' i * Ilford Urban District Council. ANNUAL REPORT of the Medical Officer of Health FOR THE YEAR 1906. C. F. STOV1N, M.A., D.P.H., Medical Officer of Health, and Medical Superintendent of the Isolation Hospital. ILFORD- SOUTH ESSEX RECORDERS, Ltd., Printers. PUBLIC HEALTH COMMITTEE, 1906—1907. Chairman: Councillor E. Reynolds. Vice-Chairman: Councillor Hammond. Councillors: J. A. G. Bodger, J.P. (Chairman of the Council). T. Philpot (Vice-Chairman of the Council). G. Church. G. E, Partington. W. J. T. Cullis. J. H. Souster. F. G. Grimwood. R. Stroud, C.C. G. T. Walter. HOSPITAL SUB-COMMITTEE, 1906-1907. Chairman: Councillor W. J. Hammond. Councillors: G. Church. R. Stroud, C.C. G. E. Partington. G. T. Walter. J. H. Souster. E. Reynolds (Ex-officio). 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. C. W. Fisher, Assoc. 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 1906. I estimate the total population at 69,745, or, excluding the public institutions, 65,165. 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 correct. The death-rate for the year was 9.8, or, corrected for age and sex distribution, so as to be comparable with other districts, 10.5. The birth-rate was 26.1. 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. With regard to 6 this matter, I cannot do better than repeat what I said last year in my report, as the conditions are still similar, viz.:— "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, 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 born. In Ilford, as I pointed out in 1904 and again during the past year, a great part of the death-rate is due to want of knowledge, and help in that direction, I am more and more convinced, would be attended with beneficial results. Of course the problem is a very complex 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 an increase in the total number of infectious diseases over the previous year, 548 being notified for 1906, as against 446 for 1905. On referring to the various tables it will be seen that there has been an increase in all the diseases, and it has not been due to any one. Scarlet Fever has been somewhat prevalent, but has been fairly distributed throughout the district, and there never appeared to be any one common source of infection. The same remark also applies to Diphtheria. As I poinetd out last year, I am sure that the "school supervision" is a very great help with regard to these two diseases, as I have seen a large number of children with sore throats, and it was 7 difficult to say whether or not they were infected with something more. By excluding these children from school a very great safeguard was brought into action. Complaints, during the year, have been received both with regard to the method of dust and sewage disposal. These matters have received the careful and constant attention of the Council, with a view to removing any future cause of complaint. This year the return of deaths is more correct than it has hitherto been, as we have been able to obtain returns of Ilford residents dying in London and the various outside institutions, i.e., Romford Infirmary and the County Asylum, Brentwood. 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. 15 Statistical Summary 17 Population 19 Births 21 Deaths 22 Zymotic Death-Rate 23 Mortality in Age Groups 24 Inquests 24 Infantile Mortality 25 Table V. of Local Government Board Facing Page 28 Weekly Rainfall for Year 29 Table I. of the Local Government Board 30 ,, IV. ,, ,, ,, ,, 32 SECTION II. Infectious Disease. 33 Infectious Disease 35 Scarlet Fever 35 Diphtheria and Membranous Croup 37 10 CONTENTS. Section 11.—continued. packs. Enteric Fever 38 Erysipelas 40 Puerperal Fever 41 Measles 41 Chicken Pox 42 Whooping Cough 43 Phthisis 43 Respiratory Diseases other than Phthisis 44 Cancer 44 Table III. of the Local Government Board 46 Table giving Death-Rate from various Infectious Diseases during past 15 years 47 Isolation Hospital. 48 Diseases treated in Hospital 48 Average stay in Hospital 49 Table of Admissions 51 Administration 52 Scarlet Fever 53 Return Cases of Scarlet Fever 54 Woodford Urban Council—Number of Admissions, etc. 55 Disinfection 56 Table of Houses, etc., disinfected 57 SFCTION III. Schools. 59 Summaries of Infectious Diseases reported in connection with Schools Facing Page 60 Infectious Disease and Medical Inspection 61 Scarlet Fever 64 Diphtheria 65 Measles 66 11 CONTENTS. Section III.—continued. pages. Chicken Pox, Mumps, and Whooping- Cough 67 Ringworm 67 Vision 68 Hearing 68 Minor Defects 68 Defective, Epileptic, and Backward Children 69 School Closure 70 SECTION IV. Sanitary Administration. 71 Food and Drugs Act 73 Meat Supply 74 Vegetable and Fruit Shops 74 Offensive Trades 74 Factories 74 Workshops and Workplaces 75 Tables of Home Office 77 Bakehouses 81 Water Supply 82 Removal of House Refuse 83 Milk Supply 84 Sewage Works 84 SECTION V. Report of Sanitary Inspector. 85 Nuisances 88 Drainage 88 Defects in Dwelling-Houses 89 Ilford Improvement Acts 90 Bye-Laws 90 Dairies Regulations 90 12 CONTENTS. Section V.—continued. pages. Accumulations of Refuse, etc. 90 Workshop Acts 91 Infectious Disease (Prevention) Act 91 Generally 91 Notices served 92 Summary of Journal 93 Complaints 94 Gipsies and Tent Dwellers 95 Periodical Inspections 95 Cowsheds 95 Dairies and Milkshops 95 Bakehouses 96 Workshops 96 Slaughterhouses 96 Housing- of Working Classes Act 96 Inspection of Food 97 Infectious Diseases 97 Water Supply 97 Removal of House Refuse 98 Disposal of House Refuse 100 13 PHYSICAL AND GEOLOGICAL FEATURES. The surface generally is gently undulating, flatter in the southern and more thickly inhabited portions, 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 area of brick-earth lying roughly in the angle between the junction of the Romford Road with the Ilford Lane, extending down the Romford Road nearly as far as St. Mary's Church, and down Ilford Lane nearly to Uphall Farm. The rest of the subsoil is gravel. SECTION I. Vital Statistics. 17 STATISTICAL SUMMARY. Enumerated Population at Census, 1901 41,234 Estimated ,, ,, middle of 1902 49,000 ,, ,, ,, ,, 1903 54,226 ,, „ ,, 1904 59,700 ,, ,, ,, ,, 1905 65,021 „ ,, ,, ,, 1906 69,745 Area of District in Statute Acres—Land 8,470 ,, ,, ,, Inland Water 26 ,, ,, ,, Tidal ,, 7 .Density of Population, i.e., No. of Persons per acre 8.2 Average No. of Persons per acre in 33 great towns 32.4 Total number of births registered in 1906 1,701 Representing a birth-rate of 26.1 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 1906 645 Representing a nett death-rate of 9.8 Total number of deaths registered in 1905 549 Representing a nett death-rate of 8.9 18 Total number of deaths registered in 1904 563 Representing a nett death-rate of 10.4 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 seven principal Zymotic diseases in 1906 97 Representing a Zymotic death-rate of 1.4 Total number of deaths from the seven principal Zymotic diseases in 1905 60 Representing a Zymotic death-rate of 1.0 Total number of deaths from the seven principal Zymotic diseases in 1904 120 Representing a Zymotic death-rate of 2.2 Total number of deaths from the seven principal Zymotic diseases in 1903 66 Representing a Zymotic death-rate of 1.3 Total number of deaths from the seven principal Zymotic diseases in 1902 47 Representing a Zymotic death-rate of 1.05 Total number of deaths from the seven principal Zymotic diseases in 1901 110 Representing a Zymotic death-rate of 2.6 Infantile mortality rate for 1906 109.9 ,, ,, ,, 1905 86.9 ,, ,, ,, 1904 127 „ ,, ,, 1903 92.6 „ ,, ,, 1902 74.2 ,, ,, ,, 1901 156.5 19 Rateable Value—Houses £368,327 10 0 ,, ,, Land 7,678 10 0 £376,006 0 0 Inhabited Houses, 1906 13,299 ,, „ 1905 12,335 ,, ,, 1904 11,045 ,, ,, 1903 10,132 ,, „ 1902 9,088 ,, ,, 1901 7,649 POPULATION. I estimate the total population for 1906 at 69,745. 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 65,165. It is arrived at thus:— Total number of houses in district 14,549 Total number of inhabited houses in district 13,299 Total number of uninhabited houses in district 1,250 At the Census in 1901 there were:— Number of inhabited houses 7,649 Number of uninhabited houses721 Total number of houses 8,370 20 Since then certificates for new houses have been granted by the Council as follows:— From 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 From July, 1905, to June 30th, 1906 964 Making the total for the past year14,549 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 districts for the number of persons per house to increase, so that this error, if present, under-estimates rather than overestimates 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's 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 21 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 57,432. BIRTHS. The number of births reg-istered during the year was 1,701, giving a birth-rate of 26.1. 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 ,, 1906 ,, ,, ,, 1,701 65,165 26.1 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. 22 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 1906 was 920. The total number of deaths registered for the district proper, apart from the institutions, is 645. These include deaths in:— London Hospital 32 Metropolitan Hospital 1 Evelina Hospital 1 National Hospital 1 Chest Hospital, Victoria Park 2 Children's Hospital, Great Ormond Street 1 St. Luke's House 1 Passmore Edwards Hospital, East Ham ... 1 Westminster Hospital 1 St. Peter's Hospital 3 Guy's Hospital 3 Holborn Infirmary 1 Bethnal House Asylum 1 East London Hospital 1 Middlesex Hospital 2 St. Bartholomew's Hospital 3 City of London Asylum, Stone 1 West London Hospital 1 North-Eastern Children's Hospital 1 Whitechapel Infirmary 1 Ilford Isolation Hospital 11 Dagenham Isolation Hospital 1 Romford Infirmary 30 County Asylum 7 Total 108 23 This gives a death-rate of 9.8 for the year 1906 for the district proper, or a corrected death-rate of 10.5. The death-rate was 9.0 for the year 1905. ,, ,, ,, 10.4 ,, ,, 1904. ,, ,, ,, 10.0 ,, ,, 1903. ,, ,, ,, 9.3 ,, ,, 1902. ,, ,, ,, 11.1 ,, ,, 1901. Of non-residents dying in Institutions in the district:— Claybury Asylum 223 West Ham Asylum 132 Dr. Barnardo's Homes 16 Ilford Isolation Hospital 4 Total 375 Zymotic Death-rate.—The number of deaths registered from the seven principal zymotic diseases for the year 1906 was giving a zymotic death-rate of 1.4 per 1,000. In previous years it has been as follows:— 1900 70 1.8 1901 110 2.6 1902 47 1.0 1903 66 1.3 1904 120 2.2 1905 60 1.0 24 The seven diseases included in this rate are:— Diseases. Deaths Deaths 1906. 1905. Small Pox - - Measles 5 3 Scarlet Fever 3 4 Whooping Cough 11 14 Diphtheria 11 4 Typhoid Fever 1 4 Diarrhœ (epidemic) 66 31 Totals 97 60 Mortality in 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 1906 187 207 148 INQUESTS. In 1902 there were 26 Inquests held. „ 1903 „ 46 „ „ 1904 „ 37 „ „ 1905 „ 22 „ „ 1906 „ 41 „ 25 Infantile Mortality. The number of deaths registered for children under 1 year of age was 187, giving an infantile mortality rate of 109.9 deaths to every 1,000 births registered. The infantile mortality rates for Ilford during the past five years have been as follows:— 1901. 1902. 1903. 1904. 1905 156.5 74.2 92.6 127.0 86.9 This rate for 1906 was:— No. of Deaths under 1 year. Rate per 1,000 Births registered. Ilford 187 109.9 Acton 201 130 East Ham 463 127 Colchester 125 129 Southend-on-Sea 156 142 Wimbledon 175 148 It will thus be seen that this rate is higher during the past year again, although it compares favourably with the above towns taken at random, but approximating to Ilford in character, population, etc. As I have drawn attention in former years to this rate, I do not propose to say much this time, but I am still of opinion that in a district like this the rate should not exceed 90, and with care might approximate 80 deaths per 1,000 births. By referring to the accompanying table it will be seen that out of this total of 187 deaths 59 were due to Diarrhœa 26 in its various forms. As these are very largely preventable, it is in this direction that every preventive effort should be made. As I have said in former years, I am convinced that the question in Ilford is one largely of ignorance. During the year a conference on infantile mortality was held in London, and the scope of the conference can be seen from the following resolutions passed by the meeting:— (1). That the Education Department be urged to add instruction in elementary hygiene with reference to the dietary and rearing of infants in their present scheme for systematically training girls in the senior classes in the practice and principles of personal hygiene and the elements of dietary. (2). That, in the opinion of this conference, immediate legislation is required enabling Sanitary Authorities to establish or support depots for the supply of pure, modified, or sterilised milk, and to defray any cost out of the monies available for public health purposes. (3). That, in view of the information submitted, the conference is of opinion that all still births should be notified within 48 hours to the medical officer of health of the district in which they occur, and that no burial should take place without a medical certificate. (4). That notification of all births he given within 48 hours to the medical officer of health of the district in which they occur. (5). That in the opinion of this conference the question of the insurance of infant lives under twelve months is one demanding serious consideration, and with 27 a view to receiving reliable information the Government should be asked to appoint a departmental committee of inquiry on the whole question. (6a). That the period of one month's abstention from factory work away from the home now imposed on mothers be extended to at least three months, and that, on their return to work, evidence must be produced satisfactory to the local authority that proper provision has been made for the care of the child. (6b). That no employer of labour shall permit a woman advanced in pregnancy to engage in factory labour unless her ability therefor has been certified to the satisfaction of the local authority. (7a). That having regard to the ascertained fact that in centres of industries where women are largely employed away from their home, an excessive number of deaths of infants takes place, and that this is contributed to by the improper conditions existing at the houses in which infants are placed cut to nurse, it is necessary that the persons by whom and the places into which infants are received should be under supervision by the local sanitary authority. (7b). That the Infant Life Protection Act should be amended to remedy abuses which are not at present provided against. (8). That all preparations offered or sold as food for infants should be certified by a government analyst as non-injurious, and that each packet should contain its analysis. 28 (9). That the Dairies, Milkshops, and Cowsheds Order is defective, and that any amendment should extend the definition of disease as applied to animals, and should make the provision of regulations by local authorities compulsory. That the scope of the regulations should be extended to cover dirty milk, and should enable local authorities to prohibit the sale of any milk which fails to comply with the conditions of purity agreed upon. (10). That in the opinion of this conference the appointment of qualified women specially trained in the hygiene of infancy is necessary as an adjunct to public health work. (11). That in the opinion of this conference the Midwives Act, 1902, should be extended to Scotland and Ireland. Recommendation No. 10 is the one I have constantly urged on this Authority, as, with a population of the type it is, education is the necessary factor to obtain a better condition of things. Of the cases of Infective Enteritis that occurred in the summer, Mr. King made enquiries in 35, and found that of that number only 4 were fed on the breast entirely. Two were fed on breast and other food as well. 1 he others were fed as can be seen from the following table:— Breast Fed. Breast and other Food. Cow's Milk. Condensed Milk. Cow's Milk and Condensed Milk. Patent Food. 4 2 9 10 6 4 TABLE V. INFANTILE MORTALITY DURING THE YEAR 1906. 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. i. Common Infectious Diseases. Small-pox ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Chicken-pox ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Measles ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... 1 Scarlet Fever ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Diphtheria: Croup ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Whooping Cough ...... ...... ...... ...... ...... 1 ...... ...... 1 ...... ...... 1 2 ...... 1 ...... 6 ii. Diarrhœal Diseases Diarrhœa, all forms ...... ...... 1 ...... 1 2 2 3 4 4 3 3 5 2 ...... 2 31 1 Enteritis,Muco-enteritis Gastro-enteritis ...... ...... ...... 1 1 5 2 4 4 2 3 ...... 2 2 1 ...... 26 Gastritis, Gastrointestinal Catarrh ...... ...... ...... ...... ...... 2 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 2 iii. Wasting Diseases Premature Birth 21 2 ...... ...... 23 ...... 2 1 ...... ...... ...... ...... ...... ...... ...... ...... 26 Congenital Defects 4 1 1 ...... 6 1 ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... 8 Injury at Birth 1 ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 Want of Breast-milk, ...... 1 ...... 2 3 ...... 1 ...... 1 ...... ...... ...... ...... ...... ...... ...... 5 Atrophy, Debility, Marasmus 3 ...... 1 ...... 4 4 4 ...... 1 1 ...... ...... 1 ...... 1 ...... 16 iv. Tuberculous Diseases. Tuberculous Meningitis ...... ...... ...... ...... ...... ...... 1 1 1 ...... ...... 1 ...... ...... ...... ...... 4 Tuberculous Peritonitis: ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... 1 2 Other Tuberculous Diseases ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... 2 v. Other Causes. Erysipelas ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Syphilis ...... ...... 1 ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 1 Rickets ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... 1 1 ...... 3 Meningitis (not Tuberculous) ...... ...... ...... ...... ...... ...... ...... 1 2 ...... ...... ...... ...... ...... ...... 1 4 Convulsions 2 3 ...... ...... 5 ...... 1 ...... ...... 1 ...... 1 ...... 1 ...... ...... 9 Bronchitis ...... ...... ...... 1 1 2 ...... 1 ...... ...... 1 1 ...... ...... 1 ...... 7 Laryngitis ...... ...... ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... ...... ...... 1 Pneumonia ...... ...... 2 ...... 2 3 ...... ...... 3 1 2 ...... ...... 1 ...... 2 14 Suffocation, overlaying 1 ...... ...... 1 2 ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... 3 Other Causes 2 2 1 2 7 2 ...... 1 3 ...... ...... ...... ...... 1 ...... 1 15 Total 34 9 7 7 57 24 13 14 21 9 9 9 10 91 5 7 187 29 WEEKLY RAINFALL FOR THE YEAR 1906. Week ended Rainfall in inches. Week ended Rainfall in inches. Jan. 6th 1.01 July 7th Nil „ 13th 1.18 „ 14th Nil „ 20th 1.04 „ 21st .24 „ 27th .56 „ 28th .48 Feb. 3rd .06 Aug. 4th .72 „ 10th .29 „ 11th .04 „ 17th .65 „ 18th .43 „ 24th .60 „ 25th .25 Mar. 3rd .13 Sept. 1st Nil „ 10 th .05 „ 8th .75 „ 17th .42 „ 15th .63 „ 24th .18 „ 22nd .32 „ 31st .10 „ 29th Nil Apr. 7th Nil Oct. 6th .63 „ 14th .06 „ 13th .72 „ 21 St .07 „ 20th .13 „ 28th .42 „ 27th .06 May 5th .24 Nov. 3rd 1.46 „ 12th .08 „ 10th 2.26 „ 19th .14 „ 17th .45 „ 26th .74 „ 24th .60 June 2nd .42 Dec. 1st .03 „ 9th .02 „ 8th .29 „ 16th .04 „ 15th .29 „ 23rd .17 „ 22nd .60 „ 30th 1.43 „ 3Ist .32 Total rainfall for year in inches, 21.80. 30 TABLE 1. Vital Statistics of Whole District during 1906 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 Districts. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institution 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. Number. Rate. Number. Rate per 1,000 Births registered. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 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 1340 650 20.3 281 268 13 382 12.6 1900 37,204 34,399 1,037 300 147 141.7 655 17.6 231 231 25 449 13.0 1901 42,622 39,022 1,194 305 187 156.6 657 15.4 245 245 22 434 11.1 1902 49,000 44,530 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 15.6 383 370 29 563 10.4 1905 65,021 60,441 1,587 26.2 138 86.9 822 12.6 357 348 75 549 9.0 Averages for years 1896— 1905. 41,485 38,266 1,094 28.2 128 122.7 679 17.3 308 299 ? 397 10.4 1906. 69.745 65.165 1,701 26.1 187 109.9 920 13.1 386 375 100 645 9.8 31 This table has been corrected as regards "estimated population" by calculating the ratio of increase of the population year by year from 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, Village Homes, Barkingside. It will be noticed that for the earlier years the rates are too low; that is due to this method of bringing the populations for the earlier years too high. This table should be compared with the corresponding table in last year's report. 32 TABLE IV. Causes of, and Ages at, Death during Year 1906. Causes of Death. Deaths at the subjoined ages of " Residents" whether occurring in or beyond the District. Deaths at all ages of " Residents" belonging to Localities, whether occurring in or beyond the district. Total Deaths whether of Residents" or non Residents" in Public Institutions 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. Clementswood Ward. South Hainault Ward. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 1 4 ... ... ... ... ... ... 1 1 2 1 ... 4 Scarlet Fever 3 ... 1 2 ... ... ... ... ... 1 ... 1 ... ... 5 Whooping Cough 11 6 4 ... 1 ... ... ... 1 2 2 2 2 1 ... Diphtheria and Membranous Croup 11 ... 4 6 ... 1 ... 1 ... ... 2 5 2 1 9 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Other contin'd ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 6 ... ... ... 1 3 2 1 ... 3 ... ... 1 ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 39 34 4 ... ... ... 1 2 6 4 3 6 15 3 6 Enteritis 27 23 3 1 ... ... ... 3 3 5 2 8 4 2 1 Puerperal Fever 2 ... ... ... 1 1 ... 1 ... ... ... 1 ... ... ... Erysipelas 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... Other septic Diseases 11 1 2 1 2 5 ... ... 3 3 1 2 2 ... 2 Phthisis (Pulmonary Tuberculosis) 37 1 ... 1 8 27 ... 1 6 3 6 8 4 5 50 Other Tubercular Diseases 21 6 5 2 4 4 ... 2 6 2 ... 2 5 1 17 Cancer, Malignant Disease 54 ... 1 ... 2 31 20 13 8 4 4 8 11 3 13 Bronchitis 32 7 2 ... ... 8 15 2 4 4 3 6 9 3 18 Pneumonia 50 14 6 ... ... 18 12 8 9 5 5 12 7 3 56 Pleurisy 3 1 ... ... ... 2 ... ... 1 1 ... ... ... 1 3 Other Diseases of Respiratory Organs 3 1 ... ... 1 1 ... ... 1 ... 1 ... 1 ... 2 Alcoholism Cirrhosis of Liver 5... ... ... ... ... 4 1 2 1 ... 1 1 ... ... 1 Venereal Diseases 2 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... Premature Birth 26 26 ... ... ... ... ... 2 6 4 ... 4 8 2 ... Diseases and Accidents of Parturition 3 ... ... ... ... 3 ... ... 2 ... ... 1 ... ... ... Heart Diseases 61 3 2 4 29 23 9 9 7 4 12 12 5 15 Accidents 16 4 ... ... ... 5 3 4 2 1 2 3 3 ... 6 Suicides 3 ... ... ... 1 2 ... ... ... ... ... 2 1 ... ... All other causes 212 58 11 9 3 61 70 24 31 23 18 42 30 25 177 All causes 645 187 51 24 28 207 148 76 100 73 55 129 118 56 386 Perhaps it will be as well to explain that columns 9-15 in this table do not agree with column 2 or columns 3-8, as we were unable to obtain the addresses of residents dying in the County Asylum, Brentwood, or Romford Infirmary. SECTION II. Infectious Disease. 35 INFECTIOUS DISEASE. During- 1906, 548 cases of Infectious Disease were notified. „ 1905, 446 „ „ „ „ „ 1904, 508 „ „ „ „ „ 1903, 364 „ „ „ „ „ 1902,738 „ 1901, 437 „ „ „ „ From the institutions in the district the following cases have been notified:— Village Homes. Scarlet Fever 2 Diphtheria 3 Typhoid Fever 1 Claybury Asylum. Typhoid Fever 2 Erysipelas 1 SCARLET FEVER. The following' figures give the number of cases of Scarlet Fever and the number of deaths caused by this disease during the past year. A comparison with other towns is also shown:— Cases. Deaths. Rates per 1,000. Ilford 326 3 .04 Acton 173 7 .13 Colchester 37 1 .02 Southend 193 3 .06 East Ham 790 18 .14 36 Below is given the figures for Ilford for the past five years:— Cases. Deaths. Rates per 1,000. 1905 288 4 .06 1904 224 5 .09 1903 181 2 .04 1902 264 2 .04 1901 285 0 — On examining the table of infectious disease it will be seen how evenly the cases have been distributed over the district, taking into consideration the probable population of the various wards. It has been most prevalent on the south side, but, all thing's considered, it is extraordinary how uniform has been the distribution. The whole question of the prevalence and spread of Scarlet Fever requires careful study and investigation. Doubtless there are a large number of mild cases going about which are only infectious for a limited time, but during that time infect some case with a sharper attack, and so the spread goes on. A similar sort of prevalence of this disease has been going on in London during the past year—no epidemic, but a high level of fairly uniform predominance. Of our cases notified, 228 were removed to the Isolation Hospital, the remainder being nursed at home. SCARLET FEVER CHART OF NOTIFICATIONS. 37 DIPHTHERIA AND MEMBRANOUS CROUP. During the year 132 cases have been notified; of these, 3 occurred at the Village Homes, leaving a total of 129 for the district proper. Of the total cases notified, 11 proved to be fatal, and were distributed in wards as follows:— Cranbrook Ward 1 North Hainault Ward 2 Loxford Ward 5 Clementswood Ward 2 South Hainault Ward 1 Total 11 7h^' foregoing figures give a death-rate of .16 per 1,000 living, or 8.3 per cent, of the cases notified. A comparison with the past five years is given below:— Years. Cases. Deaths. Rate per 1,000 living. Death-rate per cent. of cases notified. 1905 85 4 .06 4.7 1904 181 10 .18 5.5 1903 95 14 .28 14.7 1902 86 8 .17 9.3 1901 76 6 .15 8.0 38 A comparison with four other towns for the year 1906, with regard to this disease, is shown below:— Cases. Deaths. Rate per 1,000. Ilford 132 11 . 16 Acton 46 2 .04 Colchester 29 3 .07 Southend 71 5 .10 East Ham 249 27 .20 So that from the above particulars it will be seen that there has been no particular prevalence of this disease during the past year. Several of the cases that were notified appeared to be of a mild type. It is here that the provision of free bacteriological examination would be of great use, as it is impossible in some cases to say if it is Diphtheria without a bacteriological examination. From Table III. it will be seen that there has been no prevalence on the south side of the High Road, as was contended by some. As a matter of fact, the largest number notified in any one ward was 32 in the Park Ward. This prevalence was, however, more apparent than real. ENTERIC FEVER. During the past year 35 cases have been notified. One death was registered from this disease in the South Hainault Ward, giving a death-rate of .01 per 1,000 living, or 2.8 per cent. of the cases notified. In 1905, 22 cases were notified, with 4 deaths, giving a death-rate of .06 per 1,000, or 18.18 per cent. of the cases notified. DIPHTHERIA AND MEMBRANOUS CROUP CHART OE NOTIFICATIONS. 39 A comparison with four other towns, for the year 1906, with regard to this disease is shown below:— Cases. Deaths. Rate per 1,000. Ilford 35 1 .01 Acton 13 3 .05 Colchester 12 2 .04 Southend 19 2 .04 East Ham 39 8 .06 From September 18th to October 18th, 14 cases of Typhoid Fever were notified, 11 of which were in the Clementswood Ward, the majority being in two roads in that ward. They were notified on the 18th, 27th, 28th, 29th, and 30th September, and 2nd, 5th, 6th, 9th, nth, 12th, 13th, and 18th October respectively. The only thing they apparently had in common was the water, which is supplied ,by the South Essex Waterworks Co. Two samples were taken and sent to Dr. Thresh for analysis, with the following result:— Sample taken on 1st October, 1906. „ „ 3rd „ „ "These waters differ very little chemically; they are of the same degree of hardness, and both are (chemically) of the highest degree of organic purity. "The bacterial examination gives no indication of pollution by manurial or sewage matter, but both are unusual, since the gelatine plates on the second day only showed one or two colonies, yet on the third day the surface of the jelly was completely liquified, and there were obviously innumerable small colonies. As I have never met with this phenomenon 40 before, I am at a loss to explain it. As in all other respects the water is so satisfactory, I do not think the water can be in any way unwholesome." There was no history of eating shell-fish; in one or two instances ice-cream had been partaken of, and also in one or two cases there was a history of the purchase of fried fish; but seeing that both of these are common occurrences amongst a population of this type, they do not seem to have any importance in relation to this outbreak. The milk supply was varied, and hardly any two were supplied by the same milkman. Of these cases, 11 were removed to the Isolation Hospital, and in seven instances specimens of blood were sent for examination to test their reaction to Vidal's Test, with the following result:— Three gave a marked positive reaction of 1 in 100; the other four had only a slight effect, 1 in 30, and practically no effect 1 in 100 dilution. From the character of the outbreak one would expect to find some common cause producing this small epidemic, as the cases were so collected and the outbreak so localised. I regret to say we could not find such cause, nor explain why it occurred. ERYSIPELAS. For 1906, 52 cases were notified, with 1 death. „ 1905, 48 „ „ „ 3 deaths. „ 1904, 56 „ „ „ 1 death. „ 1903, 49 „ „ „ no death. „ 1902, 67 „ „ „ 4 deaths. „ 1901, 37 „ „ „ 1 death. TYPHOID FEVER CHART OF NOTIFICATIONS ERYSIPELAS CHART OF NOTIFICATIONS. 41 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 1906 there were 3 cases notified and 2 deaths „ 1905 „ „ 3 „ „ „ 3 „ „ 1904 „ „ 4 „ „ „ 4 „ „ 1903 „ „ 2 „ „ „ 1 death. „ 1902 „ „ 3 „ „ „ 2 deaths. MEASLES. During the past year there have been reported from the schools and other sources 545 cases of Measles, with 5 deaths, giving a death-rate of .07 per 1,000 living. In 1904 Measles was removed from the schedule of the Infectious Diseases (Notification) Act, and it was feared by some that this was a retrograde step to take. So far, the past year has shown 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 „ 805 „ „ 5 „ „ .12 „ 1902, 564 „ „ 3 „ „ .06 „ 1903, 684 „ „ 10 „ „ .20 „ 1904, 1138 „ and reported 17 „ „ .30 „ 1905, 136 „ reported 3 „ „ .05 „ 1906, 545 „ „ 5 „ „ .07 42 The following figures show the death-rates from this disease for 1906 for four other towns, as compared with Ilford:— Deaths. Death-rate per 1,000 living. Acton 27 .51 Colchester 9 .22 Southend 3 .06 East Ham 32 .24 Of course, it may be contended that 545 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. If there is a case of Measles in a school it is likely to spread, especially amongst the infants, so that I should soon get to know of its prevalence. There are four attendance officers, the chief of whom reports to me, personally, every morning, of any case of infectious disease coming under their notice. The chief reason of the comparative freedom from Measles during the past year is, I believe, due to the excessive prevalence during the year before last, thus rendering a large proportion of the infant population immune to the infection. Also, every three or four years Measles tends to assume an epidemic form. CHICKEN POX. Of the minor infectious diseases reported from the schools, I received information of 263 cases of Chicken Pox. Last year 423 cases were reported. 43 WHOOPING COUGH. For the past year there were reported 187 cases of Whooping Cough. There were 11 deaths, giving a deathrate of .16 per 1,000 living. In 1905 there were 14 deaths, giving a death-rate of .23. „ 1904 „ 8 „ „ „ .14. „ 1903 „ 19 „ „ „ .30. „ 1902 „ 3 „ „ „ .06. „ 1901 „ 21 „ „ „ .53. PHTHISIS. For 1906 there were 37 deaths, giving a death-rate of .56. „ 1905 „ 38 „ „ „ .62. „ 1904 „ 33 „ „ „ .60. „ 1903 „ 36 „ „ „ .72. „ 1902 „ 32 „ „ „ .71. „ 1901 „ 19 „ „ „ .48. Below are shown the number of deaths and death-rate from Phthisis for 1906 for four other towns, as compared with Ilford:— Deaths. Death-rate. Ilford 37 .56 Acton 43 .81 Colchester 32 .78 Southend 50 .99 East Ham 122 .93 It is curious how little the gross numbers of the deaths have varied the last five 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 1906 there were 88 deaths, giving a death-rate of 1.3. „ 1905 „ 88 „ „ „ 1.4. „ 1904 „ 69 „ „ „ 1.2. „ 1903 „ 73 „ „ 1.4. „ 1902 „ 67 „ „ „ 1.5. „ 1901 „ 44 „ „ „ 1.1. A comparison with four other towns for the year 1906 is given below:— Deaths. Death-rate. Ilford 88 1.30 Acton 104 1.96 Colchester 69 1.69 Southend 58 1.15 East Ham 242 1.86 CANCER. For 1906 there were 54 deaths registered from Cancer, which is a very large increase over previous years. The reason for this I am not prepared to explain, but at the same time it must be borne in mind that this year, for the first time, I am able to give the deaths of Ilford residents dying in Romford Infirmary and the County Asylum, Brentwood, which makes a slight addition to the sum total. Also, too, we are now getting returns of Ilford residents who die in London hospitals, etc. For 1905 there were 33 deaths, giving a death-rate of .54. „ 1904 „ 28 „ „ „ .51. „ 1903 „ 21 „ „ „ .42. „ 1902 „ 19 „ „ „ .41. „ 1901 „ 19 „ „ „ .48. 45 A comparison with four other towns for the year 1906 is given below:— Deaths. Death-rate. Ilford 54 .82 Acton 43 .81 Colchester 22 .54 Southend 47 .93 East Ham 74 .56 These two last diseases are placed here for convenience. TABLE III. Cases of Infectious Disease notified during the Year 1906. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 120 1 32 62 14 20 ... 16 31 9 8 28 22 15 6 14 7 8 25 17 5 Membranous Croup 3 1 1 1 ... ... ... ... 1 2 ... ... ... ... ... 1 2 ... ... ... ... Erysipelas 52 ... ... 8 3 34 7 11 11 4 5 10 3 8 1 ... ... ... ... ... ... Scarlet Fever 326 4 81 211 19 11 ... 35 49 36 20 77 75 34 17 24 24 18 63 58 24 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 35 ... ... 9 10 16 ... 2 3 5 5 5 12 3 1 ... 2 2 3 10 1 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 ... ... ... 1 2 ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 548 6 114 291 47 83 7 66 95 56 38 121 112 60 25 39 35 28 91 85 30 47 Table giving Death Rate from 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. 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 3 .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 8 .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 .01 181 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 3 .04 ...... 3 .04 60,441 1906 ...... ...... ...... 52 1 .01 132 11 .16 326 3 .04 35 1 .01 3 2 .03 ...... 5 .07 65,165 48 ISOLATION HOSPITAL. Number of patients in hospital at beginning of year:- Scarlet Fever 31 Diphtheria 4 Number of patients admitted during year:- Scarlet Fever 268 Diphtheria 88 Typhoid Fever 19 Erysipelas 1 Measles 1 Number of patients remaining in hospital on the 1st Jan., 1907:— Scarlet Fever 44 Diphtheria 6 Number of deaths in hospital during year, showing comparison with 1905:— No. of Deaths. Death-rate per cent. 1906. 1905. 1906. 1905. Scarlet Fever 4 3 1.49 1.92 Diphtheria 10 4 11.36 7.27 Typhoid Fever 1 1 5.26 7.69 Puerperal Fever — 1 — — Erysipelas — 1 — — 49 Average stay in hospital:— 1906. 1905. Scarlet Fever 42.84 days 48.94 days. Diphtheria 33.36 „ 28.62 „ Typhoid Fever 38.37 „ 32.0 „ Erysipelas 14.0 „ 2 „ Puerperal Fever — 13 „ Measles 10.0 „ — Percentage removed to the hospital of cases notified:— 1906. 1905. Scarlet Fever 70.24 41.66 Diphtheria 63.63 63.52 Typhoid Fever 54.28 59.09 Puerperal Fever — 33.33 Erysipelas 1.92 2.08 The following shows how the average length of stay of patients in the hospital is arrived at:— Days. Average Days in Hospital. 31 cases of Scarlet Fever in Hospital, 1st Jan., 1906 1,336 43.09 220 recovered cases of Scarlet Fever 10,221 46.4 4 fatal cases of Scarlet Fever 78 19.5 44 cases of Scarlet Fever in Hospital, 1st Jan., 1907 1,175 26.7 Giving an average stay in hospital, of Scarlet Fever patients, of 42.84 days. 4 cases of Diphtheria in Hospital, 1st Jan., 1906 92 23.0 72 recovered cases of Diphtheria 1,918 26.6 10 deaths from Diphtheria 93 9.3 6 cases of Diphtheria in Hospital, 1st Jan., 1907 67 11.14 Giving an average stay in hospital, of Diphtheria patients, of 33.36 days. 50 18 recovered cases of Typhoid Fever 718 39.8 1 death from Typhoid Fever 11 — Giving an average stay in hospital, of Typhoid Fever patients, of 38.37 days. 1 recovered case of Erysipelas 14 - 1 recovered case of Measles 10 - Average number of patients per day in hospital during the year 1906, 38.18. 5t TABLE OF ADMISSIONS In the Respective Months during the last Five Years. Months. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever Measles. 1902 1903 1904 1905 1906 1902 1903 1904 1905 1906 1902 1903 1904 1905 1906 1903 1905 1906 1905 1906 January 12 16 17 10 21 8 7 3 5 2 - - - 1 - - - - - - February 2 11 17 18 11 5 5 10 8 5 - - 1 - - - - - - - March 8 3 13 15 17 1 4 3 3 13 1 — 1 - - - - - - - April 13 11 12 9 17 3 2 4 10 3 3 — — 1 1 — 1 — — — May 6 9 8 10 20 1 4 4 3 12 3 1 — 2 2 — — 1 - — June 9 7 4 16 14 2 1 15 1 9 3 — 2 2 - - - - - - July 8 6 12 5 25 2 1 5 2 6 2 — — 4 2 — — — — 1 August 11 8 10 10 18 — 3 3 8 4 10 2 2 1 - - - - - - September 2 5 4 9 21 — 3 7 4 9 6 4 2 — 2 - - - - - October 16 11 10 23 40 4 2 9 3 12 5 2 — 1 9 - - - - - November 18 11 7 15 33 1 2 12 4 7 — 2 1 1 3 — — — 1 — December 15 17 26 16 31 4 3 5 4 6 - - - - - 1 - - - - Totals 120 115 140 156 268 31 37 80 55 88 33 11 9 13 19 1 1 1 1 1 52 The present Isolation Hospital was built in 1898, and added to in 1902. The original Hospital consisted of three blocks, containing respectively 10, 4, and 6 beds, together with an administrative block, laundry, ambulance shed, stable and coach-house, with a small mortuary. In 1902 another block of 26 beds was added, the administrative block enlarged, another mortuary provided, and a discharge block built. In 1905 a house was built just outside the Hospital, which provides accommodation for 8 convalescent Scarlet Fever patients. That is, the patients, or the number of them that we can accommodate, are disinfected through the discharge block, have fresh disinfected clothes provided, and then they are transferred to this house for a fortnight or so before going home. It thus makes a half-way house between the Hospital and the home. The hope was to limit the number of return cases, as several patients caught cold on leaving the discharge block straight for home, developed a discharge from nose or ears, and infected other children. During the whole year, owing to the prevalence of Scarlet Fever, the accommodation of the Hospital has been strained to the utmost, and the greatest difficulty has been experienced in receiving the cases when desired. At one time I was of opinion that this was merely a temporary strain, but it has gone on now for so long that I trust the Council will take the question of enlarging into consideration at an early date. When the constant increase of population is taken into consideration, also the steady increase of building of smaller property, in which it is practically impossible to isolate efficiently, the necessity of other provision than now exists will be recognised by the Council. 53 What is required is another block of about 20 beds, with two side wards, as in the last new block, and a recreation room over. A fair-sized block is much cheaper to administer, from a nursing point of view, than a small one, and looking at the growth of the district, this would be none too large. A day or recreation room over would be a great advantage, especially in winter time, for children who are recovering from Scarlet Fever but who are still infectious. With this some additional provision must be made for the resident staff. During the past winter most undesirable contrivances had to be resorted to for providing sleeping accommodation, and this difficulty will be of ever-increasing recurrence, unless some better provision be made. What form this provision should take will require the careful consideration of the Committee. A small isolation block of about 4 beds would be invaluable to deal with complicated cases. That is, a patient having a combined attack of Scarlet Fever or Whooping Cough or Chicken Pox, etc, or a case of doubtful diagnosis. SCARLET FEVER. Average stay in Hospital:— 1902. 1903. 1904. 1905. 1906. 56 58 54.7 48.9 42.8 From the above figures it will be seen the average stay of Scarlet Fever cases has been reduced from 56 days in 1902 to 42.8 in 1906. I hope this time will be able to be still further reduced. Manifestly the shorter time the case is in the Hospital the less cost will that particular case be to the 54 rates, and also it is found that the prolonged detention of a case of Scarlet Fever in an Isolation Hospital does not tend to lessen the chance of carriage of infection on its return home, but the reverse. It has been shown that a case detained in Hospital nine weeks is more likely to cause a "return" case than one kept in only six weeks, so that in every way it is desirable not to detain a case of Scarlet Fever in Hospital longer than is absolutely necessary. During the past year there were six houses in which there were return cases, viz.:— J. F., 1st case notified 27th Jan., discharged from Hospital, 22nd Mar. „ 2nd „ „ 28th Mar., „ „ „ G. B., 1st „ „ 17th Aug., „ „ „ 24th Sept. „ 2nd „ „ 3rd Oct., „ „ „ S. W., 1st „ „ 3rd Oct., „ „ „ 1st Nov. „ 2nd „ „ 10th Nov., „ „ „ N. P., 1st „ „ 2nd Oct., „ „ „ 21st Nov. „ 2nd „ „ 4th Dec., „ „ „ R. C., 1st „ „ 23rd Oct., „ „ „ 10th Dec. „ 2nd „ „ 14th Dec., „ „ „ E. B., 1st „ „ 21st Oct., „ „ „ 10th Dec. „ 2nd „ „ 20th Dec., „ „ „ „ 3rd „ „ 23rd Dec., „ „ „ Of the above, one case, G. B., did not pass through the Convalescent Home. If the percentage of return cases can be kept down to 2.2 per cent. I do not think the district will have anything to complain of, seeing that under the Metropolitan Asylums Board the percentage at the present is 4.1; but it will be impossible for us to maintain that figure if we are compelled to fill up our wards for any length of time without intermittence. 55 So that it will be seen, during 1906, 268 cases of Scarlet Fever were taken into the Hospital, and of these in six instances a further case developed in the house within three weeks of the return of the first patient to its home, thus giving a percentage of 2.2. For 1905, 156 cases of Scarlet Fever were taken into the Hospital, and of these in seven instances another case occurred in the house to which the patient returned, giving a percentage of 4.4 for 1905. Thus it will be seen that during the past year the precentage of return cases is just half that of 1905. There seems to me little doubt that if a patient gets any complications, and for that reason has to remain in Hospital longer than the ordinary time, the chances of that child infecting another case on its return home are very much increased. The use of the Convalescent Home was hoped to have a favourable influence on these cases, and I believe it has. Several cases after removal to the home developed slight complications, which, if they had gone straight to their own homes, would almost certainly have given rise to further trouble. In one family a second case of Scarlet Fever was notified two days before the first case left the Hospital, so that in this case there was no question of Hospital influence. In accordance with a contract made with the Woodford Urban District Council to admit a certain number of their infectious cases, the following number have been taken into our Hospital:— Scarlet Fever 39 Diphtheria 4 The following number remained in the Hospital at the; end of 1906:— Scarlet Fever 7 56 The following table shows the number of these cases admitted, and the deaths occurring during the respective months of the year:— Scarlet Fever. Diphtheria. Admissions. Deaths. Admissions. Deaths. January 10 — — — February — — — — March 5 1 — — April 2 1 — — May 3 — — — June — 1 — — July 1 — — — August 3 — — — September 2 — 4 1 October 5 — — — November 2 — — — December 6 — — — Totals 39 3 4 1 DISINFECTION. The disinfection of the town bedding, etc., is carried out at the Hospital, and has formerly been performed by two men who, in addition, devoted their spare time to other work at the Hospital. The disinfecting work has continued to grow so much that these men's spare time for Hospital duties became little or nothing. Accordingly during the past year one man, who holds the certificate of the Sanitary Institute, has been appointed Assistant Sanitary Inspector, and is responsible for the carrying out of this work. The other man drives the 57 vans and assists at the Hospital still. If the table of disinfections be examined, it wiil be found that the Council has not erred on the side of haste in making this needed change, the work having nearly doubled since its inception in 1903. TABLE OF HOUSES, &c., DISINFECTED In Respective Months during the Last Four Years. Month. Houses. Articles. 1903 1904 1905 1906 1903 1904 1905 1906 January 29 36 71 26 602 397 783 321 February 26 35 48 31 307 544 727 436 March 18 30 40 40 270 487 707 604 April 15 21 40 32 239 209 579 555 May 22 22 31 39 273 479 757 597 June 14 55 16 35 147 447 196 446 July 9 24 13 39 144 96 187 566 August 21 28 20 33 234 301 220 412 September 20 28 16 30 250 260 205 666 October 18 35 34 63 141 338 397 677 November 29 28 33 66 280 241 478 751 December 31 30 20 42 363 458 179 570 Totals 252 372 382 476 3250 4257 5415 6601 SECTION III. Schools. SUMMARY OK 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 ... ... ... l 33 15 1 1 16 8 ... ... 9 4 6 ... ... ... 89 56 Horns 527 ... 6 ... 3 ... ... ... ... 1 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 3 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 ... ... ... ... ... ... ... ... ... ... ... ... ... 5 13 Private Schools ... 23 ... 2 ... ... ... 1 ... 15 ... ... ... 2 ... ... ... ... ... ... ... ... ... 43 ... Totals 10,690 105 139 45 84 1 4 7 7 102 84 6 12 381 268 96 42 195 69 70 ... 1 ... 1,009 709 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, 1906. SCHOOLS. Average Attendance during December, 1906. DISEASES AND CONTACTS. Scarlet Fever. Diphtheria. Membranous Croup. Typhoid Fever. Erysipelas. 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. Cases. Contacts. Cleveland Road 1,421 45 57 5 22 ... ... 2 6 2 ... 22 26 2 ... 12 5 50 9 20 2 20 ... ... ... 180 127 Downshall 1,405 36 46 9 20 ... 3 1 2 ... ... 133 79 4 3 132 46 109 27 38 5 15 ... ... ... 477 231 Loxford 1,104 22 48 11 27 ... ... ... ... ... ... 90 72 ... ... 9 9 10 4 21 6 9 ... 1 ... 173 166 Christchurch Road 1,157 16 39 14 20 ... ... ... 5 2 ... 18 18 1 2 7 11 18 12 2 ... 10 1 ... ... 88 108 Highlands 786 10 19 7 8 ... ... ... ... ... ... 79 22 ... ... 3 1 5 1 34 7 10 ... ... ... 148 58 Horns 517 14 22 1 ... 1 2 ... ... ... ... 14 22 1 ... 28 22 19 7 ... ... 2 ... ... ... 80 75 National, Ilford 448 7 22 ... 8 ... ... 4 ... 1 ... 9 13 ... ... 3 3 9 3 ... 1 5 ... ... ... 38 50 Chadwell 444 5 6 ... ... ... ... ... ... ... ... 1 3 ... ... 2 1 ... ... ... ... ... ... ... ... 8 10 Goodmayes 434 4 4 1 4 ... ... ... 2 ... ... 6 10 ... ... 34 13 33 10 24 5 9 ... ... ... 111 48 Uphall 497 4 11 2 4 ... ... ... ... ... ... 50 40 ... ... 1 2 3 ... 7 2 1 ... ... ... 68 59 National, Barkingside 218 2 2 ... 3 ... ... ... ... 1 ... ... 6 ... ... ... ... ... ... 7 6 ... ... ... ... 10 17 Roman Catholic 220 2 3 ... ... ... ... ... ... ... ... 13 7 ... ... 5 3 13 5 ... ... 1 ... ... ... 34 18 Infants, High Road 122 3 3 ... ... ... ... ... ... ... ... 2 1 ... ... ... ... 2 3 1 ... ... ... ... ... 8 7 Beehive 94 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 3 1 Ilford Lane 88 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... 3 ... Aldborough Hatch 65 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 1 2 Secondary 444 3 7 ... 4 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 12 Private Schools ... 11 ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... 3 ... ... ... ... ... 19 ... Totals 9,464 184 289 52 120 1 5 7 16 7 ... 441 319 8 5 236 110 275 84 157 34 83 1 1 ... 1,452 989 61 INFECTIOUS DISEASES. During the past year there has been a slight modification in the method of receiving information of infectious disease from the various schools. Formerly the Head Teachers used to inform me, on a special form, of any case of infectious disease coming under their notice. Also, all the attendance officers used to report to me personally every morning of all cases observed by them. At present, however, only the Chief Attendance Officer reports to me personally, thus allowing the other officers to push on with their morning work. The notification by the teachers has been to a great extent discontinued, as it was thought there was some tendency to duplication when both the attendance officers and the teachers reported; also, too, the attendance officer gets earlier information than the head teachers. To a certain extent, there is some truth in these contentions, but I am inclined to think the converse is also true, and the head teachers often hear before the attendance officers; and, as early information is the essence of the whole plan, it seems to me very probable that the original scheme, in so far as the head teachers are concerned, will have to be reverted to. On examining the table at the beginning of this section it will be seen that Scarlet Fever has been unduly prevalent during the year, and that Diphtheria, on the other hand, has been slight in its incidence. Mumps have been more in evidence than for several years, a moderate prevalence occurring in the Spring, and specially affecting Cleveland Road and Downshall Schools. 62 Measles.—Downshall, Loxford, and Highlands Schools were most affected by this disease. On looking at the table it will be seen what a large proportion of "contacts," or healthy children living in the same house as the patient, have to be excluded in such diseases as Scarlet Fever and Diphtheria. In neither Erysipelas nor Typhoid Fever do we exclude these "contacts," unless the patient is nursed at home, and means of isolation are very defective. With regard to the other diseases, Measles, Chicken Pox, and Whooping Cough, "contacts" are not excluded if they are not in the infants' department and have had the disease before. "Contacts" attending infant schools are, however, excluded, as the incidence of these diseases is the heaviest in the infants' department. In Ringworm, of course, "contacts " are not excluded. By this somewhat relaxed method, a far larger number of children are kept at school, thus affecting the attendance less, and at the same time with no increased risk of spreading the disease. So far, it has been found to work well. If the Education Bill of the past year had become law, it would have been compulsory to medically examine all new children on entering school, and it would then be possible to have a schedule for each child, and in a short time the school authority would be in possession of a complete physical history of each child. In this connection, it may be of interest to the Committee to give Dr. Mackenzie's account of his recent visit to a 63 German school, with the idea of seeing how this scholar examination is conducted in that country :— "One morning, at 9 o'clock, I went with one of the school doctors to an elementary school in one of the poorest quarters of Wiesbaden. We proceeded direct to the department where the infant boys were. The class teacher, a man, had already received notice of the visit. He had, in a simple portfolio, a series of schedules, printed back and front. On the schedules he had already entered the names, addresses, ages, names of parents, occupations, class, the height and weight, and one or two other particulars. The portfolio was handed, with some explanations, to the Doctor, who forthwith proceeded to examine the children in their order. He did so in the class-room, for in this school there is not a doctor's room. He had meanwhile secured from a higher class two boys whose duty is was to assist in undressing and redressing the children. He examined first the general condition, and I must say most of the children were thin. They did not seem to me any better nourished than our own children of the same grade; but, as simple inspection is very deceptive, I make this remark subject to the correction afforded by the heights and weights. The doctor recorded the nature of the constitution as good, medium, bad. He examined the throat and teeth, using a separate piece of wood as a tongue depressor for each child, and throwing it away to be burned afterwards. "He examined nose, ears, eyes, skin, bones, joints, spine, heart, lungs, ascertained the presence or absence of hernia (rupture), measured the chest, tested the speech by making the child repeat certain test words, tested the eyesight roughly, and the hearing roughly. In suspected cases, eyes and ears are afterwards examined more thoroughly. Any defects requiring correction or further expert examination are referred to the parents, who receive either a verbal or a written message, saying that the child should be taken to 64 the family doctor. Where the parents are very poor they are directed to take the child to the town hospital or an eye dispensary. To this dispensary the municipality contributes a certain sum in payment of the work undertaken. Similarly with every other condition requiring treatment, the parents are advised, inquiry is afterwards made as to steps taken, and if nothing has been done further inquiry is made, and the child is ultimately attended to. The purpose of the inspection is not to treat, but to discover. But indirectly the steady pressure put on the parents ultimately results in treatment. Every defect discovered is entered on the schedule, with the date of the examination. The portfolio of schedules is then handed back to the teacher who is responsible for its safekeeping. He hands it on to the teacher of the next class when the time comes for the passing of the class to the next stage." SCARLET FEVER. From the table of infectious diseases, it will be seen that there were 184 cases of Scarlet Fever notified attending the various schools. This number involved the exclusion of 289 contacts, or other children from the same house who were excluded for longer or shorter periods. If the patient suffering from the disease is sent to the Hospital, the other children are excluded from school for a period of seven days from the date of house disinfection. If, on the other hand, the child is nursed at home, the other children are excluded from school until a week after the house has been disinfected. In this way the nursing of a case of Scarlet Fever at home involves a serious loss of schooling to the other children in the house. Of the cases notified, 70.2 per cent. were removed to the Isolation Hospital. If the table be examined it will be seen how evenly the disease has been distributed all over the district, looking at the number of cases notified in connection with each school, and also the 65 character of the surrounding. population. So that, although there has been an undue prevalence of the disease, there was never any indication of its being spread by school influence. The spread and control of the diffusion of the infection of this disease requires detailed study, so as to arrive, if possible, at some more efficient control than at present. There have been several instances during the year of a child attending school in the early stage, and even vomiting there, without any further spread taking place; so that, probably, it is not very infectious in an early stage. The discovered cause of diffusion has nearly always been some discharge from the nose or ears of a patient, otherwise apparently recovered from the disease. After a patient is discharged from the Isolation Hospital, return to school is not allowed for a fortnight. The practice of seeing children at my office every morning has been of use in this connection, as any suspicious sore-throat is kept away from school for a certain period; and in many instances I believe this has had a beneficial effect. In several of these cases it is impossible to say how it is going to turn out; and also there is to be taken into consideration the possibility of increase of virulence as the infection passes from child to child. DIPHTHERIA. Only 52 cases have been notified in connection with the schools for the past year. Some of these were very mild cases, and it is doubtful if the diagnosis would have been confirmed by a bacteriolgical examination. After a time there is no doubt the Council will be compelled to make 66 provision for bacteriological examinations free of cost to the patient, as only by this means will they be able to definitely decide tne question as to whether it is Diphtheria or not. In connection with Diphtheria, as I mentioned with Scarlet Fever, the examination and exclusion from school of children with sore throats seen at my office every morning is doubtless of great benefit. Sore-throat is one of those things that no teacher should ever hesitate over as to the desirability of excluding from school. "Always send a child home with sore-throat" should be, with teachers, a maxim allowing of no querying. Probably the exceptional sunny summer had also something to do with the diminished prevalence of Diphtheria. MEASLES. The prevalence of Measles has not been marked during the past year, due, I believe, to the large number of children who have had the disease. There are a relatively small number attending school who have not had Measles. Dr. Kerr, Medical Officer to the London County Council Education Authority, says that directly the number of unprotected children in a class reaches 30 or 40 per cent. the disease tends to spread until the proportion is reduced to 15 to 20 per cent, unprotected. It is more especially so with regard to Measles, and in this connection the examination and record of new entrants to school would be beneficial. The previous history of the child would be obtained from the parent, entered on his schedule, and so a permanent and ready means of knowing the percentage of children in a class who had had Measles would be provided. 67 The relaxation of the rules with regard to Measles "contacts," as has been mentioned before, has worked well, and has had a beneficial effect on the attendance in the Boys' and Girls' Departments. CHICKEN POX, MUMPS, AND WHOOPING COUGH. There have been several outbreaks of these diseases at various periods, but nothing of an alarming character. There were more cases of true Mumps than I ever remember before. There is a great confusion in the minds of parents between swollen cervical glands and Mumps, with the result that one is constantly hearing of children suffering from Mumps, and which, on investigation, is found to be nothing more than swollen glands. RINGWORM. This disease wants constant attention to keep it within bounds, and one of the causes is that parents are often apt to send their children back to school before they have thoroughly recovered. On the other hand, in older cnildren some parents seem to think it is a merciful dispensation of providence, take no trouble to get the disease better, and keep the child at home for weeks or months at a stretch. Teachers, however, are very vigilant, and exclude the children from school, or send them on to me if there is any doubt. Ringworm is one of those diseases that ought to be eradicated, but apparently cannot be under present circumstances. 68 VISION. During the past year numerous children have been examined as regards their eyesight, and 19 have been advised to have the condition remedied by attendance at a hospital. Most of them have done so, and received great benefit, but a small proportion of parents cannot afford to pay for the spectacles when ordered. When the wage earner is only in receipt of 25 or 30 shillings per week, and out of that has to pay seven or eight a week for rent, it is obvious, if there are many others in the family, that the importance of spectacles will not appear to be of urgent necessity. HEARING. Several children have been advised to seek advice with a view to the removal of Adenoids. They have derived much benefit from this procedure, and their educational possibilities much improved. MINOR DEFECTS. During the past year I have examined 1,665 children at the office, and certificates have been given as to whether they should attend school, according to the necessities of the various cases. Several cases of infectious disease have thus been discovered, "dirty heads" ordered to be cleansed, and homes from which neglected children have come have been visited and cleansed, etc., on notice from the Public Health Department. 69 DEFECTIVE, EPILEPTIC, AND BACKWARD CHILDREN. In compliance with the Defective and Epileptic Children's Act, 1903, I was appointed medical examiner for this district by the Council. One epileptic child has been examined and sent to a special school. There are several defective children scattered through the schools, whom, it is hoped, will receive attention before long. Under the usual routine of an ordinary elementary school, these children have no chance of improving or learning as they should, and often are a serious detriment to the other members of the class in which they happen to be. The parents of these children are usually very poor, often one parent being deficient, so that it is rather a difficult and costly subject for an Education Authority to deal with. Especially so in a district like Ilford, which has not a sufficient number, fortunately, of such children to make it necessary for special provision to be made by themselves, but yet a sufficient number to make it costly to send to other schools. In addition, there are numerous " backward " children distributed through the various schools—not many in any particular one, but if you take a dozen in one school, eight in another, and so on, the total reaches a respectable figure. As to what constitutes a "backward" child is open to discussion. Dr. Kerr takes an arbitrary criterion, that an ordinary child should be in Standard I. at seven years of age, and then progress a standard a year until leaving school. How it works out in practice is difficult to estimate, as many teachers do not keep a backward child in the 70 standard which approximates to the child's knowledge, but keep the child moving, with the view that it is better for it than being kept in one particular standard. Under either circumstances, the question comes as to whether the Education Authority is doing its duty by that particular child. SCHOOL CLOSURE. No school has been closed during the year, and there is no doubt that, with the careful exclusion of individual children, the necessity for school closure should become less. With an increasing knowledge of the exact history of school children, probably classroom closure would be all that would be required. SECTION IV. Sanitary Administration. 73 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 I here apppend:— SAMPLES TAKEN IN ILFORD. No. Taken. No. Adulterated. No. Genuine. Butter 65 7 58 Milk 83 8 75 Jam 2 - 2 150 15 135 Proceeding's taken in 9 cases :— Butter.—2 dealers fined 40/- and 14/6 costs. 1 dealer ,, 20/- ,, 14/6 „ 1 dealer summoned absconded. Milk.—1 dealer fined 40/- and 14/6 costs. 1 ,, ,, ,, 10/- ,, I4/6 ,, 1 ,, ,, 20/- ,, 14-/6 ,, (second offence). 1 ,, refusing to sell, fined 10/- and 4/- costs. 1 summons withdrawn. 74 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. During the year action was taken against a man for slaughtering on unlicensed premises, a conviction obtained, and a fine of £5 and costs imposed. 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 in case of fire, and also of sufficient sanitary convenience. 75 The following is a list of the factories in the district:- Laundries (Steam) 4 Saw Mills and Joinery Works 7 ,, ,, Wheel Works 1 Brush and Veneer Cutter 1 Printers 5 Engineers 4 Granary 3 Chemical Works 2 Photographic Plate Works, etc. 1 Paper Mill 1 Carriage Works 4 Gas Works 4 Electric Light Works 1 Celluloid Collar Works 1 Brickfields 2 Furniture Makers 1 Total 39 WORKSHOPS AND WORKPLACES. Under the Factory and 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 by masters in their district, but who reside in other districts. The Medical Officer of Health is required to report to the Home Office and 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 floors on which wet processes are carried on. (e) Provision of suitable and sufficient sanitary conveniences. 76 Three hundred and seven have been inspected during the year. They are : — Dressmakers 100 Milliners 28 Tailors 34 Wearing Apparel Makers 16 Bootmakers and Repairers 54 Saddlers and Harness Makers 5 Hand Laundries 17 Smiths 6 Cycle Makers and Repairers 4 Stonemasons 5 Picture Framers 2 Upholsterers 4 Surgical Belt Makers 2 Watch and Clock Repairers 7 Electrical Fitters 1 Umbrella Repairers 5 Undertakers 4 Carpenters and Joiners 17 Carriage Builders and Wheelwrights 4 Plumbers 3 Dentists 2 Printers 1 Feather Dressers 4 Lace Workers 1 Sign Writer 1 Domestic Machinist 1 Tie Makers 4 Blind Maker 1 Bead Worker 1 French Polisher 1 Florists 1 Brush Makers 2 Total 338 77 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. I—INSPECTION. Including Inpections made by Sanitary Inspectors or Inspector of Nuisances. Premises. Number of Inspections. Written Notices. Prosecucutions. (1) (2) (3) (4) Factories (including Factory Laundries 39 - - Workshops (includingWorkshop Laundries) ... \ 147 11 11 Workplaces (other than Outworkers' premises included in part 3 of this Report) — — — Total 186 11 - 78 2.—DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Insp'tor. (1) (2) (3) (4) (5) Nttisances under the Public Health Acts:— Want of Cleanliness 15 15 Want of ventilation Overcrowding 9 9 Want of drainage of floors Other nuisances 32 32 Sanitary accommodation insufficient unsuitable or defective not separate for sexes Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 11 11 Other Offences (Excluding offences relating to outwork which are included in part 3 of this Report.) Total 67 67 79 3—HOMEWORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Number of Inspections of Outworkers premises. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109,110 L ists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions: Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outwork ers. Lists. Outwork ers. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) making, &c 27 84 43 54 42 (2) cleaning and washing Lace, lace curtains and nets Furniture and Upholstery Fur pulling Umbrellas 1 Paper Bags and Boxes 3 1 Brush making Stuffed Toys File making Electro Plate Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Total 27 84 47 54 43 8o 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number (1) (2) Important classses of workshops, such as workshop bakehouses, may be enumerated here. Bakehouses 32 Total number of workshops on Register 32 81 For 1905 there were 307 on the register. For 1904 there were 293 011 the register. For 1903 there were 250 on the register. 1.1 notices were sent under the Public Health Act. Notices of outworkers residing in this district were received in 47 instances from other Authorities. A record is kept of their addresses. Notices of outworkers residing in other districts were sent in 54 instances. A list of outworkers supplied by 14 employers was kept; 8 notices were sent to the Factory Inspector, where young persons were employed and no abstract of the 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 I underground bakehouse in the district. Frequent inspections have been made, and are required, to keep some of them in a reasonably suitable condition. 82 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 the district is supplied by the South Essex Water Company. Analyses have been made of this water during the year, and a typical chemical report is here appended:— PHYSICAL EXAMINATION. Turbidity: Quite bright; no deposit. Colour: Very faint yellow. Odour: None. CHEMICAL EXAMINATION. Determinations. Results in Grains per Gallon. - Parts per 100,000. Total Solid Matterdriedat 18odeg.C. ... ... Chlorine— 3.85 5.5 Equivalent to Chlorides (6o% Cl.) 6.4 9.2 Nitric Nitrogen— 0.06 0.09 Equivalent to Nitrates (17%N.) 0.36 0.55 Nitrites None. None. Hardness: Permanent 3 deg.; Temporary 19 deg.; Total 22 deg. ... Lead, Copper, Zinc, Iron None. None. Free Ammonia 0.000 0.000 Organic Ammonia 0.0021 0.0030 Oxygen absorbed at 98 F. in 3 hours 0.0190 0.0270 83 One house in Ley Street has hitherto been supplied by a shallow well, but an analysis of the water giving an unsatisfactory result, its use has been discontinued, the house now being connected with the South Essex Water Company's main. There are several other shallow wells in the district which would obviously be better closed, but at present it is difficult to get a better supply at a reasonable cost. 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 was scavenged by the Council themselves, and as 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 under the direction of the Sanitary Inspector, and is carried out very efficiently. The refuse is taken to the brickfield. Most of the dustbins are portable ones, and supervision is exercised to see that suitable receptacles are used and kept in order. During the past year numerous complaints have been made of the condition of the brickfield where the refuse has 84 been deposited, and the Council are, at present, taking the matter into consideration with a view to disposing of the refuse in a more sanitary and desirable way. MILK SUPPLY. In last year's report I presented a very full account of the milk supply of Ilford, and there is nothing further to add to it this year, save that the premises are constantly inspected, and there are now 7 cowsheds and 51 dairies and milkshops on the register. One man was summoned, under Section 7 of the Dairies, Cowsheds and Milkshops Order of 1885, for occupying as a dairy, premises in which provision was not made for lighting and ventilation, including air-space, and the cleansing, drainage, and water supply of same. He was fined £10, and since then has taken other premises and provided reasonable accommodation. SEWAGE WORKS. During the year several complaints were received as to smells alleged to be proceeding from the sewage works. The Council obtained the services of Mr. G. R. Strachan, Mem.Inst.C. E., to make a report on the works. He made various recommendations which are at present being carried out, as covering in the septic tanks and carriers, which, when complete, should go a long way towards removing any alleged nuisance. SECTION V. Report of Sanitary Inspector. 87 ANNUAL REPORT of Chief Sanitary Inspector. Public Health Department, Council Offices, Ilford. 26th March, 1907. To the Chairman and Members of the Ilford Urban District Council. Gentlemen I have the honour to submit to you my Fourteenth 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, Assistant Inspectors, have both done good work, and I believe they have conscientiously endeavoured by their efforts to maintain the sanitary condition of the district in a high state of efficiency. 88 I must also record my approval of the satisfactory manner in which Messrs. Bull and Aldous, the Clerks, have worked. They have always been willing, obliging and painstaking. 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. I am, Gentlemen, Your obedient Servant, F. W. KING, Chief Sanitary Inspector. 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 ou:— Drainage. Drains cleansed 399 Do. repaired or relaid 134 W.C. pans and traps provided 68 W.C. fittings repaired 33 Flushing cisterns to W.C.'s repaired or provided 120 Soil pipes repaired or renewed 29 Ventilating shafts repaired or provided 41 89 Drainage—continued. Cesspits and privies abolished 4 Do. do. do. repaired 4 Do. do. do. emptied and cleansed 35 W.C. floors cemented 49 Rain-water pipes disconnected from drains 12 Ditches cleansed 8 Water laid on to closets 18 Premises connected with main sewer 4 Sink-waste pipes provided and repaired 23 Do. do. disconnected from drain 1 Drains disconnected from water course 3 Yards drained . 28 Manhole covers fitted 42 Kitchen sinks fitted 2 Defects in Dwelling-Houses. Floors repaired 6 Roofs repaired 15 Window and door frames repaired 29 Yard paving repaired 94 Rain-water spouts repaired or provided 24 Water storage cisterns provided 1 Water laid on 23 Do. fittings repaired 6 Houses or parts of houses cleansed 56 Bedding cleansed 3 W.C.'s cleansed 6 Overcrowding abated 1 Yards cleansed 20 Dilapidated houses repaired 7 Do. do. demolished 1 Basements concreted 3 Do. ventilated 2 90 Defects in Dwelling Houses—continued. Windows made to open 15 Walls protected 15 Do. and ceilings repaired 49 Do. do. do. cleansed 1 Gutters and downpipes provided 3 Ilford Improvement Acts. Yards paved 25 Galvanised iron dust-bins provided 105 Ice-cream vessels cleansed 11 Water laid on 3 Bye-Laws. Water storage cisterns cleansed 163 Do. do. do. covered 58 Dairies Regulations. Animals groomed 6 Dairy floors cleansed (under notice) 1 Dairies and cowsheds cleansed (under notice) 18 Dairy utensils cleansed (under notice) 2 Dairies ventilated 1 Dairies paved 1 Water laid on 1 Dairy walls rendered with cement 2 Accumulations of Refuse, Etc. Manure and refuse removed 71 Offal bins provided 2 Trade refuse bins provided 8 91 Accumulations of Refuse, Etc.—continued. Manure pits provided 33 Stagnant water removed from basements 12 Rags removed 1 Dead animals removed 8 Workshop Acts. Drains repaired 3 Do. cleansed 5 Yards paved and drained 3 Do. cleansed 5 Overcrowding abated 9 Walls and ceilings cleansed and limewashed 15 Water laid on 1 W.C.'s provided 1 Hoods fitted 1 Flushing cistern fitted 1 Bakehouses cleansed (under notice) 11 Animals removed 12 Premises connected with main sewer 1 Infectious Diseases (Prevention) Act. Rooms stripped and cleansed 81 Generally. Animals (improperly kept) removed 306 Smoke nuisances abated 2 Roadways, courtways, and rearways paved and drained 8 Roadways, courtways, and rearways cleansed 6 Quarries filled in 2 Lands fenced in 2 92 Generally -continued. Wells cleansed 4 Do. covered 1 Stables discontinued 2 Smoke-loft do. 1 Stream cleansed 1 NOTICES SERVED. Notices. Served 1906. Complied with 1906. Outstanding 1907. Statutory 8 7 2 Preliminary 254 235 21 Do. (by letter) 319 319 - Pave Yard (Ilford Improvement Act) 9 4 6 Dustbins (Ilford Improvement Act) 132 135 6 Cleanse Cistern (Bye-laws) 138 130 14 Cover do. Do. 38 36 4 Lay on water to Dwelling-House 8 8 1 Cleanse Dwelling House (Infectious Diseases (Prevention) Act, 1890) 54 52 2 Cleanse Dwelling-House (1875 Act) 2 2 — Workshop 11 17 — Housing Working Classes Act 3 1 2 Totals 976 *946 58 * Included in this number are some notices outstanding previous to 1906. 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, they recommend to the Council that a statutory notice be 93 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 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 no 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 DECEMBER, 1906. Houses and premises inspected 3499 Do. do. do. do. during progress of work , 3802 Nuisances detected 1055 Do. abated 1038* Do. unabated 37 Complaints received 293 Houses disinfected 476 Articles do. 6583 Summonses taken out 2 Convictions 2 Amount of fines £10 and £5 = £15. *Included in this number are some nuisances outstanding previous to 1906. 94 Articles of unsound food detained and destroyed:— Apples 47lbs. Rabbits 45 Haddocks 115 Hake 26 Bullock's liver 8½lbs. Blood pudding 1 Neck of Mutton 1 Sausages 2 COMPLAINTS. The complaints received were as follows:— Choked drains 41 Sewage smells pervading the neighbourhood 25 Accumulations of refuse and manure 53 Animals improperly kept 18 Smoke nuisances 6 Improper water supply 14 Sanitary defects 36 Houses being dirty and insanitary 8 Decomposing bodies of animals 8 Flooding of premises 6 Gipsies ••• 3 Streams obstructed 3 Defective drains 50 Insanitary rear and sideways 10 Unwholesome food 1 No dustbins 6 Unregistered cowkeeper 1 Contraventions of Factory and W.S. Acts 3 Do. do. do. do. I.D.P. Act 1 293 95 All these were investigated at once, and accordingly dealt with as necessity demanded. GIPSIES AND TENT DWELLERS. Considerable trouble was given by these people during the past year. The annoyance caused by them however must, I think, diminish as the land becomes built over. The system adopted of calling 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 vans on 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 White Rose Hall, Barkingside 245, High Road, rear of New Road Green Lane All these have been visited, and on the whole they have been kept in a satisfactory condition. It is, however, quite necessary to visit them frequently, as in one or two cases the occupiers are inclined to show laxity in the care of the premises as regards cleanliness. 2. Dairies & Milkshops (51). These have been frequently visited, and careful attention given so as to obtain 96 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 and cleansing carried out when necessary. The general condition of them may be stated as satisfactory. 4. Workshops. There are 338, including laundries and domestic workshops, on the register. These have been visited and notices served to abate any nuisances when found to exist. Various works were carried out at different workshops, as can be seen from the summary of nuisances. 5. Slaughter-houses. These are situated as follows :— Rear—3, The Pavement, Ilford Lane. Rear—6o, High Street. Rear—The Post-Office, High Street, Barkingside. HOUSING OF THE WORKING CLASSES ACT. No legal action under this Act had to be taken during the year. Two of the notices served under this Act, and which were outstanding at the close of the year, represent repairs to two cottages and seven cottages respectively. The notice for the two cottages has since been complied with, and the works at the seven cottages are well in hand and nearing completion. 97 INSPECTION OF FOOD. Periodical visits were made to the shops in the district for the purpose of inspecting food exposed for sale, but no seizures of unsound food had to be made. INFECTIOUS DISEASES. Nearly every house in which any infectious disease occurred was visited; the sanitary arrangements 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 rules 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 548. 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 Board, of water being cut off from inhabited houses. 98 These houses were at once visited and notice served upon the responsible person, to reinstate the supply within 48 hours. Intimation is seldom given by the S.E.W.W. Co., when they cut off the supply, although I have frequently requested them to give me this information. I see no reason why they could not send notice in the same way as the Metropolitan Water Board. In the Ilford Improvement Act, 1898, there is a provision as to houses without a water supply, and the Owner is liable to a penality of £5 for allowing a dwelling house to be occupied without a proper and sufficient supply. REMOVAL OF HOUSE-REFUSE. The number of loads of refuse removed and the number of horses and vans engaged in the collection during the year ended the 29th December, was as follows:— Loads of Refuse. Horses and Vans. Five weeks ended 3rd Feb. 1059 309 Four do. do. 3rd March 843 248 Do. do. do. 31st do. 858 248 Do. do. do. 28th April 876 246 Five do. do. 2nd June 1096 316 Four do. do. 30th do. 828 241 Do. do. do. 28th July 843 248 Five do. do. 1st Sept. 1043 316 Four do. do. 29th do. 795 248 Do. do. do. 27th October 836 248 Five do. do. 1st Dec. 1058 313 Four do. do. 29th do. 864 246 10,999 3,227 The number of days upon which collections were made was 305. The average number of horses and vans engaged per day was 10.58. The average number of loads of refuse removed per horse per day was 3.4o. The capacity of the vans is 3 cubic yards each and allowing as a fair average that a load of refuse weighs 1 ton 6½ cwt., the total number of loads represents in weight about 14,570 tons. About 960 houses were erected during the year, and these had to be visited as they became occupied. I estimate there are about 13,500 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. 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. 99 100 DISPOSAL OF HOUSE REFUSE. As in former years the greater part of the refuse collected was carted to the brickfield in Vicarage Lane, and about 8,630 loads were deposited there. Although great care was taken to minimise any nuisance arising from the deposited refuse, by levelling it and covering it over with earth, numerous complaints were received during the latter end of the summer, and in the autumn. The remainder of the refuse was disposed of for filling up a hole at the Depot, and for filling up pits from which gravel had been taken. F. W. KING, Chief Sanitary Inspector.