Borough of £1forb. Health Report FOR THE YEAR A. H. G. BURTON. M.D., B.S., D.P.M , D.P.H., Barriiter-at-Law. Medical Officer of Health, etc. Borough of filforb. 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 1931. fiford Borough Council. November, 1930—November, 1931. Alderman Herbert George Odell, J.P., Mayor. Alderman F. D. Smith, J.P., C.A. (E.C.C.), Deputy Mayor. Aldermen : Church, George. Pitt, Bertram Sidney John, J.P. Dane, Frederick Hopper, M.B.E., Sheat William James Oliver, J.P., C.A. (E.C.C.). Davey, George Robert. Gunary, George, J.P. Smith, Frank Douglas, J.P., C.A. Odell, Herbert George, J.P., (E.C.C.), Deputy Mayor. Mayor. Councillors : Billington, Henry. Harding, Alfred Daniel Bartlett. Bisson, Walter William Harding, Mrs. Beatrice Alice Louise Ann. Preston. Heath, William Henry Charles. Blow, Charles Barkworth. Jay, Charles Frederick. Braitiiwaite, Thomas. Meade, William Edward. Carrell, Mrs. Sage Ward. Powney, William George. Clark, Charles William. Rowntree, Ernest Morton Daniels, Russell Stearn. Elborne, John, M.A. Shipman, James Henry,C.C. Eves, Charles. Spencer, Walter Robert. Farman, Claude Augustus. Waters, Owen, O.B.E.. E.C.C. Green, Arthur William, E.C.C. (from September, 1931). Griggs, Albert Philip, E.C.C. Wetton, George John, E.C.C. Hamilton, Alfred Parke. Young, Alexander, Major, T.D. PUBLIC HEALTH COMMITTEE. November, 1930—November, 1931. Councillor C. W. Clark. Chairman. Alderman G. Church, Vice-chairman. *Alderman H. G. Odell, J.P., Councillor Mrs. B. A. L. A. Mayor. Harding. *Alderman F. D. Smith, J.p., C.A. Councillor W. H. C. Heath. (E.C.C.), Deputy Maor. Councillor C. F. Jay. Councillor C. B. Blow. Councillor W. E. Meade. Councillor Mrs. S. W. Carrell. Councillor W. G. Powsei . Councillor R. S. Daniels. Councillor W. R. Spencer. Councillor A. W. Green, E.C.C. Councillor O. Waters, O.B.E., Councillor A. P. Griggs, E.C.C. E.C.C. Councillor A. P. Hamilton. Councillor G. J. Wetton, E.C.C. Councillor A. D. B. Harding. *Ex-officio Members. MATERNITY AND CHILD WELFARE STATUTORY COMMITTEE. November, 1930—November, 1931. Councillor A. P. Griggs, E.C.C., Chairman. Councillor Mrs. S. W. Carrell, V ice-Chairman. *Alderman H. G. Odell, J.P., Councillor A. P. Hamilton. Mayor. Councillor A. I). B. Harding. *Alderman F. D. Smith, J.P., C.A. Councillor Mrs. B. A. L. A. (E.C.C.), Deputy Mayor. Harding. Alderman G. Church. Councillor E. M. Rowntree Councillor H. Btllington. (until September, 1931). Councillor C. B. Blow. Councillor W. R. Spencer. Councillor C. W. Clark. _ Councillor 0. Waters, O.B.E., Councillor R. S. Daniels. ,, ,, . E.C.C. (from September, 1931 . Councillor A. W. Green, E.C.C. Co-opted Members : Mrs. C. J. Earl. Mrs. B. E. Paddon. Mrs. A. E. Gillard. Mrs. B. Strachan. Mrs. L. Hardy. Mrs. E. M. Wise. Mrs. E.J. Hinton. *Ex-officio Members. EDUCATION COMMITTEE. November. 1930—November, 1931. Councillor C. B. Blow, Chairman. *Rev. A. Butterworth, M.A., I 'ice-Chairman. †Alderman H. G. Odell, J.P., Councillor A. W. Green, E.C.C. Mayor. _ Councillor A. P. Hamilton. †Alderman F. D.j Smith, J.P., C.A. (E.C.C.), Deputy Mayor. Councillor Mrs. B. A. L. A. Harding. Alderman F. H. Dane, M.B.E., J.P., C.A. (E.C.C.). Councillor VV . E. Meade. Alderman G. Gunary. Councillor E. M. Rowntree (until September, 1931). Alderman B. S. J. Pitt, J.P. Councillor W. R. Spencer. Alderman W. J. o. Sheat, O.B.E.' J. p. C.C. Councillor O. Waters, O.B.E., E.C.C. (from September, 1931, Councillor H. Billington. previously a Co-opted Member). Councillor W. W. P. Bisson. Councillor Major A. Young, T.D. Councillor T. Braithwaite. *Mr. A. Cato. Councillor Mrs. S. W. Carrell. *Mr. H.J. Gilby. Councillor C. W. Clark. *Miss J. B. Larkin. Councillor R. S. Daniels. *Mr. S. P. Lonergan. Councillor C. A. Farman. *Mr. J. J. Taylor, J.P. *Co-opted Members. †Ex-officio Members. OFFICERS OF THE PUBLIC HEALTH SERVICES, JANUARY, 1932. 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. D. Regan , B.A., B.Sc., M.B., Ch.B., B.A.O. (N.U.I.), D.P.H. (Liverpool). E. S. Stephen, M.B., Ch.B. (Glasgow), D.P.H. (Cantab.). Resident Medical Officer (Isolation Hospital). Agnes P. Routledse, M.B., Ch.B. (Glasgow). Dentist: M. J. K. Soutter, L.D.S., R.C.S. (Eng.). Assistant School Dentist: A. R. Tran, L.D.S., R.C.S. (Eng.). Matron of Isolation Hospital. Matron of Maternity Home. Miss I. Millar. Miss M. E. Roberts. Senior Sanitary Inspector: 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. W.E. Colston. Health Visitors and School Nurses: Miss A. Batten. Miss A. L. Drinkwater. Miss 0. Bell. Miss E. J. Marsh. Miss E. Blackwall. Miss K. B. Mathieson. Miss M. E. Cartwright. Miss E. Prior. Miss M. D. Seager. District Midwife : Miss C. Blockley. 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 Orthopaedic Surgeon: H. J. Seddon, F.R.C.S. (Eng.). Oculist: D. C. L. Vey, M.C., B.A., M.B., B.Ch. (Cantab.), D.O. (Oxon.). Veterinary Surgeon : Ralph Bennett, F.R.C.V.S. Assistant Medical Officer (Infant Welfare Centres): Marion Lones, M.B., B.S., B.Sc. (Lond.), D.P.H., R.C.P.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 14 Physical Features of District 15 Rainfall 17 Population 17 Births 17 Deaths 18 Inquests 19 Death-rates from Tuberculosis and Cancer 19 Poor Relief 20 Marriages 20 Vital Statistics—Tables of 24 Table I 21 Table la 22 Causes of Death—Registrar-General's Short List 23 Table III 24 SECTION II.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Public Health Officers of the Authority 25 District Nursing 25 Midwives 26 National Health Insurance 26 Laboratory Facilities 26 Table of number of specimens examined (Bacteriological Laboratory) 28 Legislation in Force 29 Hospital Provision 29 Maternity and Nursing Homes 33 Maternal Mortality 34 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children 34 Ambulance Facilities 34 Clinic and Treatment Centres 34 Tuberculosis Dispensary 35 SECTION III.—SANITARY CIRCUMSTANCES OF THE AREA. Water Supply 36 Rivers and Streams 36 Drainage and Sewerage 36 Closet Accommodation 37 Scavenging, Collection of House Refuse 37 Sanitary Inspection of District 39 (a) Notices served 39 (b) Complaints of Nuisances 39 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 40 Smoke Abatement 40 Premises and Occupations which can be controlled by Bye-laws or Regulations 40 8 SECTION 111—continued. PAGE Bye-laws relating to Houses, Lodgings, Tents, etc. 40 Schools 41 Rag Flock Acts, 1911 and 1928 41 Housing 41 Overcrowding 41 Unhealthy Areas 41 Housing Table 41 SECTION IV.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply 43 Licences—Graded Milk 44 Milk Sampling 45 Tubercular Milk 47 Meat Regulations 48 (а) Slaughterhouses 48 (б) Articles of Food Surrendered and Seized 48 Bakehouses 49 Sale of Food and Drugs Acts 49 Contagious Diseases (Animals) Acts 49 Rats and Mice Destruction Act 50 Petroleum (Consolidation) Act 50 SECTION V.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Disease Generally 50 Notifications in Institutions 51 Isolated in Hospital 52 Table II—Summary of Cases of Infectious Diseases Notified 53 Deaths from Infectious Diseases 54 (а) Smallpox 54 Smallpox Hospital Accommodation 30 (б) Scarlet Fever 55 (c) Diphtheria 55 Table of Nos. Schick Tested 56 (d) Enteric Fever 56 (e) Cerebro-spinal Fever 57 (/) Ophthalmia Neonatorum 57 (g) Acute Influenzal and Acute Primary Pneumonia 58 (h) Encephalitis Lethargica 58 (i) Plague 58 (j) Puerperal Fever 59 (&) Puerperal Pyrexia 59 Zymotic Diseases 60 Incidence and Deaths from Infectious Diseases in Age Groups 61 Tuberculosis 62 Tuberculosis, Treatment of 64 Tuberculosis Care Association 64 Venereal Diseases 65 Notification of Non-notifiable Acute Infectious Diseases 66 Disinfection 66 9 SECTION VI. -FACTORIES AND WORKSHOPS. PAGE Factories 66 Workshops 67 Table 1—Inspection of factories, Workshops, Workplaces 68 ,, II — Defects Found 69 ,, III—Homework 70 ,, IV—Other Matters 71 ISOLATION HOSPITAL. Patients Admitted 75 Scarlet Fever 77 Enteric Fever 78 Puerperal Fever 78 Puerperal Pyrexia 78 Diphtheria 78 Cerebro Spinal Fever 79 Pemphigus Neonatorum 80 Observation Cases 80 Tuberculosis 80 Training of Nurses 81 Schick and Dick Testing of Staff 81 Hospital Extensions 82 MATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907 and 1915 87 Registration Act, 1836 and 1926 88 Infant Mortality 89 Neonatal Mortalitv 94 Table IVIllegitimate Births and Deaths 96 Maternal Mortality 96 Infant Life Protection 99 Work of Health Visitors 100 Supervision of Midwives 101 Supply of Milk to Expectant and Nursing Mothers and for Infants 103 Infant Welfare Centres 104 Ante-Natal Clinics 105 Dental Clinic 106 Ophthalmic Clinic 107 Orthopaedic Clinic 107 Ophthalmia NeonatorumTreatment of Minor Ailments 108 Maternity Home 109 District Midwife 115 Maternity Home Extensions 116 SCHOOL MEDICAL SERVICE. General Survey 119 Staff 122 School Premises 122 Medical Inspection 124 10 SCHOOL MEDICAL SERVICE—continued. PAGE Findings of Medical Inspection 125 Infectious Disease 126 Diphtheria Prevention 127 "Following-up" 129 Medical Treatment:— Minor Ailments 129 Ophthalmic Department 131 Orthopaedic Department 132 Dental Department 134 Treatment of Uncleanliness 137 Other Ailments 138 Open Air Education 139 Physical Training 142 Provision of Meals 144 Supply of Free Cod Liver Oil, Emulsion, etc 144 Co-operation of:— Parents, Teachers, School Attendance Officers and Voluntary Bodies 144 Physically and Mentally Defective Children 145 Employment of School Children and Young Persons 150 Medical Examination of Teachers, etc 151 New School Clinic 151 Statistical Tables:— I.—Number of Children Inspected 151 IIa.—Return of Defects 152 IIb.—Number of Children found to Require Treatment 153 III.—Numerical Return of Exceptional Children 154 111A .—Number of Children notified to the Local Mental Deficiency Authority 158 IV.—Group I—Minor Ailments 159 Group II—Visual Defects 160 Group III—Nose and Throat Defects 160 Group IV—Dental Defects 161 Group V"—Uncleanliness and Verminous Conditions 161 V.—Summary of Number of Children Inspected 162 VI.—A.—Average Heights and Weights of Boys Inspected 164 B.—Average Heights and Weights of Girls Inspected 166 VII.—Summary of Infectious Diseases among School Children 168 VIII.—Summary of Scarlet Fever among School Children 168 IX.—Summary of Diphtheria among School Children 170 X.—Summary of Measles and German Measles among Schoolchildren 171 XI.—Summary of Chicken-pox among School Children 172 XII.—Summary of Whooping Cough among School Children 173 XIII.—Summary of Mumps among School Children 174 PREFACE. Public Health Offices, Ilford, May, 1932. To His Worship the Mayor, the Aldermen and Councillors of the Borough of ll-ford. Mr. Mayor, Ladies and Gentlemen, I herewith submit, the Annual Report required by the Ministry of Health and the Board of Education. The statistical figures in the Report for 1930 were based on the Registrar-General's estimate for 1929; that is, 116,200. The Census taken in April, 1931, showed the population on that date to be 131,016, and the Registrar-General has now issued an estimate for the mid-year 1930 of 125,000. The statistical figures for 1930 have therefore been adjusted in this report. I have pointed out on several occasions that the estimate of the population must be considerably below the actual figure, and this has been borne our by the result, of the Census. It will be observed that, there has been a rise in the death rate from 8.1 in 1930 to 9.3 in 1931. The death rate is still low, but in view of the continual ingress into the district of a young population, this is not necessarily an index of the health of a district such as Jlford. The infant mortality rate, which reached the low figure last year of 33, has risen this year- to 55.6, the highest infant mortality rate in Ilford since the year 1919, when it. reached the figure of 61. There has been a marked decline in the incidence of most infectious diseases. There has. been an increase in (he deaths, however, from pneumonia, which has not until recently been generally recognised as an infectious disease. The satisfactory results which have followed the new serum treatment of this disease at the Isolation Hospital emphasises how important it is that acute pneumonia should receive the same isolation hospital accommodation for its treatment as do other infectious diseases which have less killing power. In this connection it will be noted that cerebro-spinal fever has again made its appearance. The only three cases in the district which recovered (out of ten cases) were treated at the Ilford Isolation Hospital. 12 Unfortunately, Ilford is deficient in hospital accommodation of all kinds, both general hospital, isolation hospital, maternity hospital and for the special treatment which school children require. It is again unsatisfactory for me to have to point out that the deaths of school children in Ilfordl form a higher percentage of the total deaths registered than do the deaths of children of school age in England and Wales generally. There is no outpatient department in Ilford at which school children can attend for treatment. The consequence is, as I have pointed out for several years, that the children have to travel to hospitals in London to receive the expert attention which they require. Although the school population in Ilford has increased from 10,781 in 1919 to 17,576 at the present time there is still only one school clinic to serve the whole of this large area. It is therefore very regrettable that the Council has found it necessary to postpone the erection of the clinic at Goodmayes, which would have served the large child population in Becontree and would also have provided ante-natal facilities for the women in that area and adequate infant welfare centre accommodation. The high death-rate of children from rheumatic fever (probably associated with the recent high incidence of scarlet fever) points to the need of the establishment in Ilford of a rheumatic clinic with hospital beds for treatment such as has been done in other districts. It will again be observed that mothers confined and children born in the Ilford Maternity Home have a considerable advantage as regards prospect of life over those in the district generally. It is unfortunate that the ward for difficult cases at the Maternity Home, the extension of the Maternity Home generally, and the provision of adequate ante-natal premises, have also been deferred. When th.ese are erected I am convinced that a great boon will be conferred on the mothers of Ilford. The deficiency in the Isolation Hospital accommodation is still under the consideration of the Council, and I hope that this work will be proceeded with in the near future before the district is faced with another outbreak of infectious disease. 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. 15 SECTION I. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Land 8,4701 Area (in Acres) .. - Inland Water 26- 8,50-3 Tidal Water 7 Population (Census, 1931) 131.046 ,, (Census, 1921)85,194 Registrar-General's Estimate of resident Population, June 30th, 1931132,150 ,, 30th, 1930 125,000 Number of inhabited houses (end of 1931) according to Rate Books 33,580 Rateable Value—October 1st, 1931 £977,033 Sum represented by a penny rate, October 1st, 1931 £3.945 Education Rate— 1930. 1931. Elementary 2s. 2.92d. 2s. 1.84d. in the £. in the £. Higher Os. 6.50d. 0s. 6.50d. in the £. in the £. Combined Rate (all services) 13s. 2d. l1s. 10d. in the £. 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. 16 Total. M. F. 1931. 1930. Legitimate 1,938 1,017 921 Rirth Live Births 56 21 20 Rate 15.4 15.2 Rate per 1,000 Still Births56 32 24 total births 27.5 33.0 Deaths 1,194 592 602 Death rate 9.3 8.1 Percentage of total deaths occurring in public institutions 47.9 38.9 Deaths from diseases and accidents of pregnancy an 1 childbirth:— From sepsis 6 2 From other causes 1 5 Death-rate of Infants under one year of age per 1,000 live births:— Legitimate, 55.7 Illegitimate, 48.8. Total 55.6 33.0 Deaths from Measles (all ages) — 9 ,, Whooping Cough (all ages) 4 2 ,, Diarrhoea (under 2 years of age) 6 9 Diphtheria has been less prevalent in the Town than in any year since 1927. After three years of heavy incidence, Scarlet Fever was less prevalent. 1. Physical Features and General Character of the District.—Vide Annual Report, 1925. 17 2. Rainfall.—The total rainfall registered in the district during the year was 20.66 inches. The greatest fall in 24 hours was registered on 3rd May, being 82 inches. The number of days on which rain fell was 151. 3. Population. Census, 1911 78,188 Census, 1921 85,194 (including institutions) Census, 1931 131,046 „ Registrar-General's Estimate on 30th June, 1931 132,150 ,, ,, The number of patients and resident staff on the 30th June, 1931, at the following public institutions, was:— Claybury Mental Hospital 2,647 West Ham Mental Hospital 1,237 Total 3,884 The net population for 1931 of 128,266 is obtained by deducting the population in institutions (3,884) from the Registrar-General's Estimate, 132,150, and this is the figure used as the basis for compiling the various rates in this year's Report. When the birth and death rates were calculated in my Annual Report for the year 1930, the Registrar-General's estimate of population of the Borough at the 30th June, 1930, was not available, and therefore the 1929 figure was then used. Since the publication of the 1930 report I have received information from the Registrar-General that the gross population of the Ilford district on the 30th June, 1930, was estimated at 125,000. This gives a net population of 121,256 at the same date. For comparison purposes, therefore, the birth and death rates for 1930 have been re-calculated on this new basis. 4. Births.—The number of births registered during the year was 1,979. Legitimate 1,017 Males 921 Females Illegitimate 21 ,, 20 ,, i.e., 2.0 per cent. of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was:—1.9 in 1930; 2.27in 1929; 2.01 in 1928; 2.65in 1927; 2.25 in 1926; 3.37in 1925; 216in 1924; 2.5in 1923; 2.5 in1922; 2.5in 1921. The birth-rate, calculated on the net estimate of the population of 128,266, is 15.4 per 1,000, as compared with 15.2 in 1930; 15.6 18 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. 5. Deaths.—The total number of deaths of Ilford residents was 1,194. This is obtained by taking the total deaths registered in the district (1,048), subtracting the deaths of non-residents occurring in the district (270), and adding the deaths of Ilford residents registered as having died in other districts (416). The total number of deaths registered in the district during the year was 1,048 Number of deaths of non-residents registered in the district (principally in large institutions) 270 The latter 270 deaths occurred as follows:— In Claybury (L.C.C.) Mental Hospital 154 In West Ham Borough Mental Hospital 62 In King George Hospital 32 Other Non-Residents 22 270 Included in the deaths of residents belonging to the district are 3 which occurred in Dr. Barnardo's Village Homes. The total number of deaths of Ilford residents registered as having died in other districts during the year was 416. This figure includes deaths at the following institutions:— The Infirmary, Romford 215 Essex County Mental Hospital 16 The London Hospital 23 Queen Mary's Hospital, West Ham 14 Hospital for Sick Children, Great Ormond Street 8 St. Bartholomew's Hospital 13 Charing Cross Hospital 9 Royal Eastern Counties' Institution 2 Middlesex Hospital 2 St. Thomas's Hospital 1 Westminster Hospital 2 National Hospital, Queen Squar 2 University College Hospital 2 Severalls Mental Hospital, Colchester 5 London Fever Hospital 4 Whipps Cross Hospital 5 In other Hospitals, Institutions and Residences outside the Ilford District 94 Total 416 19 The death-rate, calculated on the net estimate of the population of 128,266, is 9.per 1,000, as compared with 8.1 in 1930; 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 1922; 9.5 in 1923; 9.5in 1922: 9.2 in 1921. Inquests.—During the year, 51 inquests were held in the district, 37 on Ilford residents, and 14 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. 5 — — 9 ' 6 7 14 10 Causes of inquest-deaths under 1 year. Cause of death unaseertainable owing to decomposition 1 Want of proper attention at birth 1 Accidental suffocation by meconium whilst being born 1 Accidental asphyxia by a caul being over child's mouth and nose when born. 1 Accidental death from Toxaemia and Pneumonia following scalds 1 Causes of inquest-deaths over 1 year:— Accidents 31 Suicides 10 Found drowned 1 Rupture of Aortic Aneurism 1 Cerebral Haemorrhage 1 Myocardial Degeneration; Over-exertion, Swimming; Overloaded Stomach 1 Myocardial Degeneration. Shock of surgical operation properly performed 1 Death-Rates from Tuberculosis and Cancee, 1931. The following Table shows the death-rates for 1931 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:— IIford. England and Wales. Respiratory Tuberculosis .67 .87 Other Tuberculosis .06 .16 Cancer 1.29 1.45 20 6. Poor Relief.—The total amount expended in IIford during the year was £10,046 17s. 8½d. The average weekly number of cases in receipt of relief was 385. The number of admissions to the Guardians' Institutions from Ilford during the year was 613, made up as follows:— Men 205 Women 354 Children 54 7. Marriages.—846 marriages have taken place during 1930. The following details explain the allocation:— Marriages taking place in the Ilford District 616 Marriages of Ilford Residents at Register Office, Romford— Both Parties belonging to Ilford 153 The Male only belonging to Ilford 35 The Female only belonging to Ilford 42 8. Tables of Vital Statistics.—Table I gives a comparative statement of the population, birth-rate and death-rate for the past six years. Table 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 1931, arranged according to the age groups at which deaths occurred. 21 TABLE I. Vital Statistics of Whole District During 1931 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 (ft). 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 1926 100,500 96.885 1,477 1,509 15.6 847 8.4 244 235 68 451 838 8.7 1927 108.310 104,766 1,526 1 ,657 15.8 937 8.6 255 326 74 440 1,008 9.6 1928 1 1.3,500 109,871 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 125,000 121,256 1,710 1,845 15.2 882 7.0 224 322 61 33.0 980 8.1 1931 132,150 128,266 1,821 1,979 15 4 1,048 7 9 270 416 110 55 .6 1,194 9.3 (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. 22 TABLE IA. Table showing comparison between the Birth-rate, Death-rate, etc., of IIford. other Towns, and of England and Wales for the Year 1931. (Provisional figures.) (The mortality rates for England and Wales refer to the whole population, but for London and the towns to civilians only). Rate per 1,000 Total 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. Diairhua and Enteritis (under2Yrs). Total Deaths under 1 Year. Certified by Registered Medical Practitioners. Tnquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. Stillbirths. England and Wales 15.8 0.067 12.3 0.01 0.00 0.08 0.01 0.06 0.07 0.36 0.54 6.0 66 91.18 6.17 1.70 0.95 107 County Boroughs and Great Towns, including London 16.0 0.067 12.3 0.00 0.00 0.10 0.01 0.07 0.08 0.33 0.48 8.4 71 91.43 5.84 2.24 0.49 159 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 15.6 0.73 11.3 0.00 0.00 0.07 0.01 0.05 0.05 0.36 0.43 4.0 62 92 17 5.49 1.25 1.09 London 15.0 0.50 12.4 0.01 0.00 0.03 0.02 0.07 0.06 0.57 9.7 65 89.52 6.23 4.24 0.01 ILFORD (Estimated Gross Population, 132,150 mid. 1931) 14.9 0.42 9.0 0.00 0.00 0.00 0.007 0.03 0.03 0.34 0.27 3.0 55.6 90.8 5.5 3.4 0.1 23 The following is the Registrar-General's Short List of Deaths and Causes Table III, on page 24, differs very slightly from the RegistrarGeneral's Short List, and has been prepared on the lines of previous Annual Reports:— Causes of Death. M. F. All Causes. 592 602 1. Typhoid and paratyphoid fevers — - 2. Measles — - 3. Scarlet fever 1 - 4. Whooping cough 2 2 5. Diphtheria 2 2 6. Influenza 14 31 7. Encephalitis lethargica — — 8. Cerebro-spinal fever 6 1 9. Tuberculosis of respiratory system 48 39 10. Other tuberculous diseases 4 4 11. Syphilis 3 1 12. General paralysis of the insane, tabes dorsal is .. 3 - 13. Cancer, malignant disease 71 95 14. Diabetes 5 11 15. Cerebral haemorrhage 26 42 16. Heart disease 108 145 17. Aneurysm 3 3 18. Other circulatory diseases 21 21 19. Bronchitis 30 27 20. Pneumonia (all forms) 41 39 21. Other respiratory diseases 9 9 22. Peptic ulcer 7 1 23. Diarrhoea, etc. (under 2 years) 4 2 24. Appendicitis 4 5 25. Cirrhosis of liver 1 2 26. Other diseases of liver, etc. 1 8 27. Other digestive diseases 18 13 28. Acute and chronic nephritis 16 1 29. Puerperal sepsis — 6 30. Other puerperal causes — 1 31. Congenital debility, premature birth, malformations, etc. 46 23 32. Senility 8 13 33. Suicide 9 3 34. Other violence 35 1 35. Other defined diseases 44 51 36. Causes ill-defined or unknown 2 — Special Causes (included in No. 35 above):— Smallpox - - Poliomyelitis — — Polioencephalitis - - 24 TABLE III. Causes of, and Ages at, Death during the Year 19??? 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 Typhoid and paratyphoid fevers - - - - - - - - - 1 2 Measles - - - - - - - - - - 3 Scarlet fever 1 — 1 - - - - - - 1 4 Whooping cough 4 1 2 1 - - - - - 1 5 Diphtheria 4 — — 1 1 — 1 1 — 4 6 Influenza 44 2 1 — 1 1 7 10 22 2 7 Encephalitis lethargica — — — — — — — — — 1 8 Cerebro-spinal fever 7 2 2 1 1 1 — — — 6 9 Tuberculosis of respiratory system 87 1 1 - 1 22 43 16 3 17 10 Other tuberculous diseases 8 — 1 1 1 — 2 1 2 1 11 Syphilis 4 2 - - - - - 1 1 — 12 General paralysis of the insane, tabes dorsalis 3 - - - - - 3 - - 29 13 Cancer, malignant disease 165 - - - - - 18 74 73 25 14 Diabetes 16 - - - - - 1 5 10 2 15 Cerebral haemorrhage, etc. 68 — — — — 1 2 19 46 10 16 Heart disease 265 1 — — 5 5 18 51 185 58 17 Aneurysm 6 - - - - - - 3 3 3 18 Other circulatory diseases 44 - - - - - - 11 33 23 19 Bronchitis 55 2 1 — — — 1 13 38 1 20 Pneumonia (all forms) 80 13 6 4 2 — 5 17 33 35 21 Other respiratory diseases 17 — — — — — — 7 10 2 22 Peptic ulcer 11 — — — 1 — 3 7 — 4 23 Diarrhoea, etc. (under 2 years) 6 6 - - - - - - - 2 24 Appendicitis 8 — — 1 1 — 3 3 — 4 25 Cirrhosis of liver 4 - - - - - - 2 2 2 26 Other diseases of liver, etc. 6 - — — - - 1 4 1 3 27 Other digestive diseases 22 3 — — — — 1 7 11 11 28 Acute and chronic nephritis 22 - - - - - - 10 12 22 29 Puerperal sepsis 6 — — — — — 6 — — 4 30 Other puerperal causes 1 — — — — — 1 — - 1 31 Congenital debility, premature birth, malformations, etc. 68 67 1 - - - - - - 10 32 Senility 25 - - - - - - 1 24 2 33 Suicide 12 — — — - 2 5 5 - 1 34 Other violence 36 2 — — 7 2 9 7 9 22 35 Other defined diseases 87 7 1 1 6 8 10 28 26 46 36 Causes ill-defined or unknown 2 1 — — — — — — 1 — Special Causes (included in No. 35 above):— Smallpox - - - - - - - - - - Poliomyelitis - - - - - - - - - - Polioencephalitis - - - - - - - - - - Totals 1194 110 17 10 27 42 140 303 545 356 25 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. 10,292 visits were paid by the nurses in 1931, compared with 11,019 in 1930. The following is a summary of the work carried out during the year 1931 :— Number of New Cases 447 Number of Visits—Medical 6,658 Surgical 2,445 Operations 18 Massage 1,171 Number of applications made for Nurses' services 447 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 22 Number of eases on the books at the end of the year 51 The cases were distributed in wards as under:— Cranbrook 59 Park 61 Seven Kings 91 North Hainault 91 Loxford 69 Clementswood 41 South Hainault 24 Goodmayes 11 The Medical Officer of Health is a member of the District Nursing Committee. 26 The Council on the 25th February, 1930, passed a Minute of the Public Health Committee, recommending that accommodation at the Isolation Hospital should be provided for cases of Measles, when necessary for nursing reasons, and that preference should be given to such cases over mild Scarlet Fever cases that might in many cases be nursed at home. All cases of Measles are visited by the Health Visitors, and special enquiries are made as to the necessity for admission to Hospital. 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 101, Maternity and Child Welfare Section. A subsidy of £20, payable in four quarterly instalments of £5 was granted by the Council to a local midwife. Only one payment of £5 was made as the midwife left the district. There is one District Midwife on the establishment of the Local Authority. There are 13 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. 27 Specimens for diagnosis of Venereal Disease are examined at the London Hospital; for Tuberculosis at the Counties' Public Health Laboratories. Blood cultures and swabs for the presence of hæmolytic streptococci are sent to Charing Cross Hospital Institute of Pathology. Chemical and bacteriological examination of milk samples is carried out at the Clinical Research Association. Examinations of such urgent specimens as Diphtheria swabs are carried out at the Ilford Public Health Offices. The accompanying table shows that 1,039 specimens have been examined at the Ilford Laboratory during the past year. 28 Bacteriological Laboratory, 1931. 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 125 546 2 11 14 31 21 73 162 661 Nose, Ear, Eye, etc. „ 6 12 1 3 2 6 8 22 17 43 Throat Contacts ,, 15 105 1 4 — — — — 16 109 Nose ,, „ 1 2 - - - - - - 1 2 Hairs Ringworm 1 3 — — 4 8 — — 5 11 Urine Various Abnormalities — — — 3 — 3 3 3 3 9 Totals 204 835 Grand Total 1039 Direct Smears examined in 5 cases (all negative). 18 Diphtheritic Specimens were sent to laboratories in London for a test for virulence—7 were virulent, 11 avirulent. 29 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 houses and houses let in lodgings. (4) Slaughterhouses and humane slaughtering of animals. (5) Offensive trades:— (а) Bone boilers. (b) Fellmongers. (c) Leather dressers. (d) Soap boilers. (e) Tanners. (/) Tallow me Iters. (g) Fat melters or fat extractors. (h) Glue makers. (i) Tripe boilers. (j) Size makers. (k) Gut scrapers. (l) Fish frier. (m) Fish curer other than fishmonger. (n) 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. The proposals of the Essex County 30 Council for the admission of intermediate and somewhat advanced cases of pulmonary tuberculosis instead of surgical cases are now under consideration. (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) Flever.—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.—The agreement entered into between Ilford and West Ham Corporation by which cases occurring in Ilford were admitted to Orsett or Dagenham Hospitals, expires on the 13th March, 1932. The West Ham Corporation decided not to continue arrangements, and the Orsett Hospital no longer being available, the E.C.C. approached the L.C.C. as to any provision they could offer, and called a conference of Local Authorities of 31 the south-west portion of the County, which was held in London during March, 1931, representatives of Ilford attending, when it was decided the E.C.C. should enter into negotiations with the L.C.C. to accept patients of local Authorities from the E.C.C. area into the L.C.C. Hospital at Joyce Green. At a further conference held on March 20th, the terms of the L.C.C. were submitted for the admission of cases from the Boroughs of East Ham, West Ham, Southend-on-Sea, and 23 other Local Authorities in the E.C.C. area, including Ilford. Later, in December, 1931, the L.C.C. withdrew their offer and the position left was that the Orsett Joint Hospital Board will enter into agreements with Local Authorities in South-West Essex for accommodation of patients up to a maximum of 22 beds for a period not exceeding three years as a temporary measure, the charge to be 12 guineas per week, per patient, whilst there is only one patient in the Hospital, ancl 6 guineas per week per patient when more than one, with a retaining fee at the rate of 10s. per 1,000 of the population, with a minimum of £300 per annum for the whole area. The L.C.C. have now responded to further negotiations by the E.C.C., that if, without prejudice to the adequate discharge of their responsibilities, they could assist they would be prepared to admit individual cases into their Institutions, subject to the Local Authority sending the case agreeing to bear the cost involved, and to provide the necessary transport, also that these arrangements should be regarded as supplementary to any agreement with the Orsett Joint Hospital Board, and that Local Authorities would not be able to avail themselves of these facilities without first entering into the suggested arrangements and agreement with the Orsett Joint Hospital Board. As to future permanent arrangements, the E.C.C. are at the present time considering the question of their becoming the Smallpox Hospital Authority for South-west Essex, under section 63 of the Local Government Act, 1929, for the provision of Hospital accommodation for this part of their area, and the Ilford Borough Council having intimated their agreement in principle, reserve the right to further consider matters of detail at a later date. The six-monthly contribution by Ilford to the Corporation of West Ham ended March, 1931, was £85 19s. 4d., and for the six months ended the 30th September, 1931, was £132' 7s. 6d. No primary vaccinations or re-vaccinations were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917, during the year. 32 (/) Other.—The new buildings of the King George Hospital were opened by His Majesty the King on the 18th July, 1931. The table on this page gives the number of beds available at this Hospital on the 31st December, 1931. The new buildings include a Consultative Out-Patient Department and Administrative Block, Operating Theatre Suite, and a Home for Nurses. There is a Staff of Visiting Physicians and Surgeons on the Staff of this Hospital, and there are special X-Ray, Ophthalmic and Massage Departments and an Out-Patient Department. A Pathologist is also on the Hospital Staff. An Out-Patients' Clinic in connection with King George Hospital was opened at Dagenham by the President of the Hospital, the Lord-Lieutenant of the County, on the 3rd January, 1931. The following is a statistical return in respect of King George Hospital for the year 1931:— NUMBER OF BEDS. Adult. Children. Male. Female. Total number of Beds at 31st December, 1931* 47 61 22 (Allocation as to male or female according to demand). Allocation as to Surgical and Medical Cases according to demand. * 74 beds only until July. NUMBER OF CASES TREATED. Ilford Cases only. Cases from other Districts. Male. Female. Male. Female. Number of adult in-patients admitted 306 373 210 255 †Number of children admitted 350 249 †‡Number of operations performed 1,311 †Number of casualties attended 4,840 4,251 †Number of X-Ray examinations made 1,180 1,036 † The allocation as between male and female is not ascertained, ‡ The allocation as between Ilford and other Districts is not ascertained The average cost per patient per week in the Hospital for the year 1931, £3 5s. 2d. Male. Female. Children. Number resident on 30th June:— Patients 23 32 31 Staff 3 72 — 33 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 Tlford residents. There are two large Mental Hospitals in the district, the West Ham Mental Hospital, with 1,136 patients (males 539, females 597), and Claybury Mental Hospital, with 2,405 patients (males 1.003, females 1,402) in residence on 30th June, 1931. 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. On the 1st January, 1931, 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. The following is the action taken under the Nursing Homes Registration Act, 1927, during the year:— Maternity Homes. Other Nursing Homes. (1) Number of applications for registration 2 — (2) Number of homes registered 1 — (3) Number of orders made— (a) Refusing Registration 1 — (b) Cancelling Registration 1 — (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 - - 34  Maternity Homes. Other Nursing Homes. (7) Number of cases in which exemption has been:— (a) granted — — (b) withdrawn — — (c) refused — — One maternity home was voluntarily closed during the year. On December 31st, 1931, there were four private registered nursing homes in the district—two for maternity patients only, one for maternity and medical or minor surgical cases, and the other for medical and surgical cases. 9. Maternal Mortality.—This matter is dealt with on page No. 96, 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 1,460 children and 203 staff in residence on the 30th June, 1931. Admission to this Institution is controlled by Headquarters at Stepney, E. 11. Institutional provision, if any, for the oare of mental defectives (vide Annual Report, 1930, page 35, par. 11.) 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:— 35 United Methodist Church (entrance in Monday, 2.0 p m. Balmoral Gardens, opposite Vernon Road) Seven Kings. Holy Trinity Church Hall, Mossford Monday, 2.0 p.m. Green. All Saints' Church Hall, Goodmayes Tuesday, 9.30 a.m. Lane, Goodmayes. Congregational Church, Birkbeck Road, Tuesday, 2.0 p.m. Newbury Park. Public Health Offices, Valentines Man- Tuesday, 2.0 p.m. sion. Congregational Church Hall, Grosvenor Wednesday, 2.0 p.m. Road , Ilford. Congregational Church Hall, Woodford Wednesday, 2.0 p.m. Avenue (entrance in Ethelbert Gardens) 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, Thursday and Saturday mornings. School Clinic.—Clinics are held at the Public Health Offices for— (1) the treatment of minor ailments; (2) dental treatment of school children, expectant mothers and children under 5 years of age; and of tuberculosis patients. (3) ophthalmic treatment of same classes as in (2) excepting tuberculosis patients. (4) orthopædic treatment of school children and children under five years of age. The provision of an additional School Clinic for the Goodmayes and Becontree area has been deferred. 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—Tuesday, 3 to 5 p.m.; Wednesday (workers only)r 7 to 8 p.m., and Friday, 3 to 5 p.m. For children—Wednesday, 10 to 12 noon. 36 SECTION III.—SANITARY CIRCUMSTANCES OF THE AREA. 1. Water Supply.—Vide Annual Report, 1925. Two samples of the piped water supply (one from each Companysupplying the district) were sent for examination, and each sample gave a satisfactory bacteriological and chemical analysis. A short description of the South Essex Waterworks Company's scheme was included in my Annual Report for 1930. In continuation of that report, I have now received a communication from Mr. B. W. Bryan, the Engineer to the South Essex Waterworks Company, to the effect that the Stour water will come into supply on the 8th April, 1932. 2. Rivers and Streams.—Vide Annual Report, 1925. (а) Seven Kings Stream. Difficulty is still created by this stream becoming polluted by the discharge from the effluent of the Corporation's Sewage Works at Hainault. During the year it was found necessary to submit six samples for chemical and bacteriological analysis, only two of which gave a satisfactory result. The beet washing effluent has been diverted from the Hainault Sewage Works and is now irrigated over the crops on the land. The matter is still under the observation of this Department and the Borough Surveyor, and further action is being taken, in order to ascertain whether an improvement can be made. (b) Outfall Sewer from Ilford Sewage Works to River Roding. As reported last year, a certain amount of difficulty is still created by the entry of acid into the effluent pipe from the Corporation's Sewage Works before its discharge into the River Roding. The pipe has been inspected in Ilford Lane and no acid has been found in the pipe at that point. Careful investigation has been carried out at Chemical Works adjacent. The matter is under the observation of the Corporation and the Port of London Authority. 3. Drainage and Sewerage.—The Borough Surveyor states that no large alterations or extensions have been carried out at either the Ilford or Hainault Sewage Works in view of the Ilford and Barking Joint Sewage Scheme, as it is anticipated if the present rate of progress of the latter scheme is maintained, that these works although at times severely taxed, will tide the Council over the transitional period. Considerable progress has been made with the joint scheme during the past year, and the whole of the Ilford section completed, and the flume chamber constructed, although the apparatus has not yet been installed. The joint sewer is almost complete as far as the Pumping Station, and the contracts for the 37 rising main and tunnel crossing at Barking Creek have been let, and the works are in progress. The Pumping Station contract is in hand, together with the construction of the storm tanks, and the London County Council have agreed to our proposals regarding the connection to the London Outfall sewer. The further extension of the Seven Kings Valley sewer as far as New North Road, which was anticipated last year, was deferred for a period of six months, owing to the economic crisis, but in view of the rapid development of the North-Eastern district the scheme cannot be further delayed for any length of time, unless the Council are prepared to add considerably to the number of cesspools already existing in the Borough. The mid- and low-level sewers have been extended along the north-western boundary of the district to provide for estate development in this area. The Eastern Avenue sewer, constructed last year, between Aldborough Road to the Seven Kings Valley sewer has been extended as far as Oaks Lane, principally at the expense of the Crown Commissioners. Apart from the further extension of the Seven Kings Valley sewer, it is difficult to anticipate any projected works as these will only materialise as development takes place. 4. Closet Accommodation.—In addition to the water carriage system of sewage, there are in the rural area 37 oesispools, 40 pail closets, and 18 privies. The clearing of cesspools, privies and pail closets is carried out by the Council, the former by means of two vacuum emptiers. All pail closets are emptied twice weekly. Two houses with pail closets and two with cesspools in Aldborough Hatch were connected to the sewer in 1931. 5. Scavenging, etc.—The collection of house refuse is undertaken by means of horse-drawn and mechanically-propelled vehicles. Some of the refuse is taken to the destructor, Suffolk Road, Seven Kings. Refuse is also barged by contract, and in 1931, 16,078 tons were so dealt with. 351 defective and unsuitable receptacles have been replaced during the year. The following figures give information as to the collection of house refuse during 1931:— 38  Horse. Electric. Vulcan. Freighters. Total. No. 9. No. 10. No. 11. Nos. 12 to 16. Number of collection days 102 307 277 25 283 307 1,301 Aggregate number of days vehicles employed 323 1,868 277 25 283 1,173 3,949 Total number of loads dollected 1,096 5,382 938 74 988 3,711 12,189 Average number of vehicles employed per day 3.1 6.1 1.0 1.0 1.0 3.8 16 Average number of loads collected per day 10.7 17.5 3.4 3.0 3.5 12.1 50.2 Average number of loads collected per vehicle per day 3.4 2.9 3.4 3.0 3.5 3.2 3.1 Tons Cwts. Qtrs. Tons. Cwts Qtrs. Tons. Cwts. Qtrs. Tons. Cwts. Qtrs. Tons. Cwts. Qtrs Tons. Cwts. Qtrs. Tons. Cwts. Qtrs. Total weight of refuse collected 1,166 14 0 14,083 1 0 1,742 8 1 201 14 0 1,784 14 0 9,996 6 1 28,974 17 2 Average weight per load 1 1 1.1 2 12 1.3 1 17 0.6 2 14 2.1 1 16 0.5 2 13 3.5 2 7 2.2 s. d. s. d. s. d. s. d. s. d. s. d. s. d. Estimated average cost of collection per ton 9 10.9 8 4.7 9 7.7 8 8.9 8 6.2 7 8.4 8 3.6 Collection has been improved by the extended use of low-loading vehicles, two S.D. Freighters having been purchased during 193( The Council now have six vehicles of this type engaged upon Refuse Collection. 39 As the capacity of the Refuse Destructor is insufficient to deal with the quantity of refuse collected, it has been necessary to continue removal by barge. 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 8,242 Houses and premises re-inspected (works in progress) 10,408 Visits during disinfection 888 Houses in which nuisances were detected 639 Houses in which nuisances were abated 557 Premises disinfected 625 Premises from which articles only disinfected 52 Articles disinfected 2,786 Premises disinfected for verminous conditions 5 Notices served:— Statutory:— Served. Complied with. Public Health Act, 1875 22 19 Housing Act, 1930 368 356 Cleanse Dwelling House (Infectious Disease (Prevention) Act, 1890) 1 1 Provide Dustbin (Ilford Improvement Act) 357 351 Pave Yard (Ilford Improvement Act) 1 2 Provide Water Supply to Dwelling House 9 8 Cleanse Water Storage Cistern (Byelaws) 9 10 Cover Water Storage Cistern (Byelaws) 2 3 Informal 326 322 Total 1,095 1,072 In addition to the above, 281 notices (213 statutory and 68 informal) served during 1930 were also complied with. Complaints.—During the year, 301 complaints of nuisances have been received and investigated. The following is a summary:— Accumulation of manure and refuse 35 Animals improperly kept 5 Bad smells 36 Dampness of premises 9 Defective drains, w.c.'s and fittings 34 40 Defective or no provision of dustbin 3 Defective roofs, gutters, downpipes, etc. 28 Defective water fittings 12 Dirty and verminous houses 26 Dirty condition of rearway 7 Flooding of premises 3 Overcrowding 13 Smoke nuisances 12 Miscellaneous 78 Total 301 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 2, and the number of certificates issued was 2. 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, 5 letters of warning having been issued. 8. Premises and Occupations which can be Controlled by Byelaws or Regulations.—Fish-frying licences have been granted in respect of four premises during 1931. Byelaws relating to houses, to houses let in lodgings, and to tents, vans, sheds, etc.—-It has not been considered necessary to seek any revision of existing byelaws. A full list of the byelaws in operation is given on page 29 of this report. On 11 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. 41 No action has been found necessary in respect of underground sleeping rooms (Housing Act, 1925, Sect. 18 (1). 9. 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 123 School Medical Service Section. 10. Rag Flock Acts, 1911 and 1928.—There are no premises on which rag flock is manufactured, used or sold. 11. Housing.—During the year 1931 the number of houses built by private enterprise was 2,058. At the end of the year 1,184 houses were in course of erection. The extension of the Council's housing scheme, providing 146 houses on the site adjacent to the existing Tomswood Hill Estate, was completed on the 1st June. 12. Overcrowding.—Notices were served in respect of 7 premises, of which 7 were complied with during the year. In two of these cases it was found necessary to institute legal proceedings to enforce compliance with the notices served. 13. 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:— 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,398 12 (b) Number of inspections made for the purpose 3,349 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 396 (b) Number of inspections made for the purpose 1,523 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 526 2. Remedy of defects during the year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 503 3. Action under Statutory Powers during the year:— a. Proceedings under sections 17, 18, and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 309 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 369* (b) By local authority in default of owners — b. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 3 (b) By Local Authority in default of owners — c. Proceedings under sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 6† (2) Number of dwelling-houses demolished in pursuance of Demolition Orders - 43 d. Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made - (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit - e. Proceedings under section 3 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 88** (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 - f. Proceedings under sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which Closing Orders were made - (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit - (3) Number of dwelling-houses in respect of which Demolition Orders were made - (4) Number of dwelling-houses demolished in pursuance of Demolition Orders — * Includes compliances during 1931, of Notices served in 1930. **Compliances during 1931 of Notices served prior to 1931. †Now under consideration. SECTION IV.—INSPECTION AND SUPERVISION OF FOOD. 1. Milk Supply.—There are 89 dairies and milkshops and 4 cowsheds on the register. In addition, 10 premises are registered to sell cream only. 243 inspections of dairies, milkshops and cowsheds were carried out during the year. 44 68 inspections (included in above) were made of the 4 cowsheds on 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 89 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, 6 from general shops and 5 from restaurants, 4 are retailers in a small way with rounds and also provision for storage of milk, while 45 sell sterilised bottled milk only. In 4 premises, pasteurising plant has been installed. Only 2 of these have, however, been licensed. There are 4 wholesale dealers in milk, all having cows on the premises. All these dealers are also retailers. In addition, one firm, having premises outside the district, is registered as a wholesale purveyor of milk in sealed containers. 2. Licences were granted under the Milk (Special Designa. tions) Order, 1923, during 1931, for the sale of:— "Certified" Milk 5 "Grade A" Milk 13 "Grade A (Tuberculin Tested)" Milk 21 "Pasteurised" Milk 18 "Grade A Pasteurised" Milk 2 The above include supplementary licences which were issued for "Certified" milk, 2; "Grade A" milk, 5; "Grade A (Tuberculin Tested)" milk, 8; and "Pasteurised" milk, 7. These are licences granted to firms who already have a licence from another Authority, the milk being bottled outside the town, but sold in Ilford. 45 3. Milk Sampling.—16 samples of "Grade A (Tuberculin Tested)," 4 samples of "Grade A," 1 sample of "Grade A Pasteurised," 21 samples of "Pasteurised" milk, and 51 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. 4 660 15 12,780 5 480 17 5,590 6 495 53 8,900 10 2,920 A .1 1,920 11 7,663 — — 12 11,850 — — 13 4,593 — — 23 8,780 — — 27 3,730 — — 34 118,850 — — 36 9,913 — — 61 3.863 — — 67 3,793 — — 68 1,656 — — C.5 793 — — C.6 180 — — With regard to sample No. 34, the Ministry of Health were communicated with owing to the presence of coliform bacillus in 1/100 c.c. A letter of warning was sent to the producer from the Ministry. A further sample taken at a later date proved satisfactory. The standard for "Grade A Milk Pasteurised" is that a sample shall be found to contain (a) not more than 30,000 bacteria per cubic centimetre ; and (b) no coliform bacillus in one-tenth of a cubic centimetre. One sample of this grade of milk (No. 33) was taken, the number of bacteria being 170 per cubic centimetre; no coliform bacillus in one-tenth of a cubic centimetre. The standard for "Pasteurised" milk is that a sample shall be found to contain not more than 100,000 bacteria per cubic centimetre. 46 The following table shows the result of the analyses of the samples of "Pasteurised'' milk:— Sample No. No. of Bacteria. per c.c. Sample No. No. of Bacteria. per c.c. 1 4,923 52 165 14 5,023 59 1,166 16 6,863 63 2,030 18 107,700 65 47,650 20 140,000 69 5,846 25 8,026 70 21,950 30 62,700 75 5,846 38 69,650 A.3 7,850 40 55,950 C.2 5,913 47 55,500 D.1 4,843 50 380 — — With regard to samples Nos. 18 and 20, above-mentioned, the following action was taken:— No. 18.—The unsatisfactory bacterial count was reported to the Medical Officer of Health of a neighbouring authority, and the matter was dealt with by his department. A series of samples was subsequently analysed and proved to be satisfactory. No. 20.—Similar action to the case mentioned above was taken in this instance, and subsequent samples taken proved to be satisfactory. The following table shows the result of the analyses of the samples of ordinary milk taken during the year:— Sample No. No. of Bacteria per c.c. Sample No. No. of Bacteria per c.c. Sample No. No. of Bacteria per c.c. 2 17,933 41 69,100 66 17,300 3 68,466 42 498,000 71 31,133 7 66,566 43 277,000 72 55,233 8 29,133 44 26,633 73 35,900 9 27,300 45 98,500 74 87,300 19 59,100 46 15,866 A.2 16,566 21 759,500 48 265,000 C.1 3,950 22 39,166 49 275,000 C.3 67,933 24 438,500 51 295,000 A.4 55,933 26 50,600 54 58,000 B.1 55,233 28 8,470,000 55 114,666 C.4 36,633 29 766,500 56 27,666 D.2 1,188,000 31 90,166 57 58,666 D.3 67,000 32 75,866 58 19,000 D.4 479,500 35 127,966 60 68,666 D.5 15,200 37 88,433 62 27,233 D.6 50,333 39 77,266 64 36,533 D.7 4,650 47 With reference to samples Nos. 21, 24 and 49, letters of warning were sent to the local retailers, owing to the high bacterial count and the presence of coliform bacillus. Further samples were subsequently taken, and these proved satisfactory. In the case of samples of Nos. 28 and 51, these were both taken from the same retailer. His name was removed from the register of retail purveyors of milk as the result of legal action by a neighbouring authority. The case is further reported upon below. In the case of samples Nos. 29, 42, 48, D2 and D4, the retailers' premises were situated outside the Ilford district. Owing to the high bacterial count and the presence of coliform bacillus the matter was dealt with through the Medical Officer of Health of the district concerned. Further samples were taken, which proved satisfactory. Under the provisions of Section 2 of the Milk and Dairies (Amendment) Act, 1922, a man, who, on the 16th December, 1930, appeared before the Council on an appeal, and was removed from the Ilford Register, again applied for registration as a dairyman within the district, the Council decided on 22nd September, 1931, not to re-register in this case. A dairyman, with registered premises in Barking, and registered in Ilford as a purveyor of milk, whose samples and reports were unsatisfactory and whose name was removed from the Barking Register, appeared before the Council in January, 1932. and his name removed from the Ilford Register. One sample of milk taken from this dairyman showed as much as 8,470,000 bacteria per c.c. Where samples taken from dairymen showed an unsatisfactory bacterial count, warnings were issued, and further samples were taken, which, in all cases, showed improved conditions. The number of milk samples submitted for a biological test for tuberculosis was 55. 1 sample was found to be positive, and 54 negative. 4. Tubercular Milk.—A sample of milk was taken in the Ilford district on the 17th August from a retailer in the Romford Rural District who also retails in this district. The sample of milk was submitted to bacteriological examination and the presence of tuberculosis was established. 48 The County Medical Officer of Health was notified under Section 4 of the Milk and Dairies (Consolidation) Act, 1915, and rhe Medical Officer of Health, Romford Rural District, was also informed. The Essex County Council Veterinary Inspector visited the farm belonging to this retailer, and from which he obtained his supplies, on the 23rd September. The Ilford Borough Council's Veterinary Inspector visited the farm in question at the time of the visit of the Essex County Council's Veterinary Inspector. 11 cows were examined, and one cow was detected with tuberculous disease of the udder. The Essex County Council dealt with the matter under the Tuberculosis Order of 1925, and the cow was slaughtered, the disease being confirmed by post-mortem examination. A warning was served under Section 5 of the Milk and Dairies ^Consolidation) Act, 1915, on the retailer. A further sample of milk was obtained on the 4th November, and the result of the analysis did not show 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 48 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:—22 lbs. hake; 2 pigs; 4½ sheep; 7 sheep's plucks. Police Court proceedings were taken against a butcher in the district for exposing one bovine liver for sale which was 49 unsound and unfit for human consumption. After seizure it was examined by myself, condemned, and ordered to be destroyed by a Magistrate. The defendants, father and son, were fined £20 and £10 respectively. 7. Bakehouses.—There are 36 bakehouses in the district, including 17 factory bakehouses. 124 inspections of bakehouses were carried out during the year. It was necessary to call upon the occupiers of bakehouses to carry out cleansing and other works in 20 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 as to samples collected in fhe Ilford district, which I append: — Samples of Milk taken 129 Samples of Butter taken 119 Other Samples 113 Total 361 Proceedings were instituted in respect of a sample of milk, but were eventually withdrawn. 9. Contagious Diseases (Animals) Acts, 1894-1925.—Major J. A. Boseley, M. R.C.V.S., Veterinary Inspector under the Diseases of Animals Acts, 1894-1925, and the Milk and Dairies Order, 1926, resigned on the 30th July, 1931, and the Council appointed, as from 1st October, 1931, Mr. R. Bennett, F.R.C.V.S., in his place. Regulation or Movement or Swine Fever Order, 1922.—Five Licences have been received from various Local Authorities affecting 51 animals sent into the district for stock and other purposes. No Licences have been issued by this Authority for the movement of animals into other districts. Foot and Mouth Disease Regulation of Movement Order, 1931.— This Order was made by the Ministry of Agriculture and Fisheries on the 19th June, 1931, prohibiting the movement of cattle except by Licence. The Senior Sanitary Inspector has issued the necessary Licences as required 50 under the Order. It was found necessary to obtain the services of the Council's Veterinary Inspector to examine 17 animals on one farm before a sale could take place. On the 30th June, 1931, the Ministry revoked the Order and imposed in its place a controlled Area Order, thus restricting the movement of animals in certain parts of Great Britain. Anthrax.—60 gallons of anthrax-infected milk, Grade A. T.T., were reported at a dairy in the Borough. The milk was sterilised by boiling and the dairy utensils disinfected, the milk being destroyed. Sheep Scab Order, 1928.—Since these Regulations under the above Order came into force in the Borough on the 7th July, 1931, up to the end of December, 1931, 1,756 sheep have been dipped as required at a farm in the Borough. 10. Rats and Mice Destruction Act, 1919.—45 complaints have been received of the existence of rats affecting 116 premises. In 7 of these cases ferrets have been used, in 14 poison gas, and in the remaining cases other steps have been taken. A public institution and a private business firm employed a firm of rat-catchers at their own expense with success. 11. Petroleum (Consolidation) Act, 1928.—The Senior Sanitary Inspector made 259 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested 33 petroleum appliances or fittings. The number of Licences issued was 111, and the fees paid to the Council for such Licences was £77 15s. 7 Licences were issued for the storage of calcium carbide, the fees payable being £2 SECTION V.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. I.—Infectious Diseases Generally.—During 1931, 841 cases were notified, as compared with 974 in 1930. 51 The following diseases are notifiable to the Medical Officer of Health:— Smallpox. Pemphigus Neonatorum. Cholera. Cerebro-Spinal Fever. Diphtheria. Plague. Membranous Croup. Ophthalmia Neonatorum. Erysipelas. Tuberculosis. Scarlatina or Acute Influenzal Pneumonia. Scarlet Fever. Acute Primary Pneumonia. Typhus Fever. Dysentery (including amoebic and bacillary dysentery). Typhoid Fever. Enteric Fever. Malaria. Relapsing Fever. Acute Poliomyelitis. Continued Fever. Acute Polio-Encephalitis. Puerperal Fever. Acute Encephalitis Lethargica. Puerperal Pyrexia. Anthrax. 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 diseases notified during 1931, arranged according to age and distribution in wards. Of these 71 were notified from institutions as follows: — Claybury Mental Hospital:— Scarlet Fever 2 Pneumonia 7 Enteric Fever 6 Erysipelas 7 Dysentery 2 Tuberculosis—Pulmonary 1 Other forms 1 Puerperal Pyrexia 1 27 Dr. Barnardo's Girls' Village Homes:— Diphtheria 9. Cerebro-spinal Fever 3 Tuberculosis—Pulmonary 3 15 52 West Ham Mental Hospital:— Tuberculosis—Pulmonary 1 Erysipelas 1 2 King George Hospital:— Cerebro-spinal Fever 4 Diphtheria 4 Scarlet Fever 5 Erysipelas 3 Pneumonia 4 Tuberculosis—Pulmonary 2 Other forms 1 Puerperal Pyrexia 3 Acute Poliomyelitis 1 27 Of the cases notified (exclusive of those from Public Institutions) the following table shows the percentage isolated in hospitals:— Scarlet Fever 86.2 Diphtheria and Membranous Croup 96.2 Enteric Fever 100.0 Puerperal Fever 92.3 Puerperal Pyrexia 90.9 Cerebro-spinal Fever 100.0 53 TABLE II.- Cases of Infectious Diseases Notified during the Year 1931. 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 3 1 - 1 - - - 1 - - - - - 2 - 1 3 Scarlet Fever 218 1 41 131 28 16 1 - 13 6 22 33 23 50 20 51 182 Diphtheria, including Membranous Croup 201 1 26 104 36 28 6 - 13 14 20 51 20 20 28 35 181 Enteric Fever (Typhoid and Para Typhoid) 8 — — 1 1 5 1 — - 1 — 7 — — — — 2 Pneumonia 107 8 20 12 7 24 24 12 7 5 8 22 4 8 6 47 17 Puerperal Fever 13 - - - 4 9 - - 2 1 - 4 1 2 - 3 12 Puerperal Pyrexia 15 - — — 1 14 - — 2 - - 9 3 - 1 - 10 Cerebro-Spinal Fever 10 2 6 1 1 - - - - - - 7 1 1 - 1 10 Acute Poliomyelitis 1 - 1 - - - - - - - - 1 - - - - 1 Acute Polio-Encephalitis 2 - - 1 1 - - - - - - - 1 - - 1 2 Encephalitis Lethargica 1 - - - - 1 - - - 1 - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - Dysentery 2 - - - - - - 2 - - - 2 - - - - - Ophthalmia Neonatorum 11 11 - - - - - - - 1 1 3 - 2 - 4 2 Erysipelas 55 1 - - 4 10 26 12 3 1 6 20 7 4 8 6 9 Pemphigus Neonatorum 5 5 — — — — — — — — — 2 — 1 — 2 4 Tuberculosis—Pulmonary 150 - - 5 39 77 28 1 9 10 25 28 17 15 17 29 - Other Forms 39 - 5 12 8 6 8 - 1 6 2 9 5 5 5 6 — Anthrax - - - - - - - - - - - - - - - - - Malaria—Believed to be contracted in this country - - - - - - - - - - - - - - - - - Believed to be contracted abroad - - - - - - - - - - - - - - - - - Totals 841 30 99 270 130 190 94 28 50 46 84 198 82 110 85 186 435 54 The total number of deaths of Ilford residents from the chief infectious diseases during 1931 was 248, as against 176 in 1930, classified as follows:— 1930. 1931. Enteric Fever — — Scarlet Fever 1 1 Diphtheria 12 4 Measles 9 — Whooping Cough 2 4 Influenza 11 45 Tuberculosis—Pulmonary 61 87 „ Other forms 8 8 Pneumonia 59 80 Diarrhoea (under 2 years) 9 6 Cerebro-spinal Fever 2 7 Puerperal Fever 2 6 Total 176 248 The following table shows a comparison of the incidence of the chief infectious diseases for the past five years — 1931. 1930. 1929. 1928. 1927. Scarlet Fever 218 287 476 502 387 Diphtheria 201 330 305 260 187 Enteric Fever 8 11 12 30 11 Pneumonia 107 69 146 92 139 (a) Smallpox.—Three cases of this disease were notified, of which the following is a brief summary. They were all of the mild type and made a good recovery:— (a) and (b) A brother and sister, aged 11 and 7 years respectively (unvaccinated). They were seen by me and their removal to hospital was ordered on the 8th April from an address in the Clementswood Ward. As a result of enquiries it was established that this family visited an address in Dagenham, where a child was stated to have had chickenpox. Upon further enquiries being made, it was found that two of the Dagenham children showed marks typical of a Smallpox distribution. The Dagenham family had been in contact with a family in Bethnal Green, where a child was found with scars, suggestive of an attack of Smallpox. 12 contacts were kept under observation for the usual 18 days. No further cases of Smallpox occurred. (c) A male, aged 74 years (not vaccinated since infancy). This patient was a contact of two cases that were removed to hospital from an address in Islington on the 12th and 13th October. The Ilford case left Islington on the 10th October for temporary residence in the Goodmayes Ward, and was kept under observation in the meantime. He was notified on the 17th October and was removed to hospital the same day. 14 contacts were kept under observation for the usual 18 days. No further cases of Smallpox occurred. Notifications of 139 persons who had been in contact with cases of Smallpox in other districts were received. All these were visited by the Sanitary Inspectors for the usual period. 55 The following gives particulars as to Vaccination during 1931: Certificates of Successful Vaccination 1,058 Postponed 110 Conscientious Objections 811 Unsuccessful Vaccination 25 Left the District 106 (b) Scarlet Fever.—218 cases were notified in 1931, as compared with 287 in 1930; 476 in 1929; 502 in 1928; 387 in 1927; 171 in 1926; 146 in 1925. The following "return'' cases have occurred during the past five 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. 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 1931 216 180 1 .5 36 2 5.5 (c) Diphtheria.—201 cases were notified in 1931 as compared with 330 in 1930; 305 in 1929; 260 in 1928; 187 in 1927; 148 in 1926; 56 in 1925. Of the 330 cases, 9 were notified from the Girls' Village Homes, Barkingside, and 4 from King George Hospital. The Schick Testing and Immunising of children has been continued, and the following table shows the number Schick Tested 56 and Immunised at the Diphtheria Clinic held at the Public Health Offices, and at Becontree, Goodmayes and St. Vincent's Schools:- Tabular Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinic from 1st January, 1931, to 31st December, 1931. School Children (Various Schools). Children under 5 years of age. Total. Numbers Schick Tested:— Positive 76 2 78 Negative 9 1 10 Numbers inoculated (full course) 94* 190 284 Positive after full course of inoculations, and re-inoculated 2 1 3 Negative after full course of inoculations 28 64 92 Awaiting re-test 60 119 179 Not re-tested after inoculation (on account of leaving District, etc.) 4 5 9 Positive after re-test, but not inoculated for same reason - 1 1 Final Schick Test in 1931 (1930 Cases):— Positive 11 2 13 Negative 150 111 261 Positive after full course of inoculations, and re-inoculated 11 — 11 * Schick + 1931 = 76; Schick I-1930 = 9; Not Tested, = 9. A total number of 568 attended at the Diphtheria Clinic at the Public Health Offices during 1931, making a total number of 2,505 attendances, with an average of 51 per session. The re-immunising and re-testing of school children (inoculated in 1930) at Becontree, Goodmayes and St. Vincent's Schools was completed during 1931, the following number of children being dealt with during the year:— Negative after re-inoculation 98 Test not completed owing to child having left the district 1 The 99 children mentioned are not included in the foregoing table. The last visit to these schools for the purpose of immunising or testing was made on the 7th May. (d) Enteric Fever.—8 cases were notified in 1931, as compared with 11 in 1930; 12 in 1929; 30 in 1928; 11 in 1927 ; 6 in 1926; 10 in 1925. 6 of the cases occurred at Claybury Mental Hospital. 57 The following is a summary of the remaining 2 cases:— Both were due to infection liy Bacillus Para-typhosus B. Both of these cases had partaken of milk in the Epping district during the outbreak of para-typhoid fever. In one case the patient was employed in that district, and the other stayed there during a week-end. Both of the 2 cases mentioned above were removed to the Isolation Hospital and made a good recovery. (e) C'erebro-Spinal Fever.—10 cases were notified, 7 having a fatal termination. The following table gives particulars of the cases:— Age. Sex. Admitted to Admitted from Result. 17 yrs. M. King George Hospital An Ilford address Fatal. 2 yrs. M. Isolation Hospital Dr. Barnardo's Homes Fatal. 2 yrs. M. Isolation Hospital Dr. Barnardo's Homes Recovered. 8 yrs. M. Isolation Hospital An IIford address Recovered. 2 yrs. M. Isolation Hospital Dr. Barnardo's Homes Recovered. 5 mos. M. King George Hospital An Ilford address Fatal. 3 yrs. M. Oldehurch Hospital An Ilford address Fatal. 1¼ yrs. M. King George Hospital A Dagenham address Fatal. 1 11-12 yrs. M. King George Hospital An Ilford address Fatal. 11 mos. F. London Hospital An Ilford address Fatal. Meningococci were found in the cerebro-spinal fluid of all these patients. (f) Ophthalmia Neonatorum.—11 cases were notified during 1931. as compared with 5 in 1930; 6 in 1929; 4 in 1928; 2 in 1927; 3 in 1926. Two cases were admitted to St. Margaret's Hospital. The remaining nine were treated at home by private medical practitioners. 58 One case sustained a slight nebula of the left eye, and with this exception all the children recovered without impairment of vision. Cases. Vision Unimpaired. Vision Impaired Total Blindness Deaths Notified. Treated. At Home. In Hospital. 11 9 2 10 1 — — (g) Acute Influenzal and Acute Primary Pneumonia.—107 cases were notified (of which 11 were in institutions) in 1931, compared with 69 in 1930; 146 in 1929; 92 in 1928; 139 in 1927; 73 in 1926: and 103 in 1925. The following is a statement of the number of cases of acute influenzal pneumonia and acute primary pneumonia notified during 1931, together with the number of deaths of notified cases, compared with the year 1930:— Acute Inf. Pneumonia. Acute Primary Pneumonia. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1931 36 16 71 16 107 32 1930 10 2 59 10 69 12 (h) Encephalitis Lethargica.—One case was notified during 1931, a female, aged 38 years. The patient was nursed at home, and died. The cause of death was given as encephalitis, rheumatic origin. (i) Plague.—No contacts of cases of this disease were received during the year. 59 (j) Puerperal Fever.—13 cases were notified during the year. 10 of these were treated at the Isolation Hospital (of which 3 died); 1 at the London Hospital; 1 at Queen Charlotte's Hospital, which died; and 1 was nursed at home and died. There were transferred to this district 2 notifications of death — 1 at Queen Mary's Hospital and 1 at Oldchurch Hospital. Thirteen oases of Puerperal Fever were notified. Of these five died. Four of these died in hospital, were baeteriologically examined, and the infection found to be due to haemolytie streptococci. One of the remaining cases died at home was not bacteriologically examined. Of the 13 cases in which a swab was taken from the nurse in attendance, one showed the presence of haemolytie streptococci; in a second case which died, the patient was nursed by a monthly nurse who had been associated with a case of Puerperal Fever, whilst a swab from the person in daily attendance showed haemolytie streptococci. In a third case, the swabs from the nurse and doctor showed the presence of haemolytie streptococci. In a fifth case the swab from the nurse showed the presence of haemolytie streptococci. In a sixth case, the swab from the nurse showed the presence of haemolytie streptococci. The patient's mother, who was in the house with her, developed septic tonsillitis and a swab from her gave a pure culture of haemolytie streptococci. In a seventh case, the swab from the keeper of the nursing home showed haemolytie streptococci. These cases show the means of throat infection in the causation of puerperal fever and the need that all those in attendance in a case of confinement should wear masks to cover efficiently the mouth and nose. (k) Puerperal Pyrexia.—15 notifications were received, 1 being subsequently diagnosed as puerperal fever, and removed to the Isolation Hospital. The remaining 14 were suffering from the following conditions:— 60 Cause of Pyrexia. Number of Cases. Mastitis 2 Cracked nipples 1 Uterine infection following miscarriage 2 *Suppurative pylonephritis, pelvic cellulitis, the result of obstructed labour. (The cause of the pyrexia was: (a) the patient inflicted injuries with her nails upon herself: (b) there was some degree of injury due to impaction to the vaginal wall 1 B. Coli infection 2 Influenza 1 Septic laceration 2 Puerperal pyelitis, B. coli infection 1 Sapraemia 1 Cause unknown 1 *This case had a fatal termination. Six of the cases were treated at the Isolation Hospital, 3 at King George Hospital, 2 at the Council's Maternity Home, 2 at home, and 1 at Claybury Mental Hospital (this case proving fatal). All the remaining patients recovered satisfactorily. 2. Zymotic Diseases.—The deaths registered were as follows:— Smallpox — Measles — Scarlet Fever 1 Whooping Cough 4 Diphtheria and Croup 4 Enteric Fever — Diarrhoea 6 61 Table showing Incidence of, and Deaths from, Infections Diseases, 1931, 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. J 15—20. 20—35. J 35—45 45—65. Over 65 Smallpox 3 1 - - - - 1 - - - - - 1 3 - - - - - - - - - - - - - Scarlet Fever 218 1 5 12 14 10 96 35 14 27 3 1 - 182 1 — 1 - - - - - - - - - - Diphtheria 201 1 5 5 10 6 84 20 19 34 11 6 - 181 4 — - - 1 - 1 - - - 1 1 — Enteric Fever (including Paratyphoid) 8 - - - - - 1 - - 5 1 1 - 2 - - - - - - - - - - - - - Pneumonia 107 8 4 7 6 3 8 4 1 19 11 24 12 17 80 13 6 2 2 — 2 — - 2 3 17 33 Puerperal Fever 13 - - - - - - - 1 11 1 - — 12 6 — — — — - — - - 4 2 — — Puerperal Pyrexia 15 - - - - - - - 1 10 4 — - 10 - - - - - - - - - - - - - Cerebro-spinal Fever 10 2 2 3 1 - 1 — 1 - — - — 10 7 2 2 1 — - 1 - 1 — — — — Acute Poliomyelitis 1 - - 1 - - - - - - - - - 1 - - - - - - - - - - - - - Acute Polio-Encephalitis 2 - - - - - 1 - 1 - - - - 2 - - - - - - - - - - - - - Encephalitis Lethargica 1 - - - - - - - - - 1 - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 2 - - - - - - - - - - - 2 - - - - - - - - - - - - - - Ophthalmia Neonatorum 11 11 - - - - - - - - - - - 2 - - - - - - - - - - - - - Ervsipelas 55 1 - - - - - 2 1 4 9 26 12 9 3 1 - - - - - - 1 - - 1 — Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria—believed to be contracted in this - - - - - - - - - - - - - - - - - - - - - - - - - - - „ —believed to be contracted abroad - - - - - - - - - - - - - - - - - - - - - - - - - - - Pemphigus Neonatorum 5 5 - - - - - - - - - - - 4 - - - - - - - - - - - - - 62 3. Tuberculosis.—During the year 1931 there were 150 new notifications of Pulmonary Tuberculosis and 39 of other forms of Tuberculosis. Thirty-seven cases of Pulmonary and fourteen cases of Non-Pulmonary Tuberculosis were transferred to Ilford. Notification and Deaths from Tuberculosis of Ilford Residents during 1931. Age Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 year - - - - - * 1 - - 1-5 years — — 4 1 1 — 2 — 5-10 2 — 3 4 - — — 1 10-15 1 2 2 3 — 1 — — 15-20 8 8 1 2 1 3 — — 20-25 7 16 1 4 5 13 — - 25-35 29 21 2 3 13 14 1 1 35-45 15 12 — 1 10 6 — - 45-55 11 9 2 2 11 1 — 1 55-65 5 3 3 1 4 — — - Over 65 — 1 — — 3 — 1 1 Totals 78 72 18 21 48 39 4 4 * There was no notification of this case before death. Of the above new cases, the following were notified from Institutions in the district:— Pulmonary Tuberculosis. Other Forms. The Girls' Village Homes, Barkingside 1 — King George Hospital 5 2 Claybury Mental Hospital 1 1 West Ham Mental Hospital 1 — Ten of the above deaths, or 10.5 per cent. of the deaths from tuberculosis, had not been notified ; this gives a ratio of 1 in 9.5. Of the 95 deaths which occurred of Ilford residents, notification had previously been made of 82 of the cases. Three were 63 notified at or after death. Ten were not notified, six by reason of the medical attendants believing the cases to have been already notified; three were notified to other authorities, and in one case the presence of Tuberculosis was not discovered until post mortem examination. The notification of tuberculosis in the area by Medical Practitioners may be considered as satisfactory, but in any case arising of failure to notify, the Medical Attendant is communicated with immediately. It has not been found necessary to institute proce-edings, no case of wilful neglect or refusal to notify having occurred. During the year 1931, the following deaths occurred from Tuberculosis:— Pulmonary. Non-Pulmonary. Ilford Residents 87* 8 Non- Residents:- Claybury Mental Hospital 9 1 West Ham Mental Hospital 7 - * Includes 1 at King George Hospital. On the 1st January, 1931, there were 740 cases on the register of the department. On the 31st December, 1931, with 189 new cases notified and 51 transfers (Institution cases omitted), and allowing for deaths, removals from district, and cases removed from the register as " cured," there were 793 cases on the register. The new cases of Tuberculosis are visited by the Tuberculosis Nurse of the Esses County Council. 765 of the cases of longer standing were visited by the Sanitary Inspectors during the year, and the following reports were obtained:— Pulmonary Cases. Other Cases. Stated to be cured, recovered or better 143 72 Improved or fairly well 229 92 Not so well 72 13 In Sanatorium 58 13 No information as to present condition 5 3 Removed from district, etc. 49 16 Totals 556 209 64 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, 1931, there were 638 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. 57 patients were treated, 16 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 Cart Association.—This Association has continued to do good work during the year. 76 cases have been assisted with extra nourishment, clothing, and in other ways. Two cases were provided with dentures free of charge. I have received information from the County Medical Officer of Health that the number of patients from Ilford sent to Institutions under the County Tuberculosis Scheme during 1931 were as follows:— Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. Adults 42 37 5 3 87 Children 2 — 9 6 17 Public Health Act, 1925, Section 62.—No action has been taken for the compulsory removal of infectious persons to hospital or other institutions. Infectious Diseases (Prevention) Act, 1890.—In connection with deaths from infectious diseases, nine certificates in respect of the deaths of patients were issued, stating that the bodies should not be removed from hospital except for the purpose of being buried forthwith. 65 4. Venereal Diseases.—In the following table are classified the deaths notified as due to (1) Syphilis; (2) Locomotor Ataxy and General Paralysis of the Insane, which are certainly due to Syphilis; and (3) Aortic Aneurysm, which is very frequently caused by this disease. Ages 0-1 1-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75-85 85 up NonResidents in Institutions Totals Syphilis 2 — — — — — — 1 1 — - - 4 Locomotor Ataxy - - - - - - - - - - - - - General Paralysis of Insane — - - — — 3 — — — — - 29 32 Aortic Aneurysm — — - — — — — 3 3 — - 2 8 The deaths in Institutions of Ilford non-residents occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital; 14 per cent. of the registered causes of death in these Institutions fell under the above headings. Many other patients died from incidental causes; the reason, however, for their admission to the Mental Hospital was some venereal infection. The prevalence of Ophthalmia Neonatorum shows an 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 eases; 1923, 9 cases; 1924, 4 cases; 1925, 3 cases; 1926, 3 cases; 1927, 2 cases; 1928, 4 cases; 1929, 6 cases; 1930, 5 cases; 1931, 11 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 treatment of patients, and with the London Hospital for the free examination of bacteriological specimens submitted by doctors in the district. 66 5. Notification of Non-Notifiable Acute Infectious Diseases, including Influenza, occurring in Elementary School Children is received from the Head Teachers or School Attendance 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. 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. "Five 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. SECTION VI.—FACTORIES AND WORKSHOPS. Factories. There are 159 factories on the register, made up as follows:— Bakehouses 17 Nautical Instrument Maker 1 Boot Makers and Repairers 30 Optician 1 Builders, Joinery and Carpentry Works 5 Paint Manufacturer 1 Paper Mills 1 Cabinet Maker 1 Photographic Works 1 Cable Works 1 Picture Moulders 1 Carbon Works 1 Plating and Enamelling 1 Cardboard Box Maker 1 Polish Manufacturer 1 Carriage Works 1 Poultry Appliance Maker 1 Chemical Works 1 Printers' Engineer 1 Collar Works 1 Printing Works 8 Confectionery Maker 1 Saw Mills 5 Corset Maker 1 Seed Sorting 1 Cutlery and Tool Grinders 2 Shirt Makers 3 Cycle Repairers 2 Sign Maker 1 Dyers and Cleaners 1 Stone Mason 1 Electricity Supply Works 1 Tarpaulin Repairer 1 Engineers 14 Tool Engineer 1 Gas Mantle Manufacturer 1 Toy Maker 1 Gilding Works 1 Umbrella Repairers 2 Hardware Manufacturer 1 Vulcanising Works 1 Iron Cutting Works 1 Watchmaker and Repairer 1 Laundries 4 Wearing Apparel Makers 3 Leather Worker 1 Wire and Cable Manufacturer 1 Mattress Maker 1 Wireless Apparatus Makers 2 Meat Cutting 9 Wood Cutter 1 Metal Worker 1 Mineral Water Manufacturer 1 Total 159 Motor Engineers 14 67 Workshops. There are 590 workshops on the register, made up as follows:- Artificial Flower Maker 1 Mechanical Dentist 1 Bakehouses 19 Mica Makers 2 Basket Maker 1 Milliners 31 Beet Boiler 1 Mineral Water Manufacturer 1 Bookbinder 1 Metal Moulders 3 Boot Repairers 36 Motor Cab Proprietor 1 Boot Makers and Shoe Sewers 15 Motor and Cycle Engineers and Repairers 39 Brush Workers 5 Builders and Carpenters 37 Optician 1 Cabinet Makers 2 Packing Case Repairer 1 Carpet Planning 1 Photographers 4 Clergy Robes Maker 1 Piano Repairer 1 Coach Builder 1 Picture Framers 3 Confectioners 6 Plumbers 9 Dressmakers 60 Printers and Stationers 7 Dyers and Cleaners 11 Rag and Bone Merchants 2 Electrical and Mechanical Engineers 6 Scale Makers 1 Shirt Makers 6 Electric Battery Charging 3 Sign Makers 3 Embroidery and Lace Workers 21 Sports Outfit Repairers 3 Feather Cleaner 1 Squeegee Maker 1 Flag Maker 1 Tailors 34 Floor Polish Makers 2 Tie Makers 7 Florists 4 Tile Fender Makers 4 French Polishers 4 Timber Merchants 5 Furniture Repairers 3 Tinsmiths 4 Furriers 6 Toy Maker and Repairer 1 Glass Cutters and Glaziers 5 Typewriter Repairer 1 Glove Maker 1 Umbrella Repairer 6 Grate and Furnace Maker 1 Undertakers 6 Hand Laundry 1 Upholsterers 14 Hairdressers 2 Watch and Jewellery Repairer 14 Harness Maker 1 Wearing Apparel and Under clothiers 74 Hat Makers 3 Ice Cream Factor 1 Wheelwrights and Farriers 12 Incubator Maker 1 Wire Worker 1 Leather Workers 8 Wireless Apparatus Makers 3 Life Belt Maker 1 Wood cutters 8 Masonry 1 Mattress Maker 1 Total 590 Meat Cutting 1 68 FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections Made by Sanitary Inspectors. Premises. (1) Number of Inspections (2) Written Notices. (3) Prosecutions (4) Factories (including Factory Laundries) 78 6 Workshops (including Workshop Laundries) 398 1 — Workplaces (other than Outworkers' premises included in Part 3 of this report) — — — Total 476 7 — 69 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 10 10 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 2 2 — — Sanitary accommoda tion insufficient 3 3 — — unsuitable or defective 5 5 - - not separate for sexes — — — — Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouse (s. 101) - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this report) - - - - Total 20 20 - — *Including those specified in sections 2,3,7 and 8 of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. 70 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Sending twice in the year. Sending once in the year. Lists. Outworkers. Lists. Outworkers. Contractors Work- men. Contractors Workmen (1) (2) (3) (4) (5) (6) (7) Wearing Apparel:— Making, etc. 16 19 41 — — — Cleaning and Washing - - - - - - Household Linen 2 — 2 — — — Lace, Lace Curtains and Nets - - - - - - Total 18 19 43 — — - Note.—No home-workers were known to be engaged in the following occupations:—Curtains and Furniture Hangings; Furniture and Upholstery; Electroplate; File Making; Brass and Brass Articles; Fur Pulling; Cables and Chains; Anchors and Grapnels; Cart Gear; Locks; Latches and Keys; Umbrellas, etc.; Artificial Flowers; Nets, other than Wire Nets; Tents; Sacks; Racquet and Tennis Balls; Paper, etc.; Boxes; Paper Bags; Brush Making; Pea Picking; Feather Sorting; Carding, etc., of Buttons, etc.; Stuffed Toys; Basket Making; Chocolates and Sweetmeats; Cosaques, Christmas Crackers, Christmas Stockings, etc.; Textile Weaving. No notices were served under Section 108 of the Factory and Workshops Act, for outwork being oarried out in unwholesome premises. 71 4.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshops Act (s. 133, 1901) 3 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5, 1901) Notified by H. M. Inspector 2 Reports (of action taken) sent to H.M. Inspector 2 Other — Underground Bakehouses (s. 101):— In use at the end of the year - ISOLATION HOSPITAL. 75 ISOLATION HOSPITAL. 421 patients were admitted during 1931, as compared with 525 in 1930, 664 in 1929, 577 in 1928, and 519 in 1927. 86.5 per cent. of the cases of diphtheria occurring in the district and 82.5 per cent. of scarlet fever were admitted to 1he 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. 1931 86 5 82.5 1930 928 66.7 1929 900 63.0 1928 92 7 66.8 1927 92 4 77.3 1926 876 86.6 1925 94 4 78.7 1924 93 5 94.3 1923 92 7 93.5 1922 88 3 84.8 The following table shows the total admissions for the past ten years:— Year. Scarlet Fever. Diphtheria. Tuberculosis. Other Diseases. Total. 1931 180 174 7 60 421 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 76 The 421 patients admitted during 1931 had the following" diseases:— Scarlet Fever 180 Diphtheria 174 Enteric Fever 2 Cerebro-spinal Fever 4 Puerperal Pyrexia 7 Puerperal Fever 10 Pemphigus Neonatorum 5 Tuberculous Diseases 7 Acute Influenzal Pneumonia 3 Acute Primary Pneumonia 2 Broncho-Pneumonia 1 Scabies 4 Meningo-myelitis 1 Measles 3 Influenza 1 Under observation 17 Number of deaths in Hospital, 11. Diphtheria 4 Scarlet Fever 1 Cerebro-spinal Fever 1 Puerperal Fever 3 Acute Influenzal Pneumonia 1 Septic Broncho-Pnuemonia 1 Number of patients in Hospital on 1st January, 1931 and 1932 respectively:— 1st Jan., 1st Jan., 1931. 1932. Scarlet Fever 19 15 Diphtheria 27 16 Tuberculous Diseases 12 11 Under observation 3 2 Pemphigus Neonatorum — 2 Measles — 1 Puerperal Pyrexia — 1 The average length of stay in Hospital was for Scarlet Fever 28.1 days. Diphtheria 42.5 ,, Tuberculous Diseases 177 ,, Average stay in Hospital of all cases 32.7 ,, The above averages are based on cases that completed their stay in hospital during the year. Average number of patients in hospital per day, 50.4. 77 Scarlet Fever.— The 180 cases, admitted to hospital during 1931 were distributed among the following age groups:— Under 1 yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. 1 35 109 23 9 2 1 One death occurred during the year, as follows: — A boy, 1 year 10 months, admitted on the day of appearance of the rash, with a history of enteritis for three days. He was an obvious case of septic Scarlet Fever, and died on the 18th day from Septicaemia, the blood culture showing Haemolytic Streptococcus Type III. 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 London County Council :— 1927. 1928. 1929. 1930. 1931. Ilford .6 .5 .3 1.05 .5 L.C.C. .6 .63 .60 .73 not available. Complications present on admission:— Percentage. Meningitis 1 5 Otorrhoea 1 "5 Adenitis (abscess developed)1 -5 Albuminuria 1 '5 Surgical Scarlet Fever (after operation, 1; after burns, 2) 3 1-6 Erysipelas (abscess) 1 -5 Complication developing after admission:— Percentage. Otorrhoea 9 5.0 Adenitis 4 2.2 Relapse 2 1.1 Rhinitis 2 1.1 Empyema 1 .5 Septicaemia 1 .5 Onychia 1 .5 Two cases admitted with scarlet fever were found to be also suffering from diphtheria. * In one of these cases the solution used for the Dick Test was unsatisfactory. A subsequent test with another solution showed that the child was susceptible to Scarlet Fever. If this had been known previously she would have been removed from the ward and the relapse would not have occurred. In the second case the Dick Tests on the 12th and 19th days were negative, on the 26th day was pseudo-negative, and on the 33rd day was Dick positive. The child was then removed to the Isolation Ward, but too late to prevent a relapse. 78 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. Enteric Fever.—Two cases were admitted. Both gave a positive Widal Test for B. Paratyphosus B. Both were mild cases and made satisfactory recoveries without any complications. Puerperal Fever.—Ten cases notified as Puerperal Fever were admitted. Three of these patients died, the causes of death being (1) Septicaemia, General Peritonitis and Broncho Pneumonia; (2) Septicaemia; (3) Septic Pneumonia. All three were haemolytic streptococcal infections. Of the remaining seven, two had Parametritis, and five Sapraemia (one with a B. Coli infection of the kidney in addition). Four of the seven cases were caused by a haemolytic streptococcal infection of a Scarlatinal type. Puerperal Pyrexia.— Seven cases notified as Puerperal Pyrexia were admitted. One case proved to be Puerperal Fever with haemolytic streptococcal infection, one had sapraemia, two mastitis, one a coliform infection, one Influenza, and one cracked nipples, but also a haemolytic streptococcal infection of the cervix. All the cases of Puerperal Pyrexia made a good recovery. Diphtheria.— The 174 cases admitted to hospital were distributed among the following age groups:—- Under 1 Year. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. 1 25 89 32 12 9 6 Six of the above cases proved to be non-virulent K.L.B. carriers, 4 nasal carriers of virulent K.L.B.. and one was suffering from Tonsilitis (non-diphtheritic). 79 Four deaths, due to Diphtheria, occurred in the Hospital. The ages of the patients were 6½ years, 35 years, 59 years, 3½years. Three of these died within 48 hours or less of admission. The following complications occurred in the patients discharged during the year:— 14 eases developed various Paralyses, as follows:— Palatal 7 Palatal + strabismus+ciliary 1 Palatal + strabismus 1 Various 5 Other complications:— Adenitis 1 Otorrhea (Streptococcal, 2) 5 Bronchitis 1 Secondary Tonsillitis:— Pneumococcal 3 Streptococcal 7 Pharyngeal abscess (present on admission) 1 Streptococcal septicaemia (fatal) (present on admission) from septic thumb 1 Three of the cases admitted with Diphtheria were found to be also suffering from Scarlet Fever. Six cases had a streptococcal tonsillar infection, one of which developed adenitis and streptococcal abscess. One case was suffering from Tonsillitis (not diphtheritic). Six cases were treated with serum intravenously; two of these died, and of the remaining four, one developed Palatal Paralysis and one Adenitis + streptococcal abscess. The following table shows the percentage death-rate of cases of diphtheria admitted to the Il ford Isolation Hospital during the past five years, compared with that of the Institutions of the London County Council:— 1927. 1928. 1929. 1930. 1931. Ilford 4.8 3.4 5.2 3.6 2.4 L.C.C. 4.0 3.66 3.6 3.7 not available. Cerebro-Spinal Fever.— Four cases were admitted. One case, a. male aged two years, admitted from Dr. Barnardo's Homes, had a fatal termination. Two further cases were admitted from the same Institution, males, aged two years, and both made good recoveries. All these were due to Meningococcus type I. A boy, 80 aged eight years, admitted from a private house in Ilford, made a good recovery after 17 weeks in Hospital and 78 lumbar punctures. He was infected with an aberrant meningococcus. Pemphigus Neonatorum.—Five cases were admitted to hospital, and made good recoveries. Observation Gases.—Seventeen cases were admitted. Two patients admitted as doubtful cases of Cerebro-spinal Meningitis, proved to be (1) suffering from syphilitic meningitis, and (2) septicaemia from a salpingitis. The latter case had a fatal termination, and the former was transferred back to King George Hospital, from which she had been admitted. Two patients were admitted as doubtful cases of Enteric Fever. One was proved to be suffering from a pelvic abscess and was transferred to Charing Cross Hospital; the other gave negative Widal results to B. Typhosus and B. Paratyphosus B., and was suffering from Colic. One case admitted with a rash suspicious of Scarlet Fever proved to be Marasmus. One Nurse was admitted from King George Hospital as a carrier of Scarlet Fever organisms. Four of the nursing staff at the Council's Maternity Home were admitted being temporary carriers of Haemolytic Streptococci. One patient was admitted from the Maternity Home as a uterine cervical haemolytic streptococcal carrier. Four patients from the Maternity Home were admitted with abscesses, one of whom was a woman suffering from Mastitis, the other three being babies, one with Cellulitis of the neck, one with an axillary abscess and one with an abscess of the neck. Two patients were admitted from the Maternity Home, one of whom was suffering from a haemolytic streptococcal tonsillitis, and the other with a rash suspicious of Scarlet Fever, but proved to be an enema rash. Tuberculosis.—Seven cases of Surgical Tuberculosis were admitted, as compared with 14 in 1930. The organs involved in the 7 cases admitted were as follows:— Glands of neck, 2; peritoneum, 1; lumbar abscess, 1; spine, 1; hip, 1; abscess in groin, 1. At the end of the year the following patients were in the Sanatorium :— Period in Nature of Case. Hospital. Spine and Hip 64 months. Spine 25 ,, Spine 32 ,, Spine 19 ,, Spine 18 ,, Peritoneum 6 ,, Lumbar abscess 5 ,, Glands of Neck 4 ,, Spine 4 ,, Hip 3 weeks. Abscess in Groin 3 days. 81 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 1931, ten nurses passed Part I of the examination of the General Nursing Council, and ten obtained the Certificate by completing Part II. The following table shows the number of the Staff at the Isolation Hospital who were Schick and Dick Tested during 1931, and also the numbers inoculated:— Staff. Numbers Schick Tested:— Positive 11 Negative 12 Numbers inoculated (full course) 10 Numbers re-tested:— Negative after full course of inoculations 4 Positive after full course of inoculations, and re- inoculated 2 Numbers Dick Tested:— Positive 4 Negative 19 Numbers inoculated (full course) 4 Numbers re-tested:— Negative after full course of inoculations 1 Positive after full course of inoculations, and re- inoculated — No members of the Staff at the Isolation Hospital developed Scarlet Fever or Diphtheria during the year. 82 Hospital Extensions.— The Special Committee re Council Finance. 15th September, 1931, in recommending that consideration of the extensions of the Isolation Hospital be deferred for the present, passed a reference to the Public Health Committee to endeavour to make temporary arrangements with neighbouring authorities for accommodation should there be an epidemic demanding additional beds. The following is a copy of a Special Report I presented to the Public Health Committee at its meeting on the 14th October, 1931: — ''I may say that I view with grave apprehension the probable result on the health of the town in the next few years of the postponement of the extension to the Isolation Hospital. "It will be remembered that in February, 1929, I estimated that there were 18 beds less at the Hospital than were required for the district. The Census figures show that there are actually 20 beds less than what can be regarded as the minimum for the district. This is not an estimate for an epidemic period but the normal requirements for outbreaks of infectious disease such as occur in Ilford. As a matter of fact, in Ilford this estimate is on the low side, as owing to the character of the houses in the district, the nursing of infectious cases at home cannot as a rule be recommended. "It will be recalled that in the Winter of 1929 it was necessary to entirely close one Ward of the Hospital for Scarlet Fever patients and a number of such cases were compelled to be nursed at home. Although at the present time Ilford is not subject to any great incidence of Diphtheria or Scarlet Fever, the incidence might increase greatly, as although in 1925 only 199 cases were admitted to the Hospital, yet in 1920, 506 cases were admitted to the Hospital; in 1929, 664 cases were admitted, and in 1930 525 cases. "As far as neighbouring authorities are concerned, it must be remembered that whilst they would be willing to admit cases from Ilford into their Hospitals, such assistance would only be available at a time when their hospitals were not full, and since outbreaks of infectious disease always occur at the same time in neighbouring districts as in Ilford, such accommodation would not be available and would necessitate many infectious eases being nursed at home. "In the neighbouring authority of Dagenham, in spite of the increased Isolation Hospital accommodation, in 1930, 221 cases of Scarlet Fever and 43 cases of Diphtheria had to be nursed at home. As far as Ilford is concerned, the present 20 bed shortage, which will be accentuated with the rapidly increasing population, gives an estimate that the Hospital is not able to accommodate a total of 240 patients per annum suffering from infectious diseases, which it should be able to do, and it will be necessarv for the Committee to arrange with neighbouring authorities to accommodate this number of patients. 83 "If, unfortunately, an actual epidemic in infectious disease occurred, such as has not taken place in Ilford except that of Influenzal Pneumonia, the above number would of course be greatly increased. "As far as Influenzal Pneumonia is concerned, an outbreak of this disease would find the town with entirely inadequate Hospital accommodation. "As far as the Isolation Hospital extensions are concerned it will be remembered that the Council in December, 1929, approved the plans and estimates for the extension and transmitted the same to the Ministry of Health for their approval. The Ministry of Health, In December, 1930, stated that the proposals were such as might be generally approved, subject, before sanction to the necessary loans being given, to a satisfactory estimate of the cost of the works based on the tender it was proposed to accept, a list of the tenders received, a specification of the works, and a copy of the resolution of the Town Council making formal application in the matter.'' "The legal difficulty of compelling isolation in a Hospital where the Hospital is far distant from the town, as, for example, the L.C.C. Hospitals, must be borne in mind." MATERNITY AND CHILD WELFARE 87 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 orver must be notified to the Medical Officer of Health within 36 hours. The number of births notified under the above Acts during 1931 was 1,878 (982 males and 896 females). During the year attention was called in 24 instances to default in complying with the requirements of the Notification of Births Acts. In one instance a letter of warning was addressed to the parents, doctor and nurse regarding the requirements of the Act. The percentage of births notified by the various responsible persons was as follows:— By Medical Practitioners 35.51 By Certified Midwives 50.74 By Parents and others 13.74 In addition, 49 stillbirths (26 males and 23 females) were notified. The causes of the 49 stillbirths were as follows: — Difficult labour 4 Cord around neck 3 Prematurity 1 Extended breech 3 Ante-partum haemorrhage 4 Macerated foetus 5 Malformed infant 1 Anencephalus 1 Albuminuria 1 Pneumonia of mother 1 Foetal distress 1 Shock 1 Fall of mother 3 Contraction of pelvis 1 Unknown 19 In addition, 1 have received notice of 6 stillbirths which took place outside the district, although the parents reside in Ilford. 88 The causes of the stillbirths were as follows:— 4 at Queen Mary's Hospital, Stratford— Asphyxia 1 Albuminuria I Death of mother 1 Unknown 1 1 at Salvation Army Mothers' Hospital, Clapton, E.— Eclampsia 1 1 at Maternity Hospital, Plaistow, E.— Prolonged labour 1 Where necessary, visits are paid by the Health Visitors to obtain particulars as to the cause of stillbirths. In this connection 36 visits were paid during 1931. Registration Act, 1836. By the Registration Act, 1836, all live births are registered with the Registrar of Births within six weeks. The birth-rate is calculated on the births registered, and during last year 1,979 (1,038 males and 941 females) births were registered, giving a birth-rate of 15.4 per 1,000 persons calculated on the net population, mid-year 1931, as compared with 1,845 births and a birth-rate of 15.2 per 1,000 persons in 1930. 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 1931, 56 stillbirths (32 males and 24 females) were registered. Of these one male and one female were illegitimate. The figures of 1,979 live births and 56 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 1,878 and 49 stillbirths notified are births actually occurring in the Ilford district. 89 Infant Mortality. The number of infante dying within the first year of life was 110, the total number born being 1979. The infant mortality or rate of death per 1,000 births was, therefore, 55.6. The comparative figures for the past 10 years were as follows Year. No. of Deaths under 1 year. Rate per 1,000 Registered Births. 1931 110 55.6 1930 61 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 4.11 1922 80 54.2 The infant mortality rate for 1931 was 66 for England and Wales, 65 for London, and 71 for the 107 towns having a population exceeding 50,000. The infant mortality rate for .1931 for Ilford is the highest recorded since 1919, when the figure was 61. The following table shows the comparison for Ilford, England and Wales, London and towns having a population exceeding 50,000 for past 12 years:— Year. Ilford. England and Wales. London. Towns with population over 50,000. 1931 55.6 66 65 71 1930 33.0 60 59 64 1929 49.6 74 71 79 1928 45.4 65 67 70 1927 44.0 69 59 71 1926 45.1 70 64 73 1925 52.5 75 67 79 1924 43.2 75 69 80 1923 41.1 69 60 72 1922 54.2 77 74 82 1921 50.9 82 80 87 1920 54.0 79 75 85 1919 61.0 89 85 93 90 The deaths from pneumonia totalled 17, as compared with 11 for 1930. There were 30 deaths of premature infants as compared with 17 in 1930. The following table shows the infant mortality in each ward of the district Ward. Sex. No. of Births. No. of Infant Deaths. Infant Mortality per 1,000 Births. Infant Mortality per 1,000 Births both sexes together. 1931. 1930. 1929. North Hainault M. 239 20 83.6 74.4 38.3 47.0 F. 204 13 63.7 Cranbrook M. 54 8 148.1 76.2 56.1 50.5 F. 64 1 15.6 Park M. 73 8 109.6 65.7 45.4 58.8 F. 64 1 15.6 Seven Kings M. 128 9 70.3 44.2 9.6 63.1 F. 98 1 10.2 South Hainault M. 66 6 90.9 52.6 32.7 42.4 F. 67 1 14.9 Loxford M. 103 6 58.2 76.5 40.7 69.2 F. 80 8 100.0 Clementswood M. 107 6 56.0 49.3 26.3 41.0 F. 116 5 4.31 Goodmayes M. 160 12 75.0 54.1 45.3 60.7 F. 154 5 32.4 The above table only accounts for 1,777 of the total births registered and belonging to the district. The remaining 202 are included by the Registrar-General as belonging to Ilford, but have not been allocated by him to the various wards. 44 births were registered in this district belonging to other areas. These have not been included in the foregoing figures. Three 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 each ward. 91 A statement as to the ages at, and causes of, 1nfant deaths 1n the var1ous wards 1s g1ven below:— 1n the North Ha1nault Ward there were 33 1nfant deaths. 14 d1ed under 1 week. 1 d1ed at 1 week from premature b1rth. 1 d1ed at 1 week from marasmus, prematur1ty and men1ngocele. 1 d1ed at 1 week from congen1tal atres1a of oesophagus. 1 d1ed at 3 weeks from marasmus and lues. 1 d1ed at 1 month from prematur1ty. 1 d1ed at 1 month from bronch1t1s and premature b1rth. 1 d1ed at 1 month from 1nab1l1ty to ass1m1late nour1shment and premature b1rth. 1 d1ed at 1 month from acute bronch1t1s. 1 d1ed at 6 weeks from pylor1c stenos1s. 1 d1ed at 2 months from congen1tal pylor1c stenos1s. *1 d1ed at 2 months from convuls1ons and pneumon1a. 1 d1ed at 3 months from broncho-pneumon1a. *1 d1ed at 4 months from d1arrhoea and vom1t1ng. 1 d1ed at 4 months from marasmus and deb1l1ty. 1 d1ed at 4 months from broncho-pneumon1a and 1nfluenza. *1 d1ed at 7 months from toxaem1a, acute broncho-pneumon1a and acute streptococcal ot1t1s med1a. 1 d1ed at 7 months from m1l1ary tuberculos1s, probably ar1s1ng from pulmonary focus. *1 d1ed at 9 months from encephal1t1s. *1 d1ed at 10 months from broncho-pneumon1a and 1nfant1le convuls1ons. * These ch1ldren had attended an 1nfant welfare centre. 1n the Cranbrook Ward there were 9 1nfant deaths. 8 d1ed under 1 week. 1 d1ed at 2 months from enter1t1s. None of these ch1ldren had attended an 1nfant welfare centre. 1n the Park Ward there were 9 1nfant deaths. 4 d1ed under 1 week. 1 d1ed at 2 weeks from broncho-pneumon1a and bronch1t1s. 1 d1ed at 3 weeks from men1ng1t1s and sp1na b1f1da. * 1 d1ed at 5 months from acute broncho-pneumon1a and teeth1ng. 1 d1ed at 5 months from men1ng1t1s. 1 d1ed at 6 months from acute suppurat1ve lymphaden1t1s of neck and sept1caem1a. * Th1s ch1ld had attended an 1nfant welfare centre. 1n the Seven K1ngs Ward there were 10 1nfant deaths. 2 d1ed under 1 week. 1 d1ed at 2 weeks from broncho-pneumon1a. 1 d1ed at 3 weeks from marasmus and congen1tal syph1l1s. 1 d1ed at 4 weeks from broncho-pneumon1a. 1 d1ed at 2 months from congen1tal deb1l1ty. 1 d1ed at 2 months from 1nfant1le convuls1on and bronch1t1s. *1 d1ed at 6 months from whoop1ng cough. 1 d1ed at 7 months from heart fa1lure, bronch1t1s and congen1tal heart d1sease . 1 d1ed at 10 months from toxaem1a and pneumon1a follow1ng scalds susta1ned by acc1dent . * Th1s ch1ld had attended an 1nfant welfare centre. 92 In the South Hainault Ward there were 7 infant deaths. 3 died under 1 week. 1 died at 1 week from marasmus and gastric catarrh. 1 died at 1 week from laceration cerebral sinus. *1 died at 5 months from cerebro-spinal meningitis. *1 died at 10 months from intussusception. * These children had attended an infant welfare centre. In the Loxford Ward there were 14 infant deaths. 6 died under 1 week. 1 died at 1 week from deficient inherent vitality. 1 died at 1 week from prematurity (second twin). 1 died at 1 week from morbus maculosus neonatorum. 1 died at 3 weeks from heart failure, toxaemia, marasmus and umbilical sepsis; meningeal haemorrhage, cerebral thrombosis. 1 died at 4 weeks from broncho-pneumonia. 1 died at 3 months from cachexia, enteritis and double hare-lip and cleft palate. 1 died at 7 months from erysipelas and suppurative cervical adenitis. *1 died at 10 months from meningococcal meningitis. * This child had attended an infant welfare centre. In the Clementswood Ward there were 11 infant deaths. 4 died under 1 week. 1 died at 2 weeks from inanition and prematurity. 1 died at 3 weeks from heart failure and debility from birth. 1 died at 6 weeks from congenital pyloric stenosis. 1 died at 2 months from cardiac failure and marasmus. *1 died at 7 months from heart failure and meningitis (cerebral). *1 died at 9 months from heart failure and broncho-pneumonia. *1 died at 10 months from acute gastritis and malnutrition. * These children had attended an infant welfare centre. In the Goodmayes Ward there were 17 infant deaths. 7 died under 1 week. 1 died at 4 weeks from meningitis and spina bifida. 1 died at 2 months from broncho-pneumonia, influenza and prematurity. * 1 died at 2 months from acute primary broncho-pneumonia and prematurity. 1 died at 3 months from gastro-enteritis. 1 died at 4 months from marasmus and bronchitis. *1 died at 5 months from heart failure, infantile convulsions and enteritis. 1 died at 5 months from broncho-pneumonia. 1 died at 8 months from cardiac failure, diarrhoea and vomiting and haematemesis. 1 died at 8 months from intussusception of small intestine. *1 died at 9 months from broncho-pneumonia. * These children had attended an infant welfare centre. It will be seen that of the 110 infants who died under one year of age only 16 had attended Ilford infant welfare centres, and 93 in some cases only one attendance was made. 64, 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 22.4 per 1,000 as compared with 74.9 per 1,000 in those not attending an Ilford infant welfare centre. 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 46 children who died between the age of one month and one year (all of whom might have been in attendance at a welfare centre), only 16 had attended an infant welfare centre, or, in other words, that 78 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. It is interesting to note that deaths under 1 month advanced from 31 during 1930 to 64 during 1931. The following were the causes:— 1930. 1931. Meningitis — 1 Pneumonia 3 4 Enteritis 1 — Syphilis - 1 Injury at birth — 0 Atelectasis 4 6 Congenital malformations 6 6 Premature birth 16 29 Atrophy debility and marasmus 1 7 Other causes Nil 5 31 64 The rate advanced from 16-8 for 1930 to 32-3 for 1931. In the group 1 month to 1 year the deaths occurred from the following causes:— 94 1930. 1931. Measles 1 — Whooping cough — 1 Erysipelas — I Tuberculous Meningitis — 1 Meningitis (not Tuberculous) 1 5 Convulsions 2 — Bronchitis 4 4 Pneumonia (all forms)— 8 13 Enteritis 4 6 Gastritis — 1 Syphilis — 1 Injury at birth — — Atelectasis — — Congenital Malformations 1 4 Premature birth 1 1 Atrophy, Debility and Marasmus 2 4 Other causes 6 4 30 46 The largest number of deaths occurred in the first quarter of the year. Neonatal Mortality. The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 64 deaths of infants under four weeks of age during 1931, and the rate for the year was 32.3 per 1,000 births. The following table shows the Neonatal Death-rate in Iliord compared with that for England and Wales during the previous twelve years: — 1931 Ilford 32.3 England and Wales. not available 1930 16.8 31 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 1919 30.8 40 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. 95 Table IV.— Infant Mortality. 1931. Net Deaths from stated causes at various Ages under 1 Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Smallpox .. .. .. .. .. .. .. .. .. .. Chickenpox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. l .. l Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. l .. l Tuberculous Meningitis .. .. .. .. .. .. .. l .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. l l l 2 l l 6 Convulsions .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 3 1 .. .. 4 Pneumonia (all forms) 1 .. 2 l 4 5 3 l 4 17 Diarrhoea .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. 1 4 l .. 6 Gastritis .. .. .. .. .. .. .. .. 1 1 Syphilis .. .. .. l 1 .. 1 .. .. 2 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation (overlying) .. .. .. .. .. .. .. .. .. , . Injury at birth 4 l .. .. 5 .. .. .. .. 5 Atelectasis 6 .. .. .. 6 .. .. .. .. 6 Congenital Malformations 4 2 .. .. 6 3 .. l .. 10 Premature birth 26 2 1 .. 29 1 .. .. .. 30 Atrophy, Debility and Marasmus 4 2 .. 1 7 3 1 .. .. 11 Other Causes 3 1 .. l 5 .. .. 2 2 9 Totals 48 8 3 5 64 17 12 9 8 110 96 Illegitimate Births and Deaths. 41 of the births registered (21 males and 20 females) were illegitimate, that is 2.0 per Cent. of the births registered. Two illegitimate children died under one year of age. The deaths of the two illegitimate children occurred as follows:— One died at three months at the Hospital for Sick Children, Great Ormond Street, from cachexia, enteritis, double hare lip and cleft palate; one died at six months at Queen Mary's Hospital, Stratford, from acute suppurative lymphadenitis of neck and septicemia. The infant mortality rate of illegitimate children was 48.8 per 1,000, compared with the infant mortality rate of 55.7 for legitimate children. The following table shows the death-rate of illegitimate and legitimate infants for the past ten years: — []Year. Illegitimate Infants. Legitimate Infants. Births. Deaths. Rate per 1,000 Illegitimate Births. Births. Deaths. Rate per 1,000 Legitimate Births. 1931 41 2 48 1,938 108 55 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 Maternal Mortality. The total number of deaths due to childbirth during the year was seven, which gives a maternal mortality rate (i.e., number of deaths per 1,000 births) of 3.5. 17 The causes of the deaths were as follows: — Puerperal Fever: — Pneumonia, puerperal sepsis 1 Lobar pneumonia, streptococcal septicaemia 1 Broncho-pneumonia, puerperal septicaemia 1 Puerperal septicaemia 1 Puerperal septicaemia, complicated by general peritonitis following full-time delivery 1 Septicaemia, pelvic cellulitis, puerperal sepsis 1 Other causes:— Post-partum haemorrhage and exhaustion 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 1,000 Births, England and Wales. From Puerperal Fever. From Other Causes. 1931 6 1 1,979 3.5 4.11 1930 2 5 1,845 3.7 4.40 1929 3 4 1,755 4.0 4.33 1928 0 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 ] ,606 2.49 3.81 1922 3 3 1,475 4.07 3.81 1921 3 1 1,492 2.68 3.91 *Revised Table. In July, 1931, I presented the following leport to the Maternity and Child Welfare Committee on the subject of Maternal Mortality 98 in connection with the Ministry of Health Circular 1167 and Memorandum 156/MCW. The matter has been deferred for the time being. The following is the Report presented to the Committee:— MATERNAL MORTALITY. I have to report as follows on the Memorandum issued by the Ministry of Health. The Memorandum deals with the subject under six sections, viz.:— Section I.—Ante-Natal Services. During the year 1930 the number of cases attended by midwives was 284. Of this number 57 attended the Ante-Natal Clinic. It is suggested by the Ministry of Health that a list might be prepared by the Authority of those doctors practising in the area willing to undertake the examination of uninsured women who engage midwives and who are not willing to attend an ante-natal centre, and that the midwives, where the women are unwilling to attend the centre, encourage them to select one of the doctors on the list as being the doctor to be called in by the midwife if any emergency should arise. The Ministry of Health informed me in a letter dated 17th April, 1931, that the Ministry would agree to the doctor being paid a fee of five shillings for each examination. Section II.— Supply of Midwives. It is suggested in the Memorandum that local authorities should encourage the employment of midwives instead of a handy woman in cases attended by a doctor and a handywoman by contributing to the fee of the midwife. In 1930, 850 cases were attended in Ilford by a doctor and a woman who was not a certified midwife, but in some cases she was a partly-trained monthly nurse. Section III.—Consultants. The Ministry consider it is desirable that a consultant should be available for any doctor who needs assistance in difficulties or complications arising during pregnancy, or at or after confinement . There is no such provision in Ilford. In January, 1929, it was found that 22 districts in and around London had arranged for the services of such a consultant. The district in which the services of a consultant was utilised during 1928 on the greatest number of occasions was Shoreditch, and in this district he was called in on seven occasions The Borough of Hampstead first instituted this system, and in 1929 consultants were called in for five cases for difficult labour, incurring a cost of £16 16s. to the Council. (£5 5s. per case is the fee for which the Council is responsible to the Consultant.) I am not satisfied that any very substantial improvement would be effected by such a scheme until the beds are available at the Maternity Home for the admission of difficult cases. It will be remembered that the plans of the scheme for the provision of such beds are before the Ministry of Health. 39 Section IV.— Hospital Beds. As stated above, the plans for the scheme for such beds are at present under consideration by the Council. Section V.—Provision of Ancillaries. (1) Sterilised maternity outfits are available; (2) Home Helps have not yet been provided; (3) a scheme for the supply of milk for expectant and nursing mothers is in operation in thi3 district; (4) laboratory facilities for the examination of pathological material submitted by doctors are available, Section VI.—Education. This section deals with the education of women on th? subject of maternity, and the desirability of taking advantage of the facilities provided. 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 1st. April, 1930. All the Health Visitors of the Council have been appointed Infant Life Protection Visitors and visit foster-children in their district fortnightly, 1,026 visits being paid during the year 1931. All foster-children under five years of age are required to attend the infant welfare centres. The Medical Officer of Health has been authorised by the Council to fix the number of infants which may be kept by a fostermother. Five foster-mothers failed to give notice of the reception of foster children within the prescribed time At the end of the year 25 foster-mothers each had one child in her care, and 3 foster-mothers each had 3 children in her care. 19 new foster-mothers were registered during the year. The Sanitary Inspectors have visited all the houses which have been reported during the year as accommodating fosterchildren, or where transfers have taken place. In four houses defects were found and the necessary repairs were carried out. 100 The following is a summary of the work carrier! out : — Foster- Children . Number of foster-children on books on 1st January, 1931 39 Number of foster-children who were notified to me during 1931 30 Number of foster-children returned to their mothers during 1931 9 Number of foster-children taken off the records for various other reasons during 1931 26 Number of foster-children on records on 31st December, 1931 34 Poster-Mothers . Number of foster-mothers with children on records on 1st January, 1931 29 Number of persons who became foster-mothers during 1931 19 Number of foster-mothers whose names were taken off records during 1931 20 Number of foster-mothers with children on records on the 31st December, 1931 28 Houses Visited by Sanitary Inspectors. Number of houses visited by the Sanitary Inspectors for the purpose of the Act during the year 1931 24 Number of visits made by the Sanitary Inspectors for the purpose of the Act during the year 1931 44 Woke of Health Visitors. All live infants notified in the district, or transferred (410 during 1931) from other areas, are visited by the Health Visitors within the first month of life, and afterwards three times during the first year of life. Between the age of one and five years visits are paid twice or three times a year. In addition, many infants attending the welfare centres are seen more frequently by the Health Visitors. 19,058 attendances of children from 1 to 5 years were made at the Welfare Centres in 1931. The congestion at the Centres does not enable sufficient time to be given to the toddler. 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. 101 The following is a summary of the visits paid by the Health Visitors during 1031 as far as the Maternity and Child Well are work is concerned:— First visits to newly-born infants 2,238 Subsequent visits to children under 1 year of age 6,465 Subsequent visits to children over 1 year of age and under 5 14,886 Visits to expectant mothers 175 Home visits for other reasons 1,777 Total visits paid 25,541 Supervision of Midwives. There are 13 certified midwives resident and practising in the district (apart from those at the Maternity Home), and 9 certified midwives resident outside Ilford, but practising in Ilford. Dr. D. Regan was appointed by the Council as Inspector of Midwives, following the resignation of Dr. Worthington. 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. 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. One midwife was suspended from practice for a period of five weeks in order to prevent spread of infection after attendance upon a person who was suffering from Puerperal Fever. A claim 102 of £4 10s. 0d. for compensation under Section 6 (2) of the Midwives Act, 1918, and Section 2 (1) of the Midwives Act, 1918. and Section 2 (1) of the Midwives and Maternity Homes Act, 1926, was paid. The midwife was a temporary throat carrier of haemolytic streptococci. The following is a summary of the notices received from midwives during 1931 Medical Help 299 Death of Mother or Child 11 Laying out the Dead 2 Stillbirths 20 Liability to be a source of infection. . 16 Artificial Feeding 8 356* *Of these 180 were from the Ilford Maternity Home. Death of Mother or Child. All the notices received related to infants. The causes of death are embodied in Table IV, Infant Mortality, on page 95. Laying out the dead. Two notifications of having laid out a dead body were received. In one case the patient had died from Pneumonia, and the other case was a stillborn infant. Stillbirths. Twenty notifications were received. The causes of the stillbirths are included in the particulars set out on page 87. Liability to be a Source of infection. Sixteen notices were received from midwives after attendance on patients suffering from the following conditions:— Haemorrhage 1 Influenza 1 Inflammation of, or discharge from the eyes 3 Mammary Abscess 1 Pemphigus Neonatorum 6 Pneumonia 1 Puerperal Fever 3 16* * 3 of these occurred at the Ilford Maternity Home. Artificial Feeding. Eight notifications were received from midwives that it was proposed to substitute artificial feeding for breast feeding. The reasons given were as follows:— 103 Mastitis. Insufficient lactation and general condition of breasts. Scarified condition of breasts due to repeated abscess. Mother never fed first baby, having plenty of nourishment, but not sufficient in the breasts. Mother suffering from Puerperal mania. Mother suffering from Pneumonia. Mother obliged to leave home indefinitely. Advice of medical practitioner. Of the above, six were received from the Tlford Maternity Home. Inflammation of, or Discharge from, the Eyes of an Infant. Medical aid was sought in 29 instances where the infant was found to have inflamed or discharging eyes. Six of the cases were subsequently 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. Sterile Outfits. In December, 1930, the Maternity and Child Welfare Committee made provision for arrangements in this district for supplying midwives with sterile outfits for their patients. The outfits, containing the following articles, are sold at 4s. each:— ½ doz. large Perineal Pads (wrapped in 3). 1 doz. small Perineal Pads. 1 packet Hospital Wool. ½ doz. Safety Pins. 2 sheets Tarred Paper. 1 Sterilized Accouchement Sheet, 12x12. In any case where it is shown that the person is unable to afford the outfit, it is supplied at a reduced cost, or free of charge. 19 outfits were supplied in 1931—17 at full cost, and 2 free of charge. All patients attended by the district midwife, who is employed by the Council, are provided with an outfit, the cost of which is included in the fee for her services. Supply of Milk to Expectant and Nursing Mothers and for Infants. Under the Regulations of the Ministry of Health, during 1931, 153 mothers and infants were supplied with cows' milk free, 50 with dried milk, and 10 with condensed milk. A total of 8,646½ quarts of cows' milk, 1,102 lbs. of dried milk, and 121 tins of condensed milk were given free under the Regulations. 104 In 1930, 109 mothers and infants were supplied free with cows' milk, 3(5 with dried milk, and 8 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 llford Lane Centre one of the ladies has carried on a clothing club since 1921, to which mothers could contribute small sums weekly and withdraw the whole or part of their contributions as necessity arose. During 1931, £22 11s. 0d. was saved by 29 mothers. During the year the following attendances were recorded : — Figures for 1930. 1931. Total number of attendances of infants 36,710 42,839 First attendances 2,056 2,415 Total number of children on roll, December 31st, after omission of all those who had not attended for six months 2,465 2,817 First Attendances— Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. 179 193 204 200 166 223 273 159 202 287 179 150 Subsequent Attendances— 3125 3013 3064 3378 2674 3420 3944 2506 3584 4801 3701 3214 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. 1931 42,839 2,415 2,817 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 Five hundred and thirty sessions were held during the year, the average attendance at each session being 80 mothers with their infants. 105 The following are the figures for each Centre :— Sessions. Average Attendance Seven Kings 48 116 Barkingside 48 76 Goodmayes 48 59 Valentines 47 51 Newbury Park 48 87 Grosvenor Road 48 90 Woodford Avenue 48 81 Park and Cranbrook (morning) 49 63 Park and Cranbrook (afternoon) 49 66 Becontree 49 76 Ilford Lane 48 116 Ante-Natal Clinics.— The Ante-Natal Clinics were continued during 1931 at the Maternity Home on Monday and Saturday mornings. An additional Clinic was commenced on Thursday, 5th November, to relieve the congestion which was occurring on Monday and Saturday mornings. The following attendances were recorded:— First attendances 784 Subsequent attendances 3,677 Number of expectant mothers on the rolls on 31st December, 1931 277 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. 1931 784 4,461 277 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 53 106 All patients entering the Maternity Home who are 10 be attended by a midwife, are medically examined at the Ante-Natal Clinic. During the year, 80 cases other than those booked for admittance to the Maternity Home were examined at the Clinic. There were 188 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 1931, 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 1931 173 Number of attendances of mothers 493 Number of mothers, having teeth extracted, to whom "general'' anaesthetics were given 91 Number of mothers, having teeth extracted, to whom "local" anaesthetics were given 31 Number of mothers having teeth filled or otherwise treated 55 Number of mothers having dentures supplied (including 3 free of charge) 46 (b) Treatment of Children under five years of age. Number of children treated 145 Number of attendances of children 164 Number of children, having teeth extracted, to whom "general" anaesthetics were given 108 Number of children having teeth filled or otherwise treated 43 The following are the figures for the past five years :— 1927. 1928. 1929. 1930 1931. Number of mothers treated 189 183 136 150 173 Number of children treated 96 79 94 135 145 107 Ophthalmic Clinic.— Children under five years of age who are found to be suffering from squint or other defects of vision 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 1931:- (а) Number of children for whom spectacles were prescribed and provided 34 (b) Number of children examined by Oculist for whom spectacles were not prescribed 29 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. Fifteen mothers were .so treated during 1931. Orthopaedic Clinic.—An arrangement has been made with the Royal National Orthopaedic Hospital, whereby an Orthopædic Surgeon, Mr. H. J. Seddon, F.R.C.S., attends a Clinic held at the Public Health Offices. Mr. Seddon commenced duties on the 17th April following the sudden death of Mr. J. B. Barnett, F.R.C.S. He attended on 21 occasions during 1931, and examined 174 children under 5 years of age, the Clinic being held twice monthly except on February, June and August, when only one clinic was held during the month. These children made a total of 374 attendances. The defects found comprised the following: — 108 Genu- valgum 36 Outward curvature of tibia 46 Congenital calc valgus 2 Hammer-toe 2 Infantile paralysis 3 Other defects 23 Total 112 Arrangements have also been made for the attendance four 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 112 children received treatment. The children made a total of 309 attendances. Ophthalmia Neonatorum.—During the year 1923 arrange ments were made with the Metropolitan Asylums Board for the reception at their St. Margaret's Hospital of cases of Ophthalmia Neonatorum from the Ilford District, details of which were printed in the report for 1923. The L.C.C. is now the authority controlling St. Margaret's Hospital. Two cases were admitted to St. Margaret's Hospital during the year under the above arrangements. One case reoovered without any impairment of vision, the other case sustained a slight nebulo, of the left eye. Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant AVelfare Centres. 164 belts and 17 trusses have been supplied to infants suffering from hernia during the year 1931. A certain number of infants were brought to the Public Health Offices to receive treatment for minor ailments. Queen Mary's Hospital, Stratford, has undertaken since the 1st January, 1921, to carry out operative treatment for enlarged 109 tonsils and adenoids at an inclusive charge for each Ilford child under 5 years of age recommended for such treatment by the Medical Officer of Health. During the past year, 70 children under 5 years of age have been treated under the above arrangements. 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. Five children were treated free and one child at part cost during the past year. MATERNITY HOME. During 1931, 510 women were admitted into the Home as compared with 489 in 1930, 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. The patients were admitted to the Home from the following wards:— North Hainault 120 Cranbrook 26 Park 73 Seven Kings 79 South Hainault 29 Loxford 54 Clementswood 75 Goodmayes 53 One patient was admitted from outside the district on the recommendation of the Maternity and Child Welfare Committee. Sixty-three cases could not be admitted during the year owing to lack of accommodation. 110 At the end of the year 219 cases were booked for future admission to the Home. The average number of patients in the Home per day during 1931 was 19.61, and the average length of stay of patients 14.36 days. Of the 510 cases admitted during 1931, 503 were confined in the Home, 3 cases were admitted for observation only, and in 4 cases the babies were born before arrival at the Home. In 15 of the 503 confinements the patient had been previously admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 503 confinements there were:— (а) 316 cases of first confinement. (b) 187 cases having their second or subsequent ment. Of the total cases confined in the Home:— (a) TO cases were living in 2 rooms or less (48 being first confinements). (b) 141 cases were living in 3 rooms, 93 being first finements). Of the 503 confinements, 30 women had engaged their own doctor, 7 of these cases were, however, delivered by a midwife, the doctor not being piesent at the birth. 473 were attended by one of the midwives at the Home. It was necessary to call in a doctor in 185 of the latter casts, owing to the following complications :— (a) Ante-natal 35 Disproportionate measurements 5 Small measurements 6 Flat pelvis 2 Contracted pelvis 4 Albuminuria 9 High Blood pressure 3 Threatened eclampsia 3 General condition 2 Post maturity 1 111 (b) During labour 70 *Extended breech 10 Prolapsed cord 2 Severed cord 1 Impacted shoulders 2 Episiotomy 5 Persistent occipito posterior 9 Foetal distress 6 Uterine inertia 5 Prolonged labour 22 Maternal distress 1 Placenta praevia 2 *Ante- partum haemorrhage and transverse lie 1 Ante-partum haemorrhage 1 Post- partum haemorrhage 2 Adherent placenta 1 * These conditions were diagnosed on admission to the Home. The other conditions were diagnosed after admission. (c) After labour 68 Ruptured perineum 49 Internal lacerations 1 Puerperal mania 1 Varicose veins 3 Mastitis 4 Influenza 1 Tonsillitis 1 Pneumonia 1 Pleurisy 1 Puerperal pyrexia 4 Post-partum haemorrhage 2 (d) For infant 12 Melaena neonatorum 3 Dangerous feebleness 7 Ophthalmia neonatorum 1 Conjunctivitis 1 There were 8 deaths of infants in the Home, from the following causes:— Congenital debility and prematurity 4 Cerebral congestion, compression at birth 1 Atelectasis and prematurity 1 Eclamptic convulsions and prematurity 1 Accidental suffocation by meconium whilst being born 1 The average stillbirth rate at the Maternity Home for the past four years was 2.69 per cent., compared with 2.76 per cent. for births elsewhere in the Ilford district. Stillbirths were first registerable on July 1st, 1927. At the East London Maternity Hospital for a period of four years from the year 1925, comprising 10,376 oases, the stillbirth rate was 2.7 per cent. of all births. The 112 Medical Officer stated that it was somewhat disappointing to find that measures which were effective in reducing maternal mortality by 75 per cent. have not had more effect upon the stillbirth rate. The same remark would appear to apply to the cases in the Ilford Maternity Home. (The rate for the same period of the Ilford Maternity Home was 1.7 per cent.) The causes of the 16 stillbirths in the Home during 1931 were as follows:— Prematurity 1 Extended breech 2 Ante- partum haemorrhage (twin) 2 Macerated foetus 5 Prematurity— Congenital heart 1 Forceps delivery for foetal distress 1 Enlarged Thymus 1 Forceps delivery 1 Toxemia, concealed accidental haemorrhage Forceps delivery 1 Unknown 1 The neo-natal death-rate of babies horn in the Maternity Home was 1.9 per cent. compared with 3.7 per cent. in the district in general. The death-rate of babies who died before 14 days, born in the Maternity Home, was 1.6 per cent. in 1931 and .8 per cent. in 1930. This appears to be a satisfactory figure, the corresponding figure for the East London Maternity Hospital was 1.3 per cent. in the series of cases mentioned above. In Ilford the neo-natal rate for 1930 was 1.68 per cent. and for 1931 was 3.2 per cent. For England and Wales for 1930 it was 3. per cent. Puerperal Pyrexia.— Four cases of puerperal pyrexia occurred due to (1) septic laceration of vagina following mid-forceps delivery for obstructed labour, (2) puerperal pyelitis, bacillus coli infection, (3) mastitis, (4) sapraemia. The last two cases were admitted to the Isolation Hospital. All made satisfactory recoveries. The average rate for puerperal pyrexia cases occurring at the Maternity Home for the past five years was 4.6, ocmpared with 5.5 for the births elsewhere in the Ilford district. Puerperal pyrexia was first notifiable on 1st October, 1926. One case of puerperal insanity occurred, the patient being removed to Romford Infirmary. The patient made a good recovery. Two cases (and one doubtful case) of pemphigus neonatorum occurred at the Home during the year. The infants and mothers were removed to the Isolation Hospital. The patients recovered. 113 One ease of ophthalmia neonatorum (gonococcal) occurred. The mother and child were removed to St. Margaret's Hospital. The infant recovered without any defect of vision. The following cases had to be removed to the Isolation Hospital:—Two cases of influenza; one case of mastitis; one case of acute primary pneumonia; one case of tonsillitis; one case of septic neck; one case of axillary abscess; two cases of haemolytic streptococcal infection; one of the throat and the other a uterine cervical carrier. All of these cases made satisfactory recoveries. The Consulting Obstetrician paid the usual fortnightly visits, to the Home. During 1931, he paid 25 ordinary visits, and examined 113 patients referred from the Ante-Natal Clinics. During the year he was also called in ten times for other casesr as follows:— To perform Caesarian operations 5 For consultation re ante-partum haemorrhage and cord presentation 1 For consultation re placenta praevia 2 For consultation re probable Caesarian section 1 For consultation re uterine inertia and subsequent delivery 1 The reasons for the five Caesarian section operations were as follows:— Disproportionate measurements 2 Contracted pelvis 1 Extended breech 2 The infant mortality rate of children born in the Maternity Home was 30.3 per 1,000 births, as compared with 64. born in their own homes. The figure of 64. has been arrived at after deduction of all deaths of infante from the Maternity Home, 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 ten years:— Maternity Home. District generally. 1931 30.3 64.0 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 56.3 114 No maternal death occurred at the Maternity Home. The maternal mortality rate for the Home for the ten years from 1922—1931 is .84, as compared with the maternal mortality rate in the district generally of 3.15. 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 paic by women admitted to the Home:— Fees Paid Per Week. No. of Patients admitted. Fees Paid Per Week. No. of Patients Admitted. Free of Charge. 1 57/6 9 Maternity Benefit. 1 60/- 31 15/- 6 62/6 1 17/6 1* 63/- 7 20/- 22 65/- 7 25/- 20 67/6 3 27/6 2 70/72/6 21 30/- 46 9 32/6 1 75/- 1 35/- 35 77/6 4 40/- 27 80/- 11 42/- 113 82/6 1 45/- 33 85/- 1 47/6 2 87/6 1 50/- 18 90/- 3 52/- 1 92/6 2 52/6 43 100/- 13 55/- 11 107/6 1 *Plus maternity benefit. Of the above patients:— (а) 296 paid an additional fee of 15s. to the Council for the service of one of the midwives of the Home. (b) 1 paid a fee of £3 3s. for the services of the Assistant Medical Officer of Health. (c) 167 paid a fee of £1 1s. for the services of the Assistant Medical Officer of Health. 115 (d) 5 paid a fee of £5 5s. for the services of the Consulting Obstetric Surgeon. One paid half of the fee, the Council paying the remaining half. (c) 1 paid a fee of 7s. 6d. per week, 1 a fee of 10s. per week, and 1 a fee of 12s. 6d. 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; seven who were engaged during ihe year were successful in passing the examination of the Central Midwives Board. Maternity Cases—Queen Mart'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 1931. District Midwife. During 1931, the District Midwife attended 112 cases; of these 14 were delivered by doctors and 98 by herself; a doctor was called in, however, in 39 of the 98 cases delivered by the District Midwife, for the following causes: — Albuminuria 2 (а) Ante-Natal 4 History of eclamptic fit 1 High blood pressure 1 Uterine inertia 3 Prolonged labour 1 (b) During labour 11 Extended breech 1 Post-partum haemorrhage 3 General condition 3 Ruptured perineum 8 (c) After labour 16 Influenza 3 Bacillus coli infection 3 General condition 2 (d) For infant 8 dangerous feebleness 2 Inflammation of eyes 6 116 The 112 eases attended were in the following wards:—North Hainault, 42; Cranbrook, 4; Park, 10; Seven Kings, 22; South Hainault, 3; Loxford, 12; Clementswood, 15; Goodmayes, 4. Of the infants born there was one stillbirth (cause unknown); one died 24 hours after birth from atelectasis, and one died 24 hours after birth from atelectasis pulmonum, prolonged labour and prematurity. Three cases of puerperal pyrexia occurred due to (1) cracked nipples, (2) influenza, (3) bacillus coli infection. All these cases were removed to the Isolation Hospital and made satisfactory recoveries. Twenty-seven 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 Special Committee re Council Finance, meeting in September, recommended that the Extension be postponed for the present. This was confirmed by the meeting of the Council, 22nd September. SCHOOL MEDICAL SERVICE. 119 GENERAL SURVEY OF THE SCHOOL MEDICAL SERVICE. The report shows that there are approximately 17,570 children on the school rolls, compared with 16,303 in 1930. The number of children in average attendance at school for the period April 1st, 1930, to March 31st, 1931, was 14,168. 6,541 children were medically inspected, compared with 6,521 in 1930. 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 1930— Defects. BOARD OF EDUCATION. ILFORD. Estimated incidence per 1,000 children in average attendance which was adopted in 1923. Incidence per 1,000 children ascertained by School Medical Officers in 1930, based on average attendance (1st April, 1929, to 31st March, 1930) 4,940,831. IncidenceRate per 1.000 children in average attendance (1st April, 1929, to 31st March, 1930). IncidenceRate per 1,000 children in average attendance (1st April, 1930, to 31st March, 1931). Blind:— Totally 0.4 0.4 - *** 0.1* Partially 1.0 1.0 1.0*** 0.8** Deaf:— Totally 0.9 0.7 0.5 0.6 Partially 0.3 0.4 0.5 0.1 Mentally Defective (educable) 8.6 6.5 5.0 3.8 Epileptics—Severe 0.6 0.4 0.4 0.4 Physically Defective:— (a) Active Tuberculosis— Pulmonary and Glandudular (infectious) 0.7 0.5 0.5 0.5 Pulmonary and Glandular (non-infectious) 1.7 2.5 0.7 0.7 Non-pulmonary 1.5 1.9 0.2 0.8 (b) Delicate 15.5 16.5 10.3 12.1 (e) Crippled 10.0 9.2†† 1.8† 6.1†† * This figure is calculated, in accordance with the Hoard of Education definition, on the number of children who are totally blind or "so blind that they can only be appropriately taught in a school or class for totally blind children.'' ** This figure is calculated, in accordance with the Board of Education definition, on the number of children, who though they cannot read ordinary school books, or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a school or class for the partially blind. *** Certain cases were included as partially blind which would under the present definition be classed as totally blind. † This figure includes only children who are so crippled as to require instruction at a Cripple School. †† This figure includes children (other than those with active tuberculous disease) who are suffering from " a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life.'' 120 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 1930. Defects. Board of Education Average. Ilford. Incidence-Rate per 1000. Incidence-Rate per 1000. 1930. 1929. 1930. 1931.† Skin Disease 12.9 13.1 11.8 12.6 Defects of Vision 88.3* 66.8 81.4* 53.0* Squint 9.0 2.7 2.0 3.1 Other Eye Diseases 8.7 6.8 5.4 5.8 Defects of Hearing 3.9 5.1 3.2 4.0 Otitis Media 5.4 3.0 3.6 3.2 Enlarged Tonsils and Adenoids 66.5 51.4 29.7 76.4 Other Throat and Nose Defects 6.3 8.6 4.1 8.9 Organic Heart Disease 2.1 2.2 0.5 3.2 Pulmonary Tuberculosis: (a) Definite 0.2 — - - (b) Suspected 0.8 0.6 0.3 0.3 Non-Pulmonary Tuberculosis 0.9 1.2 0.2 0.5 Deformities 9.6 8.6 9.9 19.4 Nervous Diseases 2.1 3.3 4.4 8.6 *In calculating this figure the entrants have been left out of account. †The figures in this column with the exception of Defects of Vision have been calculated on the total number of defects (including those kept under observation) of Table IIa on page 152. 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 1930 and 1929. Table showing the Principal Causes of Death among Children of School Age (i.e., from 5—15 years), in England and Wales during 1929 and 1930, compared with those in Ilford for 1929 and 1930. 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 1930 1929 1930 1929 1930 1929 1930 1929 1. Measles .9 .6 .9 .2 3.6 2.1 2.7 - 2. Scarlet Fever .2 .1 .1 .1 2.4 1.9 — 2.6 3. Whooping Cough .4 1.2 .2 .8 0.6 1.7 — — 4. Diphtheria .8 .6 1.2 1.5 14.2 12.2 13.5 30.8 5. Influenza 1.1 5.5 1.1 3.6 1 .2 3.8 5.4 2.6 6. Tuberculosis 7.9 7.1 7.0 7.3 14 8 14.7 10.8 7-7 7. Rheumatic Fever .3 .3 1.1 .3 3.2 3.5 13.5 5.2 8. Bronchitis, Pneumonia and other respiratory diseases 11.4 15.7 9.6 17.5 10.1 12.6 5.4 2.6 9. *Meningitis and Nervous system 9.0 8.2 .2 .2 8.1 8.3 2.7 — 10. Heart Disease 19.8 18.1 22.7 20.9 6.3 6.0 5.4 7.7 11. Acute and Chronic Nephritis 3.4 2.9 3.4 3.5 1.8 1.9 2.7 2.6 12. Violence 4.9 4.1 2.8 4.2 12.9 12.4 8.1 12.6 13. Other conditions 39.9 35.6 49.7 39.9 20.8 18.9 29.8 25.6 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 *Excludes Meningococcal infections. England and Wales.— The deaths of children of School Age during 1930 represent 2.8 per cent. of the Total Deaths registered (all ages), and during 1929 2.6 per cent. Ilford.— The deaths of children of School Age during 1930 represent 3.8 per cent. of the Total Deaths registered (all ages). ,, The deaths of children of School Age during 1929 represent 3.6 per cent of the Total Deaths registered (all ages). 121 122 1. Staff.— Dr. D. Regan, Assistant Medical Officer of Health, commenced his duties on the 1st September, 1931, vice Dr. A. T. Worthington, who terminated his duties on 15th July, 1931. Dr. K. Edgecombe, Assistant Medical Officer of Health, terminated her duties on the 7th November, 1931, and has been succeeded by Dr. E. S. Stephen, who commenced duty in the New Year. Mr. R. A. Tran, Assistant School Dentist, commenced his duties on 2Gth May, vice Dr. A. F. Crow, who terminated her duties on the 16th May. 2. Co-ordination.— Vide Annual Report, 1920. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. 3. School Premises.— There are 25 schools, with 48 departments. The schools have accommodation for approximately 17,775 scholars, and 17,57G were actually on the rolls on December 31st, 1931. The reorganisation of the Cleveland, Loxford and Uphall Schools under the Hadow Scheme; the completion of the building of Beal Modern School; and the provision of a rest shed at Benton School have resulted in the following alterations in the elementary schools. School. Date of Alteration. Old Designation. New Designation. Ages. Accommodation . Cleveland 1-4-31 Boys' Dept. Middle Boys' Dept. 8 to 11 yrs. 470 boys. ,, Girls' Dept. Middle Girls' Dept. 8 to 11 yrs. 470 girls. Loxford „ Boys' Dept. The Loxford 11 to 14 yrs. 480 boys. Girls' Dept. Junior Dept. The Woodlands 5 to 8 yrs. 400 infants. Uphall „ Boys' Dept. J The Mount 11 to 14 yrs. 480 girls. Girls' Dept. Junior Dept. The Uphall 5to 8yrs. 300 infants. South Park Central 24-8-31 Boys' Dept. South Park Upper Boys 11 to 14 yrs. 240 boys. „ Girls' Dept. South Park Upper Girls 11 to 14 yrs. 240 girls. Beal Modern „ - Boys' Dept. 11 to 15 yrs. 400 boys. — Girls' Dept. 11 to 15 yrs. 400 girls. Benton ' ' 6 to 15 yrs. 120 boys and girls. 123 Extensions are now being built at Downshall and Gearies Schools as follows:— Schools. Ages. Accommodation. Downshall Middle Boys' Dept. 8 to 11yrs. 288 Middle Girls' Dept. 8 to 11 yrs. 288 Gearies Middle Boys' Dept. 8 to 11 yrs. 96 Middle Girls' Dept. 8 to 11 yrs. 96 Lower Dept. 5 to 8 yrs. 96 The Sanitary Inspectors have paid monthly visits to the various elementary schools in the Borough and a total of 387 visits have been made during the year. By means of these inspections a considerable number of sanitary defects have been located and remedied. The replacement of the trough closets at Barkingside School (Boys and Girls) by modern pedestal pans with separate flushing cisterns has not yet been carried out. At Highlands and Loxford Schools (with the exception of two separate pedestals in each School) sets of syphonic latrine type of W.C.'s with separate pans set over a trough and trapped on outlet with automatic flush are still in existence, and these should be replaced with separate pedestal W.C. pans and traps with separate flushing cisterns. During the year the old pattern of trough closets at the Ilford R.C. School, Downshall and Newbury Park Schools, have been replaced with separate W.C.s of pedestal type, with separate flushing cisterns. The old type of drinking fountain is still in existence at the following schools:—Highlands (Girls and Infants, 1); Gearies (Upper Boys, 1; Middle Boys, 1); SS. Peter and Paul (Boys, 1; Girls and Junior, 1): Mossford. The new type of "Hygienic Spa" fountain has been fixed at the following schools during the year:—Uphall (3), Highlands (4), Benton Open Air (2), Goodmayes (6), Gearies (5), Becontree (9), Newbury Park (5), Downshall (4), Gordon (2), Mayesbrook (2), Fairlop (2), South Park (9), Chadwell (2), Little Heath (2), Loxford (4), Valentines (2), Christchurch (5), and Beal Modern (6) 124 4. Medical Inspection.— This has been carried out in accordance with the Board of Education (Special Services)Regulations, dated the 18th August, 1925, Section 17 of which states :— The Authority must provide for the medical inspection of all children in Public Elementary Schools as soon as possible in the twelve months following :— (а) their first admission to Public Elementary Schools, and (б) their attaining the age of eight years, and (c) their attaining the age of twelve years. During 1931 the number of visits by the Medical Officers to 48 different departments of 25 schools for the purposes of routine medical inspection was 356. The number of children examined during the year, falling within the above age groups, totalled 6,541 (3,118 boys and 3,423 girls), an increase of 21) over the figures for 1930. In addition, a number of children of varying ages were presented by the Head Teachers for special medioal examination, being thought by the teachers to be suffering from some ailment. During 1931, 439 such children (215 boys and 224 girls) were examined. 3,780 re-examinations (1,914 boys and 1,866 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 10,760 examinations were made at the various schools during the year. Routine medical inspection at the Mossford School, Dr. Barnardo's Girls' Village Home, was again carried out by my Department during the year, 349 children being examined, the treatment of Ihe children being left, as previously, in the hands of the Home Authorities. The following table compare? the numbers of children examined in previous years:— Routine Medical Inspection. Special Cases. Re-examination at following up. 1931 6,541 439 3,780 1930 6,521 356 2,530 1929 6,254 152 2,072 1928 5,910 137 1,811 1927 5,738 126 1,697 125 5. Fxndinqs of Medical Inspection.— Table II shows the return of defects found in the course of medical inspection. (a) TJn cleanliness.— At routine medical inspection 103 children out of a total of 6,541 (or 1.6 per cent.) were found to have nits or vermin in their hair, while 5 (or .07 per cent.) were found to be iiea-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. (b) Tonsils and Adenoids.— 500 children (or 7.6 per cent, of those examined) were found to be suffering either from adenoids or from tonsils so enlarged, or causing such symptoms, that it was considered necessary to advise the parents to obtain medical advice. (c) Tuberculosis.— 2 cases of suspected pulmonary tuberculosis were found at medical inspection, and referred to the Tuberculosis Officer. (d) Skin Disease.— 3 cases of Scabies, 7 cases of Impetigo, and 71 cases of other diseases of the skin were discovered at' routine medical inspection (e) External Eye Disease.— 16 cases of Blepharitis, i.e., inflamed eylids, and 7 cases of Conjunctivitis were discovered. (/) Vision.— 262 children (or 4.0 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 §, while the remaining 231 had vision of § or lessj and 159 cases were referred for re-examination at a later date. Further particulars of these cases will be found on page 152. Seventy-nine per cent, of the cases referred for treatment received treatment from the School Oculist. (ff) Ear Disease and Hearing.— 26 children (or 0.40 per cent, of those examined) were found to be suffering from defective hearing. 21 children were found to be suffering from a discharge from the ear, due to an old otitis media. 126 (h) Dental Defects.— 622 (or 9.5 per cent, of those examined) were found to be suffering from teeth so defective as to impair health. These cases were referred to the School Dentist for treatment. A more complete inspection of the teeth of the children is carried out by the Dentist, a summary of the results of which appears on page 161, Table IV (Group IV). (i) Deformities.— 15 children were found to be suffering from slight spinal curvature, and 112 from other minor deformities (such as round-shoulders, flat-feet, etc.), which could be corrected by special physical exercises. 6. Infectious Disease.— The following table shows the incidence of Scarlet Fever, Diphtheria and Measles, including German Measles, in the Ilford schools since 1922:— Scarlet Fever. Diphtheria. Measles. 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 1931 121 97 72 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, Christchurch, Cleveland, Downshall, Little Heath, Mayesbrook, Mossford and SS. Peter and Paul Schools. No schools were closed during the year on account of infectious disease. Tables VII to XIII on pages 168 to 174 show, the incidence of each infectious disease in the Ilford schools during 1931. (a) Scarlet Fever.— 121 cases were notified in 1931, as compared with 174 in 1930. 127 The following table shows the percentage attack-rate of Scarlet Fever at the various schools during 1931 :— School. Percentage Attack Rate. Barkingside 0.3 Becontree 1.0 Cleveland 0.7 Downshall 0.7 Fairlop 0.3 Gearies 0.5 Goodmayes 0.5 Gordon 6.2 Highlands 0.5 Loxford 0.9 Mayesbrook 0.9 Newbury Park 0.2 Roman Catholic, Ilford 0.9 South Park 0.9 Uphall 1.4 Valentines 0.3 Woodlands, The 0.5 No cases occurred at Beal, Benton, Chadwell, Christchurch, Little Heath, The Mount and St. Vincent's Schools. The table has been calculated on the cases notified, compared with the number of children on the roll (all departments). (6) Diphtheria.— 97 cases were notified in 1931, as compared with 208 in 1930. Diphtheria Prevention— The re-immunising and re-testing of school children (inoculated in 1930) at Becontree, Goodmayes and St. Vincent's Schools was completed during 1931, the following number of children being dealt with during the year at these Schools:— Negative after re-inoculation 98 Testing not completed after leaving district 1 The remaining 68 of the 167 children awaiting re-test from 1930 were referred to the Clinic at these Offices, and 27 were completed, 6 are awaiting re-test. The remaining 35 were not dealt with for various reasons. The last visit to these Schools for the purpose of Schick testing was made on the 7th May. In addition to the school children re-tested at school, a number of children from vaiious elementary schools were 128 immunised 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 during 1931:— Schick tested 85 Positive 76 Negative 9 Not Schick tested 9 Inoculated (full course) 94 Schick + 1931 76 Schick + 1930 9 Not tested 9 Negative after full course of inoculation 28 Positive after full course of inoculation and re-inoculated 2 Awaiting re-test 60 Not re-tested after inoculation on account of leaving district, etc 4 Result of final Schick test in 1931 of cases inoculated in 1930 (134 at the Clinic and 27 at the Schools) :— Positive and re-inoculated 11 Negative 150 (c) Measles and German Measles.— 72 cases were notified from the schools in 1931, compared with 1,295 during 1930. No deaths from Measles in a child of school age occurred in 1931, compared with nil in 1930, nil in 1929, 1 in 1928, and nil in 1927. (d) Small Pox.— Two cases of Small Pox among children of school age occurred during the year. Case No. 1.— This was an unvaccinated boy, aged 11 years, a scholar attending Loxford School, notified on the 8th April. The patient was removed to Hospital the same day, and the house disinfected. The contacts of the case (7 of whom were children of school age) were followed up. Case No. 2.— This was an unvaccinated girl, aged 7 years, a scholar attending Gordon School, notified 8th April. This girl is a sister of the child mentioned in Case No. 1. She was herself removed to hospital on same day, and the house disinfected. Both cases were of the mild type, and I am pleased to record that, owing to the measures adopted, no further cases occurred. 129 (e) Chicken Pox, Whooping Cough and Mumps.— 439 cases of Chicken Pox occurred in 1931, as compared with 234 in 1930; 531 in 1929; 197 cases of Whooping Cough in 1931, as compared with 171 in 1930 and 278 in 1929; and 115 cases of Mumps in 1931, as compared with 179 in 1930 and 252 in 1929. Five school children were X-rayed at the clinic during the year. 7. Following Up.— This has been carried out in the manner described in my previous reports. During 1930, 5,008 home visits by the Nurses were paid for the purpose, and 3,780 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 1931 were as follows: — Number of individual children seen at the Clinic 2,126 Number of attendances of children 5,251 Number of exclusion certificates granted 2,107 Number of certificates of fitness to attend school granted 1,430 The following table shows the variety of conditions dealt with «t the School Clinio during the year:— Malnutrition 14 Uncleanliness:— Head 8 Body 1 130 Skin:— Ringworm: Head 7 Body 7 Scabies 21 Impetigo 159 Other Diseases (Non-Tuberculous) 382 Eye:— Blepharitis 18 Conjunctivitis 97 Keratitis 1 Corneal opacities 1 Defective Vision (excluding Squint) 42 Squint 3 Other conditions 64 Ear:— Defective Hearing 14 Otitis M,edia 34 Other Ear Diseases 46 Nose and Throat:— Enlarged Tonsils only 118 Adenoids only 12 Enlarged Tonsils and Adenoids 155 Other Conditions 198 Mouth Breathing 13 Enlarged Cervical Glands (Non-Tuberculous) 43 Defective Speech 1 Teeth—Dental Diseases 76 Heart and Circulation:— Organic 6 Functional 3 Anasmia 53 Debility 149 Infectious Diseases:— Diphtheria 8 Whooping Cough 6 Mumps 9 Chicken Pox 12 Influenza 7 Colds 24 Lungs:— Bronchitis 29 Other Non-Tubercular Diseases 10 131 Tuberculosis:- Pulmonary:— Suspected — Non-Pulmonary:— Glands 1 Nervous System:— Epilepsy 3 Chorea 8 Other conditions 29 Deformities:— Spinal Curvature 4 Other forms 19 Other Defects and Diseases 304 Total number of ailments 2,219 (6) Ophthalmic Department.— During the year 1931 the School Oculist held 90 sessions for the refraction of children suffering from defective vision. Full details of the work are given in Table IV, Group II, on page 160. 622 school children were examined, 67 of these being cases referred for refraction in 1930. Of the 622 cases, 299 were referred from medical inspection, 163 were referred from the School Clinic, 117 were " under observation" cases re-examined, 43 were re-examined at parents' request. The 622 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 6/6 65 74 55 63 38 35 17 11 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 622 children examined, 500 were found to require spectacles, 196 being children who had previously had spectacles and 304 (new cases) by reason of the following defects:— 132 Myopia 55 Myopic Astigmatism 33 Hypermetropia 37 Hypermetropic Astigmatism 136 Mixed Astigmatism 23 Anisometropia 5 Hypermetropia with Squint 10 Total 304 Of the remaining 122 children, (a) 18 were suffering from the following other diseases, and spectacles were not prescribed: — Asthenopia 4 Amblyopia 2 Corneal Ulcers, Nebulae, Conjunctivitis, etc. 6 Paralysis of Orbital Muscles 1 Cataract 2 Retino-Choroiditis 1 Dacryocystitis 1 Strabismus 1 38 (b) 36 children were found not to require spectacles, having no refractive error requiring correction. (c) 68 children were kept under observation and were reexamined during the year. In addition to the above, the School Oculist examined 31 children from the County High School and prescribed spectacles in each case. Under the Education Committee's scheme 404 complete pairs of spectacles were provided, some of these being renewals after breakages. Of this number, 14 pairs of spectacles were provided free, and 5 pairs at a reduced charge, on necessitous grounds. In addition, in 225 cases the lenses of spectacles were changed after re-examination or repairs of frames were carried out. (c) Orthopaedic Department.— This Department has sustained a great loss by the early death of Mr. J. B. Barnett, F.R.C.S. whose brilliant work and enthusiastic support placed the 133 -orthopaedic treatment of children in this town on a firm foundation. He was succeeded by Mr. H. J. Seddon, F.R.C.S., who took up duties on April 17th. The Orthopaedic Surgeon attended a total number of 21 sessions during 1931 and examined 233 individual children of school age, the Clinic being held twice monthly except in February, June and August, when only one Clinic was held during the month. A total number of 468 attendances were made by these children. The 233 children were found to be suffering from the following defects: — Paralyses: — Infantile paralysis 22 Spastic monoplegia 2 ,, paraplegia 2 ,, hemiplegia 2 Facial palsy 4 Spinal curvature:— Scoliosis 29 Lordosis 6 Kyphosis 11 Congenital equino-varus (club-foot) 11 Torticollis (wry-neck) 5 Genu valgum (knock-knee) 34 Genu varum (bow-leg) 5 Flat feet 26 Round shoulders 30 Pigeon chest 10 Other defects 34 233 Ten children of school age were admitted to the Country Branch of the Royal National Orthopaedic Hospital at Stanmore, Middlesex, in 1931, suffering from (1) pes valgus, (2) congenita] dislocation of the hip, (3) dislocation of left ulnar nerve over condyle, (4) left torticollis, (5) congenital equino-varus, (6) genuvalgum, (7) infantile paralysis, (8) right spastic hemiplegia, (9) spastic paraplegia, (10) osteomyelitis. Eight children were discharged during the year, 3 of whom were admitted during 1930, and 5 were still in the institution on the 31st December, 1931. 134 The Masseuse has attended the Clinic for Orthopaedic treatment and Remedial exercises every Monday, Wednesday and Friday mornings, to carry out the treatment recommended. An extra session was arranged on Wednesday afternoons commencing April 8th. A total number of 152 visits were made by the Masseuse to the Treatment Clinic during 1931. There were a total number of 142 individual children of school age treated during the period mentioned, and a total number of 3,497 attendances were made by these children. Ten pairs of padded wooden splints (1 free of charge), also instruments in 4 cases, were supplied to school children during the year. 43 cases were discharged by the Orthopaedic Surgeon during the year, 8 cases left the district and 13 cases left school or were transferred to private or secondary schools. All oases discharged are followed up and examined periodically at school with a view to ascertaining the permanence of the cure. As a result of the following up, 18 cases discharged from the Orthopaedic Clinio were re-examined at school medical inspection, 13 of these being found to be permanently cured; of the remaining 5 cases, 1 was advised to continue breathing exercises at home; in 4 other cases the condition was considerably improved, and the children are being kept under observation. yd) Dental Department.— During the year the Dentists paid 199 visits to the schools for the purpose ol 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 16,273 children inspected by the Dentists (including special cases), 9,020 (or 55.4 per cent.) were found to require treatment, compared with 135 6,738 (or 56.8 per cent.), 1930; 60.6 per rent., 1929; 60.1 per cent., 1928; 56.9 per cent., 1927; 56 per cent., 1926; 56 per cent., 1925. 43.4 per cent, of the cases requiring treatment obtained it at the School Clinic. In 1930, 57.9 per cent.; in 1929, 50.8 per cent.; in 1928, 39.5 per cent.; in 1927, 50.1 per cent.; in 1926, 45.9 per cent.; in 1925, 47.6 per cent; in 1924, 62 per cent.; in 1923, 53.3 per cent.; in 1922, 41.1 per cent, acceptances of treatment were received. In addition to the ordinary dental work of fillings and extractions, a considerable amount of "regulation" work has been done. 55 regulation plates were supplied during 1931. 2,057 visits were made by children to the Dental Clinic for regulation purposes. 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 2,148 1,278 59.14 6 2,727 1.239 45.44 7 2,730 1,479 54.14 8 2,010 1,277 60.55 9 1,732 1,174 66.05 10 1,694 1,062 62.69 11-12 1,859 1,211 P5.09 136 The following table shows the percentage of acceptances of treatment by the School Dentists in the various departments of the schools during 1931:— School. Department. Number inspected. No. referred for treatment. No. of acceptances of treatment. Percentage of acceptances. Barkingside Sen. Mixed 404 214 41 19.15 Becontree Mixed Boys 377 286 63 22.02 „ Mixed Girls 407 270 61 22.59 „ Lower 967 660 205 31.06 ,, Sen. Boys 113 90 14 15.55 „ Sen. Girls 119 88 11 12.50 Catholic Up. Mixed 296 135 60 44.44 „ L. Mixed 137 96 47 48.95 Chadwell Mixed 513 374 121 32.35 Christchureh Boys 269 127 44 34.64 „ Girls 265 122 27 22.13 „ Jun. 755 441 175 39.70 Cleveland Boys 246 134 30 22.38 ,, Girls 282 160 47 29.37 „ Jun. Mixed 463 188 137 72.87 Downshall Boys 333 148 64 43.24 „ Girls 412 187 81 43.31 „ Jun. 885 404 203 50.24 Fairlop Mixed 470 334 90 26.94 Gearies Middle 330 248 136 54.83 ,, Lower 703 332 166 50.00 ,, S. Boys 122 69 21 30.43 ,, S. Girls 146 93 39 41.93 Goodmayes Boys 349 275 102 37.09 ,, Girls 285 235 97 41.27 „ Jun. 774 467 183 39.18 Gordon Mixed 463 279 83 29.74 Highlands Boys 238 160 62 38.75 „ Girls 286 185 72 38.91 „ Jun. 616 284 98 34.50 Little Heath Mixed 139 104 21 20.19 Loxford Boys 275 228 45 19.73 Mayesbrook Mixed 365 259 55 21.23 Newbury Park Sen. Mixed 248 216 67 31.01 „ Jun. ,, 316 237 65 27.42 Open Air Mixed 253 86 84 97.67 South Park Middle 265 185 45 24.32 ,, Lower 371 166 66 39.75 St. Vincent Mixed 129 83 31 37 .34 Uphall Jun. 155 102 55 53.92 Valentines Lower 192 90 69 76.66 Woodland Jun. 281 185 97 52.43 Mount G irls 227 93 18 19.35 With regard to ohildren 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 137 the percentage of acceptances of treatment as a result of the Dentists' 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. Becontree Jun. 106 104 51 49.03 Chad we 11 „ 83 69 31 44.92 Christchurch ,, 55 51 34 66.66 Cleveland ,, 34 34 15 44.11 Downshall ,, 118 110 70 63.63 Fairlop ,, 54 54 31 57.40 Gearies ,, 141 136 101 74.26 Goodmayes ,, 135 132 90 68.18 Gordon ,, 93 89 43 48.31 Highlands ,, 30 26 18 69.23 Little Heath ,, 33 31 11 35.48 Mayesbrook ,, 48 44 25 56.81 Newbury Park ,, 59 56 22 39.28 Catholic ,, 53 49 24 48.97 South Park ,, 78 75 62 82.66 St. Vincent ,, 69 65 31 47.69 Uphall ,, 32 29 22 75.86 Valent ines ,, 31 26 20 76.92 Woodlands ,, 145 141 82 58.15 Totals .. 1,397 1,321 783 59.27 In addition to these figures, the Dentist has carried out three complete inspections of the children's teeth at the Open-Air School, and all those referred for treatment, viz.: 84, 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 157. (e) Treatment of Uncleanliness.— It was found necessary to deal with 125 children under the Education Act, 1921. Section 87, statutory notices being served on the parents. In 34 instances the statutory notices not being complied with, the children were brought to the School Clinio by the Nurse and cleansed. 138 The School Nurses paid 210 visits to the school (an average of 7 visits to each school during the year), for the purpose of inspecting the heads and clothing of the children, with the following result:— Number of Children Inspected. Number Infected. Per Cent. 58,643 1,773* 3.0 *177 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 the past ten years were as follows: — 1922 5 1923 5 1924 4 1925 4 1926 3 1927 2.9 1928 2.8 1929 2.9 1930 3.3 1931 3.0 No prosecutions were instituted during 1931 under Section 87 of the Education Act, 1921. During 1931 the ambulance was used on 34 occasions to bring verminous children to the Sohool Clinic for cleansing purposes. (f) Other Ailments.— During the past year 203 children have been operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford. 11 children were treated free during the past year, and 4 at a reduced charge, on necessitous grounds. In addition, 13 children have been operated on for the removal of enlarged tonsils and adenoids under the agreement with the King George Hospital, all being treated as in-patients. 1 was treated free and 2 at a reduced, charge. In addition to the treatment of tonsils and adenoids, 61 letters were given to Ilford school children, for whom hospital treatment was required, to attend at Queen Mary's Hospital. 139 9. Open-Air School.— During 1931, 58 children were admitted, 11 ceased attendance, and on the 31st December, 1931, 111 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:— School Medical Officer's Department 41 Director of Education's Department 5 Hospitals 3 Tuberculosis Officer 6 Others 3 The above 58 children were admitted to the Open Air School for the following reasons:— School Medical Officer's Department:— Anaemia and subnormal nutrition 30 Chronic bronchitis 1 pulmonary catarrh and asthma 1 Pulmonary Fibrosis 1 Post tuberculosis 2 Probable Post— Encephalitis Lethargica 1 Spastic diplegia 1 Spinal caries 1 41 Director of Education's Department:— Haemophilia 1 Anaemia and subnormal nutrition 4 5 Hospitals:— Pulmonary Fibrosis 1 Rheumatic carditis 1 Mitral stenosis 1 3 Tuberculosis Officer:— Bronchitis 1 Tuberculosis adenitis 1 Subnormal nutrition 4 6 140 Others:— Subnormal nutrition 2 Post chorea 1 3 The 41 children not now on the school-roll ceased attendance for the following reasons:— Found fit to resume attendance at ordinary School 29 Left the district 6 Admitted to Royal National Orthopaedic Hospital Country Branch, Stanmore 1 Unable to benefit by reason of mental defect 1 Physical condition retrogressing 1 Admitted to a Convalescent Home 1 Admitted to West Wickham Heart Home 1 Admitted to Sanatorium 1 All cases discharged from the Open-Air School, and subsequently re-admitted to ordinary schools, are re-examined at school. Of the 41 children ceasing attendance during 1931. 24 were readmitted to ordinary schools and are being kept under observation. 5 being over 14 years of age did not return to ordinary school. 41 of the children discharged since the opening of the school were re-exarnined at ordinary school during 1931 and 37 were found to have maintained their improvement in health, but in 4 cases the children's condition was stationary. Of the children admitted to the Open-Air School since its commencement in 1929, 8 children had never previously -attended school (of these 1 was admitted in 1929, 2 in 1930, and 5 in 1931), and 8 children had not been in attendance at school for long periods (of these 4 were admitted in 1929 and 4 in 1931). A Medical Officer has, since the inception of the School, attended one half-day every alternate week to examine and report upon special oases, 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. 141 In addition to this, the School Dentist has carried out three complete inspections of the children's teeth. The following table shows briefly the dental work carried out:- Number of children examined by the School Dentist 127 „ ,, referred for treatment 40 ,, ,, treated bv School Dentist 44 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 103 ,, ,, Cod-liver Oil Emulsion 38 ,, ... Virol 3 To see Oculist 8 Treatment for Otorrhcea, etc. 5 To see Orthopaedic Surgeon re Remedial Exercises, etc. 8 To see Tuberculosis Officer 1 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. During the year a rest shed has been provided with accommodation for an additional 20 children. The Head Teacher states: — During the year 1931, at six-monthly intervals, 1 have continued tlie Northumberland Standardised Educational Tests, and. once again the average increase in mental age for the School is above the adv; nee in chronological age, that is, thirteen months in the year. In view of the fact that in 1931 there were (52) fifty-two children in the school of 8—14 years of age, yet with a mental age of less than eight years in arithmetic—a. subject which gives a good general indication of a child's standard of educational attainments—it will be seen that this rate of progress is considerably greater than they can have made at any earlier stage of their school life. In considering the rate of progress of children at the Open-Air School, it must be borne in mind that m many cases the children's educational attainments are so low that previous progress must have been so slow, owing to ill-health with consequent non-attendance at school, as to be almost negligible. Many children on admission can only be classified as seven years—itnd until they pass the barrier of seven years (mental age) their progress, although it may be considerable, does not appear in the result. As the average chronological age of the School becomes lower, as is 142 the tendency, so are there more and more of those, lor the moment, unproductive seven years children (mental age). At the other end of the scale, those children who once reach the mental age of sixteen years can make no apparent progress, i.e., according to Northumberland Tests. I am glad to state that the provision of a myopic desk has been the means of changing one child's altitude to work. Until recently, the child participated in the oral lessons only, and lost in the other lessons that which she had gained. Her attitude towards work was erratic, and this affected her general demeanour. For the last six months she has taken a keen interest in all written subjects, and, although several years' work have been lost, she is now working—slowly, it is true— on a level with her class. Average attendance for the year was 88, with an average roll of 104. There is little loss of attendance through trivial causes, in fact, in only seven cases do I feel that the attendanoe could be termed irregular. Most of the lost attendance is due to long absences, when it has been quite obvious that it was impossible for children to be in attendance. Twenty-two children have been absent for periods varying from five weeks to eighteen weeks. Fourteen of these children have spent part, or all, of their period of absence in hospital or convalescent home, returning to school at the earliest opportunity. In view of these figures it can be seen that the average of 88, with an average roll of 104. is actually a good result. 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 to Seaford, in July, 1930, was so successful and proved to have had such beneficial results, both educationally and physically, that the experiment was repeated in 1931. On June 19th a party of 27 children from the Open-Air School left Ilford to spend ten days at Seaford— being accommodated once again at Flint House. Again the School journey party was fortunate, the weather was favourable and work, rest and play was taken under full "open-air" conditions. Everything went smoothly with no untoward incident to mar the happiness of the children, who returned at the end of the ten days looking remarkably fit, and with a decidedly stronger interest in work. The total cost of the School Journey was £78 15s. 11a. The maximum amount charged per child was £2 10s. Every child made a contribution towards the cost of the holiday, the subscriptions ranging from 10s. to £2 10s. 10. Physical Training.—The following is the report of the Supervising Instructor in Physical Training:— 143 I.— Staff. No increase in the staff has been made during the year. 11.— Duties and Organisations. My duties as Supervising Instructor in Physical Training continue to lie 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 Authority's schools. Staff conferences and practical demonstrations still constitute an important part of the general routine. The whole of the work is governed by the relevant Syllabuses issued from time to time by the Board of Education. Regular and systematic visits have been made during the year to the schools, the public baths and the various playing fields- 111.— Special Features. I a) During the year facilities were provided at The Mount School for the holding of voluntary classes in physical training for members of the teaching staff (both sexes). The classes were much appreciated by all who availed themselves of the facilities provided. (b) On 15th January i visited, by arrangement with the London County Council, the Rachel McMillan Nursery School at Deptford, and viewed, with much interest, the school premises and organisation and the work of the pupils. On 6th and 7th March I attended the 12th Annual Conference, held in London, of the National Association of Organisers of Physical Education. An inspiring address by the Director of Education for the City of Bradford was a special feature of this gathering. (c) Throughout the year the various branches of the Ilford Schools' Sports Association continued their activities :n the promotion of athletic meetings and cricket, netball, hockey and football matches The annual swimming gala proved to be one of the most successful yet arranged, such result being, in my opinion, attributable, in no small measure, to the extended instruction rendered possible by the availability of considerably improved facilities, and to the sustained popularity of the arrangements made in respect of winter swimming. (d) I am gratified to record that appreciable economy has been effected as a result of the supply to the schools of a new type of non-inflatable rubber ball, which has been issued to them for experimental use in connection with physical training games. This ball replaces the inflatable football, which has been used in the past, and, in actual practice, has proved in every way satisfactory. (e) Steady progress is being made in the group of schools reorganised in accordance with the Hadow principles last Easter, The work being performed at the Beal Modern School, opened in August last, shows promise. 144 (f) During the period covered hy this report, cases of minor defect referred by the School Medical Officer have received appropriate attention. (g) School playgrounds have again been marked out for the purpose of assisting in the conduct of games and activity excercises; and attention has been given to the provision, where necessary, of additional apparatus. (h) 1 again express my full appreciation of the valuable assistance rendered bv the Handicraft Centre and the Works Department in connection with the repair and construction of apparatus for use during the physical training and at various sports meetings. IV.— Review of General Position. I have much pleasure in stating that the work, in all its branches, continues to develop; the general position evidences a pronounced tendency in the direction of steady progress; and the loyal co-operation of all concerned is worthy of special note. The re-ults obtained during the last few years are extremely gratifying, especially in view of the difficulties which arise as a natural result of the phenomenal growth of the Borough. F. J. ROBERTS. Supervising Instructor in Physical Training. 31s£ December, 1931. 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 1931. 11a. Supply of Free Cod-Liver Oil Emulsion, Cod-Liver Oil and Malt, etc.— During 1931, 20 necessitous cases were dealt with. 12. School Baths.— Vide Annual Report. 1920. 13. Co-operation of Parents.— During 1931, 5,253 parents, or 80 per cent., attended the medical inspections. 14 and 15. Co-operation of Teachers and Attendance: Officers.—Vule Annual Report, 1920. 145 16. Co-operation of Voluntary Bodies.— Since January 1920, 1 have acted as Hon. District Correspondent for the National Society for the Prevention of Cruelty to Children. Inspector Bartholomew has continued to render very valuable services in this district, with excellent results. The following is a brief resume of the work done by the Society in Ilford during the past year :— Total number of cases investigated, 36, made up as follows :— (1) Of neglect 28 (20 reported from the Public Health Department, for neglecting medical advice, and 8 reported from other sources for general neglect.} (2) Ill-treatment cases 4 (3) Other causes 4 70 children (30 boys and 40 girls) were involved, 47 being of school age. In addition to this work, 148 supervision visits were paid to different cases, some of which were made to those reported during the previous year. 17. Physically and Mentally Defective Children.—A return of all children falling within this category is included in Table III, information having been obtained from the records in this department and from a circular addressed to all the Head Teachers of the various departments of the public elementary schools. (a) Physically Defective Children :— During 1931 seven cases were referred for medical examination and report by the School Medical Officer, and the following is a detailed summary of the children dealt with under this heading :— Partially Blind Children.— Recommended for Special School 3 Crippled Children.— Recommended School for Cripples 2 Spina Bifida Case.— Recommended School for Physically Defective Children 1 6 146 1st. Totally and Partially Blind Children.— There are 2 children so blind that they can only be appropriately taught in a school or class for totally blind children; one of these is in a certified residential school for the blind, and the other is in Oldchurch Hospital. There are 13 children who, although they cannot read ordinary school books or cannot read them without injury to their eyesight, 1'Mve such power of vision that they can appropriately be taught in a school or class for the partially blind. Five of these children are in certified residential schools for the blind or partially blind, 1 being also deaf and dumb Eight cases are awaiting admission to certified residential schools for the blind or partially blind (5 are attending ordinary elementary schools, 1 is attending the Benton Open-Air School, 1 (aged 14 years) is not attending any school, and 1 being also deaf and dumb is not attending any school). 2nd. Totally and Partially Deaf and Dumb Children.— There are 9 children so deaf that they can only be appropriately taught in a school or class for the totally deaf. All these children are also dumb or partially dumb. Six are in residential special schools for the deaf, and 3 are awaiting admission to a special school and not at present attending any school (1 being over 14 years of age). There are 2 children who can appropriately be taught in a school or class for the partially deaf, awaiting admission to a special school, who are at present attending public elementary schools. In addition, there is 1 mentally defective (feeble minded) child who is also dumb. 3rd. Epileptic Children.— There are 3 children suffering from severe epilepsy, 1 is in a certified residential school for epileptics and 2 are not attending any school. In addition, there also 4 children included under "Children Suffering from Multiple Defects," 3 mentally deficient and epileptic (1 is attending a certified residential school for epileptics, 1 is attending a public 147 elementary school, and 1 is in Oldchurch Hospital). The remaining child is a cripple as well as being epileptic, and is over 14 years of age. There are 16 children suffering from epilepsy whose disease is of such a kind as not to unfit them for attendance at an ordinary elementary school. 4th. Tuberculous Children.— There are 14 children notified as suffering from pulmonary tuberculosis. Of these, 6 are active cases, 2 being in sanatoria, 2 are in Oldchurch Hospital, and 2 are not attending school. Of the remaining 8 cases of quiescent or arrested tuberculosis, 2 are attending school, and the remainder are all over 14 years of age, and are not attending any school-. Thirty-seven children are notified as suffering from glandular tuberculosis. 29 are at present attending school (8 being in the Open-Air School), 6 are not attending any school, 1 is in a sanatorium and 1 is in a convalescent home. In addition, there is also 1 child included under "Children Suffering from Multiple Defects," who is an imbecile, and also has tubercular glands. There are also 17 children notified as suffering from other forms of tuberculosis, of whom 3 are in sanatoria, 8 are attending school, 3 are in hospital and 3 are at no school or institution. 5SA. Crippled Children.— There were at the end of the year 87 crippled children (other than those with active tuberculous disease) who are suffering from a degree of crippling sufficiently severe to interfere with the children's normal mode, of life-, 8 of these were not attending school (4 being over 14 years of age), 66 were attending public elementary schools, 1 was attending a private school, 1 was attending a Cripples' Training College, 2 were attending certified day cripple schools, 2 were attending certified day open-air school in Ilford, 1 was at a certified residential cripple school, and the remaining 6 at certified hospital cripple schools. In addition, there were also four children included 148 under the heading "Children suffering from multiple defects"; of these children, two were mentally defective (feeble-minded) as well as cripples, one was crippled and blind, and one was a severe epileptic as well as being a cripple. None of the four latter children were attending school. 6th. Children suffering from severe heart disease. There are 5 children with severe heart disease; 4 are not attending school and 1 is at a certified residential cripple school. All physically defective children of school age not in institutions are examined every six months by the Assistant Medical Officers. (b) Mentally Defective Children:— During 1931 I medically examined and reported upon 14 children under the Mental Deficiency (Notification of Children) Regulations, 1928, classified as follows: — Feeble-minded Children.— Total number certified in 1931 7 Recommended for admission to a special school (day or residential 4 Recommended for admission to a special school (residential) 3 idiot Children.— Total number certified in 1931 5 Recommended for admission to a residential institution 6 Imbecile Children.—Total number certified in 1931 1 Recommended for notification to Essex County Council 1 Dull and Backward Children.— Total number certified in 1931 1 Recommended attendance at special class for dull and backward children for one year, and then to be reexamined 1 The following table shows the mental age (by the Binet Simon tests) and the intelligence quotient of the feeble-minded children examined during 1931. The border-line of mental deficiency is where the intelligence quotient is about 75. 149 Actual age in years. Mental age in years. intelligence Quotient. 5.75 2.80 48.70 6.25 3.17 50.72 7.25 5.60 77.24 7.66 6.00 78.33 7.87 5.60 70.92 10.92 6.80 62.29 11.17 7.25 64.91 (1) Idiots.—Idiots are, within the meaning of the Mental Deficiency Act, 1913, persons so defective in mind from an early age as to be unable to guard themselves against common physical dangers. The Authority responsible for dealing with such children is the Essex County Council. There are 21 cases under the age of 16 years known to the department. Eight 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 18 cases under the age of 16 years known to the department, 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 1931) 52 such oases under the age of 16 years known to me, of whom 17 are attending public elementary schools in the district, 1 is in a Convent School, 1 is at Oldchureh Hospital, 18 are in residential schools, and 14 are not at school (9 being over 14 years of age). All mentally defective children are visited at home by the School Nurses at least once a quarter. 150 In addition to these, there are 3 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. 14 children were thus examined during 1931. 18, 19, 20. Nursery Schools, Secondary and Continuation ,Schools.— Vide Annual Report, 1920. 21. Employment of School Children and Young Persons. —From special enquiries made at the various schools during 1931, it was found that 115 children were employed out of school hours. 9 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 9 The Juvenile Employment Committee has, during the past year, found occupation for 946 children, as follows: — ON REGISTER, 1st JANUARY, 1931:— Boys. Girls. Total. Claimants 30 8 38 Non-claimants 21 36 57 Totals 51 44 95 Fresh Claims to Unemployment Insurance Benefit 219 164 383 Renewal Claims 268 114 382 Totals 487 278 765 Fresh Registration (for work only) 599 468 1067 Re-registrations 151 249 400 Totals 750 717 1467 151  Boys. Girls. Total. Total number of young persons dealt with during the year 1288 1039 2327 Placed by Bureau: Locally 408 396 804 Placed by Bureau: Non-locally 96 46 142 Totals 504 442 946 22. Miscellaneous.— In accordance with the Education Committee's regulations, the undermentioned bursars, student-teachers, teachers and school caretakers were medically examined and reported upon during the year by the School Medical Officer :— Bursars 20 Student-teachers 14 Newly-appointed teachers 44 Teachers absent through illness 4 School caretakers 4 Total 86 Re-examinations:— Bursars 3 Student-teachers 1 Newly-appointed teachers 1 Teacher's Sickness Regulations 1 Total 6 23. New School Clinic.— The plans for the erection of a school clinio and infant welfare centre on the Mayesbrook School site at a cost of £7,500 were approved by the Education Committee in February, but in September it was decided to postpone the election of the building for the present. Tablk I.— Return of Medical Inspections. A.— Routine Medical Inspections. Number of Code Group Inspections:— Entrants 2,141 Intermediates 2.209 Leavers 2,191 Total 6,541 Number of other Routine Inspections Nil Other Inspections. Number of Special Inspections:— Medical inspection at School 439 At School Clinic 2,126 Number of Re-Inspections:— Medical Inspection at School 3,780 At School Clinic 5,251 Total 11,596 152 Table II, A.— Return of Defects found by Medical Inspection in the Year ended 31st December, 1931. Defect or Disease. Routine Inspections. Special^ Inspections No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requ iri ng Treat men t. Requiring Treatment. Requiring to be kept under observation , but not requiringTreatment. (1) (2) (3) (4) (5) Malnutrition 8 6 14 Unoleanliness:— — — — - (See Table IV., Group V.) Skin 'Ringworm: Scalp — — 7 - Body 2 — 7 - Scabies 3 — 24 - Impetigo 7 — 165 - Other Diseases (Non-Tuberculous) 55 16 389 1 Eye Blepharitis 14 2 18 - Conjunctivitis 6 1 99 - Keratitis — — 1 - Corneal Opacities — — 1 - DefectiveVision(exoludingSquint) 262 159 79 3 Squint 12 8 4 — Other Conditions 9 6 64 — Defective Hearing 18 8 15 — Ear Otitis Media 6 15 34 1 Other Ear Diseases 8 4 46 1 Nose and Throat Enlarged Tonsils only 137 244 122 1 Adenoids only 12 7 12 — Enlarged Tonsils and Adenoids.. 77 23 157 — .Other Conditions 36 22 204 3 Enlarged Cervical Glands (Non-Tuberculous) 17 33 47 2 Defective Speech 15 9 1 — Teeth—Dental Diseases 622 — 76 — (See Table IV., Group IV.) Heart and Circulation 'Heart Disease:— Organic — 21 7 — Functional — 29 3 1 .Anaemia .. 55 52 54 2 Lung Bronchitis 134 122 44 — Other Non-Tuberculous Diseases 2 6 5 — Tuberoulosift 'Pulmonary:— Definite — — — — Suspected 2 — — — Non-Pulmonary:— Glands — — 1 — Spine 1 — — — Hip — — — — Other Bones and Joints — — — — Skin 2 — — Nervous System Other Forms — — — — Epilepsy 2 2 3 — Chorea 2 1 8 1 Other Conditions 25 24 29 — Deformities Rickets — — — — Spinal Curvature 15 — 4 — Other Forms 90 22 20 — Other defects and diseases 320 177 516 7 153 Table II.— Continued. B.— Number of individual Children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases.) Group. (1) Number of Children. Percentage of Children found to require Treatment (4) Inspected. (2) Found to require Treatment. (3) Code Groups :— Entrants 2,141 447 20.8 Intermediates 2 209 419 18.9 Leavers 2,191 387 17.6 Total (Code Groups) 6,541 1,253 19.1 Other Routine Inspections — — — 154 Table III.— Return of all Exceptional Children in the Area on 31st December, 1931. Boys Girls Total Children suffering from the following types of Multiple Defect, i.e., any combination of Total Blindness, Total Deafness, Mental Defect, Epilepsy, Active Tuberculosis, Crippling (as defined in penultimate category of the Table), or Heart Disease The actual combination of defects and the type of School, if any, attended are indicated on a separate statement following this Table. 4 4 8 Blind (including partially blind) (i) Suitable for training in a School for the totally blind At Certified Schools for the Blind 1 1 At Public ElementarySchls. - - - At other Institutions 1 — 1 At no School or Institution - - - (ii) Suitable for training in a School for the partially blind At Certified Schools for the Blind or Partially Blind 4 1 5* AtPublic ElementarySchls. 2 4 6 At other Institutions — — — At no School or Institution 2 — 2*ø Deaf (including deaf and dumb and partially deaf) (i) Suitable for training in a School for the totally deaf or deaf and dumb At Certified Schools for the Deaf 4 9 6 AtPublic ElementarySchls. — - — At other Institutions — — At no School or Institution 1 2 3ø (ii) Suitable for training in a School for the partially deaf At Certified Schools tor the - - - AtPublic ElementarySchls. 2 — 2 At other Institutions — — — At no School or Institution — — — Mentally Defective Feebleminded At Certified Schools ior Mentally Defective Children 11 7 18 At Public Elementary Schls. 6 10 16 At other Institutions I 3 4† At no School or Institution 8 3 11‡ Notified to the Local Mental Deficiency Authority during the year. See Table IIlA Epileptics Suffering from severe epilepsy. At Certified Schools for Epileptics 1 1 At Certified Residential Open Air Schools At Certified Day Open Air Schools At Public ElementarySchls. — — At other Institutions — — — At no School or Institution 2 — a Sufferingfrom epilepsy which is not severe At PublicElementarvSchls. 11 5 16** At no School or Institution — — — * 1 of these children is also totally deal and dumb. † 3 of these children are at Dr Barnardo's Girls' Village Homes, Barkingside. ‡ 7 of these children are over 14 years of age. ø 1 of these children is over 14 years of age. ** 1 of these children is in Mossford School, Dr. Barnardo's Girls' Village Homes, Barkingside. 155 Table III.— Continued. — Boys Girls Total Physically Defective Active pulmonary tuberculosis (including pleura and intrathoracic glands) At Sanatoria or Sanatorium Schools approved by the Ministrj' of Health or the Board 2 2 At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools - - - At other Institutions — 2 2 At no School or Institution 1 1 2 Quiescent or arrested pulmonary tuberculosis (including pleura and intrathoracic glands). At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools 1 1 2 At other Institutions - - - At no School or Institution 3 3 6* Tuberculosisof the peripheral glands. At Sanatoria or Sanitorium Schools approved by the Ministry of Health or the Board - 1 1 At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools 3 5 8 At Public Elementary Schools 13 8 21 At other Institutions 1 — 1 At no School or Institution 5 1 6§ Abdominal tuberculosis At Sanatoria or Sanitorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools .. - - - At Certified Day Open Aii Schools - - - At Public Elementary Schools 1 3 4 At other Institutions — 2 2 At no School or Institution — — — * All of these children are over 14 years of age. § 4 of these children are over 14 years of age. 156 Table III. — Continued. — — Boys Girls Total Physically Defective (continued) Tuberculosis of bones and joints (not including deformities due to old tuberculosis). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 2 1 3 At Public Elementary Schls. — 2 2 At other Institutions — 1 1 At no School or Institution 1 2 3 Tuberculosis of other organs (skin. etc.). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board - - - At Public Elementary Schls. 1 1 2 At other Institutions — — - At no School or Institution — — — Delicate Children, i.e. all children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open Air School. At Certified Residential Cripple Schools 1 - 1 At Certified Day Cripple Schools - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools 53 47 100 At Public Elementary Schls. 36 30 66 At other Institutions 1 1 2 At no School or Institution 1 1 2 Crippled Children (other than those with active tuberculous disease) who are suffering from a decree of crippling sufficiently severe to interefere materially with a child's normal mode of life. At Certified Hospital Schools 4 2 6 At Certified Residential Cripple Schools - 1 1 At Certified Day Cripple Schools 1 1 2 At Certified Residental Open Air Schools - - - At Certified Day Open Air Schools - 2 2 At Public Elementary Schls. 36 30 66 At other Institutions 2 — 2 At no School or Institution 6 2 8* Children with heart disease, i.e., children whose defect is so severe as to necessitate the provision of educational facilities other than those of the public elementary school. At Certified Hospital Schools — — - At Certified Residential Cripple Schools - 1 1 At Certified Day Cripple Schools - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schls. - - - At other Institutions 1 - 1 At no School or Institution 2 1 3 * 4 of these children are over 14 years of age. 157 Table III. Return of all Exceptional Children in the Area. Children Suffering from Multiple Defects . Statement showing combination of defects from which the children under the first heading of Table III are suffering, and type of school attended. 1 boy Mentally Defective (feeble-minded) and also Epileptic. At a Public Elementary School. 1 boy Mentally Defective (feeble-minded) and also a cripple. At no school. 1 boy Severe Epileptic and also Mentally Defective (feeble-minded). At Certified School for Epileptics. 1 boy Physically Defective (Tuberculosis of peripheral glands) and also an imbecile. At no school. 1 girl Mentally Defective (feeble-minded) and also Epileptic. At no school. 1 girl Mentally Defective (feeble-minded) and also dumb. At no school. 1 girl Mentally Defective (feeble-minded) and also a cripple. At no school. 1 girl Severe Epileptic and also a cripple At no school. 158 Table IIIa. Statement op the Number op Children Notified During thb Year Ended 31st December, 1931, by the Local Education Authority to the Local Mental Deficiency Authority. Total number of children notified 8 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 (6) Imbeciles 1 1 (c) Others - - ii. Children unable to be instructed in a Special School without detriment to the interests of the other children: (a) Moral defectives — — (6) Others - - (2) Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 3 1 (3) Feeble-minded children notified under Article 3, i.e., "Special Circumstances" cases — — (4) Children, who in addition to being mentally defective, were blind or deaf — — Grand Total 5 3 159 Table IV— Return of Defects Treated during the Year ended 31st December, 1931. TREATMENT TABLE. Group 1.— Minor Ailments (excluding Uncleanliness, for which see Group V). Disease or Defect. Number of Defects treated or under treatment during the year. Under the Authority's Scheme Otherwise. Total. (1) (2) (3) (4) Skin:— Ringworm—Scalp 7 — 7 Ringworm—Body 7 — 7 Scabies 21 — 21 Impetigo 159 — 159 Other skin disease 382 27 409 Minor Eye Defects 184 13 197 (External and other, but excluding cases falling in Group II.) Minor Ear Defects 94 39 133 Miscellaneous 505 434 939 (e.g., minor injuries, bruises, sores, chilblains, etc.) Total 1,359 513 1,872 160 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) 622 52 24 698 (Operations for Squint should be recorded separately in the body of the Report). Other Defect or Disease of the Eyes (excluding those recorded in Group 1.) - 4 - 4 Total 622 56 24 702 Total number of children for whom spectacles were prescribed :— (a) Under the Authority's Scheme 500 (b) Otherwise 76 Total number of children who obtained or received spectacles :— (a) Under the Authority's Scheme *629 (b) Otherwise 76 *This number includes 225 children whose spectacles have been changed or repaired. Group III.— Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total Number treated. Under the Authority'8 Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total (1) (2) (3) (4) (5) 216 90 306 19 325 161 Table IV.— Continued. Group 1 V.— Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentists:— Aged 5 2,l48 Total 14,900 Routine Age Groups 6 2,727 7 2,730 8 2,010 9 1,73 10 1,694 11 1,859 Specials 1,373 Re-inspections 1,397 Grand Total 17,670 (b) Found to require treatment 9 020 (c) Actually treated 3,917 (d) Re-treated 1 ,446 (2) Half-days devoted to Inspection 199 \ Total 969 Treatment 770 / (3) Attendances made by children for treatment 7,034 (4) Fillings Permanent Teeth 3,109 Total 6,729 Temporary Teeth 3,620 (5) Extractions Permanent Teeth 833 Total 8,545 Temporary Teeth 7,712 (6) (a) Administrations of general anaesthetics for extractions 1,444 (b) Administrations of local anaesthetics for extractions 3,149 (7) Other operations Permanent Teeth 2,376 Total 3,053 Temporary Teeth 677 Group V.— Uncleanliness and verminous conditions. (i.) Average number of visits per school made during the year by the School Nurses 7 (ii) Total number of examinations of children in the Schools by School Nurses 210 (Hi ) Number of individual children found unclean *1,773 (iv.) Number of children cleansed under the arrangements made by the Local Education Authority 34 (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil (b) Under School Attendance Bye-laws Nil *In addition 111 children were found unclean at medical inspection and in the School Clinic. 162 163 Table V— Table showing number of Children Medically Inspected at various Schools during 1931. Ages—Years. 5—6 6—7 7—8 8—9 9—10 10—11 11—12 12—13 13—14 14—15 15—16 Totals. SCHOOLS. Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Routine. Barkingside - - - - - - 5 7 7 5 2 4 2 3 18 10 l 1 - - - - 35 30 Beal Modern — — — — — — — — — — 2 56 80 14 9 - 2 - 1 - 1 70 95 Beoontree 107 98 36 29 23 18 109 140 22 18 18 24 12 20 107 84 10 13 - 1 - - 444 445 Benton 1 2 4 3 2 5 10 6 10 7 13 14 12 13 3 5 1 6 2 1 2 - 60 62 Chadwell 22 17 10 11 15 14 19 24 4 7 5 4 4 12 12 9 2 5 - - - - 93 103 Christchurch 71 67 11 12 8 8 70 59 9 3 3 3 2 7 26 30 2 3 2 - - - 204 202 Cleveland 36 59 7 10 5 14 93 91 26 24 17 13 2 1 11 15 1 - - - - - 198 227 Downshall 113 83 12 26 15 14 101 108 14 15 13 21 8 10 50 33 6 7 - 2 - - 332 319 Fairlop 55 31 5 4 7 5 31 26 — — — — - — — - — - - - - - 98 66 Gearies 87 77 11 12 15 11 76 72 8 8 9 9 5 10 36 38 4 3 - - - - 251 240 Goodmayes 51 36 12 8 8 6 88 54 13 4 15 5 5 2 50 3 5 — - - - - 247 145 Gordon 32 28 5 1 0 5 17 1 3 4 - - - - - - - - - - - - 62 45 Highlands 53 50 7 7 9 8 36 60 8 10 6 8 ; 11 14 26 2 4 - - - - 137 184 Little Heath 1 3 3 1 4 4 2 2 3 - - - 4 - 2 1 1 - - - - - 20 11 Loxford 51 37 10 4 3 3 53 42 6 7 12 9 10 5 48 21 6 3 2 2 - - 201 133 Mayesbrook 26 39 10 8 4 12 10 12 — 1 — 1 - - - - - - - - - - 50 73 Mossford — 39 — 32 — 24 — 55 — 35 - 34 - 32 - 104 - 21 - - - - - 376 Mount, The — — — — — — — — — — — 1 - 10 - 29 - 1 - - - - - 42 Newbury Park 42 31 6 1 5 4 38 28 3 5 3 3 1 1 23 20 1 1 1 - - - 123 94 Roman Catholic 14 15 5 11 8 8 34 26 7 6 5 4 5 2 15 11 4 2 2 1 - - 99 86 South Park 30 41 14 10 8 13 43 46 11 10 18 5 11 12 24 29 1 10 2 - - - 162 166 St. Vincent's 16 15 7 2 3 3 13 28 1 1 4 5 — 3 8 10 1 - - - - - 53 67 Uphall 34 29 5 6 6 8 16 26 — 1 — 4 1 6 3 22 1 - - - - - 66 102 Valentines 30 30 8 6 3 5 31 27 2 6 1 2 - 2 - - - - - - - - 75 78 Woodlands, The 25 23 2 — 3 6 8 3 — - - - - - - - - - - - - - 38 32 Total 897 850 190 204 159 198 903 949 157 177 144 175 142 242 464 536 49 83 11 8 2 1 3118 3423 Specials. Barkingside — - - - - - - - - - - - - - - - - - - - - - - 9 Real Modern - - - - - - - - -—- - - - - - - - - - - - - - - - Becontree 1 — 2 2 2 —- — 5 3 3 6 14 - 12 2 1 1 4 - - - - 19 41 Benton 2 3 2 5 14 11 12 10 18 18 20 14 32 38 8 10 5 9 4 5 2 2 119 125 Chadwell — — — — 1 — — 1 1 — — — - 1 - - - - - - - - 2 2 Christchurch - - - - - - - - 2 - - - - - - - - - - - - - 2 - Cleveland 1 — 1 1 1 2 2 3 2 2 1 1 - - - - - - - - - - 8 9 Downshall 4 — 2 - 2 3 — — — — — 1 2 - - - - - - - - - 10 14 Fairlop — — — I — — — — — - - - - - - - - - - - - - - 1 Gearies 2 1 — 1 3 — 3 — - 2 1 - - - - - - - - - - - 9 4 Goodmayes 2 1 — — 1 2 2 — 2 — 2 - - 1 1 - 1 - - - 1 - 12 4 Gordon 1 1 — — 1 — — — - - - - - - - - - - - - - 2 1 Highlands 3 — — 1 1 2 — 2 - 1 - 2 - - - - - - - - - - 4 8 Little Heath -— - - - - - - - - - 1 - - - - - - - - - - - 1 - Loxford — — 1 — — — 1 — — - - 1 2 1 - - - - - - - - 4 2 Mayesbrook — 1 - - - - - - - - - - - - - - - - - - - - - 1 Mossford — — — 1 - — — — - - - - - - - - - - - - - - - 2 Mount, The - - - - - - - - -—- - - - - - - - - - - - - - 1 - Newbury Park — — — — — — 1 1 — 1 - - - - - - - - - - - 1 3 Roman Catholic — 1 — — 1 — — 1 - - - - - - - - - - - - - - 1 2 South Park 1 - - - - - - - - - 1 - - - - - - - - - - - 2 - St. Vincent's — — 1 — 1 — 1 — 4 1 3 2 3 4 - - - - - - - - 13 7 Uphall — - 2 2 - 1 2 — - - - 1 - - - - - - - - - - 4 4 Valentines — — 1 — — — — 1 - - - - - - - - - - - - - - 1 2 Woodlands, The 1 - - - - - - - - - - - - - - - - - - - - - 1 - Total 18 8 12 14 28 21 24 24 3? 98 3s* 37 4] 58 11 13 7 14 4 5 3 2 215 224 164 165 Table VI. A — Table Showing the Average Heights and Weights of the BOYS Examined. School. Age Groups. Age Groups. 5—6 Years. 6—7 Years. 7—8 Years. 8—9 Years. 9—10 Years. 10—11 Years. 11—12 Years. 12—13 Years. 13—14 Years. Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds) Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches) Average Weight (In Pounds). Number of Children Examined. Average Height (In Inches). Average Weight | (In Pounds). Number of Children I Examined. Average Height [ (In Inches). Average Weight (In Pounds) Number of Children 1 Examined. Average Height (In Inches). Average Weight (In Pounds). 1 Number of Children 1 Examined. Average Height (In Inches). Average Weight (In Pounds). 1 Number of Children Examined. Average Height (In Inches). Average Weight (In Pounds). Barkingside - - - - - - - - . 5 51.18 57.55 7 50.78 61.95 2 52.36 69.23 2 55.53 88.40 18 55.53 75.18 1 59.84 87.76 Beal Modern — - — — — — — — — — — — — - - - - — 56 55.52 78.50 14 57.08 83.56 — — — Becontree 107 41.74 40.80 36 44.49 45.42 23 46.73 50.03 109 48.03 51.59 22 50.40 59.08 18 53.15 67.90 12 54.33 66.34 107 55.90 64.60 10 57.08 81.80 Benton Open Air 1 38.59 31.96 4 4410 40.13 2 49.21 55 .55 10 47 .64 48.06 10 50.40 55.77 13 51 .97 60.85 12 53.94 65.26 3 55.12 63.73 1 61 .04 97 .00 Chadwell 22 44.48 41.70 10 46.85 44.10 15 50.00 52.45 19 51.56 59.75 4 55.12 63.05 5 55.90 64.83 4 52.75 70.33 12 56.70 76.94 2 56.70 82.68 Christchurch 71 42.53 41.45 11 43.70 44.10 8 4...45 50.49 70 49.60 50.93 9 52.36 65.70 3 52.76 64.83 2 53.94 72.54 26 56.32 80.80 2 55.90 83.12 Cleveland 36 42.17 40.78 7 46.45 50.70 5 47.24 49.37 93 49.60 54.67 26 51.19 60.17 17 53.54 69.22 2 55.13 80.25 11 55.52 77.25 1 59.05 83.28 Downshall 113 42.90 42.55 12 45.7 45.57 1. 47.24 4960 101 49. 0 56.22 14 51.97 62.84 13 5314 67.69 8 53.94 72.75 50 56 70 79.83 6 57.87 84.66 Fairlop 55 42.13 40.90 5 46.05 44.98 7 48.04 56.00 31 48.43 58.82 — — — — .— — — — — — — — — — — Gearies 87 42.93 41.90 11 45.80 47.84 15 48 04 50.90 76 49.60 56.87 8 51.58 63.27 9 52.76 62.84 5 55.13 71.21 36 55.12 80.80 4 58.67 89.96 Goodmayes 51 42.92 41.85 12 45.67 46.08 8 48.04 51 .36 88 48.83 55.78 13 50.78 61.06 15 53.14 67.90 5 54.33 69.00 50 57.88 82.90 5 58.27 89.74 Gordon 32 42.13 41 68 6 45.67 46.73 i> 49.21 56.43 17 48.42 56.67 3 49.60 60.17 — — — — — — — — — — — — Highlands 53 43.30 41.23 7 44.48 46 .50 9 46 .45 47 .53 36 48.42 54.48 8 51.98 64.38 6 51.54 62.62 2 54.34 71.44 14 55.90 79.36 2 58 26 73.20 Little Heath 1 46 05 53.35 3 43.30 44.73 4 47.63 50 .46 47.63 5 t .46 3 47.23 58.22 — — — 4 56.31 88.40 2 50.61 63.27 1 56.70 79.37 Loxford 51 43.72 42.36 10 46.45 47.83 3 47.24 50.03 53 49.60 io.76 6 50.00 57.55 12 52.76 68.34 10 52.76 68.76 48 55.12 75.68 6 57.08 85.79 Mayesbrook 26 42.52 40.56 10 45.27 46.50 4 46.02 52.45 10 47.64 51.15 — — — — — — — — — — — — — — — Mossford Newbury Park.. 42 42.53 40.56 6 45.28 48.50 5 46.85 50.21 38 48.83 54.68 3 51.18 57.77 3 52.76 66.35 1 58.27 83.78 23 55.90 78.26 1 63.01 119.07 Roman Catholic 14 42.91 41.00 5 46.05 48.95 8 47.64 54 .90 34 49.21 56.00 7 51.58 61.06 5 53.54 68.56 5 55.52 76.28 15 56.30 79.83 4 60 .25 80.02 St. Vincent's .. 16 42.55 40.34 7 43 .30 42.78 3 46.85 50.71 13 48.42 53.58 1 51.56 57.34 4 53.15 65.28 — — — 8 54.74 68.35 1 53.54 69.68 The Mount South Park 30 43.30 43.20 14 44.58 47.95 8 47.64 53.56 43 49.20 55.77 11 50.40 61.06 18 5314 69.44 11 55.70 71.44 24 55.70 76.94 1 62.61 106.73 Uphall .. 34 42.53 40.78 5 46.45 49.15 6 46.05 48.06 16 48.83 55.55 — — — — — — 1 57.87 87.76 3 57.48 82.04 1 58.67 91.03 Valentines 3(1 42 .52 41.67 8 45.63 48.73 3 48.03 50 .49 31 49.60 57.55 2 51.58 71.87 1 52.36 66.57 — — — — ■— — — — Woodlands 25 43.30 41.90 2 44.40 42.34 3 48.03 50.94 8 50 .40 57.76 — — — — — — — — — — — — — Average Heights and Weights of I If or d Children 897 42 .84 41.04 190 45 31 46 49 159 47.56 51.94 903 4911 55 02 157 51.13 62.33 144 53 10 66.38 142 54 94 75.22 464 56.07 75.99 49 57.87 85.22 Anthropometric Standard (Boys). Ages. Ages. 5 Years. 6 Years. 7 Years. 8 Years. 9 Years. 10 Years. 11 Years. 12 Years. 13 Years. 1 Height (In Inches) 1 Weight (In Pounds) Height (In Inches) Weight (In Pounds) Height (In Inches) Weight (In Pounds) | Height (In Inches) Weight (In Pounds) Height (In Inohes) Weight (In Pounds) | Height (In Inches) Weight (In Pounds) | Height (In Inches) 1 Weight (In Pounds) j Height (In Inches) 1 1 j Weight (In Pounds) 1 | Height (In Inches) 1 | 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 77.40 166 167 Table VI. B.—Table showing the Average Heightsand 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 i hildren 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 — — — — — — — — — 7 48.83 50.49 5 52.76 67.04 4 55.13 67.69 3 55.52 76.50 10 57.08 78.94 1 57.88 75.41 Beal Modern — — — — — — — — — — — — — — — — — — 82 57.56 76.91 9 57.47 78.05 2 61.02 95.68 Becontree 98 41.25 38.36 29 44.48 43.23 18 46.45 49.38 140 48.41 50.93 18 50.79 59.96 24 52.36 60.85 20 53.54 69.88 84 55.98 75.10 13 59.05 92.15 Benton Open Air 2 42.13 37.93 3 43.30 39.24 5 46.05 44.53 6 49.21 50.04 7 50.00 50.94 14 52.76 57.55 13 53.32 65.70 5 59.84 77.37 6 58.67 78.50 Chadwell 17 42.92 38.80 11 46.85 45.20 14 48.04 48.28 24 50.00 53.35 7 52.76 58.42 4 50.00 64.80 12 58.66 79.59 9 60.64 78.94 5 59.84 95.25 Christchurch 67 42.92 41.68 12 43.30 41.45 8 47.24 51.80 59 48.60 53.79 3 51.57 56.44 3 52.76 63.94 7 54.73 73.65 30 56.70 77.36 3 58.68 102.79 Cleveland 59 41.74 38.57 10 44.10 42.26 14 46.85 48.28 91 48.83 52.48 24 50.78 59.30 13 53.54 68.78 1 56.35 71.87 15 56.70 83.34 — — — Downshall 83 42.88 39.24 26 44.87 44.54 14 46.05 46.94 108 49.29 54.56 15 52.76 60.63 21 53.54 65.70 10 54.33 76.50 33 57.08 77.60 7 61.04 90.47 Fairlop 31 42.48 39.71 4 43.74 38.38 5 48.42 52.45 26 48.04 51.36 — ~~ — — — — — — — — — — — — — Gearies 77 42.91 41.23 12 43.70 41.89 11 46.45 47.62 72 48.83 53.35 8 51.98 60.40 9 55.58 64.59 10 57.08 81.98 38 57.08 74.30 3 59.05 108.26 Goodmayes 36 43.30 41.90 8 44.49 44.75 6 47.64 50.48 54 48.20 53.13 4 50.40 57.77 5 52.76 65.26 2 51.98 61.74 30 56.70 80.57 — — — Gordon 28 42.50 39.75 1 46.05 48.95 5 47.55 49.22 7 49.20 52.55 4 50.78 56.66 — - — — — — — — — — Highlands 50 42.53 40.78 7 44.57 44.28 8 47.24 51.36 60 49.60 53.56 10 50.78 57.90 8 52.76 65.26 11 54.73 77/60 26 57.88 78.26 4 61.82 98.78 Little Heath 3 40.16 39.68 1 38.97 35.73 4 46.45 45.86 2 48.03 54.67 — — — — — — — — — 1 57.48 92.60 — — — Loxford 37 43.30 43.86 4 45.68 45.20 3 46.45 50.26 42 50.00 54.67 7 51.97 61.50 9 52.76 65.26 5 55.52 78/72 21 57.87 81.80 3 58.66 94.14 Mayesbrook 39 42.53 39.92 8 44.87 43.66 12 45.67 46.09 12 48.04 50.94 1 50.00 57.33 1 51.19 67.01 — — — — — — — — Mossford 39 41.74 41.88 32 43.30 45.63 24 46.05 50.04 55 47.40 55.77 35 49.60 61.29 34 51.58 67.47 32 53.54 75.84 104 55.52 80.25 21 58.27 97.60 Newbury Park.. 31 42.52 39.24 1 45.28 41.90 4 45.67 44.98 28 48.42 53.79 5 51.18 64.47 3 51.78 56.22 1 53.94 72.75 20 57.74 84.88 1 59.45 83.34 Roman Catholic 15 42.92 40.56 11 44.87 44.54 8 47.23 46.50 26 49.60 52.45 6 50.78 59.75 4 53.14 64.81 2 55.90 76.50 11 57.08 81.13 2 57.08 73.85 S.Vincent's R.C. 15 42.52 40.77 ?. 42.52 34.83 3 45.68 44.53 28 48.42 51.59 1 50.80 61.06 5 51.18 60.85 3 56.30 76.28 10 55.90 73 .20 — — — South Park 41 42.93 42.12 10 45.68 45.20 13 47.24 49.54 46 50.00 56.44 10 50.78 56.60 5 53.54 66.80 12 55.90 74.08 29 58.87 79.56 10 60.64 100.32 The Mount — — — — — — — — — — — — — — — 1 53.54 57.33 10 55.13 74.74 29 57.08 75.18 2 61.03 87.32 Uphall .. 29 42.92 39.68 6 45.67 45.64 8 49.60 55.55 26 48.41 55.24 1 50.40 51.37 4 50.17 72.54 6 55.13 76.94 22 55.90 77.12 — — — Valentines 30 42.53 42.75 6 45.49 44.75 5 48.03 52.24 27 49.60 57.33 6 52.76 67.69 2 53.14 62.84 2 53.54 75.62 — — — — — — Woodlands 23 43.30 40.34 — — — 6 48.04 53.13 3 46.85 58.64 — — — — — — — — — — — — Average Heights and Weights oj I If or d Children 850 42.52 40.13 204 43.47 43.39 198 47.02 49.51 949 48.71 53.41 177 51-18 59.32 173 53.00 67.81 244 55.15 75.01 536 57.38 78.93 83 59.48 92.91 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) 1 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 80.37 168 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, 1931. SCHOOLS. Number on Roll. DISEASES AND CONTACTS. Scarlet Fever. Diphtheria. Measles & German Measles. Chickenpox. Whooping Cough. Mumps. Smallpox. Ringworm . Totals. 1931. Totals. 1930. Cases. Contacts. Cases. Contacts. Cases. Contacts. J Cases Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Cases. Contacts. Cases. Contacts. Barkingside 298 1 — — — 1 — 4 1 — — 2 — — — — 8 1 1 13 Beal Modern 676 — 3 3 — — — — — — — — — — 1 — 3 4 — — Becontree 2079 21 34 5 8 4 7 11 13 7 2 6 — — 2 2 56 66 151 121 Benton 114 — 1 3 4 — — 1 I — — 2 — — — — 6 6 8 7 Chadwell 455 — 4 1 1 — 1 27 9 2 — 13 — — — — 43 15 24 13 Christchurch 1172 — 3 8 10 19 5 54 22 35 5 6 — — — — 122 45 242 72 Cleveland 1204 8 13 6 8 3 1 14 6 20 — 5 — — — — 56 28 157 63 Downshall 1634 12 12 7 13 3 1 79 29 1 — 3 — — — 1 106 55 336 89 Fairlop 317 1 3 — — 8 1 6 1 5 4 17 — — — — 37 9 63 15 Gearies 1276 7 7 5 2 3 2 56 14 2 1 6 — — — 1 80 26 190 50 Goodmayes 1346 7 11 6 16 17 9 61 16 5 — 3 — — — — 99 52 172 85 Gordon 276 17 6 2 1 3 — 2 2 27 2 2 — 1 2 — 54 13 3 — Highlands 1063 5 8 6 6 1 17 9 24 5 7 — — — — 60 28 169 35 Little Heath 103 — — — 5 — — — — — — — — — — — — 5 26 11 Loxtord, The 447 4 9 — 7 1 1 2 3 — — — — 1 1 — 8 21 225 62 Mayesbrook 235 2 5 2 — 1 2 — — 3 — — — — 2 — 8 9 5 1 Mount, The 441 2 4 — — — — 1 2 1 — 1 — — — — 3 6 — — Newbury Park 803 2 3 4 8 1 1 37 15 4 1 3 — — — 1 52 28 61 33 Roman Catholic, Llford 507 5 7 2 5 — — 2 2 14 4 20 — — — — — 18 66 45 St. Vincet;s R. C., Bec 380 — 2 1 — — — — — — — — — — — — 1 2 7 9 Soouth Park 979 9 15 12 16 6 4 16 1 2 — 2 — — 4 2 49 40 164 41 Uphall 222 3 9 9 3 1 — 41 17 36 2 7 — — — — 97 31 99 41 Valentines 366 ] — 3 5 — — 7 — 1 — 10 — — — — 22 5 33 3 Woodlands, The 372 2 3 1 — — — — — 8 1 — — — — — 11 4 — — *Mossford (G.V.H.) 748 — — 4 — — — — — — — —— — — — — 4 — 25 — *County High — 5 4 1 6 — — — — — — —— — — — — — 6 10 — 23 *Private — 9 4 6 10 — — — — — — — — — — — 15 14 — 30 Totals 17576 121 170 97 134 72 35 438 163 197 27 115 — 2 12 7 1049 541 2274 862 Paratyphoid Fever:—1 case (Christchurch). Cerebro-Spinal Fever:—2 cases (Cleveland-Loxford) and 1 contact (Becontree). 169 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, 1931. SCHOOLS. No. on Roll. Jan. Feb. Mar. April. May. June. July August. Sept. Oct. Nov. Dec. Totals 1931. Totals, 1930. 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 298 — — 1 — — — — — — — — — — — — — — — — — — — — — 1 — — 5 Beal Modern 676 — — — — — — — — — — — — — — — — — — 2 — — — 1 — 3 — — Beoontree 2079 1 2 — 2 3 1 — 2 5 11 2 3 — 3 1 — 1 2 2 i 3 5 3 2 21 34 8 13 Benton 114 — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 3 1 Chadwell 455 — — — — — — — 4 — — — — — — — — — — — — — — — — — 4 4 4 Christchurch 1172 — — — — — — — — — — — — — — — — — — — — — — — 3 — 3 20 25 Cleveland 1204 — — 1 2 — — — 1 — — 3 4 — — — — 1 1 1 i 2, 2 — 2 8 13 6 7 Downshall 1634 1 1 2 1 2 — — — — — 1 1 2 3 2 3 — 2 1 — 1 1 — — 12 12 18 24 Fairlop 317 — — — 3 — — — — — — — — — — — — 1 — — — — — — — 1 3 8 8 Gearies 1276 2 — — — 1 1 1 3 1 —: 1 1 — 1 — — — — 1 1 — — — — 7 7 19 11 Goodmaves 1346 — — — — — — 1 1 1 1 — — — — — 4 — — 1 2 1 3 3 — 7 11 8 18 Gordon 276 1 — — — — — 1 — — — 9 5 — — 1 — — — 4 1 — — 1 — 17 6 1 — Highlands 1063 — — — — — — — — — 2 1 1 — — — — 1 1 1 1 1 2 1 1 5 8 12 11 Little Heath 103 — — — — — — — — — — — — — — — — —— — — — — — — — — — — — Loxford, The 447 — — 2 2 1 4 — — — — — 1 — — — — 1 — — 1 — 1 — — 4 9 7 2 Mayesbrook 235 — — — — — 2 1 1 — — 1 2 — — — — — — — — — — — — 2 5 — — Mount, The 441 — — — — — — — — — — — 1 — 1 — 1 — — — 1 — — — — — 4 — — Newbury Park 803 — — 1 2 — — — — — — — — — — 1 — — 1 — — —— — — — 2 3 5 9 R. Catholic, Ilford 570 — — — — — — 1 1 — — 1 3 1 — — — — — 1 ?, 1 1 — — 5 7 5 20 S.Vincent'sR.C. Be 380 — — — — — — — — — — — — — — — — — — — 2 — — — — — 2 1 6 South Park 979 1 2 1 2 — — 1 2 — — 3 2 2 2 1 3 — — — 2 — — — — 9 15 13 13 Uphall, The 222 — — — — 1 6 — — — 1 2 1 — — — — — — — 1 — — — — 3 9 13 18 Valentines 366 — — — — — — — — — — — — — — 1 — — — — — — — — —— 1 — 1 — Woodlands, The 372 — — — — — — — — — — — — 1 1 1 — — — — 1 — 1 — — 2 3 — — County High — — — — — — 1 — — — — — — 1 — — — — — 1 2 2 — 1 1 5 4 9 11 Private .. .. — — — — — 3 — — — 1 2 — — 1 — — — 1 1 1 1 — — 2 — 9 4 12 13 Mossford (G.V.H.) 748 — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — Totals 17576 6 5 8 14 11 15 6 15 8 17 24 25 8 12 8 11 6 8 14 22 11 16 11 10 121 170 174 218 170 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, 1931. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Totals, 1931. Totals. 1930. Cases. Conts. j Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. j Cases. j Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 298 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Beal Modern 676 — — — — — — — — — — — — — — — — — 1 — 1 — — — 3 — — — Beoontree 2079 1 — — — — — — 2 — — 1 1 — — — 2 1 3 1 — 1 — — — 5 8 32 51 Benton 114 2 — 1 4 — — — — — — — — — — — — — — — — — — — — 3 4 3 2 Chadwell 455 — — — — — — — 1 — — — — — — — —— 1 — — — — — — — 1 1 2 1 Christchurch 1172 5 4 1 2 2 3 — — — — — — — — — 1 — — — — — — — — 8 10 26 25 Cleveland 1204 1 — — — — — 1 2 — 4 2 1 — — — — 1 1 — — — — — — 6 8 11 26 Downshall 1634 3 3 1 4 1 1 1 1 — — 1 2 — — — — — — — — — 1 — 1 7 13 16 30 FairloD 317 — — — — — — — — — — — — — — — — — — — — — — — — — — — 2! Gearies 1276 — — 1 — — — 1 1 — — — — — — — — — — 2 1 1 — — — 5 2 4 4 Goodmayes 1346 1 6 — — 2 — 1 — — — — 1 — — — — — — 2 7 — 2 — — 6 16 41 37 Gordon 276 1 — 1 — — — — — — — — 1 — — — — — — — — — — — — 2 1 2 — Highlands 1063 3 2 1 — 1 1 — — — — — — 1 — — 3 — — — — — — — — 6 6 4 5 Little Heath 103 — — — 5 — — — — — — — — — — — — — — — — — — — — — 5 — 1 Loxford, The 447 — 5 — — — 1 — — — 1 — — — — — — — — — — — — — — — 7 8 3 Mayesbrook 235 1 — — — — — — — — — — — — — 1 — — — — — — — — — 2 — 2 — Mount, The 441 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Newbury Park 803 1 — — 1 — — — — — — — —— — — — — — 1 — 9 3 4 — — 4 8 3 2 R. Catholic Ilford 570 1 2 — — — — — — — — — — — — — — — — — 1 1 2 — — 2 5 15 14 S. Vincent'sR.C., Be 380 — — — — — — — — — — — — — — — — — — 1 — — — — —— 1 — — 3 South Park 979 — 3 — — — 2 11 — 1 — 1 2 6 4 1 3 — — — — — — 2 2 12 16 4 11 Uphall, The 222 2 — 2 — 3 2 2 1 — — — — — — — — — — — — — — — — 9 3 5 5 Valentines 366 1 111 — — — — 1 1 — — — — — — — 1 — 2 — — — — 1 — 3 5 — — Woodlands, The 372 — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — — — County High — — 2 — — — 2 — — — — — — — 1 — — — — 1 1 — — — — 1 6 6 12 Private — — 2 1 — 2 6 — — — — 2 — — — — — — 1 1 — — 1 — — 6 10 20 17 Mossford (G.V.H.) 74 8 4 — — — — — — — — — — — — — — — — — — — — — — — 4 — 4 — Totals 17576 27 30 9 16 11 18 8 9 2 5 8 8 7 5 3 10 3 8 9 12 7 10 3 3 97 134 208 251 171 MEASLES AND GERMAN MEASLES. Table X.—Summary of Cases of Measles and German Measles among School Children, and of Contacts of such Cases, ixclumd from School Attendance, during the Year ended the 31st December, 1931. SCHOOLS No. on Roll. Jan. Feb. March. April. May. June. July August. Sept. Oct. Nov. Dec. Totals, 1931. Totals, 1930. j Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. j Cases. Conts. j Cases. Conts. Cases. Conts. j Cases. Conts. Cases. Conts. Cases. Conts Cases Conts. Cases. Conts Cases Conts. Cases. Conts. Barkingside 298 — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — 1 7 Beal Modern 676 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Beoontree 2079 — — — — — — — — 1 2 3 3 — — — — — — — — — — — —! 4 7 74 33 Benton 114 — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 Chadwell 455 — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 10 4 Christchurch 1172 — — 2 — — — 1 — — — — — — — — —— — 1 — — — — 16 4 19 5 146 13 Cleveland 1204 — — — — — — — — 1 — 1 1 — — — — — — 1 — — — — — 3 1 105 19 Downshall 1634 — — 1 — — — — — — — 1 — 1 — — — — — — — — — — 1 3 1 162 18 Fairlop 317 1 — — — — — — — — — — — — — — — — — — — 2 — 5 1 8 1 31 2 Gearies 1276 — — 1 1 — — — — — — — — 1 1 — — — — — — 1 — — — 3 2 105 24 Goodmayes 1346 — — — — — — 3 2 8 5 5 2 — — — — — —— — — — — 1 — 17 9 95 22 Gordon 276 — — — — — — — — — — 3 — — — — — — — — — — — — — 3 — — — Highlands 1063 — — — — — — — — 1 — — — — — — — — — — — — — — — 1 — 133 14 Little Heath 103 — — — — — — — — — — — — — — —— — — — — — — — — — — — 24 8 Loxford, The 447 — — — — — — — — — — 1 — — — — — — — — 1 — — — — 1 1 119 35 Mayesbrook 235 — — — — — — — — — — 1 2 — — — — — — — — —— — — — 1 2 — — Mount, The 441 — — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — — Newbury Park 803 — — — — — — 1 — — — — — — — — — — — — — — — — — 1 — 36 14 R. Catholic, Ilford 570 — — — — — — — — — — — — — — — — — — — — — — — 1 — — 40 9 S .Vincent'sR .C. ,Bc. 380 — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — South Park 979 1 1 — 1 — — — — 2 — 1 2 1 — — — — — — — — — 1 — 6 4 125 13 Uphall, The 222 — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — 69 16 Valentines 366 — — — — — — — — — — — — — — — — — — — — — — — — — — 18 — Woodlands, The 372 — — — — — — — — — — — — — — — — — — — — — — — — — — —— — •Mossford (G.V.H.) 748 — — — — — — — — — — — — — — — — — — — — — — — — — — —— — Totals 17576 2 1 4 2 — — 5 2 13 7 16 10 3 1 — — — 1 2 2 3 — 24 10 72 35 1295 253 *Notifications of Measles and German Measles in this school have not been received. 172 CHICK EN POX. Table XI.—Summary of Cases of Chickenpox among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended 31st December, 1931. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July August. Sept. Oct. Nov. Dec. Totals, 1931. Totals, 1930. 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 298 — — — — 1 — 1 1 1 — 1 — — — — — — — — — — — — — 4 1 — — Beal Modern 676 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Beoontree 2079 — 1 — — — — — — — — 5 2 1 1 — — 1 1 — — 1 3 3 5 11 13 18 12 Benton 114 — — — — — — — — — — 1 1 — — — — — — — — — — — — 1 1 2 1 Chadwell 455 10 9 14 4 2 3 — — — — — — — — — — — — — — 1 — — — 27 9 8 3 Christchurch 1172 2 1 — — — — 1 1 6 3 3 2 8 1 — — 7 5 22 7 3 2 — — 54 22 19 6 Cleveland 1204 9 1 2 — 2 — 2 9 1 — — — — — 1 — — — — — — — 4 3 14 6 4 4 Downshall 1634 1 — 9 2 6 4 16 5 19 9 21 7 4 2 — — 1 — 1 — — — 1 — 78 29 36 14 Fairlop 317 — — — — 6 1 — — — — — — — — — — — — — — — — :— — 6 1 2 1 Gearies 1276 — — — 1 — — — — — — 1 — — — 1 2 5 2 38 7 10 2 1 — 56 14 27 9 Goodmayes 1346 — — 2 — — — — — 5 1 29 9 24 6 — — — — — — — — 1 — 61 16 17 6 Gordon 276 — — — — — —— — — — — — — — 1 — 1 2 — — — — — — 2 2 — — Highlands 1063 1 — — — 1 1 1 1 — — — — — — — — 1 — 5 3 6 3 2 1 17 9 2 2 Little Heath 103 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Loxford, The 447 — — — — — — — — — — — — — — — — — — — — — 2 2 1 2 3 55 16 Mayesbrook 235 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Mount, The 441 — — — — — — — — — — — — — — — — — — — — 1 2 — — 2 2 — — Newbury Park 803 4 1 — — — — — — 5 3 20 11 7 — — — — — — — 1 — — — 37 15 6 1 R. Catholic, Ilford 570 — — — — — — — — 1 — 1 1 — 1 — — — — — — — — — — 2 2 3 1 S. Vincent'sR .C.Bc 380 — — — — — — — — — — — — — — — — — — — — — — —— — — — 2 1 South Park 979 — — — — — — 5 — 2 — — — 4 1 — — 1 — 1 — 2 — 1 — 16 1 18 3 Uphall, The 222 — — — — — — — — 2 1 — — 1 1 — — — — 6 — 23 12 9 3 41 17 10 1 Valentines 366 — — — — — — — — — — 4 — — — — — 2 — — — — — 1 — 7 — 5 2 Woodlands, The 372 — — — — — — — — — — — — — — — — — — — — — — — — — — — — *Mossford (G.V.H.) 748 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Totals 17576 20 6 27 7 18 9 26 10 42 17 88 33 49 13 3 9 19 10 73 17 48 26 25 13 438 163 234 83 *Notifications of Chickenpox in this school have not been received. 173 WHOOPING COUGHs TABLE XII.—Summary op Cases op Whooping Cough among School Children, and of Contacts of such Cases Excluded from School Attendance during the Year ended 31st December, 1931. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. J une. July. August. Sept. Oct. Nov. Dec. Totals, 1931. Totals, 1930. Cases. Conts. Cases. Conts. Cases Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. j Cases. j Conts. j Cases. Conts. Cases. Conts. j Cases. J Conts. Cases. j Conts. j Cases. 1 Conts. Cases. Conts. Barkingside 298 — — — — — — — — — — — — — — — — — — — — — —— — — — — — — Beal Modern 676 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Beoontree 2079 — — — — — — — — — — — — — — — — 1 — — —— 3 — 3 2 7 2 16 4 Benton 114 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Chadwell 455 — — — — — — — — — — — — — — — — — — — — — — 2 — 2 — — — Christchurch 1172 8 1 9 9 6 1 4 — 5 — — — — — 1 1 2 — — — — — — 35 5 10 — Cleveland 1204 — — — — — — 1 — 1 — 5 — 11 — — — 1 — — — 1 — — — 20 — 29 3 Downshall 1634 — — 1 — — — — — — — — — — — — — — — — — — — — — 1 — 56 1 Fairlop 317 — — — — — — — — — — — — — — — — 1 1 — — 1 3 2 — 5 4 14 1 Gearies 1276 — — — — — — — — — — 2 1 — — — — — — — — — — — — 2 1 6 — Goodmayes 1346 — — — — — — — — — — 1 — — — 1 — 2 — — — — — — 5 — 7 — Gordon 276 — — — — — — — — — — — — 3 — 3 2 3 — 7 — 7 — 4 — 27 2 — — Highlands 1063 — — — — 2 — 1 — 1 — 3 1 2 — 13 2 2 2 — — — — — — 24 5 8 1 Little Heath 103 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Loxford 447 — — — — — — — — — — — — — — — — — — — — — — — — — — 12 — Mayesbrook 235 — — — — — — — — — — 1 — — — — — — — — — — — 2 — 3 — — — Mount, The 441 — — — — — — — — — — — — 1 — — — — — — — — — — — 1 — — — Newburv Park 803 — — — — — — — — — — — — — — — — — — — — — — 4 1 4 1 1 — R. Catholic, llford 570 — — — — — — — — — — 9 2 3 1 — — 1 — — — 1 — — 1 14 4 — — S.Vincent'sR .C. ,Bc. 380 — — — — — — — — — — — — — — — — — — — — — — — — — — — —— South Park 979 — — — — — — — — — —— — — — — — — — — 1 — 1 — — — 2 — — — Uphall, The 222 — — 6 — 14 — 6 — 3 1 1 1 — — — — 5 — 1 — — — — — 36 2 1 — Valentines 366 — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 8 — Woodlands, The 372 — — — — — — — — — — 2 — 4 — — — 2 1 — — — — — — 8 1 — — *Mossford (G.V.H.) 748 — — — — — — — — — — — — — — — — — — — — — — — — — — — Totals 17576 8 1 16 2 22 1 13 — 10 1 24 5 25 1 18 5 20 4 9 — 15 3 17 4 197 27 1 168 10 *Notifications of Whooping Cough in this school have not been received. 174 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, 1931. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Totals, 1931. Totals, 1930. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. j Conts. Cases. Conts. Cases. Conts. Cases. Cont. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Barkingside 298 — — — — — — — — — — — — 2 — — — — — — — — — — — 2 — — — Beal Modern 676 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Becontree 2079 — — 1 — — — — — 3 — 2 — — — — — — — — — — — — — 6 — 2 — Benton 114 — — — — — — — — 1 — 1 — — — — — — — — — — — — — 2 — — — Chadwell 455 — — 4 — 7 — 2 — — — — — — — — — — — — — — — — — 13 — — — Christchurch 1172 — — — — 2 — — — 2 — 1 — — — — — — — — — 1 — — — 6 — 19 — Cleveland 1204 — — — — — — — — 1 — 1 — 1 — — — — — 1 — — — 1 — 5 — 1 — Downshall 1634 — — — — 1 — 2 — — — — — — — — — — — — — — — — — 3 — 47 — Fairlop 317 — — — — — — 1 — 1 — 12 — 2 — 1 — — — — — — — — — 17 — 8 — Gearies 1276 — — — — — — 1 — — — — — — — — — 3 — — — 2 — — — 6 — 29 — Goodmayes 1346 — — — — — — — — — — 1 — 2 — — — — — — — — — — — 3 — 3 — Gordon 276 1 — — — — — — — — — 1 — — — — — — — — — — — — — 2 — — — Highlands 1063 — — — — — — — — — — — — — — 2 — 5 — — — — — — — 7 — 10 — Little Heath 103 — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — Loxford, The 447 — — — — — — — — — — — — — — — — — — — — — — — — — — 23 — Mayesbrook 235 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Mount, The 441 — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — — — Newbury Park 803 — — — — 1 — — — — — — — — — — — — — — — — — — — 3 — 9 — 11. Catholic, Ilford 570 — — 8 — 11 — 1 — — — — — — — — — — — — — — — — — 20 — 2 — S.Vincent'sR.C.,Bc 380 — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — South Park 979 — — — — — — 1 — — — — — — — — — — — — — 1 — — — 2 — 3 — Uphall, The 222 — — — — — — 5 — — — — — 1 — — — — — — — — — 1 — 7 — 1 — Valentines 366 — — — — 1 — — — 2 — 6 — 1 — — — — — — — — — — — 10 — 1 — Woodlands, The 372 — — — — — — — — — — — — — — — — — — — — — — — — — — — — *Mossford (G.V.H. 748 — — — — — — — — — — — — — — — — — — — — — — — — — — 17 — Totals 17576 1 — 15 — 23 — 13 — 10 — 26 — 9 — 3 — 8 — 1 — 4 — 2 — 115 — 179 — *Notifications of Mumps in this school have not been received.