Brough Of Alford 1254 HEALTH REPORT FOR THE YEAR 1929 A. H. G. BURTON, M.D., B.S., D.P.M., D.P.H., Barrister-at-Law. Medical Officer of Health, &e. IX Borough of Alford. Annual Report 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 1929 Alford Borough Council. November, 1928 -November, 1929. Alderman G. Gunary, J.P., Mayor. Alderman W. J. O. Sheat, O.B.E., J.P., C.C., Deputy-Mayor. Aldermen: Church, George. Odell, Herbert George. Dane, Frederick Hopper, M.B.E., Pitt, Bertram Sidney John, J.P. J.P., C.A. (E.C.C.). Sheat, William James Oliver, Davey, George Robert. O.B.E., J.P., C.C. Gunary, George, J.P. Smith, Frank Douglas, E.C.C. Councillors : Billington, Henry. Bisson, Walter William Preston. Blow, Charles Barkworth. Braithwaite, Thomas. Carrell, Mrs. Sage Ward. Clark, Charles William. Cornwell, Arthur Edward. Daniels, Russell Stearn. Elborne, John, M.A. Eves, Charles. Farman, Claude Augustus. Giiigcs, Albert Philip, E.C.C. Hamilton, Alfred Parke. Harding, Alfred Daniel Bartlett. Harding, Mrs. Beatrice Alice Louise Ann. Heath, William Henry Charles. Jay, Charles Frederick. 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.C.C. Young, Alexander, Major, T.D. PUBLIC HEALTH COMMITTEE. November, 1928—November, 1929. Councillor C. W. Clabk, Chairman Alderman G. Church, Vice-Chairman. *Alderman G. Gunary, J.P. Councillor Mrs. B. A. L. A. *Alderman "W. J. O. Sheat, Harding. O.B.E., J.P., C.C. Councillor AV. H. C. Heath. Councillor C. B. Blow. Councillor C. P. Jay. Councillor T. Braithwaite. Councillor Rev. C. Reed, B.D., Councillor Mrs. S. W. Carrell. Hon. C.F. Councillor R. S. Daniels. Councillor W. R. Spencer. Councillor A. P. Griggs, E.O.C. Councillor 0. Waters, O.B.E., Councillor A. P. Hamilton. E.C.C. Councillor A. D. B. Harding. Councillor G. J. Wetton, E.C.C. *Ex-officio Members. MATERNITY AND CHILD WELFARE STATUTORY COMMITTEE. November, 1928—November, 1929. Councillor A. P. Griggs, E.C.C., Chairman. Councillor Mrs. S. W. Carrell, Vice-Chairman. Alderman G. Church. Councillor A. P. Hamilton. *Alderman G. Gunary, J.P. Councillor Mrs. B. A. L. A. *Alderman W. J. O. Sheat, Harding. O.B.E., J.P., C.C. Councillor C. F. Jay. Councillor H. Billington. Councillor Rev. C. Reed, B.D., Councillor C. B. Blow. Hon. C P. Councillor T. Braithwaite. Councillor 0. Waters, O.B.E., Councillor C. W. Clark. E.C.C. Co-opted Members: Mrs. C. J. Earl. Mrs. B. E. Paddon. Mrs. W. H. Gillard. Mrs. B. Straohan. Mis, l. Hardy. Mrs. E M. Wise. Mrs. E. J. Hinton. *Ex-officio Members. EDUCATION COMMITTEE November, 1928—November, 1929. Councillor C. B. Blow, Chairman. *Mr. A. W. Green, Vice-Chairman. Alderman G. Church. Councillor R S. Daniels. Alderman F. H. Dane, M.B.E., Councillor J. Elborne, M.A. J.P., C.A. (E.C.C.). Councillor C. A. Farman. †Alderman G. Gunary, J.P. Councillor A. P. Hamilton. Alderman H. G. Odell. Councillor Mrs. B. A. L. A. Alderman B. S. J. Pitt, J.P. Harding. †Alderman W. J. O. Sheat, Councillor Rev. C. Reed, B.D., O.B.E., J.P., C.C. Hon. C.F. Councillor H. Billington Councillor E M. Rowniree. Councillor T. Braithwaite. Councillor W. R. Spencer. Councillor Mrs. S. W. Carrell. Councillor 0. Waters, O.B.E., Councillor C. W. Clark. E.C.C. *Mr. W. J. Alderson. Councillor Major A. Young, T.D. *Mr. G. Colvin. *Rev. A. Butterworth, M.A. *Mrs. E. J. Craig. "Mr. S. P. Lonergan. *Miss J. B. Larkin *Co-opted Members. †Ex-officio Members. OFFICERS OF THE PUBLIC HEALTH SERVICES, JANUARY, 1930. 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.D., 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). Kathleen Edgecombe, M.D., Ch.B. (Liverpool), D.P.H. (Liverpool). Dentist: M. J. K. Soutter, L.D.S., R.C.S. (Eng.). Assistant School Dentist: Anne F. Crow, M.B., Ch.B., L.D.S. (St. Andrews). Matron of Isolation Hospital. Matron of Maternity Home. Miss I. Millar. Miss M. E. Roberts. Senior Sanitary Inspector: T. V. Haigh, Mem. Roy. San. Inst. Deputy Senior Sanitary Inspector and Chief Clerk: H. C. Monkcom, Assoc. Roy. San. Inst., A.M.I.S.E. Sanitary Inspectors: C. W. Fisher, Assoc. Royal San. Inst. S. G. Rackham, Assoc. Royal San. Inst. P. W. English, Assoc. Royal San. Inst. C. A. Dyer, 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 Hone and Puerperal Fever Regulations)i Everard H. C. Williams, M.D., B.Ch. (Cantab), M.R.C.P. (Lond.). Consulting Orthopaedic Surgeon: J. B. Barnett, F.R.C.S. (Eng.). 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 Births 20 Deaths 20 Inquests 21 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 26 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 31 Sanitary Inspection of District 32 (a) Notices served 32 (b) Complaints of Nuisances 33 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 33 Smoke Abatement 33 Rag Flock Acts 33 Housing 33 Overcrowding 34 Unhealthy Areas 34 Byelaws relating to Houses, Lodgings, Tents, etc. 34 Housing Table 34 8 SECTION III.—SUPERVISION OF FOOD. PAGE Milk Supply 35 Licences—Graded Milk 36 Milk Samples 36 Tubercular Milk 38 Meat Regulations 39 (a) Slaughterhouses 39 (b) Articles of Pood Surrendered and Seized 39 Bakehouses 39 Sale of Food and Drugs Acts 40 Diseases of Animals Acts 40 SECTION IV.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Disease Generally 41 Notifications in Institutions 42 Isolated in Hospital 43 Table II—Summary of Cases of Infectious Diseases Notified 44 Deaths from Infectious Diseases 45 Attack Rates of Infectious Diseases :— 45 (а) Smallpox 46 Smallpox Hospital Accommodation 47 (б) Scarlet Fever 47 (c) Diphtheria 48 (d) Enteric Fever 48 (e) Cerebro-spinal Meningitis 48 (/) Ophthalmia Neonatorum 48 (g) Acute Influenzal and Acute Primary Pneumonia 49 (h) Encephalitis Lethargica 49 (i) Plague 49 (j) Puerperal Fever 49 (k) Puerperal Pyrexia 49 Zymotic Diseases 50 Incidence and Deaths from Infectious Diseases in Age Groups 51 Tuberculosis 52 Tuberculosis, Treatment of 54 Tuberculosis Care Committee 54 Venereal Diseases 55 SECTION V.—OTHER SERVICES. Bacteriological Laboratory 56 Table of Number of Specimens Examined 57 9 SECTION VI.—FACTORIES AND WORKSHOPS. PAGE Factories 58 Workshops 58 Table I—Inspection of Factories, Workshops, Workplaces 60 ,, XI—Defects Found 61 ,, III—Homework 62 ,, IV—Other Matters 63 ISOLATION HOSPITAL. Patients Admitted 67 Scarlet Fever 69 Enteric Fever 70 Puerperal Fever 70 Diphtheria 70 Tuberculosis 71 Training of Nurses 72 Hospital Extensions 72 VIATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907 and 1915 79 Registration Act, 1836 and 1926 80 Infant Mortality 80 Neonatal Mortality 85 Table IV 86 Illegitimate Births and Deaths 87 Maternal Mortality 87 Infant Life Protection 88 Work of Health Visitors 89 Supervision of Midwives 90 Supervision of Maternity Homes 91 Supply of Milk to Expectant and Nursing Mothers and for Infants 92 Infant Welfare Centres 92 Ante-Natal Clinics 95 Dental Clinic 96 Ophthalmic Clinic 97 Orthopaedic Clinic 97 Ophthalmia Neonatorum 98 Treatment of Minor Ailments 98 Maternity Home 99 District Midwife 105 Maternity Home Extensions 105 SCHOOL MEDICAL SERVICE. General Survey Ill Staff 120 School Premises 120 Medical Inspection 121 Findings of Medical Inspection 122 10 SCHOOL MEDICAL SERVICE—{continned)t PAGE Infectious Disease 124 "Following-up" 127 Medical Treatment:— 127 Minor Ailments 127 Ophthalmic Department 129 Dental Department 130 Treatment of Uncleanliness 133 Other Ailments 134 Open-Air Education 135 Physical Training 140 Provision of Meals 142 Supply of Free Cod Liver Oil, Emulsion, etc. 142 Co-operation of:— Parents, Teachers, School Attendance Officers and Voluntary Bodies 142 Physically and Mentally Defective Children 143 Employment of School Children and Young Persons 147 Medical Examination of Teachers, etc. 148 Statistical Tables:— I.—Number of Children Inspected 149 IIa.—Return of Defects 150 IIb.—Number of Children found to Require Treatment 151 III.—Numerical Return of Exceptional Children 152 IIIa.—Number of Children notified to the Local Mental Deficiency Authority 154 IV.—Group I—Minor Ailments 155 Group II—-Visual Defects 156 Group III—Nose and Throat Defects 156 Group IV—Dental Defects 157 Group V—Uncleanliness and Verminous Conditions 157 V.—Summary of Number of Children Inspected 158 VI.—A.—Average Height and Weights of Boys Inspected 160 B.—Average Heights and Weights of Girls Inspected 162 VII.—-Summary of Infectious Diseases among School Children 164 VIII.—Summary of Scarlet Fever among School Children 165 IX.—Summary of Diphtheria among School Children 166 X.—Summary of Measles and German Measles among School Children 167 XI.—Summary of Chicken-pox among School Children 168 XII.—Summary of Whooping Cough among School Children 169 XIII.—Summary of Mumps among School Children 170 PREFACE. Public Health Offices, Ilford. May, 1930. To His Worship the Mayor, the Aldermen and Councillors of the Borough of Ilford. Mr. Mayor, Ladies and Gentlemen, I herewith submit the Annual Report required by the Ministry of Health and Board of Education. The Registrar General's estimate of the population for the middle of 1929, which is 116,200, appears to be unduly low. The census is due to be taken next year and it will be seen how far the estimate is below the actual population in the district. The death rate has risen slightly. This was chiefly due to an outbreak of influenza which occurred in the early months of the year. It will be noted that there were 39 deaths from influenza and 112 deaths from pneumonia in 1929 compared with 8 deaths from influenza and 60 deaths from pneumonia in the previous year, 1928. For the same reason the infant mortality rate has also risen, there being 22 deaths from pneumonia in infants under 1 year of age last year as compared with 11 in 1928. It will be noted from the report that smallpox has visited the town on 5 occasions during the year. It is satisfactory to be able to say that in each case the disease has been limited to the house in which it first occurred. There were, however, 380 contacts of cases of smallpox from other districts notified to me. The work of visiting these contacts, which has fallen upon the sanitary inspectors, has caused their attention to other duties to b restricted. It is unlikely that Ilford will continue to remain as immune from smallpox as it has done during the past 10 years. In the neighbouring Borough of West Ham over 1,200 cases of smallpox occurred during 1929. If such an outbreak were to occur in Ilford, a 6d. rate would have to be expended in dealing with it. The type of smallpox which is occurring is still of the non-fatal variety but it is causing immense cost and unnecessary work to the Local Authorities. 12 Vaccination is our only real weapon against the inroads of smallpox. The incidence of certain cases of encephalitis, following vaccination in some cases, has caused some concern. Although the cases have been extremely rare compared with the number of vaccinations carried out, it is to be hoped that medical research will speedily find a means by which they can be altogether avoided. In the meantime, in August, 1929, the Ministry of Health, in accordance with the report of the Committee on Vaccination, amended the Vaccination Orders by which in lieu of 4 insertions of lymph, only one should be made, and that multiple scarification should be avoided. The occurrence of these cases of encephalitis emphasises the fact that infancy is the time of choice for primary vaccination to be carried out. The outbreak of paratyphoid fever which occurred in 1928 did not again occur in 1929. Scarlet fever and diphtheria were again epidemic in the town. The number of cases of scarlet fever showed some decrease on those in the previous year. There was a considerable increase, however, in the number of cases of diphtheria. 123 cases occurred in houses in the L.C.C. Housing Estate at Becontree. It will be noted that of the 305 cases which occurred in Ilford, 155 occurred in the G-oodmayes Ward. The disease was of a severe type and it will be noted from Table Ia that the provisional figures of the Registrar General show that the annual death rate from diphtheria in Ilford was .14 compared with .08 in the country generally. The attack rate from diphtheria in 1928 was, for England and Wales, 1.55; Ilford, 2.0; Dagenham, 3.16. The disease did not appear to be conveyed to any extent by school attendance and the outbreak was probably occasioned by the accumulation of a large number of susceptible persons in the Becontree area and also an increase in the ' 'carrier'' rate. Such outbreaks have occurred in other new housing estates. It is a question, however, whether the actual incidence of diphtheria was greater in Becontree than it would have been in the areas from which the families concerned were removed. The only method of dealing with such a problem is to raise the number of insusceptible persons in the area. At the request of the London County Council a Carrier Clinic was established at Guys 13 Hospital in order to see whether it was possible to deal with the diphtheria problem in the L.C.C. Schools by eradicating the diphtheria "carriers." The report of the Clinic (1929) states that ' 'the advantages gained by eliminating 'carriers' would probably be few as susceptible children would still be in contact with diphtheria and with 'carriers' not of school age There is an alternative method—Schick testing and immunising, which is simpler and cheaper and which would probably eliminate diphtheria from the L.C.C. Schools." In Ilford an attempt has been made to deal with the most susceptible children in the Becontree and Goodmayes area of the town. 937 children, most of whom were under 8 years of age were tested towards the end of 1929, 161 were found insusceptible, and 755 have been immunised to date. In addition, a Clinic for the immunisation of children was established at these offices in November, 1929, and up to date. 284 children have been immunised. A total of 1,039 children have therefore been immunised since November, 1929. The effect of immunisation will be to limit the outbreaks of diphtheria not only by providing a mass of children who will not be susceptible, but such children will act as buffers between "carriers"' and susceptible children. Unless, of course, a very large proportion of the susceptible childhood is immunised, no very great effect will be seen in the incidence of diphtheria. It is satisfactory that there have been so many parents who have been willing to avail themselves of this means of prevention. In view of the continued increase in the population of the town, I am glad to be able to report that with the purchase of the additional land for Isolation Hospital purposes there are now 27.8 acres of land available for an Isolation Hospital which will be sufficient for the town when it is completely built upon. The accommodation of the Isolation Hospital has been strained to the utmost and it has been necessary to limit the admission of cases of scarlet fever. Scarlet fever is as a rule such a mild disease compared with what it was years ago, that it is unnecessary and undesirable to admit all mild cases of scarlet fever to an Isolation Hospital. The hospital accommodation available should be used for the admission of severe cases of such diseases as measles and whooping cough, and the 14 admission of scarlet fever oases should be limited to severe cases requiring special nursing and medical attention and to those which cannot be attended to at home. The use of anti-scarlatinal serum has enabled the stay of scarlet fever patients in Hospital to be considerably reduced. In 1909 the average stay in Hospital of scarlet fever patients was 44 days, in 1929 it was 31.3 days. Most cases of scarlet fever who receive serum early in the disease can now be discharged from the Hospital at the end of 3 weeks without any complications occurring, and without any more risk of return cases but possibly less than if they were retained for longer periods in the hospital. The investigations which have been able to be made at the Isolation Hospital have considerably assisted the hospital administration of scarlet fever. No relapse from this disease has occurred since October, 1928. Previously there was a relapse rate of about 3 per cent. The amount of infection among the nursing staff has been reduced to a negligible amount, although owing to the number of diphtheria cases it has not been possible to keep all nurses from nursing such cases until they were completely immune. The School Medical Service has been extended by the provision of an Orthopaedic Scheme and by the appointment of an additional School Dentist. The Open Air School has already proved its value to the child life of the district. The Maternity Home, as I pointed out last year, requires extension particularly by the provision of a ward for difficult emergency cases. In October, the Council lost the services of Mr. King, the Senior Sanitary Inspector, after 37 years service in the district, owing to the operation of the Superannuation Act. The value of the work which Mr. King has done has been commented on by myself previously and it was with much regret that I lost his assistance in the Department. 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 1929) 116,200 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) 13.7 Rateable Value—October 1st, 1929 £869,505 0 0 Sum represented by a penny rate, October 1st, 1929, £3,530. Education Rate— 1928. 1929. Elementary 2s. 5½d. 2s. 2.78d. in the £. in the £. Higher 0s. 5¼d. 0s. 4.25d. in the £. in the £. General District Rate 6s. 4d. Combined in the £ rate Poor Rate 9s. 2d. 12s. 4d. in the £ in the £. 18 2.—Extracts from Vital Statistics of the Year. 1928. 1929. Total number of Births Registered— Legitimate 1,704 1,715 Illegitimate 35 40 1,739 1,755 Birth-rate per 1,000 of population 15.8 15.6 Total number of Stillbirths Registered— Legitimate— Males 18 31 Females 20 16 Illegitimate— Males — 1 Females 1 1 39 49 Total number of Deaths Registered— Males 462 541 Females . 462 556 924 1,097 Death-rate per 1,000 of population 8.4 9.7 Number of Women dying in, or in consequence of, Childbirth— Sepsis 2 3 Other causes 5 4 7 7 Maternal Mortality per 1,000 births 4.0 4.0 Total number of Deaths of Infants under 1 year of age— Legitimate 69 83 Illegitimate 10 4 79 87 Infant Mortality per 1,000 births— Legitimate 40 48 Illegitimate 285 100 19 Infant Mortality per 1,000 registered births 45.4 49.5 Total number of Deaths from seven principal Zymotic Diseases 32 35 Zymotic death-rate per 1,000 of population .29 .31 Total number of Deaths from— Measles (all ages) 5 2 Whooping Cough 7 9 Diarrhoea (under 2 years of age) 10 7 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 24.45 inches. The greatest fall in 24 hours was registered on 24th October, being 1.78 inches. The number of days on which rain fell was 198. 3. Population. Census, 1911 78,188 Census, 1921 85,194 (including institutions) Registrar-General's Estimate on 30th June, 1929 116,200 „ „ To obtain the net population, must be deducted the number of patients and resident staff on the 30th June at the following public institutions:— Claybury Mental Hospital 2,522 West Ham Mental Hospital 1,189 This makes a net population of 112,489. 20 4. Births.—The number of births registered during the year was 1,755. Legitimate 872 Males 843 Females Illegitimate 18 „ 22 „ i.e., 2.27 per cent. of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was:—2.01 in 1928; 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. The birth-rate, calculated on the net estimate of the population of 112,489, is 15.6 per 1,000, as compared with 15.8 in 1928; 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. 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. 5. Deaths.—The total number of deaths of Ilford residents was 1,097. The total number of deaths registered in the district during the year was 996 Number of deaths of non-residents registered in the district (principally in large institutions) 279 The latter 279 deaths occurred as follows:— In Claybury (L.C.C.) Mental Hospital 170 In West Ham Borough Mental Hospital 62 In Ilford Isolation Hospital 2 In Ilford Emergency Hospital 19 Other Non-Residents 26 279 Included in the deaths of residents belonging to the district are 12 which occurred in Dr. Barnardo's Village Homes. 21 To be added to the total number of deaths registered in the district are 380 deaths of Ilford residents registered as haying died in other districts. This figure includes deaths at the following institutions:— The Infirmary, Romford 196 Essex County Mental Hospital 13 The London Hospital 25 Queen Mary's Hospital, West Ham 13 Hospital for Sick Children, Great Ormond Street 7 St. Bartholomew's Hospital 5 In other Hospitals, Institutions and Residences outside the Ilford District 122 Total 380 The total number of deaths of Ilford residents was, therefore, 1,097. The death-rate, calculated on the net estimate of the population of 112,489, is 9.7 per 1,000, as compared with 8.4 in 1928; 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. Inquests.—During the year, 51 inquests were held in the district, 40 on Ilford residents, and 11 on non-residents. The ages at death and causes assigned were as follows:— Under 1 year. 1-2 years 2-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 years and upwards. 3 1 3 5 2 8 15 14 Causes of inquest-deaths under 1 year.—Accidental asphyxia whilst in bed with mother, 2; congenital malformation of heart and broncho pneumonia, 1. Causes of inquest-deaths over 1 year.— Accidents 26 Suicides 9 Heart Disease 5 Pneumonia 3 Bronchitis 1 Anaemia 1 Cerebral Haemorrhage 1 Post-partum Haemorrhage 1 Abdominal Aneurism 1 22 6. Poor Relief.—The total amount expended in Ilford during the year was £15,598 17s. 2d. The average weekly number of cases in receipt of relief was 295. The number of admissions to the Guardians' Institutions from Ilford during the year was 522, made up as follows:— Men 213 Women 246 Children 63 7. Marriages.—741 marriages have taken place during 1929. The following details explain the allocation:— Marriages taking place in the Ilford District 593 Marriages of Ilford Residents at Register Office, Romford— Both Parties belonging to Ilford 101 The Male only belonging to Ilford 24 The Female only belonging to Ilford 23 8. Tables of Vital Statistics.—Table I gives a comparative statement of the population, birth-rate and death-rate for the past 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 1929, arranged according to the age groups at which deaths occurred. 23 TABLE I. Vital Statistics of Whole District During 1929 and Previous Years. Year. Gross Population estimated to Middle of each Year. Net Population estimated to Middle of each Year (a). Births. Total Deaths Registered in the District. Transferable Deaths Net Deaths Belonging to the District. Uncorrected Number. Net (b). of Non-Residents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate (c). Number. Rate (d). Number. Rate per 1.000 Net Births. Number. Rate (e). 1 2 2a 3 4 5 6 7 8 9 10 11 12 13 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 1929 116,200 112,489 1,635 1,755 15.6 996 8.8 279 380 87 49.5 1,097 9.7 (а) The net estimated population is found by deducting the population of Claybury and West Ham Asylums from the gross estimated population. The population of Dr. Barnardo's Girls' Village Homes is included in the net estimated population of the district. (b) The net number of births is obtained by taking the uncorrected number of births supplied by the local Registrar and adding to 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 1929. (Provisional figures. The rates have been calculated on a population estimated to the middle of 1929. 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. Diarrhœa and Enteritis (under 2 Years). Total Deaths under One Year. Causes of Death certified by Registered Medical Practitioners. Inquest Cases. Uncertified Causes of Death. England and Wales 16.3 13.4 0.01 0.00 0.08 0.02 0.15 0.08 0.74 0.55 8.1 74 91.5 6.1 0.9 107 County Boroughs and Great Towns, including London 16.6 13.7 0.01 0.00 0.12 0.02 0.19 0.09 0.76 0.50 10.9 79 91.8 5.8 0.5 157 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 16.0 12.3 0.01 0.00 0.06 0.02 0.15 0.07 0.71 0.45 5.9 69 92.6 5.4 1.0 London 15.7 13.8 0.01 0.00 0.04 0.02 0.26 0.08 0.69 0.56 10.7 70 89.5 6.8 0.0 ILFORD (Estimated Net Population, 112,489) 15.6 9.7 0.00 0.00 0.02 0.01 0.08 0.14 0.35 0.29 3.9 49 91.3 5.6 0.0 25 TABLE III. Causes of, and Ages at, Death during the Year 1929. 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 - - - - - - - - - 3 2 Smallpox - - - - - - - - - - 3 Measles 2 — 1 1 - - - - - 4 Scarlet fever 1 — - — i — — — — 1 5 Whooping cough 9 3 1 5 - - - - - 1 6 Diphtheria 16 — - 4 12 - — — — 15 7 Influenza 39 1 1 — 1 3 4 12 17 11 8 Encephalitis lethargica 1 — - — — — 1 — — — 9 Meningococcal meningitis 2 - 2 - - - - - - 1 10 Tuberculosis of respiratory system 74 - - - 2 14 38 17 3 23 11 Other tuberculous diseases 6 1 1 1 1 - 2 - - 6 12 Cancer, malignant disease 139 - - - 1 1 6 64 67 22 13 Rheumatic fever 3 — — — 2 1 — — — 3 14 Diabetes 9 - - - - - 2 6 1 2 15 Cerebral haemorrhage, etc 36 - - - - - 4 10 22 8 16 Heart disease 229 1 — — 3 2 17 60 146 26 17 Arterio-sclerosis 29 — — — — — 1 8 20 31 18 Bronchitis 64 2 — 1 — 1 — 8 52 4 19 Pneumonia (all forms) 112 18 5 3 1 2 15 34 34 53 20 Other respiratory diseases 16 1 - - - 1 1 3 10 7 21 Ulcer of stomach or duodenum 13 - - - - - - 8 5 5 22 Diarrhoea, etc. (under 2 years) 7 6 1 - - - - - - - 23 Appendicitis & typhlitis 8 — — — 1 — 1 5 1 6 24 Cirrhosis of liver 4 - - - - - - 3 1 — 25 Acute and chronic nephritis 39 - 1 - 1 1 4 13 19 30 26 Puerperal sepsis 3 — — - — 1 2 — — 3 27 Other accidents and diseases of pregnancy and parturition 4 - - - - - 4 - - 1 28 Congenital debility and malformation, premature birth 46 45 - 1 - - - - - 7 29 Suicide 13 - - - - - 3 8 2 — 30 Other deaths from violence 33 3 1 1 5 3 3 6 11 21 31 Other defined diseases 138 6 1 4 8 6 14 30 69 52 32 Causes ill-defined or unknown 2 — — — — — — 2 — — Totals 1097 87 15 21 39 36 122 297 480 342 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). (f) Other.—There is an Emergency Hospital (now known as King George Hospital) in the district, maintained by voluntary subscriptions and by patients' fees, the number of beds being 64. During the year 1929, 1,143 in-patients were admitted, 712 operations were performed, 2,908 casualties were attended to, and 662 X-Ray examinations were made. The average cost per patient per week was £3 4s. 11d. There are two large Mental Hospitals in the district, the West Ham Mental Hospital, with 1,063 patients (males 494, females 569), and Claybury Mental Hospital, with 2,522 patients (males 994, females 1,302) in residence on 30th June, 1929. In addition, there is the Girls' Village Homes, one of the late Dr. Barnardo's Institutions, which had 1,463 children and 204 staff in residence on the 30th June, 1929. 10. District Nursing.—This is a voluntary Committee, the organisations concerned being mentioned in my Annual Report 27 for 1921. 9,563 visits were paid by the nurses in 1929, compared with 10,632 in 1928. The following is a summary of the work carried out during the year 1929:— Number of New Cases 466 Number of Visits—Medical 4,694 Surgical 4,109 Operations 55 Massage 705 Number of applications made for Nurses' services 466 Number of patients under the charge of a Doctor at 31st December 43 Number of patients not under the charge of a Doctor — Number of necessitous cases referred to Committee 3 Number of cases on the books at the end of the year 43 The cases were distributed in wards as under:— Cranbrook 75 Park 72 Seven Kings 94 North Hainault 60 Loxford 68 Clementswood 48 South Hainault 25 Goodmayes 24 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 10 certified midwives resident and practising in the district (apart from those at the Maternity Home). 11. Ambulance Facilities. (a) Infectious Cases.—An Austin 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). (4) orthopaedic treatment of school children and children under five years of age. An additional School Clinic is to be provided for the Goodmayes and Becontree area. 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 The buildings formerly used as a Maternity Home at 130-132, Cranbrook Road, have been purchased from the Ilford Council by the Essex County Council, and are to be converted into a Tuberculosis Dispensary. This will be a great improvement on the premises used at present. 13. Chemical Work.—The Essex County Council Public Health Laboratory carries out any chcmical 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:— (a) Bone boilers. (b) Fellmongers. (c) Leather dressers. (d) Soap boilers. (e) Tanners. (f) Tallow melters. (g) Fat melters or fat extractors. (h) Glue makers. (i) Tripe boilers. (j) Size makers. (k) Gut scrapers. (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. 30 There are two local Acts in operation—(1) The Ilford Improvement Act, 1898, which has important sanitary provisions, and (2) Ilford Urban District Council Act, 1904, the section of which (dealing with the control of Tuberculosis) is now over-ruled by the Milk and Dairies Act, while the section dealing with infectious disease has enactments similar to the Public Health Acts of 1907. Sections 62 and 63 only of Part IV of the Public Health Act, 1907, have been adopted. SECTION II.—SANITARY CIRCUMSTANCES OF THE AREA 1. Water Supply.—Vide Annual Report, 1925. 2. Rivers and Streams.—Vide Annual Report, 1925. 3. Drainage and Skiwekage.—No alterations or extensions have taken place at the Outfall Works during the year. The low-level and mid-level Roding Valley Sewers have been extended to the northern side of Eastern Avenue, in order to provide drainage for this area, which is now being developed, and incidentally it dispenses with a number of cesspools. Sanction has also been given by the Ministry of Health for a loan for the extension of the Seven Kings Valley Sewer, which will deal with the drainage from 1,700 acres in the north-east area of the borough. It is anticipated that this sewer will be completed during the early part of 1930. 4. Closet Accommodation.—In addition to the water carriage system of sewage, there are in the rural area, 49 cesspools, 18 privies and 60 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. Two properties were connected to the sewer during the year. 31 It is anticipated that a further 20 houses with pail closets in Redbridge Lane will be connected to the sewer in the early part of 1930. 5. Scavenging, Etc.—The collection of house refuse is undertaken by means of horse-drawn and mechanically propelled vehicles. Some of the refuse is taken to the destructor, Suffolk Road, Seven Kings. Refuse is also barged by contract, and in 1929 4,841 tons were so dealt with. 530 defective and unsuitable receptacles have been replaced during the year. The following figures give information as to the collection of house refuse during 1929:— Number of days on which collection was made 1,268 (Horse 254, electric 307, 2-ton Vulcan 282, 4-ton Vulcan 147, S.D. Freighter 278) Number of days vehicles employed 3,741 (Horse 970, electric 2,064, 2-ton Vulcan 282, 4-ton Vulcan 147, S.D. Freighter 278) Average number of vehicles employed per day 13.4 (Horse 3.7, electric 6.7, 2-ton Vulcan 1.0, 4-ton Vulcan 1.0, S.D. Freighter 1.0) Total number of loads collected 11,077 (Horse 3,033, electric 5,834, 2-ton Vulcan 872, 4-ton Vulcan 374, S.D. Freighter 964) Average number of loads collected per day 39.9 (Horse 11.9, electric 19.0, 2-ton Vulcan 3.1, 4-ton Vulcan 2.5, S.D. Freighter 3.4) Average number of loads collected per vehicle per day (Horse 3.1, electric 2.8, 2-ton Vulcan 3.1, 4-ton Vulcan 2.5, S.D. Freighter 3.4. Average of all vehicles per day, 2.9.) Total weight of refuse collected, 21,057 tons 1 cwt. 2 qrs. (Horse, 3,072 tons 10 cwts. 0 qr.) (Electric, 13,685 tons 5 cwts. 0 qr.) (2-ton Vulcan lorry, 1,506 tons 5 cwts. 3 qrs.) (4-ton Vulcan lorry, 1,098 tons 19 cwts. 1 qr.) (S.D. Freighter, 1,694 tons 1 cwt. 2 qrs.) 32 Average weight per load: — Horse-drawn vehicles 1 ton 0 cwt. 1 qr. Electric vehicles 2 tons 6 cwts. 3.6 qrs. 2-ton Vulcan lorry 1 ton 14 cwts. 2.1 qrs. 4-ton Vulcan lorry 2 tons 18 cwts. 3 qrs. S.D. Freighter 1 ton 15 cwts. 0 qr. Average 1 ton 18 cwts. 0 qr. Average cost of collection per ton:— £ s. d. Horse vehicles 0 11 6.7 Electric vehicles 0 10 8.1 2-ton Vulcan lorry 0 11 11.3 4-ton Vulcan lorry 0 11 3.7 S.D. Freighter 0 10 6.1 Average of all vehicles 0 10 10 These figures include capital and depreciation costs and all incidental charges. 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 6,898 Houses and premises re-inspected (works in progress) 6,109 Visits during disinfection 1,777 Houses in which nuisances were detected 514 Houses in which nuisances were abated 425 Premises disinfected 916 Premises from which articles only disinfected 135 Articles disinfected 4,997 Premises disinfected for verminous conditions 4 Notices served:— Statutory:— Served. Complied with. Public Health Act, 1875 32 19 Housing Act, 1925 101 52 Cleanse Dwelling House (Infectious Diseas (Prevention) Act, 1890) 11 10 Provide Dustbin (Ilford Improvement Act) 374 324 Pave Yard (Ilford Improvement Act) 1 — Provide Water Supply to Dwelling House 9 9 Cleanse Water Storage Cistern (Byelaws) 63 43 Cover Water Storage Cistern (Byelaws) 9 8 Informal 443 354 Total 1,043 819 33 In addition to the above, 158 notices (112 statutory and 46 informal) served during 1928 were also complied with. Complaints.—During the year 262 complaints of nuisances have been received and investigated:— The following is a summary:— Accumulation of manure and refuse 24 Animals improperly kept 7 Bad smells 36 Dampness of premises 9 Defective drains, w.c.'s and fittings 39 Defective or no provision of dustbin 2 Defective roofs, gutters, downpipes, etc. 24 Defective water fittings 28 Dirty and verminous houses 14 Dirty condition of rearway 2 Flooding of premises 3 Overcrowding 5 Smoke nuisances 13 Miscellaneous 56 Total 262 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 10, and the number of certificates issued was 7. 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 1929 the number of houses built by private enterprise was 1,091. In addition, 124 houses were erected by the Council, making a total of 1,215. At the end of the year 1,083 houses were in course of erection. 34 The Council have under consideration the question of an extension to the housing scheme, on a site adjacent to the existing Tomswood Hill Estate, whereby an additional 146 houses would be erected. Overcrowding.—Notices were served in respect of nine premises, of which six were complied with. 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 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 1929:— (а) Total 1,215 (b) With State assistance under Housing Acts:— (1) By local authority 124 (2) By other bodies or persons 1,091 1. Unfit Dwelling Houses:— Inspection:— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,085 (2) Number of dwelling houses which were spected , and recorded under the Housing Consolidated Regulations, 1925 206 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habita ion 479 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 390 35 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 101 (2) Number of dwelling houses which were dered fit after service of formal notices:— (а) By owners 52 (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 3 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 3 (b) By Local Authority in default of owners — (o) 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 — SECTION III.—INSPECTION AND SUPERVISION OF FOOD. 1. Milk Supply.—There are 71 dairies and milkshops and 6 cowsheds on the register. 394 inspections of dairies, milkshops and cowsheds were carried out during the year. Of the 71 premises from which milk is retailed in Ilford, 16 are branches of one firm, 2 another and 3 another, while another 36 is a branch of a large firm of retailers, 7 retail from dairy shops or stores, 8 from general shops and 5 from restaurants. Four are retailers in a small way with rounds and also provision for storage of milk, while 25 sell sterilised bottled milk only. In four premises, pasteurising plant has been installed. Only two of these have, however, been licensed. There are sis 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 1929, for the sale of:— "Certified" Milk 17 "Grade A" Milk 9 "Grade A (Tuberculin Tested)" Milk 28 "Pasteurised" Milk 21 "Grade A Pasteurised" Milk 1 The above include supplementary licences which were issued for "Certified" milk, 17; "Grade A" milk, 5; "Grade A" (Tuberculin Tested) milk, 8; and "Pasteurised" milk, 4. 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. 3. Milk Sampling.—Nine samples of "Grade A (Tuberculin Tested)," 6 samples of "Grade A," 1 sample of "Grade A Pasteurised," 14 samples of "Pasteurised" milk, and 61 samples of ordinary milk were taken. The standard for "Grade A (Tuberculin Tested)" and "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. 37 The following table shows the result of the analyses of the samples of "Grade A (Tuberculin Tested)" and "Grade A" milk:— "Grade A (Tuberculin Tested)." "Grade A." Sample No. No. of Bacteria per c.c. Sample No. No. of Bacteria per c.c. 151 14,100 144 7,733 154 9,303 156 1,810 163 67,700 165 3,836 180 3,900 178 47,500 188 2,633 205 20,800 190 5,100 209 7,936 206 51,466 — — 213 24,133 — — 219 89,000 - - The standard for "Grade A Milk Pasteurised" is that a sample shall be found to contain (a) not more than 30,000 bacteria per cubic centimetre; and (b) no coliform bacillus in one-tenth of a cubic centimetre. One sample of this grade of milk (No. 229) was taken, the number of bacteria being 295. The standard for “Pasteurised” milk is that a sample shall be found to contain not more than 100,000 bacteria per cubic centimetre. The following shows the result of the samples taken during the year:— Sample No. No. of Bacteria per c.c. Sample No. No. of Bacteria per c.c. 152 1,640 203 6,846 153 12,600 207 38,366 157 20,330 210 17,900 179 68,500 225 1,256 182 1,866 226 17,666 194 359,000 227 28.000 195 3,900 228 21,833 38 The following table shows the result of the analyses of the samples of ordinary milk:— No. No. of Bacteria per c.c No. No. of Bacteria per c.c. No. No. of Bacteria per c.c. 146 14,133 173 11,066 201 11,200 147 107,333 174 317,666 202 11,100 147a 497,333 175 57,666 204 88,466 148 365,666 176 228,666 208 645,500 149 66,466 177 24,333 211 18,400 150 65,400 181 29,666 212 7,233 155 31,700 183 585,000 214 110,000 158 73,233 184 28,333 215 29,200 159 99,000 185 39,000 216 28,466 160 272,333 186 58,333 217 28,700 161 41,066 187 17,000 218 49,000 162 261,000 189 81,000 220 41,466 164 131,000 191 31,666 221 56,400 166 30,133 192 42,000 222 48,133 167 91,700 193 79,000 223 61,233 168 59,933 196 107,000 224 112,666 169 22,466 197 68,533 230 11,233 170 56,966 198 52,700 231 761,000 171 46,233 199 39,033 172 56,633 200 171,000 In cases showing an unsatisfactory bacterial report, the retailers were warned or their attention directed to the need for cleaner conditions in the production and storage of milk, and further samples were taken after an interval, with satisfactory results. Three samples of ordinary milk were taken for the presence of Tubercle bacilli only. All gave a negative result. 4. Tubercular Milk.—A sample of milk was taken on the 6th August, 1929, from a local retailer. The sample of milk was submitted to bacteriological examination and the presence of tuberculosis was established. The tradesman obtained his supplies from a farmer at Barking. The County Medical Officer was notified under Section 4 of the Milk & Dairies (Consolidation) Act, 1915, and the Medical Officer of Health, Barking, was also informed. 39 A warning was served under Section 5 of the Milk & Dairies (Consolidation) Act, 1915, on the local retailer and also on the Barking farmer. Major J. A. Boseley, the Council's Veterinary Inspector, visited the farm at Barking on the 1st October in company with the Veterinary Inspector from the Essex County Council. 15 milking cows were examined, all being in fair condition. No cow showed any definite symptoms of tuberculosis. Two were suffering from induration of the udder. Samples of the milk from these two cows were taken and forwarded to the County Analyst for microsoopical examination. Tubercle bacilli were found in one instance, and the cow was destroyed. The other sample was submitted to biological examination, when a negative result was obtained. A third cow was traced to a farm at Romford. This cow was emaciated and had a cough. A tuberculin test was made, a re-action obtained, and the cow was slaughtered. 5. Meat.—All the local tradesmen are now complying with the Public Health (Meat) Regulations, 1924. There is only one licensed slaughterhouse in the district, at which 50 inspections were paid during the year. 6. Articles of Food Surrendered.—During the year, the following articles of food were surrendered and condemned as being unfit for the food of man.:—1 box of hake; 1 trunk of fresh haddocks; 2 boxes of kippers; 5 Dover soles; 1 pound of beef sausages. No articles of food were seized during the year. 7. Bakehouses.—There are 31 bakehouses in the district, including 17 factory bakehouses. There is one underground bakehouse. 153 inspections of bakehouses were carried out during the year. 40 It was necessary to call upon the occupiers of bakehouses to carry out cleansing and other works in 11 instances, 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 78 Samples of Butter taken 144 Other Samples 136 Total 358 Proceedings were taken in two instances. In the first case the defendant was ordered to pay £1 1s. costs in lieu of a fine for the sale of Raisin Wine containing salicylic acid. In the other case, the defendant was fined £2 and 6s. costs for milk deficient in milk fat. 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. Haigh (Senior Sanitary Inspector) being appointed as Inspector for the purposes of these Acts. Swine Fever.—During the year, Swine Fever occurred on two premises in the district. Notice under the Swine Fever Order of 1908 was served on the premises, declaring them as infected with Swine Fever. These two premises were subsequently declared free of infection, and the notices withdrawn. In the year 1928, the disease had occurred at a certain Institution, and further cases having occurred during 1929, the 41 order declaring the premises as infected with Swine Fever not having been withdrawn during 1929, the premises are still declared as infected with Swine Fever. Towards the end of the year, on account of the prevalence of the disease in the County of Essex, the Ministry of Agriculture and Fisheries extended the infected area of part of Essex so as to include the whole of the County of Essex. An order was made on the 2nd December extending to other parts of Essex, including Ilford, the Essex and Hertfordshire Swine Fever Infected Area Order of 1929, placing stringent restrictions on the movement of pigs. One movement licence for the removal of swine for slaughter was issued during the year under the Order. The full effect of the restrictions not having effect until after the end of the year, this will be dealt with in the next Report. Tuberculosis.—During the year, five cows (two in milk) at the farm attached to a public Institution were reported as suspected cases of Tuberculosis. In three cases, the cows were found to be suffering from Advanced Tuberculosis, and in the other two cases the cows had a chronic cough and showed definite clinical signs of Tuberculosis. All the cows were slaughtered. SECTION IV.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. 1. Infectious Disease Generally.—During 1929, 1,166 cases were notified, as compared with 1,095 in 1928. The following diseases are notifiable to the Medical Officer of Health:— Smallpox. Cerebro-Spinal Fever. Cholera. Plague. Diphtheria. Ophthalmia Neonatorum. Membranous Croup. Pemphigus Neonatorum. Erysipelas. Tuberculosis. Scarlatina or Acute Influenzal Pneumonia. Scarlet Fever. Acute Primary Pneumonia. 42 Typhus Fever. Dysentery (including amoebic Typhoid Fever. and bacillary dysentery). Enteric Fever. Malaria. Relapsing Fever. Acute Poliomyelitis. Continued Fever. Acute Polio-encephalitis. Puerperal Fever. Acute Encephalitis Lethargica. Puerperal Pyrexia. Anthrax. Pemphigus Neonatorum.—At a meeting of the Council held on the 28th May, 1929, it was resolved to make an order for the compulsory notification of Pemphigus Neonatorum. A copy of the resolution was forwarded to the Ministry of Health, and was duly approved. The compulsory notification of this disease came into force on the 29th June, 1929. 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, toxic jaundice, epitheliomatous or chrome ulceration, contracted in any factory or workshop. Table II shows the number of cases of infectious disease notified during 1929, arranged according to age and distributed in wards. Of these 65 occurred in institutions as follows:— Claybury Mental Hospital Pneumonia 14 cases. Enteric Fever 10 cases. Erysipelas 9 cases. 33 cases. 43 Dr. Barnardo's Girls' Village Homes:— Diphtheria 4 cases. Scarlet Fever 9 cases. Erysipelas 2 cases. Tuberculosis—Pulmonary 5 cases. „ Other forms 2 cases. 22 cases. West Ham Mental Hospital:— Scarlet fever 1 case. Dysentery 2 cases Tuberculosis—Pulmonary 1 case. 4 cases Emergency Hospital:— Cerebro-spinal fever 2 cases Puerperal fever 1 case. Erysipelas 1 case. Pneumonia 2 cases 6 cases, Of the cases notified (exclusive of those from Public Institutions) the following table shows the percentage isolated in hospitals— Scarlet Fever 63.9 Diphtheria and Membranous Croup 90.1 Enteric Fever 100.0 Puerperal Fever 100.0 Encephalitis Lethargica 100.0 44 TABLE II.—Cases of Infectious Disease Notified during the Year 1929. 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 6 - 1 2 1 2 - - 1 1 1 1 - - - 2 6 Scarlet Fever 476 1 64 333 51 23 4 - 44 44 52 68 38 42 50 138 298 Diphtheria, including Membranous Croup 305 2 46 218 17 18 4 - 12 27 18 26 26 21 20 155 282 Enteric Fever (Typhoid and Para Typhoid) 12 - - - 2 5 2 3 1 1 10 - - - - 2 Pneumonia 146 9 3? 14 10 27 33 21 10 17 5 25 7 5 12 65 19 Puerperal Fever 8 - - - 3 5 - - 2 - 1 3 - 2 - - 8 Puerperal Pyrexia 9 — — — 3 6 — — — — 3 — 3 1 1 1 3 Cerebro-Spinal Fever 3 — 2 1 — — — — — — — 2 — 1 — — 3 Acute Poliomyelitis - - - - - - - - - - - - - - - - - Acute Polio-Encephalitis - - - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - 1 Continued Fever - - - - - - - - - - - - - - - - - Dysentery 2 - - - - - 2 - - - - - - - 2 - - Ophthalmia Neonatorum 6 6 - - - - - - - - - 1 2 — 1 2 2 Erysipelas 49 - 1 1 2 22 18 5 6 1 4 16 3 6 4 9 5 Tuberculosis—Pulmonary 97 — — 4 31 48 13 1 6 11 9 11 16 8 6 30 — Other Forms 46 1 8 22 5 10 — — 4 6 3 6 7 3 4 13 - Anthrax - - - - - - - - - - - - - - - - - Malaria—Believed to be contracted in this - - - - - - - - - - - - - - - - - Believed to be contracted abroad - - - - - - - - - - - - - - - - - Totals 1166 19 154 596 125 166 76 30 86 108 97 169 102 89 100 415 629 45 The total number of deaths of Ilford residents from the chief infectious diseases during 1929 was 270, classified as follows:— Enteric Fever - Scarlet Fever 1 Diphtheria 16 Measles 2 Whooping Cough 9 Influenza 39 Tuberculosis—Pulmonary 74 ,, Other forms 6 Pneumonia 112 Diarrhoea (under 2 years) 7 Cerebro-Spinal Meningitis 1 Puerperal Fever 3 270 The following table shows a comparison of the incidence of the chief infectious diseases for the past five years:— No. of Cases. 1929. 1928. 1927. 1926. 1925. Scarlet Fever 476 502 387 171 146 Diphtheria 305 260 187 148 56 Enteric Fever 12 30 11 6 10 Pneumonia 146 92 139 73 103 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 1929 116,200 110,882 005 005 40 4.2 2.6 2.7 1928 113,500 108,285 — — 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 1.6 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 46 Year. Population. Enteric Fever Puerperal Fever. Erysipelas. a b a b a b a b 1929 116,200 110,822 0.10 0.02 0.07 0.07 0.42 0.34 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 (a) Including all Institutions. (b) Excluding all Institutions. (a) Smallpox.—Six cases of this disease were notified, of which the following is a brief summary:— (а) An unvaccinated woman, aged 27 years, in Cranbrook Ward, removed to Orsett Hospital, on 28th March. The patient had visited Swindon, where an outbreak had occurred. There were 11 contacts, and 22 other persons who had visited the house. All were kept under observation. (b) An unvaccinated girl, aged 3½ years, in Park Ward removed to Orsett Hospital, on 1st September. The patient had visited Ramsgate for a week, returning to Ilford on the 10th August. On the 19th August, the patient had visited Bow and stayed one night. There were eight contacts in this case. All were kept under observation. (c) An unvaccinated girl, aged 8 years, in North Hainault Ward removed to Orsett Hospital, on 18th September. The patient had stayed at an address in Islington for six weeks, from which a case of Smallpox was removed on 31st August. There were eight contacts in this case, and 23 other persons who had visited the house in question or had been visited by the family were kept under observation. (d and e) A girl of 15 years, in Goodmayes Ward, said to have been unsuccessfully vaccinated in infancy, removed to Orsett Hospital, on 23rd November. The patient was a scholar at a secondary school at Poplar. Her brother, resident at the same house, aged 7 years, unvaccinated, developed Smallpox and was removed to Orsett Hospital, on 6th December. There were four contacts living in the same house, nine other persons who had visited the house, and five others who had attended a lecture at which the first patient was also present, were kept under observation. (f) An unvaccinated man, aged 33 years, in Seven Kings Ward, removed to Orsett Hospital, on the 5th December. There 47 were three contacts living in the same house, and 12 other persons who had visited the house or had been visited by the patient. There was also one person living in the district who had been in contact at the patient's place of business. All were kept under observation. None of the contacts of the above cases developed Smallpox. Notifications of 380 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. The following gives particulars as to vaccinations during 1929:— Certificates of Successful Vaccination 955 Postponed 120 Conscientious Objections 760 Unsuccessful Vaccinations 7 Left the District 111 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, 1929, was £90 10s. 4d. (b) Scarlet Fever.—476 cases were notified in 1929, as compared with 502 in 1928; 387 in 1927; 171 in 1926; 146 in 1925; 157 in 1924. 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:— 48 Year. Cases notified (excluding Institutions) . Admitted to Isolation Hospital. "Return" Hospital Cases. Per Cent. Home Cases. Cases arising in same house. Per Cent. 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 1929 466 294 7 2.3 172 4 2.3 (c) Diphtheria.—305 cases were notified as compared with 260 in 1928; 187 in 1927; 148 in 1926; 56 in 1925; 82 in 1924; 131 in 1923. Of the 305 cases, 4 occurred in the Girls' Village Homes, Barkingside. (d) Enteric Fever.—Twelve cases were notified in 1929, as compared with 30 in 1928, 11 in 1927, 6 in 1926, 10 in 1925, and 5 in 1924. Ten of the cases occurred at Claybury Mental Hospital. The remaining two cases are mentioned in the Isolation Hospital Section of this Report. One was due to infection by B. Paratyphoid B, the source of infection was not discovered; the other to B. Typhosus, the infection being probably acquired abroad. (e) Cerebro-spinal Fever.—Three cases were notified, and all were fatal. One was an Ilford child of 1½ years, who died in St. Thomas's Hospital. The other cases were children of 1½ years and 5 years. Both were Dagenham residents, but in-patients of the Ilford Emergency Hospital. (f) Ophthalmia Neonatorum.—Six cases were notified during 1929, as compared with 4 in 1928; 2 in 1927; 3 in 1926; and 3 in 49 1925. Two were admitted to the Ilford Isolation Hospital. The remaining four were treated at home by private medical practitioners. Notified. Cases. Vision Unimpaired. Vision Impaired Total Blindness Deaths Treated. At Home. In Hospital. 6 4 2 6 — — — (g) Acute Influenzal and Acute Primary Pneumonia.—146 cases of Pneumonia were notified (of which 16 were in institutions), compared with 92 in 1928; 139 in 1927; 73 in 1926; and 103 in 1925. (h) Encephalitis Lethargica.—One case was notified during the year. He was a boy of 7 years, and was first admitted to the Ilford Emergency Hospital, afterwards being transferred to Oldchurch Hospital, Romford. He was still in this Institution at the end of the year. (i) Plague.—No contacts of cases of this disease were received during the year. (j) Puerperal Fever.—There were 8 cases of this disease notified during the year. Five of these were treated at the Isolation Hospital (of which 2 were fatal), 2 at the Emergency Hospital (1 of which was fatal) and 1 at the London Hospital. (k) Puerperal Pyrexia.—Nine notifications were received, 1 being subsequently notified as Puerperal Fever. 50 The remaining 8 were suffering from the following conditions:— (1) Suppurative bursitis; (2) retained placenta; (3) common cold; (4) perineal inflammation; (5) general peritonitis, rupture of uterus (fatal); (6) pelvic cellulitis; (7) sapraemia; (8) pelvic cellulitis. Five of the cases were treated at home, (5) above-mentioned being fatal; the others recovered satisfactorily. Three were treated in Hospital, viz., (1), (7), and (8). All of these recovered. 2. Zymotic Diseases.—The deaths registered were as follows :— Small-pox — Measles 2 Scarlet Fever 1 Whooping Cough 9 Diphtheria and Croup 16 Enteric Fever — Diarrhœa 7 This gives a zymotic death-rate for 1929 of .31 per 1,000 of the net population. The zymotic death-rate for the previous five years was .29 in 1928, .29 in 1927, .36 in 1926, .25 in 1925, and .24 in 1924. 51 Table showing Incidence of, and Deaths from, Infectious Disease, 1929, 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. j 10—15. 15—20. 20—35. 35—45. 45—65. Over 65 Smallpox 6 - - - 1 - 2 - 1 2 - - - 6 - - - - - - - - - - - - - Scarlet Fever 476 1 6 10 15 33 248 85 37 14 18 5 4 298 1 - - - - - - - - - - - - Diphtheria 305 2 4 6 17 19 177 41 13 4 12 6 4 282 16 - - - 1 2 12 1 - - - - - Enteric Fever (including Paratyphoid) 12 - - - - - - - 1 3 3 2 3 2 - - - - - - - - - - - - - Pneumonia 146 9 9 4 10 9 11 3 7 11 19 33 21 19 112 18 5 - 3 — 1 - I 3 13 34 34 Puerperal Fever 8 - — — — — — - — 7 1 — — 8 3 - - - - - - - - 2 1 — — Puerperal Pyrexia 9 - - - - - - - - - - - - - - - - - - - - - - - - - - Cerebro-spinal Fever 3 - 2 — — — 1 - — — — — — 3 1 — 1 - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - - Encephalitis Lethargica 1 - - - - - 1 - - - - - - 1 1 - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 2 - - - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 6 6 - - - - - - - - - - - - - - - - - - - - - - - - - Erysipelas 49 — — 1 — — — 1 1 5 18 18 5 5 1 - - - - - - - - 1 - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria—believed to be contracted in this country - - - - - - - - - - - - - - - - - - - - - - - - - - „ —believed to be contracted abroad - - - - - - - - - - - - - - - - - - - - - - - - - - - 52 3. Tuberculosis.—During the year 1929, there were 97 new notifications of Pulmonary Tuberculosis and 46 of other forms of Tuberculosis. Twenty-six cases of Pulmonary and eleven cases of Non-Pulmonary Tuberculosis were transferred to Ilford. The following table shows the cases notified in 1929, and the deaths which occurred in 1929, classified according to age and sex:— Age Periods. New Oases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 year 1 - - - 1 - 1-5 years — 6 2 — — 1 1 5-10 years.. — 7 7 — — — — 10-15 years — 4 4 4 — 2 — 1 15-20 years 5 6 2 — 1 5 — — 20-25 years 10 11 3 — 5 3 — — 25-35 years 14 14 1 5 11 7 1 1 35-45 years 13 6 3 1 11 9 — — 45-55 years 7 2 — 8 6 — — 55-65 years 4 — — 2 1 — — Over 65 years 1 — — 2 1 — — Totals 54 43 27 19 40 34 3 3 Of the above new cases, the following were notified from Institutions in the district. West Ham Mental Hospital, Pulmonary Tuberculosis 1 The Girls' Village Homes, Barkingside— Pulmonary Tuberculosis 5 Other forms 2 Two of the above deaths, or 2.5 per cent. of the total deaths, had not been notified. Of the 80 deaths which occurred of Ilford residents, notification had previously been made of 72 of the cases. Six were notified at or after death. Two were not notified, 1 due to an 53 oversight and the other by reason of the medical attendant believing the case to have been already notified. During the year 1929, the following deaths occurred from Tuberculosis:— Pulmonary Tuberculosis for the district proper (including 2 at Girls' Village Homes) 74 Claybury Mental Hospital 14 West Ham Mental Hospital 9 Tuberculosis (all other forms) for the district proper 6 Claybury Mental Hospital 3 Ilford Isolation Hospital (not Ilford resident) 1 Emergency Hospital (not Ilford residents) 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:— 1920 1921 1922 1923 1924 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 42 .50 53 .64 46 .55 55 .64 54 .61 Tubercular Meningitis 5 .06 2 .02 — — — — — - Tuberculosis (all other forms) 11 .13 9 .11 10 .12* 12 .14* 11 .12* 1925 1926 1927 1928 1929 No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Pulmonary Tuberculosis 81 .84 66 .65 58 .53 59 .52 74 .65 Tubercular Meningitis - - - - - - - - - - Tuberculosis (all other forms) 16 .17* 10 .09* 13 .12* 13 11* 6 .05* *Including Tubercular Meningitis for the years 1922-1929. 54 On the 1st January, 1929, there were 594 cases on the register of the department. On the 31st December, 1929, with 135 new cases notified and 36 transfers (Institution cases omitted), and allowing for deaths, removals from the district, and cases removed from the register as cured, there were 628 cases on the register. The new cases of Tuberculosis are visited by the Tuberculosis Nurse of the Essex County Council. 578 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 90 52 Improved or fairly well 195 65 Not so well 63 7 In Sanatorium 49 11 No information as to present condition 6 4 Removed from district, etc. 28 8 Totals 431 147 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, 1929, there were 679 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. 80 patients were treated, 16 being supplied with dentures. Tuberculosis Care Association.—This Association has continued to do good work during the year. 86 cases have been assisted with extra nourishment, clothing and in other ways. Nine children were sent to various convalescent homes, for periods of two and 55 three months. Four of these cases received, from the Association, necessary clothing before admission, and return railway fares were paid in 2 other cases. 4. Venereal Diseases.—In the following table are classified tne 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 j 65-75 75-85 J 85 up NonResidents in Institutions Totals Syphilis 1 — — - - 1 1 — — — — 1 4 Locomotor Ataxy - - - - - - - 1 - - - - I General Paralysis of Insane — — — — 1 1 3 1 — — 29 35 Aortic Aneurysm — — — — — 1 — 1 4 — — 2 8 The deaths of non-residents in Institutions occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital; 14 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; 1928, 4 cases. 56 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. 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 1,560 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. 57 Bacteriological Laboratory, 1929. 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 182 752 4 19 17 54 37 86 240 911 Nose, Ear, Eye, etc. „ 16 35 5 8 15 27 14 20 50 90 Throat Contacts „ 13 170 1 9 — 12 — — 14 191 Nose „ „ 5 14 — 4 2 1 — — 7 19 Hairs Ringworm — — — — 13 6 — — 13 6 Urine Various Abnormalities — — — 2 1 8 8 — 9 10 Totals 333 1227 Grand Total 1560 Direct Smears from swabs were examined in 8 cases. 15 Diphtheritic Specimens were sent to laboratories in London for a test for virulence—17 were virulent, 16 avirulent, Other examinations for various purposes, 2, 58 SECTION VI—FACTORIES AND WORKSHOPS. Factories. There are 157 factories on the register, made up as follows:— Bakehouses 17 Boot Makers and Repairers 27 Builders, Joinery and Carpentry Works 4 Cabinet Maker 1 Cable Works 1 Carbon Works 1 Cardboard Box Maker 1 Carriage Works 2 Chemical Works 2 Collar Works 1 Confectionery Maker 1 Corset Maker 1 Cutlery and Tool Grinders 2 Cycle Repairers 2 Electricity Supply Works 1 Engineers 10 Fur Dyer 1 Gas Mantle Manufacturer 1 Gear Cutting 1 Gilding Works 1 Hardware Manufacturer 1 Iron Cutting Works 1 Joinery Works 1 Laundries 5 Leather Worker 1 Mattress Maker 1 Meat Cutting 9 Metalworker 1 Mineral Water Manufacturer 1 Motor Engineers 11 Nautical Instrument Maker 1 Optician 1 Paint Manufacturer 1 Paper Mills 1 Photographic Works 1 Picture Moulders 1 Plating and Enamelling 1 Polish Manufacturer 1 Poultry Appliance Maker 1 Printer's Engineer 1 Printing Works 10 Saw Mills 5 Seed Sorting 1 Shirt Makers 3 Sign Maker 1 Stone Mason 1 Tarpaulin Repairer 1 Tool Engineer 1 Toy Maker 1 Umbrella Repairers 2 Vulcanising Works 1 Watchmaker and Repairer 1 Wearing Apparel Makers 3 Wire and Cable Manufacturer 1 Wireless Apparatus Makers 3 Wood Cutter 2 Total 157 Workshops. There are 501 workshops on the register, made up as follows:— Artificial Flower Maker 1 Bakehouses 14 Basket Maker 1 Beet Boiler 1 Bookbinder 1 Boot Repairers 34 Boot Makers and Shoe Sewers 8 Brush Workers 7 Builders and Carpenters 37 Cabinet Makers 2 Carpet Planning 1 Clergy Robes Maker 1 Coach Builders 3 Confectioner 1 Dressmakers 38 Dyers and Cleaners 10 Electrical and Mechanical Engineers 5 Electric Battery Charging 3 Embroidery and Lace Workers 14 Feather Cleaner 1 Floor Polisher Maker 1 Florists 4 French Polishers 4 Furniture Repairers 5 Furriers 7 Glass Cutters and Glaziers 3 Glove Maker 1 Grate and Furnace Makers 1 Hand Laundry 1 Hairdresser 1 Harness Makers 1 59 Workshops—continued. Hat Makers 3 Ice Cream Factor 1 Incubator Maker 1 Leather Workers 6 Life Belt Maker 1 Mattress Maker 1 Meat Cutting 1 Mechanical Dentist 1 Mica Maker 1 Milliners 29 Mineral Water Manufacturer 1 Metal Moulder 1 Motor Cab Proprietors 4 Motor and Cycle Engineers and Repairers 28 Optician 1 Packing Case Repairer 1 Photographers 3 Piano Repairer 1 Picture Framers 3 Plumbers 7 Printers and Stationers 5 Rag and Bone Merchants 3 Scale Maker 1 Shirt Makers 4 Sports Outfit Repairers 3 Squeegee Maker 1 Tailors 38 Tie Makers 7 Tile Fender Makers 2 Timber Merchants 5 Tinsmiths 3 Toy Maker and Repairer 1 Typewriter Repairer 1 Umbrella Repairers 4 Undertakers 5 Upholsterers 11 Watch and Jewellery Repairers 15 Wearing Apparel and Under- clothiers 65 Wheelwrights and Farriers 11 Wire Worker 1 Wireless Apparatus Maker 1 Wood Cutters 7 Total 501 60 FACTORIES. WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections Made by Sanitary Inspectors. Premises. Number of Inspections Written Notices. Prosecutions (1) (2) (3) (4) Factories (including Factory Laundries) 141 2 - Workshops (including Workshop Laundries) 506 4 — Workplaces (other than Outworkers' premises included in Part 3 of this report) — — — Total 647 6 — 61 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 5 5 — - Want of ventilation 1 1 — - Overcrowding — — — - Want of drainage of floors — — — - Other nuisances — - Sanitary accommoda tion insufficient 1 1 - - unsuitable or defective - - 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 7 7 — — *Including those specified in sections 2,3,7 and 8 of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Sending twice in the year. Sending once in the year. Lists. Outworkers. Lists. Outworkers. Contractors Work- men. Contractors Workmen (1) (2) (3) (4) (5) (6) (7) Wearing Apparel:— Making, etc. 14 20 24 I 4 Cleaning and Washing - - - - - — Household Linen 2 - 2 - - — Lace, Lace Curtains and Nets - - - - - - Total 16 20 26 1 - 4 Note.—No home-workers were known to be engaged in the following occupations:—Curtains and Furniture Hangings; Furniture and Upholstery; Electro plate; File Making; Brass and Brass Articles; Fur Pulling; Cables and Chains; Anchors and Grapnels; Cart Gear; Locks; Latches and Keys; Umbrellas, etc.; Artificial Flowers; Nets, other than Wire Nets; Tents; Sacks; Racquet and Tennis Balls; Paper, etc.; Boxes; Paper Bags; Brush Making; Pea Picking; Feather Sorting; Carding, etc., of Buttons, etc.; Stuffed Toys; Basket Making; Chocolates and Sweetmeats; Cosaques, Christmas Crackers, Christmas Stockings, etc.; Textile Weaving. No notices were served under Section 108 of the Factory and Workshops Act, for outwork being carried out in unwholesome premises. 4.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H. M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 5 Action taken in matters referred by H.M. Inspector as remediable Notified by H.M. Inspector 4 under the Public Health Acts, but not under the Factory and Workshop Act (s. 5, 1901) Reports (of action taken) sent to H.M. Inspector 4 Other — Underground Bakehouses (s. 101):— In use at the end of the year 1 ISOLATION HOSPITAL. 67 ISOLATION HOSPITAL. 664 patients were admitted during 1929, as compared with 577 in 1928, 519 in 1927, and 331 in 1926. 90.0 per cent, of the cases of diphtheria occurring in the district and 63.0 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. 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 1929 90.0 63.0 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 87 more cases were admitted than in any preceding year. This was chiefly due to a rise in the incidence of diphtheria in the autumn, when it was necessary to close one ward for scarlet fever cases to allow the admission of diphtheria cases. 68 The following table shows the total admissions for the past ten years:— Year. Scarlet Fever. Diphtheria. Tuberculosis. Other Diseases. Total. 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 1929 339 290 13 22 664 The *664 patients admitted during 1929 had the following diseases:— Scarlet Fever 339 Diphtheria 290 Enteric Fever 2 Puerperal Fever 5 Puerperal Pyrexia 1 Pemphigus Neonatorum 2 Erysipelas 2 Ophthalmia Neonatorum 2 Scarlet Fever and Diphtheria 1 Under observation 7 Tuberculous Diseases 13 *By arrangement with the Romford Joint Hospital Board, 45 cases of Scarlet Fever and 9 cases of Diphtheria were admitted to the Ilford Isolation Hospital during May, June, July, August, September and October. Number of deaths in Hospital, 19. Diphtheria 15 Scarlet Fever 1 Puerperal Fever 2 Tuberculous Diseases 1 69 Number of patients in Hospital on 1st January, 1929 and 1930 respectively:— 1st Jan., 1929. 1st Jan., 1930. Scarlet Fever 42 22 Diphtheria 30 85 Tuberculous Diseases 12 12 Enteric Fever 1 — The average length of stay in Hospital was for Scarlet Fever 31.3 days. Diphtheria 38.0 ,, Tuberculous Diseases 100.1 ,, Average stay in Hospital of all cases 34.2 ,, The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day, 73.9. Scarlet Fever.—The 339 cases admitted to Hospital during 1929 were distributed among the following age groups:— Under l yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. 1 49 230 39 10 7 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:— 1925. 1926. 1927. 1928. 192.9 Ilford Nil. Nil. .6 .5 .3 M.A.B. 1.1 .8 .6 .63 Not available. The following complications occurred in the patients discharged during the year:— Percentage. Rhinitis 6.9 Adenitis 10.3 Relapse .3 Nephritis 1.4 Albuminuria .6 Suppurative Cervical Adenitis .3 Tonsillitis 1.9 Quinsy .8 Rheumatism .8 70  ntage. Otorrhoea 7.2 Onychia 2.2 Mastoiditis 1.7 Broncho-Pneumonia 8 Bronchitis .6 Vulvo-Vaginitis .3 Endocarditis .6 Myocarditis .. .6 Dacryocystitis .3 Jaundice .3 Pyaemic Abscess .3 One death occurred in a child of 5 years from BronchoPneumonia. She had previously been operated on for Mastoiditis. Enteric Fever.—Two cases were admitted. One gave a positive Widal test for B. Typhosus and the other for B. Paratyphosus B. Both were mild cases, and made satisfactory recoveries without any complications. Puerperal Fever.—Five cases notified as Puerperal Fever were admitted. Two of these died—one of Septicaemia with a Septic Broncho-Pneumonia, one of General Peritonitis, in spite of laparotomy being performed by Dr. Everard Williams. Both were haemolytic streptococcal infections. Of the remaining three, one developed General Peritonitis and recovered after laparotomy had been performed by Dr. Everard Williams. Of the remaining two cases, one had pyelonephritis (of B. Coli infection), the other had Septicaemic symptoms but a sterile blood culture, but both showed haemolytic streptococci on cultures of cervical swabs. One case of Puerperal Pyrexia was admitted. She was suffering from a suppurative bursitis of the right prepatellar bursa. She made a good recovery. Diphtheria.—The 290 cases admitted to hospital were distributed among the following age groups:— Under 1 Year. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. 2 48 205 16 11 5 3 71 Fifteen deaths, due to Diphtheria, occurred in the Hospital. The ages of the patients were 12 years, 9 years, 8 years, 7 years (four), 6 years (two), 5 years (two), 4 years, 3 years (three). Four of these died within 48 hours or less of admission. Nineteen cases developed various Paralyses, as follows:— 12 palatal, 1 palatal and accommodation, 1 palatal and strabismus, 1 palatal, accommodation, facial and palmar, 1 palatal and pharyngeal, 1 (fatal) palatal, pharyngeal, ptosis, facial, paresis of legs, diaphragm, 1 (fatal) palatal, pharyngeal, and cardiac, 1 palatal, ptosis, accommodation, paresis of upper and lower limbs. Six cases developed Otorrhoea. The following table shows the percentage death-rate of cases of diphtheria admitted to the Ilford Isolation Hospital during the past five rears, compared with that in the M. A. B. Institutions in London:— 1925. 1926. 1927. 1928. 1929. Ilford Nil. 6.6 4.8 3.4 5.2 M.A.B. 5.0 4.9 4.0 3.66 Not available. Observation Cases.—Seven were admitted. Four proved to be non-virulent K.L.B. carriers. One was clinically Diphtheria; one was a doubtful Diphtheria nasal carrier, who gave negative swab results after admission; the remaining patient was under observation as a doubtful case of Scarlet Fever. Tuberculosis.—Thirteen cases of Surgical Tuberculosis were admitted, as compared with 13 in 1928. At the end of the year, the following patients were in the Sanatorium:— Nature of Case. Period in Hospital. Spine and Hip 40 months. Spine 29 ,, Hip 27 ,, Hip 24 ,, Bones and Psoas Abscess 21 ,, 72 Nature of Case. Period in Hospital. Spine and Psoas Abscess 20 months Spine 8 ,, Spine 8 „ Hip 3 „ Spine 6 weeks. Hip 4 „ Spine 4 ,, One death, from Pulmonary Oedema occurred of a patient with Tuberculosis Adenitis and Iritis with Sympathetic Ophthalmia who had required excision of one eye. The organs involved in the 13 cases admitted were as follows:— Genito-urinary, 1; knee joints, 3; spine 4; hip, 4; ulcer over ankle, 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 1929, four nurses passed Part I of the examination of the General Nursing Council, and 10 obtained the Certificate by completing Part II. HOSPITAL EXTENSIONS. On the 7th February, 1929, a public enquiry was held by the Minister of Health regarding the Council's application for sanction to borrow £5,750 for the purchase of 16.7 acres of additional land, as shown in the layout plan, for Hospital Extension purposes. The application was approved. The evidence given was that the area of the Borough (without watercourses) is 8,470 acres, of which approximately one-half has been developed, chiefly by the erection of private dwelling-houses. A portion of the Becontree Housing Estate of the London County Council is situate in the Borough. The Registrar-General's estimate of the population to the middle of 1927 was 108,310. The estimated population at the time was 130,000. The site of the present Hospital, comprising an area of approximately 11 acres, is situate at Grove Road, Chadwell. The original building was opened in 1898, when the population of the district was only approximately 20,000, with accommodation for 20 patients. From time to time, extensions to the Hospital have been made, and as recently as last year it was found 73 essential to provide one complete new block comprising eight cubicles and offices and to alter and enlarge Block No. 3 by converting the same into eight cubicles together with the requisite offices. The present accommodation at the Hospital comprises 123 beds, distributed as follows:— Ward Block No. 1 26 beds for Diphtheria. „ „ 2 6 beds for Diphtheria (or 7 for losis patients when the work of the Hospital permits). „ „ 3 8cubicle beds ,, ,, 4 10 beds for overflow cases. ,, Nos. 5 and 5a 52 beds for Scarlet Fever. „ „ 6 12 beds for Tuberculosis patients (treated under agreement with the Essex County Council). ,, ,, 7 8 cubicle beds. There are thus 110 beds for infectious cases, or 18 beds less per 1,000 than is required. There is no accommodation available at the Hospital in ordinary times for nursing such cases as Measles, Pneumonia, Whooping-cough, etc. The Hospital is proving inadequate to the demands made upon it. For the past two years, only cases of Scarlet Fever which could not adequately be treated at home have been admitted. The percentage of Scarlet Fever cases removed to Hospital has dropped from 86.6 per cent., in 1926, to 66.8 per cent, in 1928. The Nurses' Home is full. Six of the Nurses have to be accommodated in a temporary hut in the grounds'. Neighbouring Authorities are in similar difficulties, and have approached this Authority to admit cases for them. There is a considerable demand in Ilford for Isolation Hospital facilities. The proposed enlargement and reconstruction of the Hospital in accordance with the layout plan prepared by the Borough Engineer and Surveyor makes provision ultimately for an additional 320 beds, with extension of Nurses' Home, etc. If the area of Ilford be reduced by 1,116 acres, the total area of open spaces and land scheduled for development for industrial purposes, and a figure of 7,354 acres is taken to be built on with an average number of houses of 14 per acre, by estimating only 4 persons per house, the ultimate population of the Borough will be 411,824; while if 6 persons per house be estimated on, the ultimate population will be 617,736. West Ham, with an acreage of only 4,706 acres, has a population of 315,900. If the present rate of increase of population in Ilford is maintained, the population of the Borough in 18 years time will be approximately 400,000. With the additional land there will be 27.8 acres available for Isolation Hospital purposes to meet the ultimate requirements of the Borough. 74 The Council, in December, approved a recommendation for extensions to the Isolation Hospital, the cost being as follows:— £ Extensions to Nurses' Home 13,361 Provision of two Cruciform Cubicle Blocks, 20 beds each 17,196 Medical Officer's Residence 1,704 New Laundry Block 6,700 Clerk of Works 380 Legal and Loan Charges 420 £39,761 The plans and estimates have been transmitted to the Ministry of Health for their approval. 75 • Borough of Ilford • Lay out plan showing proposed Extension to the Isolation Hospital, Grove Road MATERNITY & CHILD WELFARE. 79 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 1929 was 1,648 (827 males and 821 females). In addition, 49 stillbirths (31 males and 18 females) were notified. The percentage of births notified by the various responsible persons was as follows:— By Medical Practitioners 22.76 By Certified Midwives 50.91 By Parents and others 26.33 The causes of the 49 stillbirths were as follows:— Fall in pregnancy of mother 3 Kidney trouble in mother 1 Fright during pregnancy, malformed infant, spina bifida 1 Difficult labour, breech 4 „ large child 1 „ extended arms and legs; also big baby 1 Difficulty in delivery (after coming head) 1 Macerated foetus 8 Shock 1 Twin, breech 1 Hydramnios 1 Twin 1 Placenta praevia 1 Small measurements 1 Born with pemphigus 1 Cord around arms 2 Prolapse of cord and early rupture of membranes 1 Unreduced occipito posterior 1 Prolonged and difficult labour 1 Hydrocephalus 1 Foetal asphyxia 1 Anencephalus 1 Prolapse of cord 1 Ante-partum haemorrhage and abnormal presentation 1 Malformed infant, spina bifida 1 Malformed infant (distended urinary bladder) 1 Unknown (breech) 1 Unknown cause 9 80 In addition, I have received notice of 2 stillbirths which took place outside the district, although the parents reside in Ilford. The causes of the stillbirths were as follows:— 1 at Maternity Hospital, Plaistow—difficult labour. 1 at Forest Gate Sick Home, Plaistow—hydramnios. The Public Health Committee has had under consideration the non-compliance with the Notification of Births Acts. It was decided that before taking legal proceedings (a) notice be given by advertisement in the local Press directing attention to the provisions of the Acts, a copy of such circular be also sent to the local Ministers of Religion, and (b) notice be given by circular to all medical practitioners and midwives practising in the area of the district, directing their attention to the obligations imposed upon them. This has now been done. 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 1,755 (890 males and 865 females) births were registered, giving a birth-rate of 15.6 per 1,000 persons calculated on the net population, as compared with 1,739 births and a birth-rate of 15.8 per 1,000 persons in 1928. 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 1929 49 stillbirths (32 males and 17 females) were registered. Of these 1 male and 1 female were illegitimate. Infant Mortality. The number of infants dying within the first year of life was 87, the total number born being 1,755. The infant mortality or rate of death per 1,000 births was, therefore, 49.6. 81 The infant mortality rate for the district is higher than it should be, from the fact that 1 death of a baby in the Girls' Village Homes, Barkingside, is included, although the child concerned was not born in Ilford. If the death of this baby in the Girls' Village Homes is excluded there remains an infant mortality rate for the district of 49.0 per 1,000 births. The comparative figures for the past 10 years were as follows:— Year. No. of Deaths. under 1 year. Rate per 1,000 Registered Births. 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 44.0 1928 79 45.4 1929 87 49.6 The rise in the infant mortality rate is chiefly due to the increase in the number of deaths from pneumonia, there being 22 from this cause in 1929 as compared with 11 for 1928. 8 of the 22 deaths occurred in February when there was an outbreak of influenza. The infant mortality rate for 1929 for Ilford compares favourably with that of 74 for England and Wales, 70 for London, and 79 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 63 West Ham 77 Willesden 58 East Ham 57 Tottenham 62 Wimbledon 50 Enfield 54 Walthamstow 53 Leyton 58 Ealing 46 Acton 81 Hornsey 53 50 The following table shows the infant mortality in each Ward of the district:— 82 Ward. Sex. No. of Births. No. of Infant Deaths. Infant Mortality per 1,000 Births. Infant Mortality per 1,000 Births both sexes together. North Hainault 1929. 1928. 1927. M. 167 13 77.8 47.0 48.3 49.8 F. 152 2 13.2 Cranbrook M. 47 4 85.1 50.5 67.8 38.0 F. 44 1 22.7 Park M. 91 7 76.9 58.8 20.5 16.8 F. 96 4 41.7 Seven Kings M. 100 9 90.0 63.1 29.1 46.6 F. 90 3 33.3 South Hainault M. 74 2 27.0 42.4 35.4 56.0 F. 91 5 54.9 Loxford M. 84 5 59.5 69.2 54.5 45.2 F. 75 6 80.0 Clementswood M. 103 5 48.5 41.0 29.7 49.2 F. 92 3 32.6 Goodmayes M. 142 12 84.5 60.7 77.1 42.8 F. 138 5 36.2 If the death of 1 female infant occurring in the Village Homes, Barkingside is added to the infant deaths occurring in the North Hainault Ward, there is an infant mortality rate of 50.2 (77.8 M. and 19.7 F.) per 1,000 births for that ward. The above table only accounts for 1,586 of the total births registered and belonging to the district. The remaining 169 are included by the Registrar-General as belonging to Ilford, but have not been allocated by him to the various wards. 49 births were registered in this district belonging to other areas. These have not been included in the foregoing figures. 12 births (7 males and 5 females) 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 Park, Seven Kings, South Hainault, Loxford and Clementswood Wards. A statement as to the ages at, and causes of, infant deaths in the various Wards is given below:— In the North Hainault Ward there were 15 infant deaths, exclusive of those dying at the Girls' Village Homes, Barkingside. 7 died under 1 week. 1 died at 12 days from inanition and congenital debility. 83 1 died at 2 months from acute gastro-enteritis. *1 died at 3 months from accidental asphyxia whilst in bed with mother. *1 died at 3 months from broncho-pneumonia and marasmus. *1 died at 4 months from broncho-pneumonia. 1 died at 4 months from acute gastro-enteritis. *1 died at 9 months from septic meningitis, septic gums and primary dentition. *1 died at 10 months from acute broncho-pneumonia, heart failure and influenza. *These children have attended an infant welfare centre. In the Cranbrook Ward there were 5 infant deaths. 3 died under 1 week. 1 died at 2 weeks from septicaemia and pemphigus neonatorum. 1 died at 6 months from convulsions, infantile diarrhoea, pertussis and chicken pox. None of the above children have attended an infant welfare centre. In the Park Ward there were 11 infant deaths. 4 died under 1 week. 1 died at 1 week from prematurity. 1 died at 4 weeks from spina bifida and convulsions. 1 died at 1 month from bronchitis and broncho-pneumonia. 1 died at 2 months from hypertrophic pyloric stenosis. 1 died at 6 months from broncho-pneumonia. 1 died at 8 months from acute-enteritis and erythroedema polyneuritica. *1 died at 9 months from broncho-pneumonia, whooping cough and congenital heart disease. *This child had attended an infant welfare centre. In the Seven Kings Ward there were 12 infant deaths. 4 died under 1 week. 1 died at 2 weeks from diarrhoea due to aphthous infection of mouth. 1 died at 3 weeks from acute bronchitis. *1 died at 2 months from broncho-pneumonia. 1 died at 2 months from ruptured ileum and congestion of brain. 1 died at 2 months from congenital hypertrophy of the pylorus. 1 died at 2 months from myocardiac failure, persistent foramen ovale and lobar pneumonia. *1 died at 7 months from broncho-pneumonia and bronchitis. *1 died at 9 months from gastro-enteritis. *These children have attended an infant welfare centre. In the South Hainault Ward there were 7 infant deaths. 5 died under 1 week. 1 died at 2 weeks from congenital hemiplegia and bifid spine. 1 died at 3 months from cardiac syncope and bronchopneumonia. None of these children have attended an infant welfare centre. 84 In the Loxford Ward there were 11 infant deaths. 3 died under 1 week. 1 died at 1 week from prematurity and congenital syphilis. 1 died at 1 week from prematurity. 1 died at 2 weeks from cardiac failure, diarrhoea and vomiting. 1 died at 1 month from broncho-pneumonia, prematurity and marasmus. *1 died at 4 months from heart failure and pneumonia. 1 died at 8 months from broncho-pneumonia and bronchitis. *1 died at 8 months from broncho-pneumonia and prematurity. *1 died at 11 months from convulsions and cerebral haemorrhage (from birth). *These children have attended an infant welfare centre. In the Clementswood Ward there were 8 infant deaths. 3 died under 1 week. 1 died at 1 week from acute peritonitis (streptococcal). 1 died at 1 week from broncho-pneumonia. 1 died at 13 days from haemorrhagic pneumonia, embolism of popliteal artery and gangrene of foot. 1 died at 3 weeks from intra ventricular haemorrhage, hydrocephalus and convulsions. 1 died at 8 months from broncho-pneumonia. None of these children have attended an infant welfare centre. In the Goodmayes Ward there were 17 infant deaths. 4 died under 1 week. 1 died at 2 weeks from broncho-pneumonia, acute peripheral bronchitis. 1 died at 3 weeks from icterus neonatorum and prematurity. 1 died at 6 weeks from shock and toxaemia from scalds. 1 died at 1 month from congenital malformation of heart and broncho-pneumonia. *1 died at 2 months from acute primary broncho-pneumonia. *1 died at 3 months from broncho-pneumonia and gastroenteritis. 1 died at 5 months from acute primary broncho-pneumonia. 1 died at 5 months from congenital heart disease. *1 died at 6 months from marasmus and prematurity. 1 died at 10 months from bronchitis and whooping cough. *1 died at 10 months from tuberculous meningitis. *1 died at 10 months from acute peripheral bronchitis. 1 died at 11 months from influenza and bronchitis. *hese children have attended an infant welfare centre. It will be seen that of the 87 infants who died under one year of age only 17 had attended Ilford infant welfare centres, and in some cases, only one attendance was made. Forty-eight, however, of the deaths occurred in the first month of life, and these infants would naturally not have been brought to a centre. 85 The mortality of infants under one year attending Ilford infant welfare centres was 26.l per 1,000, as compared with 62.6 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 39 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 17 had attended an infant welfare centre, or, in other words, that 56 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 48 deaths of infante under 4 weeks of age during 1929, and the rate for the year was 27.4 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. 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 1928 23.6 31 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. 86 Table IV.—Infant Mortality. 1929. 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 .. .. .. .. .. .. .. 1 2 3 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. 1 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. 1 1 Convulsions 2 .. .. .. 2 .. .. .. .. 2 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. 1 1 .. .. .. 1 2 Pneumonia (all forms) .. 2 l .. 3 5 6 6 2 22 Diarrhoea .. .. l .. 1 .. .. .. .. 1 Enteritis 1 .. l .. 2 1 1 1 1 6 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation (overlying) 1 .. .. .. 1 .. 1 .. .. 2 Injury at birth .. .. .. .. .. .. .. .. 1 1 Atelectasis 4 .. .. .. 4 .. .. .. .. 4 Congenital Malformations 3 .. l l 5 4 .. .. .. 9 Premature birth Atrophy, Debility and 20 3 .. l 24 1 .. .. .. 25 Marasmus .. 1 .. .. 1 .. .. 1 .. 2 Other Causes 2 1 l .. 4 2 .. .. .. 6 Totals 33 7 5 3 48 13 8 9 9 87 87 Illegitimate Births and Deaths. 40 of the births registered (18 males and 22 females) were illegitimate, that is 2.3 per cent. of the births registered. 4 illegitimate children died under one year of age. The deaths of the 4 illegitimate children occurred as follows:— 1 died at 1 month at the Salvation Army Home, Clapham, from troncho-pneumonia, prematurity and marasmus; 1 died at 4 months at Queen Mary's Hospital, West Ham, from heart failure and pneumonia; 1 died at 6 months at the Girls' Village Homes, Barkingside, from broncho-pneumonia and bronchitis; and 1 died at 7 months, from broncho-pneumonia and bronchitis, at home. The infant mortality rate of illegitimate children was, therefore 75 per 1,000, compared with the infant mortality rate (exclusive of those children dying in the Girls' Village Homes) of 48 for legitimate children. If the deaths of infants in the Girls' Village Homes are included, there is an illegitimate infant mortality rate of 100 per 1,000, and 48 per 1,000 for legitimate children The following table shows the death-rate of illegitimate and legitimate infants for the past ten years:— Year. Illegitimate Infants. Legitimate Infants. Births. Deaths. Rate per 1,000 Illegitimate Births. Births. Deaths. Rate per 1,000 Legitimate Births. 1929 40 4 100 1,715 83 48 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 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. 88 The causes of the deaths were as follows:— General peritonitis and puerperal fever 1 Albuminuria and eclampsia 1 Pneumonia and puerperal septicaemia 1 Puerperal septicaemia and miscarriage 1 Post-partum haemorrhage 1 Hyperemesis gravidarum 1 Peritonitis and rupture of uterus during labour 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 Mortality Rate per 1,000 Births, Ilford. Maternal* Mortality Rate per 1,000 Births, England and Wales. From Puerperal Fever. From Other Causes. 1928 2 5 1,739 4.0 4.42 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 *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 died during the year, 1 died at home from broncho-pneumonia and whooping cough. This child did not attend a welfare centre. One died in Queen Mary's Hospital from heart failure and pneumonia. This baby had previously attended a welfare centre. 89 The Sanitary Inspectors have visited all the houses which have been reported during the year as accommodating fosterchildren. The following is a summary of the work carried out:— Foster-Children . Number of foster-children on books on 1st January, 1929 48 Number of foster-children who were notified to me during 1929 44 Number of foster-children returned to their mothers during 1929 12 Number of foster-children taken off the records for various other reasons during 1929 30 Number of foster-children on records on 31st December, 1929 50 Foster-Mothers . Number of foster-mothers on records on 1st January, 1929 36 Number of persons who became foster-mothers during 1929 13 Number of foster-mothers whose names were taken off records during 1929 18 Number of foster-mothers on records on the 31st December, 1929 31 Houses Visited by Sanitary Inspectors. Number of houses visited by the Sanitary Inspectors for the purpose of the Act during the year 1929 21 Number of visits made by the Sanitary Inspectors for the purpose of the Act during the year 1929 49 Under Section 2 (a) of the Local Government Act, 1929, as and from the 1st April, 1930, the administration of the Children Act, 1908, Part I, formerly carried out by the Romford Board of Guardians, will be undertaken by the Ilford Council. I have been appointed the Officer to receive notice under Part I of the Act, and the Health Visitors have been appointed Infant Life Protection Visitors. Work of Health Visitors. The Ilford area is divided into eight districts, one nurse carrying out all the home visits both for Maternity and Child Welfare work and School Medical Service work in each area. 90 The following is a summary of the visits paid by the Health Visitors during 1929 as far as the Maternity and Child Welfare work is concerned:— First visits to newly-born infants 1,909 Subsequent visits to children under 1 year of age 5,271 Subsequent visits to children over 1 year of age and under 5 11,167 Visits to expectant mothers 243 Home visits for other reasons 924 Total visits paid 19,514 Supervision of Midwives. There are 9 certified midwives resident and practising in the district (apart from those at the Maternity Home), and 6 certified midwives resident outside Ilford, but practising in Ilford. 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 such work can be carried out as efficiently and economically by the local Public Health Department. Under the Local Government Act, Section 62, the Council of any district having established a Maternity and Child Welfare Committee may apply to the Minister of Health to be made the Local Supervising Authority under the Midwives Act, 1902 to 1926, and the Minister if he is satisfied that the district council are in a position to discharge the whole of the functions of a local supervising authority, may by order direct that the council shall become the local supervising authority for the district in place of the county council, and provide for the manner in which the expenses of the district council and the county council are to be defrayed. Before making an order under this subsection the Minister shall consult with the county Council, and shall if requested by them hold a local enquiry. 91 The Ilford Council has made application to the Minister of Health to become the local supervising authority under the Midwives Acts, and awaits the decision of the Ministry thereon. 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 five persons have been registered in Ilford for the purpose of carrying on Maternity Homes. The Ilford Council, having made application in 1928 and being refused the delegation of the powers and duties of the Essex County County Council under the Nursing Homes Registration Act, 1927, Section 9 (2), have now made representation to the Ministry of Health under Section 9 (3) of the Act. This states that any District Council having made application to the County Council without success for delegation of the powers or duties of the County Council under this Act, and is aggrieved by the refusal, may make representation to the Minister of Health. The Minister after consultation with the County Council may direct the County Council to delegate to the District Council such powers and duties as the Minister thinks proper, and the County Council shall comply with any direction so given. The representation is now receiving the consideration of the Minister of Health. It was necessary to draw the attention of the County Medical Officer of Health to a Maternity Home in Ilford which had been registered, although no resident midwife had been engaged. A resident midwife was eventually engaged. My attention was called to a probable case of Pemphigus at a private maternity home at Seven Kings, which was reported to the County Medical Officer of Health. The infant was born before the 92 arrival of either a doctor or a midwife. The proprietor of the Home was warned by the County Medical Officer that in future she must ensure the presence of a qualified midwife before the birth of any baby in the Home, and against interference with any of the patients in the home in respect of the nursing. A resident midwife has now been engaged at this Home. Supply of Milk to Expectant and Nursing Mothers and for Infants. Under the Regulations of the Ministry of Health, during 1929, 131 mothers and infants were supplied with cow's milk free, 42 with dried milk, and 3 with condensed milk. A total of 9, 185½ quarts of cow's milk, 619 lbs. of dried milk, and 73 tins of condensed milk were given free under the Regulations. In 1928, 167 mothers and infants were supplied free with cow's milk, 54 with dried milk, and 9 with condensed milk. 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 could contribute small sums weekly and withdraw the whole or part of their contributions as necessity arose. During 1929 £15 14s. was saved by 23 mothers. In December I drew the Committee's attention to the large number of children on the roll at the Infant Welfare Centres at Valentines and Becontree, and reported that it was desirable that an additional session should be opened for each of these Centres. The number attending at the Valentines Centre made the work difficult, and I considered that a new Centre should be established 93 in the neighbourhood of Eastern or Woodford Avenue for these mothers living in that area. At Becontree if a new session was established, I considered that more mothers would attend than at present. The premises at Barkingside were not adequate for the district, and I thought a fresh attempt should be made to find larger and more suitable premises. Any extension in the Infant Welfare work would require (1) the appointment of another Health Visitor which I recommend, in any case the Committee to include in their next year's Estimates; (2) the engagement of Dr. Abbott for the additional sessions, or another part-time Medical Officer. I was instructed to make enquiries and report as to suitable premises available for the provision of an additional Infant Welfare Centre in the Eastern or Woodford Avenue district and the Becontree area, and also as to increased accommodation required at Barkingside. The cost was included in the estimates for the provision of another Health Visitor and the engagement of Dr. Abbott or another part-time Medical Officer for two additional sessions. A site is to be purchased in Goodmayes Lane for School Medical, and Maternity and Child Welfare purposes. This will be a great benefit to parents living in the Becontree and Goodmayes area, and will enable the work to be carried on under more satisfactory conditions. During the year the following attendances were recorded:— Figures for 1928. 1929. Total number of attendances of infants 33,590 32,971 First attendances 1,913 1,970 Total number of children on roll December 31st, after omission of all those who had not attended for six months 2,145 2,323 94 First Attendances— Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. 172 118 146 164 189 187 204 141 162 241 147 99 Subsequent Attendances— 2749 1938 2346 2136 2690 2687 3342 2029 2778 3575 2646 2085 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. 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 1929 32,991 1,970 2,323 483 sessions were held during the year, the average attendance at each session being 68.26 mothers with their infants. The following are the figures for each Centre:— Sessions. Average attendance. Seven Kings 48 99.66 Barkingside 48 44.54 Goodmayes 49 61.00 Valentines 49 84.20 Newbury Park 49 64.16 Grosvenor Road 48 74.89 Park and Cranbrook (morning) 47 48.10 Park and Cranbrook (afternoon) 47 58.57 Ilford Lane 49 83.12 Becontree 49 63.42 The following table gives some indication of the physical defects found in the infants making a first attendance at the Welfare Centres during the year:- 95 Nature of Defect Under 6 mths. 6 mths. to 1 year Age group of child 1—2 years 2—3 years 3—4 years 4—5 years Hernia— Umbilical 82 5 4 5 1 - Inguinal 21 1 - 1 2 - Phimosis 81 12 4 3 - - Hare lip and cleft palate 3 — 1 - - - Erbs' paralysis 2 — — - - - Eyes— Conjunctivitis 56 12 8 5 - 1 Blepharitis 3 5 10 7 4 2 Squint — 8 8 6 4 1 Defects of vision - - 1 3 - 3 Rickets 1 7 17 4 1 - Flat foot — - 3 - - 1 Bow legs — 4 17 5 - - Knock knees — 1 6 17 9 - Other orthopaedic defects 3 2 2 - - 1 Tonsils and Adenoids 1 1 23 36 20 30 Mouth breathing 1 3 2 - 4 1 Otorrhoea 17 9 10 5 3 1 Rhinitis - 1 1 2 2 1 Stuttering — — — 1 1 1 Skin diseases 33 21 34 13 9 5 Naevus 36 1 - - - - Icterus Neonatorum 3 — - - - - Alimenlary— Enteritis 57 36 17 2 2 - Thrush 51 5 4 4 2 6 Pyloric Stenosis 1 — - - - - Intussusception 1 1 - — - - Rumination 1 - - - - - Prolapsed rectum — — 1 - - - Thread worms - 1 31 19 24 4 Enuresis - - 4 4 5 1 Dental Caries - - 5 11 21 23 Bronchitis 25 33 17 11 1 1 Congenital heart disease 2 - - - - - Mongolism 2 - 1 - - - Hydrocephalus 1 — - — - - Tuberculosis - — 1 1 4 1 Glands in neck 4 4 10 7 5 7 Chorea - - - - - 1 Arthritis — — — — — 1 Age at 1st attendance during year 1087 309 355 259 207 118 Ante-Natal Clinics.—The Ante-Natal Clinics were continued during 1929 at the Maternity Home on Monday and Saturday mornings. 96 The following attendances have been recorded:— First attendances 710 Subsequent attendances 2,896 Number of expectant mothers on the rolls on 31st December, 1929 215 The following is a comparison of the attendances since the inception of an Ante-Natal Clinic: — 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 1929 710 3,606 215 All patients entering the Maternity Home who are to be attended by a midwife, are medically examined at the Ante-Natal Clinic. During the year 40 cases other than those booked for admittance to the Maternity Home were examined at the Clinic. There were 68 attendances by such cases. 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 1929, one half-day per week being allocated for this purpose. 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 1929 136 Number of attendances of mothers 365 Number of mothers, having teeth extracted, to whom "general" anaesthetics were given 77 Number of mothers, having teeth extracted, to whom "local" anaesthetics were given 23 Number of mothers having teeth filled or otherwise treated 98 Number of mothers having dentures supplied 40 (including 3 free of charge) 97 (b) Treatment of Children under 5 years of age. Number of children treated 94 Number of attendances of children 103 Number of children, having teeth extracted, to whom "general" anaesthetics were given 74 Number of children having teeth filled or otherwise treated 27 The following are the figures for the past five years:— 1925. 1926. 1927. 1928. 1929. Number of mothers treated .. 203 241 189 183 136 Number of children treated .. 89 85 96 79 94 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 1929:— (а) Number of children for whom spectacles were prescribed and provided 30 (b) Number of children examined by Oculist for whom spectacles were not prescribed 19 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 1929. Orthopaedic Clinic.—An arrangement has been made with the Royal National Orthopaedic Hospital, whereby an Orthopaedic Surgeon, Mr. J. B. Barnett, F.R.C.S., attends a Clinic held at the Public Health Offices once a month. He attended the first session on December 20th. Arrangements have also been made for the attendance three times a week of a qualified Orthopaedic Masseuse 98 for the purpose of carrying out the orthopaedic treatment and remedial exercises recommended by the Surgeon. She attended for the first time on December 23rd. 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. Two cases of Ophthalmia Neonatorum were admitted to the Isolation Hospital. Further details with regard to Ophthalmia Neonatorum will be found on page 48. Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 98 belts and 21 trusses have been supplied to infants suffering from hernia during the year 1929. 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. As mentioned in my report for the year 1928, arrangements have now been made with the Ilford Emergency Hospital for the operative treatment of 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. It has been agreed to retain children in the hospital overnight, where, owing to home conditions, or for other reasons, the Medical Officer considers it desirable. 99 During the past year, 73 children under 5 years of age have been treated as follows:— Out- Patients. Inpatients. Queen Mary's Hospital 36 — Ilford Emergency Hospital 22 15 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. Four of these children were treated free during the past year (3 at Queen Mary's Hospital and 1 in-patient at the Ilford Emergency Hospital), and 2 at a reduced fee (1 at Queen Mary's Hospital and 1 in-patient at the Ilford Emergency Hospital). MATERNITY HOME. During 1929, 481 women were admitted into the Home as compared with 481 in 1928, 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 97 Cranbrook 34 Park 77 Seven Kings 73 South Hainault 40 Loxford 36 Clementswood 73 Goodmayes 42 9 patients were admitted from outside the district on the recommendation of the Maternity and Child Welfare Committee. 100 60 cases could not be admitted during the year. 26 of these cases, however, had to be refused because the Home was being decorated in June. Therefore, 34 cases could not be admitted to the Home during 1929 owing to lack of accommodation. At the end of the year 179 cases were booked for future admission to the Home. The average number of patients in the Home per day during 1929 was 17.82, and the average length of stay of patients 13.60 days. Of the 481 cases admitted during 1929, 472 were confined in the Home, 2 cases were admitted for observation only, 2 were cases of inevitable abortion, and in 5 cases the babies were born before arrival at the Home. Of the 472 confinements there were :— (a) 274 cases of first confinement. (b) 198 cases having their second or subsequent confinement. Of the total cases confined in the Home:— (а) 98 cases were living in 2 rooms or less (59 being first confinements). (б) 100 cases were living in 3 rooms (75 being first confinements). Of the 472 confinements, 29 women had engaged their own doctor, 11 of these cases were, however, delivered by a midwife, the doctor not being present at the birth. 443 were attended by one of the midwives at the Home. 101 It was necessary to call in a doctor in 119 of the latter cases, owing to the following complications:— (a) Ante-Natal 36 Small measurements 16 Pre-eclampsia 14 Version 4 Ante-partum haemorrhage 2 (b) During labour 37 Adherent placenta 3 Premature labour 1 Prolonged labour 9 Persistent occipito-posterior 6 Extended breech 9 Brow 1 Prolapsed cord 2 Secondary uterine inertia 3 Foetal distress 2 Rudimentary vagina 1 (c) After labour 34 Ruptured perineum 29 Pyelitis 2 Synovitis and pre-patellar bursitis 1 Scarlet Fever 1 Pyo-salpinx 1 (d) For infant 12 Congenital absence of rectum 1 Melena 2 Secondary umbilical haemorrhage 1 Dangerous feebleness 6 Spina bifida 2 There were 6 deaths of infants in the Home, from the following causes:— Prematurity 4 Congenital atelectasis and undeveloped diaphragm 1 Convulsions and intra-cranial haemorrhage 1 There were 9 stillbirths in the Home from the following causes:— Macerated foetus 1 Difficult labour 2 Shock 1 Foetal asphyxia 1 Abnormal dilated bladder 1 Anencephalus 1 Prolapse of cord 1 Ante-partum haemorrhage and abnormal presentation 1 102 Two cases of Pemphigus Neonatorum occurred at the Maternity Home during the year, on the 23rd February and on 13th June. Both infants, together with their mothers, were removed to the Isolation Hospital for treatment. All necessary precautions were taken, and no further cases occurred. One case of Scarlet Fever occurred at the Maternity Home in October, and both mother and baby were removed to the Isolation Hospital, where they made a good recovery. No further cases occurred. There were two cases of Puerperal Fever during the year. In one case the mother was transferred to the Isolation Hospital and the baby remained in the Home, and in the other one both mother and baby were removed to the Isolation Hospital. In both cases the mother made a good recovery. One of the cases proved to be due to pyelonephritis (due to B. Coli), the other had the symptoms of Septicaemia but the blood culture was sterile. Both showed haemolytic Streptococci on culture of cervical swabs. Two cases of Puerperal Pyrexia occurred. In one case the mother had synovitis of the knee, and both mother and child were transferred to the Isolation Hospital where the mother made a good recovery. In the other case the mother was suffering from acute pyo salpinx, and the Consulting Obstetric Specialist was called in. She was transferred to Charing Cross Hospital where she made a good recovery. An operation will, however, have to be performed at a later date. Dr. Everard Williams, Consulting Obstetrician, paid his usual fortnightly visits to the Home. During 1929, he paid 23 ordinary visits, and examined 73 patients referred from the Ante-Natal Clinics. During the year he was also called in eight times for other cases, as follows:— 103 To perform eaesarian section operations 2 For consultation re threatened eclampsia 1 To deliver a baby in a case of extended breech 1 For consultation re acute yellow atrophy and post-partum eclampsia 1 For consultation re probable eaesarian section 1 For consultation and delivery for obstructed labour 1 For consultation re acute pyo salpinx 1 The infant mortality rate of children born in the Maternity Home during the year was 15.0 per 1,000 birtihs, as compared with 61.2 for those born in their own homes. The figure of 61.2 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 rate in the Maternity Home and in the district generally for the past 10 years:— Maternity Home. District generally. 1929 15.0 61.2 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 1923 15.3 40.4 1922 25.6 56.3 1921 20.5 52.4 1920 24.5 50.6 One death occurred of a woman from albuminuria and eclampsia. The maternal mortality rate for the Home for the ten years from 1920-1929 is 1.0 as compared with the maternal mortality rate in the district generally of 3.4. The circumstances of those unable to pay a fee of two guineas per week are inquired into by the Health Visitors, and a fee is decided on by the Medical Officer of Health. Cases for free admission are referred to the Maternity and Child Welfare Committee. 104 The following table shows in extenso the fees which were paid by women admitted to the Home:— 2 mothers were admitted free of charge. 2 mothers were admitted at a fee of 15s. per week. 18 ,, ,, ,, 20s. ,, 1 mother was admitted at a fee of 21s. ,, 2 mothers were admitted at a fee of 22s. 6d. ,, 18 ,, ,, ,, 25s. 49 ,, ,, ,, 30s. 1 mother was admitted at a fee of 31s. 6d. ,, 26 mothers were admitted at a fee of 35s. ,, 15 ,, ,, 40s. 111 ,, ,, ,, 42s. 27 ,, ,, ,, 45s. 2 ,, ,, 47s. 6d. ,, 33 .. ,, ,, 50s. 33 ,, ., ,, 52s. 6d. ,, 12 ,. ,, 55s. 10 ,, ,, ,, 57s. 6d. ,, 26 ,, ,, ,, 60s. ,, 10 ,, ,, ,, 62s. 6d. ,, 13 ,, ,, ,, 63s. 6 ,, ,, ,, 65s. ,, 2 ,, ,, ,, 67s. 6d. ,, 17 ,, ,, i, 70s. ,, 1 mother was admitted at a fee of 75s. ,, 1 ,, ,, ,, 77s. 6d. ,, 12 mothers were admitted at a fee of 80s. ,, 4 „ ,, ,, 82s. 6d. ,, 5 ,, ,, ,, 84s. ,, 1 mother was admitted at a fee of 90s. ,, 6 mothers were admitted at a fee of 100s. ,, 2 ,, ,, ,, 105s. ,, 12 ,, ,, ,, 110s. 1 mother was admitted at a fee of 70s. for 16 days. Of the above patients:— (a) 308 paid an additional fee of 15s. to the Council for the service of one of the midwives of the Home. (b) 1 paid a fee of £3 3s. for the services of the Assistant Medical Officer of Health. (c) 110 paid a fee of £1 Is. for the services of the Assistant Medical Officer of Health. (d) 4 paid a fee of £5 5s. for the services of the Consulting Obstetric Surgeon. (e) 2 paid a fee of 10s. Od. per week for the maintenance of babies in the Home apart from their mothers. The work of training Pupil Midwives has continued in a satisfactory manner; 6 who were engaged during the year were successful in passing the examination of the Central Midwives' Board. 105 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 1929. District Midwife. During 1929 the District Midwife attended 116 cases; of these 14 were delivered by doctors and 96 by herself; 6 were born before arrival of either doctor or midwife; a doctor was called in, however, in 32 of the 102 cases delivered by the District Midwife, for the following causes:— (a) Ante-natal 2 Pre-eclampsia 2 Prolonged labour 7 Extended breech 1 Premature labour 1 (6) During labour 13 Multiple pregnancy 1 Uterine inertia 1 Foetal distress 1 General condition 1 (c) After labour 15 Post-partum haemorrhage 3 Varicose veins 2 Ruptured perineum 9 ? appendicitis .. 1 (d) For infant 2 Blue asphyxia . 1 Septic spot 1 The 116 cases attended were in the following wards:—North Hainault, 41; Cranbrook, 5; Park, 19; Seven Kings, 21; South Hainault, 6; Loxford, 8; Clementswood, 12; Goodmayes, 4. Of the infants born there was 1 stillbirth of a Macerated foetus. Extensions of Maternity Home. In October, 1928, I was requested to report to the Maternity and Child Welfare Committee as to the necessity of the extension of the Maternity Home. My Report was considered in January, 1929. I recommended— 106 "That steps should be taken to prepare draft plans for extensions to the Maternity Home, particularly in view of the possibility of a quinquennial grant being introduced in lieu of the present percentage grant. Although the urgency for more maternity beds is not immediately apparent, there is no doubt that it will be so during the next few years. "The number of patients admitted to the Home each year since 1919 has been as follows 1919, 139; 1920, 169; 1921, 198; 1922, 204; 1923, 205; 1924, 191 ; 1925, 215; 1926 (new Home opened), 383; 1927, 454; 1928, 481. "The Home is now almost continuously full and 27 patients have not been able to be booked for admission this year owing to the Home being fully booked when application was made. "The District Midwife is also fully occupied and is occasionally attending more than her maximum of 10 cases per month. She was originally appointed particularly for the Barkingside and Newbury Park district, but it is desirable that facilities should be given for this service in other parts of the town. Owing to lack of accommodation, another District Midwife cannot be at present housed. "The Ante-Natal Clinic is also being fully attended. I consider also that in any future scheme, accommodation should be made for emergency difficult cases which require a separate staff, and at ;present are obliged to be sent to Hospitals in London. "The extensions required are :— (1) Extensions to the present Nurses' Home, giving more accommodation for a larger district as well as Institution Staff. (Plans for such extension are already in existence, the Home being so designed.) (2) A new ward block giving separate accommodation for emergency difficult cases. 107 (3) A new Ante-Natal Clinic; if possible a separate block for this purpose is desirable. (4) Enlargement of the present laundry (in accordance with the original design)." The Committee recommended that the Borough Engineer and Surveyor be instructed to submit plans for the extension of the Maternity Home in accordance with the suggestion made by the Medical Officer of Health, and that the Ministry of Health be advised accordingly. SCHOOL MEDICAL SERVICE. 111 GENERAL SURVEY OF THE SCHOOL MEDICAL SERVICE. The report shows that there are 15,562 children on the school rolls, compared with 14,910 in 1928, and 10,981 in 1922. 6,254 children were medically inspected, compared with 5,910 in 1928, and 4,072 in 1922. The following table compares the incidence-rate of physically and mentally defective children in Ilford with that of the previous year, and with the Board of Education average for the country as arrived at in 1928. It will be noticed that the number of orippled 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.. 1927, to 31st Mar., 1928). IncidenceRate per 1000 children in average attendance (1st Aor., 19-27, to 31et Mar., 1928). Incidence Rate per 1000 children in average attendance (1st Apr., 1928 to 31st Mar, 1929). Totally Blind .4 – – Partially Blind 1.0 .8 .6 Totally Deaf .8 .9 .9 Partially Deaf .4 .2 .2 Mentally Defective (Educable) 6.6 6.3 5.3 Epilepsy (Severe) .5 .3 .5 Infectious (Pulmonary and Glandular) Tuberculosis .6 .1 .1 Non-Infectious but Active Pulmonary and Glandular Tuberculosis 2.8 .9 .6 Active Non-Pulmonary Tuberoulosis 1.9 .5 .5 Crippled Children 9.1 1.4 1.7 Delicate Children 17.5 12.5 14.t 112 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 bv the Board of Education in 1928. It will be seen that on the whole Ilford is fairly comparable with the country in general:— Defects Board of Education Average. Ilford. Incidence-Rate per 1000. Incidence-Rate per 1000. 1928. 1927. 1928. 1929. *Defects of Vision 86.8 68.1 74.6 66.8 Squint 8.9 3.1 1.8 2.7 Other Eye Diseases 8.6 2.8 3.5 6.8 Defects of Hearing 4.2 5.7 4.4 5.1 Otitis Media 5.4 4.7 3.9 3.0 Enlarged Tonsils and Adenoids 63.0 60.8 66.8 51.4 Other Throat and Nose Defects 6.4 4.5 3.6 8.6 Organic Heart Disease 1.8 1.2 1.8 2.2 Pulmonary Tuberculosis: (a) Definite .. .3 — — — (6) Suspected.. 1.1 1.4 .9 .6 Non-Pulmonary Tuberculosis.. 1.0 .5 .5 1.2 Deformities 9.0 5.2 10.1 8.6 Nervous Diseases 1.9 2.0 3.2 3.3 * In calculating this figure the entrants have been left out of account. 113 Table showing the Principal Causes of Death among Children of School Age (i.e., from 5—15 years,, in England and Wales during 1927 and 1928, compared with those in Ilford for 1927 and 1928. The Table also gives a Comparative Percentage of Deaths registered at all Ages, and 5—15 years. Disease. England and Wales, Percentage of total deaths (all ages). Ilford, Percentage of total deaths (all ages). England and Wales, Percentage of total deaths at ages 5—15. Ilford, Percentage of total deaths at ages 5—15 1928 1927 1928. 1927. 1P28 1927 1928. 1927. 1. Tuberculosis 7.9 7.8 7.8 7.0 16.4 17.3 17.9 19.5 2. Violence 4.6 4.1 5.1 4.5 12.1 11.5 7.1 8.3 3. Diphtheria .7 .5 .8 1.0 11.8 9.8 10.7 8.3 4. Bronchitis, Pneumonia and other respiratory diseases 12.9 14.4 13.0 12.6 11.5 13.0 _ 11.1 5. Meningitis and Nervous system 9.2 9.3 .2 — 8.4 8.7 3.6 — 6. Heart Disease 16.8 14.8 20.9 17.4 6.2 5.5 21.5 5.5 7. Measles and Whooping Cough 1.5 1.5 1.3 .7 4.2 3.2 7.1 —. 8. Rheumatic Fever .3 .3 .3 .2 3.9 3.7 — —. 9. Appendicitis .6 .5 .6 1.2 3.C 3.8 — 5.5 10. Acute and Chronic Nephritis 3.3 2.8 2.0 2.4 2.1 1.9 — 11.1 11. Acute Infective Osteomyelitis .1 1 2 — 1.9 1.8 7.1 — 12. Influenza 1.6 4.5 .8 4.8 1.8 3.6 — 5.5 13. Scarlet Fever .1 .1 .2 .2 1.7 1.8 — 2.8 14. Tonsillitis, etc., Adenoid Vegetations .2 .2 — — 1.5 1.2 — — 15. Other conditions 40.2 39.1 46.8 48.0 12.9 13.2 25.0 22.4 100.0 100 0 100.0 100.0 100.0 100.0 100.0 100.0 England and Wales.—The deaths of children of School Age during 1928 represent 2.8 per cent, of the Total Deaths registered (all ages). Ilford.—The deaths of children of School Age during 1928 represent 3 per cent, of the Total Deaths registered (all ages). ,, The deaths of children of School Age during 1927 represent 3.5 per cent of the Total Deaths registered (all ages). 114 I have compared in the foregoing table the principal causes of death among children of school age (i.e., from 5 to 15 years) in England & Wales with those in Ilford for 1928 and 1927. I cannot say that an analysis of this table is favourable as far as the school population of Ilford is concerned. It shows: — 1st.—That rather more deaths of children of school age, compared with the total deaths, occurred in Ilford during 1928 and 1927 than in the country generally. This is partly, but not, I think, altogether, explained by the large child population in Ilford. 2nd.—That Tuberculosis is a greater factor in causing deaths among school children in Ilford than it is in the country generally, although for all ages the proportion is much the same. This is an added argument for the establishment of the Open-Air School for weakly children, who are likely to develop such a disease. 3rd.—Violence is a much smaller factor as a cause of the deaths of children in Ilford than in the country generally. 4th.—In 1928 and 1927 Ilford was in a favourable position as far as the deaths from Diphtheria in school children is concerned, compared with the country as a whole. It is possible that with the outbreaks of diphtheria which have occurred on the L.C.C. Estate at Becontree, this position may be reversed in 1929. 5th.-—Bronchitis and Pneumonia were not factors in causing deaths among Ilford school children in 1928. In 1927, however, the percentage rate approximated to that in England and Wales. On the other hand, Ilford was in an unfavourable position as regards measles, whooping cough and heart disease in 1928 compared with the country generally. One factor causing this is no doubt the lack of hospital accommodation for measles and whooping cough, and the absence of any Rheumatic Clinic or 115 patients' Department where children suffering from sub-acute rheumatism, causing heart disease, can receive treatment. It may be pointed out that heart disease is a greater factor in causing the deaths of persons of all ages in Ilford than it is in England and Wales generally. The following improvements have been effected in the School Medical Service during the past year:— 1. Operative Treatment of Tonsils and Adenoids at King George Hospital. This arrangement represents a distinct advance, as many children can now be treated as in-patients, which was quite impossible formerly, and further, the long distances which had to be travelled by children for treatment has been obviated. On the 18th February, 1929, an agreement was entered into between the Education Authority and the Ilford Emergency Hospital (now King George Hospital) with respect to operative treatment of tonsils and adenoids in children attending elementary schools in the Borough. The first Clinic at King George Hospital was held on the 24th April, and further Clinics have been held at approximately fortnightly intervals throughout the year. The agreement provides for in-patient and out-patient treatment, where recommended by the School Medical Officer. A detailed report as to the number of cases treated during 1929 will be found on pages 26 and 27. Arising out of representations made to the General Purposes (Ambulance Matters) Sub-Committee on the 16th January, the Council resolved : "That the use of the Corporation's ambulances will be permitted for the removal from the Hospital to their homes after treatment of such children as are certified by the Laryngologist to be unfit to proceed home in the ordinary way, at a special fee of 2s. 6d. per child, being half the usual scale fee for private removals within the Borough, this fee to include one person in charge of each child." 116 2. Dental Services. The appointment of an Assistant Dental Surgeon has enabled the Dentist to interview parents at the schools, and many more acceptances of treatment have been obtained. Much more rapid treatment of the defects found at the Dental Inspections has also been possible. 3. Orthopaedic Treatment. The establishment of the Orthopaedic Clinic has enabled a very complete control of the crippled children in the Borough to be maintained; it has also obviated the great difficulty which parents have experienced in the past, of taking these children long distances to Orthopaedic Departments in London. The establishment of the Remedial Exercises Clinic will, I am convinced, have a profound effect upon the physical condition of the school children in the district. An agreement between the Corporation and the Royal National Orthopaedic Hospital was concluded on the 8th October, and haa received the approval of the Board of Education. The Scheme provides for the attendance at the Orthopaedic Clinic held at the Public Health Offices of an Orthopaedic Surgeon (Mr. J. B. Barnett, F.R.C.S.), once a month, or at more frequent intervals as may be arranged, for the purpose of examining patients as may be submitted to him by the School Medical Officer or the Medical Officer of Health. The Scheme also provides for the attendance of a qualified Orthopaedic Nurse Masseuse at the Orthopaedic Clinic for the carrying out of such treatment as may from time to time be prescribed by the Orthopaedic Surgeon. The Orthopaedic Surgeon will normally attend the Clinic on the third Friday in each month, at 2 p.m. Owing to the number of cases outstanding, intermediate Clinics will have to be arranged during the first quarter of 1930. The Orthopaedic Masseuse will normally attend the Clinic on Mondays, Wednesdays and Friday, at 10 a.m.. to carry out the treatment recommended. 117 Provision is also made whereby three beds are reserved for in-patient treatment at the Royal National Orthopaedic Hospital. The first Clinic held by Mr. Barnett was on the 20th December. The numbers that will have to be dealt with are as follows:— Orthopiedic Cases 80 Remedial Exercises Cases 113 193 There were, at the end of 1929, 60 mentally defective children who have been certified as requiring special school education, apart from 6 in attendance at Mossford School. Twenty-two of these children were at home, not receiving any education at all. In connection with the suggestions embodied in the Hadow Report, the Director of Education presented a Memorandum on the Re-organisation of the Schools under the jurisdiction of the Authority, to the School Management Sub-Committee at its meeting on the 9th December, 1929. In the summary on the re-organisation, paragraph (91) states: — "The pupils of Chadwell School ultimately to be transferrd as opportunity affords, the Chadwell School to be utilised for the education of retarded children drawn from the Borough as a whole." It has also been suggested that accommodation should be provided at this School, for cripple children and those suffering from severe heart disease, etc. There are only 21 children in Ilford who are so physically defective as to require such special school education, 8 of these are sufficiently fit to attend an ordinary school if special precautions are taken as to their welfare. The Special Sub-Committee appointed by the Education Committee to consider the question of an additional School Clinic met in February and recommended that a Clinic be established in the eastern portion of the Borough. The Education Committee at its meeting on the 18th March recommended that the Clinic be erected on the school site in Goodmayes Lane (Mayesbrook Site). 118 The restrictions as agreed by the vendor of the land would not, however, permit of accommodation being provided in the School Clinic for Maternity and Child Welfare Services. The Education Committee at its meeting on the 20th January, 1930, decided to recomnienu the Council to purchase a site for the erection of a permanent School Clinic in Goodmayes Lane at the corner of Meldrum Road. This recommendation was passed by the Council at its meeting on the 28th January, 1930. Plans for the erection of the building are in course of preparation. The provision of a School and Dental Clinic in this part of the Borough will supply a much needed want, and will obviate much of the travelling necessary with only one Clinic in operation. The control of ringworm is well maintained, there being only 1 case under observation at the end of the year. I must again point out that before medical inspection commenced there were 135 cases of ringworm of the scalp absent from school because of this condition, although the number of children on the school rolls was very much less. There was a high incidence of infectious disease during the year. Diphtheria was responsible for the deaths of thirteen children of school age, seven of whom resided on the L.C.C. Estate in the Becontree Area. Three cases of Small Pox among children of school age occurred during the year. Case No. 1.—This was an unvaccinated girl, aged 8 years, a late scholar of Highlands .School, who had not attended school since the 24th July. The case was notified on the 18th September. The patient was removed to Orsett Hospital the same day, and the house disinfected. The 31 contacts in the case (9 of whom were children of school age) were followed up. Case No. 2.—This was a girl, aged 15 years, who was unsuccessfully vaccinated in infancy. The case was notified on the 23rd November. The patient, who attended Hourah House Secondary School, Poplar, was removed to Orsett Hospital the same day, and the house disinfected. The 23 contacts of the case living in Ilford (3 of whom were children of school age) were followed up. 119 Case No. 3.—This was a boy, aged 7 years, and was a brother of Case No. 2. He had not been vaccinated in infancy. The case was notified on the 6th December. The patient, who attended Goodmayes Junior School, was removed to Orsett Hospital the same day, and the house disinfected. All the children made a good recovery, and I am pleased to record that owing to the measures adopted, no further cases occurred. For the quarter ending March, 1929, 418 cases of influenza among schoolchildren were notified to me by the Head Teachers, School Attendance Officers, etc. The year was a comparatively light one as regards the socalled minor infectious diseases, i.e., Measles, Chicken Pox, etc. A considerable incidence of Measles may be expected during the coming year. With reference to the conveniences in the schools, there are still trough closets at Loxford, Downshall, Newbury Park Boys' and Girls', Highlands and the Roman Catholic School. The oldest type of trough closets are at the Barkingside School, which is a Voluntary School. The Committee in July considered my recommendations on this matter, and decided that 9 trough closets in the Downshall Girls' School should be replaced by separate pedestal pans with flushing cisterns, and that the trough closets remaining in the various schools be replaced as -and when necessary by the same type. The recommendation with regard to Downshall Girls' School has been carried out, and at Loxford Junior Boys' 2 trough closets have been replaced by pedestal pans. At Highlands Girls' School 2 trough closets have also been replaced by pedestals. With regard to drinking fountains, bubble-fountains are in use at Becontree, Valentines Senior, Gearies, Fairlop and the Open-Air School. The Committee proposes to experiment with a new type of bubble-fountain at two other schools. The question of the urinals at the schools requires attention; many of these are of the slate-back type, and these should all be replaced with glazed stoneware urinals with stalls. 120 ]. Staff.— Dr. Jessie A. MacLaren, Assistant Medical Officer, terminated her appointment on the 30th July, 1929. Dr. Kathleen Edgecombe, appointed Assistant Medical Officer, vice Dr. MacLaren, commenced duties on the 31st July, 1929. Dr. Anne Crow, Assistant School Dentist, commenced duties on the 26th August, 1929. With these exceptions the medical and nursing stafis remained unchanged during the year. An additional School Nurse will shortly be required, provision for this having been made in the estimates. 2. Co-ordination.—Vide Annual Report, 1920. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. 3.—School Premises.—There are 20 schools, with 45 departments. The schools have accommodation for 17,463 scholars, and 15,562 were actually on the rolls on December 31st, 1929. The Gearies' School at Gants Hill Crescent, to accommodate 1.152 children, was opened on the 26th August. The St. Vincent's Catholic School, Waldegrave Road, to accommodate 360 children, was opened on the 26th August. The Fairlop Temporary School, Fencepiece Road, to accommodate 300 junior mixed children, was opened on the 2nd December. The Mayesbrook Temporary School, to accommodate 350 junior mixed children is nearing completion, and will be opened during the early part of the ensuing year. 121 The Golfe Road Temporary School, to accommodate 350 junior mixed children has been commenced, and will be opened during the ensuing year. The temporary school at St. Thomas' 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, 194 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, Section 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— (а) their first admission to Public Elementary Schools, and (б) 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 ior 1920. During 1929 the number of visits by the Medical Officers to 45 different departments of 20 schools for the purposes of routine medical inspection was 386. The number of children examined during the year, falling within the above age groups, totalled 6,254 (3,032 boys and 3,222 girls), an increase of 344 over the figures for 1928. 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. 122 During 1929, 162 such children (76 boys and 86 girls) were examined. 2,072 re-examinations (1,065 boys and 1,007 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 number of 8,488 examinations was made at the various schools during the year. The following table compares the numbers of children examined in previous years:— Routine Medical Inspection. R e-examination at following up. Special Cases. 1929 6,254 152 2,072 1928 5,910 137 1,811 1927 5,738 126 1,697 1926 5,658 139 1,709 1925 4,545 165 1,587 5. Findings of Medical Inspection.—Table II. shows the return of defects found in the course of medical inspection. (а) Uncleanliness.—At routine medical inspection 62i children out of a total of 6,254 (or 1.0 per cent.) were found to have nits or vermin in their hair, while only 4 (or .006 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 25. (б) Tonsils and Adenoids.—322 children (or 5.1 per cent, of -nose 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. 123 (c) Tuberculosis.—4 suspected oases 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.—3 cases of Scabies (Itch), 21 of Impetigo, and 31 oases of other diseases of the skin were discovered at routine medical inspection. (e) External Eye. Disease.—15 cases of Blepharitis, i.e., inflamed eyelids, and 13 cases of Conjunctivitis were discovered. (/) Vision.—418 children (or 6.6 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. 87 of these cases saw f, while the remaining 331 had vision of f or less. All children having vision f or less are referred for treatment. Further particulars of these oases will be found on page 21. 94 per cent, of the cases received treatment from the School Oculist. (g) Ear Disease and Hearing.—32 children (or .5 per cent, of those examined) were found to be suffering from defective hearing. 19 children were found to be suffering from a discharge from the ear, due to an old otitis media. (h) Dental Defects.—328 (or 5.2 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 49, Table IV (Group IV). (i) Deformities.—9 children were found to be suffering from slight spinal curvature, and 43 from other minor deformities (such as round-shoulders, flat-feet, etc.), which could be corrected by special physical exercises. These cases are being referred to the Orthopredic Surgeon. 124 6. Infectious Disease.—The following table shows the incidence of Scarlet Fever, Diphtheria and Measlee, including German Measles, in the Ilford schools since 1920:— Scarlet Fever. Diphtheria. Measles. 1920 154 130 790 1921 202 105 108 1922 116 82 893 1923 79 61 174 1924 85 2o 1,026 1925 93 22 484 1926 93 60 1,713 1927 244 67 83 1928 349 117 1,383 1929 309 210 141 Disinfection of all the cloakrooms at the public elementary schools was carried out both during the Summer and Xmas vacations. In addition, disinfection was also carried out at Goodmayes, Becontree and Loxford Schools, following cases of infectious disease. No schools were closed during the year on account of infectious disease. Tables VII to XIII on pages Nos. 56-62, show the incidence of each infectious disease in the Ilford schools during 1929. ('a) Scarlet Fever.—309 cases were notified in 1929, as compared with 349 in 1928. The following table shows the percentage attack-rate of Scarlet Fever at the various schools during 1929:— School. Percentage Attack Rate. Barkingside 3.1 Becontree 2.9 Chadwell 1.3 Cliristchurch 1.4 Cleveland 1.3 Downshall 2.3 Gearies 1.5 Goodmayes 1.4 Highlands 2.1 Little Heath 0.9 125 School. Percentage Attack Kate Loxford 1.8 Newbury Park 0.9 Open Air 3.0 Roman Catholic, Ilford 1.9 St. Vincent's 0.2 South Park 1.3 Uphall 1.3 Valentines 2.6 The table has been calculated on the cases notified, compared with the number of children on the roll (all departments;. (6) Diphtheria.—210 cases were notified in 1929, as compared with 117 in 1928. Owing to the prevalence of this disease at Becontree and Goodmayes Schools during October and the ensuing months, I circularised the parents of children attending the Lower Department of Becontree School and the Junior Mixed Department of Goodmayes School, offering facilities for the immunisation of their children against Diphtheria. Subsequently the parents of children attending the Middle Boys' and Girls' Departments of Becontree School, and also St. Vincent's School, were similarly circularised. Thirteen deaths of children of school age occurred from this disease during the year, seven of whom resided in the L.C.C. Estate at Becontree. They attended the following schools :— Becontree 3 Cleveland 1 Christchurch 1 Goodmayes 6 Private 2 The following is a copy of the report I made to the School Management Sub-Committee at its meeting on the 9th December, 1929:— " Diphtheria Epidemic. " The cases occurred chiefly in the L.C.C. houses on the Becontree Estate. Of 44 cases (from August 31st—November 30th), at Goodmayes School, 34 were from houses in this Estate. These were distributed as follows:—Goodmayes 126 Junior, 20; Boys, 9; Girls, 5. In addition, 13 cases occurred in Becontree School. " A number of visits have been paid to both schools. In view of the number of cases which had occurred in one class, I requested the Director of Education to allocate a School Attendance Officer to visit the absentees, and also to ensure that none were re-admitted without a medical certificate. As a result., no cases have occurred in this class since October 24th. " In view of the incidence of this disease on the L.C.C. Estate, all parents of children in the Becontree and Goodmayes Junior Departments have been offered immunisation against diphtheria. 480 acceptances of this treatment were received. Most of the children (whose parents have accepted) will be treated before the Xmas holidays and the remainder immediately afterwards." (c) Measles and German Measles.—141 cases were notified from the schools in 1929, compared with 1,383 during 1928. No deaths from Measles in a child of school age occurred in 1929, compared with one in 1928, nil in 1927, and 7 in 1926. (d) Chickenpox, Whooping Cough and Mumps.—331 cases of Chickenpox occurred in 1929, as compared with 278 in 1928; 278 cases of Whooping Cough in 1929, as compared with 341 in 1928; and 252 cases of Mumps in 1929, as compared with 207 in 1928. 1,021 home visits were paid by the Health Visitors in connection with cases of minor infectious disease. (e) Ringworm.— No. of cases at beginning' of 1929. No. of cases reported during 1929. Total. Remedied during 1929, No. of cases under observation at end of 1929. Ringworm: — Scalp 5 6 11 10 l Body — 9 9 9 — 5 15 20 19 l 127 Nine school children were X-rayed at the clinic during the year, 3 being cases from 1928. 7. Following Up.— This has been carried out in the manner described in my previous reports. During 1929, 2,821 home visits by the Nurses were paid for the purpose, and 2,072 children were re-examined by the doctors at school. 8. Medical Treatment.— The Clinic for minor ailments has been held as previously each morning. (a) Minor Ailments.—The attendances at the morning Clinic during 1929 were as follows :— Number of individual children seen at the Clinic 2,157 Number of attendances of children 5,182 Number of exclusion certificates granted 2,267 Number of certificates of fitness to attend school granted 1,571 The following table shows the variety of conditions dealt with at the School Clinic during the year:— Malnutrition 7 Uncleanliness: — Head 24 Body 2 Skin:— Ringworm: — Head 6 Body 9 Scabies 17 Impetigo 218 Other Diseases 187 Eye:— Blepharitis 22 Conjunctivitis 61 Corneal Ulcer 2 Defective Vision and Squint 67 Other Conditions 35 128 Ear:— Defective Hearing 19 Otitis Media 51 Other Ear Diseases 24 Nose and Throat:— Enlarged Tonsils 54 Adenoids 24 Enlarged Tonsils and Adenoids 57 Other Conditions 199 Mouth Breathing 23 Enlarged Cervical Glands 75 Teeth—Dental Diseases 71 Heart and Circulation:— Organic 4 Functional 3 Anaemia 19 Debility 103 Infectious Diseases:— Scarlet Fever 1 Diphtheria 6 Whooping Cough 17 Mumps 47 Chickenpox 13 German Measles 1 Influenza 4 Colds 81 Lungs:— Bronchitis 31 Other Non-Tubercular Diseases 14 Tuberculosis:— Pulmonary:— Suspected 2 Non-Pulmonary:— Glands 3 Nervous System:— Chorea 4 Other Conditions 9 Deformities 12 Minor Injuries 138 Other Defects and Diseases 192 Total number of ailments 1,957 129 (6) Ophthalmic Department.— During the year 1929 the School Oculist held 84 sessions for the refraction of children suffering from defective vision. Full details of the work are given in Table IV, Group II, on page 48. 545 school children were examined, 49 of these being cases from 1928. Of the 545 cases, 480 were referred from medical inspection, and 65 from the School Clinic. The 545 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 8 8 6/0 87 133 99 74 55 52 30 15 The children who saw 6/6practically normal vision) were suffering from symptoms such as headaches, inflamed eyelids, etc., which rendered further examination necessary. Of the 545 children examined, 456 were found to require spectacles by reason of the following defects:— Myopia 83 Myopic Astigmatism 68 Hypermetropia 77 Hypermetropic Astigmatism 148 Mixed Astigmatism 39 Anisometropia 8 Hypermetropia with Squint 33 Total 456 130 Of the remaining 89 children, 22 were suffering from the following other diseases, and glassess were not prescribed :— Asthenopia 1 Amblyopia 1 Corneal Ulcers, Nebulae, Conjunctivitis, etc. 5 Choroidal Atrophy 1 Paralysis of orbital muscles 1 Persistent Pupillary Membrane 1 Strabismus 7 Supra-orbital Neuralgia 1 Other Diseases 4 22 43 other children were found not to require spectacles, and in 24 cases the lenses already in use were found not to require changing. A number of children (68) were kept under observation and were re-examined during the year, the spectacles being changed in 17 instances. In addition to the above, the School Oculist examined 20 children from the County High School and prescribed spectacles in each case. Under the Education Committee's scheme 456 pairs of spectacles were provided Of this number, 17 pairs of spectacles were provided free, and 6 pairs at a reduced charge, on necessitous grounds. In addition, spectacles were renewed or repaired in 139 cases. (c) Dental Department.—During the year the Dentists paid 232 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 10,693 131 children inspected by the Dentists (including special cases), 6,485, or 60.6 per cent., were found to require treatment, compared with 60.1 per cent., 1928; 56.9 per cent,, 1927; 56 per cent., 1926; 56 per cent,, 1925; 62 per cent., 1924. 50.8 per cent, of the cases requiring treatment obtained it at the School Clinic. In 1928, 39.5 per cent., 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 1,282 727 56.71 6 1,630 1,010 61.9 7 1,636 1,146 70.05 8 1,816 1,188 65.42 9 J,915 1,194 62.35 10 1,130 681 60.27 11-12 956 539 56.38 The following table shows the percentage of acceptances of treatment by the School Dentist in the various departments of the schools during 1929:— 132 School. Department. Number inspected. No. referred for treatment. No. of acceptances of treatment Percentage of acceptances. Barkingside Sen. Mixed 152 134 79 58.95 9 9 • • Jun. Mixed 121 86 61 70.93 Becontree Upper Boys 97 65 7 10.77 ft '' ,, Girls 105 76 9 11.84 ” Middle (B. and G.) 413 229 94 41.04 ” Lower 681 341 102 29.91 Catholic, Ilford Upper 199 133 43 28.10 ” Lower 142 94 44 42.71 Chadwell Upper 43 23 16 69.56 ” Lower 53 28 13 46.42 Christchurch Boys 234 180 59 32.77 ” Girls 279 201 86 42.26 ” Jun. Mixed 321 204 136 66.66 Cleveland Boys 177 103 40 38.83 ” Girls 244 137 37 27.00 ” Jun. Mixed 445 243 100 41.15 Downshall Boys 278 125 49 39.2 ” Girls 128 62 27 43.54 ” Jun. Mixed 508 307 165 53.74 Gearies Upper Boys 26 21 4 19.05 ” ,, Girls 15 11 7 63.63 ” Middle .. 269 221 110 49.77 ” Lower 303 208 154 74.07 Goodmayes Boys 378 201 99 49.25 ” Girls 248 124 73 58.87 ” Jun. Mixed 476 283 145 51.73 Highlands Boys 234 182 94 51.64 ” Girls 223 164 84 51.22 ” Jun. Mixed 295 235 153 65.10 Little Heath Upper 37 10 8 80.00 ” Lower 35 15 5 33.33 Loxford Boys 111 86 64 74.42 ” Girls 172 81 25 30.86 ” Jun. Mixed 363 209 117 56.00 Newbury Park Sen. ,, 273 208 58 27.88 ” Jun. ,, 252 207 138 66.66 Open Air Mixed 115 80 80 100.00 South Park Middle 246 110 75 68.18 ” Lower 336 176 68 38.63 St. Vincent's Mixed 172 143 93 65.03 Uphall Boys 117 72 34 47.22 ” Girls 166 97 33 35.05 ” Jun. Mixed 222 138 74 53.62 Valentines Upper 162 72 43 59.72 9 9 Lower 193 101 74 73.26 133 With regard to children who had previously been inspected by the Dentist and found to require dental treatment, and whose parents had not accepted such treatment, the following table shows the percentage of acceptances of treatment as a result of the Dentist's Re-inspection. Notices were issued to the parents requesting their attendance at the re-inspections. School. Department. No. of Children Re-inspected. No. referred for treatment. No. of acceptances of treatment. Percentage of acceptances. Barkingside Mixed 79 79 20 25.31 Chadwell Mixed 32 32 17 51.51 Christchurch Jun. Mixed 59 59 35 59.32 Cleveland „ 65 63 32 50.79 Gearies Lower 97 95 53 55.78 Highlands Jun. Mixed 88 86 40 46.51 Loxford ,, 50 48 27 56.25 Newbury Park ,, 92 89 57 64.04 R. Catholic Mixed 136 122 42 34.42 South Park Lower 43 39 19 48.71 Uphall Jun. Mixed 68 64 29 45.31 Valentines Mixed 24 22 13 59.09 Totals 833 798 384 48.12 In addition to these figures, the Dentist has carried out four complete inspections of the children's teeth at the Open Air School, and all those referred for treatment, viz., 80, have received attention. Full details of the dental work are shown in Table IV, Group IV, on page 49. (d) Treatment of Uncleanliness.— It was found necessary to deal with 28 children under the Education Act, 1921, Section 87, statutory notices being served on the parents. In 7 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 134 visits to the schools (an average of 7 visits to each school during the year), for the purpose of 134 inspecting the heads and clothing of the children, with the following result:— Number of Children Inspected. Number Infected. Per Cent. 41,470 1,238* 2.9 *97 of these children were found to be infected with living vermin; the remainder with nits only. 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 1929 2.9 No prosecutions were instituted during 1929 under Section 87 of the Education Act, 1921. During 1929 the ambulance was used on 7 occasions to bring verminous children to the School Clinic for cleansing purposes. (e) Other Ailments.— During the past year 123 children have been operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford. 10 children were treated free during the past year, and 8 at a reduced charge, on necessitous grounds. In addition, since 24th April, 167 children have been operated on for the removal of enlarged tonsils and adenoids under the agreement with the Ilford Emergency Hospital (King George THE BENTON OPEN-AIR SCHOOL, ILFORD. 10. 1. Child aged 6 years. Typical case of Debility. fos. 2 and 3. Children gardening on Individual Plots. 4. Sun exposure during rest. 135 Hospital). 106 children were treated as out-patients, and 61 as in-patients. 12 in-patients were treated free and 2 at a reduced charge, 5 out-patients free and 1 at a reduced charge. In addition to the treatment of tonsils and adenoids, 40 letters were given to Ilford school children, for whom hospital treatment was required, to attend at Queen Mary's Hospital. 9. Open-Air Education.—Since the commencement of the Open-Air School on the 29th January, 1929, and up to the 31st December, 115 children have been admitted, 17 have ceased attendance, and at the date of this report, 98 children are on the school-roll. The whole of the children who have attended the Open-Air School were personally examined by myself prior to admission. They were originally recommended to me for examination from the following sources: — Head Teachers 45 As a result of Medical Inspection at School, School Clinic, etc.41 Tuberculosis Officer 15 Great Ormond Street Hospital 4 Parents'application 6 Royal National Orthopaedic Hospital 1 Director of Education 2 Private Medical Practitioner 1 The 17 children not now on the school-roil ceased attendance for the following reasons:— Returned to ordinary School at parent's request 3 Over School age (exempt) 4 Found fit to resume attendance at ordinary School 5 Admitted to Orphanage School 1 Unfit to attend any School 1 Discharged through unsatisfactory attendance 2 Admitted to Convalescent Home 1 A Medical Officer has, since the inception of the school, attended one half-day every alternate week to examine and report 136 upon special cases, and a routine examination of every child has been carried out at the end of each six months. One of the School Nurses attends monthly to take the heights, and weights of each child. These are entered on special cards, as is also the Medical Officer's findings, and recommendations. In addition to this, the School Dentist has carried four complete inspections of the children's teeth. The following table shows briefly the dental work carried out:— Number of children examined by the School Dentist 115 „ „ re-examined 87 „ „ referred for treatment 80 „ „ treated by School Dentist 80 „ „ re-treated 17 Every child in the School whose teeth required treatment has now received it. As a result of the Medical Officer's periodic examinations, a number of the children have been recommended certain treatment as follows:— Administration of Milk in School 48 „ „ Cod-liver Oil Emulsion 41 To see Oculist 8 Treatment at Clinic for External Eye Disease 2 Operative Treatment for Tonsils and Adenoids 3 To see Orthopaedic Surgeon re Remedial Exercises, etc 17 Recommendations have also been made to the Head Teacher as to the amount of exercise individual children should undergo, and also as to the taking of shower-baths. A digest of the weight-graphs shows that 93 per cent, of the children show an appreciable increase in weight since their admission to the school. A number of children will shortly become due for discharge to ordinary schools. 137 The Committee has decided upon the provision of a rest shed to the east of the present main building, and the plans are now before the Board of Education, for approval. Having regard to the type of child admitted, I consider that the children have, generally speaking, shown marked improvement in their health and physique since admission, a condition that would not have resulted had they remained at an ordinary school. In my opinion the school has well justified its existence. The children at present at this school have been selected as the most urgent. They therefore have needed a more lengthy stay than is usually the case at Open-Air Schools. Those who will replace the children discharged will probably not require such prolonged treatment. A fact that must not be lost sight of in connection with the Open-Air School, is that 9 of the children who were previously not attending any school, are now attending regularly. As an instance, one of these children had not been to school for over six years, and yet since admission her attendance has been quite satisfactory. A further analysis shows that 23 of the children, prior to admission to this school, had very bad records from the school attendance point of view. Many of these children were absent for lengthy periods, but since admission to the school their attendances may generally be regarded as very satisfactory. Up to the end of 31st October, the average weekly attendance percentage was 87.3, whilst that for the whole year was approximately 84 per cent. Having regard to the type of child admitted to the Open-Air School, I think the attendance records are, even from that point of view alone, a criterion of the usefulness of the school. As regards the educational progress of the children attending the Open-Air School, the Head Teacher informs me that she has carried out standardised educational tests (Northumberland) of the children at six monthly intervals, and up to the present, results show an average increase in mental age of 1-9/12 years 138 in one year. In considering this rate of progress, the Head Teacher points out that it must not be forgotten that many of the children when admitted had, through various causes, a low mental age, and therefore the result is the more noticeable when it is remembered that in many cases the previous rate of progress must have been very slow. The Head Teacher mentions that the subjects the children were tested in were arithmetic, English, history and geography, general intelligence, and reading, and points out it is interesting to note that the rate of progress is more rapid in general intelligence than in other subjects. To quote from the Head Teacher's report: "this is what one would expect, I think, from personal observation. The children quickly give evidence of increased mental vigour, and this factor, plus the more stimulating course of instruction necessarily provided for children working temporarily under conditions such as exist at an Open-Air School, seem to give an immediate return in this direction." The following is a Copy of the Report presented to the School Management Sub-Committee on the 9th December by the Director of Education: — REPORT ON THE BENTON SCHOOL For the Period 29th January, 1929, to 31st October, 1929. Opening.—The Benton School was formally opened on 29th January, 1929, with an initial roll of eighty-eight children (boys and girls). The School has subsequently been recognised by the Board of Education as providing accommodation for an average of ninety pupils, and the roll on 31st October had increased to ninety-eight. Selection of Pupils.—The School has as one of its aims the improvement of the health of those children whose physical condition, through one cause or another, has been impaired; a natural corollary is that reinforced physical energy tends to produce a similarly healthy mental capacity. Suitable cases are referred from time to time by the School Medical Officer for admission when vacancies occur. During the period under review, one hundred and ninety-two cases were so referred, of which number one hundred and fifty-three have been invited to attend the School with the following results, namely:— Number of admissions 115 Number of non-acceptances 38 139 Of the remainder, four have removed from Ilford, one was over age, and thirty-four still await admission. Attendance.—Official returns show that the School has had an average attendance of 82.4 and an average percentage of 87.3. Having regard to the number of necessary absences caused by the attendance of pupils at Hospitals in London and elsewhere, this percentage is regarded as exceptionally good, and it is no doubt partly achieved by the conveyance of the pupils to and from School in all weathers by motor ambulance, but partly also to the fact that many of the children, for the first time, enter into school life with zeal, owing to the different conditions that necessarily exist in an open-air school, with its atmosphere of controlled freedom and its provision of suitable activities which give to many of them an outlet for their individual initiative under the special care and guidance of an enthusiastic staff, both teaching and domestic. The roll number, as shown above, stands at ninety-eight, whilst one hundred and fifteen have, since the opening of the School, been on the registers. Of the seventeen leavers, ten returned to their home schools, four reached school-leaving age, two were admitted into Hospital, and one transferred to a Residential School. Curriculum.—Instruction is given mainly out of doors, the classrooms being used only when necessary. The time-table has been most carefully planned to ensure that there shall be no nervous strain; the subjects entailing the greater mental strain are generally taken in the morning, the afternoon being devoted to practical work. The child's interest in its lessons is stimulated by a different approach from that used in an ordinary school, and full advantage is taken of the school garden. Practical Arithmetic in the grounds often takes the place of the Abstract Mathematics of the classroom, whilst such subjects as Geography, History (approached from the dramatic side), English, and Singing are all adapted to open-air methods. Thus Mensuration, Map Building, and History become inspiring to a pupil who can walk around using a real surveyor's tape, build a map, or even assume, for the time being, the personality of a great historical figure. The children, on entry, are tested by the Northumberland Standardised Tests, which give the teachers the mental age of children in various subjects and an immediate knowledge of the gaps that exist in their education. The children will be tested on leaving, and it is hoped to prove in the future that they advance in educational age more than the actual time period spent at the School. The individual method of teaching has made a great difference to many children, who give evidence of its value, plus the general treatment, in the vigour with which they grapple with their difficulties and in their responsiveness to the instruction given. Full individual records of each child's school career are kept by the teacher; these entail heavy work but are of invaluable assistance in dealing with the child, and should be of use in future for purposes of reference. A love of nature is inculcated by the observation of living plants in the school garden, by the bird bath, the beehives, the wormery, and the goldfish aquaria. Medical Inspection and Hygiene.—The children are under the direct care of the School Medical Officer. They are medically examined upon admission, whilst a Doctor pays a fortnightly visit to the School in order that progress from a health point of view 140 may be ensured. In addition, a nurse attends once a month in order that records of increase in heights and weights of each child may be kept. Every attention is given to personal hygiene. Toothbrush drill is carried out before the day's work commences, and showerbaths are given every other day on the recommendation of the Medical Officer. Meals.—Food is carefully considered. A fortnightly menu is thoughtfully prepared, and dinners of suitable food are cooked on the school premises and are served at midday. After the meal the children rest on special rest chairs in the open. The midday rest lasts for an hour, and, as during cold weather blankets are provided, the time is usually spent in sound and healthy sleep. A nominal charge of 2s. 6d. per week is made to cover the cost of meals, although in necessitous cases this amount is reduced. These payments are called for weekly by the School Attendance Staff during their ordinary rounds of visitation, and, in this manner, £288 13s. 0d. has been collected, which sum, having regard to the reduced payments operating in certain cases, approximates to the amount of expenditure incurred in the provision of the necessary food commodities. Progress.—Photographs are taken of the children upon admission, and it is interesting and easy to note by comparison with the present condition of the children the very marked improvement which has in many cases taken place in the comparatively short time the School has been open; weight and height cards show similar satisfactory results—in some cases as much as nine to twelve pounds having been gained since January, 1929. These cases of marked improvement exist amongst all ages. Many of the children who on admittance appear lethargic, disheartened, and uninterested, become, in a short time, mentally alert, responsive and happier in appearance. The fact that the age-range is five to fourteen years, and that the "House System" is firmly established, has proved of great advantage to the senior pupils, who, it has been observed, have gained not only in health but in a sense of that responsibility which is so vital to children whose physical disabilities have rendered them the "sheltered" in their old school environment. Education Offices, Ilford. 5th December, 1929. 10. Physical Training.—The following is the report of the Supervising Instructor in Physical Training:— I.—Staff. No increase in the staff has been made during the year, II.—Duties and Organisation. My duties as Supervising Instructor in Physical Training continue to be of an advisory, instructional and supervisory character as regards the teaching of physical 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 141 the Board of Education's (a) Syllabus of Physical Training for Schools, 1919; (b) Reference Book of Gymnastic 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 during the year. III.—Special Features. (a) During the year, voluntary classes in physical training, organised games, and folk and country dancing for members of the teaching staff were continued, each lesson being, as heretofore, of one hour's duration. These classes were again much appreciated. (b) From 4th May to 24th July the several playing fields were occupied by the schools almost daily for the conduct of athletic meetings and sports fixtures. A larger number of schools, as compared with last year, undertook these activities, which were all of a most successful character and extensively patronised by the parents. (c) The Annual School Sports, organised by the Ilford Schools' Athletic Association, were held on the Crioklefield Playing Field on Thursday, 27th June. In spite of the weather, which was cold and showery, some excellent results were achieved by the competitors in several events, e.g., hurdles, broad and high jumps, and relay races. Great credit is due to the Association in connection with the generally high standard of the meeting. (d) The Ilford Schools' Football Association continued its successful work, the League and Inter-Cup games arousing a healthy rivalry. The District Team reached the Final of the Corinthian Shield Competition, a very creditable achievement. The Team met the other Finalists, the West Ham Boys, on the ground of the Ilford Football Club on 30th March, a keenlycontested game resulting in a win for West Ham by two goals to nil. (e) The Ilford Schools' Netball and Swimming Associations have also had a very successful season. In this connection, the development of winter swimming for boys is a notable feature. The experiment proved a complete success, sixty per cent. of those taking part remaining for the full course of instruction. Moreover, the movement is increasing in popularity; more schools are providing pupils; and the average attendance is maintaining a satisfactory standard. (f) The work of the Ilford Schools' Cricket Association continues to show great promise. The Ilford Cricket Club again generously granted the use of their ground for a special match, the game being played by teams representing respectively the north and south schools of Ilford. There was a large public attendance at the match; and the ability of the players resulted in considerable enthusiasm. (g) Playground markings have been repainted throughout, and continue to be a valuable amenity. 142 (h) During the year, special home exercises have, on the recommendation of, and in consultation with, the School Medical Officer, been advised in a number of cases of minor physical defect. (i) Two additional playing fields have been allotted during the year, and the increased facilities are gratefully acknowledged by all concerned. (j) During the period covered by this report, valuable assistance has been rendered by the Handicraft Centre and the Works Department in connection with the repair and construction of apparatus for the physical training lessons and school sports meetings. IV.—Review of General Position . In conclusion, I am pleased to state that the steady maintenance of the progress noted in former years, coupled with the loyal co-operation of all grades of the teaching staff, is satisfactory evidence of enthi^iastic interest in the work, enabling the future to be faced with every confidence. F. J. ROBERTS, Supervising Instructor in Physical Training. 31st December, 1929. 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 1929. 11a. Supply of Free Cod-Liver Oil Emulsion, Cod-Liver Oil and Malt, Etc.—During 1929, 14 necessitous cases were dealt with. 12. School Baths.—Vide Annual Report, 1920. 13. Co operation of Parents.—Vide Annual Report, 1920. During 1929, 4,847 parents, or 77 per cent., attended the medical inspections. 14 and 15. Co-operation of Teachers and Attendance Officers.—Vide Annual Report, 1920. 16. Co-operation of Voluntary Bodies.—Since January, 19201, I have acted as Hon. District Correspondent for the National Society for the Prevention of Cruelty to Children. 143 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, 53, made up as follows:— (1) Of neglect 37 (25 reported from, the Public Health Department, for neglecting medical advice, and 12 reported from other sources for general neglect.) (2) Ill-treatment cases 7 (3) Other causes 9 74 children (41 boys and 33 girls) were involved. 55 being of school age. In addition to this work. 199 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 1929, eighteen 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 1 Recommended for admission to a special school for partially blind and deaf children (these children were twins 2 Deaf and Dumb.—Certified fit for re-admission to special school for deaf children 1 144 Epilepsy.—Certified fit to attend ordinary school, subject to precautions 1 Certified unfit to attend ordinary school 2 Recommended for admission to a residential institution for epileptic children 1 Cardiac Disease.—Recommended for admission to a special school for physically defective children 1 Certified unfit to attend any school (to be reexamined 1 Hydrocephalus.—Certified unfit to attend any school 1 Paralysis.—Certified fit to attend ordinary school 3 Certified unfit to attenu any school (to be reexamined) 2 Recommended for admission to a special school for physically defective children 1 ltickets.—Certified fit to attend ordinary school 1 Total 18 1st. Blind Children.—There are seven 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. Four cases are awaiting admission to such schools (three are attending public elementary schools, and one is not attending any school). In addition to these, there are two children (twins), included under Deaf and Dumb Children, who are also partially blind. 2nd. Deaf and Dumb Children.—There are fourteen children falling within this category. Of these, six are deaf and dumb, six are deaf, and two are dumb only. Ten cases are in residential special schools for the deaf, and two are attending a day special school. The remaining two are awaiting admission to a special school (being in attendance at elementary schools in the meantime). Two of the children (twins) are also partially blind. 3rd. Epileptic Children.—There are thirty children known to the department. Two of these are in residential certified schools for epileptics (one being also mentally defective). 23 are attending public elementary schools, 5 are not attending any school (one of these is awaiting admission to a special school, and two are over 14 years of age). 145 4th. Tuberculous Children.—There are six children who have suffered from pulmonary tuberculosis, two of whom are attending public elementary schools, one is in a sanatorium, and three are over 14 years of age and have left school. Three children are suffering from active glandular tuberculosis and are at present attending school. In addition, at the end of 1929, eighty-two 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, twenty-one physically defective children suitable for admission to a cripple school; nine of these cases were not attending school, three were attending public elementary schools, one was attending a private school in the district, three were in institutions, four were attending certified residential cripple schools, and one was attending a certified day cripple school. Of the twenty-one children mentioned, seven are 12 years of age or over. In addition to the above, 80 orthopaedic eases and 113 remedial exercises cases are being referred to the Orthopaedic Surgeon for examination, now the Clinic has commenced at the Public Health Offices. A summary of these cases will appear in my report for the ensuing year. (b) Mentally Defective Children— During 1929 I medically examined and reported upon 16 children under the Mental Deficiency (Notification of Children) Regulations, 1928, classified as follows:— Feeble-minded Children.—Total number certified in 1929 8 Recommended for admission to a special school (day or residential) 2 Recommended for admission to a special school (residential) 4 Recommended for admission to a special school (day) 2 146 Idiot Children.—Total number certified in 1929 2 Recommended for admission to a residential institution 2 Imbecile Children.—Total number certified in 1929 5 Recommended for admission to a residential institution 5 jDull and Backward Children.—Total number certified in 1929 1 Recommended attendance at special class for dull and backward children for one year, and then to be re-examined 1 The following table shows the mental age (by the Binet 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. Actual age in years. Mental age in years. Intelligence Quotient. 7.08 5.8 81.92 7.75 5.2 67.07 8.16 5.8 71.07 8.66 6.2 71.59 8.91 6.3 70.70 12.25 8.5 69.38 13.16 8.8 66.86 15.5 8.9 57.41 (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 Essex County Council. There are 20 cases under the age of 16 years known to the department (1 being notified during the present year). 3 are in a residential institution, and 17 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 18 cases under the age of 16 years known to the department (9 being notified during the present year), 17 are at home, and 1 is attending a public elementary school. 147 (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 1929) 60 such cases under the age of 16 years known to me, of whom 27 are attending public elementary schools in the district, 2 are attending private schools, 1 is at a Convalescent Home, 14 are in residential schools, and 22 are not at school (17 being over 14 years of age). All mentally defective children are visited at home by the School Nurses at least once a quarter. It will be seen that there are 46 educabie 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 6 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 52 educabie 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 1929 it was found that 120 children were employed out of school hours. 4 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 4 148 During 1929, 2 children were examined under Section 13 of the Education Act, 1918 (Employment of Children in Entertainments Act, 1918), the certificates being granted. The Juvenile Employment Committee has, during the past year, found occupation for 697 children, as follows:— ON REGISTER, 1st JANUARY, 1929. Boys Girls. Total. Claimants 11 2 13 Non-claimants 46 53 99 Totals 57 55 112 Fresh Claims to Unemployment Insurance Benefit 123 79 202 Renewal Claims 88 39 127 Totals 211 118 329 Fresh Registration (for work only) 348 313 661 Re-registrations 153 222 375 Totals 501 535 1,036 Total number of young persons dealt with during the year 769 708 1,477 Placed by Bureau: Locally 309 221 530 Placed by Bureau: Non-locally 88 79 167 Totals 397 300 697 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 15 Student-teachers 19 Newly appointed teachers 76 Teachers absent through illness 23 School Caretakers 5 Total 138 Re-examinations:— Bursars 5 Student-teachers 3 Newly appointed teachers 16 Total 24 149 Table I.—Return of Medical Inspections. A.— Routine Medical Inspections. Number of Code Group Inspections:— Entrants 2,351 Intermediates 2.240 Leavers 1,663 Total 6,254 Number of other Routine Inspections Nil. B.—Other Inspections. Number of Special Inspections— Medical Inspection at School 162 At School Clinic 2,157 Number of Re-Inspections— Medical Inspection at School 2,072 At Sohool Clinic 5,182 Total 9,573 150 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1929. 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 referled for Treatment. (1) (2) (3) (4) (5) Malnutrition 4 — 7 — Uncleanliness:— Head 62 — 24 — Body 4 — 2 — Skin Ringworm:— Scalp — — 6 — Body — — 9 — Scabies 3 — 17 — Impetigo 21 — 218 — Other Diseases (Non-Tubercular) 31 3 187 — Eye Blepharitis 15 — 22 — Conjunctivitis 13 — 61 — Keratitis — — — — Corneal Ulcer 1 — 2 — Corneal Opacities 2 — — — Defective Vision 418* 49 65 11 Squint 17 — 2 1 Other Conditions 12 — 35 — Ear Defective Hearing 32 9 19 — 1 Otitis Media 19 — 51 — 1 Other Ear Diseases 36 2 24 — Nose and Throat Enlarged Tonsils only 140 32 54 7 Adenoids only 35 10 24 — Enlarged Tonsils and Adenoids 147 19 57 8 (Other Conditions 54 23 199 6 Enlarged Cervical Glands (Non-Tubercular) 17 5 75 — Defective Speech 6 3 2 1 Teeth—Dental Diseases 328 — 71 — Heart and Circulation Heart Disease:— Organic 14 12 4 4 Functional 9 14 3 3 Anaemia 24 11 19 7 Lungs Bronchitis 30 19 31 — Other Non-Tubercular Diseases 7 2 14 — Tuberculosis Pulmonary:— Definite — — — — Suspected 4 5 2 — Non-Pulmonary:— Glands 7 — 3 — Spine — — — - Hip — — — — Other Bones and Joints 1 — — — Skin — — — — Nervous System Other Forms — — — — Epilepsy 5 — 1 2 Chorea 7 — 4 1 Other Conditions 9 6 9 — Deformities Rickets 2 — 1 — Spinal Curvature 9 — 2 — Other Forms 43 5 11 — Other defects and diseases 184 29 632 — *87 of these cases saw f but were suffering from other conditions, rendering refraction advisable. 151 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 2,351 702 29.8 Intermediates 2,240 450 20.0 Leavers 1,663 331 19.9 Total (Code Groups) 6,254 1,483 23.7 Other Routine Inspections — — — 152 Table III.—Return of all Exceptional Children in the Area in 1929. — — — 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 1 — 1 Deaf (including deaf and dumb and partially deaf) (i) Suitable for training in a School or Class for the totally deaf or deaf and dumb Attending Certified Schools or Classes for the Deaf 8 3 11§ Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — (ii) Suitable for training in a School or Class for the partially deaf Attending Certified Schools or Classes for the Deaf — 1 1 Attending Public Elementary Schools 1 1 2 At other Institutions — — — At no School or Institution — — — Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority) Attending Certified Schools for Mentally Defective Chn. Attending Public 7 7 14 tary Schools At other Institutions (Priv- 13 14 27 f vate School) At other Institutions 2 2 valescent Home) — 1 1 At no School or Institution 14 8 22 J Epileptics Suffering from severe epilepsy. Attending Certified Special Schools for Epileptics 1 1 2ø In Institutions other than Certified Special Schools — — — Attending Public Elementary Schools 1 1 2 At no School or Institution 2 1 3¶ Suffering from epilepsy which is not severe Attending Public Elementary Schools 12 9 21 At no School or Institution 1 1 2 153 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. 1 1 2 At other Institutions — — — At no School or Institution 1 2 3* Non-infectious but active glandular tuberculosis At Public Elementary Schls. 1 2 3 Delicate children (.e.g., pre—or latent tuberculosis, malnutrition, debility anaemia, etc.) At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools 52 46 98 At Public Elementary Schls. 50 32 82 At other Institutions — 1 1 At no School or Institution — — — 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 2 2 4 At Certified Day Cripple Scs. 1 — 1 At Public Elementary Schls. 3 — 3 At other Institutions 2 1 3 At no School or Institution 3 6 9 At Private School 1 1 * These cases are over 14 years of age. † 6 of these children are from Mossford School, Dr, Barnardo's Girls' Village Home. ‡ 17 of these cases are over 14 years of age. ø 1 of these children is also mentally defective. § 2 of these children are also partially blind. ¶ 2 of these children are over 14 years of age. 154 Table IIIa. Statement of the Number of Children Notified During the Year Ended 31st December, 1929, by the Local Education Authority to the Local Mental Deficiency Authority. Total number of children notified 12 Analysis of the Above Total. Diagnosis. Boys. Girls. (1) i. Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots — 1 (b) Imbeciles 4 5 (c) Others — — ii. Children unable to be instructed in a Special School without detriment to the interests of the other children: (a) Moral defectives — — (b) Others — 1 (2) Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 1 — (3) Feeble-minded children notified 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 5 7 155 Table IV.—Return of Defects Treated during the Year ended 31st December, 1929. 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) Skin:— Ringworm—Scalp 6 — 6 Ringworm—Body 9 — 9 Scabies 17 — 17 Impetigo 218 — 218 Other skin disease 187 64 251 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 120 51 171 Minor Ear Defects 94 44 138 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 597 549 1,146 Total 1,248 708 1,956 156 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 refraotion by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for Squint should be recorded separately in the body of the Report). 545 11 7 563 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) — — — — Total 545 11 7 563 Total number of children for whom spectacles were prescribed:— (а) Under the Authority's Scheme 456 (b) Otherwise 18 Total number of children who obtained or received spectacles :— (a) Under the Authority's Scheme 456 (b) Otherwise 18 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total Number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total (1) (2) (3) (4) (5) 290 61 351 32 383 157 Table IV.—Continued. Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentists:— Aged: Total 10,365 Routine Age Groups 5 1,282 6 1,630 7 1,636 8 1,816 9 1,915 10 1,130 11 956 Specials 328 Grand Total 10,693 (b) Found to require treatment 6,485 (c) Actually treated 3,295 (d) Re.treated during the year as the result of periodical examination 1,073 (2) Half.days devoted to Inspection 232 Total 611 Treatment 379 (3) Attendances made by children for treatment 5,017 (4) Fillings Permanent Teeth 1,095 Total 3,553 Temporary Teeth 2,458 (5) Extractions Permanent Teeth 446 Total 6,291 Temporary Teeth 5,845 (6) Administrations of general anaesthetics for extractions 1,478 (7) Other operations Permanent Teeth 595 Total 983 Temporary Teeth 388 Group V.—Uncleanliness and verminous conditions. (i.) Average number of visits per school during the year by the School Nurses 7 (ii.) Total number of examinations of children in the Schools by School Nurses 41,470 (iii.) Number of individual children found unclean 1,233 (iv.) Number of children cleansed under the arrangements made by the Local Education Authority 7 (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil (b) Under School Attendance Bye.laws. Nil 158 159 Table V.—Table showing number of Children Medically Inspected at various Schools during 1929. 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 25 21 2 2 3 6 14 33 2 — 1 1 1 1 10 25 - - - - 58 89 Becontree 175 187 53 35 29 19 174 204 21 22 - 1 17 6 133 129 4 1 - - 606 604 Open Air 1 1 4 3 9 9 14 11 11 8 7 7 4 2 7 6 4 7 - - 61 54 Chadwell 12 14 4 1 3 3 11 12 2 — 1 - - - 7 5 - - - - 40 35 Christchurch 46 45 36 19 4 13 69 57 — 1 — — - 1 39 44 - - - - 194 180 Cleveland 96 80 16 14 6 6 47 97 3 1 — 3 1 2 63 48 - 3 - - 232 254 Downshall 109 116 14 11 16 8 114 113 1 2 1 3 3 5 54 47 2 11 . . 314 316 Fairlop 12 10 4 5 - — — — — — — - - - - - - - - - 16 15 Gearies 37 44 8 8 — — 27 18 4 2 - 5 - 2 - 4 - 7 - - 76 90 Goodmayes 70 74 16 17 15 7 86 87 — 5 — 3 - 1 75 65 2 3 1 - 265 262 Highlands 66 54 9 10 9 11 65 79 3 - 2 2 1 20 41 3 1 - - 174 202 Little Heath 9 9 2 2 — — 9 7 2 - 2 - - - 3 3 - - - - 27 21 Loxford 69 61 20 10 8 5 68 73 1 - 1 - - 14 44 44 - - - - 211 207 Mossford — 11 — 18 — 27 — 17 — 16 — 19 - 27 - 29 - 30 - - - 194 Newbury Park 39 35 3 9 4 2 45 33 — - - 2 - - 17 43 - - - - 108 124 Roman Catholic, Ilford 21 35 1 2 4 2 48 23 — — 2 1 — 3 33 16 - - 109 82 St. Vincent's R.C., Bec. 29 24 28 28 — — 34 21 5 17 3 1 1 6 3 10 - 3 - - 103 110 South Park 49 42 9 13 8 1 58 49 3 1 - - 35 20 36 49 - - - 198 175 Uphall 38 30 5 8 1 3 36 28 3 1 - - 1 - 29 30 1 - - - 114 100 Valentines 34 35 24 13 4 3 59 52 3 - 1 1 1 2 - 2 - - - - 126 108 Total 937 928 258 228 123 125 978 1014 61 79 19 49 66 93 573 640 16 66 1 - 3032 3222 Specials. Barkingside 4 - - - - 1 - - - - 1 - - - - - - - - - 5 1 Becontree — 4 2 3 3 2 7 10 1 1 4 - 3 1 1 2 - 1 - - 21 24 Open Air — — — — - - - - - - - - - - - - - - - - - - Chadwell — I 1 — — — 1 1 - - - - - - 1 - - - 3 2 Christchurch 3 — 1 3 — 2 - - - - - - 1 - 2 - - - - - 7 5 Cleveland — 2 — 1 — — — 1 - - - 1 1 - - - - - - 1 5 Downshall 2 1 7 3 1 4 — 1 2 2 . . . . . 2 . . . . 12 13 Fairlop — — — 1 — — — - - - - - - - - - - - - - - 1 Gearies — 2 - - - - 2 - - - - 1 - - - - - - - 1 4 Goodmayes — 1 — 1 — 1 3 1 1 - 1 - - 2 1 1 - - - - 6 7 Highlands 2 3 3 — 1 - - - - 1 - - - - - 2 - - - - 6 6 Little Heath — — 1 — — 1 — — - 1 - 1 - - - - - - - - 1 3 Loxford 1 1 — — 2 - - - - - - - - - - - - - - - 3 1 Mossford - - - - - - - - - 1 — — - - - 1 - - - - - 2 Newbury Park — 1 2 — — 1 — 1 — 1 — — - 1 - - - - - - 2 5 Roman Catholic, Ilford — 1 — 1 1 - - - - - - - - - - - - - - - 3 2 St. Vincent's R.C., Bec. 1 — — — 1 — 1 — — 1 — — 1 - - - - - - - 4 1 South Park — 1 - - - 1 - - - - - - - - - - - - - - - 2 Uphall - - - - - - - - 1 — — - - 2 - - - - - - 1 2 Valentines — — — — — — — — - - — — - - - - - - - - - - Total 13 18 7 13 9 13 12 17 5 8 8 2 7 6 4 8 1 1 — — 76 86 Grand Total 3108 3308 Total Number of Children Examined, 6,416. 160 161 Table VI. A.—Table Showing the Average Heights and Weights of the BOYS Examined. School. Age Groups. Age Groups. 5—6 Years. 6—7 Years. 7—8 Years. 8—9 Years. 9—10 Years. 10—11 Years. 11—12 Years. 12—13 Years. 13—14 Years. 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 i Examined. Average Height (In Inches) Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (Tn 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 25 42.03 40.17 2 46.13 45.87 3 46.38 49.70 14 49.60 51.03 2 54.71 59.42 1 56.23 68.31 1 53.61 73.73 10 59.44 74.82 - - - Becontree 175 42.87 42.83 53 45.40 48.23 29 48.21 50.23 174 49.93 52.67 21 52.77 58.77 - - - 17 55.92 70.85 133 57.30 71.63 4 59.39 78.61 Open Air 1 42.19 38.34 4 42.51 40.78 9 46.85 43.27 14 48.11 50.38 11 51.38 53.39 7 50.78 50.92 4 55.51 73.41 7 56.61 70.70 4 53.14 60.62 Chadwell 12 41.68 39.26 4 44.32 48.31 3 51.30 49.82 11 51.18 50.14 2 50.46 61.42 1 67.10 71.85 — — — 7 58.47 69.03 — — — Christchurch 46 42.16 45.01 36 46.29 46.14 4 46.29 48.67 69 50.62 53.38 — — — - — — — — — 39 54.72 72.63 — — — Cleveland 96 42.07 43.17 16 43.72 49.10 6 48.23 50.51 47 48.31 52.35 3 49.44 57.31 - — — 1 52.38 69.02 63 55.90 74.61 — — — Downshall 109 41.93 40.99 14 47.29 46.31 16 46.07 51.36 114 48.32 50.81 1 48.07 54.81 1 63.17 64.40 3 59.60 70.46 54 56.39 70.37 2 58.41 76.39 Fairlop 12 43.37 46.46 4 49.41 43.29 - - - - - - - - - - - - - - - - - - - - - Gearies 37 41.70 40.34 8 46.72 49.31 - - — 27 47.91 53.74 4 51.46 59.30 - — — — — — — — — — — — Goodmayes 70 42.13 42.27 16 45.18 47.32 15 47.38 49.40 86 48.32 52.34 — — — - — — — — — 75 56.17 76.42 2 58.79 80.43 Highlands 66 44.01 41 63 9 43.63 49.60 9 46.37 49.91 65 49.18 49.38 — — — - — — 2 61.70 74.24 20 58.31 71.83 3 59.32 81.25 Little Heath 9 42.18 42.70 2 41.34 50.02 — — — 9 51.33 53.62 2 51.40 57.40 2 54.29 60.84 — — — 3 54.72 70.41 — — — Loxford 69 42.03 42.18 20 45.91 47.23 8 47.87 50.23 68 47.02 52.47 1 53.03 63.88 1 53.95 64.27 — — — 44 55.53 72.36 — — — Mossford - - - - - - - - - - - - - - - - - - - - - - - - - - - Newbury Park. 39 43.12 41.44 3 44.05 46.29 4 50.14 49.48 45 51.30 52.87 — — — - — — — — — 17 54.92 69.41 — — — Roman Catholic 21 42.74 42.37 1 46.12 50.92 4 46.32 48.70 48 48.37 51.49 — — — 2 52.36 64.79 — — — 33 58.00 72.86 — — — St. Vincent's. 29 41.39 40.16 28 45.17 47.33 — — — 34 47.64 49.30 5 52.71 59.05 3 54.51 68.15 1 56.30 70.13 3 59.31 81.23 — — - South Park 49 42.18 43.20 9 42.81 48.71 8 47.62 50.38 58 49.39 53.97 3 52.17 58.45 - - - 35 55.69 69.82 36 54.16 73.61 - — - Uphall 38 41.72 43.55 5 45 .09 46.39 1 44.29 51.17 36 48.70 50.47 3 50.82 60.22 - - - 1 53.84 74.33 29 54.62 72.94 1 57.62 77.16 Valentines 34 42.56 43.01 24 44.61 47.04 4 48.03 49.82 59 47.94 52.63 3 49.24 55.91 1 54.57 60.32 1 63.81 70.28 — — — — — — Average Heights and Weights of Ilford Children 937 42.17 41.73 258 45.83 46.03 123 46.29 49.63 978 48.33 51.55 61 51.18 57.64 19 53.89 59.63 66 55.80 66 42 573 56 91 72.63 16 57 02 74.83 Anthropometric Standard (Boys). Ages. Ages. 5 Years. 6 Years. 7 Years. 8 Years. 9 Years. 10 Years. 11 Years. 12 Years. 13 Years. Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) 40.68 38.68 42.83 42.24 45.04 46.40 47.39 52.00 49.18 55.90 50.84 60.35 52.98 66.41 54.88 72.66 56.07 77.40 162 163 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 Child re Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height tin inches.) Average Weight (in pounds). No. of Children Examined. Average Height (in inches;. Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). Barkingside 21 43.79 39.61 2 48.63 46.38 6 45.98 45.18 33 47.61 50.07 - - - 1 50.34 67.97 1 57.28 70.92 25 57.36 69.04 Becontree 187 41.43 41.38 35 44.70 45.61 19 47.39 50.30 204 48.28 49.18 22 51.29 57.32 1 54.23 63.24 6 53.72 72.36 129 58.91 74.32 1 57.63 91.70 Open Air 1 43.87 35.26 3 44.49 36.39 9 46.85 47.25 11 47.61 46.95 8 49.80 51.36 7 54.33 66.13 2 52.98 66.13 6 56.69 76.27 7 57.74 75.29 Chadwell 14 42.91 42.83 1 46.81 47.92 3 46.31 48.69 12 48.52 53.04 — — — — — — — — — 5 55.63 71.61 — — — Christchurch 45 42.64 42.82 19 43.64 46.87 13 46.46 48.91 57 47.37 53.62 1 48.13 53.21 — — — 1 55.70 71.33 44 59.70 75.94 — — — Cleveland 80 43.60 40.95 14 42.55 44.97 6 49.01 47.84 97 48.30 49.80 1 52.16 57.93 3 49.71 66.73 2 54.03 66.39 48 55.11 73.07 3 57.83 83.65 Downshall 116 42.06 41.57 11 41.65 46.81 8 47.32 52.16 113 51.07 53.24 2 51.93 60.78 3 54.32 69.07 5 55.17 69.63 47 56.09 73.43 11 58.00 87.91 Fairlop 10 43.21 42.68 5 44.81 44.61 - - - - - - - - - - - - - - - - - - - - - Gearies 44 42.63 40.38 8 43.02 42.94 — — — 18 49.43 51.65 2 49.87 57.86 5 52.99 65.32 2 52.16 71.64 4 57.82 81.29 7 58.37 84.93 Goodmayes 74 43.00 43.79 17 44.17 44.87 7 45.17 47.52 87 47.06 54.16 5 50.67 59.03 3 54.35 62.07 1 54.29 70.18 65 55.54 76.12 3 59.69 90.07 Highlands 54 42 .39 40.91 10 42.63 45.86 11 46 .45 49.62 79 49.31 52.37 3 54.16 55.80 2 50.15 70.13 1 56.67 67.52 41 57.91 78.64 1 62.55 77.51 Little Heath 9 41.43 43.87 2 49.91 47.20 - - - 7 46.16 49.32 - - - - - - - — — 3 54.99 77.33 — — — Loxford 61 43.78 40.72 10 46.89 45.01 5 47.18 46.90 73 47.83 50.27 — — — — — — 14 54.11 69.18 44 58.85 78.90 — — — Moseford 11 49.37 41 .80 18 45.07 44.65 27 46.33 47.83 17 46.39 49.17 16 49.39 57.39 19 51.53 68.73 27 53.57 71.13 29 54.70 76.27 30 58.07 85.87 Newbury Park 35 42.62 38.37 9 44.06 39.72 2 46.37 45.61 33 43.82 52.30 - - - 2 53.35 70.33 — — — 43 56.19 74.63 — - — Roman Catholic 35 41.30 40.26 2 43.24 45.73 2 48.16 53.71 23 48.21 57.29 — — — 1 50.39 72.51 3 55.01 69.28 16 57.20 78.44 — - — S.Vincent's R.C. 24 41.36 38.67 28 43.20 42.93 — — — 21 50.04 53.38 17 51.03 61.82 1 52.87 67.93 6 53.23 74.23 10 60.36 70.72 3 58.96 79.67 South Park 42 42.46 42.30 13 45.52 44.81 1 46.51 49.44 49 45.23 56.33 1 54.16 58.79 — — — 20 54.71 70.39 49 57.33 73.39 — — — Uphall 30 43.40 39.01 8 49.97 39.40 3 47.83 50.87 28 44.67 51.82 1 47.49 53.82 — - — — — — 30 56.19 69.18 — — — Valentines 35 42.67 40.60 13 41.85 42.38 3 44.60 47.37 52 48.71 49.47 — — — 1 53.27 68.70 2 53.99 71.85 2 58.74 74.05 — — — Average Heights and Weights of Ilford Children 928 42.76 40.83 228 43.17 43.25 125 45.02 47.89 1014 46.53 51.10 79 50.06 56.91 49 51.96 67.33 93 53.07 69.69 640 56.83 71.13 66 57.82 84.03 Anthropometric Standard (Girls) Ages. Ages. 5 Years. 6 Years. 7 Years. 8 Years. 9 Years. 10 Years. 11 Years. 12 Years. 13 Years. Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) 40.44 37.74 42.53 41.24 44.76 44.93 46.94 49.55 48.71 54.09 50.60 58.69 53.01 65.52 55.48 73.86 56.81 80 37 164 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, 1929. SCHOOLS. Number on Roll. DISEASES AND CONTACTS. Scarlet Fever. Diphtheria. Measles & German Measles. Chicken. pox. Whooping Cough. Mumps. Small Pox. Ringworm. Totals. 1929. Totals. 1928. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Cases. Contacts. Cases. Contacts. Barkingside 254 8 6 6 10 1 3 18 15 4 4 2 - - - 1 40 36 97 41 Becontree 2138 64 80 43 38 24 19 32 20 44 9 38 — - - - 245 165 242 139 Open Air 98 3 2 1 2 — - 1 1 — - - - - - - 5 5 - - Chadwell 228 3 6 2 1 — — 1 1 10 - - - - - - 16 8 42 14 Christchurch 1141 17 21 18 19 23 15 58 14 4 1 17 — - - - 137 70 200 68 Cleveland 1149 15 13 10 8 6 5 28 4 16 4 63 — - - - 138 34 206 75 Downshall 1514 35 30 10 8 6 1 20 3 16 3 48 - - - 2 137 45 401 147 Fairlop 144 — — 1 1 — - — - - - - - - - - 1 1 - - Gearies 836 13 7 — — 2 - 46 14 1 1 — - 1 - - 63 22 - - Goodmayes 1369 20 26 59 63 7 3 14 9 38 5 16 — 1 2 - 155 108 308 90 Highlands 1057 23 16 3 8 24 9 49 15 9 1 2 — - 1 - 110 50 347 80 Little Heath 102 1 3 — - 2 2 - — 7 - - - - - - 10 5 3 - Loxford 982 18 15 3 3 15 8 4 - 38 5 6 — - - 1 85 31 251 69 Newbury Park 707 7 13 5 3 2 1 10 1 15 6 7 - - - 2 48 24 90 53 Roman Catholic, Ilford 454 9 17 4 5 6 3 36 22 17 3 13 - - 2 - 85 52 74 28 St. Vincent's R.C., Bec 366 1 — 2 1 — - - - - - 1 - - - - 4 1 - - South Park 1292 17 12 22 24 1 1 3 2 30 2 10 — - - - 83 41 177 41 Uphall 652 9 12 6 9 21 8 11 6 19 1 29 — - - - 95 36 90 46 Valentines 298 8 5 3 3 1 2 — — 10 2 - — - - - 22 12 103 20 County High — 5 7 1 4 - - - - - - - - - - - 6 11 4 10 Private — 27 29 10 12 - - - - - - - - 1 1 - 38 42 50 45 Mossford (G.V.H.) 781 6 — 1 — — — — — — — — — — — — 7 - 9 - Totals 15562 309 320 210 222 141 80 331 125 278 47 252 — 3 6 6 1530 799 2694 966 Acute Influenzal Pneumonia:—1 case (Downshall). Acute Primary Pneumonia:—3 cases (Christchurch); 2 cases (Newbury Park); 5 cases (Becontree); and 1 case (South Park). Encephalitis Lethargica:—1 case (Downshall). 165 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, 1929. SCHOOLS. No. on Roll. Jan. Feb. Mar. 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 254 - - - - - - - - - - - - 1 - 1 - 2 2 2 - 2 4 8 6 2 3 Becontree 2138 2 1 — 2 - — 1 - - - 2 5 9 11 15 21 24 29 3 3 8 8 64 80 32 52 Open Air 98 - - 1 - - - - - - - - - - 1 1 - - 1 - - 1 — 3 2 — — Chadwell 228 - — 1 — - — — - - 3 — — 1 1 — — — — — — 1 2 3 6 4 8 Christchurch 1141 2 2 - — - — 1 1 - — — — — — — — 2 6 7 6 5 6 17 21 19 27 Cleveland 1149 4 1 — - 1 - 1 1 1 — 2 1 1 — 1 1 I 4 — 4 3 1 15 13 30 22 Downshall 1514 4 2 6 7 4 4 1 2 - 4 1 1 — 3 6 4 3 1 7 — 3 2 35 30 83 87 Fairlop 144 — — — — — — — — - — — — — — — — — — — — — — — - — — Gearies 836 — — — — — — — — - — — — 2 — 1 — 3 2 3 3 4 2 13 7 — — Goodmayes 1369 - — 2 2 1 1 2 1 2 1 1 9 3 3 2 3 2 6 4 6 1 1 20 26 20 26 Highlands 1057 5 4 4 2 3 4 1 1 2 2 1 - 3 — — — 1 — — — 3 3 23 16 39 21 Little Heath 102 - — — — — — — — — — — 2 — — — — 1 1 — — — — 1 3 1 — Loxford 982 1 2 6 1 — — - — 2 — 2 3 — 3 1 2 3 4 3 — — — 18 15 35 22 Newbury Park 707 3 3 — 6 — — 1 — — — — — — — — — 1 3 2 1 — — 7 13 10 15 R. Catholic Ilford 454 1 — — — 3 4 1 2 1 - - - - - - 2 - - 1 5 2 4 9 17 5 4 S.Vincent'sR .C. Bc. 366 — — — — — — — — — — — — — — — — — — — — 1 — 1 — — — South Park 1292 1 — 2 — — — — — — — 1 — 1 4 — — 2 2 5 5 5 1 17 12 18 7 Uphall 652 3 1 1 1 - - 1 - - 2 - 3 - - - - - - 1 5 3 — 9 12 13 8 Valentines 298 — — 5 2 1 1 — — — 1 — — 2 1 — — — — — — — — 8 5 5 1 County High - — 1 1 3 — — - 1 — — — — — 1 — — 2 — 2 1 — — 5 7 4 8 Private — 5 9 3 — 5 4 3 1 2 4 1 1 1 3 1 1 1 2 1 3 4 1 27 29 29 31 Mossford (G.V.H.) 781 2 — — — 2 — — — 1 — — — — — — — — — — — 1 — 6 — — — Totals 15562 33 26 32 26 20 18 13 10 11 17 11 18 24 31 29 34 48 63 41 42 47 35 309 320 349 342 166 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, 1929. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July and August. Sept. Oct. Nov. Dec. Totals, 1928. Total. 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 254 - - - 2 - - 1 - 1 - - 1 1 4 - - 3 3 - - - - 6 10 - - Becontree 2138 2 4 4 3 2 2 - - - - 1 2 5 3 - - 4 3 10 11 13 10 43 38 12 27 Open Air 98 - - - - - - - - - - - - - - - - - - - - 1 1 1 2 - - Chadwell 228 — - - - - - - - - - - - 1 - - - 1 1 - - - - 2 1 1 2 Christchurch 1141 2 - 2 4 - - - - - - 1 - 1 1 2 1 2 6 7 2 2 18 19 11 10 Cleveland 1149 1 1 - - - - - - - - - - - 2 1 - 1 - 3 3 3 2 10 8 9 14 Downshall 1514 - - 1 1 - - - - - - - - 1 1 - - - - 5 5 .3 1 10 8 6 16 Fairlop 144 - - - - - - - - - - - - - - - - - - - - 1 1 1 1 - - Gearies 836 — — — — - — - - - - - - - - - - - - - - - - - - - - Goodmayes 1369 1 - - 2 - - - - - - - - 3 3 7 8 19 27 17 15 12 8 59 63 12 11 Highlands 1057 - - - - - - - - - - 1 5 1 - - 1 - 1 - - 1 1 3 8 7 15 Little Heath 102 — — — — - — - - — - — - - - - - - - - - - - - - - - Loxford 982 - - - - - - 1 - - - - - - 1 1 1 1 1 - - - - 3 3 9 15 Newbury Park 707 - - 1 - - 1 - - - - 2 1 - - - - - - 2 1 - - 5 3 4 11 R. Catholic Ilford 454 - 1 - - 1 2 - - 1 - - - - - - - 2 1 - 1 - - 4 5 1 6 S. Vincent'sR .C .,Bc. 366 - - - - - - - - - - - - - - - - - - 1 1 1 - 2 1 - - South Park 1292 - - - - - - - - - - - - - - 1 - 4 6 11 11 6 7 22 24 9 12 Uphall 652 4 2 2 5 - - - 2 - - - - - - - - - - - - - - 6 9 16 23 Valentines 298 — — 1 1 - — - - — - 1 — 1 2 - - - - - - - - 3 3 1 3 County High — — — — — - — - - — - — — — — - - - 1 - 2 1 1 1 4 - 2 Private - 1 - 4 - 1 - - - - 2 1 - - - - - - 3 2 3 1 4 10 12 10 9 Mossford (G.V.H.) 781 - — 1 - - - — — — - - - - — — — — - - - - - 1 - 9 - Totals 15562 11 8 16 18 5 5 2 3 4 2 7 9 14 17 12 11 37 51 57 60 45 38 210 222 117 176 167 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, 1929. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July and August. Sept. Oct. Nov. Dec. Totals, 1929. Totals, 1928. 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 254 - - — - - - - - — - 1 1 - 9 - - - - - - - - 1 3 77 35 Becontree 2138 - — — - 2 2 5 4 8 6 5 3 - - 1 2 2 1 1 1 - - 24 19 62 24 Open Air 98 - — — - — — - — — — - - - - - - - - - - - - - - - - Chadwell 228 - - - - - - - - - - - - - - - - - - - - - - - - 33 4 Christchurch 1141 - — — - 2 — 1 — 9 5 9 4 1 3 — - - 2 1 1 - - 23 15 139 25 Cleveland 1149 - — — - 2 9 — — — - 1 - 1 3 — - - - 1 - 1 - 6 5 127 35 Downshall 1514 - - - - - - 2 1 2 - - - - - - - 1 - - - 1 - 6 1 183 28 Fairlop 144 - - - - - - - - - - - - - - - - - - - - - - - - - - Gearies 836 - - - - - - - - - - - - - - - - - - - - 2 - 2 - - - Goodmayes 1369 - — 4 1 — - 1 1 1 — 1 1 - - - - - - - - - - 7 3 160 42 Highlands 1057 - — — - 2 1 2 2 5 — 11 4 3 2 — - 1 - — - - - 24 9 173 26 Little Heath 102 - - - - - - - - 2 2 - - - - - - - - - - - - 9 2 1 - Loxford 982 - — 1 - — - 3 — 3 3 8 5 - - - - - - - - - - 15 8 162 22 Newbury Park 707 - - - - - - - - 1 1 1 - - - - - - - - - - - 2 1 60 25 Roman Catholic 454 - - - - - - 2 - - - 3 3 - - - - 1 - - - - - 6 3 57 16 S.Vincent'sR .C .Bc 366 - - - - - - - - - - - - - - - - - - - - - - - - - - South Park 1292 - - - - - - 1 1 - - - - - - - - - - - - - - 1 1 33 4 Uphall 652 - - - - - - 1 — 5 4 8 1 7 3 - - - - - - - - 21 8 57 15 Valentines 298 - 1 - - - - - - - - - - - - 1 1 - - - - - - 1 2 53 7 County High - - - - - - - - - - - - - - - - - - - - - - - - - - - Private - - - - - - - - - - - - - - - - - - - - - - - - - 6 3 Mossford (G.V.H.) 781 - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 15562 - 1 5 1 8 5 18 9 36 21 48 22 12 13 2 3 5 3 3 2 4 - 141 80 1383 311 168 CHICKENPOX. Table XI.—Summary of Cases of Chickenpox among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended 31st December, 1929. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July and August. Sept. Oct. Nov. Dec. Totals, 1929. Totals, 1928. 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 254 12 10 - - - - 1 - 5 3 - - - - - - - - - — - - 18 13 9 3 Becontree 2138 10 6 8 6 4 1 — 1 1 — - 1 1 1 - 3 - — — 1 1 32 20 74 26 Open Air 98 - - - - - - - - - - - - - - - 1 - - - - - - 1 1 — — Chadwell 228 - - - - - - - - - - - - 1 1 - - - - - - - - 1 1 2 — Christchurch 1141 - - - - - - - - 2 1 18 2 33 10 4 1 — - 1 — - - 58 14 3 2 Cleveland 1149 4 1 — — 4 1 10 - 2 1 — — — — 2 - 2 1 4 — - - 28 4 6 1 Downshall 1514 - - - - - - - - 4 2 3 1 11 — — - 1 - — — 1 - 20 3 6 2 Fairlop 144 — — — — — — — — — — — — — — — - — - — — - - — — — — Gearies 836 - - - - - - - - - - - - - - - 2 12 3 19 7 15 2 46 14 — — Goodmayes 1369 — — 2 2 1 — 1 — 1 — — — 2 2 — — — — 3 3 4 2 14 9 11 4 Highlands 1057 1 — 1 1 — — — — 5 3 7 — 34 10 — — — 1 1 — — — 49 15 68 15 Little Heath 102 — — — — — — — — — — — — — — — — — — — — — — — — — — Loxford 982 - - 2 - - - - - - - - - - - - - - - - - 2 — 4 — 6 4 Newbury Park 707 - - - - - - 7 — 1 1 1 — 1 - - - - - - - - - 10 1 10 2 R. Catholic, Ilford 454 — — — — 10 11 9 5 16 6 - - 1 - - - - - - - - - 36 22 5 2 S.Vincent'sR.C.,Bc 366 - - - - - - - - - - - - - - - - - - - - - - - - - - South Park 1292 - - - - - - 1 - - - 1 1 - - - - - - 1 1 — — 3 2 46 14 Uphall 652 2 1 — — — — 1 — — — 1 2 6 2 - - - - - - 1 1 11 6 1 - Valentines 298 - - - - - - - - - - - - - - - - - - - - - - - - 28 4 County High - - - - - - - - - - - - - - - - - - - - - - - - - - - Private - - - - - - - - - - - - - - - - - - - - - - - - - 3 2 Mossford (G.V.H.) 781 — — — — — — — — — — — — — — — — — — — — - — - - — - Totals 15562 29 18 13 10 21 16 31 5 37 18 31 6 90 26 7 4 18 5 30 11 24 6 331 125 278 81 169 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, 1929. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July and August. Sept. Oct. Nov. Dec. Totals, 1929. Totals, 1928. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. COHtS. Cases. Conts. Barkingside 254 - - - - - - - - - - 4 2 - 2 - - - - - - 4 4 8 - Becontree 2138 — - 2 1 8 2 13 2 7 3 7 — 7 1 - - - - - - - - 44 9 33 10 Open Air 98 - - - - - - - - - - - - - - - - - - - - - - - - - - Chadwell 228 3 - — - 7 — - - — - — — - — — - - - - - — - 10 - 1 - Christchurch 1141 — - 1 - 1 — 1 1 — — 1 — - — — - - - - - — - 4 1 19 4 Cleveland 1149 4 1 4 1 4 1 3 — — — — — 1 1 — - - - - - — - 16 4 29 3 Downshall 1514 - - 3 2 1 - 6 1 3 - 2 - 1 — — - - - - - - - 16 3 96 14 Fairlop 144 - - - - - - - - - - - - - - - - - - - - - - - - - - Gearies 836 - - - - - - - - - - - - - - 1 1 - - - - - - 1 1 - - Goodmayes 1369 1 - 1 — 9 3 22 2 3 — 1 - - - - - 1 - - - - - 38 5 30 7 Highlands 1057 1 1 3 — 1 — — — 1 — 1 — 2 — — — - - - — - 9 1 52 3 Little Heath 102 — - — — 1 — 6 — — — — — - — — - - - - — - 7 — - — Loxford 982 26 4 5 — 4 — 1 — 1 — 1 — - — — 1 - - - - — - 38 5 37 6 Newbury Park 707 — — — — 5 — 1 2 8 3 1 1 - - - - - - - - - - 15 6 5 - R. Catholic, Ilford 454 1 1 3 — 1 — 3 — 3 1 — — 6 — — 1 - - - - — - 17 3 4 — S.Vincent'sR.C.,Bc. 366 - - - - - - - - - - - - - - - - - - - - - - - - - - South Park 1292 12 1 8 1 3 — 4 — 1 — 1 — 1 — — - - - - — - 30 2 8 4 Uphall 652 — — 5 — 7 1 3 — 3 — 1 — - — — - - - - - — - 19 1 3 — Valentines 298 10 2 - - - - - - - - - - - - - - - - - - - - 10 2 16 5 County High - - - - - - - - - - - - - - - - - - - - - - - - - - - Private - - - - - - - - - - - - - - - - - - - - - - - - - - - Mossford (G.V.H.) 781 - - - - - - - - - - - - - - - - - - - - - - - - - - Total 15562 58 10 35 5 52 7 63 8 30 7 16 1 22 4 1 5 1 - - - - - 278 47 341 56 170 MUMPS. TABLE XIII.—Summary or Cases of Mumps among School Children, and of Contacts of such Cases, excluded from School Attendance, during the Year ended 31st December, 1929. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July and August. Sept. Oct. Nov. Dec. Totals, 1929. Totals, 1928. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Casss. Conts. Barkingside 254 - - - - - - - - - - - - - - - - - - 2 - - - 2 - 1 - Becontree 2138 6 — 6 — 5 — 13 - 6 — 2 - — - - — — — - — - - 38 — 28 — Open Air 98 - - - - - - - - - - - - - - - - - - - - - - - - - - Chadwell 228 - - - - - - - - - - - - - - - - - - - - - - - - 1 — Christchurch 1141 — — — — — — 1 - 2 — 5 - 9 - - — — — - — - - 17 - 8 — Cleveland 1149 1 — — — 1 — — - 9 — 29 - 21 - 1 — — — - — 1 - 63 - 5 — Downshall 1514 — — — — 3 — 8 - 15 — 8 - 13 - 1 — — — - — - - 48 - 21 — Fairlop 144 - - - - - - - - - - - - - - - - - - - - - - - - - - Gearies 836 - - - - - - - - - - - - - - - - - - - - - - - - - - Goodmayes 1369 2 — 1 — 1 — 5 - 3 — 1 - — - - — — — 2 — 1 - 16 - 74 — Highlands 1057 - - - - - - - - - - - - 1 - 1 - - - - - - - 2 - 6 - Little Heath 102 - - - - - - - - - - - - - - - - - - - - - - - - - - Loxford 982 - - - - - - 1 - 4 1 - - - - - - - - - - - 6 - 2 - Newbury Park 707 - - - - - - - - 5 - 2 - - - - - - - - - - - 7 - 1 - R. Catholic, Ilford 454 — — 1 — 3 — 2 - 1 — 3 - 3 - - — — — — — - - 13 - 1 — S.Vincent'sR.C. BC 366 - - - - - - - - - - - - - - - - - - - - 1 - 1 - - — South Park 1292 — — — — 5 — — - 2 — 2 - — - 1 — — — — — - - 10 - 59 — Uphall 652 — — 3 — 7 — 16 - 3 — — - — - - — — — — — - - 29 - — — Valentines 298 - - - - - - - - - - - - - - - - - - - - - - - - - - County High - - - - - - - - - - - - - - - - - - - - - - - - - - - Private - - - - - - - - - - - - - - - - - - - - - - - - - - - Mossford (G.V.H.) 781 - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 15562 9 — 11 — 25 — 46 — 50 — 53 — 47 — 4 — — — 4 — 3 — 252 — 207 — liliii . ;in».