ILF 053 Urban District of Ilford. ANNUAL REPORT of the Medical Officer of Health, School Medical Officer, Medical Officer to the Maternity and Child Welfare Statutory Committee, and Medical Superintendent of the Isolation Hospital, Including the Report of the Inspector of Nuisances. FOR THE YEAR 1919. A. H. G. BURTON, M.D., B.S. (Lond.), D.P.H. (Cantab.), Fellow of the Society of Medical Officers of Health. Fellow of the Royal Institute of Public Health. ILFORD: South Essex Recorders, Ltd., High Road. Ilford Urban District Council. PUBLIC HEALTH COMMITTEE. 1919-1920. Councillor G. Church, Chairman. Councillor E. G. Culpin, Vice-Chairman. Councillor H. L. Crofts. Councillor J. Lowe. Councillor G. Cushing. Councillor H. G. Odell. Councillor G. R. Davey, J.P. Councillor F. D. Smith, C.C. Councillor A. Kapadia. Councillor W. H. Stevens. Councillor O. Waters, O.B.E., C.C. MATERNITY & CHILD WELFARE STATUTORY COMMITTEE. 1919-1920. Councillor W. H. Stevens, Chairman. *Mrs. E. M. Wise, Vice-Chairman. Councillor G. Church. Councillor E. G. Culpin. †Councillor G. R. Davey, J.P. *Mrs. Gillard. †Councillor A. Kapadia. Councillor H. G. Odell. *Dr. O. E. Powell. Councillor F. D. Smith, C.C. *Mrs. Stewart. Councillor 0. Waters, O.B.E., C.C. *Co-opted Members. †Ex-officio Members. EDUCATION COMMITTEE. 1919-1920. Councillor W. H. Stevens, Chairman. Councillor Geo. Gunaby, Vice-Chairman. *Mr. J. It. Baldwin. Councillor G. Chubch. Councillor H. L. Cbofts. Councillor E. G. Culpin. †Councillor G. R. Davey, J.P. *Mr. S. P. Lonebgan. Councillor J. Lowe. *Mr. J. Mein. Councillor H. G. Odell. Councillor B. S. J. Pitt. Councillor Sir Peter Gbiggs, M.P.*Mrs. S. E. Sanders. J.P., C.A. *Mr. D. Hunteb, O.B.E. †Councillor A. Kapadia. *Miss J. B. Labkin. Councillor G. Lee. Councillor W.J. O. Sheat, O.B.E., J.P. Councillor F. D. Smith. *Mr. H. J. Weston. *Co-opted Members. †Ex-officio Members. Secretary to the Committee: W. S. Tobuitt, M.A., L.L.M. OFFICERS of the PUBLIC HEALTH SERVICES. MAY, 1920. Medical Officer of Health, School Medical Officer, Medical Superintendent of Isolation Hospital, Medical Officer to the Ma ternity and Child Welfare Statutory Committee : A. H. G. Burton, M.D., B.S. (Lond.), D.P.H. (Cantab.). Assistant Medical Officers of Health: N. Gebbie, M.B., Ch.B., (Glasgow), D.P.H. (Manch.) Alice Rattray, M.B., Ch.B. (St. Andrews). School Oculist (part time): School Dentist (part time): R. S. Chabsley, M.R.C.S., L.R.C.P. C. F. Rose, L.D.S., R.C.S. (Eng.). Matron of Isolation Hospital: Matron ol Maternity Home. Miss I. Millar. Miss E. Waring, C.M.B. Inspector of Nuisances: F. W. King, Mem. Royal San. Inst., F.I.S.E. Assistant Inspectors of Nuisances: H. C. Monkcom, Assoc. Royal San. Inst., A.I.S.E. T. V. Haigh, Mem. Royal San. Inst. C. W. Fisher, Assoc. Royal San. Inst. Health Visitors: Miss M. E. Cartwhight, C.M.B. Mrs. H. Morris, C.M.B. (School Nurse). Mrs. A. Dukes, C.M.B. Miss M. D. Seager, C.M.B. Clerk: F. J. Bull. Assistant Clerks: G. A. Aldous. J. L. Taylor. PREFACE. Public Health Department. Ilford. May 17 th, 1920. To the Chairman and Members of the ILFORD URBAN DISTRICT COUNCIL. Gentlemen, In accordance with the regulations of the Ministry of Health and the Board of Education, 1 herewith submit my Annual Report for the year 1919. Dr. Oates relinquished his duties as Medical Officer of Health on the 13th September, 1919, since which date I have carried out the duties of the office, having been duly appointed by you to the vacancy on the 27th October, 1919. The work of the department is steadily increasing in all directions. You will be considering in the near future the questions of increasing the accommodation at the Isolation Hospital, of providing improved premises for the School Clinic, and of the establishment of a new Maternity Home. The Maternity and Child Welfare work has grown to considerable proportions, and on the 27th October, 1919, Dr. Alice Rattray was appointed to act as Assistant Medical Officer particularly for this work. On the 24th February, 1920, Dr. N. Gebbie was appointed as Assistant Medical Officer to fill the vacancy caused by my appointment as Medical Officer of Health. The appointment of a whole-time Dentist will permit the dental work to be carried on as before the war. 8 The low death-rate and zymotic death-rate show that the health of this district is good, while the low infantile mortality is an indication of an increased diffusion of knowledge of the care of infants. Unfortunately, owing to war conditions, the statistics of the department during the past few years have not been compiled as formerly; the present report has only been prepared by the laborious effort of the clerical staff, to whom I must express my indebtedness. The staff in all branches of the service have worked loyally and well, and I am convinced that you are being rendered efficient service. May I also express my appreciation of the consideration which I have received at the hands of the responsible Committees and of the interest they have shown in the varied activities of the department. I am, Gentlemen, Your obedient Servant, A. H. G. BURTON, Medical Officer of Health. TABLE OF CONTENTS. pages. General. Physical and Geological Features 13 Statistical Summary 14 Poor Relief 15 Population 15 Vital Statistics—Table I 16-17 Births 18 Table III 20-21 Zymotic Diseases 22 Notifiable Diseases 23-27 Tuberculosis 28 Bacteriological Laboratory 29 Supervision of Food Supply 30-31 Housing & Town Planning Acts 31 Inspection of District and Abatement of Nuisances 32-33 Removal of House Refuse 33 Sewerage 33 Factories and Workshops 33-39 Isolation Hospital 43-46 Maternity and Child Welfare. Notification of Births Acts 49 Infant Mortality 49-51 Work of Health Visitors 52 Infant Welfare Centres 53-56 Dental Treatment 56 Supply of Free Milk 56 Ante-Natal Clinics 57 Maternity Home 57-60 Children's Hospital 60—61 10 pages. School Medical Service. School Accommodation 65 General Statement of Extent and Scope of Medical Inspection 66 Board of Education Grant 67 Employment of Children Act 67 School Clinic 68-69 Ophthalmic Work 70-71 School Dentist and Table D 72-73 Further Development of School Medical Service 74-76 Education (Provision of Meals) Act, 1906-1914 76 Mentally Defective Children 77 Infectious Diseases amongst School Children 78-79 Appendices :— Board of Education Tables Nos. I., II., III., IV., V. 80-84 Height and Weight Tables 85 Table of Cases of Scarlet Fever 88 ,, ,, Diphtheria 89 ,, „ Measles and German Measles 90 ,, ,, Chicken Pox 91 „ „ Whooping Cough 92 GENERAL. 13 PHYSICAL, GEOLOGICAL, AND OTHER FEATURES. The surface generally is gently undulating, flatter in the southern 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 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, the population being concentrated in the Southwestern portion of the district, while the remaining larger portion is still rural. A large proportion of the inhabitants earn their living in London, which is only seven miles distant. The population mainly belong to the lower middle class, with a proportion of other classes. There are a few industries :—(1) Photographic works, (2) paper mills, (3) manufacturing chemists, (4) electric battery makers, (5) nautical instrument makers, (6) aeroplane works. The latter three are modern developments. Water Supply.—The district is divided by the Cranbrook Road into two areas. The portion North and West of this road is supplied bv the Metropolitan Water Board, the remaining portion by the South Essex Waterworks Company. There are now no public wells in existence. There are still a few private wells in the rural area. 14 STATISTICAL SUMMARY. Enumerated Population at Census, 1911 78,188 Registrar-General's Estimate of the For birth rate 82,840 Civil Population at the midde of For death rate 79,524 1919. 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 (including public institutions) 10.3 Total number of births registered for 1919 1,167 *Representing a birth-rate of 14.1 per 1,000. Total number of births registered for 1918 1,053 *Representing a birth-rate of 12.9 per 1,000. Total number of deaths registered for 1919 789 *Representing a death-rate of 9.9 per 1,000. Total number of deaths registered for 1918 947 *Representing a death-rate of 13.0 per 1,000. Total number of deaths from the seven principal Zymotic diseases in 1919 24 *Representing a Zymotic death-rate of .31 per 1,000. Total number of deaths from the seven principal Zymotic diseases in 1918 31 *Representing a Zymotic death-rate of .42 per 1,000. Total number of deaths under one year of age 71 Giving an Infantile Mortality rate to every 1,000 births registered of 61. Rateable Value—Houses £449,305 10 0 „ Land 7,203 10 0 £456,509 0 0 15 Education Rate :— Elementary 1s. 10½d. Higher 1d. Assessable Value £439,780 18 6 General District Rate 5s. 6d. in the £ Poor Rate 5s. 9d. ,, * Calculated on the Registrar-General's estimate for this purpose. POOR RELIEF. Total amount expended in Ilford during the year... £3,620 10 0 Number of persons in receipt of out-relief during the year (approximate) 540 Admissions to Workhouse and Infirmary (approximate) 318 made up as follows :— Men 95 Women 152 Children 71 POPULATION. The Registrar-General's estimate of the population of Ilford For the purpose of the Birth-rate 82,840 For the purpose of the Death-rate 79,524 To obtain the estimated gross population must be added the number of inmates and resident staff at the following Public Institutions :— CLaybuiry Mental Hospital 3,640 West Ham Mental Hospital 1,052 4,692 making a total gross population for the purposes of the Birth-rate of 87,532 Death-rate of 84,216 The total estimated number of dwelling-houses in the district at the middle of the year, 18,426. Assuming there were no empty dwelling-houses, there was an average population of 4.49 persons per inhabited building. TABLE I. Vital Statistics of Whole District during 1919 and Previous Years. Year. Gross Population estimated to middle of each year. Nett Population estimated to middle of each year (a). Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett (b). of \Ton.Residents registered in the District. of Residents not registered in the District. Under 1 Year of age. At all ages. Number. Rate (c). Number. Rate (d). Number. Rate per 1,000 Nett Births. Number. Rate (e). 1 2 2a 3 4 5 6 7 8 9 10 ii 12 13 1914 85932 82,098 1.490 1,505 183 926 10.8 352 147 93 62 721 8.8 1915 84,581 80,350 1.511 1,538 191 1,091 12.9 410 185 122 79 846 10.5 1916 ‡83,897 *79,744 - 1,490 17.2 - - -.. — 89 60 711 8.9 t86,796 f 1917 ‡79.194 *75,130 - 1,170 14.4 - - — — 82 70 791 10.5 †83749 1918 ‡76,602 *72825 — 1,053 12.9 - - — - 73 69 947 13.0 †81598 1919 ‡84,21 *79,524 = 1,167 141 1,029 12.2 416 176 71 61 789 9 .9 †82,840 * The Registrar-General's estimate for the purpose of the Death Rate. † The Registrar-General's estimate for the purpose of the Birth Rate. ‡The Registrar-General's estimate for the purpose of the Death Rate, including the populations of Clayburyand West Ham Mental Hospitals. 16 17 Note on Table I. In column 6 there is entered the whole of the deaths registered during the year as having actually occurred in the district. In column 12 there is entered the number in column 6, corrected by the subtraction of the number in coilumn 8 and the addition of the number in column 9. Deaths in column 10 are similarly corrected by the subtraction of the dearth® under 1, and included in the number given in column 8, and the addition of the deaths under 1 included in the number given in column 9. (ii) The nett estimated population is found by deducting the population of Claybury and West Ham Asylums from the gross estimated population. (h) The nett number of births is obtained by taking the uncoiirecited number of births supplied by the local Registrar and adding to or subtracting from it such a number as is supplied for this purpose by the RegistrarGeneral. (c) The birth-rate is calculated on the estimated nett tion for birth-rate. (d) Calculated on the estimated nett population for death-rate. (e) Calculated on the estimated nett population. "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than thart in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in columns 8 or 9, except i.n certain instances under 8 (ft) below. There is stated in column 8 the numl>er of transferable dearths of " non-residents " which have not been deducted, and there is in column 9 the number of deaths of "residents "registered outside the district which have been added in calculating the nett death-rate of the district. The following special cases arise as to Transferable Deaths:— (1) Persons dying in Institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses), must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an Imslbiitution had no fixed residence at the time of admission, the death is transferable. Tf the patient has been directly transferred from one such Institution to another, the dearth is transferable to the district of residence at the time of admission to the first Institution. (2) The dearths of in faults born and dying within a year of birth in an Institution to which the mother was admitted for her confinement should be referred to the district of fixed or usual residence of the parent. (3) Deaths from violence a,re to be referred (a) to the district of residence, under the general rule; (It) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known; and (d) failing this, to the district where the body was found. 18 BIRTHS. Number of births registered during the year 1,167 Legitimate Males 584, Females oTS Illegitimate Males 35, Females 29 The birth-rate, calculated on the Registrar-General's estimate of the population of 82,840 for this purpose is 14.1 per 1,000. As compared with 12.9 in 1918 14.4 in 1917 17.2 in 1916 19.1 in 1915 18.3 in 1914 DEATHS. Total number of deaths registered in district during the year was 1,029 Number of deaths of non-residents registered in the district (principally in the large institutions) 416 These deaths occurred as follows:— In Claybury (L.C.C.) Mental Hospital 290 In West Ham Borough Mental Hospital 105 In Ilford Isolation Ho-spital and Sanatorium 3 In Emergency Hospital 4 Other non-residents 8 Total 416 To be added to the total are 176 deaths of Ilford residents registered as having died in other districts, 19 The latter figure includes deaths at the following institutions:— The Infirm,ary, Romford 74 The Essex County Mental Hospital 24 The London Hospital 19 The East London Hospital 2 The Royal Free Hospital, London 5 Guy's Hospital 2 Queen Mary's Hospital 2 Royal Eastern Counties Hospital, Colchester 2 Several!'s Asylum, Colchester 2 Infectious Diseases Hospital, Colchester 1 In other Hospitals, Institutions and residences beyond the Ilford district 43 Total 176 The total deaths accountable to Ilford is therefore 789 Calculated on the Registrar-General's estimate of the population for this purpose the death-rate is 9.9, compared with 13.00 per 1,000 during 1918, and with 10.5 in 1917. 8.5 in 1911). 10.5 in 1915. 8.8 in 1914. 20 TABLE III. Causes of, and Ages at Death during the Year 1919. 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. «i.') years and upwards. 1 Enteric fever 2 - - - - 1 - 1 - 2 2 Small-pox - - - - - - - - - — 3 Measles 9 2 — 4 3 — — — — — 4 Scarlet fever 1 — — — 1 — — — — — 5 Whooping cough 1 1 - - - - - - - — 6 Diphtheria and croup 6 1 1 1 2 — — 1 — 5 7 Influenza 64 3 1 2 4 9 23 14 8 13 8 Erysipelas 2 — — — — 1 1 — - — 9 Pulmonary tuberculosis 57 — — 1 2 13 21 18 2 123 10 Tuberculous meningitis 11 2 1 2 5 1 — — — 0 11 Other tuberculous diseases 16 1 1 2 4 2 1 5 — 10 12 Cancer, malignant disease 87 — — \ — 1 9 39 37 15 13 Rheumatic fever 1 - — - — 1 — — — - 14 Meningitis 2 1 1 — — — — — — 1 15 Organic heart disease 90 - — — 1 4 15 25 45 17 16 Bronchitis 51 3 2 — — — — 9 37 7 17 Pneumonia (all forms) 34 4 8 3 2 1 7 3 6 30 18 Other respiratory diseases 16 — — — — — 2 10 4 1 19 Diarrhoea, &c. (under 2 years) 5 5 - - - - - - - 1 20 Appendicitis and typhlitis 3 — — 1 1 — 1 — — 3 21 Cirrhosis of liver 3 - - - - - - 2 1 2 21a Alcoholism - - - - - - - - - — 22 Nephritis & Bright's disease.. 13 - - — — 1 3 8 1 9 23 Puerperal fever - - - - - - - - - — 24 Parturition, apart from puer peral fever 4 - - — — 2 2 — — 2 25 Congenital debility, &c. 40 40 — — — — — — — 4 26 Violence, apart from suicide 20 3 1 2 4 2 4 3 1 9 27 Suicide 9 — — — — — 2 5 2 3 28 Other defined diseases 241 4 2 1 9 6 27 48 144 223 29 Causes ill-defined or unknown 1 1 - - - - - - - - Totals 789 71 18 20 38 45 118 191 288 485 Special causes (included above): Cerebro spinal meningitis 1 — — — — - 1 — — 1 Poliomyelitis - - - - - - - - - — Dysentery - - - - - - - - - 19 21 Notes to Table III. The classification and numbering of Causes of Death are those of the "Short List" on page XXV. of the Manual of the International List of Causes of Death, which should be consuited and followed in all cases of doubt. (a) All "Transferable Deaths" of residents, i.e., of persons resident in the District who have died outside it, are included with the other deaths in Columns 2-10. Iransferable deaths of nonresidents, i.e.. of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term "transferable deaths " see footnote to Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or of non-residents, are entered in the last column of Table III. (c) All deaths certified by registered Medical titioners and all Inquest cases are classed as ''Certified" : all other deaths are regarded as " Uncertified." 22 ZYMOTIC DISEASES. The deaths registered were as follows:— Small Pox Measles S Scarlett Fever 1 Whooping Cough 1 Diphtheria and Membranous Croup 6 Enteric Fever 2 Diarrhœa 5 Total 24 This gives a Zymotic death-rate for 19'19 of .31 per 1000 of the population. This appears to be the lowest Zymotic deathrate so far recorded for this district. The Zymotic death-rate for the previous five years was as under :— 1914 35 per 1,000 1915 82 do. 1916 45 do. 1917 93 do. 1918 42 do. NOTIFIABLE DISEASES. During 1919, 1,770 cases were notified, as compared with 900 in 1918. Table II. shows the number of cases of infectious disease notified during 1919, arranged according tc age and distributed in Wards. Of these the following occurred in institution:— Cases of Infectious Disease Occurring in Institutions in the District During the Year, 1919. Clayburv Mental Hospital— Enteric Fever 6 case>. Erysipelas 6 ,, Pneumonia 6 ,, Dysentery 22 ,, 23 West Ham Mental Hospital— Diphtheria 1 cases. Enteric Fever 1 ,, Erysipelas 1 ,, Pneumonia 3 ,, Barnardo's Village Homes— Scarlet Fever 10 cases. Diphtheria 01 ,, Erysipelas 4 ,, Pneumonia 3 ,, Of the cases notified, exclusive of those from Public Institutions, the following table shows the per cent, removed to the Isolation Hospitals — Small-pox 100.0 Diphtheria 88.6 Scarlet Fever 82.8 Enteric Fever 57.1 Erysipelas 15.1 Puerperal Fever 66.6 Ophthalmia Neonatorum 66.6 Influenzal Pneumonia 41.1 Cerebro-Spinal Fever 100.0 Encephalitis Lethargica 100.0 The total number of deaths from infectious disease in the district is shown in the following table:— Deaths from Infectious Disease in the District During 1919. Scarlet Fever 1 Diphtheria and Croup 6 Enteric Fever 2 Erysipelas 2 Influenza 64 Pneumonia (all forms) 34 24 Puerperal Fever 0 -Cerebrospinal Fever 1 Measles 9 Pulmonary Tuberculosis 57 Tuberculous Meningitis 11 Other Tuberculous Diseases 16 The following additional diseases were made notifiable by order of the Local Government Board in January, 1919:— (1) Dysentery (5) Acute Primary (2) Encephalitis Lethargica Pneumonia (3) Malaria (6) Relapsing Fever (4) Acute Influenzal Pneumonia (7) Trench Fever 28 cases of Malaria occurred in demobilised or discharged soldiers who contracted the disease while on active service. 22 cases of Dysentery occurred in Claybury Mental Hospitat. It is a common ailment in Institutions of this character- One case of Encephalitis Lethargica was removed to the Isolation Hospital. Measles and German Measles accounted for 930 notifications, as against £76 in 1918. These diseases cease to be notifiable on and after January 1st, 1920. Small-Pox. One case was notified on March 24th and was removed to the Metropolitan Asylums Board Hospital at Dartford. Vaccination of contacts and disinfection of premises were carried out. No further cases arose. The origin of the case was obscure. The man was a worker in a factory at Purfleet. A number of cases of contacts of Small-pox have been referred to this department either from the Army or Navy or from incoming ships; all such contacts have been kept und~r careful observation. 25 The Relieving Officer informs me that during the year 611 primary vaccinations have been performed. The number of births registered was 1,167, showing the proportion of infants vaccinated to be 523 per 1,000. This is an undesirable state of affairs, and it is only by extreme vigilance on the part of the Public Health Department that spread of the disease does not occur Scarlet Fever. 231 cases of this disease were notified during the year in comparison with 167 in 1918. In common with other London districts there was a marked rise in the number of cases in the autumn and winter of 19'19. As is well known scarlet fever shows a periodic rise in incidence every fifth to sixth year. The disease was fortunately of a mild type and only one death of an Ilford resident occurred, and this in a hospital outside Ilford. Diphtheria. 260 cases were notified during 1919 as compared with 216 in 1918. The increase, 'however, is not a real one, as 101 of the cases occurred in Dr. Barnnrdo's Girls' Village Homes, and most of these were not true clinical cases but children suffering from discharging ears, the diphtheria bacillus having been detected bacteriologicallv in the discharge. It is necessary to notify these cases as they may, under certain unknown conditions, act as "carriers" of the disease to healthv children. The problem of dealing with them is a very difficult one, and is much exercising the minds of the authorities of the Home. In my opinion surgical treatment of the ears affected is the only method likely to be successful. Enteric Fever. Fourteen cases only were notified during 1919, and of these six occurred in Claybury Mental Hospital and one in West Ham Mental Hospital. 26 Cerebro-Spinal Fever. One case was notified and removed to the Isolation Hospital. It was sporadic. The origin was obscure, and no further cases arose. In spite of active serum-treatment, unfortunately, a fatal issue ensued. Ophthalmia Neonatorum. Nine cases were notified during the year compared with eight in 1918. The corresponding figures for England and Wales were 6,532 in 1918, and 8,548 in 1919. It must be remembered that the birth-rate for England and Wales in 1918 was 17.7, and in 1919, 18.5. It is now well known that ophthalmia of the newly born is caused by venereal disease (gonorrhoea) in the mother, and the above figures are a fairly satisfactory indication that venefeal disease is not yet rampant in Ilford. Of the nine cases, six were admitted to the Isolation Hospital ; of the others, one was treated at the London Hospital and recovered, one died of tetanus at the West Ham Hospital, and one left the district and its after-history is unknown. Acute Influenzal Pneumonia and Acute Primary Pneumonia. It will be seen from Table II. that 46 cases of pneumonia were notified during the year. The number of deaths from Influenza and Pneumonia amongst Ilford residents during 1919 as compared with 1918 may be seen from the following:— 1919. 1918. Influenza 64 249 Pneumonia 34 55 The services of temporary nurses have been engaged from time to time to assist in making enquiries as to any possible sources of infection, and to provide help in nursing patients stricken with these complaints. 27 TABLE II.—Cases of Infectious Disease Notified during the Year 1919. NOTIFIABLE DISEASE. At all Ages Number of Cases Notified. At Ages—years. Total Cases Notified in each Ward. Total Cases Removed to Hospital. Under 1 1 and under 5 5 and under 1 5 15 and under 25 25 and under 45 45 and under 65 65 and upwards Cranbrook Park Seven Kings North Hainault Loxford Clements wood South Hainault Small Pox 1 - - - 1 - - - - - - - - 1 - 1 Scarlet Fever 231 - 34 173 19 - — — 19 31 28 21 37 64 31 183 Diphtheria, including Membranous Croup 260 - 32 132 53 19 2 - 14 32 33 107 14 26 34 142 Enteric Fever (Typhoid and Para Typhoid) 14 - - 4 4 4 9 - 1 2 - 8 1 1 1 4 Pneumonia 46 - 2 5 5 16 15 3 — 3 - 10 5 12 11 15 Puerperal Fever 3 - — — 1 2 — — - 1 - - 2 — - 2 Cerebro-Spinal Fever 1 - - - - 1 - - - - - 1 - - - 1 Encephalitis Lethargica 1 — — — — 1 — — — — — — — 1 - 1 Dysentery 24 — — — 1 10 9 4 — ,— — 23 1 — — — Erysipelas 42 — - 1 5 15 14 4 2 1 7 11 8 10 3 5 Ophthalmia Neonatorum 9 9 — — — — - — 2 2 1 1 2 1 — 6 Tuberculosis—Pulmonary 138 — 1 12 34 62 28 1 8 24 19 23 17 30 17 - Other Forms 42 1 7 23 5 1 4 1 2 5 3 9 15 11 4 - Malaria—Stated to be imported to this country 28 - - - 12 15 1 - 4 3 8 - 2 9 9 - Measles 881 15 183 672 8 3 - - 115 182 98 21 168 206 91 11 German Measles 49 1 9 29 7 3 - - 4 4 8 2 11 11 9 — Total 1770 28 271 1071 155 157 75 13 171 290 210 230 283 383 203 371 The number of cases of infectious disease notified having teen carefully revised will account for any discrepancy that may occur in comparison with the weekly return sent to the Local Government Board and the Essex County Council. 28 Tuberculosis. During the year 1919 there were 138 fresh notifications of pulmonary tuberculosis and 41 of other forms of tuberculosis. The following particulars as to the sex and age of notified cases of Tuberculosis are 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. - - 7 19 17 10 13 10 — 82 F - 1 5 15 16 13 2 3 1 50 Tuberculosis (all other forms) M. 1 4 12 2 - 1 1 — 1 22 F. - 3 11 3 - - 2 1 — 20 Totals 1 8 35 39 33 30 18 14 2 180 Cases notified from Institutions in the District:— Claybury Mental Hospital.—Pulmonary Tuberculosis 13 Dr. Barnardio's Village Homes.—Pulmonary Tuberculosis 3 Tuberculosis (all other forms) 1 During 1919 there were 57 deaths from pulmonary tuberculosis and 27 from ether forms of tuberculosis. The following Table shows the number of deaths from Tuberculosis of Ilford residents, together with the death rate for that disease per 1,000 living persons, during the last eight years. 1912 1913 1914 1915 No. Rate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 43 55 51 6 55 90 74 92 Tubercular Meningitis 12 15 15 18 0 07 15 18 Tuberculosis (all other forms) 13 16 7 08 8 09 12 14 1910 1917 1918 1919 No. Hate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 04 .80 79 1.05 82 1.12 57 .71 Tubercular Meningitis 9 .10 7 .09 7 .09 11 .13 Tuberculosis (all other forms) 10 .12 12 .15 10 .10 10 .20 It will be seen that there was a decline in the death-rate from pulmonary tuberculosis in 1919 from the very heavy death rates of 1917 and 1918. There is no doubt the heavy rate in 1918 was influenced by the epidemic of Influenza. 29 BACTERIOLOGICAL LABORATORY. The following is a table of the Bacteriological Examinations carried out during 1919, the Bacteriological Laboratory having been re-opened in April, 1919. Nature of Specimen. Disease Suspected. Sent byLocal Medical Practitioners. Sent by Medical Officer of Health. Sent by School Medical Officer. Sent from Isolation Hospital. Totals. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Throat Swabs. Diphtheria 148 332 3 33 — 12 34 232 185 609 Nose Swabs Diphtheria 5 31 - — — — 6 6 11 37 Ear Swabs Diphtheria 83 98 - — — - 4 2 87 100 Hairs Ringworm 1 — - - 18 5 — — 19 5 Cerebro-Spinal Fluid Cerebro-Spinal Meningitis — 2 - - - - - 1 — 3 Blood Malaria — 1 — — — — — — — 1 Sputum Tuberculosis — 1 - - - - - - - 1 Vaginal Discharge Gonorrhœa — 2 - - - - - - - 2 Faeces Dysentery —' 1 - - - - - - - 1 Totals 237 468 3 33 18 17 44 241 302 759 Total 1,061. 30 SUPERVISION OF FOOD SUPPLY. (1) Food and Drugs Act. These Acts are administered by the Essex County Council. Mr. H. C. Card, the Chief Inspector, has kindly given me certain particulars, which I append:— Samples of milk taken 135 Samples of butter taken 18 Other samples 47 Total 200 Proceedings were taken in six cases, fines being inflicted in four cases as follows:— Milk 10s. fine and 5s. costs. Milk £1 1s. costs. Milk £1 fine and £1 12s. costs. Milk £20 fine and 4s. costs. In the remaining two cases, milk vendors pleaded, and substantiated, warranties. (2) Milk Supply. There were in the Ilford district at the end of the year 46 dairies and milkshops and 10 cowsheds on the register. 149 inspections of dairies, milkshops, and cowsheds were carried out during the year. (3) Bakehouses. There are 25 bakehouses in the district, including 7 factory bakehouses. There is 1 underground bakehouse. 68 inspections of bakehouses were carried out during the year. (4) Slaughterhouses. There are two licensed slaughterhouses in the district. 72 inspections of slaughterhouses were carried out during 1919. (5) Articles of Food Surrendered and Seized. During the year the following articles of food were surrendered and condemned as being unfit for the food of man:— 1 bullock's head without tongue. 1 bullock's tongue. 31 2 bullock's lungs. 1 bullock's liver. 1 bullock's paunch. 1 gut fat spleen and udders. 1 forequarter of mutton. Quantity of skate (2 lots). 3 boxes of kippers. 122½ boxeis of dates. 1 beef liver. 1 buit.tock of beef. 1 box bloaiters and quantity of herrings. 5 ducks. 13 chickens. 1 case of rabbits. 1 box of mackerel. 1 box of fresh herrings. 1 barrel of fresh herrings. 1 barrel of crabs. 1 box of oalt-fish. 2 boxes of whiting. 1 carcase of beef with all organs. 1 forequarter and loin. 1 brattock a.nd tihiok flank. The following articles of food were seized and condemned : - (a) 12 chick fins. (b) 19 geese amd 40 chickens. (c) 1 lb. 10 ozs. bacon. On legal proceedings being instituted, the following w ere the results of the prosecutions:— (а) The defendant was convicted and fined £5. (б) The defendant was convicted and fined £20 and £3 3s. costs, (c) The defendants were convicted and fined £5 and 40s. costs respectively. HOUSING AND TOWN PLANNING ACT, 1909. Following are particulars as to work under the Housing and Town Planning Act, 1909:— Number of houses inspected 353 Number represented to the Local Authority as being unfit for human habitation 1 Number of closing orders made by the Local Authority 1 Number of closing orders determined — Number of houses voluntarily demolished after closing order — Number of houses in which defects were remedied without closing orders 19 Ordeais to execute work under Section 15 252 32 INSPECTION OF THE DISTRICT AND THE ABATEMENT OF NUISANCES. Summary of visits as recorded during the year 1919:— Houses and premises inspected 3055 Houses and premises re4nspected (works in progress) 3081 Visits during disinfection 531 Houses in which nuisaincas were detected 631 Do. do. abated 505 Notices served 986 Do. complied with 516 The following is a list of notices served and complied with:— Notices Served, &c. 1919. Notices. Served 1919. Complied with, 1919. Statutory 63 13 Pave Yard (Ilford Improvement Act) 11 — Informal 370 289 Provide Dustbin (Tlford Improvement Act) 104 40 Cleinse Water Storage Cistern (Bye-laws) 127 105 Cover ditto ... 8 — Provide Water to Dwelling House 21 20 Cleanse Dwelling House (Infectious Diseases (Prevention) Act, 1890) 30 30 Housing and Town Planning Act, 1909 252 19 Totals 986 516 Complaints. During the vear 285 complaints have been received and investigated. The following is a summary:— Accumulation of manure and refuse 6 Animals improperly kept 9 Bad smells from drains 19 Bad smells in houses 4 Blocked drains and w.c.'s 23 Cesspools full and overflowing 2 Defective drains and w.c.'s 6 Defective dustbins 27 Dirty and verminous houses 25 Dirty condition of reanvay 2 Defective roofs, gutters and down pipes 25 Defective water fittings 28 Defective w.c. fittings 42 33 Dampness of premises 12 Flooding of premises 2 Overcrowding 5 Sanitary defects 6 Smoke nuisances 4 Water in basements 6 Miscellaneous 32 Total 285 REMOVAL OF HOUSE REFUSE. The Chief Sanitary Inspector, Mr. F. W. King, was responsible for this work until the end of October, and I am obliged to him for the following particulars:— During the 52 weeks ended 31st December, 1919, 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, 5,776. Loads, 10,154. Collection took place an 303 days. Average number of horses and vans pea- day, 19.06. Average number of loads per horse per day, 1.77. The refuse was disposed of as follows Deposited at Destructor Works 10,024 loads. Deposited elsewhere 130 ,, 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:— 83 Cesspools and privies. 56 Pail closets. FACTORIES. There are 68 factories on the register, made up as follows:— Alloy Moulder 1 Bakehouses 7 Boot Making and Repairing 3 Brick Maker 1 Brush Back Manufacturer 1 Builders Joinery and Carpentry Works 6 Cardboard Box Maker 1 34 Carriage Works 1 Chaff Cutting and Corn-Blowing 1 Chemical Works 1 Chocolate Works 1 Collar Works 2 Cutlery Grinding 2 Electric Motor Works 1 Electric Wire and Battery Works 3 Engineers 4 Fancy Bag Maker 1 Iron Cutting Works 1 Ironing Shield Maker 1 Laundries 4 Meat Cutting 2 Motor Engineering 2 Motor Gear Engineer 1 Paper Mill 1 Photographic Works 1 Printing Works 5 Saw Mills and Joinery Works 3 Seed Sorting 1 Sweet Makers 1 Toy Maker 1 Wearing Apiparel Makers 3 Wood Cutting 4 Total 68 WORKSHOPS. There are 377 workshops on the register, made up as follows:— Artificial Flowers 1 Bakehouses 18 Blacksmith 5 Book-binder 2 Boot Repairing 40 Braid Work 1 Brush Worker 5 Carpenter 11 Carpet Planning 1 Clergy Robes 1 Coach Building 2 35 Corset Maker 3 Cycle Repair 14 Dairy Utensil Maker 1 Dressmaking 57 Electrical Accessories 1 Embroidery 3 Fancy Collars 2 Feather Cleaning 3 Florists 2 Flower Mounting 1 French Polisher 2 Furrier 1 Glass Cutter 1 Hand Laundry 7 Harness Maker 2 Lace Worker 2 Ladies' Belt Maker 4 Leather Worker 3 Mechanical Demist 4 Millinery 27 Motor Engineering 2 Optician 1 Picture Framing 4 Paint Mixing 2 Plumber 6 Poultry Appliance Maker 1 Printer 3 Rag and Bone Merchant 2 Scale Maker 1 Sheet Metal Worker 1 Shirt Making 2 Shoe Bows 1 Tailors 37 Tie Makers 5 Toy Making 1 Umbrella Repairing 3 Undertaker 2 Upholstering 5 Watch Repairs 15 Wearing Apparel and Underclothing 48 Wheelwright and Farrier 4 Wood Carver and Gilder 1 Wood Cutting 3 Total 377 36 FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 29 — - Workshops (including Workshop Laundries) 47 4 — Work places (other than Outworkers' premises included in Part 3 of this report) — - — Total 76 4 — 37 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referrec to H.M. Insp'tor (1) (2) (3) (4) (5) Nuisances under the Public Health Acts Want of cleanliness 2 2 Want of ventilation 1 1 Overcrowding 1 1 Want of drainage of floors Other nuisances 1 1 Sanitary accommodation insufficient - — unsuitable or defective - - not separate for sexes 1 1 Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) - - Breach of special sanitary requirements ments for bakehouses (ss. 97 to 100) - - Other offences — — (Excluding offences relating to outwork which are included in Part 3 of this report.) Total 6 6 — — *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 38 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Sending twice in the year. Sending once in the year. Lists. Outworkers. Outworkers. Contractors. Workmen. Lists. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) Wearing Apparel— Making, &c. 9 10 12 — — — Cleaning and Washing - - - - - - Household Linen - - - - - - Lace, Lace Curtains and Nets 1 - 3 - - - Total 10 10 15 — — — Note.—No home-workers were known to be engaged in the following occupations:—Curtains and Furniture Hangings; Furniture and Upholstery; Electro-plate; File Making; Brass and Brass Articles; Fur Pulling; Cables and Chains; Anchors and Grapnels; Cart Gear; Locks, Latches and Keys; Umbrellas, etc.; Artificial Flowers; Nets, other than Wire Nets; Tents; Sacks; Racquet and Tennis Balls; Paper, etc., Boxes, Paper Bags; Brush Making; Pea Picking; Feather Sorting; Carding, etc., of Buttons, etc.; Stuffed Toys; Basket Making; Chocolates and Sweetmeats; Cosaques, Christmas Crackers, Christmas Stockings, etc.; Textile Weaving. 39 4.— REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the Year. Number. (1) (2) Bakehouses (excluding 7 Factory Bakehouses) 18 Boot Repairs 40 Carpentering 11 Dressmakers 57 Laundries ... 7 Milliners 27 Tailoring 37 Wearing Apparel and Underclothing 48 Miscellaneous Workshops 132 Total number of Workshops on Register 377 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 4 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):— In use at the end of the year 1 ISOLATION HOSPITAL. 43 ISOLATION HOSPITAL. The work of the Hospital has been carried on in a most satisfactory manner during the year. During the autumn and winter months the capacity has been strained to the utmost, and the question of enlargement is one which is now under consideration; also that of providing a motor-ambulance and disinfecting-van service. I am satisfied that the nursing staff is at the present time carrying on its duties most efficiently. The usual course of lectures was given, and two probationer nurses passed the examination of the Fever Nurses' Association during the year. The following tables show the variety of diseases which were under treatment during the course of the year:— Number of patients in Hospital at beginning of vear:— Scarlet Fever 14 Diphtheria 9 Phthisis 14 Erysipelas 1 Under observation 2 Number of patients admitted during the year:— Scarlet Fever 183 Diphtheria 142 Enlteric Fever 4 Pneumonia 15 Puerperal Fever 1 Abscess of tlhe Breasts 1 Cerebro-Spinal Fever 1 Encephalitis Lethargica 1 Erysipelas 5 Ophthalmia Neonatorum:— Infainits 6 Mothers 4 Pulmonary Tuberculosis 92 Measles 11 Mumps 1 Scabiets 4 Tubercular Meningitis 1 Hemiplegia 1 Under Observation 8 44 Number of deaths in Isolation Hospital:— Diphtheria 5 Enteric Fever 1 Influenzal Pneumonia 10 Abscess of the Breasts 1 Cerebro-Spinal Fever 1 Pulmonary Tuberculosis 3 Tubercular Meningitis 1 Hemiplegia 1 Marasmus (Ophthalmia Neonatorum Patient) 1 Number of patients remaining in Hospital on 1st January 1920:— Scarlet Fever 54 Diphtheria 15 Pulmonary Tuberculosis 7 The following' shows the average length of stay of patients in Hospital:— Scarlet Fever 45.3 days. Diphtheria 30.2 ,, Pulmonary Tuberculosis 67.0 ,, Average stay in Hospital of all cases 40.2 ,, The above averages are based on cases that completed their stay in Hospital during the year 1919. Average number of patients in Hospital per day 49.9 Influenzal Pneumonia. Of 15 cases admitted during the year no less than 10 died. Whilst the chief cause of this high mortality is the very fatal character of the disease, I think the removal of such cases to Hospital is also a factor, and in my opinion no case should be removed unless the home conditions make it absolutely imperative. Scarlet Fever and Diphtheria The results in these diseases were satisfactory. No death from Scarlet Fever occurred, while from Diphtheria five deaths only occurred. These were cases coming late under treatment. Any delay in the injection of serum in a case of diphtheria detracts from the chance of recovery and may make a fatal result inevitable. 45 Ophthalmia Neonatorum. Six cases were admitted; one died from marasmus, the other five made a complete recovery with no loss of vision in either eye. The disease can only be cured by constant unremitting attention on the part of the nursing- staff, and the results achieved are a credit to the Institution. The cost of 5 blind children to trie State would be not inconsiderable and this lowest motive makes the treatment of these cases an important section of preventive medicine. In four of the cases the infants were accompanied by their mothers in order that breast feeding might be continued. Fifty per cent, of the cost of maintenance will be refunded under the Maternity and Child Welfare Grant. Scabies. Four children were admitted with this complaint, having been treated for considerable periods at the School Clinic without success. They quickly yielded to a few days' efficient treatment in Hospital. Cases under Observation. Eigflit were admitted. These were doubtful cases of infectious disease. Six were discharged, not having shown any definite sign of the disease. One, admitted as doubtful enteric fever, proved to be appendicitis, and was removed to the Emergency Hospital. One, admitted as doubtful meningitis, was found to be suffering from cerebral tumour and was transferrer to the London Hospital. Tuberculosis. The treatment of tuberculosis patients proceeded on the usual lines. Unfortunately but few of the cases are in such an early stage that any possibility of cure can be hoped for, although most show improvement by their stay in the Sanatorium. Three were in such an advanced condition that death ensued. 'Hie prospect of tuberculosis patients who spend their lives in or out of a Sanatorium until deaths overtakes them is a sad one. Very little 46 hope of dealing with the problem exists unless a determined attempt is made (1) to segregate all advanced cases in residential institutions. (2) To' adequately assist the patient's dependents financially, so that he can accept Sanatorium treatment at the earliest stage and remain in the Institution until arrest of the disease occurs. (3) To commence with the treatment of the pre-tuberculous child in open-air schools, etc., and so prevent the onset of the disease. ISOLATION HOSPITAL. SUMMARY OF EXPENDITURE. 1919-1920. £ s. d. Salaries of Medical Officer, Matron, Nursing and Domestic Staff 1,468 17 6 Wages of Engineer, Porters 1,250 6 5 Provisions 4,047 8 3 Heating, Lighting and Water 2,184 11 7 Drugs, Medicines and Appliances 388 11 5 Rates, Taxes and Insurances 107 11 7 Repairs to Buildings, Decorations, Renovations, etc. 1,621 10 3 Replacements and Renewal of Furniture, Linen and Redding 930 19 Crockery, Chandlery and Ironmongery 367 8 7 Repairs to Machinery 76 19 ii Clothing and Uniform 99 17 10 Telephone, Books, Printing and Travelling Expenses 147 15 1 Contributions re Small Pox Hospital 58 2 6 Motor Chassis (3) and cost to date of Bodies 1,301 3 6 Sundries 109 15 1 Gross Expenditure 14,160 19 4 £ s. d. Less Repairs 1,621 10 3 Bedding 930 19 4 Crockery 367 8 7 2,919 18 2 11,825 0 10 Add l/5th of above for one year's charges 583 19 8 11,241 1 2 £ s. d. Less Motors 1,301 3 G Small Pox 58 2 6 1,339 6 0 £10,465 14 10 MATERNITY & CHILD WELFARE. 49 NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. The number of births notified under the above Acts during 1919 was 1,233. The percentage of births notified by the various responsible persons is as follows By Medical Practitioners 29 ,, Certified Midwives 36 ,, Parents and others 33 INFANTILE MORTALITY. The number of infants dying- within the first year of life was 71, the total number born being 1,167. The infant mortality or rate of death per 1,000 births was therefore 61. In previous years the total number of deaths and the rates have been as follows:— Year. No. of Dearths under 1 year. Rate per 1,000 Registered Births. 1913 102 68 1914 93 62 1915 122 79 1916 89 60 1917 82 70 1918 73 69 1919 71 61 The figure for 1919 is therefore a satisfactory one and compares favourably with that of 89 for England and Wales and 85 for London. The following table shows the infantile mortality in each ward of the district:— Ward. Number of Births. No. of Infant Deaths Infantile Mortality per 1,000 Births. Cranbrook 118 5 42 Park 178 13 78 Seven Kings 15!) 9 50 North Hainault 75 8 106* South Hainault 150 13 86 Clementswood 252 12 47 Loxford 235 11 46 Ilford 1,167 71 61 *Deducting from the North Hainault Ward the deaths of Infants occurring in the Village Homes, Barkingside, there is left an Infantile Mortality rate of 13 per 1,000 births for that ward. 50 The extreme handicap which a child suffers as to its chance of life by being born out of wedlock is shown by separating the illegitimate children from the total infant deaths. Of 64 illegitimate children born, 10 died, giving an infantile mortality rate Of 156, while of 1,103 legitimate children born 61 died, giving an infantile mortality rate of 55. On the following page is seen an analysis of the causes of death in infants during the first year of life. It will be seen that the chief causes are atrophy, debility and marasmus, 16 deaths; premature birth, 14 deaths. It is difficult to say how far these two causes can be minimised. They are chiefly due to maternal ill-health or disease. Syphilis is a factor in some cases of premature birth, but there are other causes for the determination of which further medical research is necessary. It is hoped that the system of Ante -Natal Clinics w hen established, by their effect on the health of the mother during pregnancy, will reduce the number of deaths from these causes. It is satisfactory to note that diarrhoea and enteritis only caused five deaths of infants under 1 year. Three infants were suffocated by overlying, a preventable cause of death which should not occur at all in a district like Ilford. 51 Table IV.— Infant Mortality. 1919. Nett Deaths from stated causes at various Ages under 1 Year of Age. Causes of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months and under 6 months 6 months and under 9 month. 9 months and under 12 months Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... 1 ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 l 2 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... l 1 Diphtheria and Croup ... ... ... ... ... ... ... ... l 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 2 ... ... 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... 1 ... 1 ... ... ... ... 1 Meningitis (not Tuberculous) 1 ... ... ... 1 ... ... ... ... 1 Convulsions 1 ... ... 1 2 3 ... ... ... 5 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 1 ... ... 2 Pneumonia (all forms) ... ... ... ... ... 1 3 2 2 8 Diarrhœa ... ... ... ... ... ... 3 ... ... 3 Enteritis ... ... ... ... ... ... 2 ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 1 ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying l ... ... ... 1 1 1 ... ... 3 Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 3 1 ... ... 4 1 1 ... ... 6 Premature birth 14 ... ... ... 14 ... ... ... ... 14 Atrophy, Debility and Marasmus 8 ... 1 3 12 2 ... ... 2 16 Other Causes ... ... ... ... ... 1 ... ... ... 1 Unknown 1 ... ... ... 1 ... ... ... ... 1 Totals 29 l 2 4 36 11 14 3 7 71 Nett Births in the year— Nett Deaths in the year— Legitimate 1103 Legitimate infants 61 Illegitimate 64 Illegitimate infants 10 52 WORK OF HEALTH VISITORS. The first Health Visitor was appointed in Ilford in June, 1909. This lady was responsible for the whole district, and Naturally the work she was able to do was of a very limited scope. In 1916 two nurses were appointed as Health Visitors and School Nurses. In 1917 these were increased to three. In 1919 the number was still further increased to four, one of whom is, however, almost entirely occupied with School Medical work. The work of the Infant Welfare Centres is increasing to such an extent that when the Ante-Natal Clinics are in working order it is doubtful if the present staff will be able to cope with the work. The area is divided into three districts, for each of which one Health Visitor is responsible. She visits the home three weeks after the birth of a child where a doctor is in attendance, or 10 to 14 days if a midwife has attended the confinement. Subsequent visits are paid according to the condition of the child and the circumstances of the parents. The most satisfactory plan is to visit infants— Under 1 year, once a month. Under 2 years, once a quarter. Under 5 years, once in 6 months. but with the present staff it has not been possible to carry this out completely. In 1919 the following visits were paid:— First Visits 1,195 Subsequent (to children under 1 year of age) 2,861 Subsequent (to children over 1 year age) 4,133 An important work which I hope the Health Visitors will be able to extend still further is that of visits of advice to expectant mothers. This will be correlated with that of the Ante-Natal Clinics. 63 47 visits have been paid to expectant mothers during the year. Cases of still-birth, cases of premature births, and of deaths, of young infants are enquired into by the Health Visitors. The work of the Health Visitors has been still further increased by the Milk (Mothers and Children) Order, 1918, and the Milk (Mothers and Children) Order, December 22nd, 1919. The enquiries into the circumstances of expectant and nursing mothers who are so necessitous as to require milk at a reduced rate, or free, have in all cases been carried out by the Health Visitors. The present high price of milk has brought many applicants, and a large number of visits of enquiry have been made, as I shall show in my next Annual Report. INFANT WELFARE CENTRES. This work in Ilford dates from April 2nd, 1914, when a small Voluntary Committee of interested ladies commenced a School for Mothers at the Friends' Meeting House, Albert Road. In April, 1916, a second centre was opened by the same committee at Barkingside. On April 16th, 1917, another Voluntary Committee opened a centre at Seven Kings; while on September 4th, 1917, a fourth centre was opened at Newbury Park. The above Centres were taken over by the Council in April, 1917, a Maternity and Child Welfare Sub-Committee having been appointed in February, 1917. In September, 1918, a Statutory Maternity and Child Welfare Committee, consisting of eight Councillors and four co-opted members, was appointed by the Council. During the past year a new Centre was opened in June at the Cecil Hall, and the attendances show that it is much appreciated by the mothers of the district. 54 In view of the number of mothers and children attending the Centre at the Friends' Meeting House it was decided to divide this Centre and additional premises were found at Emmanuel Church, Ilford Lane, and a very satisfactory Centre is now flourishing there. The Barkingside Centre had never shown the success common to the others, and in December it was decided to amalgamate it with that at Newbury Park. This has been done with improved results. More satisfactory premises are being obtained for the Newbury Park and Albert Road Centres, which will enable the work to be carried on under better conditions. The amount of work and the appreciation which has attended the extension of the Welfare Centres is shown by the following figures for the past year:— Total number of attendances of Infants 5,643 First attendances 629 The monthly figures being as follows:— Jan. Feb. Mar. Apl May. June July Aug Sept. Oct. Nov. Dec. First attendances 53 23 48 44 66 53 61 51 60 66 64 40 Subsequent 323 294 316 368 454 439 502 415 554 728 661 589 Total number of children on rolls December 31st, 1919, after omission of all those who had not made an attendance for six months, 652. The main function of the Infant Welfare Centre is advisory, and treatment should be limited to that required for digestive and similar disturbances. Very many of the minor ailments of infants are due to errors of feeding and a doctor's advice can prevent more serious illnesses resulting. The purpose of a Centre is therefore preventive rather than curative. The scope of the work of a Centre is laid down by the Ministry of Health as follows:- (1) Consultations by a Doctor.—This is carried out in Ilford in a satisfactory manner, all the infants attending 55 the Centre being seen at regular intervals by a Doctor, and the mother given advice. (2) Home Visiting.—I have already referred to the work of the Health Visitors. (3) Collective Teaching.—Health talks are given by a doctor from time to time. Mothers are advised as to the clothing of their infants. Mannikins and model sets of garments have been provided & teach of the Centres. (4) Sale of Clothing.—Wool and suitable materials for infants' clothing have been sold at cost price. I am arranging also for cut-out garments to be provided. This work is of importance, as emphasizing the quality of material which is suitable to be used and is of advantage, especially in the poorer districts where mothers are unable to cope with the present prices of good garments. (5) Sale of Food and Milk.—This has been carried on in increasing degree during the past year. No mother is allowed to obtain dried milk or other food except on a certificate from the Medical Officer. It is not the purpose of a Welfare Centre to become merely a distributing agent for dried milk, but with the present high cost of milk the advantage of obtaining such milk from a Welfare Centre is very much accentuated. Our experience with dried milk has proved that it is a satisfactory substitute for fresh cow's milk, while it has the advantage of being freer from contamination. The following are the quantities of food dealt with during 1919:— Sold. Free. Dried milk 12,331 lbs. 1,043 lbs. Fat emulsion 1,128 lbs. 3 lbs. Condensed milk 210 tins. 88 tins. Lactagol 90 packets. 56 (6) Treatment of Minor Ailments.— These have been treated to some extent at the Public Health Offices in connection with the School Clinic. This is a work which should show considerable development in the future. (7) Records.—A case-sheet is kept for each child attending the Centre and a weight card supplied to each mother. I hope to be able to give some of the information to be derived from these records in a future Report. DENTAL TREATMENT. Mr. Rose, the part-time Council Dentist, has continued the work of treating expectant and nursing mothers, and children under five. The arrangement has been to give one session to this work as required. During 1919, 116 mothers and 10 children under five have been treated. No arrangements having been come to for the provision of dentures for mothers, it has not been so easy to get patients to attend the Dental Clinic, especially where a number of extractions have been required. The decision of the Council to appoint a whole-time Dentist who will do the work of the Maternity as well as the Education Committee, will enable me to arrange for dentures to be provided at a minimum charge, or if necessary free to necessitous cases. I therefore anticipate a very large increase in this work when it is placed on a satisfactory basis. SUPPLY OF FREE MILK (MOTHERS AND CHILDREN) ORDER, 1918. In 1919, 1,043 lbs. of dried milk were supplied free to necessitous nursing and expectant mothers. In view of the high price of cow's milk and pursuant to the wishes of the Ministry of Health, a very considerable increase in this department of the work will be necessary next year. 57 ANTE-NATAL CLINICS. In November, 1919, the Ministry of Health sanctioned the use of certain rooms in the Maternity Home for the purpose of an Ante-Natal Clinic. Owing to shortage of medical staff it was not found possible to commence this scheme, but the appointment by the Council in November, 1919, of a Lady Assistant Medical Officer of Health will enable this most important work to be proceeded with. Its purpose is:— (1) To discover those conditions which make a confinement difficult or dangerous to the mother so that as far as possible they can be dealt with beforehand. (2) To discover any conditions which would prejudice the birth of a living healthy child and as far as possible to rectify them. A scheme of this character in such a district as Ilford is not easy to carry on to large proportions, but I feel convinced that if the susceptibilities of the mothers are considered it will be soon found to exercise a most useful function and will reduce Infantile Mortality below the present rate. MATERNITY HOME. This was opened at 130-2, Cranbrook Road, Ilford, on July 20th, 1918, the two houses concerned having been thoroughly redecorated and adapted as far as possible for the purpose. The Home can accommodate nine mothers with their babies. The staff at first consisted of a Matron and two Staff Nurses. Later a Pupil midwife was appointed, and in the latter part of 1919 a second trained nurse was accepted as Pupil Midwife for training. The former lady obtained her C.M.B. certificate during the year. The staff is now adequate for ordinary events, but when there is a patient seriously ill, requiring undivided attention, it has been necessary to employ the services of a temporary nurse, as also at the times of the annual vacations of the nursing staff. 58 The Home speedily became popular and its value recognised in the district, and it therefore became necessary to refuse cases from adjacent districts. On December 31st, 1919, 53 cases had been booked for future admission into the Home. From the date of opening until December 31st, 1919— 161 women were admitted into the Home; of these 151 were confined in the Home, of the remaining ten 5 were admitted immediately after confinement, 1 was admitted after an incomplete abortion, 1 after a threatened abortion, 3 for examination as to some puerperal condition ; of these, 1 was transferred to the Emergency Hospital for an abdominal operation, and 1 to the Isolation Hospital suffering from mastitis. 1 had a slight operation (curettage) in the Home and was discharged, being cured. Of the 151 confinements 82 had engaged their own doctor, and 69 were attended by one or other of the Midwives of the Home; owing to various complications it was necessary to call in a doctor in 28 of the latter cases. Eight deaths occurred in the Home—5 women and 3 babies —3 of the women died from influenzal pneumonia during the epidemic of the winter of 1918 and spring of 1919, having been admitted owing to home exigencies while suffering from this very fatal ailment. One woman died from nephritis and severe postpartum hæmorrhage, and one from severe ante-partum and postpartum hæmorrhage. The three babies died from congenital debility, one lived only 8 hours, another 26 hours, and the third 16 days. Four children were still-born. 1 owing to eclampsia in the mother. 1 craniotomy—difficult labour. 2 macerated foetus. In November, 1919, a woman w as admitted while incubating scarlet fever, and developed the rash shortly after admission. She was removed to the Isolation Hospital, the Home placed in quarantine and thoroughly disinfected, and no further cases occurred. 59 In April, 1919, a case of puerperal fever was notified from the Home. The patient went home and is still suffering from attacks of pyrexia, which are now considered by her doctor to be due to a septic condition of the gums. I do not think that the case was associated with any septic infection during the confinement. It is interesting to note that "twilight sleep" was administered in three cases, and that twins were born on only one occasion, but that 10 children were born prematurely, necessitating the use of the incubator. 29 babies have been circumcised at the Home. No case suitable of admission to the Home has been refused. Seven unmarried mothers were admitted. Two necessitous cases were admitted free, and three others were admitted at nominal fees. At the present time the circumstances of all those unable to pay an adequate fee are enquired into by the Health Visitors and reported to the Medical Officer of Health, who, in conjunction with the Statutory Committee, decides as to what reduction shall be made. Of the 101 cases above referred to, the average stay in the Home was 16 days. The premises at present used for the Maternity Home are not altogether adapted for institutional work and entail a good deal of unnecessary labour. The popularity of the Home, together with this fact, led the Statutory Committee to negotiate, with the sanction of the Ministry of Health, for the purchase of a site in Hatch Lane for the erection of a fully equipped Home of 20 beds. Draft plans of the new Home are under consideration at present, and I hope by the issue of my next report to be able to state that this project is on its way to completion. 60 The following is a summary of the expenditure incurred in connection with the Maternity Home to the 31st March, 1919:— £ s. d. Salaries of Staff 204 13 10 Uniform Allowances of Staff 12 7 5 Travelling Expenses 12 8 2½ Furniture 437 10 9 Crockery and Chandlery 14 18 11½ Provisions, etc. 245 11 9½ Stationery 21 13 3 Instruments and Medical Requisites 98 18 4 Repairs and Alterations 172 0 9 Laundry 29 4 11 Advertisements 16 0 2 Heating and Lighting 113 12 1 Rent, Rates and Taxes 98 0 6 Linen 162 7 1 Telephone 14 10 3 Ironmongery 55 5 10 Sundries 14 1 7 1,723 5 8½ Revenue 222 2 0 £1,501 3 8½ CHILDREN'S HOSPITAL. This most necessary adjunct to Child Welfare work is proposed to be built by the Ilford War Memorial Committee, with the assistance of the Ministry of Health, on a site adjacent to the proposed Maternity Home. At the present time the facilities for treatment of child-ailments in Ilford are very meagre, and mothers are obliged to take their sick children to hospitals in London to get the necessary attention. Furthermore, there is no provision in Ilford for ailing babies who require the skilled nursing which an institution alone can provide. The Statutory Committee considered, therefore, the possibility of using Valentines Mansion as a Children's Hospital until such time as the War Memorial Hospital could be erected. After a careful examination of the suitability of the building, the cost of adaptation, and the number of patients that could be treated, it was 61 decided not to proceed further with the scheme, but to concentrate on the provision of a modern children's hospital which could be worked in conjunction with the new Maternity Home from a common administrative block. This will be both an economic and a practical method of dealing with the subject. The Children's Hospital will serve the School Medical Service to a greater extent than that of Infant Welfare, though it will provide for infant ailments requiring hospital treatment. I hope, however, that the time will come in Ilford when there will be one Committee responsible for all matters affecting the health of the child, both before and during school age. Such an arrangement would tend both to efficiency and to economy of labour. The following is a summary of the expenditure incurred in connection with Maternity and Child Welfare to 31st March, 1919:— £ s. d. Health Visitors— Salaries—Nurses Steward and East 190 0 2 Uniform Allowances 16 3 6 Travelling Expenses 10 2 0 Welfare Centres— Heating, Lighting and Cleaning 41 8 0 Drugs, etc. 36 7 0 Dried Milks, etc. 41 3 3 Provision of Midwife to necessitous case 0 15 6 Hospital Provision—Three cases of Ophthalmia Neonatorum and one case of Acute Poliomyelitis 34 17 6 Printing, Stationery and Postage, etc. 38 4 1 Other items of expenditure:— X-ray Treatment, Advertisements, etc. 33 0 3 Dental Treatment—Mr. Rose's Fees 20 17 4 Cow's Milk provided to Necessitous Cases 21 9 6 Clerical Assistance 35 0 0 Payment to Registrar in respect of Unnotified Births 0 15 0 530 1 Amount received for sale of Dried Milk £31 9 5 Amount recovered for X-ray Treatment 0 17 6 32 6 11 £487 16 2 62 For the purpose of carrying on the Maternity and Child Welfare work during the year 1920 and 1921 the Ministry of Health have made a grant of £1,403 2s. 7d. The grant is made up as follows:— £ s. d. 50 per cent. of the net eligible expenditure during the financial year 1918-1919 994 9 11 Less Amount paid in the financial year 1918-1919 193 7 4 801 2 7 40 per cent. of the estimated expenditure during the current financial year, say 602 0 0 £1,403 2 7 SCHOOL MEDICAL SERVICE. 65 School Accommodation.— There were at the end of the year 16 public elementary schools in the district, with 35 departments, and accommodation for 13,486 children, the Boys' Department of Church of England School (National) being closed in December. The total number of children on the school rolls was 10,781. Sanitary Condition of the Schools.—Most of the schools are of a modern type and in good sanitary condition. Disinfection of Schools.—During the mid-summer holidays the cloak-rooms and lobbies in the various schools have been disinfected bv spraying. After several cases of infectious disease in a school it has been the practice to disinfect the class-rooms and any articles likely to carry infection. The following gives the complete schedule of work carried out:- Date. School. Part Disinfected. 2/1/19 Loxford All lobbies 2/1/19 Barkingside All lobbies 3/1/19 Chadwell All lobbies 3/1/19 Cleveland All lobbies 23/4/19 Uphall No. 7 Room Junior Mixed and all lobbies 24/4/19 Goodmayes All lobbies 25/4/19 Christchurch All lobbies Midsummer Holidays All Schools All lobbies 4/10/19 Loxford Class 6, Room 6; Class 7, Room 8 and lobby 11/10/19 Cleveland Class 8, Room 1 and lobby 21 11 19 Highlands Room 1 and lobby—Junior Mixed 22/12/19 Loxford Junior Mixed -all class rooms (8) and lobbies 23/12/19 Highlands Junior Mixed—8 class rooms and lobbies School Medical Staff.— There were a good many changes during the past year. Dr. Oates resumed his duties as School Medical Officer on demobilisation in December, 1918. He left in September, 1919. Dr. Dundas, temporary School Medical Officer left on March 31st, 1919. 66 Dr. Burton, Assistant Medical Officer, resumed his duties on demobilisation on March 17th, 1919, was appointed Acting School Medical Officer on Dr. Oates leaving the district, and School Medical Officer on October 27th. Dr. Rattray appointed as Lady Assistant Medical Officer, took up her duties on November 24th. Drs. Coleman and Whiting (local medical practitioners) assisted with medical inspection towards the end of the year. Another Assistant Medical Officer is to be appointed by the Council. Nurse Sandle acted as School Nurse during the whole of 1919. GENERAL STATEMENT OF EXTENT AND SCOPE OF MEDICAL INSPECTION. Number of visits paid to 25 different departments of 10 schools in the district, 128. Number of children examined during the year, 2,512 (1,194 boys ard 1,318 girls). Number of children presented for special examination, in addition to the above, 47 (25 boys and 22 girls). From March, 1919, the Medical Inspection has been carried out in accordance with Article 58 (b) of the Code of Regulations : (1) of all children freshly admitted to school, (2) all children between 8 and 9 years of age, (3) all children between 12 and 13 years of age, together with children over 13 years of age who have not been examined on reaching the age of 12. The practice which became necessary during the war, of only examining children who were supposed to be ailing, resulted in numbers of children suffering from remediable defects being overlooked. 67 The resumption of Medical Inspection on the old basis obviates this, and is much more satisfactory. BOARD OF EDUCATION GRANT FOR THE YEAR 1918-1919. A total grant of £490 18s. l1d. was made. This figure practically amounts to half the actual cost of the school medical service for the year ending 31st March, 1919. The following shows the particulars of expenditure:— £ s. d. Salaries of Medical Officers 100 0 0 Salaries of Assistant Officers 28 16 0 Salaries of Specialist Officers 117 5 0 Salary of School Nurse 110 18 0 Clerical Assistance 243 0 9 Travelling Expenses 7 4 6 Printing, Stationery, Postages, etc. 68 16 10 Drugs, Materials, etc. 30 18 5 Apparatus 4 2 6 Provision of Spectacles 60 6 11 Provision of Premises, including Repayment in respect of Loans 46 1 1 Maintenance of Premises (Rates, Gas, Heating, Lighting, Cleaning and Upkeep of Furniture) 134 16 7 Bacteriological Examinations 17 17 6 Miscellaneous 80 1 8 1,050 5 9 Less—Dental Receipts £16 9 0 X-Ray Receipts 2 0 0 Spectacle Receipts 49 18 11 68 7 11 £981 17 10 EMPLOYMENT OF CHILDREN ACT (BYE-LAWS). This matter is under the control of the Clerk-Solicitor to the Council. The necessary supervision is carried out by a Shops Act Inspector. I am informed that no prosecutions were taken during the year 1919. A Report was presented by the School Medical Officer in February, 1919, on the question of relaxing the provisions of Section 13 (1) (i) of the Education Act, 1918. The subject is still under consideration. 68 SCHOOL CLINIC. The Clinic held at the Public Health Offices each morning was continued during the year. A large number of minor ailments, especially skin diseases, received treatment. This work is much hampered by the inadequacy of the accommodation. Records of all children attending the Clinic are kept, and either certificates of exclusion or of fitness to attend school are given. A number of children are referred to the Clinic from Medical Inspection in the Schools, when more detailed examination is required. Also a number attend as a result of the " following up " by the School Nurse, of defects which have been discovered at Medical Inspection. The number of individual children seen at the Clinic during 1919 was 962. Many of these children attended on numerous occasions. A total of 2,028 exclusion certificates and 789 of fitness to attend school were given. The variety of ailments met with is seen from the following list. One marked feature is that no less than 74 cases of scabies or itch were treated. This is a high figure for such a district as Ilford, and is probably due to infection from men returning from military service. Many of the cases of scabies were protracted, and four were so obstinate to treatment that they were admitted to the Isolation Hospital, where they were cured in from 5 to 14 days. Ailments of children attending the Inspection Clinic :— Uncleanliness:— Head 19 Body 6 Skin:— Ringworm:— Head 49 Body 24 Scabies 74 Impetigo 248 Other Diseases 100 69 Eye:— Defective Vision and Squint 18 External Eye Disease 311 Ear:— Defective Hearing 7 Ear Disease 28 Nose and Throat:— Enlarged Tonsils 4 Adenoids 10 Enlarged Tonsils and Adenoids 9 Other Conditions 125 Defective Speech 4 Heart and Circulation:— Heart Disease—Organic 3 Anæmia 50 Lungs:— Pulmonary Tuberculosis:— Definite 3 Suspected 2 Chronic Bronchitis 5 Other Diseases 5 Nervous System:— Epilepsy 3 Chorea 6 Other Diseases 4 Non-Pulmonary Tuberculosis:— Glands 4 Bones 2 Other Forms 5 Deformities 6 Other Defects or Diseases 109 Total 962 CLEANSING OF CHILDREN, &c. Children Act, 1908, Section 122. It was found necessary during the year to deal with 3 cases under the above Act. Statutory notice was served in each case on the parents or guardians of the child, to remedy a "verminous or foul or filthy condition" within 24 hours. In one of the three cases the child was brought to the Clinic and thoroughly cleansed. 70 The. School Nurse paid 35 visits to the schools, for the purpose of inspecting the heads and clothing of the children, for any verminous condition, with the following result:— No. of Children Inspected. No. Infected. PerCent. 9,083 972 10.7 OPHTHALMIC WORK. Dr. Charsley, the School Oculist, continued to attend when necessary during the year, and held 32 sessions. A total of 368 children w ere examined, and of these 118 were re-examined. 345 were found to have a defect of vision. Here again a great increase in the work is to be observed. In 1918 274 children were examined by the Oculist. In 1919 368 children were examined by the Oculist. 297 pairs of spectacles were provided; of this number, 30 pairs of spectacles were provided free, and 16 pairs partly free of charge—on necessitous grounds. All spectacles are now provided by the Education Committee, the cost being recovered from the parents whenever possible. In a few cases the parents preferred to take the prescription and obtain the spectacles other than from the Council's Opticians, who continue to supply spectacles at as moderate a charge as possible. The appreciation of this work by the parents of the school children is shown by the fact that 88 per cent. of the defects of vision found during 1919 were remedied. 71 The following table shows the delects detected, arranged according to age and sex:— 1. Cases with Defects Discovered in 1919 and Treated in 1919. boys. girls. Under 8 8—12 12—14 Under 8 8—12 12—14 1 Hypermetropia 9 7 7 13 13 7 2 Hypermetropic Astigmatism 6 17 25 11 33 11 3 Myopia 1 3 7 2 4 6 4 Myopic Astigmatism 1 8 10 4 10 3 5 Mixed Astigmatism 2 1 5 2 7 7 6 Anisometropia — 1 — — 1 — Total 19 37 54 32 68 34 2. Cases Discovered in 1918 and Treated in 1919. boys. girls. Under 8 8—12 12—14 Under 8 8—12 12—14 1 Hypermetropia — — 1 — 2 2 2 Hypermetropic Astigmatism — 4 3 2 8 2 3 Myopia — — 1 — — 3 4 Myopic Astigmatism — 2 4 — 3 2 5 Mixed Astigmatism 1 — 1 — 1 1 6 Anisometropia — 1 — — — — Total 1 7 10 2 14 10 3. Cases of Defect Discovered at other Times and Treated in 1919. boys. girls. Under 8 8—12 12—14 Under 8 8—12 12—14 1 Hypermetropia — 3 2 3 3 — 2 Hypermetropic Astigmatism l 0 4 — 9 7 3 Myopia — — — — — 1 4 Myopic Astigmatism — 3 3 — 3 1 5 Mixed Astigmatism — 1 2 — 3 3 6 Anisometropia - - - - - - Total l 12 11 3 18 12 Total 345 72 SCHOOL DENTIST. Mr. C. F. Rose, L.D.S., continued his work as temporary School Dentist, giving two half-days a week during the school terms. From Table D below it will be seen that 2,095 children were inspected by the Dentist, and of these no less than 1,413 were found to require treatment; but that only 577 accepted the treatment offered them. The work in this department has increased very considerably during the past year. The figures do not, of course, compare with those of the work carried out by a whole-time Dentist in 1915, and two half-days a week are quite inadequate for dental treatment of the school children of a district of this size. The question of the appointment of a whole-time Dentist is now under consideration. 73 TABLE D.— TREATMENT OF DENTAL DEFECTS. 1. Number of Children Dealt With. Age Groups. Specials seen by the School Medical Officer. Total. 5 6 7 8 9 10 11 12 13 14 (a) Inspected by Dentist - 1,935 — — — — 160 — 188 2,283 (b) Referred for Treatment — 1,302 - — — — 111 — 188 1,601 (c) Actually Treated - 550 — — — — 27 - 188 765 (d) *Re-treated (result of periodical examination) — 69 — — - — 1 — — 70 * It is understood that cases under this head are included under (c) above. 2. Particulars of Times Given and Operations Undertaken. Number of half days devoted to Inspection. Number of half days devoted to Treatment. Total number of attendances made by the Children at the Clinic. Number of Permanent Teeth. Number of Temporary Teeth. Total number of Fillings. Number of administrations of general Anæsthetics included in Nos. 4 and 6. Number of other Operations. Extracted. Filled. Extracted. Filled. Permanent Teeth. Temporary Teeth. 1 2 3 4 5 6 7 8 9 10 11 22 68 997 198 242 1,678 - 242 696 2 46 74 FURTHER DEVELOPMENTS OF THE SCHOOL MEDICAL SERVICE. In March, 1919, a Report was presented by the School Medical Officer on the Education Act, 1918, so far as it affects the School Medical Service. The main points represented as requiring attention were:— (1) The Employment of a Whole-time Dentist.— This matter is at the present time under consideration. (2) The Extension and Improvement of the School Clinic Premises.— I regard this matter of the greatest importance. The present premises served the purpose when Medical Inspection was in its infancy, but are no longer large enough or suitable. (3) The Appointment of Additional School Nurses.— There is only one nurse allocated to School Medical work. The duties of the nurse are now so extensive, including (1) attendance at the School Clinic, (2) attendance with the School Dentist when anæsthetics are given, (3) "following up" defects, (4) inspections as to cleanliness, (5) visits with reference to cases of infectious disease; that it is not possible for one nurse to carry out the work efficiently in such a wide district as Ilford. (4) 'The Treatment of Nose, Throat and Ear Diseases.— No means exist at present in Ilford by which children suffering from such ailments can receive treatment by a Specialist. Parents are forced to take their children long distances and wait for long periods before the necessary attention can be given. Some Local Authorities have appointed a nose, thoat and ear surgeon to attend to the school children in their district, and such an arrangement is urgently required in Ilford. It would be necessary to have beds for cases requiring operative treatment. 75 (5) The Establishment of Nursery Schools.— In my opinion these should be established in close connection with the already existing Infant Welfare Centres, from which suitable children could be drafted. The possibilities of infection in schools for children of 2 to 5 years of age are considerable, and it will be necessary to have them very completely under the supervision and control of the School Medical Staff, if the spread of infection is to be limited. The main condition which should be observed in the creation of a Nursery School are:— (i.) It must be easy for access from the children's homes, (ii.) It must be an open-air school with ample garden space. (iii.) Provision must be made for meals and for rooms for rest and sleep. All children admitted will be required to be fed at the School. (v.) Admission should be limited, at least at the commencement, to those children who are in unsatisfactory home conditions. (v.) Infection should be avoided by daily inspection by a nurse of every child entering the School. (vi.) Medical inspection and treatment of all children admitted should be enforced and in this way physical defects cured at their earliest stage. It will be seen that Nursery Schools will be expensive to maintain, and in the first place will be of an experimental character. There is no doubt that there are districts in Ilford where such schools would serve a most useful purpose. (6) The Establishment of a Special School for Mentally Defective Children who can be Educated.—This matter is now under consideration. It will be seen from Table II. that there are 21 who have been certified as mentally deficient but educable. A number of children come under the notice of the School Medical Officer who are not mentally deficient but backward, and require more attention than is possible in a class of normal children. Some provision should be made for such children. 76 (7) Establishment of a Special School for Physically fective Children.—(a) From Table III. it will be seen that at the present time there are 15 children who are so physically defective as to be unable to attend a public elementary school. It may be possible for the Committee to make some arrangements for teaching cripple children and others who require to be taken to school in vehicles, and who further require special accommodation at school, in connection with the school for mentally defective children. (b) There are a number of children also who are suffering from slight physical deformities, e.g., lateral curvature, defective chest development, etc., who require remedial physical exercises, massage, etc., which should be given by a skilled instructor, under the direction of the School Medical Officer, at a Special Clinic. (8) Establishment of an Open-air School.—There is little doubt that such a school is required in Ilford. There are numbers of children examined by the School Doctors who are in a pre-tubercular condition, who would greatly benefit by a school of this character. There are at the present time 62 school children attending the Ilford Tuberculosis Dispensary who are pre-tubercular EDUCATION' (PROVISION OF MEALS) ACTS, 1906-1914. There did not arise during the year any necessity to put into force the provisions of these Acts. During 1919, three individual children (all of one family) were supplied with a total of 51 meals, funds being supplied from voluntary sources. 77 MENTALLY DEFECTIVE CHILDREN. The following table shows the number of children examined (luring 1919, and the result of the examination :— Ages. Boys. Girls. Total. Form "A" Form "B" Form "C " Form " A " Form " B" Form "C " 7 to 15 years 1 5 - - 5 1 12 Under Form " A "— The child is certified as "not incapable, by reason of mental defect, of receiving benefit from the instruction in an ordinary Public Elementary School." Under Form " B "— The child is certified as "not being merely dull or backward and not being an idiot, or imbecile, or a moral imbecile, is feeble-minded within the meaning of the Mental Deficiency Act, 1913, but is not incapable by reason of mental defect of receiving benefit from instruction in a special school or class under the Elementary Education (Defective and Epileptic Children) Act, 1899." Under Form "C"- The child is certified as "incapable, by reason of mental defect, of receiving benefit from instruction in a special school or class under the Elementary Education (Defective and Epileptic Children) Act, 1899." The children who are found to be imbeciles or idiots are notified to the Essex County Council, who are responsible few their control. From Table III. it will be seen that at the present time there are 21 mentally deficient children for whom the Ilford Education Committee is responsible; of these 6 are institutional cases, 15 are suitable for a day special school. The provision of such a school is now under contemplation. 78 RINGWORM. No. of Cases at begining of 1919 No, of cases reported during 1919. Total. Remedied during 1919. No. of cases under observation at end of 1919. Ringworm :— Scalp 13 36 49 34 15 Body — 24 24 22 2 13 60 73 56 17 The X-ray treatment by the operator employed by the Education Committee continues to be most satisfactory. No case of permanent loss of hair occurred, though dermatitis resulted in a few cases. A total of 29 children were X-rayed during the year. It will be seen that the number of cases at the beginning and end of the year was practically the same. When parents fully realise the very chronic character of ringworm of the scalp, unless treated by X-rays, the difficulty at present experienced in some cases of obtaining consent to its use will be overcome. INFECTIOUS DISEASE IN SCHOOL CHILDREN. Scarlet Fever. There has been a considerable increase in the number of cases reported from the schools during 1919. 165 notifications were received as against 49 in 1918. This is the highest number of cases of scarlet fever which has been notified since 1912, when 208 cases occurred in school children. All the schools were affected, but Loxford especially so. The disease was part of a general epidemic which attacked the London and extra London districts. Fortunately the type of scarlet fever was a mild one, but this also increased the chances of spread, several children being discovered attending school by the School Medical Officer in a peeling stage, having previously suffered from a slight sore throat, which had not directed attention to the real condition. 79 Diphtheria. The figures for 1919 are satisfactory; 78 cases were notified from the schools as compared with 115 in 1918. There was no special incidence in any one school. Measles and German Measles. There was a distinct rise in the number of cases in 1919, 645 cases being reported as compared with 151 in 1918. The following table shows the incidence of Scarlet Fever, Diphtheria, and Measles (including German Measles) in the Ilford schools since 1915:— Scarlet Fever. Diphtheria. Measles. 1915 136 66 851 1916 83 82 1821 1917 57 104 1115 1918 49 115 151 1919 165 78 645 Chicken-Pox and Whooping Cough. 263 cases of Chicken Pox occurred, compared with 188 in 1918, while only 15 cases of Whooping Cough were reported, as compared with 471 in 1918. On the whole it may be said that 1919 was an average year as regards the incidence of infectious disease in the schools, with the exception of Scarlet Fever, of which there was an unusually large number of cases. 80 TABLE I.—Number of Children Inspected 1st January, 1919, to 31st December, 1919. A "Code" Groups. Age Entrants. 3. 4. 5. 6. Other Ages. Total. Boys ... ... 197 100 70 367 Girls ... ... 148 80 55 283 Totals ... ... 345 180 125 650 Intermediate Group. Leavers. Grand Total. Age 8. 12. 13. 14. Other Ages. Total. Boys 244 308 208 38 29 827 1194 Girls 311 378 272 35 39 1035 1318 Totals 555 686 480 73 68 1862 2512 B Groups other than "Code." * (1) Intermediate Group (other than 8 years). (2) Special Cases,† (3) Re-Examinations (i.e., No. of Children Re-Examined). (4) M.I. Clinic. Boys ... 25 + 509 ... Girls ... 22 + 451 ... Totals ... 47 + 960 ... *In areas where routine inspections have been have been suspended and the "ailing children" basis adopted, the number of children inspected should be entered in column (3). † Under this head should be included all special cases which were medically inspected during the year, whether the inspection took place in the schools or at the inspection clinic, and from whatever source the cases were derived, 81 TABLE II.—Return of Defects found in the course of Medical Inspection in 1919. Defect or Disease. Code Groups. Specials. Number referred for Treatment Number requiring to be kept under observation, but not referred for Treatment Number referred lor Treatment. Number requiring to be kept under observation, but not referred for Treatment (1) (2) (3) (4) (5) Malnutrition — — 1 — Uncleanliness— Head 211 — 19 — Body 3 — 6 — Skin Ringworm- Head 3 — 49 — Body 1 — 24 — Scabies 3 — 74 — Impetigo 10 — 248 — Other Disease 2 — 100 — Eye Defective Vision and Squint 229 — 18 — External Eye Disease 8 — 30 — Ear Defective Hearing 57 — 7 — Ear Disease 32 — 28 — Teeth- Dental Disease (see N.B. (2) below vide Report on Work of School Dentist. Nose and Throat Enlarged Tonsils 57 — 4 — Adenoids 50 — 10 — Enlarged Tonsils and Adenoids 38 — 9 Other Conditions — — 125 — Defective Speech 8 — 4 — Heart and Circulation Heart Disease— Organic 8 1 3 — Functional — — . — — Anæmia 10 — 50 — Lungs Pulmonary Tuberculosis— Definite 2 — 3 — Suspected 2 — 2 — Chronic Bronchitis 6 — 5 — Other Disease 1 — 5 — Nervous System Epilepsy 3 — 3 — Chorea — — 6 — Other disease — — 4 — Non-pulmonary Tuberculosis— Glands 2 — 4 — Bones — — 2 — Other Forms — — 5 — Rickets — — — — Deformities 5 — 6 — Other Defects or Diseases 41 1 109 1 Totals 792 2 963 1 82 TABLE III.—Numerical Return of all. Exceptional Children in the area in 1919. Boys. Girls. Total. Blind (including partially blind) Attending Public Elementary Schools — — — Attending Certified Schools for the Blind 1 — 1 Not at School — — — Deaf and Dumb (including partially deaf) Attending Public Elementary Schools — — — Attending Certified Schools for the Deaf 4 1 5 Not at School — — — Mentally Deficient Feeble Minded Attending Public Elementary Schools 6 3 9 Attending Certified Schools for Mentally Defective Children 2 2 4 a Notified to the Local (Control) Authority during the year — 1 1 Not at School 3 5 8 Imbeciles At School — — — Not at School 7 9 166 Idiots 1 — 1 Epileptics Attending Public Elementary Schools 3 2 5c Attending Certified Schools for Epileptics — — — Not at School — 1 1c Pulmonary Tuberculosis Attending Public Elementary Schools 14 11 25 Attending Certified Schools for Physically Defective Children — — — Not at School 5 4 9 Physically Defective Other forms of Tuberculosis Attending Public Elementary Schools 11 13 24 Attending Certified Schools for Physically Defective Children — — — Not at School 3 6 9 Cripples other than Tubercular Attending Public Elementary Schools 20 17 37 Attending Certified Schools for Physically Defective Children — 1 1 Not at School 3 3 6 *Dull or Backward Retarded 2 years 133 78 211c Retarded 3 years 39 26 65c *Judging according to age and standard. (a) All of these are in Residential Institutions, (b) of these three were also Physically Defective and three were Epileptic, (c) These figures are incomplete 83 TABLE IV.—Treatment of Defects of Children during 1919. Condition. Number of defects found for which Treatment was considered necessary. Number of defects for which no report is available. Number of defects treated. Results of Treatment. Number of defects not treated. Percentage of defects treated. From previous year. * New. Total. Remedied. Improved. Unchanged. Clothing — 3 3 — 3 3 — — — 100 Footgear — 12 12 — 12 11 1 — — 100 (a) Cleanliness of Head 1 36 37 — 37 37 — — — 100 Cleanliness of Body — 10 10 1 9 9 — — 90 Nutrition — 1 1 — 1 1 — — — 100 Nose and Throat — 292 292 35 231 198 12 21 26 79 External Eye Disease 1 37 38 1 35 29 6 — 2 92 Ear Disease — 60 60 1 43 38 3 2 16 71 (b)Teeth — 1697 1697 — 765 765 — — 932 45 Heart and Circulation 1 71 72 4 62 43 11 8 6 86 Lungs — 26 26 5 19 15 4 — 2 73 Nervous System 1 15 16 4 12 8 3 1 — 75 Skin 17 498 515 16 407 407 — — 92 79 Rickets — — — — — — — — — — Deformities — 11 11 5 6 3 2 1 — 54 Tuberculosis— Non-Pulmonary — 13 13 6 7 3 4 — — 53 Speech — 12 12 1 10 2 4 4 1 83 Mental Condition — 13 13 — 7 — — — 6 53 Vision and Squint 162 247 368 1 366 366 — — 42 88 Hearing — 64 64 6 44 28 5 11 14 68 Miscellaneous 142 142 17 98 81 8 9 27 69 Totals 183 3,260 3,443 103 2,174 2,047 63 57 1,166 63 {a) Cleanliness of Head.—In addition to the above, see School Nuise's visits to schools, also Table II. The above figures are only of children found with living vermin. re (b) Teeth—Of these 1,697 cases, 1,649 were the result of examination by the School Dentist ; and 48 were found on Medical Inspection to require very urgent treatment. * The return should show comprehensively all defects found during the year, from whatever source derived, which required treatment.. 84 TABLE V.—Inspection, Treatment, &c., of Children during 1919. (1) The total number of children medically inspected (whether Code Group, special or ailing child) M.I. 2,559 Clinic 962 Dental 2,095 Total 5,616 (2) The number of children in (1) suffering from defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment) M.I. 3 (3) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 3,381 (4) The number of children in (3) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 2,113 Note :—In (1) above—2,095 children were inspected by the School Dentist. In (3) above - Included in this total are 1,413 cases referred by the School Dentist. In (4) above—Included in this total are 765 cases treated by the School Dentist. 85 The following Table shews the average Heights and Weights of the Boys examined :— Ages of Children—Years. 5.6 6.7 7.8 8.9 12.13 13.14 14.15 Number of Children Examined 197 100 70 244 303 208 38 Heights Centimetres 104.40 112.85 121.78 124 37 140.70 145.38 149 67 Inches 41.10 44 42 47.94 48.96 55.39 57.23 58.92 Weights Kilograms 17.88 19.58 22.17 24.08 32.94 36.38 38.40 Pounds 39.40 43.15 48.82 53.07 72.59 80.18 84.63 Anthropometric Standard. Height Centimetres 103.3 109.2 120.3 124.7 139.7 142.2 147.8 Inches 40.66 42.99 47.36 49.09 54.99 55.98 58.18 Weight Kilograms 17.4 19.1 23.5 25.3 33.1 35.0 38.2 Pounds 38.34 42.09 51.79 55.76 72.95 77.14 84.19 The following Table shews the average Heights and Weights of the Girls examined:— Ages of Children—Years 5.6 6.7 7.8 8.9 12.13 13.14 14.15 Number of Children Examined 148 80 55 311 360 272 35 Heights Centimetres 105.15 111.90 122.54 124.72 140.96 147.01 153.75 Inches 41.39 44.05 48.24 49.10 55.49 57.87 60.53 Weights Kilograms 17.56 19.33 22.09 23.19 34.29 38.09 42.86 Pounds 38.70 42.60 48.68 51.16 75.57 83.96 94.46 Anthropometric Standard. Height Centimetres 102.6 108.2 119.3 123.6 141. 2 144.7 149.3 Inches 40.39 42.59 46.96 48.66 55.59 56.96 58.77 Weight Kilograms 17.0 18.5 22.5 24.4 33.5 36.4 40.3 Pounds 37.46 40.77 49.59 53.77 73.83 80.22 88.82 86 Summary of Medical Inspection, Year 1919. Ages—Years. 5—C 6-7 7—8 8—9 9—10 10-11 11—12 12—13 13—14 14—15 Total. SCHOOI.S. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Hoys. Girls. Boys. Girls. Goodmayes 24 30 17 8 8 7 46 32 — — — — — — 29 25 24 20 9 5 157 127 Newbury Park 7 10 2 2 — 1 20 28 — — — — — 1 23 24 31 25 — 1 88 92 South Park 41 42 10 6 2 1 72 70 — — .— — — 2 53 80 46 62 6 7 230 270 Uphall Road 13 9 0 4 4 2 22 75 — 12 — — — — 57 63 40 40 6 9 147 220 Cleveland — — — — — — 2 2 — 4 1 1 1 1 34 53 25 36 5 8 08 105 Barkingside 6 2 3 1 — — 11 11 3 2 2 — — — 14 17 15 10 1 1 55 44 Little Heath 4 1 1 — 1 1 8 9 — — — — 1 1 8 4 5 6 1 — 29 22 Valentines 7 3 2 1 2 5 — 2 3 1 3 — — 2 6 3 2 9 — — 25 26 Downshall 04 39 22 33 14 10 19 54 4 2 1 6 3 6 61 58 10 30 2 4 200 242 Highlands 31 12 38 25 39 28 44 28 7 7 5 4 — 5 18 33 10 28 3 — 195 170 Total 197 148 100 80 70 55 244 311 17 28 12 11 5 18 303 360 208 272 38 35 1194 1318 SPECIALS. Goodmayes 3 — 1 — — — 1 — 2 — — — — — — 1 — — — — 7 1 Newbury Park — — — — — — — — — — — — —— — — — — — — — 1 — South Park — — 3 3 3 9 1 2 — 1 — — — — — — — — — — 7 8 Uphall Road 1 — — — — — 1 — 1 — — — — — — — — — 1 — 4 — Cleveland — — — — — — — 1 — — — — — — — 2 — — — — — 3 Barkingdside — — — — — — — — — — — — — — — — — — — — — — Little Heath 1 — 1 — — — — — — — — — — — — —— — — — — 2 — Valentines — 1 — — — — — — — — — — 2 — — — — — — — •2 1 Downshall — — 1 1 — — 1 — — 2 — 3 — — — — — — — — 2 8 Highlands — — — — — — — — — 1 — — — — — — — — — — — 1 Total 5 1 6 4 3 2 5 3 3 4 — 3 2 2 — 3 — — 1 — 25 22 T otal Number Children Examined 2559. Grand Total 1219 1340 87 Summary of Infectious Diseases and Children who have been excluded owing to Contact with Patients in connection with the Schools during the year ended the 31st December, 1919. SCHOOLS. • Number on Roll. DISEASES AND CONTACTS. Scarlet Fever. Diphtheria. Enteric Fever. Measles. and German Measles Chicken Pox. Mumps. Whooping Cough. Ringworm Totals. 1919. Totals. 1918. Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases. Cases Contacts Cases Contacts Downshall 1302 18 21 13 30 — — 46 24 59 23 75 5 — — 11 225 105 134 178 Cleveland Road 1312 5 19 6 10 — — 86 98 8 6 31 3 — — 2 138 136 100 151 Christchurch* 1245 l5 15 10 22 1 — 80 82 5 3 83 15 — — 6 196 137 127 153 Loxford 1071 37 42 3 4 1 — 93 46 76 29 12 — 2 — 4 228 121 98 98 Highlands 827 14 12 7 6 — — 20 10 4 3 39 16 6 2 — 90 49 98 73 South Park 1280 16 13 2 3 — — 53 32 11 2 66 5 4 — 4 156 55 130 136 Uphall 1047 10 12 2 9 — — 21 30 17 6 20 5 — — 3 73 62 63 109 National and Church Infants 265 1 2 1 6 — — 7 20 2 2 8 7 — — 2 21 37 47 69 Newbury Park 476 3 6 3 7 — — 2 9 32 25 7 4 — — — 47 51 42 86 Goodmayes 828 15 14 9 8 — — 66 19 38 14 50 1 — — 4 182 56 81 95 Chadwell 253 — — 1 — — 31 31 — — — — — — — 31 32 24 36 Barkingside 265 2 4 1 2 — — 8 4 4 2 — — — — — 15 12 2 10 Roman Catholic 367 4 6 3 10 — — 22 14 5 4 2 1 — — — 36 35 8 26 Valentines 96 — — — — — — — — 1 1 5 3 — — — 6 4 — 3 Little Heath 147 1 3 3 10 — — — — — — 1 — — — — 5 13 42 55 Countv High School — 2 1 1 1 — — 3 1 1 — 1 2 — — — 8 5 6 11 Private Schools — 22 17 14 17 — — 107 30 — — 2 — — — — 145 64 33 29 Totals 10781 165 187 78 146 2 — 645 450 263 120 402 67 15 4 36 1602 974 1035 1318 88 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 1918. SCHOOLS. Number on Roll. Jan. Feb. March & April. May. June. July. August. Sept. October. Nov. Dec. Total 1919 Total 1918 Cases. Conts. Case». Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Caess. Conts. Cases. Conts. Cases. Conts. Downshall 1302 1 l - 2 2 7 1 1 2 2 7 4 - - 1 - 1 1 1 - 2 3 18 21 3 7 Cleveland Road 1312 — — — 1 1 1 1 3 — 1 1 — — — 1 3 — 3 — — 1 7 5 19 7 8 Christchurch 1245 1 1 1 - 2 6 3 - 1 2 3 2 — — 1 - — - — 2 3 2 15 15 10 14 Loxford 1071 6 7 - - 2 - - - - - 1 - - - 2 - 8 11 11 15 7 9 37 42 4 6 Highlands 827 1 1 — - 1 1 — - — — — — — — — - — - 5 2 7 8 14 12 2 5 South Park 1280 1 1 — - 1 — 2 1 — - 3 1 — — 1 - 1 1 5 7 2 2 16 13 3 6 Uphall Road 1047 — — — - 5 4 — — — — 1 7 — — — - — - 2 1 2 — 10 12 5 10 Nat. & Church Infants 265 - - - - - - - - - - - - - - 1 2 - - - - - - 1 2 2 4 Newbury Park 476 - - - - - — 1 6 — — - - — — 1 - — - 1 - - - 3 6 - - Goodmayes 828 — 1 1 — — — — — — — 5 4 — — 2 — 4 2 2 1 1 6 15 14 2 1 Chadwell 253 - - - - - - - - - - - - - - - - - - - - - - - - - - Barkingside 265 — — 1 - — — — 4 — — — — — — — — 1 — — — — — 2 4 — — Roman Catholic 367 — - — - — - - — — — 1 2 — — 2 4 — — 1 - — - 4 6 1 3 Valentines 96 - - - - - - - - - - - - - - - - - - - - - - - - - Little Heath 147 — 2 - - - - - - - - - - - - - - - - - - 1 1 1 3 — — County High — — — — - 1 — — — — — — — — — — — — — — 1 1 — 2 1 3 1 Private Schools - 1 3 1 - 2 1 3 1 - - 3 4 - - - 2 2 - 3 2 7 4 22 17 7 5 Totals 10781 11 17 4 3 17 20 11 16 3 5 25 24 — — 12 11 17 18 31 31 34 42 165 187 49 69 89 DIPHTHERIA. Table showing the Number of Cases of Diphtheria and the contacts involved excluded in connection with the Schools, also Total Comparisons with 1918. SCHOOLS. Number on Roll. Jan. Feb. March & April. May. June. July August. Sept. Oct. Nov. Dec. Total 1919. Total 1918. 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 1302 1 - 2 7 2 14 4 2 - 14 2 3 - - 2 3 - - - - 13 30 7 6 Cleveland Road 1312 1 3 - - - 5 - - 3 - - - - - - - 1 1 1 1 6 10 16 46 Christchurch Road 1245 1 4 1 - - - 1 1 - - 1 2 2 3 1 5 1 4 2 3 10 22 17 31 Loxford 1071 1 3 - - - - - - - - - - 2 1 - - - - - - 3 4 13 20 Highlands 827 4 3 - - - - - - 1 - - 1 1 1 1 1 - - - - 7 6 3 6 South Park 1280 1 - 1 1 - 2 - - - - - - - - - - - - - - 2 3 4 15 Uphall 1047 - 2 - - - 4 - 3 - - 1 - - - - - - - - - 2 9 11 20 Nat. & Church Infants 265 1 1 - - - - - - - - - - - - - 2 - - - - 1 6 5 7 Newburv Park 476 - 2 1 3 1 1 - - - - - - 1 1 - - - - - - 3 7 15 38 Goodmayes 828 — - - - 2 1 2 1 1 1 - - - - 3 3 - - 1 2 9 8 4 6 Chadwell 253 - - - - - - - - - - - 1 - - - - - - - - - 1 1 - Barkingside 265 1 2, - - - - - - - - - - - - - - - - - - 1 2 - - Roman Catholic 367 - - - - - - - - - - - - - - - - - - - - 1 2 - - Valentines 96 - - - - - - - - - - - 1 1 1 2 1 - 2 - 6 3 10 1 6 Little Heath 147 1 8 - - - - - - - - - - - - - - - - 1 2 3 10 3 6 County High - - - - - - - - - 1 - - - - - - - - - - - 1 1 1 6 Private Schools - 2 2 — — 1 — 1 2 2 — 5 5 — — — 1 1 1 2 6 14 17 14 14 Totals 10781 14 30 5 11 6 27 8 9 8 2 9 12 8 7 9 17 3 8 8 23 78 146 115 *230 90 MEASLES AND GERMAN MEASLES. Table showing the Number of Cases of Measles and German Measles and the Contacts involved excluded in connection with the Schools, also Total Comparisons with 1918. SCHOOLS. Number on Roll. Jan. Feb. March & April. May. June. July & August. Sept. Oct. Nov. Dec. Total 1919 Total 1918 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 1302 - - - - 2 1 - - - - 11 12 - - - - 1 4 32 7 46 24 21 49 Cleveland Road 1312 1 1 7 13 47 50 19 25 9 4 2 3 1 2 - - - - - - 86 98 8 38 Christchurch Road 1245 1 1 2 2 31 36 24 26 21 11 — 1 — — 1 5 - - - - 80 82 7 17 Loxford ... 1071 — — — — 1 1 — 3 55 19 36 23 — — — - - - 1 - 93 46 11 14 Highlands 827 — — —. — 1 1 — 1 — — 19 8 - — — — - — - - 20 10 1 1 South Park 1280 — — 1 - 2 2 — 2 3 — 41 27 3 — 2 — 1 1 - - 53 3? 46 65 Uphall 1047 — — 2 1 5 13 1 7 2 — 1 5 1 - - - - - - 4 21 30 7 28 Nat. & Church Infants. 265 — 2 — — 7 15 — 3 — — — — — — — — — - - - 7 20 12 19 Newbury Park 476 - - - - 2. 9 - - - - - - - - - - - - - - 2 9 3 8 Goodmaves 828 - — — — — — — 1 61 13 2 3 - - - - - 2 3 — 66 19 8 17 Chadwell 213 — — — — — — 1 1 — — 3 8 — — 1 4 6 18 20 - 31 31 3 6 Barkingside 265 — — — — 2 — 2 3 — — 3 1 — — 1 — — — - — 8 4 — 3 Roman Catholic 367 — — — — 3 8 1 1 17 4 1 1 - - - - - - - - 22 14 2 10 Valentines 96 - - - - - - - - - - - - - - - - - - - - - - - - Little Heath 147 - - - - - - - - - - - - - - - - - - - - - - 10 22 County High School — — — — 1 — 1 1 — — — 1 — — — — — — — - — 3 1 1 2 Private Schools - - - - 1 3 6 13 .3 33 7 30 9 - - - - - - 26 4 107 30 11 5 Totals 10781 2 4 12 18 108 143 62 76 201 58 150 101 5 2 5 9 8 25 91 15 645 450 151 304 91 CHICKEN POX. Table showing the Number of Cases of Chicken Pox and the Contacts involved excluded in connection with the Schools, also Total Comparisons with 1918. SCHOOLS. Number on Roll. Jan. Feb. March & April. May. June. July & August. Sept. Oct. Nov. Dec. Total, 1919. Total, 1918. 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 1302 _ _ 2 _ 2 _ 1 _ 1 _ 6 3 _ 4 15 6 20 7 9 3 59 23 14 17 Cleveland Road 1312 — — 1 2 4 1 2 1 1 - - 2 - - - - - - - - 8 6 15 4 Christchurch Road 1245 1 2 - — 2 1 - - - - - - - - - - 1 - 1 - 5 3 32 25 Loxford 1071 - — 1 2 46 13 25 11 2 1 - - - - - - 1 - 1 2 76 29 24 17 Highlands 827 — 2 — — - - 1 1 - - - - 2 - - - 1 - - - 4 3 21 21 South Park 1280 - - - - 10 2 - - - - - - - - - - - - - - 11 2 11 8 Uphall 1047 3 3 1 — 3 1 7 2 - - - - - - - - 1 - - - 17 6 19 14 Nat. & Church Infants 265 - - - - - - - - - - - - - - - - - - 1 2 2 9 8 7 Newburv Park 476 — — 2 1 19 20 4 - 1 2 - - - - - - - - 6 2 32 ?5 9 10 Goodmaves 828 — — — — 3 - 6 2 - - - - 1 2 - - 5 3 23 7 38 14 17 22 Chad well 253 — — — — - - - - - - - - - - - - - - - - - - 12 14 3 Barkingside 265 — — — — - - 2 2 2 - - - - - - - - - - - 4 2 2 Roman Catholic 307 — — 2 2 - - - - - - - - - - - - 2 1 1 1 5 4 - - Valentines 96 — - - - - - - - - - - - - 1 - - - Little Heath - - - - - - - - - - - - - - - - - - - - - 1 - County High - - - - - - - - - - - - - - - - - - - - - - - 2 1 Private Schools - - - - - - - - - - - - - - - - - - - - - - - 1 4 Totals 10781 4 7 9 7 90 38 48 19 10 3 6 5 7 7 15 0 31 11 43 17 263 120 188 177 92 WHOOPING COUGH. Table showing the Number of Cases of Whooping Cough and the Contacts involved excluded in connection with the Schools, also Total Comparisons with 1918. SCHOOLS. Number on Roll. Jan. Feb. March & April. May. June. July & August. Sept. Oct. Nov. Dec. Total, 1919 Total, 1918. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. j Conts. Cases. Conts. Downshall 1302 1 2 - - - - - - - - 1 - - - l - - - - - 3 2 81 86 Cleveland Road 1312 - - - - - - - - - - - - - - - - - - - - — — 44 37 Christchurch Road 1245 - - - - - - - - - - - - - - - - - - - - - - 53 56 Loxford 1071 - - - - 1 - - - - - - - - 1 - - - - - 2 — 41 27 Highlands 827 1 2 2 — 3 — - - - - - - - - - - - - - - 6 2 60 30 South Park 1280 - - - - - - - - - - - - - - - - - - 4 - 4 - 60 39 Uphall 1047 - - - - - - - - - - - - - - - - - - - - - - 14 19 Nat. & Church Infants 265 - - - - - - - - - - - - - - - - - - - - - - 13 28 Newbury Park 476 - - - - - - - - - - - - - - - - - - - - - 15 30 Goodmayes 828 - - - - - - - - - - - - - - - - - - - - - - 50 4!) Chadwell 253 - - - - - - - - - - - - - - - - - - - - - - 8 16 Barkingside 265 - - - - - - - - - - - - - - - - - - - - - - - 4 Roman Catholic 367 - - - - - - - - - - - - - - - - - - - - - 4 7 Valentines 96 - - - - - - - - - - - - - - - - - - - - - - - - Little Heath 147 - - - - - - - - - - - - - - - - - - - - - - 28 27 Countv High - - - - - - - - - - - - - - - - - - - - - - - 1 Private Schools - - - - - - - - - - - - - - - - - - - - - - - 1 Total 10781 2 4 2 - 4 - - - - - 1 - - - 2 - - - 4 — 15 4 471 457