ILFORD 1911 / ILF 51 ILFORD URBAN DISTRICT COUNCIL. PUBLIC HEALTH DEPARTMENT. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1911. C. F. STOVIN, M.A., D.P.H., Medical Officer of Health, Medical Superintendent of the Isolation Hospital, and School Medical Officer. ILFORD South Essex Recorders, Ltd., High Road. PUBLIC HEALTH COMMITTEE, 1911 — 1912. Chairman: Councillor G. W. Davis. Vice-Chairman : Councillor Geo. Cushing. Councillor W. J. Hammond, J.P. (Chairman of the Council). Councillor P. E. Brand. Councillor W. Everett. Councillor G. W. M. Gott. Councillor F. H. Dane (Vice-Chairman of the Council) Councillor G. Gunary. Councillor F. D. Smith. Councillor R. Stroud. OFFICERS OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: C. F. Stovin, M.A., D.P.H. Inspector of Nuisances: F. W. King, Mem. Royal San. Inst., F.l.S.E. 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. Health Visitor: Miss L. Radford, M.I.H., C.M.B., Assoc. Royal San. Inst Clerk: F. J. Bull. Assistant Clerks: G. A. Aldous. A. A. Rogers. E. C. Burn. ISOLATION HOSPITAL. Medical Superintendent: C. F. Stovin, M.A., D.P. H. Matron: Miss C. A. Barling. EDUCATION COMMITTEE. Chairman: Councillor W. P. Griggs, J.P., Alderman C.C. Vice-Chairman: *Mr. H. J. Weston. Councillor B. Bailey. Councillor G. Gunary. Councillor G. Church. †Councillor W. J. Hammond. Councillor T. H. Connew. *Mr. D. Hunter. Councillor W. J. T. Cullis. *Mrs. Nastrowsky. Councillor G. Gushing. *Mr. J. Norton. †Councillor F. H. Dane. Councillor T. Philpot. Councillor J. Deveson. *Mr. J. Reynolds. *Mr. F. H. Dovey. Councillor J. H. Rule. *Mr. H. Gilbey, C.C. Councillor W. J. O. Sheat. Councillor F. D. Smith. * Co-opted Member. † Ex-officio Member. Secretary to the Committee: W. S. Torbitt, M.A., LL.M. School Medical Officer: C. F. Stovin, M.A., D.P.H. School Nurse: Miss L. Radford. PREFACE. Public Health Department, Ilford, 3rd April, 1912. To the Chairman and Members of the ILFORD URBAN DISTRICT COUNCIL. Gentlemen, In accordance with the regulations of the Local Government Board and the Board of Education, I herewith present my Annual Report for the year 1911. This makes the eleventh I have had the honour to place before you on the health of this district, and the fourth under the (Education (Administrative Provisions) Act, 1907. From the Census returns taken in April the total population is given as 78,205, and as my estimate was 80,522 it seems to me there is every reason for congratulation that the difference was so small. An intercensal period of ten years is a long time, allowing numerous possibilities of error to creep in. As the reliability of most of the various rates depends on the accuracy of this estimate of the population, it will readily be seen how important it is for this estimate to be approximately correct. The death-rate for 1911 was 9.4, as compared with 7.9 in 1910. One potent factor in increasing the number of deaths was the hot, dry summer, which caused 64 deaths from Diarrhoea. The infantile mortality figure for the year was 83, and if that portion of the Report is examined it will be seen how favourably Ilford compares in this respect with other towns. The Notification of Births Act, and the consequent measures under that Act, appear to me undoubtedly to have very materially assisted in achieving this result, so that the Council can congratulate itself on its wisdom in adopting and carrying out this Act. 6 During the year a temporary Assistant Medical Officer was appointed, to meet the requirements of the Board of Education with regard to the medical inspection of school children, and this temporary appointment was succeeded by the permanent appointment of Dr. Oates as Assistant Medical Officer, so that it will now be possible to place the medical inspection of school children on a more organised and satisfactory footing. The question of infectious disease occurring amongst school children requires increased attention, as the direct and indirect financial loss to the Council, apart from other considerations, from this cause is very great, and I would direct their attention to the portion of the report in the School Section on Scarlet Fever. The question of laundry accommodation at the Hospital has received attention during the past year, and investigations have been made as to the best form of drying accommodation. I trust this matter will be decided and dealt with during the ensuing year, as the present accommodation is quite inadequate. The question of dealing with Consumption will assume increased importance shortly, when the Insurance Act comes into operation, and I have outlined a scheme under that heading in the section on infectious disease as to the best and most economical way of dealing with that question in this district. It is a matter that requires careful consideration and adjustment if the most effectual result is to be achieved from any grant made, while the needs and means of every district vary so much that there is real danger if rural and urban districts are all to be dealt with on similar lines. With a rapidly growing district such as this is, also with the increased attention paid to public health matters, with the consequent increase of work due to various new Acts and Regulations, the organisation of the Department has received 7 attention, and the Staff Administration Committee made certain recommendations which were approved by the Council during the year. This work consists .of a large amount of detail, which has been efficiently carried out by the officers concerned, and to all I am personally indebted for their co-operation in discharging our mutual duties to the Council. I am, Gentlemen, Your obedient Servant, C. F. STOVIN. CONTENTS. pages Physical and Geological Features 15 SECTION I. Vital Statistics. Statistical Summary 19 Population 20 Census, 1911, Particulars 22 Births 23 Diagram showing the Birth-Rates for the last 21 years Facing Page 23 Deaths 24 Diagram showing the Death-Rates for the last 21 years Facing Page 24 Zymotic Death Rate 26 Diagram showing the proportion of the Total Deaths from various Diseases Facing Page 26 Infantile Mortality 27 Diagram showing the Infantile Mortality rates for the last 21 years Facing Page 28 Diagram showing the Diseases which caused the principal amount of Infantile Mortality Facing Page 29 Table IV. of the Local Government Board 31 Notification of Births Act, 1907 32 Number of Births notified 33 Summary of visits paid and particulars obtained under the Notification of Births Act, 1907 33 Mortality in Age Groups 34 Inquests 35 Weekly Rainfall for the Year 35 Table I. of the Local Government Board 36 ,, III. ,, ,, ,, ,, 37 10 CONTENTS. SECTION II. pages Infectious Disease. Infectious Disease 41 Bacteriological, &c., Examinations 41 Small Pox 42 Scarlet Fever 43 ,, Chart Facing Page 43 Diphtheria 44 ,, Chart Facing Page 44 Enteric Fever 45 Diagram showing the number of cases of Enteric Fever during the last 21 years Facing Page 45 Erysipelas 46 Puerperal Fever 47 Phthisis 47 Respiratory Diseases other than Phthisis 51 Cancer and Malignant Diseases 52 Table II. of the Local Government Board 53 Table giving Death-Rate from various Infectious Diseases during the past 15 years 54 Isolation Hospital. Diseases treated in Hospital 55 Average lengths of stay in Hospital 55 Percentage of cases notified removed to Hospital 56 Table of Admissions Facing Page 56 Hospital Buildings, accommodation, etc. 57 Nursing 58 Summary as to cost of food Facing Page 58 Scarlet Fever 59 Diphtheria 60 Enteric Fever 60 Erysipelas 61 Phthisis 61 11 CONTENTS. Section II.—continued. pages Disinfection 61 Table of Houses and Articles Disinfected 63 Table as to Age and Sex of Scarlet Fever patients admitted 64 Table as to Age and Sex of Diphtheria patients admitted 64 SECTION III. Sanitary Administration. Food and Drugs Acts 67 Water Supply 67 Milk Supply 70 Bakehouses 72 Meat Supply 72 Fish Shops 73 Factories 73 Workshops and Workplaces 73 Tables of Factories, Workshops, etc. 77 Table.—1. Inspections 77 ,, 2. Defects found 78 ,, 3. Homework 79 ,, 4. Registered Workshops 79 „ 5. Other Matters 80 Housing, Town Planning, &c., Act, and the Housing of the Working Classes Acts 81 Sewage and Sewage Disposal 82 Removal of House Refuse 83 Public Latrines 83 Town Ambulance 84 Inspector of Nuisances:— Summary of Journal 86 Nuisances 86 Drainage 86 12 CONTENTS. Section III.—continued. pages Defects in Dwelling-Houses 87 Ilford Improvement Acts 88 Bye-Laws 88 Infectious Diseases (Prevention) Act 88 Dairies and Cowsheds Regulations 88 Accumulations of Refuse, &c. 88 Slaughter-House—Bye-Laws 88 Factory and Workshops Acts 88 Miscellaneous 89 Complaints 89 Notices served 90 SECTION IV. Schools. List of Schools 93 Cleanliness and disinfection of Schools 93 Medical Inspection:— Organisation and Method of Inspection 95 General Statement of extent and scope of Medical Inspection 96 General and Physical Conditions:— Malnutrition 98 Uncleanliness 98 Baths for School Children 98 Clothing and Footgear 99 Vision 99 Hearing 99 Adenoids 100 Tonsils 100 Glands 101 Mental Condition 101 Speech 101 Dental Condition of Children 102 Causes and Treatment of Tooth Decay 102 13 CONTENTS. Section IV.—continued. pages External Eye Defects 103 Ears 103 Heart and Anaemia 103 Lungs and Tuberculosis 104 Deformity and Rickets 104 Nervous System 104 Other Conditions 104 Mentally Defective Children 105 Deaf and Dumb Children 105 Blind Children 105 Feeding of School Children 105 The Health Visitor 108 Summary of work done by the Health Visitor Facing Page 108 Summary of defects detected upon Medical Inspection Facing Page 109 Summaries of Heights and Weights of children examined:— Boys 110 Girls 116 Children examined at the Public Health Offices 122 Summary of children presented for Special Examination Facing Page 122 Table showing results of Medical Inspection Following Page 122 Table showing results of Medical Inspection carried out previous to 1911 Following Page 122 Infectious Disease 124 Summary of Infectious Disease 125 Scarlet Fever 126 ,, ,, Table 127 Diphtheria 130 ,, Table 131 Measles 132 ,, Table 133 14 CONTENTS. Section IV.—continued. pages German Measles 134 ,, ,, Table 135 Chicken Pox 136 ,, ,, Table 137 Mumps 138 „ Table 139 Whooping Cough 140 ,, „ Table 141 Ringworm 142 ,, Table 143 Deaths amongst School Children 144 15 PHYSICAL, GEOLOGICAL, AND OTHER 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 of 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. Ilford is one of the largest Urban Districts in the County of Essex, and, as will be seen from the map, the population is largely concentrated in the South-Western portion of the district. So that, this South-Western portion is Urban in character while the remaining larger portion is still Rural. Being within seven miles of London, a large proportion of the inhabitants earn their living in the City, going there in the morning and returning at night. The population mainly belong to the lower middle class, occupying houses of from £20 to £40 a year, with a proportion of other classes. SECTION I. Vital Statistics, 19 STATISTICAL SUMMARY. Enumerated Population at Census, 1911 78,205 Estimated ,, ,, the middle of 1911 79,129 Area of District in Statute Acres—Land 8,470 ,, ,, ,, Inland Water 26 ,, , ,, ,, Tidal Water 7 Density of Population, i.e., No. of Persons per acre 9.3 Total number of births registered for 1911 1,589 Representing- a birth-rate of 21.4 per 1,000 Total number of births registered for 1910 1,679 Representing a birth-rate of 22.2 per 1,000 Total number of deaths registered for 1911 695 Representing a death-rate of 9.4 per 1,000 Total number of deaths registered for 1910 601 Representing a death-rate of 7.9 per 1,000 Total number of deaths from the seven principal Zymotic diseases in 1911 103 Representing a Zymotic death-rate of 1.3 per 1,000 Total number of deaths from the seven principal Zymotic diseases in 1910 33 Representing a Zymotic death-rate of .4 per 1,000 Total number of deaths under one year of age 133 Giving an Infantile Mortality rate to every 1,000 births registered of 83 Rateable Value—Houses £412,775 0 0 Land 7,275 10 0 £420,050 10 0 Education Rate— Elementary is. 8½d. Higher 1d. Education Estimated Expenditure, 1911-12, £58,295 8s. 3d. 20 POPULATION. The total population at the Census taken in April, 1911 was 78,205, which includes Village Homes 1,407 West Ham Asylum 977 Claybury Asylum 2,699 Total 5,083 Deducting this total from 78,205 leaves 73,122 as the nett population at the Census period. The Registrar-General's estimate for the total population in June, 1911, is 79,129, and deducting the populations of the institutions in the district as above, leaves a nett population of 74,046, which is taken for the purpose of estimating the various rates during the year. My previous estimate of the total population was 80,522, so that there was an error in excess of 2,317. When one considers the numerous possibilities of error, and that these possibilities are spread over an inter-censal period of ten years, there is every reason for congratulation that the mistake was so small. The Registrar-General's estimate for the same period was 70,028, so that his calculation was 8,177 below the correct figure, as compared with my 2,317 above. In view of the above facts, although I have taken the Registrar-General's figure for the year 1911, I propose to still adhere to the method of calculating the population from the number of inhabited houses, and using the Census figure of the number of persons per house. In a rapidly developing neighbourhood such as this, where the rate of building varies from year to year, the method of calculating from the number of inhabited houses appears to give the best and most accurate results. 21 By the kindness of Mr. Farrow, I have been supplied with the following information from the Census returns. I understand they are not absolutely accurate, but are sufficiently so for practical purposes. One important fact appears out of these returns, and that is the number of persons per house has fallen from 4.9 in 1901 to 4.3 in 1911. It is one which I did not expect, but is a fact of some interest, and a subject for congratulation. CENSUS—1911. Numbers of Enumeration Districts. Dwellings or Tenements. Buildings not used as dwellings. Population. Inhabited. Uninhabited. Building. Males. Females. Total. llford Urban District Civil Parish 1-63 16,856 903 129 382 35,637 42,568 78,205 Clementswood Ward 23-35 3,964 203 13 66 7 812 8 806 16 618 Cran brook Ward 1-8 2,287 114 10 34 4,245 5.761 9,961 Hainault Ward—North 9-13 813 33 1 31 1,954 1,916 3,870 Claybury 61 1 — — — 1,083 1,616 2,699 Dr. Barnado's 63 1 — — — 10 1,397 1,407 Hainault Ward—North — 815 33 1 31 3,047 4,929 7,976 Hainault—South 52-60 2,264 107 57 58 4,470 5,227 9,697 West Ham Asylum 62 1 — — — 456 521 977 Hainault Ward—South — 2,265 107 57 58 4,926 5,748 10,674 Loxford 43-51 2,809 140 1 73 5,980 6.348 12,328 Seven Kings 36-42 2,040 171 15 42 4,165 4,657 8,822 Park 14-22 2,676 135 32 78 5,462 6,364 11,826 Sub-District Total — 16,856 903 129 382 35,637 42,568 78,205 22 23 From the 1st April to the 30th June, certificates for occupation of new houses have been granted in 81 instances, thus making 16,934 inhabited houses. BIRTHS. The total number of births registered during the year was 1,589 (784 males and 805 females), giving a birth-rate of 21.4, or a corrected birth-rate of 19.6 per thousand of the population. Of the above, 14 males and 14 females were illegitimate. On examination of the diagram on the opposite page it will be seen that this is the lowest birth-rate yet recorded. The highest total number of births was registered in 1907, viz., 1,711. Since that year there has been a decline in the total number registered, in spite of the increase of population. During 1910 there were 1,679 births registered, so it will be seen that at present there is a decreasing total number of births, while the population is steadily increasing in numbers, but the serious thing is that this population consists mainly of people at the child-bearing period, but there are evidently factors at work which are affecting the normal rate of increase. From a national point of view this is of the utmost importance. The interesting feature about it, however, is that it is not confined to England, but is common to all European countries, showing that an advancing civilisation and a high birth-rate do not go together. It is one of those matters that will have to be faced and altered, or a time will come when the European nations will go down before a more virile people. Also, unfortunately, the deficiency in quantity is not made up in quality, as the degenerate and lower strata of society is increasing at a very much greater ratio than the more educated portions of the community, who should be producing a higher type of child; at any rate the prenatal influence of poverty, and its 24 dant tax on the mother, are absent, while the early years of the child should be, and usually are, passed in surroundings more conducive to healthy growth and life. The Notification of Births Act was adopted by this Council on May 25th, 1909, and has done a great deal to assist the survival of those children born; Miss Radford has been indefatigable in carrying out this work, as will be seen later on in this report. DEATHS. The total number of deaths registered during 1911 was 1,011. The total number of deaths registered for the district, apart from institutions, was 695. These include deaths in: — Romford Infirmary 45 The London Hospital 41 Essex County Asylum 12 St. Bartholomew's Hospital 5 Guy's Hospital 2 The Middlesex Hospital 2 The Cancer Hospital 2 Queen's Hospital, Bethnal Green 2 West Ham Hospital 2 University College Hospital 1 St. Mary's Hospital 1 The Evelena Hospital 1 The Eastern Hospital 1 The Italian Hospital 1 The Fridenheim Hospital 1 The Children's Hospital, Great Ormond St. 1 St. Joseph's Hospital, Hackney 1 King's College Hospital 1 The Royal Hants County Hospital, Winchester 1 25 Woolwich Infirmary 1 Bethnal House Asylum 1 Camberwell House Asylum 1 Marivale Sanatorium, London 1 The Sutrey Commercial Docks 1 " Pinewood," Wokingham 1 Lunds Hawes Junction (Midland Railway) 1 New Lodge, Billericay 1 Hurtwell, Potterspury, Northants 1 163, Mornirtgton Road, Leytonstone 1 4, Cromer Road, Romford 1 27, Southchurch Avenue, Southend 1 9, Sea View Terrace, Margate 1 The River Thames, off Pimlico 1 5, Norman Villas, Garlinge 1 1, Belle View Villas, Southchurch 1 26, Ridley Road, West Ham 1 A railway carriage, Stratford Station 1 Total 141 The number of non-resident dying in the district may be seen from the followinc :— Claybury Asylum 219 West Ham Asylum 88 Dr. Barnardo's Homes 9 Total 316 For the district proper, apart from institutions in the district receiving non-residents, the death-rate for the past year was 9.4, or corrected for sex and age the rate is 10.1 per thousand of the population. As will be seen from the diagram on the opposite page, this rate is higher than for 1910. The number of deaths 26 from Infantile Diarrhœa is largely responsible for this rise. During 1911 there were 64 deaths from this disease, as compared with 7 in 1910. The hot, dry summer was in a great degree responsible for this marked increase, and but for the Notification of Births Act, and the measures taken under that Act, I have no doubt the total number of deaths under this head would have been larger still. (As will be seen from the table of causes of death at the end of this section, the next disease responsible for the largest total number of deaths is Heart Disease. The total number registered for the year from this cause was 68, and this fact opens up the question as to whether the conditions of modern life, by increasing heart strain, are responsible for this large number, or whether the greater accuracy of diagnosis and consequent registration have something to do with it. Cancer is also responsible for a large number of deaths, the total number registered for the year from this disease being 58.) There is one other class of disease I should like to call attention to, and that is the Tubercle class. Here 70 deaths were registered from various forms of Tubercle, and this is essentially a preventible disease. Zymotic Death-rate. The number of deaths registered from the seven principal zymotic diseases for the year 1911 was 103, giving a zymotic death-rate of 1.3 per thousand. A reference to the detailed list below will show where and how this increase has occurred. In previous years it has been as follows :— No. Rate. 1900 70 1.8 1901 110 2.6 1902 47 1.0 1903 66 1.3 1904 120 2.2 27 1905 60 1.0 1906 97 1.4 1907 55 .8 1908 57 .8 1909 47 .6 1910 33 .4 The seven diseases included in this rate are :— Diseases. Deaths, 1911. Small Pox — Measles 16 Scarlet Fever 3 Whooping Cough 7 Diphtheria 9 Enteric Fever 4 Diarrhœa 64 Total 103 Infant Mortality. The infant mortality rate for the year 1911 is 83 per thousand births registered. On referring to the diagram it will be seen that there is an upward tendency during 1911. The climatic conditions prevailing during the summer are largely responsible for this. On referring to the infant mortality table, 54 deaths will be found to have been registered from Diarrhoea and Enteritis during 1911. In 1910 only four deaths were registered from the same causes, so it will be seen what influence the weather has on infant life, and also, too, I think the following list for previous years will show what can be done to limit this evil by judicious exertions. 28 In previous years the total numbers of deaths and the rates have been as follows :— Year. No. of Deaths under 1 year. Rate per 1,000 Births registered. 1891 38 124 1892 49 132 1893 43 121 1894 49 125 1895 58 127 1896 61 122 1897 88 138 1898 107 153 1899 120 134 1900 147 141 1901 187 156 1902 99 74 1903 141 92 1904 198 127 1905 138 86 1906 187 109 1907 134 78 1908 132 79 1909 112 68 1910 124 73 1911 133 83 The classification adopted in the diagram in the opposite page is largely provisional, as there is no finality in preventive medicine, and one would hope that deaths under the heading of Premature Birth and Congenital Malformations, 19 in all, may become more preventible as ante-natal influences are better known and understood. There were four deaths under one year of age from Measles, and this should be, at any rate, to a large extent preventible. 29 As mentioned above, the exceptional nature of the summer weather necessitated special measures being taken to prevent, as far as possible, its effect on infant life. Accordingly, in July, the following hints on a card were drawn up and posted to the parent of every child under one year of age in the district :— Precautions against Summer Diarrhcea in Infants. 1. Hot weather is very likely to cause fatal Diarrhoea in infants. 2. Flies are apt to carry the infection of Diarrhcea. 3. All windows should be kept open day and night, so as to obtain as much fresh air as possible. 4. Infants fed by hand are more likely to suffer from Diarrhcea than infants fed on the breast. 5. All milk should be boiled before use. 6. All vessels used for storing milk must be kept scrupulously clean, and covered with a clean cloth to keep out the flies and dust. 7. Feeding bottles and teats must be kept in clean cold water. 8. When asleep, a muslin curtain should be spread over the baby, to prevent the flies settling on the child's mouth. 9. If the baby shows any signs of Indigestion or Diarrhoea, no milk should be given for 24 hours, but a little plain barley or rice water instead; if the Diarrhcea then continues, medical advice should at once be obtained. In addition, Miss Radford, the Health Visitor, devoted special attention and care to those children requiring it. Judging by the results, and comparing them with other 30 tricts as below, it will be seen how indebted the Council is to her energy, tact and ability for such a satisfactory result in spite of the most adverse conditions. Personally, I should like to here express my indebtedness to her loyal co.operation, and I have always found no demand on her time or strength was too much for me to ask, or for her to meet. The following is a comparison of 11ford's rate for 1911 with other districts:—. Town. Population. Rate per 1,000 births registered. 1lford 74,046 83 Ealing 61,940 121 Wood Green 49,750 123 Edmonton 65,268 144 Enfield 56,684 133 Southend . on . Sea 63,570 121 Barking 31.546 155 East Ham 134,441 118 31 TABLE IV. INFANTILE MORTALITY. 1911. Nett Deaths from stated causes at various Ages under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1.2 Weeks. 2.3 Weeks. 3.4 Weeks. Total under 1 Month. 1.3 Months. 3.6 Months. 6.9 Months. 9.12 Months. Total Deaths under One Year. Small.pox — — — — — — — — — — Chicken.pox — — — — — — — — — — Measles — — — — — — — — 4 4 Scarlet Fever — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Whooping Cough — — — — — — — — 1 1 Diarrhoea — — — — — 7 11 14 6 38 Enteritis — — — — — 4 7 1 4 16 Tuberculous Meningitis — — — — — 1 1 — 2 4 Abdominal Tuberculosa — — — — — — — — — — Other Tuberculous Diseases — — — — — — 2 — — 2 Congenital Malformations 2 — — — 2 — — — — 2 Premature Birth 13 1 1 — 15 1 — 1 — 17 Atrophy, Debility, and Marasmus — 3 3 2 8 1 2 — — 11 Atelectasis 1 — — — 1 — — — — 1 Injury at Birth — — — — — — — — — Erysipelas — 1 — — 1 — — — — 1 Syphilis — — — — — — 1 — — 1 Rickets — — — —. — — — — 1 1 Meningitis (not Tuberculous) — — — — — 3 1 — — 4 Convulsions 3 — — — 3 1 1 — — 5 Gastritis — — — — — — — — — Laryngitis — — — — — — — — — — Bronchitis — — — — — 3 1 2 2 8 Pneumonia (all forms) — 1 — 1 2 — 1 4 4 11 Suffocation, overlying — — —« — —. — — — — — Other Causes 1 1 2 1 2 1 6 Total 19 7 5 3 34 22 30 23 21 133 Nett Births in the year:—Legitimate, 1,589; Illegitimate, 28. 32 NOTIFICATION OF BIRTHS ACT, 1907. This Act was adopted in this district on May 25th, 1909. As will be seen from the particulars, it has worked well, and has been of great benefit to the community. The results have been obtained without friction, and it should be noticed that 97 per cent, of the births were notified under this Act, and only 3 per cent, occurred of missed births, due to accidents such as ignorance of the Act by locum tenens in the absence of the ordinary medical attendant, medical men living elsewhere and attending cases in the district, an occasional misunderstanding between the persons responsible, etc. The method of procedure adopted has been for the Health Visitor to pay a visit to the home three weeks after the birth of the child if a doctor is in attendance, and ten to fourteen days after if a non.medical person is in attendance. At the visit particulars are obtained, printed matter containing the usual information is left, and more or less personal advice, according to the circumstances of the case. Further visits are paid if deemed desirable from the information obtained. During the past year a great number of babies have been fed on dried milk. This has either been supplied at cost price, or has been supplied free from a voluntary fund. The particular brand used has been "Glaxo," and it has answered its purpose extremely well. It seems to be well assimilated, the babies thrive on it, and it is not so liable to contamination as some of the condensed milks. Under suitable conditions, it forms one way out of the difficulty of infant feeding. 33 The total number of births notified under the Act was 1,528, separated into wards as under:— Cranbrook Ward 137 Park Ward 221 Seven Kings Ward 190 North Hainault Ward 94 Loxford Ward 301 Clementswood Ward 379 South Hainault Ward 206 Total 1,528 The following gives a percentage of the notifications by Jhe various responsible persons:— By Medical Men 50.2 By Midwives 16.1 By Parents and others 30.3 By Parents, on Registrar's suggestion 3.4 47 births were registered during the year which were not notified under the Act, as compared with 121 for 1910. This fact speaks well for the working of the Act in this district, and the thanks of the Council are due to the medical men and others for their co.operation in carrying out the provisions of the Act. Summary of Visits Paid, and Particulars Obtained under the Notification of Births Act, 1907, by the Health Visitor. Visits paid :— First Visits 1,407 Continuing Visits 3,755 Cases with Medical Practitioner in attendance at birth 1,090 „ „„ Midwife „ „ „ „ 292 „ „ Other person „ „ „ „ 5 34 Methods of feeding the babies at time of the Health Visitor's first visit:— Naturally 1,155 Artificially 165 Mixed feeding (natural and artificial) 24 Premature Births 68 Stillborn „ 27 Illegitimate ,, 14 Deaths shortly after birth (up to 2 weeks) 17 ,, from 2 weeks to 12 months 82 Children suffering from eye affections 21 ,, ,, ,, Cleft Palate 2 Condition of homes :— Good 510 Fair 636 Poor 230 Mothers who go out to work 28 „ „ take work in 5 The above figures are not altogether complete, as information on various points was not obtainable, hence the apparent discrepancy. These visits include births taken from the Registrar's Return, but which were not notified. Mortality in Age Groups. Under 1 year 25.45 45.65 Over 65. 133 80 169 184 I havt split up the over 65 group, which I think will give interesting particulars:— 65.75 75.85 85.95 Over 95. 89 75 18 2 35 INQUESTS. 33 inquests have been held during the year, 29 on residents in the district and 4 on residents in institutions in the district. WEEKLY RAINFALL FOR THE YEAR 1911. Week ended Rainfall in inches. Week ended Rainfall in inches. Jan. 7 th 44 July 1st 42 „ 14th 53 8th 08 21 st Nil 15th Nil ,, 28th 04 „ 22nd Nil Feb. 4th .01 „ 29th 35 „ 11th 14 Aug. 5th 03 „ 18th 23 „ 12th Nil „ 25th 29 „ 19th .10 Mar. 4th 43 ,, 26th 59 „ nth 37 Sept. 2nd 08 „ 18th 74 9th Nil „ 25th 37 „ 16th .48 Apr. 1st .60 23rd .47 „ 8th .2 „ 30th .37 ,, 15th 01 Oct. 7th 40 ,, 22nd Nil „ 14th 34 „ 29th 42 „ 21st 44 May 6th 27 ,, 28th 1.49 ,, 13th 19 Nov. 4th 61 „ 20th 26 „ 11th 1.16 „ 27th Nil ,, 18th 1.16 June 3rd 03 25th .22 ,, 10th Nil Dec. 2nd 23 „ 17th 67 9th 81 „ 24th 1.39 ,, 16th 63 „ 23rd 1.07 „ 30th 49 Total rainfall for the year, 19.65 inches TABLE I. Vital Statistics of Whole District during 1911 and P*evious Years. Year. Total Population estimated to middle of each year. Nett Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Un.corrected Number. Nett. of Non.Residents registered in the District. of Residents not registered in the District. Under 1 Year of age. At all ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1906 69,745 65,165 1,701 ? 261 920 131 375 100 187 109 9 645 98 1907 71,278 66,698 1,711 ? 25.4 839 11.6 324 104 134 78.3 619 9.2 1908 76,295 71,221 1,653 ? 232 836 10.9 299 95 132 79.8 632 89 1909 79,392 74,364 1,647 ? 221 886 11.1 334 105 112 68 0 657 88 1910 85,522 75,327 1,679 ? 222 772 96 273 102 124 73 8 601 7.9 1911 79,122 74,046 1,589 1,589 21.4 840 127 316 141 133 . 83 695 9.4 36 37 TABLE III. Causes of, and Ages at Death during the Year 1911. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of "Residents" or " Non-Residents " in Institutions in the District. All ages. Under 1 year. 1 aod under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 Enteric Fever 4 - - - - 1 2 1 - 2 Small-pox - - - - - - - - - - Measles 16 4 5 5 2 - - - - 1 Scarlet Fever 3 - 1 - 2 - - - - 3 Whooping Cough 7 1 4 2 - - - - - - Diphtheria and Croup 9 — 2 1 6 - - - - 7 Influenza 6 - — 1 1 - 1 1 2 - Erysipelas 1 1 - - - - - - - - Cerebro-Spinal Fever — - - - - - - - - - Rotheln 1 - - - - - - 1 - - Phthisis (Pulmonary Tuberculosis) 49 2 — — 1 8 28 10 - 36 Tuberculous Meningitis 8 3 1 1 2 1 - - - 2 Other T uberculous Diseases 13 1 1 2 4 2 1 1 1 5 Rheumatic Fever 3 - - - - - - 3 - - Cancer, Malignant Disease 58 — — — - 1 7 30 20 12 Bronchitis 34 7 2 1 1 - - 10 13 5 Broncho-Pneumonia 10 5 2 - - 1 - 2 - 14 Pneumonia (all other forms) 30 7 5 2 — - 2 8 6 44 Other Diseases of piratory Organs 8 1 — 1 - 2 - 2 2 5 Diarrhcea and Enteritis 64 54 6 - - — 1 — 3 4 Appendicitis and Typhlitis 2 — — - 1 — - 1 - - Alcoholism - - - - - - - - - - Cirrhosis of Liver 3 - - - - - - 2 1 1 Nephritis and Bright's Disease 24 - — - 1 — 4 11 8 8 Puerperal Fever 1 — — — — — 1 - — - Other accidents and eases of Pregnancy and Parturition 4 - - - - - 4 - - - Congenital Debility and Malformation, including Premature Birth 32 28 2 — — — 1 1 1 Violent Deaths, excluding Suicide 14 1 — — 4 3 1 3 2 3 Suicides 7 — - - - 1 2 4 - - Organic Heart Diseases 68 — — 1 5 3 9 21 29 11 Other Defined Diseases ... 122 10 3 2 9 4 16 43 35 74 Diseases ill-defined or known 94 8 2 2 3 — 2 15 62 90 695 133 36 21 42 27 81 170 .185 328 SECTION II. Infectious Disease. 41 INFECTIOUS DISEASE. During 1911 notifications were received of 578 cases. ,, 1910 ,, ,, ,, 365 ,, ,, 1909 „ „ „ 525 „ „ 1908 „ „ „ 679 ,, „ 1907 „ „ „ 651 .. 1906 ,, ,, ,, 548 ,, „ 1905 „ „ „ 446 „ „ 1904 „ „ „ 508 „ „ 1903 „ „ „ 364 „ " I902 „ „ „ 738 „ From institutions in the district the following cases have been notified:— L.C.C. Asylum, Claybury. Erysipelas 2 Enteric Fever 1 Village Homes, Barkingside. Diphtheria 2 Erysipelas 7 Scarlet Fever 5 Of the total 578 cases of infectious disease notified, 88 were due to Phthisis, of which 10 were duplicate notifications. This disease has only been included for 1909 and 1910. During 1911, the following specimens were sent to the County Laboratories for bacteriological and other examination, with the results shown:— Disease. No. sent. Positive. Negative. Diphtheria 389 112 277 Enteric Fever 4 1 3 Tubercle 59 17 42 Ringworm 569 325 244 Now that the Assistant Medical Officer of Health has been appointed, it will be possible to do the bulk of this work within the district, and a small laboratory has been fitted up at the offices with that object in view. 42 There will be certain cases still, however, where it will be desirable to have an outside and independent opinion, and specimens from these cases will still be sent to the County Laboratory, as heretofore. It will be seen that the work is practically confined to the three diseases, Diphtheria, Tubercle, and Ringworm. The Tubercle examinations are likely to increase with the increased attention paid to this disease, but one would hope that the Ringworm examinations should decrease with the efforts made to control the spread of this disease. On receipt of a notification of infectious disease a visit is paid to the house by a Sanitary Inspector, and information obtained as to its possible cause, milk and water supply, if of school age, school attended, occupation of self or parent, or any other relative particulars. The sanitary conditions of the premises are gone into and, if necessary, notices are served to remedy any defect found. On receipt of this information further enquiries are made at school or elsewhere, as deemed desirable. This is found to be of practical importance with regard to Scarlet Fever, as it appears to be the " missed " cases which give rise to so much trouble, and it is only by following up possible clues that the district can be safeguarded. This method is attended with a certain amount of success, but intercommunication and possible sources of contact are so numerous that it is impossible to trace the origin of the majority of the cases. SMALL POX. In the beginning of March a man, aged 26 years, was notified as suffering from Small Pox. He was employed at the Albert Docks. After the notification I was asked to see him. There was a distinct history of backache, also headache. The rash was profuse, but the distribution was more characteristic of Chicken Pox than Small Pox. The constitutional symptoms were not in proportion to the amount SCARLET FEVER. 43 of rash. The man had been vaccinated about two years previously, which vaccination had been successful. As the case had been notified, I arranged for his removal to Hospital. On arrival at the Hospital he was examined and sent back as, presumably, not suffering from Small Pox. In view of all the circumstances, however, arrangements were made for his isolation at home. All the others in the house had been vaccinated at once on the occurrence of the rash. All contacts were dealt with, and every precaution taken as though there was no doubt about the accuracy of the diagnosis. It was the only safe and wise course to pursue in the circumstances, and no further trouble arose. The man made a good recovery, and in due course returned to work, after thorough disinfection had taken place. SCARLET FEVER. Year. Cases. Deaths. Rate per 1,000. Per cent, of Cases Notified. 1911 295 3 04 1.01 1910 198 5 06 2.52 1909 267 Nil Nil Nil 1908 446 3 04 .67 1907 470 5 07 1.06 1906 326 3 04 92 1905 288 4 06 1.38 1904 224 5 09 2.23 1903 181 2 04 1.10 1902 264 2 04 .75 This disease has been more prevalent again during 1911. From the chart it will be seen it has been fairly evenly distributed throughout the year, at its minimum during the holidays, and at its maximum towards the end of the year, as one would expect. Of the 295 cases, 205 occurred in patients between the ages of 5 and 15, so it will be seen that this is essentially a disease of school life, and will be dealt with more fully in the School section. With the 44 creased number of cases there has been no corresponding increase in the number of deaths. During 1911 there were 3 deaths registered from this cause, while in the previous year, 1910, there were 5 deaths. As Scarlet Fever is a disease that tends to recur in cycles, 1 am rather afraid we are on a rising wave, and that 1912 will show a further increase, unless successful means can be adopted to limit the spread. The disease as a whole has been of a mild type. In a modern town like Ilford the associated sanitary conditions are not bad, and therefore do nothing to produce that more severe type of disease which is met with when sanitary surroundings are primitive and bad. DIPHTHERIA. Year. Cases. Rate per Deaths. l,000. Per cent, of Cases Notified. 1911 135 9 12 6.66 1910 68 3 .03 4.4 1909 132 11 .14 8.3 1908 161 7 .09 4.3 1907 108 7 . 10 6.5 1906 132 11 .16 8.3 !905 85 4 .06 4.7 1904 181 10 .18 5.5 1903 95 14 .28 14.7 1902 86 8 .17 9.3 As will be seen from the chart, Diphtheria was fairly evenly distributed throughout the year, but with an increasing incidence in the autumn, as might be expected. Of the 135 cases notified, 90 were between the ages of 5 and 15, and as this corresponds with the school age, and, as a matter of fact, involved the schools, more detailed report on this disease will be made in the School section. Unfortunately there were 9 deaths registered from this disease. For some years now, Anti-toxin has been supplied free to any medical practitioner who cares to apply DIPHTHERIA. ENTERIC FEVER. 45 for it, and also means of free bacteriological diagnosis are supplied by the Council. With regard to the taking of swabs for purposes of diagnosis, there is one point that should be borne in mind, and that is the delay necessarily involved in hearing the result. Thus valuable time may be wasted before Anti-toxin is injected, and the patient's life imperilled. It is generally recognised now, I think, that it is undesirable to inject Anti-toxin unnecessarily, but the risk is as nothing compared with allowing a patient to absorb for some time the Diphtheria Toxins, without counteracting their action by the injection of Anti-toxin. In other words, the risk of Anaphylaxis is small compared with the risk of the results of untreated Diphtheria. ENTERIC FEVER. Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1911 10 4 .05 40 1910 16 1 .01 6.28 1909 7 1 .01 14.28 1908 12 Nil Nil Nil 1907 10 Nil Nil Nil 1906 35 1 .01 2.85 1905 22 4 .06 18.18 1904 32 4 .07 12.5 1903 28 2 .04 7.14 1902 61 7 .15 11.47 From the diagram on the opposite page it will be seen how low the incidence of this disease is keeping, and if it were possible to secure still more accuracy in diagnosis I have no doubt the number of cases would be still further diminished. Five of the cases, that is, one - half, occurred in the month of September, after holidays had been taken in various parts of the country. Of course it is extremely difficult to trace the origin of an isolated attack after 46 an incubation period of a fortnight. One case was fairly definite as to the infection being probably derived from a village water supply. Another was almost certainly infected from polluted ice cream, as there had been other cases in the district visited derived from this source. A third had partaken freely of shellfish whilst on a visit, and this may or may not have been polluted. The other cases seemed to arise without any possibility of tracing the source of infection. In one house, two other inmates were infected before the original case was clearly diagnosed. The symptoms in this original case were so slight and indefinite that there seemed no sufficient ground for diagnosing it as Enteric Fever until the other two cases occurred. ERYSIPELAS. Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1911 45 1 .01 2.22 1910 42 2 .02 4.76 1909 62 2 .02 3.23 1908 56 3 .04 5.35 1907 60 2 .02 3.33 1906 52 1 .01 1.92 1905 48 3 .04 6.25 1904 56 1 .01 1.78 1903 49 Nil Nil Nil 1902 67 4 .08 5.97 It is an interesting point as to how much the reduction of bacterial diseases is due to administrative action and how much to climatic conditions. 47 PUERPERAL FEVER. The following record speaks for itself :— Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1911 4 1 .01 25.0 1910 1 Nil Nil Nil 1909 2 2 .02 100.0 1908 2 Nil Nil Nil 1907 2 1 .01 50.0 1906 3 2 .03 66.66 1905 3 3 .04 100.0 1904 4 4 .07 100.0 1903 2 1 .02 50.0 1902 3 2 .04 66.66 PHTHISIS. The compulsory notification of Phthisis, which came into force on the 1st January, 1912, will alter the whole administrative methods of dealing with this disease. It is to be hoped, too, that local authorities will be able to get financial assistance under the Insurance Act in course of time, and then some real advance will be able to be made. Heretofore the method of dealing with this disease, qua disease, has been practically nil, and until the disease can be looked at as a whole it will be impossible to deal with it effectively. There are three classes of the disease which have to be coped with : the advanced, the medium, and the slight classes. In addition to the disease itself there is also the financial problem to be faced, as the disease is essentially one of adult life, and therefore more complicated than other infectious diseases which occur chiefly in childhood. At present the advanced cases are largely connected with the Poor Law. As a result they are pressed to go to the Infirmary at Romford. Perhaps they go, stay for a week or longer, and then are home again. These cases are probably a very 48 serious source of infection, and as their home conditions are nearly always unsuitable, undoubtedly the Infirmary, or some similar institution, is the best place for them. The difficulty is to get them to stay there for any length of time. The whole subject is coming before the Public Health Committee at no distant date, and it is hoped that some comprehensive scheme may be evolved capable of dealing with the problem. Then, if other local authorities will do the same, I have no doubt a very marked reduction in the incidence of Phthisis will be the result. With regard to the best means of dealing with Phthisis in this district, I am convinced that some such scheme as the following would give the best results, both from a financial point of view and also as a means of dealing with the disease in detail. The County should provide a central Sanatorium for the treatment of curable cases, and to this Sanatorium should be attached a sufficient number of experts to provide skilled advice to local authorities. The problem of Consumption is so large, and the type of case so various, that the majority of cases could be dealt with locally. But the early cases and the ones suitable for admission to the central Sanatorium should be selected by an expert attached to the Sanatorium. I should suggest that the local Medical Officer of Health should communicate with the County Medical Officer of Health, or direct with the Sanatorium, that he has so many cases more or less suitable for admission. By arrangement the expert then sees and examines these cases at the local centre and decides accordingly. The Poor Law will still take a certain number of the more advanced cases as heretofore. In this district, at the Isolation Hospital, which stands in a favourable position and where extra accommodation could easily be provided, as there are some six or seven acres of land still not utilised, provision should be made for dealing with more advanced cases, and these as a rule do not like to go far from home. 49 Some who would be temporarily aided by residence at such an institution, some who would be better removed from existing surroundings and would be so likely to diminish the risk of infecting others, some who would be helped by the education so provided that on returning to their homes and work they would be a much less source of danger to their associates, and some for other reasons. Then, in addition, there must be some central meetingplace in the district for patient and medical adviser. At the office at present there is accommodation in the form of waiting and consulting rooms. These could be set aside one or two afternoons a week, or as often as necessary, for the dealing with Phthisis. Under due supervision this could be done without danger. Here the cases could be seen by the expert from the Sanatorium, cases requiring it could be treated and examined, sputum could be examined on the premises or other laboratory methods carried out, and here would be all the notifications with information collected arising from them. From here, too, would proceed the visits for examining the home conditions, for examination of contacts, dealing with children attending school, and so on. To carry this out would require an addition to the staff of a medical resident at the Isolation Hospital. This assistant could also attend at the offices at the appointed times for examining or treating the Phthisis cases, and would also visit the homes to examine contacts or for other reasons. Another Health Visitor would be necessary, and if, as would be, her time was not fully occupied in this work, part of it could be allocated to assist in the medical inspection of school children, where more of such help is badly wanted. Then there would be the expense of the provision of accommodation at the Isolation Hospital, which need not be costly, and the administrative portion is, of course, already there. 50 If, under the Insurance Act, a grant could be made by the County to this authority out of the " Sanatorium benefit," the cost to the Ilford Council would not be great, and the control of Tubercle would be much more efficient than by any other scheme I can conceive of for this district. A local authority, if it will, is able to deal with its own local problems far more efficiently and economically than by any means devised by a central body. At present the procedure on receipt of notification is for the Chief Inspector to visit, give what help is possible, and after death, offer and carry out disinfection where possible. The particulars are as follow :— Year. Deaths. Death-rate Per 1,000 Persons. 1911 49 .6 1910 47 .6 1909 44 •5 1908 38 .S 1907 48 .7 1906 37 .5 1905 38 .6 1904 33 .6 1903 36 .7 1902 32 .7 VOLUNTARY NOTIFICATIONS. Twenty-two cases of Phthisis were voluntarily notified ; of these, 4 were also notified under the Public Health (Tuberculosis) Regulations, 1908, and 4 under the Public Health (Tuberculosis in Hospitals) Regulations, 1911. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1908. Twenty-three cases of Phthisis were notified under these regulations, of which 4 were voluntarily notified and 2 were also notified under the Public Health (Tuberculosis in Hospitals) Regulations, 1911. 51 PUBLIC HEALTH (TUBERCULOSIS IN HOSPITALS) REGULATIONS, 1911. Forty-three cases of Phthisis were notified under these regulations; 4 were also notified under the Voluntary Notifications, and 2 under the Public Health (Tuberculosis) Regulations, 1908. After deducting the above duplicate notifications, a nett total of 78 cases of Phthisis was notified during the year. Of these, 8 were inmates of Claybury Asylum, and therefore should not be included as belonging to Ilford, which leaves a further reduced figure of 70 cases belonging to the Ilford district. As far as I can ascertain, 11 of the cases of Phthisis notified during the year have proved fatal. Six of the cases notified during 1909 and 1910 have died during 1911. DISINFECTION OF HOUSES AFTER PHTHISIS. Thirty-two houses altogether were disinfected after Phthisis. Disinfection was offered in 37 instances but only accepted in 23. Upon request from the occupiers, 9 houses were disinfected thus making the total of 32 mentioned above. RESPIRATORY DISEASES OTHER THAN PHTHISIS. Per 1,000 In 1911 there were 81 deaths, giving a death-rate of 1.1 ,, 1910 ,, 88 ,, ,, ,, 101 ,, 1909 ,, . 107 , ,, ,, 1.40 „ 1908 ,, 93 , ,, ,, 1.3 „ 1907 ,, 105 ,, ,, ,, 1.5 „ 1906 „ 88 ,, ,, ,, 1.3 „ 1905 ,, 88 ,, ,, ,, 1.4 52 CANCER AND MALIGNANT DISEASE. Per 1,000 In 1911 there were 58 deaths, giving a death-rate of .7 ,, 1910 ,, 62 ,, ,, ,, .8 ,, 1909 ,, 57 ,, ,, ,, .7 ,, 1908 ,, 55 ,, ,, ,, .7 ,, 1907 ,, 42 ,, ,, „ .6 ,, 1906 ,, 54 ,, ,, ,, .8 ,, 1905 ,, 33,, ,, ,, .5 53 TABLE II. Cases of Infectious Disease Notified during the Year 1911. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. 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 45. 45 to 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Small-pox 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 135 ... 24 90 10 10 1 ... 8 16 20 17 23 27 24 93 Erysipelas 45 2 1 7 5 16 10 4 5 6 4 11 8 7 4 1 Scarlet Fever 295 1 64 205 13 11 1 39 50 50 28 33 47 48 219 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 10 ... ... 4 2 3 1 ... ... ... 2 2 4 1 1 4 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... ... ... ... 4 ... ... ... ... ... ... ... 3 1 ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis Under Tuberculosis Regulations, 1908 23 ... ... ... 4 15 3 1 ... 3 1 8 2 7 2 ... Under Tuberculosis Regulations, 1911 43 ... 1 4 9 23 6 ... 7 2 6 ... 11 13 4 ... Others 22 ... ... ... 2 16 4 ... 1 3 3 ... 1 8 6 ... Totals 578 3 90 310 45 99 26 5 60 80 86 66 82 114 90 318 54 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 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 ...... ...... 05 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 n 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 1907 ...... ...... ...... 60 2 .02 108 7 .10 470 5 .07 10 ...... ...... 2 1 .01 ...... 4 .05 66,698 1908 ...... ...... ...... 56 3 .04 161 7 .09 446 3 .04 14 1 .01 2 ...... ...... ...... 6 .08 71,221 1909 ...... ...... ...... 62 2 .02 132 11 .14 267 ...... ...... 8 1 .01 2 2 .02 ...... 15 .20 74,362 1910 ...... ...... ...... 42 2 .02 68 3 .03 198 5 .06 16 1 .01 1 ...... ...... ...... 2 .02 75,327 1911 1 ...... ...... 45 1 .01 135 9 .12 295 3 .04 10 4 .05 4 1 .01 ...... 16 .21 74,046 55 ISOLATION HOSPITAL. Number of patients in Hospital at beginning of year:— Scarlet Fever 37 Diphtheria 13 Enteric Fever 3 Number of patients admitted during the year:— Scarlet Fever 220 Diphtheria 93 Enteric Fever 4 Erysipelas 1 Number of patients remaining in Hospital on 1st January, 1912:— Scarlet Fever 63 Diphtheria 23 Number of deaths, and death rates per cent. of cases admitted to the Hospital during the year, showing comparison with 1910 :— Number of Deaths. Death-rate per cent. 1911 1910 1911 1910 Scarlet Fever 3 5 1.2 2.6l Diphtheria 7 3 7.5 4.16 Enteric Fever 2 3 50 27.27 The following shows the average length of stay of patients in the Hospital:— Days. Average days in Hospital Scarlet Fever. 35 cases of Scarlet Fever in Hospital on 1st January, 1911 1,718 49.08 2 cases of Scarlet Fever in Hospital on 1st January, 1911, but which died during 1911 50 25 56 155 recovered cases of Scarlet Fever 9,165 59.12 1 fatal case of Scarlet Fever 122 122 63 cases of Scarlet Fever in Hospital on 1st January, 1912 2,146 34.06 Average stay in Hospital of Scarlet Fever patients 51.56 Diphtheria. 13 cases of Diphtheria in Hospital on 1st January, 1911 650 50 63 recovered cases of Diphtheria 2,724 43.23 7 fatal cases of Diphtheria 34 4.85 23 cases of Diphtheria in Hospital on 1st January, 1912 338 14.68 Average stay in Hospital of Diphtheria patients 35.33 Enteric Fever. 3 cases of Enteric Fever in Hospital on 1st January, 1911 170 56.66 2 recovered cases of Enteric Fever 82 41.00 2 fatal cases of Enteric Fever 11 5.5 Average stay in Hospital of Enteric Fever patients 37.57 Erysipelas. 1 recovered case of Erysipelas 17 Average stay in Hospital of all patients 46.55 Average number of patients in Hospital per day 47.19 Percentage of cases notified removed to the Isolation Hospital:— Scarlet Fever 73.89 Diphtheria 66.66 Enteric Fever 40 Erysipelas 2.2 2 No cases were admitted from outside the district. TABLE OF ADMISSIONS In the Respective Months during the last Nine Years. Months. Scarlet Fever. Diphtheria. Enteric and Continued Fevers. Erysipelas. Puerperal Fever. Measles. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1903 1904 1905 1906 1907 1908 1909 1910 1911 1903 1904 1905 1906 1907 1908 1909 1910 1911 1903 1905 1906 1907 1908 1909 1910 1911 1905 1906 January 16 17 10 21 40 29 31 14 24 7 3 5 2 3 10 10 11 5 — — 1 — — — — 2 — — — — — — — 1 — — — February 11 17 18 11 31 26 13 14 15 5 10 8 5 8 1 12 5 6 — 1 — — — — — — — — — — 1 — — — 1 — — March 3 13 15 17 26 26 22 15 17 4 3 3 13 8 5 7 3 4 — 1 — — — 1 — — — — — — — — — — — — — April 11 12 9 17 33 23 3 11 8 2 4 10 3 9 5 8 2 5 — — 1 1 2 — — — 1 — 1 — 1 2 — — — — May 9 8 10 20 31 20 11 11 16 4 4 3 12 4 5 4 8 4 1 — 2 2 — 1 — 9 — — — 1 — — — 1 — — — June 7 4 16 14 18 27 16 5 10 1 15 1 9 6 5 8 2 3 — 2 2 1 — — — — — — — — — — — — — July 6 12 5 25 28 36 10 14 6 1 5 2 6 4 10 1 4 7 — 4 2 1 1 — — — — — — — — — — — — 1 August 8 10 10 18 27 17 9 8 7 3 3 8 4 5 8 3 — 5 2 2 1 — 1 2 — — — — — — 1 — — — — — — Sept. 5 4 9 21 28 30 17 16 23 3 7 4 9 6 9 4 1 14 4 2 2 1 1 1 — 1 — — — — — — — — — — October 11 10 23 40 35 20 18 10 30 2 9 3 12 11 6 14 7 6 2 1 9 2 3 — 3 2 — — — — — — — — — — November 11 7 15 33 34 16 8 17 32 2 12 4 7 3 9 6 4 9 2 1 1 3 — 2 2 — — — — — — — — — — 1 December 17 26 16 31 38 31 28 20 31 3 5 4 6 3 6 11 8 25 — — — — — 1 — 3 — 1 — — 1 — — — — — — Totals 115 140 156 268 369 301 186 155 219 37 80 55 88 70 79 88 55 93 11 9 13 19 8 12 3 10 4 1 1 1 3 1 2 2 1 1 1 57 HOSPITAL. 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, and 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 so infected other children. In June, 1908, the new extension to the Hospital was opened. This gives additional accommodation for 26 patients, as the new block consists of two main wards of 12 beds each, with two side wards for one patient each. On the upper floor are 12 bedrooms for the nursing staff, with separate sitting-room accommodation for Sisters and Nurses. There is also a kitchen, living room, and the usual offices, with accommodation also for a resident medical officer. This upper floor is reached by an outside staircase at each end, so that there is no direct communication between the wards and the staff quarters. The laundry accommodation was not increased on the extension of the Hospital, with the result that the present accommodation is quite inadequate for the present needs of 58 the Hospital. The matter has been before the Public Health Committee, plans for increased accommodation have been prepared, and a Sub-Committee has been formed to formulate the requirements, so that it is hoped that the extension will take place during the present year. NURSING. The regular staff of the Hospital consists of 1 Matron, I Assistant Matron, 3 Sisters, 4 Staff Nurses, and 10 Probationers. The nursing requirements of an Isolation Hospital are, however, necessarily of a very fluctuating character, and it is an extremely difficult matter to adjust the staff to the number of patients. Without any warning, a sudden increased demand may be made on the nursing staff, and has to be met in various ways, such as obtaining temporary help. This is, of course, expensive, and is not desirable in more ways than one if it can be avoided. The Assistant Matron resigned during the year, and the post was filled by the appointment of Sister Stevens. The scale of salaries was revised during the year, and now stands as follows:— By Annual Commence Increments of To Sisters £38 £2 £44 Staff Nurses £26 £2 £30 Probationers, £18 for the first year;£20 for the second year; and if they stay the third year, to receive £22 per annum. This is a higher scale than has been in force, and it is hoped that the increase will secure a good type of nurse, for, of course, the success of the institution largely depends on its nursing. This work is carried on away from the public eyes, and I am sure the Council appreciate the good and effective work put in by the nursing staff, from the Matron downwards. The responsibility is never-ceasing, continuous, day and night, from week to week, so that the more honour COST. STATEMENT AS TO COST OF FOOD AT THE ISOLATION HOSPITAL. 1900-01 1901-02 1902 03 1903-04 1904-05 1905-06 1906 07 1907-08 1908-09 1909-10 1910-11 Number of Staff 9 12 15 17 18 24 27 26 26 31 28.7 ,, Patients 189 175 214 220 267 275 464 478 430 294 263 Average length of stay of Scarlet Fever Patients (days) 51 49.4 56.9 47 49.1 46.4 40.5 37.6 45.5 48.1 54.1 ,, ,, ,, Diphtheria „ „ 21.3 31.8 30.5 25.3 29.1 24.4 22.2 24.9 30.5 38.6 46.7 ,, ,, ,, Enteric Fever „ „ 30.5 37 37.9 41 42.3 31.5 39.8 25.1 34.9 34.0 45.6 ,, ,, ,, Puerperal Fever „ „ ... ... ... ... ... 13 ... ... ... ... ... ,, ,, ,, Erysipelas „ „ ... ... ... 29 ... 2 16.5 7.5 9.0 12.3 20 ,, ,, ,,Measles „ „ ... ... ... ... 25 ... 10 ... ... ... ... ,, ,, ,, All ,, ,, 43.5 45.2 49.2 40.9 42.7 40.6 36.2 35.3 41.8 44.8 52.1 ,, number of patients in hospital per day 22.5 21.7 28.8 24.5 31.2 30.8 461 46.7 49.3 36.1 37.5 Total number of days for Staff 3,285 4,380 5,475 6,222 6,570 8,760 9,855 9,516 9,490 11,315 10,501 ,, ,, ,, Patients 8,233 7,925 10,533 8,996 11,412 11,167 16,837 16,903 18.016 13,188 13,705 ,, ,, weeks for Staff and Patients combined 1,645 4 1,757.8 2.286.8 2,174 2,568.8 2,846.7 3,813 3,774.1 3,929.4 3,500.4 3,458 Cost of Meat ... ... £199 19 6 £186 19 7 £198 8 1 £257 11 4 £375 6 9 £377 19 7 £391 2 6 £345 13 11 £333 11 11 „ Groceries ... ... 184 6 7 200 17 5 208 12 3 260 3 4 316 15 7 289 12 6 296 4 1 330 6 8 322 12 6 ,, Vegetables ... ... 23 8 4 33 8 9 25 2 1 40 1 11 56 12 3 69 5 4 71 14 10 63 7 6 69 8 9 ,, Bread and Flour ... ... 41 6 0 44 2 4 51 3 8 61 4 5 76 17 9 79 0 10 77 7 11 71 0 11 74 14 10 „ Milk and Eggs ... ... 150 17 10 153 12 0 162 18 6 143 17 10 254 13 10 192 3 3 182 6 6 175 8 2 208 10 4 ,, Fish and Poultry ... ... 31 4 4½ 31 13 0 48 17 5½ 29 3 11 38 8 1 41 13 7 45 15 6 38 17 4 32 12 7 Total cost of all food ... ... £631 2 7½ £650 13 1 £695 2 0½ £792 2 9 £1,118 14 3 £1,049 15 1 £1,064 11 4 £1,024 14 6 1,041 10 11 Cost of food per head per week for Staff and Patients combined ... ... 5 6 5 11 5 4 5 6 5 10 5 6 5 5 5 10 6 0 59 is due to those who freely give their services, and carry out their work as it is carried out at the Hospital. The post of Matron to a Hospital where there is no resident Medical Officer is a very trying one, and makes many and various demands on the capacity of anyone occupying such a position, much more so, probably, than is generally recognised. SCARLET FEVER. The following is the average stay in days of patients admitted to the Hospital suffering from this disease, for the last few years:— 1903 1904 1905 1906 1907 1908 1909 1910 1911 58 54 48 42 36 42 44 52 51 It will be seen from this that the average stay during 1911 was slightly less than the previous year. The percentage of Scarlet Fever cases admitted was 73.8 for 1911, compared with 75.2 in 1910 and 69.7 in 1909. There were three deaths in Hospital from this disease. Two were from Endocarditis, supervening on the primary attacks, and the other was a young baby whose powers of resistance were defective. There were two instances where another case was notified within three weeks of the first case returning home from the Hospital. One was discharged on the 31st March, 1911, and a second case was notified on the 5th April, 1911. The other returned home on the nth September, 1911, and two others were notified from the same house on the 25th September. Even supposing these were undoubted "return" cases, due to infection from the discharged patient, the percentage is a very small one. But it must not be forgotten that, where there are numerous other possibilities of infection, one must not be too prone to jump at erroneous conclusions. 60 During the year an open verandah has been built facing south at one end of the last new Scarlet Fever Block. This will give an accommodation for about six patients, and will prove extremely useful in the management of some types of Scarlet Fever. DIPHTHERIA. The average stay in hospital for these cases for the last few years has been:— 1908 1909 1910 1911 27.1 33.8 35.5 35.3 days so it will be seen that the average stay in Hospital has been practically the same during the last two years. There were seven deaths in Hospital from this disease. In four cases tracheotomy was performed, and of this four, three recovered. The diagnosis is, as a rule, checked by bacteriological methods, and cases are not sent home until a negative result is obtained from this same means. The essential factors in the successful progress of patients suffering from this disease are the early recognition, and suitable treatment with Anti-toxin. Every hour's delav in neutralising the Toxins formed by the unchecked advance of the disease increases the ultimate risk to the patient's life. As a rule these two factors are borne in mind, with satisfactory results in this district, but there are still instances which make it desirable to labour these points, so as to get still more satisfactory results. There have been no return cases from this disease. In two instances where this disease was nursed at home there was an extension of infection to other members of the same family. ENTERIC FEVER. Four cases of Enteric Fever were admitted to the Hospital during 1911, and of these, two died. 61 ERYSIPELAS. One case of this disease was admitted during the year. It occurred in a woman of advanced age who had no accommodation in her lodging for suitable attention, and accordingly her removal was necessitated. She made a good recovery. PHTHISIS. Although the Council agreed to take in these cases under suitable conditions for six months as an experiment, it was not possible to carry it out on the lines suggested, as the demands for the accommodation of the other diseases left no sufficient available space. One man, however, was so treated. He was an employee of the Council, was persistently losing flesh, had a continuous temperature above normal, but gave no physical signs. As he was getting progressively worse, I decided to take him in. He was kept in bed in the open air whenever the weather conditions did not absolutely compel his being under cover, and in about a fortnight his temperature became normal, and in about seven weeks he returned to work, and has remained well since. As the Hospital site covers about eleven acres of ground, and only about four to five ate in use at the present time, it will be desirable for the Council to take the whole question into consideration, especially in view of the Insurance Act. DISINFECTION. After a case of infectious disease has terminated, the Assistant Sanitary Inspector, who is responsible for this work, visits the house, sprays out the infected room or rooms with a Cyllin solution, and removes the infected bedding and other articles to the Hospital in one of the vans provided. At the Hospital there is a disinfector of the Washington Lyon improved type, and the removed articles are then put through the disinfector. The leather tabs on the bedding are ruined, being hardened by the steam, so 62 these are all renewed, and the bedding, with the other articles, is then returned home in another van which bas not been infected. A list of the articles removed is entered in a book, checked by the householder, and signed for on recovery. Occasional complaints are received on account of the discolouration that inevitably takes place on subjecting old bedding to the high temperature. Blankets, with linen, are usually put in soak by the Inspector, and the householder is responsible for their proper washing. It seems impossible to subject blankets to the action of the disinfection without spoiling them, and therefore, unless there are special circumstances necessitating this procedure, they are not removed. The Inspector carries out this work well, efficiently, and with discretion. 63 TABLE OF HOUSES AND ARTICLES DISINFECTED In Respective Months during the Last Nine Years. Month. Houses. Articles. 1903 1904 I905 1906 1907 1908 1909 1910 1911 1903 1904 I905 1906 1907 1908 1909 1910 1911 January 29 36 71 26 52 56 63 48 40 602 397 783 321 509 533 633 406 270 February 26 35 48 31 51 38 47 27 35 307 544 727 436 612 432 347 163 333 March 18 30 40 40 45 42 66 29 34 270 487 707 604 si2 455 305 369 336 April 15 21 40 32 53 53 29 19 27 239 209 579 555 648 584 166 305 181 May 22 22 31 39 39 34 24 33 38 273 479 757 597 595 368 309 253 400 June 14 55 16 35 26 44 34 14 27 147 447 196 446 312 299 256 120 205 July 9 24 13 39 43 55 23 14 23 144 96 187 566 484 439 147 110 163 August 21 28 20 33 43 52 40 20 2 5 234 301 220 412 345 342 162 137 185 Sept. 20 28 16 30 43 62 23 21 41 2 50 260 20s 666 339 532 129 149 285 October 18 35 34 63 6S 44 44 23 57 141 338 397 677 565 334 291 248 360 Nov. 29 28 33 66 51 48 28 32 46 280 241 478 751 421 505 270 186 482 Dec. 31 30 20 42 61 68 48 33 63 363 458 179 570 507 542 306 291 844 Totals 252 372 382 476 572 596 469 313 456 3250 4257 5415 6601 5849, 5365 3321 2737 4053 64 Table Showing Ages and Sex of Patients Admittbd Suffering from SCARLET FEVER. Month. Under 5 yeais 5 to 10 years 10 to 15 years 15 to 25 years Over 25 years Totals M F M F M F M F M F M F January 2 1 6 9 2 3 1 - - - 11 13 February i 2 0 2 — 2 — 1 1 - 8 7 March 1 1 6 8 — — — — 1 - 8 9 April 2 — 4 1 — 1 — - — — 0 2 May 2 2 5 1 3 1 — 1 — 1 10 6 June — — 5 1 1 3 — — — — 6 4 July — 2 2 1 — 1 — — — — 2 4 August — 1 1 3 1 1 - — — — 2 5 September 5 i 0 4 3 2 - 1 — i 14 9 October 2 3 7 8 1 1 - 3 8 2 13 17 November 10 4 6 8 — 2 - 1 — 1 16 16 December 3 5 6 9 4 2 - - 1 1 14 17 Totals 28 22 60 55 15 19 1 7 6 6 110 109 Table Showing Ac.es and Sex of Patients Admitted Suffering from DIPHTHERIA. Month. Under 5 years 5 to 10 years 10 to 15 years 15 to 25 years Over 25 years Totals M F M F M F M F M F M F January 1 1 1 - - 2 - - 1 4 February 2 — — — 1 1 — 2 - - 3 3 March 1 — — 1 — 2 — — - - 1 3 April — 2 1 1 — 1 — — - - 1 4 May 1 - 1 - 1 - - 1 - - 3 1 June - 1 2 - - - - - - - 2 1 July 1 — 3 3 - - - - - - 4 3 August — — — 2 1 1 — 1 — 1 4 September — — 7 4 — 2 1 — — - 8 6 October 1 — 1 3 — 1 — — — - 2 4 November 1 2 2 1 2 1 — — - - 5 4 December 1 4 5 5 5 3 - 1 1 - 12 13 Totals 8 10 22 21 11 12 1 7 1 — 43 50 SECTION III. Sanitary Administration. 67 FOOD AND DRUGS ACTS. The above Acts are administered by the County, and Mr. C. H. Baxfield, the Chief Inspector, has kindly given me a return of the number of samples taken, with the results, which I herewith append :— The total number of samples taken in Ilford was 144— 77 of butter, 66 of milk, and 1 of oil of nutmeg. Of these, 3 of butter and 4 of milk were found to be adulterated. The sample taken as "oil of nutmeg" proved to be " oil of mirbane." In the latter case enquiries were made, and it was found that a mistake had been made by the wholesale firm. Proceedings were instituted, but subsequently withdrawn. For selling margarine as butter, prosecutions were instituted, and resulted as follows :— 2 dealers were fined £2 and costs, 9/-. 1 dealer was „ £1 „ „ 9/-. The amount of adulteration of the 4 samples of milk was not sufficient to warrant further proceedings, and the dealers were cautioned. WATER SUPPLY. The district is broadly divided by the Cranbrook Road into two areas of water supply. The portion to the West and North of that road is supplied by the Metropolitan Water Board, and the remaining portion by the South Essex Waterworks Company. Some of the outlying portions are supplied by shallow wells, and these keep diminishing in number as the mains of the Water Companies are extended. In this way numerous shallow wells have been closed during the course of the last few years, though only one has been so dealt with during the year that has just passed. 68 At one of the farmhouses in the district, as there had been cases of infectious disease occurring- over an extended period, and no sufficient explanation was obtainable, a sample of the water from a shallow well supplying the house was submitted to Dr. Thresh for analysis, who stated " that this water is of a very curious character, is good bacteriologically but bad chemically. At present the water must be regarded with suspicion." As there was another shallow well less than 100 yards away, an analysis cf this was also made, as possibly providing an alternative better supply. The result of this was that he said, " This water is loaded with saline matter, is excessively hard, contains an excess of organic matter, and the bacteriological examination shows that this is from a dangerous source." Accordingly the first well was opened out, cleaned, tree roots, etc., removed, with satisfactory results. In May a sample of the South Essex water was submitted for analysis, with the result that the report stated : " This was a water of the highest degree of organic purity, and bacteriologically it is above suspicion. The hardness is only 7 degrees. A purer and better water for the purposes of a public supply it would be impossible to obtain." 69 On December 15th a sample was taken from the water supplied bv the Metropolitan Water Board, and Dr. Thresh's chemical analysis is hereto appended :— Chemical Examination. Determination, Results in Grains per Gallon. Parts per 100,000. Total Solid Matter dried at 180 deg. C. 29.4 42.0 Chlorine 2.1 3-° Equivalent to Chlorides (60% C1.) 3.5 5.0 Nitric Nitrogen 0.04 0.06 Equivalent to Nitrates (17% N.) 0.23 0.33 Nitrites 0.00 0.00 Hardness: Permanent 50; Temporary 120; Total 170 240 Lead, Copper, Zinc, Iron 0.0 0.0 Free Ammonia 0.000 0.000 Organic Ammonia 0.0021 0.003 Oxygen absorbed at 36.6 deg. C. in 3 hours 0.0203 0.029 During 1911 there were two houses where notices were received of the water being cut off by the Metropolitan Water Board. Nine written notices were also received from the South Essex Waterworks Company, as well as other verbal notices received by telephone from this Company. Practically all these cessations of supply were due to the fact that the tenant had failed to pay the water rate. Action by way of notice from the Council is taken under Section 54 of the Ilford Improvement Act, 1898, which states:— "The owner of any dwelling house which is not provided with a proper and sufficient water supply, who shall occupy, or 70 allow to be occupied, such dwelling house, shall be liable to a penalty not exceeding five pounds and to a daily penalty not exceeding forty shillings, unless he can prove that he was unable to obtain such supply." MILK SUPPLY. At the present time there are 58 dairies and milkshops on the register, with 14 cowsheds. One new cowshed has been built during the year. These premises are all regularly inspected so as to maintain them in as good a condition as possible. Three have been closed or their use discontinued, and 9 new ones opened. Before any new dairy is opened the Council require the provision of a sufficient dairy for the keeping of milk and also for washing up the utensils. A suitable supply of hot and cold water must also be provided, the dairy must admit of free ventilation, the floor must be made of suitable impervious material draining to a gully outside the buildings, and the walls inside must be rendered in cement to a convenient height. The selling of milk in small general shops is discouraged, and in only 5 instances is this done in this district. The dry summer with consequent dearth of food for the cows affected the quantity and quality of milk supplied to the district. Of course it was possible to supply this lack of natural food by suitable other forms, but as all this meant increase of cost to the farmer with no increase in price of milk, it was not to be wondered at, perhaps, that this was not always carried out. In September the following analysis of a milk then taken explains what took place :— 71 " Sample of milk from Ilford :— The milk had commenced to turn acid. It contained :— Fat 2.83 per cent. Solids not fat 8.01 per cent. 10.84 Ash, .705 per cent. The specific gravity was 1,029.0. No preservatives could be detected. This is a milk of very poor quality indeed. It corresponds to milk of the lowest standard accepted as genuine with about 6 per cent. of added water." In December another sample was submitted to Dr. 'Iliresh for analysis, which gave the following result :— " Report on a sample of milk submitted by the Ilford Urban District Council. Received December 1st, 1911 :— The specific gravity was 1,032. Each 100 parts contained :— Fat 3.3 Solids not fat 8.8 Total solids 12.1 Ash 0.71 Preservatives : none detected. This has all the characteristics of a genuine milk of not over good quality." What are known as the Manchester clauses were incorporated in the 1904 Ilford Improvement Act, but in a 72 district of this description it is exceedingly difficult to carry them out satisfactorily. With increased attention likely now to be given to Consumption it will be increasingly important to guard the pollution of the milk supply from tubercle. Everything points to the importance of milk in the causation of various forms of tubercle, especially in early life, and if the problem of tuberculosis is to be attacked as a whole, this portion of the problem, with its possibilities, must not be lost sight of. Possibly before another year has passed the Milk Bill prepared by the President of the Local Government Board may be brought in and passed. If so a considerable help forward to the movement for a proper milk supply will take place, as it will tend to eliminate the undesirable milk producers and sellers while not interfering with the more enlightened members of the trade. BAKEHOUSES. There are 33 bakehouses altogether in the district. Of these 4 are factory bakehouses. One is an underground bakehouse of fair construction, though the ventilation is not too good. The question of ventilation of bakehouses is a very vexed one, as most bakers insist on having the temperature of the bakehouse as high as possible during the process. This of course means that all access of fresh air is prevented, and the atmosphere becomes very close and heavy. MEAT SUPPLY. There are three slaughterhouses in the district, one at Barkingside, in the more outlying portion of the district; the other two are situated in the town itself. 73 During the year the following articles were condemned as unfit for human consumption:— 1 ox pluck and liver. 1¾ lb. brawn. The slaughterhouses have been kept under careful supervision during the year, and two of the Assistant Sanitary Inspectors are specially qualified as meat inspectors. FISH SHOPS. During the past year these have been constantly inspected, and the following fish were condemned as unfit for human consumption :— 3st. 51bs. of plaice. 1 barrel of herrings. 2 boxes of haddocks. 1 box of mixed fish. A certain quantity of the above was brought to the office by the retailer, so as to obtain a certificate for the refunding of the purchase-money from the wholesale salesman. Every care is exercised as to obtaining the particulars and the name of the salesman, in order to prevent any abuse in this connection either with the salesman or with the consumer. 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. 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. 74 The Medical Officer of Health is required to report to the Home Office and the Local Government Boar 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. WORKSHOPS. There are 451 workshops on the register, made up as follows :— Artificial Flower Makers 5 Bead Worker 1 Belt (Fancy) 2 Blind and Cover Makers 3 Box Maker 1 Brush Maker 1 Boot Makers and Repairers 58 Carpet Planning and Upholstery 6 Corset Makers 3 Cycle and Motor Making and Repairing 12 Dentists 2 Dressmakers 93 Book Binder 1 Embroiderers and Lace Workers 3 Engineer's Workshop 1 Feather Cleaning and Dressing 2 Firewood Cutting 1 French Polishers 3 Gas Fittings, &c. 1 75 Grindery Works 1 Glass Cutting- 1 Jewellery and Watch Repairing 13 Joinery Workers 9 Laundries (Hand) 31 Machine Repairs 1 Masons 4 Meat Cutting and Small Goods 2 Milliners 30 Lace Workers 3 Indiarubber and Surgical Instrument Maker 1 Optician 1 Picture Framers, etc. 4 Printers 6 Plumbers, &c. 8 Purse Maker and Mattress Tuft Maker 1 Rag Sorting and Storing 3 Saddlers and Harness Makers 3 Scale Maker 1 Smiths 9 Tin Plate Workers 2 Umbrella Makers and Repairers 4 Wearing Apparel (including Tailors) 104 Wheelwrights and Carriage Builders 5 Undertakers 4 Soda and Mineral Water Manufacturer 1 Total 451 76 FACTORIES. There are 52 factories on the register, made up as follows :— Boot Making and Repairing 7 Building, etc. 4 Electrical Works (Motor) 5 Paper Making 1 Printers 4 Plate Powder Manufacturer 1 Motor and Cycle Making 2 Saw Mills 9 Seed Sorting, etc. 1 Smithy, etc. 1 Meat Cutting, etc. 3 Chemical Factory 1 Carriage Works, etc. 2 Corset Making 1 Grindery Works 1 Iron Covers, etc. 1 Laundries 5 Photographic Works 1 Lithographic Works 1 Wearing Apparel 1 Total 52 77 FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.-INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 15 ... ... Workshops (including Workshop Laundries) 143 1 ... Workplaces (other than Outworkers' premises included in Part 3 of this report) ... ... ... Total 158 1 ... 78 a.—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES Particular*. Number of Defects. Number of Prosecution*. Found. Remedied. Referred to H.M. Insp'tor (1) (2) 0) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 4 4 Want of ventilation 1 1 Overcrowding Want of drainage of floors Other nuisances Sanitary accommodation insufficient 1 1 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) 18 18 Other offences (Excluding offences relating to outwork which are included in Part 3 of this report.) Total 24 24 79 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, Section 107. Lists received from Employers twice in the year. Lists. Outworkers. Contractors Workmen. Wearing Apparel— Making, &c. 34 23 70 Total 34 23 70 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number (1) (2) Bakehouses (excluding 4 Factory Bakehouses) 29 Total number of workshops on Register 29 80 5.—OTHER MATTERS. Class. Number (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 3 Action taken in matters referred by H.M. Inspector as remediable under the Public Healthy Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspector 2 Other ... Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 1 81 HOUSING AND TOWN PLANNING AND HOUSING OF THE WORKING CLASSES. During the year, under the Regulations issued by the Local Government Board under Section 17 of the above Act, Mr. King was designated the officer to make inspections in accordance with the Act, under the direction and supervision of the Medical Officer of Health. A list of the houses in my opinion requiring inspection was submitted to, and approved by, the Public Health Committee. The work done has been as follows:— Number of houses inspected 90 No action required 15 Houses for which notices served under H. W. C1. Act to place in habitable repair 30 Notices complied with 17 Notices outstanding 11 Houses closed voluntarily 2 Preliminary notices served, or letters 45 Preliminary notices complied with 30 Preliminary notices outstanding 15 Notices under the Housing of the Working Classes Act were served where a general state of neglect required general renovations to place the houses in a state of habitable repair. The preliminary notices or letters were sent when some smaller or more limited defects required attention. A number referred to increased paving being required, defective gullies, or walls requiring partial pointing or repairing. The result of the last Census declaring Ilford to have a population over 50,000 will bring a much larger proportion of houses under Section 15. When the Act was passed this section only applied to houses under £16 a year in this district, but now it will apply-to all houses under £26 a year, so that for all these houses which have been let since the passing 82 of the Act there will be implied a condition that "the house is at the commencement of the holding in all respects reasonably fit for human habitation." Also under Section 15 the condition stated above shall "during the holding be kept by the landlord in all respects reasonably fit for human habitation," so that with every succeeding year it appears that this section will have an increasing effect, and require more attention. This district is well supplied with houses of a certain type, but there are very few under 7s. 6d. a week with accommodation for one family. The result is that two or three families occupy a house that was built for one, and where the accommodation is unsuitable. The more the district grows, and the older smaller cottages are pulled down, the more this evil tends to grow. There is a very real need for cottages for men earning 30s. a week or under, at a rental they can afford to pay, say 5s. a week, or thereabouts. SEWERAGE AND SEWAGE DISPOSAL. As the district grows and extensions of the sewers take place, more and more of the outlying cottages become connected to the sewers A new sewer has been laid down Goodmayes Lane and along Longbridge Road during the year, which will enable a house to be connected to this sewer that has given rise to good deal of nuisance, owing to its not having sufficient ground to deal with its own waste, with a result that the neighbouring ditch becomes very foul. At the present time the district has an almost universal system of water carriage in use, but in the outlying portions of the area there are:— Number of cesspools 55 „ „ privies 42 „ „ pail closets 64 83 These are emptied and dealt with by the owners and occupiers concerned, a cart being provided by the Council, which is kept at the Depot and is fetched by the owners as required. The efficiency of the cesspools varies very much, and it is practically impossible to have them emptied sufficiently frequently to prevent their being overfull, owing to the quantity of water that gains access to them, either directly or indirectly. They are frequently inspected, and receive as regular attention as possible, so as to minimise the evils they give rise to. REMOVAL OF HOUSE REFUSE. This is carried out by the Council with their own horses and dust vans. Collection is made once a week throughout the district, and the refuse is taken to a tip in Aldborough Road. During the year the Council have been negotiating for a site for a dust destructor, and have agreed to purchase cne, subject to the Local Government Board's approval. The present tip is being rapidly filled up, and there will be increasing difficulty in securing another within reasonable distance of the town. Obviously, the further away the greater the cost for carting, and the larger the capital outlay for vans, etc., to overcome the difficulties in connection with the lengthened journeys. The dustbins are nearly all portable ones, and care is taken that they are replaced when necessary. 16,883 tons of refuse were collected during the year 1911. PURLIC LATRINES. During the previous year a new underground convenience was opened in Roden Street, which provides enlarged accommodation for men, and also accommodation for women. Before this there was no provision for the female portion of the population in the district. Upon this new latrine being 84 opened the smaller one in the Broadway was closed, as there was no necessity to have two open so near together. The district is now provided with three latrines in all, the one mentioned above, another underground convenience at Seven Kings, and one above ground at Goodmayes. TOWN AMBULANCE. The public ambulance kindly given to the town about 10 years ago by Mr. A. Cameron Corbett is still being extensively used. During the year it was used on 22 occasions for street accidents, and on 83 occasions to convey patients to and from the various hospitals at their own or friends' expense. On the 28th September, 1909, the Council passed a resolution giving the Medical Officer power to grant free use of the ambulance to deserving cases for conveying patients to and from various hospitals. This concession has been taken advantage of on 8 occasions. 85 INSPECTOR OF NUISANCES. As Ilford is an Urban District the appointment of only one Inspector of Nuisances is legal. In addition there are three Assistant Sanitary Inspectors. Section 189 of the Public Health Act, 1875, which sanctions the appointment of Inspector of Nuisances in Urban Districts, mentions this appointment in the singular, while the following section, which applies to Rural Districts, mentions the plural number. It was an unfortunate drafting of the clause, as one Inspector for a large urban area is obviously insufficient, and any other officers appointed have no legal standing. Two of the Assistants hold extra certificates, but have no power to seize unsound food, a very serious disqualification in a large and growing area such as this. Moreover none of the salary of the Assistant Inspectors is recoverable from the County, this district thus only being assisted by the repayment of the half salary of the Inspector of Nuisances. If at any time the Council promote another Bill in Parliament, a clause permitting the appointment of more than one Inspector of Nuisances obviously requires insertion, as it would mean assistance from the County of about £300 a year, and more in the future as the staff increases. At the present time two of the Assistant Inspectors have certain separate portions of the district assigned to them, and each deals chiefly with nuisances and enquiries as to infectious disease, etc., in his respective areas. The other Assistant Inspector is responsible for, and carries out the work of, disinfection over the whole area, and when not so engaged carries out the same duties as the other Assistant Sanitary Inspectors, but in a separate portion of the district. Below is given a statement, according to the last Local Government Regulations, of the detailed work carried out by these officers. 86 From that statement will be seen the varied and extensive nature of the duties performed. It has been done in an efficient manner, and I should like here to express my indebtedness to the various officers for their co-operation and assistance in this portion of the work of the Public Health Department. INSPECTION OF THE DISTRICT AND THE ABATEMENT OF NUISANCES. Summary of visits as entered in the Journal during the year 1911:— Houses and premises inspected 2772 Do. do. visited during progress of work 7223 Nuisances detected 877 Do. abated 762 Do. unabated 115 Complaints received 344 Visits re disinfecting of premises 892 Houses disinfected 456 Articles do 4053 NUISANCES. The details of the result of the inspection are as follow: Drainage. Totals. Cesspit provided 1 Cesspits and privies abolished 2 Do. do. emptied and cleansed 26 Privies provided 1 Ditches cleansed 1 Drains cleansed 291 Do. disconnected from sewer 2 Do. disconnected from ditch 1 Do. intercepted do 1 Do. repaired or relaid 123 Do. sealed 23 Do. connected to main sewer 2 87 Totals. Glazed stoneware sinks fitted 7 Flushing cisterns to W.C.'s repaired or provided 116 Inspection chambers provided 25 Do. do. covers fitted 49 Rain-water down pipes disconnected from drain 3 Sink waste pipes repaired or provided 29 Soil pipes renewed 22 Ventilating pipes do 48 W.C. pans and traps fitted 108 W.C. fittings repaired 174 W.C. floors concreted 116 Yards drained 78 Do. cleansed 1 Defects in Dwelling Houses. Houses concreted under floors 2 Do. ventilated do 6 Floors repaired 21 Houses cleansed 83 Gutters and down pipes cleansed, repaired, or provided 36 Roofs repaired 23 Walls and ceilings repaired 38 Do. protected against dampness 4 Water fittings repaired 17 Windows and frames, doors and frames, repaired 10 Yards, paving repaired 127 Do. cleansed 10 W.C.'s demolished 5 Do. erected 24 Do. ventilated 24 Pig styes drained 3 Smoke loft abolished 1 88 Ilford Improvements Acts. Totals. Galvanized iron dustbins provided 139 Lands fenced in 2 Water laid on 15 Yards paved 43 Water supply improved 1 Bye-laws. Water storage cisterns cleansed 97 Do. do. covered 23 Infectious Diseases (Prevention) Act. Articles removed for disinfection 4053 Houses disinfected 456 Rooms stripped and cleansed 111 Dairies and Cowsheds Regulations. Animals groomed 19 Cowsheds cleansed 7 Dairy utensils cleansed 6 Do. sheds cleansed 20 Hot water supply provided 5 Accumulation of Refuse, &c. Dead animals removed 1 Manure and refuse removed 98 Stagnant water removed from basement 7 Manure receptacle provided 1 Slaughter House—Bye-Laws. Slaughter houses cleansed 8 Factory and Workshop Act. Workshops cleansed and limewashed 4 Bakehouses cleansed 17 Do. sanitary defects remedied 1 Workshops ventilated 1 W.C. provided 1 89 Miscellaneous. Totals. Roadways, rearways, and courts cleansed 9 Smoke nuisances abated 1 Overcrowding in dwelling-houses abated 9 Animals (improperly kept) removed 143 Water courses cleansed 1 Wells closed (filled in) 1 Do. cleansed 1 Unauthorised sheds removed 2 Houses closed by arrangement 1 COMPLAINTS. Accumulations of manure, refuse, etc 35 Animals improperly kept 20 Alleged overcrowding 10 Choked drains 73 Decomposing body of animal 1 Defective drains and sanitary arrangements 52 Do. roofs, gutters, &c 2 Fouling of stream 4 Houses being damp 9 Insanitary condition of roadway, rearway, etc. 6 Do. do. premises 20 Milkseller not being registered 1 Smoke nuisance 16 Smells pervading neighbourhood 45 Unsatisfactory water supply 5 Water in basement 16 Unwholesome food 1 Premises without water supply 11 Obstruction of light 2 Squatting of gipsies 6 Unsatisfactory milk supply 2 Alleged fouling of lake 1 Miscellaneous 6 Total 344 90 The following is a list of notices served during the year:— NOTICES SERVED. Notices. Served 1911. Complied with 1911. Outstanding 1912. Statutory 89 52 37 Preliminary 361 352 9 Do. (by letter) 190 184 6 Pave Yard (Ilford Improvement Act) 25 21 4 Provide Dustbin (Ilford Improvement Act) 146 137 9 Cleanse Cistern (Bye-laws) 117 114 3 Cover Do. Do. 27 25 2 Provide Water to Dwelling-House 11 10 1 Cleanse Dwelling-House (Infectious Diseases (Prevention) Act, 1890) 96 95 1 Cleanse Dwelling-House (Sec. 46 Public Health Act, 1875) 11 11 - Factory and Workshop 1 1 — Housing of the Working Classes Act 29 18 11 Totals 1103 1020 83 SECTION IV. Schools 93 SCHOOLS. The schools providing accommodation for 13,231 children in this district, under the Education Authority, are the following:— Council. Downshall Uphall Cleveland Road Newbury Park Christchurch Road Goodmayes Loxford Chadwell Highlands Valentines South Park Little Heath Voluntary. National, High Road, Ilford, C. of E. Infants, High Road, Ilford, C. of E. Roman Catholic, Ilford. Aldborough Hatch. Barkingside. No extensive alterations or building new premises have been carried out during 1911. The plans for South Park School extension have advanced to a further stage. Renovations and repair of minor defects have taken place as necessity arose. The National School has been the subject of a report by the Inspector, and the ventilation of this school leaves much to be desired. CLEANLINESS AND DISINFECTION OF SCHOOLS. The cloak-room lobbies and certain class-rooms in the various schools have been disinfected with a Cyllin solution at various times, as it was possible for this to be carried out by the Assistant Sanitary Inspector consistent with the other demands on his time. 94 The detailed list is as follows:— Date. 1911. Room. School. Remarks. 26th Jan. 9 Girls Downshall Sprayed and Utensils destroyed 11th Feb. 5, 7&8 J. Mixed South Park Sprayed only 18th „ 3 & 4 J. Mixed South Park Sprayed only 21st „ 1 J. Mixed Downshall Sprayed and Utensils destroyed 13th Mar. 7 J. Mixed Downshall Sprayed and Utensils destroyed 18th „ 9 Senior Girls South Park Iron Building Sprayed only 20th „ 9 J. Mixed Uphall Sprayed and Utensils destroyed 31st „ 2 & 3 J. Mixed Goodmayes Sprayed only 18th April Lobbies only Goodmayes „ „ 18th „ „ „ Chadwell „ „ 19th „ „ „ Loxford „ „ 19th „ „ „ Downshall „ „ 20th „ „ „ National High Road „ „ 20 th „ „ „ Cleveland Road „ „ 22nd „ „ „ Christchurch Road „ „ 27th July „ „ National High Road „ „ July and „ „ Infants' High Road „ „ August „ „ Catholic „ „ Holidays „ „ Chadwell „ „ „ „ „ Little Heath „ „ „ „ „ Uphall „ „ „ „ „ Loxford „ „ „ „ „ Cleveland „ „ „ „ „ Christchurch „ „ „ „ „ Highlands „ „ „ „ „ Goodmayes „ „ „ „ „ South Park „ „ „ „ „ Valentines „ „ „ „ „ Barkingside „ „ „ „ „ Aldboro' Hatch „ „ „ „ „ Newbury Park (2 Schools) „ „ 20th Sept. Boys' Class 6 Newbury Park Sprayed Room, Disinfected part and destroyed Utensils 17th Oct. J. Mixed, Room 2 Newbury Park „ „ 13th Nov. Room 1 Newbury Park, J. Mixed „ „ 29th Dec. Lobbies only South Park Sprayed 95 MEDICAL INSPECTION. During the year the work of medical inspection has been considerably amplified by the appointment in April last of Dr. Armly Ashkenny, M. B., C. B., B.Sc. (Public Health), as temporary Assistant School Medical Officer. To him fell the duty of carrying out the bulk of this work at the schools, and, as this report shows, he has carried out the work in a very efficient manner. There are 17 schools with 35 departments in the district. There are 11,733 children on the books of the elementary schools out of a nett population of 74,046, giving a percentage of 15.8 of the population. ORGANISATION AND METHOD OF INSPECTION AND CORRELATION WITH THE PUBLIC HEALTH SERVICE. The Board of Education's inspection card has been followed out. Some of the items, however, have been described in slightly greater detail. Thus, in heart and lung cases the degree of the defect is given for signs and symptoms respectively. The inspections were conducted by the Medical Officer, without the assistance of a nurse. A considerable amount of clerical work was performed by the teachers in sending notifications to parents and preparing cards for the inspections. In most cases they also willingly assisted during the inspection by preparing and dressing the children, etc. The following notice was sent by teachers to parents, notifying the inspection, and inviting them to attend:— "Madam,—The Medical Officer will attend at this school to examine your child on at and the Committee request you to attend at that time, if convenient to yourself.— Yours faithfully, Head Teacher." 96 At the usual introductory addresses given to parents assembled for the inspection, Dr. Ashkenny laid stress on the desirability and importance of parents being present to obtain the advice then given as to how to remedy the defects noted. No less than 65 per cent. of parents were present at these inspections. This must be regarded as most satisfactory, showing that parents highly appreciated the advice given at the inspection of their children. At some of the Junior Departments 100 per cent. of the parents were present. The inspections were conducted in one of the class-rooms or in a teacher's room. In one case a corridor was used, and at Barkingside part of a class-room only was available, the class going on in the other part, which was, however, screened off. Teachers were notified of the date of the doctor's visit some days beforehand, and arrangements were made, where possible, so that it did not come when the teachers were too busy with their other work. The inspections were generally conducted according to Section 58 (b) of the Board's code. GENERAL STATEMENT OF EXTENT AND SCOPE OF MEDICAL INSPECTION. 268 visits were made to the 35 different departments in the 17 schools in the district. Three classes of children were examined—those recently admitted to the schools, those about to leave school, and special cases brought forward by the teachers. The total number of children examined during the year was 3,813, 1,819 boys, 1,834 girls, and 160 cases presented for special examination. The total time occupied by these examinations was 542 hours and 41 minutes, or an average of 8.5 minutes per child. 97 The following table gives the age and sex distribution of those examined, excluding specials:— 4-5 5-6 6-7 7-8 8-9 9-10 Boys — 576 l6l 114 95 74 Girls 1 538 170 109 97 85 Totals 1 1114 331 223 192 159 101-1 11-12 12-13 13-14 11-15 15-16 Boys 62 71 56 503 98 9 Girls 109 6l 62 506 88 8 Totals 171 132 1l8 1009 186 17 The head teachers are requested to forward lists of those children admitted to their departments since the last inspection, and those who are about to leave school. Arrangements are then made for the doctor to visit the school at stated times. Parents present at the inspection of children found defective were carefully advised how to remedy these defects. This was particularly useful in prolonged debilitating conditions, and where, for some reason or other, the parent cannot obtain the advice of a local medical practitioner, and in those cases where the personal and domestic hygiene appears to be defective. In some cases it was possible, at the request of parents, to have the defect demonstrated to them, such as wax in ears, enlarged tonsils, etc. This convinced the parents and made them more willing to have the defect attended to. The average time taken in the examinations per child was 8.5 minutes. This figure excludes the time wasted in getting the room, cards and children ready for inspection, but includes the time taken in testing vision, weighing and measuring, and advising and addressing parents. 98 GENERAL AND PHYSICAL CONDITION. Malnutrition.—This defect is admittedy one of the most difficult to estimate and classify, but is very important from the school point of view. So many features have to be considered together; thus, the relation of height and weight, firmness and muscularity, condition of the skin and mucous membranes. Inspectors therefore differ considerably, the figures given varying from about 30 to 3 per cent. for school children classed as sub-normal. In Ilford 12.29 percent. of the 3,653 children examined were sub-normal, and 4.68 per cent, showed bad nutrition. Uncleanliness. —(1) Verminous Conditions found on Inspection.—Two classes of children come under this category. The first being those whose unsatisfactory home or personal condition tends to keep up and breed uncleanliness. The second class are those unfortunate children who, whether in or out of school, come into too close relation with those of class one, and thus get infected. 35.82 per cent., or one out of every three girls, and 14.14 per cent. of the boys had recently had live vermin in their heads, as shown by their still possessing numerous nits, while 4.14 per cent. of the girls and 2.42 per cent. of the boys showed live vermin at the time of inspection. A great and serious responsibility thus rests with those who are responsible for the education of the children, not only in protecting class two above referred to, but to encourage and teach personal and general hygiene in the schools. (2) Baths for School Children.—In many of the larger modern schools a room is provided with cubical arrangements for shower baths. This provision of shower batfrs with hot and cold water for school children is a great incentive for personal cleanliness, and should not be lost sight of when the Ilford Council decides to provide public baths for the district. Proper use of baths would also improve other 99 filth conditions found on the bodies and clothing of children examined. Thus 3.57 per cent. of the bodies of boys and 4.96 of the girls had been recently attacked by vermin, as shown by the fleabitten condition of their bodies. About 5 per cent. showed a somewhat dirty or dirty condition of their bodies, indicating that no body bath had been used for several weeks or, maybe, months. Clothing and Footgear.—Parents usually dress and prepare their children more carefully than usual for the day of the inspection. The figures therefore given in the table for defective clothing, footgear, and verminous conditions are considerably under-estimated. Vision.—Of the 3,653 children examined, 239 boys and 211 girls were found to have a more or less serious state of defective eyesight. This gives a percentage of 12.05 for boys and 12.81 for girls. All these required careful attention from one specially experienced in eye examinations. But this parents often cannot obtain, owing to the expense or the difficulty in finding time to seek advice from a special hospital outside the district. Through the eyes, most of the education of the children is effected, and it is most important that when defective they should not be strained, and thus become liable to progressive deterioration. It is therefore the duty of the education authorities to prevent this harm being done to the children by providing means for treating those suffering from defective vision. The Council have already submitted a scheme to the Board for providing treatment of these defects. If adopted, the Medical Officer will supply prescriptions and enable parents to obtain the necessary glasses at cost price. Hearing.—Hearing was tested with the "forced whisper" test. Considerably below 1 per cent. of the children showed this defect. Most of these cases were associated with discharge or abscess of the middle ear, which subject is dealt with in the section of Ear Diseases. 100 Adenoids.—Severe nasal obstruction due to adenoids, and urgently requiring removal, was found in 1.7 per cent. of the boys and 1.4 of the girls. Adenoids can rarely, if ever, be directly observed during the ordinary routine inspection. One therefore has to be guided to a diagnosis by indirect evidence. In a few cases where the parent was anxious for a definite diagnosis, the finger was used to estimate the amount of the obstruction of the naso-pharynx by adenoid overgrowth. In slight cases one often has to be guided to a diagnosis by finding that persistent mouth breathing, unassociated with nasal obstruction, is associated with a fulness of the buccal pharynx, and some chronic pharyngitis. In this way about 20 per cent. were classed as having slight adenoid enlargement. No doubt by far the larger number of these children grow out of this condition, but not without leaving more or less permanent damage to the body or mind. It must be remembered that adenoids, while they last, starve the lungs of their natural respiratory food. In considering the cause and prevention of adenoid enlargement, it should be remembered that a large proportion of infants at one time or another suffer from nasopharyngeal or bronchial catarrh in a more or less sub-acute or chronic stage. This tends to cause frequent nasal obstruction. Some 5 per cent. of the children were, at the time of inspection, suffering from nasal obstruction due to coryza, and some 4.5 per cent. showed other nasal or throat defect. The less patent the nasal passages are from non-use of the handkerchief, the more liable they are to adenoid enlargement. Tonsils.—Tonsil enlargement is closely associated with, and in fact partly caused, in the one case, by adenoid enlargement, where the child is forced to breathe through the mouth, and, on the other hand, by the constant passage over them of purulent and other septic matter from decayed teeth. 7.26 per cent. of boys and 8.5 of girls have tonsils sufficiently 101 enlarged as to urgently require removal by operation. Over 16.5 per cent. had considerably enlarged tonsils, while another 30 per cent. very slightly enlarged tonsils. Many of the children have already undergone one operation, and others who have had two or even three operations for the same condition, but so long as the original cause is not attended to, so long will frequent operations be required to remedy the neglect. Glands.—The glandular condition of the neck was investigated with some care, for even the slightest enlargement. Sub-maxillary, cervical and sub-clavicular glands were respectively noted. 60 per cent. showed very slight or moderate enlargement, 4 per cent. showed considerable enlargement, and some 0.2 per cent. showed great enlargement. The age distribution and the relation with other conditions, such as teeth, nose and throat defects, of this 60 per cent. will be gone into elsewhere. Mental Condition.—147 children examined were found to be unusually backward, or mentally dull for their age. This gives a percentage of 3.85 for boys and 4.19 for girls. These children are a great drawback to the class they attend, and often the despair of an anxious teacher. In most cases, no doubt, this defect is the result of past neglect of some physical bodily defect, such as adenoids, or of unsatisfactory home conditions, such as uncleanliness, inanition, etc. But a few other cases were found to be mentally defective in a greater or less degree. There are, I am aware, a fair number of cases who, though not hopeless from an educational point of view, stay permanently away from school. This suggests that altogether there may be found a sufficient number of children who would gain great benefit by attending a special class or school for such defect. Speech.—96 children, or 2.62 per cent., were found to have a greater or less defect in their speech, but as most of 102 these cases were in infants, no doubt they will improve as their education progresses. A few were associated with mental defect, and others seem to have acquired the habit of stammering from playmates or relations. Dental Condition of Children.—Of the 3,653 children examined during the year, 2,098 (57.46 per cent.) showed from one to six decayed teeth, 506 children (13.85 per cent.) had more than six decayed teeth, being a total of 2,604 children, or 71.32 per cent., having decayed teeth, and only 28.67 Per cent. of the children had no decayed teeth. 172 children (4.71 per cent.) were found to have dental abscesses, discharging foul matter into the mouth and its being swallowed. 1,731 children (47.41 per cent.) showed "uncleanliness" of the teeth, apart from actual decay. By uncleanliness is meant that condition when creamy or yellowish matter is adherent to the surface of the teeth, or in the crevices between the teeth and the gums, and which can be rubbed off with a brush or spatula. 196 children, some 5 per cent., showed notable irregularity of the teeth in the gums. The above facts and figures speak for themselves, and prove what an enormous amount of real suffering and preventible defect is allowed to exist among school children, to undermine their constitution and lessen their wage-earning capacity. Thousands of young men are rejected every year by the recruiting officers for the Army and Navy on account of defective teeth. Causes and Treatment of Tooth Decay.—Acid fomentation of food particles left between the teeth and gums is a primary cause of tooth decay, which begins in the infant stage and progressively increases as the child gets older. This suggests that "tooth brushing" drill among infant departments would materially lessen this evil. But prevention should always be associated with actual curing of the defects already existing. Thus a very great benefit has 103 already resulted in many districts in England and Wales where "dental cliniques" have been established. No special accommodation is required, and the cost of dental equipment, that is, dental chair, fittings, and instruments, need only come to about £30. In the majority of cliniques a part-time dentist is appointed for so many half days per week, or is paid per case. External Eye Defects.—276 children showed external eye defects, such as conjunctivitis and chronic blepharitis, the latter mostly the result of neglected eye complications with measles. Notices were sent in 22 instances, advising the parents to seek further treatment, and in the majority of instances this was done. Ears.—470 children, 13 per cent. of those examined, were found on inspection to be suffering, or to have recently suffered, from Middle Ear Disease, and to have the external auditary meatus closed by a waxy secretion. In 102 cases where the ear discharge was profuse or offensive, or where both ears were closed by wax, notices were sent to the parents advising them to seek further advice and treatment. Heart and Anæmia.—Out of the 3,653 children examined, 572, or 15.66 per cent., showed some abnormality of the heart or circulation. About half of this number were cases of anæmia. In many cases, no doubt, the heart defect is compensated, and no symptoms are therefore complained of by the child. In others, however, the disease is such as to cause more or less serious symptoms. In 40 of the most serious cases notices were sent to parents to seek further advice, and in the majority of cases this was done. In many cases parents were not aware of the existence of any heart defect, for the symptoms, even when complained of by the child, are often ascribed to other causes, such as debility, anaemia, gastritis, etc., which, indeed, are frequently produced by the heart disease itself. 104 Lungs and Tuberculosis.—437 of the children examined, 11.96 per cent., showed more or less sub-acute or chronic congestion of the bronchioles of the lungs. In many cases it was associated with a temporary catarrhal condition of the respiratory passages, i.e., nose and throat. In some cases it was more chronic, the signs being more localised and associated with wasting, glandular enlargement, anæmia, or other conditions which are usually associated with tuberculosis. About 1 per cent. of these cases were strongly suspicious of Phthisis, but none could be proved to be so bacteriologically. Most of the cases suspected of Phthisis were re-examined two or three months subsequent to the first inspection. Many of these had obtained advice and treatment, and were found to be very much improved. Altogether 52 notices were sent to parents advising them to seek further advice and treatment. In addition to the foregoing, there were a number of children who were found to be suffering from other tubercular conditions, such as tubercular glands or abscesses. Deformity and Rickets.—Of the 174 cases of deformity found on inspection, the majority were cases of more or less marked spinal curvature, chest deformities, shortening or malformation of limbs due to infantile paralysis, or tuberculosis were also included. Eleven parents were notified as to the existence of a deformity, and the necessity to obtain further advice and treatment. Nervous System.—199 defects were referred to this system, under which were included epileptic fits and hysterical conditions, restlessness of body, but more than half of this number were cases of headache, most of which, no doubt, belong to other systems, but could not be properly classified at the time of inspection. Other Conditions.—40 children were found to be suffering from various skin affections. 14 parents were notified, and most of them had the defects remedied. 41 105 children were definitely found upon inspection to be suffering from worms. No doubt many others were suffering from this condition, but had been overlooked by the parents. MENTALLY DEFECTIVE CHILDREN. During the inspection of school children 26 scholars were discovered who were sufficiently mentally defective as to make it desirable that they should be treated in special schools. This number of course does not represent the total, although probably there are not many more in the schools in this district. The number, however, is sufficiently large as to require the attention of the Council, and now that the medical inspection has been placed on a more permanent basis I hope to present a report to the Committee on this matter, as the bulk of these children are merely marking time and are a serious embarrassment in the ordinary elementary school, while the outlook for their ultimately being of use to the community is by no means hopeful. DEAF AND DUMB CHILDREN. Three deaf and dumb children were examined during the year, and certified for the Deaf and Dumb School at Margate. BLIND CHILDREN. One blind boy was sent to the East London School for the Blind during the year. FEEDING OF SCHOOL CHILDREN. This matter has again been under the consideration of the Care Committee. The Secretary wrote to all the head teachers in the district and obtained from them the names and addresses of those children they considered were 106 Underfed or where the feeding was not suitable for the child's physical needs. These returns contained 167 names. This list was then given to the Health Visitor, who visited the homes and obtained particulars as to home conditions. As a result of her enquiries it was found that 25 either had no father or that he was unable to earn anything owing to serious organic defects. In the largest proportion of the other cases the father was constantly out of work for various reasons. Afterwards all the children were then examined at the schools by either Dr. Ashkenny or myself, and of the 167, 107 were in such a condition as to require better nourishment than they were receiving and were incapable of making the best opportunity of their educational facilities. Of the others, 9 had left Ilford, 10 were doubtful cases, and 41 were considered in such a condition as not to require assistance. Doubtless there are other children in the schools who on further examination require more or better food than they are receiving, so that in this district as a whole I consider there are about 150 children who may be considered underfed. Of course the individual children are constantly varying, as a child may be in a very debilitated condition at the present time owing to the parent being out of work, and in a month's time on the parent again earning full money the altered condition is reflected in the child. At the end of the year this matter was receiving the attention of the Care Committee. The following cases give an idea as to the conditions found by the Health Visitor:— L.A.—Father dead; mother a housekeeper, and this child lives with her aunt; aunt appears to do her best for the child, but she has several children of her own and her husband is out of work. 107 A. D.—Respectable people; father out of work 9 months, healthy now, told that he was too old. W.J.—Poor neglected children; father deaf and dumb; mother neglects family; father frequently ill and in the infirmary. J.M.—Father a fish hawker, been very poor lately; large family, none old enough to go to work. W.O.—Poor home; father and mother living apart; mother hard-working and does her best for the children, but has a struggle to get food at times. A.W.—Father consumptive and unable to work; large family. A.H.—Father out of work and only done odd days for past 2 years; mother weakly, but at times does a day's cleaning; very poor indeed. A.P.—Very poor and weakly family; father dead— consumption; two brothers also consumptive. I.M.—Father a fish hawker, been very poor lately; large family, none large enough to go to work. A. & E.M.—Father out of work; mother goes washing and cleaning; 2 rooms, very poor home. A.H.—Father dead; mother clean and hard-working, but has lost several of her regular places through the family moving to Ilford. A. & L.Y.—Father in regular work, also one son; mother has a private laundry; plenty of food. A. & L.W.—Poor deserving family; father often out of work; large family of weakly children; mother very hard-working. A. P.—Father through accident about 18 months ago injured his head and is unfit for work, 16s. weekly compensation; 5 children, all weakly. 108 E.S.—No parents, lives with her grandparents; very uncared-for. W.D. & E.F.—Father consumptive, unable to leave his bed; respectable people; mother very hardworking, but has a very hard struggle to provide for the children, and at times food is very scarce. V.G.—This child was at one time very dirty and neglected, but is improving; the father is in work, but the mother does not keep the home well; at the time of visit it was dirty and untidy. G.B.—Large family; father dead; parish allows a little; mother a clean hard-working woman and does her best for the children. A.B.—Father a cripple, unable to work; mother a hardworking and respectable woman who does her best for the children. HEALTH VISITOR. During the year Miss Radford has continued her valuable work as Health Visitor. Her salary is contributed to by the Education Committee and the Public Health Committee. Two-thirds are allocated for education purposes and one-third for the Notification of Births Act work. The education work has consisted in visiting the schools periodically, following up the cases thus found, and also those that have been notified as requiring treatment on the routine medical inspection work or other examination, discovering whether any treatment has been carried out, and, if not, endeavouring to get the parents to have the defects remedied I give a summary of the results of the two great classes of defects found, one, those inspected by the Health Visitor herself and presented by the teachers on visiting the Summary of Work done and Cases followed up by the Health Visitor during 1911. Explanation:—A, cases remedied and treated; B, cases ended (children left); C, cases under observation 1st January, 1912. SCHOOL. downshall. CLEVELAND ROAD. CHRISTCHURCH ROAD. LOXFORD. HIGHLANDS. SOUTH PARK. UPH ALL. NATIONAL & CHURCH INFANTS. NEWBURY PARK. GOODMAYES. CHADWELL. BARKINGSIDE. ROMAN CATHOLIC. VALENTINES. ALDBOROUGH HATCH. LITTLE HEATH. TOTALS. ORIGIN. Medical Health Visitor. Medical Insp:ction. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. Medical Inspection. Health Visitor. DEFECT. A B C A B C A B C A B C A B C A B C A B C A B c A B c A B C A B C A B C A B C A B C A B C A B C A B C A B c A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C Clothing dirty and verminous 1 ... 1 4 1 8 ... ... ... 1 1 6 ... ... ... 1 ... 2 ... ... ... 1 5 ... ... ... ... ... ... ... ... ... ... 4 1 3 ... 1 4 4 1 11 ... ... 1 ... 6 16 1 ... 3 4 ... 7 ... ... ... 5 3 4 ... ... ... 3 2 5 ... ... 4 4 ... 6 ... ... 7 ... ... 5 ... ... 2 2 1 4 ... ... ... 3 ... ... ... ... ... ... ... ... 2 1 22 33 21 77 Head dirtv and verminous 26 3 10 65 19 46 30 15 27 39 18 48 38 2 21 63 8 74 30 10 25 41 16 62 16 ... 41 36 8 30 36 3 16 27 5 30 48 12 43 56 17 90 48 20 23 25 14 17 22 7 18 37 2 43 12 4 5 15 1 43 12 5 20 13 6 25 11 5 5 6 4 32 4 ... 22 19 2 22 5 2 5 5 3 6 ... ... ... 3 ... 4 3 1 6 5 ... 16 341 89 287 455 123 588 Ringworm 2 ... ... 27 1 2 3 1 ... 26 3 2 2 ... ... 22 1 6 2 ... ... 49 ... 9 2 1 2 16 1 1 7 ... 2 14 ... 5 3 ... 2 14 1 5 2 ... 1 29 ... 6 ... 2 ... 6 ... 6 1 ... ... 14 1 6 1 ... ... 1 ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 4 7 219 8 50 Body dirty ... ... 2 ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 ... ... ... 1 5 ... 1 ... 3 ... ... 3 ... ... ... 4 1 4 ... 1 ... 4 1 11 3 1 1 ... 6 16 1 ... 3 4 ... 7 ... ... 1 5 3 4 ... ... ... 3 2 5 2 ... 4 4 ... 6 ... ... 5 ... ... 5 ... ... 2 2 1 4 ... ... ... ... ... ... ... ... ... ... 3 7 2 21 28 23 67 Speech defective ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 23 3 ... 3 Hearing defective ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... ... 1 Vision defective 13 4 11 ... 1 1 22 10 23 4 ... 1 10 3 12 4 ... 4 9 11 27 2 ... ... 15 6 16 1 1 1 9 1 7 ... ... ... 13 7 22 4 1 2 8 1 9 3 2 3 10 4 5 3 3 1 31 1 14 2 ... 1 3 ... 3 ... ... 1 3 1 3 3 ... 1 ... 1 2 2 ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... 1 2 2 ... 2 147 52 156 33 9 19 Malnutrition ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ...• ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... 2 Teeth dirty, foul and carious 10 15 11 ... ... 1 23 6 12 ... ... ... 21 13 11 1 ... ... 5 8 31 ... ... ... 12 1 19 1 ... ... 9 ... 10 ... ... ... 9 9 21 ... ... 1 2 1 8 ... ... 1 6 5 5 ... ... ... 30 11 6 ... 1 ... 2 ... 1 ... ... ... 4 ... 2 ... ... ... 4 ... 2 ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 139 70 140 2 1 3 Nose and throat affections 1 ... 2 ... ... ... / 3 2 ... ... ... 2 ... 3 ... ... ... 2 1 2 ... ... ... 3 ... 4 ... ... ... 5 ... 1 ... ... ... 1 1 1 ... ... ... 1 ... 4 ... ... 1 2 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 25 8 25 ... ... 1 Coryza ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 4 1 2 ... ... ... Tonsils enlarged 1 ... 9 ... ... ... 12 1 6 2 ... ... 22 2 15 ... ... ... 5 2 20 ... ... ... 13 3 13 ... ... ... 19 4 9 ... ... ... 16 5 17 ... ... ... 11 5 12 ... ... ... 4 2 9 ... ... 1 ... ... 4 ...... ... ... 2 ... 3 2 ... ...... 1 ... 1 ... ... ... 8 1 4 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 4 ... ... ... 116 26 126 2 ... 1 Adenoids ... ... 2 ... ... ... 2 ... ... ... ... 1 ... ... ... 1 ... ... 3 ... 1 ... ... ... 5 3 ... 2 ... ... 4 1 1 ... ... ... 3 ... 1 1 1 ... 2 1 1 ... ... ... 2 ... 2 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 4 4 3 ... 1 Glanced enlarged ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... ... Eye diseases 1 1 ... 2 ... 3 5 2 1 ... ... ... ... ... ... 5 ... ... 2 ... ... ... ... ... ... ... ... ... ... 1 2 ... 1 ... ... ... 1 ... 3 1 ... ... 1 ... ... ... ... 1 1 ... ... ... ... 1 ... 2 2 1 1 1 ... ... 1 ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 12 5 8 12 1 11 Ear diseases 8 ... 1 1 ... ... 12 5 6 ... ... ... 9 ... 4 ... ... 2 5 ... 7 2 ... 3 9 4 5 ... ... ... 5 ... 2 ... ... 1 2 2 1 ... ... ... 2 ... 2 ... ... ... 1 ... 4 ... ... ... 4 1 1 ... ... 1 ... ... 3 ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 1 ... ... 60 9 38 ... 4 10 Heart affections ... ... ... ... ... ... 1 ... ... 1 ... ... 7 ... ... ... ... ... 2 ... 2 ... ... ... 3 2 1 ... ... ... 5 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 3 9 1 ... ... Lung affections ... ... 4 ... ... ... 8 ... 3 ... 1 ... 5 1 ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... 7 ... 4 ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... 2 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 3 16 ... 1 ... Other chest affections 2 ... 3 ... ... ... 7 ... 4 ... ... ... 3 ... 2 ... ... ... 2 3 4 ... ... ... 3 1 1 ... ... ... ... ... ... ... ... ... 2 3 5 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 8 20 ... ... ... Nervous affections ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... ... 2 Epilepsy, etc. ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 7 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... Tubercule ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Deformities of spine ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 7 ... ... 2 Other deformities 1 ... ... ... ... ... ... ... 1 ... ... 1 3 ... 1 ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 5 ... ... 1 Skin diseases ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... 1 ... ... 1 ... ... ... 1 ... ... 2 ... ... ... ... ... ... ...... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 ... 1 1 ... 1 Anæmia ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 1 ... 1 Worms 1 ... 2 ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ...... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 6 ... ... ... Rupture ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... Paralysis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... General physical condition ... ... ... ... ... 3 ... ... ... ... ... 1 1 ... 1 1 ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 3 2 6 Other diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... 2 ... ... 2 ... ... ... ... ... 1 ... ... 2 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 7 ... 4 7 ... 6 The following table shows the defects detected, separated according to sex; also percentage of the total children examined. Schools. Downshall. Cleveland Koad. Christchurch Rd. Loxford. Highlands South Park. Uphall. N ational & Church Infants. Newbury Park. Goodit ayea. Chadvrell BarkingBide. Roman Catholic. Valentines Aidhoron eh Hatch. Little Heath. Totals. Percentage of defects of children examined. Sex. M F M F M F M F M F M F M F M F M F M F M I F M F M I F M F M F M F M F M F No. of children examined. 190 164 228 205 152 182 224 203 150 145 150 179 222 244 l(i:, 112 112 88 108 129 43 64 IS 39 50 1 47 13 6 3 3 20 24 1819 1834 Defects found. 1 2 Clothing—Fair only 10 5 70 33 11 3 5 3 5 4 11 6 36 20 27 21 25 15 3 3 10 15 12 14 6 ... 5 1 1 3 3 240 148 13.0 8.06 Bad ... 2 2 1 ... ... ... ... ... 1 ... ... 2 4 2 2 2 1 ... ... 1 1 1 ... ... ... ... ... 11 12 .59 .65 Insufficient ... ... 9 2 ... ... ... ... ... 1 ... 3 4 9 ... 4 5 1 ... ... ... 6 9 ... ... ... ... ... 33 21 1.81 1.14 In need of repair 1 ... 3 1 ... 2 ... ... 1 ... ... 16 3 8 2 6 ... 1 ... 2 3 2 1 1 1 2 1 ... 1 "i 46 15 2.53 .81 Unclean ... 1 1 1 ... ... ... ... ... 1 ... 1 ... 2 2 2 ... ... ... ... 3 1 1 ... ... ... ... ... 8 9 .44 .49 Verminous and nitty ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... .16 Footgear—Fair only 2 4 16 20 5 4 2 ... ... 4 1 ... 21 15 15 11 9 6 2 1 2 2 5 7 1 ... 1 1 ... 3 1 85 80 4.68 4.3 Bad ... 1 1 2 ... ... ... ... ... ... ... 3 1 2 4 ... ... ... 1 ... 2 1 ... ... ... ... ... ...... 7 11 38 .59 Insufficient ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... 2 4 ... ... ... ... 1 ... ... ... ... ...... ... 5 5 .27 .27 In need of repair ... 1 1 4 2 2 ... 1 1 ... 1 2 12 4 8 5 2 2 ... 2 1 3 ...3 5 ... ... ... ... ... 31 31 1.70 1.68 Cleanliness— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Head—Somewhat dirty 9 4 20 23 2 5 9 3 7 6 16 9 11 6 20 5 14 11 4 8 3 3 10 7 7 1 1 ... ... 2 1 135 92 7.43 5.01 Very dirty ... 1 ... 5 ... ... ... 1 ... 1 1 2 2 1 ... 1 2 3 ... 1 ... ... 2 1 ... ... ... ... ... 1 17 .38 .92 Nits detected 10 35 20 63 16 62 27 68 12 32 17 23 48 137 33 78 24 40 5 18 10 43 14 17 10 26 2 2 2 2 7 ii 257 657 14.14 35.82 Lice detected 2 3 4 8 1 2 2 6 1 4 1 1 12 16 8 14 3 6 ... ... 3 9 5 3 1 2 ... 1 ... 1 1 44 76 2.42 4.14 Sores detected ... ... ... 1 ... ... ... 2 ... 3 ... ... 1 2 ... 2 ... ... ... ... ... 3 2 1 1 ... ... ... ... 4 14 .22 .76 Alopecia detected ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 .05 .05 Ringworm suspected ... 2 1 i 1 2 1 ... ... 2 7 1 2 1 2 1 2 2 1 1 ... 1 ... ... ... ... ... ... ... 17 14 .93 .76 Body—Somewhat dirty ... 5 13 8 3 4 3 3 2 2 3 3 8 15 14 24 18 11 2 1 1 11 10 6 2 2 1 ... ... 2 2 82 97 4.51 5.29 Very dirty ... ... ... 1 1 1 ... 1 ... ... 1 1 4 4 5 5 1 1 ... ... ... 1 3 2 ... ... ... 1 1 1 17 18 .93 .98 Fleabitten 1 2 5 5 ... 3 3 11 ... 1 1 1 22 32 16 11 3 4 1 ... 2 6 4 8 ... 3 1 1 2 4 3 65 91 3.57 4.96 Bu gs detected ... ... ... ... ... 1 ... 2 ... 1 ... 1 ... 1 2 ... ... ... 1 ... ... 2 ... ... ... 1 ... ... ... 3 9 .16 .49 Lice detected ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 3 2 .16 .10 Erythema detecte ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 .05 .05 Hash detected ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... -I 1 1 .05 .05 Mental condition—Dull 2 3 5 9 8 10 6 10 9 7 8 4 19 14 3 5 2 2 1 3 1 4 1 ... 2 5 1 ... ...... 2 1 70 77 3.85 4.19 Mentally defective ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... ... 1 ... 0 0 .33 .16 Speech defective. 3 3 5 6 5 3 5 4 6 1 13 6 3 4 5 2 6 ... 2 4 2 ... 3 ... 2 2 1 ... ... 61 35 3.35 1.9 Hearing defective ... ... 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 4 1 .22 .05 Vision defective 12 21 37 32 10 18 33 29 33 14 6 12 29 42 7 11 12 14 22 18 7 11 3 6 5 5 1 ... ... 2 3 219 235 12.05 12.81 Blind in one eye ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... 1 ... .05 .... Nutrition—Below normal 16 12 30 27 29 32 25 16 20 15 23 29 35 33 17 13 14 8 6 5 5 10 6 2 5 6 2 1 6 2 239 211 13.15 11.50 Bad 4 3 9 8 10 17 11 10 8 9 11 5 12 12 12 7 2 ... 2 2 3 5 1 1 5 4 ... 1 ... 1 1 91 80 0.00 4.3 Teeth—Somewhat dirty 137 86 104 81 70 87 76 73 84 51 68 47 101 97 68 62 67 29 86 74 23 29 25 17 25 21 9 4 3 "3 12 12 958 773 52.72 42.14 Foul 2 3 13 11 9 7 19 7 9 5 12 7 10 16 2 8 5 11 1 1 2 3 4 1 2 3 ... ... ... 1 89 8 4.89 4.52 Decayed (1—6) 115 86 167 140 93 104 143 124 89 90 89 104 117 140 66 65 69 54 67 72 24 41 32 2 29 36 7 3 2 2 9 17 1018 1080 56.02 58.83 „ (over 6) 12 21 36 26 20 33 42 33 25 18 25 17 39 38 14 18 17 7 8 8 4 6 3 3 6 7 3 2 ... 1 2 2 266 240 14.63 13.08 Septic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... ... ... ... ... ... ... ... 3 1 .16 .05 Notably defective enamel l ... 2 i ... ... ... ... 1 ... 2 3 ... ... 4 ... 1 2 ... 1 ... ... 1 ... ... ... ... ... ... 12 7 .66 .38 Notable irregularity 3 7 30 24 6 6 7 8 3 8 9 8 6 3 3 7 15 9 2 3 ... 3 6 6 1 1 ... ... 1 1 102 94 5 61 5.12 Nose and throat affections— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Coryza—Nasal obstruction due to Coryza 2 1 11 16 6 7 5 4 4 3 11 10 14 16 13 11 5 5 2 ... 7 12 2 1 2 2 1 1 ... 1 2 1 87 89 4.78 4.85 Polypus—Nasal obstruction due to Polypus ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 .05 .05 Tonsils—Slightly enlarged . 30 35 64 63 52 61 81 52 47 58 48 66 75 73 41 39 30 23 14 20 11 27 17 15 13 17 4 4 1 2 "9 7 537 562 29.5 30.58 Considerably enlarged 13 22 42 33 33 33 44 42 21 21 35 31 35 37 15 19 23 19 8 12 11 10 10 3 16 6 3 1 2 ii 3 314 292 17.22 15.92 Urgently requiring removal 2 5 8 11 10 22 12 18 14 16 18 17 22 25 19 16 9 7 5 2 4 2 2 3 4 5 1 ... ... 2 7 132 156 7.26 8.50 Adenoids—Slight nasal obstruction, probably due to Adenoids 19 12 38 35 55 55 49 40 40 32 38 45 45 54 40 26 21 15 16 15 17 18 8 ... 15 17 4 1 ... 1 6 10 411 376 22.61 20.50 Severe nasal obstruction, probably due to Adenoids 1 3 3 ... ... 4 5 3 4 3 2 ... 3 4 4 2 2 2 4 1 ... 1 1 ... 2 ... ... ... ... 1 31 26 1.70 1.41 Glands—Slightly enlarged 68 77 134 132 116 138 148 114 97 94 98 118 144 153 70 72 55 57 46 43 31 37 25 16 36 38 10 5 3 3 18 17 1099 1114 60.48 60.74 Considerably enlarged 4 4 2 6 9 12 10 5 8 13 15 13 7 5 9 4 ... ... 3 5 4 4 1 1 6 3 1 ... ... ...... 1 ... 80 75 4.40 4.08 Greatly enlarged ... ... ... ... ... ... ... ... 2 1 1 1 1 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 5 3 27 .16 Other nose & throat affections 11 5 11 7 18 12 5 7 16 10 5 8 4 11 6 3 6 2 4 2 ... ... 3 3 4 1 1 ... ... ... 2 ... 96 71 .5.33 3.87 Deflected Nasal Septum 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .05 ... Diphtheria suspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... .05 ... Pharyngitis 1 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... .33 ... External eye diseases 11 ... 26 20 14 10 12 17 13 5 15 19 15 18 11 11 9 9 4 2 1 4 6 3 2' 5 ... ... ... ... 1 2 143 133 7.83 7 .25 Ear diseases (Discharges — past and present and wax) 17 13 48 47 18 23 36 24 26 21 14 18 32 29 7 21 9 5 2 14 8 7 4 5 8 9 ... 2 ... ...... 2 3 231 239 12.71 13.3 Aural obstruction ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .05 ... Heart affections 18 23 43 38 39 42 39 29 29 28 32 28 26 20 17 15 27 13 10 7 4 11 7 5 6 6 3 2 ... ... 2 3 302 270 16.62 14.2 Lung affections 14 11 33 23 29 30 25 12 19 12 37 22 50 37 8 11 14 5 5 2 9 6 3 5 7 4 1 ... ... ... ... 3 254 183 13.97 9.97 Nervous affections 4 14 16 17 7 9 8 13 13 7 19 6 7 4 6 11 6 7 2 1 1 7 ... 11 1 ... 1 1 ... ... ... ... 91 108 5.00 5.88 Tubercule ... ... 2 1 2 6 1 1 5 1 4 8 3 2 1 2 2 1 ... 1 ... 3 ... ... 1 ... ... ... ... ... ... ... 21 26 1.15 1.41 Tuberculous shoulder ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .05 ... Rickets ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 2 .05 .10 Deformities 10 6 10 23 13 6 17 9 14 8 10 5 10 4 3 4 1 1 4 2 2 4 3 ... 1 1 1 ... ... ... 1 1 100 74 5.50 4.03 Hernia 1 ... 2 ... ... ... 1 ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 8 1 .44 .05 Worms 2 1 1 ... 5 2 4 3 2 1 2 ... 9 2 ... ... ... ... 1 1 2 ... ... ... 1 1 ... ... ... ... 1 ... 30 11 1.65 .59 Skin affections 1 3 ... ... 1 1 2 4 ... 3 1 2 1 8 1 3 ... ... ... ... 2 2 ... ... ... 2 1 ... ... ... ... ... 12 28 .66 1.52 Gastric affections ... 1 ... 4 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 .05 .27 Hip disease ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .05 Chest affections ... ... l ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 .11 .05 Infectious disease ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ...... ... 1 1 .05 .05 Bright's Disease ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 4 .. .21 Rheumatism ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 .. .05 Injury to knee ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .05 ... Oral Sepsis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 ... .05 ... Dislocated Shoulder ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .05 ... Other diseases 2 1 1 1 ... 1 ... ... 4 ... 1 1 2 1 2 ... 1 ... 2 ... ... ... 1 ... 1 ... ... ... ... ... ... ... 17 5 .92 .27 109 schools or by letter, the other as a result of the medical inspection. In addition, Miss Radford has visited the schools every three months and examined the heads of all the children. By this means a steady improvement has been effected, and from the fact that the heads are subject to a periodical inspection a great deal has been effected in keeping parents alive to the importance of attending to this condition. It entails, of course, an enormous amount of work, but the result justifies the effort. I give a summary of the work done under the two headings:— 110 The following table shows the average heights and weights of the Boys examined during 1911, also comparison with the findings of the Anthropometric Committee. Ages of children—Years 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 15-16 Total number of children examined ... 576 161 114 95 74 62 71 56 503 98 9 Heights Cms. ... 105.48 111.45 125.12 121.42 126.27 130.59 135.76 139.89 147.46 150.90 165.11 Ins. ... 41.52 43-87 49.25 47.80 49.71 51.41 53.44 55.07 58.05 59.09 64.90 Ins. ... +49 -13 +3.28 +.75 +.01 -.43 -.06 +.08 +1.14 -.24 +2.66 ALL SCHOOLS— Weights Kilos. ... 17.63 19.04 21.35 23.01 24.85 27.85 32.05 33.17 36.27 40.95 41.4 Lbs. ... 38.86 41.96 47.06 50.72 54.78 61.39 70.65 73.12 79.87 90.27 91.27 Lbs. ... -1.04 -2.44 -2.64 -4.18 -5.62 -6.11 -1.35 -3.58 -2.73 -1.73 -11.43 Number ot children ... 42 10 13 6 1 1 1 2 95 18 1 Heights Cms. ... 106.8 110.8 116 122.6 127 143 146 141.5 153.3 154 148 Ins. ... 42.04 43.62 45.66 48.26 49.99 56.29 57.48 55.70 60.35 60.62 58.26 Ins. ... +1.01 -.38 -.31 +1.21 +.29 +4.45 +3.98 +.71 +3.44 +1.29 -3.98 DOWNSHALL— Weights Kilos. ... 16.75 19.45 21.21 22.93 23.2 30.2 . 32.4 33.2 36.84 40.94 35.2 Lbs. ... 36.90 42.88 46.75 50.55 51.14 66.57 71.42 73.19 81.24 90.15 77.6 Lbs. ... -3.00 -1.52 -2.95 — 4.35 —9.26 -.93 -58 -3.51 -1.39 -1.85 -25.1 Number of children ... 75 8 9 9 8 10 11 7 74 16 1 Heights Cms. ... 104.5 108.72 3.3 122.3 127.7 129.5 137 143.2 145.73 149.2 156 Ins. ... 41.14 42.80 44.60 48.14 50.27 50.98 53.93 56.37 57.37 58.74 61.41 Ins. ... +.11 —1.2 -1.37 +1.09 +.57 -.86 +.43 +1.38 +.46 -.59 -.83 CLEVELAND ROAD— Weights Kilos. ... 17.33 18.2 22.2 23.15 26.7 27.34 31.9 34.64 36.89 39.95 40.2 Lbs. ... 38.20 40.12 48.94 51.03 58.86 60.27 70.32 76.36 81.32 88.07 88.62 Lbs. ... - 1.70 -4.28 -.76 -3.87 -1.54 -7.23 -1.68 -.34 -1.28 -3.93 -14.08 111 Boys—continued. Ages of children—Years 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11 -12 12-13 13.14 14-15 15-l6 Number of children ... 71 24 5 3 2 3 ... 4 34 6 ... Heights Cms. ... 105.4 112.5 112.8 121.3 132 129 ... 148.5 150 157.75 ... Ins. ... 41.49 44.28 44.39 47.75 51.96 50.78 ... 58.46 59.05 62.10 ... Ins. ... +.46 +.28 -1.58 +.70 +2.26 —1.06 ... +3.47 +2.13 +2.77 ... CHRISTCHURCH ROAD Weights Kilos. ... 17.83 19.53 20.48 22.1 27.2 26.66 ... 41.1 36.1 42.5 ... Lbs. ... 39.30 43.05 45.15 48.72 59.96 58.77 ... 90.60 79.58 96.69 ... Lbs. ... -.60 -1.35 -4.55 -6.18 -.44 -8.73 ... +13.9 -3.02 +4.69 ... Number of children ... 73 19 15 14 12 9 11 10 48 13 ... Heights Cms. ... 106.16 113.3 116.06 118.4 123 130.5 130.9 135.05 142.4 145.2 ... Ins. ... 41.79 44.60 45.69 46.61 48.42 51.37 51.53 53.16 56.06 57.15 ... Ins. ... +.76 +.60 -.28 -.44 -1.28 -.47 -1.97 -1.83 -.85 -2. l8 .... LOXFORD— Weights Kilos. ... 17.92 19.89 20.4 21.7 24.6 27.37 29.5 32.91 32.5 41.15 ... Lbs. ... 39.50 43.84 44.97 47.83 54.23 60.33 65.03 72.55 71.64 90.72 ... Lbs. ... -.40 -.56 -4.73 -7.07 -6.17 -7.17 -6.97 -4.15 —10.96 -1.28 ... Number of children ... 29 16 10 7 11 7 7 8 33 l6 6 Heights Cms. ... 108.6 113.2 121.8 125.8 130.13 134.57 142.28 145 150.90 151.5 170.8 Ins. ... 42.77 44.56 47-95 49.52 51.23 52.97 56.01 57.08 59.40 59.64 67.24 Ins. ... +1.74 +.56 +1.98 +2.47 +1.53 +1.13 +2.51 +2.09 +2.49 +.31 +5.00 HIGHLANDS— Weights Kilos. ... 18.28 19.35 21.92 23.48 26.61 31.7 29.7 35.47 39.12 41.9 42.66 Lbs. ... 40.30 42.65 48.32 51.76 58.66 69.88 65.47 78.19 86.24 92.37 94.04 Lbs. ... +.40 -1.75 -1.38 -3.14 - 1.74 +2.38 -6.53 +2.51 +3.56 +.37 -8.66 112 Boys—continued. Ages of children—Years 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11 -12 12-13 13-14 14-15 15-16 Number of children ... 71 26 6 7 1 I 2 ... 31 5 ... Heights Cms. ... 107 111.5 115.16 120 112 129 140.5 ... 145.74 150.4 Ins. ... 42.12 43.89 45.33 47.24 44.09 50.78 55.31 ... 57.37 59.21 ... Ins. ... +1.09 -.11 -.66 +.19 -5.6l -1.6 +1.81 ... +.46 -.12 ... SOUTH PARK— Weights Kilos. ... 18.03 19.03 19.83 22.37 20 26 30.7 ... 36.80 37.68 ... Lbs. ... 39.74 41.95 43.71 49.31 44-09 57.31 67.68 ... 81.12 83.06 ... Lbs. ... -.16 -2.45 -4.99 -5.59 -16.31 -10.17 -4.32 ... -1.48 -8.91 ... Number of children ... 63 25 25 18 16 16 16 16 26 1 ... Heights Cms. ... 103.78 108.48 115.5 119.83 12125 132.25 134.90 136.75 141.57 146 ... Ins. ... 40.85 42.70 45.47 47.17 47-73 52.06 53.11 53.83 55.73 57.48 ... Ins. ... -.18 -1.3 -.5 +.12 -1.97 +.22 -.39 -1.16 -1.18 -1.85 ... UPHALL— Weights Kilos. ... 17.4 18.98 21.68 24.01 23.72 27.73 30.13 29.53 34.27 35.04 ... Lbs. ... 38.36 41.84 47.79 52.93 52.29 62.13 66.42 65.10 75.55 78.04 ... Lbs. ... -1.56 -2.56 -1.91 -1.97 -8 11 -5.37 -5.58 -11.6 -7.05 -13.96 ... Number of children ... 22 10 10 5 6 6 10 5 29 2 ... Heights Cms. ... 106.77 111.75 115 124 140.83 128.5 .35-1 142.4 139.06 148 ... Ins. ... 42.03 43.99 45.27 48.81 55 44 50.59 53.18 56.06 54.74 58.26 ... Ins. ... +1.00 -.01 -.70 +3.76 +5-74 -1.25 -.32 +1.07 -2.17 -1.05 ... NATIONAL AND CHURCH INFANTS Weights Kilos. ... 17.38 17.86 21.08 24.44 24.9 27.33 31.32 35.84 33.37 36 Lbs. ... 38.31 39.37 46.47 53.88 54.89 60.25 69.04 79.01 73.56 79.36 ... Lbs. ... - 1.59 - 5.03 -3.23 —1.02 -5.51 -7.25 -2.96 +2.31 -9-04 -12.64 ... 113 Boys—continued. Ages of children—Years. 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11 -12 12-13 13-14 14-15 15-16 Total number of children examined ... 28 2 4 6 6 6 8 2 45 5 ... Heights Cms. ... 104 113.5 116.25 122.3 123.25 125.6 139.75 129.25 147.64 151.9 ... Ins. ... 40.94 44.68 45.76 48.14 48.52 49.44 55.01 50.88 58.12 59.80 ... Ins. ... -.09 +.68 -.21 +1.09 -1.18 -2.40 +1.51 —4.11 +1.21 +.47 ... NEWBURY PARK— Weights Kilos. ... 17.18 21.2 22.85 23.73 23.46 26.7 32.35 27.4 37.27 39.72 ... Lbs. ... 37.87 46.73 50.37 52.31 51.71 58.86 71.31 60.40 82.16 87.56 ... Lbs. ... -2.03 +2.33 +.67 -2.59 -8.69 -8.64 -.69 -16.30 -.44 -4.44 ... Number of children ... 22 9 9 9 2 ... 2 .. 45 11 ... Heights Cms. ... 108.31 114.88 119.55 124.22 130 ... 137 ... 151.81 154.54 ... Ins. ... 42.64 45.22 47.06 48.90 51.18 ... 53.93 ... 59.76 60.84 ... Ins. ... +1.61 +1.22 +1.09 +1.85 +1.48 ... +.43 ... +2.85 +1.51 ... GOODMAYES— Weights Kilos. ... 20.00 19.04 22.04 24.57 24 ... 35.5 ... 37.70 42.72 ... Lbs. ... 44.09 41.97 48.58 54.16 52.91 ... 78.26 ... 83.11 94.18 ... Lbs. ... +5.81 -2.43 -1.12 -.64 -7.49 ... +6.26 ... +.51 +2.18 ... Number of children ... 17 3 3 2 3 2 1 1 10 ... 1 Heights Cms. ... 103.70 100.83 118.83 125 123 125 127 144.5 143.3 ... 153 Ins. ... 40.82 39.69 46.78 49.21 48.42 49.21 49.99 56.88 56.41 ... 60.23 Ins. ... —.21 -4.31 +.81 +2.16 -1.28 -2.63 -3.51 -1.98 -.5 ... -2.01 CHADWELL— Weights Kilos. ... 16.4 15.4 20.93 24.1 23.6 25.3 27 32.8 34.32 ... 41.2 Lbs. ... 36.15 33.95 46.15 53.13 52.02 55.77 59-52 72.31 75.66 ... 90.83 Lbs. ... -3-75 -10.45 -3.55 -1.77 -8.38 -11.73 -12.48 -4.39 -6.94 ... -11.87 114 Boys—continued. Ages of children—Years 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 15-16 Number of children ... 25 3 1 3 2 ... 1 ... 12 1 ... Heights Cms. ... 103.92 113 109 115 124.5 ... 132 ... 144.58 157 ... Ins. ... 40.91 44.48 42.91 45.27 49.01 ... 51.96 ... 56.92 61.81 ... Ins. ... -.12 +.48 —3.06 -1.78 -.69 ... -1.54 ... +.01 +2.48 ... BARKINGSIDE— Weights . Kilos. ... 17.64 20.93 20 21.06 26 ... 28 ... 38.61 46.6 ... Lbs. ... 38.88 45.34 44.09 46.42 57.31 ... 61.72 ... 85.11 102.75 ... Lbs. ... —1.02 +.90 -5.61 -8.48 -3.09 ... -10.28 ... +2.51 +10.75 ... Number of cnildren ... 20 6 2 3 3 1 ... ... 11 4 ... Heights Cms. ... 106.45 111.5 123 120 130 135 ... ... 149.18 151 ... Ins. ... 41.00 43.89 48.42 47.24 51.18 53.14 ... ... 58.73 59.44 ... Ins. ... +.87 -.11 +6.45 +.19 +1.48 +1.30 ... ... +1.82 +.11 ... ROMAN CATHOLIC— Weights . Kilos. ... 17.65 19.5 23 23.2 26 30.6 ... ... 37.09 36.5 ... Lbs. ... 38.91 42.98 50.70 51.14 57.31 67.56 ... ... 81.75 81.46 ... Lbs. ... -.99 -1.42 +1.0 -376 -3.09 +.06 ... ... -.85 -10.54 ... Number of children ... 9 ... 1 3 ... ... ... ... ... ... ... Heights Cms. ... 109 ... 124 124 ... ... ... ... ... ... ... Ins. ... 42.91 ... 48.81 48.81 ... ... ... ... ... ... ... Ins. ... +1.88 ... +2.84 +1.76 ... ... ... ... ... ... ... THE VALENTINES— Weights . Kilos. ... 18.11 ... 25.4 23.66 ... ... ... ... ... ... ... Lbs. ... 39.92 ... 55.99 52.02 ... ... ... ... ... ... ... Lbs. ... +.02 ... +6.29 -2.88 ... ... ... ... ... ... ... 115 Boys—continued. Ages of children—Years 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 15-16 Number of children ... ... ... ... ... ... ... ... ... 3 ... ... Cms. ... ... ... ... ... ... ... ... ... 144 ... ... Heights Ins. ... ... ... ... ... ... ... ... ... 56.6 ... ... Ins. ... ... ... ... ... ... ... ... ... -.31 ... ... ALDBOROUGH HATCH— Kilos. ... ... ... ... ... ... ... ... ... 34.23 ... ... Weights Lbs. ... ... ... ... ... ... ... ... ... 75.46 ... ... Lbs. ... ... ... ... ... ... ... ... ... -7.14 ... ... Number of children ... 9 ... 1 ... 1 ... 1 1 7 ... ... Cms. ... 105.22 ... 109 ... 119 ... 109 141 138.78 ... ... Heights Ins. ... 41.42 ... 42.91 ... 46.85 ... 42.91 55.51 54.63 ... ... Ins. ... + .38 ... -3.06 ... - 2.85 ... -10.59 +.52 -2.28 ... ... LITTLE HEATH— Kilos. ... 17.2 ... 16 ... 22 ... l6 32.4 32.45 ... ... Weights Lbs. ... 37.91 ... 35.27 ... 48.5 ... 35.27 71.42 71.53 ... ... Lbs. ... - 1.99 ... - 14.43 ... -11.9 ... -36.73 - 5.28 -11.07 ... ... 116 The following table shows the average heights and weights of the Girls examined during 1911. also comparison with the findings of the Anthropometric Committee. Ages of children—Years 4.5 5.6 6.7 7.8 8.9 9.10 10.11 11.12 12.13 13.14 14.15 15.16 Total number of children examined 1 538 I7O 109 97 85 109 61 62 506 88 8 Cms. 105 105.50 111.71 116.17 121.72 127.14 130.48 135.40 142.8 148.2 150.38 155 Heights Ins. 41.33 41.53 43.98 45.73 47.92 50.05 51.36 53.30 56.22 58.34 59.20 61.02 Ins. +3.05 +.98 +1.10 +1.28 + 1.32 + 1.32 + .31 +.20 +.56 +.57 -.60 +.09 ALL SCHOOLS— Kilos. 19.6 18.28 18.86 21.1 23.16 25.42 26.18 29 33.54 35.31 40 40.50 Weights Lbs. 43.21 40.30 41.57 46.51 51.05 56.04 57.61 63.93 73.95 77.84 88.14 89.28 Lbs. + 7.11 +1.10 -.13 .99 -1.05 +.54 -4.39 -4.17 -2.45 -9.36 -8.56 -17.02 Number of children ... 40 11 10 12 2 4 1 2 68 13 1 Cms. ... 104.74 110.16 115.7 122.91 126 131.62 136 142.5 148.61 153.61 157 Heights Ins. ... 41.16 43.36 45.55 48.38 49.60 51.71 53.54 56.1 58.50 60.47 61.81 Ins. ... +.61 + .48 +1.10 + 1.78 + .87 4..66 +.44 +.44 +.73 +.67 4..88 DOWNSHALL— Kilos. ... 17.37 19.24 21.34 24.16 24.1 27.65 29 31.8 38.90 42.86 44.2 Weights Lbs. ... 39.29 42.41 47.04 53.26 53.13 61.62 63.93 70.1 85.75 94.48 97.44 Lbs. ... + .09 +.71 -.46 +1.16 -2.37 -.38 .4.17 -6.3 -1.45 -2.22 8.86 Number of children ... 53 9 6 8 9 19 6 11 69 13 2 Cms. ... 106.63 108.06 115.66 127.43 127.72 131.57 139.91 144.5 152.53 151.10 157.75 Heights Ins. ... 41.98 42.54 45.53 50.16 50.28 51.79 55.08 56.88 60.05 59.48 62.10 Ins. ... + 1.43 -.34 +1.08 +3.56 +1.55 + .74 +1.98 +1.22 +2.28 -.32 + 1.17 CLEVELAND ROAD— Kilos. ... 17.34 17.86 20.36 25.05 26.13 27.28 33.63 34.27 36.51 38.66 46.1 Weights Lbs. Lbs. ... 38.22 39.36 44.88 55.22 57.60 60.14 74.14 75.55 80.48 85.22 101.63 ... .98 2.34 -2.62 +3.12 +2.10 -1.86 +6.04 -.85 -6.72 -11.48 -4.67 117 Girls—continued. Ages of children—Years 4.5 5.6 6.7 7.8 8.9 9.10 10.11 11.12 12.13 13.14 14.15 15.16 Number of children ... 68 29 l6 9 6 6 5 2 40 1 ... Cms. ... 105.08 111.56 118.93 121.55 124 136.16 135 144 146.5 149 ... Heights Ins. 4136 43.92 46.82 47.85 48.81 53.60 53.14 56.69 57.67 58.66 ... Ins. ... +.81 +1.04 +2.37 +1.25 +.08 +2.55 +.04 +1.03 ..10 .1.14 ... CHRISTCHURCH ROAD— Kilos. ... 17.65 19.15 22.20 22.17 23.6 30.03 29.16 34.4 37.63 46.2 ... Weights Lbs. ... 38.91 42.21 48.94 48.72 52.02 66.20 64.27 75.83 82.95 101.85 ... Lbs. ... -.29 +.49 + 1.44 +3.38 -3.48 + 4.20 -3.83 -.57 -4.25 +5.15 ... Number of children ... 59 20 12 6 20 19 9 6 42 10 ... Cms. ... 106.30 111.29 117.28 121.33 129.97 128.52 134 138.66 143.33 141.7 ... Heights Ins. ... 41.85 43.81 46.17 45.83 51.16 50.59 52.75 54.59 56.42 55.78 ... Ins. ... + 1.30 +.64 -.43 2.90 +.11 -2.51 -2.89 -3.18 -3.38 -5.15 ... LOXFORD— Kilos. ... 17.08 18.28 21.51 23 26.46 27.26 29.81 33.43 37.77 37.48 ... Weights Lbs. ... 37.65 40.30 47.42 50.70 58.33 60.09 65.71 73.69 83.26 82.62 ... Lbs. ... -1.55 -1.4 -.08 -1.4 +2.83 -1.91 -2.39 -2.71 -3.94 -14.08 ... Number of children ... 26 15 9 11 8 7 8 7 40 13 1 Cms. ... 107.03 113.33 116.33 122.27 131.37 146 133.62 142.92 150.73 155.14 151 Heights Ins. ... 42.13 44.81 45.79 48.13 51.72 57.48 53.60 52.26 59.34 61.57 59.44 Ins. ... +1.58 +1.93 +1.24 +1.53 +2.99 +6.43 +.5 -3.4o +1.57 +1.77 -1.49 HIGHLANDS— Kilos. ... 17.19 17.79 20.73 22.18 25.89 30.5 28.33 35.22 38.98 42.41 39 Weights Lbs. ... 37.89 39.21 45.70 48.89 57.07 67.24 62.45 77.64 85.93 93.49 85.97 Lbs. ... -1.31 -2.49 1.8 -3.21 +1.43 +5.24 -5.65 +1.24 -1.27 -3.21 -10.33 118 Girls—continued. Ages of children—Years 4.5 5.6 6.7 7.8 8.9 9.10 10.11 11.12 12.13 13.14 14.15 15.16 Number of children ... 91 17 5 7 1 2 ... 1 42 12 1 Cms. ... 106.64 117.46 116.4 120.28 126 133.5 ... 153 150.02 150 148 Heights Ins. ... 41.98 46.23 45.82 47.35 49.60 52.45 ... 60.23 59.06 59.05 58.26 Ins. ... +.57 +3.35 +1.37 +.75 +.87 +1.40 ... +4.57 +1.29 -.75 -2.67 SOUTH PARK— ... Kilos. ... 17.40 19.65 21.96 21.68 25.2 26.4 ... 36.4 38.15 37.8 32 Weights Lbs. ... 38.36 43.32 48.31 47.79 55.56 58.20 ... 80.24 84.10 83.33 70.54 Lbs. ... -.84 +1.62 +.81 -4.31 +.06 -3.80 ... +3.84 -3.10 -13.37 -35.76 Number of children 1 76 25 20 7 19 22 12 13 46 3 ... Cms. 105 103.91 104.63 113.04 123.68 124.83 128.09 132.5 141.33 145 133.33 ... Heights Ins. 41.33 40.90 41.91 44.50 48.69 49.14 50.42 52.16 55.64 57.08 52.49 ... Ins. +3.05 +.35 -.97 +.05 +2.09 +.41 -.53 -.94 -.02 -.69 -7.31 ... UPHALL— Kilos. 19.6 17.05 18.43 19.72 24 24.28 26.07 27.46 32.50 36.27 33.06 ... Weights Lbs. 43.21 37.58 40.63 43.42 52.91 53.52 57.47 60.53 71.64 79.96 72.88 ... Lbs. +7.11 -1.62 -1.07 -4.08 +.81 -1.98 +-4.53 -7.57 -4.76 -7.24 -23.82 ... Number of children ... 22 7 10 18 9 10 7 6 22 1 ... Cms. ... 102.61 112.8 114.9 119.72 124.1 127.05 130 148.5 148.49 151 ... Heights Ins. ... 40.39 44.40 45.23 47.13 48.85 50.01 51.18 58.46 58.46 59.44 ... Ins. ... -.16 +1.52 +.78 +.53 +.12 -1.04 -1.92 +2.80 +.69 -.36 ... NATIONAL AND CHURCH INFANTS— Kilos. ... 17 19.9 21.59 23.04 24.17 25.94 27.2 32.53 32.45 41.4 ... Weights Lbs. ... 37.47 43.87 47.59 50.79 53.28 57.18 59.96 71.71 71.63 91.27 ... Lbs. ... -1.73 +217 +.09 -1.31 -2.22 -4.82 -8.14 -4.69 -15.57 -5.43 ... 119 Girls—continued. Ages of children—Years 4.5 5.6 6.7 7.8 8.9 9.10 10.11 11.12 12.13 13.14 14.15 15.16 Total number of children examined ... 29 6 3 1 2 3 3 5 34 2 ... Cms. ... 104.48 110.66 121 114 124 129.16 133 142.8 149.07 153.5 ... Heights Ins. ... 4i.i3 43.56 47.63 44.88 48.81 50.84 52.36 56.22 58.68 5983 ... Ins. ... + .58 + 1.32 + 3.18 +1.72 +.08 -.21 -.74 +.56 +.91 +.03 ... NEWBURY PARK— ... Kilos. ... 17.19 19.33 22.46 19 25 26 28.86 35.16 38.7 44.9 ... Weights Lbs. ... 37.89 42.61 49.51 41.88 55.11 57.31 63.62 77.51 85.31 98.98 ... Lbs. ... 1.31 -.91 +2.01 -10.22 -.39 -4.69 -4.48 +1.11 -1.89 +2.28 ... Number of children ... 24 17 8 6 4 4 3 2 49 11 1 Cms. ... 107.50 114 117 123 130.25 137 133.66 144 147 153 53 Heights Ins. ... 42.32 44.88 46.06 48.42 51.27 53.13 52.62 56.69 57.87 60.23 60.23 Ins. ... +1.77 +2.00 +1.61 +1.82 +2.54 +2.8 -.48 + 1.03 +.10 + .43 -.70 GOODMAYES— Kilos. ... 18.42 20.28 21.42 24.43 27.6 28.63 28.53 35.9 37.02 41.72 37 Weights Lbs. ... 40.61 44.70 47.22 53.85 60.84 63.11 62.89 79.14 81.91 91.97 81.57 Lbs. ... +1.41 + 3.00 -.28 +1.75 +5.34 +1.11 -5.21 +2.74 -5.29 -4.73 -24.73 Number of children ... 10 4 5 6 2 9 5 2 14 7 ... Cms. ... 104 111.5 114.9 116.91 116.25 130.22 134 132.25 148.32 147.8 ... Heights Ins. ... 40.94 43.89 45.23 46.02 45.76 51.26 52.75 52.06 58.39 58.18 ... Ins. ... +.39 +1.01 +.78 -.58 -2.97 + 21 -.35 -3.60 +.62 -1.62 ... CHADWELL— Kilos. ... 16.77 18.6 19.12 20.33 26.6 26 30 26.4 36.83 34.5 ... Weights Lbs. ... 36.97 41.0 42.15 44.82 58.64 57.31 66.13 58.2 81.19 76.8 ... Lbs. ... -2.23 -.70 -5.35 -7.28 -3.14 -4.69 -1.97 -18.2 -6.01 -19.90 ... 120 Girls—continued. Ages of children—Years 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 15-16 Number of children... ... 15 4 1 ... ... 1 1 1 16 ... ... Cms. ... 102 110 113 ... ... 136 132 151 146.37 ... ... Heights Ins. ... 40.15 43.30 44.48 ... ... 53.54 51.96 59.44 57.62 ... ... Ins. BARKINGSIDE— ... -.4 +.42 +.03 ... ... +2.49 -1.14 + 3.78 -.15 ... ... Kilos. ... 16.86 19.1 17.8 ... ... 27.2 26.8 35.2 36.5 ... ... Weights Lbs. ... 37.16 42.10 39.24 ... ... 59.97 59.08 77.6 80.46 ... ... Lbs. ... -2.04 +.03 -8.26 ... ... -2.03 -9.02 -1.2 -6.74 ... ... Number of children ... 11 4 4 4 3 ... ... 2 15 2 2 Cms. ... 106.45 113.25 118.5 121.3 128.33 ... ... 148 147.6 157.5 157.5 Heights Ins. ... 41.91 44.58 46.65 47.76 50.52 ... ... 58.26 58.11 62.00 62.00 Ins. ... +1.36 +1.70 + 2.20 +1.16 + 1.79 ... ... +1.60 +.34 +2.20 +1.07 ROMAN CATHOLIC— ... ... Kilos. ... 17.4 19.95 22.9 24.8 24.2 ... ... 34.9 36.94 48.6 40.1 Weights Lbs. ... 38.36 43.98 50.48 54.67 53.55 ... ... 76.94 77.02 107.14 88.4 Lbs. ... -.84 + 2.28 + 2.98 + 2.57 -1.95 ... ... +.54 -10.18 +10.44 -17.9 Number of children ... 5 ... ... ... ... ... 1 ... ... ... ... Cms. ... 106.16 ... ... ... ... ... 132 ... ... ... ... Heights Ins. ... 41.79 ... ... ... ... ... 51.96 ... ... ... ... Ins. ... +1.24 ... ... ... ... ... -3.70 ... ... ... ... THE VALENTINES— Kilos. ... 17.52 ... ... ... ... ... 26.8 ... ... ... ... Weights Lbs. ... 38.62 ... ... ... ... ... 59.08 ... ... ... ... Lbs. ... -.58 ... ... ... ... ... -9.02 ... ... ... ... 121 Girls—continued. Ages of children—Years 4-5 5-6 6-7 7-8 89 9-10 10-11 11 -12 12-13 13-14 14-15 15-16 Number of children ... 1 ... ... ... ... 1 ... ... 1 ... ... Cms. ... 109 ... ... ... ... 136 ... ... 155 ... ... Heights Ins. ... 42.91 ... ... ... ... 53.54 ... ... 61.02 ... ... Ins. ... +2.36 ... ... ... ... + 2.49 ... ... + 3.25 ... ... ALDBOROUGH HATCH— Kilos. ... 18.8 ... ... ... ... 30.6 ... ... 41.4 ... ... Weights Lbs. ... 41.44 ... ... ... ... 79.36 ... ... 91.27 ... ... Lbs. ... +2.24 ... ... ... ... +17.36 ... ... +4.07 ... ... Number of children ... 8 2 ... 2 ... 2 ... 2 8 ... ... ... 108.37 101 ... 132.5 ... 129.5 ... 138.5 143.25 ... ... Heights Ins. ... 42.66 3976 ... 52.16 ... 50.98 ... 54.52 56.12 ... ... Ins. ... + 2.11 -3.12 ... + 5.56 ... -.07 ... -1.14 -1.65 ... ... LITTLE HEATH— ... ... ... Kilos. ... 18.4 147 ... 27.8 ... 26.8 ... 31.7 33.67 ... ... Weights Lbs. ... 3976 32.4 ... 61.28 ... 59.08 ... 69.8 74.22 ... ... Lbs. ... +.56 -9.3 ... + 9.18 ... -2.92 ... -6.6 -12.98 ... ... 122 CHILDREN EXAMINED AT THE OFFICE. In addition to the Inspection at the schools, any parent, teacher, or Attendance Officer can send a child to my office any morning between 9 and 10 o'clock. The child is then seen and a certificate given as to the length of time of exclusion from school, or returning, as the case may be. During 1911, 4,520 certificates were issued, and the causes of exclusion may be roughly classified as under:— Diseases of Ear 15 „ „ Eye 102 „ „ Nose 9 „ „ Skin 308 Dirty Heads 1,048 Infectious Diseases 30 Ringworm 14 Swollen Glands 112 Sore Throats 362 Tubercular Diseases 1 All other Diseases 410 Total 2,411 Certificates of fitness to attend school were given in 2,109 instances. The number of certificates granted in previous years have been as follows:— In 1910 2,876 In 1909 1813 In 1908 1,882 In 1907 2,070 In 1906 1,665 In 1905 1,493 In 1904 1,518 The following Table shows the SPECIAL CASES Inspected during 1911. Reason for Special Inspection. Downshall Cleveland Christchurch Loxford Highlands South Park National Newbury Park Goodmayes Chadwell Barkingside Roman Catholic Valentines Aldboro' Hatch Little Heath Uphall Total M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F Speech Defective 1 - - - 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - 3 1 Dealness 1 — — — — — 1 — — — 2 1 2 - - - - - - - - - - - - - - - - - - - 0 1 Rhinorrhœa 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 — Sore Throat — 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 Debility — 2 — — 1 — 2 — — — 4 1 6 1 — 1 - - - - - - - - - - - - - 1 - - 13 6 Vision Defective — — 1 2 1 2 3 1 — 7 1 5 — 4 1 1 7 5 - - - - - - - - - - - - - 1 14 28 Adenoids Probable — — — 2 — — 3 1 — 1 3 2 — 2 1 1 - - - - - - - - - - - - - - - - 7 9 Ear Diseases - - - 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 Tonsils Enlarged - - - 1 - 1 - - - - 2 1 - 1 - - - - - - - - - - - - - - - - - - 2 5 Chest Affections - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 Mentally Defective — — — — — — 4 — — 1 — — 1 — 1 3 4 1 — — — — 1 — — — — — — — — — 11 5 Nasal Affections - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - 1 1 Nervousness — — - - - - - - - - 1 - - - 2 - - - - - - - - - - - - - - - - - 3 — Fits - - - - - - - - - - 2 - - - - - 1 - - - - - - - - - - - - - - 1 3 2 Skin Affections — - - - - - - - - - - 2 - - - - - - - - - - - - - - - - - - - 1 — 3 Neglected - - - - - - - - - - - - - 1 - 5 - - - - - - - - - - - - - - - - 0 10 Eye Diseases - - - - - - 1 - - - - - - 4 - - - - - - - - - - - - - - - - - - 1 4 Ringworm - - - - - - 2 1 - - - - - - - - 1 - - - - - - - - - - - - - - 1 3 2 Glands - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - 1 Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 2 3 2 Heads Dirty - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 — Other Causes - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - 2 1 2 Totals 3 4 1 9 4 4 18 3 — 9 16 12 9 13 6 11 13 7 — — — 1 1 — 6 6 — — — 1 3 8 80 88 The following table shows the results up to the 31st December, 1911, of the Medical Inspection carried out during 1911. school. downshall. cleveland road. christchurch road. loxford. highlands. south park. uphall. national and church infants. newbury park. goodmayes. chadwell. barkingside. roman catholic. valentines. aldborough hatch. little heath. totals. defects. Number of notices sent. Cases remedied and treated. Cases ended, children left. Percentage of Total Cases. Number of notices sent. Cases remedied and treated. Cases ended, children left. Percentage of Total Cases. Number of notices sent. Cases remedied and treated. Cases ended, children left. Percentage of Total Cases. N umber of notices sent. Cases remedied and treated. Capes ended, children left. Percentage of Total Cases. Number of notices sent. Cases remedied and treated. Cases ended, children left. Percentage of Total Cases. Number of notices sent. Cases remedied and treated. Cases ended, children left. Percentage of Total Casts. Number of notices sent. Oases remedied and treated, Cases ended, children left. Percentage of Total Cases. Number of notices sent. Cases remedied and treated. Cases ended, children left. Percentage of Total Cases Number of notices sent. Cases remedied and treated. Cases ended, children left. Percentage of Total Cases. Number of notices sent. Cases remedied and treated, Cases ended, children left. Percentage of Total Cases. Number of notices sent, Cases remedied and treated. Cases ended, j children left. Percentage of Total Cases. Number of notices sent. Cases remedied and treated. Cases ended, children left, Percentage of Total Cases. Number of notices sent, Cases remedied and treated. Oases ended, children left, Percentage of Total Cases. Number of notices sent Cases remedied and treated. Cases ended, children left, Percentage of Total Oases. Number of notices sent. Oases remedied and treated. Oases ended, children left. Percentage of Total Cases. Number of notices sent. Cases remedied and treated. Cases ended children left. Percentage of Total Cases. Number of notices sent. Cases remedied and treated. Cases ended, children left. Percentage of total cases treated. Percentage of total cases left. Treated Left Treated Left Treated 1eft Treated Left Treated Left Treated left Treated Left Treated Left Treated Left Treated Left Treated Left Treated Left Treated Left Treated Left Treated Left Treated Left Clothing dirty and verminous 1 1 ... 100 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 ... 1 ... 14.28 ... ... ... ... ... 8 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 ... 1 ... 4.54 Head dirty and verminous 42 26 8 6190 714 57 30 15 52.63 26.31 50 33 2 66 4 89 29 9 32.58 10.11 38 16 9 42.05 23.68 57 35 3 61.40 5.26 138 47 10 34.05 7.24 102 48 19 47.05 18.62 68 21 7 30.88 10.29 21 10 3 38.09 9.52 46 12 4 26.08 8.69 26 11 42.30 19.23 8 4 ... 50 ... 9 2 ... 22.22 ... ... ... ... ... ... 13 3 1 23.07 7.69 767 325 89 42.37 11.60 Ringworm 2 2 100 ... 4 8 1 75 25 3 2 ... 66.66 ... 4 2 ... 50 ... 3 2 ... 66.66 ... 8 7 ... 87.5 ... 4 3 ... 75 ... 3 2 ... 66.66 ... 3 ... 2 ... 66.66 2 1 ... 50 ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... 39 26 3 66.66 7.69 Body dirty ... ... ... ... ... ... ... ... ... ... 2 1 ... 50 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 50 6 3 1 50 16.66 5 1 ... 20 ... ... ... ... ... ... 1 ... ... ... ... 5 2 ... 40 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 8 1 38.09 4.76 Speech defective ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... Hearing defective ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... 3 1 1 33.33 33.33 Vision defective 28 12 4 42.85 14.28 44 22 9 50 20.45 26 6 2 23.07 7.69 52 9 11 17.30 21.15 40 11 4 27.5 10 21 9 1 42.85 4.76 52 19 ... ... 13.46 18 8 1 44.44 5.55 25 10 4 100 16 34 22 1 38.23 ... 8 3 ... 37.5 ... 8 3 1 37.5 12.5 7 ... 1 ... 14.28 1 ... 1 ... 100 ... ... ... ... ... 5 ... 1 ... 20 369 118 48 32.00 13.00 Malnutrition ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 50 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 50 ... Teeth dirty, foul or carious 31 10 15 1290 29.58 35 21 5 60 14.28 22 10 3 45.45 13.63 48 5 8 10.41 16.66 28 8 1 28.57 3.57 24 9 37.5 ... 38 7 0 18.42 ... 16 2 1 12.5 6.25 19 6 5 31.57 26.31 30 19 7 26.66 10 4 2 ... 50 ... 7 4 ... 57.14 ... 8 4 ... 50 ... 2 1 1 50 50 ... ... ... ... ... 2 ... ... ... ... 314 89 40 28.34 12.73 Nose and throat affections 5 1 ... 20 ... 10 7 3 70 30 5 2 ... 40 ... 5 ... 1 40 20 3 ... ... ... ... 6 5 ... 83.33 ... 4 1 1 25 25 4 1 ... 25 ... 6 2 ... 33.33 ... ... ... ... ... ... ... ... ... ... ... 3 1 ... 33.33 33.33 2 ... ... ... ... 1 ... 1 ... 100 ... ... ... ... ... 1 ... ... ... ... 55 22 7 40 12.72 Coryza ... ... ... ... ... 2 2 ... 100 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... 9 4 1 44.44 11.11 Tonsils enlarged 10 1 ... 10 ... 17 12 1 6470 588 24 21 2 87.5 8.33 33 5 2 15.15 6.06 31 13 3 41.93 9.67 30 19 4 48.71 10.27 42 16 5 38.09 11.90 30 11 5 36.66 16.66 19 4 2 21.05 10.52 6 ... ... ... ... 6 2 ... 33.33 ... 2 1 ... 50 ... 13 8 1 61.53 7.69 3 1 ... 33.33 ... ... ... ... ... ... 8 1 1 12.5 12.5 277 115 26 41.51 9.38 Adenoids 2 ... ... ... ... 2 2 ... 100 ... ... ... ... ... ... 4 3 ... 75 ... 4 3 1 75 25 6 4 1 66.66 16.66 3 3 ... 100 ... 4 2 1 50 25 4 2 ... 50 ... ... ... ... ... ... 1 1 ... 100 ... 1 1 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 22 3 73.33 10 Glands enlarged ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 ... 100 ... Eye diseases ... ... ... ... ... 7 5 2 71.42 28.57 ... ... ... ... ... 2 2 ... 100 ... ... ... ... ... ... 5 2 ... 40 ... 4 1 ... 25 ... 1 1 ... 100 ... 1 1 ... 100 ... 1 ... 1 ... 100 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 12 2 54.54 9.09 Ear diseases 10 8 ... 80 ... 18 12 5 66.60 27.77 13 9 ... 69.23 ... 19 5 ... 26.31 ... 9 4 4 44.44 44.44 8 5 ... 62.5 ... 7 1 2 14.28 28.57 7 2 ... 28.57 ... 1 1 ... 100 ... 4 3 1 ... 25 2 ... ... ... ... 2 2 ... 100 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 102 54 12 52.94 11.76 Heart affection ... ... ... ... ... 2 1 ... 50 ... 7 7 ... 100 ... 5 2 ... 40 ... 3 2 ... 66.66. ... 7 5 ... 71.42 ... 2 ... ... ... ... 1 ... ... ... ... 8 3 37.5 ... 2 ... ... ... ... ... ... ... ... ... 3 1 1 33.33 33.33 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 40 21 1 52.5 2.5 Lung affection ... 4 ... ... ... ... 8 8 ... 100 ... 6 5 ... 83.33 16.66 2 ... ... ... ... 2 1 1 50 50 12 7 ... 58.33 ... 3 1 33.33 ... 3 ... 1 ... 33.33 6 2 ... 33.33 ... ... ... ... ... ... 2 1 ... 50 ... 3 1 1 33.33 33.33 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 52 23 3 44.23 5.76 Other chest affections 4 2 ... 50 ... 9 7 ... 77.77 ... 6 3 ... 50 ... 18 2 3 15.38 23.07 4 3 1 75 25 ... ... ... ... ... 15 2 3 13.33 20 2 1 ... 50 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 50 50 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 57 24 9 42.10 15.78 Nervous affections ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... 3 1 1 33.33 33.33 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 1 50 25 Epilepsy, etc. ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 2 1 ... 50 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 2 ... 40 ... Tubercule ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 100 ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... Deformities of spine ... ... ... ... ... 1 ... ... ... ... 3 2 ... 66.66 ... 2 1 ... 50 ... 2 ... ... 50 ... 2 2 ... 100 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 5 ... 45.45 ... Other deformities 1 1 ... 100 ... ... ... ... ... ... 3 3 ... 100 ... ... ... ... ... ... 4 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 6 ... 50 ... Skin diseases ... ... ... ... ... 3 2 ... 66.66 ... 2 2 ... 100 ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 100 ... 3 2 ... 66.66 ... 2 ... ... ... ... 2 2 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 10 ... 71.42 ... Anæmia ... ... ... ... ... 1 1 ... 100 ... 1 1 ... 100 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... 100 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 2 1 28.57 14.28 Worms 3 1 ... 33.33 ... 1 1 ... 100 ... 1 1 ... 100 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 6 2 33.33 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 5 ... 33.33 Rupture ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... l ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... 33.33 Paralysis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... General physical condition ... ... ... ... ... ... ... ... ... ... 2 1 ... 50 ... 1 1 ... 100 ... 4 ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 3 ... 27.27 ... Other diseases ... ... ... ... ... 6 6 ... 100 ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... 3 2 ... .66.66 ... ... ... ... ... ... 2 2 ... 100 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 12 ... 92.30 ... Table showing the defects detected upon Medical Inspection before, but which have been Remedied and Treated or where the Children have left the School or District during 1911. School All Schools Downshall Cleveland church Loxford Highlands South Park Uphall Nat. & Ch. Inf'ts Newbury Park Goodmayes Chadwell Barking side Roman Catholic Valentines Aldboro Hatch Little Heath Defects Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Remedied & Treated Left Clothing Dirty 2 - 1 - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - Head Dirty and Verminous 8 8 - - - - - - - 1 - - 1 - 1 2 - 1 1 - 2 1 - 1 - - - - 3 2 - - - — Ringworm 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - Body Dirty 2 - 1 - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - Vision Defective 10 3 — - - 1 4 1 - - 4 1 - - 1 - - - — — — — — — — — — — 1 — — — — — Teeth Dirty, Foul or Carious 24 22 6 8 1 1 11 10 - — 3 - - - 2 3 - — — — — — — — — — — — 1 — — — — — Tonsils Enlarged 1 - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - Adenoids 1 - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - Ear Affections 2 - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - 1 - - - Other Affections and Diseases 1 - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - Totals 52 33 8 8 1 2 16 11 — 1 8 1 1 — 5 5 1 4 — 2 1 — 1 — — — — 6 2 1 — — — 123 I have also examined 55 teachers for the Education Committee during the year. In addition, 10 children have been examined by me as to their fitness to attend special schools, and, as will be seen in another portion of this report, 3 have been sent to the Deaf and Dumb School at Margate and 1 to the East London Blind School. 124 INFECTIOUS DISEASE. On examining the table on the opposite page, it will be seen that there has been a marked increase in the total amount of infectious disease as compared with the previous year, the greatest increase being with regard to Measles, Scarlet Fever, and Diphtheria. As I am of the same opinion as last year, I cannot do better than reproduce what I stated then, as it still holds good. "A great deal depends on the head teacher with regard to limiting the spread of any outbreak that may occur, but intercommunication, both within and without the school, is so free that it is beyond the care of any teacher to prevent the introduction of infective material into the school. When that occurs one of the most important factors is the amount of inflammable material in that school. For instance, if the infection of Measles is imported into a school where the bulk of the children have not had Measles before, there will probably be a rapid extension of the disease. Whereas, if it is introduced into a school where the bulk of the children have previously suffered, little or no result will probably follow. All these factors have to be taken into account in considering the question. At the same time the more effective supervision that can be exercised, the less extension of disease will there be, which means a diminished death rate and an improved attendance rate. As an investment, I believe it would pay the Education Authority to employ a Health Visitor to do nothing but follow up cases of infectious or suspected infectious disease and to give advice to the parents as to isolation, etc. Take the case of measles and whooping cough last year, which were responsible for 23 deaths. Probably half those were due to the fact of insufficient care being taken with the first infective case as regards isolation and intercourse with the younger members of the family. Scarlet Fever again is more prevalent than it should be. Every case should be followed up at school and all possible contacts examined. Under present circumstances this is impossible, but I hope more may be done in the future with more skilled assistance." Summary of Infectious Diseases and Children who have been excluded owing to Contact with Patients in connection with the Schools during the year ended the 31st December, 1911. SCHOOLS. Average Attendance. DISEASES AND CONTACTS. Scarlet Fever. Diphtheria. Enteric Fever. Measles. German Measles. Chickcn Pox. Mumps. Whooping Cough. Ringworm. Totals. 1911. Totals. 1910. Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts ; Cases Cases Contacts Cases Contacts Downshall 1318 44 49 19 24 - - 199 39 15 3 5 2 33 1 4 - 12 331 118 161 30 Cleveland Road 1324 22 19 10 15 1 - 104 39 20 9 15 9 5 - 30 4 20 227 95 98 25 Christchurch Road 1150 13 21 4 6 — - 124 48 2 4 21 12 1 - 13 4 15 193 95 241 62 Loxford 1125 5 7 2 8 — — 110 29 23 6 17 9 3 - 10 1 35 205 60 247 51 Highlands 877 17 18 - 5 — — 131 29 33 12 19 1 8 2 32 1 3 243 68 109 32 South Park 781 18 19 12 9 — - 185 56 13 7 5 3 1 - 16 2 15 265 96 58 11 Uphall 923 15 23 7 12 1 - 90 36 4 8 80 56 16 - 28 10 14 255 145 178 74 National and Church Infants 424 4 5 1 7 — — 32 55 5 9 5 15 - — 2 3 15 64 94 42 14 Newbury Park 487 24 34 4 19 — — 39 23 2 — - - 2 - - - 6 77 76 46 25 Goodmaves 634 13 8 5 6 1 - 154 32 17 5 48 17 5 - - 1 10 253 69 105 16 Chadwell 297 - - - 2 - - 1 - - - - - - 1 - - 1 5 3 47 11 Barkingside 248 - - 2 3 1 — 4 — 0 1 — - - - - - 3 12 4 10 1 Roman Catholic 276 2 3 2 3 — - 5 2 2 - - - 3 - 1 - 1 16 8 34 20 Valentines 93 — - 3 7 - - 2 2 - - - - - - - - - 5 9 18 4 Aldborough Hatch 24 — - — - — — 1 5 - - - - - - - - - 1 5 5 2 Little Heath 115 4 6 2 6 — — 2 2 — — 3 4 — — 1 - - 12 18 17 1 Countv High School ? — 8 I 9 — — 1 - — — 3 2 - - - - - 5 19 1 4 Private Schools ? 10 12 8 3 — — 4 1 — — — — — — — — 22 16 22 22 Totals ? 191 232 82 144 4 - 1188 398 138 64 221 130 80 4 137 26 150 2191 998 1439 405 126 SCARLET FEVER. In the schools during- 1911 there were 191 cases of this disease, as compared with 109 in 1910. Now that more medical assistance has been provided it will be possible to take further precautions for the prevention of the spread of this disease. During the year, at the end, there was a small outbreak at one of the schools. As it seemed impossible to locate it to a class-room, every child in the school was examined for the presence of any sign or symptom of an unrecognised attack of Scarlet Fever. As a result, about 20 children were excluded from attendance for a week. They were again seen at the end of a week, when two-thirds of them were allowed to attend. The other third were excluded for another week, and so on until they all appeared to be safe to return. By this means the whole outbreak came to an end, and the school was cleared. By following up all notified cases to the school and examining contacts I am of opinion a great deal of good can be done. The difficulty is, of course, the time required to carry it out systematically. Every effort is made to trace the origin of each case, but in the majority of instances this is a very difficult matter. The communication with other districts is so free that there is always the possibility of infection through an unrecognised slight case moving about. The far greater number of patients are of school age, and, seeing how persistent the disease has been, it seems to me worth while for the Council to consider —as an experiment in the first instance, I should suggest— as to whether it would not pay them, from a public health and also from an education attendance point of view, to appoint a health visitor to follow up all cases of suspicious illness which might be notified to me from the schools. This would cost them less than £100 a year, and if any material reduction could be made in the incidence of Scarlet Fever of course it would be money well spent. Quite recently an addition was made to the accommodation at the Isolation SCARLET FEVER. Table showing the Number of Cases of Scarlet Fever and the Contacts Involved in connection with the Schools, also Total Comparisons with 1910. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1911. Totals 1910. Cases Conts. Cases. Conts. Cases. Conts. Casrs. Conts. Canes. Conts. Cases. Conts. Cases. Conts. Cases Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conta. Downshall 1318 8 9 4 3 6 7 2 5 1 - 6 13 2 - - - 2 - 5 5 6 2 2 5 44 49 11 6 Cleveland Road 1324 3 3 1 — 1 2 1 — 5 5 4 5 1 2 — — — — 2 — 1 2 3 — 22 19 10 10 Christchurch Road 1150 2 3 - — 2 1 — — 2 3 1 1 1 3 — — 2 4 3 4 — — — 2 13 21 12 16 Loxford 1125 1 1 1 2 - - - - - 1 3 3 - - - — — — — — — — — — 5 7 2 2 Highlands 877 1 2 1 1 — — 4 1 2 — 1 — — — 1 1 1 3 3 7 3 3 17 18 8 15 South Park 781 3 — 2 1 2 1 - — 1 — — — — — 1 1 — — 1 2 2 1 6 13 18 19 5 7 Uphall 923 — — 1 1 4 3 — — 2 — — — — — 2 3 3 0 1 — — 5 2 6 15 23 17 38 National and Church Infants 424 1 2 - - - - - - - 1 - 1 - - - - - - 2 1 - - 1 - 4 5 4 8 Newbury Park 487 1 6 — — 1 5 - - - - - - 1 — 2 1 9 8 4 1 4 7 2 6 24 34 6 9 Goodmayes 634 - - - 3 1 - — — — — — — 1 — 1 — — — 3 1 5 2 2 2 13 8 11 10 Chadwell 297 - - - - - - - - - - - - - - - - - - - - - - - - - - 4 9 Barkingside 248 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Roman Catholic 276 - - - - - - - - 1 2 - - - - 1 1 - - - - - - - - 2 3 4 6 The Valentines 93 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Aldborough Hatch 24 - - - - - - - - - - - - - - - - - - - - - - - - - - — — Little Heath 115 2 2 1 4 - - 1 - - - - - - - - - - - - - - - - - 4 6 2 1 County High School ? - - - - - - - - - 5 - - - - - - - 2 - - - 1 - - - 8 1 4 Private Schools ? — — 1 — 2 — 1 1 — 1 — — 1 1 — — — — 1 4 — - 4 5 10 12 13 14 Totals ? 22 28 12 15 19 19 9 7 14 18 14 23 8 6 7 6 17 20 23 21 21 27 25 42 191 232 109 155 128 Hospital, but that is now barely adequate to meet the demands made, and the annual cost to the Council of that addition, for repayment of loan only, is over £400 per annum. So that, from a purely financial standpoint, the matter is worth the attention of the Council; in addition fo that there is the loss of education grant from direct nonattendance of patients and contacts, and, what is far greater, the absence of other children through anxiety of parents to avoid any risk of infection. Most important of all, however, is the prevention of disease and the consequent misery and possible risk to life. Always, in an outbreak of Scarlet Fever, there are so many grades of the disease that it is quite easy for an attack to be passed over as merely a sore throat, allowed to return to school and then infect others. In several instances classrooms were disinfected by a thorough spraying with Cyllin solution, and the books, pencils, etc., destroyed where such a proceeding was indicated. Of course, in many instances there was a clear history of the disease being contracted from an outside source and not from attendance at school. The parent as a rule, naturally perhaps, concludes because a child catches Scarlet Fever and is attending school that therefore the school is the cause of all the trouble. INFECTIOUS DISEASES—continued. 130 DIPHTHERIA. For 1911 there was a very marked increase in the prevalence of this disease. 82 cases occurred in children attending school, as compared with 30 in 1910. On examining the table on the opposite page it will be seen that the cases have been fairly evenly distributed. In September there was an outbreak of 6 cases in connection with Cleveland Road School, most of them from one class. The type of disease was severe. There were about 60 children in this class, so a swab was taken of every child, and 3 gave a positive result. There was no apparent symptom with any of them, and no discharge of any sort. These were excluded from school until a negative swabbing was obtained. There were no further cases in that class. At the end of the year, in a private school, there was also a small outbreak. Some 70 children were in attendance at this school. All were examined individually and swabs taken of 4 presenting suspicious symptoms. Three of these gave positive results, and the children were excluded. No other case occurred at that school. There is a tendency for Diphtheria and Scarlet Fever to break out concurrently. In December, it will be seen, there were 9 cases of Diphtheria at South Park School and also 6 of Scarlet Fever. Both diseases, too, affected Downshall more than any other school during 1911. In several instances where children presented suspicious-looking throats on their examination at the office in the morning, swabs were taken with positive results. One case resulted in finding two other children at home with bad throats, who also gave positive results. The whole three were removed to the Isolation Hospital. DIPHTHERIA. Table showing the Number of Cases of Diphtheria and the Contacts Involved in connection with the Schools, also Total Comparison with 1910. SCHOOLS. Average Attendance. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1911. Totals 1910. Cases. Oonts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Downshall 1318 1 - - - 1 - - - - - - - - - 2 1 3 5 3 8 2 1 7 9 19 24 1 3 Cleveland Road 1324 - - - - - - 1 1 1 — — — 2 2 — — 6 9 — — — — - 8 10 15 5 6 Christchurch Road 1150 — — — — — — — — — — — — 1 — — — 2 1 — 4 1 1 - - 4 6 4 5 Loxford 1125 — — — 1 — — — 2 — — — — 1 2 1 3 - - - - - - - - 2 8 2 4 Highlands 877 — — — — — 2 — — — — — 1 - — — — — - — 2 — - — - - 5 - 4 South Park 781 — — 1 — — — 1 1 — — — — - — — — — - — — 1 3 9 5 12 9 3 1 Uphall 923 — 2 — — — — 3 — 1 — — — - — — — 1 4 2 6 — — - - 7 12 3 6 National and Church Infants 424 - - - - 1 4 - - - - - - - - - - - - - 2 - - - 1 1 7 1 3 Newbury Park 487 — — — — — — — — 2 10 — — 1 2 1 7 - - - - - - - - 4 19 2 3 Goodmayes 634 — — — — 1 — — — 1 — 1 — 1 2 — — — — — — — — 1 4 5 6 - 1 Chadwell 297 - - - - - - - - - - - - - - - - - - - - - - - 2 - 2 2 2 Barkingside 248 1 2 - - 1 1 - - - - - - - - - - - - - - - - - - 2 3 1 - Roman Catholic 276 — — — — — — — — — — — — 1 — — 3 - - — — — — 1 — 2 3 1 1 The Valentines 93 - - - - - - - - - - - 1 - - - - - - - - 3 6 - - 3 7 - - Aldborough Hatch 24 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Little Heath 115 — — 1 2 — — — — — — — — — — — — — — — — 1 4 - — 2 6 — - County High School ? — — — 1 — 2 — — — 1 — — — — — — — 1 — — — — 1 4 1 9 - - Private Schools ? 1 — — — — — — — — — — — — — — — — 2 1 — — — 6 1 8 3 5 8 Totals ? 3 4 2 4 4 9 5 4 5 11 1 2 7 8 4 14 12 22 6 22 8 15 25 29 82 144 30 47 132 MEASLES. As will be seen from the table on the opposite page, Measles was very prevalent during the first six months of the year. It began in Downshall and Christchurch Road, and then passed on to South Park and Goodmayes at one end of the district, and Highlands and the National at the other, later involving Loxford and Uphall. Frequent visits were made to the schools, consultations held with the teachers, and children examined and excluded. None of the schools were closed, as it has been found from experience how useless that procedure is. The routine followed was to exclude the patient and any other contact in the same house who had not had Measles, allowing the children in the upper schools who had already had Measles to attend school as usual. Nearly all the cases were in the Junior Mixed or Infants' Departments. The information supplied by the teachers and Attendance Officers concerning these minor infectious diseases is extremely valuable, but it would be of greater use still if it could be obtained more promptly. This is very difficult to manage, as there is nearly always delay before the school authorities obtain the information themselves. The Chief Attendance Officer visits the Public Health Office every morning, so as to cause as little delay as possible in the exchange of information. Of the 1,188 cases occurring among school children, 2 terminated fatally. But there were 14 deaths among children under 5, the infection having been brought into the house by older children. MEASLES. Table showing the Number of Cases of Measles and the Contacts Involved in connection with the Schools, also Total Comparison with 1910. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1911. T otals 1910. Cases. Conts. Cases. Conts Cases. Conts. Cases. Conts. Cases. Conts. Cares. Conts. Cases. Conts. Cases Cents. Cases. Conts. Cases. Conts. Cases. Conts. Cases Conts. Cases. Conts Cases. Conts. Downshall 1318 29 7 36 6 74 12 7 1 32 6 16 7 5 - - - - - - - - - - - 199 39 5 1 Cleveland Road 1324 2 — 8 8 49 18 18 2 17 3 5 1 5 7 - - - - - - - - - - 104 39 20 3 Christchurch Road 1150 35 7 62 24 20 12 3 — 1 2 2 2 1 1 - - - - - - - - - - 124 48 13 11 Loxford 1125 1 — 3 1 19 6 54 8 30 12 2 1 - - - - - - - - 1 1 — — 110 29 71 10 Highlands 877 4 — 75 11 19 10 19 6 12 2 2 — - — - — — — — — — — — — 131 29 3 1 South Park 781 13 1 118 29 27 9 6 6 15 5 4 5 2 1 - - - - - - - - - - 185 56 2 1 Uphall 923 1 — 3 1 30 10 36 12 18 9 1 3 - - - - - - - - 1 1 — — 90 36 55 14 National and Church Infants 424 1 - 11 20 8 7 4 3 3 15 5 10 - - - - - - - - - - - - 32 55 2 2. Newbury Park 487 — - 2 3 13 14 20 6 4 - - - - - - - - - - - - - - - 39 23 1 — Goodmayes 634 1 — 90 22 17 4 16 3 23 3 2 — 4 — — — — — — — — — 1 — 154 32 2 — Chadwell 297 — — — — — — — - 1 — — — — — — — — — — — — — — — 1 — 1 — Barkingside 248 — — — - — - 1 — 3 — . — — - - - - — - — - — - — — 4 - - - Roman Catholic 276 1 2 — — 3 - - — - — — — 1 - - - — - - — — — — - 5 2 4 3 The Valentines 93 — — — - — - 2 2 - - - - - - - - - - - - - - - - 2 2 1 1 Aldborough Hatch 24 — — — — 1 3 — 1 - 1 - — — — — — — — — — — — — — 1 5 - - Little Heath 115 1 1 1 1 - - - - - - - - - - - - - - - - - - - - 2 2 1 - County High School ? - - - - - - - - 1 - - - - - - - - - - - - - - - 1 - - - Private Schools - — — 2 1 1 — 1 — — — — - — — — — — — — — — — — — 4 1 — — Totals ? 89 18 411 127 281 105 187 50 160 58 39 29 18 9 - - - - - - 2 2 1 — 1188 398 181 47 134 GERMAN MEASLES. As will be seen from the table, 138 cases of German Measles have been reported from the schools during 1911, compared with 5 in 1910. In the ordinary way this disease is not of much importance, as anything but a favourable termination is practically unknown. Usually there is no difficulty connected with the diagnosis, at other times it becomes a very nice question as to whether a particular case is one of German Measles or Scarlet Fever. It is essentially a disease of school life, and is more prevalent in the spring and early summer than any other part of the year. GERMAN MEASLES. Table showing the Number of Cases of German Measles and the Contacts Involved in connection with the Schools, also Total Comparison with 1910. SCHOOLS. Average Attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1911. Totals 1910. 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. Cases. Contacts. Downshall 1318 ... ... ... ... ... ... 2 ... 3 1 6 2 4 ... ... ... ... ... ... ... ... ... ... ... 15 3 ... ... Cleveland Road 1324 1 ... ... ... ... ... 1 ... 14 5 4 4 ... ... ... ... ... ... ... ... ... ... ... ... 20 9 2 ... Christchurch Road 1150 ... ... 1 ... ... 3 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 4 1 ... Loxford 1125 ... ... ... ... 1 ... 10 4 11 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 23 6 ... ... Highlands 877 ... ... 1 ... 4 3 5 3 9 2 6 2 8 2 ... ... ... ... ... ... ... ... ... ... 33 12 1 ... South Park 781 ... ... 1 ... 1 1 ... ... 7 2 9 3 2 1 ... ... ... ... ... ... ... ... ... ... 13 7 ... ... Uphall 923 ... ... ... ... ... ... 1 ... 3 5 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 4 8 1 ... National and Church Infants 424 ... ... ... ... ... ... ... ... 2 3 3 6 ... ... ... ... ... ... ... ... ... ... ... ... 5 9 ... ... Newbury Park 487 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... Goodmayes 634 ... ... ... ... 1 ... 2 ... 7 3 3 ... 3 ... ... ... 1 2 ... ... ... ... ... ... 17 5 ... ... Chadwell 297 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Barkingside 248 ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... Roman Catholic 276 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... Valentines 93 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Aldboro' Hatch 24 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Little Heath 115 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... County High School ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Private Schools ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ? 1 ... 3 ... 7 7 22 7 60 24 27 21 17 3 ... ... 1 2 ... ... ... ... ... ... 138 64 5 ... 136 CHICKEN POX. The number of cases of this disease reported from the schools varies little from year to year, 221 for 1911, 297 for 1910, and 202 for 1909. At the end of 1910 there was an undue prevalence in Christchurch Road. Then it broke out in Goodmayes, which was rather extraordinary, considering it is the other end of the district and there could be found no connection between the two. Later on in the year there was a rather heavy incidence in Uphall. From an attendance point of view this disease is of great importance, as it is very infectious and readily spreads from child to child. The only other practical importance is the resemblance of this disease to Small Pox, and the possibility of a confusion in diagnosis. CHICKEN POX. Table showing the Number of Cases of Chicken Pox and the Contacts Involved in connection with the Schools, also Total Comparison with 1910. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July Aug. Sept. Oct. Nov. Dec. Totals 1911. Totals 1910. Casee. Conte. Cases. Cents, Casee. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Couts. Cases. Conts. Cases. Conts. Cases. Conte. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Downshall 1318 ... ... 1 ... ... 2 3 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 5 2 36 15 Cleveland Road 1324 ... ... 1 1 ... ... ... ... 1 ... 2 ... 2 1 ... ... ... 1 1 2 4 1 4 3 15 9 8 2 Christchurch Road 1150 14 ... 4 ... 1 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 1 1 1 1 21 12 85 17 Loxford 1125 3 ... 2 ... 4 1 1 1 3 2 1 ... ... ... ... ... ... ... 2 2 1 3 ... ... 17 9 114 31 Highlands 877 2 ... 8 ... 2 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 19 1 9 4 South Park 781 1 ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... 1 2 1 ... 5 3 3 1 Uphall 923 ... ... ... ... 5 7 ... ... ... ... ... ... ... ... 1 4 1 2 28 13 42 26 3 4 80 56 8 1 National and Church Infants 424 1 ... 2 2 ... 4 1 2 ... ... ... ... ... 3 ... ... ... ... ... ... 1 3 ... 1 5 15 2 ... Newbury Park 487 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 8 Goodmayes 634 ... ... 20 4 14 8 2 1 6 2 ... ... 1 ... ... ... ... ... 1 ... 1 1 3 1 48 17 6 1 Chadwell 297 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Barkingside 248 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Roman Catholic 276 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 2 The Valentines 93 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Aldborough Hatch 24 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 Little Heath 115 ... ... ... ... ... ... 1 ... 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 ... ... County High School ? ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... ... ... ... 1 ... ... ... 3 2 ... ... Private Schools ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ? 21 6 38 7 26 24 11 4 14 8 5 4 4 5 1 4 1 3 32 17 52 37 16 11 221 130 297 84 138 MUMPS. During 1911 only 80 cases of this disease were reported from the schools, as compared with 407 in 1910. Downshall district was most affected, but there it was distributed over several months, and some of the cases were really glandular enlargements rather than true mumps. There was a curious sudden outcrop of 11 cases at Uphall in October, but beyond that there has been nothing worthy of notice during the year. The cases were all mild, and no serious complications arose. MUMPS. Table showing the Number of Cases of Mumps and Contacts Involved in Connection with the Schools, also Total Comparison with 1910. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1911. Total 1910. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. 1 Cases. Conts. Downshall 1318 4 ... 7 1 13 ... 1 ... 2 ... ... ... ... ... ... ... 1 ... ... ... 4 ... 1 ... 33 1 60 3 Cleveland Road 1324 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 5 ... 27 1 Christchurch Road 1150 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 43 3 Loxford 1125 ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 31 3 Highlands 877 ... ... 2 1 3 ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 2 59 7 South Park 781 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 6 ... Uphall 923 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 11 ... 4 ... ... ... 16 ... 44 5 National and Church Infants 424 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... Newbury Park 487 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... Goodmayes 634 1 ... ... ... 3 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 61 ... Chadwell 297 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 3 1 39 ... Barkingside 248 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 1 Roman Catholic 276 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 2 Valentines 93 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... Aldborough Hatch 24 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... Little Heath 115 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 ... County High School ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Private Schools ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... totals ? 6 ... 12 3 20 ... 3 1 9 ... 2 ... 1 ... ... ... 2 ... 11 ... 11 ... 3 ... 80 4 407 25 140 WHOOPING COUGH. As a rule, when an epidemic of Measles occurs in a district, it is followed or accompanied by one of Whooping Cough. For 1911, however, there were only 137 cases of this disease reported, compared with 273 in 1910. What cases there were chiefly affected the schools which were infected with Measles. At Goodmayes, however, there were 154 cases of Measles, but not a single case of Whooping Cough reported. There were 7 deaths, but they were all in children under 5 years. Here too, however, the infection may be brought home by an older child with a fatal result for the younger. The dependence of the general health and death-rate of the district on the combined work of the Council as education and health authority is well exemplified in these diseases. Thus the wisdom of the central authority in advocating the union of the public health and education medical work in one department can be easily justified by considering the waste of time and opportunity when the machinery is duplicated, to take only this class of disease. Any step taken with regard to a school child cannot stay there if the case is infectious and there are other children in the same house. WHOOPING COUGH. Table showing the Number of Cases of Whooping Cough and Contacts Involved in Connection with the Schools, also Total Comparison with 1910. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1911. Totals 1910. Cases. Conts. Cases Conts. Cases. Conts. Cases. Conts. Cases. Conls Cases. Conls Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Downshall 1318 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 4 ... 13 2 Cleveland Road 1324 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 5 ... 3 ... 14 1 7 2 30 4 19 3 Christchurch Road 1150 ... ... 3 ... 1 ... ... ... 1 1 2 ... 5 3 ... ... ... ... ... ... ... ... 1 ... 13 4 64 10 Loxford 1125 ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... 5 1 ... ... ... ... 1 ... 10 1 12 1 Highlands 877 1 ... 10 ... 9 ... 1 1 5 ... 1 ... 1 ... ... ... 4 ... ... ... ... ... ... ... 32 1 22 1 South Park 781 ... ... ... ... ... ... ... ... 1 ... 1 ... 3 ... 6 2 5 ... ... ... ... ... ... ... 16 2 28 1 Uphall 923 ... ... ... ... 2 1 ... ... 11 4 4 1 4 ... ... ... 2 3 ... ... 3 ... 2 1 28 10 37 10 National and Church Infants 424 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 2 3 22 1 Newbury Park 487 ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 5 Goodmayes 634 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 13 4 Chadwell 297 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Barkingside 248 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Roman Catholic 276 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 9 6 Valentines 93 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 3 Aldborough Hatch 24 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Little Heath 115 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... County High School ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Private Schools ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... Totals ? 1 ... 13 1 12 2 3 1 18 5 9 1 17 3 6 2 21 4 4 ... 18 1 15 6 137 26 273 47 142 RINGWORM. For 1911 the total number of cases reported was 150, while in 1910 the number was 128, and in 1909 it was 114. There has never been such careful supervision and examination of the heads of school children as during the past year, therefore the increase in the total is probably due to that cause. There have been the children examined at the ordinary medical inspection, and then, in addition to that, the Health Visitor has inspected the heads of all the children in the schools every three months, so that it is not easy for any suspicious case to escape notice. Also, too, these measures encourage the teachers to take more notice of any unusual condition. The diagnosis is always confirmed by microscopical examination, and no child is allowed to return to school until this examination shows the absence of Ringworm fungus. This increased attention and stricter supervision of these cases should produce some effect another year in diminishing the total number of cases. TREATMENT. The treatment of Ringworm by the X-ray method, as explained in last year's report, has been continued on the same lines, and the following gives the results for the year 1911. There have been no mishaps or drawbacks to the application. RINGWORM. Table showing the number of Cases of Ringworm in connection with the Schools, also Total Comparison with 1910. Schools. Average Attendance. January. February. March. April. May. June. July. August. September. October. November. December. Totals, 1911. Totals, 1910. Downshall 1,318 1 4 2 - 1 - 1 1 - - 2 - 12 34 Cleveland Road 1,324 2 2 2 3 4 - - - 2 1 2 2 20 7 Christchurch Road 1,150 - 4 1 1 3 - - 1 1 2 2 — 15 18 Loxford 1,125 5 13 1 2 3 - - 1 2 4 4 — 35 15 Highlands 877 1 - - - - - 1 - — 1 - — 3 6 South Park 781 1 3 1 - 3 - - 1 3 1 1 1 15 10 Uphall 923 2 2 - - - - 1 1 - 5 2 1 14 11 National and Church Infants 424 - 3 3 1 2 - - - 2 2 1 1 15 5 Newbury Park 487 - 1 - - 1 - - — 2 1 1 — 6 4 Goodmayes 634 - - 2 1 - 2 1 — — — 3 1 10 11 Chadwell 297 - - - - - 1 - - - - — — 1 — Barkingside 248 - - - - 1 - - - 1 - 1 — 3 2 Roman Catholic 276 - - - - - 1 - - - - — — 1 4 The Valentines 93 - - - - - - - - - - — — — Aldborough Hatch 24 - - - - - - - - - - - — — 1 Little Heath 115 - - - - - - - - - - - - - - Totals 10,096 12 32 12 8 18 4 4 5 13 17 19 6 150 128 143 144 28 children have been submitted to the X-ray treatment during 1911:— H. B. suffered from Ringworm 2 years, cured 6 weeks after X-Rays. M. W. „ „ 15 months, „ 10 weeks „ „ D. L. „ „ 10 months, „ 5½ weeks „ „ L. P. ,, „ 6 weeks, „ 5 months „ „ E. C. ,, „ 4 months, „ 3½ months „ „ N. C. „ ,, 5 months, „ 4½ months „ „ D. P „ „ 5 weeks, „ 7 weeks „ „ M. M. L. „ „ 2 weeks, „ 3 weeks „ „ E. C. „ „ 2 weeks, „ 7 weeks „ „ G. P. „ „ 4 months, „ 1 month „ „ M. P. „ „ 3½ months, „ 1 month „ ,, G. M. „ „ 12 months, „ 5 months „ „ J. D. „ ,, 12 months, „ 1 month „ „ D. I.. „ „ 6 months, „ 5 weeks „ ,, R. H. „ „ 9 months, „ 1 month „ „ L. S. „ „ 14 months, 6 weeks „ „ W. C. „ „ 9 months, „ 5 weeks ,, ,, L. C. „ „ 9 months, „ 5 weeks „ „ I. I. „ „ 6 weeks, „ 3½ months „ „ L. P. „ „ 6 weeks, „ 3½ months „ „ S. S. „ „ 8 months, „ 0 weeks „ „ E. E. „ „ 12 months, „ 8 weeks „ „ R. E. „ „ 9 months, „ 5 weeks „ „ H. W. „ „ 7 months, „ 2 months „ „ N. M. „ „ 3 months, „ 8 weeks „ „ L. S. „ „ 2½ months, „ 8 weeks „ „ B. S. „ ,, 12 months, „ 4 weeks „ „ R. S. „ „ 7 months, „ 4 weeks „ „ DEATHS AMONGST SCHOOL CHILDREN. 42 deaths have occurred amongst children of school age. 2 from Measles. 2 „ Scarlet Fever. 6 „ Diphtheria and Croup. 1 „ Influenza. 1 „ Phthisis. 2 „ Tuberculous Meningitis. 4 „ Other Tuberculous Diseases. 1 „ Bronchitis. 1 „ Appendicitis and Typhilitis. 1 „ Nephritis and Bright's Disease. 4 „ Violent Deaths, excluding Suicide. 5 „ Organic Heart Diseases. 9 „ Other defined Diseases. 3 „ Diseases ill-defined or unknown.