ILF 047 I.J.K.Lee Ilford Urban District Council. ANNUAL REPORT OF the Medical Officer of Health INCLUDING A SPECIAL REPORT ON MILK SUPPLY. C. F. STOVIN, M.A., D.P.H., Medical Officer of Health: and Medical Superintendent of the Isolation Hospital ILFORD: Wilson and Whithworth Ltd.. Steam Printers. PUBLIC HEALTH COMMITTEE. 1905-1906. Chairman: Councillor R. Stroud. C.C. Vice-Chairman: Councillor W. K. Aitchison. Councillors: W. P. Griggs, J.P., C.C. (Chairman of the Council). J. A. G. Bodger (Vice-Chairman of the Council). G. W. M. Gott. W. J. Hammond. W. Pallant. T. Philpot. J. H. Souster. H. M. Thornton. G. T. Walter, OFFICERS OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: C. F. Stovin, M. A.. D.P H. Chief Inspector of Nuisances: F. W. King, Mem. Royal San. Inst. Assistant Inspectors of Nuisances: H. C. Monkcom, Assoc. Royal San. Inst., A.I.S.E. T. V. Haigh, Mem. Royal San. Inst. Clerk: F. J. Bull. Assistant Clerk: G. A. Aldous. INFECTIOUS DISEASES HOSPITAL. Medical Superintendent: C. F. Stovin, M.A., D.P.H. Matron: Miss C. A. Barling. PREFACE. To the Chairman and Members of the ILFORD URBAN DISTRICT COUNCIL. Gentlemen, Every Medical Officer of Health appointed under an order of the Local Government Board is required to make an Annual Report with regard to the Sanitary District which is under his superintendence. I herewith beg to present my Annual Report for the year, 1905. I estimate the total population at 65,021, or, excluding the Public Institutions 60,411; a great deal of trouble has been expended in the endeavour to get this as correct as possible, and I believe the above estimate to be fairly accurate. The death-rate for the year was 8.9, or connected for age and sex distribution so as to be comparable with other district, 9.6. The birth-rate was 26.25. On looking at the tables it will be seen how small is the increase in the number of births compared with the growth of the population. So that the birth-rate for Ilford, in the same way as in the country generally, is gradually and steadily falling. No nation which is unable to freely renew its population can hope to remain in the forefront in these days; and this falling off in the birth-rate, if continued, is a most serious matter. 6 It is outside the power of Local Governing bodies to affect the birth-rate, but it is within their power to reduce the number of children who die in the first year of life. When one considers that out of every 1,000 children born, 132 die in the first year of life, in the smaller towns, it is apparent that every Local Governing body should take every means in their power to reduce this fearful waste of Infant life. What can be done by a municipality in this direction, has been shown by Huddersfield in the past year, which by combined effort their death-rate has been reduced to half. In other words, a saving of about 60 children has been effected in every 1,000 bom. In llford as I pointed out in 1904, and again during the past year, a great part ot tLe death-rate is duo to want of knowledge, and help in that direction, I nm more and more convinced would be attended with beneficial results. Of course, the problem is a very comjlex one, but in this particular district education, or lack of it. is the main factor. It must not be forgotten, too, that though we hear of the deaths, we do not hear of the numbers of other babies who are not thriving as they should do. There has been no marked epidemic of any Infectious disease during the past year. Scarlet Fever has been the most prevalent; but, as can been seen by the spot map, it has been fairly distributed throughout the district. Seeing how rife this disease has been in surrounding districts, llford. may congratulate itself on having got off so well. In this connection, and also with regard to Diphtheria, the school supervision is a great help, as large numbers of children are excluded from school as soon as they show signs of sore throat, and it is often very difficult to say where one disease ends and the other begins. In the section on Schools I have included some of the findings of the "Departmental Committee on Medical Inspection in Schools" as there seems to be a good 7 deal of doubt in some minds as to what Medical Inspection should consist of. There has been a marked absence of measles during the past year. The provision of contact beds to complete the scheme at the sewage works has been proceeded with and is now nearly complete. When these are completed and the other modifications of the works finished, there should be a largely diminished cause for the complaints received during the year of smells and other nuisances. I have included a special report on the Milk Supply of the district, which gives some interesting particulars. Taken as a whole the result must be considered disappointing, though probally no worse than the usual milk supply of a district. The chemical analysis gives 12 percent. of the milks examined as being below the by no means high standard of the Board of Agriculture. With regard to the Bacteriological examination it is difficult to compare the milks as there is no definite standard authoritatively laid down. All the milks were more or less polluted, and 80 per cent. shewed signs of manurial defilement. The sample that gave the best analysis came from a cowshed situated within the district, but taken generally the samples show the necessity for some more general and complete control of the milk supply than obtains at present. Dr. Thresh in is letter says:— "The only means of prevention by a Public Authority would be (a) frequent Veterinary Inspection of Cows, (b) byelaws, properly enforced, to secure 8 greater cleanliness in milking, and (c) byelaws enforcing cooling of milk to 50° F immediately after milking.'' And for this purpose it seems desirable also that farms should be compulsorily registrable in the district to which they send their milk, so as to be open to Inspection at any time. Finally, I should once more like to express my thanks and indebtedness to the various officials of the Council for their assistance in many ways, and especially to those of the Public Health Department. I am, Gentlemen, Your Obedient Servant, C. F. STOVIN, M.A.., D.P.H. Medical Officer of Health CONTENTS. PAGES. Physical and Geological Features 13 SECTION I. Vital Statistics. 16 Statistical Summary 17 Population 19 Births 21 Deaths 21 Zymotic Death Rate 23 Mortality in Age Groups 24 Inquests 24 Infantile Mortality 24 Table V. of Local Government Board Weekly Rainfall for year 31 Table I. of the Local Government Board 32 Table IV. „ „ „ 34 SECTION II. Infectious Disease. 37 Scarlet Fever 37 Diphtheria and Membranous Croup 39 Enteric Fever 40 Erysipelas 41 Puerperal Fever 41 Measles 41 Chicken Pox 43 10 CONTENTS. Section II —continued. PAGES. Whooping Cough 43 Phthisis 43 Respiratory Diseases exclusive of Phthisis 44 Cancer 44 Table III. of the Local Government Board 45 Table giving Death Rate from various infectious diseases during the past 15 years 46 Isolation Hospital- 47 Diseases treated in Hospital 47 Table of Admissions 49 Average stay in Hospital 50 Death Rate in Hospital 50 Administration 50 Return cases of Scarlet Fever 51 Woodford Urban Council — Number of Admissions 53 Disinfection 54 SECTION III. Schools. 55 Medical Inspection 57 Infectious Disease 62 Measles 63 Chicken'Pox 61 Ringworm 61 Exclusion of children under 5 years of age 65 Underfed children 67 V sion 67 Hearing 68 New Schools 63 Summary of Infectious Disease reported in connection with Schools 69 11 SECTION IV. PAGES. Milk Supply. 71 Ilford Cowsheds and Dairies 76 Condensed Milk 78 Chemical Analyses 83 Bacteriological Examinations 93 Powers with regard to the Legal Regulation of the Milk Supply 110 Summary 113 Municipal Milk Depots 115 SECTION V. Sanitary Administration. 123 Food and Drugs Acts 121 Meat Supply 125 Vegetable and Fruit Shops 125 Offensive Trades 125 Factories 125 Workshops and Workplaces 126 Table of Home Office 128 Bakehouses 131 Water Supply 131 Removal of House-refuse 132 Sewage Works 132 SECTION VI. Report of Sanitary Inspector. 135 Nuisances 138 Drainage 138 Defects in Dwelling-houses 139 Ilford Improvement Acts 139 Bye-laws 139 12 CONTENTS. Section VI.—Continued. PAGES. Dairy Regulations 140 Accumulations of Refuse, &c. 140 Workshops Acts 140 Infectious Disease (Prevention) Act 140 Generally 140 Notices served 141 Summary of Journal 142 Complaints 143 Gipsies and Tent Dwellers 143 Periodical Inspections 144 Cowsheds 144 Dairies and Milkshops 144 Bakehouses 144 Workshops 145 Slaughter-houses 145 Housing of the Working Classes Act 145 Inspections of Food 145 Infectious Diseases 146 Water Supply 146 Removal of House-refuse 147 Disposal of House-refuse 149 13 PHYSICAL AND GEOLOGICAL FEATURES. The surface generally is gently undulating. Flatter in the southern and more thickly inhabited portion, but rising to a higher elevation in the more northern parts. Ilford is situated on the London Clay, but this only comes to the surface as a narrow strip running almost due East and West through the middle of the district. In addition, there is a large patch to the North-West, as exemplified in the names Clayhall and Claybury. There is a large square urea of brick-earth lying roughly in the angle between the junction of the Romford load with the 11 ford Lane, extending down the Romford road nearly as as far as St. Mary's Church, and down Ilford Lane nearly to Uphall Farm The rest of the subsoil is gravel. SECTION 1. Vital Statistics. 17 STATISTICAL SUMMARY. Enumerated Population at Census, 1901 41,229 Estimated „ „ middle of 1902 49,000 „ „ „ „ 1903 54,226 „ „ „ „ 1904 59,700 „ „ „ „ 1905 65,021 Area of District in Statute Acres—Land 8,470 „ „ „ „ Inland Water 26 „ „ „ Tidal „ 7 Density of Population, i.e. No. of Persons per acre 7.6 Average No. of Persons per acre in 33 great towns 32.4 Total number of births registered in 1905 1,587 Representing a birth-rate of 26.25 Total number of births registered in 1904 1,548 Representing a birth-rate of 28.6 Total number of births registered in 1903 1,522 Representing a birth-rate of 30.6 Total number of births registered in 1902 1,334 Representing a birth-rate of 29.9 Total number of births registered in 1901 1,194 Representing a birth-rate of 30.5 Total number of deaths registered in 1905 549 Representing a nett death-rate of 8.9 Total number of deaths registered in 1904 563 Representing a nett death-rate of 10.4 B 18 Total number of deaths registered in 1903 498 Representing a nett death-rate of 10.0 Total number of deaths registered in 1902 415 Representing a nett death-rate of 9.3 Total number of deaths registered in 1901 434 Representing a nett death-rate of 11.1 Total number of deaths from the 7 principal Zymotic diseases in 1905 61 Representing a Zymotic death-rate 1.0 Total number of deaths from the 7 principal Zymotic diseases in 1904 120 Representing a Zymotic death-rate 2.2 Total number of deaths from the 7 principal Zymotic diseases in 1903 66 Representing a Zymotic death-rate of 1.3 Total number of deaths from the 7 principal Zymotic diseases in 1902 47 Representing a Zymotic death-rate of 1.05 Total number of deaths from the 7 principal Zymotic diseases in 1901 99 Representing a Zymotic death-rate of 2.6 Infantile mortality rate for 1905 86.9 „ „ 1904 127 „ „ 1903 92.6 „ „ 1902 74.2 „ „ 1901 156.5 Rateable Value £359,608 Inhabited Houses 1905 12,335 „ „ 1904 11,045 „ „ 1903 10,132 „ „ 1902 9,088 „ „ 1901 7,649 19 POPULATION. I estimate the total population for 1905, at 65,021, Deducting from this total:— Dr. Barnardo's Homes 1,000 Claybury Asylum 2,660 West Ham Asylum 920 Total 4,580 this leaves a nett population for the district proper of 60.441. It is arrived at thus:— Total number of houses in district 13,585 Total number of inhabited houses in district 12.335 Total number of uninhabited houses in district 1,250 At the Census in 1901 there were:— No. of inhabited houses 7,649 No. of uninhabited houses 721 Total number of houses 8,370 Since then certificates for new houses have been granted by the Council as follows:— Prom March, 1901 to June 30th, 1902 1,545 From July, 1902 to June 30th, 1903 1,226 From July, 1903 to June 30th, 1904 1,270 From July, 1904 to June 30th, 1905 1,174 Making to total for the past year 13,585 20 The Census gives 4.9 persons per house for Ilford, so that by multiplying the number of inhabited houses by 4.9 gives the population I have taken above. There are two possible sources of error in this estimate. (1) That 4.9 persons per house does not represent Ilford at the present time. The tendency is in all these suburban district for the number of persons per house to increase, so that this error, if present, under-estimates rather than over estimates the population. In Walthamstow at the census, persons per house 5.8 „ East Ham do. do 5.6 „ Romford do. do 4.8 (2) The second source of error is that the number of empty houses may be under-estimated. This error has been carefully guarded against in counting them, and moreover allowance has been made in addition for possible errors. So that I have adopted the figures given by this means rather than the Registrar General method. In a rapidly growing neighbourhood like this it seems to me this is more likely to be the correct one if carefully carried out. Also, too, it must be remembered that the Registrar General's estimate is based on the ratio of increase during the ten years between the last two census years Now, although the increase of Ilford was phenomenal during those ten years, the first four years showed comparatively but slight increase, and the real increase came during the last six years, so that is another reason, I think, why this estimate is more likely to be the correct one. The Registrar General's estimate is 54,322. 21 BIRTHS. The number of births registered during the year was 1,587, giving a birth-rate of 26.25. This is the lowest birth-rate for some years. The increase in the number of births is by no means keeping pace with the increase of population. Population. Rate. In 1900 the total No. of births was 1,037 34,399 30.0 „ 1901 „ „ „ 1,194 39,022 30.5 ,, 1902 „ „ ,, 1,334 44,530 29.9 „ 1903 ,, „ „ 1,522 49,646 30.6 „ 1904 „ „ „ 1,548 54,120 28.6 „ 1905 „ „ „ 1,587 60,441 26.2 In a district like Ilford where the population is largely composed of young married people, this is a very serious matter; moreover, it is exactly what is occurring all over the country, and while conditions of life remain as they are at the present time there is every prospect of the same causes continuing to operate, with a diminishing birth-rate as the result. Increasing civilisation and a high birth-rate do not go together, either in this country or any other. DEATHS. The total number of deaths registered for 1905 was 897. The total number of deaths registered for the district proper, apart from the institutions, is 549. 22 These include deaths in: German Hospital 1 City of London Asylum 1 London Hospital 17 Childrens' Hospital—Gt. Ormond St 3 Camberwell House Asylum 2 Hospital for Women 2 Hospital of St. John and St. Elizabeth 1 Camberwell Infirmary 2 Royal Chest Hospital 1 St. Ann's House, Stoke Newington 1 St. Stephen's Avenue, Hammersmith I North Eastern Children's Hospital 1 Guy's Hospital 1 East London Children's Hospital 1 Charing Cross Hospital 1 King's College Hospital 1 Evelina Hospital 1 llford Isolation Hospital 9 County Asylum 9 Romford Infirmary 26 Clacton-on-Sea I East Ham Hospital 1 Total 84 This gives a death-rate of 8.91 for the year 1905 for the district proper, or a corrected death-rate of 9.6. The death-rate was 10.4 for the year 1904 „ „ „ 10.0 „ „ 1903 „ „ „ 9.3 1902 „ „ „ 11.1 „ „ 1901 23 Of non-residents dying in Institutions in the district:— Claybury Asylum 203 West Ham Asylum 129 Dr. Barnardo's Homes 15 Ilford Isolation Hospital 1 Total 348 Zymotic Death-rate.—The number of deaths registered from the seven principal zymotic diseases for the year 1905 was 60, giving a zymotic death-rate of 1.00 per 1,000. In previous years it has been as follows:— Year. Deaths. Rate. 1900 70 1.8 1901 110 2.6 1902 47 1.0 1903 66 1.3 1904 120 2.2 1905 60 1.0 The seven diseases included in this rate are:— Diseases Deaths in 1905. Deaths in 1904. Small Pox - — Measles 3 17 Scarlet Fever 4 5 Whooping Cough 14 8 Diphtheria 4 10 Typhoid Fever 4 4 Diarrhoea (epidemic) 31 76 Totals 60 120 It will thus be seen that, as compared with the year before, the deaths for this past year have been about half. 24 Mortality of Age Groups, On referring to the table at the end of this section, it will be seen that the greatest number of deaths were between 25 and 65. Number of deaths occurring at the following ages: Year. Under 1 year 25 to 65. Over 65. 1902 99 109 101 1903 141 129 108 1904 198 130 100 1905 138 187 112 INQUESTS. In 1902 there were 26 Inquests held. „ 1903 „ 46 „ 1904 „ 37 „ 1905 „ 22 „ Infantile Mortality. The number of deaths registered for children under 1 year of age was 138, giving an infantile mortality rate of 86.9 deaths to every 1,000 births registered. The rate has been: 1900. 1901. 1902. 1903. 1904. 1905. 141 156 74 92 127 86 The low rate for this past year has been due to the comparatively few deaths from Summer Diarrhoea. Only 30 for 1905 as against 76 for 1904. The following table shows the causes of death in children under 1 year of age, for the past year. TABLE V. INFANTILE MORTALITY DURING THE YEAR, 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. Common Infectious Diseases. Small-pox .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Chicken-pox .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Measles .... .... .... .... .... .... .... .... .... .... .... 1 .... 1 .... .... 2 Scarlet Fever .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Diphtheria: Croup .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Whooping Cough .... .... .... .... .... 1 .... .... 1 .... .... .... 1 1 .... .... 4 Dinrrhœal Diseases. Diarrhoea, all forms .... .... .... .... .... 1 2 1 .... 1 2 2 1 1 1 .... 12 Enteritis (not Tuberculous) .... .... .... .... .... 1 3 .... 3 1 2 3 1 .... .... 14 Gastritis, Gastrointestinal Catarrh 3 .... .... 2 5 .... 1 .... 1 1 .... .... .... .... 1 .... 10 Wasting Diseases. Premature Birth 20 4 5 2 31 1 1 .... .... .... .... .... .... .... .... .... 33 Congenital Defects 3 .... .... .... 3 .... .... .... .... .... 1 .... .... .... .... .... 4 Injury at Birth .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Want of Breast-milk .... .... .... .... .... .... .... .... .... .... 1 .... .... .... .... .... 1 Atrophy, Debility, Marasmus 4 1 1 2 8 5 2 .... .... .... .... .... .... .... 1 .... 16 Tuberculous Diseases. "Tuberculous Meningitis .... .... .... .... .... .... 1 .... .... .... .... .... .... .... .... .... 1 Tuberculous Peritonitis; Tabes Mesenterica .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Other Tuberculous Diseases .... .... .... .... .... .... .... 1 .... .... 1 .... .... .... .... .... 2 Erysipelas .... .... .... .... .... .... .... .... .... .... 1 .... .... .... .... .... 1 Syphilis .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Rickets .... .... .... .... .... .... .... .... .... .... .... .... .... 1 .... 1 Meningitis (not Tuberculous) .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Convulsions 3 .... .... .... 3 4 .... .... .... .... 1 .... .... .... .... .... 8 Bronchitis .... .... .... .... .... 2 2 1 .... 1 1 1 .... 1 1 .... 10 Laryngitis .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Pneumonia .... .... 1 1 2 .... .... .... .... 1 2 .... .... .... 1 2 8 Suffocation. overlaying 1 .... .... .... 1 .... .... .... .... .... .... .... .... .... .... .... 1 Other Causes 3 .... .... .... 3 .... 2 1 2 .... .... .... .... 2 .... .... 10 Total 37 5 7 7 56 16 14 4 7 4 11 6 5 7 6 2 138 25 INFANTILE MORTALITY. In 1905, the number of deaths amongst Infants under one year was 138, giving a proportion of 86.9 deaths to every 1,000 born. As I consider the greatest need of a Health administration at the present time is the dealing effectively with this question of Infantile Mortality. I presented the following short report on the subject advocating the appointment of a female sanitary inspector, but I regret to say the Council did not adopt my suggestion. In the following table it will be seen that the excessive mortality amongst children, is largely due to Summer Diarrhoea, which carries off far too large a proportion of Infantile life every year. 26 TABLE SHOWING CAUSES OF DEATHS OF CHILDREN UNDER 1 YEAR OF AGE, For the 4 Quarters of the Past Yeah, also Corresponding Periods for 1904. CAUSES OF DEATH March Quarter. June Quarter. September Quarter. December Quarter. Total for Year. 1905 1904 1905 1904 1905 1904 1905 1904 1905 1904 Measles 2 - - - - - - 4 2 4 Scarlet Fever - 1 - - - - - - - 1 Whooping Cough 2 - - 1 3 2 - 2 5 5 Diphtheria and Membranous Croup - - - - - 1 - - - 1 Diarrhœa and Enteritis 1 2 1 1 27 71 1 2 30 76 Erysipelas 1 - - - - - - - 1 - Other Tubercular Diseases 1 4 1 - 2 3 - 1 4 8 Bronchitis 4 2 2 - 1 - 1 7 8 9 Pneumonia 4 2 3 4 - 3 2 2 9 11 Other Diseases of Respiratory Organs - 1 - - - - - 1 - 2 Premature Birth 5 5 10 4 9 8 12 6 36 23 Heart Diseases - 1 - 1 - 1 1 4 1 7 Accidents - 2 - - - - - - - 2 All other causes 11 7 9 10 1 18 13 14 42 49 Totals 31 27 26 21 51 107 30 43 138 198 27 It will thus be seen that the past year compares very favourably with 1904, due, I believe, to the more favourable weather conditions. The rain-fall for the months of July and August, ot this and last year, was:— 1904. 1905. July 1.59 inches 1.30 inches. August 66 „ 2.29 „ It has been shewn that Summer Diarrhoea amongst infants, is most prevalent when the earth temperature at the depth of 1 foot, reaches 59 deg. F., to 62 deg. F. Naturally this occurs when the rain-fall is less, and the Sun is more powerful, viz:—in July and August, and possibly part of September. This condition is most favourable to the growth of all kinds of Bacteria, which develop rapidly in all forms of milk food. There is no doubt that the number of children fed from the bottle, is on the increase, and especially in Urban Districts; partly due to disinclination on the part of some mothers to suckle their children, but more often, I believe, the mother in Urban Districts is becoming more and more unable to herself provide her child with milk that is sufficient in quantity and suitable in quality. The following is a table shewiug the average rate of infants dying under 1 year of age, per 1,000 births:— 28 Years. Average rate of Infants dying under I year of age per 1,000 births. Urban Counties. Rural Counties. Males. Females. Males. Females. 1873 to 1877 176 146 140 113 1898 to 1902 180 149 139 111 Of 74 deaths from Diarrhoea in 1904, only 4 were fed by the mother; and during the past year the following shews how the children were fed. Of 27 deaths, only 3 were suckled. Of the others, 9 were fed with cows milk. „ „ 15 „ „ condensed milk, and 7 were receiving some form of patent food in addition to the milk. It will be seen by the following table, that the bulk of the deaths occur in the smaller rented houses. Rental. 1904. 1905. £15 and under 12 10 £15 to £20 22 13 £20 to £25 9 4 £25 to £30 8 — £30 and over 4 — A certain proportion of the children that succumb to Summer Diarrhoea, are previously healthy children; but the greater number are not, owing to their receiving food that is not suitable to their needs. They are not in such a vigorous condition as they should be, and often even a mild attack of Diarrhœa is more than the enfeebled infant can survive. 29 Now that the birth-rate throughout the country is on the decrease, it is of national importance that the utmost should be done to preserve the lives of those that are born. This can only be done with each locality dealing with its own area. To do any good at all, the problem must be attacked from the birth of the child; or, as near as it is possible to get to it. Therefore, the first thing to do, is to get a return from the Registrar, of the births of all children in the district. Secondly, to appoint a female sanitary inspector, or health visitor, who shall visit every house where a birth is registered; or, such as shall be necessary. It will be most important to exercise great care in her selection, as she should be a trained nurse with experience of children, and used to this kind of work. She should also have sanitary qualifications. When I was appointed Medical Officer of Health in 1901, I drew up a pamphlet on "Care of Infants," and that it did a certain amount of good, is shown, I think, by the following table:— Towns. years. 1900. 1901. 1902. 1903. 1904. 1905. Ilford 141 156 74 92 127 86 Barking 203 198 134 113 142 142 East Ham 166 156 117 113 140 129 Leyton 140 136 107 99 138 94 Walthamstow 158 147 115 113 135 104 West Ham 192 172 151 148 165 156 Woodford 182 127 110 107 126 89 Romford (Urban) 105 138 101 99 110 130 Acton 168 170 149 105 142 — Battersea 159 163 136 135 147 — Croydon 132 140 133 104 128 — Lewisham — 128 122 92 122 — Willesden 139 131 130 123 115 - 30 Thus showing that the question is largely one of education ; and there is no education like the personal one. The hulk of the mothers are willing enough to receive advice, often from unsuitable sources, and I do not think there would be any difficulty about their resenting capable help. Then, again, the Council would receive a very valuable mass of information as to the condition of the babies in the district; and, until that knowledged is acquired, it is useless going in for any scheme which might or might not be beneficial. This plan has now been adopted iu some 47 towns, and is everywhere spoken of as beneficial in its action. In Ilford, from the character of its population, I am convinced that this plan would be followed by good results. Of course, this visitor would in no way interfere with the Doctor, as she is not meant in any way to advise in illness. Her duty would be to advise only before the child is ill; in other words, she would assist, if necessary, but never intermeddle. I merely mention this, because there was some expression of opinion last year, that she would be a sort of amateur doctor. That is absolutely out of the question. 11 WEEKLY RAINFALL FOR THE YEAR, 1905. Week ended Rainfall in inches. Week ended Rainfall in inches. Jan. 7 .30 July 1 .68 „ 14 .08 „ 8 .26 „ 21 .44 „ 15 .43 „ 28 .02 „ 22 .05 Feb. 4 Nil „ 29 .18 „ 11 .08 Aug. 5 .38 „ 18 .10 „ 12 .37 „ 25 .22 „ 19 .02 Mar. 4 .15 „ 26 .26 „ 11 .59 Sept. 2 1.29 „ 18 1.57 „ 9 .29 „ 25 .06 „ 16 .42 April 1 .12 „ 23 Nil „ 8 .22 „ 30 1.46 „ 15 .87 Oct. 7 .17 „ 22 .26 „ 14 .02 „ 29 .12 „ 21 .12 May 6 .34 „ 28 .06 „ 13 Nil Nov. 4 1.19 „ 20 .16 „ 11 .45 „ 27 .01 „ 18 .75 June 3 .27 „ 25 .16 „ 10 1.33 Dec. 2 .50 „ 17 1.07 „ 9 .33 „ 24 .13 16 .04 „ 23 Nil „ 31 .31 Total Rainfall for year in inches, 18.70. 32 TABLE 1. Vital Statistics of Whole District during 1905 and Previous Years. Year. Total Population Estimated to Middle of each year. Nett Population Estimated to Middle of each year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Under 1 Year of age. At all Ages. N umber. Rate. Number. Rate per 1,000 Births registered. Number. Rate. Number. Rate. 1 2 3 4 5 5 7 8 9 10 11 12 13 1895 18,822 18,122 455 25.1 58 127.4 532 28.2 358 358 ? 174 9.5 1896 21,570 20,570 496 24.1 61 122.9 483 22.3 301 301 ? 182 8.8 1897 24,719 23,319 635 27.2 88 138.5 481 19.4 254 254 ? 227 9.7 1898 28,328 26.468 697 26.2 107 153.5 535 18.8 271 259 12 276 10.4 1899 32,464 30,154 895 29.6 120 134.0 650 20.3 281 268 13 382 12.6 1900 37,204 34,399 1,037 30.0 147 141.7 655 17.6 231 231 25 449 13.0 1901 42,622 39,022 1,194 30.5 187 156.6 657 15.4 245 245 22 434 11.1 1902 49,000 4 4,530 1,334 29.9 99 74.2 748 15.2 393 363 30 415 9.3 1903 54,226 49,646 1,522 30.6 141 92.6 828 16.6 364 357 27 498 10.0 1904 59,700 54,120 1,548 28.6 198 127.0 933 18.6 383 370 29 563 10.4 Average for vears 1895— 1904. 36,865 34,035 981 28.1 120 126.8 650 18.9 306 300 ? 360 10.4 1905. 65,021 60,441 1,587 26.2 138 86.9 897 13.7 357 348 75 549 8.9 33 This table has been corrected as regards " estimated population" by calculating the ratio of increase of the population year by year 10,913, in 1891 to 42,622 in 1901, that is from census to census. Column 8 is thus calculated from the total estimated population in column 1. All the other columns are calculated from the estimated nett population, that is, not including the populations of the Public Institutions, viz.:— Claybury Asylum. West Ham Asylum. Dr. Barnardo's Village Homes. It will be noticed that for the earlier years the rates are too low; that is due to this method bringing the populations for the earlier years too high. This table should be compared with the corresponding table in last year's report. C 34 TABLE IV. Causes of, and Ages at, Death during Year 1905. Causes of Death Deaths at the subjoined ages of "Residents" whether occurring in or beyond the district Deaths at alt. ages of "Residents" belonging to Localities, whether occurring in or beyond the district. Total, Deaths whether op Residents or non "Rial dents" in Public ions in the District All Ages Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Cranbrook Ward Park Ward Seven Kings Ward North Hainault Ward Loxford Ward Clements Wood Ward South Hainault Ward Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 2 ... 1 ... ... ... ... 1 ... ... ... ... 2 3 Scarlet Fever 4 ... 2 2 ... ... ... 3 ... ... ... 1 ... 3 Whooping-cough 14 5 8 1 ... ... ... 1 2 1 2 5 1 2 2 Diphtheria and Membranous Croup 4 ... 3 1 ... ... ... ... 1 ... ... 1 ... 2 1 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 4 ... ... ... 2 2 ... ... l ... ... 1 2 ... ... Other contin'd ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 4 ... 1 ... ... 2 1 ... ... 1 ... 3 ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 18 18 ... ... ... ... ... ... 2 2 3 5 4 3 3 Enteritis 13 12 ... ... ... 1 ... ... 3 1 3 ... 5 1 ... Puerperal Fever 3 ... ... ... ... 3 ... ... 2 ... ... ... 1 ... ... Erysipelas 4 1 ... ... ... 2 1 1 ... 1 ... ... 1 1 ... Other septic Diseases 4 ... ... 1 ... 3 ... ... ... ... ... 2 2 ... 2 Phthisis (Pulmonary Tuberculosis) 38 ... ... 4 5 27 2 6 5 7 4 4 9 3 37 Other tubercular Diseases 8 4 ... 3 ... 1 ... ... 1 1 1 2 1 2 8 Cancer, Malignant Disease 35 ... ... ... ... 29 6 6 11 4 3 5 4 2 9 Bronchitis 37 8 4 ... ... 4 21 4 ... 4 10 4 6 2 17 Pneumonia 48 9 8 1 22 8 8 7 4 6 9 11 3 60 Pleurisy 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... 3 Other Diseases of Respiratory Organs 7 ... ... ... ... 4 3 ... ... ... ... 1 4 2 ... Alcoholism 8 ... ... ... ... 4 4 1 2 ... ... 1 2 1 2 Cirrhosis of Liver Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 36 36 ... ... ... ... ... 6 3 3 3 10 4 7 ... Diseases and Accidents of Parturition 4 ... ... ... 1 3 ... 2 ... ... 1 1 ... ... ... Heart Diseases 50 1 ... 3 3 29 14 5 10 5 5 14 8 3 23 Accidents 3 ... 1 ... ... 1 1 ... ... ... ... 1 1 1 2 Suicides 4 ... ... ... ... 2 2 1 ... ... ... 1 1 1 ... All other causes 160 42 8 8 6 47 49 14 26 19 20 31 30 21 173 All Causes 514 138 35 25 17 187 112 55 87 54 62 101 98 59 348 SECTION II. Infectious Disease. SCARLET FEVER CHART OF NOTIFICATIONS. 37 INFECTIOUS DISEASES. During 1905 there were notified 446 cases of infection diseases „ 1904 „ „ 508 „ „ 1903 „ „ 364 „ „ 1902 „ „ 738 „ „ 1901 „ „ 437 „ „ 1900 „ „ 356 From the institutions in the district the following cases have been notified:— Village Homes. Claybury Asylum. West Ham Asylum. Scarlet Fever 82. Erysipelas 2. Erysipelas 1. Diphtheria 3. So that deducting the infectious cases occuring in the Public Institutions leaves a grand total of 358. When the increase in population is taken into consideration, also the growth of the number of schools with the increased number of children of susceptible ages, this result speaks well for the control exercised and the measures taken for limiting the spread of these diseases. SCARLET FEVER. At the begining of 1905 Scarlet Fever was very prevalent in the Village Homes, and altogether 82 cases were notified at the begining of the year from that source. The attacks were cod fined to the Houses and there was no spread in the neighbourhood. Deducting these 82 cases leave 206 which were notified from the district proper, and of the these 4 died giving a death-rate .06 per 1,000 living. 38 In 1904, out of 224 cases notified, 5 died, giving a death-rate of .09 In 1903, out of 181 cases notified, 2 died, giving a death-rate of .04 In 1902, out of 264 cases notified, 2 died, giving a death-rate of .04 Considering that Scarlet Fever has been ripe in the metropolis and in the neighbouring Borough of East Ham, it is surprising that this district has managed to escape so well. Of the 86 households where the patient was nursed at home, a spread of the disease to other members of the family occurred in 11 instances. The infection of Scarlet Fever is a very difficult matter to deal with as there are so many mild cases where it is most difficult to say whether it is really Scarlet Fever or not. In 3 separate instances during the year I have known of children attending school in the peeling stage with their hands shedding skins in the class rooms, and yet no second case has occured in those class rooms. Of course, the children were excluded as soon as discovered. But there were cases where one would expect to find the disease spreading and yet there was nothing developed. All the children were away from school for some days each, while the acute stage lasted, and possible this may have had something to do with the immunity of the others. With regard to the outbreak in the Village homes, it is very difficult to account for this, as the cases did not occur in any one cottage, but were distributed about—one case in this cottage, and another in that, iu the most irregular DIPHTHERIA CHART OF NOTIFICATIONS. 39 manner. The children are constantly moving about, backwards and forwards to London, so that makes the problem more difficult of investigation, but easier of explanation. As the greater the number of points-of-contact, so the easier the spread of infection. DIPHTHERIA AND MEMBRANOUS CROUP. During the past year 85 cases have been notified with 4 deaths giving a death rate of .06 per 1,000 living. In 1904 out of 181 cases notified 10 died giving a death rate of 18 per 1,000. In 1903 out of 95 cases notified 14 died giving a death rate of 28 per 1,000. In 1902 out of 86 cases notified 8 died giving a death rate of .17 per 1,000 In 1901 out of 75 oases notified 6 died giving a death rate of .15 per 1,000. On referring to the table on page 46 it will be seen that it is necessary to go back to 1898 before finding so low a death rate from this disease as the past year. The cases have been fairly evenly distributed over the whole district and as will be seen from the chart, at no time has there been any great prevalence. Of the 4 deaths, 2 occurred through the parents mistaking the condition for an ordinary sore throat and neglecting to call in help until it was too late. Provided medical advice is sought in time no disease is so easy to arrest as Diphtheria, now Antitoxin is as certain in its action as a 40 chemical re-action provided only it is injected in time and in sufficient quantity. I am sure the provision of this to medical men in this district has been of immense value in reducing the death rate. ENTERIC FEVER. During the past year 22 cases have been notified, with 4 deaths, giving a death rate of .06 per 1,000. In 1904 out of 32 cases notified 4 died giving a death rate of .07. In 1903 out of 28 cases notified 2 died giving a death rate of .04. In 1902 out of 59 cases notified 7 died giving a death rate of .15. In 1901 out of 33 cases notified 4 died giving a death rate of .10. Of the 22 cases notified, 6 gave a history of having eaten shell fish during the fortnight previous to attack, but of course it is impossible to say if one was the result of the other. Another case had been staying at Lincoln during the epidemic there, was infected at Lincoln, came homo and died in a short time. One case removed to Isolation Hospital turned out not to be Typhoid Fever was thence removed to the London Hospital and died there from Peritonitis but the cause of this was undiscoverable on a Post Mortem examination. Several of the cases were of a mild type and ran a short course, terminating in recovery. ENTERIC OR TYPHOID FEVER CHART OF NOTIFICATIONS. ERYSIPELAS CHART OF NOTIFICATIONS. 41 ERYSIPELAS. For 1905, 48 cases were notified with 3 deaths. „ 1904, 56 „ „ 1 „ „ 1903, 49 „ „ no death. „ 1902, 67 „ „ 4 deaths. „ 1901,17 „ „ 1 „ In these days the inclusion of Erysipelas under the Infectious Disease (Notification) Act appears to be of doubtful benefit, as the majority of the cases are slight, and are no index to the condition of the surroundings of the patient. PUERPERAL FEVER. During 1905 there were 3 cases notified and 3 deaths. „ 1904 „ 4 „ 4 „ „ 1903 „ 2 1 „ „ 1902 „ 4 „ 2 „ One case was removed to Hospital and every effort made to save her life, but she seemed to have absorbed such a large dose of toxins before admission that nothing appeared to make any impression. There was no connection between any of the cases, each appeared to arise de novo and was followed by no other notification. MEASLES. During the past year there have been reported from the schools and other sources 136 eases of measles, with 3 deaths, giving a death-rate of .04 per 1,000 living. 42 In 1904 measles was removed from the schedule of the Notification of Diseases Act, and it was feared by some that this was a retrograde step to take. So far this past year has shewn no sign of supporting this contention. In 1898, 425 cases were notified, with 5 deaths, or rate of .18 „ 1899 467 „ „ 12 „ „ .39 „ 1900 326 „ „ 2 „ „ .05 „ 1901 805 „ „ 5 „ „ .12 „ 1902 564 „ „ 3 „ „ .06 „ 1903 684 „ „ 10 „ „ .20 „ 1904 1138 „ and reported 17 „ „ .30 „ 1905 936 „ were reported 3 „ ,, .05 Of course it may be contended that 136 cases represented but a small proportion of the actual cases occurring. To a certain extent that may be true, but it would only apply to some of the cases under school age, and only those where there was no other child in the house attending school. Moreover, if there were many it is very unlikely to be so limited in its spread. There are four attendance officers, who report to me personally every morning, of any case of infectious disease coming to their notice, and the teachers also are supplied with forms to send me immediately they hear or suspect any such case, and I must say the teachers are extremely good in the care they take in watching for and reporting any case. Also, too, if there is a case of measles in a school it is so apt to spread, especially amongst the infants, that I should soon get to know of its prevalence. The chief reason of the freedom from measles during the past year, I believe, is largely due to the excessive prevalence during the previous year, thus rendering a large proportion of the infant population immune to the infection. 43 CHICKEN POX. Of the minor infectious diseases reported from the schools Chicken Pox has been the most prevalent during the last year. 423 cases have been so reported, and it is curious how it passed from the most southern school in the district to the north, through the centre of the district. WHOOPING COUGH. For the past year there were reported 243 cases of Whooping Cough. There were 14 deaths, giving a deathrate of .23 per 1,000 living. In 1904 there were 8 deaths, giving a death rate of .14 „ 1903 „ 19 „ „ „ .30 „ 1902 „ 3 „ „ .06 „ 1901 „ 21 „ „ „ .53 PHTHISIS. For 1905 there were 38 deaths, giving a death-rate of .62 „ 1904 „ 33 „ „ „ .60 „ 1903 „ 36 „ „ „ .72 „ 1902 „ 32 „ „ „ .71 „ 1901 „ 19 „ „ „ .48 It is curious how little the gross numbers of the deaths have varied the last four years. Sheffield has obtained power to make the notification of Phthisis compulsory, and it will be of interest to watch the result of the experiment. 44 RESPIRATORY DISEASES OTHER THAN PHTHISIS. For 1905 there were 88 deaths, giving a death-rate of 1.4 „ 1904 „ 69 „ „ „ 1.2 .. 1903 „ 73 „ „ „ 1.4 „ 1902 „ 67 „ „ „ 1.5 „ 1901 „ 44 „ „ „ l.l CANCER, For 1905 there were 33 deaths, giving a death-rate of .54 „ 1904 „ 28 „ „ „ .51 ,, 1903 „ 21 „ „ „ .42 „ 1902 „ 19 „ „ „ .41 „ 1901 „ 19 „ „ „ .48 These last two diseases are placed here for convenience. TABLE III. Cases of Infectious Disease Notified during the Year 1905. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Casks Removed to Hospital from each Locality, At all Ages. At Ages—Years. Cranbrook Ward. Park Ward. Seven Kings Ward. North Hainault Ward. Loxford Ward. Clementswood Ward. South Hainault Ward. Cranbrook Ward, Park Ward. Seven Kings Ward. North Hainault Ward. Loxford Ward. Clementswood Ward. South Hainault Ward. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 82 .. 18 40 14 10 .. 14 10 12 4 9 13 20 6 5 10 4 8 7 14 Membranous Croup 3 .. 2 1 .. .. .. .. .. 1 .. 1 .. 1 .. .. .. .. .. .. .. Erysipelas 18 1 1 6 10 24 6 7 6 5 7 7 9 7 .. .. .. .. .. 1 .. Scarlet Fever 288 1 59 174 40 14 .. 30 45 17 86 47 37 26 6 34 .. .. 36 21 15 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 22 .. .. 9 7 6 .. 2 3 .. 1 7 7 .. 2 1 .. 1 4 3 .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 3 .. .. .. .. 3 .. .. 2 .. .. .. 1 .. .. 1 .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 446 2 80 230 71 57 6 53 66 35 98 71 67 56 14 41 14 9 48 32 31 46 Table giving Death Rate Form Various Infectious Diseases during the Past 15 Years. Years. Small Pox. Erysipelas. Diphtheria & Membranous Croup. Scarlet Fever. Enteric and Continued Fever. Puerperal Fever. Measles. Estimated Population. Cases. Deaths. Rate per 1,000 Cases. Deaths. Rate per 1,000 Cases. Deaths. Rate per 1,000. Cases. Deaths. Rate per 1,000. Cases. Deaths. Rate per 1,000. Cases. Deaths. Rate per 1,000. Cases. Deaths. Rate per 1,000. 1891 .... .... .... 9 .... .... 51 9 .82 11 .... .... 11 3 .27 .... .... .... .... 4 .36 10,913 1892 1 1 .08 18 .... .... 29 .... .... 25 1 .08 6 1 .08 .... .... .... .... 3 .24 12,406 1893 4 .... .... 30 .... .... 75 12 .85 138 4 .28 11 2 .14 3 2 .14 .... .... .... 14,082 1894 21 1 .06 27 1 .06 29 4 .25 90 1 .06 10 1 .06 1 .... .... .... 5 .31 15,974 1895 1 .... .... 36 1 .05 24 2 .11 32 .... .... 11 2 .11 .... .... .... .... 1 .05 18,022 1896 .... .... .... 47 4 .18 46 7 .34 157 3 .14 34 5 .24 2 2 .09 38 2 .09 20.570 1897 .... .... .... 35 .... .... 32 1 .04 132 .... .... 34 6 .25 2 2 .08 325 3 .12 23,319 1898 .... .... .... 36 .... .... 66 2 .07 74 .... .... 33 3 .11 .... .... .... 425 5 .18 26,468 1899 .... .... .... 60 .... .09 74 11 .36 128 1 .03 26 6 .19 1 .... .... 467 12 .39 30,154 1900 12 .... .... 59 1 .02 71 4 .11 190 .... .... 23 4 .11 1 1 .02 326 2 .05 34,394 1901 6 .... .... 37 1 .02 76 6 .15 285 .... .... 33 4 .10 .... .... .... 805 5 .12 39,022 1902 44 8 .17 67 4 .08 86 6 .17 264 2 .04 61 7 .15 3 2 .04 564 3 .06 44,530 1903 9 1 .02 49 .... .... 95 14 .28 181 .2 .04 28 2 .04 2 1 .02 684 10 .20 49,646 1904 11 .... .... 56 1 .01 174 10 .18 224 5 .09 32 4 .07 4 4 07 1138 17 .30 54,120 1905 .... .... .... 48 3 .04 85 4 .06 288 4 .06 22 4 .06 3 5 .04 .... 3 .04 60,441 47 ISOLATION HOSPITAL. Number of patients in hospital at beginning of year:— Scarlet Fever 40 Diphtheria 1 Number of patients admitted during year:— Scarlet Fever 156 Diphtheria 55 Typhoid Fever 13 Puerperal Fever 1 Erysipelas 1 Number of patients remaining in hospital on the 1st Jan., 1906:— Scarlet Fever 32 Diphtheria 4 Number of deaths in hospital during year:— Scarlet Fever 3, giving a death-rate of 1.92 per cent. Diphtheria 4, „ „ 7.27 „ Typhoid 1, „ „ 7.69 ,, Puerperal Fever 1, „ „ - Erysipelas 1, „ „ — 48 Average stay in hospital:— Scarlet Fever 48.94 days. Diphtheria 28.62 „ Typhoid Fever 32.0 „ Erysipelas 2 „ Puerperal Fever 13 „ Percentage removed to the hospital of cases notified:— Scarlet Fever 41.66 Diphtheria 63.52 Typhoid Fever 59.09 Puerperal Fever 33.33 Erysipelas 2.08 49 TABLE OF ADMISSIONS In the respective months, during the last four years. Months. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. 1902 1903 1904 1905 1902 1903 1904 1905 1902 1903 1904 1905 1903 1905 1906 January 12 16 17 10 8 7 3 5 - - - 1 — — — February 2 11 17 18 5 5 10 8 — — 1 - — - - March 8 3 13 15 1 4 3 3 1 — 1 — — — - April 13 11 12 9 3 2 4 10 3 — — 1 — 1 - May 6 9 8 10 1 4 4 3 3 1 - 2 — — — June 9 7 4 16 2 1 15 1 3 — 2 2 — — — July 8 6 12 5 2 1 5 2 — — 4 — — - August 11 8 10 10 - 3 3 8 10 2 2 1 — — — September 2 5 4 9 - 3 7 4 6 4 2 — — — - October 16 11 10 23 4 2 9 3 5 2 — 1 — - - November 18 11 7 15 1 2 12 4 — 2 1 1 - — 1 December 15 17 26 16 4 3 0 4 - - - - 1 - - Totals 120 115 140 156 31 37 80 55 33 11 9 13 1 1 1 D 50 Average stay in hospital in days:— 1902. 1903. 1904. 1905. Scarlet Fever 56 58 54.7 48.94 Diphtheria 35 — 21.07 28.62 Typhoid Fever 38 — 40.66 32.0 Deaths in hospital:— Scarlet Fever. Diphtheria. Typhoid Fever. 1902. I death 2 deaths 7 deaths Rate - .83% Rate-6.72% Rate -21.2% 1903. 1 death 4 deaths 2 deaths Rate - .86% Rate -11.4% Rate - 18.1% 1904. 4 deaths 7 deaths 2 deaths Rate -2.66% Rate - 8.75% Rate - 22.22% 1905. 3 deaths 4 deaths 1 death Rate - 1.92% Rate - 7.27% Rate-7.69% During the year Miss Brown, who has been Matron since the opening of the Hospital in 189S, resigned. I should like to put on record here, my appreciation of her services to the Hospital and so to the town. In starting an Isolation Hospital of the size that this was, a great deal depends on its popularity with the patients and their friends. Probably still more a few years ago than even now. Miss Brown was ever ready to sacrifice herself to the interests of the patients and the hospital, which quickly gained for her the respect and affection of a series of inmates and visitors. If one thing, more than another, contributes to the value of an Isolation Hospital it is the efficiency of its nursing staff, and in changing matrons it is desirable to take stock of the nursing conditions, to see if they can be improved. A large 51 proportion of the nurses employed are probationers without previous experience, and it is essential that these should be well trained and taught, as well as infused with a real enthusiam for their calling. Miss Barling, the new matron, fully sympathises with this ideal, and I trust that under her guidance the Hospital will still further increase in efficiency. RETURN CASES OF SCARLET FEVER. During the year there have been 7 cases discharged from the Hospital, to houses in which another case has been notified within 21 days after the previous case returned home. Curiously enough, there were 7 instances, too, where secondary cases were notified in houses in which the first case was nursed at home. That is, after an interval of more than 7 days; thus shewing that these 7 cases were not infeoted directly by the first patient before it was isolated. This is an exceedingly difficult question, and one that worries the mind of those responsible for Isolation Hospitals as much as anything. If a pa tient is discharged quite well, free from any discharge or obvious signs of infection, on the way home or shortly after, a "chill is caught," the child gets a running from the nose, which appears to re-light up the infection and another member of the family is infected in consequence. This was the history of five of the above cases. No care on the part of the Hospital management can obviate this, and yet this question is one that severely militates against the usefulness of Isolation Hospitals. In 1899, Professor Simpson reported to the Metropolitan Asylums Board on the subject of these "return rases" after a special investigation his principal conclusions were:— 62 (1). That about half the number of supposed "return oases" were really due to eases leaving the Hospital in an infectious condition. (2). That these constituted at least 1.6 of the total discharges. (3). That 80 per cent. of the primary infective cases are connected with discharges from the mucous membranes (nose, throat and ear). (4). That "return cases" are not due to premature discharge and the isolation in Hospital is, if anything, too long. (5). That warm baths immediately before the patient is sent out of Hospital, do not remove the infection but contribute to its increase. During the past year the result of a further investigation has been reported by Dr. Cameron, to the Metropolitan Asylums Board, and the following are his principal conclusions:— (1). That the supposed infectious cases are 4.1 percent. of the total number discharged. (2). That the majority of these were probably the actual causes of infection in the return cases. (3). That although a large proportion of the iufecting cases are those which have been detained beyond the average time in Hospital, length of detention is not in itself the cause of infectiousness. (4). That the principal cause of the occurrence of "return cases" is the persistence and recurrence of 53 mucous discharges from the nose, and that this happens especially in the winter. (5). That late "peeling" cannot be regarded as evidence of infectiousness. The experience of these sort of cases in this district, coincides with the conclusions here quoted, and are set out for that reason. During the year a "temporary shelter" has been built in one portion of the Hospital grounds but outside the actual Hospital precincts. It is proposed to use this as a convalescent home or "half-way house" between the Hospital and the home, for Scarlet Fever patients—this when not otherwise required. By this means it is hoped to minimise the number of return cases by hardening off, so to speak, the patient before returning home. The shelter was declared open in December of the past year. It will provide accommodation for about 8 patients. During the year a contract was made with the Woodford Urban District Council to admit a certain number of their infectious cases. The following number have been admitted to our pital:— Scarlet Fever 34 Diphtheria 1 The following number have been discharged:— Scarlet Fever 23 Diphtheria 1 The following number remained in Hospital at the end of 1905:— Scarlet Fever 11 Diphtheria — 54 DISINFECTION. There is a large-sized Washington Lyon Steam Disinfector at the Hospital. This is used for disinfecting the hospital bedding, and also the infected material from the town. For this purpose two vans are employed; one for removing the infected articles, and the other for returning them after disinfection. The following table shows the number of houses and articles disinfected for the past three years. Houses. Articles. 1903. 1904. 1905. 1903. 1904. 1905. January 29 36 71 602 397 783 February 26 35 48 307 544 727 March 18 30 40 270 487 707 April 15 21 40 239 209 579 May 22 22 31 273 479 757 June 14 55 16 147 447 196 July 9 24 13 144 96 187 August 21 28 20 234 301 220 September 20 28 16 250 260 205 October 18 35 34 141 338 397 November 29 28 33 280 241 478 December 31 30 20 363 458 179 Totals 252 372 382 3250 4257 5415 Two men are employed on this work part time. The rooms are sprayed with a 1 or 2 per cent. Formalin solution, from a "Mackenzie's Spray." Cyllin has been used in some oases recently. SECTION III. Schools. 57 Medical Inspection.—An interesting report has been issued during the past year by the Inter Departmental Committee on "Medical inspection of children attending Public Elementary Schools,'' and as there seems to be a good deal of doubt as to what should be included in the term "Medical Inspection," in the minds of the public, I propose to quote some of the findings of that report as being of practical import to this town. Medical Officers for educational purposes have been appointed by six Counties, 35 County Boroughs, 31 Boroughs, and 13 Urban Districts. The duties of the School Medical Officer may include any of the following:— (а) Periodic examination of, and report on, the sanitary condition of the school premises and the general health of the scholars; examination from this standpoint, of plans for new schools and enlargements. (b) The prevention of the spread of infectious disease. (c) Examination of children alleged to be physically unfit to attend school. (d) Periodic visits to the schools and examination of the eyes, ears, teeth, and general physical condition of the children. (e) Making of an anthropometric survey. (f) The examination of defective and epileptic children, and the superintendence of special schools for defective, epileptic, blind, and deaf children. 58 (g) Advising the authority on special points; lecturing to the teachers and advising them as to the curriculum for certain children, and as to general matters of health. (h) Examination of the health of teachers and other employes. The report goes on to state that it must not be assumed that all these duties are assigned to every Medical Officer, and in point of fact very seldom are all assigned to him. In Ilford, most of the duties stated above are carried out, and I trust as time goes on, that they will all be attended to and carried out in their entirety. One of the most difficult would be (e) the making of an anthropometric survey, as it involves a great amount of time and detail; but it is one that would be most interesting, and could be tried as an experiment in two of the schools—say one of the Council schools and one of the non-provided schools. An interesting comparison could then be made between the physique and stamina of the two sets of children. The following extract from the list of duties of the Medical Officer for Kidderminster shows the possibilities which lie before a sympathetic Officer. "The funotion of the Medical Offloer in relation to the children in the schools is preventive, and in individual cases only applied to matters involving educational questions. The conditions of the special senses, the avenues of knowledge, are of great importance with regard to educational success. The officer can call attention to the need of glasses, but has nothing to do with prescribing them. He may 59 notice the presence of Adenoids, but takes no part in their removal. On the other hand his work should extend far beyond mere investigation of the sanitary state of the buildings, or the excluding of unhealthy or diseased children. The methods of education, requirements of physical exercise, avoidance—particularly in the very young—of overstrain from prolonged fatigue or from improper tasks, are all matters in which improvement can only be obtained by the Medical Officer acting, not as an authority to shut or close, to disturb or interrupt the proper work of the school, but as a counsellor and adviser, with a knowledge of school routine, and of the requirements for health; to assist and collaborate with the Committee, and it is with this in his mind that he should enter any sohool." Thus it is seen that it is most important for the Medical Officer to work in harmony with the teacher, and really their object is the same in the long run, though on the surfaoe, occasionally, their ideas may be opposed. They are both anxious to help and assist the individual child and to maintain the attendance at the best point possible. In most areas where medical inspection is organised, the School Medical Officer does not examine each individual child; he relies very largely upon the teachers for information as to the children who need his attention, and in a district like Ilford, with 10,000 children and 16 schools, which the Medical Officer is expected to visit once a month, it is obviously impossible to examine each child individually. In Section 21 of the Report attention is drawn to another aspect of the matter as follows:—"We have received information from several towns, where the staff of the Sanitary 60 ment, acting under the Medical Officer of Health, have been of material assistance in following up in the house, oases of infectious disease, and of dirty and verminous children. Also there are distinct advantages in the School Medical Officer being also Medical Officer of Health. The duties of the two offices naturally overlap. The inspection of children for the prevention of the spread of infectious disease and the sanitary inspection of the premises are examples of this. The union of the two offices tends to prevent duplication of work. It has the additional advantage that the staff of the Authority's Sanitary Department is thus made easily accessible for any special work. They are employed for disinfecting schools, and for following up cases of dirty and verminous children, and for obtaining attention to the condition of the homes as well as of the children. At the same time the Medical Officer of Health finds that his position as Educational Medical Officer greatly facilitates his work in preventing the spread of infectious disease." In the report of the Inter-Departmental Committee, the results of medical inspection have been summarised as follows:— (1) There is no doubt that the establishment of proper organisations for the prevention of the spread of infectious disease has had marked results. Diphtheria especially, it is stated, is now in several areas under such oomplete control, that it can be stopped in a few days. The knowledge now possessed by many teachers of the symptoms of infectious diseases, enables them to act with the promptitude which is essential if effective measures are to be taken. The Education Act of 1902, by unitiug to a large 61 extent the Sanitary and Educational Authorities, has undoubtedly facilitated prompt and effective action in dealing with epidemic sickness. (2) Much has been done to secure greater cleanliness and freedom from vermin, and to attack such troublesome diseases as Ringworm. The results here have been further improved in certain areas, by the prosecution of the parents in extreme cases of neglect. Apart from the general physical gain to the child, resulting from greater cleanliness, there is also the consequent improvement in the morale of the school. (3) The establishment of medical inspection has caused more careful and widespread attention to be given to defective children. Minor physical defects have been remedied; surgical apparatus has been obtained. (4) To nothing, probably, has more attention been paid than to eyesight, and in no direction have beneficial results more certainly been obtained. Defects have been discovered which would otherwise have passed unnoticed, and spectacles have been provided. Overstraining of the eyes has often been stopped, with the consequent disappearance of many headaches and much apparent stupidity. (5) Some steps have been taken towards dealing with the more difficult question of defective hearing. (6) Teachers have been lead to take more intelligent and more sympathetic interest in the physical welfare of the children placed under their care. Ventilation is better attended to as its importance becomes more fully realised. 62 The School Medical Officer gives teachers valuable support in any effort they may make to arouse the better feelings of the apathetic or negligent parent. (7) Generally, we feel no doubt that the medical inspection has done much towards bringing to view defects, the treatment of which secures the child from unnecessary suffering, and may save him from serious trouble in after life. Finally, we desire to point out now small is expenditure which inspection involves; in no urban area does it require more than one tenth of a penny rate—generally not so much. After all, medical inspection is but now making a beginning, and there is every reason to hope that as time goes on its value will become more widely recognised by the parents, and that the results it produces will thus become more completely satisfactory. INFECTIOUS DISEASE. From the table of infectious diseases in the schools, for 1904 and 1905, it will be seen that the past year compares favourably with the year 1904 in the more serious infectious deseases. In the table this year a double column has been placed, shewing the children who have been actually suffering from the disease, and also the number of contacts, or children from the infected houses who have been excluded from school in consequence. Thus it will be seen that out of a total number of 1,009 children who have been excluded from school as suffering from infectious disease, 709 other children have also been excluded who have been in contact with the affected children. It is surprising what a large proportion of children are involved, and what a serious matter it is from a financial 63 point of view alone. For about every six children attending school, one has been excluded for a shorter or longer time for infectious disease. Last year the proportion was about the same, without including contacts, a record of whom has been kept this year for the first time, so that the record for this year is better than last, but only proves the necessity for still further effort. I also think it would be a good plan if teachers on admitting new children would find out from the parent if the child has had Measles, Whooping Cough, or Chicken Pox. It could easily be done and would involve little extra trouble on the part of teachers, as all they would have to do would be to add another column to the admission register. This information would be specially valuable in the case of Measles, as after a short time it would be an extremely valuable guide as to the closure, or not, of a school, as then the proportion of susceptible children would be known. MEASLES. Measles has been markedly absent this year, probably due to its great prevalence during the former two or three years, thus rendering a great proportion of the children immune to a renewed attack during the year 1905. The following regulation has worked well and with ut trouble:— "In certain cases where there are children in the same house who have previously suffered from Measles and are over eight years of age, certificates will be granted by the Medical Officer of Health for these children to attend school. The granting of these certificates will depend on whether the arrangements for the isolation and nursing of the patient are satisfactory or not." 64 CHICKEN POX. Chicken Pox.—The infectious disease of most prevalence has been Chicken Pox, and this affected the attendance at Loxford Infants, and thence spread to the High Road Infants, Cleveland Road, and Christchurch Road Schools. Chicken Pox is such a mild disease and is so seldom followed by any serious result, that it might seem questionable whether it might not be left alone and allowed to run its course without supervision, especially as there are numerous cases where there are only a few spots, and the child's general health does not appear to suffer at all. There are three objections to this course, viz.:— (1) It is not fair to the parents of other children not to do the best possible to protect their children from any infection. (2) The more it spreads—and the less it is supervised the more it spreads—the more disastrously it affects the attendance register. (3) If there was auy Small Pox in the district, the gaining kuowledge and location of cases of Chicken Pox would be of material assistance in discovering mild cases of Small Pox, and would save the Sanitary Authority the expense of making Chicken Pox a notifiable disease under the Act as was done during the last Small Pox epidemic. RINGWORM. Ringworm.—This is a constant source of trouble in the schools, though I am glad to say that there has not been any great prevalence. In 11 instances, where it was doubtful whether it was fit for a child to return to school after 65 worm, a bacteriological opinion was obtained. This is the only way to settle the question if return, or not, to school is desirable, and it is quite a question whether it would not be to the advantage of the school authority to provide a free bacteriological examination to any Medical Practitioner who desired to make certain before sending a patient who has had Ringworm back to school. The risk to the school of a premature return is so great, and the difficulty of determining when a patient is fit to go to school is also sometimes a serious matter. EXCLUSION OF CHILDREN UNDER 5. Exclusion of Children under 5, from the elementary schools has received a good deal of attention during the past year. In the Councils' there were about 600 children under 5, and since the Board of Education has left it to the discretion of the local authority to exclude them or not, a great many authorities have excluded these children. In Ilford 10 schools have excluded all children under 5 years, of course depending on the style of school. On the Continent the usual age for compulsory school attendance is at 6, and in America it is about the same. Some of the members of the Moseley Commission were struck with the difficulty the teachers had in teaching children of 7 years of age the elements of learning. In districts like Ilford, where the Education Rate is going up, and likely to continue to increase, unless some other means than at present exist are found for lightening the local burden, the financial element is likely to have most weight with the authority and the ratepayers. Though here some provision later will have to be made for these children, and there will be the loss of attendance at school of older girls who will be kept at home to look after their smaller brothers and sisters. E 66 It is worth considering, however, which is likely to be most beneficial to the child and the teacher in the long runA great many Medical Officers of Health have advocated the exclusion of children under 5, on the ground of the prevalence of Measles and Whooping Cough in Infant schools. But if schools are such propagators of Measles, it means, of course, that the incidence of Measles will be postponed to a later age, which will have a more serious effect on the interruption of school work, as if the same standard is required the teacher will have less time to instruct the child, and consequently the interruption will be more serious. With Whooping Cough the greatest mortality is under 2 years of age, and consequently its effects are felt before school life begins. The postponement of the age of Measles attack would probably have a beneficial effect on the death-rate, but to what extent it is problematical, as here, too, a large number of children develope Measles before 3 years of age, and still more before 4. There is an idea that children under 5 cannot learn, but this ie a mistake. With the right sort of instruction a great deal is learnt, habits of school discipline are formed, and I have been astonished at the results achieved in some of the infant schools under an efficient mistress. The effect on the average child is entirely beneficial so long as the education is carried out on the right lines and impossibilities are not attempted. Moreover, the child developes physically far better if it is using its brain to a legitimate extent than if it is limited to the monotony of the back yard or confined premises, day after day. It is a difficult matter to prove, but my impression is that more children shew signs of over-pressure who started 87 school after 5, than those who started before. It is a matter which requires careful consideration, and the effect studied. UNDERFED CHILDREN. A good deal of attention has been paid to this matter during the year, but the amount of underfeeding in Ilford, is not great. In most of the schools 2 or 3 children in each department was about the average, and these were generally examples rather of bad feeding than under feeding. I examined about 40 of these children and most of them were suffering from malnutrition. I then personally visited most of the homes concerned. The father was generally out of work, or they were children of widows; so that in about two-thirds of these cases, there was real need of some help. It is a very difficult matter to deal with, as the supply is very apt to create the demand, and that was the case in about onethird of the cases mentioned above. During the year I was appointed to act under the Epileptic and Defective Childrens' Act, and one severe case of Epilepsy in a boy 12 years of age, was examined and sent to Lingfield School. There are about a dozen defective children scattered through the schools, who are deriving no benefit from their present instruction. VISION. Out of the number of ohildren who have been examined for defective vision, 27 have been advised to seek medical advice, and a certain proportion have had spectacles in consequence. Some did not need them and in other instances 68 the parent either would not take the trouble to take them to the hospital, or said they could not afford to get the spectacles. HEARING. The number of children in the schools suffering from Adenoids are not numerous. A few have been seen, advised to seek surgical treatment, and some have benefited by the operative treatment. The open mouth, vacant expression and dulled senses, are detrimental to the child in more ways than one ; but here, too, sometimes the parent will take pains to have the matter remedied, and sometimes not. Thess are the children who give rise to great trouble if they contract either Scarlet Fever or Diphtheria; and they are difficult to clear of infection. NEW SCHOOLS. One new temporary iron school has been erected during the year, at Goodmayes, and one new permanent school at the Highlands has been opened. During the year I have examined 1493 children at the Town Hall, us to their fitness to attend school, or not, and have given certificates to that effect. SUMMARY OF INFECTIOUS DISEASES AND CHILDREN WHO HAVE BEEN EXCLUDED. OWING TO CONTACT WITH PATIENTS, IN CONNECTION WITH SCHOOLS DURING THE YEAR ENDED 31st DECEMBER, 1905. SCHOOLS. No. of Scholars on Roll. DISEASES AND CONTACTS. Scarlet Fever. Diphtheria. Membranous Croup. Typhoid Fever. Measles. German Measles. Chicken Pox. Mumps. Whooping Cough. Ringworm. Ophthalmia. Totals. Cases Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts Cases. Contacts. Cases. Contacts. Cases. Contacts. Cleveland Road 1,763 7 15 3 7 .. .. 1 .. 7 13 .. 2 76 52 21 11 57 14 19 .. .. .. 191 114 Downshall 1,697 11 18 6 18 .. .. .. .. 17 11 3 4 16 10 5 1 67 32 9 .. .. .. 134 94 Loxford 1,607 25 39 3 10 .. .. 1 1 6 13 .. .. 152 110 29 3 15 7 19 .. .. .. 250 183 Christchurch Road 1,356 16 24 5 14 .. .. 1 .. 17 14 .. .. 70 49 3 1 7 6 8 .. 1 .. 128 108 Highlands 820 9 7 15 20 .. .. .. 1 33 15 1 1 16 8 .. .. 9 4 6 .. .. .. 89 56 Horns 527 .. 6 .. 3 .. .. .. .. I 1 .. .. 10 6 2 2 .. .. .. .. .. .. 13 18 Chadwell 466 2 4 3 2 1 4 .. .. .. .. .. .. 7 14 .. .. 3 .. .. .. .. .. 16 24 Goodmayes 379 4 4 4 4 .. .. .. .. 1 1 .. .. 3 2 .. .. 1 .. 1 .. .. .. 14 11 National, Ilford 509 1 3 1 .. .. .. 1 5 .. 9 .. 2 7 4 1 1 5 .. 4 .. .. .. 23 24 Infants. High Road 142 .. 6 1 1 .. .. .. .. .. .. 2 3 22 12 1 • • 8 .. .. .. .. .. 34 22 National, Barkingside 290 .. .. .. .. .. .. .. .. 1 7 .. .. .. .. 19 19 6 1 3 .. .. .. 29 27 Roman Catholic 257 4 .. 1 2 .. .. .. .. .. .. .. .. .. 1 .. .. 6 3 1 .. .. .. 12 6 Beehive 112 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7 2 .. .. .. .. 7 2 Ilford Lane 104 .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. 15 4 .. .. .. .. .. .. 16 5 Aldborough Hatch 81 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 .. .. .. .. .. 5 2 Secondary 580 2 10 1 3 .. .. 1 .. 1 .. .. .. 2 .. .. .. • • .. .. .. .. .. 5 13 Private Schools .... 23 .. 2 .. .. .. 1 .. 15 .. 12 381 .. .. .. .. .. .. .. .. .. 43 .. Totals 10,690 105 139 45 84 1 4 7 7 102 84 6 268 96 42 195 69 70 .. 1 .. 1009 709 B 69 Summary of Infectious Diseases reported in connection with Schools for the Year ended 31st December, 1904. Schools. No. of Scholars on Roll. Disease. Small Pox. Scarlet Fever. Diphtheria. Membranous Croup. Typhoid Fever. Continued Fever. Measles. German Measles. Chicken Pox. Mumps. Whooping Cough. Ringworm. Glass Pox. Total . Downshall 1.632 .... 31 7 1 3 .... 248 23 4 1 9 16 .... 343 Loxford 1,484 .... 12 14 1 2 1 170 .... 14 3 8 1 .... 226 Christchurch Road 1,223 .... 14 9 2 2 .... 136 6 9 .... 13 2 .... 193 Cleveland Road 1.626 .... 34 16 .... 1 .... 176 13 27 .... 21 8 .... 296 Highlands 641 .... 8 25 .... .... .... 31 1 28 2 13 6 3 117 National, Ilford 522 .... 8 1 1 1 .... 33 2 .... 1 .... .... 47 Chadwell 508 .... 22 2 .... .... .... 7 8 1 .... 2 2 .... 44 National, Barkingdide 290 .... 1 1 .... .... .... 54 .... 3 .... 1 1 .... 61 Infants'. High Road 153 .... 2 1 1 .... .... 62 2 1 .... .... .... .... 69 Horns 439 .... 2 .... .... .... .... 99 2 4 1 .... .... .... 108 Roman Catholic 215 .... 1 1 .... .... .... 13 .... 1 .... 2 1 .... 19 Secondary .. .... .... 4 .... 2 .... 3 .... 1 .... .... .... .... 10 Beehive 107 .... 1 .... .... .... .... 9 .... 4 .... 1 .... .... 15 Ilfrord Lane 67 .... 2 .... .... .... .... 7 .... .... .... 2 .... .... 11 Aldborougb Hatch 93 .... 1 1 .... .... .... .... .... 2 .... .... .... .... 4 Totals 9,000 .... 139 82 6 11 1 1,048 57 99 7 73 37 3 1,563 SECTION IV. Special Report on Milk Supply. 73 MILK SUPPLY. For some time past the milk supply of Ilford has received a good deal of attention, but in accordance with the instructions of the Council, I am presenting a special report on the subject. The bulk of the milk that comes into the district, comes from farms in Essex, direct to the retailer; that is, the larger retail dairymen contract direot with the farmer, and receive their milk direct from him, either by road or rail. Thirty-two farmers in Essex and one in Norfolk thus deal with 20 Ilford dairymen. The smaller dairymen obtain their supply through a company which acts as an intermediary between the farmer and the retailer. This company obtains its milk from farms in Norfolk, Suffolk, Essex, Cambridgeshire, and Hertfordshire. Every week some 3,300 churns of milk come into Ilford by train, and in addition about 200 churns come in by road. Each churn, if full, should contain 68 quarts; 60 that one may reckon that about 238,000 quarts of milk come into Ilford from outside sources, every week. The amount produced and sold within the district is not large. There are 7 cowsheds registered in the district, containing 3, 35, 19, 14, 5, 44. and 120 cows respectively. Thus the milk that is produced locally is small compared with that imported from without. Taking 10 quarts a day as the average yield of a cow about midway in her milking period, will give 2,400 quarts per day produced in Ilford, or 16,800 quarts per week, out of the 253,680 quarts sold. 74 LIST OF PLACES SUPPLYING ILFORD WITH MILK. No. of separate Farmers. District. 1 Braintree, Essex. 1 Boreham, „ 3 liillericay, „ 3 Brentwood, „ 1 Chelmsford, „ 1 Chad well, „ 1 Dunmow, „ 5 Ingatestone, „ 1 Havering, „ 1 Harold Wood, „ 1 Lambourne Fnd, „ 1 Ongar, „ 8 Romford, 1 South Weald, „ 1 Southminster, 1 Shenfield, „ 2 Takely, S.O. 1 Writtle, „ 1 Woodham Ferris, „ 2 Witham. „ 2 Wickford „ 1 Merton, Norfolk. 1 Shipdham, „ 2 Hailsworth, Suffolk. 1 Ipswich, „ 1 Long Melford, „ 1 Saxmundham, „ 1 Wickham Market, „ 1 Yoxford. „ 1 Linton, Cambridgeshire. 1 Sheedy Camp. „ 1 Buntingford, Herts. Total 51 75 From the list of farmers shown on the opposite page it will be seen that a large proportion of the milk comes from farms within easy reach of Ilford Railway Station. In that way, Ilford may consider itself fortunate, for, when one realises that milk often spends some nine or more hours in transit from farmer to retailer, in railway trucks with no special provision for keeping it sweet, the advantage of this proximity is obvious. The result of the evening milking, instead of spending the night being shaken up in a railway train, can be delivered to the dairyman the same evening; kept cool in his dairy and sent out on the early morning round. Likewise the morning milking can in a similar way go direct to the consumer within 3 or 4 hours after leaving the cow. With such an article as milk, which affords such an excellent food for all sorts of putrefactive bacteria, this is a very great advantage. In June, 1904, there was an outbreak of Diphtheria in Ilford, probably due to the milk supplied from a particular farm being infected ; and as a result of the condition of things found at that farm, I was authorised by the Council, with the voluntary assistance of the dairymen, to inspect all these farms supplying Ilford. As a consequence a great many of them have been inspected; and a regular inspection, by joint action of the Medical Officer of Health and the dairymen, would in time result in bringing some of the more backward farmers up to a better standard. The care in milking and attending to the dairy, of course varies greatly. Some leave little to be desired while others are careless and slovenly. Ofteu a difficulty in the country districts is the scarcity of water, 76 All milk after being druwn from the cow should be cooled, which is usually done by passing the milk slowly over a series of tubes through which cold water is kept running. The water used to run through these tubes is often obtained from a pond, or it may be rain-water that is used over and over again ; so that in summer, when cold water is required the water used is not much below the temperature of the milk. Moreover, if by any chance the cooler goes wrong and the tubes leak, this filthy water gains access to the milk. As one farmer naively remarked to me that he could not make out the increased yield of milk from his cows, until one day he discovered a leakage in his cooler. Then again, there is also the difficulty of keeping the animals clean. Cows are about the most difficult of all animals to keep clean in the region of the udder ; and this dirt is very apt to pollute the milk. On most farms, now, in Essex at any rate, men-milkers have replaced the old-time "dairymaid." There is reason to think that this change is not for the better, either for the cow or for the cleanliness of the milk. ILFORD COWSHEDS AND DAIRIES. As mentioned before, there are 7 Cowsheds in Ilford. Of these, 4 are modern, well drained, paved, and with sufficient cubic air space for the cows. The other three are in the rural part of the district, the buildings are old and only waiting for the development of building, to be pulled down. They are fairly well kept, and only provide accommodation for some 23 cows in all. There are 44 Milkshops and Dairies registered in the district, and of these, about one-half may be said to have 77 good Lrick-built accommodation for storing .their milk, a plentiful supply of hot and cold water for washing milk cans and other utensils, and good drainage from impervious floors. The others are either small shops where the milk is sold among other things over the counter in small quantities, and have no milk round, or are men with a small round who have been established some years, do all the work themselves, and keep their premises and cans in a cleanly condition. On two occasions during the past year, men who started a milk round without having given the Council proper notice of their intention to do so, or making any suitable provision for carrying on their business, ceased to sell milk when they were informed that the Council intended to take action to compel them to provide suitable accommodation. In a new neighbourhood like this, by making free use of the "Milkshops and Dairies Order," it is easy to prevent new dairymen from starting selling milk, unless they provide suitable accommodation for storing their milk, and for for keeping their vessels and milk cans clean. The small general shops that sell about a gallon per day over the counter, are the most difficult to deal with. The milk is generally kept in an open vessel oh the counter, surrounded by all kinds of goods, such as bacon, firewood, blacking, oil lamps, &c., &c. Under these conditions, in summer-time especially, with flies dropping in and out of the milk on to the various other articles in the shop, one may imagine what condition the milk gets into after a few hours. Fortunately the quantity kept under these conditions is small, and also, too, that most of this milk is consumed by adults, in their tea, cocoa, &c 78 To feed babies on milk of this sort, in summer-time, is to court disaster; though, doubtless, it is sometimes done. A regulation should be made to compel all milk-sellers to provide a muslin cover to prevent flies and coarser dirt particles from obtaining access to the milk when exposed for sale in an open vessel on the counter. This could easily be done and would do a certain amount of good. CONDENSED MILK. No account of the milk supply of the district would be complete without taking into consideration the question of condensed milks. Of these, there are three groups sold, according to Dr Hutchison on "Food and Dietetics," They are:— (1). Unsweetened and condensed whole milk. (2). Sweetened and condensed whole milk. (3). Sweetened and condensed skim milk. The quantity of group 1 sold in Ilford is so small as to be practically nil. The chief reason, I believe, being the difficulty in keeping it. Owing to the absence of sugar it often goes wrong. Group 2 contains what is ordinarily called the best condensed milk. This contains, as a rule, rather more added cane-sugar than solids in the milk. 79 An analysis of the better brands from Pearmain and Moore's "Analysis of food and drugs," is here given:— Brand. Total solids. Proteide. Fat. Milk sugar. Cane sugar. Nestle 77.2 9.7 13.7 15.0 37.2 Rose 76.6 8.3 12.4 17.6 36.1 "Milkmaid" 76.3 9.7 11.0 14.6 38.7 "Full weight" 76.5 12.3 11.0 13.5 37.2 "Anglo Swiss" 74.4 8.8 10.8 16.0 37.1 Now condensed milk is simply cows milk from which a large part of the water has been removed. As a rule the cows' milk is reduced to a third of its original volume by evaporation under reduced pressure; so that all that should be necessary would be to add twice its volume of water, to restore it to its original condition. There is, however, so much cane-sugar added that at that strength, it is too sweet to be drinkable. Pearmain and Moore give the following table shewing the character of the liquid that is produced by following out the directions on the labels of half-a-dozen of the best brands of sweetened whole cream milk:— Sweetened whole milk. Dilution recommended for household purposes. Fat in such product Dilution recommended for Infant's use. Fat in such product. A. 1 to 3 2.6% 1 to 5 1.8% B. 1 to 5 1.6% 1 to 14 0.7% c. 1 to 5 1.6% 1 to 14 0.6% D. 1 to 6 1.4% 1 to 15 0.7% E. 1 to 6 2.1% 1 to 14 0.8% F. 1 to 5 1.7% 1 to 14 0.7 % Human milk .. .. .. 3.5% "Group 3. or condensed sweetened skim milk, resembles group 2, or the sweetened whole milk in composition, but differs in that there is almost an entire absence of fat; so that 80 when diluted as recommended, the resulting fluid is very poor, in proteid, and almost free from fat; and is therefore entirely unsuited for a baby's nourishment." (Dr. Hutchison on "Food and Dietetics.") With Mr. King's help careful enquiries have been made of all the shops selling condensed milk in Ilford, and they were all good enough to supply the information required. It was found that some ft 5 shops sell between them:— Of group 2- sweetened condensed whole milk 350 dozen tins per week. Of group 3—sweetened condensed skim milk 310 dozen tins per week. Of course, the skim condensed milks are far the cheaper; selling at an average of three-pence per tin, as compared with an average of Five-pence-half-penny for the whole milk tins. Doubtless this cheapness accounts for the immense sale of these skim milks, but from a nutritive point of view they are far the dearer. When one considers that many babies are fed on this condensed skim milk, through pure ignorance on the part of the mothers, it seems to me that it is time some Authority stepped in and pointed out to the mothers the dangers they are running in feeding their children on this skimmed condensed milk. There has lately come on to the market a Condensed Humanised Milk, which gives on dilution of 1 in 2, a percentage of fat, similar to human milk. The marked 81 difference will be seen on comparing this percentage with the table of dilutions of other condensed milks. It is mors expensive, and will therefore have some difficulty in competing with the oheaper brands ; especially so with the poorer mothers, but with others it should have a future as providing a suitable milk in a cheap form and without the indigestible curd of cows' milk, which makes the latter impossible of digestion with some babies. "Humanised oondensed milk possesses the following advantages:— 1. When diluted with 2 parts of water it has the same chemical and physical characteristics as human milk. 2. It is free from micro-organisms. 3. It is free from colouring matters, preservatives, staroh, cane-sugar, and all other foreign additions. 4. It has a standard composition. 5. It is easily digested. 6. It is moderate in price." F RESULT OF Chemical Analyses of ILFORD MILKS, made by DR. J. C. THRESH. The samples were all collected in sterile bottles, packed in ice and sent by hand direct to the Laboratory. 85 CHEMICAL ANALYSIS. The Board of Agriculture in excerci6e of the powers conferred on them by Section 4 of the "Sale of Food and Drugs Act, 1899 " have made the following regulations:— 1. "Where a sample of milk (not being milk sold as skimmed, or separated, or condensed milk) contains less than 3 per cent. of milk-fat, it shall bo presumed for the purpose of the "Sale of Food and Drugs Acts, 1875 to 1899," until the contrary is proved, that the milk is not genuine, by reason of the abstraction therefrom of milk-fat or the addition thereto of water. 2. "Where a sample of milk (not being sold as skimmed, or separated, or condensed milk) contains not less than 8.5 per cent. of milk solids other than milk-fat, it shall be presumed for the purposes of the "Sale of Food and Drugs Acts, 1875 to 1899," until the contrary is proved, that the milk is rot genuine, by reason of the abstraction therefrom of milk solids other than milkfat, or the addition thereto of water. 3. "Where a sample of skimmed or separated milk (not being condensed milk) contains less than 9 per cent. of milk-solids, it shall be presumed for the purposes of the "Sale of Food and Drugs Acts, 1875 to 1899," until the contrary is proved that the milk is not genuine, by reason of the abstraction therefrom of milk solids other than milk-fat, or the addition thereto of water," 4. "These regulations shall extend to Great Britain." 86 5. "These regulations shall come into operation on the first day of September, one thousand nine hundred and one. 6. "These regulations may be cited as the" Sale of Milk Regulations." I quote these regulations as being the chemical standard laid down for milk, and the following analyses will show how far the Ilford Milks exceed, or come below, this by no means high standard. In the report of the Department Committee on •'Preservatives and Colouring Matters in Food," a recommendation was made that: 1. The use of Formaldehyde in food and drink be absolutely prohibited, and that Salicylic Acid be not used in greater proportion than one grain per pint per pound respectively for liquid or solid food, its presence in all cases to be declared. 2. That the use of any preservative or colouring matter in milk be made an offence under the "Sale of Food and Drugs Acts." Of the 25 samples of Ilford milks, examined for Boron Compounds or Formalin, not one gave any indication of their addition. Of the 25 samples examined, 21 gave a percentage of fat above the Board of Agriculture standard, 3 are just at the and one below. Of the "solids—-uot fat" 18 milks are above the 8.5% standard, 4 just reach that percentage, and 3 are below it. 87 So that—13 milks may be classed as chemically of a good quality. Four milks may be classed as chemically of a fair quality. Five milks may be classed as chemically of a poor quality. Three milks may be classed as chemically of a bad quality. One of the milks classed as bad was a sample taken from a milkseller whose dairy is situated in another district, but sells milk in Ilford. Only a month previously he had been fined for selling milk with added water. 88 CHEMICAL ANALYSIS. Samples Collected on 14th December, 1905, and Delivered on same day. A b C d e Specific Gravity 1,031 1,031 1,031 1,033 1,030 Fat per cent 3.2 3.2 5.0 3.9 3.6 Solids not Fat, per cent 8.65 8.54 8.9 9.17 8.35 Total Solids per cent 11.85 11.74 13.9 13.07 11.86 Preservatives; Formaldehyde Absent Absent Absent Absent Absent Boron Compounds Absent Absent Absent Absent Absent General Remarks upon the above: No preservative was present in any of the samples. The chemical quality leaves much to be desired. The milk with most dust and dirt in it, "D," was the best in chemical quality. "C" was also very good. "A" and "B" just exceed the lowest possible standard, and "E" barely reaches that standard. 89 CHEMICAL ANALYSIS. Samples Collected on 20th December, 1905, and Delivered same day. F G H. I J Specific Gravity 1,0308 1,0304 1,0297 1,033 1,032 Fat, per cent 3.4 3.8 3.0 3.0 3.5 Solids, not fat, per rent 8.53 8.51 8.25 8.99 8.84 Total Solids 11.93 12.31 11.25 11.99 12.34 Preservatives: Boron compounds Absent Absent Absent Absent Absent Formaline Absent Absent Absent Absent Absent General Remarks upon the above: All are tree from preservatives. The milk "H" is below the low standard of the Board of Agriculture, and doubtless contains added water. 90 CHEMICAL ANALYSIS. Samples Collected on 4th January, 1906. and Delivered on same day. K L M N O Specific Gravity 10,308 10,328 1,033 1,031 10,301 Butter fat per cent 4.3 4.2 3.5 3.5 3.2 Solids, not fat, per cent 8.71 9.18 8.96 8.6 8.32 Total Solids per cent 13.01 13.38 12.46 12.1 11.52 Boracic Acid or Borax Not detected in any specimen Formsline Not detected in any specimen General Remarks upon the above: "L" was a milk of very good quality chemically. "C" was below the standard and was doubtlessly watered. All appeared free from preservatives. 91 CHEMICAL ANALYSIS. Samples Collected on 14th January, 1906, "T" on 15th January, 1906, and Delivered on 15th January. P Q R S T Specific Gravity 1,033 1,031 1,033 1,031 1,032 Fat, per cent 2.42 3.7 3.5 3.0 3.2 Solids, not fat, per cent. 9.24 8.61 9.01 8.62 8.71 Total Solids 11.66 12.31 12.52 11.62 11.91 Boron Compounds and Formalin - - - - - Note on Chemical Results Some fat removed Fair Good Poor Fair General Remarks upon the above: One of the milks is good, two are fair, one is just passable, and one has had some of the fat abstracted. 92 CHEMICAL ANALYSIS Samples Collected on 22nd January, 1906, and Delivered same day. U V W X Y Specific Gravity 1,033 1,032 1,034 1,032 1,034 Fat, per cent 3.9 3.2 3.2 3.9 3.5 Solids, not fat, per cent 9.29 8.75 9.40 8.91 9.46 Total Solids 13.19 11.95 12.60 12.82 12.96 Boron Compounds and Formaline - - - - - Note on Chemical Results Excellent Fair Very Good Very Good Excellent RESULT OF Bacteriological Examination. OF ILFORD MILKS. MADE BY Dr. J. C. THRESH. The samples were all collected in sterile bottles, packed in ice and sent by hand direct to the Laboratory. 95 BACTERIOLOGICAL EXAMINATION. The object of making bacteriological examinations of milk, is to arrive at the amount of dirt and other extraneous matter that gains access to it. For whenever dirt in any form is added to milk, bacteria are also added at the same time. Of course some bacteria are harmless, but others lead to putrefaction and hasten the decomposition of the milk. When milk is obtained direct from the udder of the cow— especially if the "fore milk" or first drawn milk be rejected —it is practically free from any bacteria. But in the act of milking, as ordinarily carried out, some bacteria are almost certain to gain access to the milk, either from the udder and teats of the cow, the hands of the milker, the milk cans, Ac., or from the atmosphere of the cowshed. Milk is an excellent food for the growth of bacteria, so that if a small quantity of bacteria gain access at the time of milking, the longer the milk is kept the greater the number of bacteria, provided the milk is not kept artificially cooled. In other words—vide Dr. Houston in his report on "Bacteriological Examination of Milk," to the London County Council:— "Time and temperature are the two great factors influencing the degree of bacteriological impurity of the milk." The report says: "It follows that a comparatively clean milk to start with, may, after a lapse of some time, yield worse results as judged by the ordinary bacteriological tests, than a milk containing initially an excess of filth but which has been maintained at a low temperature; or which has been examined shortly after milking." 96 When one considers the stages that milk has to pass through before reaching the consumer—(1) at the farm, (2) in transit, (3) in distribution at the locality, and (4) in the house of the consumer, it is no wonder that it is often an exceedingly impure article by the time it is consumed. Then too, milk has been practically proved often to contain the germs of certain diseases, such as Diphtheria, Scarlet Fever, Typhoid Fever, Tuberculosis, and certain forms of sore throat that has given rise to more or less widespread epidemics. There is no definite bacteriological standard laid down in the same way as the chemical one. but according to Dr. Lister, in the New York Department of Health "Milk above the temperature of 50 deg. Fahrenheit is there defined as adulterated; and whenever found in the hands of dairymen, carriers, dealers, or retailers, is liable to summary destruction." In the following examinations it will be seen that Acidfast bacilli were present in 3 samples; pointing to the probability of Tuberculosis beiug present in the udder of one or more cows from which the milk was derived. It must not be forgotten, though, that the absence of these bacilli does not prove the absence of the Tubercle, as the bacilli might not be present in sufficient numbers ; and it has been found that the inoculation of guinea-pigs with milk deposit has given rise to Tubercle, although there were no signs of the Acid-fast bacilli, on microscopical examination. Pus cells or abscess matter were found in 7 of the 25 samples examined, which points to the probability of some of the cows having some inflammatory affection of the udder. Unless present in large quantities and in association with other bacteria, probably no harm would result, but I can conceive no benefit in drinking "matter," even if bovine. The milk from these cows should not be mixed with other milk. 97 The following remarks by Dr. Houston in the abovementioned report are interesting, and are here given:— (1) B. Enteritidis SporcgonesTest.—Asminute amounts both of human fœces and cow dung give a positive result with this test, and as the spores of this anaerobe do not seemingly multiply in milk under ordinary conditions of time and temperature, it is obvious that the test, as a test, may be of considerable value in the bacterioscopic analysis of milk. Whether or not this anaerobe may on occasion be the exciting cause of Diarrhoea in the human being, is a controversial blatter which need not be considered here." (2) Coli Test.—Both human foeces and cow dung contain B. coli in abundance. Unfortunately B. coli multiplies rapidly in milk in summer temperature, so that the results obtained may be interpreted with gieat discretion. If, however, the proportion of a standard temperature (below 10 deg. Centiigrade) for milk be entertained, the test at once becomes of great value. Under these circumstances the B. coli test is a valualle means of measuring the degree of excremental pollution of milk, and also is a means of guaging its bacteriological status as regards potential danger to health." (3) "Streptococcus Test. — Streptococci are present in abundance in human saliva, in human foeces, in cow dung, and in many morbid affections of the cows' milk secreting apparatus. Moreover, serious epidemics of illness have been ascribed to the ingestion of milk containing specific Streptococci. Intrinsically this te6t would appear to be unsurpassed in judging the purity of milk were it not for two circumstances. One is that G 98 some Streptococci at all events, multiply rapidly in milk at summer temperature; the other is that the ' fore milk' of apparently healthy cows way sometimes contain numerous streptococci. Moreover, it is a matter of great difficulty to sift the harmful streptococci from those of the innocuous sort. The first difficulty may he surmounted of the imposition of a standard temperature for. milk (below 10deg. centigrade) be considered practicable; the second difficulty may perhaps eventually be solved by the discovery of new media and improved methods of isolating and differentiating streptococci." (4) "Total Number of Bacteria.— Bacteria multiply so rapidly in milk, that to judge the purity of a milk by the total number of microbes present in it, is open to many objections. Not least among these is the fact that the majority of bacteria in milk are innocuous. Yet even this test, although of subordinate importance to tests 1, 2, and 3, may be of some value if a standard temperature below lOdeg. centigrade be adopted." 100 BACTERIOLOGICAL ANALYSIS. Samples—Colleoted on 14th December, 1905, and delivered on same day, A B c D E Bacteria per e.c. 134,400 164,000 100,800 201,600 159,400 Bacillus coli in 1 e c. Present Present Present Present Present B. Enteritidis sparogones in 10 o.c. Absent Absent Absent Absent Present B. Enteritidis in 15 c.c. Absent Absent Absent Absent Present Centrifuoalized deposit: Amount Small Moderate Small Abundant Small Colour Grey Brownish Light Brown Light Brown with Black specks Pale Brown Epithelial Cells Present Present Present Present Present Organic Debris Present Present Present Present Present Pus Corpuscles Absent Absent Absent Absent Absent Blood Corpuscles Absent Absent Absent Absent Absent Staphylococci Present Present Present Present Present Slreptococoi Present Present Present Present Present Bacilli Present, no filaments Present, no filaments Present, many long filaments Present, no filaments Present, no filaments Aoid fast Bacilli Absent Absent Absent Absent Absent Moulds, spores of Present Present Present Present Present 101 GENERAL REMARKS UPON THE ABOVE. No sample could be considered really clean; all contained a certain amount of " dirt" in suspension. "D" was distinctly dirty, as also was "E." In no case was anything found indicating that the milk came from cows with diseased udders. Though Streptococoi were found in all, they were not associated with pus cells or blood corpuscles. Bacteria indicative of the presence of manurial dust were present in all, most marked in " E," which contained the Bacillus Enteritidis Sporogones as well as the Bacillus Coli. No Bacillus resembling the Tubercle Bacillus could be found in any of the samples. The number of Bacteria present was in all cases below the average of samples promiscuously collected. In samples "B" and "E" there were some organisms which liquified the gelatine so rapidly that they could not be counted after the second day. Doubtless, therefore, the numbers given were below the actual numbers present. 102 BACTERIOLOGICAL ANALYSIS. Samples —Collected on 20th December, 1905, and delivered on same day. F G H I J Bacteria per c.c. 93,000 436,000 176,000 61,000 83,000 Bacillus coli in 1 e.c. Present Absent Present Present Absent A Bacillus allied to the B. coli Present Present Present Present Present Bacillus Enteritidis Sporogones Doubtful Present Present Present Doubtful Cenirifugauzed deposit : 15 c.c. Milk Amount 3 loops 4 loops 2 loops 1½ loops 1½ loops Colour Very pale Fawn Pale Brown Darker Brown Pale Brown Grey Staphylococci Present Predominant Predominant Predominant Present Streptococci Predominant Few Present Present Present Bacilli Present Few Present Present Present Acid fast Bacilli resembling Tubercle Bacilli Absent Absent Absent Absent Present Spores of moulds Present Present Present Present Present Organic debris and Epithelial cells Present Present Present Present Present Blood Corpuscles and Leucocytes Absent Absent Absent Absent Absent 108 GENERAL REMARKS UPON THE ABOVE. In all cases the number of Bacteria present was so great that by the third day the plates were liquified, though the dilution used was I in 10,000 (1 c.e. to 10 litres of sterile water). The numbers given were the counts on the second day at end of 48 hours. The greatest amount of dirt and of Baoteria was present in "G." Streptococci were so prevalent in "F" as to suggest some infection of the cows' udder, but no definite pus cells could be found in the milk. The only sample containing Bacilli which may be Tubercle is "J." The cows should be examined or an inoculation test applied to ascertain if they are really Tubercle Bacilli. "H," "G," and "1" shew presence of fœcal matter; the other two, "F" and "J" are clean. 104 BACTERIOLOGICAL ANALYSIS. Samples—Collected on 4th January, 1906, and delivered on same day. K L M N O No. of Bacteria per c.e. 48 hours growth 370,000 2,120,000 450,000 460,000 360,000 No. of Bacteria per c.e. hours growth 540,000 4,000,000 All liquid 840,000 620,000 Bacillus coli in 1 e.c. Present An allied form. An allied form Present An allied form Bacillus Enteritidis Sporogoues in 2 c.e. Present - - - - Do. in 10 c.c. Present Absent Prest nt Present Present Centrifugauzed deposit: from 15 c.c. Quantity in loops 2 3 1½ 3 2 Colour Pale Grey brown Brown Pale grey brown Pale grey brown Brown Acid fast Bacilli Absent Absent Absent Absent Absent Predominant type of organism Staphylococci Staphylococci Staphylococci Staphylococci Staphylococci Blood corpuscle and pus cells NOT DEFINITELY RECOGNISED IN ANY SA,PLE. 106 GENERAL REMARKS UPON THE ABOVE. All the above contain an excessive number of bacteria and bacteria of manurial origin. "K" and "L" especially the latter, are worst in this respect. "L" and "N" contain most "dirt" but again "L" was the worse. No organism resembling the tubercle bacilli was found in any. None contained any number of Streptococci. 106 BACTERIOLOGICAL ANALYSIS. Samples—Collected on 14th January, 1906, "T" on 15th January, 1906, and delivered on 15th January. P Q R S T Bacteria per 1 c.c. at end of 48 hours growth 6,400,000 5,3:0,000 7,250,000 8,300,000 4,190,000 Bacteria of intestinal type in 1 c.c. (i.e. giving acid and gas in Bile Salt broth) + + - - + Presence or absence of true Bacillus coli in 1 c.c. - + - - + Presence or absence of Bacillus Enteritidis Sp. in 1 c.c. - - - - - Ditto in 10 c.c. A typical + — + + Centrifugalised Dkposit from 15 c.c. Amount in loops 3 2 2½ 1 2 Colour White, a few colored specks Grey Light brown Grey with specks Light brown Pus cells — + — + + Acid fast bacilli — — — — + Predominant organisms Strepto cocci Minute cocci Minute cocci Minute eocoi Minute cocci Hairs, epidemial cells, debris of veg-tissue spores + + + + + Abundant 107 GENERAL REMARKS UPON THE ABOVE. The milks contained an enormous number of bacteria, far in excess of what should be found in good clean milk. Organisms derived from manure were present in "Q," "T," and possibly in all but "R" and "S," but in much smaller numbers. All except "S" and "T" contained an excessive amount of "dirt" the most being in "P." Pus cells were formed in 3 out of the 5. The significance of this is not absolutely certain, but in all probability it means that in cows of all the herds supplying the milk in which pus cells were found, there were some suffering from a more or less inflammatory condition of the udder. Taking milk from known healthy cows we do not find such cells, nor were they found in "P" and "R." 108 BACTERIOLOGICAL ANALYSIS. Samples—Collected on 22nd January, 1906, and delivered on same day. U V w X Y Bacteria per c.c. at end of 48 hours 196,000 165,000 139,000 318,000 126,000 Bacteria of intestinal type in 1 c. c. (i.e. giving acid and gas in Bile Salt broth) + + + + + Presence or absence of true Baccilus Coli in 1 c.c. - - - - - Presence or absence of Bacillus Enteritidis Sparogones in 1 c.c. + - + + - Do. do in 10 c.c + + + + + Centrifugalized deposit from 15 c.c. Amount in loops 3 3½ 2 2 1 Colour Dirty Brown Grey-Brown Light Grey Light Brown Grey rus cells ' + - + + Many + Acid fast Baccili — - - - — Predominant organisms Diplococci Staphylococci Staphylococci Staphylococci Staphylococci Hairs, epidemal cells, debris of veg.-tissue, spores + + + + Very little GENERAL REMARKS UPON THE ABOVE. The milks contained an enormous number of bacteria, far in excess of what should be found in good, clean milk. All contained an excessive amount of "dirt," the most, being in "W" and "V." Pus cells were found in 4 out of the 5 samples, but were most abundant in "X." 109 110 THE COUNCILS' POWERS WITH REGARD TO THE LEGAL REGULATION OF ITS MILK SUPPLY. The powers respecting the regulation of the milk supply are embodied in the following Orders and Acts:— (1). The Dairies, Cowsheds and Milkshops Orders of 1855 and onwards. (2). The Infectious Diseases (Prevention) Act of 1890. (3). The Ilford Improvement Act of 1898. (4). The Ilford Urban District Council Act of 1904. (5). Sale of Food and Drugs Acts, 1875-1899. In No. 1, the Dairies, Cowsheds and Milkshops Orders the Council have power to compel:— (a) The registration of all milk sellers. (b) The reasonably suitable construction, as regards ventilation, drainage, etc., and water supply of new dairies and cowsheds. (c) The provision of suitable accommodation for the health and good condition of the cattle. Also for the cleanliness of milk vessels, etc., and for the protection of the milk therein against infection or contamination. (d) The prevention of any person suffering from a dangerous infectious disorder from handling milk in any way. (e) The abolition of any water-closet or privy which communicates directly with or ventilates into any dairy. 111 (f) The prevention of a dairy being used as a sleeping apartment. (g) The prevention of the milk from any cow with a tubercular udder from being mixed with other milk, or sold or used for human consumption. In 1902 the Council adopted under the same order, the following regulations.— (a) For the Inspection of Cattle in Dairies. (b) For prescribing and regulating the lighting, ventilating, cleansing, drainage, and water supply of Cowsheds and Dairies in the occupation of persons following the trade of Cowkeepers or Dairymen. (e) For the provision of 800 cubic feet of air space for each cow in cowsheds in which cows are kept that are not habitually turned out to graze for the greaterpart of the year. (d) For securing the cleanliness of milk stores, milk shops, and of milk vessels used for containing milk for sale by persons following the trade of Cowkeepers or Dairymen. (e) For prescribing precautions to be taken by purveyors of milk and persons selling milk by retail, against infection or contamination. Under No. 2, the Infectious Diseases (Prevention) Act, 1890:— If the Medical Officer of Health is in possession of evidence that any person in his district is suffering 114 from infectious disease attributable to milk from any dairy either within or without his district, such Medical Offioer shall, if authorised by an order of a Justice having jurisdiction in the place where such dairy is situated, have power to inspect suoh dairy, and if accompanied by a Veterinary Inspeotor, have power to inspect the animals therein, and if on such inspection the Medical Officer of Health shall be of opinion that infectious disease is caused from consumption of the milk supplied, he shall report thereon to the local authority, and the local authority may therefrom give notice to the dairyman to appear before them, within such time as may be specified, to show cause why au order should not be made requiring him not to supply any milk therefrom within the district until such order has been withdrawn by the local authority, etc. Under No. 3. the Ilford Improvement Act of 1898, Section 65, provides for the prohibition of any person who is suffering from infectious disease, milking any cow or carryingon any trade or business in such a way as to be likely to spread the infectious disease. Under No. 4, the Ilford Urban District Council Act of 1904 contains clauses for:— (а) Dairymen to notify infectious disease among their servants. (b) Medical Officer may require Dairymen to furnish list of sources of their supply of milk, and of persons supplied. (c) Compensation to dairymen. 113 (d) Compensation to persons ceasing employment through one of the above sections. (e) Penalty for selling milk from diseased cows. (f) Penalty on failing to isolate diseased cows. (g) Obligation to notify cases of Tuberculosis. (h) Power of Medical Officer to take samples of milk. (i) Power to inspect cows and take samples of milk. Under No. 5, the Sale of Pood and Drugs Acts. The obj ect of these acta is to prevent:— (a) The mixing of injurious ingredients with any article of food. (b) The selling of any such article if of inferior quality. (c) The selling of any such article from which abstractions have been made to effect its quality in j uriously. As Ilford is an urban district, the County Council administers this Act in this di.^trict, and is the proper authority to do so. The Council can also exercise all the powers of the Act, but owing to the fines being paid over to the County, they have decided not to incur the expense. To Summarise :— (1) The chemical standard of the Ilford milk, is, on the whole, fairly good. Three out of the 25 samples beiug below standard, or 12%. 114 (2) Bacteriologically examined, us a guide to the amount of dirt and outside matter gaining access to the milk, the result is not good; though probably no worse than most milks consumed in urban districts. (3) The absence of preservatives in all the milks examined is satisfactory, but the samples being taken in December and January, it is not the time of year when one would expect to find —em to any extent. (4) Though so much milk coming from outside the district, it is difficult to exercise any effective control over distant farms. Here a certain amount of good may be done by Local Authorities, but until the public awake to the fact of the importance of a clean milk supply, and insist upon getting it, ev6n at a slightly increased cost, it will be impossible to get sufficient care taken in milking and keeping the cattle clean. At present the Council should: (a) Continue to enforce their legal powers as to the condition of dairies in their district. (b) Exercise what control they can, iu voluntary association with the dairymen over the farms supplying milk to this district. (c) Have samples of the milk supplied to their district taken from time time; and, if necessary, take action under the Food and Drugs Aot on their own account independently of the county. (d) Make the following regulation under the "Dairies, Cowsheds and Milkshops Order" 115 "Every purveyor of milk, or person selling rr.ilk by retail, shnll cause every vessel containing milk for sale to be kept properly covered or to be otherwise sufficiently protected from contamination by dust or Hies." (e) Do all in their power to ensure proper cleanliness in all that pertains to the dairy, cowsheds, and cows; to encourage in every possible way proper and sufficient cooling of the milk below 50 degrees Fahrenheit. (f) Support any effort made to obtain compulsory powers to compel registration of farmers in districts to which they supply milk. MUNICIPAL MILK DEPOTS. As Municipal Milk Depots have been discussed to a great extent recently, a brief description may be of interest. The first one to be established in this country was at St. Helens, in 1899, aud since that time, depots have been started at Ashton, Liverpool, Battersea, and other places. In starting a depot the first thing is to ensure a supply of milk from a farm where the cows are not tuberculous, where the milking is conducted under cleanly conditions, cooled to 40 degrees Fahrenheit, and sent in sealed cans to the depot. It is then modified by the addition of water and cream in varying proportions according to the age of the baby it is to be provided for. 11$ I The following table gives the proportions whioh are taken from Dr. McCleary's book on "Infants' Milk Depots." Age of Child. Modification. No. of bottles per day. Amount per bottle. Amount per day. Daring 1st Fortnight. Milk 1 part, water 2 parts 9 1½ oz. 13½ oz. „ 2nd „ „ „ 9 2½ „ 22½ „ „ 2nd Month „ „ „ 9 2¼ „ 22½ „ „ 3rd ,, Milk 1 part, water 1 part 9 3 „ 27 „ „ 4th „ „ „ „ 8 4 „ 32 „ „ 5th „ Milk 2 parts, water 1 part 7 5 „ 35 „ „ 6th„ „ „ „ •y 7 5 „ 35 „ „ 7th „ Milk unmodified 6 6 „ 36 „ ,, 8th „ „ „ 6 6 „ 36 „ Over 8 months „ „ 6 7 „ 42 „ 117 This milk is then put into bottles in varying quantities, and then sealed and sterilized. According to the age of '.he child, bottles are supplied and filled with sufficient milk for one feed. These bottles are supplied in wire baskets, each basket holding from 6 to 9 bottles, and containing a 24 hours supply. So that all the parent has to do is to take one of the bottles, warm it, unseal and fit on a rubber teat, thus doing away with the "feeding bottle." At Battersea the following instructions are issued to each mother: — 1. "The charge for the full weekly supply of humanised milk for infants under 6 months is Is. 6d., payable in advance. If a day's supply only is taken, the charge is 3d. The charge for the full weekly supply for infants aged from fi to 12 months is 2s., or 4d. per day. Children above 1 year old will be charged 2s. 6d. per week, or 5d. per day. The scale of charges for children living outside the Borough is as follows Under 6 months 2s. 3d. per week, or 4d. per day. Six to 12 months 2s. 9d. 0d. „ Over 1 year old 3s. 3d. „ 6d. „ 2. The depot is open from 11 a.m. to 6 p.m. on weekdays, and is closed on Sundays. 3. The Milk will be supplied in bottles in a basket, each bottle containing sufficient milk for one meal, the amount varying with the age of the child. 118 lnfants under two months receive nine bottles per day; older children receive fewer bottles, as they should be fed less frequently. 4. If children are sent for the milk, they must be warned not to tamper with the stoppers of the bottles. On no account must a bottle be opened until the infant is ready to be fed. 5. Just before using, each bottled should be placed unopened in a basin or jug of hot water, and warmed to the proper temperature. The bottle should then be opened and the teat put ou. The child should be fed at regular intervals, and fed from these bottles only. On no account should any other feeding-bottle be used. The teat should be kept scrupulously clean. 6. When all the milk in one bottle is not used, the remainder must not be warmed up again, but a fresh bottle opened for th9 next meal. Where there are other children this milk need not be wasted. 7. On no account should any other food be given unless ordered by a doctor 8. After using, the bottles should be thoroughly rinsed in cold water. 9. Breakages will be charged for at the rate of Id. per bottle, and damage to baskets must be made good. Ali bottles, baskets, and rubber rings not returned to the depot will be charged full value. 119 10 It is important that the child should be brought once a week to be weighed. The depot is open for this purpose on Tuesdays and Wednesdays from 2.30 to 4 p.m. 11. The presence of infectious disease in a house mu9t be at once notified to the Medical Officer of Health, N.B.—The milk should never be used in preference to mothers' milk, which is the best of all foods for young infants." The homes of all the children fed on this milk are visited by the Lady Sanitary Inspector. The result of the milk depots cannot vet be definitely determined, but there is a growing body of evidence pointing to their beneficial influence on the Infantile Mortality in the districts where they have been introduced. The cost of fitting up a depot is given by Dr. McCleary, Medical Officer of Health for Battersea, as about 3£ 100 in his Borough; cost of appliances £150, and for fitting up and altering the premises £250. 120 He also gives the following table as Expenditure and Income for the years I90u to 1904 in St. Helens:— Current Expenditure. 1900—1901. 1901-1902. 1902—1903. 1903—1904. £ s d. £ s. d. £ s. d. £ s d. Wages for Attendance 115 11 5 119 2 2 116 7 9 108 13 11 Milk 272 9 2 185 5 10 185 13 4 123 19 2 Rent of House and Rates 18 0 0 18 0 0 21 15 0 22 3 11 Sugar 8 6 6 14 2 6 16 6 6 9 2 0 Fuel, Gas, and Water 9 4 0 9 19 10 15 4 8 12 2 8 Sundries 21 13 5 22 19 6 22 16 1 25 11 7 Renewal of Bottles, &c. 25 18 8 33 6 5 62 1 2 24 14 2 471 3 2 402 16 3 440 4 6 326 7 5 Income from sale of Milk 328 9 5 245 16 3 208 16 8 139 13 8 Amount falling on Rates 142 13 7 157 0 0 231 7 10 186 13 9 121 FOOD AND DRUGS ACTS. These Acts are administered by the County, and Mr. McKirdy, Chief Inspector, has kindly given me a return of the number of samples taken with the results which 1 here append: SAMPLES TAKEN IN ILFORD. No. taken. No. geuuine. No. adulterated. No. in which Reports are pending. Milk 82 69 7 6 Butter 59 47 4 8 Jum 3 3 — — Bread 1 I - - Totals 145 120 11 14 SECTION V. Sanitary Administration. 125 MEAT SUPPLY. This is nearly all obtained from the Central Market at Smithfield; but there are three slaughter-houses licensed annually, in which a few beasts, and more sheep and pigs are killed. One is satisfactory, the others are not so good, but are periodically inspected. VEGETABLE AND FRUIT SHOPS. These have been frequently inspected. OFFENSIVE TRADES. There are none in the district. FACTORIES. The duties of Sanitary Authorities with regard to factories are not extensive, and are practically limited to supervision with regard to provision of means of escape iu case of fire, and also of sufficient sanitary convenience. The following is a list of the factories in the district:— Laundries (Steam) 4 Saw Mills and Joinery Works 6 „ Wheel Works 1 Biush and Veneer Cutter 1 Printers 5 Engineers 1 Granary 2 Chemical Works 2 Photographic Plate Works, etc. 1 Paper Mill 1 Carriage Works 3 Carried forward 27 126 Brought forward 27 Gas Works 1 Electric Light Works 1 Celluloid Collar Works 1 Brickfields 2 Furniture Makers 1 Patentee 1 Total 34 WORKSHOPS AND WORKPLACES. Under the Factory aud Workshops Act, 1901, each Local Authority is obliged to keep a register of Workshops and Workplaces, and to forward to other Authorities the addresses of outworkers employed bv masters in their district, but who reside in other districts. The Medical Officer of Health is required to report to the Home Office aud the Local Government Board on the administration of the Act in their district during the preceding year, with regard to:— (a) Cleanliness. (b) Air space. (c) Ventilation. (d) Drainage of doors on which wet processes are carried on. (e) Provision of suitable aud sufficient sanitary conveniences. Three hundred and seven have been inspected during the year. 127 They are : — Dressmakers 86 Milliners 24 Tailors 28 Bootmakers and Repairers 47 Sadlers and Harness Makers 5 Hand Laundries 14 Smiths 6 Cycle Makers and Repairers 6 Motor Makers and Repairers I Stonemasons 6 Picture Framers 5 Upholsterers 5 Surgical Belt Makers 2 Watch and Clock Repairers 6 Glass Cutter 1 Electrical Fitters 4 Umbrella Repairers 6 Undertakers 6 Carpenters and Joiners 13 Carriage Builders & Wheelwrights 6 Plumbers 3 Dentists 2 Printers 1 Feather Dressers 4 Lace Workers 2 Basket Maker 1 Signwriter 1 Domestic Machinist 1 Tie Makers 3 Wearing Apparel 8 Florists 5 307 128 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK 1 .—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspector of Nuisances. Premises. Number of Inspections Written Notices. Prosecutions. Factories (including Factory Laundries) 34 Nil Nil Workshops (including Workshop Laundries 323 26 Nil Workplaces Nil Nil Nil Home workers' Premises 56 Nil Nil Total 413 26 Nil 129 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions Found. Remedied. Referred toH.M. Inspector. Nuisances unner the Public Health Aits:— Want of cleanliness 3 3 Want of ventilation Overcrowding 4 3 Want of drainage of floors 3 2 Other nuisances 28 27 Sanitary accommodation insufficient 2 2 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) 10 9 Failure as regards lists of outworkers (a 1071 13 13 Giving out work to be done in premises which are unwholesome (S. 108) infected (S. 110) Allowing wearing apparel to be made in premises infected by scarlet lever or small pox (s. 109) Other offences Total 63 59 130 3.—OTHER MATTERS. Class. Number. Mat tors notified to H.M. Inspector of Factories Failure to affix Abstract of the Factory and Workshop Act (s. 133) 26 Action taken in matters referred by H.M. Inxpectors as rempdialde underthe Public Health Acts, but not under the Factory Act (s. 5) Notified by H.M. Inspectors Reports (of action taken) sent to H.M. Inspectoi Other Underground Bakehouses (s. 101) Certificates granted during the year In use at the end of the year 1 Homework:— Number of hist. of Outworkers (s. 107) : — Lists. Outworkers. 1 Lists received 33 34 Addresses of outworkers forwarded to other Authorities 39 received from otherAuthoritie 26 Wearing Apparel; Otber. Homework in unwholesome or injected premises:— Notices prohibiting homework in unwholesome premises (s. 108) Cases of infectious disease notified in homeworkers' premises Orders prohibiting homework in infected premises (s. 110) Workshops on the Register (s. 131) at the end of the year 307 Bakehouses 32 Total number of workshops on Register 339 131 For 1904 there were 293 on the register. For 1903 there were 250 on the register. 26 notices were sent under the Public Health Act. Notices of outworkers residing in this district were received in 26 instances from other Authorities. A record is kept of their addresses. Notices of outworkers residing in other districts were sent in 39 instances. A list of outworkers supplied by 13 employers was kept; 26 notices were sent to the Factory Inspector, where young persons were employed and no abstract of tlie Act was posted. There are several small laundries in the district, worked by members of one family, which are, of course, outside the scope of the Factory Act; but in any fresh Act they should be brought in. BAKEHOUSES. There are 32 bakehouses in the district. There is 1 underground bakehouse in the district. Frequent inspections have been made, and are required, to keep some of them in a reasonably suitable condition. WATER SUPPLY. The district is supplied by the Metropolitan Water Board on all that portion north of the Cranbrook Road, and including Fencepiece. Analysis has given satisfactory results. The other portion of (he district is supplied by the South Essex Water Company. This water has given a much better 132 result on analysis, thau has occurred before. This company is siuking a well in the Roding Valley in this district, and also one in Mill Road. REMOVAL OF HOUSE-REFUSE. Collection is made once a week throughout the whole district, and is carried out by the Council. Previous to 1901 this work was carried out by contractors ; but in that year part of the district wns scavenged by the Council tliemselvf s, and it was found possible to do it more efficiently and cheaply than it was done under the contract system in 1902, the Council decided to take the whole district. It is uuder the .Direction of the Sanitary inspector, and is carried out very efficiently. The refuse is taken to the brickfields. Most of the dustbins are portable ones, and supervision is exercised to see that suitable receptacles are used and kept in order. In the New Jlford Urban District Council Act a clause has bc< u obtained as to the regulation of provision of d ustbics. SEWAOE WORKS. Good progress has been made with the extension of the Sewage Works during the year. Two i.ew grit chambers have been provided, and two screens similar to those already in use. 133 Two open septic tanks have been laid down with a capacity of 950,000 gallons each; and the old settling tanks have been knocked into one, making another open septic tank of 600.000 gallons capacity. Making in all a cnpacity of 2,5(10,000 gallons. Also a storm roughing filter of an area of 1,178 yards has been laid down, made of clinker three feet in depth. Two-and-a-half acres of contact beds have been started and split up into ten beds. These will be filled with coke breeze five feet in depth, and of such a size as to pass through a screen excluding all above two inches, and all below one inch. It is expected that these beds will be completed by the spring of 1906, and be in full working order then. The effluent passes from the works to empty into the river Thames below Barking Creek. SECTION VI Report of Sanitary inspector. 137 ANNUAL REPORT OF Chief Sanitary Inspector Public Healih Department. Council Offices, Ilford., 13th March, 1906, To the Chairman and Members of the Ilford Urban Distrirt Council. Gentlemen, I have the honour to submit to you my Thirteenth Annual Report, and in doing so, desire to express my appreciation of the kindness and support I have received from the Public Health Committee. Mr. Monkcom, and also Mr. Haigh who commenced his duties in April last, have both done good work as Assistant Sanitary Inspectors, and 1 believe they have conscientiously endeavoured by their effort, to maintain the sanitary condition of the district in a high state of efficiency. 138 1 must also record my approval of the satisfactory manner iu which Messrs. Bull and Aldous, the Clerks, have worked. They have always been willing, obliging aud paintaking. A word of praise is also due to Mr. May, the Dust Foreman. To his steady working and courteous manner, the efficiency in the collection of the house refuse is, to a great extent, due. I also appreciate and desire to acknowledge the kind co-operation of the other officials. 1 am, Gentleman, Your obedient Servant, F. W. KING, Chief Sanitary impector. NUISANCES. For the detection and abatement of nuisances, the district has been systematically inspected, especially in the localities where they are likely to exist and recur. As a result, the following work was carried out:— Drainage. Drains cleansed 258 Do. repaired or relaid 93 W.C. pans and traps provided 67 Flushing cisterns to W.C.'s repaired or provided 138 Soilpipes repaired or renewed 22 Ventilating shafts repaired or provided 35 Cesspits and privies abolished 18 Do. do. do. emptied and cleansed 25 W.C. floors cemented 49 139 Dra in age—continued. Rain-water pipes disconnected from drains 4 Ditches cleansed 6 Water laid on to closets 6 Premises connected with main sewer 7 Sink-waste-pipes provided and repaired 20 Do. do disconnected from drain 1 Bath-waste-pipes do. do. 1 Yards drained 14 Manhole covers fitted 26 Manure pit drained 2 Defects in Dwelling-Houses. Roofs repaired 40 Yard paving repaired. 92 Rain-water spouts repaired or provided 41 Water laid on 7 Houses or parts of houses cleansed 40 Bedding cleansed 7 W.C.'s cleansed 5 Overcrowding abated 2 Yards cleansed 16 Dilapidated houses repaired 11 Basements ventilated 11 Trough-sink provided 1 Llford Improvement Acts. Yards paved 13 Galvanized iron dustbins provided 161 Ice-cream vessels cleansed 1 Byelaics Water storage cisterns cleansed 124 Do. do. do. covered 89 140 Dairies Regulations. Milk stores cleansed 10 Accumulations of Refuse, &c. Manure, soil and urine removed 30 Fish offal removed 1 Refuse removed 43 Manure pit provided 2 Stagnant water removed from basements 17 Workshop Acts. Yards paved 3 Overcrowding abated 2 Ceilings repaired 2 Walls, floors and ceilings cleansed 21 W.C.'s cleansed 1 W.C.'s provided 1 Hoods fitted 2 Floors paved 3 Bakehouses cleansed 20 Infectious Diseases (Prevention) Act Rooms stripped and cleansed 34 GKenekallt, Animals (improperly kept) removed 11 Smoke nuisances abated 3 Roadways, courtways, and rear ways paved and drained 3 Roadways, courtways, and rearways cleansed 3 Fowl-houses cleansed 1 Quarry filled in 1 Lands fenced in 2 141 NOTICES SERVED. Notices. Served 1905. Complied with, 1905. Outstanding, January, 1906. Statutory 33 46 1 Preliminary 219 237 2 Do. (by letter) 115 115 — Pave Yard (Ilford Improvement Act) 9 13 1 Dustbins (Ilford Improvement Act) 116 107 9 Cleanse Cisteru (Bve-laws) 127 125 6 Cover do. (Do) 62 64 2 Lay on water to Dwelling-House 5 5 1 Cleanse Dwelling-House, (Infectious Disease (Prevention) Act, 1890) 12 12 - Workshop 26 22 6 Abate overcrowding 1 1 — Totals 725 *747 28 * Included in this number ure some notices outstanding previous to 1905. Where a nuisance is found, the procedure is to call the attention of the owner or occupier (as the case may be), to the fact by letter or preliminary notice. If no action is taken, the matter is brought before the Committee, and if necessary, the}' recommend to the Council that a statutory notice be served; and if not complied with within the time stated, legal proceedings to be taken. As you will see under the heading "Notices Served," very few statutory notices were issued. Most of the work 142 mentioned in the above statement was executed, upon the owner or occupier receiving either a letter or preliminary notice, calling attention to the particular defect or breach of bye-laws, and stating the remedial measures required to be carried out. I find most owners of property willing to carry out my requirements, provided I can convince them they are not unreasonable. This is borne out by the fact that 110 legal proceedings had to be taken during the year, to enforce compliance with a notice. SUMMARY OF VISITS AS ENTERED IN JOURNAL DURING THE YEAR ENDED 31st DEC., 1905. Houses and premises inspected 2746 Do. do. do. during progress of work 3405 Nuisances detected 832 Do. abated 846* Do. unabated 20 Complaints received 186 Houses disinfected 382 Articles do. 5415 Summonses taken out 5 Convictions 3 Amount of fines 5/-, 10/- & 40/-, = £2 15s. 0d. * Included in this number are some nuisances outstanding previous to 1905. 143 COMPLAINTS. The complaints received were as follows:— Choked drains 84 Sewage smells pervading the neighbourhood 18 Accumulations of refuse and manure 22 Animals improperly kept 10 Smoke nuisances 8 No water supply 7 No water to W.C.'s 2 Houses being dirty and insanitary 9 Decomposing bodies of animals 4 Flooding of premises 4 Gipsies 2 Streams being obstructed 2 Overcrowding 1 Sundry 4 Total 177 All of these were investigated at once, and accordingly dealt with as necessity demanded. GIPSIES AND TENT DWELLERS. Very little trouble was given by these people during the past year The annoyance caused by them formerly, must, I think, diminish as the laud becomes built over. However, the system adopted of caliing upon the Police for assistance in order to prevent a breach of the peace, and going to the encampment with some men and a chain-horse to draw the 144 vans ou to the highway, and by generally worrying them, also tends to keep these most undesirable visitors out of the district. PERIODICAL INSPECTIONS. 1. Cowsheds (7). These are situated as follows:— Hainault Farm, Chadwell. Padnall Corner (2), Chadwell. While Rose Hall, Barkingside. '245, High Road, rear of New Road. Green Lane. All these have been visited, and ou the whole they have been kept in a satisfactory condition. It is, however, quite necessary to visit them frequently, as iu one or two cases the occupiers are inclined to show laxity in the care of the premises as regards cleanliness. 2. Dairies & Milkshops (44). These have been frequently visited, and careful attention given so as to obtain cleanliness of the vessels, and suitable accommodation for storing the milk under suitable conditions. 3. Bakehouses (32). The bakehouses have been frequently inspected and limewashing aud cleausiug carried out when accessary. The general conditiou ol' them may Lie stated as satisfactory. 14-5 4. Workshops. There are 307, including laundries and domestic workshops, on the register. These have been visited and notices served to abate any nuisances when found to exist. Overcrowding was abated in two instances. 5. Slaughter houses These are situated as follows - Rear—3, The Pavement, Ilford Lane. Rear—60, High Street. Rear—The Post-Oftiee, High Street, Barkingside. HOUSING OF THE WORKING CLASSES ACT. No action under this Act had to be taken during the year. Sixteen cottages however were pulled down to make room for other buildings, viz :—Roding cottages (10) for erection of Pumping Station for the S.E.W.W. Co., and Goodmayes Cottages (6) for a Church. These cottages were let at about 4/6 or 5/- per week, and as none are now erected to let at a like rental, it is to be assumed that these families are now living in part of a house where there is also another family living. INSPECTION OF FOOD. Periodical visits were made to the shops in the distriot for the purpose of inspecting food exposed for sale, but n0 seizures of unsound food had to be made. 146 INFECTIOUS DISEASES. Nearly every house in which any iufectious disease occurred was visited ; the sanitary avrangements and surroundings being carefully inspected for the purpose of ascertaining whether any defects or nuisances existed. Directions were given as to isolation and the usual rides to be obtained to prevent the spread of disease. Inquiry was also made to ascertain the probable origin of the disease, and where possible the history traced. The result of the enquiry was then reported to the Medical Officer of Health. The number of infectious diseases notified and entered in the Register was 446. WATER SUPPLY. Very few complaints were received respecting shortage of water, and these, upon investigation, showed that the cause was due to defective fittings. There were only 11 intimations from the Metropolitan Water Boai d, of water being cut off from inhabited houses. These houses were at once visited and notice served upon the responsible person, to reinstate the supply within 4H hours. No intimation is given by the S.E.W.W. Co , when they cut off the supply, although I frequently requested them to give me this information. 147 In the Ilford Improvement Act, 1898, there is a provision as to houses without a water supply, and the Owner is liable to a penalty of £o for allowing a dwelling house to be occupied without a proper and sufficient supply. REMOVAL OF HOUSE REFUSE. The removal of house refuse during the year ended the 31st December, was, I consider, carried out most satisfactory, both as regards efficiency and cost. Very few complaints were received, and these when investigated were found generally to be caused through no fault of the men, but rather to a misunderstanding respecting our method of collecting and principally among the new residents. A slight disorganisation occurred through no collection being made on Public Holidays, especially at Easter, although the dustman gave notice to the house-holders the week before that the collection would be made either a day earlier or a day later (as the case might be> the following week. Since then I have given public notice either by printed notice posted on the vans, or announcement, in the local newspapers. However, the collection on these occasions would have been facilitated had, the house-holders allowed the dustbins to be emptied each week, and not have allowed the refuse to accumulate for two or three weeks. All appear to wish to see their dustbins clear of superfluous refuse at holiday time, but they do uot seem to realize the extra labour involved, and at a time when we are practically doing two days work in one, by failing to allow the dustbins to be emptied weekly 148 The cost of the work for collection and disposal of the refuse I must leave over until the end of the financial year, yet it will not exceed the estimate. The number of loads of refuse removed aud the number of horses and vans engaged in the collection was as follows:— Loads of refuse. Horses and Vans. January 828 220 February 816 220 March 1,029 275 April 851 231 May 1,033 287 June 806 230 July 762 232 August 949 290 September 772 232 October 810 233 November 1,050 304 December 848 246 Totals 10,554 3,000 The number of days upon which collections were made was 307. The aveiage number of horses and vans engaged per day was 9 77. The average number of loads of refuse removed per horse per day was 3"51. The capacity of the vans is 3 cubic yards, and allowing as a fair average that a load of refuse weighs 1 ton 6cwt., the total number of loads represents in weight about 14,000 tons. 149 About 1,000 houses were erected during the year, and these had to be visited as they became occupied. I estimate thure are about 12,500 houses in the district from which the refuse is removed weekly The refuse is also collected from the Village Home each week. It will thus be seen that the average number of horses and vans engaged, and the number of loads of refuse removed per horse per day is very satisfactory, especially taking into consideration the position of the tip, and the bad condition of the approaches to same during wet weather. DISPOSAL OF HOUSE REFUSE. As in former years most of the refuse has been carted to the brickfields where it is piled in large heaps, and there to remain in a more or less state of decomposition until reduced to a condition that it can be broken down and sifted. The tine sittings are mixed with the clay used for making bricks, aud the cinders are used for burning the bricks. The coarser material is then thrown into the holes from where the clay to make the bricks was dug out. Complaints respecting the depositing of house refuse in the brickfields, and the nuisances arising therefrom were far less numerous than in former years This no doubt was due iu some measure to the climatic conditions, but every precaution was taken after the refuse had been deposited, to minimize any nuisance that would arise, by levelling and covering with dry material. loO The difficulty of disposing of the refuse is becoming greater every vear. At the present time there is only one brickfield where a shoot is available, and should anything occur to prevent us going there, we should be in a very awkward position. It is therefore absolutely necessary that the question of "What shall be done with the dust," must be very seriously considered without delay. F. W KING, Chief Sanitary Inspector.