Glandular Affections 55 Vertigo 2 Rheumatism 55 Dermatitis 2 Heart Affections 53 Endocarditis 1 Abscesses 48 Appendicitis 1 Nervous Disorders 35 Cheiropompholyx 1 Nose Affections 35 Gastritis 1 Chorea 34 Parotitis 1 Alopecia 30 Pleurodynia 1 Unclassified 29 Somnambulism 1 Tuberculosis 24 Pes-equino Varus 1 Pityriasis Alba 17 Lupus 1 Cynovitis 16 Hydrocele 1 Shingles 15 Marasmus 1 Urticaria 14 Papillar Bursitis 1 Mental Affections 12 Ictenis 1 Whitlow 12 Mastoid Abscess 1 Herpes 10 Sencorrhœa 1 Diarrhœa 10 Ganglion 1 Epilepsy 8 Thread Worms 1 Nephritis 8 Fish Poisoning 1 Non-Specific Rashes 8 Prolapsis Recti 1 Paralysis 6 Cataract 1 Hernia 6 Total 5,885 Deformities 6 Enteritis 5 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 25 26 27 29 32 35 36 41 44 50 57 60 68 134 Totals. Impetigo 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Blepharitis ... 5 4 1 2 5 2 ... ... ... ... 1 1 ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 174 External Inflammation of Eyes other than Blepharitis. 10 6 1 ... 2 3 1 3 1 1 1 ... ... ... 1 2 1 1 1 ... 1 ... ... ... ... 1 ... 2 ... ... ... 1 ... ... 418 Discharging Ears and Deafness 20 7 5 ... 5 2 1 2 1 3 1 4 1 1 3 2 ... 1 2 2 ... 1 ... 1 2 ... 1 ... 1 ... 1 ... 1 1 869 Ringworm Body ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Head 1 ... 2 ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 56 Septic Sores and Abscess Formation. 8 7 6 7 3 4 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 192 Eczema 2 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 Scabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 48 54 54 32 65 84 35 56 18 40 44 72 26 14 60 64 51 36 80 42 50 26 27 29 64 35 36 82 44 50 57 60 68 134 1737 107 TREATMENT CLINIC. The accompanying table gives the affections for which treatment was provided and the results obtained. The Clinic is open for treatment each morning except Saturday. It will be seen on reference to the detailed table that the largest number of attendances was for Discharging Ears. This condition, if not treated at the Clinic, is often neglected and the children, if allowed to attend school, would be obnoxious tf> those in association with them, besides the danger of the child becoming deaf. Discharging ears, if neglected, becomes a chronic disease, and of the 70 cases treated only 40 were given as cured, 17 relieved, and 13 unchanged. External Eye Diseases were next in number, and were treated with success. Corneal Ulceration, if neglected, leads to scarring of the Visual Media, rendering1 vision defective for life. FABLE OF RESULTS OF CLINIC TREATMENT (Dental and Vision Cases Excluded). Cured. Relieved. Unchanged. Left the Borough. Totals. Impetigo 2 ... ... ... 2 Blepharitis 17 8 6 ... 31 Corneal Ulceration and other external eye inflammation. 23 9 4 ... 36 Discharging Ears and Deafness 40 17 13 ... 70 Ringworm— Body 2 ... ... ... 2 Head 7 ... ... ... 7 Septic Wounds, Abscesses, &c. 44 ... ... ... 44 Eczema 3 ... ... ... 3 Scabies ... ... ... ... ... Totals 128 44 23 ... 195 108 The report of the Ophthalmic Surgeon and report on the Dental Clinic will be found in Appendix I. and II. 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 Mr. Thompson, Secretary to the Committee, for many courtesies and helpful acts, to the School Nurses and Teachers for their response to the call for increased services, and to Miss Perry for the neat and careful records of the work she has prepared, especially for this Report. I am, Mrs. Ford and Gentlemen, Your obedient Servant, WILLIAM BENTON, Medical Officer to Education Committee. 109 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. Spectacles are now supplied at a flat rate of 2s. 6d. per pair. For this price a good solid nickel or nickel steel frame and best quality lenses are provided. In 106 cases it was found the parents could not afford to pay for the spectacles. These were supplied out of a fund supported by voluntary contributions and controlled by the School Medical Officer. This fund is now exhausted, and it will be necessary for the Committee to make further arrangements for supplying the glasses in necessitous cases. 110 52 cases of squint (31 being without refractive error) were treated by means of shades worn for varying periods. Squint cases with refractive error have responded to the shade treatment (i.e., exclusion of the good eye whilst at school) very satisfactorily, but squint cases without refractive error have not shown good results. These shades were also supplied out of the voluntary fund. During the year 1914 there were 474 cases examined as follows, as compared with 355 in 1913 :— Myopia 69 Simple Myopic Astigmatism 14 Compound Myopic Astigmatism 24 Hypermetropia 104 Simple Hypermetropic Astigmatism 33 Compound Hypermetropic Astigmatism 55 Mixed Astigmatism 25 Odd Eyes 25 Squint without error of refraction 31 Corneal Opacities 14 Ciliary Spasms 27 Cataract 2 Various Congenital Defect 5 No defects 46 Total 474 Each of the above received appropriate treatment. 111 APPENDIX II. Report on the Dental Treatment at the School Clinic. Mr. Taylor, the School Dentist, having been called up for military service as an Officer in the Territorial Force early in August, some delay was caused before Mr. Rivers Cole was appointed as Temporary School Dentist, which fact partly accounts for the diminished number of children examined and treated. During the year it was only found possible to visit one school; the remainder treated were those cases left over from the previous year who applied for treatment, and cases discovered by the School Medical Inspectors at the ordinary routine examination, together with cases sent up by teachers whose attendance at school was interfered with on account of the bad condition of the teeth. The cases examined by the School Dentist and cases treated at the Dental Clinic are given in the following tables. 565 children were treated at the Clinic during the year. 1,550 temporary and 175 permanent teeth were extracted, mostly by means of a local anæsthetic. In only two cases was it thought necessary to give a general anæsthetic (Ethyl Chloride). In addition to this 85 fillings were inserted. 112 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 ... 2 1 Central Park Road ... ... ... ... 14 1 14 1 Essex Road ... ... 3 ... 7 8 10 8 Fourth Avenue ... ... ... ... 2 5 2 5 Hartley Avenue 73 72 90 78 52 43 215 193 High Street ... ... ... ... 9 17 9 17 Higher Elementary ... ... ... ... ... ... 1 1 Kensington Avenue ... ... ... 3 12 8 12 11 Lathom Road ... ... 11 5 28 17 39 22 Manor Park ... ... ... ... 8 7 8 7 Monega Road ... ... 1 6 26 29 27 35 Napier Road ... ... 1 ... 13 16 14 16 New Beckton ... ... ... ... 1 ... 1 ... North Woolwich ... ... ... ... 4 2 4 2 Plashet Lane ... ... ... ... 21 19 21 19 St. Winefride's R.C. ... ... ... ... ... ... ... ... Sandringham Road ... ... 1 ... 3 7 4 7 Shaftesbury Road ... ... ... ... 41 34 41 34 Shrewsbury Road ... ... ... ... 10 10 10 10 Silvertown R.C. ... ... ... ... 1 1 1 1 Vicarage Lane ... ... ... ... 22 47 22 47 Walton Road ... ... ... ... 10 6 10 6 73 72 107 92 286 278 467 443 113 CASES TREATED AT DENTAL CLINIC. Ages. Sex. Number Exam'd. Temporary Teeth. Permanent Teeth. Extractions. Anæsthetics. Scalings. Dressings. Fillings. Saveable. Unsaveable. Saveable. Unsaveable. Temp. Teeth. Perm. Teeth. Local. N2O. 5 years B. 45 5 162 ... ... 122 ... 30 ... ... ... 3 G. 56 1 165 1 ... 137 ... 43 ... ... ... 1 6 years B. 59 2 248 12 4 183 2 61 ... ... 1 1 G. 63 ... 291 8 2 240 1 60 ... ... 1 5 7 years B. 47 ... 161 9 2 139 1 37 ... ... 1 4 G. 51 1 225 14 1 183 1 47 ... 2 2 10 8 years B. 47 2 145 8 7 137 10 27 1 ... ... 5 G. 54 5 147 9 9 165 7 37 ... ... 1 8 9 years B. 31 7 114 21 9 98 8 22 1 ... ... 6 G. 21 ... 59 20 12 47 13 18 ... ... ... 5 10 years B. 15 ... 47 ... 4 17 13 16 ... ... ... ... G. 18 ... 43 7 22 27 21 14 ... 1 ... 4 11 years B. 12 ... 32 8 18 16 11 1 ... 1 ... 5 G. 8 5 13 10 7 18 6 8 ... ... ... 9 12 years B. 15 ... 22 10 16 14 13 14 ... 1 ... 1 G. 7 ... 1 5 12 ... 12 12 ... ... ... 3 13 years B. 17 2 4 7 28 2 25 20 ... 2 ... 3 G. 13 ... 6 8 33 5 30 1 ... 2 ... 6 14 years B. 1 ... ... ... 1 ... 1 1 ... ... ... ... G. ... ... ... ... ... ... ... ... ... ... ... ... Totals B. 289 18 930 75 89 728 84 229 2 4 2 34 G. 291 12 950 82 98 822 91 240 ... 5 4 51 580 30 1880 157 187 1550 175 469 2 9 6 85 Report OF THE Chief Sanitary Inspector FOR THE YEAR 1914. 116 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 nineteenth Annual Report on the work done by the Sanitary Inspectors during the year ended 31st December, 1914. INSPECTION OF THE BOROUGH AND ABATEMENT OF NUISANCES. The total number of primary inspections made during the year under consideration was 6,022, as compared with 5,627 for the previous year 1913. It will be observed that there is an increase of 395 in the number of inspections made. These 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. PRIMARY INSPECTIONS. Beckton and N. Woolwich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total. 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 January 61 23 107 263 194 60 92 124 22 20 146 93 622 583 February 24 69 242 128 61 150 99 84 14 44 145 90 585 565 March 77 34 84 136 50 132 65 135 10 61 117 117 403 615 April 77 15 172 148 34 112 126 111 20 25 95 85 524 496 May 48 96 105 92 105 164 96 151 39 39 120 97 513 639 June 37 173 152 59 32 68 49 112 66 75 75 51 411 538 July 47 105 172 104 66 63 40 133 49 90 54 75 428 570 August 34 38 49 58 35 48 72 70 18 6 70 11 278 231 September 49 125 76 66 89 88 86 63 26 16 78 31 404 389 October 70 119 97 100 81 150 114 79 38 36 86 40 486 524 November 35 161 141 120 65 57 122 85 30 24 77 38 470 485 December 50 46 91 168 128 85 133 45 30 18 71 25 503 387 Totals 609 1004 1488 1442 940 1177 1094 1192 362 454 1134 753 5627 6022 The Following is a Record in Detail of the Inspections made during the Years 1913-1914:— Beckton and North Woolwich Ward. Central East Ward. Central West Ward. Manor Park Ward. Plashet East Ward. Plashet West Ward. Total. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. 1013 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1918 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 Premises found in fair condition 263 324 99 266 424 377 220 265 444 384 61 211 463 352 8 4 120 163 3 29 341 337 113 ... 2055 1937 504 811 Factory workshop premises 55 38 ... ... 80 66 ... ... 48 51 ... ... 102 102 ... ... 21 35 ... ... 41 80 ... ... 347 372 ... ... Outworkers' premises 47 35 ... ... 75 63 ... ... 144 148 ... ... 23 33 ... ... 39 46 ... ... 95 143 ... ... 423 468 ... ... Bakehouses 9 4 ... ... 15 7 ... ... 36 21 ... ... 18 19 ... ... 23 8 ... ... 31 32 ... ... 132 91 ... ... Slaughter-houses 1 7 ... ... 13 28 ... ... 4 5 ... ... 98 135 ... ... ... ... 18 26 ... ... 134 201 ...... ... Dairies 44 47 ... ... 61 76 ... ... 78 84 ... ... 100 112 ... ... 29 22 ... ... 56 60 ... ... 868 401 ... ... Urinals inspected 81 17 ... ... 47 37 ... ... 36 26 ... ... 21 22 ... ... 4 13 ... ... 20 32 ... ... 159 147 ... ... Walls and ceilings dirty and dilapidated 17 38 48 109 48 67 147 159 74 59 31 84 96 97 99 132 23 45 26 26 66 77 93 11 324 383 444 521 Yards improperly paved and dilapidated 4 4 21 24 35 22 85 ... 29 30 13 43 56 42 62 101 11 13 22 21 24 18 107 22 159 129 310 283 No forecourt paving 2 3 ...... 32 4 5 115 6 19 21 33 123 8 23 28 110 3 4 20 18 29 26 111 35 65 82 307 324 Drains unstopped and cleansed 251 326 ... ... 402 387 ... ... 437 389 ... ... 402 402 ... ... 235 117 ... ... 225 231 ... ... 1952 1852 ... ... Defective drains 2 7 7 4 23 2 9 14 6 10 ... 13 18 83 ... 3 3 5 1 ... 24 15 41 1 76 122 58 37 Defective w.c. connections 7 1 2 9 5 5 1 4 4 4 ... 2 9 3 3 1 ... 2 ... ... 5 1 3 ... 30 19 9 16 Defective w.c. traps 1 1 1 11 7 7 8 3 2 5 ... 2 21 17 5 17 5 4 5 ... 6 2 1 ... 42 36 15 33 Soil pipes and drains insufficiently ventilated ... 1 ... 1 ... ... 8 ... 1 2 ... 6 ... 13 ... 4 1 2 ... 5 1 2 7 2 3 20 15 18 Defective flushing apparatus 9 5 13 10 25 17 25 17 30 13 1 21 32 85 16 33 13 14 12 ... 25 11 21 1 134 95 88 85 Soil pans foul and broken 1 5 4 12 21 19 19 23 20 23 1 30 51 38 41 41 22 18 26 19 44 26 117 27 159 129 208 152 Defective vent pipes ... 2 ... 3 14 9 10 14 6 6 ... 10 20 19 8 46 3 8 5 6 12 6 29 1 55 50 52 80 R W. pipes and eaves gutters defective 4 2 8 14 32 14 28 32 10 16 5 15 43 45 32 55 3 5 28 6 20 7 28 2 112 89 129 124 Do. connected to drain ... ... ... 1 ... 1 ... ... ... 1 ... 1 2 4 3 ... ... 1 9 1 3 2 28 2 5 9 40 5 Roofs leaky 3 9 7 19 13 8 19 32 11 8 1 14 19 16 9 30 2 8 6 8 16 8 29 8 64 57 71 111 Defective sink waste pipes ... 4 10 4 9 6 14 27 9 10 8 15 25 25 7 25 3 5 10 ... 10 11 33 2 56 61 82 76 Houses without water (M.W.Bd.) ... 1 ... ... 2 4 ... ... 1 5 ... ... 4 1 ... ... 4 1 ... ... 4 ... ... ... 15 12 ... ... Cisterns without covers ... 1 ... 19 4 4 12 ... 2 2 2 1 3 ... ... ... 3 1 ... 3 10 2 19 8 22 10 33 31 Drinking water improperly stored 1 ... ... ... 30 27 138 26 33 17 28 40 44 51 6 128 18 21 28 18 22 7 65 6 148 123 265 218 Dilapidated floors ... 3 11 12 2 ... 18 22 14 3 2 ... 8 9 29 24 1 2 6 1 11 6 41 2 36 23 107 66 Insufficient underfloor ventilation ... 3 11 15 8 9 24 22 13 3 6 30 14 19 34 113 3 6 25 30 8 11 112 15 46 51 212 225 Dampness 3 5 6 21 7 9 15 20 6 16 ... 16 39 30 25 57 7 5 9 ... 9 12 26 71 77 81 117 Accumulations 13 11 ... ... 24 28 ... 2 26 20 ... 1 29 34 8 5 17 12 ... ... 24 22 1 ... 133 127 9 8 Inundations ... ... ... ... ... ... ... ... 5 ... ... ... 1 ... ... 3 3 ... ... ... ... 4 1 ... 9 4 1 3 Overcrowding 3 2 ... 1 4 6 1 ... 4 5 ... ... 16 8 1 1 1 1 ... ... 3 1 ... ... 31 23 2 2 Unsound food ... 1 ... ... ... ... ... ... 8 4 ... ... 10 16 ... ... ... ... ... ... ... 4 ... ... 18 25 ... ... No dust bins 1 ... 3 13 7 2 5 16 4 6 ... 10 14 15 29 17 2 4 4 1 6 8 7 1 34 30 48 58 No manure bins ...... ... ... ... 1 ... ... ... ... 1 ... ... 1 1 1 ... 3 ... ... ... ... 1 1 ... 5 3 2 ... Animals improperly kept 2 2 ... ... 4 5 2 4 4 ... ... 1 11 7 4 8 ... 1 ... ... 2 3 8 ... 23 18 14 13 Temporary buildings found 2 ... ... ... 5 6 ... ... 7 4 ... ... 9 6 2 ... ... 2 2 ... 7 5 30 23 4 ... Smoke nuisance 45 22 ... 1 93 112 ... 4 8 2 ... ... 1 5 2 1 1 2 ... ... 5 3 1 ... 153 146 3 6 Rear passages unpaved or undrained ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... Gipsies ... 3 ... ... 187 116 ... ... 11 ... ... ... 45 68 ... ... ... ... ... ... ... 1 ... ... 243 188 ... ... Breaches of Bye-Laws and Regulations 6 5 ... ... 8 3 ... ... 6 6 ... ... 3 10 ... ... 1 2 ... ... 6 6 ... ... 30 32 ... ... Other nuisances 21 31 8 52 37 89 32 56 40 50 10 50 51 100 19 54 13 51 16 10 45 42 59 15 207 363 144 237 Drains tested 83 137 9 7 167 213 6 18 142 146 ... 4 155 224 13 16 65 124 6 ... 156 132 42 ... 768 976 76 48 Inspections 422 503 187 501 870 878 618 564 777 705 163 472 911 905 183 287 266 360 96 94 678 644 450 109 3924 3995 1703 2027 117 As a result of the 6,022 inspections made of premises in the Borough, some 7,262 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 1,720 preliminary notices, 67 statutory notices, 4 water notices, 303 dust bin notices, a large number of intimation letters, together with numerous interviews, and in 11 instances legal proceedings were instituted. Facing 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:— 118 COMPLAINTS RECEIVED. During the year, 1,157 complaints were received, 678 written and 479 verbal, the figures for the previous year being 1,028 complaints, 605 written and 423 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. 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 January 4 6 24 20 14 18 25 17 14 4 28 10 109 75 February 3 7 16 31 8 10 18 13 8 6 16 4 69 71 March 2 8 14 19 12 13 12 13 10 16 9 37 59 106 April 4 3 23 27 22 11 48 39 14 1 18 17 129 98 May 6 6 14 19 13 17 27 42 12 14 16 27 88 125 June 10 9 14 12 20 18 17 30 7 13 13 9 81 91 July 5 11 25 18 14 22 30 44 5 7 18 16 97 118 August 4 12 18 12 11 12 19 41 5 8 17 8 74 93 September 6 13 25 14 17 32 20 22 10 11 9 19 87 111 October 10 13 26 13 14 36 33 26 11 13 10 13 104 114 November 4 2 12 13 17 27 22 33 12 8 9 6 76 89 December 9 9 13 13 9 13 12 17 7 7 5 7 55 66 Totals 67 99 224 211 171 229 283 337 115 108 168 173 1028 1157 119 They referred to the following nuisances:— COMPLAINTS—NUISANCES. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total. 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 Drains Choked 55 33 41 47 27 74 53 48 40 72 46 41 45 62 35 48 51 63 38 69 50 57 30 42 511 656 Accumulations (Refuse, etc.) 14 3 6 7 7 7 19 11 17 11 7 8 8 14 8 7 2 13 13 10 5 6 6 10 112 107 Water cut off 6 1 2 — — 3 1 — 3 3 1 — — — — 2 1 1 — 3 — 2 1 — 15 15 Offensive smells 4 2 — 1 3 1 3 8 2 9 2 4 6 7 8 9 4 12 8 3 3 2 — 2 43 60 Dilapidations — — 1 — — — 2 8 — — — — — 1 — - — — 4 1 — — — 5 7 15 Insanitary condition. 5 6 2 — 7 — 3 — 2 2 2 6 6 1 7 2 3 — 14 1 3 1 5 — 59 19 Overcrowding 2 8 5 1 — 3 2 3 1 2 4 4 8 5 2 2 1 2 3 3 1 1 2 1 31 35 No dust bins — 4 — — 3 1 7 — 1 — 2 1 2 1 2 1 1 3 7 — 3 — 1 — 29 11 Dampness 8 2 — — 2 1 23 - - - - 1 - - - - 2 - - 1 1 — — 2 36 7 Others (various) 15 16 12 15 10 16 16 20 22 26 17 26 22 27 12 22 22 17 17 23 10 20 10 4 185 232 Total 109 75 69 71 59 106 129 98 88 125 81 91 97 118 74 93 87 111 104 114 76 89 55 66 1028 1157 120 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 of infectious cases receives first claim upon the Inspectors' time. The number of premises visited was 2,027, as compared with 1,703 for the previous year. Of the 2,027 premises visited, 811 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 40.0 premises in fair condition, and 60.0 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 an increase of 324, in the number of inspections made. 121 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 49 31 18 Boundary Road 10 8 2 Claremont Street 76 35 41 Elizabeth Street 24 7 17 Fabian Street 22 14 8 Glenister Street 36 28 8 High Street, North Woolwich 14 11 3 vlontpelier Gardens 34 19 15 Roman Road 131 41 90 Robert Street 21 6 15 Savage Gardens 07 22 45 Wilson Road 23 5 18 507 227 280 Central Ward East. Park Avenue 24 10 14 Sussex Road 5 3 2 Langdon Road 15 1 14 Barking Road 13 6 7 Brighton Road 13 7 6 Bonny Downs Road 2 2 — Calverton Road 14 9 5 Dukes Road 3 3 — Eastbourne Road 45 24 21 Folkestone Road 23 19 4 Howard Road 5 5 — Market Street 34 30 4 Poulett Road 40 6 34 St. Olaves Road 51 20 31 Talbot Road 12 12 — Telham Road 14 14 — Welstead Road 91 48 43 Nelson Street 28 14 14 Ranelagh Road 73 33 40 Napier Road 62 35 27 567 301 266 Central Ward West. Barking Road 8 8 - Bartle Avenue 8 8 — Benson Avenue 70 52 18 Central Park Road 1 1 — Dickens Road 72 13 59 Ernald Avenue 67 35 32 Hockley Avenue 26 22 4 Katherine Road 72 51 21 Parr Road. 2 2 — Spencer Road 40 33 7 Thackeray Boad 89 31 58 455 256 199 122 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 Manor Park Ward. Barrington Road 29 29 - Eighth Avenue 44 41 3 Parkhurst Road 183 183 - Walton Road 27 27 - 283 280 3 Plashet Ward East. Bath Road 6 6 - Clifton Road 37 26 11 Coleridge Avenue 9 9 — Colston Road 8 6 2 60 47 13 Plashet Ward West. Bristol Road 34 13 21 Green Street (Ann's Cottages) 0 6 — Sherrard Road 4 4 — Walpole Road 2 1 1 Waterloo Road 25 16 9 Whitfield Road 1 — 1 Washington Road 10 7 3 Wortley Road 38 18 15 Wyndham Road 40 33 7 155 98 57 2,027 1,209 818 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. There are 27,517 houses in the Borough, and at 1,852 the drains have been unstopped and cleansed, being 6.8 per cent. The figures for the year 1913 were 1,952, being 7.23 per cent. DRAINAGE WORK. At 1,024 houses the drains have been tested, and in 159 instances defects in the drains have been discovered. 37 of these were the result of house to house inspections, and 122 by routine work, such as visits caused by the occurrence of a case of infectious 123 disease, or complaint of offensive smells. In addition to the 159 defective drains there were 35 defective water closet connections and 69 defective water closet traps. In 281 instances soil pans were renewed or cleansed, and 130 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 cut during the past year:— 97, 99, 101, 103, 105, 107, 109, 111, 113. Alverstone Road. 77-91, Barking Road. 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, Carlton Road. 1, 3, 5, 7, 27, 29, 31, 33, 35, 37, 39, Durham Road. 133, Hampton Road. 38, Holme Road. 22, 30, 32, and 34, Katherine Road. 39, 41, 43, 45, Manor Park Road. 69, Park Avenue. 634, 636, 809, 811, 930, 932, 934, 936, Romford Road. 14, Shaftesbury Road. 22 and 31, Spencer Road. " Rose Cottage," Sussex Road. 65-75, Talbot Road. 2, 4, 6, 8, 10 12, 113, 115, 117, 119, 121, 123, 125, 127, Walton Road. 6-12, Waterloo Road. SANITARY APPLIANCES. This term includes the appurtenances to the drains proper, and during the year there have been 180 flushing apparatuses to the water closets renewed or repaired, as compared with 222 for the previous year. 137 waste pipes from scullery sinks and baths were dealt with, as compared with 138 for the year 1913. 124 DIRTY PREMISES. Under this form of nuisance are included dirty walls and ceilings, and at 901 premises the internal cleansing of walls and ceilings has been performed, the figures for the previous year being 768. By reference to the nuisance table inset facing page 117, it will be seen that there have been 2,027 house to house inspections made, and at 521 of the houses internal dirty walls and ceilings were discovered. This is equal to 25.7 per cent. of the inspections made, while as a result of ordinary routine work, which includes the inspections made upon complaint, and at dairies, slaughterhouses, bakehouses, etc., the inspections were 3,995, and nuisances arising from dirty walls and ceilings were 383, being equal to 9.6 per cent., the figures for 1913 being 8.25. ROOFS, EAVES GUTTERS, AND RAIN-WATER PIPES. In 381 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 the 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 147 houses improvement has been effected, in 129 instances a branch pipe from the Water Board's rising main has been fixed, and in 18 cases cisterns cleansed and fitted with proper coverings; the figures for the previous year being 468 branches from rising main fixed and 55 cisterns cleansed and covered. There is a decrease in figures for 1914 as compared with 1913, 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 125 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 12 occasions, as compared with 15 for the previous year, and 22 for the year 1912. In every case the water was cut off for waste, and with few exceptions 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 (27,517), the number that were deprived of water (12) is exceedingly small. In each of the 12 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 and defective damp courses. On 194 occasions, as compared with 424 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 818 instances, the number for the previous year being 841. 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. 126 OVERCROWDING. Twenty-five cases of overcrowding have been investigated and dealt with by the service of Notice, as compared with 33 for the previous year. In each instance the Notice was complied with by either the occupants moving or the re-arranging of the sleeping accommodation. Overcrowding is a form of nuisance that is invariably associated with poverty. Force of circumstances is the factor that determines how many rooms a family can occupy. It is not how many rooms are necessary, but how much rent can be paid out of the family's income. The effectual remedy is a social problem largely educational and only time will solve the difficulty. The serving of notices and harassing of poor people from house to house is not a solution of the difficulty or the abatement of the nuisance. 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 two new underground conveniences in the Barking Road have been opened, which have accommodation 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 127 usually left open, affording facilities to any person who desires to dispose of any objectionable matter. 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 152 occasions of the emission of smoke from chimneys, as compared with 156 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 92 bodies received and 55 post-mortems during the year, the figure for 1913 being 98 bodies, 65 post-mortems. VAN DWELLERS AND SQUATTERS. The geographical position of East Ham to London affords facilities for gipsy trading, and I am afraid that while there is unfenced land in the Borough these nomads will continue to pest the inhabitants who live near the sites they select for squatting. On four occasions legal proceedings were instituted and convictions obtained in three instances. In June an elderly couple, alleged to be brother and sister, squatted on a piece of vacant land in Green Street. Every effort made to get them removed failed, and a summons was applied for and granted. When the case was heard the Stipendiary Magistrate adjourned the case twice to allow the squatters to remove. This gracious act also failed, and a fine of 10s. and costs was imposed or 14 days' imprisonment. The defendant went to prison. During his incarceration his sister held the citadel. Subsequent to his release, as he would not remove, fresh summonses were taken out against both squatters, and the magistrate imposed a fine 128 of £3 against the male defendant and dismissed that against the female. The fine was paid and soon after the squatters left the district. TEMPORARY BUILDINGS. The erection of 23 temporary buildings contrary to the Council's Bye-Laws have been detected by the Inspectors. The figures for the previous year were 34. 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 fiushers. 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 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 44 tons of Carbolic Powder and 1,600 gallons of Disinfectant Fluid have been distributed. 129 UNSOUND FOOD. The markets have been regularly inspected, and on 11 occasions the Inspectors have discovered food exposed for sale, which, in their opinion, was unfit for human consumption, 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 13 consignments of unsound food surrendered for condemnation, including fish, rabbits, meat, milk and apples. Certificates relating to the unsound condition of the said commodities, declaring them to be unfit for human food, are issued to tradesmen at the time of surrender. Great care is exercised to do justice to the wholesale dealer, as well as the retail purchaser, although 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 oilice to take minute details such as time, marks, weights, etc., and furnish them on the certificates. Two seizures of butcher's meat have been effected during the year and legal proceedings were instituted, convictions being obtained in each case. One was a consignment of meat delivered at one of the Feeding Centres of the Corporation, and the other was a fore-quarter of beef which was deposited in a butcher's meat safe and intended for the food of man. DAIRIES AND COWSHEDS. There are six registered cowsheds and 158 registered dairies in the Borough. During the year 22 were added to the register. 401 inspections have been made, as compared with 368 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 130 paring the general condition of cowsheds of to-day and of a fewyears back there is a decided improvement, but there yet remains much to be done before wholesome milk is obtainable. There are 15 registered and licensed slaughter-houses in the Borough, and during the year 201 inspections have been made, as compared with 134 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. In previous reports I have stated that the private slaughterhouse 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 question of meat inspection is one of vital importance, and to be effective must be done at the time of slaughtering, when the carcase, together with the viscera, can be examined. Under existing conditions there is no security for the public against diseased meat, nor is there likely to be until it is made compulsory for all animals intended for human food to be slaughtered under strict supervision, passed and marked (as is done in Kosher killed meat) before it is saleable to the public. The payment of reasonable compensation for animals surrendered, that appeared when alive to be in good health, but when slaughtered proved to be diseased, would help in some measure to eliminate diseased meat from the markets. In previous reports I have strongly advocated the substitution of the "Public Abattoir" for the private slaughter-house. But this will not solve the difficulty unless the practice be general. It would be futile for one district to embark upon this excellent principle if the neighbouring districts continued with their private slaughter-houses. 131 A local authority might erect at considerable cost a Public Abattoir and keep a resident Inspector to pass the meat before it is placed upon the market. Meat from this source could be sent to other districts where no public inspection prevailed, but where higher prices obtained. During recent years there has been an earnest attempt to cure Tuberculosis in human beings, and to-day vast sums of money are being spent to effect this good object. Whilst the community is spending large sums to mitigate the ravages of consumption, it is a stigma that the private slaughter-houses remain open to receive, prepare and distribute meat from animals suffering from this dread disease. It is in very poor districts where this cheap meat finds its way, where apathy is more pronounced; if the price is low the purchaser is not too particular as to the standard of quality. Frequently improvident parents give their children meat only partially cooked which increases the danger and may account for much of the disease that is prevalent in such localities. The closing of private slaughter-houses and the erection of Public Abattoirs is a National obligation. It may be costly, but if consideration is given to what is spent in combating the inroads of a grim disease, the expenditure to prevent it is a wise investment. It is better to remove the cause of an evil than remedy the effect. SLAUGHTER HOUSES. 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. 524, Romford Road. 638, Romford Road. 6, Station Road. 132 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. 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 ate returnable direct to the Public Health Department, and disinfected by being placed in an airtight chamber and subjected to S.O2 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 479 Factories and Workshops in the Borough, which include Bakehouses, Laundries, Blousemakers, Tailors, Boot-repairers, Shirt-makers, Embroiderers, Artificial Flowermakers, etc. During the year 931 Inspections have been made, which include 91 to the Bakehouses, and 468 to the outworkers' premises, the figure for the previous year being 902. 133 The Chief Inspector of Factories has informed us on 5 occasions of the existence of nuisances in workshops, which have been discovered by the Home Office Inspectors when performing their duties, and in 6 instances the Chief Inspector of Factories has been informed of irregularities noticed by our Inspectors, and which came within his province to deal with. 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. The collection of fish offal and butchers' bones is carried cut by private contractors. Occasional complaints are made in the summer months of the offensive odours which are emitted from the 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 these premises. 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. 134 During the year 1,959 loads have been collected and deposited at the Council's Destructor, as compared with 1,904 loads for the year 1913. TRADE REFUSE, 1914. Loads. January 169 February 151 March 165 April 160 May 170 June 159 July 171 August 151 September 164 October 172 November 164 December 163 Total 1,959 By reference to the Nuisance Table inset facing page 117, it will bs seen that 135 offensive accumulations were discovered as compared with 142 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 88 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 measurements may appear small in comparison with the old ashpit, but we learn from experience that large dust bins encourage many people to deposit therein matter which should be immediately burnt. In cases where the Notices were not complied with, the 135 Council exercised its powers by providing bins, and recovering the 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. 11,465 loads of house refuse have been collected during the year, the figure for the previous year being 11,243. there are 27,517 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 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. 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. 136 DUST COLLECTION. NUMBER OF LOADS COLLECTED DURING THE YEARS 1913 AND 1914 FROM:- Beckton and North Woolw'h Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Total Loads Collected per Month. 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 1913 1914 JANUARY 126 173 191 202 176 193 214 227 155 123 206 177 1068 1095 FEBRUARY 121 122 162 160 130 128 200 206 135 131 145 142 893 889 MARCH 140 120 156 173 144 126 232 250 134 156 158 144 964 969 APRIL 121 147 182 167 133 145 217 226 170 171 167 193 990 1054 MAY 141 152 189 194 161 149 203 234 165 142 159 150 1018 1021 JUNE 113 115 155 167 122 122 239 218 134 163 140 142 903 927 JULY 114 128 167 178 134 160 210 216 164 146 176 178 965 1006 AUGUST 134 134 160 160 126 126 178 178 122 122 127 127 847 847 SEPTEMBER 108 106 161 156 116 113 226 197 142 146 131 138 884 856 OCTOBER 123 143 178 175 137 150 194 195 122 132 182 152 936 947 NOVEMBER 133 118 159 159 122 128 195 230 125 116 138 158 872 909 DECEMBER 105 91 156 151 94 128 253 221 156 168 139 186 903 945 TOTALS 1,479 1,549 2,016 2,042 1,595 1,668 2,561 2,598 1,724 1,716 1,868 1,892 11,243 11,465 137 CONTAGIOUS DISEASES OF ANIMALS ACT. To comply with the provisions of the Swine Fever (Regulation of Movement) Order, 1906, 89 declarations have been signed and presented, and licences issued authorising the bringing into the Borough of 1,749 store pigs, while 75 licences have been issued for the removal of 1,029 fat pigs out of the Borough for slaughter. Under the East Ham Allotments (Swine Fever) Order, 1906, 49 licences were granted for the removal of 363 pigs from Langdon Crescent to local slaughter-houses. One case of Swine Fever occurred during the year. The usual Notice Form "A" was served. One case of Parasitic Mange was notified and the animal killed. The premises were thoroughly disinfected and precautions taken to prevent the spread of the disease. SHOPS ACT. There are about 2,000 shops in the Borough, comprising 68 trades, and during the past year 1,246 inspections have been made as follows:— Greengrocers 213 Bakers 197 General 165 Grocers 149 Drapers 77 Butchers 77 Confectioners 70 Tobacco 64 Milliners 45 Dairies 36 Hosiers 33 Furniture 28 Barbers 26 Tailors 21 Oil Stores 18 Fishmongers 12 Provision 12 Florist 2 Ironmonger 1 138 As a result of the inspections made 238 contraventions were discovered, resulting in legal proceedings being instituted in ten instances, as follows:— Contravening Butchers' Closing Order 3 Contravening the Grocers', Provision Dealers' and General Shop-keepers' Half-Holiday Order 2 Employing children during prohibited hours 2 Not giving Assistants their Weekly Half- Holiday 2 Failure to exhibit Assistants' Weekly Half-Holiday List 1 139 SUMMARY OF LEGAL PROCEEDINGS. Date. Address. Offence. Result. January Walton Road Having sold unsound meat Fined £3 ; 12/- costs. „ Wellstead Road Contravening East Ham Grocers', Provision Dealers and General Shopkeepers' Half Holiday Order, 1912. Fined 10/-; 5/- costs. February Green Street Contravening Bye-law Employment of Children Fined 10/-; 6/- costs. „ Barking Road Contravening Shops Act, not fixing notice Ditto. „ Ditto Ditto Assistants not getting halfholiday. Ditto. „ Ditto Ditto Ditto. „ Ditto Contravening Bye-law Employment of Children Fined 10/-: 5/- costs. June Vacant Land, Green St. Contravening Bye-law, Tents, Vans, used for human habitation. Fined 10/- and 5/- costs or 14 days' imprisonment. Went to prison. „ Reynolds Avenue Ditto Fined 10/-; 5/- costs. „ Romford Road Contravening Butchers' Closing Order, 1912 Fined 10/-; 7/- costs. July High Street North Ditto Fined 10/-; 5/- costs. „ Lonsdale Avenue Contravening Grocers', Provision Dealers', and General Shopkeepers' Half Holiday Order, 1912. Fined 10/-; 6/- costs. „ High Street North Contravening Butchers' Closing Order Fined 10/-; 8/- costs. „ Vacant Land, Green St. Contravening Bye-law, Tents, Vans, used for human habitation. Fined £3 ; 6/- costs. „ Ditto Ditto Dismissed. Ownership not proved. November Romford Road Deposited unsound meat intended for human food Fined £10 and costs. JOSEPH G. BANKS, Chief Sanitary Inspector. 140 Table showing the Localities in which certain Diseases of a Zymotic character occurred during the year 1914. LOCALITY. No. of Houses March. 1915. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Tuberculosis. Ophthalmia Neonatorum. PolioMyelitis Pulmonary. Other Forms. Ascot Road ... ... ... ... ... ... ... ... ... ... Albert Road 122 3 ... ... ... ... 3 3 ... ... Alexandra Road 82 2 3 ... ... ... 2 ... 1 ... Altmore Avenue 192 13 1 ... 1 ... 2 ... ... ... Arthur Road 11 ... 1 ... ... ... 1 1 ... ... Ashford Road 55 7 1 ... ... ... 1 ... ... ... Abbotts Road 64 ... 1 ... 1 ... 1 1 ... ... Aintree Avenue 65 1 1 ... 1 ... 5 1 ... ... Arragon Road 110 2 ... ... 6 ... 6 2 1 ... Albany Road 45 ... ... ... ... ... 1 ... ... ... Aldersbrook Lane 2 ... ... ... ... ... ... ... ... ... Aldersbrook Road 28 3 1 ... ... ... ... ... ... ... Alverstone Road 197 2 3 ... 1 ... 3 ... ... ... Ann's Cottages 9 ... ... ... ... ... ... ... ... ... Ashley Road 29 ... ... ... 1 ... 1 ... ... ... Burford Road 24 ... ... ... ... ... ... ... ... ... Boston Road 28 ... ... ... ... ... ... ... ... ... Beverley Road 42 1 ... 1 ... ... ... 1 ... ... Brampton Road 87 1 ... ... ... ... ... ... ... ... Beaconsfield Street 30 2 ... ... ... ... ... ... ... ... Beckton Road 109 4 2 ... ... ... 1 1 ... ... Buxton Road 6 1 ... ... ... ... ... ... ... ... Blenheim Road 68 2 ... ... ... ... ... 2 ... ... Brooks Avenue 80 2 2 ... ... ... 1 3 ... ... Burnaby Street ... ... ... ... ... ... ... ... ... ... Becket Avenue 61 ... 1 ... ... 1 1 1 ... ... Bedford Road 36 1 ... ... ... ... 2 ... ... ... Bridge Road 39 ... ... ... ... ... ... ... ... ... Brighton Road 63 3 ... ... ... ... ... ... ... ... Brookwood Road ... ... ... ... ... ... ... ... ... ... Bonny Downs Road 66 ... 2 ... 1 ... 1 1 ... ... Burges Road North 228 4 2 ... ... ... 2 ... 2 ... Burges Road South 12 ... ... ... ... ... ... ... ... ... Bartle Avenue 63 ... ... ... ... ... 5 ... ... ... Bendish Road 48 4 2 ... ... ... 2 ... ... ... Benson Avenue 76 ... 2 ... ... ... 1 ... ... ... Boleyn Road 98 2 ... ... ... ... 15 2 ... ... Barking Road 365 8 3 ... 1 ... 5 ... ... ... Boundary Road 108 1 1 ... 1 ... 1 2 ... ... Brancaster Road 6 ... ... ... ... ... ... ... ... ... Barrington Road 36 3 2 ... ... ... Browning Road 244 8 2 6 2 ... ... ... Bath Road 6 3 1 ... ... ... ... ... ... ... Byron Avenue 235 2 3 2 ... ... 1 1 ... ... Berkeley Road 43 4 ... ... ... ... 1 ... ... ... Bristol Road 144 2 3 ... ... ... 1 2 ... ... Balmoral Road 1 ... ... ... ... ... ... ... ... ... Birchdale Road 73 5 ... ... ... ... ... ... ... ... Chesley Gardens 42 1 ... ... ... ... 1 ... ... ... Central Avenue ... ... ... ... ... ... ... ... ... ... Clacton Road 64 1 ... ... ... ... ... ... ... ... Cotswold Gardens 51 ... 1 ... ... ... ... ... ... ... 141 LOCALITY. No. of Houses. March, 1915. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Tuberculosis. Ophthalmia Neonatorum. PolioMyelitis Pulmonary. Other Forms. Creek Terrace 34 ... ... ... ... ... ... ... ... ... Cyprus Place 41 ... 2 ... 1 ... ... 1 ... ... Cameron Street 20 1 3 ... ... ... ... ... ... ... Church Street 30 ... ... ... ... ... ... ... ... ... Claremont Street 66 1 ... ... ... ... 3 1 ... ... Calverton Road 64 ... 3 ... ... ... 4 2 ... ... Charlemont Road 126 2 2 ... 2 ... 1 ... ... ... Caulfield Road 225 5 1 ... ... ... 4 1 ... ... Caledon Road 161 3 2 ... 1 ... 1 ... ... ... Clements Road 178 4 2 1 ... ... 2 ... ... ... Compton Avenue 81 2 ... ... ... ... 4 1 ... ... Campbell Road 36 ... ... ... ... ... 2 ... ... ... Castle Street 40 ... ... ... ... ... 1 ... ... ... Cleves Road 100 1 1 ... 1 ... 13 2 ... ... Colvin Road 61 2 ... ... 1 ... 2 ... ... ... Creighton Avenue 76 1 ... ... ... ... 1 ... ... ... Central Park Road 312 9 1 1 5 ... 5 3 ... ... Charlotte Terrace 5 ... ... ... ... ... ... ... ... ... Capel Road 70 ... ... ... ... ... 1 ... ... ... Carlyle Road 120 1 1 ... ... ... 2 ... ... ... Chesterford Road 100 1 ... 1 ... ... ... 1 ... ... Carlton Road 48 1 1 ... ... ... 1 ... ... ... Clarence Road 29 ... ... ... ... ... 1 ... ... ... Cumberland Road 16 ... ... ... ... ... ... ... ... ... Colchester Avenue 69 ... ... ... ... ... 1 ... ... ... Church Road 107 10 1 ... 3 ... ... ... ... ... Colston Road 43 ... ... ... 1 ... 1 ... ... ... Clifton Road 34 ... 2 ... 1 ... 2 ... ... ... Coleridge Avenue 72 5 1 ... 2 ... ... ... ... ... Crescent Road 47 2 1 ... 1 ... 1 ... ... ... Cowper Avenue 25 ... ... 1 1 ... ... ... ... ... Cromwell Road 63 2 1 ... ... ... ... ... ... ... Chester Road 72 1 1 ... ... ... ... ... ... ... Claremont Road 62 ... ... ... ... ... ... ... ... Denbigh Road 100 5 2 ... ... ... ... ... ... ... Drew Road ... ... ... ... ... ... ... ... ... ... Dukes Avenue 3 ... ... ... ... ... ...... ... ... Dickens Road 61 ... ... ... 1 ... 5 ... ... ... Dore Avenue 39 ... ... ... ... ... 3 ... ... ... Dersingham Avenue 256 9 1 ... 2 ... 12 3 ... ... Durham Road 99 1 2 ... ... ... 1 ... ... ... Dorset Road 72 5 ... ... 3 ... 2 ... ... ... Elizabeth Street 118 2 2 ... ... ... 4 1 ... ... Eastbourne Road 58 3 ... ... ... ... 1 ... ... ... Eversleigh Road 69 ... ... ... ... ... 6 ... ... ... Ernald Avenue 70 ... 3 ... 1 ... 8 2 ... ... Empress Avenue 36 1 2 ... ... ... ... ... ... ... Eighth Avenue 54 ... ... ... ... ... ... ... .... ..... Elsenham Road 33 2 ... ... ... ... ... ... ... ... East Avenue 64 ... 2 ... ... ... ... ... ... ... Essex Road 113 2 1 ... ... ... ... ... ... ... Elizabeth Road 115 3 3 ... ... ... 1 ... ... ... Edith Road 31 ... ... ... ... ... 1 ... ... ... East Road 14 ... ... ... ... ... ... ... ... ... 142 LOCALITY. No. of Houses. March, 1915 Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Tuberculosis. Ophthalmia Neonatorum. PolioMyelitis Pulmonary. Other Forms. Frinton Road 110 2 2 ... ... ... ... ... ... ... Factory Road 2 ... ... ... ... ... ... ... ... ... Francis Street 22 1 ... ... ... ... ... ... ... ... Ferndale Street 10 ... ... ... ... ... ... ... ... ... Fabian Street 30 1 3 ... ... ... 1 ... ... ... Folkestone Road 23 ... 1 ... ... ... 1 ... ... ... Friars Road 96 2 ... ... ... ... 5 ... ... ... Florence Road 36 ... 3 ... ... ... 1 ... ... ... Fifth Avenue 42 1 ... ... ... ... 2 ... ... ... Fourth Avenue 124 3 ... ... ... ... ... ... ... ... First Avenue 144 3 1 ... 4 ... 1 ... ... ... Forest View Road 26 ... ... ... ... ... 1 ... ... ... Forest Drive 40 ... ... ... ... ... ... 1 ... ... Fry Road 15 1 ... ... 1 ... ... ... ... ... Finden Road 19 ... ... ... ... ... 2 ... ... ... Geoffrey Gardens 18 ... ... ... ... ... ... ... ... ... Grosvenor Gardens 37 ... ... ... ... ... ... 1 ... ... Glenister Street 32 1 ... ... ... ... ... ... ... ... Gresham Road 38 1 ... ... ... ... 2 ... ... Gooseley Lane 54 1 ... ... ... ... ... ... ... ... Gillett Avenue 58 2 1 ... ... ... ... ... ... ... Grosvenor Road 29 ... ... ... ...... ... ... ... ... ... Greenleaf Road 15 ... ... ... ... ... ... ... ... ... Gainsborough Avenue 48 1 ... ... 1 ... ... ... ... Grantham Road 159 ... ... ... 2 ... 3 1 ... ... Gordon Road 10 ... ... ... ... ... 2 ... ... ... Gladding Road 13 1 ... ... 1 ... 3 ... ... ... Gloucester Road 49 ... ... ... ... ... ... 1 ... ... Greenhill Grove 97 ... 2 ... 1. ... 2 ... ... ... Goldsmith Avenue 116 ... ... ... ... ... ... ... ... Gladstone Avenue 93 1 ... ... 1 ... ... ... ... ... Green Street 226 1 1 ... 4 ... ... 2 ... ... Hubert Road 74 2 ... ... 3 ... ... 1 ... ... Hollington Road 84 2 ... ... ... ... 1 1 ... ... Haldane Road 148 3 2 ... 1 ... 1 ... ... ... Henniker Gardens 161 9 1 ... 1 ... 2 ... ... ... Hatherley Gardens 173 2 2 ... ... ... 1 1 2 ... High St., North Woolwich 49 3 ... ... ... ... 1 2 ... ... Hall Road 97 1 1 ... ... ... 3 ... ... ... Hertford Road 5 ... ... ... ... ... ... ... ... Holloway Road 7 ... ... ... ... ... ... ... ... ... Holland Road 60 2 ... ... ... ... 1 ... ... ... Howard Road 11 1 3 ... ... ... 3 ... ... ... Henry Road 15 1 3 ... ... ... ... 1 ... ... Holme Road 64 2 ... ... ... ... ... 1 ... ... Harrow Road 39 1 ... ... 1 ... 1 ... ... ... Heigham Road 139 4 ... ... 2 ... 2 ... 1 ... Hartley Avenue 44 2 ... ... ... ... 2 ... ... ... Hockley Avenue 69 2 1 ... 1 ... 12 ... ... ... High Street South 173 6 4 ... 1 1 ... ... 1 ... Herbert Road 142 2 1 ... ... ... 7 1 ... ... Harcourt Avenue 113 6 ... ... ... ... 4 ... ... ... High Street North 446 12 3 ... ... ... 4 ... ... ... Halley Road 388 7 4 ... ... ... 7 l ... ... 143 LOCALITY. No of Houses. March, 1915. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Tuberculosis Oph thalmia Neonatorum. PolioMyelitis Pulmonary. Other Forms. Henderson Road 93 1 ... ... ... ... ... ... ... ... Hilda Road 28 ... ... ... ... ... 1 ... ... ... Hampton Road 30 ... ... ... ... ... ... ...... ... ... Johnstone Road 20 ... ... ... ... ... 1 ... ... ... Jephson Road 57 l ... ... 1 ... 2 ... ... ... Johnson's Place 8 ... ... ... ... ... ... ... ... ... Kennard Street 2 ... ... ... ... ... ... ... ... ... Keppel Road 104 5 l ... ... ... ... ... ... ... Kempton Road 167 12 l ... ... ... 7 1 ... ... Kimberley Avenue 73 2 ... ... ... ... 3 ... ... ... King's Road 36 ... ... ... ... ... 1 ... ... ... Katherine Road 449 5 3 ... 2 ... 11 2 ... ... Kensington Avenue 153 1 ... ... 1 ... 6 ... ... ... Lonsdale Avenue 92 1 ... ... ... ... ... ... ... ... Livingstone Street 19 ... 2 ... ... ... 2 1 ... ... Lichfield Road 105 1 ... ... ... ... ... 1 ... ... Leigh Road 94 16 ... ... 1 ... 2 ... ... ... Lydeard Road 20 2 ... ... ... ... ... ... ... ... Latimer Avenue 72 3 ... ... ... ... 4 ... ... ... Langdon Road 16 ... ... ... ... ... 1 ... ... ... Lloyd Road 41 2 ... ... ... ... ... ... ... ... Lathom Road 172 13 1 ... ... ... ... 1 ... ... Langton Avenue 44 ... 1 ... ... ... ... ... ... ... Ladysmith Avenue 75 1 1 ... ... ... 1 ... ... ... Loxford Avenue 70 ... 1 ... ... ... ... ... ... ... Lawrence Road 75 1 ... ... ... ... 3 ... ... ... Leader Avenue ... ... ... ... ... ...... ... ... ... ... Landseer Avenue 97 1 3 ... 1 ... 1 1 ... ... Little Ilford Lane 144 6 ... ... ... ... 3 1 ... ... Little Ilford Avenue 45 ... ... ... ... ... ... ... ... ... Lawrence Avenue 236 4 3 ... 1 ... 4 3 ... ... Lancaster Road 110 ... ... ... ... ... 2 ... ... ... Lansdowne Road 68 2 1 ... 1 ... ... ... ... ... Monmouth Road 48 3 ... ... ... ... ... ... ... ... Mortimer Road 84 ... 1 ... ... ... 2 ... ... ... Masterman Road 210 3 ... ... 1 ... 4 ... ... ... Mitcham Road 185 3 1 ... ... ... 4 2 ... ... Marlow Road 81 2 3 ... ... ... 1 ... ... ... Milk Street 10 ... ... ... ... ... 2 ... ... ... Aluir Street 18 ... ... ... ... ... ... ... ... ... Manor Way 12 ... ... ... ...... ... ... ... ... ... Montpelier Gardens 111 3 2 ... 1 ... 1 2 ... ... Mountfield Road 78 4 1 ... ... ... 3 ... ... ... Market Street 98 ... 4 ... ... ... 2 1 ... ... Melbourne Road 108 3 3 ... ... ... 4 ... ... ... Mafeking Avenue 78 1 ... ... ... ... 5 ... ... ... Myrtle Road 7 ... ... ... 1 ... ... ... ... ... Malvern Road 58 3 ... ... ... ... ... ... ... ... Macaulay Road 77 1 ... ...... ... 7 9. ... ... Meanley Road 143 3 ... 1 ... ... ... 1 ... ... Morris Avenue 59 1 ... 2 ... ... 1 ... ... ... Michigan Avenue 20 ... ... ... ... ... ... ... ... ... 144 LOCALITY. No. of Houses. March, 1915. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Tuberculosis. Ophthalmia Neonatorum. PolioMyelitis Pulmonary. Other Forms. Melford Road 8 ... ... ... ... ... ... ... ... ... Manor Park Road 53 ... 1 ... ... ... ... ... ...... ... Merlin Road 27 ... ... ... ... ... ... ... ... ... Monega Road 376 15 7 ... 1 ... 6 1 1 ... Marlborough Road 60 2 ... ... ... ... ... 1 ... ... Milton Avenue 168 4 1 ... ... ... 3 ... ... ... Newland Street 6 ... ... ... ... ... ... ... ... ... Norfolk Road 75 4 1 ... 1 ... 1 ... ... ... Northfield Road 55 3 ... ... ... ... 1 ... ... ... Nelson Street 46 ... 2 ... ... ... 1 ... ... ... Norman Road 23 1 ... ... ... ... ... ... ... ... Napier Road 83 1 ... ... ... ... 2 ... ... ... Navarre Road 29 1 ... ... ... ... ... ... ... Nigel Road 74 1 ... ... ... ... ... ... ... ... Outram Road 74 6 ... ... ... ... ... 1 ... ... Oakfield Road 112 7 2 ... 3 ... 4 ... ... ... Oregon Avenue 23 ... 1 ... ... ... ... ... ... ... Osborne Road 39 1 ... ... ... ... ... ... ... ... Pulleyns Avenue 89 4 3 ... ... ... 5 ... ... ... Plevna Street 13 ... ... ... ... ... ... ... ... ... Poulet Road 54 2 ... ... ... ... ... ... ... ... Park Avenue 35 ... 2 ... ... ... 1 ... ... ... Parr Road 90 5 1 ... 2 ... 2 ... ... ... Priory Road 66 1 ... ... ... ... 3 1 ... ... Parkhurst Road 270 3 4 ... ... ... ... ... ... ... Plashet Lane 177 2 ... ... ... ... 1 ... ... ... Prestbury Road 73 2 1 ... 1 ... 1 1 ... ... Park Road 63 1 1 ... ... ... ... 1 ... ... Plashet Grove 169 3 1 ... 2 ... 3 1 ... ... Robert Street 32 1 ... ... ... ... ... ... ... ... Roman Road 183 3 7 ... 1 ... 4 ... ... ... Rancliffe Road . 48 3 ... ... ... ... 2 1 ... ... Ranelagh Road 85 1 6 ... 1 ... 3 1 ... ... Redclyffe Road 46 4 1 ... ... ... ... 1 ... Romford Road 545 8 5 ... 2 ... 4 1 ... ... Rabbits Road 12 ... ... ... ... ... ... ... ... ... Rectory Road 49 1 1 ... 1 ... ... ... ... ... Reynolds Avenue ... ... ... ... ... ... ... ... ... ... Rosebery Avenue 172 5 1 ... ... ... 3 2 ... ... Ruskin Avenue 152 2 7 ... ... ... 1 1 ... ... Rixsen Road 35 4 ... ... ... ... 1 ... ... ... Rosedale Road 74 ... ... ... ... ... ... ... ... ... Rothsay Road 53 1 ... ... ... ... 2 ... ... ... Ratcliffe Road 50 3 ... ... ... ... 1 ... 1 ... Rutland Road 93 3 ... ... ... ... 1 ... ... ... Sandford Road 11 ... ... ... ... ... ... ... ... ... Station Street 21 ... ... ... ... ... ... ... ... Shepstone Street ... ... ... ... ... ... ... ... ... ... Savage Gardens 132 ... 5 ... ... ... ... 1 ... ... Stanley Street 21 ... 7 ... ... ... ... ... ... ... Storey Street 46 7 ... ... l ... ... 1 ... ... 145 LOCALITY. No. of Houses. March, 1915. Scarlet Fever. Diphtheria. Typhoid Fever. .Erysipelas. Puerperal Fever. Tuberculosis. Oph. Neonatorum. PolioMyelitis Pulmonary. Other Forms. Saxon Road 10 ... ... ... ... ... 1 ... ... ... Southchurch Road 32 ... 2 ... ... ... 1 ... ... ... Stevenage Road 40 3 1 ... ... ... ... ... ... ... Springfield Road 55 2 1 ... 1 ... ... ... ... ... St. Olaves Road 59 5 1 ... 1 ... 2 ... ... ... St. Albans Avenue 84 1 2 ... 1 ... 3 ... ... ... Southend Road 86 4 1 ... ... ... 1 ... ... ... Skeffington Road 104 3 1 ... 1 ... 3 ... ... ... Shoebury Road 48 1 1 ... ... ... 1 ... ... ... Streatfield Avenue 70 2 ... ... 1 ... 3 1 ... Sussex Road 5 ... ... ... ... ... ... ... ... ... St. Bartholomew's Road 41 4 1 ... 1 ... 2 ... ... ... Stamford Road 108 1 2 ... 1 ... 7 3 ... ... St. John's Road 81 3 ... ... 1 ... 4 1 ... ... Spencer Road 43 3 1 ... ... ... 2 1 ... ... St. Bernard's Road 96 3 1 ... ... ... 3 ... ... ... Seymour Road 88 4 3 ... ... ... 4 1 ... ... St. Martin's Avenue 53 2 3 ... 1 ... ... ... ... ... Station Road 46 ... 1 ... ... ... ... ... ... ... St. Margaret's Road 59 1 2 ... 1 ... 1 ... ... ... Salisbury Road 71 1 ... ... ... ... ... ... ... ... Second Avenue 152 ... 3 ... ... ... 1 ... ... ... Selborne Avenue 30 ... ... ... ... ... ... 1 1 ... Sixth Avenue 179 2 2 ... 1 ... 1 2 ... ... Seventh Avenue 126 4 2 ... ... ... 1 ... ... Sheringham Avenue 226 1 4 ... ... ... 4 ... ... ... School Road 26 2 2 ... ... ... 1 ... ... ... Sebert Road 1 ... ... ... ... ... ... ... ... ... Sheridan Road 95 3 ... ... ... ... 3 ... ... ... Sibley Grove 110 8 1 ... ... ... 2 ... ... ... Shelley Avenue 146 3 1 ... ... ... 2 ... ... ... Stanley Road 54 2 3 ... ... ... 1 1 ... ... Swinburne Avenue 22 ... 2 ... ... ... 1 ... ... ... Shakespeare Crescent 224 5 ... ... ... ... ... ... ... ... Strone Road 416 7 1 ... 3 ... 6 1 ... ... Sherrard Road 420 21 2 ... 2 ... 8 ... ... ... Shrewsbury Road St. Stephen's Road 304 10 ... ... ... ... 3 ... ... ... 137 1 ... ... 1 ... 1 ... ... ... Shaftesbury Road 72 1 ... ... ... ... ... ... ... ... South Esk Road 210 4 3 ... 1 ... 7 1 ... ... St. Dunstau's Road 24 ... ... ... ... ... ... ... ... Sandringham Road 34 1 ... ... ... ... ... ... ... ... Stafford Road 108 1 1 ... ... ... 4 ... ... ... Tilbury Road 12 ... ... ... ... ... ... ... ... ... Telham Road 97 1 3 ... ... ... 2 ... ... ... Talbot Road 112 2 2 ... 1 ... 1 ... ... ... Thorpe Road 46 1 ... ... ... ... 2 ... ... ... Thackeray Road 67 ... 2 ... 1 ... 2 2 ... ... Tudor Road 81 1 ... ... ... ... 1 1 ... ... Temple Road 16 ... ... ... ... ... ... ... ... ... The XChase 3 ... ... ... ... ... ... ... ... ... The Warren 27 ... 1 ... 1 ... ... ... ... ... Toronto Avenue 12 ... 1 ... ... ... ... ... ... ... Third Avenue 118 4 2 ... 1 ... 2 1 ... 1 Trevelyan Avenue 1 ... ... ... ... ... ... ... ... ... 146 LOCALITY. No. of Houses. March, 1915. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Tuberculosis. Ophthalmia Neonatorum. PolioMyelitis Pulmonary. Other Forms. Tennyson Avenue 46 ... ... ... ... ... 4 ... ... ... Vicarage Lane 38 1 ... ... 2 ... ... ... ... ... Victoria Avenue 80 4 2 1 ... ... 2 ... ... ... Vernon Avenue 7 ... ... ... ... ... ... ... ... ... Welbeck Road 70 ... 3 ... ... ... ... ... ... ... White Horse Road 25 1 ... ... ... ... ... ... ... ... Wolsey Avenue 91 ... ... ... ... ... 1 ... ... ... Wall End Road 37 3 ... ... ... ... 1 1 ... ... Wellstead Road 95 1 3 ... ... ... 5 ... ... ... Wellington Road 75 ... 1 ... ... ... 1 ... ... ... Winter Avenue 36 1 2 ... ... ... ... ... ... ... Wakefield Street 167 6 1 ... ... ... 10 ... ... ... Wilson Road 41 ... 1 ... ... ... 1 ... ... ... Worcester Road 50 ... ... ... ... ... 3 ... ... ... Wanstead Park Avenue 103 3 ... 1 ... ... ... 1 ... Walton Road 200 1 ... 2 ... ... 5 2 ... Washington Avenue 50 2 2 ... ... ... 2 ... ... Whitta Road 48 1 1 ... ... ... 1 1 ... ... Wentworth Road 33 ... ... ... ... ... ... ... ... ... Wolferton Road 6 ... ... ... ... ... ... ... ... ... Warwick Road 27 3 1 ... ... ... ... ... ... ... Woodhouse Grove 43 1 ... ... ... ... ... ... ... ... Wordsworth Avenue 54 4 1 ... ... ... ... ... ... ... Washington Road 10 ... ... ... ... ... ... ... ... ... Waterloo Road 25 1 ... ... ... ... 2 ... ... ... Walpole Road 30 2 ... ... ... ... 1 ... ... ... Whitfield Road 47 3 ... ... ... ... ... 1 ... ... Whittaker Road 42 ... ... ... ... ... 4 ... ... ... Wyndham Road 40 ... ... ... ... ... ... ... ... ... Wortley Road 36 ... 2 ... ... ... ... ... ... Woodstock Road 58 1 ... ... ... ... 1 ... ... ... Windsor Road 68 ... ... ... ... ... ... ... ... ... York Road 100 3 4 ... 3 ... ... ... ... ... 147 INDEX. A Abatement of Nuisances 116, 117 Abattoir 47, 48, 130, 131 Acreage 10, 11 Acts adopted 7, 8 Acts, Bye-Laws, and Regulations in force 7 Adenoids 96, 97 Air Temperature 54 Altitude 9 Acute polio-myelitis 33 Antitoxin 31 Area 10 Artizans' Dwellings 48 B Bacteriological Laboratory 40, 41 Bakehouses 41, 132, 133 do. Underground 41 Birth Notification 19 Births 6, 11, 12 Birth-rate 6, 11 Births, Illegitimate 12 Blepharitis 91, 92 Boots of School Children 91 Boundaries 8 Building Operations 9, 48, 49 Butchers' Offal Collection 133 Bye-Laws, Streets, Buildings, &c. 7&8 C Cancer 39 Cerebro-Spinal Meningitis 33 148 INDEX—continued. Chart, Birth-rate, 20 years 13 „ Death-rate, 20 years 1G „ Diphtheria 30 and inset „ Relative Fatality 17 „ Scarlet Fever 30 and inset Chicken Pox 39 Chief Sanitary Inspector's Report 116 to 146 Children Act 21, 79, 94 Children, Medical Inspection of 87 Cleanliness of School Children 93, 94 Cleansing Station 94 Cleansing of School Children 94 Clinic 103 to 108 „ (treatment) 107 Clothing of School Children 91 Common Lodging-house 133 Comparative Statistics 6 Complaints of Nuisances 118 Contagious Diseases (Animals) Act 137 Cost of House Refuse Collection 135 Cowsheds 42, 129, 130 Cubicle Block 70 Customs and Inland Revenue Act 42 Communicable Diseases—Non-notifiable 37 to 39 „ „ (others) 39 D Dairies 42, 129 Dampness 125 Deafness 92 Deaths, No. of 6 Death-rate, Corrected 15 Death-rate, General 3, 6 Death-rate, Illegitimate Children 12, 66 Death-rate, Infantile 3, 6, 18, 19 Deaths, Institutional 14 Deaths of Non-Residents 14 „ in Large Towns 6, 14, 15 149 INDEX—continued. Deaths, Uncertified 15 Death-rate, Zymotic 6, 24 Density of Population 6, 11 Dentistry 96 Diagram showing Relative Fatality 17 Diarrhoeal Diseases, Death-rate 19 Diphtheria 29 to 32, 69 „ Carriers 31, 85 „ Epidemic 30 „ Preventive Methods 30 Dirty Premises 124 Discharging Ears 92, 107 Disinfectants 128 Disinfectant Stations 128 Disinfection 42, 132 Disinfection of Library Books 30, 132 Diseases and Defects Remedied in School Children 107, 113 Drains Unstopped and Cleansed 122 „ (reconstruction of) 123 Drainage Work .122, 123 Dust Bins, supply of 134, 135 E Eaves Gutters 124 Ear Diseases of School Children 92 Education Report 73 to 113 Education Statistics 75 Employment of Children Act 138, 139 Enteric Fever 32, 70 Epileptic Children 97 Erysipelas 32 Eye Diseases of School Children 91, 92 Eye, External Inflammation of 91 Eye Testing 92, 109, 110 F Factories 43, 132, 133 Factory and Workshop Act 43, 132, 133 Filter Bed 52 150 INDEX—continued. Fish Offal Collection 133 "Following up" cases 99 Food and Drugs Act 46 Food Inspection 46, 47, 48 Food, Unsound and Diseased 120 Forecourt Paving 125 Foreshore, amount of 10 G Gipsies 127, 128 H Hairdressers' and Barbers' Closing Order 8 Half Holiday Orders 8, 138 Health Visitor 19 to 23 Hearing of School Children 92 Heart Diseases of School Children 92 Home Work, outworkers 43, 132 Hospital Accommodation 71 Hospital, Admissions to 68 Hospital Buildings 71 Hospital Cubicles 70 Hospital Staff 71 Hospital Staff, Health of 71 House Refuse, Removal 135 House to House Inspection 120 to 122 Housing Accommodation 48 Housing, Town Planning, etc., Act 50 Hygiene, teaching of 102, 103 Hygienic Conditions of Schools, etc. 85 I Impetigo 107, 108, 109 Improvements in School Buildings 85 Industries 9 Infant Consultation 19, 20, 21, 22, 23 Infantile Mortality 3, 6, 182 19 „ „ Methods for Prevention of 19, 20, 21 151 INDEX—continued. Infectious Diseases 26 to 37, 140 to 146 Infectious Diseases non-notifiable 37 to 39, 80 to 84 Infectious Diseases of School Children 81, 83 Infectious Diseases, Attack Rate 27 to 30, 32 Infectious Diseases, Prevention of 132 Inhabited Houses, Number of 6 Inhabited House Duty Exemption 42 Inquests 18 Inspection of Borough 116, 117 „ Primary 116 Isolation Hospital 67 to 71 L Laboratory Work 31, 40, 41 Legal Proceedings 139 Licenses, Animals 137 „ Petroleum 128 Lighting 10, 85 Lung Diseases of School Children 93 M Malignant Disease 39, 60 Mange, Parasitic 137 Market Places 129 Meals for School Children 101, 102 Means of Communication 8, 9 Measles 37, 38 Meat, Diseased 129 Medical Inspection of School Children 79 „ „ Arrangements for 77 „ „ Attendance of Parents 78 „ „ Defects 86, 96 to 99 „ „ Eyes 91, 92 „ „ Height and Weight 88, 89, 90 „ „ Method of 77 „ „ Number Examined 77 „ „ Objections to 78 „ „ Scope of 79 152 INDEX—continucH. Mental Defects of School Children 97 Mental Deficiency Act 97 Meteorology 6, 54 Milkshops 42 Mortuaries 127 Mother-craft 102, 103 Mothers, Schools for 102 Mouth Breathers 96 Mumps 38 N National Insurance Act, Beds 70 Notices Served 117 Notification of Births 19 Notification of Infectious Diseases 26 to 37 Notification Rate 26 to 34 Nuisances Abatement 117 Nuisances Discovered 117 Nutrition of School Children 87 O Observation Wards (Hospital) 70 Offal Collection 133 Offensive Accumulations 134 Offensive Trades 50, 133 Open-air Treatment 70 Open Spaces 51 Ophthalmia Neonatorum 33 Ophthalmic Report 109 Orders 8 Outworkers 132 Overcrowding 126 P Parks and Open Spaces 50, 51 Passages 126, 127 Petroleum Licenses 128 Playing Fields 51 153 INDEX—continued. Poor Law Relief 53 Population 6, 10, 11 „ Density of 10 „ Growth of 10 „ Natural Increase of 6 Public Houses 51 Puerperal Fever 33 R Rainfall 6, 54 Rainwater Pipes 124 Rateable Value and Rates 7 Refuse Destructor 51 Refuse Removal 51 Regulations 7, 8 Relief Works 53 Ringworm 97, 98, 107, 108 Roofs Leaky 124 S Sanitary Appliances 123 Scabies 107, 108 Scarlet Fever 29, 68 „ „ Return Cases 69 Schools, Elementary and Private 128 School Accommodation 75 „ Alterations made 85 „ Building Improvements 85 „ Children, Boots of 91 „ Children, Defective Clothing 91 „ Children Excluded 82 „ Children, Heart Diseases of 92 „ Children, Lung Diseases of 93 „ Children, Nutrition of 87 „ Children, Skin Diseases of 97 „ Children, Spectacles supplied to 109 „ Children, Teeth 96 „ Children, Verminous Conditions 94 154 INDEX—continued. School Clinic 103 to 108 „ Dentistry 1ll to 113 „ Hygienic condition of 55 „ Lighting 85 „ Nurses 4, 5, 108 „ Places 75 „ Register, No. of Children 75 Sewerage and Sewage Disposal 52 Shops Act 137, 138 Shopkeepers 137 Skin Diseases of School Children 97, 107, 108 Slaughter Houses 47, 48, 131, 132 Small Pox 28 „ Hospital 6, 28 Smoke Nuisances 50, 127 Spectacles Supplied to School Children 109 Sputum Examination 36, 40 Squint 91 Staff 5, 71, 74, 75 Statistics (Comparative) 6, 55, 56 Statistical Data 7 Subsoil 9 Summary of Report 6 Swimming Baths 52 Swimming Instruction 103 Swine Fever 137 T Table—Acreage 11 „ Air Temperature 54 „ Area 11 „ Attack Rate, Infectious Diseases 26 „ Bacteriological Examinations 40, 41 „ Births Registered 11, 12, 19, 55, 56 „ Birth-rate 11, 12 „ „ (England and Wales) 12 „ Birth Visitations 22 „ Cancer 39 155 IN DEX—continued. Table—- Cleansing of School Children 77, 94 „ Clinic, Treatment at 106, 107 and inset, 110 „ Comparative Statistics 6 „ Complaints—Nuisances 119 „ Complaints Received 118, 119 „ Deaths in Public Institutions 58 to 65 „ Death-rate 14, 19, 24 „ Death-rate Tuberculosis 36, 37 „ Death-rate Diarrhoeal Diseases 19, 24, 25 „ Death-rate—Great Towns 14, 15 „ Deaths Registered 19, 55, 56, 58 to 66 „ Density of Population 11 „ Dental Treatment 112, 113 „ Diphtheria, Attack Rate 30 „ „ Hospital Patients 27, 68, 69 „ „ Mortality 30 „ „ Notifications 30 „ Diseases and Defects Remedied 100, 107 „ Dust Collection 136 „ Education Rate 75 „ Enteric Fever, Attack Rate 26, 27, 32 „ „ „ Hospital Patients 68 „ „ „ Mortality 32 „ „ „ Notifications 32 „ Erysipelas Mortality 26 „ „ Notifications 26 and inset „ Eye Examinations 91, 110 „ Factories and Workshops 43 to 45 „ "Following-up" 100 „ Food and Drugs Act, Legal Proceedings 46 „ Height of Children 88, 89 „ Hospital Accommodation 71 „ Hospital (Cubicles) 68 „ Hospital Patients, Scarlet Fever 27, 68 „ Hospital Patients, Diphtheria 68 „ House to House Inspection 121, 122 „ House Refuse Collection 136 „ Infants' Clinic 22, 23 156 INDEX—continued. Table—Infant Feeding 22, 23 „ Infantile Mortality 18, 19, 66 „ Infectious Cases Removed to Hospital 26, 57 „ „ „ Notified 26 and inset, 57, 140 to 146 „ „ „ „ (in localities) 140 to 146 „ „ „ Schools 83 „ Inquests 18 „ Inspections made 116 and inset „ Legal Proceedings 139 „ Medical Inspection, Number of Children Examined 77, 80 „ „ „ Defects 83 insets „ „ „ Special Cases Examined 86 „ Meteorological Record 54 „ Notifications 57 „ Notification Rate 28 „ Nuisances Discovered 116 inset „ Outworkers 43 „ Parks and Open Spaces 51 „ Plans Passed 49 „ Population 12, 55, 56 „ Population, Density of 11 „ Population, Ward 11 „ Rainfall 54 „ Rateable Value 7 „ Relief, Poor Law 53 „ Ringworm 98 „ Scarlet Fever, Attack Rate 29 „ „ Mortality 29 „ „ Hospital Patients 27, 68 „ „ Notifications 29 „ School Children Excluded 82 „ „ „ Defects 83 insets „ School Clinic Consultations 106, 113 „ „ „ Results of Treatment 107 „ „ „ Treatment 106 „ School Places 75 „ Shopkeepers 137 „ Statistical Data 7 „ „ „ (Education) 75 157 INDEX—continued. Table— Streets and Houses, Number of 140 to 146 „ Trade Refuse Collection 134 „ Transferable Deaths 56 „ Tuberculosis, Attack Rate 27 „ „ Death-rate 36 „ „ (Wards) 37 „ „ Deaths Registered 36, 37 „ Tuberculosis, Hospital Patients 68 „ „ Notifications 34 „ „ Notification Rate 34 „ Typhoid Fever 32 „ „ „ Hospital Patients 27, 57, 68 „ „ „ Notifications 32 „ „ „ Mortality 32 „ Verminous Condition of School Children 95 „ Vision of School Children 91, 110 „ Vital Statistics (10 years) 55 „ „ (6 years) 56 „ Ward Birth Rates 11 „ Ward Death Rates 15 „ Ward Population 11 „ Ward Zymotic Death-rate 25 „ Weight of School Children 88, 90 „ Zymotic Case Rate 24 „ Zymotic Deaths 25 „ Zymotic Mortality 24, 25 Teaching Staff 75 Teeth Decayed 96 Teeth of School Children 96, 99 Temperature 54 Temporary Buildings 128 Throat Affections 81, 96 Tonsils, Enlarged 96, 97 Trade Refuse, Removal of 133, 134 Tuberculosis 33 to 37, 70 „ Attack Rate 34, 36 „ Treatment of 36, 37, 70 „ Visits 35 Tuberculous Diseases 34 158 INDEX—continued. Tuberculous Diseases of School Children 93 Tuberculosis Dispensary 35 Tuberculosis Officer 35 Typhoid Fever 32, 70 Typhus Fever 33 U Unsound Food 129 Urinals 51, 126 V Van Dwellers 127, 128 Varicella 39 Verminous Condition of School Children 94 Vision of School Children 91, 92, 109, 110 W Ward Births 11 „ Birth-rate 11 „ Death-rates 15 „ Deaths 15 „ Population 11, 19 „ Infant Mortality 19 War Service 4, 76 Water, Houses without 125 Water, Inland 10 Water Storage 124, 125 Water Supply 10, 52 Water, Tidal 10 Whooping Cough 38 Widal Test 40 Workshops 43, 132, 133 Work of School Nurses 76 Y Yard Paving 125 Z Zymotic Death-rate 6, 24, 25 Zymotic Diseases 140 to 146