ILF 7 E Urban District of IlFord. HEALTH REPORT FOR THE YEAR 1925. A. H. G. BURTON, M.D., D.P.H., Medical Officer of Health, &c. Urban District of Ilford. ANNUAL REPORT of the Medical Officer of Health, School Medical Officer, Medical Officer to the Maternity and Child Welfare Statutory Committee, AND Medical Superintendent of the Isolation Hospital, FOR THE YEAR 1925. ILFORD: South Essex Recorders, Ltd., High Road. IlforD Urban District Council. 1925-1926. Rev. Herbert Dunnico, M.P., J.P., C.C., Chairman. Major Alexander Young, Vice-Chairman. Church, George. Clark, Charles William. Corn well, Arthur Edward. Dane, Frederick Hopper, M.B.E., J.P., C.C. Davey, George Robert. Griggs, Albert Philip. Gunary, George. Kennedy, Charles Guns. King, James William. Lee, George. Norton, Thomas George. Odell, Herbert George. Pitt, Bertram Sidney John, J.P. Sheat, William J. Oliver O.B.E., J.P. Shipman, James Henry. Smith, Frank D., C.C. Stephens, Mrs. Emily Jane. Stevens, Walter H. Taylor, Joseph John. PUBLIC HEALTH COMMITTEE. 1925-1926. Councillor C. W. Clark, Chairman. Councillor G. Church, Vice-Chairman. Councillor A. E. Cornwell. Councillor J. H. Shipman. †Councillor The Rev. H. Dunnico, Councillor F. D. Smith, C.C. M.P., J.P., C.C. Councillor A. P. Griggs. Councillor Mrs. Stephens. Councillor J. W. King. Councillor J. J. Taylor. Councillor T. G. Norton. †Councillor A. Young. †Ex-officio Members. MATERNITY & CHILD WELFARE STATUTORY COMMITTEE. 1925-1926. tCouncillor The Rev. H. Dunnico, M.P., J.P., C.C., Chairman. Councillor W. H. Stevens, Vice-Chairman. Councillor G. Church. *Dr. R. Boyd Robson. Councillor C. W. Clark. Councillor J. H. Shipman. *Mrs. Dunnico. Councillor Mrs. Stephens. *Mrs. Gillard. *Mrs. Stevens. Councillor J. W. King. Councillor J. J. Taylor. Councillor B. S. J. Pitt, J.P. *Mrs. Wise. †Councillor A. Young. *Co-opted Members. †Ex-officio Members. EDUCATION COMMITTEE. 1925-1926. Councillor J. W. King, Chairman. *Mr. W. R. Spencer. Vice-Chairman. *Mr. W. J. Alderson. *Mr. J. R. Baldwin. *Rev. A. Butterworth, M.A. Councillor G. Church. Councillor C. W. Clark. Councillor F. H. Dane, M.B.E., J.P., C.C. †Councillor The Rev. H. Dunnico, M.P., J.P., C.C. *Mr. A. W. Green. Councillor G. Gunary. Councillor C. G. Kennedy* *Miss J. B. Larkin. Councillor G. Lee. Mr. S. P. Lonergan. Councillor H. G. Odeli,. Councillor B. S. J. Pitt, J.P. Councillor W. J. 0. Sreat, O.B.E., J.P. Councillor Mrs. E. J. Stephens. Councillor J. J. Taylor. †Councillor A. Young. *Co-opted Members. †Ex-officio Members. OFFICERS of the PUBLIC HEALTH SERVICES MARCH, 1926. 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. 6. Burton, M.D., B.S. (Lond.), D.P.M. (Eng.), D.P.H. (Oantab.) of the Middle Temple, Barrister-at-Law. Deputy Medical Officer of Health: V. F. Soothill, M.A., M.D. (Cantab.), D.P.H. (Cantab.). Assistant Medical Officer of Health: Marie A. Hadden, B.A., M.B., B.Ch. (Dub.), L.M. (Rot. Hosp.). G. Morgan Evans, M.R.C.S., L.R.C.P. (London). Oculist (part time): Dentist: R. S. Charsley, M.R.C.8., L.R.C.P. M. J. K. Soutter, L.D.S., R.C.S. (Eng.). Matron of Isolation Hospital: Matron of Maternity Home: Miss I. Millar. Miss M. E. Roberts. Senior Sanitary Inspector: F. W. King, Mem. Roy. San. Inst., F.I.S.E. Deputy Senior 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 O. Bell. Miss M. E. Cartwright. Miss K. B. Mathieson. Mrs. H. Morris. Miss B. Raddall. Miss M. D. Seager. District Midwife: Miss M. M. Gambrill. TABLE OF CONTENTS. SECTION I.—NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. page Preface 11 Survey 17 Statistical Summary 23 Physical Features of District 25 Occupations of Inhabitants 25 Housing of Inhabitants 26 Rainfall 27 Population 27 Births 27 Deaths 28 Inquests 29 Poor Relief 30 Marriages 30 Vital Statistics—Tables of 30 ,, „ Table I. 31 ,, „ Table Ia. 32 Causes of Death—Table III. 33 Hospital Provision 34 District Nursing 35 Midwives 35 Ambulance Facilities 36 Clinic and Treatment Centres 36 Tuberculosis Dispensary 37 Chemical Investigations 37 Byelaws and Local Acts 37 Offensive Trades 37 SECTION II.—SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply 41 Rivers and Streams 42 Drainage and Sewerage 42 Closet Accommodation 44 Scavenging, Collection of House Refuse 45 Sanitary Inspection of District 45 (a) Notices served 46 (b) Complaints of Nuisances 46 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 46 Smoke Abatement 47 Housing 47 Overcrowding 47 Fitness of Houses 47 Unhealthy Areas 48 Byelaws relating to Houses, Lodgings, Tents, etc. 48 Housing Table 48 8 PAGE. SECTION III.—SUPERVISION OF FOOD. Milk Supply 49 Licences—Graded Milk 50 Milk Samples 50 Meat Regulations 51 (a) Slaughter-houses 51 (b) Articles of Food Surrendered and Seized 52 Bakehouses 52 Food Poisoning 52 Sale of Food and Drugs Acts 52 SECTION IV—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Disease Generally 53 Notifications in Institutions 54 Isolated in Hospital 54 Deaths from Infectious Diseases 54 Table II.—Summary of Cases of Infectious Diseases Notified 55 Vaccination 56 Attack Rates of Infectious Diseases:— 56 (a) Small-pox 56 Small-pox Hospital Accommodation 57 (b) Scarlet Fever 57 (c) Diphtheria 58 (d) Enteric Fever 58 (e) Cerebro-Spinal Meningitis and Anthrax 59 if) Ophthalmia Neonatorum 59 (g) Acute Influenzal and Acute Primary Pneumonia 59 (h) Encephalitis Lethargica 59 (i) Plague 60 (j) Puerperal Fever 60 Zymotic Diseases 60 Incidence and Deaths from Infectious Diseases in age groups 61 Tuberculosis 62 Table of Comparative Cases and Deaths 62 Tuberculosis Regulations 63 Public Health Act, 1925 63 Tuberculosis, Treatment of 65 Tuberculosis Care-Committee 65 Venereal Diseases 65 SECTION V.—OTHER SERVICES. Bacteriological Laboratory 67 Table of Number of Specimens examined 68 Public Health Offices 69 ,, ,, Plan 70 9 PAGE. SECTION VI.—FACTORIES AND WORKSHOPS. Factories 71 Workshops 71 Table I—Inspection of Factories, Workshops, Workplaces 73 ,, II.—Defects Found 74 ,, III.—Homework 75 ,, IV.—Other Matters 76 ISOLATION HOSPITAL. Patients Admitted 79 Scarlet Fever 80 Diphtheria 81 Enteric Fever 81 Puerperal Fever 81 Observation Cases 81 Tuberculosis 82 Artificial Sunlight Treatment 83 Training of Nurses 83 Extension of Buildings 83 ., ,, ,, Plans 85-88 MATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907 and 1915 91 Registration Act, 1836 91 Infant Mortality 91 Neonatal Mortality 96 Table IV 97 Illegitimate Births and Deaths 98 Maternal Mortality 99 Infant Life Protection 100 Work of Health Visitors 101 Supervision of Midwives 101 Supply of Milk to expectant and nursing Mothers and for Infants 102 Infant Welfare Centres 102 Ante-natal Clinic 104 Dental Clinic 104 Ophthalmic Clinic 105 Ophthalmia Neonatorum 106 Treatment of Minor Ailments 107 Maternity Home 107 District Midwife 110 New Maternity Home 111 „ „ Plans 113-114 SCHOOL MEDICAL SERVICE. Description of 119 Staff 119 School Premises 119 Medical Inspection 119 10 PAGE. SCHOOL MEDICAL SERVICE—(continued). Findings of Medical Inspection 120 Infectious Disease 122 " Following-up " 123 Medical Treatment:— Minor Ailments 124 Ophthalmic Department 125 Dental Department 127 Treatment of Uncleanliness 128 Other Ailments 129 Operative Treatment of Tonsils and Adenoids 129 Open-air Education 129-130 Physical Training 131 Provision of Meals 132 Defective Footgear 132 Supply of Free Cod Liver Oil Emulsion, etc. 133 Co-operation of:— Parents, Teachers, School Attendance Officers and Voluntary Bodies 133 Physically and Mentally Defective Children 134-141 Employment of School Children and Young Persons 141 Medical Examination of Teachers, etc. 142 Incidence of Goitre 142 Statistical Tables:— I.—Number of Children Inspected 144 IIa.—Return of Defects 145 IIb.—No. of Children found to Require Treatment 146 III.—Numerical Return of Exceptional Children 147 IV.—Group I.—Minor Ailments 150 Group II.—Visual Defects 151 Group III.—Nose and Throat Defects 151 Group IV.—Dental Defects 152 Group V.—Uncleanliness and Verminous Conditions 153 V.—Summary of number of Children Inspected 154 VI.—A.—Average Heights and Weights of Boys Inspected 156 B.—Average Heights and Weights of Girls Inspected 158 VII.—Summary of Infectious Diseases among School Children 160 VIII.—Summary of Scarlet Fever among School Children 161 IX.—Summary of Diphtheria among School Children 162 X.—Summary of Measles and German Measles among School Children 163 XI.—Summary of Chicken Pox among School Children 164 XII.—Summary of Whooping Cough among School Children 165 XIII.—Summary of Mumps among School Children 166 PREFACE. Public Health Offices, Ilford. March, 1926. 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 and1 Board of Education. This is the seventh Annual Report which I have prepared, and is the twenty-sixth report which has been presented for this district. The Ministry of Health require that the Annual Report for 1925 should be in the nature of a survey report, and therefore of a fuller character than those of preceding years, it being intended that quinquennially such a report should be prepared by the Medical Officer of Health. In particular the Ministry ask that the report should " deal comprehensively (a) with the measure of progress during the preceding five years in the improvement of Public Health; (b) the extent and character of the changes made during that period in the Public Health services of the area; and (c) any further action of importance in the organisation or development of Public Health services contemplated by the Local Authority or considered desirable by the Medical Officer of Health.'"' As far as the vital statistics for the year 1925 are concerned, the most satisfactory feature is the low incidence of diphtheria in this district. In the year 1900, for which the first Health Report was issued, the estimated population was 43,701. In that year 70 cases of diphtheria were notified and there were four deaths. In the year 1925, with an estimated population of 93,590, there were only 56 cases of diphtheria notified, with only two deaths, one of the deaths not being confirmed as a case of diphtheria by bacteriological examination. The death-rate from diphtheria in Ilford was less than one-fifth of that in London. It is obvious that we are in the trough of a wave of depression as far as the incidence of diphtheria in this district is concerned, and also as regards the mildness of the disease. In any future year, with the appearance of that very fatal type of diphtheria known as hsemorrhagic, we may anticipate a very different record of the number of deaths from the disease. For the first time in its history, no death from diphtheria occurred at the Isolation Hospital. This result is not simply due to the mildness of the disease, but much of it may be attributed to the excellent work of the medical practitioners of the district and the way in which 12 they co-operate with the Public Health Department by sending the patients into the Isolation Hospital in the majority of cases at the earliest possible moment, and thus giving, especially young children, the best chance of recovery. No delay occurs in Ilford in the bacteriological examination of swabs. A throat swab can be left at the Public Health Office at any time and the doctor receives the result before noon next day. In addition, the medical practitioners of the town are aware that in any doubtful case they can avail themselves of my assistance for the purpose of diagnosis. The value of the bacteriological examination of swabs must not be too highly rated. The ordinary case of diphtheria should be diagnosed by the appearances in the throat of the patient. Bacteriological examination should be limited to doubtful, not severe cases, and even in the former, further investigation of the organisms found may be required to discover whether they are, in fact, diphtheria organisms, which will cause an attack of diphtheria in a human being, or are organisms simulating diphtheria organisms but which have not their poisonous effect. There are, however, cases of diphtheria which are atypical, and which, although mild and not likely to prove dangerous to the patients themselves, will spread the disease to other persons, and it is in such cases that the bacteriological examination of a swab from the throat or nose may be of special value, although in many of such cases a further examination of the organisms found, in the way I have described, may be necessary. Many of the deaths which occur from diphtheria in some districts are considered to be due to two factors : (1) that the medical practitioners rely too much on the examination of a swab, and (2) that the results from the examination of the swabs are unduly delayed. Frequently the swabs have to be posted, with a delay of two or three days before the result is obtained. If the patient in the meantime has received no anti-toxic serum and1 the case is at all a serious one, the delay may lead to a fatal issue. The vital statistics as regards infant mortality and maternal mortality are not so encouraging. There has been a decided rise in the infant mortality rate from 43.2 in 1924 to 52.5 in 1925. The neo-natal mortality rate, or the mortality of children during the first four weeks of life at the same time rose from 19.5 to 24.9. The death-rate of children during the latter 11 months of life was 23.6 in 1924, and in 1925 27.6, showing that the greatest increase occurred in infants during the first month of life. The number of deaths due to premature births rose from 9 in 1924 to 18 in 1925. These figures emphasise that it is still necessary to spend more 13 effort and more money on maternity and child welfare work, and that more and more must the importance of the ante-natal examination of expectant mothers be taught if the deaths of infants in the first month of life are to be reduced. The infantile death-rate was not assisted by a small epidemic of infantile diarrhoea which occurred in Romford Infirmary, and which accounted for the deaths of five Ilford infants. Apart from this there has been an increase in the total number of deaths from diarrhcea in children under two years of age, from 6 in 1924 to 13 in 1925. It is to be hoped that this is not any indication that there is likely to bd a return of this very fatal disease to infants in anything like the epidemic form which it has shown in years gone by. Four women died in child birth or in consequence of child birth during 1925, compared with only one in 1924. Two of the deaths were possibly unavoidable. One, however, was due to Puerperal Fever, and the other was due to what is generally regarded as an avoidable cause of death. Only one other case of Puerperal Fever was notified in the district, and this woman, although desperately ill, made an excellent recovery at the Isolation Hospital. The case which died was nursed at home. As with other serious diseases, the earlier that the patients can be received into a hospital where they can obtain expert nursing, medical and possibly operative treatment, the better the chance of recovery. It will not always be found possible to obtain a complete and satisfactory recovery, as in the above case, even whe i the patient is admitted into the hospital in the early stage of the disease. During the year the extensions to the Isolation Hospital, consisting of a new Nurses' Home and an additional ward, were completed after long delay. The new Maternity Home was also completed and ready for opening at the end of the year. The Public Health Offices were, at the beginning of the year, transferred from the very unsatisfactory accommodation which they had in Nos. 2, 4, 6 and 8, Oakfield Road, to Valentines Mansion. The Bye-laws for fish frying and dealing in rags and bones (which in 1923 were listed as "offensive trades were approved by the Ministry of Health and became operative in March of last year. The importance of these Bye-laws has already been realised in dealing with one large rag and bone business which was in existence in Ilford, and the buildings of which were destroyed 14 by fire during the year. No such business can, now the trade is an " offensive trade" in Ilford, be established without the consent of the Ilford Council. The sewage disposal system of the Council has been under consideration during the year, and there is no doubt that, in the near future, schemes for dealing with the large increase of houses in the district will become urgently required. In the rural area an extension of the sewage system became necessary in order to replace the cesspool which had been established to receive the sewage of no less than 88 houses. The milk of the district has been under close supervision by the Department. It will be satisfactory to note from page 50 that out of 30 samples of milk which were analysed (the samples constituting the supply of all the dairymen in the district) in no instance was Tuberculous milk found to be sold, and the results of the analysis show that, as regards cleanliness and the freedom from contamination with intestinal organisms, the milk in Ilford appeared to be very satisfactory, especially as the samples were taken during the warmer months of the year. The call for Grade " A " milk is increasing in the district. In 1924 there was a sale of 150 gallons of this milk daily. At the end of 1925 there was an increase to 239 gallons daily in the sale of this milk. Slowly but surely the average person is beginning to realise that unless he buys milk, bottled and sealed, and under the designation of " Grade A " or " Certified " Milk he has little protection against the vendor of dirty milk. During the year the Public Health (Meat) Regulations came into operation. Some difficulty has been experienced in many districts by the varying interpretations which can be given to the regulations as issued by the Ministry of Health. Most Local Authorities considered that the only satisfactory means of dealing with the question was the provision of fixed glass windows to both butchers' and grocers' shops. The Ministry of Health, however, issued a circular explanatory of the regulations in which they stated that they did not consider this to be essential. They, however, said that failing the provision of such windows, the meat, etc., must be kept as far within the precincts of the shop as possible, and any meat exposed near an open window be kept covered with muslin, or other suitable material. The position was therefore dealt with in Ilford in two stages. First a circular was issued calling the attention of the butchers and grocers in the district to the necessity of withdrawing meat exposed for sale on the forecourts of their premises. This request met with a response from all the retailers in the district except one. Second, 15 in those cases where a glazed window had not been provided by the retailers, a letter was issued to the retailers calling on them to comply with the regulation of the Ministry as to covering the meat with muslin. At the present time the retailers in the town have been given a certain length of time to comply with these instructions. While the meat regulations mark an advance in the obtaining of clean food, it must be at once recognised that they are limited in scope. The Ministry of Health circular specifically states that the regulations do not apply to rabbits, poultry, fish, cooked meat or sausages—although it is equally obvious that such articles of food require at least as much care in preventing contamination from dust and dirt as do uncooked butchers' meat, bacon and ham. It is true that Section 72 of the Public Health Act, 1925, extends the Public Health (Meat) Regulations to some extent to all foods, but a number of trades are exempt from it by reason of falling under Sub-Section 1 of the Factory and Workshop Act, 1901. More specific and detailed explanation of the Meat Regulations by the Ministry of Health, if any such explanations were to be given at all, might have saved Local Authorities a good deal of trouble. It is astonishing now that the Ministry of Health has dealt with such food commodities as milk and meat, that the conditions under which bread is conveyed are still not subject to any legal restriction. Loaves of bread are handled by varying persons of varying degrees of cleanliness, carried in baskets on the heads of errand boys, stocked on the floor of shopsi or bakers' vans, and then eaten by the public, generally without any further cooking. The only solution to prevent such conditions of affairs is that bread should be wrapped in hygienic waxed paper. Machinery is now on the market which enables large numbers of loaves of bread to be automatically wrapped without handling, and sooner or later it is to be hoped that bakers will be required in all cases to provide against the contamination of bread by some such means as this. During the year the appointment of an additional Sanitary Inspector in 1924 enabled progress to be made with the inspection of houses under the Housing and Town Planning Act, and 250 houses in 7 streets were inspected under this Act with the result that 114 notices were served on the owners of the property concerned. The housing difficulty in Ilford has not been eased. It will be seen from the report that no less than 2,361 houses were completed during 1925, or were in course of erection on the last day 16 of the year. All these houses, however, were built for sale and did not alleviate the position for the poorer section of the community, which is still only able to pay a small rent. The School Medical Service has continued to carry out efficient work. The most noticeable feature is that in November I was able to report that for the first time for 17 years there was no case of ringworm of the scalp in an Ilford school-child. A few sporadic cases have arisen since (some imported from other districts), but when medical inspection commenced in 1909 there were 135 cases, and the result which has been achieved is a testimony to the value of the School Medical Service and the work of the X-ray operator, Mr. Golledge. I regret to say that little progress has been made in the provision of a special school for mentally defective children. The plans for an open-air school are at present before the Board of Education. As far as the staff of the Department is concerned, an additional Assistant Medical Officer was appointed during the year to deal more particularly with the work at the Infant Welfare Centres and the Maternity Home. This will enable a good deal more medical assistance and supervision over the patients at the Maternity Home to be rendered than previously, and will also relieve a considerable amount of the congestion at the various Infant Welfare Centres as well as at the Ante-Natal Clinic. Mr. Haigh was appointed Deputy Senior Sanitary Inspector and Chief Clerk. This appointment effects a very desirable co-ordination in the work of the Department, and at the same time ensures that a qualified Sanitary Inspector shall be available at all times during office hours to deal with any sanitary matters which may require urgent attention. I have again to thank the Council for the support which I have received, and the members of my Staff for the loyal service they have rendered. I am, Madam and Gentlemen, Your obedient servant, A. H. G. BURTON, Medical Officer of Health. 17 GENERAL SURVEY OF PUBLIC HEALTH SERVICES FOR THE PAST SIX YEARS. As requested by the Ministry of Health, I append a summary of the improvements made in the Public Health Services, but as the year 1920 is the first complete year I held the appointment of Medical Officer of Health, I have included this year also. Appended are some observations as to further matters which are either at present under consideration by the various Committees of the Council, or will shortly receive their consideration. Comparison of Vital Statistics. 1920. 1921. 1922. 1923. 1924. 1925. Population 82,693 85,500 86,370 89,020 92,400 93,590 Birth Rate 20.1 18.3 178 18.8 16.2 16.5 No. of Still Births notified 26 28 21 36 21 27 Death Rate 9.0 9.2 9.5 9.5 9.9 9.9 Maternal Death Rate 3.0 2.68 4.07 2.49 0.69 2.6 Infant Mortality 54.0 50.9 54.2 41.1 43.2 52.4 Neonatal Mortality 27.0 25.5 27.1 21.2 19.5 24.9 No. of cases of Ophthalmia Neonatorum 10 7 9 9 4 3 Zymotic Death Rate .53 .37 .32 .26 .24 .25 Attack Rate—Scarlet Fever 3.09 3.8 2.4 1.5 1.8 1.6 Diphtheria 2.5 1.8 1.9 1.5 .9 .6 Death Rate from Pulmonary Tuberculosis .50 .64 .55 .64 .61 .84 General. (1) Agreement for treatment of cases of smallpox made with the West Ham Council 1922. (2) The appointment of additional medical officers allowing the service of the Bacteriological Laboratory to be improved so that medical men can now have the results of swabs reported in the minimum of time. (3) Assistant Sanitary Inspectors appointed as Sanitary Inspectors under the Sanitary Officers Order 1922. One half of the salary of these officers is now paid by the Essex County Council. (4) Appointment of an additional Sanitary Inspector, October, 1924 (the first increase in the number of Inspectors for 17 years), and the appointment in 1925 of a Deputy Senior Sanitary Inspector and Chief Clerk, with increased coordination and efficiency in the Department. (5) Fish Frying and dealing in Rags and Bones made Offensive trades " by an Order dated June 30th, 1923. Bye- laws governing these trades are included in the present report. 18 (6) The adoption of bye-laws governing the humane slaughtering of animals 1924. (7) New effluent pipe to the River Thames completed in January 1924. Two new contact beds at the outfall works completed in 1923. A new 15 in. relief sewer laid in the Uphall Road. Improved methods of dealing with the clearing of cesspools and pail closets, the former by means of vacuum emptiers. Pail closets have been emptied twice weekly since 1923. Additional length of sewer 580 yards laid in 1921 from Perth Road, across Valentines Park. Extension of the main sewer to P'adnall Grove Farm. (8) The provision of " Grade A " Milk for the Maternity Home and Isolation Hospital in 1924 and in 1925 for necessitous cases under the Milk (Mothers and Children) Order, 1919. (9) The provision of three district nurses for Home nursing commenced in October, 1921, by a voluntary Committee as the result of a Conference convened by the Public Health Committee at the Town Hall. Two important matters which require the attention of the Council are (1) the considerable degree of overcrowding and (2) an extension of the sewage works to deal with the rapidly increasing population. Maternity Work. (1) Infant Welfare Centres. 1920—two additional centres opened in Loxford and Goodmayes; better premises obtained for two existing centres; 1922—additional centre opened for Becontree ; 1923—additional centre opened for the Park and Cranbrook area ; 1925— additional doctor provided for three of the centres. (2) The first ante-natal Clinic was established in 1920. In 1925, an additional ante-natal clinic was opened. (3) Ophthalmic Treatment. Expectant and nursing mothers, and children under 5 years, received treatment from the Oculist since 1923. (4) The erection of the new Maternity Home in 1925, of more than double the capacity of the old Maternity Home which consisted of two houses quite unsuitable for the purpose. (5) The appointment of a District Midwife, April, 1923, principally for the outlying area where it was impossible to obtain the services of a trained midwife. In 1924 the District Midwife attended 72 cases, and in 1925, 95 cases. 19 (6) An agreement made in 1923 with the Metropolitan Asylums Board for the treatment of Ilford cases of Ophthalmia Neonatorum at the St. Margarets Hospital. (7) An arrangement with the Romford Board of Guardians in 1921, for the sanitary inspection of houses receiving foster children and the co-ordination of the work of the Infant Life Protection Visitor with that of the Welfare Centres. (8) Two additional health visitors appointed in 1921, and a further addition made in 1923, making a total of 7 health visitors. Since 1920, their work has been arranged so that each nurse devotes 50 per cent, of her time to Maternity work and 50 per cent, to school work and each has her own district, thus avoiding the visiting of the same house by two different nurses for different purposes. 11,584 home visits for Maternity and Child Welfare purposes were paid in 1920, compared with 17,022 in 1925. (a) This work will require in the near future additions to the staff of Health Visitors and School Nurses, (b) There is lack of provision in the district for hospital treatment for ailing infants. (c) The work in Ilford is of such an extent that as in other districts it requires a central clinic specially adapted for infant welfare purposes to replace some of the temporary buildings now used, (d) In the near future the Committee should also consider the treatment of suitable cases with artificial sunlight in view of the results achieved, in other towns. School Medical Work. In August 1920, a whole time dentist was appointed in place of the part time dentist previously employed. The dentist gives one morning a week to the work of Maternity and Child Welfare, and one afternoon a fortnight to the treatment of tuberculosis cases for the Essex County Council. (2) The increase in the number of School Nurses as mentioned in paragraph (8) under MATERNITY WORK, and the appointment of a female clerk attendant to relieve the Head Teachers' of clerical work preparatory to medical inspections and the arrangement of one School Nurse to attend all medical inspections to give the assistance previously given by the School Teachers. (3) January, 1920, the appointment of the Medical Officer of Health as Honorary District Correspondent of the N.S.P.C.C., enabling much valuable service to be obtained from this organisation. (4) In 1920, Bye-laws in the Provisions of the Employment of Children Act, 1903, and the Education Act, 1918, adopted. 20 (5) New School opened at Stevens Road, Becontree, 1923, replacing temporary School there. The Church of England Girls School closed in 1920. (G)| 1924, the provision of Malt and Oil, etc., granted to necessitous children when ordered by the School Medical Officer. (7) 1922, agreement made with Queen Mary's Hospital for the operative treatment of enlarged tonsils and adenoids, keeping all cases operated at this Hospital under the direct supervision ol the School Medical Officer. This agreement has also been made to apply to the treatment of children under school age. (8) The arrangements for the following up of defects found in medical inspection have been completely organised since 1920. In addition to notices being served on their parents, all the children found with defects are visited by the School Nurses and the children are re-examined at intervals at School by the Medical Staff. (9) The School Clinic premises were transferred from Oakfield Road, to Valentines Mansion, in 1925. The work of this department can now be carried out under satisfactory conditions. The matters which require the early attention of the Education Committee are (1) the provision of special schools for mentally defective children, (2) the institution of an open air school, (3) the provision of a clinic for remedial exercises and massage for cases of minor degrees of physical disability such as lateral curvature of the spine, etc. (4) Further growth of the district will probably entail the establishment of subsidiary school clinics for minor ailments. Isolation Hospital. (1) In 1925 the extensions of the Isolation Hospital were completed including the erection of a new Nurses Home and the provision of an additional Scarlet Fever Ward with 26 beds. (2) The Isolation Hospital was recognised by the General Nursing Council as a Training School for Nurses in 1924. (3) Artificial Sunlight treatment provided for cases of Surgical Tuberculosis in October, 1925. Further extension of the Isolation Hospital is necessary (1) to provide cubicle wards for the nursing of cases of doubtful diagnosis, (2) to provide the accommodation for nursing cases of other infectious diseases such as Measles and Whooping Cough, for which the hospital provision in the district is inadequate. GENERAL. 23 STATISTICAL SUMMARY, 1.—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 1925 93,590 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) 110 1924-25. 1925-26. Rateable Value—Houses £517,639 0 0 £541,210 0 0 ,, Land 6,021 0 0 5,923 0 0 £523,660 0 0 £547,133 0 0 Sum represented by a penny rate in 1925, £2,185. Education Rate— 1924. 1925. Elementary 2s. 2¾d. in the £. 2s. 6½d. in the £. Higher 0s. 4½d. 0s. 5d. in the £. in the £. Assessable value £512,198 0 0 £523,770 0 0 General District Rate 7s. 2d. in the £. 7s. 2d. in the £. Poor Rate 7s. 8d. in the £. 8s. 6d. in the £. 2.—Extracts from Vital Statistics of the Year. 1924. 1925. Total Number of Births Registered— Legitimate 1405 1437 Illegitimate 31 49 1436 1486 Birth rate per 1,000 of population 16.2 16.5 24 Total number of Deaths Registered— 1924. 1925. Males 415 450 Females 462 440 — 877 — 890 Death rate per 1,000 of population 9.9 9.9 Number of Women dying in, or in consequence of, childbirth— Sepsis — 1 Other causes 1 3 — 1 — 4 Maternal Mortality per 1,000 births 0.69 2.6 Total number of Deaths of Infants under 1 year of age— Legitimate 55 67 Illegitimate 7 11 — 62 — 78 Infant Mortality per 1,000 births— Legitimate 39 46 Illegitimate 226 224 Infant Mortality per 1,000 registered births 43.2 52.4 Total number of Deaths from seven principal Zymotic Diseases 21 23 Zymotic death-rate per 1,000 of population .24 .25 Total number of Deaths from— Measles (all ages) 11 4 Whooping Cough (all ages) 2 3 Diarrhoea (under 2 years of age) 6 13 25 SECTION I.—NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. 1. Physical Features and General Character of the District.—The surface is gently undulating, flatter in the southern portions, rising to a higher elevation in the northern parts. Ilford is situated on the London clay, but this only comes to the surface as a narrow strip running almost due east and west through the middle of the district. In addition, there is a large patch to the north-west, as exemplified in the names of Clayhall and Claybury. There is a large area of brick-earth lying roughly in the angle between the junction of the Romford Road with the Ilford Lane, extending down the Romford Road as far as St. Mary's Church, and down Ilford Lane nearly to Uphall Farm. The rest of the subsoil is gravel. Ilford is one of the largest Urban Districts in the County of Essex, the population being concentrated in the south-western portion of the district, while the remaining larger portion is still rural. A large proportion of the inhabitants earn their living in London, which is only seven miles distant. There are a few industries:—(1) Photographic works, (2) imitation leather works, (3) manufacturing chemists, (4) electric battery makers, (5) nautical instrument makers, (6) engineers, (7) vulcanizing and wireless instrument works. The chief occupations of the inhabitants of Ilford comprise the following:— Males. Females. Clerks, Civil Servants and Local Government Officials 6,249 3,656 Commercial Travellers and Teachers 1,217 708 Salesmen and Shop Assistants, Proprietors and Managers of wholesale and retail business, Warehousemen 2,675 1,136 26 The following statistics have been obtained from information compiled at the census of 1921:— ACCOMMODATION AND HOUSING. Percentage of Structurally Separate Dwellings returned as:— Private Houses 96 Maisonettes, Flats, Tenements, &c. — Attached to Shops, Offices, Warehouses, &c. 4 Number of Rooms per dwelling 5.75 Number of Families per dwelling 1.18 Number of Persons per family 3.98 Number of Rooms per person—all private families 1.28 Increase in dwellings, 1911-21 1,953 or 12.3% Increase in private families—1911-21 3,256 or 19.4% Population living more than two persons to a room 2,489 or Percentage of total private family population living more than two persons to a room 31 The following are particulars of Private Families, classified by size of family, rooms occupied, and density of occupation Ilford. Essex. London. Number of families occupying 1 room 508 12,107 147,797 Population of families occupying 1 room 882 23,760 262,363 Rooms occupied 508 12,100 — Number of families occupying 2 rooms 1,257 27,295 236,856 Population of families occupying 2 rooms 3,045 75,349 742,485 Rooms occupied 2,509 54,524 — Number of families occupying 3 rooms 1,748 58,514 262,785 Population of families occupying 3 rooms 5,629 224,769 1,009,708 Rooms occupied 5,235 175,474 — Number of families occupying 4 rooms 2,077 77,728 201,958 Population of families occupying 4 rooms 8,412 327,879 899,301 Rooms occupied 8,295 310,867 — Number of families occupying 5 rooms 6,875 75,153 101,213 27  Ilford. Essex. London. Population of families occupying 5 rooms 29,630 349,091 487,052 Rooms occupied 34,374 375,751 Number of families occupying 6-7 rooms 6,874 70,595 104,923 Population of families occupying 6-7 rooms 28,700 321,869 502,362 Rooms occupied 44,507 443,899 — Number of families occupying 8-9 rooms 543 11,743 36,835 Population of families occupying 8-9 rooms 2,551 56,329 175,056 Rooms occupied 4,562 97,773 Number of families occupying 10 rooms and over 177 5,694 28,530 Population of families occupying 10 rooms and over 967 31,336 165,511 Rooms occupied 1,850 67,903 — 2. Rainfall.—The total rainfall registered in the district during the year was 20.57 inches. The greatest fall in 24 hours was registered on 22nd July, being 1.60 inches. The number of days on which rain fell was 141. 3. Population.— Census, 1911 78,188 Census, 1921 85,194 (including institutions) Registrar-General's Estimate on 30th June, 1925 93,590 (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 2,503 West Ham Mental Hospital 1,015 This makes a net population of 90,072. 4. Births.—The number of births registered during the year was 1,486. Legitimate Males 767 Females 670 Illegitimate Males 30 Females 19 i.e., 3.37 per cent. of the births registered were illegitimate. 28 The percentage of illegitimate births registered in previous years was 2.16 in 1924; 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; 21 in 1913; 2.2 in 1912; and 1.7 in 1911. The birth-rate, calculated on the net estimate of the population of 90,072 is 16.5 per 1,000, as compared with 16.2 in 1924; 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; 172 in 1916; 19.1 in 1915; 18.3 in 1914; 19.15 in 1913; 19.4 in 1912; 21.4 in 1911. 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 I consider his estimate of the population of Ilford to be considerably below the actual figure. On the 15th July, 1925, there were nearly 55,000 names included in the new voters' register. This number is surprising if the population of Ilford is under 100,000 as estimated by the Registrar-General. 5. Deaths.— The total number of deaths of Ilford residents was 890. The total number of deaths registered in the district during the year was 874 Number of deaths of non-residents registered in the district (principally in large institutions) 235 The latter 235 deaths occurred as follows:— In Olaybury (L.O.C.) Mental Hospital 164 In West Ham Borough Mental Hospital 46 In Ilford Isolation Hospital and Sanatorium 2 In Ilford Emergency Hospital 12 Other non-residents 11 235 Included in the deaths of residents belonging to the district are 16 which occurred in Dr. Barnardo's Village Homes, 29 To be added to the total number of deaths registered in the district are 251 deaths of Ilford residents registered as having died in other districts. This figure includes deaths at the following institutions:— The Infirmary, Romford 113 Essex County Mental Hospital 13 The London Hospital 21 Queen Mary's Hospital, West Ham 3 Hospital for Sick Children, Gt. Ormond Street 3 St. Bartholomew's Hospital 5 In other Hospitals, Institutions and residences outside the Ilford District 93 Total 251 The total number of deaths of Ilford residents was therefore 890. The death rate, calculated on the net estimate of the population of 90,072, is 9.9 per 1,000, as compared with 9.9 in 1924; 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 over one-sixth of the deaths occurring. If the age periods 45 upwards be taken it causes over one-seventh, or of the period 45— 65 years, over one-fifteenth. Inquests.—During the year 48 inquests were held in the district. 43 on Ilford residents, and 5 on non-residents. The ages at death and causes assigned were as follows:— Under 1 yr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. & upwards. 5 — — 1 2 6 22 12 Causes of inquest-deaths under 1 year.—Meningeal hæmorrhage due to injuries received during difficult labour, accidentally, 1; intestinal obstruction, 1; dentition, convulsions, pneumonia, 1; acute enteritis and acute pneumonia, 1; status lymphaticus, 1. 30 Causes of inquest-deaths over 1 year.— Accidents 6 Suicides 6 Heart Disease 18 Acute Pneumonia 3 Cerebral Haemorrhage 3 Acute Suppurative Otitis Media and Meningitis 1 Tuberculosis 1 Accidental Poisoning 2 Killed on Railway 1 Exophthalmic Goitre 1 Chronic Nephritis 1 6. Poor Relief.—The total amount expended in Ilford during the year was £12,326 11s. The average weekly number of cases in receipt of relief was 340. The number of admissions to the Guardians' Institutions from Ilford during the year was 321, made up as follows:— Men 117 Women 171 Children 33 7. Marriages.—683 marriages have taken place during 1925. The following details explain the allocation:— Marriages taking place in the Ilford District 520 Marriages of Ilford Residents at Registry Office, Romford— Both parties belonging to Ilford 109 The male only belonging to Ilford 22 The female only belonging to Ilford 32 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 Ia. gives a comparison of the vital statistics of Ilford with England and Wales, London, and other towns. Table III. gives a classified statement of the causes of death in 1925, arranged according to the age groups at which deaths occurred. 31 TABLE I Vital Statistics of Whole District during 1925 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 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 1,475 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 16.1 849 9.6 231 259 62 43.2 877 9.9 1925 93,590 §90,072 1,424 1,486 16.5 874 9.7 235 251 78 52.4 890 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. (a) The net estimated population is found by deducting the population of Claybury and West Ham Asylums from the gross estimated population. The population of Dr. Barnardo's Girls' Village Homes is included in the net estimated population of the district. (b) The net number of births is obtained by taking the uncorrected number of births supplied by the local registrar and adding to cr subtracting from it such a number as is supplied for this purpose by the Registrar-Genera (c) The birth-rate is calculated on the estimated net population for birth-rate. (d) Calculated on the estimated total population for death-rate. (e) Calculated on the estimated net population. 32 TABLE Ia. Table showing comparison between the Birth-rate, Death-rate, &c. of Ilford, other Towns, and of England and Wales for the Year 1925. (Provisional figures. The rates for England and Wales, and Ilford, have been calculated on a population estimated to the middle of 1925, while those for the towns have been calculated on populations estimated to the middle of 1924. 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 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 18.3 12.2 0.01 0.00 0.13 0.03 0.15 0.07 0.32 0.47 8.4 75 92.1 6.9 1.0 105 County Boroughs and Great Towns, including London 18.8 12.2 0.01 0.00 0.17 0.03 0.18 0.09 0.30 0.43 10.8 79 92.1 7.3 0.6 157 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 18.3 11.2 0.01 0.00 0.15 0.02 0.14 0.06 0.31 0.38 7.6 74 93.0 5.9 1.1 London 18.0 11.7 0.01 0.00 0.08 0.02 0.19 0.11 0.23 0.46 10.6 67 91.1 8.9 0.0 ILFORD (Estimated Net Population, 90,072) 16.5 9.9 0.00 0.00 0.04 0.01 0.03 0.02 0.20 0.26 8.7 52 95.2 4.8 0.0 33 TABLE III. Causes of, and Ages at, Death during the Year 1925. Causes of Death. Net Deaths at the subjoined ages of " Residents" whether occurring within or without the district. Total Deaths, whether of "Residents" or " Non Residents" in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. 1 Enteric fever — — — — — — — — — — 2 Small-pox — — — — — — — — — — 3 Measles 4 1 1 1 1 — — — — — 4 Scarlet fever 1 — — — 1 — — — — — 5 Whooping cough 3 1 — — 2 — — — — 6 Diphtheria 2 — — 1 — — — 1 — — 7 Influenza 19 1 — — 1 1 2 7 7 1 8 Encephalitis lethargica 4 — — — 1 — 1 2 1 9 Meningococcal meningitis — — — — — — — — — — 10 Tuberculosis of respiratory system 81 1 _ 1 17 37 25 — 20 11 Other tuberculous diseases 16 2 1 2 2 2 5 2 — 8 12 Cancer, malignant disease 135 — — — 1 1 9 58 66 30 13 Rheumatic fever 10 — — 1 4 3 — 2 — 6 14 Diabetes 7 — — — — — — 2 5 1 15 Cerebral haemorrhage, &c. 46 — — — — — 2 15 29 1 16 Heart disease 133 — — — 1 3 3 39 87 8 17 Arteriosclerosis 27 — — — — — — 6 21 51 18 Bronchitis 50 4 1 1 — — — 6 38 11 19 Pneumonia (all forms) 59 11 7 1 1 1 8 13 17 28 20 Other respiratory diseases 14 1 — 1 — — 6 6 8 21 Ulcer of stomach or duodenum 9 — — — — — 1 7 1 3 22 Diarrhcea, &c. (under 2 years) 13 13 — — — — — — — 1 23 Appendicitis and typhlitis 7 — — — 3 — 2 2 3 24 Cirrhosis of liver 2 — — — — — — 2 — 2 25 Acute and chronic nephritis 22 1 — — — — 4 10 7 6 26 Puerperal sepsis 1 — — — — — 1 — — — 27 Other accidents and disease., of pregnancy and parturition 3 — — — — — 3 — — — 28 Congenital debility and malformation, premature birth 36 35 — 1 — — — — — 10 29 Suicide 9 — — — — 2 5 2 1 30 Other deaths from violence 15 — — 1 1 4 3 6 — 6 31 Other defined diseases 162 8 1 2 5 3 17 45 81 109 32 Causes ill-defined or unknown — — — — — — — — — — Totals 890 78 12 12 25 35 100 259 369 316 Special causes (included above): Poliomyelitis — — — — — — — — — — Polio Encephalitis — — — — — — — — — — 34 9. Hospital Provision.— (a) Tuberculosis.—Nineteen beds are maintained by the Essex County Council at the Isolation Hospital lor the treatment of tuberculosis (chiefly surgical) of male patients. (b) Maternity.—Ilford Council Maternity Home—23 ordinary beds, with two isolation wards and two labour wards. (c) Children.—During the past year the Emergency Hospital has provided a temporary ward of 12 beds for children. The provision of a permanent Hospital by the War Memorial Committee is still under discussion. (d) Fever.—Ilford Council Isolation Hospital, 111 beds. (e) Smallpox.—An agreement has been entered into with the West Ham Corporation for the treatment of cases of smallpox at Orsett and at their Dagenham Hospital (vide Annual Health Report, 1922). (f) Other.—There is an Emergency Hospital in the district maintained by voluntary subscriptions, and by patients fees, the number of beds being 54, an extra 12 beds having been provided for children during the year. During the year 1925, 824 in-patients were admitted—males 401, females 423, including 69 children under 5 years of age; 637 operations were performed, 1,215 casualties were attended to, and 794 X-ray examinations were made. The average cost per patient per week was £3 9s. 2d. There are two large Mental Hospitals in the district, the West Ham Mental Hospital with 901 patients (males 420, females 481) and Claybury Mental Hospital with 2,265 patients (males 985, females 1,280) in residence on 30th June, 1925. In addition there is the Girls' Village Homes, one of the late Dr. Barnardo's Institutions, which had 1,253 children and 165 staff in residence on the 30th June, 1925. 35 10. 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 1925, and has fully justified the formulation of a scheme for this beneficent service by the Medical Officer of Health, which was subsequently accepted by the Governors of the Ilford Emergency Hospital, and carried out by the District Nursing Committee. The Chairman of the Public Health Committee and the Medical Officer of Health are members of the District Nursing Committee. It is a voluntary committee, the organisations concerned being mentioned in my annual report for 1921. A total of 7,112 visits was paid compared with 5,665 in 1924. The following is a summary of the work carried out during the year 1925:— 1st Visits. Subsequent Visits. Medical. Surgical. Massage. Medical. Surgical. Massage. 297 44 13 6,450 — 308 Number of applications made for Nurses' services 341 Number of patients under the charge of a doctor 341 Number of patients not under the charge of a doctor — Number of necessitous cases referred to Committee 52 Number of cases on the books at the end of the year 30 The cases were distributed in wards as unde:— Cranbrook 56 Park 37 Seven Kings 68 North Hainault 20 Loxford 45 Clementswood 67 South Hainault 48 All cases of measles are visited by the Health Visitors, and any requiring special nursing attention are referred to the District Nursing Committee. Midwives.—The supervision of midwives is under the control of the Essex County Council. There are 9 certified midwives resident and practising in the district (apart from those at the Maternity Home). 36 11. Ambulance Facilities. (a) Infectious Cases.—A Crossley motor ambulance is provided for the conveyance of infectious cases to the Isolation Hospital. (b) Non-infectious and Accident Cases.—A Crossley and two Ford motor ambulances are provided for the use of the public for accident and other cases. 12. Clinic and Treatment Centres. Maternity and Child Welfare.—The Council has established Infant Welfare Centres with a view to preserving infant life and improving the health and physique of Ilford children. The times and places are as follows:— United Methodist Church (entrance Monday, 2.0 p.m. in Balmoral Gardens, opposite Vernon Road), Seven Kings. All Saints' Church Hall, Goodmayes Tuesday, 9.30 a.m. Lane, Goodmayes. Congregational Church, Birkbeck Tuesday, 2.0 p.m. Road, Newbury Park. Presbyterian Church Hall, Albert Wednesday, 2.0 p.m. Road, Ilford. Cecil Hall, Granville Road, Ilford ... Thursday, 9.30 a.m. and 2.0 p.m. Emmanuel Church, Ilford Lane, Friday, 2.0 p.m. Ilford. St. Thomas' Church Institute, Saturday, 9.30 a.m. Becontree Ante-Natal Clinic.—An ante-natal clinic is held at The Maternity Home, Eastern Avenue, on Monday and Saturday mornings. School Clinic.—Clinics are held at the Public Health Offices for— (1) the treatment of minor ailments ; (2) dental treatment of school children, expectant mothers and children under 5 years of age; and of tuberculosis patients. (3) ophthalmic treatment of same classes as in (2). 37 Tuberculosis Dispensary.—A dispensary is provided by the Essex County Council at 38, Oakfield Road, Ilford. Two sessions per week are held for adults and one session for children, viz.:— For adults—Tuesday, 3-5 p.m., and Friday, 4-6 p.m. For children—Wednesday, 10-12 noon. 13. Chemical Work.—The Essex County Council Public Health Laboratory carry out any chemical investigations required. The Food and Drugs Act is administered by the Essex County Council, to whom Dr. Bernard Dyer is the public analyst. 14. 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 and humane slaughtering of animals. (5) Offensive trades : — (a) Bone boilers. (b) Fellmongers. (c) Leather dressers. (d) Soap boilers. (e) Tanners. (f) Tallow melters. (g) Pat melters or fat extractors. (h) Glue makers. (i) Tripe boilers. (j) Size makers. (k) Gut scrapers. (l) Fish frier. (m) Rag and bone dealer. (6) For securing the cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (7) Nuisances in connection with the removal of offensive or noxious matter. (8) Dairies, cowsheds and milkshops, and regulations for prescribing precautions by purveyors of milk and persons selling milk. 38 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. The following are the Byelaws— BYELAWS relating to these trades which were approved by the Ministry of Health in March, 1925, made by the Urban District Council of Ilford for the regulation of Offensive Trades in the Urban District of Ilford. Interpretation. 1. Throughout these byelaws the expression " the Council" means the Urban District Council of Ilford and the expression "a rag and bone dealer" means any person who for the purpose of sale carries on upon any premises the trade of receiving, storing, sorting or manipulating any rags in an offensive condition or in a condition likely to become offensive or any bones, rabbit skins, fat or other putrescible animal products of a like nature. With Respect to the Trade of a Rag and Bone Dealer. 2. A rag and bone dealer shall not place or store, or cause or suffer to be placed or stored, any rags in an offensive condition or in a condition likely to become offensive, or any bones, fat or other putrescible animal products of a like nature in any part of the premises where his trade is carried on, which is used or occupied as a living or sleeping room, or in any warehouse, building or room that is not provided with proper and sufficient means of ventilation. 3. Every rag and bone dealer shall cause every part of the internal surface above the floor or pavement of any building in which his trade is carried on to be washed with hot lime-wash twice at least in every year, that is to say, at least once during the periods between the first and twenty-first day of April and the first and twenty-first day of October. Provided always that this byelaw shall not apply to any part of the internal surface of any building which is painted or covered with impervious materials and may be otherwise properly cleansed. 4. Every rag and bone dealer shall store all bones in suitable metal vessels or receptacles furnished with closely fitting covers or in well tarred bags kept closed, and shall cause the same to be removed from the premises at frequent intervals. 5. Every rag and bone dealer shall cause every part of the internal surface of the walls of any building and every floor or pavement upon the premises where his trade is carried on, to be kept at all times in good order, condition and repair, so as to prevent the absorption therein of any liquid filth or refuse or any noxious or injurious matter which may be splashed or may fall or be deposited thereon. 39 With Respect to the Tkade of a Fish-fkiek. 6. A fish-frier shall not cause or suffer any vessel or receptacle which has contained wet fish to be kept for a longer period than twenty-four hours upon the premises where his trade is carried on, unless such vessel or receptacle has been cleaned and rendered inoffensive. 7. Every fish-frier shall provide a sufficient number of vessels or receptacles, properly constructed of galvanised iron or of some other non-absorbent material and furnished with closely fitting covers, for the purpose of receiving and conveying from the premises where his trade is carried on, all waste fish, guts, garbage and other putrescible refuse. He shall cause all waste fish, guts, garbage and other putrescible refuse to be placed in such vessels or receptacles immediately on its production. He shall cause all waste fish, guts, garbage and other putrescible refuse to be removed from the premises in such vessels or receptacles within thirty-six hours of its production. 8. Every fish-frier shall cause the internal surface above the floor or pavement of every room or building in which any process of his trade is carried on to be kept at all times in good order and repair so as to prevent the absorption therein of any liquid filth or refuse or any noxious or injurious matter which may be splashed thereon, and he shall cause the floor or pavement or such room or building, and all apparatus, utensils and appliances used therein, and every vessel or receptacle in which any trade materials or any waste fish, guts, garbage or other putrescible refuse is placed to be kept as far as practicable clean. 9. Every fish-frier shall cause the room or enclosure in which his stove is situated to be provided with adequate and permanent means of ventilation to the external air. 10. (i) Every fish-frier shall adopt the best practicable means of rendering innocuous all gas or vapour emitted during the process of frying, from the contents of any pan upon the premises where trade is carried on. (ii) He shall cause every stove used for the purpose of his trade to be provided with side screens and a suitable hood of hard, smooth and impervious material, and shall cause such hood to be connected with a flue having a good draught, or he shall cause every pan in such stove to be completely covered with a suitable cover having an aperture which shall communicate directly with such a flue or with a suitable condenser. (iii) He shall, except where communication is made with a suitable condenser in accordance with paragraph (ii) of this byelaw, cause the gas or vapour either to be discharged from such flue into the external air in such a manner and at such a height as to admit of the diffusion of the gas or vapour without noxious or injurious effects, or to pass from such flue through a fire, or into a suitable condensing apparatus, in such a manner as effectually to consume the gas or vapour, or to deprive the same of all noxious or injurious properties. Provided always that the requirements of paragraphs (ii) iand (iii) of this byelaw shall not apply to any premises where 40 the trade of a fish-frier was carried on at the date of the confirmation of these byelaws, until the expiration of a period of twelve months from such confirmation. 11. Every fish-frier shall at all times employ such means and adopt such precautions as may be necessary for preventing effluvium arising from the gutting, cleansing, or storing of fish for the purposes of his business. 12. Every fish-frier shall cause the interior (other than the floor or pavement) of any part of the premises on which any process of his trade is carried on to be thoroughly washed with hot lime-wash at least four times in every year, that is to say, between the first and tenth days of the months of March, June, September and December respectively. Provided that this hyelaw shall not apply to any part of such interior which is properly painted or covered with hard, smooth, impervious material and may be otherwise properly cleansed. General Provisions. 13. Every person to whom any of the foregoing byelaws may apply shall cause every drain or means of drainage upon or in connection with the premises where his trade is carried on to be maintained at all times in good order and efficient action. 14. Every person to whom any of the foregoing byelaws may apply shall, at all reasonable times without previous notice afford free access to every part of the premises where his trade is carried on to the Medical Officer of Health, the Sanitary Inspectors or the Surveyor of the Council, or to any Committee specially appointed by the Council in that behalf, for the purpose of inspecting the premises. Penalties. 15. Every person who shall offend against any of the foregoing byelaws shall be liable for every such offence to a penalty of Five pounds, and in the case of a continuing offence to a further penalty of Forty shillings for each day after written notice of the offence from the Council. Provided nevertheless that the Justices or Court before whom any complaint may be made or any proceedings may be taken in respect of any such offence may, if they think fit, adjudge the payment as a penalty, of any sum less than the full amount of the penalty imposed by this byelaw. The foregoing byelaws were made and adopted by the Council on the 23rd day of September, 1924. IN WITNESS whereof the Council have caused their Common Seal to be hereunto affixed this eleventh day of November, 1924, pursuant to a resolution passed for that purpose in the presence of Resolution J. W. KING, Chairman. Minute:23/9/24 1521(j). A. PARTINGTON, Clerk. Seal Register 6084. Allowed by the Minister of Health this sixth day of March, 1925. I. G. GIBBON, Assistant Secretary, Ministry of Health. 41 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 II.—SANITARY CIRCUMSTANCES OF THE AREA. 1. Water Supply.—The district is divided by the Cranbrook Road into two areas. The portion north and west of this road is supplied by the Metropolitan Water Board, the remaining portion by the South Essex Waterworks Company, and both companies maintain a constant supply. With two or three exceptions, all houses are supplied by a pipe from the main direct to each house. There are now no public wells in existence. There are still a few private wells in the rural area. Water supplied by each of the companies was submitted to analysis during the year, with the following results:— Metropolitan Water Board. South Essex Waterworks Co. Chlorine in Chlorides 3.1 3.1 Nitrogen in Nitrates 0.0 0.0 Nitrites or Free Chlorine Absent Absent Hardness:—Permanent 5.6 4.5 Temporary 21.5 20.5 Total 27° 25° Free Ammonia 0.0020 0.0004 Albuminoid Ammonia 0.003 0.0038 Oxygen absorbed in 3 hours at 37° C 0.028 0.027 No. of Bacteria per c.c.— On Gelatine in 3 days 55 53 On Agar in 24 hours 2 5 The Bacillus Coli absent in 100 c.c. absent in 100 c.c. The sample is of a very high degree of organic and bacterial purity andean be certified as pure and wholesome. The sample can be certified as a pure and wholesome water, suitable for the purpose of a public supply. 42 2. Rivers and Streams.—The River Roding rises in The Roothings, towards the centre of Essex, and is a tributary of the Thames; it forms the western boundary of Ilford. The River Roding is tidal to a point where the old bridle path crossed the Golf Links. It is only navigable up to the bridge, at the High Road. The Seven Kings Water is a brook, which rises at Chigwell, runs through the centre of the district, and supplies the lakes in Seven Kings Park, South Park, and Barking Recreation Ground, and eventually finds its way to the Roding. Cran Brook feeds the Valentines Lake and rises in the neighbourhood of Tomswood Hill. Mayes Brook runs through the Chadwell portion of the district, feeds the lake in Goodmayes Recreation Ground and eventually finds its way to the Thames. Some difficulty has been experienced in regard to the lakes in both South and Valentines Parks, analyses of the water having shown that they were unfit for bathing purposes, and it has been necessary to suspend bathing. The lake in Valentines Park has a capacity of 7,617,578 gallons; the two lakes in South Park a combined capacity of 3,630,24.3 gallons. 3. Drainage and Sewerage.—The Council have carried out extensive works of sewerage and main drainage. The Sewage Outfall Works comprise 18¾ acres of land, on which are laid down:— Screens 2 Detritus Tanks (covered). 5 Septic Tanks (covered) equal 2,500,000 gals. 2 Clinker Filters. 13 Single Contact Beds, each ¼ acre area. 3 Storm Water Filters, 2½ acres in total area. Discharging effluent into Thames. The Ilford district has four levels of sewers, the first being by gravitation, which covers an area of 6,571 acres; the second, that known as the "Roding Valley," which takes the sewage from the Cranbrook and Loxford Wards (area 844 acres), is raised from the low level at the Pumping Station adjoining the Baths (into the high level or gravitation system) by means of four 43 fugal pumps, two Sin. and two 6in., connected to motors, the power used being electricity (with two gas engines in case of the failure of electricity). At the Outfall Works a further Pumping Station has been erected, comprising two semi-loco boilers and four centrifugal pumps, two l0in. and two 8in. The sewage from the part of the district east of Green Lane and south of the London and North Eastern Railway is connected to the Pumping Station by two large receiving culverts. The northern portion of this area, 400 acres in extent, known as the mid-level, is connected to the 8in. pumps; the southern portion, known as the low level, having an area of 688 acres, is connected to the l0in.pumps; and the whole of the sewage is brought together at the entrance to the screening chamber. For dealing with the sludge two Shones' ejectors have been provided. The sewage of the town is dealt with on what is known as the partial system, there being taken into the soil sewer all the sewage and rain water from the back roofs and yards. The surface water system conveys the roof water from the front roofs of all property and the water from the streets and roads. During the past five years extensions to meet the growth of the area have been made as follows:— 581 yards of 12in. sewer from the vicinity of Perth Road across Valentines Park to the sewer near the Pavilion, for the Lonsdale Estate of 2,155 houses. Main sewer to Padnall Grove Farm. New 15in. sewer from junction of Ilford Lane and Hampton Road to Outfall Works to relieve flooding in Uphall Road district, brought into use on 25th March, 1925. A new effluent pipe to the River Thames. 44 The construction of a 15in. sewer from Highlands Gardens to Eastern Avenue was commenced on 2nd June, 1925, and the scheme was completed and put into operation in February, 11926. The necessity for constructing this sewer has arisen owing to the development of the estate to the south-west of Eastern Avenue, near its junction with Beehive Lane. During the year building developments took place in the region of New North Road. There is no sewer in this road, and the building arrangements necessitated 88 houses draining into one large cesspool. The undesirable nature of this scheme was reported to the Public Health Committee, and it was decided to lay two new lengths of sewers in New North Road discharging into a pipe running parallel to the Woodford Branch Railway to Forest Road. In Forest Road an electrically driven centrifugal pump is to be erected to raise the sewage into an existing gravitating sewer which discharges into the main sewer at Fulwell Hatch. When fully developed the population of this district will be 7,800 persons. Before this is reached, however, it is anticipated that the new Seven Kings Valley Sewer will be constructed and the sewage will then be diverted from the above pumping station into the Seven Kings Valley Sewer in Forest Road. The above scheme will not only obviate the use of the large cesspool mentioned, but will displace 10 cesspools which are at present in use in this area. 4. Closet Accommodation.—In addition to the water carriage system of sewage, there are in the rural area 57 cesspools, 26 privies and 82 pail closets. It is an unfortunate feature that owing to building developments in the rural areas, the number of these undesirable arrangements have considerably increased during the past year. The clearing of cesspools, privies and pail closets is carried out by the Council, the former by means of 2 vacuum emptiers. All pail closets are emptied twice weekly. 45 5. Scavenging, etc.—The collection of house refuse is undertaken by means of horse drawn and mechanically propelled vehicles. The refuse is taken to the destructor, Suffolk Road, Seven Kings. 365 defective and unsuitable receptacles have been replaced during the year. The following figures give information as to the collection of house refuse during 1925:— Number of days on which collection was made 642 (Horse 261, electric 307, Vulcan lorry 74.) Number of vehicles employed 3,077 (Horse 990, electric 2,013, Vulcan 74.) Average number of vehicles employed per day 11.29 (Horse 3.79, electric 6.5, Vulcan 1.0.) Total number of loads collected 9,458 (Horse 2,706, electric 6,481, Vulcan 271.) Average number of loads collected per day 35 (Horse 10.3, electric 21.1, Vulcan 3.6.) Average per horse per day 2.7 Average per electric per day 3.2 Average per Vulcan per day 3.6 Average of all per day 3.16 Total weight of refuse collected 17,189 tons 7 cwts. 2 qrs. (Horse 3,124 tons 15 cwts.) (Electric 13,647 tons 10 cwts. 3 qrs.) (Vulcan lorry 417 tons 1 cwt. 3 qrs.) Average weight per load:— Horse-drawn vehicles 1 ton 3 cwts. 0.1 qrs. Electric vehicles 2 itons 2 cwts. 0.4 qrs. Vulcan vehicle 1 ton 10 cwts. 3.1 qrs. Average of all vehicles 1 ton 16 cwts. 1.3 qrs. Average cost of collection per ton:— £ s. d. Horse (no capital charges) 0 8 11.1 Electric (capital charges included) 0 12 5.3 Vulcan lorry (capital charges included) 0 9 0.3 Average of all vehicles 0 10 1.5 The Vulcan lorry was first used on 17th September, 1925. Arrangements are still in force whereby a special daily collection of refuse is made at Claybury Mental Hospital. 6. Sanitary Inspection of District.—The following is a summary of the work of the Sanitary Inspectors during the yea:— Houses and premises inspected 5,734 Houses and premises re-inspected (works in progress) 4,411 Visits during disinfection 725 Houses in which nuisances were detected 535 Houses in which nuisances were abated 429 Premises disinfected 359 Articles disinfected 2,604 Premises disinfected for verminous conditions 10 46 Notices Served:— Statutory:— Served. Complied with. Public Health Act, 1875 9 7 Housing Act, 1925 114 14 Cleanse Dwelling House (Infectious Disease (Prevention) Act, 1890) 21 20 Provide Dustbin (Ilford Improvement Act) 366 325 Pave Yard (Ilford Improvement Act) 4 1 Provide Water Supply to Dwelling House 5 5 Cleanse Water Storage Cistern (Byelaws) 45 44 Cover Water Storage Cistern (Byelaws) 6 3 Informal 535 429 Total 1,105 848 In addition to the above, 73 other notices (39 statutory and 34 informal) served during 1924 were also complied with. Complaints.—During the year 237 complaints of nuisances have been received and investigated:— The following is a summary:— Accumulation of manure and refuse 19 Animals improperly kept 11 Bad smells 14 Cesspools full and overflowing 2 Dampness of premises 11 Defective drains, w.c.'s and fittings 33 Defective or no provision of dustbin 3 Defective roofs, gutters, downpipes, etc. 21 Defective water fittings 10 Dirty and verminous nouses 15 Dirty condition of rearway 2 Flooding of premises 4 Overcrowding 7 Smoke nuisances 10 Miscellaneous 75 Total 237 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 42, and the number of certificates issued was 35. 47 Smoke Abatement.—It has not been necessary during the year to take any legal action for the abatement of smoke. 7. Housing. (i) General Housing Conditions in the Area.—There is a general shortage of houses in the district. The Council are now building some more houses on the Horns Road Estate, comprising 98 cottages and 48 maisonettes, making a total of 146 occupations. There is a considerable amount of building going on in the district. 11,015 houses were completed during 1925, and a further 1,346 were in course of erection on 31st December, 1925. Most, however, are being built for sale and do not help the situation for the supply of houses for letting to the poorer people. Exceptional activity is taking place in this district for the purchase of houses under the Small Dwellings Acquisition Acts, 1899-1923, but even this leaves the difficulty of housing for the poorer people. (ii) Overcrowding.—There are many cases of overcrowding, but it is impossible to take extreme measures to abate these. I have under review 14 cases of extreme overcrowding which under normal conditions it would be necessary to deal with by legal process, but under present conditions it is hardly likely that any magistrate would issue the order. Considerable difficulty was encountered in dealing with the case of a family living in an underground room, being a cellar within the meaning of the Public Health Act. Notices were served on the persons, but it was not considered possible or advisable to enforce them, and after a period of eight months had elapsed the family obtained other accommodation. It will be remembered that the Census of 1921 showed that at that time 508 families made up of 882 persons were occupying one room per family, and that 1,257 families made up of 3,045 persons were occupying two rooms per family. (iii) Fitness of Houses.—The general standard of houses in the Ilford area is good. 48 (iv) Unhealthy Areas.—No representations or complaints have been made regarding unhealthy areas during the year. (v) Byelaws relating to houses, to houses let in lodgings, and to tents, vans, sheds, etc.—It has not been considered necessary to seek any revision of existing byelaws. A full list of the byelaws in operation is given on page 37 of this report. The following is the table required by the Ministry of Health:— Number of new houses erected during 1925 (a) Total 1,015 (b) With State assistance under Housing Acts:— (1) By local authority — (2) By other bodies or persons 1,015 1. Unfit Dwelling Houses:— Inspection:— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 749 (2) Number of dwelling houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 250 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 522 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 489 3. Action under Statutory Powers:— (a) Proceedings under section 3 of the Housing, Act, 1925:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 114 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 14 (b) By Local Authority in default of owners *14 (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 3 *Notices served in 1924. 49 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 2 (b) By Local Authority in default of owners - (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:- (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. SECTION III.—INSPECTION AND SUPERVISION OF FOOD. 1. Milk Supply.—There are 62 dairies and milkshops and 6 cowsheds on the register. 674 inspections of dairies, milkshops, and cowsheds were carried out during the year. Of the 62 premises from which milk is retailed in Ilford, 12 are branches of one firm, 3 another, and 2 another. Of the remainder 5 are retailers in a large way, 5 retail from dairy shops or stores, 10 from general grocery shops, and 5 from restaurants. Eight are retailers in a small way with rounds and also provision for storage of milk, while 12 are registered for the sale of sterilized bottled milk only. In three of the premises pasteurising plant has been installed for the treatment of milk to comply with the requirements of the Milk and Dairies (Amendment) Act, 1922. Only one of these has, however, been licensed under the order, the "Silkebord" type of machine being used. There are six wholesale dealers in milk. Of these, one is also a retailer. One of the six has no cows on the premises, the remaining five keep cows. 50 2. Licences were granted under the Milk (Special Designations) Order, 1923, during 1925, for the sale of:- " Certified " milk 7 " Grade A " milk 19 " Grade A (Tuberculin Tested)" milk 7 " Pasteurised " milk 6 The above include supplementary licences which were issued for "Certified" milk 6, "Grade A" milk 8, "Grade A (Tuberculin Tested)" milk 5, and "Pasteurised" milk 5. These are licences granted to firms who already have a licence from another Authority, the milk being bottled outside the town but sold in Ilford. One trader was refused licences for the sale of "Grade A" and "Certified" milk for having bottled "Grade A" milk without a licence. 3. Milk Sampling.—13 samples of "Grade A" and 17 samples of ordinary milk were taken. In no instance was the presence of Tubercle Bacilli established. The following table shows the results of the analyses. It will be remembered that the standard for "Grade A" milk is that a sample shall be found to contain (a) not more than 200,000 bacteria per cubic centimetre, and (b) no coliform bacillus in one hundredth of a cubic centimetre. " rade A" Milk. "Ordinary Milk." Sample No. No. of Bacteria per c.c. Sample No. No. of Bacteria per c.c. 3 18,766 16 56,333 4 10,306 17 39,666 5 21,733 18 75,333 6 28,000 19 26,333 7 34,000 20 36,333 8 33,400 21 35,666 9 21,966 22 46,333 10 42,000 23 77,000 11 15,766 24 104,000 12 6,833 25 89,666 13 2,860 26 11,833 14 5,733 27 37,666 15 4,833 28 28,100 29 55,666 30 38,666 31 95,666 32 73,500 51 Although it will be noted that the bacterial contents of ordinary milk is very low it must not on that account be compared with "Grade A" milk, for most of the ordinary milk sold has been heated to more or less pasteurize it, while "Grade A" milk has been untreated by heat and depends for its low bacterial content on the cleanly method with which it has been obtained and transported. 4. Meat.—The Public Health (Meat) Regulations, 1924, came into operation on 1st April, 1925. The regulations are concerned (1) with slaughterhouses, an important provision in this section being that notice must be given to the Local Authority of slaughtering, and (2) with the exposure, transport and handling of meat in such a way as to prevent contamination and the cleanliness and proper sanitary conditions of rooms in which meat is sold or exposed for sale. On August 5th, 1925, I issued a memorandum to each of the traders to whom the regulations applied drawing their attention to the regulations which had then been in force five months, and asking them to take steps to put them into effect. No attention was paid to either the regulations or my memorandum by one of the traders, who continued to expose his meat on the forecourt of his premises without any protection. This case is at present being considered with a view to prosecution. Other traders withdrew the meat, bacon, etc., within the shop, but kept it exposed near an open window without any protection, and in January, 1926, I issued a further circular to these traders requesting compliance with the regulations. The whole matter is now under the consideration of the Public Health Committee. There is now only one licensed slaughterhouse in the district, at which 74 inspections were paid during the year. The following is the table required by the Ministry of Health:- In 1920. In Jan., 1925. In Dec. 1925. Registered - - - Licensed 2 1 1 Total 2 1 1 52 5. Articles of Food Surrendered and Seized.—During the year the following; articles of food were surrendered and condemned as being- unfit for the food of man:- 1 box of mackerel. 1 fowl (cooked). 1 box fresh haddock. 3 pigs heads. 1 box of skate. 2 pigs carcases. 2 boxes of kippers. 2 cases rabbits. Portion of box of hake. 1 dozen eggs. 6. Bakehouses.—There are 32 bakehouses in the district, including 15 factory bakehouses. There is one underground bakehouse. 351 inspections of bakehouses were carried out during the year. In six instances it was found necessary to call upon the occupiers of bakehouses to carry out cleansing and other works. The requests were complied with in five instances; in the remaining case, the bakehouse was subsequently closed. 7. Food Poisoning.—Arsenical poisoning from apples imported from abroad was investigated during the latter part of last year, as the result of communications received from the Ministry of Health. Samples of apples were obtained and arsenic discovered, but it was practically confined to the surface of the apples. The traders dealing in the apples were warned. One trader was prosecuted by the Essex County Council, but the case was dismissed. A case of supposed food poisoning was reported where a family had partaken of a meal consisting of roast beef and vegetables, followed in the case of a child by the eating of an apple. An analysis was made of a portion of the meat, but nothing likely to cause illness was found. 8. Sale of Food and Drugs Acts.—These Acts are administered by the Essex County Council. Mr. H. C. Card, the Chief 53 Inspector, has kindly given me certain particulars, which I append:- Samples of milk taken 126 Samples of butter taken 60 Other articles 56 Total 242 Proceedings in one instance were withdrawn. A case against a seller of watered milk resulted in a fine of £20 and 5s. costs. Cases against two other defendants were dismissed under the First Offenders' Act on payment in each case of £2 2s. Od. costs. SECTION IV.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. 1. Infectious Disease Generally.—During 11925, 505 cases were notified, as compared with 536 in 1924. 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 amoebic Typhus Fever. and bacillary dysentery). Typhoid Fever. Malaria. Enteric Fever. Trench Fever. Relapsing Fever. Acute Poliomyelitis. Continued Fever. Acute Polio-encephalitis. Puerperal Fever. Acute Encephalitis Lethargica. 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. 54 Table II. shows the number of cases of infectious disease notified during 1925, arranged according to age and distributed in wards. Of these 69 occurred in institutions as follows:- Claybury Mental Hospital:- Pneumonia 21 cases. Dysentery 4 cases. Erysipelas 8 cases. Tuberculosis—Pulmonary 7 cases. ,, Other forms 2 cases. Enteric Fever 4 cases. 46 cases. Dr. Barnardo's Girls' Village Homes:- Scarlet Fever 5 cases. Diphtheria2 cases. Tuberculosis—Pulmonary 6 cases. ,, Other forms 3 cases. 16 cases. West Ham Mental Hospital:- Diphtheria 1 case. Emergency Hospital:- Pneumonia 5 cases. Pulmonary Tuberculosis 1 case. Of the cases notified (exclusive of those from Public Institutions) the following table shows the percentage isolated in hospitals:- Scarlet Fever ... 79.4 Diphtheria and Membranous Croup 98.1 Enteric Fever 33.3 Puerperal Fever 50.0 Encephalitis Lethargica 80.0 The total number of deaths of Ilford residents from the chief infectious diseases during 1925 was 199, classified as follows:- Enteric Fever - Scarlet Fever 1 Diphtheria 2 Measles 4 Whooping Cough 3 Influenza 19 Tuberculosis—Pulmonary 81 ,, Other forms 16 Pneumonia 59 Diarrhoea (under 2 years) 13 Cerebro-Spinal Meningitis - Puerperal Fever 1 199 55 TABLE II.—Cases of Infectious Disease Notified during the Year 1925 NOTIFIABLE DISEASE. At all Ages Number of Cases Notified. At Ages—years. Total Cases Notified in each Ward. Total Cases Removed to Hospital. Under 1 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Cranbrook Park Seven Kings North Hainault Loxford Clemen tswood I South Hainault Small Pox - - - - - - - - - - - - - - - - Scarlet Fever 146 - 23 100 17 5 1 - 13 23 18 15 19 45 13 112 Diphtheria, including Membranous Croup 56 - 11 24 11 7 3 - 8 10 2 9 9 9 9 52 Enteric Fever (Typhoid and Para Typhoid) 10 - 1 1 6 1 1 - 3 - - 4 - 1 2 2 Pneumonia 103 6 21 11 7 21 24 13 10 4 6 28 9 12 34 12 Puerperal Fever 2 - - - 1 1 - - - - - - 1 1 - 1 Cerebro-Spinal Fever - - - - - - - - - - - - - - - - Acute Poliomyelitis 1 - 1 - - - - - - - - - 1 - - 1 Encephalitis Lethargica 5 - - 3 - - 2 - - 1 1 - 1 2 - 4 Continued Fever - - - - - - - - - - - - - - - - Dysentery 4 - - - - 3 1 - - - - 4 - - - - Ophthalmia Neonatorum 3 3 - - - - - - - - - - 1 - 2 - Erysipelas 28 - - 1 2 8 13 4 2 7 1 11 2 2 3 1 Tuberculosis—Pulmonary 108 1 - 4 27 58 16 2 7 11 10 22 21 16 21 - Other Forms 38 1 4 14 8 8 3 - 2 3 3 9 5 8 8 - Anthrax - - - - - - - - - - - - - - - - Malaria—Believed to be contracted in this country - - - - - - - - - - - - - - - - Believed to be contracted abroad 1 - - - - 1 - - - 1 - - - - - - Totals 505 11 61 158 79 113 64 19 45 60 41 102 69 96 92 185 56 The following table shows a comparison of the incidence of the chief infectious diseases for the past five years:- No. of Cases. 1925. 1924. 1923. 1922. 1921. Scarlet Fever 146 157 131 252 467 Diphtheria 56 82 131 182 187 Enteric Fever 10 5 5 5 15 Pneumonia 103 96 29 70 49 The attack-rates of certain infectious diseases per 1,000 of the population for the past five years is seen from the undermentioned figures:- Year Population Small Pox Scarlet Fever Diphtheria a b a b a b a b 1925 93,590 88,654 - - 16 1.6 0.6 0.6 1924 92,400 87,371 - - 1.7 1.8 0.8 0.9 1923 89,020 83,757 - - 1.5 1.5 la 1.5 1922 86,370 81,240 - - 2.9 2.4 2.1 1.9 1921 85,500 80,116 - - 5.4 3.8 2.2 1.8 Year Population Enteric Fever Puerperal Fever Erysipelas a b a b a b a b 1925 93,590 88,654 0.1 0.07 0.02 0.02 0.30 0.22 1924 92,400 87,371 0.05 0 .06 0.03 0.03 0.44 0.47 1923 89,020 83,757 0.05 0.06 0.07 0.08 0.23 0.23 1922 86,370 81,240 0.05 0.04 0.1 0.11 0.3 0.3 1921 85,500 80,116 0.2 0.06 00.9 009 0.3 0.2 (a) Including all Institutions. (b) Excluding all Institutions. (a) Small-pox.—No case of Small-pox occurred in 1925. Notifications of 26 persons who had been in contact with cases of Small-pox were received. All these were visited by the Sanitary Inspectors for the usual period. The following gives particulars as to vaccinations during 1925:- Certificates of Successful Vaccinations 786 Postponed 77 Conscientious Objections 582 Unsuccessful Vaccinations 2 Left the District 62 57 Small-pox Hospital Accommodation.—The agreement with the County Borough of West Ham made in 1922 (vide Annual Report, 1922), is still in force, the following being parties to it :— East Ham, Ilford, Romford Joint Hospital Board, Waltham Joint Hospital Board, Barking, Billericay, Wanstead, Epping Rural and Urban, Ongar Rural District Council, Brentwood, Loughton U.D.C., and West Ham. The six-monthly contribution by Ilford for the six months ended September, 1925, was £94 16s. 9d. (b) Scarlet Fever.—1146 cases were notified in 1925, as compared with 157 in 1924, 131 in 1923, 252 in 1922, and 461 in 1921. Of the 146, 5 cases occurred in the Girls' Village Homes, Barkingside. One death from Scarlet Fever occurred in Ilford in 1925. This was a child who had been in the Isolation Hospital suffering from Scarlet Fever complicated by Endocarditis; from the latter complaint she subsequently succumbed at home. The following "return" cases have occurred during the past five years, a "return" case being one which arises within twenty-eight days of the freedom of the primary case from isolation:- Year. Cases notified (excluding institutions). Admitted to Isolation Hospital. "Return" Hospital Cases. Per Cent. Home Cases. Cases arising in same house. Per Cent. 1921 309 269 9 3.3 40 1 2.5 1922 191 162 7 4.3 29 - - 1923 124 115 4 3.4 9 - - 1924 153 129 2 1.5 24 - - 1925 141 111 1 .9 30 3* 10.0 *The details regarding these three cases are of interest. The primary case had been ill since 23rd September; she was isolated and treated at home until peeling occurred. She was then notified 58 as a case of Scarlet Fever on 12th October. On 14th October, her sister, on 15th October, her brother, and on 16th October, another sister were removed to the Isolation Hospital suffering from Scarlet Fever. As the primary case eventually found its way into the Isolation Hospital, the other cases might have escaped recognition as being due to the faults of home isolation, although in fact they were, and the case illustrates the difficulties which may ensue in a family from attempting to- nurse a case at home. (c) Diphtheria.—56 cases of Diphtheria occurred in 1925, as compared with 82 in 1924, 1131 in 1923, 182 in 1922, and 187 in 1921. Of the 56 cases, 2 occurred in the Girls' Village Homes, Barkingside. There were two deaths. This is the lowest number of cases of Diphtheria which have been notified in Uford for the past 25 years, although in the meantime the Registrar-General's estimation of the population has risen from 43,701 in 1900, when there were 70 cases of Diphtheria notified, to 93,590 in 1925. With such a low incidence of Diphtheria, I have not considered it advisable to advocate any general immunization of the population by the Schick method, although I am fully convinced that this method is of extreme value in dealing with Diphtheria in districts where it is continually reaching epidemic proportions. Only two deaths from Diphtheria were notified in the district, the patients dying at home. In one case the bacteriological examination did not confirm the clinical diagnosis. (d) Enteric Fever.—Ten cases occurred in 1925, as compared with 5 in 1924, 5 in 1923, 5 in 1922, and 15 in 1921. No deaths occurred. Of the 10 cases, 4 occurred at Claybury Mental Hospital (3 were patients and 1 a probationer nurse at that Institution). Of the six remaining cases, two were admitted to the Isolation Hospital, the remaining four were nursed at home. Two were 59 cases of infection with the Paratyphoid B organism; the other four were caused by the bacillus typhosus. No clear source of infection was found in any instance; one case apparently contracted the disease at a seaside resort. In another case there had been a case of Enteric in the same house a year previously, but investigation did not show the presence of any " carrier ' of the organism. (e) Cerebrospinal Meningitis and Anthrax.—No cases of these diseases were notified. Only 4 cases of the former and 2 cases of the latter disease have been notified since 1920. (f) Ophthalmia Neonatorum.—Three cases were notified during 1925, as compared with 4 in 11924, 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 later from debility and marasmus. Cases. Vision Un- Vision Total Deaths impaired Impaired Blindness Notified. l treated At Home. In Hospital 3 3 - 8 - - 1* * Fatal when child was 6 weeks old from debility and marasmus. (g) Acute Influenzal and Acute Primary Pneumonia.—103 cases of Pneumonia were notified (of which 26 were in institutions), compared with 96 in 1924, 29 in 1923, 70 in 1922, and 49 in 1921. (h) Encephalitis Lethargica.—Five cases were notified during the year. All occurred in different parts of the district. One of these died from a cerebral tumour. Three deaths occurred at Romford Infirmary—2 males ages 28 and 60 years and 1 female, 48 years (two of these were not notified). A girl of 13 years also died 60 at home after having been ill only a few days. Another case— that of a woman of 53 years-—was admitted to Hospital, but the diagnosis was not confirmed. The other case, that of a boy of 12 years, was taken to the London Hospital, where he was treated for a month. Since his discharge he has improved, but is still under observation. (i) Plague.—2 persons were reported to have been in contact with cases of Plague on board ship. These contacts were visited and kept under observation for the usual period. (j) Puerperal Fever.—There were 2 cases of Puerperal Fever notified during the year, of which one died. She was confined and nursed at her own home. One was treated at the Isolation Hospital and recovered. 2. Zymotic Diseases.—The deaths registered were as follows:- Small-pox - Measles 4 Scarlet Fever 1 Whooping Cough 3 Diphtheria and Croup 2 Enteric Fever - Diarrhœa 13 This gives a Zymotic death-rate for 1925 of .25 per 1,000 of the net population. The Zymotic death-rate for the previous five years was .24 in 1924, .26 in 1923, .32 in 1922, .37 in '1921, and .53 in 1920. 61 Table showing Incidence of, and Deaths from, Infectious Disease, 1925, in age groups. Disease. Total cases notified. Under 1 yr. 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 Over 65 Cases admitted to Hospital. Total Deaths. Under 1 yr. 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 Over 65 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 140 - 4 3 7 9 68 33 12 7 2 1 - 112 1 - - - - - 1 - - - - - - Diphtheria 56 - 2 - 6 3 12 13 8 7 2 3 - 52 2 - - - 1 - - - - - - - 1 Enteric Fever (including Paratyphoid) 10 - - - 1 - 1 - 4 3 - 1 - 2 - - - - - - - - - - - - - Pneumonia 103 6 10 5 1 5 5 5 4 13 12 24 13 12 59 11 7 - 1 - - 1 1 1 7 13 17 Puerperal Fever 2 - - - - - - - - 2 - - - 1 1 - - - - - - - - 1 - - - Cerebro-spinal Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis 1 - - - 1 - - - - - - - - 1 - - - - - - - - - - - - - Encephalitis Lethargica 5 - - - - - - 3 - - - 2 - 4 4 - - - - - - 1 - 1 - 2 - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 4 - - - - - - - - 1 2 1 - - - - - - - - - - - - - - - Ophthalmia Neonatorum 3 3 - - - - - - - - - - - - - - - - - - - - - - - - Erysipelas 28 - - - - - - 1 2 3 5 13 4 1 1 - - - - - - - - - 1 - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria - believed to be contracted in this country - - - - - - - - - - - - - - - - - - - - - - - - - - - „ - believed to be contracted abroad - - - - - - - - - - 1 - - - - - - - - - - - - - - - - 62 3. Tuberculosis.-During the year 1925 there were 108 new notifications of Pulmonary Tuberculosis and 38 of other forms of Tuberculosis. The following table shows the cases notified in 1925, and the deaths which occurred in 1925, 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 1-5 years - - 2 2 1 - 1 2 5-10 years - - 2 5 - - - - 10-15 years 2 2 4 3 - 1 1 1 15-20 years 1 10 5 2 2 3 2 - 20-25 years 9 7 - 1 7 5 - - 25-35 years 18 17 1 3 10 12 2 1 35-45 years 13 10 2 2 11 4 2 - 45-55 years 8 2 - 1 7 7 - 1 55-65 years 3 3 - 2 7 4 - 1 Over 65 years 1 1 - - - - - - Totals 56 52 16 22 45 36 9 7 Sixteen of the above deaths or 16.5 per cent. of the total deaths had not been notified. Of the above the following were notified from Institutions in the district:- Claybury Mental Hospital-Pulmonary Tuberculosis 7 Tuberculosis (all other forms) 2 The Girls' Village Homes, Barkingside-Pulmonary Tuberculosis 6 Tuberculosis (all other forms) 3 Emergency Hospital-Pulmonary Tuberculosis 1 During the year 1925 the following deaths occurred from Tuberculosis:- Pulmonary Tuberculosis for the district proper (including 1 in the Girls' Village Homes), 2 in West Ham Mental Hospital, and 1 in Claybury Mental Hospital 81 Claybury Mental Hospital, excluding the 1 mentioned above 10 West Ham Mental Hospital, excluding the 2 mentioned above 5 63 Ilford Isolation Hospital and Sanatorium (not Ilford resident) 1 Tuberculosis (all other forms) for the district proper including 1 in the Girls' Village Homes, 1 at the Isolation Hospital, and 4 at the Emergency Hospital 16 Claybury Mental Hospital - West Ham Mental Hospital - Ilford Isolation Hospital (not Ilford resident) 1 Of the 97 deaths which Occurred of Ilford residents, notification had previously been received of 76 of the cases, and 5 were notified at or immediately after death. Of the remainder there were six deaths at various institutions of cases from Dr. Barnardo's Homes, probably notified elsewhere; two at West Ham Mental Hospital; one at the Royal National Sanatorium, Ventnor, which had been notified to another district; one was the subject of an inquest, while six were not notified by medical practitioners who were under the impression that they had already been notified. Public Health (Prevention of Tuberculosis) Regulations, 1925.—No action has been taken under these regulations as regards persons employed in the milk trade. Public Health Act, 1925, Section 62.—No action has been taken dealing with the compulsory removal of infectious persons to hospital or other institutions. 64 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:- 1916 1917 1918 1919 1920 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 64 .80 79 1.05 82 1.12 57 .71 42 .50 Tubercular Meningitis 0 .10 7 .09 7 .09 11 .13 5 .06 Tuberculosis (all other forms) 10 .12 12 .15 10 .10 16 .20 11 .13 1921 1922 1923 1924 1925 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate Pulmonary Tuberculosis 53 .64 46 55 55 .64 54 .61 81 .84 Tubercular Meningitis 2 02 - - - - - - - Tuberculosis (all other forms) 9 .11 10 .12* 12 .14* 11 .12* 16 .17* *Including Tubercular Meningitis for the years 1922-1925. On the 1st January, 1925, there were 602 cases on the register of the department. On the 31st December, 1925, with 127 new cases notified (Institution cases omitted), and allowing- for deaths and removals from the district, there were 638 cases on the register. The new cases of Tuberculosis are visited by the Tuberculosis Nurse of the Essex County Council. 297 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 73 76 Improved or fairly well 26 7 Poorly, unwell or under treatment 54 12 In Sanatorium 6 1 No information as to present conditio 9 2 Removed from district 19 12 Totals 187 110 65 The treatment of Tuberculosis is under the control of the Essex County Council. There is a Tuberculosis Dispensary in Ilfor-d, which is attended on three occasions a week by the Tuberculosis Officer. On the 31st December, 1925, there were 320 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. 134 patients were treated, 5 being supplied with dentures. Tuberculosis Care Committee.—This Committee has continued to do good work during the year. 33 cases have been assisted with extra nourishment, clothing, and in other ways. 4. Venereal Diseases.—In the following table are classified the deaths notified as due to (1) Syphilis; (2) Locomotor Ataxy and General Paralysis of the Insane, which are certainly due to Syphilis; and (3) Aortic Aneurysm, which is very frequently caused by this disease. Ages 0-1 1-5 5-15 15-25 25-35 35-45 45-55 55 65 05-75 75-85 85 up NonResidents in Institutions. Totals Syphilis - - - - - - *1 - - - - 1 2 Locomotor Ataxy- - - - - - - - 1 - - - - 1 General Paralysis of Insane - - - - - 1 - 1 - - - 45 47 Aortic Aneurysm - - - - - - - 1 1† - - 1 3 * Morbus Cordis and Syphilitic Syncope, † Cardio-vascular degeneration, Rupture of dissecting aneurysm of aorta. The deaths of non-residents in Institutions occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital, 25 per cent. of the registered causes of death in these Institutions fell under the above headings. 66 Many other patients died from incidental causes, the reason, however, for their admission to the Mental Hospital was some venereal infection. As regards Gonorrhoea, the prevalence of Ophthalmia Neonatorum 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; 1925, 3 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 Plospital 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 October 14th, at the Library Hall, Seven Kings, the films, "The Public Health Twins at Work" and "Memories," were exhibited to women only, and in the evening the same films, together with the film, "A Peep into the Human Body," was shown to a mixed audience. The speaker in the afternoon was Dr. Elizabeth Sloan. Chesser, and in the evening Dr. E. B. Turner, F.R.C.S. On November 10th a lecture to women only, entitled "The Frevention of Disease by Domestic Hygiene," was given at The Institute, Becontree. Mrs. Scharlieb, C.B.E., was the speaker. In the evening of the same day the film, "Damaged Goods," was shown to a mixed audience, the speaker on this occasion being Dr. Feldman, Professor of Physiology at the London Hospital. 67 On December 9th, Dr. N. Beattie gave a lecture at the Barking-side United Methodist Church, entitled "The Social Evil"— " Temptation." During the year the Propaganda Committee was officially recognised by the British Social Hygiene Council (successor to the National Council for Combating Venereal Diseases)), and a representative from the local Committee has been elected to the British Social Hygiene Council's Executive Committee. 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, 806 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. 68 BACTERIOLOGICAL LABORATORY, 1925. 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 34 262 2 5 3 54 38 149 77 470 „ -Nose, Ear, Eye, &c ,, 1 13 - 2 3 8 3 10 7 33 „ -Throat Contacts „ 1 41 3 27 1 6 - - 5 74 ,, -Nose Contacts „ 1 7 3 16 - 3 - - 4 26 Hairs Ringworm - 3 28 45 - - 31 46 Urine Various abnormalities - 7 5 17 1 1 12 20 Totals 137 609 Grand Total 806. Direct Smears from swabs were examined in 16 cases. There were also 17 swabs from Scarlet Fever cases examined for experimental purposes. 22 diphtheritic specimens were sent to a laboratory in London for a test for virulence. 14 were avirulent, 8 virulent. 69 Public Health Offices.—The erection of the new Library in Oakfield Road necessitated the Public Health Office and School Clinic being removed elsewhere, and in February, 1925, after Valentines Mansion had been re-decorated and electric light installed, this building was utilised for the purpose. The building had been empty for the past six years, and in many places was becoming seriously dilapidated. Its utilisation, therefore, was an economical proposition to the Council. It will be seen from the plan shown on page 70 that adequate accommodation has been now found in this building for the various activities of the Department. The School Clinic, which was carried on under the most unsatisfactory conditions in the 3½ houses in Oakfield Road, is now suitably housed, rooms being now available for the recovery of children after the administration of gas, and for the cleansing of verminous children, which were previously absent. In addition there is adequate waiting-room accommodation for the school children. The advantage of having all the Departments housed under one roof is, of course, very considerable. It was feared that the number of school children attending the School Clinic might be reduced. In fact, it will be seen that while 2,158 children attended the morning Clinic in 1924, 2,322 attended in 1925, and while 637 were examined by the Oculist in 1924, 679 were examined in 1925; also that while 3,149 attendances were made by children for treatment by the Dentist in 1924, 3,225 were registered in 1925. The fears expressed do not, therefore, appear to have been realised. Much of the cost of placing the building in order for its new purpose, would in any case require to have been spent, if it was to be kept in existence at all. 70 71 SECTION VI.—FACTORIES AND WORKSHOPS'. Factories. There are 141 factories on the register, made up as follows:- Alloy Moulder 1 Asphalte Manufacturers 1 Bakehouses 15 Boot Making and Repairing 23 Builders, Joinery and Carpentry Works 5 Cabinet Maker 1 Cardboard Box Maker 1 Carriage Works 2 Chemical Works 1 Collar Works 2 Corset Makers 1 Cutlery Grinding 1 Cycle Repairing 1 Electric Wire and Battery Works 2 Engineers 8 Fancy Bag Makers 1 Gear Cutting 1 Hardware Manufacturers 1 Iron Cutting Works 1 Laundries 5 Leather Belting 1 Leather and Cloth Works 2 Mattress Maker 1 Meat Cutting 7 Mechanical Dentist 1 Metal and Brass Finisher 1 Motor Engineering 10 Nautical Instrument Makers 1 Optician 3 Paper Mills 2 Photographic Works 1 Picture Moulding 2 Plating and Enamelling 1 Poultry Appliance Maker 1 Printing Works 6 Rag and General Merchant 1 Rubber Works 1 Saw Mills 6 Seed Sorting 1 Shirt Maker 1 Spring Maker 1 Tool Engineers 1 Toy Makers 1 Umbrella Repairing 2 Vulcanising Works 1 Watchmaker and Repairer 1 Wearing Apparel Makers 6 Wireless Apparatus 2 Wood Cutting 2 Total 141 Workshops. There are 491 workshops on the register, made up as follows:- Art Pottery Worker 1 Bakehouses 17 Blacksmiths 3 Bookbinder 1 Boot Repairing 37 Boot and Shoe Sewing 3 Brush Worker 5 Builders 22 Cardboard and Fancy Paper Maker 1 Carpenters 21 Carpet Planning 1 Cleaning and Pressing Clothes 4 Clergy Robes 3 Coach Builders 2 Collar Makers 2 Confectionery 2 Dairy Utensil Maker 1 Dressmakers 49 Electrical and Mechanical Engineers 10 Electric Battery Charging 1 Embroidery and Lace Workers 10 Feather Cleaning 1 Florists 2 French Polisher 4 Furniture Repairs 7 Furriers 3 Glass Cutters and Glaziers 3 Grate and Furnace Makers 1 Hand Laundry 1 Hairdressing 1 Harness Maker 1 Incubator Maker 1 Leather Worker 3 Life Belt Maker 1 72 Workshops—continued. Meat Cutting 1 Mechanical Dentist 3 Mica Maker 1 Millinery 43 Metal Moulder 2 Motor Cab Proprietor 3 Motor and Cycle Engineering and Repairing 39 Musical Drum Maker 1 Photographers 2 Picture Framing 4 Plumbers 19 Printers 5 Rag and Bone Merchant 2 Scale Maker 1 Screen Maker Sheet Metal Worker 1 Shirt Making 3 Smith's Shop 5 Sports Outfit Repairers 1 Stone Mason 1 Tailors 37 Tie Makers 5 Tile Fender Maker 1 Timber Merchant 1 Tinsmith 2 Tool Grinding 1 Toy Making and Repairing 2 Umbrella Repairing 2 Undertakers 4 Upholstering 8 Watch and Jewellery Repairs 15 Wearing Apparel and Underclothing 37 Wheelwright and Farrier 7 Wire Worker 1 Wood Cutting 5 Total 491 73 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) 303 6 - Workshops (including Workshop Laundries) 559 8 - Workplaces (other than Outworkers' premises included in Part 3 of this report) - - - Total 862 14 - 74 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 7 7 — — Want of ventilation — — — — Overcrowding 1 1 — — Want of drainage of floors — — — — Other nuisances 6 5 — — Sanitary accommodation insufficient — — — — unsuitable or defective 5 4 - - 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 19 17 — — * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 75 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Sending twice in the year. Sending once in the year. Outworkers. Outworkers. Lists. Contractors. Workmen. Lists. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) Wearing Apparel— Making, &c. 14 21 18 1 — 2 Cleaning and Washing - - - - - - Household Linen 2 — 2 — — — Lace, Lace Curtains and Nets Total 16 21 20 1 — 2 Note. —No home-workers were known to be engaged in the following occupations:—Curtains and Furniture Hangings; Furniture and Upholstery; Electro plate; File Making; Brass and Brass Articles; Fur Pulling; Cables and Chains; Anchors and Grapnels; Cart Gear; Locks; Latches and Keys; Umbrellas, etc.; Artificial Flowers; Nets, other than Wire Nets; Tents; Sacks; Racquet and Tennis Balls; Paper, etc.; Boxes; Paper Bags; Brush Making; Pea Picking; Feather Sorting; Carding, etc., of Buttons, etc.; Stuffed Toys; Basket Making; Chocolates and Sweetmeats; Cosaques, Christmas Crackers, Christmas Stockings, etc ; Textile Weaving. No notices were served under Section 108 of the Factory and Workshops Act, for outwork being carried out in unwholesome premises. 4.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 8 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5, 1901) Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Other — Underground Bakehouses (s. 101):- In use at the end of the year 1 76 ISOLATION HOSPITAL. 79 ISOLATION HOSPITAL. Only 199 patients were admitted during 1925, as compared with 242 in 1924, 314 in 1923, and 411 in 1922. 94.4 per cent. of the cases of Diphtheria occurring in the district and 78.7 per cent. of Scarlet Fever were admitted to the Hospital. Owing to the delay in completing the extensions, one 27bedded ward could not be used during the autumn and winter months. This necessitated limiting the number of admissions to the hospital, and on 10th October, 1925, I sent a letter to the local doctors asking them not to recommend cases of Scarlet Fever for removal to the Hospital in which there was any doubt as to the diagnosis, or cases which could be satisfactorily nursed at home. Total number of patients admitted during 1925—199—as follows:— Scarlet Fever 111 Diphtheria 51 Tuberculous Diseases 28 Enteric Fever 2 Puerperal Fever 1 Under observation 6 Number of deaths in hospital, 4:— Tuberculous Diseases 3 Pneumococcal Meningitis 1 Number of patients in hospital on 1st January, 1925, and 1926, respectively:— 1st Jan., 1st Jan., 1925. 1926. Scarlet Fever 24 17 Diphtheria 10 14 Tuberculous Diseases 19 19 The average length of stay in Hospital was for:— Scarlet Fever 49.6 days. Diphtheria 53.9 days. Tuberculous Diseases 179.3 days. Average stay in hospital of all cases 58.5 days. The above averages are based on cases that completed their stay in Hospital during the year. 80 Average number of patients in Hospital per clay :—43.8. The following table shows the total admissions for the past ten years :— Year. Scarlet Fever. Diphtheria. Tuberculosis. Other Diseases. Total. 1916 122 119 61 15 317 1917 77 169 64 28 338 1918 74 166 73 34 347 1919 183 142 92 64 481 1920 225 185 70 26 506 1921 269 134 66 24 493 1922 162 147 73 29 411 1923 115 113 61 25 314 1924 129 72 28 13 242 1925 111 51 28 9 199 Scarlet Fever.—The 111 cases admitted to Hospital during 1925 were distributed among the following age groups :— Under 1 yr. 1—5 5-15 15—25 25—35 35—45 Over 45 — 14 78 13 3 2 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 :— 1921. 1922. 1923. 1924. 1925. — — .8 — — The following complications occurred in the patients admitted:— Rheumatism 9.0 per cent. Albuminuria 6.3 per cent. Adenitis 23.4 per cent. Otitis 18.9 per cent. Relapse 3.6 per cent. Endocarditis .9 per cent. Eight children were operated on for Adenoids, in order to clear up a persistent nasal discharge which might be infectious. 81 Diphtheria.—The 51 cases admitted to Hospital were distributed among the following age groups:- Under 1 yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 65. — 9 22 11 5 2 2 No death from Diphtheria occurred in the Hospital during the year. The following table shows the percentage death-rate of cases of Diphtheria admitted to the Ilford Isolation Hospital during the past five years:— 1921. 1922. 1923. 1924. 1925. 8.2 6.1 4.4 1.4 — Two slight cases of Paralysis occurred and two of Otorrhoea. One case was complicated with a diphtheritic conjunctivitis. Two children who persistently "carried" the Diphtheria organisms in their throat or nose had their tonsils enucleated and their adenoids removed by a throat surgeon with satisfactory results. Enteric Fever.-Two cases were admitted. Both made an excellent recovery. Puerperal Fever.—One case was admitted who had Puerperal Septicaemia and was desperately ill for some weeks. She was treated with serum and finally with blood transfusion from a blood "donor" provided by the British Red Cross, and made an excellent recovery after 17 weeks' stay in the Hospital, her convalescence being complicated by a thrombosis of the vein in one leg. Observation Cases.—Six cases were admitted. Three of these were "contacts" of a case of Diphtheria, whose swabs showed the presence of the Diphtheria bacillus. Further investigation showed that the organism present was avirulent and the patients were discharged. 82 One was admitted with Meningitis. Investigation showed that the case was not one of cerebro-spinal but of pneumococcal meningitis, and it had a fatal issue. One case was admitted as a doubtful case of Diphtheria and found to be simple tonsillitis, while another was infected with avirulent organisms. Both were discharged after a short stay in the Hospital. Tuberculosis.—28 new cases were admitted, as compared with a similar number in 1924. At the end of the year the following patients were in the Sanatorium:— Nature of case. Period in hospital. Spine 21 months. Spine 20 months. Lungs 16 months. Hip 16 months. Hip 11 months. Lungs and Hip 7 months. Lungs 6 months. Abdomen 6 months. Hip 6 months. Ankle 6 months. Lungs and Spine 5 months. Lungs and Hip 5 months. Lungs 3 months. Spine 3 months. Lungs 2 months. Hip and Kidney 2 months. Lungs 1 month. Lungs and Empyema 1 month. Glands of Neck 1 month. Of the 28 new cases admitted during 1925, 18 were cases of surgical tuberculosis, 4 of these being complicated with pulmonary tuberculosis also. The various organs involved were as follows:Hip 6, spine 4, ankle 1, testicle 1, abdomen 4, glands of neck 1, pleura 1. Three deaths occurred in the Sanatorium, one from pulmonary tuberculosis, one from tuberculosis of both kidneys, and the third from general tuberculosis after being in the Sanatorium only a fortnight. 83 Artificial Sunlight Treatment has been installed at the Sanatorium, the first treatment being given in October. Three lamps are used (a) the Tungsten arc lamp for local treatment, (6) the Jesionek mercury-vapour lamp, and (c) the Alpine Sun lamp. Both the latter lamps are for general exposure. A room in Block II. has been adapted as a treatment room. In addition, patients in the cubicles can be treated by the Alpine sun lamp, which can readily be taken about. The results have been satisfactory, the patients' general condition having undoubtedly improved by this treatment. In the summer, for the past two years, patients suffering from surgical tuberculosis have been exposed to natural sunlight with successful results. The instalment of the lamps has enabled treatment to be continued during the winter months. The treatment has been carried out under the general supervision of Sir Henry Gauvain, who visits the Hospital once a month. Training of Probationer Nurses.-The Isolation Hospital is recognised by the General Nursing Council as a training school, and during the past year the Probationer Nurses have been instructed in accordance with the syllabus of that Authority. Lectures have been given by the Medical Officers in anatomy and physiology, hygiene, and the infectious diseases, and in fever nursing by the Assistant Matron and Sisters at the Hospital. During 1925 six nurses passed Part I. of the examination and five obtained the certificate by completing Part II. Extension of Buildings.—The new Nurses' Home was completed during the year and was opened on 6th June by Sir Kingsley Wood, M.P., Parliamentary Secretary to the Ministry of Health. The cost of the extensions and alterations was contracted for at £21,733. The cost of furnishing the new ward and the Nurses' Home was approved by the Ministry of Health at £2,258. The scheme consisted in converting the old Nurses' Home into a ward of 26 beds and making additions to the building erected 84 originally for the purposes of a Convalescent Home, but used for some years past as sleeping quarters for the night nurses, into a Nurses' Home. This necessitated the erection of a new building of three storeys built against the eastern end of the old building, the latter becoming a back wing, while at the rear of the northern end of the new building another back wing was built to make up the necessary accommodation. The new Nurses' Home provides for 20 bedrooms on the first floor and 24 bedrooms on the second floor, with nurses', matron's and sisters' sitting-rooms on the ground floor, and on the ground floor of the old building a selfcontained flat for the Assistant Medical Officer of Health. The precise arrangements of the rooms will be seen by reference to the plans on pages 85-88. The new ward is a replica of the ward underneath it. A lift has been built for the conveyance of patients, etc., to the upstairs ward. There is a good deal of disadvantage in having a two-storied building in an Isolation Hospital, and the system would not have been adopted in this case had it not been necessary to find accommodation for the nurses, and it was felt desirable by the Ministry of Health to remove the nurses from being in a position over a ward. I may point out that this scheme provides only a portion of the increased accommodation which I recommended to the Council in 1920. I further recommended that a cubicle ward or wards should be provided. The necessity of such provision for observation cases has again been obvious during the year, and at the end of the year I was again instructed by the Public Health Committee to present a report on the question. 85 Ilford Urban District Council Isolation Hospital Site Plan 86 Ilford Urban District council EXTENSIONS TO ISOLATION HOSPITAL ADMINISTRATIVE BLOCK 87 88 Ilford Urban District Council extensions to isolation hospital WARD BLOCK No. 5 MATERNITY & CHILD WELFARE 91 Notification of Births Acts, 1907 and 1915. By the Notification of Births Acts, 1907 and 1915, all live births and stillbirths of seven months and over must be notified to the Medical Officer of Health within 36 hours. The number of births notified under the above Acts during 1925 was 1,395 (746 males and 649 females). In addition 27 stillbirths (13 males and 14 females) were notified. The percentage of births notified by the various responsible persons was as follows By Medical Practitioners 23.30 By Certified Midwives 45.09 By Parents and others 31.61 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 1,486 (797 males and 689 females) births were registered, giving a birth-rate of 16.5 per 1,000 persons calculated on the net population, as compared with 1,436 births with a birth-rate of 16.2 per 1,000 persons in 1924. Infant Mortality. The number of infants dying within the first year of life was 78, the total number born being 1,486. The infant mortality or rate of death per 1,000 births was, therefore, 52.5. The infant mortality rate for the district is, strictly speaking, higher than it should be, from the fact that 7 deaths of babies in the Girls' Village Homes, Barkingside, are included, although the children concerned were not born in Ilford. 92 If the deaths of babies in the Girls' Village Homes are excluded there remains an infant mortality rate for the district of 47.8 per 1,000 births. There has, however, been a rise of 9 per 1,000 in the infant mortality rate. It will be seen by reference to Table IV, page 97, that there were 8 more deaths from gastritis and enteritis than occurred in 1924, 3 more deaths from prematurity and congenital malformations, and 3 more deaths from debility and other causes, while 2 more deaths occurred from injury at birth. Five of the deaths from gastritis and enteritis took place in a small epidemic which occurred in Romford Infirmary. The comparative figures for previous years were as follows: Year. No. of Deaths under 1 year. Rate per 1,000 Registered Births. 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 1925 78 52.5 The infant mortality rate for 1925 for Ilford compares favourably with that of 75 for England and Wales, 67 for London, and 79 for the 105 towns having a population exceeding 50,000. The following table compares the Infant Mortality in Ilford with that in other extra London areas:- Croydon 52 West Ham 58 Willesden 67 East Ham 61 Tottenham 62 Wimbledon 64 Enfield 58 Walthamstow 57 Leyton 66 Ealing 45 Acton 81 Hornsey 47 Ilford 53 93 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. 1925. 1924. 1923. Cranbrook M. 58 4 69.0 63.5 28.3 39.3 F. 68 4 58.8 Park M. 104 4 38.5 41.4 59.2 55.9 F. 65 3 46.2 Seven Kings M. 71 6 84.5 47.6 34.5 29.3 F. 76 1 13.2 North Hainault M. 95 4 42.1 58.8 71.9 24.1 F. 75 6 80.0 Loxford M. 100 6 60.0 64.9 37.2 33.1 F. 85 6 70.6 Clementswood M. 127 7 55.1 47.0 29.7 45.4 F. 128 5 39.1 South Hainault M. 192 8 41.7 44.5 49.3 42.6 F. 145 7 48.3 If the deaths of infants occurring in the Village Homes, Barkingside (3 males and 4 females), are added to the infant deaths occurring in the North Hainault Ward, there is an infant mortality rate of 100 (71.6 M. and 133.3 F.) per 1,000 births for that ward. The above table only accounts for 1,389 of the 1,486 total births registered and belonging to the district. The remaining 97 are included by the Registrar-General as belonging to Ilford, but have not been allocated by him to the various wards. 35 births were registered in this district belonging to other areas. These have not been included in the foregoing figures. An analysis of the figures in the foregoing table will show that the infant mortality has risen in the Cranbrook, Seven Kings, Loxford, and Clementswood 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 8 infant deaths. 1 died within 48 hours of birth. 1 died at 17 days from marasmus and convulsions (coma). 1 died at 2 months from gastro-enteritis (in Romford Infirmary). *1 died at 2 months from marasmus and bronchitis. 1 died at 3 months from gastro-enteritis (in Romford Infirmary). 94 *1 died at 4 months from influenza, bronchitis and bronchopneumonia. 1 died at 7 months from gastro-enteritis (in Romford Infirmary). 1 died at 11 months from tubercular meningitis and generally disseminated tuberculosis. * These children had attended an infant welfare centre. In the Park Ward there were 7 infant deaths. 3 died under one week. 1 died at 7 days from premature birth and atelectasis. 1 died at 11 days from convulsions. *1 died at 7 months from broncho-pneumonia. *1 died at 8 months from enteritis and broncho-pneumonia. * These two children had attended infant welfare centres. In the Seven Kings Ward there were 7 infant deaths. 2 died shortly after birth. 1 died at 9 days from spina bifida and meningitis. 1 died at 10 days from cerebral injury during labour and fits. 1 died at 19 days from premature birth. *1 died at 3 months from infantile asthenia and gastroenteritis. 1 died at 9 months from acute pneumonia. * This child had attended an infant welfare centre. 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. 1 died at 17 days from enteritis and convulsions. 1 died at 20 days from premature birth and convulsions. *1 died at 7 months from acute bronchitis and bronchopneumonia. *1 died at 8 months from broncho-pneumonia. 1 died at 10 months from gastro-enteritis (in Romford Infirmary). *1 died at 10 months from marasmus and convulsions. * The latter two of these children had attended an infant welfare centre in Ilford; the former, however, attended a centre at Islington only. In the Loxford Ward there were 12 infant deaths. 1 died shortly after birth. 1 died at 16 days from broncho-pneumonia. 1 died at 19 days from bronchitis. 1 died at 25 days from marasmus. 1 died at 25 days from enteritis and heart failure. 1 died at 26 days from inanition and premature birth. 1 died at 2 months from scrotal fistula, broncho-pneumonia, and thrombosis of cerebral sinuses. *1 died at 2 months from bronchitis and cardiac failure. *1 died at 3 months from catarrhal gastro-entero-colitis. *1 died at 5 months from broncho-pneumonia. 1 died at 10 months from dentition, convulsions and pneumonia. *1 died at 10 months from broncho-pneumonia and cardiac failure. * These children had attended infant welfare centres. 95 In the Clements wood Ward there were 12 infant deaths. 4 died within 24 hours. 1 died at 1 day from premature birth. 1 died at 2 days from premature birth. 1 died at 16 days from whooping cough and bronchitis. *1 died at 2 months from pyloric stenosis and wasting. 1 died at 5 months from asthma and broncho-pneumonia. *1 died at 6 months from acute bronchitis. 1 died at 10 months from broncho-pneumonia. 1 died at 11 months from tubercular meningitis. * These children had attended an infant welfare centre. In the South Hainault Ward there were 15 infant deaths. 2 died shortly after birth. 1 died at 11 days from weakness and jaundice. 1 died at 13 days from acute enteritis and acute pneumonia. 1 died at 18 days from congenital depression on the left side of skull and convulsions. 1 died at 3 weeks from meningeal haemorrhage due to injuries received during difficult labour accidentally. 1 died at 1 month from debility and marasmus. 1 died at 2 months from congenital malformation of heart and bronchitis. 1 died at 3 months from acute nephritis. *1 died at 3 months from broncho-pneumonia and cardiac failure. 1 died at 5 months from infective enteritis. 1 died at 5 months from broncho-pneumonia and cardiac failure. 1 died at 6 months from gastro-enteritis (in Romford Infirmary). 1 died at 6 months from broncho-pneumonia. *1 died at 7 months from gastro-enteritis and toxæmia. * The first of these two children had attended an infant welfare centre in this district, but the latter attended a Romford welfare centre only. It will be seen that of the 78 infants who died under 1 year of age, only 16 had attended infant welfare centres, and of these 2 attended Centres in other districts only, while in some cases only one attendance was made. Thirty-seven, 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. The mortality of infants under one year attending Ilford infant welfare centres was 29.5 per 1,000, as compared with 56'3 per 1,000 in those not attending a welfare centre (excluding the deaths of those children dying in the Girls' Village Homes). 96 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. It would be a fairer comparison to state that of the 41 children who died between the age of one month and one year, (all of whom might have been in attendance at a welfare centre), only 16 had attended an infant welfare centre, or in other words that 61 per cent. of the deaths of children between one month and one year of age occurred in children who had never attended an infant welfare centre. Neonatal Mortality. The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 37 deaths of infants under 4 weeks of age during 1925, and the rate for the year was 24.9 per 1,000 births. The following table shows the neonatal death-rate in Ilford compared with that for England and Wales during the previous 10 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 1924 19.5 33 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. 97 Table IV.—Infant Mortality. 1925. 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 pnd under 12 months Total Deaths under 1 Year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... l l Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... l ... l ... ... ... ... l Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... 2 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... 1 ... ... l ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... l ... 1 ... ... 2 ... 4 Pneumonia (all forms) ... ... 1 ... 1 ... 3 3 ... 11 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... 1 1 1 3 ... 2 1 ... 6 Gastritis ... ... ... ... ... 1 2 3 1 7 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation (overlying) ... ... ... ... ... ... ... ... ... ... Injury at birth 1 l ... 1 3 ... ... ... ... 3 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... l l ... 2 3 ... ... ... 5 Premature birth 15 l 2 ... 18 ... ... ... ... 18 Atrophy, Debility and Marasmus ... 1 1 2 4 3 2 2 1 12 Other Causes 3 ... ... ... 3 ... 4 ... ... 7 Totals 19 6 8 4 37 8 13 11 9 78 98 Illegitimate Births and Deaths. 49 of the births registered (30 males and 19 females) were illegitimate, that is 3.37 per cent. of the births registered. 11 illegitimate children died under 1 year of age. 2 of these children (1 male and 1 female), however, were in the Girls' Village Homes, Barkingside, and should, strictly speaking, not be included in the death-rate of Ilford infants, although so included by the Registrar-General. The deaths of the 11 illegitimate children occurred as follows;- 1 (aged 6 days), was born and died in the Salvation Army Hospital, Clapton, from premature birth. 1 (aged 9 days) was born and died in the Mothers' Hospital, Clapton, from spina bifida and meningitis. 1 (aged 17 days) was born and died in the Mothers' Hospital, Clapton, from enteritis and convulsions. The mother only resided temporarily in this district. 1 (aged 5 months) died in the Girls' Village Homes, Barkingside, from marasmus and otitis media. 1 (aged 9 months) died in the Girls' Village Homes, Barkingside, from measles, broncho-pneumonia, and otitis media. 1 (aged 10 months) died in the Romford Infirmary from gastro-enteritis. This child was an inmate of the Girls' Village Homes, Barkingside. 1 (aged 2 months) died in the Romford Infirmary from gastro-enteritis. This child was born in the Old Church Hospital, Romford. 1 (aged 3 months) died in the Romford Infirmary from gastro-enteritis. 1 (aged 6 months) was admitted to the Romford Infirmary when 3 days old, and remained there until it died from bronchopneumonia. 1 (aged 6 months) was born and died in the Romford Infirmary from gastro-enteritis. 1 (aged 10 months) was born and died in the Romford Infirmary from broncho-pneumonia. None of the 11 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, 163 per 1,000, compared with the infant mortality rate (exclusive of those children dying in the Girls' Village Homes) of 43.5 for legitimate children. If the deaths of infants in the Girls' Village Homes are included, there is an illegitimate infant mortality rate of 224 per 1,000, and 99 46 per 1,000 for legitimate children. The following table shows the death-rate of illegitimate and legitimate infants for the past ten years:— Year. Illegitimate Infants. Legitimate Infants. Births. Deaths. Rate per 1,000 Illegitimate Births. Births. Deaths. Rate per 1,000 Legitimate Births. 1925 49 11 224 1,437 67 46 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 1919 64 10 156 1,103 61 55 1918 45 13 288 1,008 60 59 1917 53 9 170 1,123 73 65 1916 43 8 186 1,447 81 56 Maternal Mortality. The total number of deaths due to childbirth during the year was four, which gives a maternal mortality rate (i.e., number of deaths per 1,000 births) of 2.69. The following table gives the maternal mortality rate for Ilford and England and Wales for the past ten 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. 1924 - 1 1436 0.69 3.70 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 3.94 100 One death was due to Puerperal Fever; the woman's confinement and subsequent death took place at her own home. Two other deaths took place from Pulmonary Embolism, one being subsequent on a miscarriage; the remaining death was due to haemorrhage during pregnancy. 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 in operation. No death of a nurse-child occurred in the Ilford district during the year. I am not satisfied that foster-children should be allowed to remain with foster-mothers who have to apply for free milk owing to the unemployment or necessitous condition of their own family, and on the instructions of the Committee can refer such cases where necessary to the Ministry of Health. 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, 1925 27 Number of foster-children who were notified to me during 1925 39 Number of foster-children returned to their mothers during 1925 8 Number of foster-children taken off the records for various other reasons during 1925 9 Number of foster children on records on 31st December, 1925 49 101 Foster-Mothers . Number of foster-mothers on records on 1st January, 1925 22 Number of persons who became foster-mothers during 1925 23 Number of persons whose names were taken off records during 1925 10 Number of foster-mothers on records on the 31st December, 1925 35 Houses Visited by Sanitary Inspectors. Number of houses visited by the Sanitary Inspectors for the purpose of the Act during the year 1925 26 Number of visits made by the Sanitary Inspectors for the purpose of the Act during the year 1925 87 Number of notices served by the Sanitary Inspectors for the purpose of the Act during the year 1925 7 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 1925 as far as the Maternity and Child Welfare work is concerned:— First visits to newly-born infants 1,576 Subsequent visits to children under 1 year of age 4,182 Subsequent visits to children over 1 year of age and under 5 10,384 Visits to expectant mothers 324 Home visits for other reasons 556 Total visits paid 17,022 Supervision of Midwives. There are nine certified midwives resident and practising in the district (apart from those at the Maternity Home). Unfortunately under the Midwives' Act, 1918, Section 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. 102 Two unqualified women were reported to the County Medical Officer of Health for attending a confinement contrary to the regulations of the Midwives' Acts, one of whom was convicted for so doing, and fined £2. Supply of Milk to Expectant and Nursing Mothers and for Infants. Under the Regulations of the Ministry of Health, during 1925, 162 mothers and infants were supplied with cow's milk free, 47 with dried milk, and 8 with condensed milk. A total of 12,870¾ quarts of cows' milk, 1,379 lbs. of dried milk, and 138 tins of condensed milk, was given free under the Regulations. In 1924, 214 mothers and infants were supplied with cows' milk, 51 dried milk and 11 with condensed milk. There is, therefore, a considerable reduction in the number of applicants for free milk. The amount, however, supplied has risen, being 10,704¼ quarts, 1,108 lbs., and 290 tins of each kind of milk in 1924. Infant Welfare Centres. As mentioned in my report for 1924, owing to the overcrowded condition of the Cecil Hall Centre held on Thursday afternoon, it was found necessary to divide the district served by this Centre into two sections, one section attending a new session arranged for Thursday morning, and the other section attending the usual afternoon session. This system has been in operation since February. As reported in 1924, it was found necessary to consider the question of appointing a new Assistant Medical Officer of Health in order to cope with the increase in the work, and during 1925 this appointment was made, Dr. Evans taking up his duties in September. The new Assistant Medical Officer in addition attends daily at the Maternity Home and assists with a portion of the school medical work. 103 Arrangements were made during the year for two doctors to be in attendance at the Seven Kings and Albert Road Welfare Centres at each session, in order to relieve the overcrowding at those centres. Ilford Lane Centre is still considerably overcrowded, and it will be necessary for two doctors to attend here also. Further centres will soon be required in order to cope with the ever-increasing influx of population in those parts of the district where new houses are rapidly being erected. 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 1925 £30 had been saved by 50 mothers. During the year the following attendances were recorded:— Figures for 1925. 1924. Total number of attendances of infants 24,245 20,988 First attendances 1,420 1,403 Total number of children on roll Decem31st, 1925, after omission of all those who had not attended for six months 1,608 1,508 Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. First Attendances— 152 107 128 88 103 109 137 114 *144 178 101 59 Subsequent Attendances- 1969 1648 1903 1839 1724 1412 2191 1426 2059 2948 2078 1628 The following is a comparison of the attendances at Infant Welfare Centres for the past eight years:— Total No. of attendances of infants. First attendances. Total No. of children on roll on 31st December. 1918 3,469 430 — 1919 5,643 629 652 1920 12,311 876 925 1921 14,492 909 1,017 1922 15,529 1,126 1,137 1923 18,600 1,284 1,371 1924 20,988 1,403 1,508 1925 24,245 1,420 1,608 104 383 sessions were held during the year, and the average attendance at each session was 63.30 mothers with their infants. The following are the figures for each Centre:— Sessions. Average attendance. Seven Kings 49 78.45 Goodmayes 48 42.45 Newbury Park 49 42.32 Albert Road 49 86.61 Park and Cranbrook (morning) 43 59.49 Park and Cranbrook (afternoon) 48 69.45 Ilford Lane 49 77.78 Becontree 48 48.66 Ante-Natal Clinic.—The Ante-Natal Clinic was continued at the Public Health Offices during the year, and the following; attendances have been recorded:— First attendances 344 Subsequent attendances 823 Number of expectant mothers on the roll on 31st December, 1925 115 The following is a comparison of the attendances for the past five years:— First Attendances. Subsequent Attendances No. of expectant mothers on the roll on 31st December. 1921 198 454 53 1922 165 402 36 1923 207 495 38 1924 282 564 70 1925 344 823 115 All patients entering the Maternity Home, who are to be attended by a midwife, are medically examined at the Ante-Natal Clinic. Now that the New Maternity Home has been erected arrangements are being made for the transference of the Ante-Natal Clinic from the Public Health Department to the Maternity Home. 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 1925. 105 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 1925 203 Number of attendances of mothers 330 Number of mothers, having teeth extracted, to whom "general" anæsthetios were given 91 Number of mothers, having teeth extracted, to whom "local" anæethetios were given 9 Number of mothers having teeth filled or otherwise treated 117 Number of mothers having dentures supplied 24 Number of mothers having part dentures supplied 3 (b) Treatment of Children under 5 years of age. Number of children treated 89 Number of attendances of children 99 Number of children, having teeth extracted, to whom ''general'' anæsthetics were given 77 Number of children having teeth filled or otherwise treated 16 The following are the figures for the past five years:— 1921. 1922. 1923. 1924. 1925. Number of mothers treated 211 167 194 188 203 Number of children treated 25 26 34 87 89 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 1925:— (a) Number of children for whom spectacles were prescribed and provided 15 (b) Number of children examined by Oculist for whom spectacles were not prescribed 16 106 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 1924 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 this service since its commencement in 1924:— 1924. 1925. (a) Number of mothers for whom spectacles were prescribed and provided 13 12 (b) Number of mothens to whom prescriptions only were given 3 — (c) Number of mothers examined by Oculist for whom spectacles were not prescribed 6 4 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. The following is a comparison of the number of children treated since the commencement of this work in 1920:— No. for whom spectacles were provided. No. for whom spectacles were not provided. 1920 — 3 1921 8 3 1922 7 3 1923 14 9 1924 28 18 1925 15 16 107 Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 146 belts have been supplied to infants suffering from hernia during the year 1925. 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 44 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. 7 children were treated free during the past year, and 6 were treated at a reduced fee. MATERNITY HOME. During 1925, 215 women were admitted into the Home as compared with 191 in 1924, 205 in 1923, 204 in 1922, 198 in 1921, 169 in 1920, and 139 in 1919. 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. 108 During the year 12 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. The patients were admitted to the Home from the following' wards:— Cranbrook 23 Park 31 Seven Kings 22 North Hainault 21 Loxford 37 Clementswood 45 South Hainault 25 Eleven patients were admitted from outside the district on the recommendation of the Maternity and Child Welfare Committee. At the end of the year 99 cases were booked for future admission to the Home. The average number of patients in the Home per day during 1925 was 8'62, and the average length of stay of patients 13'93 days. Of the 215 cases admitted during 1925, 213 were confined in the Home, and two were admitted as cases of threatened premature labour. Of the 213 confinements, 40 women had engaged their own doctor. Four cases were, however, delivered by a midwife, the doctor not being present at the birth. 173 were attended by one of the midwives at the Home. It was necessary to call in a doctor in 59 of the latter cases, owing to the following complications:— Albuminuria 6 General condition of mother 3 (a) Ante-natal 12 Contracted pelvis 2 Ante-partum haemorrhage and mitral regurgitation 1 Promolonged labour 13 Secondary uterine inertia 3 During labour 21 Foetal distress 2 Extended breech 2 Bartholinitis 1 109 Ruptured perineum 14 Retained maternal surface 2 After labour 20 Post-partum haemorrhage and adherent placenta 2 Severe internal laceration 1 (?) Placenta complete Feebleness of infant 3 (d) for infant 6 Talipes 3 There were 5 deaths of infants in the Home:— Two infants (twins) died, one after 5 hours, and the other after 19 days, from prematurity. The electric incubator was used. One infant died at ¾ hours from prematurity; white asphyxiated at birth. One infant died after 54 hours from eclampsia and convulsions; the mother was suffering from albuminuria. One infant, blue asphyxiated at birth, died after 1 hour from hypertrophy of liver and spleen, and general weakness and heart failure. There were 5 stillbirths in the Home from the following causes:— Macerated foetus 2 Cause unknown 2 General oedema 1 The infant mortality rate of children born in the Maternity Home during the year was 23.92 per 1,000 births, as compared with 58.10 for those born in their own homes. The figure of 58.10 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. The following table compares the infant mortality in the Maternity Home and in the district generally for the past 5 years:— Maternity Home. District generally. 1925 23.92 58.1 1924 16.0 45.7 1923 15.3 40.4 1922 25.6 56.3 1921 20.5 52.4 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. Cases for free admission are referred to the Maternity and Child Welfare Committee. 110 The following table shows in extenso the fees which were paid by women admitted to the Home:— 2 mothers were admitted free of charge. 3 „ „ at a fee of 10s. per week. 2 „ „ „ 15s. „ 24 „ „ „ 20s. „ 8 „ „ „ 25s. „ 22 „ „ 30s. „ 1 mother was admitted at a fee of 32s. 6d. „ 11 mothers were admitted at a fee of 35s. „ 2 „ „ „ 40s. „ 65 „ „ „ 42s. „ 8 „ „ „ 45s. „ 7 „ „ „ 50s.„ 7 „ „ „ 52s. 6d. „ 5 „ „ „ 55s. „ 2 „ „ „ 57s. 6d. „ 1 mother was admitted at a fee of 60s. „ 12 mothers were admitted at a fee of 63s. „ 1 mother was admitted at a fee of 67s. 6d. „ 1 „ „ „ 70s. „ 5 mothers were admitted at a fee of 73s. 6d. „ 3 „ „ „ 80s. „ 8 „ „ „ 84s. „ 1 mother was admitted at a fee of 90s. „ 2 mothers were admitted at a fee of 94s. 6d. „ 1 mother was admitted at a fee of 100s. „ 11 mothers were admitted at a fee of 105s. „ Of the above, 2 cases admitted for a short period for observation and treatment prior to confinement, were charged a special fee of 15s. per week in one case and 21s. per week in the other. 159 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; 2 who were engaged during the year were successful in passing the examination of the Central Midwives Board. District Midwife.—Miss Butcher terminated her duties as District Midwife on the 31st October, on taking up, an appointment in another district, and Miss Gambrill was appointed as District Midwife as from the 1st November. 111 During 1925 the District Midwife attended 95 cases; of these 28 were delivered by doctors and 67 by herself. A doctor was called in, however, in 22 of the latter cases for the followingcauses:— (а) Ante-natal Nil. Foetal distress 3 (b) During labour 7 Prolonged labour 2 secondary uterine inertia 1 Miscarriage 1 Ruptured perineum 5 Post-partum hæmorrhage 2 (c) After labour 11 Varicose veins 2 Discharging eyes 1 Adherent placenta 1 Stillbirths 2 (d) For infant 4 Macerated foetus 1 Feebleness of infant 1 The 95 cases attended were in the following wards Cranbrook, 10; Park, 14; Seven Kings, 9; North Hainault,31; Loxford, 14; Clementswood, 16; South Hainault, 1. One case booked for attendance by the District Midwife was admitted to the Home. Of the infants born there were 4 stillbirths due to the following causes:— Macerated foetus 2 Premature birth 1 Unknown cause 1 One infant died within a few hours of birth from status lymphaticus, a doctor being in attendance. New Maternity Home.—The new Maternity Home which was commenced on the 6th March, 1924, was completed towards the end of 1925, and it was arranged for Her Royal Highness Princess Beatrice to perform the opening ceremony on January 14th, 1926. It will be remembered that three acres of ground were purchased for this purpose in September, 1920, at a cost of £1,130. The contract price for erecting the buildings was 112 £25,050, and the total cost of furnishing the Home was £3,480. It will be seen from the plans on pages 113 and 115 that the buildings consist of a Nurses Home occupying a central position 50 feet from the roadway connected by a covered way with a Ward Block to the left of the Nurses Home. The Ward Block has accommodation for 27 patients. On the ground floor is one three-bedded ward, one two-bedded ward, two one-bedded wards, one four-bedded ward, and one two-bedded ward; the first five wards communicate with the verandah in front of the buildings. On the first floor there is a babies' ward, one two-bedded ward, two one-bedded wards, one four-bedded ward, and one two-bedded ward; the first five of these wards have access to a verandah. In addition to these wards on each floor is a labour room with sterilizing room adjoining and on the first floor are two separation wards. The Ante-Natal Clinic consisting of a waiting-room and doctor's room is placed on the ground floor near the entrance of the ward block, but separated from the remainder of the building by swing doors. The accommodation of the Nurses Home besides sitting room and dining room accommodation for matron, nurses, and maids, contains on the first and second floors, twelve single bedrooms, and four double bedrooms for the nursing domestic staff. Besides the Nurses Home and Ward Block in the North West angle of the site is a small laundry, and on the Western boundary is a coal store. 113 Ilford. Urban. district. Council. • NEW MATERNITY HOME • 115 SCHOOL MEDICAL SERVICE. 119 1. Staff.—Dr. G. M. Evans, newly-appointed Assistant Medical Officer, one-quarter of whose time is devoted to the work of the School Medical Service and three-quarters to that of Maternity and Child Welfare, commenced his duties on the 7th September. With this exception the Medical Staff continued unchanged. 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 36 departments. The schools have accommodation for 14,305 scholars, and 11,411 were actually on the rolls on December 31st, 1925. The temporary school at St. Thomas' Church, Becontree, was closed on the 29th May, and the new school at Stevens Road, Becontree, was opened as follows:—Lower Department on the 3rd June, Middle Department on the 10th June, Upper Boys' and Upper Girls' on the 24th August. The School has: Accommodation for Attendance roll Upper Boys' Dept. 250 children 224 children Upper Girls' Dept. 250 „ 243 „ Middle Dept. 350 „ 424 „ Lower Dept. 350 „ 500 „ Mossford Lodge School (Dr. Barnardo's Girls' Village Home, Barkingside), not included in the above figures, has accommodation for 840 children, with an attendance roll of 733 children. This school was taken over by the Education Authority on the 1st April, 1924. The arrangements for the medical inspection and treatment of children attending this school have not yet been completed. 4. Medical Inspection.—This has been carried out in accordance with the Board of Education (Special Services) Regulations, 1925, dated the 18th August, 1925, Section 17 of whi'^i states:— 120 The Authority must provide for the medical inspection of all children in Public Elementary Schools as soon as possible in the twelve months following— (a) their first admission to Public Elementary Schools, and (b) their attaining the age of eight years, and (c) their attaining the age of twelve years. Details of the system adopted are given in the Annual Report for 1920. During 1925 the number of visits made by the Medical Officers to 36 different departments of 15 schools for the purposes of routine medical inspection was 291. The number of children examined during the year, falling within the above age groups, totalled 4,545 (2,348 boys and 2,197 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 1925, 165 such children (70 boys and 95 girls) were examined. 1,587 reexaminations (841 boys and 746 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 6,297 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 350 children out of a total of 4,545 (or 7.7 per cent.) were found to have nits or vermin in their hair, while only 6 (or .1 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 128, 121 (b) Tonsils and Adenoids.—876 children (or 19.2 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.—22 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.—1 case of Scabies (Itch), 29 of Impetigo, and 28 cases of other diseases of the skin were discovered at routine medical inspection. (e) External Eye Disease.—41 cases of Blepharitis, i.e., inflamed eyelids, and 11 cases of Conjunctivitis were discovered. (f) Vision.—539 children (or 11.8 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 125. 93 per cent. of the cases received treatment from the School Oculist. (g) Ear Disease and Hearing.—23 children (or .5 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. 1 child was found suffering from a discharge from the ear, due to an old otitis media. (h) Dental Defects.—354 (or 7.7 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 152, Table IV. (Group IV.). (i) Deformities.—12 children were found to be suffering from slight spinal curvature, and 67 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. 122 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. 1917 57 104 1115 1918 49 115 151 1919 165 78 645 1920 154 130 790 1921 202 105 108 1922 116 82 893 1923 79 61 174 1924 85 28 1026 1925 93 22 484 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:—Barkingside, Christchurch Road, Cleveland Road, Highlands, Loxford, Newbury Park, and Uphall. No schools were closed during the year on account of infectious disease. Tables VII. to XIII. show the incidence of each infectious disease in the Ilford Schools during 1925. (a) Scarlet Fever.—93 cases were reported in 1925 compared with 85 in 1924. (b) Diphtheria.—22 cases were reported in 1925 as compared with 28 in 1924. The number of cases for 1925 is the lowest ever recorded in this district. (c) Measles and German Measles.—484 cases were notified from the schools in 1925 compared with 1,026 during 1924. (d) Chicken Pox, Whooping Cough and Mumps.—450 cases of Chicken Pox occurred in 1925 as compared with 182 in 1924; 348 cases of Whooping Cough in 1925 as compared with 161 cases in 1924; and 563 cases of Mumps in 1925 as compared with 120 in 1924. 1,537 home visits were paid by the Health Visitors in connection with cases of minor infectious disease. 123 11 school children were X-rayed at the Clinic during the year. The following is a copy of the report I presented to the School Attendance Sub-Committee at their meeting on the 23rd November, 1925:— "I have to report that there are no cases of ringworm of the scalp at present known to me in the Ilford schools. This is the first occasion on which such a report has been possible. Before medical inspection commenced, i.e., 17 years ago, there were 135 cases recorded, causing long periods of absence from school. "I think the present state of affairs justifies the action of the Committee— "First.—In excluding all children suffering from ringworm of the scalp from school until certified free from infection. "Second.—In refusing to recognise any medical certificate of freedom of infection, other than that of the School Medical Officer. "Third.—In instituting and pressing X-ray treatment as the only satisfactory method of an early cure of this complaint. "The fact also that, with an increased staff of School Nurses, very many more inspections of the heads of school children have been possible than previously, has had a considerable influence in this result. "Cases of ringworm of the scalp will no doubt still be reported at future meetings of the Sub-Committee, but the state of things which existed when medical inspection was first instituted should never recur in this district." 7. Following Up.—This has been carried out in the manner described in my previous reports. During 1925, 3,719 home visits by the Nurses were paid for the purpose, and 1,587 children were re-examined by the doctors at school. 8. Medical Treatment.— The School Clinic was moved from the very unsatisfactory premises in Oakfield Road to Valentines Mansion on 17th March. (e) Ringworm.— No. of cases at beginning of 1925 No. of cases reported during 1925. Total. Remedied during 1925. No. of cases under observation at end of 1925. Ringworm:— Scalp 5 11 16 14 2 Body — 10 10 10 — 5 21 26 24 2 124 Here provision has been made for (1) a large waiting-room, (2) treatment-room for minor ailments and dark-room for oculist, (3) cleansing-room with bath, etc., and accommodation for X-ray treatment of ringworm, (4) waiting-room for dental cases, (5) dental surgery, (6) recovery-room for children after dental extractions. Some fears were expressed at first that the Valentines Mansion was unsuitably situated for the purpose, but it will be observed that the number of children seen at the morning clinic has increased with the new accommodation provided. (a) Minor Ailments.—The attendances at the morning Clinic during 1925 were as follows :— Number of individual children seen at the Clinic 2,322 Number of attendances of children 6,872 Number of exclusion certificates granted 3,237 Number of certificates of fitness to attend school granted 1,708 The following table shows the variety of conditions dealt with at the School Clinic during the year:— Malnutrition 1 Defective Footgear 10 Uncleanliness:— Head 166 Body 6 Skin:— Ringworm:— 11 Head Body 10 Scabies 5 Impetigo 245 Other diseases 137 Eye:— Blepharitis 27 Conjunctivitis 30 Corneal Ulcer 3 Defective Vision and Squint 123 Other conditions 48 Ear:— Defective hearing 9 Otitis Media 1 Other Ear Diseases 72 Nose and Throat:— Enlarged Tonsils 29 Adenoids 61 Enlarged Tonsils and Adenoids 339 Other conditions 134 Mouth Breathing 86 125 Enlarged Cervical Glands 50 Teeth—Dental Diseases 143 Heart and Circulation:— Organic 4 Functional 5 Anæmia 65 Debility 140 Infectious Diseases:— Scarlet Fever 3 Diphtheria 1 Whooping Cough 21 Mumps 71 Chicken Pox 17 Measles 7 Influenza 32 Colds 187 Lungs:— Bronchitis 51 Other Non-Tubercular Diseases 58 Tuberculosis:— Pulmonary:— Definite 1 Suspected 5 Non-Pulmonary:— Lupus 1 Nervous System:— Chorea 6 Other conditions 10 Deformities 16 Minor Injuries 149 Other Defects and Diseases 574 Total number of ailments 3,159 The following table shows the number of children dealt with at the School Clinic during the past seven years:— 1920 1921 1922 1923 1924 1925 Number of individual Children seen 962 1,763 2,009 1,730 1,829 2,158 2,322 (b) Ophthalmic Department.—During the year 1925 the School Oculist held 78 sessions for the refraction of children suffering from defective vision. Full details of the work are given in Table IV., Group II, on page 151. 679 school children were examined, 67 of these being cases from 1924. 126 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 1925 679 Of the 679 cases, 560 were referred from medical inspection, and 119 from the School Clinic. The 679 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 6/0 112 211 88 107 64 61 32 4 The children who saw 6/6 (practically normal vision) were suffering from symptoms such as headaches, inflamed eyelids, etc., which rendered further examination necessary. Of the 679 children examined, 537 were found to require spectacles by reason of the following defects:— Myopia 46 Myopic Astigmatism 70 Hypermetropia 182 Hypermetropic Astigmatism 151 Mixed Astigmatism 49 Anisometropia 14 Hypermetropia with Squint 25 Total 537 Of the remaining 142 children, 10 were suffering from the following other diseases:— Corneal Ulcers, Nebulae, etc. 3 Nystagmus 1 Persistent Pupillary Membrane 1 Congenital Capsular Opacities 2 Other Diseases 3 Total 10 127 72 children were found not to require spectacles, and in 60 cases the lenses already in use were found not to require changing. A number of children (21) were kept under observation and were re-examined during the year, the spectacles being changed in 6 instances. Under the Education Committee's scheme 537 pairs of spectacles were provided. Of this number, 33 pairs of spectacles were provided free and 5 pairs at a reduced charge, on necessitous grounds. In addition, spectacles were renewed or repaired in 172 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 95 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 7,594 children inspected by the Dentist, 4,272, or 56 per cent., were found to require treatment. Only 47.6 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. It is clear that parents in Ilford do not realise the amount of ill-health, if not actual disease, which might be saved their children if their teeth were put in a healthy condition at an early age. In 1924, 62 per cent., in 1923, 53.3 per cent., in 1922, 41.1 per cent., in 1921, 50.6 per cent. acceptances of treatment were received. The considerable amount of dental disease present in children is shown by a perusal of the following table relating to school children inspected in the routine age groups by the School Dentist:— 128 Age groups (in years). No. inspected. No. referred for treatment. Percentage 5 692 407 58.81 6 617 344 55.75 7 623 403 64.68 8 814 504 61.91 9 1,031 571 55.38 10 1,137 583 51.27 11 830 450 54.21 12 703 356 50.64 13 589 271 46.01 14 248 110 44.35 15 69 32 46.37 Specials 241 241 100.00 Totals 7,594 4,272 56.25 Full details of the dental work can be seen in Table IV., Group IV., on page 152. (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 24 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 130 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. 34,088 1,412 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 1925 4 No prosecutions were instituted during 1925 under Section 87 of the Education Act, 1921. On the 8th December, 1924, I reported to the School Management Committee that it was necessary occasionally to 129 pulsorily cleanse the heads of certain children, and that when the weather is inclement or where the schools are far distant, it is sometimes difficult to convey these children to the school clinic. It was pointed out the undesirability of these children travelling in a tram-car or other public vehicle. The Committee decided that No. 2 town-ambulance van should be used for this purpose, the necessary charge to be borne by the Education Committee. During 1925 the ambulance was used on 12 occasions for this purpose. (e) Other Ailments.—During the past year 238 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. 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. 46 children were treated free during the past year, and 38 at a reduced charge. In addition to the treatment of tonsils and adenoids 158 letters were given to Ilford school children, for whom hospital treatment was required, to attend at Queen Mary's Hospital. 9. Open-Air Education.—The hope expressed in my last Annual Report, that the scheme for an open-air school—which has been under consideration since January, 1924——would materialise during 1925, has not yet been realised. 130 A certain amount of progress has been made. On the 16th February a joint report was presented to the Special School Provision Sub-Committee with reference to the provision of an open-air school. On the 13th July plans, designed to provide facilities on the lines of those of the Knowle (Bristol) Day Open-Air School, were submitted to this Sub-Committee, who approved the principle of the provision of an open-air school on the Benton Road site, to accommodate 100 children. The Works and Sites Committee at its meeting on the 13th July approved the plans in detail, subject to the preliminary observations of the Board of Education. On the 12th October an amended outline plan, which had been prepared as a result of suggestions made by the Board of Education, was placed before the Special School Provision Sub-Committee. At a subsequent meeting of this Sub-Committee on the 9th November, plans were re-submitted embodying detailed amendments as suggested in consultation with the Board of Education. The Special School Provision Sub-Committee at its meeting on the 14th December reaffirmed its decision to provide an open-air school, arising from the reception of a deputation by the Education Committee on the 16th November. The Works and Sites Committee at its meeting on the 16th December recommended that the plans, together with full specification and inclusive estimate of the cost of the provision, be submitted to the Board of Education for final approval, and that, subject to such approval, arrangements be made for the issue of the statutory notice, application for loan, etc. Unless, therefore, something unforeseen happens in the interim, one hopes that something tangible may result during the forthcoming year. At the end of the year 1925 I had records of 185 children who had been examined at school and considered to be in a pretubercular condition. 91 of these are attending the Tuberculosis Dispensary for observation. 131 10. Physical Training.—The following is the report of the Supervising Instructor in Physical Training:— I. Staff. No increase in the staff has been made during the year. II. Duties and Organisation. My duties as Supervising Instructor in Physical Training continue to be of an advisory, instructional and supervisory character as regards the teaching of physical exercises (inclusive of swimming instruction and organised games) throughout all the schools under the jurisdiction of the Authority. Such duties include staff conferences and practical demonstrations, and are governed, as is also the instruction given, by the Board of Education's Syllabus of Physical Training for Schools, 1919. Departmental visits continue to be made, as previously, each Department being visited approximately seven times during the course of the year. III. Special Features. (a) During the year the Classes in Folk and Country. Dances for the teaching staff of Girls' and Junior Departments were continued, in co-operation with the Head Teacher of Uphall Junior Department. The teachers attending these classes exhibited a keen interest in the lessons, their enthusiasm being in turn imparted to the Departments concerned and reflected in the work of the children. A gratifying feature was the increased number of teachers availing themselves of the special facilities provided. (b) Additional pitches have been allotted in the public parks enable organised cricket matches to be played. Increased facilities have also been afforded in several of the school playgrounds for the purpose of conducting games and activity exercises as set out in Chapter IV of the Board of Education's Syllabus. (c) On 29th May, 1925, Miss E. R. Clarke, one of the Board of Education's Inspectresses of Physical Education, paid a visit to the district and inspected the Public Baths, the Cricklefields Playing Field, and the new playing field for South Park School. Miss Clarke subsequently expressed her appreciation of the very satisfactory results of the physical instruction. (d) On 18th February, 1925, I attended the Fifth Annual Conference of the Association of Organisers of Physical Education, such Conference being held at the London Day Training College. I also attended on 31st December, 1925, the Fourteenth Annual Conference of Educational Associations, which was held at the University College, Gower Street, W.C.I. The proceedings at both Conferences were of an interesting and informative character. (e) In view of the successful results of the Netball Tournament held last year, the Ilford Schools' Netball Association decided to hold similar meetings during the current year. 132 These fixtures were arranged accordingly, the matches being played in June and December. All Girls' Departments, with one exception, competed. An interesting development of the second series of games was the match arranged between South Park Girls' School (winners of the Ilford Schools' Netball Shield) and Shaftesbury Road (East Ham) Girls' School, winners of the shield for their own district. The match was greatly appreciated by all concerned. (f) The experiment introduced at the swimming baths last season, namely, the use of improvised apparatus as an aid to the swimming instruction, proved so successful that it will be repeated during the coming swimming season. (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; very promising signs of improvement have been observed in several instances. (h) During July, August and September, 1925, school sports meetings were organised. In addition, several Girls' Departments arranged competitions in a series of field and athletic events. One of the most pleasing features of these proceedings, in view of the fact that no prizes were awarded, was the keen interest and healthy rivalry displayed. (i) Considerable assistance has again been rendered during the year by the Handicraft Centre in connection with the repair and construction of apparatus used in the games. IV. Review of General Position. The period covered by this report has been, in the main, one of steady development; and I am pleased to state, in conclusion, that this achievement is largely the result of the interest and enthusiasm displayed, and the hearty co-operation accorded, by all concerned. F. J. ROBERTS, Supervising Instructor in Physical Training. 31st December, 1925. 11. Provision of Meals.—The Education (Provision of Meals) Acts, 1906-1914, have not been put into operation in Ilford. I am also informed that no meals were provided from voluntary sources during 1925. 11a. Defective Footgear.—During the year 3 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. 133 l1b. Supply of Free Cod-liver Oil Emulsion, Cod-liver Oil and Malt, Etc.—In November, 1924, I reported to the School Management Sub-Committee that there were from time to time a number of necessitous children in the schools requiring such remedies for debility and bronchial conditions, the parents being unable to afford payment for the treatment. The matter was referred to the Board of Education, and the Sub-Committee subsequently decided that the School Medical Officer be empowered to supply these remedies free of charge to necessitous school children requiring such treatment. During 1925, 21 necessitous cases were dealt with. 12. School Baths.—Vide Annual Report, 1920. 13. Co-operation of Parents.—Vide Annual Report, 1920. During 1925, 3,567 parents, or 78 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:— The total number of cases investigated, 67, made up as follows:— (1) Of neglect 60 (41 reported from the Public Health Department, for neglecting medical advice, and 19 reported from other sources for general neglect.) (2) Ill-treatment cases 4 (3) Other causes 3 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. 134 112 children (66 boys and 46 girls) were involved, 86 being of school age. In addition to this work, 252 supervision visits were paid to different cases, some of which were made to cases reported during the previous year. 17. Physically and Mentally Defective Children.—A return of all children falling within this category is included in Table III., information having been obtained from the records in this department and from a circular addressed to all the Head Teachers of the various departments of the public elementary schools. (a) Physically Defective Children.— During 1925 nine cases were referred for medical examination and report by the School Medical Officer, and the following is a detailed summary of the children dealt with under this heading:— Tubercular Hip.—Certified as fit to attend an ordinary elementary school 1 Deaf.—Recommended for admission to a special school for deaf children 1 Deaf and, Dumb.—Recommended for admission to a special school for deaf and dumb children 1 Partially blind.—Recommended for admission to a special school for partially blind children 1 Bone disease.—Recommended for admission to a residential school for crippled children 1 Epilepsy.—Recommended for admission to a residential school for epileptic children 1 Cardiac disease.—Certified as fit to attend a school situate on the ground floor, subject to precautionary measures 1 Congenital Heart Disease.—Recommended for admission to a residential school for physically defective children, but with precautions might, pro. tern., attend an elementary school on the ground floor 1 Spastic Diplegia.—Certified as unfit to attend a department which entails going up and down stairs 1 1st. Blind Children.—There are six children who are so blind as to be unable to profit by education in an ordinary school. Three of these are attending certified schools for the blind. Three cases are awaiting admission to such a school (one is attending a public elementary school, one is attending a private school and one is not attending any school). 135 2nd. Deaf and Dumb Children.—There are eight children falling within this category. Of these three are deaf and dumb and five are deaf only. Six cases are in attendance at certified schools for the deaf, one is in attendance at a public elementary school, and one has left school, being over 14 years of age (the parents of both children having declined special school treatment). 3rd. Epileptic Children.—There are twenty-three children known to the department. Two of these children are in a certified school for epileptics, and two are awaiting admission to such an institution. Of the remaining nineteen, eighteen are attending public elementary schools in the district, and one is over 14 years of age and is not attending school. 4th. Tuberculous Children.—There are twenty-three children suffering, or who have suffered, from Pulmonary Tuberculosis, fifteen of whom are attending public elementary schools, and one is attending a private school in the district; one is in a sanatorium, six are physically unfit to attend school (five of whom are over 14 years of age and have left school). Ten children are suffering from active glandular tuberculosis and are at present attending school. In addition, at the end of 1925, one hundred and eighty-five 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, nine were attending public elementary schools, two were attending private schools in the district, and three were in institutions. Of the twenty-one children mentioned, twelve are twelve years of age or over. (b) Mentally Defective Children.— During 1925 I medically examined and reported upon 26 children under the Mental Deficiency (Notification of Children) Regulations, 1914, classified as follows 136 Dull and Backyard Children.—Total number certified in 1925 2 Recommended for special class for dull and backward children 2 Feeble-minded Children.—Total number certified in 1925 18 Recommended for admission to a residential special school 3 Recommended for admission to a special school (day or residential) 15 Idiot Children.—Total number certified in 1925 4 Recommended for admission to a residential institution 4 Imbecile Children.—Total number certified in 1925 2 Recommended for admission to a residential institution 2 (1) Idiots.—Idiots are, within the meaning of the Mental Deficiency Act, 1913, persons so defective in mind from an early age, as to be unable to guard themselves against common physical dangers. The Authority for dealing with such children is the Essex County Council. There are 16 cases under the age of 16 years known to the department, 4 being notified during the present year. 5 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 6 cases under the age of 16 years known to the department, 2 being notified during the present year, 2 are in a residential institution, 3 are at home, and 1 is attending a public elementary school. 1 case, not included in these figures, resident at the Girls' Village Home, Barkingside, was examined and certified as an imbecile, for notification to the Northumberland County Council. (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 137 responsible for the proper instruction of these children is the Local Education Authority. There are (at the end of 1925) 48 such cases under the age of 16 years known to me, of whom 33 are attending public elementary schools in the district, 1 is attending a private school, 8 are in a residential school, and 6 are not at school. 1 case, not included in these figures, resident at the Girls' Village Home, Barkingside, was examined and certified as mentally defective (feeble-minded), for notification to the Pontefract Education Authority. 1 case, included in paragraph (2) above, resident in the Royal Eastern Counties' Institution, Colchester, has proved to be ineducable, and has accordingly been notified to the Essex County Council. All mentally defective children are visited at home by the School Nurses at least once a quarter. It will be seen that there are 39 children for whom special education is required and for whom none has been provided. The Special School Provision Sub-Committee at its meeting held on the 16th February, 1925, received Board of Education Circular No. 1349, " Special Schools for Defective Children":— (1) calling attention to the present inadequacy of Special School accommodation for defective children; (2) outlining the need for a real advance in the direction of making provision for such children; (3) indicating" the lines on which Local Education Authorities should deal with the problems involved; and (4) notifying that in due course the Board will call for an advice as to intended or actual progressive action on the part of Authorities concerned. The Sub-Committee recommended that the School Medical Officer be asked to submit a report as to any improvement of, or 138 extension in, the Authority's existing arrangements which he might consider necessary, arising out of the Board's Circular. The following is a copy of my report presented to the Special School Provision Sub-Committee on the 12th October, 1925:— Special Schools foe Defective Children. I have to report on Circular No. 1349 of the Board of Education, Medical Branch, as follows:— (1) Blind and Deaf Children. The Circular states that provision should be made for all children who are blind or deaf within the meaning of the Act and who are not already in Special Schools. I have no record of any totally blind children under the age of 16 years. There are two partially blind children attending special schools; one is attending a public elementary school, awaiting admission to a special school; one is attending a private school; and one is not attending any school, being frequently out of the district. As regards deaf and dumb (including partially deaf) children, there are six attending special schools; two are attending public elementary schools, the parents being unwilling for their children's admission to a special school, and one is not attending any school, but is awaiting admission to a special school. The numbers falling within this category are fortunately small, and I do not consider that at present any extension of the Authority's arrangements is necessary. (2) Physically Defective Children. The Circular recommends that an orthopædic scheme should be adopted. I cannot find that at present there is any need for such a scheme in Ilford There are twenty-one physically defective children (including cases of heart disease) who have been recommended for a cripple school, ten of whom are attending public elementary schools; one is at a residential cripple school; two are attending private schools; one is at an institution other than a cripple school; and seven are not attending school. When the open-air school is in being, a number of these children may be admitted with benefit, and until the school is in existence and it is seen how many cripple children remain, I think the question of the provision of a cripple school might be held in abeyance. (3) Educable Mentally Defective Children. The circular recommends that steps should be taken for:— First—The complete and correct ascertainment of the children. Second—Supervisory arrangements for children for whom no Special Schools exist. These measures are already being carried out in Ilford, 139 As far as the number of educable mentally defective children in Ilford is concerned, it should be noted that the Board of Education has written pointing out that the estimated incidence-rate is 8.6 per 1,000, while the actual figure in Ilford is 3.6 per 1,000. This latter figure, however, is the same as in 1914, when the Mental Deficiency Regulations first came into force. It would appear; therefore, that either (a) the number educable mental defectives is much less in Ilford than elsewhere ; or (6) the standard of mental deficiency adopted by Dr. Oates and myself is higher; or (c) all the cases are not being notified to us from the schools. In order to test the latter point the Director of Education has obtained from the Head Teachers the names of 44 children of the ages 10-11 who are educationally retarded three or more years, and I propose to examine the mental condition of these children in due course. It is, in my opinion, very undesirable that children should be admitted to handicraft or manual classes for backward children, until their mental condition has been reported upon. It was proposed in August, 1920, to institute a Day Special School at Newbury Park Junior Mixed School, for mentally defective children, which received the commendation of the Board of Education. After prolonged negotiations the scheme was abandoned in February, 1921, on the grounds of economy, owing to representations then received from the Board of Education. The following table shows the number of educable mentally defective children under the age of 16 years, who have been examined and certified as mentally defective:— Total number 48 Of these, 10 are in residential institutions. The remaining 38 are arranged as follows as regards age and sex distribution:— Approximate age in years. Attending Public Elementary Schools. Not attending any School. M. F. M. F. 7 - 1 1 - 8 1 2 — — 9 4 - — 1 10 4 5 — — 11 4 — — — 12 3 2 1 1 13 — — — — 14 3 3 1 — 15 — - 1 - Totals 19 13 4 2 It will thus be seen that there are 23 boys and 15 girls for whom special provision is required. Of these, 8 are 14 years of age or over, 140 Of these 38 children 10 are suitable cases for a residential institution. There is considerable difficulty, however, in obtaining places for such children, and some of them would no doubt profit by a day special school education, failing that of a residential school. Under Section 56 of the Education Act, 1921, the Local Authority can deal with educable defective children either:— (1) By establishing a Special School. (2) By establishing Special Classes in ordinary schools, which must be certified by the Board of Education. (3) By sending the children to the Special School of another Authority. I consider that the time has arrived when one of these measures should be undertaken in Ilford. The question is likely to be more acute when the medical arrangements at the Barnardo's Schools are settled. There are a number of children at these schools who have been considered mentally defective by the Medical Officer-in-Charge of that Institution, and for whom the Ilford Education Committee will become responsible. These will swell the total number of mentally defective children, and it will be necessary to decide whether to establish one Special School to which the children from the Mossford Lodge School are to be sent, or to establish a special school at Mossford Lodge to which Ilford children can be sent. An alternative proposition would be to make arrangements with the Barking Authority to admit mentally defective children from the Ilford area to the Barking Special School. Of the 38 children mentioned in the foregoing table, the mental defect varies in degree, and the larger the school the easier the grading of the children concerned. Under Section 56 of the Education Act, 1921, if the average attendance for a period of three years falls below 15, the school may be discontinued upon representations received from the Authority. If the Committee is not prepared to undertake the establishment of a Day Special School, I consider that Special "Certified" Classes should be provided. The importance of such a step, to mention only one point, is that in the event of a mentally defective child not attending either a Special School or a Special Class, there is no provision under the Mental Deficiency Act for the notification to the Countv Council for its supervision or institutional care after it reaches the age of 16 years. (4) Open-Air School. The circular next deals with the delicate and pretubercular child for whom an open-air school is required. The Education Committee has, however, already decided on the early provision of a school of this type, and it is therefore unnecessary for me to report further on this matter. 24/8/1925. Although in the above report I have laid stress on the necessity of the provision of an Open-Air School and a school for mentally defective children, and have perhaps minimised the 141 importance of an orthopædic scheme, it must be understood that I am here referring to cripple children requiring special school facilities. It must be borne in mind that every year children are being referred to the Supervising Instructor in Physical Training, who suffer from lateral curvature of the spine, round shoulders and similar ailments. During the past three years 311 children have been so referred. It is obviously impossible for this officer to do all that is required for such numbers of children, and a centre is required, equipped with suitable apparatus and with means of treating these children by massage and other methods. At a subsequent meeting of the Sub-Committee on the 11th January, 1926, the Sub-Committee decided, in view of the position created by the issue of Board of Education Circular No. 1371, to leave the question for further report by the Director of Education as to the possibility of making some tentative provision for mentally defective children under existing circumstances. 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 1925 it was found that 170 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 7 Medically fit subject to obtaining treatment 2 Ineligible for employment (under age) 1 During 1925, 2 children, examined under Section 13 of the Education Act, 1918 (Employment of Children in Entertainments), were found medically fit. 142 The Juvenile Employment Committee has during the past year found occupation for 751 children, as follows:— Boys. Girls. Total. Placed by Bureau locally 335 278 613 Placed by Bureau non-locally 94 44 138 Totals 429 322 751 Fresh Claims to U.I. Benefit 149 141 290 Repeat Claims to U.I. Benefit 121 91 212 Fresh Registrations for work only 226 322 548 Re-registrations for work only 103 126 229 Totals 599 680 1,279 22. Miscellaneous.—In accordance with the Education Committee's Regulations, the undermentioned bursars, studentteachers and teachers were medically examined and reported upon during the year by the School Medical Officer:— Bursars 11 Student-teachers 16 Newly-appointed teachers 48 Teachers absent through illness 9 Total 84 Re-examinations:— Bursars 5 Student-teachers 7 Newly-appointed teachers 12 Total 24 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. 143 The following table shows the number of children examined during 1925 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 555 39 7.0 5 .9 2 .36 Girls 550 92 16.7 23 4.1 2 .36 144 Table I.—Return of Medical Inspections. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 1719 Intermediates 1496 Leavers 1330 Total 4545 Number of other Routine Inspections Nil. B.—Other Inspections. Number of Special Inspections— Medical Inspection at School 165 At School Clinic 2322 Number of Re-inspections— Medical Inspection at School 1587 At School Clinic 6872 Total 10946 145 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1925. Defect or Disease Routine Inspections Specials Number of Defects Number of Defects Number referred for Treatment Number requiring to be kept under observation, but not referred for Treatment Number referred for Treatment Number requiring to be kept under observation, but not referred for Treatment (1) (2) (3) (4) (5) Malnutrition 1 - 1 - Uncleanliness— Head 350 — 166 - Body 6 — 6 — Skin Ringworm— Scalp — — 11 — Body — — 10 — Scabies 1 — 5 — Impetigo 29 — 245 — Other Diseases (non-Tubercular) 28 — 137 — Eye Blepharitis 41 — 27 — Conjunctivitis 11 — 30 — Keratitis — — — - Corneal Ulcer 1 — 3 - Corneal Opacities — — — — Defective Vision 539* — 114 — Squint 31 — 9 — Other Conditions 55 — 48 - Ear Defective Hearing 23 1 9 — Otitis Media 1 — 1 — Other Ear Diseases 11 — 72 - Nose and Throat Enlarged Tonsils only 06 — 9 — Adenoids only 271 28 13 — Enlarged Tonsils and Adenoids 539 13 11 - Other Conditions 44 3 134 - Enlarged Cervical Glands (Non-Tubercular) 5 1 50 - Defective Speech 5 — — — Teeth—Dental Diseases 354 — 143 — Heart and Circulation Heart Disease— Organic 9 5 4 — Functional 10 15 5 — Anæmia 105 2 65 — Lungs Bronchitis 36 11 51 - Other Non-Tubercular Diseases 10 10 58 — Tuberculosis Pulmonary- Definite — — 1 — Suspected 22 30 5 2 Non-Pulmonary— Glands 1 3 — — Spine — — — — Hip — — — — Other Bones and Joints — — — — Skin — — - — Other Forms 1 — 1 — Nervous System Epilepsy — 2 — — Chorea 1 1 6 - Other conditions — 2 10 — Deformities Rickets 1 — 2 — Spinal Curvature 12 1 7 — Other Forms 16 — 7 — Other Defects and Diseases 178 11 1298 — * 186 of these cases saw 6/6 but were suffering from other conditions, rendering refraction advisable. 146 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) (4) Code Groups:— Entrants 1719 1037 60.3 Intermediates 1496 448 29.9 Leavers 1330 440 33.0 Total (code groups) 4545 1925 42.3 Other routine inspections — — — 147 TABLE III.—Return of all Exceptional Children in the area in 1925. 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 2 1 3 Attending Public Elementary Schools 1 - 1 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 the Deaf - - - Attending Public Elementary Schools 1 - 1 At other Institutions — — — At no School or Institution — 1 1* Mentally Defective Feeble Minded (cases not notifiable to the Local Control Authority) Attending Certified Schools for Mentally Defective Children 4 4 8 Attending Public Elementary Schools 19 14 33 At other Institutions — — — At no School or Institution 4 2 6 Notified to the Local Control Authority during the year Feeble Minded 1 - I Imbeciles - 2 2 Idiots 4 — 4 148 TABLE III—continued. Boys Girls. Total. Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics 1 1 2 In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools 1 - 1 At no School or Institution — 1 1* Suffering from epilepsy which is not severe Attending Public Elementary Schools 11 7 18 At no School or Institution 1 - 1* Infectious Pulmonary 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 — — — Physically Defective Non - infectious but active pulmonary Tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential OpenAir Schools - - - At Certified Day Open - Air Schools - - - At Public Elementary Schools 7 8 15 At other Institutions — - — At Private School — 1 1 At no School or Institution 4 2 6† Non - infectious but active glandular Tuberculosis At Public Elementary Schools 4 6 10 Delicate children (e.g., preor latent tuberculosis, malnutrition, debility, anæmia, etc.) At Certified Residential OpenAir Schools - - - At Certified Day Open - Air Schools 1 - 1 At Public Elementary Schools 99 86 185 At other Institutions — — — At no School or Institution - - - 149 TABLE III.—continued. Boys. Girls. Total. Physically Defective.—cont. Active nonpulmonary Tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board - 1 1 At Public Elementary Schools 1 1 2 At other Institutions 1 — 1 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 - 2 2 At Certified Day Cripple Schools - - - At Public Elementary Schools 6 3 9 At other Institutions 1 — 1 At no School or Institution 3 4 7 At Private School 2 - 2 * These cases are over 14 years of age. † 5 of these cases are over 14 years of age. 150 Table IV.—Return of Defects Treated During the Year ended 31st December, 1925. Treatment Table. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). Disease or Defect. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (8) (4) Skin— Ringworm (Scalp) 11 — 11 Ringworm (Body) 10 — 10 Scabies 6 — 6 Impetigo 245 — 245 Other skin disease 137 11 148 Minor Eye Defects (External and other, but excluding cases falling in Group II). 108 69 177 Minor Ear Defects 82 31 113 Miscellaneous {e.g., minor injuries, bruises, sores, chilblains, etc.) 893 735 1628 Totals 1492 846 2338 151 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. Number of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by Private Practitioner or at Hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report). 679 42 40 761 Other Defect or Disease of the Eyes (excluding those recorded in Group I). — — — — Total 679 42 40 761 Total number of children for whom spectacles were prescribed:— (a) Under the Authority's Scheme 537 (b) Otherwise 82 Total number of children who obtained or received spectacles:— (a) Under the Authority's Scheme 537 (b) Otherwise 82 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. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 238 181 419 70 489 Group IV.—Dental Defects. (1) Number of children who were:— (a) Inspected by the Dentist:- Aged 5 692 6 617 7 623 Routine age groups 8 814 9 1031 10 1137 11 830 12 703 13 589 14 248 15 69 Total 7353 Specials 241 Grand total 7594 (b) Found to require treatment 4272 (c) Actually treated 2034 (d) Re-treated during the year as the result of periodical examination 836 (2) Half-days devoted to Inspection 95 Treatment 335 T°tal 430 (3) Attendances made by children for treatment 3225 (4) Fillings Permanent teeth 1116 Temporary teeth 1283 Total 2399 (5) Extractions Permanent teeth 573 Temporary teeth 3581 Total 4154 (6) Administrations of general anaesthetics for extractions 1576 (7) Other operations (Permanent teeth, 182) (Temporary teeth, 89) Total 271 153 Group V.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school during the year by the School Nurses 9 (ii) Total number of examinations of children in the Schools by School Nurses 34088 (iii) Number of individual children found unclean 1412 (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 154 155 Table V.—Table showing number of Children Medically Inspected at various Schools during 1925. 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. Hoys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. ROUTINE. Barkingside 25 25 4 3 9 5 19 11 1 1 1 - - 1 21 21 1 - - - 81 67 Becontree 130 126 9 12 6 7 37 35 7 11 4 8 5 12 21 38 1 — — — 220 249 Chadwell 20 8 2 1 1 1 11 9 2 - - — — 1 12 11 — — — — 48 31 Christchurch 04 60 13 9 28 19 38 31 11 6 9 5 8 3 57 47 3 — — — 231 180 Cleveland 106 89 8 4 26 28 32 53 5 7 3 4 5 2 48 68 2 1 — — 235 256 Downshall 89 83 10 8 36 36 64 62 5 1 8 4 11 3 57 61 6 3 — 1 286 262 Goodmayes 54 53 3 4 15 10 47 45 6 3 11 12 3 7 55 52 2 3 — — 196 189 Highlands 85 72 8 11 22 20 57 48 14 14 9 17 8 5 37 29 4 5 — 1 244 222 Little Heath 7 3 — — 2 1 2 4 — - 1 — — — 7 6 — 1 — — 19 15 Loxford 45 55 1 — 14 16 43 43 2 - 1 4 3 1 32 39 4 2 2 — 147 160 Newbury Park 37 28 5 1 10 9 15 17 2 — — 1 — — 25 19 1 — — — 95 75 Roman Catholic 20 25 7 1 12 4 22 12 3 7 2 1 9 — 24 21 3 1 — — 95 72 South Park 40 45 11 7 17 19 37 39 6 - 4 4 7 4 57 47 2 1 1 — 182 166 Uphall Road 71 61 4 2 11 10 55 57 2 1 6 2 3 — 59 53 3 2 — — 214 188 Valentines 22 19 3 1 4 6 13 14 1 2 4 5 — 1 8 16 — 1 — — 00 65 Total 815 752 88 64 213 191 492 480 67 53 63 67 55 40 520 528 32 20 3 2 2348 2197 SPECIALS. Barkingside 2 - - - - - - 1 - - - 1 - 1 1 1 — - - — 3 4 Becontree 3 5 — 1 — 1 3 12 - - 1 — — — 1 4 — — — — 8 23 Chadwell 3 — - - 2 - 1 - 1 1 - 1 1 — — — — — — — 8 2 Christchurch - 1 3 - - - 5 4 - - 1 - - - 5 - - - - - 14 5 Cleveland 1 2 - - - - 4 - - - 1 2 — — — 2 — 3 — — 6 9 Downshall 1 1 — - — 2 1 7 - - 1 - 1 — — 3 — — — — 4 13 Goodmayes — 1 — — 1 1 — 1 1 3 1 — — 1 — 1 — 2 — — 3 10 Highlands — — — 1 1 1 1 — 1 — 1 — — — — — — — — — 4 2 Little Heath - - - - - - - - - - - - - - - - - - - - - - Loxford - — 1 2 - - - 1 1 - - - 2 — - — — — — 2 5 Newbury Park 1 2 1 2 — — — 1 - — - 1 — — — — — — — — 2 6 Roman Catholic 2 1 1 — — - - 1 - 1 - 1 — — — — — — — — 3 4 South Park - 1 4 1 - - - 1 - - - - — — — — — — — — 4 3 Uphall Road 4 2 - - - - - - - 5 1 — - — — — — 2 — — 5 9 Valentines 2 — — — — — 2 — — — — — — — - - - - - - 4 — Total 19 16 10 7 4 5 17 29 4 10 7 6 2 4 7 11 — 7 — — 70 95 Total Number of Children Examined. 4710. Grand Total 2418 2292 156 157 Table VI. A.—Table Showing the Average Heights and Weights of the BOYS Examined. Age Groups. Age Groups. School. 5-6 years. 6-7 years. 7-8 years. 8-9 years. 9-10 years. 10-11 years. 11-12 years. 12-13 years. 13-14 years. No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds . No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). Barkingside 25 42.04 33.88 4 45.55 47.08 9 47.20 49.06 19 46.73 50.82 1 51.37 57.20 l 51.96 61.60 - - - 21 55.00 73.04 l 56.28 78.38 Becontree 130 42.51 40.48 9 45.94 42.46 6 46.43 48.84 37 48.58 53.24 7 51.29 58.08 4 53.14 67.76 5 55.51 71.50 21 55.98 78.10 1 56.69 78.54 Chadwell 20 43.66 41.58 2 44.40 41.14 1 44.48 42.02 11 49.13 51.04 2 50.43 55.00 — — — — — 12 54.33 67 10 — - — Christchurch Rd. 64 42.67 41.58 13 45.00 45.54 28 47.87 50.38 38 49.17 53.02 11 49.52 57.64 9 53.38 68.42 8 55.98 78.98 57 55.11 76.84 3 56.29 74.36 Cleveland Rd. 106 41.81 41.58 8 43.81 40.92 26 46.45 46.86 32 47.91 51.26 5 50.07 54.78 3 55.11 72.82 5 51.06 62.70 48 55.11 75.24 2 53.93 66.66 Downshall 80 41.73 38.72 10 44.72 43.56 36 47.77 49.50 64 49.21 52.14 5 49.84 59.40 8 52.87 62.92 11 54.52 72.38 57 56.18 75.46 6 59.37 85.56 Goodmayes 54 42.51 41.36 3 43.54 44.66 15 44.72 51.26 47 49.05 57.64 6 51.29 60.94 11 51.61 62.26 3 55.59 80.46 55 56.49 78.54 2 58.58 87.34 Highlands 85 43.30 41.58 8 45.82 45.32 22 47.32 49.50 57 49.56 56.10 14 51.96 51.82 9 55.47 73.48 8 55.63 75.24 87 56.81 79.64 4 56.47 80.52 Little Heath 7 42.99 43.56 — — — 2 41.73 44.44 2 45.51 55.88 — — — 1 54.02 64.32 — — — 7 55.11 71.94 — - — Loxford 45 42.99 42.02 1 45.85 41.58 14 46.88 49.94 43 49.96 52.58 2 50.19 51.92 1 54.72 64.24 3 53.77 66.88 32 55.83 74.58 4 59.37 84.26 Newbury Park 37 42.44 38.06 5 43.23 41.36 10 48.14 49.06 15 48.14 51.48 2 50.00 58.52 — — — — — — 25 55.47 68.86 1 55.13 69 08 Roman Catholic 20 42.20 37.84 7 44.88 46.42 12 48.11 51.70 22 49.68 53.46 3 50.00 53.46 2 53.93 74.36 2 53.74 66.22 24 55.23 70.62 3 59.05 83.16 South Park 40 41.81 39.82 11 45.11 46.86 17 47.71 49.28 37 48.74 54.34 6 51.18 60.50 4 52.79 66.22 7 54.96 72.38 57 56.29 75.46 2 57.82 81.62 Uphall Rd. 71 41.57 38.94 4 45.39 45.54 11 46.69 46.86 55 48.18 49.94 2 47.83 48.62 6 53.11 68.64 3 53.11 63.58 59 55.31 72.38 3 55.11 74.36 Valentines 22 42.62 39.82 3 46.29 49.72 4 46.06 51.48 13 48.62 51.70 1 53.14 72.16 4 50.78 62.92 — — — 8 55.55 74.14 — — — Average Heights and Weights of Ilford Children 815 43.04 38.06 88 44.30 44.22 213 49.44 44.66 492 48.81 52.58 67 50.63 58.08 63 53.14 66.88 55 53.81 71.94 520 55.41 77.22 32 57.28 78.32 Anthropometric Standard (Boys). Ages. Ages. 5 years. 6 years. 7 years. 8 years. 9 years. 10 years. 11 years. 12 years. 13 years. Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds) Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). Height (in inches). Weight (in pounds). 40.68 38.68 42.83 42.24 45.04 46.40 j 47.39 52.00 49.18 55.90 50.84 60.35 52.98 66.41 54.88 72.66 56.07 77.40 158 159 Table VI. B.—Table showing the Average Heights and Weights of GIRLS Examined. School. Age Groups. Age Groups. 5—6 Years. 6—7 Years. 7—8 Years. 8—9 Years. 9—10 Years. 10—11 Years. 11—12 Years. 12—13 Years. 13—14 Years. Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Poun. s). 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). 1 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 Inchcs). Average Weight (In Pounds). Barkingside 25 42.08 40.26 3 43.70 40.26 5 46.77 49.06 11 47.24 53.28 1 50.39 56.54 - - - 1 56.10 67.54 21 56.49 80.30 - - - Becontree 126 43.03 38.72 12 44.21 42.24 7 47.36 48.40 35 48.42 53.46 11 50.90 55.22 8 50.55 55.66 12 54.29 69.96 38 56.45 73.04 — — — Chadwell 8 42.51 38.94 1 45.27 40.04 1 47.63 44.22 9 49.48 51.92 — — — — — — 1 57.87 69.08 11 57.67 78.76 — — — Christchurch Rd. 60 42.36 37.84 9 44.01 41.14 19 47.24 46.86 31 48.27 49.28 6 52.28 62.26 5 51.27 52.58 3 55.19 69.08 4/ 54.84 75.46 — — — Cleveland Rd. 89 41.77 39.82 4 43.54 42.46 28 47.36 49.28 53 48.03 51.48 7 50.19 56.54 4 52.04 60.50 2 55.74 71.28 68 55.03 71.94 1 56.89 83.82 Downshall 83 42.87 38.72 8 45.86 44.00 36 47.20 47.96 62 48.66 52.14 1 48.42 52.80 4 53.89 67.54 3 53.34 62.04 61 55.86 87.34 3 58.03 82.28 Goodmayes 53 43.74 41.14 4 45.90 50.38 10 47.08 50.82. 45 48.80 57.42 3 51.57 64.02 12 57.55 67.10 7 54.56 69.96 52 57.32 72.82 3 60.03 91.96 Highlands 72 43.14 35.86 11 45.27 45.54 20 47.95 49.72 48 49.33 53.90 14 50.55 60.28 17 54.44 70.84 5 53.46 70.40 29 56.88 75.02 5 57.32 73.92 Little Heath 3 43.50 40.26 — — — 1 44.09 47.96 4 45.51 47.50 - - — — — 6 55.59 83.38 1 59.05 67.32 Loxford 55 42.67 39.82 — — — 16 47.63 50.16 43 48.93 53.68 — — - 4 53.54 59.10 1 55.11 64.24 39 56.65 77.60 2 60.43 74.36 Newbury Park 28 42.04 37.62 1 47.36 43.12 9 48.07 48.62 17 48.07 48.84 — — - 1 55.51 39.16 — - — 19 57.48 79.64 — — — Roman Catholic 25 43.89 44.66 1 44.68 45.32 4 49.01 57.86 12 50.19 53.46 7 5094 56.32 1 54.33 78.98 — - - 21 55.86 78.10 1 58.07 75.90 South Park 45 42.20 39.38 7 44.13 43.56 19 46.73 48.18 39 48.74 53.46 — - — 4 54.52 67.10 4 53 14 7062 47 57.04 83.60 1 63.77 129.36 Uphall Rd. 61 41.61 37.84 2 43.30 45.76 10 46.65 50.16 57 48.18 51.48 1 52.48 66.44 2 50.93 53.24 — — — 53 55.82 74.36 2 57.87 74.36 Valentines 19 41.87 39.16 1 44.96 43.12 6 46.69 50.38 14 50.59 49.94 2 50.00 60.72 5 53.42 65.56 1 56.29 77.00 16 56.69 82.50 1 56.29 73.92 Average Heights and Weights of Ilford Children 752 42.48 38.72 64 44.76 43.56 191 47.04 48.62 480 48.62 52.58 53 50.86 5918 67 51.57 64.02 40 54.52 69.30 528 56.02 76.12 20 58.14 81.40 Anthropometric Standard (Girls). Ages. Ages. 5 Years. 6 Years. 7 Years. 8 Years. 9 Years. 10 Years. 11 Years. 12 Years. 13 Years. Height (In Inches) | Weight (In Pounds) Height (In Inches) Weight (In Pounds) . Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) 40.44 37.74 42.53 41.24 44.76 44.93 46.94 49.55 48.71 54.09 50.60 58.69 53.01 65.52 55.48 73.86 56.81 80.37 160 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, 1925. SCHOOLS. Number on Roll. DISEASES AND CONTACTS Scarlet Fever. Diphtheria. Measles. and German Measles. Chicken Pox. Whooping Cough. Mumps. Enteric Fever. Ringworm. Totals. 1925. Totals. 1924. Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Contacts Barkingside 332 2 - 1 1 - 4 5 2 - 43 - - - 1 52 7 33 17 Becontree 1391 1 2 1 1 201 52 46 14 22 12 4 - - - - 975 81 85 28 Chadwell 236 2 3 - - 5 1 16 2 9 4 - - - - - 32 10 37 24 Christchurch 1092 11 19 6 12 203 73 17 10 21 5 8 - - - 6 272 119 180 50 Cleveland Road 1231 16 12 — 7 8 2 44 21 32 14 71 - 1 - - 172 56 138 103 Downshall 1288 9 10 3 8 14 7 7 6 58 11 6 - - - 2 99 42 107 30 Goodmayes 790 1 - 2 2 11 9 16 4 32 4 8 - - 2 - 70 21 81 39 Highlands 985 10 9 2 1 8 6 29 11 38 7 187 - - - 2 276 34 172 49 Little Heath 105 2 2 — — 1 2 2 10 1 1 - - - - 15 6 30 12 Loxford 933 7 4 1 1 5 1 64 9 17 2 60 - - - - 154 17 208 57 Newbury Park 525 2 7 1 4 10 6 70 36 28 4 79 - - - - 190 57 82 29 Roman Catholic 407 2 3 - — 6 5 20 12 17 3 3 - - - - 48 23 79 15 South Park 1163 16 27 1 4 9 7 51 10 37 10 15 - - - - 129 58 166 49 Uphall 776 2 6 1 1 4 6 63 27 17 8 55 - - - - 142 48 147 80 Valentines 157 - - 2 2 - - - - 10 1 23 - - - - 35 3 38 12 Countv High School - 4 4 1 — - - - - - - - - - - - 4 3 4 Private Schools — 6 3 - 1 - - - - - - - - - - — 6 4 27 16 Totals 11411 93 111 22 45 484 180 450 166 318 86 563 — 1 2 11 1972 590 1613 614 Acute Primary Pneumonia, 9 cases. Influenza, 83 cases. Erysipelas, 1 case. Acute Poliomyelitis, 2 contacts. Encephalitis Lethargica—Christchurch, 1 case; Private School, 1 case; Goodmayes, 1 case, 1 contact. 161 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, 1925. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. October. Nov. Dec. Total 1925 Total 1924 Cases. Conts. Cases. Conts. Cases. Conts. Cases. Co its. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 332 2 - - - - - - - - - - - - - - - - - - - - - - - 2 - - - Becontree 1391 — — — — — — — - - - - - - - - - - - - - - - 1 2 1 2 2 2 Chadwell 236 — - - - - - - - - - 1 2 1 1 - - - - - - - - - - 2 3 - 1 Christchurch 1092 2 6 - - 3 3 1 - - - - - - - - - - - 1 1 3 7 1 2 11 19 14 17 Cleveland Road 1231 - - - - - 3 - - 1 - 7 2 1 2 2 1 - - 3 - 2 4 - - 16 12 4 10 Downshall 1288 — — 1 — 2 - - - - 4 - 1 - - - - 2 1 3 1 1 2 - 1 9 10 7 12 Goodmayes 790 — — — - — - - - - - - - - - - - 1 - - - - - - - 1 - 2 4 Highlands 985 - - - - - - - - - 3 1 - 1 - - - 3 4 2 1 2 - 1 1 10 9 3 3 Little Heath 105 - - - - - - - - - - - - 2 2 - - - - - - - - - - 2 2 1 2 Loxford 933 2 1 — - — - - - 1 1 - - 1 - - - - - - - 2 1 1 1 7 4 12 12 Newbury Park 525 - - - - - - - - - - - - 1 - - - - - 1 5 - 2 - - 2 7 6 12 Roman Catholic 407 - - - - - - - - - - 1 - 1 1 - - - - - - - - - 2 2 3 - 1 South Park 1163 1 — - 2 1 2 - - 1 - - - 1 1 1 6 4 4 4 9 2 2 1 1 16 27 10 12 Uphall 776 — — — — — — - - - - - - - 1 - - - - 1 3 1 1 - 1 2 6 5 13 Valentines 157 — - - - - - - - - - - - - - - - - - - - - - - - - - - County High - — — — - — 1 - - - 1 3 - - 1 1 - - - - - - 1 - - 4 4 1 3 Private Schools - - - - - - - 1 1 — — — - — 1 l - — — 1 1 1 - 2 — 6 3 18 11 Totals 11411 7 7 1 2 6 9 2 1 3 9 13 5 9 10 5 7 10 9 16 21 14 20 7 11 93 111 85 115 162 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, 1925. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total 1925. Total 1924. 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 332 - - - - - - - - - - - - - - - - - - 1 1 - - - - 1 1 - 1 Becontree 1391 — — — — — — - — — — — — 1 - - 1 — — - - - - - - 1 1 1 2 Chadwell 230 - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 Christchurch Road 1092 - — 1 — — — — 1 1 3 1 — 1 1 - - 1 3 - 1 - - 1 3 6 12 1 4 Cleveland Road 1231 - - - 2 - - - - - - - - - - - - - - - 1 - - - 4 - 7 6 10 Downshall 1288 — — 1 2 — 4 1 2 - - - - - - - - - - - - 1 - - - 3 8 3 6 Goodmayes 790 — — 2 1 — — — — — — — — — 1 — — — — — — — — — - 2 2 2 9 Highlands 985 — — — — — — — — — 1 — — 2 — - — — — — — — — - - 2 1 - 3 Little Heath 105 - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - Loxford 933 — — 1 1 — — — — — — — — - - - — — — — — - — - - 1 1 - 4 Newbury Park 525 — - - - - - - - - - - - - - - - - - - - - - 1 4 1 4 - - Roman Catholic 407 — — — — — — — — — — — — — — — — — — — — - — - - - - 1 2 South Park 1163 — — — — — — — 1 - — — — — — 1 2 — — — — - — - 1 1 4 3 2 Uphall 776 - - - - - - - 1 - - - - - - - - - - - - - - - - 1 1 1 6 Valentine 157 - - 1 1 - - - - - - 1 1 - - - - - - - - - - - - 2 2 1 2 County High — 1 - - - - - - - - - - - - - - - - - - - - - - - 1 - 2 1 Private Schools - - - - - - - - 1 - - - - - - - - - - - - - - - - - 1 6 5 Totals 11411 1 — 6 7 — 4 1 6 1 4 2 1 4 2 2 3 1 3 1 3 1 — 2 12 22 45 28 59 163 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, 1925. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total 1925 Total 1924 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 332 - - - - - - - - - 4 - - - - - - - - - - - - - - - 4 1 3 Becontree 1391 — — — — 1 — — 1 2 2 9 6 13 7 — — — — 7 1 137 19 32 16 201 52 68 23 Chadwell 236 — — — — 1 — — — — — — - - — — — — — — — 2 - 2 1 5 1 13 10 Christchurch Road 1092 — — - — — — — — 1 — — — — — 1 3 1 — 6 3 91 36 103 31 203 73 121 20 Cleveland Road 1231 - - - - - 1 - - - - - - - - - - 1 - 1 - - - 6 1 8 2 109 65 Downshall 1288 - - - - - - - — 3 1 5 3 2 - - - - - - - - — 4 3 14 7 63 6 Goodmaves 790 — — - — — — — — — 1 3 — 2 4 — — — — — — 2 3 4 1 11 9 61 17 Highlands 985 — — — — — — — — — — 1 1 — — — — 1 — — — 1 1 5 4 8 6 126 33 Little Heath 105 - - - - - - - 1 - - - - - - - - - - - - - - - - - 1 17 10 Loxford 933 — — 2 — — — 1 — — — — — — — — — 1 — — — — — 1 1 5 1 114 37 Newbury Park 525 — — 1 1 — — — — 1 1 — — 2 2 — — 1 1 1 — 4 1 — — 10 6 69 14 Roman Catholic 407 - - - - - - - - - - 1 1 2 3 — — — — 1 — 1 — 1 1 6 5 37 10 South Park 1163 - — - — 1 1 — — — — — — 3 2 — — 1 1 1 2 — — 3 1 9 7 107 26 Uphall 776 — — - 1 — — — — — — — — — — — 1 — — 1 — — — 3 4 4 6 83 48 Valentines 157 - - - - - - - - - - - - - - - - - - - - - - - - - - 34 10 County High - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 - Totals 11411 — — 3 2 3 2 1 2 7 9 19 11 24 18 1 4 6 2 18 6 238 60 164 64 484 180 1026 332 164 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, 1925. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total, 1925. Total, 1924. 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 382 4 1 - - - - - - - - - - - - - - - - - - - - 1 1 5 2 25 4 Becontree 1391 - - 7 2 8 2 1 2 — - 19 3 9 5 — — 1 — - — - - 1 — 46 14 3 - Chadwell 236 13 2 - - - - - - — - - - — - - - - - - — - — 3 - 16 2 22 11 Christchurch Road 1092 1 - - - 2 - 2 - 2 - 2 3 2 - — - - - - — 4 5 2 2 17 10 9 3 Cleveland Road 1231 4 — 2 1 2 - 2 1 1 2 1 — 1 1 5 2 6 2 7 7 8 3 5 2 44 21 7 11 Downshall 1288 — — 1 1 — 1 — — — — — — 5 1 — — — 2 — 1 1 — — — 7 6 26 5 Goodmayes 790 1 — l — 7 1 7 — — — — — — 3 — — — — — — — — - — 16 4 9 8 Highlands 985 - - - - - - 1 1 1 — — 1 1 1 1 — 1 — 2 1 3 2 19 5 29 11 14 8 Little Heath 105 - — — — — - — — — - 2 2 - - - - - - - - - - - — 2 2 3 - Loxford 933 3 — 1 1 19 1 31 4 6 2 — — 1 - — - — - 1 1 — — 2 — 64 9 17 2 Newbury Park 525 - — - - - - - - - — - - - - — - 7 1 36 19 24 15 3 1 70 36 1 2 Roman Catholic 407 9 2 — — 1 l — — 5 6 3 1 1 9 1 — — — — — — — — — 20 12 7 1 South Park 1163 2 1 12 1 21 3 10 3 3 1 — 1 — — — — 1 — - — 1 — 1 — 51 10 24 8 Uphall 776 — — 1 — 3 — 4 — 34 20 15 5 4 1 - - - - - - 1 — 1 1 63 27 14 7 Valentines 157 - - - - - - - - - - - - - - - - - - - - - - - - - - 1 — County High - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 11411 37 6 25 6 63 9 58 11 52 31 42 16 24 14 7 2 16 5 46 29 42 25 38 12 450 166 182 70 165 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, 1925. SCHOOLS. Number on Roll. Jan. Feb. March April. May. June. July. August. Sept. Oct. Nov. Dec. Total, 1925. Total, 1924. Cases. Conts. Cases. Conts. Cases. j Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 332 - - - - - - - - - - - - - - - - - - - - - - - - - - 7 9 Becontree 139] 6 5 9 3 4 3 - - - - - 1 - - - - 2 - - - - - - - 22 12 9 1 Chadwell 236 — — - — 9 4 - - - - - - - - - - - - - - - - - - 9 4 - - Christchurch Road 1092 3 - 14 2 1 1 1 - - - - 2 - - 2 - - - - - - - - - 21 5 29 6 Cleveland Road 1231 16 2 8 — 4 10 1 - 1 - - - 2 - - - - - - 1 - 1 - - 32 14 10 7 Downshall 1288 26 4 21 6 4 — 1 1 3 - 1 - - - - - - - 2 - - - - - 58 11 5 1 Goodmayes 790 4 1 3 1 12 2 6 - - - 6 — 1 - - - - - - - - - - - 32 4 - - Highlands 985 27 4 3 1 2 2 - - - - - - - - - - - - - - 3 - 3 - 38 7 21 1 Little Heath 105 - - 3 1 4 - - - 2 - - - - - - - - - - - - - - - 10 1 - - Loxford 933 13 1 2 1 1 - 1 - - - - - - - - - - - - - - - - - 17 2 13 2 Newbury Park 525 1 — 1 1 10 3 9 - 2 - 3 - 2 - - - - - - - - - - - 28 4 1 1 Roman Catholic 407 15 1 2 1 - 1 - - - - - - - - - - - - - - - - - - 17 3 12 - South Park 1163 2 1 3 4 14 4 11 1 6 - - - 1 - - - - - - - - - - - 37 10 19 1 Uphall 776 13 4 1 - 1 3 - - - - - - - - - 1 2 - - - - - - - 17 8 35 6 Valentines 157 - - - - 1 1 9 - - - - - - - - - - - - - - - - - 10 1 - - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total 11411 126 23 70 21 67 34 40 2 14 — 10 3 7 — 2 1 4 — 2 1 3 1 3 — 348 86 161 35 166 TABLE XIII. MUMPS. Summary of Cases of Mumps among School Children, and of Contacts of such Cases, excluded from School Attendance daring the Year ended the 31st December, 1925. SCHOOLS. Number on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Total, 1925. Total, 1924. 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. . Barkingside 332 - - 5 - 17 - 11 - 8 - 2 - - - - - - - - - - - - - 43 - - - Becontree 1391 - - - - - - - - - - 2 - - - - - - - - - 1 - - - 4 - 1 - Chadwell 230 — — - — — - - - - - - - - - - - - - - - - - - - - - - - Christchurch Road 1092 — — 1 - 3 - 1 - 1 - - - - - - - - - - - - - - - 8 - 5 - Cleveland Road 1231 - - 10 - 32 - 17 - 11 - 1 - - - - - - - - - - - - - 71 - 1 - Downshall 1288 1 — — — - - - - - - 2 - 1 - - - 2 - - - - - - - 6 - 2 - Goodmayes 790 1 — — — 2 — 2 - - - - - 1 - - - - - - - 2 - - - 8 - 6 1 Highlands 985 — — 1 — 1 — 7 - 36 - 70 - 70 - - - 1 - - - 1 - - - 187 - 7 1 Little Heath 105 — — - — 1 - - - - - - - - - - - - - - - - - - - 1 - 8 - Loxford 933 11 — 8 — 4 - 9 - 15 - 11 - 2 - - - - - - - - - - - 60 - 51 - Newbury Park 525 21 — 13 — 32 — 5 - 3 - - - - - - - 1 - - - 3 - 1 - 79 - 5 - Roman Catholic 407 — — — - — - 1 - - - 2 - - - - - - - - - - - - - 3 - 22 1 South Park 1163 - - - - 1 - - - - - 11 - 1 - - - 2 - - - - - - - 15 - 2 - Uphall 776 1 — 4 — 5 — 8 - 6 - 23 - 8 - - - - - - - - - - - 55 - 9 - Valentines 157 — — — — - - - - 3 - 5 - 2 - - - - - - - 10 - 3 - 23 - 1 - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Private Schools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 11411 35 — 42 — 98 - 61 — 83 — 129 — 88 — - — 6 — — — 17 — 4 — 563 — 120 3