C.I. 1LF5 Ac4411 (1) ILFORD Urban District of Ilford. HEALTH REPORT FOR THE YEAR 1920. A. H. G. BURTON. M.D., D.P.H., Medical Officer of Health, &c. 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 1920. 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. 1920-1921. Councillor E. G. Culpin, Chairman. Councillor G. Cushing, Vice-Chairman. Councillor G. Church. Councillor J. Lowe. Councillor H. L. Crofts. Councillor H. G. Odell, J.p. Councillor The Rev. H. Dunnico, Councillor W. H. Stevens. J.P., C.C. Councillor J. J. Taylor. Councillor Walter Everett. Councillor O. Waters, O.B.E., C.C. MATERNITY & CHILD WELFARE STATUTORY COMMITTEE. 1920-1921. Councillor W. H. Stevens, Chairman. * Mrs. E. M. Wise, Vice-Chairman. Councillor G. Church. Councillor G. Lee. Councillor E. G. Culpin. Councillor J. Lowe. Councillor The Rev. H. Dunnico, † Councillor H. G. Odell, J.P. J.P., C.C. * Dr. O. E. Powell. * Mrs. Dunnico. * Mrs. Stewart. † Councillor W. Everett. Councillor J. J. Taylor. * Mrs. Gillard. Councillor O. Waters, O.B.E., C.C. * Co-opted Members. † Ex-officio Members. EDUCATION COMMITTEE. 1920-1921. Councillor G. Gunary, Chairman. * Mr. J. Mein, Vice-Chairman. Councillor H. L. Crofts. * Mr. S. P. Lonergan. Councillor E. G. Culpin. † Councillor H. G. Odell, J.P. Councillor G. Cushing. Councillor B. S. J. Pitt. Councillor The Rev. H. Dunnico, Councillor W. J. O. Sheat, O.B.E., J.P., C.C. J.P. † Councillor \V. Everett. * Mr. W. R. Spencer. * Mr. D. Hunter, O.B.E. Councillor W. H. Stevens. * Mr. G. F. Hustwayte. Councillor J. J. Taylor. * Miss J. B. Larkin. Councillor 0. Waters. O.B.E. C.C. Councillor G. Lee. * Mr. H. J. Weston. Councillor A. Young. * Co-opted Members. † Ex-officio Memlbers. OFFICERS of the PUBLIC HEALTH SERVICES. APRIL, 1921. Medical Officer of Health, School Medical Officer, Medical Superintendent of the Isolation Hospital, Medical Officer to the Maternity 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.D., Ch.B. (Glasgow), D.P.H. (Manch.). Jessie A. Maclaren, M.B., Ch.B. (Ed.), D.P.H. (Ed.). Oculist (part time): Dentist: R.S. Charsley, M.R.C.S., L.R.C.P. S.F. Greenfield, L.D.S., R.C.S. Matron of Isolation Hospital: Matron of Maternity Home: Miss I. Millar. Miss M. E. Roberts. 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 and School Nurses: Miss M. E. Cartwright. Miss B. Raddall. Miss K. B. Mathieson. Miss C.H. Robinson. Mrs. H. Morris. Miss M. D. Seager. Clerk: F.J. Bull. PREFACE. Public Health Department, Ilford. March 22nd, 1921. To the Chairman and Members of the ILFORD URBAN DISTRICT COUNCIL. Ladies and Gentlemen, I have the honour to present herewith my Annual Report, which has been drawn up and classified in accordance with the recent instructions of the Ministry of Health and Board of Education. I am indebted to the Surveyor for details regarding Sewerage, Refuse Collection and the Housing Schemes, all of which subjects fall within his province. A comparison with the Report of last year will show a large increase in the work, more particularly in connection with the Infant Welfare and the School Medical Services. Several much needed improvements have been carried out during the year, including the re-decoration of the Isolation Hospital and Maternity Home, and the enlargement of the Public Health Offices and School Clinic. The appointment of two additional Health Visitors has enabled me to relieve the Head Teachers of the Schools of a good deal of work which they commenced voluntarily and which recently had so increased as to become a burden. The death-rate again shows a decline, while the infant mortality rate is the lowest yet recorded for the district. Infectious diseases have still been unduly prevalent, and the Isolation Hospital has been working at high pressure during the winter months. 8 The continuous expressions of appreciation from the friends of patients at the Isolation Hospital and Maternity Home speak a good deal for the Matrons of these Institutions and demonstrate that it is possible to administer Municipal Hospitals with the same sympathy as voluntary institutions. Much of the routine work of the School Medical and Infant Welfare services has necessarily fallen on the Assistant Medical Officers, and the success of these departments is largely due to them. Mr. King's intimate and long-standing knowledge of the district has been invaluable to me on many occasions. The work which he, with the Assistant Inspectors, has been able to carry out is limited, and the staff on this side of the Department needs augmenting. The preparation of this Report has thrown a good deal of additional work with overtime on the clerical staff, but they have performed it in a willing and helpful manner. I have again to express my thanks to the various Committees of the Council for the support and consideration which they have invariably extended to me. I am, Ladies and Gentlemen, Your obedient Servant, A. H. G. BURTON, Medical Officer of Health. TABLE OF CONTENTS. GENERAL. SECTION I.— NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. Page Statistical Summary 15 Physical Features and General Character of the District 16 Poor Relief 16 Hospital Provision 17 Population 17 Births 17 Deaths 18 Vital Statistics— Table l. 20 „ „ Table la. 22 Causes of Death—Table III. 23 SECTION II.— SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply 24 Rivers and Streams 24 Drainage and Sewerage 24 Closet Accommodation 25 Scavenging and Removal and Disposal of House Refuse 26 Sanitary Inspection of the District:— (a) Notices Served 27 (b) Complaints of Nuisances 28 (c) Schools 29 Bye-laws and Local Acts 28 SECTION III.— SUPERVISION OF FOOD. Milk Supply 29 Meat:— (a) Slaughter-houses 29 (b) Articles of Food Surrendered and Seized 30 Other Foods:— (a) Bakehouses 31 Sale of Food and Drugs Acts 31 SECTION IV.— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Disease generally 31 Table II.— Summary of Cases of Infectious Diseases Notified 34 (a) Small-pox 35 (b) Scarlet Fever 36 (c) Diphtheria 36 (d) Enteric Fever 36 (e) Cerebro-Spinal Meningitis 37 (f) Ophthalmia Neonatorum 37 (g) Acute Influenzal Pneumonia and Acute Primary Pneumonia 37 Zymotic Diseases 37 Tuberculosis 38 Venereal Diseases 41 10 Page SECTION V.— OTHER SERVICES. Bacteriological Laboratory 42 Table of Number of Specimens Examined 43 District Nursing 44 SECTION VI.— HOUSING 44 SECTION VII.— FACTORIES AND WORKSHOPS. Factories 51 Workshops 51 Table I.— Inspection of Factories, Workshops and Workplaces 52 ,, II.— Defects Found 53 ,, III.— Homework 54 ,, IV.— Registered Workshops 55 „ V.— Other Matters 55 ISOLATION HOSPITAL 58 MATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907 and 1915 69 Infantile Mortality 69 Table IV 71 Work of Health Visitors 72 Milk (Mothers and Children) Order, 1919 72 Supervision of Midwives 73 Infant Welfare Centres 73 Ante-Natal Clinics 75 Dental Clinic 75 Ophthalmic Clinic 76 Treatment of Minor Ailments 76 Maternity Home 76 SCHOOL MEDICAL SERVICE. Staff 83 Co-ordination 84 School Medical Service in Relation to Public Elementary Schools 85 School Hygiene 85 Medical Inspection 85 Findings of Medical Inspection 86 Infectious Disease 88 "Following-up" 92 Medical Treatment:— Minor Ailments 92 Ophthalmic Department 94 Dental Department 95 Open-air Education 97 Physical Training 97 Provision of Meals 99 School Baths 99 11 Page SCHOOL MEDICAL SERVICE.—(continued). Co-operation of:— Parents, Teachers, School Attendance Officers and Voluntary Bodies 100 Physically and Mentally Defective Children 101 Nursery Schools 106 Secondary and Continuation Schools 106 Employment of Children and Young Persons 106 Bye-laws under Employment of Children Act, 1903 and Education Act, 1918 106 Medical Examination of Teachers, etc. 110 General Physical Condition of School Children 110 Results of Treatment 110 Statistical Tables:— I.— Number of Children Inspected 111 II.— Return of Defects 112 III.— Numerical Return of Exceptional Children 113 IV.—A.— Minor Ailments 115 B.— Visual Defects 115 C.— Nose and Throat Defects 116 D.— Dental Defects 117 V.— Summary of Treatment of Defects 118 VI.— Summary relating to Children Medically Inspected at Routine Inspections 119 VII.— Summary of number of Children Inspected 120 VIII.—A.— Average Heights and Weights of Boys Inspected 122 B.— Average Heights and Weights of Girls Inspected 124 IX.— Summary of Infectious Disease among School Children 126 X.— Summary of Scarlet Fever among School Children 127 XI.— Summary of Diphtheria among School Children 128 XII.— Summary of Measles and German Measles among School Children 129 XIII.— Summary of Chicken Pox among School Children 130 XIV.— Summary of Whooping Cough among School Children 131 GENERAL. 15 STATISTICAL SUMMARY. Enumerated Population at Census, 1911 78,188 Registrar-General's Estimate of the Population at the middle of 1920 82,693 Area of District in Statute Acres—Land 8,470 ,, ,, ,, Inland Water 26 ,, ,, ,, Tidal Water 7 Density of Population, i.e., Number of Persons per acre (including public institutions) 10.2 1919. 1920. Total number of Births registered 1,167 1,666 Birth-rate per 1,000 14.1 20.1 Total number of Deaths registered 789 748 Death-rate per 1,000 9.9 9.0 Total number of Deaths from the seven principal Zymotic diseases 24 44 Zymotic death-rate per 1,000 .311 .53 Total number of Deaths under one year of age 71 90 Infantile Mortality rate per 1,000 births registered 61 54 1919. 1920. Rateable Value—Houses £449,305 10 0 456,785 0 0 ,, Land 7,203 10 0 6,969 10 0 £456,509 0 0 £463,754 10 0 Education Rate— Elementary 1s. 10¼d. 2s. 8¼d. Higher 1d. 2¾d. Assessable Value £439,780 1 8 6 446,884 1 0 General District Rate 5s. 6d. in the £. 9s. 7d. in the £. Poor Rate 5s. 9d. in the £. 9s. 2d. in the £. 16 Section I.— NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. 1. Physical Features and General Character of the District.— The surface is gently undulating, flatter in the southern portions, rising to a higher elevation in the 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 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 south-western 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 belongs 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. 2. Poor Relief.— The total amount expended in Ilford during the year was £4,145 10s. 1d. There is no return showing the yearly number of persons in receipt of relief. The average weekly number in receipt of relief was 344 or about 150 cases or families. The number of admissions to the Guardians' Institution from Ilford during the year was 234, made up as follows:— Men 79 Women 103 Children 52 17 3. Hospital Provision.— There is an Emergency Hospital in the district maintained by voluntary subscriptions, the number of beds being 42. During the year 1920, 491 in-patients were admitted, 351 operations performed, 350 casualties were attended to, and 216 X-ray examinations were made. The average cost per patient per week was £3 11s. 2d. There are two large Mental Hospitals in the district, the West Ham Mental Hospital accommodating 860 patients, and Claybury Mental Hospital accommodating 2,573 patients. In addition the Girls' Village Homes, one of Dr. Barnardo's Institutions, accommodates 1,400 children, and has a hospital with 66 beds and a sanatorium with 17 beds. The above institutions are in addition to the Ilford Isolation Hospital (accommodation 85 beds) and the Maternity Home (accommodation 11 beds), which are maintained by the Ilford Council. 4. Population.— Census, 1911 78,188 Registrar-General's Estimate (middle of 1920) 82,693 To obtain the estimated gross population must be added the number of inmates and resident staff at the following public institutions:— Claybury Mental Hospital 2,828 West Ham Mental Hospital 1,077 3,905 This makes a gross total population of 86,598. The total estimated number of dwelling-houses in the district at the middle of the year was 18,453; assuming that there were no empty houses this gives an average population of 4.47 persons per inhabited building. 5. Births.— The number of births registered during the year was 1,666. Legitimate Males 811 Females 803 Illegitimate Males 28 Females 24 i.e., 3.1 per cent. of the births registered were illegitimate. 18 The birth-rate, calculated on the Registrar-General's estimate of the population of 82,693, is 20.1 per 1,000, as compared with 14.1 in 1919; 12.9 in 1918; 14.4 in 1917; 17.2 in 1916; 19.1 in 1915; 18.3 in 1914; 19.15 in 1913; 19.4 in 1912; 21.4 in 1911; 22.2 in 1910. The birth-rate is therefore the highest that has been registered since 1911; it is unlikely that the present rate will be maintained, and I anticipate a considerable decline next year. 6. Deaths.— The total number of deaths registered in the district during the year was 894 Number of deaths of non-residents registered in the district (principally in large institutions) 306 These deaths occurred as follows:— In Claybury (L.C.C.) Mental Hospital 218 In West Ham Borough Mental Hospital 73 In Ilford Isolation Hospital and Sanatorium 3 In Ilford Emergency Hospital 2 Other non-residents 10 306 Included in the deaths of residents belonging to the district are 27 which occurred in Dr. Barnardo's Village Homes. To be added to the total are 160 deaths of Ilford residents registered as having died in other districts. This figure includes deaths at the following institutions:— The Infirmary, Romford 50 The London Hospital 31 Essex County Mental Hospital 16 The Children's Hospital, Gt. Ormond Street 5 St. Bartholomew's Hospital 4 Queen Mary's Hospital, West Ham 3 In other Hospitals, Institutions and residences beyond the Ilford District 51 Total 160 The total number of deaths accountable to Ilford is therefore 748. 19 The death-rate, calculated on the Registrar-General's estimate of the population of 82,693, is 9.0 per 1,000, as compared with 9.9 in 1919; 13.0 in 1918; 10.5 in 1917; 8.5 in 1916; 10.5 in 1915; 8.8 in 1914 ; 9.45 in 1913 ; 8.3 in 1912 ; 9.4 in 1911 ; 7.9 in 1910. Table I. gives a comparative statement of the estimated gross population, birth-rate and death-rate for the past five years. Table III. gives a classified statement of the causes of death in 1920, arranged according to the age groups at which death occurred. Table Ia. give's a comparison of the vital statistics of Ilford, with England and Wales, London and other Towns. Inquests: 32 inquests on Ilford residents were held during the year. 20 TABLE I. Vital Statistics of Whole District during 1920 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 Non-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 11 12 13 1915 84,581 80,350 1,511 1,538 19.1 1,091 12.9 410 165 122 79 846 10.5 1916 ‡8,897 *79,744 — 1,490 17.2 — — — — 89 60 711 8.9 †86,796 1917 ‡79,194 *75,130 — 1,176 14.4 — — — — 82 70 791 10.5 †83,749 1918 76.602 *72,825 — 1,053 12.9 — — — — 73 69 947 13.0 †81,598 1919 †84,216 *79,524 1,151 1,167 14.1 1,029 12.2 416 176 71 61 789 9.9 †82,840 1920 86,598 82,693 1,666 1,666 20.1 894 10.3 306 160 90 54 748 9.0 *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 Claybury and West Ham Mental Hospitals. The Register-General's estimate for the purpose of both Birth and Death Rates. 21 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 column 8 and the addition of the number in column 9. Deaths in column 10 are similarly corrected by the subtraction of the deaths 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. (a) The nett estimated population is found by deducting the population of Claybury and West Ham Asylums from the gross estimated population. The population of Dr. Barnardo's Girls' Village Homes is included in the nett estimated population of the district. (b) The nett number of births is obtained by taking the uncorrrected number of births supplied by the local Registrar and adding to or substracting from it such a number as is supplied for this purpose by the RegistrarGeneral. (c) The birth-rate is calculated on the estimated nett population 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 that 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 in certain instances under (3) (b) below. There is stated in column 8 the number of transferable deaths 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 Institution had no fixed residence at the time of admission, the death is transferable. If the patient has been directly transferred from one such Institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2) The deaths of infants 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 are to be referred (a) to the district of residence under the general rule; (b) 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. 22 TABLE IA. Table showing comparison between the Birth-rate, Death-rate, &c. of Ilford and other Towns, and England and Wales for the Year 1920. Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whoopingcough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 Years). Total Deaths under One Year. England and Wales 25.4 12.4 0.1 0.00 0.19 0.04 0.11 0.15 0.28 0.48 8.3 80 96 Great Towns, including London (Census Populations exceeding 50,000) 26.2 12.5 0.01 0.00 0.22 0.04 0.14 0.16 0.31 0.43 10.4 85 148 Smaller Towns (Census Populations'20,000—50,000) 24.9 11.3 0.02 0.00 0.19 0.03 0.10 014 0.27 0.38 7.8 80 London 26.5 12.4 0.01 0.00 0.22 0.05 0.17 0'22 0.30 0.47 9.5 75 ILFORD (Estimated Population, 82,693) 20.1 9.0 0.01 0.00 0.1l 0.03 0.15 015 0.33 0.20 2.4 54 23 TABLE III. Causes of, and Ages at Death during the Year 1920. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths, whether of "Residents" or "Non-Residents" in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. 1 Enteric fever 1 - - - - - 1 - - - 2 Small-pox - - - - - - - - - — 3 Measles 10 - 5 3 2 — — — — 1 4 Scarlet fever 3 - — 1 1 1 — — — 2 5 Whooping cough 13 3 6 4 - - - - - 8 6 Diphtheria and croup 13 — 1 2 10 — — — — 10 7 Influenza 28 — — 1 2 6 4 9 6 35 8 Erysipelas 3 — — — — — — — 3 — 9 Pulmonary tuberculosis 42 — — — 1 11 23 7 — 59 10 Tuberculous meningitis 5 2 — — — 2 1 — — 2 11 Other tuberculous diseases 11 — 3 — — 1 2 4 1 5 12 Cancer, malignant disease 86 — — 2 2 — 7 42 33 8 13 Rheumatic fever 4 — — — — 1 1 2 — — 14 Meningitis 6 2 — 1 3 — — — — 3 15 Organic heart disease 72 — — — — 2 10 25 35 14 16 Bronchitis 49 6 3 1 1 — — 11 27 4 17 Pneumonia (all forms) 47 10 3 1 8 2 9 10 4 33 18 Other respiratory diseases 14 — — 1 — — 2 5 6 1 19 Diarrhoea, &c. (under 2 years) 4 3 1 - - - - - - — 20 Appendicitis and typhilitis 2 — — — — 1 1 — — 1 21 Cirrhosis of liver 5 - - - - - 1 2 2 2 21a Alcoholism — — — - — — — — — — 22 Nephritis & Bright's disease 15 — — - — 2 1 4 8 9 23 Puerperal fever 2 — — - — 1 1 — — — 24 Parturition, apart from puerperal fever 3 - - - - 1 2 - - - 25 Congenital debility, &c. 37 37 — - — — — — — — 26 Violence, apart from suicide 19 — 1 2 3 — 4 2 7 4 27 Suicide 7 — — — — 1 — 3 3 2 28 Other defined diseases 247 27 1 2 3 1 23 51 139 178 29 Causes ill-defined or unknown - - - - - - - - - - Totals 748 90 24 21 36 33 93 177 274 381 Special causes (included above): Cerebro spinal meningitis 2 - — 1 — — — 1 — 2 Poliomyelitis - - - - - - - - - - Dysentery - - - - - - - - - 7 Encephalitis Lethargica 2 - - - - - 1 1 — 1 24 SECTION II.—SANITARY CIRCUMSTANCES OF THE DISTRICT. 1. Water Supply.—The district is divided by the Cranbrook Road into two areas . The portion north and west of this road is supplied by 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. 2. Rivers and Streams.—The River Roding rises in The Roothings, towards the centre of Essex, and is a tributary of the Thames; it forms the western boundary of Ilford. The River Rodiing As fcidal to a (point where the old bridle path crossed the Golf Links. It is only navigable up to the bridge, at the High Road. The Seven Kings Water is a brook, which rises at Chigwell, runs through the centre of the district, and supplies the lakes in Seven Kings Park, South Park, and Barking Recreation Ground, and eventually finds its way to the Roding. Cran Brook feeds the Valentines Lake and rises in the neighbourhood of Tomswood Hill. Mayes Brook runs through the Chadwell portion o'f the district, feeds the lake in Goodmayes Recreation Ground and eventually finds its wav to the Thames. Some difficulty has been experienced during the year in regard to the lakes in both South and Valentines Parks, analyses of the water having shown that they were unfit for bathing purposes, and it has been necessary to suspend bathing. The lake in Valentines Park has a capacity of 7,617,578 gallons; the two lakes in South Park a combined capacity of 3,630,243 gallons. 3. Drainage and Sewerage.—The Council have carried out extensive works of sewerage and main drainage. The Sewage Outfall Works comprise 18| acres of land, on which are laid down:— Screens 2 Detritus Tanks (covered). 5 Septic Tanks (covered) equal 2,500,000 gals. 2 Clinker Filters. 13 Single Contact Beds, each i acre area. 3 Storm Water Filters, 2i acres in total area. Discharging effluent into Thames. 25 The Ilford district has four levels of sewers, the first being by gravitation, which covers an area of 6,571 acres ; (the second, that known as the "Roding Valley," whicih takes the sewage from the Cranbrook and Loxford Wards (area 844 acres), is raised from the low level at the Pumping Station adjoining the Baths (into the high level or gravitation system) by means of four centrifugal pumps, two 5in. and two Oin., connected to motors, the power used being electricity (with two gas engines in case of the failure of electricity). At the Outfall Works a further Pumping Station has been erected, comprising two semi-loco boilers and four centrifugal pumps, two lOin. and two Sin. The sewage from the part of the district east of Green Lane and south of the Great Eastern Railway is connected to the Pumping Station by two large receiving culverts. The northern portion of this area, 400 acres in extent, known as the mid-level, is connected to the Sin. pumps; the southern portion, known as the low level, having an area of 688 acres, is connected to the lOin. pumps; and the whole of the sewage is brought together at the entrance to the screening chamber. For dealing with the sludge two Shones' ejectors have been provided. The sewage of the town is dealt with on what is known as the partial system, there being taken into the soil sewer all the sewage and rain water from the back roofs and yards. The surface water system conveys the roof water from the front roofs of all property and the water from the streets and roads. No extension has been made to the Outfall Works during the past year. Owing to the City of London building scheme it has been found necessary to make an extension of the sewer through Valentines Park to meet the additional requirements. 4. Closet Accommodation.—In addition to the water carriage system of sewerage, there are in the rural area 83 privies and 56 pail closets. The cleansing of cesspools, privies and pail 26 closets is carried out by the Council. A vacuum emptier has been purchased for this purpose. 5. Scavenging, Collection of House Refuse.—The collection of house refuse is carried out weekly by means of six electric vans, supplemented by horse-drawn vans, one electric van being first used in July, 1920. The Council have built a modern Refuse Destructor in Suffolk Road, Seven Kings. The Destructor was provided in 1914 and consists of two units of three cells each, with their combustion chamber and Babcocks and Willcocks boilers. The Destructor is an improved type made by Messrs. Heenan and Froude, and generates a temperature of 1,500 to 2,200 degrees Fahr. The refuse is deposited into bins direct from the vans. These bins are brought directly over the charging doors of the cells by means of electric cranes. The charging doors are operated by an electric motor, so that the refuse is not handled by the men except that portion which drops when the door of the van is removed previous to the discharge of the load into the bin. The clinker is removed from the cells by means of a draw bar, so that manual labour has been reduced as far as possible. At the rear of the plant house a dust catcher has been erected so that no nuisance can arise from this source. The following figures give information as to the collection of house refuse during the year 1920:— Number of days on which collection was made 308 Number of vehicles employed 5,241 (Horse-drawn vehicles 5,027, electric vehicles 214.) Average number of vehicles employed per day 17.07 (Horse-drawn vehicles 16.37, electric vehicles 1.38.) Total number of loads collected 10,486 (Horses 10,008, electric vans 478.) Average number of loads collected per day 34.04 Average loads collected per day:— Horse-drawn vehicles 1.99 Electric vehicles 2.23 Average of both 2.00 Total weight of refuse collected 12,451 tons 27 Average weight per load:— Horse-drawn vehicles 1 ton 2 cwts. 3 qrs. Electric vehicles 2 tons 4 cwts. 2.4 qrs. Average of both 1 ton 3 owts. 2.03 qrs. Average cost of collection per ton:— £ s. d. Horse-drawn vehicles 0 17 11.04 Electric vehicles 0 18 0.8 Average of both 0 17 11.5 Average cost of collection per load:— Horse-drawn vehicles 105 Electric vehicles 2 0 3.7 Average of both 1 1 3.9 6. Sanitary Inspection of the District.—The followingis a summary of the work of the Sanitary Inspectors during the year:— Houses and premises inspected 3,291 Houses and premises re-inspected (works in progress) 6,022 Visits during disinfection 1,258 Houses in which nuisauces were detected 694 Houses in which nuisances were abated 494 Notices served 1,044 Notices complied with 890 Premises disinfected 572 Articles disinfected 4,039 Notices Served. Served 1920. Complied with. Statutory 53 51 Pave Yard (Ilford Improvement Act) 6 2 Informal 486 330 Provide Dustbin (Ilford Improvement Act) 238 131 Cleanse Water Storage Cistern (Bye-laws) 160 129 Cover ditto 15 14 Provide Water to Dwelling House 17 15 Cleanse Dwelling House (Infectious Diseases (Prevention) Act, 1890) 65 62 Housing and Town Planning Act, 1909 4 156 Totals 1,044 890 28 Complaints of Nuisances. During the year 382 complaints have been received and investigated. The following is a summary:— Accumulation of manure and refuse 14 Animals improperly kept 16 Bad smells 12 Cesspools full and overflowing 1 Dampness of premises 12 Defective drains, w.c's and fittings 76 Defective or no provision of dustbin 38 Defective roofs, gutters, downpipes, etc. 43 Defective water fittings 38 Dirty and verminous houses 28 Dirty condition of rearway 1 Flooding of premises 2 Overcrowding 7 Smoke nuisances 8 Miscellaneous 86 Total 382 BYELAWS AND LOCAL ACTS. Byelaws exist for— (1) Prevention of Nuisances. (2) Cleansing of footways and pavements, and cleansing of earth closets, privies, ashpits and cesspools. (3) Dealing with common lodging houses and houses let in lodgings. (4) Slaughter-houses. (5) Offensive trades:— (a) Bone boilers. (b) Fellmongers. (c) Leather dressers. (d) Soap boilers. (e) Tanners. (f) Tallow melters. (g) Fat melter or fat extractors. (h) Glne makers. (i) Tripe boilers. (j) Size makers. (k) Gut scrapers. (6) For securing the cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (7) Nuisances in connection with the removal of offensive or noxious matter. 29 Application has been made to the Ministry of Health during the year for the approval of other byelaws dealing with— (1) Fish frying. (2) Dealers in rags and bones. There are two local Acts in operation—(1) The Ilford Improvement Act, 1898, which has important sanitary provisions, and (2) Ilford Urban District Council Act, 1904, which had a section dealing with the control of Tuberculosis, now over-ruled by the Milk and Dairies Act, also a section dealing with infectious disease, the enactments of which are similar to the Acts of 1907, Sections 62 and 63 only of Part IV. of the Public Health Act, 1907, having been adopted. During the year the special attention of the Council was directed to the conditions under which ice-cream was being manufactured. Section 28 of the Ilford Act, 1901, was therefore republished in the local press to direct the attention of vendors to the matter. In addition, 65 premises where ice-cream was known to be made were visited by the Inspectors, and a copy of Section 28 of the Ilford Act, 1901, left with the vendor of ice-cream. 7. Schools.—Full particulars of action taken in preventing the spread of infectious disease will be found in the School Medical Officer's portion of the Report (page 88). SECTION III.—SUPERVISION OF FOOD SUPPLY. 1. Milk Supply.—There were in the Ilford district at the end of the year 18 dairies and milkshops, and II cowsheds on the register. 118 inspections of dairies, milkshops and cowsheds were carried out during the year. 2. Meat.— (a) SlaughterhousesThere are two licensed slaughterhouses in the district. 67 inspections were carried out during the year. As a result of visits paid to slaughterhouses the following meat was found to be affected with tuberculosis and was subsequently destroyed:— 30 1 forequarter of beef. 1 ox head. 6 sets of lungs. 1 ox liver (14 lbs.). 2 lots of skirt. Caul and mesentery fat (178 lbs.). 1 sheep's oaul fat. The following table gives particulars of the slaughterhouses in the Ilford district:— In 1914. In January, 1920. In December, 1920. Registered — — — Licensed 3 2 2 Totals 3 2 2 (b) Articles of Food Surrendered and Seised.—During the year the following articles of food were surrendered and condemned as being unfit for the food of man:— 1 hindquarter of beef (152 57 tins corned beef (330£ lbs.). lbs). 2 tins tongue (12 lbs.). 1 portion of hindquarter of 5 tins pork and beans. beef (49 lbs.). 3 bags of periwinkles. 1 forequarter of beef. 3 lots of bacon (24 lbs. 1 oz.). 6 sets of lungs. 1 ibox salted herrings. 6 sets of lungs. 3 box fresh herrings. 1 top piece of rump of beef 1 box of megrums. (148 lbs.). 4 boxes cods' roe. 2 lots chilled beef (150 lbs.). 1 box codling. 2 ox livers (26 lbs.). 1 box tunbot. 2 pieces of skirt. 2 boxes soles. 1 lot of oaul and mesentery 1 box and 1 barrel of monk fat (178 lbs.). (rock salmon). 1 sheep's caul fat. 1 tin salmon. 7 carcases of sheep (315J 2 tins herrings, lbs.). 1 case Iceland dabs. Portions of other carcases 62 boxes dried apricots. (128 lbs.). 1 box apples. 1 leg of lamb. 454 tins condensed milk. The following articles of food were seized and condemned:— (a) 6 chickens. (b) 15 shoulders mutton, 3 double legs of mutton, and one aitchbone of beef. On legal proceedings being instituted the following were the results of the prosecutions:— (a) Defendant committed to prison for one .month, having been convicted on three previous occasions. (b) Defendant and assistant fined £20 and £5 respectively. 31 3. Other Foods.— Bakehouses.—There are 27 bakehouses in the district, including 7 factory bakehouses. There is 1 underground bakehouse. 68 inspections of bakehouses were carried out during the year. 4. Sale of 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 128 Samples of butter taken 24 Other articles 70 222 Proceedings were taken in 11 cases, fines being inflicted in 9 cases as follows:— Vinegar 9s. costs. Milk £2 costs. Milk £2 fine. Milk £2 fine. Milk £5 fine. Milk £2 fine and 5s. costs. Milk £10 fine. Milk £10 fine. Margarine £2 fine. In the remaining two cases, milk vendors pleaded, and substantiated, warranties. Cautions were issued in several other instances. SECTION IV.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. 1. Infectious Disease Generally.—During 1920, 953 cases were notified as compared with 1,770 in 1919. The figures for 1919 include 930 cases of Measles and German Measles. Neither of these diseases were notifiable during 1920, therefore the comparison should be—953 cases during 1920 and 840 during 1919. The following diseases are now notifiable to the Medical Officer of Health:— 32 Small-pox. Cerebro-Spinal Fever. Cholera. Plague. Diphtheria. Ophthalmia Neonatorum. Membranous Croup. Tuberculosis. Erysipelas. Acute Influenzal Pneumonia. Scarlatina or Acute Primary Pneumonia. Scarlet Fever. Dysentery (including amoebic Typhus Fever. and bacillary dysentery). Typhoid Fever. Malaria, Enteric Fever. Trench Fever. Relapsing Fever. Acute Poliomyelitis. Continued Fever. Acute Polio-encephalitis. Puerperal Fever. Acute Encephalitis Lethargica. Table II. shows the number of cases of infectious disease notified during 1920, arranged according to age and distributed in wards. Of these, 262 occurred in institutions as follows :— Claybury Mental Hospital:— Enteric Fever 3 cases. Pneumonia 26 ,, Dysentery 41 ,, Pulmonary Tuberculosis 8 ,, 78 „ West Ham Mental Hospital:— Dysentery 18 cases. Dr. Barnardo's Village Homes:— Scarlet Fever 62 cases. Diphtheria 81 „ Pneumonia 3 ,, Erysipelas 4 ,, Pulmonary Tuberculosis 6 ,, Tuberculosis—other forms 10 ,, 166 ,, Of the cases notified, exclusive of those from Public Institutions, the following table shows the percentage removed to the Isolation Hospitals:— Small-pox 100.0 Diphtheria and Membranous Croup 90.2 Scarlet Fever 89.3 Enteric Fever Nil. Erysipelas Nil. Puerperal Fever 20.0 Ophthalmia Neonatorum Nil. Pneumonia 6.6 Cerebro-Spinal Fever 100.0 Encephalitis Lethargica Nil. 33 The total number of deaths from infectious diseases belonging to the district during 1920 is 183, classified as follows — Scarlet Fever 3 Diphtheria and Croup 13 Enteric Fever 1 Influenza 28 Pneumonia (all forms) 47 Puerperal Fever 2 Cerebro-Spinal Fever 2 Encephalitis Lethargica 2 Erysipelas 3 Pulmonary Tuberculosis 43 Tubercular Meningitis 5 Other Tuberculous Diseases 11 Measles 10 Whooping Cough 13 34 TABLE II.—Cases of Infectious Disease Notified during the Year 1920. 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 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Cranbrook Park Seven Kings North Hainault Loxford Clemen tswood South Hainault Small Pox 1 - — — — 1 — - — 1 — — — — — 1 Scarlet Fever 314 2 39 223 36 12 2 - 21 29 41 74 34 71 44 225 Diphtheria, including Membranous Croup 286 1 32 207 29 13 4 - 17 29 32 91 29 40 48 185 Enteric Fever (Typhoid and Para Typhoid) 5 — - 1 1 3 — - 2 — — 3 — — — — Pneumonia 89 1 4 7 15 27 27 8 5 6 8 35 10 14 11 4 Puerperal Fever 5 — — — 2 3 — — 1 1 1 — 1 — 1 3 Cerebro-Spinal Fever 3 — 1 — — 1 1 — — — — — — 1 2 3 Encephalitis Lethargica 2 — — — — 1 1 — — 1 l — — — — — Trench Fever 1 — — — — 1 — — — — — — 1 — — — Dysentery 60 — — 1 3 20 27 9 — — l 41 — — 18 — Ophthalmia Neonatorum 10 10 — — — — — — 2 1 l — 4 1 1 — Erysipelas 40 — 3 3 5 13 8 8 2 5 2 7 10 9 5 — Tuberculosis—Pulmonary 101 - - 7 26 43 22 3 7 12 13 29 12 21 7 — Other Forms 31 1 4 9 8 5 3 1 - 5 2 14 3 4 3 - Malaria—Believed to be contracted in this country - - - - - - - - - - — - - — - - Believed to be contracted abroad 5 — — — 3 2 — — — — — — 3 1 1 — Totals 98 15 83 458 128 145 95 29 57 90 102 294 107 162 141 421 35 The following table shows a comparison of the incidence of the chief infectious diseases with 1919:— No. of Oases. 1920. 1919. Scarlet Fever 314 231 Diphtheria 286 260 Enteric Fever 5 14 Small-pox 1 1 Pneumonia 89 46 It will be seen that there is still a high incidence of Scarlet Fever and Diphtheria in the district, as has been experienced in the London area generally. This may be attributed largely to the present difficulties as regards housing and transport, and is unlikely to be rectified until these two conditions have been improved. (a) Small-pox.—One case was notified on 20th February and removed to the Orsett Small-pox Hospital. The patient was an Army officer on sick leave in Ilford from a military hospital, and he suffered from a semi-confluent type of the disease, having never been vaccinated. Some delay occurred before I was called in consultation over the patient, but fortunately no further cases arose and the man made an excellent recovery. Nine direct contacts and five secondary contacts were kept under observation, five contacts were vaccinated by the Medical Officer of Health and six by private practitioners. 1 am informed by the Clerk to the Guardians that during 1920, 780 primary vaccinations in Ilford were performed. The number of births registered being 1,666, gives the proportion of infants vaccinated as 4(68 per 1,000. The difficulty of control of Small-pox when it breaks out in epidemic proportions has been well illustrated in parts of Scotland and to a less extent in England during the past year, and most Medical Officers of Health view with concern the disposition of persons at the present day to dispense with the safeguard of vaccination. Small-pox Hospital Accommodation. — An agreement was made in July, 1911, by which the West Ham Council was to admit at their Hospital at Dagenham, patients from Ilford suffering from Small-pox. This agreement was terminated by the 36 West Ham Council on 29th September, 1919, by notice duly given to this Authority. The Essex County Council proposed in 1918 to apply for an order under Section 2 of the Public Health Act, 1913, empowering it to execute regulations under Section 130 of the Public Health Act, 1875, with a view to the treatment of persons affected with Small-pox in certain scheduled districts, of which Ilford was one. The application is still under consideration by the Ministry of Health. In October, 1919, the Essex County Council made arrangements for sporadic cases of Smallpox to be sent to the Orsett Joint Hospital, negotiations being made with the West Ham Council to admit cases, in the event of an epidemic, into their Hospital at Dagenham. In March, 1920, the Ministry of Health notified the Council that sporadic cases from South-West Essex could be admitted into the Metropolitan Asylums Board Hospitals. I understand that negotiations are still proceeding between the Essex County Council, the West Ham Council, and the Orsett Joint Hospital Board on this matter. (b) Scarlet Fever.—311 cases of this disease (6'2 of which were in institutions) were notified in 1920, as compared with 231 in 1919. The disease continued to show a high incidence during the spring of 1920 and again in the autumn and winter. Three deaths only occurred, one of which was in the Ilford Isolation Hospital. The disease therefore continues to be of a mild type. (c) Diphtheria.—286 cases were notified in 1920, as compared with 260 in 1919. Of the 286 cases, 81 occurred in institutions, giving a total of 205 actually from the district. The disease was on the whole of a severe type. Further reference will be found in the report of the Isolation Hospital and of the School Medical Service. (d) Enteric Fever.—Five cases only were notified in 1920, as compared with 14 cases in 1919. Of the five cases, three occurred at C'laybury Mental Hospital. The remaining two cases were in the Cranbrook Ward. Both of them had apparently contracted the disease at a holiday resort. 37 (e) Cerebro-Spinal Meningitis.—Three cases were notified. Two were fatal, in spite of serum treatment. A third made a complete recovery. The origin in two of the cases was obscure; in the third I found that two of his family had previously died of the disease, and it is possible that the man himself had been a "carrier" who had infected two of his family and finally had developed the complaint himself. (f) Ophthalmia Neonatorum.—Ten cases were notified in 1920 compared with nine in 1919. Eight of the cases recovered without any permanent injury to vision. In two cases the children were left with serious impairment of vision in one eye owing to corneal opacities. (g) Acute Influenzal and Acute Primary Pneumonia.—89cases of Pneumonia (of which 29 occurred in Institutions) were notified during the year, compared with 46 in 1919. The following table shows the number of deaths from Influenza and Pneumonia of Ilford residents during the past three years:— Deaths. 1920. Deaths. 1919. Deaths. 1918. Influenza 28 64 249 Pneumonia 47 34 55 2. Zymotic Diseases.—The deaths registered were as follows:— Small-pox — Measles 10 Scarlet Fever 3 Whooping Cough 13 Diphtheria and Croup 13 Enteric Fever 1 Diarrhoea 4 44 This gives a Zymotic death-rate for 1920 of .53. per 1,000 of the population. The Zymotic death-rate for the previous five years was as under:—.31 in 1919; .42 in 1918; .93 in 1917; .45 in 1916; .82 in 1915. 38 3. Tuberculosis.- During the year 1920 there were 101 fresh notifications of Pulmonary Tuberculosis and 31 of other forms of Tuberculosis. The following table shows the cases notified during 1920, classified according to age and sex:- 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. - - 2 11 9 12 14 2 2 52 F - - 5 15 13 9 4 2 1 49 Tuberculosis (all other forms) M - 2 2 3 1 1 1 - 1 11 F. 1 2 7 5 3 - - 2 - 20 Totals 1 4 16 34 26 22 19 6 4 132 Of the above the following were notified from Institutions in the district:— Claybury Mental Hospital—Pulmonary Tuberculosis 8 Ur. Barnardo's Village Homes—Pulmonary Tuberculosis 6 Tuberculosis (all other forms) 10 During the year 1920 the following deaths occurred from Tuberculosis:— Pulmonary Tuberculosis for district proper (including 5 in Barnardo's Homes) 43 Claybury Mental Hospital 34 West Ham Mental Hospital 17 Ilford Isolation Hospital and Sanatorium 0 Tubercular Meningitis for district proper (including 1 in Barnardo's Homes and 1 in Emergency Hospital) 5 Tuberculosis (all other forms) for district proper 11 Claybury Mental Hospital 4 West Ham Mental Hospital 1 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 ten years:— 39  1911 1912 1913 1914 1915 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 49 .61 43 .55 51 .60 55 .90 74 .92 Tubercular Meningitis 8 .10 12 .15 15 .18 6 .07 15 .18 Tuberculosis (all other forms) 13 .16 13 .16 7 .08 8 .09 12 .14 1916 1917 1918 1919 1920 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 64 .80 79 1.05 82 1.12 57 .71 42 .50 Tubercular Meningitis 9 .10 7 .09 7 .09 11 .13 5 .06 Tuberculosis (all other forms) 10 .12 12 .15 10 .10 16 .20 11 .13 It is satisfactory to note that the influences of the war and of the Influenza epidemics having been removed, the Tuberculosis death-rate has now fallen below the low rate of 1912. The precise influence of the Influenza epidemics on the Tuberculosis population is difficult to define. No doubt a large number of persons suffering from Pulmonary Tuberculosis, being particularly susceptible to Influenza, succumbed to that disease. This will lower the Tuberculosis death-rate for some years to come. On the other hand, a number of persons were made susceptible to Tuberculosis, and have in fact acquired it after attacks of Influenza with respiratory complications. This factor, together with the present housing and transport difficulties and the high cost of living, may be expected to add to the Tuberculosis population. During 1920 a careful enquiry was made by the Sanitary Inspectors into all cases of Tuberculosis that had been notified to this department since 1912. 40 On January 1st. 1920, there were 1,005 cases on the register of the department. Of these, 277 were fatal in or prior to 1920, 321 had left the district, 112 were said to be cured. On December 31st, with the 132 fresh cases notified, there were 561 cases, the circumstances of which had been investigated. The treatment of Tuberculosis is under the control of the Essex County Council. There is a Tuberculosis Dispensary in Ilford, which is attended on two afternoons a week by the Tuberculosis Officer. For some months during 1920 these duties were carried out by the Medical Officer of Health. On December 31st, 1920, there were 275 patients on the register of the Dispensary. A great improvement in the treatment of Tuberculosis has been made during the past year by the institution of dental treatment for Tuberculosis cases. The progress of a case of Phthisis is much hampered by septic teeth, and the removal of these frequently causes pyrexia to subside and the patient's condition to improve. The provision of suitable dentures causes a rapid improvement in his nutrition. In Ilford the Essex County Council has arranged with the Ilford Council to provide dental treatment for these cases from Ilford, Romford, and Harold Court Sanatorium. During 1920 a total of 51 Tuberculosis patients was treated by the Ilford Council Dentist. In June, 1920, following a public conference held at the Ilford Town Hall, a voluntary committee was formed, known as the Ilford Tuberculosis Care Association, to deal with Tuberculosis cases requiring financial assistance. The Committee has not been in existence for a sufficient length of time for me to report fully on its work. I fear, however, that the financial problems connected with the Tuberculosis patient and his dependants are far too great to be adequately dealt with by any voluntary organisation. 4) 4. Venereal Diseases.— The incidence of Venereal Disease in Ilford is difficult to determine. Deaths usually occur from their sequelae and are notified under such headings. In the following table are classified the deaths notified as due to (1) Syphilis; (2) Locomotor Ataxy and General Paralysis of the Insane, which are certainly due to Syphilis; and (3) Aortic Aneurysm, which is very frequently caused by this disease. Ages 0-1 15 5 15 15-25 25-85 35-45 45-55 55-65 65-75 75 85 85 up NonResidents in Institutions. Totals Syphilis 4 - - - - - - - - - - 5 9 Locomotor Ataxy - - - - - 1 - 1 - - - 1 3 General Paralysis of Insane - — — — — 1 1 — — — — 62 64 Aortic Aneurysm - - - - - - - - 1 - - 1 2 The deaths of non-residents in Institutions occurred chiefly at Claylbury Mental Hospital and West Ham Mental Hospital, 25 per cent. of the registered causes of death in these Institutions fell under the above headings. Many other patients, of course, died from incidental causes, the reason, however, for their admission to the Mental Hospital was some venereal infection. As regards Gonorrhoea, the prevalence of Ophthalmia Neonatorum remains at a low figure in Ilford. The following figures show the number of cases notified since notification of this disease was first enforced in 1914:— 1914, 8 cases; 1915, 6 cases; 1916, 6 cases; 1917, 5 cases; 1918, 9 cases; 1919, 9 cases; 1920, 10 cases. The diagnosis and treatment of Venereal Disease is by the Public Health (Venereal Disease) Regulations, 1916, under the control of the Essex County Council. Arrangements have been made with the various London Hospitals for the free treatment of patients, and with the London Hospital for the free examination of bacteriological specimens submitted by doctors in the district. 42 A local Propaganda Committee, formed on voluntary lines, but supported by small grants from the Essex County Council and the Ilford Council, has been active in spreading public knowledge on the subject. In February, 1920, the Committee arranged for the film "The End of the Road" to be shown at the Ilford Hippodrome, and a very large and representative audience attended. Such work requires to be tactfully and delicately carried out if any good is to result, and the Committee in Ilford is to be congratulated on the way in which it has so far performed its duties. SECTION V.— OTHER SERVICES. 1. Bacteriological Laboratory.—The Essex County Council now provides free bacteriological examinations for most specimens at their laboratory in London. The Ilford Council, however, decided to continue offering the same facilities for local examinations of such urgent specimens as diphtheria swalbs as previously. The accompanying table shows how much these facilities are appreciated, a considerable amount of delay being saved by this means. Specimens for diagnosis of Venereal Disease are examined at the London Hospital; for Tuberculosis at the Essex County Laboratory. 43 BACTERIOLOGICAL LABORATORY. Nature of Specimen. Disease Suspected. Sent by Local 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 196 828 15 125 2 45 90 392 303 1390 Nose Swabs Diphtheria 11 41 9 26 — 3 26 54 46 124 Ear Swabs Diphtheria 151 211 — - — 2 - - 151 213 Films Diphtheria — 2 — - - - - 1 - 3 Hairs Ringworm 1 4 3 - 20 10 - - 24 14 Films Gonorrhœa 1 — 2 - - - - - 3 - Films Anthrax — 1 - — — - - - - 1 Intra-uterine Swab Septicaemia — 1 - - - - - - - 1 Urine Tuberculosis — 2 — 1 — - - - - 3 Urine Gonorrhœa — — 2 2 — - - - 2 2 Films Ophthalmia — — 4 3 — - - - 4 3 Films from Teats (Cow) Streptococci — — - 2 — - - - - 2 Cerebro-Spinal Fluid Cerebro-Spinal Meningitis — — - — — - 3 2 3 2 Sputum Tuberculosis - - - - - - - 2 - 2 Totals 360 1090 35 159 22 60 119 451 538 1760 Total 2,296. 44 2. District Nursing.— The Council has had under consideration during the past year the great deficiency which existed in the provision of home nursing in Ilford. This became acute during the Influenza epidemic, but is sufficiently marked in ordinary times. Efforts were first made to obtain the assistance of the Essex County Nursing Association to form a branch in Ilford. These, however, failed owing to the demand which existed for Nurses in the rural districts in Essex. A conference was therefore held in the Town Hall in October, 1920, to consider the whole question. A provisional committee was set up, and after various enquiries approached the Governors of the EmergencyHospital, who have powers to institute a home-nursing service under their articles of association. The Governors received the suggestion with enthusiasm, and I hope in my next Annual Report to be able to state that a satisfactory commencement has been made with a staff of Nurses. SECTION VI.— HOUSING. There is still a considerable pressure on the housing accommodation in the district. In a report presented to the Housing Committee in September, 1919, the Medical Officer of Health and Surveyor estimated that the Council should provide at least 600 houses to meet local demands. The scarcity of houses has resulted in many houses in the district accommodating at the present time two or three families each, in which in pre-war days only one family was to be found. A few families who had been evicted from their dwellings and had no other house to enter, have been admitted to the Valentines Mansion during the year. The general standard of housing in the district is good and the defects found are chiefly due to lack of repairs being carried out during the war period. A large proportion of the houses have been built in modern times. There are only 10 back-to-back houses. 45 Full particulars of the houses dealt with under the Public Health Acts during 1920 will be found in the table appended. YEAR ENDED 31st DECEMBER, 1920. 1. General. (1) Estimated population 82,693 (2) General death-rate 9.0 (3) Death-rate from Tuberculosis .7 (4) Infantile mortality 54 (5) Number of dwelling houses of all classes 18,550 (6) Number of working-class dwelling bouses 16,624 (7) Number of new working class bouses erected 119 2. Unfit Dwelling Houses. 1. Inspection:— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 63 (2) Number of dwelling houses which were spected and recorded under the Housing (Inspection of District) Regulations, 1910 4 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (This house was afterwards placed in a habitable state of repair). (4) Number of dwelling houses (exclusive of those ferred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 4 2. Remedy of defects without service of formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority of their officers 8 3. Action under Statutory Powers:— (a) Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 4 (2) Number of dwelling houses which were rendered fit:— (a) By owners 156 (b) By Local Authority in default of owners — (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (B) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 44 46 (2) Number of dwelling houses in which defects were remedied:— (а) By owners 22 (б) By Local Authority in default of owners — (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909:— (1) Number of representations made with a view to the making of Closing Orders — (2) Number of dwelling houses in respect of which Closing Orders were made — (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit — (4) Number of dwelling houses in respect of which Demolition Orders were made — (5) Number of dwelling houses demolished in pursuance of Demolition Orders — 3. Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., or (b), Part II., of the Act of 1890:— (1) Name of area — (2) Acreage — (3) Number of working-class houses in area — (4) Number of working-class persons to be displaced — 4. Number of houses not complying with the building byelaws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, etc., Act, 1919 — Schemes for the erection of houses are in process of completion by (1) the Ilford Council, (2) the City of London Corporation, and (3) the London County Council. The Ilford Council are carrying out four Housing Schemes, viz., at Tomswood Hill, Horns Road, Ley Street and Chadwell Heath, on all of which building is making very satisfactory progress, and comprises a total of about 356 houses. At Tomswood Hill the site occupies a triangular piece of land at the junction of Tomswood Hill and Fencepiece Road. The lay-out is for 86 houses, 28 of which are being built on either side of a new road which the Council have made by "direct labour" at the northern end of the site; 47 the remainder face Tomswood Hill and Fencepiece Road respectively. There are two types of houses on this scheme: "A" type, with living room, scullery and three bedrooms; and "B" type, with living room, parlour, scullery and three bedrooms. Of the former there are 44, the latter making up the balance. All the houses are provided with bath rooms and one water closet, and in the majority of cases the latter are detached from the bath rooms. The "A" type houses have the water closet outside, opening off a porch, while in the "B" type they are all placed on the first floor. In the "B" type semi-detached houses the staircase and first floor landings are provided with windows for light and ventilation, but in the terrace houses of this type and all "A" type houses, light and ventilation to stairs and landings are obtained by means of skylights with opening gearCareful consideration has also been given to the position of larders; in most cases they are placed on the north or east side of the house, but in two cases this was found to be impossible, and other means were adopted to prevent the penetration of the sun's rays. Two blocks, one of 2, and one of have been built of concrete blocks and the roofs covered with tiles, while all the other houses have brick walls, roughcast outside, and the roofs slated. 1 he direct labour and concrete houses have wooden casements, but all the others have steel. In the cenltre of the scheme is a small open space for recreation of about half an acre in extent, to which most of the houses have access through back gates. The drainage generally is being carried out by two distinct systems for the soil and rain water, made to discharge into the existing sewers at Tomswood Hill and Fencepiece Road. Ample manholes are being dispersed throughout the soil drainage to enable the quick removal of any stoppage which may occur, and all soil pipes are carried up above eaves for ventilation. The Horns Road Scheme is being carried out on a site 24.537 acres, bounded on the west by Horns Road, opposite to Dr. Barnardo's Girls' Homes, and extends in an easterly direction to the Great Eastern Railway at Barkingside Station, The ultimate 48 lay-out is for 246 houses, but the contract now being executed only covers 100. Two roads with new sewers have had to be formed and were carried out under contract. The houses are all of the "B" type. The general description of drainage will follow Tomswood' Hill, the houses on Horns Road being connected up to existing sewers in that road, but all houses on new roads will be connected up to new sewers in the roads, ultimately discharging into existing sewer in Horns Road. In Ley Street a scheme for 60 houses is being carried out on a rectangular piece of ground of 5.012 acres at the junction of Ley Street with Wards Road West. A new road will be made to give access to 40 houses; the remaining 20 are placed along the Ley Street frontage. The houses are all of the "B" type with accommodation as described for Tomswood Hill, and with the exception of two houses are all carried out with brick walls roughcasted on the outside and the roofs covered with slates. The two exceptions are built with concrete walls and partitions, the exteriors finished with rockfaced concrete blocks, in place of roughcast, the roofs being covered with tiles. The general description of drainage is the same as to the above schemes, the houses facing Ley Street being drained into the existing sewers in that street. With regard to the houses in the new road, 12 at the northern end will discharge into the existing sewer in Wards Road West, while the remainder will discharge their sewage into a new sewer to be laid at the southern end; of the site aind passing along the footpath, finally discharging into the existing sewer in Ley Street. The surface water from four houses at the northern end of the new road will discharge into the existing surface water sewer in Wards Road West, while the remaining houses will discharge into' a new sewer to be made in the centre of the road, connecting up to the existing surface water sewer at the southern end of the site. The area being developed at Chadwell Heath is situated in Chadwell Heath Lane adjoining Park Lane and near the 49 way Terminus, and covers 12.34 acres, 1.54 of which is reserved for allotments. As at Horns Road, two new roads have been formed and sewers laid in same by contract. 110 houses of the "B" type are being erected to the same design and description as at Tomswood Hill and Ley Street. Two concrete houses are being built here similar to those at Tomswood Hill and Ley Street. This scheme is not generally in such an advanced state as the other three. The general description of drainage given for the other schemes equally applies here. New soil and surface sewers have been laid in the new roads. The sewage and surface water from 20 houses will discharge into existing sewers in Park Lane, but the balance will discharge into new sewers in new roads, ultimately discharging into a new 12in. sewer laid in Chadwell Heath l.ane, which in its turn discharges into the existing sewer crossing the lane to the west of Mayes Brook. The rest of the surface water is arranged to discharge into Mayes Brook some distance north of Chadwell Heath Lane. Of the houses being erected under the Council Schemes 24 were completed and in occupation at the end of the year. In addition to the above, 95 other houses erected in the district by private builders had been completed and occupied or certified for occupation. In addition to the Housing Schemes of the Ilford Council, the City of London Corporation and the London County Council have also, in pursuance of the Housing Acts, 1890 and 1919, acquired certain lands in the Ilford district. The scheme of the City of London Corporation comprises an area of 250 acres or thereabouts, situate near the centre of the district, and known as the Lonsdale Estate. It is proposed to erect 2,000 houses. The houses will be of varying size, some containing three bedrooms, bath room, two living rooms, scullery, and usual offices, and 50 others four bedrooms, bath room, two living rooms, scullery and usual offices. The London County Council scheme at Dagenham will provide 2,800 houses in the Ilford district, covering an area of 300 acres. Here also the houses will be of varying sizes, comprising the following:—Four bedrooms, bath room, two living rooms, scullery and usual offices; three bedrooms, bath room, two living rooms, scullery and usual offices; three bedrooms, bath room, one living room, scullery and usual offices; and two bedrooms, bath room, one living room, scullery and usual offices. 51 SECTION VII.—FACTORIES AND WORKSHOPS. FACTORIES. There are 86 factories on the register, made up as follows:— Alloy Moulder 1 Bakehouses 7 Boot Making and Repairing 12 Brick Maker 1 Brush Back Manufacturer 1 Builders, Joinery and Carpentry Works 5 Cardboard Box Maker 1 Carriage Works 1 Chaff Cutting and Corn- blowing 1 Chemical Works 1 Chocolate Works 2 Collar Works 2 Cutlery Grinding 2 Cycle Repairing 1 Electric Motor Works 1 Electric Wire and Battery Works 3 Engineers 4 Fancy Bag Maker 2 Iron Cutting Works 1 Ironing Shield Maker 1 Laundries 5 Meat Cutting 1 Motor Engineering 6 Motor Gear Engineer 1 Paper Mills 1 Photographic Works 1 Printing Works 5 Saw Mills and Joinery Works 4 Seed Sorting 1 Sweet Makers 1 Shell and Bone Crushers 1 Toy Maker 1 Wearing Apparel Makers 5 Wood Cutting 3 Total 86 WORKSHOPS. There are 411 workshops on the register, made up as follows:— Artificial Flowers 1 Bakehouses 20 Blacksmith 7 Book-binder 2 Boot Repairing 41 Braid Work 1 Brush Worker 5 Carpenter 13 Carpet Planning 1 Clergy Robes 1 Coach Building 1 Confectionery 3 Corset Maker 3 Cycle Repairs 13 Dairy Utensil Maker 2 Dressmaking 52 Electrical Accessories 4 Embroidery 2 Fancy Collars 5 Feather Cleaning 3 Florist 2 Flower Mounting 1 French Polisher 3 Glass Cutter 1 Hand Laundries 6 Harness Maker 2 Lace Worker 2 Ladies' Belt Maker 3 Leather Worker 3 Mechanical Dentist 4 Millinery 28 Motor Engineering 6 Optician 1 Picture Framing 5 Paint Mixing 2 Plumber 5 Poultry Appliance Maker 1 Printer 3 Rag and Bone Merchant 2 Scale Maker 1 Sheet Metal Worker 2 Shirt Making 2 Shoe Bows 1 Shoemaking 1 Tailors 38 Tie Maker 4 15oy Making 1 Umbrella Making 3 Undertaker 3 Upholstering 6 Watch and Jewellery Repairs 15 Wearing Apparel and Underclothing 66 Wheelwright and Farrier 4 Wood Carver and Gilder 1 Wood Cutting 3 Total 411 52 FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Intruding Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 88 — - Workshops (including Workshop Laundries) 143 8 - Workplaces (otherthan Outworkers' premises included in Part 3 of this report) — — — T otal 231 8 - 53 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Insp'tor (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 2 2 Want of ventilation. - - Overcrowding 2 2 Want of drainage of floors 1 - Other nuisances 3 2 Sanitary accommodation (Insufficient - - unsuitable or defective 1 1 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 for bakehouses (ss. 97 to 100) - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this report.) - - Total 10 8 — — * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 54 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. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) Wearing Apparel— Making, &c. 20 20 37 1 3 2 Cleaning and Washing - - - - - - Household Linen - — - — — — Lace, Lace Curtains and Nets 2 - 6 - - - Total 22 20 43 1 3 2 Note.—No home-workers were known to be engaged in the following occupations:—Curtains and Furniture Hangings; l'urniture and Upholstery; Electroplate; 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; leather Sorting; Carding, etc., of Buttons, etc.; Stufled Toys; Basket Making; Chocolates and Sweetmeats; Cosaques, Christmas Crackers, Christmas Stockings, etc.; Textile Weaving. 55 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the Year. Number. (1) (2) Bakehouses (excluding 7 Factory Bakehouses) 20 Boot Repairs 41 Carpentering 13 Dressmakers 52 Laundries 6 Milliners 28 Tailoring 38 Wearing Apparel and Underclothing 66 Miscellaneous Workshops 147 Total number of Workshops on Register 411 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) 3 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 8 Reports (of action taken) sent to H.M. Inspector 8 Other — Underground Bakehouses (s. 101):— In use at the end of the year 1 ISOLATION HOSPITAL. 58 ISOLATION HOSPITAL. The pressure on the accommodation of the Hospital existing at the end of 1919 continued in the spring of 1920, and again made itself evident in the autumn and winter of 1920. The appreciation of the work of the Hospital is shown by the fact that 90 per cent, of the cases of Diphtheria and 89 per cent, of the cases of Scarlet Fever occurring in this district were removed to this Institution. In July, 1920, the question of increasing the accommodation of the Hospital was again considered, when I reported that the six wards, in the Isolation Hospital (exclusive of the Convalescent Home) had the following accommodation:— Ward. No. of Beds. Observation. I. 24 plus 2 II. 7 III. 4 — IV. 10 — V. 24 plus 2 VI. 12 — 81 plus 4 Of these, 19 are reserved for Tuberculosis cases, 02 for Scarlet Fever, Diphtheria, etc. The 7 Tuberculosis cases can be evicted from Block II. in case of necessity to accommodate 6 Fever cases. The general estimate for infectious diseases is one bed per 1,000 of population. The estimated population for 1919 is 82,840 (this is the Registrar-General's estimate, and the actual population is probably considerably in excess of this figure). There should, therefore, be about 83 beds. The shortage is:— 83 minus 62 equals 21 beds (if 4 observation beds are not calculated). 83 minus 66 equals 17 beds (if 4 beds are calculated). 83 minus 72 equals 11 beds (if 4 beds and Block II. are both calculated). The shortage is not really felt unless Scarlet Fever cases occur in large numbers, as in the winter of 1919, but it must be 59 remembered that the above estimate does not make allowances for other cases, such as Measles, Influenzal Pneumonia, Ophthalmia, etc. The Committee considered building— (1) A Pavilion of 24 beds. (2) An Observation Ward on the cubicle system, of 10 to 12 beds. *The additional population to be expected in the district in the near future may foe calculated as follows:— "Additional Houses. Population. L.C.C.—Dagenham 3,200 12,800 City of London Corporation 2,400 9,600 Ilford Scheme 356 1,424 5,956 23,824 *Calculated at 4 persons per house. i.e., roughly another 24 beds would be required. I think that the two wards I have mentioned might be sufficient if no Scarlet Fever epidemic was to arise; but in the re-planning of the Hospital it is necessary to estimate for another pavilion of 24 beds to be erected if required. It will also be necessary to consider whether:— 1. The present boilers will be sufficient 2. The present laundry will be sufficient for the increased hospital accommodation. The following additional staff would be required for the new Pavilion:— 1 Sister. 1 Ward Maid. 2 Staff Nurses. 1 Laundry Maid. 3 Probationers. 1 Housemaid. For a cubicle ward of 12 beds, at least four or five Nurses would be required. With regard to accommodation for nursing and domestic staff, these are at present scattered over three buildings as shown on the next sheet. This will become more and more unsatisfactory as the staff increases. It is advisable that all the female staff should be in one administrative block. * In view of the alterations in the proposed schemes these figures have, now been reduced. 60 ISOLATION HOSPITAL. Accommodation for Nursing and Domestic Staff. I. Home over Block V. Accommodation. No. Occupied by. Bedrooms:- Single 11 1 Lady Doctor Double 2 1 Assistant Matron Lecture Room 1 2 Sisters Dining Room 1 8 Nurses Sitting Rooms 4 3 Maids II. Administrative Block. Accommodation. No. Occupied by. Bedrooms:— Single 7 1 Matron Double 4 13 Maids Sitting Rooms 2 Dining Room 1 III. Convalescent Home. Accommodation. No. Occupied by. Bedrooms:— Single 7 1 Night Sister Double 2 8 Nurses Sitting Rooms 3 Kitchen 1 61 On this report it was decided to proceed with the building of a new pavilion of 24 beds to be erected over Block I. as soon as the necessary sanction for loans was obtained. The necessity for a cubicle block in any modern Isolation Hospital hardly requires emphasis. A number of cases of doubtful diagnosis are sent by the private practitioner to prevent the spread of infection at home. If not actually suffering from the disease notified such patients run considerable risk of contracting it or of conveying a fresh infection to the other patients. Some difficulty has been experienced in obtaining an adequate nursing staff. The special risks run by the Nurses concerned demand that they should receive special consideration at the hands of Local Authorities. The Probationer Nurses received the usual course of lectures and training. At the present time the nursing work of the Hospital is being carried 011 at a very high level. Some difficulty was experienced in the work of the Hospital by the application of the 47-hour week to the male staff, and this necessitated the engagement of an additional three men. The cost of the administration of the Hospital has been increased considerably by the increased salaries paid to the nursing, domestic, and male staff, as well as the high cost of food, etc. The motor ambulance and disinfecting-van service is now ready for use. More patients were admitted to the Isolation Hospital during 1920, than have previously bee'n recorded. A total of 506 was admitted, compared with 481 in 1919 and 450 in 1907, the highest previous totals. The number of patients in Hospital on January 1st, 1920, was 76:— Scarlet Fever 54 Diphtheria 15 Pulmonary Tuberculosis 7 62 Total number of patients admitted during the year, 506:— Scarlet Fever 225 Diphtheria 185 Pulmonary Tuberculosis 70 Puerperal Fever 1 Cerebro-Spinal Fever 3 Spina Bifida 1 Scabies 6 Pneumonia 3 Broncho-Pneumonia 1 Measles 1 Under observation 10 Number of deaths in Isolation Hospital, 19:— Scarlet Fever 1 Diphtheria 10 Pulmonary Tuberculosis 3 Cerebro-Spinal Fever 2 Influenzal Pneumonia 2 Broncho-Pneumonia 1 Number of patients remaining in Hospital, 1st January, 1921, 95:— Scarlet Fever 45 Diphtheria 29 Pulmonary Tuberculosis 17 Puerperal Fever 1 Cerebro-Sipinal Fever 1 Under observation 2 The average length of stay in Hospital was for:— Scarlet Fever 44.0 days. Diphtheria 34.5 ,, Pulmonary Tuberculosis 78.5 ,, Average stay in Hospital of all cases 43.3 ,, The above averages are based on cases that completed their stay in Hospital during the year 1920. Average number of patients in Hospital per day, 59.9. DIPHTHERIA. The type of Diphtheria occurring this year in Ilford was on the whole of a virulent nature. This applied especially to the local outbreaks occurring around Seven Kings and South Hainault in October and at Loxford in December. Ten deaths occurred; many of these were of cases affected by "hæmorrhagic diphtheria," which is unfortunately a hopeless form of the disease. 63 The small outbreak occurring at Little Heath in June was of a very mild type, and no deaths took place from cases in that area. Some difficulty was experienced with children either found at school to be "carrying" the diphtheria bacillus in their nose or throat, or whose length of stay in Hospital was prolonged from such cause. Most of such cases were treated with diphtheria vaccine. Recently vaccine of the "detoxicated" variety has been used and has given most satisfactory results. I found it necessary to operate on two of the cases who were children suffering from adenoids. SCARLET FEVER. Of 225 cases admitted during the year one death occurred, giving a death-rate of 4.4 per 1,000. The fatal case was of the "toxic" variety, fortunately a rare type of Scarlet Fever to occur. Most cases were of a mild type. The following table shows the fatality of Scarlet Fever anc} Diphtheria for the past five years:— 1916. 1917. 1918. 1919. 1920. Scarlet Fever — — 13.5 — 4.4 Diphtheria 4.0 4.7 3.6 3.5 5.4 Such a table is only useful in showing the variability of the virulence of the disease in each year. INFLUENZAL PNEUMONIA. Two cases were admitted, both of which died within a short period of their admission to Hospital. The removal of such cases to hospital should only be advised where the home conditions make nursing there quite impossible. SCABIES. Six children were admitted, having been sent from the School Clinic as intractable cases, and were discharged cured within a few days. If more hospital accommodation were available the number of such cases attending at the School Clinic would be rapidly reduced, 64 CEREBRO-SPINAL FEVER. Three cases were admitted, of which two died in spite of serum treatment, while the third made a rapid and complete recovery. It is to be hoped that the research carried out on this disease in the Army will be continued, and that before long a serum will be discovered which will be effective in the treatment of the infection by all four types of the organism causing the disease. TUBERCULOSIS. Of 70 cases of Pulmonary Tuberculosis admitted during the year three died, suffering from the disease in an advanced stage. The majority of the patients admitted were too advanced in the disease to benefit by "graduated labour." Most benefited by rest, good food and open-air treatment, but all were discharged with the certainty that sooner rather than later they would again require institutional treatment. Few on discharge had any capacity for anything but very light employment. No doubt the educational effect on the patient is the most that can be expected from hospital treatment of such short duration with cases of this class. OTHER DISEASES. Ten cases were admitted "under observation." Six were discharged without any definite signs of disease, being contacts only. One was found to be suffering from influenza and another was suffering from valvular disease of the heart and was transferred to the Emergency Hospital. A baby was admitted with its mother because of an acute form of Conjunctivitis which quickly yielded to treatment. Another baby was transferred from the Maternity Home suffering from Spina Bifida with septic complications. It improved and was discharged, but later succumbed at home. One child admitted as Meningitis was found to be suffering from Broncho-Pneumonia with Meningitis as a secondary complication, which caused a fatal issue. One woman was admitted with Puerperal Fever, which yielded to treatment, and she was discharged cured. 65 ISOLATION HOSPITAL. SUMMARY OF EXPENDITURE, 1919 TO 1920. £ s. d. Salaries of Medical Officer, Matron, Nursing and Domestic Staff 1,446 7 3 Wages of Male Staff 2,240 14 11 Provisions 4,047 8 3 Heating, Lighting and Water 2,193 11 7 Drugs, Medicines and Appliances 388 11 8 Rates, Taxes and Insurance 134 8 10 Repairs to Buildings, Decorations, Renovations, etc. 628 0 6½ Replacements and Renewal of Furniture, Linen and Bedding 930 19 4 Crockery, Chandlery and Ironmongery 387 13 1 Clothing and Uniform 99 17 10 Telephone, Books, Printing and Travelling Expenses 97 12 11 Contributions re Small-pox Hospital 58 2 6 Motor Ambulance 1,285 0 4½ Upkeep of Horses, Team Labour, etc. 244 7 3 Tithes and Wayleaves 42 16 0 Miscellaneous 134 11 5½ Loans, Repayment and Interest 1,608 10 6 Gross Expenditure 15,968 14 3½ Total Income from Grants, Maintenance Fees, etc. 2,388 13 5 Nett Expenditure £13,580 0 10½ Total number of day patients for the year, 21,119. MATERNITY& CHILD WELFARE 69 NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. The number of births notified under the above Acts during 1920 was 1,692. The percentage of births notified by the various responsible persons is as follows:— By Medical Practitioners 24.6 ,, Certified Midwives 35.7 ,, Parents and others 39.6 INFANTILE MORTALITY. The number of infants dying within the first year of life was 90, the total number born being 1,666. The infant mortality or rate of death per 1,000 births was therefore 54. In previous years the total number ot deaths and the rates have been as follows:— Year. No. of Deaths 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 1920 90 54 The infant mortality rate for 1920 is the lowest recorded for Ilford. It compares favourably with that of 80 for England and Wales and 75 for London and 85 for the 96 towns having a population exceeding 50,000. 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 146 3 20.5 Park 246 15 60.9 Seven Kings 222 5 20.2 North Hainault 105 11 104.7* South Hainault 341 29 85.0 Clementswood 356 20 56.1 Loxford 209 7 33.4 Ilford 1,625 90 54.0 * Deducting from the North Hainault Ward the deaths of Infants occurring in the Village Homes, Barkingside, there is left an Infantile Mortality rate of 47.6 per 1,000 births for that ward. 70 It will be noted that the above table only accounts for 1,625 of the 1,666 total births registered. The remaining 41 births are included by the Registrar-General as belonging to Ilford, but I am unable to allocate them to the various Wards. I would again call attention to the very heavy infantile mortality among illegitimate children. Of 52 illegitimate children born 12 died, giving an infantile mortality rate of 230 per 1,000 births, while of 1,'614 legitimate children born 78 died, giving an infantile mortality rate of 48. This shows the great necessity of a strict supervision of the home conditions and the care given to these illegitimate children. Some of them are foster-children, and as such are under the supervision of the Infant Life Protection Visitor of the Romford Board of Guardians by reason of the Children's Act, 1908. With such a Maternity and Child Welfare Scheme as is in operation in Ilford it is highly desirable that these foster-children should be known to the Medical Officer of Health, be in attendance at the Infant Welfare Centres, and be visited as required by the trained Nurses attached to the Department. The Boards of Guardians were requested by the Ministry of Health in a circular dated September 30th, 1919, to confer with Local Authorities on the subject, and the Maternity Committee of the Ilford Council has approached the Romford Board of Guardians with a view to some scheme of co-ordination being carried into effect. Table IV. gives the causes of death of infants under one year of age, classified according to age. It will be noticed that prematurity and debility are the chief causes, and in my opinion the death-rate from these will not be much reduced until medical research has determined the exact reason for these conditions. While the very satisfactory fall in infant mortality may be largely ascribed to the growth of infant welfare work and extended knowledge among parents of the dieting and care of their infants, it must also be remembered that the climatic conditions have not favoured the spread of infantile diarrhœa. When this disease again makes its appearance to any considerable degree, one may expect another rise in the death-rate among young children. 71 Table IV.—Infant Mortality. 1920. 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. 1 weeks & under! 3 months. 1 3 months and under 6 months. 6 mor.ths and under 9 month. 9 months and under 12 months Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... l l l 3 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... TuberculousMeningitis ... ... ... ... ... ... ... 1 1 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... l l 2 Convulsions 2 ... ... ... 2 ... ... ... 1 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... l ... 1 2 l 2 ... 6 Pneumonia (all forms) ... ... l 1 2 3 2 3 ... 10 Diarrhœa ... ... ... ... ... ... 1 ... ... 1 Enteritis ... ... ... ... ... ... 1 1 ... 2 Gastritis ... ... ... ... 1 1 1 1 ... 4 Syphilis 2 ... l ... 3 1 2 3 ... 8 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 7 2 ... 1 10 1 ... ... ... 11 Premature birth 14 2 1 ... 17 2 ... ... ... 19 Atrophy, Debility and Marasmus 1 3 ... ... 4 2 ... ... 1 7 Other Causes 5 ... ... ... 5 2 2 3 ... 12 Unknown ... ... ... ... ... ... ... ... ... ... Totals 31 8 4 2 45 14 11 15 5 90 Nett Births in the year— Nett Deaths in the year— Legitimate 1614 Legitimate infants 78 Illegitimate 52 Illegitimate infants 12 72 WORK OF HEALTH VISITORS. In October 1920, two additional Health Visitors were appointed by the Council. This enabled me to make a change in the administration so that the time of the six Nurses was equally divided between Maternity and Child Welfare work and School Medical work. The area was therefore divided into six districts (instead of three), and the Nurse concerned carries out all the home visits in her district. The districts being half the size permitted more visits to be carried out. Much less time is spent in travelling, and overlapping of duties is prevented. Each home is visited after the birth of a child has been notified, within three weeks if a doctor is in attendance, and within fourteen days if a midwife. The following is a summary of the visits paid by the Health Visitors during 1920:— First visits to newly born infants 1,670 Subsequent visits to children under 1 year of age 3,530 Subsequent visits to children over 1 year of age and under 5 5,344 Visits to expectant Mothers 173 Home visits for other reasons 867 Total visits paid 11,584 MILK (MOTHERS AND CHILDREN) ORDER, 1919. This Order enabled the Council to supply milk free or at a reduced rate to expectant and nursing mothers and children under five years of age in other than merely necessitous cases. In Ilford only strictly necessitous cases have been so supplied, a scale of necessity having been approved. Each case is enquired into by the Health Visitors and only endorsed for free or reduced milk-supply by the Medical Officer when such enquiry is satisfactory. Each case is investigated again at the end of a month and the result again placed before the Medical Officer before the supply is continued. During 1920 72 persons were supplied with cows' milk free and 31 with dried milk. A total of .3,296 quarts of cows' milk and 1,509 lbs. of dried milk were given free. 73 SUPERVISION OF MIDWIVES. Unfortunately under the Miidwives Act, 19,18, Section 12, permission is withheld for the delegation to a District Council of the powers of the Essex County Council as Supervising Authority. There is no doubt that such work can be carried out as efficiently and economically by the local Public Health Department, and it is difficult to understand the reason for this Section of the Act. During 1920 local midwives were reported to the County Medical Officer of Health on three occasions for some infringements of the regulations of the C.M.B. INFANT WELFARE CENTRES. During the year larger premises have been obtained for the Infant Welfare Centres at Albert Road and Newbury Park, and in October, owing to the increasing numbers attending Seven Kings Centre, this was sub-divided and a new centre opened at Goodmayes. There are therefore now six Infant Welfare Centres:— Seven Kings (Library Hall). Groodmayes (All Saints' Church Hall). Albeit Road (Presbyterian Church Hall). Ilford Lane (Emmanuel Church). Park and Cranbrook (Cecil Hall). Newibury Park (Birkbeck Road Congregational Church). During the year the following attendances were made Figures for 1919. Total number of attendances of infants 12,311 5,643 First attendances 876 629 Total number of children on roll December 31st, 1920, after omission of all those who had not attended for six months 925 652 Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. First Attendances 82 78 81 52 85 96 63 56 96 85 56 46 Subsequent „ 861 778 1049 777 902 1299 915 885 1175 1040 1015 739 This represents a very large increase over the work in 1919, and, indeed, the success of the Centres in Ilford has become embarrassing. 74 1. Supply of Food.— (a) Milk.— During the year the following quantities of dried milk have been sold :— lbs. Public Health Department 1,332 Seven Kings 4,725 Goodmayes 367 Newbury Park 777 Albert Road 3,744 Ilford Lane 2,309 Park and Cranbrook 2,774 Total 16,028 (b) Condensed Milk.— tins. Public Health Department 217 Seven Kings - Goodmayes - Newbury Park 2 Albert Road - Ilrord Lane 4 Park and Cranbrook 278 Total 501 (c) Fat Emulsion.— lbs. Public Health Department 128 Seven Kings 455½ Goodmayes 119½ Newbury Park 82 ¾ Albert Road 516¾ Ilford Lane 378¾ Park and Cranbrook 461½ Total 2,142½ In November, 1919, the Ministry of Health arranged with the Sugar Distribution Branch of the Ministry of Food for an extra ration of sugar of 4 ozs. per week per child to be given on the certificate of <the Medical Officer of Health that the child was between six and eighteen months old and that it needed an additional supply of sugar. Arrangements were made for this to be carried out through the various Welfare Centres, and in this way during the year 1920, 557½ lbs. of sugar were supplied through the Centres. 75 2. Clothing Materials.— The price of wool and similar articles having been prohibitive, arrangements were made to supply these articles at practically cost price to mothers attending the Centres. During the year 85½ lbs. of wool and 390 yards of flannel were sold at the various Welfare Centres. ANTE-NATAL CLINICS. Ante-Natal Clinics were commenced at the Maternity Home on the 23rd April, 1920, and the Emmanuel Church, Ilford Lane, on the 28th April, 1920. All patients going into the Maternity Home who wish to be attended by a midwife of the Home are medically examined at the Ante-Natal Clinic beforehand. During 1920 73 women attended the Clinic at the Maternity Home and 29 at the Emmanuel Church. On December 31st there were 21 on the register of the Maternity Home Clinic and 13 on the Emmanuel Church Clinic register. The work of the Ante-Natal Clinics is one of great importance and one which will develop considerably in the future. Their two-fold purpose is to avoid a difficult confinement in the mother and to ensure the birth of a living healthy child. DENTAL CLINIC. Mr. Rose, the part-time Council Dentist, continued this work till the 21st August, 1920, and Mr. Greenfield, the newlyappointed Dentist, commenced his duties on the 23rd August, 1920. During the year 33 mothers and five children under five have been treated. With the appointment of a whole-time Council Dentist it was found possible to arrange for the provision of dentures at cost price where necessary and below cost price in cases of necessity. The following tables show the cases treated during 1920:— 76 (a) Treatment of Mothers. Number of mothers treated during 1920 33 ,, of attendances of mothers 89 ,, of mothers having teeth extracted, to whom general anaesthetics were given 9 ,, of mothers having teeth extracted to whom "local" anæsthetics were given 37 ,, of mothers having teeth filled or otherwise treated 23 (b) Treatment of Children under Five Years of Age. Number of children treated 5 ,, of attendances of children 11 ,, of children having teeth extracted to whom general anaesthetics were given 4 OPHTHALMIC CLINIC. Children not 5 years of age who are found to be suffering from squint have been referred to the Council Oculist for treatment either from the Infant Welfare Centres or by the Health Visitors from their home visits. If a squint is corrected by suitable glasses at an early age it is possible to cure the squint and also to preserve the sight of the affected eye. It is therefore of considerable importance that children suffering from these defects should be treated before they reach school age. During the year three children were examined by the Council Oculist and spectacles were recommended. TREATMENT OF MINOR AILMENTS. Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. Belts have been supplied to infants suffering from hernia and during the year 1920 90 belts were obtained for this purpose. A certain number of infants were brought to the Public Health Offices to receive treatment for minor ailments. MATERNITY HOME. The Matron of the Maternity Home having resigned, Miss M. E. Roberts was appointed Matron in July of this year. 77 Two pupil-midwives engaged during the year were successful in passing the C.M.B. Examination. During the year many rooms of the Maternity Home have been redecorated, the drainage completely overhauled, and minor improvements effected. During the year 1920 169 women were admitted into the Home, as compared with 139 in 1919. Of this number 165 were confined in the Home, 3 were admitted for curettage and were discharged cured, 1 was admitted hut found not to be pregnant. Of the 165 confinements 76 had engaged their own doctors and 89 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 19 of the latter cases. 24 children were circumcised in the Home. In 7 cases twilight sleep was administered. In 6 cases the electric incubator was used for prematurely born infants. 1 such infant, which was born during the twenty-fifth week and weighed only 2½ lbs., is now attending one of the Infant Welfare Centres, and is making satisfactory progress. There were no deaths of women in the Home. There were four deaths of infants in the Home. One died three days after birth from convulsions. Three died within a few hours after birth, being prematurely born. Three children were stillborn. The causes of stillbirth were as follows :— 1 difficult labour. 2 macerated foetus. At the present time the circumstances of those unable to pay a fee of two guineas per week are enquired into by the Health Visitor, and a fee is decided upon by the Medical Officer of Health, subject to confirmation by the Maternity and Child Welfare Committee. 78 The following table shows in extenso the fees which were paid by women admitted to the Home :— 3 Mothers were admitted free of charge. 6 were admitted at a fee of 15s. per week. 12 „ „ 20s. „ 2 „ „ 21s. „ 9 „ „ 25s. „ 31 „ „ 30s. „ 2 „ „ 35s. „ 8 „ „ 40s. „ 48 „ „ 42s. „ 4 „ „ 50s. „ 40 „ „ 63s. „ 4 „ „ 84s.„ 71 patients agreed to pay the Midwife's fee of 15s. Average number of patients in the Home per day during 1920 7.02 Average stay of patients in the Home 15.2 days. The lease for the present Maternity Home expires in September, 1922. The site for the new Maternity Home at Hatch Lane has been bought, and plans for a Home of 22 beds are at present before the Ministry of Health for their approval. The popularity of the present Home is shown by the fact that in January 1921 70 cases were booked for future admission. The following is a summary of the expenditure incurred in connection with the Maternity and Child Welfare Services during the financial year ending 31st March, 1920 :— Health Visitors: — £ s. d. £ s. d. Salaries and Uniform Allowances... 365 8 7 Travelling Expenses 24 15 0 Payments to Day Nursery 10 0 0 Welfare. Centres:— Furniture and Equipment (Renewals) 46 6 11 Heating, Lighting and Cleaning 101 13 9 Medical Attendance (including Dentist) 171 15 0 Drugs and other Medical Requisites 143 19 3 Pood (Sold) 640 3 8 Dried Milks, etc. (supplied free) 139 8 7 79  £ s. d. £ s. d. Provision of Nursing for children under 5 years (Ophthalmia Neonatorum) 39 12 8 Printing, Stationery, Postage, etc. 136 8 6 Other items of Expenditure :— Carting of Furniture, Petty Disbursements, National Health Insurance and Laundry, etc. 32 14 1 Clerical Assistance 60 2 6 1,912 8 6 Less— Amount received for Sale of Dried Milk £544 11 7½ Sundry Sales 18 9 9½ 563 1 5 1,349 7 1 Maternity Home:— Rent 100 0 0 Rates and Taxes 53 6 1 Furniture and Equipment (Renewals) 125 7 2 Heating, Lighting and Cleaning 308 3 7 Salaries of Staff 311 1 3 Food 690 16 0 Drugs and other Medical Requisites 102 15 4 Repairs, Renovations, etc. ... 159 12 3 Use of Ambulance 6 13 9 Laundry 47 19 1 1905 14 6 Less— Receipts from Patients £656 6 3 Repayment from Owners on a/c of Repairs carried out by the Council 14 0 0 670 6 3 1,235 8 3 £2,684 15 4 Average weekly cost per Patient at Maternity Home :— Whole Expenditure £4 16 10 Less Cost of Equipment, Furniture, Repairs and Renovations £4 2 5 SCHOOL MEDICAL SERVICE. 83 1. Staff.— During the year Dr. Burton continued his duties as School Medical Officer, and Dr. Rattray as Lady Assistant Medical Officer. Dr. Gebbie was appointed Assistant Medical Officer on the 24th February, 1920, and took up his duties on the 7th April, 1920. Mr. C. F. Rose, L.D.S., who has rendered very valuable services to the Education Committee as Temporary School Dentist during the war-period, discontinued his duties on 21st August, 1920. Mr. S. F. Greenfield, L.D.S., who was appointed whole-time Council Dentist on 14th June, 1920, took up his duties on 23rd August, 1920. In July the Education Committee recommended the Council to consider the appointment of additional School Nurses, and on the recommendation of the Public Health Committee, two additional Nurses were appointed, making a total of six Nurses attached to this department. The appointment of these additional Nurses made it possible for me to adjust the duties, and all now give half of their time to school medical work, the remaining half being devoted to maternity work and the other duties of the department. The result has been to produce greatly increased efficiency, the districts visited are much smaller, the Nurses are therefore able to pay more visits, and at the same time, they pay calls both to children under and over school age, thus avoiding considerable overlapping of duties. Nurse Cartwright was appointed Health Visitor and School Nurse in February. Nurse Dukes resigned her appointment in September, and Nurse Raddall was appointed in her place, taking up her duties in October. Nurses Robinson and Mathieson, the two additional Nurses, took up their duties in October and November respectively. In July I pointed out in my monthly report to the Committee the amount of clerical work devolving upon the Head Teacher's as a result of medical inspection, and: the desirability of appointing a female clerk-attendant, who could assist the teachers in this work, and, if necessary, be present at medical inspection. 84 The Committee decided to appoint a lady to carry out these duties. The arrangement proposed will enable me to relieve the Head Teachers of much of the work that has fallen upon them. A Nurse will be present at each medical inspection to weigh, measure and undress the children, and assist the doctors. Most of the clerical work, such as filling up the cards, etc., will be carried out by the female-clerk. 2. Co-ordination.— The co-ordination of the work of. the School Medical Service with that of the other Health Services is carried out to the fullest extent in Ilford, the School Medical Officer being the Medical Officer of Health and also the Medical Officer to the Maternity and Child Welfare Committee. His assistants are appointed as Assistant Medical Officers of Health, and help generally with all the work of the department At the present time the Lady Assistant is largely occupied with Infant Welfare work, and the Male Assistant chiefly with School Medical Inspection. The new arrangement of the work of the Health Visitors and School Nurses ensures a very complete coordination between the work of the School Medical Service and t'hat of Infant Welfare, the Nurse very frequently visiting a house where one child of school age is suffering from some ailment, and at the same time paying a visit concerning the health of a young infant. The services of the Council Oculist and the Council Dentist (the major part of whose time is devoted to the School Medical Service) are also utilised for the treatment of children under 5 years of age. A certain number of children under school age, found to be suffering from minor ailments, are also treated by the doctors and nurses at the Health Offices. The services of the Sanitary Inspectors are utilised in connection with the following up of cases of infectious disease. A statement of the actual time spent by the officers in the various health services is difficult, as many of the duties are co-related. The allocation for purposes of salary is as follows :— Public Health. School Medical M. & C.W. School Medical Officer 66% 17% 17% Male Assistant M.O. 23% 77% - Lady Assistant M.O. - 25% 75% Health Visitors - 50% 50% 85 THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. 3. School Hygiene.— The majority of the schools are of a modern type and in good sanitary condition. There were at the end of the year 15 schools, with 33 departments. The schools have accommodation for 12,745 children, and 10,475 were actually on the roll on December 31st, 1920. The Girls' Department of the Church of England (National) School was closed on 31st March, 1920. 4. Medical Inspection.— Age groups of the children inspected:— 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) Of all children between the ages of 8 and 9 years. (3) Of all children between the ages of 12 and 13 years, together with all children over 13 years not previously inspected. A preliminary list of the names of children falling within these groups is first obtained from the Head Teachers. Card's of any children who have been previously examined at an earlier age group are obtained from the office files, new cards being, if (necessary, made out, and enquiry cards as to infectious disease are filled in—the latter being handed out to the scholars by the teachers for the necessary information to be obtained. Arrangements are then made for the dates of medical inspection, any necessary alteration being, of course, made if these arrangements interfere with any school functions. The office files are periodically cleared of all cards of children who have left school or the district, information being obtained from the Head Teachers or from enquiries made at the school at the time of the periodical inspections. During 1920 the number of visits made by the Medical Officers to 33 different departments of 15 schools for the purposes of routine medical inspection was 229. The number of children examined during the year, falling within the above age groups, totalled 5,194 (2,685 boys and 2,509 girls). In addition a number of children were presented by the Head Teachers for 86 special medical examination,, such children not falling within the age groups, but were suspected by the teachers to be suffering from slight ailments. In this way during 1920 169 children (71 boys and 98 girls) were examined. 598 re-examinations were made at school by the doctors, to ascertain the result of treatment of defects found in the course of medical inspection. 5. Findings of Medical Inspection.— Table II. shows the return of defects found in the course of medical inspection. (a) Uncleanliness.— It will be seen that at routine medical inspection only 122 children out of a total of 5,363 were found to have nits, or vermin (or two per cent.), while only 13 were found to be infected with body vermin, i.e., .2 per cent. These results are very satisfactory, and show that the work of the school nurses in promoting the cleanliness of children is being well carried out, and also that on the whole the parents of Ilford school children take an interest in the cleanliness of their children. It must be remembered, in consideration of these figures, that a special effort is generally made by the parents that the children when presented for examination by the doctor should be in a clean condition. (b) Tonsils and Adenoids.—220 children were found to be suffering from tonsils enlarged to such a degree that it was considered necessary to advise the parent to obtain medical advice. The question of operation in the treatment of enlarged tonsils and adenoids is one of some importance, and I see no reason to alter the remarks I made in the report of 1914 on this subject, viz. :— "Some care has been taken in advising the operation for the removal of enlarged tonsils and adenoids. Most cases of enlarged tonsils are associated with carious teeth, which should first be treated. Many slight cases can be improved by suitable breathing exercises, and a circular describing these is being issued where necessary. Further, the operation is by no means free from risk, especially when it is done, as so frequently, in an out-patient department, and the child allowed to return home the same day. The conditions under which it has been urged have been:— (1) Chronic nasal obstruction with adenoids. (2) "Running ears" with enlarged tonsils or adenoids. (3) Deafness with adenoids. 87 (4) Frequent attacks of tonsillitis. A moderately enlarged tonsil may cause these, and is only to be adequately removed by dissection and not by merely cutting the tonsil. (5) Much enlarged cervical glands with no other apparent cause than enlarged tonsils. Even when the operation has been performed little benefit may be expected unless after-treatment is carefully carried out in the shape of breathing exercises, and the school nurse will in future give printed as well as oral directions. The habit of mouth-breathing has a serious effect on the mental development of the child, and is only to be remedied by much parental patience. The operative treatment of a child suffering from much enlarged adenoids is an urgent one. Until the condition is relieved, the child's progress at school is retarded, it is mentally lethargic and suffers from frequent attacks of sore throat." (c) Tuberculosis.—No case of definite tuberculosis of the lungs was detected at medical inspection. This confirms the generally accepted opinion that Pulmonary Tuberculosis is a comparatively rare infection at school age. Six suspected cases of Pulmonary Tuberculosis were detected, and these were referred to their own medical attendant or to the Tuberculosis Dispensary, for observation purposes. (d) Skin Disease.—Ten cases of Ringworm, 30 of Scabies {Itch), and 40 of Impetigo were discovered at routine medical inspection. These figures alone show the value of medical inspection and its importance in preventing the spread of these infective ailments among school children. (e) External Eye Disease.—Thirteen cases of Blepharitis or inflamed eyelids, and 1 case of Conjunctivitis were discovered. Blepharitis may be simply an infective condition of the lids, or may be due to defeat of vision, and is rapidly cured when this is corrected. (/) Vision.—570 children, or 16 per cent., were found to be suffering from vision so defective as to require treatment. Further particulars of these cases will be found in the School Clinic Report. (g) Ear Disease and Hearing.—37 children, or .7 per cent., were found to' be suffering from defective hearing. The cause in most of these cases was wax in the ear. In addition, nine children were found to be suffering from a discharge of the ear, resultant on old otitis media. It has not been found possible, with the conditions under which medical inspection is performed, to adopt the forced whisper heard at 20 feet as a standard. The most satisfactory method of testing the hearing has been found for the examiner to be placed behind and to one side of the child, and, while stopping an ear with the finger, to test the hearing in the 88 other by a question whispered in a low tone. Even slight degrees of deafness can thus be detected in younger as well as older children. The most common causes of deafness in children are :— (1) Wax in the Outer Ear.—This is not such a simple ailment as might appear, as the wax frequently overlies a perforation in the drum of the ear. The routine syringing of ears by untrained persons is not to be recommended, and in any case should not be performed unless a thorough examination with light and head mirror has previously been carried out by the doctor. (2) Diseases in the Middle Ear.—This may either result from (a) a simple catarrh due to obstruction from adenoids, or (b) suppuration, which causes a "running ear," and may occur after such infectious diseases as measles, scarlet fever and diphtheria. Probably measles is the cause of more cases of serious deafness in children than any other disease. In many cases of " running ears " from which children are found to suffer, attention to the underlying cause in the nose and throat is sufficient. Long-continued cases with offensive discharge are due to diseased bone, and can only be cured by its radical treatment. Many cases of children with slight deafness as a cause of backwardness come under the notice of the doctor, who, by ensuring that adequate treatment is carried out and that the child is placed in a suitable position in the class, can save much annoyance to a teacher and retarded education to the child. (h) Dental Defects.—141 children, or 9 per cent., were found to be suffering from teeth so defective as to impair their health, and were referred to the School Dentist for treatment. A more complete inspection of the teeth of the children is carried out by the Dentist, a summary of the results of which appears on page 117, Table IV. (D. 1 and 2). (i) Crippling Defects.—One child was found to be suffering from spinal curvature. In addition, 14 children were found to be suffering from minor deformities, which could be corrected by special physical exercises. 6. Infectious Disease.—It was found necessary to recommend the closure of the following schools during the past year :— School. Dates of closure. Cause. Uphall—Junior Mixed Dept.\ 24th Feb., 1920, to 5th March, 1920 Measles Little Heath 14th June, 1920, to 21st July, 1920 Diphtheria Loxford—Junior Mixed Dept. 13th Dec., 1920, to 22nd Dec., 1920 Diphtheria 89 The contrail of infectious disease in the schools in Ilford is carried out in as efficient a manner as possible. The Medical Officer of Health, who is also School Medical Officer, receives notification of all infectious disease, and therefore becomes at once aware of any undue incidence in any school. When this occurs the school is visited by him, investigation is made as to which department and which class is chiefly involved, and all contacts are examined, any absentees from the particular class being visited by the nurse. In this way, on several occasions during the past year a number of children have been found to be ill at home suffering from an infectious disease, unknown to their parent. The discovery of these children has in many cases prevented a more widespread outbreak of the disease concerned. When several leases of infectious disease have occurred in a school, it has been the practice to disinfect the class-rooms and disinfect or destroy any articles likely to carry infection. In addition, during the summer vacation the lobbies of the schools have been disinfected by spraying. The following gives particulars of the disinfection of the schools during 1920:— Date. School. Part Disinfected. 14/2/20 South Park Junior Mixed—Departments Nos. 1 and 2 All class-rooms 2/3/20 Uphall Road Girls' Dept.:—Room No. 2 Junior Mixed Dept: —8 class-rooms, hall and lobbies 15/5/20 Little Heath Room 4 and lobbies 17/6/20 Little Heath All class-rooms and lobbies (Utensils and books disinfected, some destroyed. 30 library books disinfected) Summer Vacation All Schools (excepting Little Heath) All lobbies 6/11/20 Downshall Junior Mixed Dept.:—9 class-rooms, 2 lobbies and hall 7/12/20 Loxford Junior Mixed Dept.:—Room 6, lobby and all utensils 20/12/20 Loxford Junior Mixed Dept.:—8 class-rooms, 2 lobbies and large hall On the 13/10/20 the whole of Ilford College, Aldborough Road, was disinfected. 90 The question of school closure is a difficult one to decide, and each case has to be carefully considered on its merits. Where the infectious disease is widely-spread in a district, it is unlikely that closure will improve matters. Where one or two classes in a school show a large number of cases of infectious disease, closure of the school may stop further spread of the infection. Tables IX. to XIV. show the incidence of each infectious disease in the Ilford Schools during 1920. (a) Scarlet Fever.—154 cases were reported in 1920, against 165 in 1919. This disease has still been widely prevalent in the London districts during the year. It cannot be said that any particular school has been affected during 1920. The infection has only been kept within reasonable bounds by the efforts of the department. (b) Diphtheria.—130 cases were reported in 1920, as compared with 78 in 1919. The disease affected particular schools, especially in May and June, when a small outbreak occurred at Little Heath School. When a number of cases of Diphtheria have been notified from a school, it has been my practice to visit the school and swab all children who are suffering from a sore throat or running nose, in order to detect "carriers" of the diphtheria bacillus. At Little Heath School I found that the carrierrate was high, and in view of this fact and that sanitary defects required attending to at the school, I recommended its closure. This resulted in a cessation of the disease. Three more cases, however, occurred in October and a further visit to the school detected another "carrier," after whose isolation the infection ceased. A number of cases of diphtheria occurred at Downshall School (Junior Mixed Department) from September to November. I found a "carrier" at the School, after whose isolation no more cases occurred. In December two children from the Junior Mixed Department of Loxford School were admitted to the Isolation Hospital suffering from a serious type of Diphtheria. On visiting the school, I discovered one "carrier," who had herself suffered from an undiscovered attack of diphtheria. Four other 91 children from the same class, absent from school, were found to be nursed at home for a "sore throat." These were in fact suffering from a bad type of diphtheria, and were removed to Hospital. I recommended the immediate closure of this school. IJ'hds was carried out and resulted in a cessation of the disease. (c) Measles and German Measles.—790 cases were notified from the schools in 1920, compared with 645 during 1919. In February there was such an outbreak at the Uphall Junior Mixed JSchool compared with the other schools in the district, 'that I recommended its closure, which was followed by satisfactory results. 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 1920 154 130 790 (d) Chicken Pox and Whooping Cough.—172 cases of Whooping Cough occurred in 1920, as compared with 15 in l919; and 116 cases of Chicken Pox, as compared with 263 in 1919. These figures do not call for any social remarks. (e) Ringworm.— No. of Cases at beginning of 1920. No, of cases reported during 1920. Total. Remedied during 1920. No. of cases under observation at end of 1920. Ringworm :— Scalp 15 39 54 39 15 Body 2 34 36 33 3 17 73 90 72 18 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 32 school children were X-rayed during the year. 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. 92 Three cases attended the school clinic from private schools in the district, and were referred to the X-ray operator, the whole of the fees being paid by the parents of the children concerned. 7. Following up.—This has been put on a satisfactory basis during the past year. The parent of every child who at school was found to be suffering from a physical defect, receives a printed notice from this department. The parent is visited within six months by a school nurse in order to see if the treatment recommended has been carried out, and the child is examined again at school by a doctor to see if such treatment has been carried ouit in a satisfactory manner. During 1920 729 home visits by the nurses were thus paid, and 598 children were re-examined by the doctors at school. In many cases the parents do not fully appreciate the necessity of obtaining treatment, until after a visit has been paid by the nurses to the home. 8. Medical Treatment.— (a) Treatment of Minor Ailments.—A clinic is held at the Public Health Department each morning at 9 o'clock. The waiting-room and treatment accommodation has previously been of a very limited and unsatisfactory character, and in the summer of 1920 a new dark-room for the Oculist was built, the waiting-room accommodation increased, and a room for the treatment of minor ailments adapted for the purpose. A large number of minor ailments, especially skin diseases, received treatment. Records are kept, and certificates of exclusion from school or fitness to attend are given. The children attending the school clinic are :— (1) Sent up by the Teachers. (2) Brought by their parents. (3) Referred from medical inspection at school. (4) Referred by the school nurses as a result of "following up.'' (5) Referred by the school attendance officers. The attendances at the Clinic during 1920 were as follows :— Number of individual children seen at the Clinic 1,763 Number of attendances of children 7,125 Number of exclusion certificates granted 4,776 Number of certificates of fitness to attend school granted 1,378 93 The following table shows the variety of ailments dealt with at the school clinic during the year:— Ailments of children attending the school clinic:— Uncleanliness: — Head 68 Body 5 Skin:— Ringworm: — Head 39 Body 34 Scabies 116 Impetigo 546 Other Diseases 147 Eye:— Blepharitis 33 Conjunctivitis 13 Corneal Ulcer 11 Corneal Opacities 4 Defective Vision 34 Other conditions 24 Ear:— Defective Hearing 15 Otitis Media 4 Other Ear Diseases 38 Nose and Throat:— Enlarged Tonsils 17 Adenoids 7 Enlarged Tonsils and Adenoids 34 Other conditions 260 Enlarged Cervical Glands 45 Teeth—Dental Diseases 46 Heart and Circulation:— Functional 2 Anæemia 23 Lungs:— Bronchitis 10 Other Non-Tubercular Diseases 6 Tuberculosis:— Pulmonary: — Suspected 1 Non-Pulmonarv:— Glands 3 Other forms 2 Nervous System :— Chorea 9 Deformities 5 Other Defects and Diseases 544 Total number of Ailments 2,205 The work is gradually increasing, as it becomes more known and appreciated by the parents. The present accommodation is only likely to suffice for a very short period. 94 The extent to which this portion of the School Medical Service has made progress is seen by the following :— 1920 1919 Number of individual Children teen 1,763 962 (b) Ophthalmic Department.— During the year 1920 the School Oculist, Dr. Charsley, held 40 sessions and the Assistant Medical Officer 2 sessions, for Che refraction of children suffering from defective vision. A total number of 464 children were examined, 13 of these being cases held over from 1919. Of the 464 cases, 370 were referred as a result of medical inspection, and 94 from the school clinic. Of the 464 children examined, 404 were found to require spectacles by reason of the following defects :— Myopia 24 Myopic Astigmatism 24 Hypermetropia 78 Hypermetropic Astigmatism 204 Mixed Astigmatism 22 Myopia with Squint 16 Squint only 4 Anisometropia 32 Total 404 Of the remaining 60 children, 52 were suffering from the following other diseases :— Nystagmus 1 Coloboma 2 Lamellar Cataract 1 Corneal Nebulæ 7 Phlyctenular Ulcers 23 Other cases examined and no defect discovered 18 52 Cases requiring operative treatment and recommended to Hospital 8 Total 60 A number of children (55) were kept under observation and were re-examined, the spectacles being changed in 13 instances. 95 The continued increase in the work in this department is seen from the following table : Total number of individual children examined by the School Oculist:— 1916 60 1917 276 1918 189 1919 368 1920 464 Under the Education Committee's scheme 404 pairs of spectacles were provided; of this number 12 pairs of spectacles were provided free and 10 pairs partly free of charge, on necessitous grounds. In addition, spectacles were renewed or repaired in 76 cases. All spectacles are now provided by the Education Committee, the cost being recovered from the parents whenever possible. In a few cases the parents prefer to take the prescription and obtain the spectacles from other than the Council's Opticians, who continue to supply spectacles at as moderate a charge as possible. The appreciation of the work of the Oculist by the parent is shown by the fact that 70 per cent. of the defects of vision detected in 1920 were remedied by the Council Oculist. Further details of this work can be seen by reference to Table IV. B. (c) Dental Department.— Mr. C. F. Rose continued giving days a week during school terms until 21st August, when Mr. S. F. Greenfield, the newly-appointed whole-time Dentist, took up his duties. The latter officer now gives the whole of his time to School Medical Service work, with the exception of one morning weekly devoted to Maternity and Child Welfare work, and one afternoon given to the treatment of Tuberculosis cases. During the year the Dentist paid 39 visits to the schools for the purpose of inspecting the teeth of children. All children between the ages of 6 and 8 years are examined by the School Dentist at the schools. Notice is sent to the parents 96 when their children are found to require treatment. The above age-group is selected, as it is at the age of 6 years that the first permanent teeth make their appearance. The extent to which dental disease is prevalent among school children is shown by the fact that of 4,188 children inspected by the Dentist, 3,025, or 72 per cent., were found to require treatment. Further details of. the work can be seen by reference to Table IV. (D. 1 and 2). (d) Treatment of Uncleanliness.— It was not found necessary during the year to deal with any children under the Children's Act, 1908, Section 122. The School Nurses paid 74 visits to the schools, for the purpose of inspecting the heads and clothing of the children, with the following result :— Number of Children Inspected. Number Infected. Per Cent. 13,325 1,400 10 In each case, where vermin or nits are found, notice is sent to the parent, and where vermin are found, the child is excluded from school until it has been cleansed. In a number of cases the parents have voluntarily consented to the cleansing of the children by the Nurse at the clinic, thus obviating the necessity of legal proceedings or service of statutory notice under the Act. (e) Treatment of other Ailments.— An arrangement has been made with Queen Mary's Hospital, West Ham, by which letters for free treatment for Ilford children can be obtained, and in 1920, 120 were given for children who required hospital treatment or whose parents were unable to afford ordinary medical advice. It is proposed to make a definite grant to this hospital by the Education Committee, by which a sum of money is to be paid for each Ilford child operated upon for enlarged tonsils and adenoids, and for whom treatment is recommended by the School Medical Officer. It will thus be possible for a much better supervision of these oases by the School Medical Officer than at the present time. 97 The provision of the Children's Hospital by the Ilford War Memorial Committee is still under consideration. There can be no question of the need of such a hospital in Ilford, owing to the difficulty of obtaining hospital treatment for children, due to the present overcrowded condition of hospitals, and the difficulty of obtaining adequate financial support for their greatly increased cost of upkeep. 9. Open- Air Education.— There is no open-air school in Ilford. I pointed out in my last report the need for such a school in this district. At the end of the year 1920, 20 children who were pre-tubercular were attending the Tuberculosis Dispensary. 10. Physical Training.— The following is the report of the Area Organiser of Physical Training :— I. Staff. At present I am the only Instructor in Physical Training employed by the Local Education Authority. I commenced my duties as Supervising Instructor in Physical Training on 26th August, 1918, and was provisionally recognised by the Board of Education as an Organiser in Physical Training on 27th October, 1919, for a period of one year, subsequently receiving the Board's full recognition on 14th November, 1919. II. Duties and Organisation. My full-time duties, which are governed by the requirements of the Board of Education's Syllabus of Physical Training for Schools, 1919, are of an advisory and supervisory character as regards the teaching of physical exercises, inclusive of swimming instruction and organised games, throughout the whole of the local public elementary schools; they comprise also staff conferences and practical demonstrations. III. Special Features. (а) The general aim has been to inculcate a love of healthy physical exercise in the children, and to broaden the scope of physical education in the schools; to include in such education, and as a definite part thereof, organised games and sports; and to afford expert advice and guidance to the teaching staff generally. The possibilities of the remedial treatment of certain physical defects by means of suitably selected and carefully graded exercises have also been borne in mind. (b) Classes have been periodically arranged for members of the local teaching staff. During the past year eight such classes have been held, three for men and five for women; the approximate average attendance at these classes has been thirty. In the conduct of the classes the staff attending have shown gratifying enthusiasm and appreciation. The demonstrations have included the recognised exercises and games, and have been first given personally by myself, and then practised by the class. 98 (c) On 20th October, 1919, an official visit of inspection of the work of the schools in physical exercises was made by Mr. Grenfell, H M.I. for Physical Training, accompanied by H.M.I. Mr. Biddle and Mr. Parker of the Board of Education, when consultations were held at the Education Offices, a number of schools visited, and a general inspection made of the practical instruction covered by the Authority's scheme for physical education. One of the suggestions arising out of this visit of inspection gave rise to my present practice of visiting a separate department for the whole of each school session, instead of, as previously, visiting as many departments as possible during the school day and arranging such visits in accordance with school timetables. Under the present scheme of visitation I am able to keep in close touch with the work throughout the schools; generally speaking, each department has been visited about ten times in the course of a year's working, and such visits are recorded in my personal time-table and submitted weekly to the Education Secretary for inspection. The detailed method I employ is to observe the teacher at work on the table for the lesson, to advise when necessary, and occasionally to take the class myself in the exercise or game. This procedure appears to be effective and stimulating. "When necessary, the staff of the department have been called together by the Head Teacher, and I have given a demonstration on points of difficulty. The time allotted to physical exercises is generally three lessons, each of twenty minutes' duration, per week, with one additional lesson devoted to organised games. (d) A new feature has been introduced during the past year by my demonstrations in the presence of parents, particularly of those whose children are in attendance in the Girls' Departments, the object of the demonstrations being to emphasise the need for girls being provided with suitable costumes, in order that the exercises may be efficiently and profitably performed. This departure has been greatly appreciated by the parents, and has met with marked success. (e) With one exception, each senior department under the Authority takes part in the swimming instruction; much interest is evidenced in this particular instruction, and a successful gala was held at the end of the season. The method of instruction adopted is that recommended by the Board of Education in Appendix D of their Syllabus of Physical Training for Schools, 1919, namely, the handbook therein referred to and issued by the Amateur Swimming Association. Further reference to the subject will be found in Section V. of this report. IV. Review of General Position. (a) All branches of the teaching staff have voluntarily attended the special demonstrations arranged on their behalf. An increased interest in the work of physical education has been obviously engendered, and its influence has been reflected in the keen and enthusiastic work of the children. (b) School Championship Leagues have been formed for Football and Netball. (c) The Authority have, where possible, provided additional open spaces for organised games. 99 (d) The teaching staff have instituted a Schools' Sports Federation to link up the whole of the activities of the several branches of school sports under one controlling and advisory body. (e) The Authority provide all necessary apparatus for organised games. V. Recommendations fob Improvement and Development. (а) It would be an advantage to have on the staff of each of the large schools at least one specially qualified teacher devoting either whole time or a substantial part thereof to the work of physical education. (b) The local provision of accommodation for the teaching of swimming is quite inadequate, and the need for increased and more modern facilities is very real. F. J. ROBERTS, Supervising Instructor in Physical Training. 5th April, 1921. 11. Provision of Meals.— There did not arise during the year any necessity to put into force the provisions of the Education (Provision of Meals) Acts, 1906-1914. When necessary, meals are supplied from voluntary sources, and during the year I understand, no such meals were supplied. 12. School Baths.— There are no school baths provided at the elementary schools. The present public bath provision in Ilford is inadequate. It comprises a swimming bath 60 ft. by 20 ft., and 6 slipper baths. Plans for new swimming baths were approved by the Council before the War, and were to have been erected on land already purchased in the High Road, east of St. Mary's Church. Provision was made for two swimming baths, respectively 100ft. by 35 ft., and 75 ft. by 25 ft., and 10 men's and 10 women's slipper baths. In consequence of difficulties in providing these, the Council is now proposing to make an open-air swimming bath, 165 ft. by 55 ft., to be erected on land to be given to the town by the Corporation of the City of London. 13. Co-operation of Parents.— As a whole, the parents have supported the work of the School Medical Service. All are notified when their children are to be examined at the school by the doctor, and in 1920 3,295 parents, or 63 per cent., attended the medical inspections. 100 14. Co-operation of Teachers .—The teachers in Ilford have very much facilitated the work of medical inspection. I have already referred to the great assistance they have given with the clerical duties. They have also taken an interest in the general course of the work, and in bringing to the notice of the Medical Officer any children thought to be physically or mentally defective. 15. Co-operation of School Attendance Officers.— The School Attendance Officers render assistance in making preliminary enquiries as to cases of minor infectious disease, and in referring cases to the school clinic. Copies of all exclusion and fitness-to-attend certificates are sent from the Public Health Department to these officers for their information. The officers frequently attend at the Public Health Offices in order to give or obtain particulars with reference to children who are absent from school. 16. Co-operation of Voluntary Bodies.— The Council permitted me to- take the office of Hon. District Correspondent for the National Society of Prevention of Cruelty to Children. This has brought me into very close touch with the work that (has been carried out in this district during the year 1920, and I must refer to the very excellent services rendered by Inspector Martin. The fact that such a tactful and able officer is performing the duties (in Ilford has been a great asset to the work of this department. The following is a resume of the work done by the Society in Ilford during the past year:— Total number of complaints investigated 31, which were made up as follows:— (1) Of neglect 25 (11 cases reported from the Public Health Department, 8 of which were neglecting medical advice, involving 14 children. 3 were general neglect.) (2) Ill-treatment 3 (3) Other wrongs 3 All the cases were improved without any prosecution. 96 children were involved, 62 children being of school age. Of the 101 96 children (50 boys and 46 girls) 10 were under two years of age. In addition, 151 visits were paid to different cases. On several occasions I have referred to the Inspector cases of parents who had refused to carry out the treatment recommended. In one particular case a girl had been recommended in 1914 for treatment for enlarged tonsils and adenoids, she suffered from severe deafness, and her progress at school was retarded in consequence. A visit by the Inspector resulted in the girl being sent to Hospital for operative treatment, with the result that her deafness has cleared up, and marked improvement in her physical health has resulted. Similar successful results have been obtained in other cases, without any necessity for prosecution. 17. Physically and Mentally Defective Children.—A return of all children falling within this category is included in Table III., information having been obtained from the records in this department and from a circular addressed to all the Head Teachers of the various public elementary schools. (a) Physically Defective Children.— 1st. Blind Children.—There are four children who are so blind as to be unable to profit by education in an ordinary school. One of these is attending a certified school for the blind. Two cases are awaiting admission to such a school, and one is physically unfit to attend school. 2nd. Deaf and Dumb Children.—There are five deaf and dumb children. Of these one is deaf and dumb, and four are deaf only. All are in attendance at certified schools for the deaf. Two of these Children were first examined in 1920. 3rd. Epileptic Children.—There are 11 epileptic children known to the department. This, however, must be a small proportion of the children so affected. One of these children is in a certified school for Epileptics. Another is away from school and is awaiting admission to such an institution. 4th. Tuberculous Children.—There are 29 school children suffering, or who have suffered, from Pulmonary Tuberculosis, and who are attending public elementary schools; three are in (sanatoria, and five are physically unfit to attend school. 102 oth. Crippled Children.— It will be seen that there are a •number of children crippled, due to various causes, who are attending school. Crippling varies from a slight degree of lameness to cases in which special chairs have had to be arranged in the class-rooms to accommodate the children concerned. 6th. Heart Disease.— There are 22 children attending school who are suffering from such a degree of cardiac disease that it has been necessary to notify the Head Teacher that special care should be given to such children, and in many cases that they should be excluded from physical drill. (b) Mentally Defective Children.- (a) Dull or Backward Children.— It will be seen from Table III. that there are 202 children who are two years behind in their education at school, and 57 who are retarded three years. These figures have been obtained from the Head Teachers of the various schools, and the children have not been specifically examined for that purpose. Their backwardness may be due to many causes, such as loss of education through commencing school at a later age than usual, frequent absence (from, school owing to ill-health, and frequent changes in the schools attended. It must not, therefore, be thought that all of these children can be considered to be abnormal. (b) Idiots.— Idiots are, within the meaning of the Mental Deficiency Act, 1913, persons so defective in mind from an early age, as to be unable to guard themselves against common physical dangers. The Authority tor dealing with such children is the Essex County Council. There are five cases known to this department, two being notified during the present year. (c) Imbeciles.— Imbeciles are persons whose mental defectiveness does not amount to idiocy, yet is so pronounced that they are incapable of managing themselves or their affairs; or in the case of children, of being taught to do so. The Authority responsible for dealing with these children is also the Essex County Council. There are nine such children known to this department. 103 (d) Feeble-minded Children.— Feeble-minded children are those whose mental defectiveness does not amount to imbecility, yet is so pronounced that they are incapable of receiving proper benefit from instruction in an ordinary school. The Authority 'responsible for the proper instruction of these children is the Local Education Authority. There are 16 such cases under the age of 16 years known to me, of whom seven are attending; an ordinary school, three are in a residential school, and six are not at school. Arrangements have been made during the past year, with a view to adapting the Junior Mixed Department of the Newbury Park School as a special school for such children, and this no doubt will be in working order during the present year. The Mentally Defective (Notification of Children) Regulations, by which the School Medical Officer is the Certifying Officer, came into force on the 1st April, 1914. A census was made of the school children by the Attendance Officers in October, 1914, and all children suspected of being mentally defective were examined by the School Medical Officer. Since that date children suspected of being mentally defective are referred to the School Medical Officer, either by the Teachers, the School Attendance Officers, or, occasionally, by the parents. Since the date of the above-mentioned regulations a number of children have been examined. A complete list is given below of those children who have been found to be either— (a) Mentally defective, but educable. (b) Idiots or imbeciles. together with information as to the present position of the children concerned. I have been in communication with Miss Neville, the Secretary of the Essex Voluntary Association for the Care of the Mentally Defective, and she has very kindly allowed me to inspect the whole of the reports of the cases which are on the books of her Association. It appears from these that there are a number of mentally defective persons in Ilford who have reached adult age and who are pursuing various occupations. I append a list of these cases, as they are of considerable social interest. 104 I. Feeble- Minded Persons. Case No. Age Years. Sex. Certified. Present occupation. 1 15 F. 1915 At home. No occupation 2 17 M. 1915 At home. No occupation 3 16 M. 1915 Working at a factory 4 18 F. 1915 In Colchester Asylum 5 17 M. 1915 In Colchester Asylum 6 18 F. 1915 At home. No occupation 7 17 M. 1915 Is a sailor 8 16 F. 1915 At home. No occupation 9 16 F. 1915 At elementary school 10 17 M. 1915 Lett district 11 17 F. 1915 Working at a factory 12 18 F. 1915 At home. No occupation 13 17 F. 1915 At home. No occupation 14 17 F. 1915 At home. No occupation 15 16 M. 1915 Apprenticed to a plumber 16 17 M. 1915 Working at a leather works 17 18 M. 1915 Working as stable boy 18 17 M. 1915 Died 19 12 F. 1915 In Colchester Asylum 20 13 M. 1916 At elementary school 21 10 M. 1917 At private school 22 16 M. 1917 In Colchester Asylum 23 15 F. 1917 Left district 24 10 M. 1919 At elementary school 25 14 F. 1919 In Colchester Asylum 26 12 M. 1919 At elementary school 27 10 F. 1919 At elementary school 28 11 M. 1920 At elementary school 29 8 M. 1920 At elementary school 30 15 F. 1920 At home. No occupation (a) 22 F. - At home. Has one illegitimate child No occupation (b) 21 F. - At home. No occupation (c) 19 F. - Domestic service (d) 16 M. - At home. No occupation (e) 17 F. - At home. No occupation. Has one illegitimate child (f) 19 M. - Working as labourer. Has been prosecuted for indecent assault 105 II. Idiots and Imbeciles. Case No. Age Years. Sex. Certified. Present occupation. 1 21 M. 1915 Lett district 2 14 F. 1915 At home 3 12 F. 1915 At home 4 16 M. 1915 At home 5 14 F. 1915 Left district 6 16 F. 1915 At home 7 17 F. 1915 Left district 8 14 M. 1915 At home 9 20 M. 1915 At home 10 21 M. 1915 In Colchester Asylum 11 19 F. 1915 In Colchester Asylum 12 12 F. 1915 Died 13 13 M. 1915 Left district 14 14 M. 1915 Left district 15 19 F. 1915 At home 16 21 M. 1915 Left district 17 17 M. 1915 Died in Colchester Asylum 18 20 F. 1915 Left district 19 14 F. 1916 At home 20 14 F. 1917 Died 21 11 M. 1917 In Colchester Asylum 22 12 F. 1917 At home 23 12 F. 1919 Left district 24 14 M. 1920 At home 25 9 F. 1920 In Colchester Asylum 26 7 F. 1920 At home 106 18. Nursery Schools.— There are no nursery schools under the Local Education Authority. Reference was made to this subject in my last Annual Report. 19 and 20. Secondary and Continuation Schools —These fall within the jurisdiction of the Essex County Council. 21. Employment of Children and Young Persons.— From special enquiries made at the various schools during the latter end of 1920 it was found that 366 children were employed out of school hours. During the past year byelaws have been approved by the Council under the provisions of the Employment of Children Act, 1903, and Education Act, 1918. They are at present awaiting the sanction of the Home Office. It will be seen therefrom that a very complete supervision of the children concerned, by the School Medical Officer, will be carried out. It is proposed to strengthen the byelaws by enacting that no child will be allowed a licence for street trading, unless a certificate has been issued by the School Medical Officer that the child is physically fit for such employment. A few children in Ilford are employed in theatrical work, and during the past year three children were examined under Section 13 of the Education Act, 1918, by the School Medical Officer as to their physical fitness for such work. BYELAWS made by the ILFORD URBAN DISTRICT COUNCIL under the Provisions of the Employment of Children Act, 1903, and the Education Act, 1918, for regulating within the URBAN DISTRICT OF ILFORD the employment of children and street trading by young persons. I.—As xo the Interpretation of Terms. Throughout the appended byelaws the following words and expressions have the meanings hereinafter respectively assigned to them, namely:— (a) The expression "child" means a person under the age of 14 years. (b) The expression "guardian" used in reference to a child, includes any person who is liable to maintain or has the actual custody of such child. (c) The expressions "employed" and "employment," used in reference to a child, include employment in any labour exercised by way of trade or for the purposes of gain, whether the gain be to the child, or to any other person. 107 (d) The expression "street trading," includes the hawking of newspapers, matches, flowers, and other articles; playing, singing, or performing for profit; shoeblacking; and any other like occupation carried on in the streets or public places. (c) The expression "industrial work" means any work in which manual labour is exercised by way of trade, or for the purposes of gain in making, altering, repairing, ornamenting, finishing, adapting for sale, or cleaning any article. (/) The expression "Local Education Authority" means the Local Education Authority for the purposes of Part III. of the Education Act, 1902. II.—As to Prohibited Employments. 1.—A child shall not be employed in any of the following occupations : — (a) To lather customers, or in a similar occupation, in a barber's or hairdresser's shop. (b) In the kitchen of any hotel, cook-shop, eating-house, or refreshment room. (c) As a marker or attendant in any billiard or bagatelle saloon, or other place licensed for games. (d) In or in connection with the sale of intoxicating liquors, except in grocers' or chemists' shops where such liquors are sold exclusively in sealed vessels. (e) In selling programmes or refreshments or other articles, or in taking checks or tickets, or in shifting scenery, in any theatre, cinematograph hall, or other place of public entertainment. (f) In the collection or sorting of rags or refuse. (g) As an attendant or assistant in any shop or hall used for the purpose of public amusement by means of automatic machines, mutoscopes, shooting ranges, games of chance or skill, or similar devices. (h) In any slaughter-house. III.— As to the Employment of Children Generally. 2.—A child under the age of 13 years shall not be employee. 3.—A child between the ages of 13 and 14 shall only be employed :— (a) On days when the school attended is open for morning or noon session, between the hours of 5 p.m. and 7 p.m. (b) On days other than Sundays when the school attended is not open, between the hours of 9 a.m. and 12 noon, except in the delivery of milk or newspapers, in which occupations such child may also be employed between the hours of 7 a.m. and 8 a.m. (c) On Sundays, in the delivery of milk or newspapers, between the hours of 8 a.m. and 10 a.m. 4.—A child between the ages of 13 and 14 shall not be employed in the delivery of milk or newspapers, or in carrying or delivering goods or parcels, or in or in connection with any shop, or in any coal yard, or in industrial work at home, or in agricultural work, unless within thirty days after these byelaws come into operation, or, in the case of a child not so employed until after that date, within fourteen days from the date when employment begins, the child has obtained from the School Medical Officer a certificate (for which no charge shall be made), that such employment will not be prejudicial to such child's health or physical development and will not render the child unfit to obtain the proper benefit from education, and the certificate has been produced to and endorsed by the employer. 108 5.—In all cases where a child is employed in the delivery of milk or newspapers, the employer shall see that such child is provided during the course of such employment with efficient waterproof footwear and a sufficient waterproof garment to protect the child from injury to health from inclement weather. 6.—A child employed in a place of public entertainment, in pursuance of a licence under Section 3 of the Prevention of Cruelty to Children Act, 1904, shall not be employed on the day or days of, or the day following, such employment, in any other employment. IV.—As to the Registration or Employers and of Children Employed in Specified Occupations. 7.—A child between the ages of 13 and 14 shall not be employed in the delivery of milk or newspapers, or in carrying or delivering goods, or parcels, or in or in connection with any shop, or in any coal yard, or in industrial work at home, or in agricultural work, unless the employer keeps available for inspection by any Officer of the Local Education Authority a written record showing the name and address and date of birth of the child, and the occupation in which, and the place at which, and the hours between which such child is employed, and unless the employer sends to the Local Education Authority on the first day of April and October, in each year, a list showing the same perticulars in respect of every such child then employed by such employer. V.—As to Street Trading by Young Persons between the ages of 14 and 16. 8.—A girl under the age of 16, and a boy under the age of 15 shall not be employed or engage in street trading. 9.—A boy under the age of 16 shall not be employed or engage in street trading before 7 a.m. or after 8 p.m. on any week day, and not at any time on a Sunday. 10.—A boy under the age of 16 engaged in street trading shall not enter any premises licensed for public entertainment, or for the sale of intoxicating liquor for consumption on the premises, for the purposes of trading or delivering goods. 11.—A boy under the age of 16 shall not be employed or engage in street trading unless furnished with a licence from the Local Education Authority. 12.—A licence to engage in street trading shall not be refused by the Local Education Authority to any boy between the ages of 15 and 16 applying for it, except on one of the following grounds: — (a) That the applicant is by reason of physical or mental deficiency unfit to trade in the streets. (b) That the applicant has not the consent of his parent or guardian to his being so employed. (c) That his licence has been previously revoked. (d) That he is not regularly attending a continuation class, as and when required by law. 13.—Licences shall be granted to expire on 31st December in each year. 14.—Every licensed person while engaged in street trading shall wear in the appointed way the badge prescribed by the Local Education Authority. 109 15.—No charge shall be made by the Local Education Authority for any licence or badge, but a deposit of one shilling (to be refunded on the return of the badge) shall be paid on the issue of the badge, provided that the Local Education Authority may forego the payment of such deposit when the circumstances of the applicant render it desirable. 16.—No licensed person shall, while trading, bo assisted by any unlicensed person under the age of 16 years. 17.—'No licensed person shall in any street or public place tout or importune to the annoyance or obstruction of any passenger. 18.—The Local Education Authority may suspend or revoke any licence on any one of the following grounds, namely, if the holder :— (a) Is convicted of any offence. (b) Commits a breach of any of these byelaws. (c) Uses the licence as a cloak for begging, immorality, imposition, or other improper purpose. (d) Alters, defaces, lends, sells, pawns, transfers, or otherwise disposes of his badge. (e) Fails to notify the Local Education Authority within one week of any change of his residence. (f) Fails to attend regularly at a continuation class, as and when required by law. Repeal of Byelaws. 19.—From and after the date of the confirmation of these byelaws the byelaws which were made by the Council under Sections 1 and 2 of the Employment of Children Act, 1903, on the 28th day of March, 1911, and the 23rd day of September, 1913, respectively, and were confirmed by one of His Majesty's Principal Secretaries of State on the 21st day of June, 1911, and 1st day of December, 1913, respectively, shall be repealed. Note as to Penalties. Any person by whom a child or other person under the age of 16 is employed in contravention of these byelaws is liable on summary conviction to a fine not exceeding Forty Shillings, or, in the case of a second or subsequent offence, to a fine not exceeding Five Pounds; and if any parent or guardian of a child or other person under the age of 16 has conduced to the commission of the alleged offence by wilful default or by habitually neglecting to exercise due care, such parent or guardian is liable on summary conviction to a like fine. If any person under the age of 16 contravenes the provisions of these byelaws as to street trading, such person is liable on summary conviction to a fine not exceeding Twenty Shillings, and, in the case of a second or subsequent offence, if a child, to be sent to an Industrial School, and if not a child, to a fine not exceeding Five Pounds. The above byelaws were adopted by the Council of the Urban District of Ilford at a meeting held on the 26th day of October, 1920. The Juvenile Employment Committee has during the past year found occupation for 249 children (134 boys and 115 girls) out of 686 children (338 boys and 348 girls) registered. Arrangements are being made for the Committee to be supplied by the School 110 Medical Officer with particulars as to the fitness of children leaving school, in order to assist them in finding suitable occupation for such children. 22. Miscellaneous.— In accordance with the Education Committee's Regulations, all bursars, student-teachers and teachers new to the Authorityare medically examined by the School Medical Officer; also teachers who have been away ill for more than seven days in 12 months without medical certificate or for 30 days in 12 months with medical certificate. During the year the following were medically examined and reported upon:— Bursars 18 Student-teachers 13 Newly-appointed Teachers 19 Teachers absent through illness 7 Total 57 Re-Examinations:— Bursars 2 Student-teachers 3 Newly-appointed Teachers 1 Total 6 23. General Physical Condition.— The tables VIIIa. and VIIIb. show the average heights and weights of Ilford school children, compared with those of elementary school children in England and Wales based on upwards of 800,000 observations recorded in School Medical Officers' Reports and tabulated by Mr. Arthur Greenwood in 1913. It will be seen that as a whole Ilford children compare favourably with those of other districts. 24. Results of Treatment.— Tables A., B. and C. show the results of medical treatment, and are, on the whole, satisfactory. A large proportion of the children recommended for treatment have actually received some form of treatment. Many cases are still under observation by this Department, and will doubtless receive treatment during the year. 111 TABLE I.— Number of Children Inspected 1st January, 1920, to 31st December, 1920. A.— Routine Medical Inspection. ]Age Entrants. 3. 4. 5. 6. Other Ages. Total. Boys ... ... 501 263 137 901 Girls ... ... 415 277 133 825 Totals ... ... 916 540 270 1726 Age Intermediate Group. Leavers. Grand Total. 8. 12. 13. 14. Other Ages. Total. Boys 783 572 295 51 83 1784 2685 Girls 626 689 267 23 79 1684 2509 Totals 1409 1261 562 74 162 3468 5194 B.— Special Inspections. Special Cases. Re-Examinations (i.e., No. of Children Re-Examined). At Clinic. Med. Ins. at School. At Clinic. Med. Ins. Boys 937 71 881 319 Girls 826 98 784 279 1763 + 169 = Total 1932 1665 + 598 = Total 2263 C.— Total Number of Individual Children inspected by the Medical Officer whether as Routine or Special Cases (no Child being counted more than once in one year). No. of Individual Children inspected. Medical Inspection 5363 Clinic 1763 Total 7126 112 TABLE II.— Return of Defects found in the course or Medical Inspection in 1920. Defect or Disease Routine Inspections Specials Number referred for Treatment Number requiring to be kept under observation, but not referred for Treatment Number referred for Treatment Number requiring to be kept under observation, but not referred for Treatment (1) (2) (3) (4) (5) Malnutrition 1 - - - Uncleanliness— Head 122 - 68 - Also se e Report on "Surveys of Cleanliness." Body 13 - 5 - Also see Report on " Surveys of Cleanliness." Skin Ringworm- Head 5 - 39 15 Body 5 - 34 - Scabies 30 - 116 - Impetigo 40 - 546 - Other Diseases (non-Tubercular) 5 - 147 - See also Table IVa. Eye Blepharitis 13 - 33 - Conjunctivitis 1 - 13 -. Keratitis - - - - Corneal Ulcer - - 11 - Corneal Opacities - - 4 - Defective Vision 570 - 94 - Squint 4 - - - Other Conditions 2 - 24 - Ear Defective Hearing 37 - 15 - Otitis Media 9 - 4 - Other Ear Diseases 11 - 38 - Nose and Throat Enlarged Tonsils 220 4 17 - Adenoids 51 2 7 - Enlarged Tonsils and Adenoids 27 - 34 - Other Conditions 10 - 260 - Enlarged Cervical Glands (Non-Tubercular) 12 - 45 - Teeth— Defective Speech 5 - - - Dental Diseases 441 - 46 - Also see Table Id. (Summary of Work of School Dentist). Heart and Circulation Heart Disease— Organic 20 1 - - Functional 3 3 2 - Anæmia 6 - 23 - Lungs Bronchitis 32 - 10 - Other Non-Tubercular Diseases 6 3 6 - Tuberculosis Pulmonary- Definite - - - - Suspected - 6 1 - Non-Pulmonary— Glands 2 1 3 - Spine - - - - Hip - - - - Other Bones and Joints 1 - - - Skin - - - - Other Forms - - 2 - Nervous System Epilepsy - - - - Chorea 4 1 9 - (Other conditions - - - - Deformities Rickets - - - - Spinal Curvature 1 - - - Other Forms - - 5 - Other Defects and Diseases 37 - 544 - Number of INDIVIDUAL CHILDREN having Defects which required Treatment or to e kept under observation— Medical Inspection 1,576 Clinic 1,763 Total 3,339 113 TABLE III.— Numerical Return of all Exceptional Children in the area in 1920. Boys. Girls. Total. Blind (including partially blind) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893 Attending Public Elementary Schools - - - Attending Certified Schools for the Blind 1 - 1 Not at School 1 2 3 Deaf and Dumb (including partially deaf) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893 Attending Public Elementary Schools - - - Attending Certified Schools for the Deaf 4 1 5 Not at School - - - Feeble Minded Attending Public Elementary Schools 5 2 7 Attending Certified Schools for Mentally Defective Children 1 2 3 Not at School 2 4 6 Notified to the Local (Control) Authority by Local Education Authority during the year - - - Mentally Deficient Imbeciles At School (a Residential Institution) 1 - 1 Not at School 3 4 7 Notified to the Local Control Authority by Local Education Authority during the year 1 - 1 Idiots At School (a Residential Institution) - 1 1 Not at School 1 1 2 Notified to the Local Control Authority by Local Education Authority during the year 1 1 2 Epileptics Attending Public Elementary Schools 5 4 9 Attending Certified Schools for Epileptics - 1 1 In Institutions other than Certified Schools - - - Not at School - 1 1 114 TABLE III— continued. Boys Girls. Total. Pulmonary Tuberculosis Attending Public Elementary Schools 16 13 29 Attending Certified Schools for Physically Defective Children - - - In Institutions other than Certified Schools 3 - 3 Not at School 3 2 5 Crippling due to Tuberculosis Attending Public Elementary Schools 8 7 15 Attending Certified Schools for Physically Defective Children - - - Physically Defective In Institutions other than Certified Schools - 3 3 Not at School - 1 1 Crippling due to causes other losis, i.e., Paralysis, Rickets, Traumatism Attending Public Elementary Schools 22 10 32 Attending Certified Schools for Physically Defective Children - - - In Institutions other than Certified Schools 1 1 2 Not at School 4 1 5 Other Physical Defectives, e.g., delicate and other children suitable for admission to openair Schools Attending Public Elementary Schools 21 20 41 Attending Open-air Schools - - - Attending Certified Schools for Physically Defective Children other than Open-air Schools - - - Not at School - - - Children suffering from severe heart disease Attending Public Elementary Schools 9 13 22 Dull or Backward Retarded 2 years 95 107 202 Retarded 3 years 22 35 57 115 Table IV. A.— Treatment of Minor Ailments. Disease or Defect. Number of Children. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Skin— Ringworm (Head) 39 39 - 39 Ringworm (Body) 34 34 - 34 Scabies 146 146 - 146 Impetigo 586 586 - 586 Other skin disease 152 152 - 152 Minor Injuries 59 59 - 59 Ear Disease 114 57 39 96 Eye Disease (external and other) 105 93 10 103 Miscellaneous 851 151 700 851 Totals 2086 1317 749 2066 Table IV. B.— Treatment of Visual Defect. Number of Children. Referred for Refraction. Submitted to Refraction. For whom Glasses were prescribed. For whom Glasses were provided. Recommended for Treatment other than by Glasses. Received other Forms of Treatment. For whom no Treatment was considered necessary Under Local Education Authority's Scheme, Clinic, or Hospital. By Private Practitioner or Hospital. Otherwise. Total. 1 2 3 4 5 6 7 8 9 10 *763 464 39 62 565 460 460 9 9 96 *Col. 1-99 of these cases were from 1919. 116 TABLE IV. C.— Treatment of Defects of Nose and Throat. Referred for Treatment. Number of Children. Received Operative Treatment. Received other Forms of Treatment. Under Local Education Authority's Scheme-Clinic or Hospital. By Private Practitioner or Hospital. Total. 308 59 82 105 101 In addition to the above, 186 children were found to be "mouth breathers," and circular letters were sent to the parents with directions as to treatment. 117 TABLE IV. D.— TREATMENT OF DENTAL DEFECTS. 1. Number of Children Dealt With. Age Groups. Specials. Total. 5 6 7 8 9 10 11 12 13 14 (a) Inspected by Dentist 3,747 441 4,188 (b) Referred for Treatment 2,584 441 3,025 (c) Actually Treated 1,538 441 1,979 (d) *Re-treated (result of periodical examination) 143 - 143 *It is understood that cases under this head are included in (c) above. 2. Particulars of Time Given and Operations Undertaken. Number of half days devoted to Inspection. Number of half days devoted to Treatment. Total number of attendances made by Children at the Clinic. Number of Permanent Teeth. Number of Temporary Teeth. Total number of Fillings. Number of administrations of general Anaesthetics 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 39 172 2,374 275 433 3,218 897 1,330 1,008 Locals 114. 53 44 118 Table V.— Summary of Treatment of Defects as shown in Table IV. (A, B, C, D and F, but excluding E). Disease or Defect. Number of Children. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Minor Ailments 2086 1317 749 2066 Visual Defects 763 464 110 574 Defects of Nose and Throat 356 59 183 242 Dental Defects 3025 1979 - 1979 Other Defects 199 19 166 185 Totals 6429 3838 1208 5046 119 TABLE VI.— Summary Relating to Children Medically Inspected at the Routine Inspections during the Year 1920. (1) The total number of children medically inspected at the routine inspections 5,363 (2) The number of children in (1) suffering from— Malnutrition 1 Skin Disease 95 Defective Vision (including Squint) 574 Eye Disease 16 Defective Hearing 37 Ear Disease 20 Nose and Throat Disease 308 Enlarged Cervical Glands (non-tubercular) 12 Defective Speech 5 Dental Disease 441 Heart Disease— Organic 20 Functional 3 Anæmia 6 Lung Disease (non-tubercular) 38 Tuberculosis— Pulmonary definite - suspected 6 Non-pulmonary 3 Disease of the Nervous System 4 Deformities 1 Other defects and diseases 37 (3) 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) 21 (4) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 1,555 (5) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 1,407 120 ,121 Table VII.— Table shewing number of Children Medically Inspected at various Schools during 1920. Ages—Years. 5—6 6—7 7—8 8—9 9-10 10-11 11—12 12—13 13-14 14—15 Total. SCHOOLS. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. ROUTINE. Barkingside 17 9 1 6 2 3 16 16 2 4 2 1 - - 26 12 2 6 1 1 69 58 Chadwell 21 9 13 9 5 2 18 20 2 3 5 1 2 6 19 26 12 18 - 1 97 95 Christchurch 86 70 54 46 24 28 99 78 74 24 17 5 25 5 86 94 66 57 20 12 551 419 Ch. England I. 23 18 15 17 1 7 - 2 - - - - - - - - - - - - 39 44 Ch England G. - - - - - - - 10 - 3 - 5 - 12 - 13 - 10 - - - 53 Cleveland 42 38 21 27 4 6 50 56 8 15 9 8 4 2 40 40 55 45 9 5 242 242 Downshall 39 26 19 11 7 9 41 43 21 5 7 4 8 1 30 68 27 13 3 - 202 180 Goodmayes 56 46 20 22 19 6 80 60 7 13 5 20 4 11 38 57 17 20 1 - 247 255 Highlands 19 21 16 12 6 7 9 9 1 1 2 15 3 6 7 23 5 1 3 - 71 95 Little Heath 2 8 2 1 - 1 2 10 1 1 - - - - 5 5 2 5 - - 14 31 Loxford 67 53 43 57 27 35 54 50 72 3 20 3 5 9 72 95 47 50 10 2 417 357 Newbury Park 23 18 9 16 22 14 26 23 9 7 1 2 2 - 46 42 7 2 - - 145 124 Roman Catholic 21 18 12 15 4 1 24 25 3 4 2 1 1 9 27 16 14 11 2 1 110 101 South Park 53 46 17 14 5 7 47 52 7 14 2 13 1 4 38 51 13 13 1 1 184 215 Uphall Road 30 31 20 23 8 7 51 62 54 4 11 1 6 - 71 75 20 11 1 - 272 214 Valentines 2 4 1 1 3 - 4 9 1 - - - 1 1 5 6 8 5 - - 25 26 Total 501 415 263 277 137 133 521 525 262 101 83 79 62 66 510 623 295 267 51 23 2685 2509 SPECIALS. Barkingside - - - 2 1 - - - - - - - - 1 - - - - - - 1 3 Chadwell - - - - 1 - - - 1 - 1 - - - - 1 - - - - 3 1 Christchurch 2 1 4 6 2 6 7 3 1 2 - - 1 - - - 2 - - - 19 18 Ch. England I. - - - - - - - - - - - - - - - - - - - - - - Ch. England G. - - - - - - - - - - - - - - - 2 - - - - - 2 Cleveland - - - - - - 1 7 - 3 - 2 - - - 3 - 3 - - 1 18 Downshall - - - - - - - - - 1 - - - - 1 - - 1 - - 2 2 Goodmayes - - - - 1 - 2 1 3 1 1 1 1 - - - 1 - - 1 9 4 Highlands - - - - - - - - - - - 2 - - - 2 - - - - - 4 Little Heath - - - - - 2 - - 1 - - - - - - - - - - - 1 2 Loxford - - - - - - 1 1 - - 1 - - 1 - - - - - 1 2 3 Newbury Park 4 2 1 2 1 2 - 1 4 3 - 5 4 1 - - - 2 - - 14 18 Roman Catholic - - - - 2 1 - 4 1 4 3 2 4 - - - - - - - 10 11 South Park - - 2 2 3 2 1 - - - - 2 - - - 1 - - - - 6 7 Uphall Road - - - - 2 - 1 - - 1 - 3 - 1 - - - - - - 3 5 Valentines - - - - - - - - - - - - - - - - - - - - - Total 6 3 7 12 13 13 13 17 12 15 6 17 10 4 1 9 3 6 - 2 71 98 Total Number of Children Examined 5363. Grand Total 2756 2607 123 122,123 Table VIII. A.— Table Showing the Average Heights and Weights of the BOYS Examined. School. Age Groups. Age Groups. 5-6 years. 6-7 years. 7-8 years. 8-9 years. 9-10 years. 10-11 years. 11-12 years. 12-13 years. 13-14 years. No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children | Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds. No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). Barkingside 17 41.73 39.67 1 45.27 40.47 2 43.30 39.23 16 47.24 51.13 2 50.39 52.89 2 51.18 59.28 - - - 26 55.90 75.37 2 59.84 89.04 Chadwell 21 42.51 39.67 13 44.48 41.87 5 47.63 50.69 18 48.42 52.89 2 51.18 61.71 5 52.36 61.71 2 53.14 63.91 19 55.51 72.73 12 51.96 74.73 Christchurch Rd. 86 43.72 42.83 54 44.73 49.21 24 47.28 52.60 99 48.48 54.98 74 50.48 5953 17 52.01 64.32 25 52.91 68.31 86 56.78 73.15 66 58.34 82.37 Ch. of Eng. (Infts.) 23 42.12 42.41 15 44.12 42.21 1 44.12 46.78 - - - - - - - - - - - - - - - - - - Cleveland Rd. 42 42.91 41.27 21 44.09 43.32 4 46.45 46.75 50 48.81 53.47 8 50.78 61.57 9 52.75 65.34 4 53.54 71.26 40 57.48 85.73 55 57.48 78.25 Downshall 39 44.48 40.33 19 44.09 43.19 7 46.85 52.67 41 49.99 53.11 21 51.55 61.71 7 51.18 58.40 8 55.11 70.08 30 55. 90 80.66 27 57.48 81.10 Goodmayes 56 42.90 41.72 20 45.71 48.73 19 46.42 48.32 80 45.32 54.21 7 52.77 63.21 5 52.16 64.41 4 53.91 68.72 38 56.79 74.91 17 5912 85.98 Highlands 19 43.00 40.11 16 44.01 43.44 6 46.15 50.14 9 50.40 59.91 1 54.70 62.01 2 50.43 57.81 3 54.71 68.67 7 55.91 76.82 5 54.50 73.20 Little Heath 2 43.01 39.71 2 42.91 39.37 - - - 2 48.82 54.00 1 49.29 56.21 - - - - - - 5 54.37 68.87 2 57.49 75.63 Loxford 67 42.14 40.21 43 43.84 44.61 27 46.13 49.57 54 50.42 54.60 72 51.61 61.75 20 53.20 64.34 5 56.30 77.63 72 57.11 77.96 47 59.42 86.11 Newbury Park 23 41. 25 38.62 9 40.12 44.50 22 44.31 49.40 26 48.52 52.97 9 48.50 57.32 1 50.82 63.05 2 55.51 68.34 46 54.36 75.41 7 56.21 79.12 Roman Catholic 21 41.00 40.61 12 42.14 42.56 4 47.26 47.42 24 49.39 53.94 3 48.89 52.98 2 55.81 68.24 1 54.37 74.71 27 54.31 72.78 14 57.51 79.28 South Park 53 42.14 42.34 17 44.23 43.92 5 47.72 46.20 47 49.73 50.81 7 48.99 52.93 2 50.43 60.97 1 61.42 78.39 38 56.42 75.42 13 58.76 85.67 Uphall Rd. 30 41.52 41.57 20 43.30 43.48 8 45.79 52.40 51 46.98 52.89 54 48.83 57.69 11 49.72 59.70 6 53.20 66.01 71 55.12 69.87 20 56.91 75.76 Valentines 2 40.12 35.30 1 46.28 46.32 3 45.47 45.71 4 47.21 51.41 1 48.81 48.13 - - - 1 52.41 70.26 5 54.31 74.12 8 55.68 76.70 Average Heights and Weights of Ilford Children 501 42.71 40.32 263 43.27 46.71 137 47.60 51. 06 521 48.87 53.56 262 50.65 58.66 83 52.17 63.48 62 53.98 71.28 510 56.98 74.59 295 5813 81.93 Anthropometric Standard (Boys). Ages. Ages. 5 years. 6 years. 7 years. 8 years. 9 years. 10 years. 11 years. 12 years. 13 years. Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). 40.68 38.68 42.83 42.24 45.04 46.40 47.39 52.00 49.18 55.90 50.84 60.35 52.98 66.41 54.88 72.66 56.07 77.40 124 125 School. Table VIII. B.—Table showing the Average Heights and Weights of GIRLS Examined. Age Groups. Age Groups. 5—6 Years. 6—7 Years. 7— Years. 8—9 Years. 9—10 Years. 10—11 Years. 11—12 Years. 12-13 Years. 13—14 Years. Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children j Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children j Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children 1 Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Barkingside 9 41.73 35.92 6 39.76 42.31 3 47.63 49.59 16 48.26 49.97 4 49.60 59.50 1 50.30 46.72 - - - 12 53.93 69.42 6 56.29 74*.27 Chadwell 9 42.51 37.46 9 44.48 42.13 2 44.88 44.08 20 48.03 49.49 3 47.60 53.77 1 52.75 54.10 6 52.75 62.59 26 56.29 74.49 18 59.83 83.75 Christchurch Rd. 70 42.51 41.42 46 44.13 44.31 28 47.01 47.89 78 47.61 51.73 24 49.61 59.37 5 52.02 59.48 5 52.73 63.82 94 56.33 70.13 57 57.56 86.24 Ch. of Eng.(Infts.) 18 41.34 40.61 17 43.57 42.61 7 45.27 48.91 2 47.82 50.74 — — — - - - - — — - — — — — — „ (Girls] - - - - - - - - - 10 50.65 52.81 3 52.65 59.31 5 55.52 68.14 12 53.97 70.41 13 57.16 74.52 10 58.23 90.14 Cleveland Rd 38 41.73 39.23 27 42.30 40.33 6 46.06 46.50 56 49.62 50.69 15 49.71 50.35 8 51.12 57.12 2 54.35 71.26 46 57.95 70.36 45 58.26 76.71 Downshall 26 42.51 41.43 11 44.48 43.41 9 46.06 39.45 43 48.42 51.79 5 49.60 61.05 4 51.96 64.13 1 53.93 69.64 61 56.69 75.15 13 62.89 83.53 Goodmayes 46 42.20 42.91 22 45.51 44.23 6 46.53 47.67 60 48.46 52.30 13 50.31 52.97 21 52.31 67.62 11 53.21 65.91 57 55.97 77.21 2 57.82 83.48 Highlands 21 43.85 41.72 12 44.16 44.81 7 46.63 46.72 9 49.93 55.61 1 51.62 57.34 15 51.68 63.92 6 53.62 66.21 23 56.88 76.32 1 55.51 72.71 Little Heath 8 44.91 37.42 1 41.49 39.32 1 50.41 56.90 10 48.45 49.21 1 48.86 49.59 - — — - — — 5 55.20 71.89 5 57.61 76.92 Loxford 63 41.37 38.58 67 43.35 43.92 35 45.28 46.32 50 48.47 53.12 3 51.21 59.55 3 52.47 64.34 9 54.77 68.37 95 55.91 75.28 50 58.35 83.96 Newbury Park 18 42.25 37.92 16 43.32 41.02 14 46.05 55. 36 23 48.82 55.41 7 48.65 54.10 2 53.91 61.31 - — — 45 56.32 71.76 2 58.21 78.72 Roman Catholic 18 44.52 37.82 15 44.25 40.31 1 47.73 46.38 25 48.82 48.50 4 51.62 55.82 1 53.13 61.23 9 52.24 65.38 16 56.32 72.61 11 59.28 83.26 South Park 46 41.78 44.11 14 44.10 44.20 7 46.12 45.10 52 48.95 53.02 14 49.60 53.27 13 51.51 58.81 4 52.59 70.96 51 58.32 77.34 13 58.30 82.98 Uphall Rd. 31 41.32 39.17 23 43.72 43.79 7 44.90 43.82 62 48.08 52.91 4 48.73 54.17 1 48.80 56.31 - — — 7 55.51 73.71 11 57.53 74.27 Valentines Average Heights and Weights of llford Children 4 415 41.00 41.15 37.42 39.58 1 277 41.33 44.31 41.50 42.83 133 46.62 47.25 9 525 47.62 47.92 51.29 53.51 101 49.59 | 58.76 79 51.87 62.49 1 66 58.31 3 54.41 72.82 66.82 62 56.71 57.02 78.40 74.80 5 267 56.91 58.31 77.60 82.61 Anthropometric Standard (Girls). Ages. Ages. 5 Years. 6 Years. 7 Years. 8 Years. 9 Years. 10 Years. 11 Years. 12 Years. 13 Years. Height (In Inches) Weight (In Pounds) Height (In Inches) ! Weight (In Pounds) J Height (In Inches) Weight (In Pounds) Height (In Inches) j Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) 40.44 37.74 42.53 41.24 44.76 44.93 46.94 49.55 48.71 54.09 50.60 58.69 53.01 65.52 55.48 73.86 56.81 80.37 126 Table IX. Summary of Cases of Infectious Diseases among School-Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1920. SCHOOLS. Number on Roll. DISEASES AND CONTACTS Scarlet Fever. Diphtheria. Enteric Fever. Measles. and German Measles. Chicken Pox. Mumps. Whooping Cough. Ringworm. Totals. 1920. Totals. 1919. Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Contacts Barkingside 298 1 2 1 — - - - - 2 1 - - - - — 4 3 15 12 Chadwell 255 3 2 — — - 9,6 14 1 2 - - - - — 30 18 31 32 Christchurch 1216 4 9 16 24 - - 96 24 38 14 2 - 19 2 5 180 83 196 137 Ch. England 99 2 2 1 5 - - 10 11 3 - 2 - 7 7 - 25 25 21 37 Cleveland Road 1290 11 23 10 7 - - 41 11 14 5 8 - 14 1 3 103 52 138 136 Downshall 1309 27 51 15 22 - - 148 40 11 7 3 - 31 6 6 241 126 225 105 Goodmayes 784 16 9 6 4 - - 94 19 22 8 1 1 10 - 4 153 41 182 56 Highlands 778 10 14 3 2 — - 36 12 3 - 4 — 26 4 2 84 32 90 49 Little Heath 143 — — 24 33 - - 8 3 — — — — — — — 32 36 5 13 Loxford 1059 13 15 12 10 - - 48 24 3 10 4 - 9 3 4 93 68 228 121 Newbury Park 484 4 4 3 3 - - 3 1 1 - - - - 1 12 8 47 51 Roman Catholic 372 7 12 4 17 - - 1 3 - - - - 6 2 - 18 34 36 35 South Park 1260 30 31 6 11 - - 111 15 11 4 9 - 37 4 4 208 65 156 55 Uphall 1021 10 19 6 16 - - 157 60 3 1 18 3 11 3 10 215 102 73 62 Valentines 101 - 1 — 3 - - 1 - 2 - - - 2 1 - 5 5 6 4 Countv High School — 4 7 1 4 - - — 1 2 — — — — — - 7 12 8 5 Private Schools — 12 12 22 27 1* - 8 7 - - - - - - - 43 46 145 64 Totals 10475 154 213 130 194 1 — 790 247 116 62 51 4 172 36 39 1453 756 1602 974 *Private School outside the Ilford District. 127 Table X. SCARLET FEVER. Summary of Cases of Scarlet Fever among School-Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1920. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. October. Nov. Dec. Total 1920 Total 1919 Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Caess. Conts. Cases. Conts. Cases. Conts. Barkingside 298 1 2 - - - - - - - - - - - - - - - - - - - - - - 1 2 2 4 Chadwell 255 - - - - - - - - - - - - - - - - - - 1 1 2 1 - - 3 2 - - Christchurch 1216 - - - 3 - - - - 2 4 - - - - - - - - - - - - 1 2 4 9 15 15 Ch. England 99 — — — — — — — — - 2 — — — — — — — — — — 1 - 1 - 2 2 1 2 Cleveland Road 1296 1 — 2 9 3 2 1 1 — 2 — — — — 1 2 — 5 — — 2 2 1 — 11 23 5 19 Downshall 1309 2 2 — — 4 6 — — 1 1 — 1 4 4 1 5 — 4 4 6 5 4 6 18 27 51 18 21 Goodmayes 784 3 3 1 — 7 4 — - 1 2 3 — 1 — — — — — — - - - - - 16 9 15 14 Highlands 778 3 7 — 1 1 1 — - — 1 1 1 — — — — — 2 — — 2 - 3 1 10 14 14 12 Little Heath 143 — — — — — — — — - - — — - - - - - - - - - - - - - - 1 3 Loxford 1059 4 4 - 2 2 - - - 1 - - - 2 5 2 - 1 1 - - 1 3 - - 13 - 37 42 Newbury Park 484 - - - - - - - - - - - - - - - - - - - - - - - - 4 4 3 6 Roman Catholic 372 — — — — — — — — 3 6 1 — 1 4 — — 1 1 1 1 — - — - 7 12 4 6 South Park 1260 1 1 3 6 2 2 1 1 - 8 — — 6 6 1 2 5 1 3 1 3 3 5 - 30 31 16 13 Uphall Road 1021 — — 3 9 — — — — - — — — — :— — - - - 5 5 1 3 1 2 10 19 10 12 Valentines 101 - - - - - - - - - - - - - - - - - - - - - - - - - - - - County High — — 3 1 2 - — — — 2 — — — — — — — — — - — - 1 1 1 4 7 2 1 Private Schools - 2 1 2 - 1 1 2 1 3 1 1 - 1 1 - - - 2 - 1 - 3 - 1 12 12 22 17 Totals 10475 17 23 12 32 24 16 4 4 13 27 6 2 16 24 5 9 7 16 14 15 17 20 19 25 154 213 165 187 128 TABLE XI. DIPHTHERIA. Summary of Cases of Diphtheria among School-Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1920. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. . Nov. Dec. Total 1920. Total 1919. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 298 - - - - - - - - - 1 - - - - - - - - - - - - - - - - - Chadwell 255 — — — — — - — — - - - - - - - - - - - - - - - - - - - - Christchurch Road 1216 1 1 2 2 1 - 1 3 1 1 - 1 2 2 2 2 1 - 1 6 1 3 3 - - - - - Ch. England 99 — — — 1 — 2 1 — — - - - - - - - - - - 1 - - - - 1 - - - Cleveland Road 1296 — — — 1 — — - - - - 1 2 - - 2 - - - 1 2 1 - - - - - - - Downshall 1309 1 2 1 - - - - - - - 1 3 - - - - 3 6 6 9 3 2 - - - - - - Goodmayes 784 1 — 1 1 — — — 1 — — - - 2 2 - - - - - - - - - - 2 4 9 8 Highlands 778 1 1 — — 1 1 - - - - 1 - - - - - - - - - - - - - 3 2 7 6 Little Heath 143 1 1 1 1 - - 2 3 4 5 11 16 1 2 - - 1 - 3 - 1 - - 3 2 6 Loxford 1059 — — — 1 — - - - - - - - 1 4 1 2 - - 2 1 - - - - - 33 3 10 Newbury Park 484 - - 2 1 - - - - - - - - - - 1 9 - - - 1 - - - 8 - 16 3 Roman Catholic 372 - 5 - - - 2 - - - - - 3 - - - - 1 1 - 3 4 - - - 3 3 3 7 South Park 1260 - - 1 - 1 1 1 1 1 3 9 5 - - - - - - - - - - - 3 4 17 3 10 Uphall 1021 1 4 - - - - - - - - - - 1 2 1 3 3 2 - - - - - 1 6 11 2 3 Valentines 101 - - - - - - - - - - - - - - - - - - - - - - - 6 16 2 9 County High - 1 - - 1 - - - 1 - - - - - - - - - - - - - 2 3 - 3 — — Private Schools - - 2 1 - 2 3 — - 2 1 2 4 1 1 1 — — — 7 6 4 3 2 7 1 22 4 27 1 14 1 17 Totals 10475 7 16 9 9 5 14 5 9 8 10 19 34 8 13 8 8 9 9 22 33 10 11 20 28 130 194 78 146 123 TABLE XII. MEASLES AND GERMAN MEASLES. Summary of Cases of Measles (including German Measles) among School-Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended 31st December, 1920. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total 1920 Total 1919 Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts Cases. Conts. Cases. Conts. Cases. Conts. Cases Conts. Cases. Conts. Barkingside 298 - - - - - - - - - - - - - - - - - - - - - - - - - - 8 4 Chadwell 255 25 13 1 1 - - - - - - - - - - - - - - - - - - - - 26 14 31 31 Christchurch Road 1216 - 2 - - 5 1 7 4 39 9 41 7 4 1 - - - - - - - - - - 96 24 80 82 Ch. England 99 — 1 — — 4 4 1 1 - 1 3 2 2 2 - - - - - - - - - - 10 11 7 20 Cleveland Road 1296 17 4 6 9 11 5 3 - 2 - - - 2 1 - - - - 1 1 1 - - - 43 13 86 98 Downshall 1309 94 20 9 4 9 - 11 6 4 3 10 2 3 - 1 1 - - 1 3 5 - 1 1 148 40 46 24 Goodmayes 781 22 5 12 — 16 2 19 5 22 5 3 1 - — - - — — - 1 - — - - 94 19 66 19 Highlands 778 1 1 3 — 3 — 1 — 3 2 16 6 9 1 — 9 — — - — — — — - 36 12 20 10 Little Heath 143 - - 4 3 - - - - - - 4 - - - - - - - - - - - - 8 3 - - I.oxford 1059 12 7 8 4 23 8 3 4 - - 1 1 - - - - - - 1 - - - - - 48 24 - 16 Newbury Park 484 1 1 - - - - - - - - 2 - - - - - - - - - - - - - 3 1 2 9 Roman Catholic 372 — — - - - - - - - - - - - - - - - - - - - - - - 1 3 22 14 South Park 1260 4 1 — — 3 1 10 2 55 8 27 3 9 - 1 - - - - - 1 - 1 - 111 15 53 32 t'phall 1021 8 3 119 31 20 24 1 1 1 - 4 - - - 1 1 - - - - 1 - 2 - 157 60 - 30 Valentines ... 101 - - - - 1 - - - - - - - - - - - - - - - - - - - 1 - - - County High - - - - - - - - - - - - - - - - - - - - - - - - - 1 3 1 Private Schools - 6 6 - — 2 1 - - - - - - - - - - - - - - - - - - 8 7 107 30 Totals 10475 190 64 162 46 97 46 57 26 126 28 111 22 29 5 3 4 — — 3 5 8 — 4 1 790 247 645 450 130 TABLE XIII. CHICKEN POX. Summary of Cases of Chicken Pox among School-Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1920. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total, 1920. Total, 1919. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases Conts. Cases Conts. Cases Conts Barkingside 298 - - - - - - - - - - - - - - - - - - - - - - - - 2 1 4 2 Cnadwell 255 — — — — 1 2 — — — — - - - - - - - - - - - - - - 1 2 - - Christchurch Road 1216 7 6 6 5 10 3 3 3 9 1 8 - - - 1 3 1 1 - - - 2 - - 38 24 5 3 Ch. England 99 - — 1 - - - - - - - - - - - - - - - - - 1 - 1 - 3 - 2, 2 Cleveland Road 1296 7 - 3 - 1 — — 2 1 — 1 — - - — - - - - - - - 1 1 14 5 8 6 Downshall 1309 6 1 2 1 — 2 — — — — 1 - - - - - - - 1 - i - - 3 11 7 59 23 Goodmayes 784 18 7 — — — — — — — — — — 1 — — — - 2 1 1 - - - 22 8 38 14 Highlands 778 — — — — l — — — — — 2 — - — — — — - — — - - — — 3 - 4 3 Little Heath 143 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Loxford 1059 - 2 - - i - - 1 - - 1 - - - - - - - - - 1 1 - - 3 10 76 20 Newbury Park 484 - - - - - - - - - - - - - - - - - - - - - - - - 1 - 32 25 Roman Catholic 372 - - - - - - - - - - - - - - - - - - - - - - - - - - 5 4 South Park 1260 4 2 1 - - - 2 - - - - - - - - - - - - - 3 - - 2 1 1 4 11 2 Uphall 1021 1 — 1 - - - - - - - - - - - - - - - - - 1 1 — - 3 1 17 6 Valentines 101 - — — — 1 — 1 — — — — — — - — - — — — — — — — — 2 - 1 1 County High - - - 1 - - - - - - - - - - - - - - - - - 1 - - - 2 — 1 - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 10475 43 21 15 6 16 12 6 6 3 1 15 — 1 - 1 3 1 1 3 1 10 5 2 6 116 62 263 120 131 TABLE XIV. WHOOPING COUGH. Summary of Cases of Whooping Cough among School-Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1920. SCHOOLS. Number on Roll. Jan. Feb. March. April. May.. June. July. August. Sept. Oct. Nov. Dec. Total, 1920. Total, 1919. Cases. Coins. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 298 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chadwell 255 - - - - - - - - - - - - - - - - - - - - - - - - - — — — Christchurch Road 1216 - - - 2 - 6 1 4 - 6 - - - - - 1 1 - - - - - - 19 2 - - Ch. England 99 1 1 1 — 3 4 2 2 - - - - - - - - - - - - - - - - 7 7 - - Cleveland Road 1296 2 2 — 1 5 1 - - 1 - 3 - 1 - - - - - - — — - - — 14 4 — — Downshall 1309 — — - — _ - 1 1 2 1 2 - - - 18 4 4 - 4 — - — - — 31 6 3 2 Goodmayes 784 — — 1 — — - 9 - 5 - 1 — - - - - 1 - — — - — — — 10 - - — Highlands 778 - 1 2 - 7 1 7 - 3 2 1 - - - - - - - - - - - - - - 26 4 6 2 Little Heath 143 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Loxford 1059 3 1 - - 3 1 - — 1 1 1 — - - - - - - 1 - - - - - 9 3 2 - Newbury Park 484 — — - - - - - - - - - - - - -- - - - - - - - - - - - - - Roman Catholic 372 l - 5 1 - 1 — — - - — - - - - - — - — - — — — — 6 2 — — South Park 1260 24 3 9 1 4 - - - - - - - - - - - - - - - - - - - 37 4 4 - Uphall 1021 1 2 1 1 2 - - - - - - - - - - - - - - - - - - - - - - - Valentines 101 - - - - 2 1 - - - - - - - - - - - - — — - — — — 2 1 - - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total 10475 37 10 19 4 28 9 18 4 17 4 17 - 1 - 22 4 8 1 5 — - - — — 172 36 15 4