CI 1LF 2 AC 44((1) REPORT) URBAN DISTRICT OF ILFORD. ANNUAL REPORT of the Acting Medical Officer of Health Acting School Medical Officer, and Acting Medical Superintendent of the Isolation Hospital, Including the Report of the Inspector of Nuisances, FOR THE YEAR 1913. GEOFFREY EUGENE OATES, M.D., B.S., London, M.R.C.P., London, D.P.I I., Cambridge, of Grays Inn, Barrister-at-Law, Fellow of the Society of Medical Officers of Healthy Fellow of the Royal Institute of Public Health, Member of the Royal Sanitary Institute. ILFORD: South Essex Recorders, Ltd., High Road. URBAN DISTRICT OF ILFORD. ANNUAL REPORT of the Acting Medical Officer of Health Acting School Medical Officer, and Acting Medical Superintendent of the Isolation Hospital, Including the Report of the Inspector of Nuisances, FOR THE YEAR 1913. GEOFFREY EUGENE OATES, M.D., B.S., London, M.R.C.P., London, D.P.H., Cambridge, of Grays Inn, Barristcr-at-Law, Fellow of the Society of Medical Officers of Healthy Fellow of the Royal Institute of Public Health, Member of the Royal Sanitary Institute. ILFORD: South Essex Recorders, Ltd., High Road. 7960 Ilford Urban District Council. PUBLIC HEALTH COMMITTEE, 1913—1914. Councillor B. Bailey, J.P., Chairman. Councillor G. Cushing, Vice-Chairman. Councillor W. T. Cadness. Councillor J. Hawkins. Councillor G. Church. Councillor W. J. O. Sheat, C.C., Councillor W. J. T. Cullis, J.P., (Vice-Chairman of the Council) (Chairman of the Council). Councillor F. D. Smith. Councillor W. Everett. Councillor W. H. Stevens. Councillor G. Gunary. Councillor R. Stroud, J.P., C.A. OFFICERS OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: (Vacant.) Assistant (Acting) Medical Officer of Health: Geoffrey E. Oates, M.D., B.S., M.R.C.P. (Lond.), D.P.H Barrister-at-Law. 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.K. T. V. Haigh, Mem. Royal San. Inst. C. W. Fisher, Assoc. Royal San. Inst. Health Visitor: Miss L. Radford, M.I.H., C.M.B., Assoc. Royal San. Inst Clerk: F. J. Bull. Assistant Clerks: G. A. Aldous. A. A. Rogers. E- C. Burn, A. C. Booth. ISOLATION HOSPITAL. Medical Superintendent: (Vacant.) Assistant (Acting) Medical Superintendent: G. E. Oates, M.D., M.R.C.P., D.P.H. Matron: Miss C. A. Barling. EDUCATION COMMITTEE, 1913—1914. Councillor W. P. Griggs, J.P., C.A., Chairman. *Mr. J. Reynolds, Vice-Chairman. Councillor B. Bailey, J. P. Councillor G. Gunary. Councillor W. T. Cadness. Councillor J. Hawkins. Councilor G. Church. *Mr. D. Hunter. †Councillor W. J. T. Cullis, *Mr. J. Norton. J.P. †Councillor W. J. O. Sheat, Councillor G. Cushing. C.C. Councillor F. H. Dane. Councillor F. D. Smith. *Mr. F. W. Dovey. Councillor W. H. Stevens. *Mr. H. Gilbey, C.C. *Mrs. E. G. Tucker. Councillor W. H. Gillard. Councillor O. Waters. *Co-opted Member. †Ex-officio Member. Secretary to the Committee: W. S. Torbitt, M.A., LL.M. School Medical Officer: (Vacant.) Assistant (Acting) 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, April 28th, 1914. 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 1913. The duties of Medical Officer of Health were Carried out by Dr. C. F. Stovin from the beginning of the year till November 20th, 1913, when he was suspended f-om office by resolution of the Council. I continued the work of Medical Officer of Health until the end of the year. Having acted as Assistant Medical Officer of Health only, during the greater part of the year, it is somewhat difficult for me to bring to bear on the sanitary and epidemiological circumstances of the year that comprehensive knowledge which could only have been gained by one who had actually filled the office throughout the year. Any shortcomings in this Report must therefore be excused by the fact that the author has often had to rely on statistics relating to events and happenings which did not come under his personal knowledge. The health of the district has continued good throughout the year. 6 With regard to the Isolation Hospital, the additional laundry accommodation has now been completed. During the greater part of the year a block of six beds has been utilised for cases of Tuberculosis sent to us by the Essex Insurance Committee. Since February, 1913, all cases of Tuberculosis have been notifiable to the Medical Officer of Health. This has somewhat increased the work of the department. The question of co-operation between the District Council and the County Insurance Committee, in the matter of Tuberculosis, is becoming increasingly important, and it is very necessary that the local Tuberculosis Officer should be formally appointed on the staff of the District Council. The work of the School Medical Service has proceeded throughout the year with good results. The question of appointing a School Dentist has been under the consideration of the Education Committee. The year 1913-14 has been noteworthy for the large grant received from the Board of Education for the School Medical Service. No less a sum than £354 15s. 8d. has been remitted, being exactly half the cost of the service, including all clerical work, rent and rates, heating and lighting. I particularly wish to direct your attention to page 76 of this Report, where the various items from which grant has been received are summarised. In conclusion, I should like to thank the officials of the Public Health Department and the Hospital for the interest and zeal they have shown in the work during the past year. I am, Gentlemen, Your obedient Servant, GEOFFREY E. OATES. M.D., B.S., M.R.C.P. (London), D.P.H. (Cambridge), Barrister-at-Law. CONTENTS. Pages Preface 5 Physical and Geological Features 12 SECTION I. Vital Statistics. Statistical Summary 15 Population 16 Births 17 Diagram showing the Birth-rates for the last 20 years Facing Page 17 Deaths 17 Diagram showing the Death-rates for the last 20 years Facing Page 19 Zymotic Death Rate 19 Infant Mortality 21 Diagram showing the Infant Mortality rates for the last 20 years Facing Page 22 Table IV. of the Local Government Board 23 Notification of Births Act, 1907 24 Number of Births notified 24 Summary of visits paid and particulars obtained under the Notification of Births Act, 1907 25 Mortality in Age Groups 25 Inquests 25 Weekly rainfall for the year 1913 26 Table I. of the Local Government Board 27 ,,III ,, ,, ,, ,, 28 8 CONTENTS. SECTION II. pages Infectious Disease. Infectious Disease 31 Small Pox 32 Vaccination 32 Scarlet Fever 32 ,, ,, Chart Facing Page 32 Diphtheria 33 ,, Chart Facing Page 34 Enteric Fever 34 Erysipelas 35 Puerperal Fever 35 Poliomyelitis and Cerebro-spinal Fever 35 Tuberculosis 36 Pulmonary Tuberculosis 36 ,, ,, Chart Facing Page 36 Tuberculosis (all other forms) 36 ,, ,, Chart Facing Page 38 Measures of Cleansing and Disinfection ... 38 Summary of Non-Pulmonary cases of Tuberculosis 39 Age and sex distribution of Tuberculosis patients 39 Respiratory Diseases other than Phthisis 40 Cancer and Malignant Diseases 40 Table II. of the Local Government Board 41 Table giving Death-rate from various infectious diseases during the last 15 years 42 Isolation Hospital. Diseases treated in Hospital 43 Average lengths of stay in Hospital 43 Percentage of cases notified removed to Hospital 44 Table of Admissions Facing Page 46 Hospital Buildings, accommodation, etc 44 Nursing 46 9 CONTENTS. Section II.—contirued. pages Disinfection 46 Table of Houses and Articles Disinfected 47 Statement as to cost of food Facing Page 48 Diphtheria 48 Scarlct Fever 48 Enteric Fever 48 Erysipelas 48 Pulmonary Tuberculosis 49 Table as to Age and Sex of Scarlet Fever patients admitted 49 Table as to Age and Sex of Diphtheria patients admitted 50 Bacteriological Laboratory: Diphtheria 50 Sputa 52 Ringworm 52 Typhoid Fever 53 SECTION III. Sanitary Administration. Food and Drugs Acts 57 Water Supply 57 Milk Supply 58 Bakehouses 59 Meat Supply 59 Fish Shops 59 Greengrocers' Shops 60 Offensive Trades 60 Factories 60 Workshops and Workplaces 60 Tables of Factories, Workshops, etc 61 Table.—1. Inspections 63 ,, 2. Defects found 64 ,, 3. Homework 65 ,, 4. Registered Workshops 65 „ 5. Other Matters 66 10 CONTENTS. Section III.—continued. pages Housing and Town Planning and Housing of the Working Classes 67 Sewerage and Sewage Disposal 67 Town Ambulance 67 Legal Proceedings 67 Inspection of the District and Abatement of Nuisances 68 Notices Served, &c 69 SECTION IV. Schools. List of Schools 73 Cleanliness and disinfection of Schools 73 The Health Visitor 74 Medical Inspection:— Children examined at the Office 75 Board of Education Grant 76 General Statement of extent and scope of Medical Inspection 77 Condition of School Children as revealed by Medical Inspection 78 Clothing 78 Footgear 79 Verminous Condition 79 Mental Condition 80 Defects of Speech 81 Condition of the Ears 81 Diseases and Defects of the Eye 81 Prescriptions of Spectacles 83 Nutrition 85 Dental Condition of School Children 86 Throat and Nose Conditions 87 Glands 87 Diseases of the Chest 88 Pulmonary Tuberculosis 88 11 CONTENTS. Section IV.—continued. pages Here follow various tables in connection with the School Medical Service. Infectious Disease 101 „ „ Table 107 Scarlet Fever 101 „ Table 108 Diphtheria 102 Table 109 German Measles 102 Measles 102 Table 110 Chicken Pox 103 ,, ,, Table 111 Whooping Cough 103 „ ,, Table 112 Mumps 103 „ Table 113 Ringworm 104 ,, Table 114 Deaths amongst School Children 105 SECTION V. Report of Chief Sanitary Inspector. Inspection of 'the District and the Abatement of Nuisances 117 Housing, Town Planning, &c., Act 118 Complaints 118 Notices Served 120 Summary of Work Done 120 Drainage 122 Hungarian Gipsies 122 Removal of House Refuse 124 12 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 belongs to the lower-middle class, occupying houses of from £20 to £40 a year, with a proportion of other classes. SECTION 1. Vital Statistics. 15 STATISTICAL SUMMARY. Enumerated Population at Census, 1911 78,188 Estimated ,, ,, middle of 1913 82,379 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 9.7 Total number of births registered for 1913 1,505 Representing a birth-rate of 19.15 per 1,000 Total number of births registered for 1912 1,492 Representing a birth-rate of 19.4 per 1,000 Total number of deaths registered for 1913 743 Representing a death-rate of 9.45 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 from the seven principal Zymotic diseases in 1913 42 Representing a Zymotic death-rate of .53 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 under one year of age 102 Giving an Infantile Mortality rate to every 1,000 births registered of 68 Rateable Value—Houses £426,198 10 0 Land 7,313 10 0 £433,512 0 0 Education Rate— Elementary 1s. 6½d. Higher 1d. Education Estimated Expenditure, 1913-14:— Elementary £59,699 2 8 Higher 1,700 0 0 16 POPULATION. The Registrar-General's estimate of the total population of the district for 1913 is 87,040, and deducting the population of the institutions, leaves a nett population of 83,242 for the district proper (including the 1,461 inhabitants of the Village Homes, who have now to be counted as belonging to the district). These institutions are:— Village Homes 1,461 West Ham Asylum 1,085 Claybury Asylum 2,713 There were:— At the Census, 1911— Number of inhabited houses 16,856 Number of uninhabited houses 903 17,759 From the time the Census was taken in 1911 until the 30th June, 1913, there were 676 newly-built houses certified as completed, which brings the total number of houses in the district 17,759 + 676 up to 18,435. It was estimated that there were 500 empty houses in the district on June 30th, 1913, making the total number of occupied houses 17,935. Now the average population per house at the 1911 Census was 4.3. Multiplying, therefore, the figure 17,935 by 4.3, and adding on 1,461, the population of the Village Homes, we get a true estimate of population for the district on June 30th, 1913, as 78,581. By adding on the population in West Ham and Claybury Asylums, we get the true gross population, 82,379. Estimated gross population 82,379 Estimated net population 78,581 Diagram showing Birth-Rates for the last 20 Years. 17 There has therefore been an increase in a period of a year of 1,764 in the gross population (including institutions), and an increase of 1,716 in the nett population. There seems to be good reason to predict a substantial increase in population during the next few years. There is at present but little empty property in Ilford, and signs are everywhere manifest of an increased activity in the building trade. BIRTHS. The total number of births registered during 1913 was 1,505 (757 males and 748 females), giving a birth-rate of 19.15 per 1,000. Of the above, 16 males and 16 females were illegitimate. As compared with 1912 there was a slight increase in the number of births, but the rate per 1,000 of population is lower, and is indeed the lowest yet recorded in this district. As will be seen from the chart, the drop in the birth-rate in the last ten years has been very great. DEATHS. The total number of deaths registered during 1913 was 1,077. The total number of deaths registered for the district, apart from institutions, was 743. This includes deaths at:— The Infirmary, Romford 40 The Essex and Colchester Asylum 32 The London Hospital 32 The Children's Hospital, Great Ormond Street 4 Guy's Hospital 4 18 The East London Hospital 3 The Poplar Hospital 3 Leytonstone 2 Southend-on-Sea 2 The Cancer Hospital, Chelsea 1 The Throat Hospital, Golden Square 1 The Middlesex Hospital 1 The Queen's Hospital 1 The London Temperance Hospital 1 The Hospital, East Ham 1 The Prince of Wales' Hospital, Tottenham 1 St. Mary's Hospital, Paddington 1 St. Mark's Hospital, City Road 1 West Ham Hospital 1 University College Hospital 1 Bethnal House Asylum 1 The Seamen's Hospital 1 St. Bartholomew's Hospital 1 The National Hospital, Queen's Square 1 The Friedenheim Hospital 1 The Royal Victoria Hospital 1 West Ham Union Infirmary 1 38, Elliott's Row, Southwark 1 St. Luke's House, 14, Pembridge Square 1 Highgate Railway Station 1 Basinghall Street, City 1 Worthing 1 Bexhill 1 Hammersmith 1 Marylebone 1 Bournemouth 1 Bishops Stortford 1 East Ham 1 Ilfracombe 1 Wharfedale 1 Margate 1 Total 154 Diagram showing Death-Rates for the last 20 Years. 19 The number of non-residents dying in the district may be seen from the following:— Claybury Asylum 208 West Ham Asylum 116 Deaths in the district of other non-residents 7 Total 331 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 residents, the death-rate for the past year was 9.45, or corrected for sex and age the rate is 10.05 Per 1,000 of the population. The district therefore continues to exhibit its usual low death-rate. There is a slight increase on the previous year, the increase being mainly under the headings of Measles, Pneumonia and Bronchitis. The diagram on the opposite page gives at a glance the position of this rate, as compared with previous years. On referring to Table III. at the end of this section, it will be seen that of the defined diseases Cancer is recorded as the cause of the largest number of deaths, 78. Organic heart disease comes next with 71, and Phthisis with 51. Bronchitis and Pneumonia were responsible for 50 and 49 deaths respectively. Zymotic Death-rate. The total number of deaths registered from the seven principal Zymotic diseases for the year 1913 was 42, giving a Zymotic death-rate of .53 per 1,000. 20 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 I904 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 1912 36 .46 This rate is a very sensitive test of the health of the district. The rate for 1913 was very low, and has been exceeded in every previous year with the exception of 1910 and 1912. Just as in 1912, there was only a slight incidence of summer diarrhœa. Any epidemic of this disease tends to send the Zymotic death-rate up considerably. The absence of any death from Enteric Fever is also a noticeable feature. The seven diseases included in this rate are:— Diseases. Deaths. Small-pox — Measles 19 Scarlet Fever 1 Whooping Cough 3 Diphtheria and Membranous Croup 5 Enteric Fever — Diarrhœa 14 Total 42 21 Infant Mortality. The infant mortality rate for the year 1913 is 68 per 1,000 births registered. In previous years the total numbers of deaths and the rates have been as follow:— 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 1912 94 63 This infant mortality rate of 68 is very satisfactory, and has only been surpassed in 1912 when it was 63. The slight rise is due to no particular cause, the climatic conditions having been much the same in each year. It is satisfactory to note that no death from Whooping Cough occurred. 22 Premature Birth accounted for 19 deaths out of a total of 102; Atrophy, Debility, and Marasmus for 17 deaths. These two causes are the most serious blots on the infant mortality record. 11 deaths from Diarrhœa are recorded. This is a disease in which hygienic surroundings and proper treatment go a long way to aid recovery. Many slight cases come to the knowledge of the Health Visitor, and the prompt action usually taken by Miss Radford has in many cases cut short the disease and averted a possible death. Diagram showing the Infantile Mortality Rates for the last 20 Years. 23 TABLE IV. INFANTILE MORTALITY. 1913. 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 2 3 Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - 2 - 2 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - 1 — 1 Meningitis (not Tuberculous) - - - - - - 1 - 1 2 Convulsions 1 - - — 1 2 1 1 — 5 Laryngitis - - - — — — — — — — Bronchitis - - - - - 2 i 4 1 8 Pneumonia fall forms) - 1 - — 1 3 3 2 3 12 Diarrhœa - - - — — 9 2 — — 4 Enteritis - - - — — 2 1 2 2 7 Gastritis - - - — — — 1 — - 1 Syphilis - — - — — 2 — — — 2 Rickets - - - — — — — — 1 1 Suffocation, overlying - - - — — 1 — 1 — 2 Injury at Birth - - — — — — — — — — Atelectasis 2 - - — 2 — — — — 2 Congenital Malformations 5 1 - - 6 - 1 - - 7 Premature Birth 14 - 2 1 17 2 — — — 19 Atrophy, Debility, and Marasmus 4 — 3 1 8 5 4 — — 17 Other Causes 1 1 - - 2 3 1 1 - 7 Total 27 3 5 2 37 24 16 15 10 102 24 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 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 personal advice given, according to the circumstances of the case. Further, visits are paid if deemed desirable from the information obtained. The total number of births notified under the Act was 1,541, separated into wards as under:— Cranbrook Ward 138 Park Ward 258 Seven Kings Ward 197 North Hainault Ward 100 Loxford Ward 280 Clementswood Ward 352 South Hainault Ward 216 Total 1,541 The following gives the percentage of notifications by the various responsible persons:— By Medical Men 46.8 By Midwives 20.3 By Parents and others 28.2 By Parents, on Registrar's suggestion 4.5 25 Summary of Visits Paid, and Particulars Obtained under the Notification of Births Act, 1907, by the Health Visitor. Visits paid:— First Visits 1,322 Subsequent Visits 2,270 Persons in attendance on Mother:— Medical Practitioners 1,027 Midwives 280 Other Persons 3 Feeding:— Natural 1,107 Artificial 145 Mixed 16 Premature Births 47 Stillborn Births 36 Illegitimate Births 20 Deaths of Infants (up to two weeks of age) 16 ,, ,, (from two weeks to 12 months) 40 Normally Healthy Children 1,175 Weakly Children 79 Children suffering from Eye Affections 14 Condition of homes:— Good 357 Fair 757 Poor 183 Mothers who go out to work 73 ,, ,, take work in 7 The above figures are not altogether complete, as information on various points was not obtainable; hence the apparent discrepancy. Mortality in Age Groups. Under 1 year 25-45 years 45-65 years 65-75 years 102 103 166 113 75-85 years 85-95 years Over 95 years 112 27 1 INQUESTS. 34 inquests have been held during the year. 26 WEEKLY RAINFALL FOR THE YEAR 1913. Week ended Rainfall in inches. Week ended Rainfall in inches. Jan. 4th .19 July 5th .26 „ 11th .88 „ 12th .67 ,, 18th .76 „ 19th .79 „ 25th .51 ,, 26th .08 Feb. 1st .44 Aug. 2nd Nil „ 8th .19 „ 9th .08 „ 15th .19 „ 16th .19 ,, 22nd .05 „ 23rd .20 Mar. 1st .08 „ 30th .78 „ 8th .11 Sept. 6th 1.07 „ 15th .40 „ 13th .07 ,, 22nd .86 „ 20th .57 „ 29th .39 „ 27th .18 Apr. 5th .38 Oct. 4th .18 „ 12th .44 „ 11th 1.18 „ 19th .38 „ 18th .19 „ 26th .36 „ 25th .72 May 3rd 1.02 Nov. 1st 1.11 „ 10th .46 „ 8th .39 „ 17th .02 „ 15th 1.44 „ 24th .03 ,, 22nd .57 „ 31st .38 „ 29th .03 June 7th .28 Dec. 6th .16 „ 14th .09 „ 13th .04 „ 21st .05 „ 20th Nil „ 28th .03 „ 27th .44 „ 31st Nil Total rainfall for the year, 20.36 inches. TABLE I. Vital Statistics of Whole District durino 1913 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. Un-corrected Number. Nett. of Non-Residents registered in the District. of Residents not registered in the District. Under 1 Year of age. At all ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 ii 12 13 14 1908 76,295 71,221 1,653 ? 23.2 836 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 88 1910 85,522 75,327 1,679 ? 222 772 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 ? 194 828 10.3 313 126 94 63 641 8.3 1913 82,379 78,581 1,485 1,505 1915 920 11.6 331 154 102 68 743 9.45 27 28 TABLE III. Causes of, and Ages at Death during the Year 1913. 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 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 and upwards. 1 2 3 4 5 G 7 8 9 10 11 Enteric Fever - - - - - - - - - - Small-pox — — - - - - - - - - Measles 19 3 5 9 2 - - - - - Scarlet Fever 1 .— 1 - - - - - - 1 Whooping Cough 3 — 2 — 1 — — — — — Diphtheria and Croup 5 — — 1 4 — — — — 3 Influenza 10 — 1 — — 1 - 5 3 2 Erysipelas 1 — — — 1 — — — — — Phthisis (Pulmonary Tuberculosis) 51 1 - - 4 12 21 11 2 37 Tuberculous Meningitis 15 2 2 4 2 4 1 — — 2 Other Tuberculous Diseases 7 — 1 1 1 2 2 — - 6 Cancer, Malignant Disease 78 — — — 1 1 7 39 30 18 Rheumatic Fever — — — — — — — — — - Meningitis — — — — — — — — — — Organic Heart Disease 71 — — — 4 6 9 22 30 30 Bronchitis 50 9 3 3 1 — 1 5 28 22 Pneumonia (all forms) 49 10 — 4 1 1 11 13 9 30 Other Diseases of Respiratory Organs 8 - - 2 - - 1 1 4 6 Diarrhoea and Enteritis 14 11 - - - - - 1 2 3 Appendicitis and Typhlitis 2 — — — 1 — 1 — — — Cirrhosis of Liver 13 — — — — 1 — 10 2 2 Alcoholism 1 — — — —. - - 1 — — Nephritis and Bright's Disease 19 - - - - 2 6 5 6 12 Puerperal Fever 4 — — — — — 4 — — 2 Other accidents and diseases of Pregnancy and Parturition 1 - - - - 1 - - - - Congenital Debility and Malformation, including Premature Birth 43 43 - - - - - - - 5 Violent Deaths, excluding Suicide 16 3 1 - 1 3 4 2 2 2 Suicide 4 — — — — — 3 1 — — Other Defined Diseases 140 9 2 1 8 3 24 39 54 144 Diseases ill-defined or unknown 118 11 4 - 2 1 8 11 81 42 Totals 743 102 22 25 34 38 103 166 253 369 SECTION II. Infectious Disease. 31 INFECTIOUS DISEASE. During 1913 notifications were received of 643 cases. ,, 1912 „ „ „ 666 „ 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 1913. L.C.C. Asylum, Claybury. West Ham Borough Asylum. Erysipelas 1 Nil THE VILLAGE HOMES, BARKINGSIDE. Scarlet Fever 4 cases Diphtheria 17 cases Erysipelas 3 cases Pulmonary Tuberculosis (Phthisis) 14 cases Other forms of Tuberculosis 34 cases 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. The water and milk supply is investigated and the names of persons who have been in contact with the case. Careful search is also made for the existence of any nuisance. All the particulars are reported to the Medical Officer of Health, who then takes any further steps which may be necessary. 32 SMALL-POX. No case of this disease has been notified in the district for 1913. The addresses in this district of several persons who had been in contact with a case of Small-pox on board ship were received at various times. These were all followed up, and observation exercised until the incubation period was safely ended, but no further development took place in any of these instances. VACCINATION. The Vaccination Officer informs me that during the year 765 primary vaccinations were performed. Taking the number of births as being 1,500 in the year, we see that at the most half the children born in Ilford are vaccinated. This is a most serious state of things from the public health point of view. The introduction of two or three cases of Small-pox into Ilford would lead to many other cases in susceptible contacts, and in all probability a devastating epidemic would ensue before there would be time to protect, by vaccination, all the unvaccinated inhabitants. SCARLET FEVER. Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1913 231 1 .01 .43 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 364 2 .04 .75 SCARLET FEVER 33 The disease is dealt with at greater length in the report of the School Medical Officer. There was no excessive incidence of Scarlet Fever as compared with previous year, and the type of disease continued to be mild in form and not dangerous to life. Whether this will remain so for long is very doubtful. Infectious diseases have their periods of quiescence as at present. But it would not be surprising if the virulent type of Scarlet Fever seen twenty or thirty years ago were again to make its appearance. DIPHTHERIA. Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1913 125 5 .06 4.0 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 .l6 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, the number of cases notified remains steady as compared with the three previous years. The chant shews the number of cases 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 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 34 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. Seventeen cases of Diphtheria were notified during the year from the Village Homes, Barkingside. I mention this because of the infrequent occurrence of epidemics of infectious disease at this well-managed institution. The Medical Superintendent, Dr. Robert Milne, is well known for his original methods of controlling infectious disease by inunction of the skin and swabbing of the throat. This method of treatment has undoubtedly proved its efficiency in his hands, but is adversely criticised by many prominent authorities who have given it a trial. ENTERIC FEVER. Year. Cases. Deaths. Rate per 1,000 Per cent. of Cases Notified. 1913 3 Nil Nil Nil 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 In one of these cases there was a history of the patient consuming a bottle of cockles sent from the Isle of Wight DIPHTHERIA. 35 16 days previous to the onset of the illness. Another case was notified from West Ham Hospital, cause of infection unknown. In the third case no probable source of infection could be traced. ERYSIPELAS. Year. Cases. Deaths. Rate per 1,000. Par cent. of Cases Notified. 1913 32 1 01 3.12 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 Most of the cases notified were mild in character. PUERPERAL FEVER. Year. Cases. Deaths. Rate per 1,000. Per cent. of Cases Notified. 1913 4 4 04 100.0 1912 6 3 03 16.66 1911 4 I 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 POLIOMYELITIS AND CEREBRO-SPINAL FEVER. No cases of these diseases were notified, 36 TUBERCULOSIS. PULMONARY TUBERCULOSIS. 143 cases have been notified, 14 of which belonged to the Village Homes. 51 deaths from Pulmonary Tuberculosis have been recorded as belonging to this district, giving a death-rate of .6 per 1,000. TUBERCULOSIS (ALL OTHER FORMS). 105 cases of all other forms of Tuberculosis have been notified, 34 of which belonged to the Village Homes. 22 deaths have been recorded as belonging to this district, giving a death-rate of .3 per 1,000. 52 houses have been disinfected after Tuberculosis. On receipt of a notification, a visit is paid as speedily as possible to the patient by the Medical Officer of Health or the Sanitary Inspector. Much discretion is needed in visiting these cases, and care is taken that the patient is not subjected to any annoyance. For instance the relatives of the patient may object to information of the nature of his disease reaching the patient. Again, the patient may wish the nature of the disease kept strictly private; for instance, a domestic servant or a lodger in a private house. The object of notification is to ensure that every person suffering from Tuberculosis is placed in the best position possible from the point of view both of curing the disease and of preventing its spread. It is my experience that a great proportion of the cases notified are under proper medical care. The recent appointment of a Tuberculosis Officer by the Essex Insurance Committee has ensured that no case lacks medical care. The more effective modes of treatment—in a sanatorium or hospital—are unfortunately still out of the reach of many; although in the course of time, no doubt, this deficiency will be remedied. The second object mentioned is the control of PULMONARY TUBERCULOSIS. 37 the spread of the disease. Cases of Pulmonary Tuberculosis are usually infectious to a greater or less extent. But provided the patient takes certain necessary precautions, the risk of communicating the disease to other individuals is minimised, although probably never absent. My experience has been that most consumptives notified to me become quickly educated to a sense of responsibility, and do their best to prevent risk of infection. It is remarkable to what extent the public mind has changed in its outlook towards the infectious nature of Phthisis. Not only is the nature of the disease, its curability and its infectious nature more clearly grasped, but there is occasionally a tendency to even exaggerate the danger of infection of a healthy person by a consumptive. Nothing could be more unfortunate than this. Provided a consumptive takes certain precautions, he is often a harmless and indeed may be a most useful member of society. From February 1st, 1913, Tuberculosis not only of the lungs but of every part of the body was made compulsorily notifiable by the issue of the Public Health (Tuberculosis) Regulations, 1912. The cases of Non-Pulmonary Tuberculosis notified during the year are classified below. It must be noted that many of these cases are of long standing, and there is no means of ascertaining what proportion are fresh cases arising during the year. For this reason, the number of cases notified during the year is exceptionally heavy, and will probably never be exceeded in subsequent years, when fresh cases only will be notified. The same inquiries are made in cases of Non-Pulmonary Tuberculosis as are made in Pulmonary Tuberculosis, and the sanitary condition of the house is carefully examined. It may be remarked that many nuisances, some of a grave nature, were brought to light during these visits. Dampness is the most important nuisance found to require remedying, and a distinct impression is left in my mind that dampness 38 is especially common in houses from which cases of Tuberculosis are notified. No systematic inquiries were made during the year as to the source of milk supply. In an urban district such as Ilford the milk supply is very mixed, and it would not seem to be a very hopeful line of investigation to attempt to trace the connection between bovine Tuberculosis and notified cases of Tuberculosis. Cases have not been usually visited subsequently during the year, except for some special reason, such as disinfection after removal. Cases of suspected Tuberculosis associated with notified cases of the disease have been in some cases referred to the private medical attendant for investigation. No arrangement has been made during the year to utilize the services of the Tuberculosis Officer or Nurses for any of the purposes arising out of notification. This matter is at present receiving careful consideration by the Council. MEASURES OF CLEANSING AND DISINFECTION. Every facility and inducement is given to obtain disinfection of rooms and bedding where necessary; for instance, after death or removal of the patient. Formalin is used to spray the walls of infected rooms. Information is given as to the utilization of beds in the Isolation Hospital for the treatment of cases of Tuberculosis in another part of this report. Following on the notification of Pulmonary Tuberculosis 117 first visits and 50 subsequent visits were paid to the patients. Following on the notification of other forms of the disease, 64 first visits were paid and 11 subsequent visits. TUBERCULOSIS (OTHER FORMS). 39 Summary of Cases of Non-Pulmonary Tuberculosis. Glands of Neck 24 Spine 13 HiP 18 Knee 6 Abdominal Glands 1 Meningitis 7 Peritoneum 3 Glands 9 Arm 2 Thigh 1 Finger 2 Ankle 3 Leg 1 Skin 4 Eye 12 Throat 1 Bladder 1 Shoulder 1 Testicles 1 Intestines 1 Pleura 1 The following distribution with regard to sex and age of Tuberculosis patients may be of interest:— Diseases. Sex. Under 1 year 1 to 5 years. 5 to 15 years. 15 to 25 years. 25 to 35 years. 35 to 45 years. 45 to 55 years. 55 to 65 years. Over 65 years. Totals. Pulmonary Tuberculosis M - 1 6 8 22 14 7 4 8 65 F — 2 '20 16 19 14 4 2 1 78 Tuberculosis (all other forms) M - 4 16 6 3 1 1 — — 32 F 3 6 24 31 7 1 - 1 — 73 40 RESPIRATORY DISEASES OTHER THAN PHTHISIS. Per 1000 In 1913 there were 107 deaths, giving a death-rate of 1.36 ,, 1912 ,, 75 ,, ,, ,, .9 ,, 1911 ,, 81 ,, ,, ,, 1.1 ,, 1910 ,, 88 ,, ,, ,, 1.1 ,, 1909 ,, 107 ,, ,, ,, 1.4 ,, 1908 ,, 93 ,, ,, ,, 1.3 ,, 1907 ,, 105 ,, ,, ,, 1.5 ,, 1906 ,,88 ,, ,, ,, 1.3 ,, 1905 ,, 88 ,, ,, ,, 1.4 CANCER AND MALIGNANT DISEASE. Per 1000 In 1913 there were 78 deaths, giving a death-rate of 1.0 ,, 1912 ,, 75 ,, ,, ,, .9 ,, 1911,, 58 ,, ,, ,, .7 ,, 1910 ,, 62 „ ,, ,, .8 ,, 1909 ,, 57 ,, ,, ,, .7 ,, 1908 ,, 55 ,, ,, ,, .7 ,, 1907 ,, 42 ,, ,, ,, .6 ,, 1906 ,, 54 ,, ,, ,, .8 ,, 1905 ,, 33 ,, ,, ,, .5 This is the highest death-rate yet recorded for this disease. After making allowance for any change in the ageconstitution of the population, there is, I think, an undoubted increase in the incidence of the disease. 41 TABLE II. Casks of Infectious Disease Notified during the Year 1913. 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 J4 15 16 17 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C) Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 125 1 15 96 7 5 1 ... 3 9 22 40 11 27 13 84 Erysipelas 32 ... 1 5 4 10 9 3 4 4 3 5 4 10 2 2 Scarlet Fever 231 ... 34 173 13 11 ... ... 22 24 24 21 30 74 36 191 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 3 ... ... 1 2 ... ... ... 1 1 ... ... 1 ... ... 1 Relapsing Fever (R) Continued Fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... ... ... ... 4 ... ... ... ... ... 1 ... 3 ... 2 Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 143 ... 3 26 24 69 17 4 ... 20 14 24 29 32 15 ... Other forms of Tuberculosis 105 4 10 40 37 12 2 ... 6 15 18 38 9 13 6 ... Totals 643 5 63 341 87 111 29 7 45 73 81 129 84 159 72 280 42 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 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 39 5 .06 286 1 .01 4 ...... ...... 6 3 .03 ...... 4 .04 76,865 1913 32 1 .01 125 5 .06 231 1 .01 3 ...... ...... 4 4 .04 ...... 19 .24 78,581 43 ISOLATION HOSPITAL. Number of patients in Hospital at beginning of year:— Scarlet Fever 36 Diphtheria 11 Number of patients admitted during the year: — Scarlet Fever 191 Diphtheria 84 Erysipelas 2 Puerperal Fever 2 Enteric Fever 1 Pulmonary Tuberculosis 27 Number of patients remaining in Hospital on 1st January, 1914:— Scarlet Fever 43 Diphtheria 16 Number of deaths, and death-rates per cent. of cases admitted to the Hospital during the year, showing comparison with 1911 and 1912:— Number of Deaths. Death-rate per cent. 1911 1912 1913 1911 1912 1913 Scarlet Fever 3 1 1 1.2 .46 .52 Diphtheria 7 4 3 75 4.08 3.57 Puerperal Fever - - 2 - — 100.0 Enteric Fever 2 - - 50.0 - — The following shows the average length of stay of patients in the Hospital:— Scarlet Fever. Days. Average days in Hospital 36 cases of Scarlet Fever in Hospital on 1st January, 1913 929 25.8 147 recovered cases of Scarlet Fever 7,177 48.8 1 fatal case of Scarlet Fever 14 14.0 43 cases of Scarlet Fever in Hospital on 1st January, 1914 1,301 30.2 Average stay in Hospital of Scarlet Fever Patients - 41.5 44 Diphtheria. Days. Average days in Hospital 11 cases of Diphtheria in Hospital on 1st January, 1913 276 25.1 65 recovered cases of Diphtheria 2,471 38.01 3 fatal cases of Diphtheria 4 1.33 16 cases of Diphtheria in Hospital on 1st January, 1914 396 24.1 Average stay in Hospital of Diphtheria patients — 33.1 Enteric Fever. 7 recovered case of Enteric Fever 47 47 Erysipelas. 2 recovered cases of Erysipelas 28 14 Puerperal Fever. 2 fatal cases of Puerperal Fever 44 22 Pulmonary Tuberculosis. 27 cases of Pulmonary Tuberculosis 1,741 64.5 Average number of patients in Hospital per day - 39.5 Average stay in Hospital of all patients — 40.7 Percentage of cases notified removed to the Isolation Hospital Scarlet Fever 82.68 Diphtheria 67.2 Enteric Fever 33.3 Erysipelas 6.25 Puerperal Fever 50 THE HOSPITAL. The present Isolation Hospital was built in 1898 and added to in 1902. The original Hospital consisted of three 45 block.;, containing; respectively 10, 4 and 6 beds, together with an administrative block, laundry, ambulance shed, stable and coach-house, and a small mortuary. In 1902 another block of 26 beds was added, the administrative bloc!: enlarged, another mortuary provided, and a discharge block built. In 1905 a house was built just outside the Hospital, providing accommodation for 8 convalescent Scarlet Fever patients. This house is at present partly used for sleeping accommodation for nurses. In June, 1909, the new extension to the Hospital was opened. This gives additional accommodation for 26 patients on the ground floor. On the upper floor are 12 bedrooms for the nursing staff, with separate sitting-room accommodation for Sisters and Nurses. There is also a kitchen, living-room, and the usual offices, with rooms for a resident medical officer. This upper floor is reached by an outside staircase at each end, so that there is no direct communication between the wards and the staff quarters. During 1913 the laundry extension was completed and a new calender was provided. With these welcome additions, the laundry should prove sufficient for a considerable time. During the year it was decided to build a pavilion of 12 beds for the treatment of cases of Tuberculosis. The County Council of Essex have agreed to contribute a weekly sum of 30s. per bed, whether occupied or not. It is anticipated that one half of the capital cost will be defrayed by a Government grant, the remainder by loan. The contribution by the County to maintenance will probably be found to cover not only the cost of maintenance but also the annual charges for sinking fund of the loan, 46 NURSING. At the present time the nursing staff at the Hospital consists of the Matron, Assistant Matron, 3 Sisters, 4 Staff Nurses and 10 Probationers. The probationers now join for two years, and are given a series of lectures by the Matron and the Medical Superintendent. This course of lectures is followed by the examination for the certificate of the Fever Nurses' Association. During the year two nurses passed this examination. The work carried out by the nursing staff during the year has been of a high standard. Much credit must also be given to the Matron for her able management and direction of the staff. The provision of additional sleeping accommodation for the nursing staff will shortly become an urgent necessity with the opening of the Tuberculosis pavilion. DISINFECTION. The disinfection of bedding, clothing, etc., is carried out at the Hospital. Two vans are kept. One of the vans is used for infected and the other for disinfected materials. The room or rooms occupied by the patient with an infectious disease are sprayed out with a "Cylli" solution after recovery of the patient. Bedding and clothing are removed to the Disinfector. Blankets are soaked in a disinfectant at the home. TABLE OF ADMISSIONS In the Respective Months during the last Ten Years. Months. Scarlet Fever. Diphtheria. Enteric and Continued Fevers. Erysipelas. Phthisis. Puerperal Fever. Measles. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1905 1906 1907 1908 1909 1910 1911 1912 1913 1913 1905 1913 1906 January 17 10 21 40 29 31 14 24 19 33 3 5 2 3 10 10 11 5 18 7 - 1 - - - - 2 - 1 - - - - - - 1 - - - - - - - February 17 18 11 31 26 13 14 15 21 14 10 8 5 8 1 12 5 6 9 6 1 - — - - — - — - — — — 1 - - 1 1 - 6 - - - March 13 15 17 26 26 22 15 17 33 19 3 3 13 8 5 7 3 4 15 1 1 - - - 1 - - - - - - - - - - - - - - 2 - - - April 12 9 17 33 23 3 11 8 24 14 4 10 3 9 5 8 2 5 4 5 - 1 1 2 — — — 1 — — 1 - - 1 2 — - 1 1 - - - - May 8 10 20 31 20 11 11 16 26 11 4 3 12 4 5 4 8 4 12 3 — 2 2 — 1 — 2 — - - - 1 — - — 1 - 2 - 2 - - - June 4 16 14 18 27 16 5 10 18 8 15 1 9 6 5 8 2 3 9 6 2 2 — - - - - - - - - - - - - - - - - - - - - July 12 5 25 28 36 10 14 6 7 10 5 2 6 4 10 1 4 7 5 12 — 4 2 1 1 — — — — — — — — - — — - — — 2 — — 1 August 10 10 18 27 17 9 8 7 4 7 3 8 4 5 8 3 — 5 2 7 - 1 — 1 2 — — — — — — — 1 - — — - — — 1 - - Sept. 4 9 21 28 30 17 16 23 13 9 7 4 9 6 9 4 1 14 6 2 2 - 2 1 1 1 — 1 — 1 — — - — — - — — 3 - - October 10 23 40 35 20 18 10 30 16 21 9 3 12 11 6 11 7 6 3 6 — 1 9 2 3 — 3 2 — — — - — - — — - - — 3 - 2 - November 7 15 33 34 16 8 17 32 16 23 12 4 - 3 9 6 4 9 6 12 1 1 - - 2 2 - - - - - - - - - - - - - 2 1 - - December 26 16 31 38 31 28 20 31 20 22 5 4 6 3 6 11 8 25 9 17 - - - - 1 — 3 - — — — — 1 - — — - — 1 1 - — Totals 140 156 268 369 301 186 155 219 217 191 80 55 88 70 79 88 55 93 98 84 9 13 19 8 12 3 10 4 1 1 i 1 3 1 2 2 1 4 2 27 1 2 1 47 TABLE OF HOUSES AND ARTICLES DISINFECTED In Respective Months during the Last Ten Years. Month. Houses. Articles. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 January 36 71 26 52 56 63 48 40 56 57 397 783 321 509 533 633 406 270 591 615 February 35 48 31 51 38 47 27 35 44 33 544 727 436 612 432 347 163 333 551 300 March ... 30 40 40 45 42 66 29 34 56 28 487 707 604 512 455 305 369 336 395 254 April 21 40 32 53 53 29 19 27 54 35 209 579 555 648 584 166 305 181 441 281 May 22 31 39 39 34 24 33 38 39 26 479 757 597 595 368 309 253 409 308 223 June 55 16 35 26 44 34 14 27 41 21 447 196 446 312 299 256 120 205 274 233 July ... 24 13 39 43 55 23 14 23 36 33 96 187 566 484 439 147 110 163 376 718 August ... 28 20 33 43 52 40 20 25 16 22 301 220 412 345 342 162 137 185 111 127 Sept. 28 16 30 43 62 23 21 41 24 24 260 205 666 339 532 129 149 285 142 180 October 35 34 63 65 44 44 23 57 36 41 338 397 677 565 334 291 248 360 257 277 Nov. 28 33 66 51 48 28 32 46 44 42 241 478 751 421 505 270 186 482 383 300 Dec. 30 20 42 61 68 48 33 63 50 64 458 179 570 507 542 306 291 844 456 400 Totals ... 372 382 476 572 596 469 313 456 496 426 4257 5415 6601 5849 5365 3321 2737 4053 4285 3908 48 DIPHTHERIA. 84 cases were admitted during; the year. Three of these were fatal. The disease was usually of a mild type, with occasional cases of much severity. Tracheotomy for laryngeal obstruction was performed in five cases, with two fatal results. One other case was moribund on admission, and died before tracheotomy could be performed. SCARLET FEVER. As mentioned before, the type of disease admitted was mild. Only one case had a fatal issue, and this was due to Tuberculous Meningitis, a totally different disease probably contracted outside the hospital. Remarkably few complications of serious nature supervened on the disease. In one case necrosis of a finger bone occurred, and had to be treated by amputation. An outbreak of Measles in one of the Scarlet Fever wards caused great inconvenience. The most important complication from the point of view of monetary expenditure is nasal discharge. This often entails the patients stopping in hospital for a long period. The practice of keeping these cases in hospital until cured is justified by experience, it being found that the danger of infection to others lasts in these cases for a considerable period. ENTERIC FEVER. One case only was admitted during the year. This was a typical case of moderate severity, and calls for no comment. ERYSIPELAS. Two cases were admitted during the year. In each case the home circumstances were such that adequate attention could not be received. 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 1912-13 Number of Staff (Average daily) 9 12 15 17 18 24 27 26 26 31 28.7 31.7 29.5 ,, Patients treated during year 189 175 214 220 267 275 464 478 430 294 263 408 369 Average length of stay of Scarlet Fever Patients (days) 51 49.4 56.9 47 49.1 46.4 40.5 37.6 45.5 48.1 54.1 52.49 4169 ,, ,, Diphtheria 21.3 31.8 30.5 25.3 29.1 24.4 22.2 24.9 30.5 38.6 46.7 32.25 34.47 „ ,, ,, Enteric Fever „ „ 30.5 37 37.9 41 42.3 31.5 39.8 25.1 34.9 34.0 45.6 23.2 ... ,, ,, ,, Puerperal Fever „ „ ... ... ... ... ... 13 ... ... ... ... ... ... ... „ ,, „ Erysipelas „ „ ... ... ... 29 ... 2 16.5 7.5 9.0 12.3 20 19 14 „ ,, ,, Measles „ „ ... ... ... ... 25 ... 10 ... ... ... ... ... ... >» ji All ,, it 43.5 45.2 49.2 40.9 42.7 40.6 36.2 35.3 41.8 44.8 52.1 45.75 39.8 ,, number of patients in hospital per day 22.5 21.7 28.8 24.5 31.2 30.8 46.1 46.7 49.3 36.1 37.5 51 40.24 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 10,767 ,, ,, „ 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 14,688.5 ,, „ weeks for Staff and Patients combined 1,645.4 1,757.8 2,280.8 2,174 2,568.8 2,846.7 3,813 3,774.1 3,929.4 3,500.4 3,458 4,322 3,636.5 Cost of Meat ... ... £199 19 6 £186 19 7 £198 8 1 £257 11 4 £375 6 9 £377 19 7 £391 2 6 £345 13 11 £333 11 11 £342 0 4 £312 0 0 „ 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 2 282 9 7 „ 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 70 5 4 ,, 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 87 0 8 „ 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 2 201 14 11 „ Fish and Poultry 31 4 4½ 31 13 0 48 17 5½ 29 3 11 38 8 1 41 13 7 45 15 6 38 17 4 32 12 7 38 4 1 30 11 7 Total cost of all food £631 2 7½ £650 13 1 £695 2 0½ £792 2 9 £1,118 14 3 £1,049 15 1 £1,064 11 4 £1,024 14 6 £1,041 10 11 £1,088 13 8 £984 2 1 Cost of food per head per week for Staff and Patients combined 5 6 5 1 5 4 5 6 5 10 5 6 5 5 5 10 6 0 5 0½ 5 5 49 PULMONARY TUBERCULOSIS. 27 cases were admitted during the year. By arrangement with the Essex County Council, six beds are allotted to cases of Tuberculosis whenever the pressure of other infectious disease does not cause the beds to be required. For this a payment of 30s. per week per bed is made. The average stay of the patients in the hospital was about two months, the usual period of treatment being either six weeks or twelve weeks. The block set apart for Tuberculosis was occupied altogether for ten months and five days. 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 1 4 9 9 3 3 1 1 1 1 15 18 February 1 - 1 4 3 1 — 2 — - 5 9 March 4 1 4 7 2 — — — — 1 10 9 April — 1 5 4 3 — 1 — — — 9 5 May 1 1 2 4 — — — 2 — 1 3 8 June — 3 — 3 — 2 — — — — — 8 July — — 2 2 5 — 1 — — 4 6 August 1 1 9 1 1 — — - — 1 4 3 September — — 5 — 2 1 — 1 — — 7 2 October 1 — 7 7 1 2 1 — 2 — 12 9 November 1 1 4 9 2 2 1 1 2 — 10 13 December 2 3 8 3 4 1 1 - - - 15 7 Totals 12 15 49 51 23 17 5 8 5 6 94 97 50 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 2 1 3 - 1 - - - - 1 6 February 1 — 1 4 - - - - - - 2 4 March — — — 1 — — — — — — — 1 April — — 2 1 1 1 — — — — 3 2 May — — — — — 2 1 — — — 1 2 June — 1 3 1 — — 1 — — — 4 2 July — — 2 6 1 1 1 1 — — 4 8 August 3 — 1 1 — — — 1 — 1 4 3 September — — 1 1 - - - - - - 1 1 October — 1 2 2 — 1 — — — — 2 4 November 1 — 2 3 3 2 — — — 1 6 6 December - 3 5 5 2 - - - 1 1 8 9 Totals 5 7 20 28 7 8 3 2 1 3 36 48 BACTERIOLOGICAL LABORATORY. During the year 1,021 specimens were examined. In last year's report a detailed description was given of the laboratory and the methods employed in examining specimens. Work was continued throughout the year on similar lines. The convenience of having a laboratory close at hand is very great. In sending specimens to another laboratory much time is lost in transmission, a matter of importance in Diphtheria, where successful treatment so greatly depends on early diagnosis. In the absence of the Assistant Medical Officer of Health, or from other cause, specimens were sent to a private bacteriologist at a cost of 2s. 6d. per specimen. DIPHTHERIA. Direct examination of Swabs was in many cases successful in making the diagnosis. This method is not absolutely 51 reliable, and wherever the clinical appearance is against Diphtheria, confirmatory evidence should be obtained from the culture before removing the patient to the Isolation Hospital. The results obtained may be classified as follows:— Swabs from Isolation Hospital:— Positive (Diphtheria) 35 Negative (Hoffmann's bacillus) — Negative 89 Total 124 Swabs from Local Medical Practitioners:— Positive (Diphtheria) 66 Negative (Hoffmann's bacillus) 1 Negative 128 Total 195 Swabs from School Medical Officer:— Positive (Diphtheria) 9 Negative (Hoffmann's bacillus) 2 Negative 28 Total 39 Swabs from Medical Officer of Health: — Positive (Diphtheria) 1 Negative (Hoffmann's bacillus) — Negative 7 Total 8 Total number of Swabs, 366. 52 Examination of Sputa.— Specimens of sputa from patients suspected of suffering from Tuberculosis were examined, with the following result:— From local Medical Practitioners— Tubercle bacilli present 49 Tubercle bacilli not found 152 From School Medical Officer— Tubercle bacilli present — Tubercle bacilli not found 4 From Isolation Hospital— Tubercle bacilli present 6 Tubercle bacilli not found 4 Two were also examined for the Tuberculosis officer with positive results. A considerable amount of time and care has been devoted to the examination of sputa that give a negative result on direct examination. In a few cases the Tuberculosis organism has been found by the method of concentration described in the last annual report. It is doubtful whether the time and trouble entailed are justified bv the results, unless corresponding care is exercised by the doctor in obtaining good samples of sputum free from saliva. It is far more satisfactory to examine a few streaks of genuine sputum than a large quantity mixed with saliva, food debris and nasal mucus. The sputum that has collected at the back of the throat during the night and is coughed up first thing is the most valuable for diagnosis. RINGWORM. Specimens examined:— Positive. Negative. Medical Practitioners 6 7 School Medical Officer 259 154 Medical Officer of Health 1 1 Total number of specimens, 427 53 The Widal redaction for Typhoid Fever was carried out in 8 cases, in each with a negative result. Two specimens for Gonorrhoea and one for Malaria were also examined. Summary of Bacteriological Specimens examined by Messrs. Thresh and Beale during 1913. Swabs. Positive. Doubtful. Negative. Medical Practitioners 13 1 13 Isolation Hospital 27 — 22 School Medical Officer 5 — 7 Sputa. Medical Practitioners 9 — 26 Hairs. Medical Practitioners 1 — — Isolation Hospital 1 — 1 School Medical Officer 26 — 12 SECTION III. Sanitary Administration. 57 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— I913- "170 samples were purchased in Ilford during the year ended December 31st, 1913. Of these, 99 were milk, 64 butter, and 7 other samples. Arising out of these samples three prosecutions for adulterated milk were undertaken, and the following fines inflicted :— £10 and £8 11s. costs, £5 and 9s. costs, and £10 and 9s. costs. No proceedings were taken in the case of one milk slightly below the standard, and no action taken in respect of an informal sample of quinine wine which was the subject of report. Three further milk prosecutions arose, but being for offences just beyond the borders of Ilford, are not included in this return." 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. During 1913 sixteen verbal notices were received from the South Essex Waterworks Company of the water being cut off. 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 58 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 60 dairies and milkshops, and 14 cowsheds on the Register. Several of the dairies have changed from one occupant to another, and 5 have been closed. 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. These premises are all regularly inspected so as to maintain them in as good a condition as possible. BAKEHOUSES. There are 31 bakehouses altogether in the district. Of these 8 are factory bakehouses. One is an underground bakehouse of fair construction, though the ventilation is not too good. 59 Two bakehouses have been closed during the year, and one new one opened. 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 seizure of a quantity of meat. During the year the following articles were condemned as unfit for human consumption:— Ox liver. Two hindquarters of beef (4 cwt.). One sheep's head. Ox liver (10 lbs.). Seven geese. The slaughterhouses have been kept under careful supervision during the year, and two of the Assistant Sanitary Inspectors are specially qualified as meat inspectors. FISH SHOPS. During the past year these have been constantly inspected, and the following fish were condemned as unfit for human consumption:— 2 boxes of bloaters. 8 lbs. of eels. 2 boxes of kippers. 60 GREENGROCERS' SHOPS. These are inspected as occasion demands. OFFENSIVE TRADES. There are no offensive trades carried on in the district. FACTORIES. The duties of Sanitary Authorities with regard to factories are not extensive, and are practically limited to supervision with regard to provision of means of escape in case of fire, and also of sufficient sanitary conveniences. WORKSHOPS AND WORKPLACES. Under the Factory and Workshop 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 repor", 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. 61 WORKSHOPS. There are 388 workshops on the register, made up as follows:— Artificial Flower Makers 2 Bakehouses 23 Bead Worker 1 Belt (Fancy) 5 Blind and Cover Maker 1 Brush Makers 2 Boot Makers and Repairers 45 Carpet Planning and Upholstery 5 Corset Makers 3 Cycle and Motor Making and Repairing 19 Dentists 3 Dressmakers 78 Book Binder 1 Embroiderer and Lace Worker 1 Engineers' Workshop 1 Feather Cleaning and Dressing 5 Firewood Cutting 1 Florist 1 French Polishers 5 Gas Fittings, &c. 1 Glass Cutting 2 Jewellery and Watch Repairing 14 Joinery Workers 12 Laundries (Hand) 17 Masons 0 Meat Cutting and Small Goods 1 Milliners 22 Lace Workers 2 Optician 1 Picture Framers, &c 4 Printers 9 Plumbers, &c 7 Rag Sorting and Storing 3 Saddlers and Harness Makers 3 Sugar Boiling 1 62 Smiths 9 Tin Plate Workers 3 Umbrella Makers and Repairers 5 Wearing Apparel (including Tailors) 57 Wheelwrights and Carriage Builders 3 Undertakers 4 Soda and Mineral Water Mnf i Miscellaneous 2 Total 388 FACTORIES. There are 73 factories on the register, made up as follows :— Bakehouses 8 Boot Making and Repairing 12 Building, etc 6 Electrical Works (Motor) 4 Paper Making 1 Printers 4 Plate Powder Manufacturer 1 Motor and Cycle Making 1 Saw Mills 8 Seed Sorting, etc 1 Smithy, etc 1 Meat Cutting, etc 4 Chemical Factory 1 Carriage Works, etc 2 Corset Making 1 Grindery Works 2 Iron Covers, &c 1 Laundries 6 Photographic Works 1 Lithographic Works 1 Wearing Apparel 3 Collar Works 1 Paint Mixing 1 Engineering 1 Box Making 1 Total 73 63 FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1—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) 44 1 ... Workshops (including Work shop Laundries) 252 8 ... Workplaces (other than Out workers' premises included in Part 3 of this report) ... ... ... Total 296 9 ... 64 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 5 5 Want of ventilation 1 1 Overcrowding Want of drainage of floors 1 1 Other nuisances 4 4 Sanitary accommodation insufficient unsuitable or defective 3 3 not separate for sexes Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) Other offences (Excluding offences relating to outwork which are included in Part 3 of this report.) Total 14 14 65 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. 32 42 59 Lace, Lace Curtains and Nets 2 ... 6 Total 34 42 65 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number (2) Bakehouses (excluding 8 Factory Bakehouses) 23 Total number of workshops on Register 23 66 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, 1901) 7 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, 1901) Notified by H.M. Inspector 7 Reports (of action taken) sent to H.M. Inspector 7 Other ... Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 1 67 HOUSING AND TOWN PLANNING AND HOUSING OF THE WORKING CLASSES. Number of houses inspected 269 Do. considered to be unfit for human habitation 3 Do. represented do. do. human habitation — Number of closing orders made — Do. houses in which defects were remedied 164 SEWERAGE AND SEWAGE DISPOSAL. The methods whereby the sewage of the district is disposed of have been detailed in previous reports. There are in the district in addition— 61 cesspools. 36 privies. 71 pail closets. 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 8 occasions for street accidents, and on 120 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 26 occasions. LEGAL PROCEEDINGS. On the 31st October, 1914, Mr. Monkcom, Assistant Sanitary Inspector, while walking past a butcher's shop late at night noticed a hindquarter of beef with an exposed 68 caseating gland. Upon investigation he found the corresponding hindquarter to be in the same condition with caseating glands. He at once informed the Medical Officer of Health, who seized both pieces of meat. A prosecution was instituted by the Council, and a fine of 40s. and costs inflicted on the butchers. INSPECTION OF THE DISTRICT AND THE ABATEMENT OF NUISANCES. Summary of visits as recorded during the year 1913:— Houses and premises inspected 2696 Do. do. re-inspected (works in progress) 5370 Visits during disinfection 1137 Houses in which nuisances were detected 766 Do. do. abated 861* Notices served 650 Do. complied with 742* Houses disinfected 426 Articles do 3908 *These figures include nuisances and notices respectively which were outstanding at the end of 1912. Articles of food condemned and destroyed:— 2 boxes of bloaters; 8 lbs. of eels; 2 boxes of kippers; 2 ox livers (about 20 lbs.); 2 hindquarters of beef (4cwt.); 1 sheep's head; 7 geese. 69 The following is a list of notices served during the year and includes those outstanding at the end of 1912. NOTICES SERVED, &c. 1913- Notices. Outstanding and served 1913. Complied with 1913 Outstanding 1914. Statutory 95 93 2 Informal 303 278 25 Do. (by letter) 108 43 65 Pave Yard (Ilford Improvement Act) 13 13 - Provide Dustbin (Ilford Improvement Act) 110 110 - Cleanse Cistern (Bye-laws) 69 67 2 Cover Do. Do. 21 14 7 Provide Water to Dwelling-House 16 16 Cleanse Dwelling-House (Infectious Diseases (Prevention) Act, 1890) 78 78 - Cleanse Dwelling-House (Sec. 46 Public Health Act, 1875) 7 5 2 Housing of the Working Classes Act 11 11 — Housing, Town Planning, etc., Act 18 14 4 Totals 849 742 107 SECTION IV. Schools. 73 SCHOOLS. The schools providing accommodation for 13,556 children in this district, under the Education Authority, are the following:— Council. Downshall Uphall Cleveland Road New Bury Park Christchurch Road Goodmayes Loxford Chadwell Highlands Valentines South Park Little Heath Voluntary. High Road, Ilford, C. of E. (St. Mary's). High Road, Ilford, C. of E. (Junior School). Roman Catholic, Ilford. Barkingside. The extension to South Park School has been completed during the year and provides accommodation for 430 extra children. The alterations required by the Board of Education at the High Road C. of E. School have been carried out. Similar alterations required at the C. of E. Junior School will be carried out during the forthcoming year. 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. A detailed list of the work carried out is as follows 74 Date. 1913. School. Room . 3rd January Loxford Lobbies 25th „ National (St. Mary's) No. 1 Room, Boys 25th March Loxford Lobbies 25th „ Goodmayes „ 26th „ Little Heath „ 26th „ Chadwell „ 24th May Downshall Whole of J. M. Dept. (9 rooms and 2 lobbies) 24th July Goodmayes Rooms 4, 5, 6 J. M. Dept. Midsummer Holidays All School Lobbies Except Downshall and Little Heath. These schools were being redecorated 15th October Chadwell Class Room No. 5 19th December Barkingside Lobbies 22nd South Park „ HEALTH VISITOR. During the year Miss Radford has continued her valuable work as Health Visitor. Her salary is debited to the Education Committee and the Public Health Committee, two-thirds being allocated for education purposes and one-third for the Notification of Births Act work. The education work has consisted in visiting the schools periodically, following up the cases thus found, and also those that have been notified as requiring treatment on the routine medical inspection work or other examination, discovering whether any treatment has been carried out, and, if not, endeavouring to get the parents to have the defects remedied I give a summary of the results of the two great classes of defects found; one, those inspected by the Health Visitor herself and presented by the teachers on visiting the schools or by letter, the other as a result of the medical inspection. 75 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 at the end of this section. 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 a return certificate, as the case may be. During 1913, 3,329 certificates were issued, and the causes of exclusion may be roughly classified as under:— Diseases of Ear 11 ,, ,, Eye 80 ,, ,, Skin 412 Dirty Heads 82 Dirty condition of Clothing and Person 8 Suspected Infectious Diseases 135 Infectious Diseases 5 Ringworm 18 Swollen Glands 59 Sore Throats 305 Tubercular Diseases 10 Chorea 25 All other Diseases 477 Total 1,627 Certificates of fitness to attend school were given in 1,702 instances. 76 The number of certificates granted in previous years have been as follows:— In 1912 2,945 In 1911 4,520 In 1910 2,876 In 1909 1813 In 1908 1,882 In 1907 2,070 In 1906 1,665 In 1905 1,493 In 1904 1,518 Special medical examinations for the Education Committee have been carried out as under:— Teachers 55 Scholars 13 School Attendance Officers (Candidates) 2 Caretakers 2 BOARD OF EDUCATION GRANT FOR THE YEAR 1913-1914. The total grant awarded was £354 15s. 8d., being half the total expenditure on the school medical service. The following are the chief items:— £ s. d. Amounts of the School Medical Officer's and Assistant School Medical Officer's Salaries returned 181 5 0 Salary of School Nurse 35 0 0 Cost of Clerical Assistance 48 6 8 Bicycle and Travelling Expenses 5 8 4 Printing, Stationery and Postage 17 8 0 Provision of Office Accommodation, Heating, Lighting, Cleaning, &c 49 8 9½ 77 GENERAL STATEMENT OF EXTENT AND SCOPE OF MEDICAL INSPECTION. 133 visits were made to the 34 different departments of 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 2,621, 1,314 boys and 1,307 girls, and 61 cases (31 boys and 30 girls) presented for special examination. The total time occupied by these examinations was 218 hours 20 minutes, or an average of 4.88 minutes per child. 63 per cent. of the parents were present at these examinations. The following table gives the age and sex distribution of those examined, excluding specials :— 5—6 6—7 7-8 8-9 9—10 1 10-11 Roys 356 173 78 69 73 58 Girls 342 190 102 66 71 47 11-12 12-13 13-14 14—15 Totals. Boys 60 319 110 8 1,314 Girls 44 362 76 7 1,307 The head teachers are requested to forward lists of those children admitted to their departments since the last inspection, and of 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, where also, 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. 78 In some cases it was possible, at the request of parents, to demonstrate the defect 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 4.88 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 .28 per cent. of the children examined were found to be wearing clothing that was considered to be below the standard of the 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 79 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 in increasing numbers 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. Owing to reasons mentioned above, but little clothing was found to be in dirty state. 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. 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. 22 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 1.4 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. Verminous Conditions.— Careful attention was directed to the presence of vermin in the hair. .23 per cent. of the girls were found to be actually infected with lice. 23.78 per cent. of the girls and 1.21 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 are still many bad cases met with of neglect in this respect. Not a few children are 80 known to the School Medical Officer who have been infested with lice for months and even for years. 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. The most important event of the year making for the welfare of these children was the passing of the Mental Deficiency Act, 1913. While this measure only deals in general with mentally defectives over 16 years of age, it will probably be completed by the passing of the complementary bill now before Parliament dealing with Mentally Defective Children. In future a new duty will fall on the Local Education Authority, that of ascertaining the names and addresses of all children who are mentally defective. This will add appreciably to the work of the School Medical Officer, and throws on him a great responsibility, that of deciding whether a child is mentally defective or not. 81 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.—3.4 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 1.18 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 speedy recovery. Other cases follow an attack of scarlet fever or measles. A certain number occur in debiiltated 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.—12.10 per cent. of boys and 10.63 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 82 a 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. (4) Reading and Sewing.—The employment of the growing 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 83 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. PRESCRIPTIONS OF SPECTACLES. 298 children (131 boys and 167 girls) have been examined. Of these, 24 boys and 28 girls were found not to require glasses. The defects found in the remaining children may be classified, roughly, as follows :— Boys. Girls. Hypermetropia 33 44 Hypermetropic Astigmatism 27 42 Mixed Astigmatism 9 13 Myopic Astigmatism 22 27 Myopia 16 13 107 139 It is interesting to notice how much more common myopia or short-sight is in boys than in girls. Most of the cases of hypermetropia, recorded above, were slight, but in all cases were giving rise to definite eye-strain or else definite defect of vision. The greater number of girls presented for examination than of boys is explained in several ways. Girls are found to complain of eye-strain more readily than boys. This may perhaps be due to the greater strain on the constitution at the onset of puberty in the girl. Again, there is a feeling that the wearing of glasses may be prejudicial to a boy's welfare in his occupation, and there is often much difficulty in persuading a boy's parents to submit him for examination. The majority of cases examined had been diagnosed at the routine medical inspection and referred to the School 84 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 homatropine 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 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. 438 children attended at the public health offices for examination subsequent to the primary examination. Many of these visits were simply for the purpose of having the spectacles supplied by the optician examined and approved. 85 Many children attended at various intervals for the purpose of observation. In some cases the glasses had to be changed after an interval. 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. These children with squint are a source of much worry to the school doctor. After having the necessary spectacles prescribed they require constant watching, and special educational treatment sometimes. It is much to be regretted that so many squints are neglected in early life, with the consequence that the eyes have become fixed in the squinting position by the time the child reaches the school age. 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., 921 were considered to show good nutrition, 1,574 normal nutrition, 128 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 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. 86 Dental Condition of School Children.— Of the children examined during the rear, 62.5 per cent. showed from one to six decayed teeth, 4.3 per cent. had more than six decayed teeth, being a total of 1,756, or 66.3 per cent., having decayed teeth, and only 33.6 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 often 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 byfilling 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 87 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. Throat and Nose Conditions.—In 3 per cent. of children adenoids were present in sufficient amount to cause harm, and in 1.8 per cent. more they urgently required removal. The diagnosis of this condition and its harmful effects have been fully dealt with in previous reports. Slight enlargement of the tonsils was detected in 12.42 per cent. of the children, and considerable enlargement, generally necessitating an operation, in 5 per cent. more 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 perefeotly healthy child. Nevertheless 43 per cent. of the school children examined showed slight enlargement of the 88 glands, .4 per cent. showed great enlargement, and in one case 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.— Six cases were notified by the School Medical Officer during the year. The disease was diagnosed by examination of the chest, and the causative 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 following table shows the detects detected, separated according to sex; also percentage of the total children examined. Defects:— Downshall. Cleveland Road. Christchurch road. Loxford. Highlands. South Park. Uphall. Church of England. Newbury Park. Goodmayes. Chadwell. Barkingside. Catholic. Valentines. Little Heath. Totals. Total defects expressed as percentage of total number of children examined. Schedule Item. Condition. 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 M F M F m F M F 5. Clothing Fair 28 42 28 36 29 48 12 5 2 14 11 14 41 44 44 48 22 36 18 23 40 29 25 27 21 16 9 6 12 9 342 397 26.02 30.37 Bad ... 2 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 .15 .15 Insufficient ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Need of Repair ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unclean ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... .07 ... 6. Footgear Fair 23 21 32 41 42 24 11 4 1 16 2 10 34 45 24 25 14 24 35 16 25 23 10 17 13 14 4 3 1 4 271 287 20.62 21.95 Bad 2 ... ... ... 1 ... ... ... ... 1 ... 1 5 4 5 3 ... 1 2 ... 2 1 ... 2 2 1 ... ... 2 2 21 16 1.59 1.22 Insufficient ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Need of Repair ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7. Head Somewhat dirty ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... .38 Very dirty ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scurf detected ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 2 .15 .15 Nits detected 1 29 2 35 1 27 ... 6 ... 12 ... 11 ... 35 5 40 3 21 1 27 ... 28 2 18 1 10 ... 6 ... 6 16 311 1.21 23.78 Lice detected ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... .23 Sores detected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Body Somewhat dirty 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... ... ... ... 2 3 .15 .23 Very dirty ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fleabitten ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .07 Bugs detected ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 .07 .07 Lice detected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Mental Condition Dull ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... 3 ... .23 ... Defective ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Speech Defective 1 4 3 2 1 1 1 ... 2 1 1 2 ... 1 ... 2 1 ... 2 1 ... 1 ... ... 1 ... ... ... ... ... 13 15 .98 1.14 13. Hearing Defective 4 5 10 3 6 5 3 ... ... 4 3 5 ... 6 6 ... 2 2 7 3 3 3 1 2 2 2 1 ... 1 ... 49 40 3.73 3.05 14. Vision Defective 16 25 20 21 17 18 7 7 9 6 6 3 14 14 10 6 7 8 29 15 12 9 3 1 8 4 1 1 ... 1 159 139 12.10 10.63 15. Nutrition Below normal 11 1 8 14 12 8 7 ... 1 4 3 2 7 2 6 3 3 3 6 7 3 1 3 15 2 ... ... 1 ... 1 72 62 5.48 4.74 Bad ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16. Teeth Somewhat dirty 93 72 70 75 58 48 22 12 56 55 9 12 62 50 34 36 28 29 80 34 36 16 29 24 20 10 9 4 12 8 618 485 47.03 37.10 Fou ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 .15 .07 Decayed (1—6) 124 138 96 114 90 89 35 23 56 86 23 39 61 56 48 47 33 33 122 104 47 28 26 22 34 26 5 10 15 10 815 825 62.02 63.12 „ (over 6) 4 8 9 12 6 7 4 4 4 5 1 3 4 2 3 3 3 1 12 8 1 5 2 1 2 ... 1 ... ... 1 56 60 4.26 4.51 Notably defective enamel 3 8 4 8 9 6 2 2 2 5 ... 1 3 4 1 3 4 1 12 8 1 2 1 3 2 1 1 ... 1 1 46 53 3.50 4.05 Notable irregularity ... ... ... 1 ... ... 1 1 ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 2 5 .15 .38 Pyorrhœa ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... 1 ... .07 17. Nose and Throat affection Rhinitis 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 .15 .07 Deflected Septum ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 .07 .07 Other affections ... ... 1 1 ... ... 1 ... ... 1 ... ... 1 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 5 3 .38 .23 18. Tonsils Slight enlargement 24 22 21 28 12 26 6 6 4 10 9 9 11 15 15 12 15 9 14 20 5 5 4 5 5 5 1 2 2 4 148 178 11.23 13.61 Considerable do. 12 8 6 13 7 7 1 1 2 5 1 7 3 4 3 3 2 3 10 11 ... 3 2 5 5 4 ... ... ... 1 54 75 4.11 5.72 Urgently requiring removal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Inflamed ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... .15 ... 19. Adenoids Slight obstruction due to 4 8 10 10 4 2 3 3 5 2 2 3 1 ... 2 ... 1 1 5 ... ... 1 1 2 2 3 ... ... 1 2 41 37 312 283 Severe do. ... 1 4 3 1 3 4 ... ... 3 ... 5 2 1 1 ... 4 1 7 5 ... 1 ... ... ... 1 1 ... 1 ... 25 24 1.90 1.83 20. Glands Slight enlargement 92 89 69 88 73 65 27 16 18 42 22 21 47 44 30 26 28 42 86 62 32 25 17 17 19 17 2 5 7 8 569 567 43.30 43.38 Considerable do. ... 1 ... 1 ... 2 2 ... 1 1 ... ... ... ... 1 ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... 7 5 .53 .38 Great do. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .07 Tubercular ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... 1 ... .07 ... 21. External Eye Diseases 7 5 4 5 9 1 5 2 ... 3 1 2 5 2 1 5 3 3 6 1 ... 2 2 ... 2 ... ... ... 1 2 46 33 350 252 22. Ear Diseases Discharges 4 2 2 1 ... 1 1 ... ... 1 ... ... 2 5 1 ... 1 ... 3 2 2 ... 2 1 ... ... ... ... ... ... 18 13 1.37 .99 Wax 1 1 ... 1 ... ... ... ... ... ... ... 1 1 ... ... 2 ... ... 1 1 3 1 ... ... ... ... ... ... 1 1 7 8 .5.3 .61 23. Heart affections ... ... 1 1 3 1 1 1 ... ... ... 1 1 ... 3 2 ... 1 2 1 2 ... ... 1 1 ... ... ... ... ... 14 9 1.06 .68 24. Lung affections 1 ... ... ... 1 ... ... ... ... ... 1 2 ... ... 2 ... 1 1 2 2 1 1 1 ... ... ... ... ... ... 1 10 7 .76 .53 25. Nervous affections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 1 .07 .07 26. Tubercule ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 3 .15 .23 28. Deformities 1 ... ... 2 1 1 ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... 2 ... 1 ... ... ... ... ... ... ... 9 3 .68 .23 29. Infectious diseases ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .07 ... Skin diseases 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 .15 .15 Rupture ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... 1 ... .07 Incontinence ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .07 ... OXPARK. VALENTINES. LITTLE HEATH. al on. Health Visitor. Medical inspection. Health Visitor. Medical Inspection. Health Visitor. C B C A B C A B C A B C A B C Clot in ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fool of ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... Negl ... ... 4 ... ... 2 2 1 9 ... ... ... ... ... 3 Head 13 6 57 3 1 6 4 2 16 ... 2 5 4 1 12 Men ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Spee ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hear 4 ... ... ... ... 1 ... ... ... ... ... 2 ... ... ... Visit 5 ... 5 ... 4 2 ... ... ... 2 ... ... 2 ... 1 Malt ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Teet 3 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Nose 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Ton 10 ... ... ... 2 ... ... ... ... ... ... 2 ... ... ... Ade 4 ... ... ... ... 1 ... ... ... ... ... 2 ... ... ... Glar ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Exte ... ... 1 ... ... ... ... ... ... ... ... 2 ... ... 1 Ear 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Hea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lun ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nery ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... Phtt ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Defo ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infe ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Ring 1 ... 6 ... ... ... ... ... 2 ... ... ... ... ... 1 Inco ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Skin 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... The following table shows the results up to the 31st December, 1913, of the Medical inspection carried out during 1913. SCHOOL. ALL SCHOOLS. DOWNSHALL. CLEVELAND ROAD. CHRISTCHURCH ROAD. LOXFORD. HIGHLANDS. SOUTH PARK. UPHALL. NATIONAL AND CHURCH INFANTS. NEWBURY PARK. GOODMAYES. CHADWELL. BARKINGSIDE. ROMAN CATHOLIC. VALENTINES. LITTLE HEATH. DEFECTS. Number of notices sent. Cases remedied and treated. Cases ended, children left. Percentage of total cases treated. Percentage of total cases left. Number of notices sent. Cases remedied and treated. Cases ended, children lelt. 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 Oases. 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. Oases remedied and treated. Cases ended, children left. Percentage of Total Cases. Number of notices sent. Cases remedied and treated. Cases ended, children left. Percentage of Total 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 leftj 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. Treated Left Treated Left Treated I eft Treatec 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 or insufficient 8 4 ... 50 ... 2 1 ... 50 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 100 ... 2 ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Footgear in need of repair 29 12 3 4137 10.34 2 ... 1 ... 50 ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... 8 3 37.5 12.5 6 3 1 50 16.66 1 ... ... ... ... 2 1 ... 50 ... 2 1 ... 50 ... 9 1 ... 50 ... 3 1 ... 33.33 ... ... ... ... ... ... 1 ... ... ... ... Heads dirty or verminous 230 55 25 23.91 10.80 19 1 2 5.26 10.52 27 6 3 22.22 11.11 29 7 ... 24.13 ... 6 3 ... 50 ... 7 1 1 14.28 14.28 6 3 ... 50 ... 28 2 3 7.14 10.71 26 7 4 26.92 15.38 19 4 3 21.05 15.68 20 9 1 45 5 24 9 4 37.5 16.66 11 2 3 18.18 27.27 6 1 1 16.66 16.66 3 ... ... ... ... 3 ... ... ... ... Neglected condition 9 3 ... 33.33 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 1 ... 50 ... 2 1 ... 50 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... 1 ... ... ... ... ... ... ... ... ... Hearing defective 75 47 5 62.66 6.66 3 1 ... 33.33 ... 14 11 1 78.57 7.14 13 11 ... 84.61 ... 3 1 ... 33.33 ... 2 2 ... 100 ... 8 6 ... 75 ... 4 3 ... 75 ... 4 2 ... 50 ... 2 ... 1 ... 50 10 3 1 90 10 5 ... ... ... ... 3 ... 2 ... 66.66 1 1 ... 100 ... 1 ... ... ... ... 2 ... ... ... ... Vision defective 233 148 7 63.52 300 32 13 1 40.02 31.2 31 22 3 70.96 9.67 33 25 ... 75.75 ... 12 9 ... 75 ... 13 9 ... 69.23 ... 8 5 ... 62.5 ... 25 10 1 40 4 11 6 54.54 9.09 6 5 ... 83.33 ... 31 27 ... 87.09 ... 13 5 1 38.40 7.69 3 2 ... 66.66 ... 10 8 ... 80 ... 2 ... ... ... ... 3 2 ... 66.66 ... Malnutrition and Debility 7 6 ... 85.71 ... 1 1 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 2 ... 100 ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Teeth defective 11 2 ... 18.18 ... 1 ... ... ... ... 3 1 ... 33.33 ... ... ... ... ... ... ... ... ... ... ... 4 1 ... 25 ... ... ... ... ... ... 1 ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nose and throat affections 18 15 ... 83.33 8.88 1 1 ... 100 ... 3 2 ... 66.66 ... 4 4 ... 100 ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... 2 1 ... 50 ... 2 2 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... 1 1 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... Tonsils enlarged 90 28 8 31.11 4.25 17 5 1 29.41 5.88 16 6 3 37.5 18.75 9 4 ... 44.44 ... 1 1 ... 100 ... 8 5 ... 62.5 ... 2 ... ... ... ... 6 2 ... 33 ... 9 2 1 22.22 11.11 4 1 ... 25 ... 5 1 1 20 20 4 ... ... ... ... 3 ... 2 ... 66.66 6 1 ... 16.66 ... ... ... ... ... ... ... ... ... ... ... Adenoids 47 21 2 44.08 14.28 5 1 1 20 20 8 5 ... 62.5 ... 2 1 ... 50 ... 3 2 ... 66.66 ... 2 2 ... 100 ... 2 1 ... 50 ... 2 ... ... ... ... 1 ... ... ... ... 4 1 ... 25 ... 11 8 ... ... ... 1 ... ... ... ... 1 ... 1 ... 100 3 ... ... ... ... 1 ... ... ... ... 2 ... ... ... ... Glands enlarged 7 6 1 85.71 ... 1 1 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... 2 2 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... 1 ... 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... External Eye diseases 53 40 ... 75.47 13.04 4 4 ... 100 ... 7 7 ... 100 ... 9 8 ... 88.88 ... 5 5 ... 100 ... 2 2 ... 100 ... 1 1 ... 100 ... 3 ... ... ... ... 5 2 ... 40 ... 3 3 ... 100 ... 6 4 ... 60.66 ... 3 3 ... 100 ... 2 ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... 2 ... ... ... ... Ear diseases 23 12 3 52.17 ... 2 1 ... 50 ... 2 2 ... 100 ... 2 1 ... 50 ... 1 1 ... 100 ... ... ... ... ... ... 1 1 ... 100 ... 4 1 ... 25 ... 2 1 ... 50 ... ... ... ... ... ... 4 3 1 75 25 3 1 ... 33.33 ... 2 ... 2 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Heart affection 18 14 ... 77.77 ... 2 2 ... 100 ... ... ... ... ... ... 3 1 ... 33.33 ... 1 1 ... 100 ... ... ... ... ... ... 3 3 ... 100 ... 1 ... ... ... ... 3 1 ... 33.33 ... 1 1 ... 100 ... 2 2 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... Lung affection 7 6 ... 85.71 ... 3 3 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... 2 1 ... 50 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... Chorœa 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Epilepsy 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Nervous affections 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis suspected 1 1 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous knee 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deformities 4 3 ... 75 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 100 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... Infectious disease suspected 3 3 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 100 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ringworm 6 4 ... 66.66 ... 1 1 ... 100 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 ... 66.66 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... Skin diseases 11 8 ... 72.72 ... 1 1 ... 100 ... 6 5 ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 50 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rupture 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Incontinence 5 3 ... 60 ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... All other diseases and affections 7 6 1 85.71 14.28 1 1 ... 100 ... 1 1 ... 100 ... 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 100 ... 1 1 ... 100 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 100 1 1 ... 100 ... ... ... ... ... ... Summary of Work done and Cases followed up by the Health Visitor during 1913. Explanation :—A, cases remedied and treated; B, cases ended (children left); C, cases remaining under observation 1st January, 1914. SCHOOL. ALL SCHOOLS. DOWNSHALL. CLEVELAND ROAD. CHRISTCHURCH ROAD. I.OXFORD. HIGHLANDS. SOUTH PARK. UPHALL. NATIONAL & CHURCH INFANTS. NEWBURY PARK. GOODMAYES. CHADWELL. BARKINGSIDE. ROMAN CATHOLIC. VALENTINES. LITTLE HEATH. 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, insufficient or in need of repair 5 1 8 ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... 2 ... ... ... ... ... ... ... 4 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Footgear insufficient or in need of repair 19 2 8 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 4 1 2 ... ... ... 4 1 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 1 ... ... ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Neglected condition 3 3 10 22 29 72 ... ... ... 1 1 7 ... ... 2 1 1 4 ... ... ... 1 1 1 ... ... ... ... ... 6 ... ... ... ... 1 1 ... ... ... 2 ... ... 1 ... ... ... 6 10 ... 2 1 10 12 8 1 1 3 ... ... 4 ... ... 1 ... 1 2 ... ... ... 2 2 9 ... ... 1 ... 2 2 1 ... ... 3 1 1 ... ... 2 2 1 9 ... ... ... ... ... 3 Heads dirty or verminous 126 68 248 318 131 743 4 4 30 23 11 78 15 9 26 34 10 55 20 4 26 45 11 71 11 2 13 21 14 69 3 5 9 34 10 17 5 1 10 18 11 71 15 9 36 39 26 145 11 9 19 28 13 39 7 4 21 8 6 57 9 1 10 23 5 25 11 7 16 7 7 35 7 5 14 17 3 37 5 5 7 13 1 17 3 1 6 4 2 16 ... 2 5 4 1 12 Mental deficiency ... 1 ... ... 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... Speech defective 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 9 ... ... ... ... ... 3 1 1 ... ... ... 2 ... 2 ... ... ... 1 2 1 ... ... ... 9 1 ...... ... ...... ... 2 ... 5 ... ... ... 1 2 1 ... ... ... 3 ... ...... ... ... ... ... ... 1 ... ... ... 2 ... 2 ... ... ... Hearing defective 69 9 26 1 ... 2 3 ... 3 1 ... ... 15 1 2 ... ... ... 11 1 1 ... ... ... 7 1 4 ... ... ... 3 ... ... 8 ... ... 13 ... 3 ... ... ... 22 1 17 13 ... ... 10 5 2 15 ... 3 6 1 1 9 ... 31 ... 1 2 ... ... 4 1 7 1 ... ... 4 1 2 1 ... ... 22 ... 1 5 ... 2 1 4 2 ... ... ... ... ... ... 2 ... 1 Vision defective ... 246 41 64 104 4 15 18 4 14 7 1 2 35 5 5 15 ... 1 38 3 2 15 3 ... 19 ... 5 ... ... 21 4 4 ... ... ... 1 ... 1 4 ... 1 2 9 1 1 ... 1 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malnutrition Debility 14 1 2 3 ... 2 3 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 3 ... 2 ... ... 1 2 ... 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Teeth defective 31 6 22 ... ... 2 10 3 6 ... ... ... 4 ... 2 ... ... ... 4 ... 1 ... ... ... 2 1 3 ... ... 3 2 5 ... ... ... ... ... 1 ... ... ... 3 ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... Nose and throat affections 20 3 4 ... ... ... ... ... 1 ... ... ... 3 ... 1 ... ... ... 4 ... ... ... ... ... ... 2 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 9 3 5 ... ... ... 3 1 7 ... ... 2 2 5 ... ... ... 3 1 3 ... ... 1 ... ... 6 ... ... ... 2 4 1 ... ... ... 6 1 5 ... ... ... ... 2 ... ... ... ... ... ... 2 ... ... ... Tonsils enlarged ... 72 38 88 3 ... 4 7 2 12 1 ... ... 9 6 10 1 ... 1 7 1 9 ... ... ... 3 4 10 ... ... 16 1 5 ... ... ... 5 6 8 1 ... ... 5 ... 3 ... ... 2 2 ... 1 ... ... ... 2 1 5 ... ... 10 ... 2 ... ... 1 ... 1 1 ... ... ... 2 1 ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Adenoids ... 46 7 34 1 ... 3 2 1 4 ... ... ... 7 1 5 1 ... ... 1 ... ... ... ... ... 7 1 4 ... ... 5 2 1 ... ... ... 2 ... 4 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 Glands enlarged ... 9 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 1 ... ... 3 ... ... 1 ... ... ... ... ... 5 1 5 1 ... ... 2 ... ... 1 ... ... 3 ... ... 1 ... 1 6 ... 2 ... ... ... 3 ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 External Eye diseases 49 2 13 11 ... 3 3 ... ... 1 ... ... 7 ... 1 1 ... 1 6 ... ... 2 ... ... 5 ... 1 ... ... 2 ... ... ... ... 1 5 ... 1 ... ... ... 3 2 ... 1 ... ... 2 ... 3 ... ... ... ... 2 ... ... ... 4 ... ... 1 ... ... 1 ... 2 ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ear diseases 23 10 8 4 ... 7 3 ... 1 ... ... ... 3 1 ... 1 ... 1 1 1 1 1 ... 1 3 1 ... ... 3 1 ... ... ... ... ... 2 ... ... ... ... ... 1 3 ... ... ... ... 2 ... 3 ... ... ... 1 ... ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Heart affections 17 ... 6 1 ... ... 2 ... ... 1 ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... 1 ... ... ... ... 2 ... ... ... ... ... 3 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lung affections 9 ... 1 2 ... ... 2 ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... Nervous affections 3 ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis suspected 6 ... 1 ... 3 1 3 ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deformities 3 ... 1 ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Infectious disease suspected 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 7 ... ... ... 3 2 6 ... ... ... 9 ... 0 ... ... ... 4 ... 10 ... ... ... 1 ... 1 ... ... ... 8 1 4 ... ... ... 3 ... 2 1 ... ... ... ... 2 ... ... ... ... ... 1 Ringworm detected 2 1 1 131 14 65 1 ... ... 12 1 4 ... ... ... 9 1 3 ... ... ... 20 3 ... ... ... 1 4 6 ...... ... ... 15 ... 2 ... ... ... 8 1 4 ... 1 ... 15 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Incontinence 3 ... 2 3 ... 2 ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Skin diseases 12 ... 6 ... ... 1 1 ... ... ... ... ... 5 ... 1 ... ... ... 1 ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Other diseases and affections 7 2 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Table showing the defects detected upon Medical Inspection before, but which have been Remedied and Treated or where the Children have left the School or District during 1913. 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 insufficient 4 3 - - - - - 1 - - - - 1 - 3 1 - 1 - - - - - - - - - - - - - - Footgear in need of repair 4 1 - 1 - - - - - - 1 - - - 1 - 1 - - - - - - - - - - - 1 - - - Head Dirty or Verminous 64 50 2 2 7 5 11 5 7 2 2 4 3 1 10 9 1 5 2 5 1 1 1 3 - 3 7 3 3 1 1 1 Hearing Defective 17 4 1 - 4 - - 1 5 2 1 - 2 - 1 - - - - 1 1 - - - - — 2 - - - - - Vision Defective 82 37 1 5 9 4 9 3 9 4 13 3 8 - 11 8 2 4 1 1 8 - - - 1 2 14 - 1 3 - - Malnutrition and Debility 11 1 3 - - - 1 - - - - 1 1 - 2 - - - - - - - - - - - 4 - - - - - Teeth Defective 27 5 11 3 4 - - - 2 1 4 1 - - 2 - 2 - - - - - - - - - 1 - - — 1 - Nose and Throat Affection 6 2 - - 1 - - - - 1 - -. - - 2 - - - 1 1 1 - - - - - 1 - - - - - Tonsils Enlarged 42 28 2 1 4 1 4 1 2 4 11 1 3 6 7 4 1 - 1 4 2 - - 1 - 2 5 1 - 2 - - Adenoids 21 5 - - 4 1 1 — 4 2 3 2 1 — 5 — — — 1 - 1 - - — — — 1 - - - - - Glands Enlarged 3 - - - - - - - - - - - 1 - 1 - - - - - - - - - - - 1 - - - - - External Eye Diseases 10 2 — — — — — — 1 — — —- 3 — 5 2 — — — — — - - — — — 1 — - — — - Ear Diseases 9 6 2 - 1 1 — 1 2 1 1 1 1 — 2 — — — — 2 — - - — — — — — - — — - Heart Affections 5 — — - 1 — — - — — 2 — — — 1 — 1 — — — — - - - — — — — - — — - Lung Affections 4 - — - 1 - 2 - 1 - - - - - - - - - - - - - - - - - - - - - - - Nervous Affections 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - Phthisis suspected 3 — 1 - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - Deformities - 1 - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - Ringworm - 1 - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - Skin Diseases 2 1 — - — — — — 1 — — - — — — 1 1 — — — — - - — — — — — - - — - Incontinence 1 — 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Other Affections and Diseases 4 - - - - - - - 2 - 1 - 1 - - - - - - - - - - - - - - - - - - - The following Table shews the Reasons for Presentation of Cases for Special Inspection during 1913. SCHOOL AH Schools. Downshall Cleveland Christchurch Loxford Highlands South Park Uphall National & Church Infants Newbury Park Goodmayes Chadwell Barkingside Roman Catholic Valentines Little Heath Reasons for Presentation. M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F Neglected Condition 3 1 - - - - - - - - - - - - - - - - 3 - - - - - - - - - - 1 - - Mental-Deficiency 4 — — — — — - — — — — — — — — — — — 1 — 1 — — — — — - — 2 — — — Defective Hearing 5 2 - — — 1 2 — — — — — — — — — — — — — 2 — — — — — - - — — 1 1 Defective Vision 9 13 — — - 11 5 1 — - — — — — — - — — — — 4 1 — — — — - - — — — - Malnutrition and Debility 2 3 - - - 2 1 - - - - - - - - - - 1 - - 1 - - - - - - - - - - - Enlarged Tonsils - 1 - - - - - 1 — - - - - - - - - - - - - - - - - - - - - - - - Adenoids Suspected 5 4 — — — — 3 3 — — — 1 — — — — — — — — — — — — — — — — — — 2 — Eye Diseases — 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - Nervous Affections 1 1 1 - - - - - - - - 1 - - - - - - - - - - - - - - - — - - - - Skin Diseases 2 2 1 - - 2 - - - - - - - - - - - - - - - - 1 - - - - - - - - - Ringworm - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - Bronchitis 1 — 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Headaches — 2 - - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - Fractured Arm 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - Totals 33 31 3 — - 19 11 5 — — — 2 — — — — — 1 4 — 8 1 1 — — — — - 3 2 3 1 89 The following table shows the average heights and weights of the Boys examined, and shows comparisons with findings of the Anthropometric Committee (marked ‡) Ages of children—Years 5-6 6-7 7-8 8-9 9-10 10-11 11 -12 12-13 13-14 14-15 Total number of children examined 356 173 78 69 73 58 60 329 110 8 Heights Cms. 107.11 112.31 118.26 122.94 128.69 130.83 134.68 138.94 145.93 147.5 Ins. 42.17 44.21 46.55 48.40 50.66 51.50 53.02 54.70 57.45 58.14 ‡ins. +1.14 +.21 + .58 + 1.35 + .96 -.34 -.48 -.29 + .54 -1.19 ALL SCHOOLS— Kilos. 18.32 19.78 21.83 24.01 26.94 27.48 31.37 34.04 36.47 38.97 Weights Lbs. 40.38 43.60 48.12 52.93 59.32 60.58 69.15 75.04 80.40 85.91 ‡Lbs. + .48 -.80 -1.58 -1.97 - 1.01 -6.92 -2.85 -1.66 -2.20 -6.09 Number of children examined 57 37 9 9 7 5 4 49 13 1 Heights Cms. 108.12 112.3 115.44 125.44 129.71 133 142.5 142.88 144.38 147 Ins. 42.56 44.21 45.44 49.38 51.06 52.36 56.10 56.25 56.84 57.87 ‡ins. +1.53 +.21 -.53 +2.33 +1.36 +.52 +2.60 +1.26 -.07 - 1.46 DOWNSHALL— Kilos. 18.45 19.65 20.92 25.55 27 27.72 36.95 34.34 35-38 37.4 Weights Lbs. 40.67 43.32 46.12 56.32 59.52 62.11 81.45 75.70 77.99 82.45 ‡ Lbs. +.77 -1.08 -3.58 +1.42 - .88 -5.39 + 9.45 -1.00 — 4.6l -9.55 Number of children examined 63 16 8 4 10 6 3 28 15 ... Heights Cms. 106.39 111.25 117 122.5 130.75 133.08 140.66 141.73 146.8 ... Ins. 41.88 43.79 46.06 48.22 51.47 52.39 55.47 55.79 57.79 ... ‡1ns. +.85 -.21 + .09 +1.17 + 1.77 + .55 + 1.97 + .80 + .88 ... CLEVELAND ROAD— Kilos. 18.56 20.02 21.55 25.15 28.3 28.16 33.33 34.56 36.10 ... Weights Lbs. 40.91 44.13 47.50 55.44 62.39 62.08 73.47 76.19 79.58 ... ‡Lbs. + 1.01 -.27 -2.20 +.54 +1.99 -5.42 + 1.47 -.51 -3.02 ... 90 Boys— continued. Ages of children—Years 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-4 14-15 Number of children examined 28 19 11 4 7 5 9 45 18 3 Heights Cms. 109 111.42 116.54 125 127.42 135.2 135.55 141.58 146.94 148.66 Ins. 42.91 43.86 45.88 49.21 50.16 53.22 53.36 55.74 57.83 58.52 ‡ Ins. +1.88 -.14 -.09 +2.16 +.46 +1.34 -.14 +.75 +.92 -.81 CHRISTCHURCH ROAD- Weights Kilos. 19.13 19.36 21.29 25.4 26.14 30 32.77 33.81 37.84 39.46 Lbs. 42.17 42.68 46.73 56.00 57.56 66.13 72.24 74.53 83.42 86.99 ‡ Lbs. +2.27 -1.72 —2.96 +1.10 -2.84 -1.37 +.24 +2.17 +.82 -5.01 Number of children examined ... 14 9 5 2 2 2 2 24 5 1 Heights Cms. 109.07 113.44 125 127.5 131.5 129.5 137.5 144.08 146.2 152 Ins. 42.94 44.66 49.21 50.19 51.71 50.98 54.13 56.72 57.55 59.84 5 Ins. +1.91 +.66 +3.24 +3.14 +2.01 -.86 +.63 +1.73 +.64 +.51 LOXFORD — Weights Kilos. 19.37 19.71 23.12 24.9 32 28.6 32.2 34.69 34.4 39.2 Lbs. 42.70 43.45 50.97 54.89 70.54 63.05 70.98 76.47 75.83 86.42 ‡ Lbs. +2.80 -.95 +1.27 —.01 +10.14 -4.45 -1.02 -.23 -6.77 -5.58 Number of children examined ... 25 15 6 4 10 2 4 10 4 ... Heights Cms. 106.92 112.46 120.83 123.25 127.5 137 137.5 145.3 145.75 ... Ins. 42.09 44.27 47.57 48.52 50.19 53.93 53.05 57.20 57.38 ... ‡lns. +1.06 +.27 +1.60 +1.47 +.49 +2.09 -.45 +2.21 +.47 ... HIGHLANDS— ... Weights Kilos. 18.35 19.77 23.56 23.95 27.92 29.1 29.7 33.72 34.3 ... Lbs. 40.45 43.58 51.94 52.80 61.55 64.15 65.47 74.33 75.61 ... ‡ Lbs. +.55 -.82 +2.24 —2.10 +1.15 -3.35 -6.53 -2.37 -6.99 ... 91 Boys—continued. Ages of children —Years ... 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 Number of children examined ... 15 13 1 2 3 ... 1 4 6 ... Heights Cms. 109.93 111.30 111 125.5 127 ... 144 147.25 145.16 ... Ins. 43.27 43.81 43.70 49.40 49.99 ... 56.69 57.97 57.14 ... ‡ Ins. +2.24 -.19 -2.27 +2.35 +.29 ... +3.19 +2.98 +.23 ... SOUTH PARK— ... ... Weights Kilos. 19.18 19.10 18.4 24.9 26.26 ... 33.8 35 38.86 ... Lbs. 42.28 42.10 40.56 54.89 57.89 ... 74.51 77.16 85.67 ... ‡ Lbs. +2.38 -2.30 -9.14 -.01 -2.51 ... +2.51 +.46 +3.07 ... Number of children examined ... 16 4 2 12 8 6 10 37 6 ... Heights Cms. 103.56 111.5 107 124.16 125.87 128.66 138.5 140.73 141.33 ... Ins. 40.77 43.89 42.12 48.88 49.55 50.65 54.52 55.40 55.64 ... ‡ins. —.26 -.11 -3.85 +1.83 -.15 -1.19 +1.02 +.41 -1.27 ... UPHALL— ... Weights Kilos. 17.63 21 17.6 24.51 25.32 27.7 30.42 33.87 34 ... Lbs. 38.86 46.29 38.80 54.03 55.82 61.06 67.06 74.66 74.95 ... ‡ Lbs. -1.04 +1.89 -10.9 -.87 -4.58 -6.44 -4.94 —2.04 -7.65 ... Number of children examined ... 14 5 4 3 4 4 5 27 12 ... Heights Cms. 105.78 109.5 113.87 121 129.75 129.5 131.75 137.66 144 ... Ins. 41.64 43.11 44.83 47.63 51.08 50.98 51.86 54.19 56.69 ... ‡ Ins. +.61 -.89 -1.14 +.58 +1.38 -.86 -1.64 -.80 -.22 ... CHURCH OF ENGLAND— ... Weights Kilos. 17.27 20.6 20.1 22.8 26.95 27.5 29.32 32.56 35.33 ... Lbs. 38.07 45.41 44.31 50.26 59.41 60.62 64.63 71.78 77.88 ... ‡ Lbs. -1.83 +1.01 -5.39 -4.64 -.99 -6.88 -7.37 -4.92 -4.72 ... 92 Boys—continued. Ages of children—Years ... 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 Number of children examined ... 18 5 5 4 2 3 3 16 2 ... Heights Cms. 105.82 113.4 120.2 117.5 128 121 130 143.06 139.5 ... Ins. 41.66 44.64 47.32 46.25 50.39 47.63 51.18 56.32 54.92 ... ‡ins. +.63 +.64 +1.35 —.80 +.69 -4.21 -2.32 +1.33 -1.99 ... NEWBURY PARK— ... Weights Kilos. 18.31 21.44 23.6 21.4 25 22 27.86 35.8 26 ... Lbs. 40.36 47.26 49.82 47.17 55.11 48.40 61.42 78.92 79.36 ... ‡ Lbs. +.46 +2.86 +.12 -7.73 -5.29 -19.10 -10.58 +2.22 -3.24 ... Number of children examined ... 60 30 19 12 11 14 7 38 5 2 Heights Cms. 107.53 113.36 120.21 121.41 129.90 133.5 140.42 143.46 149.8 151 Ins. 42.33 44.61 47.32 47.79 51.14 52.55 51.34 56.48 58.97 59.44 ‡Ins. +1.30 +.61 +1.35 +.74 +1.44 +.71 -2.16 +1.49 +2.06 +.11 GOODMAYES— Weights Kilos. 17.59 19.96 21.9 22.63 25.61 28.1 31.02 34.23 42.2 43.6 Lbs. 38.77 44.00 48.28 49.80 56.45 61.94 68.38 75.46 93.03 95.46 ‡Lbs. -1.13 -.40 -1.42 -5.10 -3.95 -5.56 -3.62 -1.24 +11.57 +3.46 Number of children examined ... 6 8 3 5 4 4 4 21 17 ... Heights Cms. 105 110.5 119.66 123.4 130.75 127 134.75 140.71 147.62 ... Ins. 41.33 43.50 47.11 48.58 51.47 49.99 53.05 55.39 58.11 ... ‡Ins. +.30 -.50 +1.14 +1.53 +1.77 -1.85 -.45 +.40 +1.20 ... CHADWELL— ... Weights Kilos. 17.86 19.27 24.26 24.32 28.15 26.2 28.35 32.43 36.86 ... Lbs. 39.37 42.48 53.48 53.61 62.05 57.76 62.50 71.50 81.26 ... ‡ Lbs. -.53 -1.92 +3.68 -1.29 +1.65 -9.74 -9.5 -5.20 -1.34 ... 93 Boys—continued. Ages of children—Years ... 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 14-15 13-14 Number of children examined ... 13 4 1 2 1 2 2 12 ... 1 Heights Cms. 108 112.25 120 116 118 125 132.5 141.83 ... 133 Ins. 42.51 44.19 47.24 45.66 46.35 49.21 52.16 55.83 ... 52.36 ‡lns. +1.48 +.19 +1.24 -1.40 -3.35 -2.63 —1.34 +.84 ... -6.97 BARKINGSIDE— ... Weights Kilos. 19.44 20.95 22.4 22.7 22.2 25.8 30.2 35 ... 29.6 Lbs. 42.85 46.18 49.38 50.04 48.94 56.87 66.57 77.16 ... 65.25 ‡ Lbs. +2.95 +1.78 -.32 -4.86 -11.46 -10.63 -5.43 +.46 ... -26.75 Number of children examined ... 15 6 3 3 3 4 3 11 6 ... Heights Cms. 106.26 114.5 119.33 123 130.66 128.25 139 143.81 146.16 ... Ins 41.83 45.07 46.98 48.42 51.44 50.49 54.72 56.61 57.54 ... ‡ Ins. +.80 +1.07 +1.01 +1.37 +1.74 -1.35 +1.22 +1.62 +.63 ... ROMAN CATHOLIC — ... Weights Kilos. 18.24 19.2 23 23.66 28.53 26.4 34.4 35.4 34.4 ... Lbs. 40.21 42.32 50.70 52.16 62.89 58.20 75.83 78.04 75.83 ... ‡Lbs. +.31 -2.08 +1.00 -2.74 +2.49 -9.30 +3.83 +1.34 -6.77 ... Number of children examined ... 4 ... 1 2 ... 1 2 2 1 ... Heights Cms. 103.75 ... 115 122 ... 123 134 136 157 ... Ins. 40.84 ... 45.27 48.03 ... 48.42 52.75 53.54 61.81 ... ‡Ins. -.19 ... -.70 +.98 ... -3.42 -.75 -1.45 +4.90 ... THE VALENTINES— ... ... ... Weights Kilos. 17.4 ... 21.8 22.9 ... 23.8 30.2 28.1 43 ... Lbs. 38.36 ... 48.06 50.48 ... 52.46 66.57 61.94 94.79 ... ‡ Lbs. -1.54 ... -1.64 -4.42 ... -15.04 -5.43 -14.76 +12.19 ... to Boys—continued. Ages of children—Years ... 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 Number of children examined ... 8 2 ... 1 1 ... 1 5 ... ... Heights Cms. 103.62 110.5 ... 124 124 ... 140 139 ... ... Ins. 40.79 43.50 ... 48.81 48.81 ... 55.11 54.72 ... ... ‡ Ins. -.24 -.50 ... +1.76 -.91 ... +1.61 -.27 ... ... LITTLE HEATH— ... ... ... ... Weights Kilos. 16.87 19.5 ... 26.6 27.6 ... 33.6 32.72 ... ... Lbs. 37.11 42.98 ... 57.64 59.84 ... 73.97 72.13 ... ... ‡Lbs. -1.79 -1.42 ... +2.66 -.56 ... +1.97 -4.57 ... ... 95 The following table shows the average heights and weights of the Girls examined, and shows comparison with figures of the Anthropometric Committee (marked §). Ages of children—Years ... 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 Number of children examined ... 342 190 102 66 71 47 44 362 76 7 Heights Cms. 107.42 111.8 123.39 123.04 126.95 131.05 136.62 143.13 147.62 152.28 Ins. 42.29 44.01 48.57 48.44 49.98 51.59 53.78 56.35 58.11 59.95 §Ins. +1.74 +1.13 +4.12 +1.84 +1.25 +.54 +.68 +.69 +.34 +.15 ALL SCHOOLS— Weights Kilos. 18.11 19.34 20.92 23.25 25.19 26.87 30.25 34.12 37.66 45.08 Lbs. 39.92 42.63 46.62 51.25 53.53 59.23 66.68 75.22 83.02 99.38 §Lbs. +.72 +.93 -.88 -.85 +.03 -2.77 -1.42 -1.18 -4.18 +2.68 Number of children examined ... 31 41 20 14 7 6 9 51 5 ... Heights Cms. 108.22 112.78 116.05 121.64 131.42 133.16 136.88 143.98 146.2 ... Ins. 42.60 44.40 45.68 47.88 51.74 52.42 53.88 56.68 57.55 ... §Ins. +2.05 +1.52 +1.23 +1.28 +3.01 +1.37 +.78 +1.02 —.22 ... DOWNSHALL— Weights Kilos. 18.32 19.58 20.2 22.81 26.74 27.76 29.84 34.92 37.6 ... Lbs. 40.38 43.16 44.53 50.28 58.95 61.19 65.78 76.98 82.89 ... §Lbs. +1.18 +1.46 -2.97 -1.82 +3.45 -.81 —2.32 +.58 -4.31 ... Number of children examined ... 64 20 12 11 3 6 4 51 18 2 Heights Cms. 107.03 111.7 116.81 120.09 126.66 129.33 141.5 142.60 149.11 149 Ins. 42.13 43.97 45.98 47.27 49.86 50.91 55.70 56.14 58.70 58.66 §Ins. +1.58 +1.09 +1.53 +1.67 +1.13 -.14 +2.60 +.48 +.93 -1.14 CLEVELAND ROAD— Weights Kilos. 17.94 19.32 21.4 23.50 25.46 25.06 33.55 34.37 38.31 43.1 Lbs. 39.55 42.59 47.17 51.80 56.12 55.24 73.96 75.77 84.45 95.01 §Lbs. +.35 +.89 -.33 -.30 -.62 —6.76 +5.86 -.63 -2.75 -1.69 96 Girls—continued. Ages of children—Years ... 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 Number of children examined ... 24 32 13 6 6 4 2 60 7 ... Heights Cms. 107.37 111.46 114.61 123 128 133.62 129.5 144.67 147.92 ... Ins. 42.27 43.88 45.12 48.42 50.39 52.60 50.98 56.95 58.23 ... §Ins. +1.72 +1.00 +.67 +1.82 +1.66 +1.55 —2.12 +1.29 +.46 ... CHRISTCHURCH ROAD- Weights Kilos. 17.99 19.51 20.41 24.43 24.5 27 28.2 34.83 38.14 ... Lbs. 39.66 42.01 44.99 53.85 54.01 59.52 62.16 76.78 84.08 ... §Lbs. +.46 +.31 -2.51 +1.75 -1.49 -2.48 -5.94 +.38 -3.12 ... Number of children examined ... 17 4 5 1 4 ... 2 5 ... ... Heights Cms. 109.63 108.5 124.5 112 125.5 ... 132.5 140.4 ... ... Ins. 43.16 42.71 49.01 44.19 49.40 ... 52.16 55.27 ... ... §Ins. +2.61 -.17 +4.56 -2.41 +.67 ... -.94 -.39 ... ... LOXFORD— ... Weights Kilos. 18.83 19.2 23.2 18.4 26.25 ... 27.4 34.44 ... ... Lbs. 41.51 42.32 51.32 40.56 57.87 ... 60.40 75.92 ... ... §Lbs. +2.31 +.62 +3.82 -11.54 +2.37 ... -7.70 -.48 ... ... Number of children examined ... 32 13 10 6 15 4 4 27 7 ... Heights Cms. 109 114.15 119.1 124 125.8 130 136.25 147.70 154.28 ... Ins. 42.91 44.94 46.88 48.81 49.52 51.18 53.64 58.14 60.74 ... §Ins. +2.46 +2.06 +2.53 +2.21 +.79 +.13 +.54 +2.48 +2.97 ... HIGHLANDS— Weights Kilos. 18.86 20.35 22.88 25.4 23.96 28.55 29.45 36.35 39.28 ... Lbs. 41.47 44.86 50.44 55.99 52.72 62.94 64.92 80.13 86.59 ... §Lbs. +2.27 +3.16 +2.86 +3.89 -2.78 +.94 -3.28 +3.73 -.6l ... 97 Girls—continued. Ages of children—Years ... 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 Number of children examinee ... 22 8 9 2 3 1 2 8 3 ... Heights Cms. 108.09 109.12 116.11 120.5 126.33 130 142.5 140.75 147.66 ... Ins. 42.55 42.96 45.71 47.44 49.73 51.18 56.10 55.41 58.13 ... §ins. +2.00 +.08 +1.26 +.84 +1.00 +.13 +3.00 -.25 +.36 ... SOUTH PARK— ... Weights Kilos. 17.69 18.85 19.57 21.3 23.66 27 32.2 31.05 38.2 ... Lbs. 38.99 41.55 43.14 46.95 52.16 59.52 70.98 68.45 84.21 ... §Lbs. -.21 -.15 -4.36 —5.15 -3.34 -2.48 +2.88 -7.95 -2.99 ... Number of children examined ... 12 3 4 5 10 8 4 48 6 ... Heights Cms. 105 115.33 114.75 122.6 125.5 129.25 133.25 141.60 144 ... Ins. 41.33 45.40 45.17 48.26 49.40 50.88 52.46 55.74 58.26 ... §Ins. +.78 +2.52 +.72 +1.66 +.67 -.17 -.64 +.08 +.49 ... UPHALL— Weights Kilos. 17.91 20.6 21.7 22.8 26.1 26.6 29.75 33.22 37.76 ... Lbs. 39.48 45.41 47.83 50.26 56.54 58.64 65.58 73.23 83.24 ... §Lbs. +.28 +3.71 +.33 -1.84 +1.04 -3.36 -2.52 -3.17 -3.96 ... Number of children examined ... 25 5 9 5 4 5 2 17 5 ... Heights Cms. 105.64 108.6 116.55 117.6 125.5 131.2 142 141.47 140.6 ... Ins. 41.59 42.75 45.88 46.29 49.40 51.65 55.90 55.69 55.35 ... §Ins. +1.04 -.13 +1.43 -.31 +.67 +.60 +2.80 +.03 -2.42 ... CHURCH OF ENGLAND— Weights Kilos. 17.5 17.84 20.75 20.4 23.75 25.72 34.5 32.24 30.12 ... Lbs. 38.58 39.33 45.74 44.97 52.34 56.70 76.05 71.07 66.40 ... §Lbs. -.62 -2.37 -1.76 -7.13 -3.16 -5.30 -7.95 -5.33 -10.80 ... 98 Girls—continued. Ages of chidren— Years ... 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 Number of children examined ... 21 8 4 1 1 2 2 20 1 ... Heights Cms. I05.04 109 114 124 130 128.5 129.5 142.6 145 ... Ins. 41.35 42.91 44.88 48.81 51.18 50.59 50.98 56.14 57.08 ... §Ins. +.80 +.03 +.43 +2.21 +2.45 -.46 -2.12 +.48 -.69 ... NEWBURY PARK— Weights Kilos. 17.84 18.65 20.9 26.8 25 26 30.4 35.31 38.4 ... Lbs. 39.33 41.11 46.07 59.08 55.11 57.31 67.01 77.84 84.65 ... §Lbs. +.13 -.159 -1.43 +6.98 -.39 -4.69 -1.09 +1.44 -2.55 ... Number of children examined ... 44 39 10 4 7 5 4 32 9 4 Heights Cms 106.86 112.89 118.1 126.5 129.71 134 138 142.57 149.33 157.75 Ins. 42.07 44.44 46.49 49.80 51.06 52.75 54.33 56.12 58.79 62.10 §ins. +1.52 +1.56 +2.05 +3.20 +2.33 +1.70 +1.23 +.46 +1.02 +2.30 GOODMAYES— Weights Kilos. 17.60 19.45 21.56 25 26.31 28.88 29.7 33.31 40.28 48.45 Lbs. 38.80 42.87 47.53 55.11 58.00 63.66 65.47 73.42 88.80 106.81 §Lbs. -.40 +1.17 +.03 +3.01 +2.50 +1.66 -2.63 -2.98 +1.60 +10.11 Number of children examined ... 13 4 2 3 1 2 5 12 10 1 Heights Cms. 106.07 109.75 107.5 127.66 134 13.5 133.4 137.58 145 139 Ins. 41.75 43.20 42.32 50.25 52.75 51.77 52.51 54.16 57.08 54.72 §ins. +1.20 +.32 -2.13 +2.65 +4.02 +.72 -.59 -1.50 -.69 -5.08 CHADWELL— Weights Kilos. 17.7 18.25 20.5 26.6 28.4 28.7 27.84 30.08 36.5 35.6 Lbs. 39.02 40.23 45.19 58.64 62.61 63.27 61.37 66.31 80.46 78.48 §Lbs. -.18 -1.47 —2.31 +6.54 +7.11 +1.27 -6.73 -10.09 -6.74 -18.22 99 Girls—continued. Ages of children—Years ... 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 Number of children examined ... 14 9 2 1 2 1 ... 13 ... ... Heights Cms. 105.50 106.77 108 119 121.5 121 ... 143.53 ... ... Ins. 41.53 42.03 42.51 46.85 47.83 47.63 ... 56.50 ... ... §Ins. +.98 -.85 -1.94 +.25 -.90 -3.42 ... +.84 ... ... BARKINGSIDE— Weights Kilos. 17.42 17.22 16.6 21.4 25.2 22.8 ... 34.01 ... ... Lbs. 38.40 37.96 36.59 47.17 55.55 50.26 ... 74.97 ... ... §Lbs. -.80 -3.74 —10.91 -4.93 +.05 -11.74 ... -1.43 ... ... Number of children examined ... 10 2 1 5 2 3 4 10 5 ... Heights Cms. 107.85 117.5 119 121 126 133 141.12 142.55 148.2 ... Ins. 42.46 46.25 46.85 47.63 49.60 52.36 55.98 56.12 58.34 ... §Ins. +1.91 +3.37 +2.40 +1.03 +.87 +1.31 +2.88 +.46 +.57 ... ROMAN CATHOLIC— Weights Kilos. 23.08 21 20.4 22.24 25.2 27.8 32.1 33.5 36.96 ... Lbs. 50.88 46.29 44.97 49.03 55.55 6l.28 70.76 73.85 81.48 ... §Lbs. +11.68 +4.59 -2.53 -3.07 +.05 -.72 +2.66 -2.55 -5.72 ... Number of children examined ... 5 ... ... 1 1 ... ... 6 ... ... Heights Cms. 106.4 ... ... 106 124 ... ... 144 ... ... Ins. 41.88 ... ... 41.73 48.81 ... ... 56.69 ... ... §Ins. +1.33 ... ... -4.87 +.08 ... ... +1.03 ... ... THE VALENTINES— ... ... Weights Kilos. 17.56 ... ... 19.4 25.2 ... ... 34.86 ... ... Lbs. 38.71 ... ... 42.76 55.55 ... ... 76.85 ... ... §Lbs. -.40 ... ... -9.34 +.05 ... ... +.45 ... ... 100 Girls—continued. Ages of children—Years ... 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 Number of children examined ... 8 2 1 l 1 ... ... 2 ... ... Heights Cms. 105.5 113.5 113 118 126 ... ... 143 ... ... Ins. 41.53 44.68 44.48 46.45 49.60 ... ... 56.29 ... ... §Ins. +.98 +1.80 +.03 -.15 +.87 ... ... +.63 ... ... LITTLE HEATH— Weights Kilos. 16.6 19.9 19.4 22 24.6 ... ... 31.5 ... ... Lbs. 36.59 43.87 42.76 48.50 54.23 ... ... 69.44 ... ... §Lbs. -2.61 +2.17 -4.74 -3.60 -1.27 ... ... —6.96 ... ... 101 INFECTIOUS DISEASE. On examining the table on page 107 it will be seen that the total amount of infectious disease in the schools was only slightly greater than in the previous year. The great increase in cases of Measles and Chicken Pox has been counter-balanced by the diminished number of cases of Mumps and Whooping Cough. SCARLET FEVER. 152 cases of Scarlet Fever were reported in school children. The type of the disease prevalent continues to be a mild one, and this leads to great difficulties in many cases. Not uncommonly the disease is present in so slight a form that the doctor called in hesitates as to the diagnosis. In the large majority of cases notified no source of infection from another case could be detected. One cannot but suppose that some of the numerous sore throats to which children are liable are scarlatinal in origin and escape diagnosis owing to the absence of any rash. Of the individual schools, South Park was notably affected, 29 cases being notified. Many visits were paid to this school, and suspicious cases of illness excluded. An appreciable number of cases of the disease were found to follow on a visit to a cinematograph theatre. It is certainly wrong that a child who is absent from school owing to a sore throat or else owing to its having been in contact with a case of infectious disease should be allowed to go to a cinematograph theatre. Nothing oan, however, be done in this matter except by action of the licensing authorities or by special legislation. 16 cases of Scarlet Fever were diagnosed and notified by the School Medical Officer. 102 DIPHTHERIA. The year 1913 was not characterised by any features of importance with regard to this disease. The type prevailing was only a mild one. Indeed, if it were not for the diagnosis of many mild cases by bacteriological examination the number of cases notified would be sensibly diminished. No school was affected more than another, with the exception of Barkingside School. In the last three months of the year 13 cases in children at Barkingside were notified. Most of the cases were extremely mild, several, however, being of great severity. Four cases of Diphtheria were diagnosed and notified by the School Medical Officer. GERMAN MEASLES. Only seven cases of this disease were reported during the year 1913. MEASLES. An epidemic of this disease commenced in the autumn of 1912, and continued through the winter of 1912-1913, subsiding in the spring. Almost every school was affected, with the exception of Cleveland Road School, in which, for some inexplicable reason, only 19 cases occurred. Barkingside School, serving a scattered area some distance from Ilford proper, also escaped with a small number of cases. The control of this disease is one of the most difficult matters with which the School Medical Officer has to deal. The ideal method of dealing with this disease would be by notification of the disease, followed by removal to an isolation hospital wherever home isolation was insufficient. This is not practicable at present owing to the expense involved. With the question of school-closure for this disease the 103 School Medical Officer has dealt in previous annual reports. 19 deaths from Measles in children under 15 were 1ecorded, as compared with one from Scarlet Fever and five from Diphtheria, it will be realised from these figures that Measles is a most dangerous disease. CHICKEN POX. There was an excessive incidence of this disease during 1913, the epidemic reaching its height in November. Of the individual schools, Highlands was specially affected, one child out of every six in attendance contracting the disease. Chicken pox is only rarely fatal. It is of importance in that the more serious disease Smallpox may be mistaken for it. WHOOPING COUGH. There was but little prevalence of this disease during the year, with the exception of the children attending Goodmayes School, amongst whom 46, or nearly 50 per cent. of the number of cases occurred. The custom was followed as before of excluding susceptible contacts for 14 days only. This is in accordance with the modern idea that the infectious period of Whooping Cough is during the preliminary cold or cough that precedes the whooping stage. By the time, therefore, that a case is diagnosed by its whooping, infection of other susceptible children has, if at all, occurred. MUMPS. There was an exceptionally large number of cases of Mumps in the latter part of 1912, and this continued during the first six or seven months of 1913. The epidemic then subsided, and only a few cases here and there were recorded during the remainder of the year. 104 No deaths from Mumps were recorded. Certain complications follow Mumps, the most important being orchitis. Otherwise the disease is but of temporary inconvenience to a child. Owing to the long period of incubation and the uncertainty of the correct diagnosis in many cases unattended by a. doctor, it is not now usual in this district to exclude contacts, or children that have been associated with the case. RINGWORM. During the last few years much attention has been devoted to this disease by the school medical staff with eminently successful results, as the following table will prove. Number of cases reported from the schools:— In 1913 82 In 1912 123 In 1911 150 In 1910 128 In 1909 114 In considering the above table it must be noted that the apparent increase in the years 1910 and 1911 was probably due to the detection of many more slight cases that would in the past have gone unrecorded and undetected. The decrease in the last two years has, I consider, been a real one, and has been brought about by careful search for and rigorous exclusion of every case, however slight. It is the practice of the department to exclude any case of Ringworm until two or more examinations of the untreated scalp have failed to reveal any spore-infected hairs. We are often criticised by parents, and even by some doctors, for our unwillingness to allow children to return when apparently cured. I think that our practice is justified by the great diminution in the number of children excluded for this disease. It is remarkable that no case of Ringworm was found in the 106 Chadwell schools during 1913 or 1912. This school has an average attendance of 257 children, mostly drawn from the poorest classes. There has been no specially large incidence at Loxford School during 1913, the number of cases being 8, as compared with 30 in 1912. As empowered by Article 53 (b) of the Code of Regulations for Public Elementary Schools, the Local Education Authority has decided that all cases of Ringworm must be certified by the School Medical Officer as being fit to return. During the year 140 children affected with Ringworm of the scalp have been certified as cured. These may be classified as follows:— Gases treated by Drugs Boys 50 Girls 48 Cases treated by X Rays privately or at a Boys 7 hospital Girls 6 Cases treated by X Rays under the School Boys 25 Medical Officer Girls 4 Total 140 29 cases received treatment by X Rays at the hands of the School Medical Officer without any untoward result. Most the cases so treated were fit for return to school after 4 to 6 weeks. Great care is exercised to be on the safe side so far as the dosage of the X Rays is concerned, and perhaps as a consequence of this several cases did not depilate sufficiently well to eradicate the disease. However, in no case was any trace of the disease left after 4 or 5 months. DEATHS AMONGST SCHOOL CHILDREN. 34 deaths have occurred amongst children of school age:— 2 from Measles. 1 „ Whooping Cough. 4 „ Diphtheria and Croup. 1 „ Erysipelas. 4 „ Phthisis. 106 2 from Tuberculous Meningitis. 1 „ Other Tuberculous Diseases. 1 „ Cancer and Malignant Disease. 4 „ Organic Heart Disease. 1 „ Bronchitis. 1 „ Pneumonia (all forms). 1 „ Appendicitis and Typhlitis. 1 „ Violent Death, excluding Suicide. 8 „ Other Defined Diseases. 2 „ Diseases ill-defined or unknown. Summary of Infectious Disease and Children who have been excluded owing to Contact with Patients in connection with the Schools during the year ended the 31st December, 1913. SCHOOLS. Average Attendance. DISEASES AND CONTACTS. Scarlet Fever. Diphtheria. Enteric Fever. Measles. German Measles. Chicken Pox. Mumps. Whooping Cough. Ringworm Totals. 1913. Totals. 1912. Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Contacts Downshall 1307 8 20 16 21 — — 34 14 — 3 132 88 66 3 8 3 10 274 152 239 84 Cleveland Road 1293 11 11 6 12 — — 19 26 — 1 50 36 — 2 — 3 93 86 238 110 Christchurch Road 1147 11 14 2 6 — - 100 72 1 — 34 9 31 2 11 0 7 197 108 238 65 Loxford 1149 10 16 3 7 — — 59 32 1 — 30 15 14 - 1 1 8 126 71 259 100 Highlands 870 10 11 2 5 — — 93 33 1 — 140 74 5 — - — 0 256 123 96 59 South Park 912 29 35 14 8 — - 80 23 1 5 107 52 52 4 15 3 6 304 130 223 57 Uphall 1035 12 13 3 4 — — 98 92 — — 32 18 9 — 1 1 11 166 128 136 74 National and Church Infants 416 11 17 2 6 — - 30 64 — — 9 6 3 — 4 — 4 56 93 67 47 Newbury Park 515 11 9 1 1 — — 57 48 — — 6 10 — — 1 77 6 82 68 97 44 Goodmives 795 6 7 3 3 — — 85 36 1 1 22 14 21 — 46 15 8 192 76 103 35 Chadwell 257 8 5 1 3 — - 16 20 — — 2 4 23 1 1 1 — 51 34 14 25 Barkingside 258 1 1 13 16 — — 5 15 — — — 1 — — — - 9 28 33 28 30 Roman Catholic 291 6 7 - — — - 27 13 — — - — 11 — 8 4 2 54 24 33 14 Valentines 103 — - - - — — — — 1 — 4 — - — — - 2 7 — 14 15 Little Heath 124 1 1 — — — — 40 34 1 - - - - - - - 1 43 35 4 2 County High School ? - 1 - - - - - — — - 2 4 2 — — — — 4 5 3 13 Private Schools ? 17 17 4 2 — — 4 — — — — 9 — — — — — 25 28 34 24 Totals 3 152 185 70 94 — — 747 522 7 10 563 340 239 10 98 33 82 1958 1194 1826 798 One case of Erysipelas was excluded from the Downshall School. 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 1912. SCHOOLS. Average attendance. Jan Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1913. Totals 1912. 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 1307 1 - - 5 - - - - 2 1 - 1 - - - - - - 2 3 1 1 2 9 8 20 24 30 Cleveland Road 1293 2 3 2 2 — — 1 — — — — — 1 2 1 1 1 - - - 2 2 1 1 11 11 14 13 Christchurch Road 1147 1 3 2 1 4 2 — — — 2 — — 1 2 - - - - - 1 2 3 1 - 11 14 17 15 Loxford 1140 1 — 2 2 - 3 1 1 - - - - - - 1 4 4 - - - 1 6 - - 10 16 7 Highlands 876 3 3 — — 1 3 — — 1 2 — - - - - - - - 1 1 3 - 1 2 10 11 23 37 South Park 912 4 6 - — 7 6 7 7 1 - 2 1 3 5 1 2 - - - - - 3 4 - 29 35 20 17 Uphall 1035 1 5 — — - - - - - - 1 - - - 1 2 - - 5 3 2 3 2 - 12 13 27 42 National and Church Infants 416 6 5 1 2 1 1 - - - - - - 1 - - - - - - - 2 9 - - 11 17 3 6 Newbury Park 515 — 1 — — — — — — — — — — 1 1 - - - - 5 3 4 2 1 2 11 9 7 20 Goodmayes 795 — — 1 1 — 1 1 — — 1 — - - - 1 - 1 - - - - - 2 4 6 7 37 21 Chadwell 257 — — — — — - - - - - - - - - - - 2 - 6 5 - - - - 8 5 - 4 Barkingside 258 - - - - - - - - - - - - - - - - - - - - - - 1 1 1 1 3 3 Roman Catholic 294 - - 3 2 - - - - - - - - - - - - - - - - 3 5 - - 6 7 1 1 Valentines 103 - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 Little Heath 124 - - - - - - - - - - - - 1 1 - - - - - - - - - - 1 1 - - County High School ? - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 8 Private Schools ? - 3 1 1 3 4 1 2 4 3 4 3 4 - — — — — — — — - — 1 17 17 23 13 Totals ? 19 29 12 16 16 20 11 10 8 9 7 5 12 11 5 9 8 — 19 16 20 35 15 25 152 185 208 238 DIPHTHERIA. Table showing the Number of Cases of Diphtheria and the Contacts Involved excluded in connection with the Schools, also Total Comparison with 1912. SCHOOLS. Average Attendance. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1913. Totals 1912. 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 1307 8 8 2 - 1 - 1 - - - - - - - - - 1 1 1 - 1 - 6 12 16 21 12 28 Cleveland Road 1293 1 3 - - - - - - - - 1 2 2 1 — 2 — — 1 1 — — 1 3 6 12 10 9 Christchurch Road 1147 — — — — — — — — — — 1 1 — — — — — — — — 1 1 — 4 2 6 11 11 Loxford 1149 — 3 - - - - - - - - 1 1 2 3 - - - - - - - - - - 3 7 3 5 Highlands 876 - - - 2 - - - - - - 1 - 1 1 - - - - - - - - - 2 2 5 — — South Park 912 1 — 4 2 — — 2 2 1 1 1 — 2 1 — — 1 1 1 — — — 1 1 14 8 10 13 Uphall 1035 - — — — - — 1 — — — — — 1 1 — — — — — — 1 3 — — 7 4 — — National and Church Infants 416 - - - - 1 - - - - - - - - - - - - - 1 3 - - - 3 2 6 2 5 Newbury Park 515 — — 1 1 - - - - - - - - - - - - - - - - - - - - 1 1 2 7 Goodmayes 795 - - - - - - 1 1 - - - - 1 2 - - - - 1 - - - - - 3 3 6 7 Chadwell 257 — — — — — — — — — — — — — — — — — — — — 1 3 — — 1 3 1 7 Barkingside 258 - - - - - - - - - - - - - - - - - - 3 4 6 6 4 6 13 16 2 5 Roman Catholic 294 - - - - - - - - - - - - - - - - - - - - - - - - - - 1 — The Valentines 103 - - - - - - - - - - - - - - - - - - - - - - - - - - 3 1 Little Heath 124 - - - - - - - - - - - - - - - - - - - - - - - - - - 4 2 County High School ? - - - - - - - - - - - - - - - - - - - - - - - - - - 1 5 Private Schools ? - - - - 1 1 - - 1 - - - 1 - 1 1 - - - - - - - - 4 2 10 11 Totals 3 5 14 7 5 3 1 5 3 2 1 5 4 10 9 1 3 2 2 8 8 10 13 12 31 70 94 78 116 MEASLES. Table showing the Number of Cases of Measles and the Contacts Involved excluded in connection with the Schools, also Total Comparison with 1912. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1913. Totals 1912. 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 1307 31 9 2 2 1 1 - 1 - - - 1 - - - - - - - - - - - - 34 14 64 6 Cleveland Road 1293 10 17 1 4 1 1 — 2 - - - - - - - - - - 1 - - - - 2 19 26 72 54 Christchurch Road 1147 85 60 6 9 3 1 4 1 2 1 — — - - - - - - - - - - - - 100 72 1 — Loxford 1149 41 23 4 2 1 2 - - - - - - - 2 — — — — — — 1 1 12 2 59 32 84 57 Highlands 876 69 17 17 11 3 3 4 2 - - - - - - - - - - - - - - - - 93 33 12 4 South Park 912 32 11 27 2 6 5 — 2 — — — — 14 3 — — — — — — 1 — — — 80 23 9 — Uphall 1035 51 56 26 18 16 12 3 3 — — — — - - - — 2 3 — — — — — — 98 92 6 15 National and Church Infants 416 28 52 - - 1 12 1 - - - - - - - - - - - - - - - - - 30 64 1 3 Newbury Park 515 36 18 19 16 1 14 - - - - - - - - - - - - - - - - 1 — 57 48 1 2 Goodmayes 795 57 18 3 6 2 1 — 1 — — 3 — 19 6 — 3 1 1 — — — — — — 85 30 3 — Chadwell 257 14 12 1 8 — — — — 1 - - - - - - - - - - - - - - - 16 20 8 9 Barkingside 258 3 3 — — — — 2 6 — 6 — — — — — — — — — — — — — — 5 15 — — Roman Catholic 294 23 8 1 - 3 5 - - - - - - - - - - - - - - - - - - 27 13 2 2 Valentines 103 - - - - - - - - - - - - - - - - - - - - - - - - - - 1 — Little Heath 124 2 1 12 11 23 19 3 3 - - - - - - - - - - - - - - - - 40 34 — — County High School ? - - - - — - - - - - - - - - - - - - - - - - - - - - - - Private Schools ? 1 - 1 - - - 2 - - - - - - - - - - - - - - - - - 4 - - - Totals ? 489 305 120 89 61 76 19 21 3 7 3 1 33 11 — 3 3 4 1 — 2 1 13 4 747 522 264 152 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 1912. SCHOOLS. Average attendance. Jan. Feb March April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1913. Totals 1912. 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. Oonts. Downshall 1307 22 8 28 15 21 8 23 17 24 24 8 4 2 6 1 2 1 4 ... ... 2 ... ... ... 132 88 22 5 Cleveland Road 1293 ... ... 4 5 ... ... 3 2 2 ... 1 2 ... ... 3 ... 4 4 12 6 16 10 5 7 50 36 23 18 Christchurch Road 1147 ... ... ... ... 2 ... 2 1 9 6 7 ... ... ... ... ... ... ... 2 1 7 1 5 ... 34 9 54 18 Loxford 1149 8 ... 16 4 1 1 4 2 ... ... 1 1 ... ... ... ... 2 4 3 3 ... ... ... ... 22 15 54 22 Highlands 876 1 ... 4 2 1 ... 1 1 3 2 1 ... ... ... ... ... 2 1 31 11 71 42 25 15 l49 74 l6 7 South Park 912 ... ... ... ... 4 1 3 ... 1 ... ... ... 1 1 ... ... ... ... 7 9 59 28 32 13 167 52 22 8 Uphall 1035 7 3 ... ... ... ... ... ... ... ... 2 2 ... ... 1 1 1 ... 11 9 10 3 ... ... 12 13 2 3 National and Church Infants 416 ... 2 ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... 2 6 25 22 Newbury Park 515 ... ... ... ... ... ... ... ... ... ... ... ... 2 4 ... 2 4 4 ... ... ... ... ... ... 6 10 14 4 Goodmayes 795 1 1 ... ... ... ... ... 1 2 1 2 ... ... ... 1 ... 2 4 ... ... ... 1 14 6 22 14 12 3 Chadwell 257 ... ... ... ... ... ... ... ... ... ... 2 1 ... 3 ... ... ... ... ... ... ... ... ... ... 2 4 1 4 Barkingside 258 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 Roman Catholic 294 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Valentines 103 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 7 13 Little Heath 124 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... County High School ? ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 2 1 2 4 ... ... Private Schools ? ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 4 ... 3 ... 9 ... ... Totals ? 38 14 52 26 29 10 37 27 41 35 24 12 5 14 6 5 16 23 67 39 165 90 83 45 563 340 256 131 WHOOPING COUGH. Table showing the Number of Cases of Whooping Cough and the Contacts Involved excluded in connection with the Schools. also Total Comparison with 1912. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1913. Totals 1912. 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 1307 ... ... ... ... ... ... ... ... 1 1 2 1 ... ... 3 ... 2 1 ... ... ... ... ... ... 8 3 96 13 Cleveland Road 1293 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... 22 9 Christchurch Road 1147 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 3 3 7 1 11 5 54 8 Loxford 1149 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 56 9 Highlands 876 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 8 South Park 912 ... ... ... ... ... ... ... ... ... ... ... ... 4 1 4 ... 6 2 ... ... 1 ... ... 15 3 42 11 Uphall 1035 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 34 10 National and Church Infants 416 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... ... ... ... ... ... ... 4 ... 13 10 Newbury Park 515 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 14 6 Goodmayes 795 ... ... ... ... ... ... 4 2 10 1 14 3 12 5 4 ... ... 2 1 ... 1 2 ... ... 46 15 31 2 Chadwell 257 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 1 3 1 Barkingside 258 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 20 Roman Catholic 294 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1... 1 7 3 8 4 12 7 Valentines 103 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Little Heath 124 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... County High School ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Private Schools ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ? 2 ... ... ... 1 1 4 2 11 2 17 4 17 6 11 ... 13 6 2 2 6 6 14 4 98 33 419 114 MUMPS. Table showing the Number of Cases of Mumps and the Contacts Involved excluded in connection with the Schools, also Total Comparison with 1912. SCHOOLS. Average attendance. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1913. Totals 1912. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Oonts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts Downshall 1307 4 1 9 ... 15 2 20 ... 9 ... 8 ... 1 ... ... ... ... ... ... ... ... ... ... ... 66 3 6 1 Cleveland Road 1293 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 85 4 Christchurch Road 1147 ... ... ... ... 6 ... 8 1 9 ... 6 1 1 ... ... ... ... ... ... ... ... ... 1 ... 31 2 78 9 Loxford 1149 1 ... ... ... ... ... 7 ... 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 14 ... 24 ... Highlands 870 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... 5 ... 13 1 South Park 912 37 3 5 1 ... ... 2 ... 6 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 52 4 109 5 Uphall 1035 2 ... 1 ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 9 ... 53 3 National and Church Infants 416 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 18 1 Newbury Park 515 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 55 5 Goodmayes 795 ... ... ... ... 2 ... ... ... 3 ... 8 ... 8 ... ... ... ... ... ... ... ... ... ... ... 21 ... 8 ... Chadwell 257 1 ... ... ... ... ... ... ... ... ... 6 ... 8 ... 6 ... 2 1 ... ... ... ... ... ... 23 1 1 ... Barkingside 258 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... Roman Catholic 294 5 ... ... ... ... ... ... ... 1 ... 4 ... 1 ... ... ... ... ... ... ... ... ... ... ... 11 ... 10 2 Valentines 103 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Little Heath 124 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... County High School ? ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... Private Schools ? ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ? 54 4 15 1 25 2 42 1 32 ... 39 1 19 ... 6 ... 2 1 1 ... 1 ... 3 ... 239 10 463 31 114 RINGWORM. Table showing the number of Cases of Ringworm in connection with the Schools, also Total Comparison with 1912. Schools. Average Attendance. January. February. March. April. May. June. July. August. September. October. November December. Totals, 1913 Totals, 1912. Downshall 1,307 - 1 - 2 3 1 1 - 2 - - - 10 12 Cleveland Road 1,293 1 — — — — — 2 — — - — — 3 9 Christchurch Road 1,147 2 1 — — 1 2 — — — - — 1 7 19 Loxford 1,149 1 — — 1 1 2 — — — - 3 — 8 30 Highlands 876 — — — — 2 2 - - - - - 1 5 8 South Park 912 1 — — 1 — — — 1 — - 1 2 6 9 Uphall 1,035 1 — 2 — 1 1 — 1 — 4 1 — 11 14 National and Church Infants 416 — — — — 1 1 — 1 — — — 1 4 5 Newbury Park 515 1 1 — 2 — — — 1 — — 1 — 6 4 Goodmayes 795 1 - - - - - — 1 1 5 — — 8 5 Chadwell 257 - - - - - - - - - - - - - - Barkingside 258 — — — 4 1 1 1 — 1 — 1 — 9 1 Roman Catholic 294 - 1 - - 1 - - - - - - — 2 5 Valentines 103 - - - - - - - - - - - 2 2 2 Little Heath 124 — — 1 - - - - - - - - - 1 — County High School — - - - - - - - - - - - - - Private Schools ? - - - - - - - - - - - - - - Totals ? 8 4 3 10 11 10 4 5 4 9 7 7 82 123 SECTION V. Report of Chief Sanitary Inspector. 117 Public Health Department, Council Offices, Ilford. 21st April, 1914.. To the Chairman and, Members of the ILFORD URBAN DISTRICT COUNCIL. Gentlemen, 1 beg to present to vou my Annual Report of the year ended 31st December, 1913. This is the twenty.first Annual Report I have had the honour of making. A tabulated summary of the various inspections made and nuisances dealt with follows:— INSPECTION OF THE DISTRICT AND THE ABATEMENT OF NUISANCES. Summary of visits as recorded during the year 1913:— Houses and premises inspected2696 Do. do. re.inspected (works in progress)5370 Visits during disinfection 1137 Houses in which nuisances were detected 766 Do. do. abated 861* Notices served 650 Do. complied with 742* Houses disinfected 426 Articles do 3908 *These figures include nuisances and notices respectively which were outstanding at the end of 1912. Articles of food condemned and destroyed:— 2 boxes of bloaters; 8 lbs. of eels; 2 boxes of kippers; 2 ox livers (about 20 lbs.); 2 hindquarters of beef (4cwt.); 1 sheep's head; 7 geese. 118 Mousing, town planning, &c., act, 1909, and the regulations made thereunder. Number of houses inspected 269 Do. considered to be unfit for human habitation 3 Do. represented do. do. human habitation — Number of closing orders made Do. houses in which defects were remedied 164 During the year 373 complaints have been received and investigated, and the following is a summary of the same:— Accumulations of manure, refuse, &c 40 Animals improperly kept 15 Alleged infectious disease in house 1 Bad smells from drains 28 Bad smells in houses 20 Bad smells pervading neighbourhood 12 Bad smells from brook 2 Bad smells from sewer 8 Burning of refuse 1 Blocked drains 58 Blocked gutter 1 Blocked waste pipe 1 Defective roof 2 Defective flushing apparatus to w.c.'s, &c. 16 Defective vent-pipe 3 Defective ventilation 1 Dampness to walls of premises 14 Defeotive down-pipe 1 Defeotive gutter 1 Defective drains 2 Dirty condition of water supply 2 Defective water frttings 3 Defective w.c. fittings 8 119 Defective gulley 2 Defective heating apparatus I Gipsies 22 Insanitary condition of rearway, waste ground, &c. 10 Insanitary condition of premises 28 Insanitary condition of urinal 1 Illegal sale of milk 2 Insufficient ventilation 1 No water supply to premises 20 Overcrowding 4 Premises used as a "convenience" 4 Pigsties, insanitary condition of 1 Smoke nuisances 6 Sideway badly lighted 1 Unsound food, &c. 1 Water in cellars 11 Miscellaneous 18 Total 373 120 The following is a list of notices served during the year and includes those outstanding at the end of 1912. NOTICES SERVED, &c. 1913. Notices. Outstanding and served 1913. Complied with 19I3.0 Outstanding I9I4. Statutory 95 93 2 Informal 303 278 25 Do. (by letter) 108 43 65 Pave Yard (Ilford Improvement Act) 13 13 — Provide Dustbin (Ilford Improvement Act) 110 110 - Cleanse Cistern (Bye-laws) 69 67 2 Cover Do. Do. 21 14 7 Provide Water to Dwelling-House 16 16 - Cleanse Dwelling-House (Infectious Diseases (Prevention) Act, 1890) 78 78 - Cleanse Dwelling-House (Sec. 46 Public Health Act, 1875) 7 5 2 Housing of the Working Classes Act 11 11 — Housing, Town Planning, etc., Act l8 14 4 Totals 849 742 107 The following is a summary of the work done during the year 1913, and for which notices and letters have been served under the various Acts and Bye-laws in force in the district :— Animals improperly kept—removed 8 Accumulations of refuse removed 16 Brickwork (chimney) repaired 2 Cesspools emptied and cleansed 4 Interceptor provided 1 121 Coppers repaired 3 Cowshed cleansed 1 Ditches cleansed 3 Drains cleansed 90 Drains repaired or relaid 79 Down-pipes repaired or provided 10 Dampness to walls of dwelling-house remedied 20 Doors repaired 4 Dustbins provided 102 Door reveals repaired 5 Fence repaired 1 Fresh-air inlets repaired or provided 5 Floors repaired or cleansed 10 Flue-pipes provided or repaired 4 Gulley dishings repaired or provided 124 Gate provided to rearway 1 Gutters repaired or renewed 57 Inspection chamber covers provided 11 Inspection chambers provided 2 Lavatory basin provided 1 Manure pits cleansed 2 Overcrowding abated 2 Privies emptied and cleansed 2 Privy receptacles provided 3 Roofs repaired 51 Rearway paved or drained 1 Cap to cleansing arm of interceptor provided 1 Removal of gipsies 5 Road gulley cleansed 1 Sanitary conveniences provided 4 Sinks provided 3 Stoves repaired 9 Ventilating pipes repaired or renewed 13 Waste-pipes repaired or renewed 33 Water storage cisterns repaired 8 Water storage cisterns cleansed 64 122 Water storage cisterns covered 18 Water supply re-instated 14 Water supply—premises connected to main 4 Water removed from basements 14 Water fittings repaired 6 Walls, ceilings and woodwork of premises cleansed 130 Walls, ceilings and woodwork of premises repaired 36 Windows and window frames repaired 29 W.c. flushing cisterns and w.c. fittings repaired 126 W.c. 's cleansed 6 W.c. doors repaired 3 W.c. pans and traps fitted or repaired 25 W.c. accommodation provided 3 Yards, etc., cleansed 10 Yards, paving provided or repaired 42 DRAINAGE. During the year the drains of 79 houses were repaired or re-laid. At 49 of the houses (62 per cent.) which were built before the formation of a Local Board for the district, the original drains were found to be in a very defeotive condition. A new system of drainage had to be laid in and the work was carried out in accordance with the Council's bye-laws. HUNGARIAN GIPSIES. On the 31st October, we found that No. 36, High Road, and also Nos. 104, 106 and 108, Ilford Lane, were occupied by some foreign gipsies. Before Giving any description of their life during their stay in Ilford from the 31st October to 6th December, perhaps the following extract from the "Morning Post" of the 15th November may be of interest : "During the week traders and residents of the Loxford Ward of the Ilford Urban Council have been 123 plaining of the Hungarian coppersmiths who settled in the district a fortnight ago. The allegation against the gipsies is that they are a nuisance from the sanitary point of view. A representative of the " Morning Posit " went to Ilford and spent an afternoon with the gipsies, taking tea with the Chief, M. Maximoff, who conversed freely about himself and his future projects. The gipsy colony numbers about eighty persons. Of the 275,000 gipsies in Hungary they belong to the 9,000 who are said to be continually on the move. They are the Komodromoi roamers or coppersmiths, and are known as the Caldarari, who wander in almost every country, often remaining seven years from Hungary. The Caldarari form a corporation organised on strict lines. They have their heirarchical chiefs, and invariably travel in groups which are commanded by chiefs of different degrees. The work is always done in common, and though the gipsies at Ilford live in different parts of the town they work together, the head chief at Temesvar usually supplying all the wandering bands with the copper used by the corporation." From the first visit it was apparent that these people would probably be a source of trouble and annoyance. This soon proved to be the case, and within a few days the premises were in a filthy condition. Their ideas of sanitation did not extend beyond those peculiar to nomads. They had no idea of the proper use of the sanitary arrangements, and consequently the w.c.'s, bath and lavatory basin waste pipes, etc., were continually blocked, and the stench arising therefrom abominable. It was therefore necessary for frequent visits to be made, and during the last three weeks the premises were visited two and three times a day, excepting Sundays, to endeavour to get the women to keep the rooms fairly clean. This was a most difficult task, as they had no idea of scrubbing, but merely throwing down a lot of cold water and mopping it up again with rags. I do not think there was any 124 overcrowding at night, but there was at times during the day, when they congregated in one room and sat huddled together drinking tea a la Russe. The gipsies had no furniture, but were well supplied with feather mattresses. They took their food squatting on the floor, and appeared to help themselves from a common dish placed in their midst. Three children— boys, aged 4 years, 11 months, and 2 years respectively— died from pleurisy and pneumonia at the premises in Ilford Lane, and this, apart from the fact that these coppersmiths could not obtain sufficient work to keep them going, I believe was the principal reason for these gipsies leaving the district so quickly. After they had left the premises, every room in the house occupied by them was thoroughly disinfected. All the rooms were then swept out, the refuse removed, and then thoroughly cleansed by the owners. REMOVAL OF HOUSE REFUSE. During the 52 weeks ended on the 27th December, the number of horses and vans engaged in the collection and the number of loads of house refuse removed were as follows:— Horses and vans, 5,990. Loads, 13,820. The loads represent about 18,200 tons. Collection took place on 307 days. Average number of horses per day, 19.51. Average number of loads per horse per day, 2.30. The refuse was disposed of as under :— Deposited in St. Swithin's pit 10,883 loads. Deposited in Brown's pit 1,782 loads. Deposited elsewhere 1,155 loads. The large increase in the number of horses required daily was mainly due to the long distance which the refuse had to be carted. It will be seen that 78.74 per cent, of the refuse was taken to St. Swithin's. 125 During the year 102 portable galvanised iron dustbins were provided by the owners of houses either after receiving a notice under Section 45 of the Ilford Urban District Council Act, 1904, or intimation by letter that one was required. There are very few fixed ashpits in the district. I remain, Gentlemen, Your obedient servant, f. w. king, Inspector of Nuisances. ' - >v : -- - . j.- ■