ILF 8 Borough of Elford. 1254/1 HEALTH REPORT FOR THE YEAR 1 928. A. H. G. BURTON, M.D., B.S., D.P.M., D.P.H., Barrister-at-Law, Medical Officer of Health, &c. Borough of Elford. 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 1928. Elford Borough Council. November, 1927 -November, 1928. Alderman W. J. O. Sheat, O.B.E., J.P., C.C. Mayor. Alderman F. H. Dane, M.B.E., J.P., C.A., Deputy-Mayor. Aldermen: Church, George. Dane, Frederick Hopper, M.B.E., J.P., C.A. Davey, George Robert. Gunary, George. Odell, Herbert George. Pitt, Bertram Sidney John, J.P. Sheat, William James Oliver, O.B.E., J.P., C.C. Smith, Frank Douglas, E.C.C. Councillors : Beattie, Dr. Nathaniel. Billington, Henry. Blow, Charles Barkworth. Braithwaite, Thomas. Carrell, Mrs. Sage Ward. Clark, Charles William. Cornwell, Arthur Edward. Daniels, Russell Stearn. Elborne, John, M.A. Eves Charles, E.C.C. Farman, Claude Augustus. Griggs, Albert Philip, E.O.O. Hamilton, Alfred Parke. Harding, Alfred Daniel Bartlett. Heath, William Henry Charles. Jay, Charles Frederick. Lee, George. Reed, Rev. Charlie, B.D., Hon. C.F. Rowntree, Ernest Morion. Shipman, James Henry. Spencer, Walter Robert Waters, Owen, O.B.E., E.C.C. Wetton, George John, E.O.C. Young. Alexander Maioir, T.D. PUBLIC HEALTH COMMITTEE. November, 1927—November, 1928. Councillor C. W. Clark, Chairman. Alderman G. Church, Vice-Chairman. *Alderman F. H. Dane, M.B.E., J.P., C.A. * Alderman W. J. 0. Sheat, O.B.E., J.P., C.C. Alderman F. D. Smith, E.C.C. Councillor C. B. Blow. Councillor T. Braithwaite. Councillor Mrs. S. W. Carrell. Councillor A. E. Cornwell. Councillor R. S. Daniels Councillor A. P. Griggs, E.O.C. *Ex-officio Membere. Councillor A. P. Hamilton. Councillor A. D. B. Harding. Councillor W. H. C. Heath. Councillor C. F. Jay. Councillor Rev C. Reed, B.D., Hon. C.F. Councillor W. R. Spencer. Councillor O. Waters, O.B.E., E.C.C. Councillor G. J. Wetton, E.C.C. MATERNITY AND CHILD WELFARE STATUTORY COMMITTEE. November, 1927—November, 1928. Councillor A. P. Griggs, E.C.C., Chairman. Councillor Mrs. S. W. Carrell, Vice-Chairman. Alderman G. Church. Councillor C. W. Clark. •Alderman F. H. Dane, M.B.E., Councillor A. E. Cornwell. J.P., C.A. Councillor R. S. Daniels. •Alderman W. J. 0. Sheat, Councillor A. P. Hamilton. O.B.E., J.P., C.C. Councillor C. F. Jay. Alderman F. D. Smith, E.C.C. Councillor Rev. C. Reed, B.D., Councillor H. Billington. Hon. C.F. Councillor C. B. Blow. Councillor 0. Waters, O.B.E., Councillor T. Braithwaite. E.C.C. Co-opted Members '. Mrs. C. J. Earl. Mrs. B. E. Paddon. Mrs. A. E. Gillabd. Dr. R. B. Robson. Mrs. B. A. L. A. Harding. Mrs. B. Straohan. Mrs. E. J. Hinton. Mrs. E M. Wisb. *Ex-officio Members. EDUCATION COMMITTEE. November, 1927—November, 1928. Councillor C. B. Blow, Chairman. *Mr. W. J. Alderson, Vice-Chairman. Alderman G. Church. † Alderman F. H. Dane, M.B.E., J.P., C.A. Alderman G. Gunary. Alderman H. G. Odell. Alderman B. S. J. Pitt, J.P. † Alderman W. J. O. Sheat, O.B.E., J.P., C.C. Councillor H. Billington Councillor T. Braithwaite. Councillor Mrs S. W. Carrell. * Mrs. E. J. Craig. * Mr. J. E. Halloway. * Miss J. B. Larkin Councillor C. W. Clark. * Co-opted † Ex-officio Councillor R. S. Daniels. Councillor J. Elborne, M.A. Councillor C. A. Farman. Councillor A. P. Hamilton. Councillor Rev. C. Reed, B.D., Hon. C.F. Councillor E. M. Rowntree. Councillor J. H. Shipman. Councillor W. R. Spencer. Councillor O. Waters, O.B.E., E.C.C. Councillor Major A. Young, T.D. *Rev. A. Butterworth, M.A. *Mr. A. W. Green. *Mr. S. P. Lonergan. Members. Members. OFFICERS OF THE PUBLIC HEALTH SERVICES, JANUARY, 1929. Medical Officer of Health, School Medical Officer, Medical Superintendent of the Isolation Hospital, Medical Officer to the Maternity and Child Welfare Statutory Committee: A. H. G. Burton, M.D., B.S. (Lond.), D.P.M. (Eng.), D.P.H. (Cantab), of the Middle Temple, Barrister-at-Law. Deputy Medical Officer of Health-. A. R. Balmain, M.B., B.S. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Oxon.). Assistant Medical Officers of Health : G. Morgan Evans, M.R.C.S. (Eng.), L.R.C.P. (London). Jessie A. MacLaren, M.B., Ch.B. (Edin.), D.P.H. (Edin.). Dentist : 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. P. W. English, Assoc. Royal San. Inst. Health Visitors and School Nurses: Miss A. Batten. Miss E. J. Marsh. Miss O. Bell. Miss K. B. Mathieson. Miss E. Blackwall. Miss E. Prior. Miss M. E. Cartwright. Miss M. D. Seager. District Midwife: Miss M. M. Gambrill. Part-Time. Consulting Obstetrician (Maternity Home and Puerperal Fever Regulations) Everard H. C. Williams, M.D., B.Ch. (Cantab.), M.R.C.P. (Lond.).: Oculist: D. C. L. Vey, M.C., B.A., M.B., B.Ch. (Cantab.), D.O. (Oxon.). Veterinary Surgeon: Major J. A. Boseley, M.R.C.V.S. (L.). Assistant Medical Officer (Infant Welfare Centres): Edith I. L. Abbott, M.B., B.S. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), TABLE OF CONTENTS. SECTION I.— NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. page Preface 11 Statistical Summary 17 Physical Features of District 19 Rainfall 19 Population 19-20 Births 19 Deaths 21 Inquests 22 Poor Relief 22 Marriages 22 Vital Statistics—Tables of 22 Table I 23 ,, Table la 24 Causes of Death—Table III 25 Hospital Provision 26 District Nursing 27 Midwives 27 Ambulance Facilities 27 Clinic and Treatment Centres 28 Tuberculosis Dispensary 28 Chemical Investigations 29 Byelaws and Local Acts 29 Offensive Trades 29 SECTION II.— SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply 30 Rivers and Streams 30 Drainage and Sewerage 30 Closet Accommodation 30 Scavenging, Collection of House Refuse 30-31 Sanitary Inspection of District 32 (а) Notices served 32 (b) Complaints of Nuisances 32 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 33 Smoke Abatement 33 Rag Flock Acts 33 Housing 33 Overcrowding 33 Unhealthy Areas 33 Byelaws relating to Houses, Lodgings, Tents, etc. .. 33-4 Housing Table 34-5 SECTION III.— SUPERVISION OF FOOD. page Milk Supply 35 Licences—Graded Milk 35 Milk Samples 36 Tubercular Milk 37-38 Meat Regulations 39 (a) Slaughterhouses 39 (b) Articles of Food Surrendered and Seized 39 Bakehouses 39—40 Sale of Food and Drugs Acts 40 Public Health (Preservatives, etc., in Food) Regulations, 1925 40 Diseases of Animals Acts 40—41 SECTION IV.— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Disease Generally 41 Notifications in Institutions 42 Isolated in Hospital 42 Table II— Summary of Cases of Infectious Diseases Notified 43 Deaths from Infectious Diseases 44 Vaccination 44 Attack Rates of Infectious Diseases:— (а) Smallpox 45 Smallpox Hospital Accommodation 46 (b) Scarlet Fever 46 (c) Diphtheria 47-48 (d) Enteric Fever 49-50 (e) Cerebro-spinal Meningitis and Anthrax 51 (f) Ophthalmia Neonatorum 51 (g) Acute Influenzal and Acute Primary Pneumonia 51-52 (A) Encephalitis Lethargica 52 (i) Plague 52 (j) Puerperal Fever 52 Zymotic Diseases 52 Incidence and Deaths from Infectious Diseases in Age Groups 53 Tuberculosis 54 Table of Comparative Cases and Deaths 54 Tuberculosis Regulations 55 Public Health Act, 1925 55 Tuberculosis, Treatment of 56 Tuberculosis Care Committee 56 Venereal Diseases 57 SECTION V.— OTHER SERVICES. Bacteriological Laboratory 58 Table of Number of Specimens Examined 59 9 SECTION VI.— FACTORIES AND WORKSHOPS. page Factories 60 Workshops 60-61 Table I—Inspection of Factories, Workshops, Workplaces 62 ,, II— Defects Found 63 ,, III— Homework 64 ,, IV— Other Matter 65 ISOLATION HOSPITAL. Patients Admitted 69-70 Scarlet Fever 71 Diphtheria 73 Enteric Fever 72 Meningitis 73 Puerperal Fever 72 Tuberculosis 73-74 Training of Nurses 74 Cubicle Blocks 74-77 MATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907 and 1915 81 Registration Act, 1836 and 1926 82 Infant Mortality 82 Neonatal Mortality 86 Table IV 87 Illegitimate Births and Deaths 88 Maternal Mortalit 88-89 Infant Life Protection 89-90 Work of Health Visitors 90 Supervision of Midwives 91 Supervision of Maternity Homes 91 Supply of Milk to Expectant and Nursing Mothers and for Infants 91 Infant Welfare Centres 92 Ante-Natal Clinics 93 Dental Clinic 93-94 Ophthalmic Clinic 94 Ophthalmia Neonatorum 95 Treatment of Minor Ailments 95 Maternity Home 96-100 District Midwife 100-101 SCHOOL MEDICAL SERVICE. General Survey 105-113 Staff 114 School Premise 114 Medical Inspection 115 Findings of Medical Inspection 116-117 10 page SCHOOL MEDICAL SERVICE—(continued). Infectious Disease 117-119 "Following-up" 120 Medical Treatment:— Minor Ailments 120-121 Ophthalmic Department 121-123 Dental Department 123-124 Treatment of Uncleanliness 124-125 Other Ailments 125 Operative Treatment of Tonsils and Adenoids 125 Open-Air Education 125-129 Physical Training 130—132 Provision of Meals 132 Supply of Free Cod Liver Oil, Emulsion, etc. 132 Co-operation of:— Parents, Teachers, School Attendance Officers and Voluntary Bodies 132—133 Physically and Mentally Defective Children 133-137 Employment of School Children and Young Persons 137 Medical Examination of Teachers, etc. 138 Statistical Tables:— I.— Number of Children Inspected 139 IIa.— Return of Defects 140 IIb.— Number of Children found to Require Treatment 141 III.— Numerical Return of Exceptional Children .. 142-143 III a.— Number of Children notified to the Local Mental Deficiency Authority 144 IV.— Group I—Minor Ailments 145 Group II— Visual Defects 146 Group III— Nose and Throat Defects 146 Group IV— Dental Defects 147 Group V— Uncleanliness and Verminous Conditions 147 V.— Summary of Number of Children Inspected 148-149 VI.— A.— Average Heights and Weights of Boys Inspected 150-151 B.— Average Heights and Weights of Girls Inspected 152-153 VII.— Summary of Infectious Diseases among School Children 154 VIII.— Summary of Scarlet Fever among School Children 155 IX.— Summary of Diphtheria among School Children 156 X.— Summary of Measles and German Measles among School Children 157 XI.— Summary of Chicken-pox among School Children 158 XII.— Summary of Whooping Cough among School Children 159 XIII.— Summary of Mumps among School Children 160 PREFACE. Public Health Offices, Ilford. May, 1929. To his Worship the Mayor, the Aldermen, and Councillors of the Borough of llford. Mr. Mayor, Ladies and Gentlemen, I herewith submit the Annual Report required by the Ministry of Health and Board of Education. The issue of the report could have been made somewhat earlier, but the Registrar-General's estimate of the population was not received by me until May 4th. As I have pointed out in the report, the estimate of 113,500 appears to be a considerable under-estimate, and if grants under the new Local Government Act are to be based on this figure, the matter may be of some importance to the Council. The year has been characterised by a particularly heavy incidence of infectious diseases which has caused great strain on the officials of the department. The attack rate of scarlet fever and of diphtheria is the highest for the past five years; in addition, there was a small outbreak of paratyphoid fever, and smallpox, on one occasion, made its appearance in the town. 12 I am hopeful that the system of immunisation against diphtheria which has now been approved by the Council will limit the number of fatalities which occur each year from this disease. The outbreak of paratyphoid fever was not traced to its source. Some suspicion in the London epidemic of this disease attached to supplies of cream, this was not so in Ilford, and I am not satisfied that there is sufficient evidence in the London cases to clearly prove that cream was the cause of the epidemic. It is possible that some unsuspected foodstuff is responsible. Ilford has been fortunate so far in its experience with smallpox, as the one case which occurred, by the sensible action of the contacts in consenting to immediate vaccination, did not infect others. A neighbouring borough is, however, experiencing the full force of a smallpox epidemic, and it is unlikely that Ilford, with a largely unvaccinated population, can escape. The type of smallpox in this country is still mainly of a nonfatal character, but the cost to the local authorities and the inconvenience and loss to trade is enormous. In the year 1927, 14,767 cases of smallpox were notified in England and Wales, with 36 deaths. The country generally is paying heavily for its neglect of vaccination and re-vaccination. I am glad to report that the much-needed cubicle wards at the Isolation Hospital, which I first recommended in 1920, are completed and have already proved their value. The open-air school, the need for which I pointed out in 1919, is also occupied, and a list of children waiting for admission as vacancies occur is prepared. Some attempt has recently been made to discredit the value of special open-air schools by suggesting that they would be unnecessary if every school were made an open-air school, Although there can be 13 no doubt that in many areas every school should be built on open-air lines, yet the majority of schools are not so built and in many cases cannot be so built. There is further to be considered the great advantage of having the delicate children, unfitted for ordinary school life, educated together in one place where they can receive the special care, observation and treatment which is impossible in an elementary school, where normal children form the majority of those in attendance. The School Medical Service is likely to be further developed by a remedial exercises clinic (which I have recommended for some years), and a complete orthopaedic scheme. The appointment of an additional dentist will enable more propaganda work to be carried on in the schools. The Maternity and Child Welfare work is still making progress. In the year 1919 when I was appointed Medical Officer of Health, there were 5,643 attendances at the various Welfare Centres; last year there were 33,590. The Maternity Home and Ante-Natal Clinics have proved so successful that extension® are necessary. A surgical ward for difficult maternity cases occurring in the district is required at the Maternity Home, and the appointment of additional district midwives is also necessary. The time has arrived when the Council should consider the establishment of permanent premises in certain parts of the town which will serve school medical purposes as well as for those connected with the Maternity and Child Welfare services. Further extensions at the Isolation Hospital are at present being considered by the Public Health Committee. The staff of the department has carried out excellent work; when it is remembered that the Health Visitors alone paid over 21,000 visits to various houses for Infant Welfare and School 14 Medical purposes, the extent to which the department is in touch with the homes of the people of Ilford, can be somewhat appreciated. I have again to thank the members of the Council for their support, and I have the honour to be Your obedient servant, A. H. G. BURTON, Medical Officer of Health. GENERAL. 17 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 1928 113,500 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) 13.4 1927-28. 1928-29. Rateable Value—Houses, etc. £618,563 10 0 £642,831 0 0 ,, Land 5,456 0 0 4,975 10 0 £624,019 10 0 £647,806 10 0 Sum represented by a penny rate in 1928, £2,670. Education Rate- 1927. 1928. Elementary 2s. 4d. 2s. 5½d. in the £. in the £. Higher 0s. 5¼d. in the £. 0s. 5¼d. in the £. Assessable value £613,994 0 0 £643,224 0 0 General District Rate 6s. 4d. in the £. 6s. 4d. in the £. Poor Rate 9s. 3d. in the £. 9s. 2d. in the £. 18 2.—Extracts from Vital Statistics of the Year. 1927. 1928. Total number of Births Registered— Legitimate 1,613 1,704 Illegitimate 44 35 1,657 1,739 Birth-rate per 1,000 of population 15.8 15.8 Total number of Deaths Registered- Males 506 462 Females 502 462 1,008 924 Death-rate per 1,000 of population 9.6 8.4 Number of Women dying in, or in consequence of, Childbirth— Sepsis 1 2 Other causes 4 5 5 7 Maternal Mortality per 1,000 births 3.0 4.0 Total number of Deaths of Infants under 1 year of age— Legitimate 65 69 Illegitimate 9 10 74 79 Infant Mortality per 1,000 births— Legitimate 40 40 Illegitimate 204 285 Infant Mortality per 1,000 registered births 44.0 45.4 Total number of Deaths from seven principal Zymotic Diseases 30 32 Zymotic death-rate per 1,000 of population .29 .29 Total number of Deaths from— Measles (all ages) — 5 Whooping Cough 8 7 Diarrhoea (under 2 years of age) 8 10 19 SECTION I.— NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. 1. Physical Features and General Character of the District.— Vide Annual Report, 1925. 2. Rainfall.— The total rainfall registered in the district during the year was 21.74 inches. The greatest fall in 24 hours was registered on 13th June, being .90 inches. The number of days on which rain fell was 144. 3. Population. Census, 1911 78,188 Census, 1921 85,194 (including institutions) Registrar-General's Estimate on 30th June, 1928 113,500 ,, ,, To obtain the net population, must be deducted the number of patients and resident staff on the 30th June at the following public institutions:— Clay bury Mental Hospital 2,483 West Ham Mental Hospital 1,146 This makes a net population of 109,871. 4. Births.— The number of births registered during the year was 1,739. Legitimate 894 Males 810 Females Illegitimate 17 ,, 18 ,, i.e., 2.01 per cent, of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was:—2.65 in 1927; 2.25 in 1926; 3.37 in 1925; 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. The birth-rate, calculated on the net estimate of the population of 109,871, is 15.8 per 1,000, as compared with 15.8 in 1927; 15.6 in 1926; 16.5 in 1925; 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, 20 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. There are two sources of information from which the appropriate estimate of the population in Ilford can be obtained:— (1) The Number of Inhabited Houses. In June, 1921 (Census), there were 18,606 houses in Ilford with a population of 85,194. Since that date, the following houses have been erected:— 1921 (June-Dec.) 272 1922 1,932 1923 264 1924 596 1925 1,015 1926 2,870 1927 1,162 1928 877 8,988 18,606 bouses in 1921 8,988 since erected Total 27,594 Assuming an average of 4-5 persons to every house (the figure arrived at with the Census of 1921), the population at the present time is 124,173. (2) The Voters List. The number of persons included in the Autumn Register of the Voters List for 1928, before inclusion of female voters of 21 years of age, was 64,167. Assuming that there is only one person a non-voter to every person a voter, the population at the present time would be 128,334, 21 In my opinion, the population of Ilford is in the region of 125,000 to 130,000 persons. 5. Deaths.— The total number of deaths of Ilford residents was 924.a The total number of deaths registered in the district during the year was 860 Number of deaths of non-residents registered in the district (principally in large institutions) 216 The latter 216 deaths occurred as follows:— In Claybury (L.C.C.) Mental Hospital 125 In West Ham Borough Mental Hospital 63 In Ilford Maternity Home 1 In Ilford Emergency Hospital 11 Other Non-residents 16 216 Included in the deaths of residents belonging to the district are 9 which occurred in Dr. Barnardo's Village Homes. To be added to the total number of deaths registered in the district are 280 deaths of Ilford residents registered as having died in other districts. died in other districts. This figure includes deaths at the following institutions:— The Infirmary, Romford 125 Essex County Mental Hospital 16 The London Hospital 24 Queen Mary's Hospital, West Ham 4 Hospital for Sick Children, Great Ormond Street 7 St. Bartholomew's Hospital 4 In other Hospitals, Institutions and Residences outside the Ilford District 97 Total 280 The total number of deaths of Ilford residents was, therefore, 924. The death-rate, calculated on the net estimate of the population of 109,871, is 8.4 per 1,000, as compared with 9.6 in 1927; 8.7 in 1926; 9.9 in 1925; 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, 22 Inquests.— During the year, 64 inquests were held in the district. 52 on Ilford residents, and 12 on non-residents. The ages at death and causes assigned were as follows Under 1.2 2.5 5.15 15.25 25.45 45.65 65 years and 1 year. years. years. years. years. years. years. upwards. 2 — 2 2 4 11 28 15 Causes of inquest-deaths under 1 year.— Accidental suffocation in cot, 2. Causes of inquest-deaths over 1 year.— Accidents 26 Internal Haemorrhage 1 Suicides 12 Cerebral Haemorrhage 2 Heart Disease 12 Cancer 2 Pneumonia 4 Suffocation 1 Bronchitis 1 Pulmonary Thrombosis 1 6. Poor Relief.— The total amount expended in Ilford during the year was £15,641. The average weekly number of cases in receipt of relief was 469. The number of admissions to the Guardians' Institutions from Ilford during the year was 445, made up as follows:— Men 123 Women 261 Children 61 7. Marriages.—780 marriages have taken place during 1928. The following details explain the allocation:— Marriages taking place in the Ilford District 587 Marriages of Ilford Residents at Register Office, Romford— Both Parties belonging to Ilford 121 The Male only belonging to Ilford 33 The Female only belonging to Ilford 39 8. Tables of Vital Statistics.— Table I gives a comparative statement of the population, birth-rate and death-rate for the past six years. Table 1a 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 1928, arranged according to the age groups at which deaths occurred. 23 TABLE I. Vital Statistics of Whole District During 1928 and Previous Years. Year. Gross Population estimated to Middle of each Year. Net Population estimated to Middle of each Year (a). Births . Total Deaths Registered in the District. Transferable Deaths Net Deaths Belonging to the District. Uncorrected Number. Net (6). of Non-Residents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate (c). Number. Rate (d). Number. Rate per 1,000 Net Births. Number. Rate (e). 1 2 2a 3 4 5 6 7 8 9 10 11 12 13 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 1926 100,500 96,885 1,477 1,509 15.6 847 8.7 244 235 68 45.1 838 8.7 1927 108,310 104,766 1,526 1,657 15.8 937 8.9 255 326 74 44.0 1,008 9.6 1928 113,500 109,871 1,671 1,739 15.8 860 7.8 216 280 79 45.4 924 8.4 (а) The net estimated population is found by deducting the population of Clay bury 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 or subtracting from it such a number as is supplied for this purpose by the Registrar-General. (c) (d) (e) Calculated on the estimated net population. 24 TABLE IA. Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1928. (Provisional figures. The rates have been calculated on a population estimated to the middle of 1928. 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. Smallpox. Measles. Scarlet Fever. Whooping Cough. 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 16.7 11.7 0.01 0.00 0.11 0.01 0.07 0.06 0.19 0.53 7.0 65 90.9 6.7 1.0 107 County Boroughs and Great Towns, including London 16.9 11.6 0.01 0.00 0.15 0.02 0.09 0.09 0.17 0.48 9.6 70 91.0 6.5 0.6 156 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 16.6 10.6 0.01 0.00 0.08 0.01 0.06 0.08 0.21 0.41 4.8 60 92.6 5.7 1.2 London 15.9 11.6 0.01 0.00 0.30 0.02 0.09 0.09 0.13 0.55 10.2 67 88.7 7.6 0.0 ILFORD (Estimated Net Population, 109,871) 15.8 8.4 0.00 0.00 0.04 0.02 0.06 0.07 0. 07 0.27 5 .7 45 94.2 5.6 0.2 25 TABLE III. Causes of, and Ages at, Death during the Year 1928. Causes of Death. Net Deaths at the subjoined ages of ''Residents,'' whether occurring within or without the District. Total Deaths, whether of "Residents" or "NonResidents" 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 Smallpox - - - - - - - - - 3 Measles 5 - 2 2 1 - - - - 2 4 Scarlet fever 2 - - 1 — — 1 - - 2 S Whooping cough 7 3 2 1 1 - - - - - 6 Diphtheria 8 - 1 4 3 — — — — 8 7 8 Influenza Encephalitis lethargica 8 — — — — 1 1 2 4 — 9 Meningococcal meningitis 2 1 1 - - - - - - - 10 Tuberculosis of respiratory system 59 - - 1 1 12 26 17 2 13 11 Other tuberculous diseases 13 1 1 1 4 1 4 - 1 8 12 Cancer, malignant disease 143 - - - - - 8 78 57 26 13 Rheumatic fever 3 — 1 — — — 1 1 - - 14 Diabetes 8 - - — — 1 1 3 3 — 15 Cerebral haemorrhage, etc. 45 - - - - - 1 13 31 4 16 Heart disease 193 1 1 — 5 3 4 64 115 19 17 Arterio-sclerosis 40 — — — — - 2 9 29 43 18 Bronchitis 43 3 — — — 2 — 7 31 3 19 Pneumonia (all forms) 60 8 3 5 — — 10 18 16 42 20 Other respiratory diseases 17 - - - - 2 2 6 7 7 21 Ulcer of stomach or duodenum 9 - - - - - 1 6 2 2 22 Diarrhoea, etc. (under 2 years) 10 10 - - - - - - - 1 23 Appendicitis & typhlitis 6 — — 1 — 2 1 2 — 2 24 Cirrhosis of liver 6 — — 1 — 3 2 2 25 Acute and chronic nephritis 17 - - - - 2 2 10 3 14 26 Puerperal sepsis 2 — — — — 1 1 — — - 27 Other accidents and diseases of pregnancy and parturition 5 - - - - 1 4 - - 1 28 Congenital debility and malformation, premature birth 46 46 - - - - - - - 7 29 Suicide 17 - - - - 2 3 10 2 1 30 Other deaths from - - - - - - - - - - violence 30 2 1 1 2 2 9 7 6 16 31 Other defined diseases 120 4 3 5 10 7 11 34 46 67 32 Causes ill-defined or unknown - - - - - - - - - Totals 924 79 16 22 28 39 93 290 357 290 26 9. Hospital Provision. (а) Tuberculosis.—Twelve beds are maintained by the Essex County Council at the Isolation Hospital for the treatment of tuberculosis (surgical) of male patients. (b) Maternity.—Ilford Council Maternity Home—23 ordinary beds, with two isolation wards and two labour wards. (c) Children.—A ward erected by the War Memorial Committee was opened in 1927 to accommodate 22 children at the Ilford Emergency Hospital. (d) Fever.—Ilford Council Isolation Hospital, 123 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). (/) Other.—There is an Emergency Hospital in the district, maintained by voluntary subscriptions and by patients' fees, the number of beds being 64. During the year 1928, 942 in-patients were admitted, including 82 children under 5 years of age, and 114 over 5 and under 12 years of age; 424 operations were performed, 2,652 casualties were attended to, and 871 X-Ray examinations were made. The average cost per patient per week was £3 1s. 11.08d. There are two large Mental Hospitals in the district, the West Ham Mental Hospital, with 1,030 patients (males 496, females 534), and Clavbury Mental Hospital, with 2,268 patients (males 980, females 1,288) in residence on 30th June, 1928. In addition, there is the Girls' Village Homes, one of the late Dr. Barnardo's Institutions, which had 1,390 children and 196 staff in residence on the 30th June, 1928. 27 10. District Nursing. This is a voluntary Committee, the organisations concerned being mentioned in my Annual Report for 1921. 10,632 visits were paid by the nurses, compared with 10,550 in 1927. The following is a summary of the work carried out during the year 1928:— Number of New Cases 433 Number of Visits—Medical 5,302 Surgical 4,569 Operations 66 Massage 695 Number of applications made for Nurses' services 433 Number of patients under the charge of a Doctor at 31st December 41 Number of patients not under the charge of a Doctor — Number of necessitous cases referred to Committee 20 Number of cases on the books at the end of the year 41 The cases were distributed in wards as under Cranbrook 93 Park 54 Seven Kings 77 North Hainault 52 Loxford 60 Clementswood 50 South Hainault 25 Goodmayes 22 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). 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.—Three Austin motor ambulances are provided for the use of the public for accident and other cases. 28 12. Clinic and Treatment Centres.— Maternity and Child Welfare.—The Council has established the following Infant Welfare Centres:— United Methodist Church (entrance in Monday, 2.0 p.m. Balmoral Gardens, opposite Vernon Road), Seven Kings. United Methodist Church, High Street, Monday, 2.0 p.m. Barkingside. All Saints' Church Hall, Goodmayes Tuesday, 9.30 a.m. Lane, Goodmayes. Congregational Church, Birkbeck Road, Tuesday, 2.0 p.m. Newbury Park. Public Health Offices, Valentines Man- Tuesday, 2.0 p.m. sion. Congregational Church Hall, Grosvenor Wednesday, 2.0 p.m. Road, Ilford. Cecil Hall, Granville Road, Ilford .. Thursday, 9.30 a.m. and 2.0 p.m. St. Thomas' Church Institute, Becontree Thursday, 2.0 p.m. Emmanuel Church, Ilford Lane, Ilford.. Friday, 2.0 p.m. 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). Tuberculosis Dispensary.—A dispensary is provided by the Essex County Council at 38, Oakfield Road, Ilford. Three sessions per week are held for adults and one session for children, viz.:— For adults—Monday, 7.30-8.30 p.m. ; Tuesday, 3-5 p.m., and Friday, 4-6 p.m. For children—Wednesday, 10-12 noon. 29 13. Chemical Work.—The Essex County Council Public Health Laboratory carries 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 house and houses let in lodgings. (4) Slaughterhouses and humane slaughtering of animals. (5) Offensive trades:— (а) Bone boilers. (b) Fellmongers. (c) Leather dressers. (d) Soap boilers. (e) Tanners. (f) Tallow melters. (g) Fat melters or fat extractors. (h) Glue makers. (i) Tripe boilers. (j) Size makers. (k) Gut sorapers. (l) Fish frier and fish curer. (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. 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. 30 SECTION II.—SANITARY CIRCUMSTANCES OF THE AREA. 1. Water Supply.—Vide Annual Report, 1925. 2. Rivers and Streams.—Vide Annual Report, 1925. 3. Drainage and Sewerage.—No alterations or extensions have taken place at the Outfall Works during the year, but an agreement has been made with the Barking Council that the whole of the sewage from Ilford and Barking be disposed of jointly, and a scheme has been prepared for the London County Council to treat the same. Plans have been prepared for submission to the Ministry of Health for the purposes of obtaining a loan for the necessary works. 4. Closet Accommodation.—In addition to the water carriage system of sewage, there are in the rural area, 51 cesspools, 18 privies and 61 pail closets. The clearing of cesspools, privies and pail closets is carried out by the Council, the former by means of two vacuum emptiers. All pail closets are emptied twice weekly. Ten old houses were connected to the sewer during the year in New North Road, Hainault Road and Loxford Lane. 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. Since September, 1927, refuse has also been barged, by contract. In 1928, 7,934 tons were so dealt with. Refuse Destructor.—The Council applied to the Ministry of Health for sanction to borrow £9,500 for four additional cells at the Refuse Destructor. An enquiry was held on 16th July, 1928, by a Ministry of Health Inspector and, after hearing evidence at considerable length, the enquiry was adjourned. The adjourned enquiry was held on 5th November. The Minister wrote, intimating that he did not see his way at present to sanction a loan for the extension of the works. 31 441 defective and unsuitable receptacles have been replaced during the year. The following figures give information as to the collection of house refuse during 1928:— Number of daya on which collection was made 1,294 (Horse 261, electric 307, 2-ton Vulcan 291, 4-ton Vulcan 285, S.D. Freighter 150) Number of vehicles employed 3,806 (Horse 1,217, electric 1,863, 2-ton Vulcan 291, 4-ton Vulcan 285, S.D. Freighter 150) Average number of vehicles employed per day 13.6 (Horse 4.6, electric 6.0, 2-ton Vulcan 1.0, 4-ton Vulcan 1.0, S.D. Freighter 10) Total number of loads collected 10,860 (Horse 3,239, electric 5,307, 2-ton Vulcan 1,055, 4-ton Vulcan 667, S.D. Freighter 592) Average number of loads collected per day 39.4 (Horse 12.4, electric 17.2, 2-ton Vulcan 3.6, 4-ton Vulcan 2.3, S.D. Freighter 3.9) Average per horse per day 2.6 Average per electric per day 2.8 Average per 2-ton Vulcan per day 3.6 Average per 4-ton Vulcan per day 2.3 Average per S.D. Freighter per day 3.9 Average of all per day 2.8 Total weight of refuse collected, 21,114 tons 4 cwts. 1 qr. (Horse, 3,827 tons 12 cwts. 2 qrs.) (Electric, 12,612 tons 11 cwts. 1 qr.) (2-ton Vulcan lorry, 1,535 tons 7 cwts. 2 qrs.) (4-ton Vulcan lorry, 2,177 tons 1 cwt. 1 qr.) (S.D. Freighter, 961 tons 11 cwts. 3 qrs.) Average weight per load:— Horse-drawn vehicles 1 ton 3 cwt. 2-5 qrs. Electric vehicles 2 tons 7 cwts. 2-1 qrs. 2-ton Vulcan lorry 1 ton 9 cwts. 0-4 qrs. 4-ton Vulcan lorry 3 tons 5 cwts. 1-1 qrs. S.D. Freighter 1 ton 12 cwts. 1-9 qrs. • Average of all vehicles 1 ton 18 cwts. 3-5 qrs. Average cost of collection per ton:— £ s. d. Horse 0 11 4.1 Electric 0 11 4.8 2-ton Vulcan lorry 0 11 8.9 4-ton Vulcan lorry 0 11 1.2 S.D. Freighter 0 10 4.8 Average of all vehicles 0 11 3.9 These figures include Capital and Depreciation costs and all incidental charges. 32 The S.D. Freighter commenced service on 1st July, 1928. Arrangements are still in force whereby a special daily collection of refuse is made from Claybury Mental Hospital. 6. Sanitary Inspection of District.—The following is a summary of the work of the Sanitary Inspectors during the year:— Houses and premises inspected 6,571 Houses and premises re-inspected (works in progress) 4,690 Visits during disinfection 1,648 Houses in which nuisances were detected 602 Houses in which nuisances were abated 437 Premises disinfected 886 Articles disinfected 4,670 Premises disinfected for verminous conditions 3 Notices served:— Statutory:— Served. Complied with. Public Health Act, 1875 8 7 Housing Act, 1925 99 70 Cleanse Dwelling House (Infectious Disease (Prevention) Act, 1890) 14 14 Provide Dustbin (Ilford Improvement Act) 333 277 Pave Yard (Ilford Improvement Act) 4 2 Provide Water Supply to Dwelling House 4 4 Cleanse Water Storage Cistern (Byelaws) 93 76 Cover Water Storage Cistern (Byelaws) 39 37 Informal 475 334 Total 1,069 821 In addition to the above, 127 notices (67 statutory and 60 informal) served during 1927 were also complied with. Complaints.—During the year 261 complaints of nuisances have been received and investigated:— The following is a summary:— Accumulation of manure and refuse 20 Animals improperly kept 3 Bad smells 36 Dampness of premises 9 Defective drains, w.c.'s and fittings 40 Defective or no provision of dustbin 2 Defective roofs, gutters, downpipes, etc. 33 Defective water fittings 12 Dirty and verminous houses 13 33 Dirty condition of rear way 2 Flooding of premises 4 Overcrowding 2 Smoke nuisances 7 Miscellaneous 78 Total 261 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 8, and the number of certificates issued was 6. Smoke Abatement.—It has not been necessary during the year to take any legal action for the abatement of smoke. Rag Flock Acts, 1911 and 1928.—There are no premises on which rag flock is manufactured, used or sold. Housing.—During the year 1928 the number of houses built by private enterprise was 877. At the end of the year 758 houses were in course of erection. An extension of the existing estate at Tomswood Hill, amounting to a further 120 houses, was commenced in September, 1928. An additional four houses on the Duke Road Estate were commenced in October, 1928. Overcrowding.—-Notices were served in respect of two premises, which were complied with. A notice served in 1927 was also complied with in 1928. Unhealthy Areas.—No representations or complaints have been made regarding unhealthy areas during the year. Byelaws relating to houses, to houses let in lodgings, and to tents, vans, sheds, etc.—It has not been considered necessary to 34 seek any revision of existing byelaws. A full list of the byelaws in operation is given on page 29 of this report. The following is the table required by the Ministry of Health:— Number of new houses erected during 1928:— (a) Total 877 (b) With State assistance under Housing Acts:— (1) By local authority — (2) By other bodies or persons 877 1. Unfit Dwelling Houses:— Inspection:— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,370 (2) Number of dwelling houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 377 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation *2 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 595 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 454 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.. 99 (2) Number of dwelling houses which were dered fit after service of formal notices:— (a) By owners 70 (b) By Local Authority in default of owners — (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 5 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (а) By owners 5 (b) By Local Authority in default of owners — 35 (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 — * These houses were demolished during the year owing to their dilapidated and dangerous condition, under Section 75 of the Towns Improvement Clauses Act, 1847. SECTION III.—INSPECTION AND SUPERVISION OF FOOD. 1. Milk Supply.—There are 72 dairies and milkshops and 6 cowsheds on the register. 444 inspections of dairies, milkshops and cowsheds were carried out during the year. Of the 72 premises from which milk is retailed in Ilford, 15 are branches of one firm, 2 another and 2 another, while another is a branch of a large firm of retailers, 8 retail from dairy shops or stores, 9 from general shops and 6 from restaurants. Five are retailers in a small way with rounds and also provision for storage of milk, while 24 sell sterilised bottled milk only. In four premises, pasteurising plant has been installed. Only one of these has, however, been licensed; the Silkeborg type of machine is in use in this case. There are six wholesale dealers in milk, all having cows on the premises. Of these dealers, four are also retailers. 2. Licences were granted under the Milk (Special Designations) Order, 1923, during 1928, for the sale of:— "Certified" Milk 15 "Grade A" Milk 5 "Grade A (Tuberculin Tested)" Milk 21 "Pasteurised" Milk 16 The above include supplementary licences which were issued for "Certified" milk. 14; "Grade A" milk, 3; "Grade A" (Tuberculin Tested) milk, 3; and "Pasteurised" milk, 7. 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. 36 3. Milk Sampling.—Six samples of "Grade A," 3 samples of "Pasteurised" and 61 samples of other milk were taken. 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. The following table shows the result of the analyses of the Ilford samples:— Sample No. No. of Bacteria per c.c. Kind of Milk. Sample No. No. of Bacteria per c.c. Kind of Milk. 71 47,333 Ordinary 106 570,000 Ordinary 72 18,000 107 104,666 „ 73 56,333 108 147,666 „ 74 402,333 109 1,635,000 „ 75 1,660 "Gr. A (T.T.)" 110 635,000 „ 76 775,000 Ordinary 111 183,333 „ 77 40,000 112 152,666 „ 78 387,666 113 116,333 „ 79 146,000 114 2,720,000 „ 80 56,000 115 157,000 „ 81 2,240,000 116 640,000 "Pasteurised" 82 900,000 > > 117 452,000 Ordinary 83 328,000 118 85,333 „ 84 234,666 > > 119 730,000 „ 85 975,000 120 17,866 „ 86 353,666 »* 121 14,566 „ 87 815,000 >» 122 264,666 „ 88 11,966 »* 123 629 500 „ 89 15,700 "Grade A" 124 44,950 „ 90 133,666 Ordinary 125 28,333 „ 91 190,000 126 895,000 „ 92 71,666 9 * 127 535,000 „ 93 4,500 "Gr. A(T.T.)" 128 287,000 „ 94 221,000 Ordinary 129 770,000 „ 95 1,280,000 > 9 130 176,666 „ 96 490,000 131 344,666 „ 97 353,000 "Gr. A (T.T.)" 132 4,733 "Gr. A (T.T.)" 98 38,200 "Pasteurised" 133 176,000 Ordinary 99 2,855,000 Ordinary 134 8,400 „ 100 5,400,000 135 36,866 „ 101 3,445,000 136 176,666 „ 102 90,000 ' 'Pasteurised'' 137 46,000 „ 103 10,800 "Gr. A(T.T.)" 138 57,333 „ 104 1,400,000 Ordinary 140 278,333 „ 105 7,570 " 141 137,000 „ In all the cases showing an unsatisfactory bacterial report, the retailers were warned and further samples were taken after various intervals of time, In all cases, these were satisfactory. 37 4. Tubercular Milk. (а) A sample of milk was taken on the 4th July, 1928, from a Dagenham retailer, who also retails in the Ilford district. The sample of milk was submitted to bacteriological examination, and the presence of tuberculosis was established. The County Medical Officer was notified under Section 4 of the Milk and Dairies (Consolidation) Act, 1915, and the Medical Officer of Health, Dagenham, was also informed. The Essex County Council Veterinary Inspector visited the 4 farms from which this retailer obtained his supplies on August 22nd and 23rd. Major J. A. Boseley, the Council's Veterinary Inspector, accompanied by the Deputy Medical Officer of Health, visited the farms in question during the visit of the E.C.C.'s Veterinary Inspector. At one farm one cow was found to have a diseased udder, and microscopical examination showed the presence of tubercle bacilli in the milk. At a second farm a cow with a nodule in the udder gave a definite reaction to a tuberculin test. No evidence of disease was found at the other two farms. The Essex County Council dealt with the matter under the Tuberculosis Order and both cows were slaughtered. A warning under Section 5 of the Milk and Dairies (Consolidation) Act, 1915, was served on the retailer. A further sample of milk was obtained from the retailer, following the slaughter of the diseased cows. The sample was submitted to bacteriological examination and no evidence of tubercle bacilli was found. (b) A sample of milk was taken on the 22nd August, 1928, from a West Ham producer, who retails in the Ilford district. The sample of milk, on submission to bacteriological examination, showed the presence of tuberculosis. 38 The Medical Officer of Health for West Ham was notified under Section 4 of the Milk and Dairies (Consolidation) Act, 1915, and warning under Section 5 of the same Act was served on the retailer. Major J. A. Boseley, the Council's Veterinary Inspector visited (he premises on the 30th October with the Veterinary Inspector for West Ham. With the exception of two cows with an enlarged and thickened quarter of the udder all were found to be in good condition, and none showed any definite clinical signs of tuberculosis. A sample of milk was taken from each of the before-mentioned two cows for examination for tubercle bacilli with negative results. Major Boseley gathered that the cows on these premises are frequently being changed, almost weekly. A further sample of milk was obtained from this retailer after a period of two months, when a negative result was obtained. (c) A sample of milk was taken on the 7th September, 1928, from a local retailer, and on the sample being submitted to bacteriological examination the presence of tubercle bacilli was established. At the time the sample was taken this retailer was obtaining his supplies from a wholesaler at Forest Gate. The Medical Officer of Health for West Ham was notified under Section 4 of the Milk and Dairies (Consolidation) Act, 1915, and warning under Section 5 of the same Act was served on the retailer. The Medical Officer of Health for West Ham found that on the date in question, milk was collected by the West Ham wholesaler, from five producers in Essex, delivered direct to the Ilford retailer and may have been taken from one churn or may have been mixed. The County Medical Officer was therefore notified under Section 4 of the Milk and Dairies (Consolidation) Act, 1915, that tuberculous milk had been found in a supply obtained from five Essex farms. Major Boseley, the Ilford Corporation Veterinary Inspector, accompanied the Veterinary Inspector to the Essex County Council on his 39 inspection of the farms on the 17th November. Three of the farms were inspected, and the cows examined; none showed any symptoms of tuberculosis. Of the other 2 farms one was sold up on the 29th September, and the other was given up on the same date. The Ilford retailer is no longer obtaining his milk from the above source. Another sample of milk was obtained from this retailer, and on submission to examination failed to show tubercle bacilli. 5. Meat.—All the local tradesmen are now complying with the Public Health (Meat) Regulations, 1924. There is now only one licensed slaughterhouse in the district, at which 44 inspections were paid during the year. 6. Articles of Food Surrendered and Seized.—During the year, the following articles of food were surrendered or seized and condemned as being unfit for the food of man:— Surrendered:— 5 pigs' heads. 1 bag of mussels. 1 box of catfish. 6 stone chat haddocks. 17½ stone of skate wings. 1 skinned rabbit. 1 box of kippers. llb. Ostend rabbit. 241b. back of bacon. Seized:— (a) 1 glass jar of ox tongue. (b) 7 chickens. The following action was taken in connection with these cases:— (a) Legal proceedings were instituted, and defendants were fined £2 and £2 2s. costs. (b) Legal proceedings were instituted, and defendant was fined £2. 7. Bakehouses.—There are 33 bakehouses in the district, including 17 factory bakehouses. There is one underground bakehouse. 180 inspections of bakehouses were carried out during the year. 40 In 10 instances, it was necessary to call upon the occupiers of bakehouses to carry out cleansing and other works, and the requests were complied with. 8. Sale of Food and Drugs Acts.—These Acts are administered by the Essex County Council. Mr. H. C. Card, the Chief Inspector, has kindly given me certain particulars, which I append:— Samples of Milk taken 75 Samples of Butter taken 78 Other Samples 108 Total 261 Analyses for the detection of preservative forbidden by the Public Health (Preservatives, etc., in Food) Regulations, 1925, were also made in the above cases. Proceedings were found to be necessary in five instances, all in relation to milk. The results were as follows:— Fined £25 for obstruction; costs, £1 8s., in lieu of fine; fined £1 and 6s. costs; fined £1. In the other case, the defendant was committed to prison for one month. 9. Diseases of Animals Acts, etc.—The Council in September, 1927, appointed Major J. A. Boseley, M.R.C.V. S., L., as Veterinary Inspector, under the Diseases of Animals Acts, 1894-1925, and the Milk and Dairies Order, 1926. The Diseases of Animals Acts are now being administered by the Borough Council, Mr. King (Senior Sanitary Inspector) being appointed as Inspector for the purposes of these Acts. Swine Fever.—During the year, swine fever occurred upon three premises in the district. Notice under the Swine Fever Order of 1908 was served declaring the premises as infected with swine fever. In 41 two instances, the premises were afterwards declared free of infection and the notices were withdrawn. The other notice has not yet been withdrawn by the Ministry of Agriculture and Fisheries. Tuberculosis.—During the year, four cows in milk at the farm attached to a public institution were reported as suspected cases of tuberculosis. They were slaughtered, and, upon the Veterinary Inspector making a post mortem examination, in each case, were found to be suffering from advanced tuberculosis. SECTION IV.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. 1. Infectious Disease Generally.—During 1928, 1,095 cases were notified, as compared with 953 in 1927. The following diseases are notifiable to the Medical Officer of Health:— Smallpox. 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. Acute Poliomyelitis. Relapsing Fever. Acute Polio-encephalitis. Continued Fever. Acute Encephalitis Lethargica. Puerperal Fever. Anthrax. Puerperal Pyrexia. In addition to the above infectious diseases notifiable to the Medical Officer of Health, certain industrial diseases are notifiable to the Chief Inspector of Factories, by medical practitioners under Section 73 of the Factory and Workshop Act, 1901, and Statutory Rules and Orders 1775, 1170 and 1505. These are cases of lead, phosphorus, arsenical, mercurial, carbon bisulphide, aniline and chronic benzene poisoning, anthrax, 42 toxic jaundice, epitheliomatous or chrome ulceration, contracted in any factory or workshop. I was notified of one case of lead poisoning which occurred in a painter. The case was a mild one, the man being able to continue his work. Poisoning by lead paint is notifiable to the Chief Inspector of Factories under Section 3 of the Lead Paint (Protection Against Poisoning) Act, 1926. Table II shows the number of cases of infectious disease notified during 1928, arranged according to age and distributed in wards. Of these 75 occurred in institutions as follows:— Claybury Mental Hospital:— Pneumonia 4 cases. Dysentery 1 case. Diphtheria 1 case. Tuberculosis—Pulmonary 4 cases. Enteric Fever 4 cases. Erysipelas l case. 15 oases. Dr. Barnardo's Girls' Village Homes:— Diphtheria 41 cases. Tuberculosis—Pulmonary 7 cases. 48 cases. West Ham Mental Hospital:— Erysipelas 3 cases. Dysentery 1 case. 4 cases. Emergency Hospital:— Pneumonia 6 cases. Pulmonary Tuberculosis 2 cases. 8 cases. Of the cases notified (exclusive of those from Public Institutions) the following table shows the percentage isolated in hospitals— Scarlet Fever 67.9 Diphtheria and Membranous Croup 92.6 Enteric Fever 65.4 Puerperal Fever 88.8 Encephalitis Lethargica 100.0 43 TABLE II.—Cases of Infectious Disease Notified during the Year 1928. NOTIFIABLE DISEASE. At all Ages. Number of Cases Notified. At Ages—years. Total Cases Notified in each Ward. Total Cases Removed to Hospital. Under 1 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Cranbrook Park Seven Kings North Hainault Loxford Clementswood South Hainault Goodmayes Smallpox 1 - - 1 — — — - - - - - 1 - - - 1 Scarlet Fever 502 2 60 379 40 20 1 - 53 55 98 40 50 56 61 89 341 Diphtheria, including Membranous Croup 260 1 40 144 36 33 5 1 18 22 23 72 37 24 8 56 203 Enteric Fever (Typhoid and Para Typhoid) 30 — 4 11 3 7 5 - 2 1 2 7 1 3 7 7 17 Pneumonia 92 3 20 17 3 23 15 11 7 11 7 16 2 6 6 37 12 Puerperal Fever 9 — — — 3 6 — - 3 1 1 2 1 1 - - 8 Puerperal Pyrexia 9 — — — 2 7 — - — 1 I 2 3 — - 2 6 Cerebro-Spinal Fever - - - - - - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - - - - - - Acute Polio-Encephalitis - - - - - - - - - - - - - - - - - Encephalitis Letharigrica 1 - - - 1 - - - 1 - - - - - - 1 Continued Fever 1 1 - - - - - - - - 1 - - - - Dysentery 2 - - - 1 - 1 - - - - 1 - - 1 - - Ophthalmia Neonatorum 4 4 - - - - - 1 1 1 1 - 1 Erysipelas 31 — - 1 1 9 19 1 2 5 6 1 5 3 8 1 1 Tuberculosis—Pulmonary 118 — - 1 32 63 20 2 7 11 16 20 24 11 10 19 - Other Forms 35 1 5 16 7 5 1 — 3 1 5 4 7 1 6 8 - Anthrax - - - - - - - - - - - - - - - - - Malaria—Believed to be contracted in this country - - - - - - - - - - - - - - - - - Believed to be contracted abroad - - - - - - - - - - - - - - - - - Totals 1095 11 129 571 129 173 67 15 96 109 159 165 133 106 108 219 591 44 The total number of deaths of Ilford residents from the chief infectious diseases during 1928 was 174, classified as follows:— Enteric Fever — Scarlet Fever 2 Diphtheria 8 Measles 5 Whooping Cough 7 Influenza 8 Tuberculosis—Pulmonary 59 ,, Other forms 13 Pneumonia 60 Diarrhoea (under 2 years) 10 Cerebro-Spinal Meningitis — Puerperal Fever 2 174 The following table shows a comparison of the incidence of the chief infectious diseases for the past five years:— No. of Cases. 1928. 1927 1926. 1925. 1924. Scarlet Fever 502 387 171 146 157 Diphtheria 260 187 148 56 82 Enteric Fever 30 11 6 10 5 Pneumonia 92 139 73 103 96 The attack-rates of certain infectious diseases per 1,000 of the population for the previous five years is seen from the following tables:— Year. Population. Smallpox. Scarlet Fever Diphtheria. a b a b a b a b 1928 113,500 108,285 0.0 0 .0 4.4 4 .4 2.3 2.0 1927 108,310 103,168 - - 3.5 3.6 1.7 1.4 1926 100,500 95,359 - - 1.7 1.7 1.5 1.4 1925 93,590 88,654 - - 1.6 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 1.5 1.5 Year. Population. Enteric Fever Puerperal Fever. Erysipelas. a b a b a b a b 1928 113,500 108,285 0 .26 0 .24 0.08 0.08 0.27 0.27 1927 108,310 103,168 0.10 0.10 0.03 0.03 0.38 0.32 1926 100,500 95,359 0.05 0.04 0.08 0.07 0.27 0.28 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 (a) Including all Institutions. (b) Excluding all Institutions. 45 (a) Smallpox.—(1) A case of Smallpox—an unvaccinated girl, aged 14—occurred intheLoxford Ward, on the 2nd May. The patient was removed to Orsett Hospital the same day, and the house disinfected. She was discharged from the Orsett Hospital on the 22nd May. The 24 contacts (12 adults and 12 children) were visited daily for 16 days from the date of contact. Ten of the contacts were schoolchildren, who were examined and certified fit before they resumed school attendance. An examination was made of all the children in the patient's class, and a survey made of all the girls in the school. A daily visit was paid to the school for a period of 16 days from the date at which the patient was last in attendance at school. All the contacts were vaccinated when the position was explained to them. No further case of smallpox occurred as a result of infection from this case. The origin of this case of smallpox was not discovered. It was of the mild type which is now so prevalent in various parts of the country. (2) On the 6th May, a case of smallpox of an Ilford resident— a man of 56 years, then in Oldchurch Hospital, Romford—was reported, the onset of the disease being about the 30th April. The case was removed to Orsett Hospital on the 5th May. The man had been in Oldchurch Hospital since January. Those persons resident in Ilford—10 in number--who recently visited this man while in Hospital were visited by the Medical Officers and Sanitary Inspectors, and all agreed to be vaccinated. Those who visited the patient when presumably in an infectious condition were visited for 16 days. Three of them were schoolchildren; 2 were excluded from school for 16 days and examined before being certified fit to resume school attendance. All the contacts of the case were medically examined at the end of the 16-day period, and none had developed smallpox. This also appeared to be a case of the mild variety of smallpox. Its origin was not discovered. Notifications of 63 persons who had been in contact with cases of Smallpox in other districts were received. All these were visited by the Sanitary Inspectors for the usual period. 46 The following gives particulars as to vaccinations during 1928:— Certificates of Successful Vaccination 1,056 Postponed 120 Conscientious Objections 686 Unsuccessful Vaccinations 13 Left the District 97 Smallpox 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, Leyton, 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, 1928, was £76 17s. 2d. The cost of maintenance of the two Ilford cases amounted to £36 14s. 8d., in addition to the above. (b) Scarlet Fever.—502 cases were notified in 1928, as compared with 387 in 1927; 171 in 1926; 146 in 1925; 157 in 1924; 131 in 1923. The following "return" cases have occurred during the past six years, a "return" case being one which arises within 28 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. 1923 124 115 4 3.4 9 — — 1924 153 129 2 1.5 24 — — 1925 141 111 1 .9 30 3 10.0 1926 165 143 2 1.3 22 — — 1927 380 301 6 2.0 81 3 3.7 1928 498 337 11 3.2 161 4 2.5 47 (c) Diphtheria.—260 cases were notified as compared with 187 in 1927; 148 in 1926; 56 in 1925; 82 in 1924; 131 in 1923. Of the 260 cases, 41 occurred in the Girls' Village Homes, Barkingside. In December, 1927, I reported to the Maternity and Child Welfare Committee as follows:— "I wish to call your attention to the comparatively large number of cases of diphtheria which occur in Becontree each year, compared with the rest of the Ilford district, in children under 5 years of age. "The percentage, compared with that in the district generally, is as follows:— 1923 44 percent. 1924 36 1925 18 1926 35½ 1927 37 „ (To date.) "I consider that the disease is being spread by the importation of 'carriers' of diphtheria germs from other districts, with the result that the young susceptible children, of which there are large numbers in the Becontree area, are being attacked. "In some districts in London, an Immunisation Clinic has been established where such children can be immunised by means of the Schick method, which consists in giving three or four injections under the skin of the arm of the children at weekly intervals. One course of such inoculations is usually sufficient to render the children insusceptible to Diphtheria during the whole of their school life, although occasionally a second course of injections is required. The resistance which is produced takes some time to develop and will not be of any service in preventing the number of cases at the present time, but will prevent such children as are inoculated being attacked in another year. "The method has been carried out satisfactorily in Edinburgh, and for nearly three years at the Ilford Isolation Hospital the whole of the domestic and nursing staff has been treated in this way, with the result that none who have been inoculated have been attacked by Diphtheria. "I beg to suggest that the Committee should consider the desirability of establishing such a Clinic, in the first place at Becontree, and then possibly elsewhere in the town, in order that parents who wish to have their children inoculated against Diphtheria may be able to do so. It would be desirable to communicate with the Ministry of Health to see whether they would agree to the cost of such work ranking for grant under the Maternity and Child Welfare Regulations." As a result, the Committee recommended (a) that preliminary application be made to the Ministry of Health for sanction to establish such a Clinic at Becontree, and for the cost thereof to 48 rank for grant under the Maternity and Child Welfare Regulations; and (b) that when such sanction is received, the Medical Officer of Health submit estimates of the cost to this Committee. The Ministry of Health wrote in reply to the application from the Council expressing appreciation of the fact that the Council are considering the provision of facilities for carrying out the Schick test and for the immunisation of the poorer inhabitants of the Borough against diphtheria, but stating that as this, under the existing law, is held to be outside the normal functions of a Sanitary Authority, the Minister would be prepared to give his formal sanction under Section 133 of the Public Health Act, 1875; and, further, that no part of the expenditure incurred in connection with the scheme would be eligible for grant under the Maternity and Child Welfare Regulations. The matter came before the Public Health Committee in February, 1928, and the Committee instructed me to present a report on the accidents which had occurred in Australia following inoculation against diphtheria. My report was made to the Public Health Committee in December, 1928, as follows:— "A Commission which investigated the fatal accidents which followed the use of this method in Australia found that the fatalities were due to the growth of microbes in the material used for injection, no antiseptic having been added to the mixture. Such accidents are guarded against in England by the Therapeutic Substances Act, which lays down the method of preparation of the material used for injection. No accident has been reported in any part of the world from the use of the mixture employed in England, although it has been used for several years on many thousands of children. Fifteen local authorities in and around London are now offering facilities for immunisation. "I would call the Committee's attention to the remarks of the Chief Medical Officer to the Ministry of Health in his last Annual Report, viz., that 'No local authority responsible for the health of children should be satisfied that it has done its duty until every parent knows that his children can be inoculated against Diphtheria with safety and with reasonable certainty of complete protection. It is for the parent to decide whether or not he will have his children immunised. It will be found, in times of epidemic in particular, that most parents are only too glad if they have taken advantage of the facilities offered. Wherever practicable, arrangements should be made to provide inoculation free for those parents who cannot afford to take their children to their own medical attendants. This can be done at Child Welfare Centres, at special Clinics held for the purpose, and in the elementary schools, particularly in infant departments. 49 " The coat of the method is comparatively small: £13 will provide sufficient material to protect 100 children. When it is considered that every case of Diphtheria in London may cost the ratepayers £37, the financial benefit alone will be realised. Experience has shown that, with a few exceptions, parents are glad to avail themselves of the facilities offered, particularly when Diphtheria is present in the district. Although in rare cases the method has failed to give full protection, and although three, or in some cases four, doses are still required to render children immune, the method can be accepted as of proved practical value." I would also draw the Committee's attention to the fact that the Diphtheria Ward at the Isolation Hospital is at present full, and I anticipate that when the present epidemic of Scarlet Fever has subsided, a higher incidence of Diphtheria may occur than has been the case for the last few years." The Council have empowered me to take such action in this matter as I may deem desirable. (d) Enteric Fever.—Thirty cases were notified in 1928, as compared with 11 in 1927, 6 in 1926, 10 in 1925, 5 in 1924, and 5 in 1923. In addition, 1 case (an Ilford resident) was notified in another district but returned to Ilford when the nature of the illness was discovered, making a total of 31 cases. Four of the cases were typhoid fever and occurred at Claybury Mental Hospital; one was a doubtful case treated at home, the diagnosis was not confirmed by the Widal reaction; one was due to infection with the B. Typhosus, and was apparently infected in South Africa or on her journey home. She was removed to the Isolation Hospital and recovered. The remaining 25 cases were due to infection with the Bacillus Paratyphosus B. The following shows the incidence of para-typhoid fever during the year. Onset. Cases. Feb 13th 1 April 4th ,, 8 th „ 10th „ 20 th ,, 21st ,, 21st „ 22nd „ 24 th „ 27th 10 May 2nd „ 3rd 2 50 Onset. Cases June 2nd 6 th „ 13th „ 16th „ 19th „ 23rd „ 23rd 7 July 4th „ 25th 2 Aug. 11th „ 23rd 2 Sept. 18th 1 Nov. 30th 1 Total 25 The heaviest incidence occurred in April. At the beginning of May, I sent a circular letter to all the doctors in practice in the town, warning them of the cases that had occurred. The outbreak appeared to be subsiding, but in June, after 29 days, there was an onset of 7 more cases. There were none then for 21 days, when 2 cases occurred during each of the months of July and August. There was again a break of 25 days, with 1 case in September. Seventythree days passed before the onset of the last case at the end of November. The diagnosis in 22 cases was confirmed by means of the Widal test, one case being of an indefinite character. The sex incidence was : female, 17; male, 8; and the ages ranged from 1-52 years. 15 cases were removed to the Ilford Isolation Hospital; 1 case was removed to Romford Infirmary; 9 cases were treated at home. No case proved fatal. No second case occurred at any house. 16 of the cases occurred within a circle, the diameter of which is about 1½ miles; 5 of the other cases were found to have partaken of food purchased in the same area or partaken at relatives' houses in the area; 10 of the total cases had obtained food in London or outside Ilford, and some of the cases appeared to have definitely contracted the complaint outside the Borough. 51 Special enquiries and investigations were made on various lines to establish the cause of the outbreak, and all suspicious circumstances as to possible infection of food have been followed up. At one time it appeared that the infection might have arisen from a trader's premises supplying pastries, cream fancy goods and cakes. Special enquiries were made into the history of the health of the workers and blood tests of the employees (six in number) most likely, if they had been carriers, to have caused infection, were made with negative results. Other possible sources of food infection have been investigated, but no evidence has been sufficient to give grounds for suspicions or doubt as to any article of food. In July and August, 262 cases were notified in London (76 typhoid, 183 paratyphoid, and 3 continued fever). No supplies of cream which appeared to give rise to the cases in London and elsewhere were traceable as causes of infection in this district, but 10 cases from Ilford partaking of food in London, or outside Ilford, might have been so infected, but it would appear that Ilford had an earlier incidence. Many of the cases had the symptoms of influenza infection, and reliable diagnosis could only be ascertained by the serological test. (e) Cerebrospinal Meningitis and Anthrax.—No cases of these diseases were notified. (f) Ophthalmia Neonatorum.—Four cases were notified during 1928, as compared with 2 in 1927: 3 in 1926; 3 in 1925; and 4 in 1924. One was admitted to the Ilford Isolation Hospital; 1 received treatment as an out-patient at St. Bartholomew's Hospital. The two others were treated at home by private medical practitioners. Notified. Cases. Vision Unimpaired . Vision Impaired Total Blindness Deaths Treated. At Home. In Hospital. 4 3 4 — — — (g) Acute Influenzal and Acute Primary Pneumonia.—92 cases of Pneumonia were notified (of which 10 were in institutions) 52 compared with 139 in 1927 ; 73 in 1926; 103 in 1925; and 96 in 1924. (h) Encephalitis Lethargica.—One case was notified during the year. He was a man of 21 years of age, and made a satisfactory recovery after being admitted to the National Hospital, Queen's Square. (i) Plague.—Four persons were reported to have been in contact with cases of Plague on board ship. The contacts were visited and kept under observation for the usual period. (j) Puerperal Fever.—There were 9 cases of this disease notified during the year. Three of these were treated at the London Hospital, one at the M.A.B. North Western Hospital, one at the Emergency Hospital, one at the Isolation Hospital, one at home, and two at the Romford Infirmary. One of the latter died, all the others made a satisfactory recovery. They were of varying degrees of severity. In addition to the above, one case of a Dagenham resident occurred in a private Ilford Maternity Home. She was removed to the London Hospital and eventually recovered. (k) Puerperal Pyrexia.—Nine notifications were received. Four of these were subsequently notified as cases of Puerperal Fever. Of the remaining five, one was a case of Influenza, two were cases of Pyelonephritis, one was due to burns, the other was probably due to haemorrhage. Mr. Everard Williams, Consultant Obstetrician, was called in consultation in one instance, and on 2 occasions I was called in consultation with local practitioners. 2. Zymotic Diseases:—The deaths registered were as follows :— Small-pox — Measles 5 Scarlet Fever 2 Whooping Cough 7 Diphtheria and Croup 8 Enteric Fever — Diarrhoea 10 This gives a zymotic death-rate for 1928 of .29 per 1,000 of the net population. The zymotic death-rate for the previous five years was .29 in 1927, .36 in 1926, .25 in 1925, .24 in 1924, and .26 in 1923. Table showing Incidence of, and Deaths from, Infectious Disease, 1928, 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. j 20—35. 35—45. j 45—65. Over 65 Smallpox 1 – – – – – – – – – – – – – – – – – – – – – – – – – – Scarlet Fever 502 2 3 7 26 24 279 100 30 26 4 1 — 341 2 – – – 1 – – – – 1 – – – Diphtheria 260 1 4 10 12 14 99 45 24 33 12 5 1 203 8 — 1 – 2 2 3 – – – – – – Enteric Fever (including Paratyphoid) 30 – 2 1 1 – 7 4 1 4 5 5 – 17 – – – – – – – – – – – – – Pneumonia 92 3 4 7 5 4 15 2 — 14 12 15 11 12 60 8 2 2 3 1 – – – 5 5 18 16 Puerperal Fever 9 — — — — — — — 1 6 2 – – 8 2 — — – – – – – 1 — 1 — — Puerperal Pyrexia. 9 – – – – – – – 1 6 2 – – 6 – – – – – – – – – – – – – Cerebro-spinal Fever – – – – – – – – – – – – – – – – – – – – – – – – – – – Acute Poliomyelitis – – – – – – – – – – – – – – – – – – – – – – – – – – – Acute Polio-Encephalitis – – – – – – – – – – – – – – – – – – – – – – – – – – – Encephalitis Lethargica 1 – – – – – – – – – – – – 1 – – – – – – – – – – – – – Continued Fever 1 – – – – – 1 – – – – – – – – – – – – – – – – – – – – Dysentery 2 – – – – – – – 1 – – 1 – – – – – – – – – – – – – – – Ophthalmia Neonatorum 4 4 – – – – – – – – – – – 1 – – – – – – – – – – – – – Erysipelas 31 — — — — — 1 — — 5 5 19 1 1 – – – – – – – – – – – – – Anthrax – – – – – – – – – – – – – – – – – – – – – – – – – – – Malaria—believed to be contracted in this country – – – – – – – – – – – – – – – – – – – – – – – – – – – ,, —believed to be contracted abroad. – – – – – – – – – – – – – – – – – – – – – – – – – – – 53 54 3. Tuberculosis:—During the year 1928 there were 118 new notifications of Pulmonary Tuberculosis and 35 of other forms of Tuberculosis. Nineteen cases of Pulmonary and 3 cases of NonPulmonary Tuberculosis were transferred to Ilford. The following Table shows the cases notified in 1928, and the deaths which occurred in 1928, classified according to age and sex Age Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 year – – – 1 – – – 1 1.5 years — — 4 1 — 1 2 — 5.10 years — — 6 4 — — 2 2 10.15 years — 1 2 4 — 1 — — 15.20 years 4 10 1 2 1 1 — 1 20.25 years 3 15 4 — 3 7 — — 25.35 years 17 18 2 2 5 9 1 2 35.45 years 19 9 1 — 8 4 1 — 45.55 years 9 5 1 — 8 1 — — 55.65 years 3 3 — — 5 3 — — Over 65 years 2 — — 2 — 1 — Totals 55 63 21 14 32 27 7 6 Five of the above deaths, or 6.9 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 4 The Girls' Village Homes, Barkingside—Pulmonary Tuberculosis 7 Emergency Hospital—Pulmonary Tuberculosis 2 Of the 72 deaths which occurred of Ilford residents, notification had previously been made of 61 of the cases. Four were notified after death, and in 2 cases the presence of tuberculosis was discovered at post mortem examination, and were then notified. The 5 remaining cases were not notified. 55 During the year 1928, the following deaths occurred from Tuberculosis:— Pulmonary Tuberculosis for the district proper 59 Claybury Mental Hospital 6 West Ham Mental Hospital 7 Tuberculosis (all other forms) for the district proper (including 4 at the Emergency Hospital, 1 at the Isolation Hospital, and 1 at the Girls' Village Homes) 13 Claybury Mental Hospital 2 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 for the compulsory removal of infectious persons to hospital or other institutions. 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:— 1919 1920 1921 1922 1923 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 57 .71 42 .50 53 .64 46 .55 55 .64 Tuberoular Meningitis 11 .13 5 .06 2 .02 — — — — tuberculosis (all other forms) 16 .20 11 .13 9 .11 10 .12* 12 .14* 1924 1925 1926 1927 1928 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 54 .61 81 .84 66 .65 58 .53 59 .52 Tubercular Meningitis — — — — — — — — — — Tuberculosis (all other forms) 11 .12* 16 .17* 10 .09* 13 .12* 13 11* *Including Tubercular Meningitis for the years 1922-1928. 56 On the 1st January, 1928, there were 557 cases on the register of the department. On the 31st December, 1928, with 140 new cases notified and 20 transfers (Institution cases omitted), and allowing for deaths, removals from the district, and cases removed from the register as cured, there were 594 cases on the register. The new cases of Tuberculosis are visited by the Tuberculosis Nurse of the Essex County Council. 531 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 41 18 Improved or fairly well 148 61 Not so well 116 28 In Sanatorium 46 10 No information as to present condition 13 1 Removed from district, etc. 43 6 Totals 407 124 The treatment of Tuberculosis is under the control of the Essex County Council. There is a Tuberculosis Dispensary in Ilford, which is attended on four occasions a week by the Tuberculosis Officer. On the 31st December, 1928, there were 754 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. 141 patients were treated, 15 being supplied with dentures, while in 2 cases the dentures were relined. Tuberculosis Care Committee.—This Committee has continued to do good work during the year. 61 cases have been assisted with extra nourishment, clothing and in other ways. 57 4. Venereal Diseases.—In the following table are classified the deaths notified as due to (1) Syphilis; (2) Locomotor Ataxy and General Paralysis of the Insane, which are certainly due to Syphilis; and (3) Aortic Aneurysm, which is very frequently caused by this disease. Ages 0-1 1-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75-85 85 up NonResidents in Institutions Totals Syphilis 1 – – – – – – – – – – – 1 Locomotor Ataxy – – – – – – – – 1 – – 1 2 General Paralysis of Insane – – – – – 1 1 1 1 – – 33 37 Aortic Aneurysm — — — – — — 1 2 — — — 1 4 The deaths of non-residents in Institutions occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital; 19 per cent, of the registered causes of death in these Institutions fell under the above headings. Many other patients died from incidental causes; the reason, however, for their admission to the Mental Hospital was some 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; 1926, 3 cases; 1927, 2 cases. The diagnosis and treatment of Venereal Disease is, by the Public Health (Venereal Disease) Regulations, 1916, under the control of the Essex County Council. Arrangements have been made with the various London Hospitals for the free treatment of patients, and with the London Hospital for the free examination of bacteriological specimens submitted by doctors in the district. 58 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 that 1,635 specimens have been examined during the past year. Specimens for diagnosis of Venereal Disease are examined at the London Hospital; for Tuberculosis, at the Essex County Laboratory. Bacteriological Laboratory, 1928. Nature of Specimen. Disease Suspected. Sent by Local Medical Practitioners Sent by Medical Officer of Health. Sent by School Medical Officer. Sent by Isolation Hospital. Totals. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Swabs—Throat Diphtheria 177 792 3 16 8 36 56 195 244 1039 Nose, Ear, Eye, etc. ,, 11 26 1 8 3 16 6 18 21 68 Throat Contacts ,, 15 170 — 4 2 16 — 3 17 193 Nose ,, ,, — 2 — — 1 — — — 1 2 Hairs Ringworm — — — 2 14 11 — — 14 13 Urine Various Abnormalities.. — — 1 2 1 5 12 2 14 9 Totals 311 1324 Grand Total 1635 Direct Smears from swabs were examined in 15 cases. 15 Diphtheritic Specimens were sent to laboratories in London for a test for virulence—7 were virulent, 8 avirulent. Other examinations for various purposes, 8. 59 60 SECTION VI—FACTORIES AND WORKSHOPS. Factories. There are 160 factories on the register, made up as follows:— Bakehouses 17 Metal Worker 1 Boot Makers and Repairers . 26 Motor Engineers 10 Builders, Joinery and Carpentry Works 8 Nautical Instrument Maker . 1 Optician 1 Cabinet Maker 1 Paint Manufacturer 1 Cable Works 1 Paper Mills 1 Carbon Works 1 Photographic Works 1 Cardboard Box Maker 1 Picture Moulders 2 Carriage Works 2 Plating and Enamelling 1 Chemical Works 2 Polish Manufacturer 1 Collar Works 1 Poultry Appliance Maker 1 Confectionery Maker 1 Printer's Engineer 1 Corset Maker 1 Printing Works 9 Cutlery and Tool Grinders . 2 Saw Mills 4 Cycle Repairers 2 Seed Sorting 1 Electricity Supply Works 1 Shirt Makers 4 Engineers 10 Sign Maker 1 Fancy Bag Maker 1 Tarpaulin Repairer 1 Fur Dyer 1 Tool Engineer 1 Gas Mantle Manufacturer 1 Toy Maker 1 Gear Cutting 1 Umbrella Repairers 2 Gilding Works 1 Vulcanising Works 1 Hardware Manufacturer 1 Watchmaker and Repairer . 1 Iron Cutting Works 1 Wearing Apparel Makers 5 Joinery Works 1 Wire and Cable Manufacturer 1 Laundries 6 Wireless Apparatus Makers . 2 Leather Worker 1 Woodcutter 1 Mattress Maker 1 Total 160 Meat Cutting 9 Mechanical Dentist 1 Workshops. There are 512 workshops on the register, made up as follows:— Artificial Flower Maker 1 Dyers and Cleaners 7 Art Pottery Worker 1 Electrical and Mechanical Engineers 7 Bakehouses 16 Basket Maker 1 Electric Battery Charging 4 Beet Boiler 1 Embroidery and Lace Workers 18 Bookbinder 1 Fancy Dressmakers 2 Boot Repairers 40 Feather Cleaner 1 Boot Makers and Shoe Sewers 3 Florists 4 Brush Workers 5 French Polishers 4 Builders and Carpenters 38 Furniture Repairers 3 Cabinet Makers 3 Furriers 8 Carpet Planning 1 Glass Cutters and Glaziers 4 Clergy Robes Maker 1 Glove Maker 1 Coach Builders 2 Grate and Furnace Makers 2 Confectioner 1 Hand Laundry 1 Dressmakers 38 Hairdresser 1 Dry Battery Worker 1 Harness Makers 3 61 Workshops—continued. Hat Makers 3 Sports Outfit Repairers 3 Ioe Cream Factor 1 Stone Mason 1 Incubator Maker 1 Tailors 35 Leather Workers 6 Tie Makers 4 Life Belt Maker 1 Tile Fender Makers 6 Meat Cutting 1 Timber Merchants 2 Mechanical Dentist 1 Tinsmiths 2 Mica Maker 1 Toy Maker and Repairer 1 Milliners 28 Typewriter Repairer 1 Metal Moulder 1 Umbrella Repairers 3 Motor Cab Proprietors 4 Undertakers 5 Motor and Cycle Engineers and Repairers 34 Upholsterers 14 Vulcanizer 1 Optician 1 Watch and Jewellery Repairers 15 Packing Case Repairer 1 Wearing Apparel and Underclothiers 60 Photographers 2 Piano Repairer 1 Wheelwrights and Farriers 13 Picture Framers 3 Wire Worker 1 Plumbers 10 Wireless Apparatus Maker 1 Printers and Stationers 6 Wood Cutters 7 Rag and Bone Merchants 2 Total 512 Scale Maker 1 Shirt Makers 4 62 FACTORIES. WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections Made by Sanitary Inspectors. Premises. Number of Inspections Written Notices. Prosecutions (i) (2) (3) (4) Factories (including Factory Laundries) 138 3 - Workshops (including Workshop Laundries) 333 1 — Workplaces (other than Outworkers' premises included in Part 3 of this report) — — — Total 471 4 — 63 2.—Defects found in factories, workshops and workplaces. Particulars. Number of Defects. Number of Prosecutions Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*:— Want of cleanliness — — – – Want of ventilation — — — – Overcrowding — — — – Want of drainage of floors — — — — Other nuisances 4 4 — – Sanitary accommoda tion ' insufficient — .—. — – unsuitable or defective 5 5 – – not separate for sexes — — — – Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouse (s. 101) – – – – Breach of special sanitary requirements for bakehouses (ss. 97 to 100) – – – – Other offences — — — (Excluding offences relating to outwork which are included in Part 3 of this report) Total 9 9 — •Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. 64 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Sending twice in the year. Sending once in the year. Lists. Outworkers. Lists. Outworkers. Con- tractors Work- men. Contractors Workmen (1) (2) (3) (4) (5) (6) (7) Wearing Apparel:— Making, etc. 14 18 29 — — — Cleaning and Washing – – – – – – Household Linen 2 — 2 — — — Lace, Lace Curtains and Nets – – – – – – Total 16 18 31 — — — Note.—No home-workers were known to be engaged in the following occupations:—Curtains and Furniture Hangings; Furniture and Upholstery; Electroplate; File Making; Brass and Brass Articles; Fur Pulling; Cables and Chains; Anchors and Grapnels; Cart Gear; Locks; Latches and Keys; Umbrellas, etc.; Artificial Flowers; Nets, other than Wire Nets; Tents; Sacks; Racquet and Tennis Balls; Paper, etc.; Boxes; Paper Bags; Brush Making; Pea Picking; Feather Sorting; Carding, etc., of Buttons, etc.; Stuffed Toys; Basket Making; Chocolates and Sweetmeats; Cosaques, Christmas Crackers, Christmas Stockings, etc.; Text le Weaving. No notices were served under Section 108 of the Factory and Workshops Act, for outwork being carried out in unwholesome premises. 65 4.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 3 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5, 1901) Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector 9 9 Other — Underground Bakehouses (s. 101) :In use at the end of the year 1 ISOLATION HOSPITAL. 69 ISOLATION HOSPITAL. 577 patients were admitted during 1928, as compared with 519 in 1927, 331 in 1926 and 199 in 1925. 92.7 per cent, of the cases of diphtheria occurring in the district and 66.8 per cent, of scarlet fever were admitted to the Hospital. The following table shows the percentage of cases of diphtheria and scarlet fever occurring in the district removed to the Hospital during the past ten years :— Year. Diphtheria. Scarlet Fever. 1919 89.87 79.22 1920 92.44 89.28 1921 90.5 87.0 1922 88.3 84.8 1923 92.7 93.5 1924 93.5 94.3 1925 94.4 78.7 1926 87.6 86.6 1927 92.4 77.3 1928 92.7 66.8 It has again been necessary to limit the admission of cases of scarlet fever to those which could not be adequately treated at home. It will be seen from the following table that 58 more cases were admitted than in any preceding year. This was chiefly due to the occurrence of scarlet fever cases in large numbers in the town, but also to a rise in the incidence of diphtheria. 70 The following table shows the total admissions for the past ten years:— Year. Scarlet Fever. Diphtheria. Tuberculosis. Other Diseases. Total. 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 1926 149 121 50 11 331 1927 306 145 51 17 519 1928 337 203 13 24 577 The 577 patients admitted during 1928 had the following diseases:— Scarlet Fever 337 Diphtheria 203 Enteric Fever 16 Puerperal Fever 1 Puerperal Pyrexia 1 Puerperal Ulceration 1 Puerperal pyelonephritis 2 Ophthalmia neonatorum 1 Tuberculous Meningitis 1 Chicken-pox 1 Tuberculous Diseases 13 Number of deaths in Hospital, 10. Diphtheria 7 Scarlet Fever 2 Tuberoulous Meningitis 1 Number of patients in Hospital on 1st January, 1928 and 1929 respectively:— 1st Jan. 1928. 1st Jan., 1929. Scarlet Fever 49 42 Diphtheria 24 30 Tuberculous Diseases 12 12 German Measles 1 — Enteric Fever — 1 71 The average length of stay in Hospital was for Scarlet Fever 41.8 days. Diphtheria 40.0 ,, Tuberculous Diseases 141.8 ,, Average stay in Hospital of all cases 42.4 ,, The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day, 77.8. Scarlet Fever.—The 337 cases admitted to Hospital during 1928 were distributed among the following age groups :—. Under 1 yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. 2 41 259 22 10 3 — The following table shows the percentage death.rate of cases of scarlet fever admitted to the Ilford Isolation Hospital during the past five years compared with the death-rate in the Institutions of the Metropolitan Asylums Board:— 1924. 1925. 1926. 1927. 1928. Ilford Nil. Nil. Nil. .6 .5 M.A.B. 1.3 1.1 .8 .6 Not available. The following complications occurred in the patients admitted and discharged during the year:- Rhinitis 9.6 per cent. Adenitis 17.1 ,, Relapse 2.9 ,, Nephritis 1.4 ,, Albuminuria 1.4 ,, Suppurative cervical adenitis 1.1 ,, Tonsillitis 2.9 ,, Quinsy 0.6 ,, Rheumatism 1.7 ,, Otorrhoea 9.0 ,, Onychia 4.6 ,, Mastoiditis 1.7 ,, Pharyngeal abscess 0.3 ,, Broncho.pneumonia 0.3 ,, Pyelitis 0.3 ,, Vaginitis 0.9 ,, Enteritis 0.3 ,, Abscesses 0.6 ,, Peritonitis 0.3 ,, 72 Two deaths occurred from scarlet fever, one was of a woman who had been confined two days previous to the onset of the attack of scarlet fever. Cultures showed haemolytic streptococci to be present in both her throat and uterus. She improved for a time, but developed peritonitis which became generalised; a laparotomy was performed by Mr. Everard Williams to relieve the condition. The result shows that puerperal scarlet fever, now fortunately so rare, may still be as fatal a condition as ever it was. The second death from scarlet fever was in a child of three years who developed broncho-pneumonia and died within five days of admission. Scarlet fever has been on the whole of a more severe type and has shown a curious tendency, when it attacked the middle ear, to involve the mastoid bone. 9 per cent, of the cases of scarlet fever developed middle ear disease and six cases of mastoiditis occurred. All of these were operated on by Mr. Stoker, and made a satisfactory recovery. In the year previous, 5 per cent, of the cases developed middle ear disease, and no case of mastoiditis occurred. Enteric Fever.—16 cases were admitted, 13 of these were cases of Paratyphoid infection, 9 of these were mild cases and made an uneventful recovery; four were more severe, two being complicated by intestinal haemorrhage, one by pyelonephritis, and the fourth by lobar pneumonia. Two of the 16 were clinically cases of enteric fever but gave a negative Widal reaction. The remaining one case was due to an infection with B. Typhosus, the patient, a woman of 56, made an excellent recovery, although the illness was complicated by a typhoid pneumonia. Puerperal Cases.—Three patients were transferred from the Maternity Home, suffering from a puerperal pyelonephritis. All made an excellent recovery. One case which had been admitted to the Maternity Home and found on admission to have a perineal abscess, was transferred. She made a good recovery, but had a recto-vaginal fistula which will subsequently require operation. One case of puerperal fever was admitted from the district. It was a mild case and recovered after a slight attack of phlebitis. 73 Diphtheria.—The 203 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 45. — 35 110 26 16 10 6 Seven deaths, due to diphtheria, occurred in the Hospital. The ages of the patients were 3½ years, 4 (two), 4½, 5½,7½ (two). Three of the deaths occurred within 48 hours of admission to the Hospital. All the deaths were due to a toxic form of diphtheria resulting in cardiac failure. In two cases the faucial diphtheria was complicated by a laryngeal diphtheria, necessitating a tracheotomy being performed to relieve respiration. The following table shows the percentage death-rate of cases of diphtheria admitted to the Ilford Isolation Hospital during the past five years, compared with that in the M.A.B. Institutions in London:— 1924. 1925. 1926. 1927. 1928. Ilford 1.4 Nil 6.6 4.8 3.4 M.A.B. 7.0 5.0 4.9 4.0 Not available. Meningitis.—Two cases were admitted with meningeal symptoms. One developed a typical attack of tuberculous meningitis which resulted in a fatal issue. The other proved to be a case of chickenpox. Tuberculosis.—13 cases of surgical tuberculosis were admitted, as compared with 51 in 1927. At the end of the year the following patients were in the Sanatorium:— Nature of Case. Period in Hospital. Hip 30 months. Spine 30 ,, Spine and hip 28 ,, Spine 16 ,, Hip 15 ,, Hip 12 ,, Bones and psoas abscess 9 ,, Spine and psoas abscess 8 ,, Knee joint 2 ,, Hip 2 ,, Glands 1 ,, Knee joint ,, 1 day. 74 The organs involved in the 13 cases admitted, were as follows:— Genito-urinary, 2; spine and genito-urinary, 1; hip joint, 2; ankle joint and thigh, 1; hip and glands, 1; bones and psoas abscess, 1; spine and psoas abscess, 1; lupus, 1; knee joint, 2; glands, 1. The patients have, as in previous years, been treated by exposure to natural sun in the summer and by artificial sunlight lamps in the winter with excellent results. The Sanatorium has been visited once a month by Sir Henry Gauvain. Training of Probationer Nurses.—During 1928, 5 Nurses passed Part I of the Examination of the General Nursing Council and 4 obtained the certificate by completing Part II. Cubicle Wards.— These wards have been completed during the year. A new cubicle block (Block VII) has been erected, consisting of four cubicle wards on each side of the duty room with glass partitions between each. The sanitary annexe is situated immediately opposite the duty room. Each duty room is provided with a higli-pressure sterilizer for the sterilisation of feeding utensils, etc. The last cubicle communicates with a small operating theatre adequately fitted up and which has a small sterilising room and sink room adjacent to it. In addition to the new block, the old ward Block III, which was of an obsolete pattern, has been converted into a cubicle block with eight beds. The contract price for the erection of the new cubicle ward and the adaptation and extension of Block III was £7,750, and the cost of furniture and equipment amounted to £1,000. On pages 75-77 will be found (1) the site plan of the hospital, showing old and new buildings; (2) the conversion of ward Block III to cubicles, and (3) the new cubicle Block VII. Additional Land for Isolation Hospital.—In September, 1928, the Council made application to the Ministry of Health for sanction to a loan of £5,750 for the purchase of 16.7 acres of freehold land adjacent to the present site, to be used for Isolation Hospital purposes when further extensions of the Hospital are required. Borough. of . Ilford Isolation Hospital Site - plan Old Buildincs - shown thus New buildings - shown - thus H SHAWm Imst.c.e BOROUCH ENGINEER Town • hall • Ilford Borough . of . ilford Conversion . of -ward . Block . No. 3. to . Cubicles Borough • of • Ilford New • Cubicle • Block • No -7 MATERNITY & CHILD WELFARE. 81 Notification or 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 1928 was 1.700 (906 males and 794 females). In addition. 4.0 stillbirths (20 males and 20 females) were notified. The percentage of births notified by the various responsible persons was as follows By Medical Practitioners 17.76 By Certified Midwives 53.57 By Parents and others 28.67 The causes of the 40 stillbirths were as follows:— Prolapse of cord 1 Breech presentation 5 Prolonged labour 2 Hydrocephalus 2 Macerated foetus 8 Ante-partum haemorrhage 2 Albuminuria 1 Accident to mother 4 Pressure on cord 2 Strangulation by cord 2 Large baby 3 Inattention at birth 1 Arrested development 1 Extended breech 2 Ruptured membranes 1 Cause unknown 3 In addition, I have received notice of 9 stillbirths which took place outside the district, although the parents reside in Ilford. The causes of the stillbirths were as follows:— 1 at Queen Mary's Hospital, Stratford—eclampsia. 2 at Queen Mary's Hospital, Stratford—accident to mother. 1 at Queen Mary's Hospital, Stratford—cause unknown. 1 at London Hospital—mother had fit. 1 at St. Bartholomew's Hospital—cause unknown. I at Queen Charlotte's Hospital—cause unknown. 1 at East End Mothers' Home—albuminuria. 1 at City of London Maternity Hospital—anencephaly. 82 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 last year 1,739 (911 males and 828 females) births were registered, giving a birth-rate of 15'8 per 1,000 persons calculated on the net population, as compared with 1,657 births and a birth-rate of 15.8 per 1,000 persons in 1927. Births and Deaths Registration Act, 1926. By the Births and Deaths Registration Act, 1926, all stillbirths are registered with the Registrar of Births within six weeks. During 1928 39 stillbirths (18 males and 21 females) were registered. Infant Mortality. The number of infants dying within the first year of life was 79, the total number born being 1,739. The infant mortality or rate of death per 1,000 births was, therefore, 45.4. The infant mortality rate for the district is higher than it should be, from the fact that 3 deaths of babies in the Girls' Village Homes, Barkingside, are included, although the children concerned were not born in Ilford. If the deaths of babies in the Girls' Village Homes are excluded there remains an infant mortality rate for the district of 43 7 per 1,000 births. The comparative figures for previous years were as follows:— Year. No. of Deaths. under 1 year. Rate per 1,000 Registered Births. 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 1926 68 45.1 1927 74 44 1928 79 45.4 83 The infant mortality rate for 1928 for Ilford compares favourably with that of 65 for England and Wales, 67 for London, and 70 for the 107 towns having a population exceeding 50,000. The following table compares the infant mortality in Ilford with that in other extra London areas. These are provisional figures issued by the Registrar-General. Croydon 53 West Ham 64 Willesden 56 East Ham 49 Tottenham 53 Wimbledon 52 Enfield 60 Walthamstow 51 Leyton 48 Ealing 40 Acton 55 Hornsey 63 Ilford 45 The following table shows the infant mortality in each Ward of the district:— Ward. Sex. No. of Births. No. of Infant Deaths. Infant Mortality per 1,000 Births. Infant Mortality per 1,000 Births both sexes together. 1928. 1927. 1926. North Hainault M. 158 8 50.6 48.3 49.8 50.6 F. 111 5 45.0 Cranbrook M. 67 6 89.5 67.8 38.0 30.0 F. 51 2 39.2 Park M. 97 3 30.9 20.5 16.8 26.6 F. 88 1 11.4 Seven Kings M. 105 2 19.0 29.1 46.6 49.1 F. 101 4 39.6 South Hainault M. 58 3 51.7 354 56.0 79.4 F. 55 1 18.2 Loxford M. 111 7 63.0 54.5 45.2 34.8 F. 91 4 44.0 Clementswood M. 96 5 52.1 29.7 49.2 63.1 F. 106 1 9.4 Goodmayes M. 160 13 81.2 77.1 42.8 40.8 F. 151 11 72.8 If the deaths of infants occurring in the Village Homes, Barkingside (3 males and 0 females) are added to the infant deaths occurring in the North Hainault Ward, there is an infant mortality rate of 59-5 (69.6 M. and 45.0 F.) per 1,000 births for that ward. The above table only accounts for 1,606 of the total births registered and belonging to the district. The remaining 133 are included by the Registrar-General as belonging to Ilford, but have not been allocated by him to the various wards. 84 67 births were registered in this district belonging to other areas. These have not been included in the foregoing figures. 7 births (6 males and 1 female) were re-registered, and these are also not included in the above figures. An analysis of the figures in the foregoing table will show that the infant mortality rate has risen in the Cranbrook, Park, Loxford and Goodmayes Wards. A statement as to the ages at, and causes of, infant deaths in the various Wards is given below In the North Hainault Ward there were 13 infant deaths, exclusive of those dying at the Girls' Village Homes, Barkingside. 3 died under 1 week. 1 died at 1 week from debility and prematurity. 1 died at 1 month from gastritis and convulsions. 1 died at 1 month from capillary bronchitis and premature birth. 1 died at 2 months from gastro-enteritis and whooping cough. *1 died at 2 months from marasmus and gastro-enteritis. *1 died at 2 months from diarrhoea, vomiting and marasmus. 1 died at 4 months from gastro-enteritis and whooping cough. *1 died at 5 months from infective gastro-enteritis. 1 died at 8 months from lobar pneumonia. *1 died at 11 months from broncho-pneumonia. *These children have attended an infant welfare centre. In the Cranbrook Ward there were 8 infant deaths. 3 died under 1 week. 1 died at 10 days from respiratory failure, cyanosis from birth, possibly cerebral haemorrhage. 1 died at 1 month from idiopathic marasmus. 1 died at 4 months from broncho-pneumonia, and congenital heart disease. 1 died at 6 months from accidental suifocation in his cot. *1 died at 6 months from posterior basic meningitis. *This child had attended an infant welfare centre in Wales. In the Park Ward there were 4 infant deaths. 2 died under 1 week. *1 died at 2 months from marasmus. *1 died at 3 months from enteritis, broncho-pneumonia and marasmus. *These children have attended an infant welfare centre. In the Seven Kings' Ward there were 6 infant deaths. 3 died under 1 week. 1 died at 1 week from premature birth. 1 died at 3 weeks from bronchitis and broncho-pneumonia. *1 died at 5 weeks from pyaemia. *This child has attended an infant welfare centre, 85 In the South Hainault Ward there were 4 infant deaths. 1 died at 12 hours from prematurity. *1 died at 4 months from gastro-enteritis. *1 died at 8 months from broncho-pneumonia. 1 died at 10 months from chickenpox, broncho-pneumonia, and pertussis. *These children have attended an infant welfare centre. In the Loxford Ward there were 11 infant deaths. 5 died under 1 week. 1 died at week from convulsions. 1 died at 4 weeks from inanition and bronchitis. 1 died at 2 months from congenital heart disease. *1 died at 4 months from gastro-enteritis. *1 died at 5 months from gastro-enteritis. 1 died at 6 months from post ehteritie marasmus. *These children have attended an infant welfare centre. In the Clementswood Ward there were 6 infant deaths. 3 died under 1 week. 1 died at 1 week from marasmus and congenital heart disease. 1 died at 3 weeks from debility. *1 died at 6 months from acute primary pneumonia. *This child has attended an infant welfare centre. In the Goodmayes Ward there were 24 infant deaths. 10 died under 1 week. 2 died at one week from prematurity. 1 died at 2 weeks from streptococcal dermatitis. 1 died at 2 weeks from heart failure, malnutrition and asphyxia, cleft palate and deformed lower jaw. 1 died at 5 weeks from prematurity. 1 died at 1 month from congenital heart disease (patent foramen). 1 died at 2 months from congenital cyst of brain stem, and respiratory failure. 1 died at 2 months from gastro-enteritis. 1 died at 2 months from icterus neonatorum. *1 died at 4 months from broncho-pneumonia and peripheral bronchitis. *1 died at 4 months from asphyxia by bed clothes in cot. *1 died at 4 months from tubercular meningitis. *1 died at 6 months from broncho-pneumonia. 1 died at 6 months from gastro-enteritis, malnutrition, and congenital syphilis. *These children have attended an infant welfare centre. It will be seen that of the 79 infants who died under one year of age only 16 had attended Ilford infant welfare centres, and in some cases, only one attendance was made. 41, however, of the deaths occurred in the first month of life, and these infants would naturally not have been brought to a centre. 86 The mortality of infants under one year attending Ilford infant welfare centres was 26.3 per 1,000, as compared with 53.1 per 1,000 in those not attending an Ilford infant welfare centre (excluding the deaths of those children dying in the Girls' Village Homes). It must be remembered in considering these figures, that rarely is a baby brought to a welfare centre under one month of age. whereas half the deaths occur in this period. It would be a fairer comparison to state that of the 38 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 58 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 4 weeks of age is known as the Neonatal Mortality. There were 41 deaths of infants under 4 weeks of age during 1928, and the rate for the year was 23 6 per 1,000 births. The following table shows the Neonatal Death-rate in Ilford compared with that for England and Wales during the previous ten years:— Ilford. England and Wales. 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 1925 24.9 32 1926 21.2 32 1927 19.3 32 Table IV gives the deaths of infants under one year of age, classified according to age. It will be noticed that prematurity still causes the greatest number of deaths, 87 Table IV.—Infant Mortality. 1928. Net Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Smallpox .. .. .. .. .. .. .. .. .. .. Chickenpox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. l l .. l 3 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. l .. .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. l .. 1 Convulsions .. 1 .. .. l l .. .. .. 2 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 1 l .. .. 2 Pneumonia (all forms) .. .. .. l l 2 3 4 .. 11 Diarrhoea .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. 3 4 1 .. 8 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. 1 .. 1 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation (overlying) .. .. .. .. .. .. .. .. .. .. Injury at birth .. .. .. .. .. .. .. .. .. .. Atelectasis 8 .. .. .. 8 .. .. .. .. 8 Congenital Malformations 1 .. .. .. 1 3 .. .. .. 4 Premature birth 17 4 .. .. 21 1 .. .. .. 22 Atrophy, Debility and Marasmus 1 1 .. l 3 .. .. 1 .. 6 Other Causes 3 3 .. .. 6 2 1 1 .. 10 Totals 30 9 .. 2 41 16 11 9 2 79 88 Illegitimate Births and Deaths. 35 of the births registered (17 males and 18 females) were illegitimate, that is 2.01 per cent. of the births registered. 10 illegitimate children died under one year of age. The deaths of the 10 illegitimate children occurred as follows:— 6 died in Romford Infirmary; 3 at 2, 4 and 5 months from gastro-enteritis; 1 at 2 days from congenital debility and prematurity; 1 at 2 months from marasmus and gastro enteritis; 1 at 6 months from post enteric marasmus; 1 died at 1 day at the Mothers' Hospital, Clacton, from prematurity; 3 died at home (2 under 24 hours and 1 at 7 days) from prematurity. The infant mortality of illegitimate children was, therefore, 286 per 1,000, compared with the infant mortality rate (exclusive of those children dying in the Girls' Village Homes) of 39 for legitimate children. If the deaths of infants in the Girls' Village Homes are included, there is a legitimate infant mortality rate of 40 per 1,000. 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. 1928 35 10 286 1,704 69 40 1927 44 9 204 1,613 65 40 1926 34 5 147 1,475 63 43 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 Maternal Mortality. The total number of deaths due to childbirth during the year was 7, which gives a maternal mortality rate (i.e., number of deaths per 1,000 births) of 4. 89 The causes of the deaths were as follows:— Puerperal septicaemia 1 Acute pneumonia and puerperal sapraemia 1 Acute pulmonary oedema 1 Ruptured ectopic gestation 1 Post partum haemorrhage, morbidly adherent placenta and anaemia 1 Pulmonary thrombosis whilst undergoing forceps delivery under chloroform anaesthesia for difficult labour 1 Internal haemorrhage and rupture of tubal pregnancy 1 The following table gives the maternal mortality rate for Ilford and England and Wales for the previous ten years:— Year. No. of Deaths. No. of Births. Maternal MortalityRate per 1,000 Births, Ilford. Maternal* Mortality Rate per 1,000 Births, England and Wales. From Puerperal Fever. From Other Causes. 1927 1 4 1,657 3.0 4.11 1926 3 1 1,509 2.6 4.12 1925 1 3 1,486 2.69 4.08 1924 — 1 1,436 0.69 3.90 1923 3 1 1,606 2.49 3.81 1922 3 3 1,475 4.07 3.81 1921 3 1 1,492 2.68 3.91 1920 2 3 1,666 3.00 4.33 1919 — 4 1,167 3.43 4.37 1918 2 1 1,053 2.85 3.79 *Revised Table. 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. Two foster-children in the care of one foster-mother, were found on attendance at a welfare centre to be suffering from gastroenteritis. They were later admitted to Romford Infirmary, where they died 90 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-Childben . Number of foster-children on books on 1st January, 1928 48 Number of foster-children who were notified to me during 1928 39 Number of foster-children returned to their mothers during 1928 13 Number of foster-children taken off the records for various other reasons during 1928 26 Number of foster-children on records on 31st December, 1928 48 Foster-Mothers . Number of foster-mothers on records on 1st January, 1928 37 Number of persons who became foster-mothers during 1928 18 Number of foster-mothers whose names were taken off records during 1928 19 Number of foster-mothers on records on the 31st December, 1928 36 Houses Visited by Sanitary Inspectors. Number of houses visited by the Sanitary Inspectors for the purpose of the Act during the year 1928 25 Number of visits made by the Sanitary Inspectors for the purpose of the Act during the year 1928 53 Work of Health Visitors. The additional Health Visitor mentioned in my report for 1927 having been appointed, it was possible during 1928 to divide the Ilford area into eight 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 1928 as far as the Maternity and Child Welfare work is concerned :— First visits to newly-born infants 1,903 Subsequent visits to children under 1 year of age 4,814 Subsequent visits to children over 1 year of age and under 5 9,852 Visits to expectant mothers 132 Home visits for other reasons 917 Total visits paid 17,618 91 Supervision of Midwives. There are nine certified midwives resident and practising in the district (apart from those at the Maternity Home). Under the Midwives' Act, 1918, Section 12, permission is withheld for delegation to a District Council of the powers of the County Council as supervising Authority; although there is no doubt that 3uch work can be carried out as efficiently and economically by the local Public Health Department. Supervision of Maternity Homes. By the Nursing Homes Registration Act, 1927, all persons carrying on a Maternity Home are liable to a penalty unless they are registered by the local supervising Authority, in this case the Essex County Council. The County Medical Officer informs me that six persons have been registered in Ilford for the purpose of carrying on Maternity Homes. It was necessary to report to the County Medical Officer of Health one case of puerperal peritonitis which occurred at a private maternity home at Seven Kings. The Essex County Council decided to cancel the certificate of registration in respect of this Home. Supply of Milk to Expectant and Nursing Mothers and for Infants. Under the Regulations of the Ministry of Health, during 1928, 167 mothers and infants were supplied with cow's milk free, 54 with dried milk, and 9 with condensed milk. A total of 11,498½ quarts of cow's milk, 1,035 lbs. of dried milk, and 168 tins of condensed milk were given free under the Regulations. In 1927, 148 mothers and infants were supplied free with cow's milk, 43 with dried milk, and 7 with condensed milk. 92 Infant Welfare Centres. The Infant Welfare Centres have, as in previous years, been carried on very economically owing to the 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. During 1928, £19 2s. 5d. was saved by 30 mothers. Owing to the lack of sufficient accommodation for perambulators at the Presbyterian Church Hall, Albert Road, Ilford, it was found necessary to transfer the Centre previously held at these premises to the Congregational Church Hall, Grosvenor Road. Ilford. The first session held at the new premises was on the 5th September. During the year the following attendances were recorded:— Figures for 1927. 1928. Total number of attendances of infants 28,142 33,590 First attendances 1,659 1,913 Total number of children on roll December 31st, after omission of all those who had not attended for six months 1,768 2,145 Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. First Attendances— 182 185 141 129 157 172 161 199 164 209 126 88 Subsequent Attendances— 2507 3155 2354 1818 2532 2828 2557 2606 2810 3718 2843 1949 The following is a comparison of the attendances at Infant Welfare Centres for the past ten years:— Total No. of attendances of infants. First attendances. Total No. of children on roll on 31st December. 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 1926 26,276 1,540 1,927 1927 28,142 1,659 1,768 1928 33,590 1,913 2,145 480 sessions were held during the year, the average attendance at each session being 69.98 mothers with their infants. 93 The following are the figures for each Centre:— Sessions. Average attendance. Seven Kings 49 101.69 Barkingside 49 37.24 Goodmayes 48 53.87 Valentines 48 82.06 Newbury Park 48 56.96 Grosvenor Road 48 94.64 Park and Cranbrook (morning) 47 54.93 Park and Cranbrook (afternoon) 47 62.28 Ilford Lane 48 90.08 Becontree 48 65.33 Ante-Natal Clinics.—The Ante-Natal Clinics were continued during 1928 at the Maternity Home on Monday and Saturday mornings. The following attendances have been recorded:— First attendances 653 Subsequent attendances 2,462 Number of expectant mothers on the rolls on 31st December, 1928 193 The following is a comparison of the attendances for the past eight years:- First Attendances. Total Attendances No. of expectant mothers on the roll . on 31st December. 1921 198 652 53 1922 165 567 36 1923 207 702 38 1924 282 846 70 1925 344 1,167 115 1926 500 1,619 139 1927 565 2,095 147 1928 653 3,115 193 All patients entering the Maternity Home who are to be attended by a midwife, are medically examined at the Ante-Natal Clinic. Dental Clinic.—Mr. M. J. K. Soutter, the Council Dentist, has continued the dental treatment of expectant and nursing mothers and of children under five years of age during 1928, one half-day per week being allocated for this purpose, 94 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 1928 183 Number of attendances of mothers 336 Number of mothers, having teeth extracted, to whom "general" anaesthetics were given 94 Number of mothers, having teeth extracted, to whom "local" anaesthetics were given 19 Number of mothers having teeth filled or otherwise treated 128 Number of mothers having dentures supplied 26 (b) Treatment of Children under 5 years of age. Number of children treated 79 Number of attendances of children 88 Number of children, having teeth extracted, to whom "general" anaesthetics were given 62 Number of children having teeth filled or otherwise treated 16 The following are the figures for the past five years:— 1924. 1925. 1926. 1927. 1928. Number of mothers treated 188 203 241 189 183 Number of children treated 87 89 85 96 79 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. The following are the figures for 1928:— (a) Number of children for whom spectacles were prescribed and provided 28 (b) Number of children examined by Oculist for whom spectacles were not prescribed 10 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, Eleven mothers were so treated in 1928, 95 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. One case of Ophthalmia Neonatorum was admitted to the Isolation Hospital at the request of the private doctor. Further details with regard to Ophthalmia Neonatorum will be found on page 51. Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 73 belts and 4 trusses have been supplied to infants suffering from hernia during the year 1928. 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 65 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. 8 children were treated free during the past year, and 8 were treated at a reduced fee. Arrangements have been made for the operative treatment of enlarged tonsils and adenoids at the Ilford Emergency Hospital. Further details will be found on page 111. 96 MATERNITY HOME. During 1928, 481 women were admitted into the Home as compared with 454 in 1927, 383 in 1926, 215 in 1925, 191 in 1924, 205 in 1923, 204 in 1922, 198 in 1921, 169 in 1920, and 139 in 1919. The patients were admitted to the Home from the following wards:— North Hainault 89 Cranbrook 41 Park 70 Seven Kings 67 South Hainault 38 Loxford 52 Clementswood 60 Goodmayes 42 22 patients were admitted from outside the district on the recommendation of the Maternity and Child Welfare Committee. The Committee decided in October that in future applications be not considered from persons residing outside the Borough earlier than four months prior to the expected confinement. At the end of the year 156 cases were booked for future admission to the Home. The average number of patients in the Home per day during 1928 was 19.51, and the average length of stay of patients 14.80 days. Of the 481 cases admitted during 1928, 471 were confined in the Home, 3 cases were admitted for observation only, 1 was admitted as a case of inevitable abortion, 1 was a miscarriage, and in 5 cases the babies were born before arrival at the Home. Of the 471 confinements, 38 women had engaged their own doctor, 4 of these cases were, however, delivered by a midwife, the doctor not being present at the birth. 433 were attended by one of the midwives at the Home. 97 It wag necessary to call in a doctor in 136 of the latter cases, owing to the following complications:— (a) Ante-natal 41 Small measurements (labour induced) 23 Breech presentation version under general anaesthetic 1 Admitted for observation (multiple pregnancy) 3 Disproportionate measurements 1 Albuminuria 9 Induction (hyperemesis) 1 Pre-eclampsia (pregnancy terminated) 1 Threatened abortion 1 . Eclampsia 1 (b) During labour 58 Persistent occipito-posterior 14 Uterine inertia 3 Episiotomy 3 Prolonged labour 16 Face presentation 1 Extended breech 8 Perineal abscess 1 Foetal distress 2 Valvular disease 3 Premature twins 1 Placenta praevia 2 Acute hydramnios 1 Premature labour 1 Inevitable abortion 2 (c) After labour 33 Ruptured perineum 25 Incomplete placenta 1 Adherent placenta 2 Puerperal insanity 1 Post-partum haemorrhage 2 Phlebitis 1 Phlegmasia alba dolens 1 (d) For infant 4 Debility 4 There were 7 deaths of infants in the Home, from the following causes:— Prematurity (including twins) 4 Pulmonary atelectasis 1 Asphyxia Pallida and prolonged labour 1 Congenital atelectasis and pericardial effusion (congenital) 1 One case of Puerperal Fever was notified. This case was removed to Romford Infirmary, and made a good recovery. 98 Two cases of Puerperal Pyrexia were notified; both proved to be cases of Pyelonephritis, due to Bacillus Coli. One was transferred to the Isolation Hospital. Both made a satisfactory recovery. Two other cases of Pyelonephritis also occurred, and one of Perineal Abscess, all of whom were transferred to the Isolation Hospital, and made a good recovery, but the case of Perineal Abscess was left with a recto-vaginal fistula. There were 9 stillbirths in the Home from the following causes:— Extended breech (unsuccessful version) 2 Macerated foetus 2 Anencephalus 1 Ante-partum haemorrhage 1 Pressure on cord 1 Hydrocephalus 2 Dr. Everard Williams, Consulting Obstetrician, paid his usual fortnightly visits to the Home. During 1928, he paid 25 ordinary visits, and examined 99 patients referred from the Ante-Natal Clinics. During the year he was also called in three times for other cases, as follows:— To perform a caesarian section operation For consultation re rise of temperature and general condition For consultation re eclampsia The infant mortality rate of children born in the Maternity Home during the year was 14.6 per 1,000 births, as compared with 54.7 for those born in their own homes. The figure of 54.7 has been arrived at after deduction of all births and infant deaths in the Maternity Home and of all infant deaths in the Village Homes, Barkingside. 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. 1928 14.6 54.7 1927 8.9 52.0 1926 10.4 56.1 1925 23.9 58.1 1924 16.0 45.7 99 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 Commitee. The following table shows in extenso the fees which were paid by women admitted to the Home:— 3 mothers were admitted free of charge. 4 mothers were admitted at a fee of 15s. per week. 23 „ „ „ 20s. „ 2 „ „ „ 21s. „ 1 mother was admitted at a fee of 22s. „ 17 mothers were admitted at a fee of 25s. „ 43 „ „ „ 30s. „ 17 „ „ „ 35s. „ 16 „ „ „ 40s. „ 95 „ „ „ 42s. „ 27 „ „ „ 45s. „ 5 „ „ „ 47s. 6d. „ 33 „ „ „ 50s. „ 29 „ „ „ 52s. 6d. „ 9 „ „ „ 55s. „ 14 „ „ „ 57s. 6d. „ 23 „ „ „ 60s. „ 12 „ „ „ 62s. 6d. „ 14 „ „ „ 63s. „ 7 „ „ „ 65s. „ 4 „ „ „ 67s. 6d. „ 24 „ „ „ 70s. „ 2 „ „ „ 72s. 6d. „ 4 „ „ „ 73s. 6d. „ 1 mother was admitted at a fee of 77s. 6d. „ 12 mothers were admitted at a fee of 80s. „ 1 mother was admitted at a fee of 82s. 6d. „ 2 mothers were admitted at a fee of 84s. „ 1 mother was admitted at a fee of 86s. „ 1 „ „ „ 92s. 6d. „ 2 mothers were admitted at a fee of 95s. 6d. „ 5 „ „ „ 100s. „ 25 „ „ „ 110s. „ 1 mother was admitted at a fee of 42s. per week for 14 days and 20s. per week for 10 days. 1 „ „ „ 60s. per week for 14 days and 25s. per week for 121 days. 1 „ „ „ 82s. 6d. per week for 14 days and 60s. per week for 20 days. Of the above patients:— (a) 326 paid an additional fee of 15s. to the Council for the services of one of the midwives of the Home. 100 (b) 2 paid a fee of £3 3s. for the services of the Assistant Medical Officer of Health. (c) 98 paid a fee of £1 1s. for the services of the Assistant Medical Officer of Health. (d) 2 paid a fee of £5 5s. for the services of the Consulting Obstetric Surgeon. (e) 2 paid a fee of 10s. 6d. per week for the maintenance of babies in the Home apart from their mothers. (f) 1 paid a fee of 15s. per week for the maintenance of a baby in the Home apart from its mother. The work of training Pupil Midwives has continued in a satisfactory manner; 3 who were engaged during the year were successful in passing the examination of the Central Midwives' Board. Maternity Cases— Queen Mary's Hospital. There has been an arrangement since July, 1923. with the Queen Mary's Hospital, Stratford, for the treatment of Maternity cases requiring operative or other treatment which cannot be carried out in the Ilford Maternity Home, and cases which require admission to a Maternity Home and cannot be dealt with at our own institution, the agreed charge being 7s. per day. No cases were, however, treated under this arrangement during 1928. District Midwife. During 1928 the District Midwife attended 120 cases; of these 32 were delivered by doctors and 81 by herself; 7 were born before arrival of either doctor or midwife; a doctor was called in, however, in 25 of the 88 latter cases for the following causes:— (а) Ante-natal — Foetal distress 1 (b) During labour 12 Prolonged labour 9 Uterine inertia 2 Post partum haemorrhage 1 Adherent placenta 3 (c) After labour 9 Ruptured perineum 1 Varicose veins 3 Rise of temperature (Puerperal Fever 1 Premature infants (including (d) For infant twins) 3 Dangerous feebleness (bronchitis) 1 The 120 cases attended were in the following wards:— North Hainault, 42; Cranbrook, 3; Park, 21; Seven Kings, 26; South Hainault. 2; Loxford, 7; Clementswood, 17; Goodmayes, 2, 101 One case of Puerperal Fever occurred. A private doctor was summoned, and the patient was removed to the Romford Infirmary. She subsequently died of Acute Pneumonia and Puerperal Sapraemia. Of the infants born there were 2 stillbirths, due to the following cause.:— Macerated foetus 2 SCHOOL MEDICAL SERVICE. 105 GENERAL SURVEY OF THE SCHOOL MEDICAL SERVICE. The report shows a still further increase in the work. There are 14,910 children on the school rolls, compared with 14,206 in 1927, and 10,981 in 1922. 5,910 children were medically inspected, compared with 5,738 in 1927, and 4,072 in 1922. The incidence-rate of physically and mentally defective children in the Borough remains much the same. The following table compares the incidence-rate in Ilford with that of the previous year, and with the Board of Education averages for the country as arrived at in 1923 and 1927. It will be noticed that the number of crippled children is very low in Ilford, but, as I pointed out in previous (years, this is due to the fact that in the Ilford figures are only included children who are so crippled as to require instruction at a Cripple School:— Defects. BOARD OF EDUCATION ILFORD. IncidenceRate per 1000 children in average attendance (1st Apr. ,1922, to 31st Mar., 1923). IncidenceRate per 1000 children in average attendance (1st Apr., 1926, to 31st Mar., 1927.) IncidenceRate per 1000 children in average attendance (1st Apr.,1926, to 31st Mar., 1927). IncidenceRate per 1000 children in average attendance (1st Apr., 1927 to 31st Mar., 1928). Totally Blind .4 .4 - - Partially Blind 1.0 1.0 .7 .8 Totally Deaf .9 .8 .7 .9 Partially Deaf .3 .4 .1 .2 Mentally Defective (Educable) 8.6 6.6 7.4 6.3 Epilepsy (Severe) .6 .5 .3 .3 Infectious (Pulmonary and Glandular) Tuberculosis .7 .7 .4 .1 Non-Infectious but Active Pulmonary and Glandular Tuberculosis 1.7 3.0 1.8 .9 Active Non-Pulmonary Tuberculosis 1.5 2.0 .4 .5 Crippled Children 10.0 8.8 1.7 1.4 Delicate Children 15.5 16.8 17.9 12.5 106 There were, at the end of 1928, 68 mentally defective children who have been certified as requiring special school education, apart from 9 in attendance at Mossford School. Nineteen of these children were at home, not receiving any education at all. The question of dealing with these children has been before the Committee on several occasions, but the matter has been deferred, pending the publication of the report of the Special Committee appointed by the Board of Education to review the education of mentally defective children in this country. There are only 17 children in Ilford who are so physically defective as to require special school education, and 8 of these were sufficiently fit to attend an ordinary school if special precautions were taken as to their welfare. The School Medical Service was inspected and reported upon by one of the Medical Officers to the Board of Education in April, and in this report he stated:— "The Board are glad to learn that a satisfactory volume of medical inspection and treatment is carried out in an efficient manner. They desire, however, to invite the Authority's attention to the following points:— "(1) The Authority's dental scheme is at present limited in scope. The Board's experience is that a whole-time school dentist is able to carry out the dental inspection and treatment of about 5,000 children in average attendance. On this basis the Authority would require for a complete scheme the services of about 2 wholetime dentists. It is hoped, therefore, that when the Authority find themselves in a position to develop their School Medical Service, an increase in the strength of the Dental Staff will be one of the first extensions to be made." "(2) The importance of systematic provision for the orthopaedic treatment of cripple children should be kept in mind, and the Authority might consider the desirability of co-operating in any scheme which may be formulated by the Local Education Authority for Essex in corvnecticm with this form of treatment." 107 In consequence of these recommendations, I was asked to report to the Education Committee, and my report was as follows:— "Dental and Orthopædic Treatment. (a) The Appointment of an Additional Dentist.— The number of school children inspected by the dentist in 1927 was 8,729, and the number treated 2,496. The number of children in daily school attendance on an average for the past six months is 12,668. The Dentist, therefore, is supposed to deal with 7,668 more children than the Board's estimate. When a whole-time school dentist was first appointed in 1920, there were 4,520 less children on the school rolls than at the present date. The only time which the dentist gives to other work is one half-day a week to Maternity and Infant Welfare work, and one half-day a fortnight to tuberculosis work. If he were relieved from either or both of these there would not be much increase in the number of school children inspected and treated. The School Dental work is limited in the following ways:— (1) Only children from the ages of 5 to 11 years can be inspected and treated. (2) The children in each school can only be inspected every fifteen months. (3) Only 45.9 per cent. of the parents whose children require dental treatment accepted such treatment in 1926. (The percentage of acceptances in 1927 was 50.1, and in 1928 was 39.5.) The Board's Medical Officer was of opinion that if another Dentist were appointed, (a) educational work could be done, e.g., by the Dentist interviewing parents at the schools, and thus obtaining their consent for treatment to be carried out; (b) the children could be more frequently inspected, and a more systematic following up of those already treated could be arranged than is 108 at present possible; (c) the delay which is bound to occur with only one Dentist supervising the care of the teeth of so many children could be avoided. If the Committee decide to agree to the Board of Education's suggestion the cost would be as follows:— (1) Another Assistant Dental Surgeon could be obtained at a salary of £450 to £500 per annum. (2) An additional Clerk-Attendant would be required at a salary of £104 to £156 per year. (3) Additional medical assistance for administering gas would be required, unless the Board of Education would sanction the administration of gas by one of the dentists. 1,701 anæstnetics were administered in 1927, and no more time can be given to this work without interfering with the other duties of the Council's Medical Officers. (4) Another dental chair could be accommodated in the present dental clinic at Valentines Mansion, and there is ample waiting room. The total cost of the additional chair and outfit would be under £100. (6) Orthopædic Treatment.—I have made enquiries of the Essex County Council and find that they have made arrangements with certain Hospitals for institutional treatment, and also have instituted Orthopædic Clinics at which an Orthopaedic Surgeon attends. The nearest centre is, however, at Romford, and would be too far for Ilford children to attend. I have made various enquiries from 17 districts in and around London, and find that nine have Orthopædic Schemes in operation, whilst in five others the question is under consideration. As far as Ilford is concerned, the nearest Hospital at which there is an Orthopaedic Surgeon, is the London Hospital, and I think the Medical Inspector had this fact in mind when he made his report. Crippled children in Ilford, therefore, have to be taken long distances under difficult conditions to see Orthopædic Specialists, 109 and on occasions have to wait long periods before treatment in a Hospital can be obtained. For instance, I have had before me recently the case of a girl, 8 years of age, suffering from infantile paralysis and club-foot, who has attended school for only one week since five years of age. This child was on the Waiting List from December, 1927 to July, 1928, before she could be admitted into Hospital. The orthopaedic problem is concerned with two classes of children: 1. Those suffering from minor crippling defects such as curvature of the spine which can be remedied by suitable exercises and massage, in some cases special appliances being required for such treatment. In Ilford the custom has been to refer such children to the Supervising Instructor of Physical Training, and during the last 3 years alone, 169 such children have been referred. Although Mr. Roberts is able to improve considerably the condition of some of these children, a number of them require a skilled masseuse and medical gymnastic apparatus to obtain a complete cure. The Board of Education only allows Mr. Roberts to supervise simple school and home exercises. 2. The second class of children are those suffering from graver physical defects, such as those the result of infantile paralysis, and similar conditions. These ohildren require in some cases orthopaedic appliances, in others, operative treatment. It is difficult to estimate the number of these children who would require treatment, as the majority of them would not be in attendance at school, and this part of the scheme should be worked in conjunction with the Maternity and Child Welfare work, so that either children under 5 or over 5 could be referred to an Orthopædic Surgeon. A complete orthopaedic scheme in Ilford would therefore entail, (1) The establishment of a Remedial Exercises Clinic in a suitable building with proper appliances and a skilled masseuse holding a Masseuse and Medical Gymnastic Certificate. The salary of such a 110 whole-time masseuse would be approximately £200 a year. There would be entailed in addition, the initial cost of providing the necessary apparatus; (2) The appointment of an Orthopaedic Surgeon who could attend at the School Clinic at Valentines Mansion, and whose salary would be 3 guineas per session of about 2 hours. The various Authorities vary in their employment of an Orthopaedic Surgeon from once a week to once a month. I am of the opinion that in the first place the services of an Orthopaedic Surgeon attending once a fortnight would be sufficient. (3) Arrangements with an Orthopaedic Hospital, such as the Royal National Orthopaedic Hospital, to admit cases requiring operations, etc., from Ilford at a net rate per child .'' The Committee had before it in December the question of the establishment of an additional School Clinic in the eastern part of the Borough at Becontree. The matter has been referred to the Special Sub-Committee appointed to deal with the questions of the Orthopaedic Scheme and the appointment of an additional School Dentist. The Open-Air School was completed during the year, and out of 288 school children recommended from various sources for Open-Air School treatment, I selected 119 children. 90 children have been admitted to the school, aud there is a waiting list of cases, which will be admitted as vacancies occur. The School was formally opened on the 29th January, by His Worship the Mayor, Alderman Gunary. The benefits which weakly children in other districts have derived from open-air school treatment will now be available for Ilford children, and I have little doubt will produce as favourable results in this district in improving the physique of the delicate, of whom so many are to be found in our schools. The following table shows a comparison of the incidence of physical defects found at routine school medical inspection in Ilford for the past three years with that in the country generally, as arrived at by the Board of Education in 1927. 1ll It will be seen that on the whole Ilford is fairly comparable with the country in general:— Defects. Board of Education Average. IIford. Incidence-Rate per 1000. Incidence-Rate per 1000. 1927. 1926. 1927. 1928. *Defects of Vision 90.3 77.0 68.1 74.6 Squint 9.1 5.3 3.1 1.8 Other Eye Diseases 8.9 9.7 2.8 3.5 Defects of Hearing 4.6 5.5 5.7 4.4 Otitis Media 5.9 6.3 4.7 3.9 Enlarged Tonsils and Adenoids 60.9 91.0 60.8 66.8 Other Throat and Nose Defects 6.4 6.8 4.5 3.6 Organic Heart Disease 1.8 1.8 1.2 1.8 Pulmonary Tuberculosis: (a) Definite .4 — - — (b) Suspected 1.1 1.8 1.4 .9 Non-Pulmonary Tuberculosis 1.1 .4 .5 .5 Deformities 8.1 12.5 5.2 10.1 Nervous Diseases 1.9 1.8 2.0 3.2 * In calculating this figure the entrants have been left out of account. The operative treatment of enlarged tonsils and adenoids at Queen Mary's Hospital continues to be satisfactory, 248 cases having been dealt with in 1928. Negotiations have been in progress during the year for the operative treatment of enlarged tonsils and adenoids at the Ilford Emergency Hospital. Nose and Throat Specialists have been appointed for the purpose by the Hospital Authorities, and the latter have also agreed to retain children in the hospital overnight, where, owing to home conditions, or for other reasons, the Medical Officer considers it desirable. This will prevent a considerable number of Ilford children being sent home after these operations have been performed, from Hospitals which are far removed, and will enable children to be retained in Hospital, where, in many cases at the present time, this is impossible, although very necessary. The number of verminous children discovered is still very satisfactory, the percentage of such children having been reduced from 10.7, in 1919, to 2.8 last year. 112 The control of ringworm is also well maintained, there being only 5 cases under observation at the end of the year. When it is remembered that before medical inspection commenced there were 135 cases of ringworm of the scalp absent from school because of this condition, the effect of X-ray treatment and strict supervision of ringworm is manifest. There was a high incidence of infectious disease during the year, particularly Scarlet Fever, and, to a lesser degree, Diphtheria.. The latter disease was responsible for the deaths of three children of school age. A case of Smallpox, an unvaccinated girl aged 14 years (a scholar at Loxford Girls' School), occurred in the Loxford Ward on 2nd May. The patient was removed to Orsett Hospital the same day, and the house disinfected. The contacts in the case were rigorously followed up, and vaccination carried out, I am pleased to record that owing to the measures adopted, no further cases occurred. As a result of a number of complaints received regarding the sanitary conveniences in some of the schools, I made a personal inspection, with the Senior Sanitary Inspector, at the beginning of the year of all the conveniences, and, as a result, forwarded the following report to the Director of Education for submission to the Works and Sites Sub-Committee:— "(1) At Cleveland Schools there are still in use the old variety of open-trough water closets. The Sanitary Inspectors have frequent complaints from the houses of children who are suffering from infectious disease and who have been in attendance at this school. I think the time has come when the Committee should consider the replacement by modern separate pedestal W.C.'s and flushing cisterns. (2) At Loxford, Downshall, Highlands, Newbury Park Boys' and Girls'. Christchurch Boys', Girls' and Infants' (W. side). there is a pattern of trough closet not so unhygienic 113 as in Cleveland School, but one which I think the Committee should consider gradually replacing by separate W.C.'s. (3) The drinking water supply at the various schools requires reconsideration, and the present standpipes with mugs should be replaced by modern bubble-fountains, of which more are required than would correspond to the existing standpipes, of which the supply for each school is inadequate. Probably, some variation in this type would be required for the Infants' Departments. The present form of drinking water supply is probably a fertile source for the spread of infectious diseases. (4) I do not consider it desirable that, as at Becontree School, the drinking fountains should be placed in the sanitary annexe. (5) The flushing to the W.C. cisterns at Becontree School is unsatisfactory. A sufficiently rapid filling of the cisterns is not maintained. (6) I consider that the urinals at Becontree School should have a glazed stoneware surface and be provided with stalls. The provision of stalls in the new urinal at Cleveland School also requires consideration. " The remarks made in para. (1) of the above report also apply to Barkingside School, which is a Voluntary School. As a result of the above-mentioned report, the following work was carried out during the year:— At Cleveland School, the old variety of open-trough closets has been replaced by modern separate W.C. pans and flushing cisterns. The trough closets at Christchurch School have also been replaced by separate W.C. pans and flushing cisterns. The matter mentioned in para. (5) has been attended to. The other matters are still outstanding. 114 1. Staff.— The medical staff remained unchanged during the year. The appointment of an additional School Nurse, which the Education Committee decided upon on the 25th April, 1927, was made during the year, Miss E. J. Marsh commencing duties on the 7th August. Miss B. Raddall, School Nurse, who had been in the service of the Council since October, 1920, resigned her appointment on the 10th October. Miss E. Blackwall, appointed to fill the vacancy, commenced her duties on the 12th November. 2. Co-ordination.—Vide Annual Report, 1920. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. 3. School Premises.—There are 16 schools, with 37 departments. The schools have accommodation for 15,549 scholars, and 14,910 were actually on the rolls on December 31st, 1928. Extensions at Valentines School to accommodate 200 children were opened on the 16th April. The extensions at Stevens Road School, Becontree, to accommodate a further 576 children were opened on the 26th November. The Gearies' School at Gants Hill Crescent is nearing completion, and will be opened after Midsummer in the coming year. This school will accommodate 1,072 children. A site has been acquired at Barkingside for the erection of a school to accommodate 300 junior mixed children, and will be opened during the coming year. The Committee are also in negotiation for a site in Goodmayes Lane, for the erection of a temporary school to accommodate 500 children. 115 The temporary school at St. Thomas's Church, Haydon Road, remained in occupation. Routine medical inspection at the Mossford School, Dr. Barnardo's Girls' Village Home was again carried out by my Department during the year, 229 children being examined, the treatment of the children being left, as previously, in the hands of the Home Authorities. 4. Medical Inspection.— This has been carried out in accordance with the Board of Education (Special Services) Regulations, dated the 18th August, 1925, Seotion 17 of which states:— 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 1928 the number of visits by the Medical Officers to 37 different departments of 16 schools for the purposes of routine medical inspection was 354. The number of children examined during the year, falling within the above age groups, totalled 5,910 (2,949 boys and 2,961 girls), an increase of 172 over the figures for 1927. 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 1928, 137 such children (69 boys and 68 girls) were examined. 1,811 re-examinations (929 boys and 882 girls) were made at school by the doctors, to ascertain the result of the treatment of defects found in the course of medical inspection. A total 116 number of 7,858 examinations was made at the various schools during the year. The following table shows the numbers of children examined in previous years:— Routine Medical Inspection. Re-examination Special Cases. at following up. 1928 5,910 137 1,811 1927 5,738 126 1,697 1926 5,658 139 1,709 1925 4,545 165 1,587 1924 4,007 125 1,402 5. Findings ok Medical Inspection.— Table II. shows the return of defects found in the course of medical inspection. (a) Uncleanliness.— At routine medical inspection 60 children out of a total of 5,910 (or 1.0 per cent.) were found to have nits or vermin in their hair, while only 3 (or .005 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 124. (b) Tonsils and Adenoids.— 395 children (or 6.6 per cent. of those examined) were found to be suffering either from adenoids or from tonsils so enlarged, or causing such symptoms, that it was considered necessary to advise the parents to obtain medical advice. (c) Tuberculosis.— 5 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), 16 of Impetigo, (and 27 cases of other diseases of the skin were discovered at routine medical inspection. (e) External Eye Disease.— 9 cases of Blepharitis, i.e., inflamed eyelids, and 6 cases of Conjunctivitis were discovered. 117 (f) Vision.— 441 children (or 7.4 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. 34 of these cases saw while the remaining 407 had vision of 6/9 or less. All children having vision 6/9 or less are referred for treatment. Further particulars of these cases will be found on page 121. 94 per cent. of the cases received treatment from the School Oculist. (g) Ear Disease and Hearing.— 26 children (or .4 per cent. of those examined) were found to be suffering from defective hearing. 23 children were found to be suffering from a discharge from the ear, due to an old otitis media. (h) Dental Defects.— 280 (or 4.7 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 147, Table IV (Group IV). (i) Deformities.— 15 children were found to be suffering from slight spinal curvature, and 44 from other minor deformities (such as round-shoulders, flat-feet, etc.), which could be corrected by special physical exercises. These cases were referred to the Supervising Instructor of Physical Training. 6. Infectious Disease.— The following table shows the incidence of Scarlet Fever, Diphtheria and Measles, including German Measles, in the Ilford schools since 1919:— Scarlet Fever. Diphtheria. Measles. 1919 165 78 645 1920 154 130 790 1921 202 105 108 1922 116 82 893 1923 79 61 174 1924 85 28 1,026 1925 93 22 484 1926 93 60 1,713 1927 244 67 83 1928 349 117 1,383 118 Disinfection of all the cloakrooms at the public elementary schools was carried out during the year. In addition, disinfection was carried out at Downshall School, after cases of infectious disease. No schools were closed during the year on account of infectious disease. Tables VII to XIII on pages Nos. 154-160, show the incidence of each infectious disease in the Ilford schools during 1928. (a) Scarlet Fever.— 349 cases were notified in 1928, as compared with 244 in 1927. The epidemic of this (disease, which occurred in 1927, continued during last year. It will be seen from the following table that it affected every school in the district, but more particularly Downshall and Loxford Schools. No deaths of children of school age were recorded from this disease. The following table shows the percentage attack-rate of Scarlet Fever at the various schools during 1928:— School. Percentage Attack Rate. Barkingside 0.5 Becontree 1.5 Chadwell 1.8 Christchurch 1.6 Cleveland 2.4 Downshall 5.5 Goodmayes 1.3 Highlands 2.7 Little Heath 1.0 Loxford 3.4 Newbury Park 1.3 Roman Catholic 1.0 South Park 1.4 Uphall 1.8 Valentines 1.3 The table has been calculated on the cases notified compared with the number of children on the roll (all departments). 119 (b) Diphtheria.— 117 cases were notified in 1928, as compared with 67 in 1927. The incidence of this disease considerably increased during the year. The Public Health Committee had before it the question of offering facilities for parents to obtain the Schick Test for immunisation against Diphtheria, and in December the Committee empowered the Medical Officer of Health to take such action in this matter as he deemed advisable. Three deaths of children of school age occurred from this disease during the year. One of these children attended South Park School, one Uphall School, and the other a private school in the district. (c) Measles and German Measles.— 1,383 cases were notified from the schools in 1928, compared with 83 during 1927. One death from Measles in a child of school age occurred in 1928, compared with nil in 1927, and 7 in 1926. (d) Chickenpox, Whooping Cough and Mumps.— 278 cases of Chickenpox occurred in 1928, as compared with 614 in 1927; 341 cases of Whooping Cough in 1928, as compared with 134 in 1927; and 207 cases of Mumps in 1928, as compared with 449 in 1927. 1,452 home visits were paid by the Health Vistors in connection with cases of minor infectious disease. (e) Ringworm.— No. of cases at beginning of 1928. No. of cases reported during 1928. Total. Remedied during 1928. No. of cases under observation at end of 1928. Ringworm:— Scalp 8 9 17 12 5 Body — 18 18 18 — 8 27 35 30 5 Five school children were X-rayed at the clinio during the year. 120 7. Following Up.— This has been carried out in the manner described in my previous reports. During 1928, 2,167 home visits by the Nurses were paid for the purpose, and 1,811 children were re-examined by the doctors at school. 8. Medical Treatment.— The Clinic for minor ailments has been held as previously each morning. The work showed a considerable increase during the year, 218 more children being seen, and 766 more attendances having been made, than in the previous year. (a) Minor Ailments.— The attendances at the morning Clinic during 1928 were as follows:— Number of individual children seen at the Clinic 2,153 Number of attendances of children 5,694 Number of exclusion certificates granted 2.706 Number of certificates of fitnesss to attend school granted 1,293 The following table shows the variety of conditions dealt with at the School Clinic during the year:— Malnutrition 4 Uncleanliness:— Head 31 Body 1 Skin:— Ringworm:— Head 9 Body 18 Scabies 12 Impetigo 232 Other Diseases 202 Eye:— Blepharitis 26 Conjunctivitis 51 Corneal Ulcer 5 Defective Vision and Squint 115 Other Conditions 63 Ear:— Defective Hearing 24 Otitis Media 68 Other Ear Diseases 25 121 Nose and Throat:— Enlarged Tonsils 98 Adenoids 36 Enlarged Tonsils and Adenoids 247 Other Conditions 269 Mouth Breathing 18 Enlarged. Cervical Glands 99 Teeth—Dental Diseases 79 Heart and Circulation:— Organic 6 Functional 7 Anæmia 29 Debility 156 Infectious Diseases:— Scarlet Fever 4 Diphtheria 2 Whooping Cough 25 Mumps 11 Chickenpox 8 Measles 8 Influenza 6 Colds 75 Lungs:— Bronchitis 42 Other Non-Tubercular Diseases 27 Tuberculosis:— Pulmonary:— Suspected 3 Non-Pulmonary:— Glands 5 Nervous System:— Chorea 6 Other Conditions 12 Deformities 10 Minor Injuries 111 Other Defects and Diseases 279 Total number of ailments 2,564 (b) Ophthalmic Department.— During the year 1928 the School Oculist held 80 sessions for the refraction of children suffering from defective vision. Full details of the work are given in Table IV, Group II, on page 146. 122 584 school children were examined, 67 of these being eases from 1927. Of the 584 cases, 482 were referred from medical inspection, and 102 from the School Clinic. The 584 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 34 203 87 94 79 56 19 12 The children who saw 6/6 (practically normal vision) were -Buffering from symptoms such as headaches, inflamed eyelids, etc., which rendered further examination necessary. Of the 584 children examined, 469 were found to require spectacles by reason of the following defects:— Myopia 53 Myopic Astigmatism 62 Hypermetropia 82 Hypermetropic Astigmatism 187 Mixed Astigmatism 37 Anisometropia 17 Hypermetropia with Squint 31 Total 469 Of the remaining 115 children, 14 were suffering from the following other diseases:— Corneal Ulcers, Nebulte, etc. 4 Nystagmus 4 Persistent Pupillary Membrane 1 Other Diseases 5 14 42 children were found not to require spectacles, and in 59 cases the lenses already in use were found not to require changing. A number of children (79) were kept under observation and were re-examined during the year, the spectacles being changed in 34 instances. 123 Under the Education Committee's scheme 469 pairs of spectacles were provided. Of this number, 20 pairs of spectacles were provided free, and 3 pairs at a reduced charge, on necessitous grounds. In addition, spectacles were renewed or repaired in 144 cases. (c) Dental Department.—During, the year the Dentist paid 91 visits to the schools for the purpose of inspecting the teeth of children. Dental disease is still prevalent to much the same extent among school children, as is shown by the fact that of 10,389 children inspected by the Dentist (including special cases), 6,252, or 60.1 per cent., were found to require treatment, oompared with 56.9 per cent., 1927; 56 per cent., 1926; 56 per cent., 1925; 62 per cent., 1924. If all the cases accepted treatment it would be impossible for one dentist to carry out the work. It is very unsatisfactory to have to report that only 39.5 per cent. of the cases requiring treatment obtained it, in spite of the facilities offered. Much ill-health in adult life would be avoided if every child's teeth were attended to from the commencement of school life. In 1927, 50.1 per cent., in 1926, 45.9 per cent., in 1925, 47.6 per cent., 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 amount of dental disease present in children at various ages is shown by the following table relating to school children inspected by the School Dentist:— Age groups (in years). No. inspected. No. referred for treatment. Percentage. 5 1,198 737 61.6 6 1,603 1,013 63.13 7 1,774 1,158 65.27 8 1,694 1,044 61.6 9 1,152 656 56.95 10 1,151 601 52.03 11-12 1,537 763 49.64 124 The following table shows the percentage of acceptances of treatment by the School Dentist in the various schools during 1928— School. Number inspected. No. referred for treatment. No. of acceptances of treatment. Percentage of acceptances. Barkingside 360 205 78 38.04 Becontree 1,435 957 259 27.06 Chadwell 328 237 39 16.45 Christchurch 809 426 244 57.27 Cleveland 830 561 185 32.97 Downshall 1,209 582 252 43.20 Goodmayes 668 391 211 53.96 Highlands 1,457 817 277 33.90 Little Heath 123 82 19 23.10 Loxford 862 498 237 47.59 Newbury Park 573 322 198 61.48 Roman Catholic 592 398 131 32.91 South Park 901 619 213 34.41 Uphall 242 157 130 82.80 Totals 10,389 6,252 2,473 39.55 Full details of the dental work are shown in Table IV, Group IV, on page 147. (d) Treatment of Uncleanliness.—It was found necessary to deal with 56 children under the Education Act, 1921, Section 87, statutory notices being served on the parents. In 21 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 172 visits to the schools (an average of 10 visits to each school during the year), for the purpose of inspecting the heads and clothing of the children, with the following result:— Number of Children Inspected. Number Infected. Per Cent. 56,645 1,607* 2.8 *78 of these children were found to be infected with living vermin; the remainder with nits only. A very high standard is 125 adopted in Ilford, and a child with any nits in the hair at all is included in these figures. The percentages for previous years were as follows:— 1919 10.7 1920 10 1921 6 1922 5 1923 5 1924 4 1925 4 1926 3 1927 2.9 1928 2.8 No prosecutions were instituted during 1927 under Section 87 of the Education Act, 1921. During 1928 the ambulance was used on 6 occasions to bring verminous children to the School Clinic for cleansing purposes. (e) Other Ailments.—During the past year 248 children have been operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford. 43 children were treated free during the past year, and 18 at a reduced charge. In addition to the treatment of tonsils and adenoids, 45 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 Open-Air School, which has been under consideration since 1924, is now erected. It has been built on the Benton Road site, which has an area of 1.674 acres, on the South side of Benton Road. The following is a Block Plan of the site of the Open-Air School:— 126 127 The cost of this School is as follows:— School Building £6,901 Furniture and fittings £405 Equipment £305 Caretaker's Lodge £742 Store and Potting Shed £100 Total £8,453 The School is a one-storey building, and is designed to allow the maximum amount of sunlight and air into the classrooms. There are three classrooms, each to accommodate 33 children. The whole of the classrooms can be opened on the south side by means of folding doors. The classrooms are also divided by folding partitions, which leave the main building clear of any obstructions throughout its length. A glazed verandah extends along the south and east sides of the building, and a covered way leads to both of the scholars' offices on the north side. The general accommodation is as follows:— (1) Three class and rest rooms (22 ft. 6 in. by 20 ft. each). (2) Dining hall (32 ft. by 22 ft. 6 in.). (3) Kitchen with serving hatch opening to dining hall and larder. (4) Gills' and Boys' Cloakrooms and Lavatories. (5) Bathroom, with eight showers and dressing boxes. Specially designed towel-airer is placed in centre. Walls surrounding the showers are covered with glazed tiles. (6) Separate rooms for Teachers and Nurse, with lavatory and w.c. accommodation. (7) Blanket and spare clothes room. (8) Large store for rest furniture. (9) Lavatory accommodation for kitchen staff. (10) Scholars' offices (completely separated). 128 A Caretaker's Lodge is now in course of erection at the east end of the site, and will shortly be completed. Potting and tool sheds are being erected in the grounds, which are laid out for cultivation by the scholars. The school site was acquired by the Education Committee in January, 1906. The School has accommodation for 100 children, who will attend daily. The Open-Air School, as I have previously pointed out, will not provide accommodation for children suffering from infective tuberculosis, but will meet a great want in the district in dealing with anaemic, debilitated children, who are so liable to attack by tuberculosis and other diseases. The Committee has entered into a 12 months' contract with a private firm for the conveyance of the children who reside in the outlying parts of the Borough, to and from school, the vehicle used being a 22-seater saloon' bus mounted on a 25/30 h.p. pneumatic-tyred Crossley, at a charge at the rate of £425 per annum, and on the basis of a maximum mileage of 8,000 per annum, the agreement to be regarded as experimental in character, to be terminable after 9 months' running on 3 months' notice being given by either side, and to afford the Council protection against third-party risks. The mid-day meal for scholars will be prepared on the school premises, with its own appointed kitchen stall. An inclusive charge to the parent or guardian will be at the rate of two shillings and sixpence per pupil per week. As far as practicable the kitchen supplies will be bought under the existing contracts of the Council. The kitchen staff will consist of a cook and two assistants. The following is a, plan of the Open-Air School. 129 Borough . of Ilford 130 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, instructiona and supervisory character as regards the teaching of physical training (inclusive of swimming instruction and organised games, throughout all the schools under the jurisdiction of the Authority. Such duties include, as previously, staff conferences and practical demonstrations, and are governed, as is also the instruction given, by the Board of Education's (a) Syllabus of Physical Training for Schools, 1919, (b) Reference Book of Gymnasti Training for Boys, 1927, and (c) Syllabus of Physical Training for Schools (Supplement for Older Girls), 1927. Departmental visits have been made regularly and systematically. each Department having been visited at least six times during the year. III. Special Features. (a) During the year, voluntary classes in physical training, organised games, and folk and country dancing for male and female members of the teaching staff were held on two evenings per week, each lesson being of one hour's duration. The classes were much appreciated by those attending, and a good average attendance was maintained. (b) On 17th February, I attended the eighth Annual Conference, held in London, of the National Association of Organisers of Physical Education. I also attended, on 12th May, a very successful demonstration of physical training, games, and country dancing, arranged by the Sunderland Education Authority, and held at Sunderland Over 3,500 children participated in the proceedings, which were well organised and of an impressive character. (c) During the months of May, June and July, I attended, on Wednesday evenings, the London County Council's Physical Training College, for the purpose of viewing the instruction of a class of male teachers drawn from London Central Schools. These visits were of special interest, more particularly in view of the fact that the average age of thoseunder instruction exceeded 40 years. (d) During the summer months, a larger number of schools, as compared with last year, held successful athletic meetings on the various playing fields. (e) The Annual School Sports, organised by the Ilford Schools' Athletic Association, were held on 19th and 20th July, two separate half-days (in lieu of one whole day, as previously) being allocated to the meetings in view of past experience and 131 owing to the large number of competitors nov. entering as a result of the great interest taken 111 these fixtures. The events for senior pupils (eight years of age and over) took place on 19th July, the later date being assigned to jump- pupils (under eight years of age). The meetings again. prove' to be exceedingly popular, and the entrants exhibited their usual keen enthusiasm. The number o parents visiting the function continues to increase, the attendance on the second day constituting a record. (f) The Ilford Schools' Football Association has had a most successful season, during which the boys have participated in league, cup and friendly games. In the District Matches, Ilford boys competed in the English, Corinthian and Sun Shield Competitions with pronounced success, reaching the final in the case of the Sun Shield, and winning, by the goals to two, a keenly-contested match with West Ham boys The game was played on the Ilford Football Ground, on 7th April. (g) The Ilford Schools' Netball Association has also experienced a most satisfactory season, all Girls Departments having entered teams in the competition for the "Spencer" Shield, this trophy being ultimately won by South Park Central Girls' Department. In the Association's senior matches certificates only are offered for competition, and these were won by Cleveland Girls' Department. Following the precedent of past seasons, two very successful tournaments were held respectively on 11th May and 8th December: and it is gratifying to record the higher standard of play and the improved knowledge of the rules which have resulted from these games (h) The Ilford Schools' Swimming Association held its Annual Gala on the evenings of 4th and 5th October. The meetings again proved highly successful: and the additional convenience and comfort resulting from the division of the events between two evenings were again very much appreciated by all concerned. Much pleasure was derived from a Water-Polo Match played between local boys and a team of boys from West Ham. This contest provided a splendid exhibition and lesulted in a win for our boys. I am gratified to record a pleasing increase in the number of Departmental swimming galas organised and held during the season. These individual functions were carried out with success, and were the cause of considerable pleasure to all participants. (i) The season's work of the Ilford Schools' Cricket Association has consisted of a number of friendly matches, no league or cup contests having yet been adopted in respect of this particular game. Very promising form has throughout been exhibited by the boys concerned; and credi is due to the responsible teachers for their enthusiastic coaching. On the evenings of 11th and 12th July, by kind permission of the Ilford Cricket Club, a match was played on this Club's ground between teams representing respectively the east and west schools of Ilford. The game produced some really skilful play, which won the unqualified admiration of a large assembly of interested spectators. 132 (j) Playground markings, originaliy laid down in ail school playgrounds for the purpose of assisting in the conduct of games and activity exercises, have been repainted and, in this connection, I beg to state that these markings have fully achieved their original purpose in effecting a considerable saving of time, which is, consequently, available for lesson purposes, and in encouraging the more frequent playing of games, not only during the lessons themselves, but also in the ordinary recreation intervals. (k) During the period covered by this report, special home exercises have, on the recommendation of, and in consultation with, the School Medical Officer, been advises, in a number of cases of minor physical defect. (l) Considerable valuable assistance has again been rendered by the Handicraft Centre in connection with the repair and construction of apparatus for use during that physical training lessons and at the various sports meetings. I desire, also, to record my appreciation of the efficient service willingly rendered on many occasions by the Works Department. IV. Review of General Position. I have pleasure in stating, in conclusion, that the past year has been a period of consistent improvement and steady development, that the future holds promise of still further extension to a gratifying degree, and that the willing co-operation of the teaching staff calls for special mention. F J ROBERTS, Supervising Instructor in Physical Training. 31st December, 1928. 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 1928. 11a. Supply of Free Cod-Liver Oil Emulsion, Cod-Liver Oil and Malt, Etc.—During 1928, 9 necessitous cases were dealt with. 12. School Baths.—Vide Annual Report, 1920. 13. Co-operation of Parents.—Vide Annual Report, 1920. During 1928, 4,255 parents, or 72 per cent., attended the medical inspections. 14 and 15. Co-operation of Teachers and Attendance Officers.—Vide Annual Report, 1920. 133 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 Bartholomew has continued to render very valuable services in this district, with excellent results. The following is a brief resume of the work done by the Society in Ilford during the past year Total number of cases investigated, 44, made up as follows:— (1) Of neglect 28 (12 reported from the Public Health Department for neglecting medical advice, and 16 reported from other sources for general neglect.) (2) Ill-treatment cases 9 (3) Other causes 7 108 children (58 boys and 50 girls) were involved, 67 being of school age. In addition to this work, 156 supervision visits were paid to different cases, some of which were made to those 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 1928, nineteen 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:— Partially Blind.—Recommended for admission to a special school for partially blind children 2 Partially Blind and Epileptic.—Recommended for admission to a special school (particulars of case referred to Board of Education) 1 Partially Deaf.—Recommended for admission to a special school for partially deaf children 2 134 Partially Deaf and Dumb.—Certified unfit for attendance at any school, owing to malignant disease 1 Deaf and Dumb.—Recommended for admission to a special school for deaf children 2 Dumb.—Recommended for admission to a special school for aphasic children 2 Epilepsy.—Certified fit to attend ordinary school 2 Recommended for admission to a residential Institution for epileptic children 1 Cardiac Disease.—Certified fit to subtend ordinary school, subject to precautions (to be re-examined in 6 months) 2 Paralysis.—Recommended for admission to Open-Air School 3 Amyotonia Congenita.—Recommended for admission to Open-Air School 1 Total 19 lst. Blind Children.—There are ten children who are so blind as to be unable to profit by education in an ordinary school. Three of these are in residential certified schools for the blind. Five cases are awaiting admission to such schools (three are attending public elementary schools, and two are not attending any school). One child, who is over 14 years of age, and has been discharged from a residential certified school for the blind, is not attending any school; and one child, at present under hospital treatment, is unable to attend school. 2nd. Deaf and Dumb Children.—There are fifteen children falling within this category. Of these, five are deaf and dumb, eight are deaf, and. two are dumb only. Seven cases are in residential special schools for the deaf, and two are attending a day special school. Of the remaining six, five are awaiting admission to a special school (four being in attendance at elementary schools in the meantime, and one not attending any school), and one child is unfit to attend; any type of school. 3rd. Epileptic Children.—There are twenty-seven children known to the department. Two of these are in residential certified schools for epileptics, and two, not attending any school, are awaiting admission to special schools. The remaining twentythree are attending public elementary schools in the district. 135 4th. Tuberculous Children.—There are nine children suffering, or who have suffered from pulmonary tuberculosis, four of whom are attending public elementary schools, one is in a sanatorium, four are physically unfit to attend school (all of whom are over 14 years of age and have left school). Four children are suffering from active glandular tuberculosis and are at present attending school. In addition, at the end of 1928, one hundred and forty-eight children who were considered to be 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, seventeen physically defective children suitable for admission to a cripple school; seven of these cases were not attending school, two were attending public elementary schools, one was attending a private school in the district, three were in institutions, three were attending certified residential cripple schools, and one was attending a certified day cripple school. Of the seventeen children mentioned, seven are 12 years of age or over. In addition to the above, fifty-nine children suffering from minor deformities, such as slight curvature of the spine, were referred to the supervising instructor in physical training, for remedial exercises. (b) Mentally Defective Children— During 1928 I medically examined and reported upon 33 children under the Mental Deficiency (Notification of Children, Regulations, 1928, classified as follows:— Feeble-minded Children.—Total number certified in 1928 19 Recommended for admission to a special school (day or residential) 11 Recommended for admission to a special school (residential) 6 Recommended for admission to a special school (day) 2 Idiot Children.—Total number certified in 1928 2 Recommended for admission to a residential institution 2 136 Imbecile Children.—Total number certified in 1928 8 Recommended for admission to a. residential institution 8 (For re-examination in one year) 2 Dull and Backward Children.—Total number oertified in 1928 2 Recommended attendance at special class for dull and backward children for one year, and then to be re-examined 2 The following table shows the mental age (by the Binêt Simon tests) and the intelligence quotient of the mentally defective children examined this year. The border-line of mental deficiency is where the intelligence quotient is about 75. In four of the cases the Binet Simon tests were not applicable:— Actual age in years. Mental age in years. Intelligence Quotient. 7.0 5.2 74.28 7.75 6.4 82.58 7.91 6.2 78.38 8.33 6.8 81.63 8.41 6.0 71.34 8.60 5.8 67.44 9.5 6.0 63.15 11.41 7.6 66.60 12.50 10.0 80.0 12.33 9.4 76.23 12.25 8.5 69.38 13.33 9.6 72.01 13.50 9.4 69.62 13.75 10.4 75.65 13.76 10.2 74.18 (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 responsible for dealing with such children is the Esses County Council. There are 19 cases under the age of 16 years known to the department (2 being notified during the present year). Six are in a residential institution, and 13 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 16 cases under the age of 16 years known to the 137 ment (8 being notified during the present year), 15 are at home, and 1 is attending a public elementary school. (3) Feeble-minded Children.—Feeble-minded children are those whose mental defectiveness does not amount to imbecility, yet is so pronounced that they are incapable of receiving proper benefit from instruction in an ordinary school. The Authority responsible for the proper instruction of these children is the Ilford Education Authority. There are (at the end of 1928) 68 such cases under the age of 16 years known to me, of whom 38 are attending public elementary schools in the district, 2 are attending private schools, 9 are in residential schools, and 19 are not at school. All mentally defective children are visited at home by the School Nurses at least once a quarter. It will be seen that there are 59 educable mentally defective children from the Ilford elementary schools, for whom education at a special school is required and for whom none has yet been provided. In addition to these, there are 9 mentally defective (feebleminded) children under the age of 16 years at Mossford School (Dr. Barnardo's Girls' Village Home). At the present time, therefore, there is a total of 68 educable mentally defective children for whom special school provision is required. 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 1928 it was found that 151 children were employed out of school hours. 2 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 2 138 During 1928, 1 child was examined under Section 13 of the Education Act, 1918 (Employment of Children in Entertainments Act, 1918), the certificate being granted. The Juvenile Employment Committee has, during the past year, found occupation for 641 children, as follows:— Boys. Girls. Total. On register: Claimants (2nd January, 1928) 17 17 34 On register: Non-claimants (2nd January, 1928) 60 36 96 Totals 77 53 130 Fresh claims to U.I. Benefit 119 109 228 Renewal claims to U.I. Benefit 92 69 161 Totals 211 178 389 Fresh Registrations (for work only) 324 389 713 Re-registrations 141 226 367 Totals 465 615 1,080 Total number of young persons dealt with during the year 753 846 1,599 Placed by Bureau: Locally 228 241 469 Placed by Bureau: Non-locally 86 86 172 Totals 314 327 641 22. Miscellaneous.—In accordance with the Education Committee's regulations, the under-mentioned bursars, studentteachers, teachers, and school caretakers were medically examined and reported upon during the year by the School Medical Officer:— Bursars 14 Student-teachers 20 Newly-appointed teachers 31 Teachers absent through illness 18 School Caretaker 1 Total 84 Re-examinations:— Bursars 3 Student-teachers 2 Newly-appointed teachers 7 Total 12 139 Table I.—Return of Medical Inspections. A.—Routine Medical Inspections. Number of Code Group Inspections:— Entrants 2,106 Intermediates 1.987 Leavers 1,817 Total 5,910 Number of other Routine Inspections Nil. B.—Other Inspections. Number of Special Inspections— Medical Inspection at School 137 At School Clinic 2,153 Number of Re-Inspections— Medical Inspection at School 1,811 At School Clinic 5,694 Total 9,795 140 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1928. Defect or Disease. Routine Inspections. Special Inspections No. of Defects. No. of Defects. No. referred for Treatment. No. requiring to be kept under observation, but not referred for Treatment. No. referred for Treatment. No. requiring to be kept under observation, but not referred for Treatment. (1) (2) (3) (4) (5) Malnutrition 2 - 4 - Uncleanliness:— Head 60 - 31 - Body 3 - 1 - Skin Ringworm:— Scalp — - 9 — Body — - 18 - Scabies 1 - 12 - Impetigo 16 - 232 - Other Diseases (Non-Tubercular) 27 - 202 - Eye Blepharitis 9 - 26 - Conjunctivitis 6 - 51 - Keratitis 1 - — - Corneal Ulcer — - 5 - Corneal Opacities 1 - — - Defective Vision 441* 66 106 7 Squint 11 — 9 — Other Conditions 4 — 63 — Ear 'Defective Hearing 26 5 24 — Otitis Media 23 — 68 — Other Ear Diseases 27 — 25 — Nose and Throat 'Enlarged Tonsils only 144 49 98 9 Adenoids only 59 6 36 1 Enlarged Tonsils and Adenoids 192 26 39 4 Other Conditions 21 40 269 2 Enlarged Cervical Glands (Non-Tubercular) 12 - 99 1 Defective Speech 8 - — — Teeth—Dental Diseases 280 — 79 — Heart and Circulation Heart Disease:— Organic 11 8 6 1 Functional 7 18 7 2 Anaemia 19 7 29 3 Lungs Bronchitis 36 24 42 — Other Non-Tubercular Diseases 4 1 27 — Tuberoulosis Pulmonary:— Definite — — — — Suspected 5 8 3 — Non-Pulmonary:— Glands 3 — 5 — Spine — — — - Hip — 1 — — Other Bones and Joints — 1 — — Skin — — — — Other Forms — —- — — Nervous System Epilepsy 3 1 1 — Chorea 4 2 6 — Other Conditions 12 4 11 — Deformities Rickets 1 3 — — Spinal Curvature 15 — — — Other Forms 44 3 10 — Other defects and diseases 157 17 685 — *34 of these cases saw 6/6 but were suffering from other conditions, rendering refraction advisable. 141 Table II.—Continued. 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 2,106 817 38.7 Intermediates 1,987 539 27.1 Leavers 1,817 339 18.6 Total (Code Groups) 5,910 1,695 28.6 Other Routine Inspections — — — 142 Table III.—Return of all Exceptional Children in the Area in 1928. - - - 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 3 - 3 Attending Public Elementary Schools - 3 3 At other Institutions — — — At no School or Institution — 4 4 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 3 5 8 Attending Public Elementary Schools 2 1 3 At other Institutions — — — At no School or Institution 1 — 1 (ii) Suitable for training in a School or Class for the partially deaf Attending Certified Schools or Classes for the Deaf - 1 1 Attending Public Elementary Schools - 1 1 At other Institutions — — — At no School or Institution — 1 1 Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority) Attending Certified Schools for Mentally Defective Chn. 6 3 9 Attending Public Elementary Schools 22 25 47† At other Institutions (Privvate School) 2 - 2 At no School or Institution 12 7 19‡ 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 - - - At no School or Institution 1 1 2 Suffering from epilepsy which is not severe Attending Public Elementary Schools 11 12 23 At no School or Institution — — — 143 Table III.—Continued. — — — Boys Girls Total Physically Defective Infectious pulmonary tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At other Institutions — 1 1 At no School or Institution — — — Non-infectious but active pulmonary tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schls. 2 2 4 At other Institutions — — - At no School or Institution 1 3 4* Non-infectious but active glandular tuberculosis At Public Elementary Schls. 2 2 4 Delicate children (e.g., pre—or latent tuberculosis, malnutrition, debility anaemia, etc.) At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - 1 1 At Public Elementary Schls. 71 77 148 At other Institutions — — - At no School or Institution 2 1 3 Active Non-pulmonary tuberculosis At Sanatoria' or Hospital Schools approved by the Ministry of Health or the Board 1 1 2 At Public Elementary Schls. 1 - 1 At other Institutions 1 2 3 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 Schls. - - - At Certified Residential Cripple Schools 1 2 3 At Certified Day Cripple Scs. 1 - 1 At Public Elementary Schls. 2 — 2 At other Institutions 3 - 3 At no School or Institution 5 2 7 At Private School - 1 1 * These cases are over 14 years of age. † 9 of these children are from Mossford School, Dr, Barnardo's Girls' Village Home. ‡ 11 of these cases are over 14 years of age. 144 Table IIIA. Statement of the Number of Children Notified During the Year Ended 31st December, 1928, by the Local Education Authority to the Local Mental Deficiency Authority. Total number of children notified 6 Analysis of the Above Total. Diagnosis. Boys. Girls. (1) i. Idiots 1 - ii. Imbeciles 1 1 iii. Children incapable of receiving benefit or further benefit from instruction in a Special School - - iv. Children unable to be instructed in a Special School without detriment to the interests of other children - - v. Moral imbeciles or moral defectives — — (2) Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 2 1 (3) Feeble-minded children notified under Article 5 of the 1914 Regulations or under Article 3 of the 1928 Regulations, i.e., "Special Circumstances" cases - - (4) Children, who in addition to being mentally defective, were blind or deaf - — Grand Total 4 2 145 Table IV.—Return of Defects Treated during the Year ended 31st December, 1928. TREATMENT TABLE. Group 1,—Minor Ailments (excluding Uncleanliness, for which see Group V). Disease or Defect. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skill:— Ringworm—Scalp 9 — 9 Ringworm—Body 18 — 18 Scabies 13 — 13 Impetigo 232 — 232 Other skin disease 202 87 289 Minor Eye Defects 145 69 214 (External and other, but excluding cases falling in Group II.) Minor Ear Defects 117 52 169 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 654 561 1215 Total 1,390 769 2,159 146 Table IV.—Continued. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. No. 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) ] Errors of Refraction (including Squint) 584 17 9 610 (Operations for Squint should be recorded separately in the body of the Report). Other Defect or Disease of the Eyes (excluding those recorded in Group I.) - - - - Total 584 17 9 610 Total number of children for whom spectacles were prescribed:— (а) Under the Authority's Scheme 469 (b) Otherwise 26 Total number of children who obtained or received spectacles:— (а) Under the Authority's Scheme 469 (b) Otherwise 26 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Under the Authority's Scheme,in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total Received other forms of Treatment. Total Number treated. (1) (2) (3) (4) (5) 248 98 346 69 416 147 Table IV .—Continued. Croup 1V.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist— Aged Routine Age Groups 5 1,198 Total 10,109 6 1,603 7 1,774 8 1,694 9 1,152 10 1,151 11 1,537 Specials 280 Grand Total 10,389 (b) Found to require treatment 6,252 (c) Actually treated 2,473 (d) Re-treated during the year as the result of periodical examination 877 (2) Half-days devoted to Inspection 91 Total 421 Treatment 330 (3) Attendances made by children or treatment 3,324 (4) Fillings Permanent Teeth 687 Total 2,429 Temporary Teeth 1,742 (5) Extractions Permanent Teeth 449 Total 5,131 Temporary Teeth 4,682 (6) Administrations of general anaesthetics for extractions 1,792 (7) Other operations Permanent Teeth 310 Total 455 Temporary Teeth 145 A detailed statement appears on page 21 of the Report. Group V.—Uncleanliness and verminous conditions. (i.) Average number of visits per school during the year by the School Nurses 10 (ii.) Total number of examinations of children in the Schools by School Nurses 56,645 (iii.) Number of individual children found unclean 1,607 (iv.) Number of children cleansed under the arrangements made by the Local Education Authority 21 (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil (b) Under School Attendance Bye-laws Nil 148 149 Table V.-Table showing number of Children Medically Inspected at various Schools during 1928. Ages—Years. 5—6 6—7 7—8 8—9 9—10 10—11 11—12 12—13 13—14 14—15 Totals. SCHOOLS. Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Routine. Barkingside 29 29 17 5 9 9 47 25 4 6 - 2 1 1 21 22 1 - - - 129 95 Becontree 74 105 12 25 16 17 105 126 — 16 5 23 16 12 87 64 14 9 1 — 330 397 Chadwell 8 9 4 1 1 5 16 8 2 1 — — — — 4 1 1 1 — — 36 26 Christchurch 84 44 10 15 13 4 114 72 2 — 7 2 5 — 51 29 5 1 — — 291 167 Cleveland 77 80 6 15 8 13 98 120 6 5 7 8 6 8 53 47 9 5 1 — 271 301 Downshall 86 71 18 23 11 14 93 79 12 6 3 11 2 4 52 40 6 3 4 — 287 251 Goodmayes 84 64 22 14 13 22 111 102 10 7 14 6 12 5 64 66 9 — — — 339 286 Highlands 59 66 23 18 9 16 54 77 5 8 3 6 12 17 69 44 6 7 3 5 243 264 Little Heath 5 4 — 2 1 — 8 4 — 1 — — 2 1 7 5 2 1 — — 25 18 Loxford 54 44 7 9 14 15 38 48 2 2 3 2 1 2 37 27 2 1 — — 158 150 Mossford — 26 — 20 — 14 — 25 — 28 — 29 — 22 — 31 — 31 — 3 — 229 Newbury Park 40 29 6 7 10 16 46 26 1 3 3 5 2 — 18 26 3 — — — 129 112 Roman Catholic 27 21 12 4 9 3 38 35 2 2 — 2 4 2 19 23 1 4 — — 112 96 South Park 58 45 12 5 11 8 87 72 4 3 3 3 83 55 94 143 1 4 — — 353 338 Uphall 40 39 4 1 4 10 49 58 3 2 3 12 4 1 51 29 1 2 — — 159 154 Valentines 33 35 8 10 7 4 34 24 2 3 3 1 - - - - - - - - 87 77 Total 758 707 161 174 136 170 938 901 55 93 54 112 150 130 627 597 61 69 9 8 2949 2961 Specials. Barkingside 1 1 - - - - - - - - - - - - - - - - - - 1 1 Becontree 1 1 — — 2 2 3 2 1 1 3 2 — 2 — 2 — — — - 10 12 Chadwell — — — 1 1 — 1 1 — — 1 — — — — — — — — — 3 2 Christchurch 1 1 4 1 1 1 2 1 1 - - - - - 1 - - - - - 10 4 Cleveland 1 - - 1 - - 1 - - 1 - - - - - - - - - - 2 2 Downshall 2 1 — - - - - 1 - - - - - - - - - - - - 2 3 Goodmayes 1 2 1 2 1 — 1 1 — 1 1 — — — 1 2 2 - — — 8 8 Highlands 6 2 2 2 1 3 — 4 — 1 — — 1 1 — 1 — 3 — 1 10 18 Little Heath - - - - - - - - - - - - - - - 1 - - - - - 1 Loxford 1 1 - — — — 1 1 — 1 - - - - 1 - - - - - 3 3 Mossford — - — - - - - - - - - - - - - - - - - - - - Newbury Park 2 1 — — 1 1 1 1 - - - - - - - 1 - - - - 4 4 Roman Catholic - - - - - - 2 2 2 - - - - - - 1 - - - - 4 3 South Park 1 — 3 — 1 1 2 1 1 - - - - - - - - - - - 8 2 Uphall 1 1 - 1 — — 1 1 — 1 — — — — — — 2 — — — 4 4 Valentines - - - - - - - - - - - - - - - - - - - - - 1 Total 18 11 10 8 8 8 15 17 5 6 5 2 1 3 3 8 4 4 — 1 69 68 Total Number of Children Examined, 6,047. Grand Total 3018 3029 150 151 Table VI. A— TableShowing the Average Heights and Weights of the BOYS Examined. school Age Groups. Age Groups. 5—6 Years. 6—7 Years. 7—8 Years. 8—9 Years. 9—10 Years. 10—11 Years. 11—12 Years. 12—13 Years. 13—14 Years. Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds) Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Barkingside 29 41.53 39.48 17 45.52 44.75 9 48.73 51.38 47 49.25 54.24 4 51.75 79.87 — - - 1 59.05 57.58 21 56.92 74.76 1 57.28 81.57 Becontree 74 41.77 41.59 12 44.58 44.91 16 47.08 48 .59 105 48.61 52.67 - - - 5 55.82 61.33 16 53.36 66.56 87 55.20 72.52 14 59.87 66.58 Chadwell 8 43.45 41.22 4 45.74 43.85 1 50.00 60.40 16 48.94 53.16 2 52.51 60.85 — — — — — — 4 56.58 82.45 1 57.88 81.57 Christchurch 84 42.87 47.40 10 45.01 46.30 13 47.40 50.36 114 48.61 57.12 2 48.41 57.39 7 50.67 59.71 5 54.33 70.17 51 55.57 76.01 5 58.20 90.61 Cleveland 77 42.05 49.02 6 44.21 45.38 8 49.85 51.79 98 48.71 48.56 6 50.97 65.38 7 51.41 64.23 6 54.67 75.18 53 55.89 78.75 9 57.69 77.58 Downshall 86 42.74 41.14 18 45.16 47.81 11 47.94 51 .85 93 52.38 52.80 12 52.55 62.81 3 55.24 68.33 2 53.14 72.98 52 56.18 76.80 6 59.56 87.74 Goodmayes 84 43.15 42.69 22 46.44 46.70 13 49.71 49.90 111 51.18 54.17 10 53.04 69.71 14 53.72 63.47 12 56.18 69.44 64 58.01 75.68 9 60.54 83.70 Highlands 59 41.59 42.68 23 45.42 48.71 9 48.69 51.67 54 47.80 56.39 5 51.38 54.21 3 59.61 60.04 12 57.16 70.63 69 56.32 74.36 6 57.03 71.62 Little Heath 5 43.90 49.03 — — — 1 52.01 48.67 8 49.79 53.16 — — — — — — 2 56.87 72.04 7 54.61 70.49 2 56.28 72.93 Loxford 54 44.18 46.72 7 45.01 47.89 14 49.73 49.44 38 48.06 50.14 2 50.17 53.17 3 54.54 59.78 1 52.19 69.44 37 55.69 71.49 57.19 70.17 Newbury Park 40 41.09 44.64 6 47.63 46.31 10 48.32 51.79 46 49.72 51.68 1 50.99 54.36 3 56.12 60.67 2 56.17 72.16 18 54.37 74.12 3 54.37 81.42 Roman Catholic 27 47.61 43.07 12 46.32 49.07 9 47.36 51.60 38 48.27 49.86 2 53.15 51.33 — — — 4 57.06 73.32 19 54.61 75.04 1 57.19 83.74 South Park 58 43.06 41 .09 12 44.87 46.32 11 45.67 48.39 87 46.41 51.08 4 50.77 60.11 3 55.09 64.17 83 53.14 70.46 94 57.01 74.36 1 53.06 79.49 Uphall 40 42.91 40.89 4 43.67 47.18 4 46.35 48.78 49 43.16 49.67 3 48.06 52.94 3 56.03 67.18 4 57.09 74.38 51 56.49 70.40 1 54.72 77.04 Valentines 33 42.00 43.99 8 45.78 49.39 7 48.59 47.91 34 45.18 51.63 2 51.27 59.30 3 54.62 71.29 - - - - - - - - - Average Heights and Weights of Ilford Children 758 43.95 42.37 161 45.81 47.28 136 47.02 49.67 938 48.35 53.67 55 52.70 60.93 54 54.76 63.89 150 54.99 70.13 627 56.25 73.80 61 58.34 79.46 Ages. Ages. Anthropometric Standard (Boys). 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 rounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) 40.68 38.68 42.83 42.24 45.04 46.40 47.39 52.00 49.18 55.90 50.84 60.35 52.98 66.41 54.88 72.66 56.07 77.40 152 153 Table VI. B.— Table showing the Average Heights and Weights of the 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. 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 fin inches,. Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). Barkingside 25 41.81 39.25 5 43.90 41.26 9 43.22 43.56 25 48.89 50.67 6 50.36 52.59 2 51.60 68.12 1 53.87 73.71 22 56.99 74.01 - - - Becontree 105 41.91 40.13 25 44.51 43.43 17 46.59 46.95 126 48.28 51.37 16 50.00 59.36 23 52.37 62.67 12 53.58 71.01 64 57.18 77.89 9 59.72 93.69 Chadwell 9 41.97 39.51 1 45.29 42.38 5 47.37 46.38 8 49.75 56.13 1 52.19 68.83 - - - - - - 1 54.58 59.16 1 64.20 92.18 Christchureh 44 42.07 39.76 15 44.22 47.01 4 48.41 52.05 72 48.33 50.65 — — — 2 53.48 70.12 — — — 29 54.37 80.07 1 60.18 75.43 Cleveland 80 43.73 41.62 15 46.16 48.33 13 45.36 49.77 120 47.82 56.18 5 48.64 69.78 8 52.26 59.67 8 58.61 63.09 47 57.19 76.51 5 57.83 86.90 Downshall 71 42.15 41.73 23 44.56 42.19 14 47.17 49.62 79 51.72 55.66 6 51.56 62.20 11 54.02 67.91 4 55.04 73.22 40 57.35 70.38 3 55.83 89.14 Goodmayes 64 44.32 40.71 14 44.38 42.58 22 49.43 53.10 102 49.37 56.34 7 51.85 53.76 6 51.07 59.67 5 54.41 66.99 66 56.14 76.98 — — — Highlands 66 44.09 38.61 18 42.69 43.20 16 46.39 49.06 77 49.67 49.70 8 54.63 55.17 6 55.17 72.81 17 53.71 74.09 44 57.19 79.72 7 59.97 90.06 Little Heath 4 42.61 38.16 2 43.21 47.18 — — — 4 48.78 57.32 1 55.17 61.32 — — — 1 55.67 72.46 5 54.19 69.17 1 56.38 72.63 Loxford 44 42.72 38.79 9 45.19 45.40 15 45.07 49.42 48 47.06 54.29 2 52.17 63.09 2 49.82 69.42 2 52.19 69.03 27 59.61 79.43 1 59.70 79.39 Moseford 26 42.47 40.03 20 44.83 50.09 14 47.31 50.62 25 49.82 53.62 28 50.73 57.82 29 53.64 67.89 22 54.72 69.55 31 55.71 79.34 31 59.70 89.93 Newbury Park 29 41.68 40.62 7 43.77 46.32 16 47.21 51.43 26 48.71 56.84 3 47.63 57.18 5 54.31 69.09 — — — 26 58.32 80.31 — — — Roman Catholic 21 43.28 39.81 4 47.17 45.71 3 46.37 49.63 35 49.37 53.21 2 48.17 54.23 2 51.82 67.12 2 54.67 72.90 23 57.61 78.41 4 56.74 72.37 South Park 45 42.22 39.17 5 49.46 49.80 8 45.63 50.41 72 49.68 54.79 3 51.64 55.67 3 54.19 69.83 55 54.63 71.37 143 59.03 77.44 4 59.63 89.63 Uphall 39 43.87 40.12 1 50.02 43.27 10 47.27 47.65 58 50.17 56.19 2 51.30 59.89 12 53.88 67.94 1 60.42 80.14 29 58.47 79.23 2 54.79 88.79 Valentines 35 40.47 40.61 10 44.31 45.91 4 48.19 49.78 24 47.69 49.12 3 50.16 60.83 I 54.73 68.37 - - - - - - - - - Average Heights and Weights of ilford Children 707 42.75 40.18 174 44.63 45.24 170 46.23 49.80 901 47.65 53.04 93 50.79 58.61 112 52.96 66.32 130 54.29 70.87 597 57.17 76.52 69 58.28 87.05 Ages. Ages. Anthropometric Standard (Girls). 5 Years. 6 Years. 7 Years. 8 Years. 9 Years. 10 Years. 1 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 80.37 154 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, 1928. SCHOOLS. Number on Roll. DISEASES AND CONTACTS. Scarlet Fever. Diphtheria . Measles and German Measles. Chickenpox. Whooping Cough. Mumps. Enteric Fever. Ringworm. Totals. 1928. Totals. 1927. Cases. Contacts. Cases. Contacts. j Cases. Contacts. Cases Contacts. Cases. Contacts. Cases. j Contacts. Cases. Contacts. Cases. Cases. Contacts. Cases. Contacts. Barkingside 396 2 3 - - 77 35 9 3 8 - 1 - - - - 97 41 20 10 Becontree 2093 32 52 12 27 62 24 74 26 33 10 28 - - - 1 242 139 93 51 Chadwell 214 4 8 1 2 33 4 2 — 1 — 1 - - - - 42 14 5 7 Christchurch 1174 19 27 11 10 139 25 3 2 19 4 8 - - — 1 200 68 233 76 Cleveland 1204 30 22 9 14 127 35 6 1 29 3 5 - - — - 206 75 267 136 Downshall 1491 83 87 6 16 183 28 6 2 96 14 21 - 1 — 5 401 147 194 65 Goodmayes 1507 20 26 12 11 160 42 11 4 30 7 74 - 1 — — 308 90 119 59 Highlands 1406 39 21 7 15 173 26 68 15 52 3 6 - - — 2 347 80 91 58 Little Heath 94 1 — — — 1 — — — — - — - 1 — — 3 — 11 6 Loxford 1018 35 22 9 15 162 22 6 4 37 6 2 - - — — 251 69 95 50 Newbury Park 766 10 15 4 11 60 25 10 2 5 — 1 - - — — 90 53 67 47 Roman Catholic 482 5 4 1 6 57 16 5 2 4 — 1 - 1 — — 74 28 38 14 South Park 1212 18 7 9 12 33 4 46 14 8 4 59 - 4 — — 177 41 180 54 Uphall 689 13 8 16 23 57 15 1 — 3 - - - - - - 90 46 106 39 Valentines 377 5 1 1 3 53 7 28 4 16 5 - - - - - 103 20 61 28 County High — 4 8 — 2 — — — — — — — - — — — 4 10 6 4 Private Schools — 29 31 10 9 6 3 3 2 — — — - 2 — — 50 45 25 15 Mossford (G.V.H.) 787 — — 9 — — — — — — — — - — — — 9 — — — Totals 14910 349 342 117 176 1383 311 278 81 341 56 207 — 10 — 9 2694 966 1611 719 Acute Influenzal Pneumonia, 1 case. Acute Primary Pneumonia, 13 cases. Smallpox, 1 case (Loxford School). 155 SCARLET FEVER. Table VIII.— 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, 1928. SCHOOLS. No. on Roll. Jan. Feb. Mar. April. May. June. July and August. Sept. Oct. Nov. Dec. Total, 1928. Total, 1927. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. J Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 396 1 - - - - - - - - - 1 - - 3 - - - - - - - - 2 3 - 2 Becontree 2093 5 6 5 7 4 7 2 2 1 3 3 9 1 3 3 6 5 2 1 2 2 5 32 52 18 31 Chadwell 214 1 1 — — — — — — - — 1 - - - - - - 1 2 6 - - 4 8 - 3 Christchurch 1174 4 8 1 2 — 1 1 1 2 1 — 2 1 2 1 2 4 5 4 2 1 1 19 27 50 58 Cleveland 1204 4 2 1 — — — 1 — 5 4 2 1 5 2 3 5 4 6 3 1 2 1 30 22 26 22 Downshall 1491 1 1 — 1 1 2 2 3 1 1 4 4 16 21 14 12 19 21 15 17 10 4 83 87 41 35 Goodmayes 1507 2 2 1 3 3 2 1 5 4 2 — - 1 3 - 3 2 2 3 1 3 3 20 26 9 18 Highlands 1406 1 — - 1 1 — 3 1 — — 3 5 7 5 6 4 4 3 7 - 5 2 39 21 6 11 Little Heath 94 — — 1 — — — — — — - - - - - - - - - - - - - 1 - - - Loxford 1018 — — 1 — 1 — 1 — 4 — 5 2 8 5 8 4 5 7 - 1 2 3 35 22 8 7 Newbury Park 766 2 3 1 1 - - 1 - - 1 - - - 1 1 2 - 1 3 4 2 2 10 15 19 26 Roman Catholic 482 1 — — — 1 2 — — 1 1 1 - - 1 1 - - - - - - - 5 4 14 11 South Park 1212 1 1 1 — 3 — — — 1 — 2 2 4 2 3 - 3 - - 1 - 1 18 7 18 23 Uphall 689 3 1 1 1 2 1 — — — — 1 2 1 2 2 - - - 1 - 2 1 13 8 11 11 Valentines 377 - - - - - - 1 - 1 1 2 - - - - - - - 1 - - - 5 1 1 2 County High - - - - - - - 1 - - - 1 - - 2 - 1 1 2 - 2 1 1 4 8 6 2 Private — 1 1 3 — 2 2 1 1 - - 2 7 8 8 1 2 3 5 5 3 5 29 31 17 14 Mossford (G.V.H.) 787 - - - — — — — - — — - - - - - - - - - — - - - - - - Totals 14910 27 26 18 16 18 17 15 13 20 14 28 34 52 60 43 41 50 55 45 37 33 29 349 342 244 276 156 DIPHTHERIA. Table IX.— 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, 1928. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July and August. Sept. Oct. Nov. Dec. Total, 1928. Total, 1927. Cases. j Conts. Cases. Conts. j Cases. Conts. Cases. Conts. j Cases. Conts. Cases. Contsj Cases J Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 396 - - - - - - - - - - - - - - - - - - - - - - - - 2 1 Becontree 2093 — — — 2 3 12 - — — — — — 1 2 1 - 2 1 2 6 3 4 12 27 12 1 4 Chadwell 214 — — 1 2 - - - - - - - - - - - - - - - - - - 1 2 1 1 Christchurch 1174 3 3 - — 1 3 1 2 — - 1 - 2 1 - - 1 - 2 1 — — 11 10 5 9 Cleveland 1204 — 1 1 2 — — 2 5 — 1 - - 2 2 1 1 1 1 2 1 — — 9 14 10 16 Downshall 1491 — — 1 5 1 1 — 3 — 1 - - — 2 - - 1 - 2 4 1 — 6 16 7 7 Goodmayes 1507 2 2 1 1 — — 2 — 2 1 1 9 — — — - 1 - 3 3 — 2 12 11 4 10 Highlands 1406 — — — — 1 3 — — 3 3 1 2 — 2 2 - — 5 — — - — 7 15 3 12 Little Heath 94 — — — — — - — - — - - - — - - - - - - - — - - — — - Loxford 1018 2 2 — — 1 2 1 3 — — 1 l — - 2 1 - 2 1 2 1 2 9 15 1 5 Newbury Park 766 1 — — — — — — 4 — — 1 l — — - - 1 1 - 1 1 4 4 11 4 4 Roman Catholic 482 — 4 - 2 - - - - - - - - - - - - - - - - - - 1 6 — - South Park 1212 1 1 1 2 — — — 2 — 3 1 l 1 — 2 2 2 — 1 1 — — 9 12 — 2 Uphall 689 2 3 1 8 5 1 1 — — — 1 - 3 2 1 2 - — - 2 9 5 16 23 5 1 Valentines 377 - - - - - 1 - - - - - l - - 1 1 - - - - - - 1 3 7 7 County High - - - - - - - - - - - - - - 1 - - - - - 1 - - - 2 — 1 Private Schools — 2 2 2 — 3 1 1 2 — 1 — 2 — — 1 — — — 1 1 - — 10 9 6 1 Mossford (G.V.H.) 787 - - - - - - - - 3 - 1 - - — — - — — 3 - 2 - 9 - - - Totals 14910 13 18 9 24 15 24 8 21 8 10 8 10 9 12 11 7 9 10 17 23 10 17 117 176 67 91 157 MEASLES AND GERMAN MEASLES. Table X.— Summary of Cases of Measles and German Measles among School Children, and of Contacts of such Cases, excluded from School Attendance, during the Year ended the 31st December, 1928. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July and August. Sept. Oct. Nov. Dec. Total, 1928. Total, 1927. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. j Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 396 - - 3 4 32 17 34 9 8 4 - 1 - - - - - - - - - - 77 35 1 1 Becontree 2093 15 2 10 5 11 3 13 7 7 2 3 2 - - - - - - 2 2 1 1 62 24 49 4 Chadwell 214 29 3 — — — - 3 — - - — - - - 1 1 - - - - - - 33 4 3 2 Christchurch 1174 3 — 39 9 95 14 1 1 - 1 - - - - - - - - 1 - - - 139 25 5 1 Cleveland 1204 4 — 12 6 102 22 9 6 - 1 - - - - - - - - - - - - 127 35 1 - Downshall 1491 47 9 116 11 15 6 3 1 - - 1 - - - - - 1 1 - - - - 183 28 3 3 Goodmayes 1507 62 8 57 16 25 8 3 4 5 4 5 2 1 - - - - - 2 - - - 160 42 10 4 Highlands 1406 5 4 111 12 52 8 1 1 1 — 2 1 - - 1 - - - - - - - 173 26 4 5 Little Heath 94 — — — — - - - — 1 - - - - - - - - - - - - - 1 - - - Loxford 1018 60 8 79 7 17 4 2 2 1 - - - 3 1 - - - - - - - - 162 22 - - Newbury Park 766 — — 2 2 20 11 32 5 6 7 - - - - - - - - - - - - 60 25 2 3 Roman Catholic 482 2 5 36 5 19 5 - - - 1 - - - - - - - - - - - - 57 16 1 2 South Park 1212 1 1 3 - 10 2 17 1 2 - - - - - - - - - - - - - 33 4 2 1 Uphall 689 — — 5 1 27 5 21 4 3 1 — 2 — - - - - - 1 2 - - 57 15 2 - Valentines 377 1 - 1 - 51 7 - - - - - - - - - - - - - - - - 53 7 - - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - Private — — — 3 3 1 - 2 - - - - - - - - - - - - - - - 6 3 - - Mossford (G.V.H.) 787 - - - - - - - - - - - - - - - - - - - - - - - - - - Total 14910 229 40 477 81 477 112 141 41 34 21 11 8 4 1 2 1 1 1 6 4 1 1 1383 311 83 26 158 CHICKEN POX. Table XI.— Summary of Cases of Chicken pox among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended 31st December, 1928. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July and August. Sept. Oct. Nov. Dec. Totals, 1928. Totals, 1927. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases.j Conts. Cases. Conts. Cases. Conts. Casesj. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 396 - - - - - - - - - - - - - 1 - - - - 7 1 2 1 9 3 5 5 Becontree 2093 — — — - - - 1 - 2 1 10 5 32 11 2 1 6 1 10 3 11 4 74 26 5 1 Chadwell 214 1 - - - - - - - - - - - 1 - - - - - - - - - 2 - 1 1 Christchurch 1174 - - 2 1 - - - - 1 1 - - - - - - - - - - - - 3 2 8 3 Cleveland 1204 1 - - - - - - - - - - - 1 1 3 - - - - - 1 - 6 1 143 85 Downshall 1491 - - - - 1 - - - - - - - 2 1 1 - 1 - 1 1 - - 6 2 55 18 Goodmayes 1507 3 - - - - - - - - - 3 - - - - - - - 5 4 - - 11 4 58 26 Highlands 1406 59 10 8 5 - - - - - - 1 - - - - - - - - - - - 68 15 65 28 Little Heath 94 - - - - - - - - - - - - - - - - - - - - - - - - 10 6 Loxford 1018 — — — — 1 2 — - 1 1 1 1 1 - - - - - 2 - — - 6 4 70 37 Newbury Park 766 4 1 5 - - - - - - - - 1 - - 1 - - - - - - - 10 2 27 14 Roman Catholic 482 - - - - - - 1 - 2 1 1 - 1 1 - - - - - - - - 5 2 4 1 South Park 1212 1 1 3 — - — 1 1 8 7 20 - 6 3 5 - 1 — 1 2 — - 46 14 56 28 Uphall 689 - - - - - - - - - - - - - - - - - - - - 1 1 - 56 22 Valentines 377 27 4 1 - - - - - - - - - - - - - - - - - - - 28 4 50 19 County High - - - - - - - - - - - - - - - - - - - - - - - - - - 1 Private - - - 2 2 - - - - - - 1 - - - - - - - - - - - 3 2 1 - Mossford (G.V.H.) 787 - - - - - - - - - - - - - - - - - - - - - - - - - - 14910 96 16 21 8 2 2 3 1 14 11 37 7 44 18 12 1 8 1 26 11 15 5 278 81 614 295 159 WHOOPING COUGH. TABLE XII.— Summary of Cases of Whooping Cough among School Children, and of Contacts of such Cases Excluded from School Attendance during the Year ended 31st December, 1928. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July and August. Sept. Oct. Nov. Dec. Totals, 1928. Totals, 1927. 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 396 - - - - - - - - 2 - 3 - 3 - - - - - - - - - 8 - - 1 Becontree 2093 - — 1 1 5 1 8 1 4 2 8 1 5 2 1 1 1 1 - - - - 33 10 2 1 Chadwell 214 - - - - - - - - - - - - - - 1 - - - - - - - 1 - - - Christehureh 1174 - - - - 1 - - - - - 1 - 3 1 14 3 - - - - - - 19 4 24 5 Cleveland 1204 - — — — — — — - - - - - - - 9 1 10 1 9 1 1 - 29 3 18 13 Downshall 1491 1 - - - - - 1 1 5 2 45 5 38 4 5 2 1 - - - - - 96 14 1 2 Goodmayes 1507 - — 5 1 — 1 — - 2 1 6 1 16 - - 2 - - 1 1 — - 30 7 11 1 Highlands 1406 - — — — 2 — 1 - 10 2 25 1 14 - - - - - - - - - 52 3 5 2 Little Heath 94 - - - - - - - - - - - - - - - - - - - - - - - - 1 - Loxford 1018 - — 1 1 — — — - — — 1 - 2 3 6 1 5 - 13 - 9 1 37 6 7 1 Newbury Park 766 - - - - - - - - - - - - 3 - 1 - - - - - 1 - 5 - 9 - Roman Catholic 482 - — — — — — 1 - - - 1 - - - 2 - - - - - - - 4 - 18 - South Park 1212 - — 2 1 — — 1 - - - - - - - 1 1 1 - 3 2 - - 8 4 18 - Uphall 689 - - - - - - - - - - - - - - - - - - - - 3 - 3 - 18 5 Valentines 377 - — — — 11 3 4 - - 1 1 1 - - - - - - - - - - 16 5 2 - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - Private - - - - - - - - - - - - - - - - - - - - - - - - - - - Mossford (G.V.H.) 787 - - - - - - - - - - - - - - - - - - - - - - - - - - Total 14910 1 - 9 4 19 5 16 2 23 8 91 9 84 10 40 11 18 2 26 4 14 1 341 56 134 31 160 MUMPS. TABLE XIII.— Summary of Cases of Mumps among School Children, and of Contacts of such Cases, excluded from School Attendance, during the Year ended 31st December, 1928. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July and August. Sept. Oct. Nov. Dec. Totals, 1928. Totals, 1927. Cases. Conts. Cases. Conts. j Cases. j Conts. j Cases. Conts. j Cases. Conts. Cases. j Conts. Cases. Conts. j Cases. Conts. j Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Casss. Conts. Barkingside 396 - - 1 - - - - - - - - - - - - - - - - - - - 1 - 11 - Becontree 2093 6 — 1 — 4 — 4 - 2 — 5 - 3 - — - - - - - 3 - 28 - 3 - Chadwell 214 - - - - - - - - 1 - - - - - - - - - - - - - 1 - - - Christchurch 1174 3 — 1 — 2 — 1 - - - - - - - - - - - 1 - - - 8 - 141 - Cleveland 1204 2 - 1 - 2 - - - - - - - - - - - - - - - - - 5 - 68 - Downshall 1491 5 — 4 — 6 — 4 — 2 — - - - - - - - - - - - - 21 - 86 - Goodmayes 1507 20 —- 11 — 13 — 13 — 10 — 3 - — - — - - - 3 - 1 - 74 - 22 — Highlands 1406 - - 4 - 1 - - - - - 1 - - - - - - - - - - - 6 - 7 - Little Heath 94 - - - - - - - - - - - - - - - - - - - - - - - - - - Loxford 1018 1 - - - - - - - - - - - - - - - - - 1 - - - 2 - 9 - Newbury Park 766 - - - - - - - - - - 1 - - - - - - - - - - - 1 - 1 - Roman Catholic 482 1 - - - - - - - - - - - - - - - - - - - - - 1 - 1 - South Park 1212 39 — 3 — 15 — — — 1 — - - — - 1 - - - - - - - 59 - 86 - Uphall 689 - - - - - - - - - - - - - - - - - - - - - - - - 12 - Valentines 377 - - - - - - - - - - - - - - - - - - - - - - - - 1 - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - Private - - - - - - - - - - - - - - - - - - - - - - - - - 1 - Mossford (G.V.H.) 787 - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 14910 77 - 26 — 43 — 22 — 16 — 10 — 3 — 1 — — — 5 — 4 - 207 — 449 — Stats page 3H 61 & total 24/7/29