AC 4411(1) ILFORD ILF 1 ILFORD URBAN DISTRICT COUNCIL. PUBLIC HEALTH DEPARTMENT. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1912. 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. ILFORD URBAN DISTRICT COUNCIL. PUBLIC HEALTH DEPARTMENT. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1912. 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, 7959 PUBLIC HEALTH COMMITTEE, 1912—1913. Councillor P. E. Brand, Chairman. Councillor G. Cushing, Vice-Chairman. Councillor G. Church. Councillor G. Gunary. Councillor W. J. T. Cullis. Councillor F. D. Smith. (Vice-Chairman of the Council) Councillor F. H. Dane Councillor W. H. Stevens. (Chairman of the Council). Councillor G. W. M. Gott. Councillor R. Stroud. OFFICERS OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: C. F. Stovin, M.A., D.P.H. Assistant Medical Officer of Health: G. E. Oates, M.D., M.R.C.P., 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. Fishek, 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. A. C. Booth. ISOLATION HOSPITAL. Medical Superintendent: C. F. Stovin, M.A., D.P.H. Assistant Medical Superintendent: G. E. Oates, M.D., M.R.C.P., D.P.H. Matron: Miss C. A. Barling. EDUCATION COMMITTEE. Councillor W. P. Griggs, J.P., C.A., Chairman. Mr. J. Norton, Vice-Chairman. 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. Cushing. *Mr. John Reynolds. †Councillor F. H. Dane. Councillor W. J. O. Sheat. Councillor J. Deveson. Councillor F. D. Smith. *Mr. F. H. Dovey. Councillor W. H. Stevens. *Mr. H. Gilbey, C.C. Councillor H. M. Thornton. *Mr. H. J. Weston. * 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. Assistant School Medical Officer: G. E. Oates, M.D., M.R.C.P., D.P.H. School Nurse: Miss L. Radford, PREFACE. Public Health Department, Ilford, 11th February, 1913. 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 1912. This makes the twelfth I have had the honour to place before you on the health of this district, and the fifth under the Education (Administrative Provisions) Act, 1907. As will be seen, the general death-rate for the year 1912 was low, and the general health of the district as is exemplified in the various sections has been good. The inauguration of the laboratory and the work carried out by Dr. Oates in connection with it has been of great benefit. A full account of his work in the schools will also be found in the School Section, and I think it will be agreed the results point to a good year's work in this direction. With regard to the Isolation Hospital, the question of the extension of laundry accommodation, to which I drew attention last year, has been put in hand and is rapidly nearing completion. At the end of the year, application was received from the County Insurance Committee to allot six beds at the Isolation Hospital for Tuberculosis patients. This is a 6 matter that will require very careful consideration in the future and opens up some very important points with regard to safeguarding the health of the rest of the community. In conclusion, as 1 have stated before, the work of the Public Health Department entails 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. Medical Officer of Health, etc. CONTENTS. pages Preface 5 Physical and Geological Features 13 SECTION 1. Vital Statistics. Statistical Summary 24 Population 25 Births 26 Diagram showing the Birth-Rates for the last 22 years Facing Page 27 Deaths 27 Diagram showing the Death-Rates for the last 22 years Facing Page 29 Zymotic Death Rate 29 Infantile Mortality 31 Diagram showing the Infantile Mortality rates for the last 22 years Facing Page 32 Table IV. of the Local Government Board 33 Notification of Births Act, 1907 34 Number of Births notified 35 Summary of visits paid and particulars obtained under the Notification of Births Act, 1907 35 Mortality in Age Groups 36 Inquests 36 Weekly Rainfall for the Year 37 Table I. of the Local Government Board 38 „ III. ,, ,, ,, ,, 39 8 CONTENTS. SECTION II. pages Infectious Disease. Infectious Disease 43 Small Pox 44 Scarlet Fever 44 ,, ,, Chart Facing Page 44 Diphtheria 45 ,, Chart Facing Page 45 Enteric Fever 46 Diagram showing the number of cases of Enteric Fever during the last 22 years Facing Page 46 Erysipelas 47 Puerperal Fever 47 Poliomyelitis 48 Phthisis 48 „ Chart Facing Page 56 Respiratory Diseases other than Phthisis 49 Cancer and Malignant Diseases 49 Table II. of the Local Government Board 50 Table giving Death-Rate from various Infectious Diseases during the past 15 years 51 Isolation Hospital. Diseases treated in Hospital 52 Average lengths of stay in Hospital 52 Percentage of cases notified removed to Hospital 53 Table of AdmissionsFacing Page 52 Hospital Buildings, accommodation, etc 53 Nursing 54 Summary as to cost of food Facing Page 54 Scarlet Fever 55 Diphtheria 55 Enteric Fever 56 Erysipelas 56 Phthisis 56 9 CONTENTS. Section II.—continued. pages Disinfection 57 Bacteriological Laboratory: Diphtheria 58 Sputa 61 Typhoid Fever 62 Ringworm 62 Table of Houses and Articles Disinfected 65 Table as to Age and Sex of Scarlet Fever patients admitted 66 Table as to Age and Sex of Diphtheria patients admitted 66 SECTION 111. Sanitary Administration. Food and Drugs Acts 69 Water Supply 69 Milk Supply 70 Bakehouses 71 Meat Supply 72 Fish Shops 73 Greengrocers' Shops 73 Offensive Trades 73 Factories 73 Workshops and Workplaces 74 Tables of Factories, Workshops, etc 74 Table.—i. 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 Sewerage and Sewage Disposal 84 10 CONTENTS. Section III.—continued. pages Removal of House Refuse 85 Public Latrines 86 Pollution of River 87 Town Ambulance 88 Legal Proceedings 89 Inspector of Nuisances 91 Drainage 92 Complaints 151 Summary of Journal 94 Notices served 95 SECTION IV. Schools. List of Schools 99 Cleanliness and disinfection of Schools 99 Medical Inspection:— The Health Visitor 100 Summary of Work done by the Health Visitor Facing Page 100 General Statement of extent and scope of Medical Inspection 115 Condition of School Children as revealed by Medical Inspection 116 Clothing 116 Footgear 118 Verminous Condition 118 Mental Condition 119 Defects of Speech 120 Condition of the Ears 120 Diseases and Defects of the Eye 121 Prescriptions for Spectacles 123 Nutrition 125 11 CONTENTS. Section IV.—continued. pages Dental Condition of Children 126 Throat and Nose Conditions 128 Glands 129 Diseases of the Chest 129 Pulmonary Tuberculosis 129 Summary of defects detected upon Medical Inspection Facing Page 100 Summaries of Heights and Weights of children examined:— Boys 102 Girls 108 Children examined at the Public Health Offices 114 Summary of children presented for Special Examination Facing Page 114 Table showing results of Medical Inspection Following Page 100 Table showing results of Medical Inspection carried out previous to 1912 Following Page 114 Infectious Disease 130 Summary of Infectious Disease 131 Scarlet Fever 132 ,, ,, Table 133 Diphtheria 134 Table 135 Measles 136 Table 137 German Measles 138 Table 139 Chicken Pox 140 ,, ,, Table 141 Mumps 144 „ Table 145 12 CONTENTS. Section IV.—continued. pages Whooping Cough 142 ,, ,, Table 143 Ringworm 146 ,, Table 147 X Ray treatment of Ringworm 148 Deaths amongst School Children 148 Sanitary Inspector's Report 150 13 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. 17 To the Chairman and Members of the ILFORD URBAN DISTRICT COUNCIL. Gentlemen, Before proceeding to review the Public Health work of the town during the past year, I would first place before the Council the position a Medical Officer of Health has to fill in carrying out his duties as their appointed officer, with the controlling influence, direction and approval of the Local Government Board. The requirements for a town of the size of Ilford are that the Medical Officer must possess in addition to the ordinary qualifications, a diploma in Public Health or Sanitary Science. Which means that he must be prepared to have a thorough knowledge of the law, as well as the practice of public health, including the controlling knowledge of all administration work in connection therewith. So that, as laid down by the Local Government Board, at all times" he shall be prepared to advise the Council on all matters affecting the health of the district, and on all sanitary points involved in the action of the Council." To be able to do this it is obvious he must have authority and the control of all the staff involved in the administration of a Public Health Department. Also, it must be borne in mind that in that Department are centred all the statistics and information more immediately relating to the health of the district, so that in advising as to future action it is essential to have a knowledge of the past, and this knowledge can only be collected and correlated by one individual, and that the Medical Officer of Health. It must also be remembered, too, that he is the only officer with a thorough scientific training and education, 18 which should make him able to weigh and balance evidence involved in any course of action with a due regard to the benefit of the community. In this connection, too, I would like to point out that he is the only chief official enjoying security of tenure, so that in this district he is enabled to act with more impartiality than would be possible under other circumstances. I regret it is my unpleasant but obligatory duty to refer to the friction that has taken place, and in doing so it will be necessary for me to relate plain facts. I do so, however, with the more confidence as it is a matter, which although affecting me personally, in a far greater measure involves the whole policy of the Public Health Administration of this town. In 1909 I was unanimously appointed whole-time Medical Officer, after having been eleven years in the service of the Council as a part-time official. Since the middle of 1910 there has been a series of troubles, due, in my opinion, to efforts made to limit or abolish my sphere of action. The obvious duty of a whole-time official is to devote more attention to the detailed administration of his department than he is able to do as a part-time officer. In going into things it appeared to me that drainage matters were not being conducted on sound lines, and therefore I graduallv gave these more attention as necessity arose. What was the result? An effort was made to compel me to carry out personally the duties of Medical Inspection of School Children. It was quite clearly laid down in my agreement with the Council and the Local Government Board that I was not myself to be expected to carry out this work; an agreement specially held back for the Solicitor-Clerk to revise and approve. In spite of this, however, I was compelled to prove to the Council the 19 impossibility of myself carrying out this duty. Obviously while engaged in this detailed work I was unable to devote that time to other matters which should have received attention. Moreover, if the effort had been successful, my time and attention would have been more than fully occupied in one direction only. With this question of Medical Inspection was the question of the relationship of the Inspector of Nuisances to the Medical Officer of Health. If the Minutes and the local Press be examined during the past three years, It will be found that a continued effort was made to support the authority of the Inspector against the Medical Officer of Health, both in regard to the control of the subordinate officers and especially with regard to all drainage matters. That the contention was impossible will, I think, be evident from the Minutes, for it will be seen that I was obliged to take more and more control into my own hands, and the present position is costly and indefensible. That even purely personal matters were not omitted, 1 will only mention the matter of the conversion of my houses in the Cranbrook Road into shops, culminating in the Council's resolution to the following effect:— "That Dr. C. F. Stovin, having forfeited the confidence of the Council, he be asked whether he is prepared to tender his resignation forthwith; failing which, a deputation apprise the Local Government Board of the full facts of the matter, with a view to determining his appointment as Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation Hospital." Such a resolution arising out of such a matter would be impossible, I am prepared to prove, without at least the concurrence of officials. 20 Later on, recognising the difficulties of the position, after a frank discussion with the Chairman, I wrote a letter to the Council suggesting a way out of the difficulty and for promoting good working in the future by appointing an Investigation Committee to go into the question of the organisation of the Public Health Department. Thinking of course that the Council recognised the mistake of the resolution above cited. After an endeavour to obtain an apology from me, this course was adopted and the Investigation Committee was appointed. The subsequent proceedings throw a flood of light on the previous action. On the 26th November, 1912, I presented a report on the drainage at Nos. 122 to 132, Elgin Road, drawing attention to the fact that these drains had been opened up, found defective, and notices served on the owners to relay. That on obtaining instruction to serve these notices I asked for and obtained the promise of the special support of the Public Health Committee, through the Chairman, in having these notices enforced as a Councillor had stated he was the builder and the owners had been to him. That on the 21st November I received a message from the Clerk that the Chairman, Vice-Chairman, and Chairman of the Public Health Committee, wished to interview me that evening. I attended, and these gentlemen then informed me that arising out of a report by the Surveyor to the Works Committee, they had visited these drains together with the Surveyor and the builder, and then proceeded to question my "judgment or efficiency" in serving these notices. On my request they again visited with me the next morning, and apparently altered their opinion as I received no insructions from them. I also pointed out the improper position, viz.: for another official to 21 report to a Works Committee on a matter which had already been before a Public Health Committee and on which definite action had been recommended and. approved by the Council. The Council made no comment on this report, but discussed a letter received from the builder on this matter. These drains were eventually relaid as required. Later, I presented another special report to the Council on the "Administration, Supervision and Enforcement of Drainage Bye-laws," in which I pointed out that the general question of the drainage matters had given rise to considerable friction with regard to myself. Pointing out how it had reached a climax with regard to Elgin Road drainage, where every endeavour was made to support the Surveyor and the builder, although they were the real authors of the whole trouble in that the drains had not originally been laid in accordance with the bye-laws. That various statements, both within and without the Council, with regard to this matters required correction. That in a district like this, with a large number of individual owners, the enforcement or non-enforcement of the bye-laws becomes a matter of great importance. That it is at the present the duty of the Surveyor to supervise the drainage of new buildings, and that afterwards all re-drainage works come under the Public Health Department. That of 277 houses during the last three years where a drainage nuisance was believed to exist and a notice had been served to open up the drains for inspection, 277, or 100 per cent. had been found in a defective condition and required re-drainage. That all these drainage defects had been found on complaint or arising out of visits for infectious disease. No systematic testing of drains where infectious disease occurs having been carried out as is done in some districts. That in the past 22 the Public Health Department has insisted on the bye-laws being observed, especially with regard to placing concrete under drains, while it is acknowledged that this has not been done by the Surveyor's Department. That also, it was contended that this all happened years ago and that recent conditions were different. What alterations had there been in recent years to vary the conditions existing when the drains were laid That there is a bye-law with regard to trapping of waste pipes, there appears to be considerable variation with regard to its enforcement. Also, too, I drew attention to the incorrect condition of the deposited plans and other matters. To remedy this condition of things I recommended that the supervision of the drainage of new buildings be transferred to the Public Health Department, so that the control of all this work should be under the supervision of the one Department of the Council which had proved its capacity for dealing with it. In conclusion, I asked the Council to refer this report to the Investigation Committee for consideration. The Council considered this report in Committee at that meeting and decided to take "no action." In view of this decision, I wrote a letter to the Clerk of the Council, asking him to ask the Investigation Committee to excuse my attendance as I could see no useful purpose by my presence. It seemed to me, as my idea in asking for that Committee was to promote future good working, that unless this drainage matter was settled it was hopeless to expect my being able to carry out my duties properly. So that during the past year the friction has reached a climax necessitating correspondence with the Local Government Board, and placing with them the position as regards the Public Health Administration in this district. 23 Reviewing the past, 1 am forced to the conclusion that efforts have been made to cover up the past neglect of proper enforcement of drainage bye-laws, by endeavouring to directly place the Inspector of Nuisances in control, consequently to remove my efforts from that sphere, to control the extent of repairs to drainage, and to generally limit the whole sphere of administration which is incumbent on me as advising and controlling officer to deal with in a personal manner. It is of course a matter for regret that there should have been laxity in enforcing the bye-laws, but is it, even if the reputation of the responsible officials be implicated, good administration to continue to endeavour to restrain the Medical Officer of Health in his endeavours to execute his duty, in the discovery of nuisances and their abatement? Considering the importance of the protection of the health of the district, I deliberately affirm it would be better policy to endeavour to continuously adopt more reassuring public administration by supporting the Medical Officer of Health in his efforts to deal with conditions which have unfortunately ari sen through past laxity and so give assurance for the future. To secure this there seems only one possible solution, and that is an enquiry by some expert Authority, who is well acquainted with the essentials for good government and the administrative measures required to secure that end. For that purpose I would respectfully ask the Council to again approach the Local Government Board, with a request for an enquiry by one of their Inspectors. If, after enquiry, it is found that an easy solution of existing difficulties can be discovered, the Council will be in a stronger position, or, on the other hand, if there is a serious condition of things existing which requires amendment, the Council will have the benefit of expert advice to assist them in putting their house in order. 24 STATISTICAL SUMMARY. Enumerated Population at Census, 1911 78,188 Estimated ,, ,, the middle of 1912 80,615 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 9.5 Total number of births registered for 1912 1,492 Representing a birth-rate of 19.4 per 1,000 Total number of births registered for 1911 1,589 Representing a birth-rate of 21.4 per 1,000 Total number of deaths registered for 1912 641 Representing a death-rate of 8.3 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 from the seven principal Zymotic diseases in 1912 36 Representing a Zymotic death-rate of .46 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 under one year of age 94 Giving an Infantile Mortality rate to every 1,000 births registered of 63 Rateable Value—Houses £417,563 10 0 „ ,, Land 7,310 10 0 £424,874 0 0 Education Rate— Elementary 1s. 6½ d. Higher 1d. Education Estimated Expenditure, 1912-13— Elementary £33,000 0 0 Higher 1,680 0 0 25 POPULATION. The Registrar-General's estimate of the total population of the district for 1912 is 83,080, and deducting the populations of the institutions, leaves a nett population of 79,330 for the district proper (including the 1,405 inhabitants of the Village Homes, who have now to be counted as belonging to the district). These institutions are:— Village Homes 1,405 West Ham Asylum 1,041 Claybury Asylum 2,709 5,155 There were:— At the Census, 1901— Number of inhabited houses 7,649 Number of uninhabited houses 721 8,370 At the Census, 1911— Number of inhabited houses 16,856 Number of uninhabited houses 903 17,759 so that the number of houses has rather more than doubled in the 10 years. For the district proper in 1901 there was an average of 4.9 persons per house, and in 1911 this average has been reduced to 4.3 per house, which accounts for my estimate being somewhat above the actual figures. Since the Census was taken in 1911 certificates of completion have been given for 390 houses, which brings the total number of houses in the district 17,759 + 390 to 18,149. 26 At the Census there were 903 uninhabited houses, but since then there is evidence that this number has been reduced, so allowing 600 uninhabited houses for the middle of the year 1912 and deducting those from the total number of houses, 18,149—600=17,549; this number multiplied by 4.3, as the average number of persons per inhabited house, with the 1,405 inhabitants of the Village Homes added, gives a total population of 76,865 for the district proper, as compared with the Registrar-General's estimate of 79,330. There is no doubt that the ratio of increase in the population of Ilford is diminishing. For the decennium 1891 to 1901 the population quadrupled, whereas for the ten-year period 1901 to 1911 it merely doubled. Just as the Registrar-General's estimate for 1910 was too high, so I think his estimate for 1912 is also too high, and therefore I propose to take 76,865 as my estimate of the population of the district proper for the calculation of all my rates, and by adding 3,750, the population of Claybury and West Ham Asylums, situated in this district, I arrive at 80,615 as the total population of Ilford for 1912. The manner of calculating has answered fairly well in the past, and seems to be as good a method as it is possible to use for a district of this character. The decline in the average number of persons per house is curious, and interesting, though contrary to what one expected. As the Census returns come to hand it may be necessary to modify slightly some of these figures, but they are accurate enough for practical purposes at present. BIRTHS. The total number of births registered during 1912 was 1,492 (767 males and 725 females), giving a birth-rate of 19.4, or a corrected rate of 17.7 per 1,000 of the population. Of the above, 17 males and 16 females were illegitimate. On reference to Table 1. at the end of this section it will be seen that the total number of births is steadily decreasing. Diagram showing Birth-Rates for the last 22 Years. 27 Last year (1911) was the lowest then recorded, with a total of 1,589 births, but in spite of the increase in the population, the total number of births, and consequently the birth-rate, as shown by the diagram on the opposite page, is steadily diminishing, 1912 having the lowest birth-rate yet recorded. It will be seen by the Infantile Mortality table that the deathrate among infants is also steadily diminishing, and by the adoption of the Notification of Births Act, with the consequent measures, the Council has done a great deal to assist this decline of deaths and to preserve the lives of those children born, so that something is being accomplished to modify the effect of this diminishing birth-rate. As I have remarked before, this decline is common to all European countries, thus showing that an advancing civilisation and a high birthrate do not go together. There seems to be little doubt that a greater proportion of the mothers living in urban areas are unable to nurse their offspring themselves, so that one wonders is there a corresponding decline in the fertility of the urban mother, or is this steady decline in the birth-rate due to other causes? In relation to this question it will be interesting to see the Census return as to the ages of the population, if these figures become available. DEATHS. The total number of deaths registered during 1912 was 954. The total number of deaths registered for the district apart from institutions, was 641. These include deaths in:— The Romford Infirmary 41 The London Hospital 23 The Essex County Asylum, Brentwood 21 The Children's Hospital, Great Ormond St. 3 28 The Seaman's Hospital 3 Guy's Hospital 3 St. Bartholomew's Hospital 2 St. Luke's Hospital 2 The Middlesex Hospital 2 University College Hospital 2 West Ham Hospital 2 Hospital of God, North Side 1 Bethnal House Asylum 1 Union Workhouse, Leytonstone 1 King's College Hospital 1 Brompton Sanatorium, Frimley 1 St. Joseph's Hospice, Hackney 1 The Heart Hospital, Soho 1 The Homoeopathic Hospital, Great Ormond Street 1 The Cottage Hospital, Shenfield 1 The Royal Hospital for Incurables, Wandsworth 1 The Middlesex County Asylum, Napsbury 1 The River Lea at Hackney 1 The River Thames near Battersea Bridge 1 The River Roding at Buckhurst Hill 1 New Bridge Street, City of London 1 Tylney Road, West Ham 1 The Cooper's Arms, Chadwell 1 No. 4, Magdalen Road, Hastings 1 Pembury Road, Southend 1 571, Romford Road, Manor Park 1 6, Park Street, Southend 1 Helen Bank, Wormit, Newport, Fifeshire 1 Total 126 The number of non-residents dying in the district may be seen from the following:— Diagram showing Death-Rates for the last 22 Years. 29 Claybury Asylum 213 West Ham Asylum 91 Ilford Emergency Hospital 6 West Ham, Barking and Bow Residents dying in the district 3 Total 313 For the district proper, apart from the institutions within the district (except Dr. Barnardo's Homes, the deaths in which institution must now be counted as belonging to Ilford) receiving non-residents, the death-rate for the past year was S.3, or corrected for sex and age the rate is 8.9 per 1,000 of the population. The past year gives a satisfactory drop in the death-rate for 1911. The total number of deaths for the district proper was 695, as compared with 641 for 1912, so that this is a considerable decrease. The diagram on the opposite page gives at a glance the position of this rate as compared with previous years. The number of deaths from summer diarrhoea for 1912 was 10, as compared with 64 for 1911, so that is one of the most important factors in the diminished death-rate. On referring to Table III. at the end of this section it will be seen that of the defined diseases Heart Disease is recorded as the cause of the largest number of deaths, 82. Cancer comes next with 75, and Phthisis with 43. Bronchitis and Pneumonia were responsible for 34 and 36 respectively. Zymotic Death-rate. The total number of deaths registered from the seven principal zymotic diseases for the year 1912 was 36, giving a zymotic death-rate of .46 per thousand. 30 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 1905 60 1.0 1906 97 1.4 1907 55 .8 1908 57 .8 1909 47 .6 1910 33 .4 1911 103 1.3 The seven diseases included in this rate are:- Diseases. Deaths, 1912. Small Pox — Measles 4 Scarlet Fever 1 Whooping Cough 16 Diphtheria and Membranous Croup 5 Enteric Fever — Diarrhoea 10 Total 36 This rate is a very sensitive test of the health of the district. As will be seen above, for 1912, this rate has been very low. There was a small incidence of summer diarrhoea which sent the figure up for 1911. Ten deaths for the year 1912, as compared with 64 for 1911, is a plain indicator of the different conditions existing in the two years. Measles, too, was not prevalent until the end of the year, and the weather conditions being comparatively favourable, the deaths were few. Not a single death from Enteric Fever is also a noticeable feature. 31 Infant Mortality. The infant mortality rate for the year 1912 is 63 per 1 ,000 births registered. 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 This is the lowest infantile mortality rate yet recorded, and is the nearest approach to my 50 per 1,000 suggested possibility a few years back. It seemed a hopeless suggestion then, but it is getting nearer year by year, and I still have anticipations of seeing that figure reached, 32 The past year has been a favourable one from a climatic point of view, and the deaths from summer diarrhoea being few, there was no abnormal cause, so to speak, to disturb the working of the efforts made to keep this rate low. As usual, Miss Radford has been untiring in her efforts to guard the lives of these children under one year of age, and that her endeavours have been successful, this low rate bears eloquent testimony. From Table IV. it will be seen that Premature Births are responsible for 26 deaths, and looking at the number from other causes, it will be evident that further reduction in the infant mortality will necessitate dealing in some way with this cause. How this is to be done is at present very difficult to say, as it will necessitate dealing with the mother before the birth of the child, and that presents insuperable difficulties under existing conditions. Whooping Cough was responsible for 12 deaths, which should be avoidable with more care on the part of the parents in preventing the spread of infection to these babies; but in small houses with numerous children it is difficult of realisation. Diagram showing the Infantile Mortality Rates for the last 22 Years. 33 TABLE IV. INFANTILE MORTALITY. 1912. 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 4 weeks. 4 weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — 1 — 1 — — 1 — 2 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — 1 2 5 4 12 Diphtheria and Croup — — — — — — — — — —- Erysipelas — — 1 — 1 — — — — 1 Tuberculous Meningitis — — — — — 2 1 — — 3 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — 2 — — — 2 Meningitis (not Tuberculous) — — — — — 1 1 — — 2 Convulsions — 1 — — 1 — 1 1 1 4 Laryngitis — — — — — — — — — Bronchitis — — — — — 1 — 2 1 4 Pneumonia (all forms) — — — — — 1 3 1 1 6 Diarrhœa — — — — — 1 — 1 — 2 Enteritis — — — — — 5 — — — 5 Gastritis — 1 — — 1 — — — — 1 Syphilis 1 — — — 1 — — — — 1 Rickets — — — — — — — — — — Suffocation, overlying 1 — — — 1 — — — — 1 Injury at Birth — — — — — — — — — — Atelectasis 1 — — — 1 — — — — 1 Congenital Malformations 4 1 — — 3 1 — — — 6 Premature Birth 20 1 5 — 20 — — — — 26 Atrophy, Debility, and Marasmus 1 — 1 1 3 4 3 — — 10 Other Causes 4 — — — 4 — 1 — — 5 Total 32 4 8 1 45 19 12 11 7 94 Nett Births in the year:—Legitimate, 1459; Illegitimate, 33. 34 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 97.85 per cent. of the births were notified under this Act, and only 2.14 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 red on dried milk. Coupons have been distributed enabling the parents to obtain the food at a reduced cost, or it has been supplied 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. 35 The total number of births notified under the Act was 1,509, separated into wards as under:— Cranbrook Ward 138 Park Ward 211 Seven Kings Ward 202 North Hainault Ward 116 Loxford Ward 281 Clementswood Ward 363 South Hainault Ward 198 Total 1,509 The following gives a percentage of the notifications by !he various responsible persons:— By Medical Men 46.6 By Midwives 20.9 By Parents and others 30.9 By Parents, on Registrar's suggestion 1.5 23 births were registered during the year which were not notified under the Act. Summary of Visits Paid, and Particulars Obtained under the Notification of Births Act, 1907, by the Health Visitor. Visits paid:— First Visits 1,410 Continuing Visits 3,466 Persons in attendance on Mother:— Medical Practitioners 1,098 Midwives 304 Other Persons 3 36 Feeding:— Natural 1,192 Artificial 150 Mixed 5 Premature Births 85 Stillborn ,, 44 Illegitimate ,, 8 Deaths (up to two weeks of age) 23 ,, (from two weeks to twelve months) 37 Condition of homes:— Good 443 Fair 705 Poor 241 Mothers who go out to work 26 ,, ,, take work in 8 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 65-75 94 92 157 116 75-85 85-95 over 95 83 20 1 INQUESTS. 34 inquests have been held during the year, 32 on residents in the district and 2 on residents in institutions in the district, 37 WEEKLY RAINFALL FOR THE YEAR 1912. Week ended Rainfall in inches. Week ended Rainfall in inches. Jan. 6th .99 July 6th .55 „ 13th .31 „ 13th .05 ,, 20th .78 „ 20th .06 „ 27th .86 „ 27th .47 Feb. 3rd Nil Aug. 3rd 1.05 ,, 10th .26 ,, 10th .58 „ 17th .30 „ 17th .18 „ 24th .62 „ 24th 1.08 Mar. 2nd .40 „ 31st 1.5 „ 9th .67 Sept. 7th Nil „ 16th .20 „ 14th .04 „ 23rd .82 ,, 21st Nil „ 30th Nil ,, 28th .06 Apr. 6th .16 Oct. 5th 1.86 „ 13th .06 „ 12th Nil „ 20th Nil „ 19th .24 „ 27th Nil „ 26th .73 May 4th .24 Nov. 2nd .48 „ 11th .04 „ 9th .20 ,, 18th .52 ,, 16th .22 „ 25th .02 „ 23rd .26 June 1st .14 „ 30th .78 8th 1.15 Dec. 7th .35 „ 15th .82 „ 14th .46 „ 22nd .09 „ 21st .46 ,, 29th .44 ,, 28th 1.19 „ 31st Nil Total rainfall for the year, 22.24 inches. 38 TABLE I. Vital Statistics of Whole District during 1912 and Previous Years. Year. Total Population estimated to middle of each year. Nett Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected 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 1907 71,278 66,098 1,711 ? 25.4 839 11.6 324 104 134 78.3 019 9.2 1908 76,295 71,221 1,053 ? 232 830 10.9 299 95 132 79.8 632 8.9 1909 79,392 74,364 1,647 ? 221 886 11.1 334 105 112 68.0 657 8.8 1910 85,522 75,327 1,679 ? 22.2 772 9.6 273 102 124 73.8 601 7.9 1911 79,122 74,046 1,589 ? 21.4 870 12.7 316 141 133 83 695 9.4 1912 80,615 76,865 1,492 1,492 194 828 10.3 313 126 94 63 641 8.3 39 TABLE III. Causes of, and Ages at Death during the Year 1912. 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 and under 2 years. 2 and under 5 years. 5 and under 15 j 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 — — — — — — — — — — Small-pox — — — — — — — — — — Measles 4 2 — 1 1 — — — — — Scarlet Fever 1 — — 1 — — — — — 1 Whooping Cough 16 12 4 — — — — — — — Diphtheria and Croup 5 — — 1 4 — — — — 4 Influenza 7 — 1 — — — 2 2 2 1 Erysipelas 3 1 — — — — 1 — 1 — Phthisis (Pulmonary Tuberculosis) 43 1 — 2 1 4 22 11 2 35 Tuberculous Meningitis 12 2 2 3 4 1 — — — 3 Other Tuberculous Diseases 13 2 — 1 2 2 4 2 — 3 Cancer, Malignant Disease 75 — 1 — — — 9 38 27 11 Rheumatic Fever 1 — — — — — 1 — — — Meningitis — — — — — — — — — — Organic Heart Diseases 82 2 — 1 2 3 12 24 38 26 Bronchitis 34 4 — — — — — 6 24 13 Pneumonia (all forms) 36 6 3 5 1 3 7 6 5 50 Other Diseases of Respiratory Organs 9 — — — 1 — 1 3 4 5 Diarrhoea and Enteritis 10 6 — — 1 — 1 1 1 4 Appendicitis and Typhlitis — — — — — — — — — — Cirrhosis of Liver 3 — — — — — 2 1 — 3 Alcoholism — — — — — — — — — — Nephritis and Blight's Disease 22 — — — — — 4 8 10 9 Puerperal Fever 3 — — — — — 3 — — — Other accidents and diseases of Pregnancy and Parturition 2 — — — — — 2 — — — Congenital Debility and Malformation, including Premature Birth 39 39 — — — — — — — — Violent Deaths, excluding Suicide 10 1 — 1 — 1 4 6 3 3 Suicide 6 — — — — 1 1 3 1 — Other Defined Diseases 108 5 — 3 3 8 12 38 39 106 Diseases ill-defined or unknown 91 11 1 2 1 1 4 8 63 66 641 94 12 21 21 24 92 157 220 343 SECTION II. Infectious Disease. 43 INFECTIOUS DISEASE. During 1912 notifications were received of 666 cases. „ 1911 „ „ „ 578 „ „ 1910 „ „ „ 365 „ „ 1909 „ „ „ 525 „ „ 1908 „ „ „ 679 ,, ,, 1907 „ „ „ 651 „ „ 1906 „ „ „ 548 „ „ 1905 „ „ „ 446 ,, „ 1904 „ „ „ 508 „ „ 1903 „ „ „ 364 „ „ 1902 „ „ „ 738 „ From institutions in the district the following cases have been notified during 1912:- L.C.C. Asylum, Claybury. West Ham Borough Asylum. Erysipelas 2 Erysipelas 1 Phthisis 5 Dr. Barnardo's Village Homes. Scarlet Fever 1 Diphtheria 5 Erysipelas 6 Phthisis 31 As will be seen, the total number of cases of Infectious Disease notified is the largest since 1908, but it must not be forgotten that during 1912 the compulsory notification of Phthisis was more completely carried out than in any previous year, so that the cases of this disease numbered 173 as against 78 in 1911; therefore it is evident what an effect this has had in swelling the total. 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, 44 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. No case of this disease has been notified in the district for 1912. The addresses in this district of several men who had been in contact with a case of Small Pox on board ship were received at various times. These were all followed up, occasionally the address was not correct, and observation exercised until the incubation period was safely ended, but no further development took place in any of these instances. SCARLET FEVER. Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1912 286 1 .01 .34 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 SCARLET FEVER. DIPHTHERIA. 45 As will be seen from the figures above there was a very close approximation of the number of cases notified in 1912 to that of 1911. The death rate, however, was much more satisfactory in 1912; 286 cases with one death, or a percentage of .34 is not a bad record. From that it will be evident that the prevailing type has been mild in character to a very large extent. Children of school age were chiefly attacked, and therefore this disease will be dealt with in the School report later on. DIPHTHERIA. Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1912 139 5 .05 3.59 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 1905 85 4 .06 4.7 1904 181 10 .18 5.5 1903 95 14 .28 14.7 1902 86 8 .17 9.3 As with Scarlet Fever, it will be noted how steady the number of cases notified for 1911 and 1912 has remained; 135 for the former and 139 for the latter. The death rate, however, for 1912 has been little more than half what it was for 1911. The chart shews very clearly how it has been maintained during the various months of the year and how there has been no excessive incidence at any one period. There has been nothing in the nature of an epidemic. The bacteriological examination of the material from the throats and 46 noses of contacts is an easy and effective way of controlling these and has been found of extreme service in numerous instances. It does not follow, of course, because the specific organism is found in the throat, that therefore that particular contact is infectious, but if there has been association with an active case it seems the only useful way to consider it so and take suitable precautions, especially in the case of children. The Council still continue to supply Anti-toxin free, for the use of medical practitioners, and a syringe is also available if necessary. The question of bacteriologically testing the condition of the nose and throat of patients recovering from the disease, before declaring them free to mix with others, seems to me to merit more consideration from the medical practitioner. ENTERIC FEVER. Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1912 4 Nil Nil Nil 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 As will be seen graphically represented opposite, the notification of four cases for the year is the lowest for the last twenty years. One of these four was a very doubtful case, the sister of the patient had previously been suffering from diarrhoea, and the other three all occurred in one family. The first case had suffered from Malaria Fever whilst in Africa. ENTERIC FEVER. - . . •• ' « 47 ERYSIPELAS. Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1912 57 3 .03 3.51 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 There has been nothing specially noticeable about this disease. A fair number of the cases have been trivial in character, and on visiting, sometimes the patient opens the door with a mild air of surprise as to the necessity of a visit' at all. Then when disinfection comes on later, it is considered the last straw to the astonished householder. PUERPERAL FEVER. Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1912 6 3 .03 16.66 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 48 This is the largest number of cases notified for years. The definition of these cases is difficult, but if there is any doubt, it seems to me better to notify as it enables some supervision to be exercised over the midwife or nurse. POLIOMYELITIS. One case was notified during the year, but on investigation was found to be a case of Bell's paralysis. The notification came from a London Hospital. PHTHISIS. In all, 173 cases of Pulmonary Tuberculosis have been notified during 1912. Seventy-eight cases were notified during 1911. Six of the cases notified during 1912 belonged to Claybury Asylum. Thirty-one of the cases notified during 1912 belonged to Village Homes. Seventy-three notifications were received from various sources of cases of Phthisis previously notified. Of the cases notified as actually belonging to the district during-1912, 25 have terminated fatally, so far as information supplied to me shows. Of the cases notified previous to 1912, eleven have died during 1912. Thirty-seven houses have been disinfected after Phthisis. Towards the end of the year the National Insurance Act came into force and a Tuberculosis officer was appointed by the County. Accommodation was temporarily provided at the Public Health Department and attendance was given on Monday afternoons. So much of the work is only provisional in character at present that it is not possible to 49 say much yet awhile, but before another year is over it is hoped that permanent arrangements of a suitable character may be made for dealing with these cases, and so remove a serious blot from the Public Health administration of the County. RESPIRATORY DISEASES OTHER THAN PHTHISIS. Per 1,000 In 1912 there were 75 deaths, giving a death-rate of .9 ,, 1911 ,, 81 ,, ,, ,, 1.1 ,, 1910 ,, 88 ,, ,, ,, 1.1 ,, 19O9 ,, 107 „ „ „ 1.4 „ 1908 „ 93 ,, ,, ,, 1.3 „ 1907 ,, 105 „ „ „ 1.5 „ 1906 „ 88 „ „ „ 1.3 „ 1905 ,, 88 „ ,, ,, 1.4 CANCER AND MALIGNANT DISEASE. Per 1,000 In 1912 there were 75 deaths, giving a death-rate of .9 „ 1911 „ 58 ,, „ ,, .7 ,, 1910 „ 62 ,, „ ,, .8 „ 1909 „ 57 „ 51 ,, „ ,, .7 ,, 1908 ,, 55 ,, „ ,, .7 ,, 1907 „ 42 ,, „ ,, .6 ,, 1906 ,, 54 ,, „ ,, .8 „ 1905 3 ,, „ ,, .5 The total number of deaths as seen above is the largest yet recorded, and there is every appearance of this total growing steadily year by year. Several of the deaths occurred in one locality, and it looked as though there might be some one common cause. It was a new part of the district, and on visiting I found it was merely a coincidence, the larger number suffering from the disease before they entered the district. 50 TABLE II. Cases of Infectious Disease Notified during the Year 1912. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C) Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 139 2 30 87 9 11 ... ... 5 25 20 13 11 44 22 98 Erysipelas 57 1 3 8 8 16 15 6 6 2 11 17 10 7 4 4 Scarlet Fever ... 1 39 225 14 7 ... ... 48 33 35 15 60 36 58 217 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 4 ... ... 2 1 1 ... ... ... ... ... ... 4 ... ... 1 Relapsing Fever (R) Continued Fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 6 ... ... ... 2 4 ... ... ... 2 3 ... ... ... 1 ... Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Pulmonary Tuberculosis 173 1 ... 33 44 70 19 6 16 23 16 44 26 34 14 ... Totals 666 5 73 355 78 109 34 12 75 85 85 89 111 122 99 320 51 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 1898 ...... ...... ...... 36 ...... ...... 66 2 .07 74 ...... ...... 33 3 .11 ...... ...... ...... 425 5 .18 26,468 1899 ...... ...... ...... 60 3 .09 74 11 .36 128 1 .03 26 6 19 1 ...... ...... 467 12 .39 30,154 1900 12 ...... ...... 59 1 .02 71 4 .11 190 ...... ...... 23 4 .11 1 1 .02 326 2 .05 34,394 1901 6 ...... ...... 37 1 .02 76 6 .15 285 ...... ...... 33 4 .10 ...... ...... ...... 805 5 .12 39,022 1902 44 8 .17 67 4 .08 86 8 .17 264 2 .04 61 7 15 3 2 04 564 3 .06 44,530 1903 9 1 .02 49 ...... ...... 95 14 .28 181 2 .04 28 2 .04 2 1 .02 684 10 .20 49,646 1904 11 ...... ...... 56 1 .01 181 10 .18 224 5 .09 32 4 .07 4 4 .07 1138 17 .30 54,120 1905 ...... ...... ...... 48 3 .04 85 4 .06 288 4 .06 22 4 .06 3 3 .04 ...... 3 .04 60,441 1906 ...... ...... ...... 52 1 .01 132 11 .16 326 3 .04 35 1 .01 3 2 .03 ...... 5 .07 65,165 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 1912 ............ ............ ............ 57 3 .03 139 5 .05 286 1 .01 4 ............ ............ 6 3 .03 ............ 4 .04 76,865 52 ISOLATION HOSPITAL. Number of patients in Hospital at beginning of year:— Scarlet Fever 63 Diphtheria 23 Number of patients admitted during the year:— Scarlet Fever 217 Diphtheria 98 Enteric Fever 1 Erysipelas 4 Number of patients remaining in Hospital on 1st January, 1913:— Scarlet Fever 36 Diphtheria 11 Number of deaths, and death rates per cent. of cases admitted to the Hospital during the year, showing comparison with 1910 and 1911:— Number of Deaths. Death-rate per cent. 1912 1911 1910 1912 1911 1910 Scarlet Fever 1 3 5 .46 1.2 2.61 Diphtheria 4 7 3 4.08 7.5 4.16 Enteric Fever — 2 3 — 50 27.27 The following shows the average length of stay of patients in the Hospital:— Scarlet Fever. Days. Average days in Hospital 63 cases of Scarlet Fever in Hospital on 1st January, 1912 2,700 42.85 180 recovered cases of Scarlet Fever 9 ,705 53.91 1 fatal case of Scarlet Fever 10 10 36 cases of Scarlet Fever in Hospital on 1st January, 1913 1,077 29.9 Average stay in Hospital of Scarlet Fever patients 48.18 TABLE OF ADMISSIONS In the Respective Months during the last Ten Years. Months. Scarlet Fever. Diphtheria. Enteric and Continued Fevers. Erysipelas. Puerperal Fever. Measles 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1903 1905 1906 1907 1908 1909 1910 1911 1912 1905 1906. January 16 17 10 21 40 29 31 14 24 19 7 3 5 2 3 10 10 11 5 18 — — 1 — — — — 9 1 — — — — — — 1 — — — — February 11 17 18 11 31 26 13 14 15 21 5 10 8 5 8 1 12 5 6 9 — 1 — — — — — — — — — — — 1 — — — 1 1 — — March 3 13 15 17 26 26 22 15 17 33 4 3 3 13 8 5 7 3 4 15 — 1 — — — 1 — — — — — — — — — — — — — — — April 11 12 9 17 33 23 3 11 8 24 2 4 10 3 9 5 8 2 5 4 — — 1 1 2 — — — 1 — — 1 — — 1 2 — — 1 — — May 9 8 10 20 31 20 11 11 16 26 4 4 3 12 4 5 4 8 4 12 1 1 2 2 — 1 — 9 — — — — 1 — — — 1 — 2 — — June 7 4 16 14 18 27 16 5 10 18 1 15 1 9 6 5 8 2 3 9 — — — — — — — — — — — — — — — — — — — — — July 6 12 5 25 28 36 10 14 6 7 1 5 2 6 4 10 1 4 7 5 — — 4 2 1 1 — — — — — — — — — — — — — — 1 August 8 10 10 18 27 17 9 8 7 4 3 3 8 4 5 8 3 — 5 2 2 2 1 — 1 2 — — — — — —. — 1 — — — — — — — Sept. 5 4 9 21 28 30 17 16 23 13 3 7 4 9 6 9 4 1 14 6 4 1 2 — 2 1 1 1 — 1 — — — — — — — — — — — — October 11 10 23 40 35 20 18 10 30 16 2 9 3 12 11 6 14 7 6 3 2 — 1 9 2 3 — 3 2 — — — — — — — — — — — — November 11 7 15 33 34 16 8 17 32 16 2 12 4 7 3 9 6 4 9 6 2 1 1 3 — 2 2 — — — — — — — — — — — — 1 — December 17 26 16 31 38 31 28 20 31 20 3 5 4 6 3 6 11 8 25 9 — — —~ — — 1 — 3 — — 1 — — 1 — — — — — — — Totals 115 140 156 268 369 301 186 155 219 217 37 80 55 88 70 79 88 55 93 98 11 9 13 19 8 12 3 10 4 1 1 1 1 3 1 2 2 1 4 1 1 53 Average days in Days. Hospital Diphtheria. 23 cases of Diphtheria in Hospital on 1 st January, 1912 513 22.30 83 recovered cases of Diphtheria 2,689 32.39 4 fatal cases of Diphtheria 92.5 23.12 11 cases of Diphtheria in Hospital on 1st January, 1913 199 18.09 Average stay in Hospital of Diphtheria patients 28.71 Enteric Fever. 1 recovered case of Enteric Fever 23 23 Average stay in Hospital of Enteric Fever patients 23 Erysipelas. 4 recovered cases of Erysipelas 61 15.25 Average stay in Hospital of all patients 42.01 Average number of patients in Hospital per day 46.76 Percentage of cases notified removed to the Isolation Hospital :— Scarlet Fever 75-^7 Diphtheria 70.50 Enteric Fever 25 Erysipelas 7.02 One case of Diphtheria was admitted from outside the district. THE ISOLATION HOSPITAL. The Hospital was built in 1898 and originally consisted of 20 beds. In 1902 another 26 beds were added with extension of the administrative block. A stable was also provided at the same time for the accommodation of two 5* horses used for the ambulance service in connection with the Hospital and also for disinfection work. In 1905 a convalescent home of 8 beds was provided for passing the Scarlet Fever patients through after leaving the Hospital and before returning home. In 1908 a further block of 26 beds was opened with accommodation above for the staff. During the past year a "much needed enlargement to the Laundry has been begun. The accommodation was most inadequate to meet the requirements, but now with the enlargement and provision of new machinery with increased drying accommodation, the problem of adequately dealing with the washing of the establishment should be practically solved, at any rate for the time being. NURSING. The nursing staff of the Hospital consists as a rule of 1 Matron, 1 Assistant Matron, 3 Sisters, 4 Staff Nurses and 10 Probationers. Practically this staff is subject to a good deal of variation as, of course, the patients vary in number considerably from time to time, and every effort is made to endeavour to regulate the one by the other. The National Insurance Act coming into force during the year rather seriously affects nurses ; as they have been in the habit of having medical attendance, etc., free, it is hard to see what benefits they are going to obtain under the Act except in very occasional cases. There is an endeavour being made to make special provision for nurses and it deserves every consideration. The work is very hard and trying at times, so that if some increased sick benefit could be obtained in lieu of medical benefit, it would probably go a long way to meeting the difficulty. The success of an institution like this very largely depends on the nursing staff, and I would like to take this opportunity of drawing attention to the very excellent work that has been carried out during the 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 1911-12 Number of Staff 9 12 15 17 18 24 27 26 26 31 28-7 31-7 ,, Patients 189 175 214 220 267 275 464 478 430 294 263 408 Average length of stay of Scarlet Fever Patients (days) 51 494 56-9 47 491 46-4 40-5 37-6 45 5 481 541 5249 ,, ,, ,, Diphtheria „ 213 31-8 30-5 25 3 291 24-4 22-2 24-9 30-5 38-6 46-7 32 25 „ ,, ,, Enteric Fever „ „ 305 37 37-9 41 42-3 31-5 398 25 1 34-9 340 45-6 232 ,, ,, ,, Puerperal Fever ,, ,, 13 ,, ,, ,, Erysipelas „ „ 29 2 16*5 75 "9-0 12*3 20 19 ?) jj Measles ,, 25 10 j > »» i' All ,, ,, 43 5 452 49-2 40-9 42-7 406 36-2 85*3 41-8 44-8 521 4575 ,, number of patients in hospital per day 22-5 21-7 28-8 24-5 31-2 30-8 461 467 49-3 36-1 37-5 51 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 11,589 ,, ,, ,, Patients 8,233 7,925 10.533 8,996 11,412 11,167 16,837 16,903 18,016 13,188 13,705 18,666 ,, ,, 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 4,322 Cost of Meat £199 19 6 £186 19 7 £198 8 1 £257 11 4 £375 6 9 £377 19 7 £391 2 0 £345 13 11 £333 11 11 X342 0 4 „ 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 £333 1 2 „ 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 £71 3 6 „ 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 £90 7 5 „ 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 £213 17 2 ,, Fish and Poultry 31 4 4i 31 13 0 48 17 5i 29 3 11 38 8 1 41 13 7 45 15 6 38 17 4 32 12 7 £38 4 1 Total cost of all food £631 2 7f £650 13 1 £695 2 0 i £792 2 9 £1,118 14 3 £1,049 15 1 £1,064 11 4 £1,024 14 6 £1,041 10 11 £1,088 13 8 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 5 55 past year. The matron, with the assistance of the staff, has deserved well of the Council, and I am sure that body must thoroughly appreciate the efforts put forth on behalf of those members of the community intrusted to her care. SCARLET FEVER. The type of the cases admitted during 1912 has been by no means severe, and only one death was recorded. This was due to Scarlet Fever and Pneumonia. Of the 243 patients discharged from the Hospital during 1912 in six instances another patient was notified within three weeks of the first case returning home. Of course, it by no means follows that the returning convalescent was the cause of the infection of the other case. In one instance it seemed as though both were infected from the same source, a mild unrecognised case in the same family. In another, the child on leaving the Hospital "caught cold," with a result that there was a good deal of nasal discharge which may have had something to do with causing the trouble. During the year an open-air shelter for 3 or 4 beds has been provided at the southern end of one of the Scarlet Fever wards where patients suffering from discharges have been nursed with beneficial results. One Tubercular Scarlet Fever child developed Pleurisy. Dr. Oates performed a resection of a rib and drained the pleural cavity, and this patient was nursed outside in December with a markedly satisfactory result. DIPHTHERIA. Among these patients admitted during 1912 there were four deaths. The prognosis as a rule depends on the early admission so that the sooner they are admitted the earlier 56 is it possible to give suitable treatment. The laryngeal cases are often very difficult to diagnose in the early stages, and it is those that give rise to the most trouble. Tracheotomy was performed in four of these with one death. From this it will be seen that in case of doubt it is better to consider the case one of Diphtheria rather than to wait until the diagnosis is more certain and the risk to life much greater. A bacteriological examination is made of all these patients before leaving the Hospital so as to send them out without fear of carrying the specific bacillus about as far as possible. The result of these examinations are given under the Bacteriological Laboratory heading at the end of this section. These include too, of course, examinations of many cases on their entry who appear to be doubtful on the clinical evidence. ENTERIC FEVER. Only one case of Enteric Fever was admitted during the year. The diagnosis was by no means clear, but a Widal was not made. The patient did well and no complication of any sort supervened. ERYSIPELAS. Four cases of this disease were admitted during the year. They were admitted where the home circumstances were such that adequate attention could not be received. They all did well and made a good recovery. PHTHISIS. At the end of the year application was received from the Essex County Council for 6 beds for these patients under the National Insurance Act, at 30s. per bed per week. The Council agreed to the application and applied to the Local Government Board for permission, which was granted until p:" ■ ■ : "• ' 57 July. Now that all forms of Tuberculosis are made notifiable a large number of other forms than Phthisis are discovered to be in the district, for which suitable treatment and accommodation are urgently needed, especially children, and a further development of the Hospital for this purpose would, I am sure, give excellent results. 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 bv the steam, so these are all renewed, and the bedding, with the other articles, is then returned home in another van which has 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. BACTERIOLOGICAL LABORATORY. I am largely indebted to Dr. Oates for the following account of the work done in the Laboratory. The fitting up, 58 preparing and inaugurating this work, fell almost entirely on his shoulders, and I cannot speak too highly of his extremely valuable assistance and knowledge in this matter. Any fresh departure always involves increased responsibility and anxiety, and therefore the Council are to be congratulated on having secured the services of such a valuable addition to the staff of the Public Health Department. Work was started in this laboratory on March nth. During the year 775 specimens were examined. The Assistant Medical Officer of Health took up his duties on February 1st, and soon afterwards the work of fitting up the laboratory was commenced. Two rooms have been utilised on the 1st floor at No. 2, Oakfield Road. One room facing west is used as a work room and contains an incubator, sink and centrifuge. Another room adjoining is used as a preparation and store room. A kitchen on the ground floor is used occasionally and contains a dry-air and a steam steriliser and a Koch's Inspissator. All media stains, etc., are made in the laboratory. The convenience of having a laboratory in the Public Health Offices is very great, as the diagnosis can be made more quickly than by sending the specimen to another laboratory. DIPHTHERIA. The following procedure is adopted for the examination of swabs :— A direct examination is made of a smear from the swab. In a certain number of cases a diagnosis of Diphtheria can be made with some certainty from this examination. A diagnosis of Diphtheria is at once telephoned or sent to the practitioner in charge, with a view to the immediate removal of the patient to hospital or else early treatment with Diphtheria Anti-toxin. In every case a culture is made on blood- 59 serum from the swab and the culture examined after incubation for 10 to 24 hours at a temperature of 37 degrees centigrade. Examination of the culture is the only certain method of making the diagnosis of Diphtheria in slight or doubtful cases. The medium used has the following composition and is made in the laboratory : — Loeffler's medium. Blood-serum (calf), 3 parts. Glucose peptone broth, 1 part. Films made either from the swab directly, or else from the culture, are stained with Loeffler's methylene blue or Pugh's stain, and any organisms showing the characters of Diphtheria bacilli are then stained by Neisser's method. The presence of definite granules when stained by the latter method is taken generally as indicating the presence of Diphtheria bacilli. In cases of doubt sub-cultures are made and further tests applied. Sterilised swabs enclosed in a box and addressed envelope suitable for transmission through the post are supplied to medical practitioners on application. There can be no doubt that owing to the facilities afforded by free bacteriological diagnosis, numerous slight cases of Diphtheria are recognised which might otherwise be missed. In this way the spread of Diphtheria is checked. Furthermore, bacteriological examination of the throat affords a safe method of ascertaining whether a child is free from infection after convalescence. In certain cases Diphtheria organisms may remain in the throat or nose for a long time after the child is apparently well. The result of allowing the child to mix with other children may be the conveyance of the disease to them. As a rule two successive negative swabs should be obtained before a child is considered free from infection. This is the method 60 adopted at the Isolation Hospital. There seems some reason to think that the persistence of Diphtheria in the community, even with careful isolation of notified cases, is due to a certain number of cases which are so slight that a doctor is not consulted, and as a consequence the germs linger in the throat or nose for long periods. These infected individuals, known as "carriers," may readily communicate the disease to persons they meet, although apparently quite well themselves. The result of free bacteriological diagnosis, such as obtains in Ilford, is apparently to increase the number of notified cases at first. This increase is somewhat fallacious and is due to the number of slight cases detected, which would otherwise be missed. Apart from the occasional outbreaks of epidemics there is every reason to anticipate a substantial decline in Diphtheria mortality in those districts such as Ilford, where exact bacteriological diagnosis is combined with an efficient hospital service. The results obtained may be classified as follows :— Swabs from Isolation Hospital : — Positive (Diphtheria) 30 Negative (Hoffmann's bacillus) 21 Negative 60 Total 111 Swabs from Local Practitioners :— Positive (Diphtheria) 33 Negative (Hoffmann's bacillus) 9 Negative 66 Total 108 Swabs from School Medical Officer :— Positive (Diphtheria) 6 Negative (Hoffmann's bacillus) 10 Negative 37 Total 53 61 Swabs from Medical Officer of Health :— Positive (Diphtheria) 1 Negative (Hoffmann's bacillus) 3 Negative 8 Total 12 Total number of Swabs, 284. Sputa.—97 specimens of sputum from patients suspected of suffering from Phthisis were examined, with the following result :— From practitioners— Tubercle bacilli present 28 or 31.5 per cent. Tubercle bacilli not found 61 or 68.5 per cent. From School Medical Officer— Tubercle bacilli present — Tubercle bacilli not found 7 From Medical Officer of Health— Tubercle bacilli present — Tubercle bacilli not found 1 The detection of the specific organism of Tuberculosis (bacillus tuberculosis) in the sputum is a certain method of diagnosing Pulmonary Tuberculosis. The test is a delicate one, and is especially useful when the clinical symptoms are not sufficient to diagnose the disease with certainty. It is in the earliest stages of the disease that the method is most useful. Here the symptoms may be only slight, and the doctor may rightly hesitate before diagnosing Phthisis. With the detection of the Tuberculosis bacillus the diagnosis is at once certain and treatment can be commenced at once. This is of great importance, because it is these very early cases that are most readily cured. In a similar manner the disappearance of tubercle bacilli from the sputum affords information the disease is undergoing cure. The presence or 62 absence of tubercle bacilli in the sputum indicates the contagiousness of the disease, those cases in which organisms are present in large numbers in the sputum being largely responsible for the dissemination of the disease. These are termed "open" cases, and these cases should be as far as possible prevented from coming into close contact with other persons. Sputa examined in this laboratory are first examined directly. This method demonstrates the presence of the tubercle bacillus in a certain number of cases. Those sputa which do not give a positive result are further subjected to a process of digestion with anti-formin and then placed in the centrifuge. By this method tubercle bacilli can be detected when present in extremely small amount. Of the seven specimens obtained from school children, not one was found to contain the bacillus tuberculosis. This is explained by the fact that children usually swallow sputum instead of expectorating. The specimens brought by their parents usually consist of saliva and nasal mucus. Two specimens of pleural effusion were examined for Tuberculosis with a negative result. Typhoid Fever.—Examination of the blood for the Widal reaction was carried out five times, and in each case with a negative result. The reaction is usually positive in genuine cases of Typhoid Fever, and is a great help to the doctor in the diagnosis of doubtful cases. There has been no case of Typhoid Fever in Ilford since the opening of the laboratory, and hence only a small number of blood examinations were necessary. Ringworm.—Three hundred and eighty-seven examinations for the presence of Ringworm were made in the laboratory. Every case of Ringworm occurring in elementary school children is kept under the close observation of the 63 school medical officer. The course of the disease is ascertained by frequent microscopical examinations. This is the only method of diagnosing the presence of Ringworm with absolute certainty, and is always adopted when the naked eye appearances afford any room for doubt. In case of any dispute or doubt on the part of the parent, the diseased hairs can be permanently preserved for reference. The method adopted is to soak the hairs in ether, then in 20 per cent. potash. The spores of the Ringworm fungus can then be detected by the microscope. In spite of the strict exclusion of all infected children from school, new cases continue to arise. The most common source of contagion in the past has been the intimacy of school-life; this may now be almost eliminated. Whence, then, comes the infection of the new cases which arise? A certain number come into Ilford from other districts with the disease already present on the scalp. Many children under the age of five are affected by Ringworm, which may be unrecognised by the mother. These cases are probably the most fertile sources of infection to those children with whom they associate. As these children under five do not as yet come under the observation of the school medical officer, but little can be done in preventing infection beyond educating the parents to recognise the disease and obtain treatment. Again, those infected children which have been excluded from school may communicate the disease to their relatives and playmates. Parents do not always recognise the necessity for great care in preventing spread of infection. Children with Ringworm should not attend children's parties, visit swimming baths, or play such games as football; their caps, brushes, towels, etc., should be kept separate, and they should not be attended by a hairdresser. This latter individual affords another source of contagion. Unless he 64 nises the disease and is prepared to use great care in sterilising his instruments and brushes and avoids infection from towels, gowns, and his own hands, he should not exercise his art on a child affected with Ringworm. Specimens of hair examined :— From the School Medical Officer— Ringworm present 190 No evidence of Ringworm 164 Total 354 From Local Practitioners— Ringworm present 15 No evidence of Ringworm 17 Total 32 From Isolation Hospital— No evidence of Ringworm 1 case Total specimens 387. Previous to the opening of the laboratory, Dr. Thresh examined specimens as under :— Disease. No. sent. Positive. Negative. Diphtheria 147 51 96 Enteric Fever 3 1 2 Tubercule 36 10 26 Ringworm 115 65 50 65 TABLE OF HOUSES AND ARTICLES DISINFECTED In Respective Months during the Last Ten Years. Month. Houses. Articles. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 January 29 36 71 26 52 56 63 48 40 56 602 397 783 321 509 533 633 406 270 591 February 26 35 48 31 51 38 47 27 35 44 307 544 727 43b 612 432 347 163 333 551 March 18 3o 40 40 45 42 66 29 34 56 270 487 707 604 512 455 305 369 336 395 April 15 21 40 32 53 53 29 19 27 54 239 209 579 555 648 584 166 305 181 441 May 22 22 31 39 39 34 24 33 38 39 273 479 757 597 595 368 309 253 409 308 June 14 55 16 35 26 44 34 14 27 41 147 447 196 446 312 299 256 120 205 2 74 July 9 24 13 39 43 55 23 14 23 36 144 96 187 566 484 439 147 110 163 376 August 21 28 20 33 43 52 40 20 25 16 234 301 220 412 345 342 162 137 185 111 Sept. 20 28 16 30 43 62 23 21 41 24 250 260 205 666 339 532 129 149 285 142 October 18 35 34 63 65 44 44 23 57 36 141 338 397 677 565 334 291 248 3bo 257 Nov. 29 28 33 66 48 28 32 46 44 280 241 478 751 421 505 270 186 482 383 Dec. 31 30 20 42 61 68 48 33 63 50 363 458 179 570 507 542 306 291 844 456 Totals 252 372 382 476 572 596 469 313 456 496 3250 4257 5415 6601 5849 5365 3321 2737 4053 4285 66 Table Showing Ages and Sex of Patients Admitted Suffering from SCARLET FEVER. 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 2 1 4 5 2 4 – – 1 – 9 10 February 3 — 6 8 2 2 — — — — 11 10 March 2 3 12 8 4 1 — 1 1 1 19 14 April 4 — 10 7 2 — — — — 1 16 8 May 1 — 12 6 3 1 — 3 — — 16 10 June 1 1 6 6 3 1 — — — — 10 8 July 1 — 2 2 1 1 — — — — 4 3 August — — 2 — 1 1 — — — — 3 1 September 1 — 3 4 2 — — 2 — 1 6 7 October — 3 1 6 1 2 2 1 — — 4 12 November 3 1 2 6 1 — — 1 1 1 7 9 December 3 2 9 3 1 1 1 – 13 7 Totals 21 11 69 61 23 14 2 9 3 4 118 99 Table Showing Ages 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 – 3 5 3 1 2 – 1 1 2 7 11 February 2 1 1 3 1 — — — — 1 4 5 March — 1 10 2 — — — 1 1 — 11 4 April 3 1 — — — — — — — — 3 1 May 2 1 2 4 1 1 1 — — — 6 6 June 3 1 2 1 1 — — — 1 6 3 July — — 1 2 — 2 — — — — 1 4 August 1 — 1 2 — September — 1 2 1 — 1 1 — — — 3 3 October 1 2 — — — — — — — — 1 2 November — — 3 — 1 1 — 1 — — 4 2 December – 1 3 4 1 – – – – 4 5 Totals 12 12 30 20 6 7 2 3 2 4 52 46 SECTION III. Sanitary Administration. 69 FOOD AND DRUGS ACTS. The above Acts are administered by the County, and Mr. H. C. Card, the Chief Inspector, has kindly given me a return of the number of samples taken, with the results, which I herewith append :— 1912. The following samples were purchased and submitted to analysis :— Milk, 109 samples; Butter, 68 samples; Lard, 2 samples; Jam, 3 samples; and 1 sample each of Pepper, Margarine, Cocoa, Coffee, making a total of 186 samples. Of these, four of the milk samples were adulterated, and proceedings were taken ; one case was dismissed, one was withdrawn, a fine of £2 and costs 9s. inflicted in one case, and a fine of £1 and costs 9s. in the other. Three of the butter samples were certified as being margarine. Two of these samples were taken informally, and the other resulted in a prosecution and a fine of £2 and costs 9s. One of the jam samples was certified to contain apple pulp, and a prosecution resulted in the imposition of costs £2 16s. 6d., no conviction being recorded. 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. 70 During 1912 eighteen written notices were received from the South Essex Waterworks Company of the water being cut off, as well as other verbal notices received by telephone from this Company. The Metropolitan Water Board also give us notice when they find it necessary. 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 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 in the Ilford district 65 dairies and milkshops, and 14 cowsheds on the Register. Several of the dairies have changed from one occupant to another, 5 have been closed, and 8 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. 71 These premises are all regularly inspected so as to maintain them in as good a condition as possible. What are known as the Manchester clauses were incorporated in the 1904 Ilford Improvement Act, but in a 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 gone 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. For action taken under this section, see " Legal Proceedings." BAKEHOUSES. There are 32 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. One bakehouse has been closed during the year, and one is now used as a store only. One new bakehouse has been opened, 72 All these bakehouses are periodically inspected so as to ensure the maintenance of a fair state of cleanliness and suitable conditions for the employees. In building new bakehouses, the question of the type of oven is gone into so as to secure as little pollution of the air of the bakehouse as is possible. It is an obvious advantage to stoke from the bakehouse so that the men may not have to go out from the warm air to feed their fires; at the same time this involves the storage and handling of a certain amount of coal in the bakehouse itself, which in careless hands is often undesirable. 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. Under "Legal Proceedings" will be found an account of the result of the legal action arising out of the following seizures. During the year the following articles were condemned as unfit for human consumption : — Internal organs of 6 pigs. Cow's liver and lungs. Two forequarters of beef. Portion of flank. Lungs (ox), 2 sets. Two sides of beef. Heart. Liver. Head. Tail. The slaughterhouses have been kept under careful supervision during the year, and two of the Assistant Sanitary Inspectors are specially qualified as meat inspectors. 73 FISH SHOPS. During the past year these have been constantly inspected, and the following fish were condemned as unfit for human consumption :— 26½ lbs. mixed roes. 1 trunk of haddocks. The above was brought to. the office by retailers so as to obtain a certificate for the refunding of the purchasemoney 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. GREENGROCERS' SHOPS. These are inspected as occasion demands, arising out of which : 2 sacks of Brussel top-heads were destroyed. OFFENSIVE TRADES. During the past year there were two occasions on which businesses were established for the purpose of fat-melting without having given notice to the Council or having obtained their sanction. Both were discovered and reported to the Council, with the result that legal action was threatened unless they ceased to carry on this particular business. As both were discontinued, no further action was necessary, and the continued establishment of a trade that would be likely to lead to the existence of a nuisance was avoided. 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. 74 WORKSHOPS AND WORKPLACES. Under the Factory and Workshops Act, 1901, each Local Authority is obliged to keep a register of Workshops and Workplaces, and to forward to other Authorities the addresses of outworkers employed by masters in their district, but who reside in other districts. The Medical Officer of Health is required to report to the Home Office and the Local Government Board on the administration of the Act in their district during the preceding year, with regard to — (a) Cleanliness. (b) Air space. (c) Ventilation. (d) Drainage of floors on which wet processes are carried on. (e) Provision of suitable and sufficient sanitary conveniences. WORKSHOPS. There are 438 workshops on the register, made up as follows :— Artificial Flower Makers 4 Bead Worker 1 Belt (Fancy) 3 Blind and Cover Makers 3 Box Maker 1 Brush Maker 1 Boot Makers and Repairers 56 Carpet Planning and Upholstery 5 Corset Maker 1 Cycle and Motor Making and Repairing 17 75 Dentists 3 Dressmakers 94 Book Binder 1 Embroiderers and Lace Workers 4 Engineers' Workshops 2 Feather Cleaning and Dressing 4 Firewood Cutting 5 Florist 1 French Polishers 3 Gas Fittings, &c. 1 Grindery Works 4 Glass Cutting 3 Jewellery and Watch Repairing 14 Joinery Workers 9 Laundries (Hand) 18 Machine Repairs 1 Masons 3 Meat Cutting and Small Goods 2 Milliners 20 Lace Worker 1 Indiarubber and Surgical Instrument Maker 1 Optician 1 Picture Framers, etc. 5 Printers 9 Plumbers, &c. 8 Purse Maker and Mattress Tuft Maker 1 Rag Sorting and Storing 4 Saddlers and Harness Makers 3 Scale Maker 1 Smiths 9 Tin Plate Workers 2 Umbrella Makers and Repairers 6 Wearing Apparel (including Tailors) 95 Wheelwrights and Carriage Builders 3 76 Undertakers 4 Soda and Mineral Water Manufacturer 1 Total 438 FACTORIES. There are 65 factories on the register, made up as follows :— Bakehouses 4 Bootmaking and repairing 10 Building, etc. 4 Electrical Works (Motor) 1 Paper Making 1 Printers 4 Plate Powder Manufacturer 1 Motor and Cycle Making 4 Saw Mills, etc. 11 Seed Sorting, etc. 1 Smithy, etc. 1 Meat Cutting, etc. 4 Chemical Factory 1 Carriage Works, etc. 2 Corset Making 1 Grindery Works 1 Iron Covers, etc. 1 Laundries 6 Photographic Works 1 Lithographic Works 2 Wearing Apparel 3 Collar Works 1 Paint Mixing 1 Total 65 77 FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. I-INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory Laundries) 34 2 ... Workshops (including Workshop Laundries) 3°4 9 ... Workplaces (other than Outworkers' premises included in Part 3 of this report) ... ... ... Total 338 11 ... 78 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Insp'tor (1) (2) (3) (4) (5) Nuisances under the Public Health Acts Want of cleanliness 3 2 Want of ventilation Overcrowding 3 3 Want of drainage of floors Other nuisances 3 2 Sanitary accommodation insufficient unsuitable or defective 2 2 not separate for sexes Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. xoi) . Breach of special sanitary requirements for bakehouses (ss. 97 to 100) Other offences (Excluding offences relating to outwork which are included in Part 3 of this report.) Total 11 9 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. 36 14 82 Brush Making. 2 ... 2 Total 38 14 84 4.— REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number (2) Bakehouses (excluding 4 Factory Bakehouses) 28 Total number of workshops on Register 28 80 5-—OTHER MATTERS. Class. (1) Number (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 15 Action taken in matters referred by H.M. Inspector as remediable under the Public Health. Acts, but not under the Factory and Workshop Act (s. 5) ' Notified by H.M. Inspector 6 Reports (of action taken) sent to H.M. Inspector 6 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. No. of houses inspected under Section 17 151 ,, ,, ,, unfit for human habitation Nil ,, ,, representations made for closing orders Nil ,, ,, closing orders m&de Nil ,, ,, houses remedied without closing orders 68 ,, ,, ,, after closing orders put into a fit state Nil No action required 47 Notices under H. T. Planning Act, served 22 ,, ,, ,, complied with 9 Notices served under H. W. C. Act to place in habitable repair 3 Notices served under H. W. C. Act complied with 3 Statutory notices served 10 ,, ,, complied with 10 Dustbin ,, served 5 ,, ,, complied with 5 Notices to cleanse house, P. H. A., '75, served 1 ,, ,, ,, ,, ,, complied with 1 Preliminary notices served, or letters 64 ,, ,, complied with 35 ,, ,, outstanding 29 The following is the general character of the defects found to exist under the above Act:— 82 Walls and Ceilings Defective or Dirty. Flushing Apparatus Defective. Roofs Defective. Gutters and Down Pipes Defective. Yards Defective. 36 20 24 33 19 Houses in Dirty Condition. Window and Door Fittings Defective. Want of Ventilation under Floors. Dustbins Required. Overcrowding. 15 52 1 18 1 Dampness of Rooms. Wastepipes Defective. Dishings Defective. Outside Walls Defective. Defective Water Fittings. 16 1 38 5 9 Heating Apparatus Defective. Defective Floors. Ventpipes Defective. Drains choked. Impure Water Supply. 4 3 3 2 5 83 Under the Regulations issued by the Local Government Board under Section 17 of the Housing and Town Planning Act, Mr. King was designated as the officer to make inspections in accordance with the Act, under the supervision of the Medical Officer of Health. A list of houses requiring inspection has been submitted to and approved by the Council. During 1911, 90 houses were so inspected, and in 1912, 15 x, but it is evident that considerably more attention will have to be devoted to this work if the Act is to be complied with in any real sense. The Local Government Board, in their letter to the Council of 30th December, 1912, also draws attention to the small number inspected to the number requiring examination. Now that the last census declares Ilford to have a population of more than 50,000, brings a much larger proportion of houses under Section 15. Previous to the last census this Section only applied to houses let 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 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 therefore require more attention. A large proportion of the houses inspected during 1912 belong to one landlord, or nominally so, and a great deal of time and trouble has been expended in getting the defects remedied. If the defects are of a grave character, it is comparatively easy under the statutory powers to get these remedied, but when the matters requiring attention are smaller in character, it necessitates some trouble and perseverance to have them put right. When, for instance, the only cooking stove in the living room is broken, and either cannot be used at all or only by filling 84 the room with smoke, one would expect that there would not be much trouble in getting this condition remedied, but, with a certain type of landlord, it is by no means a simple matter. The housing of the working classes in this district requires consideration, for while there is a supply of houses letting at 7s. 6d. a week and upwards, there are very few below that figure. Now it is obvious a man earning 30s. a week and under cannot afford to pay that rent. The matter is under the consideration of the Council at the present time, and is an economic problem of some complexity and magnitude. 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 recently laid down Goodmayes Lane and along Longbridge Road, which enabled a house to be connected to this sewer that has given rise to good deal of nuisance, owing to its riot having sufficient ground to deal with its own waste, with a result that the neighbouring ditch became 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 61 ,, ,, privies 36 ,, ,, pail closets 71 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 86 directly or indirectly. They are frequently inspected, and receive as regular attention as possible, so as to minimise the evils they give rise to. During 1912 a deputation from the Farmers' Association interviewed the Public Health Committee with a view to the Council emptying the various cesspools, etc., for them. Their contention was that they paid a sewer rate but derived no direct benefit from it. The Council took the matter into consideration, and authorised the laying of a sewer to drain the Padnall Corner district, which appeared the most urgent cause of complaint. With regard to the question of dealing with the other cesspools, etc., I was instructed by the Council to present a report on the cost of dealing with this matter, with a map of the district showing the situation of these various cesspools, etc. There is no doubt that if this work was carried out by the Council, it would be done more systematically than it is possible for the farmers to do it, and a correspondingly less opportunities for nuisances to arise. 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. The refuse has been taken to a tip at Aldborough Road for the eastern portion of the district. The refuse from the western part has latterly been taken to a tip at St. Swithin's, so as to relieve the Aldborough Road tip, which is being rapidly filled up. A Local Government Board Inquiry was held during 1912, on application for the Council for a loan to buy some land in Aldborough Road for the purpose of the erection of a dust destructor. The application was granted, so that the 86 provision of a destructor is a stage nearer. The difficulty of obtaining a new tip within reasonable distance makes the provision of some other form of disposal a necessity one would think. The dustbins are nearly all portable ones, and care is taken that they are replaced when necessary. During the 12 months, 4,860 vans were engaged, collecting 13,251 loads, representing about 17,800 tons of house refuse. The total number of days on which collection took place was 307; the average number of horses engaged per day being 15.50; the average number of loads removed per horse per day being 2.72. PUBLIC LATRINES. The underground convenience in Roden Street, which provides enlarged accommodation for men, and also accommodation for women, is most extensively used. Before this there was no provision for the female portion of the population of the district. Upon this new latrine being 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. The provision of another has been under consideration by the Council, and the urinals in connection with various public-houses have been improved or altered. 87 POLLUTION OF RIVER. There is a pipe from a surface water drain discharging into the Roding at the bottom of Roden Street, and a complaint was received from the Thames Conservancy that this was discharging sewage matter. A sample of the effluent was accordingly taken and sent up for analysis, with the following result :— "Report on a sample of water from the Ilford U.D. Council, taken on November 4th from a surface water drain discharging into the River Roding." The water was examined, both chemically and bacteriologically, and both results indicate that it contains matter of sewage or manurial origin. It corresponds closely to a good sewage effluent. There is a drain discharging into this main surface water drain in Roden Street, and as there is always a fair amount of water discharging through this, a sample was taken and sent up, with the following result:— "Report on a sample of water from Ilford. Taken from drain at back of houses in Roden Street on November 22nd." This is a very curious water, containing a large quantity of saline matter in solution, but very little organic matter, and the merest trace of sewage or manurial matter. It may contain an effluent from some works or it may merely be surface water from roads and yards. There does not appear to be anything in this particular sample which would deleteriously affect the river. 88 So that it does not seem that the source of the trouble has anything to do with this drain. All the houses in Roden Street or neighbourhood have been traced going to the sewer, so it is evident none of these discharge into this surface water drain. There are several road gullies connected to this drain, so that these may account for the trouble; or, as the river is very foul at that point and this surface water pipe is low, there may be a deposit from that source formed at times, so influencing the character of the effluent. At another time a complaint was received of pollution of the Roding higher up. On investigation, I found this was due to an accident with the result that some considerable quantity of malt liquor was being discharged by the East Ham surface water sewer (?) into the Aldersbrook, and so into the Roding. There is a general impression that the foul and unsightly condition of the lower part of the Roding is due to pollution from up stream, but f think there is no doubt it is the other way—comes up with the tide and becomes deposited. TOWN AMBULANCE. The public ambulance kindly given to the town about 10 years ago by Lord Rowallan is still being extensively used. During the year it was used on 22 occasions for street accidents, and on 135 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 6 occasions. 89 LEGAL PROCEEDINGS. During 1912 it was found that a man was selling milk without being registered, and also without giving notice, as required under Section 7 of the Dairies, Cowsheds and Milk Shops Order, of occupying a building in Ilford Lane as a dairy. On going into the matter, there was some difficulty as to who was the real owner of the business; but eventually Mr. B. Smith, of 104, Corporation Street, West Ham, was proceeded against for selling milk without being registered, and Mr. Nicholson, of 179, Ilford Lane, was proceeded against as occupying the building without having first given notice of his intention so to do. They were each fined ^2 and costs. On the 12th April, 1912, I visited Padnall Grove Farm, and found a carcase ready dressed hanging up in one of the sheds. The hindquarters presented an (Edematous appearance. It was a cow's, and the history was that it had calved 7 days before, and had been killed. On that day, however, I could not find the uterus. The farmer was not in, and I left word with the wife that the carcase was not to be removed and that the farmer should see me in the morning. Not meeting him the next morning, I again visited the farm, found the uterus, which was full of foul noxious dibris, and thereupon I seized the carcase. The defence was that the meat was not exposed or prepared for sale at the time of my second visit, and therefore no offence had been committed. The defendant was acquitted, but on applying for costs, the Chairman of the Justices informed him he must consider himself very fortunate in having escaped a fine. 90 On March 7th, 1912, I seized a forequarter of beef affected with tubercle, and also part of the flank similarly affected, at a butcher's shop in Ley Street, since closed. I was informed that the other half of the carcase was at another butcher's shop in another part of the district. I visited this shop and seized the forequarter, a portion of the flank, and also a part of the lungs, as all being affected with tubercle. Action was taken under Section 117 of the Public Health Act, 1875, and fines amounting to ^3 and costs were inflicted in each instance. 91 INSPECTOR OF NUISANCES. As I stated last year, that 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, which will be absolutely necessary before long. 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. The duties are of an extensive nature. They have been carried out in an efficient manner, and I should like here to 92 express my indebtedness to the various officers for their co-operation and assistance in this portion of the work of the Public Health Department. In recent times it has been necessary to define more particularly the relationship of the Inspector of Nuisances to the other Sanitary Inspectors. If good work is to result, it is obviously necessary for one man to be responsible for one job. There has been a tendency to make the Inspector of Nuisances an independent officer, but there is no getting away from the fact that he is a part of the Public Health Department, and as part of a corporate whole he can only take a valuable but subordinate position to the Medical Officer of Health. In practice this is of course quite recognised, but the time has arrived when it should be completely defined. DRAINAGE. There has been a considerable amount of trouble during the past year or more over this matter, and I have found it necessary to take the control into my own hands. In the past, it is an acknowledged fact now, that the bye-laws have not been enforced, and it has been found that all the drains which have been opened up under Section 52 of the Ilford Improvement Act, 1898, have been found to be defective. This is a serious matter, and will be likely to be more so in the future; therefore I have presented various special reports on the subject to the Council. In whatever manner a drain is laid, even if on made-up soil, it takes a few years before any obvious result ensues, but I am afraid the Council is just beginning to reap the fruit of the abrogation of the bye-law with regard to the laying of concrete under drains. However virgin the soil, it is obviously common sense that there must be a firm bed for a drain to rest on, which was provided for by the bye-law on the subject passed in 1892, and the 93 tion is why was it not enforced? In a district of this character, with so many small owners, this is a very vital question, and although the menace to health is not so great probably where there are no wells to be polluted, there is ample evidence that a sewage polluted soil close to the back door is a factor in the causation of disease, and I am convinced that this matter will require great attention in the future if danger is to be averted. During the past year a report on intercepting traps has been issued by the Departmental Committee that was appointed to consider this matter. The report is very careful to avoid any very definite recommendation, but to anyone who reads the evidence it will be obvious that the day of intercepting traps is beginning to wane. The Council have had under consideration the revision of their building byelaws, but before finally going forward have decided to wait for some guidance from the Local Government Board on the matter. If these traps are to be abolished it is certainly desirable to make the drains as air-tight as possible, and iron seems to lend itself to this end very much better than the ordinary stoneware pipe. Then there is the question of the provision or not of the inspection chambers, which also requires full consideration before the Council commits itself to a definite line of action, and here, too, the guidance of the Board would be of extreme value. The Council's byelaws at present in force with regard to drainage certainly require revision, but no amount of revision will make up for non-enforcement. I would respectfully suggest to the Council that great care be exercised in adopting or modifying the bye-laws, but that once adopted no excuse be accepted for not enforcing them. 94 INSPECTION OF THE DISTRICT AND THE ABATEMENT OF NUISANCES. Summary of visits as entered in the Journal during the year 1912 :— Houses and premises inspected 2987 Do. do. visited during progress of work 5796 Nuisances detected 823 Do. abated 832* Do. unabated 106 Complaints received 265 Articles do 173 Houses disinfected 496 Visits re disinfecting of premises 4284 * This includes nuisances which were detected previous to 1912. 95 The following- is a list of notices served during the year :— NOTICES SERVED, &c. 1912. Notices. Outstanding 1/1/12, and served 1912. Complied with 1912. Outstanding 1913. Statutory 87 41 46 Preliminary 367 334 33 Do. (by letter) 73 40 33 Pave Yard (Ilford Improvement Act) 33 30 3 Provide Dustbin (Ilford Improvement Act) 131 103 28 Cleanse Cistern (Bye-laws) 119 115 4 Cover Do. Do. 27 22 5 Provide Water to Dwelling-House 19 18 1 Cleanse Dwelling-House (Infectious Diseases (Prevention) Act, 1890) 91 88 3 Cleanse Dwelling-House (Sec. 46 Public Health Act, 1875) 6 5 1 Housing of the Working Classes Act 14 3 11 Housing, Town Planning, etc., Act 22 9 13 Totals 989 808 181 SECTION IV. Schools. 99 SCHOOLS. The schools providing accommodation for 13,126 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. Barkingside. The extension to South Park School has been begun, and will provide accommodation for 700 extra children. Aldborough Hatch School was closed in April, 1912. The question of the amendment of the National School is under consideration. CLEANLINESS AND DISINFECTION OF SCHOOLS. The cloak-rooms and lobbies have been disinfected by spraying out in the various holidays, and certain class-rooms have been disinfected and articles were destroyed after infectious disease, chiefly Scarlet Fever. A detailed list of the work carried out is as follows:— 100 Date. School. Room. Remarks. 1912. 19th Feb. Goodmayes No. 1 J. M. and Corridor Sprayed and Utensils destroyed 16th Mar. Goodmayes No. 1 J. M. No. 6 J. M. Sprayed and part of Utensils destroyed 4th April Goodmayes No. 1 J. M. Sprayed only 12th ,, Goodmayes All the Lobbies Sprayed 11th May Christchurch Road No. 5 Boys Sprayed only Summer Vacation All the Schools Lobbies Sprayed only 7th Oct. Goodmayes No. 1 J. M. Lavatory and Cloakroom. Sprayed, Utensils part disinfected & part destroyed MEDICAL INSPECTION. In February, 1912, Dr. Oates was appointed Assistant School Medical Officer, and to his share has fallen the work of carrying out this inspection. I have to thank him for his extremely valuable help, and as he has also written down the results of his work it will be possible for the Authority to judge in the following pages of the excellent work that has been accomplished by him. The same routine has been followed as described in previous reports, and the inspection conducted according to Section 58 (b) of the Board's Code. 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 Summary of work done and Cases followed up by the Health visitor during 1912 Explanation:- A cases remedied and treated; B, cases ended (children left); C, cases under observation 1st January, 1913. SCHOOL. DOWNSHALL. CLEVELAND ROAD. CHRISTCHURCH ROAD. LOXFORD. HIFHLANDS. SOUTH PARK. UPHALL. NATIONAL & CHURCH INFANTS. NEWBURY PARK. GOODMAYES. CHADWELL. BARKINGSIDE ROMAN CATHOLIC. VALENTINES. LITTLE HEATH TOTALS. ORIGIN. 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 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 Clothing dirty or in need of repair 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... 3 ... ... 1 ... ... 2 ... ... ... ... ... 11 1 3 1 ... ... 3 1 ... ... ... 1 ... 4 4 ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 5 1 ... ... ... ... ... ... ... ... ... 28 11 8 3 ... 3 Head dirty and verminous 15 4 22 65 3 48 22 10 20 23 7 59 25 4 22 75 7 66 78 17 19 46 2 50 8 6 7 45 12 23 15 4 11 21 6 39 50 17 28 54 26 98 20 15 13 39 11 49 18 5 15 25 5 55 11 1 2 32 3 30 10 6 9 14 8 31 11 2 14 13 6 31 6 3 10 26 ... 17 6 3 12 6 1 10 2 2 4 7 1 15 277 99 198 491 95 621 Ringworm ... ... ... 26 ... 3 ... ... ... 11 ... 5 3 1 ... 23 ... 9 1 ... 1 30 ... 16 1 ... ... 13 1 6 ... ... ... 15 ... 5 4 ... 1 13 ... 12 ... 1 ... 8 ... 5 ... ... ... 7 ... 8 1 ... ... 9 1 6 ... ... ... ... ... ... ... ... 1 3 ... 1 ... ... ... 5 ... 2 ... ... ... 1 2 ... ... ... ... 1 ... ... 10 2 3 165 4 78 Body dirty and neglected ... ... 1 4 ... 8 ... ... ... 2 2 6 ... ... 1 3 ... 3 ... ... ... 5 ... 1 ... ... ... 6 ... 1 ... ... 1 3 1 1 ... ... ... 8 3 12 ... ... ... 6 7 16 ... ... 3 4 1 12 ... ... ... 3 ... 3 ... ... ... 5 6 5 1 ... 1 2 ... 6 ... ... ... 3 ... 3 1 ... 2 4 ... 8 ... ... ... 1 ... 3 2 ... 9 59 20 88 Mentally or morally defective ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 4 1 3 Speech defective ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 ... 1 Hearing defective 2 ... 3 1 ... 1 2 1 3 1 ... ... 4 2 1 ... ... ... ... 1 8 ... ... ... 3 1 1 ... ... ... 2 ... 3 ... ... ... 3 1 1 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 3 ... 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 23 6 25 4 ... ... Vision defective 10 7 7 4 ... ... 32 8 11 6 ... 2 28 5 6 4 ... 4 26 12 13 5 ... 3 26 8 5 4 ... 1 24 1 4 3 ... 2 ... ... 17 5 ... 2 16 4 5 7 1 1 12 4 2 4 ... 6 15 5 1 4 1 1 4 3 1 ... ... 1 6 2 4 1 ... ... 11 1 5 4 ... 1 2 3 2 ... ... ... 2 1 ... ... ... 1 214 74 83 51 2 25 Malnutrition ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... 1 ... 2 1 ... 1 ... ... ... 1 ... 1 ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 ... 9 3 ... 3 Teeth dirty, foul and carious 14 3 20 2 ... ... 8 3 ... 1 ... ... 4 ... 6 1 2 ... 26 2 5 ... ... ... 9 5 3 ... ... ... 8 3 1 ... ... ... 13 5 2 4 1 1 8 1 2 ... ... 1 8 1 ... ... ... ... 7 1 ... 1 ... ... 1 ... ... ... ... ... 3 ... ... ... ... ... 4 ... 1 ... ... ... 1 ... ... ... ... ... 1 1 1 ... ... ... 114 25 41 9 1 4 Nose and throat affections 4 3 ... ... ... ... 1 1 1 ... ... ... 28 5 6 4 ... 4 ... 1 2 ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... 3 ... 2 ... ... ... 1 3 1 1 ... ... 3 1 2 ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 23 10 9 1 ... ... Coryza ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 3 1 ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... Tonsils enlarged 7 5 3 1 ... ... 7 5 10 ... ... ... 4 ... 6 1 2 ... 20 5 14 ... ... ... 8 3 14 ... ... ... 4 3 16 1 ... ... 16 3 8 1 ... ... 8 4 4 ... ... 1 6 5 7 2 ... 1 10 1 1 ... ... ... ... 3 2 ... ... ... ... 1 4 ... ... ... 5 ... 4 ... ... ... ... ... ... ... ... ... 1 2 2 ... ... ... 105 43 99 7 ... 2 Adenoids 2 2 1 ... ... ... ... ... 6 1 ... ... 2 1 ... ... ... ... 7 1 8 ... ... ... 3 1 5 1 ... ... 1 ... 4 ... ... ... 5 ... 5 1 ... ... 1 ... 2 ... ... ... 1 ... 3 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 24 4 38 3 ... ... Glands enlarged ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 7 ... 2 3 ... ... Eye diseases 3 ... 2 2 ... ... 4 ... 1 ... ... ... 13 ... 9 1 ... ... ... ... 1 ... ... 1 ... ... 1 2 ... 1 2 1 3 1 ... ... 6 ... 7 1 1 1 1 ... ... 3 ... ... 1 ... ... 1 ... 1 2 ... 1 ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 4 ... 1 22 3 17 15 1 6 Ear diseases 4 ... 1 2 ... ... 6 1 2 ... ... ... 1 ... 1 ... ... ... 8 4 3 2 ... 1 5 2 2 1 ... 1 3 1 1 ... ... ... 3 ... 2 ... ... ... 4 2 2 ... ... ... 2 2 2 ... ... ... 1 ... ... ... ... 1 3 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ...... ... ... ... ... ... ... ... 1 ... 1 ... 1 44 15 16 9 ... 5 Heart affections ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... 1 ... ... 2 1 ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... 1 1 1 ... ... ... 3 1 ... ... ... ... 6 1 ... ... ... ... 3 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 21 4 4 ... ... ... Lung affections 3 ... 1 ... ... 1 2 ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... ... ... ... 1 ... 1 ... ... ... 1 3 1 ... ... ... 1 ... ... 1 ... ... 1 ... ... 2 1 ... 2 1 ... 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 4 3 5 1 2 Other chest affections 2 ... ... ... ... ... 2 3 1 ... ... ... 3 1 1 1 ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 2 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 19 5 2 2 ... ... Nervous affections ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 3 ... 1 Epilepsy, etc. ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... Tubercule ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 I'eformities of spine ... ... ... ... ... ... 2 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 3 ... ... ... ... Other deformities ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 3 1 ... Skin diseases 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 5 1 ... ... ... ... 5 1 ... 1 ... ... ... ... ... ... ... ... 3 1 1 ... ... 2 ... ... 1 1 ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 18 3 5 Anasmia ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 1 ... ... ... Worms 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 1 ... ... ... ... Rupture 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... Paralysis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... General physical condition ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 ... ... ... ... Other diseases 2 1 1 1 ... ... 1 ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 1 4 5 ... 1 The following table shows the results up to the 31st December, 1912, of the Medical inspection carried out during 1912. SCHOOL. DOWNSHALL. CLEVELAND ROAD. CHRISTCHURCH ROAD. LOXFORD. HIGHLANDS. SOUTH PARK. UPHALL. NATIONAL AND CHURCH INFANTS. NEWBURY PARK. GOODMAYES. CHADWELL. BARKINGSIDE. ROMAN CATHOLIC. VALENTINES. LITTLE HEATH. TOTALS. DEFECTS. 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 Oases. 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 Oases. 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, children left. Percentage of Total Cases. N umber 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 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 cases treated. Percentage of total cases left. Treated Lett 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 Treated Left Clothing dirty and verminous, and in need of repair 3 1 ... 33.33 ... 1 1 ... 100 ... 3 ... ... ... ... 3 1 ... 33.33 ... 3 3 ... 100 ... 3 2 ... 66.66 ... 10 8 1 80 10 4 2 1 50 25 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 100 ... ... ... ... ... ... 6 1 5 16.66 83.33 ... ... ... ... ... 38 21 7 55.26 18.42 Head dirty and verminous 30 8 7 26.66 23.33 21 5 ... 23.81 ... 57 12 3 21.05 5.26 26 10 2 38.61 7.52 10 3 2 30 20 12 5 1 41.66 8.33 28 6 3 21.43 10.71 14 6 1 42.85 7.14 8 2 2 25 25 2 2 ... 100 ... 3 ... 1 ... 33.33 13 4 1 30.78 ... 13 3 ... 23.07 ... 9 4 ... 44.44 22.22 2 1 ... 50 ... 248 68 25 27.82 10.08 Ringworm ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 ... 66.66 Body dirty ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Speech defective ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hearing defective 5 3 ... 60 ... 6 2 ... 33.33 ... 9 4 2 44.44 22.22 13 ... 1 ... 7.69 6 3 1 50 16.66 5 2 ... 40 ... 6 3 1 50 16.66 ... ... ... ... ... 2 1 ... 50 ... 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 3 3 ... 100 ... ... ... ... ... ... 2 2 ... 100 ... 60 23 ... 38.33 8.33 Vision defective 34 20 ... 58.81 5.88 28 21 ... 75 ... 43 21 1 48.88 2.32 29 10 2 34.48 6.89 23 15 3 65.21 13.04 21 18 ... 85.71 ... 30 16 4 53.33 13.33 19 12 ... 63.16 ... 8 4 3 50 37.5 13 8 ... 61.54 23.07 3 ... ... ... 66.66 7 3 ... 42.85 ... 12 8 ... 66.66 ... 6 2 3 33.33 50 ... ... ... ... ... 276 148 23 53.62 8.33 Malnutrition 2 ... ... ... ... 1 1 ... 100 ... 2 ... ... ... ... 4 2 ... 50 ... 2 1 ... 50 ... 1 ... ... ... ... 3 1 ... 33.33 ... ... ... ... ... ... ... ... ... ... ... 3 2 ... 66.66 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 7 ... 38.88 ... Teeth dirty, foul or carious 23 3 1 13.04 4.26 1 ... ... ... ... 2 ... ... ... ... 2 ... ... ... ... 2 1 ... 50 ... 1 ... ... ... ... ... ... ... ... ... 2 2 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 ... 75 ... ... ... ... ... ... 1 ... ... ... ... 39 10 1 25.64 2.56 Nose and throat affections 2 2 ... 100 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 ... 25 ... ... ... ... ... ... 2 ... ... ... ... 2 2 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... 14 6 ... 42.85 ... Coryza 1 1 ... 100 ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 100 ... Tonsils enlarged 15 9 2 60 13.33 16 2 4 12.5 25 15 4 1 26.66 6.66 16 5 1 31.25 6.25 11 3 ... 27.27 ... 16 4 ... 25 ... 9 3 1 33.33 11.11 5 4 ... 80 ... 5 3 60 20 6 5 ... 83.33 ... 2 ... ... ... ... 4 ... ... ... ... 5 3 ... 60 ... 4 ... ... ... 75 ... ... ... ... ... 129 45 13 34.88 10.07 Adenoids 3 2 ... 66.66 ... 7 ... ... ... ... 3 1 ... 33.33 ... 16 6 1 37.5 6.25 10 4 1 40 10 3 1 ... 33.33 ... 7 2 1 28.57 14.28 2 ... ... ... ... 2 1 ... 50 ... 2 1 ... 50 ... ... ... ... ... ... 2 ... ... ... ... 2 1 ... 50 ... ... ... ... ... ... 1 1 ... 100 ... 60 20 3 33.33 5 Glands enlarged ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... 1 1 ... 100 ... 1 ... ... ... ... 2 2 ... 100 ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 100 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 6 ... 75 ... Eye diseases 4 2 ... 50 ... 5 2 ... 40 ... 6 2 ... 33.33 ... 6 2 ... 33.33 ... ... ... ... ... ... 3 ... ... ... ... 11 1 ... 9.09 ... 1 1 ... 100 ... 1 1 ... 100 ... 4 1 ... 25 ... ... ... ... ... ... 1 1 ... 100 ... 2 ... ... ... ... 1 ... 1 ... 100 ... ... ... ... ... 45 13 1 28.88 2.22 Ear diseases 4 3 ... 75 ... 4 3 ... 75 ... 2 ... ... ... ... 3 ... ... ... ... 4 2 2 50 50 2 1 ... 50 ... 3 1 ... 33.33 ... 2 2 ... 100 ... 1 1 ... 100 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 13 2 50 7.69 Heart affection 1 1 ... 100 ... 2 1 ... 50 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 1 ... 50 ... 3 3 ... 100 ... 1 1 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 12 8 ... 66.66 ... Lung affection ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... Other chest affections ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... Nervous affections ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... 1 ... 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 50 50 Epilepsv, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... Tubercule 2 1 ... 50 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 ... 50 ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deformities of spine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other deformities ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Skin diseases 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... 1 ... ... ... ... 1 ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 2 ... 28.57 ... Anaemia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 50 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 50 ... Worms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rupture 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... 3 3 ... 100 ... Paralysis ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... General physical condition ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other diseases 3 1 ... 33.33 ... ... ... ... ... ... 2 2 ... 100 ... 5 1 ... 20 ... 1 ... ... ... ... 1 ... ... ... ... 1 1 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... 16 8 ... 50 ... 101 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 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:— 102 The following table shows the average heights and weights of the Boys examined during 1912, also comparison with figures of 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 Total number examined ... 395 113 69 60 58 46 57 424 308 8 Heights Cms. ... 106.07 111.16 117.45 123.24 128.29 131.97 136.10 142.07 145.56 150.62 Ins. ... 41.75 43.76 46.24 48.51 50.50 51.95 53.58 55.93 57.30 59.29 Ins. ... + .72 -.24 +.27 +1.46 +.80 +.11 +.08 +.94 +.39 -.04 ALL SCHOOLS— Weights Kilos. ... 17.95 19.51 21.74 24.29 25.80 28.54 30.82 33.o8 36.30 40.25 Lbs. ... 39.57 43.01 47.92 53.54 56.87 62.91 67.94 72.92 80.02 88.73 Lbs. ... -.33 -1.39 -1.78 -1.36 -3.53 -4.59 -4.06 -3.78 -2.58 -3.27 Number examined ... 47 17 13 6 8 6 5 62 53 1 Heights Cms. 107.12 112.24 110.75 123.5 132.62 131.16 138.2 142.12 145.57 156 Ins. ... 42.17 44.18 43.60 48.62 52.21 51.63 54.40 55.95 57.31 61.41 Ins. ... +1.14 +.18 -2.37 +1.57 +2.51 -.21 +.90 +.96 +.40 +2.08 DOWNSHALL— Weights Kilos. ... 17.41 20.38 20.32 23.33 28.32 28.43 33.6 32.02 35.75 43 Lbs. ... 38.38 44.921 44.79 51.43 62.43 62.67 74.06 76.59 78.81 94.79 Lbs. ... -1.52 +.52 -4.91 -3.47 +2.03 -4.83 +2.06 —.11 -3.79 +2.79 Number examined ... 50 18 5 7 7 3 8 33 48 ... Heights Cms. ... 106.1 111.22 116.3 126.14 132.56 123.33 132.5 142.3 145.64 ... Ins. ... 41.77 43.78 45.78 49.66 52.18 48.55 52.26 56.02 57.33 ... Ins. ... +.74 -.22 -.19 +2.61 +2.48 -3.29 -1.24 +1.03 +.42 ... CLEVELAND ROAD— Weights Kilos. ... 18.18 19.65 21.6 26.37 26.97 26 30.55 34.37 35.67 ... Lbs. ... 40.07 43.32 47.61 58.13 59.45 57.31 67.45 75.77 78.63 ... Lbs. ... +.17 -1.08 -2.09 +3.23 -.95 -10.19 -4.55 -.93 -3.97 ... 103 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 Number examined ... 26 17 4 5 8 1 3 16 19 2 Heights Cms. ... 105.65 111.64 118 120.4 125.75 129 142 138.62 147.89 153 Ins. ... 41.59 43.95 46.45 47.40 49.50 50.78 55.90 54.57 58.22 60.22 Ins. ... +.56 -.05 +.48 +.35 -.20 -1.06 +2.40 -.42 +1.31 +.89 CHRISTCHURCH ROAD— Weights Kilos. ... 17.83 18.96 21.4 28.28 24.67 29.2 33.73 31.55 37.6I 38.9 Lbs. ... 39.30 41.79 47.17 62.34 54.38 64.37 74.36 69.55 83.91 85.75 Lbs. ... -.60 -.61 -2.53 +7.44 -6.02 -3.13 + 2.36 -7.15 +1.31 -6.25 Number examined ... 46 10 9 7 4 2 3 49 32 I Heights Cms. ... 107.40 112.1 118.55 121.65 131.25 140 134 145.30 145.09 158 Ins. ... 42.28 44.13 46.67 47.89 51.77 55.11 52.75 57.20 57.12 62.20 Ins. ... +1.25 +.13 +.70 +.84 +1.93 +3.27 -.75 +2.21 +.21 +2.87 LOXFORD— Weights Kilos. ... 18.19 18.34 21.44 25.74 27.55 32.7 27.6 32.82 36.28 50 Lbs. ... 40.10 40.43 47.26 56.70 60.73 72.09 60.84 72.35 79.98 110.23 Lbs. ... +.20 -3.97 -2.44 +1.80 +.33 +4.59 -11.16 -4.35 -2.62 +18.23 Number examined ... 35 11 9 6 3 4 9 51 34 2 Heights Cms. ... 107.28 110.54 123 126.83 132 133.75 136.55 144.65 148.68 148.5 Ins. ... 42.23 43.51 48.421 49.93 51.96 52.65 53.73 56.94 58.53 58.46 Ins. ... +1.20 -.49 +2.45 +2.88 +2.26 +.81 +.23 +1.95 +1.62 -.87 HIGHLANDS— Weights Kilos. ... 17.61 19.47 24.77 25.66 30.66 27.5 32.73 34.39 38.72 42.4 Lbs. ... 38.82 42.92 54.60 56.57 67.59 60.62 72.15 75.81 85.36 93.47 Lbs. ... -1.08 -1.48 +4.90 +1.67 +7.19 -6.88 +.15 -.89 +2.76 +1.47 104 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 Number examined ... 45 6 2 2 ... ... 1 43 1 9 ... Heights Cms. ... 106.84 110.83 126.5 I31-5 ... ... 135 143.11 145.52 ... Ins. ... 42.06 43.63 49.80 51.77 ... ... 53.14 56.34 57.29 ... Ins. ... +1.03 -.37 +3.83 +4.72 ... ... -.36 +1.35 + .38 ... SOUTH PARK— Weights Kilos. ... 18.17 20.7 22.8 25 ... ... 32.2 33.57 36.5 ... Lbs. ... 40.05 45.63 50.26 55.01 ... ... 70.98 74 80.46 ... Lbs. ... +.15 +1.23 +.56 +.11 ... ... -1.02 -2.7 -2.14 ... Number examined ... 48 12 14 11 9 15 6 45 29 ... Heights Cms. ... 103.81 110.08 117.07 122.27 122.66 130.86 137 139 142.72 ... Ins. ... 40.86 43.33 46.09 48.13 48.29 51.51 53.93 54.72 56.18 ... Ins. ... -.44 -.67 +.12 +1.08 -1.41 -.33 +.43 -.27 -.73 ... UPHALL— Weights Kilos. ... 17.87 19.38 21.57 23.98 23.8 28.41 30.66 32.01 35.69 ... Lbs. ... 39.39 42.72 47.55 52.86 52.46 62.63 67.59 70.56 78.68 ... Lbs. ... -.51 -1.68 -2.15 -2.04 -7.94 -4.87 -4.41 -6.14 -3.92 ... Number examined ... 23 6 6 6 7 6 8 31 18 1 Heights Cms. ... 103.56 107.16 116.33 122.66 127.14 132.33 130.75 140.29 144 135 Ins. ... 40.77 42.18 45.79 48.29 50.05 52.09 51.47 56.25 56.69 53.14 Ins. ... -.26 -1.82 -.18 +1.24 +.35 +.25 -2.03 +1.26 -.22 -6.19 CHURCH OF ENGLAND— Weights Kilos. ... 18.05 19.16 21.43 24 26.6 28.66 28.47 34.06 35.98 29 Lbs. ... 39.79 42.24 47.24 52.91 58.64 63.18 62.76 75.08 79.32 63.93 Lbs. ... -.11 -2.16 -2.46 -1.99 -1.86 -4.32 -9.24 -1.62 -3.28 -28.07 105 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 Number examined ... 9 4 ... ... 2 1 4 22 15 ... Heights Cms. ... 102.66 112 ... ... 128 131 143.5 142.45 145.16 ... Ins. ... 40.41 44.09 ... ... 50.39 51.57 56.49 56.08 57.26 ... Ins. ... -.62 +.09 ... ... +.69 -.27 +2.99 +1.09 +.35 ... NEWBURY PARK— ... Weights Kilos. ... 17.37 19.15 ... ... 28.4 24.2 30.5 33.39 35.14 ... Lbs. ... 38.29 42.21 ... ... 62.61 53.35 67.24 73.61 77.46 ... Lbs. ... -1.61 -2.19 ... ... +2.21 -14.15 -4.76 -3.09 -5.14 ... Number examined ... 16 1 2 4 5 2 6 31 13 ... Heights Cms. ... 108.12 121 126.5 122.25 129.2 136 135 142.64 146.30 ... Ins. ... 42.56 47.63 49.80 48.12 50.86 53.44 53.15 56.15 57.59 ... Ins. ... +1.53 +3.63 +3.83 +1.07 +1.16 +1.60 -.35 +1.16 +.68 ... GOODMAYES— ... Weights Kilos. ... 18.6 23.6 23.5 22.1 27.2 30.5 30.83 34.44 34.23 ... Lbs. ... 41 52.02 51.80 48.72 59.96 67.24 67.96 75.92 75.46 ... Lbs. ... +1.1 +7.82 +2.10 +6.18 -.44 -.26 -4.04 -.78 -7.14 ... Number examined ... 4 1 1 ... 1 ... ... 2 1 ... Heights Cms. ... 105.5 112 112 ... 125 ... ... 138 143 ... Ins. ... 41.53 44.09 44.09 ... 49.21 ... ... 54.33 56.29 ... Ins. ... +.50 +.09 -1.88 ... -.49 ... ... -.66 -.62 ... CHADWELL— Weights Kilos. ... 16.5 19.8 18.2 ... 22.8 ... ... 26.7 34.2 ... Lbs. ... 36.37 43.64 40.12 ... 50.26 ... ... 58.86 75.39 ... Lbs. ... -3.53 -.76 -9.58 ... -10.14 ... ... -17.84 -7.21 ... 106 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 Number examined ... 9 ... ... ... ... ... ... 20 11 ... Heights Cms. ... 108.66 ... ... ... ... ... ... 138.6 141.09 ... Ins. ... 42.77 ... ... ... ... ... ... 54.56 55.54 ... Ins. ... + 1.74 ... ... ... ... ... ... -.43 -1.37 ... BARKINGSIDE— Weights Kilos. ... 19.95 ... ... ... ... ... ... 31.39 33.09 ... Lbs. ... 43.98 ... ... ... ... ... ... 69.20 72.95 ... Lbs. ... +4.08 ... ... ... ... ... ... -7.50 -9.65 ... Number examined ... 17 6 3 6 3 3 2 12 6 1 Heights Cms. ... 105.94 109.16 119.66 120.33 129 130.66 134.5 140.75 148.5 153 Ins. ... 41.70 42.97 47.11 47.37 50.78 51.44 54.52 55.41 58.46 60.23 Ins. ... +.67 -1.03 +1.13 +.32 +1.08 -.40 +1.02 +.42 +1.55 +.90 ROMAN CATHOLIC— Weights Kilos. ... 18.95 19.2 20.06 21.9 24.53 27.86 27.6 32.73 38.73 37.4 Lbs. ... 41.77 42.32 44.22 48.28 54.07 61.34 60.84 72.15 85.38 82.45 Lbs. ... +1.87 -2.08 -5.48 - 6.62 -6.33 -6.16 -11.16 -4.55 +2.78 -9.55 Number examined ... 11 1 ... ... 1 3 2 3 6 ... Heights Cms. ... 106.45 121 ... ... 136 132.66 137 145.33 147.33 ... Ins. ... 41.90 47.63 ... ... 53.54 52.22 53.93 57.21 58.00 ... Ins. ... +.87 +3.63 ... ... +3.84 +.38 +.43 +2.22 +1.09 ... THE VALENTINES— Weights Kilos. ... 17.28 22 ... ... 20 30.86 29 35 35.8 ... Lbs. ... 38.09 48.50 ... ... 44.09 68.03 63.93 77.16 78.92 ... Lbs. ... -1.91 +4.10 ... ... -16.31 +.53 -8.07 +.46 -3.68 ... 107 Boys—continued. Number examined ... 9 3 1 ... ... ... ... 4 4 ... Heights Cms. ... 102.44 110.33 123 ... ... ... ... 142.75 142.5 ... Ins. ... 40.33 43.43 48.42 ... ... ... ... 56.20 56.10 ... Ins. ... -.70 -.57 +2.45 ... ... ... ... +1.21 -.81 ... LITTLE HEATH— Weights Kilos. ... I6.35 18.06 25.8 ... ... ... ... 34.95 33.45 ... Lbs. ... 36.04 39.81 56.87 ... ... ... ... 77.05 73.74 ... Lbs. ... -3.86 -4.59 +7.17 ... ... ... ... +.35 -8.86 ... 108 The following table shows the average heights and weights of the Girls examined during 1912 ; also comparison with figures of 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 Total number examined 1 316 116 71 57 64 54 63 383 313 5 Heights Cms. 100 105.67 110.66 117.79 121.46 127.65 131.75 I39.24 142.68 146.84 146.8 Ins. 39.37 41.60 43.56 46.37 47.81 50.25 51.86 55.99 56.17 57.81 57.79 Ins. +1.11 +1.05 +.68 +1.82 +1.21 +1.52 +.81 +2.89 +.51 +.04 -2.01 ALL SCHOOLS— Weights Kilos. 12.4 17.39 19.01 21.10 22.77 26.01 27.92 3I.52 33.66 36.87 38.48 Lbs. 27.33 38.33 41.90 46.51 50.19 57.34 61.55 69.48 74.20 81.28 84.83 Lbs. -8.77 -.87 +.20 -.99 -1.91 +1.84 -.45 +1.38 -2.20 -5.92 -11.87 Number examined ... 36 18 7 9 10 9 8 84 35 1 Heights Cms. ... 105.69 109.83 116 124.22 125.8 132.13 137.25 142.61 148.6 156 Ins. ... 41.61 43.24 45.66 48.90 49.50 52.01 54.03 56.14 58.50 61.41 Ins. ... +1.06 +.36 +1.21 +2.30 +.77 +.96 +.93 +.48 +.73 +1.61 DOWNSHALL— Weights Kilos. ... 17.23 18.25 21.34 22.53 24.72 28.48 29.72 32.72 37.19 43.4 Lbs. ... 37.98 40.22 47.04 49.66 54.49 62.78 65.52 72.13 81.98 95.67 Lbs. ... -1.22 -1.48 -.46 -2.44 -1.01 +.78 -2.58 -4.27 -4.22 -1.03 Number examined ... 48 15 7 8 7 5 2 42 54 3 Heights Cms. ... 105.85 109.86 115.14 119.75 132.78 137.3 136.25 143.88 147.78 148 Ins. ... 41.67 43.25 45.33 47.14 52.27 54.05 53.64 56.64 58.18 58.26 Ins. ... +1.12 +.37 +.88 +.54 +3.47 +.3 +.54 +.98 +.41 -1.54 CLEVELAND ROAD— Weights Kilos. ... 17.52 18.33 19.77 22.85 29.31 30.08 30.3 34.64 37.58 38 Lbs. ... 38.62 40.41 43.58 50.37 64.61 66.31 66.79 76.36 82.84 83.77 Lbs. ... -.58 -1.29 -3.92 -1.73 +9.11 +4.31 -1.31 -.04 -4.36 -12.93 109 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 Number examined ... 23 9 18 5 8 7 15 53 30 ... Heights Cms. ... 106.04 110.77 117.2 123 129.37 135.28 142.93 144.16 147.43 ... Ins. ... 41.74 43.61 46.14 48.42 50.93 53.25 56.27 56.74 58.04 ... Ins. ... +1.19 +.73 +1.69 +1.82 +2.20 +2.20 +3.17 +1.08 +.27 ... CHRISTCHURCH ROAD— Weights Kilos. ... 18.23 18.42 21.15 24.64 26.55 31.05 34.74 34.18 36.32 ... Lbs. ... 40.18 40.60 46.62 54.32 58.53 68.45 76.58 75.35 80.07 ... Lbs. ... +.98 -1.10 -.88 +2.22 +3.03 +6.45 +8.48 -1.05 -7.13 ... Number examined ... 39 12 11 7 13 8 12 31 41 ... Heights Cms. ... 106.11 111.66 118.36 122.14 123.23 129.5 137.63 144.80 148.22 ... Ins. ... 41.77 43.96 46.59 48.08 48.51 50.98 54.18 57.00 58.75 ... Ins. ... +1.22 +1.08 +2.14 +1.48 +.22 -.07 +1.08 +1.34 +.98 ... LOXFORD— Weights Kilos. ... 17.25 18.51 21.34 22.02 24.72 24.8 28.73 33.09 38.34 ... Lbs. ... 38.02 40.80 47.04 48.54 54.49 54.67 63.32 72.95 84.52 ... Lbs. ... -1.18 -.90 -.46 -3.56 -1.01 -7.33 -4.78 -3.45 -2.68 ... Number examined 1 27 11 5 2 7 8 9 27 25 ... Heights Cms. 100 107.14 111.36 118.6 120 134 131.37 137.88 144.25 148.79 Ins. 39.37 42.18 43.84 46.69 47.24 52.75 51.72 54.28 56.79 58.57 ... Ins. +1.11 +1.63 +.96 +2.24 +.64 +3.98 +.67 +1.18 +1.13 +.80 ... HIGHLANDS— Weights Kilos. 12.4 18.34 20.01 23.2 20.2 28.42 27.87 30.4 33.9 37.75 ... Lbs. 27.33 40.43 44.11 51.14 44.53 62.65 61.44 67.11 74.73 85.22 Lbs. -8.77 +1.23 +2.41 +3.64 -7.57 + 7.15 -.56 -.99 -1.67 -1.98 ... 110 Girl s—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 Number examined ... ... 32 8 3 1 1 1 1 34 33 ... Heights Cms. ... 106.46 113.12 117 120 127 127 132 142 146.60 ... Ins. ... 41.91 44.53 46.06 47.24 49.99 49.99 51.96 55.9o 57.71 ... Ins. ... + 1.36 +1.65 +1.61 + .64 +1.26 - 1.06 -1.14 + .24 — .06 ... SOUTH PARK— Weights Kilos. ... 17.6 19.6 21.13 23.8 24 25.2 29.8 33.07 36.52 ... Lbs. ... 38.80 43.21 46.58 52.46 52.91 55.55 65.69 72.90 80.51 ... Lbs. ... -.40 + 1.51 -.92 + .36 -2.59 -6.45 - 2.41 -3.5o -6.69 ... Number examined ... ... 53 20 9* 7 3 3 4 28 15 1 Heights Cms. ... 103.90 108.75 111.63 116.85 121 134 135.25 140.60 136.13 134 Ins. ... 40.90 42.81 43.94 46 47.63 52.75 53-24 55.35 53.59 52.75 Ins. ... + .35 -.07 -.5i - .60 - 1.10 + 1.70 + .14 -.31 -4.18 -7.05 UPHALL— Weights Kilos. ... 17.23 18.94 20.62 22.94 22.93 30.66 31.75 32.76 36.09 35 Lbs. ... 37.98 41.75 45.45 50-57 5o.55 67.59 69.99 72.26 79.56 77.16 Lbs. ... - 1.22 + .05 - 2.05 -1-53 -4.95 + 5.59 +1.89 -4.14 -7.64 -19.54 Number examined ... ... 5 8 5 2 2 4 3 11 18 ... Heights Cms. ... 105.6 109.75 115.19 117.5 127.5 123 137 145.18 145.83 ... Ins. ... 41.57 43.20 45.35 46.25 50.19 48.42 53.93 57.15 57.41 ... Ins. ... + 1.02 + .32 + .90 -.35 +1.46 -2.63 + .83 + 1.49 -.36 ... CHURCH OF ENGLAND— Weights Kilos. ... 17.4 19.1 20.28 26.4 24.2 24.35 30.73 34 35.36 ... Lbs. ... 38.36 42.10 44.70 58.20 53.35 53.68 67.74 74.95 77.95 ... Lbs. ... -.84 + .40 -2.80 -6.10 -2.15 -8.32 -.36 -1.45 -9.25 ... * One of these children (Uphall—7-8 years) was deformed and in plaster and was therefore neither weighed nor measured. 111 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 Number examined ... ... 7 1 1 1 1 1 2 19 13 ... Heights Cms. ... 108.14 115 115 128 125 126 135.5 143.58 148.46 ... Ins. ... 42.57 45.27 45.27 50.39 49.21 49.60 53.34 56.52 58.44 ... Ins. ... + 2.02 + 2.39 + .82 + 3.79 + .48 -1.45 + .24 + .86 + .67 ... NEWBURY PARK— Weights Kilos. ... 18.11 21.4 21.8 21 25.4 24.8 31.1 34.61 37.46 ... Lbs. ... 39.92 47.14 48.06 46.29 55.99 54.67 68.56 76.30 82.58 ... Lbs. ... + .72 + 5.44 + .56 -5.81 +.49 -7.33 + .46 -.10 -4.62 ... Number examined ... ... 6 3 ... 5 7 3 3 25 16 ... Heights Cms ... 104.66 108.33 ... 125.5 126.5 136.33 151.33 144.1 145.81 ... Ins. ... 41.20 43.64 ... 49.40 49.80 54.67 59.57 56.73 57.40 ... Ins. ... + .65 + .76 ... + 2.80 +1.07 + 3.62 + 6.47 +1.07 -.37 ... GOODMAYES— Weights Kilos. ... 16.93 19.33 ... 24.44 24.42 28.46 37 33.22 33.3 ... Lbs. ... 37.32 42.61 ... 53.98 53.93 62.74 81.57 73.23 73.41 ... Lbs. ... - 1.88 + .91 ... + 1.88 -1.57 + .74 -12.53 -3.17 - 13.79 ... Number examined ... ... 3 1 ... 4 2 1 1 3 ... ... Heights Cms. ... 103 114 ... 1l6 131 124 138 152.33 ... ... Ins. ... 40.55 44.88 ... 45.66 51.57 48.81 54.33 59.97 ... ... Ins. ... ... + 2 ... -.94 + 2.84 - 2.24 + 1.23 + 4.31 ... ... CHADWELL— Weights Kilos. ... 16.93 19.4 ... 20.85 28 26.8 34.8 38.13 ... ... Lbs. ... 37.32 42.76 ... 45.96 61.72 59.08 76.72 84.06 ... ... Lbs. ... - 1.88 +1.06 ... -6.14 + 6.22 — 2.92 + 8.62 + 8.34 ... ... 112 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 Number examined ... ... 2 1 2 ... ... ... ... 9 12 ... Heights Cms. ... 106 106 116 ... ... ... ... 138.22 143.66 ... Ins. ... 41.73 41.73 45.66 ... ... ... ... 54.41 56.55 ... Ins. ... + 1.18 -1.15 + 1.21 ... ... ... ... -1.25 - 1.22 ... BARKINGSIDE— Weights Kilos. ... 16.4 18.2 21.4 ... ... ... ... 31.86 33.76 ... Lbs. ... 36.15 40.12 47.17 ... ... ... ... 70.23 74.42 ... Lbs. ... -3.05 -1.58 -.33 ... ... ... ... -6.17 - 12.78 ... Number examined ... ... 18 7 2 5 3 2 3 7 10 2 Heights Cms. ... 106.05 1.1185 117.5 118.8 130 128 138.66 144 144.4 ... Ins. ... 41.75 44.03 46.25 46.77 51.18 50.39 54.59 56.69 56.85 ... Ins. ... +1.20 + 1.15 +1.80 +.17 + 2.45 -.66 + 1.49 + 1.03 -.92 ... ROMAN CATHOLIC— Weights Kilos. ... 17.78 19.75 20.3 21.36 28.6 27.6 29.66 32.77 37.3 ... Lbs. ... 39.19 43.54 44.75 47.09 63.05 60.84 65.38 72.24 82.23 ... Lbs. ... -.01 + 1.84 -2.75 -5.01 + 7.55 - 1.16 - 2.72 - 4.16 -4.97 ... Number examined ... ... 9 1 2 1 1 ... 2 7 ... Heights Cms. ... 106.33 124 119 113 ... 138 ... 148 148.28 ... Ins. ... 41.86 48.81 46.85 44.48 ... 54.33 ... 58.26 58.37 ... Ins. ... + 1.31 + 5.93 + 2.40 -2.12 ... +3.28 ... + 2.60 + .60 ... THE VALENTINES— Weights Kilos. ... 17.24 24.8 22.5 23.8 ... 28.6 ... 34.3 35.8 ... Lbs. ... 38 54.67 49.60 52.46 ... 63.05 ... 75.61 78.92 ... Lbs. ... - 1.2 + 12.93 + 2.10 +.36 ... +1.05 ... -.79 -8.28 ... 113 Girls—continued. Number examined ... ... 8 1 ... ... ... 1 ... 8 4 ... Heights Cms. ... 101.62 126 ... ... ... 131 ... 137.75 146.75 ... Ins. ... 40 49.60 ... ... ... 51.57 ... 54.23 57.77 ... Ins. ... -.55 + 6.72 ... ... ... + .52 ... - 1.43 ... ... LITTLE HEATH— Weights . Kilos. ... 16.77 26 ... ... ... 27 ... 32.97 35.04 ... Lbs. ... 36.97 57.31 ... ... ... 59.52 ... 72.68 78.04 ... Lbs. ... -2.23 + 15.61 ... ... ... -2.48 ... -3.82 — 9.16 ... 114 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 1912, 2,945 certificates were issued, and the causes of exclusion may be roughly classified as under :— Diseases of Ear 23 ,, ,, Eye 47 ,, ,, Nose 1 ,, ,, Skin 267 Dirty Heads 40 Dirty condition of Clothing and Person 32 Infectious Diseases 74 Ringworm 22 Swollen Glands 105 Sore Throats 368 Tubercular Diseases 18 Enlarged Tonsils 3 Heart Affection 1 All other Diseases 397 Total 1,398 Certificates of fitness to attend school were given in 1,547 instances. The number of certificates granted in previous years have been as follows:— In 1911 4,520 In 1910 2,876 In 1909 1,813 In 1908 1,882 In 1907 2,070 In 1906 1,665 In 1905 1,493 In 1904 1,518 Table showing the Reasons why Cases were Presented for Special Medical Inspection in 1912. SCHOOL All Schools Downshall Cleveland Christchurch Loxford Highlands South Park Uphall National & Church Infants Newbury Park Goodma yes Chadwell Barkingside Roman Catholic Valentines Little Heath Sex 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 \1 F M F M F Suspected Verminous Children 1 – – – – – – – – – – – – – – – – – 1 – – – – – – – – – – – – – Head Dirty and Verminous – 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 – – Mental Deficiency 7 7 – 3 3 – – 2 – 1 – – – – – – – – – – 1 – – – – – – – 2 1 – – Speech Defective 1 – – – – – 1 — – – – – – – – – – – – – – – – – – – – – – – – – Hearing Defective 2 – – – 1 – – – – – – – – – – – – – – – – – – – – – – – – – – Vision Defective 10 16 — — 1 2 2 1 — 1 — — — 1 3 3 2 — — – — – — – – — 2 8 — — — — Malnutrition and Debility 6 2 – 1 – – – – – – – – – – – – 1 – – – 1 1 – – – – 2 – – – 2 – Nose and Throat Affections – 3 – – – – – 1 – – – – – – – 1 – – – – – – – – – – – – – 1 — — Tonsils Enlarged — 3 – – – – – – – – – 2 – – – 1 – – – – – – – – – – – – – – – – Adenoids 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Eye Diseases 3 3 — — – – – – – 2 – – – – – – – – – – – – – – – – – – – – – – Ear Diseases 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Heart Affections 4 2 — 1 – – – – – 1 – – – – – – 4 – – – – – – – – – – – – – – – Lung Affections 3 – – – – – – – – – – – – – 1 – – – – – – – – – – – – – – – – – Other Chest Affections 2 – – – – – – – – – – – – – – – 2 – – – – – – – – – – – – – – – Nervous Affections 3 – 1 — 1 — — — – – – – – – – – – – – – – – – – – – 1 – – – – – Deformities – 2 – 1 – 1 – – – – – – – – – – – – – – – – – – – – – – – – – – Skin Diseases 2 – – – – – – – 1 – – – 1 – – – – – – – – – – – – – – – – – – – Rupture 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 – – – Other Affections 1 – – – 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – Totals 48* 39 1 6 7 3 3 4 3 5 — 2 3 1 5 5 9 – 2 – 2 2 – – – — 5 8 3 3 2 – * This figure is not identical with the number of Special Boys examined, some of the Children having been presented for more than one reason. 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 the District during 1912. School All Schools Downshall Cleveland Christchurch Loxford Highlands South Park Uphall Nat. & Ch. Inf'ts Newbury Park Goodmayes Chadwell Barking side Roman Catholic Valentines 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 Clothing Dirty or in need of repair 8 1 1 – – – – – – – – – – – 4 1 – – 1 – – – – – 1 – – – 1 – – – Head Dirty and Verminous 146 65 8 1 15 7 8 — 34 8 4 3 5 4 31 20 11 8 11 2 3 3 3 2 6 1 3 3 2 1 2 2 Ringworm 4 3 — — — — 1 1 1 — 1 — — 1 1 — — 1 — — — — — — — — — – – – – – Body Dirty 3 — — — — — — — — — — — — — 2 — — — — — — — — – – — – — 1 – – – Speech Defective 1 — – – – – – – – – – – – – – – – – – – – – 1 – – – – – – – – – Hearing Defective — 1 — — — 1 — — — — – – – – – – – – – – – – – – – – – – – – – – Vision Defective 86 46 5 7 10 8 7 2 16 10 9 4 4 – 12 7 4 3 5 1 3 1 3 1 3 – 3 1 – – 2 1 Teeth Dirty, Foul or Carious 96 25 9 2 9 3 5 – 26 2 5 2 7 3 18 10 5 1 4 – 2 1 1 – 3 – 1 – – – 1 1 Nose and Throat Affection 16 5 2 1 1 – 2 1 – 1 1 – 1 – 1 1 1 1 3 – – – 1 – 1 – 1 – – – 1 – Coryza 1 1 – – – – – – – – – – – 1 – – – – – – – – – – – – 1 – – – – – Tonsils Enlarged 47 33 2 5 3 3 7 – 14 5 3 2 4 3 7 6 2 2 1 1 1 1 – 2 – 1 2 – – – 1 2 Adenoids 1 3 – 2 – – – – 1 – – 1 – – – – – – – – – – – – – – – – – – – – Glands Enlarged 1 – – – – – – – – – 1 – – – – – – – – – – – – – – – – – – – – – Eye Diseases 6 4 — — 2 – — — — — — — 2 1 2 2 – – – – – – – 1 – – – – – – – – Ear Diseases 28 13 1 — 3 1 3 1 8 4 3 – 2 1 2 1 2 1 – 1 – – 3 1 — 1 1 – — – – 1 Heart Affections 10 3 — – 1 1 — 1 2 1 — 1 – — 1 — – 4 – — – 1 — — — — — — – – – Lung Affections 14 4 3 – 2 – — – 3 — 1 — 1 3 1 1 1 – 1 – – – – – 1 – – – – – – – Other Chest Affections 17 6 2 – 2 3 — – 2 3 — – – – 7 – 1 – 1 – – – – – – – – – – 2 – Epilepsy, &c. 2 – – – – — — – –_ — — – 1 – 1 – – – – – – – — — — — — – — — — — Deformities of Spine 5 3 — — 2 1 – — 1 — 1 — 1 2 — – – – – – – – – – – – – – – – – – Other Deformities 7 1 – — 1 — 1 1 — — 2 – 1 – — – – – 1 – – – — — 1 — – — — — — — Skin Diseases 2 – – – 1 – – – – – – – – – 1 – – – – – – – – – – – – – – – – – Anæmia 3 1 — — 1 — — — — 1 — – – – – – 1 – – – – – – — — — 1 — — – – – Worm 8 3 2 — — — 1 — 1 — 1 – 1 1 2 2 – – – – – – – – – – – – – – – – Rupture 2 — — — — — — — — — — — – – – — — — 1 – — — — — — – 1 — — — — — Paralysis 1 – – – – – – – – – – – 1 – – – – – – – – – – – – – – – – – – – General Physical Condition 4 1 — — — — 1 — — — — – 2 1 – – – – 1 – – – – – – – – – – – – – Other Diseases 4 – 2 – 1 – – – – – 1 – – – – – – – – – – – – – – – – – – – – – Totals 523 222 37 18 54 27 37 6 108 36 34 12 34 21 92 52 28 17 34 5 9 6 13 7 16 3 14 4 4 1 9 7 _ 115 1 have also examined 36 teachers for the Education Committee during the year. In addition, 7 children have been examined by me as to their fitness to attend special schools, 2 have been sent to Schools for the Deaf, and 1 to a Blind School. GENERAL STATEMENT OF EXTENT AND SCOPE OF MEDICAL INSPECTION. 164 visits were made to the 34 different departments in the 16 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 2,982, 1,538 boys, 1,444 girls, and 79 cases (40 boys and 39 girls) presented for special examination. The total time occupied by these examinations was 249 hours and 45 minutes, or an average of 4.90 minutes per child. 57 per cent. of the parents were present at these examinations. 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 — 395 113 69 60 58 Girls 1 316 116 72 57 64 Totals 1 711 229 141 117 122 10-11 11-12 12-13 13-14 14-15 — Boys 46 57 424 308 8 — Girls 54 63 383 313 5 — Totals 100 120 807 621 13 — 116 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 4.90 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. CONDITION OF THE SCHOOL CHILDREN AS REVEALED BY MEDICAL INSPECTION. Clothing.—This is carefully examined as to quality, sufficiency and cleanliness. The condition found on inspection can hardly be called the normal condition of the clothing, owing to the notice given beforehand to the parents. The child usually has on its best clothes and newly-washed body linen. In the case of some of the less fortunate children, the clothing is even sometimes borrowed, and the child may have on more clothing for the occasion than hygiene necessitates. Even allowing for these circumstances, no less than 26 per cent. of the children examined were found to be wearing clothing that was considered to be below the standard of the 117 well-clothed child. In four cases the clothing was of such a nature as to be very injurious to the child's health, and notice was sent to the parents,. The principal defects in children's clothing noted were :— (a) Substitution of Flannelette for the very necessary Flannel or Wool.—The flannelette, although cheaper to buy, is not really economical, as it wears away rapidly. It has also the disadvantage of being inflammable, and, worst of all, it has little capacity for retaining the heat of the body. (b) Unequal Distribution of the Clothing over the Body. —This was specially noticed in many girls ; the upper part of the body being well clothed, but the lower extremities being only clothed in flannelette or cotton with stockings. Many parents do not realise that the short petticoats worn by school girls are of little value in warming the body. It is satisfactory to note that an increasing number of girls are wearing woollen combinations, together with flannel "bloomers." This is the most suitable underclothing for a growing girl. (c) The too early use of Corsets.—These are considered harmful to young girls by most authorities. There is no reason except custom for their presence. The clothing was generally found to be in good repair, but occasionally an unfortunate child was found to be pinned u;., buttons being conspicuous by their absence. Owing to reasons mentioned above, but little clothing was found to be in dirty state. Actual body vermin were found on four children. Occasionally the marks of vermin bites were detected although the clothing revealed no evidence of vermin. A subsequent unexpected visit to the school, however, showed vermin to be present. 118 Footgear.—In judging of the boots, capability of keeping the foot dry and suitability for the growing foot were the two chief features looked for. 18 per cent. were thought to be markedly deficient in these requirements. Numbers of children undoubtedly suffer from damp feet in wet weather, and are predisposed thereby to colds, bronchitis, and the more serious disease, rheumatism. In 1.2 per cent. the state of the footgear was thought to exert a markedly injurious effect on the child's health, and notices were sent to the parent. The boys in the agricultural parts of the district are of necessity well shod, but the great weight of the country boot must cause fatigue, and the rigidity of the sole predisposes to flat-foot. Some of the elder girls were found to be wearing very high heels, and advice was given that their use should be discontinued. A small number of children absented themselves from school owing to their having no boots, and several children had to be excused from school owing to sores on the feet, usually due to ill-fitting boots. Verminous Conditions.—Body lice have been dealt with above. Careful attention was directed to the presence of vermin in the hair .55 per cent of the girls were found to be actually infected with lice. .18.45 Per cent. of the girls and .76 per cent. of the boys were found to have been recently infected, as shown by the presence of the eggs or "ova" on the hairs. Dealing first with the boys, the condition is usually a temporary one, due to infection from a sister or playmate. The problem does not lie here, but with the girls. There has undoubtedly been an improvement here during the year, due to a more healthy public opinion and the labours of the School Nurse. Unfortunately there are still many bad cases met with of neglect in this respect. Not a few children are known to the School Medical Officer who have been infested with lice for months and even for years. It will probably be necessary before long to proceed to strong 119 measures against neglectful parents, and should the Education Authority decide to take legal proceedings they will undoubtedly have the moral support of the community. By far the greater number of the cases of infection found in the schools are of slight degree, and indicate recent contamination by a dirty child, for which the parent of the clean child cannot always be blamed. But few parents will be now found who will excuse the presence of living vermin in the hair, as used to be done in old days. There still remains, however, a remarkable indifference in some mothers to the presence of the eggs or ova in the hair. The excuse is often made that the eggs are dead. It cannot be too strongly insisted on that the presence of the eggs, whether dead or alive, is the mark of a loathsome insect, and should not be tolerated by any mother who is proud of her children. Mental Condition.—Many children were found to be markedly below the normal level of intellect. There were also some apparently dull children seen who were found on careful examination to be partly deprived of the "avenues of sensation" owing to deafness or defective eyesight. Some children, again, were merely backward owing to long absence from school. Occasional children are met with in which the dulled mentality is due to chronic under-feeding or underclothing. During the year a careful census was made of the numbers of children above the age of eight and on the school roll who were feeble-minded. These children are practically incapable of benefitting from the ordinary class teaching. They respond much more readily to individual teaching and to class teaching (such as manual work) where no strain is put on the reasoning powers. When in the ordinary elementary school they are often a hindrance to the effective teaching of the other scholars. It is to be hoped that before long special schools, followed by permanent supervision, will be provided for these unfortunate children. 120 In September I reported:— While Dr. Oates has been going round the schools on medical inspection, I have asked him to examine and report the number of mentally defective children existing in the schools. At the present time, he reports that there are 54, and their total ages are as under:— Years 8 9 10 11 12 13 14 15 No. of children 11 13 7 5 8 7 2 1 These are all children who can be classified as mentally defective and requiring special treatment. Defects of Speech.—1 per cent. showed various defects of speech. Slight defects of speech, such as lisping and baby-talk, are common amongst the younger children, but are of no permanent importance. The cases of stammering and stuttering which occur amongst the older children are of greater importance. While certain cases improve and get better, a number persist to adolescence and adult life. For these latter nothing except individual careful training from an expert teacher is of avail. At present but little is done amongst poor children for the cure of stammering. It is to be hoped that Education Authorities may see their way in the course of time to give the matter their attention. Condition of the Ears.—1.4 per cent. of those examined were found to be deaf to such an extent that their educational progress was being retarded. In many children an excessive amount of wax was discovered. This is a common cause of slight deafness. Another cause is the presence of adenoids. Continued ear discharge leads ultimately to permanent deafness. The condition of "running ears" was found in 3.2 per cent. of children, and many other scholars were stated to have suffered from it in the past. This state is most often found to be due to the presence of adenoids, and the removal of the latter usually affords a 121 speedy recovery. Other cases follow an attack of scarlet fever. A certain number occur in debilitated children without obvious cause. In one or two instances the discharge had a most offensive smell, so bad in fact that the question of excluding the child from school had to be considered. Diseases and Defects of the Eye.—12.74 per cent. of boys and 14.44 Per cent. of girls examined were found to be suffering from defective vision. The defect was considered to be present in such degree that their capacity for education was impaired, unless spectacles should be used or other medical treatment should be employed. It will be noted that .1 larger percentage of girls than boys suffered from defective eyesight. This is probably due in some degree to the functional stress incidental to the onset of puberty in girls, but to a much larger extent to the strain entailed on the eyesight by fine sewing. The prevention of defective eyesight is a matter of some importance. The principal causes are as follow:— (1) Heredity.—This is of great importance in the condition known as short sight, or myopia. Its influence is probably of small import in the other and more numerous varieties of the defect. (2) Hygienic Conditions.—These, when bad, certainly predispose a child to bad sight. There is no doubt that defects of eyesight that would remain latent in a healthy child soon assert themselves in a debilitated or badly-nourished child. (3) Illumination.—Defective lighting of schools, churches and dwelling houses is an important contributory cause. The child is forced to bring print close to its eyes in a bad light; this leads to excessive convergence of the eyes and consequent strain on the eyeball. 122 (4) Reading and Sewing.—The employment of the glowing eye for near work is a most important factor. The teaching of reading should be postponed to as late an age as possible, and sewing should not as a rule be allowed under the age of ten. Books should be well printed and the paper unglazed. At present the School Medical Officer has little opportunity of advising educational authorities on these matters. If any progress is to be made in the prevention of defective eyesight, the criticism of the Medical Officer should be sought in the above-mentioned branches of the curriculum. It is often stated that we are becoming a nation of spectacled people. This phenomenon is more apparent than real. Owing to the improved hygienic condition of the masses, there would indeed be a lessened prevalence of defective eyseight, were this decrease not largely discounted by the universal literary education of the present day, with its strain on the young eye. A most important feature of the year has been the initiation of a scheme for prescribing spectacles for school children. This scheme does not rank as treatment in the eyes of the Board of Education, and does not require their sanction. The work is carried out by the Assistant School Medical Officer during his spare time. One of the empty rooms in the Public Health Department has been fitted up as an examination room. In one corner a small dark-room has been boarded up. This contains an electric lamp, and can be used not only for the examination of the eye but for use in the diagnosis of diseases of the ear, nose and throat. In one corner of the room are the test types for testing the acuteness of vision. These are arranged on a revolving frame and illuminated by a powerful lamp. A set of trial lenses, frames, etc., have also been purchased. 123 No charge is made for the examination of the eyesight. Those cases requiring glasses can obtain them from a local optician who has contracted to supply them at the following prices:— Steel frames, 2s. a pair. Nickel frames, 3s. and 3s. 6d. Rolled gold, 4s. 6d. These figures cover the cost of all spectacles except certain expensive kinds which are not often required. The prescription having been taken to the optician, he fits the glasses and the child returns with them to the School Medical Officer. The latter ascertains that the prescription has been correctly carried out and that the spectacles fit the child. If any defects in fit are noticed, the child returns to the optician, who is instructed how to remedy them. The majority of parents are both willing and able to purchase the necessary spectacles for their children. In a few cases of great poverty advantage has been taken of a small voluntary fund to pay the whole or part of the cost of the glasses. It is desirable that some permanent provision should be made for supplying spectacles free of charge to necessitous children. The expenditure of two or three shillings on a pair of spectacles often puts a great strain on the family exchequer, and means a lessened expenditure on food and clothing, especially when defective eyesight runs in a family, as it often does. The work of prescribing spectacles was started in July, 1912. 155 children (66 boys and 89 girls) have been examined. Of these, 12 boys and 17 girls were found not to require glasses. Two cases were referred to hospital for surgical 124 treatment. The defects found in the remaining children may be classified roughly as follows:— Boys. Girls. Hypermetropia 8 13 Hypertrophic Astigmatism 10 22 Mixed Astigmatism 6 8 Myopic Asstigmatism 10 15 Myopia 13 9 47 7 Included amongst the above were 6 boys and 4 girls who were suffering' from squint in addition to an error of refraction. The majority of cases examined had been diagnosed at the routine medical inspection and referred to the School Medical Officer by the School Nurse. A certain number were sent to the department by their teachers on suspicion of having defective eyesight. Others, again, were brought by their parents for advice on the matter. A few words may be said as to the method of examination employed. In all children under eight years of age atropine ointment is used to dilate the pupils and paralyse the muscles of accommodation. In children over eight atropine is not used unless there is any special indication for it, but homotropine and cocaine drops are instilled into the eye at the time of examination. In certain of the older children no mydriatic is required. There is need for some insistence on the fact that the examination of the eyes of children necessitates the use of poisonous drugs, the use of which must be carefully regulated. Many sight-testing opticians claim to be able to test correctly children's eyesight without the use of a mydriatic drug. This claim is confuted by the unanimous opinion of 125 the leading ophthalmic surgeons that such a drug is almost always necessary, and should only be administered under medical supervision. Arrangements have been made to keep all cases treated in the department under supervision until they leave school. Most of the children will be examined in two years' time and a change of glasses ordered if necessary. Unlike the adult eye, the eye of the child is in a state of growth, and hence the strength of lens necessary to correct the refractive error may vary from time to time. Certain children are found to require more constant supervision, and attend the department at shorter intervals of time. Treatment of Squint.—This condition urgently requires treatment when noticed in a child. The wearing of spectacles is often sufficient to bring the eyes into line and cure the condition. In certain cases this measure is insufficient, and recourse must be made to an operation to bring the eye straight. 22 cases of squint were detected during the medical inspection. At the eye department 10 cases obtained treatment by spectacles. In two cases it was found necessary to refer the parents to a hospital for the necessary surgical treatment. Nutrition.—The estimation of the degree of nutrition involves several considerations, such as physique, muscular development, firmness of subcutaneous tissues, facial appearance, redness of mucous membranes, condition of hair, eyes, etc., 1,262 were considered to show good nutrition, 1,502 normal nutrition, 217 poor, 1 very poor. The greater number of children were classified as normal, but it must not be thought that normal in this case means satisfactory. We should like to see all children classified as having good nutrition. At present there is much room for improvement. Lack of food is, of course, of minor importance in a district such as Ilford. Rather more importance must be attached 126 to the use of unsuitable food, especially in infancy and early childhood. The matter lies beyond the purview of the school doctor at present, and we can only hope that increasing knowledge of hygiene amongst parents will lead to improvement. Dental Condition of School Children.—Of the children examined during the year, 62 per cent, showed from one to six decayed teeth, 3.5 per cent. had more than six decayed teeth, being a total of 1,963, or 65.5 per cent., having decayed teeth, and only 34.5 per cent. of the children had no decayed teeth. The growing child is specially prone to show the evil effects of dental caries, the most constant being slight degrees of debility and anaemia, followed by disturbances of digestion and impairment of nutrition. Should the caries progress sufficiently to destroy the whole or part of the tooth, the sufficient mastication of the food may be impossible, and the food is in consequence digested with difficulty. Lastly, toothache may be present. This is often a source of much misery to the child. The remembrance of a decayed tooth is offen one of the earliest and most vivid that the adult retains through life. The predisposing factors of dental caries are twofold : defective enamel of the tooth and the presence of decomposing food on the surface of the enamel. The latter factor can be minimised in importance by the use of the tooth brush. Defective enamel is the heritage of ill-health in early infancy —a matter that is beyond the purview of the School Medical Officer at present. The most easily carried out methods for preventing the onset of dental caries are the daily use of a tooth brush and the eating of fruit, such as apples, that have a cleansing action on the teeth. Early treatment of the condition by 127 filling the carious cavity is also to be ranked as a measure of prevention, inasmuch as the condition is at once prevented from spreading. The question of treatment is thus linked up with the means of prevention. The alternative to filling a decayed tooth is to extract it. This should rarely be necessary provided the teeth have been carefully looked after. Unfortunately this counsel of despair is too often the only treatment adopted. The teeth of children should not be extracted unless there is severe toothache, or serious overcrowding of teeth, or else the doctor is satisfied that the presence of the decayed teeth is injuriously affecting the child's health. The consequence of extracting the first teeth is to prevent proper development of the lower jaw, and consequent overcrowding of the permanent teeth. What, then, is to be done with decayed teeth in childhood? The treatment should be essentially conservative, that is to say, it should aim at taking the decay at its earliest stages and preserve the teeth. The first of the permanent teeth appears in or about the seventh year of life, and it is to the preservation of the important permanent teeth that the attention of the dentist should be directed. The problem confronts the educational authorities as to how best to deal with dental caries, now that they have legal powers and some financial inducement to do so. The matter has already been approached in some districts by the appointment of special school dentists. Is there any need for a school dentist in Ilford? From the experience of the School Medical Inspector practically nothing is done by parents at present to treat dental caries. There are some three or four qualified dentists practising in Ilford, and there is reason to think that their time is already fully occupied in the treatment of adults. Possibly one or two of them could give part of their time to the treatment of school children. The 128 alternative is to appoint a salaried full-time dentist. The recovery of a small fee from each parent and the allotment of a Government grant would go wholly or a long way to meeting this expense. It is no exaggeration to say that such an expenditure would be repaid over and over again in the increased health and vigour of the coming generation. Throat and Nose Conditions.—In 3 per cent. of children adenoids were present in sufficient amount to cause harm, and in 1.5 per cent. they urgently required removal. The diagnosis of this condition and its harmful effects have been fully dealt with in previous reports. The question of the prevention is one that must be faced in the future, although but little can be done while children under five are not subjected to regular medical supervision. The conditions which are usually thought to initiate the disease are:— (1) Lack of use of the handkerchief in young children; (2) inattention to the cleansing of the nose in infants; both these conditions causing (3) mouth breathing, with its attendant troubles. (4) All these three may be traced to a chronic catarrh of the nose, which in turn is often due to (5) confinement in a vitiated atmosphere, especially the air of the bedroom with closed windows. These hints as to the causation of adenoids may appear far-fetched, but the sequence of events is logical and clear, and rests on a physiological basis. Certain cases of adenoids occur in exceptionally well cared for children, in whom no predisposing cause can be ascertained. These cases seem to be "natural variation," and may possibly have some hereditary cause. 129 Slight enlargement of the tonsils was detected in 13.7 per cent. of the children, and considerable enlargement, generally necessitating an operation, in 5 per cent. children. Many cases of these enlarged tonsils were co-existent with the presence of adenoids, the two conditions being closely related. Glands.—The condition of the glands in the neck is easily ascertained by the medical examiner, and affords a more useful indication of the general health and vigour of the child. One should not be able to feel the glands in a perfectly healthy child. Nevertheless 40 per cent. of the school children examined showed slight enlargement of the glands, 17 per cent. showed great enlargement, and in 4 cases the glands were so large as to urgently require medical treatment. The chief causes of enlarged glands are:— (1) Catarrhal conditions of the nose and throat. (2) Enlargement of the tonsils and adenoids. (3) Tuberculosis. (4) Carious teeth. (5) Constitutional weakness. Diseases of the Chest.—Many children were found to be suffering from bronchitis to some extent. This is usually a temporary condition due to catarrh. In the course of inspection only the front and upper part of the chest is examined, unless any suggestive signs lead to further examination. In spite of this incomplete examination, it is improbable that any cases of chest disease are overlooked. Pulmonary Tuberculosis.—Two cases were notified to the Medical Officer of Health during the year. The disease was diagnosed by examination of the chest, and the causative 130 organism was in no case to be found in the available sputum. This is the usual thing in children, and makes the disease most difficult to diagnose. Phthisis may be said to be a rare disease in childhood. The treatment of this disease has a bright outlook before it. Owing to the provision of sanatoria and dispensaries under the National Insurance Act, and the appointment of Tuberculosis Officers, there will be no difficulty in obtaining treatment for these cases. Most school children are dependants on insured persons, and will probably be eligible for treatment under the new insurance regulations. INFECTIOUS DISEASE. On examining the table on the opposite page it will be seen that the total amount of infectious disease in the schools during 1912 has been slightly less than in 1911. The great decline in Measles has been made up by the increase in Mumps and Whooping Cough. Mumps was very prevalent at one time in South Park, Cleveland Road, Christchurch Road, Uphall and Newbury Park schools, Whooping Cough at Downshall, Christchurch Road and Loxford schools. An outbreak of Measles occurred at Loxford, Cleveland Road and Downshall schools at the end of the year. Apart from this the schools had been very free from Measles during the greater part of the year. No schools have been closed for epidemic reasons, but Loxford Junior Mixed was closed by the Authority for a few days in December on financial grounds, arising out of the bad attendance from Measles and other causes. The figures for Scarlet Fever and Diphtheria have fallen. There having been only 78 cases of the latter disease during 1912 is a satisfactory feature. The numbers for Ringworm are also down, and it is to be hoped that this is the beginning of more satisfactory figures in the future as the result of the efforts the Education Authority have made and are making to eliminate this disease from the schools. 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, 1912. SCHOOLS. Average Attendance. DISEASES AND CONTACTS. Scarlet Fever. Diphtheria. Enteric Fever. Measles. German Measles. Chicken Pox. Mumps. Whooping Cough. Ringworm. Totals. 1912. Totals. 1911. Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases tsm Downshall 1332 24 30 12 28 — — 64 6 3 1 22 5 6 1 96 13 12 239 84 331 118 Cleveland Road 1362 14 13 10 9 1 1 72 54 2 2 23 18 85 4 22 9 9 238 110 227 95 Christchurch Road 1182 17 15 11 11 — — 1 — 3 2 55 20 78 9 54 8 19 238 65 193 95 Loxford 1146 7 7 3 5 — — 84 57 1 — 54 22 24 — 56 9 30 259 100 205 60 Highlands 888 23 37 — — — — 12 4 — 2 16 7 13 1 24 8 8 96 59 243 68 South Park 848 20 17 10 13 — — 9 — 2 8 22 8 109 5 42 11 9 223 57 265 96 Uphall 1033 27 42 — — — — 6 15 — 1 2 3 53 3 34 10 14 136 74 255 145 National and Church Infants 456 3 6 2 5 — — 1 3 — — 25 22 18 1 13 10 5 67 47 64 94 Newbury Park 497 7 20 2 7 — — 1 2 — — 14 4 55 5 14 6 4 97 44 77 76 Goodmaves 774 37 ? 6 7 — — 3 — 1 2 12 3 8 — 31 2 5 103 35 253 69 Chadwell 278 — 4 1 7 — — 8 9 — — 1 4 1 — 3 0 7 14 25 5 3 Barkingside 249 3 3 2 5 — — — — — — 2 2 2 — 18 20 1 28 30 12 4 Roman Catholic 283 1 1 1 — — — 2 2 — — 2 2 10 2 12 7 5 33 14 16 8 Aldborough Hatch — — — — — — — — — — — — — — — — — — — — 1 5 Valentines 101 1 1 3 1 — — 1 — — — 7 13 — — — — 2 14 15 5 9 Little Heath 133 — — 4 2 — — — — — — — — — — — — — 4 2 1 18 County High School ? 1 8 1 5 — — — — — — — — — — — — — 3 13 5 19 Private Schools ? 23 13 10 11 1 — — — — — — — — — — — 34 24 22 16 Totals ? 208 238 78 116 2 1 264 152 12 13 257 133 463 31 419 114 123 1826 798 2191 998 132 SCARLET FEVER. The total number of cases of this disease in the schools has been slightly greater than in 1911. There was a troublesome series of cases in Goodmayes Junior Mixed, mostly occurring in one class-room. Every child attending this class was examined, but no satisfactory cause could be discovered. The room was thoroughly disinfected and all articles likely to contain infection were destroyed. The head teacher took great personal interest in the matter, and everything was done to avoid overlooking any intermediate cause of infection. Some more cases occurred, however; another inspection was made, but nothing definite discovered. The room was again disinfected and its use discontinued for a time, when the trouble come to an end. Great care is taken to exclude any children from school with a sore throat, or who exhibit any suspicious symptoms, but mild cases are frequently discovered, either in the course of medical inspection or from the examination made when they attend at the Public Health Offices for other reasons. So long as mild cases escape observation, it is obvious that there is continual danger of infection to the other children. The Council took into consideration the question of appointing another nurse to watch these cases, but decided not to take further action in the matter, at any rate at present. SCARLET FEVER. Table showing the Number of Cases of Scarlet Fever and the Contacts Involved excluded in connection with the Schools, also Total Comparisons with 1911. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1912. Totals 1911. 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. Cases. Conts. Downshall 1332 6 6 1 1 2 3 4 4 1 – – – 1 – 1 – 4 9 3 4 – 1 1 2 24 30 44 49 Cleveland Road 1362 1 2 1 — — — 2 2 1 – – – – – – – 1 1 2 2 3 2 3 4 14 13 22 19 Christchurch Road 1182 — — 3 3 3 4 1 2 2 2 5 3 — — – — – – 1 – 1 1 1 17 15 13 21 Loxford 1146 1 — — — 1 — 2 1 — 3 – 1 1 2 – – – – 1 – – – 1 – 7 7 5 7 Highlands 888 — — 1 1 1 2 – – 5 3 2 3 – – 1 3 1 2 3 6 8 13 1 4 23 37 17 18 south Park 848 5 1 1 2 2 3 3 1 – – 1 2 1 1 – – 2 2 – – 2 1 3 4 20 17 18 19 Uphall 1033 2 2 3 5 5 17 4 9 3 3 2 2 2 – – – 1 1 2 2 2 – 1 1 27 42 15 23 National and Church Infants 450 1 1 – – – – – – – – – – – – – 9 – – – – 9 3 3 6 4 5 Newbury Park 497 – – 2 8 1 3 2 4 1 1 3 – – – – – – – – – 1 – 7 7 20 24 34 Goodmayes 774 2 – 4 1 12 12 3 1 6 3 4 1 1 – 1 – 1 – 2 3 – – 1 – 37 ?1 13 8 Chadwell 278 — – — — — — – – – – – – – – – – – – – 4 – – – – – 4 – – Barkingside 249 – – 1 — – – – 1 – – 1 – – – – – – 1 – – – – 1 1 3 3 – – Roman Catholic 283 – – – – – – – – – – 1 1 – – – – – – – – – – – – 1 1 2 3 Valentines 101 — 1 — — — — — — — — – – 1 1 – – – – – – – – – – 1 1 – – Little Heath 133 — – — — — — – – – – – – – – – – – – – – – – – – – – 4 6 County High School ? — 1 – 1 – 1 – – – 2 – 1 – – – 1 – 1 1 – – – – – 1 8 – 8 Private Schools ? 2 – 3 – 5 1 2 4 2 1 3 2 – – – – – – – 2 6 3 — — 23 13 10 12 Total ? 19 12 21 23 32 46 23 29 21 17 20 19 7 4 3 4 10 19 15 23 22 21 15 21 208 238 191 232 134 DIPHTHERIA. There was a slight decrease in the prevalence of this disease in the schools for 1912. It will be seen from the table on the opposite page that there was no great incidence in any one particular school, and the cases were fairly evenly distributed through the year. Swabs are taken from any suspicious case, and if the specific bacillus is found the child is excluded until a negative result is obtained. Whether the mere presence of the Klebs Lœffler bacillus in the throat is a possible danger I am not at present prepared to say, but it seems to me safer to err on the side of extra caution than to run any risk. To render this condition dangerous certainly seems to require other factors, but what those factors are it is extremely difficult to state at present. There appears to be some evidence in this district that the prevalence of offensive smells of a particular character have some influence in assisting the growth of this organism. More than one case was discovered in the course of the examination of children at the Public Health Offices in the morning. DIPHTHERIA. Table showing the Number of Cases of Diphtheria and the Contacts Involved excluded in connection with the Schools, also Total Comparison with 1911. SCHOOLS. Average Attendance. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1912. Totals 1911. 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. Cases. Conts. Downshall 1332 3 4 – – – 7 – – 1 3 1 4 2 3 – – 1 – – 3 1 – 3 4 12 28 19 24 Cleveland Road 1362 – 1 – 1 4 3 1 — 2 4 — — 1 — — — — — — — — — 2 — 10 9 10 15 Christchurch Road 1182 — 1 2 2 1 — — — 2 — 1 3 — — 1 1 1 — — 1 1 1 2 2 11 11 4 6 loxford 1146 1 2 – – – – – – – – – – – – 1 3 1 – – – – – – – 3 5 2 8 Highlands 888 – – – – – – – – – – – – – – – – – – – – – – – – – – – 5 South Park 848 1 1 1 – 7 6 – – – 1 – – – – – – – – – 3 1 – – 2 10 13 12 9 Uphall 1033 – – – – – – – – – – – – – – – – – – – – – – – – – – 7 12 National and Church Infants 456 – – – – – – – – – 1 – – – – – – 1 2 1 2 – – – – 2 5 1 7 Newbury Park 497 – – 1 2 1 2 – – – – – – – – – – – – – 3 – – – – 2 7 4 19 Goodmayes 774 1 – – – 2 – – 1 – – – – – – 1 2 – – 1 1 1 1 – – 6 7 5 6 Chadwell 278 – – – – – – – – – 4 1 3 – – – – – 1 7 2 249 – – 1 2 – – – – – – – – 1 3 – –— — — – — — — — – 2 5 2 8 Roman Catholic 283 – – 1 – – – – – 1 – 2 3 101 3 1 – – – – – – – – – – – – – – – – – – – – – – 3 1 8 7 Little Heath 133 – – – – – – 2 — 2 2 — — – — — — — — — — — — — — 4 2 2 6 County High School ? — 2 – – – – – – – – – – – – – – – – – 1 – – 1 2 1 5 1 9 Private Schools ? 2 3 – – – 1 1 – – – 1 1 1 – – – – 1 4 1 – 2 1 2 10 11 8 3 Totals ? 11 15 6 7 15 21 4 1 7 15 4 11 5 6 3 6 4 3 6 15 4 4 9 12 78 116 82 144 136 MEASLES. The table on the opposite page gives a very interesting summary of the cases of this disease for 1912. It will be observed that, with the exception of Downshall in May and June, how remarkably free the schools were from this disease until November is reached. In that month Loxford and Cleveland Road became affected. In December there was an expressed desire to close Loxford Junior Mixed, but, as I had been carefully watching the epidemic, it seemed to me undesirable to close the school when the epidemic was at its worst. The Education Authority, however, on financial grounds anticipated the Christmas holidays by about 10 days, so that the school was closed for 16 school days in all. Of course, one might be always closing schools for Measles, if this procedure was carried out when it would be likely to do most good—at the beginning of an outbreak. It is practically impossible to do this, also, too, the association of children together out of school in a district of this sort is so close that even then the desired object is not attained. On the other hand, to close a school when the epidemic is at its height is obviously useless and is undesirable from a health standpoint, as thus all knowledge of the occurrence of cases is lost. The prompt and careful exclusion of particular scholars seems to me undoubtedly the most satisfactory method to adopt, and the one likely to give the best results. MEASLES. Table showing the Number of Cases of Measles and the Contacts Involved excluded in connection with the Schools, also Total Comparison with 1911. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1912. Totals 1911. 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 Cases. Conts. Downshall 1332 — — — — — — 1 — 47 3 15 3 1 — — — — — — — — — — — 64 6 199 39 Cleveland Road 1362 — — — — 2 — — — — — — — 2 1 1 1 1 — — 6 15 60 37 72 54 104 39 Christchurch Road 1182 — — 1 — — — — — — — — — — — — — — — — — — — — — 1 — 124 48 Loxford 1146 — — — — — — — — — — 2 — — — — — — — — 1 25 28 57 28 84 57 110 29 Highlands 888 — — — — — — 1 — — — — — 1 1 — — — — — 4 2 —8 8 3 12 4 131 29 South Park 848 — — — — — — — — — — 1 — — — — — — — — — 3 — 5 — 9 — 185 56 Uphall 1033 1 — — — — — — — — — 1 — — — — — 1 — 1 1 — 6 2 8 6 15 90 36 National and Church Infants 456 — — — — — — — — — — — — — — — — — — — — — — 1 3 1 3 32 55 Newbury Park 497 1 — — — — — — — — — — — — — — — — — — — — 2 — — 1 2 39 23 Goodmayes 774 — — — — — — — — — — — — — — — — 1 — — — — — 2 — 8 — 154 32 Chadwell 278 — — — — — — — — — — — — — — — — — — — — — — 8 9 8 9 1 — Barkingside 249 — — — — — — — — — — — — — — — — — — — — — — — — — — 4 — Roman Catholic 283 — — — — — — — — — — — — — — — — — — 1 — — — 1 2 2 2 5 2 Valentines 101 — — — — — — — — — — — — — — — — — — — — — — — — 1 — 2 2 Aldborough Hatch — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 1 Little Heath 133 — — — — — — — — — — — — — — — — — — — — — — — — — — 2 2 County High School ? — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — Private Schools ? — — — — — — — — — — — — — — — — — — — — — — — — — — 4 1 Totals 5 2 — 1 — 3 — 2 — 47 3 19 3 4 2 1 1 3 — 2 2 36 51 144 90 264 152 1188 398 138 GERMAN MEASLES. From the table on the opposite page it will be seen that there have only been 12 cases of this disease reported for the year from the schools. The system adopted with all these infectious diseases is for the Teacher or Attendance Officer to report any cases coming to their knowledge to the School Medical Officer, and, as the Attendance Officer visits the Public Health Office every morning, fairly complete information is obtained. The only difficulty experienced is that, owing to the exigencies of the attendance system, the cases are not always reported so promptly as to obtain the best results from a preventive point of view. During the year the Health Visitor has given very valuable assistance in following up and investigating some of these so-colled minor infectious diseases, and so assisting in obtaining more effective preventive measures. GERMAN MEASLES. Table showing the Number of Cases of German Measles and the Contacts Involved excluded in connection with the Schools also Total Comparison with 1911. SCHOOLS. Average Attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1912. Totals 1911. 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 1332 ... 1 ... ... ... ... ... ... l ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 1 15 3 Cleveland Road 1362 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 2 20 9 Christchurch Road 1182 1 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 2 2 4 Loxford 1146 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 23 6 Highlands 888 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 33 12 South Park 848 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 1 2 3 13 7 Uphall 1033 ... ... ... ... ... l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 8 National and Church Infants 456 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 9 Newbury Park 497 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... Goodmayes 774 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 17 5 Chadwell 278 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Barkingside 249 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 Roman Catholic 283 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... Valentines 101 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Little Heath 133 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... County High School ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Private Schools ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ? 1 2 ... 2 2 1 1 1 2 2 2 1 ... ... ... ... ... ... ... ... l 2 3 2 12 13 138 64 140 CHICKEN POX. The number of cases of this disease reported from the schools has been slightly larger for 1912 than in the previous year. Christchurch Road and Loxford were the two schools mostly affected. It will be seen from the table opposite, however, that most of the other schools were more or less affected. Now Chicken Pox is an extremely infectious disease, and it is very curious that when a case or two occurs in a school, in some instances there is a fairly heavy incidence on that particular school, while in other instances nothing further occurs. At Loxford it will be seen that in September there were 3 cases, and in the following month 23 cases were reported. On the other hand, take Downshall, where in several months 2 or 3 cases were reported, nothing further developed. The care and attention of the Head Teacher undoubtedly often has a marked effect, but in the case of Loxford the Head Teacher was most intelligently careful and observant, but did not meet with the reward that should follow such efforts. CHICKEN POX. Table showing the Number of Cases of Chicken Pox and the Contacts Involved excluded in connection with the Schools, also Total Comparison with 1911. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. J uly. Aug. Sept. Oct. Nov. Dec. Totals 1912. Totals 1911. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Casss. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Downshall 1332, ... ... 1 ... 3 1 ... ... 9 1 3 2 ... ... ... ... ... ... 2 ... 2 1 2 ... 22 5 5 2 Cleveland Road 1362 3 1 6 7 1 1 1 ... 1 1 1 1 1 ... ... ... ... ... 1 ... 7 7 ... ... 23 18 15 9 Christchurch Road 1182 ... ... 2 2 3 ... 1 1 11 2 21 8 12 3 ... ... 2 2 ... ... 1 ... 1 ... 54 18 21 12 Loxford 1146 1 ... 1 ... 2 2 9 3 ... ... ... ... ... ... ... ... 3 1 23 5 15 11 ... ... 54 22 17 9 Highlands 888 2 3 1 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 7 1 3 2 1 ... 16 7 19 1 South Park 848 ? 5 2 1 1 ... 1 ... ... ... 6 1 9 1 ... ... ... ... 1 ... ... ... ... ... 22 8 5 3 Uphall 1033 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 2 ... ... ... ... 2 3 80 56 National and Church Infants 456 1 4 1 1 1 1 ... 2 16 8 5 4 ... ... ... ... ... ... 1 2 ... ... ... ... 25 22 5 15 Newbury Park 407 2 ... ... ... 9 2 2 ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 4 ... ... Goodmayes 774 ... ... 3 1 2 ... 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 1 12 3 48 17 Chadwell 278 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 ... ... ... ... ... ... 1 4 ... ...... Barkingside 249 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 2 2 2 ... Roman Catholic 283 ... ... ... ... ... ... ... ... 1 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... The Valentines 101 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5 2 8 ... ... 7 13 ... ... Little Heath 133 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 County High School ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 Private Schools ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ? 11 13 18 13 22 7 19 6 40 17 37 16 23 4 ... ... 6 7 41 15 31 30 8 3 256 131 220 130 142 WHOOPING COUGH. On examining the opposite table it will be seen that there was a considerable excess of cases of this disease in 1912 as compared with 1911. Also that they nearly all occurred in the first six months of the year. Whooping Cough has a very disastrous effect on the attendance in the schools, as it may be a considerable time before the child recovers sufficiently to render it desirable for it to return to its studies. Even if the infection is at an end, the debilitating effect of an attack of Whooping Cough is often very marked, sapping its vitality and rendering the child unfit to attend school from that cause. Often, too, running concurrently with Whooping Cough, a large number of the children develop a cough which it is extremely difficult to determine, as a precursor of Whooping Cough or merely the result of a "cold." The worst result is the carrying of the infection into the home, and frequently the younger member of the family, under 2 years of age, contracts the disease, with a fatal result. Although Downshall heads the list with the greatest number of cases, it is apparent that nearly all the schools were affected about the same time, though the incidence on Highlands was curiously different. WHOOPING COUGH. Table showing the Number of Cases of Whooping Cough and Contacts Involved excluded in Connection with the Schools. also Total Comparison with 1911. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1912. Totals 1911. 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. Conta. Cases. Conta. Downshall 1332 1 1 6 4 23 4 34 2 20 ... 12 2 ... ... ... ... ... ... ... ... ... ... ... ... 96 13 4 ... Cleveland Road 1362 17 2 1 5 2 ... ... ... ... ... 1 2 ... ... 1 ... ... ... ... ... ... ... ... ... 22 9 30 4 Christchurch Road 1182 9 1 11 2 24 5 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 54 8 13 4 Loxford 1140 2 2 5 1 13 2 10 2 19 1 3 1 ... ... ... ... ... ... 4 ... ... ... ... ... 56 9 10 1 Highlands 888 ... ... ... ... ... ... ... ... 2 1 8 ... 8 ... ... ... ... ... 1 ... ... ... ... ... 24 8 32 1 South Park 848 0 1 4 5 9 4 9 1 6 ... 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... 42 11 16 2 Uphall 1033 2 2 2 1 2 ... 7 2 4 1 8 4 9 ... ... ... ... ... ... ... ... ... ... ... 34 10 28 10 National and Church Infants 456 7 4 2 4 1 1 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 10 2 3 Newbury Park 497 ... 1 1 ... 2 3 11 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 6 ... ... Goodmayes 774 1 ... 2 ... 13 ... 6 1 3 ... 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... 31 2 ... 1 Chadwell 278 ... ... ... ... ... ... 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... Barkingside 249 ... ... 1 ... 15 17 1 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 18 20 ... ... Roman Catholic 283 3 2 4 ... 4 3 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 12 7 1 ... Valentines 101 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Little Heath 133 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... County High School ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Private Schools ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 54 4 16 39 22 108 39 93 13 55 4 37 10 23 8 5 2 2 ... 6 ... 1 ... 2 ... 419 114 137 26 144 MUMPS. The year 1912 was characterised by a considerable number of cases of this disease. On looking at the table opposite it will be seen that nearly all the larger schools were affected throughout the district. Mumps is a troublesome disease to manage in connection with schools, as the incubation period, 17 to 19 days, is so long. Generally speaking, once started it goes on for three or four months. The epidemic was mild in character, and there were no serious results brought to my notice. There is often a good deal of confusion in the parent's mind between swollen glands in the neck, and mumps, but care has been taken to eliminate the former, so that I believe the figures opposite to be fairly accurate as to the actual incidence. MUMPS. Table showing the Number of Cases of Mumps and Contacts Involved excluded in Connection with the Schools, also Total Comparison with 1911. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1912. Totals 1911. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Cases. Downshall 1332 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 1 6 1 33 1 Cleveland Road 1362 1 ... 2 1 1 ... 2 ... 9 ... 29 1 24 2 2 ... 9 ... 2 ... 2 ... 2 ... 85 4 5 ... Christchurch Road 1182 ... ... 13 2 8 ... 15 ... 15 ... 16 2 11 2 ... ... ... ... ... ... ... ... ... ... 78 9 1 ... Loxford 1146 2 ... 3 ... 2 ... 2 ... 4 ... 3 ... 5 ... ... ... 1 ... ... ... 2 ... ... ... 24 ... 3 ... Highlands 888 ... ... ... ... 1 ... ... ... ... ... 5 1 ... ... ... ... ... ... 3 ... 3 ... 1 ... 13 1 8 ... South Park 848 ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... ... ... 3 ... 7 ... 41 ... 55 ... 109 5 1 ... Uphall 1033 1 1 ... ... 2 ... 5 ... 7 ... 21 ... 11 2 ... ... 2 ... 2 ... 2 ... ... ... 53 3 16 ... National and Church Infants 456 ... ... ... ... 1 ... ... ... 1 1 5 ... 10 ... ... ... ... ... ... ... ... ... 1 ... 18 1 ... ... Newbury Park 497 ... ... ... ... 1 ... 3 1 11 1 21 ... 16 3 ... ... 1 ... ... ... ... ... ... ... 55 5 2 ... Goodmayes 774 ... ... ... ... ... ... ... ... 2 ... 5 ... 1 ... ... ... ... ... ... ... ... ... ... ... 8 ... 5 ... Chadwell 278 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 3 1 Barkingside 249 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... ... Roman Catholic 283 ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... ... 2 ... ... ... ... ... 3 2 10 2 3 ... Valentines 101 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Little Heath 133 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... County High School ? ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Private Schools ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ? 5 1 18 3 16 3 27 1 55 2 108 4 81 9 4 ... 18 17 ... 51 1 63 7 463 31 80 4 146 RINGWORM. From the figures given in the table, it will be seen that there has been a diminution in 1912 of the number of cases of this disease reported. From the increased attention and care given to this disease, I think that this result is satisfactory. Not so much, perhaps, that the efforts made are diminishing the disease, though I hope that is so, but that with the increased care taken this diminished number represents all the cases that have occurred in the schools. The heaviest incidence has been on Loxford School, the same as last year, and this is very curious, seeing the great trouble that was taken with that school. At an examination of the heads made by the Health Visitor several children were discovered suffering from Ringworm, and from evidence obtained it seemed probable that the source of infection was rather outside the premises, or, rather, perhaps, the evidence pointed to some of these excluded children having been infected from an outside source. It is a question whether really satisfactory results will be obtained until there is some suitable method evolved of dealing with this outside danger. It is one full of difficulty, however, at present, but requires attention for future consideration. TREATMENT. The treatment of Ringworm by the X Rays has been continued without any untoward results, and the particulars of the children treated are given in the following table:— 147 RINGWORM. Table showing the number of Cases of Ringworm in connection with the Schools, also Total Comparison with 1911. Schools. Average Attendance. January. February. March. April. May. June. July. August. September. October. November. December. Totals, 1912. Totals, 1911. Downshall 1,332 - - 5 1 1 1 1 - 2 1 - - 12 12 Cleveland Road 1,362 1 - 3 — - - - 1 2 1 1 - 9 20 Christchurch Road 1,182 — 1 2 4 1 1 3 2 - 1 3 1 19 15 Loxford 1,146 2 1 5 6 2 - 4 - 10 - - - 30 35 Highlands 888 — 1 2 — - - - - - 4 - 1 8 3 South Park 848 3 1 1 1 - - 1 - - 1 - 1 9 15 Uphall 1,033 — 1 1 — - - - 1 5 5 1 - 14 14 National and Church Infants 456 - - - - - 3 - - - 1 1 - 5 15 Newbury Park 497 — - — — - 2 - - - - 1 1 4 6 Goodmayes 774 — — 1 — — — 1 - - - 1 2 5 10 Chadwell 278 - - - - - - - - - - - - - 1 Barkingside 249 — - - — - - - - - 1 - - 1 3 Roman Catholic 283 — - 1 1 - - - 3 - - - - 5 1 Valentines 101 — - 1 - 1 - - - - - - - 2 - Little Heath 133 - - - - - - - - - - - - - - County High School ? - - - - - - - - - - - - - - Totals ? 6 5 22 13 5 7 10 7 19 15 8 6 123 150 148 28 children have been submitted to the X-ray treatment during 1912:— E. B. suffered from Ringworm 2 months, cured 4 months after X-Rays H. P. „12 months, „ 5 months „ „ C. P. „ „ 9 months, „ 5 months „ „ H. P. „ „ 6 months, „ 2½ months „ „ A. L. „ „ 3 months, „ 1½months „ „ K. C. „ „ 4½ months, „ 1½months „ „ L. L. „ „ 8 months, „ 7 weeks „ „ E. R. „ „ 2½ weeks, „ 3 months „ „ J. B. „ „ 1 month, „ 3½ months „ „ D. K. „ „ 2 months, A. O. „ „ 1 month, „ 2½ months „ „ W. F. „ „ 5 weeks, „ 2½ months „ „ M. R. „ „ 2 weeks, „ 6½ months „ „ A. F. „ „ 4 weeks, „ 5½ months „ „ K. L. „ „ 1 week, „ 2½ months „ „ C. S. „ „ 4 months, „ 2 months „ „ K. G. „ „ 12 months, „ 1½ months „ „ L. C. „ „ 2½ years, „ 4 months „ „ H. P. „ „ 3 months, „ 6 weeks „ „ H. E. „ „ 12 months, „ 8 weeks „ „ A. S. „ „ 6 months, „ 2 months „ „ V. S. „ „ 3 months, „ 2 months „ „ P. J. „ „ 2 years, l½ months „ ,, E. N. „ „ 1 week, „ 2 months „ „ A. N. „ „ 3 weeks, „ 2 months „ „ F. N. „ „ 1 month, „ 2 months „ „ K. B. „ „ 4 months, „ 1½ months „ „ E. B. „ „ 4 months, „ 1½ months „ „ Of course it must be borne in mind that all cases treated by X Ray are extensive in character. DEATHS AMONGST SCHOOL CHILDREN. 21 deaths have occurred amongst children of school age. 1 from Measles. 4 „ Diphtheria. 1 „ Phthisis. 149 3 from Tuberculous Meningitis. 2 „ Other Tuberculous Diseases. 2 „ Organic Heart Diseases, 1 „ Pneumonia (all forms). 1 „ Other Diseases of Respiratory Organs. 1 „ Diarrhoea and Enteritis. 3 „ Other defined Diseases. 1 „ Diseases ill-defined or unknown. I am, Gentlemen, Your obedient Servant, C. F. STOVIN, Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation Hospital. 150 Public Health Department, Ilford, 11th February, 1913. To the Chairman and Members of the ILFORD URBAN DISTRICT COUNCIL. Gentlemen, I beg to present a summary of the work carried out during 1912:— Houses and premises inspected 2,987 Inspections during supervision of works 5.796 Visits during disinfection 1,173 Nuisances detected 823 Nuisances abated 832 Nuisances unabated 106 Notices served 857 Notices complied with 819 Houses disinfected 496 Articles disinfected 4,284 LIST OF NOTICES SERVED AND COMPLIED WITH. Notices. Served. Complied with. Statutory 50 41 Preliminary 326 334 „ by letter 73 40 Paving 29 30 Cleanse water storage cistern 96 115 Cover ditto 25 22 Cleanse room (I.D.P. Act, 1890) 87 88 Cleanse house (Sec. 46, P.H.A., 1875) 6 5 Provide water supply (I.I.A., 1898) 18 18 Provide dustbin 122 103 Housing, Town Planning Act 22 9 Housing Working Classes Act 3 3 857 808 151 COMPLAINTS. Accumulations of manure, refuse, etc. 25 Animals improperly kept 8 Alleged overcrowding 11 Choked drains 58 Decomposing bodies of animals 3 Defective drains and sanitary arrangements 33 Do. roofs, gutters, &c. 2 Houses being damp 8 Insanitary condition of roadway, rearway, etc. 9 Do. do. premises 19 Milkseller not being registered 1 Smoke nuisance 7 Smells pervading neighbourhood 33 Unsatisfactory water supply 1 Water in basement 9 Premises without water supply 27 Squatting of gipsies 5 Miscellaneous 6 Total 265 REMOVAL OF HOUSE REFUSE The following particulars give the number of horses and vans employed and the number of loads of refuse collected each month:— Horses & Vans. Loads. Four weeks ended 27th January 354 1,010 „ „ „ 24th February 355 1,012 Five „ 30th March 447 1,262 Four „ „ 27th April 355 1,015 Five „ „ 1st June 469 1,275 Four „ „ 29th June 382 1,021 „ „ „ 27th July 382 1,030 Five „ „ 30th August 477 1,273 Four „ „ 28th September 384 1,030 „ „ „ 26th October 387 1,030 Five „ „ 30th November 493 1,288 Four „ „ 28th December 375 1,005 Totals 4,860 13,251 152 The loads represent about 17,800 tons. Collection took place on 307 days. Average number of horses per day, 15.50. Average number of loads per horse per day, 2.72. The refuse was disposed of as under:— Deposited in Brown's pit 9,891 loads. „ „ St. Swithin's pit 2,891 „ „ elsewhere 469 „ I am, Gentlemen, Your obedient Servant, F. W. KING, Inspector of Nuisances. It: / ' -Mrr -