ILF 10 Hsg Insfor 18/6 = II 8/5/31 Borough of Ilford. HEALTH REPORT FOR THE YEAR 1930 A. H. G. BURTON, M.D., B.S., D.P.M., D.P.H., Barrister-at-Law. Medical Officer of Health, &c. Jalslated 5/2/22 Hsg.Stats Borough of Ilford. Annual Report of the Medical Officer of Health, School Medical Officer, Medical Officer to the Maternity and Child Welfare Statutory Committee, and Medical Superintendent of the Isolation Hospital, FOR THE YEAR 1930 Ilford Borough Council. November, 1929—November, 1930. Alderman F. D. Smith, J.P. (E.C.C.), Mayor. Alderman G. Gunary, J.P., 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, J.P. (E.C.C.) Deputy Mayor. Mayor. Councillors : Billington, Henry. Hamilton, Alfred Parke. Bisson, Walter William Harding, Alfred Daniel Bartlett. Preston. Harding, Mrs. Beatrice Alice Blow, Charles Barkworth. Louise Ann. Braithwaite, Thomas. Heath, William Henry Charles. Carrell, Mrs. Sage Ward. Jay, Charles Frederick. Clark, Charles William. Reed, Rev. Charlie, B.D., Hon. C.F. Daniels, Russell Stearn. Rowntree, Ernest Morton. Elborne, John, M.A. Shipman, James Henry, E.C.C. Eves, Charles. Spencer, Walter Robert. Farman, Claude Augustus. Waters, Owen, O.B.E., E.C.C. Green, Arthur William, E.C.C. Wetton, George John, E.C.C. Griggs, Albert Philip, E.C.C. Young, Alexander, Major, T.D. PUBLIC HEALTH COMMITTEE. November, 1929—November, 1930. Councillor C. W. Clark, Chairman. Alderman G. Church, Vice-Chairman. *Alderman F. D. Smith, J.P. (E.C.C.), Councillor Mrs. B. A. L. A. Mayor. Harding. *Alderman G. Gunary, J.P., Councillor W. H. C. Heath. Deouty Mayor Councillor C. F. Jay. Councillor C. B. Blow. 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.C.C. Councillor O. 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, 1929—November, 1930. Councillor A. P. Griggs, E.C.C., Chairman. Councillor Mrs. S. W. Carrell, Vice-Chairman. *Alderman F. D. Smith, J.P. (E.C.C.), Councillor R. S. Daniels. Mayor. Councillor A. P. Hamilton. *Alderman G. Gunary, Councillor A. B. D. Harding. Deputy Mayor. Councillor Mrs. B. A. L. A. Alderman G. Church. Harding Councillor H. Billington. Councillor Rev. C. Reed, B.D., Councillor C. B. Blow. Hon. C.F. Councillor C. W. Clark. Councillor W. R. Spencer. Co-opted Members: Mrs. C. J. Earl. Mrs. B. E. Paddon. Mrs. A. E. Gillard. Mrs. E. M. Wise. Mrs. L. Hardy. Dr. W. S. Macgowan. Mrs. E. J. Hinton. * Ex-officio Members. EDUCATION COMMITTEE November, 1929—November, 1930. Councillor C. B. Blow, Chairman. * Rev. A. Butterworth, M.A., Vice-Chairman. †Alderman F. D. Smith, .T.P. (E.C.C.), Councillor C. A. Farman. Mayor. Councillor Mrs. B. A. L. A. †Alderman G. Gunaey, J.P., Harding. Deputy Mayor. Councillor Rev. C. Reed, B.D., Alderman F. H. Dane, M.B.E., Hon. C.F. J.P., C.A. (E.C.C.). Alderman H. G. Odell. Councillor E. M. Rowntree. Alderman B. S. J. Pitt, .J.P. Councillor W. R. Spencer. Alderman W. J. O. Sheat, Councillor O. Waters, O.B.E., O.B.E., J.P. (E.C.C.) (E.C.C.). Councillor H. Biixington. Councillor Major A. Young, T.D. Councillor W. W. P. Bisson. *Mr. W. J. Alderson. Councillor T. Braithwaite. *Mr. A. Catto. Councillor Mrs. S. W. Carrell. *Mr. G. Colvin. Councillor C. W. Clark. *Miss J. B. Larkin. Councillor R. S. Daniels. *Mr. S. P. Lonergan. Councillor J. Elborne, M.A. *Mr. J. J. Taylor. * Co-opted Members, † Ex-officio Members. OFFICERS of the PUBLIC HEALTH SERVICES, JANUARY, 1931 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: Kathleen Edgecombe, M.D., Ch.B. (Liverpool), D.P.H. (Liverpool). A. Wobthington, M.A. (Cantab.), M.B., B.Ch. (Cantab.), M.R.C.S., L.R.C.P. Resident Medical Officer (Isolation Hospital): Phyllis M. Grainger, M.B., Ch.B. (Birm.), D.P.H. 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. Miss A. L. Drinkwater. District Midwife: Miss M. M. Gambrill Part-Time. Consulting Obstetrician (Maternity Home and Puerperal Fever Regulations): Everard H. C. Williams, M.D., B.Ch. (Cantab.), M.R.C.P. (Lond.). Consulting Orthopedic 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): Marion Lones, M.B., B.S., B.Sc. (Lond.), D.P.H., R.C.S. (Eng.), M.R.C.S. (Eng.), L.R.C.P. (Lond.). TABLE OF CONTENTS SECTION I.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. pAGE Preface 11 Statistical Summary 19 Physical Features of District 21 Rainfall 21 Population 21 Births 21 Deaths 22 Inquests 23 Death-rates from Tuberculosis and Cancer 24 Poor Relief 24 Marriages 24 Vital Statistics—Tables of 25, 26, 27, 28 „ Tabic I 25 „ Ia 26 Causes of Death—Registrar General's Short List 27 Table III 2S SECTION II.-GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Public Health Officers of the Authority 5 District Nursing 29 Midwives 30 National Health Insurance 30 Laboratory Facilities 30 Table of number of specimens examined (Bacteriological Laboratory) 31 Legislation in Force 32 Hospital Provision 32 Maternity and Nursing Homes 34 Maternal Mortality 35 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children 35 Institutional Provision for the Care of Mental Defectives 35 Ambulance Facilities 38 Clinic and Treatment Centres 30 Tuberculosis Dispensary 37 SECTION III. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply 37 Rivers and Streams 39 Drainage and Sewerage 40 Closet Accommodation 40 Scavenging, Collection of House Refuse 40 Sanitary Inspection of District 42 (а) Notices served 43 (b) Complaints of Nuisances 43 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 43 Smoke Abatement 44 Premises and Occupations which can be controlled by Bye-laws or Regulations 44 8 SECTION III—continued. PAGE Byelaws relating to Houses, Lodgings, Tents, etc. 44 Cemetery Extension 44 Schools 45 Rag Flock Acts, 1911 and 1928 45 Housing 45 Overcrowding 45 Unhealthy Areas 45 HousingTable 45 SECTION IV.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply 50 Licences—Graded Milk 50 Milk Sampling 51 Tubercular Milk 53 Meat Regulations 54 (a) Slaughterhouses 54 (b) Articles of Food Surrendered and Seized 54 Bakehouses 55 Sale of Food and Drugs Acts 55 Diseases of Animals Acts 55 Rats and Mice Destruction Act 56 Petroleum (Consolidation) Act 56 SECTION V.—PREVALENCE OF, AND CONTROL OVER. INFECTIOUS DISEASES. Infectious Disease Generally 56 Notifications in Institutions 57 Isolated in Hospital 57 Table II—Summary of Cases of Infectious Diseases Notified 58 Deaths from Infectious Diseases 59 (а) Smallpox 59 Smallpox Hospital Accommodation 61 (б) Scarlet Fever 61 (c) Diphtheria 62 Table of Nos. Schick Tested 63 (d) Enteric Fever 64 (e) Cerebro-spinal Fever 64 (/) Ophthalmia Neonatorum 64 (g) Acute Influenzal and Acute Primary Pneumonia 65 (h) Encephalitis Lethargica 65 (i) Plague 65 (j) Puerperal Fever 65 (A:) Puerperal Pyrexia 65 Zymotic Diseases 66 Incidence and Deaths from Infectious Diseases in Age Groups 67 Tuberculosis 68 Tuberculosis, Treatment of 70 Tuberculosis Care Association 70 Venereal Diseases 70 Notification of Non-notifiable Acute Infectious Diseases 71 Disinfection 72 9 SECTION VI.—FACTORIES AND WORKSHOPS. PAGE Factories 73 Workshops 73 Table I—Inspection of Factories, Workshops, Workplaces 75 „ II—Defects Found 76 „ III—Homework 77 „ IV—Other Matters 78 ISOLATION HOSPITAL. Patients Admitted 81 Scarlet Fever 82 Enteric Fever 84 Puerperal Pyrexia 84 Diphtheria 84 Cerebral Spinal Fever 85 Pemphigus Neonatorum 85 Tuberculosis 86 Observation Cases 85 Training of Nurses 86 Schick and Dick Testing of Staff 87 Hospital Extensions 87 MATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907 and 1915 91 Registration Act, 1836 and 1926 92 Infant Mortality 93 Neonatal Mortality 98 Table IV 99 Illegitimate Births and Deaths 100 Maternal Mortality 100 Infant Life Protection 102 Work of Health Visitors 103 Supervision of Midwives 103 Supply of Milk to Expectant and Nursing Mothers and for Infants 106 Infant Welfare Centres 106 Ante-Natal Clinics 110 Dental Clinic 111 Ophthalmic Clinic 112 Orthopedic Clinic 112 Ophthalmia Neonatorum 113 Treatment of Minor Ailments 113 Maternity Home 114 District Midwife 120 Maternity Home Extensions 121 SCHOOL MEDICAL SERVICE. General Survey 125 Staff 128 School Premises 128 Medical Inspection 129 10 SCHOOL MEDICAL SERVICE—continued. PAGE Findings of Medical Inspection 130 Infectious Disease 132 Diphtheria Prevention 134 "Following-up" 137 Medical Treatment:— Minor Ailments 137 Ophthalmic Department 139 Orthopaedic Department 140 Dental Department 141 Treatment of Uncleanliness 143 Other Ailments 144 Open Air Education 145 Physical Training 148 Provision of Meals 150 Supply of Free Cod Liver Oil, Emulsion, etc. 150 Co-operation of:— Parents, Teachers, School Attendance Officers and Voluntary Bodies 150 Physically and Mentally Defective Children 151 Employment of School Children and Young Persons 155 Medical Examination of Teachers, etc. 156 Statistical Tables:— I.—Number of Children Inspected 157 IIa.—Return of Defects 158 IIb.—Number of Children found to Require Treatment 159 III.—Numerical Return of Exceptional Children 160 IIIa.—Number of Children notified to the Local Mental Deficiency Authority 102 IV.—Group I—Minor Ailments 163 Group II—Visual Defects 104 Group III—Nose and Throat Defects 164 Group IV—Dental Defects 105 Group V—Uncleanliness and Verminous Conditions 165 V.—Summary of Number of Children Inspected 166-7 VI.—A.—Average Heights and Weights of Boys Inspected 168-9 B.—Average Heights and Weights of Girls Inspected 170-1 VII.—Summary of Infectious Diseases among School Children 172 VIII.—Summary of Scarlet Fever among School Children 173 IX.—Summary of Diphtheria among School Children 174 X.—Summary of Measles and German Measles among Schoolchildren 175 XI.—Summary of Chicken-pox among School Children 176 XII.—Summary of Whooping Cough among School Children 177 XIII.—Summary of Mumps among School Children 178 PREFACE Public Health Offices, Ilford. May, 1931. To His Worship the Mayor, the Aldermen and, Councillors of the Borough of Ilford. Me. Mayor, Ladies and Gentlemen, I herewith submit the Annual Report required by the Ministry of Health and the Board of Education. This is the Thirty-first Report which has been presented for this district and is the Twelfth Annual Report which I have prepared. The Ministry of Health have decided that quinquennially the Annual Report should contain more detail and be more in the nature of a Survey Report. The last Report of this character was presented in 1925, and the arrangement of the accompanying Survey Report is in accordance with the instructions of the Ministry of Health. I would point out that the Registrar-General has not made any estimate of the population of the various towns for the past year, and as suggested by the Ministry of Health, the Registrar-General's estimate for the mid-year, 1929, has been adopted for the purposes of the calculation of the birth-rate and death-rate. Until the Census figures which are now in course of preparation have been completed, it cannot be said how far the estimate of population is inaccurate, but it is quite certain that in Ilford it is very much too low. The figures given in the Report for the death-rate and the birth-rate are, therefore, both higher than they should be. There are certain very satisfactory features with regard to the vital statistics in the area, to which I would call your attention:— 1.—The infant mortality rate of 33 is the lowest ever recorded for the district. It is also the lowest of any district in London or of the 17 towns in the outer ring of London. In the remainder of England it is lower than any other town with a population of 50,000 inhabitants or over. The premier position to which Ilford has attained in the campaign against infant mortality is undoubtedly due to the way in which the Council has met the demand for infant welfare centres, by increasing the number of these centres as required, and by placing them in positions where 12 they can be readily reached by the mothers. Last year there were 36,710 attendances of infants at the various welfare centres. 2.—The death-rate of 8.7 (although, as I have pointed out, this figure is inaccurate and should be lower), is also lower than the death-rate of any London district or of any town in the outer ring of London and, with one exception, of any town in England with a population of 50,000 or over. 3.—More cases of smallpox have occurred in the district than for many years. 25 cases in all were notified, and it is highly satisfactory to be able to report that the disease did not spread to any but the immediate contacts of the original case. The ease with which this disease might be spread unless great precautions were taken can be seen from the case which occurred in a local hospital in January. A woman was removed to this hospital from Dagenham, thought to be suffering from some acute abdominal trouble. The pains from which she suffered were, however, the preliminary symptoms of smallpox. It was not until the third day of the rash that I was called in to see this case. The rash of smallpox came out on the patient while in a ward, and in all there were 55 direct contacts and 146 indirect contacts of the case. 4.—The effort by immunisation which was commenced in November, 1929, to combat the outbreaks of diphtheria which were occurring in the Beeontree and Goodmayes area of the town has met with considerable success. It will be seen from the table in the Report that 1,523 children have been dealt with either at school or at the Public Health Offices. The following table shows that the number of cases in the Beeontree and Goodmayes schools has been reduced by nine-tenths for the months when diphtheria is most prevalent, while the number of cases in the other schools in Ilford has not appreciably diminished ; also that the number of cases of diphtheria in Goodmayes ward is less than a seventh of what it was in the corresponding period, October, 1929, to February, 1930, although the number of cases of diphtheria in the remainder of Ilford is much the same:— October, 1929, October, 1930, to to February, 1930. February, 1931. Number of cases of diphtheria in Beeontree and Goodmayes Schools 100 10 Number of cases of diphtheria in all the other schools in Ilford 93 86 13 Number of oases of diphtheria in Goodmayes Ward Number of cases of diphtheria in remainder of Ilford October, 1929, to February, 1930. 160 124 October, 1930, to February, 1931 22 129 Although there are other epidemiological factors which must be taken into account, the effect of immunisation by providing a mass of insusceptible children in the area in question has undoubtedly been a considerable agent in producing the results achieved. In this connection I would again point out that no cases of scarlet fever or diphtheria occurred during the year among the staff at the Isolation Hospital. The effects of modern methods and our advance in the knowledge of infectious diseases are also shown in connection with the treatment of scarlet fever. I pointed out last year that in 1909 the average stay in hospital of scarlet fever patients was 44 days. In 1929 it was 31.3 days, while last year it was 29.1 days. All cases of scarlet fever are now treated with anti-scarlatinal serum, with the result that uncomplicated cases can be discharged with safety within three weeks of admission, and it will be seen from the table in the Report that the return case-rate from the Isolation Hospital was less than that from cases nursed at home. I was also able to employ the advance in our knowledge of scarlet fever at a local hospital when in December two cases of scarlet fever arose in the children's ward of the hospital. It was found that two patients and two of the nursing staff were "carriers " of scarlet fever organisms, and on these being removed and isolated, no further cases arose in the hospital. The Local Government Act, 1929, has enabled the Ilford Council to become the local supervising authority under the Mid wives Acts. I have pointed out in many previous reports the advantage which would be gained by this work being done locally. The operation of the Local Government Act also transferred the supervision of foster children to this authority. The supervision of nursing homes was also transferred to this Council by direction of the Ministry of Health. It is hardly necessary for me to point out that much of the efficiency of the health services of a district depends on the centre 14 from which they are administered. In the London districts where, for example, the school medical and other services are administered by the London County Council from Westminster, while other health services are administered by the Metropolitan Borough Councils, no ideal unit of health administration can be obtained. For health services to be efficiently administered, they should be locally administered, and the area which the local authority supervises should not be too extensive. In Ilford, with a few exceptions (such as the administration of the tuberculous services), the whole of the health services, including sanitary, school medical, maternity and child welfare and Isolation Hospital, are all under the control of one authority, and are administered locally, not from some far-distant authority. In the quinquennial Report for 1925, I pointed out, among other things, the importance of the provision of an open air school and of a clinic for remedial exercises and massage for cases of minor degrees of physical disability, and it will be seen from the body of the Report how successful these have already been. I also pointed out the necessity of the provision of cubicle wards at the Isolation Hospital. These also have now been provided and further extensions have already been approved. In 1925, I drew attention to the fact that four women died in childbirth. In 1930, seven women died during childbirth, the maternal mortality rate being 3.7, only a little lower than that for England and Wales. I have noted in the Report that in the Ilford Maternity Home the average maternal mortality rate for the past ten years was 0.92, as compared with the maternal mortality rate in the district generally of 3. The need for further extensions to the Maternity Home, both for cases which can be booked and for cases which have not been booked and have proved to be difficult cases requiring special provision, hardly needs emphasis, when the above figures are considered. The Public Health Services of Ilford are economically administered. The estimated cost for the year 1931-2 of the whole of the maternity and child welfare services was only 1.5d. rate, while that for the school medical service was 0.9d. rate. It is unsatisfactory for me to have to report that the deaths of children of school age in 1929, as in 1928, form a higher percentage of the total deaths registered than do the deaths of children of 15 school age in England and Wales generally. This implies that children of school age are not receiving such medical attention as they might. Many school children in Ilford still have to travel to hospitals in London to receive the expert attention which they require, and I hope that the King George Hospital will find means of so adapting their out-patients system that at least school children who require out-patient hospital treatment, sometimes for continued periods, shall be able to receive it, in the place in which they are resident. In my Report for 1925, I drew attention to the need of subsidiary clinics, to serve school medical and maternity and child welfare services. I am glad to say that the plans for the provision of such a clinic in the Becontree and Goodmayes area have now been passed. This clinic will prove invaluable for the children of the area in which it is to be built, and when it is remembered that at the last Census of school children, 46% of the total child population was to be found in this area, the need for the clinic is apparent. I wish 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 19 SECTION I. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in Acres) Land 8,470 ... 8,503 Inland Water 26 Tidal Water 7 Population (Census, 1921) 85,194 Number of inhabited houses (1921) 18,606 Number of inhabited houses (end of 1930) according to Rate Books 30,660 Number of families or separate occupiers (Census, 1921) 20,059 Rateable Value—October 1st, 1930 £909,282 Sum represented by a penny rate, October 1st, 1930 £3,685 Education Rate— 1929. 1930. Elementary 2s. 2. 78d. in the £. 2s. 2. 92d. in the £. Higher 0s. 4. 25d. in the £. 0s. 6. 50d. in the £. Combined Rate (all services) 12s. 4d. in the £. 13s. 2d. in the £. Social conditions, including the chief occupations of the inhabitants, and the influence of any particular occupation on public health :— Vide Annual Report for 1925. Total. M. F. 1930. 1929. Live Births Legitimate 1,809 915 894 Birth Rate Illegitimate 36 13 23 16.4 15.6 20  Total. M. F. 1930. 1929. Still Births 63 32 31 Rate per 1,000 total births 34.1 27.9 Deaths 980 457 523 Death Rate 8.7 9.7 Percentage of total deaths occurring in public institutions 38.9 35.9 Number of women dying in, or in consequence of, childbirth:— From sepsis 2 3 From other causes 5 4 Death-rate of Infants under one year of age per 1,000 libe births:- Legitimate, 32.0 Illegitimate, 83.3. Total 33.0 49.5 Deaths from Measles (all ages) 9 2 ,, ,, Whooping Cough (all ages) 2 9 ,, ,, Diarrhoea (under 2 years of age) 9 7 Diphtheria has been prevalent in the Town, principally during the earlier months of the year. The effects of Immunization against Diphtheria, which has been extensively carried out among the child population of the eastern portion of the Town, is now making itself felt, and the number of cases for that part of the District, shows a very considerable decline. After two years of heavy incidence, Scarlet Fever was less prevalent. 21 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 27 -14 inches. The greatest fall in 24 hours was registered on 29th August, being 1 -85 inches. The number of days on which rain fell was 145. 3. Population. Census, 1911 78,188 Census, 1921 85,194 (including institutions) Registrar-General's Estimate on 30th June, 1929 116,200 „ „ The number of patients and resident staff on the 30th June, 1930, at the following public institutions, was:— Claybury Mental Hospital 2,551 West Ham Mental Hospital 1,193 As explained in section No. 4 on page 22, the 1929 net population figure of 112,489 is used as the basis for compiling the various rates in this year's Report. 4. Births.—The number of births registered during the year was 1,845. Legitimate 915Males 894Females Illegitimate 13 „ 23 ,, i.e., 1.9 per cent, of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was:-2.27 in 1929; 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. The birth-rate, calculated on the net estimate of the population of 112,489, is 16.4 per 1,000, as compared with 15.6 in 1929; 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. 22 I am informed by the Ministry of Health that the RegistrarGeneral, in computing his estimate of population for mid-year 1930, intends to take into account the populations as ascertained by the 1931 Census ; the 1930 estimate will therefore not be available before the end of June. The Ministry of Health suggest that the Report should not be delayed for the mid-year 1930 population figure, but that the Registrar-General's mid-year 1929 estimate of population should be used and a statement to that effect included in the Report. In accordance with this suggestion I am, therefore, using the mid-year 1929 population figure for the purposes of computing the various rates in this report. 5. Deaths.—The total number of deaths of Ilford residents was 980. The total number of deaths registered in the district during the year was 882 Number of deaths of non-residents registered in the district (principally in large institutions) 224 The latter 224 deaths occurred as follows:— In Claybury (L.C.C.) Mental Hospital 121 In West Ham Borough Mental Hospital 59 In Ilford Isolation Hospital 2 In King George Hospital 21 OtherNon-Residents 21 224 Included in the deaths of residents belonging to the district are 7 which occurred in Dr. Barnardo's Village Homes. To be added to the total number of deaths registered in the district are 322 deaths of Ilford residents registered as having died in other districts. This figure includes deaths at the following institutions:— 23 The Infirmary, Romford 163 Essex County Mental Hospital 12 The London Hospital 18 Queen Mary's Hospital, West Ham 9 Hospital for Sick Children, Great Ormond Street 4 St. Bartholomew's Hospital 11 Charing Cross Hospital 9 Royal Eastern Counties' Institution 1 Middlesex Hospital 2 St.Thomas's Hospital 3 Westminster Hospital 3 National Hospital, Queen Square 3 University College Hospital 2 In other Hospitals, Institutions and Residences outside the Ilford District 82 Total 322 The net deaths for the Borough is obtained by taking the total deaths registered in the district (882), subtracting the deaths of non-residents occurring in the district (224), and adding the deaths of Ilford residents registered as having died in other districts (322). The total number of deaths of Ilford residents was, therefore, 980. The death-rate, calculated on the net estimate of the population of 112,489 is 8.7 per 1,000, as compared with 9.7 in 1929; 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. Inquests.—During the year, 35 inquests were held in the district, 18 on Ilford residents, and 17 on non-residents. The ages at death and causes assigned were as follows:— Under 1-2 2-5 5-15 15-25 25-45 45-65 65 years and 1 year. years. years. years. years. years. years. upwards. 31 43476 7 Causes of inquest-deaths under 1 year.—Accidental death from shock of intussusception whilst under anaesthetic, 1; accidental asphyxia whilst in bed, 1 ; accidental septicaemia following scalds, 1. Causes of inquest-deaths over 1 year.— Accidents 27 Suicides 2 Arteriosclerosis 2 Pleurisy 1 24 Death-Rates from Tuberculosis and Cancer, 1930. The following Table shews the death-rates for 1930 for Ilford, compared with the provisional death-rates for England and Wales for the same period, per 1,000 population; the figures having been supplied by the Registrar-General:— Ilford. England and Wales. Respiratory Tuberculosis .54 .73 Other Tuberculosis .07 .15 Cancer 1.36 1.45 6. Poor Relief.—The total amount expended in Ilford during the year was £9,555 12s. 1d. The average weekly number of cases in receipt of relief was 550. The number of admissions to the Guardians' Institutions from the Ilford North district during the year was 244, made up as follows :— Men 86 Women 139 Children 19 I am informed by the Clerk to the Guardians' Committee that the number of admissions to the Institution from the South district is not available. 7. Marriages.—857 marriages have taken place during 1930. The following details explain the allocation :— Marriages taking place in the Ilford District 614 Marriages of Ilford Residents at Register Office, Romford— Both Parties belonging to Ilford 157 The Male only belonging to Ilford 49 The Female only belonging to Ilford 37 8. Tables of Vital Statistics.—Table 1 gives a comparative statement of the population, birth-rate and death-rate for the past six years. Table Ia gives a comparison of the vital statistics of Ilford with England and Wales, London and other towns. Table III gives a classified statement of the causes of death in 1930, arranged according to the age groups at which deaths occurred. 25 TABLE I.—Vital Statistics of Whole District During 1930 and Previous Years. Year Gross Population estimated to Middle of each Year Net Population estimated to Middle of each Year (a) Births. Total Deaths Registered in the District. Transferable Deaths Net Deaths Belonging to the District. Uncorrected Number Net (6). of Non-Residents registered in the District of Residents not registered in the District Under 1 Year of Age. At all Ages. Number Rate (c) Number Rate (d) Number Rate per 1,000 Net Births Number Rate (e) 1 2 2a 3 4 5 6 7 8 9 10 11 12 13 1924 92,400 88,791 1,382 1,436 16.1 849 9.2 231 259 62 43.2 877 9.9 1925 93,590 90,072 1,424 1,486 16.5 874 9.3 285 251 78 52.4 890 9.9 1926 100,500 96,885 1,477 1,509 15.6 847 8.4 244 235 68 45.1 838 8.7 1927 108,310 104,766 1,526 1,657 15.8 937 8.6 255 326 74 44.0 1,008 9.6 1928 113,500 109,871 1,671 1,739 15.8 860 7.6 216 280 79 45.4 924 8.4 1929 116,200 112,489 1,635 1,755 15.6 996 8.6 279 380 87 49.5 1,097 9.7 1930 116,200* 112,489* 1,710 1,845 16.4 882 7.6 224 322 61 33.0 980 8.7 (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) and (e) Calculated on the estimated net population. (d) Calculated on the estimated gross population. *Registrar-General's Estimate for mid-year, 1929. 26 TABLE 1A. Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1930. (Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1930, but those for the towns have been calculated on populations 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. Diarrhoea and Enteritis (under 2 Years). Total Deaths under One Year. Causes of Death certified by Registered Medical Practitioners. Inquest Cases. Uncertified Causes of Death. England and Wales 16.3 11.4 0.01 0.00 0.10 0.02 0.05 0.09 0.12 0.55 6.0 60 90.4 6.9 1.0 107 County Boroughs and Great Towns, including London 16.6 11.5 0.01 0.00 0.15 0.02 0.05 0.10 0.11 0.50 8.3 64 90.6 6.6 0.5 159 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 16.2 10.5 0 .00 0.00 0.08 0.01 0.05 0.07 0 .13 0.43 4.4 55 91.8 5.9 1.1 London 15.7 11.4 0 .01 0.00 0.23 0.02 0.03 0.10 0.08 0.55 9.9 59 88.3 7.4 0.0 ILFORD (Estimated Gross Population 116,200) (mid 1929) 15.9 8.4 0.01 0.00 0.08 0.01 0.02 0.11l 0.09 0.19 4.8 33 96.4 3.5 0.0 27 The following is the Registrar-General's Short List of Deaths by Causes. Table III on page 28 differs very slightly from the Registrar-General's Short List, and has been prepared on the lines of previous Annual Reports :— Causes of Death. M. F. All Causes. 457 523 1. Enteric fever 1 — 2. Smallpox — — 3. Measles 5 4 4. Scarlet fever 1 — 5. Whooping cough — 2 6. Diphtheria 5 7 7. Influenza 7 4 8. Encephalitis lethargica 1 — 9. Meningococcal meningitis 1 1 10. Tuberculosis of respiratory system 41 20 11. Other tuberculous diseases 3 5 12. Cancer, malignant disease 65 89 13. Rheumatic fever 3 8 14. Diabetes 10 5 15. Cerebral hæmorrhage, etc. 19 36 10. Heart disease 90 128 17. Arterio-sclerosis 6 19 18. Bronchitis 10 14 19. Pneumonia (all forms) 33 18 20. Other respiratory diseases 5 7 21. Ulcer of stomach or duodenum 9 4 22. Diarrhœa, etc. (under 2 years) 6 3 23. Appendicitis and typhlitis 5 5 24. Cirrhosis of liver 2 1 25. Acute and chronic nephritis 9 20 26. Puerperal sepsis — 2 27. Other accidents and diseases of pregnancy and parturition - 5 28. Congenital debility and malformation, premature birth 16 11 29. Suicide 4 — 30. Other deaths from violence 16 7 31. Other defined diseases 84 98 32. Causes ill-defined or unknown — - 28 TABLE III. Causes of, and Ages, Death during the Year 1930. 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 1 - - - - - - - 1 2 2 Smallpox - - - - - - - - - - 3 Measles 9 1 2 5 1 - - - - 2 4 Scarlet fever 1 - — — - - 1 — — 2 5 Whooping cough 2 - 1 1 - - - - - - 6 Diphtheria 12 - 1 5 5 1 — — - 11 7 Influenza 11 - — — 2 — i 4 4 — 8 Encephalitis lethargica 1 - - - - - - 1 — 1 9 Meningococcal meningitis 2 - - - 1 - 1 - - 2 10 Tuberculosis of respiratory system 61 - — 1 15 30 14 1 24 11 Other tuberculous diseases 8 - — — 4 1 3 — — 5 12 Cancer, malignant disease 156 - - - - 2 14 70 70 27 13 Rheumatic fever 11 - — — 5 3 2 — 1 5 14 Diabetes 15 - - - - - 1 4 10 2 15 Cerebral hæmorrhage, etc. 55 1 - - - - - 16 38 7 16 Heart disease 222 1 — — 2 4 7 57 151 34 17 Arterio-sclerosis 27 - - - - - - 7 20 18 18 Bronchitis 24 - - - - - - 3 21 1 19 Pneumonia (all forms) 59 8 3 3 2 — 9 13 21 30 20 Other respiratory diseases 12 - - - - - 2 5 5 — 21 Ulcer of stomach or duodenum 12 - - - - - 2 6 4 4 22 Diarrhœa, etc. (under 2 years) 9 9 - - - - - - - 1 23 Appendicitis & typhlitis 10 — — — 3 2 2 3 —. 6 24 Cirrhosis of liver 3 — — — — — — 1 2 1 25 Acute and chronic nephritis 33 - - - 1 2 3 9 18 22 26 Puerperal sepsis 2 — — — — 1 1 — — — 27 Other accidents and diseases of pregnancy and parturition 5 - - - - - 5 - - 2 28 Congenital debility and malformation, premature birth 32 32 - - - - - - - 6 29 Suicide 4 — — — — 1 2 1 — — 30 Other deaths from violence 23 - 1 2 3 3 3 3 8 21 31 Other defined diseases 158 9 1 3 8 8 22 41 66 64 32 Causes ill-defined or unknown - - - - - - - - - - Totals 980 61 9 20 37 43 111 258 441 300 29 SECTION II. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 1. Public Health Officers of the Authority.—Vide page at the beginning of this Report. 2. Nursing in the Home. Nature of the Arrangements in the Area. (a) District Nursing.—This is a voluntary Committee, the organisations concerned being mentioned in my Annual Report for 1921. 11,019 visits were paid by the nurses in 1930, compared with 9,563 in 1929. The following is a summary of the work carried out during the year 1930:— Number of New Cases 462 Number of Visits—Medical 6,796 Surgical 3,069 Operations 58 Massage 1,096 Number of applications made for Nurses'services 462 Number of patients under the charge of a Doctor at 31st December 51 Number of patients not under the charge of a Doctor - Number of necessitous cases referred to Committee 31 Number of cases on the books at the end of the year 15 The cases were distributed in wards as under:— Cranbrook 60 Park 85 Seven Kings 78 North Hainault 62 Loxford 70 Clementswood 47 South Hainault 38 Goodmayes 22 The Medical Officer of Health is a member of the District Nursing Committee. 80 All cases of measles are visited by the Health Visitors, and any requiring special nursing attention are referred to the District Nursing Committee. With regard to the home-nursing of cases of notifiable infectious disease, nursing is not provided by arrangement with the District Nursing Committee or directly by the Sanitary Authority. 3. Midwives.—The supervision of midwives has, since the 1st October, 1930, been under the control of the Ilford Borough Council. This matter is dealt with in detail on page 103, Maternity and Child Welfare Section. One application has been received from a local midwife for a subsidy, and this case is under consideration by the Public Health Committee. There is one District Midwife on the establishment of the Local Authority. There are 12 certified midwives resident and practising in the district (apart from those at the Maternity Home). 4. National Health Insurance.—There are no important points in which the work of the Local Authority is related to or is administered in co-operation with this service. 5. Laboratory Facilities.—The Essex County Council provides free bacteriological examinations for most specimens at the Counties' Public Health Laboratories in London; this laboratory also carries out any chemical investigations required. Specimens for diagnosis of Venereal Disease are examined at the London Hospital; for Tuberculosis at the Counties' Public Health Laboratories. Examinations of such urgent specimens as diphtheria swabs are carried out at the Ilford Public Health Offices. The accompanying table shows that 1,631 specimens have been examined at the Ilford Laboratory during the past year. 31 Bacteriological Laboratory, 1930. 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 236 872 1 11 15 64 30 71 282 1,018 Nose, Ear, Eye, etc. ,, 21 31 4 9 8 21 14 27 47 88 Throat Contacts ,, 15 138 — 5 1 8 — — 16 151 Nose „ ,, 1 11 — — — 3 — — 1 14 Hairs Ringworm — — — — 3 2 — — 3 2 Urine Various Abnormalities — — — 2 — 5 2 — 2 7 Totals 351 1,280 Grand Total 1,631 Direct Smears from swabs were examined in 5 cases (3 negative, 2 positive). Other examinations for various purposes, 7. 29 Diphtheritic Specimens were sent to laboratories in London for a test for virulence—21 were virulent, 8 avirulent. 32 6. Legislation in Force. 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. (/) Tallow melters. (g) Fat melters or fat extractors. (h) Glue makers. (i) Tripe boilers. (j) Size makers. (k) Gut scrapers. (I) Fish frier and fish curer. (m) Rag and bone dealer. (6) For securing the cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (7) Nuisances in connection with the removal of offensive or noxious matter. There are two local Acts in operation—(1) The Ilford Improvement Act, 1898, which has important sanitary provisions, and (2) Ilford Urban District Council Act, 1904, the section of which (dealing with the control of Tuberculosis) is now over-ruled by the Milk and Dairies Act, while the section dealing with infectious disease has enactments similar to the Public Health Acts of 1907. Sections 62 and 63 only of Part IV of the Public Health Act, 1907, have been adopted. 7. Hospital Provision. (a) Tuberculosis.—12 beds are maintained by the Essex County Council at the Isolation Hospital for the treatment of tuberculosis (surgical) of male patients. 33 (b) Maternity.—Ilford Council Maternity Home—23 ordinary beds, with two isolation wards and two labour wards. Number and Classification of Medical and Nursing Staff :— Assistant Medical Officer 1 Matron 1 Sisters 2 Staff Nurses 3 Pupil Midwives 6 District Midwife 1 The services of Dr. Everard Williams, Consulting Obstetrician, are available as required. (c) Children.—A ward erected by the War Memorial Committee was opened in 1927 to accommodate 22 children at the Ilford Emergency Hospital (now the King George Hospital). (d) Fever.—Ilford Council Isolation Hospital, 123 beds. Number and Classification of Medical and Nursing Staff:— Medical Superintendent 1 Resident Medical Officer 1 Matron 1 Assistant Matron 1 Night Sister 1 Ward Sisters 5 Staff Nurses 8 Probationers 20 Total 38 The services of Mr. F. Stoker, Ear, Nose and Throat Surgeon, are utilised as required ; also those of Dr. Everard Williams, Consulting Obstetrician (Puerperal Fever Regulations). (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). This expires on 13th March, 1932. The arrangements after this date are at present under consideration. (/) Other.—There is a Voluntary Hospital (now known as King George Hospital) in the district, maintained by voluntary subscriptions and by patients' fees, the number of beds being 74. 34 During the year 1930, 1,677 in-patients were admitted, 1,038 operations were performed, 5,016 casualties were attended to, and 841 X-Ray examinations were made. The average cost per patient per week was £3 4s. 2d. A scheme has been prepared for an ultimate provision of 300 beds at this Hospital. The building of half this scheme is nearing completion, and it is proposed to open the new extensions on the 18th July, 1931. This will provide a Hospital containing 150 beds, with an Out-patients' Department, and Nurses' Home. An Out-patients' Clinic in connection with this Hospital has been opened at Dagenham. There is a Staff of Consulting and Visiting Surgeons at King George Hospital, and there are special X-Ray, Ophthalmic and Massage Departments. A Pathologist is also on the Hospital Staff. Owing to the close proximity of this district to London, a large number of the inhabitants avail themselves of the services of the General and Special Hospitals in and around Central London. Queen Mary's Hospital at Stratford is used considerably by Ilford residents. A General Hospital in the Town, on the lines of the large General Hospitals in London, with an adequate Out-patients' Department, is very necessary. There are two large Mental Hospitals in the district, the West Ham Mental Hospital, with 1,098 patients (males 506, females 592), and Claybury Mental Hospital, with 2,820 patients (males 996, females 1,324) in residence on 30th June, 1930. 8. Maternity and Nursing Homes. As a result of representation made to the Ministry of Health under Section 9(3) of the Nursing Homes Registration Act, 1927, the duties under the Act were transferred from the Essex County Council to the Ilford Borough Council as from the 1st October, 1930. At that date there were five private registered nursing homes in the district, three for maternity patients only, one for maternity and medical or minor surgical cases, and the remaining one for medical and surgical cases. 35 The following is the action taken under the Nursing Homes Registration Act, 1927, since 1st October, 1930:— Maternity Homes. Other Nursing Homes. (1) Number of applications for registration 1 — (2) Number of homes registered — — (3) Number of orders made refusing or cancelling registration — — (4) Number of appeals against such orders — — (5) Number of cases in which such orders have been:— (a) confirmed on appeal — — (b) disallowed — — (6) Number of applications for exemption from registration — - (7) Number of cases in which exemption has been:— (a) granted — — (b) withdrawn — — (c) refused — — An order refusing the only application for registration was not made until January, 1931. 9. Maternal Mortality.—This matter is dealt with on page 100, Maternity and Child Welfare Section. 10. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children.—The Chelmsford Diocesan Girls' Aid Association have a Rescue and Preventive Home at No. 80, Ingleby Road, for girls and young unmarried women, with accommodation for five cases. In addition, there is the Girls' Village Homes, one of the late Dr. Barnardo's Institutions, which had 1,480 children and 212 staff in residence on the 30th June, 1930. Admission to this Institution is controlled by Headquarters at Stepney, E. 11. Institutional Provision, if any, for the Care of Mental Defectives.—There is no institution for the care of mental defectives, provided by the Local Authority. Feebleminded children of school age are admitted, when accommodation is available, to the Royal Eastern Counties' Institution at Colchester. A number of children are sent to other Institutions for 36 Mentally Defective Children, when accommodation is available. A fuller report on this subject is contained in the School Medical Service Section of this Report. 12. 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. 13. Clinic and Treatment Centres.— Maternity and Child Welfare.—The Council has established the following Infant Welfare Centres:— United Methodist Church (entrance in Balmoral Gardens, opposite Vernon Road), Seven Kings. Monday, 2.0 p.m. Holy Trinity Church Hall, Mossford Green Monday, 2.0 p.m. All Saints' Church Hall, Goodmayes Lane, Goodmayes. Tuesday, 9.30 a.m. Congregational Church, Birkbeck Road, Newbury Park. Tuesday, 2.0 p.m. Public Health Offices, Valentines Mansion Tuesday, 2.0 p.m. Congregational Church Hall, Grosvenor Road, Ilford. Wednesday, 2.0 p.m. Congregational Church Hall, Woodford Avenue (entrance in Ethelbert Gardens) Wednesday, 2.0 p.m. 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. 37 (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 130/132, Cranbrook Road. 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, 3-5 p.m. For children—Wednesday, 10-12 noon. The buildings formerly used as a Maternity Home at 130-132, Cranbrook Road, were purchased from the Ilford Council by the Essex County Council, and have been converted into a Tuberculosis Dispensary. These are a great improvement on the premises previously used. The Tuberculosis Dispensary at 130-132, Cranbrook Road was officially opened on 18th July, 1930. SECTION III.—SANITARY CIRCUMSTANCES OF THE AREA. 1. Water Supply.—Vide Annual Report, 1925. It has not been found necessary to send for analysis any samples of the piped water supply. The South Essex Waterworks Company are proceeding with a scheme for obtaining water supply from the River Stour. Upon the completion of the Scheme the water will be utilized throughout the Company's District but will not be the sole source of supply, as the existing eight wells of the Company will still be utilized, though to a less extent than at the present time. 38 For the past two years the Company have obtained a supplemental supply of water from the Metropolitan Water Board to meet the constantly increasing demands due to the unprecedented growth of houses in their District: the major portion of the water thus purchased is consumed in Ilford. It is hoped that by the end of the present year the Stour Works will be sufficiently advanced as to allow of a supply of water being furnished, although the whole of the works will not be completed till a somewhat later date. Mr. Bryan, the Engineer to the South Essex Waterworks Company, has kindly supplied me with the following short description of the Scheme:— "The Scheme is authorised under the powers contained in the South Essex Waterworks Act, 1928. "The source of supply is the River Stour from which water will be abstracted at an Intake situated near Langham Mill and will flow by gravity through a 40 in. diameter pipe to the sump of the Langham Low Lift Pumping Station. "The water will be pumped thence through a 40 in. diameter main, about 650 yards in length, to a Sedimentation Reservoir and will flow by gravity from the reservoir, through a 40 in. diameter main about 400 yards in length, to the Primary Filters, where a preliminary process of rapid filtration will ensue. A bye-pass main will be provided around the reservoir to allow of the water being pumped direct from the Low Lift Station to the Primary Filters if required. "After leaving the Primary Filters the water will flow (by gravity) to six sand filter beds of the ordinary type and after being again filtered and chlorinated will pass into the Filtered Water Reservoir. An outlet main of 40 in. diameter will carry the water from the latter reservoir to the suction branches of the three sets of pumping plant situated at the Langham High Lift Pumping Station. "The water will then be pumped through a main 32 in. diameter and slightly over 14 miles in length into a covered reservoir placed in close proximity to the Tiptree Pumping Station, from which it will be carried to the suction branches of the three pumping units by a short length of main of 36 in. diameter. "The Tiptree Pumping Plant will pump the water thus received, through a main 32 in. diameter and 9¾ miles in length to the Danbury Reservoir, the top water level of which will be about 358 O.D. "From the latter reservoir the water will flow by gravity through a main of 34 in. diameter and about 13¼ miles in length to the Company's Herongate Reservoir, from which it will be supplied to the Company's District. "The whole of the mains will be constructed of steel, coated internally with a bitumen lining applied eentrifugally." 39 Considerable mains extensions have been carried out by both the Metropolitan Water Board and the South Essex Waterworks Company, to deal with the development of the various building estates in the more outlying parts of the Town. 2. Rivers and Streams.—Vide Annual Report, 1925. (a) Seven Kings Stream. A certain amount of difficulty has been created in this stream by the discharge of the effluent from the Corporation's Sewage Works at Hainault, unsatisfactory samples having been obtained ; it was considered that this might be on account of trade sewage being admitted from a firm of tarpaulin manufacturers. This firm, on representation, put in a series of settlement and filtration tanks, and this was sufficient to render their sewage satisfactory for treatment, as proved by analysis. Further samples of effluent discharged into the stream, did not, however, give a good result, and the Analyst reported that beet washing from certain premises might interfere with the treatment of the sewage. This beet washing effluent has been diverted from the Hainault Sewage Works, and irrigated over the crops on the land. Further samples of the effluent are being taken. (b) Goodmayes Watercourse. A firm of Accumulator manufacturers were found to be discharging into the surface water sewer, drainage from presses in the pasting shop. A sample of the discharge was taken and the Analyst's report stated: "this is a markedly acid liquid containing large traces of lead and iron salts." This firm subsequently constructed a filter for cleansing the effluent prior to its discharge into the surface water sewer. (c) Outfall Sewer from Sewage Works to River Roding. Complaint was made during the early part of the year by the Port of London Authority that acid was being discharged into the River Roding through the effluent pipe from the Sewage Works. The pipe was inspected in Ilford Lane and no acid was found in the pipe at that point. The pipe afterwards passes close to a chemical works and through the curtilage of another chemical works. Both these firms use acids in considerable quantities. Careful investigation was made at the time, but the source of the acid discharge was not located. Further excavation and investigation was carried out, and the Port of London Authority, as well as this Department, have the matter under observation. (d) River Roding (Wanstead Sewage Works). Arising out of a complaint received as to pollution of the River Roding by the Wanstead Sewage Works a sample of the effluent was taken and the result transmitted to the Wanstead Urban District Council. A reply was received to the effect that a Contract had been entered into by the Wanstead Urban District Council for carrying out extensions to their Works, which should be completed in nine months from April, 1930. 40 3. Drainage and Sewerage.— No alterations or extensions have taken place at the Outfall Works during the year. In the meantime, several sections of work on the Ilford and Barking Joint Sewerage Scheme have been commenced, good progress having been made by the contractors on their respective works. It is anticipated that the Ilford Section and Barking Town Section to the Barking Outfall Works will be completed during the year, and that further contracts will be commenced during the year 1931. The Seven Kings Valley Sewer has been extended to Eastern Avenue, to which is connected at this point the Eastern Avenue sewer constructed in tunnel. The Seven Kings Sewer when fully extended will deal with the drainage from 1,700 acres in the NorthWest area of the Borough. It is anticipated that a further extension of the Seven Kings Valley Sewer to New North Road will be commenced during 1931, and a relief sewer to be constructed in Forest Road will be connected thereto. Projected works in sewerage also include a further extension to the Roding Valley Low Level sewer, along Roding Lane to the North-Western boundary of the Borough. 4. Closet Accommodation.—In addition to the water carriage system of sewage, there are in the rural area, 48 cesspools, 16 privies and 38 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. 24 houses with pail closets in Redbridge Lane and Claybury Hall Farm Cottages were connected to the sewer in the early part of 1930. 5. Scavenging, etc.—The collection of house refuse is under taken 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 1930, 16,306 tons were so dealt with. 41 362 defective and unsuitable receptacles have been replaced during the year. The following figures give information as to the collection of house refuse during 1930:— Number of days on which collection was made 1,368 (Horse 125, electric 307, No. 9 Vulcan 259, No. 10 Vulcan 111, No. 11 S.D. Freighter 285, Nos. 12/14 S.D. Freighter 281.) Number of days vehicles employed 3,728 (Horse 388, electric 2,065, No. 9 Vulcan 259, No. 10 Vulcan 111, No. 11 S.D. Freighter 285, Nos. 12/14 S.D. Freighter 620.) Average number of vehicles employed per day 15.0 (Horse 3.1, electric 6.7, No. 9 Vulcan 1.0, No. 10 Vulcan 1.0, No. 11 S.D. Freighter 1.0, Nos. 12/14 S.D. Freighter 2.2.) Total number of loads collected 11,144 (Horse 1,282, electric 5,858, No. 9 Vulcan 804, No. 10 Vulcan 294, No. 11 S.D. Freighter 930, Nos. 12/14 S.D. Freighter 1,976.) Average number of loads collected per day 45.2 (Horse 10.2, electric 19.0, No. 9 Vulcan 3.1, No. 10 Vulcan 2.6, No. 11 S.D. Freighter 3.3, Nos. 12/14 S.D. Freighter 7.0.) Average number of loads collected per vehicle per day 3.0 (Horse 3.3, electric 2.8, No. 9 Vulcan 3.1, No. 10 Vulcan 2.6, No. 11 S.D. Freighter 3.3, Nos. 12/14 S.D. Freighter 3.2.) Total weight of refuse collected, 25,591 tons 16 cwts. 0 qr. (Horse, 1,389 tons 11 cwts. 1 qr.) (Electric, 15,011 tons 3 cwts. 0 qr.) (No. 9 Vulcan lorry, 1,507 tons 15 cwts. 1 qr.) (No. 10 Vulcan lorry, 866 tons 4 cwts. 1 qr.) (No. 11 S.D. Freighter, 1,688 tons 12 cwts. 3 qrs.) (Nos. 12/14 S.D. Freighter, 5,128 tons 9 cwts. 2 qrs.) Average weight per load :— Horse-drawn vehicles 1 ton 1 cwt. 2.7 qrs. Electric vehicles 2 tons 11 cwts. 1 qr. No. 9 Vulcan lorry 1 ton 17 cwts. 2 qrs. No. 10 Vulcan lorry 2 tons 18 cwts. 3.7 qrs. No. 11 S.D. Freighter 1 ton 16cwts. 1.2qrs. Nos. 12/14 S.D. Freighter 2tons 11 cwts. 3.6qrs. Average 2 tons 5cwts.3.7qrs. 42 Average cost of collection per ton :- £ s. d. Horse vehicles 0 10 3 Electric vehicles 0 9 1 No. 9 Vulcan lorry 0 10 8.6 No. 10 Vulcan lorry 0 9 4.2 No. 11 S.D. Freighter 0 10 1.6 Nos. 12/14 S.D.Freighter 0 8 9.7 Average of all vehicles 0 9 1.3 These figures include capital and depreciation costs and all incidental charges. Collection has been improved by the extended use of low loading Motor Vehicles, the Council now having four vehicles of this type engaged upon refuse collection. Owing to the capacity of the existing destructor being insufficient to deal with the quantity of refuse now collected, it has been necessary to continue barging. The present contract calls for a weekly delivery of 250 tons of refuse for disposal by barge; the balance is disposed of by incineration at the Council's Refuse Destructor. 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 8,927 Houses and premises re-inspected (works in progress) 11,519 Visits during disinfection 1,622 Houses in which nuisances were detected 668 Houses in which nuisances were abated 579 Premises disinfected 833 Premises from which articles only disinfected 108 Articles disinfected 4,453 Premises disinfected for verminous conditions 6 43 Notices served:— Statutory:— Served. Complied with. Public Health Act, 1875 59 40 Housing Act, 1930 284 101 Cleanse Dwelling House (Infectious Disease (Prevention) Act, 1890) 1 1 Provide Dustbin (Ilford Improvement Act) 422 362 Pave Yard (Ilford Improvement Act) 3 — Provide Water Supply to Dwelling House 4 2 Cleanse Water Storage Cistern (Byelaws) 25 38 Cover Water Storage Cistern (Byelaws) 3 5 Informal 310 336 Total 1,111 885 In addition to the above, 163 notices (102 statutory and 61 informal) served during 1929 were also complied with. Complaints.—During the year, 204 complaints of nuisances have been received and investigated:— The following is a summary:— Accumulation of manure and refuse 18 Animals improperly kept 5 Bad smells 11 Dampness of premises 15 Defectivedrains,w.c.'sandfittings 30 Defective or no provision of dustbin 3 Defective roofs, gutters, downpipes, etc. 27 Defective water fittings 11 Dirty and verminous houses 14 Dirty condition of rearway 3 Flooding of premises 1 Overcrowding 7 Smoke nuisances 7 Miscellaneous 52 Total 204 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 4, and the number of certificates issued was 4. 44 7. Smoke Abatement.—It has not been necessary during the year to take any legal action for the abatement of smoke. It has been necessary, however, to deal with several factories in the eastern part of the Borough, for abatement of smoke nuisance. Periodic observations have been kept, and the owners communicated with. 8. Premises and Occupations which can be Controlled by Byelaws or Regulations.—Fish-frying licences have been granted in respect of four premises during 1930, subject to the requirements of the Medical Officer of Health being complied with. 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 32 of this report. On six occasions it has been found necessary to remove encampments of gipsies on waste land within the Borough. As the vacant land becomes occupied for building purposes, this difficulty will, of course, disappear. In one case it was found necessary to serve formal notice on the proprietor of an amusement park to provide suitable and sufficient sanitary accommodation for the van dwellers. The amusement park was subsequently closed by the occupier. No action has been found necessary in respect of underground sleeping rooms (Housing Act, 1925, Sect. 18 (1). 9.—Other Sanitary Conditions. Cemetery Extension.—Owing to the rapidly approaching attainment of the complement of burials at Buckingham Road Cemetery, the Council, in March, 1930, purchased 28 acres at Barkingside for the purpose of cemetery extension. 45 10. Schools.—The sanitary condition and water supply of public elementary schools are inspected and reported upon monthly by the Sanitary Inspectors, and a list of defects requiring attention is forwarded to the Director of Education for consideration by the Works (Education) Sub-Committee. This subject is further reported upon on page 129, School Medical Service Section. 11. Rag Flock Acts, 1911 and 1928.—There are no premises on which rag flock is manufactured, used or sold. 12. Housing.—During the year 1930 the number of houses built by private enterprise was 1,797. At the end of the year 1,374 houses were in course of erection. The extension of the Council's housing scheme on the site adjacent to the existing Tomswood Hill Estate is nearing completion. This involves an additional 146 houses. 13. Overcrowding.—Notices were served in respect of 23 premises, of which 18 were complied with during the year. 14. Unhealthy Areas.—No representations or complaints have been made regarding unhealthy areas during the year. HOUSING. The following is the table required by the Ministry of Health:— (a) Statistics. Number of New Houses erected during 1930:— (a) Total (including numbers given separately under (6) ) 1797 (i.) By the Local Authority Nil (ii.) By other Local Authorities Nil (iii.) By other bodies and persons 1797 46 (6) With State assistance under the Housing Acts:— (i.) By the Local Authority:— (а) For the purpose of Part ii of the Actof 1925 Nil (b) For the purpose of Part iii of the Act of 1925 Nil (c) For other purposes Nil (ii) By other bodies or persons Nil 1. Inspection of Dwelling Houses during the year:— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) and the number of inspections made:— Number of Houses Inspected 1,272 Number of Inspections made 3,048 (2) Number of dwelling houses which were inspected and recorded under the Housing Consolidated Regulations, 1925, and the number of inspections made:— Number of Houses Inspected 361 Number of Inspections made 1,407 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 545 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 436 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 272 (2) Number of dwelling houses which were rendered fit after service of formal not ices :— (a) By owners 106 (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 — 47 (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:— (а) By owners 3 (b) By Local Authority in default of owners — (c) Proceedings under Sections 11,14 and 15 of the Housing Act, 1925:— (1) Number of representations made with a view to the making of Closing Orders — (2) Number of dwelling houses in respect of which Closing Orders were made — (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit — (4) Number of dwelling houses in respect of which Demolition Orders were made — (5) Number of dwelling houses demolished in pursuance of Demolition Orders — 4. Number of houses owned by the Local Authority distinguishing those built in the last two years and held under : (1) Part III of the Housing Act, 1925; (2) Part II of the Housing Act, 1925, and (3) Other powers:— (1) Under Part III of the Housing Act, 1925, during last two years 120 (2) Other houses owned 527 Total houses owned by Local Authority 647 (b) Housing Conditions. 1.—General observations as to housing conditions, including the standard of houses, the prevalent types, age and approximate numbers and general soundness of the several types—any information as to prevailing forms of defects and of prevailing bad conditions resulting from overcrowding. A large number of dwelling-houses have been and are being erected by private enterprise. Generally they consist of 6 or 7 rooms, comprising Drawing, Dining, Kitchen, Scullery, 3 or 4 bedrooms with Bathroom and separate W.C. accommodation, and are erected as semi-detached or in terraces of 4 or 6. The type of house applies generally in the district, with the exception of the older type of cottage or smaller working class house, the latter being about 50—100 years old. There are no very serious overcrowding difficulties, although during the last few years there has been a tendency to sublet rooms in houses which were originally erected for one family. 48 In Junc, 1926, a Report on Congested Houses (63 in number) was presented to the Local Authority and was subsequently transmitted to the Ministry of Health. 2.—Sufficiency of supply of houses. (a) Extent of shortage, if any, of houses available at reasonable rents, and the measures taken or contemplated to meet any shortage. The Corporation during the last five years has erected 416 houses. At the present time there is a considerable waiting list of applicants. The numbers erected by private enterprise for the same period was 7,797. Owing to the large number of houses in course of erection by private enterprise, and contemplated, it is not anticipated that any acute shortage of houses will arise. There is, in this district, as in any other, a certain number of tenants who would benefit by the provision of houses at cheaper rents. (b) Information as to any important changes in population during the period under review or anticipated in the future. No information available or anticipated of any important changes in population, except a steady increase. (c) Any special difficulties in the way of providing suitable sites for new houses. No difficulties. 3.—Overcrowding. (а) Extent—The basis on which the estimate has been made should be stated. Information as to Housing conditions in the district has been obtained during visits to houses following cases of infectious disease, house to house inspection, complaints and other visits such as tc birth notifications. The basis of calculating overcrowding is that contained in the Model Byelaws of the Ministry of Health, Scries 13 c (Section 8, Housing Act, 1930), Part II, and during the year, 23 premises were found to be overcrowded and these were abated in 18 instances during the year. (б) Causes—how far is it due to inability to pay the rents of available houses. There are few houses to let in the district, but these are at a high rental. Overcrowding occurs in some cases where friends or relatives of occupiers become sub-tenants with a view to reducing the cost of the occupiers' purchase of the house. (c) Example of special action taken during the year 1930 to deal with, overcrowding. Statutory Notices were served in 23 instances, and in 10 these were complied with without proceedings being taken. In 6 cases Police Court proceedings have been taken, and orders were issued (and complied with) for abatement of the nuisance within periods of 14 days to 1 month. Two cases were dealt with by County Court summonses, issued by the person on whom the Statutory Notice had been served. Five cases were still being dealt with at the end of the year. 49 4.—Fitness of Houses. (а) Difficulties found in action under the Public Health Acts or under Section 3 of the Housing Act, 1925. No difficulties have been found. On service of Statutory Notices the owners have dealt with the matter without legal proceedings. (b) Special measures taken or suggested, e.g., in relation to particular types of insanitary property or in regard to arrangements for the gradual carrying out of programmes of repair. Houses are being scheduled for inspection under the Housing Acts. No special measures have been required. (c) Extent to which houses have not an adequate internal water supply, distinguishing those houses supplied by :— (a) Private and (b) Common supplies. Approximately 100 cottages in various parts of the district are supplied with Water Companies Water by standpipe, and approximately 20 houses are supplied from private wells. (d) Extent to which houses have no water closet or other adequate sanitary accommodation within their own curtilage, distinguishing those having : (а) Private and (b) Common accommodation. There are seven houses which have no water closet within their own curtilage but in these cases the sanitary accommodation is provided within the curtilage of the block of property concerned. 5.—Unhealthy Areas. Extent to which areas of the district arc unhealthy, with information as to complaints received or representations made, and action taken, in regard to any of these areas. None. 6.—Byelaws relating to houses, to houses let in lodgings, and to tents, vans, sheds, etc. Adequacy of existing byelaws of each class, and special difficulties in or limits upon their enforcement. By reason of the available land being built upon there is every year less difficulty with the van-dweller. It. has been necessary on six occasions to draw vans from open land, and on several more occasions van dwellers left on being requested to do so. 7.—General observations on housing matters not already covered, and on any difficulties experienced in housing administration and the measures taken to meet them. No exceptional difficulties have been met with. 50 SECTION IV.—INSPECTION AND SUPERVISION OF FOOD. 1. Milk Supply.—There are 80 dairies and milkshops and 5 cowsheds on the register. In addition, 9 premises are registered to sell cream only. 232 inspections of dairies, milkshops and cowsheds were carried out during the year. 63 inspections (included in above) were made of the 5 farms registered under the provisions of the Milk and Dairies (Consolidation) Act, 1915, and the Milk and Dairies (Amendment) Act, 1922, and the Milk and Dairies Order, 1926. Structural alterations have been carried out under supervision at 2 farms. Of the 80 premises from which milk is retailed in Ilford, 16 are branches of one firm, 2 another and 4 another, while another is a branch of a large firm of retailers, 6 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 34 sell sterilised bottled milk only. In 4 premises, pasteurising plant has been installed. Only 2 of these have, however, been licensed. There are 5 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 1930, for the sale of :— " Certified " Milk 5 " Grade A " Milk 6 " Grade A (Tuberculin Tested) " Milk 9 " Pasteurised " Milk 21 " Grade A Pasteurised" Milk 5 The above include supplementary licences which were issued for "Certified" milk, 5; "Grade A" milk, 3; "Grade A 51 (Tuberculin Tested)" milk, 6; 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.—10 samples of "Grade A (Tuberculin Tested)," 4 samples of "Grade A," 2 samples of "Grade A Pasteurised," 24 samples of "Pasteurised" milk, and 65 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. 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. 11 923 2 2,046 12 2,853 3 930 20 687,000 80 98,500 35 1,596 88 1,653 36 3,850 — — 41 3,750 — — 56 195 — — 57 6,593 — — 81 9,916 — — 98 6,730 - — 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. Two samples of this grade of milk (Nos. 1 and 78) were taken, the number of bacteria being 95 and 8,723 respectively. The standard for "Pasteurised" milk is that a sample shall be found to contain not more than 100,000 bacteria per cubic centimetre. 52 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. 7 65,950 64 8,853 18 6,913 65 7,780 21 97,850 68 9,726 24 8,020 70 923 25 2,723 71 1,450 33 5,763 73 4,723 38 4,730 74 5,913 42 3,723 79 6,010 48 3,863 83 7,920 49 5,016 86 5,253 53 6,013 87 38,750 63 10,730 89 29,850 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. 4 2,823 37 30,633 75 29,200 5 37,966 39 60,233 76 38,466 6 326,600 40 49,200 77 1,858,500 8 271,500 43 466,500 82 67,300 9 27,300 44 579,500 84 222,866 10 39,166 45 38,666 85 1,309,000 13 35,900 46 37,333 90 117,800 14 496,500 47 42,333 91 4,580,000 15 69,166 50 56,600 92 769,500 16 17,966 51 47,966 93 50,233 17 27,266 52 858,500 94 378,000 19 329,500 54 20,166 95 60,100 22 66,600 55 58,466 96 61,133 23 137,300 58 59,233 97 68,466 26 488,000 59 1,037,500 99 1,453 27 597,000 60 87,833 100 17,233 28 49,233 61 67,266 101 9,200 29 40,166 62 59,133 102 37,233 30 18,533 66 76,633 103 19,100 31 15,233 67 70,100 104 37,300 32 27,300 69 99,200 105 649,000 34 27,933 72 50,233 - - 53 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. The number of milk samples submitted for a biological test for tuberculosis was 59. I sample was found to be positive, and 58 negative. 4. Tubercular Milk.— (a) A sample of milk was taken on the 2nd July from a Dagenham retailer who also retailed in the Ilford district. The sample of milk was submitted to bacteriological examination and the presence of tuberculosis was established. The County Medical Officer was notified under Section 4 of the Milk and Dairies (Consolidation) Act, 1915, and the Medical Officer of Health, Dagenham, was also informed. The Essex County Council Veterinary Inspector visited the 5 farms from which this retailer obtained his supplies on 20th, 21st and 22nd August. Major J. A. Boseley, the Ilford Veterinary Inspector, visited the farms in question during the visit of the Essex County Council Veterinary Inspector. At one of the farms two cows were discovered with indurated udders which gave a definite reaction to the tuberculin test. The Essex County Council dealt with the matter under the Tuberculosis Order of 1925, and both cows were slaughtered. No evidence of disease was found in the cows at the other four farms. A warning was served under Section 5 of the Milk and Dairies (Consolidation) Act, 1915, on the retailer. A further sample of milk was taken on the 11th August from the Dagenham retailer. The sample was submitted to bacteriological examination, and did not shew the presence of tuberculosis. 54 (6) A report was received from the County Medical Officer of Health to the effect that under the Milk and Dairies (Consolidation) Act, 1915, a sample of milk was taken by the Essex County Council Inspector on the 31st July, from a producer in the Ilford district. The sample was submitted to bacteriological examination and was considered to have contained tubercle bacilli. The County Veterinary Surgeon visited the premises. The Ilford Veterinary Surgeon inspected the producer's cattle but no evidence of tuberculosis was found in any of the cows. A sample of milk had been taken in the usual routine way by the Ilford Sanitary Inspector. The result of this did not show the presence of tuberculosis. It was found, however, that a sale of cows took place between the day of the sample of milk taken by the Essex County Council Inspector and that of the Ilford Sanitary Inspector. Subsequent enquiries proved that a red cow, which had been under suspicion by the Ilford producer, was sold on the 17th September at Romford Market to a dealer, and was shipped abroad. Two further samples of milk were obtained on the 19th August and the 18th September from the cows of the Ilford producer, and both samples did not shew the presence of tuberculosis. 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 42 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 Dutch lettuce; 5 stone of skate; 48 lbs. of prawns; 5 stone 1½ lbs. of hake; 4 dozen rabbits; 1 pig ; 1 pig's head ; 3 stone of rock salmon. No articles of food were seized during the year. 55 7. Bakehouses.—There are 34 bakehouses in the district, including 14 factory bakehouses. 191 inspections of bakehouses were carried out during the year. The only underground bakehouse was closed during the year. It was necessary to call upon the occupiers of bakehouses to carry out cleansing and other works in 21 instances, and the requests were complied with. 8. Sale of Food and Drugs Acts.—These Acts are administered by the Essex County Council for whom Dr. Bernard Dyer is the Public Analyst. Mr. H. C. Card, the Chief Inspector, has kindly given me certain particulars, which I append :— Samples of Milk taken 144 Samples of Butter taken 84 Other Samples 120 Total 348 Proceedings were instituted in one instance for the sale of milk deficient in milk fat. A fine of £2 and 6s. costs was inflicted. 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. Regulation of Movement of Swine Order, 1922.—Ten licences were received during the year from various Local Authorities, authorizing the movement of swine into this district. These comprised 165 animals, 28 of them being for slaughter and 137 for other purposes. In addition to the above, 9 licences were issued by the Senior Sanitary Inspector to other Authorities, authorizing the movement of 32 animals, 19 being for slaughter and 13 for other purposes. Importation of Animals Act, 1922.—One licence was received authorizing the removal into this district of 14 cows. Glanders.—A notice was received from the Police that a horse had been observed appearing to be suffering from Glanders. The Corporation Veterinary Inspector inspected the animal, and found that it was not suffering from this disease. 56 Rabies.—A case of suspected rabies was reported by the Police, a dog having bitten 4 persons residing in a house. The dog had been destroyed and the carcase was at the Police Station. The necessary report was made to the Ministry of Agriculture and Fisheries. The feeding and drinking utensils used by the dog were disinfected. A post mortem examination of the carcase was carried out, and this proved that rabies did not exist. Anthrax Order, 1910.—A cow, 4 years old, died suddenly under circumstances suggestive of Anthrax, but the Corporation Veterinary Inspector, by means of a microscopical examination of the blood, was able to certify that the case was not one of Anthrax. 10. Rats and Mice Destruction Act, 1919.—During the year complaints have been received of 100 premises infested with rats. In 20 of these cases a rat catcher was employed, and in the remaining cases other steps were taken. 11. Petroleum (Consolidation) Act, 1928.—During the year the Senior Sanitary Inspector made 490 visits to premises where petroleum is stored, or in connection with the installation of such storage, and tested 44 petroleum appliances or fittings. The number of licences issued was 113, and petroleum licence fees to the value of £76 3s. 3d. were collected during the year. SECTION V.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. 1. Infectious Disease Generally.—During 1930, 974 cases were notified, as compared with 1,166 in 1929. The following diseases are notifiable to the Medical Officer of Health :— Smallpox. Cholera. Diphtheria. Membranous Croup. Erysipelas. {Scarlatina or Scarlet Fever. Typhus Fever. Typhoid Fever. Enteric Fever. Relapsing Fever. Continued Fever. Puerperal Fever. Puerperal Pyrexia. Pemphigus Neonatorum. Cerebro-Spinal Fever. Plague. Ophthalmia Neonatorum. Tuberculosis. Acute Influenzal Pneumonia. Acute Primary Pneumonia. Dysentery (including amoebic and bacillary dysentery). Malaria. Acute Poliomyelitis. Acute Polio-Encephalitis. Acute Encephalitis Lethargica. Anthrax. 57 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 1930, arranged according to age and distributed in wards. Of these 59 occurred in institutions as follows:- Claybury Mental Hospital:- Small Pox 5 cases. Pneumonia 4 cases. Enteric Fever 5 cases. Erysipelas 1 case. Dysentery 10 cases. 25 cases. Dr. Barnardo's Girls' Village Homes:- Diphtheria 6 cases. Scarlet Fever 4 cases. Erysipelas 4 cases. Tuberculosis—Pulmonary 3 cases. „ Other forms 1 case. 18 cases. West Ham Mental Hospital:— Diphtheria 1 case. 1 case. King George Hospital:— Small Pox 1 case. Diphtheria 2 cases. Scarlet Fever 2 cases. Erysipelas 1 case. Pneumonia 9 cases. 15 cases. Of the cases notified (exclusive of those from Public Institutions) the following table shows the percentage isolated in hospitals:- Scarlet Fever 67.8 Diphtheria and Membranous Croup 93.1 Enteric Fever 66.6 Puerperal Fever 100.0 58 TABLE II.—Cases of Infectious Disease Notified during the Year 1930. 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 25 - - 8 8 5 4 - 1 7 - 7 2 3 2 3 25 Scarlet Fever 287 2 42 186 31 24 1 1 16 38 47 66 29 19 29 43 192 Diphtheria, including Membranous Croup 330 2 59 219 28 19 3 - 14 43 32 40 22 28 30 121 300 Enteric Fever (Typhoid and Para Typhoid) 11 - - - 1 4 5 1 3 1 - 5 - - 2 - 4 Pneumonia 69 3 16 10 4 17 13 6 2 4 3 16 3 4 6 31 19 Puerperal Fever - — — — — — — — — — — — — — — — — Puerperal Pyrexia 10 — - — 6 4 - - 1 — 1 1 2 — 1 4 8 Cerebro-Spinal Fever 2 - - 1 - 1 - - - — 1 — — — — 1 2 Acute Poliomyelitis - — — — — — — — — — — — — — — — — Acute Polio-Encephalitis 1 - - 1 - - - - - - - - 1 - - - - Encephalitis Lethargica — — — — — — — — — — — — — — — — — Continued Fever - - - - — - - - — — - — — — — - — Dysentery 10 — — — — 3 5 2 — — — 10 — — — — — Ophthalmia Neonatorum 5 5 — — — — — - — — — 1 — 2 — 2 — Erysipelas 59 2 3 2 5 22 18 7 4 6 8 12 8 10 2 9 11 Pemphigus Neonatorum 3 3 - — — - — - - — — 1 — 1 — 1 1 Tuberculosis—Pulmonary 125 - 1 4 32 66 19 3 14 10 11 24 17 17 15 17 — Other Forms 37 — 5 16 8 6 2 — 1 2 3 9 6 2 6 8 — Anthrax - — — — — — — — — — — — — — — — — Malaria—Believed to be contracted in this country - - - - - - - - - - - - - - - - - Believed to be contracted abroad - - - - - - - - - - - - - - - - - Totals 974 17 126 447 123 171 70 20 56 111 106 192 90 86 93 240 562 59 The total number of deaths of Ilford residents from the chief infectious diseases during 1930 was 176, classified as follows:- Enteric Fever - Scarlet Fever 1 Diphtheria 12 Measles 9 Whooping Cough 2 Influenza 11 Tuberculosis—Pulmonary 61 „ Other forms 8 Pneumonia 59 Diarrhoea (under 2 years) 9 Cerebro-Spinal Fever 2 Puerperal Fever 2 176 The following table shows a comparison of the incidence of the chief infectious diseases for the past five years:- 1930. No. of Cases. 1926. 1929. 1928. 1927. Scarlet Fever 287 476 502 387 171 Diphtheria 330 305 260 187 148 Enteric Fever 11 12 30 11 6 Pneumonia 69 146 92 139 73 (a) Smallpox.—Twenty-five cases of this disease were notified, of which the following is a brief summary:— (a) An unvaccinated woman, aged 26 years, was removed to King George Hospital from an address in Dagenham on the 8th January, with acute abdominal trouble and influenza. I was called in to see this patient on the 13th January and diagnosed the case as one of Smallpox. The patient was removed to Orsett Smallpox Hospital on the same day. The ward was placed in quarantine and thorough disinfection at the hospital was carried out. There were 55 direct contacts and 146 indirect contacts of this case. Fortunately all the patients in the same ward had been vaccinated, some on several occasions. Vaccination of contacts was carried out at the hospital. No further cases occurred. (b) Five cases, all male adults, were notified from Claybury Mental Hospital (3 on the 10th April and 2 on the 16th April). 6 Ilford contacts were kept under observation. No further cases occurred. 60 (c) An unvaccinated boy, aged 15 years, was removed to Joyce Green Hospital from an address in the Park Ward, on May 5th. There were 14 contacts, all of whom were kept under observation. (d) A girl, aged 13 years (unvaccinated in infancy), who was a contact of case (c). She was removed to the Wharf Hospital, Deptford, on the 17th May from an address in the Park Ward. The 13 contacts were kept under observation. (e) A girl, aged 13 years (unvaccinated in infancy), who was a sister of case (c). She was removed to the Wharf Hospital, Deptford, on 18th May, from an address in the Park Ward. The 13 contacts were kept under observation. (f) An unvaccinated girl, aged 9 years. She was removed to Joyce Green Hospital, on the 22nd May, from an address in the Park Ward. The 4 contacts were kept under observation. The case was probably connected with (c), (d) and (e). (g) An unvaccinated boy, aged 16 years. He was removed to Joyce Green Hospital on the 19th May from an address in the Goodmayes Ward. The 21 contacts were kept under observation. (h) Two sisters, aged 14 and 11 years respectively (unvaccinated), who were in the same house in the Goodmayes Ward, mentioned in (g) above. Both cnildren were removed to Joyce Green Hospital on the 6th June. 3 contacts were kept under observation. (i) An unvaccinated boy, aged 9 years. He was removed to Joyce Green Hospital on the 2nd June from an address in the Goodmayes Ward. The 5 contacts were kept under observation. (j) An unvaccinated woman, aged 25 years. She was removed to Joyce Green Hospital on the 14th June from an address in the Loxford Ward. This person was a contact of a case of smallpox in the West Ham area. The 9 contacts were kept under observation. (k) An unvaccinated woman, aged 53 years. She was removed to Joyce Green Hospital on the 16th June from an address in the North Hainault Ward. The 11 contacts were kept under observation. (l) An unvaccinated man, aged 18 years. He was removed to Joyce Green Hospital on the 30th June from an address in the South Hainault Ward. This person was a direct contact of a boy living in Chadwell Heath. I examined the latter on the 30th June ; he had scars suspicious of smallpox and gave a history of illness with a rash which occurred a month previously. The 17 contacts were kept under observation. (m) An unvaccinated man, aged 22 years. He was removed to Orsett Hospital on the 14th July from an address in the Cranbrook Ward. The 4 contacts were kept under observation. (n) A male, aged 22 years, and two females, aged 9 and 19 years respectively, all unvaccinated. They were members of one family living in the same house. Two of the cases were removed from an address in the Park Ward to Orsett Hospital on the 9th August, and the remaining case to the same hospital on the 24th August. The 16 contacts were kept under observation. 61 (a) An unvaccinated man, aged 27 years. He was removed to Orsett Hospital on the 16th August from an address in the Clementswood Ward. The 7 contacts were kept under observation. (b) An unvaccinated boy, aged 10 years. This case was detected as suffering from smallpox in the School Clinic. He was removed to Joyce Green Hospital on the 25th August, his home address be'ng in the Clementswood Ward. The 40 contacts were kept under observation. (q) An unvaccinated boy, aged 16 years. He was removed to Joyce Green Hospital on the 30th August from an address in the Loxford Ward. The 17 contacts were kept under observation. (r) A man, aged 48 years, vaccinated in infancy, but not again until 22nd August, too late to prevent infection. This was a contact of case (o). He was removed to Joyce Green Hospital on the 2nd September from an address in the Clementswood Ward. The 6 contacts were kept under observation. All the patients made a good recovery. Notifications of 486 persons who had been in contact with eases 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 1930:— Certificates of Successful Vaccination 753 Postponed 87 Conscientious Objections 690 Unsuccessful Vaccinations 11 Left the District 39 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. This agreement expires on the 13th March, 1932. The six-monthly contribution by Ilford for the six months ended March, 1930, was £197 9s. 9d., and for the six months ended 30th September, 1930, £472 17s. 2d. (b) Scarlet Fever.—287 cases were notified in 1930, as compared with 476 in 1929; 502 in 1928; 387 in 1927; 171 in 1926 ; 146 in 1925. 62 The following "return" cases have occurred during the past six years, a "return" case being one which arises within 28 days of the freedom of the primary case from isolation:- Year. Cases notified (excluding Institutions). Admitted to Isolation Hospital. "Return" Hospital Cases. Per Cent. Home Cases. Cases arising in same house. Per Cent. 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 1930 283 189 3 1.5 94 2 2.1 On the 22nd and 23rd December two cases of Scarlet Fever occurred at King George Hospital and were removed to the Isolation Hospital. On my advice the ward contacts and nursing staff were swabbed for hemolytic streptococci, and the ward placed in quarantine. Two patients and two of the nursing staff were subsequently removed to the Isolation Hospital as "carriers," and one of the nursing staff, also a " carrier," was isolated at her home address. Owing to the measures adopted, no further cases occurred at King George Hospital. (c) Diphtheria.—330 cases were notified in 1930 as compared with 305 in 1929; 260 in 1928; 187 in 1927; 148 in 1926; 56 in 1925. Of the 330 cases, 6 were notified from the Girls' Village Homes, Barkingside, 2 from King George Hospital, and 1 from West Ham Mental Hospital. The Schick Testing and Immunising of children has been continued, and the following table shows the number Schick Tested and Immunised at the Diphtheria Clinic held at the Public Health Offices, and at Becontree, Goodmayes and St. Vincent's Schools:— 63 Tabular Statement as to Number of Children Schick Tested and Immunised at School, and at Diphtheria Clinic, from 12th November, 1929, to the 31st December, 1930. At School. At Diphtheria Clinic, Public Health Offices. Total. School Children (Becontree, Goodmayes and St. Vincent's). Children under 5 years of age. School Children (Various Schools). Children under 5 years of age. Numbers Schick Tested:- Positive 697 3 196 - 896 Negative 160 — 45 — 205 Numbers inoculated (full course) 690 51 260 317 1,318 Negative after full course of inoculations 481 — 110 171 762 Positive after full course of inoculations , and re-inoculated 139 - 3 4 146 Awaiting re-test 28 43 140 132 343 Not re-tested after inoculation (on account of leaving district, &c.) 33 8 5 10 56 Positive after re-test, but not inoculated for same reason 9 — 2 — 11 64 (d) Enteric Fever.—11 cases were notified in 1930, as compared with 12 in 1929; 30 in 1928; 11 in 1927; 6 in 1926 ; 10 in 1925. 5 of the cases occurred at Claybury Mental Hospital. The following is a summary of the remaining 6 cases :— (a) Bacillus Typhosus 3 cases. (b) Bacillus Para-typhosus B 1 case. (c) Negative Widal Reaction, and probably not cases of Typhoid Fever 2 cases. Of the cases mentioned in (a) :— One patient was a visitor to Ilford and contracted the disease whilst resident outside this district; the second patient had been a member of a touring party, and the source of infection was acquired in Palestine, one other member of the same party (not an Ilford case) had also contracted the disease ; in the remaining case it was not possible to trace the source of infection. The case mentioned in (b), was contracted outside the Ilford District, as this patient was living away from Ilford during the incubation period. Of the 6 cases mentioned above, 4 were removed to the Isolation Hospital and made a good recovery; 2 cases were nursed at home, 1 proving fatal. (e) Cerebro-Spinal Fever.—2 cases were notified, and both were fatal. One was an Ilford child of 7 years, who died in Oldchurch Hospital, and the other a person of 33 years, who died in the Isolation Hospital. No meningococci were found in the cerebro-spinal fluid of either patient. (f) Ophthalmia Neonatorum.—5 cases were notified during 1930, as compared with 6 in 1929 ; 4 in 1928 ; 2 in 1927 ; 3 in 65 1926; and 3 in 1930. One case was admitted to St. Margaret's Hospital. The remaining four were treated at home by private medical practitioners. Cases Vision UnImpaired Vision Impaired. Total Blindness. Deaths Notified. Treated At Home In Hospital 5 4 1 5 — — — (g) Acute Influenzal and Acute Primary Pneumonia.—69 cases were notified (of which 13 were in institutions) in 1930, compared with 146 in 1929; 92 in 1928; 139 in 1927; 73 in 1926; and 103 in 1925. (h) Encephalitis Lcthargica.—No cases were notified during 1930. (i) Plague.—No contacts of cases of this disease were received during the year. (j) Puerperal Fever.—No cases were notified during the year. (k) Puerperal Pyrexia.—10 notifications were received, 3 subsequently proving to be Puerperal Fever. Of these 3 cases, one was treated at the Isolation Hospital and made a good recovery; and two cases were treated at Oldchurch Hospital, one having a fatal termination. The remaining 7 were suffering from the following conditions :— (1) Gluteal abscess; (2) pyelonephritis; (3) sapræmia,; (4) unknown; (5) pyelonephritis; (6) pyelonephritis; (7) scarlet fever. Case No. (4) was treated at home ; No. (5) was treated at the Maternity Home; Nos. (1), (2), (3) and (6), were treated at the Isolation Hospital, and No. (7) at the London Hospital. 66 All the patients recovered satisfactorily. 2. Zymotic Diseases.—The deaths registered were as follows :— Small-pox — Measles 9 Scarlet Fever 1 Whooping Cough 2 Diphtheria and Croup 12 Enteric Fever 1 Diarrhœa 9 67 Table showing Incidence of, and Deaths from, Infectious Disease, 1930, in age groups. Disease. Total cases notified. Under 1 yr. 1—2. 2—3. 3—4. 4—5. 5—10. 10—15. 15—20. 20—35. 35—45. 45—65. Over 65. Cases admitted to Hospital Total Deaths. Under 1 yr. 1—2. 2—3. 3—4. 4—5. 5—10. 10—15. 15—20. 20—35. 35—45. 45—65. Over 65. Smallpox 25 - - - - - 3 5 5 7 1 4 — 25 - - - - - - - - - - - - - Scarlet Fever 287 2 3 3 18 18 135 51 21 27 7 1 1 192 1 - - - - - - - - 1 - - - Diphtheria 330 2 7 20 18 14 170 49 11 30 6 3 — 300 12 - 1 1 2 2 4 2 - - - - - Enteric Fever (including Paratyphoid. 11 - - - - - - - — 4 1 5 1 4 1 - - - - - - - - - - - 1 Pneumonia 69 3 9 2 3 2 5 5 1 9 11 13 6 19 59 8 4 1 1 1 1 — - 3 6 14 20 Puerperal Fever — — — — — — — — — - — — — — — — — - — — — — - — — — — Puerperal Pyrexia 10 - - - - - - - - 10 - - - 4 - - - - - - - - - 1 - - - Cerebro-spinal Fever 2 - - - - - 1 - - 1 - - - 2 2 — — - — — 1 — - 1 — — — Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Polio-Encephalitis 1 - - - - - 1 - - - - - - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 10 - - - - - - - - 1 2 5 2 - - - - - - - - - - - - - - Ophthalmia Neonatorum 5 5 - - - - - - - - - - - - - - - - - - - - - - - - - Erysipelas 59 2 3 — — — — 2 2 12 13 18 7 11 6 1 1 - - - - - - - 1 3 — Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria—believed to be contracted in this country - - - - - - - - - - - - - - - - - - - - - - - - - - - ,, —believed to be contracted abroad - - - - - - - - - - - - - - - - - - - - - - - - - - - Pemphigus Neonatorum 3 3 - - - - - - - - - - - 1 - - - - - - - - - - - - - 68 3. Tuberculosis.—During the year 1930, there were 125 new notifications of Pulmonary Tuberculosis and 37 of other forms of Tuberculosis. Thirty-two cases of Pulmonary and thirteen cases of Non-Pulmonary Tuberculosis were transferred to Ilford. Notification and Deaths from Tuberculosis of Ilford Residents during 1930. Age Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 year - - - - - - - - 1-5 years 1 — 4 1 1 — — — 5-10 years — — 7 4 — — — 1 10-15 years — 4 2 3 — — 1 2 15-20 years 5 7 3 4 5 — 1 — 20-25 years 8 12 — 1 8 7 — — 25-35 years 26 18 — 2 8 2 — 1 35-45 years 16 6 1 3 12 8 1 1 45-55 years 6 4 2 — 5 2 — — 55-65 years 7 2 — — 7 — — — Over 65 years 2 1 — — — 1 — — Totals 71 54 19 18 41 20 3 5 Of the above new cases, the following were notified from Institutions in the district:- Pulmonary Tuberculosis. Other Forms. The Girls' Village Homes, Barkingside 4 1 King George Hospital 3 4 Three of the above deaths, or 4.3 per cent, of the total deaths, had not been notified. Of the 69 deaths which occurred of Ilford residents, notification had previously been made of 59 of the cases. Seven were 69 notified at or after death. Three were not notified, by reason of the medical attendants believing the cases to have been already notified. The notification of tuberculosis in the area by Medical Practitioners may be considered as very satisfactory, and in any case arising of failure to notify, the Medical Attendant is communicated with immediately. It has not been found necessary to institute proceedings, no case of wilful neglect or refusal to notify having occurred. Copies of the Public Health (Tuberculosis) Regulations, 1930, have been forwarded to all local Medical Practitioners. During the year 1930, the following deaths occurred from Tuberculosis:— Pulmonary. Non-pulmonary. IIford Residents 61* 8† Non-Residents:— Claybury Mental Hospital 14 1 West Ham Mental Hospital 9 - King George Hospital — 1 Ilford Isolation Hospital 1 *Includes 1 at King George Hospital † 2 „ „ On the 1st January, 1930, there were 628 cases on the register of the department. On the 31st December, 1930, with 162 new cases notified and 45 transfers (Institution cases omitted), and allowing for deaths, removals from the district, and cases removed from the register as cured, there were 740 cases on the register. The new cases of Tuberculosis are visited by the Tuberculosis Nurse of the Essex County Council. 608 of the cases of longer standing were visited by the Sanitary Inspectors during the year, and the following reports were obtained:— 70  Pulmonary Cases. Other Cases. Stated to be cured, recovered or better 103 57 Improved or fairly well 191 82 Not so well 54 7 In Sanatorium 44 14 No information as to present condition 8 2 Removed from district, etc. 38 8 Totals 438 170 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, 1930, there were 636 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. 79 patients were treated, 21 being supplied with dentures. Public Health (Prevention of Tuberculosis) Regulations, 1925.—-No action has been taken under these regulations as regards persons employed in the milk trade. 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. Five children were sent to various convalescent homes, for periods of two and three months. Two cases were provided with dentures free of charge. Public Health Act, 1925, Section 62.—No action has been taken for the compulsory removal of infectious persons to hospital or other institutions. 4. Venereal Diseases.—In the following table are classified the deaths notified as due to (1) Syphilis ; (2) Locomotor Ataxy and General Paralysis of the Insane, which are certainly due to Syphilis ; and (3) Aortic Aneurysm, which is very frequently caused by this disease. 71  Ages 0-1 1-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75-85 85 up NonResidents in Institutions Totals. Syphilis - - - - — — 1 — — - — 4 5 Locomotor Ataxy - - - - - - - 1 1 - - - 2 General Paralysis of Insane - - - - - - - - - - - 23 23 Aortic Aneurysm — - — — — — 2 3 — — — — 5 The deaths of non-residents in Institutions occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital; 15 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. 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 ; 1929, 6 cases ; 1930, 5 cases. The diagnosis and treatment of Venereal Disease is, by the Public Health (Venereal Disease) Regulations, 1916, under the control of the Essex County Council. Arrangements have been made with the various London Hospitals for the free treatment of patients, and with the London Hospital for the free examination of bacteriological specimens submitted by doctors in the district. 5. Notification of Non-Notifiable Acute Infectious Diseases, including Influenza, occurring in Elementary School Children is received from the Head Teachers or School Attendance 72 Officers. As circumstances warrant, the School or Home is visited by the Sanitary Inspector or Health Visitor, and in certain cases by the Medical Officer of Health. In February I received information relating to a female, employed as a daily help, who was supposed to be suffering from influenza. Upon further enquiries being made, and a communication being sent to the private medical attendant, it was ascertained that this patient was suffering from Psittacosis, and that she had been in contact with a family at Barking, where there had been a case of this disease. Thorough cleansing of the premises was carried out, and observation kept until the recovery of the patient. 6. Disinfection by the Local Authority is carried out of premises and articles after the notification of infectious diseases, and also, upon request, after fatal cases of cancer. In the case of deaths from tuberculosis, the premises are visited by the Sanitary Inspectors, who arrange for the necessary disinfection to take place. Six verminous premises were disinfected during the year under the Public Health Acts, and in the School Medical Service Section will be found a record of the number of children cleansed under the Education Act, Section 87. 73 SECTION VI.—FACTORIES AND WORKSHOPS. Factories. There are 162 factories on the register, made up as follows:- Bakehouses 20 Boot Makers and Repairers 27 Builders, Joinery and Carpentry Works 5 Cabinet Maker 1 Cable Works 1 Carbon Works 1 Cardboard Box Maker 1 Carriage Works 1 Chemical Works 1 Collar Works 1 Confectionery Maker 1 Corset Maker 1 Cutlery and Tool Grinders 2 Cycle Repairers 2 Dyers and Cleaners 1 Electricity Supply Works 1 Engineers 11 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 12 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 Printers'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 4 Wire and Cable Manufacturer 1 Wireless Apparatus Makers 3 Woodcutter 2 Total 162 Workshops. There are 578 workshops on the register, made up as follows :— Artificial Flower Makers 2 Bakehouses 20 Basket Maker 1 Beet Boiler 1 Bookbinder 1 Boot Repairers 36 Boot Makers and Shoe Sewers 14 Brush Workers 7 Builders and Carpenters 39 Cabinet Makers 3 Carpet Planning 1 Clergy Robes Maker 1 Coach Builders 3 Confectioners 2 Dressmakers 53 Dyers and Cleaners 10 Electrical and Mechanical Engineers 6 Electric Battery Charging 3 Embroidery and Lace Workers 19 Feather Cleaner 1 Flag Makers 1 Floor Polisher Maker 1 Florists 4 French Polishers 2 Furniture Repairers 4 74 Workshops— continued. Furriers 8 Printers and Stationers 5 Glass Cutters and Glaziers 4 Rag and Bone Merchants 3 Glove Maker 1 Scale Maker 1 Grate and Furnace Makers 1 Shirt Makers 6 Hand Laundry 1 Sign Maker I Hairdresser 1 Sports Outfit Repairers 3 Harness Makers 1 Squeegee Maker 1 Hat Makers Tailors 46 Ice Cream Factor 1 Tie Makers 7 Incubator Maker 1 Tile Fender Makers 4 Leather Workers Timber Merchants 5 Life Belt Maker 1 Tinsmiths 2 Mattress Maker 1 Toy Maker and Repairer 1 Meat Cutting 1 Typewriter Repairer 1 Mechanical Dentist 1 Umbrella Repairers 4 Mica Maker 1 Undertakers 5 Milliners 37 Upholsterers 15 Mineral Water Manufacturer 1 Watch and Jewellery Repairers 15 Metal Moulder 1 Wearing Apparel and Under clothiers 70 Motor Cab Proprietors 4 Motor and Cycle Engineers and Repairers 29 Wheelwrights and Farriers 14 Wire Worker 1 Optician 1 Wireless Apparatus Maker 1 Packing Case Repairer 1 Woodcutters 7 Photographers 3 Total 578 Piano Repairer 1 Picture Framers 3 Plumbers 10 75 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) 85 1 — Workshops (including Workshop Laundries) 247 2 — Workplaces (other than Outworkers' premises included in Part 3 of this report) — — — Total 332 8 — 76 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 6 6 — — Want of ventilation — - — — Overcrowding — - — — Want of drainage of floors — - — — Other nuisances — — Sanitary accommoda tion insufficient 1 1 — — unsuitable or defective 6 6 - - not separate for sexes — — — — Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this report) - - - - Total 13 13 — — * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. 77 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Sending twice in the year. Sending once in the year. Lists. Outworkers. Lists. Outworkers. Contractors Workmen Contractors Workmen (1) (2) (3) (4) (5) (6) (7) Wearing Apparel:— Making, etc. 16 20 41 — — — Cleaning and Washing — — — — — — Household Linen 2 — 4 — — — Lace, Lace Curtains and Nets - - - - - - Total 18 20 45 — — — 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. 78 4.—OTHER MATTERS. Class. Number. (l) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshops Act (s. 133, 1901) 2 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5, 1901) Notified by H.M. Inspector 5 Reports (of action taken) sent to H.M. Inspector 5 Other — Underground Bakehouses (s. 101):— In use at the end of the year - ISOLATION HOSPITAL. 81 ISOLATION HOSPITAL. 525 patients were admitted during 1930, as compared with 664 in 1929, 577 in 1928, 519 in 1927, and 331 in 1926. 92.8 per cent. of the cases of diphtheria occurring in the district and 66.7 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. 1930 92.8 66.7 1929 90.0 63 0 1928 92.7 66.8 1927 92.4 77.3 1926 87.6 86.6 1925 94.4 78.7 1924 93.5 94.3 1923 92.7 93.5 1922 88.3 84.8 1921 90.5 87.0 The following table shows the total admissions for the past ten years:— Year. Scarlet Fever. Diphtheria. Tuberculosis. Other Diseases. Total. 1930 189 300 14 22 525 1929 339 290 13 22 664 1928 337 203 13 24 577 1927 306 145 51 17 519 1926 149 121 50 11 331 1925 111 51 28 9 199 1924 129 72 28 13 242 1923 115 113 61 25 314 1922 162 147 73 29 411 1921 269 134 66 24 493 82 The 525 patients admitted during 1930 had the following diseases:— Scarlet Fever 189 Diphtheria 300 Scarlet Fever and Diphtheria 4 Enteric Fever 4 Cerebro Spinal Fever 1 Puerperal Pyrexia 4 Pyelitis 1 Pemphigus Neonatorum 1 Tuberculous Diseases 14 Under observation 7 Number of deaths in Hospital, 15. Diphtheria 11 Scarlet Fever 2 Cerebro Spinal Fever 1 Tuberculous Diseases 1 Number of patients in Hospital on 1st January, 1930 and 1931 respectively 1st Jan., 1st Jan., 1930. 1931. Scarlet Fever 22 19 Diphtheria 85 27 Tuberculous Diseases 12 12 Under observation — 3 The average length of stay in Hospital was for Scarlet Fever 29 1 days. Diphtheria 42.5 „ Tuberculous Diseases 111.7 „ Average stay in Hospital of all eases 38.2 „ The above averages are based on cases that completed their stay in hospital during the year. Average number of patients in hospital per day, 67 -1. Scarlet Fever.— The 189 cases admitted to hospital during 1930 were distributed among the following age groups:— Under 1 yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. — 40 107 22 12 6 2 83 Two deaths occurred during the year, as follows:— (a) A male, aged 30 years. He was admitted to hospital at the end of the first week after the onset of the disease, suffering from toxic scarlet fever, with nephritis. In spite of intensive treatment he died 8 days later. (b) A female, aged 24 years. She was admitted on the second day of the disease, and developed acute otitis media two days later. She received 90 c.c. of Scarlet Fever Anti-toxin intramuscularly during the first four days in hospital. Arthritis of the left shoulder then set in. A blood culture two days later showed the presence of a Septicaemia, due to Type I Streptococcus Scarlatinæ. She died on the fourteenth day of the disease, with a terminal bronchopneumonia. It would appear that in this case the anti-toxin used was not of sufficient potency to combat the initial infection and prevent a fatal result. 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:— 1926. 1927. 1928. 1929. 1930. Ilford Nil. .6 .5 .3 1.05 M.A.B. .8 .6 .63 .60 not available The following complications occurred in the patients discharged during the year:— Complications present on admission:— Percentage. Otorrhœa 7 3.6 Mastoiditis 2 1.05 Nephritis (fatal) 1 .5 Bronchitis 4 2.1 Abscess (axillary) 1 .5 Complications developing after admission:— Percentage. Otorrhœa 10 5.2 Mastoiditis 3 1.5 Adenitis 5 2.6 Suppurative adenitis (groin) 1 .5 Tonsillitis 1 .5 84 Albuminuria 1 .5 Rheumatism 1 .5 Vaginitis 1 .5 Septicæmia (fatal), Arthritis, Broncho-pneumonia 1 .5 Broncho-pneumonia 1 .5 All the patients admitted with Scarlet Fever are treated with Anti-Scarlatinal Serum. This enables them to be discharged, if uncomplicated, after a period of three weeks from admission. All the Scarlet Fever patients are Dick tested on the eleventh day after admission, and at weekly intervals afterwards. All those found Dick positive are isolated in the cubicle and other separate wards. This practice has enabled me to reduce the relapse-rate at the Hospital from 3.2% to.2%. Enteric Fever.—Four cases were admitted. One case gave a negative result for B. Typhosus and B. Paratyphosus B., and was transferred to King George Hospital. The cause of the Pyrexia was not determined. One case gave a negative Widal test for B. Typhosus, and the remaining two gave positive results for B. Typhosus and B. Paratyphosus B. All the patients made a good recovery. Puerperal Pyrexia.—Five cases notified as Puerperal Pyrexia were admitted. One case proved to be Puerperal Fever. Two of the cases had Pyelonephritis (of B. Coli infection), one a Gluteal Abscess, and the other was found to be suffering from Sapræmia. All the patients made a good recovery. Diphtheria.—The 300 cases admitted to hospital were distributed among the following age groups:— Underl Year. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. — 73 180 28 12 4 3 Nine of the above cases proved to be non-virulent K.L.B. carriers. Eleven deaths, due to Diphtheria, occurred in the Hospital. The ages of the patients were 15 years, 11 years, 8 years, 7 years (two), 5 years (two), 4 years, 3 years (two), 2½ years. Seven of these died within 48 hours or less of admission. 85 24 cases developed various Paralyses, as follows:— Palatal 10 Palatal+strabismus 3 Palatal+pharyngeal 3 Palatal + pharyngeal+ciliary 1 Ciliary paralysis 2 Palatal +pharyngeal+cardiacfailure (fatal) 2 Palatal+cardiac failure (fatal) 1 Paralysis present on admission Palatal 1. General 1. Other Complications:— Adenitis 4 Onychia 7 (including 1 following Diphtheria & S. Fever) Bronchitis 2 Otorrhœa 12 (including 1 present on admission and 1 following Measles and 1 following S. Fever) Albuminuria 1 Secondary Tonsillitis 11 (including Streptococcal, 6; Pneumococc al, 3) 11 cases were treated with serum intravenously; in spite of this, six proved fatal. The following table shows the percentage death-rate of cases of diphtheria admitted to the Ilford Isolation Hospital during the past five years, compared with that in the M.A.B. Institutions in London:— 1926. 1927. 1928. 1929. 1930. Ilford 6.6 4.8 3.4 5.2 3.6 M.A.B.4.9 4.0 3.66 3.6 not available Cerebro Spinal Fever.— One case, a female, aged 33 years, was admitted to hospital. The case had a fatal termination. No Meningococci were found in the cerebro-spinal fluid. Pemphigus Neonatorum.— One case was admitted to hospital, and made a good recovery. Observation Cases.— Seven were admitted. Two patients admitted as doubtful cases of Scarlet Fever, proved to be German Measles, and Measles, respectively; one case, admitted for observation for Diphtheria, gave negative swab results after admission; 86 one case, admitted as doubtful Enteric Fever, proved to be colitis; two patients and one of the nursing staff (also another during January, 1931) were admitted from King George Hospital as carriers of Scarlet Fever organisms. The cases of Scarlet Fever at King George Hospital are reported upon on page 62. Tuberculosis.— Fourteen cases of Surgical Tuberculosis were admitted, as compared with 13 in 1929. The organs involved in the 14 cases admitted were as follows:— knee joint, 1; spine, 9; skin, 2; elbow joints, 2. At the end of the year, the following patients were in the Sanatorium Period in Nature of Case. Hospital. Spine and Hip 52 months. Hip 39 „ Spine 20 „ Hip 15 „ Spine 13 „ Spine 12 „ Spine 8 „ Elbow 7 „ Spine 6 „ Spine 6 weeks. Spine and psoas abscess 2 „ Knee 4 „ One death of a patient occurred from Tuberculosis of the Spine with Lumbar and Psoas Abscesses. 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 approximately once a month by Sir Henry Gauvain. Training of Probationer Nurses.— During 1930, four nurses passed Part I of the examination of the General Nursing Council, and nine obtained the Certificate by completing Part II. 87 The following table shows the number of the Staff at the Isolation Hospital who were Schick and Dick Tested during 1930, and also the numbers inoculated:— Numbers Schick Tested:— Staff. Positive 14 Negative 16 Numbers inoculated (full course) 13 Numbers re-tested:— Negative after full course of inoculations 10 Positive after full course of inoculations, and re-inoculated 2 Numbers Dick Tested:— Positive 10 Negative 20 Numbers inoculated (full course) 10 Numbers re-tested:— Negative after full course of inoculations 4 Positive after full course of inoculations, and re-inoculated 3 No members of the Staff at the Isolation Hospital developed Scarlet Fever or Diphtheria during the year. HOSPITAL EXTENSIONS. The Council, in January, 1931, approved a recommendation that the Town Clerk be instructed to make formal application to the Ministry of Health for sanction to the necessary loan, and that tenders be invited for carrying out the works. Notification has been received from the Essex County Council that they raise no objection to the Corporation's proposals with regard to the Isolation Hospital extensions. The cost of the extensions to the Isolation Hospital, as estimated, amount to the sum of £39,761, details of which appeared in my Annual Report for 1929. MATERNITY AND CHILD WELFARE 91 Notification of Births Acts, 1907 and 1915. By the Notification of Births Acts, 1907 and 1915, all live births and stillbirths of seven months and over must be notified to the Medical Officer of Health within 36 hours. The number of births notified under the above Acts during 1930 was 1,703 (852 males and 851 females). The percentage of births notified by the various responsible persons was as follows:- By Medical Practitioners 32.53 By Certified Midwives 51.61 By Parents and others 15.85 In addition, 52 stillbirths (25 males and 27 females) were notified. The causes of the 52 stillbirths were as follows:— Difficult labour 9 Cord around neck 1 Ill health of mother 2 Shock 3 Fall of mother 2 Anencephalus 4 Extended breech 1 Macerated foetus 1 Foetal distress 1 Malformed infant 1 Death of mother, premature infant 1 Prolapse of cord 1 Eclampsia 1 Ante-partum hæmorrhage 2 Toxaemia of pregnancy 2 Unknown 20 92 In addition, I have received notice of 7 stillbirths which took place outside the district, although the parents reside in Ilford. The causes of the stillbirths were as follows:— 6 at Queen Mary's Hospital, Stratford— Caesarian section operation 1 Prolonged obstructed labour 1 Ante-partum hæmorrhage 1 Abnormal lie 1 Kidney trouble in mother 1 Eclampsia 1 1 at East End Maternity Hospital, Commercial Road, E.— Macerated foetus 1 As mentioned in my last Annual Report the Public Health Committee considered the non-compliance with the Notification of Births Acts. Notice of the requirements of the Act was given by advertisement in the local Press. A copy of the circular was sent to the local Ministers of Religion, and all medical practitioners and midwives practising in the area were circularised. In 1930 the attention was called to default in complying with the Act in 29 instances. The chief reasons of failure to notify within the prescribed time was stated to be absence of knowledge of the requirements by parents and oversight on the part of medical practitioners and midwives. Registration Act, 1836. By the Registration Act, 1836, all live births are registered with the Registrar of Births within six weeks. 93 The birth-rate is calculated on the births registered, and during last year 1,845 (928 males and 917 females) births were registered, giving a birth-rate of 16.4 per 1,000 persons calculated on the net population, mid-year 1929, as compared with 1,755 births and a birth-rate of 15.6 per 1,000 persons in 1929. 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 1930, 63 stillbirths (32 males and 31 females) were registered. Of these 1 male and 3 females were illegitimate. The figures of 1,845 live births and 63 stillbirths registered are supplied by the Registrar-General and include births registered in other districts and belonging to Ilford. These are transferred to Ilford and births registered in Ilford belonging to other districts are transferred out in a similar manner. The figures of 1,703 and 52 stillbirths notified are births actually occurring in the Ilford district. Infant Mortality. The number of infants dying within the first year of life was 61, the total number born being 1,845. The infant mortality or rate of death per 1,000 births was, therefore, 33.0. The infant mortality rate for the district is higher than it should be, from the fact that I death of a baby in the Girls' Village Homes, Barkingside, is included, although the child concerned was not bom in Ilford. If the death of this baby is excluded there remains an infant mortality rate of 32.5 per 1,000 births. The comparative figures for the past 10 years were as follows:— 94 No. of Deaths Rate per 1,000 Year. under 1 year. Registered Births. 1930 01 33.0 1929 87 49.6 1928 79 45.4 1927 74 44.0 1926 68 45.1 1925 78 52.5 1924 62 43.2 1923 66 41.1 1922 80 54.2 1921 76 50.9 The infant mortality rate for 1930 for Ilford compares favourably with that of 60 for England and Wales, 59 for London, and 64 for the 107 towns having a population exceeding 50,000. The infant mortality rate for 1930 for Ilford is the lowest ever recorded. The deaths from pneumonia totalled 11, as compared with 22 for 1929. There were 17 deaths of premature infants as compared with 25 in 1929. These two factors chiefly account for the decline in the number of infant deaths in 1930. The number of deaths from pneumonia in 1929 was partly due to an outbreak of influenza. 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 48 West Ham 65 Willesden 58 East Ham 52 Tottenham 52 Wimbledon 51 Enfield 52 Walthamstow 38 Leyton 45 Ealing 40 Acton 46 Hornsey 41 Ilford 34 The following table shows the infant mortality in each ward of the district:— 95 Ward. Sex. No. of Births. No. of Infant Deaths. Infant Mortality per 1,000 Births. Infant Mortality per 1,000 Births both sexes together. 1930. 1929. 1928. North Hainault M. 197 8 40.6 38.3 47.0 48.3 F. 194 7 36.0 Cranbrook M. 47 2 42.5 56.1 50.5 67.8 F. 42 3 71.4 Park M. 87 6 68.9 45.4 58.8 20.5 F. 89 2 22.4 Seven Kings M. 95 1 10.5 9.6 63.1 29.1 F. 112 1 8.9 South Hainault M. 67 2 29.8 32.7 42.4 35.4 F. 55 2 36.3 Loxford M. 83 5 60.2 40.7 69.2 54.5 F. 89 2 22.4 Clements wood M. 91 3 32.9 26.3 41.0 29.7 F. 99 2 20.2 Goodmayes M. 160 8 50.0 45.3 60.7 77.1 F. 149 6 40.2 If the death of 1 male 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 40.9 (45.6 M. and 36.0 F.) per 1,000 births for that ward. The above table only accounts for 1,656 of the total births registered and belonging to the district. The remaining 189 are included by the Registrar-General as belonging to Ilford, but have not been allocated by him to the various wards. 54 births were registered in this district belonging to other areas. These have not been included in the foregoing figures. 3 births (2 males and 1 female) were re-registered, and these are also not included in the above figures. An analysis of the figures in the foregoing table will show that the infant mortality rate has risen in the Cranbrook Ward only. 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 one dying at the Girls' Village Homes, Barkingside. 96 7 died under 1 week. 1 died at 3 weeks from heart failure and broncho-pneumonia. 1 died at 3 weeks from infantile convulsions and congenital heart disease. *1 died at 1 month from broncho-pneumonia. *1 died at 2 months from broncho-pneumonia and gastro-enteritis. 1 died at 2 months from marasmus. *1 died at 3 months from meningitis. 1 died at 3 months from generalised broncho-pneumonia, acute bronchitis and prematurity. *1 died at 4 months from measles and marasmus. * These children have attended an infant welfare centre. In the Cranbrook Ward there were 5 infant deaths. 1 died at 1 month from septicaemia and cellulitis of neck. 1 died at 1 month from prematurity. 1 died at 1 month from cellulitis of the chest. 1 died at 1 month from meningitis,hydrocephalus and spinabifida. *1 died at 5 months from suffocation by turning on her face while in bed by herself. This child had attended an infant welfare centre. In the Park Ward there were 8 infant deaths. 7 died under 1 week. 1 died at 5 weeks from cellulitis of the face and alveolar abscess. None of these children had attended an infant welfare centre. In the Seven Kings Ward there were 2 infant deaths. 1 died under 1 week. 1 died at 2 weeks from asthenia and prematurity. Neither of these children had attended an infant welfare centre. In the South Hainault Ward there were 4 infant deaths. 3 died under 1 week. 1 died at 3 months from acute bronchitis and prematurity. None of these children had attended an infant welfare centre. In the Loxford Ward there were 7 infant deaths. 1 died under 1 week. *1 died at 1 month from acute enterit is and gangrene of extremities. 1 died at 2 months from heart failure and broncho-pneumonia. *1 died at 3 months from gastro-enteritis. 1 died at 4 months, from bronchitis and gastro-enteritis. 1 died at 6 months from heart failure, fits and nephritis. *1 died at 11 months from teething and convulsions. *These children have attended an infant welfare centre. 97 In the Clementswood Ward there were 5 infant deaths. 2 died under 1 week. 1 died at 19 days from catarrhal gastro-enteritis. 1 died at 3 weeks from premature birth and marasmus. 1 died at 6 weeks from marasmus and gastro-enteritis. None of these children had attended an infant welfare centre. In the Goodmayes Ward there were 14 infant deaths. 4 died under 1 week. 1 died at 3 weeks from acute primary broncho-pneumonia. 1 died at 1 month from cerebral hemorrhage and bronchopneumonia. 1 died at 1 month from bronchitis, gastro-enteritis and congenital debility. 1 died at 1 month from acute primary broncho-pneumonia. *1 died at 4 months from gastro-enteritis. 1 died at 4 months from shock and toxaemia, intussusception. *1 died at 5 months from convulsions, bronchitis and premature birth. *1 died at 7 months from broncho-pneumonia. *1 died at 8 months from broncho-pneumonia. *1 died at 8 months from convulsions, teething and heat wave. *These children have attended an infant welfare centre. It will be seen that of the 61 infants who died under 1 year of age only 13 had attended Ilford infant welfare centres, and in some cases only one attendance was made. 31 however of the deaths occurred in the first month of life, and these infants would naturally not have been brought to a centre. The mortality of infants under one year attending Ilford infant welfare centres was 17 -3 per 1,000, as compared with 42 -9 per 1,000 in those not attending an Ilford infant welfare centre (excluding the death of one child 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 30 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 13 had 98 attended an infant welfare centre, or, in other words, that 57 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 31 deaths of infants under 4 weeks of age during 1930, and the rate for the year was 16.8 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. 1930 16.8 Not available 1929 27.4 32 1928 23.6 31 1927 19.3 32 1926 21.2 32 1925 24.9 32 1924 19.5 33 1923 21.2 32 1922 27.1 34 1921 25.5 35 1920 27.0 35 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. 99 Table IV.— Infant Mortality. 1930. 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 ... ... ... ... ... ... ... ... ... ... Chicken pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... ... 1 Convulsions ... ... ... ... ... ... ... 1 1 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 3 ... ... 4 Pneumonia (all forms) 1 ... ... 2 3 5 1 2 ... 11 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... 1 ... 1 2 2 ... ... 5 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation (overlying) ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 4 ... ... ... 4 ... ... ... ... 4 Congenital Malformations 5 ... ... 1 6 1 ... ... ... 7 Premature birth 14 ... 1 1 16 1 ... ... ... 17 Atrophy, Debility and Marasmus 1 ... ... ... 1 2 ... ... ... 3 Other Causes ... ... ... ... ... 2 2 2 ... 6 Totals 25 — 2 4 31 14 10 5 1 61 100 Illegitimate Births and Deaths. 36 of the births registered (13 males and 23 females) were illegitimate, that is 1*9 per cent, of the births registered. 3 illegitimate children died under 1 year of age. The deaths of the three illegitimate children occurred as follows: one died at 6 weeks at Oldchurch Hospital, Romford, from marasmus and gastro-enteritis; one died at 2 months at the Girls' Village Homes, Barkingside, from convulsions and gastroenteritis; one died at 3 months at Oldchurch Hospital from gastro-enteritis. The infant mortality rate of illegitimate children was, therefore 55'5 per 1,000, compared with the infant mortality rate (exclusive of one child dying in the Girls' Village Homes) of 32 '0 for legitimate children. If the death of the infant in the Girls' Village Homes is included, there is an illegitimate infant mortality rate of 83 3 per 1,000, and 32 0 per 1,000 for legitimate children. Thefollowing 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. 1930 36 3 83 1,809 58 32 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 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 3.7. 101 The causes of the deaths were as follows:— Cardiac failure, Caesarian section, operation, general peritonitis 1 Cardiac failure, haemorrhage and shock following lacerated uterus 1 Puerperal eclampsia, eight months pregnancy 1 Septicaemia, recent delivery, ante-partum infection 1 Ruptured uterus, childbirth 1 Premature childbirth, albuminuria of pregnancy 1 Puerperal septicaemia 1 Enquiries into the cause of maternal deaths are made by the Medical Officer of Health from the medical practitioner in charge of the case or from the Institution to which the patient was admitted, in accordance with the Ministry of Health's requirements. A special form is used for this purpose which is forwarded to the Ministry of Health on completion. Cases notified as puerperal fever or puerperal pyrexia are investigated by the Sanitary Inspectors and Health Visitors. 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 ] ,000 Births, England and Wales. From Puerperal Fever. From Other Causes. 1930 2 5 1,845 3.7 4.40 1929 3 4 1,755 4.0 4.33 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 * Revised Table. 102 Foster-Children— Children Act, 1908, Part I. Under the Local Government Act, 1929, the duties carried out by the Board of Guardians were transferred to the Council as from the 1st April, 1930. All children are visited by the Health Visitors fortnightly, and 639 visits were paid during 1930. One foster child died at 3 months at Oldchurch Hospital from gastro-enteritis. This child had previously attended a welfare centre. 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, 1930 50 Number of foster-children who were notified to me during 1930 32 Number of foster-children returned to their mothers during 1930 20 Number of foster-children taken off the records for various other reasons during 1930 23 Number of foster-children on records on 31st December, 1930 39 Foster-Mothers. Number of foster-mothers on records on 1st January, 1930 31 Number of persons who became foster-mothers during 1930 14 Number of foster-mothers whose names were taken off records during 1930 16 Number of foster-mothers on records on the 31st December, 1930 29 Houses Visited by Sanitary Inspectors. Number of houses visited by the Sanitary Inspectors for the purpose of the Act during the year 1930 26 Number of visits made by the Sanitary Inspectors for the purpose of the Act during the year 1930 64 103 Work of Health Visitors. The Ilford area is divided into nine districts, one nurse carrying out all the home visits both for Maternity and Child Welfare work and School Medical Service work in each area. The following is a summary of the visits paid by the Health Visitors during 1930 as far as the Maternity and Child Welfare work is concerned :— First visits to newly-born infants 1,992 Subsequent visits to children under 1 year of age 6,071 Subsequent visits to children over 1 year of age and under 5 13,914 Visits to expectant mothers 170 Home visits for other reasons 1,388 Total visits paid 23,535 Supervision of Midwives. There are 12 certified midwives resident and practising in the district (apart from those at the Maternity Home), and 5 certified midwives resident outside Ilford, but practising in Ilford. As mentioned in my last report, application had been made to the Minister of Health to become the local supervising authority under the Midwives Acts. As a result of representations made to the Minister of Health, the powers held by the Essex County Council were delegated to the Ilford Borough Council as from the 1st October, 1930. The following is a copy of the Order made by the Minister of Health :— [Copy.] 16th September, 1930. Midwives Acts, 1902 to 1926. Order under Section 62 of the Local Government Act, 1929. COUNTY OF ESSEX. BOROUGH OF ILFORD. BOROUGH OF LEYTON. WHEREAS the County Council of Essex (in this order referred to as " the County Council") are the local supervising authority under the Midwives Acts, 1902 to 1926 (in this order referred to as "the Midwives Acts ") for each of the Boroughs of Ilford and Leyton (in this order together referred to as " the Boroughs "); 104 And whereas the Council of each of the Boroughs (which Councils are in this order together referred to as "the Borough Councils"), being a council who have established a maternity and child welfare committee and employ a medical officer of health who, by the terms of his appointment, is restricted from engaging in private practice, have under section 02 of the Local Government Act, 1929, applied to the Minister of Health to be made the local supervising authority under the Midwives Acts ; And whereas the Minister has consulted with the County Council and has not been requested by them to hold a local inquiry: And whereas the Minister is satisfied that each of the Borough Councils is in a position to discharge the whole of the functions of a local supervising authority under the Midwives Acts : NOW THEREFORE the Minister of Health in the exercise of his powers in that behalf, hereby orders as follows:— 1. Each of the Borough Councils shall become the local supervising authority under the Midwives Acts for the Borough in place of the County Council. 2. (1) The expenses of each of the Borough Councils under the Midwives Acts shall be defrayed out of the general rate fund of the Borough. (2) The expenses of the County Council under the Midwives Acts shall be defrayed as expenses for special county purposes from contribution to which the Boroughs are exempt. Provided that those expenses may, if the County Council think fit, be defrayed as expenses for general county purposes subject to the condition that the County Council shall pay to each of the Borough Councils the amount raised by the County Council in the Borough in respect thereof. 3. This order may be cited as the Bford and Leyton (Supervision of Midwives) Order, 1930, and shall come into operation on the first day of October, 1930. Given under the Official Seal of the Minister of Health, this Sixteenth day of September, in the year One thousand, nine hundred and thirty. A. B. MACLACHLAN, Assistant Secretary, Ministry of Health. Dr. A. T. Worthington was appointed by the Council as Inspector of Midwives. All midwives resident and practising in the Ilford district are visited every quarter by the Inspector of Midwives, for the purpose of inspecting their register of cases and maternity outfits. Visits are also paid to midwives arising out of any cases of infectious disease, or where the midwife is likely to be a source of infection, from her practice. 105 Any special inspection of a midwife necessary in connection with a birth attended in Ilford by a midwife residing outside the district is carried out by our Inspector and a copy of his report sent to the County Medical Officer. Similarly if an Ilford midwife attends a patient in the County area and a special inspection is made, a copy of the County Inspector's report is forwarded to me. Liability to be a Source of Infection. Three notices were received from midwives after medical help had been sought, in two cases for rise of temperature, and in the third case by reason of an infant's discharging eyes. Upon enquiry it was ascertained that in one case the rise of temperature was due to respiratory causes, and the other person was notified as suffering from Puerperal Pyrexia and Scarlet Fever and removed to Hospital. No notification of Ophthalmia Neonatorum was received in respect of the infant who had discharging eyes. The eyes were found to be quite clear within a few days of receipt of the notice. The following is a summary of the notices received from midwives from 1st October to 81st December, viz.:— Notices received from Midwives. Medical Help 49* Death of Mother or Child — Laying out the dead — Stillbirths — Liability to be a source of infection 3 Artificial feeding 2† * 26 of these were from the Ilford Maternity Home, † 1 of these was from the Ilford Maternity Home. 106 Artificial Feeding. Two notifications were received from midwives that it was proposed to substitute artificial feeding for breast feeding. In one case the mother was suffering from Puerperal insanity, and in the other case it was due to general weakness on the part of the mother. Inflammation of, or Discharge from, the Eyes of an Infant. Medical aid was sought in 3 instances where the infant was found to have discharging eyes. None of the cases was notified as suffering from Ophthalmia Neonatorum. The Council has adopted the suggestion of the Minister of Health that they should refrain from exercising their power of recovery of the fee of the Medical Practitioner under Section 14 (4) of the Midwives Act, 1918, in this class of case. Supply of Milk to Expectant and Nursing Mothers and for Infants. Under the Regulations of the Ministry of Health, during 1930, 109 mothers and infants were supplied with cows' milk free, 36 with dried milk, and 8 with condensed milk. A total of 6,900 quarts of cows' milk, 737 lbs. of dried milk, and 115 tins of condensed milk were given free under the Regulations. In 1929, 131 mothers and infants were supplied free with cows' milk, 42 with dried milk, and 3 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 107 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 1930, £5 16s. 2d. was saved by 12 mothers. Owing to the number of mothers attending the Valentines Centre and to which I referred in my last report, arrangements were made to transfer a portion of the Centre to a new Centre at Woodford Avenue. This was opened on the 2nd July, 1930. The Barkingside Welfare Centre was transferred to more commodious premises at Holy Trinity Church Hall, Mossford Green, on 5th January, 1931. During the year the following attendances were recorded:— Figures for 1929. 1930. Total number of attendances of infants 32,971 36,710 First attendances 1,970 2,056 Total number of children on roll, December 31st, after omission of all those who had not attended for six months 2,323 2,465 First Attendances— Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. 220 140 146 188 165 123 194 162 210 243 160 105 Subsequent Attendances— 3409 2738 2654 2713 2862 2201 3366 2020 2959 4263 3198 2271 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. 1930 36,710 2,056 2,465 1929 32,971 1,970 2,323 1928 33,590 1,913 2,145 1927 28,142 1,659 1,768 1926 26,276 1,540 1,927 1925 24,245 1,420 1,608 1924 20,988 1,403 1,508 1923 18,600 1,284 1,371 1922 15,529 1,126 1,137 1921 14,492 909 1,017 108 506 sessions were held during the year, the average attendance at each session being 72 mothers with their infants. The following are the figures for each Centre:— Sessions. Average attendance. Seven Kings 48 104 Barkingside 48 57 Goodmayes 48 57 Valentines 48 74 Newbury Park 48 70 Grosvenor Road 49 87 *Woodford Avenue 25 63 Park and Cranbrook (morning) 48 51 Park and Cranbrook (afternoon) 48 62 Ilford Lane 48 73 Beeontree 48 89 * Opened 2nd July, 1930. 109 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:— Nature of Defect Age group of child Under 6 mths. 6 mths. to 1 year. 1—2 years 2—3 years 3—4 years 4—5 years Respiratory Diseases. 1.—Nose and Throat:— Enlarged tonsils — 3 17 26 27 15 Enlarged adenoids 1 1 — — — — Enlarged tonsils and adenoids — — 4 12 23 16 Mouth breathing 1 — 3 2 2 6 Snuffles 21 1 — 1 — — Cleft palate and hare lip 3 — — 2 — - Congenital laryngeal stridor 1 2.—Lungs :— Bronchitis 34 40 31 4 6 6 Broncho-pneumonia 1 Alimentary System. Stomatitis — 1 2 1 — — Gastro-enteritis 6 16 11 - 2 — Enteritis 44 64 38 8 2 1 Thrush 36 6 2 1 — — Rectal prolapse — — 3 — — — Thread worms — 1 16 19 15 11 Melaena 2 — 1 1 — — Dental caries — — 2 11 31 36 Other defects — — — 1 — — Genito-urinary. Undescended testicle — 1 - 1 — — Hydrocele 2 1 — — — 1 Enuresis — — 15 17 6 5 Vaginal discharge — — — 2 — — Phimosis 98 5 9 2 — — Lymphatic glands. Enlarged cervical glands 4 5 9 5 10 8 Adenitis 1 — — 1 — — Tuberculous glands — 1 — — 1 — Nervous system. Stammering — — — 1 — — Defective articulation 1 Facial paralysis... 1 — — — — — Deformities. Rickety (flat foot, bow legs, knock knees) 3 3 32 22 5 - Infantile paralysis — — — — 1 - Torticollis 2 — -— 1 — - Talipes — — 1 — — - Other defects 5 7 27 9 3 3 Rickets — — 11 — — — 110 Nature of Defect Age group of child Under 6 mths. 6 mths. to 1 year. 1—2 years 2—3 years 3—4 years 4—5 years Eye diseases (including vision). Defects of vision 2 — — — — — Squint 3 6 2 7 11 6 Congenital cataract 1 — — — — — Conjunctivitis 69 11 8 4 4 3 Blepharitis 2 5 8 2 5 — Hordeolum 1 4 5 2 — — Other defects 1 1 3 1 — — Ear Diseases. Otitis media 12 9 10 8 5 5 Cerumen in ear 5 1 3 — 1 — Skin Diseases. General 85 65 111 64 25 17 Naevus 37 5 3 — 1 — Infectious Diseases. Diphtheria — — — — 1 — Scarlet Fever — — — — 1 — Measles 2 4 2 3 — — Pertussis 4 2 7 1 — 1 Rubella — 1 2 — — — Varicella — — — 1 — 2 Mumps - - - - - 1 Nutrition. Malnutrition 1 — — — — — Anaemia — — 2 1 1 6 Hernia. Umbilical 133 11 8 4 1 — Inguinal 11 2 3 2 — — Miscellaneous defects. Mongolism 1 — — 2 — — Hydrocephalus 1 - - - - - Icterus Neonatorum 9 - - - - - Tongue tie 6 — 1 — — — Discharging umbilicus 13 - - - - - Suppurative cervical adenitis 1 — — — — — Hsematoma 3 1 — — — — Mastitis 1 — — — — — Rheumatism — — — — — 1 Other defects 2 — 2 4 1 — Number of children at first attendance in each age group 1275 1156 1089 677 439 279 Ante-Natal Clinics.—The Ante-Natal Clinics were continued during 1930 at the Maternity Home on Monday and Saturday mornings. 111 The following attendances were recorded :— First attendances 747 Subsequent attendances 3,278 Number of expectant mothers on the rolls on 31st December, 1930 243 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. 1930 747 4,025 243 1929 710 3,606 215 1928 653 3,115 193 1927 565 2,095 147 1926 500 1,619 139 1925 344 1,167 115 1924 282 846 70 1923 207 702 38 1922 165 567 36 1921 198 652 53 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, 57 cases other than those booked for admittance to the Maternity Home were examined at the Clinic. There were 134 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 1930, 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 1930 150 Number of attendances of mothers 418 Number of mothers, having teeth extracted, to whom " general" anaesthetics were given 92 Number of mothers, having teeth extracted, to whom " local" anaesthetics were given 31 Number of mothers having teeth filled or otherwise treated 72 Number of mothers having dentures supplied 42 (including 1 free of charge) 112 (b) Treatment of Children under 5 years of age. Number of children treated 135 Number of attendances of children 159 Number of children, having teeth extracted, to whom " general" anaesthetics were given 110 Numberof children having teeth filled or otherwise treated 43 The following are the figures for the past five years:— 1926. 1927. 1928. 1929. 1930. Number of mothers treated241 189 183 136 150 Numberof childrentreated85 96 79 94 135 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 1930:— (а) Number of children for whom spectacles were prescribed and provided 43 (б) Number of children examined by Oculist for whom spectacles were not prescribed 24 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. Five mothers were so treated during 1930. 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. 113 The Orthopaedic Surgeon attends once monthly, or more often if there are a sufficient number of cases awaiting examination. He attended on 22 occasions during 1930, and examined 101 children. These children made a total of 228 attendances. The defects found comprised the following:— Genu-valgum 37 Outward curvature of tibia 43 Congenital calc. valgus 3 Hammertoe 3 Infantile paralysis 2 Other defects 13 Total 101 Arrangements have also been made for the attendance three times a week of a qualified Orthopaedic Masseuse for the purpose of carrying out the orthopaedic treatment and remedial exercises recommended by the Surgeon. The Masseuse attended on 152 occasions, when 74 children received treatment. The children made a total of 286 attendances. Ophthalmia Neonatorum.— During the year 1923 arrangements were made with the Metropolitan Asylums Board for the reception at their St. Margaret's Hospital of eases of Ophthalmia Neonatorum from the Ilford District, details of which were printed in the report for 1923. One case was admitted to St. Margaret's Hospital during the year under the above arrangements. Treatment of Minor Ailments.— Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 125 belts and 11 trusses have been supplied to infants suffering from hernia during the year 1930. A certain number of infants were brought to the Public Health Offices to receive treatment for minor ailments. 114 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 were made with the King George 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. The arrangements with the King George Hospital have been discontinued since July. During the past year, 70 children under 5 years of age have been treated as follows:— Out- Inpatients. Patients. Queen Mary's Hospital 37 King George Hospital 23 10 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. Two of these children were treated free during the past year (1 at Queen Mary's Hospital and 1 at the King George Hospital). MATERNITY HOME. During 1930, 489 women were admitted into the Home as compared with 481 in 1929, 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. 115 The patients were admitted to the Home from the following wards:— North Hainault 1X9 Cranbrook 17 Park 72 Seven Kings 78 South Hainault 38 Loxford 40 Clementswood 81 Goodmayes 42 2 patients were admitted from outside the district on the recommendation of the Maternity and Child Welfare Committee. 63 cases could not be admitted during the year owing to lack of accommodation. At the end of the year 181 cases were booked for future admission to the Home. The average number of patients in the Home per day during 1930 was 19 -25, and the average length of stay of patients 14 -52 days. Of the 489 cases admitted during 1930, 481 were confined in the Home, 2 cases were admitted for observation only, 3 were cases of inevitable abortion, and in 3 cases the babies were born before arrival at the Home. In 19 of the 481 confinements the patient had previously been admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 481 confinements there were :— (a) 276 cases of first confinement. (b) 205 cases having their second or subsequent ment. 116 Of the total cases confined in the Home:— (a) 79 cases were living in 2 rooms or less (54 being first confinements). (b) 119 cases were living in 3 rooms (80 being first ments). Of the 481 confinements, 27 women had engaged their own doctor, 5 of these cases were, however, delivered by a midwife, the doctor not being present at the birth. 454 were attended by one of the midwives at the Home. It was necessary to call in a doctor in 108 of the latter cases, owing to the following complications:— (a) Ante-Nataf 31 Small measurements Albuminuria Spinal curvature Fractured pelvis High blood pressure Threatened labour 15 8 1 1 4 2 (b) During labour 42 Extended breech Foetal distress Brow presentation Prolonged labour Revealed accidental haemorrhage Concealed accidental haemorrhage Post-partum haemorrhage Adherent placenta Rigidity of soft parts Persistent occipito posterior 8 6 1 8 2 2 1 3 1 10 (c) After labour 28 Ruptured perineum Ruptured perineum before delivery Lacerated labia... Severe internal lacerations Puerperal mania 22 1 1 3 1 (d) For infant 7 Prematurity, white asphyxiated at birth Congenital atelectasis Mongol Difficult breathing Convulsions Severe melaena 1 1 1 1 1 2 117 There were 5 deaths of infants in the Home, from the following causes:— Prematurity 2 Congenital atelectasis 1 Atelectasis, laryngeal obstruction and enlarged liver 1 Congenital occlusion of bile duct and convulsions 1 There were 18 stillbirths in the Home from the following causes:— Difficult or prolonged labour 5 Mother fell downstairs before admission 1 Anencephalus 3 Extended breech 1 Foetal distress 1 Ante-partumhaemorrhage 1 Toxaemia of pregnancy, albuminuria 1 Toxaemia and ante-partum haemorrhage 1 Macerated foetus 1 Unknown 3 Three cases of Puerperal Pyrexia occurred. In each case they were due to Bacillus coli pyelonephritis. Two of these cases were removed to the Isolation Hospital; the other, which occurred after a Caesarian section, remained at the Home. All made satisfactory recoveries. One case of Puerperal Insanity occurred, the patient being removed to Romford Infirmaiy. The patient made a good recovery. One case of Pemphigus Neonatorum occurred at the Home during the year. The infant, together with its mother, was removed to the Isolation Hospital for ti'eatment, and no further case occurred. The mother had slight impetigo of the lip and had wiped the child's neck with her own handkerchief causing a spread of the infection. The Consulting Obstetrician paid the usual fortnightly visits to the Home. During 1930, he paid 24 ordinary visits, and examined 122 patients referred from the Ante-Natal Clinics. During the year lie was also called in fourteen times for other cases, as follows:— 118 To deliver a patient 1 To perform Caesarian section operations 7 For consultation re threatened eclampsia 2 For consultation in a case of fractured pelvis 1 For consultation re bacillus coli infection 2 For consultation re accidental haemorrhage 1 The reasons for the seven Caesarian section operations were as follows:— Obstructed labour 1 Disproportionate measurements 3 Contracted pelvis 2 Concealed accidental hemorrhage 1 The infant mortality rate of children born in the Maternity Home was 19-3 per 1,000 births, as compared with 37 -0 for those born in their own homes. The figure of 37 -0 has been arrived at after deduction of all deaths of infants from the Maternity Home and the Village Homes, Barkingside, and is calculated on the total births in the district excluding those in the Maternity Home. 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. 1930 19.3 37 .0 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 No maternal death occured at the Maternity Home. The maternal mortality rate for the Home for the ten years from 1921.1930 is .92 as compared with the maternal mortality rate in the district generally of 3.0. 119 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. The following table shows in extenso the fees which were paid by women admitted to the Home:— 5 mothers were admit ted free of charge. 3 ,, ,, at a fee of 15s. per week. 16 „ „ „ 20s. 13 „ „ „ 25s. „ 58 „ „ „ 30s. ,, 1 mother was admitted at a fee of 31s. 6d. „ 1 „ „ „ 32s. „ 31 mothers were admitted at a fee of 35s. ,, 30 ,, ,, 40s. ,, 117 „ „ „ 42s. „ 29 „ „ „ 45s. 1 mother was admitted at a fee of 47s. 6d. „ 29 mothers were admitted at a fee of 50s. ,. 23 „ „ „ 52s. 6d. „ 8 „ „ „ 55s. ,, 10 „ „ „ 57s. 6d. „ 29 „ „ „ 60s. „ 3 „ „ „ 62s. 6d. „ 11 „ „ „ 63s. „ 3 „ „ „ 65s. ,, 3 „ „ „ 67s. 6d. „ 21 „ „ „ 70s. „ 1 mother was admitted at a fee of 72s. 6d. „ 5 mothers were admitted at a fee of 77s. 6d. „ 16 „ „ „ 80s. ,, 2 „ „ „ 82s. 6d. „ 3 „ „ „ 84s. „ 1 mother was admitted at a fee of 85s. „ 5 mothers were admitted at a fee of 90s. „ 8 „ „ „ 100s.„ 1 mother was admitted at a fee of 105s.„ 2 mothers were admitted at a fee of 110s.„ Of the above patients :— (а) 323 paid an additional fee of 15s. to the Council for the service of one of the midwives of the Home. (б) 104 paid a fee of £1 Is. for the services of the Assistant Medical Officer of Health. (c) 9 paid a fee of £5 5s. for the services of the Consulting Obstetric Surgeon. 120 (d) 2 paid a fee of 10s. Od. per week, and 1 a fee of 15s. 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. 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 1930. District Midwife. During 1930, the District Midwife attended 113 cases ; of these 14 were delivered by doctors and 91 by herself ; 8 were born before arrival of either doctor or midwife ; a doctor was called in, however, in 33 of the 99 cases delivered by the District Midwife, for the following causes:— (a) Ante-Natal 4 Albuminuria 3 General condition 1 (6) During labour 15 Foetal distress 1 Secondary uterine inertia 1 Rigidity of soft parts 1 Persistent occipito posterior 2 Shoulder presentation 1 Brow presentation 1 Face presentation 1 Extended breech 1 Prolonged labour 5 General condition 1 (c) After labour 9 Ruptured perineum 5 Rise of temperature Varicose vein 2 121 (d) Forinfant 5 1 Dangerous feebleness 3 I Inflammation of eyes 2 The 113 eases attended were in the following wards:—North Hainault, 49; Cranbrook, 5; Park, 12; Seven Kings, 17; South Hainault, 6; Loxford, 8; Clementswood, 12; Goodmayes, 4. Of the infants born there was 1 stillbirth of a macerated foetus; one died 9 hours after birth from asphyxia and prematurity, and one died 45 minutes after birth from asphyxia neonatorum. Twenty-five cases who applied for the services of the District Midwife had to be refused, owing to her services being already booked. Extensions of Maternity Home. The original extensions to the Maternity Home as mentioned in my last report have been modified, and now provide for an antenatal clinic, a surgical ward block, new laundry, and extension to the nurses' home. Plans are at present under consideration. SCHOOL MEDICAL SERVICE. 125 GENERAL SURVEY OF THE SCHOOL MEDICAL SERVICE. The report shows that there are approximately 16,303 children on the school rolls, compared with 15,562 in 1929. The number of children in average attendance at school for the period April 1st, 1929, to March 31st, 1930, was 13,172. 6,521 children were medically inspected, compared with 6,254 in 1929. 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 1929 :— Defects BOARD OF EDUCATION ILFORD IncidenceRate per 1,000 children in average attendance (1st Apr., 1928, to 31st Mar., 1929). IncidenceRate per 1,000 children in average attendance (1st Apr., 1928, to 31st Mar., 1929). IncidenccRate per 1,000 children in average attendance (1st Apr.,1929, to 31st Mar., 1930). Totally Blind .4 - - Partially Blind 1.1 .6 1.0 Totally Deaf .8 .9 .5 Partially Deaf .4 .2 .5 Totally Dumb — — .1 Mentally Defective (Educable) 6.7 5.3 5.0 Epilepsy (Severe) .5 .5 .4 Infectious (Pulmonary and Glandular) Tuberculosis .6 .1 .5 Non-Infectious but Active Pulmonary and Glandular Tuberculosis 2.9 .6 .7 Active Non-Pulmonary Tuberculosis 1.9 .5 .2 Crippled Children 9.4 1.7* 1.8* Delicate Children 18.5 14.4 10.3 *This figure includes only children who are so crippled as to require instruction at a Cripple School. 126 The following table shows a comparison of the incidence of physical defects found at routine school medical inspection in Ilford for the past three years with that in the country generally, as arrived at by the Board of Education in 1929 :— Defects. Board of Education Average. Ilford. Incidence-Rate per 1000. 1929. Incidence-Rate per 1000. 1928. 1929. 1930. Defects of Vision 86.2* 74.6 66.8 81.4* Squint 8.7 1.8 2.7 2.0 Other Eye Diseases 8.6 3.5 6.8 5.4 Defects of Hearing 4.2 4.4 5.l 3.2 Otitis Media 5 -3 3.9 3.0 3.6 Enlarged Tonsils and Adenoids 66.8 66.8 51.4 29.7 Other Throat and Nose Defects 6.8 3.6 8.6 4.1 Organic Heart Disease 2.0 1.8 2.2 0.5 Pulmonary Tuberculosis : (a) Definite .3 — — — (b) Suspected .9 .9 .6 .3 Non-Pulmonary Tuberculosis .8 .5 1.2 .2 Deformities 9.7 10.1 8.6 9.9 Nervous Diseases 2.0 3.2 3.3 4.4 * In calculating this figure the entrants have been left out of account. The following table compares the principal causes of death among children of school age (i.e., from 5 to 15 years) and at all ages in England and Wales with those in Ilford for 1929 and 1928. 127 Table showing the Principal Causes of Death among Children of School Age (i.e., from 5—15 years), in England and Wales during 1928 and 1929, compared with those in Ilford for 1928 and 1929. 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. 1929 1928 1929 1928 1929 1928 1929 1928 1. Tuberculosis 7.1 7.9 7.3 7.8 14.7 16.4 7.7 17.9 2. Violence 4.1 4.6 4.2 5.1 12.4 12.1 12.6 7.1 3. Diphtheria 0.6 .7 1.5 .8 12.2 11.8 30.8 10.7 4. Bronchitis, Pneumonia and other respiratory diseases 15.7 12.9 17.5 13.0 12.6 11.5 2.6 - 5. Meningitis and Nervous system 8.2 9.2 .2 .2 8.3 8.4 — 3.6 6. Heart Disease 18.1 16.8 20.9 20.9 6.0 6.2 7.7 21.5 7. Measles and Whooping Cough 1.8 1.5 1.0 1.3 3.8 4.2 — 7.1 8. Rheumatic Fever .3 .3 .3 .3 3.5 3.9 5.2 — 9. Appendicitis .5 .6 .7 .6 3.1 3.6 2.6 - 10. Acute and Chronic Nephritis 2.9 3.3 3.5 2.0 1.9 2.1 2.6 — 11. Acute Infective Osteomyelitis .1 .1 — .2 1.8 1.9 — 7.1 12. Influenza 5.5 1.6 3.6 .8 3.8 1.8 2.6 — 13. Scarlet Fever .1 .1 .1 .2 1.9 1.7 2.6 14. Tonsillitis, etc., Adenoid Vegetations .2 .2 — — 1.5 1.5 — — 15. Other conditions 34.8 40.2 39.2 46.8 12.5 12.9 23.0 25.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 England and Wales.—The deaths of children of School Age during 1929 represent 2.6 per cent. of the Total Deaths registered (all ages). Ilford.—The deaths of children of School Age during 1929 represent 3.6 per cent. of the T otal Deaths registered (all ages). „ The deaths of children of School Age during 1928 represent 3.0 per cent. of the Total Deaths registered (allages). 128 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. This applies also to children of school age. The deaths of children of school age in Ilford still represent a higher percentage of the total deaths than is the case in the country generally. As anticipated in my last report the favourable position with regard to diphtheria has been reversed and the outbreaks in Becontree caused the % of deaths of children from this cause to be trebled. 1. Staff.—Dr. A. T. Worthington, Assistant Medical Officer of Health, commenced his duties on the 1st September, vice Dr. G. M. Evans. Miss A. Drinkwater, an additional Health Visitor and School Nurse, commenced her duties on the 11th August. 2. Co-ordination.—Vide Annual Report, 1920. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. 3.—School Premises.—There are 22 schools, with 48 departments. The schools have accommodation for approximately 18,000 scholars, and 16,303 were actually on the rolls on December 31st, 1930. The Mayesbrook Temporary School, to accommodate 350 junior mixed children, was opened on 1st April, 1930. The Gordon School, Golf Road, to accommodate 350 junior mixed children, was opened on 25th August. The new Beal Central School to accommodate 400 senior girls and 400 senior boys has been commenced. The tenancy of the temporary school at St. Thomas' Church, Haydon Road, was terminated on 23rd July, owing to the opening of the Mayesbrook School. 129 The Sanitary Inspectors have paid monthly visits to the various elementary schools in the Borough, and a total of 346 visits have been made during the year. By means of these inspections a considerable number of sanitary defects have been located and remedied. A type of trough closet is still in existence at Downshall (Girls' department 9, Boys' department 8); Highlands (Girls' department 8, Infants' department 8, Boys' department 7); Barkingside (Boys' and Girls' department); Newbury Park (Boys, Girls, Senior and Junior); Loxford (except 2 in Junior Boys); Roman Catholic (Senior and Junior Girls), and these require conversion to separate pedestal W.C.'s with separate flushing cisterns. A new type of bubble fountain has been fixed at Highlands (Senior and Infant Girls 2); Valentines (Boys Senior 1); Loxford (Boys 2) ; Benton (2); Mayesbrook (2) ; Gordon (2) ; Becontree (Middle Girls 2, Middle Boys 1, Upper Boys I, Upper Girls 1, Lower Girls 1); Goodmayes (Boys 2); Cleveland (Boys 2, Senior Girls and Junior mixed 2); Uphall (Boys 2, Girls and Junior mixed 2); Gearies (Girls 1). An older type of bubble fountain is fixed at Fairlop (2); Valentines (Girls Senior 1); Gearies (8). Routine medical inspection at the Mossford School, Dr. Barnardo's Girls' Village Home, was again carried out by my Department during the year, 308 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— 130 (a) their first admission to Public Elementary Schools, and (b) their attaining the age of eight years, and (c) their attaining the age of twelve years. Details of the system adopted are given in the Annual Report for 1920. During 1930 the number of visits by the Medical Officers to 48 different departments of 22 schools for the purposes of routine medical inspection was 347. The number of children examined during the year, falling within the above age groups, totalled 6,521 (3,110 boys and 3,411 girls), an increase of 267 over the figures for 1929. In addition, a number of children of varying ages were presented by the Head Teachers for special medical examination, being thought by the teachers to be suffering from some ailment. During 1930, 356 such children (149 boys and 207 girls) were examined. 2,530 re-examinations (1,256 boys and 1,274 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 9,407 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. Special Cases. Re-examination at following up. 1930 6,521 356 2,530 1929 6,254 152 2,072 1928 5,910 137 1,811 1927 5,738 126 1,697 1926 5,658 139 1,709 5. Findings of Medical Inspection.— Table II shows the return of defects found in the course of medical inspection. (a) Uncleanliness.—At routine medical inspection 146 children out of a total of 6,521 (or 2.3 per cent.) were found to have nits or vermin in their hair, while 7 (or .10 per cent.) were found 131 to be flea-bitten. 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 143. (b) Tonsils and Adenoids.—194 children (or 3 per cent. of those examined) were found to be suffering either from adenoids or from tonsils so enlarged, or causing such symptoms, that it was considered necessary to advise the parents to obtain medical advice. (c) Tuberculosis.—2 suspected cases of pulmonary tuberculosis were referred to their own medical attendant or to the Tuberculosis Dispensary for observation purposes. (d) Skin Disease.—18 cases of Impetigo, and 54 cases of other diseases of the skin were discovered at routine medical inspection. (e) External Eye Disease.—19 cases of Blepharitis, i.e., inflamed eyelids, and 5 cases of Conjunctivitis were discovered. (/) Vision.—353 children (or 5.4 per cent. of those examined) were found to be suffering from vision so defective or from such symptoms as headache, etc., as to require treatment. 31 of these cases saw 6/6, while the remaining 322 had vision of 6/9 or less. All children having vision 6/9 or less are referred for treatment. Further particulars of these cases will be found on page 139. 82 per cent. of the cases received treatment from the School Oculist. (g) Ear Disease and Hearing.—21 children (or .3 per cent. of those examined) were found to be suffering from defective hearing. 23 children were found to be suffering from a discharge from the ear, due to an old otitis media. 132 (h) Dental Defects.—717 (or 10.9 per cent. of those examined) were found to be suffering from teeth so defective as to impair health. These eases 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 165, Table IV (Group IV). (i) Deformities.—30 children were found to be suffering from slight spinal curvature, and 35 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 Orthopaedic Surgeon. 6. Infectious Disease.—The following table shows the incidence of Scarlet Fever, Diphtheria and Measles, including German Measles, in the Ilford schools since 1921 :—- Scarlet Fever. Diphtheria. Measles. 1921 202 105 108 1922 116 82 893 1923 79 61 174 1924 85 28 1,026 1925 93 22 484 1926 93 60 1,713 1927 244 67 83 1928 349 117 1,383 1929 309 210 141 1930 174 208 1,295 Disinfection of all the cloakrooms at the public elementary schools was carried out during the Summer vacation, and during the Christmas vacation the cloakrooms at Barkingside, Chadwell, Cleveland, Downshall, Christchurch, Little Heath, Mossford, SS. Peter and Paul and St. Vincent's. In addition disinfection was also carried out at the Becontree and Open-Air Schools following cases of infectious disease. No schools were closed during the year on account of infectious disease. 133 Tables VII to XIII on pages 172 to 178 show the incidence of each infectious disease in the Uford schools during 1930. (a) Scarlet Fever.—174 cases were notified in 1930, as compared with 309 in 1929. The following table shows the percentage attack-rate of Scarlet Fever at the various schools during 1930 :— School. Percentage Attack Rate. Barkingside 0.0 Becontree 0.4 Chad well 1.3 Christchurch 1.7 Cleveland 0.5 Downshall 1.2 Fairlop 4.2 Gearies 1.8 Goodmayes 0.6 Gordon 0.4 Highlands 1.2 Little Heath 0.0 Loxford 0.7 Mayes brook 0.0 Newbury Park 0.6 Open Air 3.1 Roman Catholic, Ilford 1.0 St. Vincent's 0.3 South Park 1.0 Uphall 2.0 Valentines 0.3 The table has been calculated on the cases notified, compared with the number of children on the roll (all departments). (b) Diphtheria.—208 cases were notified in 1930, as compared with 210 in 1929. Five deaths of children of school age occurred from this disease during the year (three of whom resided in the L.C.C. Estate at Becontree). They attended the following schools :— Becontree 1 Cleveland 1 Goodmayes 2 Gearies 1 134 Diphtheria Prevention.—The Schick testing and immunising of school children at Becontree, Goodmayes and St. Vincent's Schools was continued during 1930, and the following statement shows the number of children dealt with from the commencement of the work in November, 1929, to the 31stDecember last:— Schick tested 857 Of these 697 were positive and 160 were negative. Of the 697 positive cases 690 were given a full course of inoculations with the following results :— Negative after re-test 481 Positive after re-test and re-inoculated 139 Awaiting re-test 28 Not re-tested after inoculation on account of removal or other reasons 33 Positive after re-test but not re-inoculated for various reasons 9 In addition to the school children immunised at school, a number of children from various elementary schools were dealt with at the Clinic established in November, 1929, at the Public Health Offices. The following are the particulars showing work carried out at this Clinic in connection with children of school age from November, 1929, to 31st December, 1930 Schick tested 241 Positive 196 Negative 45 Not Schick tested 67 Partially immunised 8 Inoculated (full course 260 (c) Measles and German Measles.—1,295 cases were notified from the schools in 1930, compared with 141 during 1929. No deaths from Measles in a child of school age occurred in 1930, compared with nil in 1929, 1 in 1928, nil in 1927, and 7 in 1926. (d) Small Pox.—Eight cases of Small Pox among children of school age occurred during the year. 135 Case No. 1.—This was an unvaccinated girl, aged 13 years, a scholar of Newbury Park School. The case was notified on the 17th May. The patient was removed to Hospital the same day, and the house disinfected. The contacts of the case (1 of whom was a sister of school age) were followed up. Case No. 2.—This was an unvaccinated girl, aged 13 years. The case was notified on the 18th May. The patient, who attended Newbury Park School, was removed to Hospital the same day, and the house disinfected. All the contacts of the case living in Ilford (none being of school age) were followed up. Case No. 3.—This was an unvaccinated girl, aged 9 years. The case was notified on the 2'2nd May. The patient, who attended Newbury Park School, was removed to Hospital the same day, and the house disinfected. The contacts of the case (1 of whom was a child of school age) were followed up. Case No. 4.—This was an unvaccinated boy, aged 9 years, a scholar attending Goodmayes School, notified on the 2nd June. The patient was removed to Hospital the same day, and the house disinfected. The contacts of the case (1 of whom was a child of school age) were followed up. Case No. 5.—This was an unvaccinated girl, aged 14 years, a scholar attending South Park Central Girls' School, notified on the 6th June. This girl is a sister of the child mentioned in Case No. 6, and a contact of a case of Small Pox previously removed to hospital. She was herself removed to hospital on 6th June, and the house disinfected. The contacts of the case (none of whom were children of school age) were followed up. Case No. 6.—This was an unvaccinated girl, aged 11 years, notified on the 6th June, a scholar attending Becontree Upper Girls' School, a sister of the above case, and a contact of a case previously removed to hospital. This girl was removed to hospital on 6th June, and the house disinfected. The contacts of the case (none being of school age) were followed up. 136 Case No. 7.—This case was of an unvaccinated girl, aged 9 years, attending Roman Catholic School, notified on the 9th August. This girl was removed to Hospital on the same day, and the house disinfected. The contacts (including 2 children of school age) were all followed up. Case No. 8.—This was the case of a boy, aged 10 years, attending Loxford School, who was found to be suffering from Small Pox at the School Clinic, and notified on the 25th August. He was removed to Hospital the same day and disinfection carried out. All contacts, including 34 children attending the School Clinic on the same morning, were followed up, and 2 brothers, scholars at Newbury Park School, as well as the 34 other children, excluded from attendance at school. All the cases have made a good recovery, and I am pleased to record that, owing to the measures adopted, no further cases occurred. (e) Chicken Pox, Whooping Cough and Mumps.—234 cases of Chicken Pox occurred in 1930, as compared with 331 in 1929 ; 278 in 1928 ; 171 cases of Whooping Cough in 1930, as compared with 278 in 1929 and 341 in 1928 ; and 179 cases of Mumps in 1930, as compared with 252 in 1929 and 207 in 1928. 924 home visits were paid by the Health Visitors in connection with cases of minor infectious disease. (f) Ringworm.— No. of cases at beginning of 1930. No. of cases reported during 1930. Total Remedied during 1930. No. of cases under observation at end of 1930. Ringworm :— Scalp 1 4 5 4 1 Body - 9 9 9 — 1 13 14 13 1 Four school children were X-rayed at the clinic during the year. 137 7. Following Up.—This has been carried out in the manner described in my previous reports. During 1930, 4,198 home visits by the Nurses were paid for the purpose, and 2,530 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 1930 were as follows :— Number of individual children seen at the Clinic 2,237 Number of attendances of children 5,444 Number of exclusion certificates granted 2,497 Number of certificates of fitness to attend school granted 1,479 The following table shows the variety of conditions dealt with at the School Clinic during the year :— Malnutrition 9 Uncleanliness :— Head 23 Body 2 Skin :— Ringworm :— Head 5 Body 18 Scabies 17 Impetigo 217 Other Diseases 285 Eye :— Blepharitis 15 Conjunctivitis 64 Corneal Ulcer 1 Defective Vision and Squint 24 Other Conditions 37 Ear :— Defective Hearing 11 Otitis Media 59 Other Ear Diseases 10 138 Nose and Throat :— Enlarged Tonsils 107 Adenoids 4 Enlarged Tonsils and Adenoids 194 Other Conditions 139 Mouth Breathing 11 Defective Speech 2 Enlarged Cervical Glands 44 Teeth—Dental Diseases 80 Heart and Circulation :— Organic 2 Functional 4 Anæmia 15 Debility 133 Infectious Diseases :— Small Pox 1 Scarlet Fever 1 Diphtheria 11 Whooping Cough 5 Mumps 16 Chicken Pox 14 Measles 1 German Measles 1 Influenza 3 Colds 32 Lungs :— Bronchitis 22 Other Non-Tubercular Diseases 2 Tuberculosis Pulmonary :— Suspected 2 Non-Pulmonary :— Glands 2 Nervous System :— Chorea 6 Other conditions 12 Deformities 12 Minor Injuries 45 Other Defects and Diseases 359 Total number of ailments 2,079 139 (b) Ophthalmic Department.— During the year 1930 the School Oculist held 86 sessions for the refraction of children suffering from defective vision. Full details of the work are given in Table IV, Group II, on page 164. 574 school children were examined, 116 of these being cases from 1929. Of the 574 cases, 458 were referred from medical inspection, 91 from the School Clinic, and 25 at the parents request. The 574 children were not all suffering from grave defects of vision. The following table shows the vision in the worst eye, as tested by Snellen's Type :— 6 6 6 9 6 12 6 18 6 24 6 36 6 60 6 0 109 83 88 94 67 73 33 27 The children who saw 6/6 (practically normal vision) were suffering from symptoms such as headaches, inflamed eyelids, etc., which rendered further examination necessary. Of the 574 children examined, 478 were found to require spectacles by reason of the following defects :— Myopia 66 Myopic Astigmatism 90 Hypermetropia 70 Hypermetropic Astigmatism 165 Mixed Astigmatism 42 Anisometropia 9 Hypermetropia with Squint 36 Total 478 Of the remaining 96 children, 10 were suffering from the following other diseases, and glasses were not prescribed :— Conjunctivitis 2 Nebulæ 1 Partial Optic Atrophy 1 Strabismus 3 Blepharitis 3 10 140 43 other children were found not to require spectacles, and in all cases the lenses already in use were found not to require changing. A number of children (83) were kept under observation and were re-examined during the year, the spectacles being changed in 23 instances. In addition to the above, the School Oculist examined 28 children from the County High School and prescribed spectacles in each case. Under the Education Committee's scheme 460 pairs of spectacles were provided. Of this number. 14 pairs of spectacles were provided free, and 3 pairs at a reduced charge, on necessitous grounds. In addition, spectacles were renewed or repaired in 187 cases. (c) Orthopadic Department.—As mentioned in my last Report the Orthopaedic Surgeon held his first Clinic at the Public Health Offices on the 20th December, 1929. He attended a total number of 23 sessions during 1929 and 1930. On the 20th December and during 1930 the Orthopaedic Surgeon examined 245 individual children of school age. A total number of 558 attendances were made by these children. The 245 children were found to be suffering from the following defects :— Infantile paralysis 19 Flat feet 21 Round shoulders 60 Scoliosis 50 Lordosis 9 Knock knees 21 Pigeon chest 7 Other defects 58 245 5 children of school age were admitted to the Country Branch of the Royal National Orthopaedic Hospital at Stanmore, Middlesex, in 1930, suffering from : (1) torticollis, (2) infantile paralysis, (3) spastic paraplegia two cases, (4) osteomyelitis. 2 were discharged during the year, and 3 were still in the institution on the 31st December, 1930. 141 The Masseuse has attended the Clinic for Orthopædic treatment and Remedial exercises every Monday, Wednesday and Friday, to carry out the treatment recommended. A total number of 152 visits were made by the Masseuse to the Treatment Clinic during December, 1929, and during 1930. There were a total number of 128 individual children of school age treated during the period mentioned, and a total number of 1,613 attendances were made by these children. 5 pairs of splints were supplied to school children during the year. (d) Dental Department.—During the year the Dentists paid 126 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 11,867 children inspected by the Dentists (including special cases), 6,738, or 56.8 per cent., were found to require treatment, compared with 6,485, or 60.6 per cent., 1929 ; 60.1 per cent., 1928; 56.9 per cent., 1927; 56 per cent., 1926 ; 56 per cent., 1925 ; 62 per cent., 1924. 57.9 per cent. of the cases requiring treatment obtained it at the School Clinic. In 1929, 50.8 percent., in 1928, 39.5 percent., in 1927, 50.1 per cent., in 1926, 45.9 percent., in 1925, 47.6 percent., in 1924, 62 per cent., in 1923, 53.3 percent., 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 Dentists :— Age groups (in years). No. inspected. No. referred for treatment. Percentage. 5 1,174 762 64.90 6 1,569 953 60.74 7 1,723 1,149 66.68 8 1,690 1,052 62.24 9 1,726 1,212 70.22 10 1,725 1,112 64.46 11-12 855 547 63.97 142 The following table shows the percentage of acceptances of treatment by the School Dentists in the various departments of the schools during 1930 :— School. Department. Number inspected. No. referred for treatment. No. of acceptances of treatment. Percentage of acceptances. Barkingside Sen. Mixed 81 41 17 41.46 Becontree Middle B. 474 407 79 19.42 „ and G. 543 423 92 21.74 ,, Lower 604 484 163 34.11 Catholic, Word Upper 233 115 53 46.08 9f Lower 117 77 40 51.94 Chadwell Upper 95 54 24 46.29 ,, Lower 72 54 22 40.74 Christchurch Boys 175 100 42 42.00 ,, Girls 156 98 30 31.62 ,, Jun. Mixed 276 159 61 38.40 Cleveland Boys 213 133 32 24.06 „ Girls 261 143 46 30.61 ,, Junior 315 196 103 52.55 Downshall Boys 324 179 83 46.33 ,, Girls 313 191 78 40.89 ,, Junior 474 282 183 64.88 Fairlop Mixed 122 89 28 31.46 Gearies Middle 336 190 76 40.00 ,, Lower 359 176 69 39.20 Goodmayes Boys 341 277 90 32.49 ,, Girls 250 218 84 30.89 ,, Lower 343 258 119 46.12 Gordon Mixed 217 129 57 44.10 Highlands Boys 229 92 44 47.82 ,, Girls 212 102 37 35.28 ,, Junior 338 203 86 42.36 Little Heath Upper} 25 15 13 86.66 Lower} Loxford Boys 186 155 56 36.12 ,, Girls 164 136 49 36.02 ,, Junior 379 258 112 43.41 Mayesbrook Mixed 125 76 44 57.78 Newbury Park Senior 227 113 27 23.88 ,, Junior 303 178 51 29.21 Open Air Mixed 130 82 74 90.24 South Park Middle 285 233 98 42.06 ,, Lower 264 196 95 48.46 St. Vincent's Mixed 301 215 91 42.32 Uphall Boys 127 75 17 22.66 ,, Girls 122 80 28 35.00 ,, Junior 199 130 78 60.00 Valentines Upper 156 93 63 67.74 ,, Lower 164 94 44 46.80 143 With regard to children who had previously been inspected by the Dentists 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 103 93 35 37.67 Becontree Lower 178 174 89 51.14 Christchurch Junior 55 54 30 55.55 ,, Girls 96 70 50 71.42 ,, Boys 52 43 20 44.18 Downs hall Junior 103 90 52 57.77 Fairlop ,, 43 43 23 53.48 Highlands ,, 73 64 30 46.86 Little Heath Mixed 32 32 7 21.87 Mayes brook Junior 49 45 21 46.66 Newbury Park Junior 86 83 25 29.41 Totals ... 870 791 382 48.68 In addition to these figures, the Dentist has carried out two complete inspections of the children's teeth at the Open. Air School, and all those referred for treatment, viz., 82, have received attention, either by the School Dentists or elsewhere. Full details of the dental work are shown in Table IV, Group IV, on page 165. (e) Treatment of Uncleanliness.—It was found necessary to deal with 67 children under the Education Act, 1921, Section 87, statutory notices being served on the parents. In 18 instances the statutory notices not being complied with, the children were brought to the School Clinic by the Nurse and cleansed. The School Nurses paid 172 visits to the schools (an average of 7 visits to each school during the year), for the purpose of 144 inspecting the heads and clothing of the children, with the following result :— Number of Children Inspected. Number Injected. Per Cent. 50,651 1,693* 3.3 *224 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 1930 under Section 87 of the Education Act, 1921. During 1930 the ambulance was used on 11 occasions to bring verminous children to the School Clinic for cleansing purposes. (/) Other Ailments.—During the past year 113 children have been operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford. 9 children were treated free during the past year, and 4 at a reduced charge, on necessitous grounds. In addition, 133 children have been operated on for the removal of enlarged tonsils and adenoids under the agreement with the King George Hospital, 93 children were treated as outpatients, and 40 as in-patients. 8 in-patients were treated free and 4 at a reduced charge, 1 out-patient free and 2 at a reduced charge. 145 As the result of a complaint received in July, the further treatment of cases at the King George Hospital has been suspended. In addition to the treatment of tonsils and adenoids, 32 letters were given to Ilford school children, for whom hospital treatment was required, to attend at Queen Mary's Hospital. 9. Open-Air School.—During 1930, 50 children were admitted, 51 ceased attendance, and on the 31st December, 1930, 97 children were on the school-roll. The whole of the children who have been admitted to 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 3 As a result of Medical Inspection at School, School Clinic, etc. 25 Tuberculosis Officer 13 Great Ormond Street Hospital 2 Parents' application 2 Director of Education 1 Private Medical Practitioner 3 Victoria Park Hospital 1 The 51 children not now on the school-roll ceased attendance for the following reasons :— Found fit to resume attendance at ordinary School 44 Left the district 4 Admitted to London Hospital 1 Unable to benefit by reason of mental defect 2 All cases discharged from the Open Air School, and subsequently re-admitted to ordinary schools, are re-examined at school. Of the 51 children ceasing attendance during 1930, 38 were readmitted to ordinary schools and 20 have been re-examined and found to have benefited by their attendance at the Open Air School, and to be in good health. The remainder will be re-examined at school in due course. 146 A Medical Officer has, since the inception of the school, attended one half-day every alternate week to examine and report 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. In addition to this, the School Dentist has carried out two complete inspections of the children's teeth, and one re-inspection was carried out. The following table shows briefly the dental work carried out:— Number of children examined by the School Dentist 88 „ „ re-examined 71 „ ,, referred for treatment 82 ,, ,, treated by School Dentist 74 „ „ re-treated 37 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 47 „ „ Cod-liver Oil Emulsion 43 Administration of Virol 1 To see Oculist 12 Treatment at Clinic for Impetigo and Sores, etc. 7 Operative Treatment for Tonsils and Adenoids 2 To see Orthopædic Surgeon re Remedial Exercises, etc. 3 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. Two children suffering from Myopia have been provided with special Myopic desks. A digest of the weight-graphs shows that 98 per cent. of the children show an appreciable increase in weight since their admission to the school. 147 As mentioned in my previous Report the Council has decided upon the provision of a rest shed. The plans have now received the approval of the Board of Education, and tenders have been invited for the erection of the building. 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 these continue to prove their helpfulness in estimating the mental development of new admissions and in testing progress made by the children whilst under new school conditions. The Head Teacher states : —"The results have been satisfactory. The average yearly increase in mental age being 1 year 4 months in the year 1930: the subjects tested being arithmetic, English, general intelligence and reading. All children are now tested as they reach the age of eight years. Again it is to be noticed that the increase in mental age is greatest in general intelligence—this subject showing most quickly a return from greater mental activity resultant from improved bodily condition. It is interesting but not surprising to note that the increase in the mental age in reading is most marked in the Junior Class where the children are mastering the technicalities of reading. " During the year 1930 the children have shown an increased desire for individual development in fundamental subjects, and there have been several outstanding cases of children making marked improvement either generally or in one subject. One interesting example is of a girl of ten who had attended school intermittently and who had developed an inferiority complex over her failure to read ; this girl learned to read in her first term." The following is a Summary of the Report of the Head Teacher of the Open Air School on the School Journey to Seaford in July :— The School Journey was made to Seaford from June 27th to July 10th. The party included 15 girls and 16 boys. They were well accommodated in a three-storey house, the girls in two dormitories on the ground floor and two dormitories on the top floor, whilst the boys 148 were accommodated in two dormitories on the first floor. One teacher slept on the ground floor, another teacher on the first floor, while the attendant slept on the top floor. Each child had a separate single bed ; there were three bathrooms in the house and three lavatories. The children rose at 7.45 a.m., breakfast was served at 8.45; the children were taught to make their own beds after breakfast. At 10 o'clock breathing exercises were taken in the front garden. The mornings were spent on the beach with lessons, individual work and bathing : definite sun exposure being taken each morning before bathing. Dinner was served at 1 p.m. After this the children changed into their bathing costumes and rested in the open air for about 1½ hours ; breathing exercises were taken after the rest and after this a short walking excursion was taken. Talks were given each evening from 5.45 to 6.30 p.m. At 6.30 p.m. a light meal was served. All the children were in bed by 8.30 p.m. Before the outward journey each child's individual record was studied and the children grouped in three groups according to their mental ages Group 1 7-9 years. Group 2 9-12 „ Group 3 12+ ,, The total cost of the school journey, including cost of taking attendant, was £91 6s. 5½d. The estimated cost per head was £2 15s. 0d. The full amount charged per child was £2 6s. 2d. 17 of the party, paying this amount. The remaining children paid subscriptions varying from 5s. to £2. 10. Physical Training.— The following is the report of the Supervising Instructor in Physical Training :— I.— Staff. No increase in the staff has taken place 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 the whole of the physical training (inclusive of swimming instruction and organised games) throughout the schools under the jurisdiction of the Authority. Such duties include, as previously, staff conferences and practical demonstrations, and are governed, as is also the instruction given, by the Board of Education's (a) Syllabus of Physical Training for Schools, 1929; (6) Beference Book of Gymnastic Training for Boys, 1927 ; (c) Syllabus of Physical Training for Schools (Supplement for Older Girls), 1928; (d) Physical Exercises for Children under Seven Years of Age, 1927; and (e) Suggestions in Begard to Games, 1927. Visits to the schools, the public baths, and the various playing fields have been regularly and systematically made during the year. 149 III.—Special Features. (а) The classes arranged for members of the teaching staff have again experienced a successful year. The use at these classes of special gymnastic apparatus has resulted, not only in the enhanced interest of all concerned, but has rendered possible a definite expansion of the syllabus. (b) Arrangements were made for a rota of 16 members of the male teaching staff, selected from the schools, to receive instruction in organised games, the class being conducted at the Cricklefield Playing Field on Thursday and Friday afternoons from 3 to 4 o'clock. The course consisted of six lessons, and those who availed themselves of the facilities provided showed a keen interest in the work and a full appreciation of the arrangements made on their behalf. (c) On 14th and 15th March I attended the Eleventh Annual Conference of the National Association of Organisers of Physical Education, held in London ; and on 9th July, at the invitation of the Huddersfield Local Education Authority, I witnessed, at Huddersfield, a demonstration of modern methods in physical education given by the children attending the schools under that Authority's jurisdiction. The demonstration was well organised and of an impressive character. (d) All the activities of the Ilford Schools' Sports Association continue to develop in a gratifying manner; and full evidence of this development is clearly shown by the large number of schools arranging athletic meetings, swimming galas, and other fixtures (e.g., in one instance, a cross-country race was held). (e) The Annual Athletic Meeting, organised by the same Association and held on the Cricklefield Playing Field on Thursday, 3rd July, again proved an eminently successful fixture. An outstanding feature of this year's meeting was the inclusion in the programme of more team events, resulting in a larger number of actual participants and a correspondingly keener rivalry. (/) During the winter season, swimming has shown further development; and I am very gratified to be able to state that, in addition to the boys' classes already held, five girls' schools are now sending pupils to the baths for instruction. The popularity of this experiment is now definitely established; and a satisfactory standard of attendance is being maintained. (g) During the year, cases of minor physical defect referred by the School Medical Officer have again received attention, approved home exercises having been advised in a number of cases. Personal instruction at the schools was given in two instances. (h) During July and August, I attended the vacation course held at Eastbourne and organised by the Board of Education for Organisers of Physical Education. The course was most interesting and instructive. (i) Playground and hall markings have again proved a useful adjunct to the instruction in connection with games and agility exercises. In addition, some further apparatus has been provided to assist in the development of this branch of the work. 150 (j) Additional facilities for the use of pitches in the parks have been granted by the Parks Committee; and increased dressing accommodation has been provided for the use of the pupils. In this connection, I beg to express the full appreciation of all concerned for the extended amenities. (k) During the year, the Handicraft Centre has again rendered valuable assistance in connection with the construction and repair of apparatus. I also desire to place on record my appreciation of the help given, in a similar manner, by the Works Department. IV.—Review of General Position. I have pleasure in stating, in conclusion, that the work continues to develop and improve; that the result of past effort by all concerned becomes increasingly evident as time progresses; and that further extension in the future is assured by the continued enthusiasm, goodwill, and loyal co-operation of all connected with this branch of local educational activity. F. J. ROBERTS, Supervising Instructor in Physical Training. 31st December, 1930. 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 1930. 11a. Supply of Free Cod-Liver Oil Emulsion, Cod-Liver Oil and Malt, etc.—During 1930, 16 necessitous cases were dealt with. 12. School Batiis.—Vide Annual Report, 1920. 13. Co-operation of Parents.—During 1930, 5,081 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, 1920, I have acted as Hon. District Correspondent for the National Society for the Prevention of Cruelty to Children. Inspector Bartholomew has continued to render very valuable services in this district, with excellent results. 151 The following is a brief resume of the work done by the Society in Ilford during the past year:— Total number of cases investigated, 59, made up as follows :— (1) Of neglect 43 (34 reported from the Public Health Department, for neglecting medical advice, and 9 reported from other sources for general neglect.) (2) Ill-treatment cases 4 (3) Other causes 12 115 children (57 boys and 58 girls) were involved, 99 being of school age. In addition to this work, 181 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 Childre:— During 1930 eight 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 and Menially Defective Child—Recommended for re-examination in 1 year's time 1 Aphonic child.—Recommended for re-admission to an ordinary school 1 Deaf.—Recommended for a School for Deaf Children 1 Amputation of Leg.—Recommended ordinary school subject to precautions 1 Rheumatism.—Recommended ordinary school subject to precautions 1 Neurotic child.—Unfit for school 1 Muscular dystrophy.—Recommended admission to a Residential School for Crippled Children 1 Paralysis.—Recommended Orthopaedic Treatment 1 8 152 1st. Blind Children.—There are thirteen children who are so blind as to be unable to profit by education in an ordinary school. Four of these are in certified residential schools for the blind, one being also an epileptic. Seven cases are awaiting admission to such schools (four are attending ordinary elementary schools, two are attending the Open-Air School, one, who is also a cripple, aged 15 years, is not attending any school). The remaining case is that of a child not at present attending any school, who is probably also mentally defective, and is due for re-examination during the present year. 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 thirteen children falling within this category. Of these four are deaf and dumb, eight are deaf, and one is dumb only. Nine cases are in residential special schools for the deaf (one being admitted in January, 1931), and one is attending a day special school. Three are awaiting admission to a special school (two being in attendance at elementary schools in the meantime) and one not at any school. In addition there is one mentally defective child who is also dumb. 3rd Epileptic Children.—There are twenty-four children known to the department. Three of these are in certified residential schools for epileptics (one being also mentally defective). Nineteen are attending public elementary schools, two are not attending any school, and one is over 14 years of age. There is also one child included under Partially Blind Children who is both partially blind and epileptic and is attending a special blind school. 4th. Tuberculous Children.—There are six children notified as suffering from pulmonary tuberculosis ; two are in sanatoria and three are over 14 years of age and have left school, and one is not attending school. Six children are suffering from active glandular tuberculosis and five are at present attending school, the other is in a sanatorium. 153 5th. Other Physically Defective and Crippled Children.— There were, at the end of the year, twenty-four physically defective children suitable for admission to a cripple school ; eleven of these cases were not attending school, three were attending public elementary schools, one was attending a private school in the district, two were in institutions, four were attending certified residential cripple schools, two were attending certified hospital schools, and one was attending a certified day cripple school. Of the twenty-one children mentioned, fourteen are 12 years of age or over. All physically defective children of school age not in institutions are examined every six months by the Assistant Medical Officers. Six were thus examined during 1930. (b) Mentally Defective Children :— During 1930 I medically examined and reported upon 21 children under the Mental Deficiency (Notification of Children) Regulations, 1928, classified as follows :— Feeble-minded Children.—Total number certified in 1930 13 Recommended for admission to a special school (day or residental) 5 Recommended for admission to a special school (residential) 5 Recommended for admission to a special school (day) 2 Recommended foradmission to a residential institution 1 Idiot Children.—Total number certified in 1930 1 Recommended for admission to a residential institution 1 Imbecile Children.—Total number certified in 1930 3 Recommended for admission to a residential institution 2 Recommendedfoi notification to Essex County Council 1 Dull and Backward Children.—Total number certified in 1930 4 Recommended attendance at special class for dull and backward children for one year, and then to be reexamined 4 The following table shows the mental age (by the Binet Simon tests) and the intelligence quotient of the mentally defective children examined during 1930. 154 The border-line of mental deficiency is where the intelligence quotient is about 75. Actual age in years. Mental age in years. Intelligence Quotient. 7.00 6.0 85.70 7.16 3.4 47.48 8.08 6.5 80.44 8.25 5.8 70.30 8.33 4.2 50.42 8.40 6.4 76.20 8.41 5.4 64.20 9.50 6.8 71.70 10.80 4.8 44.44 11 00 6.6 60.00 11.50 5.8 50.40 12.80 9.1 71.10 13.66 8.7 63.68 (1) Idiot.— 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 17 cases under the age of 16 years known to the department (1 being notified during the present year). 4 are in a residential institution, and 13 are at home. (2) Imbeciles.—Imbeciles are persons whose mental defectiveness does not amount to idiocy, yet is so pronounced that they are incapable of managing themselves or their affairs : or in the case of children, of being taught to do so. The Authority responsible for dealing with these children is also the Essex County Council. There are 21 cases under the age of 16 years known to the department (3 being notified during the present year) all of whom are at home. (3) Feeble.minded Children.—Feeble.minded children are those whose mental defectiveness does not amount to imbecility, yet is so pronounced that they are incapable of receiving proper benefit from instruction in an ordinary school. The Authority responsible for the proper instruction of these children is the Ilford Education Authority. There were (at the end of 1930) 65 such cases under 155 the age of 16 years known to me, of whom 17 are attending public elementary schools in the district, 1 is in a Convent, 1 is at Oldchurch Hospital, 1 is at Rob Roy Cripple Home, Margate, 1 is attending the Essex Voluntary Association Centre at Goodmayes, 16 are in residential schools, and 28 are not at school (21 being over 14 years of age). All mentally defective children are visited at home by the School Nurses at least once a quarter. In addition to these, there are 2 mentally defective (feebleminded) children under the age of 16 years at Dr. Barnardo's Girls' Village Home, but not in attendance at Mossford School. All mentally defective children of school age, not in institutions, are examined as to their intelligence quotient each year by the Assistant Medical Officers. 17 children were thus examined during 1930. 18, 19, 20. Nursery Schools, Secondary and Continuation Schools.—Fide Annual Report, 1920. 21. Employment of School Children and Young Persons. —From special enquiries made at the various schools during the latter end of 1930, it was found that 102 children were employed out of school hours. 2 children were submitted to me for medical examination under Section III, paragraph 4, of the Byelaws under the Provisions of Employment of Children Act, 1903, with the following result:— Medically fit ... ... ... ... ... ... ... ... 2 156 The Juvenile Employment Committee has, during the past year, found occupation for 825 children, as follows ON REGISTER, 1st JANUARY, 1930 Boys. Girls Total. Claimants 15 5 20 Non-claimants 35 72 107 Totals 50 77 127 Fresh Claims to Unemployment Insurance Benefit 168 119 287 Renewal Claims 114 71 185 Totals 282 190 472 Fresh Registration (for work only) 375 436 811 Re-registrations 126 265 391 Totals 501 701 1,202 Total number of young persons dealt with during the year 833 968 1,801 Placed by Bureau: Locally 355 332 687 Placed by Bureau: Non-locally 63 75 138 Totals 418 407 825 22. Miscellaneous.—In accordance with the Education Committee's regulations, the undermentioned bursars, studentteachers, teachers, and school caretakers were medically examined and reported upon during the year by the School Medical Officer:— Bursars 11 Student-teachers 7 Newly appointed teachers 45 Teachers absent through illness 7 School Caretakers 3 Total 73 Re-examinations:— Bursars 6 Student-teachers 13 Newly appointed teachers 8 Total 27 157 Table I.—Return of Medical Inspections. A.—Routine Medical Inspections. Number of Code Group Inspections:— Entrants 2,186 Intermediates 2,235 Leavers 2,100 Total 6,521 Number of other Routine Inspections Nil. B.—Other Inspections. Number of Special Inspections:— Medical Inspection at School 356 At School Clinic 2,237 Number of Re-Inspections — Medical Inspection at School 2,530 At School Clinic 5,444 Total 10,567 158 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1930. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. No. referred for Treatment. No. requiring to be kept under observation, but not referred for Treatment. No. referred for Treatment. No. requiring to be kept under observation, but not referred for Treatment. (1) (2) (3) (4) (5) Malnutrition - - 9 - Uncleanliness:— Head 146 - 23 - Body 7 - 2 - Skin Ringworm:— Scalp — — 5 - Body 2 — 18 - Scabies — - 17 - Impetigo 18 - 217 - Other Diseases (Non-Tubercular) 54 1 285 - Eye Blepharitis 19 1 15 - Conjunctivitis 5 - 64 - Keratitis Corneal Ulcer 1 - 1 - Corneal Opacities 1 - — - Defective Vision 353* 117 21 17 Squint 13 1 3 — Other Conditions 9 2 37 Ear Defective Hearing 21 6 11 1 Otitis Media 23 5 59 - Other Ear Diseases 4 4 10 - Nose and Throat Enlarged Tonsils only 109 67 107 8 Adenoids only 21 3 4 1 Enlarged Tonsils and Adenoids 64 7 194 1 Other Conditions 27 13 150 1 Enlarged Cervical Glands (Non-Tubercular) 28 14 44 — Defective Speech 12 8 2 1 Teeth—Dental Diseases 717 80 Heart and Circulation Heart Disease:— Organic 3 11 2 2 Functional 4 37 4 - Anaemia 34 16 15 1 Lungs Bronchitis 60 42 22 3 Other Non-Tubercular Diseases 2 5 2 7 culosis Pulmonary:— Definite — — — — Suspected 2 4 2 — Non-Pulmonary:— Glands 1 — 2 — Spine — — — — Hip 1 — — — Other Bones and Joints — — — Skin - - - - Other Forms - — - — Nervous System Epilepsy 1 1 1 - Chorea 6 2 6 1 Other Conditions 22 10 11 3 Deformities Rickets - — - - Spinal Curvature 30 5 3 — Other Forms 35 5 9 — Other defects and diseases 321 94 622 1 *31 of these eases saw 6/6 but, were suffering from other conditions, rendering refraction advisable. 159 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 2,186 509 23.2 Intermediates 2,235 572 25.5 Leavers 2,100 383 17.2 Total (Code Groups) 6,521 1,464 22.4 Other Routine Inspections — - — 160 Table III.—Return of all Exceptional Children in the Area in 1930. — — — Boys Girls Total Blind (including partially blind) (i) Suitable for training in a School or Class for the totally blind Attending Certified Schools or Classes for the Blind Attending Public Elementary Schools At other Institutions — - — At no School or Institution — — — (ii) Suitable for training in a School or Class for the partially blind Attending Certified Schools or Classes for the Blind 2 2 4* Attending Public Elementary Schools 2 5 7 At other Institutions - - - At no School or Institution 2 — 2† Deaf (including deaf and dumb, dumb and partially deaf) (i) Suitable for training in a School or Class for the totally deaf or deaf and dumb Attending Certified Schools or Classes for the Deaf 4 2 6‡ Attending Public Elementary Schools At other Institutions — — — At no School or Institution — — — (ii) Suitable for training in a School or Class for Aphasic children Attending Public Elementary Schools — 1 1 (iii) Suitable for training in a School or Class for the partially deaf Attending Certified Schools or Classes for the Deaf 2 1 3 Attending Public Elementary Schools 2 2 At other Institutions — — — At no School or Institution — 1 1 Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority) Attending Certified Schools for Mentally Defective Chn. 8 8 16 Attending Public Elementary Schools 7 10 17 At other Inst itutions 2 4 6§ At no School or Institution 19 9 28|| ¶ Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics 2 1 3** In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools - - - At no School or Institution 2 — 2†† Suffering from epilepsy which is not severe Attending Public Elementary Schools 12 7 19 At no School or Institution — — 161 Table III.—Continued. — — — Boys Girls Total Infectious pulmonary tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 1 At other Institutions - - — At no School or Institution - 1 1‡‡ Non-infectious but active pulmonary tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 1 At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools - - - At other Institutions - - - At no School or Institution 1 2 3§§ Physically Defective Non-infectious but active glandular tuberculosis At Public Elementary Schools 3 2 5 At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 - 1 Delicate children (e.g., pre—or latent tuberculosis, malnutrition, debility anaemia, etc.) At Certified Residential Open Air Schools At Certd. Day Open Air Schls. 52 45 97 At Public Elementary Schools 22 18 40 At other Institutions — — — At no School or Institution — — — Active Non-pulmonary tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board At Public Elementary Schools 1 — 1 At other Institutions — — — At no School or Institution — 1 1 Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease At Certified Hospital Schools 2 2 At Certified Residential Cripple Schools 1 3 4 At Certified Day Cripple Schls. 1 — 1 At Public Elementary Schools 2 1 3 At other Institutions 2 — 2 At no School or Institution 5 6 11l||| At Private School 1 - 1 * 1 of these children is also an epileptic. † 1 of these children is also a cripple. † 2 of these children are also partially blind. § 2 of these children are in Dr. Barnardo's Girls' Village Homes, but over 14 years of age, and 1 other girl is a cripple. || 1 of these children is also dumb and 1 a cripple. ¶ 21 of these children are over 14 years of age. **1 of these children is also mentally defective. †† of these children is over 14 years of age. ‡‡This child is over 14 years of age. §§ 2 of these children are over 14 years of age. |||| 3 of these children are over 14 years of age. 162 Table IIIa. Statement of the Number of Children Notified during the Year ended 31st December, 1930, by the Local Education Authority to the Local Mental Deficiency Authority. Total number of children notified 10 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 1 (b) Imbeciles 2 2 (c) Others 1 — ii. Children unable to be instructed in a Special School without detriment to the interests of the other children : (a) Moral defectives — — (b) Others - - (2) Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 2 1 (3) Feeble-minded children notified under Article 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 6 4 163 Table IV.—Return of Defects Treated during the Year ended 31st December, 1930. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V). Disease or Defect. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin:— Ringworm—Scalp 5 — 5 Ringworm—Body 18 — 18 Scabies 17 — 17 Impetigo 217 — 217 Other skin disease 285 7 292 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 115 7 122 Minor Ear Defects 80 11 91 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 548 517 1,065 Total 1,285 542 1,827 164 Table IV.—Continued. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for Squint should be recorded separately in the body of the Report ). 574 33 16 623 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) - - - - Total 574 33 16 623 Total number of children for whom spectacles were prescribed:— (а) Under the Authority's Scheme 478 (b) Otherwise 49 Total number of children who obtained or received spectacles:— (a) Under the Authority's Scheme 460 (b) Otherwise 49 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. (4) Total Number treated. (5) Under the Authority's Scheme, in Clinic or Hospital. (1) By Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total (3) 246 21 267 16 283 165 Group IV.—Dental Defects. (1) Number of Children who were (a) Inspected by the Dentists :— Aged Routine Age Groups 5 1,174 Total 10,462 6 1,569 7 1,723 8 1,690 9 1,726 10 1,725 ll 855 Specials 618 Reinspection 870 Mossford 699 Open-Air 88 Grand Total 12,737 (6) Found to require treatment 6,738 (c) Actually treated 3,903 (d) Re-treated during the year as the result of periodical examination 1,455 (2) Half-days devoted to Inspection 126 Total 939 Treatment 813 (3) Attendances made by children for treatment 6,982 (4) Fillings Permanent teeth 3,665 Total 8,436 Temporary Teeth 4,771 (5) Extractions Permanent Teeth 545 Total 6,473 Temporary Teeth 5,928 (6) Administrations of general anaesthetics for extractions 1,309 Local 2,362 (7) Other operations Permanent Teeth 1,634 Total 2,245 Temporary Teeth 611 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 50,651 (iii.) Number of individual children found unclean 1,693 (iv.) Number of children cleansed under the arrangements made by the Local Education Authority 18 (v.) Number of cases in which legal proceedings were taken:— (а) Under the Education Act, 1921 Nil (b) Under School Attendance Bye-laws Nil 166 167 Table V.—Table showing number of Children Medically Inspected at various Schools during 1930. 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 — — — — — 2 16 23 — 3 2 2 1 — 12 12 2 — — — 33 42 Becontree 75 79 22 13 16 18 72 146 24 26 21 24 17 10 68 60 7 18 1 — 323 394 Chadwell 16 13 5 6 8 8 12 10 2 4 5 7 2 3 2 3 — — — — 52 54 Christchurch 69 76 25 10 8 7 96 73 11 18 3 10 3 4 26 25 2 1 — 3 243 227 Cleveland 66 55 8 8 6 5 58 67 15 7 3 15 2 3 40 27 1 1 2 — 201 188 Downshall 78 73 27 23 6 14 50 80 5 26 8 6 6 5 34 49 3 5 1 — 218 281 Fairlop 28 32 8 6 12 3 10 3 — — — — — — — — — — — — 58 44 Gearies 100 88 26 27 27 13 75 66 8 24 11 14 1 5 31 31 6 8 1 2 286 278 Goodmayes 74 65 19 10 15 16 117 93 26 25 12 10 5 7 59 34 2 2 — 1 329 263 Gordon 24 24 5 9 3 1 6 2 — 2 — — — — — — — — — 38 38 Highlands 75 54 10 10 14 13 42 47 21 14 5 11 2 5 37 32 1 6 2 1 209 193 Little Heath 6 4 — — 1 1 4 5 1 1 — 2 2 — 3 2 — 1 1 — 18 16 Loxford 72 67 10 15 8 12 111 95 6 14 9 5 1 4 30 34 4 4 — — 251 240 Mayesbrook 37 35 5 9 7 5 18 12 1 1 — — — — — — — — — — 68 62 Mossford — 5 — 24 — 6 — 45 — 56 — 41 — 43 — 121 — 12 — 3 — 356 Newbury Park 41 40 6 7 6 5 42 55 2 16 3 6 2 2 19 19 2 1 — — 123 151 Open Air School 1 1 7 4 13 6 12 9 10 7 13 7 — 7 4 3 6 4 — — 66 48 Roman Catholic, Ilford 22 21 4 8 6 6 35 26 10 — 4 3 3 1 16 15 3 4 1 - 104 84 South Park 58 53 19 17 8 11 61 55 8 8 8 9 55 56 48 41 2 2 — 1 267 253 St. Vincent's R.C., Bee. 18 17 1 — 3 5 23 28 1 3 3 3 1 2 5 11 1 — — — 56 69 Uphall 24 32 4 4 4 1 38 33 3 — 3 2 1 1 24 13 1 — — — 102 86 Valentines 22 15 5 5 3 3 24 15 7 5 3 1 1 - - - - - - - 65 44 Total 906 849 216 215 174 161 922 978 161 260 116 178 105 158 458 532 43 69 9 11 3110 3411 Specials. Barkingside - - - - - - - - - - - - - - - - - - - - - - Becontree — 1 1 2 2 1 5 5 1 11 2 20 3 1 — 3 — 2 — — 14 46 Chadwell — — — — — — — 1 — 1 1 — — 1 — — — — — — 1 3 Christchurch — — — — — — — — 1 1 — 1 1 — 2 — 1 — — — 5 2 Cleveland — — — 1 1 2 — — 1 1 — — — — — — — — — — 2 4 Downshall — 2 3 3 — 3 — — — 2 — 1 — 1 — 1 — — — — 3 13 Fairlop — — 2 — 2 — — — — — — — — — — — — — — — 4 — Gearies 1 1 1 — 3 2 1 4 — — — — — 1 — 1 — 1 — — 6 10 Goodmayes 3 — 1 1 1 1 1 3 — 2 3 1 1 — — 1 3 — — 1 13 10 Gordon — — — — — — — — — — — — — — — — — — — — — — Highlands — — 1 1 3 3 — 2 — 3 — 1 — 1 1 — — 2 — — 5 13 Little Heath 1 - - - - - - - - - - - - - - - - - - - 1 1 Loxford — 1 1 - - - - - - - - - - - - - - - - 1 1 6 Mayesbrook - - - - - - - - - - - - - - - - - - - - 1 — Mossford - - - - - - - - - - - - - - - - - - - 1 — 1 Newbury Park — — — — — 3 — — — — — — — — — — — — — — — 3 Open Air School — 2 5 11 7 4 14 8 15 14 16 24 5 3 5 12 5 8 2 1 74 87 Roman Catholic, Ilford 2 - - - - - - - — — — — — — — — — — — — 2 — South Park — 1 - - - - - - - - - - - - - - - - - - - 2 St. Vincent's R.C., Bee. — 1 1 — 4 1 — — 3 — 4 3 — — — — 1 — — — 13 5 Uphall — 1 2 - - - - - - - - - - - - - - - - - 3 1 Valentines - - - - - - - - - - 1 - - - - - - - - - 1 — Total 7 10 18 19 24 21 22 23 21 36 27 54 10 9 8 18 10 13 2 4 149 207 Total Number of Children Examined, 6,877 Grand Total 3259 3618 168 169 Table VI. A.—Table Showing the Average Height and Weights of the BOYS Examined. School. Age Groups. Age Groups. 5—6 Years. 6—7 Years. 7—8 Years. 8—9 Years. 9—10 Years. 10—11 Years. 11—12 Years. 12—13 Years. 13—14 Years. No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). | No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). Barkingside - - - - - - - - - 16 49.21 55 .11 — — - 2 50.40 63.27 1 53.95 74.55 12 55.90 74.75 2 61.38 96.56 Becontree 75 42.09 40.60 22 44.06 44.25 16 44.76 50.96 72 48.90 54 .70 24 49.64 60.45 21 52.90 66.61 17 53.74 69.00 68 55.12 74.74 7 58.67 87.18 Open Air 1 43.30 37.48 7 43.90 41.50 13 46.49 44.21 12 48.30 52 .97 10 51.11 59.07 13 52.08 62.23 — — 4 53.94 67.69 6 56.30 71.21 Chadwell 16 43.45 40.96 5 46.05 45.20 8 48.83 50.55 12 49.40 56 .24 2 51.58 57.99 5 56.10 70.99 2 59.05 79.14 2 56.34 76.73 — — — Christchurch 60 42.96 42.11 25 45.39 48.50 8 47.90 55.11 96 48.86 53 .87 11 52.36 63.49 3 52.37 67.24 3 54.73 68.79 26 55.28 75.98 - 56.70 83.55 Cleveland 66 42.95 42.27 8 45.13 48.76 6 47.04 52.69 58 49.02 54 .90 15 51.77 59.09 3 54.02 70.41 2 54.53 72.09 40 56.18 15.75 1 57.47 87.74 Downshall 78 42.91 43.24 27 45.86 48.51 6 47.24 50.49 50 50.04 57 .14 5 51.50 63.23 8 52.60 64.94 6 54.33 75.10 34 55.78 78.48 3 57.08 86.42 Failop 28 4.26 44.00 8 43.90 43.60 12 47.13 50.63 10 49.32 54 .76 — — — — — — — — — — — — — — Gearies 100 43.38 41.63 26 45.86 46.87 27 48.42 52.95 75 49.28 55 .34 8 52.84 62.04 11 54.33 69.00 I 58.27 74.96 31 55.12 77.30 6 60.23 87.74 Goodmayes 74 41.81 39.95 19 45.13 46.56 15 47.32 53.20 117 49.72 60 .45 26 51.34 62.35 12 54.98 74.43 5 54.33 74.89 59 55.93 78.28 2 61.02 110.23 Gordon 24 42.63 42.18 5 45.86 48.17 3 46.16 50.44 6 48.63 52 .72 — — — — — — — — — — — — — — Highlands 75 43.94 42.08 10 45.40 45.93 14 48.07 52.45 42 49.02 54 .68 21 51.30 63.38 5 53.39 74.43 53.54 68.13 37 56.74 80.62 1 56.30 71.65 Little Heath 6 40.00 40.56 — — - 1 46.45 52.45 4 46.28 53 .04 1 51.58 65.26 — — — 53.94 72.42 3 53.78 76.28 — — — Loxford 72 43.47 42.50 10 45.83 47.34 8 48.89 56.48 111 50.00 57 .94 6 51.8 58.88 9 53.35 74.34 1 55.90 69.87 30 56.14 77.17 4 60.69 98.98 Mayesbrook 37 42.52 42.50 5 47.32 48.29 7 47.64 52.31 18 48.54 53 .90 1 51.18 61.28 - - — - - — — — — — — — Mossford — — — — - — — — — — — — - - - - - - - - - - - - - — — Newburv Park 41 42.32 40.56 6 43.77 43.35 6 48.11 53.50 42 49 .02 53.87 2 50.78 55.63 3 52.08 62.62 2 57.08 83.44 19 56.50 80.12 2 60.13 87.73 Roman Catholic 22 43.50 46.26 4 43.30 46.51 6 47.36 49.60 35 49 .64 56.36 10 51.85 68.07 4 52.54 67.20 3 53.54 66.57 16 57.98 81.56 3 57.48 78.83 St. Vincent's 18 41.77 40.24 1 45.27 50.70 3 48.67 54.90 23 48 .70 53.58 1 47.24 56.30 3 51.18 58.64 1 50.00 58.64 5 55.90 76.94 1 52.37 65.26 South Park 58 43.47 41.88 14 46.61 48.28 8 48.18 53.07 61 50 .58 58.74 8 53.62 69.10 8 51.97 61.50 55 55.44 75.15 48 57.87 78.12 2 58.67 91.71 Uphall 24 41.50 40.50 4 44.97 51.37 4 48.41 60.40 38 48 .56 53.70 3 52.76 63.42 3 52.28 68.13 1 51.18 77.16 24 55.97 78.73 1 55.52 92.80 Valentines 22 43.30 43.30 5 45.36 44.65 3 48.54 53.80 24 49 .05 56.66 7 51.94 63.65 3 54.14 73.42 1 54.33 70.55 - — — - - — Average Heights and Weights of Ilford Children 906 42.87 42.05 216 44.49 45.36 174 47.52 52.45 922 48 07 54.46 161 51.41 62 .47 116 53 10 68.13 105 54.41 74.17 458 55.93 77.33 43 58.34 86.22 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 .40 170 Table VI. B.—Table Showing the Average Heists and Weights of the GIRLS examined. School. Age Groups. Age Groups. 5—6 Years. 6—7 Years. 7—8 Years. 8—9 Years. 9—10 Years. 10—11 Years. 11—12 Years. 12—13 Years. 13—14 Years No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). | No. of Children Examined. Average Height (in inches) Average Weight (in pounds). No. of Children Examined. Average Height (in inches). Average Weight (in pounds). No. of Children Examined. Average Height (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 - - - - - - 2 46.85 49.92 23 49.02 50.65 3 50.52 57.47 2 50.00 61.04 — - — 12 56.83 75.15 Becontree 79 41.81 38.62 13 42.25 39.68 18 46.57 48.40 146 48.22 51.99 26 50.86 57.64 24 52.28 65.70 10 54.84 68.33 60 55.70 80.95 18 60.24 89.50 Open Air 1 40.95 33.06 4 44.68 43.70 6 47.24 47.17 9 48.46 47.43 7 51.33 58.24 7 52.32 59.74 7 56.30 69.34 3 55.78 68.50 4 61.81 78 05 Chadwell 13 41.97 38.36 6 46.22 48.50 8 48.26 49.15 10 48.60 49.15 4 52.76 65.04 10 53.98 66.28 3 56.70 79.36 3 59.84 88.91 - - - Christchurch. 76 42.58 40.04 10 43.58 41.17 7 47.46 51.15 73 48.28 56.26 18 52.37 62.39 15 52.56 65.04 4 55.52 79.36 25 57.24 82.78 1 57.88 97.00 Cleveland 55 42.98 42.99 8 44.48 43.71 0 47.73 55.90 67 49.10 51.49 7 51.85 62.95 6 52.44 67.58 3 54.72 73.84 27 56.78 79.64 1 58.66 91.63 Downshall 73 42.79 43.84 23 45.51 47.56 14 45.85 46.40 80 49.02 55.63 26 51.58 65.88 - 52.37 60.94 5 56.43 71.44 49 56.79 79.89 5 60.07 92.72 Fairlop 3'2 41.70 38.49 6 44.33 43.46 3 47.36 48.56 3 48.89 54.58 - - - 14 54.64 - - - - - - - - — — Gearies 88 43.47 41.02 27 44.92 44.28 13 50.00 61.02 66 49.13 56.42 24 51.81 61.43 10 51.65 69.90 5 55.32 74.30 31 55.52 74.96 8 56.46 77.20 Goodmayes 65 42.09 39.92 10 44.87 43.78 16 46.28 49 00 93 48.11 53.12 25 52.55 72.36 - - 61.37 7 53.35 68.14 34 56.14 79.22 2 55.90 74.95 Gordon 24 42.84 42.06 9 45.08 44.75 1 45.27 44 09 2 48.82 49.60 2 48.22 52.24 11 53.83 - - - - - - - 6 57.47 87.30 Highland 54 43.58 40.24 10 45.44 48.97 13 46.85 45.50 47 49.28 54.01 14 52.60 61.32 2 49.60 65.81 5 56.95 82.18 32 57.79 84.89 Little Heath 4 40.55 41.89 — — — I 46.06 52.04 5 45.75 53.35 1 47.64 56.44 5 51.50 72.41 - - - 2 53.54 84.21 1 54.33 95.23 Loxford 67 43.27 41.89 15 46.53 53.13 12 48.17 50.54 85 48.93 54.02 14 48.91 53.12 - - 64.90 4 53.94 77.60 34 57.32 82.65 4 59.69 92.16 Mayesbrook 35 43.12 41.71 9 45.1 6 45.36 5 46.24 47.22 12 48.79 54.42 1 49.60 55.55 41 50.93 - - - - - - - - - - Mossford 5 42.43 44.16 24 44.76 49.25 6 47.47 52.82 45 48.07 57.37 56 49.80 63.05 6 55.04 64.93 43 53.44 77.60 121 56.10 84.85 12 55.36 85.98 Newbury Park 40 42.28 38.96 7 44.40 45.50 5 47.83 49.84 55 48.30 50.25 16 50.32 56.66 3 51.68 71.26 2 55.32 65.70 19 56.97 77.93 1 60.13 92 15 Roman Catholic '21 42.52 41.63 8 45.57 47.78 6 46.28 49.83 26 50.00 57.72 - - - 3 51.97 68.62 1 52.76 61.73 15 56.70 77.34 4 58.27 80.78 St.Vincent's 17 43.87 42.76 — — — 5 47.64 50.04 28 48.98 54.26 3 51.85 57.27 9 54.33 65.38 2 55.51 63.36 11 55.00 74.52 - - - South Park 53 43.30 41.68 17 45.27 42.94 11 48.04 50.88 55 49.57 54.71 8 2-52.98 62.87 2 53.74 69.36 56 56.54 77.37 41 57.71 81.57 2 58.67 88.17 32 42.50 40.95 4 44.29 43.41 1 46.85 33 48.07 52.97 - - - - - 69.33 1 57.07 82.67 13 589.0 83.38 - - - Valentines 15 43.72 43.47 5 45.82 49.58 3 49.10 52.75 15 48.98 52.26 5 51.68 60.15 1 52.37 62.28 - - - - - - - - - Average Heights and Weights of Ilford Children 849 42.76 41.00 215 45.00 45.81 161 47.31 50.11 978 48.70 53.26 260 51.26 6115 178 52.72 65.56 158 55.74 75.26 532 56.74 80.62 69 57.96 86.35 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 80.37 171 172 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, 1930. SCHOOLS. DISEASES AND CONTACTS. Number on Roll. Scarlet Fever. Diphtheria. Measles & German Measles. Chickenpox. Whooping Cough. Mumps. Small Pox. Ringworm. Totals, 1930. Totals, 1929. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Cases. Contacts. Cases. Contacts. Barkingside 278 - 5 - - 1 7 - - - - - - - 1 - 1 13 40 36 Becontree 2024 8 13 32 51 74 33 18 12 16 4 2 - 1 8 - 151 121 245 165 Open Air 97 3 1 3 2 — 2 2 1 - - - - 1 - 8 7 5 5 Chadwell 302 4 4 2 1 10 4 8 3 — — — - - 1 - 24 13 16 8 Christchurch 1165 20 25 26 25 146 13 19 6 10 — 19 - - 3 2 242 72 137 70 Cleveland 1106 6 7 11 26 105 19 4 4 29 3 1 - - 4 1 157 63 138 34 Downshall 1561 18 24 16 30 162 18 36 14 56 1 47 - - 2 1 336 89 137 45 Fairlop 190 8 8 — 2 31 2 2 1 14 1 8 - - 1 — 63 15 1 1 Gearies 1088 19 11 4 4 105 24 27 9 6 — 29 - - 2 — 190 50 63 22 Goodmayes 1355 8 18 41 37 95 22 17 6 7 — 3 - 1 2 — 172 85 155 108 Gordon 236 1 — 2 — — — — — - — — - - — — 3 — — — Highlands 996 12 11 4 5 133 14 2 2 8 1 10 - - 2 — 169 35 110 50 Little Heath 89 — - — 1 24 8 — — — — 2 - - 2 — 26 11 10 5 Loxford 965 7 2 8 3 119 35 55 16 12 — 23 - 1 6 — 225 62 85 31 Mayesbrook 185 — - 2 — — — — — — — 3 - - 1 — 5 1 — — Newbury Park 758 5 9 3 2 36 14 6 1 1 — 6 - 3 7 1 61 33 48 24 Roman Catholic, Ilford 481 5 20 15 14 40 9 3 1 — — 2 - 1 1 — 66 45 85 52 St. Vincent's R.C., Bee. 371 1 5 — 3 2 — 2 1 - — 2 - — — — 7 9 4 1 South Park 1325 13 13 4 11 125 13 18 3 — — 3 - 1 1 — 164 41 83 41 Uphall 638 13 18 5 5 69 16 10 1 1 — 1 - — 1 — 99 41 95 36 Valentines 339 1 — — - 18 - 5 2 8 — 1 - — 1 — 33 3 22 12 County High - 9 11 6 12 - - - - - - - - - - - 15 23 6 11 Private - 12 13 20 17 - - - - - - - - - - - 32 30 38 42 Mossford (G.V.H.) 753 1 — 4 — — — — 3 — 17 - — — — 25 — 7 — Totals 16303 174 218 208 251 1295 253 234 83 171 10 179 - 8 47 5 (2274 862 1530 4*)9 Acute Primary Pneumonia:—1 case (Becontree). Acute Cerebro-Spinal Meningitis:—1 case (Private School). 173 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, 1930. SCHOOLS. No. on Roll. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals, 1930. Total 1929. 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. JCases. Conts. Barkingside 278 - 1 - - - - - - - - - - - - - - - - - - - - - - - 5 8 6 Becontree 2024 2 — - - - 4 2 2 2 2 - - 1 - - - 1 1 - - - 2 - 2 8 13 64 80 Open Air 97 3 - - - - - - - - - - - - - - - - - - - - - - 3 1 3 2 Chadwell 302 — — - - 1 — 1 1 — — 1 2 1 1 - - - - - - - - - — 4 4- - - Christchurch 1165 5 7 2 4 2 4 1 — 1 2 1 1 2 1 1 1 - 2 2 1 - 1 3 1 20 25 17 21 Cleveland 1106 — — 2 — — — — — — — 1 2 1 4 1 - 1 — — 1 - - - - 6 7 15 13 Downshall 1561 — 3 2 — — 2 1 1 3 4 1 1 1 1 2 2 1 — — 1 4 6 3 3 18 24 35 Fairlop 190 — 2 1 — — — — — — — - — — 1 — 1 - — 1 - 5 3 1 1 8 8 - - Gearies 1088 4 4 1 1 2 — 1 1 2 — 4 1 1 — — 2 - - 1 - 3 2 - - 19 11 13 7 Goodmayes 1355 3 4 1 1 — 7 - - 2 - - 3 - - - - - - - 1 - - 2 2 8 18 20 26 Gordon 236 — — — — — — — — — — — — — — — — - — — - 1 — — — 1 — — — Highlands 996 1 1 2 1 2 4 3 — 1 1 — — 1 1 1 3 - - - - - - 1 — 12 11 23 16 Little Heath 89 — — — — — — — — — — — — — — — — - — — - — — — — — — 1 3 Loxford 965 3 2 3 - - - - - - - - - - - - - - - - - - - - - 7 2 18 15 Mayesbrook 185 — — — — — — — — — — — — — — — — - — — - — — — — — — — — Newbury Park 758 1 1 1 2 1 — — — — — — 1 — 1 — — - — 1 2 — 2 1 — 5 9 7 13 R. Catholic. Ilford 481 — 1 — — — 7 — — 1 — 1 2 — — 1 4 1 1 — — 1 2 — 3 5 20 9 17 S.Vincent'sR.C.Be. 372 — - — — - 2 — — — — — — — — — — - — 1 3 — — — — 1 5 1 — South Park 1325 1 — 1 1 1 — 1 — 2 2 — — — — — 3 1 2 4 3 2 2 — — 13 13 17 12 Uphall 638 1 2 2 — 1 1 1 1 2 5 4 7 — — 2 2 - — — — — — — — 13 18 9 12 Valentines 339 — - - - — — — — — — — — — — — - — — — — — 1 — 1 — 8 5 County High - 1 2 3 - 1 4 - 1 - - - - - 1 — — 2 2 2 — — 1 — — 9 11 5 7 Private - - - 1 1 — 1 1 3 2 1 1 1 1 — 1 2 1 1 1 — 1 2 3 12 13 27 29 Mossford(G.V.H.) 753 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 16303 25 30 22 11 12 35 12 8 19 18 14 21 9 12 8 19 10 9 13 14 16 26 14 15 174 218 309 320 174 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, 1930. SCHOOLS. No. on Roll. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 1930. Totals, 1929. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 278 - - - - - - - - - - - - - - - - - - - - - - - - — - 6 10 Becontree 2024 6 10 3 8 6 4 2 7 5 2 2 2 - 2 2 4 2 3 - 2 3 5 1 2 32 51 43 38 Open Air 97 — — — 1 1 — — 1 — — — — - — — — — — - — 2 — - — 3 2 1 2 Chadwell 302 — — 2 1 - - - - - - - - - - - - - - - - - - - - 2 1 2 1 Christchurch 1165 4 4 — — 2 4 1 3 - - - - - - 1 2 2 5 4 2 9 4 3 1 26 25 18 19 Cleveland 1106 4 1 1 — — — 1 1 — — 3 2 - — — 1 2 — — 1 19 — 1 11 26 10 8 Downshall 1561 1 2 — 1 2 2 — 2 2 3 — — - — 1 7 1 1 3 5 4 1 2 6 16 30 10 8 Fairlop 190 — 2 — — — — — — — — — — - — — — — — — — — — — — — 2 1 1 Gearies 1088 1 1 — 1 2 — — — — — — — - — — — — — — — — — 1 2 4 4 — — Goodmayes 1355 7 11 9 5 7 7 2 1 3 2 3 4 4 2 1 1 1 2 1 — 1 — 2 2 41 37 59 63 Gordon 236 — — — — — — — — — — — — — — — — - — — — — — — — 2 — — — Highlands 996 — — — — — 4 1 — 1 — — — 1 — 1 1 — — — — — — — — 4 5 3 8 Little Heath 89 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Loxford 965 2 1 1 — 1 — — — — — 1 — — — 1 1 2 1 - - - - - - 8 3 3 3 Maves brook 185 — — — — — — — — — — — — — — 1 — — — — — 1 — — — - — — — Newbury Park 758 1 1 - - - - - - - - - - - - - - - - - - - - - - - 2 5 3 R. Catholic, Ilford 481 1 1 4 1 4 7 2 1 - - - - - - 1 2 1 1 — — 2 1 — — 15 14 4 5 S.Vincent'sR.C.Be. 372 — 1 — — — 2 — — — — — — — — — — — — — — — — — — — 3 2 1 South Park 1325 1 1 2 1 1 — — 3 — 2 — — — — — — — — — 1 — 2 — 1 4 11 22 24 Uphall 638 — 1 2 1 — 1 — — — — — — — — 1 1 — — 1 — 1 1 — — 5 5 6 9 Valentines 339 - - - - - - - - - - - - - - - - - - - - - - - - - - 3 3 Couuty High - 2 1 — 1 4 — — — — — — — 2 1 — — — — — 1 3 2 1 6 12 1 4 Private 1 - — 1 2 — 1 — 1 — 1 — — — — 3 2 6 7 3 2 2 5 20 17 10 12 Mossford (G.V.H.) 753 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 16303 29 39 25 21 29 35 11 19 12 9 10 8 6 7 11 19 15 17 15 18 32 38 13 21 208 251 210 222 175 MEASLES AND GERMAN MEASLES. 9 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, 1930. SCHOOLS. No. on Roll. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals, 1930. Totals, 1929. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 278 - - - - - - - - - - - - - - - - - - - - - - - - 1 7 1 3 Becontree 2024 4 3 28 10 32 14 9 3 1 2 - - - - - - - - - - - - - - 74 33 24 19 Open Air 97 — — -— — — — — 1 - 1 - - - - - - - - - - - - - - — 2 — — Chadwell 302 2 1 7 3 - - - - - - - - - - - - - - - - - - - - 10 4 - — Christchurch 1165 2 — 104 8 33 2 3 — - - - - - - - - - - 1 1 1 1 - 1 146 13 23 15 Cleveland 1100 2 3 30 4 69 11 4 1 - - - - - - - - - - - - - - - - 105 19 6 5 Downshall 1561 1 — 112 9 42 8 2 - 3 1 - - - - - - 1 - - - 1 - - - 162 18 6 1 Fairlop 190 — — 5 — 25 2 1 - - - - - - - - - - - - - - - - - 31 2 - — Gearies 1088 6 2 68 10 27 11 1 - 3 1 - - - - - - - - - - - - - - 105 24 - — Goodmayes 1355 1 2 37 9 47 8 7 - 2 — 1 - - - - - - - - - - - - - 95 - 7 3 Gordon 236 — — — — — — — — — — - - - - - - - - - - - - - - — — — — Highlands 996 1 1 43 4 85 9 2 - 1 - 1 - - - - - - - - - - - - - 133 14 24 9 Little Heath 89 1 — 22 8 1 - - - - - - - - - - - - - - - - - - - 24 8 2 Loxford 965 6 2 77 27 29 5 4 1 1 — 1 - - - - - - - - - - - 1 - 119 35 15 8 Mayesbrook 185 — — — — — — — — — — - - - - - - - - - - - - - - — — — — Newbury Park 758 1 — 6 1 2 — 2 1 14 6 8 5 3 1 - - - - - - - - - - 36 14 2 1 R. Catholic, Ilford 481 — — 27 8 13 1 - - - - - - - - - - - - - - - - - 40 9 6 3 S.Vincent'sR.C.Be. 372 — — 1 — — — 1 — — — — — - - - - - - - - - - - - 2 - — — South Park 1325 1 1 70 9 53 3 - - - - - - - - - - - - - - - - - - 215 13 1 1 Uphall 638 — 1 22 5 43 8 - - 3 - - - - - - - - - - - - - - - 69 16 21 8 Valentines 339 - - 2 - 7 - 7 - 2 - - - - - - - - - - - - - - - 18 — 1 - — — — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 15550 28 16 661 115 508 87 43 10 35 15 11 5 3 1 - - 2 - 1 1 2 2 1 1 1295 257 141 80 176 CHICKEN POX. Table XI.—Summary of Cases of Chicken Pox among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended 31st December, 1930. SCHOOLS. No. on Roll. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals, 1930. Totals, 1929. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 278 - - - - - - - - - - - - - - - - - - - - - - - - - - 18 13 Becontree 2024 7 2 2 — 2 - — - 3 2 — - 1 — - — 2 1 - - - 1 1 6 18 12 32 20 Open Air 97 — — 1 — — - 1 1 — — — - — — - — — - - - — 2 1 1 1 Chadwell 302 1 — 2 1 2 1 1 - — — 1 - — — - — — - - - 1 1 — 8 3 1 1 Christchurch 1165 — — — — 3 1 2 2 2 — 6 1 3 — - — — - 1 1 2 1 19 6 58 14 Cleveland 1106 — — 1 3 — - 1 — 1 — — - — — - — — - - - 1 1 — — 4 4. 28 4 Downshall 1561 17 3 — — 9 4 1 — 4 3 2 1 1 1 - — 1 1 1 1 — — 36 14 20 3 Fairlop 190 — — 2 1 — — — — — — — - — — - — — - - - — — 2 1 — — Gearies 1088 13 3 6 1 — — 1 — 1 3 5 1 — — - — — - 1 1 — — 27 9 46 14 Goodmayes 1355 7 3 1 1 — — 5 — — — 2 1 1 1 - — — - 1 - — — 17 6 14 9 Gordon 236 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Highlands 996 - - - - - - - - - - - - - - - - - - - - - - - - 2 2 49 15 Little Heath 89 — — — — — — — — — — — - — — - — — - - - - - — — — — — Loxford 965 15 1 6 1 10 4 3 1 12 3 2 2 4 1 - - - - - - 1 - 2 3 55 16 4 — Mayesbrook 185 — — — — — — — — — — — — — — - — — - - - - - — — — — — — Newbury Park 758 - - - - - - 1 - 1 - - - - - - - - - - - - - 2 1 6 1 10 1 R. Catholic, Ilford 481 - - - - - - - - - - - - - - - - - - - - - - - - 3 1 36 22 S.Vincent'sR.C.Be. 372 - - - - - - - - - - - - - - - - 1 - - - - - - - 2 1 — — South Park 1325 2 — 5 1 8 2 - - - - - - - - - - - - 1 - 2 - - - 18 3 3 Uphall 638 6 — 3 1 - - 1 - - - - - - - - - - - - - - - - - 10 1 11 6 Valentines 339 — — - — — — 1 — — — 1 — 3 2 - - — - - - — - — — - 2 - — — — — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — — - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 15550 68 12 31 11 34 12 18 5 25 11 20 7 15 6 - — 4 2 5 3 7 3 7 11 234 83 331 125 177 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, 1930. SCHOOLS. No. on Roll Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals, 1930. Totals, 1929. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 278 - - - - - - - - - - - - - - - - - - - - - - - - - - 4 4 Becontree 2024 - - 4 1 2 - 3 2 7 1 - - - - - - - - - - - - - - 16 4 44 9 Open Air 97 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chadwell 302 - - - - - - - - - - - - - - - - - - - - - - - - - - 10 - Christchurch 1165 2 - - - 1 - 1 - - - - - - - - - 1 - 1 - 1 - 3 - 10 - 4 1 Cleveland 1106 - - - 1 1 - 1 1 1 - 9 - 7 - 7 1 3 - - - - - - - 29 3 16 4 Downshall 1561 - - 4 - 3 - 3 - 16 - 19 1 2 - - - 1 - 3 - 4 - 1 - 56 1 16 3 Fairlop 190 - - - - - - 1 - - - 1 1 - - 9 - 3 - - - - - - - 14 1 - - Gearies 1088 1 - - - - - - - 1 - - - 3 - 1 - - - - - - - - - 6 - 1 1 Goodmayes 1355 - - - - - - 1 - 2 - 2 - - - - - 1 - - - - - 1 - 7 - 38 5 Gordon 236 1- - - - - - - - - - - - - - - - - - - - - - - - - - - - Highlands 996 1 - - - - - - - 3 1 - - 4 - - - - - - - - - - - 8 1 9 1 Little Heath 89 - - - - - - - - - - - - - - - - - - - - - - - - 7 - Loxford 965 2 - 2 - 2 - 2 — 1 - 1 - 2 - — - - - - - - - - - 12 - 38 5 Mayesbrook 185 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Newbury Park 758 - - - - - - - - 1 - - - - - - - - - - - - - - - 1 - 15 6 R. Catholic, Ilford 481 - - - - - - - - - - - - - - - - - - - - - - - - - - 17 3 S.Vincent's R.C.Be. 372 - - - - - - - - - - - - - - - - - - - - - - - - - - - - South Park 1325 - - - - - - - - - - - - - - - - - - - - - - - - - - 30 2 Uphall 638 - - 1 - - - - - - - - - - - - - - - - - - - - - 1 - 19 1 Valentines 339 - - - - - - - - 1 - 4 - 3 - - - - - - - - - - - 8 - 10 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 15550 6 - 11 2 9 - 12 3 33 2 36 2 21 - 17 1 9 — 4 - 5 - 5 - 168 10 278 47 178 MUMPS. Table XIII.—Summary of Cases of Mumps among School Children, and of Contacts of such Cases, excluded from School Attendance, during the Year ended 31st December, 1930. SCHOOLS. No. on Roll Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals, 1930. Totals, 1929. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 278 - - - - - - - - - - - - - - - - - - - - - - - - - - 2 - Becontree 2024 1 - 1 - - - - - - - - - - - - - - - - - - - - - 2 - 38 - Open Air 97 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chadwell 302 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Christchurch 1165 - - - - 1 - 1 - 2 - 2 - 5 - 1 - - - - - 5 - 2 - 19 - 17 - Cleveland 1106 - - - - - - - - - - 1 - - - - - - - - - - - - - 1 - 63 - Dowshall 1561 - - — — — - — - 36 - 10 - 1 - - - - - - - - - - - 47 - 48 - Fairlop 190 - - 1 - 1 - 2 - 1 - 1 - - - - - 2 - - - - - - - 8 - - - Gearies 1088 - - 1 - - - - - 6 - 7 - 7 - 4 - 3 - 1 - - - - - 29 - - - Goodmayes 1355 - - 1 - - - - - 1 - 1 - - - - - - - - - - - - - 3 - 16 - Gordon 236 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Highlands 996 1 - - - - - - - 4 - 2 - 1 - - - 2 - - - - - - - 10 - 2 - Little Heath 89 - - - - - - - - 1 - - - 1 - - - - - - - - - - - 2 - - - Loxford 965 - - - - - - 1 - 6 - 7 - 7 - - - 2 - - - - - - - 23 - 6 - Mayes brook 185 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Newbury Park 758 - - - - 1 - - - 1 - 3 - 3 - - - 1 - - - - - - - 9 - 7 - R. Catholic, Ilford 481 - - - - - - - - - - 2 - - - - - - - - - - - - - 2 - 13 - S. Vincent's R.c.Be. 371 - - - - - - - - - - - - - - - - - - - - 2 - - - 2 - 1 - South Park 1325 - - - - 2 - - - - - - - - - 1 - - - - - - - - - 3 - 10 - Uphall 638 - - - - - - 1 - - - - - - - - - - - - - - - - - 1 - 29 - Valentines 339 - - - - - - - - - - - - - - - - 1 - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Mossford (G.V.H.) 753 - - 16 - 1 - - - - - - - - - - - - - - - - - - - 17 - - - Totals 16303 2 - 20 — 6 — 5 - 58 - 36 — 25 - 6 - 11 - 1 — 7 — 2 - 179 - 252 -