Urban district of 7 Hford. HEALTH REPORT FOR THE YEAR 1924. A. H. G. BURTON, M.D., D.P.H., Medical Officer of Health, &c. urban District of Hford. 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 1924. ILFORD: South Essex Recorders, Ltd., High Road. Hford urban District Council 1924-1925. James William King, J.P., Chairman. Rev. Herbert Dunnico, M.P., J.P., C.C., Vice-Chairman. Church, George. Odell, Herbert George. Clark, Charles William. Pitt, Bertram Sidney John. Corn well, Arthur Edward. Sheat, William J. Oliver O.B.E., J.P. Cushing, George. Dane, Frederick Hopper,M.B.E., Smith, Frank D., C.C. J.P., C.C. Smythe, Herbert James Bevis. Davey, George Robert. Stephens, Mrs. Emily Jane. Gunary, George. Stevens, Walter H. Kennedy, Charles Guns. Taylor, Joseph John. Lee, George. Young, Alexander. Norton, Thomas George. PUBLIC HEALTH COMMITTEE. 1924-1925. Councillor G. Gushing, Chairman. Councillor G. Chubch, Vice-Chairman. Councillor C. W. Clark. Councillor T. G Norton. Councillor A. E. Cornwell. Councillor P. 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. †Ex-officio Members. MATERNITY & CHILD WELFARE STATUTORY COMMITTEE. 1924-1925. †Councillor The Rev. H. Dunnico, M.P., J.P., C.C., Chairman. Councillor W. H. Stevens, Vice-Chairman. *Dr. R. Boyd Robson. †Councillor J. W. King. Councillor G. Church. Councillor T. G. Norton. Councillor C. W. Clark. Councillor B. S. J. Pitt. Councillor G. Cushing. Councillor Mrs. Stephens. *Mrs. Dunnico. *Mrs. Stevens. #Mrs. Gillard. Councillor J. J. Taylor. *Mrs. Wise. •Co-opted Members. †Ex-officio Members. EDUCATION COMMITTEE. 1924-1925. Councillor G. Lee, Chairman. *A. W. Green, Esq., Vice-Chairman. *Mr. J. R. Baldwin. *Mr. J. Mein. Councillor G. Church. Councillor H. G. Odeli,. Councillor C. W. Clark. Councillor B. S. J. Pitt. Councillor P. H. Dane, M.B.E., Councillor W. J. 0. Sheat, J.P., C.C. O.B.E., J.P. †Councillor H. Dunnico. M.P. *Mr. W. R. Spencer. J.P., C.C. Councillor G. Gunary. Councillor Mrs. E. J. Stephens. Councillor C. G. Kennedy. Councillor J. J. Taylor. †Councillor J. W. King. *Mr. H. J. Weston. *Miss J. B. Larkin. Councillor A. Young. *Mr. S. P. Lonergan. *Co-opted Members. †Ex-officio Members. OFFICERS of the PUBLIC HEALTH SERVICES. MARCH, 1925. 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. Bdrton, M.D., B.S. (Lond.), D.P.M. (Eng.), D.P.H. (Cantab.) of the Middle Temple, Barrister-at-Law. Assistant Medical Officers of Health: V. F. Soothill, M.A., M.D. (Cantab.), D.P.H. (Cantab.). Marie A. Hadden, B.A., M.B., B.Ch. (Dub.), L.M. (Rot. Hosp.). Oculist (part time): Dentist: R. S. Chaksley, M.R.C.S., L.R.C.P. M. J. K. Soutter, L.D.S., R.C.S. (Eng.). Matron of Isolation Hospital: Matron of Maternity Homr: Miss I. Millar. Miss M. E. Roberts. Senior Sanitary Inspector: F. W. King, Mem. Royal San. Inst., F.I.S.E. Sanitary Inspector and Chief Clerk: T. V. Haigh, Mem. Roy. San. Inst. Sanitary Inspectors: H. C. Monkcom, Assoc. Royal San. Inst., A.M.I.S.E. C. W. Fisher, Assoc. Royal San. Inst. S. G. Rackham, Assoc. Royal San. Inst. R. A. Reeves, Assoc. Royal San. Inst. Health Visitors and School Nurses: Miss A. Batten. Miss K. B. Mathieson. Miss O. Bell. Mrs. H. Morris. Miss M. E. Cartwright. Miss B. Raddall. Miss M. D. Seager. District Midwife: Miss M. F. Botcher. PREFACE. Public Health Offices, Ilford. March, 1925. To the Chairman and Members of the Ilford Urban District Council. Madam and Gentlemen, I have the honour to present herewith the Annual Report required by the Ministry of Health and Board of Education. The table on page 24 shows that Ilford maintains its place as far as health is concerned. The figures are most noticeable when infectious diseases are considered. I pointed out last year that the Zymotic death-rate (or death-rate from the chief infectious diseases) was the lowest recorded. In 1924, however, the Zymotic death-rate was still lower. The position is most satisfactory as far as diphtheria is concerned. A less number of cases of Diphtheria was notified than for the past fourteen years. In fact, since the year 1900, only in 1900, 1901, 1905. and 1910 were fewer cases notified. In 1924 only 1 death from diphtheria occurred in the district; this is the lowest number of deaths recorded from diphtheria in any year in Ilford for the last quarter of a century. When it is remembered how in the last twenty-four years the population in Ilford has increased, these figures give considerable cause for satisfaction. The causes which produce the rise and fall of epidemics in infectious disease are still very imperfectly understood, but these cannot altogether explain such a result in a nonepidemic year. The high percentage of cases of diphtheria treated in the isolation hospital, their early diagnosis by medical practitioners, the employment of the services of a nose and throat surgeon during the past few years to attempt to free "carriers" of their infecting organisms, and an active School Medical Service, have all been factors in the result. It will be noted that the death-rate from diphtheria in Ilford last year was one-twelfth of that in London. The infant mortality rate in Ilford shows a slight rise in common with that which occurred generally in England, although fortunately it was less marked in Ilford. This was coincident with a fall in the birth-rate. In Ilford there were 4 less deaths of babies, but 170 less births. For the infant mortality rate to have remained the same as in 1923 there should have been seven less deaths of babies. Measles was epidemic in Ilford in 1924, and five deaths of children under one year of age occurred from this cause, while none occurred in 1923. It may, therefore, be presumed that in another year the rate will again be lowered. We 8 still know as little of the cause and control of Measles as we did thirty years ago. Medical research in this disease would well repay the money spent. The continuous epidemics and deaths from Measles show how futile general sanitary measures are in controlling a disease for which we have no specific remedy and no scientific means of prevention. The present social conditions are likely to result in an everdecreasing birth-rate, and it may presently become an acute problem, in the interests of the State, to conserve every child that is born. A satisfactory feature of the infant mortality statistics is that of the neonatal mortality or death-rate of infants in the first month of life. The figures given on page 67 show that in 1924 the neonatal death-rate was lower than for the past 10 years. The Ante-Natal and Maternity Home facilities appear at last to be having some effect in saving the youngest infants. It is also a satisfactory feature of the report that only one death of a woman in child-birth was notified and no deaths occurred from puerperal sepsis. As far as other public health work is concerned, I would point out that Ilford has thought well to adopt the humane slaughtering byelaws. To anyone who thinks that these are unnecessary, I would commend a visit to a slaughterhouse in a rural area where such byelaws are not in force. It is difficult to understand how the Christian population in this country has been able to tolerate for so long such avoidable suffering of dumb creatures. The Health Committee in this matter has been a Humanity Committee. Every effort has been made during the past year to promote the sale of "Grade A" and other designated milks. An enquiry at the end of the year showed that just over 150 gallons of "Grade A" milk (or about one-tenth of the total sale of all milk) was retailed daily in the district. The standard of "Grade A" milk is not so high that the question may rightly be asked "Why should not all milk sold be ' Grade A' milk?" A little more cleanliness on the part of the farmer and in the transport of milk is all that is required to attain this object. The various designations of milks' sanctioned by the Government has been unnecessarily multiplied ; the ordinary consumer of milk has no inclination to differentiate between them. There is little demand at present for pasteurised milk sold as such. Much milk is pasteurised and sometimes re-pasteurised, but is sold as pure fresh new milk to the consumer. A simpler legislation would be to enact that any milk sold must be pasteurised, sold as such, and come up to a given standard, or, if not so 9 teurised, must also come up to a given or somewhat similar standard. At the present time the multiplicity of nomenclature used in designated milk is defeating the object intended. The housing difficulty has been very little eased in Ilford. A number of cases come to my notice which would in ordinary times be dealt with as serious cases of overcrowding, but which have to be tolerated under present conditions. The School Medical Service has carried out efficient work. 1 have pointed out in the course of the report, evidences of the fact. In 1908, before medical inspection started, there were 135 cases of Ringworm in the Ilford schools. At the end of 1924 there were only 5 cases under observation. In 1919, after the interference with School Medical work caused by the War, 10'7 per cent, of the children in the schools were dealt with for uncleanly conditions. In 1924 only 4 per cent. Similarly in the year after the War, 30 cases of Itch were discovered at medical inspection and 116 cases at the School Clinic. These figures were reduced last year to only 2 cases at medical inspection and 3 at the Clinic. In the same way the number of cases of Impetigo or contagious sores has been reduced from 546 to 243. At its lowest value, therefore, the School Medical work is causing a very considerable saving in school attendances. The fact that 2,158 children attended the Clinic for minor ailments, in addition to 3,036 who were treated by the Dentist and 637 who were treated by the Oculist, illustrates the amount of work which has been carried out for school children in the very inadequate premises at Oakfield Road. The provision of special schools in Ilford is still delayed. An open-air school is still under consideration and a site was approved for the purpose in July by the Board of Education. There is no doubt that this school will have a profound effect on the physique of the, C.3 child. There is no school for mentally defective children. I find that at the present time there are 30 young persons over 16 years of age who were certified when at school in Ilford to be feeble-minded, 22 of whom have had no training in a special school such as they required to face the battle of life. There are 20 feeble-minded children attending elementary schools and 7 not attending any school, who should be receiving education in a special school, either day or residential. The Public Health Department has lost the services of Mr. Bull, for many years its Chief Clerk. His appointment as Superintendent Registrar to the Romford Board of Guardians is a promotion well earned by the very capable and efficient work he did in Ilford. It has also lost, by the untimely decease after a long and acutely painful illness, Nurse Robinson, a Health Visitor who was deservedly popular with the mothers and children with whom she had to deal. The Department has been strengthened by the 10 appointment of an additional Sanitary Inspector, the first increase in the staff of Sanitary Inspectors for the past 17 years. This will enable their very important duties, which are being continually increased by new legislation, to be carried out with a greater efficiency than has been possible previously. The extensions at the Isolation Hospital and the new Maternity Home are nearing completion. Fortunately the very light incidence of infectious diseases has prevented serious difficulties arising from the delay in the completion of the Isolation Hospital building. The members of the staff have given loyal service to the Council, and I have again to thank them and the Councillors and the co-opted members of the Committee for the support which has enabled the varied activities detailed in the report to be carried out. I am, Madam 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 Rainfall 19 Poor Relief 19 Hospital Provision 19 Population 20 Births 20 Deaths 21 Inquests 22 Marriages 22 Vital Statistics—Tables of 22 Table 1 23 „ „ Table l. 24 Causes of Death—Table III 25 SECTION II.—SANITARY CIRCUMSTANCES OF THE DISTRICT. Drainage and Sewerage 26 Closet Accommodation 26 Scavenging, Collection of House Refuse 26 Sanitary Inspection of the District:— (а) Notices Served 27 (б) Complaints of Nuisances 27 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 28 Bye-laws and Local Acts 28 SECTION III.—SUPERVISION OF FOOD. Milk Supply 29 The Milk and Dairies (Amendment) Act, 1922 29 The Milk (Special Designations) Order, 1922 30 Meat:— (a) Slaughter-houses 30 (b) Articles of Food Surrendered and Seized 32 Other Foods:— Bakehouses 32 Sale of Food and Drugs Acts 32 SECTION IV.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Disease generally 33 Table II.—Summary of Cases of Infectious Diseases Notified 35 Attack Rates of Infectious Diseases 36 (a) Small-pox 36 Small-pox Hospital Accommodation 36 (b) Scarlet Fever 36 (c) Diphtheria 37 12 Page. SECTION IV.—(continued). (d) Enteric Fever 37 (e) Cerebro-Spinal Meningitis 37 (f) Ophthalmia Neonatorum 37 (g) Acute Influenzal and Acute Primary Pneumonia 37 (h) Encephalitis Lethargica 37 (i) Plague 38 (j) Puerperal fever 38 Zymotic Diseases 38 Tuberculosis 38 Tuberculosis Care-Committee 41 Venereal Diseases 41 SECTION V.—OTHER SERVICES. Bacteriological Laboratory 43 Table of Number of Specimens Examined 44 District Nursing 45 SECTION VI.—HOUSING 45 SECTION VII.—FACTORIES AND WORKSHOPS. Factories 47 Workshops 47 Table I.—Inspection of Factories, Workshops and Workplaces 49 „ II.—Defects Found 50 „ III.-—Homework. 51 „ IV.—Registered Workshops 5-2 „ V.—Other Matters 52 ISOLATION HOSPITAL 55 MATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907 and 1915 63 Registration Act, 1836 63 Infant Mortality 63 Neonatal Mortality 67 Table IV, 68 Illegitimate Births and Deaths 69 Maternal Mortality 69 Infant Life Protection 70 Work of Health Visitors 71 Supervision of Midwives 71 Supply of Milk to expectant and nursing Mothers and for Infants 72 Infant Welfare Centres 72 Ante-Natal Clinic 74 Dental Clinic 74 Ophthalmic Clinic 75 Ophthalmia Neonatorum 75 Treatment of Minor Ailments 76 Maternity Home 76 District Midwife 79 SCHOOL MEDICAL SERVICE. Staff 83 School Premises 83 Medical Inspection 83 13 Page SCHOOL MEDICAL SERVICE—(continued). Findings of Medical Inspection 84 Infectious Disease 86 "Following-up" 87 Medical Treatment:— Minor Ailments 87 Ophthalmic Department 89 Dental Department 90 Treatment of Uncleanliness 91 Other Ailments 91 Operative Treatment of Tonsils and Adenoids 91 Open-air Education 92 Physical Training 93 Provision of Meals 94 Defective Footgear 95 Co-operation of:— Parents, Teachers, School Attendance Officers and Voluntary Bodies 95 Physically and Mentally Defective Children 96-100 Employment of School Children and Young Persons 101 Medical Examination of Teachers, etc. 102 Incidence of Goitre 102 Statistical Tables:— I.—Number of Children Inspected 103 IIA.—Return of Defects 104 IIB.—No. of Children found to Require Treatment 105 III.—Numerical Return of Exceptional Children 106-108 IV.—Group I.-Minor Ailments 109 Group II.—Visual Defects 110 Group III.—Nose and Throat Defects 110 Group IV.—Dental Defects Ill Group V.—Uncleanliness and Verminous Conditions 112 V.—Summary of number of Children Inspected 114 VI.—A.—Average Heights and Weights of Boys Inspected 116 B.—Average Heights and Weights of Girls Inspected 118 VII.—Summary of Infectious Disease among School Children 120 VIII.—Summary of Scarlet Fever among School Children 121 IX.—Summary of Diphtheria among School Children 122 X.—Summary of Measles and German Measles among School Children 123 XI.—Summary of Chicken Pox among School Children 124 XTI.—Summary of Whooping Cough among School Children 125 XIII.—Summary of Mumps among School Children 126 GENERAL. 17 STATISTICAL SUMMARY. l.—General Statistics. Area of District in Statute Acres—Land 8,470 „ „ „ Inland Water 26 „ „ „ Tidal Water 7 Enumerated Population (Census 1911) 78,188 „ „ (Census 1921) 85,194 Registrar-General's Estimate of Population middle of 1924 92,400 Number of Inhabited Houses, 1921 18,606 „ Families or Separate Occupiers, 1921 20,059 Density of Population, i.e., Number of persons per acre (including public institutions and calculated on the Registrar-General's estimate of the population) 10.9 1923-24. 1924-25. Rateable Value—Houses £505,083 0 0 £517,639 0 0 „ Land 6,292 0 0 6,021 0 0 £5111,375 0 0 £523,660 0 0 Sum represented by a penny rate in 1924, £2,090. Education Rate— 1923. 1924. Elementary 2s. 2¼d. 2s. 2¾d. in the £. in the £. Higher 0s. 3¾d. 0s. 4¼d. in the £. in the £. Assessable value £499,676 0 0 £512,198 0 0 General District Rate 6s. 6d. 7s. 2d. in the £. in the £. Poor Rate 7s. lOd. 7s. 8d. in the £. in the £. 2.—Extracts from Vital Statistics of the Year. 1923. 1924. Total Number of Births Registered— Legitimate 1565 1405 Illegitimate 41 31 1606 11436 Birth rate per 1,000 of population 18.8 16.2 18 Total number of Deaths Registered— 1923. 1924. Males 380 415 Females 428 162 808 877 Death rate per 1,000 of population 9.5 9.9 Number of Women dying in, or in consequence of, childbirth— Sepsis 3 — Other causes 1 1 - 4 - 1 Maternal Mortality per 1,000 births 2.49 0.69 Total number of Deaths of Infants under 1 year of age— Legitimate 59 55 Illegitimate 7 7 - 66 - 62 Infant Mortality per 1,000 births— Legitimate 38 39 Illegitimate 1171 226 Infant Mortality per 1,000 registered births 41.1 43.2 Total number of Deaths from seven principal Zymotic Diseases 22 21 Zymotic death-rate per 1,000 of population .26 .24 Total number of Deaths from— Measles (all ages) 2 11 Whooping Cough (all ages) 4 2 Diarrhoea (under 2 years of age) 3 6 19 Section I.—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 27.64 inches. The greatest fall in 24 hours was registered on the 17th July, being .95 inches. The number of days on which rain fell was 160 2. Poor Relief.—The total amount expended in Ilford during the year was: Cash, £12,143 Is. 8d.; kind, £3,299 3s. 11½d. The average weekly number of cases in receipt of relief was 450. The number of admissions to the Guardians' Institutions from Ilford during the year was 377, made up as follows:— Men 138 Women 157 Children 82 3. Hospital Provision.—There is an Emergency Hospital ir. the district maintained by voluntary subscriptions, the number of beds being 42. During the year 1924, 703 in-patients were admitted—males 240, females 355, children 108; 500 operations were performed, 540 casualties were attended to, and 477 X-ray examinations were made. The average cost per patient per week was £3 15s. 4¼d. There are two large Mental Hospitals in the district, the West Ham Mental Hospital with 880 patients (males 418, females 462) and Claybury Mental Hospital with 2,373 patients (males 1,026, females 1,347) in residence on 30th June, 1924, 20 In addition there is the Girls' Village Homes, one of the late Dr. Barnardo's Institutions, which had 1,275 children and 145 staff in residence on the 30th June, 1924. 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, 1924 92,400 (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 2,607 West Ham Mental Hospital 1,002 This makes a net population of 88,791. In calculating the various rates per 1,000 of the inhabitants I 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 to be considerably below the actual figure. 5. Births.—The number of births registered during the year was 1,436. Legitimate Males 706 Females 699 Illegitimate Males 11 Females 20 i.e., 2.16 percent, of the births registered were illegitimate. 21 The percentage of illegitimate births registered in previous years was:- 2.5 in 1923; 2.5 in 1922; 2.5 in 1921; 3.1 in 1920; 5.8 in 1919; 4.2 in 1918; 4.5 in 1917; 2.8 in 1916; 1.9 in 1915; 1.8 in 1914; 2.1 in 1913; 2.2 in 1912; and 1.7 in 1911. The birth-rate, calculated on the net estimate of the population of 88,791 is 16.2 per 1,000, as compared with 18.8 in 1923; 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. 6. Deaths.— The total number of deaths of Ilford residents was 877. The total number of deaths registered in the district during the year was 849 Number of deaths of non-residents registered in the district (principally in large institutions) 231 The latter 231 deaths occurred as follows:— In Claybury (L.C.C.) Mental Hospital 160 In West Ham Borough Mental Hospital 52 In Ilford Isolation Hospital and Sanatorium 1 In Ilford Emergency Hospital 7 Other non-residents 11 231 Included in the deaths of residents belonging to the district are 7 which occurred in Dr. Barnardo's Village Homes. To be added to the total number of deaths registered in the district are 259 deaths of Ilford residents registered as having died in other districts. This figure includes deaths at the following institutions:— The Infirmary, Romford 140 Essex County Mental Hospital 16 rIhe London Hospital 21 Queen Mary's Hospital, West Ham 9 Hospital for Sick Children, Gt. Ormond Street 3 St. Bartholomew's Hospital 8 In other Hospitals, Institutions and residences outside the Ilford District 62 Total 259 The total number of deaths of Ilford residents was therefore 877. 22 The death rate, calculated on the net estimate of the population of 88,791, is 9.9 per 1,000, as compared with 9.5 in 1923; 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-sixth, or of the period 45—65 years, over one-quarter. Inquests.—During the year 50 inquests were held in the district. 38 on Ilford residents, and 12 on non-residents. The ages at death and causes assigned were as follows :— Under 1 yr. 1-2yrs. 2-5yrs. 5-15yrs. 15-25yrs. 25-45yrs. 45-65yrs. 65 yrs. & upwards. 5 — — 1 3 8 16 17 Causes of death under 1 year:—Compression of brain, 1; premature birth, 1; asphyxia, want of attention, 1; peritonitis, 1; accidental—due to being born in w.c. pan, 1. Causes of death o ver 1 year:— Accidents 4 Rupture of abdominal Suicides 9 aneurism 1 Cerebral Haemorrhage 1 Meningitis following a fall 1 Heart Disease 15 Haemorrhage due to rupture 1 Found drowned 1 Chronic Bronchitis 1 Acute Pneumonia 2 Congestion of lungs follow- Septicsemia following Abrasion 3 ing fall 2 Peritonitis 2 Rupture due to fall 1 Uncertain 1 7. Marriages.—551 marriages have taken place during 1924. The following details explain the allocation:— Marriages taking place in the Ilford District 425 Marriages of Ilford Residents at Registry Office, Romford— Both parties belonging to Ilford 86 The male only belonging to Ilford 17 The female only belonging to Ilford 23 8. Tables of Vital. Statistics.—Table I. gives a comparative statement of the population, birth-rate and death-rate, for the past seven years. Table III. gives a classified statement of the causes of death in 1924, 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. 23 TABLE I Vital Statistics of Whole District during 1924 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 (b). of Non-Residents registered in the District. of Residents not registered in the District. Under 1 Year of age. At all ages. Number. Rate (c). Number. Rate (d). Number Rate per 1,000 Net Births. Number. Rate (e). 1 2 2a 3 4 5 6 7 8 9 10 11 12 13 1918 ‡76,602 *72,825 — 1,053 12.9 — — — - 73 69 947 13.0 †81,598 1919 ‡84,216 *79,524 1,151 1,167 14.1 1,029 12.2 416 176 71 61 789 9.9 †82,840 1920 86,598 §82,693 1,666 1,666 20.1 894 10.3 306 160 90 54 748 9.0 1921 85,500 §81,567 1475 1,492 18.3 821 9.6 252 181 76 50.9 750 9.2 1922 86,370 §82,624 1,475 1,475 17.8 914 10.5 314 195 80 54.2 795 9.5 1923 89,020 §85,251 1,570 1,606 18.8 816 9.2 222 214 66 41.1 808 9.5 1924 92,400 §88,791 1,382 1,436 16.1 843 9.6 231 259 62 43.2 877 9.9 *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. 24 TABLE IA. Table showing comparison between the Birth-rate, Death-rate, &c. of Ilford, other Towns, and of England and Wales for the Year 1924. (Provisional figures. The rates for England and Wales, and Ilford, have been calculated on a population estimated to the middle of 1924, while those for the towns have been calculated on populations estimated to the middle of 1923. 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. Diarrhoea 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 18.8 12.2 0.01 0.00 0.12 0.02 0.10 0.06 0.49 0.44 7.3 75 92.3 6.6 1.1 105 County Boroughs and Great Towns, including London 19.4 12.3 0.01 0.00 0.18 0.03 0.12 0.08 0.45 0.40 9.2 80 92.5 6.9 0.6 157 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 18.9 11.2 0.01 0.00 0.08 0.02 0.09 0.06 0.50 0.36 6.2 71 93.3 5.5 1.2 London 18.7 12.1 0.01 — 0.29 0.03 0.11 0.12 0.36 0.44 8.4 69 91.3 8.6 0.1 ILFORD (Estimated Net Population, 88,791) 16.2 9.9 0.01 0.00 0.12 — 0.02 0.01 0.42 0.35 4.2 43 95.5 4.3 0.2 25 TABLE III. Causes of, and Agss at, Death during the Year 1924. Causes of Death. Net Deaths at the subjoined ages of " Residents'" whether occuiring 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 - - - 1 2 Small-pox - - - - - - - - - - 3 Measles 11 5 2 2 1 1 - - - 2 4 Scarlet fever - - - - - - - - - - 5 Whooping cough 2 1 — 1 - - - - - - 6 Diphtheria 1 — — 1 — — — — — 1 7 Influenza 37 — — 1 1 5 9 10 11 7 8 Encephalitis lethargica 3 - - - - - 1 2 — - 9 Meningococcal meningitis - - - - - - - - - - 10 Tuberculosis of respiratory system 54 1 2 - 7 12 19 11 2 29 11 Other tuberculous diseases 11 1 — 4 3 1 1 — 1 4 12 Cancer, malignant disease 117 — — — - 6 20 51 40 10 13 Rheumatic fever 10 — — 1 3 1 3 2 - 3 14 Diabetes 11 — — — 1 - 3 6 1 1 15 Cerebral haemorrhage, &c. 37 - - - - - 4 9 24 2 16 Heart disease 85 — 1 — 1 3 14 28 38 8 17 Arterio-sclerosis 14 - - - - - - 6 8 48 18 Bronchitis 72 8 1 — - 1 10 11 41 5 19 Pneumonia (all forms) 50 3 4 6 1 4 10 9 13 29 20 Other respiratory diseases 15 1 — — — 1 3 7 3 3 21 Ulcer of stomach or duodenum 4 — — — — 1 — 2 1 1 22 Diarrhoea, &c. (under 2 years] 6 5 1 - - - - - - - 23 Appendicitis and typhlitis 4 — — — 1 — 1 2 — 2 24 Cirrhosis of liver 4 - - - - - 1 2 1 1 25 Acute and chronic nephritis 27 — — — 1 3 2 14 7 5 26 Puerperal sepsis — — — - — — — — — - 27 Other accidents and diseases of pregnancy and parturition 1 - - - - 1 - - - 1 28 Congenital debility and malformation, premature birth 26 24 - _ - - 1 1 - 1 29 Suicide 9 — — — — - 2 5 2 2 30 Other deaths from violence 22 1 — 1 3 2 6 2 7 5 31 Other defined diseases 241 11 1 6 4 3 30 40 146 93 32 Causes ill-defined or unknown 2 1 — — — — — — 1 — Totals 877 62 12 23 27 46 140 220 347 264 Special causes (included above): Poliomyelitis — — — — — — — - - - Polioencephalitis - - - — — — — — — — 26 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 was brought into life in January, 1924. A new 15 in. Relief Sewer from the junction of Ilford Lane and Hampton Road to the Outfall Works has been commenced to relieve flooding in the Uphall Road district. 4. Closet Accommodation.—In addition to the water carriage system of sewage, there are in the rural area 39 cesspools, 20 privies and 75 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. 5. Scavenging, Collection of House Refuse.—Vide Annual Report, 1920. 322 defective and unsuitable receptacles have been replaced during the year. The following figures give information as to the collection of house refuse during 1924:— Number of days on which collection was made 565 (Horse 257, electric 308.) Number of vehicles employed (Horse 876, electric 2,112¼.) 2,988¼ Average number of vehicles employed per day (Horse 3.4, electric 6.8.) 10.2 Total number of loads collected (Horse 2,441, electric 6,601.) 9,042 Average number of loads collected per day (Horse 9.4, electric 21.4.) 30.8 Average per horse per day 2.7 Average per electric per day 3.1 Average per both per day 2.9 Total weight of refuse collected 16,836 tons 19 cwts. 3 qrs. (Horse 3,091 tons 10 cwts. 0 qrs.) (Electric 13,745 tons 9 cwts. 3 qrs.) Average weight per load:— Horse-drawn vehicles 1 ton 5 cwts. 1.3 qrs. Electric vehicles 2 tons 1 cwt. 2.5 qrs. Average of both 1 ton 17 cwts. 0.9 qrs. 27 Average cost of collection per ton:— £ s. d. Horse 0 7 11.4 Electric 0 11 10.8 Both 0 11 2.3 Arrangements have now been made.whereby a special daily collection of refuse is made at Claybury Mental Hospital. 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 4,282 Houses and premises re-inspected (works in progress) 4,015 Visits during disinfection 1,040 Houses in which nuisances were detected 465 Houses in which nuisances were abated 447 Premises disinfected 432 Articles disinfected 4,267 Notices Skrved. Served Complied with. Statutory 14 14 Preliminary 372 365 Informal 141 129 Provide Dustbin (Ilford Improvement Act) 211 221 Pave Yard (Ilford Improvement Act) 6 4 Cleanse Water Storage Cistern (Bye-laws) 57 57 Cover ditto 14 13 Provide Water to Dwelling House 13 13 Cleanse Dwelling House (Infectious Disease (Prevention) Act, 1890) 32 32 Housing Acts, 1890-1919 14 2 Totals 874 850 On Mr. Bull leaving his appointment as Chief Clerk, Mr. Haigh was appointed Sanitary Inspector and Chief Clerk. Two new appointments of Sanitary Inspectors (Messrs. Rackham and Reeves) were made. There are therefore now a whole-time Senior Sanitary Inspector, four whole-time Sanitary Inspectors (one of whose time is taken up chiefly with disinfection work), and a Chief Clerk, who is also a part-time Sanitary Inspector. Complaints.—During the year 291 complaints of nuisances have been received and investigated:— 28 The following is a summary:— Accumulation of manure and refuse 17 Animals improperly kept 9 Bad smells 28 Cesspools full and overflowing 2 Dampness of premises 7 Defective drains, w.c.'s and fittings 54 Defective or no provision of dustbin 10 Defective roofs, gutters, downpipes, etc. 45 Defective water fittings 13 Dirty and verminous houses 9 Dirty condition of rearway 1 Flooding of premises 5 Overcrowding 7 Smoke nuisances 16 Miscellaneous 68 Total 291 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920.—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 39, and the number of certificates issued was 20. 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. (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. 29 (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 by an order dated June 30th, 1923, declared to be offensive trades. The order was confirmed by the Minister of Health and came into operation on 17th September, 1923. Byelaws under this order are at present waiting the approval of the Ministry of Health. 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. SECTION III.—SUPERVISION OF FOOD SUPPLY. 1. Milk Supply.—There are 46 dairies and milkshops and 6 cowsheds on the register. 371 inspections of dairies, milkshops and cowsheds were carried out during the year. Of the 46 premises from which milk is retailed in Ilford, 8 are branches of one firm, 4 another, and 2 another. Of the remainder, three are retailers in a large way. 12 retail from dairy shops or stores, 7 from general grocery shops, and 3 from restaurants. 7 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. 30 There are seven wholesale dealers in milk. Of these, one is also a retailer. One of the seven has no cows on the premises; the remaining six have cowsheds. Licenses were granted under the Milk (Special Designations) Order, 1922, during 1924, for the sale of:— "Certified" milk 7 "Grade A" milk 16 "Grade A (tuberculin tested)" milk 5 "Pasteurised" milk 6 The above include supplementary licenses which were issued for "Certified" milk 4, "Grade A" milk 5, "Grade A (tuberculin tested)" milk 5, and "Pasteurised'' milk 6. These are licences granted to firms who already have a license from another Authority, the milk being bottled outside the town but sold in Ilford. 2. Meat. (a) Slaughterhouses.—There is now only one licensed slaughterhouse in the district. 63 inspections were carried out during the year. The following table gives particulars of the slaughterhouses in the Ilford district:— In 1914. In January, 1924. In December, 1924. Registered — — — Licensed 3 1 I Totals 3 1 1 The following byelaws were adopted by the Council for the humane slaughtering of animals. They were approved by the Ministry of Health on 3rd December, 1924, and came into force on the same day:— BYELAWS made by the LTrban District Council of Ilford with respect to slaughter-houses in the Urban District of Ilford. 1. From and after the date of the confirmation of these byelaws, the following byelaws shall be added to and construed as one with the series of byelaws with respect to slaughterhouses which was made by the Urban District Council of Ilford on the tenth day of April, 1906, and which was confirmed by the Local Government Board on the seventh day of June, 1906. 31 2. Every person engaged in a slaughter-house in driving or bringing any animal to the place of slaughter shall (a) avoid, so far as practicable, driving or bringing the animal over any ground which is likely to cause the animal to slip or fall, and (b) otherwise adopt such methods and precautions as will prevent the infliction upon the animal of unnecessary suffering or pain. 3. A person shall not in a slaughter-house proceed to slaughter any animal until the same shall have been effectually stunned, and such stunning shall, except as hereinafter provided, be effected with a mechanically operated instrument suitable and sufficient for the purpose: Provided that this byelaw so far as it would require the stunning of sheep and the use of a mechanically operated instrument shall not apply until the expiration of three months from and after the date of the confirmation of these byelaws: Provided further that this byelaw shall not be deemed to apply to any member of the Jewish faith, duly licensed by the Chief Rabbi as a slaughterer, when engaged in the slaughtering of cattle intended for the food of Jews according to the Jewish method of slaughtering, if no unnecessary suffering is inflicted. 4. A person sball not, in a slaughter-house, slaughter, or cause or suffer to be slaughtered, any animal, or dress, or cause or suffer to be dressed, the carcase of any animal in the view of another animal. 5. A person shall not use any instrument for slaughtering or stunning any animal unless his training, physical condition and ability qualify him to use the same so as to inflict on the animal as little pain or suffering as practicable. 6. An occupier of a slaughter-house shall not cause or allow any blood or other refuse to flow from such slaughterhouse so as to be within the sight or (so far as it is practicable to avoid it) within the smell of any animal in the slaughterhouse, and he shall not cause or allow any such blood or other refuse to be deposited in the waiting pens or lairs. The foregoing byelaws were adopted by the Council of the Urban District of Ilford at a meeting held on the 22nd day of July, 1924. IN WITNESS whereof the said Council have caused their Common Seal to be hereunto affixed this seventh day of November, 1924, pursuant to a resolution passed for that purpose at the said Meeting by A. PARTINGTON, Clerk. in the presence of J. W. KING, Chairman. Resolution Minute: 22/7/24, Seal Register 1149 (XVIII) 6026. Allowed by the Minister of Health this third day of December, 1924. F. L. TURNER, Assistant Secretary, Ministry of Health. 32 (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:— 1 box roe. 1 box fresh herrings. 2 lots of skate. 1 box of catfish. 1 box of hake. 2 boxes of smoked sprats. 2 boxes of codling. 1 6-lb. tongue. 2 bojces of dabs. 1 hindquarter of beef. 1 box of kippers. Rump, buttock, thick and trimmings of beef (13 stone 6 lbs ). Seized:— 1 piece beef suet. 9 lambs' kidneys. 2 pieces ox kidney. 6 lamb chops. 3 pieces of veal. 1 piece scrag of lamb. 1 target of lamb. 3 sheeps' hearts. 2 half shoulders of lamb. A letter of warning was addressed to the firm where the above meat was seized. In addition they were also asked to carry out certain requirements. 3. Other Foods. Bakehouses.—There are 30 bakehouses in the district, including 16 factory bakehouses. There is one underground bakehouse. 134 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 132 Samples of butter taken 85 Other articles 30 Total 247 Proceedings were taken in one instance against the seller of a sample of watered milk and a fine of £1 and 5s. costs was imposed by the Court. 38 SECTION IV.—PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. 1. Infectious Disease Generally.—During 1924, 536 cases were notified, as compared with 499 in 1923. 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 amcebic 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. In addition to the above infectious diseases notifiable to the Medical Officer of Health, certain industrial diseases are notifiable to the Home Office. These are cases of lead, phosphorus, arsenical, or mineral poisoning, anthrax, toxic jaundice, epitheliomatous or chronic ulceration contracted in any factory or workshop. Table II. shows the number of cases of infectious disease notified during 1924, arranged according to age and distributed in wards. Of these 58 occurred in institutions as follows:- Claybury Mental Hospital:— Pneumonia 19 cases. Dysentery 8 cases. Erysipelas 1 case. Tuberculosis—Pulmonary 8 cases. Diphtheria 1 case. Enteric Fever 1 case. Scarlet Fever 2 cases. 40 cases. Dr. Barnardo's Girls' Village Homes:— Scarlet Fever 2 cases. Diphtheria 4 cases. Tuberculosis—Pulmonary 5 cases. ” Other forms 2 cases. Erysipelas 1 case. 14 casea. 34 West Ham Mental Hospital:— Enteric Fever 1 case. Erysipelas 2 cases. Pneumonia 1 case. 4 cases. Of the cases notified (exclusive of those from Public Institutions) the following table shows the percentage isolated in hospitals:— Scarlet Fever 84.9 Diphtheria and Membranous Croup 94.8 Enteric Fever 100.0 Puerperal Fever 100.0 Encephalitis Lethargica 42.8 The total number of deaths of Ilford residents from the chief infectious diseases during 1924 is 173, classified as follows:— Enteric Fever 1 Scarlet Fever — Diphtheria 1 Measles 11 Whooping Cough ... ... 2 Influenza 37 Tuberculosis—Pulmonary 54 „ Other forms 11 Pneumonia 50 Diarrhoea (under 2 years) 6 Cerebro-Spinal Meningitis — Puerperal Fever — 173 The following table shows a comparison of the incidence of the chief infectious diseases in 1924 with that in 1923 and 1922:— 1924. No. of Cases. 1923. 1922. Scarlet Fever 157 131 252 Diphtheria 82 131 182 Enteric Fever 5 5 5 Pneumonia 96 29 70 35 TABLE II.—Cases of Infectious Disease Notified during the Year 1924. 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 157 - 37 95 12 13 - - 16 17 30 15 27 28 24 130 Diphtheria, including Membranous Croup 82 1 24 34 15 7 1 — 6 7 9 11 11 14 24 73 Enteric Fever (Typhoid and Para Typhoid) 5 - — 1 3 - 1 — 1 — — 1 1 — 2 4 Pneumonia 96 2 12 4 6 23 22 27 8 11 8 23 9 7 30 — Puerperal Fever 3 — - — — 3 — — 1 — 1 — — 1 — 3 Cerebro-Spinal Fever - - - - - - - - - - - - - - - - Acute Poliomyelitis — — — — — — — — — - — — — — — — Encephalitis Lethargica 7 — 1 — - 2 - — — — 3 1 - 2 1 3 Continued Fever _ — — - - — — - — — — — — — — — Dysentery 8 — — — - 3 5 — — - — 8 — — — — Ophthalmia Neonatorum 4 4 - — — - — - — — - 2 1 1 — - Erysipelas 41 2 - 2 6 10 14 7 5 4 3 2 7 14 6 — Tuberculosis—Pulmonary 106 — 1 13 24 44 23 1 8 10 3 23 19 23 20 — Other Forms 26 1 7 5 9 1 2 1 — 7 1 9 5 6 2 — Anthrax — — - - — — — - — — — — — — — — Malaria—Believed to be contracted in this country — - - - - - - - - - - - - - - Believed to be contracted abroad 1 — — — — — 1 - — 1 — — — - — — Totals 536 10 82 154 77 106 71 36 45 57 58 91 80 96 109 213 36 The attack-rates of certain infectious diseases per 1,000 of the population as compared with 1923 and 1922 is seen from the undermentioned figures:— Year Population Small Pox Scarlet Fever Diphtheria a b a b a b a b 1924 92,400 87,371 — — 1.7 1.8 0.8 0.9 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 Year Population Enteric Fever Puerperal Fever Erysipelas a b a b a b a b 1924 92,400 87,371 0.05 0.06 0.08 0.03 0.44 0.47 1923 89,020 83,757 0.05 0.06 0.07 0.08 0.23 0.23 1922 80,370 81,240 0.05 0.04 0.1 0.11 0.3 0.3 (a) Including all Institutions. (b) Excluding all Institutions. (a) Small-pox.—No case of Small-pox occurred in 1924. Notifications of 13 persons who had been in contact with cases of Small-pox were received. The following gives particulars as to vaccinations during 1924:— Certificates of Successful Vaccinations 932 Postponed 112 Conscientious Objections 504 Unsuccessful Vaccinations 8 Left the District 114 Small-pox Hospital Accommodation.—Vide Annual Report, 1922. (b) Scarlet Fever.—157 cases were notified in 1924, as compared with 131 in 1923, 252 in 1922, and 461 in 1921. Of the 157, 2 cases occurred in the Girls' Village Homes, Barkingside. No deaths from Scarlet Fever occurred in Ilford in 1924. 37 (c) Diphtheria.—82 cases of Diphtheria occurred in 1924, as compared with 131 in 1923, 182 in 1922, 187 in 1921. Of the 82 cases, 4 occurred in the Girls' Village Homes, Barkingside, with no deaths. 1 death occurred in the Isolation Hospital. (d) Enteric Fever.—5 cases occurred in 11924, as compared with 5 in 1923, and 5 in 1922. One of the 5 cases notified died. Of the five cases notified three occurred in institutions (a nurse at West Ham Mental Hospital, a ward maid at St. Bartholomew's Hospital, a patient at Claybury Mental Hospital). Of the two remaining cases which occurred in the district, one apparently contracted a severe type of the disease at a seaside resort and succumbed, the other case appeared clinically to be a case of enteric fever, but showed a persistent negative blood reaction. He made an excellent recovery. (e) Cerebro-Spinal Meningitis and Anthrax.—No cases of these diseases were notified. (f) Ophthalmia Neonatorum.—4 cases were notified during 1924, as compared with 9 in 1923, 9 in 1922, and 7 in 1921. All of the cases recovered without any permanent injury to the vision. In one case the child died of pneumonia. Cases. Vision Unimpaird Vision Impaired Total Blindness Deaths Notified. Treated At Home. In Hospial 4 3 1 4 — - 1* * Fatal when child was 7 months old—pneumonia. (g) Acute Influenzal and Acute Pulmonary Pneumonia.—96 cases of Pneumonia were notified (of which 20 were in institutions), compared with 29 in 1923, 70 in 1922, and 49 in 1921. (h) Encephalitis Lethargica—Seven cases were notified during the year. One of these proved to be a case of tumour of the brain ; two died, one of the deaths being due to an aneurysm of the carotid artery. Of the other four cases, one (aged 30) was very mild, the only symptoms being double vision and sleepiness, one (aged 21) recovered but with some mental impairment. The other two, which occurred in girls aged 21 and 3 years respectively, apparently made a complete recovery. 38 (i) Plague.—2 persons were reported to have been in con^ tact with cases of Plague on board ship. These contacts were visited and kept under observation for the usual period. (j) Puerperal Fever.—There were 3 cases of Puerperal Fever notified during the year. All of these recovered. Two were treated at the Isolation Hospital and one at the London Hospital. 2. Zymotic Diseases.—The deaths registered were as follows:— Small-pox — Measles 11 Scarlet Fever — Whooping Cough 2 Diphtheria and Croup 1 Enteric Fever 1 Diarrhoea 6 This gives a Zymotic death-rate for 1924 of .24 per 1,000 of the net population. The Zymotic death-rate for the previous five years was .26 in 1923, .32 in 1922, .37 in 1921, .53 in 1920, and .31 in 19119. (3) Tuberculosis.—During the year 1924 there were 106 new notifications of Pulmonary Tuberculosis and 26 of other forms of Tuberculosis. The following table shows the cases notified, classified according to age and sex:— Age Periods. New Cases. Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F Under 1 year - - 1 - 1 - 1 - 1-5 years 1 — 5 2 1 1 2 1 6-10 years — 1 1 5 — 1 1 2 10-15 years - 5 — — — 2 — — 15-20 years 7 3 1 2 2 2 1 1 20-25 years 7 0 4 1 6 5 — — 25-35 years 13 14 — — 6 5 — — 35-45 years 8 10 1 — 2 4 1 — 45-55 years 8 10 1 1 5 6 — — 55-65 years 8 2 — — 3 — — — Over 65 years - 1 — 1 1 1 — 1 Totals 51 55 14 12 27 27 6 5 Six of the above deaths or 9 per cent, of the total deaths had not been notified. 39 Of the above the following were notified from Institutions in the district:— Claybury Mental Hospital—Pulmonary Tuberculosis 8 Tuberculosis (all other forms) nil The Girls' Village Homes, Barkingside—Pulmonary Tuberculosis 5 Tuberculosis (all other forms) 2 During the year 1924 the following deaths occurred from Tuberculosis:—• Pulmonary Tuberculosis for the district proper (including 1 in the Girls' Village Homes, 1 in the Ilford Isolation Hospital and Sanatorium) and 1 in West Ham Mental Hospital 54 Claybury Mental Hospital 15 West Ham Mental Hospital, excluding the 1 mentioned above 10 Ilford Isolation Hospital and Sanatorium (not Ilford resident) 1 Tuberculosis (all other forms) for the district proper including 1 in the Girls' Village Homes 11 Claybury Mental Hospital 2 West Ham Mental Hospital 1 Of the 65 deaths which occurred of Ilford residents, notification had previously been received of 48 of the cases, and 11 were notified at or immediately after death. Of the 6 remaining, 1 died at one of Dr. Barnardo's Village Homes and 1 at London Hospital from Dr. Barnardo'g Homes, and were probably notified elsewhere; 1 at Brentwood Mental Hospital, and 1 at Queen Mary's Hospital, Stratford; while 2 were not notified by medical practitioners who were under the impression that they had been previously notified. 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 :— 40  1915 1916 1917 1918 1919 No. Rate, No. Rate. No. Rate. No. Rate. No. Rate Pulmonary Tuberculosis 74 .92 64 .80 79 1.05 82 1.12 57 .71 Tubercular Meningitis 15 .18 9 .10 7 .09 7 .09 11 .13 Tuberculosis (all other forms) 12 .14 10 .12 12 .15 10 .10 16 .20 1920 1921 1922 1928 1924 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate .61 Pulmonary Tuberculosis 42 .50 53 .64 46 .55 55 .64 54 Tubercular Meningitis 5 .06 2 .02 — — — — — - Tuberculosis (all other forms) 11 .13 9 .11 10 .12* 12 .14 11 .12 *Including Tubercular Meningitis for the years 1922-1924. On the 1st January, 1924, there were 593 cases on the register of the department. On the 31st December, 1924, with 117 new cases notified (Institution cases omitted), and allowing for deaths and removals from the district, there were 602 cases on the register. The new cases of Tuberculosis are visited by the Tuberculosis Nurse of the Essex County Council. 365 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 102 104 Improved or fairly well 30 9 Poorly, unwell, or under treatment 78 24 In Sanatorium 9 — No information as to present condition 3 6 Totals 222 143 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- 41 culosis Officer. On the 31st December, 1924, there were 295 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. 155 patients were treated, 13 being supplied with dentures. Tuberculosis Care Committee.—This Committee has continued to do good work during the year. 43 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 5-16 15-25 25-85 35-45 45-65 55 65 65-75 75-85 85 up Non- Residents in Institutions. Totals Syphilis — — — — — — — — 1 — l 2 Locomotor Ataxy General Paralysis of Insane — — — — — 1 1 — — - — 44 46 Aortic Aneurysm — — - — — — 1 — — — — — 1 The deaths of non-residents in Institutions occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital, 21 per cent. of the registered causes of death in these Institutions fell under the above headings. Many other patients died from incidental causes, the reason, however, for their admission to the Mental Hospital was some yenereal infection, 42 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; 1924, 4 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 afternoon of 8th April the film—“ The Gift of Life"— was exhibited to women only, and in the evening of the same day the film—“ Whatsoever a Man Soweth “—was exhibited to a mixed audience at the Library Hall, Seven Kings. At the afternoon meeting the speaker was Dr. Mary B. Douie and in the evening Dr. E. B. Turner, F.R.C.S. In the evening of 11th April, the film—“ The End of the Road "—was exhibited to a mixed audience at St. Thomas' Hall, Becontree, when Dr. E. B. Turner, F.R.C.S., was again the speaker. On the afternoon of 24th November an illustrated lecture, to women only, entitled " The Women's Attitude to the Hidden Plague," was given at the Town Hall. The speaker was Professor Winifred Cullis, O.B.E., D.Sc. In the evening of the same day the films—“ The Hidden Plague " and " The White Plague “—were exhibited to a mixed audience, the speaker on this occasion being Dr, E. B. Turner, F.R.C.S, 43 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 accompanying table shows how much these facilities are appreciated, 1,030 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. BACTERIOLOGICAL LABORATORY, 1924. 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 46 392 — 14 1 51 48 181 95 638 „ —Nose, Ear, Eye, &c „ 1 7 — 3 — 13 7 15 8 38 „ —Throat Contacts „ — 47 — 37 — 20 — — — 104 „ —Nose Contacts „ 1 8 — 1 2 6 — — 3 10 Hairs Ringworm 2 1 3 3 43 29 — — 48 33 Urine Various abnormalities — — 1 3 9 32 2 1 12 36 Smears—Vaginal Gonorrhoea — 1 — — — — — — — 1 „ —Conjunctival Ophthalmia Neonatorum - - - 1 - - - - - 1 Blood Pernicious Anaemia - - - - - - - 1 — 1 Cerebro-Spinal Fluid. Tuberculosis — — - — — — — 1 — 1 Pleuritic Fluid Tuberculosis - - - - - - - 1 — 1 Totals 106 864 Grand Tota 1,030. 45 2. District Nursing.—In my last annual report I stated that the provision of three district nurses for home nursing was commenced in October, 1921. The demand for these nurses was maintained during the year 1924, 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. A total of 5,665 visits was paid compared with 4,753 in 1923. The following is a summary of the work carried out during the year 1924 :— 1st Visits. Subsequent Visits. Medical. Surgical. Midwifery. Medical. Surgical. Midwifery. 261 23 — 5,376 4 — Number of applications made for Nurses' services 284 Number of patients under the charge of a doctor 284 Number of patients not under the charge of a doctor — Number of necessitous cases referred to Committee 47 Number of cases on the books at the end of the year 19 The cases were distributed in wards as under :— Cranbrook 43 Park 37 Seven Kings 65 North Hainault 15 Loxford 34 Clementswood 54 South Hainault 36 SECTION VI.—HOUSING. Private enterprise is not sufficient to meet existing requirements. 496 houses were completed by this means during 1924, and a further 405 houses were in course of erection on the 31st December. The Council has applied to the Ministry of Health for permission to complete their housing scheme, 356 only of the 504 houses proposed having been erected. The following is the table required by the Ministry of Health :— Number of new houses erected during 1924 :— (a) Total 496 (b) With State assistance under Housing Acts, 1919, 1923 or 1924 : — (1) By local authority nil (2) By other bodies or persons 496 46 1. Unfit Dwelling Houses: — Inspection:— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 890 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, and Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 53 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 562 2. Remedy of defects without service of formal Notices: — Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 533 3. Action under Statutory Powers: — (a) Proceedings under section 28 of the Housing, Town Planning, etc., Act, 1919: — (1) Number of dwelling houses in respect of which notices were served requiring repairs 14 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 2 (b) By Local Authority in default of owners — (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (b) Proceedings under Public Health Acts: — (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 14 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 14 (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 — One house was demolished during the year owing to its dilapidated and dangerous condition, under Sect. 75 of the Towns Improvement Clauses Act, 1847. 47 SECTION VII.—FACTORIES AND WORKSHOPS. Factories. There are 134 factories on the register, made up as follows :— Alloy Moulder 1 Metal and Brass Finisher 1 Asphalte Manufacturers 1 Motor Engineering 8 Bakehouses 14 Nautical Instrument Makers 1 Boot Making and Repairing 20 Optician 2 Builders, Joinery and Carpentry Works 5 Paper Mills 2 Photographic Works 1 Cabinet Maker 1 Picture Moulding 1 Cardboard Box Maker 1 Plating and Enamelling 1 Carriage Works 2 Printing Works 7 Chemical Works 1 Rag and General Merchant 1 Collar Works 2 Saw Mills 6 Corset Makers 1 Seed Sorting 1 Cutlery Grinding 2 Tarpaulin Repairing Works 1 Cycle Repairing 1 Tool Engineers 2 Electric Wire and Battery Works 2 Toy Makers 2 Umbrella Repairing 1 Engineers 11 Vulcanising Works 1 Fancy Bag Makers 1 Watchmaker and Repairer 1 Gear Cutting 1 Wearing Apparel Makers 6 Hardware Manufacturers 1 Wireless Apparatus 2 Iron Cutting Works 1 Wood Cutting 2 Laundries 5 Leather Belting 1 Leather and Cloth Works 1 Total 134 Meat Cutting 7 Mechanical Dentist 1 Workshops. There are 413 workshops on the register, made up as follows :— Art Pottery Worker 1 Embroidery 11 Artificial Flowers 2 Feather Cleaning 1 Bakehouses 14 Florists 2 Blacksmiths 5 French Polisher 3 Bookbinder 1 Furniture Repairs 3 Boot Repairing 35 Furriers 1 Boot and Shoe Sewing 3 Galvanised Iron Works 1 Brush Worker 4 Glass Cutters and Glaziers 2 Builders 17 Grate and Furnace Makers 1 Carpenters 16 Hand Laundry 1 Carpet Planning 1 Hairdressing 2 Cleaning and Pressing Clothes 3 Ladies' Belt Maker 1 Leather Worker 4 Clergy Robes 1 Meat Cutting 1 Coach Builders 2 Mechanical Dentist 2 Confectionery 2 Millinery 29 Dairy Utensil Maker 1 Metal Moulders 2 Dressmakers 43 Motor Cab Proprietor 1 Drug Packing, etc. 1 Motor and Cycle Engineering and Repairing 30 Electrical and Mechanical Engineers 7 Optician 1 48 Workshops—continued. Picture Framing 4 Tinsmith 3 Plumbers 10 Tool Grinding 1 Poultry Appliance Maker 1 Toy Making and Repairing 3 Printers 4 Umbrella Repairing 2 Rag and Bone Merchant 2 Undertakers 4 Scale Maker 1 Upholstering 7 Sheet Metal Worker 1 Watch and Jewellery Repairs 13 Shirt Making 1 Side Car Screens 1 Wearing Apparel and Underclothing 43 Smith's Shop 3 Sports Outfit Repairs 2 Wheelwright and Farrier 5 Stone Mason 1 Wire Worker 1 Surgical Belt Maker 1 Wood Cutting 4 Tailors 32 Total 413 Tie Makers 4 Timber Merchant 1 49 FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. I.—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) 224 3 - Workshops (including Workshop Laundries) 464 1 — Workplaces (other than Outworkers' premises included in Part 3 of this report) — — Total 683 10 — 50 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 1 1 — — Overcrowding 1 1 — — Want of drainage of floors — — — — Other nuisances 2 2 — — Sanitary accommodation insufficient 4 2 — — unsuitable or tive 2 2 — — 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 13 11 — — * Including those specified in sections 2, 3, 7 and 8 of the Factory and Work shop Act, 1901, as remediable under the Public Health Acts, 51 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Sending twice in the year. Sending once in the year. Lists. Outworkers. Outworkers. Contractors. Workmen. Lists. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) Wearing Apparel— Making, &c. 16 22 27 1 — 1 Cleaning and Washing - - - - - - Household Linen 2 — 3 — — — Lace, Lace Curtains and Nets - - - 1 — 1 Total 18 22 30 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. 52 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the Year. Number. (1) (2) Bakehouses (excluding 16 Factory Bakehouses) 14 Boot Repairs 35 Carpentering 16 Dressmakers 43 Laundries 1 Milliners 29 Tailoring 32 Wearing Apparel and Underclothing 43 Miscellaneous Workshops 200 Total number of Workshops on Register 413 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) 5 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5, 1901) Notified by H.M. Inspector 8 Reports (of action taken) sent to H.M. Inspector 8 Other 1 Underground Bakehouses (s. 101):— In use at the end of the year 1 ISOLATION HOSPITAL. 55 ISOLATION HOSPITAL. There have been many less new admissions to the Isolation Hospital than for some years past. This has been due (1) to a marked decline in the incidence of diphtheria, (2) to the longer stay in Hospital of the surgical cases of tuberculosis as compared with the previous short stay of pulmonary cases. 242 patients were admitted in 1924, 314 in 1923, 411 in 1922, and 493 in 1921. 93.5 per cent. of the cases of diphtheria occurring in the district and 84.3 per cent. of those of scarlet fever were admitted to the Hospital. Total number of patients admitted during 1924—242—as follows :— Scarlet Fever 129 Diphtheria 72 Tuberculous Diseases 28 Enteric Fever 3 Encephalitis Lethargica 1 Puerperal Fever 2 Meningitis 2 Measles 1 Diabetes 1 Influenza 1 Under Observation 2 Number of deaths in Hospital, 8:— Diphtheria 1 Tuberculous Diseases 2 Enteric Fever 1 Meningitis 1 Measles and Broncho-pneumonia 1 Laryngismus Stridulus 1 Diabetes 1 Number of patients in Hospital on 1st January, 1924 ant. 1925 respectively:— 1st Jan., 1924. 1st. Jan., 1925 Scarlet Fever 16 24 Diphtheria 9 10 Tuberculous Diseases 15 19 Puerperal Fever 1 — Under Observation 3 — The average length of stay in Hospital was for :— Scarlet Fever 48.7 days. Diphtheria 40.3 , Tuberculous Diseases 34.0 Average stay in Hospital of all cases 43.4 ,, 56 The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per Jay, 42.4. Scarlet Fever.—The 129 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 — 35 75 9 9 1 — No death from scarlet fever occurred during the year. The following table shows the percentage death-rate of cases of scarlet fever admitted to the Ilford Isolation Hospital during the past five years :— 1920. 1921 1922. 1923. 1924. .4 — — .8 — The following complications occurred in the patients admitted :— Rheumatism 3.8 per cent. Albuminuria 9.3 ,, Adenitis 17.0 ,, Otitis 8.5 „ Relapse 3.8 „ Seven children were operated on for adenoids, to clear up a chronic nasal discharge. Two children were operated on for an acute mastoiditis. Diphtheria.—The 72 cases admitted to Hospital were distributed among the following age groups :— Under 1 1—5 5—15 15—25 25—35 35—15 Over 45 1 25 26 13 5 1 1 One child, aged five, died within four days of admission of toxaemia with cardiac failure. The following table shows the percentage death-rate of cases of diphtheria admitted to the Ilford Isolation Hospital during the past five years :— 1920. 1921. 1922. 1923. 1924. 5.4 8.2 6.1 4.4 1.4 57 One probationer nurse contracted a severe type of the disease at the Hospital and ultimately developed a widespread paralysis of the limbs, from which she made a good recovery. No other cases of paralysis were observed. The other complications occurring were otorrhœa 3 cases, on one of which an operation for acute mastoiditis had to be performed. One child admitted suffering from both measles and acute laryngitis, possibly diphtheritic in origin, died from bronchopneumonia. One child with laryngeal diphtheria had the operation of tracheotomy performed, and a satisfactory recovery ensued. An interesting case was admitted as laryngeal diphtheria. The child, however, was suffering from " air-hunger " caused by diabetes. The child rapidly passed into coma, and although insulin was injected intravenously a fatal result ensued. Analysis of the urine showed 6.9 per cent. of sugar with acetone and di-acetic acid. Meningitis.—Two cases notified as meningitis were admitted, one child, aged two, was suffering from a streptococcal meningitis which unfortunately is invariably fatal, as it was in this instance. In the other case, which was discharged, no definite evidence of meningitis could be found. Puerperal Fever.—Two mild cases of this disease were admitted. Both made an excellent recovery with serum treatment. Enteric Fever.—Three cases were admitted. One girl, aged 19 years, died from a severe type of the disease with intestinal haemorrhage. The two others, one of whom gave a persistent negative blood reaction, made an excellent recovery. Encephalitis Lethargica.—One case, a youth aged 21, was admitted suffering from the disease of a typical lethargic type. He recovered, but did not regain his normal mentality. 58 Observation Cases.—Two cases were admitted, one a boy " carrying " the diphtheria bacillus in his nose; the condition rapidly cleared up under treatment. The other child was admitted in a moribund condition suffering from a laryngitis which was not diphtheritic in origin. Tuberculosis.—28 new cases were admitted, as compared with 61 in 1923. This decline is due, as explained previously, to the fact that the surgical cases have remained in the Sanatorium for many months. At the end of the year the following patients were in the Sanatorium :— Nature of Case. Period in Hospital. Hip 20 months. Spine 20 months. Hip 17 months. Spina 11 months. Hip 11 months. Spine 9 months. Spine 9 months. Shoulder 9 months. Lungs 9 months. Spine 9 months. Lungs 8 months. Hip and Lungs 5 months. Lungs 5 months. Hip 4 months. Hip 4 months. Lungs 4 months. Lungs and Renal Tuberculosi 1 month. Glands 1 month. Ankle 1 month. Of the 28 new cases admitted during 1924, 19 were cases of surgical tuberculosis, four of these being complicated with pulmonary tuberculosis also. The various organs involved were as follows:—Hip 5, Spine 4, Ankle 2, Shoulder 2, Elbow 1, Kidney 1, Glands 2, Abdomen 1, and Fistula 1. One case of abdominal and pulmonary tuberculosis died after a long illness. The remainder have either improved with treatment and been discharged or are still under treatment. Only nine cases of pulmonary tuberculosis were admitted during 1924. Of these, one died after a stay of twelve months in the Hospital. The remainder improved under treatment. 59 Training of Probationer Nurses.—In May, 1924, the Isolation Hospital was recognised by the General Nursing Council as a training school. This means that nurses who receive two years training at the Hospital and pass the examination of the Nursing Council can be registered in the Fever Nurses' Section of the Register, and on a further two years training (instead of the usual four) in a General Hospital can be registered as both general and fever trained nurses. The usual course of lectures given by the Medical Officers will therefore have to be considerably extended. It is to be feared that the syllabus of the course has been made very much too theoretical. An examination paper in Hygiene for a nurse in her first year of training could well be omitted, while the subject of Venereal Diseases included in the syllabus for the second part of the examination hardly comes within the province of Isolation Hospital work. During the year the probationer nurses were prepared for the examination of the Fever Nurses' Association, and four were successful in obtaining the certificate. Extension of Buildings.—From various causes the erection of the new Nurses' Home and the alteration of the existing one into a new ward has been much delayed. The Nurses' Home, which should have been occupied many months ago, is unlikely to be ready for occupation before Easter, 1925, in consequence the new ward has not been commenced. The delay has necessitated a new wooden hut being erected for sleeping accommodation for the night nurses. ► ' MATERNITY&CHILD WELFARE 63 Notification of Births Acts, 1907 and 1915. By the Notification of Births Acts, 1907 and 1915, all live births and stillbirths of seven m,onths and over must be notified to the Medical Officer of Health within 36 hours. The number of births notified under the above Acts during 1924 was 1,411 (714 males and 697 females). In addition, 21 stillbirths (7 males and 14 females) were notified. The percentage of births notified by the various responsible persons was as follows :— By Medical Practitioners 21.69 By Certified Midwives 44.58 By Parents and others 33.73 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 1,436 (717 males, 719 females) were registered, giving a birth-rate of 16.2 per 1,000 persons calculated on the net population, as compared with 1,606 births with a birth-rate of 18.8 per 1,000 persons in 1923. Infant Mortality. The number of infants dying within the first year of life was 62, the total number born being 1,436. The infant mortality or rate of death per l,000 births was, therefore, 43.2. The infant mortality rate for the district is, strictly speaking, higher than it should be, from the fact that 2 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 4T8 per 1,000 births. 64 The comparative figures for previous years were as follows: Year. No. of Deaths under 1 year. Rate per 1,000 Registered Births. 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 1924 62 43.2 The infant mortality rate for 1924 for Ilford compares favourably with that of 75 for England and Wales, 69 for London, and 80 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 55 West Ham 69 Willesden 76 East Ham 65 Tottenham 74 Wimbledon 77 Enfield 50 Walthamstow 69 Leyton 65 Ealing 39 Acton 61 Hornsey 49 Ilford 43 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 sexes together. 1924. 1923. 1922. Cranbrook M. 49 2 40.8 28.3 39.3 69.7 F. 57 1 17.5 Park M. 85 5 58.8 59.2 55.9 23.1 F. 84 5 59.5 Seven Kings M. 77 1 130 34.5 29.3 31.6 F. 68 4 58.8 North Hainault M. 71 8 112.7 71.9 24.1 80.6 F. 68 2 29.4 Loxford M. 118 4 33.9 37.2 33.1 45.8 F. 97 4 41.2 Clementswood M. 98 4 40.8 29.7 45.4 61.3 F. 104 2 19.2 South Hainault M. 180 11 61.1 49.3 42.6 55.7 F. 185 7 37.8 If the deaths of infants occurring in the Village Homes, Barkingside (1 male and 1 female) are added to the infant deaths occurring in the North Hainault Ward, there is an infant mortality rate of 86.3 (126.8 M. and 44.1 F.) per 1,000 births for that ward. 65 The above table only accounts for 1,341 of the 1,436 total births registered and belonging to the district. The remaining 95 are included by the Registrar-General as belonging to Ilford, but have not been allocated by him to the various wards. 41 births were registered in this district belonging to other areas, and one birth was 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 4 less deaths of babies in Ilford, but the number of births has decreased by 170. In consequence, the infant mortality rate shows a slight increase over the previous year. An analysis of the figures in the foregoing table will show that the infant mortality has risen in the Park, Seven Kings, North Hainault, Loxford and South Hainault Wards. 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 3 infant deaths. 1 died at 14 days from laryngismus stridulus and asphyxia. 1 died at 21 days from congenital atresia of the bile duct. 1 died at 7 weeks from gastro-enteritis and marasmus. The latter child had attended an infant welfare centre. In the Park Ward there were 10 infant deaths. 3 died under 1 week. 1 died at 10 days from inanition. 1 died at 7 weeks from broncho-pneumonia. 1 died at 3 months from marasmus. 1 died at 9 months from measles and broncho-pneumonia. 1 died at 10 months from measles and broncho-pneumonia. 1 died at 11 months from laryngismus stridulus. 1 died at 4 months from cholera infantum and convulsions. The latter child had attended an infant welfare centre. In the Seven Kings Ward there were 5 infant deaths. 1 died at 11 days from septic absorption due to scalds. 1 died at 3 months from bronchitis and exhaustion. 1 died at 4 months from peritonitis. 1 died at 4 months (one of twins) from acute gastro-enteritis and exhaustion. 1 died at 3 months from bronchitis and broncho-pneumonia. The two latter children had both attended infant welfare centres. 66 In the North Hainault Ward there were 10 infant deaths, exclusive of those dying at the Girls' Village Homes, Barkingside. 4 died under 1 week old. 1 died at 7 days from congenital atresia of the duodenum. 1 died at 28 days from bronchitis. 1 died at 3 months from acute bronchitis. 1 died at 6 months from tubercular meningitis. 1 died at 5 months from broncho-pneumonia. 1 died at 7 months from acute bronchitis and bronchopneumonia. The two latter children had both attended infant welfare centres (one of these two babies attended a centre once only six months before death). In the Loxford Ward there were 8 infant deaths. 3 died shortly after birth. 1 died at 4 days from congenital heart disease. 1 died at 17 days from acute yellow atrophy liver. 1 died at 2 months from prematurity and inanition. 1 died at 7 months from marasmus. 1 died at 9 months from congenital malformation and asthenia. None of these children attended an infant welfare centre. In the Clementswood Ward there were 6 infant deaths. 1 died shortly after birth. 1 died at 2 months from convulsions and whooping cough. 1 died at 3 months from congenital pyloric stenosis, diarrhoea and vomiting. 1 died at 3 months from bronchitis and convulsions. 1 died at 7 months from acute gastritis, diarrhoea, and exhaustion. 1 died at 8 months from capillary bronchitis and cardiac failure. The four latter children all attended infant welfare centres. In the South Hainault Ward there were 18 infant deaths. 6 died under 1 week. 1 died at 9 days from spina bifida. 1 died at 14 days from congenital malformation of the head. 1 died at 23 days from congenital intestinal defect. 1 died at 1 month from measles and marasmus. 1 died at 1 month from bronchitis. 1 died at 2 months from malnutrition and exhaustion. 1 died at 4 months from tubercular meningitis'. 1 died at 6 months from acute broncho-pneumonia and measles. 1 died at 11 months from congenital heart lesion. 1 died at 3 months from broncho-pneumonia. 1 died at 4 months from acute gastro-enteritis. 1 died at 5 months from septic pneumonia. The three latter children all attended infant welfare centres. It will be seen that of the 62 infants who died under 1 year of age, only 13 had attended infant welfare centres. 28, 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, 67 The mortality of infants under one year attending Ilford infant welfare centres was 27.7 per 1,000, as compared with 48'7 per 1,000 in those not attending a welfare centre (excluding the deaths of those children dying in the Girls' Village Homes). It must be remembered in considering these figures that rarely is a baby brought to a welfare centre under 1 month of age, whereas half the deaths occur in this period. Neonatal Mortality. The death-rate of infants under four weeks of age is known as the Neonatal Mortality. For the year 1924 it was 19.5 per 1,000 births. The following table shows the neonatal death-rate in Ilford compared with that for England and Wales during the past nine years :— Ilford. England and Wales. 1915 34.3 38 1916 22.1 37 1917 24.6 37 1918 30.4 36 1919 30.8 40 1920 27.0 35 1921 25.5 35 1922 27.1 34 1923 21.2 32 Table IV. gives the deaths of infants under 1 year of age, classified according to age. It will be noticed that prematurity still causes the greatest number of deaths. 68 Table IV.—Infant Mortality. 1924. 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. 4 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 ... ... ... ... ... ... 1 2 2 5 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... TuberculousMeningitis ... ... ... ... ... ... 1 ... ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... 1 ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 4 2 ... 8 Pneumonia (all forms) ... ... ... ... ... 1 2 ... ... 3 Diarrhoea ... ... ... ... ... ... 1 ... ... 1 Enteritis ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... 1 2 1 ... 4 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation (overlying) ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 1 ... ... ... l ... ... ... ... 1 Congenital Malformations 4 ... 1 2 7 ... 1 ... 2 10 Premature birth 9 ... ... ... 9 1 ... ... ... 10 Atrophy, Debility and Marasmus 1 ... ... ... 1 1 1 1 ... 4 Other Causes 5 2 2 ... 9 ... 2 ... 1 12 Totals 21 2 3 2 28 8 14 7 5 62 69 Illegitimate Births and Deaths.—31 of the births registered (11 males and 20 females) were illegitimate, that is 2.16 per cent. of the births registered. Seven illegitimate children died under 1 year of age. One of these children, however, was in the Girls' Village Homes, Barkingside, and should, strictly speaking, not be included in the death-rate of Ilford infants, although it is so included by the Registrar-General. The deaths of the seven illegitimate children occurred as follows :— 3 (aged 3, 9 and 10 months) died in the Romford Infirmary from measles and broncho-pneumonia. 2 died within 24 hours of birth, 1 from want of attention 1 died in the Girls' Village Homes from bronchitis. 1 died in Romford Infirmary from marasmus. This child was born in the Infirmary on May 24th, was taken out by the mother on June 28th, but was re-admitted on the same day as an unknown child, being deserted and abandoned. None of the seven 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, 193 per 1,000, compared with the infant mortality rate (exclusive of those children dying in the Girls' Village Homes) of 38.4 for legitimate children. If the deaths of infants in the Girls' Village Homes are included, there is an illegitimate infant mortality rate of 226 per 1,000, and 39 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. 1924 31 7 226 1,405 55 39 1923 41 7 171 1,565 59 38 1922 37 5 135 1,438 75 52 1921 38 10 263 1,454 66 45 1920 52 12 230 1,614 78 48 Maternal Mortality. The total number of deaths due to childbirth during the year was one, which gives a maternal mortality rate (i.e., number of deaths per 1,000 births) of 0'69. 70 The following table gives the maternal mortality rate for Ilford and England and Wales for the past nine years :— No. of Deaths. No. of Births. Maternal Mortality Rate per 1,000 Births, Ilford. Maternal Mortality Rate per 1000 Births, England and Wales. From Puerperal Fever. From Other Causes. 1923 3 1 1606 2.49 3.60 1922 3 3 1475 4.07 3.58 1921 3 1 1492 2.68 3.71 1920 2 3 1666 3.00 4.12 1919 — 4 1167 3.43 4.12 1918 2 1 1053 2.85 3.55 1917 1 - 1176 0.85 3.66 1916 — 1 1490 0.67 3.87 1915 — 5 1538 3.25 3.94 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 by the Board of Guardians is linked up with the work of the Public Health Department, has continued to work in a satisfactory manner. No death of a nurse-child occurred in the Ilford district during the year. The Sanitary Inspectors have visited all the houses which have been reported during the year as accommodating fosterchildren. The following is a summary of the work carried out:— Foster-children. Number of foster-children on books on 1st January, 1924 36 Number of foster-children who were notified to me during 1924 15 Number of foster-children returned to their mothers during 1924 7 Number of foster-children taken off the records for various other reasons during 1924 17 Number of foster-children on records on 31st December, 1924 27 71 Foster- Mothers . Number of foster-mothers on records on 1st January, 1924 30 Number of persons who became foster-mothers during 1924 13 Number of persons whose names were taken off records during 1924 21 Number of foster-mothers on records on the 31st December, 1924 22 Houses Visited by Sanitary Inspectors. Number of houses visited by the Sanitary Inspectors for the purpose of the Act during the year 1924 16 Number of visits made by the Sanitary Inspectors for the purpose of the Act during the year 1924 31 Number of notices served by the Sanitary Inspectors for the purpose of the Act during the year 1924 6 Work of Health Visitors.—The Ilford area is divided into seven districts, one nurse carrying out all the home visits both for Maternity and Child Welfare work and School Medical Service in each area. The following is a summary of the visits paid by the Health Visitors during 1924 :— First visits to newly-born infants 1,572 Subsequent visits to children under 1 year of age 4,441 Subsequent visits to children over 1 year of age and under 5 11,448 Visits to expectant mothers 119 Home visits for other reasons 715 Total visits paid 18,295 Supervision of Midwives.—There are 9 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 1924 it was found necessary to report one local midwife to the County Medical Officer of Health for 72 ment of the regulations of the Central Midwives' Board by attending a case without having notified her intention to practice in the district. Two unqualified women were 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 1924, 214 mothers and infants were supplied with cow's milk free, 51 with dried milk, and 11 with condensed milk. A total of 10,704¼ quarts of cows' milk, 1,108 lbs. of dried milk, and 290 tins of condensed milk was given free under the above Regulations. Infant Welfare Centres.—Owing to the overcrowded condition of the Cecil Hall Centre held on Thursday afternoon, it will be found necessary to divide the district served by the Centre into two sections, one section attending a new session arranged for Thursday morning, and the other section attending the usual afternoon session. A letter has been received from the Ministry of Health pointing out that the Centres at Seven Kings, Albert Road, and Ilford Lane are all considerably overcrowded, and the Council has now under consideration the question of establishing further Centres in order to relieve this congestion. The appointment of a new Assistant Medical Officer of Health is being considered in order to cope with the increase in the work. 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 1924 £20 7s. 9d. had been saved by 43 mothers. 73 There are now seven Infant Welfare Centres, which are held as follows :— Seven Kings (United Methodist Church), Monday afternoon. Goodmayes (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 1923. 1924. Total number of attendances of infants 18,600 20,988 First attendances 1,284 1,403 Total number of children on roll December 31st, 1924, after omission of all those who had not attended for six months 1,371 1,508 Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. First Attendances— 155 102 101 109 118 86 150 101 143 164 120 59 Subsequent Attendances1797 1384 1638 1624 1718 1186 1976 1287 1754 2301 1838 1082 333 sessions were held during the year, and the average attendance at each session was 63.02 mothers with their infants. The following are the figures for each Centre:— Sessions. Average Attendance. Seven Kings 48 68.50 Goodmayes 48 40.58 Newbury Park 48 39.73 Albert Road 47 77.53 Ilford Lane 48 70.50 Park and Cranbrook 46 91.37 Becontree 48 54.46 The supply of foods at the Centres has been continued as in previous years. 74 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 1923:— First Attendances. Subsequent Attendances, No. of expectant mOthers on the rolls , 31st December. 1924 282 564 70 1923 207 495 38 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 1924. 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 1924 188 Number of attendances of mothers 367 Number of mothers, having teeth extracted, to whom " general " anaesthetics were given 99 Number of mothers, having teeth extracted, to whom " local " anaesthetics were given 7 Number of mothers having teeth filled or otherwise treated 111 Number of mothers having dentures supplied 28 Number of mothers having dentures repaired 4 Number of mothers having part dentures supplied 3 (b) Treatment of Children under 5 years of age. Number of children treated 87 Number of attendances of children 94 Number of children, having teeth extracted, to whom " general " anaesthetics were given 72 Number of children having teeth filled or otherwise treated 21 The following are the figures for the past five years :— 1920. 1921. 1922. 1923. 1924. Number of mothers treated . 33 211 167 194 188 Number of children treated 5 25 26 34 87 75 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 1924 :— (a) Number of children for whom spectacles were prescribed and provided 28 (b) Number of children examined by Oculist for whom spectacles were not prescribed 18 The Ministry of Health in a letter dated January, 1923, sanctioned expenditure and the payment of grant for the examination and treatment of the eyes of expectant and nursing mothers where such treatment tended in the opinion of the Medical Officer of the Centre to preserve the mother's health during pregnancy and lactation. Since the middle of the year a number of nursing mothers, whose sight has become impaired, have been referred to the Council Oculist for treatment from the Infant Welfare Centres. The following are the figures for 1924 :— (а) Number of mothers for whom spectacles were prescribed and provided 13 (б) Number of mothers to whom prescriptions only were given 3 (c) Number of mothers examined by Oculist for whom spectacles were not prescribed 6 Ophthalmia Neonatorum.—During the year 1923 arrangements were made with the Metropolitan Asylums Board for the reception at their St. Margaret's Hospital of cases of Ophthalmia Neonatorum from the Ilford district, details of which were printed in the Report for 1923. No cases were treated at St. Margaret's Hospital during the year. 76 Treatment ok 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 1924. 104 belts were obtained for this purpose. A certain number of infants were brought to the Public Health Offices to receive treatment for minor ailments. Queen Mary's Hospital, Stratford, has undertaken since 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 40 children have been treated under the agreement. 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. 11 children were treated free during the past year. MATERNITY HOME. During 1924, 191 women were admitted into the Home as compared with 205 in 1923, 204 in 1922, 198 in 1921, 169 in 1920, and 139 in 1919. During the year 6 cases have been referred to the District Midwife, sufficient accommodation at the Home not being available. These cases are included in the report on the work of the District Midwife below. In February, 1923, the Committee decided 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. 77 The patients were admitted to the Home from the following' wards :— Cranbrook 27 Park 35 Seven Kings 17 North Hainault 19 Loxford 29 Clementswood 34 South Hainault 27 Three patients were admitted from outside the district on the recommendation of the Maternity and Child Welfare Committee. At the end of the year 53 cases were booked for future admission to the Home. The average number of patients in the Home per day during 1924 was 7'62, and the average length of stay of patients l4.39 days. Of the 191 cases admitted during 1924, 188 were confined in the Home, one was admitted as a case of inevitable abortion, one as incomplete abortion, and one as a case for “ induction ” of labour. Of the 188 confinements, 50 women had engaged their own doctor, 14 of these were, however, delivered by a midwife, the doctor not being present at the birth. 138 were attended by one of the midwives at the Home. It was necessary to call in a doctor in 53 of the latter cases, owing to the following complications :— (a) Ante-natal 14 Albuminuria 13 Contracted pelvis 1 (b) During labour 20 Prolonged labour 12 Incomplete abortion 2 Inevitable abortion 2 Pregnancy terminated 1 Face presentation 1 Extended breech 1 General condition of mother; post partum hæmorrhage 1 (c) After labour 11 Adherent placenta 1 (?) Placenta complete 1 Ruptured perineum 9 78 (d) For infant 8 Feebleness of infant 4 Talipes 3 Hæemetemesis 1 48 children were circumcised in the Home. There were 3 deaths of infants in the Home :— One premature child died from debility, the mother had suffered from accidental haemorrhage. It was placed in an incubator and oxygen administered contuiuously, but only lived for 40 hours. One child, 4 days old, died from congenital heart disease (the mother also had valvular disease of the heart). One premature child died from congenital heart disease (mother suffered from albuminuria). The child was white asphyxiated at birth, and only lived 17 hours. One child was stillborn, the infant being a macerated foetus. The infant mortality rate of children born in the Maternity Home during the year was 16.0 per 1,000 births, as compared with 45'7 for those born in their own homes. The figure of 45.7 has 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 is, therefore, still correct to say that if every mother in Ilford could have her baby born in a Maternity Home the deathrate of babies in Ilford could be reduced by considerably 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 :— 6 mothers were admitted free of charge. 1 mother was admitted at a fee of 10s. per week. 1 „ „ „15s. ,, 14 mothers were admitted at a fee of 20s. per week. 1 mother was admitted at a fee of 21s. per week. 5 mothers were admitted at a fee of 25s. per week. 17 ,, ,, ,, 30s. ,, 3 ,, ,, ,, 35s. ,, 2 ,, ,, „ 40s. „ 55 ,, ,, ,, 42s. ,, 7 ,, ,, „ 45s. ,, 27 ,, „ „ 50s. „ 79 1 mother was admitted at a fee of 52s. 6d. per week, 6 mothers were admitted at a fee of 55s. ,, 13 ,, ,, ,, 63s. ,, 3 ,, ,, ,, 70s. ,, 5 ,, ,, ,, 73s. 6d. ,, 3 ,, ,, ,, 80s. ,, 10 ,, „ ,, 84s. ,, 2 ,, ,, ,, 90s. ,, 7 ,, ,, ,, 100s. ,, 2 ,, ,, ,, 105s. ,, One patient paid an extra fee of 15s. for the services of the District Midwife after leaving the Home. 112 of the above patients paid 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.—The construction of the new Maternity Home is now being proceeded with, and the new building should be in occupation during the year. District Midwife.—During 1924 the District Midwife, Miss Butcher, has attended 72 cases; of these 26 were delivered by doctors and 46 by herself. A doctor was called in, however, in 16 of the latter cases for the following causes :— Hyperemesis 1 Ante-natal 6 Contracted pelvis 2 Albuminuria 3 Transverse presentation 2 During labour 4 Delayed labour 1 Miscarriage 1 Post partum hsemorrhage 2 Ruptured perineum 1 After labour 5 influenza 1 Varicose veins 1 For infant 1 Tongue tie 1 One case was transferred to the Maternity Home owing to persistent haemorrhage after the confinement. Of the infants born there were 5 stillbirths due to the following causes:— Anencephaly 1 Premature birth 2 Difficult labour 2 One infant died within a few minutes of birth from asphyxia neonatorum, a doctor being in attendance. SCHOOL MEDICAL SERVICE. 83 1. Staff.—During the year the Medical Staff continued unchanged. Owing to the unfortunate decease of Nurse Robinson a new Health Visitor and School Nurse was appointed (Miss O. Bell), one-half of whose time is allocated to School Medical work. 2. Co-ordination.— Vide Annual Report, 1920. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. 3. School Premises.— There are 15 schools, with 33 departments. One of these is a temporary school at Becontree, which since May 14th, 1923, has been accommodated in the St. Thomas' Church Institute pending the completion of a permanent school which is in course of erection. This building will be opened during the early part of 1924, and will accommodate 1,200 scholars. The schools have accommodation for 13,525 scholars, and 10,693 were actually on the rolls on December 31st, 1924. 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 1924 the number of visits made by the Medical Officers to 33 different departments of 15 schools for the purposes of routine medical inspection was 244. The number of children examined during the year, falling within the above age groups, totalled 4,007 (2,090 boys and 1,917 girls). In addition, a number of children of varying ages were presented by the Head Teachers for special medical examination, being thought by the teachers to be suffering from some ailment. During 1924, 125 84 such children (56 boys and 69 girls) were examined. 1,402 reexaminations (763 boys and 639 girls) were made at school by the doctors, to ascertain the result of treatment of defects found in the course of medical inspection. A total number of 5,534 examinations was made at the various schools during the year. 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 227 children out of a total of 4,007 (or 5.6 per cent.) were found to have nits or vermin in their hair, while only 8 (or .2 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 91. (b) Tonsils and Adenoids.— 556 children (or 13.8 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.— 18 suspected cases of pulmonary tuberculosis were detected, and these were referred to their own medical attendant or to the Tuberculosis Dispensary for observation purposes. (d) Skin Disease.— 2 cases of Scabies (Itch), 13 of Impetigo, and 17 cases of other diseases of the skin were discovered at routine medical inspection. The effect of medical inspection is strikingly shown in the reduction of the incidence of scabies. In 1920 when medical inspection was first put on a proper basis after the war period there were no less than 30 cases of itch discovered at Medical 86 Inspection and 116 at the School Clinic. These figures have been reduced to 2 cases discovered at Medical Inspection and 3 at the School Clinic. In the same way the total number of cases of Impetigo or .sores have been reduced from 40 at Medical Inspection to 13 and from 546 at the School Clinic to 243. Apart from the effect on the health of the children the saving in school attendances must have been very considerable. (e) External Eye Disease.— 12 cases of Blepharitis, i.e., inflamed eyelids, and 8 cases of Conjunctivitis were discovered. (f) Vision.— 543 children (or 13.5 per cent. of those examined) were found to be suffering from vision so defective or from such symptoms as headache, etc., as to require treatment. Further particulars of these cases will be found on page 89. (g) Ear Disease and Hearing.—11 children (or .2 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. 8 children were found suffering from a discharge from the ear, due to an old otitis media. In response to an inquiry made of the Head Teachers, the names of 302 children suffering, or who have suffered, from discharging ears or defective hearing have been referred to me for examination. These figures accentuate the need of the appointment of a Nose, Throat and Ear Surgeon, who could give the same attention to the ears of the school children as is now given by the Oculist to their vision. (h) Dental Defects.— 323 (or 8.6 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 111, Table IV. (Group IV.). 86 (i) Deformities.—14 children were found to be suffering from slight spinal curvature, and 61 from other minor deformities (such as round shoulders, flat feet, etc.), which could be corrected by special physical exercises. These cases were referred to 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 1917 :— Scarlet Fever. Diphtheria. Measles. 1957 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 1924 85 28 1026 Disinfection of all the lobbies at the public elementary schools was carried out during the year. In addition, disinfection was carried out at the following schools, after cases of infectious disease:— Becontree, Christchurch Road, Highlands, Loxford, and Uphall Schools. Tables VII. to XIII. show the incidence of each infectious disease in the Ilford Schools during 1924. (a) Scarlet Fever.— 85 cases were reported in 1924 compared with 79 in 1923. (b) Diphtheria.— 28 cases were reported in 1924 as compared with 61 in 1923. (c) Measles and German Measles.— 1,026 cases were notified from the schools in 1924 compared with 174 during 1923. (d) Chicken Pox and Whooping Cough.— 182 cases of Chicken Fox occurred in 1924 as compared with 402 in 1923; and 161 cases of Whooping Cough in 1924 as compared with 159 cases in 1923. 1,309 home visits were paid by the Health Visitors in connection with minor infectious disease cases. 87 (e) Ringworm.— No. of cases at beginning of 1924 No. of cases reported during 1924. Total. Remedied during 1924. No. of cases under observation at end of 1924. Ringworm :— Scalp 9 10 19 14 5 Body 2 2 4 4 — 11 12 23 18 5 9 school children were X-rayed at the Clinic during the year. The effect of the School Medical Service on the incidence of ringworm in the Schools is shown by the following figures. In 1908, before Medical Inspection started, there were 135 cases of Ringworm in the Schools. At the end of last year there were only 5 cases under observation. 7. Following Up.— This has been carried out in the manner described in my previous reports. During 1924, 2,825 home visits by the Nurses were paid for the purpose, and 1,402 children were re-examined by the doctors at school. 8. Medical Treatment.— (a) Minor Ailments.— The attendances at the morning Clinic during 1924 were as follows :— Number of individual children seen at the Clinic 2,158 Number of attendances of children 7,034 Number of exclusion certificates granted 3,559 Number of certificates of fitness to attend school granted 2,310 The following table shows the variety of conditions dealt with at the School Clinic during the year :— Malnutrition 3 Defective Footgear 19 Uncleanliness :— Head 143 Body 4 Skin :— Ringworm :— Head 10 Body 2 Scabies 3 Impetigo 243 Other diseases 186 88 Eye:— Blepharitis 64 Conjunctivitis 59 Keratitis 3 Corneal Ulcer 5 Corneal Opacities 2 Defective Vision and Squint 199 Other conditions 93 Ear: — Defective hearing 8 Otitis Media 6 Other Ear Diseases 84 Nose and Throat: — Enlarged Tonsils 31 Adenoids 78 Enlarged Tonsils and Adenoids 825 Other conditions 244 Mouth Breathing 137 Enlarged Cervical Glands 72 Teeth—Dental Diseases 135 Defective Speech 2 Heart and Circulation :— Organic 4 Functional 2 Anæmia 66 Debility 140 Infectious Diseases :— Scarlet Fever 3 Diphtheria 2 Whooping Cough 13 Mumps 33 Chicken Pox 8 Measles 7 Influenza 27 Colds 247 Lungs :— Bronchitis 68 Other Non-Tubercular Diseases 59 Tuberculosis :— Pulmonary :— Definite 2 Suspected 15 Non-Pulmonary :— Glands 4 Other Forms — Nervous System :— Epilepsy 3 Chorea 6 Other conditions 12 Deformities 10 Minor Injuries 168 Other Defects and Diseases 555 Total number of Ailments 3,614 89 The following table shows the number of children dealt with at the School Clinic during the past six years 1919 1920 1921 1922 1923 1924 Number of individual Children seen 962 1,763 2,009 1,730 1,829 2,158 (b) Ophthalmic Department.— During the year 1924 the School Oculist held 75 sessions for the refraction of children suffering from defective vision. Full details of the work are given in Table IV., Group II., on page 110. 637 school children were examined, 31 of these being cases from 1923. 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 :— 1918 189 1919 368 1920 464 1921 490 1922 458 1923 585 1924 637 Of the 637 cases, 502 were referred from medical inspection, and 135 from the School Clinic. The 637 children were not all suffering from grave defects of vision. The following table shows the vision in the worst eye, as tested by Snellen's Type :— 6/6 6/9 6/12 6/18 6/24 6/36 6/60 106 196 146 85 49 31 24 The children who saw (practically normal vision) were suffering from symptoms such as headaches, inflamed eyelids, etc., which rendered further examination necessary. 90 Of the 637 children examined, 510 were found to require spectacles by reason of the following defects :— Myopia 36 Myopic Astigmatism 50 Hypermetropia 176 Hypermetropic Astigmatism 160 Mixed Astigmatism 36 Anisometropia 22 Myopia with Squint 1 Squint only 1 Hypermetropia with Squint 28 Total 510 Of the remaining 127 children, 5 were suffering from the following other diseases :— Corneal Ulcers, Nebulas, etc 1 Persistent Pupillary Membrane 1 Nystagmus 3 Total 5 94 children were found not to require spectacles, and in 28 cases the lenses already in use were found not to require changing. A number of children (18) were kept under observation and were re-examined during the year, the spectacles being changed in 7 instances. Under the Education Committee's scheme 510 pairs of spectacles were provided. Of this number, 41 pairs of spectacles were provided free and 7 pairs at a reduced charge, on necessitous grounds. In addition, spectacles were renewed or repaired in 114 cases. (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 Tuberculosis cases. During the year the Dentist paid 82 visits to the schools for the purpose of inspecting the teeth of children. The extent to which dental disease is prevalent among school children is shown by the fact that of 5,678 children 91 spected by the Dentist, 3,523, or 62 per cent., were found to require treatment. Only 62 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. This is an improvement on previous years, showing that the good work of the Dentist is being recognised. In 1923, 53.3 per cent., in 1922, 41.1 per cent., in 1921, 50.6 per cent. acceptances of treatment were received. Full details of the dental work can be seen in Table IV., Group IV., on page 111. (d) Treatment of Uncleanliness— It was found necessary to deal with 38 children under the Education Act, 1921, Section 87, statutory notices being served on the parents. In 33 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 129 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. 35,453 1,497 4 Here again the effect of the School Medical Service is being steadily felt, the percentages for previous years being :— 1919 10.7 1920 10 1921 6 1922 5 1923 5 1924 4 No prosecutions were instituted during 1924 under Section 87 of the Education Act, 1921. (e) Other Ailments.— During the past year 221 children have been treated under the agreement with Queen Mary's Hospital, Stratford. 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 treatment. 92 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. 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. 51 children were treated free during the past year, and 46 at a reduced charge. In addition to the treatment of tonsils and adenoids 147 letters were given to Ilford school children, for whom hospital treatment was required, to attend at Queen Mary's Hospital. 9. Open-Air Education.— There is as yet no open-air school in Ilford. I have pointed out in my last five reports the need for such a school in this district. At the end of the year 1924 I had records of 177 children who had been examined at school and considered to be in a pre-tubercular condition. 113 of these are attending the Tuberculosis Dispensary for observation. In January, 1924, the Ilford Tuberculosis Care Association forwarded a resolution to the Education Committee, urging upon them the necessity of providing an open-air school. In January, 1924, in accordance with the Committee's instructions, I presented a report, and emphasised the desirability of establishing an open-air school in Ilford. On the 29th April, 1924, Dr. R. P. Williams and Mr. Cohen, from the Board of Education, visited Ilford, inspected the Benton Road site and expressed a favourable opinion as to the suitability of this site for the purpose of the establishment of an open-air school (with an initial accommodation of 100 children). At a meeting of the Special School Provision Sub-Committee on the 14th July, 1924, the Director of Education reported the receipt of a letter from the Board of Education notifying the preparedness of the Board 93 to entertain a proposal from the Authority for the provision on the Benton Road site of an open-air school for 100 children, and requesting the receipt in due course, of plans of the proposed premises, and estimate of the cost of erection. On the 10th November, 1924, the Special School Provision Sub-Committee recommended that the School Medical Officer, Architect and Director of Education prepare a joint report for presentation to a subsequent meeting of this Sub-Committee. A further resolution from the Ilford Tuberculosis Care Association has been received by the Education Committee, emphasising the urgency of the need for the provision of an open-air school. It is to be hoped that this scheme, which has been under consideration for the past twelve months, will materialise during the next year. 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. II. Duties and Organisation. My duties in connection with the physical training of the scholars attending the schools under the jurisdiction of the Authority continue to remain as previously, namely, of an advisory, instructional, and supervisory character as regards the whole of the physical training (inclusive of swimming instruction and organised games). 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, except the Mossford School, which has received three visits since 1st April, 1924, the date on which this School was taken over by the Ilford Local Education Authority. III. Special Features. (a) During the year, certain playgrounds, formerly gravel, have been tarpaved, and additional apparatus (e.g., iron rings on brackets) have been fixed in the playgrounds, thus providing improved facilities for the conduct of games recommended in Chapter IV. of the Board of Education's Syllabus. 94 (b) On 22nd and 23rd February, I attended the Fourth Annual Conference of the Association of Organisers of Physical Education, held at the London Day Training College, Southampton Row, W.C.I. The proceedings were of an instructive and interesting character. (c) During the year, in co-operation with the Head Teacher of Uphall Junior Department, a class in Country Dances and Singing Games was formed for the staffs of the Girls' and Junior Departments of all schools. The teachers attending the class exhibited a keen and very enthusiastic interest in the instruction. (d) During November a most successful Netball Tournament took place, all Girls' Departments competing. A pleasing feature of the tournament was the match, arranged at the end of the series, between a team of scholars selected from various schools and a team composed of members of the local teaching staff. This proved a very interesting item, which was most instructive to the large gathering witnessing the game. (e) During the swimming season, an experiment was introduced at the Baths in the form of improvised belts for breast and back stroke swimming, and floats in order to assist in the cultivation of a good style and to impress on the scholars the effects and consequent value of correct leg action. The apparatus proved of considerable value, and the experiment will be repeated during the forthcoming season. (/) School playgrounds have again been painted for the purpose of conducting organised games, in addition to general activity and agility exercises. Where necessary, new and additional apparatus has been provided. (g) 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. (h) Again I desire to record my appreciation of the great assistance rendered by the Handicraft Centre in connection with the making of apparatus for use in the games and swimming instruction. IV. Review of General Position. In conclusion, I have much pleasure in stating that the training continues on lines of steady development and progress. During the year, special attention has been drawn to the beneficial results secured by exercising the scholars in the open air on all occasions when weather conditions permit. F. J. ROBERTS, Supervising Instructor in Physical Training. 1st January, 1925. 11. Provision of Meals.— The Education (Provision of Meals) Acts, 1906-1914, has not been put into operation in Ilford. When necessary, meals are supplied from voluntary sources, and during the year I understand that no such meals were supplied. 95 11a. Defective Footgear.— During the year 16 necessitous school children, found either at routine medical inspection or at the school clinic to be wearing very defective footgear, were referred to the Director of Education. I understand that the children have been supplied with shoes from a voluntary source. 12. School Baths.— Vide Annual Report, 1920. 13. Co-operation of Parents.— Vide Annual Report, 1920. During 1924, 2,872 parents, or 71 per cent., attended the medical inspections. 14 and 15. Co-operation of Teachers and Attendance Officers.— Vide Annual Report, 1920. 16. Co-operation of Voluntary Bodies.— Since January, 1920, I have acted as 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 resume of the work done by the Society in Ilford during the past year :— Total number of cases investigated, 56, made up as follows :— (1) Of neglect 43 (28 reported from the Public Health Department, for neglecting medical advice, and 15 reported from other sources for general neglect.) (2) Ill-treatment cases 8 (3) Desertion 1 (4) Other causes 4 There was a marked improvement in the cases visited. Those that had neglected medical advice either attended the Public Health Offices for treatment or for hospital letters, or received private medical advice. 132 children (56 boys and 76 girls) were involved, 89 being of school age. In addition to this work, 283 supervision visits were paid to different cases, some of which were made to cases reported during the previous year. 96 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. (a) Physically Defective Children.— During 1924 seven 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 : — Epilepsy—Recommended for admission to a residential special school for epileptic children 1 Lateral curvature of the spine—Recommended for hospital treatment 1 Bone disease—Recommended for admission to an openair school, or for a school for physically defective children 1 Infantile Paralysis—Recommended for operative treatment at hospital 1 Friedreich's Ataxy—Recommended for attendance at an ordinary school, subject to special precautions 1 Polyarthritis—Recommended for admission to a residential special school for physically defective children 1 Cripple and nearly blind—Recommended for admission to Romford Infirmary 1 1st. Blind Children.— There are four children who are so blind as to be unable to profit by education in an ordinary school. Two of these are attending certified schools for the blind. Two cases are awaiting admission to such a school. 2nd. Deaf and Dumb Children.— There are eight children falling within this category. Of these one is deaf and dumb and seven are deaf only. Six 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). 3rd. Epileptic Children.— There are twenty-six children known to the department. Two of these children are in a certified school for epileptics, and two are awaiting admission to such an 97 institution. Of the remaining twenty-two, sixteen are attending public elementary schools in the district, and six are over 14 years of age and are not attending school. 4th. Tuberculous Children.— There are thirty-seven children suffering, or who have suffered, from Pulmonary Tuberculosis, twenty-nine of whom are attending public elementary schools, and one is attending a private school in the district; one is in a sanatorium, one is physically unfit to attend school, and five are over 14 years of age and have left school. In addition, at the end of 1924, one hundred and seventyseven children who were pre-tubercular were attending public elementary schools in the district. 5th. Other Physically Defective and Crippled Children.— There were at the end of the year, twenty-one physically defective children suitable for admission to a cripple school; seven of these cases were not attending school, ten were attending public elementary schools, two were attending private schools in the district, and two were in institutions. Of the twenty-one children mentioned, ten are twelve years of age or over. (b) Mentally Defective Children.— During 1924 I medically examined and reported upon 21 children under the Mental Deficiency (Notification of Children) Regulations, 1914, classified as follows :— Dull and Backward Children.— Total number certified 11 Recommended for Special Class for dull and backward children 7 Recommended for continuance of attendance at an ordinary elementary school 4 Feeble-minded Children.— Total number certified 9 Recommended for admission to a Residential Special School 3 Recommended for admission to a Special School (Day or Residential) 6 Imbecile Child.— Total number certified 1 Recommended for admission to a Residential Institution 1 (1) Idiots.— Idiots are, within the meaning of the Mental Deficiency Act, 1913, persons so defective in mind from an early 98 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 17 cases under the age of 16 years known to the department, 1 being notified during the present year. 6 are in a residential institution, and 11 are at home. (2) Imbeciles.— Imbeciles are persons whose mental defectiveness does not amount to idiocy, yet is so pronounced that they are incapable of managing themselves or their affairs; or in the case of children, of being taught to do so. The Authority responsible for dealing with these children is also the Essex County Council. There are 7 cases under the age of 16 years known to the department, 1 being notified during the present year, 3 are in a residental institution and 4 are at home. (3) 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 1924) 39 such cases under the age of 16 years known to me, of whom 20 are attending public elementary schools in the district, 1 is attending a private school, 11 are in a residential school, and 7 are not at school. The position as regards feeble-minded, i.e., educable mentally defective children is unnecessarily complicated by the fact that there are two legal definitions of such children. The definition in the Mental Deficiency Act, 1913, is that of " Persons in whose case there exists from birth or from an early age mental defectiveness not amounting to imbecility, yet so pronounced that they require care, supervision and control tor their own protection or for the protection of others, or, in the case of children that they, by reason of such defectiveness, appear to be permanently incapable of receiving benefit from the instruction in ordinary schools." Feeble-minded children under the age of 16 years come under the control of the Education Committee, and the latter is 99 under Section 55 of the Education Act, 1921, required to make arrangements for ascertaining " what children in their area, not being imbecile and not being merely dull or backward, are defective ; that is to say, what children by reason of mental or physical defect are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of that defect of receiving benefit from instruction in such special classes or schools as under this part of the Act may be provided for defective children." Before admission to a special school a medical certificate has to be obtained that the " child not being merely dull or backward and not being an idiot or a moral imbecile is feeble.minded within the meaning of the Mental Deficiency Act, 1913, but is not incapable, by reason of mental defect, of obtaining benefit from instruction in a special school or Class under Section 56 of the Education Act, 1921." The certificate is, however, endorsed that it must not be used as evidence of feeble.mindedness within the meaning of the Mental Deficiency Act, 1913, after the child reaches the age of 16 years. The position arises therefore:. (1) That there are two definitions of feeble.minded persons— for those over the age of 16 years and those under. In those under 16 the question of educability is the sole factor to be considered. (2) That even for persons under the age of 16 years the definitions in the two Acts differ. In the Mental Deficiency Act the lack of educability has to be a permanent one. (3) Yet the certificate has to be given under the Mental Deficiency Act, 1913, and not under the Education Act, 1921. (4) The certificate, although given under the Mental Deficiency Act, 1913, is not allowed to be in force after the age of 16. It would appear to be very much better to apply the " social " definition to all ages, and to define a mentally defective or feebleminded person whether under or over the age of 16 years as one 100 who from mental defectiveness existing from birth or from an early age, not amounting to imbecility, will throughout his life require care, supervision and control, for his own protection or for the protection of others. At the present time many children enter special schools, being at the time ineducable in ordinary schools. They improve with special instruction and resume their attendance at ordinary schools. Such children are not mentally defective under the Mental Deficiency Act, 1913, yet they have been so within the meaning of Section 55 of the Education Act, 1921. The mentally defective child in the meaning of the Mental Deficiency Act never improves to this extent. When he reaches the age of 16 years, he permanently requires assistance from others, he is a failure socially, and frequently morally. It would appear, therefore, desirable to have another class of certificate for children requiring special education under Section 55 of the Education Act, 1921, which would be entirely different from that of the Mental Deficiency Act, 1913, and would not cause any stigma to be attached to the child. The special schools would then be worked in connection with dull and backward classes, and there would be no difficulty in the transference of such children to ordinary schools or classes if improvement from late development of the mental faculties took place. On the other hand, the mentally defecti\e child within the meaning of the Mental Deficiency Act would not be allowed to proceed from a special school into the world to produce illegitimate children, or be arrested for moral offences, and be generally a danger to society. In Ilford the tendency to notify children as mentally defective who may only possibly be mentally retarded, has been avoided, and the figures in this district are low. It will be seen, however, that there are 27 children for whom special education is required and for whom none has been provided. A scheme for adapting the Newbury Park Junior School for this purpose was held up by the Board of Education from reasons of economy and has not been proceeded with. 011 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 1924 it was found that 161 children were employed out of school hours. 10 children were submitted to me for medical examination under Section III., paragraph 4, of the Byelaws under the Provisions of Employment of Children Act, 1903, with the following result :— Medically fit 8 Medically fit subject to obtaining treatment 2 During 1924 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 928 children, as follows:— Boys. Girls. Total. Placed locally by Employment Exchange for the period January, 1924, to 30th September, 1924 332 288 620 Placed locally by Juvenile Employment Bureau for the period October, 1924, to 31st December, 1924 91 53 144 423 341 764 Placed in London by Employment Exchange for the period January, 1924, to 30th September, 1924 50 69 119 Placed in London by Juvenile Employment Bureau for the period October, 1924, to 31st December, 1924 23 22 45 73 91 164 Fresh Registrations received by Employment Exchange for the period January, 1924, to 30th September, 1924 506 491 997 Fresh Registrations received by Juvenile Employment Bureau for the period October, 1924, to 31st December, 1924 113 85 198 619 576 1195 102  Boys. Girls. Total. Re.Registrations received by Employment Exchange for the period January, 1924, to 30th September, 1924 297 242 539 Re.Registrations received by Juvenile Employment Bureau for the period October, 1924, to 31st December, 1924 61 25 86 358 267 (fc5 22. Miscellaneous.—In accordance with the Education Committee's Regulations, the undermentioned bursars, student. teachers and teachers were medically examined and reported uoon dunne the vear bv the School Medical Officer:— Bursars 11 Student.teachers 11 Newly.appointed teachers 22 Teachers absent through illness 2 Total 46 Re.examinations:— Bursars 4 Student.teachers 5 Newly.appointed teachers 7 Total 16 23. Incidence of Goitre.—On the 12th March, 1924, the Chief Medical Officer to the Board of Education circularised School Medical Officers in order to obtain more accurate information as to the incidence of goitre throughout the country. As one means of obtaining the desired information, it was suggested that a record of the result of the examination for this purpose of all children (both boys and girls) on uniform lines on the occasion of routine examination at the age of 12 years would be valuable. The following table shows the number of children examined in the Ilford district, and the result of the Medical Officers' findings:— INCIDENCE OF GOITRE. Sex. Total No. of children examined. Slight enlargement. Marked enlargement. So enlarged as to suggest that treatment may be required. No. found Percentage No. found Percentage No. found Percentage Boys 626 21 33 — — — — Girls 622 86 13.8 15 24 4 6 103 Table I.—Return of Medical Inspections. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 1256 Intermediates 1449 Leavers 1302 Total 4007 Number of other Routine Inspections Nil. B.—Other Inspections. Number of Special Inspections— Medical Inspection at School 125 At School Clinic 2158 Number of Re.inspections— Medical Inspection at School 1402 At School Clinic 7034 Total 10719 104 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1924. 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 2 3 . Uncleanliness— Head 227 . 143 . Body 8 . 4 . Skin Ringworm— Scalp — . 10 . Body — . 2 . Scabies 2 3 . Impetigo 13 — 243 . Other Diseases (non.Tubercular) 17 . 186 . Eye Blepharitis 12 . 64 . Conjunctivitis 8 . 59 . Keratitis — . 3 . Corneal Ulcer . . 5 . Corneal Opacities — 2 . Defective Vision 543* . 190 . Squint 14 . 9 . Other Conditions 11 . 93 . Ear 'Defective Hearing 11 2 8 . Otitis Media 8 1 6 . Other Ear Diseases 29 3 84 . Nose and Throat Enlarged Tonsils only 159 9 31 . Adenoids only 151 5 22 . Enlarged Tonsils and Adenoids 246 11 34 . Other Conditions 29 1 244 . Enlarged Cervical Glands Non.Tubercular) 3 — 72 . Defective Speech 5 — 2 . Teeth—Dental Diseases 323 — 135 . Heart and Circulation Heart Disease— Organic 15 4 4 . Functional 11 7 2 . Anaemia 50 — 66 . Lungs . Bronchitis 16 1 68 . Other Non.Tubercular Diseases 17 5 59 _ Tuber. culosis Pulmonary— Definite — — 2 . Suspected 18 11 15 8 Non.Pulmonary— Glands 2 — 4 — Spine — — — — Hip 1 — — — Other Bones and Joints — — — — Skin . — . . Other Forms 1 — . . Nervous System Epilepsy 8 — 3 . Chorea 6 1 e . Other conditions 1 — 12 — Deformities Rickets 1 — 3 . Spinal Curvature 14 — 5 — Other Forms 20 — 2 Other Defects and Diseases 178 . 1054 — * JO0 of these cases saw § but were suffering from other conditions, rendering refraction advisable 105 Table II. B.—Number of Individual Children Found at Routine Medical Inspection to Require Treatment (excluding. Uncleanliness and Dental Diseases). Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (1) (2) (3) (5) Code Groups:— Entrants 1256 474 374 Intermediates 1449 567 391 Leavers 1302 571 43.8 Total (code groups) 4007 1612 402 Other routine inspections — — — 106 TABLE III.—Return of all Exceptional Children in the AREA in 1924. 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 — — — 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 1 2 Attending Public Element'ary Schools . . . At other Institutions (private school) 1 . 1 At no School or Institution — 1 1 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 2 4 6 Attending Public Elementary Schools . . . At other Institutions — . — At no School or Institution . — (ii) Suitable for training in a School or Class for the partially deaf Attending Certified Schools or Classes for tne Deaf . . . Attending Public Elementary Schools 1 1 2 At other Institutions — — — At no School or Institution — — — Mentally Defective Feeble Minded (cases not notifiable to the Local Control Authority) Attending Certified Schools for Mentally Defective Children 5 6 11 Attending Public Elementary Schools 15 5 20 At other Institutions — — — At no School or Institution 4 3 7 Notified to the Local Control Authority during the year Feeble Minded — — — Imbeciles — 1 1 Idiots 1 — 1 107 TABLE III—continued. Boys Girls. Total. Epileptics Suffering from severe Attending Certified Special Schools for Epileptics 1 1 2 epilepsy In Institutions other than Certified Special Schools . . . Attending Public Elementary Schools . . . At no School or Institution .— 2 2 Suffering from Attending Public Elementary Schools 10 6 10 lepsy which is not severe At no School or Institution 3 3 6* 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 . infectious but active pulmonary and glandular Tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board . . . At Certified Residential Open. Air Schools . . . At Certified Day Open . Air Schools . . . At Public Elementary Schools At other Institutions 17 12 29 At Private School . 1 1 At no School or Institution 5 1 6 Delicate children (e.g., pre. or latent tuberculosis, malnutrition, debility,anaemia, etc.) At Certified Residential Open. Air Schools . . . At Certified Day Open . Air Schools . . . At Public Elementary Schools At other Institutions 90 87 177 At no School or Institution . . . 108 TABLE III.—continued. Boys. Girls. Total Physically Defective.—cont. Active non. pulmonary Tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board . . . At Public Elementary Schools — — — At other Institutions —. — — At no School or Institution — — — Crippled Children (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 . 1 1 At Certified Day Cripple Schools... At Public Elementary Schools 6 4 10 At other Institutions 1 — l At no School or Institution 4 3 7 At Private School 2 . 2 * These cases are over 14 years of age. 109 Table IV.—Return of Defects Treated During the Year ended 31st December, 1924. Treatment Table. Group I.—Minor Ailments (excluding; Unclean lines®, 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) 9 1 10 Ringworm (Body) 2 . 2 Scabies 5 . 5 Impetigo 243 1 244 Other skin disease 186 5 191 Minor Eye Defects (External and other, but excluding cases falling in Group II). 226 14 240 Minor Ear Defects 98 23 121 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 774 798 1572 Totals 1543 842 2385 110 Group 11.—Defective Vision and Scjuimt (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 theAuthor. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report). 637 39 20 696 Other Defect or Disease of the Eyes (excluding those recorded in Group I). — — — — Total 637 39 20 690 Total number of children, for whom spectacles were prescribed :— (a) Under the Authority's Scheme 510 (b) Otherwise 59 Total number of children who obtained or received spectacles:— (a) Under the Authority's Scheme 510 (b) Otherwise 59 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority s Scheme, in Clinic or Hospital. Bv Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 221 102 323 89 412 Ill Group IV.—Dental Defects. (1) Number of children who were:— (a) Inspected by the Dentist: Aged 5 494 Total 5477 6 675 7 1039 Routine age groups 8 963 9 854 12 729 13 577 14 146 Specials 201 Grand total 5678 (b) Found to require treatment 3523 (c) Actually treated 2202 (d) Re.treated during the year as the result of periodical examination 834 (2) Half.days devoted to Inspection 82 Total 434 Treatment 352 (3) Attendances made by children for treatment 3149 (4) Fillings Permanent teeth 990 Total 2,379 Temporary teeth 1389 (5) Extractions Permanent teeth 526 Total 4079 Temporary teeth 3553 (6) Administrations of general anaesthetics for extractions 1416 (7) Other operations (Permanent teeth, 127) Total 203 (Temporary teeth, 76) 112 Group V.— Uncleanliness and Verminous Conditions. (i) Average number of visits per school during' the year by the School Nurses 8 (ii) Total number of examinations of children in the Schools by School Nurses 35453 (iii) Number of individual children found unclean 1497 (iv) Number of children cleansed under the arrangements made by the Local Education Authority 38 (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil. (b) Under the School Attendance Byelaws Nil. 114 115 Tabt.e V.—Table showing number of Children Medically Inspected at various Schools during 1924. Ages—Years. 5—6 6—7 7—8 8—9 9—10 10—11 11—12 12—13 13—14 14—15 Totals. SCHOOLS. Boys Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. ROUTINE. Becontree 86 76 8 4 5 6 27 24 . . . . . . . . . . . . 126 110 Barkingside 25 17 — 1 1 — 51 16 . . 6 — — — 37 15 . — — — 120 49 Chad well 4 8 — — — — 18 14 1 — . 1 1 . 23 20 — — — — 47 43 Christchurch 50 38 — — 6 1 65 66 9 4 1 4 3 1 55 69 1 — — — 190 183 Cleveland 68 60 17 7 4 3 66 64 . 3 2 2 1 2 61 60 1 — — — 220 201 Downshall 53 58 3 1 8 2 77 77 2 1 4 6 3 5 71 64 . 1 — — 221 215 Goodmaves 46 43 10 4 6 6 77 90 14 7 23 15 18 12 92 122 1 15 — — 287 314 Highlands 53 51 5 7 4 4 27 34 2 11 9 7 1 2 46 30 3 — 1 — 151 146 Little Heath 8 3 1 — 1 — 10 8 1 — — 1 — — 6 14 1 — — — 28 26 Loxford 52 54 1 . 9 7 72 61 . . 2 . — — 43 49 — — — — 179 171 Newbury Park 25 25 — 2 3 3 51 42 — 2 2 2 1 1 47 37 — — — — 129 114 Roman Catholic 17 8 3 8 — — 24 24 3 2 1 1 — — 32 23 1 1 — 1 81 68 South Park 40 38 6 2 1 4 63 56 6 4 2 1 56 61 6 2 — — 180 168 Uphall Road 30 18 2 0 — 3 29 30 — — 3 2 — — 39 30 — — — — 103 85 Valentines 8 10 1 — 2 — 11 5 — — 3 1 — — 3 8 — — — . 28 24 Total 565 507 57 38 50 39 668 611 32 30 62 46 no 24 611 602 14 19 1 1 2090 1917 SPECIALS. Becontree . . 2 . . . . . . . . . . . . . . . . . 2 — Barkingside . . — — — — . 1 — — 1 2 — — — — 2 — — — 3 3 Chadwell . . — — — — 3 . . — — 2 — — — — — — — — 3 2 Christchurch . . 2 8 — . 4 3 3 . . . — — — 1 1 — — — 10 7 Cleveland . 1 . — — 2 1 4 . . . 5 — — — 1 — — — — 1 13 Downshall . . 1 — — — . . . 1 . . — — — 1 — — 1 — 2 2 Goodmayes 2 1 — 1 — 2 — 4 — 6 4 1 — — — 1 3 — — — 9 16 Highlands 4 a 3 2 . — 1 . . . . . . 1 . . . . . . 8 6 Little Heath — — — — — — 2 . — . . . 2 — — 5 — — — — 4 5 Loxford 2 — — 4 — . 1 . . . . 3 . . . . . . — 1 3 8 Newbury Park — — 4 1 — — — 1 — 1 4 . — 2 — — — — — — 8 5 Roman Catholic . . . . . . . . . . . . . . . . . . . . — — South Park . 1 . — 1 — . . . . . . — — — — — — — — 1 1 Uphall Road — — — . . — . 1 — — . — . — — — — — — — — 1 Valentines 1 — — — — — 1 . . . . . . . . . . . . . 2 — Total 9 6 12 11 1 4 13 14 3 8 9 13 2 3 — 9 6 — 1 1 56 69 Total Number of Children Examined. 4132. Grand Total 2146 1986 116 117 Table VI. A.—Table Showing the Average Heights and Weights of the BOY S 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 j (in inches). Average Weight (in pounds). No. of Children j 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 (in pounds). No. of Children Examined. Average Height (In inches). Average Weight (in pounds). No. of Children Examined. 1 Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds'. No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). Barkingside 25 41.81 39.82 - - - l 46.45 45.76 51 49.37 52.14 - - - 6 53.93 69.52 - 37 54.60 73.04 — — — Becontree 86 42.75 40.48 8 44.05 48.00 5 46.77 48.62 27 47.59 52.58 — — — — — — — — — — — - — - - Chadwell 4 41.73 37.81 — — — — — — 18 49.48 54.56 1 50.78 58.08 — — — 1 53.14 73.04 23 56.10 71.06 — — — Christchurch Rd. 50 42.04 40.48 — — — 6 47.24 51.70 65 48.03 52.14 9 52.20 61.38 1 53.54 68.64 3 54.37 65.78 55 56.37 73.48 1 57 24 82 50 Cleveland Rd 68 42.51 40.92 17 45.51 45.32 4 45.66 45.98 66 48.62 52.80 - — — 55.90 64.68 1 58.26 79.42 61 55.86 75.46 1 57.08 78.32 Downshall 53 42.12 40.70 3 42.04 37.18 8 47.12 51.70 77 48.81 53.90 2 49.21 52.80 4 52.75 54.56 3 54.33 77.88 71 55.90 73.92 58.66 . Goodmayes 40 42.08 40.48 10 45.47 47.74 6 47.00 45.76 77 47.36 52.14 14 49.60 56.10 23 51.81 66.44 18 53.93 68.42 92 55.03 72.60 57.08 Highlands 53 42.12 39.82 5 44.48 43.78 4 46.85 49.72 27 50.00 58.30 2 51.57 63.58 9 53.14 66.00 1 57.48 83.60 46 54.70 71.06 8 57.08 74.36 Little Heath 8 41.10 37.40 1 41.92 40.48 1 47.36 52.58 10 47.16 48.18 1 51.18 54.12 — — — - - - 6 53.93 66.44 58.26 75.24 Loxford 52 42.51 41.14 i 44.88 46.20 9 46.85 50.60 72 48.42 53.24 — — — - 53.93 68.86 - - - 43 55.01 75.24 - - Newbury Park 25 42.12 40.92 — — — 3 46.96 47.74 51 48.30 51.26 — — - 2 50.00 55.00 - 54.29 69.30 47 53.30 73.26 - - Roman Catholic 17 41.45 36.74 3 44.29 34.10 — — — 24 49.33 53.24 3 51.81 55.66 1 48.81 53.24 - 32 55.27 73.70 59.25 83.33 South Park 40 41.69 39.16 6 44.52 43.78 1 47.55 53.90 63 47.48 53.02 — — — 6 54.09 68.20 2 5413 70.51 56 56.77 77.88 58.11 85.14 UphallRd. 30 41.73 38.28 2 42.51 37.40 — — — 29 47.95 51.04 — — — 52.75 62.48 — — — 39 54.68 70.18 Valentines 8 43.50 38.50 1 42.91 45.32 2 48.03 47.52 11 48.23 53.24 — — — 52.70 63.04 — — - 3 57.08 Average Heights and Weights of Ilford Children 565 42.63 40.48 57 43.89 40.48 50 46.92 49.50 668 51.06 52.58 32 51.88 58.74 62 52.24 64.90 30 55.23 71.94 611 55.64 73.04 14 58.14 83.82 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). 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 77.40 118 119 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 I 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. I 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 17 41.20 38.94 1 43.11 45.32 16 47.67 51.70 - - - - - - - - - 15 54.33 67.10 - - - Becontree 71 42.36 38.28 4 44.01 40.48 6 47.55 48.18 24 48.11 50.38 — — — — — — — — — — — — — — — Chadwell 8 42.71 38.94 — — — — — — 14 48.77 47.96 — — — l 51.96 55.88 — — — 20 56.73 71.94 — — — Christchurch Rd. 38 42.20 39.82 — — 1 47.40 49.94 66 48.07 50.60 4 50.07 54.46 4 51.96 63.80 1 55.35 68.04 09 55.74 74.58 — — — Cleveland Rd. 60 41.73 38.94 7 44.09 43.78 3 46.06 48.18 64 47.63 49.28 3 49.60 54.78 2 51.53 63.36 2 52.75 74.36 60 50.69 80.24 — — — Downshall 58 42.12 38.72 1 44.88 43.78 2 48.03 53.68 77 48.52 52.80 1 50.78 53.02 6 53.07 63.14 5 56.29 70.40 64 55.66 79.64 1 64.17 97.24 Goodmayes 48 42.32 41.30 4 45.59 46.86 6 47.79 54.78 90 48.30 51.70 7 49.52 57.20 15 52.36 64.68 12 54.80 75.02 122 55.82 76.78 15 58.54 86.02 Highlands 51 42.51 39.60 7 44.48 41.36 4 47.24 47.52 34 18.81 54.34 11 51.18 60.06 7 53.54 67.32 9 56.29 71.72 30 56.69 74.80 — — — Little Heath 3 42.00 37.88 — 8 47.95 51.48 — — — 1 48.81 54.78 — — — 14 56.85 71.06 — — — Loxford 54 41.33 38.06 — — — 7 44.88 45.32 01 48.03 52.30 — — — — — — - — — 49 55.90 74.14 — — — Newbury Park 25 42.51 38.94 2 44.48 40.26 3 48.03 45.32 42 48.03 51.04 2 54.72 71.00 2 53.54 58.52 I 51.96 55.44 37 56.29 71.94 — — — Roman Catholic 8 42.40 42.46 8 44.75 39.38 24 49.44 52.80 2 49.76 53.08 1 49.72 53.46 — — — 23 56.22 09.08 1 58.26 80.08 South Park 38 42.36 39.38 2 44.88 45.10 4 47.67 51.48 56 48.54 51.04 — — — 4 53.54 65.56 1 5236 60.72 61 56.22 76.34 2 54.92 08.80 Uphall Rd. 18 41.33 36.96 9 42.32 35.42 3 45.45 44.44 30 47.51 47.74 — — — 2 51.95 55.60 — — — 30 55.78 72.82 — — — Valentines 10 43.93 41.14 — — — — — — 5 48.42 52.36 — — — 1 50.38 64.24 — — — 8 56'85 76.12 — — — Average Heights and Weights of Ilford Children 507 41.26 3916 38 44.64 43.12 39 46.96 48.84 611 47.24 49.94 30 50.59 57.20 46 52.44 62.48 24 54.84 72.38 602 56.23 75.24 19 58.58 85.58 Ages. Ages. Anthropometric Standard (Girls). 5 Years. 6 Years. 7 Years. 8 Years. 9 Years. 10 Years. 11 Years. 12 Years. 13 Years. Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) 40.44 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 73.80 56.81 80.37 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, 1924. SCHOOLS. Number on Roll. DISEASES AND CONTACTS Scarlet Fever. Diphtheria. Measles. and German Measles. Chicken Pox. Whooping Cough. Mumps. Enteric Fever. Ringworm. Totals. 1924. Totals 1923. Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Conflicts Barkingside 309 - - - 1 1 3 25 4 7 9 - - - - - 33 17 9 4 Becontree 471 2 2 1 2 68 23 3 - 9 1 1 - - - 1 85 28 48 12 Chadwell 221 - 1 — 2 13 10 22 11 - - - - - - 2 37 24 3 3 Christchurch 1045 11 17 1 4 121 20 9 3 29 6 5 - - - 1 180 50 183 Cleveland Road 1202 4 10 6 10 109 65 7 11 10 7 1 - - - 1 138 103 80 37 Downshall 1245 7 12 3 6 63 6 5 - 1 - - - - 1 107 30 340 85 Goodmayes 1336 2 4 2 9 61 17 9 8 - - 6 1 - - 1 81 39 122 88 Highlands 870 3 3 - 3 126 33 14 8 21 1 7 1 - - 1 172 49 136 60 Little Heath 120 1 2 1 — 17 10 3 - - - 8 - - - - 30 12 72 16 Loxford 876 12 12 - 4 114 37 17 2 13 9 51 - 1 - - 208 57 108 33 Newbury Park 511 6 12 - - 69 14 1 2 1 1 - - - - - 82 29 13 3 Roman Catholic 406 - 1 1 2 37 10 7 1 12 - 22 1 - - - 79 15 33 12 South Park 1155 10 12 3 2 107 26 24 8 19 1 2 - - - 1 166 49 95 46 Uphall 796 5 13 1 6 83 48 14 7 35 6 9 - - 147 80 125 63 Valentines 130 — — 1 2 34 10 1 — — — 1 — 1 38 12 1 1 County High School — 1 3 2 1 - - - - - - - - - - - 3 4 - 6 Private Schools — 18 11 6 5 3 - - - - - - - - - - 27 16 8 11 Totals 10693 85 115 28 59 1026 332 182 70 161 35 120 3 1 - 10 1613 614 1376 563 Encephalitis Lethargica—Loxford School, 1 contact. Influenza From 11th February to 31st May, 1924, 835 cases of school children reported as suffering from Influenza were notified to me by the Head Teachers of the various departments of the Public Elementary Schools. 120 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, 1921. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. October. Nov. Dec. Total 1924 Total 1923 Cases. Conts. Cases. Conts. Cases Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Caess. Conts. Cases. Conts. Cases. Conts. Barkingside 309 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Becontree 471 1 1 - - - - - - - - - - - - - - - - - - - - 1 1 2 2 7 3 Chadwell 221 — — — — — — - - — - - - - - - - - - - 1 - - - - - 1 - - Christchurch 1045 - - - - - 1 - 1 - - - - 1 - - - 1 3 7 8 2 3 3 1 14 17 4 3 Cleveland Road 1202 1 3 — — — — — — — — — 1 1 1 — — — - 1 — 1 4 — 1 4 10 8 12 Downshall 1245 1 2 2 3 1 — - 2 1 4 1 1 - - 1 - - - - - - - - - 7 12 13 8 Goodmayes 1336 1 2 - 2 - - - - - - - - - - - - 1 - - - - - - - 4 4 18 29 Highlands 870 - - 1 - - - - - - - - - - - - - - - - 1 1 2 1 - 3 8 9 7 Little Heath 120 — — — — — — - - - - - - - - - 1 2 - - - - - - 1 2 - - Loxford 876 — — — — — - - - 1 1 7 8 2 - 2 2 - - - - - - - 1 12 12 6 11 Newbury Park 511 - 1 - - - - - - 1 - - - - - 1 3 2 6 1 1 1 1 - - 6 12 - - Roman Catholic 406 - - - - - - - - - - - - - - - - - - - 1 - - - - - 1 2 1 South Park 1155 1 2 - - 2 4 - - 4 - - 2 1 4 - - - - - - - - - - 10 12 5 6 Upall 796 - - - - - - - 1 1 1 - 5 1 5 - - - - 1 1 - - - - 5 13 3 4 Valentines 130 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 County High — — 1 — — — — - — — — - 1 — — 1 — — - - 1 — - — - 1 3 - 3 Private Schools - 1 3 1 - 2 - l — 4 2 1 1 1 1 3 1 — 1 2 2 — - 2 — 18 11 4 7 Totals 10693 6 15 4 5 5 5 l 4 12 8 13 19 7 11 8 6 5 12 12 16 5 10 7 4 85 115 79 95 121 122 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, 1924. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total 1924. Total 1923 Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cjjses. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 309 - 1 - - - - - - - - - - - - - - - - - - - - - - - 1 2 - Becontree 471 - - - 2 - - - - - - - - - - - - - - - - - - - - 1 2 1 - Chadwell 221 _- — — — — - - 1 - - - 1 - - - - - - - - - - - - - 2 - 4 Christchurch Road 1045 - - - - - - - - - 1 1 - - - - - - 3 - - - - - - 1 4 1 6 Cleveland Road 1202 3 4 2 2 - - - - - - - - - - - - 1 2 - - - 2 - - 6 10 5 3 Downshall 1245 - - - - - - - - - - - - 1 2 1 4 1 - - - - - - - 3 6 6 14 Goodmayes 1336 — 5 - - - 1 - - - - - - - - - - - - 1 2 - - 1 1 2, 9 22 32 Highlands 870 — — — — — — — — — 1 — 1 — — — — - - — - - - - 1 - 3 2 1 Little Heath 120 - — 1 - - - - - - - - - - - - - - - - - - - - - 1 - - 2 l.oxford 876 - - - - - - - 2 - - - - - - - - - - - 2 - - - - - 4 2 1 Newbury Park 511 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Roman Catholic 406 - - - - - - 1 2 - - - - - - - - - - - - - - - - 1 2 1 1 South Park 1155 - — — — — — 1 1 - — — - — - - - 1 - - - - - 1 1 3 2 6 11 Uphall 796 1 4 — - - - - - - - - 2 - - - - - - - - - - - - 1 6 9 9 Valentines 130 - - - - - - - - - - - - - - - - - - - - 1 2 - - 1 2 - - County High - - - - - 1 1 - - - - - - - - - 1 - - - - - - - 2 1 - 3 Private Schools - 1 1 1 - - - l 1 - - - - — — 1 — — — 1 2 — 1 1 — 6 5 4 4 Totals 10693 6 15 4 4 — 2 4 7 — 2 1 4 1 2 2 4 4 5 2 6 1 5 3 3 28 59 61 91 123 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, 1924. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total 1924 Total 1923 Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts Cases.. J Conts. J Cases. Conts. Cases. Conts. Cases. Conts Cases. Conts. Barkingside 309 - - - - 1 1 - 1 - l - - - - - - - - - - - - - - 1 3 - - Becontree 471 1 — — - 3 1 10 3 52 18 2 1 — — - - - - - — - - - — 68 23 3 1 Chadwell 221 — — 3 — 1 — - 3 8 6 1 1 - - - - - - - - - - - - 13 10 1 4 Christchurch Road 1045 3 — 55 5 51 13 3 - 9 2 - - - - - - - - - - - - - - 121 20 1 - Cleveland Road 1202 — — — 2 9 23 18 4 45 19 29 11 7 3 1 2 - - - - - - - 1 109 65 2 — Downshall 1245 2 — 4 — 5 1 2 2 26 1 18 1 5 1 - - - - 1 - - - - - 63 6 114 25 Goodmayes 1336 1 — 37 9 18 8 — — 4 - — — 1 — — - — — - - - - - - 61 17 36 12 Highlands 870 4 1 35 7 43 7 13 4 21 11 8 2 1 — — - - — - — 1 1 — — 126 33 4 1 Little Heath 120 — — — - — — 2 — 1 - 10 5 4 5 — — — — — - - — — — 17 10 - - Loxford 876 3 — 26 6 43 14 8 2 12 3 12 5 10 7 — — — — - - - - - — 114 37 3 — Newbury Park 511 2 — 39 4 28 10 - — — — — — — — — — — — — — — — — — 69 14 — — Roman Catholic 406 — — 18 8 16 2 — — 1 - — — 2 — - — — — — — - — — — 37 10 1 — South Park 1155 16 6 42 11 6 - 8 2 11 3 16 4 7 - 1 - - - - - - - - - 107 26 7 3 Uphall 796 8 4 39 23 7 4 — — 6 2 14 9 8 6 1 - - - - - - - - - 83 48 2 — Valentines 130 31 7 3 3 - - - - - - - - - - - - - - - - - - - - 34 10 - - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - - Private Schools - - - 3 - - - - - - - - - - - - - - - - - - - - - 3 - - - Totals 10693 71 18 304 78 231 84 64 21 196 66 110 39 45 22 3 2 — — 1 — 1 1 — 1 1026 332 174 46 124 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, 1924. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total, 1924. Total, 1923. 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 300 1 - - - - - - - - - - - 3 1 - - - - 1 - 3 1 17 2 25 4 5 3 Becontree 471 1 - - - 1 - - - - - - - - - - - 1 - - - - - - - 3 - 25 8 Chadwell 221 — — 1 1 9 5 5 l 4 3 - - - - - - - - - - - - 3 1 22 11 - - Christchurch Road 104 8 2 1 1 - - - - - - - - - - - - - - - - - - - - 9 3 56 46 Cleveland Road 1202 1 — 1 - 2 1 1 2 1 8 1 - - - - - - - - - - - - - 7 11 17 13 Downshall 124 15 5 5 - 6 - - - - - - - - - - - - - - - - - - - 26 5 39 22 Goodmayes 1336 2 — 1 - 4 4 - 2 1 - - - 1 2 - - - - - - - - - - 9 8 6 8 Highlands 870 — — 2 3 4 1 2 2 5 1 - - - - - - 1 1 - - - - - - 14 8 102 51 Little Heath 120 3 - - - - - - - - - - - - - - - - - - - - - - - 3 - 1 1 I.oxford 876 8 4 1 2 - - - - - - - - - - - - - 1 1 1 - 1 - 17 2 43 11 Newbury Park 511 - - - - 1 1 - - - - - - - - - - - - - 1 - - - - 1 2 3 1 Roman Catholic 406 1 - - - - - - - - 1 - - - - - - - - - - 2 - 4 - 7 1 6 3 South Park 1155 12 3 7 4 1 - — - - - 1 - 2 1 - - - - - - - - 1 - 24 8 26 19 Uphall 796 7 2 2 3 — - 2 2 2 - - - - - - - 1 - - - - - - - 14 7 73 49 Valentines 130 - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 10693 59 12 25 13 30 12 10 9 13 13 2 — 6 4 — — 3 1 2 2 6 1 26 3 182 70 402 235 125 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, 1924. SCHOOLS. Number on Roll. Jan. Feb. March April. May. June. July. August. Sept. Oct. Nov. . Dec. Total, 1924. Total, 1923. 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. V Barkingside 309 - - - - - - - - - - 3 2 3 7 - - 1 - - - - - - - 7 9 - 1 Becontree 471 — — — — - — — — - - - - - - - - 1 - - - 2 - 6 1 9 1 7 - Chadwell 221 — — — — — — — - — - - - - - - - - - - - - - - - - - 1 - Christchurch Road 1045 — — — — 1 — — — — — — — 1 - 1 - 4 - 6 1 10 4 6 1 29 6 32 15 Cleveland Road 1202 — — — — 2 1 — — — — — — 6 - - - 1 2 - - - - 1 4 10 7 10 7 Downshall 1245 — — — — — — — — — - 1 - - - — - - 1 - - 2 - 2 - 5 1 8 1 Goodmayes 1336 - - - - - - - - - - - - - - - - - - - - - - - - - - 17 7 Highlands 870 — — — — — — — — — — — — - — — — - - 2 — 6 — 13 1 21 1 3 - Little Heath 120 - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - Loxford 876 - - 1 - - - - - - - - - - - - - 1 — 3 1 4 1 4 - 13 2 59 11 Newbury Park 511 — - - - - - - - - - - - - - - - 1 1 — — — — — - 1 1 2 1 Roman Catholic 406 - - - - - - - - - - - - - - - - - - - - - - - - 12 - 7 - South Park 1155 — — — — — — 1 — — — 11 — - — 4 — 3 1 — — - — - - 19 1 9 7 Uphall 796 — — 3 1 — — — — — — — — 11 2 — — — — 6 — 9 2 6 1 35 6 3 2 Valentines 130 — - - - - - - - - - - - - - - - - - - - - - - - - - - - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total 10693 — — 4 1 3 1 1 — — — 15 2 21 9 5 — 12 5 17 2 40 7 43 8 181 35 159 54 126 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, 1921. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total, 1924. Total, 1923. 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 309 - - - - - - - - - - - - - - - - - - - - - - - - - - 2 - Becontree 471 - - - - 1 - - - - - - - - - - - - - - - - - - - 1 - 3 - Chadwell 221 - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - Christchurch Road 1045 1 - - - - - - - - - 1 - 1 - - - - - 1 - 1 - - - 5 - 87 8 Cleveland Road 1202 - - - - 1 - - - - - - - - - - - - - - - - - - - 1 - 38 2 Downshall 1245 — — — — — — - — — - 1 - - - - - - - 1 - - - - - 2 - 156 15 Goodmayes 1336 1 — — 1 2 — — — 2 — I — — — — - — - - — - - - 6 1 22 - Highlands 870 1 — — — 1 — — — 1 — 3 — - — — — — — - — 1 1 — - 7 1 15 - Little Heath 120 4 - - - 2 - - - 2 - - - - - - - - - - - - - - - 8 - 1? 2, Loxford 876 2 — — — 3 — 11 — 14 — 3 — - — — — - — 11 — 4 - 3 - 51 - 52 9 Newbury Park 511 1 — — — — — 1 — — — — - — — — — — — - — 2 — 1 - 5 - 3 - Roman Catholic 406 3 — 4 — 4 1 1 — 7 - 3 — — — — - - - - - — - - - 22 1 11 - South Park 1155 - - - - 1 - - - 1 - - - - - - - - - - - - - - - 2 44 5 Uphall 796 - - - - - - - - - - 5 - 3 - - - - - - - - - 1 - 9 - 33 1 Valentines 130 - - 1 - - - - - - - - - - - - - - - - - - - - - 1 - - - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 10693 13 — 5 1 15 1 13 — 27 - 17 — 4 — — — — - 13 - 8 l 5 — 120 3 479 42