ILF 054 Urban District of Iford. 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, FOR THE YEAR 1923. ILFORD: South Essex Recorders, Ltd., High Road. Ilford Urban district Council. 1923-1924. George Lee, Esq., J.P., Chairman. James William King, Esq., Vice-Chairman. Church, George. Clark, Charles William. Cushing, George. Dane, Frederick Hopper, M.B.E., J.P., C.C. Davey, George Robert. Dunnico, Herbert, ltev., M.P., J.P., C.C. Gunary, George. Kennedy, Charles Guns. Norton Thomas George Odell, Herbert George. Pitt, Bertram Sidney John. Sheat, William J. Oliver O.B.E., J.P. Smith, Frank D., C.C. Smythe, Herbert James Bevis Stephens, Mrs. Emily Jane. Stevens, Walter H. Taylor, Joseph John. Whitten, Mrs. Marion Ann. Young, Alexander. PUBLIC HEALTH COMMITTEE. 1923-1924. Councillor G. Cushing, Chairman. Councillor G. Church, Vice-Chairman. Councillor C. W. Clark. Councillor F. D. Smith, C.C. Councillor The Rev. H. Dunnico, Councillor Mrs: Stephens. M.P., J.P., C.C. Councillor W. H. Stevens. †Councillor J. W. King. Councillor J. J. Taylor. †Councillor G. Lee, J.P Councillor Mrs. Whitten †Ex-officio Members. MATERNITY & CHILD WELFARE STATUTORY COMMITTEE. 1923-1924. Councillor Rev. H. Dunnico, M.P., J.P., C.C., Chairman. Councillor W. H. Stevens, Vice-Chairman. *Dr. P. Poyd Pobson. Councillor G. Church. Councillor C. W. Clark. Councillor G. Cushing. *Mrs. Dunnico. *Mrs. Gillard. †Councillor J. W. King. †Councillor G. Lee, J.P. Councillor Mrs. Stephens. *Mrs. Stevf.ns. Councillor J. J. Taylor. Councillor Mrs. Whittf.n *Mrs. Wise. *Co-opted Members. †Ex-officio Members. EDUCATION COMMITTEE. 1923-1924. Councillor B. S. J. Pitt, Chairman. *Miss J. B. Larkin, Vice-Chairman. *Mr. J. R. Baldwin. *Mr. J. Mein. Councillor G. Chlrch. Councillor T. G Norton. Councillor F. IT. Dank, M.B.E., Councillor H. G. Odell. J.P., C.C. *Mr. A. W. Grben. Councillor W. J. O. Sheat, O.B.E., J.P Councillor G. Gunary. Councillor H. J. B. Smythe. Councillor C. G. Kennedy. *Mr. W. R. Spencer. †Councillor J. W. King. Councillor Mrs. E. J. Stephens. †Councillor G. Lee Councillor J. J. Taylor. *Mr. S. P. Lonergan. *Mr. H. J. Weston. Councillor Mrs. M. A. Whitten. *Co-opted Members. †Ex-officio Members. OFFICERS of the PUBLIC HEALTH SERVICES. MARCH, 1924. 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., U.S. (Loud.), D.P.H. (Cantab.), of the Middle Temple, Barrister-nt-Law. Assistant Medical Officers of Health: V. F. Soothill, M.A., M.D. (Cantab.), D.P.H. (Cantab.). Marie A. Madden, B.A., M B., B.Ch (Dub.), L.M. (Rot. Hosp.). Oculist (part time): Dentist: It. S. Charsley, M.B.C.S., L.R.C.P. M.J. K. Soutter, L.D.S., R.C.S (Eng.). Matron of Isolation Hospital: Matron of Maternity Home: Miss 1. Millar. Miss M. E. Roberts. Senior Sanitary Inspector: F. W. King, Mem. Royal San. Inst., F.I.S.E. Sanitary Inspectors: H. C. Monkcom, Assoc. Royal San. Inst., A.M.I.S.E. T. V. Haigh, Mem. Royal San. Inst. C. W. Fisher, Assoc. Royal San. Inst. Health Visitors and School Nurses: M iss A. Batten. Mrs. H. Morris. Miss M. E. Cartwright. Miss B. Raddall. Miss K. B. Mathieson. Miss C. H. Robinson. M iss M. D. Seager. District Midwife: M iss M. F. Butcher. Chief Clerk: F. J. Bull. PREFACE. Public Health Offices, Ilfokd. March, 1924. To the Chairman and Members of the Ilford Urban District Council. Ladies and Gentlemen, 1 have the honour to present herewith the Annual Report required by the Ministry of Health and Board of Education. It shows two satisfactory features as regards the health of the town:— (1) The infant mortality rate of 41 is the lowest yet recorded. In 1904 with a population half that of last year and a much wider rural area, 198 babies died in the first year of life. The Medical Officer of Health in his report for 1904 said, "It will be seen from the above, too, that the waste of infant life is far greater in Urban communities than in Rural—a fact which must be borne in mind with regard to rapidly increasing Ilford as becoming more and more truly Urban in character." However, with a far larger urbanisation of the district in 1924, and double the population of 1904, only 66 babies died in the first year of life. Not all of this improvement can be held to be due to Infant Welfare work, for there are other factors besides (e.g., the declining birth-rate), and the infant mortality showed a distinct reduction before such work was undertaken, but there are certain significant figures which show the importance of the work. Of the 66 babies who died last year in the first year of life, only 5 had ever attended an Infant Welfare Centre. Admitting that of the 66, 34 died in the first month and were too young to be brought to a Centre, we are left with the figures that five times as many deaths occurred in infants during the first year of life who had never attended such a Centre as in those who had. One of the best compliments paid to the Infant Welfare Centre work in Ilford, is the conversation of an undertaker who, on calling to arrange for the funeral of a young baby, asked the mother if she had taken her baby to an Infant Welfare Centre; she admitted she had not. "Ah!" the undertaker replied, "that is where you should have gone—we have had no trade in babies since they started those Centres." The figures at the Maternity Home are more remarkable still, for here the infant mortality rate was less than half that in the district generally. The majority of infant deaths occur in the first month of life, and it is to adequate ante-natal supervision 8 and Maternity Home facilities that we must look to further reduction in our infant mortality. Serious midwifery operations are undertaken in private houses often under such adverse conditions that no doctor would dream of performing other surgical operations of less severity. Apart from the chance of loss of life, and still greater chance of loss of health to the woman, the result is too frequently the birth of a dead or weakly infant. With the growth of Maternity Hospital accommodation, it is to be hoped that in the near future women will have the right to have such operations performed in as ideal conditions as would any other surgical operation be carried out, and with the growth of antenatal work these operations will be reduced to a minimum. The Maternity Home at Ilford has proved its usefulness, although its work has been carried out under conditions prejudicial to the aims of such an institution. It is, therefore, a considerable satisfaction to know that the provision of a modern Maternity Home will be accomplished within the course of a few months. A District Midwife has been appointed, and in Miss Butcher the Council have found a lady who has earned the praises of all who have engaged her services. The correlation of her work with that of the Maternity Home is likely to prove of great benefit to the district. (2) The Zymotic diseases death-rate (or death-rate of the chief infectious diseases), is the lowest ever recorded for the district. The death-rate is .26 compared with 2.2 in 1904. Unfortunately, the control of infectious diseases is still an unsatisfactory problem. Isolation Hospitals cannot much limit their spread, for we are still ignorant of the bacteria causing such diseases as Scarlet Fever, while as regards the "carrier" problem, which must be dealt with before we can eliminate diphtheria, we are still very much in the dark. It was once thought that the "Milne" treatment practised at the Barnardo.s Homes by the late Dr. Milne would render Isolation Hospitals unnecessary. A detailed investigation of the results by Dr. Gushue-Taylor has proved that the method is an unsound one. His conclusions are that the treatment "(a) does not prevent the occurrence of return cases, (b) does not prevent the infection spreading to susceptible patients and attendants during the course of treatment, (c) does not prevent secondary complications." Such conclusions, which were published in the "Lancet," and are based on statistics extending over 18 years, will not inspire Local Authorities to adopt the methods mentioned. If, however, Isolation Hospitals cannot claim to have greatly limited the spread of Infectious Disease there is no doubt as to 9 the reduction in the mortality of I he diseases they treat. Severe diphtheria is still a very fatal disease in a child untreated by antitoxin. Even a moderately severe case of diphtheria requires the constant attendance of a nurse trained in infectious diseases if the patient is to have the best chance of recovery. It is, therefore, most satisfactory to note the large percentage of cases of diphtheria occurring in the district which are treated in the Ilford Isolation Hospital, and the low mortality last year. Scarlet Fever is a less fatal disease than it was years ago. It should be obvious, however, that a child stands a better chance of treatment in a modern Isolation Hospital than in a small crowded house. The complications of Scarlet Fever when they occur are severe and may handicap a child through life. The work at the Isolation Hospital in Ilford has been so carried out that the Hospital is more popular than ever before, and a higher percentage of notified cases of infectious disease admitted than has ever previously been recorded. With reference to other Public Health work, I would point out that the new Milk Orders have not met with any marked success. Only one milk vendor with premises in Ilford has been licensed to sell Pasteurised Milk. The same vendor has also been licensed to sell Grade "A" and Certified Milk—other vendors have licences to sell Certified Milk. The present price of Certified Milk piaces it beyond the reach of most consumers, while Grade "A" and Pasteurised Milk can be obtained at 1d. a quart over the market price of ordinary milk. It does not appear that there will be much improvement in the bacterial cleanliness of milk generally until a standard is fixed below which no milk must be retailed at all. At the same time legislation is necessary to ensure that if milk is pasteurised it must be sold as such, and the pasteurisation must be carried out by an approved process. Much milk sold at the present time is pasteurised, more or less efficiently, with the simple commercial object of making it keep a few hours longer. The newspaper scare as to the retail of tinned meats from army dumps has been gone into with some thoroughness in IlfordAs will be seen from the report, 80 visits were paid, and the various grocers. stocks inspected. There was no basis as far as Ilford was concerned for any such scare. The visits of inspection have, however, served a desirable purpose in impressing on the retailers the necessity of not dealing in any stock of doubtful quality. One prosecution was instituted, and the defendant fined £5 and £5 5s. costs. The administration of the Housing and Town Planning Acts cannot be said to be satisfactory. With the present dearth of houses it is impossible to proceed to the extreme measure of closure which would be adopted in ordinary times. 10 The Sanitary Inspectors have carried out their duties under difficult conditions as far as these Acts are concerned. This side of the department, as I have pointed out previously, is understaffed, and in the event of an outbreak of an epidemic no adequate control of contacts would be possible with the present staff of Sanitary Inspectors. The School Medical Service has again been carried out with efficiency. The fact that 93 per cent. of the defects of vision detected were remedied testifies to the efficiency of the work carried out by Mr. Charsley, and the appreciation of it by Ilford parents. The Council is fortunate in having such a skilled Ophthalmic Surgeon on its staff. The work of the Dental Department in Mr. Soutter.s skilled hands has increased considerably, although the premises in which the School Clinic work is carried out are far from ideal. During the year he has treated 2,775 children, in addition to 194 expectant and nursing mothers, and 108 tuberculous patients. The provision of an open-air school is now before the Education Committee, and will ere long, I hope, become an accomplished fact. This is a true Public Health measure, it is a poor policy to provide sanatoria for the adult if no attempt is made to increase the resistance of the susceptible child. There is still no adequate provision for mentally defective children in Ilford. The attendance of these children at ordinary schools neither benefits their teachers or the normal children in the school, while the mental defectives themselves suffer from the lack of the special training they require. It is hoped that the scheme which was postponed by the Board of Education will shortly be proceeded with. The Census figures which are given in the Report are instructive. They show that at the time of the Census there were 508 families of 882 persons living in one room, while there were 1,257 families of 3,045 persons occupying two rooms. These conditions, while not as bad as in other districts, do not favour the health of a district. The Census figures also show that 21,749 persons living in Ilford find their daily employment outside the district, while 6,901 persons not resident in the district yet are employed within it. It is surprising with such a population daily coming in and out of Ilford that we are not more attacked by epidemic disease. I think the body of the Report, which is mainly statistical, will show that the health services of the town are being as efficiently carried out as is possible under present conditions. I have again to thank the members of the staff for the way in which they have assisted me, and the members of the Council, and the co-opted members of the responsible committees for the support I have received. 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 17 Physical Features and General Character ot the District 18 Rainfall 18 Poor Relief 18 Hospital Provision Population 9 Births 24 Deaths 25 Inquests 26 Marriages 26 Vital Statistics—Tables of 26 „ „ Table 1. 27 „ „ Table 1a. 28 Causes of Death—Table III. 29 SECTION II.—SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply 31 Rivers and Streams. 31 Drainage and Sewerage 31 Closet Accommodation . 31 Scavenging and Removal and Disposal of House Refuse 31 Sanitary Inspection of the District:— (а) Notices Served 32 (b) Complaints of Nuisances 32 Increase of Rent and Mortgage Interest tions) Act, 1920 33 Bye-laws and Local Acts 33 SECTION III.—SUPERVISION OF FOOD. Milk Supply 35 The Milk and Dairies (Amendment) Act, 1922. 35 The Milk (Special Designations) Older, 1922. 35 Meat:— (a) Slaughter-houses 36 (b) Articles of Food Surrendered and Seized... 36 Tinned Foods 37 Other Foods: — Bakehouses 37 Sale of Food and Drugs Acts 37 SECTION IV.—PREVALENCE OF, AND CONTKOl OVER, INFECTIOUS DISEASES. Infectious Disease generally 38 Table II.—Summary of Cases of Infectious Diseases Notified 40 Attack Rates of Infectious Diseases 41 12 Page SECTION IV.—(continued). (a) Small-pox 41 Small-pox Hospital Accommodation 41 (b) Scarlet Fever 41 (c) Diphtheria 42 (d) Enteric Fever 42 (e) Cerebro-Spinal Meningitis 42 (f) Ophthalmia Neonatorum 42 (g) Acute Influenzal and Acute Primary Pneumonia 42 (h) Anthrax 42 (i) Plague 42 (j) Puerperal fever 43 Zymotic Diseases 43 Tuberculosis 43 Tuberculosis Care-Committee 43 Venereal Diseases 40 SECTION V.—OTHER SERVICES. Bacteriological Laboratory Table of Number of Specimens Examined 49 District Nursing 50 SECTION VI.—HOUSING 50 SECTION VII.—FACTORIES AND WORKSHOPS. Factories 52 Workshops 53 Table I.—Inspection of Factories, Workshops and Workplaces 54 „ II.—Defects Found 55 „ III.—Homework 56 „ IV.—Registered Workshops 57 „ V.—Other Matters 57 ISOLATION HOSPITAL 61 MATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907 and 1915 69 Registration Act, 1836 69 Infant Mortality 69 Table IV. 74 Infant Life Protection 75 Work of Health Visitors 77 Supervision of Midwives 78 Supply of Milk to expectant and nursing Mothers and for Infants 78 Infant Welfare Centres 79 Ante-Natal Clinic 80 Dental Clinic 80 Ophthalmic Clinic 81 Ophthalmia neonatorum 81 Treatment of Minor Ailments 82 Maternity Home 83 District Midwife 87 SCHOOL MEDICAL SERVICE. Staff 91 Co-ordination 91 School Medical Service in Relation to Public Elementary Schools 91 13 Page SCHOOL MEDICAL SERVICE—(continued). School Hygiene 91 Medical Inspection 91 Findings of Medical Inspection 92 Infectious Disease 93 "Following-up" 95 Medical Treatment:— Minor Ailments 95 Ophthalmic Department 97 Dental Department 99 Treatment of Uncleanliness 100 Other Ailments 100 Operative Treatment of Tonsils and Adenoids 100 Open-air Education 101 Physical Training 101 Provision of Meals 102 School Baths 102 Co-operation of:— Parents, Teachers, School Attendance Officers and Voluntary Bodies 102-3 Physically and Mentally Defective Children 103-113 Nursery Schools, Secondary and Continuation Schools 114 Employment of School Children and Young Persons 114 Medical Examination of Teachers, etc. 114 Statistical Tables:— I.—Number of Children Inspected 115 II.—Return of Defects 116 III.—No. of Children found to Require Treatment 117 III.—Numerical Return of Exceptional Children 118-120 IV.—Group I.—Minor Ailments 121 Group II.—Visual Defects 122 Group III.—Nose and Throat Defects 122 Group IV.— Dental Defects 123 Group V.—Cncleanliness and Verminous Conditions 124 V.—Summary of number of Children Inspected 127 VI.—A.—Average Heights and Weights of Boys Inspected 128 B.—Average Heights and Weights of Girls Inspected 130 VII.—Summary of Infectious Disease among School Children 132 VIII.—Summary of Scarlet Fever among School Children 133 IX.—Summary of Diphtheria among School Children 134 X.—Summary of Measles and German Measles among School Children 135 XI.—Summary of Chicken Pox among School Children 136 XII.—Summary of Whooping Cough among School Children 137 XIII.—Summary of Mumps among School Children 138 GENERAL. 17 STATISTICAL SUMMARY. Enumerated Population at Census, 1911 78,188 „ „ „ 1921 85,194 Registrar-General.s Estimate of the Population at the middle of 1923 89,020 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 and calculated on the Registrar-General.s estimate of the population) 10.5 1922. 1923. Total number of Births registered 1,475 1,606 Birth-rate per 1,000 of the population 17.8 18.8 Total number of Deaths registered 795 808 Death-rate per 1,000 of the population 95 9.5 Total number of Deaths from the seven principal Zymotic Diseases 27 22 Zymotic death-rate per 1,000 of the population .32 26 Total number of Deaths under one year of age 80 66 Infant Mortality per 1,000 births registered 54.2 41.1 1922-23. 1923-24 Rateable Value—Houses £7481,711 10 0 £505,083 0 0 „ Land 0,364 0 0 6,292 0 0 £488,075 10 0 £511,375 0 0 Education Rate— Elementary 2s. 6¾d. in the £. 2s. 2¼d. in the £. Higher 4¼d. in the £ 3¾d. in the £. Assessable Value £476,339 17 6 £.499,676 0 0 General District Rate 7s. 1d. in the £ 6s. 6d. in the £. Poor Rate 9s. 6d. in the £ 7s. 10d. in the £. 18 Section 1.—NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. 1. Physical Features and General Character of the District.— Vide Annual Report, 1920. 1a. Rainfall.—The total rainfall registered in the district during the year was 23.35 inches. The greatest fall in 24 hours was registered on the 9th July, being 1.32 inches. The number of days on which rain fell was 155. 2. Poor Relief.—The total amount expended in Ilford during the year was: Ordinary, £9,683 10s. 10½d; Unemployment, £7,744 0s. Od. The average weekly number of persons in receipt of relief was:— Men. Women. Children. Total Persons. Ordinary 90 251 281 622 Unemployment 147 124 276 547 The number of admissions to the Guardians. Institutions from Ilford during the year was 362, made up as follows:— Men 108 Women 164 Children 90 3. Hospital Provision.—There is an Emergency Hospital in the district maintained by voluntary subscriptions, the number of beds being 42. During the year 1923, 663 in-patients were admitted, 478 operations performed, 639 casualties were attended to, and 343 X-ray examinations were made. The average cost per patient per week was £3 13s. 9¼. There are two large Mental Hospitals in the district, the West Ham Mental Hospital with 923 patients, and Claybury Mental Hospital with 2,452 patients in residence on 30th June, 1923. 19 In addition there is the Girls. Village Homes, one of the late Dr. Barnardo.s Institutions, which had 1,330 children and 164 staff in residence on the 30th June, 1923. There are also 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 Census, 1921 85,194 (including institutions) Registrar-General.s Estimate on 30th June, 1923 89,020 do. To obtain the net population must be deducted the number of patients and resident staff on the 30th June at the following public institutions:— Claybury Mental Hospital 2,711 West Ham Mental Hospital 1,058 This makes a net population of 85,251. In calculating the various rates per 1,000 of the inhabitants 1 have again used the Registrar-General.s estimate of the population of the area, so as to be on a comparable basis with other districts, although, owing to the large increase in the number of houses built by the Corporation of the City of London, the London County Council, the Ilford Urban District Council and private enterprise since the census was taken in 1921, I consider the estimate of the population of Ilford is considerably below the actual figure. Since issuing my Annual Report for the year 1922, the completed census figures for the County of Essex have been published, and the following statistics with regard to the population on the night of the 19th-20th June, 1921, are of interest:— 20 ACCOMMODATION AND HOUSING. Ilford. East Ham. West Ham. Barking. Walthamstow. Leyton. Essex. London. Percentage of Structurally Separate Dwellings returned as:— Private Houses 96 88 88 91 89 81 91 68 Maisonettes, Flats, Tenements, &c. — 5 4 2 5 13 3 21 Attached to Shops, Offices, Warehouses,&c. 4 7 8 7 6 6 6 11 Number of Rooms per dwelling 5.75 5.21 5.27 4.72 5.22 5.52 5.41 5.85 Number of Families per dwelling 1.13 1.26 1.43 1.12 1.20 1.26 1.19 1.60 Number of Persons per family 3.98 4.17 4.33 4.64 4.36 4.02 4.39 3.79 Number of Rooms per person—all private families 1.28 0.99 0.85 0.90 1.00 1.08 1.09 0.96 Increase in dwellings, 1911-21 1,953 or 2,838 or 1,859 or 1.048 or 1,745 or 1,078 or 24,983 27,738 12.3% 90.5% 4% 18.2% 7.6% 4.6% or 9.5% or 4.1% Increase in private families, 1911-21 3,256 or 4,764 or 6,903 or 1,339 or 3,138 or 3,656 or 43,955 96,946 19.4% 16.3% 11.2% 21.4% 11.9% 13.4% or 14.9% or 9.5% Population living more than two persons to a room 2,489 10,983 48,792 4,052 9,606 8,841 113,775 683,498 or Percentage of total private family population living more than two persons to a room 3.1 7.8 16.4 11.5 7.5 7.1 8.1 16.1 21 The following are particulars of Private Families, classified by size of family, rooms occupied, and density of occupation:— Ilford. Essex. London. Number of families occupying 1 room 508 12,107 147,797 Population of families ing 1 room 882 23,760 262,363 Room.s occupied 508 12,100 Number of families occupying 2 rooms 1,257 27,295 236,856 Population of families occupying 2 rooms 3,045 75,349 742,485 Rooms occupied 2,509 54,524 — Number of families occupying 3 rooms 1,748 58,514 262,785 Population of families occupying 3 rooms 5,629 224,769 1,009,708 Rooms occupied 5,235 175,474 — Number of families occupying 4 rooms 2,077 77,728 201,958 Population of families occupying 4 rooms 8,412 327,879 899,301 Rooms occupied 8,295 310,867 — Number of families occupying 5 rooms 6,875 75,153 101,213 Population of families occupying 5 rooms 29,630 349,091 487,052 Rooms occupied 34,374 375,751 — Number of families occupying 6-7 rooms 6,874 70,595 104,923 Population of families occupying 6-7 rooms 28,700 321,869 502,362 Rooms occupied 44,507 443,899 — Number of families occupying 8-9 rooms 543 11,743 36,835 Population of families occupying 8-9 rooms 2,551 56,329 175,056 Rooms occupied 4,562 97,773 — Number of families occupying 10 rooms and over 177 5,694 28,530 Population of families occupying 10 rooms and over 967 31,336 165,511 Rooms occupied 1,850 67,903 — Compared with other surrounding districts the populations of the families occupying one and two rooms are:— One Room. Two Rooms. East Ham 3,286 8,466 West Ham 9,496 27,180 Walthamstow 1,640 5,225 Southend 2,017 5,365 ILFORD 882 3,045 The following table gives a comparative view of the differences in sex, age, marital condition for the Administrative County of Essex (with associated County Boroughs) and Urban Areas with more than 50,000 population:— 22 Area. Average Age. Age distribution per 1,000 of each sex ( Ages last birthday) Marital condition distribution per 1,000 of each sex. Number of Married Women aged less than 45 per 1,000 females of all ages. Number of Females per 1,000 Males. Males. Females. Males. Females. Males. Females. 0-4 5-19 20-39 40- 0-4 5-19 19-39 40- Single. Married. Widowed and Divorced. Single. Married. Widowed and Divorced. Essex Admin. County (with Associated County Boroughs) 29.7 30.9 93 305 288 314 83 280 314 323 551 417 32 531 391 78 234 1091 East Ham C.B. 28.7 29.7 94 312 300 294 83 293 324 300 549 423 28 524 403 73 249 1066 Southend-on-Sea C.B. 30.8 33.0 88 284 289 339 65 242 33G 357 501 471 28 516 390 94 235 1319 West Ham C.B. 27.5 28.1 110 332 286 272 102 312 314 272 580 388 32 548 377 75 242 1058 Leyton U.D. 29.8 31.2 91 299 296 314 78 271 328 323 534 429 37 524 391 85 241 1114 Walthamstow U.D. 28.4 29.3 91 331 288 290 82 305 321 292 556 416 28 543 387 70 238 1093 Ilford U.D. 31.4 32.4 75 275 293 357 60 263 319 358 514 458 28 527 395 78 223 1205 23 This table shows that 45.8 per cent. of the male population in Ilford are married and 51.4 per cent. are single, and that 39.5 per cent. of female population are married and 52.7 per cent. single. In actual numbers, however, there were only 17,711 married men present as compared with 18,378 married women. The total numbers returned as divorced were 16 males and 24 females. The proportion of married men is higher in Ilford than in the county as a whole, and also exceeds the averages for East Ham, West Ham, Leyton and Walthamstow. The proportion of married women shows a much smaller excess over the county average but is higher than those for all the four above-mentioned towns, except East Ham. The appended list shows the occupations followed by the largest number of persons living in Ilford:— Males. Females. Clerks 4,904 3,351 Domestic servants (indoor) 51 2,036 Salesmen and shop assistants 1,113 949 Proprietors and managers of wholesale and retail business 1,197 178 Civil Service officials and clerks 895 256 Teachers 392 696 Commercial travellers 825 12 General labourers 748 9 Local Authorities. Officials and Clerks 450 49 Postmen and sorters 423 7 Carpenters 388 — Mental attendants 122 255 Warehousemen 365 9 Messengers 322 46 Dressmakers 5 360 Mechanical engineers 321 1 Motor drivers 317 3 No other single occupation accounted for more than 300 persons, but it may be noted that 634 persons were occupied in the group of occupations connected with railway transport, and 647 in agricultural occupations. There are also included in the returns 3,275 persons classified as "retired," but it is necessary to point out that this is due in great measure to the inclusion of a considerable proportion of the inmates of the two mental hospitals situated within the district. 24 The following statistics as to places of occupation of residents of Ilford are interesting:— Males. Females. Occupied persons over 12 years of age (and students over 18 enumerated in the area) 25,641 11,327 With workplace in the area 7,335 5,164 With no fixed workplace 1,852 302 Workplace not stated 270 296 With workplace outside area 16,184 5,565 The workplaces outside the area being as follows:— Essex 3,816 Hertfqrdshire 19 Kent 43 London, City of 9,607 London, Metropolitan Boroughs 7,738 Middlesex 164 Surrey 57 Other parts of England and Wales 244 Outside England and Wales 61 Judged by occupation Southend-on-Sea and Ilford are very similar, the middle class element being at its maximum in these towns as compared with other areas in the County of Essex. 5. Births.—The number of births registered during the year was 1,606. Legitimate Males 796 Females 769 Illegitimate Males 26 Females 15 i.e., 2.5 per cent. of the births registered were illegitimate. The percentage of illegitimate births registered in previous years Was 2.5 in 1922; 2.5 in 1921; 31 in 1920; 5 8 in 1919; 4 2 in 1918; 4.5 in 1917; 2 8 in 1916; 19 in 1915; 18 in 1914; 21 in 1913; 2.2 in 1912; apd 17 in 1911. The birth-rate, calculated on the net estimate of the population of 85,251 is 18.8 per 1,000, as compared with 17.8 in 1922; 18 3 in 1921; 20.1 in 1920; 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. 25 6. Deaths.— The total number of deaths of Ilford residents is 808. The total number of deaths registered in the district during the year was 816 Number of deaths of non-residents registered in the district (principally in large institutions) 222 These deaths occurred as follows:— In ClavbUrv (L.C.C.) Mental Hospita 145 In West Ham Borough Mental Hospital 61 In Ilford Isolation Hospital and Sanatorium 5 In Ilford Emergency Hospital 6 Other non-residents 5 222 Included in the deaths of residents belonging to the district are 10 which occurred in Dr. Barnardo's Village Homes. To be added to the total are 214 deaths of Ilford residents registered as having died in other districts. This figure includes deaths at the following institutions:— The Infirmary, Romford 93 Essex County Mental Hospital 15 The London Hospital 20 Queen Mary's Hospital, West Ham 8 Hospital for Sick Children, Gt. Ormond Street 4 The Middlesex Hospital 2 St. Bartholomew's Hospital 2 In other Hospitals, Institutions and residences outside the Ilford District 70 Total 214 The total number of deaths of Ilford residents is therefore 808. 26 The death rate, calculated on the net estimate of the population of 85,251, is 95 per 1,000, as compared with 9.5 in 1922; 9 2 in 1921; 9.0 in 1920; 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. It will be seen from Table III. that cancer is the cause of about one-seventh of the deaths occurring. If the age periods 45 upwards be taken it causes over one-fifth, or of the period 45—65 years, one-quarter. Inquests.—During the year 34 inquests were held in the district. 27 on Ilford residents, and 7 on non-residents. The ages at death and causes assigned were as follows:— Under 1 yr. 1-2 yrs. 2 5 yrs. 6-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. & upwards. 2 2 2 1 4 2 13 8 Causes of death under 1 year:—Asphyxia by bed clothes, 1; pneumonia, 1. Causes of death over 1 year:— Syncope 5 Found drowned 1 Accidents 11 Acute Pneumonia 1 Suicides 4 Abscess of Liver and Peri- Cerebral Haemorrhage 1 tonitis 1 Burns and Scalds 4 Septicemia following Streptococcal Meningitis 1 Abrasion 1 Heart Disease 2 7. Marriages.—628 marriages of Ilford residents have been recorded at the Registrar's Offices at Romford and Ilford during 1923. 8. Tables of Vital. Statistics.—Table I. gives a comparative statement of the population, birth-rate and death-rate, for the past 6 years. Table III. gives a classified statement of the causes of death in 1923, arranged according to the age groups at which deaths occurred. Table Ia. gives a comparison of the vital statistics of Ilford with England and Wales, London, and other towns. 27 TABLE I Vital Statistics of Whole District durino 1923 and Previous Years, Year. Gross Population estimated to middle of each year. Net Population estimated to middle of each year (a). Births, Total Deaths Registered in the District. Transferable Deaths. Net Deaths belonging to the District. Uncorrected Number. Net (6). 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 Net Births. Number. Rate (e). 1 2 2a 3 4 5 6 7 8 9 10 11 12 13 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 1,666 201 894 10 3 306 160 90 54 748 9.0 1921 85,500 §81,567 1,475 1,492 183 821 9-6 252 181 76 509 750 9.2 1922 86,370 §82,624 1,475 1,475 17-8 914 105 314 195 80 542 795 9.5 1923 89,020 §85,251 1,570 1,606 18.8 816 9.2 222 214 66 41.1 808 9.5 *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 estimated net population, inclusive of the Girls' Village Homes, Barkingside. 28 TABLE IA. Table showing comparison between the Birth-rate, Death-rate, &c. of Ilford, other Towns, and of England and Wales for the Year 1923. (Provisional figures. The rates for England and Wales, and Ilford, have been calculated on a population estimated to the middle of 1923, while these for the towns have been calculated on populations estimated to the middle of 1922. The mortality rates refer to the whole population as regards England and Wales, but only to civilians as regards London and the groups of towns). Birthrate per Per 1,000 Population. Annual Death-rate per 1,000 Population. Rate per 1.000 Births. Percentage of Total Deaths. All Causes Enteric Fever. Small-pox. Measles. Scarlet Fever. Whoopingcough. Diphtheria. Influenza. Violence. Diarrhœa and Enteritis (under 2 Years). Total Deaths under One Year. Causes of Death certified by Registered Medical Practitioners. Inquest Cases. Uncertified Causes of Death. England and Wales 19.7 11.6 0.01 0.00 0.14 0.03 0.10 0.07 0.22 0.44 7.7 69 92.0 69 1.1 105 County Boroughs and Great Towns, including London 204 11.6 0.01 0.00 0.15 003 0.12 00.9 022 0.40 9.9 72 92.2 72 0.6 157 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 198 10 0 001 — 019 002 010 006 021 038 64 69 92.6 6.1 1.3 London 20.2 11.2 0.01 0.00 0.08 0.02 0.09 0.13 0.17 0.45 10.2 60 90.8 9.1 0.1 ILFORD (Estimated Net Popula tion, 85,251) 18.8 9.5 0.01 0.00 0.02 0.01 0.04 0.05 0.14 0.29 5.6 41 95.8 4.2 — 29 TABLE III. Causes of, and Ages at, Death during the Year 1923. Causes of Death. Net 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 2 - 1 1 - - - - - 1 4 Scarlet fever 1 - - 1 - - - - - 1 5 Whooping cough 4 2 1 1 - - - - - - 6 Diphtheria 5 — — 1 3 — 1 - - 5 7 Influenza 11 — — — 1 1 4 2 3 1 8 Encephalitis lethargica — — — — — - - - - 9 Meningococcal meningitis 2 — — 1 — — 1 - - - 10 Tuberculosis of respiratory system 55 - - 1 2 11 21 16 4 27 11 Other tuberculous diseases 12 — 1 1 1 2 5 1 1 11 12 Cancer, malignant disease 114 — — — - 2 10 51 51 18 13 Rheumatic fever 3 — — - 1 1 - - 1 1 14 Diabetes 5 — — - - - - 1 4 - 15 Cerebral hæmorrhage, &c. 37 - - - - - - 16 21 2 16 Heart disease 85 — — — 1 5 9 25 45 15 17 Arterio-sclerosis 19 — — — — - - 4 15 31 18 Bronchitis 44 — — 2 - 1 3 11 27 10 19 Pneumonia (all forms) 42 7 1 1 1 2 5 12 13 15 20 Other respiratory diseases. 9 - - - - - 1 3 5 - 21 Ulcer of stomach or duodenum 9 - - - - 1 2 5 1 3 22 Diarrhœ, &c. (under 2 years) 9 8 1 - - - - - - 3 23 Appendicitis and typhlitis 6 1 - - 1 1 1 1 1 3 24 Cirrhosis of liver 2 - - - - - - 1 1 - 25 Acute and chronic nephritis 15 - - 1 - 1 3 7 3 8 26 Puerperal sepsis 3 - - - - - 3 - - 2 27 Other accidents and diseases of pregnancy and parturition 1 - - - - - 1 - - - 28 Congenital debility and malformation, premature birth. 32 32 - - - - - - - 1 9 Suicide 6 — - — - 2 - 4 - 1 30 Other deaths from violence 22 - 1 3 - 3 5 6 4 11 31 Other defined diseases 251 16 3 2 6 8 21 53 142 123 32 Causes ill-defined or unknown 1 - - - - - - 1 - - Totals 808 66 9 16 17 41 96 221 342 293 Special causes (included above): Poliomyelitis - - - - - - - - - - Polioencephalitis — — — — - — - — — .30 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 net 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 net estimated population of the district. (b) The net number of births is obtained by taking the uncorrrected number of births supplied by the local Registrar and adding to or subtracting from it such a number as is supplied for this purpose by the RegistrarGeneral. (c) The birth-rate is calculated on the estimated net population for birth-rate. (d) Calculated on the estimated total population for death-rate. (e) Calculated on the estimated net 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 net death-rate of the district. The following special cases arise as to Transferable Deaths: — (1) Persons dying in Institutions for the sick ot 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 not 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; (e) failing this, to the district where death occurred, if known; and (d) failing this, to the district where the body was found. 31 SECTION II.— SANITARY CIRCUMSTANCES OF THE DISTRICT. 1. Water Supply.— Vide Annual Report, 1920. 2. Rivers and Streams. — Vide Annual Report, 1920. 3. Drainage and Sewerage.— Vide Annual Report, 1920. The new effluent pipe to the River Thames is now nearing completion. A new 15 in. Relief Sewer to relieve flooding' in the Uphall Road district is to be laid. The work has been sanctioned by the Ministry of Health and will be commenced as soon as possible. Two new Contact Beds at the Outfall Works have been completed and are now in use. 4. Closet Accommodation.—In addition to the water carriage system of sewage, there are in the rural area 56 cesspools, 35 privies and 62 pail closets. The clearing of cesspools, privies and pail closets is carried out by the Council by means of a vacuum emptier. All pail closets are emptied twice weekly. One railway station premises in the outlying part of the district has been connected to the sewer during the year. 5. Scavenging, Collection of House Refuse.—Vide Annual Report, 1920. At the end of the year six electric vans and a 1-ton Ford van and four horse-drawn vehicles were in use. The system of collection has been carefully gone into and revised during the year. 427 defective and unsuitable receptacles have been replaced during the year. The following figures give information as to the collection of house refuse during 1923:— Number of days on which collection was made 569 (Horse 262, electric 307.) Number of vehicles employed 3,374 (Horse 1,093, electric 2,281.) 32 Average number of vehicles employed per day 11.47 (Horse 4.07, electric 7.4.) Total number of loads collected 8,658 (Horse 2,587, electric 6,071.) Average number of loads collected per day 29.1 (Horse 9.4, electric 19.7.) Average per horse per day 2.3 Average per electric per day 2.7 Average per both per day 2.5 Total weight of refuse collected 16,193 tons 13 cwts. 2 qrs. (Horse 3,397 tons 5 cwts. 2 qrs.) (Electric 12,796 tons 8 cwts. 0 qrs.) Average weight per load:— Horse-drawn vehicles 1 ton 6 cwts. 0.2 qrs. Electric vehicles 2 tons 2 cwts. 1.4 qrs. Average of both 1 ton 14 cwts. 0.8 qrs. Average cost of collection per ton:— £ s. d. Horse 0 9 0.3 Electric 0 13 5.9 Both 0 11 3.1 6. Sanitary Inspection of the District.—-The following is a summary of the work of the Sanitary Inspectors during the year:— Houses and premises inspected 4,136 Houses and premises re-inspected (works in progress) 4.042 Visits during disinfection 989 Houses in which nuisances were detected 465 Houses in which nuisances were abated 456 Notices served 839 Notices complied with 837 Premises disinfected 463 Articles disinfected 5,154 Notices Served. Served Complied with. Statutory 12 15 Pave Yard (Ilford Improvement Act) 2 4 Informal 382 384 Provide Dustbin (Ilford Improvement Act) 318 323 Cleanse Water Storage Cistern (Bye-laws) 58 56 Cover ditto 6 6 Provide Water to Dwelling House 11 11 Cleanse Dwelling House (Infectious Disease (Prevention) Act, 1890) 31 32 Housing Acts, 1890-1919 19 6 Totals 839 837 Complaints.—During the year 351 complaints of nuisances have been received and investigated:— 33 The following is a summary:— Accumulation of manure and refuse 17 Animals improperly kept 10 Bad smells 23 Dampness of premises 8 Defective drains, w.c.'s and fittings 103 Defective or no provision of dustbin 10 Defective roofs, gutters, downpipes, etc. 28 Defective water fittings 21 Dirty and verminous houses 17 Dirty condition of rearway 4 Flooding of premises 5 Overcrowding 9 Smoke nuisances 16 Miscellaneous 80 Total 351 Increase of Rent and Mortgage Interest (Restrictions) Act, 1020.—The Senior Sanitary Inspector was authorised by the Council in December, 1919, to make visits and certify under the provisions of the Acts. The number of applications received under Section 2 (4) of the Act was 76, and the number of certificates issued was 42. The landlords, upon receiving a copy of the certificate issued, have carried out the work necessary to place the premises in a reasonable state of repair, and in a few cases only was it necessary for the tenants to apply to the County Court for assistance. 7. 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 melters or fat extractors. (h) Glue makers. (i) Tripe boilers. (j) Size makers. (k) Gut scrapers. 34 (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. (8) Dairies, cowsheds and milkshops, and regulations for prescribing precautions by purveyors of milk and persons selling milk. Fish frying and dealing in rags and bones were scheduled during the year as offensive trades. The order was confirmed by the Minister of Health and came into operation on 17th September. Byelaws under this order are being submitted to the Ministry of Health for approval. Fish Curing.— Application was also made to the Ministry of Health that curing should be registered as an offensive trade. This is already registered as an offensive trade in Walthamstow and is dealt with in the London County Council area by regulations made under section 9 of the London County Council (General Powers) Act, 1908. After prolonged correspondence, however, the Ministry of Health declined to permit this trade to be so scheduled. This is an unsatisfactory position, as fish curing, which is carried out in many cases under unsatisfactory conditions, cannot be dealt with until the conditions become so offensive as to constitute a nuisance within the meaning of the Public Health Acts. 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, the section of which (dealing with the control of Tuberculosis) is now over-ruled by the Milk and Dairies Act, while the section dealing with infectious disease has enactments similar to the Public Health Acts of 1907. Sections 62 and 63 only of Part IV. of the Public Health Act, 1907, have been adopted. 35 SECTION III.— SUPERVISION OF FOOD SUPPLY. 1. Milk Supply.— There are 44 dairies and milkshops and 7 cowsheds on the register. 288 inspections of dairies, milkshops and cowsheds were carried out during the year. Of the 44 premises from which milk is retailed in Ilford, 8 are branches of one firm, 4 another, 2 another, and 2 another. Of the remainder, three are retailers in a large way. 7 retail from dairy shops or stores, 5 from general grocery shops, and 2 from restaurants. 11 are retailers in a small way with rounds and also provision for storage of milk. In three of the premises pasteurising plant has been installed for the treatment of milk to comply with the requirements of the Milk and Diaries (Amendment) Act, 1922. Only one of these has, however, been licensed under the Order. There are eight wholesale dealers in milk. Of these, two are also retailers. Two of the eight have no cows on the premises ; the remaining six have cowsheds. Licenses were granted under the Milk (Special Designations) Order, 1922, during 1923, for the sale of:— "Certified" milk 7 "Grade A" milk 6 "Grade A (tuberculin tested)" milk 1 "Pasteurised" milk 5 (four of these licenses are held by the same dairyman.) The above include supplementary licenses which were issued for "Certified" milk 4, "Grade A" milk 5, and" Pasteurised" milk 1. These are licenses granted to firms who already have a license from another Authority, the milk being bottled outside the town but sold in Ilford. By the Milk (Special Designations) Order, dated 25th May, 1923, an amendment was made to the Order of 9th December, 1922, as regards the treatment of "Pasteurised" milk. The Order of 9th December, 1922, required that "Pasteurised" milk should not, after treatment, contain more than 30,000 bacteria per cubic centimetre nor any bacillus coli in one-tenth of a cubic centimetre, while the latter Order requires that any sample taken between 1st July and 31st December, 1923, should not 36 tain more than 200,000 bacteria per cubic centimetre, and as from 1st January, 1924, not more than 100,000 bacteria per cubic centimetre. The test for bacillus coli has also been removed. 2. Meat. (a) Slaughterhouses.—There is now only one licensed slaughterhouse in the district. 46 inspections were carried out during the year. The following table gives particulars of the slaughterhouses in the Ilford district:— In 1914. In January, 1923. In December, 1923. Registered — — — Licensed 3 2 1 Totals 3 2 1 (b) Articles of Food Surrendered and Seized.— During the year the following articles of food were surrendered or seized and condemned as being unfit for the food of man:— Surrendered:— 43 tins condensed milk. 3 boxes kippers. 4 tins salmon. 1 tin apricots. 27 tins pilchards. 1 forequarter beef (22 stone). 5½ stone skate. 10 calves' plucks. 5½ stone plaice. 1 ox tongue (salt). 1 box skate. 1 piece loin of pork (salt). 1 box fresh haddocks. 20 lbs. leg of pork (salt). 1 case whiting. Seized:— (a) 2 6½ lb. tins, apricot pulp. 7 tins sardine sandwich. 2 tins potted sardines. 2 tins sardines with tomatoes. 2 tins sardines 1 2 lb. tin jam. 1 tin fresh herrings. (b) 7 tins sardines. (c) 1 leg mutton, ½ leg mutton. 1 forequarter lamb. 1 piece breast mutton. 2 shoulders mutton. 1 neck mutton. 2 pieces mutton 8 pieces beef. 4 pieces pork. Trimmings. Total weight 5 stone 12 lbs. 37 The following action was taken in connection with these cases:— (a) Legal proceedings were instituted and defendants were each fined £5 and £5 5s. costs. (b) Letter of warning sent by Clerk to the Council. (c) Legal proceedings were pending but the defendant died before the case could be brought into Court. Tinned Foods.— At the latter end of 1922 and early in 1923 visits were paid by the Sanitary Inspectors to grocers and other tradesmen dealing in these articles. In all 80 visits were made. In two cases only was it found necessary to seize unsound articles, and the result of the action taken is referred to above. 3. Other Foods. Bakehouses.—There are 27 bakehouses in the district, including 15 factory bakehouses. There is one underground bakehouse. GG inspections of bakehouses were carried out during the year. 4. Sale of Food and Drugs Acts.—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 75 Samples of butter taken 59 Other articles 29 Total 163 Samples of cream were procured for the purpose of the enforcement of the Milk and Cream Regulations, 1912 and 1917. A number of reports were dealt with and proceedings were taken against one vendor in respect of butter, and resulted in a fine of £5 being imposed. There was also a fine of £2 and 5s. costs in respect of adulterated milk, and a fine of £2 in respect of the sale of sponge cake found to contain boric preservative. The Public Health (Condensed Milk) Regulations came into operation on the 1st October, 1923, and the enforcement of the provisions contained therein necessitated the inspection of the stocks in the various vendors' premises in addition to the taking of samples. 38 SECTION IV.— PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. 1. Infectious Disease Generally.— During 1923, 499 cases were notified, as compared with 713 in 1922. The following diseases are notifiable to the Medical Officer of Health. 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 amœbic 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. Anthrax. Table II. shows the number of cases of infectious disease notified during 1923, arranged according to age and distributed in wards. Of these 67 occurred in institutions as follows: Claybury Mental Hospital:— Pneumonia 6 cases. Dysentery 28 cases. Erysipelas 1 case. Tuberculosis - pulmonary 7 cases. ,, Other forms 1 case. 43 cases. Dr. Barnardo's Girls' Village Homes:— Scarlet Fever 7 cases. Diphtheria 7 „ Pneumonia 2 „ Tuberculosis—Pulmonary 5 „ „ Other forms 1 case. 22 cases. Ilford Emergency Hospital: — Puerperal Fever 2 cases. Of the cases notified (exclusive of those from Public Institutions) the following table shows the percentage isolated in hospitals:— 39 Scarlet Fever 93.5 Diphtheria and Membranous Croup 92.7 Enteric Fever 60.0 Puerperal Fever 71.4 Ophthalmia Neonatorum 44.4 Cerebro- Spinal Fever 50.0 Acute Poliomyelitis 100.0 Encephalitis Lethargica 50.0 Anthrax 100.0 The total number of deaths of Ilford residents from the chief infectious diseases during- 1923 is 147, classified as follows:— Enteric Fever 1 Scarlet Fever 1 Diphtheria 5 Measles 2 Whooping Cough 4 Influenza 11 Tuberculosis—Pulmonary 55 „ Other forms 12 Pneumonia 42 Diarrhoea (under 2 years) 9 Cerebro-Spinal Meningitis 2 Puerperal Fever 3 147 The following table shows a comparison of the incidence of the chief infectious diseases in 1923 with that of 1922 and 1921:— No. of Cases. 1923. 1922. 1921. Scarlet Fever 131 252 467 Diphtheria 131 182 187 Enteric Fever 5 5 15 Pneumonia 29 70 49 40 TABLE II.— Cases of Infectious Disease Notified during the Year 1923. 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 Clementswood South Hainault Small Pox - - - - - - - - - - - - - - - - Scarlet Fever 131 1 23 90 15 2 - - 12 10 19 10 14 11 45 116 Diphtheria, including Membranous Croup 131 - 26 74 16 14 1 - 7 12 9 11 16 9 67 115 Enteric Fever (Typhoid and Para Typhoid) 5 - 1 1 - 2 1 - 2 - - - - 1 2 3 Pneumonia 29 1 - 5 6 10 5 2 2 - 3 11 1 2 10 - Puerperal Fever 7 - - - 2 5 - - - - 1 8 1 1 1 5 Cerebro-Spinal Fever 2 — 1 - - 1 - - - 1 - - - - 1 1 Acute Poliomyelitis 1 - - - 1 - - - - 1 - - - - - 1 Encephalitis Lethargica 2 — - 1 - - 1 - - - - - - 2 — 1 Continued Fever - - - - - - - - - - - - - - - - Dysentery 29 1 - - 1 10 13 4 — 1 - 28 — — — - Ophthalmia Neonatorum 9 9 - — — — — — — 1 1 1 3 1 2 3 Erysipelas 21 1 — 2 1 6 8 3 - 1 7 1 3 5 4 — Tuberculosis—Pulmonary 106 — — 10 21 48 23 4 12 10 5 23 12 21 23 — Other Forms 25 — 5 9 4 7 - - 2 2 5 3 3 5 5 - Anthrax 1 - - - 1 - - - - - - - - - 1 - Malaria—Believed to be contracted in this Country - - - - - - - - - - - - - - - 1 Believed to be contracted abroad - - - - - - - - - - - - - - - - Totals 499 13 56 192 68 105 52 13 37 39 50 91 53 68 161 246 41 The attack-rates of certain infectious diseases per 1,000 of the population as compared with 1922 and 1921 is seen from the undermentioned figures:— Year Population Small Pox Scarlet Fever Diphtheria a b a b a b a b 1923 89,020 83,757 — — 1.5 1.5 1.5 1.5 1922 86,370 81,240 — — 2 9 2.4 2.1 1.9 1921 85,500 80,116 - - 5.4 3.8 2.2 1.8 Year Population Enteric Fever Puerperal Fever Erysipelas a b a b a b b 1923 89,020 83,757 0.05 0.06 0.07 0.08 0.23 0.23 1922 86,370 81,240 0.05 0.04 0.1 0.11 0.3 0.3 1921 85,500 80,116 0.2 0.06 0.09 0.09 0.3 0.2 (a) Including all Institutions. (b) Excluding all Institutions. (a) Small-pox.— No case of Small-pox occurred in 1923. Notifications of 8 persons who had been in contact with cases of Small-pox were received. The following gives particulars as to vaccinations during 1923:— Certificates of Successful Vaccinations 1290 Postponed 134 Conscientious Objections 526 Unsuccessful Vaccinations 8 Left the District 134 Small-pox Hospital Accommodation.— Vide Annual Report, 1922. (b) Scarlet Fever.—131 cases were notified in 1923, as compared with 252 in 1922, and 461 in 1921. Of the 131, 7 cases occurred in the Girls' Village Homes, Barkingside, with no deaths. One death only occurred from scarlet fever in the Isolation Hospital. 42 (c) Diphtheria.—131 cases of Diphtheria occurred in 1923, as compared with 182 in 1022, and 187 in 1921. Of the 131 cases, 7 occurred in the Girls' Village Homes, Barkingside, with no deaths. 5 deaths occurred in the Isolation Hospital. (d) Enteric Fever.—5 cases occurred in 1923, as compared with 5 in 1922, and 15 in 1921. No cases occurred in institutions in the district during 1923. One of the 5 cases notified died. Of the five cases one proved to be a case of Pneumonia, a second was doubtful Enteric not confirmed by blood examination, two others were a mother and her child who apparently contracted the disease in a seaside resort, the last was a case of Paratyphoid B. in a child who also contracted the disease in a seaside resort. (e) Cerebro-Spinal Meningitis.—2 cases of this disease were notified, only one of these was confirmed by bacteriological examination. Both cases died, one at home, the other at the Middlesex Hospital. (/) Ophthalmia Neonatorum.—9 cases were notified during' 1923, as compared with 9 in 1922, and 7 in 1921. Seven of the cases recovered without any permanent injury to the vision. In the remaining- 2 cases 1 was left with impairment of vision in both eyes, and 1 died in hospital. I have referred to the new arrangement made for the hospital treatment of Ophthalmia Neonatorum on page 81. (g) Acute Influenzal and Acute Pulmonary Pneumonia.—29 cases of Pneumonia were notified, of which 8 were in institutions, compared with 70 in 1922, and 49 in 1921. (h) Anthrax.— One case of Anthrax was notified during the year. The patient was a youth engaged as a "learner to Horse Hair Dressing." He was admitted to the London Hospital for treatment, and recovered from the disease. (i) Plague.—2 persons were reported to have been in contact with cases of Plague on board ship. These contacts were visited and kept under observation for the usual period. 43 (j) Puerperal Fever.— There were 7 cases of Puerperal Fever notified during the year; of these two died in the Emergency Hospital and one in the London Hospital. The remaining four cases recovered. Two were treated at the Isolation Hospital, one in the. London Hospital and one at home. 2. Zymotic Diseases.—The deaths registered were as follows:— Small-pox — Measles 2 Scarlet Fever 1 Whooping Cough 4 Diphtheria and Croup 5 Enteric Fever I Diarrhoœa 9 This gives a Zymotic death-rate for 1923 of .26 per 1,000 of the net population. The Zymotic death-rate for the previous five years was .32 in 1922; .37 in 1921; .53 in 1920; .31 in 1919; and .42 in 1918. (3) Tuberculosis.— During the year 1923 there were 106 new notifications of Pulmonary Tuberculosis and 25 of other forms of Tuberculosis. The following table shows the cases notified, 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. - - 5 12 21 14 7 2 2 63 F. - - 5 9 7 6 9 5 2 43 Tuberculosis (all other M. - 3 5 - 4 1 - - - 13 forms) F. - 2 4 4 2 - - - - 12 Totals - 5 19 25 34 21 10 7 4 131 44 Of the above the following' were notified from Institutions in the district:— Claybury Mental Hospital—Pulmonary Tuberculosis 7 Tuberculosis (all other forms) 1 The Girls' Village Homes, Barkingside—Pulmonary Tuberculosis 5 Tuberculosis (all other forms) 1 During the year 1923 the following deaths occurred from Tuberculosis:— Pulmonary Tuberculosis for the district proper (including 2 in the Girls' Village Homes, 2 in Claybury Mental Hospital and 1 in the Ilford Isolation Hospital and Sanatorium) 55 Claybury Mental Hospital (excluding the 2 mentioned above 14 West Ham Mental Hospital 6 Ilford Isolation Hospital and Sanatorium (not Ilford residents) 4 Tuberculosis (all other forms) for the district proper (including 3 in the Ilford Emergency Hospital and 1 in the Ilford Isolation Hospital and Sanatorium) 12 Claybury Mental Hospital 3 West Ham Mental Hospital 2 Ilford Emergency Hospital (not included above) 1 Ilford Isolation Hospital and Sanatorium (not included above) 1 Of the G7 deaths which occurred of Ilford residents, notification had previously been received of 53 of the cases, and 7 were notified at or immediately after death. Of the 7 remaining, 1 died at one of Dr. Barnardo's Convalescent Homes and was probably notified elsewhere; 2 at Claybury Mental Hospital, the usual place of residence being unknown; while 4 were not notified by medical practitioners for various reasons. The following table shows the number of deaths from Tuberculosis of Ilford residents, together with the death-rate for that disease per 1,000 persons living, during the last ten years:— 45  1914 1915 1916 1917 1918 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 55 .90 74 .92 64 .80 79 1.05 82 1.12 Tubercular Meningitis 6 .07 15 .18 9 .10 7 .09 7 .09 Tuberculosis (all other forms) 8 .09 12 .14 10 .12 12 .15 10 .10 1919 1920 1921 1922 1923 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 57 .71 42 .50 53 .64 46 .55 55 .64 Tubercular Meningitis 11 .13 5 .06 2 .02 - - - - Tuberculosis (all other forms) 16 .20 11 .13 9 .11 10 .12* 12 .14 *Including Tubercular Meningitis for the year 1922. On the 1st January, 1923, there were 570 cases on the register of the department. On the 31st December, 1923, with 117 new cases notified (Institution cases omitted), and allowing for deaths and removals from the district, there were 593 cases on the register. The new cases of Tuberculosis are visited by the Tuberculosis Nurse of the Essex County Council. 461 of the cases of longer standing were visited by the Sanitary Inspectors during the year, and the following reports were obtained:— Pulmonary Cases. Other Cases. Stated to be cured, recovered or better 138 133 Improved or fairly well 54 22 Poorly, unwell, or under treatment 65 19 In Sanatorium 9 4 No information as to present condition 12 5 Totals 278 183 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 Tuber- 46 culosis Officer. On the 31st December, 1923, there were 296 patients on the register of the Dispensary. The arrangements made with the Essex County Council for the dental treatment of tuberculous patients from Ilford, Romford, Leyton, Walthamstow, and Harold Court Sanatorium, were continued. Two afternoon sessions per month were set aside for the treatment of these cases. 108 patients were treated, 3 being supplied with dentures. Tuberculosis Care Committee.— This Committee has continued to do good work during the year. 55 cases have been assisted with extra nourishment, clothing, and in other ways. (4) Venereal Diseases.— 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 1-5 5-15 15-25 25-35 35-45 45 55 55 65 65 75 75 85 85 up NonResidents in Institutions. Totals Syphilis *1 - - - - - - - - - - - 1 Locomotor Ataxy - - - - - - - 3 1 - - - 4 General Paralysis of Insane — — — §1 1 2 2 — — - — 57 63 Aortic Aneurysm — — — — — — — 1 — — — 1 2 *Occurred in the Girls' Village Homes §Transferred in from the Essex County Mental Hospital. The deaths of non-residents in Institutions occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital, 28 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. 47 As regards Gonorrhoea, the prevalence of Ophthalmia Neonatorum shows no increase 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; 1921, 7 cases; 1922, 9 cases; 1923, 9 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. The Local Propaganda Committee continued to carry on its work during the year in the following manner:— On the 4th March a meeting for men was held at St. Thomas' Church, Becontree, when an address was given by the Medical Officer of Health, the subject being "The Hidden Plague." On the afternoon of 13th March the film "Social Hygiene for Women," was exhibited to women only at Cranbrook Hall, Cranbrook Road. An address was given by Dr. Elizabeth Sloan Chesser. In the evening of the same day the film, "Damaged Goods," was exhibited to a mixed audience, and an address was given by Dr. A. J. Cokkinis. The Ilford V.D. Propaganda Committee and the Ilford Branch of the Alliance of Honour co-operated and arranged a meeting for women only at the Town Hall, Ilford, on 15th October, when the film, "The Shadow," was exhibited, and an address given by Dr. Winifred Cullis. A meeting for men only was also held at the Town Hall on the 17th October, when the film, "Whatsoever a man Soweth," was exhibited, an address being given by Dr. A. J. Cokkinis. 48 SECTION V.— OTHER SERVICES. 1. Bacteriological Laboratory.— The Essex County Council provides free bacteriological examinations for most specimens at their laboratory in London. Examinations of such urgent (specimens as diphtheria swabs are examined in the laboratory at the Public Health Offices. The accompanyingtable shows how much these facilities are appreciated, 1,451 specimens having been examined during the past year. Specimens for diagnosis of Venereal Disease are examined at the London Hospital; for Tuberculosis at the Essex County Laboratory. 49 BACTERIOLOGICAL LABORATORY, 1923. 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. Swabs—Throat Diphtheria 68 381 - 25 8 68 89 273 165 747 „ —Nose 1 14 2 4 10 17 14 40 27 75 Hairs Ringworm 2 1 — 1 71 72 — — 73 74 Sputum Tuberculosis 1 3 - 1 — — 1 1 2 5 Urine Tuberculous — - - — - — 1 2 1 2 Urine Other abnormalities — - — 9 7 69 6 - 13 78 Smears—Vaginal Gonorrhœa — 1 1 23 — — — — 1 24 „ Conjunctival Ophthalmia Neonatorum — — 1 7 - — — - 1 7 Contact Swabs—Nose Diphtheria 1 1 2 8 2 7 - — 5 10 „ „ —Throat Diphtheria 1 65 5 37 3 23 - — 9 125 Smear Anthrax 1 — — - — — — — 1 — Totals 298 1153 Grand Total 1,451. 50 2. District Nursing.— In my last annual report I stated that the provision of district nurses for home nursing was commenced in October, 1921. The demand for these nurses was maintained during the year 1923, and has fully justified the formulation of a scheme for this beneficent service by the Medical Officer of Health, which was subsequently accepted by the Governors of the Ilford Emergency Hospital, and carried out by the District Nursing Committee. The following is a summary of the work carried out during the year 1923:— 1st Visits. Subsequent Visits. Medical. Surgical. Midwifery. Medical. Surgical. Midwifery. 195 19 — 4,520 19 Number of applications made for Nurses' services 214 Number of patients under the charge of a doctor 213 Number of patients not under the charge of a doctor 1 Number of necessitous cases referred to Committee 34 Number of cases on the books at the end of the year 20 The cases were distributed in wards as under:— Cranbrook 41 Park 24 Seven Kings 44 North Hainault 11 Loxford 15 Clementswood 49 South Hainault 30 SECTION VI.— HOUSING. There is still a great shortage of houses in the Ilford district. The housing schemes which have been carried out in the district have provided 2,161 houses, 356 being erected by the Ilford Council, 220 by the City of London Corporation, and 1,585 by the London County Council; this last scheme being completed in the early part of the year. The three schemes were originally intended to supply 5,304 houses, viz., 504 by the Ilford Council, 2,000 by the City of London Corporation, and 2,800 by the London County Council. It will be seen that the total number of houses erected is well under half the original proposal. An additional 7 houses, comprising 14 flats, have been erected by the Ilford Council at the rear of the Fire Station, Ley Street, for Council employees. 51 Private enterprise does not appear to be sufficient to meet existing requirements. 250 houses were completed by this means during 1923, a further 242 houses being in course of erection on the 31st December. From the census figures on page 21 it will be seen that there were 1,257 families, consisting of 3,045 persons, living in two rooms. The following is the table required by the Ministry of Health as to the houses dealt with during 1923 under the Public Health Acts:— 1. Unfit Dwelling Houses: — (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 76 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 10 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 42 2.Remedy of Defects without services of formal Notice:- Number of Defective dwelling houses rendered fit in consequence of informal action action by the Local Authority or their officers 65 3. Action under Statutory powers:- (A) Proceeding under section 28 of the Housing, Town Planing, etc., Act, 1919:- (1) Number of dwelling houses in respect of which notices were served requiring repairs 19 (2) Number of dwelling houses which were rendered fit:— (a) By owners 6 (6) 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) Proceeding under public Health Acts:- (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 465 52 (2) Number of dwelling houses in which defects were remedied:— (a) By owners 456 (b) By Local Authority in default of owners - (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Acts, 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 - SECTION VII.— FACTORIES AND WORKSHOPS. Factories. There are 134 factories on the register, made up as follows:— Alloy Moulder 1 Meat Cutting 6 Bakehouses 15 Mechanical Dentist 1 Boot Making and Repair- Motor Engineering 10 ing 18 Nautical Instrument Builders, Joinery and Car- Makers pentry Works 5 Optician 1 Cardboard Box Maker 1 Paper Mills 2 Carriage Works 2 Photographic Works 1 Chemical Works 1 picture Moulding 1 Collar Works 2 Plating and Enamelling 1 Confectionery Makers 1 Printing Works Corset Makers 1 and General Merchant 1 1 Cutlery Grinding 1 Saw Mills 2 Cycle Repairing 1 Seed Sorting 1 Electric Wire and Battery Engineers 2 Works 3 Toy Makers 2 Engineers 12 Umbrella Repairing 2 Fancy Bag Makers 2 Vulcanising Works 1 Fancy Bag Makers 2 Matchmaker and Repairer 1 Gear Cutting 1 Wearing Apparel Makers 7 Hardware Manufacturers 1 Wireless Apparatus 2 Iron Cutting Works 1 Wood Cutting 5 Ironing Shield Maker 1 Laundries 5 Total 134 Leather Belting 1 53 Workshops. There are 432 workshops on the register, made up as follows:— Art Pottery Worker 1 Motor Cab Proprietor 1 Artificial Flowers 2 Motor and Cycle Bakehouses 12 ing and Repairing 29 Blacksmiths 3 Optician 2 Bookbinder 2 Picture Framing 6 Boot Repairing 39 Photographers 1 Boot and Shoe Sewing 3 J lumbers 10 Brush Worker 6 Poultry Appliance Maker 1 Builders 17 Printers 5 Cake Maker 1 Rag and Bone Merchant 3 Carpenters 16 Scale Maker 1 Carpet Planning 1 Sheet Metal Worker 2 Cleaning and pressing 1 Shoe Bows 1 Clothes 1 Side Car Screens 1 Clergy Robes 1 Smith's Shop 2 Coach Builders 1 Sports Outfit Repairs 2 Confectionery 2 Surgical Belt Maker 1 Dairy Utensil Maker 1 Tailors 40 Dressmakers 37 Tie Maker 5 Drug Packing, etc. 1 Timber Merchant 1 Electrical and Mechanical Tinsmith 1 Engineers 5 Tool Grinding 1 Embroidery 4 Toy Making and Repairing 3 Feather Cleaning 1 Umbrella Repairing 3 Florists 2 Undertakers 4 French Polisher 4 Upholstering 7 Galvanised Iron Works 1 Watch and Jewellery Re- Glass Cutters and Glaziers 2 pairs 15 Hand Laundry 1 Wearing Apparel and Harness Maker 1 Underclothing 07 Hair dressing 2 Wheelwright and Farrier 8 Ladies' Belt Makers 1 Wire Worker 1 Ladies Belt Maker 1 Wireless Apparatus 1 Leather Worker 3 Wood Cutting 4 Mechanical Dentist 2 Millinery 30 Total 432 Metal Moulders 4 54 FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Including Inspections made by Sanitary Inspectors. Premises Number of Inspections. Written Notices. Prosecutions (1) (2) (3) (4) Factories (including Factory Laundries) 214 4 - Workshops (including Workshop Laundries) 482 5 - Workplaces(otherthan Outworkers' premises included in Part 3 of this report) - - - Total 696 9 - 55 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Insp'tor (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 3 3 - - Want of ventilation 2 2 - - Overcrowding 1 1 - - Want of drainage of floors - - - - Other nuisances 3 3 - - Sanitary modation insufficient 1 1 - - unsuitable or defective 5 5 - - not separate for sexes - - - - Offences under the Factory and Workshops 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 15 15 - - *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 56 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 28 31 1 — 1 Cleaning and Washing - - - - - - Household Linen 2 — 4 — — — Lace, Lace Curtains and Nets - - - 1 - 1 Total 22 28 35 2 - 2 Note.— No home-workers were known to be engaged in the following occupations:—Curtains and Furniture Hangings; Furniture 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; Feather Sorting; Carding, etc., of Buttons, etc.; Stuffed Toys; Basket Making; Chocolates and Sweetmeats; Cosaques, Christmas Crackers, Christmas Stockings, etc; Textile Weaving. 57 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 181) at the end of the Year. Number. (1) (2) Bakehouses (excluding 15 Factory Bakehouses) 12 Boot Repairs 39 Carpentering 16 Dressmakers 37 Laundries 1 Milliners 30 Tailoring 40 Wearing Apparel and Underclothing 57 Miscellaneous Workshops 200 Total number of Workshops on Register 432 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) 8 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 1 Reports (of action taken) sent to H.M. Inspector 1 Other — Underground Bakehouses (s. 101):— In use at the end of the year 1 ISOLATION HOSPITAL. 61 ISOLATION HOSPITAL. There has been less pressure on the Isolation Hospital in 1923 than for some years previously. 314 patients were admitted in 1923 as compared with 411 in 1922, 493 in 1921 and 506 in 1920. By far the great majority of cases of scarlet fever and diphtheria occurring in the district are nursed in the Hospital. In 1923, 93.5 per cent. of the cases of scarlet fever and 92.7 per cent. of the cases of diphtheria were admitted to the Hospital. The usual courses of lectures were given to the probationer nurses and six were successful in obtaining the certificate of the Fever Nurses' Association. The number of patients in Hospital on 1st January, 1923, was 55:— Scarlet Fever 18 Diphtheria 18 Tuberculous Diseases 16 Under Observation 3 Total number of patients admitted during the year, 314:— Scarlet Fever 115 Diphtheria 113 Tuberculous Diseases 61 Enteric Fever 3 Ophthalmia Neonatorum 1 Puerperal Fever 3 Meningitis 1 Infantile Diarrhœa. 4 Under Observation 13 Number of deaths in Hospital, 11:— Scarlet Fever 1 Diphtheria 5 Tuberculous Diseases 4 Meningitis 1 Number of patients remaining in hospital on 1st January 1924, 44:— Scarlet Fever 16 Diphtheria 9 Tuberculous Diseases 15 Puerperal Fever 1 Under Observation 3 62 The average length of stay in hospital was for:— Scarlet Fever 50.8 days. Diphtheria 36.7 Tuberculous Diseases 90.4 ,, Average stay in Hospital of all cases 50.5 „ The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day, 49.0. Scarlet Fever.— The 115 cases admitted to Hospital were distributed among the following age groups:— Under 1 1—5 5—15 15—25 25—35 35—45 Over 45 — 21 80 13 1 — — One death occurred from scarlet fever during the year. The disease was complicated by purpura and occurred in a child of 3½ years. The following table shows the percentage death-rate of cases of scarlet fever admitted to the Ilford Isolation Hospital during the past five years:— 1919. 1920. 1921. 1922. 1923. — .4 — — .8 The following complications occurred in the patients admitted:— Rheumatism 6.0 per cent. Albuminuria 8.6 „ Adenitis 21.7 „ Otitis 4.3 „ Purpura .8 „ One child was operated on for adenoids to clear up a chronic nasal discharge. Diphtheria.— The 113 cases admitted to Hospital were distributed among the following age groups:— Under 1 1—5 5—15 15—25 25—35 35—45 Over 45 — 23 61 15 7 6 1 Five deaths from diphtheria occurred during the year All of these died from severe toxic diphtheria with cardiac failure. Three died within twenty-four hours of admission, the disease being too advanced to re-act to treatment. Apart from the cases 63 of cardiac failure only two patients showed signs of diphtheritic paralysis. Both were paralysis of the soft palate which lapidly cleared up. One child developed otorrhœa. The following table shows the percentage death-rate of cases of diphtheria admitted to the Ilford Isolation Hospital during the past five years:— 1919. 1920. 1921. 1922. 1923. 3.5 5.4 8.2 6.1 4.4 Three children who were "carriers" of the diphtheria bacillus were operated on for enlarged tonsils and adenoids and were discharged free from infection. Tuberculosis.— Of the 61 cases admitted during the year 16 were surgical cases. Most of these benefited considerably by treatment. Sir Henry Gauvain visited the Sanatorium at intervals and advised as to any special treatment required for the surgical cases. Most of these had been transferred from hospitals after operative treatment. Four deaths occurred, one within six weeks of transfer, from tuberculosis of the spine and psoas abscess, and a second suffering from multiple tuberculous abscesses died from generalised tuberculosis. The other two deaths were from pulmonary tuberculosis. One died from advanced chronic phthisis within three weeks of admission, the second from chronic phthisis with frequent attacks of haemoptysis. The pulmonary cases have been treated lately with the new Dreyer's vaccine, but it is too early to express an opinion on this method. Pneumothorax treatment was tried with one patient, a temporary improvement resulted. Enteric Fever.—Three cases were admitted as enteric fever. One proved to be a case of pneumonia which made a good recovery. The two others were a mother and child. The child had a severe attack but ultimately recovered after a relapse. The mother was admitted towards the end of the attack, and being 64 advanced in pregnancy had her baby while in the Isolation Hospital. Both mother and baby did well. It is interesting to note that the Widal re-action of the baby's blood was negative. Ophthalmia Neonatorum.— One severe case, with sight impaired on admission, was admitted, being sent each day to the ophthalmic department of the London Hospital for special treatment, and was discharged as soon as the mother was able to take the child there herself. The child recovered but with impaired vision in both eyes. Puerperal Fever.—One case proved to be puerperal mania and was removed to Romford Infirmary. The two other cases made a good recovery with serum treatment. Meningitis.—One case was admitted and died within 48 hours of admission. An inquest was held, and a post-mortem and bacteriological examination showed that the cause of death was a streptococcal infection. Infantile Diarrhœa.—Three babies were admitted during the summer. All improved under treatment. Observation Cases.—Thirteen cases were admitted harbouring the diphtheria bacillus in nose and throat, being " contacts of other cases. Eleven of these proved to be temporary carriers, the condition more or less rapidly clearing up. In the two other cases the organisms were proved on examination to be avirulent, and the patients were therefore discharged. Isolation Hospital Extensions.—On the 29th January, 1923, Lieut-Col. E. Wilkinson, Inspector of the Ministry of Health, held an enquiry at the Town Hall, Ilford, as to the necessity of extending the accommodation at the Isolation Hospital (vide pages 58 to 61 of my annual report for the year 1920). As a result of the enquiry sanction has been granted for the scheme to be carried out. These extensions and alterations have 65 been contracted for at the sum of £21,733, and it is hoped that the new buildings will be ready for use towards the latter end of 1924. It will be remembered that the original suggestion to the Ministry of Health was that an additional ward of 27 beds should be built over Block I. After inspection of the hospital by an architect and a medical officer to the Ministry, the Ministry of Health finally recommended that the present nurses' home over Block V should be converted into a ward of the above capacity, and that the convalescent home, which for some years has been used as sleeping accommodation for the night nurses, should be altered and form part of a new nurses' home. MATERNITY & CHILD WELFARE 69 Notification of Births Acts, 1907 and 1915. By the Notification of Births Acts, 1907 and 1915, all live births and stillbirths of seven months and over must be notified to the Medical Officer of Health within 36 hours. The number of births notified under the above Acts during 1923 was 1,541 (800 males and 741 females). In addition, 36 stillbirths (25 males and 11 females) were notified. The percentage of births notified by the various responsible persons was as follows:— By Medical Practitioners 19.72 ,, Certified Midwives 44.71 ,, Parents and others 35.57 Registration Act, 1836. By the Registration Act, 1836, all live births are registered with the Registrar of Births within six weeks. The birth-rate is calculated on births registered, and during the last year 1,606 (822 males and 784 females) were registered giving a birth-rate of 18.8 per 1,000 persons calculated on the net population; as compared with 1,475 births with a birth-rate of 17.8 per 1,000 persons in 1922. Infant Mortality. The number of infants dying within the first year of life was 66, the total number born being 1,606. The infant mortality or rate of death per 1,000 births was therefore 41.1. The infant mortality rate for the district is, strictly speaking, higher than it should be, from the fact that the deaths of babies in the Girls' Village Homes, Barkingside, are included, although the children concerned were not born in Ilford. If the deaths of babies in the Girls' Village Homes are excluded there remains an infant mortality rate for the district of only 37.4 per 1,000 births. 70 The comparative figures for previous years were as follows: Year. No. of Deaths under 1 year. Rate per 1.000 Registered Births. 1914 93 62 1915 122 79 1916 89 60 1917 82 70 1918 73 69 1919 71 61 1920 90 54 1921 76 50.9 1922 80 54.2 1923 66 41.1 The infant mortality rate for 1923 for Ilford compares favourably with that of 69 for England and Wales, 60 for London, and 72 for the 105 towns having a population exceeding 50,000. The following table compares the Infant Mortality in Ilford with that in other extra London areas :— Croydon 52 West Ham 58 Willesden 54 East Ham 54 Tottenham 67 Wimbledon 44 Enfield 62 Walthamstow 50 Leyton 50 Ealing 50 Acton 71 Hornsey 58 Ilford 41 The following Table shows the Infant Mortality in each Ward of the district:— Ward. Sex. Number of Births. No. of Infant Deaths. Infant Mortality per 1,000 Births. Infant Mortality per 1,000 Births both sex together. 1923. 1922. 1921. Cranbrook M. 60 2 33.3 39.3 69.7 15.1 F. 67 3 44.7 Park M. 85 5 58.8 55 9 23.1 57.2 F. 76 4 52.6 Seven Kings M. 99 3 30.3 29.3 31.6 66.4 F. 68 2 29.4 North Hainault M. 78 1 12.8 24.1 80.6 24.5 F. 88 3 34.1 Loxford M. 118 5 42.4 331 45.8 73.5 F. 123 3 24.4 Clementswood M. 126 6 39.6 454 61.3 46.3 F. 138 7 50.7 South Hainault M. 211 11 52.l 42.6 55.7 42.3 F. 188 6 31.9 If the deaths of infants occurring in the Village Homes, Barkingside (3 males and 3 females) are added to infant deaths occurring in the North Hainault Ward, there is an infant mortality rate of 60.3 (51.3 M. and 68.1 F.) per 1,000 births for that ward. 71 The above table only accounts for 1,525 of the 1,606 total births registered and belonging to the district. The remaining 81 are included by the Registrar-General as belonging to Ilford, but 1 am unable to allocate them to the various wards. 45 births were registered in this district belonging to other areas, and 4 births were re-registered—these have not been included in the foregoing figures. It will be seen on comparing the infant mortality with last year, that there have been 14 less deaths of babies in Ilford and 88 more births; in consequence there has been a considerable drop in the infant mortality. An analysis of the figures in the foregoing table will show that the infant mortality has only risen in the Park Ward. A statement as to the ages at, and causes of, infant deaths in the various wards is given below. In the Cranbrook Ward there were 5 infant deaths. 4 were under one week old. 1 died at 3 months from congenital heart disease. None of these children attended an infant welfare centre. In the Park Ward there were 9 infant deaths. 6 were under cne week old. 1 died at 1 month from acute infection of the tongue. 1 died at 3 months from marasmus. 1 died at 5 months from diarrhoea. None of these children had attended an infant welfare centre. In the Seven Kings Ward there were 5 infant deaths. 1 died shortly after birth. 1 died at 14 days from marasmus. 1 died at 1 month from appendicitis. 1 died at 5 months from broncho-pneumonia. 1 died at 10 months from broncho-pneumonia. None of these children had attended an infant welfare centre. In the North Hainanlt Ward there were 4 infant deaths, exclusive of those dying at the Girls' Village Homes, Barkingside. 2 died shortly after birth. 1 died after 4 months (a twin) from prematurity. 1 died after 6 months asphyxiated by bed clothes. None of these children attended an infant welfare centre. 72 In the Loxford Ward there were 8 infant deaths. 5 died under 1 week. 1 died at 10 days from prematurity. 1 died at 2 months from gastro-enteritis. 1 died at 9 months, an idiot child subject to bronchitis. The two latter children had both attended infant welfare centres. In the Olementswood Ward there were 12 infant deaths. 5 died under 1 week. 1 died at 3 weeks from erysipelas. 1 died at 1 month from septicaemia. 1 died at 3 months from gastro-enteritis. 2 died at 3 months from marasmus. 1 died at 9 months from congenital deformity. 1 died at 3 months from gastro-enteritis. The latter child had attended an infant welfare centre. In the South Hainault Ward there were 17 infant deaths. 7 died under 1 week. 1 died at 18 days from broncho-pneumonia. 1 died at 1 month from prematurity. 1 died at 2 months from broncho-pneumonia. 1 died at 2 months from gastro-enteritis. 1 died at 4 months from pneumonia (a nurse child, having only been one day in the district). 1 died at 9 months from broncho-pneumonia. 2 died at 10 months (twins) from broncho-pneumonia and whooping cough. 1 died at 5 months from gastro-enteritis. 1 died at 9 months from intussusception. The latter two children had attended infant welfare centres, one, however, in another district. It will be seen that of the 66 infants who died under 1 year of age, only 5 had attended infant welfare centres. 34, however, of the deaths occurred in infants in the first month of life, and these infants would naturally not have been brought to a centre. 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 still cause the greatest number of deaths. 73 The mortality of infants under one year attending' Ilford infant welfare centres was 11.3 per 1,000, as compared with 46.3 per 1,000 in those not attending; a welfare centre (excluding the deaths of those children dying in the Girls' Village Homes, also the child in the South Hainault Ward who had attended a centre outside Ilford). It must be remembered in considering these figures that rarely is a baby brought to a welfare centre under 1 month of age, whereas the majority of deaths occur in this period. 74 Table IV.—Infant Mortality. 1923. Net Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 1 weeks & under 3 months. 3 months and' under 6 months 6 months and under 9 months 9 months and under 12 months Total Deaths under 1 year. Small-pox ... … … … … … … … … … Chicken-pox … … … … … … … … … … Measles … … … … … … … … … … Scarlet fever … … … … … … … … … … Whooping Cough … … … … … … … … 2 2 Diphtheria and Croup … … … … … … … … … … Erysipelas … … … 1 1 … … … … 1 Tuberculous Meningitis … … … … … … … … … … Abdominal Tuberculosis … … … … … … … … … … Other Tuberculous Diseases … … … … … … … … … … Meningitis (not Tuberculous) … … … … … … … l … l Convulsions 1 l … … 2 … … … … 2 Laryngitis … … … … … … … … … … Bronchitis … … ... … … … … … … … Pneumonia (all forms) … … … … 1 l 3 … 2 7 Diarrhœa … … … … … l … … … 1 Enteritis … … … … … l 6 … … 7 Gastritis … … … … … … … … … … Syphilis … … … … … … 1 … … 1 Rickets … … … … … … … … … … Suffocation (overlying) … … … … … … … … … … Injury at birth … … … … … … … … … ... Atelectasis … … … … … … … … … … Congenital Malformations 3 … … … 3 l … … 1 5 Premature birth 16 l l … 18 l 2 … … 21 Atrophy, Debility and Marasmus 1 … 2 … 3 … 3 … 1 7 Other Causes 5 l … … 6 3 … l 1 11 Totals 26 3 4 I 34 8 15 2 7 66 75 Illegitimate Births and Deaths.—41 of the births registered (26 males and 15 females) were illegitimate, that is 2'5 per cent. of the births registered. Seven illegitimate children died under one year of age. Three of these children, however, were in the Girls' Village Homes, Barkingside, and should, strictly speaking, not be included in the death-rate of Ilford infants, although they are so included by the Registrar-General. Two died within 36 hours of birth. None of the four other deaths of illegitimate children occurred in foster children. The infant mortality of illegitimate children, excluding those who died in the Girls' Village Homes, was therefore 97.5 per 1,000, compared with the infant mortality rate (exclusive of those children dying in the Girls' Village Homes) of 35.7 for legitimate children. If the deaths of infants in the Girls' Village Homes are. included there is an illegitimate infant mortality rate of 171 per 1.000. and 38 per 1.000 for legitimate children. The following table shows the death-rate of illegitimate and legitimate infants for the past five years:— Year. Illegitimate Infants. Legitimate Infants. Births. Deaths. Rate per 1,000 Illegitimate Births. Births. Deaths. Rate per 1,000 Legitimate Births. 1923 41 7 171 1,565 69 38 1922 37 5 185 1,438 75 52 1921 38 10 263 1,454 66 45 1920 52 12 230 1,614 78 48 1919 64 10 156 1,103 61 55 Foster- Children. The arrangement come to with the Romford Board of Guardians in accordance with the recommendations made by the Ministry of Health in a circular dated September 30th, 1919, by which the work of the Infant Life Protection Visitor employed 76 by the Board of Guardians is linked up with the work of the Public Health Department, has continued to work in a satisfactory manner. Death of Nurse-child.—One death occurred of a nurse-child in the Ilford district during the year. The child, a female, aged 4 months, was brought by its mother from Yorkshire to Chadwell Heath, on the 8th June, apparently in good health, became unwell soon after arrival but was not seen by a doctor until after its death on the 10th June. An inquest was held and a certificate of death was given for "pneumonia accelerated by a long train journey taken two days before death." The foster-mother stated that she received no money for the child; it was not therefore a "foster-child" within the meaning of the Act. Having been informed by the Infant Life Protection Visitor of the death, the Medical Officer of Health attended the inquest and was allowed by the Coroner to put questions to the fostermother which brought out the facts that she had received the sum of £130 for the reception of another foster-child which she had not notified to the Infant Life Protection Visitor, and also that the mother of the dead child had taken another foster-child from Ilford to another person in Pontypool. The Coroner in giving his verdict stated:— "I think it is undesirable that little children should be planted about the country in this way, coming down from Yorkshire to Essex, and remaining a few days, a week, or a couple of weeks, and then being sent to Pontypool. It cannot be good for their health and it is not good for those persons appointed by the Government to look after the welfare of children." The Sanitary Inspectors have visited all the houses which have been reported during the year as accommodating fosterchildren. 77 The following is a summary of the work carried out:— Foster-Children. Number of foster-children on books on 1st January, 1923 51 Number of foster-children who were notified to me during 1923 16 Number of foster-children returned to their mothers during 1923 6 Number of foster-children taken off records for various reasons during 1923 25 Number of foster-children on records on 31st December, 1923 36 Foster-Mothers. Number of foster-mothers on records on 1st January, 1923 36 Number of persons who became foster-mothers during 1923 15 Number of persons whose names were taken off records during 1923 21 Number of foster-mothers on records on the 31st December, 1923 30 Houses Visited by Sanitary Inspectors. Number of houses visited by Sanitary Inspectors for the purpose of the Act during the year 1923 22 Number of visits made by the Sanitary Inspectors for the purpose of the Act during the year 1923 32 Number of notices served by the Sanitary Inspectors for the purpose of the Act during the year 1923 6 Work of Health Visitors.—In October 1923 an additional Health Visitor was appointed by the Council, and commenced her duties on the 1st November, 1923. This appointment was necessitated owing to the large Increase in the population of the district caused by the development of the new L.C.C. Estate at Becontree, requiring a new elementary school and infant welfare centre. The Ilford area has now, therefore, been divided in to seven districts (instead of six), one nurse carrying out all the home visits both for Maternity and Child Welfare work, and School Medical Service in each district. The following is a summary of the visits paid by the Health Visitors during 1923:— 78 First visits to newly-born infants 1,727 Subsequent visits to children under 1 year of age 4,115 Subsequent visits to children over one year of age and under five 9,898 Visits to expectant mothers 14 Home visits for other reasons 920 Total visits paid 16,674 Owing to the serious illness of two of the Health Visitors, the number of visits made is somewhat lower than the total paid during 1922. Supervision of Midwives.—There are 10 certified midwives resident and practising in the district (apart from those at the Maternity Home). Unfortunately under the Midwives Act, 1918, Section 12, permission is withheld for delegation to a District Council of the powers of the 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 1923 it was not found necessary to report any local midwives to the County Medical Officer of Health for infringement of the regulations of the Central Midwives Board. One unqualified woman was reported to the County Medical Officer of Health for attending a confinement contrary to the regulations of the Midwives' Acts. Supply of Milk to Expectant and Nursing Mothers and for Infants.—Under the Regulations of the Ministry of Health, during 1923 176 mothers and infants were supplied with cow's milk free, 40 with dried milk, and 15 with condensed milk. A total of 8,784½ quarts of cows' milk, 905 lbs. of dried milk, and 355 tins of condensed milk were given free under the above Regulations. 79 Infant Welfare Centres.—The Seven Kings Welfare Centre was transferred from the Seven Kings Library Hall to more commodious premises in the School Room of the United Methodist Church, Seven Kings Road, Seven Kings, on July 23rd. The Becontree Centre was transferred from St. Thomas' Church to the Church Institute on September 29th. The Infant Welfare Centres have, as in, previous years, been carried on very economically owing to the ready assistance which ladies in the town have voluntarily given. At the Ilford Lane Centre one of the ladies has carried on a Clothing Club since 1921, to which mothers can contribute small sums weekly and withdraw the whole or part of their contributions as necessity arises. At the end of 1923 £73 l0.s l0d. had been saved by 75 mothers. There are now seven Infant Welfare Centres, which are held as follows:— Seven Kings (United Methodist Church), Monday afternoon. Goodraayes (All Saints' Church Hall), Tuesday morning. Newbury Park (Birkbeck Road Congregational Church), Tuesday afternoon. Albert Road (Presbyterian Church Hall), Wednesday afternoon. Ilford Lane (Emmanuel Church), Wednesday afternoon. Park and Cranbrook (Cecil Hall), Thursday afternoon. Becontree (St. Thomas' Church Institute), Saturday morning. During the year the following- attendances were recorded:— Figures for 1922. 1923. Total number of attendances of infants 15,529 18,600 First attendances 1,126 1,284 Total number of children on roll December 31st, 1923, after omission of all those who had not attended for six months 1,137 1,371 Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. First Attendances— 154 95 76 93 126 118 106 1ll 108 155 90 52 Subsequent Attendances- 1861 1381 1349 1132 1418 1374 1353 1399 1555 1880 1540 1074 80 334 sessions were held during the year, and the average attendance at each session was 55.69 mothers with their infants. The following are the figures for each Centre:— Sessions. Average Attendance. Seven Kings 48 55.31 Goodmayes 48 34.14 Newbury Park 47 38.08 Albert Road 48 75.48 Ilford Lane 48 67.70 Park and Cranbrook 47 70.98 Becontree 48 48.08 The supply of foods at the Centres has been continued as in previous years. Ante-Natal Clinic.—The Ante-Natal Clinic was continued at the Public Health Offices during the year, and the following attendances have been recorded as compared with those registered during 1922:— First Attendances. Subsequent Attendances. Number of expectant mother on the rolls 31st December. 1923 207 495 38 1922 165 402 36 All patients entering; the Maternity Home, who are to be attended by a midwife, are medically examined at the Ante-Natal Clinic. Dental Clinic.—Mr. M. J. K. Soutter, the Council Dentist, has continued the dental treatment of expectant and nursing mothers, and of children under five years of age during 1923. The following is a summary of the work carried out for the Maternity and Child Welfare Committee during the year:— (a) Treatment of Mothers. Number of mothers treated during 1923 194 Number of attendances of mothers 408 Number of mothers, having teeth extracted, to whom "general" anæsthetics were given 86 81 Number of mothers, having teeth extracted, to whom "local" anaesthetics were given 15 Number of mothers having teeth filled or otherwise treated 144 Number of mothers having dentures supplied 20 Number of mothers having dentures repaired 5 (b) Treatment of Children under 5 years of age. Number of children treated 34 Number of attendances of children 37 Number of children, having teeth extracted, to whom "general" anæeisthetics were given 30 Number of children having teeth filled or otherwise treated 4 The following are the figures for the past five years 1919. 1920. 1921. 1922. 1923. Number of mothers treated 116 33 211 167 194 Number of children treated 10 5 25 26 34 Ophthalmic Clinic.—Children under five 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. It is difficult to make parents understand the importance of this work, and only a few accept the treatment offered them. The following are the figures for 1923:— (а) Number of children for whom spectacles were prescribed and provided 14 (b) Number of children examined by Oculist for whom spectacles were not prescribed 9 Ophthalmia Neonatorum.—During the year arrangements have been made with the Metropolitan Asylums Board for the reception at their St. Margaret's Hospital of cases of Ophthalmia 82 Neonatorum from the Ilford district, the rate agreed upon for the maintenance and treatment of these cases being 10s. per day. A maintenance and treatment of these cases being 10s. per day. An additional daily charge of 10s. is also payable in respect of a mother where she is admitted with her child. Patients from Ilford will only be admitted on the application of the Medical Officer of Health for the district. 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 1923 140 belts were obtained for this purpose. A certain number of infants were brought to the Public Health Offices to receive treatment for minor ailments. An agreeement has now been completed whereby Queen Mary's Hospital, Stratford, has undertaken from the 1st January, 1921, to carry out operative treatment for enlarged tonsils and adenoids at an inclusive charge for each Ilford child under 5 years of age recommended for such treatment by the Medical Officer of Health. During the past year 15 children have been treated under the basis of the agreement. The parent receives a form from the Medical Officer of Health, which is presented to the nose, throat and ear surgeon at the hospital, and arrangements are then made for the treatment. The child is again examined by the Medical Officer of Health at the Public Health Offices a fortnight or so after the operation has been performed to ensure that no further treatment is required, and written instructions as to breathing exercises are given. When possible the parents pay the necessary fee at the Public Health Offices, but if the parents' income is below the scale approved by the Ministry of Health, arrangements are made for treatment free or at a reduced charge. 83 1 child was treated free during the past year. A letter dated the 1st December, 1921, was received from the Ministry of Health, sanctioning an annual expenditure of £30 for children under the age of 5 years recommended by the Medical Officer of Health for operative treatment for enlarged tonsils and adenoids, and for whom free treatment, or treatment at a reduced charge, is granted. The demand on the accommodation at the Maternity Home has not diminished during the year. During 1923, 205 women were admitted into the Home as compared with 204 in 1922, 198 in 1921, 169 in 1920, and 139 in 1919. In February the Committee decided in future to strictly limit the number of bookings to 18 in any one month, owing to the congested state in which the Home was frequently placed. At the end of the year 40 cases were booked for future admission to the Home. The patients were admitted to the Home from the following wards:— Cranbrook 21 Park 38 Seven Kings 33 North Hainault 18 Loxford 32 Clementswood 36 South Hainault 27 One woman died in the Home. She was an emergency case admitted at the request of one of the local doctors, and was suffering from advanced kidney disease which resulted in a fatal issue 22 hours after admission. MATERNITY HOME. 84 The average number of patients in the Home per day during 1923 was 7.97, and the average length of stay of patients 14.37 days. Of the 205 cases admitted during 1923, 202 were confined in the Home, 3 were admitted as cases of inevitable abortion. Of the 202 confinements, 71 women had engaged their own doctor, and 131 were attended by one of the midwives at the Home. It was necessary to call in a doctor in 47 of the latter cases, owing to the following complications:— (a) Ante-natal 9 History of premature labour 1 History of abdominal operation (uterine) 2 Marked anæmia 1 History of difficult labours 3 History of puerperal mania 1 History of inflammation of veins 1 (b) During labour 18 Prolonged labour 8 Multiple growth on labia ... 1 Ruptured perineum before delivery 1 Foetal distress 1 Rupture of membranes 10 days before delivery 1 (c) After labour 17 Vaginal discharge 3 High temperature on admission 2 Foot presentation 1 Retained chorion 2 Persistent red lochia 2 Adherent placenta 4 (rf) For infant 3 Ruptured perineum 9 Stillbirth 1 Debility 2 21 children were circumcised in the Home. In 2 cases twilight sleep was administered. There were 3 deaths of infants in the Home:— One died owing to white asphyxia, artificial respiration having been tried for 2 hours 20 minutes, and the breathing partially established. The child lived for 16 hours. 85 One prematurely born child died owing to cyanosed extremities and general œdema. Lived 13 hours. One prematurely born child died from convulsions. Six children were stillborn. The causes of stillbirth were as follows:— 3 macerated foetus. 1 owing, to membranes being ruptured 10 days before delivery. 2 causes unknown. The infant mortality rate of children born in the Maternity Home during the year was 15.3 per 1,000 births as compared with 40.4 for those born in their own homes. This is an accurate statement. The figure of 40.4 having been arrived at after deduction of all births and infant deaths in the Maternity Home, and of all infant deaths in the Village Homes, Barkingside. It would therefore appear to be fair to say that if every mother in Ilford could have her baby born in a Maternity Home the death-rate of babies in Ilford could be reduced by more than one-half. At the present time the circumstances of those unable to pay a fee of two guineas per week are enquired into by the Health Visitors, and a fee is decided on by the Medical Officer of Health, subject to confirmation by the Maternity and Child Welfare Committee. The following table shows in extenso the fees which were paid by women admitted to the Home:— 8 mothers were admitted free of charge. 3 mothers were admitted at a fee of 15s. per week. 21 „ „ „ 20s.„ 5 „ „ „ 25s. „ 20 „ „ „ 30s.„ 1 „ „ „ 31s. 6d.„ 5 „ „ „ 35s. „ 86 5 mothers were admitted at a fee of 40s. per week. 67„ „ 42s. „ 3 „ „ 45s. „ 8 „ „ „ 50s.„ 3 „ „ „ 52s. 6d. „ 1 „ „ „ 55s. „ 24 „ „ „ 63s.„ 2 „ „ „ 70s.„ 1 „ „ „ 73s, 6d. „ 1 „ „ „ 80s. „ 13 „ „ „ 84s.„ 3 „ „ „ 90s.„ 11 „ „ „ 100s.„ 109 of the above patients agreed to pay an additional fee of 15s. to the Council for the services of one of the midwives of the Home. The work of training pupil midwives has continued in a satisfactory manner; three who were engaged during the year were successful in passing the examination of the Central Midwives' Board. New Maternity Home.—On March 19th, 1923, Dr. Janet Campbell and B. T. Kitchen, Esq., F.R.I.B.A., of the Ministry of Health, held a public enquiry at the Town Hall, Ilford, with reference to the Council's application for sanction to a loan for the purposes of erection of the new Maternity Home. Sanction has now been given to proceed with the scheme (with the deletion of the doctor's residence). At the time of writing a contract has been entered into for the sum of £25,050, and the work has been commenced. District Midwife.—As a result of representations made by the District Nursing Committee a district midwife was appointed 87 in April, 1923. In the outskirts of the district it has been impossible to obtain a midwife, the private midwives having declined to attend such cases, which have fallen into the hands of untrained women, with a doctor called in at the last moment. There are also cases of women who are unable, for family reasons, to enter the Maternity Home, and are unable to pay doctors' or midwives' fees. It is desirable that the midwife attending such cases should be under the control of the Local Authority. Further, the pupil midwives at the Maternity Home require, by the regulations of the C.M.B., training in district midwifery. This is now possible with the appointment which has been made. During 1923 the District Midwife, Miss Butcher, has attended 31 cases. Of these 22 were delivered by herself, seven by doctors, and two were cases of inevitable abortion. SCHOOL MEDICAL SERVICE. 91 1. Staff.—During the year Dr. Burton continued as School Medical Officer and Dr. V. F. Soothill as Assistant Medical Officer. Dr. M. A. Hadden took up her duties as Lady Assistant Medical Officer on the 12th February, 1923, succeeding Dr. J. A. Maclaren. Mr. M. J. K. Soutter, L.D.S., continued his duties as Council Dentist. 2. Co-ordination.—Vide Annual Report, 1920. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. 3. School Hygiene.—The majority of the schools are of a modern type and are in good sanitary condition. There are 15 schools, with 33 departments. One of these is a temporary school at Becontree, which since May 14th has been accommodated in the St. Thomas' Church Institute pending the erection of a permanent building. The schools have accommodation for 13,525 scholars, and 10,914 were actually on the rolls on December 31st, 1923. 4. Medical Inspection.—This has been carried out in accordance with Article 58 (b) of the Code of Regulations, viz.:- (1) Of all children newly 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. Details of the system adopted are given in the Annual Report for 1920. During 1923 the number of visits made by the Medical Officers to 33 different departments of 15 schools for the purposes of routine medical inspection was 251. The number of children examined during the year, falling within the above age groups, totalled 4,104 (2,126 boys and 1,978 girls). In addition, a num ber of children of varying ages were presented by the Hea Teachers for special medical examination, being thought by 92 teachers to be suffering from some ailment. During 1923, 157 such children (74 boys and 83 girls; were examined. 1,708 reexaminations (871 boys and 837 girls) 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.—At routine medical inspection 306 children out of a total of 4,261 (or 7.1 per cent.) were found to have nits or vermin in their hair, while only 15 (or .3 per cent.) were found to be infected with body vermin. It must be remembered in considering 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, and a comparison should be made with the surveys of cleanliness made by the School Nurses, and reported on page 100. (b) Tonsils and Adenoids.—339 children (or 7.9 per cent. of those examined) were found to be suffering either from adenoids or from tonsils so enlarged, or with such symptoms, that it was considered necessary to advise the parents to obtain medical advice. (c) Tuberculosis.—2 cases of definite tuberculosis of the lungs were detected at medical inspection. 17 suspected cases of pulmonary tuberculosis were detected, and these were referred to their own medical attendant or to the Tuberculosis Dispensary for observation purposes. In addition, at the end of 1923, 96 children attending school were found to be pre-tubercular. (d) Skin Disease.—7 cases of Scabies (Itch), 25 of Impetigo, and 27 cases of other diseases of the skin were discovered at routine medical inspection. (e) External Eye Disease.—20 cases of Blepharitis, i.e., inflamed eyelids, and 2 cases of Conjunctivitis were discovered. 93 Blepharitis may be simply an infective condition of the lids, or may be due to defect of vision, and is rapidly cured when this is corrected. (f) Vision.—396 children (or 9.2 per cent. of those examined) were found to be suffering from vision so defective as to require treatment. Further particulars of these cases will he found on page 122. (g) Ear Disease and Hearing.—16 children (or .4 per cent. of those examined) were found to be suffering from defective hearing. The cause in most of these cases was wax in the ear. 11 children were found suffering from a discharge from the ear, due to an old otitis media. (/j) Dental Defects.—334 (or 7'8 per cent. of those examined) were found to be suffering from teeth so defective as to impair health. These cases 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 123, Table IV. (Group IV.). (i) Deformities.—71. children were found to be suffering from slight spinal curvature, and 88 from other minor deformities (such as round shoulders) which could be corrected by special physical exercises. The whole of these cases were dealt with by the Supervising Instructor of Physical Training. 6. Infectious Disease.—The following table shows the incidence of Scarlet Fever, Diphtheria and Measles, including German Measles, in the Ilford schools since 1916:— Soarlet Fever. Diphtheria. Measles. 1916 83 . 82 1821 1917 57 104 1115 1918 49 115 151 1919 165 78 645 1920 154 130 790 1921 202 105 108 1922 116 82 893 1923 79 61 174 94 The following gives particulars of the disinfection of the schools during 1923:— Date. School. Part Disinfected. 3/1/23 Goodmayes . All Depts.:—Lobbies 3/1/23 South Park All Depts.:—Lobbies 3/1/23 Uphall All Depts. :—Lobbies 3/1/23 Loxford Junior Mixed Dept: —Lobbies 3/1/23 Chadwell Lobbies 3/1/23 Little Heath Lobbies 4/1/23 Loxford Boys' and Girls' Depts. :—Lobbies 4/1/23 Highlands All Depts.:—Lobbies 5 1/23 Downshall All Depts.:—Lobbies 5/1/23 Newbury Park All Depts. :—Lobbies 8 1/23 Valentines Lobbies 8/1/23 Cleveland All Depts. :—Lobbies 29 3 23 Goodmayes Boys' Dept. :—Class-rooms Nos. 2, 5 and 7 and lobbies 29/3 23 Cleveland All Depts.:—Lobbies 3/4/23 Chadwell Lobbies 3 4/23 Christchurch All Depts.:—Lobbies 3/4 23 R. Catholic Lobbies 4/4/23 Little Heath Lobbies 4 4/23 Valentines Lobbies 12/4/28 Christchurch Junior Mixed Dept.:—Class-rooms 1 and 5, and lobbies 14 4/23 Downshall Junior Mixed Dept.:—All class-rooms and lobbies 9/6/23 Loxford Junior Mixed Dept.:—Class-rooms 3, 4, 5, 6, 7 and 8, and lobbies 6/7/23 Summer Loxford Boys' Dept.:—Class-room 4 and lobby Vacation All Schools All Depts.:—Lobbies 27/7/23 Highlands Junior Mixed Dept.:—All class-rooms 22 10/23 Uphall Junior Mixed Dept:—Class-rooms Nos. 1, 3, 6, 7 and 9, and lobbies 31 12 23 Goodmayes All Depts.:—Lobbies Tables VII to XIII show the incidence of each infectious disease in the Ilford schools during 1923. (a) Scarlet Fever.—79 cases were reported in 1923, compared with 116 in 1922. (b) Diphtheria.—61 cases were reported in 1923, as compared with 82 in 1922. (c) Measles and German Measles.—174 cases were notified from the schools in 1923, compared with 893 during 1922. 95 (d) Chicken Pox and Whooping Cough.—402 cases of Chicken Pox occurred in 1923, as compared with 182 in 1922; and 159 cases of Whooping Cough in 1923, as compared with 311 cases in 1922. 972 home visits were paid by the Health Visitors in connection with minor infectious disease cases. (e) Ringworm.— No. of Cases at beginning of 1923 No, of cases reported during 1923. Total. Remedied during 1923. No. of cases under observation at end of 1923. Ringworm:— Scalp 6 21 27 18 9 Body 1 8 9 7 2 7 29 36 25 11 The X-ray treatment, as carried out by the Operator employed by the Education Committee continues to be most satisfactory. 18 school children were X-rayed at the Clinic during the year. 7. Following up.—This has continued to be efficiently carried out during the past year. The parent of every child who, when inspected at school was found to be suffering from a physical defect, received 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 re-examined at school or at the clinic by doctor to ascertain if such treatment has been performed in a satisfactory manner. During 1923, 2,644 home visits by the Nurses were paid for this purpose, and 1,708 children were re-examined by the doctors at school. 8. Medical Treatment.— (a) Treatment of Minor Ailments.—The clinic has been held at the Public Health Offices each morning at nine o'clock. A large number of minor ailments, especially skin diseases, received treatment. Records have been kept, and certificates of exclusion 96 from school or fitness to attend school have been given. The children attending the school clinic came from the following sources:— (1) Referred 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. The attendances at the Clinic during 1923 were as follows :— Number of individual children seen at the Clinic 1,829 Number of attendances of children 6,582 Number of exclusion certificates granted 4,685 Number of certificates of fitness to attend school granted 1,670 The following table shows the variety of conditions dealt with at the School Clinic during the year:— Malnutrition 3 Defective Footgear 7 Uncleanliness: — Head 105 Body 4 Skin:— Ringworm: — Head 21 Body 8 Scabies 36 Impetigo 344 Other diseases 237 Eye: — Blepharitis 57 Conjunctivitis 79 Keratitis 2 Corneal Ulcer 9 Corneal Opacities 3 Defective Vision and Squint 159 Other conditions 50 Ear: — Defective hearing 19 Otitis Media 9 Other Ear Diseases 93 Nose and Throat: — Enlarged Tonsils 73 Adenoids 58 Enlarged Tonsils and Adenoids 39 Other conditions 229 Mouth Breathing 107 Enlarged Cervical Glands 81 Teeth-Dental Diseases 82 97 The following- table shows the number of children dealt with at the School Clinic during- the past five years :— 1919 1920 1921 1922 1923 962 1,763 2,009 1,730 1,829 Number of individual Children seen (b) Ophthalmic Department.—During the year 1923 the School Oculist held 59 sessions for the refraction of children suffering from defective vision. Full details of the work given in Table IV., Group II., on page 122. are 585 school children were examined, 69 of these being cases from 1922. Defective Speech 3 Heart and Circulation: — Organic 7 Functional 26 Anaemia Debility 124 Infectious Diseases: — Scarlet Fever 2 Diphtheria 3 Whooping Cough 28 Mumps 68 Chicken Pox 28 Measles 2 Colds 169 Influenza 8 Lungs:— Bronchitis 95 Other Non-Tubercular Diseases 72 Tuberculosis: — Pulmonary:— Definite — Suspected 23 Non-Pulmonary: — 2 Glands Other Forms 3 Nervous System:— Epilepsy 3 Chorea 12 Other conditions 8 Deformities 12 Minor Injuries 232 Other Defects and Diseases 317 Total number of Ailments 3,165 98 The increasing amount of work done 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 1921 490 1922 458 1923 585 Of the 585 cases, 451 were referred as a result of medical inspection, and 134 from the School Clinic. Of the 585 children examined, 499 were found to require spectacles by reason of the following defects:— Myopia 49 Myopic Astigmatism 40 Hypermetropia 136 Hypermetropic Astigmatism 149 Mixed Astigmatism 50 Anisometropia 26 Myopia with Squint 11 Squint only 12 Hypermetropia with Squint 26 Total 499 Of the remaining 86 children, 14 were suffering from the following other diseases:— Corneal Ulcers, Nebulae, etc. 4 Retinal Diseases 3 Persistent Pupillary Membrane 1 Nystagmus 2 Congenital Capsular Opacities 1 Other diseases 3 Total 14 66 children were found not to require spectacles, and 6 required operative treatment and were recommended to a hospital. A number of children (29) were kept under observation and were re-examined during the year, the spectacles being changed in 16 instances. 99 Under the Education Committee's scheme 499 pairs of spectacles were provided. Of this number, 22 pairs of spectacles were provided free and 4 pairs at a reduced charge, on necessitous grounds. In addition, spectacles were renewed or repaired in 115 cases. All spectacles are now provided by the Education Committee, the cost being recovered from the parents whenever possible. The Council's opticians continue to supply spectacles at as moderate a charge as possible. The appreciation of the work of the Oculist by the parents is shown by the fact that 93 per cent. of the defects of vision detected in 1923 were remedied by the Council Oculist. (c) Dental Department.—The Dentist has given the whole of his time to School Medical work, with the exception of one morning weekly to Maternity and Child Welfare work, and one afternoon every alternate week to the treatment of Tubenculosis cases. During the year the Dentist paid 77 visits to the schools for the purpose of inspecting the teeth of children. All children between the ages of 5 and 14 years have been examined at the schools by the School Dentist. Notice is sen to the parents when their children are found to require treatment. The extent to which dental disease is prevalent among school children is shown by the fact that of 6,241 children inspected by the Dentist, 4,013, or 64 per cent., were found to require treatment. Only 53.3 per cent. of these actually accepted treatment. If all the cases accepted treatment it would be impossible for one dentist to carry out the work. Full details of the dental work can be seen in Table IV., Group IV., on page 123. 100 (d) Treatment of Uncleanliness.—It was found necessary to cieai with 29 children under the Education Act, 1921, Section 87, statutory notices being served on the parents. In 27 instances the statutory notices not being complied with, the children were brought to the School Clinic by the Nurse and cleansed. The School Nurses paid 116 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. 32,204. 1,667. 5. The previous percentages of children infected were 10 in 1920, 6 in 1921, and 5 in 1922. In cases where vermin or nits are found, notice is sent to the parents, 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. It was found necessary during the year to summon the parents of five children, under Section 87 of the Education Act, 1921. In each case fines were imposed. (e) Treatment of other Ailments.—An agreement was completed on February 12th, 1922, whereby the Queen Mary's Hospital, Stratford, undertakes to carry out operative treatment for enlarged tonsils and adenoids at an inclusive charge for each Ilford school child recommended for such treatment by the School Medical Officer. During the past year 171 children have been treated under the basis of the agreement. The parent receives a form from the School Medical Officer which is presented to the nose, throat and ear surgeon at the hospital and arrangements are then made for the treatment. 101 The child is again examined by the School Medical Officer at the School Clinic a fortnight or so after the operation has been performed to ensure that no further treatment is required, and is given written instructions as to breathing exercises. By this means a very complete control of the scheme is maintained, which has not been previously possible. The parents pay a fee for the treatment at the School Clinic, but if the parents' income is below the scale approved by the Board of Education, the School Medical Officer arranges for treatment free or at a reduced charge. 47 children were treated free during the past year. In addition to the treatment of tonsils and adenoids 53 letters for other ailments were given to Ilford school children to attend at the Queen Mary's Hospital when hospital treatment was required. 9. Open-Air Education.— There is no open-air school in Ilford. 1 have pointed out in my last four reports the need for such a school in this district. At the end of the year 1923, 96 children were pre-tubercular, 53 of whom were attending the Tuberculosis Dispensary. 10. Physical Training.— The following is the report of the Supervising Instructor in Physical Training :— I. Staff. During the year no increase in the staff has been found necessary. 11. Duties and Organisation. My duties as Supervising Instructor in Physical Training remain as previously, namely, of an advisory, instructional, and supervisory character as regards the physical training (inclusive of swimming instruction and organised games) throughout all the schools under the jurisdiction of the Authority. Such duties include staff conferences and practical demonstrations, and are governed, as is also the instruction given, by the Board of Education's Syllabus of Physical Training for Schools, 1919. Departmental visits have been made regularly and systematically, each Department having been visited at least six times during the year. III. Special Features. (a) During the year, two additional playing fields have been allotted in the public parks, and the necessary apparatus provided; in 102 addition, playground facilities have been increased for the purpose of conducting organised games and general activity exercises as set out in Chapter IV of the Board of Education's Syllabus. (b) On 14th and 15th June an official visit of inspection to the district was made by Miss E. R. Clarke, one of the Board of Education's lnspectresses of Physical Training. Miss Clarke visited the local Swimming Baths to view the swimming instruction of both boys and girls, and expressed, on the termination of the visit, her appreciation of the very satisfactory results being achieved. Miss Clarke also visited the Cricklefields playing fields, inspected the dressing accommodation provided for the scholars, and again expressed approval of the provision made. (<•) On 20th September the whole of the Authority's schools were closed to enable the children to compete in the School Sports organised for that day. This was the first Sports meeting held since the War, and the revival of this branch of the work was received with considerable enthusiasm, keen inter-school rivalry was displayed, and over 3,200 entries (a record number) were received. (d) Throughout the year special home exercises were, on the recommendation of, and in consultation with, the School Medical Officer, advised in a number of cases of minor physical defect. (e) The whole of the school playgrounds have again been painted for the purpose of conducting organised games. Where necessary, newapparatus has been provided. (/) Considerable assistance has again been rendered by the Handicraft Centre in the construction of apparatus for use in connection with both field and playground games. IV. Review of General Position. In conclusion it gives me much pleasure to state that the general position continues to be one of steady development and progress. F. J. ROBERTS, Supervising Instructor in Physical Training. 1st January, 1924. 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.— Vide Annual Report, 1920. 13. Co-operation of Parents.— Vide Annual Report, 1920. During 1923, 2,905 parents, or 68 per cent., attended the medical inspections. 103 14 and 15. Co-operation of Teachers and Attendance Officers.— Vide Annual Report, 1920. 16. Co-operation of Voluntary Bodies.— In January, 1920, I was permitted to take the office of Hon. District Correspondent for the National Society for the Prevention of Cruelty to Children. Inspector Martin has again rendered very valuable services in this district with excellent results. The following is a brief resum6 of the work done by the Society in Ilford during the past year:— Total number of cases investigated, 95, made up as follows :— (1) Of neglect 81 (65 reported from the Public Health Department, for neglecting medical advice, and 16 reported from other sources for general neglect.) (2) Ill-treatment cases 10 (3) Other wrongs 1 (4) Advice sought 3 One case of general neglect was prosecuted. There was a marked improvement in the cases visited. Those than. had neglected medical advice either attended the Public Health Offices for treatment or for hospital letters, or received private medical advice. 151 children (67 boys and 84 girls) were involved, 126 being of school age In addition to this work, 257 supervision visits were paid to different cases, some of which were made to cases reported during the previous year. 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 departments of the public elementary schools. 104 During 1923 ten cases were referred for medical examination and report by the School Medical Officer, and the following is a detailed summary of the children dealt with under this heading :— Tubercular hips 2 Recommended for admission to a special school for crippled children 1 Unfit to attend school 1 Tubercular knee— Fit to attend school, but excused physical drill 1 Pulmonary Tuberculosis— Recommended for admission to a special school 1 Osteomalacia— Recommended for admission to a special school for crippled children 1 Spastic Diplegia— Recommended for admission to a special school for crippled children 1 Old Infantile Paralysis—Fit to attend school subject to the provision of a surgical boot 1 Epilepsy 2 Fit to attend school 1 Recommended for admission to a residential special school for epileptic children 1 Fragilitas Ossium— Recommended for admission to a special school for crippled children 1 (a) Physically Defective Children.— lit. Blind Children.— There are five children who are so blind as to be unable; to profit by education in an ordinary school. Four of these are attending certified schools for the blind. One case is awaiting admission to such a school. '2nd. Deaf and Dumb Children.— There are nine children falling within this category. Of these one is deaf and dumb and eight are deaf only.. Five cases are in attendance at certified schools for the deaf, two are in attendance at public elementary schools (the parents of one of the children having declined special school treatment) ; and two, not attending any school, are awaiting admission to a special school. 3rd. Epileptic Children.— There are eighteen children known to the department. One of these children is in a certified school for epileptics, and two are awaiting admission to such an institution. Of the remaining fifteen, fourteen are attending public elementary schools in the district, and one is not attending school. 14th. Tuberculous Children.— There are thirty-two children suffering, or who have suffered, from Pulmonary Tuberculosis, 105 twenty-six of whom are attending public elementary schools in the district; one is in a sanatorium, and five are physically unfit to attend school. In addition, at the end of 1923, ninety-six children who were pre-tubercu!ar were attending public elementary schools in the district. 5th. Crippled Children.— It will be seen on reference to Table III. that there are a considerable 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 fifty-one 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 oases that they should be excluded from physical drill; three cases are physically unfit to attend school. The following is, as far as possible, a complete record of the physically defective children (207) in the district known to the department on the 31st December, 1923. The children may be divided into four classes as under :— I. Those not Attending any School.— 30 children fell within this category. They were suffering from the following ailments :— (a) Pulmonary Tuberculosis— 5 cases. These were all children either under hospital or other medical form of treatment and unfit to attend any kind of school. (b) Crippling due to Tuberculosis— 3 cases. (1) Tuberculosis of the Joints— 3 cases. 3 children suffering from tubercular hips are undergoing hospital treatment. (c) Crippling due to other causes— 12 cases. (1) Various forms of Paralysis— 12 cases. 1 child is mentally defective and paralysed; 3 children with paralysis of both legs could attend a school for 106 physically defective children; 1 child with spastic diplegia could attend a school for physically defective children (the parents in this ease, however, have refused a residential special school); 2 children were undergoing treatment and were unfit to attend school; 2 children suffering from muscular dystrophy were unfit to attend school; 3 children were so paralysed as to be unfit for any form of instruction. (d) Epilepsy— 3 cases. 1 child was suffering from attacks of epilepsy so frequent as to prevent its benefiting from any form of instruction; 2 children have been recommended for admission to a residential special school for epileptic children. (e) Heart Disease— 3 rases. 2 children were so affected as to be unable to attend any school; 1 child could attend a school for physically defective children. (f) Other conditions— 4 cases. 1 child was receiving hospital treatment for a nervous complaint; 1 child was suffering from achondroplasia and is at present unfit to attend school; 1 child, whose left leg was amputated at the knee joint, and has also a right club foot, is at present unable to attend school; 1 child, said to have diabetes, is at present unable to attend school. II. Those Attending a Private School.— Eight children fell within this category. 5 children suffered from infantile paralysis, which had so far improved that they were able to attend school— some having a special boot or other form of appliance; 2 children had suffered from tuberculosis of the spine, which had been cured, but had resulted in one oase in a deformity, for which a special splint was worn; 1 child, suffering from a tubercular hip should be at a physically defective school. III. Those in Institutions.— Seven children fell within this category. They were suffering from the following ailments :— (a) Pulmonary Tuberculosis— 1 case. 1 child is in a sanatorium undergoing treatment. (b) Crippling due to Tuberculosis— 2 cases. 2 children, suffering from tubercular hips, are resident in institutions for physically defective children. (c) Crippling due to other causes— 2 cases (1) Various forms of Paralysis— 2 cases. 1 child, suffering from paralysis, is in a residential institution; 1 child (also mentally defective), suffering from paralysis, is in a residential institution. (d) Epilepsy— 2 cases. 1 child (also mentally defective) is in a residential institution; 1 child is resident in a special school for epileptic children. 107 IV. Those Attending Public Elementary Schools.— 162 children fell within this category. They were suffering' from the following ailments :— (a) Pulmonary Tuberculosis— 26 cases. 26 children, in whom the disease is not infectious, are attending school. (b) Crippling due to Tuberculosis— 13 cases. (1) Tuberculosis of the Joints— 11 cases. 4 children, who have suffered from tubercular hips, in whom the disease is now cured, can only walk with crutches, and should be in attendance at a school for physically defective children. 1 child, who has suffered from a tubercular knee and is lame, is able to attend school. 2 children, who have suffered from tubercular hips wear a high boot, and are able to attend school. 4 children, who have suffered from tubercular hips, walk with a limp, but are able to attend school. (2) Tuberculosis o] the Bone— 2 cases. 1 child, who has suffered from a tubercular spine, is able to attend school; a special desk and table has been provided, but this child should be in attendance at a school for physically defective children. 1 child, who has suffered from tuberculosis of the bone of the arm, which is now in a splint, is able to attend school. (c) Crippling due to other causes— 50 cases. (1) Various forms of Paralysis— 30 cases. 4 children, who are partially paralysed in both legs, should be in attendance at a school for physically defective children. 2 children with paralysis of the arm are able to attend school. 2 children, who are partially paralysed in the right side, are able to attend school; 1 of these cases is also feeble-minded and has been recommended for admission to a special school. 7 children, with partial paralysis of the legs, are wearing surgical boots, but are able to attend school. 15 children, who are slightly lame owing to old infantile paralysis, are able to attend school. (2) Other Crippling Defects— 20 cases. 4 children, with congenital dislocation of the hip. 1 child, right hand absent from birth. 1 child, left forearm absent from birth. 2 children with spinal curvature. 5 children, suffering from club-feet, and receiving hospital treatment. 1 child, suffering from flat-feet, is lame and wearing instruments. 1 child, old fracture of the elbow joint. 108 3 children with deformed hands. I oh 1 III who has fracture of the spine. 1 child, suffering from the effects of inflammation of the hone of tho leg. All those 20 children are able to attend school. (d) Epilepsy— 14 cases. 14 children, subject to occasion:)! fits at somewhat rare intervals, are able to attend school ; 1 of these cases is also feeble-minded and has been recommended for admission to a s|iecial school. (e) Heart Disease— 51 cases. 1 child, suffering from heart disease, should be in attendance at a school for physically defective children. 60 children, suffering from varying degrees of heart disease, are being kept under observation. (f) Other Conditions— 8 ruses. (1) Tuberculosis of the (Hands— 4 cases. 4 children, suffering from tubercular glands, are able to attend school. (2) Miscellaneons— 4 ruses. 1 child is receiving treatment for pituitary disturbance. 2 children, suffering from asthma, are able to attend school. 1 child is being kept under observation for abdominal tuberculosis. There were at the end of the year, nineteen physically defective children suitable for admission to a cripple school; six of these cases were not attending school, and thirteen were attending public elementary schools in the district. Of the nineteen children mentioned, nine are twelve years of ape or over. (b) Mentally Defective Children.— (a) Dull or Backward Children.— There are 131 children who are retarded two years in their education at school, and 38 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 by me as to their mental condition. Their backwardness may be due to many causes, such as loss of education through commencing school late, absence owing to ill-health, and frequent changes of school. It must not, therefore, be presumed that all these children are to be considered abnormal. 109 (b) Idiots.— Idiots are, within the meaning of the Mental Deficiency Act, 19.13, parsons so defective in mind from an early age, as to be unable to guard themselves against common physical dangers. The Authority for dealing with such children is the Essex County Council. There are 16 cases under the age of 16 years known to the department, 2 being notified during the present year. 3 are in a residential institution, and 13 are at home. (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 arc 6 cases under the age of 16 years known to the department. 2 are in a residential institution and 4 are at home. (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 (at the end of 1923) 33 such cases under the age of 16 years known to me, of whom 17 are attending public elementary schools in the district, 1 is attending a private school, 9 are in a residential school, and 6 are not at school. The Mental Deficiency (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 again in 1921, and all children suspected of being mentally defective were examined by the School Medical Officer. Since these dates 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. 110 During 1923 1 medically examined and reported upon 31 children under the Mental Deficiency (Notification of Children) Regulations, 1914, classified as follows:— Dull and Backward Children.— Total number certified 18 Recommended for Special Class for dull and backward children 14 .Recommended for continuance of attendance at an ordinary elementary school 4 Feeble-minded Children.— Total number certified 11 Recommended for admission to a Residential Special School 5 Recommended for admission to a Special School (Day or Residential) 6 Idiot Children.— Total number certified 2 Recommended for admission to a Residential Institution 2 A complete list follows of those children who have been found to be either— (а) Mentally defective, but eduoable. (б) Idiots or imibeciles. together with information as to the present position of the children concerned. 1ll I. Feeble-Minded Persons. A.— Total No. of Feeble-Minded Casts under the age of 16 years— 33. Case No. Age Years. Sex. Certified. Present occupation. 22 14¼ F. 1915 In Institution* 23 15¾ M. 1916 Working for plumber 26 13½ M. 1917 In Institution* 28 12 M. 1917 At private school 29 14½ M. 1919 In Institution* 30 13 M. 1919 At elementary school 32 12½ F. 1919 At elementary school 33 10 M. 1920 In Institution* 35 13 M. 1920 At elementary school 36 12½ m. 1921 At elementary school 37 12¾ F. 1921 In Institution* 38 14¾ F. 1921 In Institution* 39 9¼ m. 1921 At elementary school 41 14¼ F. 1921 At home 42 14¼ m. 1922 At home 43 12¾ F. 1922 In Institution at Halstead 44 8½ F. 1922 At elementary school 45 10¼ F. 1922 At home 46 10 m. 1922 At home 47 14¾ F. 1922 At elementary school 48 8 F. 1922 At elementary school 49 11½ F. 1922 In Institution at Halstead 50 12 m. 1922 At home. 52 7¾ m. 1923 In Institution* 53 6¼ m. 1923 At elementary school 56 7¾ F. 1923 At elementary school 56 8½ M. 1923 At elementary school 57 8½ F. 1923 At elementary school 58 9 m. 1923 At elementary school 59 7¼ m. 1923 At elementary school 60 12½ m 1923 At elementary school 61 11 m. 1923 At elementary school 62 8½ F. 1923 At elementary school 112 I. Feeble-Minded Persons— continued. B.— Total No. of Feeble-Minded Cases over 16 years— 31. Case No. Age Years. Sex. Certified. Present occupation. 1 17½ F. 1915 At home. No occupation 3 19½ m. 1915 Working as a Carpenter 4 18¼ m. 1915 Working at engineering works 5 20½ f. 1915 In Institution* 7 19½ M. 1915 In Institution* 8 19¾ m. 1915 Sailor 9 20½ f. 1915 At home. No occupation 11 18¼ f. 1915 At home. No occupation 13 19¼ F. 1915 Working for farmer 14 20 f. 1915 At home. No occupation 15 18½ F. 1915 At home. No occupation 16 18¼ M. 1915 At home. No occupation 17 20¼ M. 1915 Working as a Stable-boy 18 19¾ M. 1915 Working at a leather works 19 19¼ F. 1915 Domestic service 24 17¾ F. 1917 At home. No occupation 27 18½ M. 1917 In Institution* 31 16¼ F. 1919 In Institution* 34 18¼ F. 1920 In Institution* (b) 21½ F. - At home. No occupation (c) 23 F. - At home. No occupation (d) 23½ F. — At home. No occupation. Has three ille gitimate children (e) 21 M. - In Army— R.G.A. (f) 23 F. - At home. No occupation (g) 18 F. - Daily help (h) 18¼ M. - Works handcart with hardware goods (i) 22 f. - Working for farmer (j) 20 F. - Daily help (k) 24 M. - Working for farmer (1) 24 M. - Working for farmer (m) 37 F. — In Romford Infirmary Cases Nos. 2, 6, 10, 12, 20, 21, 25, 40, 51 and 54 and (a), are either deceased or have left the district. * Royal Eastern Counties Institution for Feeble-minded, Colchester. 113 II. Idiots and Imbeciles. Total No. of Cases— 47. Case No. Age Years Sex Certified Present occupation 1 16½ F. 1915 At home 3 15 M. 1915 In Romford Infirmary 4 18½ M. 1915 At home 5 23 M. 1915 In Institution* 7 19 F. 1915 At home 9 16½ M. 1915 At home 10 22¾ M. 1915 At home 11 21½ F. 1915 In Institution* 16 23½ F. 1915 At home 17 16½ M. 1915 Works for farmer 20 16¼ F. 1916 At home 25 12 M. 1918 In Earlswood Institution 20 11 F. 1920 In Institution V 9½ M. 1921 In Institution 28 8¼ F. 1921 At home 29 9¼ M. 1921 In Institution* 30 9 1/8 F. 1921 At home 33 9¼ F. 1922 At home 34 11 F. 1922 At home 35 8½ M. 1922 At home 30 11 F. 1922 At home 37 7¼ M. 1922 At home 38 15½ M. 1922 At home 39 10½ M. 1922 At home 40 15½ F. 1922 At home 41 14 F. 1922 At home 42 10½ F. 1922 At home 43 7 F. 1922 At home 44 6½ M. 1922 At home 45 13 M. 1922 At home 46 6 F. 1923 At home 47 4½ F. 1923 At home * Royal Eastern Counties Institution for Feeble-minded, Colchester. Cases Nos. 2, 6, 8, 12, 13, 14, 15, 18, 19, 21, 22, 23, 24, 31 and 32 are either deceased or left the district. 114 18, 19, 20. Nursery Schools, Secondary and Continuation Schools.—Vide Annual Report, 1920. 21. Employment of School Children and Young Persons. —From special enquiries made at the various schools during the latter end of 1923, it was found that 135 children were employed out of school hours. No children were submitted to me for medical examination under Section 111, para. 4, of the Byelaws under the Provisions of Employment of Children Act, 1903. During 1923 no children were examined under Section 13 of the Education Act, 1918 (Employment of Children in Entertainments). The Juvenile Employment Committee has during the past year found occupation for 714 children, as follows :— Boys. Girls. Placed locally 327 259 In London 57 71 Totals 384 330 The numbers registered for employment were :— Boys. Girls. New Oases 580 599 Re-registrations 252 232 Totals 832 831 22. Miscellaneous.— In accordance with the Education Committee's Regulations, the undermentioned bursars, student- teachers and teachers were medically examined and reported upon during the year by the School Medical Officer:— Bursars 10 Student-teachers 13 Newly-appointed teachers 16 Teachers absent through illness 7 Total 46 Re-examinations:— Bursars 1 Student-teachers 4 Newly-appointed teachers 1 Total 6 115 Table 1.— Return of Medical Inspections. A.— Routine Medical Inspections. Number of Code Group Inspections— Entrants 1433 Intermediates 1473 Leavers 1198 Total 4104 Number of other Routine Inspections Nil. B.— Other Inspections. Number of Special Inspections— Medical Inspection at School 157 At School Clinic 1829 Number of Re-inspections— Medical Inspection at School 1708 At School Clinic 6582 Total 10276 116 TABLE II. A.— Return of Defects found by Medical Inspection in the Year ended 31st December, 1923. Defect or Disease Routine Inspections Specials Number of Defects Number of Defects 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 - 3 - Uncleanliness— Head 306 — 105 — Body 15 — 4 — Ringworm— Skin Scalp — — 21 — Body — — 8 — Scabies 7 — 36 — Impetigo 25 — 344 — Other Diseases (non-Tuberculous) 27 — 237 — Eye Blepharitis 20 —• 57 — Conjunctivitis 2 — 79 — Keratitis — — 2 — Corneal Ulcer — — 9 — Corneal Opacities — — 3 — Defective Vision 396 — 155 — Squint 10 — 4 — Other Conditions 9 — 50 — Ear Defective Hearing 16 — 19 — Otitis Media 11 2 9 — Other Ear Diseases 38 — 93 — Nose and Throat Enlarged Tonsils only 144 14 73 — Adenoids only 65 2 58 — Enlarged Tonsils and Adenoids 130 4 39 — , Other Conditions 24 — 229 — Enlarged Cervical Glands (Non-Tuberculous) 11 — 81 — Defective Speech 3 — 2 — TeethHeart and Circulation Dental Diseases 334 — 82 — Heart Disease— Organic 29 4 5 — Functional 8 2 7 — Anaemia 37 — 26 — Lungs Bronchitis 38 — 95 — Other Non-Tubercular Diseases 31 9 72 — Pulmonary— Tuberculosis Definite 2 — — — Suspected 17 6 10 4 Non-Pulmonary— Glands 1 — 2 — Spine — — 1 — HiP — — 1 — Other Bones and Joints - — 1 — Skin — — — Other Forms - — — — Nervous System Epilepsy 9 — 3 — Chorea 5 - 12 — Other conditions 5 — 8 — Deformities Rickets 1 4 — Spinal Curvature 71 — 3 — Other Forms 8 — 5 — Other Defects and Diseases 99 — 988 — 117 Table II. B.— Number of Individual Children Found at Routine Medical Inspection to Require Treatment (excluding; Uncleanliness amd Dental Diseases). Number of Children. Percentage of Children found to require treatment. Group. Inspected. Found to require treatment. (1) (2) (3) (4) Code Groups :— Entrants 1433 423 295 Intermediates 1473 572 38 8 Leavers 1198 350 29 7 Total (code groups) 4104 1361 329 Other routine inspections - — - 118 TABLE III.— Return of all. Exceptional Children in the area in 1923. Boys. Girls. Total. Blind (including partially blind) (i) Suitable for training in a School or Class for the totally blind Attending Certified Schools or Classes for the Blind 1 1 Attending Public Elementary Schools At other Institutions — — _ At no School or Institution — — — (ii) Suitable for training in a School or Class for the partially blind Attending Certified Schools or Classes for the Blind 1 2 3 Attending Public Elementary Schools - - - At other Institutions (private school) 1 - 1 At no School or Institution — — — Deaf (including Deaf and Dumb and partially Deaf) (i) Suitable for training in a School or Class for the totally deaf or deaf and dumb Attending Certified Schools or Classes for the Deaf 4 1 5 Attending Public Elementary Schools - - - At other Institutions — - — At no School or Institution - 2 2 (ii) Suitable for training in a School or Class for the partially deaf Attending Certified Schools or Classes for the Deaf - — — Attending Public Elementary Schools 1 1 2 At other Institutions - — — At no School or Institution - — — Mentally Defective F eeble Minded (cases not notifiable to the Local Control Authority) Attending Certified Schools for Mentally Defective Children 4 5 9 Attending Public Elementary Schools 11 7 18 At other Institutions - — — At no School or Institution 4 2 6 Notified to the Local Control Authority during the year Feeble Minded - - - Imbeciles - - - Idiots 1 1 2 119 TABLE III— continued. Boys Girls. Total. Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics 1 1 In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools - - - At no School or Institution — 2 2 Suffering from epilepsy which is not severe Attending Public Elementary Schools 8 6 14 At no School or Institution - 1 1 Physically Defective Infectious Pulmonary and glandular Tuberculosis . At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 - 1 At other Institutions — — — At no School or Institution - - - Non - inf. ctious but active pulmonary and glandular Tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential OpenAir Schools - - - At Certified Day Open - Air Schools - - - At Public Elementary Schools 15 11 26 At other Institutions — - — At no School or Institution 2 3 5 Delicate children (e.g., preor latent tuberculosis, malnutrition, debility, anrpmia, etc.) At Certified Residential OpenAir Schools - - - At Certified Day Open - Air Schools - - - At Public Elementary Schools 43 53 96 At other Institutions — — — At no School or Institution — — — 120 TABLE III.— continued. Boys. Girls. Total. Physically Defective.— cont. Active nonpulmonary Tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board - 2 2 At Public Elementary Schools 1 1 2 At other Institutions — — — At no School or Institution 2 1 3 Crippled Childrer. (other than those with active tuberculous disease) e.g., children suffering from paralysis, etc., and including those with severe heart disease At Certified Hospital Schools . - - - At Certified Residential Cripple Schools - - - At Certified Day Cripple Schools - - - At Public Elementary Schools 56 58 114* At other Institutions — 1 1 At.no School or Institution 13 5 18 * 19 of these are defective within the meaning of the Education Act, 1921 (and for whom special school accommodation is required). 121 Table IV.— Return of Defects Treated During The Year ended 31st December. Treatment Table. Group I.— Minor Ailments (excluding- Uncleanliness, for which see Group V.). Disease or Defect. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin- Ringworm (Scalp) 18 3 21 Ringworm (Body) 8 — 8 Scabies 43 — 43 Impetigo 344 — 344 Other skin disease 240 24 264 Minor Eye Defects (External and other, but excluding cases falling in Group II). 202 29 231 Minor Ear Defects 112 35 147 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 478 507 1075 Totals 1445 688 2133 122 Group II.— Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments— Group I.). Defect or Disease. Number of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by Private Practitioner or at Hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) 585 14 10 009 (Operations for squint should be recorded separately in the body of the Report). Other Defect or Disease of the Eyes (excluding those recorded in Giroup I). - — - — Total 585 14 10 609 Total number of children for whom spectacles were prescribed :— (a) Under the Authority's Scheme 499 (b) Otherwise 24 Total number of children who obtained or received spectacles :— (a) Under the Authority's Scheme 499 (b) Otherwise 24 Group III.— Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. Received other forms of Treatment. Total number treated. (1) (2) (3) (4) (5) 171 81 252 43 295 123 Group IV.— Dental Defects. 1. Number of Children Dealt With. Routine Age Groups. Specials. Total. 5 6 7 8 9 10 12 13 14 (a) Inspected by Dentist 8,011 2,965 265 6,241 (b) Found to require Treatment 3,748 265 4,013 (c) Actually Treated 1,876 265 2,141 (d) Re-treated (result of periodical examinations) 634 - 634 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 for Treatment. 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 77 351 3,475 288 1,257 2,895 1,760 3,017 1,235 Locals 97. 300 91 124 Group V.— Uncleanliness and Vermimous Conditions. (i) Average number of visits per school made during the year by the School Nurses 8 (ii) Total number of examinations of children in the Schools by School Nurses 32204 (iii) Number of individual children found unclean 1667 (iv) Number of children cleansed under the arrangement's made by the Local Education Authority 27 (v) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 5 (h) Under the School Attendance Byelaws Nil. 126 127 Table V.— Table showing number of Children Medically Inspected at various Schools during 1923. Ages— Years. 5—6 6-7 7-8 8—9 9-10 10-11 11—12 12-13 13-14 14-15 Total. SCHOOLS. Boy. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. ROUTINE. Becontree 76 73 63 53 18 15 14 20 - - - - - - - - - - - - 171 161 Barkingside 11 13 — — — — 26 19 - - - - - - 22 11 - - - - 59 43 Chadwell 4 4 1 — 1 — 26 13 - - 1 1 - - 13 8 - - - - 46 26 Christchurch 39 38 21 7 6 2 102 101 - 2 1 - 1 - 48 41 - - - 1 218 192 Cleveland 43 55 11 18 6 — 68 68 - - 1 6 - 6 60 63 - - 1 1 190 217 Downshall 61 59 4 3 — — 72 65 2 - 6 6 1 1 79 49 - - - - 225 183 Goodmayes 66 68 58 35 11 4 102 104 15 - 8 13 25 10 64 74 15 26 - - 364 334 Highlands 45 44 2 3 1 5 44 37 4 - 10 2 3 1 49 41 3 - - - 161 133 Little Heath 4 2 — 1 — - 6 7 - - - - - 1 10 5 - - - - 20 16 Loxford 44 50 2 1 — 2 49 45 2 - 1 8 - - 45 44 1 1 - - 144 151 Newbury Park 24 30 — — — 1 27 22 - - 2 - - - 19 27 - - - - 72 80 Roman Catholic 11 9 2 — 2 7 34 23 1 5 4 1 - 2 32 24 2 3 2 - 90 74 South Park 52 60 6 5 5 1 78 77 3 2 2 8 - - 61 73 7 2 - - 214 218 Uphall Road 33 20 — 1 1 1 45 49 - - 2 5 - - 52 58 1 1 - - 134 135 Valentines 11 7 — — — 1 — 6 — - - - - - 7 1 - - - - 18 15 Total 524 522 170 127 51 39 693 656 27 9 38 50 30 21 561 519 29 33 3 2 2126 1978 SPECIALS. Becontree 1 2 1 1 1 - - - - - - - - - - - - - - - 3 3 Barkingside — 1 — 1 - 1 - 1 - 1 - - - - - - - - - - - 5 Chadwell - 4 - 1 - - - - 1 - - 1 - 1 - - - - - - 1 7 Christchurch 1 2 1 1 1 1 6 3 1 1 - - - - - - - - - - 10 8 Cleveland 1 3 1 9 1 2 - 1 1 - - 1 1 1 - - - - - - 5 10 Downshall 1 2 — 1 1 1 - - 1 - - - 1 - - - - - - - 4 4 Goodmayes 4 3 4 6 3 2 2 - 1 1 1 2 9 1 1 - 1 - - — 19 16 Highlands 2 2 2 1 1 1 3 1 2 - 2 - 1 - - - - - - - 13 5 Little Heath 1 1 1 1 1 - - - - - - - - - - - - - - - 3 2 Loxford 1 2 1 5 - 1 - 1 - 1 - 1 - 1 - - - - - - 2 12 Newbury Park 1 1 - 1 — - - - - - - - - - - - - - — — 1 2 Roman Catholic 1 1 1 1 1 1 - - - - - - - - - - - - - - 3 3 South Park 1 1 1 1 1 1 - - - - - - - - - - - - - - 3 3 Uphall Road 1 1 1 2 1 - 1 - 1 - 1 - - - - - - - - - 6 3 Valentines - - 1 - — — — — - — - — - — — — — — — — 1 — Total 16 26 15 25 12 11 12 8 8 4 4 5 5 4 1 1 — — - 74 83 Total Number of Children Examined, 4261. Grand Total 2200 2061 128 129 Table VI. 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 Heigth (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 j Examined. Average Height (in inches). Average Weight (in pounds . No. of Children Examined. Average Height (in inches). Average Weight ( n pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). Barkingside 11 40.21 37.93 - - - - - - 26 48.22 51.17 - - - - - - - - - 22 53.97 70.28 - - - Becontree 76 40.01 37.52 63 43.91 44.62 18 45.10 46.21 14 47.01 49.97 - - - - - - - - - - - - - - - Chadwell 4 40.23 38.96 1 43.17 42.43 1 41.72 46.40 26 49.22 52.31 - - - - - - - - - 13 53.21 70.31 - - - Christchurch Rd. 39 41.86 40.22 21 44.59 45.69 6 46.40 47.12 102 49.18 53.32 - - - 1 52.74 66.28 1 53.28 69.12 48 54.27 71.26 - - - Cleveland Rd. 43 41.76 40.30 11 44.21 44.64 6 46.58 47.31 68 49.23 53.46 - - - 1 51.38 65.29 - - - 60 55.11 72.03 - - - Downshall 61 42.01 40.17 4 45.10 45.10 - - - 72 48.86 54.81 2 48.22 54.73 1 52.86 67.28 1 54.18 71.23 79 56.27 72.93 - - - Goodmayes 66 40.96 39.03 58 43.12 42.21 11 45.87 46.23 102 47.98 52.96 15 51.23 56.28 6 51.04 64.26 95 54.01 69.13 64 55.18 71.16 15 60.74 85.01 Highlands 45 43.22 43.24 2 46.14 45.26 1 47.42 51.31 44 51.91 55.26 4 52.23 61.70 8 54.17 68.21 3 55.17 74.28 49 57.80 74.23 3 61.71 85.96 Little Heath 4 40.22 37.91 - - - - - - 6 47.72 50.28 - - - 10 50.02 59.71 - - - 10 54.54 72.63 - - - Loxford 44 42.13 41.01 2 46.12 46.21 - - - 49 48.69 53.76 9 50.37 57.01 - - - - - - 45 55.32 72.90 1 60.01 81.34 Newburv Park 21 40.96 38.57 - - - - - - 27 47.97 52.77 - - - 1 51.13 63.74 - - - 19 54.76 71.59 - - - Roman Catholic. 11 41.12 38.11 2 42.98 43.17 2 46.23 46.96 34 48.69 52.26 1 50.14 56.28 2 50.24 59.63 - - - 39 53.32 73.48 2 59.36 80.21 South Park 52 42.64 42.72 6 44.70 45.96 5 47.17 48.26 78 49.13 53.76 3 51.24 57.85 4 52.96 67.04 - - - 61 55.01 71.27 7 59.23 80.11 UphallRd. 33 41.38 38.17 - - - 1 44.11 45.82 45 48.01 51.24 - - - 9 50.37 60.05 - - - 52 54.78 74.55 1 60.17 83.28 Valentines 11 40.73 38.35 — — — - - - - - - — — - 2 50.11 60.21 — — — 7 52.15 70.74 - - - Average Heights and Weights of Ilford Children 524 41.98 39.02 170 43.97 43.87 51 46.83 47.99 693 48.68 53.77 27 51.02 55.32 38 50.84 60.97 30 54.23 69.74 561 55.43 72.85 29 60.27 84.28 Ages. Ages. 5 years. 6 years. 7 years. 8 years. 9 years. 10 years. 11 years. 12 years. 13 years. Anthropometric Standard (Boys). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). 1 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 77.40 130 131 Table VI. B.— Table showing the Average Heights and Weights of GIRLS 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. 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 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 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 13 40.32 37.24 - - - - - - 19 47.23 49.36 - - - - - - - - - 11 54.21 73.27 - - - Becontree 73 40.26 35.52 53 40.97 31.12 15 41.70 43.22 20 46.14 49.71 — — — — - — — — — — — — — — — Chadwell 4 40.48 39.30 - - - - - - 13 48.12 50.62 - - - 1 52.22 58.31 — - — 8 54.47 73.15 — — — Christchurch Rd. 38 41.02 38.18 7 42.78 11.24 2 44.22 44.63 101 48.23 50.64 2 49.27 55.71 - — — — — — 41 56.82 74.36 — — — Cleveland Rd. 55 41.76 39.79 18 42.16 40.11 - — - 68 47.96 49.63 — — - 6 51.76 51.27 6 53.26 68.44 63 55.26 72.16 - — — Downshall 59 41.91 39.15 3 43.72 43.76 - - - 65 48.33 51.31 — — — 6 50.23 59.01 1 53.13 65.28 49 54.98 72.14 — — — Goodmayes 68 40.28 35.32 35 42.23 41.82 4 43.86 43.76 104 47.26 50.28 — — — 13 52.28 61.26 10 54.17 66.27 74 55.12 71.23 26 60.24 82.53 Highlands 44 42.11 39.76 3 44.12 45.16 5 44.86 14.27 37 50.14 53.66 — — — 2 51.61 59.32 1 54.21 66.35 41 56.99 76.67 — — — Little Heath 2 40.11 35.12 1 41.71 38.60 — - - 7 47.11 50.29 — — — — — — 1 53.26 64.19 5 52.24 70.01 — — — Loxford 50 40.98 39.70 1 42.25 41.51 2 43.71 43.62 45 48.28 51.32 - — — 8 52.20 60.26 — — — 44 55.17 72.24 1 61.02 82.07 Newburv Park 30 40.21 35.20 - - - 1 43.90 42.66 22 47.01 49.28 - - - - — — — — — 27 55.12 74.16 — - — Roman Catholic 9 40.01 39.71 - - - 7 43.76 42.27 23 47.30 49.64 5 48.20 50.43 1 51.96 59.27 2 53.19 67.14 24 54.85 76.25 3 60.01 80.43 South Park 50 42.16 39.98 5 42.36 40.21 1 45.52 43.28 77 48.32 51.81 2 49.11 54.32 8 50.01 58.96 - - - 73 56.13 76.70 2 61.21 82.66 Uphall Rd. 20 41.11 37.17 1 42.13 38.86 1 44.98 44.63 49 47.91 49.38 — — - 5 50.32 58.21 — — — 58 55.71 74.23 1 60.72 80.49 Valentines 7 39.28 38.13 — - — 1 42.12 42.61 6 47.37 49.11 - — — — — - — — — 1 54.21 74.13 — — - Average Heights and Weights of Ilford Children 522 41.99 39.04 127 42.54 42.07 39 44.71 44.24 656 47.86 50.26 9 49.06 53.98 50 51.93 59.32 21 53.74 66.41 519 55.73 74.71 33 60.87 82.10 Ages. Ages. 5 Years. 6 Years. 7 Years. 8 Years. 9 Years. 10 Years. 11 Years. 12 Years. 13 Years. Anthropometric Standard (Girls). 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) 40.44 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 80.37 132 Table VII. 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, 1923. SCHOOLS. Number on Roll. DISEASES AND CONTACTS Scarlet Fever. Diphtheria. Measles. and German Measles. Chicken Pox. Whooping Cough. Mumps. Enteric Ringworm Totals. 1923. Totals. 1922. Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Contacts Barkingside 305 - - 2 - - - 5 3 - 1 2 - - - - 9 4 102 80 Becontree 334 7 3 1 — 3 1 25 8 7 - 3 - - - 2 48 12 3 2 Chadwell 241 — — — 4 1 4 - - 1 - 1 - - - - 3 8 117 37 Christchurch 1113 4 3 1 6 1 - 56 46 32 15 87 8 — - 2 183 78 147 64 Cleveland Road 1200 8 12 5 3 2 - 17 13 10 7 38 2 - - - 80 37 218 112 Downshall 1317 13 8 6 14 114 25 39 22 8 1 156 15 — - 4 340 85 365 109 Goodmaves 1418 18 29 22 32 36 12 6 8 17 7 22 - - - 1 122 88 131 60 Highlands 871 9 7 2 1 4 1 102 51 3 - 15 - 1 - - 136 60 147 38 Little Heath 132 - - — 2 - - 1 1 59 11 12 2 - - - 72 16 12 4 Loxford 918 6 11 2 1 3 - 43 11 2 1 52 9 - - - 108 33 166 55 Newbury Park 525 — - - - - - 3 1 7 2 3 - - - - 13 3 27 35 Roman Catholic 420 2 1 1 1 1 - 6 3 9 7 11 - - - 3 33 12 44 20 South Park 1174 5 6 6 11 7 3 26 19 3 2 44 5 - - 4 95 46 126 46 Uphall 827 3 4 9 9 2 - 73 49 - - 33 1 - - 5 125 63 89 47 Valentines 119 — 1 — - - — - - 1 - - - - - - 1 1 4 3 Countv High School - - 3 - 3 - - - - - - - - - - - - 6 14 6 Private Schools — 4 7 4 4 — — - - — - - - - - - 8 11 26 25 Totals 10914 79 95 61 91 174 46 102 235 159 54 479 42 1 - 21 1376 563 1738 743 Encephalitis Lethargica— Cleveland Road School, 1 case. Erysipelas— Downshall School, 1 case; Uphall School, 1 case. 133 TABLE VIII. 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, 1923. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. October. Nov. Dec. Total 1923 To*al 1922 Cases. Conts. Cases. Conts. Cases. Conts. Cases. Co ts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Caess. Conts. Cases. Conts. Cases. Conts. Barkingside 305 - - - - - - - - - - - - - - - - - - - - - - - - - - 5 6 Becontree 334 2 1 - - - - - - - - - - 1 - - - 4 - - 1 - 1 - - 7 3 - - Chadwell 241 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Christchurch 1118 - - - - - - 1 - - - - - 1 1 - - - - - - 2 1 - 1 4 3 8 10 Cleveland Road 1200 - - 2 4 1 1 - 1 - - - - 1 - - - - — 1 2 1 2 2 2 8 12 34 44 Downshall 1317 1 — — - - - - - 8 5 - - - 1 1 1 2 1 - - - - 1 - 13 8 7 15 Goodmayes 1418 — - 1 - 2 3 1 1 4 4 6 6 2 5 1 2 - 2 - 4 1 2 - - 18 29 11 11 Highlands 871 - - - - 1 1 - - - - - - 2 4 2 - 2 - - - 2 2 - - 9 7 7 8 Little Heath 132 — — - - - - - - - - - - - - - - - - - - - - - - - - - - Loxford 918 1 — 3 2 - - - - 2 3 - - - - - - - - - - - 5 - 1 6 11 9 14 Newbury Park 525 — — - - - - - - - - - - - - - - - - - - - - - - - - 10 8 Roman Catholic 420 — - - - — - - - - - - - 1 - - - 1 1 - - - - - - 2 1 3 8 South Park 1174 - - - - - - - - - - - - 1 1 - - - - 3 5 1 - - - 5 6 10 13 Uphall Road 827 — - - - - - - - - - 1 2 1 1 - - 1 1 - - - - - - 3 4 1 5 Valentines 119 - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 - - County High - - - - - - - - - - - - - - 2 - - - - - - - 1 - - - 3 7 3 Private Schools — — 1 — — 1 - - - - — - - — - — — — - 2 1 1 1 — 4 4 7 4 11 Totals 10914 4 2 6 6 5 5 2 2 14 12 7 8 10 15 4 4 10 5 6 13 8 15 3 8 79 95 116 166 134 Table IX. 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, 1923. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total 1923. Total 1922. 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 305 - - - - - - - - - - - - - - - - 1 - - - - - 1 - 2 - 4 7 Becontree 334 - - - - - - - - - - 1 - - - - - - - - - - - - - 1 — 1 1 Chadwell 241 - - - - - - - - - - - 4 - - - - - - - - - - - - - 4 6 7 Christchurch Road 1113 — 3 - - - - - - - - - - - 1 - - - - 1 2 - - - - 1 6 3 4 Cleveland Road 1200 — — 1 — — — — — 1 1 — — — — — — 1 1 1 — — — 1 1 5 3 9 12 Downshall 1317 — 1 1 3 1 1 1 2 - - - - - - - - - 1 - - 1 1 2 5 6 14 11 l7 Goodmayes 1418 3 2 5 7 2 — 5 4 3 7 2 6 — — — 1 — 1 1 3 — — 1 1 22 32 14 21 Highlands 871 1 - 1 1 - - - - - - - - - - - - - - - - - - - - 2 1 7 6 Little Heath 132 - - - - - - - - - 1 - - - - - - - - - - - 1 - - - 2 - - Loxford 918 — - 1 — — — — — — — — — — — — — — — 1 1 — — — - 2 1 2 1 Newbury Park 525 - - - - - - - - - - - - - - - - - - - - - - - - - - 4 5 Roman Catholic 420 - - - - - - - - - - - - - - - - - - 1 1 - - - - 1 1 - - South Park 1174 2 1 1 — — — 1 3 — 1 1 3 — — — — 1 3 — — — — — - 6 11 4 1 Uphall 827 — - 1 — 2 2 5 6 — — — — 1 1 — — — — — — — — — - 9 9 7 21 Valentines 119 - - - - - - - - - - - - - - - - - - - - - - - - - - - - County High - - - - - - 1 - - - - - - - 1 - - - - - - - 1 - - - 3 4 3 Private Schools - - - 1 - - - 1 - - - 1 1 - - 1 1 - 1 - 1 - - - - 4 4 6 12 Totals 10914 6 7 12 11 5 4 13 15 4 10 5 14 1 3 1 2 3 7 5 8 1 3 5 1 61 91 82 118 135 TABLE X. 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, 1923. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total 1923 Total 1922 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 305 - - - - - - - - - - - - - - - - - - - - - - - - - - 51 37 Becontree 334 - - 1 1 — — — — — — 1 — — — — — — — - — - - 1 — 3 1 1 1 Chadwell 241 1 4 - - - - - - - - - - - - - - - - - - - - - - 1 4 3 3 Christcliurch Road 1113 — - - - - - - - - - - - - - - - - - - - - - 1 - 1 - 78 18 Cleveland Road 1200 - - - - - - - - 1 - - - - - - - - - - - 1 - - - 2 — 119 32 Downshall 1317 1 — 3 — 18 4 53 15 25 3 6 3 4 — — — — — 4 — - — - — 114 25 172 26 Goodmaves 1418 - — — — — — 8 3 9 4 11 1 7 4 — — — — — — 1 — — — 36 12 61 14 Highlands 871 — — — — - — — — 2 1 1 - - - - - - - - - - - - - 4 1 93 19 Little Heath 132 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Loxford 918 — — — — — — — — 1 — — — — — — — — — 2 — — — — — 3 — 134 29 Newburv Park 525 - - - - - - - - - - - - - - - - - - - - - - - - - - 5 2 Roman Catholic 420 - - - - - - - - - - 1 - - - - - - - - - - - - - 1 — 23 10 South Park 1174 1 1 — — — — 2 - 2 2 2 - - - - - - -- - - - - - - 7 3 81 19 Uphall 827 — — — — — — — — — — — — — — — — — — 1 — — — 1 — 2 — 55 14 Valentines 119 - - - - - - - - - - - - - - - - - - - - - - - - - - - - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 — Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 - Totals 10914 3 5 4 1 18 4 63 18 40 10 22 4 11 4 - — — - 7 - 3 — 3 — 174 46 893 224 13fl Table XI. 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, 1923. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total, 1923. Total, 1922. Cases. Conts. Cases. Conts. Cases. Conts. Ca es. Cont. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 305 2 2 2 - - - 1 1 - - - - - - - - - - - - - - - - 5 3 6 7 Becontree 334 - - 6 - 7 1 6 1 - - - - - - - - 2 - - - 4 6 - - 25 8 - - Cnadwell 241 - - - - - - - - - - - - - - - - - - - - - - - - - - 3 1 Christchurch Road 1113 3 1 5 2 3 1 2 1 1 - 1 - 1 3 - - - - 11 3 24 30 5 5 56 46 20 15 Cleveland Road 1200 7 4 3 - 1 - - - - - 1 4 4 5 - - - - - - 1 - - - 17 13 18 12 Downshall 1317 12 9 5 5 4 1 1 - 1 - - - 1 - 1 1 - - 1 1 3 2 10 3 39 22 71 29 Goodmayes 1418 - 1 - - - - 4 6 - - - - - - - - 1 - - - 1 1 - - 6 8 7 6 Highlands 871 - - - - - - 1 - 5 2 36 18 56 31 1 - 2 - 1 - - - - - 102 51 6 2 Little Heath 132 - - - - - - - - - - 1 1 - - - - - - - - - - - - 1 1 - - Loxford 918 2 1 3 2 12 4 10 1 6 9 7 1 - - - - - - 3 - - - - - 43 11 13 10 Newbury Park 525 - - - - - - - - - - 1 - - - - - 2 1 - - - - - - 3 1 2 1 Roman Catholic 420 - - 1 - 1 - 2 - - - - - - - - - 1 - - - - 2 1 1 6 3 3 1 South Park 1174 8 7 4 2 1 - - - - - - - 2 4 - - - - 1 2 1 - 9 4 26 19 22 13 Uphall 827 3 3 - - - - 1 - 1 - - - - - - - 1 - 36 25 22 12 9 9 73 49 9 3 Valentines 119 - - - - - - - - - - - - - - - - - - - - - - - - - - - - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 2 Totals 10914 37 28 29 11 29 7 28 10 14 4 47 24 64 43 2 1 9 1 53 31 56 53 34 22 402 235 182 102 137 TABLE XII. 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, 1923. SCHOOLS. Number on Roll. Jan. Feb. March April. May. June. July. August. Sept. Oct. Nov. Dec. Total, 1923. Total, 1922 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 305 - - - - - - - - - - - - - - - - - - - - - - - - - 1 34 20 Becontree 334 - - 2 - 4 - 1 - - - - - - - - - - - - - - - - - 7 - - - Chadwell 241 - - - - 1 - - - - - - - - - - - - - - - - - - - 1 - 10 8 Christchurch Road 1113 — — — - 1 - 1 - 1 - - - 2 1 2 - 24 14 1 - - - - - 32 15 35 17 Cleveland Road 1200 — — 2 6 - - - - - - 4 1 4 - - - - - - - - - - - 10 7 34 12 Downshall 1317 5 1 2 - - - 1 - - - - - - - - - - - - - - - - - 8 1 91 71 Goodmayes 1418 2 1 — — 5 2 1 - 1 - 2 2 4 1 1 - - - 1 1 - - - - 17 7 29 8 Highlands 871 - — - — 2 - 1 - - - - - - - - - - - - - - - - - 3 - 33 3 Little Heath 132 — — — — - - - - - - - - - - - - - - - - 1 - - - 1 - 6 4 Loxford 918 - - - - - - - - 17 3 38 6 3 1 - - 1 1 - - - - - - 59 11 3 1 Newbury park 525 — — — — - - - - - - - - - - - - 2 1 - - - - - - 2 1 3 9 Roman Catholic 420 1 2 - - - - 4 - 1 - - - - - - - 1 - - - - - - - 7 2 11 1 South Park 1174 3 2 3 3 1 1 - - - - - - - - 1 - 1 1 - - - - - - 9 7 3 - Uphall 827 — — — — 1 1 1 - - - - - 1 1 - - - - - - - - - - 3 2 15 4 Valentines 119 - - - - - - - - - - - - - - - - - - - - - - - - - - 4 3 County High - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total 10914 11 6 9 9 15 4 10 — 20 3 44 9 14 4 4 - 29 17 2 1 1 1 — — 159 54 311 111 138 Table XIII. MUMPS. Summary of Cases of Mumps among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1923. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total, 1923. Total, 1922. 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. Cases. Barkingside 305 - - - - - - - - - - - - - - - - - - 2 - - - - - 2 - 2 3 Becontree 334 - - - - 1 - - - - - - - - - - - 2 - - - - - - - 3 - - - Chadwell 241 - - - - - - - - - - - - - - - - - - - - - - 1 - 1 - 95 18 Christchurch Road 1113 - - 2 1 25 1 12 4 8 1 16 1 22 - 1 - 1 - - - - - - - 87 8 3 - Cleveland Road 1200 - - 3 - 4 - 9 - 2 - 13 1 - - 1 1 - - - - - - - - 38 2 3 - Downshall 1317 13 5 18 2 74 5 49 3 1 - 1 - - - - - - - - - - - - - 156 15 13 1 Goodmayes 1418 2 — 6 — 6 — 1 - — - — - — — 1 - 2 - 1 - 3 - - - 22 - 5 - Highlands 871 — — 1 — 3 — — - — - 2 - 7 - — - 2 - - - - - - - 15 - - - Little Heath 132 - - - - - - - - - - - - - - - - 2 - 6 1 4 1 - - 12 9 3 - Loxford 918 1 1 1 — 1 1 5 - 4 1 7 1 10 - - - 3 1 5 - 7 4 8 - 52 9 3 - Newbury Park 525 - - 1 - - - - - - - 2 - - - - - - - - - - - - - 3 - - - Roman Catholic 420 — — — — — — 2 - — — — — — — — — 6 — 2 — 1 — — — 11 - 2 - South Park 1174 — — 2 — 3 — 14 1 19 2 5 2 1 - - - — - - - - - - - 44 5 1 - Uphall 827 — — - — - - 3 - 1 - 15 1 12 - - - - - 1 - - - 1 - 33 1 1 - Valentines 119 - - - - - - - - - - - - - - - - - - - - - - - - - - - - County High - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 10914 16 6 34 3 117 7 95 8 35 4 61 6 58 — 3 1 18 1 17 1 15 5 10 — 479 42 131 22