From Pleaseant to 4201/3 ILF 12 Borough of Ilford. Health Report FOR THE YEAR 1935 A. H. G. BURTON, M.D., B.S., M.R.C.P., D.P.M., D.P.H., Barrister-at-Law, Medical Officer of Health, etc. Borough of Ilford Annual Report OF THE Medical Officer of Health, School Medical Officer, Medical Officer to the Maternity and Child Welfare Statutory Committee and Medical Superintendent of the Isolation Hospital, FOR THE YEAR, 1935. Ilford Borough Council. November, 1934—November, 1935. Alderman Albert Philip Griggs, J.P., E.C.C., Mayor. Alderman Bertram Sidney John Pitt, J.P., Deputy Mayor. AIdermen: Clark, Charles William. Dane, Frederick Hopper, M.B.E., J.P., C.A. (E.C.C.). Griggs, Albert Philip, J. P., E.C.C., Mayor. Gunary, George, J.P. Odell, Herbert George. Pitt, Bertram Sidney' John, J.P., Deputy Mayor. Shipman, James Henry, C. C. Smith, Frank Douglas, J.P., C.A. (E.C.C.). Young, Alexander, Major, T.D. Councillors: Ames, James Henry. Billinoton, Henry. Bisson, Walter William Preston, E.C.C. Blow, Charles Barkworth (died 25th January, 1935). Braithwaite, Thomas. Clark, Harry (from February, 1935). Colvin, Gilbert. Cooper, Albert Edward (from April, 1935). Daniels, Russell Stearn. Dixon, Robert James, F. C. I.S. Eke, William Benjamin. Elborne, John, M. A. Farman, Claude Augustus. Green, Arthur William, J. P., E.C.C. Harding, Alfred Daniel Bartlett. Harding, Mrs. Beatrice Alice Louise Ann. Heath, William Henry Charles. Jay, Charles Frederick. Jones, Ioan Llewelyn (from April. 1935). Meade, William Edward. Parfitt, William Arnold. Spiller, Leslie Thomas. Smith, Harold. Tubb, John. Tyler, George Frederick. Wetton, George John, E.C.C. Woods, Sidney Charles Victor (from April, 1935). PUBLIC HEALTH COMMITTEE. November, 1934—November, 1935. Alderman F. D. Smith, J.P., C.A. (E.C.C.), Chairman. Councillor C. B. Blow (died 25th January, 1935) Councillor G. F. Tyler (from February, 1935) Vice-Chairman. Alderman C. W. Clark. *Alderman A. P. Griggs, J. P., E.C.C., Mayor. *Alderman B. S. J. Pitt, J. P., Deputy Mayor. Councillor J. H. Ames. Councillor H. Clark (from February, 1935). Councillor R. S. Daniels. Councillor R. J. Dixon, F.C.I.S. Councillor W. B. Eke. Councillor A. W. Green, J.P., E.C. C. Councillor A. D. B. Harding. Councillor Mrs. B. A. L. A. Harding. Councillor W. H. C. Heath. Councillor W. E. Meade. Councillor W. A. Parfitt. Councillor L. T. Spiller. Councillor S. C. V. Woods (from 1st April, 1935). * Ex-officio Members. MATERNITY AND CHILD WELFARE STATUTORY COMMITTEE. November, 1934—November, 1935. Councillor Mrs. B. A. L. * Alderman A. P. Griggs, J. P., Alderman C. W. Clark. *Alderman B. S. J. Pitt, J. P., Deputy Mayor. Alderman F. D. Smith, J. P., C.A. (E.C. C.). Councillor J. H. Ames. Councillor H. Billington. Councillor C. B. Blow (died 25th January, 1935). A. Harding, Chairman. E.C.C., Mayor, Vice-Chairman. Councillor H. Clark (from February, 1935). Councillor R. J. Dixon, F.C.I.S. Councillor W. B. Eke. Councillor A. W. Green, J. P., E.C.C. Councillor A. D. B. Harding. Councillor W. A. Parfitt. Councillor J. Tubb. Co-opted Members: Mrs. C. J. Earl. Mrs. A. E. Gillard. Mrs. L. Hardy. Mrs. E. J. Hinton. Mrs. B. E. Paddon. Mrs. B. Strachan. Mrs. E. M. Wise. * Ex-officio Members. EDUCATION COMMITTEE. November, 1934—November, 1935. Councillor C. A. Farman, Chairman. Mr. C. J. Ridout, Vice-Chairman. Alderman F. H. Dane, M.B.E., J.P., C.A. (E.O.C.). †Alderman A. P. Griggs, J. P., E.C.C., Mayor. Alderman G. Gunary, J. P. Alderman H. G. Odell. †Alderman B. S. J. Pitt, J. P., Deputy Mayor. Alderman Major A. Young, T.D. Councillor H. Billington. Councillor W. W. P. Bisson, E.C.C. Councillor C. B. Blow (died 25th January, 1935). Councillor T. Braithwaite. Councillor H. Clark (from February, 1935). Councillor G. Colvin. Councillor R. S. Daniels. Councillor W. B. Eke. Councillor A. W. Green, J.P., E.C.C. Councillor Mrs. B. A. L. A. Harding. Councillor W. H. C. Heath. Councillor C. F. Jay. Councillor W. E. Meade. Councillor W. A. Parfitt. Councillor J. Tubb. *Mr. A. Catto. *Misa J. B. Larkin. *Mr. S. P. Lonergan. *Mr. W. Sanford. *Mr. W. R. Spencer. *Mr. J. J. Taylor, J. P. * Co-opted Members, † Ex-officio Members. OFFICERS OF THE PUBLIC HEALTH SERVICES, JANUARY, 1936. 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.), M.R.C.P. (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. M. B. Gross, M.D., Ch.B. (Leeds), D.P.H. (Lond.). E. S. Stephen, M.B., Ch.B. (Glas.), D.P.H. (Cantab.). C. M. Gray, M.B., Ch.B. (Glas.), D.P.H. (Leeds). M.O.H. and Resident Medical Officer (Isolation Hospital)-. J. H. Weir, M.D., B.S., B.Hy., D.P.H. (Durham). Resident Medical Officer (Maternity Home): W. M. Hill, M.B., Ch.B. (Bristol). Dentist: M. J. K. Soutter, L.D.S., R.C.S. (Eng.). Assistant School Dentists: B. Connelly, B.D.S. (Lond.), L.D.S., R.C.S. (Eng.). F. J. Lord, 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: H. C. Monkcom, Assoc. Roy. San. Inst., A.M.I.S.E. Sanitary Inspectors: S. G. Rackham, Assoc. Royal San. Inst. P. W. English, Assoc. Royal San. Inst. R.J. Daw. L. Pingttey. G. W. Newman, Assoc. Royal San. Inst. T. B. Tompkins, Assoc. Royal San. Inst. Chief Cleric: F.J. Hooking. Health Visitors and School Nurses: Miss A. Batten. Miss K. B. Mathieson. Miss O. Bell. Miss R. Noble. Miss E. Blackwall. Miss W. E. Phebey. Miss M. E. Cartwright. Miss M. F. Pittar. Miss H. E. Clynes. Miss E. Prior. Miss A. L. Drinkwater. Miss M. D. Seager. District Midwife: Ante-Natal Clinic Nurse: Miss C. Blockley. Miss A. G. Pox. OFFICERS OF THE PUBLIC HEALTH SERVICES—continued. Part Time:— Consulting Obstetrician (Maternity Home and Puerperal F ever Regulations): Everard H. G. Williams, M.D., M.R.C.P. Deputy Consulting Obstetrician: R. L. Dodds, F.R.C.S. Surgeon in charge of Orthopaedic Clinic: A. T. Fripp, F.R.C.S. Oculist: H. D. Smart, M.D., B.S. Surgeon in charge of Aural Clinic: C. R. Sandiford, M.D., F.R.C.S. Physician in charge of Rheumatism Clinic: W. P. H. Sheldon, M.D., F.R.C.P. Veterinary Surgeon: Ralph Bennett. F.R.C.V.S. Masseuse : Miss G. U. Comyn, C.S.M.M.G., M.E. TABLE OF CONTENTS. SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. page Preface 11 Statistical Summary 15 Physical Features of District.. 17 Rainfall 17 Population 17 Births 17 Deaths 18 Inquests 19 Death-rates from Tuberculosis and Cancer 19 Poor Relief 20 Marriages 20 Vital Statistics—Table I 21 „ Table Ia 22 Causes of Death—-Registrar-General's Short List 23 SECTION B.— GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Public Health Officers of the Authority 24 Nursing in the Home 24 Laboratory Facilities 25 Table of number of specimens examined (Bacteriological Laboratory) 26 Legislation in Force 27 Essex County Council Act, 1933:— Part IV.—Establishments for Massage and Special Treatment 27 Part VI.—Hairdressers' and Barbers' Premises 28 Part XI.—Manufacture and Sale of Ice Cream 29 Camping Grounds and Moveable Dwellings 30 Shops Acts, 1912-34 32 Hospital Provision 32 Ambulance Facilities 35 Clinic and Treatment Centres 35 Tuberculosis Dispensary 37 Maternity and Nursing Homes 37 SECTION C.—SANITARY CIRCUMSTANCES OF THE AREA. Water Supply 38 Drainage and Sewerage 39 Rivers and Streams 39 Closet Accommodation 40 Public Cleansing, Collection of House Refuse 40 Sanitary Inspection of the Area:— (a) Summary of Inspections 42 (b) Notices served 42 (c) Complaints of Nuisances 43 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1933 43 Smoke Abatement 43 Premises and Occupations which can be controlled by Bye-laws or Regulations 44 Slaughter of Animals Act, 1933 44 8 SECTION D.— HOUSING. PAGE Bye-laws relating to Houses, Lodgings, Tents, etc. 44 Rag Flock Acts, 1911 and 1928 44 Schools 44 Overcrowding 45 Unhealthy Areas 45 Housing Statistics 45 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply 47 Dairies, Wholesale and Retail Purveyors, etc. 47 Licences—Graded Milk 48 Milk, Cream and Ice-Cream Sampling 48 Tubercular Milk 48 Inspection of Dairy Herds 49 Legal Proceedings 49 Registration 49 Meat and Other Foods:— (а) Slaughterhouses 50 (b) Articles of Food Surrendered 50 Sale of Food and Drugs Acts (Adulteration, etc.) 50 Food Poisoning 50 Bakehouses 51 Contagious Diseases (Animals) Acts 51 Rats and Mice Destruction Act 51 Petroleum (Consolidation) Act 52 SECTION F.— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Disease Generally 52 Acute Rheumatism 53 Notifications in Institutions 56 Treated in Institutions 56 Table II—Summary of Cases of Infectious Diseases Notified 57 Deaths from Infectious Diseases 58 Incidence of Chief Infectious Diseases 58 Smallpox 58 Vaccination 59 Smallpox Hospital Accommodation 32 Scarlet Fever 59 Diphtheria 59 Table of Nos. Schick Tested and Immunised 60 Enteric Fever 61 Cerebro-spinal Fever 62 Ophthalmia Neonatorum 62 Acute Influenzal and Acute Primary Pneumonia 63 Encephalitis Lethargica 63 Anterior Poliomyelitis 63 Puerperal Fever 63 Puerperal Pyrexia 63 Zymotic Diseases 64 Incidence and Deaths from Infectious Diseases in Age Groups 65 Tuberculosis—New Cases and Deaths 66 Tuberculosis, Treatment of 67 Tuberculosis Care Association 68 Tuberculosis Regulations, 1925 68 Public Health Act, 1925, Section 62 68 Infectious Diseases (Prevention) Act, 1890.. 68 Venereal Diseases 68 Notification of Non-notifiable Acute Infectious Diseases.. 70 Disinfection 70 9 SECTION G.—FACTORIES AND WORKSHOPS. PAGE Factories 70 Workshops 71 Table I—Inspection of Factories, Workshops, Workplaces 72 „ II—Defects Found 73 „ III—Homework 74 „ IV—Other Matters 75 ISOLATION HOSPITAL. Patients Admitted 79 Deaths in Hospital 80 Scarlet Fever 81 Enteric Fever 82 Pneumonia 82 Puerperal Fever 82 Puerperal Pyrexia 82 Diphtheria 82 Pemphigus Neonatorum 83 Observation Cases 83 Tuberculosis 84 Training of Nurses 84 Schick and Dick Testing of Staff 84 Hospital Extensions 84 MATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907 and 1915 97 Stillbirths 97 Registration Act, 1836 and 1926 99 Infant Mortality 99 Neonatal Mortality 103 Table IV 105 Illegitimate Births and Deaths 106 Maternal Mortality 106 Infant Life Protection 108 Children and Young Persons Act, 1932 108 Work of Health Visitors 109 Supervision of Midwives 110 Supply of Milk to Expectant and Nursing Mothers and for Infants 112 Infant Welfare Centre 112 Ante-Natal Clinics 113 Post-Natal Clinic 115 Dental Clinic 115 Ophthalmic Clinic 116 Orthopaedic Clinic 116 Artificial Sunlight 117 Aural Clinic 118 Rheumatism Clinic 118 Ophthalmia Neonatorum 119 Treatment of Minor Ailments 119 Maternity Home 120 Maternity Home Extensions 126 District Midwife 138 10 SCHOOL MEDICAL SERVICE. page General Survey 143 Staff 147 School Premises 147 Medical Inspection 149 Findings of Medical Inspection 155 Infectious Disease 156 Diphtheria Prevention 157 "Following-up" 159 Medical Treatment:— Minor Ailments 159 Ophthalmic Department 161 Orthopaedic Department 162 Artificial Sunlight 164 Aural Department 165 Rheumatism Department 167 Dental Department 167 Treatment of Uncleanliness 171 Other Ailments 171 Open Air Education 172 Physical Training 174 Provision of Meals 176 Provision of Milk 176 Supply of Free Cod Liver Oil, Emulsion, etc. 176 Co-operation of:— Parents, Teachers, School Attendance Officers and Voluntary Bodies 176 Physically and Mentally Defective Children 177 Nursery, Secondary and Continuation Schools 181 Employment of School Children and Young Persons 181 Medical Examination of Teachers, etc. 184 Statistical Tables:— I.—Number of Children Inspected 185 IIa.—Return of Defects 185 IIb .—Number of Children found to Require Treatment 186 III.—Numerical Return of Exceptional Children 187 IIIa.—Number of Children notified to the Local Mental Deficiency Authority 191 IV.—Group I—Minor Ailments 192 Group II—Visual Defects 193 Group III—Nose and Throat Defects 193 Group IV—-Orthopaedic and Postural Defects 194 Group V—Dental Defects 194 Group VI—Uncleanliness and Verminous Conditions 194 V.—Summary of Number of Children Inspected 196 VI.—A.—Average Heights and Weights of Boys Inspected 198 B.—Average Heights and Weights of Girls Inspected 200 VII.—Summary of Infectious Diseases among School Children 202 VIII.—Summary of Scarlet Fever among School Children 203 IX.—Summary of Diphtheria among School Children 204 X.—Summary of Measles and German Measles among School Children 205 XI.—Summary of Chicken-pox among School Children 206 XII.—Summary of Whooping Cough among School Children 207 XIII.—Summary of Mumps among School Children 208 PREFACE. Public Health Offices, Ilford, June, 1936. His Worship the Mayor, Aldermen and Councillors of the Borough of llford. Mr. Mayor, Ladies and Gentlemen, I herewith submit the Annual Report required by the Ministry of Health and the Board of Education. It will be observed that the vital statistics of the district generally remain satisfactory; the death rate being 8.2 per 1,000 compared with the provisional rates of 11.7 for England and Wales, and 11.4 for London, while the infant mortality rate was 42.8 per 1,000 Compared with the provisional figures of 57 per 1,000 for England and Wales, and 58 for London. An account is given in the Report of (1) The Mayesbrook Clinic, which has enabled the facilities of the School Medical and Maternity and Child Welfare Services to be made much more readily accessible to the residents in the eastern portion of the town. (2) The extensions to the Isolation Hospital, which bring the accommodation at the Isolation Hospital to the minimum generally considered to be required. (3) The extensions of the Maternity Home, by an increase of the number of beds for ordinary booked cases, a new Ante-Natal Clinic, and six beds on the cubicle ward system for emergency cases. 12 The work which these extensions has entailed for the Committees concerned and the staff of the Department in furnishing the extensions may be gathered from the fact that for the furnishing of the Hospital extensions, 43 firms tendered for 240 items, while for the Maternity Home extensions, 63 firms tendered for 424 items. It will be noted that the wave of infectious disease has been on the decline, the number of notifications of cases of scarlet fever and diphtheria having considerably diminished. It will be observed that acute rheumatism in persons under 16 years of age has now been made a notifiable disease, and it is hoped that this will enable the disease to be dealt with at such an early stage that the heavy toll in deaths which has resulted from its sequela (organic heart disease in the child and young adult) will be further reduced. I pointed out in my last Report that the regular examination of cows by Veterinary Inspectors, which had been introduced by the Essex County Council, might be expected to have satisfactory results and it will be noted that in llford alone, which has but few dairy farms, six tuberculous cows were discovered as a result of these inspections. I wish again to thank the Members of the Council for their support, and 1 have the honour to be, Your obedient Servant, A. H. G. BURTON, Medical Officer of Health. GENERAL. 15 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in Acres) Land 8,402 Inland Water 26 Tidal Water 7 8,435 Population (Census, 1931) 131,061 „ (Census, 1921) 85,194 Registrar-General's Estimate of resident Population, June 30th, 1935 151,390 „ 30th, 1934 146,070 Number of inhabited houses (end of 1935) according to Rate Books 40,000 Rateable Value—October 1st, 1935 (Houses and Land).. £1,315,140 Sum represented by a penny rate, October 1st, 1935 £5,290 (Approx.) Education Rate— 1934-5. 1935-36. Elementary 2s. 4.28d. 2s. 4.36d. in the £. in the £. Higher (County).. 0s. 6.5d. 0s. 6.75d. in the £. in the £. „ (Ilford Council) 0s. ,06d. O.s. .05d. in the £. in the £. Combined Rate (all services) 12s. 4d. 12s. 4d. in the £. in the £. Social conditions, including the chief industries carried on in the area, and the influence of any particular occupation on public health: — Vide Annual Report for 1925. 16  Total. M. F. 1935. 1934. Live Births Legitimate 2,002 1,036 966 Birth Rate 13.9 13.8 Illegitimate 48 19 29 Still Births 72 40 32 Rate per 1,000 total births 34.0 33.5 Deaths 1,212 597 615 Death Rate 8.2 8.7 Percentage of total deaths occurring in public institutions 35.8 29.3 Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. 1935. 1934. 1935. 1934. Puerperal sepsis 3 2 1.41 .98 Other puerperal causes 4 4 1.88 1.97 Total 7 6 3.29 2.95 Death-rate of Infants under one year of age:— 1935. 1934. All infants per 1,000 live births 42.8 38.7 Legitimate infants per 1,000 legitimate live births 43.5 37.8 Illegitimate infants per 1,000 illegitimate live births 20.8 67.8 Deaths from Measles (all ages) — 12 „ Whooping Cough (all ages) 6 — „ Diarrhoea (under 2 years of age) 14 5 17 1. Physical Features and General Character of the District.—Vide, Annual Report, 1925. 2. Rainfall.—The total rainfall registered in the district during the year was 23.18 inches. The greatest fall in 24 hours was registered on 3rd October, being .94 inches. The number of days on which rain fell was 167. 3. Population. Census,1911 78,188 Census, 1921 85,194 (including institutions) Census, 1931 131,061 „ „ Registrar-General's Estimate on 30th June, 1934 146,070 „ „ Registrar-General's Estimate on 30th June, 1935 151,390 „ „ The number of patients and resident staff on the 30th June, 1935 at the following public institutions, was:— Claybury Mental Hospital 2,585 West Ham Mental Hospital 1,335 Total 3,920 The net population for 1935 of 147,470 is obtained by deducting the population in institutions (3,920) from the RegistrarGeneral's Estimate, 151,390 and this is the figure used as the basis for compiling the various rates in this year's Report. 4. Births.—The number of births registered during the year was 2,050. Legitimate 1,036 Males 966 Females Illegitimate 19 „ 29 „ i.e., 2.34 per cent. of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was:—3.0 in 1934; 2.7 in 1933; 1.45 in 1932; 2.0 in 1931; 1.9 in 1930; 2.27 in 1929; 2.01 in 1928; 2.65 in 1927; 2.25 in 1926; 3.37 in 1925. The birth-rate, calculated on the net estimate of the population of 147,470 is 13.9 per 1,000, as compared with 13.8 in 1934; 13.4 in 1933; 14.9 in 1932; 15.4 in 1931; 15.2 in 1930; 15.6 in 1929; 15.8 in 1928; 15.8 in 1927; 15.6 in 1926; 16.5 in 1925. 18 5. Deaths.—The total number of deaths of Ilford residents was 1,212. This is obtained by taking the total deaths registered in the district (1.069) subtracting the deaths of non-residents occurring in the district (290), and adding the deaths of Ilford residents registered as having died in other districts (433). The total number of deaths registered in the district during the year was 1,069 Number of deaths of non-residents registered in the district (principally in large institutions) 290 The latter 290 deaths occurred as follows:— In Claybur (L.C.C.) Mental Hospital 112 In West Ham Borough Mental Hospital 64 In King George Hospital 94 Other Non-Residents 20 290 Included in the deaths of residents belonging to the district are 9 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 432. This figure includes deaths at the following institutions:— Oldchurch Hospital, Romford 212 Essex County Mental Hospital, Brentwood 8 The London Hospital 30 Queen Mary's Hospital, West Ham 5 Hospital for Sick Children, Great Ormond Street 5 St. Bartholomew's Hospital 8 Charing Cross Hospital 8 Middlesex Hospital 1 Guy's Hospital 2 East Ham Memorial Hospital 4 St. Thomas' Hospital 3 University College Hospital 1 Brompton Hospital 1 St. Luke's Hospital 3 Severalls Mental Hospital. Colchester 16 London Fever Hospital 2 In other Hospitals, Institutions and Residences outside the Ilford District 124 Total 433 19 The death-rate, calculated on the net estimate of the population of 147,470 is 8.2 per 1,000; as compared with 8.7 in 1934; 8.8 in 1933; 8.7 in 1932; 9.3 in 1931; 8.1 in 1930; 9.7 in 1929; 8.4 in 1928; 9.6 in 1927; 8.7 in 1926; 9.9 in 1925. Inquests.—During the year, 56 inquests were held in the district, 36 on Ilford residents, and 20 on non-residents. The ages at death and causes assigned were as follows:— Under 1 year. 1-2 years 2-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 years and upwards. — 2 — 10 4 17 13 10 Causes of inquest-deaths. Accidents 34 Suicides 13 Found in road; fracture of base of skull and multiple injuries; open verdict 1 Shock from intracranial haemorrhage, fall from a ladder; open verdict 1 Exhaustion following acute gastro-enteritis; misadventure 1 Haemorrhage from rupture of right meningeal artery due to fracture of skull following fall from bicycle; open verdict 1 Operative shock due to operation for removal of thyroid gland whilst deceased was suffering from exophthalmic goitre and lymphation; misadventure 1 Shock from surgical operation for chronic mastoiditis (left) with toxaemia from thrombosis of left lateral sinus; misadventure 1 Pelvic abscess due to injury to vaginal vault caused by a foreign body in posterior fornix; conviction of manslaughter 1 Shock and secondary haemorrhage following removal of a gangrenous gall bladder; misadventure 1 Cardiac failure following an ether anaesthetic induced for undescended testicle when suffering from a congenital hydrocephalus; misadventure 1 Death-Rates from Tuberculosis and Cancer, 1935. The following Table shows the death-rates for 1935 for Ilford, compared with the provisional death-rates for England and Wales for the same period, per 1,000 population; the figures having been supplied by the Registrar-General:— Ilford. England and Wales. Respiratory Tuberculosis .407 .605 Other Tuberculosis .067 .113 Cancer 1.519 1.587 20 6. Poor Relief.—The total amount expended in Ilford during the year was £15,398 14s. 2d. The average weekly number of cases in receipt of relief was 856. The number of admissions to Oldchurch Hospital from Ilford during the year was 654, made up as follows:— Men 235 Women 363 Children 56 The number of destitute persons admitted to the Institution during 1935 was 12 made up as follows:— Men 10 Women 2 Children — 7. Marriages.—1,086 marriages have taken place during 1935. The following details explain the allocation:— Marriages taking place in the Ilford District 812 Marriages of Ilford Residents at Register Office, Romford— Both Parties belonging to Ilford 168 The Male only belonging to Ilford 53 The Female only belonging to Ilford 53 8. Tables of Vital Statistics.—Table I gives a comparative statement of the population, birth-rate and death-rate for the past seven years. Table Ia gives a comparison of the vital statistics of Ilford with England and Wales, London and other towns. Table II gives a classified statement of the causes of death in 1935, arranged according to the age groups at which deaths occurred. 21 TABLE I.—Vital Statistics of Whole District During 1935 and Previous Years. Year. Gross Population estimated to Middle of each Year. Net Population estimated to Middle of each Year (a). Births. Total Deaths Registered in the district. Transferable Deaths Net Deaths Belonging to the District. Uncorrected Number. Net (b). of Non-Residents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate (c). Number. Rate (d). Number. Rate per 1,000 Net Births. Number. Rate (e). 1 2 2a 3 4 5 6 7 8 9 10 11 12 13 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 5.6 1,1 4 9.3 1932 137,480 133,620 1,787 1,987 14.9 1,095 7.9 318 385 79 39.8 1,162 8.7 1933 141,800 137,920 1,616 1,852 13.4 1,123 7.9 284 375 83 44.8 1,214 8.8 1934 146,070 142,131 1,666 1,961 13.8 1,054 7.2 241 428 76 38.7 1,241 8.7 1935 151,390 147,470 1,697 2,050 13.9 1,069 7.0 290 433 88 42.8 1.212 8.2 (а) The net estimated population is found by deducting the population of Claybury and West Ham Mental Hospitals 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 Ilford, other Towns, and of England and Wales for the Year 1935. (Provisional figures.) The rates for England and Wales have been calculated on a population estimated to the middle of 1935. but those for London and the Towns have been calculated on populations estimated to the middle of 1934. - Rate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 Yrs). Total Deaths under 1 Year. Live Births. Stillbirths. England and Wales 14.7 0.62 11.7. 0.00 — 0.03 0.01 0.04 0.08 0.18 0.52 5.7 57 121 County Boroughs and Great Towns, including London 14.8 0.68 11.8 0.00 — 0.04 0.01 0.04 0.09 0.16 0.45 7.9 62 140 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1931) 14.8 0.64 11.2 0.00 0.03 0.01 0.03 0.07 0.17 0.41 3.8 55 London 13.3 0.52 11.4 0.00 — 0.00 0.01 0.04 0.06 0.11 0.51 11.2 58 ILFORD (Estimated Gross Population, 151,390 mid. 1935) .. 13.5 0.47 8.0 0.00 — 0.00 0.00 0.03 0.05 0.10 0.26 6.8 42.8 23 The following is the Registrar-General's Short List of Deaths and Causes TABLE II. Causes of, and Ages at, Death during the Year 1935. Causes of Death. Net Deaths at the subjoined ages of "Residents," whether occurring within or without 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 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. ALL CAUSES 1212 88 10 12 27 32 72 97 128 209 265 272 1 Typhoid and paratyphoid fevers - - - - - - - - - - - - 2 Measles - - - - - - - - - - - - 3 Scarlet fever 1 - - - - - - - - - - - 4 Whooping cough 6 1 2 2 1 - - - - - - - 5 Diphtheria 8 1 1 1 4 1 - — — — — — 6 Influenza 16 1 — — — 1 2 3 1 2 3 3 7 Encephalitis lethargica 2 — — — — — 1 — 1 — — — 8 Cerebro-spinal fever 2 1 - - - - - - - - - - 9 Tuberculosis of respiratory system 60 - - - 1 13 20 10 5 7 2 2 10 Other tuberculous diseases 10 — 2 — 3 1 3 1 — — — — 11 Syphilis 1 - - - - - - - - - 1 — 12 General paralysis of the insane, tabes dorsalis 4 - - - - - - - 1 2 1 - 13 Cancer, malignant disease 224 — — — — 1 7 17 29 66 65 39 14 Diabetes 10 — — — — — — — — 1 5 4 15 Cerebral haemorrhage, etc. 58 - - - - - 2 2 6 15 16 17 16 Heart disease 322 — — — — 3 9 18 29 52 102 109 17 Aneurysm 8 — — — — 1 — 1 3 2 1 — 18 Other circulatory diseases 41 - - - - - - - 3 12 12 14 19 Bronchitis 25 2 — 2 — 1 — — 5 3 3 9 20 Pneumonia (all forms) 35 7 — 1 1 — 1 4 8 5 3 5 21 Other respiratory diseases 14 — — — 1 1 1 2 1 4 3 1 22 Peptic ulcer 10 - - - - - 1 2 4 3 — — 23 Diarrhoea, etc. 19 14 — 2 — — 1 — 1 — 1 — 24 Appendicitis 12 — — 1 2 2 1 - 2 - 2 1 25 Cirrhosis of liver — — — — — — — — — — — — 26 Other diseases of liver, etc. 9 - - - - - 2 1 2 2 1 1 27 Other digestive diseases 20 — — 1 — — 1 1 4 3 7 3 28 Acute and chronic nephritis 36 - — 1 2 1 3 1 5 8 9 6 29 Puerperal sepsis 3 - - - - 2 - 1 - - - - 30 Other puerperal causes 4 - - - - - - - - - - - 31 Congenital debility, premature birth, malformations, etc. 56 56 - - - - - - - - - - 32 Senility 33 - - - - - - - - - 5 28 33 Suicide 16 - - - - - 4 6 3 1 1 1 34 Other violence 39 - 2 - 7 2 7 4 4 5 4 4 35 Other defined diseases 107 5 3 1 5 1 6 18 11 14 18 25 36 Causes ill-defined or unknown 1 - - - - - - - - 1 — - Special Causes (included in No. 35 above):— Smallpox - - - - - - - - - - - - Poliomyelitis - - - - - - - - - - - - Polioencephalitis - - - - - - - - - - - - 24 SECTION B. . GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 1. (i) Public Health Officers of the Authority.—Vide page 5 at the beginning of this Report. (ii) Nursing in the Home. Nature of the Arrangements in the Area. (a) General Nursing.—There is a voluntary Committee, the organisations concerned being mentioned in my Annual Report for 1921. 10,367 visits were paid by the nurses in 1935, compared with 10,963 in 1934. The following is a summary of the work carried out during the year 1935:— Number of New Cases 632 Number of Visits—Medical 6,789 Surgical 2,487 Operations 4 Massage 1,087 Number of applications made for Nurses' services 632 Number of patients under the charge of a Doctor at 31st December 48 Number of patients not under the charge of a Doctor — Number of necessitous cases referred to Committee 3 Number of cases on the books at the end of the year 48 The cases were distributed in wards as under:— Cranbrook 49 Park 74 Seven Kings 105 North Hainault 189 Loxford 77 Clementswood 40 South Hainault 46 Goodmayes 52 25 The Medical Officer of Health is a member of the District Nursing Committee. (b) Nursing of Cases of Infectious Disease. — Vide Annual Report, 1931. (iii) Laboratory Facilities.—Vide Annual Report, 1933. Examinations of such urgent specimens as Diphtheria swabs are carried out at the Laboratory at the Ilford Public Health Offices. The accompanying table shows that 1,220 specimens have been examined at the Laboratory during the year. 26 Bacteriological Laboratory, 1935. 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. Tot als. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Swabs—Throat Diphtheria 101 626 — 7 4 89 23 130 128 852 Nose, Ear, Eye, etc. „ 5 25 1 4 9 76 11 22 26 127 Throat Contacts „ 5 66 2 1 — 1 — 1 7 69 Nose ,, „ — — 1 — — — — — 1 — Hairs Ringworm - - - - - 5 — — — 5 Urine Various Abnormalities — — — 1 1 3 — — 1 4 Totals 163 1,057 Grand Total 1 ,220 3 Direct Smears examined (negative). 60 Diphtheritic Specimens were sent to laboratories in London for a test for virulence—25 were virulent, 27 avirulent, 8 no K.L.B in culture. 27 (iv) 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. (б) Fellmongers. (c) Leather dressers. (d) Soap boilers. (e) Tanners. (f) Tallow melters. (g) Fat melters or fat extractors. (h) Glue makers. (i) Tripe boilers. (j) Size makers. (k) Gut scrapers. (I) Fish fryers. (to) Fish curers other than fishmongers. (n) Rag and bone dealers. (6) For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (7) Nuisances in connection with the removal of offensive or noxious matter. (8) Establishments for Massage and Special Treatment. also Byelaws made under Essex County Council Act, 1933, as follows: (a) (Part IV—Establishments for Massage and Special Treatment.) The Council appointed Dr. Balmain (Deputy Medical Officer of Health) as Inspector of licensed establishments, inspections to be carried out quarterly and recorded on a special Inspection Form. During the year 1935, 25 Applications for Licences were received. Before the grant of a licence an inspection is made of the proposed establishment and its equipment, and careful investigation is made as to the training and qualification of those persons who will administer massage and special treatment. All electrical apparatus is inspected by the Borough Electrical Engineer's Department. The Council granted licences in respect of 21 establishments. All such licences expire on 31st March, 1936. Applications in respect of two premises were refused owing to the applicant not providing information that he possessed such technical qualifications as may be reasonably necessary. Due notice of such refusal to grant a licence was given by the Town Clerk to the other Licensing Authorities. The granting of licenses in respect of two 28 establishments was postponed until the applicants produced satisfactory evidence of their qualifications to carry out the treatment. The evidence was subsequently produced in one case and the licence granted. The other application is still pending, satisfactory evidence being received of ability of applicant as regards certain treatment proposed to be carried out. One other application is still pending for a like reason. Change of address was sanctioned in respect of two licensed establishments. With the issue of the licence each licencee is provided with a Treatment Record Book and a Staff Record Book, which is required to be kept in accordance with the Byelaws. Any irregularities in the keeping of these books, or any other infringements of the Byelaws which are found at inspections (of which prior notice is not given), are reported to the Town Clerk for any necessary action. (b) (Part VI—Hairdressers' and Barbers' Premises.) The following are the Byelaws approved by the Ministry of Health on the 1st October, 1935, which came into operation as from 1st November, 1935. It will be noted that authority is only given for inspection and not registration. These inspections are carried out by the Sanitary Inspectors at regular intervals, they being appointed by the Council "as the officers duly authorised by the Local Authority" for the purposes of Part VI of the Act. Byelaws made by the Mayor, Aldermen and Burgesses of the Borough of I If or d, pursuant to Section 87 of the Essex County Council Act, 1933, for the purpose of securing the cleanliness of any premises in the Borough of I If or d used for the purpose of carrying on the business of a hairdresser or barber and the instruments, towels and materials used in such places. 1. For the purpose of securing the cleanliness of the premises used for the purpose of carrying on the business of a hairdresser or barber every person carrying on such a business shall in every part of the premises so used cause. (a) the surface of all internal walls, partitions and ceilings and the underside of the roof of any room where there is no ceiling to be kept at all times in such repair and to be so painted, distempered, whitewashed, papered or similarly treated in manner appropriate to each such surface and to be so cleansed at such intervals as to maintain the same in a cleanly condition; (b) the floor of every room to be cleansed at least once during every day on which business is carried on; (c) the floor to be swept as often as may be necessary to prevent the accumulation of hair clippings, neck wool or other litter; (d) a sufficient number of covered receptacles to be provided and all hair clippings, neck wool or other litter swept from the floor or otherwise accumulating in connexion with the business to be placed therein. He shall cause every such receptacle to be emptied as often as may be necessary and at least once during every day upon which business is carried on; 29 (e) every chair or seat to be cleansed as often as may be necessary; (/) every shelf, fitting or table on which instruments, towels or materials are placed to be kept clean; (g) every washbasin and all fixtures and fittings used in connexion therewith to be kept clean. 2. For the purpose of securing the cleanliness of the instruments, towels and materials used in premises used for the purpose of carrying on the business of a hairdresser or barber a person carrying on such business shall cause (a) each metal instrument to be cleansed before use upon each person; (b) each hairbrush, comb or other similar instrument used in the business to be thoroughly washed at least once daily and otherwise kept clean; (c) each shaving brush, sponge or other article similarly used and each shaving mug or other similar utensil to be cleansed immediately after use for each person so as to ensure that no dirt, soap, lather or other matter remains adhering thereto; (d) where neck wool or other material is used any one piece of such wool or material to be used for not more than one person; Provided that if a material other than wool is used which is capable of being cleansed this Byelaw shall not operate so as to prevent the subsequent use of any one piece of material after being cleansed; (e) any styptic, not applied by means of a spray or upon fresh cotton wool or other clean material, to be clean; (/) soap, other than liquid or powdered or tube soap or shaving cream, to be thoroughly rinsed before use for each separate person; (g) every towel or other similar article used in connexion with the business to be clean; (h) paper or linen placed on the back of the chair or head rest to be clean; (i) a fresh supply of water for each person to be used for shaving, lathering or washing. (c) (Part XI—Manufacture of Ice Cream.) Section 158 of this Act, which requires the registration of manufacturers and vendors of ice cream and the premises used by them, came into operation in the Borough on the 1st February, 1934, and 127 applications for registration in respect of 119 premises were considered or re-considered during the year. 30 Registration was granted in 112 cases (concerning 104 premises) as follows:— Multiple firms retailing their own production 5 Purveyors retailing multiple firms' productions 80 Purveyors manufacturing and retailing their own productions (made apart from domestic premises) 13 Purveyors manufacturing and retailing their own productions (made on domestic premises) 14 In 15 cases, involving 15 premises, registration was refused as the premises were not suitable for the manufacture of ice cream or on account of the unsatisfactory storage arrangements. (d) Camping Grounds and Moveable Dwellings. The following are the Byelaws confirmed by the Minister of Health on the 30th September, 1935, which came into operation on the 1st November, 1935. Made by the Mayor, Aldermen and Burgesses of the Borough of Ilford acting by the Council, in pursuance of section 111 of the Essex County Council Act, 1933, for the purpose of securing the amenities of their district in relation to Camping Grounds and Moveable Dwellings situate thereon. 1. Throughout these byelaws the "district" means the Borough of Ilford; "owner" means the person by agreement with whom or by licence from whom a moveable dwelling is placed on a camping ground. 2. The owner of a camping ground on which twenty or more persons are encamped shall:— (а) if it is not otherwise so provided or available, provide sufficient privy accommodation on the camping ground or within two hundred feet thereof and shall maintain it in a clean and wholesome condition; (б) if it is not otherwise so provided or available, provide adequate means for the disposal of waste water; (c) if they are not otherwise provided or available, provide sufficient receptacles or allocate suitable places for deposit of broken glass, bottles, tins, litter or other refuse; (d) as often as may be necessary for securing the cleanliness of the camping ground and the moveable dwellings thereon and for preventing the amenities of the district being prejudicially affected; (i) cleanse privies with moveable receptacles where such receptacles are provided by him, (ii) empty receptacles provided by him for the deposit of broken glass, bottles, tins, litter or other refuse, (iii) cover pits, whether provided by him or not, used for the purposes set out in sub-clauses (a), (b) and (c) of this byelaw, (iv) clear ditches, hedgebottoms, and bushes of any broken glass, bottles, tins, litter or other refuse left by the persons occupying a moveable dwelling on or frequenting the camping ground; 31 (e) for securing the proper control and management of the camping ground by himself or his servant keep reasonable watch for breaches of byelaws 3 (three) and 4 (four) and record the name and address of any occupier or (if known to him) any person frequenting the camping ground who to his knowledge or that of the said servant contravenes the provisions of these byelaws. 3. A person who occupies a moveable dwelling on or frequents a camping ground shall:— (a) not deposit or cause any solid or liquid filth to be deposited in any place so as to cause a nuisance; (b) maintain in good order and in a reasonably clean and some condition any privy accommodation for which he is responsible; (c) deposit broken glass, bottles, tins, litter or other refuse in the receptacle or place provided for the same. 4. A person who frequents a camping ground or occupies a moveable dwelling situate thereon shall not:— (a) throw into or place in any river, stream or watercourse passing through or adjoining the camping ground any broken glass, bottles, tins, litter, paper, filth, human excreta or other refuse or matter whatsoever; (b) play or use any musical instrument, gramophone, wireless installation, loudspeaker, amplifier or similar instrument so as to make a noise so loud and so continuous or repeated as to annoy residents in or visitors to the district; (c) indulge in any noisy, indecent or other offensive conduct to the annoyance of the residents in or visitors to the district; (d) make any fire in such a position as is likely to cause, or without such precautions as are necessary to prevent, danger of igniting any tent, structure or vehicle or any bush, tree or undergrowth. 5. Every person who shall offend against any of these byelaws shall be liable for every offence to a fine not exceeding the sum of two pounds and in the case of a continuing offence to a further fine not exceeding the sum of twenty shillings for each day during which the offence continues after conviction therefor. Provided that where an offence is committed against these byelaws and against a byelaw in any other series of byelaws which is in force in the district, or against any limitation or condition imposed by the Minister of Agriculture and Fisheries under section 193 of the Law of Property Act, 1925, or against any statute which is in force in the district, a person shall not be liable to more than one penalty in respect of the same offence. 6. These byelaws shall cease to be in force on the expiry of five years from the date on which they came into operation. 32 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 overruled 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. Parts 2, 3, 4 and 5 of the Public Health Act, 1925, were adopted by the Council and came into operation on 3rd August, 1927. Shops Acts, 1912-1934 (Section 10 and 13).—The Sanitary Inspectors have been appointed to carry out the inspections required in accordance with Sections 10 and 13 (3) of such Act. (v) Hospitals. (a) Tuberculosis.—20 beds are maintained by the Essex County Council at the Isolation Hospital for the treatment of pulmonary tuberculosis of male patients. (b) Maternity.—Vide Annual Report, 1931. (c) Children.—Vide Annual Report, 1932. (d) Fever. — Vide Annual Report, 1931. (e) Smallpox.—The Essex County Council prepared a scheme under Section 63 of the Lo al Government Act, 1929, which has been approved by the Ministry of Health whereby the County Council will provide accommodation for the treatment of cases of smallpox in the county, exclusive of the Borough of Colchester. The expenses incurred by the County Council in this connection will be defrayed as special expenses of that part of the Administrative County concerned. The Corporation of Colchester will provide hospital accommodation comprising not less than 24 beds to be made available for treatment of cases occurring in the Administrative County in accordance with an agreement to be entered into between the 33 Corporation and the County Council. The accommodation will also be available for cases occurring in the Borough of Colchester. The County Council informed the Town Clerk that such accommodation would be available at the end of 1935, and that the Orsett Joint Hospital Board had informed them that the agreements with the various contracting Authorities will be allowed to lapse without formal notice at the end of 1935. The County Council will provide an ambulance for the conveyance of smallpox cases, also for an accompanying nurse. The contribution by Ilford to the Orsett Joint Hospital Board was £39 Os. Od. for the six months ended 31st March, 1935, and for the six months ended 30th September, 1935, and £19 10s. Od. for the 3 months to the 31st December, 1935. 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. (/) Other.—King George Hospital:—The Secretary informs me that the need for more beds is pressing and that plans are being prepared as follows:— (i) Extension to Nurses' Home. (ii) Complete new Out-Patient Unit. (iii) Additional Ward Block of 54 beds. Ample space is available for this scheme, and will be proceeded with as and when funds permit. It is hoped to be able to include a much extended X-Ray Department in the Out-Patient Unit, where there is now insufficient room for consultation, waiting, X-rays, etc. The Nurses' Home must be extended before more beds are provided. The following is a statistical return in respect of King George Hospital for the year 1935:— NUMBER OF BEDS. Total number of Beds at 31st December, 1935 Private Patients. Other Patients, Children. Medical. Surgical. 32 (Allocation as to male or female according to demand). Male. Female. Male. Female. 21 27 27 39 61 34 NUMBER OF CASES TREATED. Ilford Cases only. Barking Cases. Dagenham Cases. Cases from other Districts. Male. Female. Male. Female. Male. Female. Male. Female. *ISfumber of adult in-patients admitted 1,329 149 710 530 'Number of children admitted 398 49 201 152 Number of operations performed †1,692 Number of casualties attended 3,730 717 2,421 1,505 Number of attendances 22,469 Number of new patients, Massage Dept. 407 41 38 113 Number of attendances †19,206 Number of X-Ray examinations . 2,663 501 2,039 844 Number seen in Consultative Out- Patient Department 2,130 177 1,680 822 Number of attendances .. .. †13,745 Number of new patients, X-Ray Therapy Department 64 2 8 18 Number of treatments † 3,958 * The allocation as between male and female is not ascertained. f The allocation as between Ilford and other Districts is not ascertained. The 19,920 new Out-patients from all districts made 05,425 attendances. The complete allocations were as follows:— In-patients (Adults and Children). New Out-patients. Ilford 1,727 Ilford 8,994 Barking 198 Barking 1,438 Dagenham 911 Dagenham 6,186 (excluding the Becontree Centre . Other Districts 682 Other Districts 3,302 The average cost per patient per week in the Hospital for the year 1935 was £3 1s. 0d. for General Ward and £4 lis. lid. for Private Ward patients. Male. Female. Children. Number resident on 30th June, 1935:—Patients 72 97 24 Staff 8 126 — 35 The Council has arrangements with certain hospitals as mentioned on pages 32, 114, 119, 138, 163 and 171 of this Report. There are two large Mental Hospitals in the district, the West Ham Mental Hospital, with 1,223 patients (males 578, females 645), atid Claybury Mental Hospital, with 2,375 patients (males 991, females 1,384) in residence on the 30th June, 1935. (vi) Ambulance Facilities. (a) Infectious Cases.—Two Austin motor ambulances are 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 oases. (c) Maternity Patients.—The Town Ambulance is available for the conveyance of maternity patients, when required. An " After-hours " charge of 5s. Od. is made for cases removed to the Ilford Council Maternity Home. (vii) Clinics and Treatment Centres.— Maternity and Child Welfare.—The Council has established the following Infant Welfare Centres :— United Methodist Church (entrance in Balmoral Gardens, opposite Vernon Road), Seven Kings. Holy Trinity Church Hall, Mossford Green. Congregational Church, Birkbeck Road, Newbury Park. Public Health Offices, Valentines Mansion. Congregational Church Hall, Grosvenor Road, Ilford. Congregational Church Hall, Woodford Avenue (entrance in Ethelbert Gardens) Mayesbrook Clinic, Goodmayes Lane, Goodmayes. Chadwell Christian Mission Hall, Essex Road, Chadwell Heath. Cecil Hall, Granville Road, Ilford Mayesbrook Clinic, Goodmayes Lane Emmanuel Church, Ilford Lane, Ilford St. John's Church Hall (entrance in Devonshire Road), Seven Kings. Monday, 2.0 p.m. Monday, 2.0 p.m. Tuesday, 2.0 p.m. Tuesday, 2.0 p.m. Wednesday, 2.0 p.m. Wednesday, 2.0 p.m. Wednesday, 2.0 p.m. Thursday, 9.30 a.m. Thursday, 9.30 a.m. and 2.0 p.m. Thursday, 2.0 p.m. Friday, 9.30 a.m. and 2.0 p.m. Friday, 2.0 p. m. 36 Ante-.Yatal Clinic.—An ante-natal clinic is held at the Maternity Home, Eastern Avenue, on Thursday, Friday and Saturday mornings, and on Monday, Tuesday, Wednesday, Thursday and Friday afternoons, and at the Mayesbrook Clinic on Tuesday mornings. Post-Natal Clinic.—This clinic is held at the Maternity Home on Monday mornings. School Clinics.—(a) 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) orthopaedic treatment of school children and children under 5 years of age; (5) artificial sunlight treatment (as in 4); (6) otorrhoea, deafness and other ear defects (as in 4); X (7) rheumatism (as in 4); (8) diphtheria prevention (as in 4). (b) The following Clinics are held at the Mayesbrook School Clinic:— (1) treatment of minor ailments; (2) dental treatment of school children; (3) ophthalmic treatment of school children and children under 5; (4) orthopaedic treatment (as in 3); (5) artificial sunlight treatment (as in 3); (6) ante-natal; (7) two Infant Welfare Centres; (8) diphtheria prevention (as in 3). 37 Additional Clinics mentioned in Section (vii) above are referred to in the respective Sections of this Report. 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, 10 to 12 noon; Wednesday (workers only), 7 to 8 p.m.; and Friday, 3 to 5 p.m. For children—Wednesday, 10 to 12 noon. 2. (i) 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, 1935, there were 4 private registered nursing homes in the district, 1 for maternity patients only, 2 for maternity and medical or minor surgical cases, and the remaining 1 for medical and surgical cases. On December 31st, 1935, there were three private registered nursing homes in the district—two for maternity and medical or minor surgical cases, and the other for medical and surgical cases. A case of puerperal fever occurred at a private nursing home on 8th October, the patient being removed to the London Hospital on the same day, and discharged on 1st December. On 13th October a case of puerperal pyrexia occurred. The patient was conveyed to her home and on the next day was removed to Queen Charlotte's Maternity Hospital, Isolation Block, Hammersmith, and died on 21st October. The nursing home was then closed for maternity cases as from 14th October. On 18th October the daughter of the keeper (who resides nearby) of the nursing home was notified as suffering from scarlet fever and had been in the home. In consequence the keeper was instructed on 22nd October to close the home for the admission of any further cases, and also the attendance outside by nurses from the home (maternity or other) until the case of scarlet fever was declared free of infection and disinfection carried out. Disinfection was carried out on 9th November. 38 SECTION C.— SANITARY CIRCUMSTANCES OF THE AREA. 1. (i) Water Supply.—Vide Annual Report, 1925. 6 samples of the piped water supply (2 from one Company and 4 from another, supplying the district) were sent for examination, and each sample gave a satisfactory bacteriological and chemical analysis. In May and June two complaints were received from occupiers in the Cranbrook Ward as to "insects" found in the drinking water supply. These were ascertained to be a harmless variety of "fresh water shrimp." The Metropolitan Water Board were communicated with immediately. Remedial measures were taken by the Company, i.e., by main flushing, diversion of supply) etc. A sample of the water taken in June for chemical and bacteriological examination proved satisfactory. A further complaint of a similar nature was received in December. This was referred to the Water Company. The Town Clerk is also in communication with the Company on the same matter. Mr. B. W. Bryan, the Engineer to the South Essex Waterworks Company, informs me that the Company has not obtained a supplementary supply of water from the Metropolitan Water Board during 1935. During the year 5,802 yards of main were laid in the Borough, the diameter of the mains being 18in., 9in., 6in., 4in. and 3in. During the year the Company obtained an Act of Parliament for the abstraction of a further supply of water from the River Stour (Essex and Suffolk), and constructional work has been commenced. The Company is empowered to abstract additional water up to a maximum of 35 million gallons per day from the river and to construct a reservoir in the neighbourhood of Abberton which will hold over 5,000 million gallons. 39 The water will be normally abstracted from the river from November to May, when a large amount of surplus water is available, and the large reservoir is for the purpose of storing the water so abstracted for use at other times of the year. The scheme further authorises the construction of three pumping stations, filtration plant and about 26 miles of pipe lines. It is not anticipated that the scheme will come into supply before 1940. (ii) Drainage and Sewerage.—The Borough Engineer has kindly supplied me with the following report. (a) Sewage Works Generally. Several small sewer extensions have been connected up to the Seven Kings Valley Sewer in the north-east part of the district, and to the MidLevel Sewer in the north-west part of the district. Owing to the growth of the district, some of the main trunk sewers are now overcharged and the preparation of a scheme for the reconstruction of these sewers has been commenced. A scheme is also in course of preparation for the reconstruction of the Roden Street Pumping Station, including new rising mains. (b) Ilford and Barking Joint Sewerage Scheme. The Ilford and Barking Joint Sewerage Scheme has now been completed. The connections from the Ilford Sewers have been completed and the whole of the Ilford Sewage has been discharged into the Joint Pumping Station since the 25th July, 1935. The average dry weather flow amounts to 4f million gallons per day at the present time, and the installation is now working satisfactorily. The surplus plant at the Ilford Sewage Works has been disposed of and negotiations are in progress for the sale of the site. 2. Rivers and Streams.—Vide Annual Report, 1925. (a) Seven Kings Stream. Pollution by sewage is still taking place outside the Borough boundary. Request has been'made from an outside Local Authority to the Borough Council to take the sewage from several of the houses in the Chigwell area causing this pollution, and the Council has agreed to connect them into the Seven Kings Valley Sewer. This has not yet been carried out 40 (b) Rirer Roding. During the early part of the year the River Roding Catchment Board carried out certain cleansing works on the section oftht Main River between the "Carrier" and Woodford Bridge. The general condition of the river is still under discussion. 3. (i) Closet Accommodation.—In addition to the water carriage system of sewage, there are in the rural area 26 cesspools, 21 pail closets and 11 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. The following were connected to the sewer or demolished in 1935 :— Cesspools. - 3 in Aldborough Hatch and 1 in Woodford Avenue. Pnil Closets.—3 in Aldborough Hatch, 2 in Painters Road and 2 in Billet Road. Privies.—2 in Billet Road and 1 in Oaks Lane. (ii) Public Cleansing.—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. 425 defective and unsuitable receptacles have been replaced during the year. The following table gives information as to the collection of house refuse during 1935:— 41 STATISTICS AS TO REFUSE COLLECTION, 1935. Horse. Electric. Vulcan. S. D. Freighters. Total. Nos. 6 & 8. No. 9. No. 11. Nos. 12 to 20, 2, 3 & 5. dumber of collection days 32 297 307 228 225 307 1,396 Aggregate number of days vehicles employed 152 576 529 228 225 2,890 4,600 rotal number of loads collected 510 1,648 1,879 815 889 9,568 15,309 Average number of vehicles employed per day 4.7 1.9 1.7 1.0 1.0 9.4 19.7 Average number of loads collected per day 15.9 5.6 6.1 3.6 3.9 31.1 66.2 Average number of loads collected per vehicle per day 3.3 2.9 3.5 3.6 3.9 3.3 3.3 Tons Cwts. Qrs. Tons Cwts. Qrs. Tons Cwts. Qrs. Tons Cwts. Qrs. Tons Cwts. Qrs. Tons Cwts. Qrs. Tons Cwts. Qrs. Total weight of refuse collected 578 14 2 4,425 3 0 5,481 17 2 1,566 15 1 1,811 6 0 24,273 16 2 38,137 12 3 Average weight per load 1 2 2.8 2 13 2.8 2 18 1.4 1 18 1.8 2 0 3 2 10 3 2 9 3.3 s. d. s. d. s. d. s. d. s. d. s. d. s. d. Estimated average cost of collection per ton 9 5 8 1.2 6 7.2 8 10.7 7 8.4 8 3.9 7 7.S Collection has been improved by the extended use of low-loading motor vehicles, three S.D. Freighters having been purchased during 1935. The Council now has two electric, three Vulcans and thirteen Freighters engaged upon Refuse Collection. 42 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, the total amount of refuse barged by Messrs. Cory's ex Intrades Wharf, Barking, being 25,836 tons. Arrangements are still in force whereby a special daily collection of refuse is made from Claybury Mental Hospital. Collection and Disposal cf Wastepaper. Weight Collected. Income. Cost. Profit. T. c. q- £ 8. d. £ s. d. £ s. d. 968 10 2 1,517 5 8 539 19 0 977 6 S Of the profit made, 75 per cent is credited to Removal of House Refuse Costs, and 25 per cent, paid in bonus to the men engaged. (iii) Sanitary Inspection op the Area.—The following is a summary of the work of the Sanitary Inspectors during the year:— Houses and premises inspected 12,326 Houses and premises reinspected (works in progress) 9,910 Visits during disinfection 1,322 Houses in which nuisances were detected 1,094 Houses in which nuisances were abated 997 Premises disinfected 682 Premises from which articles only disinfected 103 Articles disinfected 3,227 Premises disinfected for verminous conditions 13 Shops Act—inspections 692 do. reinspections 58 Notices served:— Statutory:— Served. Complied with. Public Health Act, 1875 7 5 Public Health Act, 1925 (Verminous Premises) Housing Act, 1930 3 106 2 75 Cleanse Dwelling House (Infectious Disease (Prevention) Act, 1890) 1 1 Provide Dustbin (Ilford Improvement Act) 265 227 Provide Water Supply to Dwelling House 4 4 Cleanse Water Storage Cistern (Byelaws) 13 11 Cover Water Storage Cistern (Byelaws) 5 4 Informal 676 515 Total 1,080 844 In addition to the above, 181 notices (102 statutory and 79 informal) served during 1934 were al^o complied with. 43 Complaints.—During the year, 719 complaints of nuisances have been received and investigated. The following is a summary:— Accumulation of manure and refuse 76 Animals improperly kept 10 Bad smells 49 Dampness of premises 20 Defective drains, w. c.'s and fittings 78 Defective roofs, gutters, downpipes, etc. 53 Defective water fittings 20 Dirty and verminous houses 69 Dirty condition of rearway 9 Flooding of premises 5 Overcrowding 13 Smoke nuisances 63 Miscellaneous 254 Total 719 (iv) Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1933.—The Senior Sanitary Inspector was authorised by the Council in December, 1919, to make visits and certify under the provisions of the Acts. 1 application was received under Section 2 (4) of the Act and 1 certificate issued. (v) Smoke Abatement.—Numerous complaints were received during the year, particularly up to March, regarding alleged discharge of soot from a factory in the eastern part of the Borough. A preliminary notice under the Smoke Abatement Act was served on the firm by the Senior Sanitary Inspector, and a new soot extraction plant was erected by the owners of the factory in an endeavour to abate the nuisance. Three major series of complaints followed during the year, with considerable periods between. These latter complaints were due to fires at the works. A High Court action was taken by the owner of adjoining land against the factory owners, at which the Senior Sanitary Inspector was subpoenaed to give evidence. Apart from the above, observation has been maintained of several factories in the same vicinity and three letters of warning have been served on the owners to abate smoke nuisances. 44 (vi) Special Classes op Premises and Occupations subject to Control by the Local Authority.—Fish-frying licences (6 of which were transfers) have been granted in respect of 8 premises during 1935. Slaughter of Animals Act, 1933.—Two licences to act as slaughtermen were granted during the year. Byelaws relating to houses, to houses let in lodgings, and to tents, vans, sheds, etc.—It has not been considered necessary to seek any revision of existing byelaws. A full list of the byelaws in operation is given on page 27 of this report. (vii) Other Sanitary Conditions Requiring Notice. (a) On 3 occasions it has been found necessary to remove encampments of gipsies on waste land within the Borough. No action has been found necessary in respect of underground sleeping rooms (Housing Act, 1925, Sect. 18 (1) ). (viii) Under Section 25 of the Burial Act, 1857, supervision was carried out on one occasion in connection with the removal and re-interment of human remains at Barkingside Cemetery, an exhumation licence having been issued by H.M. Home Office. (ix) Rag Flock Acts, 1911 and 1928.—The Medical Officer of Health and the Sanitary Inspectors are the appointed Officers for the purposes of enforcing the provisions of these Acts. There are no premises on which rag flock is manufactured, but 4 premises are using rag flock and are periodically inspected. 4. 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 149, School Medical Service Section. 45 SECTION D.—HOUSING. (i) During the year 1935, the number of houses built by private enterprise was 2,092. At the end of the year 1,661 houses were in course of erection. (ii) Overcrowding.—Informal Notices were served in respect of 6 premises, all of which were complied with. (iii) Unhealthy Areas.—No representations or complaints have been made regarding unhealthy areas during the year. (iv) HOUSING STATISTICS. 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)1,359 (b) Number of inspections made for the purpose.. 3,037 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 112 (b) Number of inspections made for the purpose 071 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 12 (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 642 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 585 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 106 46 (2) Number of dwelling-houses which were rendered lit after service of formal Notices:— (а) By owners 128 (б) 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 6 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (а) By owners 5 (б) By local authority in default of owners — c. Proceedings under sections 19 and21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 4 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4f d. Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — * Includes compliances during 1935 of Notices served in 1934. † In addition 8 dwelling-houses were demolished in anticipation of formal procedure under Section 19. (iv) Housing Act, 1935: Overcrowding Survey.—In accordance with the instructions of the Ministry of Health, an overcrowding survey under the above-mentioned Act has taken place, a temporary staff being employed for the purpose, and the final report will be issued to the Council and the Ministry of Health in due course. 47 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply. (i) The following is a summary of Persons and Premises registered as at 31st December, 1935:— Premises registered as dairies and milkshops 42 Cowkeepers registered 5 Persons registered as retail purveyors of milk 54 Persons registered as retail purveyors of milk in sealed cartons or containers 65 Persons registered as retail purveyors of milk (sterilized) in sealed bottles 60 Persons registered as retail purveyors of milk in sealed cartons or containers; and also sterilized in sealed bottles 12 Persons registered as retail purveyors of cream 11 Persons registered as retail purveyors of milk in the Ilford district, whose premises are outside the Borough 24 Persons registered as wholesale purveyors of milk 5 Persons registered as wholesale purveyors of milk (sterilized) in sealed bottles 2 Person registered as wholesale purveyor of milk in sealed cartons or containers 1 460 inspections of dairies, milkshops, cowsheds and other premises where milk is sold were carried out during the year. Ill inspections (included in above) were made of the 5 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. 3 of the 5 registered cow-keepers are wholesale and retail purveyors of milk; 2 are retail purveyors only. Structural alterations have been carried out under supervision at 2 farms. Of the 186 premises from which milk is retailed in Ilford, 17 are branches of one firm, 5 another, while 2 are branches of a large firm of retailers, 3 retail from dairy shops or stores, 8 from general shops and 5 from restaurants, 9 are retailers in a small way with rounds and also provision for storage of milk; while 60 sell sterilised bottled milk only, 12 sell sterilised milk and also milk in sealed containers, and 65 retail milk in sealed containers only. In 2 premises, pasteurising plant has been installed. Only 1 of these has, however, been licensed. 48 In addition, 1 firm, having premises outside the district, is registered as a wholesale purveyor of milk in sealed containers. (ii) Licences were granted under the Milk (Special Designations) Order, 1923, during 1935, for the sale of:— "Certified'' Milk 6 "Grade A" Milk 6 "Grade A (Tuberculin Tested)" Milk 25 "Pasteurised'' Milk 23 "Grade A Pasteurised'' Milk 2 The above include supplementary licences which were issued for "Certified Milk," 1; "Grade A" milk, 5; "Grade A (Tuberculin Tested)" milk, 11; and "Pasteurised" milk, 11. These are licences granted to firms who already have a primary licence from another Authority, the milk being bottled outside the town, but sold in Ilford. (iii) Sampling.— (a) "Certified" Milk.—12 samples were taken for bacteriological examination for the Ministry of Health. All were satisfactory with the exception of 1 sample which did not comply with the standard as regards B. Coli Content, and the result was transmitted to the Ministry of Health. (b) "Grade A (Tuberculin Tested)" Milk.—46 samples were taken, 11 of which did not comply with the standard as regards B. Coli Content in the case of 8 retailers. (c) "Grade A" Milk.—5 samples were taken, all of which were factory. (d) "Grade A Pasteurised" Milk.—11 samples were taken, 2 of which did not comply with the standard as regards B. Coli Content in the case of 1 retailer. (e) "Pasteurised" Milk.—73 samples were taken, 8 of which did not comply with the standard as regards Bacterial Count, and 8 as regards B. Coli Content, in the case of 6 retailers. (/) Ungraded Milk.—75 samples were taken. In 4 cases, affecting 4 firms, the retailers were communicated with owing to a high Bacterial or B. Coli Content. (g) Cream.—1 sample was taken, which was satisfactory. (h) Ice Cream.—68 samples were taken. In 2 cases, affecting 2 firms, the retailers were communicated with owing to a high Bacterial or B. Coli Content. (iv) Tubercular Milk.—45 samples of milk were submitted to a biological test for tuberculosis; 2 samples were found to be positive. 49 The following is a brief resume of the cases:— (a) Ungraded Milk.—Sample taken from Ilford retailer on 22nd January. Supplies were obtained from a farm at Sudbury, in Suffolk, having 79 cows; 6 of these had indurated udders, individual samples of milk were taken, but negative results obtained. (b) Ungraded Milk.—Sample taken from Ilford retailer on 8th May. Supplies were obtained from a farm at Romford, having 28 cows; 2 cows were found to be tuberculous and were slaughtered. In each of the above-mentioned cases the farms were visited by the E.C.C. or Ilford Veterinary Officers, the County Medical Officer was notified under Section 4 of the Milk and Dairies (Consolidation) Act, 1915, and warnings were served on the retailers under Section 5 of the Milk and Dairies (Consolidation) Act, 1915. Further samples were also obtained by this Authority and the biological examinations gave negative results. (v) Milk and Dairies Order, 1926: Inspection of Dairy Herds.— In February, 1934, the Essex County Council appointed a Chief Veterinary Officer, Mr. F. W. Medlock, who formulated a scheme for the routine inspection of dairy herds in the Administrative County three times a year. The work commenced on the 1st October, 1934, and is being carried out by part-time Veterinary Surgeons, most of whom had hitherto undertaken work for the County Council under the Diseases of Animals Act. In November, 1934, Mr. Ralph Bennett, F. R.C. V.S., the Veterinary Surgeon to the Ilford Borough Council, was appointed by the Essex County Council to carry out the herd inspections in Ilford, thus greatly facilitating the work under both the above-mentioned Order and the Diseases of Animals Act. Routine inspections were commenced by Mr. Bennett in Ilford during December, 1934. Under Section 5 of the Milk and Dairies (Consolidation) Act, 1915, and Clause 11 of the Milk and Dairies Order, 1926, it is usual to serve a notice upon the owner of the animal or animals affected, upon which it becomes an offence to sell the milk of such an animal for the purposes specified in the Section. The Veterinary Services Joint Advisory Sub-Committee of the Public Health and Agricultural Committees of the County Council have made arrangements whereby Mr. Bennett notifies me of every notice under Section 5 served upon Ilford cow-keepers. As a result of inspections during the year by the Veterinary Officer, 7 notifications were received of suspected cases of tuberculosis. 6 cows were slaughtered from farms in the Borough, and 1 from the farm of a public institution. In each case post-mortem examination revealed the presence of tuberculosis. (vi) Legal Proceedings.—None were taken during the year. (vii) Registration.—The Council refused to register:— (а) An applicant, residing outside the Ilford district, who applied for registration as a retail purveyor of milk in the Borough. Upon enquiries from the Medical Officers of Health for Romford and Dagenham, it was ascertained that he was not registered in their areas, having no suitable premises. (б) An applicant for a licence under the Milk (Special Designations) Order, 1923, to sell Pasteurised Milk. Upon enquiries it was found that no provision for cold storage existed, and it was proposed to store the milk on the shop counter. 50 Meat and Other Foods.—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 54 inspections were paid during the year. (i) Articles of Food Surrendered. During the year the following articles of food were surrendered and condemned as being unfit for the food of man:— 456 tins of Italian cherries; 138 tins of mixed fruit, vegetables, fish and meat; 1 tin of pears; 38 lbs. cod fish; 249 stone of imported beef, pork mutton and lamb, home-killed veal, beef, lamb, sausage meat and ducks; 3 stone fillet of cod; 40 tins of plums; 11 rabbits and 5 boxes of soft roes. Adulteration, etc. (i) 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 the Ilford district, which I append:— Samples of Milk taken 33 Samples of Butter taken 48 Other Samples 303 Total 384 No prosecutions were undertaken during the year. Food Poisoning. (i) On the 21st March suspected food poisoning was reported, four members of one family being affected. Full enquiries were made and a specimen of the sauce complained of, and partaken with the food, was sent to the Ministry of Health Laboratories. The Pathologist was unable to find a bacterial cause, and a further specimen of the sauce was sent to the Public Analyst, who was unable to find an indication of anything injurious. The members of the family were only temporarily affected, and made speedy recoveries. (ii) On the 9th July a case of suspected food poisoning was reported to me by the Coroner's Officer, the deceased being a male, aged 26 years. The Pathologist carried out a bacteriological examination, but failed to find any trace of food poisoning. The cause of death was "Exhaustion following acute gastro-enteritis; misadventure." No other members of the family were affected. 51 Bakehouses.—There are 39 bakehouses in the district, including 23 factory bakehouses. 238 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 29 instances, and the requests were complied with. Contagious Diseases (Animals) Acts, 1894-1925. (i) Regulation of Movement of Swine Fever Order, 1922.—8 Licences have been received from various Local Authorities affecting 195 animals sent into the district for stock and other purposes. Isolation for the necessary period was enforced. One pig was returned to another district under Licence. (ii) Sheep Scab Order, 1928.—These regulations under the above Order came into force in the Borough on the 7th July, 1931, and during the year ending 31st December, 1935, 1,640 (1st dippings 820, 2nd dippings 820) sheep have been dipped as required at a farm in the Borough. (iii) Swine Fever Order, 1908.—-Notice was received of a suspected case of Swine Fever at an allotment in the Borough. Form ' 'A'' Notices were served creating the premises an infected place. It was later cleared by the Ministry of Agriculture and Fisheries from being an infected place. (iv) Parasitic Mange Orders of 1911 and 1918. On two occasions mange was notified as existing amongst the horses at a farm, and also at the farm of a public institution in this Borough. 2 animals were slaughtered. The remainder were isolated, and on recovery the premises were cleansed and disinfected. Rats and Mice Destruction Act, 1919.—62 complaints have been received of the existence of rats affecting 108 premises. In 21 of these cases poison gas has been used, and in the remaining cases other steps have been taken. National Rat Week (November, 1935).—In accordance with the instructions issued by the Ministry of Agriculture and Fisheries, special efforts were made during National Rat Week, and I append herewith a summary of the action taken:— 52 (i) Five sets of three special slides were provided and these were put on the screen at five Cinemas in the Borough at each performance during the week. In addition, a special illustrated poster was exhibited in each of the five Cinemas, in the vestibule. (ii) At two other Cinemas it was not possible to show the slides on the screen; at one of these a special illustrated poster was placed in the vestibule and two posters on the outside boards, and at the other Cinema two posters were displayed on the outside boards. (iii) Printed placards were posted on the public notice boards throughout the Borough, and these placards were also sent out to suitable private premises where considered necessary, viz., factories, farms, business houses, cinemas, Town Hall, and other buildings belonging to the Borough Council, etc. (iv) Public notice was given in the newspapers circulating in the Borough. (v) The property owned by the Corporation was carefully considered. Where any rat infestation was found, this was treated by gassing. (vi) 5,000 handbills were distributed throughout the Borough with adult library books, by kind permission of the Chairman of the Libraries Committee and the Borough Librarian. The response to this extensive publicity is somewhat disappointing, only ten complaints being received, apparently, as a direct result. Petroleum (Consolidation) Act, 1928.—The Senior Sanitary Inspector made 401 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested 28 petroleum appliances or fittings. The number of Licences issued was 126 and the fees paid to the Council for such Licences was £88 15s. Od. 6 Licences were issued for the storage of calcium carbide, the fees payable being £1 15s. Od. SECTION F.—PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. 1.—Infectious Diseases Generally .■—During 1935, 964 cases were notified, as compared with 1,280 in 1934. 53 The following diseases are notifiable to the Medical Officer of Health:— Smallpox. Cholera. Diphtheria. Membranous Croup. Erysipelas. Scarlatina or Scarlet Fever. Typhus Fever. Typhoid Fever. Enteric Fever. Relapsing Fever. Continued Fever. Puerperal Fever. Puerperal Pyrexia. Pemphigus Neonatorum. Cerebro-Spinal Fever. Plague. Ophthalmia Neonatorum. Tuberculosis. Acute Influenzal Pneumonia. Acute Primary Pneumonia. Dysentery (including amoebic and bacillary dysentery). Malaria. Acute Poliomyelitis. Acute Polio-Encephalitis. Acute Encephalitis Lethargica. Anthrax. Acute Rheumatism. ^ 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. Application was made to the Ministry of Health requesting that rheumatism be made notifiable in children up to 16 years of age, and on the 18th March, 1935, an Order was made to operate as from 1st April, 1935, as follows:— The Ilford (Acute Rheumatism) Regulations, 1935, dated March 18, 1935, made by the Minister of Health. Whereas the Minister of Health is empowered by section 130 of the Public Health Act, 1875, as amended by the Public Health Act, 1896, from time to time to make alter and revoke regulations with a view to the treatment of persons affected with any endemic or infectious disease and for preventing the spread of the disease and to provide for the enforcement and execution of the regulations; And whereas acute rheumatism as herein defined is an endemic disease: Now therefore the Minister of Health in pursuance of the recited enactments and of all powers enabling him in that behalf hereby makes the following regulations that is to say:— Definitions. 1.—(1) In these regulations unless the context otherwise requires:— (a) The expression "local authority" means the council of the borough of Ilford; 54 (6) The expression "the district" means the borough of Ilford; (c) The expression "medical officer of health" means the medical officer of health of the local authority; (d) The expression "medical practitioner" means any person for the time being registered under the medical Acts and resident or practising within the district; (e) The expression "acute rheumatism" means the following conditions occurring separately or together in a child under the age of 16 years:— (1) rheumatic pains or arthritis if accompanied by a rise of temperature; (2) rheumatic chorea; (3) rheumatic carditis. (2) The Interpretation Act, 1889, applies to the interpretation of these regulations as it applies to the interpretation of an Act of Parliament. Commencement of regulations. 2. These regulations shall come into operation on the first day of April nineteen hundred and thirty-five and shall continue in operation for a period of three years from that date and shall be enforced and executed in the district by the local authority. Notice of provisions of regulations. 3. The local authority shall forthwith cause notice to be given to every medical practitioner of the duties imposed upon him by these regulations. Notification by medical practitioner. 4. Subject to the provisions of these regulations every medical practitioner as soon as he becomes aware that a child who is resident within the district and upon whom he is in professional attendance is suffering from acute rheumatism shall forthwith make and sign a notification of the case in the form set forth in Schedule A to the Public Health (Notification of Infectious Diseases) Regulations, 1918, and shall transmit the notification to the medical officer of health: Provided that a medical practitioner shall not be required to notify a case of acute rheumatism under this section and shall not be paid a fee for so doing if he has reasonable grounds for supposing that the case has already been notified under these regulations. Supply of forms of notification. 5. For the purposes of these regulations the local authority shall provide and maintain a sufficient supply of printed copies of the prescribed form of notification and shall as soon as practicable after these regulations come into operation and afterwards from time to time when application is made to them furnish printed copies of the said form to every medical practitioner. 55 Transmission of notifications. 6. A notification to be transmitted to the medical officer of health in pursuance of these regulations shall be enclosed in a sealed envelope addressed to that officer and may be transmitted by being delivered to him or by being delivered at his office or residence or may be sent by prepaid letter post addressed to him at his office or at his residence: Provided that the requirement herein contained that a notification shall be enclosed in a sealed envelope shall be deemed to be complied with if the notification is folded in such a manner that during its transmission the particulars of the notification cannot be observed. Fees for notification. 7.—(1) The local authority shall pay to every medical practitioner a fee of two shillings and sixpence for each notification duly made signed and transmitted by him under these regulations except in a case occurring in his practice as a medical officer of any public body or institution when the fee shall be one shilling. (2) The said fees shall in each case be deemed to cover all expenses including the cost of transmission. Duties of local authority and of medical officer of health. 8.—(1) Upon the receipt of a notification under these regulations or on becoming aware in any other way of a case or suspected case of acute rheumatism in the district the medical officer of health or a person acting under the instructions of the medical officer of health shall make such inquiries and take such steps as are necessary or desirable for investigating the source of disease for removing conditions harmful to the patient and arranging for the treatment of the patient. (2) Nothing in this section shall be deemed to authorise the local authority or the medical officer of health or other person as aforesaid to take any of the steps herein mentioned at any institution other than one belonging to the local authority except with the consent of the managers of that institution. (3) The duties assigned to the medical officer of health by the Sanitary Officers Order, 1926, shall be deemed to extend to and include all action by a medical officer of health in the execution of these regulations. Notification not required in certain cases. 9. Nothing in these regulations shall be construed as requiring a notification to be transmitted to a medical officer of health under these regulations in respect of an inmate of any building ship vessel boat tent van shed or similar structure belonging to His Majesty the King whose case falls within the provisions of paragraph (b) of section 5 of the Local Government (Emergency Provisions) Act, 1916 (as made permanent by the Expiring Laws Act, 1925, and as applied to the Royal Air Force by the Air Force (Application of Enactments) (No. 2) Order, 1918). Short title. 10. These regulations may be cited as the Ilford (Acute Rheumatism) Regulations, 1935. Given under the official seal of the Minister of Health this eighteenth day of March nineteen hundred and thirty-five. 56 Table II shows the number of cases of infectious diseases notified during 1935, arranged according to age and distribution in wards. Of these 131 were notified from institutions as follows:— Clavbury Mental Hospital:— Pneumonia 2 Enteric Fever 9 Erysipelas 11 Tuberculosis—Pulmonary 1 Dysentery 27 0 Dr. Barnardo's Girls' Village Homes:— Scarlet Fever 25 Diphtheria 15 Tuberculosis—Pulmonary 1 41 Ilford Council Maternity Home:— Pemphigus Neonatorum 1* Puerperal Pyrexia 2 Ophthalmia Neonatorum 3 Tuberculosis—Pulmonary 1 West Ham Mental Hospital:— Pneumonia 1 Tuberculosis—Pulmonary 11 Erysipelas 2 Dysentery 1 15 King George Hospital:— Diphtheria 5 Scarlet Fever 1 Pneumonia 4 Tuberculosis—Non-Pulmonary .. 3 Enteric Fever 1 Acute Poliomyelitis 1 Dysentery 1 Acute Rheumatism 2 18 * Discharged and treated at own home. Of the cases notified, the following table shows the percentage treated in institutions, including those who were treated in the institutions from which they were notified:— Scarlet Fever 83.2 Diphtheria and Membranous Croup 97.8 Enteric Fever 93.7 Puerperal Fever 100.0 Puerperal Pyrexia 75.0 Pneumonia 53.6 57 TABLE II.—Cases of Infectious Diseases Notified during the Year 1935. NOTIFIABLE DISEASE. At all Ages. Number of Cases Notified. At Ages—years. Total Cases Notified in each Ward. Total Cases Admitted 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 Barkingside North Hainault Loxford Clementswood South Hainaultj Goodmayes Smallpox Scarlet Fever 357 4 55 226 33 38 1 27 13 42 37 65 23 38 41 71 297 (a) Diphtheria, including Membranous Croup.. 189 3 26 119 20 17 4 11 9 15 18 31 27 24 27 27 185 (b) Enteric Fever (Typhoid and Para-Typhoid) 16 — 2 4 1 4 5 — 1 3 — 9 1 — — 1 1 15 (c) Pneumonia 69 5 8 8 6 20 11 11 2 10 6 8 11 4 14 6 8 37 (d) Puerperal Fever 5 — — — 3 2 — — 1 1 — — 1 — 2 — 5 Puerperal Pyrexia 16 — — — 4 12 — - — 3 2 3 5 — 3 — — 12 (e) Cerebro-Spinal Fever - Acute Poliomyelitis 1 — 1 — — - - - — - 1 — 1 (f) Acute Polio-Encephalitis Encephalitis Lethargica Continued Fever Dysentery 29 — — 1 3 11 11 3 — — — 27 1 — — 1 — 29 (g) Ophthalmia Neonatorum 11 11 4 1 4 — — — 2 3 (h) Erysipelas 52 1 i 1 4 14 22 9 3 4 7 14 3 3 7 4 7 29 (i) Pemphigus Neonatorum 4 4 — — — — — — 1 — — 1 1 — — — 1 — Tuberculosis—Pulmonary Other Forms 130 36 5 3 12 27 10 70 8 28 1 2 16 1 16 4 16 3 8 3 14 9 9 5 16 2 22 3 13 6 Anthrax Malaria—Believed to be contracted in this — — — — — — — — — — — — — — — — — - country — _ - - — — — - Believed to be contracted abroad — — — — — — — - - - — — - Acute Rheumatism 49 — 1 48 — — — 4 6 5 3 3 2 3 3 20 9 (j) Totals 964 28 99 422 11 1 196 83 25 66 69 101 132 149 74 107 110 156 622 * See note on following page. 58 * Note to Table II. (a) Includes 25 cases notified from and treated at Girls' Village Homes. 1 case ,, King George Hospital and transferred to Barking Isolation Hospital. (b) ,, 15 cases ,, and treated at Girls' Village Homes. ,, 5 ,, ,, King George Hospital, 3 of which we transferred to Ilford Isolation Hospita and 1 to Romford Isolation Hospital. ,, lease ,, Belgrade Hospital for Children, Clapham, and transferred to Grove L.C. C. Hos pital. (e) ,, 9 ,, ,, and treated at Claybury Mental Hospital. ,, 1 case ,, ,, ,, King George Hospital. (d) ,, 2 cases ,, ,, ,, Claybury Mental Hospital. ,, 1 case ,, ,, ,, West Ham Mental pital. ,, 4 cases .. .. ,, King George Hospital. (e) ,, 2 ,, ,, Ilford Maternity Home, 1 being treated at the Home and 1 transferred to Ilford Isolation Hospital. (f) ,, 1 case ,, and treated at King George Hospital. (g) 27 cases ,, ,, ,, Claybury Mental Hospital. 1 case ,, ,, ,, West Ham Mental Hospital. 1 ,, ,, ,, ,, King George Hospital. (h) ., 3 cases ,, the Ilford Maternity Home, 1 treated at the Maternity Home and 2 at the Royal London Ophthalmic Hospital. (0 ,, 11 cases .. ,, Claybury Mental Hospital. 2 ,, .. ,, West Ham Mental Hospital. (J) ,, 2 cases ,, ,, ., King George Hospital. The total number of deaths of Ilford residents from the following infectious diseases during 1935 was 157, as against 213 in 1934. 1934. 1935. Scarlet Fever 2 1 Enteric Fever 1 — Encephalitis Lethargica 3 2 Diphtheria 18 8 Measles 12 — Whooping Cough — 6 Influenza 12 16 Tuberculosis—-Pulmonary 70 60 Other forms 10 10 Pneumonia 77 35 Diarrhoea (under 2 years) 5 14 Cerebro-spinal Fever 1 2 Puerperal Fever 2 3 Total 213 157 The following table shows a comparison of the incidence of the following infectious diseases for the past five years:— 1935. 1934. 1933. 1932. 1931. Scarlet Fever 357 461 406 257 218 Diphtheria 189 343 150 85 201 Enteric Fever 16 6 19 21 8 Pneumonia 69 159 152 126 107 59 (a) Smallpox.—Notifications of 16 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. No case of Smallpox occurred. The folio wing.gives particulars as to Vaccination during 1935 :— Certificates of Successful Vaccination 949 Postponed 72 Conscientious Objections 834 Unsuccessful Vaccination 9 Left the District 111 (6) Scarlet Fever .—357 cases were notified in 1935, as compared with 461 in 1934; 406 in 1933; 257 in 1932; 218 in 1931; 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 (including Institutions). Admitted to Isolation Hospital. "Return" Hospital Cases. Per Cent. Home Cases. Cases arising in same house. Per Cent. 1931 218 180 1 .5 36 2 5.5 1932 257 206 7 3.4 44 — — 1933 406 321 9 2.1 58 — — 1934 461 326 19 5.8 94 — — 1930 357 266 8 3.0 60 — — (c) Diphtheria.—189 cases were notified in 1935 as compared with 343 in 1934; 150 in 1933; 85 in 1932; 201 in 1931; 330 in 1930; 305 in 1929; 260 in 1928; 187 in 1927; 148 in 1926; 56 in 1925. One death occurred at Oldchurch Hospital, Romford, of an Ilford resident. The Schick Testing and Immunising of children has been continued, and the following table shows the number Schick Tested and immunised at the Diphtheria Clinics held at the Public Health Offices and the Mayesbrook School Clinic. 60 Tabular Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January, 1935, to 31st December, 1935. Public Health Offices. Mayesbrook Clinic. Grand Totals. Both Clinics. School Children (Various Schools). Children under 5 years of age. Total. School Children (Various Schools). Children, under 5 years of age. Total. Numbers Schick Tested :— Positive 66 5 71 27 2 29 100 Negative 47 — 47 7 7 54 Numbers inoculated (full course) 494* 343 837 145* 109 254 1,091 Positive after full course of inoculations, and re-inoculated 8 1 9 2 2 11 Negative after full course of inoculations.. 354 241 595 106 87 193 788 Awaiting re-test 121 98 219 35 20 55 274 Not re-tested after inoculation (on account of leaving District, etc.) .. 11 3 14 2 2 4 18 Positive after re-test, but not inoculated for same reason — — — — Final Schick Test in 1935 (1934 Cases):— Positive after full course of inoculations, and re-inoculated 4 1 5 5 Negative 241 173 414 28 26 54 468 * Schick+1935 = 66; Schick-f-1934 = 5; Not Tested = 423. * Schick-f 1935 = 27 Tested=118. ; Not During 1935 a total number of 1,618 children attended at the Diphtheria Prevention Clinics (1,303 at the Public Health Offices and 315 at Mayesbrook), making a total number of attendances of 7,497 (6,264 and 1,233), with an average per session of 87 and 40 respectively. 61 At the request of the Stratford Division of the British Medical Association, the Borough Council consented to the following arrangements. The Ministry of Health sanctioned these under Section 133 of the Public Health Act, 1875. The Ministry's sanction was given "on the understanding that the arrangements will be under the general supervision of the Medical Officer of Health and that full details of the work will be given in his Annual Report." The arrangements which the Ministry of Health have approved, as above, are that diphtheria prophylactic should be supplied free for those cases which are inoculated under this scheme on condition :— (1) that the Medical Officer of Health is furnished on a form provided for the purpose with the names, ages, addresses, etc., together with the dates of injection of those patients inoculated; (2) that the children immunised are subsequently Schick Tested at the Council's Diphtheria Prevention Clinics. The medical practitioners resident in the Borough were circularised on the 24th May, with detailed instructions as to immunisation, and since that date to the end of the year 15 doctors have been supplied with prophylactic for the treatment of 57 children (11 under 5 years and 46 over 5 years of age). The following is a brief summary:— Numbers inoculated (full course) by medical practitioners.. 51 Numbers of forms not yet returned to Public Health Offices 6 Numbers Schick tested at Clinics and found negative .. 12 Numbers not Schick tested owing to having left district, etc. 4 Numbers awaiting Schick test at Clinics in 1936 35 (d) Enteric Fever.—16 cases were notified in 1935, as compared with 6 in 1934; 19 in 1933; 21 in 1932; 8 in 1931; 11 in 1930; 12 in 1929; 30 in 1928; 11 in 1927; 6 in 1926; 10 in 1925. 9 of the cases occurred at Claybury Mental Hospital, of which 4 died at this Institution. 62 Five cases were admitted to the Ilford Isolation Hospital. In one case the infecting organism was B. Typhosus. The patient had stayed for a week at a seaside resort. In the other 4 cases the infecting organism was B. Para-typhosus B. Three of these patients had visited areas outside Ilford, but the other had not been away from the Borough. One case was nursed at home; and infection was also due to B. Para-typhosus B. in this case. This patient had also visited an area outside the Borough. One case occurred at King George Hospital, the organism found being B. Para-typhosus B. The patient, who was admitted for abdominal trouble, had previously stayed on a farm in Essex where water was obtainable from a well. All of these patients recovered satisfactorily. (e) Cerebro-Spinal Fever.—No notifications of this disease were received during the year. Two deaths, however, occurred in Oldchurch Hospital from meningococcal meningitis. (f) Ophthalmia Neonatorum.—11 cases were notified during 1935, as compared with 16 in 1934; 14 in 1933; 11 in 1932; 11 in 1931; 5 in 1930; 6 in 1929; 4 in 1928; 2 in 1927; 3 in 1926; 3 in 1925. Of the 11 cases, o were treated at home by private medical practitioners; 6 attended the Out-Patient Department of the Royal London Ophthalmic Hospital; 1 was treated at the Maternity Home, and the other at the Public Health Offices. Notified. Cases. Vision Unimpaired. Vision Impaired Total Blindness Deaths Treated. At Home. In Hospital. 11 4 7 11 — — 63 (g) Acute Influenzal and Acute Primary Pneumonia.—69 cases were notified (of which 7 were in institutions) in 1935, compared with 159 in 1934; 152 in 1933; 126 in 1932; 107 in 1931; 69 in 1930; 146 in 1929; 92 in 1928; 139 in 1927; 73 in 1926; 103 in 1925. The following is a statement of the number of cases of acute influenzal pneumonia and acute primary pneumonia notified during 1935, together with the number of deaths of notified cases, compared with the year 1934 :— Acute Inf. Pneumonia. Acute Primary Pneumoi. a. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1935 .. 1934 .. 28 38 6 14 41 121 14 44 69 159 20 58 (h) Encephalitis Lethargica.—No cases of this disease were notified during the year. (i) Acute Poliomyelitis.—1 case was notified during 1935—a male child aged 22 months. (j) Puerperal Fever.—5 cases were notified during the year; 2 were treated at the Isolation Hospital, 1 at St. Bartholomew's Hospital, 1 at Oldchurch Hospital, and 1 at the London Hospital. All were residents of Ilford. Of the 5 cases notified in Ilford, 1 died at St. Bartholomew's Hospital from septicaemia and septic endometritis. (k) Puerperal Pyrexia.—16 cases were notified, 6 being removed to the Isolation Hospital; 3 to Oldchurch Hospital, Romford; 1 to King George Hospital; 1 to Queen Charlotte's Isolation Hospital, Hammersmith—this case proved fatal from general sepsis and peritonitis; 1 was nursed at the Maternity Home; 1 at the Royal Free Hospital (where the patient had been confined); 1 at the Mothers' Hospital, Clapton (where the patient had been confined); 1 at a private nursing home, and 1 at home. 64 The 16 patients were suffering from the following conditions :— Cause of Pyrexia. Number of Cases. Miscarriage 1 Mastitis 1 Retained placenta 1 Sapraemia 3 B. coli infection 2 Pneumonia 1 Sub-involution of uterus 1 Septic lacerations 1 Uterine sepsis 1 Scarlet fever 2 Pyaemia 1 Septicaemia (fatal) 1 2. Zymotic Diseases.—The deaths registered were as follows:— Smallpox — Measles — Scarlet Fever.. 1 Diphtheria and Croup 8 Enteric Fever — Diarrhoea 14 65 Table showing Incidence of, and Deaths from, Infectious Disease, 1935, in age groups. Disease. Total cases notified. Under 1 yr. 1—2. 2—3. 3—4. 4—5. 5—10. 10—15. 15—20. 20—35. 35—45. 45—65. Over 65. Cases admitted to Hospital Total Deaths Under 1 yr. 1-2. 2—3. 3—4. 4—5. 5—10. 10—15. 15—20. 20—35. 35—45. 45—65. Over 65 Smallpox Scarlet Fever 357 4 5 6 17 27 158 68 22 32 17 1 — 272 1 - - - - - - - - - 1 - - Diphtheria 189 3 5 10 4 7 70 49 6 24 7 4 — 169 8 1 1 1 - - 1 3 1 — — — - Enteric Fever (including Paratyphoid) 16 2 4 3 2 5 - 6 - - - - - - - - - - - - - Pneumonia 69 5 - 5 3 3 5 4 1 1 11 11 11 34 35 7 1 1 1 4 13 8 Puerperal Fever 5 - 1 4 5 2 1 1 - 16 -- - - - - - - 13 3 - - 12 1 1 - - - Cerebro-spinal Fever - - - - - - - - - - - - - - 2 1 - - - - - - - 1 - - Acute Poliomyelitis 1 1 Acute Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - 2 - - - - - - - - 1 - 1 - Continued Fever .. - - - - - - - - - - - - - - - - - - - - - - -- - - - Dysentery 29 - - — — 1 7 7 11 3 1 - - - - - - - - - - - - - Ophthalmia Neonatorum 11 11 - - - - - - - - - - - - - - - - - -- - - - - - Erysipelas 52 1 1 - - - - 1 1 6 11 22 9 16 4 1 - - - - - - - - 2 1 — Anthrax - - - - - - - - - - - - - - - - - - - - - - - -- - - Malaria—believed to be contracted in this country - - - - - - -- - - - - - - -- - - - - - - - - - - - ,, —believed to be contracted abroad.. - - - - - - - - - - - - - - - - - - - - - - - - - - - Pemphigus Neonatorum .. 4 4 - - - - - - - - - - - 1 1 1 - - - - - - - - - - - Acute Rheumatism 49 — 1 — 16 32 — — — — — 9 — — - - - - - - - — - — — * Excludes cases occurring at Barnardo's Homes, Claybury Mental Hospital, and West Ham Mental Hospital. 66 3. Tuberculosis.—-During the year 1935, there were 130 new notifications of Pulmonary Tuberculosis and 36 of other forms of Tuberculosis. 25 cases of Pulmonary and 3 cases of NonPulmonary Tuberculosis were transferred to Ilford. Notification and Deaths from Tuberculosis of Ilford Residents during 1935. Age Periods. New Oases. Deaths. Respiratory NonRf spiratory Respiratory NonRespiratory M F M F M F M F Under 1 year 1-5 years — — 2 3 — — 1 1 6-10 1 — 4 1 — — 1 — 10-15 1 1 5 2 1 — 1 1 15-20 6 2 1 3 1 2 — — 20-25 9 10 4 2 2 8 1 — 25-35 31 17 1 6 11 9 1 2 35-45 13 9 1 —> 6 4 — 1 45-55 16 2 — — 5 — — — 55-65 10 — — 1 7 — — — Over 65 1 1 — — 1 3 — — Totals 88 42 18 18 34 26 5 5 67 Tuberculosis was not discovered until post-mortem examination; in 1 case the presence of tuberculosis only became known at an operation, and in 1 case the presence of Tubercle Bacilli was discovered in the sputum, the result only becoming known after the death of the patient. During the year 1935, the following deaths occurred from Tuberculosis :— Pulmonary. Non-Pulmonary. Ilford Residents *60 *10 Non-Residents:— Claybury Mental Hospital .. 9 3 West Ham Mental Hospital.. 6 — King George Hospital — 3 * Includes 2 at King George Hospital. On the 1st January, 1935, there were 804 cases on the register of ihe department. On the 31st December, 1935, with 166 new cases notified alid 28 transfers, and allowing for deaths, removals from district and cases removed from the register as " cured," there were 771 cases on the register. The new cases of Tuberculosis are visited by the Tuberculosis Nurse of the Essex County Council. 772 of the cases of longer standing were visited by the Sanitary Inspectors duritig the year, and the following reports were obtained :— Pulmonary Other Cases. Cases Stated to be cured, recovered or better 227 104 Improved or fairly well 178 54 Not so well 69 7 In Sanatorium 61 13 No information as to present condition 7 3 Removed from district, etc. 41 8 Totals 583 189 The treatment of Tuberculosis is under the control of the Essex County Council. The Tuberculosis Dispensary in Ilford is 68 attended on four occasions a week by the Tuberculosis Officer. On the 31st December, 1935, there were 600 patients on the register of the dispensary. The arrangements made with the Essex County Council for the dental treatment of tuberculous patients from llford, Romford, Leyton and Walthamstow were continued. Two afternoon sessions per month were set aside for the treatment of these cases. 77 patients were treated, 10 being supplied with dentures. The Council's Dentist also made 1 visit to the tuberculous patients at the llford Sanatorium. 20 patients were inspected, 10 of whom received treatment. I have received information from the County Medical Officer of Health that the number of patients from llford sent to Institutions under the County Tuberculosis Scheme during 1935, was as follows:— Pulmonary. N on-Pulmonary. Total. Males. Females. Males. Females. Adults 61 36 4 2 103 Children 2 1 4 5 12 Tuberculosis Care Association.—This Association has assisted 86 cases with extra nourishment, clothing, and in other ways. Public Health (Prevention of Tuberculosis) Regulations, 1925.—No action has been taken under these regulations as regards persons employed in the milk trade. Public Health Act, 1925, Section 62.—No action has been taken for the compulsory removal of infectious persons to hospital or other institutions. Infectious Diseases (Prevention) Act, 1890.—In connection with deaths from infectious diseases, 13 certificates in respect of the death of patients were issued, stating that bodies should not be removed from hospital except for the purpose of being buried forthwith. 4. Venereal Diseases.—In the following table are classified the deaths notified as due to (1) Syphilis; (2) Locomotor Ataxy and 69 General Paralysis of the Insane, which are certainly due to Syphilis; and (3) Aortic Aneurysm, which is very frequently caused by this disease. Ilford Residents. NonResidents in Institutions Totals Ages 0-1 !-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75-85 85 up Syphilis — — — — — — i — 1 — — i 3 Locomotor Ataxy i 1 1 — — 3 General Paralysis of Insane — — — — — 1 — 1 — 1 — 25 28 Aortic Aneurysm — — — — — 1 — 2 2 — - 4 9 The deaths in Institutions of Ilford non-residents occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital; 17.0 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 following figures show the number of cases notified since notification of this disease was first enforced in 1914: — 1914, 8 cases; 1915, 6 cases; 1916, 6 cases; 1917, 5 cases; 1918, 9 cases; 1919, 9 cases; 1920, 10 cases; 1921, 7 cases; 1922, 9 cases; 1923, 9 cases; 1924, 4 cases; 1925, 3 cases; 1926, 3 cases; 1927, 2 eases; 1928, 4 cases; 1929, 6 cases; 1930, 5 cases; 19.31, 11 cases; 1932, 11 cases; 1933, 14 cases; 1934, 16 oases; 1935, 11 cases. It is to be remembered that not all cases of ophthalmia neonatorum are due to gonorrhoeal infection. The diagnosis and treatment of Venereal Disease is carried out as stated in 1932 Report. <1 70 5. Notification of Non-Notifiable Acute Infectious Diseases, vide 1932 Report. 6. Disinfection by the Local Authority is carried out as stated in 1932 Report. Thirteen 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 G.— FACTORIES AND WORKSHOPS. Factories. There are 303 factories on the register, made up as follows :— Advertising Novelty Maker .. 1 Nautical Instrument Maker .. 1 Bakehouses 23 Optician 1 Bedstead Maker- 1 Oxygen Maker 1 Boot Makers and Repairers .. 48 Paint Manufacturer 1 Brick Maker 1 Paper Mills 2 Brush Maker 1 Photographic Works .. 2 Builders. Joinery and Plating and Enamelling 1 try Works 14 Poultry Appliance Maker Printers' Engineer 1 Cabinet Makers 4 1 Cable Works 2 Printing Works 15 Carbon Works 1 Provender Preparers 2 Carriage Works and Rubi er Worker 1 wrights 3 Saw Mills and Timber Cellulose Sprayer 1 chants 9 Chemical YVorks 3 Seed Sorting 1 Confectionery Makers 3 Shirt Makers 4 Corset Maker 1 Sign Makers 2 Cycle Repairers 2 Spectacle Case Maker 1 Dentist's Mechanic 1 Sports Goods and Electrical Dyers and Cleaners 3 Fittings Maker 1 Ebonite Goods 1 Stone Masons 2 Electric Battery Charging 2 Tarpaulin Repairer 1 Electric Lamp Maker 1 Tailor 1 Electric Equipment Repairers 4 Tile Fender Maker 1 Electricity Supply Works 3 Tool Engineers 4 Engineers 14 Toy Maker 1 Fire Cement Maker 1 Umbrella Repairers 2 Gas Mantle Manufacturer 1 Undertaker 1 Hardware Manufacturer 1 Upholsterers 4 Iron Cutting Works 1 Vulcanising Works 1 Laundries 8 Watch and Clock Makers and Leather Workers 5 Repairers 3 Mattress Makers 2 Water Softener Maker 1 Meat Cutting 14 Wearing Apparel Makers 19 Metalworker. 3 Wheelwrights and Farriers .. 2 Metal Polish Maker 1 Wireless Apparatus Makers .. 2 Mica Worker 1 Wood Cutters 4 Milk Pasteurisers 3 Mineral Water Manufacturer.. 1 Total 303 Motor Engineers 27 71 Workshops. There are 420 workshops on the register, made up as follows :— Bakehouses 16 Motor and Cycle Engineers and Beet Boiler 1 Repairers 40 Bookbinder 1 Optician 1 Boot Repairers 15 Packing Case Repairers 2 Boot Makers and Shoe Sewers 4 Photographers 2 Box Workers 2 Piano Repairer 1 Brush Worker .. 1 Pickle Maker 1 Builders and Carpenters 34 Picture Framers 2 Cabinet Makers 2 Plumbers 6 Carpet Planning 2 Poster Writers 2 Cartage Contractor 1 Printers and Stationers 4 Clergy Robe Maker 1 Rag and Bone Merchants 2 Coach Builder .. 1 Scale Maker 1 Coffee Grinder 1 Scrap Metal Merchant 1 Confectioners 3 Shirt Makers 3 Dressmakers 51 Sign Makers and Writers 2 Dyers and Cleaners 14 Sports Outfit Repairers 2 Electrical and Mechanical Tailors 29 Engineers 4 Tie Makers 2 Electric Battery Charging 8 Tile Fender Maker 1 Embroidery and Lace Workers 5 Timber Merchants 4 Flag Maker 1 Tinsmith 1 Floor Polish Maker 1 Toilet Requisites 1 Florists 4 Toy Makers and Repairers 2 French Polisher 1 Typewriter Repairer 1 Furriers 2 Umbrella Repairer 1 Glass Cutters and Glaziers .. 5 Undertakers 6 Glove Maker 1 Upholsterers, etc. 16 Hand Laundry.. 1 Watch and Jewellery Repairers 12 Hairdressers 4 Wearing Apparel and Under- Harness Maker.. 1 clothiers 46 Hat Maker 1 Wheelwrights and Farriers .. 7 Lamp-Shade Maker 1 Wire Worker 1 Leather Workers 4 Wireless Apparatus Makers .. 4 Monumental Mason 1 Woodcutter 1 Mica Cutter 1 Milliners 16 Total 420 Mineral Water Manufacturer.. 1 72 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) 120 Workshops (including Workshop Laundries) 778 6 — Workplaces (other than Outworkers' premises included in Part 3 of this report) — — — Total 898 6 — 73 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*:— Want of cleanliness — — — — Want of ventilation — — — — Overcrowding 1 1 — Want of drainage of floors — — — Other nuisances 3 3 — — Sanitary accommoda tion insufficient .. — — — — unsuitable or defective .. 3 3 — — not separate for sexes .. — — ' — — Offences under the Factory and Workshops Acts:— Illegal occupation of ground bakehouse (s. 101) — — — — Breach of special sanitary requirements for houses (ss . 97 to 100) .. — — — — Other offences — — — — (Excluding offences re- relating to outwork which are included in Part 3 of this report) Total 7 7 — — ♦Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. 74 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Lists received from Employers. Sending twice in the year. Sending once in the year. Lists. Outworkers. Lists. Outworkers. Contractors ; Workmen. Contractors Workmen (1) (2) (3) (4) (5) (6) (7) Wearing Apparel:— Making, etc. 16 16 49 — — — Cleaning and Washing — —. — — Household Linen — 1 — 1 Lace, Lace Curtains and Nets Total 16 16 49 I — 1 Note.—No home-workers were known to be engaged in the following occupations:—Curtains and Furniture Hangings; Furniture and Upholstery; Electro-plate; File Making; Brass and Brass Articles; Fur Pulling; Cables and Chains; Anchors and Grapnels; Cart Gear; Locks; Latches and Keys; Umbrellas, etc.; Artificial Flowers; Nets, other than Wire Nets ; Tents; Sacks; Racquet and Tennis Balls; Paper, etc.; Boxes , Paper Bags; Brush Making; Pea Picking; Feather Sorting; Carding, etc., of Buttons, etc.; Stuffed Toys; Basket Making; Chocolates and Sweetmeats; Cosaques, Christmas Crackers, Christmas Stockings, etc.; Textile Weaving. No notices were served under Section 108 of the Factory and Workshops Act, for outwork being carried out in unwholesome premises. 75 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) 4 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 Reports (of action taken) sent to H.M. Inspector — Other — Underground Bakehouses (s. 101):— In use at the end of the year ISOLATION HOSPITAL. 79 ISOLATION HOSPITAL. 558 patients were admitted during 1935, as compared with 706 in 1934, 569 in 1933, 422 in 1932, 421 in 1931 and 525 in 1930. 88.3 per cent, of the oases of diphtheria and 75.3 per cent, of scarlet fever occurring in the district (excluding those cases treated at the Institutions at which they were notified, or were transferred to other Isolation Hospitals) were admitted to the hospital. The following table shows the percentage of cases of diphtheria and scarlet fever occurring in the district, removed to the hospital during the past ten years. Year. Diphtheria. Scarlet Fever. 1935 88.3 75.3 1934 92.7 77.0 1933 90.6 79.0 1932 92 9 80 .1 1931 86.5 82.5 1930 92.8 66.7 1929 90.0 63.0 1928 92.7 66.8 1927 92.4 77.3 1926 87.6 86.6 The following table shows the total admissions for the past ten years:— Year. Scarlet Fever. Diphtheria. Tuberculosis. Other Diseases. Total. 1935 266 167 49 76 558 1934 326 270 49 61 706 1933 321 136 21 91 569 1932 207 91 28 96 422 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 80 The 558 patients admitted during 1935 were as follows:— Scarlet Fever 266 Puerperal Scarlet Fever 3 Diphtheria 167 Enteric Fever 5 Puerperal Pyrexia 4 Puerperal Fever 2 Pemphigus Neonatorum 1 Tuberculous Diseases 49 Tuberculous Meningitis 2 Pneumonia 20 Measles 6 Whooping Cough and Pneumonia 3 Meningitis 1 Erysipelas 12 Scabies 2 Acute Rheumatism 7 Under observation 8 In January it was necessary to send 2 cases of scarlet fever to the London Fever Hospital owing to lack of accommodation at the Isolation Hospital. Number of deaths in Hospital:— Diphtheria 7 (1 admitted in 1934) Scarlet Fever and Pulmonary Tuberculosis 1 Pneumonia 6 Pneumonia and Whooping Cough 1 Puerperal Septicaemia 1 (Admitted in 1934) Erysipelas 1 Tuberculous Meningitis 2 Pemphigus Neonatorum 1 Number of patients in Hospital on 1st January, 1935 and 1936 respectively:— 1st Jan., 1935. 1st Jan., 1936. Scarlet Fever 40 43 Diphtheria 43 28 Tuberculous Diseases 19 20 Puerperal Pyrexia 2 - Erysipelas — 1 Measles — 2 Pneumonia — 2 Acute Rheumatism — 4 Under observation — 3 The average length of stay in Hospital was for— Scarlet Fever 38.9 days. Diphtheria 50.2 ,, Tuberculous Diseases 85.7 ,, Average stay in Hospital of all cases 45.0 ,, 81 The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day, 83.1. Scarlet Fever.—The 266 cases admitted to Hospital during 1935 were distributed among the following age groups:— Under 1 yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. 3 47 166 21 16 12 1 One death occurred from scarlet fever, the patient having pulmonary tuberculosis of long standing. The following table shows the percentage death-rate of cases of scarlet fever admitted to the Ilford Isolation Hospital during the past five years, the rate being calculated each year only on those admissions which proved to be clinically scarlet fever. 1931. 1932. 1933. 1934. 1935. Ilford .5 Nil. Nil. .3 .37 The following complications occurred in the patients discharged during the year:— Complications present on admission:— Percentage. Impetigo 1 .38 Septic laceration of ankle 1 .38 Septic toe 1 .38 Cervical Adenitis 2 .77 Acute Nephritis 1 .38 Septic injury to leg 1 .38 Burns of leg 1 .38 Abscess of neck 1 .38 Pulmonary Tuberculosis 1 .38 Otorrhoea 2 .77 Scabies 1 .38 Septic thumb 1 .38 Osteomyelitis of leg 1 .38 Complications developing after admission:— Otorrhoea 8 3.1 Adenitis 9 3.5 Nephritis 1 .38 Albuminuria 7 2.7 Rheumatism 2 .77 Mastoiditis 1 .38 Onychia 8 3.1 Tonsillitis 5 1.9 Adenitis with abscess formation 1 .38 Purpura and Nephritis 1 .38 Otorrhoea and Septicaemia 1 .38 Albuminuria and Endocarditis 1 .38 Haematuria 1 .38 Otorrhoea and Adenitis 1 .38 Abscess of thigh 1 .38 Peritonsillar abscess 1 .38 82 Five cases suffered from Chickenpox, 1 from Measles, and 4 from Nasal Diphtheria as well as Scarlet Fever. Enteric Fever.—5 cases were admitted. One gave a positive Widal Test for B. Typhosus and 4 gave positive Widal Tests for B. Para-typhoid B. All the patients recovered satisfactorily without complications. Pneumonia.—20 patients were admitted, of whom 6 died (aged 3, 21, 27, 30, 39 and 73 years). The following were the types of infection:— Pneumococcus—Type II 1 Type III 2 (1 fatal) Type IV 7 (1 fatal) No evidence of Pneumococci 1 No bacteriological examinations. 8 (4 fatal) Haemolytic Streptococci 1 Of the 6 deaths, three occurred within 24 hours of admission, 1 within 6 days, 1 within 9 days, and 1 within 11 days. The patients were admitted during the following months:— Jan. 2, Feb. 1, Mar. 2, April 2, May 1, Sept. 3, Oct. 3, Nov. 2, Dec. 4; and were in the following age groups:— Under 1 yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. 1 2 1 3 4 3 6 Consequent on the pressure on the Hospital accommodation, it was generally not possible to admit cases of Pneumonia. Puerperal Fever.—2 cases of Puerperal Fever were admitted. They both made a good recovery after intensive serotherapy. Puerperal Pyrexia.—7 cases were admitted. They were due to:—Sapraemia (3 cases), septic lacerations (1 case), puerperal scarlatina (3 cases)—one of these three cases was complicated by a recto-vaginal fistula. All made a good recovery. Diphtheria.—The 167 cases admitted to Hospital were distributed among the following age groups:— Under 1 yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. 1 26 99 20 10 7 4 83 38 of the above cases did not show, on admission, clinical evidence of diphtheria. 2 cases proved to be avirulent K.L.B. carriers, 2 were cases of Tonsillitis and 2 of Streptococcal Tonsillitis and carriers of haemolytic streptococci. The operation of tonsillectomy was performed in 2 cases for persistent carrier conditions. 7 deaths due to Diphtheria occurred in the Hospital. The ages of the patients were 7 months, 1½, 2½, 8, 13, 13 and 13J years. The following complications occurred in the patients discharged during the year:— 2 cases developed Palatal Paresis. Other complications:— Streptococcal Tonsillitis 4 Otorrhoea 2 Albuminuria 2 Intravenous Therapy.—Eleven cases were treated with intravenous injections of anti-toxic serum, glucose and insulin. 8 recovered, 3 developed palatal paresis, 1 was a case of haemorrhagic diphtheria (fatal), 1 developed cardiac failure (fatal), 1 palatal, pharyngeal and respiratory paralyses (fatal). 4 cases suffered from laryngeal diphtheria, 6 from nasal diphtheria, and 3 from laryngeal and faucial diphtheria. Two of this last group were fatal. The following table shows the percentage death-rate of cases of diphtheria admitted to the Ilford Isolation Hospital during the past five years, the rate being calculated each year only on those admissions which proved to be clinically diphtheria. 1931. 1932. 1933. 1934. 1935. Ilford .. .. 2.4 1.28 4.8 8.8 5.7 Pemphigus Neonatorum.—1 case was admitted to Hospital, and died 4 days after admission. Observation Cases.—Eight cases were admitted as follows:— (1) Influenza, (2) Streptococcal tonsillitis, (3) Pustule on back of infant, (4) Pyelonephritis, (5) Streptococcal tonsillitis and pregnancy, (6) Abscess of scalp of infant, (7) (?) Scarlet fever, (8) (?) Para-typhoid fever. 84 Tuberculosis.—49 cases of Pulmonary Tuberculosis were admitted, as compared with 49 in 1934. Training of Probationer Nurses.—-During 1935, 5 nurses passed Part I of the examination of the General Nursing Council, and 7 obtained the Certificate by completing Part II (3 of these being Staff Nurses). The following table shows the number of the Staff at the Isolation Hospital who were Schick and Dick Tested during 1935, and also the numbers inoculated:— Numbers Schick Tested:— Staff. Positive 17 Negative 48 Numbers inoculated (full course) 14 Numbers re-tested:— Negative after full course of inoculations 4 Positive after full course of inoculations, and reinoculated 4 Numbers Dick Tested :— Positive 18 Negative 47 Numbers inoculated (full course) 10 Numbers re-tested:— Negative after full course of inoculations 2 Positive after full course of inoculations, and reinoculated 6 Isolation Hospital Extensions.— The extensions, commenced in April, 1934, were formally opened by the Mayor (Mr. Alderman A. P. Griggs, J.P., E.C.C.) on July 6th, 1935. The new buildings and extensions were designed, and the work supervised, by the Borough Engineer, the main Contractors being Messrs. G. H. Miller & Co., Ltd., the contract being approximately £48,780, including Boiler House, Heating Ducts, Water Tower, sewers, roads, etc. (excluding furnishing). Description of Buildings. (a) Two Cubical Wards, each of 20 beds, constructed with red hand-made bricks, Bangor slates and artificial stone copings, are cruciform in shape, with 5 cubicles to each wing; a central octagonal duty room, with observation windows on 4 walls, has access to these. The Duty Room is fitted with sinks, utensil and instrument sterilisers, electric refrigerator, and 85 the latest type of fire hose reel. The floors of the cubicles and verandahs are laid with Terrazzo. At each wing is placed a bathroom, W.C. and a sinkroom, all of which are fitted with the latest sanitary appliances, including 4 bed-pan washers and 1 bed-pan steriliser for each cubicle block. Adjoining the centre of the cubicles a large linen room is provided, also a larder. The buildings are so situated that the verandah fronts face either south-east or south-west. (b) Laundry.—The new building, which is top lighted, also side lighted in centre section, has a floor area of approximately 3,050 square feet and is divided into three departments—"Receiving Room," washing, drying and ironing sections, and "Delivery Room." The machinery and equipment include 3 rotary washing machines, one with continuous flushing and disinfecting apparatus, and another with interrupter gear for washing flannels. Two highspeed hydro-extractors are provided, together with soap boilers, disinfecting bins, etc. The drying machine (20ft. x 10ft.) is hand operated and delivers the washed articles automatically ready for ironing. The drying and ironing section has a teak wood block floor and is furnished with a two-roller ironing and finishing machine, shirt, collar and cuff machine, a twin garment press and an ironing bench with 9 electric Sexless hand irons. Electricity provides all the power for driving and washing; drying and ironing machines. (c) Boiler Home and Water Tower (centralised heating system).—The Boiler House is built in stock brick facings with flat asphalte-covered roofs. The engineering services have been carried out under the supervision of Mr. J. Roger Preston, M.I.Mech.E The principal engineering equipment is grouped in one block, comprising boiler house, pump and calorifier room, fuel bunkers, fan chamber, disinfector room, etc., and so planned to control from the block the heating, steam and hot water services for the whole Hospital. 86 There are 2 steam boilers, with automatic chain coal feed, one acting as a standby, with provision for a third should this be necessary. Each boiler has a capacity of approximately 7,500 lbs. of steam per hour, which serves the heating and hot water supply for the Institution, also for sterilising and disinfection purposes. Heating is by low pressure hot water, the heat being produced in steam-heated calorifiers and circulated by turbine driven pumps through underground mains. The plant is designed for economical running: all exhaust steam being utilised, either in the heating and hot water supply calorifiers or for heating the boiler feed water, and the condensate from the calorifiers, and as much as possible from the Laundry, is returned to the hot well and pumped back to the boilers. The Water Tower is a reinforced concrete structure with a storage tank at the top for holding 12,000 gallons. Below is one storey containing two auxiliary tanks, and on the first floor is the water softening plant and storage for salt. On the ground floor is installed a transformer sub-station. One meter deals with the whole of the electric supply (A.C.) to the Hospital. (d) Nurses' Home.—The extensions to this block have provided 41 new bedrooms, enlarged dining room, sitting rooms and a lecture room (32ft. x 16ft.). The elevations were designed to match the original home. The corridors are laid in Rhodesian block flooring and the bedroom floors are of Jarrah in narrow boards. The bathroom, lavatories and slop rooms have tiled walls with Terrazzo floors, the fittings being chromium plated. Each bedroom is provided with a hand basin, with hot and cold water, and a hot water radiator. (e) Resident Medical Officer's House.—Erected in corner of Hospital grounds, contains lounge hall, 2 reception rooms, 4 bedrooms, kitchen and usual offices. (/) Generally.-—The new buildings and grounds occupy 2¾ acres. The Isolation Hospital now provides accommodation for 170 patients (20 being cases of T.B.). 87 The cost of furnishing and equipping the new buildings and extensions was £2,364. On the following pages will be found— (1) the site plan of the Hospital showing old and new buildings; (2) the two new cubicle blocks, laundry and boiler house; (3) the Nurses' Home, and photographs of; (4) Exterior of New Cubicle Block; (5) Duty Room of New Cubicle Block; (6) New Laundry. 88 89 90 Ilford Isolation Hospital—New Cubicle Block. Ilford Isolation Hospital—Duty Room : New Cubicle Block. MATERNITY AND CHILD WELFARE 97 Notification of Births Acts, 1907 and 1915. By the Notification of Births Acts, 1907 and 1915, all live births and stillbirths of seven months and over must be notified to the Medical Officer of Health within 36 hours. The number of live births notified under the above Acts during 1935 was 1,692 (869 males and 823 females). Of these, 25 (10 males and 15 females) took place in Ilford, the ordinary place of residence of the parents being outside the district. In addition, 358 notifications of birth (179 males and 179 females) which took place outside the district, although the ordinary residence of the parents is in Ilford, were transferred to this district. During the year, 28 cases in which there was default in complying with the requirements of the Notification of Births Acts were referred to the Town Clerk. The percentage of live births occurring in Ilford, notified by the various responsible persons, was as follows:— By Medical Practitioners 24.58 By Certified Midwives 66.38 By Parents and others 9.04 In addition, 57 stillbirths (32 males and 25 females) were notified. The notifications of 14 stillbirths (5 males and 9 females) which took place outside the district, although the ordinary residence of the parents is in Ilford, were transferred to this district. 98 The causes of the 57 stillbirths which took place in Ilford were as follows:— Anencephalic foetus 1 Ante-partum haemorrhage 2 Breech presentation 15 Craniotomy 1 Difficult labour 5 Fall before birth 2 Induction of labour for disproportion 1 Maternal malnutrition 1 Maternal toxaemia 4 Precipitate labour 1 Placenta praevia 1 Prematurity 8 Pressure on cord 7 Unknown 8 The causes of the 14 stillbirths which took place outside the district, although the parents reside in Ilford, were as follows:— 6 at Queen Mary's Hospital, Stratford— Anencephalic foetus 2 Difficult labour 1 Maternal toxaemia 2 Transverse presentation 1 3 at Oldchurch Hospital, Romford— Breech presentation 1 Face presentation 1 Unknown 1 2 at Mothers' Hospital, Hackney— Difficult labour 1 Maternal toxaemia 1 1 at East End Maternity Hospital— Breech presentation 1 1 at Maternity Hospital, Plaistow— Unknown 1 1 at Royal Free Hospital, Grays Inn Road, W.C.— Tonic uterine contraction 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 1935. 99 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 live births registered, and during last year 2,050 (1,055 males and 995 females) births were registered, giving a birth-rate of 13.9 per 1,000 persons, calculated on the net population, mid-year 1935, as compared with 1,961 births and a birth-rate of 13.8 per 1,000 persons in 1934. 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 1935, 72 stillbirths (40 males and 32 females) were registered. Of these, 1 male was illegitimate. The figures of 2,050 live births and 72 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. Infant Mortality. The number of infants dying within the first year of life was 88, the total number born being 2,050. The infant mortality or rate of death per 1,000 births was, therefore, 42.8. The comparative figures for the past 10 years are as follows:— Year. No. of Deaths under 1 year. Rate per 1,000 Registered live Births. 1935 88 42.8 1934 76 38.7 1933 83 44.8 1932 79 39.8 1931 110 55.6 1930 61 33.0 1929 87 49.6 1928 79 45.4 1927 74 44.0 1926 68 45.1 100 The infant mortality rate for 1935 was 57 for England and Wales, 58 for London, and 62 for the towns having a population exceeding 50,000. The following table shows the comparison for Ilford, England and Wales, London and towns having a population exceeding 50,000 for the past 10 years:— Year. Ilford. England and Wales. London. Towns with population over 50,000. 1935 42.8 57 58 62 1934 38.7 59 67 63 1933 44.8 64 59 67 1932 39.8 65 66 69 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 The deaths from pneumonia totalled 8, as compared with 15 for 1934. There were 33 deaths of premature infants as compared with 20 in 1934. 101 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 live Births. Infant Mortality per 1,000 live Births both sexes together. 1935. 1934. 1933. Barkingside M. 104 4 38.4 47.6 — — F. 127 7 51.1 North Hainault.. M. 146 10 68.5 60.1 25.1 37.1 F. 120 6 50.0 Cranbrook M. 56 2 35.7 35.1 70.6 94.7 F. 58 2 34.5 Park M. 81 7 86.4 83.9 60.7 41.7 F. 62 5 80.6 Seven Kings M. 92 3 32.6 27.1 65.9 32.4 F. 92 2 21.7 South Hainault .. M. 82 4 48.8 47.9 49.4 56.7 F. 64 3 46.9 Loxford M. 103 4 38.8 49.7 37.4 97.4 F. 98 6 61.2 Clementswood M. 112 8 71.4 63.4 58.8 47.3 F. 93 5 53.7 Goodmayes M. 105 3 28.5 48.3 47.2 61.3 102 7 68.6 The above table only accounts for 1,697 of the total live births registered and belonging to the district. The remaining 353 are included by the Registrar-General as belonging to Ilford, but have not been allocated by him to the various wards. 29 live births were registered in this district belonging to other areas. These have not been included in the foregoing figures. 2 births 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 except Cranbrook, Seven Kings and South Hainault. A statement as to the ages at, and causes of, infant deaths in the various wards is given below:— In the Barkingside Ward there were 11 deaths. 6 died under 1 week. 1 died at 2 weeks from pemphigus neonatorum. *1 died at 3 months from enteritis and malnutrition. *1 died at 4 months from congenital hydronephrosis. 1 died at 4 months from gastro-enteritis. 1 died at 9 months from infective enteritis. 102 In the North Hainault Ward there were 16 deaths. 5 died under 1 week. 1 died at 1 week from suppurative pericarditis and suppurative mastitis. 1 died at 2 weeks from cardiac failure and stomatitis. 1 died at 2 weeks from acute bronchitis and prematurity. *1 died at 1 month from prematurity. 1 died at 2 months from acute pericarditis and nephritis following erysipelas. *1 died at 2 months from gastro-enteritis. *1 died at 2 months from prematurity. 1 died at 2 months from convulsions, meningocele and spina bifida. 1 died at 3 months from malnutrition and gastro-enteritis. 1 died at 4 months from gastro-enteritis. 1 died at 8 months from gastro-enteritis. In the Cranbrook Ward there were 4 deaths. 3 died under 1 week. 1 died at 1 week from prematurity. In the Park Ward there were 12 deaths. 7 died under 1 week. 1 died at 1 week from atelectasis of lungs and congenital malformation of heart. 1 died at 3 months from laryngismus stridulus, bronchitis and prematurity. 1 died at 7 months from broncho-pneumonia, bronchitis and gastro-enteritis. *1 died at 8 months from congenital heart disease. 1 died at 9 months from gastro-enteritis and pneumonia. In the Seven Kings Ward there were 5 deaths. 2 died under 1 week. 1 died at 1 week from influenza. 1 died at 4 weeks from marasmus and hypospadias (complete). *1 died at 8 months from gastro-enteritis. In the South Hainault Ward there were 7 deaths. 4 died under 1 week. 1 died at 1 month from gastro-enteritis, marasmus and bronchitis. 1 died at 6 months from gastro-enteritis. *1 died at 7 months from acute gastro-enteritis. In the Loxford Ward there were 10 deaths. 3 died under 1 week. 1 died at 2 weeks from prematurity (twin). 1 died at 3 weeks from prematurity (twin). 1 died at 1 month from broncho-pneumonia. *1 died at 2 months from marasmus. *1 died at 3 months from broncho-pneumonia and whooping cough. *1 died at 5 months from marasmus, congenital biliary obstruction and laparotomy. *1 died at 7 months from broncho-pneumonia. 103 In the Clementswood Ward there were 13 deaths. 7 died under 1 week. *1 died at 3 months from gastro-enteritis following operation for pyloric stenosis. *1 died at 3 months from enteritis. *1 died at 6 months from broncho-pneumonia, congenital morbus cordis and patent foramen ovale. *1 died at 6 months from meningococcal meningitis. *1 died at 8 months from broncho-pneumonia. *1 died at 10 months from gastro-enteritis and congenital hydrocephalus. In the Goodmayes Ward there were 10 deaths. 4 died under 1 week. 1 died at 1 week from congenital heart disease. *1 died at 1 month from acute bronchitis and inherent lack of vitality. I died at 3 months from broncho-pneumonia. 1 died at 5 months from hydrocephalus and injury at birth. 1 died at 6 months from gastro-enteritis. 1 died at 7 months from diphtheria. * These children had attended an Infant Welfare Centre. It will be seen that of the 88 infants who died under one year of age, only 19 had attended infant welfare centres, and in some cases only one attendance was made. 51, 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 12.0 per 1,000, as compared with 40.6 per 1,000 in those not attending an Ilford infant welfare centre. It would be a fairer comparison to state that of the 37 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 19 had attended an infant welfare centre, or, in other words, that 48 per cent. of the deaths of children between one month and one year of age occurred in children who had never attended an infant welfare centre. Neonatal Mortality. The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 51 deaths of infants under four weeks of age during 1935, and the rate for the year was 24.8 per 1,000 live births. 104 The deaths of infants under one month increased from 37 during 1934 to 51 during 1935. The following were the causes:— 1934. 1935. Bronchitis — 1 Convulsions 1 — Pneumonia 1 — Injury at birth 2 1 Atelectasis 2 2 Congenital malformations 8 9 Premature birth 19 31 Atrophy, debility and marasmus 3 — Other causes 1 7 37 51 The rate increased from 18.8 for 1934 to 24.8 for 1935. In the group one month to one year the deaths occurred from the following causes:— 1934. 1935. Diphtheria and croup — 1 Erysipelas — 1 Meningitis (not tuberculous) 2 1 Convulsions 1 — Bronchitis 1 2 Pneumonia (all forms) 15 8 Enteritis 6 14 Injury at birth 1 — Congenital malformations 4 5 Premature birth 1 2 Atrophy, debility and marasmus 1 3 Other causes 7 — 39 37 The largest number of deaths occurred in the third quarter of the year. The following table shows the Neonatal death-rate in Ilford compared with that for England and Wales during the previous ten years:— Ilford. England and Wales. 1935 24.8 Not available. 1934 18.8 31 1933 25.9 32 1932 20.6 32 1931 32.3 32 1930 16.8 31 1929 27.4 33 1928 23.6 31 1927 19.3 32 1926 21.2 32 Table IV gives the deaths of infants under one year of age, classified according to age. It will be noticed that prematurity still causes the greatest number of deaths. 105 Table IV.—Infant Mortality. 1935. Net deaths from stated causes at various ages under one year of age. of Death. Under l 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 .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. 1 .. 1 Erysipelas .. .. .. .. .. l .. .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuber- culous) .. .. .. .. .. .. .. l .. l Convulsions .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. 1 .. 1 1 1 .. .. 3 Pneumonia (all forms) .. .. .. .. .. 1 2 4 1 8 Diarrhoea .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. 2 6 5 1 14 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation (overlying) .. .. .. .. .. .. .. .. .. .. Injury at birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis 2 .. .. .. 2 .. .. .. .. 2 Congenital Malformations 7 2 .. .. 9 1 2 1 l 14 Premature birth 28 1 l l 31 2 .. .. .. 33 Atrophy, Debility and Marasmus .. .. .. .. .. 2 1 .. .. 3 Other Causes 3 2 2 .. 7 .. .. .. .. 7 Totals 41 5 4 l 51 10 12 12 3 88 106 Illegitimate Births and Deaths. 48 of the live births registered (19 males and 29 females) were illegitimate, that is 2.34 per cent. of the births registered- One illegitimate child died, aged one day. The death of the 1 illegitimate child occurred at Oldchurch Hospital from prematurity. The infant mortality rate of illegitimate children was 20.8 per 1,000, compared with the infant mortality rate of 43.5 for legitimate children. The following table shows the death-rate of illegitimate and legitimate infante for the past ten years:— Year. Illegitimate Infants. Legitimate Infants. Live Births. Deaths. Rate per 1,000 Illegitimate Live Births. Live Births. Deaths. Rate per 1,000 Legitimate Live Births. 1935 48 1 21 2,002 87 43 1934 59 4 68 1,902 72 38 1933 51 4 78 1,801 79 44 1932 29 2 69 1,958 77 39 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 Maternal Mortality. The total number of deaths due to childbirth during the year was 7, which gives a maternal mortality rate (i.e., number of deaths per 1,000 live births) of 3.4. The causes of the deaths were as follows:— Puerperal Fever:— Confined at own home and died in Isolation Hospital, Ilford; Puerperal Septicaemia 1 Confined at own home and died in St. Bartholomew's Hospital; Syncope, Septicaemia and Septic Endometritis 1 107 Confined at Cranbrook Nursing Home, Ilford, and died in Queen Charlotte's Hospital; general Sepsis and general Peritonitis following full term normal delivery of first child 1 Other causes:— Confined at and died in Oldchurch Hospital, Romford; acute dilation of stomach; Caesarian Section 1 Confined at and died in Queen Mary's Hospital, Stratford; Childbirth; failed forceps and shock; occipito posterior position of child 1 Confined at and died in own home; Pulmonary Embolism 1 Confined at and died in own home; Pulmonary Embolism following Parturition 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 past ten years:— Year. No. of Maternal Deaths, Ilford. No. of Registered Live Births, Ilford. Maternal Mortality Rate per 1,000 Live Births registered, Ilford. Maternal* Mortality Rate per 1,000 Live Births registered, England and Wales. From Puerperal Fever. From Other Causes. 1935 3 4 2,050 3.4 4.10† 1934 2 4 1,961 3.1 4.42 1933 5 3 1,852 4.3 4.51 1932 3 2 1,987 2.5 4.21 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 2 5 1,739 4.0 4.42 1927 1 4 1,657 3.0 4.11 1926 3 1 1,509 2.6 4.12 Revised Table. †Provisional Figure. 108 Foster-Children—Children Act, 1908 (Part I), Children and Young Persons Act, 1932 (Part V). 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, 1,050 visits being paid during the year 1935. 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 children under nine years which may be kept by a foster-mother. Eight foster-mothers failed to give notice of the reception of foster-children within the prescribed time; letters of warning were sent in each case. At the end of the year 30 foster-mothers each had one child in their care, 1 foster-mother had 3 children in her care, and 1 fostermother had 2 children in her care. 13 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 one house defects were found and the necessary repairs were carried out. The following is a summary of the work carried out:— Foster-Children. Number of foster-children on books on 1st January, 1935 42 Number of foster-children who were notified during 1935 23 Number of foster-children returned to their mothers during 1935 9 Number of foster-children taken off the records for various other reasons during 1935 21 Number of foster-children on records on 31st December, 1935 35 109 Foster-Mothers. Number of foster-mothers with children on books on 1st January, 1935 38 Number of persons who became foster-mothers during 1935 13 Number of foster-mothers whose names were taken off records during 1935 19 Number of foster-mothers with children on records on the 31st December, 1935 32 Houses Visited by Sanitary Inspectors. Number of houses visited by the Sanitary Inspectors for the purpose of the Act during the year 1935 14 Number of visits made by the Sanitary Inspectors for the purpose of the Act during the year 1935 28 Work of Health Visitors. All live infants notified in the district, or transferred (584 during 1935) 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 ages 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. 24,965 attendances of children from 1 to 5 years were made at the Welfare Centres in 1935. The congestion at the Centres does not enable sufficient time to be given to the toddler. The Ilford area is divided into 12 districts, one nurse carrying out all the home visits both for Maternity and Child Welfare work and School Medical Service work in each area. The following is a summary of the visits paid by the Health Visitors during 1935 as far as the Maternity and Child Welfare work is concerned:— First visits to newly-born infants 2,661 Subsequent visits to children under 1 year of age 5,841 Subsequent visits to children over 1 year of age and under 5 13,219 Visits to expectant mothers 290 Home visits for other reasons 2,056 Total visits paid 24,067 110 Supervision of Midwives. There are 10 certified midwives resident and practising in the district (apart from those at the Maternity Home), and 13 certified midwives resident outside Ilford, but practising in Ilford. Their supervision has been carried out as in previous years. The following is a summary of the notices received from mid- wives during 1935:— Medical Help 478 Death of Mother or Child 22 Laying out the Dead 4 Stillbirths 25 Liability to be a source of infection 36 Artificial Feeding 36 601* *Of these, 354 were received from the Ilford Maternity Home. Death of Mother or Child. Twenty-one of the notices received related to infants and one to a mother. The causes of death are embodied in Table IV, Infant Mortality, on page 105, and Maternal Mortality on page 106. Laying out the Dead. Four notifications of having laid out a dead body were received. In one case the patient died from acute necrosis of liver (two notifications received); in another case from broncho-pneumonia and prematurity; and one was a stillborn infant. Stillbirths. Twenty-five notifications were received. The causes of the stillbirths are included in the particulars set out on page 98. Liability to be a Source of Infection. Thirty-six notices were received from midwives after attendance on 30 cases suffering from the following conditions:— Abscess on face 1 Abscess on scalp 1 Acute Necrosis of liver 1 Chill 2 Caruncle of labia 1 Erysipelas and Septicaemia 1 Follicular Dermatitis 1 Influenzal Pneumonia 1 Pemphigus Neonatorum 2 Perineal boil 1 Post-abortion Sepsis 1 Puerperal Fever 2 Puerperal Fever and Scarlet Fever 2 Puerperal Pyrexia 8 Ophthalmia Neonatorum and discharging eyes 2 Scarlet Fever 3 30* *9 of these occurred at the Ilford Maternity Home. — 1ll Claims for Compensation. Claims for compensation were received from two midwives following their suspension from practice in order to prevent the spread of infection. In one case £4 7s. was paid by the Council, and in the other case £2 8s. 6d. Payment of Midwife's Fee in Necessitous Cases. The Council contributed to, or paid the whole of, the private midwife's fee in 4 instances. A total of £6 18s. was paid. Artificial Feeding. Thirty-six notifications were received from midwives that it was proposed to substitute artificial feeding for breast feeding. The reasons given were as follows:— Adoption of baby 1 Eczema 1 Deficiency of milk for twins 2 General condition of mother 8 History of previous mastitis; breasts unsatisfactory 1 Lactation insufficiently established 10 Lactation unsatisfactory 1 Multiple pregnancy 1 Pain caused by previous abscesses 1 Persistent sore nipples 5 Pulmonary tuberculosis 1 Refusal of mother to feed baby 1 Transfer of mother to hospital 3 Of the above, thirty-two were received from the Ilford Maternity Home. Inflammation of, or Discharge from, the Eyes of an Infant. Medical aid was sought in 46 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. 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. 68 outfits were supplied in 1935—67 at full cost and 1 free of charge. In addition, 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. 112 Supply of Milk to Expectant and Nursing Mothers and for Infants. Under the Regulations of the Ministry of Health, during 1935, 330 families were supplied with cows' milk free, 117 with dried milk and 4 with condensed milk. A total of 26,129 quarts of cows' milk, 2,394 lbs. of dried milk and 88 tins of condensed milk were given free under the Regulations to 88 nursing mothers, 36 expectant mothers and 478 infants. In 1934, 377 families were supplied free with cows' milk, 97 with dried milk and 9 with condensed milk. Infant Welfare Centres. The Infant Welfare Centres have, as in previous years, been carried on very economically owing to the assistance which ladies in the town have voluntarily given. 84 ladies were engaged in the work at the end of December, 1935. At the Ilford Lane Centre one of the ladies has carried on a clothing club since 1921, to which mothers could contribute small sums weekly and withdraw the whole or part of their contributions as necessity arose. During 1935, £20 7s. Od. was saved by 24 mothers. During the year the following attendances were recorded:— Figures for 1934. 1935. Total number of attendances of infants 52,409 54,011 First attendances 2,121 2,127 Total number of children on roll, December 31st, after omission of all those who had not attended for six months 3,152 2,994 First Attendances— Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. 231 175 191 129 259 151 237 141 180 219 146 68 Subsequent Attendances— 5167 4242 4395 3107 5216 3279 5303 3173 4559 5867 4555 3021 113 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.' 1935 54,011 2,127 2,994 1934 52,409 2,121 3,152 1933 53,694 2,458 3,150 1932 48,405 2,425 3,098 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 1,927 668 sessions were held during the year, the average attendance at each session being 81 mothers with their infants. The following are the figures for each Centre:— Sessions. Average Attendance. Downshall 47 112 Seven Kings 47 79 Barkingside 47 138 Goodmayes 48 65 Valentines 48 65 Newbury Park 48 83 Grosvenor Road 47 104 Woodford Avenue 48 92 Park and Cranbrook (morning) 48 83 Park and Cranbrook (afternoon) 48 73 Becontree 48 61 Chadwell 48 52 Ilford Lane (morning) 48 64 Ilford Lane (afternoon) 48 66 The Goodmayes and Becontree Infant Welfare Centres were transferred to the Mayesbrook School Clinic as from Tuesday, 21st May, and Thursday, 23rd May, respectively. Ante-Natal Clinics. The Ante-Natal Clinics were continued during 1935 at the Maternity Home, on Monday, Thursday, Friday and Saturday mornings and Tuesday afternoons. 114 An additional Clinic was commenced on Thursday afternoon, 14th November. A weekly session was held at Mayesbrook Clinic, commencing on Wednesday afternoon, the 25th September. The following is a comparison of the attendances for the past ten years:— First Attendances. Total Attendances. No. of expectant mothers on roll on 31st December. 1935 776 6,545 300 1934 842 6,771 313 1933 738 5,980 246 1932 763 5,643 253 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 All patients entering the Maternity Home who are to be attended by a midwife, and those who are to be attended by the District Midwife, are medically examined at the Ante-Natal Clinic. During the year, 167 cases other than those booked for admission to the Maternity Home and attendance by the District Midwife, were examined at the Clinic. There were 810 attendances by such cases. X-Ray Examination of Ante-Natal Patients. In September, 1933, the Council made an arrangement with King George Hospital for the X-Ray examination and report on patients referred from the ante-natal clinic at a fee of 15s. 13 examinations were made in 1935. The fee is recovered from the patient, except in cases where it is shown that they are unable to afford the fee. The following attendances were recorded at the respective Clinics:— Maternity Home. Mayesbrook Clinic. First attendances 724 52 Subsequent attendances 5,511 258 Number of expectant mothers on the rolls on 31st December, 1935 246 54 115 Post-Natal Clinic. The Post-Natal Clinic was continued during 1935 at the Maternity Home on each Tuesday morning. The following attendances were recorded:— First attendances 282 Subsequent attendances 422 Number on roll on 31st December, 1935 47 Dental Clinic. The Council dentist has continued the dental treatment of expectant and nursing mothers and of children under 5 years of age during 1935, 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 patients treated during 1935 220 Number of attendances of patients 684 Number of administrations of "general" anaesthetics 202 Number of administrations of "local" anaesthetics 68 Number of fillings and other operations 434 Number of mothers having dentures supplied 52 (including 2 free of charge and 1 at part cost). (b) Treatment of Children under five years of age. Number of patients treated 239 Number of attendances of patients 308 Number of administrations of "general" anaesthetics 219 Number of fillings and other operations 147 The following are the figures for the past five years:— 1931. 1932. 1933. 1934. 1935. Number of mothers treated 173 155 247 151 220 Number of children treated 145 156 255 220 239 116 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 1935:— (a) Number of children for whom spectacles were prescribed and provided 21 (b) Number of children examined by Oculist for whom spectacles were not prescribed 20 (c) Number of children examined by Oculist wearing spectacles already and the lenses in use did not require changing 17 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. Seven mothers were so treated by the Council Oculist during 1935. Orthopaedic Department. (i) Valentines Clinic.—30 sessions were held during 1935, 275 children under five years of age being examined, making 467 attendances. (ii) Mayesbrook Clinic.—5 sessions were held during 1935, 47 children under five years of age being examined, making 82 attendances. The 322 children were found to be suffering from the following defects:— Valentines. Mayesbrook. Rickets 11 1 Genu-varum 4 — Genu-valgum 133 24 Outward curvature of tibia 46 3 Congenital calc. valgus 3 1 Deformity of toes 6 2 Pes-valgus 16 6 Flat feet 6 2 Other defects 50 8 Totals 275 47 117 Five children were admitted to the Royal National Orthopaedic Hospital, Country Branch, Stanmore, during the year, suffering from (1) outward curvature of tibia, (2) rickets, (3) Perthe's disease, (4) flexion contracture of right thumb, and (5) pes varus. Three of the children were discharged during the year, and two were still in the Hospital on the 31st December. At the Valentines Clinic, 117 children under five years of age were treated by the Masseuse during the year, and 427 attendances were made by these children. She also treated 26 children who made 147 attendances at the Mayesbrook Clinic. Artificial Sunlight Clinic. 48 sessions were held at the Valentines Clinic and 29 at Mayesbrook Clinic. 82 children in all were treated, making 1,204 attendances. The conditions treated were as follows:— Rickets 52 Subnormal nutrition 1 Anaemia, debility or malnutrition 20 Bronchitis 3 Defective enamel to teeth (vitamin deficiency) 1 Adenitis 1 Asthma 1 Anterior polio-myelitis 1 Post pneumonia 1 Tubercular cervical adenitis 1 Total 82 33 cases were still attending at the end of the year; of the remainder, four had left the district and in nine cases the parents had discontinued treatment. All the others were discharged from further treatment, having improved. 118 Aural Clinic. The Aural Surgeon attended at 52 afternoon sessions during 1935, and 57 attendances were made by 27 children of pre-school age, 24 being new cases, who were found to be suffering from the following conditions:— Nature of Disease. Still under treatment. Recommended Hospital treatment. Recommended Special School. Discharged as cured. Discharged as no treatment required. Totals. 1. Acute Suppurative Otitis Media 2 — — 5 — 7 2. Chronic Suppurative Otitis Media due to Tympanic Sepsis and Acute Mastoiditis — 1 — — — 1 3. History of Otorrhoea — 1 — — 5 6 4. History of Otorrhoea; Tonsils and Adenoids enlarged — 2 — — — 2 5. Total Deafness due to:— (i) Meningitis — — 1 — — 1 (ii) Congenital defect — — 2 — — 2 6. Partial Deafness due to Catarrhal Rhinitis — — — 1 — 1 7. Rhinitis 2 1 — 2 — 5 8. External Otitis — — — — 1 1 9. History of Epistaxis — — — — 1 1 Totals 4 5 3 8 7 27 Rheumatism Clinic. A total of 36 morning sessions were held during the year. Six children (all new cases) made 13 attendances. The following is a summary of the cases treated:— Discharged (no active rheumatic condition) 2 Mitral disease (not rheumatic) 1 Congenital heart disease 1 Rheumatism 1 Rheumatoid arthritis 1 Total 6 119 Ophthalmia Neonatorum. During the year 1923 arrangements were made with the Metropolitan Asylums Board for the reception at their St. Margaret's Hospital of cases of Ophthalmia Neonatorum from the Ilford District details of which were printed in the report for 1923. The L.C.C. is now the authority controlling St. Margaret's Hospital and in December, 1932, informed the Ilford Council that they had decided to continue such arrangements subject to accommodation being available after the requirements of London patients had been met and that payments were made to include:—(1) cost of maintenance and treatment; (2) accommodation; (3) a percentage added to cover central administrative expenses. The present charge for maintenance and treatment is £5 9s. 3d. per week per person. No cases were admitted to St. Margaret's Hospital during the year under the above arrangements. Treatment of Minor Ailments. Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 110 belts and 10 trusses have been supplied to infants suffering from hernia during the year 1935. A certain number of infants were brought to the Public Health Offices to receive treatment for minor ailments. Queen Mary's Hospital, Stratford, has undertaken since the 1st January, 1921, to carry out operative treatment for enlarged tonsils and adenoids at an inclusive charge for each Ilford child under five years of age recommended for such treatment by the Medical Officer of Health. During the year 36 children under five years of age were treated under the above arrangements, three free of charge. Under the agreement with the King George Hospital ten children were operated on at that hospital for the removal of enlarged tonsils and adenoids. One of these cases was treated free of charge and one at part cost. 120 MATERNITY HOME. During 1935, 450 women were admitted into the Home, as compared with:— 1934 474 1926 383 1933 474 1925 215 1932 488 1924 191 1931 510 1923 205 1930 489 1922 204 1929 481 1921 198 1928 481 1920 169 1927 454 1919 139 The patients were admitted to the Home from the following wards:— Barkingside 58 North Hainault 91 Cranbrook 30 Park 43 Seven Kings 61 South Hainault 33 Loxford 51 Clementswood 42 Goodmayes 41 218 cases could not be admitted during the year owing to lack of accommodation. As the north-east corner of the Ward Block was being converted and extended, the number of bookings for December was reduced from 38 to 20. At the end of the year 306 cases were booked for future admission to the Home. The average number of patients in the Home per day during 1935 was 21.01, and the average length of stay of patients 16.46 days. Of the 450 cases admitted during 1935, 442 were confined in the Home, 2 cases were transferred to hospital, one was admitted and subsequently confined at home, one was admitted for antenatal treatment and had not been re-admitted for the confinement at the end of the year, 2 had miscarriages, one died before delivery, and in one case a stillborn baby was born before arrival at the Home. 121 In 20 of the 442 confinements the patient had been previously admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 442 confinements there were:— (a) 267 cases of first confinement. (b) 175 cases having their second or subsequent ment. (c) 34 cases living in 2 rooms or less (24 being first finements). (d) 71 cases living in 3 rooms (46 being first confinements). Of the 442 cases, 26 women had engaged their own doctor. 18 of these cases were, however, delivered by a midwife, the doctor not being present at the birth. 416 were attended by one of the midwives at the Home. It was necessary to call in a doctor in 222 of the latter cases for the following reasons:— (a) Ante-natal 19 Albuminuria 2 Ante-partum haemorrhage 2 General anaesthetic for surgical induction 9 General anaesthetic for external version 1 General condition 1 Heart disease 1 Pyrexia 1 Toxaemia 1 Varicose veins 1 (b) During labour.. 60 Anaesthetic for Caesarian Section 4 Breech presentation 2 Face presentation 1 Foetal distress 9 General condition 1 Impacted shoulder 2 Maternal distress 4 Persistent occipito—posterior presentation 4 Prolapsed cord 3 Prolonged labour 7 Retained placenta 5 Rigid perineum 5 Small outlet 2 Uterine inertia 11 122 (c) After labour 90 Eclampsia 1 Inflammation of arm 1 Mastitis 3 Obstetric shock 1 Perineal tear 66 Phlebitis 13 Post-partum haemorrhage 1 Pyrexia 4 (d) For infant 53 Abscess on head 1 Asphyxia 4 Blocked tear duct 1 Burn 1 Conjunctivitis 30 Cyanosis 1 Feebleness at birth 4 General condition 3 Prematurity 3 Rash 2 Septic spots 3 Forty-four cases were delivered by means of forceps, 5 following surgical induction; 4 of the infants were stillborn; 1 died aged 13 days and 1 aged one day. In addition, labour was surgically induced in 12 cases; 1 of the infants was stillborn and 1 died, aged 2 days, from debility and prematurity. There were 8 deaths of infants in the Home, from the following causes:— Atelectasis; cardiac failure 1 Atelectasis of lungs; congenital malformation of heart 1 Debility and prematurity 1 Haemorrhagic disease of the new born 1 Prematurity; 24 weeks pregnancy 1 Prematurity; maternal eclampsia 1 Prematurity; termination of pregnancy; acute hydram- nios 1 Pulmonary atelectasis; prematurity 1 The neo-natal death-rate of babies born in the Maternity Home was 1.8 per cent. compared with 2.7 per cent. in the district in general. The death-rate of babies who died before 14 days, born in the Maternity Home, was 1.8 per cent. in 1935 and 1.3 per cent. in 1934. The infant mortality rate of children born in the Maternity Home was 20.6 per 1,000 births, as compared with 48.9 born in their own homes. The figure of 48.9 has been arrived at after deduction of all deaths of infants from the Maternity Home, and is calculated on the total births in the district, excluding those in the Maternity Home. 123 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. 1935 20.6 48.9 1934 26.4 42.5 1933 34.6 48.2 1932 29.4 43.0 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 The causes of the 12 stillbirths in the Home during 1935 were as follows:— Breech presentation 1 Craniotomy 1 Difficult labour 2 Induction of labour for disproportion 1 Maternal toxaemia 1 Pressure on cord 5 Unknown 1 The average stillbirth rate at the Maternity Home for the past five years was 3.20 per cent., compared with 2.96 per cent. for births elsewhere in the Ilford district. Two cases were notified as puerperal pyrexia, one being admitted to the Isolation Hospital. The cases made a satisfactory recovery. The following cases were also removed to the Isolation Hospital:— One infant with pustule on back; 1 infant with abscess of scalp; 1 woman with streptococcal tonsillitis and 1 woman with pyelonephritis. One case of pemphigus neonatorum occurred at the Home during the year. The infant and mother were removed home. The patient recovered. 124 Three cases of ophthalmia neonatorum were notified from the Home. One case was due to a staphylococcal conjunctivitis. The other two were due to a blocked lachrymal duct with some dacryocystitis. The Consulting Obstetrician or his Deputy paid the usual fortnightly visits to the Home. During 1935, 26 ordinary visits were paid, and 208 patients referred from the Ante-Natal and Post- Natal Clinics were examined. During the year 23 other cases were visited, as follows:— To perform Caesarian section operations 4 For consultations 19 The reasons for the 4 Caesarian section operations were as follows :- Disproportionate measurements 3 Severe cardiac disease 1 The consultations were for the following reasons:— Difficult labour 8 Pyrexia 3 Toxaemia conditions 3 Acute necrosis of liver 1 Version 2 General condition 2 One patient died at the Maternity Home from acute necrosis of liver. The maternal mortality rate for the Home for the ten years from 1926—1935 is .88, as compared with the maternal mortality rate in the district generally of 3.43, the rate in each case being calculated on the total live births. 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, special cases being referred to the Maternity and Child Welfare Committee. 125 The following table shows in extenso the fees which were paid by women admitted to the Home :— Fees Paid per Week. No. of Patients Admitted. Fees Paid per Week. No. of Patients Admitted. 7/6 3 67/6 4 10/- 7 70/- 15 12/6 1 72/6 14 15/- 6 75/- 6 17/6 1 77/6 2 20/- 21 80/- 6 21/- 1 82/6 1 22/6 2 87/6 2 24/- 1 90/- 2 25/- 21 92/6 1 27/6 2 100/- 3 30/- 52 105/- 3 35/- 28 Fees for whole period. 40/- 17 42/- 64 46/- 2 42/6 3 104/3 1 45/- 28 107/2 1 47/6 1 150/- 1 50/- 24 172/10 1 52/6 38 177/10 1 55/- 8 196/5 1 55/6 1 215/8 1 57/6 10 234/- 1 60/- 28 242/2 1 62/6 3 252/10 1 63/- 1 277/10 1 65/- 5 282/10 1 Of the above patients :— (a) 243 paid an additional fee of 15s. to the Council for the services of one of the mid wives of the Home. (b) 169 paid a fee of £1 Is. for the services of the Assistant Medical Officer of Health. (c) 8 paid a fee of £5 5s. for the services of the Consulting trician. In 14 instances part of the fee was paid by the patient, the remainder being paid by the Council. In 4 instances, the Council paid the whole of the fee. (d) 1 paid a fee of 2s. per week for the maintenance of the baby in the Home apart from its mother. The work of training Pupil Midwives has continued in a satisfactory manner; six who were engaged during the year were successful in passing the examination of the Central Midwives Board. 126 Maternity Home Extensions. The Extensions were commenced in December, 1934, and formally opened by the Mayor (Ald. J. H. Shipman, J.P., C.C.) on February 7th, 1936. The Borough Engineer designed the new buildings and extensions and supervised the work. The main Contractor was Messrs. A. E. Symes, and the amount was £38,755 (excluding furniture and equipment). Description of Buildings. (a) Nurses' Home.— The present extensions are in the nature of additions to each end. The additional accommodation provided is a self-contained flat for the R.M.O., Lecture Room (30ft. × l8ft.), sitting and dining rooms, office and 34 bedrooms. Each bedroom is fitted with a built-in wardrobe and a wash-basin with hot and cold water. All rooms are heated by radiators; fireplaces are also installed in some of the principal rooms. (b) New Surgical Block and Ante-Natal Clinic.—Situated on the south-east corner of the site, this building is brick-built with a patent stone cornice and a string course at first floor level; the entrance is constructed in Portland stone. The accommodation provided is as follows:— Ground Floor (Ante-Natal Clinic).—Vestibule leading from verandah to a Waiting Hall accommodating 75 persons, two Consulting Rooms with six dressing cubicles giving access to either consulting room, rooms for both the Clinic nurse and District Midwife, Dispensary, lavatory accommodation for the medical staff and patients, stores, etc. The flooring in the Waiting Hall, Consulting Rooms and all other rooms on this floor is finished in 12in. Terrazzo tiles, with the exception of the lavatories and W.C.'s, where Adamantine tiles are laid. First Floor (Surgical Ward Block).—Six single-bed wards on the cubicle system, all giving access to a balcony in front with a Central Duty Room giving observation in either direction; Operating Theatre, Sterilizer Room, Sink Room, Doctor's Room, Babies' Room, Kitchen, with lavatory and bathroom accommodation. 127 A lift has been installed to enable patients to be conveyed direct to the first floor. The Operating Theatre is heated by ceiling and wall panels and is provided with an "Ideal" K.B.B. shadowless lamp. The floor is laid in 12in. Terrazzo tiles and the walls finished in Keene's plaster, white enamelled. The sterilizing equipment consists of a crockery sterilizer in the Duty Room, a dressings sterilizer, a combined bowl and instrument and hot and cold water sterilizer in the Sterilizer Room. The whole equipment works under steam pressure and is the latest of its type, all fittings being chromium plated or of stainless steel. A bed pan washer is installed in the Sink Room. The cubicles are heated by radiators, and a surgeon's basin is fitted in each. Oak block flooring is laid in the cubicles, the doors of which are flush and contain observation panels. The flooring in the corridors is in Terrazzo, and the first floor corridor gives access to a fire-escape staircase. Ventilation is by means of a powerful electric fan connected by a system of ducts to openings in the ceilings of the various wards, etc. (c) New Ward Block :—Brick built and situated on the east side and in alignment with the Old Ward Block, will eventually accommodate 27 patients, but the present scheme includes the construction of the ground floor storey only, with the following accommodation:— Two four-bed wards, three two-bed wards and two single- bed wards (sixteen beds), all with access to a verandah in front. Reception Ward, with waiting room, bathroom and W.C. Labour Room, Sterilizer Room, Sink Room, Babies' Room, Duty Room, Kitchen, etc. : bathrooms and lavatory accommodation. 128 The sterilizing equipment (excepting the crockery sterilizer) is similar in type to that installed in the Surgical Block. An "Ideal" K.B.B. shadowless lamp is installed in the Labour Room. The wards are heated by radiators, with fireplaces in the larger wards, and each is fitted with a surgeon's basin with hot and cold water. The flooring has been laid in oak blocks. All the doors are flush and contain observation panels. The corridor flooring is in 12in. Terrazzo tiles and the walls are painted. (d) Old Ward Block.—The room in this building previously used as an Ante-Natal Clinic has been converted into a two-bedded ward, and a small extension added on the north-east corner has enabled this to be adapted as a Reception Ward with waiting room, bathroom and lavatory. A Babies' Room has also been introduced. (e) Boiler House and Water Tower and Centralized Heating System.—The boiler house is erected on the north-west boundary of the site. The tower is a steel-framed structure faced up and panelled in brickwork. The engineering services have been carried out under the supervision of Mr. J. Roger Preston, M.I.Mech.E. The whole of the heating, hot water and steam services for the Home are served from this Central Station. There are two steam boilers (with provision for a third when required), each with a duty of about 2,500 lbs. of steam per hour, one acting as a standby. Steam is taken from the boilers to serve the heating and hot water supply units on the first floor, the turbines driving the circulating pumps, the induced draught engine, etc., in the Central Station and by way of the trenches to the Laundry and the various blocks. The heating is by means of low pressure hot water, the mains being run in trenches to the various buildings. The system is thermostatically controlled, as also is the hot water supply. 129 To enable the Engineer to check the thermal load, etc., instruments are provided to record the amount of water evaporated, feed water temperature, CO2 in the flue gases, etc., etc. Automatic feed control is also provided. Adjacent to the pump room (ground floor) is the water softening plant and salt store. The whole of the hot water supply is softened by this plant, which also supplies soft water for boiler feed purposes and cold supply to the Laundry. On the second floor of the tower are the hot water storage cylinders with a capacity of 900 gallons, whilst on the third floor are the cold storage tanks holding 3,500 gallons. To avoid building an unsightly brick chimney, a steel chimney is run up inside the tower. An induced draught fan is fitted, this having special grit-arresting arrangements. (f) The Laundry.—Erected on the northern boundary, is brick built, top and side lighted, and divided into three compartments— "Receiving,'' washing and drying and ironing. The walls are finished in white glazed brickwork to a height of 5ft. ; the flooring is part granolithic and part teak-blocks. The equipment comprises two large rotary washing machines, one 30in. diameter hydro extractor, one 18in. by 90in. "Decoudan" ironing machine, one 38in. laundry taper press, drying closet with 8 draw-out drying horses, steeping tanks, sorting racks, washing tubs, ironing tables, etc. The ironing process is by electric fiexless irons. (g) Generally. — "Keepalite" emergency lighting has been installed in the following:— New Surgical Block.—Operating Theatre, sterilizer room, sink room, kitchen, babies' room, duty room and 6 cubicle wards. New Ward Block.—Labour Room, sterilizer room, sink room, servery, babies' room, reception ward and waiting room, and in the 7 bed wards. 130 The clocks throughout the new extensions and Old Ward Block are electric and controlled by a master clock. All the various buildings and a number of bedrooms are connected, by internal extensions, to the P.O. telephone. The cost of furnishing and equipping the Extensions was £2,895 (including part cost of sterilizing equipment). The Home now provides accommodation for 51 patients as follows: — Old Ward Block. Ground floor—One four-bed ward; Three two-bed wards; One three-bed ward; Two single-bed wards; One single-bed reception ward 16 beds. First floor — One four-bed ward; Two two-bed wards; Two single-bed wards; Two single-bed separation wards 12 ,, New Ward Block. Two four-bed wards; Three two-bed wards; Two single-bed wards; One single-bed reception ward 17 ,, Surgical Block. Six single-bed wards 6 ,, The 6 cubicles in the Surgical Block giving facilities for the reception of complicated oases from the district or from the Home itself. On the following pages will be found (a) the site plan of the Maternity Home, showing old and new buildings; (b) the Nurses' Home; (c) the Surgical Block, Ante-Natal Clinic, Laundry and Central Boiler House; and (d) New Ward Block and Old Ward Block, showing conversion and extension at north-east corner, and photographs of (e) Operating Theatre (Surgical Block); (f) Labour Room (New Ward Block); and (g) New Laundry. The area of the site is approximately 3 acres, of which approximately .6 of an acre is occupied by buildings. 131 MATERNITY HOME block plan 132 MATERNITY HOME plans 133 MATERNITY HOME plans 134 MATERNITY HOME plans Ilford Council Maternity Home Operating Theatre— Surgical Block. Ilford Council Maternity Home—Labour Room : New Ward Block. Ilford Council Maternity Home Laundry. 138 Maternity Cases— Queen Mary's Hospital. There has been an arrangement since July, 1923, with the Queen Mary's Hospital, Stratford, for the treatment of maternity eases 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. This is, of course, subject to accommodation being available. Two cases were treated during 1935. District Midwife. During 1935 the District Midwife attended 152 cases. They were in the following wards:—Barkingside, 22; North Hainault, 16; Cranbrook, 1; Park, 30; Seven Kings, 33; South Hainault, 3; Loxford, 22; Clementswood, 17; Goodmayes, 8. Twelve cases were delivered by doctors and 128 by herself, and in 9 cases the babies were born before the Midwife's arrival. One case was transferred to the Maternity Home and 2 to Queen Mary's Hospital, Stratford, before delivery (one of the latter died from childbirth, failed forceps and shock and occipito posterior position of child). A doctor was called in, however, in 51 of the 128 cases delivered by the District Midwife for the following reasons:— (a) Ante-natal 12 Albuminuria 2 Albuminuria and hyperpiesis 2 Ante - partum haemorrhage 5 General condition 3 (b) During labour 12 Breech presentation 1 Foetal distress 1 Persistent occipito-posterior presentation 2 Prolonged labour 6 Pyrexia 1 Retained placenta 1 (c) After labour 20 Perineal tear 16 Phlebitis 1 Pyrexia 2 Tonsillitis 1 139 (d) For infants 7 Conjunctivitis 1 Feebleness at birth 2 General condition 3 Prematurity 1 Six cases were transferred to the Isolation Hospital suffering from (1), (2) and (3) Puerperal Pyrexia, (4) Scarlet Fever, (5) Streptococcal Tonsillitis, and (6) Acute Influenzal Pneumonia (the latter case died 11 days after admission from influenzal pneumonia and parturition). One case was also transferred to Oldchurch Hospital suffering from Puerperal Pyrexia. Of the infants born there were 3 stillbirths from the following causes:— Difficult labour 1 Maternal toxaemia 1 Prematurity 1 Three infants died from the following causes:— Congenital cardiac malformation, aged 3 days. Hæmorrhagic disease of the newly born, aged 4 days. Icterus neonatorum, aged 6 days. Thirty-six cases who applied for the services of the District Midwife had to be refused owing to her services being already booked. Visit by Ministry of Health Inspectors. Dr. C. Sims and Miss Hobbs, of the Ministry of Health, inspected various portions of the services on November 14th, 19th, 26th and 27th. The Secretary of the Ministry of Health has written as follows:— "I am directed by the Minister of Health to state that he has had under consideration the report of Dr. Carol Sims, Medical Officer in the Ministry, after her recent visit to Ilford, and to express the Minister's appreciation of the progressive nature of the maternity and child welfare services carried out in the Borough. "The Minister notes with satisfaction the valuable services rendered by voluntary workers at the Welfare Centres." SCHOOL MEDICAL SERVICE. 143 GENERAL SURVEY OF THE SCHOOL MEDICAL SERVICE. There were 18,920 children on the school rolls on December 31st, 1935, compared with 18,459 on the same date in 1934. The number of children in average attendance at school for the period April 1st, 1934, to March 31st, 1935, was 16,412 (or 16,507 including the Open Air School). 7,483 children were examined at routine medical inspections, compared with 7,147 in 1934. The following table compares the incidence-rate of physically and mentally defective children in Ilford with the Board of Education average for the country, as arrived at in 1923:— Defects. BOARD OF EDUCATION ILFORD Estimated incidence Rate per 1,000 children in average attendance which was adopted in 1923. IncidenceRate per 1,000 children in average attendance (1st April, 1934, to 31st March, 1935). Blind:— Totally 0.4 0.2 Partially 1.0 0.9 Deaf:— Totally 0.9 0.7 Partially 0.3 0.2 Mentally Defective (educable) 8.6 4.9 Epileptics (Severe) 0.6 0.3 (a) Delicate 15.5 8.4 (6) Crippled 10.0 3.7 144 The following table shows a comparison of the incidence of physical defects found at routine school medical inspection in Ilford in 1934 with that in the country generally, as arrived at by the Board of Education. TABLE A. Defect. Incidence of Defects per 1,000 requiring Treatment. 1934. Incidence of Defects per 1,000 under Observation. 1934. BOARD OF EDUCATION. ILFORD. BOARD OF EDUCATION. ILFORD. Skin Diseases 9.2 14.2 2.0 3.5 Defects of Vision 78.5* *85.3 *39.7 *17.7 Squint.. 7.7 5.9 4.3 1.2 Other Eye Diseases 7.5 10.7 2.3 2.6 Defects of Hearing 3.2 1.7 2.4 0.8 Otitis Media 4.6 4.3 1.8 1.2 Chronic Tonsillitis 19.6 6.6 46.3 30.7 Adenoids 2.9 1.4 3.4 2.9 Chronic Tonsillitis and Adenoids 17.7 4.9 11.3 8.2 Other Defects Nose & Throat 6.0 5.0 5.3 2.1 Defects of Speech 1.0 0.4 2.5 3.5 Organic Heart Disease 1.6 2.8 3.5 3.9 Pulmonary T.B.— (a) Definite 0.1 — 0.1 — (b) Suspected 0.4 0.1 0.6 0.1 Non-Pulmonary Tuberculosis 0.6 0.2 0.8 — Epilepsy 0.2 0.1 0.4 0.2 Chorea 0.5 0.8 0.4 0.5 Other Nervous Conditions .. 1.2 7.1 2.0 8.2 Deformities— Rickets 1.4 0.1 2.7 — Spinal 2.5 4.0 1.9 0.4 Other Conditions 7.1 17.5 6.9 5.9 *In calculating this figure, the entrants have been left out of account. 145 Table B shows the same figures for Ilford for 1935, those for the country generally not yet being available. TABLE B. Defect. ILFORD. Incidence of defects per 1,000 requiring treatment. 1935. Incidence of defects per 1,000 under observation. 1935. Malnutrition 2.5 — Skin Diseases 7.75 5.87 Defects of Vision 73.1* 21.2* Squint 3.6 1.47 Other Eye Diseases 5.07 6.3 Defects of Hearing 1.87 2.0 Otitis Media 1.9 1.07 Enlarged Tonsils 3.6 39.03 Adenoids 0.1 2.4 Enlarged Tonsils and Adenoids 4.0 8.0 Other Nose and Throat 6.5 5.07 Defects of Speech 0.67 4.9 Organic Heart Disease 2.5 3.2 Pulmonary T.B.— (a) Definite 0.1 — (6) Suspected — — Non-Pulmonary T.B. — 5.34 Epilepsy — 0.26 Chorea 0.26 1.33 Other Nervous Conditions 1.9 10.0 Deformities— Rickets 0.26 5.34 Spinal 2.0 0.1 Other Conditions 39.2 10.0 *In calculating this figure, the entrants have been left out of account. 146 Table showing the Principal Causes op Death among Children of School Age (i.e., prom 5—15 years). in England and Wales during 1933 and 1934, compared with those in Ilford for 1933 and 1934. 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 1933 1934 1933 1934 1933 1934 1933 1934 1. Measles .3 .8 .08 .97 1.8 3.6 4.5 5.9 2. Scarlet Fever .1 .2 — .16 2.4 3.0 — 5.9 3. Whooping Cough .4 .4 .08 — .7 .8 — — 4. Diphtheria .5 .8 .5 1.35 12.6 18.7 13.7 32.4 5. Influenza 4.6 1.2 3.6 .97 2.8 1.1 — — 6. Tuberculosis 6.7 6.5 7.2 6.4 12.9 11.5 13.7 5.9 7. Rheumatic Fever .2 .3 .74 .4 3.7 3.8 — — 8. Bronchitis, Pneumonia and other respiratory diseases 11.3 10.5 10.6 10.9 10.8 9.2 13.7 5.9 9. *Meningitis and Nervous system 7.8 8.2 .16 .97 7.9 8.0 — 5.9 10. Heart Disease 21.7 22.9 23.6 23.1 6.1 6.7 — 2.9 11. Acute and Chronic Nephritis 2.7 3.3 2.0 2.28 2.0 2.5 — — 12. Violence 4.5 4.8 4.8 4.8 12.8 10.7 9.0 11.7 13. Other conditions 39.2 40.1 46.6 47.7 23.5 20.4 45.4 23.5 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 *Excludes Meningococcal infections. England and Wales.— The deaths of children of School Age during 1934 represent 2.6 per cent. of the Total Deaths registered (all ages), and during 1933, 2.3 per cent. Ilford.— The deaths of children of School Age during 1934 represent 2.7 per cent. of the Total Deaths registered (all ages), and during 1933 represent 1.8 per cent. 147 1. Staff.—(a) Medical.—Dr. D. M. B. Gross commenced duties as Assistant Medical Officer of Health and Assistant School Medical Officer on the 6th August, 1935. Dr. H. D. Smart commenced his duties as part-time Oculist on the 16th January, 1935. (b) Dental.—Mr. F. J. Lord, who was appointed as an additional Assistant School Dentist, commenced duties on the 4th September, 1935. (c) Nursing.—Miss M. E. Sumpner, Health Visitor and School Nurse, resigned her appointment as from the 26th June. Miss R. Noble was appointed to the vacancy and commenced duties on the 27th June, 1935. Miss H. E. Clynes, additional Health Visitor and School Nurse, commenced duties on the 1st July, 1935. 2. Co-ordination.—Vide Annual Report, 1920. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. 3. School Premises.—There are 23 schools, with 55 departments. The schools have accommodation for approximately 18,726 scholars, and 18,920 were actually on the rolls on December 31st, 1935. The following are the alterations which have taken place in the accommodation at the elementary schools during the year:— School. Date of Reorganisation. Revised Accommodation. Fairlop Upper Boys' 26.8.35 360 ,, ,, Girls' „ 360 ,, Middle „ 480 ,, Lower „ 384 Newbury Park Upper „ 240 „ „ Middle „ 300 ,, ,, Lower „ 300 SS. Peter and Paul Lower „ 192 Barkingside Church of England School closed 25.8.35. The Mayesbrook School Clinic was formally opened by His Worship The Mayor on 15th May, 1935, the first School Clinic being held on 20th May. 148 The Clinic has been erected on a site situated on the West side of Goodmayes Lane adjoining the Mayfield Central School. The new building faces South-East and is of two storeys. The front entrance to the building is approached from Goodmayes Lane and the Entrance Lobby affords access to a spacious Waiting Hall on each side of which are placed the various Consulting and Treatment Rooms. On the left hand side, the Minor Treatment and Weighing Room and one Consulting Room, and on the right hand side the Orthopaedic Clinic, Dressing Room (with 6 cubicles), and another Consulting Room. The exit doors at rear of Waiting Hall open out to a covered way leading to the Bathroom Block. The staircase in front lobby leads to another Waiting Hall on the first floor, on the right hand side of which are placed the Dentist's Room, Recovery Room and Consulting Room, and on the left a Consulting Room, Office, Stores and Kitchen. The flooring of the Waiting Halls, Dental Clinic and Minor Treatment Room are laid in terrazzo, the Consulting Rooms in wood blocks and the Orthopaedic Clinic in rubber. Lavatory accommodation has been placed in accessible positions at the rear of Waiting Halls on both floors. Provision has been made at the rear of the building for the shelter of perambulators during inclement weather. The building is an all-electric one, the heating being by means of tubular heaters and wall and ceiling panels. The Education Committee decided that the Minor Treatment Clinic be held on Monday, Wednesday and Saturday mornings, and that children from the following schools should attend: Becontree, Goodmayes, Gordon, Chadwell, St. Vincent's, South Park, Mayfield and S. S. Peter and Paul. The architectural treatment follows very closely that of the Mayfield Central School, and the two blocks, together with the Caretaker's Lodge, form a particularly pleasing group of buildings. 149 The cost of the buildings amounted to £6,375, and the furnishing and equipping £420. The building was designed and the work supervised by the Architect to the Education Committee, and Messrs. Thos. Bates & Sons, of Coventry, were the Contractors. The following pages show the plan of the Clinic, and photographs of the Orthopaedic Clinic, Waiting Hall and Dental Clinic. The proposed new schools or extensions are as follows:— School. Accommodation. Balfour Road (former County High School)—Building to be used in connection with further reorganisation ­ *Eastern Avenue (Aldborough) Middle 500 ,, ,, ,, Lower 500 Redbridge Middle 300 ,, Lower 300 Clayhall ­ *Now in course of erection. The Sanitary Inspectors have paid the usual monthly visits and visits in connection with milk supplies to the various elementary schools in the Borough, and a total of 449 visits have been made during the year. 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 (b) their attaining the age of eight years, and (c) their attaining the age of twelve years. During 1935 the number of visits by the Medical Officers to 55 different departments of 23 schools for the purposes of routine medical inspection was 417. The number of children examined during the year, falling within the above age groups, totalled 7,483 (3,630 boys and 3,853 girls), an increase of 336 over the 150 Mayesbrook Clinic.—Orthopaedic Clinic. Mayesbrook Clinic.—Orthopædic Clinic. Mayesbrook Clinic.—Waiting Hall. Mayesbrook Clinic.—Dental Clinic. 155 figures for 1934. In addition, a number of children of varying ages were presented by the Head Teachers for special medical examination, being thought by the teachers to be suffering from some ailment. During 1935, 185 such children (82 boys and 103 girls) were examined. 4,499 re-examinations of children (some on several occasions) 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 12,167 examinations were made at the various schools during the year. The following table compares the numbers examined in previous years:— Routine Medical Inspection. Special Cases. Re-examination at following up. 1935 7,483 185 4,499 1934 7,147 182 5,471 1933 6,935 282 4,837 1932 6,640 392 4,160 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 Routine medical inspection at the Mossford School, Dr. Barnardo's Girls' Village Home, was again carried out by my Department during the year, 315 children being examined, the treatment of the children being left, as previously, in the hands of the Home Authorities. 5. Findings of Medical Inspection.—Table II shows the return of defects found in the course of medical inspections. (а) Uncleanliness.—At routine medical inspection 175 children out of a total of 7,483 (or 2.3 per cent.) were found to have nits or vermin in their hair, while 4 (or .05 per cent.) were found to be fleabitten. (b) Tonsils and Adenoids.—58 children (or .77 per cent. of those examined) were found to be suffering 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.—One case of pulmonary tuberculosis was referred to the Tuberculosis Officer. 156 (d) Skin Disease.—4 cases of Scabies, 3 cases of Impetigo, and 95 cases of other diseases of the skin were discovered. (e) External Eye Disease.—31 cases of Blepharitis, i.e., inflamed eyelids, and 5 cases of Conjunctivitis were discovered. (f) Vision.—400 children (or 5.3 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. 54 of these cases saw 6/6, while the remaining 346 had vision of 6/9 or less, and 267 cases were referred for re-examination at a later date. 76 per cent. of the cases referred for treatment received treatment from the School Oculist. Further particulars of these cases will be found on page 161. (g) Ear Disease and Hearing.—14 children (or .18 per cent. of those examined) were found to be suffering from defective hearing. In addition, 5 out of 22 children found to be suffering from a discharge from the ear, due to an old otitis media, were also deaf. (h) Dental Defects.—395 (or 5.2 per cent. of those examined) were found to be suffering from teeth so defective as to impair health. These cases were referred to the School Dentist for treatment. A more complete inspection of the teeth of the children is carried out by the Dentist, a summary of the results of which appears on page 194, Table IV (Group V). (i) Deformities.—16 children were found to be suffering from slight spinal curvature, and 368 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 infectious diseases in the Ilford schools since 1926:— Scarlet Fever. Diphtheria . Measles. Chicken Pox. Mumps. Whooping Cough. Small Pox. 1926 93 60 1,713 536 124 465 — 1927 244 67 83 614 449 134 — 1928 349 117 1,383 278 207 341 1 1929 309 210 141 331 252 278 3 1930 174 208 1,295 234 179 171 8 1931 121 97 72 438 115 197 2 1932 152 34 1,077 263 203 355 — 1933 256 82 371 399 293 280 — 1934 274 178 1,053 476 363 318 — 1935 209 106 445 355 540 447 — 157 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 Christchurch, Cleveland, Downshall, Mossford, SS. Peter and Paul, and St. Vincent's Schools. No schools were closed during the year on account of infectious disease. Tables VII to XIII on pages 202 to 208 show the incidence of each infectious disease in the Ilford schools during 1935. Diphtheria Prevention Clinics.—The following are the particulars showing work carried out at Valentines (72 sessions) and Mayesbrook (31 sessions) Clinics in connection with children of school age during 1935:— Valentines. Mayesbrook. Primary Schick tested 113 34 Positive 66 27 Negative 47 7 Inoculated (full course) 494 145 Schick + 1934 5 ­ Schick + 1935 66 27 Not tested 423 118 Negative after full course of inoculation 354 106 Positive after full course of inoculation and re-inoculated 8 2 Awaiting re-test 121 35 Not re-tested after inoculation on account of leaving district, etc. 11 2 Result of final Schick test in 1935 of cases inoculated in 1934:— Valentines. Mayesbrook. Positive and re-inoculated 4 ­ Negative 241 28 966 individual children were treated (786 at Valentines and 180 at Mayesbrook), making 4,363 attendances (3,585 and 778 respectively). Since June, 1932, children under 8 years of age have not been Schick tested prior to immunisation, unless there was some particular reason to suppose that the child might give a combined reaction to the Schick test. 158 Since the first introduction of immunisation against Diphtheria in Ilford in 1929, 2,651 children of school age, and 1,744 children under school age have been immunised. During 1935, 27 Teachers attended for immunisation against Diphtheria with the following result:— Primary Schick Tested 27 Positive 18 Negative 9 Inoculated (full course) 18 Negative after full course of inoculations 13 Awaiting re-test 5 Measles.—445 cases were notified from the schools, compared with 1,053 in 1934 and 371 in 1933. No deaths occurred from Measles of children of school age. All the cases of measles were visited by the School Nurses immediately after notification. In addition, the cases were visited afterwards to enquire as to the child's progress. It was found that of the 445 cases, the following complications occurred:— Enlarged Cervical Gland 3 Styes 2 Styes and Conjunctivitis 1 Styes and Whooping Cough 1 Bronchitis 6 Whooping Cough 1 Earache, Swollen Glands and Conjunctivitis 1 2,409 home visits were paid by the Health Visitors in connection with cases of minor infectious disease. Ringworm:— No. of cases at beginning of 1935. No. of cases reported during 1935. Total. Remedied during 1935. No. of cases under observation at end of 1935. Ringworm:— Scalp 1 1 2 2 — Body —- 8 8 7 I 1 9 10 9 1 The school child suffering from ringworm of scalp was X-rayed at the Clinic during the year. 159 7. Following Up.—This has been carried out in the manner described in my previous reports. During 1935, 4,365 home visits by the Nurses were paid for the purpose, and 4,499 re-examinations of children were carried out by the doctors at school; 429 visits to schools were made for this purpose. 8. Medical Treatment.—The Clinic for minor ailments has been held as previously each morning at Valentines Mansion, and on Monday, Wednesday and Saturday mornings at Mayesbrook Clinic commencing on May 20th. (a) Minor Ailments.—The attendances during 1935 were as follows:— Valentines. Mayesbrook. Number of individual children seen at the Clinics 2,166 633 Number of attendances of children 6,510 1,954 Number of exclusion certificates granted 2,557 799 Number of certificates of fitness to attend school granted 1,095 267 The following table shows the conditions dealt with at both the School Clinics during the year:— Malnutrition 3 Uncleanliness:— Head 109 Skin:— Ringworm:— Head 1 Body 8 Scabies 21 Impetigo 178 Other Diseases (Non-Tuberculous) 670 Eye:— Blepharitis 17 Conjunctivitis 83 Keratitis 2 Corneal opacities 1 Defective Vision (excluding Squint) 174 Squint 7 Other conditions 121 Ear:— Defective Hearing 25 Otitis Media 60 Other Ear Diseases 60 160 Nose and Throat:— Chronic Tonsillitis only 28 Adenoids only 10 Chronic Tonsillitis and Adenoids 91 Other Conditions 326 Enlarged Cervical Glands (Non-Tuberculous) 64 Defective Speech 8 Teeth—Dental Diseases 51 Heart and Circulation:— Functional 1 Anaemia 46 Debility 13 Infectious Diseases:— Scarlet Fever 2 Diphtheria 1 Whooping Cough 22 Mumps 29 Chicken Pox 11 Measles and German Measles 9 Influenza 69 Colds 214 Lungs:— Bronchitis 123 Other Non-Tubercular Diseases 2 Tuberculosis:— Pulmonary:— Suspected 5 Nervous System:— Epilepsy 4 Chorea 17 Other conditions 72 Deformities:— Spinal Curvature 3 Other forms 59 Minor Injuries 187 Rheumatism 79 Other Defects and Diseases 219 Total number of ailments 3,305 161 (b) Ophthalmic Department.—During the year 1935 the School Oculist held 202 sessions for the refraction of children suffering from defective vision (152 at Valentines and 50 at Mayesbrook). Full details of the work are given in Table IV, Group II, on page 193. 2,664 attendances (1,897 at Valentines Clinic, 767 at Mayesbrook Clinic) were made by 1,202 school children (972 at Valentines Clinic 230 at Mayesbrook Clinic), as compared with 1,059 school children in 1934. 77 of the cases were referred for refraction in 1934. Of the 1,202 cases, 517 were referred from medical inspection, 313 were referred from the School Clinic, 305 were "under observation," cases re-examined, 65 were re-examined at parents' request, 1 referred by the Director of Education and 1 by the Invalid Children's Aid Association. The 1,202 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 6/9 380 160 185 167 116 112 63 19 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 1,202 children examined, 914 were found to require spectacles, 424 being children who had previously had spectacles and 490 (new cases) by reason of the following defects:— Myopia 37 Myopic Astigmatism 54 Hypermetropia 82 Hypermetropic Astigmatism 211 Mixed Astigmatism 37 Anisometropia 29 Hypermetropia with Squint 40 Total 490 162 Of the remaining 288 children, (i) 52 were suffering from the following other diseases, and spectacles were not prescribed:— Amblyopia 4 Corneal Ulcers, Nebulae, Conjunctivitis, Blepharitis, etc. 21 Interstitial Keratitis 1 Diplopia 1 Optic Atrophy 2 Strabismus 20 Episcleritis 1 Coloboma 1 Congenital Naevus 1 52 (ii) 82 children were found not to require spectacles, having no refractive error requiring correction. (iii) 154 children were wearing spectacles already and the lenses in use did not require changing. Under the Education Committee's scheme 692 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 488 cases the lenses of spectacles were changed after re-examination or repairs of frames were carried out. 51 pairs of spectacles were provided free of charge and 7 pairs at a reduced rate on necessitous grounds. (c) Orthopaedic Department.— (i) Valentines Clinic.—30 sessions were held during 1935, 337 individual children of school age being examined making 640 attendances. (ii) Mayesbrook Clinic, 5 sessions were held during 1935, 129 individual children of school age being examined, making 144 attendances. 163 The 466 children were found to be suffering from the following defects:— Valentines. Mayesbrook. Paralyses:— Infantile paralysis 14 5 Spastic monoplegia 1 — Spastic paraplegia 2 — Spastic hemiplegia 3 1 Spinal curvature:— Scoliosis 34 9 Kyphosis 12 7 Slight Kypho-Lordosis 20 8 Congenital equino-varus (club-foot) 5 2 Torticollis (wry-neck) 7 2 Genu valgum (knock-knee) 70 24 Flat feet 18 6 Round shoulders 14 3 Pigeon chest 4 8 Pes valgus 22 6 Old osteomyelitis 1 — Deformity of toe 14 5 Congenital dislocation of hips 1 — Flat chest 13 4 Depressed sternum 13 1 Hallux valgus 3 1 Other defects 66 37 337 129 13 children of school age were admitted to the country branch of the Royal National Orthopaedic Hospital, at Stanmore, in 1935, suffering from:—(1) Hallux valgus; (2) Scoliosis; (3) Spastic paralysis of left leg; (4) Congenital equino-varus; (5) Dorsal displacement of 5th toes; (6) External popliteal nerve paralysis; (7) Hammer toe; (8) Torn external semilunar cartilage; (9) Torticollis; (10) Multiple septic arthritis; (11) Genu valgum (3 cases). 15 children were discharged during the year, 5 of whom were admitted during 1934, and 3 were still in the institution on the 31st December, 1935. 9 surgical instruments were supplied to school children during the year. 36 cases were discharged from the Orthopaedic Clinic as cured and 71 cases were discharged but recommended to be kept under observation at school. 10 cases left the district and 25 cases left school or were transferred to private or secondary schools. 164 Of the 71 cases discharged for observation at school, 18 were examined during the year, 10 were found to be permanently cured, in 8 cases the condition was considerably improved and the children are being kept under observation. At Valentines Clinic, 217 individual children of school age were treated by the Masseuse during the year and 2,122 attendances were made by these children. She also treated 78 children, who made 1,031 attendances at the Mayesbrook Clinic. (d) Artificial Sunlight Clinic.—48 sessions were held at Valentines Clinic and 29 at Mayesbrook Clinic. 40 children in all were treated, making 637 attendances. The lamp used in each case is a mercury vapour one, the whole of the body surface being exposed, commencing with a minimum of one minute and reaching a maximum of ten minutes' exposure. The conditions treated were as follows:— Anaemia, Debility and Malnutrition 22 Pulmonary Fibrosis 4 Bronchitis 3 Bronchiectasis 1 Asthma 1 Adenitis 7 Corneal Ulcer 2 16 cases were still attending at the end of the year. Of the remainder, 2 had left the district, and in 1 case the parent had discontinued treatment. All the others were discharged from further treatment, having improved, although no dramatic results were obtained. The Masseuse attends the Valentines Clinic for orthopaedic treatment on Wednesday afternoon, Thursday morning and afternoon and Friday morning, and for artificial sunlight treatment on Monday afternoon. She also attends the Mayesbrook Clinic on Tuesday morning and afternoon for orthopaedic treatment and on Wednesday morning for artificial sunlight treatment. A total number of 340 sessions 165 / were held by the Masseuse for treatment during 1935 (248 at Valentines Clinic and 92 at Mayesbrook Clinic). (e) Aural Clinic.—This Clinic is held at Valentines Mansion, the Surgeon attending on one afternoon weekly. 52 sessions were held during 1935 and 1,059 attendances were made by 310 children of school age, 262 being new cases. The following table shows the work of the Clinic:— 166 AURAL CLINIC. School Cases. Nature of Disease. Still under treatment. Recommended Hospital treatment. Recommended Special School. Discharged as cured. Discharged as improved Discharged as no treatment required. Discharged as left district. Discharged as left school. Totals. (i) Acute Suppurative Otitis Media 2 1 — 19 — — — — 22 (ii) ,, Catarrhal ,, — — — 2 — — — — 2 (iii) Chronic Suppurative Otitis Media due to:— 1. Tympanic Sepsis 9 2 — 24 — — 1 1 37 2. ,, ,, and Granulations 3 1 — 12 2 — 1 1 20 3. ,, ,, and Polypi 1 — — 1 — — — — 2 4. ,, ,, and previous Mastoid Operation 6 — — 4 — — 1 — 11 (iv) Tympanic Sepsis and Rhinitis 2 1 — 1 — — — — 4 (v) Mastoid Disease (previous operation) — — — — — 11 — — 11 (vi) Partial Deafness due to:— 1. Nerve Deafness — — — — 1 — — — 1 2. Tonsils and Adenoids — 11 — — — — — — 11 3. Retraction of Membrana Tympani — 2 — — 5 — — — 7 4. Scarring ,, ,, ,, — 1 — 1 1 — 1 — 4 5. Catarrhal Rhinitis — — — 3 1 — — — 4 6. Wax — — — 9 — — — — 9 7. No apparent disease 1 — 1 — 1 2 1 — 6 (vii) Rhinitis 5 5 — 7 4 — 1 — 22 (viii) ,, and Septic Antra 10 — — 4 1 — 1 — 16 (ix) History of Otorrhoea — 4 — — — 17 — — 21 and 1. Tonsils and Adenoids enlarged — 6 — — — — — — 6 and 2. Rhinitis — 1 — — — — — — 1 and 3. Scarring of Membrana Tympani 1 1 — — — 2 — — 4 (x) History of Earache 1 7 — — — 12 — — 20 (xi) ,, Deafness — 2 — — — 11 — — 13 (xii) ,, Tinnitus — — — 1 — — — — 1 (xiii) External Otitis 2 — — — — — — — 2 (xiv) Enlarged Tonsils and Adenoids — 11 — — — — — — 11 (xv) ,, Tonsils — 1 — — — 2 — — 3 (xvi) ,, Adenoids — 3 — — — — — — 3 (xvii) Mouth Breathing — 3 — — — 1 — — 4 (xviii) Deflected Septum 2 2 — — — 3 — — 7 (xix) ,, ,, and pharyngitis 1 — — — — — — — 1 (xx) Injury to Nose — — — — — 4 — — 4 (xxi) Cleft Palate — — — — — 1 — — 1 (xxii) Adenitis — 12 — — — — — — 12 (xxiii) Laryngitis — 1 — — — — — — 1 (xxiv) Asthma — 1 — — — — — — 1 (xxv) Hay Fever — — — — — 2 — — 2 (xxvi) History of Croup — 1 — — — — — — 1 (xxvii) ,, Quinsy 1 — — — — — — — 1 (xxviii) Removal of ligature from throat following Tonsil and Adenoid operation — — — 1 — — — — 1 Totals 47 80 1 89 16 68 7 2 310 167 (f) Rheumatism Clinic.—The Physician attended 36 morning sessions during the year. The Secretary of the Ilford Branch of the Invalid Children's Aid Association attends at each clinic in order to arrange convalescent treatment for those children requiring it. During the year 271 children (149 of these being new cases), made 726 attendances. Of these, 88 were discharged, showing no active rheumatic condition. The remainder were as follows:— History of Rheumatism for observation 61 History of Chorea for observation 12 Rheumatic Carditis 51 Mitral Disease not Rheumatic 5 Tachycardia of nervous origin 3 Congenital Heart Disease 9 Rheumatism 23 Chorea 11 Habit Spasm 1 Anaemia, Subnormal Nutrition or Debility 7 Number of cases referred to Convalescent Home 30 „ „ „ Heart Home 7 „ „ „ Hospital (In-patients) 5 „ „ „ (Tonsils and Adenoids operation) 8 „ „ „ Residential Open-Air School 1 (g) Dental Department.—During the year the Dentists paid 95 visits to the schools for the purpose of inspecting the teeth of children. Of 12,773 children inspected by the Dentists (including special cases), 7,541 (or 59.3 per cent.) were found to require treatment, compared with 9,350 (or 70.4 per cent.) in 1934; 55.6 per cent. in 1933; 55.4 per cent. in 1932; 55.4 per cent. in 1931; 56.8 per cent. in 1930; 60.6 per cent. in 1929; 60.1 per cent. in 1928; 56.9 per cent. in 1927. 63.2 per cent. of the cases requiring treatment obtained it at the School Dental Clinic. In 1934, 50.08 per cent.; in 1933, 35.9 per cent.; in 1932, 38.4 per cent.; in 1931, 43.4 per cent.; in 1930, 57.9 per cent.; in 1929, 50.8 per cent.; in 1928, 39.5 per cent.; in 1927, 50.1 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 168 done. 59 regulation plates were supplied during 1935. 477 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 1,188 829 69.7 6 1,603 1,151 71.8 7 1,763 1,200 68.0 8 1,923 1,329 69.1 9 1,667 1,079 64.7 10 1,665 1,001 60.1 11—12 1,704 952 55.8 The following table shows the percentage of acceptances of treatment by the School Dentists in the various departments of the schools during 1935:— 169 School. Department. No. inspected . No. referred for treatment. No. of acceptances of treatment. Percentage of acceptances. Beal Boys 34 18 6 33.33 „ Girls 32 14 5 35.71 Becontree Lower 469 373 97 26.01 „ M. Boys 331 123 85 69.11 „ M. Girls 179 95 63 66.32 „ U. Boys 109 14 13 92.86 „ U. Girls 115 30 19 62.33 Chadwell Middle 262 184 82 44.57 „ Lower 211 145 61 42.41 Christchurch Girls 192 147 61 41.49 „ Boys 193 112 43 38.39 „ Junior 276 173 90 57.80 Cleveland Girls 455 310 123 39.68 „ Boys 476 340 122 35.88 „ Junior 235 165 46 27.88 Downshall U. Girls 85 56 17 30.36 „ U. Boys 172 107 41 38.32 „ M. Girls 283 237 125 52.74 „ M. Boys 307 196 95 48.47 „ Junior 447 278 116 41.72 Fairlop U. Boys 66 50 14 28.00 „ U. Girls 60 28 14 50.00 „ Middle 131 100 73 73.00 „ Lower 295 251 121 48.20 Gearies U. Girls 110 75 21 28.00 „ U. Boys 136 90 40 44.44 „ Middle 395 293 174 59.39 „ Junior 500 320 156 42.50 Goodmayes M. Girls 172 91 38 41.76 „ M. Boys 161 108 69 63.89 „ Lower 500 320 156 42.50 Gordon Mixed 197 142 65 47.25 Highlands Girls 201 111 60 54.05 „ Boys 178 91 42 46.15 „ Junior 277 187 75 40.11 Loxford Boys 173 110 40 36.36 Mayfield Boys 94 62 21 33.87 „ Girls 86 58 21 36.24 The Mount Girls 122 79 29 36.24 Newbury Park Upper 149 71 31 43.66 „ Middle 324 217 74 34.10 „ Lower 209 137 93 67.88 SS.Peter & Paul Upper 196 107 62 57.94 „ Lower 127 95 37 38.94 St. Vincent Mixed 297 182 148 81.32 South Park U. Girls 122 68 30 44.12 „ U. Boys 112 70 37 52.86 „ Middle 275 184 85 46.20 „ Lower 222 148 75 50.68 Uphall Jun. Mixed 140 112 55 49.11 Valentines Mixed 316 248 163 65.73 Woodlands „ 307 208 74 35.57 170 The following table shows the percentage of acceptances of treatment as a result of the Dentists' re-inspection of children who had previously been inspected by the Dentists and found to require dental treatment, and whose parents had not accepted such treatment. Notices were issued to the parents requesting their attendance at the re-inspections. School. Department. Number inspected. No. referred for treatment. No. of acceptances of treatment. Percentage of acceptances. Becontree Junior 117 111 70 63.06 Chadwell „ 47 47 27 57.45 Christchurch „ 45 43 17 37.33 Cleveland „ 51 48 29 56.86 Downshall „ 68 64 37 54.41 Fairlop „ 95 89 38 40.00 Goodmayes „ 65 62 40 64.52 Gordon „ 34 34 22 64.71 Highlands „ 40 32 21 52.50 Newbury Park „ 46 44 26 56.52 SS.Peter & Paul „ 31 29 13 44.83 St. Vincents „ 22 21 12 57.14 South Park „ 65 62 47 75.81 Uphall „ 54 51 23 42.59 Woodlands „ 66 65 29 43.94 Totals 846 802 451 54.11 In addition, the Dentist has carried out four complete inspections of the children's teeth at the Open Air School, 380 children being examined, and 111 referred for treatment, all of whom have received attention by the School Dentists. The Dentist also made 4 visits for inspection at Mossford School, 568 children being examined, 283 being referred for treatment, the treatment, as previously, being left in the hands of the Home Authorities. Full details of the dental work are shown in Table IV, Group V, on page 194. Dental Exhibition.—The Authority accepted an offer from the Dental Board of the United Kingdom for their Dental Exhibit, accompanied by a trained demonstrator, to be shown to the older scholars, and the demonstration of the exhibit was held accordingly 171 in the several schools during the fortnight commencing 13th May, 1935. (h) Treatment of Uncleanliness.—It was found necessary to serve statutory notices under the Education Act, 1921, Section 87, on the parents of 107 children. In 45 instances, the statutory notices not being complied with, the children were brought to the School Clinic by the Nurse and cleansed, an ambulance being used for conveyance. The School Nurses paid 181 visits to the schools (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 Examinations Number Per of Children. Infected. cent. 49,221 *1,142 2.3 * 94 of this number 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:— 1926 3.0 1927 2.9 1928 2.8 1929 2.9 1930 3.3 1931 3.0 1932 2.7 1933 2.7 1934 2.6 1935 2.3 No prosecutions were instituted during 1935 under Section 87 of the Education Act, 1921. (i) Other Ailments.—During the past year 92 children have been operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford. 12 children were treated free and 2 at a reduced rate on necessitous grounds. Under the agreement with the King George Hospital, 30 children were operated on at that Hospital for the removal of enlarged tonsils and adenoids, 8 children being treated free and 2 at a reduced charge, on necessitous grounds. 172 In addition to the treatment of tonsils and adenoids, 59 letters were given to Ilford school children, for whom hospital treatment was required, to attend Queen Mary's Hospital. 9. Open-Air School.—During 1935, 54 children were admitted, 56 ceased attendance, and on the 31st December, 1935, 113 children were on the school roll. Those admitted were recommended for examination from the following sources:— School Medical Officer 32 Director of Education 4 Tuberculosis Officer 2 Rheumatism Clinic 5 Aural Clinic 1 Others 10 The above 54 children were admitted for the following reasons:— School Medical Officer:— Malnutrition, Anaemia and Debility 23 Recurrent Bronchitis 2 Recurrent Asthma 1 Asthma and Pulmonary Fibrosis 1 Pulmonary Fibrosis 1 T.B. Adenitis 1 Right Hemiplegia 1 Non T.B. Arthritis 1 T.B. Ankle Joint Amputation 1 Director of Education:— Debility and Bronchitis 1 Bronchitis and Anaemia 1 Chronic Pulmonary Catarrh and Recurrent Pneumonia 1 Achondroplasia and Bronchial Catarrh 1 Rheumatism Clinic:— Malnutrition and Debility 1 Rheumatic Carditis 3 Anaemia following Rheumatism 1 Aural Clinic:— Nervous Irritability 1 Tuberculosis Officer:— Pulmonary Fibrosis 1 T.B. Hip 1 Others:— Malnutrition and Pulmonary Fibrosis 1 Subnormal Nutrition, Anaemia and Debility 4 Recurrent Bronchitis 4 Cyclical Vomiting 1 173 The 56 children not now on the school roll ceased attendance for the following reasons:— Resumed attendance at ordinary School 30 Left the district 11 Left School—Over age 5 Admission to Residential Open-Air School 1 Admission to Convalescent Homes 3 Unable to benefit owing to mental defect 1 Admission to County High Schools 2 Removed from School at parents' request 3 82 of the children discharged since the opening of the school were re-examined at their ordinary schools during 1935, and 75 were found to have maintained their improvement in health, but in 6 cases the children suffered a relapse; 2 of these were re-admitted to the Open Air School, 1 was placed on the waiting list for readmission to the Open Air School but has not yet been admitted, 1 was placed on the waiting list for re-admission but subsequently reached the age of 14 years and left school, and the remaining 2 are due for further re-examination at an early date. Of the children admitted to the Open Air School since its commencement in 1929, 23 children had never previously attended school (1 admitted in 1929, 2 in 1930, 5 in 1931, 5 in 1932, 3 in 1933, 4 in 1934, and 3 in 1935), and 21 children had not been in attendance at school for long periods (of these, 4 were admitted in 1929, 4 in 1931, 1 in 1932, 2 in 1933, 1 in 1934, and 9 in 1935.) The School Dentist has carried out at the Open Air School four complete inspections of the children's teeth. The following table shows brieflv the dental work carried nut:— Number of children examined by the School Dentist 380 Number of children referred for treatment 111 Number of children treated by School Dentist 111 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 49 Administration of Cod-liver Oil Emulsion 45 Administration of Malt and Oil, Parrish's Food, etc. 6 To see Oculist 11 Treatment for Otorrhoea, Blepharitis, etc., 9 To see Orthopaedic Surgeon re Remedial Exercises, etc. 6 To see Dentist 9 To attend Rheumatism Clinic 2 To attend Aural Clinic 4 174 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 and natural sunshine. 10. Physical Training.—The following is the report of the Supervising Instructor in Physical Training:— I.—Staff. No addition has been made to the staff during the year. II.—Duties and Organisation. The duties of the Supervising Instructor in Physical Training continue to be of an advisory, instructional, and supervisory character as regards the physical training (inclusive of swimming instruction and organised games) throughout all the schools under the jurisdiction of the Authority. As formerly, such duties are inclusive of staff conferences and practical demonstrations, and are governed, as is also the instruction given, by the various relevant Syllabuses issued from time to time by the Board of Education for use in schools. Regular and systematic visits have been made during the year to the schools, the public baths, and the several playing fields. III.—Special Features. (а) In January, classes in physical training for members (men and women) of the teaching staff were commenced at the Beal Modern School under the direction of the Supervising Instructor on three evenings per week, each meeting being of one hour's duration. In March, arrangements were made for the classes to be extended for a further period of six weeks. (b) On 27th February demonstrations were held by the Supervising Instructor at the Beal School from 6 p.m. to 9 p.m., and were based on the Board of Education's Syllabus of Physical Training. Physical exercises were performed by classes of children working under their own teachers and drawn from several of the schools. A very large and appreciative audience was present, consisting of the majority of the Authority's teaching staff. The interest displayed was extremely gratifying. (c) On 1st March the Supervising Instructor attended the Annual Conference of the National Association of Organisers of Physical Education. The Conference met in London; and, in connection with the function, a visit was made to the Chelsea 175 Physical Training College for Women, where demonstrations in modern methods of physical training were given by representative children drawn from the primary schools of England and Wales. (d) During the year increased facilities have been made available by the provision of further playing fields and additional apparatus. (e) The considerable success achieved during the year in connection with the swimming instruction is worthy of special mention, the number of certificates awarded being as follows:— Boys. Girls. Preliminary 608 665 Intermediate 291 319 Proficiency 106 136 Advanced 1 2 Totals 1,006 1,122 The Annual Gala, organised by the Ilford Schools' Swimming Association, was held on the evenings of 10th and 11th October, the function again proving extremely popular and highly successful. The Ilford team were successful in all the Inter-District events in which they competed and South Park Girls' School established a record by winning the Championship Award of the Essex County Swimming Association for the third year in succession. (f) The Cricket, Football, and Netball Associations all experienced a very successful year. The work of the first-named Association continues to be of exceptional merit, as evidence their unbeaten record in Inter-District matches during the past three seasons. (g) During the summer months annual athletic meetings were held by a number of schools, either on the Cricklefield Playing Field or, where existing, on the playing fields attached to the schools concerned. (h) Throughout the year cases of minor postural defect referred by the School Medical Officer received appropriate attention by way of remedial exercises. (i) The Supervising Instructor again expresses his appreciatio of the valuable assistance rendered by the Works Department in connection with the construction and repair of apparatus used for physical training and at various sports meetings. IV.—Review of General Position. The period covered by the present Report has been, in the main, one of steady and consistent progress, and the enthusiastic interest which continues to be displayed in this branch of the work is worthy of comment. 176 11. Provision of Meals.—-The Education (Provision of Meals) Acts, 1906-1914, have not been put into operation in Ilford. 11a.—Malnutrition.—In accordance with the Board of Education's Memorandum No. 124, dated the 31st December, 1934, the nutrition of school children found at Routine Medical Inspection was classified into four categories. (See Table 2b, page 187.) 116. Provision of Milk for School Children.—Circular 1,437, issued by the Board of Education, dated the 5th September, 1934, provides for the supply of milk to children in school at the price of ½d. for one-third of a pint. The Director of Education states that in December, 1935, approximately 9,050 children were receiving milk in school. Of this number, 150 received it free and 8,900 on payment. In a return earlier in the year (on 29th March) the numbers were 140 and 10,892 respectively. 11c. Supply of Free Cod-Liver Oil Emulsion, Cod-Liver Oil and Malt, etc.—During 1935, 173 necessitous cases were dealt with. 12. School Baths.—Vide Annual Report, 1920. 13. Co-operation of Parents.—During 1935, 5,351 parents, or 72 per cent., attended the medical inspections. 14 and 15. Co-operation of Teachers and Attendance Officers.—Vide Annual Report, 1920. 16. Co-operation of Voluntary Bodies.—Since January, 1920, I have acted as Hon. District Correspondent for the National Society for the Prevention of Cruelty to Children. (1) Inspector Cutbush 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, 34, made up as follows:— (1) Of neglect 22 (4 reported from the Public Health Department, for neglecting medical advice, and 30 reported from other sources for general neglect.) (2) Ill-treatment cases 9 (3) Other causes 3 177 78 children (36 boys and 42 girls) were involved, 40 being of school age. In addition to this work, 179 supervision visits were paid to different cases, some of which were made to those reported during the previous year. (2) The Invalid Children's Aid Association established an Ilford Branch on 1st December, 1933, and has done very valuable work in the district. The Secretary, Miss C. H. H. Burns, informs me that— 41 children were sent to residential schools and paid for by the Education Committee. 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 1935, 10 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:— Deaf or Deaf and Dumb Children—Recommended special school for Deaf and Dumb Children 1 Partially Blind Children—Recommended Partially Blind School 1 Crippled Children—Recommended school for Physically Defective Children 5 Delicate Children—Recommended Residential Open-Air School 1 Epileptic Children—Recommended Residential Institution for Epileptic Children 2 10 lst. Totally and Partially Blind Children.—There are 4 children so blind that they can only be appropriately taught in a school or class for totally blind children; all are in a certified residential school for the blind. There is also 1 child included under "Children suffering from Multiple Defects." 178 There are 16 children who, although 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. 10 of these children are in certified residential schools for the blind or partially blind (4 being over 14 years), 6 cases are awaiting admission to certified residential schools for the blind and partially blind (5 are attending ordinary elementary schools, and 1 at a Private School). 2nd. Totally and Partially Deaf and Dumb Children.—There are 12 children so deaf that they can only be appropriately taught in a school or class for the totally deaf, and also one dumb child. All these children were also dumb or partially dumb. 12 are in residential special schools for the deaf, and 1 is awaiting admission to a special school and not at present attending any school. There are 4 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, 2 of these being over 14 years. 3rd. Epileptic Children.—There are 6 children suffering from severe epilepsy, 2 are in certified residential schools for epileptics, 1 attending an ordinary elementary school, 2 at other institutions, and 1 at no school, being over 14 years of age. In addition, there are 5 children included under "Children suffering from Multiple Defects," who are mentally deficient and epileptic. (2 in Certified Special Schools, 1 attending a public elementary school and 2 are not attending any school.) There are 10 children suffering from epilepsy whose disease is of such a kind as not to unfit them for attendance at an ordinary elementary school, 5 are not attending any school, being over 14 years of age. 4th. Tuberculous Children.—There are 3 children notified as suffering from pulmonary tuberculosis; all are active cases, 1 being in a sanatorium and 2 at no school or institution, 1 being over 14 years of age. 31 children are on the Tuberculosis Register suffering from non-pulmonary tuberculosis. 18 are at present attending Public 179 Elementary schools; 11 attending the Open-Air School; 1 is over 14 years of age and not attending any school. There is also 1 child included under "Children suffering from Multiple Defects," who is a cripple and also has abdominal tuberculosis. 5th. Delicate Children.—There are 138 children who are so delicate as to necessitate open-air school treatment. 91 are in the Ilford Open-Air School and 14 in a special school. 6th. Crippled Children.—There were at the end of the year 61 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 no mal mode of life; 13 of these were not attending school (9 being over 14 years of age), 30 were attending public elementary schools, 10 were attending the Benton Open-Air School in Ilford, 7 were attending certified residential cripple schools, 1 a private school. In addition, there were also 5 children included under the heading "Children suffering from Multiple Defects"; 4 were mentally defective (feeble-minded) as well as cripples, and 1 was crippled and also suffering from abdominal tuberculosis. 2 of the 5 latter children were attending ordinary elementary schools, 2 not attending any school, and 1 attending a technical school. 1th. Children suffering from severe heart disease. There are 16 children with severe heart disease; 3 are not attending school (1 being over 14); 5 at certified hospital schools; 3 are at the Ilford Open-Air School, and 5 at public elementary schools. In addition, 1 child is included under the heading "Children suffering from Multiple Defects," also mentally defective and was attending an elementary school. (b) Mentally Defective Children:— During 1935, 17 children were medically examined and reported upon under the Mental Deficiency (Notification of Children) Regulations, 1928, classified as follows:— Feeble-minded Children.—Total number certified in 1935 and recommended for admission to a special school (day or residential) 17 180 Imbecile Children.—Total number certified in 1935 and recommended for notification to Essex County Council 2 Idiots.—Total number certified in 1935, and recommended for notification to Essex County Council 2 Dull and Backward Children.—Total number certified in 1935 and recommended attendance at special class for dull and backward children for one year, and then to be re-examined 15 The following table shows the mental age (by the Binet Simon tests) and the intelligence quotient of the feeble-minded children examined during 1935. The border-line of mental deficiency is where the intelligence quotient is about 75. Actual age in years. Mental age in years. Intelligence Quotient. 5.1 3.0 58.8 5.3 3.0 56.3 5.4 2.8 51.8 5.5 2.7 50.0 7.5 4.4 58.6 7.8 5.6 70.6 8.1 3.8 48.2 9.0 6.6 73.0 9.25 4.4 47.5 10.2 6.2 60.8 10.35 7.0 67.7 12.0 8.2 68.3 12.17 6.9 58.3 12.66 9.0 71.0 13.3 9.2 69.6 13.4 9.3 69.4 13.9 9.2 66.2 (1) Idiots.-—Idiots are, within the meaning of the Mental Deficiency Act, 1913, persons so defective in mind from an early age as to be unable to guard themselves against common physical dangers. The Authority responsible for dealing with such children is the Essex County Council. There are 15 cases under the age of 16 years known to the department. 5 are in a residential institution and 10 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 20 cases under the age of 16 years known to the department. 1 is in a residential institution and 19 are at home. 181 (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 1935) 81 such cases under the age of 16 years known to me, of whom 40 are attending public elementary schools in the district (3 being in Dr. Barnardo's Girls' Village Homes, Barkingside); 7 attend private schools; 17 are in residential schools, and 17 are not at school (11 being over 14 years of age). All mentally defective children are visited at home by the School Nurses at least once a quarter. 18, 19, 20. Nursery Schools, Secondary and Continuation Schools.—Vide Annual Report, 1920. 21. Employment of School Children and Young Persons. —From special inquiries made at the various schools during 1935, it was found that 170 children were employed out of school hours. 140 children were submitted for medical examination in accordance with the Byelaws made under Part II of the Children and Young Persons Act, 1933, with the following result:— Medically fit 136 The following are the Byelaws which came into force on 1st February, 1935. I.-—As to Interpretation of Terms. Throughout these byelaws the following words and expressions have the meanings hereinafter respectively assigned to them, namely (a) the expression child means a person under the age of 14 years, provided that a person who is attending a public elementary school and who attains the age of 14 years during a school term shall not be deemed to cease to be a child until the end of that term ; (b) a person who assists in a trade or occupation carried on for profit shall be deemed to be employed notwithstanding that he receives no reward for his labour; (c) the expression Local Education Authority means the Local Education Authority for the purposes of Section 3 (1) of the Education Act, 1921. II.-—As to Employment of Children generally. 1. A child under the age of 13 years shall not be employed. 182 2. A child of the age of 13 years or over shall only be employed— (а) on any school day between the hours of 5 p. m. and 7 p. m.; (b) on any week-day when school is not open during any one period of 3 consecutive hours between 9 a.m. and 7 p.m. 3. A child taking part in any entertainment in pursuance of a licence under Part II of the Children and Young Persons Act, 1933, shall not be employed on the day or days of, or the day following, such employment, in any other employment. 4. For the purposes of these byelaws Sunday is prescribed as a whole holiday, and no child shall be employed on that day. III.—As to Prohibited Employments. 5. A child shall not be employed in any of the following occupations: (a) as a lather boy, or in a similar occupation, in a barber's or hairdresser's shop; (b) in the kitchen of any hotel, cookshop, fried fish shop, eating-house, or refreshment room; (c) as a marker or attendant in any billiard or bagatelle saloon, or other place licensed or used for games, or in any registered club; (d) in or in connection with the sale or delivery of intoxicating liquors; (e) in selling programmes or refreshments or other articles, or in selling or taking checks or tickets, or in shifting scenery in any theatre, music hall, picture theatre, or other place of public entertainment; (f) in the collection or sorting of rags or refuse; (g) as an attendant or assistant in any premises or fair-ground used for the purpose of public amusement by means of automatic machines, mutoscopes, shooting ranges, games of chance or skill, or similar devices; (h) in any slaughterhouse; (i) in or in connection with any racing course or track, or other place where any like sport is carried on, or as an assistant in any business conducted therein. N.B. — By Section 18 (1) (/) of the Children and Young Persons Act, 1933, no child may be employed to lift, carry or move anything so heavy as to be likely to cause injury to him. IV.—As to Conditions of Employment. 6. A child of the age of 13 years or over shall not be employed, except under the following conditions: (a) The employer shall keep available for inspection by any officer of the Local Education Authority a written record showing the name and address and date of birth of the child, and the occupation in which, and the place at which, and the hours between which, each child is employed on school days and on week-days 183 when school is not open. Such written record must be displayed in a conspicuous position in the place at which the child is employed. (b) The employer shall send a written notification to the Local Education Authority stating his own name and address and the name, address, and date of birth of the child, the occupation in which, and the place at which, and the hours between which, the child is employed. Such notice shall be sent within 7 days of the date upon which these byelaws come into operation, or, in the case of a child not so employed until after that date, within 24 hours after the employment begins. The employer shall send to the Local Education Authority thereafter on the first day of January and the first day of July in every year a list showing the same particulars in respect of each child then employed by him. (c) The Local Education Authority shall issue to each child, in respect of whom such notice is given, a card called in these byelaws an employment card, and, after such card is issued, a child shall not be employed at any time unless he has such card with him. He shall produce the card for inspection if and when required to do so by any authorised officer of the Local Education Authority. (d) The Local Education Authority shall cause to be entered on the employment card the name and address and date of birth of the child, the occupation in which, and the times between which, the employment of such child is permitted. The times so entered shall be such as the employer may choose, provided they are such as are allowed by these byelaws. The times may be altered by the Local Education Authority from time to time on the application of the employer. (e) The child to whom an employment card has been issued shall not be employed except within the times entered by the Local Education Authority on the card. (f) The child shall obtain from the School Medical Officer within 30 days of the date upon which these byelaws come into operation, or in the case of a child not employed until after that date, within 14 days from the date when employment begins, a certificate that his employment will not be prejudicial to his health or physical development, and will not render him unfit to obtain the proper benefit from his education, and shall produce such certificate to his employer for endorsement. No charge shall be made for such certificate. 7. Every person employing a child in any work out of doors shall see that such child is provided during the course of such employment with efficient waterproof footwear and a sufficient waterproof garment to protect the child from risk of injury to health from inclement weather. V.—As to Repeal of Byelaws. 8. From and after the date of the confirmation of these byelaws, the byelaws which were made by the Council of the Urban District of Ilford under the provisions of the Employment of Children Act, 1903, on the 26th day of October, 1920, and were confirmed by one of His Majesty's Principal Secretaries of State on the 27th day of April, 1921, shall be repealed. 184 Penalties. Section 21 of the Children and Young Persons Act, 1933, provides as follows: If a person is employed in contravention of any of the foregoing provisions of this Part of this Act, or of the provisions of any byelaw made thereunder, the employer and any person (other than the person employed) to whose act or default the contravention is attributable shall be liable on summary conviction to a fine not exceeding £5 or, in the case of a second or subsequent oifence, not exceeding £20. 22. Miscellaneous.—In accordance with the Education Committee's regulations, the undermentioned student-teachers and teachers were medically examined and reported upon during the year by the School Medical Officer Newly-appointed teachers 60 Teachers absent through illness 29 School attendance officers 2 Total 91 185 Table I.— Return of Medical Inspections. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 2,489 Second Age Group 3,046 Third Age Group 1,948 Total 7,483 Number of other Routine Inspections Nil b.—Other Inspections. Number of Special Inspections 3,096 Number of Re-Inspections 12 963 Total 16,059 C.—Children found to Require Treatment. Number of individual children found at Routine Medical Inspection to require treatment (excluding Uncleanliness and Dental Diseases):— Entrants 525 Second Age Group 620 Third Age Group 413 Total 1,558 Other Routine Inspections — Grand Total 1,558 186 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1935. Defect or Disease. Routine Inspections. Special Inspections No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation , but not requiringTreatment. (1) (2) (3) (4) (5) Skin Ringworm: (1) Scalp — — 1 - (2) Body — — 8 - (3) Scabies 4 — 23 - (4) Impetigo 3 — 179 - (5) Other Diseases (Non-Tuberculous) 51 44 679 1 Total (Heads 1 to 5) 58 44 890 1 Eye (6) Blepharitis 12 19 18 - (7) Conjunctivitis 3 2 83 - (8) Keratitis — 1 2 - (9) Corneal Opacities — — 1 - (10) Other Conditions (excluding Defective Vision and Squint) 23 25 133 1 Total (Heads 6 to 10) 38 47 237 1 (11) Defective Vision 400 267 192 6 (12) Squint 27 11 8 1 Ear (13) Defective Hearing 14 15 26 1 (14) Otitis Media 14 8 61 2 (15) Other Ear Diseases 15 18 62 1 Nose and Throat (16) Chronic Tonsillitis only 27 292 31 5 (17) Adenoids only 1 18 12 — (18) Chronic Tonsillitis and Adenoids 30 60 92 - (19) Other Conditions 49 38 332 1 (20) Enlarged Cervical Glands (Non-Tuberculous) 11 89 65 1 (21) Defective Speech 5 37 9 - Heart and Circulation Heart Disease:— (22) Organic 19 24 - - (23) Functional 7 42 2 - (24) Anaemia 32 24 47 - Lungs (25) Bronchitis 104 56 123 1 (26) Other Non - Tuberculous Diseases 3 4 2 — Tuberculosis Pulmonary:— (27) Definite 1 — — — (28) Suspected — — — — N on-Pulmonary:— (29) Glands — 1 — - (30) Bones and Joints — — — - (31) Skin — — — — (32) Other Forms — 3 — — Total (Heads 29 to 32) — 4 — — Nervous System (33) Epilepsy — 2 4 - (34) Chorea 2 11 17 - (36) Other Conditions 14 74 76 - Deformities (36) Rickets 2 4 - - (37) Spinal Curvature 15 1 3 - (38) Other Forms 293 75 66 3 (39) Other defects and diseases (excluding Uncleanliness and Dental Diseases) 533 413 874 10 Total 1,714 1,677 3,231 34 187 Table II.—Continued. B.—Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age Groups. No. of Children Inspected A. (Excellent) B. (Normal) C. (Slightly Subnormal) D. (Bad) No. % No. % No. % No. % Entrants 2,489 478 19.2 1,832 73.6 174 7.0 5 0.2 Second Age-Group 3,046 639 21.0 2,237 73.4 161 5.3 9 0.3 Third Age-Group 1,948 467 24.0 1,407 71.9 69 3.8 5 0.3 Other Routine Inspections - - - - - - - - - Total 7,483 1,584 21.2 5,476 73.2 404 5.4 19 0.2 Table III. Return of Exceptional Children in the Area on 31st December, 1935. Children Suffering From Multiple Defects. Any combination of the following types of defect:— Blindness (not partial Blindness), Deafness (not partial Deafness), Mental Defect (Feeble minded), Severe Epilepsy. Active Tuberculosis. Crippling (as defined in Table III.—Crippled Children.) Heart Disease. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. Feeble Minded and Cripple - 2 - 2 4 ,, ,, Epileptic 2 1 — 2 5 ,, ,, Blind — — 1 — 1 ,, ,, Deaf Mute 1 — — — 1 ,, ,, Severe Heart - 1 — — 1 Abdominal Tuberculosis & Cripple — - 1 — 1 188 Table III.—Continued. Blind Children. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 4 - — — 4 Partially Blind Children. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. *9 †1 5 †1 — 16 * Three over 14 years of age. †One over 14 years of age. Deaf Children. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. *12 — — 1 13 * Three over 14 years of age. 189 Table III.—Continued. Partially Deaf Children. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — *4 — — 4 * Two over 14 years of age and two at Girls' Village Home. Mentally Defective Children. (Feeble-Minded Children.) At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. *17 †40 ‡7 §17 81 * Six over 14 years of age. ‡ Two over 14 years of age. † Eight over 14 years of age and three at Girls' Village Home. § Eleven over 14 years of age. Epileptic Children. (Children suffering from Severe Epilepsy.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total *2 1 2 *1 6 * One over 14 years of age. 190 Physically Defective Children. A.—Tuberculous Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions At no School or Institution. Total. (i) Children suffering from Pulmonary Tuberculosis. (Including pleura and intrathoracic glands.) 1║ — — †2 3 (ii) Children suffering from non-Pulmonary Tuberculosis (This includes all sites other than those shown in (i) above.) 11 18† — 1 30 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 105* 29‡ 3 1 138 Crippled 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 17† 30§ 1 13** 61 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 8† 5 — 3 16 † One over 14 years of age. ‡ One at Girls' Village Home. * Four over 14 years of age. Over 14 years of age from Girls' Village Home. ** Nine over 14 years of age. § One over 14 years of age and 5 at Girls' Village Home. 191 Table IIIa. (Form 307 M.) Statement of the Number of Children Notified During the Year Ended 31st December, 1935, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children Notified 7 Analysis of the Above Total. Diagnosis. Boys. Girls. (1) i. Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots 1 (b) Imbeciles 1 1 (c) Others 2 - ii. Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives — (b) Others - - (2) Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 2 — (3) Feeble-minded children notified under Article 3, i.e., "Special Circumstances" cases - - Note. No child should be notified under Article 3 until the Board have issued a formal certificate (Form 308m) to the Authority. (4) Children who in addition to being mentally defective, were blind or deaf - - Note. No blind or deaf child should be notified without reference to the Board—see Article 2, proviso (ii). Grand Total 6 1 192 Tablb IV.—Return of Defects Treated during the Year ended 3Lst December, 1935. TREATMENT TABLE. Group I,—Minor Ailments (excluding Uncleanliness, for which see Group VI). 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 (i) X-Ray Treatment 1 — 1 (ii) Other — — — Ringworm—Body 8 — 8 Scabies 21 6 27 Impetigo 178 4 182 Other skin disease 670 79 749 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 121 31 152 Minor Ear Defects 60 40 100 Miscellaneous (e.g., minor injuries, bruises, sores, blains, etc.) 856 368 1,224 Total 1,915 528 2,443 193 Table IV.—Continued. Group II—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. (1) No. of Defects dealt with Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) 1,202 109 1,311 Other Defect or Disease of the Eyes (excluding those recorded in Group I) — 17 17 Total 1,202 126 1,328 No. of Children for whom spectacles were:— (a) Prescribed 914 102 1,016 (b) Obtained 891 109 1,000 Group III—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total Number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 20 221 1 3 118 16 16 1 45 1 17 4 163 17 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and adenoids. (iv) Other defects of the nose and throat. 194 Table IV.—Continued. Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. (1) Otherwise, (2) Total number treated. Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) No. of children treated. 18 — 448 2 2 13 483 Group V.—Dental Inspection and Treatment. (1) Number of Children inspected by the Dentists:— (a) Routine Age Groups— Age. 5 6 7 8 9 10 11 12 13 14 Total. Number 1,190 1,603 1,763 1,922 1,667 1,664 1,685 19 — — 11,513 (b) Specials 1,260 (c) Total (Routine and Specials) 12,773 (2) Number found to require treatment 7,541 (3) Number actually treated 4,768 (4) Attendances made by children for treatment 10,595 (5) Half-days devoted to Inspection 149 Treatment 869 Total1,018 (6) Fillings Permanent Teeth 4,567 Temporary Teeth 3,329 Total 7,896 (7) Extractions Permanent Teeth 1,129 Temporary Teeth 7,193 Total 8,322 (8) (a) Administrations of general anaesthetics for extractions 1,646 (b) Administrations of local anaesthetics for extractions 2,346 Total 3,992 (9) Other operations Permanent Teeths 3,872 Temporary Teeth 681 Total 4,553 Group VI.—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 49,221 (iii) Number of individual children found unclean *1,142 (iv) Number of children cleansed under the arrangements made by the Local Education Authority 45 (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 175 children were found unclean at medical inspection and 109 in the School Clinic. 196 197 Table V.—Table showing number of Children Medically Inspected at various Schools during 1935. 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. — — — — — — 1 4 2 1 — — — — 3 5 Barkingside — — — — — — — — — — 8 17 69 63 — — 1 2 1 — — — 79 83 Beal Modern — — — — — — — — 9 14 18 18 14 19 64 80 18 14 1 — — — 297 319 Becontree 62 60 15 10 8 10 88 94 3 1 7 2 2 — 29 20 6 3 — — — — 146 121 Chadwell 52 41 9 5 3 7 35 42 5 6 3 3 2 5 38 40 3 7 1 1 — — 205 199 Christchuroh 66 57 13 18 5 4 69 58 14 16 8 22 3 1 — — — — — — — — 234 267 Cleveland 39 45 13 18 6 10 151 165 14 17 11 14 15 14 69 86 7 8 4 — — — 359 368 Downshall 76 86 13 19 15 11 135 113 11 12 10 14 11 12 58 44 5 11 — 2 — — 290 259 Fairlop 95 78 22 19 17 8 61 59 23 10 8 14 10 21 67 43 5 4 — 2 — — 313 281 Gearies 86 73 28 23 13 14 73 87 13 9 10 12 3 1 1 — — — — — — — 168 146 Goodmayes 55 41 8 10 11 4 67 69 — — — — — — — — — — — — — — 55 58 Gordon 34 43 9 7 3 3 9 5 13 8 6 6 7 1 42 35 5 3 1 1 — — 215 192 Highlands 53 67 15 12 8 3 65 56 — — 2 — 10 — 183 — 14 — 1 — — — 210 — Loxford Central — — — — — — — — — — — — — — — — — — — — — — — — Mavfield Central — — — — — — — — — — — — 6 2 87 108 18 9 1 2 — — 112 121 Mossford 20 23 2 14 — 13 4 49 — 11 1 19 — 13 — 89 — 43 — 14 — — 27 288 Mount Central — — — — — — — — — — — — — 8 — 194 — 20 — — — — — 222 Newbury Park 42 32 8 8 5 1 39 28 — 3 3 — 1 3 26 25 3 5 — — — — 127 105 Open Air 2 — 4 7 11 12 13 13 17 8 17 10 6 9 7 9 4 3 2 — — 2 83 73 S.S. Peter and Paul 21 27 7 10 8 5 24 27 12 8 — 4 5 3 37 10 6 2 — 1 — — 120 97 South Park 62 62 12 23 9 7 117 102 15 15 9 15 17 17 50 73 12 5 1 4 — — 304 323 St. Vincent's 20 14 1 6 4 2 21 33 1 5 — — 1 1 14 24 — — — — — — 62 85 Uphall 20 27 6 5 4 3 13 18 — — — — — — — — — — — — — — 43 53 Valentines 29 33 11 11 9 4 22 27 4 6 — 8 — — — — — — — — — — 75 89 Woodlands 63 59 11 17 15 10 14 14 — — — — — — — — — — — — — — 103 100 Total 897 868 207 232 154 131 1020 1059 154 149 121 168 182 193 773 884 109 140 13 27 — 2 3630 3853 Specials. Barkingside — — — — — — — — — — — — — — — — — — — — — — — — Beal Modern — — — — — — — — — — — — — — — — — — — — — — — — Becontree — — 2 1 2 2 3 2 1 3 1 8 — 5 — — 1 3 1 1 — 1 11 25 Chadwell — 1 — 1 1 1 — 1 — — — 1 — 2 — — — 1 — — — — 1 8 Christchuroh — — — — — — — — — — — — — — 1 — — — — — — — 1 — Cleveland — — — — 2 — — — — — — — — — — — — — — — — — 2 — Downshall — 1 — — — — — — — — — — — 1 — — — — — — — — — 3 Fairlop 2 — 2 — 2 1 — 1 — — 1 — 1 — — — 1 — — — — — 9 2 Gearies 1 — — 1 2 — — — 1 — — — — — — — — — — — — — 4 1 Goodmayes — — — — — — — 2 — — — — — — — — — — — — — — 3 2 Gordon 1 — 4 2 1 — — — — — — — — — — — — — — — — — 6 2 Highlands — — 1 — — — 1 1 — 1 — — — — 1 — — 1 — — — — 3 3 Loxford Central — — — — — — — — — — — — — — — — — — — — — — — — May field Central — — — — — — — — — — — — — — — 1 — — — — — — — 1 Mossford — — — — — — — — — — — — — — — — — — — — — — — — Mount Central — — — — — — — — — — — — — — — 2 — — — — — — — 2 Newbury Park — — — 1 — — — — — — — — — — — — — — 1 1 — — 1 2 Open Air 1 — 1 3 3 3 4 2 3 — 4 3 4 8 2 1 — 3 — — — — 22 24 S.S. Peter and Paul — 1 — — 2 — — 1 — — — — — 1 — — — — — — — — 2 3 South Park 1 — 2 — — — — 1 — 2 — 2 — 6 1 3 1 — 1 — — — 6 14 St. Vincent's — — 1 — — 2 — 1 — 1 4 1 1 — — — — 1 — — — — 6 6 Uphall — — — — — — — — — — — — — — — — — — — — — — — — Valentines — — — — — — — — — — — — — — — — — — — — — — 2 1 Woodlands 3 1 — — — — — — — — — — — — — — — — — — — — 3 4 Total 9 4 14 11 16 10 8 12 5 7 11 17 8 23 5 7 3 9 3 2 — 1 82 103 196 199 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 Centimetres). Average Weight (in Kilogrammes). Number of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). Number of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes) Number of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). Number of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes) Number of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes) Number of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). Number of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). Number of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). Barkingside — — — — — — — — — — — — — — — — — — — — — 1 157 45.0 2 150 40.1 Beal Modern — — — — — — — — — — — — — — — 8 139 32.1 69 141 33.3 — — — 1 151 38.2 Becontree 62 109 18.5 15 116 20.7 8 117 21.5 88 1125 24.5 9 130 26.5 18 131 27.6 14 140 32.4 64 143 34.8 18 144 37.6 Chadwell 52 107 18.6 9 116 21.1 3 118 23.1 35 126 26.1 3 133 28.6 7 137 31.7 2 142 35.1 29 146 37.3 6 149 40.2 Christchurch 66 110 18.7 13 113 20.9 5 120 22.1 69 125 24.3 5 132 28.1 3 135 31.5 2 142 34.0 38 145 36.8 3 148 37.9 Cleveland 39 111 19.1 13 113 20.0 6 128 27.4 151 125 23.9 14 134 30.8 8 132 26.9 3 133 27.0 — — — — — — Downshall 76 109 18.9 13 118 22.4 15 120 22.6 135 123 24.7 14 130 26.7 11 137 31.0 15 141 36.9 69 147 37.2 7 158 45.1 Fairlop 95 111 19.4 22 115 20.6 17 123 24.1 61 127 25.9 11 131 27.3 10 132 28.4 11 141 34.8 58 143 35.1 5 146 38.3 Gearies 86 111 19.7 28 117 20.8 13 123 23.8 73 128 26.3 23 133 29.1 8 137 33.7 10 141 32.1 67 146 39.3 5 154 45.3 Goodmayes 55 109 18.9 8 112 19.5 11 119 22.6 67 127 25.6 13 133 29.4 10 139 33.9 3 141 31.8 1 140 29.5 — — — Gordon 34 111 18.8 9 111 19.1 3 117 20.9 9 126 23.8 — — — — — — — — — — — — — — — Highlands 53 112 19.7 15 116 21.6 8 123 24.0 65 127 26.7 13 131 27.8 6 137 33.0 7 144 35.5 42 145 37.8 5 149 37.6 Loxford Central — — — — — — — — — — — — — — — 2 142 33.9 10 140 32.9 183 145 37.5 14 150 39.2 Mayfield Central — — — — — — — — — — — — — — — — — 6 143 35.0 87 145 37.2 18 149 39.6 Mossford 20 104 18.1 2 98 15.8 — — — 4 121 23.1 — — — 1 122 25.2 — — — — — — — — — Mount Central — — — — — — — — — — — — — — — — — — — — — — — — — — — Newbury Park 42 117 19.8 8 114 20.0 5 116 20.5 39 127 26.5 — — — 3 140 31.5 1 130 29.7 26 146 36.4 3 147 39.7 Open Air 2 107 16.5 4 116 21.1 11 123 23.0 13 124 25.9 17 133 28.5 17 136 29.3 6 140 34.7 7 147 36.4 4 151 41.6 S.S. Peter & Paul 21 110 18.5 7 114 19.6 8 122 23.5 24 126 25.0 12 134 90.9 — — — 5 139 32.7 37 147 39.0 6 145 37.7 South Park 62 111 19.6 12 116 21.5 9 120 23.2 117 128 26.1 15 131 27.7 9 136 30.1 17 140 33.6 50 149 39.6 12 150 40.9 St. Vincent's 201 108 19.8 1 113 21.0 4 118 21.8 21 124 25.4 1 122 23.7 — — — 1 137 35.6 14 140 35.0 — — — Uphall 20 109 18.5 6 112 20.2 4 118 22.0 13 125 24.1 — — — — — — — — — — — — — — — Valentines 29 112 20.3 11 116 21.6 9 124 24.4 22 126 27.4 4 131 28.4 — — — — — — — — — — — — Woodlands 63 111 19.6 11 118 21.7 15 119 22.2 14 129 26.1 — — — — — — — — — — — — — — — Average Heights and Weights of Iljord Children 897 111 19.2 207 115 20.8 154 121 23.1 1020 126 25.3 154 132 28.5 121 135 30.3 182 141 33.6 773 145 37.5 109 149 39.7 Anthropometric Standard (Boys) Ages. Ages. 5 Years. 6 Years. 7 Years. 8 Years. 9 Years. 10 Years. 11 Years. 12 Years. 13 Years. Height (In Cms.) Weight (In Klgms.) Height (In Cms.) Weight (In Klgms.) Height (In Cms.) Weight (In Klgms.) Height (In Cms.) Weight (In Klgms.) Height (In Cms.) Weight (In Klgms.) Height (In Cms.) Weight (In Klgms.) Height (In Cms.) Weight (In Klgms.) Height (In Cms.) Weight (In Klgms.) Height (In Cms.) Weight (In Klgms.) 103 16.6 108 19.1 114 21.0 120 23.5 124 25.3 129 27.3 134 30.1 139 32.9 142 34.6 200 201 Table VI. B. Table showing the Average Heights and Weights of the GIRLS Examined. School. Age Groups. Age Groups. 5—6 Years. 6—7 Years 7—8 Years. 8—9 Years. 9—10 Years. 10—11 Years. 11—12 Years. 12—13 Years. 13—14 Years. No. of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). No. of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). No. of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). No. of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). No. of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). No. of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). No. of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). No. of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). No. of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). Barkingside — — — — — — — — — — — — — — — — — — — — — 4 145 35.4 1 167 45.2 Beal Modern — — — — — — — — — — — — — — — 17 140 31.6 63 144 34.3 — — — 2 154 50.8 Becontree 60 107 17.9 10 113 19.7 10 118 21.6 94 124 24.3 14 128 27.4 18 132 29.4 19 141 33.6 80 145 36.5 14 153 42.1 Chadwell 41 108 17.8 5 115 20.6 7 121 22.3 42 125 24.9 1 122 23.6 2 137 27.3 — — — 20 147 36.9 3 150 42.4 Christchurch 57 109 18.4 18 113 20.0 4 118 21.4 58 126 25.4 6 131 25.4 3 140 31.2 5 140 36.5 40 148 39.3 7 156 44.5 Cleveland 45 119 17.9 8 117 20.2 10 130 23.5 165 123 25.4 16 133 30.1 22 133 29.2 1 121 23.4 — — — — — — Downshall 86 111 18.8 19 115 20.2 11 119 22.1 113 126 25.0 17 132 27.6 14 135 30.0 14 140 33.9 86 147 38.3 8 152 42.2 Fairlop 78 108 18.1 19 116 20.9 8 124 24.5 59 126 24.9 12 139 29.1 14 137 30.4 12 140 32.5 44 146 35.1 11 152 40.2 Gearies 73 111 19.6 23 117 21.2 14 122 23.7 87 127 25.5 10 130 26.9 4 133 28.4 21 123 23.9 43 150 40.1 4 152 41.9 Goodmayes 41 107 18.0 10 114 20.1 4 122 22.0 69 126 27.1 9 130 26.7 12 135 39.0 1 132 23.6 — — — — — — Gordon 43 108 18.4 7 116 21.0 3 118 20.1 5 126 24.3 — — — — — — — — — — — — — — — Highlands 67 110 18.6 12 115 20.3 3 117 19.7 56 128 27.1 8 126 27.5 6 136 30.0 1 141 31.4 35 148 37.5 3 160 48.8 Loxford Central — — — — — — — — — — — — — — — — — — — — — — — — — — — Mayfield Central — — — — — — — — — — — — — — — — — — 2 150 38.4 108 148 38.2 9 149 41.5 Mossford 23 105 18.1 14 112 19.8 13 118 23.0 49 122 24.0 11 127 27.4 19 132 29.8 13 136 31.4 89 143 38.0 43 150 44.7 Mount Central — — — — — — — — — — — — — — — — — — 8 138 34.4 194 146 37.2 20 150 41.8 Newbury Park 32 110 18.7 8 116 20.4 1 116 19.2 28 126 24.4 3 130 25.9 — — — 3 148 40.9 25 149 40.1 5 154 45.4 Open Air — — — 7 110 19.8 12 117 20.2 13 124 22.7 8 130 24.8 10 138 31.1 9 139 32.6 9 144 33.2 3 157 46.2 S.s.Peter & Paul 27 112 20.0 10 112 19.9 5 122 22.6 27 121 24.1 8 131 27.6 4 129 28.2 3 146 32.9 10 147 36.6 2 153 46.9 South Park 62 110 19.0 23 115 20.3 7 118 21.5 102 128 25.6 15 131 28.1 15 135 31.5 17 142 35.1 73 149 39.2 5 155 45.5 S. Vincents 14 108 19.0 6 113 19.9 2 113 21.3 33 125 25.2 5 128 26.3 — — — 1 133 26.7 24 145 36.9 — — — Uphall 27 110 18.5 5 113 18.7 3 118 23.7 18 126 24.2 — — — — — — — — — — — — — — — Valentines 33 110 19.2 11 115 21.6 4 118 22.4 27 126 25.1 6 129 27.4 8 137 29.0 — — — — — — — — — Woodlands 59 110 18.7 17 113 19.5 10 119 21.0 14 125 24.6 — — — — — — — — — — — — — — — Average Heights and Weights of Ilford Children 868 110 18.6 232 115 20.3 131 120 22.2 1059 125 25.0 149 130 27.5 168 135 30.1 193 139 32.8 884 146 37.8 140 152 43.6 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 Cms.) 1Weight (In Kgms.) Height (In Cms.) Weight (In Kgms.) Height (In Cms.) Weight (In Kgms.) Height (In Cms.) Weight (In Kgms.) Height (In Cms.) Weight (In Kgms). Height (In Cms.) Weight (In Kgms.) Height (In Cms.) Weight (In Kgms.) Height (In Cms.) Weight (In Kgms.) Height (In Cms.) Weight (In Kgms.) 102 17.1 108 18.7 113 20.3 119 22.4 123 24.5 128 26.6 134 29.7 140 33.5 144 36.4 202 Table VII.—Summary ok Cases of Infectious Diseases among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1935. SCHOOLS. Number on Roll. DISEASES AND CONTACTS. Scarlet Fever. Diphtheria . Measles & German Measles. Chickenpox. Whooping Cough. Mumps. Smallpox. Ringworm. Totals. 1935. Totals. 1934. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Cases. Contacts Cases. Contacts †Barkingside — — — — — — 1 1 4 — — — — — — — — 5 5 4 Beal Modern 638 1 8 2 2 — — 2 2 1 — — — — — — 6 12 13 23 Becontree 1768 29 37 6 19 2 3 23 19 69 13 8 — — — — 137 91 171 138 Chadwell 744 8 13 16 13 5 1 11 3 37 3 14 — — — — 91 33 88 22 Christchurch 1043 6 2 3 8 11 5 28 7 27 5 13 — — — — 88 27 208 83 Cleveland 1276 6 9 17 13 41 17 19 3 37 5 71 — — — — 191 47 137 69 Downshall 2017 21 30 9 16 95 10 57 18 50 6 9 — — — — 241 80 372 69 Fairlop 1413 20 23 3 9 93 16 26 12 12 6 26 — — — — 181 66 191 54 Gearies 1547 12 7 5 5 64 1 15 2 7 1 43 — — — — 146 16 215 39 Goodmayes 746 10 5 1 6 1 — 5 2 23 2 3 — — — 43 15 167 68 Gordon 230 2 2 — 2 64 6 12 4 16 2 — — — — — 99 16 74 10 Highlands 1012 9 10 8 11 6 3 12 3 19 2 257 — — — — 304 29 160 56 Loxford Central 553 2 1 — 5 — 4 2 2 1 — 3 — — — — 8 12 10 27 Mayfield Central 689 6 7 3 2 — — 3 1 — — — — — — — 12 10 5 11 Newbury Park 776 6 6 — 6 33 7 21 5 31 8 9 — — — — 100 32 107 23 Open Air 115 1 3 — — — — 1 — 3 — — — — — — 5 3 3 5 SS. Peter and Paul's 553 5 4 1 3 4 — 57 26 6 — 5 — — — — 78 33 113 43 St. Vincent's 383 — — 1 5 — — 3 2 4 1 1 — — — — 9 8 20 24 South Park 1318 20 13 2 7 1 — 4 2 22 3 5 — — — — 54 25 103 40 The Mount Central 513 2 5 1 3 2 — 2 2 1 — 18 — — — — 26 10 18 29 Uphall 212 3 1 5 4 1 1 1 — 24 4 40 — — — — 74 10 50 12 Valentines 420 3 — 2 3 3 — 38 4 58 9 6 — — — — 110 16 88 16 Woodlands 308 2 2 2 5 19 3 12 3 6 1 4 — — — — 45 14 262 40 *Mossford (G.V.H.) 646 22 — 11 — — — — — — — — — — — — 33 — 23 - *County High — 5 3 3 6 — — — — — — — — — — — 8 9 4 21 *Private — 8 4 5 8 — — — — — — — — — — — 13 12 28 20 Totals 18920 209 195 106 161 445 78 355 126 447 71 540 — — — 1 2103 631 ||2663 ¶961 Para-typhoid fever: 1 case at Christchurch School, 1 case at Downshall School. ||Includes 28 at Mayeebrook. Typhoid fever:1 case at Goodmayes School. ¶ „ 15 „ „ *Notification of minor infectious diseases in these sohools are not reoeived. †Closed as from 25th August—number on roll—56. 203 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, 1935. SCHOOLS. No. on Roll. Jan. Feb. Mar. April. May. June. July August. Sept. Oct. Nov. Dec. Totals, 1935. Totals, 1934. 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 — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 Beal Modern 638 — 3 — 2 — — — — — — — — — — — — — — 1 1 — 2 — — 1 8 7 7 Becontree 1768 3 5 7 3 5 6 2 4 — — 1 1 1 1 — 2 — 3 3 3 4 7 2 2 29 37 19 38 Chadwell 744 1 1 — — — 1 — 1 1 — 1 1 — — 2 — — 3 1 5 1 1 1 — 8 13 10 2 Christchureh 1043 1 2 1 — — — — — — — — — 1 — — — — — 1 — — — 2 — 6 2 24 21 Cleveland 1276 3 3 — — — — — — — 1 — 2 — — 2 — — 1 — 1 — — 1 1 6 9 15 24 Downshall 2017 — 1 — 1 1 4 1 4 5 9 1 — — 2 1 — i — 2 4 2 1 7 4 21 30 30 15 Fairlop 1413 — — — — — — 1 1 — — 1 2 3 — — 1 2 2 3 3 3 5 7 9 20 23 4 3 Gearies 1547 — — 2 — 2 1 1 1 — — — 1 — — 1 1 1 — — — 1 — 4 3 12 7 18 12 Goodmaves 746 1 — — — 3 1 — — — — — — — — — — 5 4 1 — — — — — 10 5 12 12 Gordon 230 — — — — 1 — 1 — — — — — — — — 1 — — — — — — — 1 2 2 5 1 Highlands 1012 — — 1 — 2 1 3 1 2 1 — — — 2 — — — 2 1 — — 1 — 2 9 10 37 28 Loxford Central 553 — — — — — — — 1 — — — — 1 — — — — — — — — — — — 2 1 2 7 Mayfield Central 689 — 1 1 — — — — 1 1 1 — — — — — — 2 2 — — 1 1 1 1 6 7 — 1 Newbury Park 776 — — 1 2 — — 1 3 — — — — — — — — 1 — 1 — 1 1 1 — 6 6 14 13 Open Air 115 — — — 1 1 — — 1 — — — — — — — — — — — — — — — 1 1 3 — — SS. Peter and Pauls 553 — 1 — — — — 1 1 — — — — 2 — 1 1 — — — — 1 1 — — 5 4 2 10 S.Vincent's 383 — — — — — — — — — — — — — — — — — — — — — — — — — 7 17 South Park 1318 1 2 — 1 2 3 — — 5 1 3 1 1 1 1 1 1 — 3 1 3 2 — — 20 13 17 19 The Mount Central 513 — — — 1 — — — 2 — — — 1 — — — — 1 — — — 1 — — 1 2 5 4 8 Uphall 212 — — — — — — — — — — — — 1 — 1 — 1 — — — — — — — 3 — 4 4 Valentines 420 — — 1 — — — — — — — — — — — — — — — — — — — 1 — 3 1 4 5 Woodlands 308 1 — — 1 — — — — — — — — — — — — — — 1 1 — — — — 2 2 9 3 Mossford (G.V.H.) 646 4 — 1 — — — 1 — 1 — 1 — — — 1 — 3 — 1 — 7 — 2 — 22 — 3 — Countv High — — 2 1 — 2 — 1 — — — — — — — — — — 1 1 — — — — — 5 3 2 17 -Private — — — 1 — 1 — 1 — — — 1 — — — — — 1 1 — — 1 2 2 1 8 4 18 13 Totals 18920 15 21 17 12 20 17 14 21 15 13 11 9 10 6 11 8 19 19 20 19 26 24 31 26 209 195 2741|| 2881|| * Closed as from 25th August. || Includes 7 at Mayesbrook. DIPHTHERIA. Table IX.—Summary or Cases of Diphtheria among School Children, and of Contacts of such Cases excluded from School Attendance, during the Year ended the 31st December, 1935. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Totals, 1935. Totals. 1934. 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 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Beal Modern 638 — — — — — — — — 2 — — 1 — — — — — — — — — 1 — — 2 2 4 8 Becontree 1768 — 3 2 3 — 3 — — 1 1 — — — — 1 4 — 3 — 2 — — 1 — 6 19 32 49 Chadwell 7-44 — 1 — — — — — — 4 1 — — 7 4 5 4 — 3 — — — — — — 16 13 2 2 Christ-church 1043 — — — 1 3 — — 1 3 1 1 — — — — — — — — — — — 1 3 8 34 35 Cleveland 1276 1 1 6 1 1 4 1 1 2 1 — 1 — — 1 — 4 1 1 2 — — — 1 17 13 20 18 Downshall 2017 3 1 — — — 2 2 4 1 1 2 5 — — — — — — 1 — — 1 — 2 9 16 7 12 Fairlop 1413 — 4 1 — — — — — — — — — — — — — 1 2 1 — — 2 — — 3 9 — 4 Gearies 1547 2 2 — 2 1 — 1 — — — 1 1 — — — — — — — — — — — — 5 5 — 3 Goodmayes 746 — — — — — — — — — — — — — — — — — — — — — — — — 1 6 13 17 Gordon 230 — — — — — — — — — — — — — — — — — — — — — — — — — 2 3 1 Highlands 1012 3 4 — — — 3 1 — 2 1 — — — — — — — — 1 1 — — 1 2 8 11 8 3 Loxford Central 553 — — — 1 — — — — — — — — — — — — — — — — — — — — 5 1 13 Mayfield Central 689 1 — 1 — — — — — — — — — — — — — — — — — — — — — 3 2 2 6 Newbury Park 776 — — — — — — — — — — — — — — — — — — — — — — — — — 6 2 3 Open Air 115 — — — — — — — — — — — — — — — — — — — — — — — — — 1 1 SS.Peter and Paul's 553 — 1 — — — — — — — — — — — — — — 1 2 — — — — — — 1 3 3 6 S.Vincent's 383 — 2 — — — — — — — — — — — — 1 3 — — — — — — — — 1 5 1 1 South Park 1318 — 1 — — — 2 — — — 3 1 — — — — — — — — — 1 1 — — 2 7 2 9 The Mount Central 513 — — — — — — — 2 — — — — — — — — 1 1 — — — — — — 1 3 4 11 Uphall 212 — — — 2 1 — — — — — 1 — — — — 2 — — 1 — 2 — — — 5 4 — 2 Valentines 420 1 1 — — — — — — — — — 2 1 — — — — — — — — — — — 2 3 3 1 Woodlands 308 1 2 — — — — — — — 2 — — — — — — — 1 1 — — — — — 2 5 2 1 Mossford (G.V.H.) 64 6 1 — 2 — — — 2 — 1 — — — — — 1 — — — 2 — 1 — 1 — 11 — 20 — County High — 1 2 — — 1 1 — 1 1 — — 1 — — — — — — — — — 1 — — 3 6 2 4 Private — — — — 2 2 — — 1 1 — — — — — — — — 1 — — 2 4 — — 5 ??? 10 7 Totals 18920 15 25 12 17 7 18 7 10 16 16 6 16 8 5 10 14 7 16 8 8 7 10 3 6 106 161 †178 ‡220 *Closed as from 25th August. †Includes 2 at Mayesbrook. ‡ „ 3 „ 205 MEASLES AND GERMAN MEASLES. Table X.— Summary of Cases of Measles and German Measles among School Children, and of Contacts of such Cases, excluded from School Attendance, during the Year ended the 31st December, 1935. SCHOOLS No. on Roll. Jan. Feb. March. April. May. June. July August. Sept. Oct. Nov. Dec. Totals, 1935. Totals. 1934. 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 — — — — — — 1 — — — — — — — — — — — — — — — — — — — 1 3 — Beal Modern 638 — — — — — — — — — — — — — — — — — — — — — — — — — — 1 5 Becontree 1768 — — — — — — — — 1 2 1 — — 1 — — — — — — — — — 2 3 89 36 Chadwell 744 — — — — — — — — — — 1 — 3 — — — — — — — — — 1 — 5 1 45 11 Christchurch 1043 — — 1 — — — 1 — 1 1 — — 8 4 — — — — — — — — — — 11 5 102 19 Cleveland 1276 — — 1 1 2 3 1 1 4 3 — — 33 9 — — — — — — — — — 41 17 59 13 Downshall 2017 — — — — — 1 — — 23 4 66 4 6 — — — — — — — — 1 — — 95 10 171 23 Fairlop 1413 — 1 — — 59 7 28 6 4 2 — — 1 — — — — — — — — — 1 — 93 16 125 34 Gearies 1547 — — — — — — 1 — 2 1 51 — 10 — — — — — — — — — — — 64 1 49 11 Goodmayes 746 — — — — — — — — 1 — — — — — — — — — — — — — — — 1 — 55 11 Gordon 230 — — — — — — 4 — 24 2 12 1 24 3 — — — — — — — — — — 64 6 49 7 Highlands 1012 1 2 — — 1 1 — — 2 — 2 — — — — — — — — — — — — — 6 3 16 3 Loxford Central 553 — — — — — — — — — 1 — — — 3 — — — — — — — — — — — 4 2 — Mayfield Central 689 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Newbury Park 776 — — — — — — — 1 — — 1 — 32 6 — — — — — — — — — — 33 7 48 6 Open Air 115 — — — — — — — — — — — — — — — — — — — — — — — — — — 1 2 SS .Peter and Paul's 553 — — — — — — — — — — — — 4 — — — — — — — — — — — 4 — 56 20 S.Vincent's 383 — — — — — — — — — — — — — — — — — — — — — — — — — — 8 3 South Park 1318 — — — — — — — — — — — — — — — — — — — — — — — — 1 — 28 6 The Mount Central 513 — — — — — — — — — — — — 1 — — — — — — — — — — — 2 — 5 4 Uphall 212 — — — — — — — — 1 — — — — 1 — — — — — — — — — — 1 1 30 3 Valentines 420 — — — — — — — — 1 — 1 — 1 — — — — — — — — — — — 3 — 17 2 Woodlands 308 1 — — — — — 7 — 7 3 3 — — — 1 — — — — — — — — — 19 3 83 15 †Mossford (G.V.H.) 646 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Totals 18920 2 3 3 2 63 13 42 8 71 19 138 5 123 27 1 — — — — — — 1 2 — 445 78 ‡1053 §235 *Closed as from 25th August. †Notifications of Measles and German Measles in this School are not received. ‡ Includes 11 at Mayesbrook. § ,, 1 „ to o C5 CHICKENPOX. Table XI.—Summary of Cases of Chickenpox among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended 31st December, 1935. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July August. Sept. Oct. Nov. Dec. Totals, 1935. Totals, 1934. 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 — — — — — 1 4 — — — — — — — — — — — — — — — — — — 1 4 — 3 Beal Modern 638 — — — — — — — — — — — — — — — — — — 1 1 1 — — 1 2 2 1 3 Becontree 1768 1 2 — — 4 9 3 1 1 1 1 4 3 — — — — — 2 1 2 1 5 — 23 19 19 13 Chadwell 744 1 — — — — — — 1 1 — — — 3 — — — 1 — 2 — 2 — 2 1 11 3 4 3 Christchurch 1043 4 3 1 — — — — — — — — — 1 1 1 — — — 1 — 15 2 5 — 28 7 18 5 Cleveland 1276 4 1 — — 3 1 3 — — — 4 — 3 1 — — — — — 1 2 — — — 19 3 12 12 Downshall 2017 4 2 2 — — — — — — — — — 1 — — 1 — 5 7 30 5 14 4 57 18 24 11 Fairlop 1413 — — — — 1 — — — — — — — 21 6 1 1 2 1 — 2 — — 1 2 26 12 9 6 Gearies 1547 3 — — — — — — — — — 1 — — — — — 1 — — — 1 1 9 1 15 2 58 12 Goodmayes 746 — — — — — — 1 1 — — — — — — — — — — — — 3 — 1 1 5 2 66 25 Gordon 230 1 — 5 1 4 — 1 — — 1 1 1 — — — — — — — — — — — 1 12 4 5 1 Highlands 1012 5 2 3 1 2 — — — — — — — — — — — — — — — 2 — — — 12 3 59 22 Loxford Central 553 1 — — — 1 2 — — — — — — — — — — — — — — — — — — 2 2 3 6 Mayfield Central 689 1 — — — — — 1 1 — — — — — — — — — — — — — — 1 — 3 1 3 4 Newbury Park 776 1 1 2 1 1 — 3 3 — — — — — — — — — — 5 — 4 — 5 — 21 5 3 1 Open Air 115 — — — — — — — — 1 — — — — — — — — — — — — — — — 1 — — 2 SS .Peter and Paul's 553 1 1 — — 3 1 9 2 23 18 19 1 2 3 — — — — — — — — — — 57 26 28 5 S.Vincent's 383 — — — — — — — — — — 1 2 — — — — 2 — — — — — — — 3 2 4 3 South Park 1318 — — — — 1 — — — — — — — — — — — — — — — — — — — 4 2 23 5 The Mount Central 513 — — 1 1 — — — — — — — — — — — — — — 3 — 1 — — — 2 2 2 6 Uphall 212 — — — — — — — — — — — — — — — — — — — — — — — 1 — 12 3 Valentines 420 3 — 17 2 — — 10 1 — — — — — — — — — — 1 — 5 1 1 — 38 4 24 8 Woodlands 308 10 1 — — — 1 1 — — — — — — — — — — — 2 — 1 1 — — 12 3 94 20 ‡Mossford (G.V.H.) 646 — — — — — — — — — — — — — — — — — — — — — — — — — — — 20 Totals 18920 40 13 31 6 21 20 32 11 26 20 27 8 34 11 2 2 7 1 22 12 69 11 44 11 355 126 ||476 §183 *Closed as from 25th August. ‡Notifications of Chicken Pox in this School are not received. || Includes 5 at Mayesbrook. § „ 4 at „ 207 WHOOPING COUGH. TABLE XII.—Summary of Cases of Whooping Cough among School Children, and of Contacts of such Cases Excluded from School Attendance during the Year ended 31st December, 1935. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July. August. Sept Oct. Nov. Dec. Totals, 1935. Totals, 1934. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. j Cases. Conts. j Cases. Conts. Cases. Conts. Cases. Conts.j Cases. Conts. Cases. Conts.j Cases. Conts. Cases. Conts. Cases. Conts. *Barkingside — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — Beal Modern 638 — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — Becontree 1768 15 2 18 3 11 2 5 1 9 5 6 — — — — — 5 — — — — — — — 69 13 6 2 Chadwell 744 — 1 4 — 19 1 8 — 2 1 1 — 1 — — — 1 — 1 — — — — — 37 3 20 4 Christchurch 1043 — — — 1 1 — 1 — 4 1 12 3 7 — — — 2 — — — — — — — 27 5 27 3 Cleveland 1276 — — — — — — 3 — 24 5 4 — 5 — — — — — 1 — — — — — 37 5 9 2 Downshall 2017 — — — — 2 — 3 — 21 4 12 1 11 1 — — 1 — — — — — — — 60 6 73 8 Fairlop 1413 — — 1 — — 1 3 — 4 3 — 1 — — — — — — — — — — 4 1 12 6 44 7 Gearies 1547 — — — — — — — — — — 1 — 2 — 1 — 3 1 — — — — — — 7 1 16 1 Goodmayes 746 2 — — — 1 — 2 — 3 — 1 — 2 — 5 — 4 — 1 — 2 2 — — 23 2 15 3 Gordon 230 — — — — — — 4 — 11 1 1 — — 1 — — — — — — — — — — 16 2 9 — Highlands 1012 1 — 3 1 1 1 4 — 1 — — — — — 1 — 1 — — — — — — — 12 2 33 — Loxford Central 553 — — — — — — — — — — — — — — 1 — — — — — — — — — — — — 1 Mayfield Central 689 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Newbury Park 776 — — 1 2 9 2 5 1 4 — 2 — 7 — 1 — 1 — — — — 1 1 2 31 8 7 — Open Air 115 — — — — — — — — — — — — — — — — — — — — — — — — — — — SS.Peter and Paul's 553 — — — — — — — — — — 4 — 2 — — — — — — — — — — — 6 — 12 2 S.Vincent's 383 2 1 — — 1 — — — 1 — — — — — — — — — — — — — — — 4 1 — — South Park 1318 — — — — 1 — — — 7 3 5 9 — — — — — — — — — — — 22 3 30 1 The Mount Central 513 — — — — — — — — — — — — — — — — — — — — — — — — — — Uphall 212 — — 2 — 13 4 5 — 1 — — — 3 — — — — — — — — — — 24 4 2 — Valentines 420 1 — — — 30 7 — — — — 11 — 16 1 — — — — 1 — — — — 58 9 1 — Woodlands 308 — — — — — — — — 2 1 2 — — — — — 2 — — — — — — — 6 1 10 1 ‡Mossford (G.V.H.) 646 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Totals 18920 21 4 29 7 89 18 45 2 95 24 62 5 67 3 9 — 20 1 3 1 2 3 5 3 447 71 †318 35 *Closed as from 25th August. † Includes 2 at Mayesbrook. ‡Notifications of Whooping Cough in this School are not received. to o 00 MUMPS. TABLE XIII.—Summary of tasks of Mumps among School Children, and of Contacts of such Cases, excluded from School Attendance, during the Year ended 31st December, 1935. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Totals, 1935. Totals, 1934. 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 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Beal Modern 638 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Becontree 1768 — — 2 — — — 1 — 1 — — — — — — — — — 2 — 2 — — — 8 — 6 — Chadwell .. 744 — — — — 3 — 1 — 2 — 1 — 3 — — — 1 — 1 — — — 2 — 14 — 7 — Christchurch 1043 — — — — — — — — 1 — 5 — 5 — 2 — — — — — — — — — 13 — 2 — Cleveland 1276 1 — — — 2 — 1 — 7 — 31 — 24 — 1 — 4 — — — — — — — 71 — 22 — Downshall 2017 — — — — 1 — 1 — 2 — 1 — 2 — — — — — 2 — — — — — 9 — 67 — Fairlop 1413 1 — — — 1 — — — 2 — 19 — 3 — — — — — — — — — — — 26 — 9 — Gearies 1547 — — 18 — 15 — 4 — 4 — — — — — — — 2 — — — — — — — 43 — 74 — Goodmayes 74 6 — — — — 1 — — — — — — — — — — — 1 — — — — — 1 — 3 — 6 — Gordon 230 — — — — 1 — — — 1 — — — 2 — — — — — 1 — — — — — 5 — 3 — Highlands 1012 — — 2 — 2 — 16 — 135 — 70 — 29 — 1 — — — 1 — — — 1 — 257 — 7 — Loxford Central 553 — — — — — — — — — — — — 1 — — — 2 — — — — — — — 3 — 2 — Mayfield Central 689 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Newbury Park 776 — — — — — — — — 1 — — — 6 — — — 1 — — — 1 — — — 9 — 33 — Open Air 115 — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — SS .Peter and Paul's 553 — — — — — — — — 1 — 2 — — — 1 — 1 — — — — — — — 5 — 12 — S. Vincent's 383 — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — — — South Park 1318 1 — — — — — — — 3 — — — 1 — — — — — — — — — — — 5 — 3 — The Mount Central 513 1 — — — — — 1 — 2 — 5 — 6 — — — 1 — 1 — 1 — — — 18 — 3 — Uphall 212 — — — — 12 — 2 — 15 — 3 — 6 — 1 — 1 — — — — — — — 40 — 2 — Valentines 420 — — — — — — 1 — — — — — — — — — — — — — — — 5 — 6 — 39 — Woodlands 308 — — — — — — — — — — — — — — — — — — — — — — 2 — — — 64 — ‡Mossford (G.V.H.) 646 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Totals 18920 4 — 23 — 38 — 28 — 177 — 137 — 89 — 6 — 14 — 9 — 4 — 11 — 540 — ||363 — *Closed as from 25th August. ‡Notifications of Mumps in this School are not received. || Includes 1 at Mayesbrook.